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MINNESOTA MEDICINE
Journal of the Minnesota State Medical Association, Southern Minnesota Medical Association,
Northern Minnesota Medical Association, Minnesota Academy of Medicine, and
Minneapolis Surgical Society
Owned and Published by
THE MINNESOTA STATE MEDICAL ASSOCIATION
Under the Direction of Its
EDITING AND PUBLISHING COMMITTEE
E. M. Hammes, M.D., St. Paul
Philip F. Donohue, M.D., St. Paul
H. W. Mf.yerding, M.D.. Rochester
B. O. Mork, Jr., M.D., Minneapolis
C. L. Oppegaard, M.D., Crookston
T. A. Peppard, M.D., Minneapolis
H. A. Roust, M.D., Montevideo
O. W. Rowe, M.D., Duluth
Henry L. Ulrich, M.D., Minneapolis
A. H. Wells, M.D., Duluth
EDITOR
Carl B. Drake, M.D., Saint Paul
ASSOCIATE EDITORS
George Earl, M.D., Saint Paul
Henry L. Ulrich, M.D., Minneapolis
VOLUME 33
JANUARY— DECEMBER, 1950
EDITORIAL AND BUSINESS OFFICES
2642 University Avenue - -- -- -- -- -- Saint Paul 4, Minn.
BUSINESS MANAGER
J. R. Bruce
Copyrighted 1950, by the
Minnesota State Medical Association
i
Index to Volume 33
A
Abdomen, Acute conditions of the, 1133
Abdominal operations, thoracic and upper, Controlled
respiration in, 1031
Abscess, liver, Solitary pyogenic, 588
Acute conditions of the abdomen, 1133
Acute inversion of the uterus, 700
Acute yellow atrophy of the liver from SH virus trans-
mitted by a blood bank, 1211
Adrenocorticotropic hormone, Pituitary (ACTH) in
asthma, 797
Advantages and limitations of the quantitative VDRL
slide test, 573
Aged and chronically ill, Challenging problems and de-
mands of the, 450
Alcoholism, “Antabuse” (tetraethylthiuram disulfide) in
the treatment of, 1200
Alexander, H. A. : Fundamental principles in the treat-
ment of varicose veins, 626
Allergies, Respiratory, in children, 893
Amerongen, Werner W., Manlove, Charles H., and Rea,
Charles E. : Banti’s disease, 347
Analysis of 10,000 appendectomies, 46
Anderson, David P. : An appraisal of major surgery in a
small hospital, 31
Aneurysm, Dissecting, of the aorta, 255
“Antahuse” (tetraethylthiuram disulfide) in the treat-
ment of alcoholism, 1200
Aorta, Dissecting aneurysm of the, 255
Aorta, thoracic, Hypoplasia of, clinically simulating co-
arctation, 1193
Appendectomies, 10,000, Analysis of, 46
Appraisal of major surgery in a small hospital, An, 31
Arnold, Ann W. : Hemolytic transfusion reaction in ob-
stetrics, 597
Associated diseases of the skin and eye, 147
Asthma, Pituitary adrenocorticotropic hormone (ACTH)
in, 797
Asthmaticus, status. The management of, 983
Ataxia, Friedreich’s, The heart in, 1000
Atelectasis, Ciliary action and, 1009
Atomic weapons, The radioactive effects of, 1085
Auricular fibrillation, Treatment of, from the stand-
point of the general practitioner, 1196
B
Back pain, low, Subfascial fat abnormalities and, 593
Bacon, Harry E., Sherman, Lloyd F., and Campbell,
William N. : Hemangiopericytoma, 683
Banti’s disease, 347
Barbiturate poisoning, Treatment of, with metrazol
(case report), 370
Baronofsky, I. D. : Some recent aspects of cardiac and
juxta-cardiac surgery, 339
Baronofsky, Ivan D., and Briggs, John F. : Surgical
treatment of mitral heart disease, 881
Baronofsky, Ivan D., Dickman, Roy W., and Vander-
hoof, Edward S. : The treatment of acute chest in-
juries, 49
Baronofsky, Ivan D., Ferrin, Allan L., and Briggs, John
F. : Hypoplasia of thoracic aorta clinically simulating
coarctation, 1193
Bauer, Henry, and Kimball, Anne C. : Advantages and
limitations of the quantitative VDRL slide test, 573
Behmler, F. W. : Health — an international as well as
local problem, 1088
Benign tumors, nevi and precanceroses, 908
Berylliosis, 904
Better rural transfusion program, A, 773
Blood bank, Acute yellow atrophy of the liver from SH
virus transmitted by a, 1211
Blood transfusions, The rationale of, in the treatment
of the true toxemias of pregnancy, 39
Blumenthal, J. S. : Dissecting aneurysm of the aorta, 255
Blumenthal, I. S. : Pituitary adrenocorticotropic hormone
(ACTH) in asthma, 797
Borgerson, A. H. : A better rural transfusion program,
773
Bowel, large, Cancer of the, 897
Briggs, John Francis: The pulmonary mimicry in
bronchogenic carcinoma, 82
Briggs, John F., and Baronofsky, Ivan D. : Surgical
treatment of mitral heart disease, 881
Briggs, John F., Baronofsky, Ivan D., and Ferrin, Allan
L. : Hypoplasia of thoracic aorta clinically simulating
coarctation, 1193
Brower, J. W., and Rosenfield, A. B. : Progress in ma-
ternal and infant health in Minnesota, 582
Brucellosis in Minnesota, Studies on, 333
Brucellosis, Milk-borne, in Minnesota, 981
Burch, Edward P., and Freeman, Charles D. : Associated
diseases of the skin and eye, 147
Book Reviews
American Medical Association: AMA directory, 851
Anderson, Camilla M. : Saints, sinners and psychiatry,
955
Bailey, Harold : The physiology of thought ; a functional
study of the human .mind, 411
Beder, Oscar Edward : Surgical and maxillofacial pros-
thesis, 1164
Buchler, Walter: Parkinson’s disease, 1162
De Kruif, Paul : Life among the doctors, 305
Delitala, E., and Bonola, A. : Ernia del Disco e sciatica
vertebrale, 306
Dodson, Austin Ingram : Urological surgery, 548
Doyle, Leo : Handbook of obstetrical and diagnostic
gynecology, 956
Dry, Thomas J., et al : Congenital anomalies of the heart
and great vessels, 306
Fabricant, Noah D. (editor) : Amusing quotations for
doctors and patients, 850
Faulkner, Robert L., and Douglass, Marion: Essentials of
obstetrical and gynecological pathology, 548
Feinberg, Samuel M., Malkjel, Saul, and Feinberg, Alan
R. : The antihistamines; their clinical application,
1161
Gold, Harry : Quinidine in disorders of the heart, 547
Gradwohl, R. B. H. : Clinical laboratory methods and
diagnosis, 747
Grubbe, Emil H. : X-ray treatment, its origin, birth and
early history, 305
Harris, Harold J., with assistance of Stevenson, Blanche
L. : Brucellosis (undulant fever); clinical and sub-
clinical, 748
Hawk, Philip B., Oser, Bernard L. and Summerson,
William H. : Practical physiological chemistry, 850
Herrmann, George R. : Clinical case-taking ; guides for
the study of patients ; history taking and physical
examination or semiology of diseases in the various
systems, 213
Ivy, A. C., Grossman, M. I., and Bachrach, W. H. :
Peptic ulcer, 1162
Kleiner, Israel S. : Human biochemistry, 213
Lull, Clifford B., and Hingson, Robert A. : Control of
pain in childbirth : anesthesia, analgesia, amnesia, 106
Maliniac, Jacques W. : Breast deformities and their re-
pair, 850
December, 1950
Q 1 o tz
1277
INDEX TO VOLUME 33
Merck & Co. : The Merck manual of diagnosis and
therapy : a source of ready reference for the physi-
cian, 851
Myers, J. Arthur: Invited and conquered, 107
Perera, Charles A. (editor) : May’s manual of the
diseases of the eye for students and general prac-
titioners, 547
Fold, John F. : Cerebral palsy, 1060
Schweitzer, Albert : Out of my life and thought, 1163
Taylor, Norman Burke (editor! : Stedman’s medical dic-
tionary, 106
Thomson, Elizabeth H. : Harvey Cushing: surgeon,
author, artist, 1164
Titus, Paul : The management of obstetric difficulties,
1274
Traquair, H. M. : Clinical ophthalmology for general
practitioners, 106
Watson, Leland A., and Tolan, Thomas : Hearing tests
and hearing instruments, 411
C
Campbell, William N., Bacon, Harry E., and Sherman,
Lloyd F. : Hemangiopericytoma, 683
Cancer of the large bowel, 897
Cancer statistical research service, 1948, Results of the,
42
Cancer statistical study, The 1949, 782
Carcinoma, bronchogenic, The pulmonarv mimicry in,
82
Cardiac and juxta-cardiac surgery, Some recent aspects
of, 339
Cardiac deaths. Syphilitic, in over fifty thousand deaths,
437
Cardiovascular disease, hypertensive, Review of 250
necropsy cases of, 441
Carr, David T., Seybold, W illiam D., Schmidt, Herbert
w., and Karlson, Alfred G. : Intravenous adminis-
tration of para-aminosalicylic acid for streptomycin-
resistant tuberculosis of the trachea, 363
Challenging problems and demands of the aged and
chronically ill, 450
Chapman, Carleton B., and Hammersten, James F. :
Spontaneous remission in subacute leukemia, 259
Chest injuries, acute, The treatment of, 49
Childhood, The common hemorrhagic diseases of, 1098
Children, Respiratory allergies in, 893
Chorionepithelioma, Placental polyp simulating a, 601
Chronically ill, The emotional problems of the, 673
Chronic leukemic infiltration of the gastric wall simulat-
ing peptic ulcer, 1004
Ciliary action and atelectasis, 1009
Clawson, B. J. : Syphilitic cardiac deaths in over fifty
thousand autopsies, 437
Clinical application of quantitative reports of serologic
tests for syphilis, The, 579
Clinical detection of pulmonary emphysema from respira-
tory tracings, 889
Clinical observations of experiments of nature, 685
Coarctation, Hypoplasia of thoracic aorta clinically sim-
ulating, 1193
Cole, WGllace: Treatment of fractures with the intra-
medullary nail (discussion only), 821
Common hemorrhagic diseases of childhood, The, 1098
Common injuries of the knee joint, 1217
Compression fractures of the spinal column, 154
Conley, Robert H. : Treatment of auricular fibrillation
from the standpoint of the general practitioner, 1196
Conley, Robert II. , and Wfilson, J. Allen: Chronic leuke-
mic infiltration of the gastric wall simulating peptic
ulcer, 1004
Controlled respiration in thoracic and upper abdominal
operations, 1031
Coronary thrombosis, The prediction and prevention of,
in the younger age groups, 999
Cortical hyperostosis. Infantile (case report), 1113
Coventry, Mark B. : Flatfoot, with special consideration
of tarsal coalition, 1091
Cranio-cerebral injuries, Neuropsychiatric and laboratory
observations in 147 patients following, 233
Creevy, Donald : Current mortality of transurethral re-
sections (abstract), 820
Culligan, Leo C. : Problems in acute intestinal obstruc-
tion, 1 136
Culligan, John A., and Culligan, John M. : The present
status of surgery of the spleen, 1245
Culligan, John M., and Culligan, John A. : The present
status of surgery of the spleen, 1245
Current mortalitv of transurethral resections (abstract),
820
Clinical-Pathological Conferences
Diagnostic case study (homologous serum hepatitis), 163
Diagnostic case study (suppurative arthritis), 266
Communications
American Cyanamid Companv (Parathion poisoning),
1934
D
Deafness, Treatment of, with histamine, 157
Depropanex in post-surgery, 1102
Hickman, Roy W., Vanderhoof, Edward S., and Baron-
ofsky, Ivan D. : The treatment of acute chest in-
juries, 49
Diehl, Harold S., and Weaver, Myron M. : The plans
of medical students for practice, 446
Dissecting aneurysm of the aorta, 255
Dittrich, R. J. : Subfascial fat abnormalities and low
back pain, 593
Dockerty, Malcolm B„ Hodgson, Corrin H., and Nacht-
wey, Robert A. : Berylliosis, 904
Dry, Thomas J., Woltman, Henry W., and Flipse, M.
Eugene: The heart in Friedreich’s ataxia, 1000
Duodenal ulcers, gastric and. The surgical management
of massive hemorrhage from, 244
E
Ectopic pregnancy, Practical considerations in the diag-
nosis and treatment of, 1215
F.gge, S. G. : Psychiatry in general practice, 365
Eisenstadt, William Sawyer: The management of status
asthmaticus, 983
Elias, F. J. — photograph, 68
Elias, F. J. : Medical practice on level four, 877
Emergencies in the newborn period, 1204
Emergency maternity and infant care program in Min-
nesota (EMIC), The, 910
Emotional problems of the chronically ill, The, 673
Experiments of nature, Clinical observations of, 685
Emphysema, pulmonary, Clinical detection of, from
respiratory tracings, 889
External fixation of facial fractures, 726
Eye, Associated diseases of the skin and, 147
Editorial
AM A dues for 1950, 382
AMA meeting, 814
Advertising program, 813
Advisory Committees to Selective Service, 1233
Alas, a lack! 383
1278
Minnesota Medicine
INDEX TO VOLUME 33
American Journal of Proctology, The, 7 1(>
Blood banks, 925
Christmas seals, 1233
Civil defense, 1025
Cloaking of signs and symptoms by cortisone and ACTH
administration, 714
Colds and allergy, 72
Coronary thrombosis in early life, 1027
Deficit government spending, 72
Doctor Rossen — Commissioner of Mental Health, 278
Electrophrenic respiration, 177
Fahr, George E., 614
General practice and GP, 715
Good doctors and bad medicine, 1124
Industrial commission reports, 613
Isolation and quarantine requirements. 70
Less syphilis, 1127
Luetic aortitis, 1126
MSMA annual dues, 71
Maternal mortality study in Minnesota, 475, 1232
Medical editors’ conference, 473
More physicians in service, 925
NPH insulin, 1230
National health proposals, 278
Poliomyelitis in Minnesota, 1231
Prevention of dental caries, 178
Red Cross fund campaign, 177
Registration and induction of physicians, 1124
Regulation of drugs and materials used in the home, 812
Rose by any other name, A, 714
Saline solution in treatment of burn shock, 1127
Shoe-fitting fluoroscopes, 813
Socialized medicine, 176
State meeting, The, 473
State officers elected, 713
Status of vitamin consumption, The, 382
Streptomycin in tuberculosis, 474
Symposium on hypertension, 1026
Terramycin, 713
VDRL test for syphilis, The, 613
World Medical Association, 1230
Year 1950, The, 70
F
Perrin, Allan L., Briggs, John F., and Baronofsky, Ivan
D. : Hypoplasia of thoracic aorta clinically simulat-
ing coarctation, 1193
Fisketti, Henry: Cancer of the large bowel, 897
Fisketti, Henry : Renal tumors, 799
Flatfoof, with special consideration of tarsal coalition,
1091
Fleming, D. S., and Pearce, N. O. : Results of the 1948
cancer statistical research service, 42
Fleming, D. S., and Pearce, N. O. : The 1949 cancer
statistical study, 782
Flipse, M. Eugene, Dry, Thomas J., and Woltman, Henry
W. : The heart in Friedreich’s ataxia, 1000
Fourth International Congress of Neurology, The, 184
Fracture discourse, 186
Fractures, facial, External fixation of, 726
Fractures, Treatment of. with the intramedullary nail
(discussion only), 821
Friedreich’s ataxia, The heart in, 1000
Frog test, The Rana pipiens, for pregnancy, 1208
Fundamental principles in the treatment of varicose
veins, 626
G
Gardner, Walter P. : Psychiatry in geriatrics, 353
< rastric and duodenal ulcers, The surgical management of
massive hemorrhage from, 244
December, 1950
Gastric wall, Chronic leukemic infiltration of the, sim-
ulating peptic ulcer, 1004
Geriatrics, Psychiatry in, 353
Gibbon, John H., Jr.: Controlled respiration in thoracic
and upper abdominal operations, 1031
Giblin, Mary, and Nelson, C. B. : Milk-borne brucellosis
in Minnesota, 981
Goiter, Lingual, 181
H
Hammersten, Janies F., and Chapman, Carleton B. :
Spontaneous remission in subacute leukemia, 259
Hammes, Ernest M. : The Fourth International Con
giess of Neurology, 184
Hansen, R. E., and Harris, C. N. : Hemochromatosis, 54
Harris, C. N., and Hansen, R. E. : Hemochromatosis, 54
Harris, Lloyd E. : Emergencies in the newborn period,
1204
Health — an international as well as local problem, 1088
Health is a community problem, 263
Heart disease, mitral, Surgical treatment of, 881
Heart in Friedreich’s- ataxia, The, 1000
Heimark, J. J., and Parsons, R; L. : Depropanex in post-
surgery, 1102
Heimark, J. J., and Parsons, R. L. : The prediction and
prevention of coronary thrombosis in the younger
age groups, 999
Hemangiopericytoma, 683
Hemochromatosis, 54
Hemolytic transfusion reaction in obstetrics, 597
Hemorrhage, massive, The surgical management of,
from gastric and duodenal ulcers, 244
Hemorrhagic diseases of childhood, The common, 1098
Henderson, Edward D. : Common injuries of the knee
joint, 1217
Henrikson, Earl C., Nelson, Maynard C., and Moos,
Daniel : Fracture discourse, 186
Hermann, Harold W., Naslund, Ames W., and Karl-
strom, Arthur E. : Infantile cortical hyperostosis
(case report), 1113
Hilding, A. C. : Ciliary action and atelectasis, 1009
Hilger, Terome: External fixation of facial fractures,
726 '
Histamine, Treatment of deafness with, 157
Hodgson, Corrin H., Nachtwey, Robert A., and Dock-
erty, Malcolm B. : Berylliosis, 904
Hodgson, Jane E., and Taguchi, Reiko : The Rana pipiens
frog test for pregnancy, 1208
Hoffman, G. N., Miller, Winston R., and Sherman, R.
V. : Acute yellow atrophy of the liver from SH
virus transmitted by a blood bank, 1211
( Homologous serum hepatitis ) diagnostic case study, 163
Horns, Richard C. : Primary tumors of the optic nerve,
241
Householder, James R. : Review of 250 necropsy cases
of hypertensive cardiovascular disease, 441
Huston, Roberta, and Rosenfield, A. B. : Infant methe-
moglobinemia in Minnesota due to nitrates in well
water, 787
Hyperostosis, Infantile cortical (case report), 1113
Hypoplasia of thoracic aorta clinically simulating co-
arctation, 1 193
History of Medicine in Minnesota
Medicine and its practitioners in Olmsted County prior to
1900, 61, 166, 269, 371. 466, 603, 705, 804, 914, 1017,
1115, 1219
I
Infant care program, The emergence maternity and, in
Minnesota (EMIC), 910
1279
INDEX TO VOLUME 33
Infant, maternal and, health in Minnesota, Progress in,
582
Infant methemoglobinemia in Minnesota due to nitrates
in well water, 787
Infant mortality study, Maternal and, in a small general
hospital, 36
Infantile cortical hyperostosis (case report), 1113
Insurance, Life, and medical research, 25
Intestinal obstruction, acute, Problems in, 1136
Intravenous administration of para-aminosalicylic add
for streptomycin-resistant tuberculosis of the trachea,
363
Ivins, John C. : Compression fractures of the spinal
column, 154
In Memoriam
Adams, Ralph Crawe, 630
Anderson, James Kerr, 530
Arnold, Duma Carroll, 730
Baker, Ernest L., 836
Barber, John Phineas, 1260
Barton, John Currer, 530
Benson, Otis O., Sr., 1146
Brabec, Frank J., 942
Branton, Berton J., 836
Camp, Walter E., 181
Cardie, Archibald E., 838
Cowern, Ernest William, 730
Cutler, Charles William, 292
Dahlquist, Gustaf William, 1260
Davis, I. Grant, 1260
Davis, Thayer C., 94, 198
Dunn, George R., 94
Dumas, Alexander G., 1260
Esser, John, 292
Esser, Oscar J., 839
Foster, William K., 530
Geer, Everett K., 730
Gilfillan, James S., 82
Gough, William Henty, 732
Harriman, Leonard, 95
Hart, Vernon L., 840
Head, George Douglas, 530
Johnson, Charles Harcourt, 534
Johnson, Nimrod A., 1146
Kilbride, John S., 839
Lynam, Frank, 1262
McCoy, Joseph Ellsworth, 1260
McKeon, Joseph Owen, 94
McKinley, John Chamley, 198, 292, 1244
Mariette, Ernest S., 1261
Matthews, Justus, 732
Meierding, William Arnold, 1262
Nauth, Walter W., 534
Parsons, Joseph G., 732
Ratcliffe, John J., 732
Reed, Charles Anthony, 1038
Rodgers, Charles LeRoy, 292
Rollins, Frederick H., 630
Ryan, Mark E., 1038
Schaefer, Samuel, 73 2
Schneider, John P., 732
Scofield, Charles L., 630
Shaw, Albert W., 534
Shrader, Edwin Elmer, 1262
Spicer, Frank William, 534
Sturre, Julius R., 535
Sweetser, Horatio B., 840
Watson, John Douglas, 396, 536
Werner, Olaf S., 536
Westby, Nels, 632
Wilson, Kenneth G., 840, 942
J
Joffe, Harold H., Moe, Thomas, and Wells, Arthur H. :
Diagnostic case study (homologous serum hepati-
tis), 163
Joffe, Harold H., Wells, Arthur H., and MacRae, Gor-
don C. : Diagnostic case study (suppurative arthri-
tis), 266
K
Karlson, Alfred G., Carr, David T., Seybold, William
D., and Schmidt, Herbert W:. : Intravenous admin-
istration of para-aminosalicylic acid for streptomy-
cin-resistant tuberculosis of the trachea, 363
Karlstrom, Arthur E., Hermann, Harold W., and Nas-
lund, Ames W. : Infantile cortical hyperostosis (case
report), 1113
Keil, Marcus, Mikkelson, John, and Shragg, Harry:
Acute inversion of the uterus, 700
Kimball, Anne C., and Bauer, Henry : Advantages and
limitations of the quantitative VDRL slide test, 573
Kinsella, Thomas J., and Sharp, David V. : The signif-
icance of the isolated pulmonary nodules, 886
Knee joint. Common injuries of the, 1217
Koucky, R. W. : Transfusion problems, 1015
Kusz, Clarence V. : Venography in the postphlebitic
syndrome, 619
L
Larson, Lawrence M., and Rosenow, John H. : Solitary
pyogenic liver abscess, 588
La Vake, R. T. : The rationale of blood transfusions in
the treatment of the true toxemias of pregnancy, 39
Laymon, Carl W. : Benign tumors, nevi and precancer-
oses, 908
Lepak, J. A.: Challenging problems and demands of the
aged and chronically ill, 450
Leukemia, subacute, Spontaneous remission in, 259
Leukemic infiltration of the gastric wall. Chronic, sim-
ulating peptic ulcer, 1004
Level four, Medical practice on, 877
Life insurance and medical research, 25
Lingual goiter, 181
Liver abscess, Solitary pyogenic, 588
Liver, Acute yellow atrophy of the, from SH virus
transmitted by a blood bank, 1211
Loomis, G. L. : Treatment of deafness with histamine,
157
Lynch, Francis W. : The clinical application of quantita-
tive reports of serologic tests for syphilis, 579
Me
McKenzie, Charles H. : Practical considerations in the
diagnosis and treatment of ectopic pregnancy, 1215
McKinlay, C. A. : Clinical observations of experiments
of nature, 685
McPheeters, H. A. : Resume of present-day care and
treatment of varicose veins and their complications,
628
M
MacKinnon, Donald C. : The surgical management of
massive hemorrhage from gastric and duodenal
ulcers, 244
MacRae, Gordon C., Joffe, Harold H., and Wells, Arthur
H. : Diagnostic case studv (suppurative arthritis),
266
1280
Minnesota Medicine
INDEX TO VOLUME 33
Madden, John F. : Management of the pyodermas, 462
Magney, F. H. : Placental polyp simulating a chorion-
epithelioma, 601
Magraw, Richard M. : Psychological medicine in a gen-
eral medical setting, 776
Management of status asthmaticus, The, 983
Management of the pyodermas, 462
Manlove, Charles H., Rea, Charles E., and Amerongen,
Werner W. : Banti’s disease, 347
Marcley, Walter J. : Tuberculosis in selectees disqualified
for the army, 689
Maternity and infant care program in Minnesota
(EMIC), The emergency, 910
Maternal and infant health in Minnesota, Progress in,
582
Maternal and infant mortality study in a small general
hospital, 36
Medical practice on level four, 877
Melanomata and nevi, 456
Methemoglobinemia, Infant, in Minnesota due to ni-
trates in well water, 787
Metrazol, Treatment of barbiturate poisoning with (case
report), 370
Michael, J. C. : “Antabuse” (tetraethylthiuram disulfide)
in the treatment of alcoholism, 1200
Mikkelson, John, Shragg, Harry, and Keil, Marcus:
Acute inversion of the uterus, 700
MHk-bome brucellosis in Minnesota, 981
Miller, Winston R., Sherman, R. V., and Hoffman, G.
N. : Acute yellow atrophy of the liver from SH
virus transmitted by a blood bank, 1211
Mills, Melvin D., and Smith, Harry L. : Paroxysmal
tachycardia with attacks of unconsciousness, 703
Milton, J. S., and Stennes, J. L. : Treatment of barbit-
urate poisoning with metrazol (case report), 370
Moe, Thomas, Wells, Arthur H., and Joffe, Harold H. :
Diagnostic case studv (homologous serum hepatitis),
163
Moos, Daniel, Henrikson, Carl C., and Nelson, Maynard
C. : Fracture discourse, 186
Mortality study, Maternal and infant, in a small general
hospital, 36
Mulvaney, William P. : Tuberculosis of the uterus, 160
Medical Economics
AMA gets report on British Medical Association con-
ference, 1028
AMA president hits state socialism issue, 818
AMA rises again to answer Ewing, 1130
Administration called a “playing referee,” 617
American doctor studies British Health Service, 1130
Analysis shows United States healthiest nation, 282
Britain has new problems plus more expense, 478
Britain’s socialism — a Frankenstein monster??? 616
British finance chief optimistic, 75
Canadian doctor reports on British Health Service, 1234
Committee quotes words of wisdom, 718
Committee studies British medical education, 1028
Congress, bills and taxes, 283
Congressman discusses socialism — American variety, 928
Dewey advises avoiding never-never land, 718
Doctors get small fraction of country’s money, 1130
Election offers new challenge, 1234
Ewing denies analogy of British, U. S. plans, 179
FSA called seed bed of socialism, 927
FSA estimates 1960 need for doctors, 179
Federal government is a big business, 386
Forefathers warned of too much security, 385
Government debt bigger than ever, 1235
Graduates warned of deficit spending, 817
Health insurance book issued by committee, 1235
Hospital occupancy rate leveling, 75
Industrialists explain demand for pensions, 1129
Industry leaders sanction “rights of free men,” 818
“Ism” mania, The, 283
December, 1950
Journal questions more security, 1029
Layman among first to pay AMA dues, 179
Legion commander scores tax medicine, 74
Legislator assails federal lobbying, 1235
Lobby investigations bring acid comments, 1029
London Times pokes fun at socialism, 180
Many compromise bills in hopper now, 180
Medical costs more easily paid here, 281
Medicine continues to thrive on truth, 615
Michigan doctor hits government medicine, 1236
More and more security means “piggy-back” ride, 384
Newspaper complains of too many zeros, 1129
Of mice and men, 617
Organizations in state oppose socialized medicine, 281
Polls show opposition to socialized medicine, 615
Posterity still bears burden, 817
Purchasing power now less than in 1931, 717
Security — for all? — forever? 385
Security replacing freedom as goal, 282
Senator McClellan blows away the fog, 717
Short-sightedness may be greatest disadvantage, 386
Socialism — a step toward communism, 616
Stassen attacks SM in print, on air, 179
Welfare state — what is it? 476
Whitaker & Baxter report progress, 74
Why not include pets in scheme? 74
Minnesota Department of Health
Birth and stillbirth certificates, 1132
Methemoglobinemia in infants, 1132
Minnesota State Board of Medical Examiners
Minnesota State Board of Medical Examiners :
Licentiates, 1949, 76
Licentiates, 1950, 1237
State of Minnesota vs :
Baldwin, Rose Vivian, 479
Catterson, Walter F., 617
Colwell, Mrs. Carrie Grace, 388
Dressier, Otto W., 929
Fossum, Florence, 719
Gold, Frank Herman, 308, 1236
Gray, Lafayette M., 478
Heck, Helen A., 1131
King, Tracy A., 1030
Lichty, Gabriel Bickley, 617
Ramer, Mrs. Val A., 929
Rudd, Helen Geneva, 1275
Schwede, Paul C., 719.
Milton Culver v.s. Minnesota State Board of Phar-
macy, 1030
Miscellaneous
American Medical Association — House of Delegates —
Summary of Proceedings, 930
BCG vaccination, 816
Rehabilitation of handicapped children, 1027
Suggestions for the diagnostic study of a patient with an
abnormal x-ray shadow of the chest, 814
N
Nachtwey, Robert A., Dockerty, Malcolm B., and Hodg-
son, Corrin H. : Berylliosis, 904
Naslund, Ames W., Karlstrom, Arthur E., and Herman,
Harold W. : Infantile cortical hyperostosis (case re-
port), 1113
Nelson, C. B., and Giblin, Mary: Milk-borne brucellosis
in Minnesota, 981
1281
INDEX TO VOLUME 33
Nelson, Lloyd S., and Stoesser, Albert V.: Respiratory
allergies in children, 893
Nelson, Maynard C., Moos, Daniel, and Henrikson,
Earl C. : Fracture discourse, 186
Nerve, optic, Primary tumors of the, 241
Neurology, The Fourth International Congress of, 184
Neuropsychiatric and laboratory observations in 147 pa-
tients following cranio-cerebral injuries, 233
Nevi, Benign tumors, and precanceroses, 908
Nevi, Melanomata and, 456
Newborn period, Emergencies in the, 1204
Nitrates in well water, Infant methemoglobinemia in
Minnesota due to, 7 87
Nodule, isolated pulmonary, The significance of the, 886
Nordland, Martin, and Nordland, Martin A. : Lingual
goiter, 181
O
Obstetrics, Hemolytic transfusion reaction in, 597
Olsen, Axel, and Rossen, Ralph: Neuropsychiatric and
laboratory observations in 147 patients following
cranio-cerebral injuries, 233
Optic nerve, Primary tumors of the, 241
Owens, Frederick M., Ir. : Vagotomy in the treatment
of peptic ulcer, 1250
P
/
Para-aminosalicylic acid, intravenous administration of,
for streptomycin-resistant tuberculosis of the trachea,
363
Parathion poisoning, 360
Park, W. E. : Parathion poisoning, 360
Paroxysmal tachycardia with attacks of unconsciousness,
703
Parsons, R. L., and Heitnark, J. J. : Depropanex in post-
surgery, 1102
Parsons, R. L., and Heimark, J. J. : The prediction and
prevention of coronary thrombosis in the younger
age groups, 999
Paulson, Elmer C. : Analysis of 10,000 appendectomies,
46
Pearce, N. O., and Fleming, D. S : Results of the 1948
cancer statistical research service, 42
Pearce, N. O., and Fleming, D. S. : The 1949 cancer
statistical study, 782
Pendergrass, Eugene P. : The roentgen diagnosis of
silicosis, 988, 1 104
Peptic ulcer, Chronic leukemic infiltration of the gastric
wall simulating, 1004
Peptic ulcer in infancy and childhood, 57
Peptic ulcer, Vagotomy in the treatment of, 1250
Pituitary adrenocorticotropic hormone (ACTH) in
asthma, 797
Placental polyp simulating a chorionephithelioma, 601
Plans of medical students for practice, The, 446
Plimpton, Nathan C. : The postthrombotic syndrome,
618
Poisoning, barbiturate, Treatment of, with metrazo!
(case report), 370
Poisoning, Parathion, 360
Polyp, Placental simulating a chorionepithelioma, 601
Postphlebitic syndrome, Venography in the, 619
Postthrombotic syndrome, The, 618
Practical considerations in the diagnosis and treatment
of ectopic pregnancy, 1215
Precanceroses, Benign tumors, nevi and, 908
Prediction and prevention of coronary thrombosis in the
younger age groups, The, 999
Pregnancy, ectopic, Practical considerations in the diag-
nosis and treatment of, 1215
Pregnancy, The Rana pipiens frog test for, 1208
Pregnancy, true toxemias of, The rationale of blood
transfusions in the treatment of the, 39
Present status of surgery of the spleen, The, 1245
Priest, Robert E. : Recent advances in the bronchoscopic
study of pulmonary disease, 720
Primary tumors of the optic nerve, 241
Problems in acute intestinal obstruction, 1 136
Progress in maternal and infant health in Minnesota, 582
Psychiatry in general practice, 365
Psychiatry in geriatrics, 353
Psychological medicine in a general medical setting, 776
Pulmonary disease, An unusual type of, involving six
members of a family, 694
Pulmonary disease, Recent advances in the bronchoscopic
study of, 720
Pulmonary emphysema from respiratory tracings, Clin-
ical detection of, 889
Pulmonary mimicry in bronchogenic carcinoma, The, 82
Pulmonary nodule, isolated, The significance of the, 886
Pyodermas, Management of the, 462
President's Letter
1950, 69
AMA in 1950, The, 381
Are you an 18 per center? 924
Arms and the medical, 1123
Cordial invitation, A, 472
Medical emergency: world size, 1024
No agenda of promises, 712
Postgraduate seminars, 175
Postponed health problems, 811
Potts, Dr., would be surprised, 612
Thought and celebration, 1229
Why compromise? 277
Q
Quattlebaum, Frank W. : The return of “vein stripping,"
623
Quick, Armand J. : The common hemorrhagic diseases
of childhood, 1098
R
Radioactive effects of atomic weapons. The, 1085
Rana pipiens frog test for pregnancy, The, 1208
Rationale of blood transfusions in the treatment of the
true toxemias of pregnancy. The, 39
Rea, Charles E., Amerongen, Werner W., and Manlove,
Charles H. : Banti’s disease, 347
Recent advances in the bronchoscopic study of pulmonary
disease, 720
Renal tumors, 799
Respiratory allergies in children, 893
Respiratory tracings, Clinical detection of pulmonary
emphysema from, 889
Results of the 1948 cancer statistical research service, 42
Resume of present-day care and treatment of varicose
veins and their complications, 628
Return of “vein stripping,” The; 623
Review of 250 necropsy cases of hypertensive cardiovas-
cular disease, 441
Roentgen diagnosis of silicosis, The, 988, 1104
Roniacol, The vasodilator, 133
Rosenfield, A. B. : The emergency maternity and infant
care program in Minnesota (EMIC), 910
Rosenfield, A. B., and Brower, J. W. : Progress in ma-
ternal and infant health in Minnesota, 582
1282
Minnesota Medicine
INDEX TO VOLUME 33
Rosenfield, A. B., and Huston, Roberta : Infant methe-
moglobinemia in Minnesota due to nitrates in well
water, 787
Rosenow, John H., and Larson, Lawrence M. : Solitary
pyogenic liver abscess, 588
Rossen, Ralph, and Olsen, Axel : Neuropsychiatric and
laboratory observations in 147 patients following
cranio-cerebral injuries, 233
Rutledge, L. H. : An unusual type of pulmonary dis-
ease involving six members of a family, 694
Reports and Announcements
AMA clinical session, 934
American Academy of General Practice, 88
American Academy of Neurology, 284
American Association of Industrial Physicians and Sur-
geons, 284
American Board of Ophthalmology, 284, 390
American College of Chest Physicians, 192, 284, 520, 934,
1252
American College of Physicians, 634, 734, 934
American College of Surgeons, 934, 1252
American Congress of Physical Medicine, 284, 520, 634
American Dermatological Association, 1252
American Goiter Association, 192
American Medical Writers’ Association, 734, 1254
American Physicians Art Association, 284
American Roentgen Ray Society, 830
Award for research in infertility, 634
Blue Earth Valley Society, 88, 194, 286
Brown-Redwood-Watonwan County Society, 638
Cerebral palsy clinic, 1046
Clay-Becker County Society, 194
Cleveland Heart Society, 1252
Congress on Obstetrics and Gvne~ology, 88
Continuation courses, 192, 286, 392, 834, 936, 1042, 1144,
1254
Continuation course in cancer, 88
Courses in endocrinology, 390
Course in neurologic roentgenology, 734
Course in postgraduate gastroenterology, 636
Crippled children clinics, 390
Crippled children services, 832
Fellowship in medicine available, 636
Fourth Pan-American Congress on Ophthalmology, 734
Freeborn County Society, 194, 394
Goodhue County Society, 90
Hennepin County Society, 394, 522
Industrial Health Conference, 192
Institute of Industrial Health, 1040
International Academy of Proctology, 520
International and Fourth American Congress on Obstet-
rics and Gynecology, 284
International College of Surgeons, United States Chapter.
88, 734, 830
Interurfcan Academy of Medicine, 819
Judd, E. Starr, lecture, 192
Lyon-Lincoln Medical Society, 940
McLeod County Society, 286
Mental health week, 390
Minneapolis Academy of Medicine, 522
Minneapolis Surgical Society:
Meeting of October 6, 1949, 186
Meeting of November 3, 1949, 618
Meeting of December 1, 1949, 1031
Meeting of January 5, 1950, 1133
Meeting of February 3, 1950, 1141
Meeting of March 2, 1950, 1141
Meeting of April 6, 1950, 1250
Minnesota Academy of Medicine :
Meeting of October 12, 1949, 82
Meeting of November 9, 1949, 181
Meeting of December 14,- 1949, 396
Meeting of January 11, 1950, 518
Meeting of February 8, 1950, 720
December, 1950
Meeting of March 8, 1950, 820
Meeting of April 12, 1950, 820
Meeting of May 10, 1950, 1244
Minnesota Public Health Conference, 936
Minnesota Society of Clinical Pathologists, 832
Minnesota Society of Internal Medicine, 638, 1256
Minnesota Society of Neurology and Psychiatry, 192, 390,
1044, 1 144
Minnesota State Medical Association :
Annual meeting, announcements and program, 480
Roster, 486
Summary of Proceedings, House of Delegates, 822
Minnesota Surgical Society, 638
Mississippi Valley Medical Society, 638, 734, 1254
National Conference of County Medical Society Officers,
520
National Gastroenterological Association 1950 Award
Contest, 286, 934
New film on cancer, 830
New Orleans Graduate Medical Assembly, 1252
Northern Minnesota Medical Association, 736, 1044
Omaha Mid-west Clinical Society, 1040
Parkinson’s Disease Foundation, 1144
Pennington County Society, 834, 1044
Plastic surgery award, 636
Postgraduate conference in otolaryngology, 1042
Postgraduate seminars, 832, 938
Radiological Society of North America, 1042
Ramsey County Society, 90
Range Medical Society, 394
Red River Valley Society, 194, 1046
Research in arthritis, 830
Rice County Society, 522, 1144
St. Louis County Society, 194, 522
Saint Paul Surgical Society, 1256
Scott-Carver County Society, 734
Southern Minnesota Medical Association, 1044
Southwestern Minnesota Medical Society, 90, 638, 834,
1256
State meeting, 390
Stearns-Benton County Society, 194, 1144
Symposium on hypertension, 828
Twin City blood banks arrange reciprocal “pool,” 828
Urology award, 1040
Vancouver summer school clinics, 520
Van Meter prize award, 934
Wabasha County Society, 1144
Washington AMA meeting, The, 88
Washington County Society, 286, 394, 638, 1046
Winona Countv Society, 194
Woman’s Auxiliary, 92, 196, 288, 398, 524, 638, 736,
840, 1036, 1142, 1258
Wright County Society, 90, 1144
S
Saslow, George : The emotional problems of the chron-
ically ill, 673
Schmidt, Herbert W., Karlson, Alfred G., Carr, David
T., and Seybold, William D. : Intravenous adminis-
tration of para-aminosalicylic acid for streptomycin-
resistant tuberculosis of the trachea, 363
Selectees disqualified for the army, Tuberculosis in, 689
Seybold, William D., Schmidt, Herbert W., Karlson,
Alfred G., and Carr, David T. : Intravenous admin-
istration of para-aminosalicylic acid for strepto-
mycin-resistant tuberculosis of the trachea, 363
Sharp, David V., and Kinsella, Thomas J. : The sig-
nificance of the isolated pulmonary nodule, 886
Sher, David A. : Health is a community problem, 263
Sherman, Lloyd F., Campbell, William N., and Bacon,
Harry E. : Hemangiopericytoma, 683
Sherman, R. V., Hoffman, G. N., and Miller, Winston
R. : Acute yellow atrophy of the liver from SH
virus transmitted by a blood bank, 1211
1283
INDEX TO VOLUME 33
Shragg, Harry, Keil, Marcus, and Mikkelson, John :
Acute inversion of the uterus, 700
Significance of the isolated pulmonary nodule, The, 886
Silicosis, The roentgen diagnosis of, 988, 1104
Skin and eye, Associated diseases of the, 147
Smith, Harry L., and Mills, Melvin D. : Paroxysmal
tachycardia with attacks of unconsciousness, 703
Solitary pyogenic liver abscess, 588
Some recent aspects of cardiac and juxta-cardiac sur-
gery, 339
Soucheray, Philip H. : Clinical detection of pulmonary
emphysema from respiratory tracings, 889
Spinal column, Compression fractures of the, 154
Spink, Wesley W. : Studies on brucellosis in Minne-
sota, 333
Spleen, The present status of surgery of the, 1245
Spontaneous remission in subacute leukemia, 259
Stelter, L. A.: Acute conditions of the abdomen, 1133
Stennes, J. L., and Milton, J. S. : Treatment of barbit-
urate poisoning with metrazol (case report), 370
Stoesser, Albert V,, and Nelson, Lloyd S. : Respiratory
allergies in children, 893
Streptomycin-resistant tuberculosis of the trachea, Intra-
venous administration of para-aminosalicylic acid
for, 363
Students, medical, The plans of, for practice, 446
Studies on brucellosis in Minnesota, 333
Subfascial fat abnormalities and low back pain, 593
(Suppurative arthritis), Diagnostic case study, 266
Surgery, major, An appraisal of, in a small hospital, 31
Surgery, post-, Depropanex in, 1102
Surgical management of massive hemorrhage from gas-
tric and duodenal ulcers, The, 244
Surgical treatment of mitral heart disease, 881
Syphilitic cardiac deaths in over fifty thousand autopsies,
437
Syphilis, The clinical application of quantitative reports
of serologic tests for, 579
T
Tachycardia, Paroxysmal, with attacks of unconscious-
ness, 703
Taguchi, Reiko, and Hodgson, Jane E. : The Rcma
pipiens frog test for pregnancy, 1208
Tarsal coalition, Flatfoot, with special consideration of,
1091
Thoracic and upper abdominal operations, Controlled
respiration in, 1031
Toxemias, true, of pregnancy, The rationale of blood
transfusions in the treatment of the, 39
Trachea, streptomycin-resistant tuberculosis of the, In-
travenous administration of para-aminosalicylic acid
for, 363
Transfusion problems, 1015
Transfusion program, rural, A better, 773
Transfusion reaction, Hemolytic, in obstetrics, 597
Transfusions, blood, The rationale of, in the treatment
of the true toxemias of pregnancy, 39
Transurethral resections, Current mortality of (abstract),
820
Treatment of acute chest injuries, The, 49
Treatment of auricular fibrillation from the standpoint
of the general practitioner, 1196
Treatment of barbiturate poisoning with metrazol (case
report), 370
Treatment of deafness with histamine, 157
Treatment of fractures with the intramedullary nail
(discussion only), 821
Tuberculosis in selectees disqualified for the army, 689
Tuberculosis of the trachea, streptomycin-resistant, Intra-
venous administration of para-aminosalicylic acid
for, 363
Tuberculosis of the uterus, 160
Tudor, Robert B. : Peptic ulcer in infancy and child-
hood, 57
Tumors, Benign, nevi and precanceroses, 908
Tumors, Primary, of the optic nerve, 241
Tumors, Renal, 799
U
Ulcer, Peptic, in infancy and childhood, 57
Ulcer, peptic, Vagotomy in the treatment of, 1250
Ungerleider, Harry E. : Life insurance and medical re-
search, 25
Unusual type of pulmonary disease involving six mem-
bers of a family, An, 694
Uterus, Acute inversion of the, 700
Uterus, Tuberculosis of the, 160
V
VDRL slide test, quantitative, Advantages and limita-
tions of the, 573
Vagotomy in the treatment of peptic ulcer, 1250
Vanderhoof, Edward S., Baronofsky, Ivan D., and
Dickman, Roy W. : The treatment of acute chest
injuries, 49
Varicose veins and their complications, Resume of pres-
ent-day care and treatment of, 628
Varicose veins, Fundamental principles in the treatment
of, 626
Vasodilator, The — Roniacol, 133
“Vein stripping,” The return of, 623
Venography in the postphlebitic syndrome, 619
W
Weaver, Myron M., and Diehl, Harold S. : The plans
of medical students for practice, 446
Wells, Arthur H. : Melanomata and nevi, 456
Wells, Arthur H., Joffe, Harold H., and Moe, Thomas:
Diagnostic case study (homologous serum hepatitis),
163
Wells, Arthur H., MacRae, Gordon C., and Joffe, Harold
H. : Diagnostic case study (suppurative arthritis),
266
White, Asher A. : The radioactive effects of atomic
weapons, 1085
White, S. Marx: The vasodilator — Roniacol, 133
Wilson, J. Allen, and Conley, Robert H. : Chronic leu-
kemic infiltration of the gastric wall simulating
peptic ulcer, 1004
Woltman, Henry W., Flipse, M. Eugene, and Dry,
Thomas J. : The heart in Friedreich’s ataxia, 1000
Wright, Robert R. : Maternal and infant mortality study
in a small general hospital, 36
1284
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Insurors to:
Minnesota State Bar Association
Minnesota State Dental Association
Minnesota State Medical Association
Minnesota Society of C.P.A.
Minnesota State Pharmaceutical Assn.
Minnesota Auto Dealers Association
Hennepin County Medical Society
Hennepin County Bar Association
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2
Minnesota Medicinb
Journal of the Minnesota State Medical Association, Southern Minnesota Medical Association, Northern Minnesota
Medical Association, Minnesota Academy of Medicine and Minneapolis Surgical Society
Volume 33 January. 1950 No. 1
Contents
Life Insurance and Medical Research.
Harry E. Ungerleider, M.D., New York, New
York 25
An Appraisal of Major Surgery in a Small
Hospital.
David P. Anderson, M.D., F.A.C.S., Austin, Min-
nesota 31
Maternal and Infant Mortality Study in a
Small General Hospital.
Robert R. Wright, MS., M.D., Austin, Minnesota 36
The Rationale of Blood Transfusions in the
Treatment of the True Toxemias of Preg-
nancy.
R. T. La Vake, M.D., Minneapolis, Minnesota... 39
Results of the 1948 Cancer Statistical Research
Service.
N. O. Pearce, M.D., and D. S. Fleming, M.D.,
M.P.H., Minneapolis, Minnesota 42
Analysis of 10,000 Appendectomies.
Elmer C. Paulson, M.D., Minneapolis, Minnesota 46
The Treatment of Acute Chest Injuries.
Ivan D. Baronofsky, M.D., Roy W. Dickman,
M.D., and Edward S. Vanderhoof, M.D., Min-
neapolis, Minnesota 49
Hemochromatosis.
C. N. Harris, M.D., and R. E. Hansen, M.D., Hib-
bing, Minnesota 54
Peptic Ulcer in Infancy and Childhood.
Robert B. Tudor, M.D., Bismarck, North Dakota 57
History of Medicine in Minnesota:
Medicine and Its Practitioners in Olmsted County
Prior to 1900 (Continued from December issue )
Nora H. Guthrey, Rochester, Minnesota 61
Photograph :
F. J. Elias, M.D., President, Minnesota State Med-
ical Association 68
President’s Letter :
1950 69
Editorial :
The Year 1950 70
Isolation and Quarantine Requirements 70
Deficit Government Spending 72
Colds and Allergy 72
Medical Economics :
Whitaker & Baxter Report Progress 74
Legion Commander Scores Tax Medicine 74
Why Not Include Pets in Scheme? 74
British Finance Chief Optimistic 75
Hospital Occupancy Rate Leveling 75
Minnesota State Board of Medical Examiners —
New Licentiates 76
Minnesota Academy of Medicine:
Meeting of October 12, 1949 82
The Pulmonary Mimicry in Bronchogenic Car-
cinoma.
John Francis Briggs, M.D., Saint Paul, Minne-
sota 82
Reports and Announcements 88
Woman’s Auxiliary 92
In Memoriam 94
Of General Interest 96
Book Reviews 106
Contents of Minnesota Medicine copyrighted by Minnesota State Medical Association, 1950
Entered at the Post Office in Saint Paul as second class mail matter. Accepted for mailing at the special rate of postage provided
for in Section 1103, Act of October 3, 1917, authorized July 13, 1918.
January, 1950
3
MINNESOTA MEDICINE
Official Journal of the Minnesota State Medical Association
Published by the Association under the direction of its Editing and Publishing Committee
Office of Minnesota State Medical Association,
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EDITORIAL STAFF
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Minnesota Medicine
c J?/vu ~Asu o^^3^uj cujj lived Hakeem,
the Wise One,
and many people went to him for counsel, which he gave freely to all, asking nothing in return.
There came to him a young man, who had spent much hut got little, and said: “Tell
me. Wise One, what shall I do to receive the most for that which I spend? ”
Hakeem answered: “A thing that is bought or sold has no value unless it contains that which
cannot be bought or sold. Look for the Priceless Ingredient.”
“But what is this Priceless Ingredient? ” asked the young man.
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Copyright, 1922, 1945, E. R. Squibb & Sons
E* R Squibb & Sons
MANUFACTURING CHEMISTS TO THE MEDICAL PROFESSION SINCE 1858
January, 1950
5
MINNESOTA STATE MEDICAL ASSOCIATION
OFFICERS
F. J. Elias, M.D.
W. F. Hartfiel, M.D.
C. W. Moberc, M.D. .
B. B. Souster, M.D.
W. H. Condit, M.D. .
C. G. Sheppard, M.D.
H. M. Carryer, M.D.
R. R. Rosell
President
... First Vice President ...
.. Second Vice President ..
Secretary
T reasurer
Speaker, House of Delegates
Vice Speaker
. . . Executive Secretary . . .
Duluth
. . Saint Paul
Detroit Lakes
. . Saint Paul
. Minneapolis
. . Hutchinson
. . . Rochester
. . Saint Paul
COUNCILORS*
First District
R. L. J. Kennedy, M.D. (1950).
Rochester
Fifth District
Justus Ohage, M.D. (1952).
Saint Paul
Second District
L. L. Sogge, M.D. (1950)
Windom
Sixth District
O. J. Campbell, M.D. (1951)
(Chairman) Minneapolis
Third District
P. G. Smith, M.D. (1952)
Seventh District
W. W. Will, M.D. (1952) . .
Bertha
Fourth District
H. I. Nilson, M.D. (1951)
....North Mankato
Eighth District
W. L. Burnap, M.D. (1951).
Fergus Falls
Ninth
District
A. O. Swenson, M.D. (1950) Duluth
HOUSE OF DELEGATES, AMERICAN MEDICAL
ASSOCIATION*
Alternates
Members
J. A. Bargen, M.D. (1950) Rochester
W. A. Coventry, M.D. (1950) Duluth
A. E. Cardle, M.D. (1951) Minneapolis
George Earl, M.D. (1951) Saint Paul
*Terms expire December 31 of year indicated.
J. C. Hultkrans, M.D. (1950 Minneapolis
W. L. Burnap, M.D. (1950) Fergus Falls
W. W. Will, M.D. (1951) Bertha
E. M. Hammes, M.D. (1951) Saint Paul
SCIENTIFIC COMMITTEES
COMM ITTEE ON SCIENTIFIC ASSEMBLY
F. J. Elias, M.D., General Chairman Duluth
E. M. Hammes, M.D Saint Paul
R. R. Rosell Saint Paul
SECTION ON MEDICINE
J. A. Bargen, M.D Rochester
H. B. Sweetser, Jr., M.D Minneapolis
SECTION ON SPECIALTIES
G. I. Badeaux, M.D Brainerd
C. B. Nessa, M.D Saint Cloud
COMMITTEE ON CANCER*
A. H. Wells, M.D. (1950) Duluth
1). P. Anderson, Jr., M.D. (1952) Austin
Herbert Boysen, M.D. (1952) Madelia
D. S. Fleming, M.D. (1950) Minneapolis
M. G. Fredericks,. M.D. (1950) Duluth
E. C. Hartley, M.D. (1952) Saint Paul
J. A. Johnson. M.D. (1951) Minneapolis
N. L. Leven M.D. (1950) Saint Paul
T. B. Magath, M.D. (1950) Rochester
F. H. Magney, M.D. (1951) Duluth
Martin Nofdland, M.D. (1951) Minneapolis
I. L. Oliver, M.D. (1952) Graceville
SECTION ON SURGERY
A. II. Pederson, M.D Saint Paul
M. G. Gillespie, M.D Duluth
LOCAL ARRANGEMENTS
A. J. Spang, M.D Duluth
COMMITTEE ON ANESTHESIOLOGY
R. C. Adams, M.D Rochester
J. W. Baird, M.D Minneapolis
J. H. Crowley, M.D Saint Paul
R. T. Knight, M.D Minneapolis
K. E. Latterell, M.D Duluth
T. H. Seldon, M.D Rochester
*Terms expire December 31 of year indicated.
COMMITTEE ON CHILI) HEALTH
G. B. Logan, M.D Rochester
S. L. Arey, M.D Minneapolis
F. G. Hedenstfom, M.D Saint Paul
R. J. Josewski, M.D Stillwater
R. L. T. Kennedy, M.D Rochester
E. E. Novak, M.D New Prague
R. E. Nutting, M.D Duluth
W. B. Richards, M.D Saint Cloud
L. F. Richdorf, M.D Minneapolis
A. B. Rosenfield, M.D Minneapolis
V. O. Wilson, M.D Rochester
O. S. Wyatt, M.D Minneapolis
Irvine McQuaiirie, M.D. (ex officio) Minneapolis
6
Minnesota Medicine
COMMITTEE ON CONSERVATION OF HEARING
L. R. Boies, M.D Minneapolis
W. L. Burnap, M.D Fergus Falls
C. E. Connor, M.D Saint Paul
J. B. Gaida, M.D Saint Cloud
A. V. Garlock, M.D Bemidji
G. J. Halladay, M.D Minneapolis
A. C. Hii.ding, M.D Duluth
C. L. Lundell, M.D Granite Falls
O. B. Patch, M.D Duluth
R. E. Priest, M.D Minneapolis
K. M. Simonton, M.D Rochester
Andrew Sinamark, M.D Hibbing
G. E. Strate, M.D Saint Paul
COMMITTEE ON DIABETES
J. R. Meade, M.D Saint Paul
C. N. Harris, M.D Hibbing
J. A. Lepak, M.D Saint Paul
J. K. Moen, Jr., M.D Minneapolis
W. S. Neff, M.D Virginia
B. F. Pearson, M.D Shakopee
R. H. Puumala, M.D Cloquet
E. H. Rynearson, M.D Rochester
R. V. Sherman, M.D Red Wing
C. J. Watson, M.D Minneapolis
COMMITTEE ON FIRST AID AND RED CROSS
J. S. Lundy, M.D Rochester
E. R. Anderson, M.D Minneapolis
G. I. Badeaux, M.D Brainerd
Charles Bagley, M.D Duluth
Paul F. Dwan, M.D Minneapolis
J. W. Edwards, M.D Saint Paul
B. A. Flesche, M.D Lake City
A. F. Giesen, M.D Starbuck
G. H. Goehrs, M.D Saint Cloud
E. V. Goltz, M.D Saint Paul
COMMITTEE ON FRACTURES
E. T. Evans, M.D Minneapolis
N. H. Baker, M.D Fergus Falls
O. K. Behr, M.D Crookston
W. H. Cole, M.D Saint Paul
B. C. Ford, M.D Marshall
R. K. Ghormley, M.D Rochester
V. P. Hauser, M.D Saint Paul
J. H. Moe, M.D Minneapolis
M. J. Nydahl, M.D Minneapolis
L. G. Rigler, M.D Minneapolis
J. A. Thabes, Jr., M.D Brainerd
M. H. Tibbetts, M.D Duluth
Nels Westby, M.D Madison
I
COMMITTEE ON GENERAL PRACTICE
R. H. Creighton, M.D Minneapolis
E. C. Bayley, M.D Lake City
R. M. Burns, M.D Saint Paul
C. S. Donaldson, M.D Foley
J. F. DuBois, M.D Sauk Centre
R. J. Eckman, M.D Duluth
R. E. Gruys, M.D Windont
W. E. Hart, M.D Monticello
W. W. Rieke, M.D Wayzata
C. H. Sherman, M.D Bayport
HEART COMMITTEE*
F. P. Hirschboeck, M.D. (1951) Duluth
G. N. Aagaard, Tf., M.D. (1950) Minneapolis
C. A. Boline, M.D. (1952) Battle Lake
P. G. Boman. M.D. (1951) Duluth
T. F. Borg, M.D. (1951) Saint Paul
P. F. Dwan, M.D. (1952) Minneapolis
C. N. Hensel, M.D. (1952) Saint Paul
M. M. Hitrwitz, M.D. (1950) Saint Paul
Charles Koenigsberger, M.D. (1950) Mankato
R. L. Nelson, M.D. (1952) Duluth
M. T. SHAPtRo, M.D. 0950) Minneapolis
H. L. Smith, M.D. (1951) Rochester
S. M. White, M.D. 11952) Minneapolis
Arlie R. Barnes, M.D. (ex officio) Rochester
*Terms expire December 31 of year indicated.
HISTORIC All COMMITTEE
Robert Rosenthal, M.D.
H. M. Weber, M.D
Richard Bardon, M.D..
F. H. Dubbe, M.D
Olga Hansen. M.D
R. C. Hunt, M.D
F. R. Huxley, M.D,..,
A. G. Ltedloff, MD....
O. F. Mellby, M.D
G. E. Sherwood. M.D..
A. M. Watson, M.D....
January, 1950
Saint Paul
Rochester
Duluth
New LMm
Minneapolis
Fairmont
Faribault
Mankato
Thief River Falls
Kimball
Royalton
COMMITTEE ON HOSPITALS AND
MEDICAL EDUCATION
H. S. Diehl, M.D
A. R. Barnes, M.D
T. E. Bratrud, M.D
T. E. Broadie, M.D
E. W. Humphrey, M.D..
C. C. Kennedy, M.D
A. J. Spang, M.D
H. L. LTlrich, M.D
W. H. Valentine, M.D. .
H. B. Zimmermann, M.D.
. . . . i . Minneapolis
Rochester
Thief River Falls
Saint Paul
Moorhead
Minneapolis
Duluth
Minneapolis
Tracy
Saint Paul
i
COMMITTEE ON INDUSTRIAL HEALTH
L. S. Arling, M.D
T. E. Barber, Jr., M.D.
N. W. Barker, M.D....
C. C. Bell, M.D
E. E. Christensen, M.D.
L. W. Foicer, M.D
G. H. Goehrs, Jr.. M.D.
C. W. Jacobson, M.D...
T. A. Lowe, M.D
O. L. McHaffie, M.D..
J. R. McNutt, M.D....
A. E. Wilcox, M.D
J. F. Shronts, M.D. ...
A. A. Zierold, M.D
Minneapolis
Austin
Rochester
Saint Paul
.Winona
Minneapolis
Saint Cloud
Chisholm
South Saint Paul
Duluth
Duluth
Minneapolis
Minneapolis
Minneapolis
COMMITTEE ON MATERNAL HEALTH
J. J. Swendson, M.D Saint Paul
R. N. Andrews, M.D Mankato
C. J. EhrenbErg, M.D Minneapolis
G. F. Hartnagel, M.D Red Wing
A. D. Hoidale, M.D Tracy
A. B. Hunt, M.D Rochester
J. L. McKelvey, M.D. .: Minneapolis
F. L. Schade, M.D Worthington
J. F. Schaefer, M.D Owatonna
F. J. Schatz, M.D Saint Cloud
A. O. Swenson, M.D Duluth
V. O. Wilson, M.D Rochester
COMMITTEE ON MEDICAL TESTIMONY
E. M. Hammes, Sr., M.D Saint Paul
B. S. Adams, M.D Hibbing
L. A. Barney, M.D Duluth
H. Z. Giffin, M.D Rochester
S. R. MaxEiner, M.D Minneapolis
L. Ht Rutledge, M.D Detroit Lakes
W. G. Workman, M.D Tracy
COMMITTEE ON MILITARY AFFAIRS
J. H. Tillisch, M.D Rochester
M. S. Belzer, M.D Minneapolis
E. G. Benjamin, M.D Minneapolis
T. T. Catlin, M.D Buffalo
R. V. Fait, M.D Little Falls
M. G. Gillespie. M.D Duluth
R. P. Griffin, M.D Benson
K. E. Johnson, M.D Duluth
W. P. Ritchie, M.D Saint Paul
A. K. Stratte, M.D Pine City
COMMITTEE ON NERVOUS AND MENTAL
DISEASES
W. P. Gardner, M.D Saint Paul
J. R. Brown, M.D... Rochester
S. A. Ciiallm an. M.D Minneapolis
L. R. Gowan, M.D Duluth
R. C. Gray, M.D Minneapolis
B. P. Grimes, M.D Saint Peter
E. M. Hammes, Jr.. M.D Saint Paul
W. H. Hengstler, M.D Saint Paul
Wr. L. Patterson, M.D Fergus Falls
COMMITTEE ON OPHTHALMOLOGY
T. R. FritschE, M.D New Ulm
A. F. Adair, Jr., M.D Saint Paul
W. L. Benedict, M.D Rochester
F. P. Frisch, M.D Willmar
H. W. Grant, M.D Saint Paul
E. W. Hansen, M.D Minneapolis
H. C. Johnson, M.D Mankato
F. N. Knapp, M.D Duluth
L. W. Morseman, M.D Hibbing
C. L. Oppegaard, M.D Crookston
C. E. Stanford, M.D Minneapolis
W. T. Wenner, M.D Saint Cloud
7
COMMITTEE OIV PUBLIC HEALTH NURSING
M. McC. Fischer, M.D Duluth
F. S. Babb, M.D Saint Paul
L. V. Berghs, M.D Owatonna
W. C. Chambers, M.D Blue Earth
L. F. Davis, M.D Wadena
J. N. Libert, M.D Saint Cloud
C. E. Merkert, M.D Minneapolis
COMMITTEE ON SYPHILIS AND SOCIAL
DISEASES
P. A. O’Leary, M.D Kochester
J. A. Butzer, M.D Mankato
G. C. Doyle, M.D Duluth
W. E. Hatch, M.D Duluth
H. G. Irvine, M.D Minneapolis
F. W. Lynch, M.D Saint Paul
H. E. Michelson, M.D Minneapolis
C. W. Moberg, M.D Detroit Lakes
S. E. Sweitzer, M.D Minneapolis
COMMITTEE ON TUBERCULOSIS
J. A. Myers, M.D Minneapolis
R. N, Barr, M.D Saint Paul
R. E. Boynton, M.D Minneapolis
J. F. Briggs, M.D Saint Paul
F. F. Callahan, M.D Saint Paul
S. S. Cohen, M.D Oak Terrace
K. A. Danielson, M.D Litchfield
R. E. Hansen, M.D Hibbing
G. A. Hedberg, M.D Nopeming
C. H. Hodgson, M.D Rochester
L. S. Jordan, M.D Granite Falls
T. J. Kinsella, M.D Minneapolis
Thomas Lowry, M.D Minneapolis
Hilbert Mark, M.D Minneapolis
E. A. Meyerding, M.D Saint Paul
W. E. Peterson, M.D Willmar
K. H. Pfuetze, M.D Cannon Falls
C. G. Sheppard, M.D Hutchinson
S. A. Slater, M.D Worthington
W. H. Ude, M.D Minneapolis
COMMITTEE ON VACCINATION AND
IMMUNIZATION
R. N. Barr, M.D Saint Paul
E. E. Barrett, M.D Duluth
A. J. Chesley, M.D Saint Paul
W. W. Higgs, M.D Park Rapids
C. O. Kohlbry, M.D Duluth
L. F. Richdorf, M.D Minneapolis
R. B. J. Schoch, M.D Saint Paul
C. S. Strathern, M.D Saint Peter
R. L. Wilder, M.D Minneapolis
N ON-SCIENTIFIC COMMITTEES
EDITING AND PUBLISHING COMMITTEES*
E. M. Hammes, Sr., M.D. (1951) Saint Paul
P. F. Donohue, M.D. (1953) Saint Paul
H. W. Meyerding, M.D. (1954) Rochester
B. O. Mork, Jr., M.D. (1951) Minneapolis
C. L. Oppegaard, M.D. (1950) Crookston
T. A. Peppard, M.D. (1952) Minneapolis
H. A. Roust, M.D. (1953) Montevideo
O. W. Rowe, M.D. (1952) Duluth
H. L. Ulrich, M.D. (1950) Minneapolis
A. H. Wells, M.D. (1954) Duluth
*Terms expire December 31 of year indicated.
INSURANCE LIAISON COMMITTEE
A. W. Adson, M.D Rochester
B. S. Adams, M.D Hibbing
B. J. Branton, M.D Willmar
L. A. Dwinnell, M.D Fergus Falls
B. J. Gallagher, M.D Waseca
P. W. Harrison, M.D Worthington
V. P. Hauser, M.D Saint Paul
R. W. Morse, M.D Minneapolis
A. H. Zachman, M.D Melrose
COMMITTEE ON INTERPROFESSIONAL RELATIONS
W. P. Gardner, M.D Saint Paul
M. J. Anderson, M.D Rochester
J. J. Catlin, M.D Buffalo
E. E. Christensen, M.D Winona
K. A. Danielson. M.D Litchfield
C. O. Estrem, M.D Fergus Falls
K. R. Fawcett, M.D Duluth
M. I. Hauge, M.D Clarkfield
J. M. Hayes, M.D Minneapolis
R. F. Heoin, M.D Red Wing
Arthur Neumaier, M.D Glencoe
F. J. Savage, M.D Saint Paul
L. G. Smith, M.D Montevideo
W. H. Valentine, M.D Tracy
COMMITTEE ON MEDICAL ECONOMICS
George Earl, M.D. (General Chairman) Saint Paul
Executive
George Earl, M.D Saint Paul
A. W. Adson, M.D Rochester
A. E. Cardle, M.D Minneapolis
R. F. Erickson, M.D Minneapolis
W. H. Hengstlf.r, M.D Saint Paul
R. D. Mussey, M.D Rochester
C. E. Proshek, M.D Minneapolis
Editorial
George Earl, M.D Saint Paul
W. F. Braasch, M.D Rochester
W. L. Patterson. M.D Fergus Falls
H. F. R. Plass, M.D Minneapolis
D. W. Wheeler, M.D Duluth
MEDICAL ADVISORY COMMITTEE
W. H. Hengstler, M.D Saint Paul
B. J. Branton, M.D Willmar
Ivar SivErtsen, M.D Minneapolis
COMMITTEE ON MEDICAL ETHICS
R. D. Mussey, M.D Rochester
H. S. Diehl, M.D Minneapolis
P. E. Hermanson, M.D Hendricks
Harry Klein, M.D Duluth
C. E. Rea, M.D Saint Paul
COMMITTEE ON MEDICAL SERVICE
A. W. Adson, M.D Rochester
F. S. Babb, M.D Saint Paul
J. A. Bargen, M.D Rochester
B. G. Lannin, M.D Saint Paul
C. B. MoKaig, M.D Pine Island
R. A. Murray, M.D Hibbing
J. F. Norman, M.D Crookston
G. R. Penn, M.D Mankato
H. F. R. Plass, M.D Minneapolis
R. E. Priest, M.D Minneapolis
E. J. Simons, 'M.D Swanville
A. O. Swenson. M.D Duluth
W. W. Will, M.D Bertha
i
COMMITTEE ON STATE HEALTH RELATIONS
C. E. Proshek, M.D Minneapolis
Earl Barrett, M.D Duluth
E. C. IIayley, M.D Lake City
R. B. Bray, M.D Biwabik
C. S. Donaldson, M.D Foley
John Earl, M.D Saint Paul
R. R. Heim, M.D Minneapolis
D. L. Johnson, M.D Little Falls
A. G. LiEdloff, M.D Mankato
C. N. McCloud, Jr., M.D Saint Paul
Carl Simison, M.D Barnesville
S. A. Slater, M.D Worthington
COMMITTEE ON PUBLIC HEALTH EDUCATION
A. E. Cardle, M.D. (General Chairman) Minneapolis
Executive
A. E. Cardle. M.D Minneapolis
R. M. Burns, M.D Saint Paul
H. M. Carryer, M.D Rochester
C. B. Drake, M.D Saint Paul
(And Chairmen of all Scientific Committees)
Editorial
C. B. Drake, M.D
K. W. Anderson. M.D
R. P. Buckley, M.D
G. W. Clifford. M.D
T. T. Edwards, M.D
H. W. Schmidt, M.D
RADIO COMMITTEE
R. M. Burns, M.D Saint Paul
G. N. Aagaard, Jr.. M.D Minneapolis
R. N. Andrews, M.D Mankato
C. M. Bagley. M.D Duluth
N. W. Barker, M.D Rochester
C. N. Harris, M.D Hibbing
E. A. Heiberg. M.D Fergus Falls
R. N. Jones. M.D Saint Cloud
F. R. Kotchevar. M.D Eveleth
L. R. Prins, M.D Albert Lea
R. H. Wilson, M.D Winona
. Saint Paul
Minneapolis
Duluth
. Alexandria
.Saint Paul
. . Rochester
8
Minnesota Medicine
SPEAKERS’ BUREAU
COMMITTEE ON RURAL MEDICAL SERVICE
H. M. Carryer, M.D Rochester
G. N. Aagaard, Jr., M.D Minneapolis
J. F. Briggs, M.D Saint Paul
J. W. Duncan, M.D Moorhead
P. J, Hiniker, M.D Le Sueur
P. A. Lommen, M.D Austin
Gordon MacRae, M.D Duluth
J. F. Norman, M.D Crookston
J. D. Van Valkenburg, M.D Floodwood
M. 0. Wallace, M.D Duluth
COMMITTEE ON PUBLIC POLICY
R. F. Erickson, M.D. (Chairman) Minneapolis
L. L. Sogge, M.D. (Consultant) Windom
A. W. Adson, M.D Rochester
K. W. Anderson, M.D Minneapolis
G. I. Badeaux, M.D Brainerd
L. A. Barney, M.D Duluth
F. W. Behmler, M.D Morris
Edward Bratrud, M.D Thief River Falls
R. M. Burns, M.D Saint Paul
O. J. Campbell, M.D Minneapolis
J. F. Du Bois, M.D Sauk Centre
J. M. Hayes, M.D Minneapolis
P. E. Hermanson, M.D Hendricks
V. M. Johnson, M.D Dawson
E. J. Kaufman, M.D Appleton
M. E. Lenander, M.D Saint Peter
J. N. Libert, M.D Saint Cloud
C. J. T. Lund, M.D Fergus Falls
M. O. Oppegaard, M.D , Crookston
C. E. ProshEk, M.D Minneapolis
R. H. Puumala, M.D Cloquet
L. H. Rutledge, M.D Detroit Lakes
H. R. Tregilgas, M.D South Saint Paul
J. C. Vezina, M.D Mapleton
Magnus Westby, M.D Madison
R. H. Wilson, M.D Winona
MINNESOTA STATE CERTIFICATION BOARD ON
PBULIC HEALTH NURSING
F. J. Savage, M.D Saint Paul
First District
P. C. Leck, M.D. (Chairman) Austin
Second District
V. M. Doman, M.D Lakefield
Third District
Magnus Westby, M.D Madison
Fourth District
F. J. Traxler, M.D..... Henderson
Fifth District
A. K. Stratte, M.D Pine City
Sixth District
W. E. Hart, M.D Monticello
Seventh District
(To be appointed later)
Eighth District
C. W. Jacobson, M.D Breckenridge
Ninth District
J. K. Butler, M.D Cloquet
COMMITTEE ON UNIVERSITY RELATIONS
E. M. Hammes, Sr., M.D Saint Paul
A. E. Cardle, M.D ..Minneapolis
L. A. Buie, M.D Rochester
E. J. Simons, M.D Swanville
E. L. Tuohy, M.D ...Duluth
COMMITTEE ON VETERANS MEDICAL SERVICE
R. H. Creighton, M.D Minneapolis
S. H. Boyer, Jr., M.D Duluth
C. J. Fritsche, M.D New Ulm
W. P. Ritchie, M.D Saint Paul
C. A. Wilmot, M.D Litchfield
A FORMULA, a couple of machines and a label?
. . . That’s about it — for just any ampoule.
But the careful physician won’t settle for just
any product — ampoule or otherwise.
When he prescribes, he wants the label to
signify — beyond the shadow of a doubt —
a clean manufacturing record, preferably
one stretching back a generation or more;
unfading adherence to controls;
a research program with adequate staff
and facilities; and for final confirmation, a
place on the roster of Council accepted products.
You need settle for nothing less when
you specify medication labeled
THE SMITH-DORSEY COMPANY
LINCOLN, NEBRASKA
BRANCHES AT LOS ANGELES AND DALLAS
•
MANUFACTURERS OF FINE
PHARMACEUTICALS SINCE 1908
January, 1950
9
SIMIKAC
so similar to human breast milk
that there is no closer
equivalent
1. SAVES TIME AND MONEY— one can of Similac
supplies 1 16-oz. of formula— 20 calories an ounce
at an average cost of less than 9/lOths of a cent
per ounce.
2. SAVES TIME AND MONEY -no milk modifiers
needed with Similac; its higher vitamin content
must be considered; helps avoid costly compli-
cations of ordinary formula feedings.
3. SAVES TIME AND MONEY — easily prescribed,
easily prepared — simply 1 measure ot Similac to
2 oz. of water.
SIMILAC FOR GREATER INFANT FEEDING VALUES
10
Minnesota Medicine
WANGENSTEEN
SUCTION SYSTEM
by PHELAN
DESCRIPTION Height 26 inches, diameter 15
inches. Weight approximately 35 pounds. Mounted
on four Bassick casters.
The tank is hollow with a crowned head and invert-
ed bottom. It is made of 16 gauge steel of welded and
brazed construction throughout and finished in ham-
mered aluminum lacquer, baked for durability.
On the top of the tank is a vacuum gauge reading
in inches of mercury, a needle valve, a pump handle
and a handle for moving the piece. IV tubing connects
the tank to the drainage bottle.
ADVANTAGES
Silent in operation.
Safe for patient — no water used — patient’s stomach
cannot be flooded.
Impossible to develop positive pressure or exces-
sive negative pressure.
Complete — requires no electrical or power con-
nections.
A device requiring a minimum of attention — a
time saver.
Easily portable — requires a minimum of space.
Economical — saving bottle replacements, etc.
Explosion proof.
In case drainage bottle is allowed to overflow,
suction to the patient is not interrupted.
Hundreds of these units in use and not one
request for service or replacement of parts.
SOME OF ITS USES
Decompression and drainage of stomach by
connecting to nasal tube.
Gastrostomy decompressioh by connecting to
gastrostomy tube.
Enterostomy decompression by connecting to
enterostomy tube.
Aseptic decompression of bowel.
Withdrawal of blood in exchange transfusions.
WANGENSTEEN SUCTION SYSTEM -BY PHELAN
PHYSICIANS AND HOSPITALS SUPPLY CO., Inc.
MINNEAPOLIS MINNESOTA
January, 1950
11
The established relationship between sound dietary planning
and a state of maintained good health emphasizes the nutri-
tional importance of meat, man’s favorite protein food.
Not only does meat taste good, but of greater significance,
it provides a host of nutritional benefits. Developments in the
field of nutrition* have proved that complete protein— the
kind that meat supplies in abundance— aids in building and
maintaining immunity, hastens recovery after acute infectious
diseases and following injury and burns, promotes health
during pregnancy, aids in the growth and development of
husky children, and is needed to maintain everyone in top
physical condition.
No matter from what walk of life your patients come, and
whether their pocketbooks demand economy or permit satis-
faction of that urge for the fanciest cuts, meat gives them full
value for their money.
♦McLester, J. S.: Protein Comes Into Its Own, J.A.M.A. 139: 897 (April 2) 1949.
American Meat Institute
Main Office, Chicago. ..Members Throughout the United States
The Seal of Acceptance denotes that
the nutritional statements made in
this advertisement are acceptable to
the Council on Foods and Nutrition
of the American Medical Association.
12
Minnesota Medicine
TRIM ETON ®
Detection mustM
be
sarlu
WM m ■ Wm Early vigorous treatment of diabetes increases the
patient’s chances for longevity. One million diabetics
remain undetected in the United States.* The diabetic must be detected before it is “ too late.”
Selftester— for the general public, is a simple home test for the detection of urine-sugar. Its pur-
pose is to help discover the hidden diabetic and bring him to the physician for adequate care.
Control must be complete
A well-controlled diabetic is less susceptible to infection and acidosis. The incidence
of vascular complications, retinitis, gangrene, and renal intercapillary glomerulosclerosis
is reduced with vigorous control. “ Too little ” is the symbol of inadequate control.
Cl'mitest for
physician and patient
Clivitest (Brand) Reagent Tablets dispense with external heating and cumbersome
laboratory apparatus in the detection of urine-sugar. The tablets provide a simple,
rapid, inexpensive method for adequate diabetic control resting upon the cardinal principles
of diet and insulin administration guided by the urine-sugar level.
Selftester to detect
Cl'mitest to control
Urine-sugar
*Joslin, E. P., Postgrad. Med.: 4:302 (Oct.) 1948.
Selftester trademark
Clinitest trademark reg. U. S. and Canada
AMES COMPANY, INC. • ELKHART, INDIANA
14
Minnesota Medicine
^ Calling All Doctors,
Your Receivables Have
Suffered A Set-Back! ^
Every doctor should immediately examine his accounts
receivable. A thorough diagnosis is certainly in order
promptly after due date. If some of your accounts are
suffering from “slow collectibility” they should be
receiving treatment while they still will respond.
COLLECTIBILITY OF ACCOU NTS— Based On Age
Accounts 60 days past due are 93% collectible. Accounts 1 year past due are 40% collectible.
Accounts 90 days past due are 85% collectible. Accounts 2 years past due are 25% collectible.
Accounts 6 months past due are 70% collectible. Accounts 3 years past due are 18% collectible
Accounts 5 years past due are practically lost.
lOOO DOCTORS
HOSPITALS AND CLINICS
A National Organization . .
Offered and recommended by
over 50 trade and professional
associations from coast to coast.
Write for references of service in
your area.
I
I
I
OUR ETHICAL COLLECTION SERVICE
★ NOT A COLLECTION AGENCY- All
Monies paid directly to you.
★ RETAINS GOOD WILL-Methods are
ethical, courteous and effective.
PROFESSIONAL CREDIT
PROTECTIVE BUREAU
Division of The I. C. System,
310 Phoenix Bldg., Minneapolis, Minn.
Further Inquiry Invited —
FILL OUT AND MAIL COUPON NOW
Professional Credit Protective Bureau
310 Phoenix Building
Minneapolis, Minn.
Gentlemen:
Without obligation, please send complete information
regarding this service.
Name ’
Address.
City
.Zone.
.State.
January, 1950
15
more physicians are satisfied
The development of the new improved Biolac supplies a long-sought need in infant
nutrition. To accomplish this, Borden scientists surveyed our present nutritional knowledge.
They then tested more than 500 formulations. Having decided on the formula that
would best supply the normal infant’s nutritional requirements in their most assimilable
form, a modern plant was constructed in 1949 so that the new formula could
also benefit from the most up-to-date techniques and control in processing equipment.
A Biolac formula that is both new and improved is thus made available.
For up-to-date, completi
infant nutrition, prescribe
v improved
Biolac
a development of
The Prescription Products Division
The Borden Company
Biolac is intended for prescription by every physician with infants among his patients.
It satisfies the physician’s demand for a complete
food to which only vitamin C need be added.
That means it is simplicity itself to prepare
and provides the maximum in formula
safety for the infant.
And yet, for all these advantages,
Biolac costs no more.
Ingredients: nonfat dry milk
solids, dextrins-maltose-
dextrose, lactose, coconut oil,
destearinated beef fat, lecithin,
sodium alginate, disodium phosphate,
ferric citrate, vitamin Bi,
concentrate of vitamin A and D
from fish liver oils, and water.
Homogenized and sterilized.
Dilution: one fluid ounce to one and a half
ounces of boiled water for each
pound of body weight.
Biolac is available in 13 fluid ounce tins.
The Borden Company, Prescription Products Division
350 Madison Avenue, New York 17
16
Minnesota Medicine
in the Pneumonias
Aureomycin possesses a broad spectrum of effectiveness
that indicates its use in pneumococcal, streptococcal,
staphylococcal and so-called “virus” pneumonias. It has
also been shown to be highly effective against Hemophilus
influenzae and is indicated in infections caused by that
organism.
Aureomycin is useful for the control of bacteroides
septicemia, brucellosis, Gram-negative infections — in-
cluding those caused by the coli-aerogenes group, Gram-
positive infections — including those caused by streptococ-
ci, staphylococci and pneumococci, granuloma inguinale,
lymphogranuloma venereum, psittacosis, Q, fever, rick-
ettsialpox, Rocky Mountain spotted fever, subacute
bacterial endocarditis resistant to penicillin, tularemia,
typhus, viral-like and bacterial infections of the eye.
Capsules: Bottles of 25, 50 mg. each capsuie. Bottles of 16, 250 mg. each
capsule. Ophthalmic: Vials of 25 mg. with dropper; solution prepared by
adding 5 cc. of distilled water.
LEDERLE LABORATORIES DIVISION
AMERICAN Guuuunid COMPANY
30 Rockefeller Plaza, New York 20, N. Y.
Tanuary, 1950
17
WHY MANY LEADING
NOSE AND THROAT
S
PECIALISTS SUGGEST
Where smoking is a factor in a throat condition,
the physician may advise "Don't Smoke."
But where the patient persists, many eminent
specialists suggest "Change to Philip Morris". . .
the one cigarette proved definitely less irritating.**
Perhaps you too will find it advantageous
to suggest to your throat patients
"Change to Philip Morris." For your
own smoking as well. Doctor, in fact for all
smokers, Philip AAorris is by far the wisest choice.
PHILIP MORRIS
Philip Morris & Co., Ltd., Inc.
119 Fifth Avenue, N. Y.
IF YOU SMOKE A PIPE ... We suggest an
unusually fine new blend— Country Doctor Pipe
Mixture. Made by the same process as used in
the manufacture of Philip Morris Cigarettes.
*Co mpletely documented evidence on file.
**Reprints on Request:
Laryngoscope, Feb. 1935, Vo I. XLV, No. 2, 149-154; Laryngo-
scope, Jan. 1937, Vo I. XLVII, No. I, 58-60; Proc. Soc. Exp .
Biol, and Med., 1934, 32,241; N. Y. State Journ. Med., Vo I.
35, 6-1-25 , No. II, 590-592.
18
Minnesota Medicine
The infant's digestive tract
can handle Cartose
(mixed dextrins, maltose and
dextrose) with ease since
each of these carbohydrates has a
different rate of assimilation
releasing a steady supply of carbohydrate
for "spaced" absorption. The low rate
of fermentation of Cartose
means less likelihood of colic.
CARTOSE0
Liquid Carbohydrate * Easy to Use * Economical
Bottles of 16 oz. 1 tablespoonful = 60 calories
Write for complimentary formula blanks
LESS
ilSDSilll’
New York 13, N. Y. Windsor, Ont.
in Propylene Glycol.
Milk Diffusible Vitamin D 2
Daily dose for infants 2 drops, for children and adults
4 to 6 drops in milk. Bottles of 5, 10 and 50 cc.
Cartose and Drisdol, trademarks reg. U. S. & Canada
Now also milk diffusible DRISDOL with VITAMIN A
INC.
t ODORLESS
6 TASTELESS
4 NON ALLERGENIC
J
January, 1950
19
SNOOZER PETE
/4 a dytca/djavt r(?/ieat
Skip the morning repast? Not Pete. If he snoozes
until 8:02, he can still make the 8:24 by a flying
leap — with a few minutes at the other end for
gulped coffee and a cigarette. Scanty breakfast?
He’ll make it up at lunch — if he has time.
Pete doesn’t think he’s a meal-cheater. Neither
does the food faddist, the worrier, the reducing
expert’ ’ nor any of their kin likewise committed to
dietary sin. Thus do they become prey to all the
associated evils of subclinical vitamin deficiency.
When you examine the habit patterns of these
patients, it’s obvious that overnight dietary reform
won't come easy. So isn’t it wise to make use of
the aid provided by vitamin supplementation?
Wise also to specify Abbott. You know there’s
a dependable Abbott vitamin product to serve
nearly every vitamin need — for supplementary or
therapeutic levels of dosage, for oral or parenteral
administration. Your pharmacist can always sup-
ply fresh and potent Abbott vitamin products in a
wide variety of attractive forms and package sizes.
Abbott Laboratories, North Chicago, III.
/ ABBOTT VITAMIN PRODUCTS
20
Minnesota Medicine
To provide the flexibility needed to adjust dosage
to the individual patient’s requirements, Purodigin
is supplied in three strengths: Tablets of 0.1 mg.,
0.15 mg. and 0.2 mg. You can rely on Purodigin to
produce a constant response. The pure, crystalline,
orally active glycoside — not a mixture . . .
PURODIGIN"
Pure Crystalline Digitoxin Wyeth
The
heart
of
the
matter
Incorporated • Philadelphia 3, Pa.
January, 1950
21
Pure, Crystalline Anti- Anemia Factor
IMPORTANT PRICE REDUCTION
Economical — the new, low price of
Cobione* makes this highly potent
therapeutic substance a most eco-
nomical preparation.
Weight for Weight, the Most Potent Thera-
peutic Substance Known
Minimum Dosage — Maximum Therapeutic
Activity
Nontoxic — Stable — Nonsensitizing
Effective and well tolerated in patients sensi-
tive to liver or concentrates
RAPID THERAPEUTIC EFFECT
Because Cobione is virtually nonirritating on
injection, large doses capable in many instances
of producing rapid relief of neurologic manifesta-
tions in pernicious anemia may be administered
with this pure, crystalline anti-anemia factor.
P-R-O-L-O-N-G-E-D ACTION
Large doses of Cobione also may be given with-
out tissue irritation or induration to obtain a
tnore prolonged therapeutic effect.
The U.S.P. Anti-anemia Preparations Advisory Board lias recently advised
that — with the exception of preparations of Crystalline Vitamin B12 — it is
considered to be contrary to the best interests of patients and of the medical
and pharmaceutical professions for the result of unofficial assay procedures
for Vitamin B12 to be stated on the labels of U.S.P. Anti-anemia Preparations.
♦COBIONE is the registered trade-mark of Merck
& Co., Inc. for its brand of Crystalline Vitamin B12
MERCK & CO., Inc.
Manufacturing Chemists
RAHWAY, N. J.
3id Cobione
Crystalline Vitamin B12 Merck
Minnesota Medicine
If she is one
of your patients
...Your help now may spell the difference between unprovided-for old oge
and economic security.
Women in business who ore nervous, emotionally unstable and generally
distressed by symptoms of the climacteric almost inevitably experience
a reduction in efficiency as well as earning power.
" Premarin " offers a solution. Many thousand physicians prescribe this
naturally-occurring, oral estrogen because...
7 . Prompt symptomatic improvement usually follows therapy.
2. Untoward side-effects are seldom noted.
3. The sense of well-being so frequently reported tends to
quickly restore the patient's confidence and normal efficiency.
4. This "Plus" (the sense of well-being enjoyed by the patient)
is conducive to a highly satisfactory patient-doctor
relationship.
5. Four potencies provide flexibility of dosage: 2.5 mg.,
1 .25 mg., 0.625 mg. and 0.3 mg. tablets; also in liquid
form, 0.625 mg. in each 4 cc. (1 teaspoonful).
While sodium estrone sullate is the principal estrogen
in "Premarin," other equine estrogens ... estradiol,
equilin, equilenin, hippulin . . . are probably also pres-
ent in varying amounts as water-soluble conjugates.
TV TV HI r 1 TVT1T99
ESTROGENIC SUBSTANCES (WATER-SOLUBLE)
also known as CONJUGATED ESTROGENS (equine)
Ayerst, McKenna & Harrison Limited 22 East 40th Street, New York 1 6, New York
January, 1950
23
"•it m
M(IR{
,XNtCOVOG«TS
APPROVE
bv „i.rt iM-""*
, tty ana Koromex Cr ^ f.do« ■; ^
, .«***• <»' hZo.
" » *• v‘.“* •££“.*.«• <»” b*"'" wuW-»*
•mitidal an ^ ^ cohesWeness P»°*' ,.Wy °r ^ s sopPor» *•
, „ilo, „„a *. ,«.*«. “'*■
— - ~
lCt that the ' . ... advised. ,nUH BEN2°A1E
,here pregnancy » ‘ ^ 2.0%, )£llY OR CREA^ 6ASE '
ACTIVE INCRE°'ENTS' ACETAL 0.°2% lH S „ fOR AVAU
)XVQU ELLY OR CREAM EASEb. atURE
ease5ENDForava,a6eePRoeess^e
fOR.ORECO.— WEOMARE
1
24
Minnesota Medicine
Journal of the Minnesota State Medical Association, Southern Minnesota Medical Association, Northern Minnesota
Medical Association, Minnesota Academy of Medicine and Minneapolis Surgical Society
Volume 33
January. 1950
No. 1
LIFE INSURANCE AND MEDICAL RESEARCH
HARRY E. UNGERLEIDER, M.D.
New York, New York
I *HE BEST prophet naturally is the best
guesser,” wrote Thomas Hobbes a few cen-
turies ago in The Leviathan, “and the best guesser,
he that is most versed and studied in the matters
he guesses at, for he hath most signes to guesse
by.”
We may adopt this terse quotation from
Hobbes as a statement of the primary function
of life insurance medicine. Unlike clinical medi-
cine, which deals chiefly with problems of the
present, insurance medicine is concerned to a
greater degree with the remote future, specifically
the life expectancy of the individual, and in this
function the physician plays the role of prophet
rather than healer. To a greater extent than in
clinical medicine, one must necessarily rely more
heavily on objective findings than on symptoms,
and accordingly “signes to guesse by,” to use
Hobbes’ phrase, assume considerable importance.
Some twenty years ago the Equitable Life As-
surance Society of the United States installed a
complete diagnostic laboratory as an adjunct to
the examination of candidates for life insurance.
I believe I can best illustrate our subject, “Life
Insurance and Medical Research,” by reviewing
some of the activities of the diagnostic laboratory
over the past two decades, for in this way we can
review specific problems rather than discuss gen-
eralities.
Very soon after we began employment of the
x-ray and electrocardiograph on a fairly broad
Presented at the Minnesota Society of Internal Medicine,
Saint Paul, October 13, 1949.
Dr. Ungerleider is Medical Director of the Equitable Life
Assurance Society of the United States.
scale, it became evident that precision apparatus
does not necessarily supply precise information.
This fallacy, unfortunately, still holds consider-
able sway in the domain of clinical medicine. The
range of normal variation in almost all facets of
the cardiovascular examination is very consider-
able. It became necessary to define standards of
normality so that there would be a basis of refer-
ence in evaluating particular findings. Data de-
rived from the study of patients in hospitals or
private practice have obvious deficiencies in this
respect. Observation of large 'groups of normal
individuals studied in connection with applica-
tions for life insurance, on the other hand, pro-
vides an ideal opportunity to establish normal
standards. Important contributions in such ques-
tions as standards of body build and blood pres-
sure have been made through the co-operative
efforts of the various insurance companies, under
the Joint Committee of the Association of Life
Insurance Medical Directors and Actuarial So-
ciety of America.
We first addressed our attention to the problem
of heart size. It has long been an aphorism in
cardiology that an enlarged heart is a diseased
heart, but standards of heart size in the teleo-
roentgenogram were lacking until Dr. Charles
Clark and ll, in 1938, undertook a study of 1,460
individuals to establish standards for the trans-
verse diameter of the heart based on weight and
height.24 In a subsequent study, standards were
presented for the area of the frontal cardiac sil-
houette derived simply on a nomogram chart from
measurement of the long and broad cardiac diam-
eter.25 On the same nomogram chart were like-
January, 1950
25
LIFE INSURANCE AND MEDICAL RESEARCH— UNGERLEIDER
wise presented the predicted transverse diameter
of the heart and transverse diameter of the aortic
arch silhouette, based on the Sheridan Index,19
the utility of which we confirmed in a study of
several (hundred cases.25 Employment of this
nomogram chart makes possible the accurate de-
tection of cardiac enlargement and aortic abnor-
mality in very simple fashion. Measurements of
the transverse diameter and of the frontal cardiac
area up to 10 per cent above that predicted for
weight and height are 'within allowable normal
limits, but measurements exceeding this limit may
be considered to indicate cardiac enlargement,
since the distribution curve of normal values
shows only a very Ismail percentage or normal
measurements above this range. Several clinical
studies, such as those of Comeau and White,3
Kurtz,18 Gomez,6 and pathological correlations
by Sherman and Ducey,22 have confirmed the
value of these simple measurements of heart size,
and these standards have achieved widespread
application in clinical medicine as well as in the
field of insurance. By way of illustrating the
prognostic importance of cardiac enlargement, it
may be mentioned that in subjects with an apical
systolic murmur, the mortality among those with
moderate cardiac hypertrophy is fully twice that
of subjects whose hearts are not enlarged. The
importance of recognizing cardiac enlargement is
therefore clearly evident.
In hypertension, the presence of cardiac hyper-
trophy likewise is an extremely important prog-
nostic consideration.26 Serious complications,
such as cardiac enlargement and decompensation,
and arteriosclerotic changes in the coronary and
cerebral vessels, are related more to the duration
than to the degree of elevation of the blood pres-
sure.4 The presence of left ventricular hyper-
trophy provides a clue to the existence of ele-
vated blood pressure of some duration. X-ray
methods are not too satisfactory for the detec-
tion of early left ventricular hypertrophy, for
hypertrophy, as such, is a matter of increase in
thickness of the left ventricular myocardium of
a few millimeters, and this change cannot be de-
tected by any roentgenologic method. Accord-
ingly, we undertook a study some years ago on
a large group of subject studied in our diagnostic
laboratory to establish specific electrocardio-
graphic criteria of left ventricular hypertrophy
and to compare the sensitivity of electrocardio-
graphic versus x-ray methods in the detection
of hypertrophy.15 Briefly, we found the follow-
ing to provide a good index of left ventricular
hypertrophy :
1. An increase in voltage of the QRS complex best
expressed as a sum of the R wave in lead I and the S
wave in lead III. An amplitude of R1 plus S3 of 25
mm. or more is abnormal since 99 per cent of normal
individuals with left axis deviation fall within this range.
R1 exceeding 15 mm. is similarly indicative of left
ventricular hypertrophy even in the absence of left axis
deviation. This increase in voltage as the earliest sign
of left ventricular hypertrophy.
2. Depression of the ST segment in lead I of any
perceptible degree even as slight as one-half millimeter.
3. T wave changes in lead I.
Employing these criteria, it was found that the
electrocardiogram provides the most sensitive in-
dex of left ventricular hypertrophy, more so than
any roentgenologic method. In a mortality study
carried out on 424 insurance applicants with
hypertension, we found that in subjects with
identical blood pressure readings, the mortality
rate was twice as high when the electrocardio-
graphic pattern of left ventricular hypertrophy
was present as when the electrocardiogram was
normal.5 This study indicates that the stage of
hypertensive disease, as determined by electro-
cardiographic evidence of left ventricular hyper-
trophy, is an important consideration in the eval-
uation of life expectancy. It is our practice to
take electrocardiograms and teleoroentgenograms
of the chest routinely when hypertension is pres-
ent in candidates for life insurance. These pro-
cedures have helped greatly in appraising the se-
lection of subjects with hypertension, and have
made possible a more liberal policy in subjects
with no evidence of cardiovascular disease, as
well as helping to exclude unfavorable risks.
Numerous other factors have important bearing
on prognosis and life expectancy in hypertension,
as we have discussed elsewhere. Particularly may
be mentioned the rather benign course of hyper-
tension in women as compared to men, which
accords well with clinical experience.
Analysis of the extensive material available in
our diagnostic laboratory has helped to establish
criteria in evaluating two other frequent and im-
portant electrocardiographic abnormalities, i.e.,
extra systoles which are the most frequent of
all arrhythmias, and the Q3 deflection.
26
Minnesota Medicine
LIFE INSURANCE AND MEDICAL RESEARCH— UNGERLEIDER
In a study of 1,142 cases of extra systoles, sev-
eral abormalities were found preponderantly in
cases of organic heart disease.27 Among these
were: (1) the occurrence of premature beats of
multi-focal origin ; (2) frequent and persistent
premature beats, particularly if they occur suc-
cessively in short runs interrupting the regular
rhythm; (3) a definite increase in the number,
or a shower of extra systoles immediately follow-
ing exercise; (4) occurrence of premature con-
tractions and presence of a rapid heart beat; (5)
inversion of the T wave in the regular beat which
follows the extra systoles; (6) postextrasystolic
pulsus alternans. In fully 58 per cent of subjects
with premature beats, no objective evidence of
heart disease whatsoever was found. The mere
presence of extra systoles, therefore, is not to be
regarded adversely, unless further examination
discloses evidence of organic heart disease. How-
ever, since arrhythmias are frequently a clue to
the presence of organic heart disease, it is good
insurance medicine just as it is good clinical medi-
cine to carry out a complete cardiovascular survey
when an irregularity of a heart beat is detected
on physical examination.
Few problems are more vexing to the cardi-
ologist than the expression of a definite opinion
of the significance of a 03 deflection in the elec-
trocardiogram in the absence of other signs of
heart disease. A 03 deflection may be the only
residue of previous coronary occlusion, or may
occur in perfectly normal individuals with trans-
versely placed hearts ; and in insurance selection
particularly it is essential to make a clear-cut
distinction if possible between these two groups.
In a comparative analysis of two large groups,
the first normal individuals with a 03, and the
second comprised of individuals on disability due
to previous posterior wall infarction, certain signs
were found to be helpful in distinguishing the
normal from the pathological G3.20 Any of the
following electrocardiographic changes in con-
junction with a Q3 denotes it to be of abnormal
origin :
1. Absence of the S wave in lead I.
2. The presence of a Q wave in lead II exceeding one
millimeter.
3. Flattening of the T wave in lead II below 1 mm.
in amplitude.
4. Large amplitude of the Q wave in lead III where
the Q wave exceeds 75 per cent of the amplitude of the
tallest R wave in the limb lead.
5. A wide Q wave in lead III of at least 0.04 sec-
onds in duration.
6. Deep inversion of the T wave in lead III ex-
ceeding 2.5 mm.
7. The presence of a sizable Q3 in individuals less
than 5 per cent overweight.
The advent of unipolar limb leads has helped
further in clarifying the significance of the Q3
deflection, a Q wave in the unipolar left leg lead
indicating that the Q3 is abnormal. Recently, we
have found that the presence of a Q wave in
a unipolar lead taken over the left lumbar area
posteriorly is even more sensitive than the uni-
polar left leg lead.
Another diagnostic procedure which has helped
us greatly in insurance selection has been the
roentgenkymogram, which records the pulsations
of the heart and great vessels graphically on a
single film. Roentgenkymograms are taken on
all individuals studied in our laboratory above the
age of forty. Abnormal pulsations along the
left ventricular contour, of which the most sig-
nificant is a reversal of pulsation or systolic
expansion, occur in the majority of cases with
previous attacks of coronary occlusion, and such
changes in pulsation frequently are permanent.13
On numerous occasions, we have found such ab-
normalities in the roentgenkymogram to provide
the only clue to previous infarction, where the
electrocardiogram was perfectly normal.
I have entered into a discussion of these diag-
nostic techniques at some length in order to de-
lineate their sphere of usefulness in insurance
selection. It has been necessary for us to estab-
lish specific criteria in the evaluation of these
various signs. Clinical studies deal, by and large,
with the grossly abnormal, whereas in insurance
selection, lone is confronted constantly with the
normal and borderline, and this type of material
lends itself very well to establishing standards of
normality and abnormality. Apart from clinical
applications, to which we shall 'presently refer,
such research has shown its value abundantly in
the field of insurance medicine. The more exact
application of the various diagnostic procedures
in 'cardiovascular disease has placed insurance
selection on a much sounder scientific basis, mak-
ing possible more equitable action, both to the
insurance company and to the insured.
It is an important function of those engaged
in insurance medicine to remain constantly
January, 1950
27
LIFE INSURANCE AND MEDICAL RESEARCH— UNGERLEIDER
abreast of advances in clinical medicine. By way
of example may be cited the recent simplification
of ballistocardiography by Dock, which promises
to make this method a routine part of examina-
tion of the heart in clinical cardiology. In our
brief experience with one of these instruments
loaned to us by Dr. Dock, we have been much
impressed by its potentialities. Almost the first
case in which we employed it was one with a
classic history of angina pectoris where examina-
tion otherwise, including an exercise electrocar-
diogram test of coronary insufficiency, was en-
tirely negative. The ballistocardiogram shows
a marked respiratory variation in wave form
which has been described in cases of coronary
artery disease by Starr23 and more recently by
Brown.2 There appears to be no doubt that
ballistocardiography is by far the most sensitive
method for recording the mechanical activity of
the heart. Considerable study remains to be done
to establish normal standards in various age
groups and proper technique for recording the
ballistocardiogram. Here, too, with its large
source of material in various age groups, insur-
ance medicine can make a substantial contribu-
tion of value, not only in its own field but in
clinical application as well. The determination of
various biological standards is an important con-
tribution by insurance medicine to the field of
clinical medicine. The annual proceedings of the
Association of Life Insurance Medical Direc-
tors of America are replete with contributions
by the Medical Departments of the various Amer-
ican life insurance companies in such fields as
glucose tolerance, blood pressure, heart murmurs,
in addition to studies such as We have described
in detail.
Research in insurance medicine cannot be car-
ried out profitably within an ivory tower of statis-
tics. Like other types of research, it must have
free access to the various modalities of investi-
gation. Dealing so closely with problems of a
clinical nature, a close liaison particularly is nec-
sary with clinical material. Many of our studies
have been carried out through the kindness of
Dr. William Dock, Professor of Medicine at the
Long Island College of Medicine in its Kings
County Hospital Division, where there is ample
material for clinical study. A full-time Fellow
in Medicine is maintained by the Equitable in the
Department of Medicine of the Long Island
College of Medicine to assist in problems under
clinical investigation.
Several studies undertaken to resolve problems
in insurance medicine have led us inevitably into
the domain of clinical medicine. Thus, recogni-
tion of the inadequacy of casual blood pressure
readings in life insurance examinations among
subjects with elevated blood pressure led to the
evolution of very simple pressor and depressor
tests. The breath-holding test originally de-
scribed by Ayman,1 and the hyperventilation plus
carotid sinus pressure test, both of which we
have described in detail elsewhere,7 were found to
correspond very closely with the cold pressor
and the sodium amytal depressor tests, respec-
tively. Employment of these very simple pro-
cedures makes it possible to determine the ceiling
and basal levels of blood pressure within a very
few minutes, and lends itself very well to rou-
tine office use in clinical practice in studying
subjects with hypertension. Another pertinent
illustration was an analysis of several thousand
arterial sphygmograms recorded in our diagnostic
laboratory which led to a study of the mechan-
ism of pulsus alternans.8 In the fields of electro-
cardiography and roentgenology of the heart, we
have found constantly that our activities have ex-
tended into the clinical sphere. We have sum-
marized our various observations on these sub-
jects in the section on roentgenology of the heart
in Myers and McKinlay’s book21 and in an article
entitled "Newer Aspects of Clinical Electrocar-
diography” which appeared last year in the New
York State Journal of Medicine .9
As we have already mentioned, research fre-
quently extends beyond the horizons within which
it is originally conceived. While our own scope
of activities has been primarily concerned with
questions of prognosis and diagnosis, which re-
late naturally to clinical problems, our work has
carried us into investigations of cardiac physi-
ology, and into therapy as well. Thus, employing
the technique of roentgenkymography, to which
we have already referred, simultaneously with
diodrast contrast visualization of the heart cham-
bers, we have been enabled to make observations
on the dynamics of the interventricular septum.10
We have shown that far from being a passive
partition between the two ventricles, the inter-
ventricular septum plays a very significant dy-
namic role as an integral part of the left ventricle
28
Minnesota Medicine
LIFE INSURANCE AND MEDICAL RESEARCH— UNGERLEIDER
in systolic ejection. In another physiololgical
study, the principle of specific dynamic action was
applied as a means of augmenting peripheral blood
flow.11 Glycine was used to augment heat pro-
duction in the liver which was dissipated by an
increase in blood flow to the extremities. These
observations have been confirmed recently by
Gustafson and his colleagues of the University
of Michigan18 who have indicated from 'exten-
sive and extended experience with this simple
amino acid that it is “a definite adjunct to the
conservative treatment of peripheral vascular in-
sufficiency.”
Some of our studies have been directly in the
field of therapy. For some time, we have been
engaged in a project on the chemotherapy of
tuberculosis. A new sulfone compound synthe-
sized in our chemical laboratory has shown con-
siderable promise in in vitro studies, and in ex-
perimental mouse tuberculosis experiments car-
ried out in collaboration with Dr. Rene Dubos
at the Rockefeller Institute for Medical Re-
search.12 More recently, in another series of
tests, this work has been confirmed both in the
mouse and in hamsters, and the drug was found
to possess antituberculosis activity approximately
twice that of para-aminosalicylic acid, and to be
completely lacking in toxicity, both in acute and
chronic toxicity studies. A study of its efficacy
in man is now being undertaken.
Currently, we are actively engaged in studies
on various aspects of arteriosclerosis. Some of
you may be acquainted with our survey of ar-
teriosclerosis which appeared in the American
Journal of Medicine some months ago.14 In a
study we recently carried out on the significance
of blood cholesterol, it was found that signifi-
cantly less arteriosclerosis occurred in the sub-
jects with a low level of blood cholesterol com-
pared to those with so-called normal levels of cho-
lesterol and with hypercholesterolemia.28 These
observations suggest that the so-called normal
cholesterol is, in reality, a high cholesterol, and
that the cholesterol level of the average American
population is of such an order as to predispose
to the development of arteriosclerosis. One of
the difficulties in cholesterol studies has been ob-
viated by the introduction by Kendall and his
colleagues of a highly accurate method for deter-
mining its concentration in the serum,17 a tech-
nique we are now employing in our laboratory.
The prevention of arteriosclerosis is beyond ques-
tion the Number 1 public health problem in the
United States today. It will be of immense im-
portance to establish whether, as our preliminary
studies suggest, low levels of blood cholesterol
confer protection against the development of ar-
teriosclerosis, and if this is so, to find simple
and effective means to maintain a low level of
blood cholesterol.
I have tried to illustrate the subject of this
talk on Life Insurance and Medical Research,
by a description of our own research program
at the Equitable Life Assurance Society of the
United States, rather than to deal with this sub-
ject in generalities. In our own activities, we
have had occasion to exploit the statistical mate-
rial which is uniquely available to life insur-
ance organizations, employing in our various
studies data on ordinary life insurance and mor-
tality experience, subjects receiving disability
benefits, and our large group insurance coverage
embracing large segments of the population in
various industries. In addition, we have con-
stantly utilized the facilities of our own diagnos-
tic laboratory and chemical laboratory. During
the war, our diagnostic laboratory served as a
cardiac consultation station for the Naval Re-
cruiting Bureau.29 In other studies, we have em-
ployed the facilities of our hospital which pro-
vides medical service to our several thousand
personnel. It has been our good fortune to main-
tain a close clinical liaison in our research pro-
gram. Such varied facets of operation are very
necessary, for research cannot be confined profit-
ably within particular precincts, since it fre-
quently leads in unexpected directions.
It must be apparent that life insurance has a
very substantial interest in medical research and
progress, for beyond the specific problems of
insurance medicine, improvement in the health
and longevity of the population is of vital con-
cern to insurance. The need for fostering re-
search has been recognized by the life insurance
companies of the United States in the creation,
in 1945, as a co-operative enterprise among the
various companies, of the Life Insurance Medical
Research Fund. This Fund makes available some
two-thirds of a million dollars annually for fun-
damental research in cardiovascular disease.
Under the guidance of a council composed of
outstanding figures in American medicine, its
January, 1950
29
LIFE INSURANCE AND MEDICAL RESEARCH— UNGERLEIDER
work already has proven most fruitful. Several
hundred publications have appeared regarding
work which was aided by the Fund, and up to
1948 Grants-in-Aid had been given to 165 re-
search programs and seventy-one Research Fel-
lowships had been awarded. It is expected that
this project will prove increasingly rewarding in
its objectives of stimulating research in funda-
mental aspects of rheumatic fever, hypertension,
arteriosclerosis and other cardiovascular dis-
orders. The Equitable as well as other insur-
ance companies has actively supported the pro-
grams of such organizations as the American
Fleart Association. As you can see, our Society
has had a program of research for many years.
The insurance companies should, and are, con-
tributing to the sum total of our medical knowl-
edge in an increasing degree. There is no doubt
in my mind that other companies are making
contributions similar to those outlined. Scientific
knowledge, from whatever source, should be wel-
comed by the medical profession. We in insur-
ance medicine feel that we are not apart from
those who are actively engaged in clinical medi-
cine. Our problems are the same, and although
our approach may be different, the common goal
we seek is the prolongation of human life.
Bibliography
1. Ayman, D. and Goldshine, A. D. : The breath-holding test:
A simple standard stimulus of blood pressure. Arch. Int.
Med., 63:899, 1939.
2. Brown, H. R., Jr., and de Lalla, V., Jr.: The diagnostic
significance of the respiratory variation in the ballistocardio-
graph. Proc. 40th Ann. Meeting, Am. Soc. Clin. Investig.,
May, 1948.
3. Comeau, W. J., and White, P. D.: A critical analysis of
standard methods of estimating heart size from roentgen
measurements. Am. J. Roentgenol., 47:665, 1942.
4. Daley, R. M., Ungerleider, H. E., and Gubner, R. : Prog-
nosis in hypertension, J.A.M.A., 121:383, 1943.
5. Daley, R. M., Ungerleider, H. E., and Gubner, R. : Prog-
nosis and insurability of hypertension with particular refer-
ence to the electrocardiogram. Trans. Assoc. Life Ins. Med.
Dir. America, 28:18, 1941.
6. Gomez, G. E. : Cardiac hypertrophy. J.A.M.A., 137:1297,
1948.
7. Gubner, R., Silverstone, F., and Ungerleider, H. E. : Range
of blood pressure in hypertension. J.A.M.A., 130:325, 1946.
8. Gubner, R., and Ungerleider, H. E. : The mechansim of
pulsus alternans. Presented at 2nd annual meeting, Am.
Fed. Clin. Research, Minneapolis, May, 1942.
9. Gubner, R., and Ungerleider, H. E. : Newer aspects of
clinical electrocardiography. New York State J. Med., 48:
2491, 1948.
10. Gubner, R., Ungerleider, H. E., and Hirshleifer, I.: Dy-
namics of the interventricular septum. Proc. 3rd Inter-
American Cardiological Congress. Am. Heart J., 37:637,
1949.
11. Gubner, R., Di Palma, J. R., and Moore, E. : Specific
dynamic action as a means of augmenting peripheral blood
How. Use of aminoacetic acid. Am. J. Med. Sci., 213:46,
1947.
12. Gubner. R., Dubos, R. J., Pierce, C., and Ungerleider, H.
E. : 4-CaproyIamino Diphenylsulfone, 4'-Aminomethylsul-
fonic acid sodium salt. Pharmacology and effect in experi-
mental tuberculosis. J. Clin. Invest., 27:538, 1948.
13. Gubner, R., Crawford, J. H., 'Smith, W. A., and LTnger-
leider, H. E. : Roentgenkymography of the heart. Am.
Heart J., 18:729, 1939.
14. Gubner, R., and Ungerleider, H. E. : Arteriosclerosis. A
statement of the problem. Am. J. Med., 6:60, 1949.
15. Gubner, R., and Ungerleider, H. E. : Electrocardiographic
criteria of left ventricular hypertrophy: Factors determining
the evolution of the electrocardiographic patterns in hyper-
trophy and bundle branch block. Arch. Int. Med., 72:196,
1943.
16. Gustafson, J. R., Campbell, K. N., Harris, B. M., and Mal-
ton, S. D. : The use of glycine in the treatment of peripheral
vascular disease. Surgery, 25:539, 1949.
17. Kendall, F., et al.: Demonstration of specificity of a sim-
plified method for the determination of total cholesterol.
Fed. Proc., 8:212, 1949.
18. Kurtz, C. M.: Book review. Am. Heart J., 26:573, 1943.
19. Sheridan, J. T. : The transverse diameter of the frontal
aortic arch silhouette. Trans. Assoc. Life Ins. Med. Dir.
America, 28:49, 1941.
20. Ungerleider, H. E., 'and Gubner, R.: The Q3 and QS3 de-
flections in the electrocardiogram: Criteria and significance.
Am. Heart J., 33:807, 1947.
21. Ungerleider, H. E., and Gubner, R. : Roentgenology of the
heart. Section in “The Chest and the Heart,” edited by
J. A. Myers and W. McKinlay. Springfield, Illinois: C. C
Thomas, 1948.
22. Sherman, C. F., and Ducey, E. F. : Cardiac mensuration.
Am. J. Roentgenol., 51:439, 1944.
23. Starr, I.: 'The ballistocardiograph. Harvey Lectures, 42:
194, 1947.
24. Ungerleider, H. E., and Clark, C. P. : A study of the
transverse diameter of the heart silhouette ‘with prediction
table based on the teleoroentgenogram. Am. Heart J., 17:
92, 1939.
25. LIngerleider, H. E., and Gubner, R. : Evaluation of heart
size measurements. Am. Heart J., 27:494, 1942.
26. Ungerleider, H. E., and Gubner, R.: The relation of heart
size to prognosis: Modern concepts of cardiovascular dis-
ease, 41 :3, 1943.
27. LIngerleider, H. E., and Gubner, R. : Extrasystoles and the
mechanism of palpitation. Trans. Am. Therapeutic Soc.,
42:169, 1942.
28. Ungerleider, H. E. ; Gubner, R., and Rodstein, M. : Inter-
relationships between cholesterol, arteriosclerosis, diabetes
and obesity. Proc. 22nd Scientific Session, American Heart
Association, June, 1949.
29. Ungerleider, H. E. ; Duhigg, T. F., and Gubner, R.: Ex-
amination of the heart in Navy applicants. U. S. Naval M.
Bull., 41:441, 1943.
LIVING CONDITIONS AND TUBERCULOSIS
The public welfare officer has long known that
tuberculosis differs from other diseases affecting his
clients because of the problem created in the patient’s
family even after the patient is out of the home. The
worse the living conditions, the greater is the danger of
infection, and the public welfare officer’s clients are
frequently those representing the worst living conditions
in the community. The health officer and his nurses
will watch the contact cases. It is their responsibility
to see that regular and thorough examinations are
given and that such families are trained in health
education. These are the families that should have
good housing, more adequate food than families in
which there has been no tuberculosis, and no serious
overwork or overstrain. Here the public welfare officer
has a traditional opportunity. No one can assure good
housing to any needy family today, tuberculous or
nontuberculous, but the goal of decent housing should
never be lost sight of, and it should be attained for the
families of the tuberculous whenever possible. Ade-
quate food can be supplied, and with sufficient economic
security the members of the family should be saved
from serious overwork. Ruth Taylor, Nat. Tuberc. A.
Bull., Oct., 1949.
30
Minnesota Medicine
AN APPRAISAL OF MAJOR SURGERY IN A SMALL HOSPITAL
DAVID P. ANDERSON, M.D.. F.A.C.S.
Austin, Minnesota
A REVIEW of 1000 consecutive major sur-
gical operations, performed by the author
and his colleagues of the Austin Clinic in the St.
Olaf Hospital, Austin, Minnesota, has been under-
taken as a background for the appraisal of general
surgery in a small, non-metropolitan hospital. It
is felt that such an appraisal is timely for several
reasons :
1. It should be of interest to other physicians
who practice surgery, either part time or as a spe-
cialty, in small communities.
2. It offers factual evidence to challenge the
public claims of politicians who would have us be-
lieve that medical practice in predominantly rural
areas, such as ours, is universally substandard.
3. It may be useful in re-evaluating training
programs for general surgeons, to ascertain
whether or not such surgeons are being adequatelv
trained to cope with all the problems of general
surgery, including traumatic surgery and the sur-
gical subspecialties, as they are necessarily en-
countered in hospitals in non-metropolitan areas.
A complete classification of the 1000 operations
in this survey is given in Table I. The selection
of operations for classification as “major” pro-
cedures has been entirely arbitrary. Multiple-
stage operations have been listed only once, and
combined operations have been listed only under
the title of the primary procedure.
There were twenty-one hospital deaths in this
series. This operative mortality of 2.1 per cent
compares favorably with reports from other gen-
eral hospitals4 and is an improvement over the
mortality rate of 3.9 per cent in 785 cases reported
by the author in 1942. 1 A detailed analysis of the
deaths in this series is given in Table II. There
were no deaths attributable directly to the anes-
thetic. In two patients, technical operative factors
were directly or indirectly responsible for the
deaths : in one case there was partial obstruction,
although no leakage, at the site of an end-to-end
anastomosis of the ileum ; and in another case a
fairly large common-duct stone was inadvertently
overlooked in performing a choledochostomy on a
critically ill patient. Surgical shock was listed as
Presented at the annual meeting of the Southern Minnesota
Medical Association, Red Wing, Minnesota, September 12, 1949.
TABLE I. ONE THOUSAND CONSECUTIVE MAJOR
SURGICAL OPERATIONS IN A SMALL NON-
METROPOLITAN HOSPITAL
Number of
Operation Operations
Head-N eck-Faciomaxillary Surgery
Craniotomy (Subdural hematoma, extradural
hematoma and depressed skull fractures) 4
Thyroidectomy 14
Breast and Chest Surgery
Mastectomy, radical 17
Thoracotomy (Lung abscess and empyema) 5
Subdiaphragmatic abscess, I & D of 1
Lobectomy, pulmonary 1
Gastrointestinal and General Abdominal Surgery
Gastric resection 15
Pyloroplasty 11
Gastroenterostomy 3
Perforated' peptic ulcer, closure of 2
Intestinal resection, large and small bowel 21
Cecostomy . . . . 1
Colostomy 8
Rectal perforation, closure of 1
Appendectomy (including perforative appendicitis) 267
Appendectomy and Meckel’s diverticulectomy 5
Appendectomy and excision of urachus 2
Appendiceal abscess, drainage of 7
Abdominal exploration 6
Intestinal obstruction, simple, release of 6
Herniorrhaphy, elective 162
Herniorrhaphy, strangulated 15
Herniorrhaphy, strangulated, with bowel resection.... 2
Splenectomy 4
Fixation of recurrent prolapsed rectum 1
Duodenal diverticulectomy 1
Intussusception and Meckel’s diverticulectomy 1
Biliary Tract and Liver Surgery
Liver, closure of traumatic rupture of 3
Cholecystostomy 4
Cholecystectomy 90
Cholecystectomy and choledochostomy 30
Choledochostomy 6
Choledocho-duodenostomy 1
Gynecological Surgery
Myomectomy 1
Perforated uterus, closure of 1
Hysterectomy, abdominal 57
Hysterectomy, vaginal 25
Perineorrhaphy and cystocele repair 36
Salpingectomy, salpingo-oophorectomy and oophorectomy 46
Uterine suspension 13
Cesarean section 17
Vulvectomy, radical 3
G enito- U rinary Su rgery
Nephrectomy and nephroureterectomy 2
Plastic operation, kidney pelvis 2
Uretero- and pyelolithotomy 2
Uretero-vesical anastomosis 1
Cystectomy 1
Penectomy, radical 1
Orthopedic and Traumatic Surgery
Open reduction, major fractures 68
Amputations, major 5
Bone grafts, major 2
Total 1000
the primary cause of death in three patients. In
each instance the age of the patient, the nature of
his illness, or his cardiovascular status prior to
operation influenced the unfavorable postoperative
course, and in no case was the use of whole blood
transfusions or other supportive therapy neglect-
ed. Pulmonary embolism, proven or strongly sus-
pected in four patients who died, and present as a
serious nonfatal postoperative complication in
three other patients, has been one of our greatest
January, 1950
31
MAJOR SURGERY IN A SMALL HOSPITAL— ANDERSON
worries. Early ambulation — and that means the
day of or the day following operation — has not
greatly influenced the incidence of this compliea-
No specific sociological survey has been made
of this group, although such a study might prove
interesting, but it is known that many of these
TABLE II. OPERATIVE DEATHS IN 1000 CONSECUTIVE MAJOR OPERATIONS
Patient
Operative Diagnosis
Operation
Primary Cause of Death
Interval
Age
A.F. 08
Fracture neck of femur
Internal fixation
Pulmonary embolus
15 days
A.M. 86
Fracture neck of femur
Internal fixation
Coronary occlusion
22 days
C.B.66
Fracture neck of femur
Internal fixation
Bronchopneumonia and
Parkinson’s Disease
8 days
B.C. 65
Fracture neck of femur
Internal fixation
Arteriosclerotic Parkinsonism
2 months
L.U. 89
Intertrochanteric fracture
of femur
Open reduction
Shock
6 hours
L.R.79
Intertrochanteric fracture
of femur
Open reduction
Cerebral thrombosis
5 days
J.S. 58
Carcinoma of stomach
Exploration
Carcinomatosis
23 days
C.K. 55
Carcinoma of stomach
-acute perforation
Gastric resection
Shock-aspiration of vomitus
6 hours
G.H. 63
Carcinoma of stomach
-acute perforation
Gastric resection
♦Pulmonary embolus
12 days
O.L. 75
Carcinoma of stomach
Gastric resection
Acute auricular
fibrillation-shock
18 hours
L.J. 32
Chronic duodenal ulcer with
massive hemorrhage
Gastric resection and
common duct obstruction
choledochostomv
♦Pulmonary embolus
10 days
A.K. 42
Cholelithiasis
Cholecystectomy
Pulmonary embolus
8 days
J.W. 60
Cholelithiasis-common duct
C holecystec tomy
Suppurative cholangitis
calculus
-choledochostomy
secondary to residual
common duct calculus
6 weeks
G.N. 83
Acute cholecystitis with
perforation-common duct
Cholecystectomy
calculus
-choledochostomv
Bronchopneumonia
27 days
A.M. 49
Chronic portal cirrhosis
Exploration
Esophageal hemorrhage
6 days
L.F. 67
Ulcerated duodenal diverti-
culum with massive
hemorrhage
Diverticulectomy
Shock-? acute cardiac failure
1 hour
J.M 62
Strangulated hernia-gangrene
and perforation of bowel
Small bowel resection
Peritonitis
2 days
E.W.6C
Acute intestinal obstruction
Small bowel resection
♦Mesenteric thrombosis
-gangrene of ileum
-partial obstruction
at anastamosis
14 days
J.G. 78
Incarcerated hernia
Herniorrhaphy
Bronchopneumonia and
Parkinson’s Disease
10 days
P.G. 75
Carcinoma of sigmoid
-complete obstruction
Cecostoiny
♦Carcinomatosis
6 days
L A. 73
Arteriosclerotic gangrene
Second low-thigh
?Pulmonarv embolus
bilateral, ? embolic
amputation
auricular fibrillation
in OR
indicates autopsy.
tion for us. Recently we have instituted the rou-
tine use of dicumarol therapy postoperatively in
all major surgical cases except those where the
nature of the procedure is contraindicative.
Surgery in the Aged
A special survey has been made of the seventy-
eight major operations performed on the patients
seventy years of age and over in this series. This
survey is presented in Table III. There were eight
hospital deaths in this group, or a mortality rate of
10.3 per cent. As is to be expected, cardiovascu-
lar complications were the primary cause of death
in the majority of the eight elderly patients who
did not survive operation.
Major operations must frequently be undertak-
en in aged patients in spite of the increased risks
in the older age group. We believe that such pa-
tients should be treated in their home commu-
nities, whenever possible, as elderly individuals do
not adjust well to environmental changes and of-
ten do not tolerate or cannot be persuaded to ac-
cept transfer to distant medical centers.
elderly patients have been restored to comfortable
and useful activity. Very few are dependent,
socially useless wards of the state. One man, now
seventy-nine years of age, who has had two bowel
resections for intestinal obstruction during the
past ten years, is active in business and apparent-
ly more prosperous than ever before in his career.
A woman, now approaching ninety years of age,
who fortunately is financially independent, is also
physically independent, active, and free of pain
one year after an internal fixation of a fracture
of the neck of the femur. When last examined
one year after a subtotal gastrectomy for an early
carcinoma of the pylorus, a woman of eighty-six
years was doing her own housework and com-
plaining only of minimal lumbar arthritic pains
which were aggravated by working in her garden !
Several survivors in this group are farmers who
still actively participate in the management of
their farms. Even a few such recoveries — and
the cases cited above are not isolated examples —
justify a conscientious effort on the part of the
32
Minnesota Medicine
MAJOR SURGERY IN A SMALL HOSPITAL— ANDERSON
surgeon to prolong life and make it more pleas- pendicitis, exclusive of incidental appendectomies
ant for those patients who have outlived their al- performed during the course of other operations,
lotted three-score years and ten. There have now been 503 consecutive operations
TABLE III. SURGERY IN THE AGED
Operative Procedure
Number of Cases and Deaths
by Age Groups
Total
Ages 70-80
Ages 80-90
Over 90
Appendectomv, perforated appendix
2
1
0
3
Amputation, low thigh
2(1)
0
0
2(1)
Cecostomy
1(1)
0
0
HD
Cholecystectomy
4
0
0
4
Cholecystectomv-choledochostomy
2
1(1)
0
3(1) ,
Choledochojejunostomy
1
0
0
1
Cvstectomy and ureterectomy, partial
0
1
0
1
Colon resection
2
1
0
3
Exploratory, abdominal
1
0
0
1
Fracture, femur, internal fixation
9(1)
9(2)
1
19(3)
Fracture, tibia, open reduction
1
0
0
1
Gastric resection
2(1)
1
0
3(1)
Gastroenterostomy
2
0
0
2
Herniorrhaphy, elective
9
0
0
9
Herniorrhaphy, strangulated
5(1)
0
1
6(1)
Herniorrhaphy, with bowel resection
0
1
0
1
Intestinal obstruction, release of
1
0
0
1
Intestinal obstruction, with resection
1
0
0
1
Mastectomy, radical
3
1
0
4
Nephrectomy
1
0
0
1
Ovarian carcinoma, excision of
1
0
0
1
Penectomy, radical
1
0
0
1
Vaginal hysterectomy and plastic
9
0
0
9
Totals
60(5)
16(3)
2
78(8)
Note: Hospital deaths are denoted by ( ).
Mortality rate — 10.3 %.
Pediatric Surgery
An analysis of the major surgery among the
infants and children under twelve years of age in
this series is presented in Table IV. There were
no operative deaths in this group of 134 patients.
It is interesting to note that fifty-one of these
children were from strictly rural areas. The ex-
cellent preoperative diagnosis and care of these
children by the referring general practitioner is
largely responsible for the favorable operative rec-
ord in this group.
Ladd and Gross2 have demonstrated that partic-
ular care is required in the surgical management
of the infant and small child. The general sur-
geon who must operate upon these tiny patients
should make every effort to prepare himself spe-
cifically for the task. A certain temperamental,
as well as a technical, readjustment must be made
in the change from adult to pediatric surgery, and
more careful attention must be given to altered
physiology.
Surgery in Appendicitis
A consideration of some of the various oper-
ations and specific surgical diseases covered by
this survey is of interest. The most common dis-
ease requiring surgical treatment is appendicitis.
In this series, there were 281 operations for ap-
TABLE IV. SURGERY IN INFANTS AND CHILDREN
Appendectomy, simple 59
Appendectomy and Meckel’s diverticulectomy 2
Appendectomy and excision of urachus 1
Appendectomy, perforative appendicitis 10
Duodenojejunostomy (congenital atresia) 1
Decompression, acute subdural hematoma 1
Fracture, skull, depressed, elevation of 2
Fracture, long bones, open reduction of 4
Herniorrhaphy, elective 32
Herniorrhaphy, incarcerated or strangulated 5
Intussusception and Meckel’s diverticulectomy 1
Liver, suture of traumatic laceration 3
Pyloroplasty, congenital pyloric stenosis 11
Splenectomy 1
LTretero-pelvic stricture, plastic repair of 1
Total : 134
for appendicitis, including all stages of this dis-
ease, performed during the time that the author
has been the surgeon for the Austin Clinic. There
have been no deaths in this series of 503 oper-
ations.
A discussion of the surgical management of
appendicitis is not within the scope of this paper,
but a few brief comments may be in order.
1. We do not practice the policy of “when in
doubt, operate.” There is no question of the fact
that acute appendicitis should be treated by early
operation, but this does not license the surgeon
to operate indiscriminately on all patients with
right lower abdominal pain. The majority of
cases of acute appendicitis can be accurately diag-
January, 1950
33
MAJOR SURGERY IN A SMALL HOSPITAL— ANDERSON
nosed preoperatively. In doubtful cases, re-ex-
amination after the administration of a small dose
of morphine may aid in the diagnosis. In other
cases, we have not hesitated to observe the patient
under hospital management and supportive ther-
apy for periods up to twenty-four hours. We
must frankly admit that operation has thus been
delayed in a few cases of acute appendicitis, al-
though without any apparent ill-effects, and that
an occasional patient with a mild acute appen-
dicitis has recovered without the benefits of oper-
ation. However, this policy has saved us the em-
barrassment on many occasions of performing an
unnecessary or even a harmful operation.
2. In the presence of local or general perito-
nitis of appendiceal origin, it has been our policy
to perform an appendectomy and drain the peri-
toneal cavity with a soft Penrose drain. An excep-
tion is made in those cases where a large, localized
appendiceal abscess is present when the patient is
first examined. Under such circumstances, the ab-
scess is drained — preferably through the rectum
if it points in the pelvis — and the patient is ad-
vised to have an elective appendectomy in three to
four weeks. We do not subscribe to the so-called
expectant treatment of perforative appendicitis,
although a few hours delay for the preoperative
preparation of a toxic or dehydrated patient is
usually advantageous.
Surgery of the Gall Bladder and Biliary Tract
Disease of the gall bladder and biliary tract is
of special interest to surgeons. In this series
there were 131 operations on the gall bladder and
bile ducts. The three deaths in these 131 oper-
ations give an operative mortality of 2.3 per cent
for surgery of the biliary tract. We consider this
mortality rate too high, and can justify it only by
a critical review of the three deaths, as reported
in Table II, and by the fact that the statistical
results in our biliary surgery prior to this series
have been much more favorable.
It will be noted that we have explored the com-
mon duct in 28 per cent of the operations on the
biliary tract. Definitely positive findings, chiefly
the presence of calculi, are encountered in about
half of the cases in which the common duct is ex-
plored. The frequency with which we explore
the common duct is fully justified by the fact
that many common-duct calculi are thereby detect-
ed which could have been easily overlooked. We
have so often discovered “silent” common-duct
stones — as many as forty-four within the duct
in one case — that we now fully appreciate the
stand that Lahey3 has taken for years in urging
that the common and hepatic ducts be explored
in up to 50 per cent of all gall-bladder operations.
The procedure itself, in the hands of an expe-
rienced surgeon, does not increase the mortality
and morbidity of biliary tract surgery, and adds
only a few days to the patient’s total recovery
period.
The Surgical Treatment of Hernia
Hernia is another affliction which is of never-
ending surgical interest. It is a common ailment,
which in this series was encountered in 1 78 of
1000 major operations. The fact that the recur-
rence rate after hernia operations remains high,
even in the hands of otherwise competent sur-
geons, is a particular challenge to the general sur-
geon in a small community to continually improve
his results. Large clinics can readily absorb the
embarrassment of an occasional recurrence after
herniorrhaphy, but the individual surgeon in a
small community must have a hernia recurrence
rate which approaches nil, an accomplishment
which is more than theoretically possible.
We have found one procedure helpful in eval-
uating the technical efficiency of our hernia re-
pairs, a procedure which we have never seen de-
scribed in the surgical literature: Under local
anesthesia, which is our anesthetic of choice in
primary hernia repairs, the patient is instructed to
give a forceful cough during various stages of the
operation. The strength of the repair can thus
be demonstrated, and if stainless steel wire su-
tures are employed, one can be reasonably cer-
tain that the repair will remain firm until tis-
sue healing is complete. With this assurance of
a firm repair of the hernia, we have no misgiv-
ings in urging early ambulation in our cases. The
patient is allowed to walk to the bathroom at any
time after the operation, thus making postoper-
ative catheterization a rare necessity. The average
patient is discharged from the hospital on the
third to fifth postoperative day. Sedentary occu-
pations may be resumed in ten days, light work
in two to three weeks, and unlimited activity is
permitted after four weeks. We have had no
known recurrences in the herniorrhaphies report-
ed in this series.
34
Minnesota Medicine
MAJOR SURGERY IN A SMALL HOSPITAL— ANDERSON
Gastrointestinal Surgery
There are two aspects of gastrointestinal sur-
gery that we would like to mention briefly, al-
though with some hesitation.
1. We have adopted, during the past two years,
a modification of the non-operative treatment of
acute perforated peptic ulcer originally described
by British surgeons. Our experience has been
limited to ten cases thus far, so that we cannot
speak authoritatively nor can we urge others to
follow our example. However, we have been so
favorably impressed by the clinical course of these
patients that we are inclined to believe that this
method of treatment may prove superior to the
operative treatment, at least in selected cases. We
have had no deaths in our cases, and in each in-
cidence the recovery has been much smoother
than we would have anticipated with the oper-
ative method of treatment. One word of caution
should be injected : this non-operative treatment
is strictly a surgical problem, and it demands the
careful personal supervision of the surgeon.
2. In re-establishing continuity between seg-
ments of the intestinal tract, including the colon,
we have used a so-called “open” type of anas-
tomosis in all cases with good results. This
fact is mentioned because numerous reports from
various surgeons with wide experience advocate
so many different types of “closed” anastomoses
and multiple-stage operations that the general
surgeon with a limited volume of gastrointestinal
surgery is left in a quandary trying to decide
which technique to adopt. Again we cannot speak
with authority, because of our limited experience
in comparison with statistical reports from large
clinics, but we agree with those surgeons who con-
tend that sepsis and peritonitis usually result from
a technically poor suture line and not from the
minimal contamination that theoretically occurs
with an open anastomosis. We believe that the
average surgeon can perform a more secure anas-
tomosis, free from the danger of leakage, by
an “open” technique.
Gynecologic Surgery
Gynecological operations accounted for approx-
imately one in five of all major operations in this
surgery. This high incidence of gynecologic sur-
gical problems makes it essential that the general
surgeon who practices in a small community,
where specialists in gynecologic surgery are not
always available, be well trained in this subspe-
cialty. Training programs that omit such train-
ing for the general surgeon are to be condemned.
It also seems to us that the man who is trained as
a specialist in gynecologic surgery should have an
adequate background of general surgery, as the
arbitrary division of the abdomen of the female
at the brim of the pelvis is not always respected
by intra-abdominal disease processes.
There were no deaths in the 199 gynecological
operations in this series, and we now have a total
of 104 consecutive hysterectomies without a death.
Traumatic Surgery
The management of injuries is another aspect
of general surgery that demands our considera-
tion. In non-metropolitan areas, the general prac-
titioner and the general surgeon are responsible
for the treatment of injuries of all types. Auto-
mobile, farm and industrial accidents account for
our more serious injuries. These often tax the
skill of the surgeon to the utmost, and quite often
he finds himself becoming involved, of necessity,
in surgical problems that require a fundamental
knowledge of the various surgical subspecialties.
The treatment of compound fractures, primary
tendon and nerve suture, and the care of internal
visceral injuries are commonplace in a general
surgical practice in a small community. A great
variety of fractures of the long bones and crush-
ing fractures of the vertebrae are encountered.
Intracranial injuries are frequent problems, and
an occasional depressed skull fracture or a local-
ized intracranial hemorrhage will require the gen-
eral surgeon to perform an emergency cranial
operation. Since neurosurgeons, orthopedists and
other such specialists are not universally avail-
able, general surgeons must be trained who are
capable of administering skilled early definitive
treatment to injuries of all types.
Conclusion
A survey of 1000 consecutive major surgical
operations in a small non-metropolitan hospital
has been presented, and an appraisal made of the
various aspects of general surgery in a small com-
munity. Emphasis has been placed upon the ne-
cessity of maintaining training programs that will
adequately prepare surgeons for the broader scope
of general surgery as it is encountered in areas
away from metropolitan medical centers.
(References on Page 95)
January, 1950
35
MATERNAL AND INFANT MORTALITY STUDY IN A SMALL GENERAL HOSPITAL
ROBERT R. WRIGHT, M.S.. M.D.
Austin, Minnesota
TV/TEDICAL LITERATURE contains many
reports of maternal and infant mortality
studies. A large majority of the published studies
come from large hospitals and clinics in metropol-
itan areas. There is a dearth of published mate-
rial from the small general hospitals in the rural
areas of our country.
Concurrent with the trend toward socialization
of medical practice, maternal and infant care
comes into sharp focus. Published figures of
maternal and infant mortality are no longer the
sole property of medical literature, for they now
appear in our morning paper, in reports to the
President, and in the proceedings of our legisla-
tive bodies.
A personal interest in determining the quality
of obstetrical, infant, and premature infant care
provided by private practicing physicians in a
small general hospital provided the stimulus for
this study. A comparison with published results
from other hospitals in representative sections of
our country is included.
This study is based on the hospital records of
2,519 consecutive deliveries in the St. Olaf Hos-
pital, Austin, Minnesota, during the years 1946,
1947, and 1948. This general hospital serves the
city of Austin, with a population of about 30,000,
and a large surrounding rural area, making a total
population of about 50,000. The population is al-
most entirely white. The hospital has a bed ca-
pacity of 105 with twenty-five bassinets. The
average adult occupancy for the three-year period
of this study was 76 per cent.
The hospital is staffed by thirty-three physi-
cians, twenty-one of whom practice obstetrics.
During the years studied, all of the work was
done by general practitioners. There are no in-
terns or residents in the hospital, and prior to
January 1, 1949, there was no obstetrical specialist
on the staff.
In this group of 2,519 deliveries there was one
maternal death, a mortality rate of 0.039 per cent
(Table I). This maternal mortality figure com-
pares most favorably with other published figures.
Newberger,5 in an analysis of maternal mortality
Presented at the annual meeting of the Southern Minnesota
Medical Association, Red Wing. Minnesota, September 12, 1949.
TABLE I. MATERNAL AND INFANT MORTALITY
Total
Maternal
Maternal
Source
Deliveries
Deaths
Mortality
St. Olaf Hospital
1946-1948
2,519
1
0.039%
U. S. Dept, of Labor
Newberger, Illinois State
0.306%
Statistics, 1943
Connor (Wenatchee,
0.27 %
Washington. 1944-1946)
2,500
0.20 %
TABLE II. STILLBORN INFANT MORTALITY
Hospital
Total No.
Live Births
No.
Stillbirths
Rate/ 1000
Live Births
St. Olaf Hospital
1946-1948
2490
40
16.06
Philadelphia Lying- In
1009
25
24.8
Gaston Hospital, Memphis
355
20
56.3
in the state of Illinois during 1943, found a mor-
tality rate of 0.27 per cent. The Department of
Labor,7 in a survey of the United States for the
year 1940, found a maternal mortality of 0.376
per cent. Connor,1 in a comparable study, reports
a mortality of 0.20 per cent among mothers de-
livered in two small general hospitals in the state
of Washington.
The cause of death in the one fatality in the
St. Olaf Hospital study was acute yellow atrophy
of the liver. It is an interesting and significant
commentary that there were no deaths nor serious
complications due to puerperal sepsis or toxemia
in the three years studied. This, considered with
the very low maternal mortality figure, speaks fa-
vorably for the obstetrical care afforded the pa-
tient by the general practitioner in the small gen-
eral hospital in this rural area.
The infant mortality rate in this study was
found to be favorable in comparison with other
reports. There was a total of forty stillborn in-
fants in the three-year study, with a stillborn in-
fant mortality rate of 16.06 per 1000 live births
(Table II). Hingson et al3 report a stillborn in-
fant mortality rate of 24.8 per 1000 live births.
Connor reports a stillborn mortality rate of 1.12
per cent, but uses his figures in relation to total
babies born, instead of in relation to live births, as
is the customary procedure in statistical analyses.
Using similar computation, the present study re-
veals a stillborn mortality rate of 1.56 per cent of
total babies born. In a study of caudal anesthesia
36
Minnesota Medicine
MATERNAL AND INFANT MORTALITY STUDY— WRIGHT
TABLE III. NEONATAL INFANT MORTALITY
TABLE IV. NEONATAL INFANT
MORTALITY CAUSE
OF DEATH
Total No.
No. of Rate 1000
Source
Live Births
Deaths Live Births
Cause
St. Olaf Hospital
St. Olaf Hospital
Prematurity
26
1946-1948
2490
54
21.7
Atelectasis
11
Philadelphia Lying-In
Pneumonia
5
1942-1945
1009
21
20.8
Congenital deformity
3
Gaston Hospital
Erythroblastosis fetalis (fetal
edema)
1
1946
355
6
16.9
Anemia of newborn (not Rh
factor)
1
Minn. Dept, of
Intracranial hemorrhage
1
Pub. Health— 1947
28.6
Unclassified
6
U. S. Dept, of
—
Pub. Health— 1947
34.0
Total neonatal deaths
54
TABLE V.
PREMATURE MORTALITY
Fatality Rate
No.
Incidence
1000-
1501-
2001
Total
No. of
Weighing
of
Less than 1500
2000
2500
2500 gm.
Live
2500 gm.
Premature
1000 gm. gm.
gm.
gm.
or-Less
Period
Births
or Less
Births
2-3 3-5
4-6
5-8
5-8
St. Olaf Hospital
1946-1948
Long Island College
2490
148
5.94
70.6 64.7
25.7
8.8
16.0
Hospital— 1940-1945
9084
637
7.0
92.0 41.4
17.3
4.6
16.3
in obstetrics, Hingson reports a remarkable still-
born mortality rate of 9.1 per 1000 live births in
one series. However, a control group using gen-
eral anesthesia at the same hospital had a still-
born mortality rate of 24.8 per 1000 live births. In
the St. Olaf Hospital study, general anesthesia
was universally used during the second stage of
labor. Caudal anesthesia was not used in any
of the deliveries during the three-year period of
this study.
There was a total of fifty-four neonatal deaths
in the St. Olaf Hospital Study, giving a neonatal
infant mortality of 21.7 per 1000 live births (Ta-
ble III). Hingson reports a neonatal infant mor-
tality of 20.8 per 1000 live births. The Minnesota
Department of Health reports a neonatal infant
mortality in 1947 of 28.6 per 1000 live births. The
United States Department of Health in the same
year reports a neonatal infant mortality of 34.0
per 1000 live births for the entire United States.
An analysis of the cause of death in the neonatal
group in this study is given in Table IV.
Of the neonatal deaths, forty (74.0 per cent)
occurred in premature infants. By definition, a
premature infant is any infant born alive who
weighs 2,500 grams (5 pounds 8 ounces) or less,
whose heart beats or who moves. This definition
is accepted by the American Academy of Pediat-
rics.6 In this study, the premature mortality rate
for the three-day period was 16.0 per 1000 live
births (Table V). Koch et aP report a prema-
ture mortality rate of 16.3 per 1000 live births in
a study of 9,084 live births at the Long Island'
College Hospital from 1940 to 1945. Their prema-
ture mortality rate of 16.3 per 1000 live births
was achieved following a concerted attempt to im-
prove the premature care in the Long Island Col-
lege Hospital. A previous study in the Long Is-
land College Hospital, covering the period 1924-
1940, had revealed a premature mortality rate of
28.4 per 1000 live births. A tabulation of the
premature fatality rates in the four standard
weight division groups will be found in Table V.
The four standard weight division groups include
those infants weighing less than 1,000 gm., 1,001
to 1,500 gm., 1,501 to 2,000 gm. and 2,001 to 2,500
gm. A comparison of the results of the study re-
ported herein with the results of the Long Island
College Hospital is presented in Table V. It
should be noted that the fatality rate in premature
infants weighing less than 1,500 gm. (3 pounds
5 ounces) is high. The efforts of the obstetrical
practitioner to carry the mother through to the
period when an infant’s weight would be above
1,500 gm., and preferably above 2,000 gm., would
be compensated by a more favorable premature
mortality rating.
Of the 2,519 deliveries, sixteen were by cesar-
ean section, an incidence of only 0.63 per cent.
There were two infant deaths in the sixteen in-
fants delivered by cesarean section, resulting in an
infant mortality of 12.5 per cent. Ehrenberg,2 in
an extensive study of cesarean sections performed
in the hospitals of Minneapolis, Minnesota, re-
ports an incidence of 2.6 per cent, with an infant
mortality of 3.9 per cent. Connor reports an in-
cidence of 2.96 per cent in cesarean sections done
in Wenatchee, Washington, with an infant mor-
January, 1950
37
MATERNAL AND INFANT MORTALITY STUDY— WRIGHT
tality of 2.0 per cent. The high infant mor-
tality in cesarean sections in this study is of little
statistical significance because of the small number
of sections performed. Of the two infant fatal-
ities, one was due to abruptio placentae, and the
other was due to atelectasis and prematurity in a
case of marginal placenta praevia.
TABLE VI. CESAREAN SECTIONS
St. Olaf
Hospital
1946-1948
Minneapolis
(Ehrenberg)
1946
Washington
(Connor)
1944-1946
Total deliveries
2519
15,556
2500
No. cesarean sections
16
405
74
Incidence per cent
0.63
2.6
2.96
Maternal mortality
0.00%
0.49%
0.00%
Infant mortality
12,5%
3.9 %
2.0 %
All cesarean sections were of the classical type.
All were performed by general surgeons and gen-
eral practitioners who do obstetrical surgery. The
low incidence of cesarean sections and the appar-
ent reticence of the staff to perform the lower
cervical section is to be noted in this study. The
absence of any maternal mortality and the low
morbidity experienced make a favorable com-
mentary.
Summary
1. A survey of the maternal and infant mor-
tality in 2,519 consecutive deliveries by general
practitioners in a small general hospital is pre-
sented.
2. The statistics as revealed in this study are
compared with published statistical material from
representative sections of the United States.
3. It is apparent in this study that the inci-
dence of cesarean section is low. It is suggested
that the cesarean section should occupy a greater
role in the obstetrical care of the patient in this
locality.
4. The general practitioner in the small gen-
eral hospital can secure excellent maternal and
infant mortality results in obstetrics.
References
1. Connor, C. E. : Obstetrics in the small general hospital.
Surg., Gynec. & Obst., 86:499-501, 1948.
2. Ehrenberg, C. J. : A survey of cesarean section in Min-
neapolis, Minnesota, in 1946. Minnesota Med., 31 :987,
(Sept.) 1948.
3. Hingson, R. A., et al : Newborn mortality and morbidity
with continuous caudal analgesia. J.A.M.A., 136:221-229,
(Jan. 24) 1948.
4. Koch, L. A., et al : Reduction of mortality from premature
birth. J.A.M.A., 136:217-221, (Jan. 24) 1948.
5. Newberger, C. : Statistical study of obstetrical activities in
Illinois hospitals during 1943. Illinois M. J., 87:136-144,
1945.
6. Round Table Discussion on Prematurity. J. Pediat., 8:104-
130, (Jan.) 1936.
7. U. S. Department of Labor Bulletin. Maternal Mortality
for the Year 1940.
SIGHT CAN BE SAVED
“From 50 to 75 per cent of all blindness is prevent-
able,” declares Dr. Franklin M. Foote of New York
City, director of the National Society for the Prevention
of Blindness. Dr. Foote was the guest speaker at the
Minnesota Society for the Prevention of Blindness at
their annual meeting held in Minneapolis, November 28.
“In the United States there are 260,000 blind. One
out of every seven has become blind as the result of an
eye injury, the majority of which could have been
prevented. The other six attribute their blindness to eye
diseases, many of which could have been corrected if
taken in time,” said Dr. Foote.
A field in which much educational work has been done
and where there is great need for work to continue is in
informing the public about glaucoma. Dr. Foote pointed
out that there are 800,000 cases of glaucoma in the
United States which have not yet come to the attention
of eye specialists. “The big challenge which glaucoma
presents is the problem of early diagnosis. During
the late stages the patient’s central vision fails, and
when this takes place the condition is so advanced that
there is little hope of retaining useful sight. Vision
which is lost in chronic simple glaucoma is lost forever.
But when treatment is given in the early stages it is
possible to retain what vision has not been lost.”
According to Dr. Foote, a study of national and state
figures reveals that we are now spending $56,000,000 a
year to help the blind, but less than half a million for
preventing blindness. “The average pension that a blind
person in Minnesota receives,” commented Dr. Foote,
“is less than $58 per month, a small amount for a per-
son who is sightless. We should indeed increase the
amount we are spending for the blind, but more im-
portant still, we should increase many times what we
are spending for the prevention of blindness.” — Min-
nesota’s Health, December, 1949.
38
Minnesota Medicine
THE RATIONALE OF BLOOD TRANSFUSIONS IN THE TREATMENT OF THE
TRUE TOXEMIAS OF PREGNANCY
R. T. La VAKE. M.D.
Minneapolis, Minnesota
TN TWO FORMER reports to the Minnesota
Academy of Medicine,1’2 clinical, laboratory,
autopsy, and experimental data were presented
which converge, in proof, upon the hypothesis that
the true toxemias of pregnancy are diseases
caused by cell substances from the products of
conception ; cell substances that are not possessed
by the cells of the mother and are toxic to her
cells.
The cell substances involved are the organic
compounds implicated in blood incompatibility ;
namely, the A, B, and Rh substances, and, likely,
other cell substances that must be assumed to ex-
ist, at times, because of irregular agglutination
reactions in crossmatching.3
In nature, the cure of these diseases is for-
warded by the active generation of specific anti-
toxic substances by the cells of the mother, and
by the expulsion of the fetus and its antenatal
appendages.5
To complete the circle of the toxin-antitoxin
mechanism between fetus and mother, if the anti-
toxin strength in the maternal serum becomes
relatively too great, the cells of the fetus contain-
ing the specific toxic substance or substances may
be injured or killed, with resulting temporary or
permanent injury to the fetus or death. Such
injury manifests itself in neonatal jaundice,
erythroblastosis fetalis, congenital hemolytic an-
emia, and, likely, in many degenerative diseases,
such as progressive muscular dystrophy, mental
abnormality, and cardiovascular-renal inade-
quacy, due to the weakening and destruction of
fetal cells under maternal antitoxin attack. Fur-
thermore, there is clinical and serologic obstetrical
evidence that suggests forcibly that as fetal toxic
cell substances may injure the cells of the mother,
likewise, at times, maternal cell substances may
injure fetal cells, even to the extent of causing
fetal death.5
It has been shown that the true toxemias of
pregnancy follow a mechanism of cause and cure
similar to that demonstrated by diseases due to
cell substances from certain bacteria and cell sub-
Read before the Minnesota Academy of Medicine, October 12,
1949.
stances in snake venom. In the true toxemias of
pregnancy, intraspecies cell substances, that cause
disease because of the parasitic relationship be-
tween the products of conception and the mother,
are involved. The snake injects toxic cell sub-
stances contained in its venom by a special mech-
anism ; the fetus may deliver its relatively toxic
cell substance or substances through breaks in the
placental barrier. In the latter instance, therapy
is complicated by the fact that we must aim so to
handle the situation that, without permanent or
lethal consequences to the mother, the attach-
ment of the fetus is preserved, at least until the
parasitic fetus has reached an age permitting
independent viability.
As in other diseases caused by toxic cell sub-
stances, the extent and severity of the manifesta-
tions of disease tend to vary directly with the
virulence and dosage of the toxic cell substance
or substances, and indirectly with the strength
of the specific antitoxic substances in the mother.
The strength of the specific antitoxic sub-
stance is most easily determined by titering its
so-called isoagglutinin. However, the antitoxic
substance has two other arms that are equally
specific and tend to parallel in strength the iso-
agglutinin ; namely, the lytic arm and the hemo-
tropic or opsonic arm. Though, in the past, the
physiological function and the biological sig-
nificance of the isohemolysins, isoagglutinins, and
isohemotropins in human blood have been deemed
to be unexplainable, obstetrical research in the
true toxemias of pregnancy seem to make it clear
that their physiological function in nature is to
protect the mother against a fetus containing cell
substances toxic to her cells, and biologically they
have played a part in evolution and the breeding
in or out of cell substances.
Our traditional concepts of the serologic com-
ponents of human blood, our definitions of these
components and our explanations of how these
components interact, have been based largely
upon demonstrable phenomena consequent upon
the unnatural mixture of bloods and gross blood
transfusion. In nature, the chance of the mix-
ture of bloods obtains only in the parasitic rela-
tionship between fetus and mother, and here the
January, 1950
39
TRUE TOXEMIAS OF PREGNANCY— LA VAKE
spill from the fetus is usually in such minute
amounts that the cells of the mother, if injured
by a toxic substance, have time to generate a spe-
cific antitoxic substance that aids in the elimina-
tion of the toxic substance and the cells contain-
ing the toxic substance, usually before the lethal
mechanical effects of gross agglutination have a
chance to operate. The natural mechanism is
most clearly demonstrated by the Rh negative
woman who, after one or many pregnancies, may
develop an Rh antitoxin. Prior or coincident
with the development of this antitoxin, as would
be expected, she will show signs of toxemia until
the strength of her antitoxin is sufficient to pro-
tect her completely. All lines of evidence con-
sidered, it is logical to conjecture that it has been
this fetus-mother relationship, since the origins of
the human species evoluted to the placental type,
that has brought about the present inherited com-
position of human bloods as regards isohemoly-
sins, isoagglutinins, and isohemotropins in our
infinitessimal segment of evolutionary time. Ob-
stetrical serologic studies would seem to indicate
clearly that incompatibility between human bloods
stems from the fact that the incompatible blood
contains a cell substance or substances, in its cells
and serum, toxic to the cells of the individual,
to whose blood it is incompatible. Its incom-
patibility is due to the fact that the blood with
which it is mixed contains either inherited or
actively acquired antitoxic substances specific to
the toxic substances involved.
Thus, incompatible blood is basically toxic to
the cells of the recipient due to its cell substance
content, and, as we see in the Rh negative woman,
Rh positive blood becomes incompatible only after
the Rh negative woman develops an anti-Rh anti-
toxin. She develops this antitoxic substance be-
cause the Rh substance is toxic and injurious to
her cells. This concept of the actual toxicity of
cell substances to cells of individuals whose cells
do not contain the involved cell substances in their
inherited molecular cell structure is essential to
the understanding of the cause of the true tox-
emias of pregnancy. Likewise, using the Rh neg-
ative woman as an example, it is essential to
understand that the appearance of the so-called
specific anti-Rh isoagglutinin is an antibody re-
action in the true sense of response to injury
and is a manifestation of the active generation
of a specific antitoxic substance which contains
lytic and opsonic properties. If this same Rh
negative woman, who has developed the anti-
Rh isoagglutinin, is killed by a gross transfusion
of Rh positive blood, the transfused red cells
containing the toxic substance will be found to
be not only agglutinated, but hemolyzed by the
lytic arm of the antitoxin, and phagocytosed under
the effects of the hemotropic or opsonic arm of
the antitoxin. It is a clear toxin-antitoxin reac-
tion phenomenon.
There is a reasonable doubt as to the exist-
ence of the traditional entities, agglutinogens and
isoagglutinins. Rut, if in respect for tradition
and for the purpose of easy popular understand-
ing, the terms agglutinogen and isoagglutinin are
used, it would seem that it should be understood
that the specific cell substance and the specific
agglutinogen are one and the same entity, and
that the specific isoagglutinin is only a manifes-
tation or part of the specific antitoxic substance.
Agglutination is most reasonably explainable as
a phenomenon brought about when a specific
antitoxic substance injures the red cells contain-
ing the involved toxic cell substance. This in-
jury allows the cells to approach closer to one
another in solution and results in their sticking
together, where formerly, in health, they glided
by one another freely.
From the frequency of certain findings in the
late pregnancy toxemias and the common progres-
sive sequence of their appearance, the cell sub-
stances capable of causing this disease may be
classified roughly as hemotoxins. They attack
the hematopoietic system of the host, causing at
times various types and degrees of toxic anemias,
anemias that tend to be refractory to iron and
liver therapy, even when given parenterally.
They attack the cells of the vascular tree, caus-
ing increasing permeability; first to water, with
consequent hidden and visible edema, and bring-
ing about abnormal increments of weight ; then to
the larger albumen molecule, with further increase
of weight and brawniness of soft tissues, albumen
in the urine, and eye ground splashes; then to red
cells, with red cells in the urine and petechial
hemorrhages in the eye grounds and sometimes
in skin and internal organs. In some instances
these petechial hemorrhages may assume ecchy-
motic proportions in the internal organs. Prior or
coincident with these manifestations, the blood
pressure tends to rise, likely due to direct stimula-
tion of the vessel cells and furthered by inter-
vascular pressure of permeated fluids, especially
40
Minnesota Medicine
TRUE TOXEMIAS OF PREGNANCY— LA VAKE
in encapsulated organs such as the kidney. Vascu-
lar spasm is most clearly demonstrable in the eye
grounds. It would seem likely that the differ-
ences in manifestations and their progress se-
quence observable in many toxemias arise from
differences in the chemistry of the toxic sub-
stances involved and variation in the constitutional
chemistry structure of the maternal cells.
The acceptance of this hypothesis of cause log-
ically directs serologic therapy. The aims en-
visaged by the use of blood transfusions are : to
raise the red cell and hemoglobin content and
thus increase the detoxifying power resident in
oxidation ; to aid in replacing albumen lost in the
urine and aid in restoring the normal chemistry
of the blood ; to relieve the tissues of the host of
a part of the weight of the toxic attack by the
absorptive power of the transfused blood ; and,
where the A or B substances are involved, to add
at least a small complement of inherited specific
antitoxic substance similar to that inherited by
the mother.
The thought immediately arises that the ideal
blood for use would be the blood of a woman
whose blood is consonant with that of the mother
as regards A, B, and Rh status; a woman who
has just recovered from a toxemia caused by the
same cell substance and whose titer of specific
antitoxic substance is demonstrably high. In 1926
McMahon6 reported ten cases in which he used
the sera of recovered women. The results were
considered to be remarkably excellent. He could
suggest no explanation for these results, nor
could any one of us who reviewed and pondered
over his findings. At that time, though some of
us had been investigating the Dienst theory of
fetal blood incompatibility as the cause of tox-
emia, we interpreted our findings in accord with
traditional concepts deduced from the unnatural
mixture of bloods and blood transfusion and con-
sidered that it was entirely the mechanical effects
of red cell agglutination and the necessities 'of
elimination that caused the toxemia, if there were
any connection between fetal blood incompatibility
and the toxemias. We never harbored the idea
that the cell substances involved were the basic
cause. The results reported by McMahon were
attributed to chance because obstetric and sero-
logic data, at that time, did not seem to permit of
a logical explanation of benefits that might be at-
tributed to the use of such sera alone, and even
when transfusion of normal blood was used to
combat recalcitrant anemia or loss of blood in
toxemias, we never attributed beneficial results to
any factors other than those of replacement.
Our present knowledge would seem to direct
that we use transfusions' in the toxemias of preg-
nancy for serologic purposes to combat the fetal
toxic cell substances as we use transfusions in
erythroblastosis fetalis and allied fetal injury to
combat maternal antitoxic substances. This pur-
pose is so new to us that no amount of clinical
data has yet been accumulated that can have any
statistical value.
The invitation to give another report on this
subject was accepted with avidity, because when
attention was directed to investigating the possible
practical advantages in point of therapy that
might be derived from the application of the the-
ory, it soon became apparent that statistically
convincing evidence, founded upon comparisons
of large series, could be obtained only if the the-
ory and the consequent rationale of treatment
were more widely understood and accepted, at
least to the extent that men would be willing to
give it a trial.
This investigation is being continued, in the
reasoned belief, based upon the logical implica-
tions of the theory and a reanalysis and reapprais-
al of the meaning of outstanding clinical obser-
vations to date, that serologic therapy will prove
definitely its position as an important adjuvant
in the treatment of the true toxemias by bringing
about a significant reduction in morbidity and
mortality.
References
1. La Vake, R. T. : Serology and obstetrics. Minnesota Med.,
of pregnancy. Minnesota Med., 31 :372-375, (Apr.) 1948.
2 La Vake, R. T. : Serological observations in the toxemia
29:130-132, (Feb.) 1946. . i
3. La Vake, R. T. : Serology and obstetrics. Am. J. Obst. &
Gynec., 53:459-466, (March) 1947.
4 La Vake R. T. : Serology and' obstetrics. Postgrad. Med.,
1:97-105,’ (Feb.) 1947. .
5 La Vake, R. T. : Serology and obstetrics. Wisconsin M.
J., 47:690-693, 1948. , . . _
6. McMahon, J. J. : The treatment k>f eclampsia. Am, J.
Obst. ’& Gynec., 12:249-253, 1926.
Discussion
Dr. G. Albin Matson, Director, Minneapolis War
Memorial Blood Bank: The thought occurs to me that
if this theory of the incompatibility of A, B and Rh
antigens in toxemia of pregnancy is correct, then one
would expect to find, in those races in which those in-
compatibilities do not exist, a correspondingly lesser
amount of toxemia of pregnancy. It so happens that
among some of the Indians of this country, we do find
(Continued on Page 73)
January, 1950
41
RESULTS OF THE 1948 CANCER STATISTICAL RESEARCH SERVICE
State Department of Health
N. O. PEARCE. M.D.
Acting Director, Division of Cancer and Heart Disease Control
and
D. S. FLEMING, M.D., M.P.H.
Chief, Section of Preventable Diseases
Minneapolis, Minnesota
/^ANCER, the second largest cause of death in
the nation and in Minnesota, became an ac-
tive reporting project of the Minnesota Depart-
ment of Health on January 1, 1948, when a can-
cer statistical study was initiated. Under a reg-
ulation of the State Board of Health, reports
were requested on cancer cases discharged from
all Minnesota hospitals, both general and special-
ized, so that data would be Available for studies
on the incidence and prevalence of cancer. The
results obtained were to be reported periodically
to the physicians of the state. For the legal pro-
tection of those participating, cancer reporting
was incorporated into a Minnesota Statute in
1949, but all the 1948 material was collected
under the authority of regulation.
Minnesota’s cancer statistical study has been
purposely limited to reporting by hospitals. Be-
hind this choice was the idea of sampling cancer
cases as the patients are discharged from hospitals,
rather than attempting to collect a complete rec-
ord of all cancer cases occurring in the state.
To help hospitals in making reports, two trained
medical record librarians have visited each hos-
pital periodically for direct assistance to the hos-
pital staff. This approach has been valuable in
stimulating more uniform and complete record-
keeping of cancer cases as well as other hospital
admissions.
The 3,798 reports returned by hospitals in 1948
were used as a basis for making a series of charts
revealing significant trends in cancer for Minne-
sota. The generalizations made from these data
must be carefully qualified. For instance, only
80 per cent of the Minnesota hospitals reported
during this period. Also, these data are not en-
tirely representative, because the cancer cases
which were reported did not include those patients
which were treated exclusively in the doctor’s of-
fice or in the out-patient department of the hospi-
tal. With these considerations in mind, the fol-
lowing conclusions are presented.
For men and women, cancer strikes early and
late, but its prevalence increases with age. In
both sexes the youngest reported cases occurred
under five, and the oldest over ninety-two. The
bulk of cancer cases in women occur ten years
earlier than the majority of male malignancies, the
female peak coming at age sixty-two, and the male
at sixty-seven.
Digestive tract cancer, which includes the
esophagus, stomach, liver, intestines, and rectum,
leads by far in prevalence according to site, with
a slight dominance of male over female. Cancer
of the female genital tract and cancer of the breast
are close seconds. These three regions together
form more than 60 per cent of all types reported ;
of this 60 per cent, approximately 75 per cent
represent female cases.
The picture of digestive tract cancer in males
closely parallels that of females. Although the
male incidence is slightly higher, both male and
female peak years coincide at sixty-two.
Less than 2 per cent of breast cancer in women
occurs below the age of thirty-seven. Prevalence
rises precipitously to the primary peak year of
fifty-two, followed by a secondary peak at age
sixty-two. Male incidence of breast cancer is
negligible.
More cancer occurs in the uterus than in any
other single female genital organ. In making
this distinction between uterine and non-uterine
cancer cases, it was learned that uterine cancer
tends to occur ten years later than non-uterine
cancer, whose peak age is fifty-two.
Prostatic cancer occurs relatively late in the
life of the Minnesota male, its range being from
fifty-two to ninety-two with the peak at seventy-
seven. Cancer prevalence in other male repro-
ductive organs scatters itself over the normal age
range, with occurrences distributed so uniformly
as to preclude any useful generalization.
The incidence of urinary tract cancer for both
sexes is relatively low up to the age of forty-two.
The picture of male urinary tract cancer shows
two peaks, one at sixty-two and the other at
seventy-two, while the female picture shows a
slow steady increase from age forty-seven to the
42
Minnesota Medicine
CANCER STATISTICAL RESEARCH SERVICE— PEARCE AND FLEMING
County
Aitkin
Anoka
Becker
Beltrami
Benton
Big Stone
Blue Earth . . .
Brown
Carlton ......
Carver
Cass
Chippewa
Clav
Clearwater . . .
Cook
Cottonwood . .
Crow Wing . . .
Dakota
Dodge
Douglas
Faribault
Fillmore
Freeborn
Goodhue
Grant
Hennepin
Houston
Hubbard
Isanti
Itasca
Jackson
Kanabec
Kandiyohi ....
Kittson
Koochiching . .
Lac qui Parle . .
Lake
Lake of Woods
Le Sueur
Lincoln
Lyon
McLeod .......
Mahnomen . . .
Marshall
Martin
Meeker
Mille Lacs
Morrison
Mower
Murray
CANCER CASES REPORTED ACCORDING TO COUNTY OF PATIENT'S RESIDENCE
1948
Total Number of County Total Number of
Reports Received Reports Received
20 Nicollet 20
20 Nobles 21
30 Norman 23
24 Olmsted 2
11 Otter Tail 57
11 Pennington 21
84 Pine 11
44 Pipestone 5
29 Polk 70
10 Pope 8
23 Ramsey 17
26 Red Lake 16
12 Redwood 20
15 Renville 18
4 Rice 33
10 Rock 4
46 Roseau .... 22
27 St. Louis 154
5 Scott 17
23 Sherburne 8
17 Sibley 15
2 Stearns 89
24 Steele 10
54 Stevens 11
8 Swift 16
95 Todd 30
— Traverse 6
8 Wabasha 22
11 Wadena 19
50 Waseca 4
12 Washington 39
1 Watonwan 24
Wilkin 14
Winona 30
-C Wright 26
“ Yellow Medicine 21
14 Fort Snelling —
4 Minneapolis 1044
20 St. Paul 539
7 Duluth 177
30 Iowa —
13 North Dakota 1
3 South Dakota —
13 Wisconsin —
18 Canada —
22 Other States & Territories 1
27 Mexico ... —
43 Other Nations —
28 Unknown 3
15 Total 3798
peak of seventy-seven, from which point it takes
a sharp drop.
About two and one-half times as manv males as
females are afflicted with cancer of the respiratory
system. 'Among men under thirty-seven, the
prevalence of respiratory tract cancer is less than
3 per cent. For women under thirty-seven, the
figure increases to 12 per cent. The peak year
for males is sixty-two, while that for females is
fifty-seven. The majority of respiratory tract
cancer in men falls within the age range of fifty-
two to seventy-two. Outside of a moderate peak
at fifty-two, the pattern of female respiratory
tract cancer reveals no significant characteristic.
Buccal cancer occurs most frequently in older
groups of men and women. Only 3 per cent of
women and 7 per cent of men have buccal can-
cer before the age of forty-two. Men again
lead in the number of cases, reach their peak at
sixty-seven and have a high incidence in later
life. Women, on the other hand, reach their
peak year at sixty-two and fall off gradually
with advancing years.
Skin cancer predominately is a problem of the
January, 1950
43
CANCER STATISTICAL RESEARCH SERVICE— PEARCE AND FLEMING
male population. The bulk of the male skin
cancer occurs between the ages of fifty-seven and
eighty-two. Female incidence of skin cancer re-
mains low and fairly steady over life age span.
INCIDENCE OF CANCER IN MINNESOTA
Female and Male Residents for 19 48
C°ncer * excluding Leukemia ond Hodgkins diseoses
Coses *
Ages
Fig. 1.
CANCER INCIDENCE OF GENITALIA
in Minnesota Female Residents for 1948
Coses
0 2 7 12 17 22 27 32 37 42 47 52 57 6 2 67 72 7 7 8 2 87 9 2 97
Age
Fig. 3.
Leukemia and cancer of the central nervous
system, each with six cases, account for more
than half the malignancies reported under the age
of ten. No significant peaks are seen in charting
the ranges of these sites, and in both cases
no incidence is recorded after eighty-five, about
five years earlier than other recorded cancerous
conditions.
INCIDENCE OF BREAST CANCER
among Residents of Minnesota in 1948
Coses
0 2 7 12 17 22 27 32 37 42 47 52 57 62 67 72 77 82 87 92 97
Ages
Fig. 2.
CANCER INCIDENCE OF GENITALIA
in Minnesota Mate Residents for 1948
0 2 7 12 17 22 27 32 37 42 47 52 57 62 67 72 77 82 87 92 97
Age
Fig. 4.
Hodgkins’ disease has a low incidence, with
ordy thirty-nine cases reported. These occur
mainly in the middle years of life.
The interval between onset of symptoms and
44
Minnesota Medicine
CANCER STATISTICAL RESEARCH SERVICE— PEARCE AND FLEMING
consultation with a doctor is directly related to
cancer control. Although this time element in
cancer is one of the most important aspects of
the problem, it is one of the 'most difficult upon
Minnesota’s cancer statistical study is intended
to be a continuous flexible program whose results
can be significant when measured against long-
term objectives. It provides a center for the col-
INCIDENCE OF URINARY CANCER
among Residence of Minnesota in 1948
INCIDENCE OF DIGESTIVE CANCER
among Residents of Minnesota in 1948
12 17 22 27 32 37 42 47 52 57 62 67 72 77 82 87 92 97
Age
Fig. 5.
Age
Fig. 6.
which to collect accurate and complete data. The
two questions asked in the study relied upon
recall and recollection by both patient and doctor ;
in relatively few instances were these data ever
included in the original hospital record.
The belief that greater emphasis should be placed
on acquainting people with symptoms of cancer
has been borne out by the findings of this study.
Six out of ten people with cancer wait four
weeks or more before seeing their doctors. The
doctors, however, are more prompt ; five out of
ten of their patients are hospitalized in less than
a week, and six out of ten within a month. Al-
though persons suffering from mouth and skin
cancer would appear to have more noticeable
symptoms, as a group they wait the longest be-
fore seeing their doctors. Cases of cancer of
the central nervous system and leukemia, the
two neoplasms which account for more than half
of all cases under the age of ten, also are the
two types of cancer which are most likely to lead
people to seek early attention from their doctors
after onset of symptoms. Women suffering from
cancer of the reproductive organs are first to be
hospitalized, while men with genital cancers delay
the longest.
INCIDENCE OF RESPIRATORY CANCER
0 2 7 12 17 22 27 32 37 42 47 52 57 62 67 72 77 82 87 92 97
Age
Fig. 7.
lection of cancer data on Minnesota people which
has never before been available. The study is an
approximate measure by which our combined and
coordinated efforts to combat cancer may be
evaluated.
January, 1950
45
ANALYSIS OF 10.000 APPENDECTOMIES
ELMER C. PAULSON. M.D.
Minneapolis, Minnesota
TN SPITE of the fact that there is already a
voluminous literature on the subject of the
vermiform appendix, its study remains a fas-
cinating one, and the diagnosis and treatment of
its pathological states constitute a continuous
challenge to the family physician and the surgeon.
This discussion will not deal with the treatment
of appendicitis or its evaluation. Numerous ex-
cellent dissertations on this phase are available in
the literature, notable among which is the recent
exhaustive study by Green and Watkins6 of 19,-
399 cases in Cleveland. The study at hand is con-
cerned with the pathological evaluation of the ap-
pendectomy specimen.
Source of Material
This analysis is based upon 10,000 surgically-
removed vermiform appendices which were
studied and classified in the laboratory of the De-
partment of Pathology at the University of Min-
nesota Medical School. There are no autopsy
specimens in the series. These specimens com-
prise the unselected material from the years 1942
to 1948, which was sent to Dr. E. T. Bell and his
associates from numerous individual surgeons and
small hospitals scattered over the states of Minne-
sota, North Dakota, South Dakota, Montana and
Wisconsin. In general, the material arrived from
hospitals and clinics too small to support a path-
ologist of their own, and who consequently chose
to employ this particular laboratory to study their
surgical material. Most of the hospitals and sur-
geons concerned were regular clients of the Uni-
versity laboratory, and they forwarded their
formalized surgical specimens of all types every
week or two. University Hospital material is ex-
amined in a separate laboratory and none of it is
included herein.
Method of Study
As the specimens arrive each day, they are first
examined grossly and notations made concerning
length,' diameter, external appeafance, presence or
absence of fecoliths, presence or absence of per-
forations or gangrenous areas, and the character
of the luminal contents. Thus, it is important for
the sake of an accurate examination, that the ap-
pendices be submitted in toto and unopened. Sec-
tions for microscopic study are taken from the
most likely appearing portions of each appendix.
If the specimen appears grossly normal, sections
are selected at random from widely scattered por-
tions. For a period of several years, two sections
were made from each normal-appearing appendix.
More recently, three sections were made from
each, since it was observed that sometimes one
section would show the microscopic criteria of
disease and the others would be normal. Even
with three sections, it is occasionally found that
two will be normal and the third show disease.
Consequently, there is an admitted chance of er-
ror in occasionally missing the diseased portion
of an appendix. The slides are stained with
haematoxylineosin. The criteria of disease may
be summarized as follows :
Criteria
Diagnosis
1. Pus cells in tunics of appendix Suppurative appen-
dicitis
2. Lymphocytic infiltration of
serosa
3. Pus in lumen of appendix but
not in the tunics
Recurrent or healing
appendicitis
Catarrhal appendici-
tis
4. Oxyuris vermicularis in the
lumen
Pinworm infestation
Authorities have disagreed on the significance
of the obliterated appendix. It is not considered
pathological in this laboratory. Aschoff was sure
that fibrotic obliteration was due to previous in-
flammation.3 Ribbert, Zuckerkandl and others re-
garded it as a natural regressive process.3 In a
series of 400 autopsies, Ribbert found partial or
complete occlusion of the lumen in 25 per cent.
Sir Arthur Keith declared that at the age of 70, 50
per cent of individuals will have atrophied appen-
dices.
The significance of pinworms in the appendiceal
lumen is also debated by authorities. Nathan
Foot5 states that pinworms and whipworms in the
appendix may produce the typical symptoms of an
acute attack of appendicitis, although the mechan-
ism involved is obscure. It is known that pin-
worms leave pinpoint erosions in the mucosa which
may bleed slightly. M. A. Bell2 says that pin-
worms do not penetrate the wall of the appendix
46
Minnesota Medicine
ANALYSIS OF 10,000 APPENDECTOMIES— PAULSON
TABLE I. PATHOLOGICAL ANALYSIS OF 10,000 APPENDECTOMIES
Positive Appendices (4823)
Inflammatory
(4347)
Mucocele
(17)
Suppurative
& Catarrhal
Tuberculous
1
(4342)
Male
Female
Male
Female
(1)
(4)
(2051)
(2291)
Male
(4)
Female
(13)
Neoplastic
(15)
A. Adenomyoma
Female (2)
1 primary
1 metastatic
Obstructive
without
inflammation
(302)
Male
Female
B.
Carcinoid
(101)
(201)
(id
1
|
Male
Female
1
Pinworms
(2)
(9)
without
inflammation
C.
1
Carcinoma
(142)
|
Male
Female
Male
Female
(37)
(105)
(0)
(2)
Incidental to other
Major Abdominal
Surgery
(1262)
Male Female
(100) (1162)
II
Negative Appendices (5177)
Negative
(3915)
Male Female-
(1266) (2649)
Corpus lut.
(148)
Remainder
(2171)
c. Follic. cysts
(330)
until after removal of the organ, when they may
do so. Warwicke theorized that the presence of
the parasites in the empty appendix may cause
constractions simulating symptoms of appendi-
citis.
Chronic lymphoid appendicitis is described by
Foot5 as co-existing with chronic enlargement of
mesenteric lymph nodes. This eventuates in
fibrosis and obliteration.
“Chronic appendicitis,” as a clinical concept,
does not have much standing these days. No
microscopic criteria of this syndrome are recog-
nized in this laboratory.
Since fecoliths are so important in the etiology
of appendicitis, being present in about 60 per
cent of acute cases,11 the policy has been employed
of considering cases of fecolith without evidence
of inflammation in the “positive” group.
Mucoceles and neoplasms are of considerable
statistical interest and are classified logically into
their own groups.
Incidence of Various Types in the Literature
Of particular interest in close, unified groups
of physicians, is the percentage of normal ap-
pendices in a series of cases. It is generally ac-
TABLE II
Total Number Appendectomies 10,000
Incidental Normal Appendices 1,262
Corrected total for
basis of % normals 8,738
Positive Appendices 4,823 (55.2%)
Corrected Normal Appendices 3,915 (44.8%)
cepted that a good diagnostician should not have
more than 20 per cent normals in a sizable group
of appendectomies. Sappington and HornefP3
found 60.3 per cent normal appendices in 937
cases in 1938. They quote Aschoff as finding 35
per cent normals in a series of 847 cases of pri-
mary appendectomy. In 1941, Mason, Allen et al9
reported 18.6 per cent normals in a group of
1,000. In 1946, Joffe and Wells7 of Duluth re-
ported 27.4 per cent normals in a group of 1,000.
In a conglomerate group, such as I am report-
ing, with dozens of physicians scattered over
thousands of miles contributing the material, it
could hardly be expected that an ideal percentage
of diagnostic accuracy would be attained. Some
of these physicians are practicing medicine under
difficult conditions and do not have available the
diagnostic equipment or consultants of larger cen-
ters. On the other hand, certain physicians in this
group have consistently excellent rates of diagnos-
January, 1950
47
ANALYSIS OF 10,000 APPENDECTOMIES— PAULSON
tic accuracy. Table II shows the corrected nor-
mals in this group to be 44.8 per cent.
Tuberculous appendicitis is so rare that the
identification of a single case warrants its pub-
lication. In 1936, W. J. Carson4 was able to col-
lect 125 cases from the literature. Drissen and
Zollinger, in 1935, found an incidence of 0.3 per
cent among 5, 149 appendices examined at the
Peter Bent Brigham Hospital over a twenty-year
period.
In the group reported herein, tuberculous ap-
pendicitis constituted 0.05 per cent of the entire
series of 10,000, and 0.1 per cent of the patholog-
ical appendices (Table III.)
TABLE III. PERCENTAGE INCIDENCE OF RARE TYPES
In Positive
In Entire Group Group (4823)
1. Tuberculous Appendix 0.05% 0.10%
2. Mucocele 0.17% 0.35%
3. Adenomyoma 0.02% 0.04%
4. Carcinoid 0.11% 0.23%
5. Carcinoma 0.02% 0.04%
5a. Primary Carcinoma 0.01% 0.02%
R. A. Moore11 states that mucocele of the ap-
pendix occurs in about 2 per cent of all persons.
Uihlein and McDonald14 found twelve mucoceles
in the Mayo Clinic material from years 1910 to
1941. This is in contrast with 127 carcinoids and
five adenocarcinomas. These figures would indi-
cate that mucocele of the appendix is a compara-
tively rare discovery for the surgeon.
In this series there were seventeen mucoceles,
or 0.17 per cent of the entire group, and 0.35 per
cent of the pathological portion.
1 could find no references on the incidence of
adenomyoma of the appendix in the literature.
One would expect its occurrence to be closely re-
lated to the incidence of endometriosis, whether
symptomatic or not. In the two cases herein listed,
the adenomyomas were found in the serosal lay-
er, indicating, of course, that they were peritoneal
implants. The gross incidence was 0.02 per cent ;
and the incidence of the pathological group 0.04
per cent.
Carcinoids constitute the most common tumor
of the appendix, and there is a rather extensive
literature on the subject. This- very interesting
lesion was named by Oberndorfer in 190710 on the
basis of its histology and apparent benignity.
Some of the standard textbooks (Boyd,3 Bell1)
state its incidence as from 0.3 per cent to 0.5 per
cent of all appendices removed surgically. Mc-
Carty and McGrath,8 with 0.44 per cent of a
series of 8,039 from the Mayo Clinic in 1914, and
48
Selinger,12 with 0.35 per cent of a series of about
10,000 from New York Post Graduate Hospital in
1929, support this generalization. However,
Thomas Moore,10 in 1938, found only ten cases
TABLE IV
Total Female Normal Appendices 2,649
(Corrected for incidental group)
Negative appendix with resection of ovary
for small follicular or luteal cysts or
corpus luteum 478 (18.%)
A. Negative appendix plus corpus luteum. . 148 (5.5%)
of carcinoid among 10,229 appendectomies, at the
Royal Victoria Infirmary, Newcastle on Tyne,
over a ten-year period. It is interesting, in pass-
ing, to quote Young and Wyman15 to the effect
that 82 per cent of carcinoids occur in females
because that was exactly the situation in my
series.
The incidence of carcinoid in this series is in
remarkable agreement with T. Moore, rather
than with the earlier authors, namely 0.11 per cent
of the series of 10,000, and 0.23 per cent of path-
ological appendices.
True carcinoma of the appendix is very rare.
The literature has to be examined critically when
searching for reports15 on this lesion since many
writers use the term rather loosely and include
carcinoids and mucoceles in the category. Nathan
Foot says that of the thousands of appendices he
examined at New York Hospital over a twelve-
year period, not one showed true carcinoma.
Thomas Moore10 found one case of true carcinoma
in 10,229 appendectomies. This coincides with the
findings of the present series in which two true
carcinomas were found, one primary, and one
metastatic.
Comment
It will be noted that in the group of normal
appendices, after those incidental to other major
abdominal operations have been excluded, the
females outnumber the males two to one. In
view of the proximity of the female genital tract
to the appendix, and in view of the proneness of
the former to yield symptoms which may be con-
fused with appendicitis, this disproportion is
probably to be expected. Reference to Tables 1
and IV reveals some additional information con-
cerning the normal female appendices. In 478
(18.0%) of the 2,649 females from whom normal
appendices were removed, the ovary or ovaries
were resected, with the resultant pathological dis-
( Continued on Page 53)
Minnesota Medicine
THE TREATMENT OF ACUTE CHEST INJURIES
With Especial Reference to the Use of Tracheotomy
IVAN D. BARONOFSKY, M.D., ROY W. DICKMAN, M.D., and
EDWARD S. VANDERHOOF, M.D.
Minneapolis, Minnesota
h I 'HERE ARE few medical and surgical emer-
-*■ gencies wherein the patient’s recovery is de-
termined by the physician’s being able to recall
immediately the basic physiology, anatomy and
treatment of the emergency. Acute chest injury
is one such example and is illustrated by the
following case.
A thirty-five-year-old white man was admitted to the
emergency room at Ancker Hospital following a car-
train collision on April 3, 1949. He was unconscious, in
shock, markedly dyspneic, and cyanotic. He had severe
subcutaneous emphysema particularly of the neck and
face. There were fractures of the first and second ribs on
the left and of the first on the right. He also had a
comminuted fracture of the distal third of the left ulna
and radius and a fractured left clavicle. His pulse be-
came very weak and rapid. Because of his respirations,
pulse, and the rapid increase in emphysema in the
suprasternal notch, and from physical examination, a
diagnosis of severe mediastinal emphysema and left
pneumothorax was made.
A 15-gauge needle was inserted adjacent to the ster-
num into the left fourth interspace and directed medially
into the mediastinum. About 15 c.c. of air was with-
drawn with immediate respiratory relief to the patient.
Immediately following removal of the needle, the pa-
tient again developed symptoms and again was relieved
by aspiration. A 15-gauge needle connected to a stop
cock and 50 c.c. syringe then was inserted into the left
third interspace anterior-laterally and 1500 c.c. of air was
removed from the pleural cavity. This was done on
several occasions with marked improvement in the pa-
tient’s respirations and color. It was evident that the
patient had a bronchopleural fistula because of the
rapid accumulation of air into the pleural cavity, so a left
thoracostomy was done with the introduction of a No. 15
urethral catheter through a trocar in the region where the
needle was inserted. The catheter was attached to a
Stedman pump and constant suction maintained. It soon
became evident that the patient’s bronchopulmonary
tree was filling with secretion typical of the “wet lung”
syndrome. Because catheter suction of the trachea
through the larynx was unsatisfactory due to the pa-
tient’s unconsciousness, and since numerous autopsies
here have shown that many of these patients die from
pulmonary complications arising from overaccumula-
tion of bronchial secretions, a tracheotomy was per-
formed. A profuse amount of intratracheal and intra-
bronchial secretions was aspirated with again marked
From the Department of Surgery, University of Minnesota,
and Ancker Hospital.
Dr. Vanderhoof is now at Veterans Hospital, Sioux Falls,
South Dakota.
improvement in the patient's respiration. Five hundred
c.c. of blood had been started upon admission and sup-
plemented with 1000 c.c. of 10% glucose in distilled
water. Almost constant suction was maintained the next
24 hours to keep his respiratory tree cleared.
The next day, examination revealed a right pneu-
mothorax, and a right thoracostomy with a catheter and
a trocar was done after several needle aspirations of air.
His temperature rose to 104.2° but gradually subsided
during the next thirteen days. He alternated between
coma and disorientation for thirteen days, during which
time constant tracheal suction and penicillin therapy were
maintained. On the fifth day, physical examination and
radiographs revealed expansion of the lungs, and after
clamping the thoracostomy tubes for twenty-four hours
without recurrence of symptoms of pneumothorax, the
tubes were removed. He had received a total of four
pints of blood about 2000 c.c. of intravenous fluid per
day. On the seventeenth day, the tracheotomy tube was
plugged with a cork' since trachea suction was no longer
necessary and the tube was removed in twenty-four
hours. An open reduction of the ulna and radius was
performed the twenty-fifth day and on April 29, 1949,
the patient was discharged from the hospital and has
been well since.
Comment. — This case represents several inter-
esting procedures which were instituted as life-
saving measures. The mediastinal aspiration and
left thoracostomy are prime examples. Had a
tracheotomy not been done, it is probable that
pulmonary complication would have been such
that the patient would have succumbed within the
next two days because it would have been neces-
sary to bronchoscope him every three to four
hours to offer him respiratory relief from profuse
bronchial secretions. Patients in a state of coma
are unable to bring up these secretions and subse-
quently may die of bronchopneumonia. This fact
plus the presence of severe chest injury which in
itself is an important cause of “wet lungs” (ede-
ma), suggests that tracheotomy should be thought
about early in cases of the type presented. His
entire course was based upon a fundamental
knowledge of the physiology and anatomy of the
chest and training in the treatment of thoracic
injuries.
Physiology
The physiology of the thoracic structures is
only too poorly understood by many untrained
January, 1950
49
ACUTE CHEST INJURIES— B ARONOFSKY ET AL
in the chest specialties. The thorax is a semirigid
cage, within which lie the lungs and mediastinum
which respond to simple physical laws. When
the muscles of respiration act during the inspira-
tory phase, the thoracic cage is enlarged, creating
a negative pressure approximately — 6 mm. Hg
within the thorax. Air enters the lungs via the
larynx and trachea much as it would into a bel-
lows. The lung parenchyma is stretched as air en-
ters the alveoli ; and when the muscles of respira-
tion cease to act, the expiratory phase, a purely
passive action, takes place due to the contractility
of the muscle and lung tissue. At the end of ex-
piration the pressure within the thorax is about
— 2.5 mm. Hg. When a person is dyspneic, acces-
sory muscles of respiration come into play, and
the expiratory phase then becomes an active phase.
Pressures in the chest may change over tenfold.
It is readily understood that the above cycle is
dependent upon both a firm and a sealed thoracic
cage. Should a chest wall become flail through in-
jury, the wall will respond to the intrathoracic
negative pressure and transmit its negative pres-
sure to the mediastinum if it is not fixed from dis-
ease, so that no increase of intrathoracic pressure
is transmitted to the lungs and the act of inspira-
tion does not occur. This also takes place in large
sucking wounds of the thorax where the air en-
ters and leaves the thoracic cage through the
wound in response to the forces of respiration in-
stead of through the larynx and trachea.
The mediastinum contains the heart, great ves-
sels, nerves, lymph nodes, thymus and part of the
thyroid. There is no cage protecting these struc-
tures so they are also acted upon and influenced
by intrathoracic pressure. When the intrathoracic
pressure becomes more negative during inspira-
tion, the great veins and atria tend to fill with
blood because the intravenous pressure in these
organs is much less than in other parts of the
venous circulation. Expiration, especially if
forced, tends to force blood out of these organs.
These veins, including those of the neck, are
valveless and any sudden imbalance of pressure
within the thorax may adversely affect the cardio-
respiratory function of the body. Traumatic as-
phyxia due to a sudden crushing injury with a
compression of the thorax is a typical example.
The enormous increase of intrathoracic pressure
collapses the great veins and atria and forces
blood into the valveless veins of the head and
neck causing a cyanotic discoloration of a “violet
50
hue” and petechiae of the head, neck and shoul-
ders. There may be subconjunctival hemorrhage
with protrusion of eyes and swelling of the lids
and tongue. Blindness may result. Cerebral
symptoms such as coma, rigidity, and convulsions
may be present and are due to the anoxia rather
than to cerebral .petechiae. This type is known as
ecchymotic traumatic asphyxia. The pale type
may also have areas of purplish discoloration but
there is a typical pallor of the face and neck and
the patient has a cold, clammy skin ; weak, rapid,
thready pulse; and an uneven, shallow respiration.
Another important physiological problem is
intrabronchial secretions which may complicate an
acute chest injury. Normally, the bronchial secre-
tions are relatively fluid, becoming more so as they
approach the main bronchi. The bronchial tree is
kept clear by the beating of the bronchial cilia
which sweep toward the trachea and larynx and
also by the cough mechanism in which intrabron-
chial pressure is built up by sudden expiration
from the force of the expiratory muscles of res-
piration and the bronchial musculature, resulting
in marked increase of pressure of the intrabron-
chial air against a closed larynx. When the larynx
suddently opens, the intrabronchial pressure is
suddenly released carrying with it particles of
intrabronchial and tracheal secretion. When these
secretions become overabundant due to stimula-
tion of the secreting cells and more mucoid and
tenacious, it becomes more difficult to expel the
sputum. If pain is present in the chest, the pa-
tient normally inhibits his cough reflex. There is
evidence accumulating to show that following se-
vere chest injuries, the secretions of the tracheal
bronchial tree are altered and become more pro-
fuse yet more mucoid and sticky.4’15 Burford and
Burbank believe that intrathoracic organs, espe-
cially the lung, react to localized contusion of the
chest wall very much as tissues in any part of the
body may react to localized blows, that is, with
edema formation. This, in the lung, may result
in atelectasis, hypoxemia, and pneumonitis, de-
Takats16 demonstrated experimentally that the
bronchial tree goes into spasm following chest
wall injuries, pulmonary emboli, or vagal stimu-
lation and secretes thick, sticky mucus. This ma-
terial is very difficult to raise, especially if cough-
ing causes chest pain, and the cycle terminates in a
clinical entity described as “wet lung.” He proved
that atropine or papaverine in high dosages par-
tially and at times entirely blocked this mechan-
Minnesota Medicine
ACUTE CHEST INJURIES— BARONOFSKY ET AL
ism. It would seem logical therefore to use these
drugs to prevent the condition from arising. If the
secretions have already formed, they must be as-
pirated by a catheter or bronchoscope since atro-
pine will only further prevent their being diluted
by normal secretion. On occasions, such as in
this case report, tracheotomy must be resorted to
because, if untreated, the wet lung syndrome will
result in death.
With an understanding of these few funda-
mentals, a rational attack to the problem of an
acute chest injury can be launched. The first and
primary job is to correct the severe cardiorespir-
atory difficulty. From just a glance, a few words
about the type of injury sustained, percussion
and auscultation, a diagnosis of the injuries present
can usually be made. If the patient presents evi-
dence of traumatic asphyxia and dyspnea due to
increased intrathoracic pressure, it is usually ei-
ther severe tension pneumothorax or a hemotho-
rax, the differentiation of which is easily made by
percussion and auscultation. These procedures
also give information as to whether a “wet lung”
is developing. If he is breathing rapidly but is
still pale and somewhat cyanotic, a quick exami-
nation reveals whether a flail chest or a crushing
chest wound is present. If mediastinal emphy-
sema is present, there will be also severe subcu-
taneous emphysema about the neck and face ; the
diagnosis is easily made by palpation. The treat-
ment of each of these problems is well known.
Tension Pneumothorax
Tension pneumothorax may develop without
rib fracture or penetration of missiles. The pa-
tient presents a picture of acute dyspnea and cya-
nosis and has total or partial collapse of the in-
volved lung. He may present either the picture
of the pale or ecchymotic type of traumatic anoxia.
Percussion reveals marked tympany on the side
of the pneumothorax and usually a shift of the
mediastinum. Auscultation reveals little or no
breath sounds in the involved side. Diagnosis can
positively be made by x-ray, but on occasion there
is no time to wait for films. An 18-gauge needle
inserted into the chest wall at the level of third or
fourth rib anterior-laterally will result in a loud
hissing noise as the air under pressure escapes.
This will relieve the patient while a syringe is
readied with either a rubber adapter that can be
fitted over the needle and attached to the syringe
or a two-way stopcock. If the air ceases to leave
the needle and is being sucked in before the syr-
inge is ready, the adapter end of the needle must
be covered tightly to prevent air being sucked into
the thoracic cavity. With the syringe, air is re-
moved until the pleura can be felt rubbing against
the end of the needle or the patient complains of
a severe tight sensation in the chest, a cough, or
has a poor pulse.
The next day more air can be aspirated and the
lung expanded. If the pleura is left with too nega-
tive a pressure as evidenced by the severe tight
feeling the patient experiences, pleural effusion
will develop. If air rapidly accumulates after as-
piration, there is a tear into the lung parenchyma
or bronchus creating a bronchopleural fistula.'
The air should be reaspirated ; and if the accumu-
lation continues, a soft rubber catheter should be
inserted through a trocar into the thoracic cavity
at about the level of the fourth or fifth rib in the
anterior axillary line and connected to either a
Stedman pump or water trap bottle until the lung
is expanded.
Tension pneumothorax must be differentiated
from progressive bullous emphysema since aspi-
ration of these bulb usually results in death.1
Hemothorax
The patient usually complains of pain in the
involved side of the chest and may be dyspneic
and cyanotic. If the hemothorax is massive, he
may also present the picture of traumatic anoxia.
On other occasions, it is only diagnosed by rou-
tine chest films taken for rib detail and the locali-
zation of the fractured ribs. It is well proven that
immediate aspiration of the hemothorax and in-
stillation of at least 500,000 U. of penicillin with-
out air replacement is now the treatment of
choice4’5’8’13 as compared to the previous custom
of either leaving the blood in the thoracic cavity
or replacing the blood with air. If there is con-
tinuous bleeding, neither leaving the blood in the
chest nor replacing it with air will stop the bleed-
ing and a thoracotomy will be necessary.6 When
introduced into a hemothorax, air rises only to the
apex of the chest, which prevents the expansion
of the upper lobe which is the most difficult part
of the lung to expand if a “thickened pleura”
develops.5
Also, the popular belief that blood lying free in
the pleural cavity will not clot is fallacious. If
there is a crushing type trauma of the pleura or
lung, clotting readily takes place.2 Following clot-
January, 1950
51
ACUTE CHEST INJURIES— BARONOFSKY ET AL
ting multiple loculations develop necessitating
thoracotomy with decortication of the thickened
“peel” over the pleura of the lung. Actually, the
“peel” is not a thickened pleura but rather an or-
ganized exudate overlying and adhering to a nor-
mal pleura.
Mediastinal Emphysema
It is rare that mediastinal emphysema becomes
so severe that treatment must be instituted. How-
ever, the reported case demonstrates that this may
happen. The patient may present symptoms of
dysphagia, cyanosis, extrapericardial tamponade
with circulatory failure and death. There may be
electrocardiographic changes and a “popping”
sound heard during systole. Aspiration as de-
scribed by Gumbiner and Cutler should be carried
out. A needle is inserted in the third or fourth
left interspace 1 cm. to the left of the sternal bor-
der and directed medially parallel to the surface
of the sternum, and aspiration performed. Inci-
sions in the suprasternal notch should be avoided
if possible.
Flail Chest
The patient usually has acute respiratory em-
barrassment and chest pain with gross evidence of
the flail chest and paradoxical respiration. There
are fractures of the involved ribs in two places.
The chest wall must be fixed by some method, one
of which is the use of towel clips around several
of the involved ribs midway between the fractured
sites. The clips must be held under tension by
traction.3 The chest wall may be supported in
the other direction by adhesive tape. Tape alone is
of no benefit. Since the patient will have pain
with coughing in any type of rib fractures, the
best method of treatment is injection of the inter-
costal nerves with novocaine proximal to the sites
of fracture. Depressed fractures of the sternum
also result in a flail chest. The sternum must be
supported by traction instituted either with towel
clips, a wire inserted under the sternum, or malar
traction clamps. Care must be taken not to pierce
or tear the internal mammary arteries.10
Sucking Wounds
The patient presents the same symptoms as in
a flail chest. The sucking wound must be imme-
diately sealed with an occlusive dressing and the
pleural cavities aspirated of air and blood to re-
store the patient’s cardiorespiratory balance. Un-
der sterile technique the wound must be debrided,
bleeding vessels ligated, and the wound closed
primarily. Pneumothorax and hemothorax must
be handled as previously described. Penicillin
should be introduced into the pleural cavity.
Wet Lung
The interesting clinical entity, wet lung, if un-
treated, often leads to atelectasis, pneumonia,
bronchiectasis, or death. As previously described
it seems to result from chest wall trauma and
pain. If intercostal nerve blocks are done and
the patient is relieved of pain and can cough suffi-
ciently to clear the respiratory passages, the pas-
sages remain clear until the pain reappears. Atro-
pine used after clearing the passages blocks the
re-formation of the mucus.7 The technique of
intercostal block is very simple. The injections
are made preferably at the angles of the ribs. A 20-
gauge needle is directed perpendicularly until the
rib is encountered and then directed under the rib
for the distance of 0.5 cm. Five to 10 c.c. of 1 or
2 per cent novocaine are injected into this area.
All the involved ribs are injected including the
uninvolved rib above and below. Paravertebral
blocks also may be used, the technique of which is
only slightly more difficult.9 The patient should
have moderate sedation for restlessness. Morphine
sulfate can be used since the slow respirations are
more efficient than the rapid type.12 Carbon di-
oxide 100 per cent for two to three breaths fol-
lowed by coughing is helpful. If no improvement
occurs after injecting the intercostals and using
C02, place the patient in a semi-Fowler’s position
and pass a No. 16 or No. 18 urethral catheter with
suction attached through nose into pharynx. Dur-
ing an inspiration advance the catheter rather
rapidly, and it will usually pass into the larynx.15
The patient will experience a severe coughing
spell in spite of pain and will raise an appreciable
amount of the tenacious sputum. Also, if possible,
leave the catheter in place until the passageways
are clear. If clearing the passageway fails by this
method, then bronchoscopy must be resorted to.
It is to be emphasized that the bronchial pas-
sages are to be kept clear at all costs. Patients
with chest injuries frequently die of bacterial
pneumonitis after the basic disturbances in the
chest physiology have been readjusted. Catheter
suction is excellent if an experienced person is
present constantly at the bedside, because the se-
cretions accumulate rapidly. If there is any
doubt that catheter suction or bronchoscopy will
52
Minnesota Medicine
ACUTE CHEST INJURIES— BARONOFSKY ET AL
not suffice, tracheotomy should be instituted early.
With a tracheotomy present, suction of the tra-
chea and bronchi can be carried out simply, quick-
ly, and accurately. In those cases where loss of
sensorium is present in addition to severe chest
injury, it is our belief that tracheotomy should be
instituted immediately. In fact, tracheotomy prob-
ably should be employed in all patients with coma
who have a reasonable chance of getting well.
Summary and Conclusions
1. A case is presented in which bilateral pneu-
mothorax, mediastinal emphysema, rib fractures
and coma were present on admission. Treatment
of these conditions is discussed.
2. There is a short discussion of the physiology
of the chest, and treatment of the more common
types of acute chest injury is given.
3. It is suggested that tracheotomy in cases
of severe chest injury should be considered very
early in order that the bronchial secretions may be
removed adequately.
10.
n.
12.
13.
14.
is.
16.
References
Albertson, H. A., and Peterson, C. H. : A case of pro-
gressive bullous emphysema complicated by chest trauma. Vir-
ginia M. Monthly, 74:522-524, 1947.
Alexander, J.: Thoracic injuries. Am. J. Surgery, 67:216-
225, 1945.
Barrett, W. A.: Bilateral crush injuries to the thorax: with
death. Mil. Surgeon, 97:394-396, 1945.
Blades, B.: Emergencies of injuries of the chest. J.A.M.A.,
135:813-814, 1947.
Blades, B.: Recent observations concerning the treatment
of chest wounds. S. Clin. North America, 24:1410-1423, 1944.
Burbank, B., Falor, W. H., Jones, H. W. : Three hundred
seventy-four acute war wounds of the thorax. Surgery, 21:
730-738, 1947.
Burford, T. H., Burbank, B. : Traumatic wet lung. J.
Thoracic Surg., 14:415-424, 1945.
Churchill, E. D.: Trends and practices in thoracic surgery
in the Mediterranean theater. J. Thoracic Surg., 13:307-315,
1944.
Fitzpatric, L. J., Adams, A. J.: Nerve block in the treat-
ment of thoracic injuries. J. Thoracic Surg., 14.480-483,
1945.
Gardner, C. C., Jr.: Chest injuries. S. Clin. North America,
26:1082-1094, (Oct.) 1946.
Gumbiner, Bernard and Cutler Meyer M.: Spontaneous
pneumomediastinum in the newborn. J.A.M.A., ll/.zuou,
1941.
Kinsella T. J. : Thoracic injuries. Minnesota Med., 26:
524-528, 1943. . , . .
Miscall, L., Harrison, A. W.: Thoracic surgery in a hospital
center. Ann. Surg., 125:142-156, 311-333, 1947.
Rogers, W. L., Holman, E. : Penetrating wound of the
chest in the Pacific area. Ann. Surg., 124:1076-1081, 1947.
Samson, P. C., Brewer, L. A. Ill: Principles of improving
inadequate tracheobronchial drainage following trauma to
the chest. J. Thorac. Surg., 15:162-172, 1946.
deTakats, G„ Fenn, G. K., Jenkinson, E. L : Reflex pul-
monary atelectasis. J.A.M.A., 120:686-690, 1942.
ANALYSIS OF 10,000 APPENDECTOMIES
(Continued from Pag# 48)
closure of small follicular or luteal cysts or nor-
mal corpora lutea. These figures refer only to
tiny cysts, not to large ovarian cysts of various
types. Evidently, the surgeon, after his disap-
pointment in encountering a normal appendix,
went on to examine the pelvic organs. Upon find-
ing a slightly enlarged or reddish or yellowish
ovary, he resected it with the hopes that it would
cure the patients’ symptoms. Probably this is a
naive explanation. At any rate, the pathological
study of these specimens forces the conclusion that
the additional procedures were not warranted.
Particularly unjustified is the removal of a nor-
mal corpus luteum (which occurred in 5.5 per
cent of the negative female group.) Identification
of the corpus luteum for what it is in situ at the
time of surgery would enable the operator to
diagnose probable Mittelschvnerz and warn the
patient of possible similar attacks in the future.
Summary
This study comprises 10,000 consecutive surgi-
cally-removed appendices, which were examined
over a seven-year period in the laboratory of
Dr. E. T. Bell and his associates at the Univer-
sity of Minnesota. The series is analyzed by
means of several tables. The incidence of the
rare types is described and compared with that
found in the literature. After deducting the nor-
mal appendectomies incidental to other abdominal
operations, the corrected percentage of normals
is 44.8 per cent. The practice of resecting an un-
pathological ovary in the presence of a normal ap-
pendix is described and commented upon.
Bibliography
1. Bell, E. T. : Textbook of Pathology. Philadelphia: Lee
and Febiger, 1944. , , ...
2 Bell M. A. : Oxyuris vermicularis and appendicitis. Arch.
Pediat., 53:649-653, (Oct.) 1936. _
3. Boyd, William: Surgical Pathology. Philadelphia: W. B.
Saunders Co., 1947.
4. Carson, W. J. : Tuberculosis of appendix. Am. J. Surg.,
34:379-382, 1936. „
5. Foot, Mathan C. : Pathology in Surgery. Philadelphia :
Lippincott, 1945. ......
6. Green, H. W. and Watkins, R. M. : Appendicitis in
Cleveland. Surg. Gynec. & Obst., 83:613-624, (Nov.) 1946.
7. Joffe H. H. and Wells, A. H. : Normal appendices in
1 000' appendectomies. Minnesota Med., 29:1019-1021, 1946.
8. MacCarty, W. C. and McGrath, B. F. : Frequency of
carcinoma of the appendix. Ann. Surg., 59:675, 1914.
9. Mason, M. L., Allen, H. S., Queen, F. B., Gibbs . E. W. :
Quart. Bull. Northwestern Univ. M. School, 15:1-20, 1941.
10 Moore, Thomas: Carcinoid tumors of appendix. Brit. J.
Surg., 26:303, 1938.
11. Moore, R. A.: Textbook of Pathology. Philadelphia:
W. B. Saunders Co., 1944.
12. Selinger, Jerome: Primary carcinoma of vermiform ap-
pendix. Ann. Surg., 89:276, 1929.
13. Sappington and Horneff : Am. J. Surg., 39 :^3-~6, (Jan.)
14. Uihl’ein, A. and McDonald, J. R. : Primary carcinoma of
appendix resembling carcinoma of colon. Surg. Gynec. &
Obst., 76:711-714, 1943. ^ . , .
15 Young, E. L. and Wyman, S. : Primary carcinoma of the
appendix associated with acute appendicitis. New England
J. Med., 227:703-705. 1942.
4336 Elliot Avenue.
January, 1950
53
HEMOCHROMATOSIS
C. N. HARRIS, M.D. and R. E. HANSEN. M.D.
Hibbing, Minnesota
T TEMOCHROMATOSIS is a comparatively
rare disease, thought to be of metabolic ori-
gin and usually characterized by the triad :
(1) marked deposition of iron-containing pig-
ments in many of the body organs; (2) cirrhosis
of the liver; (3) diabetes mellitus.
The disease was perhaps first described in 1871
by Trosier, who recognized a bronze cachexia in
cases of diabetes mellitus. Von Recklinghausen,
in 1889, named the disease hemochromatosis and
thought it was due to primary blood destruction
which resulted in deposits of pigment through the
body.
The paucity of this disease becomes very ap-
parent when one realizes that less than 600 cases
have been reported. In a large Toronto hospital,
only nine cases in thirteen years were observed.1
Bellevue Hospital, New York, reports four cases
in 5000 autopsies ; Johns Hopkins, three cases in
100,000 admissions. Another study of 5000 dia-
betics revealed only two cases.
The disease enjoys a world-wide distribution
and is seen chiefly between the ages of forty-five
and fifty-five years. Men are especially affected,
perhaps 90 per cent of the cases being of this sex.
The etiology of the disease is uncertain and
various theories have been advanced. Some be-
lieve that the disease is due to a toxin either bac-
teriological or chemical (zinc-lead-copper) where-
by there is destruction of red blood cells with lib-
eration of iron from hemoglobin. The nutritional
basis has been offered as an explanation because
in Africa the disease is a common sequela of pel-
lagra which in turn is a dietary deficiency state.
Butt and Wilder suggest that perhaps a hypovita-
minosis A during fetal life renders the intestinal
mucosa defective and thereby permits the entrance
of amounts of iron or affects the general body
metabolism so that iron in individual cells is de-
fectively metabolized. Some writers believe there
is an association between aplastic anemia, treated
by repeated transfusions and hemochromatosis,
the iron from the destruction of blood being de-
posited in a cirrhotic liver and also in the pan-
creas. Perhaps the most adequate explanation of
the disease in the light of our present knowledge is
From the Adams Clinic, Hibbing, Minnesota.
that the disorder is an inborn error of metabolism,
probably congenital, which allows the entrance of
small amounts of iron into the cell, but does not
permit its excretion. The symptoms of the dis-
ease are due to the secondary resultant effects,
cellular destruction and fibrosis in the various or-
gans.
The pathology of the disease2 is concerned pri-
marily with pigment alteration, which secondarily
produces destruction and fibrosis of the various
body structures. Melanin, a normal skin pigment,
is markedly increased and does not enter into the
destructive process as does hemosiderin and
hemofuscin. Hemosiderin is a protein-iron com-
pound with a deep yellow to brownish-yellow col-
or and is found in all tissue, except perhaps nerve
and smooth muscle. Hemofuscin varies from a
light yellow to dark brown and doesn't react to
chemical tests for iron. It occurs, as contrasted to
hemosiderin, in smooth muscle. The total amount
of iron deposited in the body at the time of death
varies from 25 grams to 50 grams in comparison
with the average normal of 3 grams.
The changes in the liver are usually striking.
This organ is greatly enlarged, the majority of
cases presenting livers weighing over 2000 grams.
However, it has been observed that in about 10
per cent, the liver is smaller than normal. Grossly,
the liver has a reddish tint and is finely granular.
Microscopically there are deposits of hemosiderin
in the liver cells and in the fibrous tissue with
evidence of degeneration, producing a cirrhosis.
The pancreas is fibrotic and presents a reddish
tint similar to that of the liver. The islands of
Langerhans are reduced in number and exhibit fi-
brosis in about 80 per cent of the cases. The
spleen varies in size, but is usually increased.
There are deposits of hemosiderin and hemofus-
cin present but not as marked as in the liver. The
gastrointestinal tract is affected bv the pigment,
but otherwise shows no definite changes. The heart
is usually deeply pigmented with hemosiderin, but
definite fibrotic changes are not often observed.
The thyroids and parathyroids show marked pig-
ment involvement with added degenerative and fi-
brotic alterations. The adrenal cortex contains
much pigment. The anterior lobe of the pituitary
54
Minnesota Medicine
HEMOCHROMATOSIS— HARRIS AND HANSEN
practically always contains deposits. The testes
often show atrophic changes in the sperminal epi-
thelium. In the skin there is an increase in the
melanin which occurs in the deeper epidermis,
whereas the corium harbors hemosiderin, mainly
in the cells of the sweat glands. Hemofuscin is
confined to the walls of the blood vessels.
The clinical features of the disease are pri-
marily three in number ; however, a single case
may present any one, two, or three features or a
combination of them. The initial symptom in each
case may certainly vary. Sheldon states that pig-
mentation occurred first in 26 per cent of his
cases.8 Butt and Wilder noted its onset as an ini-
tial sign in 40 per cent of their series.3 Diabetes
as the first sign was noted by Sheldon in 25 per
cent and other authors have found this also. Cir-
rhosis has been noted as the anlage in about 25
per cent of the cases. Chesner5 reported a case with
some interesting features ; the disease occurred in
a fourteen-year-old, which is unusual, and the pa-
tient did not have the skin pigmentation or dia-
betes ; however, the liver and spleen were palpa-
ble. A severe hypochromocytic anemia of the iron
deficiency type preceded the disease symptoms by
six years. Diagnosis was made at autopsy, based
on the finding of pigment cirrhosis of the liver
and pancreas.
The skin pigmentation is seen in about 80 per
cent of the cases and it appears in varying degrees
from a diffuse bronzing to a slate-like metallic
tint. The face, nipples, scars and extensor areas
of the arms show the greatest color ; however, the
entire body may be pigmented. The intensity of
the pigment may vary. Certainly as the disease
progresses, the color will perhaps do likewise.
With the use of insulin, the pigmentation may
change in intensity. Humphrey7 reported a case
in which the pigmentation varied from light to
dark. This he postulated might be due to the
varying volume of water and glycogen storage in
the superficial skin cells while the patient was un-
der insulin treatment.
The diabetes once established has a tendency
to become more severe and uncontrollable. Per-
haps the patient becomes insulin resistant, but
most likely the progressive degeneration of the
pancreas is responsible. The glycemia is extreme-
ly labile, patients approaching coma on one day
and victims of hypoglycemia the next. This car-
dinal variability might be due to the cumulative
physiological action of the involved liver, adrenal,
pituitary, and thyroid glands. Sheldon showed
diabetes to be present in 70 per cent of his cases.
Wilder observed it in 86 per cent of his cases.
The enlargement of the liver has been consid-
ered the most common entity, being present in
more than 90 per cent of the cases according to
Sheldon. Clinically, the liver is smooth and not
tender on palpation, and occasionally one finds one
lobe more involved than the other. Ascites has
been observed in about 20 per cent of the cases.
The spleen is enlarged, according to Sheldon, in
60 per cent of the cases.
Some of the less protean manifestations of the
disease are interesting and bear mention. The in-
fluence of the disease on the sexual characteristics
has been reported, and the changes in the male are
noteworthy. Loss of hair, impotence, and atrophy
of the testicles are characteristic. The basis of
such changes might be explained by the inactiva-
tion of estrogens by the liver or by the infiltration
of the anterior pituitary with hemosiderin.4
Marked asthenia may be present and could be ex-
plained by the involvement of the adrenal glands.
The neurological signs such as unsteady gait and
loss of tendon reflexes are infrequently encoun-
tered.
The diagnosis is established by the integration
of the symptoms and the following laboratory
aids : intradermal test of Fishback,6 skin biopsy,
demonstration of hemosiderin in the urine and
ascites fluid, and liver biopsy.
Case Report
J. N., aged forty-eight, was seen on February 18,
1948, about 4 :30 P.M. with the following history. On
February 17, he got up to go to work, but did not feel
too well. He was slightly nauseated. He had very little
breakfast and took his usual dose of protamin zinc in-
sulin, 80 units, and went to his office. About 11 A.M.
he came home and went right to bed. He refused food.
He slept all day but was muttering in his sleep. His wife
states that he would rouse to questions, but would go
right back to sleep. At 4 P.M. she coaxed him to take
a bowl of soup. He refused food during the night and
the following morning had very little breakfast, but did
not take insulin. When seen at home, he was drowsy,
restless, irrational, complained of nausea and vomiting,
and had a loose watery stool. His fever at home was
103.5°. He would answer questions rationally and in-
telligently, but if left alone for one or two minutes
would doze off and begin muttering incoherently. He de-
nied a cold. He was hospitalized at once.
Past history revealed jaundice in youth. First symp-
toms of any serious trouble appeared in 1934. Previous
to that time, he had averaged 220 pounds in weight and
had been very rugged. He played football, and was
January, 1950
55
HEMOCHROMATOSIS— HARRIS AND HANSEN
very active in sports while in school. In 1934, he lost 66
pounds in two months. At that time, he states that he
was very tired and mentally confused. Diabetes and an
enlarged liver were discovered at that time. He main-
tained a weight of 154 pounds for eight years on a diet
and 40 units of insulin daily. He then became careless
and again lost weight down to 145 pounds. At that time,
in 1942, he came under the care of one of us (C. N. IT).
When questioned about his color, he stated that he
thought the change had begun to appear about 1934 and
had steadily become more pronounced. The size of the
liver apparently had not changed since 1934. At that
time, 1942, he complained of pain in the lower one-
third of the right thigh, which was present for six
weeks. Previous to the onset of pain in the thigh, he
had sacroiliac pain for one month. When the pain left
the back, it migrated to the thigh. Diet and increase of
insulin to 60 units corrected the pain and increased the
feeling of well-being. Between 1942 and 1946, the blood
sugar ranged from 133 to 322. In February, 1946, he
developed a carbuncle on the neck. It then became nec-
essary to increase his insulin to 80 units. In April, 1946,
he developed a boil on the scalp. From then on to 1948,
he took 80 units of protamin zinc insulin daily. He was
next seen February 18, 1948, for his present illness.
His habits had been good since 1934, except for oc-
casional carelessness about his diet. He had never been
a heavy drinker. His father and mother were living
and well. He was married and his wife and one child
were living and well.
By occupation he sold oil, gas and accessories.
Examination revealed a well-nourished, adult man,
forty-eight years of age. The hair was sparse on the
scalp and body. The skin was a bluish color, but on
the exposed surfaces of the body — face, neck, and hands
— was almost bronze. There were a few spider nevi over
the upper chest. The ears were normal. There was no
cervical adenitis. The teeth showed no caries but there
were quite a few missing as a result of extractions. The
throat was moderately injected. The uvula was edem-
atous. The heart was slightly enlarged to the left and
downward. There was a faint mitral murmur, systolic in
time, not transmitted, which had never been heard pre-
viously. The blood pressure was 120/65. The lungs pre-
sented no areas of consolidation ; the respiratory excur-
sions were full and free. There were a few scattered
rales at both bases. There was rather more than mod-
erate distention of the abdomen. The liver was en-
larged and was palpated about 4 or 5 inches below the
costal margin anteriorly, and about 2 inches laterally.
The liver dullness also extended upward beyond the av-
erage margin. The edge was rounded and firm, but not
tender. The spleen was palpable, but not tender. There
was no tenderness or muscle-spasm present. There was
no hernia. The genitalia were normal except that the
testes appeared small. Chest x-ray by a portable ma-
chine revealed no consolidation.
The laboratory reports were as follows : hemoglobin
99 per cent, gms. 14.3, WBC 12,200; N. seg. 21, Seg. 65,
Lymph 12, Mono 2. Blood sugar 266 mg. per cent.
Temperature on admission was 103°. The temperature
ranged from 100.4 to 109 degrees on the last day of ill-
56
ness. Pulse on admission was 110; pulse elevation and
respiration corresponded fairly well with the tempera-
ture range. Sedimentation rate 23 in a half hour and
27.3 in one hour. Spinal fluid clear, colorless; protein 44,
Chlorides 698, Sugar 141. Urine 3 plus sugar, albumin
trace, acid 5.5. No diacetic acid or acetone.
On February 19, rales at the base were slightly in-
creased. They were fine and crepitant. The patient was
very disoriented. There was still moderate distention of
the abdomen, the legs and arms were sore. There were
petechial spots on the left arm and shoulder. There was
redness and tenderness of the left wrist and palmar
surface. There was tenderness of the left knee with
slight fluctuation and a floating knee cap. Active and
passive motion of all extremities was painful. The pa-
tient admitted having sore throat three days previous to
admission.
On February 20, there was marked disorientation, the
patient was argumentative, the fever was lower, but the
general condition was worse. The extremities were very
painful. He objected strenuously to being moved. There
were more petechiae and more redness of the left wrist.
The blood sugar was 400 mg. per cent. Spinal fluid was
normal. On this date, there was a murmur heard over
the aortic area which had never been present before.
On February 21, the general condition was much
worse. He was very drowsy; he would rouse to ques-
tions in the morning but roused with difficulty in the eve-
ning. His color was very poor and he was quite cya-
notic. The rales at the base of both lungs had increased.
The murmurs over the aortic area and the mitral area
were softer. Both wrists were swollen and much more
tender. The left knee was very tender. There was slight-
ly more redness and swelling. There was a blood culture
taken on this date.
On February 22, oxygen was started. The temperature
curve rose steadily from 101 in the morning to 105 at
midnight. He was very much worse. On the 23rd, his
color improved under oxygen. There were no new pe-
techial spots but those on the left arm and shoulder
were larger and more numerous. There was some
edema of the back. Cultures of the wrist and knee
joints were taken on this date; no pus was found. The
temperature and respiration rose steadily from 105 at
midnight to 109 at 10 :20 the next morning, when he
expired.
Treatment of the patient was primarily symptomatic,
and consisted in the use of penicillin in an attempt to
control the infection. Insulin was prescribed in increas-
ing doses in an attempt to control the hyperglycemia. Vi-
tamins and parenteral fluids were used as supportive
treatment. The diet was high in carbohydrates and
proteins.
Post-mortem findings were: (1) hemochromatosis and
cirrhosis of the liver, (2) hemochromatosis and fibrosis
of the pancreas, (3) septic spleen, (4) cholelithiasis,
(5) arteriosclerosis grade III of the aorta, (6) atrophy
of the testes.
Mention should be made of nature’s attempt to com-
pensate for this extensive cirrhosis and the disturbance
(Continued on Page 86)
Minnesota Medicine
PEPTIC ULCER IN INFANCY AND CHILDHOOD
Report of Three Cases
ROBERT B. TUDOR, M.D.
Bismarck, North Dakota
T TQLT.10 in 1913, from a study of ninety-five
cases of duodenal ulcer in infants below the
age of one year, found that of sixty-five cases in
which the age was given, 70 per cent of the pa-
tients were between the ages of six weeks and five
months, nine occurring in the newborn. In 1922,
Paterson14 discovered in the literature 100 cases
of duodenal ulcer in infants, and contributed two
of his own. Proctor,15 in 1925, in reviewing 1,-
000 cases of gastric ulcer and 1,000 cases of duo-
denal ulcer, found that in sixteen of the cases of
gastric ulcer and in twenty-six cases of duodenal
ulcer symptoms had been present since childhood.
Butka,4 in 1927, reported a ruptured gastric ulcer
in an infant on the fourth day of life. Shore,19
in 1930, reported a fatal perforated ulceration of
the stomach in a male infant twenty-two months
old. In 1932, Selinger18 reported three cases of
peptic ulcer in children under twelve months of
age. Foschee,8 in 1932, reviewed nineteen cases
of gastric ulcer in children. In 1933, White22
reported two chronic duodenal ulcers in children.
In 1934, Smythe20 reported two perforated gastric
ulcers in newborns who lived six and seven days.
In 1935, Tashiro and Ivobayashi21 reported a case
of perforated duodenal ulcer in a child of seven.
In 1940, Burdick3 reported eight cases of peptic
ulcer occurring at the Children’s Hospital, Wash-
ington, D. C., from 1932 to 1939 out of 21,231
admissions and two cases seen in private prac-
tice. In 1941, Bird, Limper and Mayer2 col-
lected 243 cases of peptic ulcer in children ^from
the literature. In 1941 Logan and Walters!1
collected fifteen cases of chronic gastric ulcer
which had been recorded since Foschee’s report
in 1932, and contributed one of their own. Fir-
man-Edwards,7 in 1941, reported a case of a
six-month-old child with cirrhosis of the liver
who expired following a perforated gastric ulcer.
There was no evidence of von Gierke’s disease in
the liver. In 1942, Newman13 emphasized the
importance of roentgen examination of the gas-
trointestinal tract in demonstrating peptic ulcer as
the cause of obscure abdominal symptoms in
From the Department of Pediatrics, Quain & Ramstad Clinic,
Bismarck, North Dakota.
Presented at the North Dakota Pediatric Society meeting,
Fargo, North Dakota, October 15, 1949.
January, 1950
children and added six cases to the literature.
C. A. Stewart,5 in 1943, reported four instances
of ulceration in the gastrointestinal tract during
the neonatal period. In two of the infants mul-
tiple gastric ulcers coexisted with erythroblastosis
fetalis. Schwartz and Halberstam,17 in 1943,
successfully operated on an eleven-month-old
male infant with perforated duodenal ulcer. In
1943, Benner1 reported eight cases of peptic and
duodenal ulcer which had been seen in the course
of about 500 routine autopsies on infants and
children at the Colorado General Hospital. One
case was remarkable because of the association of
ulcer with possible rhubarb poisoning. Two cases
of apparently healed ulcer were included. Guth-
rie9 found nine peptic ulcers in the autopsy ma-
terial in the Glasgow Royal Hospital for Sick
Children, between the years of 1914 and 1941,
in a series of 6,059 postmortems on children un-
der the age of thirteen (Table I). In 1944,
Meiselas and Russakoff12 reported a case of a
bleeding peptic ulcer in a two and one-half
months old child who subsequently expired.
Donovan,6 in 1945, reported ten cases of gastric
and duodenal ulcers in infants and children, from
the Babies Hospital, New York. Hemorrhage
occurred in six of the ten cases. Perforation and
pyloric stenosis were also observed. Rosenberg
and Heath,16 in 1946, reported a case of a gastric
ulcer with perforation in one of premature twin
boys. In this patient vomiting began on the
ninth day of life. Brown stools and dark vomitus
began on the thirty-sixth day. He died on the
fifty-fifth day.
The etiology of peptic ulcers in infants and
children in the majority is obscure. Prematurity
has been mentioned as a cause. Cases have oc-
curred in association with erythroblastosis fetalis.
Holt10 has emphasized that the age distribution of
“marasmus” and peptic ulcers is similar. There
may be an association between the development
of ulcers and the onset of hydrochloric acid
secretion in the stomach. The acidity of the gas-
tric juice reaches a maximum within forty-eight
hours of birth, when it is equivalent to that of an
adult. Thereafter, it falls rapidly and remains
57
PEPTIC ULCER— TUDOR
low during infancy. Ulcerations have been re-
ported in association with stenosis of the intestinal
tract. They have also occurred during the course
of hepatic disease, pancreatic disease, and erythro-
majority bleed seriously or perforate. In many
the onset is precipitous without recognizable
symptoms or signs. Except in a few cases neither
clinically nor at autopsy is there evidence of in-
TABLE I. CASES OF GASTRIC AND DUODENAL ULCERS OBSERVED IN
6,509 ROUTINE AUTOPSIES ON CHILDREN1’9
Age
Sex
Diagnosis
Type of Ulcer
1.
2 days
Male
Pneumonia with Otitis Media
Duodenal Ulcer
2.
3 days
Female
Multiple Congenital Anomalies
Duodenal Ulcer
3.
3 days
Female
Hematemesis and Melena
Duodenal Ulcer
4.
5 weeks
Male
Melena and Hepatitis
Three Duodenal Ulcers
5.
2 months
Male
Pertussis with Pneumonia
Duodenal Ulcer
6.
10 weeks
Female
Melena and Otitis Media
Duodenal Ulcer
7.
10 weeks
Female
Frequent Vomiting
Duodenal Ulcer
8.
1 1 weeks
Male
Frequent Vomiting and Diarrhea for Two Days
Three Duodenal Ulcers
9.
3 months
Male
Marasmus
Two Duodenal Ulcers
10.
17 weeks
Male
Melena and Otitis Media
Duodenal Ulcer
11.
14 months
Male
Tuberculous Meningitis
Duodenal Ulcer
12.
3 years
l'
Male
Rhubarb Poisoning
Duodenal Ulcer
Massive Hemorrhage
13.
6 years
Female
Hemopneumothorax Following an Accident;
Melena
Duodenal Ulcer
14.
9 years
Male
Tetanus
Duodenal Ulcer
15.
10 years
Female
Bronchopneumonia and Ruptured Appendix
Gastric Ulcer
16.
11 years
Male
Meningitis with Otitis Media
Duodenal Ulcer
Massive Hemorrhage
TABLE II.
Sex*
Type of Ulcer
Number
Operated
On
Symptoms
Age
Male
Female
Duodenal
and
Pyloric
Gastric
Stenosing
Perfor-
ated
Bleeding
Newborn
(0-14 days)
19
14
29
16
6
1
19
23
15 days-1 year
32
20
56
10
9
8
17
31
2-6 years
15
11
21
7
9
2
3
12
7-11 years
42
24
53
17
32
11
15
12
12-15 years
48
24
59
18
67
31
26
6
Totals
156
93
218
68
123
53
80
84
*In some of these the sex was not stated.
blastosis. Two cases have followed trauma, one
following external trauma, and one following
aspiration of the newborn respiratory tract. For
years the association between severe systemic
infection and peptic ulceration has been appre-
ciated. Many organisms, including streptococci
and tubercle bacilli, have been cultured from these
ulcers. Extensive body burns are many times
followed by peptic ulcers, probably because of
the infection which is usually also present. Stim-
ulation of the diencephalon will produce hypere-
mia of the gastric mucosa and will increase gas-
tric motility, hypertonus and hypersecretion. In
the adolescent group peptic ulcer may be a psy-
chosomatic disease. It has been suggested23 that
there is a possible association between the an-
terior pituitary gland and peptic ulcer in adoles-
cent boys.
Ulcers2 in the newborn, in whom the symptoms
become outstanding within the first two weeks
of life, have special characteristics. The great
tracranial injury or localized or generalized sepsis.
The lesions are acute.
During the first twenty-four months of life be-
yond the newborn period, the nature of the dis-
ease changes. Although again the great ma-
jority of ulcers bleed grossly or perforate, there
are often premonitory symptoms, such as refusal
of feedings, evidence of abdominal pain, vomiting,
occasional streaking of blood in the vomitus,
sometimes occurring over a period of weeks or
months before the onset of graver symptoms.
Persistent pylorospasm or inflammatory or cica-
tricial pyloric stenosis is seen occasionally. Many
of the patients are septic and marasmic.
Between the ages of two and six years recog-
nized examples of peptic ulcer are very few.
As age advances beyond the seventh year, there
is a rise in the number of cases recognized, with
special accentuation on pyloric stenosis and per-
foration. Hemorrhage recedes into the back-
ground. Among the cases reported in this age
58
Minnesota Medicine
PEPTIC ULCER— TUDOR
group, the symptoms have often been present
intermittently or continuously over a period of
months or years. ,
Hemorrhage from stomach or bowel is the most
characteristic sign of peptic ulceration in chil-
dren. In the series of cases here reported, bleed-
ing occurred in 48 per cent of the children un-
der one year and in 29 per cent of the total series.
Duodenal ulcer may cause spasm of the pylorus,
so that the condition may suggest pyloric stenosis.
Regardless of the age of the child, a complaint
of epigastric pain occurring sometime after meals,
particularly at night, relieved by the ingestion of
milk or other food or by emesis, and accompanied
by tenderness in the abdomen, should lead to a
very strong suspicion of peptic ulcer. Indefinite
abdominal discomfort, particularly if epigastric in
situation, even if unaccompanied by other charac-
teristic symptoms, may be caused by ulcer. Hy-
perchlorhydria is absent usually.
Pathologically, the ulcers seen in childhood
are similar to those seen in adults. If they are
chronic in type, the appearance in no way differs
from that of chronic ulcers in adults. A striking
feature in all acute ulcers is the absence of in-
flammatory reaction, the lesion being purely des-
tructive. Duodenal ulcers invariably occur above
the ampulla of Vater and are generally situated
on the posterior wall.
Of 286 cases of peptic ulcer, 283 collected from
the literature and three of my own, 218 were duo-
denal and pyloric and sixty-eight were gastric, a
ratio of 3 to 1. Operations were performed in
123 patients, indications for operation were py-
loric stenosis, perforation, hemorrhage and un-
controllable symptoms (Table II).
Report of Personal Cases
Case 1. — P.L.Z. This patient was a white, male in-
fant. The birth was apparently normal. The baby
nursed normally and seemed to be doing well until the
fifth day of life, when the abdomen became suddenly
distended. At that time the child became cyanotic and
very dyspneic. The temperature was 100.4° when the
child arrived at the hospital. The child was in extremis
when first seen. X-ray showed a large amount of air
in the peritoneal cavity with the diaphragm displaced
upward. The child expired one hour after admission
to the hospital.
Postmortem examination showed a perforation of the
upper end of the stomach through the greater curva-
ture, through which gastric contents were escaping.
The perforation measured 15 by 18 millimeters in dia-
meter. The other abdominal organs were normal.
There was partial atelectasis of both lungs.
Case 2. — T.E. This patient was a white male who
was born one month prematurely. Birth weight was 5
pounds 2 ounces. On the second day of life he began
vomiting bile. He passed meconium per rectum which
contained squamous epithelial cells. The gastrointes-
tinal x-rays showed a dilated bowel. On admission to
the hospital he was an emaciated, jaundiced white male
who had a feeble cry. There was moderate dehydration.
Examination was essentially negative except for a dis-
tended abdomen. Chest x-ray was negative. The
K.U.B. film showed a dilated large and small bowel
with fluid levels. The baby was Rh negative. Hemo-
globin was 116 per cent, and the white blood cell count,
8,200. The urine showed 3-plus albumin with 6 to 10
red cells and no sugar. Barium enema showed a stenosis
of the sigmoid.
A transverse colostomy was done on the fourth day of
life. The patient did well until the twentieth day of
life. He was maintained with blood transfusions and
given formula orally. The distal colon was irrigated
with saline and mineral oil. The colostomy worked well
at all times. He began passing blood from the proximal
colostomy on the twenty-third day of life. Shortly after
this he became distended and expired suddenly. Post-
mortem examination showed a perforated duodenal ulcer
and a stenosis of the sigmoid.
Case 3. — A.B. This patient was a fourteen-year-old
white male who had been complaining of abdominal
pain since he was seven years old, and did not care to
eat, especially at breakfast. Shortly after the pain began
he had a tonsillectomy and adenoidectomy. In about
six months he began losing weight and the pains seemed
more severe. He would sometimes vomit intermittently
for a month. He seemed to crave milk and chocolate.
When the pain became severe, he would lie down, as
he could not stand. His appendix was removed when
he was eleven years old, without influencing the course
of his illness. By the time he was twelve, he had be-
come very nervous and would eat very little because
he said “his stomach did not feel like it needed food.”
The pain continued until when first examined he had
been vomiting for two months. He never had melena
or hematemesis.
The family history was interesting in that both
mother and father felt they had stomach trouble.
The patient was a well-developed, fairly well-nour-
ished, white male. The temperature was 99°. Weight
was 73 pounds. Blood pressure was 100/70. The
skin was moderately dehydrated, but there was no gen-
eral glandular enlargement. Head and neck were nor-
mal. The fundi were normal. Ears, nose and throat
were normal. The heart and lungs were normal. The
abdomen was diffusely tender. Genitalia were normal.
Rectal examination was negative. Extremities were
normal. Neurological examination was normal. Ac-
cessory clinical findings: hemoglobin, 88 per cent; urine
January, 1950
59
PEPTIC ULCER— TUDOR
normal ; white blood cell count,- 9,050. Stool specimens
were negative for occult blood on four occasions. In-
travenous pyelograms were normal. Gastrointestinal
x-rays showed the duodenal bulb to be markedly de-
formed, with an ulcer crater in the center of the bulb
and a second crater in the distal portion of the bulb.
The patient fainted twice during the examination.
Analysis of the gastric content showed free hydrochloric
acid of 23 degrees and combined hydrochloric acid of
15 degrees.
He was treated with bed rest, small blood transfusions,
1 :5,000 atropine sulfate, Amphojel, multiple milk feed-
ings and a bland diet. On discharge from the hospital
his weight was 80 pounds. The gastric analysis at that
time showed free hydrochloric acid of 28 and combined
hydrochloric of 14 degrees.
On his last examination three months after his ad-
mission to the hospital, his weight was 85 pounds, and
the hemoglobin was 81 per cent. He was feeling very
well and had no complaints. X-rays at this time showed
some irritability and deformity of the duodenal bulb,
but no definite ulcer crater was noted.
References
1 Benner, M. C. : Peptic ulcers in infancy and childhood. J.
Pediat., 23:463-470, 1943.
2. Bird, C. E.; Limper, M. A., and Mayer, J. M.: Surgery
in peptic ulceration of stomach and duodenum in infants
and children. Ann. Surg., 114:526-542, 1941.
3. Burdick, W. F. : Peptic ulcer in children. J. Pediat., 17:
654-658, 1940.
4. Butka, H. E.: Ruptured gastric ulcer in infancy. JAMA,
89:198-199, 1927.
5. Crawford, R., and Stewart. C. A.: Gastric ulceration com-
plicating erythroblastosis fetalis. Tournal-Lancet, 63:131-
134, (May) 1943.
6. Donovan, E. J., and Santielli, T. V. : Gastric and duodenal
ulcers in infancy and in childhood. Am. Jour. Dis. Child.,
69:176-179, 1945.
7. l'irman-Edwards, L. : Cirrhosis of liver and perforated gas-
tric ulcer in an infant of six months. Brit. M. J., 2:440,
(Sept. 27) 1941.
8. Foshee, J. C. : Chronic gastric ulcer in children. JAMA,
99:1336-1339, 1932.
9. Guthrie, K. J.: Peptic ulcer in infancy and childhood.
Arch. Dis. Childhood, 17:82-94, (June) 1942.
10. Holt, L. E.: Duodenal ulcers in infancy. Am. Jour. Dis.
Child., 6:381-393, 1913.
11. Logan, G. B., and Walters, W. : Chronic gastric ulcer in
childhood treated surgically. Ann. S.urg., 113:260-267, 1941.
12. Meiselas, L. E., and Russakoff, A. H.: Bleeding peptic ulcer
in infancy. Am. J. Dis. Child., 67:384-386, 1944.
13. Newman, A. B.: Peptic ulcer in childhood. Am. J. Dis.
Child., 64:649-654, 1942.
14. Paterson, D.: Duodenal ulcer in infancy. Lancet, 1:63-65,
(Jan. 14) 1922.
15. Proctor, O. S.: Chronic peptic ulcer in children. Surg.,
Gynec. & Obst., 41:63-69, 1925.
16. Rosenberg, A. A., and Heath, M. H.: Acute gastric ulcer
with perforation in one of premature twins. J. Pediat.,
28:93-95, 1946.
17. Schwartz, S. A., and Halberstam, C. A.: Duodenal ulcer
in infancy. Arch. Pediat., 60:185-193, (April) 1943.
18. Selinger, T.: Peptic ulcer in infants under one year of age.
Ann. Surg., 96:204-209, 1932.
19. Shore, B. R. : Acute ulcerations of the stomach in chil-
dren. Ann. Surg., 92:234-240, 1930.
20. Smythe, F. W. : Gastric ulcers in the premature newborn.
Am. J. Surg., 24:818-827, 1934.
21. Tashiro, K., and Kobayashi, N.: Perforated duodenal ulcer
in child of seven. Am. J. Surg., 29:379-383, 1935.
22. White, C. S.: Chronic peptic ulcer in childhood. J. Pediat.,
3:568-572, 1933.
23. Winkelstein, A. : Peptic ulcer in adolescence. J. Mt. Sinai
Hosp., 12:733-775, (May-June) 1945.
This paper is dedicated to Dr. W. C. Davison, Dean of
the Duke University Medical School, in appreciation of
his counsel and guidance.
MUCIN-ALUMINUM HYDROXIDE-MAGNESIUM TRISILICATE
“Mucotin”-Harrower. — An antacid mixture of
gastric mucin, dried aluminum hydroxide gel, U.S.P.
(ALO3.XH2O), and magnesium trisilicate, U.S.P. (2Mg
0.3Si02xH20), containing the labeled amounts of these
ingredients.
Actions and Uses. — A mixture of histamine-free gastric
mucin, aluminum hydroxide and magnesium trisilicate
has been found to be an effective combination for oral
administration in the control of symptomatic gastric
hyperacidity and as an adjunct in the treatment of peptic
ulcer. Gastric mucin has been shown to impart to the
mixture a more distinct protective coating effect on the
gastric mucosa than can be demonstrated with the use
of antacids alone. Gastroscopic studies indicate that the
mucin-antacid combination definitely coats the ulcer
crater and may remain in the stomach for over an hour
after instillation of the mixture. The antacid effect of
the rapidly reacting aluminum hydroxide and the more
slowly but prolonged reacting magnesium trisilicate, im-
parts to the mixture the advantages of both these
antacids. The presence of magnesium trisilicate is also
believed to counteract the constipating effect of the
aluminum hydroxide but the available evidence on this
point is not conclusive.
Dosage. — There is as yet no definite evidence by which
to determine the optimum exact proportions of the
antacids to be used in the mixture, but observations thus
far indicate that best results are obtained with prepara-
tions containing approximately 10 per cent of gastric
mucin. A ratio of 1:1.5:275 for gastric mucin-alumi-
num hydroxide-magnesium trisilicate has been found to
give good results. A tablet preparation of these pro-
portions containing gastric mucin 0.16 Gm., dried
aluminum hydroxide gel 0.25 Gm. and magnesium tri-
silicate 0.45 Gm. is recommended in doses of two tablets
every 2 hours. The tablets should be well chewed and no
fluids taken during the following half hour.
The Harrower Laboratory, Inc., Glendale 5, Calif.
Tablets Mucotin: Each tablet contains gastric
mucin 0.16 Gm. dried aluminum hydroxide gel 0.25
Gm. and magnesium trisilicate 0.45 Gm.— JAMA,
May 7, 1949.
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Minnesota Medicine
History of Medicine In Minnesota
MEDICINE AND ITS PRACTITIONERS IN OLMSTED COUNTY PRIOR TO 1900
NORA H. GUTHREY
Rochester, Minnesota
(Continued from the December issue)
There follows a chronological roster, essentially accurate, of the medical staff
of the Second Minnesota Hospital for Insane (Rochester State Hospital) from
1879 to 1899, inclusive :
Jacob Eton Bowers
William Alonzo Vincent
Alexander Brodie Cochrane
Homer Collins
Robert McEwen Phelps
J. Robert Eby (med. student)
Harry Raymond Randall
Arthur Foote Kilbourne
Lloyd Anson Faulkner
Nathaniel Morton Baker
Sara V. Linton
(Mrs. R. McE. Phelps)
Frederick Eduoard Franchere
Eric Olonzo Giere
George W. Moore
Jackman
Cyrus Bowers Eby
H. H. Herzog
W. H. Withrow
Mary Elizabeth Bassett
Cheever
Rose Anne Bebb
Abraham Franklin Strickler
Ernest Z. Wanous
Oscar C. Heyerdale
Charles L. Chappie
Superintendent
Assistant Physician
Assistant Physician
Assistant Physician
2nd Assistant Physician
1st Assistant Physician
Assistant Superintendent
Apothecary
Assistant Physician
Acting Superintendent
Superintendent
Assistant Physician
Assistant Physician
Assistant Physician
Assistant Physician
Assistant Physician
Intern
Assistant Physician
Assistant Physician
Intern
Assistant Physician
Assistant Physician
Apothecary
Assistant Physician
No Record
Intern
Assistant Physician
Assistant Physician
Assistant Superintendent
Assistant Physician
Assistant Superintendent
Assistant Physician
Assistant Superintendent
Assistant Physician
Jan. 1, 1879— Oct. 1, 1889
Mar. 1, 1881— Aug. 1, 1883
Aug. 1, 1883— Dec. 1, 1884
Dec. 1, 1884— Oct. 1, 1889
Mar. 1, 1885— Oct. 1, 1889
Oct. 1, 1889— Oct. 1, 1890
Oct. 1, 1890— Sept. 12, 1912
June ?, 1888— Oct. ?, 1889
Jan. 1, 1889— Oct. 1, 1889
June 1, 1889 — -Nov. 1, 1889
Nov. 1, 1889 — Nov. 30, 1934
Oct. 1, 1889— Nov. 1, 1889
Oct. 1, 1889— May 1, 1893
Oct. 1, 1889— Feb. 1, 1898
Oct. 1, 1891— July 1, 1892
July 1, 1892— Oct. 1, 1892
July 1, 1892— Oct. 1, 1892
Oct. 1, 1892— July 1, 1893
July 1, 1893 — No record
July 1, 1893— Dec. 9, 1893
Dec. 9, 1893— Feb. 1, 1899
Dec. 1, 1893— Feb. 1, 1899
Dec. 1, 1893— 1898?
July 19, 1895— Feb. 28, 1896
1896?
July 1, 1897— Feb. 1, 1898
Feb. 1, 1898— Mar. 3, 1900
May 16, 1899— June 10, 1899
June 10, 1899— July 10, 1899
May 19, 1899— July , 1899
July , 1899 — Feb. 1, 1902
July 13, 1899— Aug. 1, 1912
Aug. 1, 1899— July 1, 1937
Aug. 31, 1899— April 1, 1911
St. Mary's Hospital. — -The first general hospital in Olmsted County and a
large surrounding region, St. Mary’s Hospital is believed to owe its inception to the
tornado of August 21, 1883, which destroyed much of north Rochester, killed
thirty-five persons and injured more than fifty others. All unaffected persons in
January, 1950
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HISTORY OF MEDICINE IN MINNESOTA
Rochester, physicians and laity, rallied to aid the sufferers, who were housed
temporarily in private homes, in hotels, at the Academy of Our Lady of Lourdes
and elsewhere. On the day after the storm a hospital was improvised in Rommel’s
Hall, in central Rochester, and Dr. W. W. Mayo was appointed physician in
charge, and his son-in-law, Dr. D. M. Berkman (a veterinarian), an able organizer,
was appointed steward. On the same day Mother Mary Alfred, Superior of the
Sisters of the Third Order of St. Francis of the Congregation of Our Lady of
Lourdes, volunteered aid in nursing the injured and delegated four sisters to that
service.
To Mother Alfred the catastrophe gave so clear a vision of what a permanent
institution for care of the sick could mean to the community that, not long
afterward, she told Dr. Mayo that the sisters intended to establish and maintain
a hospital in the city, and asked him to help plan the hospital and to take charge of
it. The doctor tried to dissuade Mother Alfred: Public opinion would be adverse,
since hospitals at that period were not in good general repute ; the town was too
small to support a hospital ; the expense of construction and equipment would be
great; and he himself, then in his seventieth year, was too old to assume the
responsibility she asked. Mother Alfred nevertheless proceeded quietly with plans
to raise the necessary money.
In 1887, Dr. Mayo having consented to serve, a tract of nine acres was bought
as the hospital site, a mile west of the city post office and just outside the city
limits at the end of Zumbro Street. In the next two years Dr. Mayo and his elder
son, Dr. W. J. Mayo (C. H. Mayo was still in medical school), traveled widely
to study hospital planning and management. In August, 1888, Joseph D. Billings-
ley, of Winona, contractor, began the construction. In the spring of 1889 George
Weber and Granville Woodworth, of Rochester, assumed the contract, and in the
autumn of that year completed the work. During the period of construction it
was announced that the hospital facilities would be available to all physicians of
good standing in the region, that the sick would be received regardless of race,
creed or financial condition and that they might choose any physician they wished.
When the building was nearing completion, plans were made for a ceremonial
opening of the hospital on October 1, 1889, but as it happened the beginning was
simple. On September 30, 1889, St. Mary’s Hospital admitted its first patient, who
was in need of surgical aid for cancer of the eye, and on that morning Dr. W. J.
Mayo and Dr. C. H. Mayo performed the operation, with Dr. W. W. Mayo
administering the anesthetic.
On the afternoon of October 8 the Olmsted County Medical Society held a
meeting at the hospital, at which were present the members of the society, some
of whom were physicians from counties neighboring Olmsted County, and invited
guests. At the meeting Dr. W. T. Adams, of Elgin, Dr. A. W. Stinchfield, of
Eyota, and Dr. H. H. Witherstine, of Rochester, were a committee who drafted
and presented the following resolutions, which were accepted unanimously :
WHEREAS, the Sisters of St. Francis have erected this beautiful and commodious hospital
in the City of Rochester and we, the physicians of Olmsted County and adjoining counties,
represented in the Olmsted County Medical Society, upon examination find it to be one of
the finest and best arranged hospitals in the state, Therefore,
Resolved, that it is worthy of the support and patronage of the medical fraternity of
this vicinity.
Resolved, that much is due to Dr. W. W. Mayo for his valuable suggestions with reference
to the details of the hospital.
The ceremony of blessing the hospital was held on October 24, 1889, in the
presence of a few invited citizens.
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The new hospital was a three-story building of red brick with rough stone
trim. It contained two ten-bed wards, one three-bed ward, one semiprivate room
and two private rooms, a total capacity of twenty-seven hospital beds. Modern
conveniences, which at that time were almost unknown in Rochester, were lacking.
Four Sisters of St. Francis constituted the administrative and nursing staff and,
frequently, the maintenance staff. Dr. Mayo and his sons were the physicians in
charge. Miss Edith Graham (later Mrs. C. H. Mayo), of Rochester, the first
trained nurse in the city, who had been graduated that year from the Woman’s
Hospital of Chicago and who was employed by the Drs. Mayo in their offices,
gave the sisters lessons in professional nursing and became the first woman
anesthetist at St. Mary’s Hospital.
Not long after the hospital was established, Dr. W. W. Mayo began to reduce
his professional activities, and he soon relinquished the chief responsibility to
his sons. Until 1892 these two, “the greenest of a green crew,” as they afterward
described themselves, carried all medical and surgical services alone ; in surgery,
turn about, each acted as assistant to the other. They visited hospitalized patients
early in the morning, operated from 7 :30 a.m. or earlier until 1 p.m. or later, in
the afternoon held consultations at the offices downtown, and were on call, and
often at the bedside of patients, all night. In February, 1892, Dr. A. W. Stinchfield
came from Eyota to join the Drs. Mayo in practice, in offices and hospital, and in
the spring of 1894 Dr. Christopher Graham, of Rochester, recently graduated in
medicine, became a member of the group and the first intern at St. Mary’s. For
three years these five physicians were the hospital staff. By 1899 the group in-
cluded nine physicians.
For thirteen years Dr. W. J. Mayo and Dr. C. H. Mayo were the only surgeons
at St. Mary’s Hospital. When the hospital opened, the brothers, grateful to the
Sisters of St. Francis for unique opportunity, declared that they never would
“hold the knife outside St. Mary’s Hospital,” and they kept their word. Only on
occasion of emergency or when they gave aid as surgeons at the state hospitals for
insane at St. Peter and Rochester, did other operating rooms know them.
In its first three months, in 1889, St. Mary’s Hospital received sixty-eight
patients. There were 301 admissions in 1890 and 315 in 1891. The annual
registration continued to increase gradually until, in 1899, the hospital received
938 patients. It is recalled that some months before the hospital building was com-
pleted, Dr. C. H. Mayo optimistically prophesied to Mother Alfred that in time
the hospital would “get patients from all these towns around here,” and that
Mother Alfred hopefully but somewhat doubtfully agreed. Within three years
patients were coming from Illinois, Kansas, Michigan, Minnesota, Missouri,
Montana, Nebraska, North Dakota, South Dakota, New York, Ohio and Wisconsin.
Within twenty years they were coming from nearly every state of the Union and
from every continent of the world. In its first ten years two major additions were
made to the hospital building. Since 1900 there have been six great additions,
exclusive of St. Mary’s ’ Isolation Hospital, and corresponding expansion of
services. In 1918 the sisters purchased the Lincoln Hotel, remodeled it and
converted it into an isolation unit, which was opened as St. Mary’s Isolation
Hospital on June 14, 1918. Near St. Mary’s, but not an addition to the hospital
buildings proper, the unit provided additional hospital space and made possible
an important extension of service.
Although from the beginning St. Mary’s Hospital met with phenomenal success
and usefulness as a self-supporting institution, its earliest years were difficult.
At the time the hospital was planned, and when it was opened, hospitals were
regarded by the general public as last resorts for the homeless and the destitute
January, 1950
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HISTORY OF MEDICINE IN MINNESOTA
and were classed with prisons, insane asylums and county institutions, so that
most persons would not consider entering a hospital as patients. To increase the
difficulty, the project at first did not have the endorsement of all of the Sisters of
St. Francis, nor of the Catholic community, who were in the minority in Rochester.
Sectarian feeling was high, and there was hostility toward the hospital on the part
of certain Protestants of the city. The situation was made more disagreeable
by a wave of organized anti-Catholic propaganda, of the American Protective
Association, that was sweeping the country at that time, and residents of the
locality were either partisan or conservative. Most of the local physicians, al-
though they esteemed the Mayos personally, were not inclined to associate them-
selves with a doubtful venture, and consequently an attempt to organize a general
medical staff for the hospital was a failure. In addition, there were Catholics,
and especially Catholics who had relatives in the medical profession, it is said, who
felt that the hospital should not be staffed by Protestant physicians. It was even
suggested that the hospital should be closed. Among both Catholics and Protestants,
however, the close personal friends of Mother Alfred and of Dr. W. W. Mayo and
his sons, knowing the sincerity of purpose with which the hospital had been
planned and built, remained steadfast in their friendliness towards the undertaking.
In the early nineties, when the first addition to the hospital was being projected,
a second wave of organized propaganda swept over the Northwest, and because of
it the early opposition to St. Mary’s was revived. The hospital once more was
criticized as a Catholic agency and patients were advised not to go there for
treatment. In Rochester several Protestant ministers and their congregations
entered into the campaign. Homeopathic physicians, endorsed by the opposing
ministers and congregations, in the autumn of 1892 opened a new hospital, the
Riverside, which was received with enthusiasm. When Dr. W. J. Mayo and Dr. C.
H. Mayo, faithful to St. Mary’s Hospital, refused to become associated with the
new hospital or to operate there, they again became the subjects of severe criticism,
which again they accepted without comment. The local regular physicians of the
region during this period remained essentially neutral toward St. Mary’s and took
no part in the management of the new hospital. At the end of three years the
Riverside Hospital closed and sectarian opposition to St. Mary’s ended.
Gradually the public came to appreciate the worth of St. Mary’s Hospital, and
physicians of the region other than the Drs. Mayo began to avail themselves of
the privilege of bringing in their patients. Some of the patients who were brought
could have been cared for satisfactorily at home, however, and these needlessly
occupied hospital beds. From time to time others who had been exposed to
contagious disease were admitted inadvertently, and frequently moribund patients,
were brought in. The lack of space for the seriously ill, the worry and difficulty
of dealing effectively with contagious disease, and the increase in the annual
hospital mortality, not great but a cause for anxiety, after a few years caused the
sisters, about 1895, to take the courageous step of establishing a new ruling:
that the facilities of the hospital still should be available to all physicians in good
standing, but that no patient should be admitted who had not been examined by
one of the Drs. Mayo. The rule was carried out tactfully, the Drs. Mayo simply
assuring the sisters and themselves that the privileges of the hospital were not
abused and that its welfare was not endangered.
St. Mary’s Hospital opened as a general hospital, but the influx of surgical
patients and the lack of room for them soon caused the sisters to change the
institution to an exclusively surgical hospital until sufficient space could be provided
for general hospital work. It was not until 1914, after six additions had been
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HISTORY OF MEDICINE IN MINNESOTA
made to the building, that there was marked increase in facilities for the medical
treatment of patients in the hospital.
In a booklet, A Souvenir of Saint Mary’s Hospital, issued by the sisters in 1922,
the following dedication appears: “To the memory of Mother Mary Alfred,
O.S.F., Foundress of Saint Mary’s Hospital, and of William W. Mayo, M.D., who
directed and organized the foundation, this volume is affectionately dedicated.”
Sister Mary Hyacinth was in charge of the hospital until Mother Mary Alfred was
appointed superintendent on November 5, 1889. Sister Mary Hyacinth replaced
Mother Mary Alfred on August 28, 1890. Sister Mary Joseph, who succeeded
Sister Hyacinth, on September 9, 1892, guided St. Mary’s Hospital until her
death on March 29, 1939, when Sister Mary Domitilla became superintendent.
The progress of St. Mary’s Hospital has continued without interruption (1949),
as has its relationship with the Drs. Mayo and their associates, a group which
since 1914 has been known officially as the Mayo Clinic.
The Riverside Hospital. — The Riverside Hospital, mentioned earlier in this
history, functioned in Rochester from November, 1892, into September, 1895. The
hospital was established by Dr. W. A. Allen, an esteemed pioneer homeopathic
physician who settled in Rochester in 1872, and Dr. Charles T. Granger, a native
son of Olmsted County. Dr. Granger was graduated with distinction from the
Hahnemann Medical College of Chicago in March, 1892, was licensed in Minne-
sota after passing a creditable examination, and in April entered into partnership
with Dr. Allen. In July, 1892, the two doctors bought a large residence on Line
Street, East Rochester, remodeled it and equipped it as a hospital, modern in its
day, and employed a competent nursing staff. The hospital was well received by
the press and by the public, and its wards, medical and surgical, soon were filled
with patients. As was the custom in that period, an occasional patient published
in a local newspaper an expression of gratitude for the good care received.
A group of Rochester women, many of them of the Universalist congregation,
organized the Riverside Hospital Aid Society, to help supply equipment for the
wards and to prepare surgical dressings. In March, 1894, a group of 175 friends
of the hospital surprised Dr. Allen with a social gathering on his sixtieth birth-
day and presented him with a large new homeopathic medicine case.
By the summer of 1895 the operation of the hospital had become impracticable.
In the middle of September Dr. Allen, then mayor of Rochester, announced that he
was moving to Saint Paul, to enter practice with Dr. O. H. Hall, late of Zumbrota,
that he would leave his local practice in the hands of Dr. Granger, but that he
would return to Rochester each week in order to oversee construction of the new
city sewer, which was under way.
On September 27, 1895, the Rochester Post stated that because of Dr. Allen’s
departure it had been decided to close the Riverside Hospital, which henceforth
would not be open for the reception of patients. In March, 1896, Dr. Allen
resumed residence and practice in Rochester. After August, 1896, he and Dr.
Granger were not in partnership.
The Beginnings of the Mayo Clinic
The Mayo Clinic was not established. It is a development that had its beginnings
in the private general practice of one competent pioneer physician and surgeon,
Dr. W. W. Mayo, who came to Rochester, Olmsted County, in the spring of 1863.
From a private practice there grew a private group practice in which individualism
in co-operative form was fostered and in which it has been maintained.
Dr. W. W. Mayo came to Rochester from Le Sueur as examining surgeon on the
January, 1950
65
HISTORY OF MEDICINE IN MINNESOTA
Enrollment Board of the First Congressional District of Minnesota. When he left
the board two years after his appointment, he opened an office on Third Street for
private practice. In the next twenty years he changed his office location some
seven times and on several occasions entered into partnership for medical practice
with one local practitioner or another. These associations were short lived. From
the beginning he won the confidence of laity and profession and gradually built
up a practice which by the early eighties was one of the largest in southeastern
Minnesota.
In May, 1883, shortly before his elder son, Dr. W. J. Mayo, returned home
from medical school to begin practice with him, Dr. Mayo established offices over
the drug store of George Weber, on the corner of the then Main Street and Zumbro
Street, where the C. F. Massey Company’s department store now is. In the next
thirteen years there were, at intervals of about two years, extensive renovation,
enlargement and re-equipment of the offices, to meet the requirements of the
rapidly growing practice. A major change was made just before Dr. C. H. Mayo
came home from medical school to join the family team, in 1888, and comparable
changes were made in 1892, when Dr. A. W. Stinchfield became a partner, and in
1894, when Dr. Christopher Graham joined the group. In 1893 equipment was
improved by addition of an expensive Leitz microscope, imported from Germany,
which was used in a small upstairs room. Tn 1896 the Olmsted County Democrat
gave an enthusiastic description, under the heading, “Complete Offices,” of the
quarters of the Drs. Mayo, Stinchfield and Graham, who were then occupying
additional space both on the ground floor and upstairs, and stated that Weber and
Heintz, whose drug store adjoined the offices, also had increased their space to
make room for their prescription department. In 1898 Dr. M. C. Millet and Dr.
Gertrude Booker joined the Mayo group. On November 29, 1900, the firm moved
into quarters that had been especially created for them on the ground floor of
the new Masonic Temple, diagonally across the junction of Zumbro Street and
Main Street from the former offices. There were now general reception rooms,
a reception room and library, “for visiting physicians who have come here with
cases or to attend clinics at St. Mary’s,” a clerical and business office, consulting
and examining rooms for the staff physicians, a dark room for “eye cases,” and
a small laboratory under the charge of Dr. Isabella Herb, who had begun work in
January, 1900, as pathologist and anesthetist at St. Mary’s Hospital. In this
laboratory, routine tests of blood, urine and sputum were made. There was an
x-ray room, which was not put into active use, however, until Dr. H. S. Plummer
joined the group in 1901. Tn the fourteen years of the firm’s occupancy, the
offices were enlarged within the limits of the Masonic building and by the use of
detached rooms in buildings near by.
It is important to note the fact that Dr. W. W. Mayo and, in due time, his
sons and later associates scrupulously maintained office hours, and that by so
doing they built up a large office practice — this in a period when the average
physician maintained an office only as a starting point for his daily rounds of
visiting patients in their homes.
In his early practice Dr. W. W. Mayo performed surgical operations in the
homes of his patients, as was the custom of the time. By the late seventies he
was utilizing rooms in one of the small hotels of Rochester for surgical opera-
tions and for postoperative care of patients from a distance, who by then were
coming to him in considerable numbers. In the eighties, as stated earlier, he had a
small private hospital of eight or nine beds in the home of a Mrs. Carpenter, a
practical nurse in north Rochester. He was recognized in those years as a versatile
and courageous surgeon, and he occasionally invited interested physicians from
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Minnesota Medicine
HISTORY OF MEDICINE IN MINNESOTA
neighboring towns and from Saint Paul and Minneapolis to observe surgical
operations, especially ovariotomy. Those occasions were the first surgical clinics
held in Rochester, although they were not called clinics. After the sons joined their
father, the surgical practice especially increased. They had a natural bent for
surgery. They were eager for new knowledge, and they traveled, alternately, to
study and to observe the work of other surgeons, in Chicago and in Boston, New
York, Philadelphia and elsewhere. In those early years Christian Fenger, Arpad
C. A. Gerster, Robert Weir, William T. Bull, Frederick Lange, Robert Abbe,
William W. Keen and Joseph Price and many others taught them much. Soon
they traveled abroad. They attended meetings of medical societies, local, regional,
national and international, and early began to contribute reports and papers to the
programs and to medical journals.
By 1890 many local physicians were coming to observe the surgical work of
the Mayo brothers. In the newspapers of southeastern Minnesota of the nineties
are to be found little items to the effect that Dr. , of Eyota, or Plainview
or Wabasha, for example, or a group of doctors, had spent a day or several days in
Rochester “attending clinics at St. Mary’s” or “observing operations at the Drs.
Mayo.” In these years physicians from near-by states began to come, bringing
patients and staying to observe the surgical clinics. Drs. A. J. Oschner and J. B.
Murphy, of Chicago, were among the first visitors to come from large cities. Well
before 1905 there were physicians from the East, and from Europe, among the
observers and among the personal friends of members of the firm. Evidence of
nation-wide recognition of the work in Rochester is found in the unanimous
election, in 1905, of Dr. W. Mayo to the presidency of the American Medical
Association. Visiting physicians in Rochester began to speak of the Mayos’
clinics, of the Mayos’ clinic at St. Mary’s Hospital, and soon of the Mayo Clinic.
St. Mary’s probably was the first, as early as 1899, to refer to “clinic patients.”
By the early or middle nineties, surgery, at first one part of a general practice,
had become the predominant part of the Mayos’ work, and it so remained for
nearly twenty years. In 1904 only fourteen patients were treated medically at
St. Mary’s Hospital, which had opened in 1889 as a general hospital. As stated
earlier, it was not until 1914 that special provision was made for the medical
care of patients in the hospital. That year marked the increasing interest of the
Drs. Mayo and their associates in the science and art of internal medicine and the
beginning of continuous development of all facilities for the medical care of hos-
pitalized patients.
The educational work in medicine and surgery, which since 1915 has been carried
on by the Mayo Foundation for Medical Education and Research, affiliated with
the University of Minnesota, began in the early nineties when a few medical
students, usually local young men, spent their summer vacations at St. Mary’s,
observing operations and working as orderlies and as volunteer helpers in the little
laboratory. Perhaps the first graduate observer of long attendance was Dr. W. A.
Chamberlain, of St. Charles, who in 1898 spent several months in Rochester.
Gradually the Drs. Mayo took in young graduate physicians as clinical helpers and
as assistant surgeons, training them carefully themselves. For some years these
men were known as interns, externs, and assistants. It was in 1906 that weekly
staff meetings were inaugurated by Dr. H. Z. Griffin, who had joined the Drs.
Mayo that year. These meetings and resulting and related special staff con-
ferences and seminars have had an important part in the growth of medical educa-
tion in the clinic and the foundation.
(To be conivmed in the February issue)
January, 1950
67
F. J. Elias, M.D.
President, Minnesota State Medical Association
68
Minnesota Medicine
Presidents better
1950
ORDINARILY a calendar doesn’t mean much to a physician. Except for sea-
sonal complaints — the spring epidemics, the late summer allergies, and the
many hazards that winter brings — the physician’s life is dictated more often by his
wrist watch than his calendar. But, like everyone else, physicians on January first
are jolted out of their routine into an evaluation of the year past and predictions
and plans for the year ahead.
The Minnesota State Medical Association can look back on 1949 with satisfaction.
It has been a good year. We have been able to distinguish our sociological, as well
as our medical and scientific responsibilities, and to minimize neither. This has come
about through the devoted and high -principled leadership that the Association was
fortunate enough to gain, and through the active co-operation of the membership.
In 1950, I feel sure, we can expect continued attempts to negate recognition of
medical advances and to turn medical care into a commodity. This to be sold or
doled out, according to nebulous plans, made both inside and outside the govern-
ment, by individuals who assume that an interest in the subject — either sincerely
humanitarian or hypocritical and selfish — and/or their status as recipients of med-
ical care are all the qualifications they need to be medical experts.
In addition, then, to our primary responsibility to the patient, to provide him
with increasingly better care, we are faced with usurpation of medical practice that
would transform it from a profession into a business.
It is our prime obligation to save ourselves and our patients, and medicine and
the public of the future, from this eventuality. In accomplishing this objective, we
are fulfilling more than one requirement of good citizenship. For the physician, in
convincing his fellow men that it is to their best interest to reject proposals contrary
to the American way, must mingle more in his community than, perhaps, has been
his custom. In fending off injurious legislation, the doctor will find himself
marching regularly to the polls and aiding in the selection of legislators, not politi-
cians.
It is an honor to have been elected to the highest office of the Minnesota State
Medical Association during this time of crisis, when the health of the nation is
precariously balanced between progress and deterioration, and when the action we
take, as individuals and members of an association, may well influence the choice.
My best efforts are pledged to maintaining the ethics and standards of the pro-
fession and in interpreting them to the people of Minnesota in terms of their own
health and happiness.
President, Minnesota State Medical Association
January, 1950
69
♦ Editorial ♦
Carl B. Drake, M.D., Editor; George Earl, M.D., Henry L. Ulrich, M.D., Associate Editors
THE YEAR 1950
T I IS difficult, in facing the new year, to be
complacent about the state of affairs in our
own country and the world in general.
The estimated federal deficit of 5.5 billion dol-
lars is disconcerting to one who believes in the
balancing of budgets. With high production and
employment we should be paying off on our huge
national debt rather than further increasing it. It
is obvious that the only way to balance the budget
is by increasing taxation or reducing expenditures.
Economists say that high taxes have already re-
sulted in disappearance of risk capital which has
resulted in lending by the government rather than
by private capital. Taxation has well nigh reached
the point beyond which there will be diminishing
returns. While visible taxes are burdensome, the
invisible ones which are present in everything that
is bought are insidious, in that the public is not so
conscious of their existence and is not sufficiently
spurred on to demand government economy. Suf-
ficient demand on the part of the public for the
need of government economy is the only influ-
ence which will affect Congress and our State
legislatures.
Ways have been pointed out for effecting econ-
omy in government; the Hoover report for one.
Its recommendations have not been followed.
Federal subsidy of states for activities which are
state responsibilities foster extravagance. The
temptation for the states to match federal subsi-
dies seems well nigh irresistible. The citizens of
each state are paying for both expenditures. Price
pegging by the government, while it artificially as-
sists one group, only increases the cost of living
and taxes. The more the artificial regulation of
our economy, the greater the number of govern-
ment employees needed.
Our own people are sick and tired of war. Plow
much more so must be the people of the rest of
the world. And still war and rumors of war are in
the limelight — due almost entirely to communism.
The disturbing element we call communism, and it
is so self-named, actually consists of minority
groups headed by the most diabolic despots the
world has ever known ; despots who have acquired
control of governments and maintain themselves
in power by force, intimidation and deceit. Every
effort is made to destroy all religion, and love for
God and fellow man is simply absent. There can
be no room in our country for communists whose
avowed purpose is to destroy our democratic form
of government by force and intrigue.
We are among those who see little distinction
between the aims of communism and socialism.
Both aim towards the equal distribution of this
world’s goods and, therefore, the stifling of incen-
tive and the suppression of industry. A real com-
munism has never existed. We have a typical ex-
ample of what near socialism can do to the econ-
omy of a nation like England. The recent reversal
of public opinion away from socialism in New
Zealand and Australia is indicative of what can
happen in a democratic country and of what may
happen in England. Must we go further into so-
cialism before we realize that, human beings be-
ing what they are, it just will not work?
We are among those who believe that right will
triumph in the end. Our country has muddled
through many a crisis, and we believe we shall
come through our present difficulties. Commu-
nistic regimes, based as they are on ruthless force,
just cannot continue indefinitely. Citizens of all
countries are much the same in their make-ups
and, although temporarily misled or dominated
by false leaders, have the same hopes and desires.
It is our fervent wish that the year 1950 may show
evidence of wisdom in the conduct of our govern-
ment and more justice and peace throughout the
world.
ISOLATION AND QUARANTINE
REQUIREMENTS
FT EALTH department regulations for isolation
-*■ and quarantine help in the control of com-
municable disease but the relative importance of
quarantine should be kept in mind to avoid neg-
lecting more fruitful measures. These include
diagnosis, treatment, and disinfection concurrent-
70
Minnesota Medicine
EDITORIAL
ly and terminally ; reporting and epidemiological
investigation to discover sources of infection, car-
riers, missed and suspected cases ; individual pro-
tective measures such as vaccination and immuni-
zation against smallpox, diphtheria, whooping
cough, tetanus, typhoid, and other diseases; com-
munity preventive measures such as sanitary wa-
ter supply and sewage disposal, and pasteurized
milk and cream ; and most important public health
education to stimulate people to take advantage of
preventive medicine before disease develops.
Quarantine and isolation requirements may bene-
fit the ill patient more than the community by re-
ducing his chances of contracting cross infections.
Regulations must be based on knowledge of the
disease in question and they change as our knowl-
edge changes. As in other medical fields, how-
ever, there occasionally appears the danger of the
more science, the less art. Considerable emotional
content is linked to quarantine procedures, whose
origins date from early plagues, pestilence, super-
stitions, and hysteria. This partly accounts for
slowness to change regulations.
Today public opinion as to the reasonableness
of quarantine is still important for practical ap-
plication. An acceptable compromise between the
dictates of science and common sense, therefore,
is frequently the result when 'rules are adopted.
Because conditions vary so greatly throughout the
State as to available personnel and interest for op-
erating public health programs, the regulations of
the State Board of Health set minimum require-
ments only and local boards of health have au-
thority and are encouraged to add whatever ad-
ditional precautions seem necessary.
In recent years quarantine regulations have
become more liberal and, happily, more uniform
in all states. Increasingly consideration has been
directed to scientific essentials, clarifying the han-
dling of those persons definitely infected, the
cases and carriers ; those possibly infected, the
contacts ; and the general community. Minnesota’s
regulations have followed this trend, sometimes
in the teeth of considerable public feeling against
liberalization, and sometimes only after some
pushing from others for more lenient rules.
Two of the acute communicable diseases, scarlet
fever and poliomyelitis, illustrate these trends.
Scarlet fever in recent years has been mild, and
responsive quickly to newer methods of treatment.
Experience has demonstrated the futility of quaran-
tine in stopping the spread of streptococcal respir-
January, 1950
Special Announcement
MSMA ANNUAL DUES
Following the recommendation of the Finance
Committee, the House of Delegates of the Min-
nesota State Medical Association voted May 8,
1949, to continue the $10 assessment for 1950, and
thereafter make it permanent by amending the
Constitution to raise the dues to $30 per capita.
Members of the Minnesota State Medical As-
sociation are hereby notified that dues for this
year will be a total of $30, and pending House of
Delegates action at the annual meeting, June 12,
13 and 14, dues for the Minnesota State Medical
Association will be permanently $30.
atory infections, yet joined with other measures
for control, some regulation is accepted as neces-
sary by everyone. Minnesota now requires isola-
tion of the patient for the duration of illness, with
a minimum of seven days from onset. Close con-
tacts, if children, are quarantined for the same
period, while adult contacts if well are not restrict-
ed unless local authority so decides.
In poliomyelitis, regulations have admittedly not
controlled the disease while conversely impeding
the best use of hospital facilities. Following a na-
tional conference in 1949, state health authorities
everywhere, including Minnesota, are modifying
their regulations so that patients with poliomyelitis
are isolated for seven days from onset or the dura-
tion of fever if longer, and contacts are freed
from unnecessary restrictions.
Interestingly, regulations for isolation of infec-
tious cases of tuberculosis, Minnesota’s most se-
rious communicable disease, are being strength-
ened and clarified. The control of chronic diseases
such as tuberculosis, where infected persons may
remain dangerous to their associates for long pe-
riods of time, even years, may be more directly
influenced by isolation and quarantine regulations
than in acute self-limited diseases. On the other
hand, it is difficult to attribute much of the control
of typhoid fever that has come about in Minne-
sota to the regulation by statute of those few hun-
dred typhoid carriers listed in Health Department
records, who presumably excrete typhoid germs
for years with little change in their mode of
living.
It must be accepted, in conclusion, that chang-
ing knowledge will bring changing practices. In
hardly any other .field of human health have there
71
EDITORIAL
been such great changes in recent generations as
in that of communicable diseases; quarantine reg-
ulations must expect adaptations in light of chang-
ing circumstances.
D. S. Fleming, M.D., Chief
Section of Preventable Diseases
Minnesota Department of Health
DEFICIT GOVERNMENT SPENDING
LTR FEDERAL debt is now 252.7 billion
dollars or $1700 per person. Whereas, in
1947 the treasury showed a surplus of three-
quarters of a billion and in 1948 a surplus of
$8,419,469,844; in 1949 the deficit was $1,811,-
440,048, and for the fiscal year 1950 there is an
estimated deficit of $5,500,000,000,
It was Lenin’s advice to let the capitalistic
countries spend themselves into bankruptcy. Are
we following his advice?
The responsibility for the deficit lies, for the
most part, with Congress. However, we have a
president who, instead of acting as a brake to
spending, is continuously advocating more spend-
ing and higher taxes. Lobbies for special favors
for numerous groups of citizens share in respon-
sibility for the present extravagance of govern-
ment. States that match federal subsidies with the
idea that they are getting something for nothing
also are to blame.
If some evidence of statesmanship in federal
and state governments doesn’t make its appear-
ance in the near future, the usual result of deficit
spending, bankruptcy, will inevitably follow with
untold universal suffering.
Public opinion is a powerful factor in correct-
ing poor government. The public’s attention is be-
ing called through various publicity channels to
the senseless extravagance of the federal and
state governments. We, the people, can put an
end to deficit government spending by informing
legislators of our wishes.
COLDS AND ALLERGY
npHE COMMON cold is responsible for more
"*■ loss of time among employes than any other
single disease. Medical science has been unable
either to prevent or cure the common cold, and the
thread-worn saying that a cold untreated will last
two weeks and treated will last a fortnight is only
too true.
The fact is, we don’t understand any too well
what a cold actually is. It is generally accepted
that it is a virus infection of the respiratory tract
which is followed by secondary bacterial invaders.
There is reason to believe that the cold virus is
present constantly in the upper respiratory pas-
sages in at least some persons, and we know that
a variety of bacteria are present at all times in all
nasal cavities. If the cold virus is ever present,
we must assume a natural or acquired immunity
in the absence of symptoms of a cold. The ex-
istence of the lack of immunity to the cold virus
explains the rapid spread of colds to 100 per cent
of an isolated community upon the exposure to
one with a cold. The well-known frequent return
of colds in certain individuals argues a short-lived
immunity or the existence of more than one cold
virus.
The role of exposure to drafts and chilling in
the development of a cold is not clear. It is known
that chilling the body causes a reflex vasoconstric-
tion and lowering of temperature in the nasal mu-
cous membrane. Does this cause a lowering of lo-
cal resistance which allows a cold virus that is
present to multiply? On the other hand, some in-
dividuals daily exposed to cold and chilling sel-
dom contract colds. What is more, experimental
inoculation of human beings and animals with cold
virus can be accomplished without the element of
chilling.
Recent literature has called attention to the
probability of a relationship between allergy and
the common cold.* The manifestations of a cory-
za are identical to the allergic response in hay
fever. A cold may be considered an allergic re-
sponse in an individual susceptible to the cold vi-
rus. It has been shown that allergic individuals —
those who suffer from hay fever, asthma or food
allergy — contract colds more often than normal
persons. These constitute the cold-susceptible
group who are repeatedly contracting colds. The
authors state, “The response of the physically al-
lergic person to these environmental factors (i.e.,
chilling of body, wetting of feet) may very well
result in an outpouring of histamine into various
shock centers throughout the body, particularly
the respiratory tract, in sufficient quantity to de-
stroy the local defense mechanism preparing the
*Fox, Noah, and Livingston, George: Role of allergy in the
epidemiology of the common cold. Arch. Otolaryng., 496:575-
586, (June) 1949.
72
Minnesota Medicine
EDITORIAL
tissues for acceptance of the virus of the com-
mon cold.” This assumes that the cold virus is
already present. The authors state that secondary
bacterial invaders are just as likely to be activated.
On the other hand, they call attention to the fact
that colds during attacks of hay fever are not
common, so there must be other factors besides
the condition of the mucous membrane. Immu-
nity, though often transitory, does result — other-
wise recovery from a cold would not take place.
With exposure to enough antigen, all persons can
be made to react in an allergic manner. It is
easier, however, to consider the cold-susceptible
person as one who is allergic to the cold virus.
Again, according to the authors, 80 per cent of
cold susceptible persons have other allergies or
come from families with allergies, and 100 per
cent of such persons have hyperplastic disease of
the upper respiratory tract.
It is reasoned that if, at the first appearance of
the allergic response indicative of the onset of a
cold, an anti-histaminic is taken and the nasal mu-
cous membrane returned to normal or near nor-
mal, the cold might be cut short by preventing the
development of the secondary bacterial invaders.
Reports of trial use of various anti-histaminics in
sizable groups of individuals indicate that colds
can be thus cured in twenty-four to forty-eight
hours in about 50 per cent of cases and alleviated
in an additional 25 per cent. In about 25 per
cent, the method is useless. Interestingly, some
anti-histaminics are effective for some individuals
and not for others. Some, of course, produce un-
desirable side reactions, such as sleepiness, and
some do not.
The Food and Drug Administration has re-
leased a number of anti-histaminics for over-the-
counter sale at drug stores, providing the printed
instructions as to dosage meet with its approval.
The newspapers are running full page advertise-
ments of these preparations. It will be difficult
for the biological houses that are attempting to
limit the sale of their anti-histaminics to prescrip-
tion trade to resist the temptation to share in the
millions of dollars which will be spent in over-the-
counter sales.
The anti-histaminics containing neo-hetramine
are said to produce fewer side effects and are less
likely to have harmful effects. Probably small
children should not be given any anti-histaminics.
Reports indicate, however, that something has
been found at last which will reduce the duration
of the common cold. If it is only 50 per cent
effective, it will be worth while.
CO-OPERATION IN THE TREATMENT OF
TUBERCULOSIS
The skills required in the modern treatment of pul-
monary tuberculosis are many and varied. The frequent
association of tuberculous and nontuberculous complica-
tions adds further to the need for practically all medical
and surgical specialty services, not excluding research
facilities. The closest possible association and inter-
change of information and ideas between the tuberculosis
and general hospitals is for these reasons evidently
desirable. Particularly is it desirable for the teaching
hospitals, which are the principal centers of clinical
research, to maintain active contact with tuberculosis
institutions, even to provide a quota of beds for the
interchange of patients. Carl Muschenheim, M.D.,
Am. Rev. Tuberc., July, 1949.
THE RATIONALE OF BLOOD TRANSFUSIONS
IN THE TREATMENT OF THE TRUE
TOXEMIAS OF PREGNANCY
(Continued from Page 41)
such p. condition. Among putatively full-blooded Ute
Indians, 98 per cent of them belong to Group O. At
one time these Indians were a pure Group O people.
As a result of crossing with the white man, there is
now, however, a small amount of Group A among them.
Among the Blackfeet Indians, we have a high percent-
age of Group A — there are about 80 per cent who belong
to Group A. It is reasonable to assume that these
Indians were at one time a pure Group A people, and
when you find Group O among them, it is a result of
crossing either with other Indians, the white man, or
the Negro. O is the only other type found among
them. All Indians and all Eskimos who have been
examined are Rh positive. I have inquired among the
Agency physicians in the Indian tribes I visited in the
United States, Canada, and Alaska about the incidence
of erythroblastosis fetalis and toxemia of pregnancy,
and it is the general impression that the incidence is
extremely low. Dr. Schrader said he did not recall
finding any toxemia of pregnancy among full-blooded
Blackfeet Indians. The records were checked, and it
was found that among the Blackfeet Indians there is
little recorded toxemia of pregnancy as follows :
Eclampsia 0.3 cases per 1000 pregnancies
Nephritis 3.0 cases per 1000 pregnancies
Hyperemesis Gravidarum ... 1 case per 1000 pregnancies
What is the explanation? Certainly these findings
do not go against, but rather agree, with the theory pre-
sented by Dr. (La Vake.
January, 1950
73
Medical Economics
Edited by the Committee on Medical Economics
of the
Minnesota State Medical Association
George Earl, M.D., Chairman
WHITAKER & BAXTER REPORT PROGRESS
Visualizing compulsory health insurance as a
“key political issue” in the next Congress and in
the congressional elections, Whitaker & Baxter,
the AMA’s National Education Campaign direc-
tors, reported on progress to date at the Interim
Session in Washington, December 6.
The two-point program of the campaign, as
defined last February, was: (1) To defeat the
compulsory health insurance legislation pending
in congress; and (2) to put a permanent stop to
the agitation for socialization of the medical pro-
fession by alerting the people to the costly con-
sequences of such a program, and by providing
the finest type of voluntary health insurance for
all in need of prepaid medical protection.
Plan "Simple"
Whitaker & Baxter explained the plan of their
campaign as “simple and involving only one basic
requirement — to get the truth about the advan-
tages and splendid accomplishments of American
medicine, and about the disadvantages and dangers
of government-medicine, to the people, together
with factual proof in both cases.”
The techniques used have been : a nationwide
pamphlet distribution campaign, a vigorous pub-
licity campaign, a speaking campaign and an en-
dorsement drive. Fifty-five million pieces of cam-
paign literature were prepared and distributed and
more than 65,000 posters of “The Doctor” were
mounted in hospitals, clinics, bus and railway
stations, business buildings and anywhere else
that would afford the public a view of the famed
Fildes’ painting with its challenging inscription,
“Keep Politics Out of this Picture.”
The endorsement campaign has been re-
warded with the active, public support of 1,829
national, state and local organizations.
End result of the campaign thus far, according
to Whitaker & Baxter, is : “The proponents of
government medicine made a strategic retreat,
and pigeonholed their legislation for the current
session of Congress.”
Lest too early optimism result from this report,
Mr. V hitaker and Miss Baxter cautioned :
“Although broad public disapproval of the govern-
ment-medicine program is widely acknowledged — and
although the Presidential plan to give its creator, the
federal security administrator, cabinet status, was sound-
ly defeated in a test of the same grass roots convictions
• — the administration is yet unconvinced.”
LEGION COMMANDER SCORES
TAX MEDICINE
“The American Legion is opposed to national health
insurance because it would stunt the growth and genius
of the medical profession,” the Legion’s national com-
mander said, December 8, at the Interim Session, “and
because it would add another link to an already long
bureaucratic chain.”
George N. Craig issued this statement prior
to an off-the-record address before the Confer-
ence of County Medical Society Officers.
“Whether you call it state medicine or socialized
medicine, it is still political medicine,” he added. “Under
such a system, the government is the boss, and the in-
dividual is no longer free to apply his initiative and
imagination to the advantage of the profession and pa-
tients alike. Inevitably, the scientist is supplanted by
the politician who in turn must dispense his services on
a plane of partisan patronage.”
WHY NOT INCLUDE PETS IN SCHEME?
The Wall Street Journal can see no reason for
excluding quadrupeds from the government’s
manifold schemes for medical care, pensions and
various other forms of security.
Recognizing that many families are unable to
provide systems of annuities and the like for their
pets, the Journal takes, for instance, the cat :
“The most deserving of cats might thus be left, purely
by accident, in destitution while the less deserving loll
in luxury.”
74
Minnesota Medicine
MEDICAL ECONOMICS
Happily, there is a solution, the editorial goes
on to point out :
“The only way to correct this inequity is for the
cat pensions to be provided by the federal government
on a uniform and non-contributory basis. And to remove
further inequities, the same should be done for family
canines, who are often more loyal and loved, and for
the bovines and equines, who are certainly more useful
than cats.
“Why should one dog have the best of food and
medical care whilst one more unfortunate huddles in
alleyways?’’ asks the Journal , with as penetrating a
social analysis as may be found anywhere in Fair Deal
campaign literature. “Under nationalized veterinarianism
there would be no dependence upon biological pedigrees.”
No Restraint on Budget
Pooh-poohing the notion that the cost would
be prohibitive, the Journal reminds its readers
that both the Secretary of the Treasury and the
Director of the Budget have made it clear that
in dealing with welfare matters there must be no
restraint because of budget limitations.
The editorial concludes with this stirring para-
graph :
“Doubtless the Senate Finance Committee, which
plans a study of the whole pension system, will consider
both the justice and the vote-getting potentialities of
some such plan. Considering what we receive from the
cow while she is young and productive, who suggests
society is not her debtor when she is superannuated?”
BRITISH FINANCE CHIEF OPTIMISTIC
Sir Stafford Cripps, British chancellor of the
exchequer, is optimistic about the financial fate
of England under what he prefers to call “a
mixed economy.”
The ‘‘busiest man in England” was interviewed
recently by an editor of U. S. Nezvs and World
Report and described himself as “not quite so
socialistic perhaps as some of my American
friends.”
During the course of the interview, he said :
“But of course nationalization is not in the least likely
to happen in the many private-enterprise industries that
exist, other than those which are basic to the economy.”
Asked his opinion on the trend of America
toward more and more social security benefits and
the soundness of this trend, in view of the fact
that “in a democracy . . . people can vote them-
selves bigger and bigger benefits,” Mr. Cripps
hedged thusly :
January, 1950
Give Up Democracy?
“That depends upon the responsibility of the democ-
racy. Of course if a democracy takes so irresponsible
a view of its obligations that it only regards the ex-
chequer as a deep till into which it can perpetually dip
its hand, I should personally suggest giving up de-
mocracy !”
Continuing, he said :
“But that is not how we look at it in this country
(England). We feel that it is quite possible, by giving
people the information and the knowledge of economic
facts, to instill into them a realization that they them-
selves are in fact paying for their own social benefits
by taxation and by other means, and that therefore they
must exercise restraint in the way in which they utilize
those benefits and also in the amount of them they
demand.”
He neglects to add why the people of England
have not been generally informed that the dollar
a week they pay, which supposedly finances medi-
cal and related services, is actually channeled to
“cash benefits,” such as unemployment insurance
and funeral expenses. Seventy-eight per cent of
the cost of the health scheme comes out of gen-
eral taxes and, from this fact, it may be deduced
that the British public has no accurate knowledge
of where tax money goes, and is actually being
misled concerning the cost of the medical care
program.
HOSPITAL OCCUPANCY RATE LEVELING
From a study of more than one hundred non-
governmental hospitals of varying size through-
out the country, it has been ascertained that oc-
cupancy is continuing to level off from the peak
of 1946.
“And there seems little evidence to indicate that
this trend will change significantly in either di-
rection,” states Richard D. Vanderwarker, direc-
tor of the Passavant Memorial Hospital, Chicago,
Illinois.
Costs Rising
Considering the hospital’s patient load as a
relatively stable factor, Mr. Vanderwarker goes
on to examine the rising costs of operating hos-
pitals. Among the causes he cites are : wages,
which, he feels will continue to rise because (a)
there will be continuing pressure for hospitals to
meet prevailing wages paid in industry and
commerce, and (b) the market value of profes-
sional personnel services is increasing ; the cost
(Continued on Page 86)
75
MINNESOTA STATE BOARD OF MEDICAL EXAMINERS
230 Lowry Medical Arts Bldg., Saint Paul, Minnesota
Julian F. DuBois, M.D., Secretary
PHYSICIANS LICENSED FEBRUARY 11, 1949
January 1949 Examination
Address
2707 Nicollet Ave., Minneapolis, Minn.
500 S.E. Delaware, Minneapolis, Minti.
1009 Nicollet Ave., Minneapolis, Minn.
Mayo Clinic, Rochester, Minn.
University of Minnesota Medical School,
Minneapolis, Minn.
Norwood, Minn.
Mayo Clinic, Rochester, Minn.
Minneapolis General Hospital, Minneapo-
lis 15, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Deaconess Hospital, Minneapolis, Minn.
Mayo Clinic, Rochester, Minn.
Wayne Co. General Hosp., Eloise, Mich.
Mayo Clinic, Rochester, Minn.
Midway Hospital, St. Paul 4, Minn.
Mayo Clinic, Rochester, Minn.
4937 Columbus Ave., Minneapolis, Minn.
U.S. Naval Training & Dist. Center, Main
Dispensary, Port Hueneme, California
Address
Grand Meadow, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
University of Minnesota Medical School,
Minneapolis, Minn.
2301 Jefferson St., Duluth, Minn.
315 3rd St. S.W., Wadena, Minn.
Mayo Clinic, Rochester, Minn.
605 N. Main St., Austin, Minn.
Address
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Veterans Adm. Hosp., Minneapolis, Minn.
Mayo Clinic, Rochester, Minn.
Veterans Adm. Hosp., Minneapolis, Minn.
University of Minnesota Hospital, Minne-
apolis 14, Minn.
Mayo Clinic, Rochester, Minn.
Name
AUSTIN, William Edward
CONDE, Richard Louis
ENGSTROM, Robert Birger
FOUST, Jr., Glenn Taylor
FURMAN, Morris John
GRIEBIE, Grant Leonard
JOHNSON, Carl Eric
JOHNSON, Richard S.
JOHNSTON, Richard McCreary
JORDAN, Robert Atkin
JOSSELSON, Albert Joseph
McNEILL, James Ian
RIPLEY, Herbert Robert
ROBINSON, Arthur Weaver
SANFORD, John Bryant
SARGENT, James Wellington
TESAR, Charles Eugene
THELEN, Emil Patrick
TVERBERG, Miltzo Stephen
WEYAND, Robert Devere
WIGGINS, Tames Kenneth
WILSON, Theodore Warren
Name
BELLOMO, John
BOYD Jr., David Armitage
BRZUSTOWICZ, Richard John
BURGERT, Tr„ Eran Omer
CARPENTIERI, Joseph
CLARK, Elizabeth Alice
PARKER, Charles Walter
STAPLEY, Jr., Lorel Aaron
TWIGGS, Leo Funk
Name
ARATA, Justin Eugene
BALLANTYNE, Alando Jones
BOYD, Thomas Milton
CARLIN, Maurice Patrick
CARLISLE, John Chesney
DAHL, James Curtis
FEENEY, Michael James
GRIFFIN. Jr., George D. J.
IZQUIERDO, Eleanor Roverud
KELLY, Anthony Hill
MILLER, Roland Drew
OSTERHOLM. Richard Stanley
SAIDY, John Theodore
School
U. of Manitoba
MD
1946
U. of Minnesota
MB
1948
U. of Illinois
MD
1940
U. of Virginia
MD
1942
U. of Manitoba
MD
1944
Northwestern U.
MB
1943
MD 1944
Northwestern U.
MB
1945
MD
1946
Lb of Minnesota
MB
1946
MD
1947
U. of Indiana
MD
1944
U. of Kansas
MD
1944
Northwestern U.
MB
1944
MD
1945
Queen’s U.
MD
1944
U. of California
MD
1945
U. of Kansas
MD
1944
U. of Minnesota
MB
1948
U. of Michigan
MD
1943
U. of Minnesota
MB
1947
MD
1948
Loyola U.
MD
1943
Western Reserve
MD
1947
U. of California
MD
1945
U. of Texas
MD
1942
U. of Minnesota
MB
1947
MD
1948
Reciprocity Candidates
School :
St. Louis U.
MD
1948
Jefferson Med. Col.
MD
1930
Long Is. Col.
MD
1942
U. of Oklahoma
MD
1947
U. of' Louisville
MD
1943
U. of Michigan
AID
1940
U. of Colorado
MD
1940
Northwestern U.
MB
1945
MD
1946
U. of Michigan
MD
1941
National Board
Candidates
School
Indiana U.
MD
1944
Columbia U.
MD
1942
U. of Colorado
MD
1943
Marquette U.
MD
1946
Harvard U.
MD
1945
U. of Minnesota
MB
1946
MD
1946
Duke Lb
MD
1943
Loyola U.
MD
1947
Women’s Med.
Col. of Pa.
MD
1947
Northwestern U.
MB
1946
MD
1947
Northwestern U.
MB
1945
MD
1946
Lb of Nebraska
MD
1943
U. of Minnesota
MB
1946
MD
1946
855 1st St. S.W., Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
76
Minnesota Medicine
MINNESOTA STATE BOARD OF MEDICAL EXAMINERS
Name
TAYLOR, Jr., Robert Wendel
UPSON, Jr., Mark
WATSON, John Benezet
ZELLER, William Webb
ZIMMERMANN, Bernard
Name
ACHOR, Richard William Paul
ALCOTT, Donald L.
ANDERSON, Alton Duane
ARONOW, Regine Ann
AST A, Joseph James
BASKIN, John Lane
BEARD, Earl Francis
BERENS, James J.
BRADLEY, Robert Austin
BRESETTE, James Edward
BUTIN, James Walker
CLARK III, Percival Le Mon
COLBY, Jr., Malcolm Young
COOLEY, Jack Crain
DUNLAP, Robert Weyer
FANGMAN, Richard Joseph
GILBERT, Louis William
GOOSSEN, George P.
HATTOX, Jr., John Stanley
HEMPSTEAD, Richard Hartley
HILGERMANN, George O.
HOLIAN, Darwin Kennard
HUIZENGA, Kenneth Albert
10HNS0N, Adelaide McFadyen
JOHNSON, Jr, Charles Michael
KELSEY, James Edward
KJENAAS, Ervin Arthur
KLINE, Richard Frank
LEHMANN, Arnold Louis lohn
LORTON, William Lewis
MARKLE IV, George Bushar
MATTSON, Roger Peter
McDONALD, Owen Gerard
McVAY, Tr., lames Robert
MILROY,’ Thomas Wands
OLFELT, Paul Charles
RAGSDALE, Jr., William Egbert
REINHARDT, James Henry
SAXON, Tr., Foy Fulward
SMITH, John Lawrence
SMITH, Reginald Armitage
SPONSEL, Kenath Herrick
STOY, Robert Andrew
UTNE, John Richard
VAUGHN, Charles Gordon
WALL, James Otis
WILSON, Joseph Didjon
WRIGHT, William Spurgeon
Name
AHRENS, Herbert George
DIDCOCT, John William
January, 1950
School
Harvard U.
MD
1944
Columbia Li.
MD
1945
U. of Iowa
MD
1945
Geo. Wash. U.
MD
1944
Harvard U.
MD
1945
PHYSICIANS LICENSED MAY ‘
April 1949
Examination
School
LI. of Oregon
MD
1945
Rush-Chicago U.
MD
1942
U. of Wisconsin
MD
1943
U. of- Minnesota
MB
1948
MD
1949
U. of Minnesota
MB
1948
U. of Texas
MD
1944
Northwestern U.
MB
1946
MD
1948
Cincinnati U.
MD
1945
Baylor U.
MD
1947
Northwestern U.
MB
1945
MD
1946
U. of Kansas
MD
1947
U. of Tennessee
MD
1945
U. of Texas
MD
1943
Northwestern U.
MB
1947
MD
1948
Western Reserve
MD
1945
Creighton U.
MD
1944
LI. of Nebraska
MD
1943
Southwestern
MD
1948
Medical College
LT. of Tennessee
MD
1945
U. of Michigan
MD
1944
Marquette U.
MD
1948
LI. of Minnesota
MB
1947
MD
1948
Western Reserve
MD
1944
U. of Chicago
MD
1932
Lk of Chicago
MD
1945
LI. of Minnesota
MB
1948
U. of Minnesota
MB
1948
Lk of Minnesota
MB
1947
MD
1948
U. of Manitoba
MD
1944
U. of Chicago
MD
1947
Lk of Pa.
MD
1946
LI. of Illinois
MD
1948
Rush Medical College of
U. of Chicago
MD
1939
Johns Hopkins U.
MD
1944
LL of Manitoba
MD
1945
U. of Minnesota
MB
1947
U. of Tennessee
MD
1939
Temple U.
MD
1947
Lk of Tennessee
MD
1945
U. of Rochester
MD
1948
U. of Alberta
MD
1942
U. of Chicago
MD
1943
Loyola U.
MD
1948
Lk of Illinois
MD
1948
U. of Minnesota
MB
1947
MD
1948
LI. of Minnesota
MB
1948
Stanford U.
MD
1944
U. of Minnesota
MB
1945
MD
1946
Address
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
1530 Edgcumbe Road, St. Paul 5, Minn.
1949
A ddress
Rochester State Hospital, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Children’s Hospital, 5224 St. Antoine St.,
Detroit 2, Michigan
St. Mary’s Hospital, Duluth, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Student Health Service, Ag. Campus, Univ.
of Minnesota, St. Paul, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mountain Lake, Minn.
Mayo Clinic, Rochester, Minn.
Mavo Clinic, Rochester, Minn.
4622 Casco Ave., Minneapolis, Minn.
3209 Edgewood Ave., Minneapolis 16,
Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
10 Evergreen Place, Loch Arbour, N. J.
Letterman General Hospital, San Francis-
co, California
Montgomery, Minn.
}
Veterans Adm. Hosp., Minneapolis, Minn.
Box 1254, Keewatin, Minn.
Mayo Clinic, Rochester, Minn.
5831 Knox Ave. So., Minneapolis, Minn.
205 W. 2nd St., Duluth, Minn.
Mayo Clinic, Rochester, Minn.
Ancker Hospital. St. Paul, Minn.
2428 34th Ave. So., Minneapolis, Minn.
Mayo Clinic, Rochester, Minn.
Box 214. Red Lake Falls, Minn.
Mayo Clinic, Rochester, Minn.
Walker Air Force Base, 509 Med. Group,
Roswell, New Mexico
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
105 1st St. S.E., Little Falls, Minn.
4144 N. Fremont, Minneapolis, Minn.
Plainview, Minn.
1981 Princeton Ave., St. Paul 5, Minn.
Mayo Clinic, Rochester, Minn.
University of Minnesota Hospitals, Min-
neapolis 14, Minn.
Reciprocity Candidates
School
U. of Nebraska MD 1945
Vanderbilt U. MD 1937
Address
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
77
MINNESOTA STATE BOARD OF MEDICAL EXAMINERS
Name
DURHAM, Jr., Harry Blaine
KLEMME, Arthur Edward
LAMP, Jr., Clyde Benjamin
MARTIN, William Joseph
NICKERSON, Neil Dwight
PHILP, David Robart
ROSENTHAL, Macey Herschel
ZIMMER, Frederick Ellis
Name
AHRENS, Robert Myron
BARTHOLOMEW, Lloyd Gibson
DA WE, Clyde Johnson
HAINES, Gerald Leon
MANKIN, Haven Winslow
McNEIL, John Joseph
MILLER, John Martin
PEMBERTON, Albert Hogeland
RICE, Fred Armstrong
SOLTERO, Donald Emanuel
STORKAN, Margaret Ann
SWIFT, Edward Albert
TODD III, John Wesley
Name
ADAMS, Jr., Paul
AM BERG, John
BENNETT, Frank Mocroft
BOYSEN, Edwin Elberg
BROWN, James L.
CAMPION, Richard Sylvester
CORRIGAN, Cyril J.
DESP'OPOULOS, Agamemnon
DOYLE, James Raymond
EASTWOLD, Conrad Engwold
EKLUND, Jr., Edwin Gustaf
ERICKSON, Lief W.
FLEMING, Richard E.
FLOERSCH, Adrian Joseph
GINSBERG, James P.
GROENIG, David Cress
HACKER, Elaine Mary
HANSON, William Byrne
HEDIN, Roger Willard
HENSLER, Nestor M.
JARVIS, Marilyn Anderson
JAY, Alan Robert
KEITH, Paul Jackson
LARSON, Gerald Elsworth
LINCOLN, Thomas Abraham
LUNDBLAD, Robert Myron
MAGNUSON, Raymond Carl
MARRONE, Patrick Henry
McCABE, Margaret Mary
McKENNA, Elizabeth Mary
McKENNA, William Thomas
MEINERT, John Keith
School
Northwestern U.
MB
MIJ
1944
1945
U. of Michigan
MD
1945
U. of Pittsburgh
MD
1945
Georgetown U.
MD
1943
Western Reserve
MD
1943
U. of Louisville
MD
1948
U. of Virginia
MD
1944
U. of Pennsylvania
MD
1945
National Board Candidates
School
New York Medical
College
MD
1947
U. of Vermont
MD
1944
Johns Hopkins U.
MD
1945
Lh of Vermont
MD
1944
Geo. Wash. U.
MD
1947
Tufts U.
MD
1942
U. of Indiana
MD
1945
Northwestern
MB
MD
1947
1948
Harvard U.
MD
1943
Marquette U.
MD
1944
Creighton U.
MD
1944
Syracuse LI.
MD
1943
Medical College of
Virginia
MD
1947
Address
Mayo Clinic, Rochester, Minn.
Maternity Hospital, 2215 Glenwood Ave.,
Minneapolis. Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Bratrud Clinic, Thief River Falls, Minn.
515 S. 2nd St., Mankato, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Address
904 Rice St., St. Paul, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
University of Minnesota Hospitals, Min-
neapolis 14, Minn.
Mayo Clinic, Rochester, Minn.
University of Minnesota Hospitals, Min-
neapolis 14, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
1009 Nicollet Ave. So., Minneapolis, Minn.
Mayo Clinic, Rochester, Minn.
University of Minnesota Medical School,
Minneapolis, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
PHYSICIANS LICENSED JULY 15, 1949
June 1949 Special Examination
Sch
ool
U. of
Minnesota
MB
1949
U. of
Minnesota
MB
1949
U. of
Minnesota
MB
1949
U. of
Minnesota
MB
1949
U. of
Minnesota
MB
1949
U. of
Minnesota
MB
1949
U. of
Minnesota
MB
1949
U. of Minnesota
MB
1947
MD
1948
U. of
Minnesota
MB
1949
U. of
Minnesota
MB
1949
U. of
Minnesota
MB
1949
U. of Minnesota
MB
1949
U. of
Minnesota
MB
1949
Creighton U.
MD
1948
U. of
Minnesota
MB
1949
U. of
Minnesota
MB
1949
LJ. of
Minnesota
MB
1949
U. of
Minnesota
MB
1949
U. of
Minnesota
MB
1949
LJ. of
Minnesota
MB
1949
U. of
Minnesota
MB
1949
U. of
Kansas
MD
1942
U. of
Minnesota
MB
1949
LJ. of
Minnesota
MB
1949
U. of
Minnesota
MB
1949
U. of
Minnesota
MB
1949
U. of
Minnesota
MB
1949
U. of
Minnesota
MB
1949
U. of
Minnesota
MB
1948
MD
1949
U. of
Minnesota
MB
1949
U. of
Minnesota
MB
1946
MD
1946
U. of
Minnesota
MB
1949
Address
University of Minnesota Hospitals, Min-
neapolis 14, Minn.
950 E. 59th St., Chicago, 111.
3400 S.W. Veterans Rd., Portland, Ore.
Ancker Hospital, St. Paul, Minn.
Alameda Co. Hospital, Oakland, Calif.
St. Luke’s Hospital, Denver, Colorado
Miller Hospital, St. Paul, Minn.
Philadelphia General Hospital, Philadel-
phia, Pennsylvania
Madigan General Hospital, Tacoma, Wash.
Mpls. Gen. Hospital, Minneapolis 15, Minn.
Percy Jones General Hospital, Battle
Creek, Michigan
Milwaukee Gen. Hosp., Milwaukee, Wis.
Milwaukee Gen. Hosp., Milwaukee, Wis.
4119 E. Lake St., Minneapolis, Minn.
Research & Educational Hosp., Chicago, 111.
St. Luke’s Hospital, Denver, Colo.
Detroit Receiving Hospital, Detroit, Mich.
Mpls. Gen. Hospital, Minneapolis, Minn.
Madigan General Hospital, Tacoma, Wash.
Madigan General Hospital, Tacoma, Wash.
Miller Hospital, St. Paul, Minn.
Swedish Hospital, Minneapolis, Minn.
Denver General Hospital, Denver, Colo.
St. Mary’s Hospital, Duluth, Minn.
Ancker Hospital, St. Paul, Minn.
St. Luke’s Hospital, Duluth, Minn.
St. Luke’s Hospital, Duluth, Minn.
St. Mary’s Hospital, Duluth, Minn.
420 Genesee Bank Bldg., Flint, Mich.
Milwaukee County General Hospital, Mil-
waukee, Wisconsin
4339 Cedar Ave., Minneapolis, Minn.
LTniversity of Michigan Hospital, Ann
Arbor, Michigan
78
Minnesota Medicine
MINNESOTA STATE BOARD OF MEDICAL EXAMINERS
Name
NELSON, Jr., George Ernst
NESSE, James Allan
O’CAIN, Raymond Kirby
OPSAHL, Lawrence Jurgen
POND, Norman Eggleston
REIF, Robert William
SANDE, John Peter
SAXON, Eugene Ira
SCUDAMORE, Harold Hunter
SOLHAUG, John Sims
STAHN, Louis H.
STAVIG, Paul Hjertaas
STERRIE, Norman Anderson
STONE, Julius
STUHLER II, Louis George
TROUP', Stanley Burton
TUCKER, Richard Carlyle
WALSTON, James Herbert
WEISS, lames Moses Aaron
WENDT, H. Paul
WICKS. Edwin Owen
WILHELM, Warren Fred
WOLTJEN. Myron James
WONG, Lillian
ZELL, John Richard
Name
ARTIST, Elmer Jacob
EVERETT Tr„ Ernest Frank
JOHNSON, William Steele
LINDEMAN, Raymond Jacob
VEIT, Henry
WINCHELL, Clarence Paul
Name \
BELCHER, Royden
BLOCK, Jr., William Joseph
BOLIN, Richard Reuel
DETAR, Jr., Burleigh Eli
FRIEDELL, Gilbert Hugo
FRIEND, Charles Albert
GARLOCK, Grant Leonard
HANSON, Hugh Henderson
HARADA, Thomas Taketo
HEALY, Michel Maurin
LAM, Robert C.
LAY, Coy Lafayette
MARTIN, Albert Charles
MELIUS, Marshall J.
OWENS, Ir., Frederick Mitchum
PAPANDREOU, Christine
SCHEIDEL, Alois McKeon
SEAGLE, Joseph Bowman
SOWADA, Ernest Joseph
WAGENKNECHT, Jr„ Theodore
William
YAMAMOTO, Joe
School
Address
U.
of Minnesota
MB
1949
U.
of Minnesota
MB
1949
Medical College of
MD
1941
South Carolina
U.
of Minnesota
MB
1949
U.
of Minnesota
MB
1949
U.
of Minnesota
MB
1949
U.
of Minnesota
MB
1949
u.
of Minnesota
MB
1949
Northwestern LT.
MB
1945
MD
1946
u.
of Minnesota
MB
1949
u.
of Minnesota
MB
1949
u.
of Minnesota
MB
1949
u.
of Minnesota
MB
1949
u.
of Minnesota
MB
1949
u.
of Minnesota
MB
1949
u.
of Minnesota
MB
1949
u.
of Minnesota
MB
1949
Northwestern U.
MB
1947
MD
1948
u.
of Minnesota
MB
1949
U.
of Minnesota
MB
1949
U.
of Minnesota
MB
1949
U.
of Chicago
MD
1945
U.
of Minnesota
MB
1949
U.
of Minnesota
MB
1949
U.
of Minnesota
MB
1949
Reciprocity Candidates
School
U. of Nebraska
MD
1943
Washington U.
MD
1945
Medical College of
Virginia
MD
1943
U. of Tennessee
MD
1948
Marquette LT.
MD
1943
U. of Michigan
MD
1945
St. Luke’s Hospital, Chicago, 111.
Brooke Army General Hospital, San
Antonio, Texas
102-110 2nd Ave. S.W., Rochester, Minn.
Mpls. Gen. Hospital, Minneapolis 15, Minn.
Highland Alameda County Hospital, Oak-
land, Calif.
Cleveland City Hospital, Cleveland, Ohio
Mpls. Gen. Hospital, Minneapolis 15, Minn.
San Francisco General Hospital, San Fran-
cisco, Calif.
102-110 2nd Ave. S.W., Rochester, Minn.
St. Luke’s Hospital, Denver, Colo.
Sacred Heart Hospital, Spokane, Wash.
Madigan General Hospital, Ft. Lewis,
Tacoma, Wash.
Mpls. Gen. Hospital, Minneapolis 15, Minn.
University of Oklahoma Hospital, Okla-
homa City, Okla.
Detroit Receiving Hospital, Detroit, Mich.
Strong Memorial PIosp., Rochester, N. Y.
Mpls. Gen. Hospital, Minneapolis 15, Minn.
Clarkfield, Minn.
U. S. Marine Hospital, Seattle, Wash.
Milwaukee County General Hospital, Mil-
waukee, Wis.
Eastern Maine Gen. Hosp., Bangor, Maine
102-110 2nd Ave. S.W., Rochester, Minn.
Asbury Hospital, Minneapolis, Minn.
San Joaquin General Hospital, French
Camp, Calif.
Naval Hospital, Philadelphia, Pa.
Address
102-110 2nd Ave. S.W., Rochester, Minn.
Veterans Adm. Hosp., Minneapolis, Minn.
953 Medical Arts Bldg., Minneapolis, Minn.
Paynesville, Minn.
2703“ W. Wisconsin Ave., Milwaukee Wis.
Veterans Adm. Hosp., Minneapolis, Minn.
PHYSICIANS LICENSED JULY
June 1949 Examination
School
U. of Minnesota MB 1949
U. of Texas MD 1945
Marquette U. MD 1948
U. of Kansas MD 1945
U. of Minnesota MB 1949
Tufts Med. Col. MD 1948
Hahnemann Medical MD 1948
C ollep-e
U. of Texas MD 1943
Temple U. MD 1943
Georgetown U. MD 1945
W. China Union U. MD 1945
U. of Texas MD 1946
U. of Illinois • MD 1944
U. of Minnesota MB 1949
U. of Chicago MD 1939
Boston U. MD 1947
U. of Minnesota
Indiana U.
U. of Minnesota
U. of Illinois
MB 1949
MD 1947
MB 1949
MD 1948
15, 1949
Address
Ancker Hospital, St. Paul, Minn.
Mayo Clinic, Rochester, Minn.
4340 N. Drake Ave., Chicago, 111.
Mayo Clinic, Rochester, Minn.
Mpls. Gen. Hospital, Minneapolis 15, Minn.
2703 E. Lake St., Minneapolis, Minn.
217^2 Barker Bldg., 3rd St., Bemidji,
Minn.
Mayo Clinic, Rochester, Minn.
Veterans Hospital, Minneapolis, Minn.
Mayo Clinic, Rochester, Minn.
St. Mary’s Hospital, Grand Rapids, Mich.
Mayo Clinic, Rochester, Minn.
119 S.W. Park, Luverne, Minn.
Milwaukee Co. Hospital, Milwaukee, Wis.
Veterans Adm. Hosp., Minneapolis, Minn.
Division of Psychiatry, University of Min-
nesota Hospitals, Minneapolis, Minn.
Mpls. Gen. Hospital, Minneapolis 15, Minn.
Mayo Clinic, Rochester, Minn.
Anclcer Hospital, St. Paul, Minn.
Appleton, Minn.
U. of Minnesota
MB 1948 Veterans Adm. Hosp., Minneapolis, Minn.
MD 1949
January, 1950
79
MINNESOTA STATE HOARD OF MEDICAL EXAMINERS
Name
DOVENMUEHLE, Robert Henry
EDWARDS, Charles Cornell
EVERS, Robert Neale
FASBENDER, Herman Thomas
HODGE, lames Carlton
PARSHALL, Dale Bryan
POHL, Donald Edward
SCHERBEL, Arthur Lawrence
SI EM ON, Glenn
Name
ALDRICH, Robert Anderson
FLIPSE, Martin Eugene
FREEMAN, Gerald I.
GOLDSTEIN, Norman Philip
GULLICKSON, Jr., Glenn
HOULE, Rollin John
LONGLEY, Jay Rhodes
A1ASON, Edward Eaton
SEIBEL, David Ira
SPEAR, Ivan MacDonald
VAN DUYN II, John
Name
ADSON, Martin Alfred
BEHRENS, Clayton Leo
BERNARD, Donald P.
CENTER, Sol
DANIELSON, Charles David
DAVIS, Windon Hewett
DOUST, William Charles
ESSER, Robert Anthony
FERRIN, Allan Lowell
GREENE, Jr., Wilson
HAESLY, Warren W.
HARBAUGH, John T.
HERSHENHOUSE, Samuel
Benjamin
HINES, Jr., Carl R.
HUNTER, Murray Hazen
HUNTER, Robert Carl
IVY, John Henry
KATZ, Yale Joel
KORENGOLD, Marvin Curtis
MacCARTHY, Jr., John Donald
MACFARLANE, Edmond Blakely
Mac INNIS, Donald Francis
MANAHAN, Gaylord Eugene
McCLELLAN. Samuel Goodman
McNEILL. John Alexander
MERKERT, Jr., George L.
NOBLE, John Henrv
ORWOLL, Harold Sylfest
OWEN, Howard Wayne
REITER, Ralph Alan
ROSIN, John David
Reciprocity Candidates
School
St. Louis U.
MD
1948
Colorado U-.
MD
1948
Washington U.
MD
1948
St. Louis U.
MD
1948
U. of Oklahoma
MD
1948
U. of Michigan
MD
1944
U. of Iowa
MD
1944
U. of Wisconsin
MD
1944
Stanford U.
MD
1946
National Board Candidates
School
Northwestern U.
MB
MD
1943
1944
Harvard U.
MD
1943
U. of Iowa
MD
1946
Geo. Washington U.
MD
1946
U. of Minnesota
MB
MD
1944
1945
St. Louis U.
MD
1948
Geo. Washington U.
MD
1946
U. of Iowa
MD
1945
Rochester U.
MD
1945
McGill U.
MD
1945
Johns Hopkins U.
MD
1931
Address
Hastings State Hospital, Hastings, Minn.
Department of Physiology, University of
Minnesota, Minneapolis, Minn.
1044 Lowry Medical Arts Bldg., St. Paul
St. Raphael Hospital, Hastings, Minn.
Fairview Hospital, Minneapolis, Minn.
Veterans Adm. Hosp., Minneapolis, Minn.
Crookston, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Address
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
1118 Lowry Medical Arts Bldg., St. Paul 2
Mayo Clinic, Rochester, Minn.
Div. of Physical Medicine, Univ. of Minn.
Medical School, Minneapolis, Minn.
Sauk Rapids and East St. Cloud, Minn.
Mayo Clinic, Rochester, Minn.
University of Minnesota Hospitals, Min-
neapolis 14, Minn.
Llniversity of Minnesota Hospitals, Min-
neapolis 14, Minn.
Mayo Clinic, Rochester, Minn.
5601 Grand Ave., Duluth, Minn.
PHYSICIANS LICENSED NOVEMBER 18. 1949
October 1949 Examination
School
U. of Minnesota
MB
MD
1947
1948
Temple U.
MD
1943
Marquette U.
MD
1948
U. of Minnesota
MB
1949
U. of Minnesota
MB
MD
1945
1946
U. of Minnesota
MB
MD
1948
1949
Syracuse U.
MD
1945
Northwestern U.
MB
MD
1944
1945
U. of Oregon
MD
1944
Medical College of
South Carolina
MD
1945
Northwestern U.
MB
MD
1948
1949
Indiana U.
MD
1946
U. of Illinois
MD
1944
/
1946
1947
Northwestern U.
MB
M 1 •
Marquette U.
MB
1949
LI. of Maryland
MD
1947
Northwestern LI.
MB
MD
1945
1946
LL of Minnesota
MB
1949
LL of Minnesota’
MB
1949
Johns Hopkins
MD
1946
U. of Toronto
MD
1947
Marquette LI.
MD
1936
U. of Kansas
MD
1944
Harvard LT.
MD
1944
LI. of Manitoba
MD
1944
LI. of Louisville
MD
1948
LL of Illinois
MD
1947
U. of Chicago
MD
1946
LL of Chicago
MD
1946
LI. of Maryland
MD
1946
U. of Maryland
MD
1942
Address
Mayo Clinic, Rochester, Minn.
Ancker Hospital, St. Paul, Minn.
Mpls. Gen. Hospital, Minneapolis 15, Minn.
Mpls. Gen. Hospital, Minneapolis 15, Minn.
Veterans Adm. Hospital, Oklahoma City,
Oklahoma
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Ancker Hospital, St. Paul, Minn.
Mayo Clinic, Rochester, Minn.
Wykoff, Minn.
St. John’s Hospital, St. Paul, Minn.
5525 S. Paulina St., Chicago, 111.
Mayo Clinic, Rochester, Minn.
Ancker Hospital, St. Paul. Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
3649 Stevens Ave., Minneapolis, Minn.
Mpls. Gen. Hospital, Minneapolis 15, Minn.
Department of Pathology, University of
Minnesota, Minneapolis 14, Minn.
Mayo Clinic, Rochester, Minn.
5729 Longfellow Ave., Minneapolis, Minn.
Ancker Hospital. St. Paul 1, Minn.
University of Minnesota Hospitals, Min-
neapolis, Minn.
Miller Hospital, St. Paul, Minn.
Ancker Hospital, St. Paul 1, Minn.
Browns Valley, Minn.
St. Peter, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
80
Minnesota Medicine
MINNESOTA STATE BOARD OF MEDICAL EXAMINERS
Name
iCHUT, John William
SMITH, William Thomas
'OWN SEND, William Albert
/
VAISBREN, Burton Armin
iENZ, Carl
Name
tGA, John Hesla
5EHLING, Frederick Louis
IASEY, Robert Elsworth
)AWSON, Jr., James Robertson
)ILLARD, Jr., Powell Garland
)ONALD, Ir., Thomas Claude
IDE, Mitchell
'ELDICK, Harley Glen
iOODLAD. James Homer
IARDWICKE, Henry Montfort
IOFFMAN, Murray Stanley
IOOD, Leo Thomas
ORDAN, Jr., George Lyman
CENT, jr., George Benjamin
JATHIESON, Don R.
JETCALF, Norman Barnard
COBLE, lames Hiatt
I’SHAUGHNESSY, Edward
I oseph
)SBORN, Donald Olin
)STLING, Burton Charles
'OST, David Bellar
1ETTER, Richard Henry
HESCHL, Elizabeth Katherine
iCHOLZ, Donald August
1TAHLER, Paul Anthony
TERNS, Donald
'RIPPLEHORN, Hugh Jason
VEBER, Walter Edward
VINELAND, Richard Eugene
Name
VRNESON, Charles Albert
IECKER, Donald Leo
iAREY, John Merwin
c la VEGA, Frederick James
LBERLEIN, Walter Rather
'REYMANN, John Gordon
rHORMLEY, Kenneth Owen
rIFFORD, Jr., Ray Wallace
EUB, Robert Phillip
OHNSON, Donald Arthur
KENNEDY, Timothy Vincent
Aloysius
-OLB, Lawrence Coleman
.ONGO, Vincent loseph
IYERS, Wa rren Powers Laird
IELSON, Russell Marion
)WEN, William Eugene
1UIGLEY, Walter Paul
CANLON, Paul William
'CHWYZER, Marguerite
HOCKET, Everett
'HALE, Harold Brian
VTERMAN, William Henry
VTLLESS, Hersel F.
School
Northwestern U. MB 1946
MD 1947
LI. of Kansas MD 1946
U. of Minnesota MB 1946
MD 1947
U. of Wisconsin MD 1946
Jefferson Medical MD 1949
College
Reciprocity Candidates
School
U. of Nebraska
MD
1948
LI. of Minnesota
MB
MD
1946
1947
U. of Oklahoma
MD
1945
Vanderbilt U.
MD
1931
U. of Virginia
MD
1947
Tulane U.
MD
1945
Tulane U.
MD
1945
LI. of Iowa
MD
1945
U. of Wisconsin
MD
1940
U. of Rochester
MD
1943
U. of Colarodo
MD
1947
U. of Nebraska
MD
1946
U. of Pennsylvania
MD
1944
U. of Colorado
MD
1947
U. of Minnesota
MB
MD
1936
1936
U. of Nebraska
MD
1948
U. of California
MD
1946
St. Louis U.
MD
1945
(
U. of Nebraska
MD
1946
LL of Michigan
MD
1948
U. of Michigan
MD
1948
U. of Wisconsin
MD
1943
Marquette U.
MD
1947
Western Reserve
MD
1945
Marquette U.
MD
1947
Baylor U.
MD
1945
U. of Pennsylvania
MD
1946
Stanford LL
MD
1946
LL of Michigan
MD
1946
Address
2301 4th St. N., Minneapolis, Minn.
1717 W. 31 St., Minneapolis, Minn.
State Department of Health, University of
Minnesota Campus, Minneapolis, Minn.
5537 Oliver St., Minneapolis, Minn.
Asbury Hospital, Minneapolis, Minn.
Address
217 Pleasant St., Mankato, Minn.
906 Ninth Ave. So., Moorhead, Minn.
Mayo Clinic, Rochester, Minn.
110 Anatomy Bldg., Univ. of Minnesota,
Minneapolis 14, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Buffalo Center, Iowa
Mayo Clinic, Rochester. Minn.
5601 Grand Ave., Duluth 7, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Onarnia, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
203 E. Broadway, Owatonna, Minn.
215 W. 3rd St., Hastings, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
815 North Ave., Jordan, Minn.
Mayo Clinic, Rochester, Minn.
Jordan, Minn.
Veterans Adm. Hosp., Minneapolis, Minn.
1009 Nicollet Ave., Minneapolis, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
National Board Candidates
School
Northwestern U.
MB
MD
1933
1934
Colorado U.
MD
1946
Harvard U.
MD
1945
Creighton LL
MD
1946
Harvard U.
MD
1945
Harvard LL
MD
1946
Harvard U.
MD
1946
Ohio State U.
MD
1947
Marquette LL
MD
1946
Geo. Washington U.
MD
1945
St. Louis LL
MD
1948
lohns Hopkins U.
MD
1934
Yale U.
MD
1946
Columbia U.
MD
1945
LL of Utah
MD
1947
Columbia LL
MD
1942
Marquette LL
MD
1946
Syracuse U.
MD
1946
Yale U.
MD
1943
Long Island College
MD
1948
U. of Minnesota
MB
MD
1939
1940
U. of Colorado
MD
1945
College of Medical
Evangelists
MD
1938
Address
714 Second St., Bismarck, No. Dak.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Veterans Adm. Hosp., Minneapolis, Minn.
1712 Brook Ave. S.E., Minneapolis, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
University of Minnesota Hospitals, Min-
neapolis, Minn.
St. Ansgar, Iowa
309 LaBree Ave. N., Thief River Falls
Mavo Clinic, Rochester. Minn.
% David McCloud, W2681 1st Nat. Bank
Bldg., St. Paul 1, Minn.
Mayo Clinic, Rochester, Minn.
2115 Fifth Ave., Los Angeles, Calif.
Mayo Clinic, Rochester, Minn.
St. Barnabas Hospital, Minneapolis, Minn.
anuary, 1950
81
Minnesota Academy of Medicine
Meeting of October 12, 1949
The regular monthly meeting of the Minnesota
Academy of Medicine was held at the Town and
Country Club on Wednesday evening, October 12, 1949.
Dinner was served at 7 o’clock, and the meeting was
called to order at 8:20 p.m. by the President, Dr. J. A.
Lepak.
There were fifty-five members and six guests pres-
ent.
Dr. Lepak asked Dr. H. S. Diehl to introduce Dr.
Leslie Banks, of Cambridge, England, who gave a
short talk and answered questions on the present so-
cialized medicine program in England.
Dr. Carl B. Drake read the following memorial to
Dr. James Gilfillan.
JAMES S. GILFILLAN
1869-1949
Dr. James S. Gilfillan was born April 15, 1869, the
son of Judge and Mrs. James Gilfillan of Saint Paul.
Ele attended public schools 'but was such a poor student
he was sent to Shattuck Military Academy at Faribault.
By the end of the year he was at the foot of his class,
and instead of returning to Shattuck he obtained em-
ployment with Auerbach, Finch and Van Slyke, a job-
bing house in Saint Paul, and later with the Northern
Pacific Railway. After several years so employed, he
went to Sauk Center where he spent two years with an
uncle, Dr. Tames Montgomery McMasters, reading
medicine and making calls with Dr. McMasters. Here
it was that he became interested in the study of medi-
cine. He matriculated at the University of Minnesota
Medical School, graduating in 1897. He then took
another year at the University of Pennsylvania Medical
School, obtaining an M.D., degree from that institution
in 1898. After interning at King’s County Hospital in
Brooklyn, he returned to practice in Saint Paul.
In 1906, Dr. Gilfillan married Hilda Benson. Having
made himself proficient in German, he, accompanied by
Mrs. Gilfillan, went to Vienna in 1907, to take post-
graduate study in internal medicine. He characteris-
tically refused to present letters of introduction to pro-
fessors in Vienna but before the year was out had been
put in charge of forty beds. His histories written in
German script were so reliable that he was known
as the Rock of Gibraltar. Upon his return to Saint
Paul, he limited himself to internal medicine, having
done some surgical practice before his trip to Vienna.
Although Dr. Gilfillan was anything but a student
in his youth, he became an insatiable reader and fine
student after he began the study of medicine. He be-
came very proficient in German, French and Swedish —
having learned the last of these languages from Mrs. Gil-
fillan. He was blessed with a remarkably retentive mem-
ory. His ability in the field of diagnosis was a source of
envy of the many young doctors with whom he came
in contact. His absolute honesty was universally recog-
nized by his friends and acquaintances. No description
of his character would be complete without mention of
his keen sense of humor.
Dr. Gilfillan was on the ETniversity of Minnesota
Medical School faculty from 1903 until his retirement
in 1936, having been Associate Clinical Professor of
Medicine from 1915 until 1936.
He was elected to membership in the Minnesota
Academy of Medicine in 1905 and read his thesis
February 1, 1905, entitled “Intermittent Gastric Hyper-
secretion,” which was published in the Saint Paul Med-
ical Journal (7:244, 1905). He served as president in
1931 and chose the title of “Compulsory Sickness In-
surance” for his address as retiring president on
January 13, 1932. This address was published in Min-
nesota Medicine in 1932 (15:295, 1932).
Dr. Gilfillan was a member of the Miller Clinic
during its existence from 1921 to 1933. He maintained
offices with Dr. lA. R. Hall and Dr. George E. Senkler
from 1933 until his retirement from active practice in
1938. A fractured hip sustained April 16, 1949, doubt-
lessly contributed to his death on June 13, 1949, at the
age of eighty. He is survived by his widow, a son James,
three grandchildren and four sisters.
C. B. Drake
A motion was carried that this memorial be spread
on the records of the Academy and a copy sent to the
family.
The scientific program followed.
Dr. R. T. La Vake, Minneapolis, read a paper on
"The Rationale of Blood Transfusion in the Toxemias.”
(See page 39.) Discussion by Dr. Albin Matson (by in-
vitation) of Minneapolis.
Dr. John F. Briggs, of Saint Paul, then read his
Inaugural Thesis on the subject “Pulmonary Mimicry
in Bronchogenic Carcinoma.”
THE PULMONARY MIMICRY IN BRONCHOGENIC CARCINOMA
JOHN FRANCIS BRIGGS. M.D.
Clinical Associate Professor of Medicine. University of Minnesota
Saint Paul,
There has been a great increase in the incidence of
bronchogenic carcinoma and there has been a great deal
of controversy as to whether this increase is actual or
apparent. The disease may occur at any age, but it is
essentially a disease of men and is most frequent during
the cancer decades. As far as can be determined, social
level, economic level, season or climatic condition, and
Minnesota
geographical location have nothing to do with the
development of this particular disease. Ordinary oc-
cupations apparently have no effect upon the development
of this condition but it appears more frequently in
cobalt mine workers.
1 here is no pathognomonic sign of bronchogenic
carcinoma. There is also no single symptom or physical
82
Minnesota Medicine
MINNESOTA ACADEMY OF MEDICINE
Fig. 1. Patient believed to be suf-
fering from either pulmonary infarction
or metastatic carcinoma. Ultimate
diagnosis proved to be metastatic car-
cinoma.
Fig. 2. Atelectasis at left base later
proven to be the result of a broncho-
genic carcinoma.
Fig. 3. Lung abscesses later proven
to be bronchogenic carcinoma.
finding to suggest the disease. The inherent nature of
the lesion is such that the disease can and will mimic
any other type of intrathoracic disease. Ordinarily,
the tumor begins within the bronchus, producing va-
rious degrees of obstruction to the bronchus. The signs
and symptoms of the disease depend upon the extent
of the obstruction (and whether or not there is an
associated infection. Bronchogenic carcinoma can mimic
any other intrapulmonary condition. It is for this reason
that the disease commonly becomes far advanced be-
fore it is recognized. Our duty as clinicians is to
recognize the disease sufficiently early to permit surgical
intervention.
The disease may occur in any part of the bronchus
or in any portion of the lung. Occasionally, the tumor
may arise out in the periphery of the lung. On micro-
scopic examination, the tumors may be divided into
squamous-cell carcinomas, adenocarcinomas, undif-
ferentiated carcinomas, round-cell carcinomas and, oc-
casionally, alveolar-cell carcinomas.
The chief means by which bronchogenic carcinoma
can be diagnosed is through the routine taking of chest
radiographs. Certain types of infiltration and shadows
seen on the film will often lead one to suspect the
presence of an underlying bronchogenic carcinoma.
However, since this disease can mimic any other form
of intrapulmonary lesion, it is also apparent tha-t bron-
chogenic carcinoma may simulate the x-ray appearance
of other types of intrathoracic disease. It is because of
this power of mimicry that we must use all diagnostic
aids jpossible to determine whether or not a given
lesion is a primary lung malignancy. Occasionally, the
malignancy may be associated with some other type
of chronic pulmonary disease, such as tuberculosis.
Since the disease has this power of imitation, it does
present itself in a form suggesting other intrapulmonary
disease. The diagnosis is usually made because of a
high index of suspicion concerning its existence. It is
well to remember that whenever a lung lesion fails to
follow the course originally diagnosed, one should im-
mediately suspect that it is a primary carcinoma.
Consultation with the roentgenologist will lead to the
use of highly specialized types of x-ray technique such
as bronchography, penetration films, and fluoroscopy.
The roentgenologist ihas available many procedures that
will aid him in establishing the diagnosis of a broncho-
genic carcinoma. The ultimate diagnosis, however,
depends upon the histological demonstration of a malig-
nant lesion. This may be done through a biopsy of
the tumor, a specimen having been obtained through
bronchoscopic examination. Occasionally, tumor cells
may be found in the sputum that the patient coughs up,
or tumor 'cells may be found in the material aspirated
through the bronchus. Pleural effusion, when present,
may contain demonstrable malignant cells, but when these
tests fail one may have to resort to open thoracotomy
with inspection and biopsy of the pulmonary lesion.
Once the diagnosis has been established, there is only one
treatment, pneumonectomy.
Summary
It has been emphasized that bronchogenic carcinoma
is increasing and that the disease is extremely difficult
to diagnose. It has been pointed out that the inherent
pathological nature of this condition makes it pos-
sible for this disease to simulate any other known in-
trathoracic disease. The signs and symptoms presented
by the patient are the signs and symptoms common to
all forms of chest diseases. There is no single pathog-
nomonic sign or symptom or x-ray shadow of primary
bronchogenic carcinoma. The x-ray may suggest the
diagnosis, but the ultimate diagnosis must be made by
biopsy investigation or open thoractomy investigation
of the suspected lesion. In some instances, the diagnosis
may be established by finding the tumor cells in the
exudates or aspirates of the patient. Once the disease
has been established as a bronchogenic carcinoma, there
is no other treatment but surgical intervention.
January, 1950
83
MINNESOTA ACADEMY OF MEDICINE
Conclusion
Cases have been reviewed emphasizing the tremendous
power of mimicry on the part of bronchogenic carci-
noma. These cases also emphasize that one must con-
stantly suspect that an individual with a chest condition
may be harboring bronchogenic carcinoma, and that
whenever the disease fails to follow the course ordinari-
ly peculiar to the condition, then the clinician should
suspect an underlying bronchogenic carcinoma and in-
stitute immediately those diagnostic procedures neces-
sary to refine and resolve the diagnosis.
Discussion
Dr. S. Marx White, Minneapolis: I would like to
ask Dr. Briggs what experience he has had with the
Papanicolaou method as applied to the examination of
sputum in cases of this type.
Dr. Briggs : Our experience has been too limited in
the use of this method to answer this question.
Question: What is the difference in ratio between
male and female?
Dr. Briggs : Sex ratio is about four to five males to
one female.
Dr. Leo G. Rigler, University of Minnesota: Dr.
Briggs, in his usual forthright, honest fashion, has
given us an extraordinarily clear picture of the situation
of carcinoma of the lung. This is about as lucid a
presentation as I have ever heard in a short period of
time. It might be interesting to observe that from a
statistical standpoint in the Veterans Hospital in Min-
neapolis, where the patients are practically all male,
carcinoma of the lung is seen almost twice as frequently
as carcinoma of the stomach. I would disagree with
Dr. Briggs on the question of whether there is a char-
acteristic x-ray picture of carcinoma of the lung. There
is such a characteristic picture, which, of course, as in
most clinical procedures, is not pathognomonic but is
about as good as one finds in tuberculosis, pneumonia
or other conditions of that type. Actually, of course,
we are more conservative in diagnosing carcinoma of
the lung than we would be, let us say, in diagnosing
pneumonia, since such a diagnosis means possibly an
extirpation of the whole lung. For that reason, as Dr.
Briggs has pointed out, one may wish to rely upon
cytological study. Nevertheless, at some point a diag-
nosis must be made and a conclusion reached other than
by the procedure of thoracotomy.
There is a situation in which the x-ray examination
is extremely valuable in the diagnostic identification of
carcinoma of the lung; for example, in the type of case
in which the diagnosis of pneumonitis or unresolved
pneumonia is made, a diagnosis which unfortunately
frequently covers up an actual carcinoma of the lung.
The demonstration of bronchial obstruction by bronchog-
raphy may clarify the situation, since an obstruction
of a bronchus of the second or third or fourth order
is very unusual in an inflammatory process, but very
common in carcinoma. In such cases, where the sputum
studies are negative and the bronchoscope cannot reach
the lesion, bronchography may give these final clues to
establish the diagnosis.
The problem of differentiation, of course, is an ex-
tremely difficult one. This is particularly true of the
peripheral lesions of the lung which we are seeing iso
much more frequently now than previously because of
the many survey films. Fortunately, these are in a small
minority of the cases of carcinoma.
The larger number arise in the root of the lung, and
it is here where the x-ray examination could be of
very great value. We have followed a large series of
cases in which x-ray examination had been made at
some time or other in the past. It is evident from this
series that minimal evidences of disease in the lung may
be present anywhere from six months to seven years
prior to the onset of symptoms of carcinoma of the
lung. Careful attention to small changes in the roent-
genogram, particularly moderate enlargement of one
root shadow, minor degrees of increased radiability in
one lung or band-like shadows of atelectasis, might
lead to a much earlier diagnosis than has heretofore
been possible. These findings, I should emphasize, are
those of pulmonary disease and are not necessarily indic-
ative of carcinoma ; but, once the suspicion of car-
cinoma is aroused as a result of ia routine x-ray exami-
nation of the chest, further studies will usually lead
to its identification. We shall simply have to give more
attention to the minor changes which occur in the lung
in the numerous routine films of the chest with which
we are confronted. I am grateful to Dr. Briggs for his
splendid paper.
Dr F. F. Callahan, Saint Paul: I am very glad to
hear this paper by Dr. Briggs and also Dr. Rigler’s
discussion. I think up to 40 years of age that the in-
cidence of carcinoma is about 5 to 1 in males. Very
often the diagnosis is made by the detection of meta-
static lesions, sometimes in the brain, and sometimes
in other parts of the body before the lung lesion is dis-
covered. Recently, I have had two cases that appeared
to be lymphoblastomata of the mediastinum ; both
turned out to be carcinoma of the lung. We were
looking for Hodgkin’s disease or some other type of
lymphoblastoma in these two cases. One case turned
out to be a very rapidly spreading carcinoma of the
bronchus, and the diagnosis was made by microscopic
section of an enlarged cervical lymph node. The second
case was diagnosed at autopsy. I think, in making
sections from lesions one finds in the bronchus that dif-
ferentiation of cells is extremely important.
If carcinoma of the bronchus is to be treated sur-
gically, the growth must be far enough from the corina,
or bifurcation |of the trachea, to allow good closure of
the bronchial stump. For a number of years, the
Mayo Clinic has been grading the cells of tumor tissue
removed from the bronchus into types . 1 -2-3-4. I un-
derstand that surgical treatment of types 1 and 2 has
been quite encouraging, and disappointing in types 3
and 4.
Dr. Thomas J. Kinsella, Minneapolis: I wish to
congratulate Dr. Briggs, not only for bringing this sub-
ject to our attention, but for the most sensible way in
which he has presented it. We shall never diagnose
primary bronchiogenic carcinoma at an early stage un-
less we think about it constantly and look for it in every
patient who presents a lung lesion. This tumor is
probably the most treacherous of all those with which
we must contend, for it may simulate pneumonia, tuber-
culosis, bronchiectasis, lung abscess, virus pneumonia or
almost any other known lung lesion. The terms “virus
pneumonia” and “unresolved pneumonia” are dangerous
if used as final diagnoses. If they are accepted as
diagnostic problems, then the use of such terms may
be justifiable. i
The figures quoted from the LTnited States Veterans
Bureau Facility at Fort Snelling on the relative pre-
dominance of bronchiogenic carcinoma over carcinoma
of the stomach at that facility must not be taken at face
value, for this hospital is an official chest surgery
center and receives the complicated chest cases from
several states, whereas, the gastrointestinal cases come
only from local trritory. Consequently, an erroneous
impression may be obtained, if total figures alone are
(Continued on Page 86)
84
Minnesota Medicine
A large benign chronic ulcer
with steep side walls as seen
in barium-filled shadow on
the lesser curvature Of the
stomach.
When your patient is on a special diet, as in the man-
agement of peptic ulcer, gallbladder disease, obesity,
etc., there may be insufficient fecal bulk for encouraging
the normal peristaltic reflex.
M ETA AA U C I L® is the highly refined
mucilloid of a seed of the psyllium group, Plantago
ovata (50%), combined with dextrose (50%).
SEARLE
RESEARCH
IN THE SERVICE OF MEDICINE
January, 1950
85
MINNESOTA ACADEMY OF MEDICINE
(Continued from Page 84)
considered. I can distinctly remember that not more
than four or five years ago at this same hospital where
as Consultant in Chest Surgery reviewing many chest
conditions, my diagnoses of primary bronchiogenic
carcinoma were met with the statement that they just
did not see carcinoma of the lung among their pa-
tients. The truth of the matter was that they saw
these patients but did not recognize the condition as
bronchiogenic carcinoma.
I feel that one should forget about doing routine
sputum examinations for carcinoma cells in an at-
tempt to discover primary bronchiogenic carcinoma,
because the technique is too time-consuming and detailed
to be used as a routine diagnostic procedure. Studies
of bronchial secretions aspirated directly from localized
areas of the lung are much more valuable but only if
the examinations are made by trained personnel ex-
perienced in this work. There are pitfalls which may
lead to an erroneous diagnosis. Careful bronchoscopy,
particularly using the right angle and the foroblique
telescopes through the bronchoscope, are valuable and
may enable one to visualize many tumors of the upper
lobe bronchi beyond the reach of the direct broncho-
scope. Direct biopsy from a visible tumor 'is of much
greater value than cell studies, but the latter are of
extreme value where biopsy cannot be obtained. The
bronchogram is very important, but it must be carefully
done and properly interpreted or it loses much of its
value. When confronted by an obscure lung lesion, one
should exhaust all of the diagnostic means at hand in-
cluding x-ray studies, bronchoscopy, bronchography, a
study of aspirated secretions, as well as a number of
studies for tubercle bacilli by smear technique in an at-
tempt to establish a definite diagnosis. If a diagnosis
cannot be reached by these studies and if primary
bronchiogenic carcinoma is under serious consideration,
one should not wait for negative culture reports for
tubercle bacilli for these tests are too time-consuming.
I feel rather that one should resort to exploratory thora-
cotomy with excision of the local lesion and immediate
pathologic examination. Primary bronchiogenic car-
cinoma moves too rapidly to justify a long delay for
special diagnostic studies. The big criticism in the use
of mass x-ray surveys for the discovery of primary
bronchiogenic carcinoma lies in the facts that, as or-
dinarily carried out, too much time is wasted in ruling
out tuberculosis and such time is extremely valuable in
the treatment of bronchiogenic carcinoma. I have yet
to see a resectable, curable, primary bronchiogenic car-
cinoma from the recent Minneapolis survey. In nearly
80 per cent of the patients whom we see with primary
bronchiogenic carcinoma, the disease is too far ad-
vanced to justify even an exploratory thoracotomy.
While occasionally, one may derive considerable benefit
from palliative resection in primary bronchiogenic car-
cinoma, taken by and large the amount of palliation ob-
tained is not too great. This tumor is usually a rapidly
growing type which metastasizes early and widely.
Late results from treatment are somewhat similar to
those of carcinoma of the stomach with considerably
less than 10 per cent five-year survivals. Earlier diag-
nosis and earlier treatment may improve these figures.
So far as localized nodules in the lung are con-
cerned, I believe that there is no accurate means of
diagnosing these by x-ray or other studies except by
local excision and immediate pathological examination.
Prompt investigation of these isolated nodules may bring
about recognition of a few cases of carcinoma in an
early stage.
The meeting was adjourned.
A. E. Carole, M.D., Secretary
HEMOCHROMATOSIS
(Continued from Page 56)
of portal circulation. The autopsy showed a very exten-
sive anastamosis between the omentum and the perito-
neum of the abdominal wall, extending from the crest of
the ilium up to the diaphragm. The adhesions were very
dense and firm over the liver. This shunting of the
portal circulation possibly accounts for the man’s fairly
good health and ability to carry on from 1934 until his
death.
References
1. Bearwood, J. T., and Roase, G. P. : Hemochromatosis.
Clinics, 3:251-260, (Aug.) 1944.
2. Beck, J. E. : Hemochromotosis. Backus’ Gastroenterology,
3:334-326, 1946.
3. Butt, H. R., and Wilder, R. H.: Hemochemotosis. Arch.
Path., 26:262, 1934.
4. Butt, H. R.. and Wilder, R. M.: Hemochromatosis. Proc.
Staff Meet. Mayo Clinic, 12:625-627, (Oct. 6) 1947.
5. Chesner, C.: Hemochromatosis. T. Lab. & Clin. Med., 31:
1029-1036, (Sept.) 1946.
6. Fishback, H. R. : Determination of iron in the skin in
hemochromatosis. T. Lab. & Clin. Med., 25:98-99, (Oct.)
1939.
7. Humphrey, A. A., et al. : Hemochromatosis. Arch. Dermatol.
& Syphilol., 45:1128-1132, (June) 1942.
8. Sheldon, J. H.: Hemochromatosis. Lancet, 2:1031, 1934.
HOSPITAL OCCUPANCY RATE LEVELING
(Continued from Page 75)
of supplies, which will mount due to absorption
of increased labor costs ; and food, which will
continue at present high price levels due to the
federal price supports which show no signs of
impermanence.
He adds, further :
“The past decade has been a period of phenomenal
advance in medical science which has greatly increased
the scope of hospital care and necessitated additional
facilities. The possibilities of nuclear medicine and new
diagnostic services indicate that the frontiers of med-
icine’s knowledge and effectiveness will further recede.
The hospital, having already been established as the
health center of its community, must provide the facilities
and the technical assistance to make these advances
available to the sick. Additional costs again will be
involved if we are to fulfill our mission of benefiting
mankind in the continual battle against the misfortunes
of ill health.”
He advised hospital administrators to practice
every technique of good management to prevent
the public from assuming a disproportionate share
of these rising costs, warning that adverse public
opinion could damage the entire voluntary hos-
pital system.
86
Minnesota Medicine
dnmumhh^ . . .
THE FIRST
NEUROLOGIC CENTER
FOR CIVILIANS
IN
THE NORTHWEST
The Board of Trustees of Glenwood Hills Hospitals announces the
opening in January 1950 of its Neurologic Center.
Neurologic Unit of Glenwood Hills Hospitals to be ready for service about January 15.
GLENWOOD HILLS HOSPITALS
3501 GOLDEN VALLEY ROAD • MINNEAPOLIS 22, MINNESOTA
Offering a High Standard of Facilities for 25 Years
January, 1950
87
Reports and Announcements ♦
♦
THE WASHINGTON AMA MEETING
The House of Delegates of the AMA, at its meet-
ing at Washington in December, voted to change the
By-Laws by requiring yearly membership dues of not
over $25.(10. This year will be the first in the history
of the Association that members will have ever paid any
dues. The $25.00 paid last year was in the nature of
a voluntary assessment to meet an emergency and was
paid by 80 per cent of the membership. By December
1, 1949, it netted $2,250,000 of which $2,050,000 had been
budgeted and approved for the National Education Cam-
paign of the AMA. The emergency, though relieved,
is not over. If the medical profession is going to pre-
vent the adoption of compulsory tax-supported govern-
ment medical care, educational activities will have to be
continued. The use of the funds derived from dues will
not be limited to the educational campaign, for the AMA
has need for the wherewithal to support its everexpand-
ing activities.
The 1950 AMA dues are payable now at the head-
quarters of the Minnesota State Medical Association,
496 Lowry Medical Arts Building, St. Paul 2. Members
who pay county and state association dues will maintain
their memberships in county and state organizations.
The payment of the additional $25.00 is required for
AMA membership and does not include subscription to
The Journal. That requires an additional $12.00, making
$37.00 in all. The rather anomalous situation exists
whereby a physician may be a member of a component
county and state association but not of the national
association.
Announcement was made at the AMA convention of
the retirement as of December 1, 1949, of Dr. Morris
Fishbein as editor. Dr. Austin Smith, secretary of the
Council of Pharmacy and Chemistry of the AMA for
a number of years, became editor of The Journal as of
December 1, 1949. Dr. Robert T. Stormant, medical
director of the Federal Food and Drug Administration
of the Federal Government since 1947, succeeds Dr.
Smith as secretary. Dr. W. W. Bauer, director of the
Bureau of Health Education of the AMA, becomes edi-
tor of Hygeia. Dr. Richard J. Plunkett, who has been
on the editorial staff of The Journal since 1947, as-
sumes the managing editorship of the nine scientific
journals devoted to the specialties published by the
American Medical Association.
CONGRESS ON OBSTETRICS AND GYNECOLOGY
The International and Fourth American Congress on
Obstetrics and Gynecology will be held on May 14 to 19
at Hotel Statler in New York. Mornings will be de-
voted to general sessions, and afternoons to the pro-
gram of the medical section of the Congress. Separate
afternoon sessions are planned for nurses, public health
persons, and hospital administrators. A special program
on the economic aspects of obstetrics and gynecology
will also be presented. Information as to registration,
housing data and program details can be obtained by
writing to Dr. Fred L. Adair, 161 East Erie Street,
Chicago 11, Illinois.
INTERNATIONAL COLLEGE OF SURGEONS
UNITED STATES CHAPTER
The following Minnesota surgeons were made Fellows
and Associate Fellows in the LTnited States Chapter,
International College of Surgeons, at the fourteenth
annual assembly of the group in Atlantic City, Novem-
ber 7 through 11, 1949: Certified Fellows, Dr. Harold
G. Benjamin, Minneapolis, and Dr. John D. Brown
Galloway, Minneapolis. Associate, Dr. Benjamin I.
Palen, Minneapolis. Adi'anced to Rank of Associate,
Dr. John A. Williams, Saint Paul.
In addition, the following were named Honorary
Fellowrs in the International Chapters of the International
College of Surgeons: Dr. Alfred W. Adson, Dr. Louis
Arther Buie, Dr. Byrl Raymond Kirklin, Dr. Harold I.
Lillie, Dr. J. Grafton Love, Dr. John Silas Lundy, and
Dr. Gershom J. Thompson, all of Rochester.
AMERICAN ACADEMY OF GENERAL PRACTICE
The American Academy of General Practice .will
hold its assembly at St. Louis February 20 to 23.
Twenty-two of the country’s leading clinicians will
deliver papers at the Kiel Auditorium during the ses-
sion. Hotel reservations may be made by writing to the
Hotel Reservation Bureau, A. A. G. P., 910 Locust
Street, Room 304, St. Louis 1, Missouri.
CONTINUATION COURSE IN CANCER
A continuation course in cancer for physicians will be
presented by the University of Minnesota February 16 to
18. The course is sponsored by the Minnesota State
Medical Association, the Minnesota Division of the
American Cancer Society, and the Cancer Control Di-
vision of the Minnesota Department of Health.
Dr. Henry K. Beecher, professor of anesthesiology at
Harvard Lhiiversity Medical School, will be the visiting
faculty member for the course and will also deliver
the E. Starr Judd Lecture in Surgery on the evening of
February 16.
BLUE EARTH VALLEY SOCIETY
Members of the Blue Earth Valley Medical Society,
covering Faribault and Martin Counties, elected Dr.
Lewis Hanson of Frost president of the organization at
the annual meeting in Blue Earth on November 17.
Dr. Hanson succeeds Dr. Robert Hunt of Fairmont in
the post.
Other officers elected include Dr. R. O. Burmeister,
Welcome, vice president; Dr. Hubert Boysen, Madelia,
(Continued on Page 90)
88
Minnesota Medicine
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January, 1950
89
REPORTS AND ANNOUNCEMENTS
BLUE EARTH VALLEY SOCIETY
(Continued from Page 88)
secretary-treasurer; Dr. J. J. Heimark, Fairmont, dele-
gate, and Dr. G. W. Drexler, Blue Earth, alternate dele-
gate.
Principal speaker at the greeting was Dr. R. M. Shick,
Rochester, who1 spoke on “The Practical Aspects of
Anticoagulant Therapy.”
GOODHUE COUNTY SOCIETY
Election of officers highlighted a meeting of the
Goodhue County Medical Society in Red Wing on De-
cember 1. Named as president was Dr. W. R. Miller of
Red Wing. Other officers elected were Dr. O. E. Lar-
son, Zumbrota, vice president ; Dr. G. F. Hartnagel,
secretary-treasurer; Dr. R. F. Hedin, delegate, and Dr.
G. M. B. Hawley, alternate delegate, all of Red Wing.
Society members at the meeting discussed the mass
chest x-ray survey to be conducted in Goodhue County.
RAMSEY COUNTY SOCIETY
Dr. F. G. Hedenstrom was named president-elect of
the Ramsey County Medical Society at a meeting in
Saint Paul on November 28. He will take office in 1951.
Serving as president of the group during 1950 is Dr.
Warner Ogden.
SOUTHWESTERN MINNESOTA
MEDICAL ASSOCIATION
At the annual fall meeting of the Southwestern Min-
nesota Medical Association, held in Worthington, Dr.
Gerrit Beckering of Edgerton was elected president. Dr.
Peter J. Pankratz, Mountain Lake, was named vice
president, and Dr. O. M. Heiberg, Worthington, secre-
tary-treasurer.
Dr. Beckering and Dr. E. W. Arnold, Adrian, were
elected delegates to the Minnesota State Medical Asso-
ciation, with Dr. C. L. Sherman, Luverne, and Dr. W. B.
Wells, Jackson, as alternates.
WRIGHT COUNTY SOCIETY
At a meeting of the Wright County Medical Society
in Buffalo late in November, Dr. V. T. Ryding of
Howard Lake was elected president. Other officers
elected at the meeting include Dr. W. E. Hall, Maple
Lake, vice president, and Dr. Theodore Catlin, Buffalo,
secretary.
As tuberculosis, in some aspect, is the concern of
every practitioner in whatever specialty, so its teaching
is the responsibility of the entire medical faculty. The
phthisiologist’s concern is with the segment of the prob-
lem which lies within the field of internal medicine.
As the thoracic surgeon is primarily a surgeon, so the
phthisiologist is primarily an internist. The more he
can participate with other internists in joint clinical re-
search and teachng enterprises the better will be the
education of the students who are under their mutual
guidance. Carl Muschenheim, M.D., Am. Rev. Tu-
berc., July, 1949.
Plan Now to Attend the
Sixth Annual Clinical Conference
Chicago Medical Society
February 28, March 1, 2, and 3, 1950
Palmer House Chicago 3, Illinois
A four-day meeting planned to keep you abreast of the latest develop-
ments in scientific medicine.
A group of outstanding men will present an excellent scientific program.
COLOR TELEVISION will be beamed from one of Chicago's large hos-
pitals direct to the Palmer House.
Many instructive scientific and technical exhibits.
Make Your Reservations Direct with the Palmer House
1850 — The 100th Anniversary of the Chicago Medical Society — 1950
90
Minnesota Medicine
worth consideration . . .
YOUR FUTURE WITH THE ARMY
OR THE AIR FORCE MEDICAL CORPS
Advanced medical and surgical practice with latest and
most modern equipment and techniques.
Applied or pure research in many areas of medical
science. Facilities of military and civilian medical cen-
ters— use of civilian consultant program.
Charted advancement in your selected career field
with less administrative burden, more opportunity to
practice.
Important personal rewards through extra profes-
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ances, other extras. Free retirement at comparatively
early age.
Increased professional standing through contribution
to a progressive, highly-specialized field of modern
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U. S. ARMY
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Your skills are vitally important to the national
security effort. Write the Surgeon General, U. S.
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Reserve Commissions and active duty!
i
January, 1950
91
♦
Woman's Auxiliary
♦
AUXILIARY LISTS BEST SEAL TALKS
Winners of the 1949 Christmas Seal high school radio
project, sponsored by the Minnesota Public Health As-
sociation and the Woman’s Auxiliary to the Minnesota
State Medical Association, have been announced. They
include :
High School Winners
First. — Shelly Budlong, Washington High School,
Brainerd.
Second. — Janice Kinter, Greenway High School, Cole-
raine ; Celestine Ahles, Cathedral High School, St.
Cloud ; Ruth Weber, St. Francis High School, Little
Falls; Jeanne Fortier, Little Falls High School, Little
Falls; Mary Jean Bohlinger, Mount St. Benedict Acad-
emy, Crookston ; Robert Hanson, Rochester High School,
Rochester; Joyce Lindell, Stillwater High School, Still-
water.
Junior High School Winners
First. — Barbara Sitzmann, Visitation Convent, St.
Paul.
Second. — Anne Thompson, Laboratory School, Bemid-
ji State Teachers College.
Honorable Mention
Senior Division. — Lorraine Hanson, Washington High
School, Brainerd; John Marty, Meadowland High
School, Meadowlands ; Rosemary Mahoney, Good Coun-
sel Academy, Mankato ; Bill Hempel, Elbow Lake High
School, Elbow Lake; Margaret Kramin, Danube High
School, Elbow Lake ; Elizabeth Gockowski, St. Agnes
High School, St. Paul ; Kathleen Lingle, White Bear
High School, White Bear; Carol Arch, Central High
School, Crookston ; Roger L. Nelson, Rochester High
School, Rochester; Donna Boelter, Blooming Prairie
High School, Blooming Prairie.
Junior Division. — Eddie Roos, Central Junior High
School, St. Cloud; Arlene Reed, Grand Rapids Junior
High School, Grand Rapids; Barbara Bossus, Franklin
Junior High School, Brainerd; Barbara Latterell, St.
Francis High School, Little Falls ; Marilyn Peterson,
Central Junior High School, Rochester; Marlene Ebin-
ger, Crosby High School, Crosby; Tom Uldrich, Little
Falls Junior High School, Little Falls; Irene Tomhave,
Washington Junior High School, Fergus Falls; Sally
Clare, Stillwater Junior High School, Stillwater.
WORTHINGTON RADIO SERIES POPULAR
Mrs. O. M. Heiberg*
Now going into its third year, “Your Health Hour,”
a series of radio programs on health, has proved very
popular with the KOWA, Worthington, listening audi-
ence.
‘Radio Chairman of the Woman’s Auxiliary of the South-
western Minnesota Medical Society.
92
The broadcasts, sponsored by the Woman’s Auxiliary
of the Southwestern Medical Society, are heard every
Sunday afternoon at 2 p.m. 'Transcriptions supplied by
the American Medical Association are used alternately
with live broadcasts, presented by laymen and profes-
sional people from a six-county area.
During December, radio listeners who turned to
Station KOWA learned about rheumatic fever, dodging
contagious diseases, tuberculosis, good teeth for chil-
dren, whooping cough.
The idea for the program developed from Health
Days conducted in Pipestone and Nobles counties. In-
terest in the series is maintained by spot announcements
calling the listeners’ attention to the broadcasts. Doctors
in the six counties receive a monthly card listing the
topics to be covered in the broadcasts for that month.
All newspapers in the six counties carry program an-
nouncements.
That the program creates general interest in health
problems is indicated by requests for copies of scripts
or for literature mentioned on the program.
MRS. BOIES ON NUTRITION COUNCIL
Mrs. H. E. Bakkila, president of the State Auxiliary,
has appointed Mrs. L. R. iBoies, Hopkins, to represent
the Auxiliary on the Minnesota State Nutrition Coun-
cil. The appointment was made in response to an invi-
tation issued by Irene Netz, chairman of the organiza-
tion.
Mrs. Boies is a member of the Hennepin County
Auxiliary.
RANGE BRANCH ADDS NEW MEMBERS
Mrs. G. Erskine
The Range Branch of the St. Louis County Medical
Auxiliary had a very successful membership tea, October
27, at the home of Mrs. L. W. Johnsrud, Hibbing.
Many new members were enrolled.
* * *
Mrs. J. O. Meyer has left Grand Rapids for foreign
fields. Dr. Meyer rejoined the army, with the rank of
major, and they are now in Milwaukee, awaiting orders
for Germany or Austria. They expect to sail some
time in February. Mrs. Meyer was very active on the
Grant Aid Committee and will be greatly missed.
* * *
Mrs. R. L. Bowen of Hibbing has had to curtail her
activities this year due to a very serious operation.
* * *
On account of road conditions, the Range Branch will
not meet again until March.
Minnesota Medicine
TAKE THAT WINTER VACATION
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ACAPULCO and MEXICO CITY
Special fun-filled excursion trips from the Twin Cities
to sunny Acapulco and Mexico City aboard a luxurious
28-passenger multi-engined DC-3. Spend five, seven or
ten glorious days bathing, sunning, sight-seeing or land-
ing the big ones in the world’s most famous deep sea
fishing waters.
These are personally conducted tours but your time is
your own. All reservations, including hotels, meals and
side trips will be made for you if you desire. Total cost
of round trip transportation per person is only $137.50
(plus $2.10 for Mexican tourist visa) . Hotel accommoda-
tions in the finest hotels will cost approximately $8.00 per
day including meals.
Call or write immediately for further information. Eight flights
are scheduled for January , {February and March but they are filling
fast so get your reservation in early.
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ADMINISTRATION BUILDING - HOLMAN FIELD
SAINT PAUL, MINNESOTA
In Memoriam
JOSEPH OWEN McKEON
Dr. Joseph O. McKeon of Montgomery died suddenly
in San Angelo, Texas, in November, 1949. He had been
civilian medical officer at Goodfellow Army Air Base
since June.
Dr. McKeon was born in Montgomery, Minnesota,
February 23, 1892. He obtained his M.D. degree at the
University of Minnesota in 1915 and interned at the
Minneapolis General Hospital. He served in the Army
from 1917 to 1919 with the commission of captain.
He was a member of Phi Rho Sigma medical frater-
nity and the Rice County Medical Society, the Minne-
sota State and American Medical Associations.
Surviving are his wife and three children, James and
Mary of Minneapolis and Mrs. Robert Maxeiner, Jr., of
Rochester, Minnesota, and his mother, Mrs. James Mc-
Keon, of Minneapolis.
THAYER C. DAVIS
Dr. Thayer C. Davis, a practicing physician at Wadena,
Minnesota, since 1922, died November 18, 1949. He was
sixty-two years of age.
Dr. Davis was born at Howard Lake, Minnesota, May
5, 1887. He received the degrees of M.B. and M.D. from
the University of Minnesota Medical School in 1913 and
interned at the City and County Hospital, Saint Paul.
He was a member of the Alpha Omega Alpha society at
the University.
He practiced at Warroad from 1914 to 1918 and at
Glenwood from 1918 to 1922, before locating in Wadena.
Dr. Davis was president of the First National Bank
of Wadena. He was a member of the Upper Mississippi
Medical Society, the Minnesota State and American
Medical Associations.
Surviving are his wife; two sons, Dr. Thayer Davis,
Jr. of Beaver Dam, Wisconsin, and Robert of Sheyenne,
North Dakota, and a brother, Dr. Thomas Davis,
Wadena, with whom he was associated in the practice of
medicine.
GEORGE R. DUNN
Dr. George R. Dunn, a prominent surgeon of Minne-
apolis, died on December 11, 1949, at the age of sixty-
one.
Dr. Dunn was born at Princeton, Minnesota, Decem-
ber 24, 1887. He obtained a Ph.B. degree from Hamline
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Minnesota Medicine
IN MEMORIAM
North Shore
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Winnetka, Illinois
on the Shores of
Lake Michigan
A completely equipped sanitarium for the care of
nervous and mental disorders, alcoholism and drug addiction
offering all forms of treatment, including electric shock.
SAMUEL LIEBMAN, M.S., M.D.
225 Sheridan Road Medical Director Phone Winnetka 6-0211
University in 1910 and his M.D. from Johns Hopkins
Medical School in 1914. He interned at the Johns Hop-
kins Hospital for a year.
He was a fellow of the American College of Sur-
geons, Assistant Professor of Surgery at the University
of Minnesota Medical School, and was on the staff of
Northwestern Hospital in Minneapolis. He was a mem-
ber of the Hennepin County Medical Society, the Minne-
sota State Medical Association, the American Medical
Association, the Minnesota Neurological Society and the
Minneapolis Surgical Society.
Surviving are his widow, a son and two daughters.
His sister, Grace A. Dunn, is editor and publisher of the
Princeton Union at Princeton, Minnesota.
LEONARD HARRIMAN
Dr. Leonard Harriman of Howard Lake, Minnesota,
passed away November 25, 1949.
Dr. Harriman was born in Parishville, New York, on
November 3, 1873. Later he moved to Wisconsin and
at the age of twenty-four joined the Army and served in
Puerto Rico during the Spanish-American war.
He received his M.D. degree at the University of Il-
linois medical school in 1909 and took two years of in-
ternship at St. Mary of Nazareth Hospital in Chicago,
He practiced at Lake Mills, Wisconsin, from 1911 to
1914, when he moved to Howard Lake, where he was
local surgeon for the Great Northern Railway in addi-
tion to carrying on a general practice.
Dr. Harriman had been local health officer since 1918,
president of the school board for many years, president
of the Security State Bank, and was active in many
community projects.
He was a member of the Wright County Medical
Society and the Minnesota State and American Medical
Associations.
Dr. Harriman is survived by his wife, the former
Anna Bringman.
Health education is the application of measures to in-
duce experiences which favorably influence knowledge,
attitudes and actions for the prevention of disease and
the perfection of health of the individual members of
society. Ira V. Hiscock, Pub. Health News, Feb., 1949.
AN APPRAISAL OF MAJOR SURGERY
IN A SMALL HOSPITAL
(Continued from Page 35)
References
1. Anderson, D. P. : Fate of the major surgical case in the
small hospital. Minnesota Med., 25:720, (Sept.) 1942.
2. Ladd, William E., and Gross, Robert E. : Abdominal Sur-
gery in Infancy and Childhood. Philadelphia : W. B. Saun-
ders Co., 1941.
3. Lahey, Frank H. : Common and hepatic duct stones. Am.
J. Surg., 40:209, (April) 1938.
4. Tanner, Frank H., and Cullen, George : Pathological as-
pects of death following major surgerv. Surg., Gynec. &
Obst., 84:446, (Oct.) 1947.
January, 1950
95
♦
Of General Interest
♦
All Minnesota physicians are invited to send to
Minnesota Medicine items “of general interest” con-
cerning themselves or their colleagues. To ensure
accuracy and completeness, it is suggested that items
submitted contain the answers to the age-old news-
paper questions: who? what? where? when? and (in
some cases) why? Only the facts are needed, since
items can be edited or rewritten for consistency of
style.
* * *
According to a communication from Dr. B. A.
Waisbren and Dr. Jean S. Hueckel in The Journal of
the American Medical Association of November 26,
1949, the administration of aluminum hydroxide gel
with aureomycin in order to reduce epigastric dis-
tress results in a lowering of serum levels of aureomycin
and is therefore contraindicated.
* * *
Dr. Manley F. Juergens, formerly of Thief River
Falls, became associated in practice with Dr. J. W.
Stuhr and Dr. J. E. Jensen in Stillwater on Decem-
ber 1.
The son of Dr. H. M. Juergens of Belle Plaine,
Dr. Manley Juergens was graduated from the Uni-
versity of Minnesota Medical School in 1945. After
interning at Minneapolis General Hospital, he entered
military service and served in the Army Air Corps.
Following his separation from the Army, he took
postgraduate training at the University of Minnesota,
then joined a clinic in Thief River Falls, where he
practiced during the past year.
* * *
“The Psychiatric Aspects of Alcoholism” was the
title of a talk given by Dr. Gordon R. Kamman,
Saint Paul, at a meeting of the Polk County (Wis-
consin) Medical Society at the Hazelden Foundation,
Center City, on November 17. The Hazelden Founda-
tion is a private institution, located near Center City,
for the rehabilitation of male alcoholics after they
have been discharged from medical care.
* * *
Dr. Robert Davis Mooney has opened an office at
Highland Medical Center, 670 South Cleveland Ave-
nue, Saint Paul, for the practice of internal medicine.
* * *
Minnesota has embarked upon an extensive five-
year program of state-wide professional postgraduate
education. Physicians, dentists, nurses and pharma-
cists are being invited to a series of district seminars
devoted to heart disease, cancer and psychosomatic
medicine.
Each seminar consists of eight consecutive weekly
meetings, with two lecturers usually appearing for
one hour each. There are six lectures on heart dis-
ease, six on cancer and four on mental health.
The first of the seven seminars scheduled for the
1949-1950 season was held at Bemidji, with an aver-
age attendance of twenty-five physicians and thirty
nurses at each meeting. The second seminar, held
in Fergus Falls, attracted an average of thirty-five
physicians, fifty nurses and thirty dentists for each
meeting. Interest in the seminars has been so favor-
able t hat several Minnesota communities have volun-
tarily requested that they be considered for future
sites.
The programs are planned and organized by the
Minnesota Department of Health with the assistance
of the University of Minnesota Schools of Medicine,
Dentistry, Nursing and Pharmacy, the Minnesota
State Medical Association, the Minnesota Nurses As-
sociation and the Minnesota State Pharmaceutical
Association.
* * *
Dr. David A. Sher, a pediatrician associated with
the Lenont-Peterson Clinic in Virginia, recently re-
ceived a five-year appointment to the newly created
Housing and Rehabilitation Commission of the City
of Virginia. At the organization meeting, Dr. Sher
was elected chairman of the commission.
* * *
Dr. B. O. Mork, Jr., Worthington, who is now
studying for an advanced degree in public health at
the University of Minnesota, has been replaced as
director of District 5 of the Minnesota Department of
Health by Dr. Helen B. Wolff of Worthington. Dr.
Wolff received her medical and public health training
in California. Her husband is a businessman in
Worthington.
* * *
Dr. W. W. Haesly, a former Winona resident,
opened offices for the practice of medicine in Wykoff
in the middle of November. A graduate of the
Northwestern University Medical School in 1948, Dr.
Haesly served his internship at St. Luke’s Hospital
in Chicago.
* * *
At a health clinic conducted in Red Wing on
November 14, more than 125 members of the high
school junior and senior classes received vaccinations
and Schick tests. In charge of the clinic were Dr.
George M. B. Hawley and Dr. Richard B. Graves,
both of Red Wing.
* * *
Dr. Hanns C. Schwyzer has opened an office at
2069 Ford Parkway, Saint Paul, for the practice of
general surgery. Dr. Schwyzer formerly was as-
sociated with Dr. Martin Nordland in Minneapolis.
* * *
The first issue of a Mayo Clinic newspaper, aimed
to promote a more neighborly relationship between
the clinic's medical and business staffs, was pub-
lished on November 26. In an article on the aims of
the new publication, the editor, Bill Holmes, a
former newspaper reporter, stated that in the early
days of the Mayo Clinic, when both business and
96
Minnesota Medicine
OF GENERAL INTEREST
THE THIRD OF A SERIES
We are using the opportunity afforded by the advertising
facilities of Minnesota Medicine to discuss Municipal
securities for investment of your savings.
One type of municipal securities consists of obligations issued by
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medical staffs were small, “inter-department con-
tact was a simple, neighborly process.’’ Due to the
“tremendous growth of the organization,” he con-
tinued, the “amiable open-an-adjoining-door relation-
ship” disappeared. The newspaper, it was hoped,
would help to restore that neighborly feeling.
Tabloid size, 12 by 17 inches, the first issue car-
ried four pages of feature stories and reports about
clinic personnel. It was distributed to more than
2,500 “subscribers.” Plans called for monthly pub-
lication at first, switching later to a two-week pub-
lication schedule. In the meantime a contest to select
a name for the paper was to be held.
Among those in attendance at the meeting of the
United States Chapter of the International College
of Surgeons in Atlantic City early in November was
Dr. T. A. Lowe, South Saint Paul.
* * *
Dr. Charles A. Haberle, formerly of Thief River
Falls, has joined the staff of the Arrowhead Clinic
in Duluth. A graduate of the University of Minne-
sota Medical School, Dr. Haberle received his post-
graduate training at the University Hospitals. For
the past three years he has been associated with a
clinic in Thief River Falls.
January, 1950
97
OF GENERAL INTEREST
Al the annual dinner meeting of the Minnesota
Chapter of the American Medical Technologists in
Minneapolis on December 3, the national society of
the AMT announced the reappointment of Jack O.
Kirkham for a third year as its state representative.
Chester Neese, Fergus Falls, was elected president
of the state chapter.
* * *
Dr. Frederick L. Schade, Worthington, was one of
the Minnesota physicians who attended a meeting
of the Central Association of Obstetricians and Gyne-
cologists in Oklahoma City early in November.
* * *
It was announced in November that Dr. Fred
Behling of Moorhead planned to establish residence
in Oklee on December 1 and that he had accepted a
proposal by the board of the Oklee Community Hos-
pital Association to establish a practice in a medical
clinic then being constructed in the city. A gradu-
ate of the University of Minnesota, Dr. Behling has
been on the staff of a Denver general hospital for the
past year.
* * *
On December 1, Dr. Brand A. Leopard closed his
office in Albert Lea for an indefinite period of time.
The reason announced for the closing was ill health.
# >;:
Dr. Thomas H. Seldon, of the section on anesthesi-
ology at the Mayo Clinic, was installed as president
of the American Association of Blood Banks at a
meeting of the organization in Seattle on November
5.
* * *
As principal speaker at a meeting of the Saint Paul
Business and Professional Women’s Association on
November 10, Dr. Harvey O. Beek, Saint Paul, dis-
cussed psychosomatic medicine and emotional dis-
orders.
* * *
The Duluth Chamber of Commerce opened its
1949-1950 industrial safety school series on December
7 with the first of four monthly sessions on in-
dustrial safety work. The opening session was de-
voted to medical problems, and most of the talks
were given by members of the St. Louis County
Medical Society.
Dr. Frederick J. Kottke, of the University of Min-
nesota Division of Physical Medicine, speaking at
the general meeting, discussed “The Importance of
Rehabilitation Therapy for the Injured Worker.”
Speakers at various section meetings of the safety
school were Dr. G. J. Strewler, Dr. J. J. Coll, Dr.
M. G. Fredericks, Dr. R. L. Nelson, Dr. John H.
Peterson, Dr. D. V. Luth, and Dr. E. C. Strauss, all
of Duluth, and Dr. P. B. Monroe, Cloquet.
* * *
Dr. Wayne C. Rydburg of Brooten was honored
at a dinner at the Glenwood Community Hospital on
November 29. After many years of practice in the
area, he planned to leave the community at the end
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98
Minnesota Medicine
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of December to become company physician for the
Flour City Ornamental Iron Works in Minneapolis.
A member of the Glenwood Hospital staff since
the opening of the hospital in 1940, Dr. Rydburg
served as acting chief-of-staff last year. He was
secretary of his county medical society for three
years and had been named president-elect. He was
president of the Brooten school board and had
served as mayor of Brooten for five years.
* * *
It was announced on December 1 that Dr. Kenneth
L. Nelson of Clara City planned to move to Balaton
on December 15 to open an ’office for the practice of
medicine. The village of Balaton has been without
a resident physician for several years.
* * *
Dr. Carl C. Chatterton was the principal speaker
at a meeting of Section 1 of the Child Psychology
Study Circle in Saint Paul on December 5. The
title of his talk was “Off to a Good Start.’’ Dr.
Chatterton is chief-of-staff of the Gillette Hospital for
Crippled Children and is an assistant professor of
clinical orthopedic surgery at the University of Min-
nesota Hospitals.
❖ * *
At a meeting of the Minneapolis Chapter, American
Academy of General Practice, in Minneapolis late in
November, Dr. Willis L. Herbert was elected presi-
dent to succeed Dr. Willis M. Duryea. Other of-
ficers include Dr. C. W. Del Plaine, who succeeds
Dr. J. H. Higgins as vice president, and Dr. Alex-
ander J. Ross, who succeeds Dr. James A. Blake as
secretary-treasurer.
* * *
Three county medical societies held a joint meet-
ing in New Ulm on November 17. The three groups
were the Brown-Redwood-Watonwan County Medi-
cal Society, the Blue Earth County Medical Society,
and the Nicollet-Le Sueur County Medical Society.
Principal speaker at the combined meeting was Dr.
Ben Sommers, Saint Paul, who discussed the treat-
ment of heart diseases.
* * *
After thirteen years of practice at Albert Lea,
Dr. Robert R. Swanson moved to Madison and be-
came associated with the Madison Clinic on Decem-
ber 1. In his new position, Dr. Swanson is chief of
the eye, ear, nose and throat department of the
clinic, replacing Dr. Walter N. Lee, who recently
moved to California.
After graduating from the University of Minne-
sota Medical School, Dr. Swanson spent three years
specializing in eye, ear, nose and throat diseases at
Western Reserve University Hospital in Cleveland.
Following that period of training, he opened his of-
fices in Albert Lea.
* * *
Dr. Edward B. Kinports, International Falls, and
his family spent two weeks in November at a ranch
near Tucson, Arizona. While in Tucson, Dr. Kin-
ports took a special course at St. Mary’s Hospital.
January, 1950
99
OF GENERAL INTEREST
Members of the Winona County Public Health
Association, meeting in Winona on November 10,
heard Dr. Karl H. Pfuetze, superintendent of Mineral
Springs Sanatorium, discuss the benefits of mass
chest x-ray surveys and describe the procedures
used in modern sanatorium treatment of tuberculosis.
* * *
A talk on allergy was given by Dr. Albert V.
Stoesser, clinical professor of pediatrics at the Uni-
versity of Minnesota, at a meeting of the Chelsea
Heights Child Psychology Study Circle on November
22.
* * *
Mrs. E. H. Hartung, the wife of Dr. Elmer H.
Hartung of Claremont, died in a Rochester hospital
on November 30 at the age of forty-two.
* * *
Seven Mayo Clinic physicians were honored as new
emeritus staff members at the clinic’s annual staff
meeting in Rochester on November 21. The six
men and one woman each received an honorary scroll
and a gift from the clinic staff. The new emeritus
members are Dr. Walter C. Alvarez, Dr. Harry H.
Bowing, Dr. Arthur U. Desjardins, Dr. Della G.
Drips, Dr. Bert E. Hempstead, Dr. Henry W. Meyer-
ding and Dr. Robert D. Mussey.
Mr. A. J. Lobb, legal advisor and former associate
secretary of the clinic board of governors, also be-
came an emeritus member at the meeting.
In the election of officers for 1950, Dr. H. I. Lillie
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was named president of the Mayo Clinic staff. Dr.
F. P. Moersch was elected vice president; Dr. E. N.
Cook, secretary; Dr. C. W. Rucker, first counselor,
and Dr. C. H. Watkins, second counselor.
Dr. James F. Weir, retiring staff president, pre-
sided at the meeting. In his talk he paid tribute to
Dr. Charles and Dr. William Mayo on the tenth
anniversary year of their deaths.
* * *
Open house was held on December 4 by Dr. Ralph
B. Johnson in his new office building in Lanesboro.
The new medical office is constructed of brick and
tile and contains a waiting room, x-ray room, minor
surgery room and two examining rooms.
* * *
Dr. Mellvin E. Lenander, St. Peter, was appointed
on December 5 by Governor Luther Youngdahl to
the State Board of Medical Examiners, to fill the un-
expired term of Dr. Albert Fritsche, New Ulm, who
had resigned.
* * *
Offices for the practice of medicine were opened
late in November in Richfield (Minneapolis suburb)
by Dr. Marie A. Smith. A graduate of the Uni-
versity of Illinois, Dr. Smith served her internship
at DePaul Hospital, Norfolk, Virginia. She then
practiced in maternal welfare and well-baby clinics
in Chicago before beginning a residency at the Uni-
versity of Chicago’s Lying-In Hospital. Later she
served in residencies at Maternity Hospital and St.
Mary’s Hospital in Minneapolis, then practiced in
clinics in Dwight, Illinois, and Milwaukee, Wis-
consin.
* * *
On November 16, at the fourth weekly session of
the medical postgraduate seminar held in Fergus
Falls, Dr. Robert A. Green and Dr. Robert Hebbel
were the principal speakers. Dr. Green, instructor in
internal medicine at the University of Minnesota,
spoke on “Heart Failure,’’ and Dr. Hebbel, assistant
professor of pathology at the University, discussed
“Use of Biopsy in Cancer Diagnosis.”
* * *
Dr. Peter H. Cremer was honored by being named
Eminent Citizen of Hastings at an honor assembly
held in Hastings on November 28, attended by
Governor Luther Youngdahl and high ranking of-
ficials of the Minnesota Veterans of Foreign Wars,
sponsors of the event. Said the main speaker of the
evening in paying tribute to the physician: “Dr.
Cremer is a person who put the health of the people
above the practical phase of his profession.” And he
added, “He is more of a health keeper than a book-
keeper.”
* * *
Dr. W. W. Brown, formerly of Minneapolis, has
opened offices for the practice of medicine at Big
Lake, which has been in need of a physician for
several years.
* * *
A Duluth physician, Dr. Anderson C. Hilding,
presented a paper at the fiftieth anniversary meeting
• , Minnesota Medicine
OF GENERAL INTEREST
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of the Chicago Otological Society in Chicago on
December 5. His paper was entitled “Absorption of
Air from Various Parts of the Respiratory Tract and
Its Relationship to Postoperative Lung Complica-
tions.”
* * * *
Dr. Morris Fishbein, former editor of the J.A.M.A.,
has joined the staff of Postgraduate Medicine, a pub-
lication edited by Dr. Charles W. Mayo, Rochester,
and published in Minneapolis. It was announced that
as a contributing editor, Dr. Fishbein would have a
free hand in writing editorials, a column on medicine
abroad, and his well-known “Dr. Pepys’ Diary.”
* * *
At a meeting of the city council in Crookston on
November 8, Dr. Russell O. Sather of the North-
western Clinic was named city health officer, mem-
ber of the city board of health, and water, tnilk and
cream inspector. All three positions were formerly
held by the late Dr. L. L. Brown. Dr. Sather was
appointed to the offices by Dr. M. O. Oppegaard,
mayor of Crookston.
On November 15, at a meeting in Bemidji of
hospital administrators and staff members from the
northwest part of the state, Dr. Sather was appointed
a member of a three-man committee to study the
shortage of nurses in northern and rural areas of
Minnesota. Appointed with Dr. Sather were Dr.
J. A. Cosgriff, Olivia, and Dr. W. L. Burnap, Fergus
Falls. The committee will report to the governor’s
committee on nursing in Minnesota.
* * *
Problems in setting up rural health services were
discussed by Dr. A. B. Rosenfield, director of District
6 of the Minnesota Department of Health, at a meet-
ing of the Saint Paul Area Public Health Council on
November 16.
* * *
Dr. Samuel E. Bigelow joined the staff of the
Fergus Falls State Hospital on December 1. Dr.
Bigelow went to Fergus Falls from Clinton, Iowa,
where he had been associated with the Independence
State Hospital for more than a year. Before that,
he was on the staff of the Sante Fe Railroad Hos-
pital at Fort Madsen, Colorado.
:ji j{s jj4
It was announced on November 9 that Dr. J. A.
Watkins would soon become a member of the newly
formed Cottonwood County Clinic in Windom. At
the time of the announcement, Dr. Watkins was
completing a residency in anesthesia at the Uni-
versity of Minnesota. He has taken postgraduate
training at Wayne County Hospital in Michigan.
* * *
Dr. Charles W. Mayo and Dr. Waltman Walters,
Rochester, have been appointed members of the
national American Legion medical advisory board
for 1950.
January, 1950
101
OF GENERAL INTEREST
Open house was held at the newly constructed
Edina Clinic on November 23. Occupants of the
modern two-storv structure include Dr. C. V. Rock-
well and Dr. R. G. Tinkham.
* * *
In Duluth on November 11, Dr. Mary McCoy
celebrated her nintieth birthday anniversary. Al-
though she retired from practice in 1938, Dr. McCoy
still maintains an active interest in medicine.
A graduate of the Llniversity of Michigan Medical
School, Dr. McCoy began practice in Duluth in 1890,
shortly after completing her internship at a Colum-
bus, Ohio, hospital. The start of her medical career,
she recalls, had a reverse twist: she promptly con-
tracted typhoid fever and spent the first seven- months
of her practice as a patient.
Two of Dr. McCoy’s sisters also became physi-
cians. One, Dr. Theresa Abt, still practices in Chi-
cago and was in Duluth to celebrate Dr. McCoy’s
birthday. The other sister is the late Dr. Helene K.
Knauf of Jamestown, North Dakota.
* * *
Dr. Harold W. Hermann lias become associated in
the practice of pediatrics with Dr. A. E. Karlstrom
in Minneapolis. Dr. Hermann formerly was in
practice in Caledonia with Dr. J. J. Ahlfs.
* * *
A husband and wife, both physicians, began
practice in Jordan on November 19. They are Dr.
and Mrs. Paul Strahler, both graduates of the Col-
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both served their internship at the Medical Center in
Jersey City, N. J.
* * *
Dr. Albert Faulconer, Rochester, presented a paper
entitled “Some Observations on Post-Anesthetic
Encephalopathy” at the fourteenth annual assembly
of the United States Chapter, International College
of Surgeons, in Atlantic City on November 11.
* * *
Announcement was made on December 8 that Dr.
Francis W. Lynch of Saint Paul had been elected
vice president of the American Academy of Derma-
tology and Syphilology.
* * *
Among the Minnesota physicians who attended a
continuation course in traumatic and pediatric surgery
at the University of Minnesota November 10 through
12 were Dr. Robert Gruys, Windom; Dr. B. W.
Bunker and Dr. Frank E. Mork, Anoka; Dr. A. H.
Borgerson, Long Prairie; Dr. Clarence Jacobsen,
Chisholm, and Dr. Franklin C. Anderson, Owatonna.
* * *
In Brainerd, Dr. W. E. Fitzsimons and Dr. M. D.
McGeary have moved into new offices in the east end
of the Benson Building. Their new quarters include
a waiting room and six examining rooms, all air-
conditioned and modern in design. Associated with
them in the clinic is a dentist, Dr. J. E. Echternacht.
* * *
It was announced on December 1 that Dr. Albert
C. Martin would begin medical practice in Luverne
about February 1. At the time of the announcement
Dr. Martin was located in Harvey, Illinois.
* * *
Dr. Frederic J. Kottke, associate professor of
physical medicine at the University of Minnesota,
spoke on “Goals of Rehabilitation” at a meeting of
the Minneapolis and Hennepin County Community
Chest and Council on December 14.
* * *
At the AMA mid-vear clinical session in Washing-
ton, D. C., on December 6, Dr. A. B. Baker and
Dr. Joe R. Brown described rehabilitation possibilities
of persons suffering from various neurological dis-
orders. The basis of their presentation was the work
done at the Minneapolis Veterans Hospital. Dr.
Baker is director of neurology at the University of
Minnesota, and Dr. Brown, who is now at the Mayo
Clinic, has been on the University and Minneapolis
Veterans Hospitals staffs.
* * *
The city of St. Peter acquired a new physician in
December when Dr. Harold S. Orwoll became a
staff member of the St. Peter Clinic. A graduate of
the University of Chicago Medical School in 1946,
Dr. Orwoll served his internship at Chicago
Memorial Hospital. He then practiced at the Brew-
ster Clinic in Holdrege, Nebraska, before moving to
St. Peter. In his new location he is associated in
practice with Dr. E. G. Olmanson and Dr. Helge
Sandelin.
102
Minnesota Medicine
OF GENERAL INTEREST
Mantoux tests were administered to children in
Jackson County schools during November and early
December. The testing was done under the direction
of Dr. Helen B. Wolff, medical director of District 5
of the Minnesota Department of Health.
* * *
Dr. Herman J. Moersch, Rochester, has been ap-
pointed a member of the executive committee of the
Minnesota Public Health Association.
* * *
Dr. James M. Thomson has opened offices for the
practice of medicine at the Edina Medical Center,
3939 West Fiftieth Street, Edina (Minneapolis sub-
urb). Offices are maintained in the same building
by Dr. Harry C. Jensen and Dr. Francis M. Walsh.
Dr. Irvin H. Moore, who formerly was located in
the building, has moved his offices to 5013 France
Avenue.
* * *
At the annual meeting of the Interurban Academy
of Medicine in Duluth on November 16, Dr. James
Easton, Superior, was elected president to succeed
Dr. W. J. Strobel, Duluth. Other officers named
were Dr. A. J. Bianco, Duluth, vice president, and
Dr. Milton Finn, Superior, secretary-treasurer.
The principal speaker at the meeting was Dr. John
S. Hirschboeck, Milwaukee, who spoke on “Signifi-
cance of the Blood in Medical Diagnosis.”
* * *
Dr. Herbert Plass, Minneapolis, discussed volun-
tary health insurance at a meeting of the Minne-
apolis branch of the American Association of Uni-
versity Women on November 14. Dr. Plass is co-
chairman of the Hennepin County Medical Society’s
speakers bureau. The meeting was the second of a
series devoted to national health problems.
* * *
It was announced on December 2 by Dr. Eugene L.
Zorn that his practice in Erskine would be taken
over on a part-time basis by two Red Lake Falls
physicians. Dr. Lester N. Dale and Dr. James H.
Reinhardt of Red Lake Falls planned to provide
Erskine with a physician’s services on two full days
and two half days each week.
* * *
The offices of Dr. Willmar C. Rutherford and Dr.
Robert L. Cushing have been moved into a newly
constructed building at 505-507 Washington Street
in Brainerd.
* * *
Why don’t more college-trained women reach the
top of their profession? This was the question that
four professional women, including Dr. Ruth Boyn-
ton, director of student health at the University of
Minnesota, attempted to answer at a meeting of
the Minneapolis branch of the American Association
of University Women on December 5.
The four women — a physician, a dentist, a lawyer
and an architect — agreed that the biggest problem a
professional woman faces is the prejudice of other
women. A woman, it was suggested, feels inferior
to a man, and to boost her morale she believes that
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103
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* * *
Dr. John D. Camp, Rochester, presented a paper
entitled “The Roentgenologic Significance of Intra-
cranial Calcification” at a meeting of the Radio-
logical Society of North America in Cleveland early
in December. Other Rochester physicians attending
the meeting included Dr. J. R. Hodgson, Dr. D. G.
Pugh and Dr. Martin Van Herik.
* * *
The University of Minnesota now ranks second
in enrollment of full-time students. According to a
survey by Dr. Raymond Walters, the University of
California leads the field with an enrollment of
43,426 students, the University of Minnesota is
second with 24,684, and the University of Illinois is
third with 22,854. There seems to be no unanimity
of opinion as to which of all the universities in the
country is the best.
* * *
Dr. Andy Hall of Mt. Vernon, Illinois, was chosen
the General Practitioner of the Year by the House
of Delegates at the Third Clinical Session of the
AMA in Washington, D. C., in December. Dr.
Hall, still active at the age of eighty-four, has been
mayor of Mt. Vernon, head of the township board,
chairman of his Republican county committee, Il-
linois director of public health, a company surgeon
in the Spanish-American War and chief of surgery in
a base hospital in World War I, secretary and presi-
dent of his county medical society, president of the
Southern Illinois Medical Society and a councilor to
the Illinois State Medical Society.
* * * *
The health magazine Hygeia, published by the
AMA since 1923, will change its name to Today’s
Health beginning with the March, 1950, issue. The
new name is more descriptive of the aims and con-
tents of the magazine. Beginning with the January
issue, the magazine will be edited by Dr. W. W.
Bauer, with Dr. William Bolton as associate editor.
* * *
Dr. H. O. McPheeters and Dr. C. V. Kusz, both
of Minneapolis, presented a discussion on “Varicose
Veins and Thrombophlebitis” at a meeting of the
Stearns-Benton County Medical Society in St. Cloud
on December 15.
* * 4s
Dr. Irving C. Bernstein, who was on leave from
the University of Colorado School of Medicine and
was associated with the Oliver Clinic in Graceville
for the last six months of 1949, has returned to his
post in Colorado. He is in the department of psy-
chiatry of the medical school, located in Denver.
* * *
At the annual meeting* of the Minnesota Obstetri-
cal and Gynecological Society, held in Saint Paul
on December 2, Dr. James Swendson, Saint Paul,
was elected president of the group. Other officers
named were Dr. W. F. Mercil, Crookston, vice presi-
dent, and Dr. John A. Haugen, Minneapolis, secre-
tary-treasurer.
% ijC 5*C
Dr. John Noble, who recently completed a resi-
dency in medicine at Augustana Hospital, Chicago,
became associated with the Oliver Clinic in Grace-
ville on January 1. Dr. Noble is a graduate of the
University of Illinois College of Medicine.
* * *
HOSPITAL NEWS
At the annual meeting of the medical staff at Ab-
bott Hospital, Minneapolis, in early December, Dr.
O’. J. Campbell was named staff president. Dr.
Campbell, a clinical professor of surgery at the Uni-
versity of Minnesota, has been a member of the
Abbott Hospital staff for twenty years.
Other officers elected include Dr. John Haugen,
vice president, and Dr. Walter Hoffman, secretary.
* * *
A sale of articles made by patients at Glen Lake
Sanatorium, held at the Dayton Company in Min-
neapolis in November, brought in $2,805.85 in pro-
ceeds. The sale was sponsored by the Woman’s
Auxiliary to the Hennepin County Medical Society,
which reported that the proceeds were a substantial
increase over the previous year’s sale.
* * *
BLUE CROSS-BLUE SHIELD NEWS
Minnesotans received over $1,000 000 in Blue Shield
medical-surgical benefits during the first eleven
104
Minnesota Medicine
OF GENERAL INTEREST
months of this year. In November alone, Blue Shield
paid three and a half times as many claims as during
the same month in 1948.
Minnesota Blue Shield paid 3,195 claims in No-
vember, 1949 — an average of 106.5 claims a day. In
November, 1948, Blue Shield paid 886 claims — an av-
erage of 29.5 claims a day. In medical-surgical bene-
fits this amounted to $83,413.62 more in November,
1949, compared with the November, 1948, Blue Shield
benefits.
To date this year, Blue Shield subscribers have re-
ceived $1,026,814.53 in medical-surgical benefits. Last
year, Blue Shield subscribers received $152,224 in
medical-surgical benefits during the same eleven-
month period.
Enrollment in Minnesota Blue Shield has increased
to cover 244,419 persons as of October 31, 1949.
The number of Minnesota doctors participating in
Blue Shield has also increased. Fourteen doctors
joined Blue Shield in November, making the total
Minnesota doctors participating in Blue Shield 2 568.
There is a considerable number of newly licensed
doctors, however, who have not sent in their enroll-
ment cards. Blue Shield urges all doctors who have-
n’t as yet sent in their cards to do so as soon as
possible.
Soon after the first of the year, Minnesota Medical
Service, Inc., will mail statements of Blue Shield
earnings during 1949 to all doctors to whom Blue
Shield has made payments in excess of the amounts
listed below:
State of Minnesota return — payments in excess of
$500 per year
Federal Income Tax return — payments in excess of
$600. per year
Cost of hospital services has continued to increase,
and a greater number of Blue Cross subscribers have
used hospital care. The average length of stay in
the hospital for Blue Cross patients has decreased,
however.
From January through October this year, pay-
ments to hospitals for Blue Cross subscribers’ care
amounted to $6,931,257.16 — an increase of $1,190,586.-
87 over the amount paid out during this same period
in 1948.
A review of the national scene shows an enrollment
of 12,554,012 persons in United States and Canada in
seventy-three Blue Shield or other non-profit pre-
paid medical service plans, as of June 30, 1949.
More than 35,000,000 persons in the United States
and Canada were enrolled in non-profit Blue Cross
hospital care plans on September 30, 1949. Blue
Cross has enrolled 22.11 per cent of the total popula-
tion of the forty-seven States and the District of
Columbia served by Blue Cross, and 22.99 per cent
of the combined population in the seven Canadian
provinces served by Blue Cross plans.
Eight Blue Cross plans now have an enrollment
of more than 1,000,000 members. Minnesota s Blue
Cross plan is nearing that enrollment figure with
963,111 persons in Minnesota enrolled as of October
31, 1949.
f^ropeiiion
N. P. BENSON OPTICAL CO
Laboratories in Minneapolis
and
Principal Cities of Upper Midwest
Cook County Graduate School of Medicine
ANNOUNCES CONTINUOUS COURSES
SURGERY — Intensive course in Surgical Technique,
two weeks, starting January 23, February 20.
Surgical Technique, Surgical Anatomy and Clinical
Surgery, four weeks, starting February 6, March 6.
Surgery of Colon and Rectum, one week, starting
March 6.
Esophageal Surgery, one week, starting June 5.
Breast and Thyroid Surgery, one week, starting June
Thoracic Surgery, one week, starting June 12.
Gallbladder Surgery, ten hours, starting April 24.
Fractures and Traumatic Surgery, two weeks, starting
April 17.
GYNECOLOGY — Intensive Course, two weeks, starting
February 20. , . ,
Vaginal Approach to Pelvic Surgery, one week, start-
ing March 6.
OBSTETRICS — Intensive Course, two weeks, starting
March 6.
PEDIATRICS — Intensive Course, two weeks, starting
April 3.
Personal Course in Cerebral Palsy, two weeks, starting
July 31.
MEDICINE — Intensive General Course, two weeks,
starting April 24.
Hematology, one week, starting May 8
Gastro-Enterology, two weeks, starting May 15.
Liver and Biliary Diseases, one week, starting June 5.
Gastroscopy, two weeks, starting March 6.
DERMATOLOGY — Formal Course, two weeks starting
May 8. Informal Clinical Course every two weeks.
UROLOGY — Intensive Course, two weeks, starting April
17
Cystoscopy, ten-day Practical Course, every two weeks.
General, Intensive and Special Courses in all Branches of
Medicine, Surgery and the Specialties.
TEACHING FACULTY— ATTENDING
STAFF OF COOK COUNTY HOSPITAL
Address: REGISTRAR, 427 South Honore Street
Chicago 12, Illinois
January, 1950
105
BOOK REVIEWS
BOOK REVIEWS
Books listed here become the property of the Ramsey,
Hennepin and St. Louis County Medical Libraries when
reviewed. Members, however, are urged to write reviews
of any or every recent book which may be of interest
to physicians.
HANDBOOK OF MEDICAL MANAGEMENT. Mil-
ton Chatton, A.B., M.D., Instructor in Medicine, Uni-
versity of California Medical School; Sheldon Margen,
A.B., M.D., Clinical Instructor in Medicine and Re-
search Associate in Medicine, Lffiiversity of California
Medical School ; and Henry D. Brainerd, A.B., M.D.,
Assistant Clinical Professor of Medicine and Pediat-
rica, University of California Medical School, Assist-
ant Clinical Professor of Pediatrics, Stanford Univer-
sity School of Medicine, P'hysician-in-Charge, Isolation
Division of San Francisco Hospital. 476 pages. Price
$3.00. Palo Alto, California: University Medical
Publishers, 1949.
FROM THE HILLS. An Autobiography of a Pediatri-
cian. John Zahorsky, M.D. 387 pages. Price $4.00,
cloth. St. Louis : C. V. Mosby Co., 1949.
CONGENITAL ANOMALIES OF THE HEART
AND GREAT VESSELS. Thomas J. Dry, M.D., et
al., of Mayo Clinic. 68 pages. Illus. Price $4.50,
cloth. Springfield, Illinois: Charles C. Thomas, 1949.
ESSENTIALS OF OBSTETRICAL AND GYNECO-
LOGICAL PATHOLOGY. Second Edition. Robert
L. Faulkner, M.D., F.A.C.S. Assistant Professor of
Gynecology, Western Reserve Medical School ; Asso-
KORT.iWAYNEH IkTPIAWAs
Professional Protection
Exclusively
since 1899
MINNEAPOLIS Office:
Stanley J. Werner, Rep.
816 Medical Arts Building,
Telephone Atlantic 5724
106
date Gynecologist, University Hospitals of Cleveland,
Ohio. 357 pages. Illus. Price $8.75, cloth. St.
Louis : C. V. Mosby Co., 1949.
CLINICAL OPHTHALMOLOGY FOR GENERAL PRACTI-
TIONERS AND STUDENTS. H. M. Traquair, M.D.,
F.R.C.S., Ed., Consulting Ophthalmic Surgeon, Royal Infirmary,
Edinburgh; Ophthalmic Surgeon, Chalmers Hospital, Edin-
burgh; Oculist to the Edinburgh Municipal Hospitals; Late
Lecturer on Diseases of the Eye, Edinburgh University. 264
pages. Illustrated. St. Louis: The C. V. Mosby Company,
1948. Price $9.00.
This book was written specifically for the use of gen-
eral practitioners and students. It is short and compre-
hensive, covering the common office ophthalmological
problems.
Frank Adair, M.D.
STEDMAN’S MEDICAL DICTIONARY. Seventeenth re-
vised edition. Edited by Norman Burke Taylor, M.D., Uni-
versity of Western Ontario. 1361 pages. Illus., including
color plates. Price $8.50 with thumb index ; $8.00 without
thumb index. Baltimore: Williams and Wilkins Company,
1949.
The seventeenth edition of this well-known medical
dictionary is a useful and attractively bound reference
book. In the preparation of this revision, the publishers
state, obsolete words were deleted and old definitions
revised. Most of the trade names found in the last
edition have been removed, and no new ones have been
added. The inclusion of brief biographical sketches of
the principal figures in the history of medicine consti-
tutes a new feature of the dictionary.
The book is well illustrated with clear line drawings
and several color plates. Though no more at fault than
many other dictionaries, this volume would be improved
if the definitions were set in slightly larger type.
J.H.L.
CONTROL OF PAIN IN CHILDBIRTH; ANESTHESIA,
ANALGESIA, AMNESIA. By Clifford B. Lull, M.D.,
F.A.C.S., F.I.C.S., Director, Division of Obstetrics and Gyne-
cology, Philadelphia Lying-in L'nit, Pennsylvania Hospital, and
Robert A. Hingson, M.D., F.I.C.S., F.A.C.A., F.I.C.A., As-
sociate Professor of Obstetrics; Anesthesiologist, Department of
Obstetrics, Johns Hopkins University and Hospital; Surgeon,
United Public Health Service; with an introduction by Norris
Vaux, M.D. 3rd ed. rev. and enlarged. 522 pages Illus.
Philadelphia: J. B. Lippincott Company, 1948. Price $12.00.
In reading the first edition of Lull and Hingson’s
“Control of Pain in Childbirth,” one immediately gets the
impression that the book was written as an epitome on
the use of intermittent caudal anesthesia. This is under-
standable in view of the introduction and popularization
of this method of relief of pain in labor and delivery by
the authors.
The third edition brings the reader up to date on
caudal anesthesia, results and techniques, with additional
material, such as modifications in caudal techniques in
very obese women and a section entitled “A Further
Evaluation of Caudal Anesthesia” in reviewing the litera-
ture from the time of the first edition to the present. The
paragraph on the use of continuous caudal anesthesia in
the hypertensive toxemias has been expanded. The re-
cent work done by Whitacre on the electro-encephalo-
graphic changes showing reversion toward a more nor-
mal brain wave pattern after relief of vasospasm by re-
gional nerve block is quoted as support for the use of
the intermittent caudal technique in eclampsia.
An entirely new section on the place of intravenous
Minnesota Medicine
BOOK REVIEWS
anesthesia by Louis M. Heilman of Johns Hopkins is a
worth-while addition to the book. Another valuable ad-
dition is the fairly extensive description of the techniques
and results of saddle-block anesthesia as used by Parm-
ley and Adriani and in Dieckmann’s Clinic. In the same
vein is a new chapter on continuous spinal anesthesia and
its use in obstetrics.
The book concludes with another new chapter, “The
Early Care of the Newborn Infant.”
This present edition, as its predecessor, is the best
work available on intermittent caudal anesthesia in ob-
stetrics and the apparent over-emphasis of this phase of
relief of pain in childbirth in no way detracts from the
value of the book, since other methods of pain relief
are adequately discussed. The volume takes its place as
one of the best in a difficult and everchanging field of
medicine.
Albert F. Hayes, M.D.
INVITED AND CONQUERED. J. Arthur Myers, Ph.D., M.D.,
Minnesota Public Health Association. 737 pages, 356 illustra-
tions. Webb Publishing Co., Saint Paul, Minn., 1949. Price
$6.50.
This engrossing book, written in the author’s cus-
tomarily pleasing style, and dedicated to one of the most
persistent yet unsung foes of the disease, is particularly
timely this centennial year in documenting all the sig-
nificant contributions and developments in tuberculosis in
Minnesota during the past 100 years. Every incident and
detail of anti-tuberculosis work, from the earliest pioneer
days in 1659 through the most recent diagnostic technics
of photofluorography and therapeutic procedures such
as pneumonectomy are presented in chronological se-
quence. More than 1,900 persons who have played some
role in the conquest are accorded their proper place.
Pictorially, also, in addition to the photographs of 245
anti-tuberculosis workers, 120 illustrations and 14 graphs
enhance the value of the book. It is a monumental and
much-needed documentation of medical history, cor-
relating activities within this state with the advances in
tuberculosis throughout the world.
First is traced the initial infection of the Indians from
the time of Radisson’s first landing, in 1659, through the
final stages of the New Ulm massacre in 1862. Then the
story is told of immigration to Minnesota of people from
all over the country and world, all of whom migrated
here for the climatic cure of their tuberculosis. Koch s
discovery of the tubercle bacillus only slowly was accept-
ed as proof of contagiousness of the disease. It in-
fluenced greatly the diagnosis of tuberculosis as did also
the introduction of the clinical thermometer in 1867, dis-
covery of tuberculin in 1890, use of the x-ray after 1895
and the bronchoscope in 1898. Another chapter captivat-
ingly tells of the early influx of doctors and the organ-
ization in 1853 of what is now the Minnesota State Med-
ical Association, the creation and early history of the
Minnesota Department of Health, the birth and found-
ling years of medical education culminating in the estab-
lishment of the University Medical School. Rounding
out the first part are two chapters concerned with early
mortality of human tuberculosis, and such early efforts
to control the disease as reporting cases, quarantine and
sanatoriums.
In Part II are reviewed both the lesser and epochal
advances in tuberculosis, especially as related to Minne-
sota persons, organizations and institutions. Of consum-
ing interest are three chapters discussing pioneers, former
Minnesotans, and the state’s debt to other people. No
detail is too small, no incident too trivial, no worker too
obscure to be unmentioned in the historical progress
against tuberculosis.
Among the institutions and organizations whose de-
velopment has conditioned and paralleled advances in
tuberculosis have been the University Medical School,
the Minnesota Board of Health, sanatoriums and others.
Here is the full story of the growth of the University
Medical School from one small structure and five non-
teaching faculty members in 1893 to its present size,
with 541 teaching faculty members this year. No less
intriguing and important, as far as tuberculosis is con-
cerned, is the story of veterinary medicine and the eradi-
cation of tuberculosis in cattle in Minnesota. Even more
intimately identified with eradication of human tuber-
culosis is the State Board of Health. This, too, is a fas-
cinating epic of progress from conflict with other agen-
cies to development of a special Tuberculosis Control
Division and eight branch offices throughout the state.
How Minnesota’s sanatorium situation developed from
not a single bed for tuberculous patients in 1900 to 2,200
beds for tuberculous patients in the State Sanatorium and
fourteen county institutions' provides here engrossing
reading for anyone.
Even with discord between official and lay anti-tuber-
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414 SOUTH SIXTH ST., MINNEAPOLIS/MINN.
INSTRUMENTS • TRUSSES • EQUIPMENT • PHARMACEUTICALS • DRUGS
MAIN 2494
January, 1950
107
BOOK REVIEWS
culosis organizations rife early in this century, there
ultimately emerged an effective Minnesota Public Health
Association. Since 1924, when the present personnel took
the reins, this association has energetically and unremit-
tingly employed every method and device to control the
disease. Most effective and helpful were the tuberculin
testing, tuberculin distributing and finally, the mass
mobile x-ray unit and tuberculin testing campaigns.
Unique in Minnesota’s contributions have been ac-
creditation of counties and schools in reducing the in-
cidence of tuberculin reactors.
No such volume is complete without an evaluation of
accomplishments to date, and an entire chapter is de-
voted to this topic. Comparisons of the mortality of
tuberculosis and the numbers of earlier and present tuber-
culin reactors in various groups, states and the United
States are discussed and graphically presented. In fact,
this whole chapter is a remarkable testimonial to the ef-
fectiveness of the work of the innumerable persons,
groups, agencies, organizations and institutions men-
tioned in preceding pages. Also of indispensable value is
the final chapter of mileposts in tuberculosis eradication.
Here are listed in almost outline form all the major
events from 1659 to date in the history of Minnesota’s
fight against tuberculosis.
This book is truly a masterpiece of research and a
basic contribution to the historical and tuberculosis
literature of the state, if not the nation. Certainly, no
one interested in the history of either Minnesota or
tuberculosis could afford to neglect this book.
Edwin J. Simons, M.D.
FISHBEIN HAS COLORFUL CAREER
Dr. Morris Fishbein was born in St. Louis on July
22, 1889. He has had a colorful career during his long
tenure with the American Medical Association.
RADIUM RENTAL SERVICE
2525 INGLEWOOD AVENUE
MINNEAPOLIS 5, MINNESOTA
TEL. ATLANTIC 5297
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ORDER BY TELEPHONE OR MAIL
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He worked his way through the University of Chicago
and Rush Medical College, taking lecture notes in short-
hand and selling them to classmates. By 1912, when he
received his M.D. degree, he was writing editorials for
The Journal of the American Medical Association. The
following year he became assistant editor of The Jour-
nal and has been with the AMA ever since, becoming
editor in 1924.
In addition to his editorial work with the American
Medical Association, Dr. Fishbein has written twenty-
two books, edited seven others, writes twelve to fifteen
popular magazine articles a year, delivers six or eight
lectures a month, conducts medical columns in two
magazines, writes a daily syndicated health cojumn for
more than a score of newspapers, is medical editor of
the Encyclopedia Britannica, and a member of one of
the technical advisory committees for the Atomic Energy
Commission.
Dr. Fishbein likes to recall his early days with the
AMA. When he came to the AMA in 1912, it had
eighty employes and The Journal had 45,000 subscribers
Today, the AMA has 860 employes and The Journal has
a circulation in excess of 136,000. The Journal has more
circulation than all other weekly medical journals in the
world combined. Its runner-up is the British Medical
Journal with a circulation of 65,000.
Dr. Fishbein has been in great demand as a public
speaker, making on an average of one speech every three
days. He speaks with the speed of a machine gun at
its deadliest high tempo. A Charlotte, North Carolina,
editor once wrote: “Dr. Fishbein doesn’t stop for
periods between sentences. He flies through these cus-
tomary stops with the speed of lightning and with the
grace of an eagle in its unhindered soar.”- — AMA News
Release.
STERILITY AWARD
The American Society for the Study of Sterility is
offering an annual award of $1,000 known as the Ortho-
Award for an essay on the result of some clinical or
laboratory research pertinent to the field of sterility.
Competition is open to those who are in clinical prac-
tice as well as to individuals whose work is restricted
to research in basic fields or full time teaching positions.
The prize essay will appear on the program of the forth-
coming meeting of the American Society for the Study
of Sterility, which is to be held at the Sir Francis Drake
Hotel in San Francisco on June 24 and 25, 1950.
Full particulars may be obtained from the secretary,
Dr. Walter W. Williams, 20 Magnolia Terrace, Spring-
field, Massachusetts. Essays must be in his hands by
April 1, 1950.
PATTERSON SURGICAL SUPPLY COMPANY
103 East Fifth St., St. Paul 1, Minn.
HOSPITAL AND PHYSICIANS SUPPLIES AND EQUIPMENT
Cedar 1781-82-83
108
Minnesota Medicine
"fascinating as
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BRUCE PUBLISHING CO.
2642 University Ave., St. Paul 4, Minn.
“DEE”
NASAL SUCTION PUMP
Contact your wholesale druggist or
write direct for information
DEE" MEDICAL SUPPLY COMPANY
P.O. Box 501, St. Paul, Minn.
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Consult a reliable eye doctor and then . . .
Let Us Design and Make Your Glasses
Dispensing Opticians
25 W. 6th St. St. Paul CE. 5767
Index to Advertisers
Abbott Laboratories 20
Aero Distributors Corporation 93
American Meat Institute 12
American National Bank Ill
Ames Co., Inc 14
Anderson, C. F., Co., Inc 94
Ar-Ex Cosmetics 110
Ayerst, McKenna & Harrison 23
Benson, N. P., Optical Co 105
Birches Sanitarium, Inc 98
Borden Co 16
Brown & Day, Inc 103
Bruce Publishing Co 109
Caswell-Ross Agency 2
Chicago Medical Society 90
Classified Advertising 110
Cook County Graduate School of Medicine 105
Dahl, Joseph E., Co 102
Danielson Medical Arts Pharmacy, Inc 107
“Dee” Medical Supply Co 109
Druggists Mutual Insurance Co HI
Ewald Bros Inside Back Cover
Franklin Hospital
Geiger Laboratories
Glenwood Hills Hospital
Glenwood-Inglewood
Hall & Anderson
Holland Rantos Co., Inc.
Homewood Hospital
Lilly, Eli, & Co Front Cover
Insert facing 24
M. & R. Dietetic Laboratories, Inc 10
Mead Johnson & Co 112
Medical Placement Registry HO
Medical Protective Co 106
Merck & Co., Inc 22
Milwaukee Sanitarium Back Cover
Mounds Park Hospital Back Cover
Mudcura Sanitarium 104
Murphy Laboratories Ill
Nestle Co 99
North Shore Health Resort 95
Parke, Davis & Co Inside Front Cover and 1
Patterson Surgical Supply Co 108
Philip Morris & Co., Ltd 18
Physicians Casualty Association 100
Physicians & Hospitals Supply Co 11,107, 111
Professional Credit Protective Bureau 15
Radium Rental Service 108
Rest Hospital 98
Roddy-Kuhl-Ackerman 109
St. Croixdale Sanitarium
Schering Corporation . .
Schusler, J. T., Co., Inc.
Searle, G. D., & Co
Smith-Dorsey Co
Squibb, E. R., & Sons. .
U. S. Army Medical Department
91
Juran & Moody 97
Kelley-Koett C-Ray Sales Corp. of Minnesota 89
Lederle Laboratories Division 17
Vocational Hospital 101
Williams, Arthur F HI
Winthrop-Stearns, Inc 19
Wyeth, Inc 21
January, 1950
109
Classified Advertising
Replies to advertisements with key numbers should be
mailed in care of Minnesota Medicine, 2642 University
Avenue, Saint Paul 4, Minn.
OFFICE AVAILABLE — Suite of offices available
for physician in St. Louis Park in new shopping
center. Call Whittier 5536 or write E-181, care
Minnesota Medicine.
WANTED — Physician in busy town, population 800.
Farming community of 1200. Isle Civic and Com-
merce Association, Isle, Minnesota.
ASSISTANT WANTED — Two partners in town of
2,000, planning one month’s vacation each, need assist-
ant for two months. Prefer man who would consider
permanent location, but will accept for locum tenens
only. Address E-176, care Minnesota Medicine.
OFFICE SPACE AVAILABLE— In downtown Min-
neapolis. Two rooms with a share in waiting room.
X-ray, EKG machine, and clinical laboratory facilities.
Rental, $55.00 a month. Free parking for doctors’ and
patients’ cars. Address E-179, care Minnesota Medi-
cine.
WANTED — Eye, ear, nose and throat M.D. in Min-
nesota clinic group for four. Salary first year with
percentage or partnership the second year. Address
E-178, care Minnesota Medicine.
UNUSUAL OPPORTUNITY for physician wishing to
move to Minneapolis. Free office rent. Some referred
work. Three-drugstore corner. Address E-177, care
Minnesota Medicine.
EENT PHYSICIAN WANTED — Growing clinic in
Northern Minnesota has excellent opening for practi-
tioner in EENT. Salary with percentage open. Ad-
dress E-180, care Minnesota Medicine.
GOOD LOCATION for doctor wishing to do general
practice. Offices for rent on ground floor, Main Street,
Anoka, Minnesota. Equipment for sale includes good
x-ray machine. Can make money if willing to work.
Address George H. Schlesselman, M.D., 320 East Main
Street, Anoka, Minnesota.
FOR SALE — Monocular Bausch & Lomb microscope,
with case, twelve years old, in excellent condition.
$125.00 cash. Address Mary Nilles, 1111 Nicollet Ave-
nue, Minneapolis 2, Minnesota. Telephone MAin 5584.
FOR RENT — Physician’s office space, second floor, cor-
ner Fairview and Selby Avenues, Saint Paul. Write
Mrs. J. E. Roby, 1816 Selby Avenue, Saint Paul 4,
Minnesota. Telephone Midway 9077.
POSITION WANTED — Office work and practical nurs-
ing in doctor’s office or hospital. Twin Cities or vicinity.
Part or full time. Experienced. Address E-182, care
Minnesota Medicine.
YOUNG PHYSICIAN, Board eligible in Pediatrics,
desires location with group or other pediatricians, be-
ginning July, 1950. For further information, address
E-183, care Minnesota Medicine.
* ★ POSITIONS AVAILABLE * *
* General Surgeon wanted. North Dakota. Ex-
cellent position. New ^3 million dollar hospital.
* General Practitioner for association. All equip-
ment furnished. Grossed $19,000 last year.
Good farming community.
* General Practitioner interested in surgery. Iowa.
25 bed hospital.
* Associate for established doctor wanted. Min-
nesota. Up to 50 per cent gross.
* Locum Tenens. 1 month or 2 months. $500
a month plus car plus board and room.
* Internist for partnership. Minneapolis.
For information, write or call
THE MEDICAL PLACEMENT REGISTRY
629 Washington Ave. S. E., Minneapolis GL. 9223
a
The Geiger Laboratories
/ Sderuicel for f^livfSiciani of the Upper id] id die lAJedt
uucal ^Jeruicei f-or /■" nifiictam of- une L/ipper
Mailing tubes and price lists supplied upon request.
1111 NICOLLET AVENUE MINNEAPOLIS 2
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Minnesota Medicine
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INSTRUMENTS • TRUSSES • EQUIPMENT • PHARMACEUTICALS • DRUGS
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Practical Nursing School
Approved} by Minnesota State Board of Nurses
Examiners
Twelve months course open to High
School Graduates or women with equiv-
alent education.
For further information apply to
DIRECTOR OF NURSES
FRANKLIN HOSPITAL
501 W. Franklin Avenue, Minneapolis 5, Minn.
TAILORS TO MEN SINCE 1886
The finest imported and domestic wool-
ens such as SCHUSLER'S have in stock
are not too fine to match the hand tailor-
ing we always have and always will
employ.
J. T. SCHUSLER CO., INC.
379 Robert St. St. Paul
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and money. . . . CALL CE
6666 before you buy your new
car — we will handle all details.
THE AMERICAN NATIONAL BANK
OF SAINT PAUL
Bremer Arcade Robert at 7th CE 6666
Member Federal Deposit Insurance Corporation
Radiological and Clinical
Assistance to Physicians
in this territory
MURPHY LABORATORIES
Minneapolis: 612 Wesley Temple Bldg. - - At. 4786
St. Paul: 348 Hamm Bldg. ------ Ce. 7125
If no answer, call Ne. 1291
Hall & Anderson
PRESCRIPTION PHARMACY
BIOLOGICALS
PHYSICIANS’ SUPPLIES
SAINT PAUL, MINN.
LOWRY MEDICAL ARTS BUILDING
TELEPHONE: CEDAR 2735
UNUSUAL LENS GRINDING
CATARACT,
MYO-THIN
and other difficult
and complicated
lenses are ground to
extreme thinness and
accuracy by our
expert workmen.
OKTfKIKFWlLLIAMJ sees
l ✓
Insurance
at a
Saving
MINNESOTA
Druggists' Mutual Insurance Company Prompt
OF IOWA, ALGONA, IOWA LOSS
Fire - Tornado - Automobile Insurance Service
REPRESENTATIVE-S. E. STRUBLE, WYOMING, MINN.
NUARY, 1950
111
f
I
formulas
/ /■
with DEXTRI-MALTOSE
simple to prescribe... simple to prepare
Milk plus water plus Dextri-Maltose*— simple to prescribe—
is the mixture most widely used in the flexible formula system
of infant feeding. Dextri-Maltose has helped physicians
to build this system, now recognized the world over.
Formulas with Dextri-Maltose are simple to prepare.
Dextri-Maltose is easily
measured, is readily
soluble, and can be used
in any method of
formula preparation.
*T. M. Reg. U. S. Pat. Off.
A MX ,«;>*<**
MEAD'S
DEXTRI-MALTOSE
I tO RIQf 2*.
JOHNSON TcO
112
Minnesota Medicine
Local application of THROMBIN TOPICAL rapidly controls capil-
lary bleeding. In three seconds a solution containing 1,000 units
per cc. clots ten times its own volume of blood. It may also be
applied as a dry powder.
THROMBIN
TOPICAL
THROMBIN TOPICAL reacts with blood fibrinogen to form a firm ad-
herent fibrin clot, end-result of the natural clotting mechanism. By
this physiologic action THROMBIN TOPICAL helps control bleeding
in all types of surgical procedures— lysis of abdominal or thoracic
adhesions, mastectomy, transurethral prostatic resection, nose and
throat operations, skin grafting, neurosurgery, orthopedic surgery,
dental extractions, etc. Well tolerated by the tissues, it may also be
used in conjunction with Oxycel® (oxidized cellulose, Parke-Davis).
IHI. H. UNITS Bio. 25
IROMBIN. TOPIC/1
= (BOVINE ORIGIN) =
g)R TOPICAL USE ONLY!
gDO NOT INJECT
the surface ^ Of 1h« hie
ESSiny Thrombin, TooliaL—
0or at a powder atier b55
- HSEbrlal with a tlerile gh« 5
BRrcular U. S. LicenseBQ^
IviS&CO. Detroit, Mich,,!
THROMBIN TOPICAL
( bovine origin ) is supplied in vials contain-
ing 5000 N.I.H. units each, with a 5 cc. vial
of sterile isotonic saline diluent. Also avail-
able in a package containing three vials of
THROMBIN TOPICAL (1000 N.I.H. units
each ) and one 6 cc. vial of diluent.
PARKE, DAVIS A CO. I
N
£ *
Protection for the Living
Loss of earning capacity through illness or accident is economic death
of the individual. It continues to entail suffering for those who are de-
pendent upon him.
Protection is not complete so long as it does not include the great and
growing hazard of economic death.
It's only logic that indicates that your best plan of income protection is
through the plan tested by your Society.
Tomorrow may be too late. ACT NOW.
CASWELL-ROSS AGENCY
1177 N. W. Bank Building
Minneapolis — MA 2585
Minneapolis 2, Minnesota
St. Paul— ZE 2341
Insurors to:
Minnesota State Bar Association
Minnesota State Dental Association
Minnesota State Medical Association
Minnesota Society of C.P.A.
Minnesota State Pharmaceutical Assn.
Minnesota Auto Dealers Association
Hennepin County Medical Society
Hennepin County Bar Association
St. Paul District Dental
Minneapolis District Dental
St. Cloud Dental and Stearns County
Medical Society
Duluth District Dental
East Central Medical Society
St. Louis County Medical Society
114
Minnesota Medicine
0
Journal of the Minnesota State Medical Association, Southern Minnesota Medical Association, Northern Minnesota
Medical Association, Minnesota Academy of Medicine and Minneapolis Surgical Society
Volume 33
February. 1950
No. 2
Contents
The Vasodilator — Roniacol.
5". Marx White, M.D., F.A.C.P., Minneapolis,
Minnesota 133
Associated Diseases of the Skin and Eye.
Edzi'am P. Burch, M.D., and Charles D. Free-
man, M.D., Saint Paul, Minnesota 147
Compression Fractures of the Spinal Column.
John C. Ivins, M.D., Rochester, Minnesota 154
Treatment of Deafness with Histamine.
G. L. Loomis, M.D., Winona, Minnesota 157
Tuberculosis of the Uterus.
William P. Mulvaney, M.D., Saint Paul, Minnesota 160
Clinical-Pathological Conference :
Diagnostic Case Study.
Arthur H. Wells, M.D.. Harold H. Joffe, M.D.,
and Thomas Moe, M.D., Duluth, Minnesota. . . 163
History of Medicine in Minnesota :
Medicine and Its Practitioners in Olmsted County
Prior to 1900. (Continued)
Nora H. Guthrey, Rochester, Minnesota 166
President’s Letter :
Postgraduate Seminars 175
Editorial :
Socialized Medicine 176
Red Cross Fund Campaign 177
Electrophrenic Respiration 177
Prevention of Dental Caries 178
Medical ^ Economics :
FSA Estimates 1960 Need for Doctors 179
Ewing Denies Analogy of British, U. S. Plans... 179
Layman Among First to Pay AM A Dues 179
Stassen Attacks SM in Print, on Air 179
London Times Pokes Fun at Socialism 180
Many Compromise Bills in Hopper Now 180
Minnesota Academy of Medicine :
Meeting of November 9, 1949 181
Memorial to Walter E. Camp 181
Lingual Goiter.
Martin Nordland, M.D., and Martin A. Nord-
land, M.D., Minneapolis, Minnesota 181
The Fourth International Congress of Neurology.
Ernest M. Hammes, M.D., Saint Paul, Minn-
esota 184
Minneapolis Surgical Society :
Meeting of October 6, 1949 186
Fracture Discourse.
Earl C. H enrikson, M.D., Maynard C. Nelson,
M.D., and Daniel Moos, M.D., Minneapolis,
Minnesota 186
Reports and Announcements 192
Woman’s Auxiliary 1%
In Memoriam 198
Of General Interest 200
Book Reviews 213
Contents of Minnesota Medicine copyrighted by Minnesota State Medical Association, 1950
Entered at the Post Office in Saint Paul as second class mail matter. Accepted for mailing at the special rate of postage provided
for in Section 1103, Act of October 3, 1917, authorized July 13, 1918.
February, 1950
115
MINNESOTA MEDICINE
Official Journal of the Minnesota State Medical Association
Published by the Association under the direction of its Editing and Publishing Committee
Office of Minnesota State Medical Association,
493 Lowry Medical Arts Bldg., Saint Paul 2, Minnesota.
EDITING AND PUBLISHING COMMITTEE
Philip F. Donohue, Saint Paul
E. M. Hammes, Saint Paul
H. W. Meyerding. Rochester
B. O. Mork, Jr., Minneapolis
C. L. Oppegaard, Crookston
T. A. Peppard, Minneapolis
H. A. Roust, Montevideo
O. W. Rowe, Duluth
Henry L. Ulrich, Minneapolis
A. H. Wells, Duluth
EDITORIAL STAFF
Carl B. Drake, Saint Paul, Editor
George Earl, Saint Paul, Associate Editor
Henry L. Ulrich, Minneapolis, Associate Editor
BUSINESS MANAGER
J. R. Bruce
Annual Subscription— $3.00. Single Copies — $0.40. Foreign and Canadian Subscriptions — $3.50.
The right is reserved to reject material submitted for editorial or advertising columns. The
Editing and Publishing Committee does not hold itself responsible for views expressed either in
editorials or other articles when signed by the author.
Classified advertising — ten cents a word; minimum charge, $2.00. Remittance should ac-
company order.
Display advertising rates on reauest.
Address all communications concerning the journal to Minnesota Medicine, 2642 University
Avenue, Saint Paul 4, Minnesota. Telephone Nestor 2641.
ST. CROIXD ALE ON LAKE ST.
PRESCOTT. WISCONSIN
CROIX
MAIN BUILDING— ONE OF THE 8 UNITS in "COTTAGE PLAN”
A Modern Private Sanitarium for the Diagnosis, Care and Treatment of Nervous and Mental Disorders
Located on beautiful Lake St. Croix, eighteen miles from the Twin Cities, it has the advantages of both
City and Country. Every facility for treatment provided, including recreational activities and occupational
therapy under trained personnel. Close personal supervision given patients, and modern methods of
therapy employed. Inspection and cooperation by reputable physicians invited. Rates very reasonable.
Illustrated folder on request.
NEUROPSYCHIATRISTS
PRESCOTT OFFICE
Prescott, Wis.
Howard J. Laney, M.D.
Tel. 39 and Res. 76
Hewitt B. Hannah, M.D.
Andrew J. Leemhuis, M.D.
Howard J. Laney, M.D.
511 Medical Arts Building
Minneapolis, Minnesota
Tel. MAin 1357
SUPERINTENDENT
Dorothy M. Most, R.N.
Prescott, Wisconsin
Tel. 69
116
Minnesota Medicine
f'The . . , estrogen
preferred by us is
Tremarin,’ a mixture
of conjugated estrogens,
the principal one
of which is
estrone sulfate,”
Hamblen. E.C.: North Carolina M.J. 7:533 (Oct.) 1946.
ft
In treating the menopausal syndrome
with “Premarin” Perloff* reports that
“Ninety-five and eight tenths per cent
of patients treated with 3.75 mg.
or less daily obtained complete relief
of symptoms”; also, “General tonic
effects were noteworthy and the greatest
percentage of patients who expressed
clear-cut preferences for any drug
designated ‘Premarin! ”
Thus, the sense of “well-being”
usually imparted represents a “plus” in
“Premarin” therapy which not only
gratifies the patient but is conducive to
a highly satisfactory patient-doctor
relationship.
Four potencies of “Premarin”
permit flexibility of dosage: 2.5 mg.,
1.25 mg., 0.625 mg. and 0.3 mg. tablets;
also in liquid form, 0.625 mg. in
each 4 cc. (1 teaspoonful) .
‘Perloff. W.H.: Am.J.0bst.& Gynec. 58:684 (Oct.) 1949.
While sodium estrone sulfate is the principal estrogen in
“PremarinJ’ other equine estrogens. ..estradiol, equilin,
equilenin, hippulin...are probably also present in varying
amounts as water-soluble conjugates.
Estrogenic Substances ( water-soluble) also known as Conjugated Estrogens ( equine)
5003
Ayerst, McKenna & Harrison Limited
22 East 40th Street, New York 16, N. Y.
February, 1950
117
Again, Keleket sets the pace with a
money-saving development. NOW — ALL
UNITS— -200 MA, 300 MA and 300 MA
use the SAME TRANSFORMER and CON-
TROL which can be produced at a savings. ..
passed on to you!
By standardizing many parts of the world-
famous Multicrons, Keleket is able to offer
custom-built units . . . which fit your individ-
ual requirements exactly ... at most attrac-
tive prices.
Every unit is equipped with the same func-
tionally designed cabinet, finished in hand-
some Kelekote.
CUSTOM-BUILT
This unit may be installed permanently, even
in a wall, with no worry about alterations
. . . should your future technic requirements
call for the higher capacity Muiticrons.
All units . . . 200 MA, 300 MA and 500 MA...
include the features which have made Keleket
Multicron Controls so popular with radiolo-
gists . . . for flexibility, convenience and
accuracy.
the
200 MA
vertical
control
The controls are rated as follows:
DIAGNOSTIC
200 MA unit — 125KVP at any MA from 25 to 200
300 MA unit — 125 KVP at any MA from 25 to 300
500 MA unit— 125 KVP at any MA from 25 to 500
THERAPY
All units— 140 KVP to 10 MA
An optional Photo-Timer and Photo-Timing
pushbutton control can be mounted in the verti-
cal controls. Unit is so designed and engineered
that only minor alterations are required to effect
increased capacity and timer changes.
Telephone or write for complete details
KELLEY-KOETT X-RAY SALES CORP. OF MINN
1225 NICOLLET AYE.
TEL. AT. 7174
MINNEAPOLIS 3, MINNESOTA
118
Minnesota Medicine
VERTICAL CONTROLS...200 MA...300 MA...500 MA
increasing
capacity
requires
only
timer
exchange
February, 1950
119
C/yWP ANATOMICAL SUPPORTS
for ORTHOPEDIC
CONDITIONS
THIS EMBLEM is displayed only by reliable merchants
in your community. Camp Scientific Supports are never
sold by door-to-door canvassers. Prices are based on
intrinsic value. Regular technical and ethical training of
Camp fitters insures precise and conscientious attention
to your recommendations.
Whether it be relief from
lesser degrees of postural or
occupational strain, or as
an aid in treatment follow-
ing injury or operation, the
Camp group of scientifically
designed orthopedic supports for
men, women and children will be
found “comprehensive.” Sacro-
iliac, Lumbosacral and Dorso-
lumbar supports may be prescribed
for all types of build. The Camp
system of construction fits the sup-
port accurately and firmly about
the major part of the bony pelvis
as a base for support. The unique
system of adjustment permits the
maximum in comfort. Physicians
may rely on the Camp-trained fit-
ter for the precise execution of all
instructions.
If you do not have a copy of the
Camp “Reference Book for Phy-
sicians and Surgeons”, it will be
sent on request.
J S e f vi <- -
c/yAP
g,cisniific fyappollfy
S. H. CAMP & COMPANY, JACKSON, MICHIGAN
World’s Largest Manufacturers of Scientific Supports
Offices in New York • Chicago • Windsor, Ontario • London, England
120
Minnesota Medicine
AU R EO MVC I N
HYDROCHLORIDE LEDERLE
in resistant
staphylococcal infections
Aureomycin has been shown
to be highly useful in the con-
trol of staphylococcal infec-
tions, many of which exhibit
a high degree of resistance to
other antibiotics and chemo-
therapeutic agents. The prognosis in systemic
staphylococcal infections is sufficiently serious so
that the optimum treatment should be admin-
istered immediately, and continued for one or
several days after the temperature has subsided
to normal.
Aureomycin has been found effective for the
control of the following infections: bacteroides
septicemia, brucellosis,
Gram-negative infections —
including those caused by the
coli-aerogenes group, Gram-
positive infections — includ-
ing those caused by strepto-
cocci and pneumococci, granuloma inguinale,
lymphogranuloma venereum, Hemophilus influ-
enzae infections, primary atypical pneumonia,
psittacosis, Q fever, rickettsialpox, Rocky Moun-
tain spotted fever, penicillin-resistant subacute
bacterial endocarditis, sinusitis caused by suscep-
tible organisms, tularemia, typhus, bacterial and
viral-like infections of the eye.
Capsules: Bottles of 25, 50 mg. each capsule. Bottles of 16, 250 mg. each capsule.
Ophthalmic: Vials of 25 mg. with dropper; solution prepared by adding 5 cc. of distilled water.
LEDERLE LABORATORIES DIVISION American CmnamiJ company 30 Rockefeller Plaza, New York 20, N. Y.
February, 1950
121
It was spring in Marietta and the Ohio River
was on its seasonal rampage. In fact, its swollen
waters were even licking at doorsteps in the busy down-
town section — eagerly reaching higher and higher.
Is it any wonder, then, that one of the town’s leading
x-ray technicians should be alarmed for the safety of
her charge — vital, valuable x-ray equipment in the
flood-threatened office of her employer, a well-known
Marietta doctor. Quite naturally she telephoned
GE’s Columbus, Ohio office — told of her plight.
GE Service went into immediate aciton. Checked
State Highway Department — found roads to Marietta
water-blocked. Then, chartered a plane which landed
across the river from Marietta at Williamsburg,
W. Va., about an hour later. After reaching downtown
Marietta by flatboat and walking a few blocks, the GE
serviceman arrived across the street from the doctor's
office. However, flood waters blocked the way. This
problem was neatly solved when a stalwart dentist
friend happened along and volunteered to carry him
and his equipment across the street piggy back.
The x-ray equipment was speedily dismantled,
loaded on a high wheeled truck and taken to the
doctor’s home which was located on higher ground.
Even a flood...
failed to stop GE Service!
Don’t wait for a flood to call for GE Service . . .
its available always at —
This story is typical of the hundreds of documented
GE Service reports in our files. A service which
proudly lends a new, broader conception to the
guarantee that stands back of every GE installation.
Minneapolis 808 Nicollet Avenue
Duluth 3006 West First Street
GENERAL® ELECTRIC
X-RAY CORPORATION
122
Minnesota Medicine
lO cc.
PROTAMINE ZINC INSULIN
SqyiBB
80 units per cc.
.oop In « cold pla««! nvold frgotlng
GLOBIN INSULIN
With Zi»C
&QUIOB
E-K-SqinBn &. Sons . New York
■:?.»»iraar
K»
~J2~ H. SQUIBB & Sft NH.
'NSULIN
L5"V<* PflCP.-
^u»a a
SQUIBB INSULIN PRODUCTS
...purified... potent... rigidly standardized to
meet the various requirements of diabetics.
short action: peak effect within 3 to 4 hours, waning rapidly
INSULIN SQUIBB
10-cc. vials (40, 80 t? 100 units per cc.)
INSULIN MADE FROM ZINC-INSULIN
CRYSTALS SQUIBB
10-cc. vials (40 80 units per cc.)
intermediate action: peak effect in 8 to 12 hours, with action continuing
sometimes for 16 or more hours.
GLOBIN INSULIN WITH ZINC SQUIBB
10-cc. vials (40 i? 80 units per cc.)
prolonged action: onset slow; peak effect in 10 to 12 hours, with action
sometimes persisting for 24 or more hours.
PROTAMINE ZINC INSULIN SQUIBB
10-cc. vials (40 (j- 80 units per cc.)
Squibb
MANUFACTURING CHEMISTS TO THE MEDICAL PROFESSION SINCE 1858
February, 1950
123
adaptable to all x-ray work ordinarily performed in the doctor’s office
new, low cost mm
(combination fluoroscopic and radiographic unit)
-easy to learn
-simple to operate
-sharper, clearer radiographs
exclusive features
found in no other
comparable equipment
-Jc Constant voltage regulator
insuring even flow of power
Pre-set milliamperage
Direct reading KV meter
2 MM focal spot
for sharp detail
•^C “Indexed” tube-head —
constant, perfect alignment
Ample power: optional 15MA
at 80 KVP or 30 MA at 90 KVP
(also available in 60MA at 100
KVP and in 100MA at 100 KVP)
Comes in black, glossy finish— acid
and alcohol resistant. Can pay for itself
in six months' time. Fully guaranteed!
Write for the name of your nearest dealer
EQUIPMENT COMPANY
135 SOUTH LA SALLE STREET • CHICAGO 3, ILLINOIS
124
Minnesota Medicine
mm*
90-
■ '
“good things
come
in small packages
ESTim
(ethinyl estradiol)
The desired estrogenic effects can be expected from small dosage with
Estinyl,® Schering’s ethinyl estradiol, the most potent oral estrogen
available for clinical use today. The dose is small; 0.05 mg. or less per
day usually controls menopausal symptoms.
Specificity is reflected in speedy relief, often within as few as three days;1
in marked improvement in general well-being;2 in the virtual “absence
of side reactions if minimal effective doses are administered”3; and in
economy— less than five cents per day.
Estinyl Tablets are available in 0.05 and 0.02 mg. strengths. Bottles of 100, 250 and
1000 tablets. Also available in 0.5 mg. strength. Bottles of 30 and 100 tablets. Estinyl
Liquid containing 0.03 mg. per 4 cc. Bottles of 4 and 16 oz.
(1) Lyon, R. A.: Am. J. Obst. & Gynec. 47: 532, 1944. (2) Groper, M. J., and Biskind, G. R.: J. Clin.
Endocrinol. 2:703, 1942. (3) Wiesbader, H., and Filler, W.: Am. J. Obst. & Gynec. 51: 75, 1946.
E STim
NUW,
♦ » ADDED CONVENIENCE
FOR THE PATIENT
The "RAMSES”* Tuk-A-Wayf Kit provides added
convenience tor the patient, for she will find, neatly
assembled in this colorful, washable plastic kit, all the units
required for optimum protection against conception:
a "RAMSES” Flexible Cushioned Diaphragm of the
prescribed size; a "RAMSES" Diaphragm Introducer of
corresponding size; and a regular-size tube of
"RAMSES" Vaginal Jelly. f
The Tuk-A-Way Kit packs inconspicuously in the corner of a
traveling bag or dresser drawer. It is available to
patients through all pharmacies.
*The word "RAMSES" is a registered trademark of Julius Schmid, Inc.
"RAMSES" Vaginal Jelly is accepted by the Council on Pharmacy and
Chemistry of the American Medical Association. The "RAMSES"
Diaphragm and Diaphragm Introducer are accepted by the Council on
Physical Medicine and Rehabilitation of the American Medical Association.
fTrademark of Julius Schmid, Inc. ^Active Ingredients: Dodecaethyleneglycol
Monolaurate 5%; Boric Acid 1%; Alcohol 5%.
quality first since 1883
126
Minnesota Medicine
^ Calling All Doctors,
Your Receivables Have
Suffered A Set-Back! ^
Every doctor should immediately examine his accounts
receivable. A thorough diagnosis is certainly in order
promptly after due date. If some of your accounts are
suffering from “slow collectibility” they should be
receiving treatment while they still will respond.
COLLECTIBILITY OF ACCOU NTS— Based On Age
Accounts 60 days past due are 93% collectible. Accounts 1 year past due are 40% collectible.
Accounts 90 days past due are 85% collectible. Accounts 2 years past due are 25% collectible.
Accounts 6 months past due are 70% collectible. Accounts 3 years past due are 18% collectible
Accounts 5 years past due are practically lost.
1000 DOCTORS
HOSPITALS AND CLINICS
A National Organization . . .
Offered and recommended by
over 50 trade and professional
associations from coast to coast.
Write for references of service in
your area.
OF OUR ETHICAL COLLECTION SERVICE
★ NOT A COLLECTION AGENCY- All
Monies paid directly to you.
★ RETAINS GOOD WILL-Methods are
ethical, courteous and effective.
PROFESSIONAL CREDIT
PROTECTIVE BUREAU
Division of The I. C. System,
310 Phoenix Bldg., Minneapolis, Minn.
Further Inquiry Invited —
FILL OUT AND MAIL COUPON NOW
Professional Credit Protective Bureau
310 Phoenix Building
Minneapolis, Minn.
Gentlemen:
Without obligation, please send complete information
regarding this service.
Name
I
I
I
I
Address.
City
-Zone_
_State_
February, 1950
127
The sound and wholesome nutritious
diet is an integral part of modern day
preventive and definitive therapy. A
steady stream of adequate amounts of all
the essential nutritional elements is vital
for good growth, maintenance of tissue
structure and functioning, healing after
trauma, and resistance to infection. For
maintaining this daily, steady stream -of
nutrients, however, conditions both in
health and illness often make imperative
the use of an efficient food supplement
along with the diet.
The multiple dietary food supplement
Ovaltine in milk has wide usefulness for
enhancing to full adequacy even nutri-
tionally poor diets. Its rich store of vita-
mins and minerals includes vitamins A
and D, ascorbic acid, thiamine, ribo-
flavin and niacin, and calcium, iron and
phosphorus. Its nutritionally complete
protein has excellent biologic rating
Since these vital nutritional values
along with carbohydrate and easily emul-
sifiable milk fat are incorporated in liquid
suspension or solution, Ovaltine in milk
is also especially adapted to liquid diets.
The highly satisfying flavor makes for its
ready acceptability when foods are often
distasteful.
The important overall nutrient con-
tribution of three glassfuls of Ovaltine
mixed with milk is presented in the
accompanying table.
THE WANDER COMPANY, 360 N. MICHIGAN AVE., CHICAGO 1, ILL.
Three servings of Ovaltine, each made of Vi oz. of
Ovaltine and 8 oz. of whole milk,* provide:
676 VITAMIN A 3000 I.U.
32 Gm. VITAMIN Bi 1.16 mg.
32 Gm. RIBOFLAVIN 2.0 mg.
E 65 Gm. NIACIN 6.8 mg.
1.12 Gm. VITAMIN C 30.0 mg.
0.94 Gm. VITAMIN D 417 I.U.
12 mg. COPPER 0.5 mg.
*Based on average reported values for milk.
Two kinds, Plain and Chocolate Flavored. Serving for
serving, they are virtually identical in nutritional content.
OVALT
CALORIES
PROTEIN
FAT
CARBOHYDRATE
CALCIUM
PHOSPHORUS
IRON
*
128
Minnesota Medicine
. . . and nothing but the whole gland
can achieve the effects of the full
array of cortical hormones in correcting
such typical symptoms of adrenal cortical
insufficiency as loss of weight, impaired
resistance to infections, lowered muscle
tone, lassitude and mental apathy.
Because ADRENAL CORTEX EXTRACT (UPJOHN) is a specially
extracted preparation from the whole gland, it
provides all the active principles of the
cortex for full therapeutic replacement
, ‘ V’ \ of multiple cortical action on carbohydrate,
* > - . \ fat and protein metabolism, vascular
permeability, plasma volume,
' \ body fluids and electrolytes.
Sterile Solution
in 10 cc. rubber-
capped vials for
subcutaneous ,
intramuscular , and
intravenous therapy.
ADRENAL CORTEX EXTRACT (UPJOHN)
February, 1950
PHOSPHO-SODA FLEET)
Gentle, Effective Action
Phospho-Soda (Fleet)'s* action is prompt and thorough, free
from any disturbing side effects. That's why so many modern
authoritative clinicians endorse it... why so many thousands
of physicians rely on it for effective, yet judicious relief of con-
stipation. Liberal samples will be supplied on request.
*Phospho-Soda (Fleet) is a solution containing in each 100 cc. sodium biphosphate 48 Gm. and sodium
phosphate 18 Gm. Both 'Phospho-Soda' and 'Fleet' are registered trade marks of C. B. Fleet Company, Inc.
C. B. FLEET CO., INC. • lynchburg, Virginia
130
Minnesota Medicine
Throat Specialists report on 30-day test of Camel smokers:
i\ot one single case or
throat irritation due to
/\ smoking Camels
Yes, these were the findings of
' throat specialists after a total of
2,470 weekly examinations of the
throats of hundreds of men and
women who smoked Camels — and only
Camels — for 30 consecutive days.
R. J. Reynolds Tobacco Co.. Winston-Salem, N. C.
— 1 MY DOCTOR'S L —
REPORT WAS NO SURPRISE
TO ME-CAMELS AGREED
WITH MY THROAT -
RIGHT FROM THE START!
AND CAMELS MAKE
' SMOKING SUCH ^
WONDERFUL FUN !
Long Island housewife
Edna Wright, one of the
hundreds of people from
coast to coast who made
the 30-day Camel mild-
ness test under the ob-
servation of throat
specialists.
According to a Nationwide survey
Yes, doctors smoke for pleasure, too ! In a nationwide survey, three independent research organi-
zations asked 113,597 doctors what cigarette they smoked. The brand named most was Camel !
February, 1950
131
It's New, Different, Better!
SPACE-MAKER"
Sterilizer
• Enlarged table top holds in-
struments and utility trays
with ample free working
space still available.
• Newly designed boiler cov-
er is solid bronze, for rug-
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132
Minnesota Medicine
Journal of the Minnesota State Medical Association, Southern Minnesota Medical Association, Northern Minnesota
Medical Association, Minnesota Academy of Medicine and Minneapolis Surgical Society
Volume 33 February, 1950 No. 2
THE VASODILATOR— RONIACOL
Report on a Preliminary Clinical Study
S. MARX WHITE, M.D., F.A.C.P.
Minneapolis, Minnesota
■p ONIACOL,* a vasodilator substance which is
converted in the organism to nicotinic acid,
is 3-pyridine-methanol or B-pyridyl-carbinol (the
alcohol corresponding to nicotinic acid) and has
the following structural formula :
HC
H
O-OHg-OH
hcn .OH
iK
During the experimental period the code desig-
nation for the compound was NU2121.
Roniacol is a nonvolatile solid with a slight
characteristic odor and is freely soluble in water
and in alcohol. Aqueous solutions are practically
neutral and may be used intravenously and in-
tramuscularly if given with care.
For mice the LDS0 (that dose which kills 50
per cent of .the animals) is 1.4 gm./kg. intra-
venously, 2.0 gm./kg. subcutaneously and 3.0
gm./kg. orally. No untoward symptoms were ob-
served in dogs from oral administration of 180
mg. /kg. Diets containing twelve to twenty-four
times the clinical dosage used in our study in man
were fed to rats for three months without causing
ill effects on blood formation, and produced no
significant effect on growth rate compared with
untreated animals. The daily administration to
*Roniacol is a vasodilator substance converted in the organism
to nicotinic acid. The drug was kindly supplied by the manu-
facturer, Hoffmann La Roche, Inc., Roche Park, Nutley, New
Jersey, for clinical trial. The statements as to chemistry, phar-
macology and effect on circulation in animals are those of the
manufacturer.
dogs of 250 to 500 mg. (the approximate amount
given daily to man) for three months had no ad-
verse effect on weight, blood formation, blood
glucose or nonprotein nitrogen. The effects on
the circulation in animals will not be considered
here except to state that, in general, Roniacol has
a powerful vasodilator effect on both coronary and
peripheral circulation.
Clinical Considerations
There are several conditions in which some-
what prolonged vasodilation should be of benefit,
particularly in treatment but also in diagnosis.
These include conditions in which cerebral, cor-
onary, renal, or peripheral vascular spasms are in-
volved, such as Raynaud’s disease, endarteritis,
Buerger’s disease, the syndrome of intermittent
claudication, varicose ulcers of the legs, decubital
ulcers, acrocyanosis, chilblains, the angina pectoris
syndrome, migraine associated with vascular
spasms, Meniere’s syndrome, and ophthalmic con-
ditions associated with deficient blood supply.
Collateral circulation is of paramount importance
when the vascular lumen is narrowed. Spasm of
any measurable anastomoses further diminishes
the nutrient supply beyond the point of arterial
narrowing. On the contrary, dilatation may more
or less compensate for the nutrient lack. To be
effective in aiding nutrition in an area with de-
ficient vascular supply, brief and evanescent dila-
tation in collateral vessels requires frequent repe-
tition of the dilator effect. A prolonged dilator ef-
fect is to be sought and should aid in establishing
permanent dilatation of the vessels involved.
February, 1950
133
RONIACOL— WHITE
Evidence supports the view that when vaso-
spasm occurs frequently, and especially when pro-
longed, the tendency is for constriction to occur
more and more readily and to inhibit the de-
velopment of permanent dilatation.
Also, when collateral circulation is evoked, dila-
tation which commonly occurs in the collateral
vessels, if given sufficient time, may become per-
manent. The degree to which this develops varies
greatly in different organs, states, vascular dis-
orders and particularly in different individuals.
More time and further study is needed to deter-
mine how much acute change and how much pro-
longed and permanent change can be produced by
medication, and by surgical means such as sym-
pathectomy in sites where this procedure is prac-
ticable.
While the rate of development of effective and
permanent collateral circulation in arteries un-
doubtedly differs from that in veins, all available
evidence reveals that it is slow and that the maxi-
mum dilatation is only gradually attained. There
is at the present time no certain method of visual-
izing the coronary vessels in man during life, but
analogy with situations in which either venous or
arterial collateral circulation may be visualized
should aid in understanding the processes in-
volved.
Much experience has been gained in former
years, before the use of anticoagulants became so
widespread, in the rate of development of col-
lateral circulation between the veins of the lower
abdomen and the thigh in cases of obstruction in
the iliac and femoral veins. Study of the veins
seen at the surface between thigh and abdominal
walls has shown that the full degree of dilatation
of the anastomosing veins requires many months,
in some instances a year or more.
Examples illustrating the time required for full
development of peripheral arterial anastomoses
are not so readily found, coarctation of the aorta
perhaps furnishing as good an illustration as any,
although the factor of body growth as well as
other factors is involved. It is well known that
the tortuous anastomotic arteries pulsating and
palpable over the upper back, shoulders, and base
of the neck, as well as the crenellation of the lower
rib margins as seen by x-ray, take years to be-
come evident.
The present preliminary report on Roniacol is
concerned principally with two conditions in which
vasospasm and vasodilation in a collateral circula-
tion are important and often vital : acute transitory
coronary insufficiency causing the angina pectoris
syndrome, and peripheral vascular lesions includ-
ing indolent and decubital ulcers in arteriosclerotic
patients.
Roniacol is furnished in 50 mg. tablets, scored
so that a half tablet may be used if desired. Given
by mouth the amount has varied from 50 mg. in
single doses or as often as four times daily, to
800 mg. daily in divided doses. The most com-
mon dosage was 100 mg. three or four times a
day. A great advantage of the drug is the ab-
sence of irritation of the gastrointestinal tract and
of adverse effect on the blood or blood-making
organs.
The acute or immediate effect differs greatly
with individuals and with the state of the stomach,
whether empty or containing material that would
dilute or delay absorption. The typical reaction
when an effective dose, usually 100 mg., is taken
on any empty stomach, begins in six to twelve to
fifteen minutes, with a sensation on the face and
forehead spreading to the ears, neck and upper
chest (especially the ventral surface), often later
on the hands and forearms, and occasionally in the
feet and legs and even the torso, though usually
in lesser degree. The sensation is variously de-
scribed as “warmth,” “prickling,” “tingling,” and
occasionally as “burning,” felt most strongly in
the regions first involved. Following the paresthe-
sia as a rule, but occasionally preceding or coin-
cident, a visible flush appears, which in a few sub-
jects becomes very deep. The pattern of the flush
appearance is similar to that of the paresthesia
though not identical in all cases. In a few in-
dividuals the flush involves the whole body, ex-
tremities and torso, and is usually mottled in
patches palm-size or larger. The subjective and
objective phenomena may last a half hour or long-
er, the subjective usually of shorter duration than
the visible flush. Pulse rate, respiratory rate, and
blood pressure are slightly and briefly affected.
An increase of 10 mm. Hg in blood pressure has
been observed once. The usual change is insig-
nificant and is followed by a return to normal or
only slightly below. In one instance of peripheral
vascular disease involving the legs, pulsation was
felt in a dorsalis pedis artery previously inert.
When the drug is taken with food, e.g., during
a meal, the foregoing phenomena are usually les-
sened and in some are not manifest. In a few
they have occurred in almost the full degree.
134
Minnesota Medicine
RONIACOL— WHITE
The drug has been used for patients with an-
gina pectoris to determine whether tolerance to
exercise, activity or excitement could be increased.
In the angina pectoris syndrome the criterion of
intolerance to these stresses is pain, characteristic
in site and distribution for each individual.
From the postmortem appearance of diseased
coronary vessels, change in the lumen of a nar-
rowed coronary artery sufficient to produce clini-
cally discernible benefit is improbable. Relief
within five minutes or so of anginal pain which
has caused the victim to cease activity must come
through improvement of the collateral circulation
by relaxation of spasm or through dilatation of
the collaterals to permit nutrient blood flow to the
area rendered deficient during the period of pain.
In addition, time should allow a blood supply rela-
tively inadequate only during the activity period
to become adequate when the activity has ceased.
Not having actually been seen in the anginal par-
oxysm in man, this sequence of events and the
consequences can only be surmised, but the prob-
able occurrence rests on sound clinical and patho-
logical observations.
The quick relief by rapidly acting vasodilators
strongly supports the belief that vasospasm is in
part responsible for anginal pain. The action of
the drug now under study is not sufficiently rapid
to relieve established pain but has been used in
an attempt to accomplish one or both of two ob-
jectives: (1) by a more or less prolonged vaso-
dilator effect to increase the range of activity in
which a patient may engage before pain develops,
and (2) by such prolonged action to prevent or
lessen vasospasm and encourage more permanent
vasodilation of the collateral field.
Clinically, no brilliant, immediate or dramatic
results are to be expected. The program of re-
gime and drug therapy is a long one, requiring
painstaking instruction on the part of the physi-
cian and continuous co-operation on the part of
the patient. In the many years of dealing with the
anginal syndrome this observer has seen from
time to time patients in whom such a program
conducted with care has been followed by grad-
ually increasing tolerance of exercise. It should
be emphasized that the one most important regu-
lation should be to learn the amount or extent of
exercise producing pain, to learn to stop short of
this and to remain quiet the necessary moments
before proceeding. Even the “aura” or any sensa-
tion known to precede the actual pain should be
avoided. Glyceryl trinitrite is to be used only
when the rule is forgotten, not with the idea that
any damaging effect of the painful incident can
be obviated or prevented.
The control of stimuli of an emotional charac-
ter is less readily accomplished, but here also the
physician has a responsibility, that of explanation
and reassurance, and of advice concerning the
control of the environment. Co-operation is not
as readily secured as in the exercise field. I have
not been impressed as a rule by the results when
technical psychiatric help has been sought.
The routine use of tablets so widely touted by
some of the drug houses today, combining a vaso-
dilator drug with phenobarbital is a pernicious
practice. It is a symbol of defeat in a situation
requiring instead careful management with adap-
tation to individual need and regimentation most
of all.
When improvement has occurred in the past, it
has taken as a rule many months before a meas-
urable increase in range could be noted. Not in-
frequently a year or more elapses before so great
a change occurs that patient and physician both
are confident that definite results are at hand.
This slow progress of what is believed to be prin-
cipally improvement in collateral circulation in the
coronary vessels compares quite closely with the
development of collateral circulation in surface
vessels cited earlier.
The natural history of coronary disease with
angina pectoris varies so widely in individuals that
statistical analysis of results of treatment is not
feasible. Fifty years of study of the disease by
the writer should germinate impressions of value.
Lacking better agents, I have prescribed theo-
cin, theobromine and theophyllin ethylene diamine
preparations, and at times have believed one or
another has been beneficial, but have always con-
sidered that persistent regulation of activity was
of greatest importance in preventing vasospasm in
the collaterals, thus allowing the vasodilator tend-
encies to gain the ascendency.
When it is remembered that while improvement
in one area may be taking place, an atheromatous
patch in another artery may be blocking a new
channel in the coronary jungle, it is no wonder
that in this field “art is long, the crisis is fleeting,
experiment is risky and the decision difficult.”
Patients in four groups have been studied :
(1) the angina pectoris syndrome, (2) peripheral
February, 1950
135
RONIACOL— ' WHITE
vascular disease, (3) indolent decubitus ulcers in
arteriosclerotic patients, (4) Raynaud’s disease.
I he Angina Pectoris Syndrome. — Cases 1 to
9, inclusive. In Cases 1 to 6, studied over a period
of six to twelve months, there has been noted an
increase in range of activity without producing the
pain syndrome which is greater to an appreciable
degree than the author has been able to secure by
other treatment. The increase in range and the
greater freedom from pain episodes has begun ear-
lier and has been remarkable in each of the six
cases.
It is improbable that the point or points of ather-
osclerotic stenosis in coronary arteries responsible
for the myocardial ischemia presumed to cause
the pain have been affected. It is the author’s
opinion that a positive effective and prolonged
vasodilatation is secured and that this contributes
to an improved collateral circulation in the myo-
cardial areas involved. Tt will take more time and
observation on many more patients by many stu-
dents of the problem before an adequate consensus
of opinion develops. Other patients are under ob-
servation, and similar results seem to be develop-
ing, but the time is too short for appraisal. Re-
port will be made in a subsequent contribution.
In three of the patients, Cases 7, 8, and 9, re-
sults were unsatisfactory and the drug was discon-
tinued, but in these also no actual toxic effects
were noted. Abdominal discomfort, extreme dis-
comfort from the flushing and paresthesia, or lack
of relief were responsible.
Peripheral Vascular Disease. — Cases 10, 11,
and 12. In all three the improvement in peripheral
circulation was evident early, and in the first two
of these this demonstration has aided in the deci-
sion favoring sympathectomy. In Case 10 the
hands were involved ; in Case 1 1, the left foot. In
Case 12 the improvement in circulation in the legs
has been marked and, considering his age and
mental state, has been considered satisfactory
without sympathectomy.
Indolent Decubitus Ulcers in Arteriosclerotic
Patients. — Cases 13 and 14. Two longstanding
decubitus ulcers on the heels had failed to heal
under vigorous management. Roniacol clearly
aided peripheral circulation so that healing pro-
gressed satisfactory and the ulcerated areas
closed.
Raynaud’s Disease. — One case only, in a wom-
an of fifty years (Case 15). There has been a
definite and beneficial effect, but the case is too
recent to admit conclusion as to the ultimate out-
come. The result will encourage further trial in
this field.
Conclusion
A new vasodilator substance, Roniacol, has been
given clinical trial. In six cases of the angina pec-
toris syndrome, due to coronary sclerosis, the im-
provement in range of activity permitted before
the typical pain developed has been greater than
the writer has been able to secure by other medi-
cation in the past. This suggests that an effective
degree of vasodilatation has been produced in the
collateral vessels in the coronary circulation. In
three cases the drug was discontinued because of
abdominal discomfort, discomfort from the flush-
ing and paresthesia, and failure of relief, respec-
tively. In peripheral vascular disease and in in-
dolent decubital ulcers in arteriosclerotic patients,
improvement in the circulation was readily dem-
onstrated, and in two cases in the first category
laid the bases for sympathectomy. A patient with
Raynaud’s disease has, in a short time, shown
much benefit. Results so far secured justify fur-
ther extended trial of Roniacol in coronary dis-
ease with the angina pectoris syndrome and in all
forms of peripheral vascular disease where an ef-
fective vasodilator with a somewhat prolonged ac-
tion is called for.
Case Histories*
Case 1. — H. A. N., a business executive, aged sixty-
three, was admitted to the hospital March 22, 1947.
The patient gives a history of malarial fever at twelve
and in 1917 had a bout of fever which was called typhoid.
If he walks 600 feet, he gets pain across the chest. This
same type of pain was first noted eight years ago while
fishing and compelled to row his boat against the wind
with a storm coming up. That night he wakened with
severe pain over the sternum which lasted about fifteen
minutes. This occurred the next night and lasted only
a few minutes. It was relieved by aspirin. Since then be
has had an occasional pain on effort or walking, espe-
cially in the cold weather or after heavy meals or in
walking six or seven blocks. This has occurred more fre-
quently the past year and now almost every morning. It
occasionally occurs at night for a brief period. There is
no dyspnea. The pain goes into the upper arms, right
and left, if severe.
The patient was seen again April 19, 1947, and he re-
*Case histories have been much abbreviated to permit pub-
lication.
136
Minnesota Medicine
RONIACOL— WHITE
ported pain on walking three blocks and occasionally at
night. The pain is relieved by nitroglycerin. Patient
reported on May 17, 1947, that on the night of May 10
he had had pain twice, lasting ten or fifteen minutes. He
thinks he may have had too much to eat. Had much
eructation of gas. Nitroglycerin gave relief.
Examination: Height 5 feet 8 inches, weight 158
pounds, pulse 75 per minute, blood pressure 152 systolic
and 82 diastolic. The peripheral vessels showed arterio-
sclerosis 1+. A cholecystogram on March 29, 1947,
showed the gall bladder filled and emptied normally, and
concentrated well. On March 31, 1948, gastrointestinal
barium motor studies showed the stomach filled and
emptied well, no defects, duodenum partially posterior,
normal, no tenderness. At six hours the meal was in the
hepatic flexure. At twenty-four hours, during which a
normal stool had occurred, there was no residue in the
colon. Rectal examination of the prostate showed the
prostate I+, firm and regular. There were 15 c.c. of
residual urine. Opinion was early prostatic hypertrophy
The urine had a pH of 6.0, specific gravity of 1.020, no
albumin, no sugar, no casts, no increase in leukocytes.
The hemoglobin of the blood was 82 per cent, white
blood count 8,200. The sedimentation rate of the red
blood cells was 6 mm. in one hour. Wassermann reac-
tion of the blood was negative. An electrocardiogram
showed normal complexes with auricular and ventricu-
lar premature beats.
A diagnosis of coronary arteriosclerosis with angina
pectoris syndrome was made. He was instructed to
avoid activity which brought on pain and to use nitro-
glycerin 1/100 gr. under the tongue if pain developed,
and was given theobromine sodium acetate 7*4 grain
enteric-coated tablets to be taken three times a day.
Quinidine sulphate in 3 grain doses twice daily, given
with morning and evening meal, controlled the extrasys-
toles. He did not experience satisfactory improvement
of the anginal episodes. Patient was apparently unable
to learn the necessity for stopping short of effort caus-
ing pain. His physical condition remained about as re-
ported on March 22, 1947.
On November 20, 1948, he was given Roniacol and in-
structed to take one 100 mg. tablet before meals as a
preventive of pain. On December 4, 1948, patient re-
ported that on taking the drug on an empty stomach he
has a feeling of flushing of the face, chest and ears last-
ing about five minutes. If the drug is taken with food
this does not occur. He was more carefully instructed
to try both methods, i.e., taking before and after meals,
and report which method relieved this pain. He reported
on December 4, 1948, that the first week after beginning
the drug he had no pain but did the things he formerly
did and without pain. However, after breakfast on one
day after walking four or five blocks he had some dis-
comfort but it was not pain as he had before.
On December 24, 1948, after continuing the Roniacol
in 100 mg. doses three times daily, he reported if he
takes it on an empty stomach he has about five minutes
feeling of warmth of the face, forehead and ears. He
feels that the incidence of pain is definitely lessened.
The first week on Roniacol following November 20 was
the best week he had had in four or five years. If he
takes the remedy with the meals, he does not experience
the warmth. On the morning of December 18 he took the
remedy at 8 :00 a.m., had breakfast five minutes later,
feeling of flush continued, drove downtown without a
suggestion of pain. He reports the impression that there
has been a distinct increase in range without pain.
This man now sixty-three years of age continues his
active business career. On frequent occasions he has
mild anginal pain if he walks several blocks immedi-
ately after a meal, as breakfast or lunch, but in general
is able to walk many blocks without pain, and this rela-
tive freedom has been accomplished in a much shorter
time than has been the writer’s experience in other cases.
Case 2. — P. T. B., a single male, aged sixty-four, an
executive of a wholesale pharmacy house, was admitted
to the hospital November 29, 1948. His father had died
at the age of fifty-four of arteriosclerosis. His mother
had died of pulmonary tuberculosis in 1938 at the age
of seventy-nine. The patient lived in the same apart-
ment. He used no alcohol nor tobacco. He had scarlet
fever at the age of sixteen. In 1929 he had been told his
.blood pressure was 140/84, and first knowledge of its
elevation was in February, 1943, when he was told it was
180 systolic, 110 diastolic.
He complained of precordial distress on walking two
blocks, this the past few weeks and occurring after meals
only. No dyspnea was noted. Distress ceases promptly
on standing still.
Examination : Height 5 feet 4 inches, weight 153
pounds, temperature 98.6° F., blood pressure 154 systolic,
100 diastolic, heart rate 90, regular. Carotid sinus pres-
sure right causes disappearance of heart tones for space
of three or four beats. Heart tones faint, normal, no
murmurs. General physical examination negative. Re-
flexes normal. Mantoux skin test positive. A six foot
film of the chest shows heart well within normal limits
as to size and contour. No parenchymatous lesions are
present in the lungs. Films taken of the dorsal spine
show no pathologic changes in spine. The urine is nor-
mal, hemoglobin 14.6 grams, red blood count 4,300,000,
white blood count 7,600, with a normal differential count.
The sedimentation rate of. the red blood cells is 7 mm.
in one hour. Blood cholesterol 188 mg. per cent. Elec-
trocardiogram on December 1, 1948, shows PR interval
.20 seconds, all T waves small, deep Qg. Repeated April
6, 1949, essentially unchanged.
Diagnosis : Angina pectoris syndrome, probable coro-
nary sclerosis. Instructed to avoid activity causing dis-
tress.
Treatment: Aminophyllin, enteric-coated tablets, t.i.d.,
p.c. ; weight reduction.
Decepiber 23, 1948 : Weight 146^4 pounds, blood pres-
sure 126 systolic, 82 diastolic. Reports that he can now
walk three or four blocks without pain. Stooping over
causes pain.
January 25, 1949: Weight 146 y2 pounds, blood pres-
sure 135 systolic, 86 diastolic. Reports he can walk now
five or six blocks without pain.
April 6, 1949: Has continued aminophyllin, 3 grains,
enteric, t.i.d., p.c., but recently precordial pain develops
on walking two blocks or less. Has continued work at
February, 1950
137
RONIACOL— WHITE
desk every day. Blood pressure 102 systolic, 60 diastolic,
heart rate 96 regular. Electrogram essentially unchanged
from December, 1948. To take one 100 mg. tablet of
Roniacol t.id. before meals.
He was observed weekly through April and May but
very little change was noted. May 20, Roniacol was
increased to 150 mg. t.i.d.
June 10, 1949: Reports that over-all picture is much
improved. Can stoop over without causing pain. Feel-
ing of oppression but no pain develops on walking three
or four blocks but disappears in less than five minutes.
June 24, 1949: “I am much better than I was six
months ago, can stoop without pain. Today walked sev-
en blocks at a moderate gait wthout pain or having to
stop ; can now do calisthenic exercises which I could not
do previously because of precordial distress. 150 mg.
Roniacol with early part of meal usually causes flush at
end of meal, lasting an hour and a half or longer.”
July 22, 1949: Reports continued improvement to tol-
erance of exercise without pain. At 11 :27 a.m. he was
given 150 mg. Roniacol and the reaction observed. With-
in seven miutes he reported a slight burning sensation
around “face and ear drums.” Slight flush of face and
chin was noted. In ten minutes a flush could be seen
over the upper sternal region. In twenty minutes there
was a burning sensation of the fingertips. In twenty-five
minutes the flush had increased over the face, neck, chest
to costal arch, shoulders to spines of scapulae, and over
the hands. He complained of being slightly dizzy on
getting off the examining table. During the period above,
successive blood pressure readings of 132/85, 130/84,
128/82, 130/84 were recorded and the pulse rate re-
mained between 72 and 75 per minute.
August 26, 1949: Weight 143 pounds. Efirected to in-
crease dosage to 200 mg. with meals and at hour of sleep,
i.e., 800 mg. daily during period of anticipated vacation.
October 14, 1949: Can regularly walk four or five
blocks even after meals without pain ; often several more
at a fair gait. Insists there is great improvement over
condition and range of activity before beginning present
regime.
Case 3. — H. E. G., a man, aged sixty-two, an industrial
engineer, was admitted to the hospital July 1, 1944.
Present complaint : For the past two or three weeks
he has wakened occasionally at 2 :00 or 3 :00 a.m. with
a feeling of distress under the sternum. He is not aware
that he had been dreaming. He notes also some dyspnea
on any unusual exertion such as climbing a hill at golf.
Examination : Height 5 feet 6^4 inches, weight 181
pounds, blood pressure 142 systolic, 88 diastolic, heart
rate 72 regular, pulse of normal amplitude and charac-
ter. A systolic murmur, 3+ loud and rough, was heard
loudest over the aortic area and also to the right of the
manubrium sterni and in both carotids, loudest in the
left. The murmur could be traced downward to the left
over the precordia and apex, fairly loud and rough, and
was transmitted to the anterior axillary line. A six foot
film of chest showed moderate ectasia and tortuosity of
the aorta and a prominent aortic knob. The cardiac sil-
houette was suggestive of moderate left ventricular en-
largement with a total cardiac diameter of 15.2 cm. in
a chest diameter of 30.7 cm. There was no evidence of
calcium deposit in the region of the aortic valve on fluo-
roscopic examination. Cholecystograms showed a fair
concentration of the dye, normal limits in size and shape
and position and good emptying after a fatty meal.
There were distinctive shadows of at least four calculi
measuring from 12 to 15 mm. in diameter. Barium gas-
trointestinal study showed no abnormalities throughout
the tract, studied with special attention to esophagus
and cardia. A gastric expression, free hydrochloric acid
was 10, total 34 units. Blood showed hemoglobin 18.2
grams, erythyrocytes 5,500,000, white blood count 7,000
in normal percentages. Urine had a specific gravity ol
1.022, trace albumin, 1 to 3 red blood cells per high
power fields, no casts. Ophthalmoscopic examination re-
vealed no vascular or other abnormalities. The blood
Wassermann was negative. The prostate was normal.
Electrocardiogram showed moderate left axis deviation.
Blood cholesterol was 359 mgs. per cent.
Diagnosis: Cholelithiasis, aortic sclerosis.
With dietary regimen and bile salt administration, dis-
tress ceased and conditions remained stationary until
the fall of 1948.
On September 20, 1948, he reported mild precordial
pain or “distress” if he walks a block within an hour
after a meal. Then if he stops and can belch gas, he is
relieved. Later he can walk without the distress which
he describes as a sense of pressure behind the sternum.
The previous night he had a bout of severe epigastric
pain lasting one-half hour, relieved by “bisodol followed
by eructation of large quantities of gas” and this morn-
ing he has considerable discomfort in the epigastrium.
Physical signs over the heart were essentially unchanged
from 1944; weight 183 pounds, blood pressure 136 sys-
tolic, 80 diastolic, heart rate 66 regular. Electrocardio-
graphic tracings as compared with tracings taken in
1944 showed flat T, and inverted T3 and T4 (chest
electrode at apex).
A diagnosis of coronary sclerosis and angina pectoris
syndrome is added. At his request, alphatocopherol 50
mg. t.i.d. was tried for a month without effect.
October 21, 1948: Conditions unchanged and again at
his request daily' dosage alphatocopherol was doubled to
300 mg. Reviewed by Dr. George B. Eusterman and Dr.
H. L. Smith at the Mayo Clinic, the diagnoses given
above were confirmed. They found the plasma choles-
terol values 217 and 230 mg. per cent.
January 7, 1949: Alphatocopherol discontinued. Roni-
acol, a 100 mg. tablet t.i.d., was begun.
January 14, 1949: Reports the usual reaction if drug
is taken on an empty stomach, i.e., flushing of face and
head with sensation of warmth which comes on in ten
to fifteen minutes and lasts twenty to thirty minutes.
Has no pain or pressure sensation but has been more
careful to avoid exercise causing pain. Directed to take
400 mg. daily.
March 14, 1949: After return from motor trip to
West Coast. Flushing of face and sense of warmth
after dosage as before. Has seldom had sense of pres-
sure or pain on effort. His range is very definitely in-
creased and the lessening and frequent absence of pain is
especially noted.
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RONIACOL— WHITE
June 7, 1949: Weight 176 pounds, blood pressure 155
systolic, 90 diastolic. Heart rate 48 regular. Has pain
only if he walks after meals a full block rapidly. Can
play golf without pain and dyspnea if he does not eat
beforehand.
October 6, 1949: Weight 176 pounds. Blood pressure
148/82, heart rate 54 regular. Systolic murmur over
aortic area, over precordium and at apex, transmitted
to axilla as previously reported. Has had his usual dose
of Roniacol with breakfast at 7 :45, and was able to
walk without pain or dyspnea. He was given a test dose
of 100 mg. at 11 :45 for observation. The usual paresthe-
sia began in face, ears, scalp and neck in about seven
minutes, and in ten minutes redness was visible and
promptly became marked. Blood pressure 146/80, heart
rate 48 regular. In eighteen to twenty minutes redness
began over both hands and rapidly spread to forearms —
no paresthesia here. Paresthesia lasted one-half hour,
redness about forty minutes.
Directed to increase dose of Roniacol to 150 and 200
mg. q.i.d. — although he reports he can play golf without
pain and has pain only when he walks rapidly after
breakfast.
November 11, 1949: Marked improvement in range of
activity without subsequent pain is noted. Can still bring
on pain by walking rapidly immediately after a meal, but
has learned to avoid this. Has played his usual game of
golf without discomfort. Much better than before Roni-
acol was begun.
Case 4. — L. G. S., an automobile mechanic, aged
forty-nine, was admitted to the hospital December 23,
1947.
Past history : “Pleuropneumonia” at age of two, left,
surgical drainage, frequent mild head colds. Kidney
stone passed in 1943. Appendectomy in 1904. Cig-
arettes, one-half package daily; no alcohol. Past three
months severe retrosternal pain with sensation of pres-
sure or squeezing of chest on effort, often while work-
ing as auto-mechanic and occasionally at night, waking
him from sleep. Pain goes into both arms, may last
five to ten minutes if he ceases effort or takes nitro-
glycerin tablet under tongue, but the remedy causes
headache. On one occasion two months ago the pain
lasted a half day. In November on deer hunting he
was without discomfort while walking through the
woods but had a severe attack of retrosternal pain on
arrival in camp. A severe attack is almost unbearable
and feels as if his chest would burst. Has had occa-
sional mild attack while sitting in a chair. Much wor-
ried over job and prospect of eviction from apartment.
Examination : 5 feet 4 inches, weight 156 pounds, blood
pressure 110 systolic, 78 diastolic, traumatic cataract
right, ocular reflexes on left normal, knee jerks nor-
mal, station normal. Pyorrhea present. Moderately
large tonsils with low grade chronic infection. Scars
of left thoracotomy and appendectomy. Apprehensive
and worried.
Hemoglobin 15.5 grams, white blood count 8,100 in
normal percentages, sedimentation rate of red blood
cells 6 mm. in one hour. Urine specific gravity 1,020;
no abnormalities. Electrocardiogram, normal rate and
rhythm, auricular and ventricular complexes normal
except for deep Q3 (6 mm.). A six foot x-ray film of
the chest shows no pulmonary or mediastinal (heart
and great vessels) abnormality. Mantoux skin test
1 :1000 negative, cholecystogram negative, barium gastro-
intestinal study with especial attention to cardia revealed
no abnormalities. X-ray films gave evidence of hyper-
trophic arthritis involving the fifth and sixth cervical
vertebrae with spina bifida occulta of the seventh cervical
and first dorsal spines.
Diagnosis : Coronary sclerosis, angina pectoris syn-
drome, pyorrhea alveolaris, arthritis of cervical spine,
spina bifida occulta seventh cervical and first dorsal
vertebrae.
He was cautioned against activities producing pain,
and given aminophyllin, 3 grains in enteric-coated tab-
lets q.i.d. with glyceryl trinitrite p.r.n. He continued
his work and experienced little or no change in the
amount of exercise possible without pain. An intercur-
rent incident of pain in the right shoulder and arm led
to a spinal fluid study February 14, 1948. This showed
normal values in cell count, protein, sugar, and colloidal
gold curve and negative Wassermann. In March, 1948,
he was much concerned about living quarters. On
March 15 toward morning be was awakened by severe
retrosternal pain. He took nitroglycerin eight times
within two or three hours, each time with brief relief
and then a recurrence of pain. Next day he got an
extension of occupancy of living quarters and then
fainted in court. He was studied for ten days after this ;
no fever or leuckocytosis and no change in electro-
cardiograms could be demonstrated. Course continued
as before until March 24, 1949, when he wakened at
5 :00 a.m. with a severe paroxysmal retrosternal pain
which persisted. He was hospitalized until April 30,
1949, the diagnosis by Dr. Olga S. Hansen being
acute coronary occlusion with myocardial infarction.
The electrocardiograms from March 27 through April
showed acutely progressive changes of posterior type
infarction. Following discharge from the hospital he
began to experience pain on effort as before.
He began Roniacol May 14, 1949. He was observed
by the writer after administration of 100 mg. at 4:15
p. m. He reported a sensation of prickling and warmth
of face and ears beginning in nine minutes, and this was
promptly followed by a visible flush which with the
sensation spread over face, scalp, ears, neck, upper
chest and to arms and hands within fifteen minutes
after the drug was taken. During this period and up
to forty-five minutes after administration the blood
pressure remained within a range of 120/80 to 124/82
and the pulse rate from 68 to 72.
June 21, 1949: Electrocardiogram showed return to-
ward normal type, but Q3 persisted.
Continuing a total of 400 mg. Roniacol daily, he went
to work July 9, 1949, five days a week. Has had mild
precordial pain about five times a day.
July 23, 1949: The dosage was increased to 150 mg.
q. i.d. a total of 600 mg. daily. Since this increase he
has had little or no pain, working forty hours a week
with the exception of August 2, 1949, when he had
a brief paroxysm on being served with eviction notice'.
February, 1950
139
RONIACOL — WHITE
He has had to learn to work at a moderate pace and
develop as much serenity and equanimity as possible. He
can bring on slight brief distress if he works hard and
fast or hammers hard and vigorously over many min-
utes, but to him his relief is remarkable.
August 6, 1949 : Blood pressure 138/85, heart rate
70 regular. He is taking 600 mg. Roniacol in four doses
and working every day with no pain.
August 20, 1949: Blood pressure 142/64, heart rate
75 regular, weight 165 pounds. Has been working reg-
ularly since July 11, with no pain except rarely if he
works very fast and hard. He can climb stairs and walk
indefinitely at moderate pace without pain.
October 10, 1949: He has continued 600 mg.
Roniacol daily and remains at work with only very
rare paroxyms of pain on distinct overdoing. Both he
and his wife feel that his relief has been remarkable.
November 14, 1949: Has been without Roniacol since
November 6; worked all week but repeatedly had pain,
whereas since early August has been relatively free,
developing pain only on severe exertion, working fast,
et cetera. Both patient and wife report extreme dif-
ference with relapse to former frequency of pain when
deprived of the drug.
November 19, 1949: Frequency and severity of angi-
nal pain reduced greatly after resuming November 14,
1949, with 600 mg. of the drug daily. He has worked
several days without pain.
Case 5. — J. F. M., a widow, aged seventy, was first
seen March 12, 1947.
In 1943, while in California she suffered a severe at-
tack called “flu.” Since then she has had severe pre-
cordial pain on walking, especially against a wind. The
pain extends into the left shoulder, arm, and fore-
arm but is relieved by standing still. For the past two
or three weeks her ankles have swelled and she has
been dyspneic on exertion.
Examination: Positive Mantoux skin test 1:1000.
Chest x-ray showed old apparently healed lesions at the
right apex with scattered calcification in the area. The
heart is slightly above normal in size with left ven-
tricular enlargement and a slight calcification in the
arch of the aorta. Sputum and fasting stomach con-
tents did not reveal acid-fast organisms. Height 5
feet 3 inches, weight 114 pounds, heart rate 96 regular.
Peripheral arteriosclerosis 1 ■+. Moist rales in both
lung bases on inspiration ; post-tussal rales at the right
apex. Moderate pitting on pressure of both ankles and
feet. Hemoglobin 80 per cent (13.8 grams), white blood
count 8,700. Sedimentation rate 12 mm. in one hour.
Basal metabolic rate plus 8 per cent. Electrocradiogram
showed a rate of 110, QRS .12 seconds, T4 — 1mm., T., — -
2mm., T3 — 1mm.
Diagnosis : Arteriosclerosis, corornary sclerosis,
healed pulmonary tuberculosis of the right apex, angina
pectoris syndrome.
An acute respiratory infection in July subsided prompt-
ly. Blood pressure readings varied from 126 systolic,
82 diastolic on November 14, 1947, to 134 systolic, 84
diastolic on March 10, 1948. Treatment had been prin-
cipally instruction in avoidance of effort producing pain
with use of theobromine sodium acetate and 1/100 grain
tablets nitroglycerin p.r.n. There had been no marked
reduction of pain attacks on effort, which had occurred
three or four or more times a day.
Seen December 21, 1948 : On evening of December
18, 1948, she experienced an acute precordial pain after
a hot bath and while in bed awake, reflected into the
left arm. Dyspnea lasted one hour, after which she
fell asleep and during sleep daughter noted periodic
breathing (Cheyne-Stokes).
Examination: Weight 110 pounds, blood pressure 144
systolic, 88 diastolic, heart rate 90, no murmurs, moist
rales in both lung bases. Spleen and liver normal in
size. No edema of the legs present. Precordial pain
present on walking, reflects into left arm, subsides on
standing still.
December 25, 1948: Electrocardiogram compared with
March 14, 1947, shows T less negative. T4 less
exaggerated and delayed intraventricular conduction.
December 21, 1948: Began use of Roniacol, 100
mg. t.i.d. Record of observations by patient and daugh-
ter for twenty-five days : following administration
showed uniform reaction beginning in five to ten min-
utes, lasting twenty minutes to one-half hour with
marked reddening of face, neck, upper chest, arms,
hands, and fingers with this a feeling of warmth in
these regions. During this period bouts of pain defi-
nitely lessened in frequency. Nitroglycerin used under
tongue on the average once a day.
April 11, 1949: Continuing use of Roniacol. Reports
that she has definitely less pain than three months ago,
but is more active and uses nitroglycerin under tongue
four or five times a day as a rule. Warned again
against activity producing pain. Instructed to take 100
mg. tablet Roniacol with meals instead of before.
June 10, 1949: Taking drug with meals, she does not
get the flushed skin and warm feeling. Is much im-
proved. Can walk several blocks without pain. Blood
pressure 134/72, heart rate 78 regular. Has not re-
quired nitroglycerin since April.
July 19, 1949: An intercurrent acute bronchitis and
coarse rales are present over both halves of chest. She
can walk many blocks without pain. Continues 300 mg.
Roniacol daily. Blood pressure 135/75, heart rate 90
regular. She walks about her own house in comfort
and without pain and can even walk many blocks at
moderate gait without pain. The patient and daughter
report marked improvement in strength, feeling of well-
being and endurance as well as tolerance of exercise,
most marked beginning in April, 1949. With periods of
colder weather there is so far no increase in painful
incidents.
October 22, 1949 : Has continued Roniacol 300 mg.
daily. Weight 10 1/ pounds, blood pressure 138/88,
heart rate 78 regular. Physical signs as before. She
reports she is much improved. She can walk about
without pain, but does experience pain usually mild
and of short duration if there is excitement. Her
general appearance is improved.
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RONIACOL— WHITE
Case 6. — T. R., a man, aged fifty-seven, was first seen
August 7, 1934. He began to have precordial pain on
effort in May, 1933. At times it was so severe and
constricting he had to walk “bent over.” No dyspnea
was noted. He reported that his pulse was slow, 60
per minute when recumbent, but would become rapid
on arising. He notes that for the past two weeks pain
on effort is increasing in frequency, and yesterday was
brought on by excitement. For the past ten years there
has been a weight reduction from 190 to the present
170 pounds.
Examination : Height 6 feet, good nutrition, with
slight atrophy of skin from weight reduction. Blood
pressure 138/85, heart rate 78 recumbent. Heart tones
clear; no murmurs. Moderate slowing of heart on right
carotid sinus pressure ; none on left. Moderate respira-
tory arrhythmia. Peripheral arteries palpable and show
slight tortuosity. General physical examination nega-
tive. Ophthalmoscopic examination showed vessels con-
sistent with age Prostate 2 + enlarged, soft, not tender,
non-obstructive. Expressed fluid shows 3 to 5 leuko-
cytes and 1 to 5 degenerate cells per high power dry
field. Heart contour and size showed no abnormality
on a 6-foot x-ray film or orthodiagram. Urine negative
with specific gravity 1.028. Hemoglobin of blood 86 per
cent. Electrocardiogram showed low T with moderate
respiratory arrhythmia.
Diagnosis : Coronary sclerosis with angina pectoris
syndrome. Arteriosclerosis 1 plus. Hypertrophy of
prostate.
Therapy: Instruction in limiting activity to avoid
production of pain. Theocin.
Little change occurred throughout the fall and win-
ter, but on March 12, 1935, it is noted : “Has followed
instructions regarding limitation of activity in general.
When he starts out to walk may have slight pain and
feeling of constriction but if he walks slowly this sub-
sides and he can walk slowly, as he wishes.” Weight
178 pounds, blood pressure 142/86, heart rate 84 reg-
ular. Again conditions quite stabilized with occasional
pain on unusual effort or excitement.
An electrocardiogram June 5, 1939, showed rate of
100, low amplitude of QRS 1, 2, and 3 with R4 absent
and T exaggerated.
In July, 1940, symptoms suggestive of prostatic ob-
struction developed.
Electrocardiogram July 30, 1940, showed voltage of
QRS 1, 2, and 3 increased over June 5, 1939.
August 11, 1940: Intravenous urograms showed mod-
erate pyelectasia and ureterectasia, right, with deformity
at base of bladder suggestive of enlarged prostate.
Also chronic hypertrophic changes in lumbar vertebrae
and right sacroiliac joint.
August 20, 1940: Transurethral prostate resection by
Dr. Gilbert J. Thomas with uneventful recovery except
for mild left epidymitis which subsided.
In the winter of 1940-41 he was in California and
had more frequent anginal pain possibly because of neces-
sary hill climbing, but on return home late in Febru-
ary there were less frequent pain episodes with restrict-
ed activity. On resuming theocalcin he thought his
range somewhat increased.
In April, 1943, ventricular extrasystoles developed
and from that time on until 1948 were quite well con-
trolled by quinidine sulfate, 3-grain capsules given twice
daily with morning and evening meals. Theocin, amin-
ophyllin and theobromine sodium acetate were given
at various times in doses to limit of tolerance by mouth
with variable effect, sometimes seeming to increase tol-
erance to exercise, again with indifferent results. It is
noted that tortuosity and thickening of peripheral ves-
sels has increased to 2 + .
November 7, 1946: He reported that on or about
October 10, he had an episode of the usual type of
precordial pain lasting about six hours which recurred
for a shorter period two days later, but he did not call
a physician. Since then pain has recurred more readily
and earlier on walking. Examination showed blood
pressure 150/80, heart rate 80, regular, no fever, no
hyperleukocytosis, no increased sedimentation rate of
red blood cells and no essential changes in electrocardio-
gram.
Ma) 17, 1949: He reported after several months’ ab-
sence. The usual type of precordial pain develops on
walking three blocks at a moderate gait. Blood pres-
sure 168/80, heart rate 80 and regular, falls after ten
minutes of rest in a recumbent positon to 154/74, heart
rate 74. X-ray revealed no changes in heart size or
contour since first seen. Hemoglobin 15.5 grams.
May 28, 1949: 100 mg. Roniacol given by mouth three
hours after breakfast and observations noted. The re-
actions were similar to those reported in other cases.
He has been on Roniacol 100 mg. with meals and at
bedtime, the past 10 days, and this dosage has been
continued through the period of this report.
July 1, 1949: Blood pressure 128/75, heart rate 96.
He reports more relief from pain and greater range of
activity without pain than he has experienced with any
other medication since 1934.
July 23, 1949 : Beginning about three weeks ago he
took an hour’s sun bath daily for six days ; none since.
During this period he began to notice pain after walking
a block or two, the pain going down left arm to the
elbow, for the first time in his experience. He ascribed
it to sleeping poorly. He quit the sun baths, and the
pain attacks “lifted,” i.e., he could again walk several
blocks without pain.
August 9, 1949 : Much improved. Sometimes he
can walk at a moderate gait half a day without pain.
He notes that the drug is followed shortly by redness
and sense, of burning and tingling with flush of face,
neck, and upper part of torso.
October 1, 1949: Weight 187 pounds, blood pressure
156/85, heart rate 76 regular. If he eats an unusually
heavy breakfast he may have precordial pain on walking
three or four blocks, but if not he can walk three or
four miles without pain. After such a long walk he may
have palpitation, with a definite sense of irregularity
from premature beats. This may last a few minutes
only but on rare occasions three or four hours, or if
he walked a good deal on a certain day, he may have
the same experience on lying down at night to sleep.
November 23, 1949: Physical condition unchanged.
His report : “I am able to walk farther and at a quicker
February, 1950
141
RONIACOL— WHITE
pace without pain than has been my experience since
1934. I walk miles and go many days without pain.
I do not tire so readily and my head is clearer.”
Case 7. — L. L. S., a man, aged seventy-four, was ad-
mitted to the hospital November 24, 1948.
After heavy work at the age of twenty, he began
to have pain in the lumbar and sacro-iliac regions and in
1932 his left hip became painful and lame.
In 1935 be had a transurethral resection under spinal
anesthesia, involving the median lobe of the prostate.
At that time x-ray films showed moderate calcification
in margins of intervertebral cartilages, most marked
between the first and second vertebral bodies, and the
left hip showed slight flattening of head of femur
described as “malum coxae senilis, a traumatic form
of hip arthritis.” Also senile cataracts were noted, most
advanced in right eye. The tonsils were reported ad-
herent and infected. Blood pressure was reported 140
systolic, 100 diastolic.
Present condition: Beginning in 1946, he experienced
precordial pain on severe exertion, such as mowing the
lawn, and beginning about mid-September, 1948, a re-
trosternal pain has occurred much more readily on
exercise, especially after a meal. If he sits down, pain
disappears after fifteen to twenty minutes, but if he
continues, pain increases, spreads into both shoulders and
arms, and into right mandible. The arms feel weak for
half an hour after the pain ceases. Digestion good,
nocturia once.
Height 5 feet 10 inches, weight 177 pounds (was 212
pounds twelve years ago and 185 pounds a month ago).
Blood pressure 162 systolic, 92 diastolic. Moderate
atrophy of skin, limitation of about one-third in flexion
of left hip, adherent infected tonsils, cataracts most
marked in right, peripheral arteriosclerosis 2+ (on a
scale of 4). Chest and abdomen revealed no abnor-
malities. Ophthalmoscopic examination : Left eye
showed generalized constriction of arteries with increase
of light reflex and marked compression of veins at the
arteriovenous crossings. A small superficial hemorrhage
was found to the temporal side of the disc between it
and the macula. The right eye showed hypertrophic
capsular tissue. A six-foot x-ray film of the chest
showed the heart diameter 13.1 cm. with a cardio-
thoracic index of 41 per cent, the heart contour sugges-
tive of left ventricular hypertrophy. The aortic arch
showed calcification in the wall.
Urinalysis normal. The hemoglobin was 17.0 grams,
white blood count 9,500 in normal percentages. The
sedimentation rate of the red blood cells was 2 mm.
in one hour. The electrocardiogram showed left axis
deviation with flat T and deeply negative T4 con-
sistent with fairly recent myocardial damage.
Diagnosis : Coronary sclerosis, angina pectoris syn-
drome, Hypertrophic arthritis of the spine.
Roniacol 100 mg. tablets, was begun November 26,
1948. Taking them before a meal, in about five minutes
he experienced the typical flushing and feeling of warmth
lasting fifteen to twenty minutes.
His physician writes under date of January 18, 194°:
“Mr. S. came in for a checkup this morning and I am
happy to report that he has been much better since
using Roniacol. On Wednesday of last week he made
several trips to town, exerting more than usual, and
had a recurrence of his pain. He frankly admits he
probably did too much. He is feeling better again and
is much encouraged.” Shortly after this report the
patient discontinued Roniacol, reporting recurrence of
anginal attacks and failure to get relief from the drug.
1 1 has not been learned w'hether he has had an extension
of bis underlying coronary sclerosis.
Case 8. — A. H. C., a man, aged sixty-eight, had been
a moderate smoker, and a moderate to heavy user of
alcohol up to 1926, but none since. A waiter by trade,
he had not worked since 1946.
Examination : Height 6 feet, weight 147 pounds (20
pound weight loss in two years), blood pressure 170
systolic, 100 diastolic, pulse 100 per minute regular.
Diagnosis : Arteriosclerosis with aortic and coronary
sclerosis, cardiovascular disease with hypertension and
the angina pectoris syndrome, benign prostatic hyper-
trophy, pulmonary emphysema.
Roniacol was begun in December, 1948, 100 mg. q.i.d.
On December 20, 1948, the dosage was decreased to 50
mg. t.i.d. with emotional discomfort. On February 22,
1949, Roniacol was discontinued because of continued
abdominal discomfort with increasing cardiac discomfort.
Case 9. — O. F. N., a man, aged fifty-three, a violinist,
was admitted to the hospital October 23, 1945. Patient
had received an honorable discharge from the U. S.
Navy in 1919 because of nervous disability, service con-
nected, and coronary trouble, non-service connected. In
1939 while portaging a canoe, he had had a severe
precordial pain lasting three days in all. A diagnosis
of coronary thrombosis was made, and he was kept
inactive for three months. He resumed teaching the
violin until 1942, wrhen he had a severe precordial pain
while draw-shaving logs. Again he was compelled to
rest. Some months later he began to have retrosternal
pain extending into the left elbow on walking a block
or more ; he would stop, and the pain would promptly
subside; he would walk again and have to stop. With-
in a year, i.e., some time in 1943, he began to have the
pain sometimes for thirty to sixty minutes after a meal,
on listening to the radio broadcast of a football game,
or hearing a fire engine siren.
Examination : Height 5 feet 6(4 inches, w-eight 181
pounds, blood pressure 210 systolic, 142 diastolic. Periph-
eral arteriosclerosis 1+ (on a scale of 4). Aortic
second tone accentuated, no murmurs heard, no visible
or palpable increase in precordial pulsation. Digital
rectal examination of prostate with expression of secre-
tion revealed 25 to 30 pus cells with clumps per high
power dry lens microscopic field. Prostate wras mas-
saged at five to seven day intervals by Dr. H. A. Reif,
and at the end of two months cell content had reduced to
approximately 5 to 8. A gall-bladder dye test and
barium gastrointestinal study by x-ray with especial at-
tention to the lower esophagus and cardia revealed no
abnormalities. A six foot x-ray film of chest revealed
142
Minnesota Medicine
RONTACOL— WHITE
a 40 per cent cardio-thoracic index with normal con-
tours of heart and mediastinum. Urine negative, hemo-
globin 18 grams, red blood count 5,500,000, white blood
count 6,200 in normal percentages, sedimentation rate
of the red blood cells 3 mm. in one hour. Electrocar-
diogram showed normal complexes.
Diagnosis : Arterial hypertension, angina pectoris syn-
drome, overweight.
A reducing diet was ordered and instruction in avoid-
ance of effort causing pain was given. He was seen on
rare occasions, eight in all, until April 17, 1947, on
which date his weight was 165 pounds, and a blood
pressure reading was 146 systolic, 100 diastolic. Dur-
ing this eighteen-month interval the weight reduction
had been gradual, but the 30 pound weight reduction
recommended had been attained only in part. Blood
pressure readings varied between 170/95 and 154/100
between December 3, 1945, and March 27, 1947. During
this period for approximately the first six months there
seemed to be little change in the amount of effort
producing pain, but he followed instructions quite care-
fully and the painful episodes were much less frequent.
On rare occasions the pain would occur at night as it
had before. Nitroglycerin 1/100 grain seemed to give
relief.
He was not seen again until April 12, 1949. There
was increasing frequency of pain episodes, less care in
avoiding causative effort, and pain was occurring more
frequently at night. Weight had increased to 171
pounds, and blood pressure was 172 systolic, 104 dia-
stolic, heart rate 84. No essential changes in physical
examination or electrocardiogram. He was given Ron-
iacol in 100 mg. tablets to be taken t.i.d. and instructed
again in avoidance of effort causing pain.
April 26, 1949 : Blood pressure 210 systolic, 1 15
diastolic, heart rate 84. Reports same type of reaction
after the drug as noted in other patients. A full 100
mg. dose gave so violent and disagreeable a reaction
that half tablets (50 mg.) were taken regularly after
April 26. Mild reactions occurred in similar fashion
if the dose was taken on an empty stomach and no re-
action sensed if taken with food. However, he was able
to accomplish distinctly more work without pain than
formerly. On two occasions he reported bouts of pain
about 1 1 :00 p.m. about four hours after taking the drug,
with a meal and then exercising quite severely.
November 10, 1949: Continues to excite pain on ef-
fort with the excuse that there is no one else to per-
form the services required. He experiences no relief
from Roniacol but feels that he does get some relief
from quick vasodilators such as nitroglycerine which he
takes three, four, and five a day. Roniacol discontinued.
Case 10. — W. J. N., a man, aged forty-eight, was first
admitted to the hospital September 27, 1948.
He reports that he froze his hands and feet in 1935
at a temperature of -32° F. but suffered no destructive
lesions.
In April, 1948, he thinks he had a sliver or bruise at
the tip of the middle finger of the right hand. A sinus
was found extending to the bone about the second
week in August. Since then there has been marked pain,
worse when the hand is held up. The pain is relieved
somewhat by holding it .at knee level with the body
bent forward and the right hand slightly squeezed and
massaged by the left hand. This sinus does not heal.
About the middle of August, 1948, began to have a
brownish spot at the tip of the middle finger of the
left hand. Thinks he may have had a slight bruise there.
It was painful to touch at the tip where a small crust
had developed.
Examination : Height 5 feet 8^4 inches, weight 164
pounds, pulse 76 per minute and regular, blood pressure
135 systolic and 80 diastolic. There was a large area
of urticaria over the epigastrium and legs. There were
numerous lipomata of the forearms, torso and thighs.
The mouth is furnished with an upper plate and lower
partial. The tonsils are cryptic and buried. The periph-
eral vessels show a 1+ arteriosclerosis. There is
evidence of a discharging granulating area at the tip of
the right middle finger. The hands are red and the
nails cyanotic. There is a small crust at the tip of the
left middle finger; tips of all other fingers are red and
tender. There is an area of redness and slight edema
of the dorsum of the right foot and over the outer
malleolus. He can walk without developing cyanosis
in the feet, and on elevation the skin becomes waxy
white and is slow to regain its color. X-ray film of the
chest shows the heart normal in size and position. The
lung fields are clear. X-ray of the right leg shows no
evidence of calcification in the vessels.
The hemoglobin is 18.0' grams, red blood count 5,-
100,000, leukocytes 10,500, with 56 per cent polymorpho-
nuclear cells, 41 per cent lymphocytes, and 1 per cent
monocytes. The urine is normal. The electrocardio-
graphic tracing shows normal complexes.
Diagnosis : Peripheral vascular disease, remote result
of congelation.
On September 24 the patient was placed on Roniacol in
50 mg. doses q.i.d. He was instructed to take it in
two ways : ( 1 ) about twenty minutes before a meal
and on retiring, (2) with meals and on retiring, and
to report if any difference is experienced. He notes
that when taken on an empty stomach he would have a
distinct sense of warmth around the face, ears, and
upper chest and also1 in both hands, and this positive
sense of warmth together with increased redness of hands
would persist for one-half hour or more after each
dose. This phenomenon did not develop when the drug
was taken with the meal. By November 1 it was noted
that the hands were healing somewhat, and the distinct
impression was gained that the preparation had been
effective as a vasodilator in the extremities.
In the meantime, on October 4, a cervical sympathetic
block on the left side with 1 per cent novocaine had been
done by Dr. Wallace T. Nelson. The regions of the
upper, medial, and lower left sympathetic ganglia were
each infiltrated with 10 c.c. of a 1 per cent novocaine
solution. After this -had been done the patient stated
that the left hand did not feel any warmer than the
right but “it felt like it felt' years ago.” It felt nor-
mal while the right hand had a “tingly” feeling. After
February, 1950
143
RONIACOL— WHITE
this procedure, the lateral cord of the plexus was in-
jected and this produced an immediate sensation of
warmth in the left extremity. This tends to show that
it is a nerve supply to the vascular system of the ex-
tremity that is involved.
On the basis of this information a right-sided high
thoracic sympathectomy of the pre-ganglionic type un-
der sodium pentothal anesthesia was done by Dr. H.
F. Buchstein assisted by Dr. Wallace I. Nelson. The
procedure was accomplished without difficulty, and the
patient was returned to his room in good condition.
The pleura was not opened.
The Roniacol was continued after the operation, and
healing of the left middle finger continued but was
slow, and on November 17, 1948, a high thoracic
sympathectomy, pre-ganglionic type, was done on the
left side. The same procedure was carried out on the
left side as was done on the right. On December 1,
1948, it was noted that the wounds of the fingers were
well healed and the fingers warm.
Case 11. — E. M. G., a man, aged thirty-seven, a pa-
tient of Dr. G. G. Bowers, was first admitted to the
hospital April 5, 1949.
The patient had had poliomyelitis at age three, but
sustained no residual paralysis. He was an office execu-
tive, a social drinker, smoked one package of cigarettes
a day and drank six to ten cups of coffee daily.
He began having pain in the left great toe early in
November, 1948, which would persist a day, then be
gone three or four days. He had been hospitalized in
March, 1949, for three days. After discharge from the
•hospital all his toes turned “black and blue,” and he
had severe pain in the toes and muscles of the lower leg.
Under the nail of the left great toe the pain was very
severe and throbbing. The left now developed a pain
on walking one and one-half blocks and exhibits red pain-
ful areas in the lower half of the leg.
Examination : Height 5 feet 4 inches, weight 163
pounds, temperature 98, heart rate 80, blood pressure 140
systolic, 88 diastolic. Reflexes normal. On walking
there is a marked cyanosis of the left foot and great
toe. Moderate cyanosis of the right foot is relieved by
elevation. The feet feel cool to touch. The posterior
tibial and dorsalis pedis pulsations are not evident on
the left, and the popliteal pulsation is weak. Good
pulses are present on the right. A six foot film of the
chest shows a cardio-thoracic index of SO per cent.
X-ray films of the legs show no evidence of calcification
in the vessels. Dental x-ray survey for vitality shows
all negative. Kline exclusion test for syphilis is nega-
tive. Urinalysis negative, hemoglobin 15 grams, red
blood count 4,270,000, white blood count 15,000 with a
normal differential count, sedimentation rate 6 mm.
in one hour, blood uric acid 4.75 mg. per cent (April 11)
and 4.0 mg. per cent (April 9).
Diagnosis: Thrombo-angiitis obliterans (Buerger’s
Disease).
April 9, 1949: Began Roniacol 100 mg. t.i.d.
April 18, 1949: On taking drug has had flushing in
face and forearms beginning in five to ten minutes —
this lying down but not if up and about. Pain is now
144
limited to the throbbing pain under his left great toe-
nail. Posterior tibial and dorsalis pedis artery pulsa-
tion on the left is now felt whereas it was formerly
absent, but the pulsation is weaker than on the right.
The left foot is cool to the ankle. Today he walked
thirty blocks without leg pain.
Dosage of Roniacol increased to 150 mg. q.i.d. (600
mg.) daily.
After two days of increased dosage all the pain had
disappeared from the left leg and foot, and he reported
that now after taking the drug “I would really get
red” with a more marked burning and prickling sen-
sation in the top of his head, in the face and forearms.
He has experienced no sweating at any time.
Following the demonstration of circulatory improve-
ment by vasodilatation, a left lumbar sympathectomy
was performed by Dr. Wallace 1. Nelson on June 3.
At the time of the operation, smoking was discontinued
and has not been resumed.
On June 9, the sixth day postoperative, the left thigh,
leg and foot were distinctly warmer to touch than the
right, and the skin color definitely redder. Pulsations
were felt in the popliteal dorsalis pedis and posterior
tibial arteries. On the right the pulse in the popliteal
artery was faint, in the dorsalis pedis absent and in the
posterior tibial faint. Blood pressure 128 systolic, 74
diastolic, heart rate 78, regular. 100 mg. Roniacol
were given with water on an empty stomach at 8 :45
a.m. Observations revealed a brief blood pressure rise
to a maximum of 132 systolic, 84 diastolic, which later
returned to 126 systolic, 74 diastolic, the heart rate rising
to 90 within fifteen minutes and promptly, i.e., within
twenty-five minutes, subsiding to 72 per minute. Be-
ginning within twelve minutes, paresthesia with a sensa-
tion of warmth in the face, ears and neck spread to
the upper chest and later to the arms, with visible
marked flush of same areas and increased warmth to
palpating hand. In exactly twenty-minutes he announced
that while previously there had been some pain in left
toe, this had now ceased. Redness and paresthesia lasted
a full hour. Within three weeks after operation, he
resumed his full duties in business and has remained
well and at work.
November 17, 1949: He has taken no Roniacol since
September 15, 1949. He reports that since the operation
the left thigh and leg and especially the foot are con-
stantly warmer than the right. The right foot and ankle
often feel cold to touch and often on retiring he has a
sensation of cold in this foot. He then places the sole
of foot on left thigh and it soon becomes warm.
Examination : Weight 166 pounds, blood pressure 122
systolic, 76 diastolic, heart rate 75 regular. General
physical examination negative except for legs and feet.
Left thigh, leg and foot are warm to touch, definitely
brighter pink in color than the right and there is promp*
return of a pink color to the skin after removal ol
pressure. He reports there is no sweating in this ex-
tremity. Right thigh and upper two-thirds of right leg
are approximately as warm to touch as the left but
there is less redness to the skin. Below a fairly well
demarcated line between the middle and lower thirds of
the leg, the skin temperature is palpably much cooler
Minnesota Medicine
RONIACOL— WHITE
than the left and return of color after release of pres-
sure is slow. On walking briskly no color change is
noted in the left foot and ankle, but the right becomes
paler and on resting a faint cyanosis is visible. On
elevating and depressing the right foot, color changes
develop slowly as compared to the left.
Case 12. — E. S., a man, aged seventy-seven (reported
by Dr. A. L. Miller), was first admitted to the hospital
May 1, 1949.
Examination: Height 5 feet 5)4 inches, weight 120
pounds, previous weight 160 pounds, forty pounds weight
loss in the past four to five years. Blood pressure 184
systolic, 90 diastolic, heart rate 60 per minute. He is
lean ruddy faced, sullen, obstinate and negativistic. He
has neurotic excoriations on his back, has presbyopia
but does not wear glasses, all his teeth have been extract-
ed, and his chest is emphysematous. The heart apex is in
the fourth interspace at the nipple line ; a 2+ systolic
murmur is heard at the apex. The peripheral vessels
show tortuosity and thickening, arteriosclerosis 4+.
No posterior tibial or dorsalis pedis pulsation can be felt.
The left leg had been amputated above the knee be-
cause of an accident in 1946. In the dependent posi-
tion the right leg shows a marked cyanosis up to the
knee. On elevation there is a marked pallor, a rubor
when lying down. He has been under treatment with
niacin, nitranitol and various other vasodilator drugs
without improvement.
Diagnosis : Arteriosclerotic peripheral vascular dis-
ease of the right leg.
September 27, 1949 : Roniacol 100 mg. q.i.d. with
meals was begun. With the first dose given before a
meal, he became so flushed and confused that the nurses
were alarmed. The flushing and confusion lasted for
about an hour. Later doses that day were given with
meals. After a week he still flushed considerably and
had some restlessness up to one-half hour or more after
each tablet of Roniacol.
October 7, 1949: He appears to have less acrocyanosis
and more warmth. Flushing still occurs after Roniacol.
October 15, 1949: Conditions about as above. No
pulsation can be felt.
October 20, 1949 : After taking Roniacol flushing is
less. Patient is more co-operative, speaks a few words,
and there is less acrocyanosis and definitely more warmth
but no pulsation in the extremity.
October 21, 1949: Leg is less cyanotic but definitely
warmer and the patient desires less covering over the
leg. In the dependent position there is distinctly less
cyanosis than previously. On taking the drug, flushing
and sense of warmth begin in about ten minutes, last
for about one-half hour, and then tingling and restless-
ness diminish gradually. Since October 15 patient has
been more alert, less obstinate and speaks occasionally
though rarely. He has in the past usually sat uncom-
municative in the corner. The past few days he has
been wheeling his chair up and down the hall. It is
difficult to associate this fact with the medication but
it is not accounted for otherwise. Roniacol has definite-
ly benefited this man as to peripheral vascular dilation
and circulation, but as to cerebral stimulation further
treatment and evaluation will have to be made. The
medication is tolerated and has been taken more readily
in the past two weeks. Prior to this time he would
spit out any medication. In that it is hard to com-
municate with the patient we cannot evaluate our treat-
ment from the subjective side other than his apparent
willingness now to take Roniacol.
Case 13. — H. K., a woman, aged ninety-two (reported
by Dr. A. L. Miller).
No past family history is available as the family is
quite passive concerning the patient. No children are
living.
Examination : Height 5 feet 2 inches, weight 138
pounds, no essential change for several years. Blood
pressure 142 systolic, 80 diastolic. Urinalysis showed a
trace of albumin, no casts, no pus. Wassermann test
negative. Blood normal on examination. The right
hip has been nailed. She has generalized arteriosclerosis
with mild senility, hypertrophic arthritis, cardiovascular
disease with previous hypertension.
The patient was admitted July 29, 1949, with deep
gangrenous ulcers of both heels due to arteriosclerosis
and decubitous pressure. The ulcers did not heal and on
August 16, 1949, penicillin 300,000 units started daily and
Roniacol 100 mg. q.i.d. daily, given after meald. Heat
lamp and zephiran chloride irrigations started ; also oral
unicaps t.i.d., and the patient began sitting up in a chair.
August 23, 1949, penicillin was discontinued as the
pus was gone, the ulcer craters were clean and granula-
tions noted. The skin felt warm, and the patient reports
some tingling sensations after taking the medication.
The margins continued to heal, and on September 10,
1949, zephiran chloride irrigations were discontinued.
She expressed no discomfort from Roniacol.
September 30, 1949 : The ulcers were nearly healed.
October 10, 1949: Epithelization was complete and the
ulcer entirely healed. The skin of the extremities was
warm.
Case 14. — F. E., a man, aged eighty-four, was seen
April 19, 1949 (reported by Dr. A. L. Miller).
Examination : Height 5 feet 10 inches, weight 138
pounds, a gradual loss from 180 pounds in the past
twenty years. The patient is a large boned, muscular
man. Blood pressure 196 systolic, 100 diastolic, pulse
68 per minute, absolutely irregular. Wassermann test
negative; sputum negative for acid-fast bacilli; blood
and urine negative. Skin dry and atrophic, toe nails
deformed ; chest, barrel shaped and emphysematous,
inspiratory and expiratory musical wheezing, depressed
lung borders and little chest expansion. Heart tones
soft, absolutely irregular, rate 68 ; apical beat visible at
nipple line fifth interspace, no murmurs. The peripheral
vessels showed tortuosity, arteriosclerosis 4+. Dor-
salis and post tibial vessels not palpable on the right.
Left leg had been amputated for arteriosclerotic gang-
rene in 1947. A gangrenous ulcer is present on the right
heel, 4 cm. in diameter with a gray foul-smelling pus.
The surface of the os calcis is exposed, and there is a
black ring at the margin. The skin about it is dry and
cool.
February, 1950
145
RONIACOL— WHITE
Diagnosis : Arteriosclerosis, decubitus ulcer right heel.
On April 19, 1949, treatment was begun with a heat
lamp and frequent turning in bed with daily irrigation
with zephiran chloride 1 :1,000. By May 13, 1949, there
was no improvement and the os calcis was clearly visible.
300,000 units of penicillin were given daily. Heat lamp,
irrigations and frequent turning were continued.
May 25, 1949 : The wound was cleaner ; oozing pus
had discontinued, healing was stationary. Penicillin was
continued and vitamin B complex and vitamin C started.
June 10, 1949: The ulcer was dry but not healing.
Roniacol, 100 mg. q.i.d., started.
June 17, 1949: The size of the ulcer has not de-
creased but the darkened margin is showing granulation
as is the base of the ulcer. Penicillin discontinued.
Roniacol, 800 mg. daily, continued.
June 21, 1949: Infection seems to be increasing again,
and penicillin 300,000 units daily resumed.
June 28, 1949: Penicillin, vitamin B. complex and
vitamin C stopped. Roniacol 400 mg. continued. Ulcer
margin has closed in about 25 per cent. The foot feels
warmer. No dorsalis pedis or post-tibial artery pal-
pable. Use of heat lamp discontinued.
July 8, 1949: Foot feels warmer, ulcer about 50 per
cent less in depth and extent. Acrocyanosis of toes and
distal half of foot is decreasing. The skin of the leg
seems to show less atrophy than before.
August 15, 1949: Ulcer nearly closed. Skin of foot
and leg nearly as warm as thigh.
Septembers, 1949: Ulcer covered and scar contracting,
foot warm.
September 15, 1949: The Roniacol has been temporarily
discontinued ; foot perceptibly cooler. Acrocyanosis
greater. Roniacol resumed.
October 25, 1949: Ulcer has entirely healed. Roniacol
continued.
Case 15. — J. A. C., a housewife, aged fifty, was ad-
mitted to the hospital October 3, 1949.
Patient had had a duodenal ulcer in 1943. Symptoms
had been relieved by dietary regimen and medication.
Symptoms of osteo-arthritis in the knees in 1946 had
been relieved by weight reduction. A mild acne rosacea
of the nose, cheeks and forehead was present. Meno-
pause occurred in 1948. Her childhood home had been
broken by her parents’ divorce. She is highly sensitive,
highly reactive, has often had a feeling of guilt for
“pushing my parents out of my life” after her marriage
and resents her husband’s feeling that she is wholly
responsible for the children.
Beginning about 1943, she began to experience attacks
in which the four fingers of each hand would become
pale and numb. Prolonged rubbing would result after
many minutes in some return of sensation but the fingers
would become blue, sting and burn, eventually becoming
normal in color. These attacks were brought on by
exposure to cold or by activities involving elevation of
hands and arms such as painting, hanging out clothing,
et cetera.
Examination: Height 5 feet 2 inches, weight 142
pounds, blood pressure 125 systolic, 72 diastolic, heart
rate 75 regular. General physical examination was nega-
tive except for very mild acne rosacea. The color of
her hands was normal at rest but on elevating them
above the level of the shoulders for one minute and
then placing them on her knees, her fingers were at
first noticeably pale and her sensation to touch was
greatly reduced. She described the sensation as “numb.”
In about thirty seconds her fingers became definitely
cyanotic, and she described a burning sensation. Cyanosis
with slow return of color after release of pressure
persisted for about ten minutes.
Diagnosis : Raynauds disease.
October 3, 1949: Began Roniacol, 50 mg. before each
meal and on retiring.
October 11, 1949: Patient stated that she at first took
50 mg. of Roniacol before each meal which was fol-
lowed in about ten minutes by a “fiery redness” of the
face, neck, upper chest and arms with a “burning” sen-
sation over the same areas. For the first three days
there was brief colicky pain in the stomach region be-
fore the redness of the skin appeared. After this she
took the drug with meals and on retiring, experiencing
only a mild flush but no pain and no burning sensation.
On the third day of use while doing dishes, she ex-
perienced an unusually mild attack in which her fingers
became “tingly” but not numb. On the fourth day she
forgot the remedy before retiring and had a more severe
attack with numbness but less pallor than usual. With
the cyanotic period some swelling of fingers occurred.
Since that time she has been free from attacks even un-
der provocation, except that on the eighth day of medi-
cation, while peeling apples, pallor and numbness devel-
oped but normal sensation and appearance developed
promptly with rubbing. This occurred much more
promptly and readily than before the use of the drug.
(She recalls now that at childbirth on December 10,
1924, she had scopolamine twilight sleep, and for a
month following this had cold, numb hands. This ceased
after a month, to recur paroxysmally in about 1940.
October 26, 1949: She finds that best results are
secured by taking 50 mg. of Roniacol with a small break-
fast and 100 mg. at noon and evening meals. She was
directed to take either 50 or 100 mg., whichever she finds
convenient, on retiring also. She reports she can do much
more and can tolerate more severe cold than before.
On a cold morning recently she had mild symptoms
and mild pallor in the fingers. She is now driving her
car with comfort, although for eight years she has not
dared to drive the car on cold days.
From last reports she has only slight symptoms with
the hands, is much better in every way, and is less
nervous, irritable and apprehensive than before.
146 .
Minnesota Medicine
ASSOCIATED DISEASES OF THE SKIN AND EYE
EDWARD P. BURCH, M.D., and CHARLES D. FREEMAN, M.D.
Saint Paul, Minnesota
h I ^ HERE are a large number of diseases which
may jointly involve the eye and mucocutane-
ous surfaces of the body and are therefore of
mutual interest to the dermatologist and ophthal-
mologist. It is the purpose of this discussion to
invite attention to some of the more interesting
diseases which fall into this category, and to
elaborate upon their clinical manifestations.
Among the more common diseases which de-
mand the collaboration of specialists in these two
fields is rosacea. It is a disease of adult life
which attacks the skin of the face, involving par-
ticularly the nose and cheeks. Transitory attacks
of vasodilatation in these areas finally become
permanent with concomitant hypertrophy of the
sebaceous glands, which usually become chroni-
cally infected. The etiology of this very disfigur-
ing condition remains obscure, although abnor-
mality of the gastric secretion with achlorhydria,
a diet excessively rich in carbohydrates and con-
diments, over-indulgence in alcoholic beverages
and endocrine disturbances have all been suggest-
ed as possible incriminating factors. The ocular
lesions usually commence as a mild blepharo-
conjunctivitis. At a later stage, corneal involve-
ment occurs, and unless effective therapeutic
measures can be effected, serious visual damage
may ensue. Initially, there occurs a marginal
vascularization of the cornea. As vascularization
progresses, greyish subepithelial infiltrates are
noted. Ultimately, the process involves the
corneal stroma, advancing relentlessly toward the
pupillary area of the cornea. The vascular loops
become more prominent and as the overlying epi-
thelium degenerates, ulceration usually attended
by secondary infection takes place. Finally dense,
facetted, chalky-white and heavily vascularized
scars are formed. Systemic treatment is of im-
portance. The diet should be properly regulated,
with a reduction in the carbohydrate intake. Con-
diments of all varieties should be interdicted.
Large amounts of riboflavin should be adminis-
tered. Roentgen and ultraviolet therapy to the
facial lesions is often beneficial. Local antiseptics
are of value in combatting secondary infection in
the eye, and the photophobia and blepharospasm
which may be quite marked are alleviated by
means of atropine and tinted lenses. The corneal
lesions respond to beta irradiation in a sufficiently
high proportion of cases to warrant a thorough
trial with this type of therapy. Quite recently
desensitization to the male sex hormone has been
advocated. With this latter procedure we have
had no firsthand experience, but recent reports
in the ophthalmic literature have been encourag-
ing.
Erythema multiforme is still another disease
which affects both the skin and eyes. Of toxic
origin, it is often accompanied by fever, general-
ized malaise and joint effusion. The skin eruption
characteristically consists of symmetrically situ-
ated, circular, well-demarcated erythematous
patches, associated with a central edematous exu-
date. The hands, forearms, face and legs may be
involved, as well as such mucous surfaces as the
conjunctiva, mouth and vagina. Not infrequently
the conjunctival lesion is the initial manifestation.
It may assume a catarrhal, purulent, or pseudo-
membranous form. In the catarrhal variety, nu-
merous raised areas appear on the bulbar con-
junctiva. The adjacent conjunctiva becomes
markedly congested. Secretion is scanty, but
lacrymation, blepharospasm, photophobia and in-
tense itching are usually noted.
The so-called Stevens- Johnson syndrome, with
cutaneous rash, severe stomatitis and profuse con-
junctival discharge is rare. Marked chemosis, sub-
conjunctival hemorrhages and marked conjunc-
tival exudation, followed by corneal involvement
usually constitutes the course of events. Ulcera-
tive keratitis with performation of the globe and
loss of the globe has been known to occur.
The most common ocular form of the dis-
ease is pseudomembranous conjunctivitis. The
membrane usually involves both palpebral and
bulbar surfaces. Edema of the lids, chemosis of
the conjunctiva and profuse exudation are prom-
inent features of the pseudomembranous form.
As a rule, corneal involvement with varying de-
grees of opacification takes place and a fulminat-
ing type of exudate cyclitis may further compli-
cate the clinical picture.
Treatment consists of frequent instillation of
mydriatic drugs such as atropine, penicillin local-
February, 1950
147
DISEASES OF THE SKIN AND EYE— BURCH AND FREEMAN
ly and sulfa drugs or penicillin systemically in
heavy doses ; however, it must be remembered
that the sulfa drugs may produce this condition.
If there is a profuse discharge, frequent argyrol
and boric irrigations may afford some relief.
While the illness may be severe from the general
standpoint, recovery is the rule. There may be,
however, severe visual damage as a sequela of
the keratoiritic process.
Erythema nodosum is another disease of ob-
scure origin which evinces a predilection for chil-
dren and young adults of the female sex. Both
rheumatic fever and tuberculosis have received at-
tention as possible etiological factors. The skin
eruption is ushered in with joint pains and high
fever. The cutaneous involvement consists of
dark red or purplish red swollen areas which ap-
pear in successive crops over the arms, legs,
shoulders and face. The edematous plaques in-
volve the entire thickness of the integument and
have a highly distinctive appearance. Concurrent-
ly, subconjunctival lesions may occur. These are
usually located between the cornea and caruncle.
They are either vesicular in appearance or may be
nodular and are freely movable over the underly-
ing sclera. No treatment is indicated, since the
ocular lesions disappear as the general disease
subsides.
In 1889, Doyne reported the first well-docu-
mented case of angiod streaks of the choroid.
This condition, which is frequently associated
with pseudoxanthoma elasticum of the skin, was
first recognized by Groenblad and Strandberg as
a generalized disease of elastic tissues with the
eye as a special site of predilection. Essentially,
the disease involves the corium of the skin and
lamina vitrea of the choroid. It is thought to be
due to an inherited developmental defect of elastic
tissues in the regions cited above. It may occur
at any age but usually occurs before the age of
forty. The skin lesions, first described by Darier,
consist of a symmetrical thickening, softening,
and relaxation of the skin, particularly in the
folds in proximity to large joints. A yellowish
discoloration of the affected skin takes place. In
the eye, the lesions are always bilateral. The sub-
retinal streaks resemble blood vessels in appear-
ance. Their color may be red, brownish or gray.
Ordinarily, the streaks anastomose in the region
of the nerve head, sometimes forming an incom-
plete circle from which the angioid streaks ra-
diate toward the equator. The streaks invariably
lie behind the retinal vessels, and histopathologic
investigation has shown that they represent rup-
ture of Bruch’s membrane, the lamina vitrea of
the choroid. Frequently, retinal involvement with
severe disturbance of central vision occurs as the
result of transudation or hemorrhage through the
ruptures in the lamina vitrea. Eventually connec-
tive tissue proliferation takes place and a pseudo-
tumor involving the macular region may result.
This lesion closely resembles the disciform degen-
eration which is so characteristic of Kuhnt-Junius
disease.
Molluscum contagiosum is an infectious dis-
ease which frequently affects the lid margins and
conjunctiva, as well as any of the skin surfaces.
A filter-passing virus is the causative agent, and
the lesions are very characteristic in appearance,
consisting of small circular tumors with an um-
bilicated center from which necrotic tissue con-
taining the molluscum bodies can be expressed.
Catarrhal conjunctivitis or even actual conjunc-
tival growths resembling those seen in the skin and
lid margins constitute the usual ocular findings.
Expression of the contents of the tumor and
cauterization with pure phenol constitute the
treatment of choice. Sulfapyridine has also been
advocated in small children.
A peculiar and somewhat rare form of uveitis
which is invariably accompanied by dysacousis,
alopecia, poliosis and vitiligo has been reported
by a number of ophthalmologists. The uveitis is
severe, and visual damage is the rule. No definite
cause has ever been ascribed to this curious syn-
drome which is usually given the eponymic desig-
nation of Koyanagis’ disease. A virus etiology
has been suggested. Treatment of the uveal tract
inflammation is nonspecific, and the partial deaf-
ness and cutaneous manifestations do not respond
to any form of therapy. The disease principally
affects both sexes about equally between the ages
of twenty and forty. Poliosis may also occur in
sympathetic ophthalmia.
Thallium poisoning deserves mention because of
the fact that this heavy metal has occasionally
been used as a base in the preparation of depila-
tory agents. Prolonged use of such agents may
be attended by the development of a chronic toxic
retrobulbar neuritis. It is prudent, therefore, in
toxic amblyopias of obscure origin to question the
patient closely concerning the use of substances
which have been employed to remove superfluous
hair.
148
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DISEASES OF THE SKIN AND EYE— BURCH AND FREEMAN
Of the vitamin deficiency states which may af-
fect the eye and skin, vitamin A deficiency and ari-
boflavinosis are of interest. In the former state,
the skin becomes loose, its normal texture be-
comes dry and scaly, and finally keratinization
takes place ; while in the eye Bitot’s spots appear,
the cornea loses its translucency, and actual kera-
tomalacia develops. Night blindness may appear
as an early sign of lack of vitamin A. If in-
dividuals fail to ingest adequate amounts of ribo-
flavin, quite characteristic fissures appear at the
angles of the mouth and nose. These tend to
bleed readily, become macerated and their ap-
pearance is pathognomonic. In the eye, the chief
finding is excessive limbal vascularization. In
both of these conditions the treatment is self-
evident.
A distressing condition which frequently in-
volves the skin of the lids and which may be-
come quite disfiguring is xanthelasma. It is most
frequently accompanied by a significant eleva-
tion of the cholesterol content of the blood and
often occurs in diabetic patients. The typical
lesions consist of raised, yellowish plaques situat-
ed in the superficial layers of the skin of the eye-
lids, the upper lids being involved more common-
ly than the lower. Careful surgical excision of
the lesions offers the best method of remedying
this unsightly condition. Because of the loose
structure of the skin of the eyelids, an excellent
cosmetic result can be obtained by surgical meth-
ods in the majority of instances.
Of the so-called phakomatoses, tuberous sclero-
sis associated with adenoma sebaceum is of con-
siderable interest. The typical butterfly pattern
of the adenomatous lesions over the upper cheeks
and nose is diagnostic. In the eyes, retinal tume-
factions may occur in the retina and optic nerve.
The intraocular lesions consist of greyish-white or
yellow, well-delineated elevations. More rarely
mulberry-type retinal tumors are seen. The dis-
ease, which is familial and degenerative in charac-
ter, not only involves the skin, eye and brain, but
often the heart and kidneys as well. Because of
the cerebral lesions epilepsy is common. The
disease is usually fatal.
Von Recklinghausen’s disease is another of the
phakomatoses with both skin and ocular findings.
The cafe-au-lait spots in the skin are easy to
recognize. Pigmented naevi and multiple tumors
of peripheral and cranial nerves are other mani-
festations. Tumors of the optic nerve and ret-
ina similar to those seen in tuberous sclerosis are
not uncommon. Many authorities hold to the
opinion that tuberous sclerosis and generalized
neurofibromatosis are closely related, the former
disease affecting chiefly the central nervous sys-
tem and the latter principally the peripheral
nerves. This variety of the phakomatoses, von
Hippel-Lindau’s disease or angiomatosis retinae
et cerebellae, while involving the eyes, does not
give rise to lesions of the mucocutaneous system.
A rather unusual form of glaucoma may occur
in patients with nevus flammeus or port-wine
stain of the face. This conditon, spoken of as
Sturge-Weber disease, may exhibit considerable
variation in its clinical picture. The vascular
nevi involving the face occur in the distribution
of the trigeminal nerve. As a rule, one side only
of the face is affected. If the glaucoma occurs in
infancy, buphthalmus occurs ; while in later life
the glaucoma is similar to that seen in the chronic
simple form. Cortical calcification occurs in the
brain and is accompanied by convulsive seizures.
Mental deterioration is the rule. The glaucoma
must be treated by means of miotic drugs and, if
medical therapy is unavailing, by means of some
type of external fistulizing procedure. The port-
wine stain is best left alone.
One of the more common diseases of mutual
interest to the ophthalmologist and dermatologist
is neurodermatitis involving principally the lids.
The redness, swelling, intense itching and charac-
teristic corrugated appearance of the lids renders
the diagnosis simple. Treatment, if specific al-
lergenic factors cannot be elicited, consists in
avoidance of soap and water to the affected region
and the application of antihistaminic unguents.
These are extremely effective in allaying the
marked itching. In women particularly, the pos-
sibility of allergy to cosmetics, particularly face
powder, eyelash dyes, and nail polish must be
carefully excluded.
Another condition of interest is allergic bleph-
aroconjunctivitis due to contact with drugs which
are instilled in the eye or applied to the lids.
Atropine, pilocarpine, eserine, penicillin and the
various sulfa compounds are the most common of-
fenders. The clinical picture resembles that seen
in ordinary eczema or neurodermatitis of the
lids, although in atropine sensitivity hypertrophy
of the conjunctival lymphoid tissue is quite usual.
If therapeutic drops such as eserine or pilocar-
pine are employed over a considerable length of
February, 1950
149
DISEASES OF THE SKIN AND EYE— BURCH AND FREEMAN
time to combat glaucoma, a drug sensitivity oc-
casionally develops and will necessitate the use
of other miotic compounds. A few patients ex-
hibit a violent local reaction to the various anes-
thetic agents commonly employed to reduce con-
junctival and corneal sensitivity. In the event such
a drug sensitivity is noted, it is advisable to note
the fact in bold letters in some conspicuous place
on the patient’s clinical record. A common prac-
tice among ophthalmologists is to stamp in red ink
across the chart the statement “Sensitive to (name
of drug),” the blank space being filled in by hand
with the name of the offending drug.
Among the most refractory problems common
to dermatology and ophthalmology is the treat-
ment of seborrheic blepharoconjunctivitis. The
diagnosis is made through the characteristic ap-
pearance of the eye lesions. The skin of the lid
border is covered with small white, dandruff-like
scales. The lid border is red but not ulcerated.
Examination of the scalp and external auditory
canals reveals an excessive seborrheic secretion.
Scrapings from the lid margins reveal the pres-
ence of pityrosporum ovale. Seborrheic bleph-
aritis, unlike the type due to chronic staphylococ-
cus or Morax-Axenfeld bacillus infection, wall not
respond to antibiotics or sulfa drugs used in con-
junction with vaccines and mechanical expression
of the contents of the Meibomian glands. The
seborrhea of the scalp and brows should be
brought under control before commencing treat-
ment to the lids and lashes.
Herpes simplex is caused by a filterable virus.
The inoculation of the vesicle fluid into the scari-
fied cornea of a rabbit will produce a keratitis,
and encephalitis results from succeeding animal
transfers.
The eruption may occur on the skin or mucous
membranes. It is usually preceded for a few
hours by itching, burning, and a sensation of
tenseness ; later it becomes erythematous and
slightly edematous. On this inflammatory base,
vesicles develop. These are usually of pinhead size
and filled with a serous fluid. After one or two
days the contents become cloudy and purulent and
the vesicles dry to become serous crusts. The
crusts fall off in five to ten days and the residual
erythematous macule soon disappears. Regional
lymphadenopathy is a rather common finding.
In the eye herpes simplex produces irritation, the
vesicles rupturing rapidly to leave small abrasions
in groups or rows ; rarely ulcers are found. The
150
abrasions usually heal promptly without leaving
any opacity. The involvement is generally unilat-
eral.
The treatment of the presenting attack is rather
simple. If seen in the vesicular stage, drying
agents should be used. Spirits of camphor is
easily and effectively applied ; calamine lotion,
lotio alba, and weak solutions of lead are also
used. In the crusted stage mild ointments such as
boric or weak ammoniated mercury are. em-
ployed to keep the crusts soft.
The recurrent form will often tax the in-
genuity of the clinician. Precipitating factors,
if known, should be avoided. Foci of infection
should be eradicated. X-rays and ultraviolet
light seem to be helpful in some recurrent cases.
Vaccine made from the herpes virus is advocated
by some authorities but repeated vaccination with
the standard vaccine used for smallpox immuniza-
tion produces equal or better results.
Herpes zoster is a herpetiform eruption oc-
curring along the distribution of one or more of
the posterior ganglia or of the cranial nerves.
The eruption occurs as grouped vesicles on an
erythematous base. It is usually always uni-
lateral. Neuralgic pains may precede the eruption
by a day or two and when occurring in the right
lower quadrant of the abdomen have been mis-
taken for appendicitis. This pain may persist
long after the eruption has disappeared, espe-
cially in the debilitated and the aged.
Scarring is uncommon unless severe pustula-
tion or gangrene has occurred. If the ophthalmic
division of the fifth nerve is attacked, herpes
zoster ophthalmicus results. If the eyeball is
implicated, one finds that the cornea becomes in-
sensitive and presents vesicles which progress to
an ulcerative lesion. There may be diffuse deep
infiltration with involvement of the iris and the
ciliary body. The ocular lesions are treated by
moist warm compresses of boric acid or weak
solutions of mercury bichloride. Atropine must
be employed if the anterior uvea becomes in-
volved.
In treating the skin lesions so many various
forms of therapy have been advocated that one
wonders if any are of value. Some authorities
feel that occlusion is helpful. This may be done
by liquid adhesive, collodion, or by thick cotton
dressings. Other men feel that soothing lotions
such as calamine or zinc lotion are indicated.
In the crusted stage, mild ointments such as cold
Minnesota Medicine
DISEASES OF THE SKIN AND EYE— BURCH AND FREEMAN
cream or boric ointment are used. For the relief
of pain, various injections have been advocated,
with equivocal results. These include autohemo-
therapy, pituitrin, pitressin, thiamin chloride, so-
dium iodide, and DHE 45. Aspirin, phenacetin,
codeine, and other analgesics are necessary for the
relief of pain.
Cavernous sinus thrombosis causes dilated facial
veins, protrusion of one or both eyeballs, and
sometimes papilledema of the corresponding eye
and immobility of the eyeball. The skin assumes
a dusky red color of the entire area with the veins
standing out in bas-relief. Signs of a furuncular
infection (that may have produced the thrombo-
sis) may still be evident on the skin.
Lipoid protienosis is a rare syndrome charac-
terized by yellowish-white plaques on the skin and
oral mucous membranes, and an associated warty
condition of the skin. The scalp shows a sparse
growth of hair and there are bead-like whitish
papules on the eyelids and the eyelashes are ab-
sent. There is probably an underlying constitu-
tional disturbance, and many of the patients show
a diabetic tendency. Treatment with a low car-
bohydrate diet and insulin will cause a disap-
pearance of most of the lesions of the skin and
mucous membranes.
Hydroa is a vesicular and bullous disease that
tends to recur each summer during childhood. It
is much more common in boys and tends to dis-
appear about the time of puberty. The milder
forms which are characterized by papules and
small vesicles is referred to as hydroa aestivale
while the severe type with bullae, impetiginous
crusts and pitted scars is called hydroa vaccini-
forme. The lesions are most common on the face,
dorsal hands, and the extensors of the extremities.
Lesions of the cornea will cause scarring and in-
terfere with vision, while the conjunctival lesions
resemble those seen in vernal catarrh. Some
cases are associated with porphyrinuria which may
account for the photosensitization. These cases
will show the characteristic wine-colored urine
and discolored teeth. The treatment of hydroa
is the avoidance of sunlight, use of nicotinic acid,
and soothing local applications.
Dermatitis herpetiformis is an uncommon,
chronic, relapsing, itching, burning disease which
may present ocular complications. The lesions
may be erythematous, papulovesicular, vesicular,
bullous, or urticarial. They tend to occur at sites
of predilection, on the elbows, knees, scapulae, and
the sacrum. The ocular lesion implicate the con-
junctiva and cornea. The etiology is unknown
but is thought strongly to be a virus. The tend-
ency to grouping in this disease is so marked
that the diagnosis is hard to establish in its ab-
sence. The mucous membranes are not frequently
involved and only then when the bullous lesions
are predominant. Sulfapyridine seems to control
this condition probably better than any other
single medication. However, it is not curative
and must be continued in small doses for most of
the patient’s life. Penicillin also appears helpful.
Arsenicals by mouth (either acetarsone or in the
inorganic form as Lowler’s solution or Asiatic
pills) seems helpful. Benadryl relieves the pru-
ritus in some cases but has little effect on the
course of the lesions.
Reiter’s disease is a clinical syndrome consisting
of urethritis, arthritis and conjunctivitis; how-
ever, skin lesions similar to those of gonorrheal
keratoderma are also observed. It is probable
that these two diseases are the same except that one
is due to a known agent and the other to an un-
known organism. The favorite sites of the skin le-
sions are the palms, soles, elbows and knees, al-
though it may be widespread. The primary lesion
is a vesicle and secondary changes of pustules,
crusts and keratoses develop. The keratoses appear
early as small yellow, waxy cones that grow dark-
er as they become older. The conjunctivitis is
usually bilateral and is occasionally accompanied
by iritis. Hemorrhages and purpuric lesions of
the conjunctiva and mucous membranes, as well as
of the skin, may occur. Treatment is not too
satisfactory. Penicillin, aureomycin and strepto-
mycin as well as the sulfa drugs have proved dis-
appointing. Hyperpyroxia, either by mechanical
means or by intravenous injections of typhoid
vaccine, may be tried.
Heerfordt’s disease is characterized by iridocy-
clitis, peripheral facial weakness, recurrent laryn-
geal nerve disturbances and nodular enlargement
of the parotid gland. There may also be the cu-
taneous lesions of sarcoid. The lesions of the
eye and the gland also have the histologic picture
of sarcoid. On the skin the lesions are of a dull,
yellowish-red or brown color that tend to involute
in the center and spread as a raised ring at the
periphery but may occur as nodules and plaques.
Lesions may also be found in nodes, lungs, bones
and other organic tissues. The treatment is large-
ly nutritional through a high caloric, high vita-
February, 1950
151
DISEASES OF THE SKIN AND EYE— BURCH AND FREEMAN
min diet and injection of crude liver extract.
X-rays and ultraviolet to the individual lesions
are helpful, and small individual lesions may be
destroyed by cryotherapy.
Osier’s disease or hereditary hemorrhagic tel-
angiectasia causes recurrent epistaxis with mul-
tiple telangiectases of the skin and mucous mem-
branes. The pathologic lesion seems to be small
tufts of dilated capillaries scattered superficially
over the skin and mucous membranes. The chief
symptoms are bleeding from the nose, beginning
in early childhood, but may occur in later life, and
bleeding from the skin and other mucous mem-
branes following slight trauma. There is no
efifective treatment.
Behcet’s syndrome includes simultaneous or
separate episodes of aphthous (herpetic) lesions
in the mouth, on the genitalia and ocular symp-
toms which are usually a chronic recurrent iritis
sometimes accompanied by uveitis and neuritis.
The disease is more common in men and is prob-
ably of virus etiology. No specific therapy is
known. There have been no reports but a trial
with aureomycin may be indicated.
Acanthosis nigricans is a rather rare condition
characterized by hyperpigmentation with papillary
hypertrophy. These usually occur at sites of
predilection but may be universal. On the skin,
the lesions are usually found in the axillae, on
the neck, about the arms, umbilicus and on the
flexors of the extremities. On the mucous mem-
branes, the conjunctiva, buccal mucosa and palate
are most commonly involved ; however, pigmenta-
tion is usually absent here, and only papillary hy-
pertrophy is noted. About 50 per cent of cases
occur in the younger age groups and are asso-
ciated with some form of endocrine dysfunction ;
in the remaining 50 per cent that occur in the
older age group some form of internal malignancy
is present. Mild salicylic acid or resorcin salves
will give symptomatic relief on the skin, but the
cause should be searched out and treated.
In pediculosis, the crab louse usually restricts
its activity to the genital regions but may spread
to the axillae, eyebrows and eyelashes. In the
course of its migrations there may be bluish or
slate-colored macules (maculae caeruleae) which
are formed by a secretion the louse forces under
the skin while feeding. The diagnosis is made
by seeing the louse or the nits attached to the
hairs. On the body, the cleanest treatment is dust-
ing with 10 per cent DDT in talc or by a Benzyl
benzoate solution. About the eyes, a 2 per cent
p ammoniated mercury or 1 per cent yellow oxide
of mercury is used.
Warts are a virus infection and are found on
practically all of the cutaneous surfaces. The
filiform type, which is most common on the eye-
lids and sides of the neck, is easily destroyed by
clipping at the skin surface and lightly touching
the base with a cautery. The plantar variety
usually responds well to x-rays or radium ; this
form of treatment does not incapacitate the patient
and is relatively painless. Elsewhere, cautery is
effective.
Lupus erythematosus may be a chronic, less
commonly subacute or acute, inflammatory dis-
ease characterized by sharply marginated red or
violaceous, various sized plaques, situated on the
face much more commonly than elsewhere, and
followed by cicatricial atrophy. On the mucous
membranes the inside of the cheek is usually at-
tacked. The disease first appears as bright red
patches, later becoming violaceous, or bluish
white, and depressed areas of atrophy with dilated
vessels. On the lips and mouth it appears as
scaly depressed patches, shallow erosions, or
bluish-white depressed atrophic areas. The lip
may be slightly swollen and everted. They have
been said to look as though they had been covered
with collodion and were about to peel.
On the eyelids, the disease appears much as it
does on other parts of the skin. On the margins
of the lids, the disease- superficially resembles
blepharitis but the following conditions differen-
tiate lupus erythematosus. The lid margins are
dry, not moist, and covered with finely adherent
scales. The color is not as red and inflamma-
tory appearing as in blepharitis. It may be vio-
laceous. There is no matting of the lids and the
cilia may be partially or completely absent. Later
the cilia are permanently destroyed, the margins
become irregular and atrophic, and the color dis-
appears. Ectropion and eversion of the lid mar-
gins are uncommon, as the atrophy is not of a
contractile nature. On the conjunctiva, the dis-
ease is similar to that seen on the skin except
no scales are present. The patches are red to
violaceous, edematous, sharply marginated and end
in atrophy. The atrophy may take the form of
circumscribed depressed areas or as lines and
streaks. Isolated lesions of the conjunctiva have
not been reported ; however, this may be due to
the fact that it is not recognized rather than to its
152
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DISEASES OF THE SKIN AND EYE— BURCH AND FREEMAN
extreme rarity. The acute form of lupus erythe-
matosus is a serious, frequently fatal, disease of
the collagen tissues of the body and may occa-
sionally show no skin manifestations. There ap-
pears to be a severe toxemia and the skin manifes-
tations, when present, show a greater polymor-
phism than seen with the chronic discoid form of
the disease. Fever, malaise, joint pains, and nerv-
ous disturbances are common clinical findings
while leukopenia and albuminuria are the most
consistent laboratory findings. Subacute lupus
erythematosus lies between and may show all of
the signs of the chronic as well as the acute types.
The Libman-Sacks syndrome and acute lupus
erythematosus are probably variants of the same
disease.
In the acute form of lupus erythematosus, the
fundi show marked changes characterized by peri-
vascular hemorrhages, fluffy exudates, and ob-
viously diseased arterioles showing segmentation.
These changes occurred in about 40 per cent of
one series of cases and occur independently of the
hypertension that may develop due to extensive
renal damage.
In treating lupus erythematosus, the general
health of the patient should be supported and foci
of infection should be eradicated. In the acute
types, treatment should be of a supportive na-
ture and no active therapy begun until the dis-
ease subsides. For the chronic forms, treatment
with gold or bismuth salts appears to be beneficial
in many cases. The individual lesions on the skin
may be destroyed by cryotherapy or cautery. The
lupus patient should avoid sunlight, as this not
only has a deleterious effect on the acute forms
but may cause the chronic type to flare into an
acute form of the disease.
Xeroderma pigmentosum is a rare progressive
pigmentary and atrophic disease that begins early
in childhood. It is due to a congenital hyper-
susceptibility to ultraviolet light, and several
cases in one family are common. Porphyria may
be present. There is an early development of
senile changes in the skin consisting of lentigines,
telangiectasias, keratoses and carcinoma. Photo-
phobia and lacrimation are the early eye symp-
toms. Later keratitis develops with resulting
opacities. Tumors of the lids and cornea also
develop. There is no curative treatment. Avoid-
ance of sunlight and the proper treatment of the
February, 1950
skin growths as they appear is all that can be
offered these patients.
Pemphigus of the eye may occur alone or asso-
ciated with lesions elsewhere on the skin and mu-
cous membranes. On the eye, the lesions appear
as very shallow conjunctival ulcers, usually cov-
ered with a tough membrane, and most often seen
in the folds. They heal with atrophy and shrink-
ing of the conjunctiva so that eventually the folds
become obliterated by scar tissue. The end re-
sult is immobility of the globe and cicitricial en-
tropion or even total ankyloblepharon. The cor-
nea is involved indirectly or as the result of tri-
chiasis and becomes vascularized and opaque.
On the skin, bullae arise from normal skin on
any part of the body. These bullae arise in crops
and there may be long periods of comparative
freedom. Usually the bullae rupture, leaving a
raw, red surface that shows little tendency to heal.
As constitutional symptoms increase, the skin le-
sions tend to decrease so that a patient may die
of pemphigus with relatively little to see on the
skin. The treatment of pemphigus, on the whole,
is very disappointing. Various forms of arsenic
therapy have been tried with variable results ; so-
dium naphuride (germanin) has its supporters.
General supportive therapy with a high caloric,
high vitamin diet and small transfusions at three-
day or four-day intervals seem beneficial. If the
skin lesions are at all extensive, they are prob-
ably best treated as one would a burn of the same
severity. The eye complications are also treated
more or less symptomatically. If trichiasis re-
sults, the lashes should be destroyed, and if sym-
blepharon is extreme, free dissection of the scar
tissue and mucous membrane grafts are indicated.
It is well known that opacification of the lens
may occur in association with eczema in neuro-
dermatitis of long standing. As a rule, patients
with this type of cataract are younger than those
suffering from the senile variety, and the history
of chronic skin disease is virtually diagnostic of
the syndrome. The opacities, as a ride, may bfe
noted in the subcapsular zones of the lens and ul-
timately progress to the stage of complete opaci-
fication. The treatment consists in extraction of
the lens and, because of the age of many patients,
a linear extraction or Homer-Smith procedure is
indicated. The prognosis is favorable. Allevia-
tion or improvement of the skin condition has po
appreciable effect upon the ocular lesion.
(Continued on Page 190) ' v '
153
Ft .
COMPRESSION FRACTURES OF THE SPINAL COLUMN
JOHN C. IVINS. M.D.
Rochester, Minnesota
Hr HE INCREASING complexity of modern
life brings about an ever-increasing incidence
of accidents, at work, in the home and on the
road, and as the violence of these accidents tends
to increase, the treatment of fractures comes
to occupy more and more of our time. We see
many more “broken backs” than we formerly
saw. A “broken back” was an especially com-
mon injury during the recent war, and the dread-
ful connotation of the term itself has been dis-
pelled in part by the lessons learned in treating
those injuries.
Fractures of the spinal column may be con-
venientlv divided anatomically into three groups :
(1) fractures of the transverse and spinous pro-
cesses which serve for the attachment of muscles
(these frequently are over-treated, to the detri-
ment of the patient) ; (2) fractures of the verte-
bral bodies, which transmit weight; and (3) frac-
tures of the laminas, articular processes and ped-
icles which form the neural arch behind.
In the limited time available, I wish to discuss
some important aspects of fractures of the ver-
tebral bodies. Such fractures form the ma-
jority of those we see in practice. They result
from automobile accidents or falls, usually from
some height, and they often occur in certain
sports, such as tobogganing; they may occur from
trivial injury, such as a fall on a rug, or going
over a bump in a car, especially in the aged, who
usually have some degree of osteoporosis of the
spinal column. They occur not infrequently when
a weight falls on the patient’s back or shoulders.
In all these instances, the injury usually occurs
at the junction of a movable with an immovable
portion of the spinal column. The most fre-
quent injury is to the twelfth thoracic and first
lumbar vertebrae. Often two adjacent verte-
brae are crushed, and at times one sees two in-
jured segments, separated by one or more normal
vertebrae.
Most fractures are sustained while the spinal
column is in flexion. Extension fractures are
rather uncommon, but they probably occur more
frequently than we supposed in the past. In
Dr. Ivins is a member of the Section on Orthopedic Sur-
gery, Mayo Clinic, Rochester, Minnesota.
Read at the annual meeting of the Minnesota State Medical
Association, Saint Paul, Minnesota, May 9-11, 1949.
many cases, complete paraplegia following an in-
jury in which no bony damage can be demon-
strated in the roentgenograms recently has been
shown to be due to hyperextension injuries with
rupture of the anterior longitudinal ligament and
then spontaneous reduction.
Depending on the direction the flexion force
takes, the injury may be wedging of one or more
vertebrae, comminution of a vertebral body or the
more serious fracture-dislocation. As the hyper-
flexion force is applied, the anterior portion of
the body of one vertebra gives way and is
crushed by the impact of the vertebra next above
or below, the articular facets and pedicles acting as
the fulcrum for this force. The angle at which
the force is applied seems to determine the extent
of the comminution. Impaction of the fragments
and the muscle spasm incident to the injury tend
to fix the deformity. There is a variable amount
of damage to the involved intervertebral disks.
Fortunately, the strong anterior common ligament
usually remains intact, thus enabling the surgeon
to reduce the deformity in these fractures bv
hyperextension with little danger of doing dam-
age.
After a fall or a hyperflexion injury, the pa-
tient may get up and walk, or even return to work,
with a compression of one or more segments
which cannot be demonstrated by physical exami-
nation. Usually, however, the patient will com-
plain of fairly well-localized back pain, with or
without radiating pains. The most reliable sign
is tenderness over the spine of the broken ver-
tebra, accompanied by a variable amount of
muscle spasm. Kyphos may be produced in the
presence of more severe injuries. Good antero-
posterior and lateral roentgenograms of the spinal
column should be made in every case of sus-
pected injury to the spinal column.
The fractures of vertebral bodies under dis-
cussion are best shown in the lateral views ; when
the true status is doubtful, oblique views should
also be taken if there is any question of damage
to the neural arch or articulation. There is not
sufficient time for me to dwell upon the mani-
festations of damage to the spinal cord or the
nerve roots. The cord is so well protected by
its fluid bed and covering membranes, and it fits
154
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COMPRESSION FRACTURES OF THE SPINAL COLUMN— IVINS
so loosely in its bony canal that it escapes injury
in the majority of. spinal fractures. It goes with-
out saying, however, that every patient who has a
suspected fracture of the spinal column should
have a neurologic examination. This need not
be elaborate. If the patient can move the arms
and legs, if there are no gross sensory distur-
bances, if the deep reflexes are normal and if
there is no disturbance of bladder or bowel func-
tion, there probably is no appreciable injury to
cord or nerve roots.
Proper treatment of these fractures begins
when injury to the spinal column is first sus-
pected. The segments of the trunk above and
below the site of injury are powerful levers and
can be made to inflict more damage if the patient
is improperly handled. Nothing is more im-
portant to the eventual well-being of the patient
than skillfully administered first-aid treatment.
After diagnostic roentgenograms have been
made, and a compression fracture of one or more
segments has been found, preparations are made
to immobilize the spinal column in a position
of hyperextension, with or without reduction of
the deformity. Some patients cannot tolerate the
hyperextension position for many days after the
injury, even when the deformity is minimal in
the fractured vertebra. In these patients, paraly-
tic ileus is likely to occur. For this reason, we
feel it is best to put the patient to bed for a few
days on a curved Bradford frame or simply flat
on a hard bed before attempting reduction or
immobilization in plaster. Morphine should be
used sparingly, ' if at all. If paralytic ileus oc-
curs, it is actively treated with the application of
hot stupes to the abdomen, parenteral admin-
istration of prostigmine or pitressin, insertion of
a rectal tube, withholding of food and fluids by
mouth, and the intravenous administration of
fluids. If necessary, the patient can be placed
flat in bed on a fracture board until normal
intestinal activity is restored. An indwelling
catheter may be required during the first few days
after injury.
When it is certain that the hyperextension posi-
tion can be tolerated, then it is safe to proceed
with reduction and immobilization. With the
patient under the influence of analgesia pro-
duced by a substantial hypodermic injection of
some agent, or with anesthesia when required, the
patient is put in position for postural reduction.
Generally, the weight of the body will suffice,
but gentle pressure with the hand can be exerted.
When the full hyperextended position has been
reached, a well-moulded plaster is applied ; this
must extend in front from the suprasternal notch
above to the symphysis pubis below.
Immediately after application of the plaster,
the patient is turned frequently to avoid pul-
monary congestion and to assist in the prevention
of ileus. After twenty-four to forty-eight hours
the patient is allowed to be up, and then may be
discharged to out-patient care.
These fractures are slow in consolidating; the
mistake is commonly made of removing the plaster
too soon. In any event it seems safe to say that
flexion movement must not be allowed earlier than
four months after injury. In the case of the
comminuted fractures, it may be necessary to
continue plaster immobilization for six months
or longer.
Throughout this period of immobilization in a
plaster jacket, exercises for the spinal and ab-
dominal muscles are practiced regularly. A good
system is to teach the patient a regular schedule
of doing these exercises so many minutes out of
each hour ; they cannot be overemphasized. These
exercises maintain the tone of the spinal muscles,
and if they are properly done the strength of the
supporting musculature should be greater at the
end of immobilization than it was prior to frac-
ture. Furthermore, such exercises tend to pre-
serve normal flexibility in the spinal column and
help in maintaining the patient’s confidence in his
recovery.
When a sufficient period of immobilization has
elapsed, and roentgenograms show satisfactory
bony healing, the plaster jacket is discarded. If
the exercises have been faithfully done, it should
not be necessary, in the average case, to apply a
convalescent brace, such as the Taylor brace.
However, these fractures commonly occur 'in
people who work hard with their backs, and in
such instances an additional period of strength-
ening exercises may be necessary. For this pur-
pose, regular gymnasium exercises are best ; two
or three months may be required for this phase
of the treatment.
The problem of these flexion fractures of the
spinal column extends beyond their recognition,
reduction and immobilization. The average
period of incapacity after one of these fractures
is from six to twelve months, depending on the
severity of the injury and the occupation of the
February, 1950
155
COMPRESSION FRACTURES OF THE SPINAL COLUMN— IVINS
patient. However, there are often residual and
persistent complaints which extend beyond this
period, and these are due to secondary tissue
damage.
In unreduced fractures with a residual kyphos
there may be considerable static pain caused by
poor alignment and strain on the intervertebral
articulations. Nonunion of the fragments, which
may not be apparent in roentgenograms, is a fre-
quent cause of pain. The intervertebral disk
always suffers a variable amount of damage which
may lead to narrowing of the interspace, a re-
duction in the size of the foramina, and perhaps
radiculitis. Late posttraumatic necrosis, so-
called Kummell’s disease, may occur. Localized
hypertrophic spurring probably occurs in the ma-
jority of cases, no matter how well the patient
is treated, but this alone generally is not the
cause of symptoms. The intraspinous and inter-
spinous ligaments, of course, are always injured
at the time of fracture, and this injury is per-
haps the greatest single factor in the production
of persistent pain. Stresses and strains on these
injured ligamentous structures manifest them-
selves by deep-sea'ted pain and tenderness asso-
ciated with muscle spasm. This may cause the
disability to be protracted over a year or more.
Encroachment upon the intervertebral foramina
in these crushing fractures at the thoracolumbar
junction may produce pain which extends along
the ilio-inguinal or iliohypogastric nerves.
In a minority of cases, persistent deformity
with static pain, continued relaxation of the sus-
taining ligaments, or reactive spasm of the muscles
which will not yield to conservative treatment, may
require a fusion operation. Before this is done,
the surgeon must be sure that the pain is well
localized, that it is aggravated by exertion and
that it is completely relieved by rest or the use of
a back support.
Many of these injuries have industrial or in-
surance ramifications, so that the surgeon often
will be called upon to evaluate the disability in-
curred. As far as compensation is concerned, it
must be concluded from the foregoing that the
period of active treatment varies from six to
twelve months and that, on the average, the pa-
tient will not be expected to return to work in
less than twelve months. Furthermore, there may
be late sequelae requiring treatment that will be
declared compensable.
A good general rule is to allow 20 per cent
total disability if, on final recovery, there is
useful strength and motion up to 75 per cent
of normal, with relative freedom from muscle
spasm and pain. Thirty-five per cent total dis-
ability must be allowed if recovery is adjudged
to be up to 50 per cent of normal, and finally,
about 65 per cent total disability must be allowed
if recovery is adjudged to be 25 per cent of nor-
mal. Each case must be judged on its own merits,
but these are good general points.
"SOCIALIZED MEDICINE AS I SAW IT"
Excerpts from a recent address by Dr. Ralph J . Gampell
Nine years ago I graduated from medical school and
began as an intern in a hospital in Great Britain. Four
months ago I began as an intern in a hospital here in
the U. S. What happened in those intervening years?
The Government health scheme of Great Britain. After
coming back from five years of service wiith the Medi-
cal Brandi of the Royal Air Force, I entered a large
general practice in an industrial area in Great Britain
and that, of course, is the clue as to why I am here. I
have worked under this British Government Health
Service and found it so objectionable, both personally
and as a physician, that I felt compelled to break all my
ties — and they are leal ties— with home annd friends
apd' professional background : and come to start afresh
— and from the bottom — in a new country. You see
there are some things that are not worth doing at any
price .and working tfiat sort of government medicine
seemed to me so intolerable, that I made this momentous
bersonal decision: Arid' I am not alone in making this
break. You1 won’t see many of my British colleagues
here in the U. ,S. because the problem of obtaining dol-
lars L almost "bn in^urfnoiintable one for Englishmen.
©Ut tbeyi-aijei >stEpamirig out of Great Britain to the
British Dominions. This is hardly the action of men
who are happy in the 'practice of their chosen profes-
•15b
sion. Believe me, one does not make such a decision
readily.
Over here you have been led to believe that the vast
majority of British doctors are in favor of this scheme.
The figure has been quoted to you that considerably over
90 per cent of them have already joined. The pre-
sumption, of course, is that they joined willingly. Noth-
ing can be further from the truth. Let me use my own
case as an example. Before the introduction of gov-
ernmental medicine in July, 1948, England had a
system which is little known here in the U. S. When
a doctor wished to settle in some area, it was not the
usual custom for him to just hang up a shingle. In
the normal course of events, he would succeed to the
practice of a doctor who had died, or more often, a
doctor who had retired, and for the succession he would
pay a purchase price usually calculated at D/z times the
annual gross taking of the practice though in particu-
larly favorable areas this could go up to 1)4 or even
twice the annual gross. Now these are not small sums
of money.
In the practice to which I went— not an especially
large one — the annual gross was approximately $8,000.
Therefore, it cost me $12,000. Now as you can imagine,
(Continued on Page 162)
Minnesota 'Medicine
TREATMENT OF DEAFNESS WITH HISTAMINE
G. L. LOOMIS, M.D.
Winona, Minnesota
PUBLICATION by Hallberg and Horton1
on the treatment of sudden nerve deafness
by intravenous administration of histamine has
prompted the writer to attempt a review of sixteen
similar cases that he has seen in routine office
practice. At the time these cases were treated, no
thought was given to the possibility of the review ;
hence some of these case reports may seem incom-
plete. However, certain knowledge has been
gained from the observation of this group of
nerve deafness cases which may help evaluate fu-
ture patients.
The age group varied from thirty to sixty-seven
years. The onset varied from a few days to six
months or longer. Not all the patients had pure
nerve deafness. After explaining to them that no
definite assurance could be given regarding the
outcome, I treated eleven patients with nerve deaf-
ness, two with conductive deafness, and three with
mixed deafness. No otosclerosis cases were in-
cluded in the survey. Horton3 stated that while no
improvement could be expected except in patients
who had had a sudden onset of nerve deafness,
there might be an improvement shown in those
with a conductive deafness but the chance would
be very slight. Hallberg2 stated that sometimes
one can tell beforehand if the patient is going to
have a good result. Usually sudden deafness in
older people is caused by some vascular accident
to one ear ; however, once in a while it may be
caused by sudden edema, and these people are the
ones who should benefit from vasodilating drugs
such as histamine. One can never tell in advance
which has the hemorrhage and which has the
edema. Further observation is still necessary. The
following cases are reported as showing the most
startling results.
Case Reports
Case 1— B. J., a man, aged forty, came in on May 9,
1946, complaining of a sudden loss of hearing and a
buzzing sound in the left ear, which occurred after rid-
ing in a car by an open window. An audiogram (Fig. 1)
was taken and showed a marked decrease in hearing in
the left ear. Intravenous histamine injection was begun
on May 10 and continued for three days using Horton’s
method4 of 250 c.c. of 1 :250,000 dilution, the duration of
Read in part at the December, 1948, meeting of the Minne-
sota Academy of Ophthalmology and Otolaryngology.
the injection usually lasting from one and a half to two
hours. The patient noticed such a marked improvement
that the injection was discontinued and another audio-
gram was taken on May 14 (Fig. 1), showing the
prompt restoration of hearing which occurred. On Feb-
ruary 24, 1947, the patient was re-examined and the
hearing was found to be still further improved.
Case 2. — Mrs. L. R., aged thirty-six, was first seen
November 11, 1946, complaining of a buzzing noise in
the right ear along with a sudden loss of hearing. Ex-
amination revealed no disease, but an audiogram (Fig. 2)
showed the hearing very markedly reduced in the right
ear and normal in the left ear. She was started on hista-
mine intravenously in the same manner as in Case 1.
Injections were given on November 12, 13, 14, and 15.
An audiogram (Fig. 2) taken November 20 showed the
hearing had improved from total loss for speech to only
3.4 per cent loss. The patient has had no more complaints
referrable to this condition, and an audiogram taken
recently (Fig. 2) shows her hearing the same.
Case 3. — Mr. B. P., aged thirty, was first seen on
January 27, 1947, with a history of a buzzing noise in
the left ear with sudden loss of hearing. An audiogram
taken on this date showed considerable loss of hearing
for high tones, with the left ear down in the 60 decibel
level for 2896, 4096 and 5792. Intravenous histamine in-
jection was begun on January 28 and given for four con-
secutive days. An audiogram taken on February 10
showed the patient much improved with the hearing loss
for the same three tone levels at 20 decibels. Another
hearing test taken on February 10, 1947, showed essen-
tially the same results (Fig. 3).
Case 4. — Mrs. L. S., aged sixty-seven, was first seen
on September 2, 1947, complaining of ringing in both
ears and sudden loss of hearing in the right ear. She had
been wearing a hearing aid for some time. An audio-
gram showed a marked reduction in hearing on the right
ear and a still greater deafness of a very long standing
on the left ear (Fig. 4). Intravenous histamine was be-
gun on September 3, and given on four consecutive days,
at which time she ■ noticed some improvement. Three
months later, having seen two otolaryngologists in Saint
Paul, Minnesota, who recommended further treatment,
we gave her another course of histamine therapy con-
sisting of eleven consecutive injections. In addition she
followed this at home with nicotinic acid, both orally and
parenterally. Numerous audiograms were taken shortly
after the last injection, and they all showed consider-
able improvement. The latest (Fig. 4), taken one year
after the first treatment, showed the hearing. to be very
nearly normal for a woman of her age. She has discard-
ed her hearing aid and has an entirely new personality
and outlook on life.
Fehruary, 1950
157
TREATMENT OF DEAFNESS WITH HISTAMINE— LOOMIS
Fig. 1
Fig. 2
Case 5. — Mr. W. M., aged sixty-seven, was first seen
on November 20, 1947, complaining of sudden loss of
hearing in the right ear of two days’ duration. He also
stated that his left ear had had very poor hearing for
twenty years. An audiogram (Fig. 5) taken November
20 showed very marked hearing loss in the right ear and
considerable loss in the left ear. Histamine injections
were begun the same day and repeated on the following
three days. He supplemented this treatment with nico-
tinic acid orally and parenterally. His next audiogram
was taken on February 25, 1948, showing the hearing not
only improved in the right ear but also registering some
improvement in the left ear which had been regarded as
totally deaf for the past twenty years.
Case 6. — Mr. E. V., aged forty-eight, was first seen
January 7, 1949, complaining of poor hearing in both
ears for twenty years, especially the last few weeks.
Examination showed a right chronic otitis media non-
suppurative, and a left chronic otitis media mucopurulent.
His hearing was reduced to a whispered voice 6 inches
right, 2 inches left, spoken voice 3 feet right, 2 feet left,
increased bone conduction and a bilateral negative Rinne.
He was given nicotinic acid, 50 mg. tablets three times
a day. An audiogram taken on January 7, 1949, showed
the hearing loss to be 32.5 per cent right, 56.4 per cent
Fig. 3
Fig. 4
left. He returned January 31 and said he could hear
better, which was borne out by the audiometer reading
showing 30.5 per cent right, 22.1 per cent left.
He was given intravenous histamine injections four
consecutive days as in the other cases. The hearing on
February 14 had improved to whispered voice, right 2
feet, left 2 inches, spoken voice right 8 feet, left 6 feet.
The Rinne tests were now plus, minus. A later exami-
nation on August 4 showed whispered voice 6 feet each
ear, spoken voice 10 feet, with audiometer reading giving
19.7 per cent loss right and 9.9 per cent loss left. The pa-
tient states that both he and his family are very much
aware of his improved hearing (Fig. 6).
Case 7. — Mr. L. K., aged forty-nine, was first seen on
February 8, 1949, complaining of a hearing loss for about
three days, but further questioning showed that for sev-
eral years he had known that his hearing was not normal.
Examination showed a nerve deafness, hearing whis-
pered voice right 1 foot, left 2 inches poorly ; spoken
voice right 4 feet, left 2 feet. He was given three intra-
venous injections of histamine on February 10, 11, and
12 and nicotinic acid, 50 mg. by mouth. An audiogram
taken February 15 showed a marked improvement, name-
ly, 30.9 per cent right and 14.8 per cent left. Rinne test
showed positive each ear, whispered voice right 1 foot,
158
Minnesota Medicine
TREATMENT OF DEAFNESS
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Fig. 5
Fig. 6
left 2 inches, spoken voice right 25 feet, left 25 feet.
A recent audiometer reading taken on August 29 showed
essentially the same result (Fig. 7).
Case 8. — Mr. L. P., aged thirty-nine, was seen July 15,
1949, complaining of a sudden onset of a buzzing-like
tinnitus in the left ear for one day. This was accompa-
nied by a severe attack of vertigo at the same time.
There was a slight feeling of nausea but no vomiting.
He also stated that he had noticed a lesser buzzing sound
off and on for short periods for several years. He used
to hear a pulse-like beat but not since the present at-
tack occurred. A comparison of audiograms taken on
July 15 and July 30 is interesting, showing a quick return
to normal following four histamine injections as in the
previous cases. Symptomatically he was improved after
two injections (Fig. 8).
To be absolutely impartial, those cases which
showed little or no improvement should be includ-
ed in this report. There were five patients who
showed no appreciable increase in hearing. Three
of these cases of deafness had resulted from ex-
posure to shell fire while in the military service.
It had been explained to all of these that improve-
ment might be questionable. There were three
WITH HISTAMINE— LOOMIS
Fig. 7
Fig. 8
patients who showed a slight improvement. By
more careful choosing of these cases and limiting
them to those having primarily nerve type deaf-
ness, rather than including the conductive deafness,
the percentage would look better. However, those
of the other group who were improved are happy
about the regained hearing and seem better adjust-
ed socially. In addition, nearly all patients noticed
an appreciable improvement in their general condi-
tion and well-being which was not just a transient
change.
An explanation of the rationale of this form of
therapy goes beyond the realm of this paper. For
an interesting concept on vascular and fluid
changes taking place through middle and inner ear
dysfunction, reference should be made to an article
published by S. H. Mygind4 of Copenhagen.
Summary and Conclusions
Sixteen cases of deafness are presented as a
series of cases to illustrate the relationship be-
tween intravenous histamine injections and im-
(Continued on Page 212)
February, 1950
159
TUBERCULOSIS OF THE UTERUS
Report of Three Cases
WILLIAM P. MULVANEY. M.D.
Saint Paul, Minnesota
nr HE PURPOSE of this paper is to present
three cases of uterine tuberculosis, demon-
strating the different symptom complexes which
existed, and to illustrate the methods of treatment
available for this disease.
Tuberculosis limited to the female genital tract
is uncommon. It is usually associated with a peri-
tonitis of acid-fast origin.4 The tubes are most
frequently affected, while infection of the uterus
and the cervix is more rare. Etiology of genital
tuberculosis is generally considered to be by hema-
togenous dissemination, although conjugal inocu-
lation has been implicated unconvincingly in Eu-
ropean literature.3 The presently prevailing opin-
ion holds that infection is descending and origin-
ates outside the genital tract. The low incidence of
tuberculous infection of the uterus, even in the
presence of tubal infection, may be due to the
monthly replacement of the endometrium before
invasion by the bacilli can take place. Cases of
uterine tuberculosis available for study signifi-
cantly are associated with oligomenorrhea and
amenorrhea. When ovarian function fails, endo-
metrial replacement is inhibited, and tuberculous
infection from the tubes is more likely. Menor-
rhagia may then occur with deeply penetrating
endometrial and myometrial lesions.
The diagnosis of genital tuberculosis is usually
made by biopsy, curettage, operation or autopsy.
Available treatment includes the use of tuberculin,
pneumoperitoneum,6 irradiation, streptomycin and
surgery. The first two methods have been given
very little clinical trial. Until recently, surgery
and irradiation used separately or in conjunction
have been considered the best treatment for this
disease. The value of surgery is established. X-
ray therapy is said to stimulate production of
fibroblasts and promote healing. It tends to pre-
vent recurrence and to clear up residual granula-
tion.2,5
The usefulness of streptomycin in pelvic tuber-
culosis awaits evaluation, as very few cases are
being reported. It is of known value in aiding
healing of tuberculous sinuses and fistulas. It may
also be of value in preventing dissemination of
Resident in Urology, Ancker Hospital, Saint Paul, Minnesota.
Cases from the 10th General and 20th Station Army Hospitals,
Philippine Islands.
tuberculosis after operation. The surgical mortal-
ity in toxic tuberculous patients is approximately
twice that in nontoxic patients.7 Streptomycin
may prove useful in preparing a patient with geni-
tal tuberculosis for operation by reducing the tox-
emia. Aronson and Dwight1 have reported an ap-
parent cure of endometrial tuberculosis in a young
woman, using streptomycin alone. They gave 1
gram daily for 129 days.
Case 1. — A twenty-eight-year-old Filipino came to the
clinic because of vaginal bleeding of ten days’ duration
and slight suprapubic pain. Periods had been regular,
lasting seven days monthly. There had been no pregnan-
cies since the death of her three children during the
Japanese occupation. They had died within six months of
each other at the ages of four years, two years, and 5
months of “bronchitis.” Physical examination limited
pathology to the pelvis. The uterus was asymmetrically
enlarged to the size of a ten weeks’ pregnancy and was
firm in consistency. The cervix was eroded and polyps
were present. The urine, a hemogram, a Friedman test,
and a roentgenogram of the chest showed nothing ab-
normal. The polyps were removed, the uterus curetted
and a cervical biopsy taken. The three specimens con-
tained numerous foci of giant cells, caseation necrosis,
epithelioid cells and lymphocytes arranged in tubercle
formations. Tubercle bacilli were identified after staining.
The patient refused admission until pain recurred.
Pain returned in the left flank, and the urine was loaded
with erythrocytes. An intravenous pyelogram located an
acutely kinked and dilated ureter and left hydrone-
phrosis. Bed rest alleviated the pain, and the urine
cleared. Urine cultures and guinea pig inoculations were
negative. Since the curettage there had been three epi-
sodes of scant vaginal bleeding lasting four days. Pelvic
findings were essentially the same, except for the cervicitis
which had become more severe. Observations showed a
daily fever of 101°. Repeated sedimentation rates were
about 45 mm. The hemogram : red blood cells, 4,100,000;
white cells, 0000 ; polymorphonuclear cells, 57 ; lympho-
cytes, 33; eosinophiles, 10; platelets, 170,000. The hemat-
ocrit was 36. Blood urea nitrogen and creatinine were
normal. A roentgenogram of the chest was unchanged.
The stools contained the ova of hookworm and endameba
hystolytica, as did those of nearly every patient in the
hospital. In the light of past experience, the latter were
discounted as contributing much to the patient’s toxicity.
The patient appeared well nourished and in apparent
good health. Search for foci of extragenital tuberculosis
was unsuccessful. The urinary tract was suspected but
culture of twenty-four-hour urine specimens were nega-
tive.
One gram of streptomycin was given daily. After
five weeks the temperature had dropped to normal and
160
Minnesota Medicine
TUBERCULOSIS OF THE UTERUS— MULVANEY
Fig. 1. Case 1. Lesion in the myometrium.
the sedimentation rate leveled at 5 mm. There was a
5-pound weight gain, but the cervicitis and uterine en-
largement remained. At laparotomy, a bilateral salpingo-
oophorectomy and panhysterectomy was done removing a
cuff of thickened vaginal tissue. Several “rice grain”
nodules were noted under the serosa of the cecum. The
remaining abdominal organs appeared uninvolved. The
postoperative course was uneventful and the highest
temperature was 99°. Streptomycin was continued. Ir-
radiation therapy facilities were unavailable. Three
weeks postoperatively the patient left the hospital against
advice of the staff and refused to take streptomycin as
an out-patient. She returned in two months with hema-
turia and left lumbar pain, which again subsided without
definitive treatment. Urine inoculations of guinea pigs
were reported positive for tuberculosis. The patient re-
fused therapy but was seen four months later. There
were no complaints. She looked well and had continued
to gain weight.
Examination of the organs excised showed generalized
tuberculosis. The uterus contained tubercles in the endo-
metrium and serosa. The myometrium was only slightly
involved. Tubercles were present in the muscularis of
the cervix, and the submucosa was infiltrated with
lymphocytes. The blood vessels of the adnexa were
surrounded by tubercles and caseating areas. The tubes
bulged with fibrocaseous and fibrocalcific lesions, and
the epithelium was almost completely destroyed. The
ovaries contained numerous fibrocaseous areas. The
process in the uterus seemed to be more productive than
that in the tubes and ovaries where there was more
necrosis.
Case 2. — A forty-two-year-old American woman in
seemingly good health sought treatment for a severe
aching lower abdominal pain of three months’ duration.
The pain had gradually increased and had become dis-
abling. Five years previously she had bled copiously and
was curetted. She was told she had fibroids and was too
ill for operation. Radium therapy of unknown quantity
was given. Thereafter her menses were scant in amount
and lasted three days. For the past ten months there
had been no bleeding but pain was noted at the time of
expected menses.
Past history revealed only that her last illness had
been childhood measles. There had been no pregnan-
cies. Complete examination including a roentgenogram
of the chest failed to show evidence of disease outside
the pelvis. The uterus was symmetrical and the size of
a three months’ pregnancy. It was resilient but firm.
Tubes and ovaries were not considered notable. The
cervix was fibrotic and the os stenosed by scar tissue.
A probe could not be passed. The diagnosis of cervical
stenosis secondary to radium therapy and hematometra
was made and laparotomy performed. The uterus was
enlarged, and the left tube was fibrosed, firm and par-
tially calcified. The possibility of tuberculosis was sus-
pected and a panhysterectomy and bilateral salpingo-
oophorectomy done. Radiation therapy was given along
with one gram of streptomycin daily. Healing of the
wound was complete, and the patient recovered without
incident. Streptomycin therapy was continued for sixty
days. The pathologist’s diagnosis was tuberculous pyo-
metra and healed tuberculosis of the tubes.
Case 3. — A thirty-six-year-old American woman was
examined in an attempt to determine a cause for her
sterility. There had been no pregnancy in seven years of
marriage. The patient’s past history was not remarkable
except for a “pneumonia” at the age of twenty-three with
hospitalization for three weeks. She had been examined
and given roentgenograms of the chest at yearly inter-
vals since then without evidence of disease. Menarche
was at thirteen. Periods lasted five days and arrived at
regular twenty-nine-day intervels. For the past six years,
however, the menses had become shorter and scantier.
There was slight primary dysmenorrhea. Physical exam-
ination and endocrine survey gave no hint as to the
trouble. Pelvic examination showed nothing of note.
The husband was given a urological survey and was
found not to be at fault. An endometrial biopsy was
taken to determine the presence of ovulation. Tubercu-
lous endometritis was found upon microscopic examina-
tion. No other tuberculous process could be found, nor
February, 1950
161
TUBERCULOSIS OF THE UTERUS— MULVANEY
was the patient toxic. A panhysterectomy was done and
both tubes and ovaries removed. X-ray therapy was
given. Streptomycin was not available. Two years later,
the patient had remained asymptomatic.
The pathologist’s diagnosis was tuberculous endo-
metritis and healed, calcified tuberculous salpingitis.
Comment
Radical operations were done in each case. X-
ray therapy was used as a postoperative adjunct
to treatment when possible. Streptomycin was
used in two cases. In the first patient toxicity was
reduced by streptomycin therapy, enabling the pa-
tient to undergo operation at a reduced risk.
The three patients recovered from their opera-
tions promptly and without complication. Wound
healing was complete and without sinus formation.
Further clinical trial of streptomycin treatment
of genital tuberculosis may be warranted when the
patient is young and a salvage of the reproductive
capacity is indicated. However, since tuberculous
endometritis is seldom unaccompanied by tubercu-
lous salpingitis, it is doubtful if fertility can be
restored.
When tuberculosis is limited to the genital or-
gans by careful clinical investigation, radical sur-
gery offers the patient the best chance for a cure.
It has the advantage of eliminating diseased or-
gans from an otherwise normal body. This princi-
ple has been used with success in other fields of
surgery for tuberculosis. Streptomycin and X-
ray therapy constitute valuable adjuncts to treat-
ment.
Summary
The etiology and diagnosis of uterine tubercu-
losis are briefly mentioned and the available meth-
ods of treatment outlined. Three illustrative cases
are reported which were treated by operation aid-
ed by streptomycin and x-ray when available. No
operative or postoperative complications were en-
countered. Surgical removal of the diseased or-
gans in an otherwise normal patient is the treat-
ment of choice. X-ray and streptomycin therapy
are valuable adjuncts to surgery.
References
1. Aronson, A., and Dwight, R. W. : Streptomycin in the ther-
apy of tuberculosis of the endometrium. New England J.
Med., 240:294, 1949.
2. Campbell, R. E. : The treatment of pelvic tuberculosis in
the female by radiation therapy. With discussion by H. E.
Schmitz. Am. J. Obst. & Gynec., 53 : 405-4 1 8 , 1947.
3. Cohnheim, Julius: Tuberculose vom Standpunkte der Infec-
tionslehr. Leipzig, 1879.
4. Curtis, A. H. : A Textbook of Gynecology. Vol 4, pp. 215-
219. Philadelphia: W. B. Saunders and Co., 1944.
5. Lenz, M., and Corscaden, J. A. : N-ray therapy of tuber-
culosis of female reproductive organs. Am. J. Surg., 33:518,
1936.
6. Stein, I. F. : L’oxyperitoine dans le diagnostic et le traite-
ment des salpingites tuberculeusea. Gvnec. et obst., 33 :230,
1936.
7. Wharton, L. : A Textbook of Gynecology and Female Urol-
ogv. P. 365. Philadelphia : W. B. Saunders and Companv,
1943.
"SOCIALIZED MEDICINE AS I SAW IT"
( Continued from Page 156)
after serving five years with the RAF I had no $12,000,
1 borrowed the purchase price from the bank. The
coming of the National Health Service Act — a vast sys-
tem of government medicine — made this long-established
practice of buying and selling illegal. But it should
be said in fairness that the doctors were not to be
robbed of their practice value. A sum of some .264
million dollars was appropriated as compensation. Pro-
vided, and this is the vital proviso, provided that the
doctor claiming compensation had entered the nation-
alized medical scheme on or before July 5, 1948, he
would be reimbursed. Tt will be clear to you that in
my personal case I stood to lose no less than $12,000 —
not even my own at that — should the scheme come into
operation on the appointed day and my head not
be there to be counted. And that story applies to
almost every doctor in Great Britain. As the govern-
ment claims, the doctors in Britain are 99 44/100 per cent
pure.
As a general practitioner, I had registered with me,
because of course in socialized medicine, we must have
registrations; I had registered with me some 3,200 souls
and this, believe it or not, was not the maximum. I
could have had 4,000 and even more in certain excep-
tional circumstances. I challenge any of you listening
to me to have even a conception of what is entailed
in being responsible for the health of that number of
people.
In America there is one doctor for substantially less
than a thousand persons. I used to do three one-hour
office periods each day. And I could expect twenty
people and more in one of these periods ; that is an aver-
age of three minutes per patient. And I have made as
162
many as thirty-six house calls in one working day in
addition to' my work in the office. You will, I am sure,
appreciate what sort of medicine this is.
It is just what you would have expected. The illu-
sion of “all for free” has taken firm hold and the
national hypochondriasis lias reached truly alarming
proportions. The doctors’ offices are crowded to over-
flowdng and the urgent sick are forced to wait their
turn while the doctor’s time is devoted to the mass of
unnecessary demand on his professional skill. This
impossible strain has meant inevitably that any case re-
quiring more than the barest minimum of attention has
to be got rid of as quickly as possible and this is done
bv referring the unfortunate patient to the nearest hos-
pital, not because of any necessity for hospital facilities,
but because what is needed is that thing which is in the
shortest supply — the doctor’s time.
4’he government’s original estimate for the first year’s
operation was that they would need all the sum realized
by the payroll withholding tax as well as an extra 520
million dollars from the general appropriation. At the
end of the first nine months, however, an extra ap-
propriation of some 230 million dollars was needed to
prime the pump — an elegant commentary on the accuracy
of the political planners. And, of course, this “free
for all” assembly-line medicine requires an ever-in-
creasing, snowballing expenditure. As long as he is in
possession of the right form, there is virtually nothing
that the energetic patient cannot obtain — drugs, den-
tures, toupees, surgical corsets, elastic hose, spectacles,
hearing aids, all to be had for the asking, and how thev
do ask. Before I left England I could regard myself
( Continued on Page 185)
Minnesota Medicine
CLINICAL-PATHOLOGICAL CONFERENCE
DIAGNOSTIC CASE STUDY
ARTHUR H. WELLS. M.D., HAROLD H. JOFFE, M.D. and THOMAS MOE, M.D.
Duluth, Minnesota
Dr. J. E. Egdahl: This fifty-three-year-old white
lumberjack (Case A. 4516) had apparently been in good
health until eight days before his death, when he devel-
oped gradually increasing nausea, vomiting and marked
weakness. After two days of illness he was hospitalized
with disorientation, restlessness, weakness and slight
jaundice. His temperature was normal or subnormal.
His white blood cell count was 7,500 with a normal
distribution of the white blood cells. He was given
penicillin and 10 per cent dextrose in saline. There
was some tenderness over the liver area but no enlarge-
ment of the liver. The jaundice rapidly increased in
severity and his disorientation progressed into a stupor
and after forty-eight hours in the hospital he passed
into coma. His eyes were open most of the time and
there appeared to be a loss of the blinking reflex. There
was frequent yawning and he appeared to be regaining
consciousness much of the time until the last twenty-
four hours. At no time did the physical examination
reveal any additional evidence of an explanation for this
rapid progression of a disease process. His pulse was
good. The highest pulse rate was 1 16 per minute.
There were no cardiac murmurs. The lungs were clear
and the abdomen was relaxed and not distended. He
expired on the sixth hospital day and the eighth day of
apparent illness without regaining consciousness. There
was no response to the antibiotic therapy and only a
terminal rise of his temperature above normal.
The past history revealed that the patient had injured
his forearm in a saw two months preceding the appar-
ent onset of his present illness. The extensive lacera-
tion extended down to the radius and ulna, severing
practically all the tendons on the palmar aspect of the
forearm. The wound was cleaned and closed at
another small hospital. Penicillin, tetanus antiserum,
and a unit of “Red Cross Plasma’’ were given. He
was released from the hospital as improved after ten
days. The wound healed after approximately one month.
There was no return of sensations or ability to flex
the fingers or hand.
Additional history revealed the continuous use of
alcohol in excess over a long period of years.
Dr. A. H. Wells : The case is now open for diag-
noses.
Physicians: Infectious hepatitis, acute catarrhal jaun-
dice, acute homologous serum hepatitis, acute yellow
atrophy of the liver, cancer of the pancreas or biliary
tract.
From the Department of Pathology and Graduate Educational
Service, St. Luke’s Hospital, Duluth, Minnesota.
Dr. A. H. Wells : What were the features which
led you to the proper diagnosis, Dr. Urberg?
Dr. S. E. Urberc. : Sixty days after having received
pooled plasma this man developed a rapidly increasing
jaundice, disorientation and weakness progressing to
coma and death within a very short period of time.
The diagnosis is homologous serum hepatitis until proved
otherwise.
#
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j,
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*** <• : ,
* ./i
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• ,»
"" € ‘ “ < j
, ..
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Fig. 1. Phosphotungstic acrd and hemotoxylin stain revealing
cellular debris and absorption in central zone, extreme liver cell
degenerative changes and inspissated bile in canaliculi.
I
. ry
Necropsy
The postmortem examination of this fifty-three-year-
old well nourished, embalmed, white male was essentially
negative except for the fatal acute hepatitis and asso-
ciated toxic changes in no other organs. The 820
gram liver was uniformly shrunken to approximately
50 per cent its usual size. There was a dirty grayish
green color of outer and cut surfaces with accentua-
tion of the contracted architectural markings.
Histologically two-thirds of the liver cells were rep-
resented by granular cellular debris located primarily
in central zone areas. The remainder of the parenchymal
cells were pale, swollen and had ill-defined nuclei and
cell walls. These possibly viable cells were arranged
in small groups and located in the periphery of liver
lobules (Fig. 1). Bits of inspissated bile was found
February, 1950
163
CLINICAL-PATHOLOGICAL CONFERENCE
in canaliculi and in the cellular debris. There was a
moderately severe patchy neutrophilic infiltration of
irregular distribution.
Toxic changes of mild grade were demonstrated in
the myocardium, spleen and kidneys. There were no
cerebral lesions.
Nomenclature Orientation
There is no general agreement on terminology.24’28,29
It seems likely that the terms acute catarrhal jaundice
and epidemic catarrhal jaundice will disappear from the
medical literature to be replaced by such terms as in-
fectious hepatitis, homologous serum hepatitis or virus
I.H. hepatitis and virus S.H. hepatitis. The term acute
yellow atrophy may also eventually suffer the same
fate of oblivion or be used simply to designate an ex-
tensive necrosis of liver of unknown etiology. Hepa-
titis resulting from chemicals such as cinchophen, car-
bon tetrachloride, chloroform, mushroom toxin, phos-
phorous, arsenic compounds or caused by known bac-
teria should be specifically designated as to cause.
Virus Hepatitis
Since there are no known susceptible lower animals
or satisfactory culture media for the virus involved
in virus hepatitis our knowledge is based upon clinical
observations and experimental work with inoculated hu-
man beings.16 The present consensus is that the dis-
ease can be divided into two types, each of which will
produce a permanent immunity against itself but appar-
ently not against the other. One is a natural occurring
disease in either sporadic or epidemic forms and is
termed “infectious hepatitis.” The other “homologous
serum hepatitis” is propagated by mistakes in which
the contaminated serum or blood of a carrier or diseased
person is introduced into a susceptible individual by the
use of contaminated needles, blood and serum transfu-
sions, vaccines, arsphenamine injections and even by sim-
ple accident with a hypodermic syringe.13
Infectious hepatitis is the fairly common and wide-
spread condition formerly known as acute catarrhal
jaundice. It is a disease primarily spread by fecal con-
tamination of food and drink. Since the virus occurs
normally in the blood stream, transmission by transfusion
is also frequent. Tn the Mediterranean area alone it
caused tens-of-thousands of cases of hepatitis in the
United States Army troups, involving as many as 50
per cent of a single command.7 In spite of the low
mortality of approximately 0.2 per cent it was one of
the principal medical causes of death among our troups
and the greatest cause of disability.
Prior to World War II, homologous serum hepatitis
was little understood by physicians of this country. The
potential danger of any transfusion has been more
recently emphasized. 2’3,9,19’21 The incidence is as high
as 11 in 2,443 transfusions of blood and serum19 or 29
times in 649 patients receiving dried pooled plasma.2
In a general hospital among 936 transfused patients there
were 20 who developed “possible hepatitis” and 12
with “probable hepatitis.”15 The disease is an important
problem in the conduct of a blood bank.15’19 Although
the morbidity of homologous serum hepatitis is approxi-
mately that of infectious hepatitis, its mortality has been
found to vary from 0.2 per cent to as high as 41 per
cent12 in smaller group studies.
One of the principal differences in the two forms of
virus hepatitis is the 18 to 40 days incubation period
for infectious hepatitis and 60 to 120 days for serum
hepatitis.17 Dilution, prolonged freezing and dehydra-
tion apparently do not decrease infectability. Alcoholism,
serious injuries and malnutrition23 accentuate the dis-
eases. Ultraviolet radiation of the serum,1’28 gamma
globulin prophylactic therapy24 and immunization by pre-
vious infection protect against the diseases.25
Pathology
The entire histogenesis of virus hepatitis3’5’10’20’22’29
has been revealed by numerous liver biopsies and post-
mortem studies. There appears to be no essential dif-
ference in the two types. Early and mild changes consist
of monocytic, neutrophilic and eosinophilic infiltration
of periportal areas, swelling and pallor of liver cells
particularly in the central zone. Progression of the
disease results in necrosis of parenchymal cells, first
in the central zone and if severe, large groups of liver
lobules may be destroyed leaving the stroma untouched.
In this stage there may be inspissated bile in the can-
aliculi but not in bile ducts. There is a rapid absorp-
tion of necrotic tissue. Healing generally results in a
complete replacement of liver lobules by regeneration
of the remaining liver cells.14 Several authori-
ties5’10’11’20’26 have observed progression of the proc-
ess into a form of cirrhosis of the liver. The latter
may be similar to or identical with the so-called “toxic
cirrhosis” of Mallory in which there are large areas
of stromal elements representing the skeletons of many
liver lobules and not an accumulation of scar tissue.
Concurrent lesions in other organs have been described
such as, meningoencephalitis, acute regional lymph-
node inflammation, orchitis, acute splenitis, myocarditis
and interstitial pneumonitis.21’29
Clinical Manifestations
The different outbreaks of virus hepatitis reveal a
close clinical interrelationship of the diseases of the
two or more icterogenic agents. A history of other
cases of the disease in the family or neighborhood or
recent hypodermic injections may be useful. Following
the variably long incubation periods there is described58
a prodromal or preicteric stage with tender liver en-
largement, hyperbilirubinemia, bilirubinuria and leuko-
penia. The acute stage is frequently precipitus in the
onset of its characteristic signs and symptoms. In one
large series8 the frequency of observation of signs and
symptoms were as follows, malaise 100 per cent, nausea
and vomiting 100 per cent, anorexia 100 per cent, dark
urine 100 per cent, abdominal discomfort 95 per cent,
jaundice 78 per cent, light stools 71 per cent, fever 64
per cent, palpable liver 57 per cent, constipation 57 per
cent, generalized aches and pains 35 per cent, pruritus
7 per cent, rash 7 per cent and diarrhea 7 per cent. Lass-
itude, chilly sensations, bloating, arthralgia, and myalgia
are nearly always present. The clinical picture frequently
does not reflect the severity of liver damage in the acute
164
Minnesota Medicine
CLINICAL-PATHOLOGICAL CONFERENCE
phase. The temperature is generally elevated in infectious
hepatitis but is frequently normal in homologous serum
disease. After continuous persistence or apparent recur-
rence for from four to six months the disease is
generally considered chronic. Ease of fatigue, mental
depression and aching, soreness, fullness, heaviness or
pain over the liver are the usual chronic manifesta-
tions. Rarely the development of cirrohisis and its clin-
ical signs are described as sequelae.
Laboratory studies may reveal a normal total white
blood cell count with a mild lymphocytosis. The icterus
index is generally elevated at some time during the
disease, however isolated total serum bilirubin tests
revealed high levels in only 83.8 per cent of 93 cases.12
The cephalin flocculation, cholesterol esters, galactose tol-
. erance and the bromsulphalein excretion (with normal
serum bilirubin) have all been found to be of aid in
identifying diffuse liver cell injury and were helpful in
following the progress of the disease. 3>12>18'21 Punch
biopsy of the liver is by far the most accurate diagnostic
aid.
The diseases to consider in a differential study are :
the causes of mechanical obstruction of the common
duct, virus pneumonia, infectious mononucleosis, acute
brucellosis, amebiasis, malaria and the chemical hepato-
toxins mentioned above.
Treatment
To date no antibiotic has been reported as specific
for virus hepatitis. Gamma globulin has been found
protective if used prophylactically.24 Adequate rest has
been stressed by all authorities.10 One interpretation of
this is complete bed- rest until the serum bilirubin falls
to 1.0 mgs. per 100 c.c. or until jaundice has cleared.12
Graduated activities may be permitted with disappear-
ance of liver tenderness and a return of liver function
tests to normal. With a recurrence of these signs com-
plete bed rest must be reinstituted because of the possi-
bilities of serious injury to the liver.
A nutritious diet with high carbohydrate and protein
and a low fat content is advised.8 Methiomine and
vitamins are advised. Liver toxins including alcohol
are contraindicated.
Summary
A fifty-three-year-old chronic alcoholic developed
homologous serum hepatitis and expired sixty-eight days
after receiving pooled plasma. The necropsy findings
and an incomplete literature review of virus hepatitis are
given.
References
1. Blanchard, M. C., Stokes, J., Jr., Hampil, B. L.; Wade, G.
R. and Spizen, J. : Methods of protection against homol-
ogous serum hepatitis. J.A.M.A., 138:341-343, (Oct. 2)
1948.
2. Brightman, J. and Korns, R. F. : Homologous serum
jaundice in recipients of pooled plasma. J.A.M.A., 135:268-
272, (Oct. 4) 1947.
3. Butt, H. R. and Baggenstoss, A. H. : Problems encountered
in the diagnosis of serum and infectious hepatitis. Surg.
Clin. North America, Mayo Clinic Number, 27:926-944 (Aug.)
1947.
4. Capps, R. B., Sborov, V. M. and Baker, M. H. : The
diagnosis of infectious hepatitis. J.A.M.A., 134:595-597,
(Oct. 4) 1947.
5. Dible, J. H., McMichael, T., Jr., and Sherlock, S. I’. V. :
Pathology of acute hepatitis, aspiration, biopsy studies of
epidemic, arsenotherapy and serum jaundice. Lancet, 2 :402,
1943.
6. Findlay, G. M. Martin, N. H. and Mitchell, J. B.: Hepa-
titis after vellow fever inoculations relation to infective
hepatitis. The Lancet, 11:301-307, (Sept. 2) 1944; The
Lancet, II, XI :340-344, (Sept. 9) 1944; The Lancet, XTT
of 11:365-370, (Sept. 16) 1944.
7. Gauld, R. L. : Epidemiological field studies of infectious
hepatitis in Mediterranean theater of operations. Am. T.
Hvg.. 43:248-313, (May) 1946.
8. Ginsberg, H. S. : Homologous serum, hepatitis following
transfusion. Arch. Int. Med.. 79:555-569, (May) 1947.
9. Grossman. C. M. and Saward, E. W. : Homologous serum
jaundice following the administration of commercial pooled
plasma. New England J. Med.. 234:181-183, (Feb. 7) 1946.
10. Hoffbauer, F. W. : A correlation of the composite liver
function studies with histologic changes in the liver as
noted in hiopsv material. T. Lab. & Clin. Med.. 30:381, 1945.
11. Iversen. P. M. and Roholm, K. : On aspiration biopsy of
liver, with remarks on its diagnostic significance. Acta med.
Scandinav., 102. 1. 1939.
12. Koszalka. M. F., Lindert. M. C. F., Snodgrass. H. M. and
Lerver, H. B. : Hepatitis and its sequelae, including the
development of portal cirrhosis. Arch. Int. Med., 84:782-
797. (Nov.) 1949.
13. Leiborvitz, S.._ Greenwald, I., Cohen. I.. and Litwins, J. :
Serum hepatitis in a blood bank worker. T.A.M.A., 140:
1331-1333, (Aug. 27) 1949.
14. Lucke, B. : The structure of the liver after recoverv from
epidemic hepatitis. Am. J. Path., 20:595-620 (Mav) 1944.
15. McGraw, Jr., J. J.. Strumia, M. M. and Burns, E. : The
incidence of po=ttransfusion serum hepatitis. Am. J. Clin.
Path., 19:1004-1015, (Nov.) 1949.
16. Neefe, J. R. : Recent advances in the knowledge of “virus
hepatitis.” M. Clin. North America, 30:1407-1443, (Nov.)
1946.
17. Paul. J. R. : Havens. W. P.. Jr., Sabin, A. B., and Phil-
lip. C. B. : Transmission experiments in serum jaundice and
infectious hepatitis. J.A.M.A.. 128:911-915. (July 28) 1945.
18. Rappaport, Capt. E. M. : Hepatitis following blood or
plasma transfusions. J.A.M.A., 128:932-939, (Julv 281 1945.
19. Scheinberg, H.. Kinnev, T. D. and Taneway. C. A. :
Homologous serum jaundice. T.A.M.A., 134:841-848, (Julv
5) 1947.
20. Sheldon, W. H. and James, D. F. : Cirrhosis following in-
fectious hepatitis. Arch. Int. Med., 81 :666-689, (May) 1948.
21. Sidbury J. B. and Hall. R. S. : Homologous Serum Hep-
atitis. J. Pediat., 32:420-422, (April) 1948.
22. Smith, M. H. and Hall, T. W. : Infectious hepatitis in-
advertently transmitted with therapeutic malaria. T. Lab.
& Clin. Med., 33:998-101. (Aug.) 1948.
23. Snell, A. M., Wood, D. A. and Meienberg, L. J. : Infec-
tious hepatitis with special reference to its occurrence in
wounded men. Gastroenterol. 5:241-258, (Oct.) 1945.
24. Stokes, J., Jr., Blanchard, M., Gellis S. S. and Wade, G.
R. : Methods of protection against homologous serum hep-
atitis. J.A.M.A., 138:336-342, (Oct. 2) 1948.
25. Stokes, J., Jr., and Neefe, J. R. : Homologous serum
hepatitis and infectious (epidemic) hepatitis. Am. J. M.
Sei., 210:561-576, (Nov.) 1945.
26. Watson, C. J. and Hoffbauer, F. W. : Problem of prolonged
hepatitis with particular reference to colangiolitis type and
to development of colangiolitis cirrhosis of liver. Ann.
Int. Med., 25:195 (Aug.) 1946.
27. Wirts, W. C. and, Bradford, B. K. : The biliary excretion
of bronsulfalein as a test of liver function in a group of
patients following hepatitis or serum jaundice. T. Clin.
Investig., 27:600-608, (Sept.) 1948.
28. Wolf, A. M., Mason. J., Fitzpatrick, W. J., Schwartz, S. O.
and Levinson, S. O. : Ultraviolet irradiation of human
plasma to control homologous serum jaundice. J.A.M.A.,
135 :476-477, (Oct. 25) 1947.
29. Wood, D. A.: Pathologic aspects of acute epidemic hep-
atitis with especial reference to early stages. Arch. Pathol.,
41 : 3 4 5 - 3 7 5 , (April) 1946.
The early diagnosis of tubercle remains one of the
major problems of general practice. The standard of
what constitutes early diagnosis has been considerably
altered. In the days before the general use of chest radi-
ography one had to depend upon the finding of abnormal
physical signs in the chest or on the presence of the
bacilli in the sputum — a stage nowadays considered too
February, 1950
late. In theory, of course, early diagnosis is quite easy.
The chest is x-rayed and the problem is solved. But in
actual practice things can work out very differently.
The early signs are so slight, so varied, so indeter-
minate, that unless a doctor is tubercle-conscious an
x-ray may not be called for and precious time is wasted.
— R. I. Perring, M.D., Lancet, December, 1949.
165
History of Medicine In Minnesota
MEDICINE AND ITS PRACTITIONERS IN OLMSTED COUNTY PRIOR TO 1900
NORA H. GUTHREY
Rochester, Minnesota
(Continued from the January issue)
It is remembered by some of the early junior physicians, who long have been
senior members of the permanent staff, that they came, as they recall their view-
point, “to work with the Drs. Mayo” ; they did not think of the firm and its
facilities as a clinic. It has been noted in newspapers of that period that when a
new worker, physician or not, joined the group, he “entered, the employ of the
Drs. Mayo.” As late as 1912, when a reception was given for Sir Bertrand
Dawson, of England, it was held at the “Mayo Library.”
It was in 1912, when the staff included a growing group of junior physicians
and surgeons, that it seemed proper to choose a suitable and dignified title for them,
and Dr. E. H. Beckman, it was said, suggested “fellows.” “Fellows of Mayo,
Graham, Plummer and Judd” was unthinkable, “Fellows of St. Mary’s Hospital
Mayo Clinic,” was unwieldy, and a second suggestion, “Fellows of the Mayo
Clinic,” was adopted. This decision, it is believed, inaugurated the use of the
name “Mayo Clinic” by the group concerned, although, informally and among
themselves, the staff earlier had begun to speak of “the clinic.”
In 1912, also, when the offices had become congested and to some extent de-
centralized, it was decided that an adequate new building, designed for clinical
work, must be erected, and on October 12, 1912, the cornerstone was laid. As
the Democrat announced, it was the intention of the firm of Drs. Mayo, Graham,
Plummer and Judd (Dr. Stinchfield retired from active practice in 1906) to
build a large structure, to cost $100,000, for their clinical and diagnostic offices.
The building was constructed on the site of Dr. W. W. Mayo’s first Rochester
home, which had been built in 1863. Although the Mayos and their associates, their
offices and their work long had constituted a clinic, it was not until the new
building was opened on March 6, 1914, housing unde'r one roof all clinical facilities,
including extensive laboratories, that the Mayo Clinic emerged into public recogni-
tion as such. In 1914, for the first time, the firm used “Mayo Clinic” on their
letterheads, above “Drs. Mayo, Graham, Plummer and Judd,” and then only
after hesitation on the part of the Drs. Mayo, lest the title should seem ostenta-
tious.
On October 8, 1919, when Dr. W. J. Mayo and Dr. C. H. Mayo founded the
Mayo Properties Association (beginning in 1947, Mayo Association), they said,
in reviewing the history of the clinic and its name. “. . . . the donors and their
associates have adopted, as their copartnership name, the name which has thus
been bestowed upon them.” A few years later the copartnership for medical
practice became a co-operative association for medical practice.
Even as the private practice was becoming a private group practice, better
care of the sick and better education of physicians, in science and the humanities,
166
Minnesota Medicine
HISTORY OF MEDICINE IN MINNESOTA
became to Dr. William J. Mayo and his brother a motivating purpose. The achieve-
ment of the Drs. Mayo and their associates in care of the sick and in medical edu-
cation has been and is a work of continuing growth and evolution.
Conditions of Practice at the Close of the Century
The advances in the art and science of medicine and surgery that were made
in the last twenty years of the nineteenth century have been reviewed often by
able historians. In Olmsted County, in that period, remarkable progress was
made by private practitioners in the acquisition and application of the new knowl-
edge. The county program of public .health and public welfare was improved
continuously and was carried out in co-operation with the Minnesota State Board
of Health and Vital Statistics, of which at various times some representative
physician of the county was a member. The physicians of Olmsted County main-
tained fraternal accord with one another and with their confreres elsewhere. By
the close of the century annoyance by unethical and irregular practitioners of
medicine had become minimal. The Olmsted County Medical Society, which long
had been functioning actively, was in excellent standing as part of the Minnesota
State Medical Society, and it had creditable representation in the American
Medical Association.
Biographical Sketches*
It is evident that in the evolution of medical practice in Olmsted County the
influences that combat prejudice and make for liberalism and progress steadily
gained in strength. Most members of the regular profession* remained faithful
to the tenets of their school. Many homeopaths ultimately embraced the regular
school, as did many eclectic practitioners. All had their part in bringing about
improvement. There were practitioners, of all types, who changed occupation for
reason of loss of health or of greater interest or profit in other occupations.
Others, because of lack of means or inclination to meet improving professional
standards, as stringency of medical legislation increased, dropped out of the pro-
fession.
There follows what may seem to be an undue amount of biographical material.
It is given, especially about some of the earliest physicians and about some who were
longest resident in the county, because, as an outstanding historian has said, the
personal element in biography makes for appreciation of truth. Notes are given
here on all physicians of established schools in the county about whom informa-
tion has been obtainable. Considerable detail is used, for such value as the record
may have in the history of medicine in the state, regarding practitioners who,
although they were in Olmsted County only a short time, at some period practiced
elsewhere in Minnesota. Sketches appear of a few practitioners of the county who
were not recognized physicans, for example, magnetic healers, cancer doctors,
herb doctors, and so forth ; in these, care has been taken to state plainly the avowed
methods of practice. These practitioners are included with representatives of es-
tablished schools because they were a well-known part of the medical scene and
contributed to medical history of the county.
Arthur Strong Adams, a graduate physician and surgeon aged thirty-
five years, arrived in Rochester, Minnesota, from Cleveland, Ohio, on March
18, 1885, accompanied by his wife, Emma J. Ford Adams, to whom he had
been married in Cleveland two days previously.
■“"Although this article deals essentially with the years before 1900, the biographical sketches, whenever
possible, cover the lifetimes of the subjects. When inquiry has been infeasible, or when it has not met
with response, a resume of data, believed to be authentic, has been used.
Grateful acknowledgment is made here to the innumerable persons — relatives, friends and patients of the
early physicians; editors, writers, librarians, physicians, county officers and other workers — who have given
generous help, and to many others who have expressed encouraging interest in the compilation of !the record.
February, 1950
167
HISTORY OF MEDICINE IN MINNESOTA
A son of William H. Adams and Octa B. Strong Adams, pioneer settlers of
Ohio, Arthur Strong Adams was born in Sheffield, Lorain County, Ohio, on
February 10, 1850. A few years later the family moved to Delaware County,
Ohio, where Arthur Adams received his academic education in the public
schools and at Ohio Wesleyan University. He next read medicine with an
established practitioner, and in 1876 (sometimes given 1875) was graduated
with the degree of doctor of medicine from the medical department of
Wooster University. f He entered practice in Cleveland, and during two of
the ensuing nine years was assistant physician on the city board of health.
Dr. Adams came to Olmsted County with two declared purposes : to re-
gain his health and to specialize in major surgery. He early recovered his
health. In the thirty-four years of his residence in Rochester his professional
work, however, was mainly general practice, with emphasis on nervous and
mental diseases and for a time on public health work.
On June 30, 1885, Dr. Adams received Minnesota state medical license
No. 1074 (R). His first professional card, in 1885, stated he specialized in
mechanical surgery and that he was an expert in the use of electricity. The
press added that Dr. Adams already was treating several chronic cases of
catarrh with electricity and that if he could cure catarrh by that treatment
he had struck a bonanza. Dr. Adams’ acquaintances have said that he “was
always dabbling with electricity, electrodes, therapeutic appliances.” He
gave galvanic treatment for prostatic disease; to the class in physics of the
high school, in 1893, he demonstrated the operation of electric motors and
of the Brush electric light, the kind then in use in the city. He is re-
membered as an inventor of many mechanical devices, among which were a
vacuum pump, and a cane that doubled as a medicine case. The cane sepa-
rated into two main parts, the outer portion serving as the sheath of the
inner section, which was fitted throughout its length with a tin trough in
which rested medicine bottles; they rested none too securely, for occasion-
ally when the cane was pulled apart, they all fell out.
During his years in Rochester, Dr. Adams occupied several different of-
fices, first over Hargesheimer’s Drug store, and from 1894 to 1903, ground
floor rooms in the Brackenridge Building, in order to save his numerous
rheumatic patients the inconvenience of climbing stairs. For the next three
years he occupied a small detached frame building of considerable historical
interest, it having been the original home, in 1864, of the First National Bank
of Rochester. In Dr. Adams’ time this building, which had a high false
front and a front porch with supporting pillars of the southern colonial type,
stood well back from the sidewalk on Zumbro Street, on part of the site of
the present Martin Hotel. After 1906 the doctor had space upstairs in the
Ramsey Building.
When Dr. Adams first came to Rochester, it is said, he began to practice
without first observing the convention of introducing himself to physicians
already established, an oversight that brought him the criticism of older
practitioners. If at first careless of professional amenities, he was punctilious
otherwise. He was a Mason, a Republican, an ardent prohibitionist. He
became a supporter of the Young Men’s Christian Association, a member of
the Minnesota State Historical Society, and of the local Six O’Clock Club.
tin 1881 the majority of the medical faculty of Wooster University joined with the faculty of the Cleve-
land Medical College, which since 1843 had been the medical department of Western Reserve University.
Within a year the name of the school was made “The Medical Department of Adelbert College of Western
Reserve University.” In 1822 the board of trustees of Western Reserve University conferred the ad eundem
degree of doctor of medicine upon all graduates of the Cleveland Medical College and upon such gradu-
ates of the Wooster Medical Department prior to 1881 as desired it.
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HISTORY OF MEDICINE IN MINNESOTA
He was a prominent member of the Methodist Church, its Sunday School,
Christian Endeavor and Sunnyside Club, attended church conferences, and
occasionally occupied the pulpit in Rochester and in villages of the county.
As he became known in the district, his country practice grew heavy, espe-
cially in Kalmar Township, and in June, 1891, news items from Byron stated
that Dr. Adams had fitted up an office in the J. B. Kendall house and would
be found there Monday of each week. Tall, stout, heavy-jowled and florid, his
brown hair parted low on the left, his mustache long and twirled at the
ends, he became a familiar figure, and though he was quick-tempered and
emotional, he was in general a kindly, friendly man who was well liked. In
the early years he drove a horse to a light gig. When automobiles came, he
had a Carter, a machine that was unpredictable under stress, the doctor’s
acquaintances have said, as its owner ; when a car or a horse could not or
would not go, Dr. Adams might resort to oaths and blows, but he was quite
as likely to kneel and pray.
By the early nineties Dr. Adams had begun to figure in medical organiza-
tions and was attending meetings of neighboring county societies in company
with Rochester physicians, among them Dr. A. F. Kilbourne and Dr. W. J.
Mayo. He had by then become a member of the Olmsted County Medical
Society, of which he was president in 1892. His name was on-the roster of
the Minnesota State Medical Society and of the American Medical Associa-
tion. In July, 1892, he was a charter member of the Southern Minnesota
Medical Association, its vice president in 1893-1894, its president in 1901-
1902. Records show that he presented numerous papers before local medical
groups on many subjects, including rheumatism, cirrhosis, concussion of
the brain, influence of the nervous system on disease, diagnosis of spinal
diseases, and on the therapeutic uses of electricity.
He was preceptor to at least one medical student, a young man of merit,
Patrick H. Manion, member of a well-known family of Eyota, who read with
Dr. Adams from March to September, 1887. At the end of that time Mr.
Manion entered Rush Medical College, from which he was graduated in
1890.
Dr. Adams was county coroner for two years from the autumn of 1894,
and was intermittently county physician for the district comprising the city
of Rochester and the townships of Marion, Rochester, Cascade and Haver-
hill.
In 1897 Dr. Adams was appointed city health officer of Rochester, a capacity
in which he served for nearly fifteen years, with the exception of a period
between 1906 and 1909, when Dr. J. E. Crewe held the office. Rochester
grew rapidly after the turn of the century, there were many transients among
its population, and the schools were large and were expanding. In 1911
and 1912 there came obstinate and recurrent epidemics of scarlet fever which
alarmed laity and physicians alike and officials of the railroads over which
many persons constantly were arriving in and departing from the city. Dr.
Adams, as health officer, was working under a city council which in March,
1912, rejected the offer of the Minnesota State Board of Health to aid the
city in securing an expert special health officer to supervise medical inspec-
tion of school children and to devote his entire time to public service in city
and community ; the salary was to be $3,000, one-third paid by the state board
and two-thirds by the city. Rochester was honored as one of the first
cities in southern Minnesota to receive the offer of special help. When the
city council refused this opportunity, the representative citizens of Rochester
February, 1950
169
HISTORY OF MEDICINE IN MINNESOTA
were indignant. At this point the council reappointed Dr. Adams to succeed
himself as health officer. He was typical of health officers of that period
in countless communities throughout the state and country, and in the scarlet
fever epidemic of 1912 he was confronted with an emergency with which he
obviously was not fitted to cope. Matters came to a head on May 1 of that
year when a large group of citizens, businessmen and physicians, presented
themselves before a meeting of the council, rebuked the council and certain
aldermen, demanded Dr. Adams’ resignation, and proposed to seek at once
the aid of the state board of health. Dr. Adams resigned, protesting only
that his efforts had been hampered by interference. At the close of the hectic
session, which took place between the hours of eight and twelve at night, a
delegation proceeded by automobile to Mayowood, where they offered the
vacant post of health officer to Dr. C. H. Mayo. Dr. Mayo accepted, and there-
after for many years he directed the public health work of Rochester.
After Dr. Adams retired as health officer, he returned to general practice.
His chief intellectual hobby had always been the study of physical science.
Increasingly from the early nineties he had become interested in psychic
phenomena and also in the question of immortality, subjects on which he
lectured before local groups and about which he began to write a book.
Early in 1919, on inheriting a considerable fortune, it has been said, Dr. and
Mrs. Adams returned to Ohio and thereafter made their home at Lakewood,
on Lake Erie, near Cleveland. Dr. Adams’ name was listed in each issue
of the Directory of the American Medical Association from 1919 through 1934,
after which it did not appear.
L. H. Aiken, who was born at Norfolk, Connecticut, about 1825, practiced
medicine in Connecticut, and at Vineland, New Jersey, where he combined
practice with operating a drug store. In the autumn of 1866 he came to
Minnesota because of reduced health. After a short time in Saint Paul he
came to Rochester, where with the exception of short intervals he spent the
next twelve years. Throughout his residence he was a good and conserva-
tive citizen, a prohibitionist, a member of the Congregational Church, a
worker for the improvement of the city schools; in 1872 he was a member of
the school examining committee.
There is little evidence that Dr. Aiken practiced medicine actively in Olm-
sted County. It appears rather that he was a man of some means who chiefly
conducted a loan and mortgage office; he had a brother who was at that time
the president of the First National Bank of Chicago. At various times
between 1867 and 1880 the doctor was associated in business with John
Edgar, a citizen of Rochester, who for many years gave animation to the
civic scene. For a time in 1867 and 1868 Dr. Aiken and his wife, a native
of Hartford, Connecticut, left Rochester for Rockford, Illinois, where the doc-
tor was engaged both as a real estate dealer and a druggist. Mrs. Aiken died
in Rockford, and in 1869 Dr. Aiken returned to Rochester.
On July 5, 1871, after a sedate courtship which is recalled by Rochester
residents who then were school children, Dr. Aiken was married in Rochester
to Miss Isabella Cutler, of Lexington, Massachusetts. Mrs. Aiken was a
woman of charm and ability, who had been a member of the high school
faculty since 1868 and, for a time, high school principal, the first woman to
hold the position in Rochester The Aiken home was “on Third Street, south
of the Court House,” the red brick house to be occupied forty years later by
Dr. Georgine M. Luden. In the next few years Dr. and Mrs. Aiken spent the
winters in southern travel for the doctor’s health. In Nassau, in March, 1880,
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HISTORY OF MEDICINE IN MINNESOTA
Isabella Cutler Aiken was stricken with yellow fever and died within a few
days. Dr. Aiken, then rapidly failing, returned to Rochester to dispose of
his property in preparation for spending his declining days in his native place.
He died in Norfolk, Connecticut, on October 31, 1880. An obituary contained
the following comment: “Trained from his early youth under one of New
England’s truly great men, he died as he had lived, in the faith of his fathers.”
Joseph Alexander (1826-1896) was from 1854 a useful citizen in Rochester,
Minnesota, successively carpenter, furniture manufacturer and proprietor of
a woolen mill. At all times he was an evangelist wrho believed in free thought
and free speech, and, wherein this chronicle is concerned, an herb doctor.
His factory, mill, and later a feed mill occupied sites on Bear Creek in south-
eastern Rochester. The family home near by was not far from the spot where
some years later Dr. W. W. Mayo had his farm home. In earliest years the
neighborhood was a lonely one where inquisitive Indians and prowling black
bears were the most frequent callers.
Born in the Parish of Ramsbury, County of Wilts, England, Joseph Alex-
ander came to America in 1844 accompanied by his bride, who had been
Hannah White, daughter of a feed and coal dealer of the same parish. After
a brief stay in Albany, New York, Mr. and Mrs. Alexander traveled to White-
water, Wisconsin, where they lived nine years before settling in Minnesota.
On a first trip of investigation into Minnesota Territory, Mr. Alexander
caught a ride from La Crosse with a man and his son who were driving to
Oronoco. In the late afternoon of October 12, 1854, the party crossed the
Olmsted County line and stopped for the night at a camping ground by a
stream. “At the spring I found several of the campers sick and as I had
some medicine with me and also understood what herbs to administer to
the sick, this was my first practice in Minnesota.”
This practitioner at no time claimed to be a member of the regular medical
profession, although he long had an extensive practice and sometimes used
the title “doctor.” His home was his office and there he had a medicine
closet about 6x8 feet, lined with shelves on which were stacks of little white
boxes that contained his herbs, powders and pills. After his death his daugh-
ter, Mary, carried on the practice, combining it with practical nursing and
midwifery. One of his early circulars is quoted here, in simplified form, be-
cause it indicates the undertakings of a representative herb doctor in the
second half of the last century, an honest man who played a part in the healing
of the sick:
Nature’s Remedies. Purely Vegetable! Dr. J. Alexander’s Herbal Remedies. Will purify
the blood from all impurities. Use Dr. J. Alexander’s Vegetable Medicines for healing
diseases, both chronic, acute and constitutional, such as : Blood poison, scrofula, salt rheum,
neuralgia, la grippe, constipation, liver disorders, rheumatism, malaria, eczema and itch,
worms, tape worm, and consumption. Heart disease, dyspepsia, indigestion, Bright’s disease
and other kidney troubles, all lung diseases, sick headaches, croup, erysipelas, diphtheria,
piles and catarrh.
My Bitter Sweet Ointment for all aches and pains, rheumatism, pneumonia, cuts, bums,
sprains and fever sores. Try it and find out what it will do.
Mrs. J. Alexander will prepare, and put up for sale, medicines for the diseased conditions
peculiar to women. Will keep, also, Dr. O. P. Brown’s Tissue Builder for ladies, for the
skin and complexion.
My medicines are extracted by the cold process, so that they lose none of their virtues by
heat.
Please preserve this circular and I will call for it.
February, 1950
171
HISTORY OF MEDICINE IN MINNESOTA
In 1946 there were living more than a hundred descendants of Joseph and
Hannah Alexander, many of them in Olmsted County.
Joseph S. Allen (initials sometimes misprinted J. A., J. H., or J. L.), a
member of the regular profession, physician and surgeon, came to Rochester,
Minnesota, in March, 1865, from Crawfordsville, Montgomery County, Indi-
ana, accompanied by his wife, who was in frail health, and their four chil-
dren, two sons and two daughters. Dr. Allen announced that he had pur-
chased the property known as Head’s Block on the corner of Main and
College Streets, and that in one of the stores of the building he expected to
establish a drug store. Mrs. Allen died in Rochester on December 26, 1868,
after a protracted illness from pulmonary tuberculosis.
Although Dr. Allen’s personal story is here incomplete and the family his-
tory has not been learned, significant information has been gleaned. Dr.
Joseph Allen, of Crawfordsville, Indiana, was present on June 6, 1849, at the
historic medical convention held at Indianapolis and became a charter member
of the Indiana Medical Society organized on that date. Dr. Joseph S. Allen,
of Crawfordsville, served during the Civil War as surgeon of the Tenth
Indiana Volunteer Regiment of Infantry.
In Rochester, Dr. Allen was active in organizing the early Olmsted County
Medical Society, the initial meeting of which was held in his office on April
15, 1868. He served as president pro tern, submitted an acceptable constitu-
tion for the society, was elected the first president, was appointed head of
the committee on obstetrics, and was one of a committee of six to draw up
the first fee bill.
At the annual meeting of the Minnesota State Medical Society in Saint
Paul on February 1, 1870, Dr. Allen became a member, and although he
moved from the state two years later, his name remained on the roster
through 1876. In 1871, having recently visited the Pacific Coast, he dis-
cussed before the society the climate of California in relation to phthisis.
From the memoirs of the late Dr. David Sturges Fairchild, of Iowa, who
from May, 1869, to July, 1872, was a young practitioner of medicine in the
village of High Forest, Olmsted County, comes an anecdote that gives the
only reference noted to Dr. J. S. Allen’s age and cites an incident in his prac-
tice. During the winter of 1870 Dr. Fairchild was called on a case of puer-
peral convulsions, the first of the sort he had seen. At the end of some
thirty-six hours he confessed himself discouraged, and Dr. Allen was called
in consultation. “To my great comfort the weather became so bad that
Dr. Allen would not venture to return home. It was midwinter and
the roads nearly impassable. Taking the roads together with the storm
and Dr. Allen’s advanced age, there seemed no choice for the doctor but to
remain all night.” In discussing treatment Dr. Allen decided against giving
the patient morphine because it was too dangerous and “would be only piling
congestion on congestion.” When both physicians had given the patient up,
however, he agreed that under the circumstances the drug could do no harm,
and Dr. Fairchild administered about one fourth grain of morphine, measured
out on the point of a knife blade. The patient recovered.
Although from 1865 to 1872 Dr. Allen maintained his home in Rochester,, he
was away months at a time, in Indiana or in the West, because of impaired
health. In April, 1872, convalescent after a stroke of paralysis, he disposed of
his effects in Rochester and with his son, Joseph F. Allen, and his two daugh-
ters, one of whom was an invalid, moved to Washington, in the region of
Puget Sound.
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HISTORY OF MEDICINE IN MINNESOTA
The son, Joseph F. Allen, who long was a resident of Yakima, was married
at Oakland, California, in 1878, to Mary J. Furlow, daughter of John and
Elizabeth Young Furlow, pioneer settlers of Olmsted County, and sister of
Samuel C. Furlow, who for many decades was a resident of Rochester,
prominent in business and in civic and educational enterprises. John Beard
Allen, second son of Dr. Allen, was married to Celia Bateman of Rochester.
For two and one-half years he studied law in the office of the Flon. Charles
C. Willson of Rochester, and after being admitted to the bar, he also moved
to the Northwest. John B. Allen became United States Senator from Wash-
ington ; he died in 1903.
Wilson Adolphus Allen was born on March 6, 1834, in Pendleton, Madi-
son County, Indiana, and died in Rochester, Olmsted County, Minnesota, on
May 11, 1934. Fie had been engaged in the practice of medicine sev-
enty-four years, for seventy-two of which he had been a homeopathic phy-
sician. He spent sixty-nine years in Minnesota, sixty-two of them in Olm-
sted County. At his death he long had been the oldest practicing physician
in the state.
Wilson A. Allen was one of eight children born to William Allen, a native
of North Carolina, and Sara Prather Allen, a native of West Virginia. The
progenitors of this branch of the Allen family, Leonard stated, were three
brothers of English extraction who came from Switzerland and settled in
New England and the Carolinas in an early period of American history.
Joseph Allen, a farmer, father of William Allen, immigrated to Wayne
County, Indiana, in 1809. William, also a farmer, removed to Madison
County, where he made his home; he died in 1875, at the age of seventy-
seven years, while on a visit to his son in Rochester, Minnesota. In 1910
there were living of the family, besides Dr. W. A. Allen, two daughters,
Mrs. H. A. Mann, of Wells County, and Mrs. C. W. Wyany, of Hendricks
County, Indiana, and Dr. Benjamin Frank Allen, of Glencoe, Minnesota.
Relationship between Dr. Wilson A. Allen and Dr. Joseph S. Allen, subject
of a preceding sketch, has not been established, but it is interesting that the Chris-
tian name, Joseph, was common to both families and that both groups were early
in Indiana.
Wilson A. Allen received his early education in the district schools and
the seminary at Pendleton. Although for a short time he studied for the
ministry, record shows that after his graduation from Franklyn College,
Johnson County, Indiana, he returned to Pendleton Seminary for one year
as instructor in mathematics and that thereafter for four years in Pendleton
he conducted a drug store and during that time studied pharmacy. From
childhood he had wanted to be a doctor, and in 1860 he began the study and
practice of medicine under Dr. T. G. Mitchell (1827-1903), of Pendelton, a
physician of the old school, with whom he remained five years.
On October 25, 1855, Wilson A. Allen was married to Flora S. Huston, a
daughter of John Huston and Anna Fluston of Portsmouth, Ohio ; John Hus-
ton, a native of New York, was a builder of boats that plied the Ohio River
and tributary streams. In 1856 Dr. and Mrs. Allen came to the vicinity
of Cedar Rapids, Iowa, where they lived on a homestead for three years;
in 1859 they returned to Indiafta, and in 1865, because of the doctor’s ill
health, they came to Plainview, Wabasha County, Minnesota, accompanied
by members of the Huston family. Mr. and Mrs. Huston spent their old
age in Rochester, where they died in their eighties in June, 1890, and May,
F f.rruary, 1956' ' :
HISTORY OF MEDICINE IN MINNESOTA
1891, respectively; they were survived by two daughters, Mrs. Allen and
Mrs. W. L. Hardy, of Plainview.
Dr. Allen came from Plainview to Rochester in September, 1872, taking
over the practice that he had purchased in the preceding June from Dr. Ed-
mund Beckwith, a homeopathic physician who was removing to Muncie,
Indiana. In May, 1877, Dr. Allen entered partnership with Dr. Frederick
R. Mosse, a young recent graduate of the Homeopathic Medical College of
Chicago, who had come to Rochester a few weeks earlier They had a suite
of offices in the Leland Building, which for decades was Dr. Allen’s head-
quarters. The partnership was dissolved in the summer of 1879. Early in
1879 Dr. Allen recognized the desirability of a degree in medicine, and in
March of that year was graduated from the Hahnemann Medical College
and Hospital of Chicago.
For the next thirteen years Dr. Allen practiced alone, extending his already
county-wide practice. Often in a surgical case, of hydrocele, uterine
fibroids, nevus, hernia or other condition, in which the operation was per-
formed at the patient’s home, he was assisted by his friend, and later his
partner, Dr. O. H. Hall, once of Ohio, who was long in Zumbrota, Goodhue
County, Minnesota. Dr. Allen took a postgraduate course at the Hahnemann
Medical College of Chicago in 1883, made numerous clinical trips, and was
faithful in attendance at meetings of homeopathic medical groups. He
was active in the Southern Minnesota Homeopathic Medical Society and in
the American Institute of Homeopathy. In 1887 he was elected vice president
of the Hahnemann Alumni Association.
In the spring of 1892 Dr. Charles T. Granger, of Rochester, newly gradu-
ated from the Hahnemann Medical College of Chicago, returned home to en-
ter partnership with Dr. Allen, the senior partner to specialize in the diseases
of women and the junior in diseases of eye and ear. Dr. Allen at that time
was interested in treatment for hernia also, by the Fidelity Method, which
was said to obviate the need for truss or surgical intervention. In November,
1892, Drs. Allen and Granger opened the Riverside Hospital in East Roches-
ter. In the history of this hospital, given earlier in this paper, it was told that
when the hospital was closed in September, 1895, Dr. Allen moved to Saint
Paul, in partnership with Dr. O. H. Hall, although he maintained his home
in Rochester. Because he was then mayor of Rochester, he held his mayor-
alty and returned to Rochester once a week, to inspect construction of the
city’s new sewer system and to meet with the city council. Early in 1896
he terminated his practice in Saint Paul and returned home.
(To be continued in the March issue)
174
Minnesota Medicine
President’s better
POSTGRADUATE SEMINARS
IT IS BECOMING increasingly difficult for American physicians to be good
physicians.
a
Paradoxically, the myriad developments of medical science that are making
the conquest of disease easier, are, at the same time, making the practice of
medicine more complex and challenging.
Each of us, if we are to uphold the constantly climbing standards of the
profession, must serve as a repository for an overwhelming store of therapeutic
knowledge and skills. Fortunately this obligation is easier for us to assume than
it might be, due to the efforts of the American Medical Association, our own
State Association, the component county medical societies, the Minnesota State
Board of Health and the University of Minnesota Medical School.
These groups offer continuing opportunities for the acquisition of advanced
information : the national, state and county societies, through periodic scientific
meetings ; the Board of Health and the Medical School, often pooling their
facilities to develop post-graduate courses and clinics for study.
Minnesota physicians are familiar with the courses held at the University’s
Center for Continuation Study ; but the newest result of concentrated analysis
of the post-graduate study problem is the presentation of post-graduate seminars
in the various districts of the state. Emphasis currently is on cancer, cardio-
vascular diseases and psychosomatic medicine. Pattern for the eight-week course
is an informal one, with physicians, nurses, dentists and pharmacists gathering
to discuss these problems with members of the University medical staff.
Inclement sub-zero weather during the two initial presentations did not restrain
the attendance and interest of the Duluth series of meetings in progress. These
are the first of courses to be presented throughout the state. Component societies
are encouraged to prepare for these seminars and participate in the prepara-
tion of the programs.
President, Minnesota State Medical Association
February, 1950
175
♦ Editorial ♦
Carl B. Drake, M.D., Editor ; George Earl, M.D., Henry L. Ulrich, M.D., Associate Editors
SOCIALIZED MEDICINE
THE FOLLOWING editorial appeared in the
Minneapolis Star of July 6, 1949. Senator
Humphrey of Minnesota apparently thought it so
good that he presented it to the U. S. Senate on
August 1, 1949, for publication in the Appendix
of the Record.
SOCIALIZED MEDICINE?
“Socialized medicine” is a term seldom used by the
British, although obviously that is what they have got.
Medical services are paid for from general taxation,
private practice is discouraged, and hospitals have been
taken over by the Government.
The Labor Party in Britain is a Socialist Party, but
it isn’t often called that. Thus Britishers are not likely
to apply the word “Socialist” to projects of the party.
They speak of their “health scheme.” When they oc-
casionally say “socialized medicine,” they have borrowed
the phrase from America.
In this country socialized medicine is applied to many
things which aren’t socialistic in the usually accepted
sense.
The administration has proposed a national health-
insurance program to me financed by pay-roll deductions
and other taxes. Many legitimate arguments may be
brought against such a plan— the shortage of doctors, the
tendency of people to make unwise demands upon pub-
lic services, the advantages of voluntary medical insur-
ance, etc. But the administration proposal is hardly
more socialistic than our present social-security setup
with its old-age and other benefits.
Propagandists against public health insurance are part-
ly responsible for calling this plan “socialized medicine.”
Whether such usage helps their case or not is prob-
lematical. But they may be breeding a great danger
for the future.
If at some time a public-insurance system is voted in
the United States, the people may come to accept it as
socialized medicine. That might make them more easily
susceptible to the truly socialistic projects which lead
so easily to statism.
Let’s not say socialized medicine unless that is really
what we mean.
We are reproducing the editorial, for it offers
a good illustration of the confusion which exists
in many quarters in the use of the terms “social-
ize” and “socialism.”
In England, according to the editorial, medical
care is provided by the government as part of the
socialistic form of government. The English do
not call it socialized medicine but that is what
they have. Essentially, the same kind of medical
care is proposed for our country, but we mustn’t
call it what it is — socialized medicine — because if
and when a public insurance system is adopted
other “truly socialistic projects” will be more
easily adopted by the public.
Even Webster leaves room for uncertainty as
to the meaning of “socialize” when he defines it
at “to render social or socialistic.” “Socialism”
he defines clearly as “a political and economic
theory of social reorganization, the essential fea-
ture of which is governmental control of eco-
nomic activities, to the end that competition shall
give way to co-operation and that the opportuni-
ties of life and the reward of labor shall be
equally apportioned.”
A completely socialistic government would
therefore be complete control of economic activ-
ities. While in England there still exists some
private industry, the government has control of
most of the economy, and England is a good ex-
ample of a socialistic government which it took
forty years gradually to achieve. The term “so-
cialize,” however, can refer to socialism as a
theory of government or to group action which
may have nothing to do with socialism. Commer-
cial insurance companies assume risks already
present. In a sense, the industry is socialized.
The government provides hospital care for those
who cannot provide it for themselves through
private means. This is socialized medicine but
scarcely socialistic.
When the government enters a field in compe-
tition with private industry, however, . that is
socialism, and socialism has been making inroads
on our economy to an alarming degree. Private
industry cannot compete with government-backed
projects in which tax funds make up deficits.
Government monopoly is bound to result event-
ually.
Socialism has entered our economy farther
than many realize. It has been fostered by vari-
ous groups, is known under a variety of disarm-
176
Minnesota Medicine
EDITORIAL
ing names, and has been insidious in its operation.
Any government that competes with private in-
dustry in the building field, electrification, finan-
cial loans, et cetera, has become socialistic. The
seriousness of the situation has been called to the
attention of our citizens forcibly by John T.
Flynn’s book, The Road Ahead — America’s
Creeping Revolution.* The book is rightly a best
seller and every American who has the preserva-
tion of private industry and freedom at heart
must read this book. The Reader’s Digest is to
be congratulated for running a condensation of
the book as the leading article in its February,
1950, issue. We, in America, are drifting rapidly
in the same stream that caught England and
sapped its vitality. Only an informed and free-
dom-loving public can prevent the extension of
socialism and a reversal in the present tide.
RED CROSS FUND CAMPAIGN
T N MARCH each year, the American Red Cross
goes to the people of this country for support
of its program for the year. The Red Cross
has a peace program which has many worth while
facets. It is constantly organized to meet emer-
gencies such as are presented by flood, fire and
hurricane with assistance to the unfortunate.
Less known activities include the services of some
2,000 Red Cross field workers to the armed forces
at home and abroad which last year cost some
$17,000,000; the Red Cross Motor Service which
clocked up some 9,000,000 miles of transporta-
tion last year ; the twenty-eight regional blood cen-
ters with thirty-two attached mobile units, serving
population areas totaling 40,000,000 persons. It is
expected that some fifteen additional regional
centers will be established during the fiscal year
and that blood collected from voluntary donors
will be distributed to nearly 2,000 hospitals.
Since the Red Cross began its Water Safety pro-
gram in 1914, it has issued over 6,000,000' certifi-
cates for courses completed in swimming and life
saving. The Red Cross also has its representa-
tives in the sixty-eight Veterans Administration
hospitals, has recruited nurses for “polio” duty
and for disaster-relief operations, and conducts
classes for children in the primary and elementary
grades in accident prevention, and other safety
measures.
The Red Cross, because of its performances
*Flynn, John T. : The Road Ahead. New York: The Devin-
Adair Co., 23 E. 26th Street.
February, 1950
over the years in peace as well as in war, has no
difficulty in selling itself to the people. Its newest
departure, however — the supplying of blood banks
to communities — perhaps its most valuable peace-
time activity, is a very costly project and requires
therefor generous financial support. Fully as
essential is generous co-operation on the part of
blood donors. A realization of the often life-
saving qualities of this comparatively new thera-
peutic agency should be sufficient to assure the
success of the Blood Bank.
ELECTROPHRENIC RESPIRATION
HP HE Harvard Public Health Alumni Bulletin
•*- for November, 1949, contains an account of
the development of the electrophrenic respirator
in the Physiology Department at Harvard. This
unique method of producing artificial respiration
by electrical stimulation of the phrenic nerve was
developed by Dr. Stanley J. Sarnoff and Dr.
James L. Wittenberger first on experimental ani-
mals (antivivisectionists take note) and then on
human beings. It was found possible to apply
the current in such a manner that lung ventilation
could be controlled as to depth and frequency. A
striking feature was that artificial excitation of
the phrenic nerve caused immediate suspension
of activity of the respiratory center provided the
artificial respiration was sufficient to supply oxy-
gen demands.
At first the electrode was supplied to the ex-
posed phrenic nerve. Later it was found that the
electrode need only be placed on the skin over-
lying the phrenic nerve, the indifferent electrode
being placed over the corresponding shoulder.
The only sensation experienced is a slight tingling
at the point of contact.
Work began on the development of the appara-
tus in January, 1948, and it was first used in the
fall of 1949 on a nine-year-old boy at the Chil-
dren’s Hospital in Boston who was suffering from
respiratory difficulty resulting from poliomyelitis.
His respiration was maintained continuously for
three days and three nights and intermittently
thereafter for another three days while his respi-
ratory center was recovering.
One important point is that the patient must
have constant attendance on the part of a trained
individual lest the electrode slip from its posi-
tion. Although other patients with bulbar involve-
ment in Boston and at the Los Angeles County
177
EDITORIAL
Hospital have been kept alive by this method, it
has not so far replaced the Drinker body respira-
tor (iron lung) which incidentally was also devel-
oped at Harvard by Philip Drinker and Louis A.
Shaw. The importance of a maintained electric
current is most obviously vitally essential for both
apparatuses.
PREVENTION OF DENTAL CARIES
[ T was about 110 years ago that dentistry in
America began to be a specialty distinct from
medicine. During this period American dentistry
has become “tops” compared to dentistry in the
rest of the world. But in the prevention of den-
tal caries there seems to be a woeful lack of
knowledge.
There is nothing new in the idea that fermen-
tation of starchy food between the teeth causes
the formation of lactic acid which affects the
enamel of the teeth and leads to decay ; hence,
the well-nigh universal recognition of the im-
portance of brushing the teeth. It is true that
there has been some difference of opinion as to
whether the direction of the brushing should be
north and south or east and west ; whether a
powder has distinct advantages over a paste ; and
whether a medicated or simple alkaline dentifrice
should be used. The use of dental floss or a tooth-
pick following a thorough brushing of the teeth
will convince the most skeptical that brushing
alone is not 100 per cent effective.
In the February issue of The Journal of the
American Dental Association , Dr. Leonard S.
Fosdick, professor of chemistry at Northwestern
University, reports that as a result of a study of
nearly 1,000 college students, he has found that
the simple expedient of brushing the teeth im-
mediately after meals or after the ingestion of
sugar-containing food with an unmedicated dical-
cium phosphate dentifrice reduces the incidence
of caries more than 50 per cent. He claims to
have shown that the acid action on the enamel
surface of the teeth begins as soon as three min-
utes after the sugar enters the mouth, reaches
a maximum acidity within twenty minutes, which
persists for thirty to ninety minutes. This con-
firms the opinion widely held by dentists that the
ingestion of candy is deleterious to the teeth. The
same presumably holds for chewing gum and soft
drinks, both of which contain a high percentage
of sugar. The author seems to have proven statis-
tically that students who had candy and soft
drinks convenientlv available suffered from more
dental caries than those who did not, and the
mere easy access of a drinking fountain for use
after ingestion of the sugar caused a demonstrable
lowering of the incidence of caries. We would
suggest a further arbeit for the author in the way
of an investigation of the value of dental floss or
the toothpick after meals in reducing dental caries.
We venture to predict a still further lowering of
dental caries bv this simple means.
Whether the methods of prevention of dental
caries as here suggested are likely to be generally
adopted, however, seems problematic. We have
difficulty in visualizing the general adoption of
the use of the toothpick after dessert, even though
the procedure is politely shielded by a napkin ; or
the carrying of a toothbrush for easy availability
after meals; or the final swishing about of a
mouthful of water in order to wash away the
sugar in the mouth so dangerous for the dental
enamel.
Putting levity aside, Dr. Fosdick’s observations
contain suggestions which can be put into effect at
least in part to lessen dental caries. Brushing the
teeth after eating rather than on rising and re-
tiring and the drinking of water after eating
food containing sugar are procedures easy to
follow.
The initial quality of the enamel and dentine
of the teeth depends, without any doubt, on the
quality of the diet. The natives of certain South
Sea islands who live largely on fish and animal
oil are said to have perfect teeth. This suggests
that calcium and vitamins are important factors.
The same holds true for individuals who have
been born and brought up in areas where the soil
contains fluorine. This observation has led to
the discovery that the topical application of 2
per cent sodium fluoride to the permanent teeth
of children once or twice a week on four occasions
after a cleaning of the teeth results in a reduction
of 40 per cent in the incidence of caries.* The
preliminary cleaning of the teeth seems essential.
Following the application with a 5 per cent solu-
tion of calcium chloride or more than four appli-
cations of the sodium fluoride solution does not
produce any additional reduction in the incidence
of caries. Here is a simple procedure which
seems to merit extended trial and is being widely
investigated.
’Effect of Fluorides on Dental Caries. JAMA, 141 :1302,
(Dec. 31) 1949.
178
Minnesota Medicine
Medical Economics
Edited by the Committee on Medical Economics
of the
Minnesota State Medical Association
George Earl, M.D., Chairman
FSA ESTIMATES 1960 NEED FOR DOCTORS
Using three methods of computation, the Fed-
eral Security Agency has estimated the number
of physicians needed in 1960 by the United States.
The estimates vary from 244,532 to 272,172.
Applying the formulae to Minnesota, the FSA
would raise the number of physicians in this state
from 1940’s total of 3,280 to either 5,021 or
4,723 or 4,218.
These studies, complete with charts and graphs,
are included in a publication entitled “Health
Service Areas” and subtitled, “Estimates of Fu-
ture Physician Requirements.” Anyone interested
may order this publication by writing the Super-
intendent of Documents, U. S. Goverment Print-
ing Office, Washington, D. C.
EWING DENIES ANALOGY OF BRITISH.
U. S. PLANS
Oscar Ewing’s six weeks’ inspection of Europe
is over and he is now engaged in deflating, some-
what, the airy balloons of confidence he was
launching upon first looking into Bevan’s Eng-
land.
Earlier quoted as ready to transfer, with only
minute changes, the British health scheme to
America, Ewing says now, in a laborious state-
ment that perhaps consumed most of his voyage
home, that the two plans are entirely unlike.
“I come home with even greater confidence
in President Truman’s proposal for national
health insurance in the United States,” he de-
clared. But his statement could be examined
from both sides : was England’s system working
out so inefficiently that anything else in the line
of health insurance looked good or, was the Eng-
lish system, in practice, so beneficial to the people
that the Administration’s prescription for tax-
medicine should not be longer delayed?
Mr. Ewing does nothing to clarify this issue
as he continues his press release :
“His (the President’s) proposal is based on principles
entirely different from the British program, which I
investigated in some detail. The British plan is to-
tally unsuited for the United States. In England the
health service is part of a broad program to reorgan-
ize the basic social and economic structure of the
country, and eight-tenths of its costs come out of
general tax revenues. This is utterly foreign to the
President’s proposal.”
National Press Club members, lacking Mr.
Ewing’s facility for regarding two diametrically
opposed statements as consistent, were asking
some embarrassing questions when he addressed
that group on January 24.
LAYMAN AMONG FIRST TO PAY AMA DUES
This month the AMA received a check for $25
and an explanatory letter from a Chicago busi-
nessman. The letter said, in part :
“I cannot put M.D. after my name but I can, at least
for a while, still put U.S.A. As a consequence, please
accept the enclosed check for $25 as a slight token of
regard for my doctor and all his colleagues. These are
my ‘dues’ as a citizen, and I hope they will help in
your fight against socialized medicine.”
STASSEN ATTACKS SM IN PRINT, ON AIR
Harold E. Stassen, president of the University
of Pennsylvania, has loosed an effective blast of
statistics and observations against the Truman
health plan.
Writing in the January Reader’s Digest, the
former governor of Minnesota quipped :
“. . . it is my considered opinion that the British
program has resulted in more medical care of a lower
quality for more people at higher cost.”
Most convincing of his statements was this :
“. . . it does seem that the additional tombstones in
the British cemeteries — 72,125 more than in the year
before the National Health Program went into effect
— are grim signposts on which we can read : ‘Never
take this road for a National Health Program.’ ”
Stassen has just completed a very extensive
study of the British health scheme and his report,
pared of adjectives and emotionalism, presents a
February, 1950
179
MEDICAL ECONOMICS
sharp contrast to Mr. Ewing’s six-day tour of
Britain and his report of “Excellent.”
On January 29, Mr. Stassen met Senator Pep-
per (Florida) in a radio debate, and left the
senator sans argument and sans applause.
The senator, reciting the virtues of compulsory
health insurance in other countries, lost ground
when he cited Sweden as an example and was
confronted by the fact that Swedes live longer
in Minnesota than they do in their native Sweden.
He came a cropper again when he brought up
the matter of inequitable distribution of medical
care and was reminded by Stassen that the most
severe cases of maldistribution are to be found
in the South, where the Senator’s own political
party fosters the race prejudice that deprives
Negroes of fair opportunity for medical care and
medical education.
LONDON TIMES POKES FUN AT SOCIALISM
Last month the Wall Street Journal devoted
an editorial to the neglected canines, felines and
even bovines under the present social security
system.
This month the London Times is concerned
about this same question, having been prompted by
news of three collies seeing a “Lassie” movie.
Said the Times:
“It must be confessed that the animals, so far, seem
to be getting precious little out of the welfare state.
Nothing has been done to provide them with a longer
period of compulsory education ; they have no right
to free false teeth or a cheap interment; no one has
given them a five-day week.
“Perhaps all this is to come. Perhaps, when there
is rather more money in the Exchequer, the Government
will be able to mobilize a corps of inspectors to check
up on the overtime put in by sheep dogs, to make sure
that children’s ponies are getting their due amount of
leisure and to inculcate in the cat that parity of es-
teem for its fellow animals which at present it so con-
spicuously lacks. Meanwhile, a tentative, but signifi-
cant, step in the right direction has been taken at Whit-
ley Bay, though admittedly only by private enterprise ;
for the three men who took their collies to see a film
seem to have done so without the support of the Arts
Council or any similar body.”
The editorial goes on, with trenchant drollery,
to enumerate the problems which this new sphere
of activity would bring about in an already reg-
ulation-ridden socialistic state. For example :
“If some dogs are capable (as seems the case) of
enhancing their cultural status by going to see a film
about a dog, have we any right to deny our horses a
similar opportunity?”
The absurdity of the editorial transfers easily
from the animal world to the human one and
it appears that more than one Britisher would
find the humor grimly applicable.
MANY COMPROMISE BILLS IN HOPPER NOW
Most legislative prophets have been saying that
the Administration’s health bill, containing such
familiar clauses as “payroll deduction,” “cen-
tral fund,” et cetera, hasn’t a hope of passage
this session of congress. However, physicians,
and the public whose health is guarded by family
physicians, cannot relax . at this point. For,
although the lay public is beginning to be ap-
prised of the dangers inherent in a compulsory
system of medical care, engendered and controlled
by the government, the public is not so well
aware of the dangers of so-called compromise
proposals, proposals which would bring on gov-
ernment control by progressive stages.
The school health service bill (1411) is a key
example of this piece-meal type of legislation — -
bringing in, as it would, all school children be-
tween the ages of five and seventeen, under
a government medicine program. Dangers lurk,
too, in many of the medical education assists which
are constantly being proposed, altered and con-
sidered by committees and suspiciously viewed
by those who see in federal money a hint of fed-
eral interference.
Compromise bills are being advanced by many
congressmen who have a sincere interest in bet-
tering the health of the nation, but whose pro-
posals would short cut the necessarily slow, but
sound, advancement of better health standards
through the extension of methods already tried
and proven.
Many who look at England’s system see favor-
able results. They take an unscientific view, see-
ing more people going to the doctor and receiving
more medical and hospital care than heretofore.
Even admitting the abuses committed by hypo-
chondriacs and malingerers, the system is still
considered by some as good. They even draw a
comparison between the medical and hospital care
afforded to veterans in this country under a gov-
ernmental system. The critical fallacy in this
thinking is that not now, nor in the future, will
great medical discoveries emerge from labora-
tories or practices which are supervised by the
government.
180
Minnesota Medicine
Minnesota Academy of Medicine
Meeting of November 9, 1949
The regular monthly meeting of the Minnesota Acad-
emy of Medicine was held at the Town and Country
Club on Wednesday evening, November 9, 1949. Dinner
was served at 7 o’clock and the meeting was called to
order at 8:10 p.m. by the President, Dr. J. A. Lepak.
There were sixty-two members and two guests pres-
ent.
In the absence of Dr. Cardie, Dr. William Hanson
read the minutes of the October meeting, and these were
approved as read.
Dr. Harry Zimmermann read a memorial to Dr. L. C.
Bacon, who died June 4, 1949. (This Memorial was
published in the September, 1949, issue, page 932.)
Dr. Erling Hansen read a memorial to Dr. Walter E.
Camp, who died September 4, 1949.
WALTER E. CAMP
1889-1949
Walter Edward Camp was born on September 21,
1889, in Springfield, Missouri, and died September 4,
1949, in Minneapolis, after several months’ illness. He
was educated in the public schools of Springfield and
the University of Missouri where he was given his
A.B. degree. From 1908 to 1912 he taught histology at
the University of Missouri, where he began his medical
course. In 1912, he came to Minnesota where he con-
tinued to teach in the Anatomy Department, while he
finished his medical school work. He received his M.A.
and M.D. degrees in 1915, and interned at St. Andrews
Hospital. He took postgraduate work in eye, ear, nose
and throat at New York Post-Graduate Medical School
and Hospital during part of 1917 and 1918 and at the
Massachusetts Charitable Eye and Ear Hospital in 1921.
Later he spent several months in Vienna. During World
War I, he was a Lieutenant in the Medical Corps of the
Army, serving for some time in Camp Dodge, Iowa,
and in Washington, D. C. For several years after the
first World War he was associated in practice with Drs.
Horace Newhart and Erling W. Hansen. Since 1928,
he had maintained an office alone in Minneapolis.
Dr. Camp was assistant professor of ophthalmology
in the University of Minnesota Medical School, where
he was a valued teacher in ocular pathology. His pre-
eminence in this field was nationally recognized, and,
for several years, he taught pathology in the Instruc-
tional courses given by the American Academy of Oph-
thalmology and Otolaryngology at its annual meetings.
Dr. Camp was a member of the Staffs of North-
western and Abbott Hospitals, and of the Minneapolis
Academy and Minnesota Academy of Medicine and the
Minnesota Academy of Ophthalmology and Otolaryng-
ology. He had been president of the latter two organ-
izations. He was a member of Hennepin County Medi-
cal Society, Minnesota State Medical Association, and the
American Medical Association. He was a fellow of the
American College of Surgeons. His medical fraternity
was Phi Beta Pi, and he held membership in Sigma Xi,
honorary scientific fraternity, and Alpha Omega Alpha,
honorary medical fraternity. He belonged to the Min-
neapolis Club and Minnikahda Club and was a 32nd
Degree Mason.
Dr. Camp was married to Amy Floy Kinney, whom
he met in Washington during the first World War.
They had three children, Amy Katherine Camp Walker,
Walter Edward, Jr., and Lucille Kinney Camp, all of
whom survive him, together with three grandchildren
and two brothers.
Walter Camp will long be missed by his friends
in this Academy and his many other friends, as well as
by his family to whom we extend our earnest sympathy
in their great loss.
The scientific program followed.
LINGUAL GOITER
MARTIN NORDLAND, M.D. and MARTIN A. NORDLAND, M.D.
Minneapolis, Minnesota
The occurrence of thyroid anomalies in the tongue is
quite rare. It might be observed more frequently if
hypertrophy developed in nonmigrated thyroid tissue in
all cases. This anomaly is reported only when it causes
symptoms. It should be of interest to the profession
in general from a diagnostic point of view, and is of
unusual interest to the surgeon because of the prac-
tical problems involved in the surgical removal. The
site for the occurrence of thyroid tissue in the tongue
is at the pharyngeal portion in the region of the foramen
caecum. The terms lingual thyroid, lingual goiter,
aberrant or accessory thyroid are rather loosely used.
The term lingual thyroid should be used when there
is a thyroid gland in the neck and thyroid tissue in the
tongue functioning as an accessory thyroid. Lingual
goiter refers to hyperplastic thyroid tissue on the
dorsum of the tongue which is the result of nonmigra-
tion of the thyroid anlage from the region of the fora-
men caecum with absence of thyroid tissue in the neck.
The term aberrant thyroid should not be confused with
lingual thyroid or lingual goiter. Convincing evidence
has recently been presented by Warren and Feldman that
lateral aberrant thyroids are metastatic tumors from
carcinoma of the thyroid gland. The most comprehen-
sive review of the incidence of lingual goiter and lingual
thyroid appearing in the literature to 1936 was published
by Montgomery. He established criteria of authenticity
and accepted 144 cases, including one of his own. For
his criteria of acceptance, he asked that (1) the exam-
ination of the specimen removed should reveal thyroid
gland tissue, or that (2) thyroid insufficiency should
supervene following the removal of the nodule, and
that (3) the lesion should appear in the substance of
the tongue between the epiglottis and the circumvallate
papilla.
Of the 144 cases Montgomery accepted, the lesion
February, 1950
181
MINNESOTA ACADEMY OF MEDICINE
■ j
Fig. 1. Photographs of gross specimen.
occurred on the dorsum of the tongue in 142 instances.
Our case which fulfills all these requirements of
the criteria of Montgomery is reported in order that
it may be added to the cases reported in the literature.
It was thought that it might be of interest because
of the problem of diagnosis and the method of treat-
ment.
Case Report
The patient is a white woman, aged fifty-seven, who
was first seen by us on September 3, 1948 complain-
ing of difficulty in breathing, recurrent hemorrhage from
the mouth, husky voice, chronic cough, and a growth
at the base of the tongue.
These were first noted about 1911, at which time
she underwent an operation. Prior to this, she had
consulted many doctors for all of the above complaints.
The operation was unsuccessful because of profuse
hemorrhage requiring a tracheotomy. The doctor told
her that further operation would be necessary, and that
he noted “crystals” in the contents of the “cyst” that
he removed.
The patient had recurrent exacerbations of the above
difficulties up to the time of our examination.
In the meantime, she consulted with numerous doc-
tors and clinics without any definite diagnosis having
been made. She, was treated alternately for allergy,
chronic bronchitis, asthma and various respiratory dis-
turbances without relief and with gradual increased
severity of all her symptoms.
Physical examination revealed a thin, nervous white
182
woman, aged fifty-seven, who appeared chronically ill.
The general physical examination was negative with
the exception of hypotension (blood pressure 92/70).
The pulse was normal. Examination of the head and
neck revealed a mass at the base of the tongue at the
foramen caecum. This could not be visualized by or-
dinary examination with a tongue blade, but with the
patient’s co-operation, the upper surface of the mass
could be seen and could be definitely outlined by
digital examination. The mass was round, slightly
irregular, relatively firm, not tender, and about 6 cm.
in diameter. Blood studies and urinalysis were entirely
negative.
The patient was operated upon September 10, 1948.
Under intratracheal anesthesia, a transverse incision
was made directly over the hyoid bone. The platysma
muscle was divided and the hyoid bone exposed. Ap-
proximately half a centimeter of the hyoid bone was
removed and the tumor at the base of the tongue
mobilized. The mass was removed in three pieces
with some difficulty, but hemastasis was adequate.
The mucous membrane of the pharynx was reap-
nroximated with interrupted sutures of plain 0 catgut.
The underlying cervical fascia was brought together
with interrupted sutures 00 chromic. A running sub-
cuticular suture of 00 plain catgut was employed and
interrupted sutures of dermal and Wachenfield clips
were used to close the wound. A split catheter drain
w'as left in the operative field. The pathological report
was as follows.
Macroscopic specimen — Specimen consisted of 12
grams of tissue removed from the base of the tongue
(Fig. 1). The largest portion measured 5 cm. It was
cystic and filled with degenerating necrotic yellowish
brown tissue. It also contained a portion of the hyoid
bone. A second portion measured 4 cm. and consisted
of a thin walled cyst that contained necrotic granular
material. The third portion measured 3 cm. and had
an adenomatous yellowish brown appearance and con-
tained two circumscribed nodules, measuring 1.5 and 1
cm.
Microscopic specimen. — Sections of the solid areas
showed thyroid tissue composed of small acini that
varied considerably in size. Some of the acini were
fetal in type ; others approached normal size and were
well filled with colloid. There was a tendency for the
acini to be arranged in adenomatous formation (Figs.
2 and 3). There was extensive degeneration present.
Some sections showed marked hyaline degeneration
with fibrous tissue replacement of the thyroid tissue.
The cystic areas possessed a well defined fibrous cap-
sule. The tissues were benign.
Diagnosis. — Aberrant thyroid tissue with fetal and
colloid adenomas.
Comment
Because of the location of this tumor on the back
of the ’ tongue at the foramen cecum, it is correct to
designate this as a case of lingual goiter (Fig. 4).
Thyroid insufficiency probably is responsible for most
of the simple hypertrophies of lingual thyroid tissue.
In about two-thirds of the patients who have been
reported as having lingual thyroid hypertrophy, thyroid
gland tissue was not demonstrable in the neck as in
our case. Hypertrophy of thyroid tissue is very marked
during the maturing peroid of puberty in early adult life.
Likewise, many of the cases with lingual thyroids
have been discovered during this period of life because
of the tendency of thyroid tissue to hypertrophy at this
Minnesota Medicine
MINNESOTA ACADEMY OF MEDICINE
Fig. 2. Microscopic section under medium power (50X), Fig. 3. Microscopic section under high power (200X) show-
showing a representative area. It cannot be distinguished' from ing an area wifh small acini to show cell detail,
the usual colloid adenoma or benign adenoma of the thyroid.
time. It is not easy to determine the etiology of the
characteristic changes of adenomatous goiter in the
tongue. The factors which cause this hypertrophy are
probably the same as those causing the formation of a
cervical thyroid adenoma.
Montgomery has stated that at least 90 per cent of
the patients having a lingual thyroid nodule suffer from
symptoms of pressure and obstruction such as dysphagia,
dysphonia, and dyspnea. In our case, the most conspicu-
ous symptom was dyspnea. She also had recurrent
small hemorrhages, huskiness of voice, and a chronic
irritable cough. The patient herself described the
sensation of the presence of a tumor causing fulness
and a feeling of tightness in her throat. She did not
have pain. Because of her chronic cough, she was
treated for “bronchitis” over a long period of time. She
was also treated for some mysterious allergy. This pa-
tient had never had a basal metabolism test but her
history revealed that she had a mild hypothyroidism.
We were able to palpate the gland as described in the
case history. The tumor had been described by an
otolaryngologist as a tumor of the epiglottis. The diag-
nosis of lingual thyroid had not been made.
The fact that this patient had been operated upon for
this disturbance thirty-eight years ago made it easier
for us to make a diagnosis. After palpating and visual-
izing the mass, we were certain we were dealing with
a lingual goiter. Because she had had a hemorrhage
upon the previous attempt at removal, because the op-
eration could not be completed, and because she had to
February, 1950
Fig. 4. Saggital section showing position of lingual
thyroid.
have a tracheotomy at that time, we felt that we should
remove this tumor by going through the neck in the
region of the hyoid bone. We followed the technique
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MINNESOTA ACADEMY OF MEDICINE
devised by Sistrunk for the excision of thyroglossal
duct cysts (Fig. 5). This approach, together with in-
tratracheal anesthesia, made it possible to remove this
The patient has now been observed for more than a
year. She is taking 4 grains of thyroid extract daily,
and is in excellent health.
Fig. 5. Saggital section to show the operative approach used in this case.
large mass deliberately and with safety.
One of the most interesting phases of this case was
the fact that the patient developed advanced symptoms
of hypothyroidism within six weeks of the operation.
It had not occurred to us to discuss the possibility of
the development of hypothyroidism to this patient.
When she again appeared at the office about six weeks
postoperatively, she was tired, had edema of the lids,
dry skin, a marked slowness of speech, chilliness and
all symptoms of postoperative myxedema.
References
1. Goetsch, Emil: Lingual goiter — Report of three cases.
Ann. Surg., 127:291, (Feb.) 1948.
2. Montgomery, M. L. : Lingual thyroid: A comprehensive
review. West. J. Surg. Obs. & Gynec., 43:661, 1935 ;
44:54, 122, 189, 237, 303. 373, 442, 1936.
3. Montgomery, M. L. : The lingual thyroid : A Monograph.
Portland, Oregon : West. J. Surg. Obs. & Gynec.
4. Norris, E. H. : The morphogenesis of the follicles in the
human thyroid gland. Am. J. Anat., 290:411, (Nov.) 1916.
5. Warren and Feldman: The nature of lateral “aberrant”
thyroid tumors. Surg. Gynec. & Obst., 88:31, (Jan.) 1949.
Dr. E. M. Hammes, Saint Paul, gave a report on the
Fourth International Congress of Neurology held in
Paris, September 5-10, 1949.
THE FOURTH INTERNATIONAL CONGRESS OF NEUROLOGY
ERNEST M. HAMMES. M.D.
St. Paul, Minnesota
The Fourth International Congress of Neurology was
held at Paris in Faculte de Medicine Building, September
5 to 10, 1949. Twenty-six countries had been invited;
twenty-three representatives attended. Australia did not
send any official representative. Russia and Yugoslavia
did not even acknowledge the invitation, although the
Russian language had been made one of the official
languages, along with English, French and Spanish.
The majority of the scientific papers were read in
English and French. The attendance was about twelve
hundred ; over one hundred and fifty were from the
United States of America.
Each morning session from 9:30 to 12:30 was de-
voted to a single important subject: on Monday, en-
cephalography; on Tuesday, the various problems of
the thalmus ; on Thursday, virus infections of the
central nervous system; on' Friday, neurosurgery for
relief of pain. Saturday forenoon was a general fare-
well meeting, where Pierce Bailey, of Washington,
D. C., discussed “Current Trends in Neurology in the
U. S. A.”
The morning sessions were well conducted and the
subjects scientifically presented by outstanding men in
their particular fields. On the afternoon programs
there were seven to ten papers in each section, averag-
ing about one hundred papers each afternoon. No time
limit was kept on either the essayist or the discussor.
As a result, there was considerable confusion during the
afternoon sessions, and one could not rely on the time
table of the program for any definite paper. One
hundred and seventeen American neurologists presented
papers of variable scientific value.
On Wednesday forenoon the entire group visited the
Salpetriere Flospital. This is one of the most renowned
neurological hospitals on the continent. In this hos-
pital, in the 18th Century, Pinel, was the first physician
to remove the chains from mental patients and treat
them as sick human beings. In this same hospital, Char-
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MINNESOTA ACADEMY OF MEDICINE
cot of the Charcot- joint fame, was able to hypnotize an
entire ward full of patients at one time, because of his
powerful personality and hypnotic influence.
On Tuesday evening, Dr. W. Penfield of Montreal,
gave an excellent discussion on “Cerebral Localization
of Function.” These studies were made in the course
of routine craniotomies on patients under local anesthe-
sia, by direct stimulation of the cortex with electric
currents. Among other things, he was able to demon-
strate a secondary sensory representation in arms and
legs on the superior lip and superior bank of the Fissure
of Sylvius. On Thursday evening, Dr. Penfield gave
another very stimulating address on “Localization and
Clinical Classification in Focal Epilepsy.” In the course
of a craniotomy, he would attempt to localize the focal
lesion by electrical stimulation which would initiate the
convulsion. He then would surgically remove this par-
ticular area with any abnormal brain tissue or scar,
with satisfactory results in some cases.
The Symposium on Encephalography was presented
by Bremer of Brussels, Jasper of Montreal, and Hill
of London. Their presentations were very conservative
and emphasized the fact that electroencephalography
should be considered only as a diagnostic aid, similar to
other laboratory tests. The greatest value was in the
diagnosis and investigation of the epilepsies, both essen-
tial and symptomatic. Second in importance is its aid in
evaluation of the localization and severity of cerebral
damage following traumatic head injuries. Next in im-
portance is the diagnosis and localization of expanding
intracranial lesions (tumors and abscesses) but only by
competent and experienced personnel, using the most
recently developed localization methods. Pneumo-
encephalography is still considered more accurate and
more reliable. In cerebral vascular lesions and inflamma-
tory and degenerative disorders, electro-encephalography
is of questionable value.
The Tuesday forenoon discussion of the thalmus
again demonstrated the specific functions of the various
cells groups in the brain. One of the most important
functions of some of these cells groups in the thalmus
is that of sorting stations for the segregation and re-
combination of afferent impulses so as to form spe-
cific sensory patterns which are then referred to the
cortex. This excellent symposium was presented by
LeGros Clark of Oxford, Hess of Zurich, and two other
French authors. Dr. Hess, later on, was given the
Nobel Prize for his original contributions and studies.
The viral infections of the human nervous system
were discussed by Sabin of Cincinnati, Hammond of
San Francisco, Lepine of Montreal, and Card of Stock-
holm. The classification of diseases and known viruses,
in part, was as follows :
Viral Infections of the Human Nervous System
(Classification Based on Information Available in 1949)
A. DISEASES AND VIRUSES KNOWN.
I. Basic reservoir in human beings ; worldwide in
distribution.
1. Sporadic and epidemic: poliomyelitis.
February, 1950
2. Sporadic: mumps (parotitis)
herpes simplex,
lymphogranuloma
venereum.
II. Basic reservoir extra-human; few widespread,
most limited in distribution.
1. Arthropod-borne encephalitides :
St. Louis
Western equine
Eastern equine
Venezuelan equine
Japanese B.
Russian tick-borne (Louping ill?).
2. Transmitted by animal secretions or excreta:
rabies
lymphocytic choriomeningitis
(pseudolymphocytic choriomeningitis?).
B virus (monkey)
B. VIRUS ETIOLOGY POSSIBLE, BUT VIRUSES
LITTLE KNOWN OR UNKNOWN.
Von Economo’s encephalitis lethargica.
Herpes zoster
Australial “X” (may have been Japanese B).
C. DISEASES SOMETIMES GROUPED WITH VI-
RUS INFECTIONS WITHOUT ADEQUATE
EVIDENCE.
Infectious polyneuritis (Guillain-Barre syndrome).
Postinfection and postvaccination (demyelinating)
encephalitis : measles, varicella, rubella, vaccinia,
variola, mumps, “influenza,” et cetera.
Acute hemorrhagic encephalitis.
The Symposium on Neurosurgery for the relief of
intractable pain was divided into the surgical section
of pain tracts and pathways in the spinal cord for the
relief of pain in the trunk and extremities, trigeminal
tractotomy for trigeminal neuralgia, prefrontal leucot-
omy and topectomy by cutting the frontothalamic fibres.
In an attempt to relieve severe attacks of migraine, Row-
botham of England, described some surgical precedures,
such as excising or ligating various cranial blood vessels,
with uncertain results and no definite conclusion. The
entire meeting was very stimulating and it was interest-
ing to see and meet some of the internationally famous
neurologists and neurosurgeons.
The meeting was adjourned.
A. E. Cardle, M.D.
Secretary
SOCIALIZED MEDICINE AS I SAW IT
( Continued from Page 162)
as a truly expert form filler and it is my sincere hope
that one day I may be able to make some further use of
this most doubtful acquisition.
I felt that I had had enough of this sort of govern-
ment medicine and I made my decision to make a clean
break — and I would make the same decision tomorrow.
But I would urge you all to consider the implications
for you and for all the people of this country in what
I have said. The physicians of this country have the
same hopes and the same ambitions as I have, the same
hopes and ambitions which forced me to take the action
that I took. Let us - hope that none of them here are
ever forced to make the same decision.
Insurance Economics, January, 1950
185
Minneapolis Surgical Society
Meeting of October 6, 1949
Ernest R. Anderson, M.D., Presiding
FRACTURE DISCOURSE
EARL C. HENRIKSON, M.D., MAYNARD C. NELSON. M.D.. and DANIEL MOOS. M.D
Minneapolis, Minnesota
Dr. Nelson: This talk of ours will deal with a few
common fractures of the humerus. We would like it
to be informal and invite you to participate in the dis-
cussion. By that I don’t mean for you to wait until
we finish talking. Interrupt us at any time. Don’t
save your comments.
As some of you may know, Dr. Henrikson, Dr. Moos
and I have put on this conference, or whatever you want
to call it, at various places throughout the state for the
last two or three years. The idea for this method of
presentation evolved from the Fracture X-Ray Con-
ference held each week at the Minneapolis General
Hospital. We first started to use it, and still do, in
teaching the medical students at the University. I
think it is quite a valuable teaching method. It is very
informal, and so far at least, it has kept our listeners
interested and kept us on our toes.
( First slide) This is the run-of-the-mill variety of
supracondylar fracture of the elbow and is the most
common of all elbow fractures in children. This frac-
ture is, for the great part, extra-articular. I would
think that 90 per cent of these fractures can be reduced
by traction and manipulation and then the reduction
maintained by one of several different methods depending
on which one you favor. Personally, I like a posterior
molded plaster splint. You may like something else.
The methods of reduction differ in some respects. For
instance, some men favor extending the arm and some
even hyperextend the arm. I like to keep the arm in
the position it is in when I first see the patient. This
usually is about half way between a right angle and a
straight line. Leave the arm in that positon and then
apply traction so that you will not add to the injury
of the soft parts.
( Second slide) In the arm shown in this slide there
was a great deal of swelling. After the reduction was
obtained, the elbow could be flexed only to 90 degrees,
and when the swelling went down, the fracture slipped
out of position as shown in this next slide.
( Third slide) This slide shows what happens to en-
danger the vessels in this fracture. The vessels and me-
dian nerve are underneath the fascia at the elbow. The
distal fragment carries them back across the sharp
edge of the proximal fragment. If you flex the arm
without first bringing the distal fragment forward, you
are apt to pinch the nerve and vessels.
Dr. Moos appeared by invitation.
(Next slide) Here is the re-reduction of the first frac-
ture and shows now instead of the right angle position
one of about 45 degrees of flexion. In this position the
triceps is taut over the back of the elbow and so holds
the small distal fragment in reduction.
Dr. Moos : What are the criteria of reduction of this
fracture? How do you know whether there is reduction?
What do you look for on the x-ray plate?
Dr. Nelson : The most valuable x-ray view is the
lateral. If the articular surface of the humerus is about
one-third anterior to a line dropped along the anterior
aspect of the humerous, it is in the proper position.
Dr. Henrikson : How many times would you remanip-
ulate it?
Dr. Nelson: That is an individual thing. For this
particular fracture, I don’t think it makes any difference.
If the fracture is farther down towards the joint, I
don t think you should manipulate more than once.
Die Moos: If you have a swollen elbow, how do you
know how much flexion to put it in?
Dr. Nelson : You feel the radial pulse and flex the
elbow as far as possible without obliterating the pulse,
then immobilize it there. I use a posterior molded plaster
splint to maintain this position. Thereafter the arm is
closely observed and as the swelling decreases, you can
increase the flexion of the elbow without endangering
the radial pulse.
Dr. Moos: How long does it take this fracture to
unite?
Dr. Nelson : It unites very rapidly. Usually after about
ten days you can start active motion. Take it out of the
splint several times a day for active exercises within
the limits of pain. Union is quite solid after three or
four weeks.
Dr. Henrikson : Do you put it in a sling?
Dr. Nelson : Yes, a sling or a collar and cuff strap
apparatus.
(Next slide) This is a dicondylar or transcondylar
fracture, the type that I don’t think should be manip-
ulated more than once.
Dr. Moos : What would you do with this fracture if
you saw it and couldn’t feel the pulse?
Dr. Nelson : Try to reduce it immediately by traction
and manipulation.
Dr. Moos: What kind of anesthesia would you use?
Dr. Nelson: If the radial pulse is not palpable, I
wouldn’t use any.
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MINNEAPOLIS SURGICAL SOCIETY
Dr. Henrikson : Would you send the patient to the
hospital ?
Dr. Nelson: No, treat the patient immediately. You
had better get busy right away, because this is a very
serious complication.
Dr. Horace Scott : What anesthesia would you use in
the hospital?
Dr. Nelson : This depends on the treatment you use.
If you are going to manipulate this fracture, I think a
general anesthetic is best.
Dr. Henrikson : Supposing the patient had just had
supper. Would you do it then or wait until the next
day?
Dr. Nelson : In some hospitals they pump the stomach.
I wouldn’t stop for that — use the anesthetic and let
the patient vomit when he wakes up.
Dr. Lerner: Would you use skeletal traction?
Dr. Nelson: I have used it for this fracture in an
adult but not in a child.
{Next slide ) These are x-rays of the fracture just
shown after it was placed in traction. You will notice
it is slightly overpulled but reduction on the lateral
film is pretty good.
( Next slide ) This shows an x-ray taken a little far-
ther along, about the time this case was ready to be
taken out of traction and placed in a sling or splint.
Dr. Moos : It has been my observation that when I
use traction in this type of fracture and get reduction
but have some overpull, it takes longer for this frac-
ture to heal.
Dr. Nelson : That has been my experience too. I
remember one I had in traction with a little overpull.
I treated it just like an ordinary case and at about five
or six days took it out of traction and put a splint on
and thought this would be all right. However, the x-ray
showed that the fragments had slipped out of position
and the patient had to be put back in traction. That
patient was in traction eighteen days before union was
solid enough so that a splint could be applied. The
ordinary case you can take out of traction in five or
six days.
( Next slide) This picture shows the type of traction
we usually use for a child. The child is in bed with the
edge of the bed raised a little bit for counter-traction.
Stockinette is glued to the forearm with Ace adherent
and forward pull on the distal fragment obtained as
shown. There is a little pull backwards on the proxi-
mal fragment, the shaft of the humerus, by means of a
felt sling which also is stuck to the skin with Ace
adherent so that it won’t shift.
Dr. Moos : How do you keep the patient from falling
out of bed?
Dr. Nelson: The side of the bed is raised.
Dr. Moos : I think that’s an important point. Some-
times all you need do to obtain reduction is to suspend
the arm out from the side of the bed, if the side of the
bed is raised.
{Next slide) Here is a closer view of this type of
traction showing the stockinette extending up beyond
the fingers to a spreader-block attached to the rope over
the pulley.
Dr. Moos : Will placing this fracture in this type of
traction reduce the fracture?
Dr. Nelson : Nearly so. I usually give these young-
sters some sedative, then apply the traction and wait
several hours, after which time most of them will be
reduced. If not, give them a little more sedative and
manipulate them right in the traction apparatus.
Dr. Moos : How many x-rays would you take in the
first week?
Dr. Nelson : One every day for four days or so, and
then the interval between check x-rays gradually in-
creases.
Dr. Henrikson : Would you leave the arm in the
same position while in traction or keep flexing the arm?
Dr. Nelson : I increase the flexion as the swelling goes
down.
( Next slide) This view shows the spreader to which
the stockinette is fastened.
Dr. Henrikson : We will now consider fractures high-
er up the humerus in various parts of the shaft. Here
is a slide showing a slightly comminuted and slightly
oblique fracture near the middle. There is no shorten-
ing so traction isn’t needed except to keep the frag-
ments in proper aligment.
You certainly don’t need skeletal traction in a fracture
of this type. You could use tape traction with the pa-
tient lying in bed. The arm would be abducted lying
parallel to the top of the mattress. The forearm would
be flexed at right angles to the arm with the fingers
pointing to the ceiling. About 5 pounds attached to tapes
applied to the arm would be adequate to keep the frag-
ments in aligment. Tapes applied to the forearm extend
up over the wrist to a pulley and a weight heavy enough
to balance the forearm keeps it in comfortable position.
( Next slide) This shows the x-ray picture of the
fracture at three and one-half weeks. You can see good
callus already forming. At this time the arm can be
placed in a sling or in a hanging cast. A sling will
allow satisfactory motion at both the elbow and shoul-
der. Exercising of both joints is very important to pre-
vent stiffness and muscular atrophy. If the patient is
taught by the surgeon how to exercise, special physical
therapy elsewhere would not be necessary.
Dr. Nelson : I always thought that fractures should
be well immobilized — that the joint above and below
the fracture should be stabilized.
Dr. Henrikson: Yes, in the not too distant past we
would put patients like this in a big heavy body cast
with the arm abducted, but lately the trend is to keep
the shoulder moving. The fracture heals here in most
cases in spite of the lack of fixation.
Dr. Moos : Well, I take exception. I grant you that
in the humerus you can do that but —
Dr. Henrikson : You don’t immobilize the elbow in
Colies’ fracture, the knee in Pott’s fractures, the shoul-
der in supracondylar fractures in children, do you?
Well, anyway here’s the next slide showing a long spiral
fracture rather high on the shaft. You could treat this
one in bed just like we did the last one, but here we
decided to use the hanging cast.
Dr. Nelson : Do you think a spiral fracture heals
faster than an oblique?
February, 1950
187
MINNEAPOLIS SURGICAL SOCIETY
Dr. Henrikson : It becomes stable faster because of
the wider extent of the callus. Here you will notice
in the next slide that using a hanging cast doesn’t seem
reasonable because the upper margin of the cast doesn’t
even extend over the upper part of the fracture.
Dr. Scott : Why wouldn’t you do an open operation ?
Dr. Henrikson : Most people and women especially
don’t want a scar on their arm. They all would like to
avoid an operation if possible. Here because of inter-
posed soft parts we finally had to operate.
Dr. Moos : Explain the surgical approach especially
with regards to the radial nerve. What do you do with
it?
Dr. Henrikson: To avoid the nerve we try to keep
close to the bone with our instruments. Notice in this
next slide what was done. The approach is antero-
lateral between the pectoralis major and deltoid muscles
avoiding the cephalic vein along the margin of the
deltoid. Continue downward along the lateral border
of the biceps muscle to the brachioradialis muscle. Ex-
pose the brachialis muscle by retracting the deltoid lat-
erally and the biceps medially. Then split the brachia-
lis longitudinally all the way down through the perios-
teum to expose the bone. The radial nerve will be in
the posterior half of the brachialis muscle, so retract
carefully so as not to injure it. Free up only as much
periosteum as is absolutely necessary to get at the frac-
ture site. This next slide shows the site nicely ex-
posed, a clamp holding the bones reduced, and holes
being drilled for screws. You don’t have to use a
plate in a spiral fracture of this type, as four, five, or
six screws alone will hold well. The next slide shows
Collison screws being put in.
Dr. Moos: What about the cortices? Should the
screw penetrate both cortices? Should the threads catch
in the proximal as well as the distal cortex? What is
the best way to put screws in?
Dr. Henrikson: The drill should be a size smaller
than the screw and should go through both cortices.
The screw threads should have good purchase in both
cortices, the tip protruding all the way through the
distal cortex.
Dr. Moos : Do you use a body cast after completing
the operation?
Dr. Henrikson : No. All we do is apply a well-
padded posterior molded splint from the wrist to the
area over the scapula where it is fanned out rather
widely. The arm is in the position it would be when
in a sling, which is applied when the plaster is set.
Tensor bandages are used to hold the splint on the
extremity and the shoulder area. A few days later
the plaster is removed, exercises of the shoulder and
elbow are begun, and the cast and sling reapplied un-
til next physical therapy period. The plaster mold is
kept on between times for three or four weeks or until
the callus looks firm.
Dr. Nelson: Would you suggest a sling all that time?
Dr. Henrikson : Yes.
Dr. Moos : What about special exercises for these
patients ?
Dr Henrikson : While the splint and sling are off,
the patients are taught to lean over as far as possible with
the extremity hanging loosely downwards. Then in or-
der to get good shoulder action they are told to aim
the index finger at the floor and make large imaginary
O’s, X’s, and figure-of-8’s. They are told to flex and
extend the elbow and to put the wrist and fingers
through full ranges of motion many times daily. They
are up and about the day after operation and home in
a week.
Dr. Nelson: If this were associated with radial
nerve paralysis, what would you do with the nerve?
Explore it?
Dr. Henrikson: To what type of case do you refer?
A compound fracture, a simple fracture with wrist drop
or what? One should always examine the patient for
signs of nerve injury such as weakness or paralysis
or sensory changes.
Dr. Nelson: What would you do if such things were
found?
Dr. Henrikson : If 1 were going to do an open re-
duction anyway, I would surely look to see if the nerv<
were actually cut, but wouldn’t be too radical in my
search for it if the findings didn’t seem to indicate
severance from the appearance of the muscle in which
it lies. We have a patient up and around in the wards
now whose transverse fracture of the humerus I plated
several weeks ago. He had a wrist drop, but the
brachialis and brachioradialis muscles weren’t lacerated,
and I could see no signs of a cut nerve on gingerly
exploring the site. The injury to the nerve must have
been only a contusion because function and sensation
are returning nicely.
Dr. Moos : I agree with you. When you expose the
bone, and the periosteum and muscle are intact, and
you don’t see the radial nerve in front of you, you can
reasonably assume that the injury to the nerve was a
contusion and will recover.
Dr. Culligan : Would you make the same incision
if you had a radial nerve paralysis?
Dr. Henrikson: No, I wouldn”t. I would carry it
down further over the brachioradialis, then search for it
there and work upwards on it.
Dr. Hays : It is important to repair the radial nerve
early.
Dr. Henrikson : What do you mean by early repair
— immediate? Three weeks? Three months? You
know that even just exposing the nerve at the time of
open reduction will sometimes cause paralysis.
Dr. Hays : Well, that will come back.
Dr. Henrikson: Yes, that’s the point. So will most
of those associated with fractures, so shouldn’t you wait
a while in these cases to see if function won’t come
back? In compound fractures with nerve injuries, I
think the tendency is to wait three weeks or so before
suturing the nerve, although with penicillin, sulfas,
streptomycin, et cetera, maybe we need not worry about
infection as much as in the past. Some advise waiting
three or four months. The longer you have to wait, the
poorer your chances for a good result however.
Dr. Nelson: If you operate later rather than at
once, you can work in a cleaner, drier field and get
better hemostasis. I always thought that results in the
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MINNEAPOLIS SURGICAL SOCIETY
repair of the radial nerve were pretty good, but that
is not true in the repair of the median and ulnar nerves
because they are associated with the finer motions.
Dr. Henrikson : Well the question as to when is the
best time will take a long time to work out. Ten years
from now we’ll still be arguing about the same thing.
Here is a slide showing another spiral fracture. This
fracture was treated in a hanging cast. The next slides
show the alignment to be good.
Dr. Moos : It is difficult to get a good lateral x-rtfy
of the humerus when in a hanging cast.
Dr. Henrikson : This was taken through the chest
with the uninjured arm raised and the injured arm
against the plate. The following slides show how to
correct displacements when using the hanging cast.
For posterior angulation you lower the forearm by
loosening the loop around the neck. For anterior
angulation you raise the forearm by tightening the loop.
For lateral angulation you place a large rubber sponge
down by the elbow, while for medial angulation you
place the sponge high up near the axilla. For short-
ening you tie a weight in the loop of plaster beneath
the elbow. For over-pull you support the cast lightly
in a sling. The sling will also correct the occasional
tendency to subluxation of the shoulder joint.
The cast works best in the ambulatory patient in
fractures in the lower two-thirds of the humerus in-
cluding T and Y condylar fractures provided the ar-
ticular surfaces are in good alignment.
The patient must be warned not to rest the cast on
chair arms or pillows. At night the cast is hooked up
to weights attached to the plaster loops to balance it
in a comfortable position. The cast is removed in from
four to eight weeks depending on whether callus is ade-
quate to prevent displacement. A sling is used an ad-
ditional four to eight weeks as needed.
Dr. Moos : I would like to present a simple method
for handling fractures of the surgical and anatomical
neck of the humerus which occur in the older age group.
We feel that the primary purpose in treatment of these
fractures in the patient who is over forty-five or fifty
years of age is restoration of function and not com-
plicated strenuous maneuvers designed to obtain good
anatomical reduction of the fracture at the expense of
soft tissue atrophy and ligamentous contracture. We
know that practically all fractures in this region will
unite almost regardless of what position they may be
in. We also know that healing of these fractures in a
relatively poor anatomical position is often commensurate
with good function at the shoulder joint if normal liga-
ment and muscular elasticity and tone are preserved.
We also know that if you immobilize the shoulder of
any individual in the older age group, varying amounts
of limitation of motion at the shoulder joint will occur.
We have all had the experience of seeing individuals
develop almost complete limitation of motion at the
shoulder joint when for one reason or another the arm
was allowed to remain at the side for periods longer than
ten days or two weeks.
About ten years ago at Minneapolis General Hospital
a review of all cases of this type of fracture showed
rather disappointing results in terms of function at the
shoulder joint when the older individuals were con-
sidered. For that reason the time-honored methods of
traction, abduction, airplane splints and even shoulder
spicas were largely discarded in favor of a simple routine
consisting of initial immobilization in a well-fitting Vel-
peau bandage which was allowed to remain in place
only during the period of acute pain, extravasation of
blood and muscular spasm. Depending upon the severity
of the fracture, the immobilizing bandage was replaced
by a sling with a small pillow between the elbow and
chest wall in anywhere from three to ten days. At
the same time physical therapy consisting of circum-
duction exercises with some radiant heat and light mas-
sage was encouraged. The exercise was increased in
amount and duration rapidly. Care was employed not
to allow pain to be produced by the maneuver and
passive motion was strictly contraindicated. At about
four weeks, in the average fracture, the sling was
gradually discarded and the patient encouraged to begin
active abduction exercises against gravity using the
wall-ladder and shoulder-wheel. Again passive motion
was strictly forbidden, and the yardstick of pain was
used for measuring the amount of exercise permissible
at any given stage. By the eighth week all limits were
removed. We have been gratified to find that this pro-
gram has greatly simplified handling this particular
Iracture and was followed by better and earlier return
of function than when older, more conventional methods
were employed.
(A series of slides were shown demonstrating a frac-
ture of the surgical neck of the humerus, application of
ai V elpeau bandage, circumduction exercises and the use
of the wall-ladder and shoulder-wheel.)
Dr. Nelson: How long would you immobilize a frac-
ture of the surgical neck of the humerus in a person
seventy years old?
Dr. Moos : Ten days or less, depending upon the initial
severity of the acute reaction to injury.
Dr. Nelson: How many safety pins would you use
to fix a Velpeau bandage in place?
Dr. Moos : At least twenty-five to thirty safety pins.
If you do not use enough, the bandage will rapidly slip
and defeat its purpose.
Dr. Culligan : When do you start motion in the aver-
age shoulder fracture?
Dr. Moos : The maximum period during which we al-
low the shoulder to be immobile is ten days. In the
specific case the period depends on the patient, the type
of fracture and the amount of hemorrhage. I would
say the average is from seven to ten days.
Dr. Nelson : An important point in circumduction is
that the patient should be made to understand that his
arm be absolutely relaxed so that motion may actually
occur at the shoulder joint and not be scapular. We
tell these people to imagine that their hand is a stone
and their arm is a string. Then they are encouraged
to swing the stone as a pendulum. It is necessary to
reassure the patient and relieve him of fear.
Dr. Henrikson : What would you do if you had a
fracture through the anatomical neck from which the
head was dislocated? Would you take it out?
February, 1950
189
MINNEAPOLIS SURGICAL SOCIETY
Dr. Moos : 1 don’t think so. By manipulation and
the use of temporary skeletal traction a replace-
ment of the head may often be effected. Even though
the head might be upside down or in poor relation to
the shaft, results by conservative treatment and early
motion are as good in our hands as excision of the head.
I would be inclined, however, to excise the head of the
humerus if it remained in an extracapsular position
unless some other contraindication existed.
Dr. Nelson : Will you explain the lateral x-ray view
of the humerus?
Dr. Moos : This view is taken through the chest from
the opposite axilla with the good arm abducted out of
the way. As far as 1 am concerned this is the only
view of the neck of the humerus in the lateral plane
which one can readily interpret and get something out of.
Dr. Chisholm : What is your experience with the
Kuntscher intramedullary nail?
L)r. Moos: At the present time we use it in fractures
of the femoral shaft. We have not used it in frac-
tures of the humerus. I have been pleasantly sur-
prised in femoral fractures at the ease of insertion,
solidity of fixation and the freedom of motion in the
extremity which follows its use.
Dr. Nelson : There was an article or two in some re-
cent literature recommending the Kuntscher nail fixa-
tion for pathological fractures. You have a case of
pathological fracture in the femur now. Do you in-
tend to use a Kuntscher nail ?
Dr. Moos: Yes, I plan to use it as a palliative proce-
dure. Pathological fractures in the femoral shaft are
often very difficult to handle. I feel that with the use
of an intramedullary nail these fractures can be made
solid and the patient rendered much more comfortable
by freeing them from necessity of bed rest, skeletal trac-
tion and a Thomas splint. Certain pathological fractures
are associated with spasmodic muscular twitching.
This is particularly troublesome, and the fracture can
be well controlled by intramedullary fixation.
Dr. Scott: In fracture-dislocations of the elbow joint
associated with fracture of the head of the radius with
displacement, do you treat these conservatively or do you
take the head of the radius out after the dislocation has
been reduced?
Dr. Nelson : If the head of the radius is comminuted
and the elbow dislocated, I think you should operate as
soon as possible through an anterior incision, removing
the radial head. All you have to cut is the skin be-
cause the lower end of the humerus has torn through the
brachialis muscle and lies right under the skin. The
wound should be well washed out with saline, and he-
mostasis should be complete. The dislocation should
then be reduced and the operative wound closed. With
that particular treatment you obtain a good result based
on elbow motion in nine out of ten cases. If you go in
laterally on this type of case, your result will be uni-
formly bad.
Dr. Scott: If the head of the radius is not commi-
nuted but a greenstick fracture is present, what would
you do?
Dr. Nelson : Usually you can reduce a greenstick
fracture of the neck of the radius by thumb pressure.
190
If this is unsuccessful, go in through a lateral incision
and correct the deformity. Internal fixation is not nec-
essary.
Dr. McGandy : Dr. Hays has had an interesting ex-
perience at Oak Ridge, Tennessee, concerning the use of
radioactive material in healing of fractures.
Dr. Hays : I treated a man at Oak Ridge, Tennessee,
who had a fracture of the femoral shaft and several
fractures in the right forearm. These fractures were
slow in healing. It was suggested to us that some ra-
dioactive material be administered parenterally. This
was done and followed by astonishing results. The fe-
mur became quite solid within four weeks after the
treatment was begun. Further experimentation on rab-
bits definitely demonstrated greatly increased rapidity
of healing. In my case several days before the patient
was ready to be discharged, jaundice occurred. It was
the final opinion of the medical service that this may
have been due to liver damage from the radioactive
substance. For that reason no further use of the ma-
terial has been carried out.
Dr. Scott: Have any bone sarcomas occurred?
Dr. Hays : Not to my knowledge.
Dr. Webb: (Comments on American College of Sur-
geons movie concerning the treatment of fractures ) 1
first saw this film in Boston in January, and it was
generally agreed that the plaster splint shown for Colles’
fracture should be cut back to the proximal palmar
crease in order to allow proper finger motion. I think
the sugar-tong splint should be explained. When a
Colles’ fracture occurs which is unstable, it is necessary
to get a firm hold of the carpals and metacarpals dis-
tally. Proximally the ulna is fixed. However, there is
no control over the upper end of the radius unless pro-
nation and supination are prevented by carrying a sugar-
tong plaster around the elbow joint.
Dr. Chisholm : Some interesting work at the Peter
Bent Brigham Hospital has been done by Drs. Ward
and Swanson who have been studying fractures for
several years. They fractured rabbits’ and dogs' legs and
removed some of the fracture hematoma, from which a
phosphatase concentrate was made. When this was in-
stilled into other experimental fractures, acceleration
of union was noted. I believe that it has already been
used in a number of adult humeral shaft fractures with
good result.
ASSOCIATED DISEASES OF THE
SKIN AND EYE
(Continued from Page 153)
Summary
Some of the more interesting diseases that have
common ophthalmologic and dermatologic findings
have been presented. Those conditions associated
with systemic diseases, such as syphilis and tu-
berculosis, and the endocrine and metabolic dis-
turbances have been omitted, since a discussion
of these subjects is beyond the scope of this paper.
Minnesota Medicine
Clear visualization of body cavities — for the roentgen investigation of
pathologic disorders involving sinuses . . . bronchial tree . . . uterus . . .
fallopian tubes . . . fistulas . . . soft tissue sinuses . . . genitourinary tract
, . . empyemic cavities.
Iodochlorol is notably free from irritation, free-flowing, highly stable
and has pronounced radiopaque qualities. It contains the two halogens,
iodine, 27 per cent, and chlorine, 7.5 per cent, organically combined
with a highly refined peanut oil.
Iodochlorol is available in bottles containing 20 cc. of the radiopaque
medium; each one is packed in an individual carton. G. D. Searle &
Co., Chicago 80, Illinois.
Searle
RESEARCH IN THE SERVICE OF MEDICINE
Radiopaque diagnostic medium . . .
Original development of Searle research
Iodochlorol
now
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accepted
BRAND OF CHLORIODIZED OIL
February, 1950
191
Reports and Announcements ♦
♦
PRIZE ESSAY AWARD
The Board of Regents of the American College of
Chest Physicians offers a cash prize award of $250 to
be given annually for the best original contribution,
preferably by a young investigator, on any phase relating
to chest disease.
The prize is open to contestants of foreign countries
as well as those residing in the United States. The
winning contribution will be selected by a board of im-
partial judges, and the first award will be made at
the forthcoming annual meeting of the College to be
held in San Francisco, June 22 to 25, 1950.
The College reserves the right to invite the winner
to present his contribution at the annual meeting, and
to publish the essay in its official publication Diseases of
the Chest. Contestants are advised to study the format
of Diseases of the Chest as to the length, form and
arrangement of illustrations to guide them in the prep-
aration of the manuscript.
The folllowing conditions must be observed :
1. Five copies of the manuscript, typewritten in Eng-
lish, should be submitted to the office of the American
College of Chest Physicians not later than May 1, 1950.
2. The only means of identification of the author or
authors shall be a motto or other device on the title
page and a sealed envelope, bearing the same motto on
the outside, enclosing the name of the author or authors.
Additional information may be obtained from the
executive secretary of the College, 500 North Dearborn
Street, Chicago 10, Illinois.
AMERICAN GOITER ASSOCIATION
The American Goiter Association will hold a meeting
in the Shamrock Hotel, Houston, Texas, March 9, 10
and 11, 1950.
The program for the three-day meeting will consist
of dry clinics, demonstrations, and papers dealing with
goiter and other diseases of the thyroid gland.
INDUSTRIAL HEALTH CONFERENCE
The thirty-fifth annual conference of the American
Association of Industrial Physicians and Surgeons will
be held with four other groups — the American Confer-
ence of Governmental Industrial Hygienists, the Ameri-
can Association of Industrial Nurses, and the Ameri-
can Association of Industrial Dentists, at the Sherman
Hotel, Chicago, April 22-29, 1950.
More than 100 papers will be read at the eight-day
meeting, which will be the nature of a postgraduate
course. Some of the subjects to be discussed will be :
toxic effects of materials used in industry, accident
hazards, treatment of injuries, interpretation of x-rays
in industrial cases.
Additional information may be obtained from Dr. F.
W. Slobe, 425 North Michigan Avenue, Chicago, Illinois.
MINNESOTA SOCIETY OF NEUROLOGY
AND PSYCHIATRY
A special meeting of the Minnesota Society of Neurol-
ogy and Psychiatry wras at the Town and Country Club
in Saint Paul on February 7. Dr. A. Earl Walker,
professor of neurological surgery, Johns Hopkins Uni-
versity, was the guest speaker. He addressed the society
upon the subject, “Posttraumatic Epilepsy.”
E. STARR JUDD LECTURE
The seventeenth F.. Starr Judd Lecture was given
by Dr. Henry K. Beecher, Dorr Professor of Research
in Anesthesia, Harvard Medical School, on February
16 at the University of Minnesota. Doctor Beecher’s
subject was ‘‘Growth in the Field of Anesthesia: Some
Problems in the Control of Pain.”
The late E. Starr Judd, an alumnus of the Medical
School of the University of Minnesota, established this
annual lectureship in Surgery a few years before his
death.
CONTINUATION COURSES
Gastrointestinal Diseases. — A continuation course in
gastrointestinal diseases will be presented at the Cen-
ter for Continuation Study of the University of Min-
nesota on March 6 to 8. The course is intended for
general physicians and will emphasize the diagnosis and
management of disorders of the gastrointestinal tract.
Among the subjects to be considered in the course
wall be a symposium on peptic ulcer, a discussion of
the functional bow'el syndrome, and the psychosomatic
aspects of the gastrointestinal disorders, the x-ray diag-
nosis of gastrointestinal diseases, and a clinic on gastro-
intestinal disorders in pediatrics. Faculty for the course
will include clinical and full-time members of the Uni-
versity of Minnesota Medical School and the Mayo
Foundation.
Pediatrics. — The University of Minnesota announces
a continuation course in pediatrics on April 10 to 12.
This course, w'hich will be presented at the Center for
Continuation Study, is intended for physicians specializ-
ing in pediatrics and will be devoted to disorders of
metabolism and endocrine function.
Distinguished visiting physicians who will participate
as faculty members for the course are Dr. Daniel C.
Darrow, Yale University School of Medicine, and Dr.
George M. Guest, Children’s Hospital, Cincinnati, Ohio.
The remainder of the faculty for the course will be
made up of clinical and fulltime members of the staff
of the University of Minnesota Medical School and the
Mayo Foundation.
(Continued cm Page 194)
192
Minnesota Medicine
The Center Will Have Complete Facilities For:
1 ) treatment of the hemiplegic patient
2) multiple sclerosis
3) retraining of speech disorders
4) paraplegia and other paralyses
5 ) ataxias
GLENWOOD HILLS HOSPITALS
3901 GOLDEN VALLEY ROAD • MINNEAPOLIS 22, MINNESOTA
February, 1950
Offering a High Standard of Facilities for 25 Years
193
REPORTS AND ANNOUNCEMENTS
CONTINUATION COURSES
(Continued from Pagie 192)
Symposium on Hypertension. — The University of Min-
nesota announces a symposium on Elypertension to be
presented on the campus of the University of Minne-
sota on September 18 to 20 in honor of Dr. Elexious T.
Bell, Dr. Benjamin J. Clawson, and Dr. George E. Fahr.
Dr. Bell and Dr. Clawson retired from the department
of pathology in June, 1949, and Dr. Fahr will retire in
June, 1950, from the department of medicine.
A symposium on hypertension in honor of these men
is appropriate since all three have had special interest
in this disease. The symposium will bring to the Uni-
versity distinguished scientists from the United States
and broad. Support for the symposium has been pro-
vided by the Variety Club, the Mayo Foundation and
the University of Minnesota. All interested physicians
will be welcome to attend.
BLUE EARTH COUNTY SOCIETY
At the annual meeting of the Blue Earth County Medi-
cal Society in Mankato, Dr. A. A. Schmitz was elected
president of the organization.. Other officers named
were Dr. R. W. Kearney, vice president, and Dr. O. H.
Jones, secretary. All three officers are from Mankato.
CLAY-BECKER COUNTY SOCIETY
Dr. Allen Moe, Moorhead, was elected president of
the Clay-Becker County Medical Society at its meet-
ing in Moorhead on December 9. Dr. Arnold Larson,
Detroit Lakes, was named vice president, and Dr. L.
(Complete OpLtha L
Service
or ^Jh
mtc
N. P. BENSON OPTICAL CO.
Laboratories in Minneapolis
and
Principal Cities of Upper Midwest
194
H. Flancher, Lake Park, secretary-treasurer.
Principal speakers at the meeting were Dr. Lyle
French, Minneapolis, and Dr. F. C. Jacobson, Duluth.
FREEBORN COUNTY SOCIETY
Elected president of the Freeborn County Medical
Society, at its meeting in Albert Lea on December 17,
was Dr. M. O. Nesheim of Emmons. Other officers
elected included Dr. C. E. J. Nelson, vice president;
Dr. E. S. Palmerton, secretary, and Dr. R. A. Demo,
treasurer.
RED RIVER VALLEY SOCIETY
At the annual meeting of the Red River \ alley Medi-
cal Society in Crookston on December 9, Dr. Kenneth
W. Covey of Mahnomen was elected president, to
succeed Dr. George Sather, Fosston. Elected vice pres-
ident was Dr. Donald E. Pohl, Crookston, and re-
elected as secretary-treasurer was Dr. R. O. Sather,
Crookston.
ST. LOUIS COUNTY SOCIETY
At the annual meeting of the St. Louis County Med-
ical Society in Duluth on December 8, Dr. O. L.
McHaffie, Duluth, was named president-elect of the
organization, to take office in 1951.
Dr. L. R. Gowan, Duluth, will serve as president dur-
ing 1950. Dr. J. A. Malmstrom, Virginia, is the vice
president for 1950, and Dr. C. H. Christensen, Duluth,
is secretary-treasurer.
STEARNS-BENTON COUNTY SOCIETY
The January meeting of the Stearns- Benton County
Medical Society was held in St. Cloud on January 19.
The principal feature of the scientific program was a
symposium on “Fractures of the Upper and Lower Ex-
tremities” presented by Dr. Maynard C. Nelson, Dr.
Daniel J. Moos, and Dr. Earl C. Henrickson, all of
Minneapolis.
WINONA COUNTY SOCIETY
Dr. H. T. Roemer, Winona, was elected president of
the Winona County Medical Society at its annual meet-
ing in Winona on January 9. Dr. Roemer succeeds Dr.
F. J. Vollmer, Winona, in the office.
Other officers elected include Dr. Fred Roth, Lewiston,
vice president ; Dr. Hilmar Schmidt, Winona, secretary,
and Dr. Philip Heise, Winona, treasurer. The latter
two were re-elected to office.
As a result of intensive studies during the past few
years, evidence has accumulated which suggests that
histoplasmosis — formerly believed to be a rare and
usually fatal disease — also exists as a mild asymptomat-
ic syndrome which is very prevalent in certain parts of
the world. Although quite typical cases of clinical
histoplasmosis are probably much more frequent than
previously thought, the principal significance of the
asymptomatic form is that in certain respects the dis-
ease so closely resembles tuberculosis as to be fre-
quently confused with it. — Michael L. Furcolow, M.D.,
Pub. Health Rep., November, 1949.
Minnesota Medicine
TAKE THAT WINTER VACATION
7low!
FLY TO BEAUTIFUL
ACAPULCO and MEXICO CITY
Special fun-filled excursion trips from the Twin Cities
to sunny Acapulco and Mexico City aboard a luxurious
28-passenger multi-engined DC-3. Spend five, seven or
ten glorious days bathing, sunning, sight-seeing or land-
ing the big ones in the world’s most famous deep sea
fishing waters.
These are personally conducted tours but your time is
your own. All reservations, including hotels, meals and
side trips will be made for you if you desire. Total cost
of round trip transportation per person is only $137.50
(plus $2.10 for Mexican tourist visa) . Hotel accommoda-
tions in the finest hotels will cost approximately $8.00 per
day including meals.
Call or write immediately for further information. Flights are
still scheduled for March but they are filling fast so get your
reservation in early.
Ck)W Distributors Corporation
ADMINISTRATION BUILDING - HOLMAN FIELD
SAINT PAUL, MINNESOTA
♦
Woman’s Auxiliary
UNIT PLANS FOR COMING YEAR
Mrs. R. J. Dittrich
Having arrived at the mid-point of their 1949-50 period
of activity, members of the St. Louis County Medical
Auxiliary feel they can look back on a successful first
half, with more important plans for the future.
The first social event of the year was a tea planned
by Mrs. S. N. Litman and held in the home of Mrs.
L. R. Gowan. The Auxiliary entertained the wives of
new doctors, residents and interns and also honored past
presidents.
The Duluth group exceeded their quota by almost
one hundred dollars at the annual rummage sale in
October. Mrs. L. R. Gowan and Mrs. A. O. Swenson
acted as chairman and co-chairman.
Instead of the usual White Elephant party, the So-
cial Committee entertained the members with a Social
Day at the regular meeting in November. Homemade
cakes and preserves were raffled and the proceeds were
added to the philanthropic fund.
At the December Board meeting, called by the presi-
dent, Mrs. John K. Butler, the Auxiliary focused its
attention on the serious problems that concern doc-
tors’ wives these days.
AT YOUR CONVENIENCE,
DOCTOR . . .
you are cordially invited to visit our new
and modern prescription pharmacy located on
the street floor of the Foshay Tower, 100 South
Ninth Street.
With our expanded facilities we will be able
to increase and extend the service we have
been privileged to perform for the medical pro-
fession over the past years.
Exclusive Prescription Pharmacy
Biologicals Pharmaceuticals Dressings
Surgical Instruments Rubber Sundries
JOSEPH E. DAHL CO.
(Two Locations)
100 South Ninth Street, LaSalle Medical Bldg.
ATlantic 5445 Minneapolis
Beginning with the January 10 meeting at the Kitchi
Gammi Club, the Auxiliary started with a study group
at 11:30 a.m. This was patterned after the plan of
the state workshop which was held in Minneapolis last
fall. Dr. A. O. Swenson directed and acquainted them
with the current problems of medicine, and two mem-
bers led the discussion which followed. Mrs. G. A.
Hedberg and Mrs. Karl E. Johnson were moderators
for the month of January. At 12:30 luncheon was
served, during which a resume of what had been
learned at the study period was presented.
At 1 :30 the regular formal program took place which
featured a talk on interior decorating by John Wen-
dell Engstronr.
The annual dinner dance was given at the Kitchi
Gammi Club, on January 28.
Mrs. R. H. LaBree and Mrs. F. T. Becker have charge
of the program for the remainder of the year.
On Education Board
Mrs. Anderson C. Hilding, Duluth, member of the
Woman's Auxiliary to the St. Louis County Medical
Society, was appointed by Governor Luther W. Yoting-
dahl to serve a five-year term on the State Board of
Education.
Mrs. Hilding is a graduate of the University of Min-
nesota. The wife of Dr. Anderson C. Hilding, Duluth,
she is the mother of five children.
NEW OFFICERS ELECTED
Mrs. C. W. Moberg
Mrs. James Oliver, Moorhead, was elected president
of the Woman’s Auxiliary to the Clay-Becker Medical
Society for the coming year. Mrs. Thomas Buisclair,
Detroit Lakes, was elected secretary-treasurer. Mrs.
C. W. Moberg, Detroit Lakes, is the retiring president.
The Christmas sale held at the December meeting
was a success. Proceeds were given to the patients of
the Sand Beach Sanitarium to be used as spending
money.
GROUP STUDIES BY-LAWS
Mrs. I. F. Norman
A set of revised by-laws was presented to the Red
River Valley Medical Society Auxiliary at the meet-
ing of December 9, 1949. Voting on the by-laws will
be held at the annual meeting in the spring. Mrs. C.
L. Oppegaard and Mrs. J. F. Norman presented the
by-laws.
The club met at the home of Mrs. W. F. Mercil,
Crookston.
Mrs. Oppegaard discussed a pamphlet on compulsory
health insurance, “The • Voluntary Way is the American
Way.”
New members include: Mrs. R. R. Hendrickson and
Mrs. D. E. Pohl. Mrs. C. M. Adkins of Thief River
Falls was an out-of-town guest.
196
Minnesota Medicine
promotes
aeration . . . free drainage
[Nasal engorgement and hypersecretion
accompanying the common cold and sinusitis are
quickly relieved by the vasoconstrictive action of
Nasal membrane showing increased
leukocytes with denudation of cilia.
Normal appearing nasal epithelium.
NEOSYNEPHRINE
HYDROCHLORIDE
Brand of Phenylephrine Hydrochloride
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The decongestive action of several drops in each
nostril usually extends over two to four hours. The
effect is undiminished after repeated use.
Relatively nonirritating . . . Virtually no central
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Supplied in 14% solution (plain and aromatic),
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February, 1950
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197
IN MEMORIAM
BROWN &l DAY, INC
St. Paul 1. Minnesota
In Memoriam
THAYER CLINTON DAVIS
Dr. Thayer C. Davis of Wadena passed away on
November 17, 1949, at the age of sixty-two. He suf-
fered from an attack of coronary thrombosis on July
20, 1942, which had restricted his activities in recent
years.
Dr. Davis was born at Howard Lake, Minnesota,
May 5, 1887. He graduated from the University of
Minnesota Medical School in 1913 and interned at the
City and County Hospital in Saint Paul. He practiced
at Warroad, Minnesota, from 1914 to 1918 and at Glen-
wood from 1918 to 1922.
As an undergraduate he was a member of Alpha
Omega Alpha and while residing in Wadena belonged
to the Upper Mississippi Medical Society, the Minnesota
State and American Medical Associations. He was
active in civic affairs and was president of the First
National Bank of Wadena.
Dr. Davis is survived by his wife; two sons, Dr.
Thayer Davis, Jr., of Beaver Dam, Wisconsin, and
Robert Davis of Cheyenne, North Dakota; and a brother,
Dr. Thomas L. Davis of Wadena, with whom he had
been associated in practice.
JOHN CHARNLEY McKINLEY
Dr. J. C. McKinley, formerly Professor of Neuro-
psychiatry and head of the Department of Medicine
at the University of Minnesota Medical School, died fol-
lowing an illness of several years’ duration, January
3, 1950.
John Charnley McKinley was born in Duluth, Novem-
ber 8, 1891. He attended West High School in Minne-
apolis and later the Horace Mann High School in
New York City.
He attended the University of Minnesota where he
obtained the degrees of B.S. in 1915, M.A. in 1917,
M.D. in 1919, and Ph.D. in 1921. Five years of post-
graduate study in anatomy and neuropsychiatry were
taken at the university. He acquired membership in
the societies of Sigma Xi and Alpha Omega Alpha
during his student days.
Among other appointments. Dr. McKinley was sec-
retary-treasurer of the Minnesota State Board of Ex-
aminers in the Basic Sciences. Neuropsychiatry was
Dr. McKinley’s special field and he held a professor-
ship in this field at his Alma Mater.
The family’s reaction and attitudes toward the pa-
tient’s tuberculosis can have a decided effect upon the
progress of his treatment. The members of the family,
as well as the patient, need education as to the meaning
of the disease and must be particularly aware of their
role in enabling the patient to remain in the hospital
until treatment is completed.; — William B. Tollen,
Ph.D., VA Pamphlet 10-27 , October, 1948.
198
Minnesota Medicine
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199
♦
Of General Interest
The treatment of herpes zoster in the past has been
symptomatic and has consisted largely of pain-
killers. On the whole it has been highly unsatis-
factory.
For the benefit of readers who failed to see the
report by Binder and Stubbs of the dramatic results
obtained with aureomycin in the treatment of four
cases of herpes zoster, we mention their findings:
Aureomycin, in 500 mg. doses every six hours for
two days, caused marked relief from pain within
twenty-four hours in three of the four patients and
moderate relief in the fourth.
The trial of this new “wonder-drug” for this pain-
ful affliction would seem well worth while.
* * *
Dr. Richard W. Maertz, after practicing in Good-
hue for several years, has moved to Faribault and
opened offices in the Security Bank Building.
* * *
In New Prague, Dr. Charles F. Cervenka has
moved his offices into a new medical-dental office
building. Construction of the one-story building,
which was erected by Dr. Cervenka and Martin A.
Rathmanner, D.D.S., was completed last August.
Dr. Cervenka was graduated from the University
of Minnesota Medical School in 1927. Associated
with him in practice at New Prague is Dr. E. M.
Doherty, a graduate of Marquette University School
of Medicine.
* * *
Dr. Paul R. Hawley has resigned as chief execu-
tive officer of the Blue Cross and Blue Shield Com-
missions to become director of the American College
of Surgeons, effective March 1. No one has yet been
named to succeed him. Dr. Malcolm MacEachern
will become director emeritus of the American Col-
lege of Surgeons, will continue to head the hospital
standardization program and will assist with other
special activities. <
* * *
Dr. George N. Kraemer, who was formerly as-
sociated in practice with Dr. L. J. Monson of Canby,
is now located in Minneapolis where he is taking
postgraduate training under a surgical fellowship.
* * *
The University of Minnesota J. B. Johnston Lec-
ture in Neurology was given on January 31 by
Dr. Theodore B. Rasmussen, professor of surgery
and chief of the division of neurosurgery at the Uni-
versity of Chicago. The title of his address was
“Cortical Localization.” Dr. Rasmussen is the first
University of Minnesota Medical School graduate to
give the Johnston Lecture, which is presented an-
nually in honor of the former professor of neurology
and dean of the College of Science, Literature and
the Arts at the University.
Office nurses are available through the Professional
Counseling and Placement Service of the Minnesota
Nurses’ Association, at no charge to nurse or em-
ployer. References are assembled on all registrants.
Further information may be obtained by writing to
the Minnesota Nurses’ Association, 2395 University
Avenue, Saint Paul 4, or by calling NEstor 4807.
* * *
“Cutaneous Cancer” was the title of an address
presented by Dr. Henry E. Michelson, Minneapolis,
at the second annual Mid-West Cancer Conference
in Witchita, Kansas, on January 19.
* * *
The motion picture “Be Your Age,” presented by
the Metropolitan Life Insurance Company and the
American Heart Association, depicting facts about
the heart and heart disease, should be valuable in
the education of the public. It provides excellent
educational material by showing, for example, the
response of the heart to strenuous exercise in youth
as compared to that in older age groups, and by
pointing out the favorable results from proper re-
striction of activities by persons suffering from
heart impairment.
* * *
Fishermen’s College. — The following article, about
a member of the Minnesota State Medical Associa-
tion, appeared in a recent issue of the Medical Pocket
Quarterly and is reprinted here since it definitely seems
to be “of general interest.”
Fishermen — Take Notice
Dr. Herman Linde, Minneapolis Coll. P. & S. ’05, of
Cyrus, Minn., is not only a most competent physician,
but is the head of the first and only Fishermen’s College
in the world.
Dr. Linde, dean of the institution, got the idea for
such a college in 1939. He said that during hard times
people were doing everything for everybody except the
poor fisherman. “He was a forgotten man.” So he
started to do something about it. He founded this college
which now has 1,568 members. Its diploma reads:
“This certifies that '(blank) is thoroughly educated in
the art and science of fishing and that he has a profound
knowledge of scientific ichthyology and piscatorial meta-
physics . . .”
One unique feature is that the Fishermen’s College
confers the degree of Doctor Piscator, summa cum laude,
before the examination is held. And there is a reason.
Some of the questions are — “How long can a whale hold
his breath under water?” “Did your great grandma ever
go angling?” “Define piscatorial psychosis.” “Does a
New Dealer catch more fish than a Republican?” “How
many scales has a 2,500 lb. devil fish ?” “On what day did
God create the fishes?” et cetera. There are thirty-eight
questions, winding up with “What is a straight fish
line?” He asks that the answers “possess clarified con-
ciseness, a compacted comprehensibleness, a coalescent
consistency, and a concentrated cogency.”
One interesting thing about the college is that a gradu-
ate is sure to get a diploma, which is similar to the
(Continued on Page 202)
200
Minnesota Medicine
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201
OF GENERAL INTEREST
(Continued from Page 200)
diplomas of educational institutions and signed by the
professors in various departments, which are “Bigger
and better fish,” “Original fish stories,” “How to avoid
the game warden,” and “Piscatorial prognostication” and
several others.
A man who sends a dollar to Dr. Linde with the
request to join the institution will receive the diploma
with the degree, and can let his conscience be his guide
about answering the questions.
Among the graduates are McKenzie King, late Premier
of Canada, Secretary of State Dean Acheson Gover-
nors George T. Mickelson of South Dakota; Val Peter-
son of Nebraska and Youngdahl of Minnesota; King
Haakon of Norway, as Dr. Linde was born in Norway,
and a great number of other dignitaries.
At the last banquet 260 people were present and
Governor Youngdahl was the speaker.
* * *
Dr. F. W. Wittich, Minneapolis, presented a paper
entitled “The Influence of Antihistamine Agents on
Passive Transfer Wheals” at a meeting of the
American College of Allergists in St. Louis on Janu-
ary 16, 17 and 18.
* * *
An institute to explore the application of new
techniques of information services to the field of
health education was held at the University of Min-
nesota Center for Continuation Study on January
12 and 13. The institute was presented in co-opera-
tion with the University School of Public Health,
the Audio-visual Education Service, the School of
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* * *
Among Minnesota physicians attending a post-
graduate course on diseases of the blood, held at
the Medical College of Alabama early in December
and sponsored by the American College of Physi-
cians, were Dr. Bernhard J. Cronwell, Jr., Austin,
and Dr. Donald C. Campbell, Rochester.
* * *
Dr. Robert B. Engstrom, formerly of Minne-
apolis, has opened offices for the practice of medicine
in Mankato. A graduate of the University of Illi-
nois College of Medicine in 1939, Dr. Engstrom
served his internship and a surgical residency at
St. Luke’s Hospital, Chicago. He then conducted a
general practice in Michigan City, Indiana, for three
years, after which he moved to Minneapolis and be-
came associated with the Nicollet Clinic for four
years. He has taken postgraduate work at the Uni-
versity of Minnesota.
* * *
It was announced in December that Dr. W. J.
Hruza of Minneapolis planned to move to Madelia
to become associated in practice with Dr. H. E.
Coulter of that city. A graduate of the University
of Minnesota Medical School in 1943, Dr. Hruza
served in the Navy for two years during World War
II. For the past three years he has been a surgical
resident at Swedish Hospital, Minneapolis.
* * *
A bequest of almost one-half million dollars was
presented to the University of Minnesota on Decem-
ber 23 to be used for medical research. The bequest
was from the estate of the late Silas McClure, Min-
neapolis businessman who died on February 16, 1949.
Total value of the bequest was $482,304. Mr. Mc-
Clure, who had previously given other medical re-
search funds to the University, was the originator
of the Monarch kitchen range and until his retire-
ment in 1944 was president of the Electric Machinery
Manufacturing Company, Minneapolis.
* * *
Dr. D. O. Osborn has become associated in prac-
tice with Dr. Oliver W. Roberts in Owatonna. A
graduate of the University of Nebraska, Dr. Osborn
interned at Grace Hospital, Detroit, Michigan. He
has practiced medicine at Omaha, Nebraska, and
has served in the Army for the past two years.
* * *
In the middle of December, Dr. and Mrs. Oliver W.
Anderson, of Luverne, and their two sons left for a
one-month vacation trip through the southern part
of the United States.
* * *
Dr. Jermyn F. McCahan, medical director of
Bausch & Lomb Optical Company since 1941, has
been named assistant to Dr. Carl M. Peterson, secre-
tary of the AMA Council on Industrial Health. In
his new assignment Dr. McCahan will travel ex-
tensively, visiting numerous industries throughout
the United States.
202
Minnesota Medicine
OF GENERAL INTEREST
THE FOURTH OF A SERIES
We are using the opportunity afforded by the advertising
facilities of Minnesota Medicine to discuss Municipal
securities for investment of your savings.
Investors usually buy municipal securities for safety, steady and tax
free income, and very seldom trade or sell. Generally there is no
listed market on Municipals since there is no continuing supply of
particular issues except a few of the larger municipalities such as
New York City, Philadelphia, Los Angeles, etc., where a floating
supply is usually available. It is in the nature of an unlisted market
and while not generally known, daily volume in Municipal trading
and selling exceeds that of corporate bond trading on the New York
Stock Exchange. We make bids or furnish appraisal prices on any
municipal securities.
Prices and yields for municipal bonds are based on the general con-
dition of the money market, the length of time to maturity, geograph-
ical location and other factors. It is our established policy never to
sell a municipal security to our clients which under similar personal
financial conditions any one of us would not buy for our own invest-
ment. Our offering circulars are prepared giving detailed informa-
tion on all securities offered.
JURAN & MOODY
MUNICIPAL SECURITIES EXCLUSIVELY
TELEPHONES GROUND FLOOR
St. Paul: Cedar 8407, 8408, 3841 Minnesota Mutual Life Bldg.
Minneapolis: Nestor 6886 St. Paul 1, Minnesota
Dr. Gordon R. Kamman of Saint Paul has been
appointed chief of the neuropsychiatric service at
Ancker Hospital, Saint Paul.
=k * *
Chairman of the 1950 Heart Campaign in' Crow
Wing County is Dr. Francis J. Schnugg of Brainerd.
* * *
Emergency diphtheria immunization clinics were
set up at two Minneapolis schools on January 18
by Minneapolis Health Department and school of-
ficials. It was announced by Dr. F. J. Hill, com-
missioner of health, that thirty-two of the thirty-nine
cases of diphtheria in the city from January 15,
1949, to January 15, 1950, occurred in the area in
February, 1950
which the two schools are located. Dr. Hill stated
that the deaths of two children in the previous week
were “needless" and that diphtheria could be almost
entirely prevented through immunization. Parents
were urged to bring preschool children to the clinics
and to sign release forms for school children to per-
mit immunization.
^ ^
Dr. L. McKenzie Gross, formerly of Provo, Utah,
has become a staff member of the Fergus Falls State
Hospital. A graduate of the University of Tennessee
Medical School, Dr. Gross lias been associated with
two state hospitals in Tennessee as well as one in
Provo.
203
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It was announced on December 16 that Dr. A. D.
Hoidale, a practitioner in Tracy for forty-five years,
had sold his interest and equipment at the Tracy
Medical Clinic to Dr. Lyle M. Benson of that city.
As a result Dr. Benson became the new partner of
Dr. W. G. Workman in the clinic.
Dr. Hoidale, however, continues to own jointly
with Dr. Workman the clinic’s hospital building,
where he intends to maintain his practice in the
future, occasionally relieving Dr. Benson and Dr.
Workman at the clinic.
Immediately after the announcement of the trans-
action, Dr. and Mrs. Hoidale left for Tucson, Ari-
zona, where they planned to spend the winter.
* * *
During 1949, Health District 5, comprising thirteen
counties, lost nine practicing physicians, Dr. Helen
B. Wolff of Worthington, district director, reported
early in January. That left one physician for every
1,700 persons, as compared with 1,600 in 1948. The
proportion varied from one physician per 2,800 per-
sons in Redwood County to one per 1,200 in Yellow
Medicine County.
Dentists remained practically constant in number,
with an average ratio of one per 1,850 persons. The
range, however, extended from one dentist per 5,020
persons in Murray County to one per 1,438 in Lyon
County.
With only ten of the thirteen counties in the dis-
trict reporting on the availability of nurses, regis-
tered nurses decreased during the past year by
fourteen, and practical nurses gained by fifty-five.
Full-time public health personnel in the district rose
from fifteen in 1948 to 23 in 1949.
* * *
Dr. Robert D. Semsch, Minneapolis, has been re-
appointed Hennepin County physician for 1950.
* * *
Litchfield acquired another physician on January 1
when Dr. Wayne A. Chadboum became associated
in practice with Dr. Harold E. Wilmot, Dr. Cecil A.
Wilmot and Dr. Donald E. Dille of Litchfield. A
graduate of the Liniversity of Minnesota Medical
School in 1943, Dr. Chadbourn served overseas in
the Army during World War II. Following his
term of service, he took postgraduate work at the
University of Minnesota and at Abbott Hospital,
Minneapolis.
* * *
Construction of a one-story medical office build-
ing began in Grand Rapids early in January. Own-
ers of the new structure will be Dr. Gordon M.
Erskine and Dr. Clarence R. Ferrell, whose offices
were destroyed in a recent fire. Completion of the
building is expected during March.
* * *
Retirement of Dr. Brand A. Leopard, Albert Lea,
was announced in December. After practicing in
Albert Lea for eighteen years, Dr. Leopard planned
204
Minnesota Medicine
OF GENERAL INTEREST
to retire in March or April and move to his home
in Brownsville, Texas.
A graduate of the University of Minnesota, Dr.
Leopard began his medical practice in New Rich-
land. Later he took postgraduate work in surgery
at the LTniversity of Pennsylvania, then practiced as
a group surgeon in Evanston, Illinois. Eighteen
years ago he moved to Albert Lea, where he has
since practiced. Always civic minded, he has been
a member of numerous city, medical and fraternal
organizations. His retirement is caused by ill health.
* * *
Specialized training in psychiatry will be given to
Minnesota mental hospital physicians, Governor Lu-
ther Youngdahl announced on January 6. The state
physicians will receive a week of training at the
Mayo Clinic’s psychiatric section in Rochester. Cred-
it for paving the way for the program was given to
Dr. Francis J. Braceland, head of the psychiatric
section of the Mayo Clinic and co-consultant in
psychiatry to the Minnesota Division of Public
Instruction.
* * *
Dr. Harold C. Habein, of the section on internal
medicine of the Mayo Clinic, Rochester, was mar-
ried on December 23 to Mrs. Margaret H. Webb
of Wabasha.
jfc
“The Pathologist and Law Enforcement’’ was the
title of a talk given by Dr. Arthur H. Wells, Du-
luth, at a meeting of the Exchange Club in Duluth
on January 4.
Dr. Donald M. Houston has been chosen as the
Park Rapids school physician for the present school
year. 1 he office is a new service in Park Rapids,
where it is planned to have the position rotate among
the local physicians, each serving one year.
* * *
A mass chest x-ray survey will be held in Mower
County starting in March. The survey will last nine
weeks and will be conducted by technicians from
the Minnesota Department of Health in two mobile
x-ray units.
* * *
January 1, 1950, marked the fiftieth wedding anni-
versary of Dr. and Mrs. Arthur E. Benjamin of
Minneapolis. The physician and his wife celebrated
the event at a dinner attended by their four children,
among them Dr. Harold G. Benjamin and Dr. Edwin
G. Benjamin, both of Minneapolis.
* * *
Among Minnesota physicians who attended a con-
tinuation course in obstetrics at the University of
Minnesota in the middle of December were Dr.
Bernice Thoresen, South Saint Paul; Dr. Peter J.
Kitzberger, New Ulrn and Dr. Robert A. Murray
Hibbing.
* * *
A total of 110 physicians, dentists and nurses at-
tended the final meeting on December 14 of the
eight-week seminar on heart disease, cancer and
psychosomatic medicine held in Fergus Falls. The
principal speaker at the last of the weekly meetings
was Dr. Roger Howell, associate professor of neuro-
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205
OF GENERAL INTEREST
psychiatry at the University of Minnesota Medical
School.
* * *
Work on a new medical clinic building in Oklee
was nearing completion early in January, and it was
expected that the structure would be ready for op-
eration by the end of the month. In the meantime
Dr. F. L. Behling, newly arrived physician in the
village, was using his residence as a temporary office.
The clinic building was financed by donations from
local businessmen, farmers and the village. Total
cost for the building and equipment was estimated
at $33,000.
* * *
Early in January Dr. Henry Van Meier of Still-
water attended a course on cardiovascular diseases
at the University of Minnesota Center for Continua-
tion Study.
* * *
Dr. John S. Lundy, chief of the section on anes-
thesiology at the Mayo Clinic, was honored on De-
cember 4 at a dinner in Rochester on his twenty-
fifth anniversary in Rochester. More than 100 per-
sons, many of them former associates who returned
to Rochester for the event, attended the affair. Dr.
Ralph Knight, Minneapolis, presented Dr. Lundv
with a silver tray inscribed with the names of more
than 250 of his former students. Said Dr. Knight:
“The tray is a memento of our gratified feeling for
the wisdom we received from you over a period of
twenty-five years.”
Dr. George L. Loomis, Winona, presented a paper
at the meeting of the Minnesota Academy of Oph-
thalmology and Otolaryngology in Saint Paul on
December 9. Dr. Loomis discussed the histamine
treatment of Bell’s palsy.
* * *
“Foundations for Better Health and Physical Fit-
ness” was the title of a talk presented by Dr. Ralph
J. Eckman, Duluth, at a meeting of the Parent-
Teachers Association at Jefferson School in Duluth
on December 13.
* * *
Dr. Leo G. Rigler, director and professor of radi-
ology and physical medicine at the University of
Minnesota, has been named national vice president
of the American Friends of the Hebrew University.
* * *
Minnesota’s new mental health commissioner is
Dr. Ralph Rossen, superintendent of the Hastings
State Hospital for many years. Announcement of
his appointment to the newly created post, which
became effective on January 1, was made on Decem-
ber 15 by Governor Luther Youngdahl, who issued
a two-page tribute praising the abilities and qualifi-
cations of the physician. Selection of Dr. Rossen
was made by the governor and a -professional ad-
visory committee of physicians.
* * *
Dr. O. L. Peterson of Cokato was honored at
ceremonies held in the Cokato school auditorium
on December 29. The meeting, to pay tribute to
206
Minnesota Medicine
OF GENERAL INTEREST
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Dr. Peterson for his years of service, was sponsored
by the Cokato Association and was attended by nu-
merous residents of the city and surrounding area.
Dr. Peterson, who is seventy-eight years of age,
is a graduate of the University of Minnesota Medical
School.
* * *
Principal speaker at a meeting of -the Minnesota ',
Society for the Prevention of Blindness and Conser-
vation of Vision, held in Mankato on December 14,
was Dr. Frank E. Burch of Saint Paul.
* * *
At a meeting in the Mayo Clinic, Rochester, on
December 7, members of the Association'of Fellows
elected Dr. Robert W. Jampolis, president, Dr. Don-
ald K. Buffmire, vice president, and Dr. Walter S.
Phares, secretary.
* * *
Dr. Burton Grimes, superintendent of the St. Peter
State Hospital, was the main speaker at a meeting
of the Nicollet Parent-Teachers Association in Nic-
ollet on December 14. Dr. Grimes discussed aspects
of mental health.
* * *
It was announced on December 30 that Dr. W. E.
Macklin of Mankato had accepted the position of
radiologist at the Rice Hospital.
Dr. Macklin practiced medicine at Litchfield from
1931 to 1943, when he joined the Navy and served
in the radiology department at the National Naval
Medical Center in Bethesda, Maryland, for two and
one-half years. Following his release to inactive
duty, he took postgraduate work in his specialty at
the University of Minnesota. For the past three
years he has been radiologist at the Mankato Clinic.
* * *
Dr. Francis J. Braceland and Dr. Donald W.
Hastings were appointed early in December to serve
as consultants to the division of public institutions
in the development of Minnesota’s mental health pro-
gram. Dr. Braceland is head of the psychiatric
section of the Mayo Clinic, and Dr. Hastings is pro-
fessor of psychiatry and neurology at the University
of Minnesota.
* * *
“Cancer and What You Can Do About It’’ was the
title of a talk presented by Dr. O. G. McDonald,
Duluth, at a joint meeting of the Duluth Veterans
of Foreign Wars auxiliaries’ cancer workers on
December 7.
ifc ifc ;ji
Announcement of the election of four new trustees
of the Minnesota Medical Foundation was made
on December 13. Elected for four-year terms were
Dr. Karl W. Anderson, Minneapolis, clinical associ-
ate professor of medicine at the University of Min-
nesota; Dr. E. T. Bell, Minneapolis, professor
emeritus of pathology at the University, and Dr.
Vernon Smith, Saint Paul. Elected for one year to
fill an unexpired term was Dr. George N. Aagaard,
February, 1950
207
OF GENERAL INTEREST
director of postgraduate medical education and as-
sociate professor of medicine at the University.
* * *
According to plans announced during the middle
of January, the newly constructed Pine River Clinic
was expected to be open by the end of the month.
The one-story modern-design building will house
the offices of Dr. C. M. Zeigler and Dr. A. T. Ro-
zycki of Pine River.
* * *
On December 16, Dr. Alfred M. Ridgway of An-
nandale was honored at a surprise gathering by the
Annandale Odd Fellow and Rebekkah lodges. After
tribute had been paid to him in several talks, Dr.
Ridgway was presented with a special emblem of
the order. He has beqn a member of the Annandale
Odd Fellow lodge for fifty-seven years.
* * *
Dr. George Janda, who was associated with the
Medico-Dental Clinic in Bertha during the past
year, left on January 1 to begin a four-year period
of postgraduate training in obstetrics and gynecology
at the University of Minnesota Hospitals.
* * *
Dr. George W. Drexler of Blue Earth has been
appointed president of the Faribault County Heart
Association for 1950.
* * *
Members of the Warren hospital and clinic staff
were entertained at a dinner in Hotel Warren on
December 20. Hosts and hostesses for the evening
were Dr. and Mrs. C. H. Holmstrom, Dr. and Mrs.
A. B. Nietfeld, and Dr. and Mrs. E. E. Pumala, of
Warren. Included in the program for the evening
were messages of appreciation from each of the
physicians.
* * *
Dr. Albert M. Snell, a member of the Mayo Clinic
staff since 1924, has resigned his position as head of
a section in medicine and has moved to Palo Alto,
California, to enter private practice and to become
associated with the Palo Alto Clinic.
A graduate of the University of Minnesota Medical
School, Dr. Snell practiced at the Mankato Clinic
from 1920 until he joined the Mayo Clinic in 1924.
During World War II, Dr. Snell served in the Navy
from 1941 to 1943, much of the time on a hospital
ship in the Pacific area. He then returned to Roch-
ester for six months, after which he served as
chief of the medical service at the Naval hospital
in Oakland, California. He was finally separated
from active duty in 1946.
* * *
It was announced on December 22 that Dr. Keith
D. Larson of Minneapolis had moved to Howaid
Lake and planned to open offices for the practice of
medicine shortly after January 1. He had made ar
rangements to purchase the office building, equip-
ment, residence and land of the late Dr. Leonard
Harriman of Howard Lake.
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Miller Vocational High School. VOCATIONAL NURSES |
always in demand. |
EXCELLENT CARE TO CONVALESCENT AND
CHRONIC PATIENTS |
Rates Reasonable. Patients under the care of their own physicians, |
who direct the treatment. |
5511 Lyndale Ave. So. LO. 0773 Minneapolis, Minn. |
~iiiMiiiiiiiiiiiiiiiiiiiiiimi:iiiiiiiimiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiimiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiimmiiiiii iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiMtiiiiiii i min i ii i ii i imii'iMii i iiiiiii i iii iii iiiiiiiiiii>~
Homewood hospital is one of the
Northwest's outstanding hospitals for the
treatment of Nervous Disorders — equipped
with all the essentials for rendering high-grade
service to patient and physician.
Operated in Connection with
Glenwood Hills Hospitals
HOMEWOOD HOSPITAL
Corner Penn and Plymouth Avenues North
Minneapolis Minnesota
208
Minnesota Meutcine
OF GENERAL INTEREST
Dr. R. J. Wilkowske of Owatonna has been named
chairman of the 1950 Heart Campaign for Steele
County. ‘
* * *
At a meeting of the northern St. Louis County
Public Health Activities Committee in Virginia on
December 10, Dr. Mario Fischer, Duluth, acting
county health officer, discussed a reorganization
plan for the city council health unit.
* % Jji
After practicing at Lake Benton for the past three
and one-half years, Dr. Albert M. Limburg has
moved his offices to Wilmont to conduct his practice
there.
jjl
Dr. Albert E. Krieser, Mankato, will head the
state’s new tuberculosis control program, it was an-
nounced by Carl J. Jackson, state director of public
institutions, on December 21. Dr. Krieser, who
served in the Army for five years in World War II,
has been associated with the state sanatorium at Ah-
Gwah-Ching and has been tuberculosis consultant at
the St. Peter State Hospital. His headquarters in
his new position will be at Anoka State Hospital,
where a new tuberculosis unit is being set up.
* * *
“The Recent Trend of Psychiatry” was the title
of a talk given by Dr. A. H. Langhoff of Mankato
at a meeting of the Mankato Registered Nurses
Club on December 12.
* * *
Dr. Henry Goss of Glencoe was the principal
speaker at a meeting of hospital, public health and
other registered nurses in Glencoe on December 9.
Dr. Goss spoke on “Care of the Mother and New-
born Infant.”
* * *
Four Mayo Clinic fellows received awards for
superior quality graduate theses at the annual staff
meeting on December 21. The four who received
the awards were Dr. B. E. Taylor, Dr. A. B. Taylor,
Dr. W. B. Martin and Dr. D. S. Childs.
* * *
The Willmar State Hospital acquired a new staff
physician during December when Dr. Robert B.
May arrived in the city to begin his duties at the
hospital. Dr. May is the former superintendent of
the Eastern Shore State Hospital, Cambridge, Mary-
land.
* * *
Dr. Elmer J. Martinson, son of Dr. Carl J. Martin-
son of Wayzata, has opened offices for the practice of
surgery in the Martinson Clinic Building. A graduate
of the College of Medical Evangelists, Los Angeles, Dr.
Martinson interned at Minneapolis General Hospital, then
served in the Army for several years. Following this he
completed a fellowship in surgery at the University of
Minnesota. He has been a resident surgeon at Min-
neapolis General, Minneapolis Veterans and Fargo Vet-
erans Hospitals.
Cook County Graduate School of Medicine
ANNOUNCES CONTINUOUS COURSES
SURGERY — Intensive Course in. Surgical Technique,
two weeks, starting February 20, March 20.
Surgical Technique, Surgical Anatomy and Clinical
Surgery, four weeks, starting February 6, March 6.
Basic Principles in General Surgery, two weeks, start-
ing April 3.
Personal Course in General Surgery, two weeks, start-
ing April 17.
Surgery of Colon and Rectum, one week, starting
March 6, April 10.
Esophageal Surgery, one week, starting June 5.
Breast and Thyroid Surgery, one week, starting June
26.
Thoracic Surgery, one week, starting June 12.
Gallbladder Surgery, ten hours, starting April 24.
Fractures and Traumatic Surgery, two weeks, starting
March 20.
GYNECOLOGY — Intensive Course, two weeks, starting
February 20, March 20.
Vaginal Approach to Pelvic Surgery, one week, start-
ing March 6.
OBSTETRICS — Intensive Course, two weeks, starting
March 6, April 3.
PEDIATRICS — Intensive Course, two weeks, starting
April 3.
Personal Course in Cerebral Palsy, two weeks, start-
ing July 31.
MEDICINE — Intensive General Course, two weeks, start-
ing April 24. Electrocardiography and Heart Dis-
ease, four weeks, starting March 13.
Hematology, one week, starting May 8.
Gastro-enterology, two weeks, starting May IS.
Liver and Biliary Diseases, one week, starting June 5.
Gastroscopy, two weeks, starting March 6, May 15.
DERMATOLOGY — Formal Course, two weeks, starting
May 8. Informal Clinical Course every two weeks.
UROLOGY — Intensive Course, two weeks, starting April
Cystoscopy, Ten-day Practical Course, every two
weeks.
General, Intensive and Special Courses in all Branches of
Medicine, Surgery and the Specialties
TEACHING FACULTY— ATTENDING
STAFF OF COOK COUNTY HOSPITAL
Address: REGISTRAR, 427 South Honore Street
Chicago 12, Illinois
February, 1950
209
OF GENERAL INTEREST
1909. ...1950
Physiotherapy for the relief
of Arthritis and related con-
ditions. Complete physical
examinations and laboratory
procedures given every pa-
tient. Roy T. Pearson,
M.D., Medical Director. B.
F. Pearson, M.D., associate.
U. S. Hwy. 212
anitarium
ACCIDENT • HOSPITAL • SICKNESS
INSURANCE
FOR PHYSICIANS, SURGEONS, DENTISTS EXCLUSIVELY
ML f FHYSIC,ANS\
> PREMIUMS )>( SURGEONS
COME FROM \ DENTISTS J
CLAIMS X
$5,000.00 accidental death
$25.00 weekly indemnity, accident
and sickness
$10,000.00 accidental death
$ 50.00 weekly indemnity, accident
and sickness
$15,000.00 accidental death
$ 75.00 weekly indemnity, accident
and sickness
$20,000.00 accidental death
$ 100.00 weekly indemn ty, accident
and sickness
Cost has never exceeded amounts
ALSO HOSPITAL POLICIES FOR
WIVES AND CHILDREN AT
ADDITIONAL COST
$8.00
Quarterly
$16.00
Quarterly
$24.00
Quarterly
$32.00
Quarterly
shown.
MEMBERS
SMALL
85c out of each $1.00 gross income used for
members’ benefits
$3,700,000.00 $16,000,000.00
INVESTED ASSETS PAID FOR CLAIMS
$200,000.00 deposited with State of Nebraska for protection of our members.
Disability need not be incurred in line of duty — benefits from
the beginning day of disability
PHYSICIANS CASUALTY ASSOCIATION
PHYSICIANS HEALTH ASSOCIATION
48 years under the same management
400 First National Bank Bldg., Omaha 2, Nebr.
HOSPITAL NEWS
Following are the results of various hospital staff
elections recently held in Minnesota.
Immanuel Hospital, Mankato. — Dr. G. E. Penn,
president; Dr. R. G. Hassett, vice president; Dr.
O. H. Jones, secretary. All were re-elected to
office. Named to the executive committee were Dr.
P. G. Hoeper, Dr. H. J. Nilson and Dr. F. W.
Franchere.
Asbury Hospital, Minneapolis. — Dr. Alfred N. Bes-
sesen, president; Dr. H. A. Alexander, vice presi-
dent; Dr. Richard S. Rogers, secretary-treasurer.
Dr. Stanley R. Maxeiner was elected to the medical
advisory board to serve with Dr. Ann W. Arnold,
Dr. Roscoe C. Webb, and Dr. Charles H. McKenzie.
St. Joseph Hospital, Mankato. — Dr. J. A. Butzer,
president; Dr. O. H. Jones, vice president; Dr. A. A.
Schmitz, secretary-treasurer. Reappointed to the
executive board were Dr. M. I. Howard, Dr. A. E.
Sohmer and Dr. J. A. Butzer.
Abbott Hospital, Minneapolis. — Dr. Orwood J.
Campbell, president; Dr. John Haugen, vice presi-
dent; Dr. Walter Hoffman, secretary.
Miller Hospital, Duluth. — Dr. M. G. Fredericks,
chief of staff; Dr. Earl Barrett, vice chief of staff;
Dr. Henry Jeronimus, secretary-treasurer. Named
to the executive committee were Dr. Karl Johnson,
Dr. Kenneth Teich and Dr. Mario Fischer (ex-offi-
cio member).
St. Cloud Hospital, St. Cloud. — Dr. N. F. Musa-
chio, chief of staff.
St. Gabriel’s Hospital, Little Falls. — Dr. E. J.
Simons, president; Dr. D. L. Johnson, vice president;
Dr. R. J. Stein, secretary. Named to the executive
committee were Dr. J. T. Laughlin, Dr. G. M. A.
Fortier and Dr. E. G. Knight.
Swedish Hospital, Minneapolis. — Dr. J. S. Milton,
president; Dr. Harold T. Gustason, vice president,
and Dr. Stanley Lundblad, secretary-treasurer.
Eitel Hospital, Minneapolis. — Dr. James A. Blake,
chief of staff; Dr. Alton C. Olson, assistant chief of
staff; Dr. Melvin B. Sinykin, secretary. All were
re-elected to office.
* * *
Four new medical staff members of Fairview Hos-
pital, Minneapolis, were named by the hoard of di-
rectors at a meeting on December 20. They are
Dr. Loren J. Larson, Dr. Albert J. Schroeder, Dr.
Harold S. Ulvestad and Dr. Harold G. Worman.
* * *
The Ramsey County Welfare Board voted on De-
cember 13 to retain the services of seven teaching
medical men at Ancker Hospital, Saint Paul, but it
postponed decision on where to get money to pay
them. In the past the men were financed by the
University of Minnesota. However, the L^niversity
had announced that it was withdrawing its support
beginning July 1 because of new arrangements with
Minneapolis Veterans Hospital. Since eliminating
the services of the men would greatly curtail the
activities of Ancker as a teaching hospital, the board
decided it would have to find $10,050 to finance the
men for the last half of the year.
210
Minnesota Medicine
OF GENERAL INTEREST
The Birches Sanitarium, Inc.
2391 Woodland Avenue
Duluth 3, Minnesota
A hospital for the care and treatment of
Nervous and Mental disorders. Quiet, cheer-
ful environment. Specially trained personnel.
Recreational and occupational therapy.
Psychiatrists in Charge
L. R. Gowan, M.D. L. E. Schneider, M.D.
REST HOSPITAL
2527 Second Avenue South, Minneapolis
A quiet, ethical hospital with therapeutic facilities
for the diagnosis and treatment of nervous and
mental disorders. Invites co-operation of all repu-
table physicians. Electroencephalography avail-
able.
PSYCHIATRISTS IN CHARGE
Dr. Hewitt B. Hannah
Dr. Andrew J. Leemhuis.
BLUE CROSS-BLUE SHIELD NEWS
January 10, 1950
TO : Participating Doctors of Minnesota Medical
Service Inc.
My dear Doctor :
Apparently there has been some dissatisfaction and
misunderstanding on the part of some doctors regarding
certain features of Blue Shield and Blue Cross. So,
it occurred to me that a few words of explanation
should prove of benefit to both the doctors and the or-
ganizations.
In principle, insurance serves as a protection from a
major loss. Only rarely does it fully reimburse the in-
sured for the total loss. This feature is almost uni-
versally seen in automobile insurance in which the
insured is reimbursed for the balance of $25 or $50. In
other words, were it not for this principle, that is
reimbursement of part but not all of the cost or loss,
insurance would be an investment rather than a safe-
guard against extensive loss.
Yet, it is this feature of medical care insurance that
is causing the misunderstanding in the minds of many
physicians. General practitioners complain that medical
insurance does not cover office and house calls ; various
specialists are unhappy because their full fees for each
service are not covered ; and both family doctors and
specialists are dissatisfied that all diagnostic services,
such as x-rays especially, are not covered in the policies.
It is the full coverage features among other things
which have cost the British and European health
insurance programs so excessively. It is the full cover-
age feature of Compulsory Health Insurance in this
country that will either bankrupt the government or
lead to some form of collectivism. In other words, full
coverage medical and hospital care is only possible at
exorbitant cost to its underwriters.
In the present instance, x-ray fees and services are
causing difficulty. In a recent analysis of Blue Shield
contracts, Minnesota’s was found more liberal in x-ray
services. Beyond this, administrative personnel and the
Boards of Directors are liberal in consideration of x-ray
services whenever liberality is possible. Despite these
facts, diagnostic x-ray services and hospitalization of
patients solely for the purpose of having x-ray serv-
ices paid for by either Blue Shield or Blue Cross are
working hardships upon the organizations.
LTnless it is possible to reduce costs of diagnostic x-ray
services or hospitalization 'solely for x-ray services,
the end-point could be either insolvency or raising the
premiums. Blue Shield has paid over a million dollars
for medical care and Blue Cross over eight million dol-
lars for hospital care during the past year. From the
contract holder’s viewpoint much money has been saved
him. From the doctor’s and hospital’s viewpoint it is
reasonable to assume that more bills have been paid
than would have been paid were the patients not insured
under either or both Blue Cross and Blue Shield. Add
to this the fact that these organizations provide a
program by which the American people can preserve
for themselves free choice of physician and the other
February, 1950
211
OF GENERAL INTEREST
RELIABILITY!
For years we have maintained the
highest standards ol quality, expert
workmanship and exacting conform-
ity to professional specifications . . .
a service appreciated by physicians
and their patients.
ARTIFICIAL LIMBS, TRUSSES,
ORTHOPEDIC APPLIANCES,
SUPPORTERS, ELASTIC HOSIERY
Prompt, painstaking service
Buchstein-Medcalf Co.
223 So. 6th St. Minneapolis 2; Minn.
principles of American medicine which have given them
the lowest death rate and the highest level of health
of any comparable population in the world.
So, it seems not without reason to plead co-operation
in minimizing x-ray fees for diagnosis and especially
hospitalization merely to cover diagnostic x-ray services.
Such co-operation would be a distinct contribution to
the continued success of both Blue Shield and Blue
Cross, as well as a thorn in the flesh of those advo-
cating compulsory sickness insurance.
Yours very truly,
Edwin J. Simons, M.D.
Chairman, Medical Adznsory Committee
Minnesota Medical Service, Inc.
RADIUM RENTAL SERVICE
2525 INGLEWOOD AVENUE
MINNEAPOLIS 5, MINNESOTA
TEL. ATLANTIC 5297
Radium element prepared in
type of applicator requested
ORDER BY TELEPHONE OR MAIL
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tjoocL UiddotL Al (pteatiUA.
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Don't just buy eye glasses, but eye care . . .
Consult a reliable eye doctor and then . . .
Let Us Design and Make Your Glasses
J^vdihj /lJiI fi& tnicu J
Dispensing Opticians
25 W. 6th St. St. Paul
CE. 5767
Tuberculosis is not a simple health problem like the
removal of tonsils or the repair of a broken leg. It is
a complex, long-time ailment almost always resulting
in a special way of living. Tuberculosis involves many
things besides hospital, medical, and nursing care. It
has many requirements on the social welfare side and
these needs are often of long duration. The tuberculosis
problem is one of prehospital and posthospital care with
all that they mean. Moreover, it is a problem of the
care of the patient’s family as well as of the patient. —
Ruth Taylor, Nat. Tuberc. A. Bull., October, 1949.
TREATMENT OF DEAFNESS
WITH HISTAMINE
(Continued from Page 159)
provement in hearing. The result showed eight
patients improved, five not benefited and three
slightly improved. Further study in the use of
histamine in the treatment of nerve deafness
seems warranted. Careful selection of cases is
important since it is very easy to arbitrarily give
all deaf patients the same treatment in a too zeal- j
ous attempt to achieve results beyond the realm of
this medication.
References
1. Hallberg, Olav E., and Horton, Bayard T. : Sudden nerve
deafness : treatment by the intravenous administration of
histamine. Proc. Staff Meet., Mavo Clin. 22:145-149,
(April 16) 1947.
2. Hallberg, Olav E. : Personal communication.
3. Horton, Bayard T. : Personal communication.
4. Mygind, S. H. : Acta Oto-laryng. (supp. 68), 36:7-50,
1948. Abstracted in Year Book of Eye, Ear, Nose &
Throat, pp. 345-349, 1948.
DANIELSON MEDICAL ARTS PHARMACY, INC.
PHONES:
ATLANTIC 3317
ATLANTIC 3318
10-14 Arcade, Medical Arts Building
825 Nicollet Avenue — Two Entrances — 78 South Ninth Street
MINNEAPOLIS
HOURS:
WEEK DAYS— 8 to 1
SUN. AND HOL.— 10 TO 1
PHYSICIANS AND HOSPITALS SUPPLY CO., Inc.
414 SOUTH SIXTH ST., MINNEAPOLIS, MINN.
INSTRUMENTS • TRUSSES • EQUIPMENT • PHARMACEUTICALS • DRUGS
MAIN 2494
212
Minnesota Medicine
BOOK REVIEWS
BOOK REVIEWS
Books listed here become the property of the Ramsey,
Hennepin and St. Louis County Medical Libraries when
reviewed. Members, however, are urged to write reviews
of any or every recent book which may be of interest
to physicians.
CLINICAL CASE-TAKING; GUIDES FOR THE STUDY OF
PATIENTS; HISTORY-TAKING AND PHYSICAL EX-
AMINATION OR SEMIOLOGY OF DISEASES IN THE
VARIOUS SYSTEMS. By George R. Herrmann, M.D.,
Ph.D., Professor of Medicine, University of Texas. 4th edition.
240 pages. St. Louis: The C. V. Mosby Company, 1949.
Price $3.50.
This manual is intended primarily for instruction and
guidance of clinical clerks in the author’s hospital, but
except for a few specific items of local application could
well be used anywhere. The first section presents the
importance of history taking. There is much emphasis
in establishment of proper rapport with the patient and
in attempt is made to assist the student in this direction.
Instructions for history taking and physical examination
ire very complete, covering first the general medical
iroblem and then devoting chapters to various special
problems. The appendix lists symptoms by regions with
possible causative conditions.
The book may have little appeal for physicians in
iractice ; however, for one willing to spend the time, it
serves as an excellent check on the adequacy of his
examinations.
David M. Craig, M.D.
HUMAN BIOCHEMISTRY. By Israel S. Kleiner, Ph.D., Pro-
fessor of Biochemistry and Director of the Department of
Physiology and Biochemistry, New York Medical College,
Flower and Fifth Avenue Hospitals; Formerly Associate, The
Rockefeller Institute for Medical Research, New York. 2d
edition. 649 pages. Illus. St. Louis: The C. V. Mosby Com-
pany, 1948. Price $7.00.
This book is a gratifvingly successful attempt to cor-
•elate biochemistry with clinical medicine. As a textbook
he material is well presented, is illustrated with well-
:hosen, appropriate and instructive graphs and pictures,
rhe author has drawn from many sources for his ma-
erial and has supplemented his remarks with a valuable
libliography. Besides a reference for general review of
:he changing concept of biochemistry, the practitioner
will find particular value in the last chapters which deal
with the effect of various drugs on the body and recent
dinical applications of chemistry to medicine.
David M. Craig, M.D.
“DEE”
NASAL SUCTION PUMP
Contact your wholesale druggist or
write direct lor information
"DEE" MEDICAL SUPPLY COMPANY
P.O. Box 501, St. Paul, Minn.
Index to Advertisers
Abbott Laboratories 199
Aero Distributors Corporation 195
American National Bank 215
Anderson, C. F., Co 204
Ayerst, McKenna & Harrison 117
Benson, N. P., Optical Co 194
Bilhuber-Knoll Corporation 205
Birches Sanitarium 211
Brown & Day, Inc 198
Buchstein-Medcalf Co 212
Camel Cigarettes 131
Camp, S. H., & Co 120
Caswell-Ross Agency 114
Classified Advertising ; 214
Coca-Cola 206
Cook County Graduate School 209
Dahl, Joseph E., Co 196
Danielson Medical Arts Pharmacy, Inc 212
“Dee” Medical Supply Co 213
Druggists Mutual Insurance Co 215
Ewald Bros Inside Back Cover
Franklin Hospital 215
Fleet, C. B., Co., Inc 130
Geiger Laboratories 214
General Electric X-Ray Corporation 122
Glenwood Hills Hospitals 193
Glenwood-Inglewood 209
Hall & Anderson 215
Homewood Hospital 208
Juran & Moody 203
Kelley-Koett X-Ray Sales Corp. of Minnesota 118, 119
Lederle Laboratories Division 121
Lilly, Eli, & Co Front Cover
Insert facing page 132
Mead Johnson & Co 216
Medical Placement Registry 214
Medical Protective Co 198
Milwaukee Sanitarium Back Cover
Mounds Park Hospital Back Cover
Mudcura Sanitarium 210
Murphy Laboratories 215
North Shore Health Resort 207
Parke, Davis & Co Inside Front Cover, 113
Patterson Surgical Supply Co 214
Physicians & Hospitals Supply Co 132, 212, 215
Physicians Casualty Association 210
Prime Equipment Co . 124
Professional Credit Protective Bureau 127
Radium Rental Service . . .' 212
Rego Products 202
Rest Hospital 211
Roddy-Kuhl-Ackerman 212
St. Croixdale Sanitarium 116
Schering Corporation 125
Schmid, Julius, Inc 126
Schusler, J. T., Co., Inc. 215
Searle, G. D., & Co 191
Squibb 123
Upjohn Co 129
Vocational Hospital 208
Wander Co 128
Williams, Arthur F 215
Winthrop-Stearns, Inc 197
Wyeth, Inc 201
February, 1950
213
Classified Advertising
Replies to advertisements with key numbers should be
mailed in care of Minnesota Medicine, 2642 University
Avenue, Saint Paul 4, Minn,
EENT PHYSICIAN WANTED— Growing clinic in
Northern Minnesota has excellent opening for practi-
tioner in EENT. Salary with percentage open. Ad-
dress E-180, care Minnesota Medicine.
FOR SALE — Office and full equipment plus prac-
tice in rural community established forty-six years.
One of thriftiest small cities and dairy farming com-
munities in Southern Minnesota. Office building,
22 by 70 feet, one story, eight rooms: two consul-
tation rooms; eye, ear. nose and throat room;
physiotherapy room; x-ray room; convalescent
room with two beds. Two doctors retiring be-
cause of ill health and age. Two doctors needed:
(1) General practice; (2) general practice plus eye,
ear, nose and throat. Combination in effect thirty
years. Address PI- 186, care Minnesota Medicine.
FOR RENT — Five-room office suite, including dark-
room. Population 8,000 in immediate area. Good cred-
it rating. Write or call McCa’l Riverview Pharmacy,
127 West Winifred Avenue, Saint Paul. Telephone:
CEdar 9255.
OFFICE SUITE FOR RENT— Three rooms or more.
Over drug store, corner 50th and France South, in
Edina. Will decorate to suit renter. Lease, if desired.
Address A. L. Stanchfield, 4424 W. 44th Street, Min-
neapolis. Telephone: MAin 3371 or WAlnut 4806.
OFFICE SPACE FOR RENT— Ideal for dentists and
physicians. State Bank of Sleepy Eye, Sleepy Eye,
Minnesota.
GENERAL PRACTICE AVAILABLE— In Southern
Minnesota. Doctor joining clinic elsewhere. Practice
grossed $18,000 last year, third year since beginning.
Ground floor office. House and equipment including
x-ray unit available, if desired. Services of roent-
genologist available. Address H. P. Van Cleve, M.D.,
Dodge Center, Minnesota.
WANTED — Partner in general practice, Minnesota.
Present location twenty-three years. Planning to retire
in two years; partner to continue practice. No invest-
ment required. Address E-185, care Minnesota Medi-
cine.
EXCELLENT OPENING for young physician in pros-
perous community in northwestern part of Wisconsin.
Hospital facilities available. Possibilities of perma-
nent position in clinic. Scandinavian preferred, al-
though not necessary. If interested, write qualifica-
tions. Address E-184, care Minnesota Medicine.
★ * POSITIONS AVAILABLE * *
^Internist in Minneapolis desires associate internist.
‘-General Practitioner for locum tenens Lowry Medical
Arts Building, two months.
’-Pediatrician wanted for four-man group, New Jersey.
'-General Practitioner, permanent or locum tenens; $500
to start; new hospital; Mnneapolis.
'-General Practitioner for association 28-bed hospital,
Minnesota.
'-Good general surgeon for manager new $350,000 hos-
pital.
'-Board eligible men wanted for new clinic, southern mid-
dle west territory.
For information, write or call
THE MEDICAL PLACEMENT REGISTRY
629 Washington Ave. S. E., Minneapolis GL. 9223
Patronize Our Advertisers
a
truca
The Geiger Laboratories
/ Services fior J^htjSiciani oj the Upper Iddiddle UJedt
1111
tjMciani of L Jlpper
Mailing tubes and price lists supplied upon request.
NICOLT.ET AVENUE 31 1 XN E APOLIS 2
31 AIN 2350
PATTERSON SURGICAL SUPPLY COMPANY
103 East Fifth St., St. Paul 1, Minn.
HOSPITAL AND PHYSICIANS SUPPLIES AND EQUIPMENT
Cedar 1781-82-83
214
Minnesota Medicine
PHYSICIANS AND HOSPITALS SUPPLY CO., Inc.
414 SOUTH SIXTH ST., MINNEAPOLIS, MINN.
INSTRUMENTS • TRUSSES • EQUIPMENT • PHARMACEUTICALS • DRUGS
MAIN 2494
Practical Nursing School
Approardi by Minnesota State Board of Nurses
Examiners
Twelve months course open to High
School Graduates or women with equiv-
alent education.
For further information apply to
DIRECTOR OF NURSES
FRANKLIN HOSPITAL
501 W. Franklin Avenue, Minneapolis 5, Minn.
TAILORS TO MEN SINCE 1886
The finest imported and domestic wool-
ens such as SCHUSLER'S have in stock
are not too fine to match the hand tailor-
ing we always have and always will
employ.
J. T. SCHUSLER CO., INC.
379 Robert St. St. Paul
DO YOU HAVE CHILDREN?
Train them in the habit of sav-
ing money regularly through a
SAVINGS ACCOUNT with
this bank. . . . They’ll always
thank you. OPEN AN AC-
COUNT FOR THEM TO-
DAY.
THE AMERICAN NATIONAL BANK
OF SAINT PAUL
Bremer Arcade Robert at 7th CE 6666
Member Federal Deposit Insurance Corporation
OktR'G.
Radiological and Clinical
Assistance to Physicians
in this territory
MURPHY LABORATORIES
Minneapolis: 612 Wesley Temple Bldg. - - At. 478*
St. Paul: 348 Hamm Bldg. ------ Ce. 7125
If no answer, call - -- -- -- -- Ne. 1291
Hall & Anderson
PRESCRIPTION PHARMACY
BIOLOGICALS
PHYSICIANS’ SUPPLIES
SAINT PAUL, MINN.
LOWRY MEDICAL ARTS BUILDING
TELEPHONE: CEDAR 2735
r \
UNUSUAL LENS GRINDING
CATARACT,
MYO-THIN
and other difficult
and complicated
lenses are ground to
extreme thinness and
accuracy by our
expert workmen.
flmtfWiLLwnj ss
/
Insurance " Druggists' Mutual Insurance Company Prompt
a OF IOWA, ALGONA, IOWA LOSS
Saving Fire - Tornado - Automobile Insurance Servick
MINNESOTA R E P R E S E N T A T I V E- S. E. STRUBLE, WYOMING, MINN.
EBRUARY, 1950
215
supplementation for infants
children is sound prophylactic
at all times.
in wintertime especially, when shortened
clouded skies, heavy clothing, and
lengthened indoor hours combine to deprive the
growing body of sunshine’s benefits, specific
antirachitic measures are of special importance.
For more than 15 years, physicians have
depended on Mead’s Oleum Percomorphum
to provide year-round protection against rickets
— as well as the host of additional symptoms
attributed to fat-soluble vitamin deficiencies
in children and adults alike.
Mead’s Oleum Percomorphum With Other
Fish Liver Oils and Viosterol is a standardized
source of vitamins A and D in high potency
which permits small dosage — liquid or capsule.
Council-Accepted, it is advertised to the
medical profession only.
PERCOMORPHUM
LIQUID — 60,000 units of vitamin A and 8,500 units of
vitamin D per gram, dropper bottles of 10 cc. and 50 cc.
CAPSULES — 5,000 units of vitamin A and 700 units of
vitamin D per capsule, bottles of 50 and, 250.
216
Minnesota Medicine
of course, is but one item in the total cost of
lness, the greatest expense stemming from the length of incapacitation
nd consequent loss of working time. One distinct advantage of
HLOROMYCETIN therapy is its fundamental economy— quick clinical
ssponse, reduced morbidity, shortened convalescence and earlier re-
am of the patient to his job,
IW are now obtained in a disease such
s typhoid fever, where the illness formerly ran its course for several
feeks because of lack of specific therapy. Lengthy hospitalization, spe-
ial nursing care, the supportive measures during this prolonged period
•all have contributed to increased costs. However, CHLOROMYCETIN
Ganges this: the duration of illness is greatly reduced, defervescence
ccurring within 2 to 3 days after treatment is begun. With control of
le infection, general improvement is manifest and recovery is rapid.
of efficacy of CHLOROMYCETIN has also been dem-
nstrated in a number of other diseases previously unresponsive or
oorly responsive to treatment, such as acute undulant fever, urinary
act infection, bacillary and atypical pneumonia, typhus fever, Rocky
fountain spotted fever, scrub typhus, and granuloma inguinale.
The Balance Sheet
We are all striving mightily to set aside some portion of our in-
come in reserve. This is not an easy task in this day of heavy
taxation. Yet these reserves are important; to be used for con-
tingencies that we cannot predict today. It’s silly to be forced
to stand idly aside and watch those reserves being dissipated
through protracted periods of disability when you could have
prevented it by the purchase of an outstanding Disability Policy.
It’s only logic that indicates that your best plan of income pro-
tection is through the plan available to you through your As-
sociation.
Tomorrow may be too late — ACT NOW.
CASWELL-ROSS AGENCY
1177 N. W. Bank Building
Minneapolis — MA 2585
Minneapolis 2, Minnesota
St. Paul— ZE 2341
Insurors to:
Minnesota State Bar Association
Minnesota State Dental Association
Minnesota State Medical Association
Minnesota Society of C.P.A.
Minnesota State Pharmaceutical Assn.
Minnesota Auto Dealers Association
Hennepin County Medical Society
Hennepin County Bar Association
St. Paul District Dental Society
Minneapolis District Dental Society
St. Cloud Dental and Steams County
Medical Society
Duluth District Dental Society
East Central Medical Society
St. Louis County Medical Society
218
Minnesota Medicine
Journal of the Minnesota State Medical Association, Southern Minnesota Medical Association, Northern Minnesota
Medical Association, Minnesota Academy of Medicine and Minneapolis Surgical Society
Volume 33
March. 1950
No. 3
Contents
Neuropsychiatric and Laboratory Observations
in 147 Patients Following Cranio-Cerebral In-
juries.
Axel Olsen, M.D., and Ralph Rossen, M.D.,
Minneapolis, Minnesota 233
Primary Tumors of the Optic Nerve.
Richard C. Horns, M.D., Minneapolis, Minnesota. . 241
The Surgical Management of Massive Hemmor-
rhage from Gastric and Duodenal LTlcers.
Donald C. MacKinnon, M.D., Minneapolis, Min-
nesota 244
Dissecting Aneurysm of the Aorta.
J. S. Blumenthal, M.D., F.A.C.P., Minneapolis,
Minnesota 255
Spontaneous Remission in Subacute Leukemia.
James F. Hammersten, M.D., and Carleton B.
Chapman, M.D., Minneapolis, Minnesota 259
Health Is a Community Problem.
David A. Sher, M.D., Virginia, Minnesota 263
Clinical-Pathological Conference :
Diagnostic Case Study.
Arthur H. Wells, M.D., Gordon C. MacRae,
M.D., and Harold H. Joffe, M.D., Duluth,
Minnesota 266
History of Medicine in Minnesota :
Medicine and Its Practitioners in Olmsted County
Prior to 1900 (Continued)
Nora H. Guthrey, Rochester, Minnesota 269
President’s Letter :
Why Compromise? 277
Editorial :
Doctor Rossen — Commissioner of Mental Health.. 278
National Health Proposals 278
Medical Economics :
Organizations in State Oppose Socialized Medicine 281
Medical Costs More Easily Paid Here 281
Analysis Shows United States Healthiest Nation. . 282
Security Replacing Freedom as Goal 282
Congress, Bills and Taxes 283
The “ISM” Mania 283
Reports and Announcements 284
Woman’s Auxiliary 288
In Memoriam 292
Of General Interest 294
Book Reviews 305
Minnesota State Board of Medical Examiners.. 308
Contents of Minnesota Medicine copyrighted by Minnesota State Medical Association, 1950
Entered at the Post Office in Saint Paul as second class mail matter. Accepted for mailing at the special rate of postage provided
for in Section 1103, Act of October 3, 1917, authorized July 13, 1918.
March, 1950
219
MINNESOTA MEDICINE
Official Journal of the Minnesota State Medical Association
Published by the Association under the direction of its Editing and Publishing Committee
Office of Minnesota State Medical Association,
493 Lowry Medical Arts Bldg., Saint Paul 2, Minnesota.
EDITING AND PUBLISHING COMMITTEE
Philip F. Donohue, Saint Paul
E. M. Hammes, Saint Paul
H. W. Meyerding. Rochester
B. O. Mork, Jr., Minneapolis
C. L. Oppegaard, Crookston
T. A. Peppard, Minneapolis
H. A. Roust, Montevideo
O. W. Rowe, Duluth
Henry L. Ulrich, Minneapolis
A. H. Wells, Duluth
EDITORIAL STAFF
Carl B. Drake, Saint Paul, Editor
George Earl, Saint Paul, Associate Editor
Henry L. Ulrich, Minneapolis, Associate Editor
BUSINESS MANAGER
J. R. Bruce
Annual Subscription — $3.00. Single Copies — $0.40. Foreign and Canadian Subscriptions — $3.50.
The right is reserved to reject material submitted for editorial or advertising columns. The
Editing and Publishing Committee does not hold itself responsible for views expressed either in
editorials or other articles when signed by the author.
Classified advertising — ten cents a word; minimum charge, $2.00. Remittance should ac-
company order.
Display advertising rates on reauest.
Address all communications concerning the journal to Minnesota Medicine, 2642 University
Avenue, Saint Paul 4, Minnesota. Telephone Nestor 2641.
ST. CROIXDALE ON LAKE ST. CROIX
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NEUROPSYCHIATRISTS
PRESCOTT OFFICE
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Howard J. Laney, M.D.
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511 Medical Arts Building
Minneapolis. Minnesota
Tel. MAin 1357
SUPERINTENDENT
Dorothy M. Most, R.N.
Prescott, Wisconsin
Tel. 69
220
Minnesota Medicine
in Mixed
Bacterial
Genitourinary
Infections
Aureomycin is now rapidly becoming recognized as
a drug of choice in the treatment of mixed bacterial
genitourinary infections, particularly those in which
Escherichia coli and Aerobacter aerogenes play a part.
Intractability of a genitourinary infection is an espe-
cial indication for aureomycin.
Aureomycin has also been found highly effective
for the control of the following infections: African
tick-bite fever, acute amebiasis, bacterial and virus-like
infections of the eye, bacteroides septicemia, bouton-
neuse fever, acute brucellosis, Gram-positive infections
(including those caused by streptococci, staphylococci,
and pneumococci) , Gram-negative infections (includ-
ing those caused by the coli-aerogenes group), granu-
loma inguinale, H. influenzae infections, lymphogran-
uloma venereum, peritonitis, primary atypical pneu-
monia, psittacosis (parrot fever), Q, fever, rickettsial-
pox, Rocky Mountain spotted fever, subacute bacte-
rial endocarditis resistant to penicillin, tularemia and
typhus.
AUR EOMVC IN HYDROCHLORIDE
LEDERLE
Capsules: Bottles of 25, 50 mg. each capsule. Bottles of 16, 250 mg. each capsule.
Ophthalmic: Vials of 25 mg. with dropper; solution prepared by adding 5 cc. of distilled water.
LEDERLE LABORATORIES DIVISION American Giaruwu'J company 30 Rockefeller Plaza, New York 20, N, Y.
March, 1950
221
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Give you COMPLETE
Illustration above shows ICO MA Combination with the
basic table and Floor-To-Ceiling tubestand. This com-
bination includes the famous Keleket Multicron Gen-
Here is how the
Keleket Add-A-Unit
Combinations Work
Choose the combination
to suit your practice!
You purchase the new standard (not a reduced)
size Keleket Tilt Table and Tubestand. Then add
either 15, 30 or 100 MA tube and generating
ecjuipment. You can advance from 15 to 30 and
to 100 MA but still retain the original table and
tubestand. As a result, this investment is never
lost when you step up to higher power tubes and
generating equipment.
Illustration below shows 30 MA combination with
the same basic table and Floor-To-Ceiling tube-
stand. This combination includes the 30 MA self-
contained tubehead and precision control.
222
Minnesota Medicine
Add-a-Unit Combinations
X-RAY EQUIPMENT
. . . for FULL RANGE Fluoroscopy and Radiography
Keleket scores again , with a new approach to the use and
purchase of X-ray equipment. Keleket has developed a
FULL SIZE Standard Tilting Table with a completely
new, highly flexible floor to ceiling tubestand. This basic
X-ray equipment is equally adaptable for either 15, 30
or 100 MA tube and generating units.
GROWS WITH YOUR REQUIREMENTS
Start out with the simplest 15 MA tubehead; then at a
future date change to a 30 MA tubehead, if you desire.
Whenever you’re ready, step up to a 100 MA generating
unit. As a result, your Keleket equipment grows with
your requirements.
THROUGHOUT ALL INTERCHANGES YOU RE-
TAIN THE SAME KELEKET “ADAP”-T ABLE AND
TUBESTAND.
FUTURE COSTS SAVED
This means you eliminate one of the biggest cost factors
in equipment — new table and tubestand costs as you step
up your tube capacity and power.
In addition, your original investment is never lost —
Keleket offers you generous allowance values on the
equipment you interchange.
FULL RADIOGRAPHIC-FLUOROSCOPIC FACILITIES
Any of these combinations will fully meet your current
needs for full range radiography and fluoroscopy. Per-
form radiography in horizontal and trendelenburg posi-
tions, vertical and horizontal fluoroscopy. The tubestand,
for example, is so flexible that you can swing the tube-
head away from the table and radiograph stretcher cases
on the opposite side.
And if you want a bucky diaphragm, even the lowest cost
unit is equipped to accommodate one.
Write of phone us for more information
Keleket X-Ray Sales Corporation
of Minnesota
1111 Nicollet Avenue Minneapolis 3, Minnesota
Illustration below shows same basic table and tubestand with
a new self-contained 15 MA tubehead and control.
A new approach
to use and
purchase of
X-Ray equipment.
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n Add
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March, 1950
.223
Outstanding Value . . .
Outstanding Nutritional Benefits
The Seal of Acceptance denotes that
the nutritional statements made in
this advertisement are acceptable to
the Council on Foods and Nutrition
of the American Medical Association.
Whether the pocketbook calls for economy or permits satisfaction
of that urge for the fanciest cuts, meat gives your patients full
value for their money. Every cut and kind of meat supplies, in
abundance , these essential nutrients:
1. Biologically complete protein . . . the kind which satisfies
the requirements for growth and which is needed daily for
tissue maintenance, antibody formation, hemoglobin syn-
thesis, and good physical condition.
2. The essential B complex vitamins, thiamine, riboflavin, and
niacin.
3. Essential minerals, including iron in particular.
In addition to these tangible values, meat ranks exceptionally
high not only in taste and palate appeal, but also in satiety value.
The instinctive choice of meat as man’s favorite protein food
has behind it sound nutritional justification.*
*McLester, J. S.: Protein Comes Into Its Own, J.A.M.A. 139: 897 (Apr. 2,) 1949
American Meat Institute
Main Office, Chicago. ..MembersThroughout the United States
224
Minnesota Medicine
"Nowhere in medicine are
*
Hamblen, E. C. : Some Aspects
of Sex Endocrinology
in General Practice,
North Carolina M. J.
7:533 (Oct.) 1946.
more dramatic therapeutic effects
obtained than those which
follow estrogen therapy in the
girl who has failed to develop
sexually, A daily dose of 2.5 to
3.75 mg. of Tremarin’ given in a
cyclic fashion for several months
may bring about striking adolescent
changes in these individuals.”*
Estrogenic
Substances
(water-soluble)
also known as
Conjugated
Estrogens
(equine).
“Premarin”— a naturally conjugated estrogen— long a choice
of physicians treating the climacteric— has been earning
further clinical acclaim as replacement therapy
in hypogenitalism.
In the treatment of hypogenitalism, “Premarin” supplies
the estrogenic factors that are missing, and thus tends to
eliminate the manifestation of the hypo-ovarian state. The
aim of therapy is to develop the reproductive and accessory
sex organs to a state compatible with normal function.
Four potencies of “Premarin” permit flexibility of
dosages: 2.5 mg., 1.25 mg., 0.625 mg., and 0.3 mg. tablets;
also in liquid form, 0.625 mg. in each 4 cc. (1 teaspoonful).
While sodium estrone sulfate is the principal estrogen
in “Premarin^ other equine estrogens . . .estradiol, equilin,
equilenin, hippulin . . . are probably also present in
varying amounts as water-soluble conjugates.
Ayerst, McKenna & Harrison Limited
22 East 40th Street, New York 16, New York
5003
March, 1950
225
PHYSICIANS AND HOSPITALS SUPPLY CO., Inc.
MINNEAPOLIS MINNESOTA
Your Most Complete Drug Source
A Representative Group of Ulmer Pharmacal Specialties
In our modern, completely-equipped laboratory, highly skilled graduate pharmacists and
chemists are engaged in refining and developing Ulmer Pharmaceuticals. The items offered
under the Ulmer label represent ethical development of the ideas of medical men and
are produced in cooperation with physicians, clinics, and hospitals, to meet the exacting
needs of the medical profession. Precise control and analytical laboratory tests guarantee
the uniformity and purity of all Ulmer Pharmaceuticals. The scientific activities of our
research staff assure continual development and refinement of new ideas as the need de-
velops. Full information on the Ulmer Line appears in our medical catalog. Refer to it
and be sure to include the name ULMER in your next drug order.
Write for Ulmer Specialties Price List MM-350 distributed by
22b
Minnesota Medicine
^ Calling All Doctors,
Your Receivables Have
Suffered A Set-Back! ^
Every doctor should immediately examine his accounts
receivable. A thorough diagnosis is certainly in order
promptly after due date. If some of your accounts are
suffering from “slow collectibility” they should be
receiving treatment while they still will respond.
COLLECTIBILITY OF ACCOUNTS— Based On Age
Accounts 60 days past due are 93% collectible. Accounts 1 year past due are 40% collectible.
Accounts 90 days past due are 85% collectible. Accounts 2 years past due are 25% collectible.
Accounts 6 months past due are 70% collectible. Accounts 3 years past due are 18% collectible
Accounts 5 years past due are practically lost.
lOOO DOCTORS
HOSPITALS AND CLINICS
A National Organization . . .
Offered and recommended by
over 50 trade and professional
associations from coast to coast.
Write for references of service in
your area.
OF OUR ETHICAL COLLECTION SERVICE
★ not A COLLECTION AGENCY- All
Monies paid directly to you.
★ RETAINS GOOD WILL-Methods are
ethical, courteous and effective.
PROFESSIONAL CREDIT
PROTECTIVE BUREAU
Division of The I. C. System,
310 Phoenix Bldg., Minneapolis, Minn.
Further Inquiry Invited
FILL OUT AND MAIL COUPON NOW
Professional Credit Protective Bureau
310 Phoenix Building
Minneapolis, Minn.
Gentlemen:
Without obligation, please send complete information
regarding this service.
Name
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March, 1950
227
The area surveyed in the Fifth Edition of
“Biliary Tract Disturbances,” now available,
is the entire, ramified biliary tree — its anatomic
and physiologic background and the diagnosis
and therapy of its disorders.
Physicians and surgeons acquainted with previous
editions of this monograph will find the newly
revised, enlarged and illustrated edition even more
practical. The brochure concisely presents
basic concepts of biliary tract disease, and reviews
recent progress in the management of biliary
disorders with hydrocholeretics and other
measures. You may receive your copy
on request from the Medical Department, ■
Ames Company, Inc., Elkhart, Indiana.
f AMES COMPANY, INC.
ELKHART, INDIANA
brand of dehydrocholic acid
3Va gr. tablets in bottles of 25, 100, 500, 1000 and 5000.
Decholin Sodium (brand of sodium dehydrocholate)
3 cc., 5 cc. and 10 cc. ampuls in boxes of 3 and 20.
Decholin and Decholin Sodium, Trademarks Reg. U.S. and Canada
228
Minnesota Medicine
TRIMETON
!
DOCTOR,
WILL YOU MAKE
THIS NOSE TEST?
SEE AT ONCE PHILIP MORRIS
ARE LESS IRRITATING
It is one thing to read published studies.* Quite
another to have your own personal experience
provide the proof! The Philip Morris nose test
takes but a moment. Won’t you try it?
HERE IS ALL YOU DO:
...light up a Philip Morris
Take a puff -DON'T INHALE. Just
sT-o-w-l-y let the smoke come through
your nose. AND NOW . . .
. . . light up your present brand
Do exactly the same thing — DON’T
INHALE. Notice that bite, that sting?
Quite a difference from Philip Morris!
With proof so conclusive, would it not be good practice
to suggest Piiiup Morris to your patients who smoke?
Philip Morris
Philip Morris & Co., Ltd., Inc.
100 Park Avenue, New York 17, N. Y.
* Proc.Soc. Exp. Biol, and Med., 1934, 32,241-245;N.y. State Journ. Med., Vol. 35,6-1-25, No. 11, 590-592;
Laryngoscope. Feb. 1935, Vol. XLV, No. 2, 149-154; Laryngoscope, Jan. 1937, Vol. XLVII, No. 1, 58-60
230
Minnesota Medicine
Cardiac failure, renal disease, hyperten-
sion, arteriosclerosis, or pregnancy com-
plications call ior sodium restriction. But,
without seasoning, low sodium diets are
difficult to endure.
Neocurtasal looks, pours and is used like
table salt. Available in convenient 2 oz.
shakers and 8 oz. bottles.
Salt without sodium: Neocurtasal palat-
ably seasons all foods.
neocurtasal '
me. 170 VARICK STREET, NEW YORK, N. Y.
NEOCURTASAL, trademark reg. U. S. & Canada
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Additional Monthly Benefits
First 3 Months for Hospital Disability.
Accidental Death Benefits, $12,500 Double Indemnity.
Loss of Hands, Feet or Eyes, $15,000 Double Indemnity (or)
Cash, and $400 monthly first 2 years, $300 monthly thereafter.
Adjusted benefits for disabilities occurring after age 60.
SPECIAL FEATURES
Cancellation Clause , Standard Provision 16 Non Pro-Rating , — Standard Provision 17
No Terminating Age , Standard Provision 20 Non-Assessable , — No Contingent Liability
No Increase in Premium, Once Policy is Issued Non-Aggregate, — Previous Claims Paid
Grace Period 15 Days do nof /;ml> Company's Liability
Unusually Complete Protection
if Pays Monthly Benefits from 1st Day to Life.
if Pays Benefits for both Sickness and Accident.
if Pays Lifetime Benefits for Time or Specific Losses.
if Pays Regular Benefits for Commercial Air Travel.
if Pays Benefits for Non-Disabling Injuries.
if Pays Benefits for Non-Confining Sickness.
if Pays Benefits for Septic Infections.
if Pays Whether or not Disability is Immediate.
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IMPORTANT — Permit no agent to substitute — IMPORTANT
232
Minnesota Medicine
QHmnesek QfleJicm
Journal of the Minnesota State Medical Association, Southern Minnesota Medical Association, Northern Minnesota
Medical Association, Minnesota Academy o / Medicine and Minneapolis Surgical Society
Volume 33
March, 1950
No. 3
NEUROPSYCHIATRIC AND LABORATORY OBSERVATIONS IN 147 PATIENTS
FOLLOWING CRANIO-CEREBRAL INJURIES
AXEL OLSEN, M.D., and RALPH ROSSEN, M.D.
Minneapolis, Minnesota
T"\ESPITE the excellent clinical and funda-
mental observations of various workers in
the field of cerebral concussion and post-traumatic
cerebral states it is still difficult to evaluate and
prognosticate the outcome of head injuries in the
human. The literature discloses that there is still
a wide gap in the observations pertaining to ex-
perimental cerebral concussion in animals and the
clinical impressions gained from the study of
humans, especially in the psychological
sphere.1’4’8,9
Electroencephalography appears to come the
closest to narrowing this gap, especially in the
study of post-traumatic seizures.5 Recent in-
vestigations on the physiological basis of concus-
sion1,9 and the clinical effects of trauma to the
head3 and studies of the electrical activity of the
cortex in recent and late head injury4,5,8 have
contributed much to the knowledge of this field.
However, does severe trauma to the head, whether
the ensuing pathologic process be chemical, elec-
trical or psychological, change an individual’s
total personality permanently, or can he revert to
what he was before his head injury? It is easy
to comprehend the detrimental effects psycholog-
ically in an individual who develops overt post-
traumatic neurological manifestations such as
epilepsy or a paralysis or a paresis of one or
We wish to take this opportunity to express our thanks to
Captain George Raines (MC) U.S.N., Captain S. M. Smith
(MC) U.S.N.R., and other members of the neuro-psychiatric
staff who were at the U. S. Naval Hospital, Portsmouth, Va.,
during the period from January, 1944, to January, 1946, for
their splendid co-operation in making this work possible.
The opinions or assertions contained herein are the private
ones of the writers and are not to be construed as official or
reflecting the views of the Navy Department or the naval service
at large.
March, 1950
more extremities. It is often much more difficult
to evaluate the detriment to the personality in
the individual who complains of headache, dizzi-
ness, instability, irritability, emotional instability
or fatigueability long after the event of his head
trauma. How many of these symptoms are super-
imposed psychological factors and how many
are actually due to the head injury present almost
insurmountable difficulties to the attending physi-
cian.
Do “blackouts” and vertiginous attacks2 precede
the first post-traumatic seizure and what part can
electroencephalography play in early diagnosis?
Can a pathologic condition in the region of the
inferior surface of the orbital lobe (area 13)
account for some of the symptoms of the so-called
post-concussion syndrome ?9
The foregoing problems led to the present study
of 147 patients, many of whom had sustained rel-
atively severe cranio-cerebral injuries, to deter-
mine, if possible, the relationship of the trauma
to the persisting neurological, psychiatric, elec-
troencephalographic and roentgenological abnor-
malities.
Method
An attempt was made to correlate the electro-
encephalographic findings with :
1. Time in months between head injury and E.
E. G. examination.
2. The number of patients with residual symp-
toms of :
(a) post-traumatic seizures
(b) headache
233
CRANIO-CEREBRAL INJURIES— OLSEN AND ROSSEN
(c) “blackouts”
(d) dizzy spells
(e) various other neuropsychiatric com-
plaints.
3. The number with residual defects in the skull
as shown by x-ray examination.
4. 'Those patients with objective neurological
findings.
5. The period of unconsciousness.
No follow-up was obtained on any of these
patients after they left the hospital. The objec-
tive neurological signs were not included when
they were transient or equivocal.
Material. — Over a period of two years ( 1944
and 1945) material was collected from patients
with head injuries who were on the neurosurgical
service at the U. S. Naval Hospital, Portsmouth,
Va., or from patients referred to the same activity
from surrounding naval, coast guard and army
hospitals for electroencephalogram (E. E. G.)
studies. One hundred forty-seven patients with
an age variation from nineteen to thirty-eight
years were studied. The series was divided into
two groups : Seventy-three patients who did not
have E. E. G. studies and seventy-four who did
have E. E. G. studies. Either because the pa-
tients were studied and disposed of before there
was an E. E. G. apparatus available or because
this type of consultation was not requested, E.
E. G. examinations were not performed on the
first group (seventy-three). Each case history
was analyzed in regard to age, date of injury,
type of injury, duration of unconsciousness
(where this could be obtained), residual objective
neurological findings and residual subjective neu-
ropsychiatric symptoms. The date and lapse of
time between injury and first convulsive seizure
and diagnosis were correlated. Analysis was
made of those patients with a retained foreign
body in the cranium or with skull defects as a
result of the injury. In the group which had
E. E. G. examinations attention was also given to
the time interval between head injury, onset of
first seizure and the E. E. G. examination.
All patients received careful neuropsychiatric
examinations, indicated laboratory tests and in-
dicated consultations from various other depart-
ments. The subjective complaints and objective
neurological findings considered were those that
were present at or about the time of the E. E. G.
examination and consisted of headaches, dizzy
spells, nervousness, anxiety and easy fatigue-
ability. In the group evaluated which did not
have E. E. G. examinations, the clinical findings
evaluated were those present during the patient’s
period of hospitalization.
Of the 147 patients studied, 100 were dis-
charged from the U. S. Naval Hospital, Ports-
mouth, Va. These patients were observed over
a period varying from one to six months, depend-
ing upon the severity of their residual symptoms.
Of this group forty-one were discharged with the
diagnosis of intracranial injury, twenty-four with
the diagnosis of blast concussion, ten with the
diagnosis of fractured skull, seventeen with the
diagnosis of gunshot wound (head or shrapnel
wound), three with the diagnosis of headache
and five with miscellaneous diagnoses including
psychoneurosis. The remaining forty-seven pa-
tients were from other military activities and their
discharge diagnoses were not known. The major-
ity of these individuals had sustained their head
injuries in line of duty ; many of them were
injured in front-line combat, and it was, therefore,
difficult in some of them to determine the exact
duration of unconsciousness. Every attempt was
made to obtain all pertinent data, but it was felt
that it was best to consider time periods of un-
consciousness unknown unless they were relatively
exact.
All of the patients were conscious at the time
of their E. E. G. examinations, and except for
four of them, all had suffered their head injuries
at least three months previous to their E. E. G.
examinations. Thus, no studies on very recent
severe or mild head injuries were obtained. Al-
most all of the patients had neuropsychiatric com-
plaints at the time of their E. E. G. examinations
or at the time of their admission to the hospital.
Electroencephalographic Technique and Method
of Interpretation. — The electrical activity of the
right and left frontal, parietal and occipital cortex
was recorded with a Grass 6-channel electroen-
cephalograph. All records were made with scalp
to ear leads. The indifferent electrode was formed
by interconnecting the two ear leads. Electrodes
were applied to the scalp, using the method
described by Gibbs.6 Records were taken with the
patient lying on a table in a shielded cage. Cor-
tical activity was recorded for at least ten minutes
on each subject. Two minutes were allowed for
234
Minnesota Medicine
CRANIO-CEREBRAL INJURIES— OLSEN AND ROSSEN
hyperventilation and two to three minutes were
allowed for recovery. Gibbs’ classification of
E. E. G. records7 was used throughout, with the
following modifications : all paroxysmal tracings
(petit mal, psychomotor, grand mal, spikes and
S.2 and F.2 tracings) were classified as abnormal.
The F.l and S.l tracings were classified as having
slight abnormalities. All activity in the range
of 8 to 13.5 per second was classified as normal..
In records of all tracings mention was made
as to whether the abnormalities were focal or non-
focal in type. The whole record was carefully
reviewed and random wave counts were made on
at least 40 seconds of record before and after hy-
perventilation.
TABLE I. CORRELATION OF E. E. G. FINDINGS AND
TIME IN MONTHS BETWEEN DATE OF HEAD
INJURY AND ELECTROENCEPHALOGRAPHIC
EXAMINATION
Time in Months Between
Date of Head Injury and
Electroencephalogram
Number
of Cases
Electroencephalographic Findings
Normal
Slightly
Abnormal
Greatly
Abnormal
3 to 6*
29
15
7
7
6 to 12
18
7
7
4
12 to 24
9
5
2
■2
24 to 36
4
3
1
0
36 to 48
3
2
1
0
48 to 60
0
0
0
0
60 to 72
0
0
0
0
Over 72
History of head injury,
6
4
0
2
time unknown
5
3
2
0
Total Number of Cases
74
39
(52.7%)
20
(27%)
15
(20.3%)
*The true element in 4 of these 29 cases was just under 3 months.
TABLE II. CORRELATION OF E. E. G. FINDINGS WITH PRESENTING SYMPTOMS
Presenting Symptom
Number
of Cases
Normal
Slightly
Abnormal
Greatly
Abnormal
Focal or Non-Focal
E. E. G. Abnormality
No. Pet.
No. Pet.
No. Pet.
Slightly
Abnormal
Greatly
Abnormal
“Blackout”
7
5 72%
1 14%
1 14%
Dizzy spells
15
12 80%
2 13%
1 7%
Headache
40
(a) headache alone
14
8 57.14%
3 21.43%
3 21.43%
(b) headache and other
symptoms
26
21 81%
3 11%
2 8%
One or more objective
neurological signs other
than convulsive seizure
17
5 29.4%
5 29.4%
7 41.2%
Nervousness, anxiety.
attacks of confusion,
memory lapses, easy
fatigability
15
10 67%
3 20%
2 13%
Post-traumatic seizures
prU
(observed)
9
1 H%
3 33%
5 56%
1 in the
2 in the
right.
right
parietal
and left
lead
frontal
areas
Results
Analysis of Total Number of Cases. — Analysis
was made of 147 cases of cranio-cerebral war in-
juries, one hundred of these with the closed type
(including lacerated scalp without skull fracture),
the remaining forty-seven having sustained com-
pound wounds of the skull with brain injury.
Of this total group, by far the most frequent sub-
jective complaint was headache which occurred
in 112 patients. Of these 112, seventy-three com-
plained of headache alone while thirty-nine had
in addition to their headache one or more other
subjective symptoms. Nine per cent developed
post-traumatic epilepsy, 33 per cent had residual
neurological findings of various types, 67 per
cent complained of headache, 26 per cent com-
plained of “blackout” or “dizzy spells” and 19
per cent complained of nervousness, anxiety,
memory lapses and easy fatigueability.
Analysis of 74 Cases with E. E. G. Studies. —
Forty-eight of these had closed head injuries (in-
cluding lacerated scalp without skull fracture) ;
the remaining twenty-six cases had compound
skull and brain wounds.
Table I shows the correlation between date of
head injury and the result of the E. E. G. exami-
nation. Of this group, forty gave a history of
headache plus some other symptoms, fourteen
gave a history of headache alone, seven gave a
history of “blackout,”2 fifteen stated that they
suffered from dizzy spells, fifteen voiced various
psychiatric complaints such as nervousness,
anxiety, attacks of confusion, memory lapses and
fatigue, seventeen had one or more objective
neurological findings and nine had post-traumatic
seizures.
Table II shews the distribution of the total
group in regard to symptoms and E. E. G. type
of abnormality.
March, 1950
235
CRANIO-CEREBRAL INJURIES— OLSEN AND ROSSEN
TABLE III. CORRELATION OF E. E. G. FINDINGS
WITH LENGTH OF UNCONSCIOUSNESS
Length of
U nconsciousness
Number
of Cases
Electroencephalograph
c Findings
Normal
Slightly
Abnormal
Greatly
Abnormal
Less than 6 hours
7
3
4
0
12 to 24 hours
2
0
1
1
24 to 48 hours
3
1
1
1
48 to 72 hours
2
1
1
0
3 to 6 days
2
1
0
1
14 days
T
0
1
0
Not unconscious*
3
1
1
I
Total
20
7
9
4
*Of these three cases:
One had skull fragments in his scalp. He had an abnormal E. E. G.
One was dazed and had a slightly abnormal E. E. G.
One had sustained a simple skull fracture and had a normal E. E. G.
to the left, one showed right-sided mild cerebellar
symptoms, one showed a left dilated pupil and
could not converge his eyes, one showed right-
sided homonymous heminopsia, one showed bi-
lateral anosmia and left-sided deafness, and one
showed nerve deafness of the left ear. The
seventh patient showed a focal E. E. G. (left
parietal region). In addition he had x-ray evi-
dence of a foreign metallic body in the left oc-
cipital region, a positive Hoffman (right side)
and right lower quadrant homonymous heminop-
sia.
Of the five patients who showed slightly ab-
TABLE IV. CORRELATION OF E. E. G. FINDINGS WITH TYPE OF HEAD INJURY
Type of Head Injury
Number
of
Cases
Electroencephalographic Findings
E. E. G. Findings, Focal
Normal
Slightly
Abnormal
Greatly
Abnormal
Slightly
Abnormal
Greatly
Abnormal
Compound skull and brain
26
12 (46%)
6 (23%)
8 (31%)
1 focal,
2 focal,
injury
Closed head injury without
skull fracture but includ-
ing laceration of the scalp
48
One of these
P. T. E.*
27 (56.25%)
One of these
P. T. E.
14 (29.17%)
Two of these
P. T. E.
4 of these
P. T. E.
7 (14.58%)
One of these
P. T. E.
right
parietal
bifront al,
one of these
especially
R. F.
Total
74
39 (52.7%)
20 (27%)
15 (20.3%)
*P. T. E.: post-traumatic epilepsy
Table III shows correlation of E. E. G. find-
ings with length of unconsciousness.
Table IV shows correlation of E. E. G. findings
with the type of head injury.
]. E. E. G. Results in Patients with Objective
N eurological Findings other than a Convulsive
Disorder. — Of this group of seventeen patients,
five had normal* E. E. G. findings, seven had
greatly abnormal E. E. G. findings, and five
showed slightly abnormal E. E. G. findings.
Of the five patients with normal E. E. G. find-
ings one had peripheral visual field constriction,
one had a paresis of his right arm (this patient
showed x-ray evidence of small left parietal de-
fect), one had right oculo-motor paresis (this pa-
tient showed x-ray evidence of a foreign metallic
body and a bony defect in the right temporal
area), one had an unsteady gait, slight right deaf-
ness and horizontal nystagmus (left component),
and one had right-sided nerve deafness (this pa-
tient showed x-ray evidence of a fracture through
the right temporal bone).
Of the seven who had marked abnormal E. E.
G. findings, one showed a horizontal nystagmus
normal E. E. G. findings, one had a complete
left facial paralysis and total anosmia, one showed
mild right-sided cerebellar signs, one showed
left-sided paresis of the arm, leg and face (skull
x-ray showed a bony defect in the right parietal
region), one showed horizontal nystagmus to the
left, and one had focal findings in the left frontal
and right occipital regions (this patient had an
unsteady gait and left lower facial weakness).
One patient was neurologically negative and
had a normal E. E. G. but showed x-ray evi-
dence of a foreign metallic body in the left oc-
cipital region of the skull. This man voiced sub-
jective complaints of headache and dizzy spells.
2. E. E. G. Findings in Patients Who Presented
Dizziness plus Other Subjective Complaints. —
Fifteen of the seventy-four patients presented
dizziness as a subjective complaint. All of these
patients, in addition, voiced one or more other
somatic complaints. Twelve (80 per cent) had
a normal E. E. G., one (7 per cent) had a
greatly abnormal E. E. G. and two (13 per cent)
had a slightly abnormal E. E. G.
236
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CRANIO-CEREBRAL INJURIES— OLSEN AND ROSSEN
3. E. E. G. Findings Correlated with the Dura-
tion of Unconsciousness following Head Injury.
— Of the total number of patients, seventy-four
had had E. E. G. examinations. The duration of
unconsciousness was not known in fifty-four. Of
these fifty-four patients, thirty-one had a normal
E. E. G., eleven had a greatly abnormal E. E. G.,
and twelve had a slightly abnormal E. E. G.
Seven patients had been unconscious for six
hours or less. Of these, three had normal and
four had slightly abnormal E. E. G., non-focal
in type. Two patients had been unconscious for
from twelve to twenty-four hours; one of these
had greatly abnormal and one slightly abnormal E.
E. G., non-focal in type. Three had been uncon-
scious from twenty-four to forty-eight hours;
one of these had a greatly abnormal E. E. G., one
a slightly abnormal, and one had a normal E. E. G.
Two had been unconscious forty-eight to seventy-
two hours ; one of these had a slightly abnormal
E. E. G. and the other had a normal E. E. G.
Two had been unconscious for six days ; one
of these had a greatly abnormal E. E. G., the
other had a normal E. E. G. One patient had been
unconscious for two weeks and had a slightly ab-
normal E. E. G., non-focal in type.
Three patients had not been unconscious, and
of these one had a normal E. E. G., one had a
greatly abnormal E. E. G. and one had a slightly
abnormal E. E. G., non-focal in type. Of these
three patients one had skull fragments in his
scalp. He had an abnormal E. E. G. One had
been dazed and had a slightly abnormal E. E. G.
The third had sustained a simple skull fracture
and had a normal E. E. G.
4. E. E. G. Findings in Patients Who Voiced
Symptoms of Nervousness, Anxiety and Easy
Fatigue ability. — Fifteen of the seventy-four pa-
tients gave symptoms of nervousness, anxiety,
memory lapses and easy fatigueability. Of this
group ten had normal E. E. G., three had slightly
abnormal E. E. G. and two had greatly abnormal
E. E. G.
Of the two that had greatly abnormal E. E. G.,
one complained of intermittent attacks of amnesia
and sleep-walking. The other complained of poor
memory and inability to concentrate. It is inter-
esting that the remaining thirteen patients who had
normal or slightly abnormal E. E. G. all voiced
various other somatic complaints such as head-
ache, dizziness, et cetera, in addition to their
symptoms of nervousness, easy fatigueability and
anxiety states.
5. E. E. G. Studies in Patients Who Voiced
Headache as Their Only Complaint. — Of fourteen
patients whose only presenting symptom was
headache, eight had normal E. E. G., three had
slightly abnormal E. E. G., and three had ab-
normal E. E. G.
6. E. E. G. Studies in Patients Who Voiced
Headache plus Various Other Somatic Symp-
toms.— Of twenty-six patients who voiced head-
ache in addition to other subjective symptoms in-
cluding “blackout,” dizziness, nervousness, et
cetera, twenty-one had normal E. E. G., three
had slightly abnormal E. E. G., and two had
abnormal E. E. G.
7. Analysis of Patients Who Had Post-Trau-
matic Seizures. — Of the total group of seventy-
four patients, nine (12 per cent) had suffered
convulsive seizures since their head injuries. Of
these nine cases, three had had their first seizure
in less than six months after injury, four in
from six to twelve months after injury, one in
from twelve to eighteen months after injury, and
one had had his first seizure over eighteen months
after injury.
Of the nine patients who developed post-
traumatic seizures, five showed greatly abnormal
E. E. G., two of which were focal in the right and
left frontal areas; three showed slightly abnormal
E. E. G., one of which was focal in the right
parietal area, and one showed a normal E. E. G.
Of the five patients who showed gross abnormali-
ties in the E. E. G., two showed defects in the
frontal regions in their skull x-rays. Both of
these patients had focal abnormalities in the
frontal regions upon E. E. G. examination. One
of these had a skull defect of the frontal bones, 2
inches in diameter. He was neurologically nega-
tive except for concentric constriction of visual
fields, most marked in the left. The other
showed a foreign metallic body in the left frontal
region in his skull rays. He was neurologically
negative except for enucleation of his right eye.
Of the three who showed diffuse E. E. G. ab-
normalities, one showed a foreign body in the
right frontal region by x-ray (he also had suf-
fered osteomyelitis of his. frontal bones after his
injury). Another showed small metallic bodies
March, 1950
237
CRANIO-CEREBRAL INJURIES— OLSEN AND ROSSEN
(shrapnel) in the left parietal region by x-ray,
and he had a right lower quadrant heminopsia.
The fifth had a healed occipital scar but was
otherwise neurologically negative, and his skull
rays were negative.
Of the three patients who showed slightly ab-
normal E. E. G., one had focal E. E. G. findings
in the right parietal area. X-rays of his skull
showed a defect about 1 inch in diameter in the
right parietal area. A splinter of bone had been
removed from that area following his head in-
jury, and it was observed that he had had a left
hemiparesis for several days after the accident.
His E. E. G. was done nineteen days after his
last seizure. The other two were neurologically
negative and had normal skull rays. They both
showed slight diffuse abnormalities.
One patient had a normal E. E. G. He had
had a head injury in 1937 and was unconscious
three days. Skull rays showed an old fracture
line in the right tempero-parietal region. Neu-
rological examination at time of E. E. G. exami-
nation (seven years later) revealed a left homon-
omous superior quadrant defect and impaired
olfactory sense. He had had his first seizure
seven years after his head injury. The E. E. G.
examination was done three months after his
last seizure.
As previously stated, nine in the group of
seventy-four men who gave a history of head in-
jury had a diagnosis of post-traumatic epilepsy.
Brief case histories of these nine patients are
given.
Case Reports
Case 1.— This white man, twenty-seven years of age,
was rendered unconscious for five minutes. Five months
later he was observed in a grand mal seizure (June 28,
1945). An E. E. G. done nineteen days after his
seizure was slightly abnormal with the maximum ab-
normalities in the right parietal region. He was neu-
rologically negative at the time. Skull rays showed a
defect about one inch in diameter in the right parietal
region. He had a left hemiparesis for several days
after the accident but no other symptoms.
Case 2. — This twenty-two-year-old private with two
years’ service received a head injury in 1939. First
grand mal seizure occurred about a year later followed
by two others, the last one on March 15, 1945. E. E. G.
done four months after the last seizure was abnormal
with the most marked abnormalities in frontal leads.
Skull rays showed a defect 2 inches in diameter in the
frontal bones. Neurological examination was negative
except for concentric constriction of the visual fields,
most marked on left.
Case 3. — This patient, aged twenty-five, received a
penetrating wound by shell fragment in the frontal
region on October 8, 1944. An E. E. G. eight months
later was abnormal with most marked abnormalities in
frontal region. Skull rays showed a foreign metallic
body in the left frontal region. Patient had a sudden
attack of amnesia a week prior to E. E. G. He was
neurologically normal except for an enucleation of his
right eye.
Case 4. — -This thirty-year-old patient received a head
injury in November, 1943. He was unconscious for an
indefinite time. He had his first seizure two weeks
later, December, 1943, and has had four to five severe
“blackouts” and dazed attacks since. E. E. G., done
June 19, 1945, was over two years after injury and
two months after his last seizure. This was slightly
abnormal, and it was noted that it was non-focal in type.
Case 5. — This twenty-year-old patient was in an auto-
mobile accident in 1940 and rendered unconscious for
thirty hours. He had a healed occipital scar. Ten
convulsive seizures were suffered from 1941 to April
1945. An E. E. G. done three months after the last
seizure and five years after the head trauma was greatly
abnormal and non-focal. The patient was neurological-
ly negative.
Case 6. — This patient suffered a head injury in Jan-
uary, 1943, a steel wedge penetrating his right fore-
head. Osteomyelitis for three months and four con-
vulsions, the first in 1944, were followed two years after
injury by the first E. E. G. which was greatly abnormal.
The neurological examination was negative. Skull rays
revealed a small metallic foreign body in the right
frontal region, intracranially situated. His E. E. G.
which was taken some two years after his injury was
found to be greatly abnormal but non-focal in type.
Case 7. — This thirty-two-year-old patient suffered a
right tempero-parietal fracture in an automobile acci-
dent in 1937 and was unconscious for three days. An
epileptic seizure followed about six years later. E. E. G.
examination was performed seven years after injury but
only several months after seizure. The tracing was
normal. Neurological examination showed left homono-
mous superior quadrant defect and poor olfactory sensa-
tion.
Case 8. — This patient was struck in the left parietal
region by a piece of shrapnel in late 1944 and he was
unconscious for fifteen hours. His first seizure occurred
March 30, 1945. On the following day an E. E. G.
examination showed diffuse abnormalities. The seizure
was right-sided. There have been two mild seizures
since. E. E. G. ten months after accident and seven
months after first seizure showed minimal abnormali-
ties, diffuse. The patient was neurologically negative
except for right lower quadrant heminopsia. Skull
rays showed small metallic foreign body (shell frag-
ment) in the left parietal area.
238
Minnesota Medicine
CRANIO-CEREBRAL INJURIES— OLSEN AND ROSSEN
Case 9. — This patient was struck behind the right ear
with a wine bottle in June, 1941, and was rendered un-
conscious for two weeks. The first seizure occurred
eighteen months after the accident, the second in July,
1944, and the third in November, 1944. E. E. G. exami-
nation several days after last seizure revealed minimal
abnormalities, non-focal. Neurological and skull-ray
examinations were negative.
Analysis of 73 Cases without Electroencephal-
ographic Studies. — These patients were analyzed
in regard to objective and subjective neuropsy-
chiatric residuals. Fifty-nine complained of head-
ache alone and thirteen of dizzy spells or “black-
out.” All of the patients who had dizzy spells
also complained of headache. Thirteen com-
plained of memory defect or voiced symptoms of
easy fatigueability and nervousness. Five com-
plained of tinnitus in one or both ears. Organic
neurological residuals were present in twenty-two
patients or 30.1 per cent. Twenty had compound
skull and brain wounds. Fifty-two had closed
head injuries including lacerated scalp without
fracture. One had an extradural hematoma (veri-
fied at operation). Eleven had compound skull
and brain wounds with no obvious residuals.
Nine had compound skull fractures with brain
wounds with obvious neurological residuals. Four
had post-traumatic epilepsy, and all of these had
compound skull and brain wounds. Forty-nine
of the seventy-three patients had periods of un-
consciousness of varying duration. It was not re-
corded in eighteen instances, and six were never
unconscious. All but one patient had various
subjective complaints.
It is of interest that in this group headaches
and dizziness were the two most common com-
plaints. Nervousness, anxiety and lapse of mem-
ory were next in frequency. Less than half of
the patients with compound injuries, many of
them with retained metal fragments in their brains
(confirmed by skull rays), had residual objective
neurological findings.
Summary of Results
1. The results of the analysis of 147 cases of
head injuries, 100 of which were of the closed
type and forty-seven of which had sustained com-
pound wounds of the skull with brain injury,
are tabulated and discussed.
2. It was found that headaches and dizzy spells
were the two most common subjective complaints.
Seventy-three patients complained of headache
alone and thirty-nine of headache plus some other
subjective symptom.
3. The symptoms of nervousness, anxiety,
memory lapse and easy fatigueability were next
in frequency.
4. Analysis of the total group of 147 patients
disclosed that 9 per cent developed post-traumatic
epilepsy. Thirty-three per cent had residual ob-
jective neurological findings of various types, 67
per cent complained of headache, 26 per cent com-
plained of “blackout” or “dizzy spells” and 19
per cent complained of nervousness, anxiety,
memory lapse or easy fatigueability.
5. In the group of seventy-three patients who
did not have E. E. G. studies, all complained of
headache but one. Thirteen had in addition to
their headache some other somatic symptom which
in the majority of cases was dizziness. Of this
group twenty had compound skull and brain
wounds, forty-nine had closed head injuries in-
cluding lacerated scalp without fracture, nine
had compound skull and brain wounds with ob-
vious neurological residuals, while eleven patients
had compound skull and brain wounds with no
obvious residual findings. Four of this group
developed post-traumatic seizures.
6. Of the group of seventy-four receiving E.
E. G. 51 per cent were normal, 26.2 per cent
slightly abnormal and 22.8 per cent were greatly
abnormal. Of the twenty-six patients who had
compound skull and brain injury 46 per cent were
normal, 23 per cent slightly abnormal and 31
per cent greatly abnormal. Of the remaining
forty-eight with closed head injuries 56 per cent
had normal, 29.4 per cent slightly abnormal and
14.6 per cent greatly abnormal E. E. G.
7. The time between the date of head injury
and E. E. G. examination was under six months
for twenty-nine of the cases, six to twelve months
for eighteen cases and nine patients were ex-
amined twelve to twenty- four months after their
injuries. Six of the patients had E. E. G. studies
seventy-two months or more after their head
injuries.
8. Of the total group nine (12.1 per cent)
developed post-traumatic seizures. Six of these
patients had sustained compound skull and brain
injury while three had suffered from closed head
injury (Table IV). Five had greatly abnormal
E. E. G. (two of them focal in the right and
left frontal areas), three had slightly abnormal
E. E. G. (one with focal abnormalities in the
March, 1950
239
CRANIO-CEREBKAL INJURIES— OLSEN AND ROSSEN
right parietal lead) and one had a normal E. E. G.
Of the live patients with gross E. E. G. abnormal-
ities two had defects in their skull rays in the
frontal region. Both these patients showed focal
E. E. G. abnormalities in the same area. One
other had a skull defect in the frontal region and
had a generalized abnormal E. E. G., as did one
other with a foreign metallic body in his right
parietal region. One of the cases with a slightly
abnormal E. E. G. showed a skull defect in the
right parietal region by x-ray and his E. E. G.
abnormality appeared in the same region.
9. Seventeen or 23 per cent of the group of
seventy- four had residual neurological findings,
and of this group seven had greatly abnormal
E. E. G., only one of which was focal ; five had
slightly abnormal E. E. G., only one of which
was focal, and 5 had normal E. E. G. Of the
five that were normal, two showed x-ray evi-
dence of foreign metallic objects and one had a
bony defect in the right temporal region. One
of the seven patients with objective neurological
residuals and greatly abnormal focal type of
E. E. G. showed x-ray evidence of a foreign
metallic body in the left occipital region. One of
the cases with slightly abnormal E. E. G. showed
x-ray evidence of a bony defect in the right
parietal region.
10. Of the group of seventy-four who had
E. E. G. studies, the length of unconsciousness
was unknown in fifty-four. Of these, thirty-one
had normal E. E. G., eleven had greatly abnormal
E. E. G., and twelve had slightly abnormal E. E.
G. Of the twenty patients who had known periods
of unconsciousness four had greatly abnormal,
nine slightly abnormal and seven had normal
E. E. G.
Conclusions
1. The highest degree of E. E. G. abnormality
was noted in those patients (nine in number) who
developed post-traumatic epilepsy, as 90 per cent
of these were found to have greatly abnormal or
slightly abnormal E. E. G.
2. In the cases with focal abnormalities in the
E. E. G. there was a definite correlation with the
site of injury as shown by x-rays of the skull.
3. No correlation could be made as to focal
abnormality in the E. E. G. and the objective
neurological findings. This was most probably
due to the fact that most of the head injuries
in this series were severe, leaving diffuse residual
lesions rather than those of a focal type.
4. In the group of cases where the length of
unconsciousness was known there appeared to be
no definite correlation between the E. E. G. ab-
normality and the length of unconsciousness.
5. The E. E. G. abnormality was 21 per cent
greatly abnormal and 21 per cent slightly ab-
normal in fourteen patients who voiced headache
as their only complaint, as compared with 8 per
cent greatly abnormal and 1 1 per cent slightly ab-
normal in twenty-six patients' who voiced head-
ache plus one or more other subjective neuropsy-
chiatric complaints.
6. Headaches, dizzy spells, nervousness, anxi-
ety, memory lapse and easy fatigueability were the
most common subjective complaints, with the
E. E. G. abnormality being highest in those pa-
tients who voiced headache as their only com-
plaint.
References
1. Denny-Brown, D„ and Russell, W. Ritchie: Experimental
cerebral concussion. Brain. 64:93-163, 1941.
2 Dennv-Brown, D.: The clinical aspects of traumatic epilepsy.
Am. J. Psychiat.. 100:385-592, (March) 1944.
3 Dennv-Brown, D. : Disability arising from closed head in-
jury. J.A.M.A., 127:429-436, (Feb. 24) 1945.
4. Dow, Robert S.; Ulett, George, and Raaf, John: Electro-
encephalographic studies in head injuries. J. Neurosurg.,
11:154-169, (March) 1945.
5. Gibbs, F. A.; Werner, Walter, and Gibbs, E. L.: The elec-
troencephalogram in post-traumatic epilepsy. Am. J. Psychiat.,
100:738-749, (May) 1944.
6. Gibbs, F. A., and Gibbs, E. L. : Atlas of Electroencephalog-
raphy. Private Printing. Cambridge, Mass.: Lew A.
Cummings Co., 1941.
7. Gibbs, F. A.; Gibbs, E. L., and Lennox, W. G.: Electro-
encephalographic classification of epileptic patients and con-
trol subjects. Arch. Neurol. & Psychiat., 50:111-128, (Aug.)
1943.
8. Jasper, Herbert D.; Kershman, John, and Elvidge, Arthur:
Electroencephalographic studies of injury to the head. Arch.
Neurol. & Psychiat., 44:328-348, (Aug.) 1940.
9. Walker, A. Earl; Kollros, Jerry, and Case, Theo: The phys-
iological basis of cerebral concussion. J. Neurosurg., 1:
108-116, 1944.
HEALTH EDUCATION
Health education and health services go hand in hand.
Singly, they cannot do an effective job. Together, they
complement each other and form an invaluable adjunct
in the over-all health program. Health education with-
out opportunities for medical consultation is sterile.
Likewise, medical services exist in a vacuum unless they
are called to the attention of the people. — Tula Salpas,
USPHS, Indust. Hyg. Newsletter, Aug., 1949.
240
Minnesota Medicine
PRIMARY TUMORS OF THE OPTIC NERVE
RepoekoFTwo Cases of Glioma
RICHARD C. HORNS. M.D.
Minneapolis, Minnesota
T) RIMARY tumors of the optic nerve may
be divided into two main groups : intradural
tumors (gliomas) and tumors of the nerve
sheaths (meningliomas, or endotheliomas). The
first full pathological examination of a tumor
of the optic nerve was published by Van Graefe
(1866). These tumors are rare. There have
been less than 350 cases reported in all the med-
ical literature.4 Verhoeff10 states that prior to
1932 only 300 cases were recorded. A survey of
these cases in the literature shows that 80 per cent
were gliomas, 17 per cent were meningiomas and
3 per cent were fibromas.1
Gliomas of the optic nerve usually occur during
the first decade of life and many occur before the
age of five years. From 85 per cent to 90 per
cent occur before the age of twenty. They have
a ratio of occurrence to choroidal sarcoma (malig-
nant melanoma) of 1 rROO.11 Most of these
tumors are intraorbital but some have been re-
ported in the intracranial portion of the nerve, and
in the chiasm. These tumors tend to spread
along the nerve so the point of origin is often
obscure.
Meningiomas of the optic nerve sheaths, like
meningiomas elsewhere, tend to occur later in
life than gliomas do, and the symptoms usually
develop after the first decade of life. More than
50 per cent occur after the age of thirty years.
Meningiomas arising intraorbitally are extremely
rare, and there are some observers who question
whether they ever arise within the orbital cavity.
Such origin, however, has been reported by
Byers,2 Hudson,6 and more recently by Stallard.s
Intracranial meningiomas of anterior and middle
cranial fossae frequently extend into the orbit.
Fibromatosis and malignant melanoma arising
in the optic nerve occur most frequently during
adult life but are extremely rare tumors. Malig-
nant melanoma arising in the choroid, however,
is a fairly common tumor.
The female sex is more prone to develop optic
nerve tumors. Hudson’s series6 shows a propor-
tion of female to male of 70 to 43 in gliomata, 20
Inaugural thesis presented before the Minneapolis Academy of
Medicine, Minneapolis, Minnesota, December 19, 1949.
The author is indebted to Dr. William Peyton for helpful
suggestions in preparing this paper.
March, 1950
to 7 in meningiomata, and 5 to 1 in fibromata.
The signs and symptoms of optic nerve tumor
depend on the site of origin of the tumor. When
the tumor arises from the orbital portion of the
optic nerve, there is slowly progressing unilateral
exophthalmos along with profound visual loss.
The exophthalmos is only partially due to the
tumor mass itself. The reaction of other tissues
of the orbit also add to the exophthalmos. Usual-
ly there is profound visual loss before the exoph-
thalmos appears. However, in some cases of
meningioma of the nerve sheath, vision is not
destroyed until late. There is no impairment of
the ocular muscle function until the exophthalmos
has become quite marked. In the case of glioma
there is a painless exophthalmos with the eye
pushed straight forward while in many cases of
meningioma, the eye is pushed down and in or
down and out. This is because the meningioma
has more of a tendency to expand into the orbit
transverse to the nerve, while the glioma tends to
spread along the nerve. There is no pulsation and
a hruit is not heard over the area.
Primary optic atrophy or a papilledema is seen
on ophthalmoscopic examination. The papille-
dema is due to venous obstruction which produces
hemorrhages about the disc, elevation of the disc,
white exudates and eventually a secondary optic
atrophy. There are some cases of optic nerve
tumor reported in which the ophthalmoscopic
examination has been normal. A very striking
feature of primary optic nerve tumor is the fact
that visual loss is extremely great in comparison
with the extent of primary optic atrophy or
papilledema. A patient may have only a mod-
erate degree of papilledema or primary optic
atrophy and have no light perception or only very
poor light perception.
Tumors limited to the intracranial portion of
the optic nerve almost invariably produce a pri-
mary optic atrophy, but cases have been reported
in which an ophthalmoscopic picture of unilateral
papilledema was produced. I do not know the
mechanism by which the papilledema is produced
in these cases. Bilateral papilledema occurs only
if the tumor is large enough to increase intra-
24i
PRIMARY TUMORS OF THE OPTIC NERVE— HORNS
cranial pressure, and may do so by its own mass
or by obstruction to the circulation of cerebro-
spinal fluid.
The visual field examination is usually of little
help in primary tumors of the optic nerve because
the patient usually presents himself with one
blind eye and a normal field in the other, but
visual field examination is of great significance in
tumors of the intracranial portion of the optic
nerve which extend into the optic chiasm. In
this case a field defect, usually a temporal hemi-
anopsia, is found in the opposite eye.
Roentgenographic examination is of great im-
portance in studying these cases. Gliomas of the
optic nerve usually arise intraorbitally and ex-
tend centrally through the optic foramen very
frequently enlarging the optic foramen. This
finding of a unilateral enlargement of an optic
foramen is of importance both diagnostically and
from the standpoint of treatment.
Usually there are no x-ray findings in tumors
limited to the intracranial portion of the optic
nerve, but when the tumor becomes large there
will be erosion of the anterior and posterior
clinoid processes, deformity of the sella turcica,
and erosion of the sphenoid ridge. The diagnosis
of intracranial glioma of the optic nerve and
chiasm is extremely difficult. Martin and Cush-
ing1 were able to suspect the condition in only one
out of their seven cases.
The course of both gliomas and meningiomas
is that of slow, steady gradual progression over
a period of years. Temporary periods of rapid
growth have been reported. The ultimate result
if untreated is death due to intracranial extension.
Neither gliomas or meningiomas metastasize.
On microscropic examination of gliomas, the
essential neoplastic cell is a uni- or bi-polar spon-
gioblast. These cells are spindle-shaped with oval
nuclei and straight or sometimes corkscrew-like
processes arising from each end. Verhoeff9
described three main types, all of which may un-
dergo transition from one into the other. These
types are a finely reticular type similar to normal
neuroglia, an exaggerated coarse reticular type,
and a sickle-shaped cell type made up of course
neuroglial filters. Sometimes mitotic figures are
seen. Cysts filled with mucinous-like substance
are frequently found and may be very numerous.
Because of this these tumors have been called
myxiomas in the older literature, but this mate-
rial does not show the staining reaction for mucin
(Fleischer and Scheere5). Usually the septa are
enormously thickened and made up of collagenous
fibers arranged in an irregular manner into which
glial fibers grow in all directions. The nerve
fibers are spread apart compressed and stretched
and as a rule are demyelinized at an early stage.
The microscopic examination of meningiomata
of the optic nerve-sheaths shows cells with large
vesicular nuclei and pale staining cytoplasm.
These cells are arranged in syncytial masses;, ir-
regular lobules or ill-defined columns with a ten-
dency to an arrangement in whorls. These are
typically endothelial cells and arise from either
the endothelial cells lining the sub-dural space
or from the cells covering the arachnoid. These
meningiomas tend to expand into the orbit and
neighboring structures, but do not break through
the pia to invade the optic nerve. The nerve
fibers are damaged only by compression.
There have been several reports in the literature
of glioma of the optic nerve associated with dif-
fuse neurofibromatosis of Von Recklinghausen.
I he treatment of primary tumors of the optic
nerve is surgical. If the tumor is limited to the
orbit, the blind eye together with the optic nerve
and tumor may be enucleated. In some cases the
globe has been retained by entering the orbit
from the lateral side by means of the Kronlein
operation. Also by means of a transconjunctival
approach or through a skin incision made along
the outer or upper orbital margin, the orbit can
be explored fairly well. But a much better
exposure of the lateral side of the orbit is obtained
with the Kronlein operation. There are two main
disadvantages to these transorbital approaches
to the removal of these tumors. They are, first,
the difficulty of complete excision of the tumor
if it extends well into the apex of the orbit and,
second, the danger of a cerebrospinal fluid leak
into the orbit with ensuing meningitis.
If x-ray examination or exploration of the orbit
by one of the above procedures demonstrates that
the tumor has extended through the optic fora-
men, then intracranial operation should be con-
sidered. This is done through the transfrontal
route (Dandy, Martin and Cushing3). The orbit
is unroofed and the tumor is excised. If the
globe must also be excised, this should be done
after complete healing has taken place. X-ray
therapy is of very limited value in the treatment
of these tumors.
Two cases of primary tumor of the optic nerve
242
Minnesota Medicine
PRIMARY TUMORS OF THE OPTIC NERVE— HORNS
from the neurosurgical and ophthalmological serv-
ices at the University of Minnesota Hospital are
presented.
Case 1. — A forty-one-year-old white woman was ad-
mitted to the University Hospital on January 29, 1946,
and discharged on February 8, 1946. Her complaints
on admission were failing vision in the right eye, frontal
and occipital headaches, tinnitus, and paresthesia of the
hands and feet. The chief complaint, however, was
the failing vision in the right eye, gradually progressive
since it was first noticed three months previously. The
other symptoms had been present for three years. The
general physical examination was negative with the ex-
ception of slightly reduced abdominal reflexes and slight
extensor response to the Babinski test on the left. Rou-
tine laboratory work was done and found to be normal.
Ophthalmoscopic examination revealed a 3 diopter papil-
ledema in the right eye. There was venous engorge-
ment and there were several small hemorrhages about the
disc. In the left eye there was a slight elevation of
the disc, but otherwise it was normal. The vision was
20/400 in the right eye and normal in the left. Visual
field examination showed general depression for the
right, but was normal for the left eye. The ventriculo-
gram was normal. A diagnosis of multiple sclerosis was
made, and the patient was put on histamine and dis-
charged.
Vision continued to fail in the right eye, and for this
reason she was readmitted on April 25, 1946, when it
was found that vision was merely light perception in
the right eye. A 3 to 4 diopter papilledema was
again found in this eye.
The left eye was normal. Neurological examination
revealed deep reflexes on the left, more active than on
the right. It was thought that the patient probably had
a sphenoid ridge tumor on the right. A transfrontal
craniotomy exposed a tumor of the right optic nerve.
This tumor extended from the optic foramen to the
chiasm. The involved optic nerve was enlarged to
about 1 cm., and just behind the optic foramen on the
inferior surface of the nerve there was an additional
bulbous enlargement. The tumor was excised as close
to the chiasm as seemed safe without endangering vision
in the other eye. The distal section of the optic nerve
was made anterior to the optic foramen. It was felt that
complete removal was impossible without severely dam-
aging the optic chiasm. Microscopic examination showed
the tumor to be a glioma made up of a diffuse prolifera-
tion of astrocytes. The patient was discharged on May
8, 1946. The patient was last seen in January, 1950
(three and one-half years after operation). She was well
and working in a department store. Her only symp-
tom was blindness of the right eye. On examining her
eyes it was found that there was a secondary optic
atrophy of the right optic nerve. There was no light
perception in the right eye. The left eye was normal,
her vision was 20/20 and no field defect could be
detected on the perimeter with a 3 mm. white test object
at 330 mm. or on the tangent screen with a 1 mm. white
test object at 1000 mm.
Case 2. — The second case is that of a five-year-old
white boy who was first seen at the University Hos-
pital on March 24, 1949. The parents stated that the
right eye had been very prominent for the past two
weeks. It is probable that some exophthalmus was pres-
ent for a considerably longer time than this. The
mother had noticed that for the past two years the
right eye would drift out when the child would look
in the distance. A few days before admission the
father had discovered that the child could not see with
the right eye. No other symptoms were noted. The
right eye on measurement was found to have an exoph-
thalmos of 2 mm. as compared to the left eye. There
was no light perception in the right eye, and the eye
was turned outward and downward. There was limi-
tation of motion when the eye was turned upward and
outward. On examining the eye grounds, it was found
that there was engorgement of the veins of the right
eye and a papilledema of from 4 to 5 diopters. The
left eye was normal. The physical examination was
otherwise normal and routine laboratory work was neg-
ative. A ventriculogram gave normal findings. Tt was
thought that the boy had some type of an orbital tumor,
and on March 30, 1949, a right transfrontal craniotomy
was performed. The right orbit was unroofed but the
capsule was not opened and no tumor was found. After
the operation the boy got along well, but the exophthal-
mus progressed so that by September 29, 1949, the
exophthalmus of the right eye measured 6 mm. as com-
pared to the other eye. The boy was readmitted to
the hospital on November 14, 1949. A second craniotomy
was done and the right orbit again explored through
a right transfrontal craniotomy and the capsule of the
orbit opened. A tumor of the optic nerve which extended
from the globe to the optic foramen was found. This
tumor was fusiform in shape and was about 12 mm.
across at its widest portion. The tumor had elongated
the optic nerve so that it was coiled upon itself within
the muscle cone. It was excised at the globe and dis-
sected free to the optic foramen where the nerve was
again cut across. Because there was some question of
the tumor possibly having extended through the optic
foramen, an additional portion of the nerve within the
optic foramen and proximal to the optic foramen was
excised. Postoperatively, the patient has gotten along
well. At the present time there is a ptosis on the right,
and the right eye has remained somewhat irritable.
Microscopic examination of this tumor showed glial
cells, and a diagnosis of astrocytoma was made by the
pathologist.
References
1. Coston, T. O.: Primary tumor of the optic nerve, with a
report of a case. Arch. Ophth., 15:696-702, 1936.
2. Byers, W. G. M. : The primary intradural tumors of the
optic nerve. Studies from the Royal Victoria Hospital,
Montreal, Toronto, 1:1-82, 1901.
3. Dandy, W. E. : Prechiasmal intracranial tumors of optic
nerves. Am. J. Ophth., 5:169-188, (March) 1922.
4. Duke Elder, W. S. : Textbook of Ophthalmology. Vo!. 3,
pp. 3073-3101. St. Louis: C. V. Mosby Company, 1941.
5. Fleischer, B., and Scheerer, R. : Beitrag zur Histologie der
primaren Schnerventumoren. Arch. f. Ophth., 103:46-74,
1920.
6. Hudson, A. C.: Primary tumors of the optic nerve. Royal
London Ophthalmology Hospital Reports, 18:317-439, 1912.
(Continued on Page 304)
March, 1950
243
THE SURGICAL MANAGEMENT OF MASSIVE HEMORRHAGE FROM
GASTRIC AND DUODENAL ULCERS
DONALD C. MACKINNON, M.D.
Minneapolis, Minnesota
npHE PURPOSE of this report is to review the
clinical aspects of severe bleeding from the
stomach and duodenum, and to report twenty-
three cases of massive hemorrhage requiring emer-
gency operations. All of the patients were admit-
ted to the Minneapolis Veterans Hospital during a
three-year period from April, 1946, to April,
1949.
In the literature there is confusion over the true
meaning of the term “massive hemorrhage.” Re-
cent publications attempt to define, clarify, and re-
strict the term to a specific clinical picture. Amen-
dola4 believes that it implies a rapidly progressive
exsanguination, and should be applied to a rapid loss
of blood of such proportions as to cause unmis-
takable signs and symptoms of hemorrhagic shock.
Hoerr, Dunphy, and Gray,17 in defining their ex-
sanguinated cases of massive hemorrhage, stressed
the importance of shock, and the failure to stabi-
lize the circulation with a limited number of blood
transfusions. When the term is used in a less re-
stricted sense, bleeding is extensive but less rapid,
causing milder symptoms and signs of shock, with
marked reductions in the hemoglobin, red cell, and
hematocrit determinations. Such hemorrhages are
an immediate threat to the life of the patient.
The cases reported in this review were grouped
as moderate, severe, and exsanguinating forms of
massive hemorrhage. This classification was based
on the degree or severity of the following factors :
presence of shock, rate of bleeding, persistence of
hemorrhage, and recurrent episodes of acute mas-
sive bleeding. Since the limits of each group can-
not be defined precisely, one encounters consider-
able difficulty in assigning the borderline cases to
the proper group. The cases with moderate hem-
orrhage were patients with an episode of mild
shock, a short period of bleeding at a rate not
greater than 500 to 1,000 cubic centimeters of
blood in twenty- four hours. Ordinarily these pa-
tients recover with proper medical management.
Those grouped as severe massive hemorrhage
had one episode of shock, bled for a longer period
Read at the Surgical Staff Seminar of the Minneapolis Veter-
ans Hospital, May 3, 1949.
Published with permission of the Chief Medical Director, De-
partment of Medicine and Surgery, Veterans Administration,
who assumes no responsibility for the opinions expressed or
conclusions drawn by the author.
of time but at a rate not greater than 1,500 cubic
centimeters of blood in twenty-four hours. If
they were given 1,000 to 1,500 cubic centimeters
of blood daily, they appeared to be in good circu-
latory balance. Some of these patients may recov-
er when treated medically. They require close ob-
servation, and when the rate of bleeding increases,
as evidenced by shock and an episode of acute
massive hemorrhage, surgical intervention is in-
dicated. The cases classified in the exsanguinating
group were patients who may or may not have had
long periods of steady bleeding but who bled at a
rate greater than 1,500 cubic centimeters of blood
in twenty- four hours. These were the patients
with one or two episodes of acute massive hemor-
rhage with marked shock and an unstable circula-
tion despite transfusions of 500 cubic centimeters,
or more, of blood every eight hours.
Incidence and Mortality
Warren and Lanman,32 in a comprehensive re-
view of the literature, found that in patients ad-
mitted to the hospital for ulcer, the incidence of
hemorrhage of any degree ranged from 11 to 40
per cent. The incidence of massive hemorrhage
in the same group of collected figures was between
9 and 18 per cent. They explained the wide range
of mortality under medical management (from 3
to 24 per cent) on the basis of whether the reports
include cases with hemorrhage of any degree or
only those with massive hemorrhages. In discuss-
ing surgical mortality rates, these authors further
stressed tine importance of knowing not only the
degree of hemorrhage but at what time during the
course of bleeding the operation was undertaken.
Their collected mortality rates following operation
for bleeding peptic ulcer ranged from 4.1 to 42.8
per cent, and this wide range seemed to be explica-
ble solely on the basis of the varying degrees of
exsanguination of the patients at the time of op-
eration. In summary, these authors state that ap-
proximately 25 per cent of the patients admitted to
the hospital for peptic ulcer have bleeding as a
symptom, and approximately 10 per cent of all
such admissions have massive hemorrhage. The
mortality in all patients admitted for massive hem-
orrhage and treated medically is between 5 and 10
244
Minnesota Medicine
GASTRIC AND DUODENAL ULCERS— MAC KINNON
per cent. The mortality following operation for
bleeding ulcer may be as low as 5 per cent if the
patients are operated upon within twenty-four
hours, or if elective operations are included, but it
has approached 50 per cent if one considers those
patients in a state of exsanguination and upon
whom operation followed a prolonged and unsuc-
cessful attempt at conservative management.
Other reports substantiate the dangers of mas-
sive hemorrhage. In Heuer’s20 series of 337 pa-
tients with serious or massive hemorrhage from
peptic ulcer, forty-nine (15 per cent) of the pa-
tients presented a fatal type of hemorrhage.
Amendola4 reported eighty- four patients with
massive hemorrhage treated expectantly with a
mortality rate of 15 per cent. Bergh, Hay,
and Trach6 collected 2,565 patients with mas-
sive hemorrhage treated medically and found the
mortality to be 10.2 per cent. For 214 patients
treated surgically, the mortality was 29.8 per cent.
Recent publications indicate that the present
nonoperative mortality rate in severe and mas-
sive hemorrhages has been lowered by more ade-
quate blood replacement. Costello10 reported a 4
per cent mortality ; Fraser and West14 found a 4.2
per cent mortality, while Meulengracht25 gave the
death rate under his free feeding regime as 2.5
per cent. For a clearer interpretation of mortality
figures, there is a need for separating patients with
severe hemorrhage from those with exsanguinat-
ing hemorrhage, as indicated by Hoerr, Dunphy,
and Gray.19
The mortality following massive hemorrhage
from peptic ulcer increases with the age of the pa-
tient. In patients under forty-five years of age
the risk is less, though probably not nearly as slight
as some reports indicate. In the younger age
group, Bohrer9 reported 548 patients with severe
acute hemorrhage treated conservatively. The
mortality rate below the age of forty-five years
for bleeding gastric and duodenal ulcers was 20
per cent and 6 per cent respectively. Hansen and
Pederson16 found that of 393 patients with fatal
hematemesis and melena in Copenhagen hospitals
during a period from 1915 to 1937, 13 per cent
were under forty years of age. In the group over
forty-five and fifty years of age, Allen and Bene-
dict,3 Blackford and Williams,8 and Chiesman10
report mortality rates varying from 25 to 33 per
cent. Jankelson and Segal22 found the average age
of patients with fatal bleeding ulcer to be fifty-
four years. Meulengracht25 recently reported
TABLE I COMPARISON BETWEEN MORTALITY RATES
FOR BLEEDING DUODENAL AND BLEEDING GASTRIC
ULCER ( SANDUSKY AND MAYO26)
Duodenal
Author per cent
Segal, Scott, Stevens27 3.7
Alberhart1 7.0
Welch and Yunick53 6.3
Sandusky and Mayo26 5.4
Gastric
per cent
30.0
50.0
35.3
30.0
TABLE II A COMPARISON BETWEEN THE MORTAL-
ITY RATES OF EARLY AND LATE OPERATION
Early Operation
Mortality
Author Cases Deaths per cent
Finsterer13 72 4 5.1
Heuer20 21 2 9.5
Gordon-Taylor15 18 1 5.5
Amendola4 11 1 9.0
Late Operation
Mortality
Author Cases Deaths per cent
Finsterer13 74 22 30.0
Heuer20 10 7 70.0
Gordon-Taylor15 11 4 36.0
twenty-six medical fatalities, twenty-five being
over forty years of age and over half being over
sixty. Holman18 attributes the higher mortality in
the older individuals to their greater susceptibility
to complications and to the higher incidence of
arteriosclerosis with failure of the eroded vessels
to retract. He also found that the increased mor-
tality among the older patients was not related to
the chronicity of the ulcer.
The seriousness of recurrent episodes of mas-
sive hemorrhage is stressed by Holman18’19 and
Hunt.21 The first hemorrhage also carries a con-
siderable risk. Allen2 reported a 45 per cent mor-'
tality from the first hemorrhage in his fatal cases.
Blackford and Allen7 found that 77 per cent of
their fatalities occurred during the first bleeding
episode.
The location of the ulcer is another factor in-
fluencing the mortality. Sandusky and Mayo26
report three series of cases, in addition to their
own, in which the mortality rates were calculated
separately for gastric and duodenal ulcers. Table
I shows that the mortality rate for combined med-
ical and surgical treatment in bleeding gastric ul-
cer is five to eight times as great as that in bleed-
ing duodenal ulcer.
Difficulties arise in evaluating the risk of sur-
gical intervention because the number of contribu-
tions to the literature is small, and the statistical
data are compiled upon patients with variable de-
grees of hemorrhage. Finsterer13 was the first to
show that in patients operated upon within forty-
eight hours after the onset of hemorrhage, the
mortality rate was significantly lower than in
those patients operated upon later. Other reports
March, 1950
245
GASTRIC AND DUODENAL ULCERS— MAC KINNON
have recently appeared in the literature to substan-
tiate the fact that the mortality rate decreases when
the period of medical treatment is shortened.
Table II clearly shows the lower mortality in early
operation, many patients being operated upon
within twenty-four hours of the onset of bleeding.
Difficulty also arises when mortality figures of
medical management are compared with surgical
mortality rates. The two groups are not strictly
comparable. Many patients operated upon early
might have ceased bleeding had medical treatment
been continued. Early operation can be justly
criticized when performed on patients with only
a moderate degree of acute hemorrhage. Con-
versely, when operation is performed late, after a
prolonged period of medical management has
failed, or as a last resort, the surgical mortality
rate may be exceedingly high. Such cases should
not be reported in terms of mortality rates but in
terms of lives saved. These cases represent pure
salvage ; that is, the patients would not have re-
covered without operation.
Etiology and Pathology
Since the etiology of acute bleeding depends
upon the presence of the ulcer, a definite underly-
ing cause is unknown. Persistent slow bleeding
and occasionally severe hemorrhage may be from
the ulcer wall due to the erosion of small vessels
in the submucosa or deeper layers of the stomach
or duodenum. A massive hemorrhage can arise
from a small anterior wall gastric or duodenal
ulcer. The fact is well established that fatal
hemorrhages are often due to penetrating posterior
duodenal wall ulcers with erosion of larger ves-
sels, such as the gastroduodenal and pancreatico-
duodenal arteries. If the fatal bleeding is of gas-
tric origin, the ulcers penetrate the gastrophepatic
ligament or pancreas since they are usually located
on the lesser curvature or posterior wall. They
may produce an erosion of the right or left gastric
arteries, and rarely of the splenic artery.
The ulcer is usually deep and hard, with a base
of dense fibrous scar tissue. In the base of the
ulcer there may be a thickened sclerotic artery with
a loosely attached occluding blood clot. The diges-
tion and dislodgment of the blood clot will pro-
duce recurrent episodes of bleeding. The sclerotic
vessel surrounded by dense fibrous tissue in the
ulcer base prevents retraction of the vessel and
interferes with the natural mechanism of hemo-
stasis.
Occasionally the source of bleeding is obscure
and not visible to the surgeon but may be demon-
strated by careful gross and microscopic examina-
tion of the resected specimen. A gastritis is fre-
quently associated with gastric and duodenal
ulcers. Rarely, when the ulcer is iiot found, a
severe antral gastritis with or without ulceration
will be the source of bleeding.
In 231 cases of sudden massive hemorrhage,
Allen2 found the lesions that caused the bleeding to
be the following: duodenal ulcer, gastric ulcer,
gastric carcinoma, esophageal varices, gastroje-
junal ulcer, gastritis, and leiomyosarcoma.
Diagnosis
The problem of determining the source of
bleeding may be a difficult one. As desperate as
these cases may seem, every reasonable effort
should be made to establish the diagnosis during
the period of medical management and blood re-
placement.
The history may disclose a presumptive or a
positive diagnosis of gastric or duodenal ulcer. A
bleeding gastrojejunal ulcer is strongly consid-
ered when the patient has had a previous gastro-
enterostomy. A carefully taken history and a com-
plete physical examination may suggest a gastric
carcinoma or cirrhosis of the liver with bleeding
esophageal varices. Useful information can be
obtained from liver function tests within twenty-
four hours. However, the diagnostic and thera-
peutic problem is frequently so urgent that many
of these procedures are not done. Gastroscopy
may be dangerous, unwise, and often impossible.
Heuer20 had three fatal cases of recurrent mas-
sive hemorrhage follow fluoroscopic examination
and is opposed to it. On the contrary, Hoerr, Dun-
phy, and Gray,17 and Amendola1 advocate a swal-
low of barium with fluoroscopic and x-ray exam-
ination of the esophagus, stomach, and duodenum
performed without palpation or pressure as a final
diagnostic effort. Obviously, the patient should
not be in shock during this examination. If neces-
sary, the examination can be done during a blood
transfusion. Allen2 found the x-ray examination
of the esophagus by the method of Schatzki of
value in the diagnosis of esophageal varices.
Fluoroscopic examination was performed in a few
of our cases without dangerous consequences.
Though the examination has obvious limitations,
it helped in two cases to demonstrate lesions which
were confirmed later.
246
Minnesota Medicine
GASTRIC AND DUODENAL ULCERS— MAC KINNON
Management
The management of patients with massive
hemorrhage from the stomach and duodenum re-
quires teamwork and close observation by both
the internist and the surgeon. Since the initial
treatment is medical, the patients are admitted to
the medical service of most hospitals. The great-
est single advancement in medical therapy has
been the liberal use of blood transfusions, with
emphasis on complete blood replacement. The pa-
tient’s appearance and reaction to the blood loss
are noted. The pulse and blood pressure are taken
at fifteen minute intervals and recorded. An at-
tempt is made to ascertain the source of bleeding.
If bleeding stops permanently, medical manage-
ment is continued and elective surgical interven-
tion is considered later. Further discussion of
medical therapy is not a part of this review.
To differentiate patients in whom the hemor-
rhage is likely to prove fatal, or those needing
surgical intervention, from those in whom it will
cease under proper medical therapy, has proved
most difficult. This is due to the variable course
taken by these patients and the different reactions
of patients to the blood loss. The course of the
hemorrhage falls into two main groups : ( 1 ) in-
termittent bleeding, and (2) continuous bleeding.
There are periods of acute recurrent massive
hemorrhage occurring in either group. Such a
variable pattern in the course of a bleeding episode
is a warning that a sudden fatality from ex-
sanguination may occur at any time.
Surgical Indications
A clearer definition of the surgical indications
is urgently needed. Which patient should be
operated upon, and when should the operation be
performed ? These are the basic points in the
management of these cases and remain most diffi-
cult to solve.
There are important factors in addition to the
age of the patient and the duration of bleeding
that help to determine which patient should be
submitted to operation. These important criteria
are the presence of syncope or shock, clinical evi-
dence of persistent bleeding, and clinical evidence
of acute recurrent episodes of massive hemor-
rhage. Patients who continue to bleed following
a massive hemorrhage, and/or have a second mas-
sive hemorrhage within a day or two, constitute a
dangerous group in which sudden fatalities may
occur despite desperate efforts to replace blood.
March, 1950
Persistent or recurrent shock is an exceedingly
ominous sign associated with severe uncontrolled
bleeding.
Shock is present when tachycardia, hypotension,
pallor, sweating, fainting, or cold clammy ex-
tremities are observed. Shock may not be ap-
parent until the pulse and blood pressure are
taken after the patient has been in the upright
position for a few minutes.
When the patient is bleeding acutely and blood
is being replaced, the hemoglobin, red cell, and
hematocrit determinations are not reliable. On
admission to the hospital and during an interval
between bleeding, these determinations are more
accurate estimations of the degree of exsanguina-
tion.
Hoerr, Dunphy, and Gray17 have stressed the
importance of the rate of hemorrhage. Their con-
cept implies a time factor, and they believe that
the rate of blood loss is more important than the
quantity of blood loss. It is their opinion that pa-
tients who fail to maintain a stable circulation
despite continued transfusions of not more than
500 cubic centimeters of blood every eight hours
are considered to be in a state of exsanguinating
hemorrhage. It is their belief that these are the
patients upon whom surgery must be employed.
Therefore, the rate of bleeding and recurrent syn-
cope or shock are extremely valuable factors that
should be considered in making the decision to
operate. If operation is delayed in the presence of
these ominous signs, the mere replacement of
blood may fail to fortify the patient to withstand
a major operative procedure.
Hoerr, Dunphy, and Gray17 believe that im-
mediate transfusion and early operation is justi-
fiable in selected young patients in good condition
who are bleeding moderately. This plan not only
checks the bleeding but also provides the correc-
tive subtotal gastrectomy. If such a patient is
seen late in the course of a hemorrhage, it is wiser
to apply the previously mentioned criteria for
operation.
When the decision to operate is made, the pa-
tient is prepared for emergency operation by rapid
and massive blood transfusions and transfusion is
continued throughout the operative procedure.
Operative Procedures
Palliative operative procedures to control
hemorrhage such as ligation of the larger arteries
supplying the ulcer, and ligation of the bleeding
247
GASTRIC AND DUODENAL ULCERS— MAC KINNON
vessel in the base of the ulcer by transfixion or
encircling sutures have not proved uniformly suc-
cessful when used as the sole measure to control
hemorrhage. Following suture of the bleeding ves-
sel in the ulcer base, the ligature may cut through
or be digested, resulting in a recurrence of hemor-
rhage during the first or second week after opera-
tion. When an active bleeding point is found in
a non- resectable, penetrating ulcer, ligation of the
vessel for the immediate arrest of hemorrhage is
a valuable adjunct to subtotal gastrectomy.
When the bleeding ulcer is located high on the
lesser curvature of the stomach, Heuer20 prefers
local excision of the ulcer rather than ligation be-
cause it is a better procedure for permanently
controlling the hemorrhage. Gastric and duodenal
ulcers adjacent to the pyloris cannot be excised
locally and repaired without the danger of ob-
struction, which necessitates an additional pro-
cedure, preferably a gastrojejunal anastomosis.
In these cases he recommends subtotal gastrec-
tomy.
Amendola4 believes that with adequate blood
transfusion and modern anesthesia, a patient who
cannot be safely conditioned for major gastric
surgery should not be subjected to the added risk
of an operative procedure. Subtotal gastrectomy
with excision of the ulcer is the procedure of
choice from the standpoint of controlling hemor-
rhage and permanently curing the patient.
Situations arise in which a large, fixed pene-
trating ulcer located on the posterior wall of the
duodenum or stomach cannot be excised. The ad-
hesions and firm fixation of these ulcers to the
pancreas and the common bile duct make their re-
moval hazardous and increases the risk of the
operation. A fixed penetrating posterior duodenal
wall ulcer may be excluded, left in situ, and the
duodenum proximal to the ulcer closed by em-
ploying the technique of Wangensteen.29 When
the ulcer is near the line of resection, making the
duodenum difficult to close, Wangensteen28 prefers
to seal the posterior duodenal perforation by
suturing the anterior wall of the duodenum to the
edge of the fixed posterior wall and capsule of
the pancreas so as to roll the anterior wall into
the perforation and pancreas. The exclusion
operation is then followed by subtotal gastrectomy.
1 f the penetrating posterior duodenal wall ulcer is
not resectable and is located high, immediately
adjacent to the pylorus, the ulcer base may be left
behind and the resection performed around it.
The duodenum distal to the ulcer is then mobi-
lized sufficiently to permit adequate closure of the
duodenal stump. In such cases the technique of
Judin reported by Gordon-Taylor15 has been rec-
ommended as an alternate procedure' for closing
the duodenal stump. In Judin’s technique the
duodenum is freed from the base of the pene-
trating ulcer and closed into a conical form with a
continuous suture. The cone is converted into a
snail-like form which is employed as a tampon of
the ulcer base as it is sutured to the capsule of
the pancreas. The closure of the duodenum in
any of the penetrating ulcers may result in an ex-
ceedingly difficult and laborious task. A wiser
choice may be a transection of the stomach 4 or
5 centimeters proximal to the pylorus, excision
of the antral mucosa, and closure of the pylorus
and gastric stump according to the technique of
Wangensteen.30 McNealy24 advocates plicating
or folding in the anterior wall of the duodenum
so as to act as a tampon to the ulcer crater. Mc-
Kittrick23 uses a two-stage operation in some of
these difficult cases. He removes the gastric an-
trum at a second stage following the performance,
in selected cases, of a first-stage exclusion and
partial gastrectomy. When a large gastric ulcer
penetrates the pancreas and is not resectable, the
ulcer can be left behind and a subtotal gastric
resection performed around it.
A controversial therapeutic problem arises when
the source of bleeding cannot be found after a
careful exploration of the gastrointestinal tract.
Amendola1 believes that if the source of bleeding
cannot be found after thorough inspection of the
duodenal and gastric mucosa, the stomach and
duodenum should simply be closed without fur-
ther operative procedure. A small ulcer high on
the lesser curvature or low in the duodenum may
be overlooked by this method of examination.
Wangensteen28 has observed small posterior duo-
denal wall ulcers that cannot be felt or seen until
the duodenum is separated from the pancreas.
These occult posterior duodenal wall ulcers should
be considered in cases where the cause of gas-
trointestinal hemorrhage remains obscure. In
Wangensteen’s31 Listerian Lecture, cases of mas-
sive hemorrhage were cited which were due to
superficial gastric erosion, arterial thrombosis of
a gastric vessel, or ulcerative gastritis. In the
presence of the acid-peptic digestive activity of
the gastric juice, these lesions have been observed
to be the source of bleeding. Wangensteen31 states
248
Minnesota Medicine
GASTRIC AND DUODENAL ULCERS— MAC KINNON
that occult hemorrhage from the alimentary canal
frequently has its origin in the stomach and rec-
ommends subtotal gastric resection as the thera-
peutic measure in many such instances. There-
fore, subtotal gastrectomy may be indicated purely
on the basis that the stomach and duodenum are
the most likely sites of obscure, occult hemorrhage.
Many surgeons may criticize or question the ad-
visability of doing so formidable a procedure on
such meager indications. In all probability an un-
necessary gastrectomy may be eventually done
when this plan is followed, but, in the end, more
lives may be saved.
Review of Cases
Although the number of cases of massive
hemorrhage treated by emergency subtotal gas-
trectomy at the Minneapolis Veterans’ Hospital
over a three-year period from 1946 to 1949 is
small, a total of twenty-three cases, there are cer-
tain instructive clinical points of interest shown in
the following review.
A. Sex
All or 100 per cent of the patients were males.
Such a sex incidence is to be expected in a hospital
of this type.
B. Age
Range, 24 years to 72 years
Average age — 47.2 years
Under 45 years of age, 10 cases — 43.5%
Over 45 years of age, 13 cases — 56.5'%
C. History of Uulcer
Positive, 13 cases — 56:5%
Suggestive, 7 cases — 30.4%
None, 3 cases — 13.1'%
D. History of Massive Hemorrhages
First hemorrhage, 16 cases — 69.5%
Second hemorrhage, 4 cases — 17.4%
Third hemorrhage, 3 cases — 13.1%
E. Lowest Hemoglobin and Red Cell Determinations
A hemoglobin of 8.8 grams or a red cell count of
2,500,000 and over, 13 cases — 56.5%
Under that amount, 10 cases — 43.5%
F. Duration of Bleeding Preoperativeiy
Range, 12 hours to 32 days
Under 48 hours, 6 cases — 26.1%
Over 48 hours, 17 cases — 73.9%
G. Shock
One episode of shock, 15 cases — 65.2%
Two episodes of shock, 8 cases — 34.8%
H. Amount of Blood Preoperativeiy
Range, 1,000 c.c. to 8,500 c.c.
Average, 3,826 c.c.
I. Amount of Blood During Operation
Range, 100 c.c. to 2,500 c.c.
Average, 1,383 c.c.
J. Classification or Group
Exsanguinating hemorrhage, 15 cases — 65.2%
Severe hemorrhage, 6 cases — 26.1%
Moderate hemorrhage, 2 cases — 8.7%
K. Site of Bleeding
Duodenal ulcer, 1 1 cases — 47.8%
Gastric ulcer, 8 cases — 34.7%
Gastritis, 3 cases — 13.1%
Undetermined, 1 case — 4.4%
L. Operative Procedure
Subtotal gastrectomy, excision of ulcer, or source
of bleeding, 13 cases — 56.5'%
Subtotal gastrectomy, exclusion of ulcer, 9 cases —
39.1%
Subtotal gastrectomy, site undetermined, 1 case —
4.4%
M. Complications
Five complications in 5 cases — 21.7%
1. Phlebothrombosis left leg, ligation of left super-
ficial femoral vein
2. Partial wound disruption, secondary closure of
the wound
3. Wound infection
4. Hepatitis, homologous serum jaundice follow-
ing administration of plasma for shock by the
patient’s local physician before admission to the
hospital
5. Postoperative hemorrhage for 24 hours, stopped
spontaneously
N. Mortality Results
Mortality, all cases — 23 cases, 2 deaths — 8.7%
Mortality, exsanguinating cases, 15 cases, 1 death —
6.7%
Mortality, moderate and severe cases, 8 cases, 1
death — 12.5%
Mortality according to age :
Linder 45 years, 10 cases, no deaths
Over 45 years, 13 cases, 2 deaths — 15.4%
Mortality according to time of operation :
Early operation (under 48 hours) 6 cases, 1
death — 16.7%
Late operation (over 48 hours) 17 cases,- 1 death—
5.9%
O. Causes of Death
First case — Atelectasis, peritonitis, toxemia, shock
(no autopsy)
Second case — Luetic aortitis, heart block, sudden
death on operating table — -(autopsy)
Discussion of Cases
With the exception of two cases of moderate
hemorrhage, all cases in this report were examples
of severe and exsanguinating hemorrhage. The
indications for operation in these patients were in-
dividualized, based on the degree and rate of
hemorrhage. Syncope or a period of hypotension
and tachycardia constituted shock, which was an
important sign and was present in all patients.
Recurrent shock was the most valuable single sign.
Failure to stabilize the circulation with 500 cubic
March, 1950
249
GASTRIC AND DUODENAL ULCERS— MAC K1NNON
TABLE III.
Massive
Lowest
Duration
No.
Admission
Age
History of Ulcer
Hemor-
Hgh
Shock
of Pre-
Blood Given
Blood During
Classification
Sex
rhages
RBC
operative
Preoperatively
Operation
Hematocrit
Bleeding
1.
4/25/46
51
Suggestive
First
5.3 gms. (33 %)
Once
32 days
5,000 cc.
2,000 cc.
Exsanguinating
M
1.9 million
2.
7/15/46
49
Positive
First
11.2 gnis. (72%)
Twice
36 hours
2,500 cc. blood
1,000 cc.
Exsanguinating
M
3.3 million
1,000 cc. plasma
3.
9/15/46
33
None
First
4.9 gms.
Twice
22 days
7,500 cc.
1,500 cc.
Exsanguinating
M
1.5 million
4.
3/10/47
51
Positive
First
8.4 gms. (54.2%)
Once
15 days
1 .000 cc.
1,500 cc.
Severe
M
2.8 million
29%
5.
3/25/47
55
Suggestive
First
11.2 gms. (72%)
Twice
84 hours
3,500 cc.
1 ,500 cc.
Exsanguinating
M
3.5 million
33%
6.
4/5/47
59
Positive
First
8.1 gms. (52%)
Twice
6 days
2,500 cc.
2,500 cc.
Severe
M
2.7 million
7.
5/26/47
52
Suggestive
First
9.8 gms. (63 %)
Twice
48 hours
2,000 cc.
1,200 cc.
Exsanguinating
M
3.1 million
8.
6/25/47
57
Positive
First
12.6 gms. (81 %)
Once —
18 hours
4,000 cc.
2,000 cc.
Exsanguinating
M
4. million
pro-
39.%
longed
9.
8/4/47
36
Positive
Third
5.3 gms. (34%)
Once
4 days
3.500 cc.
1,500 cc.
Exsanguinating
M
1.6 million
28.%
10.
10/4/47
24
Suggestive
First
7.7 gms. (49%)
Once
7 days
3,000 cc.
1,500 cc.
Severe
M
3.3 million
11.
1/ /48
30
None
First
8.8 gms. (56 %)
Twice
6 days
8,500 cc.
1,000 cc.
Exsanguinating
NAM
M
—
Service
—
12.
2/13/48
58
Positive
First
8.8 gms. (56%)
Once
24 hours
2,500 cc.
100 cc.
Severe
M
3.3 million
30.%
13.
2/13/48
59
Suggestive
Second
3.8 gms. (24.8%)
Once
10 days
4,000 cc.
2,000 cc.
Exsanguinating
M
2. million
13.%
14.
4/24/48
71
Positive
Second
10. gms. (65%)
Once
9 days
2,000 cc.
1 ,000 cc.
Severe
M
3.8 million
34.%
15.
5/13/48
60
Positive
First
7. gms.
Twice
14 days
6,000 cc.
1,500 cc.
Exsanguinat ing
M
(perforation)
2.7 million
21.%
16.
6/3/48
26
Positive
Second
10. gms.
Once
4 davs
2,000 cc.
1,000 cc.
Moderate
M
—
31.%
17.
6/10/48
68
Positive
First
9. gms.
Once
5 davs
5,000 cc.
1,500 cc.
Exsanguinating
i\l
(gastro-
2.7 million
enterostomy)
27.%
18.
6/11/48
72
Positive
Third
12. gms.
Once
58 hours
5,000 cc.
1,000 cc.
Exsanguinating
M
-
19.
2/2/49
28
None
First
9.7 gms. (62%)
Once
12 hours
2,000 cc.
1,500 cc.
Moderate
M
—
30.%
20.
2/3/49
43
Positive
Second
10. gms.
Once
26 hours
3,500 cc.
1,000 cc.
Exsanguinating
M
-
21.
2/8/49
39
Suggestive
First
6. gms.
Twice
6 davs
5,000 cc.
1 ,500 cc.
Exsanguinating
M
2.5 million
25.%
22.
3/4/49
32
Suggestive
Third
9.3 gms.
Once
6 davs
4,000 cc.
1,500 cc.
Exsanguinating
M
3.8 million
3,000 cc. post-
40.%
operative
23.
3/20/49
32
Positive
None
8.2 gms.
Once
6 days
3,000 cc.
1 ,000 cc.
Severe
M
—
—
250
Minnesota Medicine
GASTRIC AND DUODENAL ULCERS— MAC KINNON
TABLE III.
Surgical Indications
Bleeding Site
Operative Procedure
Result
Complications
Comments
Severe hemorrhage, improved,
Massive hemorrhage, persist-
ent hematemesis and melena
Gastric ulcer
Subtotal gastrectomy
Excision of ulcer
5/4/46
Recovered
Phlebothrombosis,
ligation left superficial
femoral vein
None
Sudden massive hemorrhage
Persistent bleeding
Second massive hemorrhage
Duodenal ulcer
Subtotal gastrectomy
Excision of ulcer
7/16/46
Recovered
Partial wound disrup-
tion, secondary closure
Ulcer inspected,
stopped bleeding.
Massive hemorrhage, stopped
Massive hemorrhage, stopped
Third massive hemorrhage
and persistent bleeding
Subacute
diffuse
gastritis
Subtotal gastrectomy,
Excision areas of
hemorrhage 10/4/46
Recovered
None
Focal mucosal and
submucosal areas of
hemorrhage
Persistent melena —
Sudden severe hemorrhage
and shock
Gastric ulcer
Subtotal gastrectomy
Excision of ulcer
3/19/47
Recovered
None
Vessel in ulcer base
Massive hemorrhage, bleeding
subsided
Second massive hemorrhage
and shock
Gastric ulcer
Subtotal gastrectomy
Excision of ulcer
3/28/47
Recovered
Wound infection
Artery in ulcer crater
Severe melena, stopped bleeding
Recurrent melena and shock
Severe
antral
gastritis
Subtotal gastrectomy
Excision bleeding area
4/11/47
Recovered
None
None
Massive hemorrhage,
Persistent hematemesis,
melena and shock
Gastric ulcer
Subtotal gastrectomy
Excision of ulcer
5/28/47
Recovered
None
Artery in ulcer base
Sudden severe massive
hematemesis, melena, and
shock
Gastric ulcer
Subtotal gastrectomy
Excision of ulcer
7/3/47
Recovered
None
Massive hemorrhage 8
days after closure of
perforated ulcer. Blood
clot found in ulcer crater.
Persistent melena —
Massive hemorrhage and shock
Gastric ulcer
Subtotal gastrectomy
Excision of ulcer
8/7/47
Recovered
None
None
Persistent melena, and
mild shock
Duodenal ulcer
Subtotal gastrectomy
Exclusion of ulcer
10/10/47
Recovered
None
None
Persistent hematemesis and
melena
Massive hemorrhage and shock
Gastric ulcer
Subtotal gastrectomy
Excision of ulcer
2/10/47
Recovered
None
Negative operative find-
ings, Pathologist — small
ulcer with vessel in crater
Persistent massive hema-
temesis, melena and shock
Duodenal ulcer
Subtotal gastrectomy
Exclusion of ulcer
2/13/48
Died on table.
Luetic aortitis
& heart block,
autopsy
Posterior wall ulcer in-
spected, not bleeding.
Large amount blood
given preoperatively.
Persistent severe melena
Duodenal ulcer
Subtotal gastrectomy
Exclusion of ulcer
2/16/48
Recovered
None
None
Persistent moderate hema-
temesis, melena, and shock
Duodenal ulcer
Subtotal gastrectomy
Exclusion of ulcer
4/26/48
Recovered
None
Duodenum opened, ulcer
not bleeding
Massive hemorrhage, persist-
ent hematemesis and melena,
Second massive hemorrhage
and shock
Duodenal ulcer
Subtotal gastrectomy
Exclusion of ulcer
5/20/48
Recovered
Hepatitis, homologous
serum jaundice following
plasmagivenbylocalM.D.
Duodenum opened, ulcer
not bleeding — healed
gastric ulcer.
Persistent melena and shock
Duodenal ulcer
Subtotal gastrectomy
Excision of ulcer
6/7/48
Recovered
None
See text — -
Persistent hematemesis,
melena and shock
Duodenal ulcer
Subtotal gastrectomy
Exclusion of ulcer
6/12/48
Died— 3rd
P.O. day
Atelectasis, peritonitis,
shock, no autopsy
Gastrojejunal ulcer
healed.
Persistent hematemesis,
melena, and shock
Duodenal ulcer
Subtotal gastrectomy
Exclusion of ulcer
6/13/48
Recovered
None
Duodenum opened, ulcer
not bleeding.
Massive hemorrhage following
gastroscopy, suspected
gastric neoplasm by x-ray
Severe
antral
gastritis
Subtotal gastrectomy
Excision of ulcerations
2/11/49
Recovered
None
Suspected granulomatous
lesion at operation. Path,
report: acute suppuration
and superficial ulceration.
Massive hemorrhage,
Persistent hematemesis and
melena
Duodenal ulcer
Subtotal gastrectomy
Exclusion of ulcer
2/4/49
Recovered
None
Alcoholic, fatty liver,
no portal hypertension.
Massive hemorrhage, ceased
bleeding. Second massive
hematemesis, melena and shock
Duodenal ulcer
Subtotal gastrectomy
Excision of ulcer
2/11/49
Recovered
None
None
Massive hematemesis, persist-
tent melena, and shock
Undetermined
Subtotal gastrectomy
3/10/49
Recovered
Bled postoperatively
24 hours, probably from
the anastomosis.
None
Persistent melena, mild
hematemesis.
Shortage AB rh-blood
Gastric ulcer
Subtotal gastrectomy
Excision of ulcer
3/21/49
Recovered
None
Duodenal ulcer present,
but not bleeding.
March, 1950
251
GASTRIC AND DUODENAL ULCERS— MAC KINNON
centimeters of blood every eight hours indicated
a dangerous rate of bleeding and provided a defi-
nite surgical indication.
Hemoglobin, red cell and hematocrit determina-
tions were of value in estimating the state of ex-
sanguination on admission to the hospital and be-
tween episodes of severe bleeding. During periods
of massive hemorrhage and liberal blood replace-
ment with rapid changes in blood volume, these
determinations were less reliable measurements of
the degree of hemorrhage, and were often not
calculated during periods of severe bleeding.
The age of the patient was considered an im-
portant factor, although the selection of the pa-
tients for operation was not based on this factor
alone, as is shown by the fact that 43.5 per cent
of the patients were under 45 years of age. One
must remember that the younger patient occasion-
ally dies from massive hemorrhage. Hoerr, Dun-
phy, and Gray17 believe the important point con-
cerning older patients is that they are more likely
to develop an exsanguinating hemorrhage and
need closer observation on this account. If the
bleeding is not exsanguinating in character, it is
equally important to avoid the risk of unnecessary
surgical procedures in the older patient. There-
fore, the fact that the patient is past middle life
is not an absolute indication for prompt operation
but a warning that there is greater danger of an
exsanguinating hemorrhage.
The duration of bleeding was a factor of less
importance in this series, since 73.9 per cent of
the patients were operated upon after Finsterer’s
forty-eight hour period had passed. The longer
interval of bleeding is explicable solely on the
striking dissimilarity and wide variations in the
degree of hemorrhage in these patients. Some pa-
tients bled slowly for days and then had a mas-
sive hemorrhage. Others had a massive hemor-
rhage, stopped bleeding for a few days, and had
a second massive hemorrhage. The decision to
operate within forty-eight hours is a difficult one
to make since the fatal type of hemorrhage can-
not always be differentiated from bleeding which
will stop with nonoperative measures. Our pa-
tients were selected for operation after careful
consideration of all the important factors and in-
dications for operative intervention, with em-
phasis on the individual behavior pattern of each
patient.
Subtotal gastrectomy, with removal of about 75
per cent of the stomach including the pylorus, was
performed in all of the patients. This procedure
was selected as the one most likely to succeed in
controlling hemorrhage and curing the patient.
The source of bleeding was removed in thirteen
cases. Nine duodenal ulcers were treated by ex-
clusion. They were judged to be technically too
difficult to remove without dangerously increasing
the risk of the operation. It is well known that
bleeding stops when the exclusion operation is per-
formed, as it did in all of our cases. Diversion of
the gastric secretions from the ulcer will prevent
repeated digestion of the blood clot and intermit-
tent hemorrhage. The ulcer, unmolested, eventual-
ly heals.
Subtotal gastrectomy for massive hemorrhage
is a formidable procedure and should not be at-
tempted by untrained surgeons or performed in
hospitals inadequately staffed or equipped to cope
with this emergency. Our patients were operated
upon by the chief surgeon, consulting surgeon,
or the senior surgical resident of the hospital.
The patients were quite well prepared for the
emergency operation as judged by our present-day
standards. The blood loss was corrected by mas-
sive transfusions prior to operation and the an-
esthesia preparation was adequate. In a few pa-
tients the intestinal tract, which was usually full
of blood, was distended with gas. One patient had
a greatly distended transverse colon which inter-
fered with the surgical procedure. The colon was
decompressed aseptically and the operation was
continued uneventfully.
The favorable mortality rate in our series is
due to the excellent anesthesia administered by
trained anesthetists, a carefully executed opera-
tion, and the employment of the recent advances
in postoperative management. The anesthesia
used was a mixture of pentothal-curare supple-
mented with endotracheal nitrous oxide and 50
per cent oxygen as advocated by Baird, Johnson,
and Van Bergen.5 Intragastric siphonage was
maintained throughout the operation and, post-
operatively, until normal peristalsis returned. A
large left subcostal incision was used. The re-
section was done according to the technique rec-
ommended by Wangensteen.28'29 Bowel continuity
was reestablished by an end-to-side gastrojejunos-
tomy, utilizing a short afferent loop, retrocolic,
antiperistaltic, Hofmeister-Polya, 6 centimeter,
aseptic anastomosis. Interrupted, fine, nonab-
sorbable suture material was used throughout, in-
cluding the closure of the abdominal wound. One
252
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GASTRIC AND DUODENAL ULCERS— MAC KINNON
gram of streptomycin and one million units of
penicillin in solution were injected into the peri-
toneal cavity. Blood was administered throughout
the operation and whenever it was needed post-
operatively. Electrolytes, vitamins, protein, strep-
tomycin, and penicillin were given postoperatively.
Early ambulation was practiced. A bland diet was
usually started on the fourth postoperative day.
The patients were weighed each day and main-
tained in a balanced state of hydration.
In a few cases the aseptic technique was broken,
momentarily, when the duodenum was opened to
inspect the posterior wall for active bleeding. Of
the few patients inspected in this manner, no pa-
tient was found to be bleeding actively during the
operation. Had such a bleeding point been en-
countered, transfixion and ligation of the vessel
would have been done for immediate control of
the hemorrhage. Some of the resected gastric ul-
cers showed an eroded vessel in the base of the
ulcer. Now and then the vessel was occluded by a
blood clot or an early thrombus.
During the three-year period of this study, two
deaths occurred from massive hemorrhage of ulcer
origin on the medical service of this hospital ac-
cording to Ebert.12 One death was that of an or-
derly who refused operation. The second death
was in a case of meningiovascular syphilis with
cerebral thrombosis. The patient was admitted in
coma and died within a few hours.
In the series operated upon, one death was due
to luetic aortitis. Heart block occurred during the
operation and the patient died on the table. The
second patient died of atelectasis, peritonitis, and
toxemia three days after the operation. The previ-
ous gastroenterostomy in this patient was difficult
to take down. The operation was long, arduous,
and was not performed aseptically.
A few patients with, severe hemorrhage in this
series might have recovered without operation.
Unquestionably, the two patients with moderate
hemorrhage would have recovered without opera-
tion. They were young, healthy males, with early
moderate hemorrhage. The operation was done
not only to check the bleeding but to provide the
corrective gastrectomy. In one patient the pre-
operative diagnosis was probable neoplasm. The
source of bleeding later proved to be a chronic
antral gastritis with suppurative inflammation and
superficial ulceration. Three patients with hemor-
rhage due to gastritis were cured by subtotal gas-
trectomy. At least one of these patients was in
such a precarious condition that a fatal outcome
seemed inevitable without operation.
Whether any of the exsanguinated patients
would have lived without surgical intervention is
not known. Based on a study of the individual
records, the surgical recoveries represent pure
salvage, that is, the patients would not have re-
covered without operation. Furthermore, opera-
tion was resorted to after medical treatment had
failed. For these reasons, surgical and medical
mortality rates are not comparable. One death in
fifteen exsanguinated patients, a mortality rate of
6.7 per cent, indicates that our present plan of
surgical management has merit, is relatively safe,
and should be continued.
Summary cmd Conclusions
1. The majority of patients with severe gastric
and duodenal hemorrhages will recover if treated
conservatively by proper medical management.
However, approximately 5 to 10 per cent of pa-
tients treated conservatively for massive hemor-
rhage of ulcer origin will have a fatal termination.
2. The incidence of death in bleeding gastric
ulcer is higher than in bleeding duodenal ulcer.
3. There appears to be a direct relationship be-
tween the duration of the bleeding and the age of
the patient to the mortality rate. The increased
mortality is noted in patients bleeding longer than
forty-eight hours and in patients over forty-five
years of age.
4. The more serious massive hemorrhages are
arterial in origin and arise usually from the gas-
troduodenal, pancreaticoduodenal, and the right or
left gastric arteries or their major branches.
5. The indications for surgical intervention
must be individualized and conservative in order
to avoid unnecessary operation. The duration of
bleeding and the age factors are important ; how-
ever, greater emphasis is being placed on the selec-
tion of patients for operation according to the rate
of bleeding, recurrent hemorrhage, and shock.
The failure to maintain a stable circulation with
a transfusion of 500 cubic centimeters of blood
every eight hours indicates an exsanguinating type
of hemorrhage. These are the patients in whom
operation is most often employed after the cir-
culation is stabilized by massive transfusions.
6. The operation of choice is a subtotal gas-
tric resection with removal of the ulcer. If it ap-
pears impossible to resect the ulcer, subtotal gas-
March, 1950
253
GASTRIC AND DUODENAL ULCERS— MAC KINNON
trectomy with exclusion of the ulcer will control
hemorrhage and cure the patient.
7. With the exception of early operation, the
mortality rate of emergency surgery in massive
gastric and duodenal hemorrhage of ulcer origin
has been high. Since the operative procedure is
employed after medical management has failed
and as a last resort to save life, surgical mortality
should not be compared with the mortality of med-
ical management.
8. Twenty-three patients with massive hemor-
rhage were reported with two deaths, a mortality
rate of 8.7 per cent for the entire group. There
were fifteen patients with exsanguinating hemor-
rhages with one death, a mortality rate of 6.7 per
cent. The one death in the exsanguinating group
was an operative death from peritonitis following
a difficult resection in the presence of an old gas-
troenterostomy. The one death in the group with
severe massive hemorrhage was an unavoidable
cardiac death from luetic aortitis and heart block
that occurred on the operating table. Although
this series is small, the mortality rate is low and
is due to the recent improvement in anesthesia,
surgical technique, and postoperative care.
References
1. Alberhart, C. A., quoted by Graham, R. R., in Bancroft,
F. W. : Operative Surgery. P. 577. New York: Appleton
Century, 1941.
2. Allen, A. W. : Acute massive hemorrhage from the upper
gastrointestinal tract. Surgery, 2:713-731, (Nov.) 1937.
3. Allen, A. W., and Benedict, E. B. : Acute massive hemor-
rhage from duodenal ulcer. Ann. Surg., 98:736-749, (Oct.)
1933.
4. Amendola, F. H. : The management of massive gastro-
duodenal hemorrhage. Ann. Surg., 129:47-56, (Jan.) 1949.
5. Baird, J. W. ; Johnson, W. R., and Van Bergen, F. H. :
Pentothal-curare solution ; a preliminary report and analysis
of its use in 160 cases. Anesthesiology, 9:141-158, (March)
1948.
6. Bergh, G. S., Hay, L. J., and Trach, B.: Peptic ulcer.
Bull. Staff Meet., Hosp. Univ. Minnesota, 11:282-305,
(March 15) 1940.
7. Blackford, T. M., and Allen, H. E. : Bleeding peptic ulcers,
151 fatalities. J.A.M.A., 120:811-812, (Nov. 14) 1942.
8. Blackford, J. M., and Williams, R. H. : Fatal hemorrhage
from peptic ulcer. J.A.M.A., 115:1774-1776, (Nov. 23) 1940.
9. Bohrer, J. V. : Massive gastric hemorrhage with special
reference to peptic ulcer. Ann. Surg., 114:510-525, (Oct.)
1941.
10. Chiesman, W. E. : Mortality of severe hemorrhages from
peptic ulcers. Lancet, 2:722-723, (Oct.) 1932.
11. Costello, C. : Massive hematemesis. Analysis of 300 con-
secutive cases. Ann. Surg., 129:289-298, (March) 1949.
12. Ebert, R. V., Chief, Medical Service, Minneapolis Veterans
Hospital : Personal communication.
13. Finsterer, H. : Surgical treatment of acute profuse gastric
hemorrhages. Surg., Gynec. & Obst., 69:291-298, (Sept.)
1939.
14. Fraser, R. W., and West, J. P. : The management of
bleeding duodenal ulcers. Ann. Surg., 129:299-304, (March)
1949.
15. Gordon-Taylor, G. : The present position of surgery in the
treatment of bleeding peptic ulcer. Brit. J. Surg., 33:336-
345. (April) 1946.
16. Hansen, J. L., and Pederson, J. : Total gastric hemorrhages.
Nord. Med., 7:1567-1574, (Sept. 21) 1940. Quoted by
Meulengracht.
17. Hoerr, S. O. ; Dunphy, J. E., and Gray, S. J. : The place
of surgery in the emergency treatment of acute massive, up-
per gastrointestinal hemorrhage. Surg., Gynec. & Obst.,
87:388-342, (Sept.) 1948.
18. Holman, C. W. : Severe hemorrhage in gastric and in
duodenal ulcer; study of 90 cases. Arch. Surg., 40:150-160,
(Tan.) 1940.
19. Holman, C. W. : Further observations on the treatment of
bleeding peptic ulcer. Surgery, 23:405-410, (March) 1948.
20. Ileuer, G. J. : The surgical aspects of hemorrhage from
peptic ulcer. New England J. Med., 235 :777-783, (Nov. 28)
1946.
21. Hunt, V. C. : Current methods in the management of peptic
ulcer. Surg., Gynec. & Obst., 70:319-327 (Feb. 15) 1940.
22. Jankelson, I. R., and' Segal, M. S. : Massive hemorrhage
from peptic ulcer. New England T. Med., 219:3-5, (July 7)
1938.
23. McKittrick, L. S., Moore, F. H., and Warren, R.: Com-
plications and, mortality in subtotal gastrectomy for duodenal
ulcer: report on 2-stage procedure. Ann. Surg., 120:531-561,
(Oct.) 1944.
24. McNealv, R. W. : Technical details in the management of
the duodenum in gastric resection. S. Clin. North America,
26:200-209, (Feb.) 1946.
25. Meulengracht, E. : Fifteen years’ experience with free feed-
ing of patients with bleeding peptic ulcer. Arch. Int. Med.,
80:697-708, (Dec.) 1947.
26. Sandusky, W. R.. and Mayo, H. W. : The management of
severe bleeding from gastric, duodenal, and jejunal ulcers.
South. Surgeon, 15:71-84, (Feb.) 1949.
27. Segal, H. L., Scott, W. J. M., and Stevens, R. S.: Man-
agement of gross hemorrhage in peptic ulcer; report of 168
cases. New York State T. Med., 41:1074-1080, (May 15)
1941.
28. Wangensteen, O. H. : The problem of surgical arrest of
massive hemorrhage in duodenal ulcer. Surgery, 8 :275-288,
(Aug.) 1940.
29. Wangensteen. O. H. : Aseptic resections in the gastroin-
testinal tract ; with special reference to resection of the
stomach and colon. Surg., Gynec. & Obst., 72:257-281,
(Feb. 15) 1941.
30. Wangensteen, O. H. : Method of closing the pylor-antral
pouch in the antral exclusion operation. Surgerv, 12:731-
741, (Nov.) 1942.
31. Wangensteen. O. H. : The ulcer problem. Canad. M. A. J.,
53 :309-331, (Oct.T 1945.
32. Warren, R., and Lanman. T. IT.: Surgery in bleeding peptic
ulcer. Surg., Gynec. & Obst., 87:291-298, (Sept) 1948.
33. Welch, C. S., and Yunich, A. M. : The problem for surgery
in the treatment of massive hemorrhage of ulcer origin.
Surg., Gynec. & Obst., 70:662-665, (March) 1940.
SOCIALISTIC MEDICINE COSTS BRITAIN MORE THAN SEVEN TIMES COLLECTIONS
Britain’s socialistic provision for free medical and
dental care for its citizens now costs that country 300
million pounds sterling annually, or about twice the
amount originally estimated by the proponents of this
paternal plan, Aneurin Bevan, Minister of Health, has
admitted.
Minister Bevan explained that one of the reasons why
the cost of the health service the first year was so much
higher than had been estimated, is the fees paid to
physicians were in certain cases raised above the level
originally scheduled. However, the chief cause of the
high cost of the socialistic scheme was the overwhelm-
ing use made of it by the public. Overnight, doctors,
dentists, oculists, pharmacists and the hospitals became
very popular with the people as health service became
“free” and everyone wanted all they could get. In the
first year 187 million prescriptions were dispensed free,
5,260,000 requests for eye-glasses were supplied and the
year’s end found 3,000,000 more on order, dentists took
care of 8,500,000 free patients, and 5,071 wigs were sup-
plied to baldheaded folk. — Insurance Economics Surveys.
February, 1950.
254
Minnesota Medicine
DISSECTING ANEURYSM OF THE AORTA
Report of a Case Diagnosed Two and One-half Years Before Death
By Rupture
I. S. BLUMENTHAL, M.D., F.A.C.P.
Minneapolis, Minnesota
npHERE ARE few more dramatic episodes in
■*- the field of medicine than that produced by a
dissecting aneurysm of the aorta. Males are most
frequently affected. Baer and Goldburgh2 report
that 65 per cent of their forty-four patients were
men, while Schlichter, Amromin and Solway12 re-
port eleven of fourteen cases as being of the same
sex. The age incidence varied greatly, between
twenty-six and seventy, with an average of about
fifty-three years.
Pain is the most conspicuous feature of the on-
set of the condition — sharp, shifting, severe. It is
usually correlated with the extent and location of
the dissection. Collapse and sudden death often
with rupture frequently ensues. Occasionally
there is no pain. Dyspnea is usually prominent.
Agitation, convulsions and other neurological
signs may suggest that the central nervous system
is involved.3’9
Physical findings are extremely varied. Fever
and tachycardia usually develop if the patient sur-
vives the initial attack. Hypertension may be
present but is not nearly as common as frequently
asserted, especially in the younger age group.
Baer and Goldburgh2 report that only 58 per cent
of their series had a high blood pressure. Schlich-
ter12 reports that only one in fourteen had a defi-
nite history of long-standing hypertension. Four
of these fourteen had an elevation of the systolic
and diastolic blood pressure only after the onset
of dissection ; the systolic blood pressure only was
elevated in two additional cases and the diastolic
blood pressure only in two others. Differences in
the pressure in the arms, as in the case presently
reported, may be present and very helpful in diag-
nosis.
Cardiac failure or myocardial infarction are
often suggested not only by the history but by the
physical and laboratory findings. Cardiac enlarge-
ments with decompensation, murmurs, gallop
rhythm, faint heart tones, tachycardia, and fric-
tion rubs are very frequently present and as fre-
quently confusing.14 Dilatation and/or deformity
of the aortic ring may give the diastolic murmur
of aortic regurgitation, and in a patient who had
not shown this before, give a very helpful hint to
the true condition.8
In the patient who survives the initial episode,'
many confusing symptoms, signs and findings
may be presented. Frequent erroneous diagnoses
are hypertensive heart disease, coronary sclerosis
and cardiac failure.6 Involvement of the spinal
cord may give paralysis.13 The increasing mental
confusion, weakness and even physical findings
may point to a cerebrovascular accident.15 Thora-
centesis is frequently done for suspected cardiac,
tuberculous or even pneumonic pleural effusion.
Gastrointestinal symptoms with nausea, vomiting,
abdominal pain and rigidity often suggest an
acute surgical abdomen. The point of dissection
may simulate a renal syndrome with back-pain and
hematuria.5
Laboratory findings are of little assistance. The
white blood counts vary greatly up to 30,000. Al-
buminuria, hematuria and casts are common.
Roentgenograms of the thorax are a great help in
showing the increased aortic shadow but are too
often not diagnostic. Fluoroscopy, if possible, is
of the greatest assistance in showing the large
pulsating aneurysm. The chief value of the elec-
trocardiogram would seem to be in the differen-
tiation from an acute myocardial infarction. This
is, however, a false assumption, as the anoxia re-
sulting from the episode results in changes in the
tracing, which, as in our case, cannot be differen-
tiated from a true infarction. This may be so
even when the coronary vessels are not at all in-
involved. In the series reported by Schlichter,12
of eight cases in which tracings were taken, one
was normal, four showed left heart strain, one
showed nonspecific changes, and two showed
changes of possible recent infarction. Weiss,16
Wainwright,14 and Baer and Goldburgh2 have re-
ported cases in which dissection extended into the
coronary arteries with occlusion and resultant
infarction. In other words, the electrocardiogram
shows the usual results of interference with the
blood supply of the affected area and does not
necessarily mean a true thrombosis.
The prognosis in dissecting aneurysm is poor.
March, 1950
255
DISSECTING ANEURYSM OF THE AORTA— BLUMENTHAL
While it has been stated13 that 10 per cent of them
will heal, and a case has been reported with a
survival of four years,12 the literature gives a very
gloomy picture as to life expectancy in cases with
Fig. 1. Elevated STi, ST2, left preponderance, ventricular
extra systoles suggestive of an anterior thrombosis.
really severe episodes of dissection. Varying sur-
gical procedures11 have and are being tried with
conflicting claims, but as yet no definite conclu-
sions have been reached.
Healing of this lesion depends, of course, on the
extent of the collateral circulation and the extent
of dissection. The very separation of the aortic
wall from its blood supply is conducive to the ex-
tension of the aneurysm.17
Since the articles by Gsell7 and Erdheim,4
anoxia of the media of the aorta has been impli-
cated as the cause of dissecting aneurysm. The
local ischemia may be due, as pointed out by
Schlichter,12 to occlusive disease of the vaso vaso-
rum, alterations of the hemodynamics of the vaso
vasorum, severe anemia, congenital abnormalities
of the vaso vasorum, or any combination of these
factors. The predilection of dissecting aneurysm,
and especially those that rupture, for the ascend-
ing aorta may be due to the fact that that part
of the aorta is -much more mobile and gets
the greatest strain of the blood stream as it is
pumped from the left ventricle. Beyond this, the
ascending aorta is not supported and surrounded
by connective tissue and other organs which pro-
tect and absorb some of the impact. The aorta be-
yond the ascending also has frequent ostia which
may provide more nourishment to the aortic wall
directly. Primarily the destruction of the aortic
media is the outstanding feature though other
factors may play a part. Hypertension4 may be
very important in some cases by causing intimal
changes in the small arteries, including the vaso
vasorum, with resultant ischemia to portions of
the aorta and medionecrosis. Vasoconstriction of
nutrient vessels of the aortic wall may be a factor.
Once the process is established, even in people
with normal blood pressure, transient high blood
pressure caused by emotional or physical strain
may be enough to cause the dissection, increase
the spread, or even rupture the wall.
Case Report
C. P., a white man, aged fifty-three, was first admitted
to St. Andrews Hospital on February 22, 1947, with com-
plaints of epigastric pain radiating to the right shoulder.
The pain had started on February 20 and increased in
severity, in spite of pills given by a doctor, until it had
become of great intensity. He was nauseated but did
not vomit, and his abdomen had become very hard, and
the pain then involved his whole right chest and abdomen.
He recalled similar, mild episodes for several years.
On admission, the man was in evident great distress.
Pulse was regular at 100. The blood pressure was 130/80
in the left arm but was not obtainable in the right arm —
a significant finding, as noted by Dr. Harry Johnson on
admission, which gave the first real clue as to the true
diagnosis. Heart tones were faint but no murmurs were
heard. The abdomen was rigid on the right, but there
was tenderness in both lower quadrants of th/e abdomen,
to the extent that on admission a diagnosis of a possible
acute surgical abdomen was entertained by the surgeon.
There were diminished breath sounds in the left base of
the lung. Temperature was 101°; urine showed 1-plus
albumin. The hemoglobin was 15.1 gm., and the white
blood count was 18,800. Electrocardiogram showed ele-
vated ST and ST., (Fig. 1), ventricular extrasystoles
and left axis deviation, a typical tracing of anterior in-
farction.10 Because of the picture of probable infarc-
tion, the patient was started on usual dicoumarol therapy
with adequate control of prothrombin times. His condi-
tion remained critical with a temperature spiking to 103°
until March 20, 1947, when it returned and remained at
normal. During this period several urine examinations
showed a specific gravity of 1.010 to 1.012 with occasion-
al granular casts and 1 to 2-plus albumin. White cell
counts ranged from 8,500 to 21,100. Icterus index ranged
from 8.4 to 9.9. Serum bilirubin on February 26, 1947,
was direct 10 minutes, 0.7 mg. per cent; direct 30 min-
utes, 2.05 mg. per cent; and indirect, 1.65 mg. per cent.
On March 4, 1947, the serum bilirubin was direct 10
minutes, 0.1 mg. per cent; direct 30 minutes, 1 mg. per
cent; and indirect, 1.65 mg. per cent. Stools were nor-
mal ; blood urea nitrogen ranged to 49 mg. per cent and
creatinin to 5.4 mg. per cent. Blood calcium and chlorides
were normal. On March 6, 1947, a loud systolic murmur
could be heard at the apex. The blood pressure, which
256
Minnesota Medicine
DISSECTING ANEURYSM OF THE AORTA— BLUMENTHAL
had fluctuated, was then 172/78 on the right and 162/108
on the left. Repeated x-ray examinations by Dr. Walter
Ude were done, as the clinical picture was quite con-
fusing. The heart showed rather marked enlargement,
and the aortic arch was prominent with diffuse dilata-
tion of the aorta (Fig. 2). There was also, on several
occasions, an abnormal density at the left base, suggestive
of a mild pleural effusion.
The patient gradually improved and was. discharged
from the hospital fifty-six days after admission. The
diagnoses entertained at the start were coronary throm-
bosis, uremia, cardiac failure, and dissecting aneurysm.
The picture gradually cleared so that on March 6, 1947,
a definite diagnosis was made of a dissecting aneurysm
of the aorta based on laboratory, clinical and x-ray find-
ings.
On October 20, 1949, the patient was readmitted. In
the interval his condition had been such that he had
resumed with no difficulty his former occupation as
guard at the Walker Art Center. On October 18, 1949,
he developed pain in the right shoulder strap area which
spread to the right lower thorax. He had increasing
dyspnea and became nauseated and later vomited. On
admission he was pale, apprehensive, but apparently not
in shock. Pulse was 150, faint and regular. The right
chest showed less movement than the left, dullness, de-
creased breath sounds — the findings of a pleural effu-
sion. The electrocardiogram showed sinus rhythm, left
preponderance, deep Q , negative T . Blood pressure was
100/60. The liver was down 4 cm. in the right mid-
clavicular line. Crepitant rales were heard in the right
chest. Temperature was 103°. White blood count was
27,450, hemoglobin 8.8 gm., red blood cells 3,100,000.
Urine showed 2-plus albumin. X-ray now showed a
marked pleural effusion on the right. An attempt to
aspirate resulted in a small amount of blood. The condi-
tion of the patient became progressively and rapidly
worse. He complained of pain in the back, vomited,
lapsed into a coma and died October 22, 1949.
Autopsy Report (by Dr. Koucky)
Body is that of a white male weighing about 190
pounds. The body shows no jaundice. There is no
edema. There are no particular special marks. The peri-
toneal cavity shows no excess fluid, no blood, and there
are no adhesions. The left pleural cavity shows no ex-
cess fluid or adhesions. The right pleural cavity is
flooded with about 3,000 to 4,000 c.c. of blood, which is
principally clotted. The blood has entered the pleural
cavity from the junction of the diaphragm and vertebral
bodies in the lowermost part of the posterior pleural
cavity. The pericardial sac is somewhat discolored by
blood infiltrating into it from tfie diaphragmatic sur-
face. The diaphragm also is infiltrated with blood, and
the infiltration extends across the dome and is visible in
the attachments of the diaphragm along the anterior
costal margin.
The heart weighs about 450 gm. There is very definite
hypertrophy of the left ventricle. The muscle shows no,
evidence of fibrosis or atrophy or softening at any point.
The valves show no recent or old endocarditis. The
coronaries throughout are large. The walls show a mini-
mal degree of thickening with no atheromata, and there
is no evidence of any old or recent occlusion.
Left lung weighs about 350 gm. There is some atelec-
tasis in the base. There is no edema. The right lung is
Fig. 2. Generalized enlargement of the aorta. Note duplica-
tion of descending aortic wall.
completely atelectatic and is compressed by the clot in
the right pleural cavity. The spleen weighs about 150
gm. It shows no infarction and no other gross change.
The liver is somewhat rotated around to the right by a
mass m the upper posterior retroperitoneal space. It
weighs about 1500 gm. and shows no chronic passive con-
gestion or cirrhosis. The gall bladder contains no stones.
The gastrointestinal tract shows no tumors or ulcers
or diverticula or other gross change. The adrenals show
no gross change. The pancreas is grossly negative.
The kidneys each weigh about 110 gm. There is ex-
tensive atrophy, and the surface of the kidney shows a
fine pitting typical of hypertension. There are occa-
sional tiny cysts in each kidney. The ureters are not
dilated. The bladder shows no cystitis or trabeculation.
The prostate shows occasional small adenomas in each
lateral lobe.
The aorta shows a duplication of the lumen beginning
immediately below the arch of the aorta. On the convex
side of the termination of the arch there is a slit-like ori-
fice which is about 1 by 44 cm. This opens into the
outer chamber of the aorta. There is a prolongation up-
ward along the arch of the aorta as far as the first part
of the aorta. This upward prolongation is almost com-
pletely closed off by a thrombus. The thrombus is
brown and hard and adherent and apparently lias been
present for a long period of time. The downward dis-
section of the aorta almost completely encircles the
aorta. There is an irregular septum of tissue which
generally follows : along the anterior part of the aorta
which holds the inner and the outer aortic cylinders to-
gether. The inner one ot the cylinders is quite straight
and has a diameter somewhat smaller than the average
March, 1950
257
DISSECTING ANEURYSM OF THE AORTA— BLUMENTHAL
aorta. The outer cylinder is extremely irregular in out-
line. There are many irregular vasculations. The lining
of the outer cylinder has the smooth and yellowish ap-
pearance similar to that of a normal aorta which is in-
volved by arteriosclerosis. The wall of this outer cylin-
der shows patches of atherosclerosis and areas of cal-
cification. At the level of the diaphragm, the outer
cylinder abruptly forms a sacculated mass which meas-
ures 7^4 by 10 inches. The mass is almost entirely a
dilation of the outer cylinder which has become filled
with hard adherent thrombus. Following the under sur-
face of the most superior part of this aneurysmal sac
there is an irregular channel which passes laterally and
to the right and perforates through the wall of the
aneurysm. This perforation enters the right crura of the
diaphragm and has perforated through the superior sur-
face of the diaphragm into the right pleural cavity. The
aneurysmal sac ends about 1 or 1*4 inches above the
vifurcation of the aorta. This terminal inch is filled with
a brown adherent thrombus, and there is more of the
thrombus extending along the right ileac artery. There is
a small channel on the side of this thrombus in the ter-
minal part of the aorta.
Conclusions
1. Arteriosclerosis
2. Arteriosclerotic dissecting aneurysm of the aorta
(old)
3. Recent rupture of arteriosclerotic aneurysm
4. Hematothorax
5. Hypertension
6. Cardiac hypertrophy
The case reported is remarkable in that the pa-
tient survived two and a half years after a major,
definite episode of dissection. He was able to re-
turn to his usual work. It also demonstrates the
difficulty in making a diagnosis. The very definite
electrocardiogram changes were not of organic
origin but rather apparently due to ischemia, as
the vessels at autopsy were patent and showed no
marked changes. It should be noted that the trac-
ing taken on his last admission showed no marked
abnormal changes. While the findings of the elec-
trocardiogram and the whole clinical picture were
confusing, in keeping with reports in the litera-
ture, the correct diagnosis was made two and a
half years before death with the help of x-ray and
the fact that the facts did not quite fit the picture
of an acute coronary thrombosis in its entirety,
especially as to symptomatology and clinical
course. It is well to keep this in mind in all cases
of atypical cardiac episodes.
References
1. Asthworth, C. T., and Haynes, D. M. : Lesions in elastic
arteries associated with hypertension. Am. J. Path., 24:195-
205, 1948.
2. Baer, S., and Goldburgh, H. L. : The varied clinical syn-
dromes produced by dissecting aneurysms. Am. Heart J.,
35:198-211, (Feb.) '1948.
3. Bauersfeld, S. R. : Dissecting aneurysm of the aorta: pres-
entation of fifteen new cases and a review of recent lit-
erature. Ann. Int. Med., 26:873, 1947.
4. Erdheim, J. : Medionecrosis aortae idiopathica. Virchows.
Arch. f. Path. Anat., 273:454-479. 1929.
5. Gager, L. T. : The symptoms of dissecting aneurysm of the
aorta. Ann. Int. Med., 2:658, 1929.
6. Gouley, B. A., and Anderson, E. : Chronic dissecting aneu-
rysm of the aorta simulating cardiovascular disease : notes on
the associated aortic murmurs. Ann. Int. Med., 14:978, 1940.
7. Gsell, O. : Wandnekiosen der Aorta als selbstandige Er-
krankung und ihre Beziehung zur Spontanruptur. Virchows
Arch. f. Path. Anat.. 270:1-36, 1928.
8. Keefer, C. S., and Resnik, H. W. : Dissecting aneurysm
with signs of aortic insufficiency: report of a case in which
the aortic valves were normal. J.A.M.A., 88:422, 1925.
9. Kellog, F., and Heald’, A. H. : Dissecting aneurysm of
the aorta. Report of a case diagnosed during life. J.A.M.A.,
100:1157, 1932.
10. Master, A. M. ; Dock, S. ; Field, L. E., and Horn, H. :
Diagnosis and treatment of acute coronary disease.
J.A.M.A., 141:887-891, (Nov. 26) 1949.
11. Paullin, J. E., and James D. F. : Dissecting aneurysm of
aorta. J. Int. Post. M. A., 4:291-299, (Oct.) 1948.
12. Schlichter, J. G. ; Amromin, G. D., and Sohvay, A. J. L. :
Dissecting aneurvsm of the aorta. Arch. Int. Med., 84 :
558-568, (Oct.) 1949.
13. Scott, R. W., and Sancetta, S. M. : Dissecting aneurysm of
aorta with hemorrhagic infarction of the spinal cord and
complete paraplegia. Am. Heart J., 38:747-756 (Nov.)
1949.
14. Wainwright, C. W. : Dissecting aneurysm producing coro-
nary occlusion by dissection of coronary artery. Bull. Johns
Hopkins Hosp., 75 : 8 1 -94, 1944.
15. Weisman, A. D., and Adams, R. D. : The neurological
complications of dissecting aortic aneurysm. Brain, 67 :67,
1944.
16. Weiss, S. : Dissecting aneurysm of the aorta: two cases
with unusual features. New England J. Med. 218:512-
517, 1938.
17. Weiss, S. ; Kinney, T. D., and Maher, M. A.: Dissecting
aneurvsm of the aorta with experimental atherosclerosis.
Am. J. M. Sc., 200:192-203, 1940.
585 — 40th Ave. N.E.
HEALTH PROTECTION IN THE HOME
The family is engaged in a variety of activities asso-
ciated with homemaking, housekeeping, and child care
with which we are so familiar that we often fail to
realize their significance. If there is to be any effective
health care and preventive medicine, as distinguished
from treatment of the sick, it cannot be provided by
doctors, nurses, or other professionals — however much
their knowledge and skills may be needed by the family.
Health care and preventive medicine are carried out in
the daily activities of housekeeping and homemaking.
258
Through marketing, cooking and the serving of meals,
basic nutritional needs must be met, and through house-
cleaning, laundering, dishwashing, and similar sanitation,
the necessary defense against infections and contamina-
tion must be maintained. Through provision of rest, care
of minor ills, and all the cherishing functions within the
home, individual members are protected and restored, so
that they can live in health and carry on their daily
activities. — Lawrence K. Frank, The Survey, Decem-
ber, 1949.
Minnesota Medicine
SPONTANEOUS REMISSION IN SUBACUTE LEUKEMIA
Report of Case
JAMES F. HAMMERSTEN, M.D. and CARLETON B. CHAPMAN. M.D.
Minneapolis, Minnesota
'"THE ACUTE and subacute leukemias are uni-
■*- formly fatal diseases, the total duration of
which may be as short as three weeks. Occasion-
ally, however, patients with the subacute form
of the disease may survive as long as eighteen
months. No entirely credible report of cure,
spontaneous or otherwise, has appeared, but a
number of reports of spontaneous remission in
the diseases are available. Judging from these
accounts, remission may be characterized by
symptomatic and hematologic improvement, some-
times to a very remarkable degree. Published
descriptions of truly complete remissions, in the
ies were done during the period of improve-
ment.3,4,5’7,12’13’14’19’2° Incomplete remissions in
acute leukemia have been frequently report-
ed .7,10,16,17,21 qq^. incidence and character of such
remissions are of utmost importance in view of
the fact that chemical agents, thought to produce
remissions that are longer than the spontaneous
variety, have recently been described.6,8’9
The following case of subacute leukemia is pre-
sented, not only as an illustration of complete
spontaneous remission but also to illustrate the
difficulty of assessing the value of therapeutic
agents in this type of hematologic disorder.
TABLE I. CASES OF ACUTE LEUKEMIA WITH REMISSION PROVED BY EXAMINATION OF BONE MARROW.
Author
Age
Sex
Type
Duration
Hematologic
Remission
Bone Marrow
During
Remission
Remarks
Complete
Incomplete
Birge, Jenks & Davis (2)
33
F
Stem
21 months
+
Normal
Pellegrini (18)
14
F
Monocytic
5 months
+
Normal
Monocytes in peripheral
blood never below 17 per
cent.
52
F
Lymphatic
3 months
+
Nearly normal
Per cent of polymorphonu-
end of re-
clears never over 57 and
mission.
hemoglobin never over 75.
39
F
Monocytic
1 year
+
Normal
Per cent of polymorphonu-
clears never over 50 and
monocytes never below 22.
Moeschlin (17)
23
M
Myelogenous
1st remission
+
Normal
7 months
2nd remission
+
Normal
f ' ■
3 months
rr’T 1
3rd remission
+
Showed abnor-
Leukopenia persisted; white
! hjj
2 months
mal numbers
blood count never over
ISf
of myelo-
4400
blasts
38
M
Myelogenous
6 weeks
+
Normal
Hemoglobin never over 82
per cent and white blood
count never over 3000.
Henning (11)
47
M
Myelogenous
3 months
+
Normal
sense that the patient becomes asymptomatic, the
abnormal physical findings disappear, and the
peripheral blood and bone marrow show no evi-
dence of leukemia, are rare. The literature con-
tains only seven cases in which the occurrence
of remission was established not only clinically
but also by adequate studies of the peripheral
blood and bone marrow (Table I). In addition,
there have been nine cases with allegedly com-
plete remissions in which no bone marrow stud-
From the Department of Internal Medicine, University of
Minnesota School of Medicine and the Veterans Hospital, Min-
neapolis, Minnesota.
Sponsored by the VA and published with the approval of the
Chief Medical - Director. The statements and conclusions pub-
lished by the authors are the result of their own study and do
not necessarily reflect the opinion or policy of the Veterans
Administration.
March, 1950
Report of Case
A twenty-year-old white man was admitted to the hos-
pital on May 17, 1948, complaining of progressive weight
loss of six months’ duration.
He was perfectly well until January, 1948, when chills
and night sweats began. In March, he developed weak-
ness which soon forced him to give up his job as a
manual laborer. In April he was told by his physician
that he had anemia, and iron therapy was instituted but
was without effect. A tooth extraction at this time
caused a moderately severe hemorrhage from the tooth
socket. In early May, he noted the appearance of
numerous, slightly tender masses in the neck, armpits,
and groins. Shortly afterwards, his physician found
“changes in the white cells” and hospitalization was
recommended. A few days before he came to the hos-
pital, members of his family noticed that he was slightly
259
SUBACUTE LEUKEMIA— HAMMERSTEN AND CHAPMAN
jaundiced. At the time of admission, he had lost about
35 pounds since the beginning of his illness although
his appetite had been excellent.
The past and family histories were irrelevant.
paratyphoid A and B, brucellosis and tularemia were
negative as were three heterophil antibody tests, car-
ried out three weeks apart. Urinalysis showed a one
plus test for albumin and a few red cells in the spun
TABLE II. SUMMARY OF HEMATOLOGIC DATA FROM
ADMISSION TO THE END OF THE FIRST REMISSION.
Date
Hb.
mg.
RBC
mill.
WBC
Thou.
PMN
%
L
%
M
%
E
%
B
%
Sed. Rate
mm. /hr.
5-15-48
10.3
52.0
7
92
1
5-17-48
9.8
19 8
14
86
67
5-19-48
4.2
7,2
16
81
2
1
5-21-48
7.8
24
74
2
5-25-48
2.7
12
88
(Wh
ole bio
od, 150
0 ec.)
00
•'f
C4
10 3
1 . 5
23
77
115
(Wh
ole bio
od, 50
0 cc.)
6-14-48
3.4
38
57
2
1
2
75
6-21-48
4.7
48
51
1
62
6-29-48
5.3
53
43
3
44
7- 6-48
9.0
4.4
67
29
4
43
7-13-48
12.2
9.1
77
19
4
35
(Wh
ole bio
od, 150
0 cc.)
7-27-48
6.5
73
24
2
1
30
8-17-48
14.8
5.4
63
35
2
32
8-27-48
5.9
49
49
2
31
9- 1-48
14.0
4.5
50
46
4
37
9-13-48
13.0
6.9
61
37
2
35
9-29-48
14.5
12.2
64
35
1
50
10- 8-48
8.8
27
70
2
1
10-12-48
10.5
3.6
5.0
25
75
10-14-48
9.8
4. 1
22
78
On admission, the temperature was 100.4 degrees, the
pulse rate 98, and the blood pressure 118/72 mm. Hg.
He was an acutely ill, well-developed young man whose
skin and conjunctivae were slightly icteric and who was
complaining of pain in the flanks. Other significant
finings were malodorous breath, a tender spleen which
extended 12 cm. below the left costal margin, tender-
ness in the right costovertebral angle and in both
flanks, small petechial hemorrhages over both ankles,
and pronounced generalized lymphadenopathy. The
nodes were discrete, firm, and slightly tender, measuring
up to 2 cm. in diameter. Tenseness of the anterior
abdominal musculature prevented adequate evaluation
of the size of the liver.
The hematologic findings on admission are summarized
in Table II. In the peripheral blood some of the lympho-
cytes were young forms but no true blast cells were
seen. Bone marrow aspiration showed decreased for-
mation of neutrophils, suppression of erythropoiesis, a
pronounced increase in the number of lymphocytes, most
of which were immature, and a large number of blast
cells which were thought to be lymphoblasts. The
bleeding time was one minute and the clotting time
four and one-half minutes. The prothrombin cencen-
tration was 58 per cent (control 14.5 seconds, patient
16.9 seconds). A bromsuphthalein test showed 22 per
cent retention in forty-five minutes. The one-minute
serum bilirubin value was 2.1, and the total 4.1 mg.
per 100 c.c. The cephalin-cholestrol flocculation test
gave 4 plus results in twenty-four and forty-eight hours.
The alkaline phosphatase test showed 43 King-Armstrong
units. The blood Kahn test was negative. The initial
blood cultures were contaminated but six subsequent
ones were negative. Agglutination studies for typhoid,
sediment. An x-ray film of the chest showed no
abnormality but a film of the abdomen showed the spleen
and liver to be grossly enlarged.
The diagnosis at this time was acute or subacute leu-
kemia. The patient’s status appeared to be grave.
The temperature chart showed daily elevations to 103
and 101 degrees and he continued to complain of severe,
generalized aching. The number of petechiae increased
and there was bleeding of the gums. An effort was
made to obtain aminopterin for therapeutic use, but be-
fore the drug could be obtained, the patient’s symptoms
began to improve. The leukocyte count began to fall
and the fever to subside. Three weeks after admis-
sion (June 7) the temperature was normal, the lymph-
adenopathy and jaundice had disappeared, the spleen
had become much smaller, and the patient felt per-
fectly well. Because of the dramatic improvement the
possibility that the initial diagnosis was in error was
considered, but a sternal aspiration still showed changes
consistent with lymphatic leukemia, although the per-
centage of blast forms was lower than at the time of
admission. Since the leukocyte count fell to leukopenic
levels, penicillin therapy was begun but was discon-
tinued after seventeen days because of continued gen-
eral improvement and changes in the total and differ-
ential leukocyte counts toward normal. On June 29,
the serum bilirubin, alkaline phosphatase, and brom-
sulphthalein values were normal but the cephalin-
cholesterol flocculation test continued to show 4 plus
values in twenty-four and forty-eight hours. On July
13, about two months after entry, the patient was ap-
parently perfectly well. The temperature was normal,
he had no complaints, and the physical findings were
those of a healthy young man except for a barely pal-
260
Minnesota Medicine
SUBACUTE LEUKEMIA— HAMMERSTEN AND CHAPMAN
pable spleen. The hemogram was almost normal and
the sedimentation rate had fallen to 35 mm. in one hour.
The appearance of the bone marrow was normal except
for a slight increase in the number of adult lymphocytes.
On this date, a severe chill and an elevation in tem-
perature to 103 degrees interrupted the remission but
the fever and accompanying symptoms subsided within
a few days. During the latter part of July and all
of August and September, the patient was perfectly
well and spent most of the time at home. On August
31, the bone marrow was completely normal in appear-
ance. The lymphadenopathy, splenomegaly and hepa-
tomegaly had disappeared.
In early October, malaise, weakness, and fever re-
turned, as did the lymphadenopathy, icterus, and spleno-
and hepatomegaly. The total leukocyte count was nor-
mal but there was a pronounced relative lymphocytosis.
The bone marrow- was dominated by immature lympho-
cytes of which 25 to 30 per cent were blast cells. The
erythrocyte sedimentation rate was again markedly ele-
vated. Liver function studies gave reults that were
very similar to those obtained on admission. Late in
October there was a partial remission but the abnormal
findings did not disappear altogether. Treatment con-
sisted of occasional blood transfusions and in November,
because of an increase in the total leukocyte count to
between 50,000 and 100,000, small doses of x-ray ther-
apy were given to the spleen (100 RU total). The
leukocyte count dropped rapidly and reached the very
low level of 900 per cu. mm. about a month after the
treatment was given. Shortly after termination of the
treatment there was a marked exacerbation of symptoms
and from this time on, the course was one of steady
deterioration. Blood transfusions and treatment with
antibiotics were continued, without significant effect.
During the first half of December, the total leuko-
cyte count varied between 750 and 3,000, of which from
84 to. 98 per cent were lymphocytes. Occasional blast
cells were seen in the peripheral blood. From this time
to the end of February the total count ranged between
1,000 and 6,000 and there was marked improvement in
the differential count, which at times reverted completely
to normal. During the last month of the patient’s
course, the total count remained below 3,000 the per-
centage of lymphocytes steadily increased, and the
hemoglobin declined. He finally succumbed on March
22, about fifteen months after the onset of his disease
and seven months after admission to the hospital. At
the time of death, the total leukocyte count was 2,000,
of which 36 per cent were neutrophils and 64 per cent
lymphocytes. The hemoglobin was 7.6 grams per 100 c.c.
of blood.
Permission for autopsy was refused.
Comment
The case presented is remarkable because of
complete spontaneous remission in a disease the
course of which is ordinarily characterized by
inexorable progression. The remission may fair-
ly be said to have begun in mid-July and to have
March, 1950
ended early in October, a period of about ten
weeks. During much of this time the only ab-
normal finding was a moderately elevated erythro-
cyte sedimentation rate, although during the latter
half of the period, the differential leukocyte count
showed signs of reverting to a state similar to
that found on admission. The bone marrow, five
weeks after the remission began, was perfectly
normal. The remarkable remission in symptoms
and abnormal physical findings was not altered
until the end of the period. Even late in the
course of the disease there were symptom-free
periods, lasting as long as a week, but the hema-
tologic and bone marrow findings never again
returned entirely to normal.
The average incidence, degree and duration of
spontaneous remission in acute leukemia are not
known with certainty. The cases available in the
literature (Table I) provide no information with
regard to incidence of spontaneous remissions,
although one authority, quoted by Farber,9 is
said to have observed them in 10 per cent of 300
cases of acute leukemia in children. The average
duration of the remissions in this group was about
ten weeks. Had it proved possible to treat the
patient, whose case report is presented, with one
of the folic acid antagonists, such as aminopterin,
or amino-an-fol, the presumption of a cause-and-
effect relation between the drug and the remission
would have been difficult to avoid.
The extreme difficulty of evaluating a thera-
peutic agent that does not produce outright cure
in acute or subacute leukemia is made apparent
by cases such as the one presented. Farber9
reported recently that over 50 per cent of approx-
imately sixty children with acute leukemia “. . .
showed improvement clinically, hematologically
of important degree attributable to the action
of these compounds.” The basis for this judg-
ment and details of the cases are not given, the
author contenting himself with the statement that
the remissions he observed were due neither to
acute infection nor to massive blood transfusion,
a procedure which, according to Bessis,1 is fol-
lowed by a high incidence of remission. Dame-
shek,6 reporting on the effect of treatment with
aminopterin in thirty-four cases of acute and sub-
acute leukemia, observed a remission rate of 26
per cent which was thought by him to be higher
than the incidence of spontaneous remission.
Meyer and co-workers15 observed beneficial re-
sults in only four of forty-three leukemic patients
261
SUBACUTE LEUKEMIA— HAMMERSTEN AND CHAPMAN
who were treated with aminopterin. Fifteen of
their patients showed grave toxic manifestations
which could not be controlled either by varying
the dose of the drug or by giving liver extract
along with it.
The therapeutic value of aminopterin and re-
lated compounds, therefore, remains very uncer-
tain. At the present time, it seems wisest to
utilize transfusion of whole blood, antibiotics, and
symptomatic measures when indicated. Spon-
taneous remission may provide the patient with
welcome relief from symptoms as it did in the
case presented, but the attempt to obtain the same
result by tbe use of folic acid antagonists seems
premature.
The jaundice and other evidence of hepatic
dysfunction are of some interest since they are
said to occur rather seldom in patients with leu-
kemia. The possibility that the hematologic dis-
order was complicated by hepatitis, either homol-
ogous serum or epidemic, cannot be ruled out
since no autopsy was done.
Summary
A case of subacute lymphatic leukemia with
complete spontaneous remission lasting about ten
weeks is presented. During the remission the
patient’s symptoms and abnormal physical find-
ings disappeared. The peripheral blood and bone
marrow became normal in all respects. The spon-
taneous improvement was comparable to remis-
sions that have recently been attributed to the use
of folic acid antagonists, the clinical status of
which is briefly discussed.
Addendum
Five additional cases of remission in acute leukemia,
substantiated by bone marrow biopsy, are cited in the
following work, which was not available until after the
preceding report was prepared : Leitner, S. J. : Bone
Marrow Biopsy. New York: Grune and Stratton, 1949.
Bibliography
1. Bessis, M. : The use of replacement transfusion in diseases
other than hemolytic disease of the newborn. Blood, 4:324-
337, 1949.
2. Birge, R. F., Jenks, A. L., Jr., Davis, S. K. : Spontaneous
remission in acute leukemia. Report of a case complicated
by eclampsia. J.A.M.A., 140:589-592, 1949.
3. Bock, H. : Zur Differentialdiagnose der myelosichen Leu-
kamie. Ztschr. f. klin. Med., 122:323-339. 1932.
4. Bosland, H. G. : Acute lymphatic leukemia with remission.
Minnesota Med., 21:500-501, 527, 1938.
5. Brogsitter, A. M., und Kress, H. : tlber die agranulocy-
tose Krankheit, eine Krittik der Kasuistik und eigene klin-
ische Beobachtungen. Virchows Arch. f. path, anat., 276:
768-819, 1930.
6. Dameshek, W. : The use of folic acid antagonists in the
treatment of acute and subacute leukemia. A preliminary
statement. Blood, 4:168-171, 1949.
7. Evensen, O. K., and Schartum-Hansen, H. : The symp-
tomatology of aleukemic paramyeloblastic leukemia. Acta
Med. Scand'inav., 107:227-281, 1941.
8. Farber, S., Diamond, L. K., Mercer, R. D., Sylvester, R.
F., and Wolff, J. A. : Temporary remissions in acute leu-
kemia in children produced by folic acid antagonists, 4-
aminopterovl-glutamic acid (aminopterin). New England
J. Med., 238:787-793, 1948.
9. Farber, S. : Some observations on the effect of folic acid
antagonists on acute leukemia and other forms of incurable
cancer. Blood, 4:160-167, 1949.
10. Flinn, L. B. : Acute lymphatic leukemia in a child of four
years with a severe granulopenic phase preceding a remis-
sion. Ann. Int. Med., 9:458-469. 1935.
11. Henning, N. : Beobachtungen zur Pathogenese der akuten
Myeloblastenleukamie. Deutsches Arch. f. klin. Med., 178:
538-549, 1936.
12. Jackson, H., Jr., Parker, F., Jr., Robb, G. P., and Cur-
tis, H. : Studies of diseases of the lymphoid and myeloid
tissue, 3. A case of acute leukemia with a five months’
remission. Folia haemat., 44:30-37, 1931.
13. Jackson, H., Jr.: The protean character of the leukemias
and of the leukemoid states. New England J. Med., 220:
175-181, 1939.
14. Marcus, I. H. : Complete temporary recovery, of long
duration, in acute aleucemic myeloid leucemia. J. Lab.
& Clin. Med., 21:1006-1009, 1936.
15. Meyer, L. M., Fink, H., Sawitsky, A., Rowen, M., and
Ritz, N. D.: Aminopterin (a folic acid antagonist) in treat-
ment of leukemia. Am. J. Clin. Path., 19:119-126, 1949.
16. Miller, F. R., and Seymour, W. B. : Leuopenic leukemia of
the myeloblastic type. Am. J. M. Sc., 196:621-632, 1938.
17. Moeschlin, S. : Subacute Paramyeloblasten-Leukamien mit
mehrfachen langern Remissionen. Deutches Arch. f.
klin. Med.. 191:213-247, 1943.
18. Pellegrini, G. : Casi di leucemia con remissione. Haema-
tologica, 28:257-292, 1946.
19. Plum, P., and Thomsen, S. : Remission under Forlobet ai
akut, aleukaemisk leukaemi. Ugesk. laeger., 98:1062-1067,
1936.
20. Wagner, A. : Remission einer akuten lymphatischen Leu-
kamie durch komplizierende Eiterung. Klin. Wchnschr.,
7:266-267, 1928.
21. Whitby, L., and Christie, J. M. : Monocytic leukemia.
Lancet. 228:80-82, 1935.
MINNESOTA’S SHARE OF PROPOSED FEDERAL BUDGET $789,365,400
If Congress should adopt in full the 42.4-billion dol-
lar budget proposed by President Truman for the fiscal
year ending June 30, 1951, Minnesota taxpayers will be
required to pay out approximately $789,365,400 in Fed-
eral taxes as their share of the cost of this spending
program.
The Minnesota Taxpayers Association has pointed out
that the $789,365,400 share which woidd be borne by
Minnesota taxpayers to support the President’s proposed
budget, which does not include social security program,
is over five times the $153,617,000 in taxes collected by
Minnesota last year to finance the entire State Govern-
ment.
According to the Association: “These social welfare
programs already exact millions of dollars annually
from Minnesota wage and salary earners in the form of
taxes deducted from their pay checks. If Congress
should approve the new proposals, these taxes will rise
sharply when the new programs get in full operation.”
The Association continued : “A substantially smaller
budget of $36-billion was proposed just four weeks ago
by Senator Harry F. Byrd of Virginia. Under Senator
Byrd’s program the Federal budget could be balanced in
1951 with some funds left over to cut the staggering
public debt. The difference between the two proposed
budgets is 6.4 billions. The saving to Minnesota would
be $119,040,000. This would go a long way towards pay-
ment of the entire cost of our State Government. It is
more than enough, in fact, to pay for the entire Veterans’
bonus.
“The Federal budget can be balanced in 1951. It can
be balanced without increasing Federal taxes. It should
be balanced by reducing non-essential expenditures just
as we have had to do it on the farm, in business and in
industry, and as every housewife in Minnesota has had
to do in these days of high taxes and high prices.
Deficit-financing should be stopped.”- — From Minnesota
Taxpayers Association.
262
Minnesota Medicine
HEALTH IS A COMMUNITY PROBLEM
DAVID A. SHER, M.D.
Virginia, Minnesota
TRACTORS which contribute to health are varied
and numerous. The doctor, the nurse, the
hospital, the public health official and allied per-
sonnel all make their contributions to the cause of
individual and community health, and co-operation
is essential. Health and illness are problems too
complex to be solved by any one of these human
elements or organizations.
It is obvious that proper physical and mental
health cannot be expected unless there are good
housing, proper clothing, satisfactory food and
happy family life. The doctor may be unaware of
a deficiency in any of the above mentioned essen-
tials- for proper physical and mental health, while
the nurse in the hospital, through her contacts with
visiting parents and relatives, may obtain hints
as to the need for further investigation.
This information passed on to the doctor and/or
public health nurse may be invaluable in continu-
ing the patient’s care at home. In this way the
public health nurse can plan her course of action
more intelligently when she comes into the home.
The doctor, too, can thus outline a more success-
ful course of therapy in the home. If some of the
essentials toward proper physical and mental
health are missing, perhaps the public health nurse
may be able to arrange for their restoration. So
often, the doctor will leave proper instructions, as-
suming that they will be carried out. But without
some sort of a check, he has no way of knowing
whether or not his orders are fulfilled in their
entirety — either because of ignorance or because
of lack of the essentials conducive to proper
health and recovery.
No field of specialized medicine has a broader
scope, greater responsibilities or greater possibil-
ities than has pediatrics.
To some the practice of pediatrics is essentially
infant feeding ; to others it is the management of
the ills of the first two or three years of life ; to
still others it is preventive medicine ; and to
a few it is simply the management of behavior
disorders. It is all these and more. Concern for
the child must antedate conception and extend
through the period of adolescence. Care of the
unborn child is provided by adequate care of the
Read at the Public Health and Hospital Nurses Conference,
Virginia, Minnesota, September 23, 1949.
March, 1950
pregnant woman, and obstetric care at the time of
delivery is reflected in the care of the infant. The
neonatal period, or the first four weeks of life, is
the single most important period of life and pre-
sents problems that never exist again. Infancy,
or the first two years of life, represents the period
of most rapid growth. This is the time when the
infant is completely dependent on others for all
phases of his care — when he is not only more
susceptible to infections and nutritional disturb-
ance but often has a pattern of response which
differs from that of later years. As the age of in-
fancy is passed and the preschool, prepuberty and
adolescent ages are attained, the child assumes in-
creasing responsibility in his own care, but in-
telligent and understanding pediatric supervision
continues to be an important aid. I mention the
above to call attention to the fact that in pediatrics
we are always dealing with a growing individual —
his physical and mental constitution is constantly
going through changes. One must be aware of
these metamorphoses in order to deal with any
deviations from the normal.
Surveys of children in all economic strata reveal
a high incidence of physical and nutritional dis-
turbances and psychological difficulties which are
remediable. Obviously in this small space I could
not possibly attempt to cover all of these physical
disturbances and psychological difficulties. I will
try to briefly touch upon two phases which are so
often neglected : convalescent care and psycholog-
ical care of the sick child.
Convalescent Care
Convalescent care as a phase of medical respon-
sibility in the management of the sick child has
received only scant attention. There is a great
need for a better understanding of both the quali-
tative and quantitative aspects of such phases of
treatment as diet, rest, and activity, and for more
adequate measures to determine when convales-
cence is complete.
In a broad sense, any child who is below par
physically is in need of convalescent care. In the
more practical sense, the term “convalescent care”
should be reserved for the management of the
more serious deviations from the states of health
which exist as the result of acute or chronic in-
263
HEALTH IS A COMMUNITY PROBLEM— SHER
factions or non-infectious illness but which are
not permanent and for which at least some degree
of improvement can be expected. The extent to
which convalescent care is needed is determined by
the pre-existing state of health and by the serious-
ness and duration of the active state of the illness.
Convalescence from short term acute illnesses
in previously healthy children should be com-
pleted in a very short time. In such instances
gradual increase in activity and special attention
to diet are all that is needed. When the illness has
been prolonged or unusually severe, greater at-
tention is necessary.
The principal factors are :
1. Rest.
2. Increasing but graded physical activity.
3. Diets which take into account increased need for
such essential items as protein, vitamins and minerals.
4. Play and occupational therapy.
5. Provision for formal schooling.
6. An environment which stimulates self-confidence
in the child and at the same time provides an adequate
sense of security.
The public health nurse, through the co-op-
eration of the hospital nurse, can do a great deal in
educating the parent in the above factors.
Children with nutritional deficiencies require
special attention. 1 f undernutrition is due to eco-
nomic factors,- every etifort should be made to see
that ample food supplies are made available.
When undernutrition has been due to poor eating
habits, which so often are the result of poor train-
ing and disturbed parent-child relationships, re-
constructive work must be carried out with the
parents while the child is still convalescing in the
hospital. Supervision and guidance should be
maintained after the child is dismissed to his own
home, through the co-operation of the public
health nurse or social worker.
When the convalescent period is spent in an in-
stitution rather than in the child’s own home, the
parents should be acquainted with the purpose and
the methods employed. This should be supple-
mented by home visits from public health nurses
and medical social workers. The nurse visiting in
the home can be of great assistance in interpreting
instructions for the parents and child and in ap-
praising the home situation for the doctor.
The responsibility for supervision of long con-
valescent periods within the child’s own home will
fall upon the physician. If he assumes this respon-
sibility, he must recognize that it is the whole child
and not the physical ravages of the disease alone
which must be provided for. He will do well to
enlist the aid of persons who can provide play and
occupational therapy and schooling within limits
which stimulate but do not overtax the child. In
some instances, the mother may be adequate for
this task ; in others, dependence will have to be
placed upon such persons as visiting teachers and
public health nurses. Communities which do not
have convalescent institutions could with advan-
tage organize such home care service for conva-
lescent patients.
Psychological Care of the Sick Child in the
Hospital
Tens of thousands of children are admitted
every year to pediatric hospitals throughout the
country. They come at different ages, with differ-
ent ailments of varying degrees of severity and
discomfort. Some never leave the hospital alive ;
the great majority return to their homes after a
short period of residence ; others must spend many
months or even years in wards of private hospital
rooms. They come from the homes of luxury,
moderate conveniences, or poverty; from atmos-
pheres of sheltered security, or family disruption ;
from reasonable parental management, pamper-
ing over-solicitude, or inadequate distribution of
affection. For many children hospitalization is an
unwelcome removal from a happy home, school or
play life; for some it is a much enjoyed first op-
portunity to find kindness, comfort, and an inter-
esting escape from domestic monotony or dis-
agreeable school situations. Unless there is at the
time of admission a clouding of consciousness or
the suffering is too acute or intense, every child
beyond the age of infancy must have the realiza-
tion that an event of the first magnitude is taking
place in his experience. He often brings with him
peculiar notions about the meaning and functions
of physicians, nurses and hospitals. He may come
with confidence or dread, with placid submission
or violent protest.
Hospital admissions are often carried out with
a gracefulness and charm which cause the child
to accept the inevitable as a special privilege. Yet
there are situations in which an impatient nurse
contributes a great deal toward a few days or
weeks of mutual irritation and veritable warfare.
A youngster may be snatched away with force and
carried to a bed where he is left unheeded, or be-
264
Minnesota Medicine
HEALTH IS A COMMUNITY PROBLEM— SHER
wail screamingly what to him seems a major in-
justice. Or his mother is allowed to lie to him
that he will be returned to her and taken back
home in a few minutes : he waits and waits until
the truth fills him with bitterness and justified re-
sentment. Thus an unpleasant first impression
may well play havoc with the patient’s adjustments
and co-operation.
In spite of the absence from home, in spite of
the imposed restrictions of activity, in spite of
drugs, injections and enemas, many children look
back with pleasant remembrances to the days of
their hospitalization.
So many a physician has said to himself that
he could help many of his parentally mismanaged
patients if only he could get them away from
home. Justified fear of losing his patients deters
him from making any such recommendations. Ill-
ness, necessitating admission to a hospital, comes
as an answer to his prayers. The spoiled, over-
protected child is away from his agitated mother,
and there is a chance to re-educate the child who
has temper tantrums, indulgence in food capri-
ciousness with or without vomiting, who is the
object of parental bowel overconcern that works
with laxatives, suppositories and enemas, has in-
numerable aches and pains, is afraid of the dark,
and gets everything he wants. Successful manage-
ment of these problems in the hospital can be
made to serve as a forceful demonstration to the
parents of adequate methods of training. But
there must be people on the staff who have learned
how to deal with such children and their parents,
and of course the public health nurse can see that
the hospital management of the problem is con-
tinued in the home — or a return to the original
difficulty will be the result-.
When a child comes to a hospital, he is not just
the incidental carrier of a disease that is to be
cured. He is not simply a case of pneumonia,
rheumatic fever, asthma, or sore throat. He is
an impressionable human being, and a member of
a family who are very much interested not only in
his blood sugar and leukocyte count but very pro-
foundly and essentially in the human being that
he is. Professional help receive excellent instruc-
tion in the treatment of diseases and care of bod-
ies, in good hospitals. If some time and thought
could be given to teaching nurses how to deal with
the children themselves, our hospitals, in addition
to their great contributions to the physical welfare
of children, would render considerable service to
the preservation and promotion of the mental
health of the patients entrusted to their care.
MORTALITY RATES
The death rate for the United States in 1948 was the
lowest in the history of the country, John L. Thurston,
Acting Federal Security Administrator, has announced.
The announcement was based on a compilation just com-
pleted by the Public Health Service’s National Office of
Vital Statistics.
The crude death rate for 1948 was 9.9 per 1,000 popu-
lation— 2 per cent below the rate of 10.1 for 1947 and 1
per cent lower than the 1946 rate, the previous record
low, the report showed.
The leading causes of death remained the same as in
1947. The major chronic diseases associated with ad-
vanced age accounted for 63 of every 100 deaths. Death
rates in this group showed only slight changes from the
1947 record. The death rate for diseases of the heart
was 322.7 per 100,000 population, while the 1947 rate
was 321.2. The death rate for cancer and other malig-
nant tumors increased from 132.4 in 1947 to 134.9 in
1948. The death rate for diabetes remained about the
same for the two years ; the 1947 rate was 26.2, and the
1948 rate 26.4. Deaths from nephritis, and from intra-
cranial lesions of vascular origin each showed small de-
clines. The 1948 death rate for intracranial lesions was
89.7, while the 1947 rate was 91.4. The nephritis death
rate dropped from 56.0 in 1947 to 53.0 in 1948.
Mortality from the major infectious diseases con-
March, 1950
tinued their long-time declines. The death rate for
pneumonia and influenza, combined, and the rate for
tuberculosis both reached new lows. A 10 per cent de-
cline from the 1947 rate brought the death rate for
tuberculosis (all forms) for 1948 down to 30.0 per
100.000 population and the rate for pneumonia and in-
fluenza down to 38.7.
Motor-vehicle accident deaths decreased for the second
successive year. The rate for 1948 for this cause was
22.1 per 100,000 population, while the 1947 rate was 22.8.
The death rate for accidents other than motor-vehicle
accidents also decreased from the 1947 rate of 46.6 to
45.0 in 1948.
Mortality from two of the communicable diseases of
childhood increased sharply from 1947, a low year. The
number of deaths from poliomyelitis and acute polio-
encephalitis increased from 580 deaths in 1947 to 1,895
deaths in 1948, bringing the death rate back up to the
1946 level of 1.3 deaths per 100,000 population. Deaths
from measles rose from 472 in 1947 to 888 in 1948,
which was still well under the figure of 1,310 recorded
for 1946. Deaths from whooping cough fell from 1,954
in 1947 to 1,146 deaths in 1948, continuing a long-term
decline. Diphtheria deaths also continued their decline,
reversed temporarily in 1945 ; 634 deaths were reported
from this cause in 1948.
265
CLINICAL-PATHOLOGICAL CONFERENCE
DIAGNOSTIC CASE STUDY
ARTHUR H. WELLS, M.D., GORDON C. MacRAE, M.D., and HAROLD H. IOFFE, M.D.
Duluth, Minnesota
Dr. A. H. Wells: Possibly the most common and
most difficult diagnostic problems in hospital experi-
ences are those cases with fever of unknown origin.
We wish to present an interesting and unusual diag-
nostic problem of this general nature. Dr. J. D.
Fickel will present the history, and Dr. F. W. Conley
will give his differential diagnosis ; neither knows the
postmortem findings.
Clinical Study
Dr. J. D. Fickel : This sixty-five-year-old white male
(Case 4439) was admitted to this hospital complaining
of weakness and loss of appetite and weight for about
one month. The patient dated his present illness to mid-
February, when upon arising one morning he fell to the
floor on his knees. Following this fall he noticed his
knees became painful and slightly swollen. Since that
time he had noted generalized weakness especially of
both legs, severe loss of appetite and an inability to
swallow. The latter was not exactly dysphagia; how-
ever, he said he could not choke food down. He had
no chills and had noted no fever.
The past history revealed a series of accidents. In
1927 he was in an accident at a coal dock which re-
sulted in fractures of the left elbow, right hip and ribs
on the left side. From this he had residual shortening
of the right leg and fixation of the left elbow. In
1937, twelve years before admission, he fractured his
occiptal skull on a snow plow. Eight years ago a
conveyor belt injury of the right hand resulted in am-
putation of the thumb and three fingers of the same
hand. On that admission he gave a history of having a
chronic cough which he attributed to coal dust. At
that time he weighed ISO pounds. His cough cleared
without establishing the etiology. Since then he has been
well until the present illness. Social and family history
were not contributory.
On admission the blood pressure was 150/60, the pulse
88, respiration 22 and the temperature 101° F. Phys-
ical examination revealed a somewhat emaciated white
man of approximately 115 pounds in weight in no acute
distress. He had an emaciated sallow face. There was
a questionable icteric tinge to the sclera. The lungs were
found to be clear. The heart tones were strong and
free from murmurs. The abdomen was soft and not
distended or tender. The liver edge was palpable about
3 cm. below the right costal margin. External hemor-
rhoids were noted. A grade I benign hypertrophy of
From the Department of Pathology and Graduate Educational
Service, St. Luke’s Hospital, Duluth, Minnesota.
the prostate was also palpated. The testes were slightly
enlarged and soft and the left one was tender. There
was no edema of the extremities. Both knees were a
little fusiform in appearance. They were, however,
not reddened or inflammed and there was no demon-
strable excessive fluid present. They were not espe-
cially tender. The left elbow was severely limited in
mobility due to an old injury. Absence of the thumb
and the first three fingers of the right hand were noted
from a previous accident. He had slightly enlarged
inguinal, axillary, epitrochlear and cervical lmyphnodes.
A consultant found moist rales at the bases of both
lung fields ; otherwise his examination was essentially
as above. The laboratory findings on admission re-
vealed a normal urine; white blood cell counts ranged
from 5,000 to 11,000 with normal differential counts.
The red blood cell count on admission was 3.4 million
and the hemoglobin 7.5 gms. The red blood cell sedi-
mentation rate was increased to 119 mm. per hour
( Westergren) . Subsequent sedimentation rates were in
this range or higher. On the tenth hospital day, for
example, the sedimentation rate was 130 mm. per hour.
The serum albumin was 4.3 gm. and globulin 1.8 gra.
per 100 c.c. Repeated blood cultures were found to be
sterile.
Biopsies of an inguinal node was described as his-
tologically normal. An axillary' node showed follicular
hyperplasia. Bone marrow aspirations from the ster-
num and from the iliac crest showed 5 per cent plasma
cells, otherwise there was a normal distribution of
marrow cellular elements. X-ray studies of the knee
revealed minimal degenerative changes involving the
knee joint on the right side. Chest and skull roentgen
pictures were normal.
Because of cold agglutinins it was impossible to
cross-match his blood for transfusions. His serum
agglutinated his own red blood cells. During the
seventy-seven days in the hospital he ran a low-grade
fever, never exceeding 101° F. Several tests for Bence-
Jones protein in the urine were negative except on one
instance there was a question of a positive test. Until
just before his death blood cultures were negative.
Six days prior to death a culture was found to be posi-
tive for staphylococcus aureus. The Felix reaction was
negative. The patient’s course in the hospital was that
of progressive loss of strength, progressive anemia,
listlessness and depression. At one time about a month
after admission he grew quite disturbed mentally, was
violent, upset and hard to keep in bed. Shortly after
this he apparently had a remission during which he
266
Minnesota Medicine
CLINICAL-PATHOLOGICAL CONFERENCE
became very much improved, was up and about and
appeared to be recovering. However, the anemia pro-
gressed down to 8 gm. of hemoglobin with 2.9 million
red blood cells. He ran a terminal temperature of
107° F., and on the seventy-seventh hospital day he ex-
pired.
A definite clinical diagnosis was never established.
Considered were multiple myeloma, acute rheumatic
fever and rheumatoid arthritis. Two consultants were in
on the case, and each of these diagnoses resulted from
one of their visits. The terminal episode was that of
bacteremia and final death.
Differential Diagnosis
Dr. F. W. Conley : This patient was a sixty-four-
year-old man with anemia, weakness, weight loss and
joint manifestations. The first three findings are non-
specific ; and therefore, I would like to discuss primarily
the joint involvement. Our patient’s first symptoms
included swelling and pain in both knees ; however, he
also had pain in both ankles, later in both wrists, also
in the back and shoulder. The differential diagnosis of
polyarthritis includes the following:
I.
II.
III.
IV.
V.
VI.
VII.
tive colitis
(f) blood dyscrasias
(g) malnutrition
(h) erythema nodo-
sum
(i) pulmonary dis-
sease
Rheumatic fever VIII. Symptomatic diseases
Gonorrheal arthritis
Suppurative arthritis
Gout
Palindromic
Rheumatoid
Brucellosis
(a) septicemia
(b) collagen diseases
(c) carcinoma
(d) multiple myelo-
ma
(e) chronic ulcera-
Briefly, I would like to review the above list of dis-
eases as they pertain to this case. Rheumatic fever is
an acute migratory polyarthritis, while about 10 per
cent of the cases of rheumatoid arthritis begin acutely.
I feel that in this case both can be excluded. Gout
usually starts as a monarticular lesion and as time
progresses may involve several joints. Gonorrheal
arthritis begins as a polyarthritis and within one to
three weeks becomes monarticular. However, in the
case under discussion no symptoms of a genital lesion
could be found and smears were negative. Brucellosis
is usually an arthralgia rather than a true synovial re-
action, and also the negative agglutination tests aid in
excluding this. The systemic diseases which cause
arthritis are the larger and more important group, and
it is here we will concentrate our attention. Septicemia
can be excluded because of the large number of negative
blood cultures. The positive culture in the last week of
life was possibly a terminal bacteremia. We can also
exclude chronic ulcerative colitis. Blood dyscrasias are
something to be considered seriously. An arthritis due
to malignancy is most often associated with bronchogenic
carcinoma and second in frequency with primary car-
March, 1950
cinoma in the pancreas. Other common sources are
cancer of the gall bladder and kidney. Of course other
malignancies can cause joint manifestations, and of
these multiple myeloma stands out. He had a severe
anemia and a very rapid red blood cell sedimentation
rate of 120 mm. per hour. Bone marrow biopsy dis-
closed 5 per cent plasma cells, and the one finding of
Bence-Jones proteinuria is to be noted. All these fea-
tures strongly favor the diagnosis of mutiple myeloma,
yet the negative x-rays of the bones and the very low
plasma cell percentage made me hesitate to make this
diagnosis.
There are many findings present in periarteritis no-
dosa and the other disseminated collagen diseases which
are missing in this patient. The pains were not “neuri-
tic in type. There was no albuminuria, hematuria, hy-
pertension, skin lesions, eosinophilia or serous reactions.
There was a leukocytosis present in only two white
blood cell counts. Leukemia and Hodgkin’s disease
should be considered. As far as I am acquainted,
Hodgkin’s disease usually does not cause any joint mani-
festations of the type we have in this patient. On the
other hand, leukemias are one of the common causes of
joint pains. The differential counts and bone marrow
studies showed no immaturity or suggestion of leukemia.
In conclusion, hidden malignancy in this sixty-four-
year-old man cannot be completely excluded. Multiple
myeloma remains a possibility. If I am held to one
diagnosis, I would choose a low-grade inflammatory dis-
ease such as a suppurative polyarthritis with a minimum
of joint reaction and occasional episodes of bacteremia
as evidenced by the abscesses in the scalp nodules biopsied
and the late positive blood culture for staphylococcus
aureus. It is possible that the patient’s confinement to
bed due to the systemic reaction kept him from trauma-
tizing his joints and thus minimized the joint reactions.
An aspiration of a knee joint might confirm the diagnosis.
Necropsy
Dr. A. H. Wells : Dr. Conley’s diagnosis is correct.
The postmortem examination revealed thick greenish
gray purulent exudate containing hemolytic staphylococ-
cus aureus in every joint entered, including both knees,
shoulders, the right ankle, left elbow and the sterno-
clavicular joints. The only apparent primary site for the
inflammation was the joint cavities themselves. The
other organs simply reveal toxic changes. A post-
mortem blood culture contained a variety of organisms.
Discussion
Dr. A. H. Wells : Concerning the etiology of 140
cases of suppurative arthritis in which cultures were
taken, Heberling1 found the following distributions:
staphylococcus aureus, fifty cases; hemolytic streptococ-
cus, thirty-seven ; negative joint culture, nineteen ; gon-
ococcus, fourteen; staphylococcus albus, ten; streptococ-
cus viridans, eight, and pneumococcus, two cases.
Among the less frequent organisms one should also list
Brucellae, Eberthella typhosa, Escherichia coli, Bacterium
dysenteriae, Leishmania donovani, lymphogranuloma
venerium and certain fungi. In most reports well over
half of the cases of suppurative arthritis are caused by
the staphylococcus and hemolytic streptococcus.
267
CLINICAL-PATHOLOGICAL CONFERENCE
The pathogenesis must frequently be theorized. Syn-
ovial tissue becomes infected by hematogenous dissemi-
nation from a remote focus in many instances. In
others, there is undoubtedly a direct invasion of the
joint from a suppurative process in the adjacent bone
such as osteomyelitis or epiphysitis. Penetrating wounds
may directly introduce the infection into the cavity.
The anatomic incidence of suppurative arthritis in
201 patients1 was as follows : knee, seventy-two ; hips,
sixty-five; ankles, seventeen; wrists, ten; elbow, eight;
shoulders, seven; small joints, four, and multiple joints,
eighteen. The ages of these patients revealed one-fourth
of them occurring in the first ten years of life and
another fourth in the second ten years, whereas only one-
eighth occurred after forty years of age.
The gross and microscopic pathologic changes in
acute arthritis are similar to the acute inflammatory re-
actions found in other tissues except for the complicating
features of digestion of articular cartilage resulting in
ulceration and irrepairable destruction. This is directly
proportional to the severity and duration of the infec-
tion. The more severe the cartilage damage the more
likely ankylosis will result. Abscesses may form in the
marrow of subchondral bone or in the soft tissues
throughout the joint.
The usual swelling, pain, heat, tenderness and conges-
tion about a joint leaves little question as to the inflam-
matory nature of the condition ; however, the co-existing
systemic disease of which the arthritis is a complica-
tion may be so severe as to completely overshadow the
joint infection.
In contrast to our patient there is nearly always a
neutrocytosis of 15,000 or more with a rapid red blood
cell sedimentation rate. Occasionally a positive blood
culture is found. The diagnosis generally can be estab-
lished by a study of the definitely purulent synovial fluid
with its many pus cells and bacteria. This demonstra-
tion by smear or culture clinches the diagnosis. How-
ever, if no bacteria are present, one must rule out acute
gout with associated hyperuricema. Dr. Conley has
given a differential diagnosis for our case study. The
entire gamut in the classification of arthritic conditions
may have to be reviewed as possibilities in certain
cases2’3 The articular picture may be masked by the
systemic reaction to suppuration as it was in our pa-
tient.
Early diagnosis and treatment is stressed by all au-
thorities since irreparable damage can result within
two weeks of the onset. Chemotherapeutic and anti-
biotic therapy, specific for the organism involved given
in proper dosage until aspirated joint fluid is sterile
and clear, is the generally accepted procedure. Some
authors feel that the drugs should also be used in the
joint. Willems method4 of incision and drainage of the
suppurative joint followed by immediate active mobiliza-
tion is highly recommended in the large series of
Heberling.1 This includes an incision of the inflammed
joint under general anesthesia and suturing of the ap-
propriate sized rubber drain to the capsule but not in-
side of the joint. Active motion to full range of motion
is repeated every three hours thereafter, even though
the joint is put in a plaster cast or in traction. Therapy
started in the first week of the infection will have
decidedly better results than that started during the
second week. If therapy is begun after the third week
.some permanent injury to the joint generally results.3
References
1. Heberling, J. A.: A review of 201 cases of suppurative
arthritis. ,T. Bone & Joint Surg., 23:917-921, (Oct.) 1941.
2. Hench, P. S., and Editorial Committee: Rheumatism and
arthritis. (Ninth Rheumatism Review). Ann. Int. Med.,
28:66-168, (Jan.) 1949.
3. McEvven, C. , and Committee of the American Rheumatisms
Association: Primer on the rheumatic diseases. J.A.M.A.,
139:1068-1076, (Apr. 16) 1949.
4. Willems, C. : Treatment of purulent arthritis by wide ar-
throtomy. Surg., Gynec. & Obst., 28:546-554, (June) 1919.
STREPTOMYCIN IN TREATMENT OF PROGRESSIVE PRIMARY TUBERCULOUS LESIONS
The results of streptomycin treatment in progressive
primary tuberculosis may be summarized as follows :
1. It uniformly lessened and in most cases obliterated
the toxic manifestations in twenty-five patients treated.
The improvement usually became apparent within a few
days after the treatment was begun.
2. It reversed the general downward clinical course of
the disease.
3. The physical findings improved and were clearly
demonstrable in thirty to sixty days after treatment was
begun.
4. The decreased roentgenologic findings followed the
improvement in the clinical picture.
5. Sputum conversion was completed in four to five
months in 89 per cent of progressive primary lesions.
6. The hospital stay was uniformly reduced roughly
from two to three weeks to six to eight months’ time.
In spite of the fact, how'ever, that streptomycin has
shown great promise especially in progressive primary
tuberculosis in children, it should not be considered a
cure-all ; its use is still in the experimental stage and
larger numbers will have to be observed over a longer
period of time before an exact and complete evaluation
of its worth in this field can be given. — McEnery,
Sweany, Turner, Chicago, Illinois Medical Journal,
January, 1950.
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History of Medicine In Minnesota
MEDICINE AND ITS PRACTITIONERS IN OLMSTED COUNTY PRIOR TO 1900
NORA H. GUTHREY
Rochester, Minnesota
(Continued f rom the February issue)
From the late nineties Dr. Allen’s inventive and mechanical genius became
manifest, especially in his Model Invalid Elevator, which he designed to
spare the bedridden invalid the strain of assuming different positions for treat-
ment and dressings and the effort of transfer from bed to chair or from
room to room. The machine has been described by a physician of Rochester
as light but strong and stable. The basic table-like structure ran on small
wheels; from it rose a strong metal arm, curved at the top, from which was
suspended a horizontal, adjustable sheet of thin metal adequate to support
an adult person. The elevation and angle of this metal sheet were con-
trolled by a crank. When the apparatus was wheeled to the bedside,
the support could be slipped under the patient, who could then be lifted and
transported. Arrangements were made for the manufacture and sale of
the elevator, and for some years it was used in hospitals to a considerable extent.
It was patented in the United States, Canada, Great Britain, Germany, France
and Belgium; in 1899 Dr. Allen was awarded the gold medal of the Academy
of Inventors of Paris and was made an honorary member of the society.
Reminiscences of townspeople and gleanings from histories and news-
papers of Rochester have thrown light on Dr. Allen’s domestic and social,
professional and civic life over his many decades in Rochester. A tall, slen-
der, bearded man, he was kindly, gentle and reliable, a good citizen, loyal to
his ideals and faithful to his responsibilities. Energetic and industrious, he
always asserted that four hours of sleep in twenty-four were enough for
any man, especially one engaged in business or professional work. For many
years he was a familiar sight, driving on his rounds in town and country in
a top buggy drawn by a gentle horse, Kittie ; in January, 1912, there appeared
a little news item that brought the modest rig sympathetically to the minds
of many Olmsted County citizens: the faithful Kittie had died at the age of
thirty-two years. In later times Dr. Allen used an automobile, which he
himself drove well into his ninety-ninth year. He was a member of the
Universalist Church and of fraternal organizations, among them the Masons
(he was a member of Lodge No. 21, A. F. and A. M., of Rochester, a Knight
Templar, and holder of the Thirty-second Degree), the Independent Order
of Odd Fellows and the Ancient Order of United Workmen. He was medical
examiner for different organizations and at one time of candidates for the
United States Military Academy at West Point.
Dr. and Mrs. Allen had a long life together; on their fiftieth wedding anni-
versary, and on the fifty-sixth, they were honored by their many friends.
Their only child was Caison Monroe Allen, who for twenty-five years after
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HISTORY OF MEDICINE IN MINNESOTA
1900 was cashier of the First State Bank of Wykofif, Fillmore County. Caison
M. Allen was married on September 12, 1882, to Betty Cole, of Chatfield.
In later years Mrs. C. M. Allen was an able teacher of music in the public
schools of many southern Minnesota towns. She died at Wykofif on February
15, 1940; Caison M. Allen died in the Episcopal Church Home at Saint Paul
on June 22, 1942. Their son and only child was L. Dana Allen, long of
Winona and later of New York City, whose death occurred in Winona in
November, 1937; burial was at Rochester.
After the death of Mrs. W. A. Allen, the doctor’s friends chose his birth-
day on which to pay him their respects. On his one hundredth birthday, March 6,
1934, Rochester’s esteemed oldest citizen, then in a hospital because of
declining strength, eagerly received more than 500 callers. Some weeks
later, as he sat writing, he stooped to pick up a postage stamp, his chair
slipped, and he fell, suffering trauma and shock. His death resulted within a
few days.
Ole W. Anderson (1840-1920) was born on May 22, 1840, near Bergen,
Norway, and died in Rochester, Minnesota, on December 26, 1920, an accredited
member of the medical profession of Minnesota; Minnesota Medicine carried
a notice of his death. After the passage of the medical practice act of 1883 he
received an exemption certificate to practice in the state, on the basis of pro-
fessional knowledge and years of experience. His was an interesting as well
as useful life, and his contribution to medicine, although remembered now by
few, was of value in its day.
When Ole W. Anderson was about eight years old he came with his parents
to the United States. The family settled in the region of Viroqua, Wisconsin,
where they were farmers. In the sixties, a student of the natural sciences and a
chemist and pharmacist, Mr. Anderson came to southern Minnesota. For a year
or more he alternated between Olmsted County and Mower County and for a
time was a contributor to a Norwegian newspaper, founded by Mr. Ole Jorgens,
of Grand Meadow.
On July 3, 1865, Ole W. Anderson was married to Gunhild (this name later
was anglicized to Julia) Lindelien, of Mower County, near Grand Meadow.
Gunhild Lindelien was born in Bergen, Norway, on February 20, 1845, and
when a small child came with her parents to southern Minnesota. In Rochester
Mr. and Mrs. Anderson established their home on South Franklin Street, where
were born their four children, Lillian B., J. William, Albert Oliver and G. Adolph.
Life in the household, friends of the family recall, was one of a certain grace
and dignity tempered by humor. The mother possessed beauty, a lovely singing
voice and musical talent. Dr. Anderson was a tall, fine-looking man, slender
when young, heavy but not ponderous when old, who always wore a full beard.
A devoted reader of the Bible and the works of Pope, Milton, Byron, Shakespeare
and Ruskin, he could quote long passages from each. A member of Rochester’s
Scandinavian Literary Society, he was one, as was Dr, William Netter, in
Rochester in the early eighties, to give “Declamations,” and he is remembered as
a delightful raconteur of an endless fund of stories.
In May, 1867, O. W. Anderson, druggist and chemist, in a shop next to Head’s
Stationery Store, Rochester, called the attention of the city and the surrounding
country to his New Drug Store, which was stocked with drugs, medicines, chemi-
cals, pharmaceutical preparations, patent medicines, perfumeries, toilet goods,
surgical instruments and miscellany and with “pure wines and liquors for
medicinal purposes.” He was a prohibitionist, at one time active in the Prohibition-
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HISTORY OF MEDICINE IN MINNESOTA
ist Party, and was as much opposed to tobacco as to alcohol. In December, 1867,
he entered partnership with Dr. William W. Mayo, in Rochester since 1863,
who made the drugstore his headquarters and put up and dispensed his own
prescriptions. Although this alliance ended in the summer of 1869, the mutual
respect and esteem of the two men continued ; much later Dr. William J. Mayo,
then an elderly man, spoke of Dr. Anderson as a fine citizen.
By 1870, well established as a manufacturing chemist and apothecary, O. W.
Anderson was offering a long list of remedies of his own compounding, “the
Norwegian Family Medicines” : a few of the titles were, Hysteric Drops, Elixir
of Life, Blood and Liver Renovator, and Compound Syrup of Blackberry Root.
In the early years of the business he used a jobbing wagon, enclosed and bearing
the legend, “O. W. Anderson’s Medicines,” which made long trips of distribution.
In 1885 he fitted up the second story of La Due’s Block on Broadway for a new
and enlarged laboratory to supply the growing demand for his preparations.
Dr. Anderson made no pretension to clinical practice such as was carried on
by graduate physicians of Rochester. He was essentially a chemist and apothecary,
the latter in the early English meaning of the word, who prescribed and dispensed
specially compounded tinctures and ointments. A distinguished physician of
Rochester who from his youth knew the Anderson family intimately and had
knowledge of Dr. Anderson’s remedies, has said, “His medicines were of the
very best, gave absolute satisfaction, and if they were still manufactured, there
would still be a call for them.” A son, Dr. G. A. Anderson, in 1945 wrote in
regard to this opinion, “I believe that the statement which you quote is true . . .
My brother Will was greatly disturbed not to be able to supply the demand, which
continued to come long after my father’s passing, when the remedies were no
longer prepared. Regarding my father’s medical practice, it is my impression
that it was largely incidental to the distribution of the Norwegian Family Medi-
cines, which he originated and prepared. These remedies were designed to meet
the home requirements of the very large Norwegian population of Minnesota,
Iowa and the Dakotas, among whom they had become household necessities, and
they were sold through the wholesale houses of St. Paul and Minneapolis in great
quantities. These consumers often appealed for personal attention and this was,
in my opinion, the clientele which he served.”
Dr. Anderson survived his wife, who died on June 13, 1913. Of their children,
Lillian B. Anderson (1866-1914) was the wife of Dr. John Abraham Freeborn,
of Ortonville and later of Fergus Falls; Dr. and Mrs. Freeborn had three
daughters, all of whom were living in 1945: Gertrude Lillian (Mrs. Paul E.)
Francis, Frances Mary (Mrs. Howard J.) Vandersluis, and Constance Margaret
(Mrs. Elmer A.) Haugen. J. William Anderson (1868-1940), a respected and
substantial citizen of Rochester, first assisted his father in the laboratory, later
ran a printing office, and for twenty-five years was clerk of the municipal court;
he lived all his life in the home where he was born, and in 1950 his wife contin-
ues to make it her home. Mrs. J. W. Anderson before her marriage was Ver-
ona Boelter, a registered nurse, member of a Rochester family. Albert Oliver An-
derson (1873- ) studied music in Chicago, New York, Paris and Berlin and
in 1923 received the Fellowship degree of the American Guild of Organists. G.
Adolph Anderson (1877- ) on graduation from the Chicago College of Dental
Surgery in 1901 became assistant to Dr. E. A. Bogue of New York City, but soon
after entered private practice, specializing in the regulation of children’s teeth.
A landscape artist of merit, he began lessons with Mrs. Mary Catherine Livermore
of Rochester, studied at the Art Students’ League of New York and at the
Academie Julien and Collorossi in Paris; his paintings, exhibited in America and
March, 1950
271
HISTORY OF MEDICINE IN MINNESOTA
in Europe, drew the favorable attention of John LaFarge (1835-1910). He was
married in 1912 to Gertrude Gregory Pease, of Ridgewood, New Jersey, who died
in 1917. Since 1928 Dr. Anderson and A. O. Anderson have lived at Mt. Tremper,
in the Catskill Mountains, New York, where they conduct extensive work in
reforestation (1946).
Amos L. Baker (1852-1932), son of Gorham Baker and Harriet Stowers
Baker, was born near Sharon, Franklin County, Maine, on December 6, 1852.
His parents were farmers, there were several children, and money was scarce,
so that he earned his own way through school and college. After leaving the
district schools, he entered Western State Normal School at Farmington, Maine,
from which he was graduated in 1876, and in 1881 he finished the course of the
Maine Central Institute, at Pittsfield, a classical school whose graduates were
qualified to teach in high schools. For a year or two thereafter he taught in the
public schools of Maine before coming, about 1883. to Dover, Olmsted County,
Minnesota.
In Dover he served two years as superintendent of the village schools and at the
same time read medicine under the direction of Dr. A. W. Stinchfield, of Eyota,
a few miles west. The long summer vacations he spent in Dakota Territory,
at Onida, where he took up a claim, and at Blunt, where he worked at carpentry
to improve his finances. On Friday, June 12, 1885, the Dover schools, which had
been “under the able management of Professor A. F. Baker, assisted by Mrs.
Horace Witherstine,” closed for the year. They were “never in more flourishing
condition.” Mr. Baker was removing to Eyota to study intensively with Dr. Stinch-
field.
In the autumn of 1885 Amos L. Baker, more than ten years older than the
average medical student, entered Rush Medical College at Chicago ; he had sold
the relinquishment of his Dakota claim to help with his expenses. In February,
1887, he was graduated with the degree of doctor of medicine and immediately
afterward he left for Maine, where he was married to Lula E. Atwood, at
Winterport, near Monroe, Waldo County. Miss Atwood, a native of Monroe, had
been from 1882 to 1886 principal of the high school at Northfield, Minnesota;
she and her husband first met in their student days at Maine Central Institute.
Her brother Charles was a physician who practiced at Winterport until his death
in the early 1900’s; her sister Abbie was married to Dr. John Sewell, of Boston.
Dr. Baker began his initial medical practice at Plainview, Wabasha County,
on June 15, 1887, filing with the clerk of court at Wabasha his state certificate
No. 1448 (R), which had been issued five days earlier. During his residence in
Plainview he occasionally substituted for Dr. Stinchfield and Dr. Nathaniel S.
Lane, when those partners were at medical meetings. When Dr. Lane removed to
North St. Paul in December, 1887, Dr. Stinchfield invited Dr. Baker into partner-
ship.
For the next two years Dr. and Mrs. Baker were residents of Eyota. Cultured
and intellectual, they were representative of down-East manners and customs in
the finest tradition. In the vicinity of Dover and Eyota, where many pioneers
from New England had settled, they found a congenial atmosphere and there as
elsewhere they won and held the admiration and affectionate regard of all who
knew them. They furthered civic and educational interests and were supporters
of the Methodist Episcopal Church. The doctor was a member of the Masonic
Lodge and the Independent Order of Odd Fellows.
From Eyota Dr. Baker removed in April, 1890, to Pleasant Grove, where a
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HISTORY OF MEDICINE IN MINNESOTA
vacancy had existed since Dr. Alonzo W. Hill, the local physician from early days,
left for the West in the previous autumn. In Pleasant Grove the Baker home and
office were in the Russell House. In January, 1891, when a fire destroyed both
household and professional equipment and even currency, the doctor in battling
the flames incurred sciatica that disabled him for months. He was recovering and
had leased new quarters when one day a delegation of citizens from Byron, in
Kalmar Township, called to invite him to that village as resident physician. He
accepted, bought the practice of Dr. Frank M. Johnson, who was leaving Byron
for Dover, and by September 1, 1891, was established in the community that he
was to serve well for the next nine years. When the Southern Minnesota Medical
Association, of which he was a founder and sometime president, was holding its
annual meeting at Rochester in August, 1893, the current officers authorized
newspaper comment on “some of the leading members present” ; “Dr. A. L. Baker
of Byron is one of the best posted among the young men and is a rustler. He
has secured a large practice in Byron, and that community is to be congratulated
on having so good a man located in its midst.”
In September, 1900, after Dr. Charles O. Wright had left Kasson, Dodge
County, west of Byron, Dr. Baker with his wife and two daughters settled in that
village, which for thirty-two years was the family home and the center of Dr.
Baker’s exceptionally active and intensive practice.
Dr. Baker was the invaluable village and country doctor of the best and high-
est type, in sympathy with the needs of the people, who had absolute confidence
in him, and with the expanding function, scientific and humanitarian, of his pro-
fession. He served many terms as county physician in the different communities
of his residence. A keen diagnostician of sound judgment, he had the important
virtue that in a difficult case he never hesitated to call for professional consulta-
tion. He early became a constructive member of local county medical societies,
the Southern Minnesota Medical Association, as noted, and of the Minnesota
State Medical Society and the American Medical Association. By frequent clinical
trips and postgraduate courses, notably at the New York Polyclinic Medical
School and Hospital, and by additions to his library and therapeutic equipment he
kept in touch with and aided medical advance.
In 1926 Dr. Baker retired from practice because of failing health; he died at
Kasson on July 22, 1932, from cardiorenal disease, survived by Mrs. Baker and
the two daughters. Ethel Baker Odden, a graduate of Winona Teachers College,
is the wife of Knute Odden, a pharmacist, of Benson, Minnesota. Mr. and Mrs.
Odden have three sons : Richard, with the United States Army during World
War II ; Robert, an electrical engineer with Farnsworth, in Indiana ; and Lloyd,
in his third year (1945) with the United States Merchant Marine. Vera Baker
Tice, a graduate of Stout Institute, is married to Harvey A. Tice, native of Omro,
Wisconsin, machine shop teacher at Technical High School of St. Cloud. After
Dr. Baker’s death Mrs. Baker made her home with Mrs. Tice, for eight years at
Huron, South Dakota, and for one year at St. Cloud ; she died at St. Cloud on
January 26, 1941.
Nathan Morton Baker (1859-1928) was an assistant physician, the ninth
appointee, on the staff of the Second Minnesota Hospital for Insane, at
Rochester, Minnesota, from October, 1889, to May, 1893.
Born near St. Peter, Minnesota, in 1859, he received his preliminary education
in the public schools of Le Sueur County and in St. Peter, Nicollet County, and in
1884 was graduated from the University of Minnesota with the degree of
Bachelor of Arts. Subsequently he taught school and later was chemist at the
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273
HISTORY OF MEDICINE IN MINNESOTA
laboratories of the state board of health at Red Wing. Having decided on the
profession of medicine, he entered the medical department of the University of
Pennsylvania, from which he was graduated in the spring of 1889. On his return
to Minnesota he received, on July 6, 1889, as a- resident of Goodhue County,
license No. 65 (R) from the medical examining board of Minnesota; this certifi-
cate in due time he filed in Olmsted County.
During his years in Rochester Dr. Baker made annual trips of several weeks
each to New York and Philadelphia for special medical study, and he became a
member of the Olmsted County Medical Society and the Minnesota State Medical
Society. Social circles found him an asset because of his personal worth and
gracious ease and wit, and professional associates valued him in addition for his
skill, his equable temper and his ethical conduct.
In May, 1893, Dr. Baker left Rochester for St. Peter, where he was called to
serve as assistant superintendent of the Minnesota Hospital for Insane under
Dr. H. A. Tomlinson. There again his record was excellent. When he resigned
in May, 1895, to enter private practice in Spokane, Washington, the trustees of
the hospital paid formal tribute to him as a fine man and conscientious physician.
In Spokane, where he married, Dr. Baker for more than thirty years conducted
a general practice, with special interest in surgery. His offices for many years
were in the Old National Bank Building, later in the Fernwell Building, and still
later in the Paulsen Building. He was a member of the city board of health, of
the Spokane County Medical Society (once its president), of the state medical
organization and of the American Medical Association. His death occurred in
Spokane in 1928.
Ira C. Bardwell, born in Wayne County, New York, in February, 1812,
removed with his parents when he was seven years old to Livingston County,
New York, where he received his early education and where, as a young man, he
read medicine in the office of Dr. Champlain for a year and a half. He next
went to Steuben County, New York, and from there to Willoughby, Ohio, where
he studied and attended medical lectures two years. For the next few years, always
trending west, he practiced medicine at different places, and in the early fifties was
in Prophetstown, Illinois.
Early in 1856 Dr. Bardwell, a reputable physician and surgeon, arrived in
Rochester, Olmsted County, Minnesota, accompanied by his wife, Louisa Cutler
Bardwell, a native of Massachusetts, to whom he was married in 1837. Shortly
after his arrival Dr. Bardwell was appointed to a two-year term as the first clerk
of the district court for Olmsted County; he served at the first session of the
court on April 4, 1856.
In 1859 with his family he left Rochester' to settle in the prosperous village of
Pleasant Grove in Pleasant Grove Township. Here for twenty-nine years, until
the coming of Dr. Alonzo W. Hill, in 1878, he was the only active resident
physician; vague reference has been noted to a Dr. Chase and to “the good and
venerable Dr. Hunt” who were there in the sixties. Dr. Bardwell was esteemed
as citizen and physician and he served his community well. He was local health
officer; he was a Republican who faithfully attended county conventions; and a
Mason, member of the Pleasant Grove lodge. In August, 1871, when a picnic was
held on College Hill, in Rochester, for organization of the Olmsted County Old
Settlers’ Association, Dr. Bardwell was elected vice president for his section of
the county.
Little has appeared about the children of Dr. and Mrs. Bardwell. In November,
1870, a daughter, Ella C. Bardwell, was married at the home of her parents to
Minnesota Medicine
HISTORY OF MEDICINE IN MINNESOTA
J. C. Wagoner; in December, 1878, Ella Bardwell Wagoner was married to Adrien
Peck. In the History of Winona and Olmsted Counties, of 1883, Mrs. Peck was
mentioned as the only living child of Dr. and Mrs. Bardwell.
On April 6, 1883, the Rochester Post reported that Dr. Bardwell had sold his
residence and other property in Pleasant Grove to D. W. Tohnson. This sale no
doubt was in preparation for removal to Dakota Territory; on June 13, 1884, the
Rochester Record and Union noted the death in Sioux Falls of Mrs. Ira C. Bard-
well, formerly of Pleasant Grove. It is probable that Dr. Bardwell, seventy-one
years old in 1883, did not practice medicine in Dakota ; his name does not appear
in the roster of physicians who registered in Dakota Territory between June 5,
1885, and June 30, 1890.
For the sake of record : In certain old commercial directories Dr. Bardwell’s
initials appear in various inaccurate combinations, and in one work the name
was printed “Bredwell.”
Elbert E. Barnum (1851-1907) was for a few months a member of the
medical profession of Olmsted County. Born in 1851, a graduate of the medical
department of the University of Michigan in 1876, Dr. Barnum in August, 1884,
settled in Eyota, Olmsted County, where he had his office in his residence, the
“first door west of Walter Dixon’s.” Well qualified though he was, he stayed in
Eyota so short a time as to leave little impress on the community. In the official
directory of physicians of Minnesota for 1883-1890 Dr. Barnum was listed as
resident at St. Peter, Nicollet County, holder of state license No. 1293 (R), which
was issued on December 10, 1886. Prior to 1896 he was well established in Pine
City, Pine County; he died there from pneumonia in January, 1907.
Marshall Thomas Bascomb (1851-1899), who spent his boyhood in Oronoco,
Olmsted County, practiced medicine in Pleasant Grove from 1895 to 1899.
Newell Bascomb, father of Marshall Thomas Bascomb, was born on October 25,
1819, in Vermont, the son of Asa Bascomb and Abigail Palmer Bascomb, both of
whom were natives of Franklin County, Vermont. Asa Bascomb served the
United States on Lake Champlain in the War of 1812. Newell Bascomb in early
life went to Cleveland, Ohio, and there and in Mount Vernon, Ohio, followed
his trade of carpenter and joiner until 1855. In the autumn of that year he came
to Oronoco, Minnesota, where he established a home and sent for his family. He
had been married on March 12, 1843, to Mary A. Upton-Damon, daughter of
George and Mary Upton-Damon, of Fairfax, Vermont. There were' four children
of the marriage: Orwin Newell was born on October 20, 1844, and died on April
12, 1865, in a military hospital at Gallatin, Tennessee, from disease incurred in
line of duty in the United States Army during the Civil War. Edwin Gordon
Bascomb was born on September 1, 1846; he was married on February 13, 1878,
to Carrie Wheat, daughter of Dr. and Mrs. John N. Wheat of Austin; Dr. Wheat
in the early eighties practiced for a year or two in Rochester. Sarah M. Bascomb
was born on June 23, 1849, and was married on December 25, 1866, to Warren
Wirt of Oronoco Township, and years later to Mr. Goodell of Oronoco.
Marshall T. Bascomb was born on November 18, 1851, and was four years old
when, in a bitter December, Mrs. Bascomb with her young family made the
hazardous trip to Minnesota to join her husband. Traveling overland from Ohio
to Galena, Illinois, she caught the last steamer of the season to forge up the ice-
clogged Mississippi. At La Crosse the boat was frozen at the levee, and it was
two weeks before Mrs. Bascomb could get across the river on the last lap of her
journey, over hills and prairies. Many travelers perished on the trails during that
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275
HISTORY OF MEDICINE IN MINNESOTA
period, and Newell Bascomb had given his family up for lost when they at last
arrived at Oronoco. Only the fact that Mrs. Bascomb had brought many bed-
clothes, which served as wraps, had saved them. As it was, Sarah and Marshall
had frozen their feet.
Marshall T. Bascomb was a pupil in the schools of Oronoco and of Rochester
and in the early seventies took a course of medical study at the University of
Michigan. In 1875 he was married to Ella B. Cook, daughter of Mr. and Mrs.
Martin W. Cook, respected pioneer citizens of Rochester. Martin W. Cook was
a native of Canada ; his wife was Mary Benedict, from Connecticut. In Olmsted
County Mr. Cook was an inaugurator of dairying and fruit farming.
There is record that from 1877 to 1879 Dr. Bascomb practiced medicine in
Brownsdale and in Grand Meadow, Mower County, and that for a year or more in
1880 and 1881 he practiced at Eau Galle, Wisconsin. The Rochester Post of
October 28, 1881, reported that Dr. M. T. Bascomb had gone to Cleveland to
attend medical college. On March 14, 1882, he received the degree of doctor of
medicine at Western Reserve University and immediately afterward went to Clark,
Clark County, Dakota Territory; under the medical practice act of Dakota, in 1885,
he registered on July 9 of that year. While in Clark he was a member of the state
board of health, in 1893-1894, and county coroner, 1894.
In 1895 Dr. Bascomb returned to Olmsted County to be near relatives, settled
in Pleasant Grove, and opened a drugstore as an adjunct to the practice of
medicine. The village had lacked a physician since Dr. A. L. Baker left for Byron
in the summer of 1892, and Dr. Bascomb, able practitioner and upright citizen,
jolly, likeable and good-looking, with his wife and two sons was well received.
He had a general practice and at the same time devoted special attention to ortho-
pedics, a held in which he studied to improve his knowledge and skill. He was a
strong member of the Olmsted County Medical Society and the Southern Minne-
sota Medical Association. He served as local county physician during most of his
years in Pleasant Grove. He was active in fraternal organizations, among them the
Masonic Lodge, Knights of Pythias, Independent Order of Odd Fellows, the
Ancient Order of United Workmen and the Modern Woodmen of America.
Dr. Bascomb by reason of personal qualities and professional service was one
of Olmsted County’s best known and most respected physicians. Regrettably his
gradually failing health limited and shortened his career. He died in his forty-
eighth year, on January 28, 1899, a few days after undergoing an operation for
removal of gallstones, at St. Mary’s Hospital, Rochester. He was survived by his
wife, two sons, Fayette W. Bascomb and Marshall R. Bascomb, his mother, his
sister Sarah and his brother, Edward G. Bascomb, of Austin.
Some weeks after Dr. Bascomb’s death Dr. Simeon P. Meredith (q.v.), of
Spring Valley, Fillmore County, bought the practice and drugstore, and Mrs.
Bascomb removed to Rochester, and later to Minneapolis. She died in Hollywood,
California, on July 11, 1931. The elder son, Fayette W. Bascomb, became a
manufacturing chemist. The younger son, Marshall Royton Bascomb, in 1924
was graduated from the General Medical College of Illinois; in 1947 he was a
practicing physician and surgeon at Maywood, Illinois. He was married on July
6, 1923, to Hulda E. Johnson; Dr. and Mrs. Bascomb have one son, a manufactur-
ing chemist.
(To be Continued in the April issue)
276
Minnesota Medicine
President s better
WHY COMPROMISE?
NOW AND AGAIN some physician says, “The welfare trend is here. We
can’t stop it. Let’s just compromise and salvage what we can.”
That, in my opinion, is the worst type of defeatism. It does not demonstrate a
broad-minded tolerance for alternative viewpoints as, superficially, it would seem
to. No, it’s cowardly thinking, lazy thinking and it has not even the saving
grace of logic.
For there can be no compromise with facts.
Medicine has given the American people the highest standard of healthy living,
the greatest research discoveries in history, more than twenty additional years of
life expectancy and a freedom from disease and suffering never before and never
elsewhere experienced.
These are facts.
Medicine is threatened now with a curtailment of its freedom, a regimentation
into uniform mediocrity, through annexation by the government, that would not
only destroy a proud profession but would rob Americans of the advantages they
now possess and the great health-potential of the future.
These are facts.
The medical profession has, therefore, set out to tell these facts to the people
who should know them — the people who, in a democratic way, will decide the
issue. The education process is being financed by physicians who believe that
Americans are as much entitled to the facts about health as they are to health
itself. Every medium of communication is being taken into consideration, and no
effort is being spared in this highly important educational work.
As in the case of those who would compromise with the facts, there are those
in the profession who would compromise in the measures taken to ward off this
first approach to the welfare state. These are the physicians whose contributions
to the campaign are negative ones — who apparently think that their responsibility
in the informational project is limited to criticizing the methods of conducting it.
This compromise of inaction is as disastrous as out and out opposition.
Unfortunately, some of our members, who failed to assume the obligation of
an AMA assessment in 1949, have been guilty of a compromise of inaction that not
only detracts from the financial backing necessary for a program of this scope
and intensity, but weakens the spirit of unity and strength that should characterize
the message of the American Family Doctor to the American public he serves.
Let’s not be guilty here of further compromises with fact and action.
March, 1950
277
♦ Editorial ♦
Carl B. Drake, M.D., Editor ; George Earl, M.D., Henry L. Ulrich, M.D., Associate Editors
DOCTOR ROSSEN— COMMISSIONER
OF MENTAL HEALTH
Hr HE dinner held at the Coffman Memorial
Building at the University of Minnesota on
the evening of February 2, 1950, served to pub-
licise the assumption of duties of the first Com-
missioner of Mental Health of the State of Min-
nesota by Dr. Ralph Rossen. Appointed De-
cember 15, 1949, Dr. Rossen officially took charge
on February 1. The dinner was arranged by a
special committee, of which Dr. Ernest M. Ham-
mes of Saint Paul was chairman, and was at-
tended by some 950 individuals from all over the
state who are interested in the new mental health
program which has been' so ably sponsored by
Governor Youngdahl. The Governor, appropri-
ately and with his usual ability, presided at the
dinner and called upon a number of those active
in the state’s program who attested Dr. Rossen’s
qualifications and pledged him their support.
The care of the mentally ill has always been a
neglected field. Commonly a long drawn out ill-
ness, most families have been forced to rely on
state aid in the care of affected family members.
As a rule, the care provided has been custodial
only, and a hopeless attitude as to cure has been
evident. Today such a pessimistic view is not
justified, for a sizeable percentage of the mentally
ill recover and resume their places in society.
There has been a growing consciousness that
much too little was being done for the mentally
ill by our State. The survey of the mental sana-
toria by Mr. Ries, under the sponsorship of the
Minnesota Unitarian Committee, of which the
Reverend Arthur Forte was chairman, confirmed
the suspicion. Our Governor, with his Advisory
Council, backed the bill for increased appropria-
tions which passed the Senate without a dissenting
voice and was signed by the Governor on April
20, 1949. This provided for an increase of 15
million dollars in the appropriation over the last
biennium for expanding the care of the mentally
ill within the State. This includes the construc-
tion of new wings and buildings, modernizing the
present institutions, the employment of enough
personnel to man the institutions, a forty-hour
week for institutional employes, a psychiatric
training program to staff the hospitals, and a re-
search program. The bill provides, in addition to
the creation of a Commissioner of Mental Health,
the appointment of two psychiatrists, a chief
nurse, a chief psychiatric social worker, a chief
dietitian, a chief psychologist, a personnel mana-
ger, and a supervisor of maintenance work.
In the not so distant past, the State ap-
propriated but $1.50 a day for the over-all care
of its mental patients which now number 14,000
in the ten state hospitals. This has been increased
recently to $3.00 a day which is about half the
$5.85 a day cost at the Veterans Psychiatric Hos-
pital at St. Cloud. There is good reason to be-
lieve that with a sufficiently well-trained person-
nel, the turn-over of patients can be greatly in-
creased to the benefit of patients and taxpayers.
In entering this new mental health program,
Minnesota is taking its place among the states
that are pioneers in this enlightened outlook in
the care of the mentally ill. Other states will have
their eyes upon us.
The choice of Dr. Ralph Rossen seems to have
met unanimous approval. Born in Hibbing, Min-
nesota, he is a graduate of the University of Min-
nesota Medical School and has taken advanced
degrees in psychiatry and neurology. Assistant
superintendent at St. Peter in 1936 before serving
as a Lieutenant Commander in the Navy, he be-
came superintendent at the Hastings mental hos-
pital at the age of twenty-eight. He is said to
have done away with restraints at this hospital —
no mean accomplishment. He is also said to have
a personal acquaintance with all his patients. Our
best wishes go to Dr. Rossen in his new under-
taking. As he has stated, progress will of neces-
sity be slow.
NATIONAL HEALTH PROPOSALS
PHYSICIANS who attended the Democratic-
Farmer-Labor Conference on National Health
Proposals at the Radisson Hotel in Minneapolis
on Saturday, February 18, could not fail to be
impressed with the importance of the health is-
278
Minnesota Medicine
EDITORIAL
sues before the American people today. The meet-
ing was supposed to be in the nature of a work-
shop for the presentation of various subjects such
as the Truman Health Program, the Voluntary
and Cooperative Health Plans, the points of view
of the AMA and CIO, ending with a summary by
Senator Hubert H. Humphrey.
Much of the program constituted fair and in-
structive presentations of the various health sub-
jects. Dr. Elmer Hess, vice chairman of the
Council on Medical Sciences of the AMA, gave
an able presentation of the reasons members of the
medical profession favor voluntary insurance
plans to provide for the cost of medical care and
are opposed to compulsory government insurance.
Roy Reuther, one of the three Reuther brothers
of CIO fame and himself co-ordinator of political
action of the United Auto Workers, let it be
known in no uncertain terms that the members of
his labor unions want government-supplied medi-
cal care and intend to attain their objective. He
severely criticized the AMA for what he called
its horse-and-buggy day attitudes in public re-
lations. He claimed that the AMA had early op-
posed the principle of voluntary insurance plans
recommended in the report of the Committee on
the Cost of Medical Care which appeared in 1932;
that support was given to the Blue Cross and Blue
Shield plans only when the government threatened
to supply this type of hospital and health insur-
ance on a compulsory basis. He mentioned the
Group Health experience in Washington, the
5,000,000 rejected draftees as a proof of the de-
plorable lack of medical care in our country, the
necessity for compulsory $25.00 AMA dues be-
cause of the poor response of the membership on
a voluntary basis, the low overhead cost of gov-
ernment-operated insurance compared with pri-
vate insurance, and now the accusation of social-
ism and even communism when the proposal of
compulsory government medical care is made. All
of these statements merit more amplification than
is possible here. Suffice it to say that many in the
medical profession from the onset backed the
voluntary insurance principle to meet the high
cost of hospital care; that the medical profession
deserves the credit for the Blue Shield which was
advocated in certain quarters at least as far back
as 1932 ; that there was considerable question as to
the legality by the appropriation of government
funds for the establishment of Group Health in
Washington; that the number of rejections at the
March, 1950
time of the draft for World War II does not con-
stitute a deplorable condition of health amongst
the American youth which could be bettered by
compulsory government health insurance ; that the
$25.00 dues is to provide funds for informing the
public about the advantages of free enterprise and
is not a lobby fund (there is some truth to the
statement that the response to the voluntary as-
sessment of $25.00 in 1949 was not as great as it
should have been) ; that government operation of
any undertaking has always proven more expen-
sive than private management. The insistence that
compulsory government health insurance is not
socialism is so absurd that it smacks of the
psychology put forth in Mein Kampf. If a false-
hood is repeated often enough, a certain amount of
credence will result.
Our Senator Humphrey wound up the program
with a summary of the national health proposals.
His statement that the battle for national health
insurance has already been won received wide-
spread newspaper publicity. It was certainly a
startling statement, and we beg to suggest that
there may be room for some difference of opinion.
He, being a member of the Committee on Labor
and Public Welfare, should know whereof he
speaks when he states that the Senate has already
passed four of the seven points in Truman’s
Health Plan. According to Mr. Humphrey, all
that remains to be done is to select one of the five
health insurance bills now before the Senate.
The total cost to the Federal Government of the
Truman health proposals already passed by the
Senate will amount to an estimated $300,000,000
a year, for which Senator Humphrey believes
there will be more than due compensation by the
cutting down in sickness and the saving of lives.
It was unfortunate that Senator Humphrey
seemed so vindictive in his attitude toward the
AMA and the local profession.* The Senator had
*The Senator claimed that the AMA had insulted Senator
Murray of Montana by failing to answer his request for
assistance in drawing up the 1946 Wagner-Murray-Dingell Bill.
He also resented the statement which appeared in The Bulletin
of the Hennepin County Medical Society of September, 1949
that “Senator Hubert H. Humphrey, with his usual agility to
distort facts, stated that Reorganization Plan No. I was in line
with the recommendations offered by the Hoover Commission. ”
What happened was that the Task Force of the Hoover Com-
mission which had to do with the reorganization of the medical
activities of the Federal Government made a supplemental report
which appeared in March, 1949, recommending that these govern-
mental activities be established as a Health Department under a
physidan with the status of a Cabinet Officer instead of being
included with Social Security and the Department of Education
as a Welfare Department as provided in Reorganization Plan
No. I. It is stated that Air. Hoover gave his approval to Re-
organization Plan No. I at the time hearings were being held by
the Senate Committee. Thus the Hoover Commission made one
recommendation and Air. Hoover another. Therefore, a statement
that Air. Hoover recommended Reorganization Plan No. I would
not have told the whole story. The medical profession also blocked
the Reorganization Plan No. I which was backed by our Senator.
279
EDITORIAL
received many replies to the letters he had sent the
profession asking for an expression of their
opinion on health matters. So he must have known
that his activities in Washington in backing Presi-
dent Truman’s health plans have not met with
their approval. Possibly the result of the recent
poll of the Minneapolis Tribune has not been
called to his attention. Whereas, according to the
Tribune’s poll held in February, 1949, 56 per
cent favored a national health insurance and only
23 per cent were against it in September, 1949, in
answer to the question as to whether one would
like to see a health program similar to P>ritain’s
adopted in this country, only 29 per cent voted
yes and 53 per cent voted no. This is very evi-
dently a reversal in public opinion in Minnesota.
After all, our senators as well as representatives
in Washington are supposed to represent the ideas
and further the wishes of their constituents. They
are the servants of the people, not their rulers,
and are delegated to pass laws, according to the
wishes of their constituents. The Democratic
platform in the last national election did not in-
clude a plank for compulsory government health
insurance, and Senator Humphrey need not feel
in duty bound to support such legislation on that
score. We, the people, include a lot more than the
officials of certain labor unions, and there are
certain indications that we are beginning to arouse
ourselves to oppose the extension of socialism in
our country.
COURSE FOR NATIONAL GUARD AND
RESERVE OFFICERS
For the convenience of National Guard and Reserve
medical officers, the School of Aviation Medicine at Ran-
dolph Field, Texas, has divided its Aviation Medical
Examiner course into three phases of three weeks each.
It is anticipated that many National Guard and reserve
officers who have been unable to leave their civilian prac-
tice long enough to take the course can now do so by
taking it in installments of three weeks each. The
only requirement is that they complete the nine weeks
of special medical training over a period of four years.
However, this does not preclude a National Guard or
reserve officer from taking two phases of the course
or the entire course in one year if he wishes to do so.
The National Guard and reserve officers who take the
course by phase will be required to complete their two
weeks of flight indoctrination with the National Guard
or reserve unit to which they are or may be assigned.
On completion of the course they will be rated as Avia-
tion Medical Examiners and qualified to serve as such
with their respective National Guard and reserve units.
After a year of such duty in the field, and on proper
recommendation, they will be eligible to become flight
surgeons.
OUR SOCIAL SECURITY
Our legislative and administrative difficulties with the
Social Security Act have arisen largely from the fact
that the Act sets up two competing methods for tackling
dependency: social assistance and social insurance. The
latter is a cruel hoax. Workers are not buying insur-
ance; they are not paying premiums; they are paying an
ordinary income tax.f They do not have a contractual
agreement that for such and such a premium they will
be entitled to a certain annuity at age 65. The workers
of this country think they are paying for old-age an-
nuities which will become payable at age 65. In reality
they will not get anything unless they stop work, and
unless they have had a specified number of years in
covered employment. What they will get, if they get it,
is a small wage-loss retirement annuity which will come
to them as a gift from the Government, that is, from
other taxpayers. These facts should be explained to the
people so that we may have an end to all this talk about
“benefits as rights.”
The fact to be borne in mind is that millions of work-
ers are destined to be fooled. Even now they are being
cheated right and left, while the Government pockets the
taxes without either paying benefits or returning what
the individual has paid in. Thus a woman- may work for
8 or 9 years before marriage and may never again re-
turn to the labor market. At age 65, if her husband has
qualified under OASI, she will be insured by virtue of
her married status and will be entitled to the fractional
benefits accruing to her as wife or widow of an insured
worker. However, she would have been entitled to those
benefits even had she paid no taxes herself. She has
thus been cheated out of 8 or 9 years’ taxes for which
she receives nothing at all. In the aggregate, the Gov-
ernment “saves” large sums by the scheme. I leave it to
you to decide what name to apply to that sort of sharp
practice.
I wish to call to your attention still another form of
“saving” which Federal officials have in mind. There
are now 3.5 million persons 65 and over who are en-
titled to benefits. Of this number 1.5 million have not
applied for OASI benefits, presumably because they do
not know their rights or are still working. During the
next 50 years millions of workers will be cheated in this
way. They will pay taxes for years but never collect any-
thing. This is part of the Federal plan, not an accident.
The Council of Economic Advisers to the President, in
discussing this matter, states :
“The following table illustrates, for the next quarter
century, the probable growth of the total aged popula-
tion and of the numbers eligible for and receiving re-
tirement benefits under proposed legislation. The esti-
mates are based on our belief that many aged individuals
will not retire voluntarily in an economy with abundant
job opportunities. Accordingly, the number of individ-
uals receiving benefits is estimated to be well below the
number eligible under the insurance system.”* — American
Medicine and the Political Scene , February 2, 1950.
fSupreme Court of tlie United States, Helvering v. Davis,
Brief for petitioners, 910, p. 40, 1937.
*The Economic Report of the President, transmitted to the
Congress January 6, 1950, p. 121.
280
Minnesota Medicine
Medical Economics
Edited by the Committee on Medical Economics
of the
Minnesota State Medical Association
George Earl, M.D., Chairman
ORGANIZATIONS IN STATE OPPOSE
SOCIALIZED MEDICINE
Minnesota has 119 organizations on record
against compulsory health insurance, making it
eighth in the nation, according to a report issued
by Dr. Elmer L. Henderson, chairman of the
Campaign Co-ordinating Committee of the
AMA’s education campaign.
Much credit is given by Dr. Henderson to the
state medical associations for their efforts to get
state and local organizations to pass resolutions
against socialized medicine. Continued action of
the state medical association in making data avail-
able to the public, will assure an even better record
for 1950.
Organizations on record against compulsory
health insurance include 145 national, 480 state
and 2,136 local groups, a total of 2,761 organi-
zations, the report states. The first seven states
and their total resolutions are : Indiana, 385 ;
Illinois, 166; Pennsylvania, 160; Michigan, 152;
New York, 140; West Virginia, 131; Ohio, 125.
Dr. Henderson notes that facts have proven
the case against government medicine for these
organizations. He says :
“All organizations listed in this report have raised
their voices in formal protest against compulsory health
insurance.
“They have studied the facts behind this important
public issue, and by their action, have notified their na-
tional lawmakers that they are opposed to government
control of medicine or for any further destruction of
their basic American freedoms.
“This is the ‘grass roots’ voice of the American
people.
“Numerous organizations are taking a position
on a national issue for the first time — and doing
it in spite of charter restrictions or partisan politics or
precedent to the contrary. This is real proof of the
growing recognition that the principles underlying this
campaign are the same as those underlying democracy
itself.”
MEDICAL COSTS MORE EASILY PAID HERE
The cost of medical care, recurrent theme of
government-medicine addicts, is not so much a
problem to be answered in terms of dollars, but
in time it takes a worker to earn those dollars.
Economists point out that the important consider-
ation is not that an appendectomy costs $150, but
how long the patient has worked to earn $150! and
the relationship of that sum to the price of other
commodities.
The Standard Steel Spring company of Penn-
sylvania has released figures showing that, in the
United States, it takes an average of thirty-eight
and one-half hours of work to purchase a two-
pants wool suit. The report states that an Eng-
lishman would work 163 hours for that same suit
and a Russian, 506 hours. By the time the Rus-
sian earned enough to purchase one suit, the
American could have bought thirteen. In other
words, the American’s earning power is about
four times that of the Englishman and over ten
times that of the Russian.
“It is only natural, therefore, that Americans should
own more commodities because their purchasing power
is far greater. They are wealthier. In the United States
one out of every four people owns a car ; in socialist
England there is one car for every twenty-two ; in com-
munist Russia, one for 252. In the free United States
one of every three people owns a radio ; in England
there is one for five, and in' Russia one for forty-five.
Or take the telephone. In America there is one tele-
phone for every five people; in socialist England there
is one for every 155; in communist Russia there is one
for every 188.”
Americans, then, work fewer hours for the
necessities and luxuries of life. But even in a
democracy the cost of government is high (right
now, to pay obligations of past wars, the average
man must, each year, work eleven days ; for
defense and the cold war, twenty-four days ; other
federal expenses, twelve days ; state and local
taxes, fourteen days). And, if present “welfare”
March, 1950
281
MEDICAL ECONOMICS
plans now before Congress are passed, Mr. Amer-
ican citizen will contribute one-third of his work-
ing time to the government.
ANALYSIS SHOWS UNITED STATES
HEALTHIEST NATION
Despite figures showing that two other coun-
tries have a higher health index than the United
States, Representative Donald L. Jackson, Cali-
fornia, contends that American standards are
highest. He reasons that advanced methods of
statistical and medical research here make pos-
sible an analysis of national health that cannot be
matched for accuracy.
He noted that there are statistics which show
that other countries have a higher health index,
but, he said, these statistics “should be carefully
weighed to determine whether or not the published
mortality figures exclude the aboriginal or native
populations. The Maori tribes of New Zealand,
which country is one of only two nations in the
world with a better health index than the United
States, are not computed in arriving at mortality
and clinical data. In our own case, every seg-
ment of our population is considered in arriving
at national health figures.”
Research Advancing
Amplifying his thesis, Representative Jackson
added :
“In brief, American health standards are more ade-
quate and more comprehensive than those of any other
country in the world. When one looks for disease it
will be found, but no one should draw any hasty con-
clusions or make comparisons of our national health on
the basis of discovery and knowledge. We know of ill-
ness and disease here at home only because our efficient
clinical methods have brought the conditions to light.”
Citing another aspect of the national health
comparisons, he said, “Ours is the only country
in the world today which is expending vast sums
of money for research into the causes and cure
of those diseases which are the great killers of
our day.”
Our health standards will stay as high as they
are, and continue to improve as long as we can
keep our health insurance on a voluntary basis.
Mr. Jackson emphasized :
“If the government is to assist in insuring better health
to the American people, it is my opinion that the assist-
ance can be better rendered at the local levels of gov-
ernment than by building a new Pentagon Building in
\\ ashington, D. C. . . . I believe that American in-
genuity, proceeding on a voluntary and American basis,
can meet the need for completely adequate protection.”
SECURITY REPLACING FREEDOM AS GOAL
Many present-day Americans are trying to
avoid the personal responsibility of freedom, Dean
Russell of the Foundation for Economic Educa-
tion says in his new pamphlet “Wards of the
Government.” By voting for men who promise
to install a system of compulsory, government-
guaranteed “security,” they are voting for a par-
tial return to the old slave laws of Georgia that
guaranteed to all slaves “the right to food and
raiment, to kind attention when sick, to mainte-
nance in old age.” Mr. Russell notes that the
arguments used to foster the compulsory security
program today are very similar to those used to
defend slavery in Lincoln’s day. For example,
he says :
“. . . many of the slaveholders claimed that they
knew what was ‘best for the slaves.’ After all, hadn’t
the masters ‘rescued’ the slaves from a life of savagery?
The advocates of government-guaranteed ‘security’ also
claim that they know what is best for the people.
Many of them argue in this fashion : ‘After all,
haven’t the American people conclusively shown that
they are incapable of handling the responsibility for their
own welfare?’
“Many of the slaveholders sincerely believed that the
‘dumb, ignorant slaves’ would starve to death unless their
welfare was guaranteed by the masters. And the advo-
cates of compulsory ‘security’ frequently say: ‘Are you
in favor of letting the people starve?’”
The advocates of government insurance seem to
indicate that they believe all Americans are too
ignorant, or lazy, or worthless to be trusted with
their own responsibility of free choice in these
matters, and it is quite true that those already
receiving support from the state are led to expect,
and to demand, more and more support from the
state. Thus they become dependents.
The constitutions of former American slave
states usually specified that the masters must pro-
vide their slaves with adequate housing, food,
medical care and old age benefits. The Missis-
sippi constitution contained this sentence:
“The legislature shall have no power to pass laws
for the emancipation of slaves . . . (except) where
the slave shall have rendered the State some distin-
guished service;”
Apropos, Mr. Russell comments that the high-
est honor that Mississippi could offer a man for
282
Minnesota Medicine
MEDICAL ECONOMICS
distinguished service to his country was personal
responsibility for his own welfare.
“His reward was freedom to find his own job and to
have his own earnings, freedom to be responsible for his
own housing, freedom to arrange for his own medical
care, freedom to save for his own old age. In short,
his reward was the individual opportunities — and the
personal responsibilities — that have always distinguished
a free man from a dependent.
“What higher honor can any government offer?”
The Choice Is Ours
Mr. Russell gives this sound advice to those
still fortunate enough to have a choice between
freedom and government control :
“Before choosing, however, consider this : When one
chooses freedom, that is, personal responsibility, he
should understand that his decision will not meet with
popular approval. It is almost certain that he will be
called vile names when he tries to explain that com-
pulsory government ‘security’ — jobs, medicine, housing,
and all the rest — is bad in principle and in its total
effect ; it saps character and strength by encouraging
greed and weakness; it destroys the individual’s God-
given responsibility for self-help, respect, compassion
and charity ; in some degree, it automatically turns all
who accept it into wards of the government ; it will
eventually turn a proud and responsible people into
cringing dependence upon the whims of an all-powerful
state; it is the primrose path to serfdom.
“No, the choice is not an easy one. But then, the
choice of freedom never has been easy. It never will
be easy. Since this capacity for personal responsibility- —
freedom — is God’s most precious gift to mankind, it
requires the highest form of understanding and cour-
age.”
CONGRESS, BILLS AND TAXES
The 81st Congress is considering more bills
relating to the public health and welfare than any
United States Congress ever has, thereby empha-
sizing the omnipresent danger of not only compul-
sory medicine, but the entire gamut of govern-
ment controls on the individual that socialism
can bring.
During the first session there were 226 such
bills on the docket ; and, of this number, about
sixteen related to health insurance and about sixty
to social security. The 79th Congress had about
seventy-five bills, and the 80th Congress consid-
ered a few more than 200 similar bills.
Most of these “security” bills, if passed, natu-
rally would mean more taxes for the American
people. The cost of the compulsory health insur-
ance bill alone has been estimated often at 15
billion dollars per year.
But the individual, who already pays from 20
to 25 per cent of his wages in taxes to the gov-
ernment, should have even more cause for alarm
over this raft of new taxes pending in the form
of “security” bills. He may be interested to know
that the federal government is taking 74 per cent
of the total taxes collected and leaving only 26
per cent for state and local governments. Results :
crippling of local responsibilities and individual
freedom.
THE “ISM" MANIA
Nowadays when sociological planning is
couched largely in “ism” words, it is interesting
to consider a literal application of the theories
being propounded. The Colorado Department of
Agriculture makes its translation of theory by
means of a simple bovine ecjuation, thus :
Idealism: If you have two cows you milk them both,
use all the milk you need and have enough left for
everyone else.
Socialism: If you have two cows, you keep one and
give the other to your neighbor.
Communism: If you have two cows, you give both to
the Government ; then the Government gives you back
some jnilk.
Soft-Pink Communism: If you have two cows,
you’re a capitalist.
Imperialism: If you have two cows, you steal some-
body’s bull.
Capitalism: If you have two cows, you sell one cow
and buy a bull.
New Dealism: If you have two cows, the govern-
ment shoots one cow, you milk the other cow, then
throw part of the milk down the sink.
Anarchism : If you have two cows, your neighbor
shoots one and takes the other.
Nazism: If you have two cows, the government
shoots you and takes both cows.
Realism: If you have two cows, they’re both dry.
It is increasingly clear that screening the general
population for tuberculosis must be combined and co-
ordinated with other screening programs for other im-
portant pathological conditions — such as cardio-vascular
disease, cancer, syphilis, and diabetes — similarly charac-
terized by relatively long subclinical periods in which
detection may be life conserving or important to com-
munity protection. — James E. Perkins, M.D., Bull. Nat.
Tuberc. A., January, 1950.
March, 1950
283
Reports and Announcements ♦
♦
INTERNATIONAL AND FOURTH AMERICAN CON-
GRESS ON OBSTETRICS AND GYNECOLOGY
The International and Fourth American Congress on
Obstetrics and Gynecology will take place at the Statler
Hotel, Chicago, May 14 through 19. Mornings will be
devoted to addresses and discussions by well-known spe-
cialists from North America, South America and Europe.
Detailed information may be obtained from headquar-
ters of the Congress at 161 East Erie Street, Chicago 11,
Illinois.
AMERICAN ACADEMY OF NEUROLOGY
The American Academy of Neurology will hold its
first interim meeting in Cincinnati on April 14 and 15,
1950. The meeting this year is being held in conjunction
with the American Chapter of the International League
Against Epilepsy which is meeting on April 15 and 16.
On April 15 there will be a joint meeting between the
two societies and a large symposium on psychomotor
epilepsy.
AMERICAN ASSOCIATION OF INDUSTRIAL
PHYSICIANS AND SURGEONS
The American Association of Industrial Physicians
and Surgeons, with the allied groups comprising the
American Conference of Governmental Industrial Hy-
gienists, the American Industrial Hygiene Association,
the American Association of Industrial Dentists and the
American Association of Industrial Nurses, Inc., will
hold its thirty-fifth annual meeting in Hotel Sherman,
Chicago, from April 22 to 29.
The extension program consists of addresses, clinics,
and panel sessions covering a great variety of problems
encountered in industrial medicine. A number of indus-
tries in the Chicago area will arrange to have their
medical departments and plants open during the week to
those attending the conference.
AMERICAN CONGRESS OF PHYSICAL MEDICINE
The American Congress of Physical Medicine will hold
its twenty-eighth annual scientific and clinical session,
August 28, 29, 30, 31 and September 1, inclusive, at
the Hotel Statler, Boston, Massachusetts. Scientific and
clinical sessions will be given on the days of August
28, 29, 30, 31 and September 1. All sessions will be
open to members of the medical profession in good
standing with the American Medical Association. In
addition to the scientific sessions, the annual instruction
seminars will be held August 28, 29, 30 and 31. These
seminars will be offered in two groups. One set of ten
lectures will consist of basic subjects and attendance
will be limited to physicians. One set of ten lectures
will be more general in character and will be open to
physicians as well as to therapists, who are registered
with the American Registry of Physical Therapy Tech-
nicians or the American Occupational Therapy Associa-
tion. Full information may be obtained by writing to
the American Congress of Physical Medicine, 30 North
Michigan Avenue, Chicago 2, Illinois.
AMERICAN BOARD OF OPHTHALMOLOGY
Candidates for the certificate of the American Board
of Ophthalmology are accepted for examination on the
evidence of a written qualifying test, held annually in
various parts of the United States. Applications are now
being accepted for the 1951 written test, and they will be
considered in order of receipt until the quota is filled.
Practical examinations for acceptable candidates of
1950 will be held in Boston on May 22 to 26, in Chicago
on October 2 to 6, and on the West Coast in January,
1951.
A new directory of all diplomates to date, arranged
alphabetically and geographically, will be published early
in 1950. No biographical material will be included.
Diplomates are urged to keep the Board office informed
of all changes of address.
AMERICAN PHYSICIANS ART ASSOCIATION
The American Physicians Art Association will have
its twelfth art exhibition in conjunction with the Ameri-
can Medical Association Convention at San Francisco
Auditorium, June 26 to 30.
Any physician who follows the hobby of fine or ap-
plied arts can exhibit at this convention by becoming a
member of the A.P.A.A. and applying for entry blanks
and shipping labels of the secretary, F. H. Redewill,
M.D., 526 Flood Bldg., San Francisco 2, Calif.
Over one hundred trophies will be awarded to ad-
vanced physician artists (A) as well as to beginners
(B — who have done art work less than two years), the
main purpose of the Association being to encourage all
physicians to take up art in some form as an avocation.
Those physicians who have never done any painting,
photography, sculpture, wood or metal craft, et cetera,
can, without obligation, learn how to become creditable
amateurs by writing to the secretary.
The American Physicians Art Association with its
4,000 members is recognized as having the finest amateur
art shows in the world during the A.M.A. conventions,
and the Association is desirous of having every physi-
cian who does art work to participate.
AMERICAN COLLEGE OF CHEST PHYSICIANS
The First International Congress on Diseases of the
Chest will be held at the Carlo Forlanini Institute, Rome,
Italy, September 17 to 20, under the auspices of the
Council on International Affairs of the American Col-
lege of Chest Physicians and the Carlo Forlanini Insti-
tute, with the patronage of the High Commissioner of
Hygiene and Health, Italy, in collaboration with the
National Institute of Health and the Italian Federation
Against Tuberculosis.
Physicians who are interested in attending the Con-
gress should communicate at once with Dr. Chevalier
L. Jackson, chairman of the Council on International
Affairs, American College of Chest Physicians, 500
(Continued on Page 286)
284
Minnesota Medicine
The nausea, vomiting and dizziness of motion sickness may
be prevented or relieved, in a high percentage of cases,
with Dramamine* (brand of dimenhydrinate).
DRAMAMINE for the Prevention and
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VIarch, 1950
285
REPORTS AND ANNOUNCEMENTS
AMERICAN COLLEGE OF CHEST PHYSICIANS
(Continued from Page 284)
North Dearborn Street, Chicago 10, Illinois, U. S. A., or
with Professor A. Omodei Zorini, Carlo Forlanini Insti-
tute, Rome, Italy.
NATIONAL GASTROENTEROLOGICAL ASSOCIATION
1950 AWARD CONTEST
The National Gastroenterological Association again
takes pleasure in announcing its Annual Cash Prize
Award Contest for 1950. One hundred dollars and a
certificate of merit will be given for the best unpublished
contribution on gastroenterology or allied subjects. Cer-
tificates will also be awarded those physicians whose con-
tributions are deemed worthy.
Contestants residing in the United States must be
members of the American Medical Association. Those
residing in foreign countries must be members of a simi-
lar organization in their own country. The winning con-
tribution will be selected by a board of impartial judges
and the award is to be made at the Annual Convention
Banquet of the National Gastroenterological Association
in October of 1950.
Certificates awarded to other physicians will be mailed
to them. The decision of the judges will be final. The
Association reserves the exclusive right of publishing
the winning contribution, and those receiving certificates
of .merit, in its official publication, The Review of Gas-
troenterology.
All entries for the 1950 prize should be limited to
5,000 words, be typewritten in English, prepared in manu-
script form, submitted in five copies acco.mpanied by an
entry letter, and must be received not later than June 1.
Entries should be addressed to the National Gastroen-
terological Association, 1819 Broadway, New York 23,
N. Y.
CONTINUATION COURSES
Dermatology. — The University of Minnesota announces
a continuation course in dermatology for doctors of med-
icine who are engaged in general practice. Throughout
the course, emphasis will be placed on the diagnosis and
management of common skin disorders. Presentations
which will be of special interest include the psychoso-
matic aspects of skin disorders and a clinic on derma-
tological problems to be presented in University Hospi-
tals.
A special feature at the close of the course will be a
conference on diagnostic problems which will challenge
the diagnostic ability of the registered physicians. The
faculty for the course will be made up of clinical and
full-time members of the staff of the University of Min-
nesota Medical School and Mayo Foundation.
This course will be presented at the Center for Con-
tinuation Study on March 27 to 29.
Gynecology. — The University of Minnesota announces
a continuation course in gynecology for doctors of medi-
cine engaged in private practice. The course will be
presented at the Center for Continuation Study on April
17 to 19. Among the subjects to be considered are uter-
ine bleeding, inflammation of the cervix uteri, urinary
incontinence, and lesions of the vulva.
Cardiovascular Disease. — The Center for Continuation
Study announces a continuation course in cardiovascular
diseases for general physicians on April 20 to 22. The
course is sponsored by the Minnesota Heart Association,
the Minnesota State Medical Association, and the Minne-
sota Department of Health. A limited number of Min-
nesota physicians will attend as guests of the Minnesota
Department of Health. It is hoped that this course will
accommodate the large number of physicians who could
not be accepted for a similar course which was given in
January.
Otolaryngology. — The University of Minnesota an-
nounces the seventh biennial continuation course in
otolaryngology, to be held June 26 to 30. This course
is designed to bring to the practicing otolaryngologist
the newer concepts and developments in the specialty.
The course will be under the direction of Dr. Lawrence
R. Boies and associates of the University Medical School.
Dr. Fred A. Figi, Dr. Henry L. Williams and others of
the Graduate School faculty will participate in the in-
struction. Guest lecturers will include Dr. Percy Ireland,
Toronto; Dr. LeRoy Schall, Boston; Dr. Philip Meltzer,
Boston; and Dr. John Shea, Memphis.
The fee for this course is $50. The enrollment is ■
limited. Application should be made at an early date
to the Director, Center for Continuation Study, Univer-
sity of Minnesota, Minneapolis 14, Minnesota.
BLUE EARTH VALLEY SOCIETY
Approximately thirty-five physicians from Faribault
and Martin Counties attended a meeting of the Blue
Earth Valley Medical Society in Fairmont on January
12. The principal feature of the program was a discus- ;
sion of bone surgery by Dr. Maynard Nelson, Dr. Dan-
iel Moos and Dr. Earl C. Henrikson, all of Minneapolis.
MCLEOD COUNTY SOCIETY
Election of officers highlighted the monthly meeting
of the McLeod County Medical Society in Hutchinson
on January 19. Dr. Arthur Neumaier, Glencoe, was
elected president of the organization, and Dr. L. L. .
Kallestad, Brownton, was named secretary-treasurer.
WASHINGTON COUNTY SOCIETY
The regular monthly meeting of the Washington
County Medical Society was held February 4. Forms
submitted by the Washington County Welfare Board
were discussed, and it was decided to communicate with
the state medical association and other county societies
regarding them.
Dr. Manley F. Juergens was elected to membership
on transfer from the Red River Valley Medical Society.
He formerly practiced at Thief River Falls.
A technicolor motion picture on pentothal sodium in
obstetrics was presented at the meeting and met with
enthusiastic approval.
286
Minnesota Medicine
rftmotuiciHa . . .
The First
NEUROLOGIC CENTER FOR CIVILIANS
in the Northwest
Governor Luther Youngdahl formally opened and dedicated our
neurologic center and opened the doors to the public on February
12, 1950, thereby offering the following new services:
1 ) treatment of the hemiplegic patient
2) multiple sclerosis
3) retraining of speech disorders
4) paraplegia and other paralyses
5) ataxias
Qualified neurologists and neurosurgeons staff this center. The staff
also includes qualified personnel who have been trained in special
therapy, occupational therapy, corrective therapy and physical
therapy.
GIENWOOD HUES HOSPITAIS
3501 GOLDEN VALLEY ROAD MINNEAPOLIS 22, MINNESOTA
Offering a High Standard of Facilities for 25 Years
March, 1950
287
Woman’s Auxiliary
PUBLIC RELATIONS WOMAN
LAUDS AUXILIARY WORK
More than half Of the women in the Auxilary to the
American Medical Association crusade actively on be-
half of the National Education Campaign, according to
Mrs. Paul C. Craig, Reading, Pennsylvania, National
Auxiliary public relations chairman. Mrs. Craig spoke
at the second annual conference of the National Edu-
cation campaign of the American Medical Association
in Chicago on February 12.
Mrs. Craig pointed out that the Auxiliary in no
sense wants to go out doing things on its own, but
wants to co-operate with the medical society of which
it is an active part. “The Auxiliary appreciates recog-
nition and the accompanying responsibility,” she said.
The Auxiliary is now twenty-eight years old and has
approximately 50,000 members, Mrs. Craig continued,
pledging the women in the organization to continued
furthering of the educational campaign of the AMA.
Mrs. Craig, wife of a Reading, Pennsylvania, ophthal-
mologist, has been associated with the national and the
Pennsylvania auxiliary for many years. She became
vice president of the Pennsylvania auxiliary in 1946 and
then served as president during 1948-49. She is a mem-
ber of the American Dietitic association and the Daugh-
ters of the American Revolution.
Liaison Officer Named
Following Mrs. Craig’s talk, it was announced that
Dr. Ernest B. Howard, assistant secretary of the AMA,
had been named liasion man between the Auxiliary
and the Board of Trustees. The announcement was
made by Dr. Elmer L. Henderson, president-elect of
the AMA and chairman of the Campaign Co-ordinating
Committee.
NEW CAMPAIGN MATERIALS NOW AVAILABLE
Continuing efforts in the campaign against compul-
sory health insurance, which the Auxiliary has actively
aided, will be bolstered by the availability of several
new pamphlets and the revision of two standard ones.
The new ones include two by Harold E. Stassen,
president of Pennsylvania university, entitled “Never !
Never! Never!” and “Granny Is Gone!”
The first pamphlet in the serie , based on S'assen’s
study of the British national health scheme, take; its
dramatic title from one doctor's simple warning: “Please
tell our friends in America never, never, never adopt
such a program !”
The second is the story of Granny, a sixty-two-year-
old woman who couldn’t get a hospital bed and subse-
quently died of pneumonia. Stassen offers this case as a
sample of what is happening in Britain today. He con-
cludes : “. . . apprehension was later revealed by a
London doctor. He told me emphatically : ‘1 believe
this system is in to stay. I therefore have nothing what-
ever to say for it or agaihst it.’ ”
“He was afraid to speak out. But the story of
Granny and thousands of her countrymen — and the facts
of the operation of the system — speak clearly for him.”
Another new pamphlet, entitled “Nationalized Medi-
cine and the Welfare State,” connects compulsory health
insurance with socialism, by pointing out that socialism
is approached by way of the welfare state “in which
the early emphasis is on measures for increasing physical
comfort including provision for medical care.” It warns
that Americans are on the way and should rise to defend
individual democracy : “When the American citizen learns
that the regimentation of war, to which he willingly
acquiesced as a patriotic duty, is to be renewed and ex-
tended in peace-time by a compulsory tax to pay for
something he does not want, he will assert his own
right to choose his doctor and his medical service.”
Also available is a reprinted address, “Socialized
Medicine,” given by Louis H. Bauer, chairman of the
Board of Trustees of the AMA, which gives a down-
to-earth analysis of the compulsory health insurance
situation and what it would mean. Through definition
and explanation, Dr. Bauer compares the British system
with the proposed compulsory health insurance bill and
concludes that it is necessary to get back to the philoso-
phy of Lincoln in his famous remark, “government of
the people, by the people, for the people.”
“The Doctor Brushed Off Utopia” by Henry La Cos-
sitt, tells the story of a British doctor who argues the
case against socialized medicine. Disgusted with red
tape and the impossibility of giving good medical care
to his forty to fifty patients a day, he left England, to
practice medicine in America. It is the first-hand story
of a doctor swamped by too many patients and too many
forms.
A new pamphlet for distribution by druggists, called
“Profit or Freedom?” emphasizes the druggists’ part in
the fight for the voluntary way of obtaining health
insurance.
The twelve-point program for the advancement of
medicine and public health, developed by the AMA, is
also available in pamphlet form. It gives a statement
and explanation of each point, together with supporting
statistics.
Revision means improvement in two pamphlets of
standard use. The first, “The Voluntary Way is the
American Way,” has a new cover and is revamped to
let appearance aid in the fight. It answers forty ques-
tions, instead of the previous fifty, on “health insurance —
compulsory or voluntary.” The second, “The Doctor,”
changes somewhat in content, making better and more
convincing use of facts and figures.
/' ny of the:e publications may be obtained by writing
to the office of the Minnesota State Medical Associa-
tion.
(Continued on Page 290)
288
Minnesota Medicine
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289
WOMAN’S AUXILIARY
(Continued from Page 288)
ANNUAL MEETING COMMITTEE HEADS NAMED
Mrs. S. N. Litman
St. Louis County Medical Society
Mrs. Anthony J. Bianco and Mrs. Kenneth W. Teich
were appointed by Mrs. John K. Butler, president of
the Women’s Auxiliary to St. Louis County Medical
Society, as chairman and co-chairman for the Minne-
sota State Auxiliary annual meeting. The meeting will
be in Duluth on June 12, 13 and 14.
Dr. F. J. Elias, president of the Minnesota State
Medical Association, addressed the St. Louis County
Medical Society auxiliary at the second session of the
study class held February 14.
P4
eddron
AUXILIARY HELPS HOSPITAL WORK
Mrs. Byron B. Cochrane
Goodhue County Medical Society
N. P. BENSON OPTICAL CO.
Laboratories in Minneapolis
and
Principal Cities of Upper Midwest
Members of the Auxiliary to the Goodhue County
Medical Society have been helping to refurnish a room
for pediatric cases in a local hospital. Members donated
toys and have made stuffed toys at monthly meetings.
Future plans include supplying children’s furniture for
the room.
Another new project was a plan to visit older pa-
tients in the hospital. Each member was made re-
sponsible for one old person and plans to visit him on
his birthday and provide refreshments.
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290
Minnesota Medicine
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When the patient can’t eat protein foods, you can rebuild and
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The source of Aminosol, animal blood fibrin, is one of the highest
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Clinical usage has shown Aminosol may safely serve as the
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(1000 cc. daily).
Stable for two years or more, Aminosol is sterilized by
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and 1000-cc. containers. A sure way to preserve the safety of
Aminosol in venoclysis is to employ sterile, disposable Venopak*
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dARCH, 1950
291
In Memoriam
CHARLES WILLIAM CUTLER
Dr. Charles W. Cutler of Park Rapids, Minnesota,
died on November 3, 1949, at the age of ninety-one, fol-
lowing fracture of the hip. Dr. Cutler was a graduate
of Rush Medical College of the class of 1880. He
served as county commissioner and village health offi-
cer and was a director of the State Bank of Park
Rapids.
JOHN ESSER
Dr. John Esser of Perham, Minnesota, died January
26, 1950, at the age of sixty-six.
Dr. Esser was born in St. Cloud, Wisconsin, June 10,
1883. He graduated from the high school in Austin,
Minnesota, in 1902 and from the medical school of the
University of Minnesota in 1908. His internship was
served at Bethesda Hospital, Saint Paul.
He was most active in local affairs, having been mayor
of Perham for four years, president of the Chamber
of Commerce in 1925, a member of the State Board of
Health, chairman of the Board of Health at Perham
and on the county Board of Health for six years.
Dr. Esser was a member of the Park Region District
and County Medical Society, the Minnesota State Medi-
cal Association and American Medical Association.
In 1909, Dr. Esser married Lucy Belle Wallace. Mrs.
Esser and an adopted son, John, survive him. His
brother, Dr. J. C. Esser of Seattle, and sister, Mrs. Lina
Johnson of Blooming Prairie, also survive him.
JOHN CHARNLEY McKINLEY
Dr. J. C. McKinley, formerly professor of neuro-
psychiatry and head of the Department of Medicine at
the University of Minnesota Medical School, died follow-
ing an illness of four and one-half years, on January 3,
1950.
Dr. McKinley was born in Duluth, Minnesota, on
November 8, 1891. His primary schooling was obtained
in Duluth public schools, following which he attended
Central High School in Duluth, West High School in
Minneapolis and the Horace Mann High School in
New York City.
He attended the University of Minnesota where he
obtained his B.S. degree in 1915, and later M.A. in
Anatomy, his thesis subject being “Myology of the
Newborn Infant.” He received his M.D. degree at the
University of Minnesota in 1919 and Ph.D. in Neuro-
psychiatry in 1921, his thesis subject being “The Tntra-
neural Plexus of Fasciculi and Fibers in the Sciatic
Nerve.”
Dr. McKinley held the following appointments at the
University of Minnesota during his academic career:
Student Assistant in Anatomy — 1915-1917
Instructor in Pathology — 1917-1918
Teaching Fellow in Neuropsychiatry — 1918-1921
Associate Professor of Neuropathology — 1921-1925
Associate Professor of Neurology — 1925-1929
Professor of Neuropsychiatry — 1925-1945
Acting Head of the entire Department of Medicine — j
1932-1943
Head of the Department of Neuropsychiatry and Di-
rector of the Psychopathic Unit at the University of
Minnesota Hospitals — 1943-1945
Professor Emeritus of Psychiatry and Neurology at
the University of Minnesota — 1946 until the time of
his death.
In 1928 Dr. McKinley received a John Simon Guggen-
heim Fellowship and studied in Europe at Breslau and
Munich.
Dr. McKinley held many very important positions in
organizations in his special field. He was a member of
the Board of Directors of the American Board of
Psychiatry and Neurology from 1941-1945. He was
chairman of the Committee on Nervous and Mental
Diseases of the Minnesota State Medical Association
from 1943-1945. He was president of the Minnesota
Pathological Society from 1946 to 1947, and president
of the Central Neuropsychiatric Association in 1939.
Dr. McKinley was a member of many societies, among
which were the Minnesota Society of Psychiatry and
Neurology, the Minnesota Academy of Medicine, the
Central Clinical Research Club, the Central Neuro-
psychiatric Association, and the American Neurological
Association. He was also a Fellow of the American
Association for the Advancement of Science, the Hen-
nepin County Medical Society, the Minnesota State Medi-
cal Association and the American Medical Association.
He was a member of a number of honor societies,
including Alpha Omega Alpha and Sigma Xi.
Dr. McKinley, during his career, published a large
number of scientific articles. He was editor of the
Outlines of Neuropsychiatry and co-author with Dr.
S. R. Hathaway of the Minnesota Multiphasic Person-
ality Inventory. He was listed in Who’s Who in
America, Who’s Who in American Men of Science,
Who’s Important in Medicine, Biographical Encyclo-
pedia of the World, Who’s Who in American Educa-
tion, and Who’s Who in Minnesota.
CHARLES LEROY RODGERS
Dr. Charles L. Rodgers, for the past seven years
medical officer at the Minnesota Soldiers’ Home, Min-
neapolis, died on December 15, 1949, at the age of
sixty-seven.
Dr. Rodgers was born February 15, 1882, at Farming- J
ton, Minnesota. He graduated from the University of
Minnesota medical school in 1907. He is survived by
his wife, Frances; two brothers, Walter S. and James,
both of Minneapolis, and a sister, Nancy, also living in
Minneapolis.
292
Minnesota Medicine
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March, 1950
293
♦
Of General Interest
♦
Dr. Paul R. Hawley h as resigned his position as
chief executive officer of the Blue Cross and Blue
Shield Commissions to become the director of the
American College of Surgeons. The change became
effective on March 1 Dr. Hawley is retaining the
presidency of the Blue Cross’s Health Service, Inc.,
which was charted in Illinois in November as a na-
tional insurance company designed to offer uniform
benefits to employes of large industrial organizations
operating in the areas of several of the Blue Cross
plans.
jfc * jjc
Dr. Stanley W. Olson, assistant director of the
Mayo Foundation at Rochester, has been named dean
of the College of Medicine at the University of Illi-
nois.
* * *
At a meeting of the American College of Aller-
gists in St. Louis on January 15 to 18, Dr. Albert V.
Stoesser, Minneapolis, was elected to the newly
created position of assistant secretary-treasurer. He
was also appointed chairman of the Program Com-
mittee for the next meeting of the College, which
will be held in Chicago in February, 1951.
* * *
Dr. Edward B. Kinports, International Falls,
showed slides on thoracic surgery at a meeting of
the Border Registered Nurses Club in International
Falls on January 23.
* * *
On January 25, Dr. Albert C. Martin officially be-
gan medical practice in Luverne when he opened
offices in the Pengra Building. A graduate of the
University of Illinois College of Medicine, Dr. Mar-
tin has been engaged in private practice near Chicago
for the past three years.
* * *
Representative Martin of Massachusetts recently
submitted figures to the House Ways and Means
Committee showing that in 1946 grants-in-aid to the
states amounted to $645,000,000. This was quite a
sizeable sum. In 1948, however, it was $1,418,000,000.
This was also quite a sizeable sum. We haven’t as
yet the figures for 1949. Included in the total were:
$39,252,000 for public health, $21,409,000 for maternal
and child health and welfare, $573,304,000 for old
age assistance, $141,738,000 for aid to dependent chil-
dren, and $16,947,000 for aid to the blind. We paid
this enormous amount in taxes, paid U. S. govern-
ment employes to collect and pay it back to the
different states to supplement funds raised by volun-
tary subscription and state taxes. Let it be clearly
understood — there is nothing free about these grants-
in-aid.
* * *
Dr. C. L. Sherman, Luverne, has been appointed
coroner and county health officer of Rock County.
He succeeds Dr. J. S. Burleigh, who resigned to
join the staff of the Minneapolis Veterans Hospital.
* * *
Announcement has been made of the engagement
of Miss Olive Constance Hurlock of Oakland, Cali-
fornia, to Dr. Harry Ogden, son of Dr. and Mrs.
Warner Ogden of Saint Paul. Both are stationed at
the U. S. Naval Hospital at Bremerton, Washington.
The wedding is planned for early April in San Fran-
cisco.
* * *
Dr. Vincent Ryding, who has practiced at Howard
Lake for the past four years, has accepted a surgical
residency at the Methodist Hospital, Dallas, Texas.
The hospital is affiliated with the Southwest Medical
University at Dallas. Dr. Ryding will begin his new
duties on July 1.
* * *
Dr. J. T. Holcomb of Marine-on-St. Croix has been
spending the winter in Phoenix, Arizona.
* * *
The Minnesota branch of the American Medical
Women’s Association held a dinner meeting at the
Colony Restaurant, Minneapolis, on January 28. Fol-
lowing a business session, Dr. Nora Winther showed
motion pictures of her European trip. Eighteen
members were in attendance, all from the Twin Cit-
ies.
* * *
Announcement has been made of the existence of
vacancies for full-time physicians in the Veterans
Administration Regional Office in San Antonio, Tex-
as. The announcement was made by Dr. A. S. Brus-
sell, a graduate of the University of Minnesota in
1933, now chief medical officer of the San Antonio
VA office.
Salary range for these positions is $6,400 to $11 000
a year, with liberal annual and sick leave and retire-
ment privileges. Qualified candidates for the posi-
tions can apply to Dr. Brussell at the regional of-
fice, 307 Dyer Avenue, San Antonio, Texas.
* * *
Dr. Lloyd Nelson, Minneapolis, spoke on the sub-
ject of respiratory allergy in children at a meeting
of the Stearns-Benton County Medical Society in
St. Cloud on February 16. Dr. Nelson is associated
in practice with Dr. Albert V. Stoesser.
* * *
Northfield acquired a new physician when Dr. J.
Richard Utne moved there on February 1 to become
associated in practice with Dr. S. T. Kucera. A
graduate of the University of Illinois College of
Medicine in 1948, Dr. Utne served his internship at
Minneapolis General Hospital. He recently com-
pleted seven months of practice in Minneapolis.
(Continued cm Page 296)
294
Minnesota Medicine
Not just milk replacement but casein replacement. . .
Casein -and also lactalbumin —are frequently the cause of hypersen-
sitiveness to cow’s milk. This hypersensitiveness can be manifested
by gastrointestinal upsets followed in time by eczema of a mild
or acute nature. In such cases cow’s milk of all types must be
eliminated from the diet. Mull-Soy is the near equivalent for milk
to be used in these cases.
Mull-Soy diluted with equal volume of water
A scientifically sound formula for avoidance
of casein allergy
Stable— vacuum packed
High in unsaturated fatty acids essential
for growth
Pleasant-tasting
A homogenized liquid, not a powder
or a hydrolysate
For hypoallergenic diet in infants
or adults look to
MULL-SOY
The Borden Company,
Prescription Products Division
350 Madison Avenue, New York 17
MgJ
At drugstores in !5'/2 oz. tins.
ft. oz. 20
Proteffj 3.1%
Fat 4.0%
Average whole cow’s milk
Carbohydrate 4.5%
Total Minerals i,q%
Water ' 87.2%
J
March, 1950
295
OF GENERAL INTEREST
( Continued from Page 294)
“Socialized Medicine” was the title of a talk given
by Dr. Martin O. Wallace, Duluth, at a meeting of
Duluth Scottish Rite groups on February 9.
* * *
Approximately 1,200 New Ulm school children, as
well as some from surrounding rural schools, re-
ceived inoculations against diphtheria and tetanus at
special clinics on January 25. The clinics, which
were conducted through the co-operation of all New
Ulm physicians, were under the direction of Dr. C. A.
Saffert, city health officer.
* * *
Dr. Paul Nyberg, formerly of Latvia and now
on the staff of Bethesda Hospital, Saint Paul, was the
principal speaker at a meeting of the Auxiliary to
the Ramsey County Medical Society in Saint Paul
on January 23. The title of his talk was “Practic-
ing Medicine Under Nazi Regime.”
* * *
After two years of practice in Detroit Lakes, Dr.
Gerald E. Bourget 1 eft on February 1 to open offices
for the practice of medicine in Hudson, Wisconsin.
In Detroit Lakes he was associated with Dr. L. H.
Rutledge.
* * *
Dr. D. P. Bernard has announced the opening of
offices for the practice of medicine at 3400 Dakota
Avenue, St. Louis Park (Minneapolis suburb). A
graduate of Marquette Lbiiversitv Medical School,
Dr. Bernard interned at Minneapolis General Hospi-
tal, then served in the Army for three and one-half
years during the war. For a time he was associated
in practice with Dr. Alton C. Olson at the Nicollet-
Lake Medical Clinic, Minneapolis.
* * *
The Saint Paul Archdiocesan Council of Catholic
Nurses has organized the Our Lady of Sorrow Nurs-
ing Guild, the purpose of which is to provide volun-
teer nursing care for critically ill, hospitalized pa-
tients of any color or creed who would otherwise be
unable to afford such care. The designation of pa-
tients to be the recipients of such free nursing care
is to be by the attending physician and the head
nurse on the floor. The plan has been instituted in
certain Saint Paul hospitals.
* * *
Dr. Nelson Bradley, clinical director at the Has-
tings State Mental Hospital for the past two years,
has been chosen superintendent of the hospital to
replace Dr. Ralph Rossen. Dr. Bradley assumed his
new office on February 1.
A graduate of the University of Alberta, Canada,
Dr. Bradley took postgraduate work at the Univer-
sity of Minnesota. In 1943 he joined the Canadian
Army Medical Corps and did psychiatric work in
England. He was released from the army in 1946.
* * *
At a meetipg of the Democratic-Farmer-Labor
women of Minneapolis on February 4, Dr. Frederic
J. Kottke, associate professor of physical medicine
at the LTniversity of Minnesota, spoke on health
legislation facing the 81st Congress.
* * *
Dr. W. L. Benedict, Rochester, was honored at a
coffee party given on February 1 by members of
the Worrall Hospital ophthalmology staff. He was
presented with an album depicting his work in the
hospital.
* * *
At a meeting of the Saint Paul Surgical Society
on January 25, Dr. John J. Culligan was elected pres-
ident of the organization. Dr. Victor Hauser was
named vice president, and Dr. William F. Hartfiel,
secretary-treasurer. Principal speaker at the meet-
ing was Dr. George T. Pack, attending surgeon of
the Memorial Cancer Center, New York City, and
clinical professor of surgery at New York Medical
College.
* * *
Dr. Robert J. Brimi has joined the medical staff
of the Richards Clinic in St. Cloud. A graduate of
the University of Minnesota Medical School in 1944,
Dr. Brimi served bis internship and a residency in
pathology at the Wayne County General Hospital,
Detroit, Michigan. After serving for two years in
the Army, he spent two years as a medical fellow at
the Lbiiversitv of Minnesota. He specializes in the
field of internal medicine.
* * *
On February 1, Dr. William O. Finkelnburg, a
former resident of Winona, returned to Winona to
become associated in practice with Dr. Irving W.
Steiner. A graduate of the University of Minnesota
Medical School in 1941, Dr. Finkelnburg interned at
Ancker Hospital, Saint Paul. After serving in the
the Army for three years, he began a residency in
surgery at Ancker Hospital in 1946 and completed
it in January, 1949. During the past year he was
associated in practice with Dr. Stanley R. Maxeiner,
Minneapolis.
* * *
Dr. Frederick W. Wittich, Minneapolis, was re-
elected secretary-treasurer of the American College
of Allergists at its meeting in St. Louis, Missouri,
January 15 to 18.
* * *
It was announced on January 22 that the library
of the St. Louis County Medical Society would be
incorporated as the David L. Tilderquist Memorial
Library, to pay tribute to the late Dr. Tilderquist,
Duluth ophthalmologist and otolaryngologist. Dr.
Tilderquist, who died on September 26, 1948, has
been described as having been the library’s “best
friend and most avid patron.” Naming the library
after him is the result of a study to find a suitable
memorial to the physician whose professional efforts
set an enduring example for his colleagues.
The memorial corporation, which will be separate
from the medical society, will have its own board of
directors and governing regulations. At present the
library has nearly 3,000 bound volumes including
texts and periodicals, and receives 105 weekly,
monthly and quarterly periodicals on medicine.
296
Minnesota Medicine
OF GENERAL INTEREST
THE FINAL OF A SERIES
We are using the opportunity afforded by the advertising
facilities of Minnesota Medicine to discuss Municipal
securities for investment of your savings.
This article will merely summarize the important points concerning Municipal secur-
ities as outlined in the iour previous discussions. Be sure to bear in mind these im-
portant factors when considering your next investment.
1. Next to United States Government Bonds, municipal securities have proven them-
selves to be the safest form of investment.
2. Under present laws, income received from them is exempt from Federal Income
taxes.
3. They are available in a wide range of maturities, geographical location, types
and interest rates to fit the needs of large or small individual investors, trust funds,
insurance companies and banks.
4. They are secured by taxes levied on real and personal property, earnings of mu-
nicipal utilities such as water, electric light and gas systems, by assessments
against property benefited by local improvements or by other municipal revenue.
5. The taxes levied for their payment constitute a lien prior to a first mortgage on real
or personal property.
6. We are merchants dealing exclusively in municipal securities and believe that
our experience in this field will be helpful to you.
IF YOU WISH TO RECEIVE OUR MUNICIPAL OFFERINGS OR OBTAIN A COPY
OF OUR TAX FREE VS. TAXABLE INCOME CHART FILL IN THE ENCLOSED
BLANK AND MAIL TO US.
JURAN & MOODY
Ground Floor, Minnesota Mutual
Life Bldg., St. Paul, Minn.
Gentlemen:
□ Please put my name on your mailing list to receive your municipal offerings.
□ Please send me a copy of your chart showing comparison of Tax free vs.
taxable income.
NAME
ADDRESS
I CITY STATE
JURAN 6l MOODY
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TELEPHONES
St. Paul: Cedar 8407, 8408, 3841
Minneapolis: Nestor 8886
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St. Paul 1, Minnesota
Dr. E. P. Strathern, retired St. Peter physician,
vas honored at the annual meeting of the St. Peter
Jivic and Commerce Association on January 18.
The eighty-one-year-old physician completed fifty
rears of medical practice in St. Peter last December.
Nearly 100 businessmen attended the honor meeting
it which Dr. Strathern reecived an original painted
parchment scroll, a lifetime membership in the or-
ganization.
>Jc
Announcement was made on January 24 that Dr.
Bussell H. Frost, director of tuberculosis work in ten
Midwestern states for the Veterans Administration,
had been named superintendent of the Glen Lake
Sanatorium. The appointment, which became effec-
tive on March 1, ended a six-month search for a suc-
cessor to Dr. Ernest S. Mariette, who resigned be-
cause of ill health after thirty-three years as super-
intendent.
A graduate of the University of Minnesota Medi-
cal School, Dr. Frost has had experience as a phy-
sician, as a sanatorium administrator, and as a mem-
ber of the Navy medical corps in World War II.
At the time of his appointment to the Glen Lake
post, he was stationed at Fort Snelling as chief of
the tuberculosis service at the area medical office
and acting attendant physician on the staff.
March, 1950
297
OF GENERAL INTEREST
EXCLUSIVE WITH qC^UIT
Fully Guaranteed by a 69- Year-Old Company
OVER 1,000,000 SATISFIED USERS
Farewell ceremonies were held in Winsted on
January 22 for Dr. Edwin E. Shrader, who was re-
tiring from active practice and moving to Watertown
to live. More than 400 persons gathered at the high
school auditorium to say goodbye to Dr. Shrader and
to present him with gifts. Dr. Shrader, now eighty-
seven years of age, began his medical practice in
Watertown in 1893.
* * *
Dr. John R. Earl, Saint Paul physician, was elect-
ed president of the Minnesota Council of Churches
at its annual meeting in Saint Paul on January 19.
* * *
The Lakeland Medical Center has been completed
in Willmar by five physicians. They are Dr. Robert J.
Hodapp, Dr. Robert V. Hodapp, Dr. Douglas L.
Jacobs, Dr. Lloyd C. Gilman and Dr. Ray K. Proe-
schel. The newly constructed building, costing
$200,000, houses offices, laboratories and x-ray facili-
ties. Dimensions of the structure are 120 by 42
feet, with two floors, the second floor housing eight
residential apartments.
* * *
Dr. Benjamin Spock, staff member of the Child
Health Institute in Rochester, was a speaker at the
annual meeting of the Family and Children’s Serv-
ice in Minneapolis on January 25. Title of his talk
was “What Is Discipline for Children?”
* * *
January 18 marked the ninety-fourth birthday of
Dr. George Haggard of Minneapolis, Minnesota's
298
oldest active physician. Though Dr. Haggard no
longer goes out on calls, he still sees some patients
at his office-home. He began practice in 1893.
* * *
The marriage of Miss Mary Kay Simon, of New
Prague, and Dr. Donald L. Alcott, formerly of Wa-
tertown, South Dakota, took place at New Prague
on January 7. The bride was a nurse at St. Mary’s
Hospital, Rochester. Dr. Alcott, a graduate of Rush
University, is a fellow of the Mayo Foundation.
* * *
At the annual meeting of the Waseca County Med-
ical Society, held in Janesville on January 11, Dr.
R. D. Davis was elected president of the organiza-
tion. Dr. S. C. G. Oeljen was named vice president,
and Dr. William B. Gallagher, secretary-treasurer.
All three are from Waseca.
* * *
Dr. Byron H. McLaughlin, who recently com-
pleted a three-year fellowship at the Mayo Clinic,
Rochester, announces his association with Dr.
Stanley R. Maxeiner at 1653 Medical Arts Building,
Minneapolis.
* * *
Dr. Kendall B. Corbin, consultant in neurology in
the Mayo Clinic and professor of neurosurgery in the
Mayo Foundation, has been appointed associate di-
rector of the Foundation by the Board of Regents
of the University of Minnesota, it was announced on
January 13.
In his new post Dr. Corbin shares administrative
Minnesota Medicine
OF GENERAL INTEREST
duties with Dr. Victor Johnson, director of the
Foundation.
Dr. Corbin became a member of the department of
neurology and psychiatry at the Mayo Clinic in
Tuly, 1946. Before that he had been an instructor in
anatomy at Stanford University and professor of
anatomy at the University of Tennessee. Fie was
also chairman of the department of anatomy and
supervisor of the department of clinical neurology.
He received his medical degree at Stanford in 1935.
^ ^
More than 2,000 students in the Edina-Morningside
school system received eye examinations in January
Trough a survey sponsored by the Edina-Morning-
side Parent-Teachers Association. The survey was
:onducted by the Minnesota Society for the Preven-
tion of Blindness, with the endorsement of the
Hennepin County Medical Society.
Jjc * Jfc
Principal speaker at a regional meeting of the
University of Minnesota Alumni Association in Vir-
ginia on February 13 was Dr. William G. Kubicek,
issociate professor of medicine at the University of
Minnesota. The meeting gave special recognition to
:he medical school and honored all physicians in the
irea who were graduates of it.
^ ^ ^
Two addresses were made in Duluth on February
1 by Dr. Frank H. Krusen, professor of physical
medicine in the Mayo Foundation and head of the
section on physical medicine at the Mayo Clinic. He
spoke on “Rehabilitation of the Handicapped” at a
meeting of the Duluth Association for the Physically
Handicapped and at a meeting of the St. Louis
County Medical Society.
* * *
A dinner to honor Dr. Ralph Rossen, Minnesota’s
first mental health commissioner, was held at the
Coffman Memorial Union on the University of Min-
nesota campus on February 2. Governor Luther W.
Youngdahl presided at the dinner, which was at-
tended by members of the medical profession, state
officials, legislators, citizens groups that fought for
the mental health program, and institutional and
psychiatric workers concerned with the program. Dr.
Ernest M. Hammes was chairman of the sponsoring
committee of the affair.
;Jc :}: j|j
Dr. Maurice B. Visscher, professor and head of the
department of physiology at the University of Min-
nesota, has been elected to the board of directors
of the National Society for Medical Research. The
organization is currently emphasizing the importance
of animal experimentation in medicine and has set
as one of its goals improved methods for procure-
ment and care of laboratory animals.
Aims and objectives of the Hennepin County
Medical Society were explained by Thomas P. Cook,
‘WlwM'BtSml
A FORMULA, a couple of machines and a label?
. . . That’s about it — for just any ampoule.
But the careful physician won’t settle for just
any product — ampoule or otherwise.
When he prescribes, he wants the label to
signify — beyond the shadow of a doubt —
a clean manufacturing record, preferably
one stretching back a generation or more;
unfailing adherence to controls;
a research program with adequate staff
and facilities; and for final confirmation, a
place on the roster of Council accepted products.
You need settle for nothing less when
you specify medication labeled
THE SMITH-DORSEY COMPANY
LINCOLN, NEBRASKA
BRANCHES AT LOS ANGELES AND DALLAS
•
MANUFACTURERS OF FINE
PHARMACEUTICALS SINCE 1908
March, 1950
299
OF GENERAL INTEREST
An
Observation on the Accuracy of Digitalis Doses
Withering made this penetrating observation in
his classic monograph on digitalis: "The more I
saw of the great powers of this plant, the more it
seemed necessary to bring the doses of it to the
greatest possible accuracy.”1
To achieve the greatest accuracy in dosage and at
the same time to preserve the full activity of the
leaf, the total cardioactive principles must be iso-
lated from the plant in pure crystalline form so
that doses can be based on the actual weight of the
active constituents. This is, in fact, the method by
which Digilanid® is made.
Clinical investigation has proved that Digilanid is
"an effective cardioactive preparation, which has
the advantages of purity, stability and accuracy as
to dosage and therapeutic effect.”2
Average dose for initiating treatment: 2 to 4 tab-
lets of Digilanid daily until the desired therapeutic
level is reached.
Average maintenance dose: 1 tablet daily.
Also available: Drops, Ampuls and Suppositories.
1. Withering, W An account of the Foxglove, London, 1785.
2. R immerman, A. B.: Digilanid and the Therapy of Congestive
Heart Disease, Am. J. M. Sc. 209 : 33-41 (Jan.) 1945.
Literature giving further details about Digilanid and Physician s Trial
Supply are available on request.
Digilanid contains all the initial glycosides from
Digitalis lanata in crystalline form. It thus truly
represents "the great powers of the plant” and
brings "the doses of it to the greatest possible
accuracy”.
Sandoz
Pharmaceuticals
DIVISION OF SANDOZ CHEMICAL WORKS, INC.
68 CHARLTON STREET, NEW YORK 14, NEW YORK
executive secretary of the organization, at a meeting
of the Rotary Club in Excelsior late in January.
* * * *
Dr. Victor W. Doman and Dr. John T. Rose are
now occupying a newly constructed clinic building in
Lakefield. The modern structure contains offices, a
treatment room, an x-ray and minor surgery room, a
laboratory and a business office.
* * *
Dr. Donald C. Balfour, director emeritus of the
Mayo Foundation, received the Builder of the Name
award of the University of Minnesota at ceremonies
held on February 16. The award was established in
1947 and is given in recognition of service to the
University. Only three other persons have received
the award.
Dr. Balfour, who served as director of the Mayo
Foundation from 1937 to 1947, first joined the staff
of the Mayo Clinic in 1907. He was named head
of a section in the division of surgery in 1912 and
later became head of the division. He was appointed
professor of surgery in the Mayo Foundation in 1923
and was named associate director in 1935.
* * *
Among Minnesota physicians attending a con-
tinuation course in cardiovascular diseases, held at
the University of Minnesota Center for Continuation
Study on January 5 through 7, were Dr. G. Ruggles,
Forest Lake; Dr. R. E. Billings, Franklin; Dr. Wil-
liam A. Owens, Montevideo; Dr. C. L. Roholt,
Waverly; Dr. C. A. Anderson, Hector; and Dr. F. M.
McCarten and Dr. Henry Van Meier, both of Still-
water.
* * *
Plans for construction of a $12,000,000 ten-story
clinic building were announced on January 5 by Dr.
Arlie R. Barnes, chairman of the Mayo Clinic board
of directors.
Site of the proposed structure will be the block
across the street from the present clinic, where the
Mayo Foundation medical museum now stands. The
new building will more than double the floor space of
the present clinic buildings. It will be planned to
handle 150,000 to 160,000 patient registrations a year,
and it will have the structural strength to allow an
additional eight stories, if necessary. Construction
cost, estimated to be $12,000,000, will be paid entirely
by the Mayo Association, a non-stock "charitable,
benevolent and educational” corporation established
by the Mayo brothers in 1919.
It was expected that ground-breaking for the struc-
ture will take place this year, perhaps in August.
Completion of construction is expected within four
years.
* * *
At a meeting of the Winona County Public Health
Nursing Advisory Committee in Winona on Janu-
ary 17, Dr. Viktor O. Wilson, acting district health
officer for the Alinnesota Department of Health,
300
Minnesota Medicine
OF GENERAL INTEREST
outlined a plan for a joint county-city health depart-
ment, as permitted by 1949 state legislation.
Jjc ifc %
A ham radio operator and a Minneapolis physician
;ollaborated on January 5 to diagnose and prescribe
treatment for a child on a ship in the Atlantic Ocean
1,500 miles away.
Fred Kaefer, a St. Louis Park amateur radio op-
erator, picked up an emergency call from the captain
of the Flying Enterprise, a trading vessel 400 miles
off the coast of New Jersey. A six-year-old child
passenger was very sick, the captain said. Kaefer
:elephoned Northwestern Hospital in Minneapolis,
■eached Dr. Cherry Cedarleaf, a resident pedia-
irician, and let her talk to the captain. The captain
described the symptoms and signs; the physician
liagnosed acute tonsilitis and prescribed appropriate
:reatment. Fifteen hundred miles away, the captain
Followed the broadcast instructions.
A few hours later, the child — a German on his way
:o the United States with his parents — was ap-
parently well on the road to recovery . . . thanks to
i triple play in communications: ship captain to radio
operator to physician.
5K jfc *
Among Minnesota physicians attending a continua-
:ion course in neurology at the University of Min-
nesota early in February were two Crookston physi-
cians, Dr. Martin Janssen of the Northwestern Clinic
ind Dr. D. E. Pohl of the Crookston Clinic.
* * *
Dr. Burril Crohn, of Mt. Sinai Hospital, New York,
will deliver the annual Phi Delta Epsilon Lecture at
the Museum of Natural History on the University
of Minnesota campus at 8:00 p.m., April 20. His
subject will be “Regional Ileitis.”
;fc
Duluth’s longest practicing surgeon, Dr. William
R. Bagley celebrated his eightieth birthday on Janu-
ary 15. A graduate of the University of Michigan
Medical School, Dr. Bagley began his practice in
Duluth in 1893, when he became associated with Dr.
William H. Magie, a pioneer Duluth surgeon. By
1910 Dr. Bagley’s strenuous night-and-day medical
schedule had undermined his health so severely that
he was forced to retire to Oregon for a long rest.
After five years of unhurried ranch life, he returned
to Duluth and his practice. Since then he has set
aside a part of each year for a good vacation to re-
enforce his health.
A civic leader and an ardent supporter of conserva-
tion— he is an ex-state president of the Izaak Walton
League — Dr. Bagley was chosen for Duluth’s Hall
of Fame in 1941, when the city paid tribute to him
for his numerous contributions to state and city.
Among his children are two physicians, Dr. Elizabeth
C. Bagley and Dr. Charles W. Bagley, both Duluth
practitioners, and the wife of a physician, Mrs. C. L.
Oppegaard, of Crookston.
* * *
Dr. Thomas B. Magath, Rochester, has resigned
from the State Board of Health after twelve years of
service. He has been president of the board since
1946. Dr. Magath joined the Mayo Clinic in 1919
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March, 1950
301 •
OF GENERAL INTEREST
and is now chief of the division of clinical pathology.
From 1941 to 1946 he served in the U. S. Navy and
was released from service with the rank of com-
modore.
* * *
Dr. Abbott Skinner has opened an office at 714
Lowry Medical Arts Building, Saint Paul, for the
practice of general surgery. Dr. Skinner was gradu-
ated from Flarvard Medical School in 1942 and in-
terned at Ancker Hospital, Saint Paul. After serving
in the Army for three years, part of the time in the
South Pacific, he took a residency in surgery at
Ancker Hospital, which he has just completed. He
received an M.S. degree in surgery at the University
of Minnesota in June, 1949.
* * *
The Co-operative Medical Advertising Bureau of
the American Medical Association, the agency which
obtains most of the advertising for most of the state
medical journals, has changed its name on the advice
of its advisory committee and with the approval of
the board of trustees of the AMA. The new name,
State Journal Advertising Bureau of the American
Medical Association, seemed more descriptive of the
bureau’s activities.
* * *
Dr. Joseph N. Gahlen and Dr. Frank J. Milnar
announce their association for the practice of in-
ternal medicine, with offices at 714 Lowry Medical
Arts Building, Saint Paul.
HOSPITAL NEWS
Following are the results of various hospital staff
elections recently held in Minnesota.
St. Joseph’s Hospital, Brainerd. — Dr. A. M. Mulli-
gan, chief-of-staff ; Dr. J. H. Bender, vice chief-of-
staff; Dr. W. W. Anderson, secretary-treasurer.
Maternity Hospital, Minneapolis. — Dr. Ray F.
Cochrane, president; Dr. Helen Haberer, secretary.
St. Andrews Hospital, Minneapolis. — Dr. Frank E.
Mork, Anoka, chief-of-staff.
St. Mary’s Hospital, Duluth. — -Dr. K. R. Fawcett,
chief-of-staff-elect ; Dr. R. P. Buckley, chief-of-staff;
Dr. A. C. Kelly, secretary.
St. Luke’s Hospital, St. Paul. — Dr. Victor P.
Hauser, chief-of-staff; Dr. C. W. Leverenz, secretary.
Officers of the board of trustees: E. G. Carpenter,
president; B. G. Griggs, first vice president; G. O.
House, second vice president; William J. Gratz,
secretary-treasurer. The hospital has been certified
by the American College of Surgeons.
St. Barnabas Hospital, Minneapolis. — Dr. Arthur
C. Kerkhof, chief-of-staff; Dr. L. A. Whitesell, vice
chief-of-staff; Dr. Edgar A. Webb, secretary-
treasurer. Executive committee: Dr. E. A. Arlander,
Dr. C. M. Cabot, Dr. M. T. Mitchell, Dr. N. H.
Lufkin, Dr. M. E. Knapp, Dr. A. V. Stoesser, Dr.
C. W. del Plaine, Dr. E. J. Lillehei, Dr. W. E.
Proffitt and Dr. H. H. Noran.
* * *
The Preston Hospital completed its sixth year of
operation on January 24. During the six years 827
A quiet, ethical hospital with therapeutic facilities
for the diagnosis and treatment of nervous and
mental disorders. Invites co-operation of all repu-
table physicians. Electroencephalography avail-
able.
PSYCHIATRISTS IN CHARGE
Dr. Hewitt B. Hannah
Dr. Andrew J. Leemhuis.
REST HOSPITAL
2527 Second Avenue South, Minneapolis
The Birches Sanitarium, Inc.
2391 Woodland Avenue
Duluth 3, Minnesota
A hospital for the care and treatment of
Nervous and Mental disorders. Quiet, cheer-
ful environment. Specially trained personnel.
Recreational and occupational therapy.
Dr. L. R. Gowan, M.D., M.S., Medical Director
Attending Psychiatrists
Dr. L. R. Gowan Dr. C. M. Jessico
Dr. J. E. Haavik Dr. L. E. Schneider
302
Minnesota Medicine
OF GENERAL INTEREST
A completely equipped sanitarium for the care of
nervous and mental disorders, alcoholism and drug addiction
offering all forms of treatment, including electric shock.
SAMUEL LIEBMAN, M.S., M.D.
225 Sheridan Road
Medical Director
Phone Winnetka 6-0211
babies were born in the hospital and 1,351 patients
were admitted for care. The hospital, which was
opened by Dr. J. P. Nehring in 1944, has been operat-
ing to full capacity since its start.
the office for the past thirty years. Dr. Baldwin
Borreson, superintendent of the sanatorium, is secre-
tary of the commission.
Health Resort
Winnetka, Illinois
on the Shores of
Lake Michigan
At a meeting of the medical staff of Maternity
jHospital, Minneapolis, on January 17, Dr. Milton
Abramson reported that the hospital had established
what was believed to be a record in 6,845 consecutive
maternity cases without a maternal death. The
record ran between April, 19401, and August, 1947.
During the past thirteen years there were only
three maternal deaths in 13,009 cases — a rate of .023
(per 1,000. The national average maternal mortality is
|1.3 deaths per 1,000.
^ ^
Plans for the proposed hospital at Madison have
[been changed to include a penthouse addition to
furnish living quarters for twelve nurses and a
[superintendent. The one-story hospital, when com-
pleted, will have a normal capacity of thirty and a
full capacity of forty-two beds. Cost of the project
[is $450,000. Of this amount, residents of the Madison
area were asked to raise $150,000. When contribu-
tions and pledges were counted after a fund-raising
[campaign, the total was $177,369.
I At the annual meeting of the Oakland Park Sana-
torium commission, Dr. O. F. Mellby of Thief River
[Falls was re-elected president. Dr. Mellby has held
March, 1950
BLUE CROSS-BLUE SHIELD NEWS
With 260,500 persons enrolled, Minnesota Blue Shield
is the thirteenth in size of the sixty-seven Blue Shield
Plans in the nation. This increase in enrollment during
1949 amounts to more than two and a half times the
enrollment in 1948, and placed Minnesota Blue Shield as
fifth in size of increased enrollment during the first nine
months of 1949.
Nearly 31,000 claims were paid by Minnesota Blue
Shield during 1949. Of the total number of claims,
over 29,000 were submitted by participating Blue Shield
doctors, who received $1,076,513.31 in Blue Shield pay-
ments for care given subscribers. Total payments to
doctors during the year amounted to more than $1,156,-
230. Throughout the United States and Canada, Blue
Shield Plans will have paid approximately $100,000,000
during 1949 for medical care to their thirteen million
subscribers.
Hospital care to Minnesota Blue Cross subscribers
during 1949 totaled $8,746,831, or 94.4 per cent of the
year’s income. This is 7.9 per cent more of earned
income than was paid to hospitals for care of subscribers
in 1948. Operating expenses during 1949 amounted to
10.8 per cent of the year’s income, and is a decrease
303
OF GENERAL INTEREST
1909.. ..1950
Physiotherapy for the relief
of Arthritis and related con-
ditions. Complete physical
examinations and laboratory
procedures given every pa-
tient. Roy T. Pearson,
M.D., Medical Director. B.
F. Pearson, M.D., associate.
U.S. Hwy. 212
anitarium
ACCIDENT • HOSPITAL • SICKNESS
INSURANCE
FOR PHYSICIANS, SURGEONS, DENTISTS EXCLUSIVELY
$5,000.00 accidental death $8.00
$25.00 weekly indemnity, accident Quarterly
and sickness
$25.00 weekly indemnity, accident Quarterly
and sickness
$10,000.00 accidental death $16.00
$50.00 weekly indemnity, accident Quarterly
and sickness
$15,000.00 accidental death $24.00
$75.00 weekly indemnity, accident Quarterly
and sickness
$20,000.00 accidental death $32.00
$100.00 weekly indemnity , accident Quarterly
and sickness
Cost has never exceeded amounts shown.
ALSO HOSPITAL POLICIES FOR MEMBERS
WIVES AND CHILDREN AT SMALL
ADDITIONAL COST
85c out of each $1.00 gross income used for
members’ benefits
$3,700,000.00 $16,000,000.00
INVESTED ASSETS PAID FOR CLAIMS
$200,000.00 deposited with State of Nebraska for protection of our members.
Disability need not l>e incurred in line of duty — benefits from
the beginning day of disability
PHYSICIANS CASUALTY ASSOCIATION
PHYSICIANS HEALTH ASSOCIATION
48 years under the same management
400 First National Bank Bldg., Omaha 2, Nebr.
from 1948 when operating expenses came to 11.2 per cent
of the total income for the year.
More persons using hospital care, increased usage of
certain hospital services, and higher hospital costs were
chief reasons for the increased utilization in 1949. Hos-
pitalization of persons protected under family contracts
was the highest in Blue Cross history, and hospitaliza-
tion under single subscriber contracts was the highest
its been in the last five years. Combined, the increased
utilization under single and family contracts resulted in
a rate of 417 cases paid per thousand Blue Cross con-
tracts compared with 374 per thousand contracts paid in
1948.
Respiratory illnesses were the chief cause for hospitali-
zation during 1949, accident cases ranked second and
maternity cases third. This is the first time since 1940
that accident cases exceeded the number of maternity
cases paid. The rate of increase, however, in both acci-
dent and maternity cases was not as great as the rate
of increase in 1948.
With 966,483 persons enrolled, Minnesota Blue Cross
continues to maintain its position as ninth largest Blue
Cross Plan in the United States. Throughout the
United States and Canada over thirty-five million persons
are enrolled in Blue Cross, and about $300,000,000 has
been paid for subscribers’ hospital care during 1949.
PRIMARY TUMORS OF THE OPTIC NERVE
(Continued from Page 243)
7. Martin, P., and Cushing, H.: Primary gliomas of the
chiasm and optic nerves in their intracranial portion. Arch.
Ophth., 52:209, 1923.
8. Stallard, H. B. : A case of endothelioma of the optic nerve
sheaths. Brit. J. Ophth., 19:576-583, 1935.
9. Verhoeff, F. H.: Primary intraneural tumors (gliomas) of
the optic nerve. Arch. Ophth., 51:120-140 and 239-254, 1922.
10. Verhoeff, F. H. : Tumors of the optic nerve. In Penfield,
Wilder: Cytology and Cellular Pathology of the Nervous Sys-
tem. Vol. 3, p. 1029. New York: Paul B. Hoeber, Inc., 1932.
11. Walsh, F. B. : Clinical Neuro-Ophthalmology. Pp. 1133-1141.
Baltimore: Williams and Wilkins Company, 1947.
5 OJO/L UlMDtL 9 A. (pPJuduDUA.
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Don't iust buy eye glasses, but eye care . . .
Consult a reliable eye doctor and then . . .
Let Us Design and Make Your Glasses
^addy J^Jd -^deAmari
Dispensing Opticians
25 W. 6th St. St. Paul
CE. 5767
304
Minnesota Medicine
BOOK REVIEWS
BOOK REVIEWS
Books listed here become the property of the Ramsey,
Hennepin and St. Louis County Medical Libraries when
reviewed. Members, however, are urged to write reviews
of any or every recent book which may be of interest
to physicians.
BRUCELLOSIS (Undulant Fever). Second Edition. Harold J.
Harris, M.D., F.A.C.P. ; with assistance of Blanche L. Steven-
son, R.N. Foreword by Walter M. Simpson, M.S., M.D.,
F.A.C.P. 618 pages. Ilius. Price $10.00, cloth. New York:
Paul B. Hoeber, Inc., 1950.
MEDICAL MANAGEMENT OF GASTROINTESTINAL
DISORDERS. Garnett Cheney, M.D. Clinical Professor of
Medicine, Stanford University Medical School. 478 pages.
Illus. Price $6.75, cloth. Chicago: The Year Book Pub-
lishers, Inc., 1950.
QUINIDINE IN DISORDERS OF THE HEART. Harry
Gold, M.D. Professor of Clinical Pharmacology at Cornell
Medical College; Attending Physician-in-Charge of the Cardio-
vascular Research Unit at the Beth Israel Hospital ; Attending
Cardiologists at the Hospital for Joint Diseases; Managing
Editor of the Cornell Conferences on Therapy. 115 pages.
Price $2.00, cloth. New York: Paul B. Hoeber, Inc., 1950.
X
-RAY TREATMENT, ITS ORIGIN, BIRTH AND EARLY
HISTORY. Emil H. Grubbe, B.S., M.D., F.A.C.P., Charter
Member and Emeritus Member of the Radiological Society of
North America; Charter Member of the American Roentgen
Ray Society; Diplomate of the American Board of Radiology;
Associate bellow of the American Medical Association; Emeri-
tus Member of the Illinois State Medical Society, and a
Member of the Chicago Medical Society. 153 pages. Illus.
Price $3.00. Saint Paul: The Bruce Publish'ng Co., 1949.
This is the professional autobiography of a living pio-
neer of radiology, whose professional life parallels the
development of that science. The locale is Chicago,
the historical aspects correct and the reading excellent.
I was impressed by the author’s scientific and physical
tenacity, the latter evidenced by the fact that he person-
ally has undergone some eighty-three operations as a
result of x-ray burns. I feel that the book should be
included in the libraries of all radiologists, of workers
in the atomic field, and in medical libraries generally,
not only because of the historical interest but because
of the contemporary interest and current reawakening
of the effects of radiation.
Leo A. Nash, M.D.
PRIMER OF ALLERG\ . Third Edition. Warren T
Vaughan, M.S., M.D. 175 pages. Illus. Price $3.50. St.
Louis: C. V. Mosby Co., 1950.
CARDIOVASCULAR DISEASE — Fundamentals, Differential
Diagnosis, Prognosis and Treatment. Louis H. Sigler, M.D.,
F.A.C.P. Attending Cardiologist and Chief of Cardiac’ Clinic,
Coney Island Hospital; Consulting Cardiologist, Rockaway
Beach Hospital; Consulting Cardiologist, Menorah Home
, , ^ ospital for the Aged. 551 pages. Illus. Price $10.00,
cloth. New \ ork : Grune & Stratton, 1949.
‘ G L PH\SIOLOGY OF 1 HOUGFIT. A Functional Study
of the Human Mind in Action. Harold Bailey, MD
F.A.C.S. 313 pages. Price $3.75, cloth. New York: Wil-
liam-Frederick Press, New York, 1949.
LIFE AMONG THE DOCTORS. Paul De Kruif in collabora-
tion with Rhea De Kruif. 470 pages. Price $4.75. New
York: Harcourt, Brace and Co., 1949.
Essentially this book deals with the activities of a num-
ber of medical men of the past few years. It is colored
by the recurring thought that all of the individuals dis-
cussed are persecuted heroes. The men whom we rec-
ognize in the book do not need that particular type of
patronage. A number of direct statements are made
and a number of reports are given which should be
challenged. Examples of poor literary taste are present
lllllllllllllllllllllllMlliniinillllllllllUlinillllllllllllllllllllllllllMIIINIIIIllllllllllMllllllllllllllllllMIINIIItllinilllllllinillllMIIMIIIIIIIIIIIIIIIIIIIMIMIIIIIIIIMIIIIIIIIIIIIIllMMIIIIIIIIIIIIIIIIllllllIllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllli
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Dietitian as Teachers and Supervisors. Certificate from i
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EXCELLENT CARE TO CONVALESCENT AND 1
CHRONIC PATIENTS |
Rates Reasonable. Patients under the care of their own physicians, |
who direct the treatment. =
5511 Lyndale Ave. So. LO. 0773 Minneapolis, Minn. |
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T T OMEWOOD HOSPITAL is one of the
J- Northwest's outstanding hospitals for the
treatment of Nervous Disorders — equipped
with all the essentials for rendering high-grade
service to patient and physician.
Operated in Connection with
Glenwood Hills Hospitals
HOMEWOOD HOSPITAL
Corner Penn and Plymouth Avenues North
Minneapolis Minnesota
Larch, 1950
305
BOOK REVIEWS
FOR CASES OF COLOSTOMY
AND ILIOSTOMY
YOU CAN
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WITH CONFIDENCE
“Carbisol” is a deodorizing capsule used success-
fully for many years and proven to be highly effec-
tive in all cases of colostomy and iliostomy. Send
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DOCTOR . . .
you are cordially invited to visit our new
and modern prescription pharmacy located on
the street floor of the Foshay Tower, 100 South
Ninth Street.
With our expanded facilities we will be able
to increase and extend the service we have
been privileged to perform for the medical pro-
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Exclusive Prescription Pharmacy
Biologicals Pharmaceuticals Dressings
Surgical Instruments Rubber Sundries
JOSEPH E. DAHL CO.
(Two Locations)
100 South Ninth Street, LaSalle Medical Bldg.
ATlantic 5445 Minneapolis
even to the point of the actual words used. It is un-
fortunate that the author, who has set himself up in the
eyes of the reading public as an able medical and
scientific reporter, has to resort to the brand of sensa-
tionalism which pervades. In spite of the publisher’s
note that the book has the deepest social implications of
all of De Kruif’s works, I doubt that any discerning
reader will be moved very much by it, if for no other
reason than that the tone is bitter, vindictive and gen-
erally low.
Leo A. Nash, M.D.
CONGENITAL ANOMALIES OF THE HEART AND GREAT
VESSELS: Clinicopathologic Study of 132 Cases. Thomas T.
Dry, M.D., of Mayo Clinic, Jesse E. Edwards. B.S., M.D., of
Mayo Clinic, Robert L. Parker, M.S. in Medicine, M.D.,
F.A.C.P., of Mayo Clinic, Howard It. Burchell, M.D.. Ph.TL
in Medicine, of Mayo Clinic. H. Milton Rogers, B.S., M.S. in
Medicine, M.D., Fellow in Medicine of Mayo Clinic, and
Arthur H. Bulbulian. M.S., D.D.S., F.A.C.D. of Mayo Clinic.
68 nages. Illus.. including color plates. Price $4.50. Spring-
field: Charles C Thomas, 1949.
This slender book is an atlas of anomalies of the
heart and great vessels, based on a study of 132 clinico-
pathologic cases. The atlas is divided into sixteen sec-
tions, roughly corresponding to a classification of the
pathologic anatomy of congenital heart disease. Each
section is composed of two pages with the following
illustrations :
1. A picture of the scientist who described the entity,
2. colored photographs of models of the heart based
on autopsy material,
3. a black and white photograph of an autopsy speci-
men,
4. a pen and ink drawing clarifying the photograph,
5. the pertinent electrocardiograph, and
6. the chest film.
A biographical and historical note accompanies each
scientist’s picture.
The text is brief, pithy and interspersed among the
illustrations in such a fashion that the illustrations yield
a maximum of information with a minimum of study.
The atlas is so well planned and illustrated that it does
the job that would otherwise require hundreds of pages
of dull text.
The atlas can be recommended to all physicians, es-
pecially those who seek an easy, painless method of
understanding the recent advances in cardiac surgery
by studying the pathologic anatomy.
Coleman J. Connolly, M.D.
ERNIA DEL DISCO E SCIATICA VERT EB RALE. F.
Delitala and A. Bonola. 213 pp. Price — 2500 lire. Bologna:
L. Cappelli, 1949.
This Italian monograph, published in 1949, contains
213 pages including an extensive bibliography on the
intervertebral disk. There are 108 illustrations, many of
which are excellent.
The authors consider “posterior intraspinal herniation
of the disk” as a more exact term for the pathologic
condition which has been variously called “protrusion,”
“dislocation,” “luxation,” “extrusion,” and so forth of
the intervertebral disk. They point out that the herni-
ated material removed at the time of operation fre-
quently is composed of fragments of the annulus.
306
Minnesota Mluicine
BOOK REVIEWS
Although the authors have observed only 200 cases
of herniated intervertebral disk, they have made a
careful study of the world’s literature on the subject
and have brought the subject up to date for the Italians
who were shut off during World War II “from the great
currents of scientific thought.”
The authors have restricted the use of iodized oil
for myelography because they fear an untoward re-
action when the oil comes in contact with the nerve
-oots. They consider the neurologic examination as the
aasis of diagnosis.
They have abandoned the intradural method of re-
noval of fibrocartilaginous fragments of disks because
af the harm that such a procedure may cause.
The authors have had to reoperate on six patients,
rrorn those six experiences they feel that systematic
surgical exploration of the space above, below and on
he opposite side should be done in instances of plurira-
liculitis because of the possibility of multiple herniation
)f a disk or disks. They also recommend vertebral
irthrodesis or radicotomy when the situation is doubtful.
:OMPARATIVE RESUME Op RESULTS OBTAINED BY
INTERVENTION FOR EXTIRPATION OF HERNIATED
INTERVERTEBRAL DISKS
Per cent
Results
Best
Good
Moderately
good
Mediocre
Bad
-K>ve :
987 of 1,217 pa-
tients operated on
from 1939 to 1941
)andy :
53.7
36.7
9.6
843 cases
irand :
200 cases
)ur own cases:
Series 1; 78 of 100
patients operated on
23.8
43.7
63.0
29.0
21.9
17.0
8.0
from 1934 to 1947
)ur own cases:
Series 2; 170 of 217
26.9
58.9
3.8
10.2
patients operated on
from 1934 to 1948
34.1
31.7
25.2
7.6
1.1
The authors have compared their results of surgical
reatment of herniated intervertebral disks with those
•f some American authors.
In the entire United States about 270,000 mental pa-
tents are coming back into the community each year,
[he spread of the disease from those who may have
ontracted tuberculosis while in mental hospitals there-
ore becomes a community problem which we cannot
fford to ignore. — Public Health Reports , January 7, 1949.
“DEE”
NASAL SUCTION PUMP
Contact your wholesale druggist or
write direct for information
"DEE" MEDICAL SUPPLY COMPANY
P.O. Box 501, St. Paul, Minn.
Iarch, 1950
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and
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St. Paul 1, Minnesota
307
MINNESOTA STATE BOARD OF MEDICAL EXAMINERS
ClQMPAM^
Professional Protection
Exclusively
since 1899
MINNEAPOLIS Office:
Stanley J. Werner, Rep.
816 Medical Arts Building,
Telephone Atlantic 5724
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BUCHSTEIN-MEDCAIF CO.
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Patronize Our Advertisers
MINNESOTA STATE BOARD OF MEDICAL
EXAMINERS
230 Lowry Medical Arts Building
Saint Paul, Minnesota
Julian F. DuBois, M.D., Secretary
Minneapolis Man Arrested Third Time for
Illegal Practices
Re Slate of Minnesota vs. Frank Herman Gold , also
knozvn as Frank H . Gould.
On January 24, 1950, Frank Flerman Gold, also known
as Frank FT. Gould, 32 years of age, residing at 4
Washington Avenue South, Minneapolis, was sentenced
by the Hon. John A. Weeks, Judge of the District Court
of Hennepin County, to a term of one year in the Min-
neapolis Workhouse. Gold had pleaded guilty on Janu-
ary 18, 1950, to an information charging him with the
crime of practicing healing without a basic science cer-
tificate. Gold was arrested on January 14, 1950, during
an investigation by the Minnesota State Board of Medi-
cal Examiners and the Minneapolis Police Department.
At the time of his arrest Gold was representing himself
as “Dr. Frank H. Gould.” Gold had recpiested one of
the Minneanolis drug stores to print some prescriptions
for him and after receiving the prescriptions wrote sev-
eral. The prescriptions were questioned by a pharmacist
and this led to Gold’s arrest.
Gold has never studied medicine but was employed for
several years as an orderly at a hospital in New York
City, and also w'orked in the same capacity for at least
three hospitals in Minneapolis and St. Paul. Gold was ;
first arrested on May 18, 1946, by Minneapolis Police
officers for representing himself as a phvsician and .
surgeon. He pleaded guilty on May 21, 1946, and on i
Tune 12, 1946. was sentenced to a term of one year in i
the Minneapolis Workhouse. Because it was Gold’s first t
conviction the sentence was staved and the defendant I
placed on probation. In March. 1948. it was learned that I
Gold was again practicing healing illegally by represent-
ing himself as a doctor of medicine. On March 8, 1948,
Gold pleaded guiltv to the charge and was sentenced by
Judge Levi M. Hall to one year in the Minneapolis •
Workhouse. Judge Hall reciuired Gold to serve the en-
tire sentence, less time off for good behavior. In De- -|
cemher, 1949, there was evidence that Gold again was ,
attempting to practice healing. The investigation made,
resulted in his arrest for the third time. Gold wras un-
able to give the Court any logical explanation for his
unusual behavior in persisting in his attempt to practice
medicine without any medical education or license.
Gold stated that he was born in New York City,
June 16, 1917; that he graduated from the James Mon-
roe High School in the Bronx, New York City. Gold
further stated that he had been in Minneapolis for the
past nine years, except for the time that he served in
the United States Navy during World War II. Gold
has in his possession, papers indicating that he served
as a Pharmacist Mate Third Class.
PHYSICIANS AND HOSPITALS SUPPLY CO., Inc.
414 SOUTH SIXTH ST., MINNEAPOLIS, MINN.
INSTRUMENTS ■ TRUSSES • EQUIPMENT • PHARMACEUTICALS • DRUGS
MAIN 2494
308
Minnesota Medicine
INDEX TO ADVERTISERS
Index to Advertisers
Abbott Laboratories 291
American Meat Institute 224
American National Bank 311
^.mes Co., Inc 228
Anderson, C. F., Co., Inc 290
4r-Ex Cosmetics, Inc 309
^yerst, McKenna & Harrison, Ltd 225
Benson, N. P., Optical Co 290
3irches Sanitarium 302
3orden Co 295
Brown & Day, Inc 307
3uchstein-Medcalf Co 308
'aswell-Ross Agency 218
Classified Advertising 310
Continental Casualty Co 232
Cook County Graduate School of Medicine 309
Dahl, Joseph E., Co 306
Danielson Medical Arts Pharmacy, Inc 310
‘Dee” Medical Supply Co 307
Druggists Mutual Insurance Co 311
Swald Bros Inside Back Cover
franklin Hospital 311
reiger Laboratories 310
Dlenwood Hills Hospitals 287
Ilenwood-Inglewood Co 307
fiall & Anderson 311
iomewood Hospital 305
uran & Moody 297
Celeket X-Ray Sales Corporation of Minnesota 222, 223
-ederle Laboratories 221
-filly, Eli, & Co Front Cover
Insert facing page 232
dead Johnson & Co 312
dedical Placement Registry 310
dedical Protective Co 308
derck & Co., Inc 293
Milwaukee Sanitarium Back Cover
dounds Park Hospital Back Cover
dudcura Sanitarium 304
durphy Laboratories 311
lestle Co., Inc 301
dorth Shore Health Resort 303
'’arke, Davis & Co Inside Front Cover, 217
3atterson Surgical Supply Co 310
3hilip Morris & Co., Ltd., Inc 230
5hysicians Casualty Association 304
Physicians & Hospitals Supply Co., Inc 226, 308, 311
Professional Credit Protective Bureau 227
5adium Rental Service 309
lego Products 306
lest Hospital 302
lexair Division, Martin-Parry Corporation 298
loddy-Kuhl-Ackerman 304
It. Croixdale Sanitarium 220
andoz Pharmaceuticals 300
^chering Corporation 229
ichusler, J. T., Co., Inc 311
iearle, G. D., & Co 285
mith-Dorsey Co 299
Vocational Hospital 305
Villiams, Arthur F 311
Vinthrop-Stearns, Inc ’ '231
Vyeth, Inc 289
Cook County Graduate School of Medicine
ANNOUNCES CONTINUOUS COURSES
SURGERY — Intensive Course in Surgical Technic, two
weeks, starting March 20, April 17, May 15.
Surgical Technic, Surgical Anatomy and Clinical Sur-
gery, four weeks, starting March 6, April 3, May 1.
Basic Principles in General Surgery, two weeks, start-
ing April 3.
Personal Course in General Surgery, two weeks, start-
ing April 17.
Surgery of Colon and Rectum, one week, starting April
10, May 15.
Esophageal Surgery, one week, starting June 5.
Breast and Thyroid Surgery, one week, starting June
26.
Thoracic Surgery, one week, starting June 12.
Gallbladder Surgery, ten hours, starting April 24.
Fractures and Traumatic Surgery, two weeks, starting
March 20, June 12.
GYNECOLOGY— Intensive Course, two weeks, starting
March 20, April 17.
Vaginal Approach to Pelvic Surgery, one week, start-
ing April 3.
OBSTETRICS — Intensive Course, two weeks, starting
April 3, June 5.
PEDIATRICS — Intensive Course, two weeks, starting
April 3.
Personal Course in. Cerebral Palsy, two weeks, starting
July 31.
Personal Course in Diagnosis and Treatment of Con-
genital Malformations of the Heart, two weeks,
starting June 5.
MEDICINE — Intensive General Course, two weeks,
starting April 24.
Electrocardiography and Heart Disease, two weeks,
starting July 17.
Hematology, one week, starting May 8.
Gastro-Enterology, two weeks, starting Majr 15.
Liver and Biliary Diseases, one week, starting June 5.
Gastroscopy, two weeks, starting May 15, June 12.
DERMATOLOGY — Formal Course, two weeks, starting
May 8. Informal Clinical Course every two weeks.
UROLOGY — Intensive Course, two weeks, starting April
17. Cystoscopy, ten day practical Course, every two
weeks.
General, Intensive and Special Courses in all Branches of
Medicine, Surgery and the Specialties.
TEACHING FACULTY— ATTENDING
STAFF OF COOK COUNTY HOSPITAL
Address: REGISTRAR, 427 South Honore Street
Chicago 12. Illinois
RADIUM RENTAL SERVICE
2525 INGLEWOOD AVENUE
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Prescribe ointments of cosmetic elegance — made with AR-EX Multi-
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71
AR-|X
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1036 W. VAN BUREN ST. CHICAGO 7, ILL.
^Iarch, 1950
309
Classified Advertising
Replies to •advertisements with key numbers should be
mailed in care of Minnesota Medicine, 2642 University
Avenue, Saint Paul 4, Minn*.
FOR RENT — Three modern suites in new building under
construction, center of large residential area, St. Louis
Park, Minneapolis suburb. Facilities for private of-
fices, examining rooms, laboratories, reception room,
x-ray room, etc. Air conditioned. Will complete to
suit tenant. Ample free parking. Telephone WHittier
3297. Write E-189, care Minnesota Medicine.
FOR SALE — Unopposed practice in excellent farming
community, Southern Minnesota. Address E-190, care
Minnesota Medicine.
FOR SALE — RF 100 Fisher X-Ray Machine complete
— in perfect condition. Reasonable asking price. Ad-
dress P.O. Drawer No. 230, International Falls, Min-
nesota.
WANTED IMMEDIATELY BY MIDWESTERN
GROUP — Surgical assistant and urological assistant.
Salary $400.00 per month. Minimum requirements :
Rotating internship. Address E-191, care Minnesota
Medicine.
PHYSICIAN WANTED— Well-established firm in
northern Minnesota desires young man for general
practice and obstetrics — deliveries in hospital. Good
income from start. Full information given and inter-
view arranged upon receipt of inquiry. Address E-192,
care Minnesota Medicine.
WANTED IMMEDIATELY — Obstetrician-gynecolo-
gist specialist for two-man clinic in midwestern city of
35,000. Give all information in first letter. Address
Box E-187, care Minnesota Medicine.
WANTED: Physician in general practice and obstet-
rics who has finished military service. Given good op-
portunity to do good clinical work. Equipped with
clinical laboratory, x-ray and electrocardiograph. State
school and internship. Address E-188, care Minne-
sota Medicine.
WANTED — Young M.D. to associate in general practice
with clinic. Salary $600 to $500 per month to start.
Month’s vacation with pay each year. Call or write
Dr. C. J. Henry or Dr. J. E. Henry, Milaca, Min-
nesota.
WANTED IMMEDIATELY — Anesthetist for anesthe-
sia duties alone or combined with other duties. 45-bed
hospital, located 60 miles from Minneapolis. Salary
open. Write Superintendent, Hutchinson Community
Hospital, Hutchinson, Minnesota.
+ * POSITIONS AVAILABLE * *
^Internist in Minneapolis desires associate internist.
*General Practitioner for locum tenens Lowry Medical
Arts Building, two months.
^Pediatrician wanted for four-man group, New Jersey.
^General Practitioner, permanent or locum tenens; $500
to start; new hospital; Mnneapolis.
^General Practitioner for association 28-bed hospital,
Minnesota.
*Good general surgeon for manager new $350,000 hos-
pital.
*Board eligible men wanted for new clinic, southern mid-
dle west territory.
For information, write or call
THE MEDICAL PLACEMENT REGISTRY
629 Washington Ave. S. E., Minneapolis GL. 9223
DANIELSON MEDICAL ARTS PHARMACY, INC
PHONES:
ATLANTIC 3317
ATLANTIC 3318
10-14 Arcade, Medical Arts Building hours:
825 Nicollet Avenue — Two Entrances — 78 South’ Ninth Street WEEK DAYS — 8 to 7
MINNEAPOLIS SUN- AND HOL_ 10 TO 1
a
iruca
THE GrEIGER LABORATORIES
/ Services por f^lujsicians oj- the Upper YU id die WJeit
1111
eruices for j-' htfSiciani of l lie Ulpper
Mailing tubes and price lists supplied upon request.
NICOLLET AVENUE MINNEAPOLIS 2
MAIN 2350
PATTERSON SURGICAL SUPPLY COMPANY
103 East Fifth St., St. Paul 1, Minn.
HOSPITAL AND PHYSICIANS SUPPLIES AND EQUIPMENT
Cedar 1781-82-83
310
Minnesota Medicine
PHYSICIANS AND HOSPITALS SUPPLY CO., Inc.
414 SOUTH SIXTH ST., MINNEAPOLIS, MINN
INSTRUMENTS • TRUSSES • EQUIPMENT • PHARMACEUTICALS • DRUGS
MAIN 2494
Practical Nursing School
Approved} by Minnesota State Board of Nurses
Examiners
Twelve months course open to High
School Graduates or women with equiv-
alent education.
For further information apply to
DIRECTOR OF NURSES
FRANKLIN HOSPITAL
501 W. Franklin Avenue, Minneapolis 5, Minn.
TAILORS TO MEN SINCE 1886
The finest imported and domestic wool-
ens such as SCHUSLER'S have in stock
are not too fine to match the hand tailor-
ing we always have and always will
employ.
J. T. SCHUSLER CO., INC.
379 Robert St. St. Paul
DO YOU HAVE CHILDREN?
Train them in the habit of sav-
ing money regularly through a
SAVINGS ACCOUNT with
this bank. . . . They’ll always
thank you. OPEN AN AC-
COUNT FOR THEM TO-
DAY.
THE AMERICAN NATIONAL BANK
OF SAINT PAUL
Bremer Arcade Robert at 7th CE 6666
Member Federal Deposit Insurance Corporation
Radiological and Clinical
Assistance to Physicians
in this territory
MURPHY LABORATORIES
Minneapolis: 612 Wesley Temple Bldg. - - At. 478*
St. Paul: 348 Hamm Bldg. ce. 712s
If no answer, call Ne. 1291
Hal^ 6? Anderson
PRESCRIPTION PHARMACY
BIOLOGICALS
PHYSICIANS' SUPPLIES
SAINT PAUL, MINN.
LOWRY MEDICAL ARTS BUILDING
TELEPHONE: CEDAR 2733
UNUSUAL LENS GRINDING
CATARACT,
MYO-THIN
and other difficult
and complicated
lenses are ground to
extreme thinness and
accuracy by our
expert workmen.
SAINT PAUL
MINNESOTA
OfffflQRfWlLLIAM;
Insua?r Druggists Mutual Insurance Company PromPt
U OF IOWA, ALGONA, IOWA LOSS
Saving Fire - Tornado - Automobile Insurance Scwick
MINNESOTA REPRESENTATIVE-?! F ftp tt rtf ut v n m t m p t m m
Tire - Tornado - Automobile Insurance Service
REPRESENT A TIVE-S. E. STRUBLE, WYOMING, MINN.
March, 1950
311
story familiar to millions of
mothers is the daily preparation of
PABLUM* and PABENA* as the first
solid foods for millions of infants.
Pablum is a mixed cereal — Pabena
is oatmeal.
Both are precooked, vitamin and
mineral enriched, and practically iden-
tical in nutritive values. They are pala-
table and readily digestible, and quickly
prepared by simply mixing with milk
or water, hot or cold.
Pablum and Pabena may be freely
alternated to provide variety in taste
for infants, or for children and adults
requiring a bland , low residue diet . Both
are prescribed by physicians every-
where, and are advertised to physicians
only . *T. M. Beg. U. S. Pat. Off.
312
Minnesota Medicine
a byword
in syphilotherapy
MAPHARSEN
MAPHARSEN (oxophenarsine
hydrochloride, Parke-Davis), is supplied in
single dose ampoules of 0.04 Gm. and 0.06 Gm.
boxes of 10, and in multiple dose
ampoules of 0.6 Gm., boxes of 10.
Flying Saucers *?
You and I probably have not seen a flying saucer, nor have we
had the opportunity to touch or feel its exterior smoothness.
Most of us are not even aware of its importance if it does exist.
This is also directly true of Accident and Sickness insurance.
The value and importance of income protection is not readily
apparent unless you have had an occasion to use the policy. But
just ask the man who’s been through a protracted period of dis-
ability. He will settle that question for you and in a hurry.
The simple, hut important, aspect is that you must buy this
coverage BEFORE disability strikes. Simple? Yes, because your
Society has already made available to you an outstanding con-
tract.
CASWELL-ROSS AGENCY
1177 N. W. Bank Building
Minneapolis — MA 2585
Minneapolis 2, Minnesota
St. Paul— ZE 2341
Insurors to:
Minnesota State Bar Association
Minnesota State Dental Association
Minnesota State Medical Association
Minnesota Society of C.P.A.
Minnesota State Pharmaceutical Assn.
Minnesota Auto Dealers Association
Hennepin County Medical Society
Hennepin County Bar Association
St. Paul District Dental Society
Minneapolis District Dental Society
St. Cloud Dental and Stearns County
Medical Society
Duluth District Dental Society
East Central Medical Society
St. Louis County Medical Society
314
Minnesota Medicine
Journal of the Minnesota State Medical Association, Southern Minnesota Medical Association, Northern Minnesota
Medical Association, Minnesota Academy of Medicine and Minneapolis Surgical Society
Volume 33
April, 1950
No. 4
Contents
Studies on Brucellosis in Minnesota.
Wesley W. Spink, M.D., Minneapolis, Minnesota.. 333
Some Recent Aspects of Cardiac and Juxta-Car-
diac Surgery.
/. D. Baronofsky, M.D., Saint Paul, Minnesota.. 339
Banti’s Disease.
Charles E. Rea, M.D., Werner W. Amerongen,
M.D., and Charles H. Manlove, M.D., Saint
Paul, Minnesota 347
Psychiatry in Geriatrics.
Walter P. Gardner, M.D., F.A.C.P., Saint Paul,
Minnesota 353
Parathion Poisoning.
W. E. Park, M.D.< Minneapolis, Minnesota 360
Intravenous Administration of Para-Amino-
salicylic Acid for Streptomycin-Resistant
Tuberculosis of the Trachea.
David T. Carr, M.D., William D. Seybold, M.D.,
Herbert W. Schmidt, M.D., and Alfred G. Karl-
son, D.V.M., Rochester, Minnesota 363
Pschyiatry in General Practice.
S'. G. Egge, M.D., Albert Lea, Minnesota 365
Case Report :
Treatment of Barbiturate Poisoning with Metra-
zol.
J. S. Milton, M.D., and /. L. Stennes , M.D.,
Minneapolis, Minnesota 370
Contents of Minnesota Medicine copyrighted
History of Medicine in Minnesota :
Medicine and Its Practitioners in Olmsted County
Prior to 1900. (Continued from March issue).
Nora H. Guthrey, Rochester, Minnesota 371
President’s Letter :
The AM A in 1950 381
Editorial :
AMA Dues for 1950 382
The Status of Vitamin Consumption 382
Alas, A Lack ! . 383
Medical Economics :
More and More Security Means “Piggy-back”
Rides 384
Security — For All? — Forever? 385
Forefathers Warned of Too Much Security 385
Short-Sightedness May Be Greatest Disadvantage 386
Federal Government Is a Big Business 386
Minnesota State Board of Medical Examiners.... 388
Reports and Announcements 390
Minnesota Academy of Medicine — Meeting of De-
cember 14, 1949 396
In Memoriam 396
Woman’s Auxiliary 398
Of General Interest 400
Book Reviews 411
by Minnesota State Medical Association, 1930
Entered at the Post Office in Saint Paul as second class mail matter. Accepted for mailing at the special rate of postage provided
for in Section 1103. Act of October 3, 1917, authorized July 13, 1918.
April, 1950
315
MINNESOTA MEDICINE
Official Journal of the Minnesota State Medical Association
Published by the Association under the direction of its Editing and Publishing Committer
Office of Minnesota State Medical Association,
493 Lowry Medical Arts Bldg., Saint Paul 2, Minnesota.
EDITING AND PUBLISHING COMMITTEE
Philip F. Donohue, Saint Paul
E. M. Hammes, Saint Paul
H. W. Meyerding, Rochester
B. O. Mork, Jr., Minneapolis
C. L. Oppegaard, Grookston
T. A. Peppard, Minneapolis
H. A. Roust, Montevideo
O. W. Rowe, Duluth
Henry L. Ulrich, Minneapolis
A. H. Wells, Duluth
EDITORIAL STAFF
Carl B. Drake, Saint Paul, Editor
George Earl, Saint Paul, Associate Editor
Henry L. Ulrich, Minneapolis, Associate Editor
BUSINESS MANAGER
J. R. Bruce
Annual Subscription — $3.00. Single Copies — $0.40. Foreign and Canadian Subscriptions — $3.50.
The right is reserved to reject material submitted for editorial or advertising columns. The
Editing and Publishing Committee does not hold itself responsible for views expressed either in
editorials or other articles when signed by the author.
Classified advertising — ten cents a word; minimum charge, $2.00. Remittance should ac-
company order.
Display advertising rates on request.
Address all communications concerning the journal to Minnesota Medicine, 2642 University
Avenue, Saint Paul 4, Minnesota. Telephone Nestor 2641.
ST. CROIXD ALE ON LAKE ST. CROIX
PRESCOTT, WISCONSIN
MAIN BUILDING— ONE OF THE 8 UNITS IN “COTTAGE PLAN”
A Modern Private Sanitarium for the Diagnosis, Care and Treatment of Nervous and Mental Disorders
Located on beautiful Lake St. Croix, eighteen miles from the Twin Cities, it has the advantages of both
City and Country. Every facility for treatment provided, including recreational activities and occupational
therapy under trained personnel. Close personal supervision given patients, and modern methods of
therapy employed. Inspection and cooperation by reputable physicians invited. Rates very reasonable.
Illustrated folder on request.
NEUROPSYCHIATRISTS
PRESCOTT OFFICE Hewitt B. Hannah, M.D. SUPERINTENDENT
Prescott, Wis. Andrew J. Leemhuis, M.D. Dorothy M. Most, R.N.
Howard J. Laney, M.D. Howard J. Laney. M.D. Prescott. Wisconsin
Tel. 39 and Res. 76 511 Medical Arts Building Tel. 69
Minneapolis, Minnesota
Tel. MAin 1357
316
Minnesota Medicine
Aureomycin has been found to exert a dra-
matic effect in the treatment of Escherichia coli
AUR E O M VC
HYDROCHLORIDE IEDERLE
in Coliform
Infections
infections; including peritonitis, bacteremia,
urinary infections, meningitis and
brain abscess. The prognosis in many
of these infections has in the past been
guarded, but the advent of aureomycin ren-
ders prompt recovery more likely.
Aureomycin has also been found effective for
the control of the following infections: African
tick-bite fever, acute amebiasis, bacterial and
virus-like infections of the eye, bacteroides
septicemia, boutonneuse fever, acute brucel-
losis, Gram-positive infections (including
those caused by streptococci, staphylococci,
and pneumococci), Gram-negative infections
(including those caused by the coli-aerogenes
group), granuloma inguinale, H. influenzae
infections, lymphogranuloma venereum, peri-
tonitis, primary atypical pneumonia, psitta-
cosis (parrot fever), Q fever, rickettsialpox,
Rocky Mountain spotted fever, subacute bac-
terial endocarditis resistant to penicillin,
tularemia and typhus.
Capsules: Bottles of 25, 50 mg. each capsule.
Bottles of 16, 250 mg. each capsule.
Ophthalmic: Vials of 25 mg. with dropper;
solution prepared by
adding 5 cc. of distilled water.
LEDERLE LABORATORIES DIVISION American Cuanamid company 30 Rockefeller Plaza, New York 20, N. Y.
April, 1950
317
from head to toe
CiREVims
CEREALS + VITAMINS + MINERALS
1 . "A Study of Enriched Cereal in Child Feeding Urbach,
C.; Mack, P. B., and Stokes, Jr., J: PeJiutrics 1:70, 1948.
*Cerevim contains neither vitamin A nor C but possibly
exercises an A-and-C sparing effect attributed to its
high content of protein and major B vitamins.
CEREVlM-fed children showed greater
clinical improvement, in the following
nutrition-influenced categories, than
children fed on ordinary unfortified
cereal or no cereal at all:1
Here’s why: Cerevim is not just a cereal.
Much more: Cerevim provides 8 natural
foods: whole wheat meal, oatmeal, milk
protein, wheat germ, corn meal, barley,
Brewers’ dried yeast and malt — PLUS
added vitamins and minerals.
hair lustre
recession of corneal invasion
retardation of cavities
condition of gums
condition of teeth
skin color
skeletal maturity
skeletal mineralization
‘blood plasma vitamin A increase
‘blood plasma vitamin C increase
subcutaneous tissues
dermatologic state
urinary riboflavin output
musculature
plantar contact
SIMILAC DIVISION
M 8c R DIETETIC LABORATORIES, Columbus 16, Ohio
318
Minnesota Medicine
GLOBIN INSULIN
WHfa Zinc
SQUIBB
. JPXSOBX
Ktrp in a <*>« !*««£.
g. R. SQUIBB A SONH, 1
'NSUL.N
PROTAMINE ZINC INSULIN
Sayi»6
60 units p«r cc*
lOcc.
pre-S)Ar>a«»« .X>nto}f>* 6r>5>n»-.«. O.S K
Keep in • ceM ptttcm fro** In*
E* IV Squibb & Sons, New York
jii.»{oarical jAbor:>t.«ric-.'-( N«-w hruiwwii-k, N. *<
SQUIBB INSULIN PRODUCTS
...purified... potent... rigidly standardized to
meet the various requirements of diabetics.
short action: peak effect within 3 to 4 hours, waning rapidly
INSULIN SQUIBB
10-cc. vials (40, 80 & 100 units per cc .)
INSULIN MADE FROM ZINC-INSULIN
CRYSTALS SQUIBB
10-cc. vials (40 ir 80 units per cc.)
intermediate action: peak effect in 8 to 12 hours, with action continuing
sometimes for 16 or more hours.
GLOBIN INSULIN WITH ZINC SQUIBB
10-cc. vials (40 & 80 units per cc.)
prolonged action: onset slow; peak effect in 10 to 12 hours, with action
sometimes persisting for 24 or more hours.
PROTAMINE ZINC INSULIN SQUIBB
10-cc. vials (40 ir 80 units per cc.)
Squibb
MANUFACTURING CHEMISTS TO THE MEDICAL PROFESSION SINCE 1858
April, 1950
319
OCtL at ^tt^
SIXTY?
Ak,C. o„„
nutritional science agree
that much depends upon the diet whether
the individual will be biologically old at
forty or biologically young at sixty.
To extend biologic youthfulness and
vigor into later years, a good nutritional
state based on an adequate diet is manda-
tory at all times. The efficient functioning
of many physiologic processes is involved
in maintaining good nutrition. On the
other hand, only the adequate diet can sus-
tain these processes. To assure such dietary
adequacy under many conditions of
physiologic stress encountered in day to
day living, a properly organized food sup-
plement often assumes vital importance.
The multiple-nutrient dietary food supple-
ment Ovaltine in milk richly provides many
nutritional essentials when such supple-
mentation is indicated. It provides excel-
lent amounts of vitamins A and D, ascor-
bic acid, niacin, riboflavin and thiamine;
the important minerals calcium, iron and
phosphorus; and biologically complete
protein. Its satisfying flavor and its easy
digestibility make it widely useful in both
general and special diets whether for chil-
dren, adults, or the aged.
The wealth of nutrients presented by
three glassfuls of Ovaltine in milk is
shown in the table below.
THE WANDER COMPANY, 360 N. MICHIGAN AVE., CHICAGO 1, ILL.
Three servings daily of Ovaltine, each made of
Vl a z. of Ovaltine and 8 oz. of whole milk,* provide:
VITAMIN A 3000 I.U.
VITAMIN Bi 1.16 mg.
RIBOFLAVIN 2.0 mg.
NIACIN 6.8 mg.
VITAMIN C 30.0 mg.
VITAMIN D 417 I.U.
COPPER 0.5 mg.
CALORIES 676
PROTEIN 32 Gm.
FAT 32 Gm.
CARBOHYDRATE 65 Gm.
CALCIUM 1.12 Gm.
PHOSPHORUS 0.94 Gm.
IRON 12 mg.
*Based on average reported values for milk.
Two kinds, Plain and Chocolate Flavored. Serving for
serving, they are virtually identical in nutritional content.
320
Minnesota Medicine
“Premarin”— a naturally oc-
curring conjugated estrogen
which has long been a choice of
physicians treating the climac-
teric—is earning further clinical
acclaim in the treatment of
functional uterine bleeding.
The aim of estrogenic therapy
in functional uterine bleeding
is to bring about cessation of
bleeding, and to produce sub-
sequent regulation of the cycle.
Once hemostasis is achieved,
the maximum daily dosage of
“Premarin” must be continued
to prevent recurrence of bleed-
ing. This schedule forms part
of cyclic estrogen-progesterone
treatment for attempted salvage
of ovarian function.
While sodium estrone sulfate
is the principal estrogen in
“Premarin” other equine estro-
gens... estradiol, equilin, equi-
lenin, hippulin...are probably
also present in varying amounts
as water-soluble conjugates.
An "estrogen of choice
for hemostasis
is Tremarin’
in tablets of 1.25 mg. . . .
The usual dose for hemostasis
is 2 tablets three times a day.
If bleeding has not decreased
definitely by the third day of
treatment the dosage level
may be increased by
50 per cent.”"
*Fry, C. O.: J. Am. M. Women’s A. 4:5] (Feb.) 1949
Estrogenic Substances ( water-soluble )
also known as Conjugated Estrogens (equine)
Four potencies of “Premarin” permit flexibility of
dosage: 2.5 mg., 1.25 mg., 0.625 mg., and
0.3 mg. tablets; also in liquid form, 0.625 mg. in each
4 cc. (1 teaspoonful ) .
Ayerst, McKenna & Harrison Limited
22 East 40th Street, New York 16, N. Y.
5009
April, 1950
321
• • •
YES!
new
Give you COMPLETE
Illustration above shows 100 MA Combination with the
basic table and Floor-To-Ceiling tubestand. This com-
bination includes the famous Keleket Multicron Gen-
Here is how the
Keleket Add-A-Unit
Combinations Work
Choose the combination
to suit your practice!
You purchase the new standard (not a reduced)
size Keleket Tilt Table and Tubestand. Then add
either 15, 30 or 100 MA tube and generating
equipment. You can advance from 15 to 30 and
to 100 MA but still retain the original table and
tubestand. As a result, this investment is never
lost when you step up to higher power tubes and
generating equipment.
Illustration below shows 30 MA combination with I
the same basic table and Floor-To-Ceiling tube-
stand. This combination includes the 30 MA self-
contained tubehead and precision control.
Minnesota Medicine
322
Vdd-a-Unit Combinations
C-RAY EQUIPMENT
. for FULL RANGE Fluoroscopy and Radiography
eleket scores again, with a new approach to the use and
irchase of X-ray equipment. Keleket has developed a
JLL SIZE Standard Tilting Table with a completely
w, highly flexible floor to ceiling tubestand. This basic
•ray equipment is equally adaptable for either 15, 30
100 MA tube and generating units.
SOWS WITH YOUR REQUIREMENTS
art out with the simplest 15 MA tubehead; then at a
ture date change to a 30 MA tubehead, if you desire,
henever you’re ready, step up to a 100 MA generating
lit. As a result, your Keleket equipment grows with
ur requirements.
HROUGHOUT ALL INTERCHANGES YOU RE-
UN THE SAME KELEKET “ ADAP”-T ABLE AND
UBESTAND.
1TURE COSTS SAVED
tis means you eliminate one of the biggest cost factors
in equipment — new table and tubestand costs as you step
up your tube capacity and power.
In addition, your original investment is never lost- — -
Keleket offers you generous allowance values on the
equipment you interchange.
FULL RADIOGRAPHIC-FLUOROSCOPIC FACILITIES
Any of these combinations will fully meet your current
needs for full range radiography and fluoroscopy. Per-
form radiography in horizontal and trendelenburg posi-
tions, vertical and horizontal fluoroscopy. The tubestand,
for example, is so flexible that you can swing the tube-
head away from the table and radiograph stretcher cases
on the opposite side.
And if you want a bucky diaphragm, even the lowest cost
unit is equipped to accommodate one.
Write of phone us for more information
Keleket X-Ray Sales Corporation
of Minnesota
1111 Nicollet Avenue Minneapolis 3, Minnesota
April, 1950
323
If the patient likes candy, he'll like the Duozine Dulcet
Tablet. It's a pale orange cube the child can eat like candy, that tastes
like candy all the way down — absolutely nothing about it to even
remind the child of medicine. Yet, each tablet contains equal parts of
sulfadiazine and sulfamerazine, as pure, stable and accurate as it
possible to compound. Indications and dosage are the same as for unflavored
tablets. Duozine Dulcet Tablets are available in two sizes, the regular 0.3 Gm. and
the half-size 0.15 Gm., through pharmacies everywhere in bottles of 100. For more
complete information on Duozine and other sulfonamide Dulcet
Tablets, write to Abbott Laboratories, North Chicago, Illinois.
CUHrott
is
Specify Abbott’s Sulfadiazine-Sulfamerazine Combination
DUOZINE DULCET
TRADE MARK
Tablets
0.3 Gm. and 0.15 Gm.
(Sulfadiazine-Sulfamerazine Combined, Abbott)
® Medicated Sugar Tablets, Abbott
324
Minnesota Mf.dicjne
In cholecystography, the “equivocal result” has virtually been elim-
inated. Cholecystograms made with Priodax® are a valuable aid to
diagnosis. An unsatisfactory, equivocal roentgenogram is a disap-
pointment to the physician and an annoyance to the patient requir-
ing a repeat examination. “Non-visualization of the gallbladder after
administration of Priodax is dependable evidence of organic gall-
bladder disease.”1 Formerly, such confusing factors as poor
absorption, vomiting, diarrhea and residual contrast medium in
the intestines hampered interpretation. Today, Priodax provides
results with minimal interference from such factors.
PRIODAX
(iodoalphionic acid)
Priodax, beta-(4-hydroxy-3, 5-diiodophenyl) -alpha-phenyl-propionic acid, is
available as 0.5 Gm. tablets in envelopes of six tablets and economy packages
of 100 envelopes and in boxes of 1, 5 and 25 envelopes each bearing instruc-
tions for the patient. Also the Hospital Dispensing packages containing 4 rolls
of 250 tablets each.
1. Brewer, A. A.: Radiology 48: 269, 1947.
CORPORATION • BLOOMFIELD, NEW JERSEY
(/> j[ o
PRIODAX
///?.
Before Treatment (P
days prior to Dihydro-
streptomycin therapy)
Diffuse lobular tubercu-
lous pneumonia , lower
half of left lung ; thin-
walled ca vity above hilus
( 3 x 3.5 cm.).
■\\\\ w
“// r
After 3 Mos. Treat-
ment ( 2 days after dis-
continuance of Dihydro-
streptomycin) Consider-
able clearing of acute
exudative process in the
diseased lung; cavity
smaller and wallthinner.
Preferred Adjuvants in the
treatment of
Dihydrostreptomycin and Streptomycin are unquestionably the most
potent antibiotics now available for use against tuberculosis. Extensive
clinical results have defined the important role of these antibiotics in
suppressing the activity of the tubercle bacillus.
MERCK & CO., Inc.
Manufacturing Chemists
R An WAY, N. J.
Streptomycin \ Dihydrostreptomycin
Calcium Chloride \ Sulfate
Complex Merck Merck
326
Minnesota Medicine
^ Calling All Doctors/
Your Receivables Have
Suffered A Set-Back! ^
Every doctor should immediately examine his accounts
receivable. A thorough diagnosis is certainly in order
promptly after due date. If some of your accounts are
suffering from “slow collectibility” they should be
receiving treatment while they still will respond.
COLLECTIBILITY OF ACCOU NTS— Based On Age
Accounts 60 days past due are 93% collectible. Accounts 1 year past due are 40% collectible.
Accounts 90 days past due are 85% collectible. Accounts 2 years past due are 25% collectible.
Accounts 6 months past due are 70% collectible. Accounts 3 years past due are 18% collectible
Accounts 5 years past due are practically lost.
1000 DOCTORS
HOSPITALS AND CLINICS
A National Organization . . .
Offered and recommended by
over 50 trade and professional
associations from coast to coast.
Write for references of service in
your area.
■
I
I
I
OUR ETHICAL COLLECTION SERVICE
★ NOT A COLLECTION AGENCY — All
Monies paid directly to you.
★ RETAINS GOOD WILL-Methods are
ethical, courteous and effective.
PROFESSIONAL CREDIT
PROTECTIVE BUREAU
Division of The I. C. System,
310 Phoenix Bldg., Minneapolis, Minn.
Further Inquiry Invited —
FILL OUT AND MAIL COUPON NOW
Professional Credit Protective Bureau
310 Phoenix Building
Minneapolis, Minn.
Gentlemen:
Without obligation, please send complete information
regarding this service.
Name_
Address_
City
_Zone_
-State.
April, 1950
327
c/yyvp
for POSTOPERATIVE
and POSTPARTUM
NEEDS
Basic design and theunique sys-
tem of adjustment make a large
variety of Camp Scientific Sup-
ports especially useful as post-
operative aids. Surgeons and
physicians often prescribe them
as assurance garments and con-
sider them essential after op-
eration upon obese persons,
after repair of large herniae, or
when wounds are draining or
suppurating. A Camp Scientif-
ic Support is especially useful in
the postoperative patient with
undue relaxation of the abdom-
inal wall. Obstetricians have
long prescribed Camp Post-
operative Supports for post-
partum use. Physicians and
surgeons may rely on the Camp-
trained fitter for precise execu-
tion of all instructions.
If you do not have a copy of the
Camp “Reference Book for Phy-
sicians and Surgeons’’, it will
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Minnesota Medicine
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). Beckman, H.: Treatment in General Practice. Philadelphia, Saunders, Sth ed., 1946, 704-705.
2. Beckman, H.: Treatment in General Practice Philadelphia, Saunders, 6th ed., 1940, 744 .
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329
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Minnesota Medicine
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332
Minnesota Medicine
Journal of the Minnesota State Medical Association, Southern Minnesota Medical Association, Northern Minnesota
Medical Association, Minnesota Academy o) Medicine and Minneapolis Surgical Society
Volume 33
April. 1950
No. 4
STUDIES ON BRUCELLOSIS IN MINNESOTA
WESLEY W. SPINK. M.D.
Minneapolis, Minnesota
"DRUCELLOSIS is an endemic disease of
livestock, especially cattle, swine and
goats. In Minnesota, it is the most common
infection of animals transmitted to man. The
disease derives its name from Sir David Bruce,6
a British Army surgeon, who first identified the
causative microbes toward the end of the last
century on the Island of Malta. The human
disease has also been designated as Malta fever
and undulant fever.
In an area like Minnesota, this infection not
only is of serious concern to the health of the
people, but the disease is costly to the livestock
and dairy industries. It is estimated that 4 to
5 per cent of the cattle in the state have brucel-
losis, and that 2 to 3 per cent of the hogs are
infected. Brucellosis is one of the most com-
mon causes of abortion in cattle and in swine.
Wherever this disease occurs in livestock, the
reproduction of animals is decreased. In cattle,
the infection also localizes in the udder so that
milk production is reduced. With 20 per
cent of the annual cash income of the farmers
in Minnesota derived from butter, it can be
readily seen why brucellosis is of importance
in the economy of the state. It has been cal-
culated on a national level that brucellosis
costs the cattle industry around $100,000,000,
annually.
It is difficult to estimate the number of hu-
From the Department of Medicine, University of Minnesota
Hospitals and Medical School, Minneapolis.
Presented, in part, as a Sigma Xi Lecture, University of
Minnesota, February 23, 1950.
Investigations on brucellosis were supported by research grants
from the Division of Research Grants and Fellowships of the
National Institute of Health, United States Public Health _ Serv-
ice; Lederle Laboratories; the Graduate School, University of
Minnesota; Committee on Scientific Research, American Medical
Association.
April, 1950
man cases of brucellosis occurring in Minnesota
because the disease can be insidious in its
symptomatology, difficult to diagnose, and
many mildly ill patients do not seek the advice
of a physician. The number of recognized
cases since the end of World War II has in-
creased. Recent studies carried on at the Uni-
versity Hospitals indicate that in the rural
population up to one-fourth of the people have
been infected at some time in their lives.25
The problem of brucellosis has not remained
unrecognized in Minnesota. Many studies have
been pioneered in this area. Investigations on
the control of the disease in cattle and in swine
have occupied the attention of a group in the
Division of Veterinary Medicine in the School
of Agriculture at the University of Minnesota,
first, under the direction of the late Dr. C. P.
Fitch, and now under Dr. W. A. Boyd. Par-
ticipating in these efforts has been the Minne-
sota Livestock Sanitary Board under the lead-
ership of Dr. R. L. West. Recognition was
also given to the human aspects of brucellosis
as long ago as 1913 when the late Dr. W. P.
Larsen, Professor of Bacteriology at the Uni-
versity of Minnesota, and Dr. J. P. Sedgwick,14
former Professor of Pediatrics, reported evi-
dence of the disease in the blood of infants, al-
though the first proved human case of brucel-
losis was not established in Minnesota until
1927. The Minnesota State Department of
Health, especially the Sections of Medical Lab-
oratories and Preventable Diseases, has long
been interested in attempts to recognize and
prevent brucellosis in human beings.
333
BRUCELLOSIS IN MINNESOTA— SPINK
Against this rich background of traditional in-
terest in brucellosis in Minnesota, investigations
on human brucellosis were initiated in the Depart-
ment of Medicine at the University Hospitals in
1937. These studies had their origin at the bed-
side of patients ill with suspected brucellosis. It
soon became apparent that the disease was difficult
to recognize and to diagnose correctly, and that
specific treatment was lacking. Some of the ob-
servations that have been made will be summar-
ized at this time. Certain outstanding features of
the disease have commanded interest. First, have
been investigations on the epidemiology of brucel-
losis, or the manner in which patients acquired the
infection. Second, has been a study of the natural
history of the illness in patients seen at the Uni-
versity Hospitals. In addition, various tissues
have been examined in an effort to ascertain what
reactions occur as a result of invasion of the body
by the microorganisms. Such an inquiry has been
directed not only to human patients, but to experi-
mentally infected animals, where the reactions
have been more precisely defined. Third, a critical
analysis has been made of the diagnostic methods
employed for recogizing human brucellosis.
Fourth, has been an evaluation of specific therapy
for human brucellosis, the results of which have
yielded quite encouraging results to date.
Epidemiology of Brucellosis in Minnesota
There are three species of Brucella that cause
disease in livestock and in human beings. The
most invasive species is Brucella melitensis, which
originally had the goat as its reservoir. Recent ob-
servations in Iowa have shown that Br. melitensis
also infects hogs under natural conditions.13 A
serious aspect of this finding is that an increasing
number of human infections caused by Br. meli-
tensis are being encountered in Iowa and in
Minnesota. These cases due to Br. melitensis re-
sult from direct contact with infected swine, or
their tissues. In Minnesota, practically all human
illness due to Br. melitensis occurs in the southern
part of the state, particularly in the counties ad-
jacent to the Iowa border.16 The next most inva-
sive species is Brucella suis, which has as its nor-
mal habitat the tissues of swine. Strains of Br.
suis have invaded and localized in the udders of
cattle, and human epidemics of brucellosis have
been caused by the ingestion of unpasteurized
cow’s milk containing this species of brucella.2’3,12
In recent years, fewer and fewer cases of human
brucellosis in Minnesota have been caused by
Br. suis. The least invasive species is Brucella
abortus with cattle as its natural reservoir. While
in general, Br. abortus causes a less severe disease
than that due to Br. melitensis or Br. suis, never-
theless, a protracted and grave illness can be in-
duced by Br. abortus, in which serious and even
fatal complications can occur. In a collaborative
study carried out between the Department of
Medicine at the University Hospitals and the
Laboratories and Section of Preventable Disease
of the Minnesota State Department of Health, the
etiology of 268 bacteriologically proved cases of
brucellosis occurring in Minnesota between Jan-
uary 1, 1945, and June 30, 194816 was determined
as follows :
Species No. Cases Per cent
Brucella abortus 230 85.8
Brucella melitensis 22 8.2
Brucella suis 16 6.0
It is quite apparent that the great majority of hu-
man infections in Minnesota are due to Br.
abortus.
Brucellosis is very rarely transmitted from hu-
man to human. The disease in Minnesota is ac-
quired through direct contact with infected ani-
mals or their tissues or secretions, and by ingest-
ing contaminated, unpasteurized milk or cream.
The microorganisms enter small abrasions of the
skin quite readily. Although there is experimental
evidence indicating that brucellosis may be ac-
quired through the respiratory tract following the
inhalation of dust which contains viable organ-
isms, there is still no clear-cut proof that this oc-
curs under natural conditions.
In the collaborative epidemiologic study already
referred to, it was found that about three-fourths
of all proved cases of brucellosis occurred in
males, and that three-fourths of these cases were
in the third, fourth or fifth decade of life. There
is no doubt that recognizable brucellosis in chil-
dren under twelve years of age occurs much less
frequently than in adults. Children appear to be
more resistant to the infection. This study also
revealed that approximately 75 per cent of all the
cases of brucellosis in Minnesota resulted from
direct contact with infected animals, or their tis-
sues and secretions, while about 25 per cent were
due to drinking unpasteurized milk. It should be
emphasized that in whole milk, Brucellae appear
in larger numbers in the cream fraction, and
334
Minnesota Medicine
BRUCELLOSIS IN MINNESOTA— SPINK
that the disease is quite readily contracted by in-
gesting fresh cream in one form or another. This
Minnesota study has emphasized quite clearly that
at least 60 per cent of the cases were occupational
in origin involving farmers as the largest single
group, followed by meat-packing plant employes.
In summary, human brucellosis in Minnesota is
due primarily to Br. abortus with three-fourths of
the cases occurring in males. Approximately 75
per cent of the cases are caused by contact, and
25 per cent are due to the ingestion of unpas-
teurized milk. At least 60 per cent of the cases are
occupational in origin with farmers constituting
the largest single group, followed by meat-pack-
ing plant employes.
Natural History of Human Brucellosis
There is no question that a clinical description
of brucellosis will depend upon the status of the
population infected, and the species of brucella
causing the disease. Thus, the over-all picture in
a well nourished people infected with Br. abortus
in Minnesota differs from that seen in under-
nourished Mexican Indians infected by Br. meli-
tensis, and who are frequently suffering from
other parasitic invasion. Acute brucellosis caused
by Br. abortus is characterized by weakness, chilly
sensations and fever, sweats, bodily aches and
pain, headache and backache. Physical abnormali-
ties may be absent in many cases, but when pres-
ent include splenomegaly, and cervical and axil-
lary lymphadenopathy. In general, the duration
of the illness is less than 6 months, and many
cases terminate in a state of well-being within a
few weeks. Not infrequently, the acute phase of
the illness is so mild the cause of the illness may
be unrecognized. Acute brucellosis is most fre-
quently misdiagnosed by being called "influenza”
or an “unknown virus disease.” In an occasional
case, a mild but acute illness may be succeeded by
a persistent state of ill health featured by a con-
tinual feeling of weakness, low-grade fever, men-
tal and physical inertia, vague aches and pains,
and mental depression. From time to time these
smoldering cases of brucellosis are diagnosed as
instances of psychoneurosis, neurasthenia or an
anxiety state. Only 10 to 15 per cent of the cases
in the Minnesota study fall into this category of
chronic brucellosis, or an illness enduring for
more than one year. It has been observed in a
large number of patients having either psycho-
neurosis or an anxiety state that many have been
misdiagnosed as having chronic brucellosis on the
basis of inadequate information, such as a posi-
tive skin test following the injection of brucella
antigen. In an occasional patient, acute brucel-
losis may be followed by a post-infectious state of
neurasthenia. But this is not specific for brucello-
sis, and occurs in other infectious diseases. The
majority of cases of culturally proved chronic
brucellosis studied at the University Hospitals
whose illness extended beyond one year have been
associated with demonstrable complications such
as spondylitis, encephalomeningitis and endocardi-
tis.24’29,30 Brucellosis does not cause human abor-
tions any more frequently than other bacterial in-
fections. Orchitis in the human is more frequent-
ly associated with infection due to Br. melitensis
than to Br. abortus. Likewise, neurological com-
plications, such as severe sciatica, are encountered
much more often in patients with illness due to
Br. melitensis.
A study of the tissue reactions induced by bru-
cella in human patients and in experimentally in-
fected animals, has yielded very helpful informa-
tion in an understanding of the natural history of
the disease. Brucellae localize principally in the re-
ticuloendothelial system. A characteristic granu-
lomatous type of lesion free of suppuration or
caseation has been demonstrated repeatedly in
sections of sternal bone marrow and liver obtained
by biopsy techniques.28’32 These lesions are simi-
lar to those encountered in sarcoidosis, tubercu-
losis and syphilis. The nonsuppurating tubercles
of brucellosis induced by Br. abortus have been
interpreted in experimentally infected animals to
represent a good defense mechanism and invasion
of the tissues by microorganisms that are only
mildly virulent. In contrast, strains of Br. suis
frequently cause destruction of tissues with sup-
puration. Br. melitensis induces a severe state of
toxemia and a chronic state of debility, but less
suppuration than that caused by Br. suis.
The death rate from brucellosis is low. In the
series at the University Hospital three patients
have died, all deaths being due to subacute bac-
terial endocarditis and caused by Br. abortus.
This is a mortality rate of about 3 per cent of all
culturally proved cases.
The Diagnosis of Brucellosis
A history of exposure to the disease and an
otherwise undefined febrile illness permit only a
presumptive diagnosis of brucellosis. A precise
April, 1950
335
BRUCELLOSIS IN MINNESOTA— SPINK
diagnosis depends upon laboratory data. The to-
tal leukocyte count is either normal or reduced,
and very rarely above 10,000 cells per cubic milli-
meter. A relative lymphocytosis is usually pres-
ent. The erythrocyte sedimentation rate may be
normal or accelerated, and is of no diagnostic
value.1 The most reliable method for screening
suspected cases is by means of the agglutination
test, which is carried out on request by the Lab-
oratories of the Minnesota Department of Health.
During the past twelve years, not a single case of
bacteriologically proved brucellosis has been seen
at the Lhiiversity Hospitals in which agglutinins
have been absent from the blood. The agglutinin
titer is usually 1 to 160 or above. In fact, over 90
per cent of the culturally proved cases have had
a titer of 1 to 320 or more. It is most unusual
to encounter a titer of 1 to 80 or less in a speci-
men of blood from which brucellae are recovered.
A significant segment of the healthy population of
Minnesota have a low titer of brucella agglutinins.
In a recent study of over 1,627 healthy donors ap-
pearing at the blood bank of the University Hos-
pitals, it was found that 18.54 per cent had bru-
cella agglutinins in a titer up to 1 to 80. Less than
2 per cent had a titer of 1 to 160 or more, and in
many of these individuals a history of exposure to
the disease was elicited.22
I f repeated examinations of the blood in a sus-
pected case of brucellosis reveal the absence of
agglutinins, it is highly unlikely that the patient
has the disease. In the absence of postive blood
cultures, too much dependence cannot be at-
tached to titers that are consistently below 1 to
160. At least one culture of blood for brucella
should be made in a patient suspected of having
the disease, and such a culture should be carried
out in every case when the agglutinin titer is 1 to
160 and above. Appropriate culture flasks may be
obtained from the Minnesota Department of
Health. At the University Hospitals, organisms
have been recovered from the blood in about 25
per cent of the cases having active disease.
A positive intradermal test with brucella anti-
gen denotes a state of hypersensitivity due to in-
vasion of the tissues by the organisms at some
time in the past. A positive skin test does not
mean the presence of active disease. Since a sur-
vey at the University Hospitals revealed that ap-
proximately 20 per cent of a predominantly rural
group of individuals had positive skin tests with-
out other evidence of the disease, the skin test as
336
a diagnostic procedure has been abandoned.25 A
positive skin test in a suspected case of brucellosis
having either low titer of agglutinins or absent
agglutinins is more confusing than enlightening.
The opsonocytophagic test, which is a quantitative
determination of phagocytosis of viable brucella
by the polymorphonuclear leukocytes, has not
yielded enough reliable information as a diagnos-
tic procedure. Its use is not recommended.
The Treatment of Brucellosis
Considerable advancements have been made in
the last few years in the specific therapy of bru-
cellosis. While many patients with acute brucel-
losis may recover from the disease spontaneously,
there are a significant number of patients whose
illnesses pursue a more chronic course, often with
debilitating and painful complications. Therefore,
an extensive research program has been directed
toward an evaluation of many agents, which
might abruptly terminate the illness when ad-
ministered to patients. These investigations have
called for the screening of a large number of
drugs in the laboratory and in experimentally in-
fected animals. 5,1°’15’18’19’34 The studies began in
1937, the year in which sulfanilamide became
available for the treatment of bacterial infections.
Because sulfanilamide, and some of the deriva-
tives of sulfanilamide, such as sulfapyridine, sul-
fathiazole, sulfadiazine, and sulfamerazine, yield-
ed encouraging results in the laboratory, patients
were treated with these agents. While there was
no question that in a few patients with acute bru-
cellosis, therapy with one of the sulfonamides
coincided with prompt recovery, the over-all re-
sults made it quite clear that the sulfonamides
were not the answer to specific therapy.
A series of experimental and clinical studies
were then undertaken with the antibiotics. Peni-
cillin was soon found to be ineffective. Much
more promising results were obtained experimen-
tally with streptomycin, but when the drug was
administered to acutely ill patients, the course of
the disease was not significantly altered. This in-
consistency between a good antibrucella effect of
streptomycin under laboratory conditions and the
poor results obtained in human beings has not
been adequately explained. By a set of fortuitous
circumstances, it was observed in a patient criti-
cally ill with brucellosis that the simultaneous ad-
ministration of streptomycin and sulfadiazine
caused a decided improvement. The advantage of
Minnesota Medici nk
BRUCELLOSIS IN MINNESOTA— SPINK
this combination was soon confirmed in several
more patients.20’21’26'27 The most dramatic effect
of this combined treatment was in a patient with
a highly fatal complication of brucellosis, that of
subacute bacterial endocarditis due to Br. abortus.
This patient recovered following treatment, and
has remained well for almost three years. Other
workers have also reported on the success of the
combination of streptomycin and sulfadiazine in
culturally proved acute and chronic brucellosis.9’17
One of the best controlled studies is that of Her-
rell and Nichols11 of the Mayo Clinic, who treated
14 patients with excellent results.
Although the combination of streptomycin and
sulfadiazine provided a definite advancement in
the therapy of human brucellosis, this treatment
also offered certain disadvantages. Prominent
among the undesirable effects was the toxicity of
streptomycin, which was reflected in vestibular
dysfunction. In addition, some of the patients
had a relapse after the completion of treatment.
Streptomycin also had to be injected intramuscu-
larly. A more desirable therapeutic approach
would be with an agent or agents that could be
administered by mouth ; that would be less toxic ;
and that would be just as efficient, if not more so.
It was just at this stage of experience at the Uni-
versity Hospitals that aureomycin appeared. This
was a relatively nontoxic antibiotic that could be
given by mouth. Preliminary experiments with
this new antibiotic indicated that aureomycin was
not as effective against brucella as the combination
of streptomycin and sulfadiazine.15 Accordingly,
a therapeutic trial with aureomycin in human bru-
cellosis was not seriously anticipated until a most
unusual opportunity for evaluation presented it-
self. Through an invitation by the Government
of Mexico, a co-operative study on the therapy of
brucellosis was carried on at the General Hospital
in Mexico City with Dr. M. Ruiz-Castaneda, who
was in charge of brucellosis control in that coun-
try. Following the use of aureomycin by mouth
in critically ill patients, the results were unexpect-
edly most dramatic.23 Patients who had relapsed
following the use of streptomycin and sulfadia-
zine, and some who were not expected to live, re-
covered promptly after receiving aureomycin.
These results were subsequently confirmed in the
treatment of patients in Minneapolis.4 More re-
cently there appeared in the British literature the
significant paper of Dr. J. E. DeBono, Professor
of Medicine in the Royal University of Malta.8
He stated, “after a long and disappointing expe-
rience in the treatment of undulant fever one
cannot help being somewhat cautious in express-
ing one’s opionion. Notwithstanding this, the re-
sults have been so constant, so rapid, and even
dramatic that it is impossible to deny that aureo-
mycin has a specific action on Brucella melitensis
in vivo.” Bryer and his associates7 of Baltimore
also look upon aureomycin with favor in the treat-
ment of brucellosis. Almost two years have
elapsed since aureomycin was introduced into the
treatment of brucellosis at the University Hospi-
tals. This has permitted a follow-up of patients
treated with the drug. Over 90 per cent of the
patients have remained well following treatment.
The recommended dose is now 20 to 30 mgs. per
kg. of body weight per day, administered in three
or four divided doses for two weeks. A maxi-
mum daily intake in an adult should be 2 gm., giv-
en in a dose of 0.5 gm. four times a day for two
weeks. It has not been found necessary thus far
to give aureomycin in combination with another
antibiotic. A few patients who have relapsed
have recovered following a second course of
therapy.
Another antibiotic introduced for the treatment
of brucellosis has been Chloromycetin. This drug
too can be administered orally and does not pro-
duce serious toxic reactions. There is no doubt
that Chloromycetin is effective in some cases of
brucellosis.33 Experience with Chloromycetin in
brucellosis at the University Hospitals has been
limited, but it appears to be less effective than
aureomycin.
There should remain no doubt that specific
therapy is now available for the treatment of hu-
man brucellosis. Prompt treatment of acute cases
not only hastens recovery, but also prevents dev-
astating and serious complications.
Some Urgent Problems in Brucellosis
Requiring Resolution
While many advancements have been made in
our knowledge of brucellosis, much work and re-
search remain to be done. Of paramount impor-
tance is the eradication of the natural reservoir of
this disease. Brucellosis will not cease to be a
threat to human health as long as there are in-
fected cattle, hogs and goats. It is now generally
agreed among authorities that brucellosis can only
be wiped out in livestock by eliminating the in-
fected animals and by protecting susceptible ani-
April, 1950
337
BRUCELLOSIS IN MINNESOTA— SPINK
mals. In cattle this has called for a program of
test and slaughter in heavily infected areas, and
the immunization of calves with living, but aviru-
lent brucella. Excellent progress along these lines
has been made in Minnesota. There are many
areas, especially in the northern part of the state,
that are free from the disease. But a more persis-
tent and aggressive effort is needed in some other
areas. The very difficult problem of control of
swine brucellosis requires further study. Brucel-
losis in hogs is not so readily diagnosed as in cat-
tle. Because brucellosis is highly contagious in
livestock it is readily seen why an eradication pro-
gram must be a co-operative effort on an area or
county basis. It is not enough that a few deter-
mined farmers and livestock producers should
fight this disease. Because of the economic loss
that is entailed it takes courage and vision to
slaughter or eliminate highly prized, but infected,
animals from a herd. Leadership and an educa-
tional program are essential in spearheading an
•effort of eradication. Physicians practicing in
rural areas may greatly encourage this program
by becoming acquainted with the status of the
animal disease in their areas, and then lending
their support to the local efforts by citing the
danger of brucellosis to public health. Finally,
brucellosis can only be completely stamped out in
animals, and the constant threat of infection elimi-
nated, by a nation-wide campaign of eradication.
It is encouraging to see the progress that has been
made along these lines during the past few years.
One of the most urgent problems in the field of
human brucellosis is a more scientific clarification
«of what is meant by chronic brucellosis. During
the past decade or two, some individuals have
crystallized attention on the chronicity of the dis-
ease to such an extent that the diagnosis is fre-
quently being made on the basis of flimsy and un-
critical data. The widespread use of the skin test
in diagnosing active disease has been most dev-
astating in rupturing scientific inquiry into the
nature of chronic brucellosis. A positive skin test
and the symptoms of neurasthenia are all that
many physicians require for an absolute diagnosis
of chronic disease. Tt reflects a serious state of
unscientific approach to problems in psychoso-
matic medicine. Tt is as though the phthisiologist
were to diagnose and treat active tuberculosis on
the basis of a positive tuberculin test and a vague
symptomatology, without any objective evidence
of localization of the disease. In an attempt to
define more accurately the nature of chronic
brucellosis a collaborative study has been insti-
tuted between the Department of Medicine at the
University of Minnesota Hospitals and the section
of Preventable Diseases of the Minnesota Depart-
ment of Health. Careful follow-up clinical and
laboratory studies are being made on a large group
of patients with bacteriologic proved brucellosis.
This investigation is being conducted with the aid
of physicians throughout the state, whose willing-
ness to co-operate in the effort has been most
gratifying. It is only on the basis of a much
needed study such as this that the frequency and
nature of chronic brucellosis can be deliniated.
Acknowledgment
In the prosecution of these studies I am indebted to
many individuals, especially to L)r. W. H. Hall, Dr. A. I.
Braude, Dr. R. Magoffin, Dr. J. M. Shaffer, Dr. E. Yow,
and Dr. B. Waisbren, and to Dorothy Anderson for
valuable technical assistance.
Bibliography
1. Agnevv, S. and Spink, W. W. : The erythrocyte sedimentation
rate in brucellosis. Am. J. M. Sc., 217:211, 1949.
2. Beattie, C. P. and Rice, R. M. : Undulant fever due to
Brucella of the porcine type — Brucella svtis. Report of a
milk-borne epidemic. J.A.M., 102:1670, 1934.
3. Borts, I. H., Harris, D. M., Joynt, M. F., Jennings, J. R.,
and Jordon, C. F. : A milk-borne epidemic of brucellosis
caused by the porcine type of Brucella (Brucella suis) in a
raw milk supply. J.A.M.A., 121:319, 1943.
4. Braude, A. I., Hall, W. H., and Spink, W. W. : Aureomycin
therapy in human brucellosis due to Brucella abortus.
T.A.M.A., 141:831, 1949.
5. Braude, A. I. and Spink, W. W. : The action of aureomycin
and other chemotherapeutic agents in experimental brucel-
losis. J. Immunol., (Submitted for publication).
6. Bruce, I).: Note on the discovery of a micrococus in Malta
fever. Practitioner, 39:161, 1887.
7. Bryer, M. S., Schoenbach, E. B. and Wood, R. M.: The
treatment of acute brucellosis with aureomycin. Bull. Johns
Hopkins Hosp., 84:444, 1949.
8. DeBono, J. E. : Aureomycin in undulant fever. Lancet,
2:326, 1949.
9. Eisele, C. W. and McCullough, N. B.: Combined streptomy-
cin and sulfadiazine treatment in brucellosis. J.A.M.A., 135:
1053, 1947.
10. Hall, W. H. and Spink, W. W. : Therapy of experimental
brucella infection in the developing chick embryo, I. Infection
and therapy via the allantoic sac. J. Immunol., 59:379, 1948.
11. Herrell, W. E. and Nichols, D. R. : The combined use of
streptomycin and sulfadiazine in the treatment of brucellosis.
M. Clin. North America, 33:1079, 1949.
12. Horning, B. G. : Outbreak of undulant fever due to Brucella
suis. J.A.M.A., 105:1978, 1935.
13. Jordon, C. F., and Borts, I. H.: Occurrence of Brucella
melitensis in Iowa. J.A.M.A., 130:72, 1946.
14. Larson, W. P., and Sedgwick, J. P. : The complement-fixa-
tion reaction in the blooa of children and infants using the
Brucella abortus antigen. Am. T. Dis. Child., 6:326, 1913.
15. Magoffin, R., Anderson, D. and Spink, W. W. : Therapy of
experimental brucella infection in the developing chick em-
bryo. IV. Therapy with aureomycin. T. Immunol., 62:125,
1949.
16. Magoffin, R. L., Kabler, P., Spink, W . W. and Fleming, D. :
An epidemiologic study of brucellosis in Minnesota. Pub.
Health Rep., 64:1021, (Aug. 19) 1949.
17. Pulaski, E. J. and Amsbacher, W. H.: Streptomycin therapy
in brucellosis. Bull. U. S. Army M. Dept., 7:221, 1947.
18. Shaffer, J. M. and Spink, W. W.: Therapy of experimental
brucella infection in the developing chick embryo. II. Infec
tion and therapy via the yolk sac. J. Immunol., 59:393, 1948.
19. Shaffer, J. M. and Spink, W. W. : Therapy of experimental
brucella infection in the developing chick embryo. III. The
synergistic action of streptomycin and sulfadiazine. T. Im-
munol., 60:405, 1948.
20. Spink, W. W. : Pathogenesis of human brucellosis with re-
spect to prevention and treatment. Ann. Tnt. Med., 29:238,
1948.
(Continued on Page* 359)
338
Minnesota Medicine
SOME RECENT ASPECTS OF CARDIAC AND JUXTA-CARDIAC SURGERY
I. D. BARONOFSKY, M.D.
Saint Paul, Minnesota
QOME of the most notable advances during the
^ last decade have been made in surgery of
the heart and great vessels. It is not surprising
that this should be so, as it has become possible
to perform extensive operations because of the
enormous amount of detailed study and experi-
ment which has been devoted to answering the
question of why patients die after operations from
causes other than hemorrhages. One of the ma-
jor trends in the past twenty-five years of Amer-
ican surgery is the emphasis on training in physi-
ology in the long-term preparation of the young
surgeon. Most advances in thoracic and vascular
surgery have been made by physiologically minded
surgeons.
It is our intention at this time to review briefly
some of the studies made in cardiac and juxta-
cardiac surgery. The following classification is
not intended to be a diagnostic chart, but merely a
group listing of the diseases that have been or are
being attacked in the human or in the experimental
animal. It must be understood that this review
can only be a small part of the work that is prob-
ably going on in laboratories or hospitals all over
the world and has not as yet been reported.
Surgery of Heart and Great Vessels
T. Congenital Abnormalities
A. Malformations which permit the body to receive
an oxygen supply sufficient for the growth of the
individual.
1. Patent ductus arteriosus
2. Defects in the auricular septum
3. Defects in the ventricular septum
4. Anomalies of the aortic arch
5. Coarctation of the aorta
6. Anomalies of the aortic valve and the ascend-
ing aorta.
B. Malformations which deprive the body of an
adequate amount of oxygenated blood.
1. The tetralogy of Fallot
2. Defective development of the right ventricle
and tricuspid atresia
3. Pure pulmonary stenosis
4. Complete transposition of the great vessels
and the common associated anomalies
5. Anomalies of the venous return
C. Defects of pericardium
From the Department of Surgery, University of Minnesota, and
the Ancker Hospital, Saint Paul.
Presented at the Medical Assembly, Saint Paul, Minnesota,
February 6, 1950.
April, 1950
II. Acquired abnormalities
A. Sequelae of rheumatic heart disease
1. Mitral stenosis
(a) Valvulotomy
(b) Commissurotomy
fc) Interatrial septal defect
(d) Pulmonary vein to azygos vein anasto-
mosis
(e) Sympathectomy
(f) Ligation of auricular appendage
B. Coronary heart disease
1. Sympathectomy for anginal pain
2. Pericoronary neurectomy
3. Coronary sinus ligation
4. Revascularization of the heart by graft from
aorta to coronary sinus
5. Anastomosis between the arterial bed of lung
grafted upon the heart and the coronary ar-
teries
6. Excision of cardiac infarcts
C. Constrictive pericarditis
TIL Pump oxygenators
Congenital Abnormalities
Malformations Which Permit the Body; to Re-
ceive an Oxygen Supply Sufficient for the Growth
of the Individual
Patent Ductus Arteriosus. — It is fitting to begirt
the discussion of surgery of the congenital mal-
formations by first discussing briefly the patent
ductus arteriosus. Gross19 in 1938 performed the
first successful ligations of the ductus. Attempts
had been made previous to this, but without suc-
cess. In 1939 he reported his first successful case,
and since that time great strides in the field of
vascular surgery have been made.' Certainly all
due credit belongs to Dr. Gross in being the
pioneer of congenital heart surgery.
Normally the communication present in utero
between the pulmonary artery and the aorta,
known as the ductus arteriosus, becomes closed
off soon after birth. In some individuals this
obligation may be delayed for weeks, for months,
or even longer. Christie12 found, from a study of
routine autopsies, that the ductus was obliterated'
in 95 per cent of subjects by the end of the twelfth
week, and in 99 per cent by the end of the first
year. The exact mechanism of closure is de-
batable. However, it must be noted that a patent
339
CARDIAC AND JUXTA-CARDIAC SURGERY— BARONOFSKY
ductus arteriosus does not represent a vital ab-
normality of any sort ; instead it is a failure of
normal closure after the child has been born.
It is not within the scope of this paper to dis-
cuss in detail the diagnosis of this abnormality.
Suffice it to say that a machinery murmur is
heard which distinguishes it from other abnormal-
ities. The hazards which are recognized and
occur rather frequently, and are an indication for
surgery, are: (1) the diversion of so much blood
from the aorta into the pulmonary artery that the
individual has a belated physical development ;
(2) the heart may enlarge in an attempt to main-
tain the peripheral circulation at a satisfactory
level; (3) there may be superimposed bacterial
infection with streptococcus viridans; (4) the
ductus may rupture.
Keys and Shapiro25 have reviewed some 600
cases of untreated patent ductus arteriosus. They
point out that patients who are alive at seventeen
years of age, with an open ductus, have a life ex-
pectancy which averages about half that of the
population as a whole. It is, therefore, on this
basis that surgical intervention and closure of the
vessel is a worthwhile procedure. This procedure
is now being carried out in numerous clinics. As
a matter of fact, a discussion of surgical inter-
vention in patent ductus arteriosus was first held
here in the state of Minnesota when Dr. Elliot
Cutler visited as a Judd lecturer in 1935. At
that time it was suggested to Dr. Wangensteen by
Dr. George E. Fahr that ligature of the patent
ductus was feasible and desirable. Dr. Cutler
suggested that a Parham band be put around the
ductus of a patient that was presented at that
time. The first ductus operation in the state was
performed by Dr. Owen H. Wangensteen35 in
1939, and since that time about 100 have been
done. Methods of closure of the ductus have un-
dergone several stages of development, but the
procedure that has been accepted by most surgeons
is one in which the ductus is cut across and the
ends ligated individually or suture ligations are
used. The group under Dr. Alfred Blalock at
Johns Hopkins has been the keenest proponent
of suture ligation, which is to be differentiated
from simple ligation.
The follow-up on patients who have had sur-
gical closure of the ductus has shown most grat-
ifying results. The mortality is less than 3 per
cent in most series in the country. The difficul-
ties of the technique that have to do with surgical
mortality are mainly those due to hemorrhage.
It is in the dissection of the posterior wall of the
ductus that this complication is met with. We
have learned by experience that in order to avoid
this complication, it is well to complete the dis-
section upward toward the aortic arch while work-
ing beside the ductus, and to keep away from the
thin-walled pulmonary artery, which is less tough
and less able to withstand manipulations and
mechanical injury.
Defects in the Auricular Septum. — Interauric-
ular septal defect may or may not lead to disturbed
function of the heart. In those cases in which a
communication between the two auricles has been
diagnosed, some attempt will surely be made in the
future to close the communication. Patients who
suffer from such conditions frequently seek med-
ical attention. Among young adults it is probably
the congenital malformation of the heart most fre-
quently seen in medical practice and least fre-
quently diagnosed correctly. Although in its
most characteristic form this malformation pro-
duces an unusual clinical syndrome, the auscula-
tory findings are subject to wide variations, and,
therefore, those who place reliance upon murmurs
and thrills are frequently misled. Introcardiac
catherization which has led to great progress
in the diagnosis of cardiovascular disease may be
used in the diagnosis of this defect.
Defects in the auricular septum are due to some
failure in the formation of the septum, or failure
in the anatomic closure of the foramen ovale.
Whenever there is a gross defect in the auricular
wall, there is free communication beetween the
two auricles. The usual direction of flow of
blood is from left to right because the pres-
sure in the left auricle is generally somewhat
higher than that in the right auricle. Complica-
tions consequent to the presence of this defect are
such that an attempt at closure would be very
beneficial. Cardiac arrhythmias are common.
Pneumonia, pulmonary infections and pulmonary
emboli are frequently encountered. Dilatation
of the right heart may take place and does take
place very frequently.
Attempts at closure of interatrial septal defects
have been proposed in various communications.
Cohn13 attempted the invagination of the wall of
the auricle and suture of this to the edges of the
defect. We have been in the process of preparing
an instrument which will work on a patch tech-
nique, as one patches a hole in a tire. This instru-
340
Minnesota Medicine
CARDIAC AND JUXTA-CARDIAC SURGERY— BARONOFSKY
ment will be inserted into the atrium and closure
of the interatrial defect will be attempted with the
use of a piece of pericardium held by means of
clips. There is no doubt that the ultimate answer
to intracardiac defects of this sort will be the
extracorporeal heart of Gibbon17 or Dennis.10
However, until the time arrives when this appa-
ratus shall have been perfected, some attempts
at closure should be made in salvage cases.
A word at this time about an unusual condition
associated with interatrial septal defect. This con-
dition is known as the Lutembacher syndrome.
This abnormality is an auricular septal defect
combined with congenital or acquired mitral ste-
nosis and enormous dilatation of the pulmonary
artery. The abnormal size of the pulmonary ar-
tery is an integral part of the abnormality. Mitral
stenosis, either congenital or acquired, increases
the strain on the right side of the heart, and in-
creases the dilatation of the pulmonary artery.
It is the great enlargement of the pulmonary artery
which differentiates this both clinically and at au-
topsy from other auricular septal defects. Dr.
Osier Abbott1 has attempted reduction in the size
of the pulmonary artery recently. He has
wrapped cellophane around the greatly dilated
vessels in an attempt to relieve some of the pres-
sure symptoms associated with this enlarged pul-
monary artery and possibly to reduce the pul-
monary blood flow. It is also interesting to note
that this condition is exactly the one that is being
produced in some cases of mitral stenosis, i.e., an
interatrial septal defect to relieve the pressure in
the left auricle.
Defects in the Ventricular Septum. — A com-
mon name for this disease is Maladie de Roger.
Essentially an interventricular septal defect may
be a high or a low defect. The high defect actually
differs from the Maladie de Roger in that, instead
of a perforation in the wall, the aortic septum
fails to meet the ventricular septum. This occurs
commonly in the tetralogy of Fallot or the Eisen-
menger complex. Generally speaking, when a low
defect is present, the prognosis in cases of a small
lesion is excellent. It is only in cases in which the
defect is so large that the arterio-venous shunt
causes changes in the pulmonary vessels that the
prognosis should be guarded. G. Gordon Mur-
ray27 recently has used an ingenious method in
attempting to close an interventricular septal de-
fect. By landmarking the projections of the in- -
terventricular septum, on the anterior and pos-
terior surfaces of the heart, he has pulled through
in an anterior posterior direction, pieces of fascia
lata and anchored them on the surface of the heart.
In this way he has been able to reduce the flow
of the left to right shunt that is present in an
abnormality of this sort. It is our intention to use
in this particular abnormality the instrument pro-
posed for use in the interatrial septal defect.
Anomalies of the Aortic Arch. — Anomalies in
the direction in which the aorta arches or ab-
normalities in the origin of the great vessels from
the arch of the aorta are by no means rare. They
may occur together or separately. When the
aorta arches to the right, the descending aorta
may lie either to the right or to the left of the
spinal column. If the aorta arches to the right and
descends upon the right, the condition is known
as a right aortic arch. When, however, the aorta
arches to the right and is drawn abruptly back
to the left and descends upon the left, the condi-
tion is known as a right aortic arch with a left
descending aorta.
Generally speaking, most of the anomalies do
not require surgical therapy. However, there are
some combinations in which, because of stridor,
dyspnea, cyanosis, hoarseness and cough, surgical
intervention is indicated :
1. The combination of a retro-esophageal right
aortic arch and left descending aorta, and a per-
sistent anterior arch. This is commonly known
as a double aortic arch or aortic ring. The trachea
and esophagus are included within the center of
the ring and constricted. Surgical therapy for
this anomaly requires division of the anterior limb
of the aorta between the origins of the left com-
mon carotid artery and the left subclavian. The
left common carotid artery is then tacked to the
back of the sternum so that it will not press on
the anterior surface of the trachea.21
2. A right aortic arch with the descending aorta
drawn to the left by a left ductus arteriosus.
There should be little difficulty in correcting this;
condition, as a division of the ductus will allow the
pulmonary artery to fall forward, thus giving:
more room for the trachea and esophagus.
3. Anomalous right subclavian artery. This
may give rise to a condition known as “dysphagia
April, 1950
341
CARDIAC AND JUXTA-CARDIAC SURGERY— BARONOFSKY
lusoria.” The right subclavian artery, instead of
arising in a normal way from the innominate
artery, has an origin from the left side of the
aortic arch so that the vessel must course upward
and to the right, crossing the midline, to reach
its normal exit on the right side of the thoracic
cage. In doing so, the vessel presses on the
•esophagus and produces symptoms at times. Sur-
gical therapy consists of division of this anoma-
lous vessel.22
Most of these conditions can be diagnosed with
accuracy by the instillation of contrast media in
the trachea and esophagus.
Coarctation of Aorta. — Coarctation of the aorta
is a narrowed or completely obstructed area of the
aorta. It has been classified as infantile or adult
in type. A good deal of overlapping of the two
types exists, and this arbitrary classification is
rather useless from a surgical viewpoint.
Surgical intervention in this disease was first
suggested by Blalock and Park,6 and first per-
formed on the human by Gross20 in this country
and Crafoord14 in Sweden. Operation offers
much hope to patients with this malformation.
Reifenstein, Lavine, and Gross,30 from a study of
cases of coarctation of the aorta in order to de-
termine the outlook for patients with this malfor-
mation, determined that subjects could be placed
in one of four groups : ( 1 ) about one-fourth live
far into adult life and old age with little or no in-
capacitation ; (2) about one-fourth die from bac-
terial endocarditis or aortitis at an average age
of twenty-eight years; (3) about one- fourth en-
counter sudden death from rupture of the aorta
at an average age of twenty-seven; (4) about
one-fourth die because of the hypertensive state
from congestive failure at an average age of
thirty-nine or from cranial hemorrhage at an
average age of twenty-eight. Thus, in summary,
it might he said that the average age of death of
the patient with coarctation is thirty-five, including
those patients who died from incidental causes.
In those who die from coarctation or one of its
complications, the average age at death is about
thirty.
Operation for correction of this abnormality
is successful and should be done. It is important
to note that in young subjects with coarctation the
pressures in the arms may be normal or slightly
elevated, whereas in older persons one may find
hypertension of moderate or marked degree.
Once the diagnosis is made, it is my feeling that
operation should be undertaken whether hyper-
tension is marked or absent.
The operation that has been done to date has
been a resection of the coarctation with an end-to-
end anastomosis of the aorta. A patent ductus,
if present, should be transected and ligated also.
Gross recently has reported on the use of arterial
grafts in the cases of coarctation in which it is
impossible to bring the two ends together. In
this recent report of Gross’s,23 he reports 100
coarctations in which surgical exploration was car-
ried out in ninety-one. Eleven deaths have re-
sulted, of which seven were felt to have been
preventable by certain changes in surgical tech-
niques, or which could have been prevented by
declining operation in view of the presence of
certain co-existing cardiovascular complications.
All in all, the procedure of resection and end-to-
end anastomosis of the aorta is a tried and thor-
oughly successful procedure.
Anomalies of the Aortic Valve and the Ascend-
ing Aorta. — Congenital aortic stenosis may be
caused by an abnormal calcification of the aortic
valves. Subaortic stenosis is caused by the per-
sistence of a band or membrane of connective
tissue which lies immediately beneath the aortic
valves. It may be possible to section these ob-
structive mechanisms by the use of a valvula-
tome. Smithy,33 before his untimely death, had
perfected an experimental technique for aortic
valvulotomy. It may indeed be possible in the
future to section a stenosed aortic valve.
Malformations Which Deprive the Body of an
Adequate Amount of Oxygenated Blood
The Tetralogy of Fallot. — Another brilliant
chapter in the treatment of congenital heart dis-
ease was written by Blalock and Taussig.7 The
description by Fallot of a combination of anatom-
ical abnormalities served to focus attention upon
certain patients in the so-called “cyanotic group”
of congenital heart disease. In this condition
there is pulmonic stenosis or atresia, an interven-
tricular septal defect, an aorta which overrides the
septal defect and right ventricular hypertrophy.
The severity of the cyanosis depends, in addition
to other conditions, upon the degree of the pul-
monic stenosis and the degree of overriding of the
aorta. It is known that at least 5 grams of re-
duced hemoglobin per 100 cubic centimeters of
circulating blood are necessary in order to pro-
duce obvious cyanosis.
342
Minnesota Medicine
CARDIAC AND JUXTA-CARDIAC SURGERY— BARONOFSKY
The most important element of the contribution
of Blalock and Taussig is the conception of the
part played by an inadequate pulmonary flow.
As a result of this, they postulated that the cyan-
osis and disability could be relieved by improving
the blood supply to the lungs by anastomosing a
systemic artery to a pulmonary artery. The proof
of the correctness of this postulate lies in the good
results of their operation. Cyanosis is often
completely relieved and is always greatly lessened
when a satisfactory anastomosis is possible ; the
disability is also greatly relieved. As the venous-
arterial shunt persists, it may be impossible, ex-
cept in the slighter cases, to relieve the cyanosis
completely, at any rate after exercise.
There is no place where greater co-operation is
necessary between internist, roentgenologist, anes-
thetist, nurse, and surgeon than in the treatment
of this anomaly. Team work is essential. With
the introduction of cardiac catheterization, it was
assumed that this would be the entire answer to
diagnosis. However, we now know that the in-
formation afforded by cardiac catheterization is
essentially complementary to other investigations.
The essential criteria for successful completion
of the operation on a patient are : (1) the primary
difficulty must be lack of adequate pulmonary
blood flow ; (2) there must be a pulmonary artery
to which the systemic artery can be anastomosed ;
(3) a systemic artery must be available for an-
astomosis; (4) the difference in pressure between
systemic and pulmonic circulation must be such
that blood will flow from aorta to pulmonary ar-
tery; (5) lung structure must be such that the
patient can survive collapse of one lung and occlu-
sion of one pulmonary artery; (6) the structure of
the heart must be such that it can adjust to the
altered circulation.
Having satisfied these postulates one may now
choose various procedures. Blalock’s preference
has been the anastomosis of a subclavian artery
to the pulmonary artery in an end-to-side manner.
At times he has used the innominate or carotid
artery. However, the mortality with use of the
latter is rather high. Potts29 has introduced a
modification which utilized an ingenious clamp for
direct anastomosis of the aorta to the pulmonary
artery. The great advantage of the Potts opera-
tion lies in those cases in which the subclavian
artery is too small or too short. Our experiences
with the Potts procedure, though limited, suggest
that it isn’t technically very difficult to do. On
the other hand, if it is possible to perform a Bla-
lock type of operation, it would appear unjustifi-
able to choose deliberately to use the aorta instead.
Although pure valvular stenosis does occur in
Fallot’s tetralogy, it is certain that infundibular
stenosis is more common. A moment’s reflection
shows that if it were possible to relieve this in-
fundibular stenosis directly, it would be far better
than short-circuiting it as in Blalock’s operation.
Brock,8 of England, suggests another important
advantage would be conferred by the operation.
In Fallot’s tetralogy, the cyanosis and disability
are due to two things — the pulmonary stenosis,
which allows too little blood to go to the lungs,
and the septal defect with an overriding aorta
which allows a mixing of venous with arterial
blood. The Blalock operation increases the blood
supply to the lungs, but does not relieve the right-
to-left intracardiac shunt. If the pulmonary-
stenosis is severe, the blood in ventricular systole
cannot pass quickly enough into the pulmonary
artery, and must be diverted into the overriding-
aorta ; if the degree of pulmonary stenosis is
slight, a far greater portion of the blood can pass
into the pulmonary artery, and a correspondingly
smaller amount passes into the aorta. The efifect
of direct operation upon the pulmonary stenosis,
and of relieving the obstruction to the outflow of
the right ventricle will be not only to increase the
amount of blood going to the lungs, but to lessen
the amount passing through the shunt and causing
venous arterial mixing. On this basis Brock has
now operated upon five patients, and either re-
sected a portion of the infundibular wall or dilated
the stenosis manually.
Defective Development of the right ventricle
and Tricuspid Atresia. — Inasmuch as the primary
difficulty is lack of circulation to the lungs and
the pulmonary pressure is low, the operation devel-
oped by Blalock and Taussig may prove of bene-
fit in this condition.
Pure Pulmonary Stenosis. — In its simplest
form, pure pulmonary stenosis may consist of a
pure valvular stenosis with no interventricular
septal defect. In most of these cases, cyanosis is
absent or slight. The most frequent complica-
tion is the gradual production of a right heart
failure. The correct treatment for this condition
is relief of the valvular obstruction by valvulot-
omy. Brock has recorded five successful trans-
Apiur., 1950
343
CARDIAC AND JUXTA-CARDIAC SURGERY— BARONOFSKY
ventricular valvulotomies. The specially designed
valvulotome is inserted in the right ventricle and
passed up into the pulmonary artery.
Complete Transposition of the Great Vessels
and the Common Associated Anomalies. — Com-
plete transposition of the aorta and pulmonary
artery is a congenital anomaly that is relatively
common. In this abnormality, the aorta arises
from the ventricle receiving oxygenated blood.
Blood that is pumped by the left ventricle through
the pulmonarv artery to the lungs returns by the
pulmonary veins and left auricle to its point of
origin in the left ventricle. In other words, there
is transposition of the great arteries without
transposition of the great veins. Generally speak-
ing, there is some degree of communication be-
tween the two arculations by way of septal defects
or other abnormalities.
Blalock recently has subjected a group of pa-
tients with transposition to surgery. The opera-
tions fell into three main groups:
1. The construction of extracardiac shunts,
either venous or arterial.
2. Creation of an auricular septal defect.
3. Combination of these two methods.
Blalock states that the combined procedures
seem to offer likelihood of improvement. Though*
most of the patients have survived the operative
procedure itself, the postoperative mortality is
high. However, some hope to these unfortunate
individuals is offered by the fact that some im-
provement has been made.
Anomalies of the Venous Return. — On occa-
sion one of the pulmonary veins may enter the
right auricle. This condition may not necessarily
cause any immediate concern, but as adulthood
is reached, an added strain may be put on the
heart. The diagnosis is essentially one of cardiac
catheterization. If and when this is made, sur-
gical intervention is indicated. The vein is ligated
or the lobe of lung, which it is draining, removed
- — probably the latter.
It must be added here, that the association of
interauricular septal defects with this other an-
omaly is frequent. We have had occasion to ex-
plore a case of anomalous pulmonary vein, only
to find that the catheter had passed through the
septal defect into the normal opening of the vein
in the left auricle.
Acquired Abnormalities
Sequelae of Rheumatic Heart Disease
Mitral Stenosis. — The need for a safe technical
approach to the surgical treatment of chronic
valvular disease of the heart has been recognized
for many years. The idea is not new, as the sur-
gical treatment of mitral stenosis was first sug-
gested by Brunton9 in 1902. In 1913 Dogen at-
tempted actual dilatation of a stenosed pulmonary
valve. In 1929 Cutler and Beck15 summarized
their personal experiences in the surgical treat-
ment of eight cases of mitral stenosis and added
four collected cases of chronic valvular disease
subjected to operation. The mortality for the en-
tire group was 83 per cent. Since that time much
progress has been made in the field of thoracic
surgery. These advances, combined with recent
developments in chemotherapy and a sounder
present-day concept of the prevention and treat-
ment of shock, minimize many of the former
hazards, and should permit reapplication of cer-
tain methods with significant reduction in mor-
tality.
Valvulotomy. — Anatomically, the stenosed mi-
tral valve can be reached by a suitable instrument
by way of either the left ventricle or left auricle,
ft is not yet entirely clear as to which is the better
approach. Objections have been raised as to the
thinness of the auricular appendage wall. Our
experiences with this segment of auricle have
been that, quite the contrary, it is at times most
thickened. Another objection has been the pos-
terior position of the left auricle. Our experi-
ence in operating on patients with mitral stenosis,
in order to ligate the auricular appendage, has
been, that with extreme cardiac enlargement, the
greatly dilated left atrium pushes the appendage
anteriorly into the operative wound. With a
curved valvulotome, much after the type that
Harken has used, we are proposing to enter the
left auricular chamber rather than the ventricle.
In order to enter the left auricle by way of the
left ventricle, it is necessary to dislocate the heart,
which may lead to irregularities.
Valvulotomy has been performed recently by
Harken, and Smithy. Sections of the leaflets are
removed, particularly the posterior leaflet, Har-
ken reports valvuloplasty in two patients with one
death, while Smithy reports the successful ex-
cision of a segment of the stenosed mitral leaflet
344
Minnesota Medicine
CARDIAC AND JUXTA-CARDIAC SURGERY— BARONOFSKY
in three of seven patients. It is interesting to
remark that one of his successful results is a
technician now working in a Saint Paul hos-
pital.
The exact indications for any procedure on the
rheumatic mitral stenosed heart are not exactly
clear yet. We wil not go into this, as we feel
that a careful discussion by surgeons and intern-
ists is in order before definite conclusions can be
reached. However, it is our feeling that this
must be done soon, as surgery has definitely some-
thing to offer the patient with rheumatic mitral
stenosis who cannot be controlled medically.
Commissurotomy. — In resection of part of the
stenosed mitral valve, one inevitably creates an
insufficiency. Are some types of insufficiency bet-
ter borne than others? Ideally, surgical inter-
vention should restore perfect valvular action ;
then the correction of obstruction in the light of
the associated degree of insufficiency that is im-
mediately produced, would not come under con-
sideration. Bailey has approached this problem
by an ingenious method of dividing the mitral
valve at the fused commissures under digital con-
trol, a procedure which he has called commis-
surotomy.
Interatrial Septal Defect. — The interesting ob-
servation first reported by Lutembacher, that pa-
tients with mitral stenosis who have a co-existing
patent interauricular septal defect, do not usually
suffer from paroxysms of pulmonary edema, has
led to the suggestion that such a defect might be
created artificially in cases of mitral stenosis.
Harken has created a defect in humans by means
of a specially devised valvulotome. Blalock has
attempted this procedure and used it in cases of
transposition of the great vessels. We have ex-
perimentally used the approach of anastomosing
the auricular appendages, either directly or by
means of a vein graft.32 By this method the
interauricular defect, which is in effect produced,
can be made under direct vision and can be broken
down immediately, should the condition of the
patient warrant it.
Pulmonary Vein to Azygos Vein Anastomosis.
— Sweet34 as used still another approach. He has
anastomosed the superior segment branch of the
inferior pulmonary vein to the azygos vein, thus
creating a communication between the systemic
and pulmonary circulations. Whereas the pul-
monic circulation is a closed circuit, the systemic
venous return is not; thus the right pressure
within the left auricle can be distributed over a
greater area.
Sympathectomy. — Some cases of mitral stenosis
may not be considered candidates for cardiac in-
tervention. This category includes patients whose
incapacitating symptoms, particularly attacks of
pulmonary edema, are associated with rapid heart
action that cannot be controlled by medical meas-
ures. For this group of patients, a palliative
procedure may be the removal of the cardiac
sympathetic accelerator and afferent nerves.
Ligation of Auricular Appendage. — One of the
most common causes of peripheral arterial emboli
is rheumatic mitral stenosis. This disease occa-
sions a showing of blood within the left atrium and
left auricular appendage. This stasis of blood,
coupled with auricular fibrillation, leads frequently
to thrombus formation in the left atrium. These
thrombi are the most common antecedents of
peripheral emboli in rheumatic heart disease. The
most common location of a thrombus in the left
atrium is the left auricular appendage. Surgical
efforts in eliminating embolization from this
source, subsequent to rheumatic mitral stenosis
would be of benefit.
Following preliminary animal experiments, sim-
ple ligation of the appendage at its junction with
the left atrium was performed in three patients.2
All of these patients had evidence of embolization
and rheumatic mitral stenosis. In two of the
patients, a total of three successful embolectomies
of the extremities were performed previous to the
auricular appendage ligations. The patients all
withstood the procedures with surprising ease
and the postoperative convalescence was unevent-
ful.
Coronary Heart Disease
Interest in the surgical approach to the problem
of coronary heart disease was stimulated by
Claude Beck,4 who formulated the concept of the
“trigger zone” of myocardial anoxemia and of a
prophylactic “blood bath” to such a functionally
impaired area. He emphasized the fact that com-
plete occlusion of all branches of a coronary
artery, however small, supplying a given area of
the heart resulted in far more rapid and irrever-
Aprii., 1950
345
CARDIAC AND JUXTA-CARDIAC SURGERY— BARONOFSKY
sible damage to myocardial function than partial
occlusion of much larger vessels.
Beck’s first operation involved covering the
heart with a flap of the pectoralis major muscle
and suturing it to the parietal pericardium, using
the vessels of that muscle as a source for a collat-
eral blood supply. In subsequent studies he ef-
fected a new blood supply to the heart through
vascular adhesions resulting from mechanical
abrasion and chemical irritants.
O’Shaughnessy28 used the omentum as a source
for a collateral blood supply, bringing it up
through the diaphragm and suturing it to the
surface of the heart. Lezius,26 on the other hand,
utilized the lower or middle lobe of the left lung
as a source for collateral blood supply. More
recently, Carter11 of Cincinnati has utilized the
same approach.
Fauteux,16 although not attempting to produce
collateral coronary circulation, sought to relieve
the symptoms of coronary heart disease by com-
bining coronary vein ligation with pericoronary
neurectomy. This, in effect, allows for arterial
blood stasis, and therefore, absorption of more
oxygen by the myocardium.
Recently Beck has utilized a new principle in
treatment of myocardial infarction. Utilizing the
coronary sinus as a new arterial pathway he has
anastomosed a segment of artery to this channel
as a direct bridge between the aorta and coronary
sinus. It is his finding that a real revasculariza-
tion of the heart takes place — blood getting into
any ischemic area by the “back door,” so to speak.
It must be finally mentioned that excision of
infarcted areas of myocardium may be a therapy
of the future. Murray found that in experimen-
tally produced cardiac infarction, the infarcted
area became dilated and functionally ineffectual
from the time of arterial occlusion. By controlling
the dilatation by excision of the dilated area and
immediate suture, he was able to save the lives of
many of his animals.
Constrictive Pericarditis
This acquired disease of the pericardium has
succumbed to surgical intervention. When the
diagnosis is made, and the sometimes associated
tubercle bacillus found, then streptomycin and
early operation are indicated. The results to
date have been excellent. In a recent follow-up
of eleven cases followed up to eleven years post-
operatively, the majority of the patients, in whom
a good decortication was possible, are at full work.
Pump Oxygenators
Finally we come to the ultimate in cardiac sur-
gery— the extra-corporeal heart. By this method
it will be possible to completely by-pass a blood-
less heart and yet pump oxygenated blood into
the arterial system. Through the ingenious ef-
forts of Gibbon, this work was begun in 1939, and
is still continuing. Dennis has been working on
a similar machine. It can be said that the solu-
tion to this most amazing problem will surely
come in the near future. Both of these workers
have been able to keep animals alive for periods
of time. There are problems still to be solved
before a fool-proof apparatus is available.
Summary
A summary of some of the work on cardiac
and juxta-cardiac surgery is presented. Surgery
within this field is progressing rapidly. It is
essentially due to the great progress made in the
physiology of the chest and in vascular techniques.
A co-operative spirit between all members of the
medical profession concerned in the care of indi-
viduals with acquired or congenital heart disease
is a necessity in the furtherance of this field.
The future of cardiac surgery holds great prom-
ise as shown by the studies made in experimental
surgery of this type.
References
1. Abbott, O. A.: In Taussig: Congenital Malformations of
Heart. Commonwealth Fund, 1947.
2. Baronofsky, I. 1).. and Skinner, A.: Unpublished report,
1949
3. Beck, C. S.: The development of a new blood supply to the
heart by operation. Ann. Surg., 102:801, 1935.
4. Beck, C. S.: Principles underlying the operative approach
to the treatment of myocardial ischemia. Ann. Surg., 118:788,
1943
5. Beck, C. S.; Stanton, E.; Batuchock, W., and Lester, E. :
Revascularization of heart by graft of systemic artery into
coronary sinus. J.A.M., 137:436, 1948.
6. Blalock, A., and Park, E. A.: Surgical treatment of experi-
mental coarctation of aorta. Ann. Surg., 119:445, 1944.
7. Blalock, A., and Taussig, H. B.: Surgical treatment of mal-
formations of the heart in which there is pulmonary stenosis
or pulmonary atresia. J.A.M.A., 128:189, 1945.
8. Brock, R. C. : The surgery of pulmonary stenosis. Brit. M.
J., 2:399-406, (Aug. 20) 1949.
9. Brunton, L. : Preliminary note on possibility of treating
mitral stenosis by surgical methods. Lancet, 1 :352, 1902.
10. Carlson, K. E. ; Dennis, Clarence; Sanderson, D., and Cul-
mer, C. : An oxygenator with increased capacity: multiple
versatile revolving cylinders. Proc. Soc. Exper. Biol. & Med.,
71:204, 1949.
11. Carter, B. N. ; Coll, E. A., and Wadsworth, C. L. : An
experimental study of collateral coronary circulation produced
by cardiopneumopexy. Surgery, 25:489, 1949.
12. Christie, A.: Normal closing time of the foramen ovale and
the ductus arteriosus. Am. T. Dis. Child., 40:323, 1930.
13. Cohn, R. : Experimental method for closure of interauricular
septal defects in dogs. Am. Heart J., 33:453, 1947.
14. Crafoord. C., and Nylin, G. : Congenital coarctation of the
aorta and its surgical treatment. J. Thoracic Surg., 14:347,
1945. „ . ,
15. Cutler, E. C., and Beck, C. S. : Present status of surgical
procedures in chronic valvular disease of heart: final report
of all surgical cases. Arch. Surg., 18:403, 1929.
16. Fauteux, M.: Treatment of coronary disease with angina by
pericoronary neurectomy combined with ligation of the great
cardiac vein. Am. Heart J., 31 :260, 1946.
17. Gibbon, J. H„ Jr.: Artificial maintenance of circulation dur-
ing experimental occlusion of pulmonary artery. Arch. Surg.,
34:1105, 1937.
(Continued on Page 369)
Minnesota Medicine
346
BANTI'S DISEASE
Report of Two Cases Treated by Splenectomy and Later Gastrectomy
CHARLES E. REA. M.D., WERNER W. AMERONGEN, M.D., and CHARLES H. MANLOVE, M.D.
Saint Paul, Minnesota
HP HE purpose of this paper is to evaluate the
various treatments of Banti’s disease and cir-
rhosis of the liver. Really, what will be discussed
is the treatment of portal hypertension and its
sequelae.
Portal hypertension has been divided into two
main groups (Whipple) : those having intrahe-
patic block and those having extrahepatic portal
block. In the first group is included the cirrhoses
and in the second group cases of fibrous replace-
ment and/or thrombosis of the portal vein or of a
main tributary, cavernous transformation of the
portal vein or it's tributaries, stenosis of the por-
tal vein, et cetera. Banti’s disease belongs in the
second group.
In 1894 Banti described the symptom-complex
which bears his name. There are three stages of
the disease : ( 1 ) the anemic phase, with spleno-
megaly, asthenia, and occasional gastrointestinal
hemorrhages; (2) transitional stage, with oliguria,
urobilinuria, hepatomegaly, pigment disturbances
of the skin and increasing gastrointestinal dis-
turbances; (3) ascitic stage, with atrophy of the
liver, hemorrhage, and death.
It is interesting that one of the workers in
Aschoff’s laboratory studied the original sections
of the spleens described by Banti and found no
difference between them and those of Laennec’s
cirrhosis. It is often stated that Banti’s disease
is just another phase of cirrhosis of the liver.
In Banti’s disease the “cirrhosis” starts in the
spleen and then goes to the liver, while in Laen-
nec’s cirrhosis, the fibrosis starts in the liver and
ends up in the spleen. While it is true that late
cases of Banti’s disease and cirrhosis may be in-
distinguishable, certainly earlier in the disease, the
enlargement and fibrosis may be limited to the
Dr. Rea is from the Department of Surgery, University of
Minnesota Medical School.
Dr. Amerongen is on the staff, Bethesda Hospital, Saint Paul,
Minnesota.
Dr. Manlove is resident pathologist, Ancker Hospital, Saint
Paul, Minnesota.
Presented before the Minnesota Academy of Medicine, Saint
Paul, Minnesota, December 14, 1949.
One of the best reviews on portal hypertension is that by
Baronofsky.2 His paper has been widely quoted in this article.
spleen with no appreciable involvement of the
liver.
As to etiology, Banti’s syndrome may be caused
by various mechanical disturbances of the portal
system. These have been listed by Baronofsky
as follows :
1. Thromboses of the splenic and/or portal veins.
(Warthin, 1910, Opitz, 1924, Rosenthal, 1925, Wall-
gren, 1927, Wilson and Lederer, 1929, Noble and
Wagner, 1933, Mallory, 1934, Smith and Farber,
1935, Klemperer, 1938.)
(a) Various inflammations of the upper abdomen
(pancreatitis, et cetera).
(b) Acute infectious diseases.
(c) Infectious processes in spleen itself.
(d) Primary degeneration in vein wall akin to
atherosclerosis of arteries.
(e) Trauma.
2. Cavernomatous transformation of the portal vein.
Beitzke (1910) and Hart (1913) were of the
opinion that this is a typical congenital malforma-
tion. Risel (1909), Verse (1910), and Emmerich
(1912), believed that the cause of this must be
sought in a thrombosis of the portal vein followed
by organization and recanalization. Pick (1909)
on the other hand argues that this is a neoplastic
lesion, an angioma, or cavernoma of the hepatoduo-
denal ligament, inasmuch as in some cases the
process extends far beyond the limits of the portal
vein.
3. Stenoses of the portal vein. (Leon-Kindberg,
1914.)
4. Compression of the portal or splenic veins from
without.
(a) Adhesions from, previous peritonitis (Smith
and Farber, 1935).
(b) Enlarged lmyph nodes (Smith and Farber,
1935).
(c) Gallstones (Armstrong, 1906).
5. Congenital narrowing of the portal bed in liver.
(Moschokowitz, 1917.)
6. Cirrhosis of the liver.
7. Congestive splenomegaly without cirrhoses. (Rol-
leston, 1914, Larrabee, 1934, Eppinger, 1937, Rous-
selot, 1940.)
What causes death in the late stages of Banti’s
disease and cirrhosis of the liver ? First : hemor-
rhage. In reviewing the cases of cirrhosis of the
liver and Banti’s disease seen at Ancker, Bethesda,
April, 1950
347
BANTI’S DISEASE— REA ET AL
TABLE I. INCIDENCE OF HEMATEMESIS IN BANTl’s
DISEASE AND CIRRHOSIS OF THE LIVER
Hospital
No. of
Cases
Hemorrhage
Died
Died of
Hemorrhage
Ancker
231
29
—
20
Bethesda
49
8
15
7
Miller
45
8
—
—
St. Joseph’s
83
32
35
16
Miller and St. Joseph’s Hospital, Saint Paul, Min-
nesota, over a ten-year period, it was noted that
of patients who came in with hematemesis, over
half die from this complication (Table I).
Secondly, some patients with Banti’s disease
and cirrhosis of the liver die of hepatic insuffi-
ciency. Hepatic insufficiency greatly increases the
risk of any surgical procedure. It is well known
that such patients do not stand anesthesia well.
Cirrhosis of the liver with ascites is not a con-
traindication to surgery as hepatic insufficiency
may not follow for a long time.
Thirdly, some of the patients with Banti’s dis-
ease succumb to intercurrent infection.
It is important to know how long a patient will
live with Banti’s disease or cirrhosis of the liver
without any treatment. This is impossible to state
as there is no series in the available literature in
which such cases have been followed from onset
of the disease until death. After all, the cause
of these conditions is not known. All the physi-
cian can hope to do is to reverse or stop the
progress of the liver damage if it is not too far
advanced by means of diet, vitamins, et cetera.
All the surgeon can hope to do is to decrease
the portal hypertension or to control hemorrhage
from bleeding “esophageal varices.” The surgeon
should always attempt to have the patient live
more comfortably if not longer.
The treatment of Banti’s disease and cirrhosis
of the liver is aimed at the alleviation of the por-
tal hypertension or its sequelae. One of the most
serious of these sequelae is hemorrhage from rup-
tured esophageal varices. This complication may
be treated :
1. Conservatively, by blood transfusion, seda-
tion, et cetera, in the hope that the bleeding will
stop by itself.
2. Tamponade. By balloon attachments to a
Miller-Abbott tube it is hoped to exert pressure
on the bleeding esophageal veins and thereby con-
trol hemorrhage. However, it is difficult to place
or hold the distended balloon accurately. While
an occasional brilliant result is seen, the method
is unsatisfactory at present in most instances of
bleeding esophageal varices.
3. Injection of esophageal varices. This meth-
od was first introduced by Crawford and Frenck-
ner of Sweden in 1939, and popularized in this
country by Moersch. The method is akin to the
injection treatment of varicose veins of the ex-
tremity. It requires skill with the esophagoscope,
is at best palliative, and is of little value if the
vein is actively bleeding.
To relieve portal hypertension in cirrhosis and
Banti’s disease, the following methods have been
proposed :
1. Talma-Morrison operation. In this opera-
tion, an attempt is made to shunt the blood from
the portal to the systemic circulation by suturing
the omentum to the anterior abdominal wall ; by
forming adhesions between the liver and the
spleen with the vault of the diaphragm on the
anterior abdominal wall, and between the gall
bladder and the anterior abdominal wall. As
compared to control series, the patients do not live
longer nor do they show marked improvement ;
therefore, the operation has been largely aban-
doned.
2. Splenectomy. The rationale of splenectomy
in the treatment of portal hypertension is that re-
moval of the spleen decreases the circulatory portal
blood volume. It is commonly said that splenec-
tomy removes 40 per cent of the portal blood
volume. Probably more correct is the statement
that in normal animals the stomach and spleen
together supply about 40 per cent of the portal
blood, the spleen itself about 18 per cent. Re-
moval of the spleen could conceivably do some
good in early cases of Banti’s disease due to
thrombosis limited to the portal vein. As a
means of controlling hemorrhage from esophageal
varices, splenectomy leaves much to be desired,
as in the cases of Banti’s disease treated by
splenectomy over a ten-year period at Ancker,
Bethesda, Miller, and St. Joseph’s Hospital, Saint
Paul, over half had hematemesis afterwards. The
fact that one patient had hemorrhages twenty-
four years and another eighteen years after
splenectomy shows the necessity for studying
these patients over a long period of time (Table
II).
348
Minnesota Medicine
B ANTI’S DISEASE— REA ET AL
3. Eck fistula. In anastomosing the portal vein
and inferior vena cava (Eck fistula) the passive
congestion of all structures drained by the portal
system is relieved. There are several bad fea-
tures of this operation however.
5. Gastric resection. Before considering the
rationale of gastric resection to relieve portal
hypertension, the question of the source of hema-
temesis in portal hypertension should be discussed.
Tt is generally thought that the hematemesis comes
TABLE II. HEMATEMESIS AFTER SPLENECTOMY IN BANTl’s DISEASE
Miller Hospital
Hospital No.
Sex
Age
in Years
Splenectomy
Post-operative
hematemesis
Course
A-20290
F
40
+
—
L & W— 2 yrs.
A-23086
F
51
—
—
L & W.
A-2708
F
60
_
—
Died hemorrhage.
A-36287
F
27
+
+
Hemorrhage off and on
18 yrs.
A-1144
F
15
+
+
Died hemorrhage and as-
cites 4 yrs. later.
St. Joseph’s Hospital
D-12318
F
36
+ 1941
+
Died 1-19-47, Hemorrhage.
D-48314
M
21
+
+
Died 13 mo. later
Hemorrhage.
Ancker Hospital
A-26165
M
16
+
+
Died 2 yrs. later
Hemorrhage.
A-33489
M
17
+
—
P. O. peritonitis.
A-149017
M
44
+
—
L & W — 3 yrs.
A-l 26046
M
50
+
—
L & W — 5 yrs.
Bethesda Hospital
178064
M
19
+
Bleeds off and on 12 yrs.
181572
M
28
+
+ 48 hrs.
90 % gastric resection.
(a) Follow-up study of patients so treated has
shown that some of the patients have had
episodes of bleeding since operation and
post-mortem examinations on some have
shown occlusion of the anastomosis.
(b) In some cases fibrous or cavernomatous
transformation of the portal vein has made
the likelihood of being able to anastomose
either the main trunk or one of its larger
tributaries with the inferior vena cava,
even with utilization of a vein graft, im-
probable.
4. Splenorenal anastomosis. Anastomosis of
the splenic vein to the renal vein reduces the por-
tal hypertension, but the following objections
have been raised against this procedure :
(a) The operation may mean the sacrificing of
a normal kidney, although by the use of
an end to side anastomosis, it is not neces-
sary to sacrifice the kidney.
(b) In a certain number of cases, thrombosis
occurs at the site of anastomosis.
(c) In removing the lumbar veins, more col-
lateral circulation is often removed than
is obtained by the splenorenal anastomosis
(Learmonth).
from bleeding esophageal varices. The varices
may bleed as a result of injury. It hardly seems
reasonable to assume that the mere hydrostatic
distention of these veins and their eventual rup-
ture is the sole cause of the hematemesis (Bar-
onofsky). In some instances, there are no de-
monstrable lesions in the esophagus, but ulcers
or erosion of the cardia are present. There is
no good statistical evidence how often this occurs.
It is interesting that duodenal ulcers are often
found at post-mortem examination of cirrhotic
patients who have died of hemorrhage from rup-
tured esophageal varices. Of three patients at
Bethesda Hospital who died of the above condi-
tion, all had chronic duodenal ulcers. However,
at Ancker Hospital, of forty-five patients with
cirrhosis and esophageal varices, only two had
duodenal ulcers at death. How often duodenal
ulcers occur in hepatic disease is not known.
This incidence of duodenal ulcer in cirrhosis is
mentioned not so much as a source of hematemesis
as to emphasize the possible gastric acidity fac-
tor in injuring the esophageal and duodenal mu-
cosa.
Regurgitation of gastric digestive juice into
the esophagus is not an uncommon occurrence.
That acid has a harmful effect on a decreased or
April, 1950
349
B ANTI’S DISEASE— REA ET AL
injured esophageal mucosa is well known (Frie-
denwold, Feldman, and Zinn). Raronofskv and
Wangensteen have shown that witli impairment of
the nutrition of the mucous membrane of the
stomach, duodenum and esophagus due to ve-
nous pooling, these areas are lowered in resistance
and will be easy prey to the gastric digestive
juices. Wangensteen and Baronofsky in their
experimental work on portal hypertension ex-
plored the following theses :
1. If the acid peptic factor of gastric secretion is
important in the causation of erosions in the esophagus,
then extensive or total gastrectomy would eliminate this.
2. If the stomach drains into the portal circulation
and the esophagus into the caval, and there is a com-
munication between the two, then isolation of the esoph-
agus from the portal circulation by means of gastrectomy
should prove satisfactory in preventing hemorrhage.
3. If extensive gastrectomy were done, there would
be an additional reduction of blood inflow into the
portal system over the attending splenectomy.
Raronofsky found that in the presence of por-
tal hypertension in dogs an extensive (90 per
cent) gastric resection afforded real but not ab-
solute protection against histamine-provoked ulcer.
Normally, 75 per cent gastric resection affords
protection against histamine-provoked ulcer, but
this percentage affords no protection in the pres-
ence of portal hypertension.
Clinically, Wangensteen has stressed that one
must perform a total gastrectomy to afford abso-
lute protection against the esophageal bleeding in
portal hvpertension. Also, one must take into
consideration the liver function of the patient. Of
eight patients with portal hypertension treated
by gastric resection, four died, three having a defi-
nite impairment in liver function.
Phemister and Humphreys performed a total
gastrectomy and an esophagogastric resection for
bleeding due to Ranti’s disease. Esophagogastric
resection is a more direct approach to manage-
ment of esophageal varices as it separates the
esophagus completely from the higher venous
pressure of the portal circulation. Wangensteen’s
idea of the amount of stomach that it is necessary
to remove is physiologically sound and is of clin-
ical value. When, on exploration, the liver ap-
pears normal, as it usually does in Ranti’s dis-
ease, the measurement of the venous pressure in
one of the tributaries of the portal vein is impor-
tant. In thrombophlebitis of the portal vein, the
venous pressure wili be up, whereas in bleeding
350
from a silent, nonpalpable gastric erosion, the
venous pressure will be normal. For the latter
type of case, the conventional 75 per cent gastric
resection is adequate ; for the portal hypertension,
at least a 95 per cent resection should be done
(Wangensteen).
It should be recorded that a subtotal esophago-
cardiectomy does not control hematemesis in
Ranti’s disease. Scott and Longmire report such
a case, in which later a total gastric resection was
performed, eliminating all signs of hemorrhage
from the intestinal tract.
Two cases of Ranti’s disease are presented
which were treated by splenectomy and finally a
gastric resection.
Case 1. — The first patient was a white man, thirty-
seven years old. At the age of seven years, his spleen
was removed for “splenic anemia." Six weeks before
admission to the hospital he had a gastrointestinal study
because of epigastric distress, fullness and loss of appe-
tite. The x-ray report states that he had active duodenal
ulcer. The day before admission to the hospital, the
patient had a hematemesis which, in spite of transfusion,
sedation and rest, persisted. The preoperative diagnosis
was bleeding duodenal ulcer. At operation, no ulceration
could be felt or seen in the duodenum or stomach. At
the esophagocardial junction were large varices. The
bleeding from esophagus was so profuse that it was
packed temporarily with gauze to partially control it. A
total gastrectomy was performed anastomosing the jeju-
num to the esophagus with an entero-enterostomy between
the limbs of the jejunum. The patient made an unevent-
ful recovery and has remained well and free from hem-
orrhage for three years.
Case 2. — The second patient was a twenty-seven-year-
old man who had “spleen trouble and hemorrhages” since
he was four years old. For two months before admis-
sion to the hospital he had noticed tarry stools and was
weak. He was admitted to the hospital in shock after
a massive hematemesis. The patient was transfused and
his general condition improved. On August 26, 1949,
a splenectomy was performed. An X00 gram fibrotic
spleen was removed. The liver appeared normal. With-
in forty-eight hours after splenectomy the patient had
hematemesis which practically exsanguinated him. He
was transfused until his blood pressure, pulse and hemo-
globin were at normal level, and on September 6, 1949,
a 90 per cent gastric resection was performed. Dilated
esophageal veins were noted at operation. The patient
has had no more hemorrhages three months after the
resection.
Summary
The current ideas concerning the treatment of
portal hypertension have been reviewed. In early
cases of Ranti’s disease due to thrombosis or
Minnesota Medicine
BANTI’S DISEASE— REA ET AL
thrombophlebitis of the splenic vein, splenectomy
may be curative ; however, splenectomy for hem-
orrhage due to bleeding esophageal varices in
Banti’s disease or cirrhosis of the liver is of
questionable value.
From an anatomic and physiologic point of
view, a total gastric resection or esophagogas-
trectomy is the procedure of choice in the treat-
ment of bleeding esophageal varices or lesions
of the cardiac end of the stomach in cirrhosis
of the liver or Banti’s disease.
How to evaluate an Eck fistula or splenorenal
anastomoses in the treatment of portal hyper-
tension is difficult, as not enough time has elapsed
to indicate the eventual outcome. The objections
to these procedures have been discussed.
Two cases of Banti’s disease are reported which
had been treated by splenectomy before a gastric
resection was performed to control hematemesis.
While these patients have been followed only
three months and three years respectively, the
results are encouraging enough to warrant gastric
resection in such patients in the future.
References
1. Banti, G. : Del l’anemia spleneca. Arch. d. surola d'Anat.
Pathol., Arch, di Annat. pat., 2:55, 1883.
2. Baronofsky, I. D. : Portal hypertension. Surgery, 25:135-
168, 1949.
3. Blakemore, A. H. : Portocaval anastomosis report on fourteen
cases. Buil. New York Acad. Med., 22:234, 1946.
4. Blakemore, A. H., and Lord, J. W. : The technique of using
vitallium tubes in establishing Portocaval shunts for portal
hypertension. Ann. Surg., 122:476, 1945.
5. Blalock, in discussion of Phemister and Humphrey, 1947.
6. Crafoord, C., and Frenckner, Paul: New surgical treatment
of varicose veins of the esophagus. Acta oto-laryng., 27:422,
1939.
7. Friedenwald, J.; Feldman, M., and Zinn, W. F. : Experi-
mental study of ulceration of the esophagus. Tr. A. Am.
Physicians. 43:315, 1928.
8. Moersch, H. J. : Treatment of esophageal varices by injec-
tion of a sclerosing solution. J. Thoracic Surg., 10:300,
1940.
9. Phemister, D. G., and Humphreys, E. M.: Gastro-esophageal
resection and total gastrectomy in the treatment of bleeding
varicose veins in Banti’s syndrome. Ann. Surg., 126:
397, 1947.
10. Wangensteen, O. H.: The ulcer problem (Listerian oration).
Canad. M.A.J., 53:309, 1945.
11. Whipple, A. O. : The problem of portal hypertension in rela-
tion to the hepatosplenopat'hies. Ann. Surg., 122:449, 1945.
Discussion
Dk. Ivan D. Baronofsky (by invitation) : I have
very little to add to Dr. Rea’s excellent discussion of
the subject. Dr. Rea is to be congratulated on his ex-
cellent results in the treatment of such a fatal disease.
I should like to present some of the experimental work
that was done while at the experimental surgery labora-
tory at the University, under Dr. Wangensteen. Before
I begin, I should like to mention that Dr. Longmire,
while at the Johns Hopkins Hospital, recently included
a series of some sixty total gastrectomies. One of these
gastrectomies was done for portal hypertension and bleed-
ing. In the laboratory, experiments were carried out
on dogs and on animals that were usually resistant to
April, 1950
the effects of histamine and beeswax, such as the rab-
bit. (Slides shown) In the rabbit it has been prac-
tically impossible to produce peptic ulcer or erosion by
means of histamine and beeswax. Dr. Lannin was finally
able to produce these lesions only when the animals had
been on a carrot juice diet for a period of at least two
weeks. The reason for the inability to produce ulcers,
without that type of diet, is probably that the rabbit’s
stomach is always filled with food. This food absorbs
the acid secretions and therefore this erosive factor is
not effective.
(Slides shown) Here is a slide that shows the effect
of portal hypertension on a rabbit’s stomach. This ani-
mal, in addition to the splenic tie procedure, has had
histamine and beeswax for three days. As you can
see there are multiple bleeding points and ulcers in the
entire specimen. A word here about the splenic tie
procedure. In some of the animals, if the splenic vein
is ligated distal to its junction with the gastroepiploic
vein, the blood will get back to the heart by way of the
esophagus and in effect a portal hypertensionlike syn-
drome is produced.
We then put this thesis to work in the dog. In
Dr. Wangensteen’s laboratory it has been found that
in order that complete protection from the ulcer diathesis
be obtained, one must do the following things in a
gastric resection for peptic ulcer : ( 1 ) a 75 per cent
gastrectomy, (2) removal of the antrum, (3) removal
of the entire lesser curvature, (4) a short loop anas-
tomosis. When these criteria were applied to a dog
with a splenic tie and the dog was given histamine
and beeswax for three to five days, no protection was
obtained. Tn other words portal hypertension greatly
accelerated the ulcer diathesis. In fact so much so
that a normal dog will easily get ulcers in five days
if cellophane is placed around the portal vein.
We then came to the conclusion that in portal hyper-
tension an even greater resection would be necessary.
We therefore gave a series of sixteen animals that had
had a 90 per cent resection and splenic tie procedure,
histamine and beeswax for a period of five days. All
the animals except two were protected against the ulcer
diathesis. In other words a 90 per cent resection could
afford protection in the great majority of animals, but
not all. One must therefore do either a total gastric
resection or something closely akin to such a pro-
cedure, in order to protect against the bleeding ulcer
diathesis associated with portal hypertension. In addi-
tion to removing the stomach, the spleen is also removed.
Thus, three things are accomplished: (1) the acid peptic
factor is removed, (2) there is a separation of the
stomach and portal blood flows, (3) about 40 per cent
of the inflow of the portal vein is removed.
Dr. C. I. Watson : This is a subject I have been
interested in for a long time. I was glad Dr. Rea pointed
out that there is such a thing as primary splenic fibrosis.
In recent years, clinicians and pathologists alike have
often said that what we have called Banti’s disease is
simply a congestive splenomegaly. Granting that this
is true in the majority of cases, I have nevertheless seen
a number of instances of diffuse splenic fibrosis with
351
B ANTI’S DISEASE— REA ET AL
esophageal varices in which there was no evidence of
cirrhosis of the liver, nor of disease of the portal vein.
1 believe, therefore, that there is a relatively small
group of cases of primary diffuse splenic fibrosis. I
recall one young man about twenty years of age with
a large spleen and repeated hematemesis. Liver function
was quite seriously disturbed (this case was studied
in the days before we were doing liver biopsies). He
died, and at autopsy his liver appeared histologically
normal. No evidence of disease in the portal or splenic
vein was found, but he did have esophageal varices.
The rationale of gastric resection for hematemesis due
to bleeding varices is quite interesting to me. I can
remember quite a number of instances of bleeding
varices seen at autopsy; if one does find the place that
bleeds, it is usually nothing more than a little slit in the
varix. If one ties off the great veins in situ before
the gastrointestinal tract is opened, one has a much
better chance of finding the bleeding varix. I have yet
to see a peptic ulcer or anything resembling it in a bleed-
ing esophageal varix, although it is true that a few
such instances have been recorded. I would say that,
by and large, the cause of bleeding from an esophageal
varix is an injury of the wall of the vein. With the
little protection these veins have, it is not too remark-
able that a slight injury can cause a tear or slit sufficient
to produce a massive hemorrhage. It should be noted
that these patients commonly have hypoprothrombinemia
and/or thrombocytopenia, to contribute to further bleed-
ing, once started.
To try to carry out any major surgical procedure in
a patient with cirrhosis of the liver is to invite disaster.
They do not tolerate anesthesia or prolonged operations
at all well. They easily develop hepatic coma after a
surgical procedure. I think it necessary to wait a long
while and accumulate a large series before any individual
method of treatment of bleeding varices can be judged.
It is well known that there may be long intervals, even
several years, between bleeding episodes in these cases.
Cirrhosis may be present for years in relatively static
condition. Ascites, with or without jaundice, no longer
offers the fatal prognosis in all cases, which used to be
assumed. In fact, cirrhosis isn’t quite as bad as we
used to think it was. The fatty cirrhosis group, related
to alcoholism and dietary deficiency, responds remark-
ably well to a good diet, if not too far advanced. The
bleeding varix problem, however, is a bad one, and we
don t have very much to do for it medically. The sug-
gestion has been made that direct tamponade of the
varices by means of an inflated condom type balloon
might be effective, and in fact, 1 believe that Dr. Hoff-
bauer has been successful in stopping bleeding with
this method, in some cases.
Dr. Clarence Dennis: I would like to ask if you
have any information on liver function after anastomosis
of the portal vein and the vena cava.
Dr. Watson : Not a great deal. Dr. Hanger tells
me that in some instances there has been a remarkable
improvement in liver function, the cephalin floccula-
tion and serum bilirubin at times decreasing significantly.
Since Dr. Hanger is a very careful student of liver dis-
ease, I am willing to accept the idea that at least some
of these individuals do have their liver function im-
proved by diverting the portal blood flow. ,
Dr. Rea (in closing) : The purpose of the gastric
resection in bleeding varices would be: (a) to reduce
the acid peptic factor of gastric secretion, which we
know is important in the causation of erosions of the
esophagus, and (b) to bring about an additional reduc-
tion of blood inflow into the portal vein over that
attending splenectomy.
The source of hematemesis in portal hypertension is
of interest. Bleeding esophageal varices are considered
the most common cause. While esophageal varices may
bleed from trauma, in the light of our experimental
knowledge, it is plausible that gastric acidity may
cause erosions of the esophagus and cardia of the stom-
ach with resulting bleeding without any trauma factor.
It should be noted that patients with obstruction of
the superior vena cava exhibiting esophageal varices
apparently do not bleed. Also it has been reported that
patients with unrelated diseases like coronary disease
may have esophageal varices.
Given a patient with bleeding esophageal varices, with
fairly good liver function, if the bleeding could not
be controlled by conservative methods, I should feel
safer performing a total gastrectomy at the present time
rather than doing any of the other procedures.
CANCER GRANTS TOTAL MILLION AND THIRD DOLLARS IN WEEK
Federal cancer grants totaling slightly more than one
and one-third million dollars were announced in the
last week. Seven universities and hospitals get $575,000
for construction of research, facilities, thirty-three
schools get $522,000 for teaching purposes, and the re-
maining $301,159 goes for control projects in twelve
states. Institutions sharing in construction grants are
North Carolina University ; South Carolina Medical Col-
lege; Wayne University; Children’s Medical Center of
Boston; Beth Israel Hospital, Boston; Boston University
School of Medicine ; and Iowa State University, College
of Medicine. . . . Over the past twenty-five months,
U. S. has approved grants of $210,000,000 toward con-
struction of 1,019 hospitals and health centers under the
Hill-Burton Act; total cost of the projects is more than
half a billion dollars, with the difference financed by
state, local and private institutions. Only 139 of the
institutions are in operation now, the remainder under
construction or in the blueprint stage. . . . Water pollu-
tion grants to states and interstate agencies are expected
to total just under one million dollars for the fiscal year
ending June 30. — A.M.A., Washington Office, March 14,
1950.
352
Minnesota Medicine
PSYCHIATRY IN GERIATRICS
WALTER P. GARDNER. M.D., F.A.C.P
Saint Paul. Minnesota
"DECAUSE of the scope of the problem of the
aged, it is felt worthwhile to review certain
psychiatric aspects of geriatrics.
It has been estimated14 that whereas in 1900 4
per cent of the population of the United States of
America were over sixty-five years of age, and in
1935 6 per cent, by 1980 approximately 14 per
cent will fall in that age group. Between 1930
and 1940 the increase in persons over sixty-five
was 35 per cent, whereas the increase in the general
population was only 7.2 per cent. The United
States Bureau of Census reported that in 1940
there were 8,956,206 persons more than sixty-five
years of age.
“White men now at the age of sixty-five can
expect to live an additional twelve and one-half
years and white women an average of fourteen
and one-half years.”19
To quote Doll5 : “Our goal should be to insure
that the major share of added years will lengthen
the period of prime rather than prolong the peri-
ods of dependent youth and decrepit old age. We
may welcome rather than fear the prospect of long
life only if the accumulated years are worth living
by adding to the sum of usefulness and happi-
ness of human life throughout its whole span.”
Maladjustments and behavioral breakdowns,
psychiatric problems, occur at a high rate in the
age group sixty-five and over. These include the
less severe psychiatric disorders such as mal-
adjustments in the mentally normal, mental aber-
rations, benign abnormal sexual behavior, alco-
holism, and certain psychoneurotic manifestations.
More grave psychiatric disorders, such as frank
psychoses and severe reactive depressions, also
occur. Physical, social, and psychological factors
are involved in their production.
As elsewhere in the body, certain alterations
occur in the brain with advancing years. Numer-
ous changes begin in all layers of the cerebral
arteries.1 The larger arteries show an extensive
intimal arteriosclerosis and a medial fibrosis.
Similar alterations occur in the smaller vessels.
They lead to narrowing of the lumen of the ves-
sel with resulting ischemia and encephalomalacia
Inaugural thesis presented at the meeting of the Minnesota
Academy of Medicine, December 14, 1949.
April, 1950
of the area supplied, and to increased fragility of
the vessel walls. The meninges become thickened
and opaque, and cerebral atrophy occurs, partic-
ularly in the frontal lobes. Diffuse nerve cell
changes, senile plaques, and less frequently neuro-
fibrillary degeneration as well as the vascular
changes are seen microscopically.
Since some brains show more evidence of these
changes at age fifty than others at age seventy-
five, it is obvious that chronological age is not the
only element at work here. Heredity as well as
various other factors influence this aging process.
These alterations need not lead to psychiatric
symptoms.
Changes incident to aging of other parts of the
body are important. Impaired absorption from
an atrophic gastrointestinal mucosa and loss of
teeth, with resulting undernourishment and vita-
min deficiency, are significant as are decreased
kidney function, endocrine imbalances6 and au-
ditory and visual impairments. Physical illnesses
and injuries act as causative agents in psychiatric
geriatric problems. They may precipitate the
physical changes of the aging process in the brain
and elsewhere in the body. Again they may be
the direct etiologic factor of the disorder, as for
example in psychoses due to brain trauma, due
to brain tumor, and in many other psychoses of
the organic reaction type.
Social elements play a role in producing mal-
adjustments and behavioral breakdowns in the
aged. The older person finds himself progres-
sively shunted away from both his work group
and his family setting. Employment is difficult
for him to retain, and once it is lost, extremely
hard to obtain. Members of his family group tend
to scatter into distant areas. His friends and rela-
tives progressively move away or die. He finds
himself more and more without firm social ties.
One etiologic factor of a psychologic nature is
the underlying personality makeup. It would
appear that persons of a stable personality tend
to withstand considerable amounts of cerebral
damage and environmental pressure without ex-
hibiting serious psychiatric manifestations, where-
as individuals who have been poorly adjusted or
inadequate earlier in life are more likely to fare
353
PSYCHIATRY IN GERIATRICS— GARDNER
badly under such attacks. Evidence is increasing
that social and psychological factors are very
significant in the etiology of these prob-
lems 12»13>15»16»20
Many persons live to advanced years with little
apparent interference with their mental function-
ing. However, frequently simple adult malad-
justment occurs in such persons. When it does,
it resembles the same syndrome as seen in earlier
periods of life. When mental changes do appear,
they are of one or usually more than one of three
types — intellectual impairment, affective abnor-
malities, and conduct disorders.
Certain alterations may be considered within
reasonable limits to be evidences of normal aging.
These limits admittedly are hard to define. They
may be termed “mental aberrations.” Some are
essentially exaggerations of previously existing
personality traits. The person fatigues very read-
ily on physical or mental exertion. He is less
alert, less able to concentrate over periods of time,
less able to assimilate new knowledge, and less able
to retain experiences of all types and to recall
them at will. A narrowing of the span of interest
and fixation of ideas, especially upon bodily health,
may often be noted. Emotional instability may be
exhibited in easy and excessive swings of mood,
irritability, unwarranted feelings of well-being
with boasting, or in some instances by more or less
prolonged periods of mild depression. At times
mild feelings of persecution or unwantedness, i.e.,
paranoid trends, may be seen. The attitudes of
others may be a basis for these trends, or feel-
ings of, or fears of his own disintegration with
attendant anxietv may be projected into the en-
vironment. Overtalkativeness and reminiscing,
selfishness and self-centeredness, resistance to
change and willfulness may be apparent. Abnor-
malities in eating habits, including overeating or
refusal to take adequate nourishment, are com-
mon. Untidiness about the body and the clothing
and carelessness in toilet habits may present them-
selves.
Benign abormal sexual behavior may appear as
one of the mental aberrations or as the chief prob-
lem of an otherwise quite well adjusted aged per-
son. It is not uncommon to find such persons who
are not frankly psychotic exhibiting their external
genital organs or fondling the external genital or-
gans of others, particularly of the opposite sex.
This form of behavior is more common in males
than in females. Old men frequently annoy or
molest young girls. They make no attempt or
poorly conceived attempts to conceal their acts.
The resumption of masturbation and the reappear-
ance of desire for sexual intercourse with or with-
out functional potency may occur in advanced
years. The latter may lead to ill-advised mar-
riages. Such activities are preferred to as benign
in contradistinction to attempted rape, rape and
even more serious “sexual crimes” committed by
elderly persons who are seriously disordered men-
tally.
The basic factors lying behind the production
of geriatric psychiatric problems may lead to a pic-
ture colored chiefly by alcoholism, or again alco-
holism which began earlier in life may continue
into old age. Its treatment demands the employ-
ment of proper methods for the withdrawal of
alcohol, a plan of management such as other mal-
adjustments and behavioral problems require, and
in some instances more formal psychotherapy.
In geriatric patients the neuroses or psycho-
neuroses mav appear superimposed upon the back-
ground of symptoms referred to as normal in
aging persons, or they may be manifested by
individuals who are sound mentally. The symp-
toms are chiefly hypochondriacal in nature, al-
though anxiety states and simple reactive depres-
sions are not infrequently seen. Here again, in
addition to other general measures of management,
more. formal psychotherapy may be required in
their treatment.
A plan for the prevention of and management
of these minor psychiatric disorders of the aged
must include adequate attention to the individual’s
physical needs and the meeting of his psycholog-
ical and social needs. The family, the individual
himself, industry, the community (government)
and medicine and its allied sciences each have re-
sponsibilities in such a program.
Any consideration of the physical needs of
older persons must center about the prevention
inasfar as is possible of the development of and
the progression of chronic diseases, the treatment
of such diseases, the correction inasfar as is pos-
sible of physical defects and attention to adequate
nutrition.
The prevalence of chronic disease increases with
age although it is well recognized that it is not
a feature of old age alone. The most important
of the chronic diseases are various forms of heart
disease, arteriosclerosis, essential hypertension,
nervous and mental disease, kidney disease, tuber-
354
Minnesota Medicine
PSYCHIATRY IN GERIATRICS — GARDNER
culosis, diabetes, and asthma. Increasing atten-
tion is being given to the provision of adequate
facilities for the care of persons suffering from
such diseases in chronic disease hospitals, main-
tained usually as integral parts of general hospi-
tals, and in convalescent and nursing homes.
However, the fact remains17 that the majority of
persons who are chronically ill can be best cared
for at home and in the office and clinic. Rehabili-
tation rather than attention to acute needs must
be the kevnote of the treatment of these diseases.
Defects in hearing and vision should be cor-
rected inasfar as is possible. Proper dental care
is highly important. Other physical defects such
as certain surgical conditions and the physical
sequellae of cerebral vascular accidents and other
neurological disorders demand rehabilitation.
The importance of adequate nutrition at this
age and the problems involved, including the ad-
ministration of supplemental vitamins, has been
stressed8'18 in the literature.
Concurrent with efforts to provide him with
the best possible physical health, a program of
attention to the psychological and social needs of
the individual must be pursued. A major share
of this program must be carried out by the family.
They must be taught the nature of the patient’s
psychological needs. These have been delineated
by Laycock 11 as :
1. The need for affection. To live in reciprocal warm
regard with one or more human beings.
2. The need for belonging. To be a desired and desir-
able member of a group.
3. The need for independence. Reasonably to order
one’s own life and make one’s own decisions.
4. The need for achievement. To do things, to accom-
plish tasks, to create things and to find success.
5. The need for recognition. To feel that ones per-
sonality and conduct meet the reasonable approval of
one’s peers.
6. The need for self-esteem. To feel that one s per-
sonality and conduct come up reasonably well to one s
own inner standards.
It is the duty of the family or the family sub-
stitutes to help older persons fulfill these inter-
dependent and somewhat overlapping needs.
The need for affection is marked. Frequently
his mate, many of his friends and associates of his
own age and even some of his children have died
or are no longer near him. Those about him
must provide him with a feeling of emotional
security. If they do not, the aged person seeks to
gain attention, usually without realizing it, by ex-
aggerating his physical illnesses and other handi-
caps and by complaining that no one ever tells
him anything, that no one cares for him, and the
like.
The need for belonging obviously shades into
the preceding need. The older person must be
made to feel that he is a wanted member of a
group, ideally of a family group. The younger
members of the family should, where possible,
include the older person in their activities. Where
this is not feasible, he should be informed in ad-
vance what the others plan to do and why he
cannot participate in the activity.
The loss of independence is very difficult for
anyone to accept. . The older person loses much
of his feeling of independence when he is forced
to give up his life’s work. Children err as often
in the matter of overprotection as they do in fail-
ure to show affection. The older person resents
being watched too closely, being told to be sure
to dress warmly, to stay out of the rain, to stay
out of the sun, to eat more, to eat less, and the
like. These admonitions should be kept at the
minimum consistent with not seriously damaging
his health or life. Again an older person’s feeling
of dependence is increased by telling him directly
or by implication that he is not wanted in the
home, that he is being tolerated there, or that he
should be happy that his family is making such
a sacrifice to give him a “good” home. The aged
person should wherever possible maintain his
own residence to avoid such emotional strains.
The need for achievement is closely connected
with employment and other work or activities such
as hobbies in which the older person may engage.
Failure to attain some degree of success in such
outlets leads to maladjustments or more severe
reactions.
Again the need for recognition and approval
is tied in with accomplishment and usefulness.
Whenever the older person does enter into activ-
ity, he should be complimented by those about
him. If the only accomplishments he can point
to are those of the past, hear him out even though
the story has been heard many times before. He
should be complimented on past achievements as
well as present ones.
It is hard to surrender our place of activity
in a fast moving world, to accept the fact we
are deteriorating physically, that we are less alert,
that we cannot concentrate as we did before, that
April, 1950
355
PSYCHIATRY IN GERIATRICS— GARDNER
we forget recent events to our embarrassment, that
we are resistant to change — and still retain our
self-esteem. The family and those about the aged
person must make every effort to help him meet
his other psychological needs in order that he may
retain his self-esteem.
In dealing with an older person, all the psycho-
therapists, including psychiatrists and other physi-
cians, ministers, professional counselors, social
workers, volunteer social workers, employers and
the family, must take an optimistic attitude toward
him. They should emphasize the compensations
of getting older. These are : (1) accumulated wis-
dom ; (2) ability to balance the new against the old
and to give advice; (3) the wealth of experience
they have to draw upon, and (4) the value of
leisure time.
Let us consider now the attitude which the
older person must take toward old age if he is
to adjust well in the family setting or its substi-
tute. He must be brought to accept the fact that
he must lead a balanced life. In other words, he
must accept the fact that as he grows older the
proportion of his time spent at work must decrease
and the time spent in resting and sleep must be
greater, as must be the time spent in recreation,
hobbies, and just plain leisure. He must be
brought to realize that the world and the ways of
life are constantly changing and that the changes
are more rapid now than when he was a youngster.
Even then, as now, the ways of the grandchild
seemed queer or even wrong to grandparents.
He must be led to realize that he must relin-
quish his control over his children and that the
control of the grandchildren in the home is the
problem of the parents, not the grandparents.
The aged must be brought to look at old age as
an opportunity to do new things and things he
always wanted to do. He must learn to dele-
gate responsibilities in his work and to prepare
to give it up at least to a large degree.
Not all older persons can be brought to accept
these attitudes, but many can. Oftentimes other
persons than members of the family and the em-
ployer may be able to accomplish the engender-
* ing of these attitudes more effectively than those
immediately concerned with him.
The matter of getting older folk to be active
is worthy of some further consideration. Activity
now should be encouraged rather than contempla-
tion of past experiences and present problems.
Participation in women’s clubs, clubs for men,
hobbies including gardening, travel, collecting,
radio, and the like, are possibilities. Interest in
sports such as golf, bowling on the green when
available, and spectator’s sports may be fostered.
This “push to activity,” as it is often called, must
be carried out under careful guidance. There is
danger involved if some degree of success is not
attained. As Barker2 has pointed out, “When we
excite our older patient to activity, physical, men-
tal or social, the occupation recommended must
be one that can be carried on with at least some
feeling of success and without fatigue or exhaus-
tion. Failure is only too likely to affect a patient
dangerously. When the right occupation is found,
the physician must watch the effect carefully, con-
tinuing, increasing, or diminishing the activity
as seems best for the patient’s welfare.” The
family and others may well aid the physician in
this guidance if they are tactful.
Industry must recognize its responsibility to
the older person. It must employ more older per-
sonnel. In 1890, 74 per cent of the aged were
employed. In 1930 only 58 per cent were em-
ployed. The recent World War brought about an
increase in employment in this age group, but now
it has again decreased. In fact at present it is
difficult for a man or woman past forty years of
age to secure new employment.
The latest war demonstrated the value of older
experienced personnel, many of whom were re-
called from retirement. The older person should
be retained as long as is possible as a teacher or
advisor. He should be made to feel that his sug-
gestions are valuable and sought. Retirement does
not necessarily eliminate one as an advisor. It
is felt that private pension and industrial insur-
ance plans should be broadened and improved.
The community — government — must not shirk
its responsibilities to the aged. There is a ten-
dency for local units to slough the responsibility
for older persons to the state and federal govern-
ment. There has been an increasing trend toward
committing elderly persons to institutions as senile
rather than toward encouraging families and lo-
cal governmental units to assume the fullest pos-
sible responsibility for them. The best possible
environment should be provided. While the care
of the aged in the family setting has been stressed,
it has to be recognized that this environment is
not always the best one. At times a home for
the aged is better, or again a nursing or rest home,
or a county home. Some require care in a general
356
Minnesota Medicine
PSYCHIATRY IN GERIATRICS— GARDNER
hospital or a chronic disease hospital. Only when
other care is not feasible should institutional facil-
ities be employed.
Community centers for the aged providing suit-
able activities and guidance clinics should be fos-
tered and developed. Their value has been dem-
onstrated where they now exist.
Old age assistance plans are at present inade-
quate. We must provide the aged with the eco-
nomic security to the fullest extent now possible.
It is the duty of medicine and its allied sciences
to assist the aged person, his family, industry, and
the community in every possible way in carrying
out a program such as has been suggested. Its
interest should -not be limited to the individual
brought to its attention but should be directed
toward the vast problem as a whole.
Although it is true that the majority of the
psychiatric problems of the aged may be classed
as “minor,” the matter of frank psychoses in the
aged is rapidly increasing in size and importance.
Whereas the minor disorders may usually be man-
aged in homes, general hospitals and chronic dis-
ease hospitals, the psychoses as a rule require
psychiatric hospital care. In fact, the increase in
admission rates for such illnesses far exceeds the
increase in population rates of this age group.5
The accumulation of aged persons has become
one of the most difficult and one of the largest
problems of such hospitals.
Psychoses due to infection and exhaustion, to
exogenous toxins, such as drugs (especially bro-
mide) and -alcohol, to endogenous toxins, to
syphilis, to Parkinson’s disease, and to brain
tumor occur in old age, as well as in earlier life.
Their recognition depends upon their always be-
ing kept in mind by the physician. They are often
overlooked or misidentified. Their proper treat-
ment obviously depends upon their recognition.
Special care and skill are required in their man-
agement. The percentage of psychoses of first
admissions falling in this group is quite small.
The two main groups of psychoses occurring
in this epoch are those due to disturbances of cir-
culation, i.e., psychosis with cerebral vascular acci-
dents, psychosis with cardiorenal disease, and
psychosis with cerebral arteriosclerosis and senile
psychosis. Of those due to disturbances of cir-
culation, approximately 94 per cent fall in the
group psychosis with cerebral arteriosclerosis.
Psychoses due to disturbances of circulation
account for about 10.6 per cent of all psychoses
of first admission or about 14,000 such admissions
per year in hospitals of all types in this country.
Senile psychoses constitute about 7.8 per cent of
psychoses of first admission or about 10,000 such
admissions per year.
The early symptoms of psychosis with cerebral
arteriosclerosis and senile psychosis have been
described above under the term “mental aberra-
tions.” The hope from treatment lies chiefly in
the proper therapy and management of the pro-
dromal states. The clinical picture of psychosis
with cerebral arteriosclerosis may be stated briefly
as follows. As a rule the onset is gradual. Fre-
quently physical complaints such as peculiar
sounds or noises in the head, headache, dizziness,
tremors, paresthesias, transitory apoplectiform
episodes, epileptiform seizures and aphasia precede
or accompany the psychiatric symptoms. The
psychiatric symptoms may appear suddenly fol-
lowing injury, illness or an epileptiform or apo-
plectic seizure.
Emotional instability becomes marked. Uncon-
trollable outbursts of laughing or crying or of
anger are often seen. Persistent depression and
paranoid delusions as well as anxiety states may
occur. Confusion, disorientation, and memory de-
fects are common. Carelessness about clothing,
body and toilet habits becomes marked. Abnormal
sexual behavior of a severe nature may appear.
The patient is often restless both day and night,
and he may be given to outbursts of violence.
Aphasia not infrequently complicates the clinical
picture.
In senile psychosis, too, the mental aberrations
become progressively more pronounced. Confu-
sion, disorientation, memory defects, fixation of
ideas upon bodily health and upon past events,
confabulations and delusions of a persecutory,
grandiose or bizarre nature present themselves.
Reversal of sleep rhythm, untidiness, incontinence
and abnormal sexual behavior are common.
These two types of psychosis are often indistin-
guishable from one another clinically and patho-
logically. Patients with well-developed clinical
pictures may present only minimal pathological
changes. Again the reverse is oftefi-'true.
The treatment of the prodromal stages has been
stressed. When the frank mental disorder ap-
pears, hospitalization usually becomes necessary.
Careful attention to physical illnesses and defects,
adequate nutrition, attention to elimination, occu-
pational therapy and proper institutional environ-
April, 1950
357
PSYCHIATRY IN GERIATRICS— GARDNER
ment are important. These patients should be
cared for in one-story buildings especially de-
signed for their use. All activities should be
geared to a tempo suited to them. They should
not be subjected to the pressures of the more ac-
tive wards of the hospital. All employes con-
cerned with their care must be aware of the phys-
ical and mental limitations of such patients and
must be very tolerant and understanding of them.
Studies have been made to determine what
happens to patients in these two classifications
after admission to mental hospitals. For example,
Camargo and Preston3 reviewed 683 psychoses of
first admission, each of whom was over sixty-
five years of age upon entering Maryland State
Hospitals. They found that 85 per cent were
classified as psychosis with cerebral arteriosclero-
sis or senile psychosis. They noted that 16.7 per
cent died within the first month, 47 per cent
died within the first year and 66 per cent died
within three years after admission. At the end
of three years 66 per cent had died, 10 per cent
had been discharged and 24 per cent remained
in the hospital. The duration of life of these
patients was shorter than the average duration
expected for the general population of the same
age group.
Where the basic etiologic factor is irreversible
changes in the brain structure, true recovery is
not possible. However, where other physical
factors and psychological and social pressures
are the chief causative factors, recovery is pos-
sible. Palmer15 pointed out that there is a group
of patients diagnostically distinguishable from
true psychoses with cerebral arteriosclerosis and
senile psychoses only by the results of treatment
in whom the prognosis is good. His study was
based upon 123 cases legally committed to a
mental hospital and diagnosed as psychosis with
cerebral arteriosclerosis, or senile psychosis,
after three or four weeks of hospitalization, gen-
eral treatment and observation. He found that
nearly 25 per cent achieved social recoveries and
returned to their former occupations or to their
homes. Palmer stressed the need to eliminate any
infectious, toxic and exhaustive factors.
In addition to the types of frank mental dis-
orders of old age considered, there remains a
group composed of manic depressive reactions,
late involutional melancholias, paranoid states
especially with depressive features distinct from
cerebral arteriosclerotic and senile psychoses with
paranoid trends, and severe reactive depressions,
in which the use of electroshock therapy is often
of great value.
Gallinek,9 Feldman et al7 and others have
described the methods of treatment, the contrain-
dication and the results obtained. One may cite
as an example of the results obtained Gallinek’s9
report of seventeen cases. Of these seven
showed complete recovery, two marked improve-
ment, one no improvement, and five recovery or
improvement with subsequent relapse. The value
of maintenance electroshock therapy in those who
relapse was stressed.
Many articles have appeared in the literature
concerning cardiovascular pathology in its rela-
tionship to electroshock therapy. Our own ex-
perience leads us to agree with the conclusions
of Kalinowsky and Hoch,10 and Rowe and
Schiele.21 There is some degree of risk in using
this form of treatment in persons with normal
hearts, and this risk is increased in patients with
abnormal hearts. The status of the heart may be
determined by an internist. However, the psy-
chiatrist must weigh the cardiac risk against the
psychiatric problem and determine on the basis
of his knowledge of the psychosis and his experi-
ence with convulsive therapy whether or not elec-
troshock treatment should be used. Experience
has shown that patients with moderately severe
cardiac disease can tolerate this form of therapy.
In the group of psychotics under consideration,
the problem of differentiating between a true ir-
reversible psychosis and one which has a reason-
able outlook for recovery or marked improvement
is more difficult than that of assaying the physical
risks involved in electroshock therapy.
In advising the family or friends of an elderly
patient who presents a psychiatric problem, the
physician should keep the following points in
mind : Guardianship should be instituted in some
instances for purposes of controling the activities
and the finances of the individual. This step
should be taken for the patient’s benefit, however,
rather than for the benefit of his relatives. One
should not be too quick to advise commitment to
an institution. Consideration should be given to
the possibility of providing adequate care at home,
in a rest home, a county home, in a home for the
aged, in a general hospital, or in a special hos-
pital for the chronically ill.
Tt should be remembered that not every person
who presents a psychosis for the first time in old
358
Minnesota Medicine
PSYCHIATRY IN GERIATRICS— GARDNER
age is suffering from a true cerebral arterio-
sclerotic or senile psychosis. The shortness of
life after commitment should never be forgot-
ten. The following things demand care in a psy-
chiatric hospital : sexual acts which are not toler-
able ; marked untidiness, particularly of the bodv
and in regard to urine and feces ; paranoid delu-
sions, especially where they center about individ-
uals rather than groups and most particularly
when these individuals are accessible to the pa-
tient ; depression because of the danger of suicide ;
and intellectual deterioration when it has pro-
gressed to the point when the ability for self
preservation is lost, or when it endangers the lives
of others.
Summary
Certain aspects of the role of psychiatry in
geriatrics have been reviewed. These included the
scope of the problem of the aged, the factors in-
volved in the production of certain of the less
severe and of the more grave psychiatric problems
of this age group, and the nature and management
of these particular disorders.
References
1. Baker, A. B. : An Outline of Neuropathology. Minneapolis:
University of Minnesota Press.
2. Barker, Lewellys F. : Psychotherapy in the practice of
geriatrics. U. S. Pub. Health Supplement, 168:88, 1941.
3. Camargo, Oswaldo, and Preston, George H.: What happens
to patients who are hospitalized for the first time when over
sixty-five years of age. Am. J. Psychiat., 102:165, (Sept.)
1945.
4. Dayton, N. A.: Mental disorders of the aged. U.S. Pub.
Health Supplement, 168:117, 1941.
5. Doll, Edgar A. : Measurement of social security applied to
older people. U.S.P.H. Supplement No. 163:145, 1941.
6. Dunn, C. W. D. : Endocrines in senescence. Clinics, 5:847,
(Dec.) 1946.
7. Feldman, Fred; Susselman, Samuel; Lipetz, Basile; and
Barrera. S. E. : Electric shock therapy of elderly patients.
Arch. Neurol. & Psychiat., 36:158, (Aug.) 1946.
8. Feldman, J. T. : The basic factors of nutrition in old age.
Geriatrics, 2:41, (Jan.-Feb.) 1947.
9. Gallinek, Alfred: Electric convulsive therapy in geriatrics.
New York State J. Med., 47:1233, (June) 1947.
10. Kalinowsky, L. B., and Hoch, P. H.: Shock Treatments and
Other Somatic Procedures in Psychiatry. New York: Grune
and Stratton, 1946.
11. Laycock, S. R. : The mental hygiene of later life. J. Canad.
M. A., 63:111, (Aug.) 1945.
12. Malamud, William: Mental disorders of the aged: arterio-
sclerotic and senile psychoses. U.S.P.H. Supplement No.
163:104, 1941.
13. Malamud, William; Sands, S. L.. and Malamud, I.: The
involutional psychoses: A socio-psychiatric study. Psychoso-
matic Med., 3:410 (Oct.) 1941.
14. Overholzer, Winfred: Orientation, mental health in later
maturity. U.S.P.H. Supplement No. 163:3, 1941.
15. Palmer, H. D.: Mental disorders in old age. Geriatrics,
1:60, (Jan.-Feb.) 1946.
16. Palmer, H. D, and Sherman, S. H.: The involutional
melancholia process. Arch. Neurol. & Psychiat, 40:762,
(Oct.) 1938.
17. Planning for the chronically ill. Joint Statement of Recom-
mendations by the Am. Hosp. Assn.; Am. Pub. Welfare
Assn; Am. Pub. Health Assn, and Am. Med. Assn. J.A.-
M.A.. 135:343, (Oct. 11) 1947.
18. Rafsky, H. A.; and Newman, Bernard: Nutritional aspects
of aging. Geriatrics, 2:101, (Mar.-Apr.) 1947.
19. Rusk, Howard A.: America’s number one problem — chronic
disease and an aging population. Am. J. Psychiat.
20. Rothschild, D, and Sharp, M. L. : The origin of senile
psychoses, et cetera. Dis. Nerv. System, 2:49, 1941.
21. Schiele, Burtrum C, and Rowe, Clarence J.: Electroconvul-
sive therapy; the cardiac risk. Bull. Univ. Minnesota Hose,
31 :1. Sept. 30, 1949.
Discussion
Dr. William H. Hengstler, St. Paul : Dr. Gardner
has covered this field so well in his paper that I
have not much to add except to express my personal
appreciation of his presentation. It is extremely im-
portant for the psychiatrist to give intelligent advice to
families as to what they should do with elderly fathers
or mothers. The individual case cannot be decided by a
textbook or by a fixed rule.
STUDIES ON BRUCELLOSIS IN MINNESOTA
(Continued from Page 338)
21. Spink, W. W. : Streptomycin in the treatment of brucel-
losis. In Streptomycin: its nature and practical application,
edited by Selman A. Waksman. Chap. 24. Baltimore:
Williams and Wilkens Co, 1949.
22. Spink, W. W. and Anderson, D. : Brucella studies on bank
blood in a general hospital. A. Agglutinins. B. Survival of
brucella. J. Lab. & Clin. Med, 35:440, 1950.
23. Spink, W. W, Braude, A. I, Castaneda, M. R. and Sylva-
Goytia, R. : Aureomycin therapy in human brucellosis due to
Brucella melitensis. J.A.M.A, 138:1145, 1948.
24. Spink, W. W. and Hall, W. W. : Encephalomeningitis due
to Brucella suis. Tr. Am. Clin. & Climatol. A, (In press).
25. Spink, W. W, Hall, W. H, and Aagaard, G. : Chronic
brucellosis. Staff Meet. Bull. Hosp. Univ. Minnesota, 17:193,
(Feb. 8) 1946.
26. Spink, W. W, Hall, W. H, Shaffer, J. M. and Braude,
A. I.: Human brucellosis — its specific treatment with a com-
bination of streptomycin and sulfadiazine. J.A.M.A, 136:382,
1948.
27. Spink, W. W, Hall, W. H, Shaffer, J. M. and Braude,
A. I.: Treatment of brucellosis with streptomycin and a
sulfonamide drug. J.A.M.A, 139:352, 1949.
April, 1950
28. Spink, W. W, Hoffbauer, F. W, Walker, W, Green, R. A.:
Histopathology of the liver in human brucellosis. J. Lab. &
Clin. Med, 34:40, 1949.
29. Spink, W. W. and Nelson, A. A.: Brucella endocarditis.
Ann. Int. Med, 13:721, 1939.
30. Spink, W. W, Titrud, L. A, and Kabler, P. : A case of
Brucella endocarditis with clinical, bacteriologic and path-
ologic findings. Am. J. M. Sc, 203:797, 1942.
31. Spink, W. W. and Yow, E. M.: Aureomycin: present
status in the treatment of human infections. J.A.M.A, 141:
964, 1949.
32. Sundberg, R. D. and Spink, W. W.: The histopathology of
lesions in the bone marrow of patients having active brucel-
losis. Blood, Suppl. No. 1, 1947.
33. Woodward, T. E, Smadel, J. E, Holbrook, W. A. and
Raby, W. T. : The beneficial effect of Chloromycetin in
brucellosis. J. Clin. Investigation, 28:968, 1949.
34. Yow, E. M. and Spink, W. W. : Experimental studies on the
action of streptomycin, aureomycin, and Chloromycetin on
hrucella. J. Clin. Investigation, 28:871, 1949.
359
PARATHION POISONING
W. E. PARK. M.D.
Director, Division of Industrial Health, Section of Environmental Sanitation
Minnesota Department of Health
Minneapolis, Minnesota
"PARATHION is one of the new organic phos-
phates which are finding so much favor as in-
secticides. It was developed by the Germans dur-
ing the last war. Details of this chemical were
taken to England and first reported in the British
Intelligence Objectives Report in 1946.
Parathion is a synthetic chemical, diethyl-nitro-
phenyl thiophosphate (C10H14O5PSN) . Chemists
in the United States were soon able to produce
it in commercial quantities, and it has become rec-
ognized as a valuable weapon in the fight against
insects. The name parathion was selected by the
Inter-Departmental Committee on Pest Control.
It has been marketed under such trade names as :
alkron, aphamite, durathion, genithion, niran, par,
paradust, parakill, paraphos, penphos, phos kil,
planthion, thiondust, thiophos and vapophos and
is now becoming quite widely used.
Parathion is a heavy, syrupy liquid which is
usually dark brown in color. It is only slightly
soluble in water, but is readily miscible with many
organic solvents such as ethers, alcohols, acetone,
carbon tetrachloride apd animal and vegetable oils.
It is quite stable in neutral oiDacid solution, but
is rapidly hvdrolized by alkalis and soaps.
Parathion is usually formulated as a wettable
powder of IS to 25 per cent strength which may
be mixed with water for application as a spray.
Tt is also sometimes formulated for application
as a dust in 1 or 2 per cent strength.
Parathion has outstanding insecticidal proper-
ties. For cockroaches it is nearly twenty times as
effective as DDT, and more than 200 times as
effective as nicotine. When properly applied, it
lias no injurious effects to plants, but because of
its low solubility in water, it remains for some
time as an effective insecticide residue.
Unfortunately, parathion is also very toxic to
warm-blooded animals and man. Animal experi-
ments have indicated that ingested dosages of 2
to 10 mg./kg. of body weight are lethal. The
toxicity for man has not been established, but it
probably is of the same order. Parathion is
readily absorbed through the skin, and near
fatalities and deaths have been caused merely by
splashing it on the skin and neglecting to wash
it off promptly. It may also find entry by inhala-
tion or by way of the gastrointestinal tract.
Because of its high toxicity, parathion is not
suitable for home and garden use. It should only
be used by large scale commercial growers or
professional sprayers who are prepared to take
all the precautions necessary. Warnings and
details of protective measures are marked on the
cans and packages by the manufacturers, who are
well aware of its dangers.
The pharmacological action of parathion ap-
pears to be dual. One effect is stimulation of the
parasympathetic nervous system. The other is
an anti-cholinesterase activity. There appears to
be an irreversible destruction of the enzyme cho-
linesterase. As a result of this action, acetyl-
choline accumulates and continues to stimulate the
parasympathetic nervous system, producing effects
resembling those of both muscarine and nicotine.
Signs and Symptoms
Common symptoms are excessive salivation,
lacrimation and sweating, headache, dizziness,
nausea, vomiting, abdominal cramps, diarrhea or
constipation, tightness in the chest, shortness of
breath, blurring of vision associated with a con-'
stricted pupil and difficulty in accommodating for
distant vision. There may be bronchial spasm
and pulmonary edema resulting from capillary
dilatation and excessive glandular secretions into
the bronchi and bronchioles. There mayjbe spasms
of the voluntary muscles or even convulsions.
Excitement of the central nervous system may be
followed bv depression, loss of reflexes, coma and
death bv failure of the respiratory center. In
some cases, death may be due to bronchial con-
striction and cardiovascular collapse associated
with pulmonary edema.
Diagnosis
A correct diagnosis depends largely on know-
ing that the patient has had an exposure to para-
thion. If some of the above symptoms and signs
are found, poisoning with an organic phosphate
360
Minnesota Medici ne
PARATHION POISONING— PARK
should be suspected. Ten c.c. of blood in citrate
may be tested for cholinesterase. If cholinesterase
is found to be considerably reduced, it is useful
confirmatory evidence.
Treatment
Prevent further absorption by immediate wash-
ing of the contaminated area with soap and water
if the mode of entry is through the skin. Empty
the stomach by inducing vomiting, or wash it out
with a stomach tube if the poison has been in-
gested. If there is dyspnea or evidence of pul-
monary edema, the patient should be placed in
an oxygen tent at once.
The most useful specific remedy is atropine,
which blocks the parasympathetic effect on the
heart and lungs. It should be given as early as
possible after a diagnosis is made, and in doses
of 1/75 to 1/50 of a grain. The atropine should
be repeated every hour or so up to ten or twelve
doses in a day if necessary to control respiratory
symptoms and keep the patient fully atropinized.
Dilatation of the pupils should be achieved. The
atropine may be given intramuscularly or intra-
venously.
Atropine can completely protect the air way,
but it should be remembered that if pulmonary
secretions have accumulated before atropine be-
comes effective, it may be necessary to turn the
patient upside down for drainage, or suck the
secretions out with a catheter. The patient may be
too weak to cough. Muscular weakness may be
so great that he cannot even breathe. In such cir-
cumstances, artificial respiration must be carried
on. Atropine does not control the muscular weak-
ness nor twitching of the muscles.
Morphine, of course, must not be given. Some
protection of the myoneural junction against the
nicotinic effects of parathion is afforded by mag-
nesium sulphate, which effect is believed to be due
to the magnesium ion. The usual dose of mag-
nesium sulphate is 10 to 20 c.c. of a 10 per
cent solution given slowly intravenously.
The acute emergency lasts twenty-four to forty-
eight hours. During this time, the patient must
be watched continuously. After danger appears
to be past, the patient must have several more
days of absolute rest. Further contact with or-
ganic phosphates must be avoided for at least
two weeks, as the patient remains very suscept-
ible to further poisoning during this time. The
explanation offered is that symptoms disappear
when the body’s supply of cholinesterase is only
partly replaced. During this period of partial
replacement, it takes very little parathion to de-
stroy the small amount of cholinesterase which has
accumulated and precipitate another acute attack.
So far as is known at present, recovery from
parathion poisoning is complete with no residual
complications. Chronic poisoning has not been
encountered. Small repeated doses of parathion,
however, may bring about depletion of cholines-
terase, so that when symptoms do develop they
may seem to be precipitated by an exceedingly
small recent exposure.
Workers with parathion may request a supply
of atropine for use in an emergency. There is
danger in granting such a request. Atropine, if
taken before exposure, will mask the symptoms.
Workers, if given atropine, should be warned not
to take it until after symptoms develop. They
should be warned that if symptoms develop, they
must stop work and seek help immediately and not
depend upon atropine to protect them.
Manufacturers of technical grade parathion are
well aware of its dangers, and have the facilities
and trained personnel to handle it safely. The
formulation of 15 to 25 per cent wettable powders
for making spraying mixtures and the formulation
of 1 or 2 per cent parathion dusting powders may
be undertaken by small manufacturers who are not
experienced in the handling of such toxic chem-
icals. Exposure of workers in these plants on
the one hand and exposure of farmers, fruit grow-
ers, sprayers and airplane pilots on the other, are
the concern of the industrial hygiene divisions of
the various state and federal public health agen-
cies.
Prevention of over-exposure is possible in
carrying out the normal operations of formulat-
ing wettable and dusting powders, and applying
the insecticide, if proper precautions are taken.
In the plant, careful planning of the operation
so that the processes are as far as possible auto-
matic and isolated is essential. General and local
good ventilation must be provided. Adequate
washing and showering facilities are required.
It is also the plant’s responsibility to provide
freshly laundered protective clothing every day.
The plant must carry out a proper training and
educational campaign.
In general, the following protective measures
should be carried out by all users of parathion
and other organic phosphates.
April, 1950
361
PARATH ION POISONING— PARK
1. Wear only protective clothing at work and
such underwear and socks as will be changed and
laundered daily. Protective clothing includes
coveralls, rubber gloves, shoes, caps, goggles and
a respirator.
2. If liquid preparations are used, additional
waterproof material must be worn, such as rub-
ber apron or waterproof cape and hat and rubber
boots.
3. Protective clothing must be changed and
laundered daily. Waterproof materials must be
thoroughly washed in soap and water at the end
of each day.
4. Careful washing of the hands and face with
soap and water before eating or smoking.
5. Never eat, smoke nor chew in an atmosphere
containing parathion, and keep all food and
lunches where they cannot be contaminated.
6. Thorough cleansing of the whole body at the
end of each shift by shower bath and liberal use
of soap.
The respirator which is to date most satisfac-
tory for general use is parathion respirator, Mine
Safety Appliances Company, No. Cr. 49290. Re-
placement cartridges are No. Cr. 49293 and re-
placement filters are No. Cr. 49294.*
Airplane pilots applying spray and others ap-
plying parathion aerosols, and workmen preparing
high concentrations or mixing the chemical with
carriers other than water, should use full-face
gas masks.
If an accident occurs, such as breakage of equip-
ment, releasing a spray of solution onto the cloth-
ing, or accidental inhalation of dust or vapors
containing parathion, the following steps should
be taken :
1 . Immediate removal of wet clothing and
thorough washing of the affected part with soap
and water.
2. Notify the plant doctor or patient’s private
physician of the exposure.
* Other suggested respirators are:
Mine Safety Appliances Co. — Chemical Cartridge Respirator
No. Cr. 45779.
Wilson Products Co., Reading, Pa. — Chemical Cartridge Res-
pirator, No. 701.
American Optical Co., Southbridge, Mass. — Chemical Cartridge
Respirator No. R-5055.
3. Send the worker home for compulsory bed
rest for twenty-four hours or so.
4. Detail a relative or someone to watch him,
who will notify the doctor if symptoms of poison-
ing occur.
I f an accidental spillage of parathion liquid
occurs in a plant, it should be cleaned up imme-
diately by absorbing it in sawdust, and then bury
or burn the sawdust. The floor where the spill-
age occurs should then be thoroughly cleaned
using an alkaline solution.
I f a powder containing parathion is spilled, it
should be cleaned up with a vacuum cleaner and
the contents of the cleaner burned.
Containers in which parathion has been shipped
must never be used again. Metal containers
should be punched full of holes and placed in a
private disposal ground. Combustible packages
should be burned as soon as emptied.
Further advice on protective measures is avail-
able from the Division of Industrial Health, Sec-
tion of Environmental Sanitation, Minnesota De-
partment of Health, University Campus, Minne-
apolis. Minnesota.
References
Andrews, J. M., and Simmons, S. W. : Developments in the use
of the newer organic insecticides of public health importance.
Am. J. Pub. Health, (May) 1948.
Dayrit. C. ; Manry, C., and Seevers, M.: Pharmacology of hexa-
ethyl tetra-phosphate. J. Pharmacol. & Exper. Therap., (Feb.)
1948.
DuBois, K. P. ; Doull, John ; Salerno, Paul R., and Coon, J. M. :
Studies on the toxicity and mechanism of action of p-nitrophenyl
diethyl thionophosphate (parathion). J. Pharmacol. & Exper.
Therap.. 95:79-91, (Jan.) 1949.
Hamblin, D. O. : Report of American Cyanamid Company. New
York. N. Y., (May) 1949.
Hough, J. Walter: Important organic insecticides. Indust. Hyg.
Newsletter, 10:4, (April) 1950.
Learn to Use Parathion Safely. American Cyanamid Company,
New York 20, N. Y., 1949.
Medical Aspects of Parathion Insecticide. Physicians’ Occupational
Health Bulletin No. 5. State of California Department of
Public Health, Bureau of Adult Health, (July) 1949.
Niran. Monsanto Technical Bulletin No. 0-52, (Nov. 19) 1948.
Monsanto Chemical Company, Organic Chemicals Division, St.
Louis, Missouri.
Organic Phosphate Poisoning. Occupational Health Bulletin
D. State of California Department of Public Health, Bureau
of Adult Health, (Oct.) 1949.
Sawitsky, A.; Fitch, H. M., and Meyer, L. M. : A study of
cholinesterase activity in the blood of normal subjects. J. Lab.
& Clin. Med., 33 :203-206, (Feb.) 1948.
Summary of Information Regarding Some of the Newer Insecti-
cides. Bureau of Adult Health, State of California Department
of Public Health, Occupational Health Bulletin No. 1, (July)
1948.
Technical Bulletin No. 2. Thiophos Parathion. American
Cyanamid Company, Agricultural Chemical Division, New
York, N. Y., (Dec.) 1948.
Townsend, J. G., Chief, Division of Industrial Hygiene, U. S.
Public Health Service: Industrial Hygiene Precautions in the
Handling of the Newer Insecticides, 1949.
Ward, J. C., and DeWitt, T. B.: Hazards associated with han-
dling the new organic pnosphates. Pests and Their Control,
(March) 1948.
362
Minnesota Medicine
INTRAVENOUS ADMINISTRATION OF PARA-AMINOSALICYLIC ACID FOR
STREPTOMYCIN-RESISTANT TUBERCULOSIS OF THE TRACHEA
Report of a Case
DAVID T. CARR, M.D.. WILLIAM D. SEYBOLD, M.D., HERBERT W. SCHMIDT, M.D., and
ALFRED G. KARLSON. D.V.M.
Rochester, Minnesota
P ARA- AMINOSALICYLIC acid (PAS) is
a new antituberculosis drug which is effective
against both streptomycin-sensitive and strepto-
mycin-resistant tubercle bacilli. The following-
report of a case illustrates the efficacy of the new
drug against tuberculosis due to streptomycin -
resistant tubercle bacilli, ft is of particular in-
terest as most of the PAS was given intravenously
to avoid the gastrointestinal irritation which
usually develops when this drug is given orally.
lumen of the left main bronchus was stenosed to a pin-
point opening so that the depth of this bronchus could
not be examined. The right main bronchus appeared
normal.
In spite of tracheal disease and the probability that
the tubercle bacilli were highly resistant to streptomy-
cin, pneumonectomy on the left was advised. This
was performed on February 1, 1949, and at the same
time partial thoracoplasty was done, parts of the fifth,
sixth and seventh ribs being removed. The immediate
postoperative course was satisfactory and on February
17, 1949, a second stage thoracoplasty was performed,
parts of the second, third and fourth ribs being re-
moved. During this time she was given 1 gm. of di-
hvdrostreptomycin each day even though it seemed
Fig. 1(a) January 25, 1949. Extensive disease is shown in the left lung before
pneumonectomy. (b) August 23, 1949. The results of pneumonectomy and
thoracoplasty are evident. Change had not occurred on the right side.
Report of Case
A white woman, thirty-two years of age, registered at
the Mayo Clinic on January 24, 1949. A diagnosis of
tuberculosis of the left lung had been made in January,
1948. She had entered a hospital where she rested in
bed and also underwent therapeutic pneumothorax on
the left side. In spite of this, tuberculosis of the left
main bronchus and of the larynx had developed for
which she was given streptomycin, one course of 1 gm.
daily for fifty-five days and another of l.S gm. daily
for one hundred and twenty-three days. The laryngeal
lesion healed but the bronchial lesion persisted, producing
stenosis of the left main bronchus. In addition, tubercles
developed in the left side of the lower end of the
trachea. Stained smears of the sputum remained posi-
tive for acid-fast bacilli throughout the period of treat-
ment. Diagnostic study at the clinic revealed extensive
disease of the left lung (Fig. la), stained smears of
sputum being positive for acid-fast bacilli. Broncho-
scopic examination revealed ulceration on the left side
of the lower 3 inches (7.6 cm.) of the trachea. The
Dr. Carr and Dr. Schmidt are with the Division of Medicine,
Dr. Seybold with the Division of Surgery and Dr. Karlson with
the Division of Experimental Medicine of the Mayo Clinic and
Mayo Foundation, Rochester, Minnesota.
April, 1950
probable that tubercle bacilli were resistant to this drug.
On February 22, 1949, bronchoscopic examination re-
vealed persistence of the extensive ulceration in the
lower end of the trachea, and stained smears of sputum
were still positive for acid-fast bacilli. By this time
it had been determined that the tubercle bacilli were
resistant to steptomycin, the micro-organism growing in
culture medium containing 100 micrograms of strepto-
mycin per milliliter of medium.
Treatment with large doses of PAS was advised and
to avoid the gastrointestinal irritation which this drug
causes, the sodium salt of PAS (NaPAS)* was ad-
ministered intravenously. On February 26, 1949, 4 gm.
of NaPAS was given and the daily dose gradually
increased until 30 gm. was being given each day. The
total daily dose was added to 1,000 c.c. of 5 per cent
glucose in distilled water and injected over a period
of about eight hours. During the third month of
treatment only 10 gm. of NaPAS was given intrave-
nously each day due to an inadequate supply of the drug.
This was supplemented by 14.4 gm. of PASf admin-
istered orally each day in three equal doses. The total
*The NaPAS was supplied by Cilag, Limited, SchafFhouse,
Switzerland.
fThe PAS was supplied by Dr. E. A. Sharp, Parke, Davis
& Company, Detroit, Michigan.
36J
PARA-AMINOSALICYLIC ACID-CARR ET AL
TABLE I. CONCENTRATION OF PAS IN BLOOD SERUM
AT INTERVALS DURING A PERIOD OF TWENTY-FOUR
HOURS*
Hours after beginning
injection
Concentration of
serum (milligrams
PAS in blood
per 100 c.c.)
Free PAS
Total PAS
4!4
32.0
28.6
li
4.9
6.4
24
<1.0
<1.0
*In the first seven and a third hours the patient was given
30 gm. of NaPAS intravenously.
dose of PAS during the three months of treatment
was 1,646 gm. of NaPAS given intravenously and 452.7
gm. of PAS by the oral route.
There was a dramatic response to this treatment. On
March 23, 1949, a bronchoscopic examination revealed
marked healing of the lesion in the trachea with only
a small ulcerated area remaining just above the orifice
of the stump of the left main bronchus. The ulceration
extended down into this stump and was covered with
a grayish-white exudate. Stained smears of sputum
which had been positive persistently for acid-fast bacilli
during the first month after pneumonectomy were now
negative. However, cultures of sputum at this time
proved to be positive for acid-fast bacilli.
After two months of treatment with PAS a broncho-
scopic examination revealed complete healing of the
tracheal ulceration. The orifice of the left main
bronchus was slightly inflamed and bled a little when
touched with forceps. A cultured specimen of the
bronchial secretions obtained at this time did not
show acid-fast bacilli to be present. After the third
month of treatment had been completed, bronchoscopic
examination did not reveal evidence of tuberculosis.
The orifice of the left main bronchus appeared as a
small dimple in the lateral wall of the lower portion
of the trachea. The mucosa appeared normal but
bled on bronchoscopic manipulation. Six specimens
of sputum, gastric washings and bronchial secretion
were cultured. Negative results were obtained from
5 cultures but 1 culture of sputum yielded a few
colonies of acid-fast bacilli. During the three months of
treatment the roentgenographic appearance of the right
lung remained unchanged. At this stage of the treat-
ment the patient left the hospital to continue rest in bed
at home.
She returned to the clinic on August 22, 1949, for
reexamination, having had no symptoms during the in-
terval. A roentgenogram of the chest (Fig. 1 b) did not
show any change when compared with the film made in
May, 1949. A bronchoscopic examination revealed no
evidence of active disease. The stump of the left main
bronchus still appeared as a small dimple on the left
in the lower portion of the tracheal wall. The mucosa
appeared normal and did not bleed on manipulation.
No secretions were present. Bronchial washings were
obtained for culture for acid-fast bacilli. Two speci-
mens of gastric washings also were cultured. One of
the gastric specimens yielded a few colonies of acid-
fast bacilli but the results of the other 2 cultures were
negative.
Evidence of toxicity to PAS was searched for care-
fully during and after the period of treatment but
none was found. There was no sign or symptom of
gastrointestinal irritation even when 30 gm. of NaPAS
was given intravenously each day. The results of weekly
blood counts, determinations of hemoglobin and
urinalyses remained within normal ranges. Biweekly to
monthly tests of renal and hepatic function showed no
evidence of damage to the kidneys or liver. The pro-
thrombin time varied from 19 to 23 seconds. There
was some irritation of the veins with thromboses but
it was possible to give the intravenous injection every
day for 90 consecutive days.
The concentration of PAS in the blood serum and the
364
TABLE II. EXCRETION OF PAS IN THE URINE
DURING A PERIOD OF TWENTY-FOUR HOURS*
Period of eight
hours
Volume of urine,
c.c.
PAS.
Free
gm.
Total
First
1,100
17.0
16.6
Second
1,100
7.0
8.0
Third
200
1.5
3.4
Totals
25.5
28.0
*In the first seven and a third hours the patient was given
30 gm. of NaPAS intravenously.
excretion of PAS in the urine were studied* during
a period of twenty-four hours in which the patient
was given 30 gm. of NaPAS intravenously during the
first seven and a third hours. The results are given
in Tables I and II.
A streptomycin-sensitivity test was performed on each
of the positive cultures for acid-fast bacilli. The micro-
organisms remained resistant to streptomycin throughout
the period of observation. Sensitivity to PAS was also
determined for all of the positive cultures. There was
no evidence of increase in resistance to PAS, all of
the cultures being sensitive to between 0.0045 and 0.072
mg. of PAS per 100 milliliters of culture medium.
Reexamination of the patient in December, 1949, re-
vealed no evidence of active tuberculosis. Culture of
three specimens of gastric washings and one specimen of
bronchial secretions aspirated during bronchoscopy did
not produce acid-fast bacilli.
Comment
It is worthy of note that a similar preparation
of NaPAS was administered to two other pa-
tients by the intravenous route and in both cases
acute hemolytic anemia developed after a few days
of treatment. The preparation had been stored at
room temperature for several months and analy-
sis revealed that 24 per cent of the NaPAS had
decomposed to meta-aminophenol and related com-
pounds. For this reason it would seem wise to
use only a freshly prepared solution of NaPAS
for parenteral administration.
Summary
The sodium salt of para-aminosalicylic acid
(NaPAS) was given intravenously in the treat-
ment for a tuberculous ulcer of the trachea due
to streptomycin-resistant tubercle bacilli which
persisted after pneumonectomy. The ulcer was
completely healed by the end of the three months
of treatment, but gastric washings remained posi-
tive for acid-fast bacilli. The microorganisms
were resistant to streptomycin and sensitive to
PAS both before and after treatment. There
was no untoward reaction to the medication ex-
cept for venous irritation. However, a similar
preparation of NaPAS given intravenously pro-
duced an acute hemolytic anemia in two other
cases, probably due to partial degradation of the
PAS to meta-aminophenol.
*With the collaboration of Dr. A. C. Bratton, Jr., Research
Department, Parke, Davis & Company, Detroit, Michigan.
Minnesota Medicine
PSYCHIATRY IN GENERAL PRACTICE
S. G. EGGE. M.D.
Albert Lea, Minnesota
Case Presentation
THE patient was a forty-four-year-old white woman
who was first seen at the office on August 16, 1949.
Her chief complaints at that time were occasional
dizziness, feeling of faintness, weakness and drawing
sensation in both groins.
History revealed that she first noted dizziness about
three months previously. She stated that she first
noted her symptoms when she was sitting in church
one Sunday and had gotten up quite suddenly. About
three weeks before her symptoms had become more
severe: the dizziness was much more marked, and the
weakness, especially of the lower extremities, had
developed. The patient stated that the difficulty in
walking had become so severe that she would occa-
sionally catch herself on a chair, table or the wall to
prevent falling.
The patient was examined again at the office and it
was felt that hospitalization was necessary, so admission
to Naeve Hospital was arranged. While the patient
was leaving the office she collapsed in front of the
elevator and was found lying on the floor. She was
apparently fully conscious, as shown by her response to
questioning, but was unable to get up. After a brief
examination which revealed no injury, she was taken
to the local hospital and admitted September 26.
Past History. — The past history was essentially nega-
tive. She had had the ordinary childhood diseases but
no serious illness or accident. She had had an appen-
dectomy about ten years previously. The only significant
finding in the past history was that the patient stated
she had had a “nervous breakdown” while a student
nurse about twenty years before.
Personal History. — The patient had completed high
school (with difficulty according to the informant) and
had started a nurse’s hospital training. She stated she
dropped out of high school in the second year because
of a “nervous breakdown.” The informant stated that
she was obliged to quit because she had difficulty in her
class work. Since that time she had been keeping
house for her father who was a widower.
About eight months ago the patient’s father remar-
ried, and the patient stayed around home for a couple
of weeks helping with the house work, but, for various
reasons, she decided “to go out on my own.” For the
past six months she had been working at house work
at several homes around her home town.
The patient mentioned on one occasion that she
had a boy friend (aged sixty) whom she had been
Presented at the staff meeting of the Naeve Hospital, Albert
Lea, Minnesota, November 14, 1949.
History was obtained from patient and informants. Inform-
ants were patient’s father and stepmother. Part of physical
findings, diagnosis and therapy reported was taken from letter
from Mayo Clinic.
April, 1950
going with for several years. She stated that on several
occasions he had made advances and she had refused
because she thought doing such a thing was a sin when
they were not married.
Family History.— Her father is living and well. Her
mother died twenty-five years ago, the cause unknown.
Two brothers and three sisters are living and well.
There is no family history of serious organic disorders,
of familial diseases, or of nervous or mental disease.
Physical Examination. — Physical examination revealed
a well-developed, slightly obese white woman in no acute
distress. She walked into the office with a slight stag-
gering gait and fell into the chair with a thud. Her
speech was somewhat thick. Her temperature was 98.6°,
pulse 82, blood pressure 170/100. Examination of the
eyes revealed that the pupils reacted slowly to light but
were equal in size. Reaction to accommodation was nor-
mal. Extra-ocular movements were normal except that
slight lateral nystagmus of both eyes was noted. Ex-
amination of ears, nose and throat was negative. There
was no cervical adenopathy and the thyroid was not
palpable. Breasts revealed no masses, chest was clear,
heart rate was regular and there were no murmurs nor
enlargement. The abdomen was soft with no masses
palpable. There was a right lower quadrant scar.
Liver, kidney and spleen were not palpable. No inguinal
adenopathy was noted. Examination of the pelvis and
rectum was negative. Extremities were normal with no
deformities noted.
Neurological Examination. — Neurological examination
revealed :
1. Pupils equal but reacted slowly to light. Examina-
tion of remainder of cranial nerves was negative.
2. Lateral nystagmus of both eyes was noted.
3. Reflexes: (a) Absent abdominal reflexes, (b) All
reflexes were equal but slightly hyperactive, (c) Ba-
binski’s sign was negative. Chaddocks, Rossolimo’s toe
signs were negative, (d) Patient exhibited a positive
Rhomberg. On asking the patient to stand she would
fall backward with jerking movements into a chair.
4. The motor system was normal. There was no
paralysis or paresis noted.
5. Sensibility — no paresthesias. Position sense, vibra-
tion sense and deep muscle pain were normal.
6. Tests for co-ordination revealed no abnormality.
F to F and F to N tests were normal.
Mental Status. — 1. Mental Content — Patient appeared
rational and was pleasant to interview. One observa-
tion noted was the apparent lack of concern about her
disability. She answered questions readily and ac-
curately but when not spoken to would move her lips
as if speaking to herself. A certain amount of mental
365
PSYCHIATRY IN GENERAL PRACTICE— EGGE
preoccupation was noted. No delusions, hallucinations
or paranoid trends were illicited.
2. Sensorium and intellect — Patient was well oriented
as to time, place and person. Memory was unusually
good. Informant stated that patient had an excellent
memory and that if any of the members of the family
wanted to know about any dates or past events, the
patient could give accurate details. Patient’s general
knowledge was fair, and thinking capacity as evidenced
by simple calculations was slow but accurate.
3. Emotional tone — Patient exhibited no evidence of
depression or agitation. She did present a somewhat
indifferent and apathetic attitude toward her illness.
4. Stream of thought — normal.
5. Attitude and manner — well dressed, natural and
open — discussed problems freely.
Laboratory. — Usual laboratory work such as uri-
nalysis, blood counts, et cetera, were normal.
A spinal tap was done the day after admission and
was negative.
Hospital Progress. — During the ten days of the pa-
tient’s hospitalization, her status remained unchanged ;
symptoms did not improve in spite of ordinary psycho-
therapeutic methods such as encouragement, reassurance
and mild sedation.
A differential diagnosis of multiple sclerosis of psy-
choneurosis, conversion hysteria, tension state, was made.
After ten days hospitalization it was decided to trans-
fer the patient to the Mayo Clinic at Rochester for fur-
ther investigation and therapy. She was admitted to the
neuropsychiatric service of St. Mary’s Hospital October
11.
Following is an excerpt of a communication from the
staff doctor at Mayo Clinic in charge of the patient :
“Her general physical examination was essentially
negative. A neurological examination revealed only a
slight degree of horizontal and vertical nystagmus. This
was considered to be of little significance with reference
to her present problem since it was noted on a previous
neurological examination in 1930. Her gait, though
extremely bizarre, did not correspond to the disturbances
seen with any ordinary neurological lesions. The na-
ture of her gait plus her bland and somewhat indefinite
attitude toward her symptoms strongly suggested the
possibility of a severe neurotic reaction. She was seen
in consultation in the psychiatric section and transferred
to that section at St. Mary’s for treatment. Her pro-
gress there has been somewhat slow. After repeated
sessions under hypnosis her gait improved somewhat.
It was noted, however, that her personality is so loosely
organized and that her thought processes are often so
illogical that she is unable to profit to any great degree
from this type of therapy. Further observation has in-
dicated that the patient is suffering from a severe con-
version hysteria or possibly a schizophrenic reaction. A
possibility of utilizing more heroic therapy such as
electroshock treatments has been considered but the final
decision has not yet been reached.”
Patient was discharged from the neuropsychiatric
service at the Mayo Clinic after about a month of inten-
sive therapy with a diagnosis of “conversion hysteria,
severe.”
Therapy consisted of psychotherapy, occupational
therapy, physiotherapy, and hypnosis. She made a satis-
factory recovery, with complete return of function of
her lower extremities, and is now on her own doing well.
Discussion
It is estimated that about 50 per cent of all pa-
tients coming to a doctor’s office are suffering
from some sort of emotional and tension disorder.
In most of these patients we are not dealing with
major mental disturbances but with some conflict
or problem which is manifesting itself in a psy-
chosomatic complaint. Most of us practitioners
are so busy diligently searching for some organic
or structural disorder that we fail to observe or
understand some simple problem in personality
which mav be causing symptoms. We usually
concentrate our attention on disease, paying little
attention to the patient as a person. We often-
times have little regard for the factors which make
the patient an individual distinguished from his
fellows. Oftentimes we see nothing more in a
patient than the sum total of a disease which has
certain detailed symptoms, etiology, prognosis,
pathological anatomy and medical or surgical treat-
ment. More often the disease has been overem-
phasized and the patient overlooked. It is true
that tremendous strides have been made in diag-
nostic methods, in laboratory methods and in med-
ical and surgical treatment, but these advances
only seem to accentuate the tendency to forget
the individual. The emotional life of the patient,
his family life, his economic and social situations
may be very essential factors in understanding
the symptoms which he presents.
It is the purpose of this paper to present some
of the factors which make up a total personality,
to show how the personality reacts to stress nor-
mally and abnormally, producing neuroses, to
discuss the etiology, diagnosis and therapy of the
most common psychiatric disorder encountered in
general practice and to try to present some helps
in psychotherapy.
The general practitioner has several advantages
over the psychiatrist in dealing with the common
psychogenic illnesses. First of all, he generally
sees them in earlier stages when they are more
amenable to therapy ; and secondly, he can ap-
proach the patient as a general practitioner rather
than as a specialist. The general practitioner may
sometimes have more rapport with the patient
since confidence in him has already been establish-
ed— in other words, he is the “family doctor.”
366
Minnesota Mkdicini
PSYCHIATRY IN GENERAL PRACTICE — EGGE
Only a small percentage of neurotic patients
will be or need be seen by a psychiatrist, and for
that reason it is becoming increasingly apparent
that a greater integration of basic psychiatric con-
cepts be accomplished bv the general doctor to take
care of the “other 50 per cent” of his medical
practice.
The study of man’s mental processes has lagged
far behind the study of his anatomical, physiologic
and chemical processes. This is most likely due
to the fact that the mental factors are less tangible
and less amenable to measurement and manipula-
tion. It is also possibly due to certain deep-rooted
superstitions and dogmas which have held sway
the past centuries.
Psychosomatic medicine has made rapid ad-
vance the past ten to fifteen years and is placing
new emphasis on the psychic and emotional life
of an individual. It recognizes that what patients
do and feel are facts no less than are the physical
conditions observed. Emotional reactions of
love, fear, anger and hate are just as real as are
the organs of the body and are capable of pro-
ducing prolonged, disabling and almost intolerable
illness.
A pathologic anxiety can cause far more suf-
fering than rheumatic cardiac lesions or uterine
fibroids which a patient may have.
Phychiatric illness afflicts the largest single
group of patients. While they occupy more hos-
pital beds than all other groups, most of them
are not in mental hospitals but are frequenting
physicians’ offices presenting multiple psychoso-
matic complaints. The time demanded by these
patients often can be reduced in the long run by
effective and disciplined management. The com-
mon disorders, tension states, reactive depressions,
involutional melancholias and other emotional dis-
orders should be recognized as such, and therapy
for actual mental illness should be instituted in-
stead of treating for some non-existent organic
disorder with diagnostic placebos.
The future of psychiatry lies not so much in
the salvage of the one million patients that crowd
mental hospitals but in the application of psychia-
try to all patients.
From the physician’s personal point of view, at
least a cultural knowledge of psychiatry has some-
thing to offer in a more rational appreciation of
his fellowmen, in human relations, in a better
understanding and perspective of himself and
possibly in the matter of some aid in his own
personality development. Finally, there is some-
thing to be said for its downright interest, for a
patient’s mind can be as interesting as his colon.
At this point I will try to mention briefly some
of the mechanisms involved in producing a neu-
roses.
Psychiatry believes that the neurotic patient
is not just an unfortunate individual who is a vic-
tim of bad fortune but that he is a person who
retreats into his illness through stages which can
be studied and whose course can be predicted.
Basically the personality of the individual is dis-
turbed in some way. It is difficult to define per-
sonality but according to leading psychiatrists it is
made up of five major factors. The first part has
to do with the physical structure of the individual,
the second deals with his biochemistry, the third
with the great field of emotions, the fourth with
his behavior, and the fifth part has to do with his
mind. These five factors make up the "total
personality.” Emotions include fear, anxiety,
jealousy, hate, anger, sex, love, courage, faith,
et cetera. A person’s behavior is adjusted either
by public opinion or the laws of the state and
country. Tt is true that what constitutes adjusted
normal behavior today may be a maladjusted state
of affairs tomorrow. The elements which make
up the mind are constant : attention, comprehen-
sion, intelligence, judgment, memory, insight,
stream of thought, sensorium, et cetera — the chief
element being intelligence. Any disturbance of
any one of the five factors making up the total
personality will tend to upset the balance between
the others and cause maladjustment.
A neurosis arises in a person as a result of
his reaction to the stress to which he is subjected.
The stress is either internal, i.e., conflicts arising
from feelings of guilt, hostility or frustration; or
external, i.e., trauma of war, shock, grief, econom-
ic threat or environmental difficulty. Factors of
emotional maladjustment are generally more po-
tent in reacting adversely to stress and any per-
sonality will break down if this stress is sufficiently
great. Against stress is aligned the patients’
mental stability which can be compared to the
physical resistance to infections and which make
up his emotional maturity. His hereditary assets,
his physical health and the sum of all his earlier
cultural and intellectual training are also important
factors in the emotional stability with which he
resists stress. When these factors are exceeded,
the equilibrium fails and compensatory mechan-
April, 1950
367
PSYCHIATRY IN GENERAL PRACTICE— EGGE
isms that are basically neurotic are mobilized.
Symptoms then appear and indicate that the de-
fense mechanism or mental stability has failed or
has exceeded what is generally regarded as normal
bounds. The personality is then said to be sick.
Help from relatives, friends, physicians or per-
haps quacks and cultists may be sought in the pa-
tient’s effort to restore a satisfactory balance.
Another alternative is that he may continue to live
his disordered life. Peptic ulcers or ulcerative
colitis may develop, he may become an alcoholic
or complain of multiple physical symptoms, seek
unnecessary surgical procedures, change jobs,
wives or physicians or even resort to suicide.
Basically then, the patient either develops mental
mechanisms such as evasion, regression, sublima-
tion, projection, rationalization, conversion or re-
pression to escape the stress situation and/or
subconsciously develops some physical manifesta-
tion as his symptoms.
Perhaps the most common psychiatric disorder
encountered in general practice is the anxiety
syndrome.
The anxiety syndrome was first described by
Hecker in 1893, but it was not until after World
War T that it received general recognition in this
country. It has been known by many other terms
such as nervousness, neurocirculatory asthenia,
spastic colon, nervous breakdown, nervous ex-
haustion, shattered nerves, shell shock, et cetera.
The picture varies in the number, character and
severity of the symptoms. Every person is bas-
ically anxious and the severity depends upon the
underlying personality foundation of the individ-
ual. The anxiety syndrome usually occurs in an
individual who is inclined to be tense, uneasy,
with transient attacks of palpitation, precordial
discomfort, perspiration, dyspnea, weakness and
faintness. The patient may complain of difficulty
in sleeping, of being easily fatigued, of constant
headache and often of pressure on the top of the
head or a band around the head. He may lose
weight, be irritable and worry without knowing
why. Examination will usually reveal a tense,
restless, uneasy individual with cold, clammy
hands and feet. The pulse rate may be increased,
the abdomen tender to palpation and the deep
reflexes overactive. The differential diagnosis be-
gins with a very careful physical, neurological
and serological examination. One should be ab-
solutely sure that the individual does not have
either some structural disease of his body or the
central nervous system. The physician must be
prepared to spend sufficient time in this to prove
to himself and the patient that there is no organic
disease. The anxiety state must be thought of as
an exaggerated expression of the lack of function
of the whole personality and treatment should be
directed against those factors which are the cause.
Attention should be paid to the environmental
factors such as family difficulties, incompat-
abilities and worries. One should have a
thorough understanding of the person’s prob-
lems, his assets and liabilities. Engaging
in a frank discussion of these problems and
giving the patient an opportunity to express him-
self is a good form of therapy and is known as
aeration, ventilation or mental catharsis. The
initial interview should be adequate and lengthy
enough so that the patient feels that the doctor is
concerned and interested in his trouble. The pa-
tient should be told about the relationship of the
symptoms to some underlying emotional difficulty,
and it is important for the patient to be told that
the symptoms are not imaginery but are the direct
result of some emotional conflict. The wise use
of sedatives plays a part in the therapy of the
anxiety syndrome.
Lastly, I will try to summarize a few of the
more common psychotherapeutic procedures and
discuss briefly some of the methods used.
The approach to the patient must be passive,
non-critical and in an interested manner. Don’t
immediately plunge into the depths of the pa-
tient’s problem, because the instinctive reaction
to this is one of defense and evasion. Don’t begin
by offering excessive or unwarranted reassurances.
Don’t be dominating or autocratic. Don’t forcibly
unwrap a patient without having some idea of
his mental anatomy and and without knowing
how to wrap him up again. As one psychiatrist
put it, “Don’t do a mental laparotomy and leave
the incision gaping open.” The neurotic person-
ality has defenses that have been built up care-
fully which serve as a protection against the
ravages of anxiety, guilt and fear. Patients are
readily made worse if these defenses are abruptly
knocked out before adequate supports have been
set up to replace them.
The interview should be guided to economize on
time and it is usually more satisfactory than push-
ing the interview.
Questions such as “Would you like to tell
me about your difficulty?” invite the patient’s co-
368
Minnesota Medicine
PSYCHIATRY IN GENERAL PRACTICE— EGGE
operation and avoids the semblance of grilling.
Direction of what appears to be significant facts
in the history may be obtained by such comments
as “I’m interested in this that you men-
tion.” Then listen attentively, sympathetically and
uncritically ; the patient ultimately will display his
real conflicts in vivid, enlightening detail.
Further points in conducting a satisfactory
psychiatric interview would be : don’t argue, don’t
try to substitute your standards for his own, don’t
accept the responsibility of making major decisions
for the patient, and don’t allow the patient to un-
load his responsibilities onto you. Approach the
neurotic patient rather with a manner that dis-
plays at least as much interest as your approach
to his roentgenogram or electrocardiogram.
Give him the assurance that you want to help
him, and encourage him to take the initiative with
the realization that at least half the responsibility
in the treatment is his.
Listen to him — attentively, sympathetically,
noncritically, without ridicule or amusement. Re-
member that his problems and symptoms are not
absurb to him.
Sift and interpret, isolating what, on the basis
of your understanding of mental illness, are the
basic etiologic factors and mechanisms. Then
gradually guide the patient back to a more mature
way of dealing with his problems. Show him the
probable relationship between his symptoms and
his maladjustments and lead him out of his neu-
rotic escape toward reality.
Consider the patient as a whole personality.
This may temper the treatment of his disease in
such a wav as to not just add years to life but
life to years. As one patient observed while
struggling along on a particularly strict medical
regime, “You don’t really live longer — it just
seems long.”
In conclusion, let me say that there should be
recognition, interpretation and treatment of the
various personality disturbances that come to the
attention of the g'eneral practitioner. There
should be a better understanding of attitudes and
facts in mental illness so that the general practi-
tioner may gain a more wholesome understanding
of life for his own sake as well as for those many
patients with personality problems who come to
him for aid. The general practitioner is inti-
mate with the patient and the family of the pa-
tient ; he constantly observes the family situations
and the family usually turns to the family physi-
cian first for help. If the general practitioner
would become interested, he is in a very excel-
lent position to make a genuine and lasting con-
tribution to the general mental health of the com-
munity.
References
1. Appel, J. W., and Beebe, G. W. : Preventive psychiatry.
J.A.M.A., 131:1469-1475, (Aug. 31) 1946.
2. Groom, D.: Some applications of psychiatry in general prac-
tice. J.A.M.A., 135-403-408, (Oct. 18) 1947.
3. Hannah, H. B.: An analysis of some of the factors in per-
sonality influencing health. Presented before the South
Dakota State Medical Association, 1949.
4. Kraines, S. H.: The Therapy of the Neuroses and Psychoses.
A Socio-Psycho-Biologic Analysis and Resynthesis. Philadel-
phia: Lea and Febiger, 1943.
5. Mohr, G. J. : Psychiatric problems of adolescence. J.A.M.A.,
137-1589-1592, (Aug. 28) 1948.
6. Ripley, H. S.; Wolf, S., and Wolf, H. G. : Treatment in a
psychosomatic clinic. J.A.M.A., 138:949-951, (Nov. 27)
1948.
7. Strecker. E. 'A.: Psychosomatics. J.A.M.A., 134:1520-1521,
(Aug. 30) 1947.
8. Thomas, H. M.: What is psychotherapy? J.A.M.A., 138:
878-880, (Nov. 20) 1948.
9. Wearn, Joseph T. : The challenge of functional disease.
J.A.M.A.. 134:1517-1520, (Aug. 30) 1947.
SOME RECENT ASPECTS OF CARDIAC AND JUXTA-CARDIAC SURGERY
( Continued from Page 346)
18. Glover, R. P.; Bailey, C. P., and' O’Neill, T. J. : Commissu-
rotomy for mitral stenosis. Bull. Am. Coll. Surg., 34:100,
1949.
19. Gross, R. E., and Hubbard, J. P. : Surgical ligation of a
patent ductus arteriosus; report of first successful case.
J.A.M.A., 112:729, 1939. . ,
20. Gross, R. E. : Surgical correction for coarctation of the
aorta. Surgery, 18:673, 1945.
21. Gross, R. E. : Surgical relief for tracheal obstruction from a
vascular ring. New England. J. Med., 233:586, 1945.
22. Gross, R. E. : Surgical treatment for dysphagia lusoria. Ann.
Surg., 124:532, 1946.
23. Gross, R. E. : Coarctation of the aorta. Circulation, 1:41,
1950.
24. Harken, D. E. ; Ellis, L. B. ; Ware, P. F., and Norman, L.
R. : The surgical treatment of mitral stenosis. New England
J. Med., 239:801, 1948.
25. Keys, A., .and Shapiro, M. J. : Patency of the ductus arterio-
sus in adults. Am. Heart J., 25:158, 1943.
26. Lexius, A. : Die kunstliche Blutversorgung des Herzmuskels.
Arch. f. klin. chir., 189:343, 1937.
April, 1950
Murray, G. Gordon: Closure of defects in cardiac septa.
Ann. Surg., 128:843, 1948.
O’Shaughnessy, L. : An experimental method of providing
a collateral circulation of the heart. Brit. J. Surg., 23:665,
1936.
Potts, W. J.; Smith, Sidney, and Gibson, S.: Anastomosis
of the aorta to the pulmonary artery. J.A.M.A., 132:627,
1946.
Reifens.tein, G. H. ; Levine, S. A., and Gross, R. E. : Co-
arctation of the aorta. Am. Heart J., 33:146, 1947.
Scott, H. William, Jr.: Closure of the patent ductus by 'su-
ture-ligation techniaue. Surg., Gynec. & Obst., 90:91, 1950.
Skinner. A., and Baronofsky, I. D.: Unpublished observa-
tions, 1949.
Smithy, H. G. ; Boone, J. A., and Stollworth, J. M.: Sur-
gical treatment of constructive valvular disease of the heart.
Surg., Gynec. & Obst., 90:175, 1950.
Sweet,. R. H., and Blond, E. F. : The surgical relief of con-
gestion in the pulmonary circulation in cases of severe mitral
stenosis. Ann. Surg., 130:384, 1949.
Wangensteen, O. H.; Varco, R. L., and Baronofsky, I. D.:
The technique of surgical division of paent ductus arteriosus.
Surg., Gynec. & Obst., 88:62, 1949.
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35.
369
Case Report
TREATMENT OF BARBITURATE POISONING WITH METRAZOL
I. S. MILTON, M.D., and J. L. STENNES. M.D.
Minneapolis, Minnesota
THE occurrence of poisoning from barbiturates is
becoming increasingly common due to the greater
use of these drugs and the greater ease with which pa-
tients find access to them, despite efforts to restrict
their indiscriminate sale.
The following case of barbiturate poisoning is reported,
not because of any new method of treatment, but be-
cause of the more persistent and successful use of
metrazol which overcame the effects of the poisoning
and resulted in a complete recovery of the patient.
The case’s history is as follows :
The patient, a white woman, aged thirty-four, was
admitted to the Swedish Hospital on October 12, 1948,
at 7:55 p.m. by ambulance. She was completely un-
conscious, both pupils were dilated, and there was poor
muscle tonus. The blood pressure was 90/55, the pulse
80 and of good quality. On the basis of the history and
of a previous occurrence of barbiturate poisoninv. the
present episode was immediately thought to be of the
same character, perhaps due to sodium pentobarbital.
It was impossible to determine whether the barbiturate
alone had been taken, or a combination of barbiturate and
amphetamine sulfate, which the patient was known to
have used occasionally. It was equally impossible to
learn what quantities of either or both of these drugs
had been ingested.
During the first thirty minutes, 18 c.c. of metrazol
were administered intravenously without any noticeable
response. Five per cent glucose in saline solution was
administered intravenously about half an hour after
admission, and the inhalation of oxygen per BLB mask
started. At various times the blood pressure dropped to
80/60 but was improved by the administration of 1 c.c.
of adrenalin (1:1,000) solution intramuscularly. Fol-
lowing the initial dose of 18 c.c. of metrazol, doses of
3 to 5 c.c. of the same drug were given intravenously
at frequent intervals so that at the end of the first
twenty-four hours, 176 c.c. had been injected. During
these twenty-four hours there had been only occasional,
very slight responses indicated by changes in the pupil-
lary reaction and occasional slight movements of the arms
and legs while the metrazol injections were actually be-
ing given. At times the respirations became very shal-
low and the patient markedly cyanotic. Late in the day
on October 13, the pulse rate had increased to 120 beats
per minute, but the respirations remained at 18 to 20
per minute and were slightly deeper. During the evening
of October 13, there seemed to be a great deal of mucus
in the respiratory passages which was cleared by suc-
tion. At this time, penicillin therapy was begun and
50,000 units were administered intramuscularly every six
hours. Supportive treatment was continued and about
midnight on October 14 the patient began to respond
during the time the suction apparatus was being used.
The metrazol injections were continued at fairly frequent
intervals during this entire period. About 2 :30 a.m.
on October 14. slight tremors and slight rigidity at the
time of the administration of the metrazol became ap-
parent. Perspiration during this time was profuse.
After the recurrence of the tremors and the rigidity, the
administration of metrazol was decreased and finally
discontinued. About 9 :30 a.m. on October 14, the
woman became very restless and thrashed about in her
bed. Shortly after this, she became rigid, with arching
of the back, together with marked twitching of the
face, extreme restlessness, and very much increased
cyanosis. About 3 :00 in the afternoon of the same day,
a definite small convulsion was observed. At this time
100 mg. of demerol were administered. Following this
the twitching and rigidity became less, although the rest-
lessness persisted all afternoon. During the night she
became relatively quieter and the cyanosis also decreased.
The temperature had now risen to 102.2°, but the pulse
was stronger. There was an occasional attempt at
coughing when mucus seemed to obstruct the respiratory
passages. About 4:00 a.m. on October 15. the patient
spoke a few words and asked the nurse who she was.
Shortly thereafter she called for her husband and
responded slowly but poorly to questions. She seemed
extremely depressed and the eyes presented a staring
appearance. During the night she talked in a confused
and irrational manner, attempted to pick up imaginary
objects from the bed, and watched her nurse very
closely.
The following morning further improvement was
noted, although the cyanosis still persisted. The tempera-
ture now was 101°, the pulse 96, and the blood pressure
120/70. The patient appeared somewhat lucid and
answered briefly when spoken to, although she still was
very much confused. During this day, she took small
amounts of liquid nourishment, and the following morn-
ing, October 16, at her regular meal apparently with en-
joyment. At this time she was much quieter, less con-
fused and more co-operative, but later in the day the
confusion again increased and there were auditory,
visual and sensual hallucinations, and marked excitement
when talking to her husband. On October 17, the wom-
an was still confused, laughed and cried alternately, and
did not sleep although she yawned a great deal. A num-
ber of times she tried to strike her nurse and attempted
to get out of bed. On October 18, the improvement
was quite marked, although the patient was still inco-
herent at intervals and apparently had occasional delu-
sions and hallucinations. However, she was definitely
quieter and much more co-operative than before. On
this day she was transferred to a sanatorium where she
remained six additional days. At the conclusion of this
period she had apparently recovered completely from
the effects of the barbiturate poisoning.
It is worthy of comment that from the time of the
patient’s admission into the hospital until the appearance
of the convulsion, which occurred during administration
of the metrazol, a total of 259 c.c. of this drug had heen
given over a period of less than three days.
We feel that this case again corroborates the con-
clusions drawn by Eckenhoff, Schmidt, Dripps, and
Kety1 that metrazol is a potent analeptic and that “the
failure of the drug as an analeptic is too often associated
(Continued on Page 412)
370
Minnesota Medio nf.
History of Medicine In Minnesota
MEDICINE AND ITS PRACTITIONERS IN OLMSTED COUNTY PRIOR TO 1900
NORA H. GUTHREY
Rochester. Minnesota
(Continued from March issue)
Mary Elizabeth Bassett (Mrs. Charles W. Bray) was from July 19, 1895,
to February 28, 1896, an intern at the Rochester State Hospital. She was the
eighteenth appointee to the medical personnel.
Mary E. Bassett was born at Beaver Dam, Wisconsin, on November 16, 1863,
the daughter of Robert Lees Bassett, a native of New Haven, Connecticut, a
bookkeeper by profession, and Mary Elizabeth Stultz Bassett, a native of Beaver
Dam, Wisconsin, who before her marriage was a schoolteacher.
After graduation from the high school at Hastings, Minnesota, as salutatorian,
in June, 1882, Mary E. Bassett was a bookkeeper for seven years. In January,
1889, she matriculated at the University of Minnesota and in her four and a
half years there she made a distinguished record. She was a member of Delta
Gamma sorority and of Phi Beta Kappa ; she received the degree of bachelor of
science in 1893 and in June, 1895, was graduated summa cum laude with the degree
of doctor of medicine. In December, 1895, bv examination, she was licensed to
practice in Minnesota.
On graduation from medical school Dr. Bassett applied for a hospital internship
and, because she was a woman, received unqualified refusal in the hospitals of
Minneapolis and St. Paul. She then came to Rochester to interview Dr. W. J.
Mayo, in the hope of entering St. Mary’s Hospital as an intern. Official intern-
ships had not yet been established at St. Mary’s, but Dr. Mayo thought that she
could obtain such a position at the state hospital and he helped her to do so. In
her months in Rochester she did excellent work at the state hospital and made
friends socially and professionally. On August 1, 1895, by unanimous vote, she
became a member of the Southern Minnesota Medical Association. From
Rochester she went as physician for six months to the Owatonna State School
for Indigent and Dependent Children. From September, 18%, to March, 1899,
she was assistant physician at the Minnesota Hospital for Insane at St. Peter.
Early in 1899 Dr. Bassett was married to Dr. Charles W. Bray (1868-1937),
of Biwabik. Her husband was a graduate of the medical school of the University
of Minnesota, in 1895, and for a time after graduation was associated in practice
with Dr. F. H. Milligan, of Wabasha. The story of Dr. C. W. Bray’s life as a
citizen of Biwabik and of his work for thirty-eight years as head of the Biwabik
hospital, which he established and owned, belongs to the history of medicine in
St. Louis County. After her marriage Dr. Bassett Bray gave up active practice
except that for several years she helped her husband with the hospital. In suc-
ceeding years, although her home and family were her primary interest, she was
active in the Congregational Church, the American Red Cross, and community
April, 1950
371
HISTORY OF MEDICINE IN MINNESOTA
and county relief work. Beginning in 1937, she served as a member of the board
of directors of the St. Louis County Health and Tuberculosis Association.
Dr. and Mrs. Charles W. Bray were the parents of five children, of whom one
daughter, Rachel Lees Bray, died young. In 1945 there were living of the family
group, Mrs. Bray, in Biwabik, and four children: Robert Bassett Bray, M.D., of
Biwabik, head of the Biwabik Hospital ; Elizabeth Bassett Bray, a high school
teacher in Minneapolis; Philip Noyes Bray, M.D., gynecologist and obstetrician,
of Duluth, during World War II a lieutenant commander in the United States
Navy; and Kenneth Eben Bray, M.D., previous to 1941 in general practice at
Park Rapids, during the war a major and flight surgeon in the United States
Army Air Force.
Hiram C. Bear (1861-1931), member of a numerous, respected and long-
established family of Olmsted County, practiced medicine from 1883 to 1890 in
the village of Dover (then known as Dover Center) in the township of that name.
Henry Bear, grandfather of Hiram C. Bear, was one of the twelve children,
several of whom settled in Olmsted County, of Samuel Bear and Mary Bricker
Bear, natives of Pennsylvania and pioneer settlers of Ohio ; Samuel Bear was an
American soldier in the War of 1812. The parents of Mrs. Henry Bear were
Adam and Catherine Bricker, both natives of New York and, like the Bears,
pioneers in Ohio. William Bear, son of Henry Bear and father of Hiram C. Bear,
was born in Seneca County, Ohio, on January 15, 1837, and came to Eyota Town-
ship, Olmsted County, Minnesota, in 1854. He was married in 1859 to Henrietta
Carl, a native of Logan County, Ohio, and a daughter of Hiram Carl and Susanna
Bodkin Carl, both of whom were born in Ohio; Mr. and Mrs. Carl came to Olm-
sted County in 1877. Mr. and Mrs. William Bear had five children, named here
in the order of their birth : William ; Hiram C. ; George, who died in infancy ;
John Buty ; and Alice May (Mrs. Charles W. Hughes).
Hiram C. Bear was born in 1861 in Eyota Township, and in that vicinity and in
the village of Eyota obtained his early schooling. He studied medicine at the
Hahnemann Medical College of Chicago, from which he was graduated in April,
1883; his Minnesota license No. 886 (H), was issued on April 22, 1884.
Liked and respected. Dr. Bear was welcomed to Dover, the scene of his first
medical practice. He was married to Minnie Smith, of Plainview, Wabasha
County, on January 1, 1890. In the autumn of 1890 Dr. and Mrs. Bear removed
to Caldwell, Kansas. On their return to Minnesota, early in 1896, they settled in
St. Charles, Winona Countv, and there spent the remainder of their lives. Dr.
Bear had a broad and successful practice in Winona and Olmsted Counties. He
died in St. Charles on June 18, 1931. Mrs. Bear survived him eleven years, and
died in St. Charles on June 15, 1942. .
Rose Anne Bebb, daughter of William G. Bebb and Margaret Price Bebb,
was born at Portage, Wisconsin, and after early school years was educated at the
University of Minnesota, receiving the degree of bachelor of literature in 1891
and the degree of doctor of medicine, cum laudc, in 1897. On graduation in
medicine she joined the staff of the Rochester State Hospital, the twenty-first
professional appointee. On the resignation of Dr. Sara V. Linton Phelps, in
February, 1898, Dr. Bebb became assistant physician and gynecologist, a position
which she held until she resigned on March 3, 1900, to remove to New York,
New York.
On arrival in New York she was invited to join the New York City Department
of Health. Interested in preventive medicine, she accepted the offer and devoted
372
Minnesota Medicine
HISTORY OF MEDICINE IN MINNESOTA
some years to public health work in association with that department and other
city health departments and with the United States Public Health Service. She
also did research and teaching in this field at New York University. Later she
resumed work in psychiatry and neurology, after two years of postgraduate study
in these subjects in Europe. Much of the time subsequently she acted as consultant
to private organizations and had her own institution for preventive treatment for
mental disorders, with her office for years at 20 Fifth Avenue, New York. Since
January, 1929, she has been associated with the New York City Department of
Hospitals as a psychiatrist (1946).
Dr. Bebb has licenses to practice in three states, Minnesota, New York and
Washington. While in Rochester, Minnesota, she was a member of the Olmsted
County Medical Society and the Southern Minnesota Medical Association. She
is a fellow of the New York Academy of Medicine (New York City), a member
of New York state and county medical societies, the New York Neurological
Society and the American Medical Association. She is a Presbyterian, a Re-
publican, and a member of Alpha Phi sorority.
Dr. Bebb has recalled with pleasure her experience in the Rochester State
Hospital, the interesting work and congenial associations, and has expressed
gratitude to Dr. Arthur F. Kilbourne, superintendent, for opportunity and en-
couragement, and to Dr. William J. Mayo, who was a surgeon to the hospital at
that time, for personal help and inspiration.
Edmund Beckwith, homeopathic physician and surgeon, came from Cleve-
land, Ohio, to Rochester, Minnesota, in January, 1868, as successor to Dr. Isaac
M. Westfall, a pioneer homeopathic practitioner who was retiring from practice
to devote himself to farming and dairying near Rochester.
Eckman, in 1941, in his essay, Homeopathic and Eclectic Medicine in Minne-
sota, reported that Edmund Beckwith was born at Nelson (in Portage County),
Ohio, on October 14, 1836, and was graduated from the old Homeopathic Hospital
College of Cleveland in 1865, and he presented the interesting speculation that
Dr. Beckwith may have come from a distinguished background in homeopathic
circles in Ohio: Dr. Seth R. Beckwith (1832-1905), a native of Ohio, was pro-
fessor of surgery, before 1870, at the homeopathic college from which Edmund
Beckwith was graduated, was one of the founders of the Pulte Medical College
of Cincinnati, and was a practitioner who attracted eminent patients, among them
James A. Garfield. Dr. David H. Beckwith (1825-1909) was professor of sanitary
science at the same Homeopathic Hospital College, president of the Ohio state and
the Cleveland city boards of health, and vice president of the Cleveland Medical
Library Association.
Whatever his forebears, Edmund Beckwith practiced medicine in Rochester
from January, 1868, into the autumn of 1872, and won liking and respect as
physician and citizen. When he opened his office in the Union Block, on Broadway
and Third Streets, his professional card stated that he made a specialty of all
chronic diseases of the throat, lungs and liver, dyspepsia and the diseases of
women and children. His home was at the corner of Franklin and College Streets
(now Second Avenue, S. W. and Fourth Street, S. W.).
Favorable recollections of Dr. Beckwith by one of Rochester’s venerable
citizens have been confirmed by comments printed in the city newspapers of that
day, as in the Federal Union of March 27, 1869:
I desire, through this public medium, to convey my thanks to those friends who came
forward with their kind proffers of assistance during the late affliction that befell my house-
hold. And also to tender my special thanks to Dr. OBeckwith. I have now been the head of a
April, 1950
3 73
HISTORY OF MEDICINE IN MINNESOTA
household during a period exceeding 38 years and the truth compels me to say that Dr.
Beckwith is the first physician whom it has been my fortune to employ, during that entire
time, who has offered essential relief to the afflicted members of my family.
J. M. Hall
And the Rochester Post, on March 25, 1871, bore this testimony: “Olmsted
County is Homeopathic, nowadays. Dr. Beckwith, of that faith, was appointed
county physician at the last session of the Board of Commissioners.”
Dr. Beckwith allied himself with the Minnesota State Homeopathic Institute
(founded in 1867) soon after he came to Rochester; at a convention held in St.
Paul in June, 1871, he was appointed a member of two committees, one on the
diseases of children and the other on contagious diseases. The next year, in June,
at the annual meeting in St. Paul, he was appointed a member of the board of
censors. In the meantime, in October, 1871, the Southern Minnesota Homeopathic
Medical Society had been founded at Owatonna bv a small group of practitioners',
among whom were Dr. Beckwith and Dr. Westfall (the latter nominally retired
from practice but active in organizational work). Dr. Westfall was elected presi-
dent and Dr. Beckwith was made one of the board of censors and also designated
to make a report on practices, at the next annual meeting, to be held in May,
1872, in Rochester.
In August, 1872, it was announced that Dr. Beckwith was leaving Rochester in
the fall and going east;* he had disposed of his business to Dr. W. A. Allen, of
Plainview. In February, 1876, then in Muncie, Indiana, Dr. Reckwith was
advertising in the Rochester papers that his residence in this city was for sale; it
was not until October 8, 1886, however, that the Post stated, “Mrs. Dr. Beckwith
has sold her former residence at the corner of College and Franklin Streets.” In
the autumn of 1878 Dr. Beckwith left Muncie for Faribault, Minnesota, having
been appointed successor to Dr. Nichols in the "Deaf and Dumb and Blind In-
stitute” in that city: “Dr. Beckwith is a worthy citizen and a skillful physician and
the appointment is a good one.” He was still in Faribault in late October, 1879.
Eckman stated that Dr. Beckwith removed to California, where he died, in
Petaluma, on September 21, 1915, regarded as a pioneer practitioner of the town.
The fact that Dr. Beckwith’s name does not appear in the first official register of
physicians of Minnesota, 1883-1890, is presumptive evidence that this physician
left Minnesota before the medical practice act of 1883 went into effect.
M. D. Bedal, a graduate of the Chicago Medical College, opened an office
in Leland’s Block, on Broadway, Rochester, Minnesota, in June, 1874, having
just completed three years in Cincinnati, Ohio, which he had spent attending
lectures and practicing in the hospitals. The Rochester Record ami Union stated, in
the usual manner of early newspapers, that he was a young physician of superior
attainments and excellent natural abilities. Evidence has not appeared that he
remained long in Rochester. It is probable, judging from a note observed about
early physicians of Mower County, that within a few months he proceeded to
Brownsdale, and that in Brownsdale he omitted mention of his stay in Rochester,
for it was said that he had come to Mower County from Cincinnati. From
Brownsdale, in the spring of 1876, he removed to Tekamah, Burt County, Ne-
braska.
This Dr. Bedal should not be confused with I )r. Sylvester L. Bedal, who although
never a practitioner in Olmsted County, it is believed, spent his boyhood in the
county. The son of a pioneer settler near Eyota, Sylvester L. Bedal read medicine
with Drs. E. C. and E. W. Cross of Rochester in the late sixties or early seventies.
The only mention noted of him as a physician appeared in a local news item in
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HISTORY OF MEDICINE IN MINNESOTA
1874: Then an assistant surgeon in the United States Army, stationed in New
York, he was visiting in Eyota.
J. S. Bell was a homeopathic physician and surgeon who came to Rochester,
Minnesota, in September, 1868, from Naperville, Illinois, and opened an office over
Andrews’ store on Broadway; in January, 1870, he was changing his office to an
upstairs room in Graham’s Block. In the summer of 1871 it was stated that he had
removed to the pretty town of Litchfield on the St. Paul and Pacific Railroad.
Thereafter he made an occasional visit to Rochester.
That he was in good standing among organized homeopaths is indicated by the
inclusion of information about him, albeit incorrectly, among homeopaths of
Minnesota in the History of Homeopathy (1880) as follows: “Dr. J. S. Bell went
to Rochester in 1869; went to Litchfield in 1873; left Litchfield in 1873.” His
departure from Litchfield is verified by an item in the Rochester Post of De-
cember 27, 1873, to the effect that Dr. J. S. Bell, formerly of Rochester, more
recently of Litchfield, had been in Rochester during the week : “The doctor is
seeking a more satisfactory and congenial climate.”
Seth Scott Bishop, son of Lyman Bishop and Maria Probert Bishop, was
born on February 7, 1852, at Fond du Lac, Wisconsin. He was graduated from
the Pooler Institute, at Fond du Lac, and for three years studied at Beloit Col-
lege. In 1869 he began the study of medicine with Dr. S. S. Bowers of his native
city, thereafter attended three courses of lectures at the medical department of
the University of the City of New York, and next enrolled at the Chicago Medical
College, from which he was graduated in 1876. After practicing medicine in Fond
du Lac for about a year, he decided to settle in Rochester, Minnesota, and in
February, 1878, made the trip with horse and buggy, accompanied by his wife.
In Rochester Dr. Bishop took over the medical and surgical practice of Dr.
St. V. Martinitz, an eclectic physician who was going to Austria to study, used
Dr. Martinitz’ office and lived near by. Both Dr. and Mrs. Bishop were talented
musicians and entertainers; soon after their arrival Mrs. Bishop gave the first
of several successful concerts, and in the same season she and her husband gave
a demonstration at Heaney’s Hall, exposing and explaining the tricks of spiritual-
istic mediums.
Established physicians of Rochester accepted Dr. Bishop as a colleague, and
in 1878 he became a member of the Minnesota State Medical Society. When Dr.
J. E. Bowers, superintendent of the hospital for insane, was away on a vacation,
Dr. Bishop carried on his work for him. On occasion of consultation Dr. W. W.
Mayo, of Rochester, and Dr. Franklin Staples, of Winona, endorsed Dr. Bishop’s
care of a patient.
In November, 1879, Dr' Bishop removed to Chicago, where as a specialist in
diseases of the ear, nose and throat he won success and honor as surgeon and
inventor of surgical instruments and therapeutic aids in that field, as writer, and as
member of medical organizations (as recorded in Physicians and Surgeons of
America , 1896).
Hamilton Philo Boardman, born in the late eighteen fifties, was the fourth
child and third son of Philo Boardman and Jane Plackett Boardman, respected
early settlers in Cascade Township, Olmsted County, Minnesota. His broth-
ers were Elkanah W. Boardman and Marcus J. Boardman, his sister, Mar-
garet Boardman (Mrs. William) Heaney.
April, 1950
375
HISTORY OF MEDICINE IN MINNESOTA
Philo Boardman was born in Cattaraugus County, New York, on January
1, 1821, was educated in the public schools of Tioga County, and became a
farmer and stock raiser. On May 5, 1855, he started for Minnesota with his
wife and children ; the family made the trip by ox team and wagon and
arrived in Cascade Township on July 4, just in time to join the pioneer resi-
dents in celebration of Independence Day. Mr. Boardman took up a govern-
ment claim in Section 15, a holding that he increased to 840 acres. After
the death of his wife he remarried and, in 1879, removed to Texas, where
he went into the cattle business. On leaving Olmsted County, he divided his
land in Boardman Valley between his two elder sons with the understanding,
it is said, that they would educate their brother Hamilton as a physician.
Hamilton P. Boardman accjuired his preliminary education in the district
and village schools and his first medical instruction from Dr. W. W. Mayo,
of Rochester, with whom he studied in the late seventies. His formal medi-
cal training he obtained at Bellevue Hospital Medical College, in New York,
from which he was graduated on March 1, 1880. In the following June the
accidental death by drowning of Dr. John N. Farrand, of Oronoco, created a
vacancy for a practitioner, and Dr. Boardman established himself in the vil-
lage, with an office in the house of J. L. Hanson, and began his initial practice.
To Oronoco at the same time came William A. Vincent, an undergraduate
medical student employed at the state hospital in Rochester, purposing to
hold a place in practice for his friend Edgar A. Holmes, of Eyota, Minnesota,
who was about to take his degree at the Chicago Medical College. The Oronoco
Journal announced on July 23, 1880, under the caption “And Still They Come,”
that all danger of death from lack of medical attendance was at an end,
and called attention to the professional cards of the three young physicians.
At Oronoco it has been said, “Dr. Boardman was a very good doctor, able
and fearless. He was very young, and a local boy. Dr. Holmes, older and
an excellent physician, was here also and there were many well-established
physicians in communities near. . . . Perhaps Dr. Boardman had more of the
pioneer spirit than others — anyway, he left and went further west.” His
first remove, in October, 1881, was to Fisher’s Landing, on Red Lake River,
in Polk County, Minnesota, where he remained five years. On November
24, 1883, he qualified under the new Minnesota “Diploma Law” and received
state license No. 401 (R) ; three days earlier he had registered in Dakota
Territory. From Fisher’s Landing he went, late in 1886, to Oakes, Dickey
County, on the southern border of North Dakota, and there he found a
widening field. After fourteen years of successful general practice he estab-
lished his own hospital in Oakes, in 1901, enlarged it the following year and
again in 1905.
Dr. Boardman was married in 1883 to Althea McMaster, a schoolteacher
and one of the six children of Mr. and Mrs. John McMaster, pioneer settlers
of Oronoco Township, Olmsted County. John McMaster was the son of
William and Margery Cunningham McMaster, natives respectively of West-
moreland County and Fayette County, Pennsylvania; he came to Iowa in
1853 and to Minnesota in early 1856; his wife was Lawrence, the daughter of
Andrew and Mary Lees-Hollister, natives of Scotland. Althea McMaster
Boardman died in Oakes on March 24, 1903, leaving a son, Lees McMaster
Boardman, about fifteen years of age. Dr. Boardman’s second marriage took
place in December, 1904, as noted by the N orthwestern Lancet of January 15,
1905: “Dr. F. W. Maercklin, of Ashley, North Dakota, and Dr. H. P. Board-
376
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HISTORY OF MEDICINE IN MINNESOTA
man, of Oakes, North Dakota, were parties to a double wedding last month.
The brides were the Misses Anna Mabel and Martha M. Irwin, of Ellen-
dale, in the same state.”
Early in 1907, Dr. Boardman retired from practice and removed to Cali-
fornia, first to Ocean Park and later to Santa Monica, where he died in
1925, survived by his wife and his son.
Wendell G. Bothwell (1844-1926), who has been described as a horse and
buggy doctor of the old school, in the early spring of 1871 arrived with his
wife and two infant children in the picturesque village of High Forest, Olm-
sted County. He found established there three physicians: Dr. Alexander
Grant, inactive professionally; Dr. Stewart V. Groesbeck, popular, definitely
a man of the people; and Dr. David S. Fairchild, well trained, very young and
dignified and of highest ethical standing. The village having begun its long
decline, in 1872, Dr. Groesbeck removed to Marshall, Minnesota, and Dr. Fair-
child to Ames, Iowa.
Wendell G. Bothwell was born in Toronto, Canada, on November 10,
1844, the son of John and Adeline Maria Bothwell, natives of Scotland, who
had come from Glasgow to Toronto. Around 1860 the family came west
to Fond du Lac, Wisconsin, and there the boy became a baker. On the
outbreak of the Civil War he joined the Union Army, with which he served
until the close of hostilities. Within the next six years he obtained his medi-
cal education, and it is said that he read medicine in Rochester with Dr.
Hector Galloway, who is recalled as one of the soundest of the pioneer
physicians of Olmsted County. About 1868 he was married to Juliette
Thomas, daughter of N. W. Thomas, a pioneer settler of Rochester; the
second child of the marriage, Gertrude Bothwell, was born in Rochester in
February, 1871. Although it has appeared in a medical directory that Dr.
Bothwell was graduated from the Chicago Medical College in 1877, it is
probable, judging from his story after he left High Forest, that he took
his degree soon after studying with Dr. Galloway and that he was newly
gradated when, in March, 1871, he began practice in High Forest A comment
that, he was in Pine Island and Goodhue some time in the early seventies has
not been confirmed.
In High Forest and Rochester Dr. Bothwell is remembered as a pillar of
the Methodist Church, a lively, jolly, friendly man, “quite a politician and
something of a joiner.” He was a member of many fraternal organizations,
among them the Masonic Lodge, in which he was one of the Knights Temp-
lar, and the Independent order of Odd Fellows, and was medical examiner
for various protective insurance associations. Although his practice in vil-
lage and community kept him busy, it was not remunerative. A letter that
Mrs. Bothwell wrote to her sister, Mrs. William Eaton, of Rochester, in the
late spring of 1871, states: “The doctor has been practicing here three
months and so far we have had fifty cents in money.” Produce was almost
too plentiful, especially when a ham weighing thirty-five pounds was brought
in to apply on the doctor’s bill, and ham was selling at ten cents a pound.
Juliette Thomas Bothwell died in High Forest in November, 1874, at the
age of twenty-seven years, and shortly after her death, Dr. Bothwell with the
two children, George, aged five years, and Gertrude, aged three years, re-
moved to Fonda, Iowa. In Fonda, in October, 1880, he was married to Miss
Ida Dodge of that place. Of this marriage there were two children, a son,
Clyde Dee, born in 1882, and a daughter Helen, born in 1895. From Fonda
April, 1950
377
HISTORY OF MEDICINE IN MINNESOTA
Dr. Bothwell removed with family in 1890 to Fairbank, Iowa, where he en-
joyed many prosperous years. Gradually he discontinued medical practice
and about 1916 left Fairbank for Des Moines, where for the last ten years
of his life he was employed in the State House.
When Wendell G. Bothwell died in 1926, his funeral rites were conducted
under the direction of the local chapter of the Grand Army of the Republic,
of which he had been an honored member, and it is said that nearly all of the
old soldiers in Iowa were present to pay him tribute. He was survived by
his wife and by one daughter. Clyde Dee Bothwell, the son of the second
marriage, was a graduate, in 1907, of the St. Louis (Missouri) College of
Physicians and Surgeons and he practiced in Olwein, Iowa, from 1907 until
his death on October 22, 1925. In 1945 there were living of Dr. W. G. Both-
well’s family: his widow, Ida Dodge Bothwell, aged eighty-six years, in
Des Moines; his daughter, Gertrude Bothwell (Mrs. J. T.) Dietz, at Fairbank,
Iowa; and three grandchildren, George E. Dietz and Lewis Wendell Dietz,
both in the service during World War II, and Mrs. J. A. (Dietz) Ohl, of
Olwein.
Jacob Eton Bowers (1841-1922), for fifty-four years a distinguished mem-
ber of Minnesota’s medical profession in the field of nervous and mental
diseases, was from January, 1879, to earlv October, 1889, a resident of Roch-
ester, Olmsted County, as superintendent and chief physician of the Second
Minnesota Hospital for Insane.
Jacob E. Bowers was born in 1841 in Berlin, Waterloo County, Province of
Ontario, Canada, the son of parents who were natives of the state of Pennsyl-
vania. He obtained his preliminary education in the schools of his birth-
place and his academic training at the University of Toronto, from which he
received the degree of bachelor of arts in 1864 and that of master of arts in
1865. In the next year he taught French and German at the London (On-
tario) Collegiate Institute, and at the same time read medicine under a pre-
ceptor. Thereafter he spent one year at the Toronto College of Medicine
and the next two years at the ETniversitv of Michigan, from which he was
graduated early in 1868 with the degree of doctor of medicine.
Soon after graduation Dr. Bowers came as assistant physician to the Min-
nesota Hospital for Insane at St. Peter (established in 1866) on the invita-
tion of Dr. Sanuel E. Schantz, the first superintendent of the institution.
When Dr. Schantz died suddenly in August, 1868, Dr. Bowers was appointed
acting superintendent and so well did he manage the hospital and prepare
the major part of the second annual report, for Dr. Cyrus K. Bartlett, the
new superintendent who came in December, 1868, that the board of trustees
allowed him full salary of superintendent. After he was relievd by Dr. Bart-
lett, Dr. Bowers spent several months in the East in postgraduate work.
In 1876 and 1877 he traveled for eight months in Europe studying nervous
and mental diseases and observing hospitals and asylums for the care of
the insane. In June, 1877, he returned to his position of first assistant at
St. Peter, where he remained until he came to Rochester.
Shortlv after enactment of the law' of March 7, 1878, which placed at
Rochester the Second Minnesota Hospital for Insane (a brief history of the
hospital appeared earlier in this article) and transferred to it the land and
unfinished buildings of the nullified Inebriate Hospital, Dr. Bowers made
his first visit to Rochester, as official representative of the board of trustees,
to inspect the equipment and devise plans for adapting it to the care of
378
Minnesota Medicine
HISTORY OF MEDICINE IN MINNESOTA
the insane. The hospital opened on January 1, 1879, with Dr. Bowers as
superintendent and sole physician.
To Dr. Bowers’ ability as physician and executive and to his character as
a humane and conscientious man were due the early growth and development
of the Second Hospital for Insane into one of the finest institutions of its
kind and time in the country. Dr. Bowers planned and began the beautiful
landscaping of the hospital grounds, primarily for the benefit of the patients,
and instituted as therapeutic measures entertainment, diversified activity and
occupational therapy. His official annual reports to the board of trustees
were not mere statistical compilations. Nearly sixty years after their writ-
ing they convey much of human and scientific interest.
The event that led to Dr. Bowers’ resignation as superintendent of the hos-
pital occurred on April 1, 1889, when a criminally insane Negro patient died,
subsecjuent to a struggle with nonprofessional attendants. (At that time, for
more than 850 patients, there had been allotted to the hospital only two
assistant physicians.) There ensued criticism of Dr. Bowers and an exhaus-
tive investigation that is a matter of detailed record in official documents.
Newspapers of St. Paul and Minneapolis publicized the affair as a cause celebre.
Dr. Bowers was exonerated fully and his management of the hospital en-
dorsed and sustained. When he resigned, he was replaced by Dr. Arthur
F. Kilbourne, formerly assistant physician to the state hospital at St. Peter.
Before leaving Rochester to enter private practice as a specialist in nervous
and mental diseases, Dr. Bowers was honored bv the citizens and the medi-
cal profession of the city, through the Olmsted County Society, of which he
was then president. In this period also the Minnesota State Medical Society
proposed a resolution of sympathy for and confidence in Dr. Bowers.
Dr. Bowers was a constructive exponent of organized medicine in various
representative groups. In the Minnesota State Medical Society, of which he
became a member on February 1, 1870, he served in many capacities, as cor-
responding secretary, member and chairman of committees, essayist, and dele-
gate to the American Medical Association; in 1889 he was cited on the roll
of honor of membership.
Jacob Eton Bowers was married on May 27, 1879, to Kate Walbank, daugh-
ter of Dr. and Mrs. S. S. Walbank, of Duluth. When they removed from
Rochester, Dr. and Mrs. Bowers, after a few months in St. Paul, made their
permanent home in Duluth. Sixteen years a specialist and more than thirty
years an honored resident of the city, Dr. Bowers died in Duluth, at St.
Luke’s Hospital, on Februarv 23. 1922, at the age of eightv-one years.
David A. S. Britts, a physician of the old school, typical of many of his
time, first practiced medicine at Marion, Marion Township, Olmsted County,
in the early seventies.
Born on March 1, 1844, in Montgomery County, Indiana, David A. S. Britts
when a young boy removed with his parents to Wisconsin ; in 1862 the fam-
ily came to Dodge County, Minnesota. Soon afterward, on November 8.
1862, David Britts enlisted from Dodge County in Company M of the First
Regiment of Mounted Rangers and with it served in the war with the Sioux
Indians until December 7, 1863. After a period of detached service in a mili-
tary hospital he re-enlisted on March 6, 1865, in Company K of the Second
Regiment of Minnesota Cavalry, under General Henry H. Sibley, and again
served in the Indian wars until he was mustered out on March 1. 1866. On
his way home from Dakota in the winter he was injured so seriously by freez-
April, 1950
379
HISTORY OF MEDICINE IN MINNESOTA
ing that the government awarded him a pension. After his disharge from
the army he attended school in Wasioja, Dodge County, at the famous old
seminary, then the Groveland Seminary (shortly afterward, the Wesleyan
Methodist Seminary), and thereafter obtained his medical training at the
Chicago Medical College, probably subsequent to reading medicine with one
of the well-known physicians of Dodge County.
Tn the summer of 1875, if not earlier, Dr. Britts began his medical prac-
tice at Marion, where he was successful, if newspaper comments are an indi-
cation. According to the Rochester Post of April 15, 1875, Dr. Britts announced
to friends in Mantorville, Dodge County, that he had been appointed assistant
room surgeon in one of the hospitals in Chicago and that he would begin the
work about June 1 ; the next week it was stated that he would remain in
Marion. Change was in his mind, for in July, 1876, he removed to Browns-
dale, Mower County, where he remained until some time in 1880, with the
exception of a few months in 1879 which he spent in Lanesboro, Fillmore
County, as assistant surgeon at the “Lanesboro Sanitarium” of Dr. David
Frank Powell (White Beaver).
Two different statements have, been observed as to Mrs. Britts’ maiden
name : in the Rochester Post of November 28, 1879, there was announced the
marriage on November 23 of Dr. D. A. Britts to Alice M. Stevens ; in the History
of Mozver County, of 1844, the name appears as “Ella Stevens Hamlin.”
From Brownsdale Dr. Britts went in 1880 to Clearwater, in Wright County.
Under the Act of 1887 he received a state exemption certificate. Prior to
1904 he settled in Minneapolis, at 39 Washington Avenue South, and con-
tinuously from that time he was listed in directories as practicing medicine in
that city ; his name appeared in the first edition of the directory of the Amer-
can Medical Association, in 1906, and was included for the last time in the
edition of 1914.
William P. Broderick (1859-1899), an assistant physician, twenty-second
appointee on the staff of the Second Minnesota Hospital for Insane, to suc-
ceed Dr. H. H. Herzog, resigned, began his work in Rochester on March 25,
1899. He died suddenly in his quarters on April 8. 1899, from Bright’s disease.
William P. Broderick was born on June 15, 1859, at Havana, Schuyler
County, New York. In 1884 he was graduated from the Bellevue Hospital
Medical College; the next seven years he was with one of the Manhattan
state state hospitals on Ward’s Island; the following eight years he was on
the staff of the Northern Hospital for the Insane at Winnebago, Wisconsin,
and from that institution came to Rochester. His wife had died in 1894,
leaving a little daughter Lucretia, two years old. Dr. Broderick was survived
by the child, a sister, Mrs. T. R. Palmer, of St. Paul, and a brother, George
C. Broderick, of Norfolk, Virginia.
(To be continued in May issue)
380
Minnesota Medicine
pi esident's llettei
The AMA in 1950
The medical profession has outgrown many of its precedents. Chief among the
discarded patterns is the familiar concept of the Family Doctor as a kindly, horse-
and-buggy-propelled individual, whose only concern was the patients of his own
community.
Perhaps I should not say that we have discarded this concept . . . for the ideals
of service held by the horse-and-buggy doctor are an integral part of medical
practice. But the medical profession has moved on to a wider perimeter of interest
and to heavier and more varied responsibilities.
The history of the American Medical Association demonstrates this widening
field of service. It has become increasingly active, over a period of years, in pro-
tecting the public against fraudulent and harmful medical practices, drugs, medi-
cines and appliances. It has demonstrated a deep concern over the cost and avail-
ability of medical care ; hence experimentation with the now accepted plans for
voluntary health insurance and numerous studies into the equitable distribution of
physicians. Ever-occupied with the necessity for higher quality medical care, the
AMA has been instrumental in abolishing medical schools of inferior grade and
tightening requirements for the remaining schools, until today there are only Class
A medical schools. The American physician is the best physician in the world, with
the most intensive training and education and the highest ethical standards.
Facts for Americans
In 1949 and 1950, the AMA has gone into the problems of medicine even more
comprehensively. Committees have been sent abroad to study medical care plans ;
commissions have been organized, with AMA financing, to explore possible solu-
tions to such problems as chronic and catastrophic illness. And to meet the chal-
lenge of knowledge-hungry, security-tempted Americans, the National Education
Campaign continues. The Campaign, which gained sufficient momentum to block
compulsory health legislation in the 81st Congress, will carry on the logical con-
clusions of the program — the possession, by every citizen, of the facts about medical
care and costs, the easy transfer of control from medicine to all economy, the com-
parison of health standards under government medicine and private medicine.
Program Grows
To support its growing program of public service activities, the AMA has estab-
lished twenty-five dollar dues. These dues have been set in a democratic fashion :
no physician will be deprived of his county or state medical association member-
ship through failure to pay AMA dues ; affiliate members and those for whom dues-
paying would constitute a hardship are exempted from payment.
The dues are far from excessive, particularly in view of their translatable value
in human health, freedom and happiness. I feel sure that the physicians of Minne-
sota, in keeping with the traditions of medicine here, will maintain membership in
the AMA, indicating by that membership that they support, actively and personally,
the broad, humanitarian program of the American Medical Association.
President, Minnesota State Medical Association
^pril, 1950
381
* Editorial ♦
Carl B Drake, M.D., Editor; George Earl, M.D., Henry L. Ulrich, M.D., Associate Editors
AMA DUES FOR 1950
T^VSTABLISHMENT of dues for members of
' 1 the American Medical Association has come
as a surprise to many. Actually, the surprising
fact is that the AMA has not required dues pay-
ment earlier in its 103-year history.
Physicians have been able to enjoy the privi-
leges of American Medical Association member-
ship without cost mainly because of the organiza-
tion’s multi-million-dollar publishing business.
This enterprise has balanced the deficits and
profits of at least ten medical specialty journals,
the AMA Directory and the Cumulative Index
Medicus, in addition to financing numerous cost-
ly public service activities, typified by Council
on Pharmacy and Chemistry.
Doctor and public alike owe a great deal to the
American Medical Association for its stewardship
of medical standards and its protective attitude
toward the nation’s health.
As the economic, social and political life of
America has become more complex, so have the
duties and responsibilities of the medical practi-
tioner and the organization that represents him to
the public. The North Central area has contribut-
ed to the pressure for an expanded AMA pro-
gram. More than a decade ago, the North Cen-
tral Conference felt that the American 'Medical
Association should interest itself more deeply in
governmental affairs. Accordingly, the Washing-
ton office and the Council on Medical Service were
established and the scope of both offices has
widened during the years.
Currently, the American Medical Association
is sending committees abroad to study medical
education, hospitals and medical care plans, has
established commissions for the consideration of
such corrosive problems as chronic and catastroph-
ic illness, and is conducting a campaign of na-
tional education to acquaint the American public
with the facts about private and government
medical practice.
If the American Medical Association is to con-
tinue to guard the public’s health and, obliquely,
its freedam, additional financing is necessary.
American Medical Association dues are payable
now. Checks should be made out to the AMA
and returned to the secretary of the county med-
ical society, who will relay the dues to the state
association office and from there they will go to
AMA headquarters.
Payment of the dues is voluntary and does not
affect membership in county and state associations,
but like other obligations of democratic organiza-
tions, payment of these dues is the responsibility
of every physician who is interested in maintain-
ing medical standards and furthering the health
goals of the nation.
THE STATUS OF VITAMIN CONSUMPTION
TN 1947, $188,000,000 was spent for vitamins
in this country. The manufacture and sale
of vitamins has thus become one of the great
national industries.
The question has been raised repeatedly
whether the millions spent yearly for vitamins
have been Avisely spent. Other questions which
naturally ha\ e arisen in regard to the vitamins
are : Is the average American diet actually de-
ficient in a itamins and, if so, in which vitamins
is it deficient? How can one determine the
need of supplemental vitamins in the absence
of clinical symptoms? If no avitaminosis
exists, does the administration of additional
vitamins serve any useful purpose and can it
do harm ?
An exhaustive review' of the whole subject
of vitamin supplementation in Health and Dis-
ease by Perry J. Culver appeared in the last
three issues of the New England Journal of
Medicine published in 1949. He answers the
questions submitted above to his own satisfac-
tion and with little room for criticism.
While admitting, of course, that there is
such a condition as avitaminosis as for instance
in chronic alcoholism, debilitating diseases as-
sociated with diarrhea (we assume) and in in-
fants whose orange juice as Avell as milk is
boiled. Culver questions the need for any wide-
382
Minnesota Medicine
EDITORIAL
spread consumption of purified vitamin supple-
ments by the public at large. He believes the
average diet in America is sufficient to prevent
clinical and subclinical vitamin deficiency and
that there is very little vitamin deficiency in
our country today. What there was ten years
ago has been gradually disappearing and began
to disappear before the practice of enriching
flour began. He cannot explain this phenome-
non and apparently does not believe the expendi-
ture of millions of dollars for supplemental
vitamins is responsible. He believes that many
estimates of the incidence of vitamin deficiency
in the United States have been based on the
presence of supposed signs of vitamin defi-
ciency which have been lately proven to be
non-specific in character. He also believes that
many claims that the American diet is inade-
quate are based on the consideration of the
dietary allowance recommended by the Na-
tional Research Council as minimal instead of
optimal.
The author claims that very little evidence
has been offered that supplemental vitamins
added to the average diet do anything in the
way of increasing fitness, increasing tolerance
to heat or cold, improving well-being, reducing
absenteeism from work, increasing appetite or
ability to work.
In the last four years between three and four
thousand medical articles on the subject of
vitamins have appeared. Innumerable cases
have been reported in which large doses of cer-
tain vitamins have cured a great variety of ab-
normal conditions. Oftentimes the therapeutic
claims have not been substantiated by other
investigators. Occasionally quackery has
made its appearance, as in the case of the en-
thusiasm for Vitamin E in the treatment of
heart disease. Shute, of London, Ontario, has
been claiming improvement the last three years
in 80 per cent of cases of angina pectoris, rheu-
matic heart disease, and hypertensive heart dis-
ease, from the use of Vitamin E; results which
others have not been able to duplicate. Just re-
cently the Council on Pharmacy and Chemistry
(J.A.M.A., Feb. 18, 1950) has indicated the
fraudulent nature of Shute’s claims. Doubtless
many of the claims for the therapeutic value of
other vitamins will not stand the test of time
and experience.
In the use of vitamins, the pendulum has
swung far, and doubtless more are used than
are warranted. Enormous doses can be harm-
ful, but this probably seldom occurs. The
pendulum will swing back and may have start-
ed its back-swing already. Let us not allow
it to swing so far that we withhold the use of
vitamins when they are indicated. An infant
off the breast still needs supplemental vita-
mins. They are indicated when for any reason
a diet may be lacking in vitamin content or
absorption of vitamin is deficient. The thera-
peutic limitations of the newer vitamins — folic
acid, B12 and rutin — is rapidly being deter-
mined.
The reality of sub-clinical avitaminosis and
the impossibility of determining its presence
frequently lead to the prescribing of a mixed
vitamin pill, with a large question mark as to
its need in the mind of the prescribing physi-
cian. The psychological value of such a pre-
scription, however, is often very real, and vita-
mins have replaced Elixir 1.0. and S. Modera-
tion in all things applies to the dispensing and
consumption of vitamins. That we — both the
public and the profession — have gone to in-
excusable extremes in the matter of vitamins
is certain.
ALAS, A LACK!
"DESIDES the dearth of the teaching of the
humanities in premedical education, there
is practically a total loss of the aura of medical
history in the medical school itself.
What is the result?
The junior professors and Fellows have lost
sight of the humanistic values inherent in the
past. Their task is piled up with the factual
load of biochemical and mechanical aids to
diagnosis ; the spectre of research ; the pressure
from the Juggernaut press; and the “Boards.”
In other words, they have no time. They
know nothing of the continuity of growth, its
significance and its pedagogical value.
Lecturing on medical history to undergrad-
uates may be a waste of time. In the selection
of teachers, however, one of the requisites
should be at least one essay by the candidate
on some great physician of the past. A club or
seminar for the study of history in this group
is just as essential to the preparation for teach-
(Continued on Page 388)
April, 1950
383
Medical Economics
Edited by the Committee on Medical Economics
of the
Minnesota State Medical Association
George Earl, M.D., Chairman
MORE AND MORE SECURITY
MEANS "PIGGY-BACK" RIDE
Frank Dickinson, head of the AMA Bureau of
Medical Economic Research, in a factual and con-
vincing speech at the Ehiiversity of Wisconsin
recently, scored the pending dangers of more and
more government security. Citing simple facts
and using them without distortion, Dickinson
made a sensible argument against the security-
extenders, asking the vital question, ‘‘Do we want
to ride piggy-back to the grave on the shoulders
of those who are now children?”
Explaining his contention that, with more se-
curity, those nearest the grave would depend on
those nearest the cradle, he said :
. . health progress is at once the measure and the
core of social progress. Length of life is a comprehen-
sive, rough measure of social progress — a quarter of a
century in the heyday of the Roman Empire (for upper
class Romans), a third of a century in Germany in 1700;
life expectancy at birth was almost a half century in
1900 and almost three score years and ten in 1950 in the
United States. Ruskin said it so beautifully, delightfully,
in one sentence : ‘There is no wealth but life.’
“I would impress upon you the simple fact that, dur-
ing the first half of the twentieth century, we have not
only enjoyed man’s greatest half century but we have
also endured a social revolution — a social revolution
more important than the fall of the Roman Empire, the
Renaissance, the French Revolution, or the Industrial
Revolution. This latest social revolution lies in the fact
that the distance from the cradle to the grave is much
longer for the average man. In 1900 there was no senti-
ment for ‘cradle to the grave’ schemes. Most of us
living in 1900 were close to the cradle. Most of the
people living today are far from their cradle days. This
social revolution is the basis for the sentiment for
‘cradle to the grave’ schemes, as Sir William Beveridge
called them; other people use different names. We are
faced primarily with medical and health progress in half
a century which have come so fast that we have difficulty
digesting them into our social institutions and into our
way of life. That, I submit, is the general problem. It
breaks down into many specific problems.”
He was talking about what sociologists call the
“cultural lag” — the principle that, with rapid ad-
vancement of science and medicine, society is un-
able to absorb such developments into its social
thinking with similar speed, resulting in an ap-
parently backward social conscience. In reality,
it is not backward social conscience, but scientific
and medical advancement.
Cites Fifty Years of Health Progress
Health progress statistics since 1900 show with
remarkable clarity how rapid the improvement has
been. Itemization of fifty years of progress
showed that :
“One thousand babies born in 1900 were destined to
live 49,000 years.
One thousand babies born in 1949 were destined to live
68,000 years.
Since 1900 the entire population of the United States
has doubled. (75 to 150 million).
Since 1900 the population age 65 and over has quad-
rupled. (3 to 12 million).
The LOWEST state maternal mortality rate in 1933
was 4.3.
The HIGHEST state maternal mortality rate in 1947
was 2.6.”
Dickinson’s main point was that society can-
not cope with this improvement rate rapidly
enough to suit the social planners. Those pro-
posing more and more security for longer and
longer periods, would force Congress into long-
range and all-inclusive measures of the type
which, they think, would bring America up to the
present level of medical advancement. Dickinson
declares :
“It is the disturbing premise of the practice of medi-
cine that the doctor cannot win. Let’s say that when he
saves a woman in childbirth he just adds her name to
the list of potential victims of cancer years later. Let’s
say the patient saved is a laboring man with pneumonia ;
all the doctor does is to add one more name to the list
of potential candidates for heart disease. The doctor
384
Minnesota Medicine
MEDICAL ECONOMICS
cannot win ! Those who study these problems must come
to understand the limitations on medical practice. They
must understand that there are limitations on medical
progress itself. The doctor can only change the age and
cause of death. Medical care can never be adequate,
despite the fact that the term ‘adequate’ is used by those
who seek to decide who and how and where and why
medical care will be provided.
“There is no adequate medical care for the family of
a dying man. But the quest for better health, for longer
life, for improved medical care will never end — it will go
on and on. All that medical care can become is better.
We are not talking about a black and white question.
We are talking about a problem in which there are only
shades of grey. We can only improve ; we cannot per-
fect.”
Dickinson concludes, saying :
“The fundamental question underlying all of this dis-
cussion today, as I see it, is simply this : What kind of a
standard of social morality do you want in this country?
That is the basic issue. Do you want this exploitation of
youth, do you want to fasten yourselves on the pay-
checks of youth and ride piggy-back ... to the grave,
or do you want to pay your own way? Many years ago
when we became old enough to vote, we faced a world
in which we knew that there was ahead of us a lifetime
of working, earning, and saving. . . . Do we want to
press down upon the brow of our own youth this crown
of security thorns? Health progress has given us the
voting power.”
SECURITY— FOR ALL?— FOREVER?
More security, for more people — even for
babies who could theoretically retire at birth — is
not beyond feasibility in the eyes of a clever
economist. Writing to Charles E. Bradley, Ph.D.,
of the AMA Bureau of Medical Economic Re-
search, he suggests :
“Every new-born child in the United States would re-
ceive from the Government a promissory note for
$20,000 at 3 per cent interest, payable in 20 years.
“The 3 per cent would return $50 monthly to go to
the child’s parents until the child is 20.
“Each year during the 20 years, the Government would
pay $1,000 into a sinking fund for the retirement of the
note ; and, when the child reached the age of 20, the
Government would give him or her the $20,000 it had
paid into the sinking fund.
“Boys and girls of 20 who elected to get married would
thus have a capital of $40,000 to care for them, without
work, for the remainder of their lives.”
The writer carried this sort of thing much fur-
ther, increasing benefits through government aids
and schemes. Although exaggerated- his “dis-
sertation” shows the extent to which his oppo-
nents, the socialistic planners, could carry their
thinking. It sounds fine, full of years of “free”
security, but in the practical application of the
theory, would lead to a flagrant infringement on
the rights of Americans to earn their own living,
accumulate private property, and work out their
own problems. Utopia such as suggested by this
writer, is an actual insult to the American spirit
of free competition. Its impossibility and im-
practicability is seen clearly in a definition from
“The Comma” : “Utopia : The conditions that
will prevail when Americans enjoy 1949 wages,
1926 dividends, 1932 prices and 1910 taxes.”
FOREFATHERS WARNED OF TOO MUCH
SECURITY
Too much security means too much govern-
ment spending; Americans are constantly giving
more and more money to government, which in
turn means less and less for the individual. Lin-
coln expressed it this way :
“Property is the fruit of labor; property is desirable;
is a positive good in the world. That some should be
rich shows that others may become rich, and hence is
just encouragement to industry and enterprise. . . . Let
not him who is houseless pull down the house of an-
other, but let him labor diligently to build one for him-
self, thus by example assuring that his own shall be safe
from violence. ... I take it that it is best for all to
leave each man free to acquire property as fast as he
can. Some will get wealthy. I don’t believe in a law to
prevent a man from getting rich ; it would do more
harm than good.”
Thomas Jefferson’s agrarian philosophy in-
cluded criticism of too much government inter-
ference and piling up of a large public debt. He
said ;
“I place economy among the first and most important
virtues, and public debt as the greatest of dangers to be
feared. . . . To preserve our independence, we must not
let our rulers load us with perpetual debt. ... We must
make our choice between economy and liberty or pro-
fusion and servitude.”
Another revered forefather recognized, too, that
socialism is a doctrine of futility — an acceptance
of mediocrity. Benjamin Franklin warned;
“They that can give up essential liberty to obtain a
little temporary safety deserve neither liberty nor safety.’
The Figures Show —
Gigantic government spending is now unprec-
edented. The Journal of the Kansas Medical So-
ciety quotes enlightening statistics on the scope of
April, 1950
385
MEDICAL ECONOMICS
phenomenal federal budget figures compared to
ordinary values :
ism. To-the-point comments on this comparison
come from the Pittsburgh Medical Bulletin:
"If all the money in this bountiful nation was divided
equally, your share would be $182.58. But your share of
the national debt is $2,875.
“If everyone in the United States cashed in all his
life insurance policies it would bring in 44 billion dol-
lars— less than enough to run our federal government
for one year.
"If every farmer sold his farm, his farm equipment
and his livestock the total would be 25 billion dollars —
less than enough to operate the federal government for
seven months.
“If Kansas sold everything at its assessed valuation
and gave the entire proceeds to the federal government,
it would operate our country a little more than one
month.”
Compared with our national income, the fed-
eral debt outstanding in 1929 equaled 19c for each
dollar of national income for that year, according
to the Pittsburgh Medical Bulletin. In 1939, the
figure rose to 58c of debt per dollar of income. In
1949, the debt per dollar of income rose to the.
alarming figure of $1.15. And all this deficit has
been incurred during years of relative prosperity.
Common sense would seem to dictate that sur-
pluses should be built up in good times, and that
deficit spending to stimulate business activity
should be reserved for poor times. If Americans
are indifferent to the fact that government ex-
penditures exceed income they may easily fall
into what economist Edwin G. Nourse calls “the
easy acceptance of deficit as a way of life.”
Or in Terms of Time
This deficit spending situation is given added
emphasis by a comparison, in terms of time, of
free American and socialistic British values. The
average American factory worker must work
about 8 minutes to earn enough to buy five pounds
of potatoes, or a quart of milk, or a package of
cigarettes. In London, the average English work-
er must work 14 minutes for the potatoes, 19 min-
utes for the milk, and 1 hour and 20 minutes for
the cigarettes.
Here are a few more items:
America
3 lbs. sugar 11/ minutes
1 pair of overalls 3 hours
20 gal. gasoline 31/ 2 hours
1 pair of women’s shoes 4 hours
England
28 minutes
8/ hours
15G hours
16/ hours
And yet intelligent Americans are being urged
to adopt some plans similar to England’s social-
“We American husbands are grateful, indeed, that we
don’t have to buy the little woman’s shoes in England;
it seems bad enough here.
“Isn’t it insulting to our intelligence and the intel-
ligence of our laboring men to have our heads of govern-
ment urge us to adopt the socialistic plans of England?
“If wide publicity were given to the above statistics —
in our newspapers, our union publications and trade
journals, our government wouldn’t have a chance of
discarding our free enterprise system for socialism.”
SHORT-SIGHTEDNESS MAY BE GREATEST
DISADVANTAGE
The Industrial News Review has placed the
emphasis in the right place by warning that there
is great danger in a mere fight against socialized
medicine, socialized grocery stores or the single
socialization of any profession or business. It
says :
“It may be that the greatest danger is short-sighted-
ness. The man who runs a store may feel, for instance,
that government ownership of some great industry, such
as electric power, is of small moment to him. The man
who works in a factory may see no personal menace in
a law that would give the government broad controls
over doctors. A labor leader may welcome more and
more governmental domination of industrial leaders
with whom he has differences. This is the way dictator-
ship comes about. One group is taken over at a time,
while the other groups stand by and argue that it’s no
affair of theirs. Then, when it is too late, we find to our
horror that we’re all in the same boat. . . . The road to
sialism is marked with cheerful signs — human welfare,
a better life for the masses of people, security against
everything.”
Divide and conquer is excellent strategy. It
swallows its victims before they know they’re
bitten.
FEDERAL GOVERNMENT IS A BIG
BUSINESS
The federal government is an ever-increasing
competitor with free enterprise. According to
Samuel B. Pettengill, columnist, radio commen-
tator and former congressman, the government
now operates light and power plants, builds and
rents houses, “buys potatoes that rot and butter
that turns rancid.” In a speech delivered in Chi-
cago recently, he enumerates government busi-
nesses :
(Ccmtinued on Page 388)
386
Minnesota Medicine
Airsickness, trainsickness, seasickness, carsickness— all respond
to treatment with Dramamine (brand of dimenhydrinate.)
DRAMAMINE — for the Prevention and
Treatment of Motion Sickness • * Trademark of G. D. Sear/e & Co.
RESEARCH IN THE SERVICE OF MEDICINE
SEARLE
April, 1950
387
MEDICAL ECONOMICS
(Continued from Page 386)
“It is in the banking business, financing even such
things as race tracks, beauty parlors and soda fountains.
“It is heavily in the insurance business for war vet-
erans and their dependents.
“It is in the peanut, wheat, cotton, beans, turpentine,
turkey and wool business.
“It owns at least two railroads, barge lines, merchant
marine ships.
“It smelts metals, refines sugar, proposes to build
steel plants.
“It operates scores of hospitals and hires doctors,
dentists, oculists, and surgeons.
“It is in the business of fixing wages, pensions, prices,
profits, interest rates and dividends.
“It proposes to finance public education from the
kindergarten through college and look after everybody
from the cradle to the grave.”
It's a Question of Social Welfare
All this is done in the name of social welfare.
Social welfare in itself is not particularly harm-
ful. It is the method by which it is obtained that
is of primary concern to all Americans who enjoy
their freedom and want to continue to enjoy it.
Many Americans have spoken out on this matter
with wisdom and sincerity. Among them is Her-
man W. Steinkraus, president of the Bridgeport
Brass company and spokesman for the United
States Chamber of Commerce. Speaking on the
Town Meeting of the Air on January 24, 1950,
he said :
“I believe in social welfare, yes, but not government-
owned, propelled, controlled social welfare. I believe in
social welfare that doesn’t choke the individual initiative;
that places a responsibility on the citizens, on the com-
munity, and on the states ; one where the federal gov-
ernment steps in to help only when private and local
efforts are not enough ; where money is given only when
needed and not handed out to any group, regardless of
their individual hardship or prosperity.
“The best thing we can do to give true social welfare
to our people is to encourage thrift, give incentives for
greater production and lower prices, to stimulate business
growth and more job opportunities, to get our country
on a sound financial basis, and let the dollar be worth a
dollar. If we can’t do it now, then when in heaven’s
name are we going to start?
“We all know the American system has given the
greatest social welfare any people have enjoyed in the
world’s history. Socialism is the road to bankruptcy, a
wrecked nation, and complete government control. The
welfare state is on the same road.
“Remember what Lenin said in Russia : ‘We shall
force the United States to spend itself into destruction.’
“I say, let’s be wise. Stop, look, and listen. Let’s not
believe government can do all these things for us with-
out all of us having to pay for them and losing our
freedom, too.”
MINNESOTA STATE BOARD OF MEDICAL
EXAMINERS
230 Lowry Medical Arts Building
Saint Paul, Minnesota
Julian F. DuBois, M.D., Secretary
Saint Paul Woman Pays $500 Fine Imposed for Viola-
tion of Federal Pure Food and Drug Act
Re. United States of America vs. Carrie Grace Col-
well, also known as Mrs. J. H. Colwell, trading
as the Coliuell Radium Company.
On February 23, 1950, Mrs. Carrie Grace Colwell,
sixty-eight years of age, 257 Johnson Parkway, Saint
Paul, Minnesota, paid a fine of $500 in the United States
District Court at Saint Paul, Minnesota. Mrs. Colwell
had been convicted by a jury on December 1, 1947, on
four counts of violating the Federal Food, Drug and
Cosmetic Act. On December 16, 1947, Mrs. Colwell was
sentenced by Judge Dennis F. Donovan to pay fines
totalling $500 and she was placed on probation for two
years. The charge against Mrs. Colwell was that she
had shipped drugs in interstate commerce that were
misbranded and mislabeled. The charges grew out of the
shipment of so-called “radium ore” that was represented
as being efficacious in the treatment of cancer, tumors,
poliomyelitis, Bright’s disease, liver disorders and numer-
ous other conditions. During the two years that Mrs.
Colwell was on probation, she did not pay her fine. Ac-
cordingly, on December 15, 1949, her probation was con-
tinued for three additional years. On February 15, 1950,
a warrant was issued for Mrs. Colwell’s arrest for vio-
lating her probation by not reporting to the probation
officer. On February 23, 1950, Mrs. Colwell paid the
$500 fine. On March 6, 1950, Judge Donovan signed an
order terminating Mrs. Colwell’s probation.
ALAS, A LACK!
(Continued from Page 383)
ing as is their scientific requisite. Equipped
with a knowledge of the past, the opportunity
to impart this knowledge to the students at
bedside clinics and conferences would enrich
the student and stimulate him toward a more
vital concept of his work.
The undergraduate of today is as much a
hero worshipper as was the student of fifty
years ago. He usually picks out, consciously
or unconsciously, a member of the faculty
whom he imitates as much as possible. If this
professor has a cultural attitude in his teach-
ing, the student will readily seek his fill of
humanistic values. Without this cultural side
of medicine, the danger to the young recruit
might very well be that his practice will be
mechanical, unhuman, depraved to a “busi-
ness” level. The medical schools of today lack
pitifull v this fundamental in pedagogy.
H. L. U.
388
Minnesota Medicine
, , ,
The First
Qualified neurologists and neurosurgeons staff this center. The staff
also includes qualified personnel who have been trained in special
therapy, occupational therapy, corrective therapy and physical
therapy.
GLENWOOD HILLS HOSPITALS
3501 GOLDEN VALLEY ROAD MINNEAPOLIS 22, MINNESOTA
Offering a High Standard of Facilities for 25 Years
NEUROLOGIC CENTER FOR CIVILIANS
in the Northwest
Governor Luther Youngdahl formally opened and dedicated our
neurologic center and opened the doors to the public on February
12, 1950, thereby offering the following new services:
1) treatment of the hemiplegic patient
2) multiple sclerosis
3) retraining of speech disorders
4) paraplegia and other paralyses
5) ataxias
April, 1950
389
♦
Reports and Announcements ♦
STATE MEETING
The annual meeting of the Minnesota State Medi-
cal Association will he held in Duluth, June 12, 13,
14, 1950.
A symposium on “Advances and Investigation in
Surgery of the Heart” and one on “New Advances in
Treatment of Joint Disease” centering around
cortisone, ACTH and gold salts will take place.
Wednesday will be largely devoted to considerations
of atomic energy, the afternoon being devoted to a
conference on “Atomic Energy in War and Peace”
open to the public.
The Northwest Pediatric Society is sponsoring
Dr. Armand J. Quick, of the Marquette University
School of Medicine, who will speak on “The Com-
mon Hemorrhagic Diseases of Childhood.” The
Arthur H. Sanford lectureship in pathology will be
given by Dr. Ancel Keys, whose subject will be “The
Diet and Cardiovascular Disease.” Presenting the
Russell D. Carman memorial lecture will be Dr. Eu-
gene Pendergrass, Professor of Radiology at the
University of Pennsylvania.
AMERICAN BOARD OF OPHTHALMOLOGY
Candidates for the certificate of1, the American Board
of Ophthalmology are accepted for examination on the
evidence of a written qualifying test. Applications are
now being accepted for the 1951 written test and will he
considered in order of receipt until the quota is filled.
Practical examinations for acceptable candidates in 1950
will be held in Boston from May 22 to 26, in Chicago
from October 2 to 6, and on the west coast in January,
1951. Further information can be obtained from the
executive office of the board, 56 I vie Road, Cape Cottage,
Maine.
MENTAL HEALTH WEEK
With approximately half the hospital beds in the
United States at any one time occupied by the men-
tally ill, and with at least half the patients of all
physicians having complaints caused by or closely
related to emotional difficulties, the medical profes-
sion has an important stake in National Mental
Health Week, April 23-29, according to Dr. Burtrum
C. Schiele, University of Minnesota Professor of
Psychiatry.
An important development is the training of medi-
cal students in comprehensive medicine, with the in-
tegration of psychiatry and medicine of vital signifi-
cance, according to Dr. Schiele. “All medical stu-
dents should be aware of the possible relationship
between life situations, personal factors and emo-
tions in physiological upheavals and disturbances.”
Mental Health Week is sponsored nationally by a
broad _group of organizations headed by the Na-
tional Committee for Mental Hygiene, the National
Mental Health Foundation, the National Insti-
tute of Mental Health, the American Psychiatric
Association, and the Junior Chamber of Commerce.
The Minnesota Mental Hygiene Society is co-ordi-
nating activities within the state, with the assistance
of the Minnesota Department of Health, the State
Division of Public Institutions, and other state agen-
cies.
MINNESOTA SOCIETY OF NEUROLOGY
AND PSYCHIATRY
The regular meeting of the Minnesota Society of
Neurology and Psychiatry was held at the Town and
Country Club, Saint Paul, on March 14. The scientific
program consisted of the presentation of two papers:
“Psychiatry in Geriatrics” by Dr. Walter P. Gardner, and
“The Electroencephalogram in Brain Tumors” by Dr.
Philip K. Arzt.
CRIPPLED CHILDREN CLINICS
The spring clinic schedule for crippled children, pre-
pared by the Division of Social Welfare, Medical Serv-
ices Unit, is as follows (clinics have already been held
at St. Cloud, Austin and Detroit Lakes) :
Place
Date
Building
C c/unties
Worthington
April 15
Grade School
Nobles
Jackson
Pipestone
Cottonwood
Murray
Rock
Grand Rapids
April 22
Senior High
Itasca
Cass
Thief River
Falls
April 29
High School
Pennington
Marshall
Red Lake
Roseau
Kittson
Faribault
May 6
High School
Rice, Carver
Goodhue, Scott
Steel, Dakota
Brainerd
May 13
Franklin
Jr. High
Crow Wing
W adena
Mille Lacs
Todd, Cass
Aitkin
Morris
May 20
High School
Stevens, Grant
Pope, Traverse
Douglas
Bigstone
Moose Lake
May 27
High School
Aitkin, Cook
Carlton, Lake
Pine
International
Falls
J une 3
Alexander
Raker School
Koochiching
Lake of Woods
COURSE IN ENDOCRINOLOGY
A postgraduate course in endocrinology will be held
by the American College of Physicians at the La Salle
Hotel, Chicago, Illinois, from May 15 to 20.
The course will provide an intensive review of recent
developments in the field of endocrinology, devoting a
considerable amount of time to the clinical uses of ACTH
and cortisone and related steroids. Special attention will
(Continued on Page 392)
390
Minnesota Medicine
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REPORTS AND ANNOUNCEMENTS
COURSE IN ENDOCRINOLOGY
(Continued from Page 390)
be paid to clinical disorders. Instructors from all areas
of the United States and Canada will participate in the
course, which will consist of lectures, round-table lunch-
eon discussions and presentations of patients.
Fees for the course will be $30 for members of the
American College of Physicians and $60 for non-mem-
bers. Further information can be obtained by writing
the director of the course, Willard O. Thompson, M.D.,
700 North Michigan Avenue, Chicago 11, 111.
CONTINUATION COURSE
A continuation course in proctology will be presented
at the Center for Continuation Study of the University
of Minnesota from May 22 to 27. Dr. George Thiele of
Kansas City will be the visiting faculty member for
the course and will discuss “The Relationship of Ano-
rectal Diseases to General Medical Problems” and “Of-
fice Management of Common Proctologic Complaints.”
Throughout the course, emphasis will be placed on
anorectal and colonic lesions most frecpiently seen by
practicing physicians. The presentation will be by means
of lectures, operative clinics, motion pictures, and sem-
inars. Faculty for the course will be made up of
clinical and full-time members of the staff of the Uni-
versity of Minnesota Medical School and the Mayo
Foundation.
SEMINAR ON PSYCHOSOMATIC MEDICINE
Three seminar lectures on psychomatic medicine
in two Minnesota areas are scheduled for April —
the month in which National Mental Health Week
falls. National Mental Health Week is scheduled
for April 23-29 and is sponsored nationally by a broad
group of organizations headed by the National Com-
mittee for Mental Hygiene, the National Mental
Health Foundation, the National Institute of Men-
tal Health, the American Psychiatric Association,
and the Junior Chamber of Commerce. The Minne-
sota Mental Hygiene Society is co-ordinating activi-
ties within the state, with the assistance of the
Minnesota Department of Health, the State Division
of Public Institutions, and other agencies.
Professional groups in the Mankato area will hear
two lectures on mental health, one by Dr. Reynold
A. Jensen, associate professor of pediatrics and psy-
chiatry, and the other by Dr. C. Knight Aldrich,
assistant professor of psychiatry at the University
of Minnesota. On April 26, during National Mental
Health Week, Dr. Aldrich will speak in the Austin
area to physicians, dentists,' nurses, and pharmacists.
Mankato’s University of Minnesota postgraduate
seminar for physicians started February 28. Phy-
sicians have been meeting at the Mankato State
Teachers College Tuesday evenings at 7:45. Eight
consecutive weekly sessions on heart disease, cancer
control, and mental health have been scheduled, with
the last one held April 25. Faculty members of the
University of Minnesota School of Medicine and the
Mayo Foundation for Education and Research have
spoken to the medical group.
(Continued on Page 394)
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392
Minnesota Medicine
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393
REPORTS AND ANNOUNCEMENTS
SEMINAR ON PSYCHOSOMATIC MEDICINE
(Continued front Page 392)
The Wednesday evening medical seminar at Austin
started March 15 and will conclude May 10. St.
Olaf Hospital in Austin has been the site of the eight
weekly meetings.
The medical seminars in these two areas have stim-
ulated other professional groups to develop pro-
grams devoted to heart disease, cancer control, and
mental health as related to the specific professions.
Dentists and nurses of Austin and Mankato areas
have been meeting for sessions of their own, and then
have been joining with the physicians for the last
four medical lectures. Pharmacists have been in-
vited to attend those lectures of any group which
they feel are of most professional value to them.
Five of the seven seminars offered during the 1949-
50 season have already been completed. Bemidji,
Fergus Falls, Duluth, St. Cloud and Winona have
held professional postgraduate education courses for
personnel within their areas.
With the completion of courses now being cur-
rently held in Austin and Mankato Minnesota’s
unique education program will draw to a close this
year. Projected on a five-year basis, the program
is expected eventually to reach most Minnesota com-
munities.
Seven Minnesota cities will be chosen for similar
seminars next year.
Sponsors of the program for physicians have been
Cook County Graduate School of Medicine
ANNOUNCES CONTINUOUS COURSES
SURGERY — Intensive Course in Surgical Technic, two
weeks, starting April 17, May 15, June 19.
Surgical Technic, Surgical Anatomy and Clinical Sur-
gery, four weeks, starting April 3, May 1, June 5.
Personal Course in General Surgery, two weeks, start-
ing April 17.
Surgery of Colon and Rectum, one week, starting April
10, May 15.
Esophageal Surgery, one week, starting June 5.
Breast and Thyroid Surgery, one week, starting June 26.
Thoracic Surgery, one week, starting June 12.
Gallbladder Surgery, ten hours, starting April 24.
Fractures and Traumatic Surgery, two weeks, starting
June 12.
Basic Principles in General Surgery, two weeks, start-
ing, September 11.
GYNECOLOGY — Intensive Course, two weeks, starting
April 17, June 19.
Vaginal Approach to Pelvic Surgery, one week, start-
ing May 15.
OBSTETRICS — Intensive Course, two weeks, starting
April 3, June 5.
PEDIATRICS — Intensive Course, two weeks, starting
April 3.
Personal Course in Cerebral Palsy, two weeks, starting
July 31.
Personal Course in Diagnosis and Treatment of Con-
genital Malformations of the Heart, two weeks, start-
ing June 5.
MEDICINE — Intensive General Course, two weeks,
starting April 24.
Electrocardiography and Heart Disease, two weeks,
starting July 17.
Hematology, one week, starting May 8.
Gastro-enterology, two weeks, starting May 15.
Liver and Biliary Diseases, one week, starting June 5.
Gastroscopy, two weeks, starting May 15, June 12.
General, Intensive and Special Courses in all Branches of
Medicine, Surgery and the Specialties.
TEACHING FACULTY— ATTENDING
STAFF OF COOK COUNTY HOSPITAL
Address: REGISTRAR, 427 South Honore Street
Chicago 12, Illinois
the University of Minnesota School of Medicine, the
Minnesota State Medical Association, the Minnesota
Department of Health, and local professional organi-
zations. Other sponsors are the Minnesota Division
of the American Cancer Society, the Minnesota Heart
Association, and the Minnesota Mental Hygiene
Society.
FREEBORN COUNTY SOCIETY
At a meeting of the Freeborn County Medical Society
in Albert Lea on February 23, the principal speaker was
Dr. R. \Y. Ridley, Rochester, who spoke on newer
developments in the field of anesthesia.
Society members reported at the meeting that $1,000
had been contributed to the Naeve Hospital equipment
fund. The money had been earned by the society in a
school immunization campaign last fall.
HENNEPIN COUNTY SOCIETY
Dr. Reuben F. Erickson, Edina, has been elected presi-
dent of the Hennepin County Medical Society, to take
office on October 2. He will succeed Dr. Robert F.
McGandy in the post.
Other new officers of the society include Dr. William
R. Jones and Dr. Robert E. Priest, vice presidents, and
Dr. George N. Aagaard and Dr. Ralph H. Creighton,
members of the board of directors.
RANGE MEDICAL SOCIETY
Dr. Gordon M. Erskine, Grand Rapids, was installed
as president of the Range Medical Society at a meeting
in Hibbing on February 28. Other officers of the so-
ciety include Dr. T. A. Malmstrom, Virginia, vice presi-
dent, and Dr. Robert E. Hansen, Hibbing, secretary.
WASHINGTON COUNTY SOCIETY
The monthly meeting of the Washington County Med-
ical Society was held on March 14. Following dinner
and a business session, two colored motion pictures,
“Cardiac Arrhythmias” and “Animated Hematology,”
were shown.
SKILL AND CARE!
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394
Minnesota Medicine
of its
Authoritative Endorsement
Phospho-Soda (Fleet)'s* endorsement by modern clinical
authorities stems in great measure from its gently thor-
ough action— free from disturbing side effects. That, too,
is why so many practitioners are relying increasingly on
this safe, dependable, ethical medication for judicious
laxative therapy. Liberal samples on request.
' Phospho-Soda (Fleet) is a solution containing in each 100 cc. sodium biphosphate 48 Gm. and
sodium phosphate 18 Gm. Both 'Phospho-Soda' and 'Fleet' are registered trade marks of
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395
Minnesota Academy
of Medicine
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Such facility indicates the brilliant per-
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Meeting of December 14, 1949
The regular monthly meeting of the Minnesota
Academy of Medicine was held at the Town and Coun-
try Club on Wednesday evening, December 14, 1949.
Dinner was served at 7 o’clock, and the meeting was
called to order at 8:10 by the President, Dr. J. A. Lepak.
There were fifty members and three guests present.
Minutes of the November meeting were read and ap-
proved.
Dr. Lepak gave a talk on various phases of the Con-
stitution and By-Laws, also election of new members.
It was voted to continue the extra assessment of $5 per
member for 1950. Motions were carried that the
Academy vote $100 to the Litzenberg Memorial Fund,
and $100 contribution to the Bell Pathological Museum.
The following officers were elected for 1950:
President William Hanson, Minneapolis
Vice President William Hengstler, Saint Paul
Secretary-Treasurer. .Wallace P. Ritchie, Saint Paul
The scientific program followed.
Dr. Charles Rea presented his paper on “Banti’s Dis-
ease Treated by Splenectomy and Later by Gastric Re-
section.” (See page 347.)
Dr. Walter P. Gardner, of St. Paul, read his In-
augural Thesis on ‘‘Psychiatry in Geriatrics.” (See
page 353.)
The meeting was adjourned.
A. E. Cardle, M.D., Secretary
In Memoriam
JOHN DOUGLAS WATSON
Dr. John D. Watson, for many years a practicing
physician at Holdingford, Minnesota, died on February
13, 1950.
Dr. Watson was born at Socorro, New Mexico, No-
vember 19, 1885. He obtained his education at London,
Ontario, in the local high school and at the London
Collegiate Institute. His medical degree was obtained
at the University of Western Ontario at London, On-
tario, in 1907. After taking postgraduate work at the
Fort Douglas Army Hospital at Salt Lake City he
practiced at Welton, Iowa, from 1907 to 1915.
Dr. Watson was a member of the Upper Mississippi
Medical Society, the Minnesota State and American
Medical Associations.
Dr. Watson is survived by his widow; a daughter,
Mrs. Peter Holliday of Chicago; a son, Dr. William J.
Watson of Saint Paul and a brother, Dr. A. M. Watson.
396
Minnesota Medicine
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pril, 1950
397
Woman’s Auxiliary
NATIONAL OFFICER ADDRESSES
STATE AUXILIARY
Mrs. Paul C. Craig, Reading, Pennsylvania, represent
ing the national board of the Woman's Auxiliary to the
American Medical Association, urged Minnesota doctors’
wives to become familiar with the many health bills
pending in Congress, so they could “give facts and thus
help people form an opinion based upon facts.”
Mrs. Craig spoke at the mid-winter board meeting and
luncheon of the Woman’s Auxiliary to the Minnesota
State Medical association February 23, at the Minnesota
Club in St. Paul. She paid tribute to the public service
activities of the state medical association and its aux-
iliary for their use of Regional Health Days to de-
velop community responsibility.
In discussing current legislation, Mrs. Craig empha-
sized that the medical profession must oppose those bills
which it considers damaging to health progress, but, she
added, the medical profession should support “much
positive health legislation.”
CHRONIC ILLNESS BEING STUDIED
She noted that the problem of the chronically ill is
one of the unsolved medical problems of modern life. A
commission for the study of this problem has been set
up by the AMA, the American Public Welfare asso-
ciation, the American Public Health association and the
American Hospital association. A grant of $23,000 from
the AMA is supporting this project.
“It is not well known,” Mrs. Craig stated, “that the
chronically ill are not covered in the omnibus compul-
sory tax medical care program supported by the federal
government.”
VOLUNTARY PLAN INCREASE SCORED
Mrs. Craig, wife of a Reading, Pennsylvania, ophthal-
mologist, called attention to the rapid development of all
types of voluntary health insurance plans throughout the
country. She informed auxiliary members, that on the
basis of growth, by the end of 1950, 77 million persons
will be covered for hospital bills, 50 million will be in-
sured against surgical costs and 21 million will be in-
sured against medical costs, using the varied types of
voluntary insurance now available in this country.
Discussing a recent fifteen month study of medical
services done in New York state, Mrs. Craig pointed
out that “the pressing need is not for additional facilities
but for improving diagnostic services and in modernizing
old buildings.” The survey concluded that additional
state aid is needed for mental and tuberculosis patients.
Mrs. Craig stated, “Already in New York 57 per cent
of the population is covered by some type of voluntary
Doctor . . .
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heat. One or two drops of the specimen to be tested are dropped
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if acetone or reducing sugar is present. False positive reactions do not
occur. Because of the simple technique required, error resulting from
faulty procedure is eliminated. Both tests are ideally suited for office
use, laboratory, bedside, and “mass-testing." Millions of individual
tests for urine sugar were carried out in Armed Forces induction and
separation centers, and in Diabetes Detection Drives.
The speed, accuracy and economy of Galatest and Acetone Test
(Denco) have been well established. Diabetics are easily taught
the simple technique. Acetone Test (Denco) may also be used for
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Bibliography
Joslin, E. P., et al: Treatment
of Diabetes Mellitus — 8 Ed.,
Phila., Lea & Febiger, 1946 —
P. 241, 247.
Lowsley, O. S. & Kirwin, T. J.:
Clinical LJrology — Vol. 1. 2
Ed., Balt., Williams & Wil-
kins, 1944— P. 31.
Duncan, G. G.: Diseases of Me-
tabolism— 2 Ed., Phila., W. B.
Saunders Co., 1947 — P. 735,
736, 737.
Stanley, Phyllis:
Journal of
nology — Vol.
1940 and
Jan., 1943.
The American
Medical Tech-
6, No. 6, Nov.,
Vol. 9, No. 1,
398
Minnesota Medicine
WOMAN’S AUXILIARY
North Shore
Health Resort
Winnetka, Illinois
on the Shores of
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A completely equipped sanitarium for the care of
nervous and mental disorders, alcoholism and drug addiction
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225 Sheridan Road Medical Director Phone Winnetka 6-0211
average . . . growing rapidly through 1949. On the
isis of this expansion in coverage, it is quite possible
) enroll up to 85 per cent of the population in Blue
ross, Blue Shield and commercial plans.”
Auxiliary members were asked to become familiar
ith the findings of the Hoover Commission report, and
) use this book for book reviews.
Mrs. Craig was introduced by Dr. F. J. Elias, Duluth,
resident of the Minnesota State Medical association,
►r. Elias praised the auxiliary, saying that it was and is
i major part in our campaign.” Citing the difficulty in
/aluating the accomplishments of any organization in a
rogram of this type, he gave credit to the auxiliary for
s help in three categories: (1) the distribution of
imphlets, (2) opinion guidance which showed up favor-
sly in the Minnesota Poll, and (3) the increase in the
umber of people covered by Blue Shield, Blue Cross
id other voluntary plans.
Nearly 100 women attended the board meeting and
incheon which was open to all state auxiliary members.
Irs. H. E. Bakkila, Duluth, auxiliary president, pre-
ded during the meeting. Mrs. Charles W. Waas, 993
omo Blvd., St. Paul, president-elect, was in charge of
>cal arrangements.
HEALTH DAY PLANS ARRANGED
Mrs. S. N. Litman
Another in the series of Health Days, to be held April
14, is being arranged by the Woman’s Auxiliary to the
St. Louis County Medical Society in co-operation with
the medical society, the Duluth Health Council and the
Minnesota Department of Health and related organiza-
tions. Health Days, initiated by the Auxiliary to the
Minnesota State Medical association, have gained na-
tional recognition and are being used by other states
who realize their value in bringing health problems before
interested people in their respective communities.
St. Louis, Cook, and Carlton counties will participate
in the Health Day, which is planned for the purpose of
bringing to the people an increased awareness of com-
munity health problems and ways of meeting them
more effectively. Medical talks, discussions, exhibits and
motion pictures will be on the day’s program in the
Spalding Hotel, Duluth.
Mrs. P. S. Rudie, general chairman, is being assisted
by Mrs. Harold Wahlquist, health day chairman for the
Minnesota State Medical auxiliary, Wallace Fulton of
the Minnesota Department of Health, and Mrs. Ruth
Hosted, secretary of the Duluth Health Council.
Statesmen and economists all over the world seem to realize the close relation between
health and economy, health and social conditions, health and the standard of living. — WHO
Newsletter, July-August, 1949.
tPRin. 1950
399
Of General Interest
♦
All Minnesota physicians are invited to submit to
Minnesota Medicine items "of general interest” con-
cerning themselves or their colleagues. To ensure
accuracy and completeness, it is suggested that items
submitted contain the answers to the age-old news-
paper questions: who,* what, where, when and (in
some cases) why. Only the facts are necessary, since
items can be rewritten for consistency of style.
* * *
Dr. John T. Smiley has been appointed by the
Minnesota Department of Health to the position of
director of Health District No. 6, comprising Anoka,
Chisago, Dakota, rural Hennepin, Isanti, Kanabec,
rural Ramsey, Washington and Wright Counties.
Dr. Smiley was formerly assistant superintendent
of Ancker Hospital, Saint Paul, superintendent of
the county hospital at Stockton, California, chief
of the Bureau of Hospital Licensing and Inspection,
California State Department of Health, and chief
medical officer of the Ledo Road project in the Bur-
ma-India Theater during World War II.
* * *
Dr. and Mrs. J. W. Stuhr of Stillwater recently
returned from a two-week visit ?n California.
* * *
The opening of offices at 1253 Medical Arts Build-
ing, Minneapolis, has been announced by Dr. John
K. Grotting, who is limiting his practice to plastic
and reconstructive surgery.
Dr. Grotting received training in general and plas-
tic surgery at the Mayo Clinic, where he has been
for the past four years. He holds a master of science
degree in plastic surgery granted by the University
of Minnesota.
At a meeting of the Polk County (Wisconsin)
Medical Society at Balsam Lake, Wisconsin, on
March 16, Dr. William B. Stromme of Minneapolis
presented a paper on “Dystocia."
* * *
Dr. Don V. Smith joined the staff of the Blue
Earth Medical Center on March 1. A graduate of
Northwestern University Medical School in 1943,
Dr. Smith served his internship at Cook County Hos-
pital, Chicago, and then served in the Army for two
years, part of the time in Japan. He completed a
one-year surgical residency at Eitel Hospital, Min-
neapolis, and then became associated in practice with
Dr. George Eitel in Minneapolis. In his new situa-
tion in Blue Earth he is associated with Dr. George
W. Drexler and Dr. Ralph E. Wenzel.
* * *
Dr. Henry E. Michelson, professor of dermatology
at the University of Minnesota Medical School, de-
livered the Alembert Winthrop Brayton birthday din-
ner address at Indianapolis on March 9. His sub-
ject was “Cutaneous Tuberculosis and Sarcoidosis.”
Dr. A. M. Watson of Royalton was one of the
chief defense witnesses when the people of Morrison
County recently went "on trial” for not doing all
they could to improve public health in their own
communities. There were twenty-one witnesses in
all at the mock trial held in the County Court House
at Little Falls. Those for the defense described the
many types of health services available to residents
of the county, but those for the prosecution made
it clear that the people were not using these serv-
ices fully or effectively, nor doing all they could to
sustain, extend and improve them.
The trial was planned by the county nursing serv-
ice, with help from the district and state offices of
the Minnesota Department of Health, and was used
to promote an immunization campaign about to start
in the county.
* * *
“Effect of Beta Irradiation on Gastric Acidity” was
the title of a paper presented by Dr. R. F. Hedin,
Dr. W. R. Miller and D. G. Jelatis, Sc.D., at a meet-
ing of the Central Surgical Association in Chicago
on February 16 to 18. Dr. Hedin and Dr. Miller
are associated wjth the Interstate Clinic in Red
Wing.
* * *
Members of the Sedgwick County Medical So-
ciety, meeting at Wichita, Kansas, on March 2, heard
Dr. Albert V. Stoesser, Minneapolis, speak on "Uses
and Abuses of the Antihistamines.”
* * *
The directors of the Passano Foundation have an-
nounced that its award for 1950 will be a dual one,
the $5,000 cash award going to Dr. Edward C. Ken-
dall and Dr. Philip S. Hench, both of the Mayo
Clinic, for their studies in clinical physiology as re-
lated to the administration of cortisone and related
hormones. The award will be presented at the annual
award dinner, held this year at the St. Francis Hotel
in San Francisco on June 28, during the week of
the A.M.A. annual meeting. The Passano Founda-
tion was established in 1943 by the Williams and
Wilkins Company, medical publishers, to aid in the
advancement of medical research.
* * *
It was announced on March 3 that Dr. Gordon
W. Franklin planned to visit Northome to look
over facilities for both office and living quarters. He
planned, it was said, to begin practice in Northome
in July, following completion of his internship.
Northome has been without the full-time services
of a physician for two years.
* * *
Dr. Nels Strandjord of the Lenont-Peterson Clinic,
Virginia, gave a talk on congenital heart disease at a
meeting of the Virginia Lions Club on March 1.
400
Minnesota Medio ne
OF GENERAL INTEREST
your TOP LAYER income
taxable investment income is your most expensive income
since, under our progressive income tax system, it is this “Top
Layer” income that pays the heaviest taxes.
There is little a taxpayer can do about his taxable income received from:
Professional Income
Salaries
Business Profits
Dividends from Business
These are main sources of revenues — your basic in-
come. “Top Layer” income, however, your invest-
ment income, is something that you definitely have
control over in that it is within your power to give
such income either a “taxable” or a “tax-free”
status.
The income from investments which is subject to
taxation actually shrinks in yield whenever your
professional income increases and forces this tax-
able “Top Layer” income into a higher bracket.
In other words, the more your active earning
power is increased, the greater percentage of your
taxable investment income will be paid out in taxes
Tax-free income is interest income on Municipal
Bonds. This interest is exempt from all present
Federal Income Taxes and consequently provides
a “Top Layer” income that remains constant re-
gardless of changes in other income or tax rates.
The two following examples clearly demonstrate the
effect of Federal Income taxes on “Top Layer”
income:
If you are in the $1 2,000-$I4,000 income tax
bracket and purchase an investment to yield
2.50% you will realize only 1.55% if the in-
come is taxable but will receive the full 2.50%
if it is not taxable.
If you are in the $20,000-$22,000 income tax
bracket and purchase an investment to yield
3.00% you will realize only 1.54% if the in-
come is taxable but will receive the full 3.00%
if it is not taxable.
We have a handy chart which will show such comparisons for the
various taxable income brackets and will be pleased to send you one
on your request.
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Dr. Gordon Kamman, Saint Paul, was the principal
speaker at a meeting of the Stearns-Benton County
Medical Society in St. Cloud on March 14. The title
of his address was “The Present Status of Shock
Therapies and Psychosurgerv.” Earlier in the month,
Dr. Kamman gave the eighth and final lecture of the
eight-week seminar on heart disease, cancer and
psychosomatic medicine held in Duluth.
* * *
The recently constructed Litchfield Clinic build-
ing was opened to the public during the first week
of March. The one-story modern-designed building
houses the offices of Dr. Harold E. Wilmot, Dr.
Cecil A. Wilmot, Dr. Donald E. Dille and Dr. W. A.
Chadbourn. In addition to providing three rooms
for each physician, the structure contains a minor
surgery room, x-ray room, laboratory, library and
drug room.
* * *
Dr. Alson E. Braley, a former resident of Lake
Mills, has been appointed professor and head of the
department of ophthalmology in the University of
Iowa College of Medicine.
* * *
Dr. A. B. Baker was a speaker at the general
meeting of the Saint Paul Branch of the American
Association of University Women in Saint Paul on
March 7. Dr. Baker, professor and director of the
April, ICO
401
OF GENERAL INTEREST
division of neurology at the University of Minnesota,
spoke on “Study, Treatment and Diseases of the
Nervous System.” He also showed the motion pic-
ture, “The Journey Back.”
* * *
Among Minnesota physicians attending the second
annual scientific assembly of the American Academy
of General Practice, held in St. Louis, February 20
to 23, were Dr. O. B. Fesenmaier, New Ulm; Dr.
Roger G. Hassett, Mankato, and Dr. J. Earl Schroep-
pel, Winthrop.
Dr. Donald E. Stewart, of the Northwestern Clinic,
Crookston, attended a three-dav cancer-detection
clinic at the University of Minnesota during the mid-
dle of February.
* * *
Cancer research funds totaling $61,071 have been
granted to the University of Minnesota for the year
beginning July 1, it was announced early in March.
* * *
The dangers of socialized medicine were described
by Dr. Willard Akins of Red Wing in a talk given
at a meeting of the Men’s Club of the First Lutheran
Church in Red Wing on February 27.
* * *
Dr. Ruth E. Boynton has been named president
of the State Board of Health, succeeding Dr. T. B.
Magath, who recently resigned. Dr. Boynton has
served as director of the Students’ Health Service
at the University of Minnesota since 1936 and has
been professor of preventive medicine and public
health since 1938. She has been a member of the
State Board of Health since 1939 and served as presi-
dent of it in 1945.
* * *
Dr. Francis J. Crombie has opened new offices at
1234 Division Street, South St. Paul. The interior
of the building at that address has been completely
remodeled and partitioned into ten rooms. All rooms
have been sound-proofed and redecorated. The
offices include examination rooms, x-ray room, minor
surgery room, nurse’s office, and a large reception
room.
* * *
Dr. S. A. Slater, Worthington, attended a two-day
meeting of the board of the National Tuberculosis
Association in Chicago on February 3 and 4.
* * *
On February 19 the engagement of Miss Angela
Marie Jelinek to Dr. Louis B. Kucera was announced.
Miss Jelinek is a resident of Saint Paul, and Dr.
Kucera is a former resident of Owatonna. The
wedding will be held in the fall.
* * *
Dr. Malcolm Hargraves, Rochester, was the prin-
cipal speaker at a meeting of the Martin County Con-
servation Club in Fairmont on February 14. Dr. Har-
graves, well known for his conservation work, is a
past president of the Minnesota chapter of the Izaak
Walton League.
* * *
In a talk before the Hennepin County Medical So-
ciety on March 6, a Scottish surgeon, T. H. Craw-
(Continued on Page 404)
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(Continued from Page 402)
ford Barclay, said that the patient, the general prac-
titioner and the specialist are all unhappy under
socialized medicine in Britain. Mr. Barclay — to use
the British method of referring to surgeons — said
that the patient feels he is not given enough time, the
general practitioner is overworked and underpaid,
and the specialist is “under the thumb” of the gov-
ernment, with the government refusing to promote
younger specialists to adequately paying positions.
Mr. Barclay described one London physician who
was forced to see 150 patients in five hours; and he
stated that tuberculosis is one of Britain’s major
problems, since not enough facilities are available for
housing the numerous infected persons.
Mr. Barclay holds a one-year United States Public
Health Service fellowship, and he is now studying
at the University of Minnesota.
* * *
At the first 1950 quarterly meeting of the Minne-
sota Occupational Therapy Association, held in Min-
neapolis on March 4, Dr. Frederic J. Kottke, of the
University of Minnesota department of physical med-
icine, was the principal speaker.
* * *
Dr. Warren W. Haesly, Wvkoff, attended the
100th anniversary convention of the Chicago Medi-
cal Society held during the first week of March.
While in Chicago, Dr. Haesly also attended the
alumni conference of St. Luke’s Hospital, Chicago.
Both gatherings featured color television demonstra-
tions of surgical operations.
sjl 5*C jjc
Dr. and Mrs. Edward A. Colp, Robbinsdale, spent
the month of February on a trip through the Rio
Grande Valley and Mexico. On his return, Dr. Colp
opened new medical offices at 3859 W. Broadway.
* * *
At the meeting of the Scott County board of
county commissioners on February 14, Dr. H. M.
Juergens, Belle Plaine, was named coroner of Scott
County. He succeeds Dr. H. W. Havel, who re-
signed recently.
* * *
Forty-live members of the American Association
of Obstetricians, Gynecologists and Abdominal Sur-
geons held a two-day mid-winter clinic in Rochester
on February 24 and 25. Among speakers at the clinic
were Dr. Robert B. Wilson, Dr. James S. Hunter,
Dr. Arthur B. Hunt and Dr. John E. Faber, mem-
bers of the Mayo Clinic section on obstetrics and
gynecology.
* * *
Dr. Francis J. Schnugg, Brainerd, was narrator
for a motion picture on the heart fund campaign
shown at a meeting of the Lions, Rotary and Ex-
change Clubs in Brainerd on February 15.
* * *
It was announced on February 16 that Dr. Vir-
ginia Gross had arrived at the Fergus Falls State
Hospital to become a member of the staff. Formerly
404
Minnesota Medicine
OF GENERAL INTEREST
An Observation on the Accuracy of Digitalis Doses
Withering made this penetrating observation in
his classic monograph on digitalis: "The more I
saw of the great powers of this plant, the more it
seemed necessary to bring the doses of it to the
greatest possible accuracy.”1
To achieve the greatest accuracy in dosage and at
the same time to preserve the full activity of the
leaf, the total cardioactive principles must be iso-
lated from the plant in pure crystalline form so
that doses can be based on the actual weight of the
active constituents. This is, in fact, the method by
which Digilanid® is made.
Clinical investigation has proved that Digilanid is
"an effective cardioactive preparation, which has
the advantages of purity, stability and accuracy as
to dosage and therapeutic effect.”2
Average dose for initiating treatment: 2 to 4 tab-
lets of Digilanid daily until the desired therapeutic
level is reached.
Average maintenance dose: 1 tablet daily.
Also available: Drops, Ampuls and Suppositories.
1. Withering, W An account of the Foxglove, London, 1785.
2. Rimmerman, A. B.: Digilanid and the Therapy of Congestive
Heart Disease, Am. J M. Sc. 209: 33-41 (Jan.) 1945.
Literature giving further details about Digilanid and Physician’s Trial
Supply are available on request.
Digilanid contains all the initial glycosides from
Digitalis lanata in crystalline form. It thus truly
represents "the great powers of the plant” and
brings "the doses of it to the greatest possible
accuracy”.
Sandoz
Pharmaceuticals
DIVISION OF SANDOZ CHEMICAL WORKS, INC.
68 CHARLTON STREET, NEW YORK 14, NEW YORK
)f Provo, Utah, she is the wife of Dr. Mackenzie
Dross, who became a staff member of the Fergus
tails hospital a short time ago.
* * *
“Socialized Medicine” was the subject discussed by
Dr. L. W. Morsman, Hibbing, on a broadcast from
he Hibbing radio station on February 28.
* * *
The work of Dr. Suad A. Niazi, a medical fellow
n surgery at the University of Minnesota, was de-
;cribed in “Blueprint for Understanding,” a recently
lublished thirty-year review of the Institute of In-
ernational Education, New York. Dr. Niazi, a phy-
iician in the Royal Medical College in Baghdad,
.raq, came to the University of Minnesota Medical
school in 1947 under a State Department fellowship
idministered through the institute. The story of
Dr. Niazi, who in 1949 won a Damon Runyan clini-
:al fellowship from the American Cancer Society for
urther research, was used in the institute’s publica-
ion as an example of important work being done by
oreign students who are studying in the United
states.
* * *
Dr. Robert R. Remsberg of Tracy took a one-week
rourse in surgery and obstetrics at the Cook County
Tospital, Chicago, early in March.
* * *
At the annual meeting of the Morrison County
Public Health Advisory Board in Swanville on Feb-
urary 7, Dr. Edwin G. Knight of Swanville was
dected chairman of the board.
Two Saint Paul physicians discussed “The Effect
of Fear on Sex Attitudes,” on February 27 at the first
of three meetings arranged by the Saint Paul Coun-
cil of Parent-Teacher Associations. Dr. Charles L.
Steinberg, a pediatrician, and Dr. Philip K. Arzt, a
psychiatrist, were the principal speakers at the panel
discussion, which was open to both parochial and
public school PTA units. The series was planned
to offer advice to parents concerned about the emo-
tional effect of sex crime publicity on children.
* * *
Miss Marjorie Wolfenden, formerly of Granville,
Wisconsin, was married to Dr. Edward Zupanc, for-
merly of Gilbert, in a ceremony performed at Me-
nomonee Falls, Wisconsin, on February 17.
Previous to her marriage, Miss Wolfenden was a
nurse at General Hospital Madison, Wisconsin. Dr.
Zupanc, a graduate of the University of Minnesota
Medical School, recently completed a fellowship in
pediatrics at the University of Wisconsin. He is now
practicing medicine in Duluth.
Ifc l{c
Dr. Harold W. Hermann, formerly of Rochester,
has begun the practice of pediatrics in Minneapolis.
He was graduated from the University of Minnesota
Medical School in 1946.
* * si-
Dr. Robert A. Good, of the University of Minne-
sota Medical School, was one of twenty medical
scientists named for $25,000 grants from the John
and Mary R. Markle Foundation, New York. The
'Writ., 1950
405
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grants are made by the foundation as part of a
program to keep young doctors on teaching and
research staffs of medical schools.
* * *
At the annual meeting of the Minnesota Mental
Health Society in Minneapolis on March 1, Dr.
Ralph Rossen, Minnesota mental health commission-
er, stated in an address, “It is imperative that each
of our state hospitals develop a psychiatric center
for its community. Only then will we attract peo-
ple who need preventative treatment and properly
prepared workers to treat them.”
* * *
Dr. Charles Vandersluis, Bemidji, attended a four-
day clinical session held by the Chicago Medical So-
ciety during the first week of March.
* * *
Two physicians were chosen to head the Steele
County School Survey Committee at a meeting in
Owatonna on February 17. Dr. Benedik Melby,
Blooming Prairie, was elected chairman of the com-
mittee, and Dr. Edward Q. Ertel. Ellendale, was
named vice chairman.
j|c % sk
Dr. C. G. Uhley, Crookston, spoke on socialized
medicine at a meeting of the Lowell Farm Bureau
on February 20.
* * *
Dr. Joseph Ryan, director of the outpatient de-
partment at St. Joseph’s Hospital, Saint Paul, was
the guest speaker at a meeting of the St. Thomas
College Mathematics and Physics Club on February
20. Dr. Ryan, who was formerly associated with
the Oak Ridge atomic project, spoke on “Effects of
the Atomic Bomb on Human Beings.”
* * *
Achievements in fighting Minneapolis health
problems and agency activities, as reported to the
public through newspaper stories, were described by
Dr. Frank J. Hill, Minneapolis health commissioner,
at a meeting of the Community Health Service hoard
of directors late in February.
* * *
Open house was held at the newly completed Pine
River Clinic on February 11. Constructed by Dr.
C. M. Zeigler and Dr. A. T. Rozycki, both of Pine
River the clinic is a one-story modern-designed
structure, 66 by 24 feet. It houses offices for the
physicians, examination rooms, laboratory, x-ray
room, reception room and an emergency treatment
room.
* * *
Dr. E. J. Lillehei, Robbinsdale, has been named a
member of the executive committee at St. Barnabas
Hospital, Minneapolis.
* * *
At the meeting of the Saint Paul Surgical Society
on February 15, papers were presented by Dr. Charles
T. Eginton, Saint Paul, and Dr. Bernard Zimmer-
man, fellow in surgery at the University of Minne-
sota. Dr. Eginton discussed “Megacolon,” and Dr.
406
Minnesota Medicine
OF GENERAL INTEREST
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Zimmerman spoke on “Adrenal Function in the
Postoperative Patient.’’
ifc ;jc
Dr. Louis Flynn, Saint Paul, has replaced Dr.
William Fleeson, Minneapolis, as consulting- psychi-
itrist at the state child guidance clinic in Fargo. Dr.
Fleeson resigned because of the press of private prac-
:ice in the Twin Cities. Plans call for Dr. Flynn
:o spend Thursday and Friday of each week at the
Fargo clinic.
Jjc ^ ik
Dr. Frank J. Elias, Duluth, was the principal
speaker at a meeting of the St. Louis County Medical
Society Auxiliary in Duluth on February 14.
* %
Among those in attendance at the fifth National
Conference on Rural Health and Medical Service,
held in Kansas City, Missouri, during the middle of
February, was Dr. John K. Butler of Carlton.
;k sj< ij?
Dr. Leonard A. Lang, Minneapolis, gave a talk on
‘Diagnosis and Treatment of Carcinoma of the
Uterus’’ at a meeting of the Cascade County Medi-
cal Society in Great Falls, Montana, on February 17.
Dr. Lang is clinical assistant professor of obstetrics
and gynecology at the University of Minnesota and
chief of the department of gynecology at General
Hospital and St. Mary’s Hospital in Minneapolis.
^
Dr. Walter Alvarez, senior consultant in the divi-
sion of medicine at the Mayo Clinic, has been ap-
April, 1950
T T OMEWOOD HOSPITAL is one of the
Northwest's outstanding hospitals for the
treatment of Nervous Disorders — equipped
with all the essentials for rendering high-grade
service to patient and physician.
Operated, in Connection with
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HOMEWOOD HOSPITAL
Corner Penn and Plymouth Avenues North
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pointed medical editor of “G.P.,” a journal published
by the American Academy of General Practice. Dr.
Alvarez was selected to succeed Dr. F. Kenneth
Albrecht, who died following an automobile accident
in March.
A graduate of Stanford University Medical School,
Dr. Alvarez became associated with the Mayo Clinic
in 1926. Having reached the age of retirement in
the Mayo Foundation, he is moving to Chicago to
carry on his duties as editor of “G.P.”
* * * *
Dr. Stanley P. Stone, Minneapolis, has moved his
offices into his newly constructed clinic building at
Lowry and Queen Avenues North.
j|c
A history of socialized medicine was presented by
Dr. L. W. Morsman, Hibbing, at a meeting of the
Community Club in Brown early in February.
5k ik *
It was announced early in February that Dr.
George Kleifgen of Park Rapids was moving his
offices into a newly constructed Medical Arts Build-
in in Park Rapids. Dr. Kleifgen, who has practiced
in Park Rapids for ten months, has taken three
years of postgraduate training in surgery at the
Mayo Clinic.
5k 5jc *
Rochester’s new public health center was opened
to the public on March 6. The only complete pub-
407
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lie health center in the Midwest, the $270,000 build-
ing houses the Rochester-Olmsted County Health
Department and the District 3 office of the State
Department of Health. The building, which is dedi-
cated to the memory of Dr. Charles H. Mayo, was
financed primarily by a gift from the Mayo As-
sociation, an appropriation by the city of Rochester,
and a Federal grant. Modern in design, it provides
facilities for all the health and welfare activities of
the area.
* * *
Dr. Edward S. Rail, a fellow in the Mayo Founda-
tion, was named winner of the American Goiter
Association VanMeter essay award on March 9. His
essay, which was presented at the Association’s annual
meeting in Houston, Texas, dealt with the identifica-
tion of iodine compounds in blood and urine.
HOSPITAL NEWS
Falls Memorial Hospital, International Falls.— At
the annual meeting of the medical staff of the Falls
Memorial Hospital, Dr. C. C. Craig was elected
chief-of-staff, and Dr. Edward B. Kinports was
named secretary-treasurer.
* * *
St. Mary’s Hospital, Minneapolis, has completed
construction work on a new postanesthesia room —
a recovery room for patients after operation. Pa-
tients are taken to the room following operation and
are kept there under the care of a special staff until
they have completely recovered from the anesthesia.
Equipment is available for immediate action in case i
emergency treatment becomes necessary. The room
was set up under the direction of Dr. Stanley Wes-
olowski, director of anesthesiology at the hospital.
* * *
It was reported on February 23 that construction
work on the new Renville County Hospital at Olivia
was progressing rapidly. Plans called for construc-
tion of partitions and plastering early in the spring.
When it was learned that the project would require
an extra $60,000, a campaign was started in the sur-
rounding villages and towns. By late February
cash and pledges had almost totaled that amount.
sfc sfc
The new neurologic center at Glenwood Hills Hos-
pitals was officially opened on February 12. The
opening day ceremonies were highlighted by talks
by Governor Luther Youngdahl, Raymond T. Ras-
cop, hospital superintendent. Dr. Julius Johnson,
chief-of-staff, and Raymond Ewald, member of the
board of trustees.
* * *
Ways and means for launching a successful cam-
paign for funds for the Aitkin Community Hospital
were discussed at a special meeting called by the
hospital board on March 6. Civic organizations
throughout the area sent representatives to give ad-
vice on setting up the project.
408
Minnesota Medicine
OF GENERAL INTEREST
BLUE CROSS-BLUE SHIELD NEWS
Blue Shield claims in January totalled 2,575, represent-
ng 3,145 medical-surgical services. Blue Shield services
•endered at homes accounted for eight claims, services
n doctors’ offices for 520 claims, and services in hos-
pitals for 2,047 claims.
Surgical procedures accounted for 1,543 Blue Shield
services in January, medical for 999 services, and X-ray,
mesthesia, and other related services for 603 Blue Shield
services rendered in January.
Single subscribers with incomes of less than $2,000 an-
lually, and family subscribers with incomes of less than
53,000 annually, who receive unlimited subscriber bene-
its, incurred 885 claims representing 34.4 per cent of the
otal claims paid in January. Although this is not the
greatest number of claims paid in any one month for
mlimited subscribers, it represents the highest per-
centage of total claims paid in any one month incurred
>y unlimited subscribers since February, 1948.
Altogether, Minnesotans received $97,269.47 in Blue
shield medical-surgical benefits during January. Of this
mount 94.2 per cent or $91,628.34 was in payment of
laims submitted by participating doctors for services to
Hue Shield subscribers, and 5.8 per cent or $5,641.13
or claims submitted by non-participating doctors.
During the month of February, Minnesota Medical
lervice Jnc., with the approval of the State Insurance
epartment, paid the balance of notes held by doctors.
)f the total $86,000 subscribed and loaned by doctors of
finnesota to assist the Blue Shield plan for working
capital, only about $20,000 was actually used. The re-
payment of the total amount of notes to doctors was
therefore not a great hardship upon the Association.
Flowever, the wonderful response of Minnesota doctors
who were willing to underwrite the Plan was most en-
couraging. We thank you all again.
During January 9,192 Blue Shield applications were
made effective, making the total Minnesota Blue Shield
enrollment 282,887, Nearly 4,000,000 persons were added
to the seventy-six Blue Shield plans in 1949, making a
total Blue Shield enrollment of more than 14,250,000 as
of December 31, 1949.
1 he demand for Blue Cross-Blue Shield coverage was
clearly demonstrated in the first non-group Blue Cross-
Blue Shield enrollment campaign ever to be conducted
in Minnesota. The campaign, which began January 1
and closed January 21, brought 22,883 inquiries and
10,362 applications were returned. Over 1,000 persons in-
quired at the information desk about the new, non-
group coverage; 6,164 persons inquired by telephone, and
15,654 persons inquired by mail. On February 10, the
final date for acceptance of non-group contracts, over
45 per cent of the people who had inquired about the
non-group coverage had sent in their applications. An
additional 652 inquiries came from thirteen other states
and Canada. These inquiries were referred to their re-
spective Blue Shield and Blue Cross plans in their area.
Minnesota Blue Cross enrollment on January 31, 1950,
totalled 989,474. Payments to hospitals during January
amounted to $741,092.03 — an increase of $82,390.51 over
the amount paid during January, 1949.
The Birches Sanitarium, Inc.
2391 Woodland Avenue
Duluth 3, Minnesota
A hospital for the care and treatment of
Nervous and Mental disorders. Quiet, cheer-
ful environment. Specially trained personnel.
Recreational and occupational therapy.
Dr. L. R. Gowan, M.D., M.S., Medical Director
Attending Psychiatrists - -
Dr. L. R. Gowan Dr. C. M. Jessico
Dr. I. E. Haavik Dr. L. E. Schneider
REST HOSPITAL
2527 Second Avenue South, Minneapolis
A quiet, ethical hospital with therapeutic facilities
for the diagnosis and treatment of nervous and
mental disorders. Invites co-operation of all repu-
table physicians. Electroencephalography avail-
able.
PSYCHIATRISTS IN CHARGE
Dr. Hewitt B. Hannah
Dr. Andrew I. Leemhuis.
Vhkil, 1950
409
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Across the nation, about 900,000 steel workers and
their families will be covered by Blue Cross as a part ,
of the agreements which settled last fall’s nationwide
steel strike. Approximately 15,000 steelworkers in Min-
nesota will come under the hospitalization program pro-
vided by Blue Cross. A commercial contract was select-
ed by the steel workers covering surgical services. It
is hoped that a national contract can eventually he
worked out to cover the steelworkers for Blue Shield
benefits.
To supply the hospitalization program for steelworkers
and their families, Blue Cross plans wrote a contract
which, for the first time, offers similar rates and benefits
for every employe regardless of where he lives. Ordi-
narily, employes of nationwide industries are enrolled
in their local plans, pay local plan rates and receive local
plan benefits. The steel contracts provide a uniformity
of benefits and rates which will serve as a model for
formulating future Blue Cross agreements in other
nationwide industries where uniform coverage of em-
ployes may be desired.
Over 36,000,000 persons in the United States and
Canada are Blue Cross subscribers.
The annual joint conference of Blue Cross and Blue
Shield plans was held in Montreal, Quebec, from Feb-
ruary 26 to March 1. Arthur M. Calvin, executive direc-
tor of the Minnesota plans, was elected a commissioner
of the Blue Shield medical care plans representing Min-
nesota, Wisconsin, Iowa, Nebraska, North Dakota and
South Dakota. Dr. A. J. Offerman, president of the
Nebraska Blue Shield plan, was also elected a commis-
sioner from this district. Each district is entitled to one
commissioner who is a doctor of medicine and one com-
missioner who is an executive director of a Blue Shield
plan.
The conference meetings primarily concerned Blue
Cross-Blue Shield policies. Some of the main actions
taken involved the Inter-Plan Transfer Agreement.!
Among other changes, the most important effected the
cancelling of contracts held by snbscribers who move
out of one plan’s area into an area served by another
participating plan.
Both Blue Cross and Blue Shield Commissions revised
their standards for approval of Plans, establishing more
definite requirements for Plans to meet financial re-
sponsibility as well as non-profit sponsorship and con-
trol.
DANIELSON MEDICAL ARTS PHARMACY, INC
PHONES:
ATLANTIC 3317
ATLANTIC 3318
10-14 Arcade. Medical Arts Building
825 Nicollet Avenue — Two Entrances — 78 South Ninth Street
MINNEAPOLIS
HOURS:
WEEK DAYS— 8 to 1
SUN. AND HOL.— 10 TO 1
PHYSICIANS AND HOSPITALS SUPPLY CO., Inc.
414 SOUTH SIXTH ST., MINNEAPOLIS, MINN.
INSTRUMENTS • TRUSSES • EQUIPMENT • PHARMACEUTICALS • DRUGS
MAIN 2494
410
Minnesota Medicine
BOOK REVIEWS
BOOK REVIEWS
Books listed here become the property of the Ramsey,
Hennepin and St. Louis County Medical Libraries when
reviewed. Members, however, are urged to write reviews
of any or every recent book which may be of interest
to physicians.
HANDBOOK OF OBSTETRICS AND DIAGNOSTIC GYNE-
COLOGY. Leo Doyle, M.S., M.D. 240 pages. Ulus.
Price $2.00, flexible binding. Palo Alto, California: Univer-
sity Medical Publishers, 1950.
A CENTURY OF MEDICINE IN JACKSONVILLE AND
DUVAL COUNTY. Webster Merritt. 201 pages. Illus.
Price $3.50, cloth. Gainesville, Florida : University of Florida
Press, 1949.
UROLOGICAL SURGERY. Second Edition. Austin Ingram
Dodson, M.D., F.A.C.S., Professor of Urology, Medical Col-
lege of \ irginia ; LTrologist to the Hospital Division, Medical
College of Virginia; Urologist to Crippled Children’s Hospi-
tal; Urologist to St. Elizabeth’s Hospital: LTrologist to St.
Luke’s Hospital and McQuire Clinic. 855 pages. Illus.
Price $13.50, cloth. St. Louis: C. V. Mosby Co., 1950.
MEDICINE OF THE YEAR. John B. Youmans, M.D.,
editor, Dean, School of Medicine, Vanderbilt University. 204
pages. Price $5.00, cloth binding. Philadelphia: T. B. Lip-
pincott Company, 1950.
rHE PHYSIOLOGY OF THOUGHT; A FUNCTIONAL
STUDY OF THE HUMAN MIND IN ACTION. Bv
Harold Bailey, M.D., F.A.C.S. 314 pages. Price $3.75.
New York: The William-Frederick Press, 1949.
This 314-page book is written by Dr. Harold Bail-
:y, ophthalmologist, living in Charles City, Iowa, a
graduate of Rush Medical College in 1897.
The preface states, “We shall limit the text to a
:onsideration of our own ideas, and we shall devote
ittle space to the discussion of views expressed by
ither wmiters.”
The contents of the book bears out this plan of
he author. His ideas, theories, and philosophies, as
et forth, show that the author did considerable
irowsing among philosophic and psychologic books,
if which he most frequently mentions William James’
Principles of Psychology.”
d he language used in the book is semi-popular, but
nough technical terms are sprinkled throughout to
nake it difficult reading for a layman.
The book can hardly be recommended as being
if any interest, much less of any scientific value, to a
nodern physician, psychiatrist, or psychologist.
[EARING TESTS AND HEARING INSTRUMENTS. By
Leland A. Watson and Thomas Tolan, M.D. 597 pages. Illus.
Price $7.00. Baltimore: Ihe Williams & Wilkins Company,
The authors state that the purpose of the book is to
rovide a comprehensive and primarily practical text on
earing instruments and their application, intended for
'hysicians, nurses, rehabilitation officers, school health
fficers, hearing aid technicians and those who dispense
nd fit hearing aids, and presented in a generalized style
ffiich avoids a strictly medical or a strictly engineering
pproach.
The material is presented in six parts, seventeen drap-
ers and 520 pages.
Part I. Background of the audiometer and funda-
\pril, 1950
BROWN & DAY, INC.
St. Paul 1. Minnesota
411
BOOK REVIEWS
mentals of hearing as related to audiometers and hearing
aids, of audiometry and of basic audiometric technique.
Part II. Interpretation of audiometric data.
Part III. Technical and engineering aspects of the
audiometer.
Part IV. Social aspects of audiometry, including
military, industrial, medico-legal and school phases.
Part V. Hearing Aids.
Part VI. Advanced audiometry, including speech
hearing tests.
This division of material facilitates ready reference.
The book reflects an exhaustive study of the literature
on hearing aids and audiometers published since 193d
and a comprehensive knowledge of these subjects. Much
material is presented on a wide variety of topics of
especial interest to the otologist, such as that on sound
proof and acoustically treated rooms for audiometry, the
relation between pure tone audiograms and speech hear-
ing tests, the role of the audiometer in military, indus-
trial and medico-legal fields and the economic aspects of
the hearing aid industry, such as the extent of the ac-
tive and potential market, annual sales, cost of hearing
aid up-keep and role of the retail dealer.
The bibliography, by author, publication and subject,
is exhaustive and usable. There is also a glossary of
terms used in audiology, sponsored by the Acoustical So-
ciety of America and by the Institute of Radio En-
gineers, Inc., which is most helpful and covers many
subjects, especially engineering, with which the otologist
has little or no acquaintance.
The hook is profusely supplied with tables and illus-
trations, including many audiograms, and a general glos-
sary and index. The material is well organized and
presented and constitutes a valuable source for reference.
It is the reviewer's opinion that the authors have well
accomplished their intended purpose ; the book is un-
reservedly recommended.
Charles E. Connor, M.D.
BARBITURATE POISONING
(Continued from Pape 370)
with the use of inadequate initial doses and neglect to
repeat as often as needed.”
The dosage of metrazol must be governed solely by
the degree of the depression present.
In a review of the literature dealing with the use of
massive doses of metrazol for the treatment of barbit-
urate poisoning, no case was found in which such a
large amount of the drug had been administered, al-
though Engstrand and Hruza2 reported a case in which
80 c.c. of metrazol had been given in divided doses with
complete recovery of the patient.
References
1. Eckenlioff, J. E. ; Schmidt, C. F. ; Dripps, R. D.. and Kety.
S. S. : A status report on analeptics (report to the Council
on Pharmacy and Chemistry). T.A.M.A., 139:780, (Mar.
19). 1940.
2. Engstrand, O. J.. and Hruza. W. W. : Metrazol therapy in
barbiturate poisoning. Journal-Lancet, 68:59, (Feb.) 1948.
Index to Advertisers
Abbott Laboratories 324
American Cancer Society 413
American National Bank 415
Anderson, C. F., Co 403
Ayerst, McKenna & Harrison, Ltd 321
Benson, N. P., Optical Co 408
Bilhuber-Knoll Corporation 392
Birches Sanitarium, Inc 409
Birtcher Corporation 396
Brown & Day, Inc 411
Buchstein-Medcalf Co 394
Camel Cigarettes 332
Camp, S. H., & Co 328
Caswell-Ross Agency 314
Classified Advertising 414
Coca-Cola 403
Cook County Graduate School of Medicine 394
Dahl, Joseph E., Co 404
Danielson Medical Arts Pharmacy 410
“Dee” Medical Supply Co 410
Denver Chemical Co 398
Druggists Mutual Insurance Co 415
Ewald Bros.
Inside Back Cover
Franklin Hospital 415
Fleet, C. B., Co., Inc 395
Geiger Laboratories 414
General Electric X-Ray Corporation 391
Glenwood Hills Hospitals 389
Glenwood-Inglewood Co 411
Hall & Anderson 415
Homewood Hospital 407
Juran & Moody 401
Keleket X-Ray Sales Corp. of Minnesota .322-323
Lederle Laboratories 317
Lilly, Eli, & Co Front Cover, Insert facing 332
M. & R. Dietetics Laboratories 318
Mead Johnson & Co 416
Medical Placement Registry 414
Medical Protective Co 408
Merck & Co 326
Milwaukee Sanitarium Back Cover
Mounds Park Hospital Back Cover
Mudcura Sanitarium 404
Murphy Laboratories 415
North Shore Health Resort 399
Parke, Davies & Co Inside Front Cover, 313
Patterson Surgical Supply Co 414
Physicians Casualty Association 406
Physicians & Hospitals Supply Co 330, 410, 415
Professional Credit Protective Bureau 327
Radium Rental Service 410
Rego Products 406
Rest Hospital 409
Rexair Division, Martin-Parry Corporation 402
Roddy-Kuhl-Ackerman 410
St. Croixdale Sanitarium 316
Sandoz Pharmaceuticals 405
Schering Corporation 325
Schmid, Julius, Inc 397
Schusler, J. T., Co., Inc 415
Searle, G. D., & Co 387
Squibb 319
Upjohn 393
U. S. Vitamin Corporation Insert Facing 328
Vocational Hospital 407
Wander Co
Williams, Arthur F. . .
Winthrop-Stearns, Inc.
Wyeth, Inc
320
415
329
331
412
Minn esot a M edi a ne
THE fight is on to save more lives in
1950! Now is the time to back
science to the hilt in its all out battle
against cancer.
Last year, 67,000 men, women and chil-
dren were rescued from cancer. Many
more can be saved — if you resolve to
save them— if you strike back at cancer.
Give! Give your dimes, quarters, dol-
lars. We need more treatment facilities,
more skilled physicians, medical equip-
ment and laboratories. The success of
great research and educational pro-
grams depends on your support. Your
contribution to the American Cancer
Society helps guard your neighbor,
yourself, your loved ones. This year,
strike back at cancer ... Give more than
before... Give as generously as you can.
AMERICAN CANCER SOCIETY
pril, 1950
413
Classified Advertising
Replies to advertisements with key numbers should be
mailed in care of Minnesota Medicine, 2642 University
Avenue, Saint Paul 4, Minn.
FOR RENT — New ground floor medical office building
being planned in good South Minneapolis location.
Room for one or two physicians. Plans will be drawn
to suit tenants’ needs. Rent very reasonable. Address
E-193, care Minnesota Medicine.
WANTED TO RENT — Doctor and family desire mod-
ern summer home with good beach located within 100
miles of Minneapolis. Prefer tenancy 4 to 6 weeks
only. Address E-197, care Minnesota Medicine.
PHYSICIAN WANTED — Well-established firm in
northern Minnesota desires young man for general
practice and obstetrics — deliveries in hospital. Good
income from start. Full information given and inter-
view arranged upon receipt of inquiry. Address E-192,
care Minnesota Medicine.
WANTED — Young general practitioner to become as-
sociated with young practitioner. Large practice —
prosperous community. Close to Twin Cities. Good
future. Address E-195, care Minnesota Medicine.
WANTED — Young physician for general practice, eligi-
ble for Wisconsin and Minnesota licenses to associate
with a young growing clinic. Partnership arranged.
Address E-198, care Minnesota Medicine.
OPENING FOR YOUNG PHYSICIAN— Excellent op-
portunity to enter established practice at Askov, Min-
nesota, 57 miles from Duluth on trunk highway and
main line railroad. Neighboring villages without physi-
cian. Living quarters and office space available. Pres-
ent physician retiring. Write Askov Commercial Club,
Harold B. Ause, President, Askov, Minnesota.
POSITION WANTED — 1948 graduate desires associa-
tion with general practitioner doing own surgery, or
man with surgical practice. Address E-194, care Min-
nesota Medicine.
POSITION WANTED — Minnesota graduate, with one
year residency in internal medicine, desires position as
assistant to internist or general practitioner for two
years before resuming residency. Write E-199, care
Minnesota Medicine.
FOR SALE— RF 100 Fisher X-Ray Machine complete
— in perfect condition. Reasonable asking price. Ad-
dress P.O. Drawer No. 230, International Falls, Min-
nesota.
FOR SALE — Bargain to close a business, X-Ray West-
inghouse complete equipment. See it and give me a
bid. Write for complete details. C. P. Robbins, M.D.,
Winona, Minnesota.
WANTED — Second hand Green’s Refractoscope and
stand. Must be in good condition. Address E-196,
care Minnesota Medicine.
WANTED — Laboratory technician well qualified, pref-
erably with x-ray experience, for 32-bed Sanford
Hospital, located at Farmington, Minnesota, 25 miles
south of Minneapolis and Saint Paul. Hospital
equipped with new laboratory and modern x-ray
equipment. Salary to start, $240.00 per month.
PHYSICIANS AVAILABLE
Internist — Boardman specializing peripheral vascular diseases,
cardiology; wants position Midwest with group clinic or
location for private practice.
Internist — Boardman specializing gastro-enterology and me-
tabolic diseases, has had training in neuropsychiatry;
wants position Midwest with group clinic.
Physician — -Female ; wants position with industrial or insti-
tutional health service.
POSITIONS AVAILABLE
Among the many positions available are;
Obstetrics and Pediatrics — Group partnership will be offered
if agreeable to both parties; office in hospital; Board
qualification not mandatory; excellent living conditions.
Internal Medicine — California; man must be certified or
eligible for certification ; partnership will be offered.
General Practice — Association with young general physician.
MEDICAL PLACEMENT REGISTRY
Campus Office, 629 S.E. Washington Ave., Telephone
Gladstone 9223, Minneapolis, Minnesota
The Geiger laboratories
(Clinical ^eruiceS j-or jf^byiicicins oj the bipper hhjtdclie lAdedt
1111
Mailing tubes and price lists supplied upon request.
NICOLLET AVENUE MINNEAPOLIS 2
MAIN 2350
PATTERSON SURGICAL SUPPLY COMPANY
103 East Fifth St., St. Paul 1, Minn.
HOSPITAL AND PHYSICIANS SUPPLIES AND EQUIPMENT
Cedar 1781-82-83
414
Minnesota Medicini
PHYSICIANS AND HOSPITALS SUPPLY CO., Inc.
414 SOUTH SIXTH ST., MINNEAPOLIS, MINN.
INSTRUMENTS • TRUSSES • EQUIPMENT • PHARMACEUTICALS • DRUGS
MAIN 2494
Practical Nursing School
Approved by Minnesota State Board of Nurses
Examiners
Twelve months course open to High
School Graduates or women with equiv-
alent education.
For further information apply to
DIRECTOR OF NURSES
FRANKLIN HOSPITAL
501 W. Franklin Avenue, Minneapolis 5, Minn.
| Radiological and Clinical j
s Assistance to Physicians |
2 in this territory i
MURPHY LABORATORIES j
? Minneapolis: 612 Wesley Temple Bldg - - At. 478* £
* St. Paul: 348 Hamm Bldg Ce. 7125 4
J If no answer, call Ne. 1291 5
TAILORS TO MEN SINCE 1886
The finest imported and domestic wool-
ens such as SCHUSLER'S have in stock
are not too fine to match the hand tailor-
ing we always have and always will
employ.
I. T. SCHUSLER CO., INC.
379 Robert St. St. Paul
f
Hall & Anderson
PRESCRIPTION PHARMACY
BIOLOGICALS
PHYSICIANS’ SUPPLIES
SAINT PAUL, MINN.
LOWRY MEDICAL ARTS BUILDING
TELEPHONE: CEDAR 2735
DO YOU HAVE CHILDREN?
Train them in the habit of sav-
ing money regularly through a
■tWtwt SAVINGS ACCOUNT with
<#> vvoEf/y this bank. . . . They’ll always
thank you. OPEN AN AC-
Ww COUNT FOR THEM TO-
DAY.
THE AMERICAN NATIONAL BANK
OF SAINT PAUL
Bremer Arcade Robert at 7th CE 6666
Member Federal Deposit Insurance Corporation
r \
UNUSUAL LENS GRINDING
J CATARACT.
MYO-THIN
C V ~a.( f s — 'vlX and other difficult
f\ YhJL 1/6?^ and complicated !
K A lenses are ground to
\ extreme thinness and
\ accuracy by our |
expert workmen.
OflMfWlLLIAPIJ sssgg
insurance Druggjsts' Mutua| Insurance Company PromPl
OF IOWA, ALGONA, IOWA LOSS
Saving Fire - Tornado - Automobile Insurance Sarvick
MINNESOTA R E P R E S E N T A TI V E- S. E. STRUBLE, WYOMING, MINN.
ril, 1950
415
lexible Yormula
...to sharpen
the focus of diet
w
T
/hen nn infant’s diet is not formulated to
his exact needs, it is like a picture out of
focus. For an individualist, the basic formula
must be flexible to meet the changing needs of
the moment — to bring the diet “into focus!’
Dextri-Maltose* has been preferred by two
generations of physicians because of its ex-
*T.M. Reg. U.S. Pat. Off.
ceptional flexibility in formulas using whole
or evaporated milk. Quantities of this carbo-
hydrate can be varied at will with the varying
caloric requirements of the individual infant;
and Dextri-Maltose is available in five forms
to meet certain clinical conditions without
disturbing the feeding routine.
Not too sweet, readily soluble and easy to
use. Dextri-Maltose is highly digestible and
slowly absorbed. No other carbohydrate for
infant feeding enjoys so authoritative a back-
ground of clinical experience.
DEXTRI - MALTOSE
DEXTRI-MALTOSE NO. I-\vith2% sodium chloride • DEXTRI-MAL-
TOSE NO. 2 -Plain • DEXTRI-MALTOSE NO. 3 -with 3% Potassium
Bicarbonate • DEXTRI-MALTOSE WITH YEAST EXTRACT AND
IRON • PECTIN-AGAR IN DEXTRI-MALTOSE.
Descriptive literature on request
416
Minnesota Medicine
significant untoward effects in patients who received
chloramphenicol under our care.” smadei, j. e.: j.a.m.a. us: 315. 1950 (discussion)
evidence of renal irritation . . . No impairment of renal function.
, . . No changes in the red-cell or white cell series of the blood . . . nor did jaundice occur.
. . . Drug fever was not observed . . . side effects were slight and infrequent.”
Hewitt, W.L., and Williams, B., Jr.: New England J. Med. 242:119, 1950
toxic reactions or signs of intolerance were observed.”
Payne, E. H.; Knaudt, J. A., and Palacios, S. : J. Trop. Med. & Hyg. 51: 68, 1948
symptoms or signs of toxic effects attributable to the drug were observed.”
Ley, H. L., Jr.; Smadei, J. E., and Crocker, T.: Proc. Soc. Exper. Biol. & Med. 68:9, 1948
CHLOROMYCETIN is effective orally in urinary tract infections, bacterial and atypical
primary pneumonias, acute undulant fever, typhoid fever, other enteric fevers due to
salmonellae, dysentery (shigella), Rocky Mountain spotted fever, typhus fever, scrub typhus,
granuloma inguinale, and lymphogranuloma venereum.
PACKAGING : CHLOROMYCETIN is supplied in Kapseals® of 0.25 Gm.
P
N
£ TV
II on V I on Pay Us a Visit
13 years ago, the Caswell Ross Agency enrolled its first group
in Minnesota under the Professional Special Disability Plan, this
group being the Hennepin County Medical Society. Today we
have a total of 19 professional associations in Minnesota enrolled
under this plan of accident and sickness insurance.
Included in this list of associations is the Minnesota State
Medical Association, thereby giving those members whose county
societies have not adopted the plan an opportunity to obtain this
splendid policy. If we have not been able to visit with you per-
sonally, we shall be very grateful if you will accept our invitation
to stop at our booth during the June Convention in Duluth and
ask us about the Special Disability Policy.
A.t Booth 7 h
CASWELL-ROSS AGENCY
1177 N. W. Bank Building
Minneapolis — MA 2585
lruuTors to:
Minnesota State Bar Association
Minnesota State Dental Association
Minnesota State Medical Association
Minnesota Society of C.P.A.
Minnesota State Pharmaceutical Assn.
Minnesota Auto Dealers Association
Hennepin County Medical Society
Hennepin County Bar Association
Minneapolis 2, Minnesota
St. Paul— ZE 2341
St. Paul District Dental Society
Minneapolis District Dental Society
St. Cloud Dental and Stearns County
Medical Society
Duluth District Dental Society
East Central Medical Society
St. Louis County Medical Society
418
Minnesota Medicine
Qtlinnesek Qfleaicme
Journal of the Minnesota State Medical Association, Southern Minnesota Medical Association, Northern Minnesota
Medical Association, Minnesota Academy of Medicine and Minneapolis Surgical Society
Volume 33 May. 1950 No. 5
Contents
Syphilitic Cardiac Deaths in Over Fifty Thou-
sand Autopsies.
B. J. Clawson, M.D., Minneapolis, Minnesota.... 437
Review of 250 Necropsy Cases of Hypertensive
Cardiovascular Disease.
James R. Householder, M.D., Duluth, Minnesota. 441
The Plans of Medical Students for Practice.
Myron M. Weaver, M.D., Vancouver, British
Columbia, and Harold S. Diehl, M.D., Minne-
apolis, Minnesota 446
Challenging Problems and Demands of the Aged
and Chronically III.
/. A. Lepak, M.D., Saint Paul, Minnesota 450
Melanomata and Nevi.
Arthur H. Wells, M.D., Duluth, Minnesota 456
Management of the Pyodermas.
John F. Madden, M.D., Saint Paul, Minnesota. . . . 462
History of Medicine in Minnesota :
Medicine and Its Practitioners in Olmsted County
Prior to 1900. (Continued from April issue.)
Nora H. Guthrey, Rochester, Minnesota 466
President’s Letter:
A Cordial Invitation 472
Editorial :
The State Meeting 473
Medical Editors’ Conference.... 473
Streptomycin in Tuberculosis 474
Maternal Mortality Study in Minnesota 475
Survey of Physicians’ Incomes 475
Medical Economics :
The Welfare State — What Is It? 476
Britain Has New Problem Plus More Expense... 478
Minnesota State Board of Medical Examiners 478
Minnesota State Medical Association :
Program — Ninety-seventh Annual Meeting 480
Roster 486
Minnesota Academy of Medicine:
Meeting of January 11, 1950 518
Reports and Announcements 520
Woman’s Auxiliary 524
In Memoriam 530
Of General Interest 538
Book Reviews 547
Contents of Minnesota Medicine copyrighted by Minnesota State Medical Association, 1950
Entered at the Post Office in Saint Paul as second class mail matter. Accepted for mailing at the special rate of postage provided
for in Section 1103. Act of October 3, 1917, authorized July 13, 1918.
May, 1950
419
MINNESOTA MEDICINE
Official Journal of the Minnesota State Medical Association
Published by the Association under the direction of its Editing and Publishing Committee
Office of Minnesota State Medical Association,
493 Lowry Medical Arts Bldg., Saint Paul 2, Minnesota.
EDITING AND PUBLISHING COMMITTEE
E. M. Hammes, Saint Paul
Philip F. Donohue, Saint Paul
H. W. Meyerding. Rochester
B. O. Mork, Jr., Minneapolis
G. L. Oppegaard, Crookston
T. A. Peppard, Minneapolis
H. A. Roust, Montevideo
O. W. Rowe, Duluth
Henry L. Ulrich, Minneapolis
A. H. Wells, Duluth
EDITORIAL STAFF
Carl B. Drake, Saint Paul, Editor
George Earl, Saint Paul, Associate Editor
Henry L. Ulrich, Minneapolis, Associate Editor
BUSINESS MANAGER
J. R. Bruce
Annual Subscription — $3.00. Single Copies — $0.40. Foreign and Canadian Subscriptions — $3.50.
The right is reserved to reject material submitted for editorial or advertising columns. The
Editing and Publishing Committee does not hold itself responsible for views expressed either in
editorials or other articles when signed by the author.
Classified advertising — ten cents a word; minimum charge, $2.00. Remittance should ac-
company order.
Display advertising rates on request.
Address all communications concerning the journal to Minnesota Medicine, 2642 University
Avenue, Saint Paul 4, Minnesota. Telephone Nestor 2641.
ST. CROIXD ALE ON LAKE ST. CROIX
PRESCOTT. WISCONSIN
MAIN BUILDING— ONE OF THE 8 UNITS IN "COTTAGE PLAN”
A Modern Private Sanitarium for the Diagnosis, Care and Treatment of Nervous and Mental Disorders
Located on beautiful Lake St. Croix, eighteen miles from the Twin Cities, it has the advantages of both
City and Country. Every facility for treatment provided, including recreational activities and occupational
therapy under trained personnel. Close personal supervision given patients, and modern methods of
therapy employed. Inspection and cooperation by reputable phvsicians invited. Rates very reasonable.
Illustrated folder on request.
NEUROPSYCHIATRISTS
PRESCOTT OFFICE
Prescott, Wis.
Howard J. Laney, M.D.
Tel. 39 and Res. 76
Hewitt B. Hannah, M.D.
Andrew J. Leemhuis, M.D.
Howard J. Laney, M.D.
511 Medical Arts Building
Minneapolis, Minnesota
Tel. MAin 1357
SUPERINTENDENT
Dorothy M. Most, R.N.
Prescott, Wisconsin
Tel. 69
420
Minnesota Medicine
AUR EOMVC IN HYDROCHLORIDE LEDERLE
in Rickettsial
Infections
The discovery of aureomycin marked an epoch in antibiotic
specific therapy. The rickettsiae, lying midway between the
bacterial and the viral infections are immediately inhibited
or killed by this antibiotic. Rocky Mountain spotted fever,
Q, fever and typhus .fever all respond dramatically to aureo-
mycin, without reference to the stage of the disease at which
therapy is begun. The ability of this agent to penetrate the
cell membranes and attack the intracellular rickettsiae is an
important factor in producing its highly specific effect.
Capsules: Bottles of 25, 50 mg. each capsule.
Bottles of 16, 250 mg. each capsule.
Ophthalmic: Vials of 25 mg. with dropper;
solution prepared by
adding 5 cc. of distilled water.
Aureomycin has also been found effective for the control of
the following infections: African tick-bite fever, acute ame-
biasis, bacterial and virus-like infections of the eye, bac-
teroides septicemia, boutonneuse fever, acute brucellosis,
Gram-positive infections (including those caused by strepto-
cocci, staphylococci, and pneumococci), Gram-negative in-
fections (including those caused by the coli-aerogenes group),
granuloma inguinale, H. influenzae infections, lymphogranu-
loma venereum, peritonitis, primary atypical pneumonia,
psittacosis (parrot fever), Q, fever, rickettsialpox, Rocky
Mountain spotted fever, subacute bacterial endocarditis
resistant to penicillin, tularemia and typhus.
LEDERLE LABORATORIES DIVISION
AMERICAN
Gfanamut
COMPANY
30 Rockefeller Plaza, New York 20, N. Y.
May, 1950
421
Widen the scope of
routine office examinations
CLINITEST
(Brand) Reagent Tablets
for detection of
urine-sugar
Prompt detection means better prog-
nosis in diabetes. This makes a
routine search for urine-sugar in-
tegral to every office examination.
For this purpose, Clinitest (Brand)
Reagent Tablets are exceptionally
useful. The test is simple, rapid and
reliable. No external heating is
needed. Set, Laboratory Outfit, and
Refills of 24 and 36 tablets.
ACETEST
(Brand) Reagent Tablets
for detection of
acetone bodies
Detection of ketosis in diabetes— and
many other conditions in which aci-
dosis, may occur— is facilitated for the
physician by Acetest (Brand) Re-
agent Tablets. This unique spot test
swiftly and easily detects acetone
bodies. The sensitivity is 1 part in
1,000. Bottles of 100 and 1000.
I-
HEMATEST
(Brand) Reagent Tablets
for detection of
occult blood
COMP
Occult blood in feces, sputum or
urine is often the earliest evidence of
pathologic processes otherwise un-
suspected. Determination of blood
(present as 1 or more parts in 20,000)
becomes a practical part of office
routine with Hematest (Brand) Re-
agent Tablets— accurate, quick, and
convenient. Bottles of 60 and 500.
ANY, INC • ELKHART, INDIANA
422
Minnesota Medicine
TERFONYL
Sulfadiazine
Sulfamerazine
Sulfamethazine — -i-k
FOR SAFER SULFONAMIDE THERAPY
i
Low Renal Toxicity
Sulfadiazine:
Danger of blockage
H
Sulfamerazine:
Danger of blockage
▲
TERFONYL:
Blockage very unlikely
with therapeutic doses
With usual doses of Terfonyl the danger of
kidney blockage is virtually eliminated. Each
of the three components is dissolved in body
fluids and excreted by the kidneys as though
it were present alone. The solubility of Ter-
fonyl is an important safety factor.
Terfonyl contains equal parts of sulfadiazine,
sulfamerazine and sulfamethazine, chosen for
their high effectiveness and low toxicity.
Terfonyl Tablets, 0.5 Gm. Bottles of 100 and 1000
Terfonyl Suspension, 0.5 Gm. per 5 cc.
Appetizing raspberry flavor • Pint bottles
Squibb MANUFACTURING CHEMISTS TO THE MEDICAL PROFESSION SINCE 1858
*7ERFONVL' IS A TRADEMARK OF E. R. SQUIBB A SONS
May, 1950
423
simplicity ; itself
to
prescribe SIMIKAC
simply add one measure of Similac to
two ounces of water to yield two ounces
of normal formula of 20 cals/oz
simplicity, itself
simplicity ,
to prepare
SIMIKAC
simply instruct mother to float the
prescribed quantity of Similac
on previously boiled water and stir
itself
to digest SIMIKAC
the proteins have been so modified
the fats so altered
the minerals so adjusted
that there is no closer equivalent
to human breast milk than
SIMIKAC
for term and premature infants throughout the
first year of life whenever breast feeding must be
supplemented or replaced. Similac has the same
zero curd tension as human breast milk.
SIMILAC DIVISION
M & R DIETETIC LABORATORIES, Coluvibus 16, Ohio
424
Minnesota Medicine
“In addition to the relief of hot
flashes and other undesirable
symptoms (of the climacteric),
a feeling of well-being or tonic ef-
fect was frequently noted” after
administration of “Premarin!’
All patients (53) described a
sense of well-being” following
“Premarin” therapy for meno-
pausal symptoms.
Neustaedter, T.: Am. J. Obst. &
Gynec. 46:530 (Oct.) 1943.
‘It (‘Premarin’) gives to the pa
tient a feeling of well-being’.
Glass, S. J., and Rosenblum, G. :
J. Clin. Endocrinol. 3:95 (Feb.) 1943
the clinicians’ evidence
“General tonic effects were note-
worthy and the greatest percent-
age of patients who expressed
clear-cut preferences for any
drug designated ‘Premarin! 1
Perloff, W. H.: Am. J. Obst. &
Gynec. 58:684 (Oct.) 1949.
Four potencies of “Premarin”
permit flexibility of dosage: 2.5
mg., 1.25 mg., 0.625 mg., and
0.3 mg. tablets; also in liquid
form, 0.625 mg. in each 4 cc. (1
teaspoonful).
of the "plus” in
"D
While sodium estrone sulfate is the
principal estrogen in “Premarin”
other equine estrogens... estradiol,
equilin, equilenin, hippulin...are
probably also present in varying
amounts as water-soluble conju-
gates.
Jill therapy
Estrogenic Substances ( water-soluble )
also known as Conjugated Estrogens (equine)
Ayerst, McKenna & Harrison Limited
22 East 40th Street, New York 16, “N. Y.
May, 1950
425
Table is same height as standard
stretcher to assure safe and easy
transfer of patient.
KELLEY-KOETT X-RAY SALES CORP. OF MINN.
1225 Nicollet Ave. Tel. AT. 7174 Minneapolis 3, Minnesota
the only table
offering 45° true
trendelenburg
The “C” Supertilt Table offers a range of angulation
never before available. The table can be angulated 135°
from 45° true Trendelenburg through horizontal to the
vertical. Permits improved diagnostic technics, easier op-
eration for fluoroscopy, radiography and fluorography.
All procedures involving encephalograms, ventriculo-
grams, myelography and genito-urinary work are per-
formed with ease and safety never before possible.
Actually, dozens of new features — results of years of re-
search and field testing with eminent radiologists — makes
the “C” Supertilt table years in advance of any table yet
developed.
Illustrated here, are just a few of the many advantages
the “C” Supertilt Table offers. Write for complete in-
formation.
Two centering points always as-
sure centering of bucky with fluoro-
scopic image, eliminating guess-
work or extra effort.
426
Minnesota Medicine
IMPORTANT ADVANCES
PIONEERED BY KELEKET!
• •• :
Long noted for simplicity and
highly automatic action, Kele-
ket Multicron Controls are now
even simpler and more auto-
matic than before.
The new 300 MA Multicron
Vertical Control automatically
assumes greater responsibility.
In addition, it provides increased
facilities for consistently high
quality diagnostic radiographs.
This reduces possibilities for error
and the cost of film “retakes.”
The new Multicron safeguards
you as your changing radio-
graphic technics require greater
power capacities. It is never nec-
essary to trade in this new Multi-
cron for a higher powered unit.
Simply exchange timers to meet
increasing requirements. And
you retain the same transformer
and control because it is capable
of producing 500 MA at 125 KV
OUTSTANDING AUTOMATIC FEATURES
• FIXED MILLI AMPERAGE
• AUTOMATIC SELECTION OF
FOCAL SPOT
• FILAMENT COMPENSATION
• KV COMPENSATION
• ELECTRONIC TIMERS
• MAINLINE SWITCH COM-
BINED WITH PROTECTIVE OVER-
LOAD CIRCUIT BREAKER
May, 1950
427
point of departure
for special
feeding cases... 8 02.
Dryco is not only the point of departure for
almost every type of infant formula — it is also
in itself a valuable food for special cases.
Dryco assures ample protein intake while its
low fat ratio and moderate carbohydrate
content minimize digestive disturbances.
The applicability of the Dryco formula is
strikingly seen in an observation by Pitt: “The
majority of cases of infant diarrhea, seen
in private practice, are of such nature that
changing the formula to one of low fat and
low carbohydrate is all that is necessary to
correct the condition . . .” Dryco is specifically
recommended for use in these cases.*
In addition to formula flexibility, Dryco
offers other advantages.
Dryco’s special drying process makes it more
easily digested by certain infants than the
fresh milk from which it is made. It supplies
more minerals, particularly more calcium,
than a corresponding formula of whole milk,
plus 2500 U.S.P. units of vitamin A and
400 U.S.P. units of vitamin D per reconstituted
quart. Only vitamin C need be added. Each
tablespoonful supplies 31 Vi calories. Readily
reconstituted in cold or warm water.
Available at pharmacies in 1 and 21/! lb. cans.
'Pitt, C.K.: The Art and Science of Artificial Infant
Feeding, J.M. Asso. Ala. 19:101 (Oct.) 1949.
a versatile
base
for
“Custom”
formulation
The Prescription Products Division, The Borden Company
350 Madison Avenue, New York 17, New York
428
Minnesota Medicine
in active rheumatoid
arthritis, the “ best
agent. . . that is
readily available. ' ' 1
Many therapeutic agents have been
advocated for the treatment of
active rheumatoid arthritis, with varying
degrees of success. Among those
now generally available, gold is
“the only single form of therapy which
will give significant improvement.”2
Solganal® for intramuscular injection is
practical and readily available therapy.
It acts decisively, inducing “almost complete
remission of symptoms” in fifty per cent
of patients and definite improvement
in twenty per cent more.3
Detailed literature available on request.
Suspension Solganal in Oil 10, 25 and
50 mg. in 1.5 cc. ampuls; boxes of 1 and
10 ampuls. Multiple dose vials of 10 cc.
containing 10, 50 and 100 mg. per cc.;
boxes of 1 vial.
(aurothioglucose)
BIBLIOGRAPHY (1) Holbrook, W. P.: New York Med. (no. 7)
4:17, 1948. (2) Ragan, C., and Boots, R. H.: New York Med. (no. 7) 2: 21, 1946.
(3) Rawls, W. B.; Gruskin, B. J.; Ressa, A. A.; Dworzan, H. J.; and
Schreiber, D.: Am. J. M. Sc. 297:528, 1944.
CORPORATION • BLOOMFIELD, N. J.
It would take
a small
excursion boat
to bring you all
the patients who represent
each of the many conditions
for which short-acting
NEMBUTAL is effective
• More than 44 clinical uses for short-acting Nembutal
have been reviewed in the literature during the 20 years the
drug has been effectively used. Some of these uses may be
applicable in your own practice.
With short-acting Nembutal, doses adjusted to the need
can provide any degree of cerebral depression — from mild
sedation to deep hypnosis. Dosage required is only about
one-half that of certain other barbiturates. Because there is
less drug to be eliminated, there is less possibility of bar-
biturate hangover and wider margin of safety.
You’ll find short-acting Nembutal available in the form of
Nembutal Sodium, Nembutal Calcium and Nembutal Elixir,
all in convenient small-dosage preparations. Write for handy
booklet, ”44 Clinical Uses for Nembutal.” n n
Abbott Laboratories, North Chicago, 111. (^U'UO'CL
In equal oral doses, no other barbiturate
combines QUICKER, BRIEFER,
MORE PROFOUND EFFECT than
NEMBUTAL*
(PENTOBARBITAL, ABBOTT)
430
Minnesota Medicine
rf'i
I err a
In conquering infection, medicine has
built a firm and lasting foundation on
products derived from the earth.
When it comes to control of infections,
be they of bacterial, viral or rickettsial
origin — our “terra firma” has provided a
widening group of effective antibiotics.
In the screening, isolation, and production
of these vital agents, a notable role
has been played by the world’s largest
producer of antibiotics
CHAS. PFIZER & CO., INC., Brooklyn 6, New York
A.ay, 1950
431
The Protein -Rich Breakfast
and Morning Stamina
Extensive studies* by the Bureau of Human Nutrition have established that
breakfasts rich in protein and supplying 500 to 700 calories, effectively
promote a sense of well-being, ward off fatigue, and sustain blood sugar
levels at normal values for the entire morning postbreakfast period.
These physiologic advantages are related mainly to the protein content rather
than to the caloric content of the breakfast. In fact, when isocaloric breakfasts
were compared, those with the higher amounts of protein led to the great-
est beneficial effects. Breakfasts providing the lower quantities of protein
(7 Gm,, 9 Gm., 16 Gm., and 17 Gm. respectively) produced a rapid rise in
the blood sugar level and a return to normal during the next three hours.
Breakfasts providing more protein (22 Gm. and 2 5 Gm. respectively) pro-
duced a maximal blood sugar rise which was lower than that following the
breakfasts of lower protein content, but the return to normal was delayed
beyond the three hour period.
The subjects on the higher protein breakfasts “reported a prolonged
sense of well-being and satisfaction.” The findings indicated that the
beneficial effects of the high protein breakfast on the blood sugar level
may extend into the afternoon.
Meat, man’s preferred protein food, is a particularly desirable means of
increasing the protein contribution of breakfast. The many breakfast
meats available are not only temptingly delicious and add measurably to
the gustatory appeal and variety of the morning meal, but they also pro-
vide biologically complete protein, B-complex vitamins, and essential
minerals. Meat for breakfast, a time-honored American custom, is sound nutri-
tional practice.
♦Orent-Keiles, E., and Hallman, L. F.: The Breakfast Meal in Relation to Blood-Sugar
Values, Circular No. 827, United States Department of Agriculture, Bureau of Human
Nutrition and Home Economics, Agricultural Research Administration, Dec., 1949.
The Seal of Acceptance denotes that the nutritional statements
made in this advertisement are acceptable to the Council on
Foods and Nutrition of the American Medical Association.
American Meat Institute
Main Office, Chicago... Members Throughout the United States
432
Minnesota Medicine
For the first time— an electro-
cardiograph that provides all
these essentials for convenience
and accuracy.
True quartz string
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Only with the BECK-LEE Electro-
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Servicing of BECK-LEE Electro-
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cal dealers.
The Model ERA with
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Camera.
THE BECK-LEE ELECTROCARDIOGRAPH
MODEL ERA $ 72 5 • MODEL E $645
You are cordially invited to visit our Booths, 7, 17
and 18, at the Minnesota Medical Meeting in Duluth
to see the Model ERA and other items of equipment.
PHYSICIANS AND HOSPITALS SUPPLY CO., Inc.
MINNEAPOLIS MINNESOTA
»Iay, 1950
433
in
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tured in the Philips tube
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York)
Can be adapted to your
present equipment. See how
at Booth 70, MSMA.
Technical data available from . . .
( X-RAY COMPANY
113 SOUTH TENTH STREET
MINNEAPOLIS 2, MINNESOTA
434
Minnesota Medicine
on your ACCOUNTS RECEIVABLE
Usually the last one to be paid is the family doctor, and very often,
no attention is given by him to the very important matter of commenc-
ing collection work promptly after due date. Too many doctors are
going “hog wild” on this point and fail to realize its significance.
Though startling as they may be, the figures shown in the following
table are the factual result of authoritative studies, and they apply
to the doctor as well as to the businessman.
COLLECTIBILITY OF
Accounts 60 days
Accounts 90 days
Accounts 6 months
Accounts 1 year
Accounts 2 years
Accounts 3 years
Accounts 5 years
ACCOUNTS-BASED ON AGE
past due are 93% collectible,
past due are 85% collectible,
past due are 70% collectible,
past due are 40% collectible,
past due are 25% collectible,
past due are 18% collectible,
past due are practically lost.
THE OUTLOOK ISN'T BRIGHT. More business and professional
men look for lower profits than hope for higher earnings this year.
That’s because of lower prices and higher costs. Proper credit control
is more important today than at any time since the war. Jobless at
present are at a postwar high of 4% million. Unemployment is
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NOW IS THE TIME to go after those “Receivables.” You can’t
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now by using the coupon below or just sign and return for more
information.
PROFESSIONAL CREDIT
PROTECTIVE BUREAU
(DIVISION OF I. C. SYSTEM)
310 Phoenix Bldg., Minneapolis 1, Minn.
Professional Credit Protective Bureau
310 Phoenix Bldg., Dept. M-l, Minneapolis 1, Minnesota
Enclosed is our check for $
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Name
Firm
Address
May, 1950
435
LACTOSE
'
■
.
iplP#
MOTHER'S
MILK
S-M-A
:
PROTEIN
,y.
MINERALS
Ready-to-use S-M-A
is patterned after human milk
. . . . with respect to quantity and quality of es-
sential nutritional factors. The nutritional history
of S-M-A infants is similar to that of breast-
fed infants.
S-M-A babies are well developed, with firm
tissue ; they are happy and contented.
The stools of S-M-A infants closely resemble
those of breast-fed infants in color, odor, consist-
ency and bacterial flora.
Vitamin C Added
S-M-A Concentrated Liquid — cans of 14.7 fl. oz. tjurajlg
S-M-A Powder — 1 lb. cans
Incorporated • Philadelphia 3, Pa.
436
Minnesota Medicine
Journal of the Minnesota State Medical Association, Southern Minnesota Medical Association, Northern Minnesota
Medical Association, Minnesota Academy oj Medicine and Minneapolis Surgical Society
Volume 33
May, 1950
No. 5
SYPHILITIC CARDIAC DEATHS IN OVER FIFTY THOUSAND AUTOPSIES
B. J. CLAWSON. M.D.
Professor Emeritus of Pathology, University of Minnesota
Minneapolis, Minnesota
HP HE deaths due to cardiac syphilis in the
records in the Department of Pathology in
the University of Minnesota during the years
1910-1947 are analyzed in respect to general
incidence, incidence of types, age and sex, and
gross and microscopic changes noted in the hearts.
Death as a result of syphilitic aortitis, valvulitis
or much less frequently from syphilitic myocardi-
tis or gumma of the myocardium in the above
autopsies is, according to Bell,1 the most common
cause of death in acquired syphilis. All of the
cases with one exception, a gumma of the myo-
cardium, were associated with syphilitic aortitis.
General Incidence
In a series of 4880 autopsies, Symmers5 found
syphilis of the aorta in 175 (3.6 per cent). At
the Boston City Hospital, Reid3 found seven cases
of syphilitic aortitis in 100 successive autopsies.
Giirich,2 in 22,179 autopsies, noted evidences of
syphilis in the heart in 806 (3.5 per cent). In our
50,730 autopsies, not including stillbirths, in the
Department of Pathology at the University of
Minnesota (1910-1947), there were 422 cases of
syphilitic cardiac deaths (0.83 per cent). These
422 cases were 4.4 per cent of the total number
(9585) of noncongenital cardiac deaths during
the same period (Table I).
The percentage of cardiac deaths in the autopsy
material is close to the percentage of such deaths
in the general population in the State of Minne-
sota. The autopsies are fairly representative and
nonselected. They have been performed in general
TABLE I. TYPES OF SYPHILITIC HEART DISEASE
422 cases in 9,585 cardiac cases (4.40 per cent) and in
50,730 autopsies (0.83 per cent), 1910-1947
Types
No.
Per cent
Per cent
Per cent
of
Cardiac
Autopsies
Group
Cases
1. Aortic insufficiency
2. Narrowing of the
247
58.53
2.57
0.48
coronary orifices
80
18.95
0.83
0.15
3. Rupture of aortic
aneurysm
89
21.09
0.93
0.17
4. Gumma of myocardium
6
1.42
0.06
0.01
Total
422
99.99
4.40
0.83
and private hospitals, on private patients of physi-
cians and in the coroner’s service. The percentage
of autopsies has been high, namely, about 25 per
cent of the deaths in Minneapolis and 10 per cent
of the State of Minnesota. This material because
of its volume, wide distribution and large autopsy
percentage appears to be valuable for making an
approach to a statistical study of the incidence of
diseases of the heart as a cause of death.
Incidence of Types of Cardiac Syphilis
Depending upon the manner in which death
occurred primarily, the 422 cases of cardiac
syphilis were divided into four types (Table I) :
aortic insufficiency, 247 cases (58.5 per cent) ;
narrowing of the coronary orifices, eighty cases
(18.9 per cent) ; rupture of an aortic aneurysm,
eighty-nine cases (21.1 per cent) ; and gumma
of the myocardium, six cases (1.4 per cent).
Commonly, there was an overlapping of the
types, especially of the first three. A question
might be raised as to whether the cases in which
From the Department of Pathology, University of Minnesota.
May, 1950
437
SYPHILITIC CARDIAC DEATHS— CLAWSON
TABLE II. INCIDENCE OF DEATHS FROM CARDIAC
SYPHILIS PER THOUSAND AUTOPSIES
Patients 40 years old or more per five-year periods,
1910-1947
Periods
No. Cases
No. Autopsies
Per Thousand
Autopsies
1914-18
21
1205
17.42
1919-23
36
1758
20.47
1924-28
73
4112
17.75
1929-33
98
7101
13.80
1934-38
88
9062
9.71
1939-43
77
9906
7.77
1944-47*
18
7799
2.30
*In the last period there are only 4 years.
end with 1947. The last period has only four years.
Only the ages of forty or over are included since
syphilitic cardiac deaths so rarely occur in younger
people. The seven periods, beginning with 1914,
showed an incidence of 17.4, 20.4, 17.7, 13.8, 9.7,
7.7 and 2.3 cases of syphilitic heart deaths per
thousand autopsies respectively. The cause of this
highly significant reduction in cardiac syphilitic
deaths can only be speculative. Education and
therapy probably have been important factors.
TABLE III. AGE AND SEX INCIDENCE IN DECADES IN TYPES OF
SYPHILITIC HEART DISEASE
422 cases as compared with the number of autopsies (50,730) in respective
decades, 1910-1947.
Males 355
Decades
Autopsies
Aortic
Insufficiency
Narrowing of
Coronary
Orifices
Rupture .of
Aortic
Aneurysm
Gumma of
Myocardium
Total
No.
M
No.
M
No.
M
No.
M
No.
M
i
4293
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
2
941
0
0.00
0
0.00
0
0.00
0
0 . 00
0
0.00
3
1819
2
1.09
1
0.54
0
0.00
1
0.54
4
2.19
4
2831
18
6.35*
13
4.59*
5
1.76
1
0 . 35
37
13.06*
5
4498
53
11.78*
26
5.78*
25
5.55*
0
0.00
104
23.12*
6
5934
88
14.82*
16
2.69
20
3.37
0
0.00
124
20.89*
7
6064
42
6.92*
5
0.82
22
3.62*
1
0.16
70
11.54*
8
4518
10
2.21
0
0 00
5
1 . 10
0
0.00
15
3.32
9
1521
1
0.65
0
0.00
0
0.00
0
0.00
1
0.65
10
94
0
0 00
0
0.00
0
0.00
0
0.00
0
0.00
32,513
214
6.58*
61
1.87*
77
2 . 36*
3
0.09
355
10.91*
Females 67
1
3123
0
0 00
0
0.00
0
0.00
0
0.00
0
0.00
2
811
0
0 00
0
0 . 00
0
0.00
0
0.00
0
0 . 00
3
1609
3
1 .86*
1
0.62
0
0 . 00
0
0.00
4
2.48
4
1877
4
2.13
4
2.13*
0
0.00
2
1.06
10
5.32*
5
2207
7
3.17*
7
3.17*
2
0 . 90*
1
0 . 45
17
7 70*
6
2597
10
3.85*
3
1.15
7
2.69
0
0.00
20
7.70*
7
2718
9
3.31*
3
1.10
3
1.10*
0
0.00
15
5.51
8
2330
0
0.00
0
0.00
0
0 . 00
0
0.00
0
0.00
9
867
0
0.00
1
1.15
0
0.00
0
0.00
1
1.15
10
77
0
0.00
0
0 . 00
0
0.00
0
0.00
0
0.00
11
1
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
18,217
33
1.81*
19
1.04*
12
0.65*
3
0.16
67
3.67*
*A statistical significant difference.
death was due to a rupture of a syphilitic aneu-
rysm should be included among the syphilitic
cardiac deaths. These cases, however, commonly
had some clinical evidences of cardiac failure and
at autopsy exhibited an associated syphilitic valvu-
litis with cardiac hypertrophy and dilatation. They
were, therefore, grouped as syphilitic cardiac
diseases.
There has been a marked and significant drop
in the incidence of cardiac syphilis in Minnesota
in the last thirty-four years, as indicated by
autopsy findings. This is illustrated in Table II
in which seven five-year periods of autopsies are
studied. These periods begin with 1914 and
Age and Sex Incidence (Table III)
The largest number of cases per thousand
autopsies in decades among the males and females
in the different types were as follows : aortic in-
sufficiency, males, sixth decade (14.8), females,
sixth decade (3,.8) ; narrowing of coronary ori-
fices, males fifth decade (5.7), females fifth de-
cade (3.1) ; rupture of an aortic aneurysm, males
fifth decade (5.5), females sixth decade (2.6) ;
and gumma of the myocardium, males in the third
decade and females in the fourth. Males pre-
dominated significantly in the first three types.
There was a total significant preponderance of
males (2.97 males to 1 female).
438
Minnesota Medicine
SYPHILITIC CARDIAC DEATHS— CLAWSON
Pathology
Gross and microscopic changes, in varying de-
grees, are seen in the valves, myocardium and
coronary orifices. The aortic was the only valve
The frequency of the two anatomic valvular
changes is noted in Table IV. The changes are
most frequent in Type 1. Marginal thickening
was observed in 84.3 per cent, separation of the
TABLE IV. INCIDENCE OF KINDS OF VALVULAR
INVOLVEMENT IN SYPHILITIC HEART DISEASE
Type
Marginal
Thickening
Separation
of Cusps
Both
One of Both
1(223)
188
84.30%
175
78.47%
149
66.81%
204
91.03%
2 (70)
27
38,57%
39
55.71%
21
30.00%
45
64.28%
3 (60)
10
16 . 66 %
' 13
21.66%
6
10.00%
17
28.33%
TABLE V. DEGREES OF CARDIAC HYPERTROPHY
IN SYPHILITIC HEART DISEASE (400 CASES)
Weight of Hearts
Type 1
Type 2
Type 3
Total
No.
Per Cent
No.
Per Gent
No.
Per Cent
No.
Per Cent
Males below 350 or Females below 300
Males 350-399 or Females 300-349
Males 400-449 or Females 350-399
Males 450-499 or Females 400-449
Males 500 or more or Females 450 or more
2
3
15
18
206
0.81
1.22
6.14
7.33
84.42
7
21
21
18
13
8.75
26.25
26.25
22.50
16.25
22
21
12
10
11
28.94
27.63
15.78
13.15
14.47
31
45
48
46
230
7.75
11.25
12.00
11.50
57.50
T otal
244
99.92
80
100.00
76
99 . 97
400
100 . 00
involved. The clinical signs referable to the heart
with syphilitic aortic valvulitis were aortic regur-
gitation with cardiac hypertrophy and dilatation.
Stenosis did not occur — a fact which is useful
clinically in differentiating aortic valvular defor-
mity due to rheumatic infection from the defor-
mity due to syphilis. Two changes are noted in
syphilitic aortitis and valvulitis : a cord-like free
marginal thickening of the aortic cusps and separa-
tion of the valvular commissures or attachments
of the cusps to the aorta. There is seldom a
diffuse thickening of the cusps but they may have
the appearance of being displaced. Microscopi-
cally in the marginal thickening of the valve there
is an increase of connective tissue, and visible
blood vessels are often greatly increased in size.
A marked microscopic similarity exists between
the structure of the free marginal thickening and
the thickened valve resulting from rheumatic in-
fection. The separation of the commissures of the
cusps is due primarily to the intimal thickening
of the aorta which separates the cusps and causes
an aortic insufficiency. The above two changes
account for nearly all of the aortic insufficiencies.
However, in a few cases the insufficiency can onlv
be explained by a stretching of the aortic ring.
This probably occurs more frequently than can
be observed at autopsy although it can sometimes
be demonstrated by the pathologist.
commissures in 78.4 per cent, both conditions in
66.8 per cent and one or both in 91.0 per cent.
There is an anatomic basis other than stretching of
the ring for the myocardial failure in at least
91 per cent of the 188 cases of this type examined.
In the seventy cases in Type 2 in which death was
due to the narrowing of the coronary orifices and
in the sixty cases in Type 3 with rupture of an
aortic aneurysm, the valvular organic changes
were less, one or both of the changes found in
64.2 per cent and 28.3 per cent respectively.
The chief gross change seen in the myocardium
was the hypertrophy. The degree of cardiac hyper-
trophy of 400 hearts in the three types of cardiac
syphilis is shown in Table V. With few excep-
tions male hearts weighing 400 grams or more and
female hearts 350 grams or more may be con-
sidered as having a greater or less degree of
hypertrophy. Two hundred and thirty-nine of the
244 hearts in Type 1 (97.9 per cent) were hyper-
trophied. Fifty-two of the eighty hearts in Type
2 ('65 per cent) and thirty-three of the seventy-six
cases (43.4 per cent) in Type 3 had varying de-
grees of hypertrophy. It is to be noted that the
incidence of hypertrophy, in general, and the
greatest degree of hypertrophy were much higher
in Type 1 than in the other two types. Gross
infarction was found in only an occasional case
May, 1950
439
SYPHILITIC CARDIAC DEATHS— CLAWSON
with a large heart and narrowing of the coronary
orifices.
Except in the few cases with gumma of the
myocardium, microscopic myocardial changes were
estimation of the frequency of deaths from ter-
tiary syphilis since cardiac syphilis has been found
to be the most common manifestation of tertiary
syphilis which results in death.
TABLE VI. DEGREES OF INVOLVEMENT OF CORONARY ORIFICES AND
CORONARY ARTERIES IN SYPHILITIC HEART DISEASE
Degrees
Type 1
Type 2
Type 3
Orifices
Arteries
Orifices
Arteries
Orifices
Arteries
(223)
(153)
(74)
(70)
(58)
(78)
No.
Per cent
No.
Percent
No.
Per cent
No.
Per cent
No.
Per cent
No.
Per cent
L 4- 4- R 4" 4~ to
L4-4- + 4- R + 4-4-4-
Lo Ro to L 4- 4- R 4- or
59
26.45
10
6.53
68
91.89
1
1.42
11
18.96
11
14.10
L 4* R 4" 4~
164
73.54
143
93 . 46
6
8.10
69
98.57
47
81.03
67
85.89
Total
223
99.99
153
99.99
74
99.99
70
99.99
58
99.99
78
99.99
seldom observed by an examination of several
blocks from each of 106 hearts (Type 1, forty-six
cases ; Type 2, twenty-five cases and Type 3,
thirty-five cases respectively). The changes which
were observed were the type commonly associated
with and resulting from atherosclerotic coronary
arterial disease. Five blocks from each of the
106 hearts were stained by the Levaditi method.
A careful search failed to reveal any spirochetes
in any of the many sections examined. These
findings agree with the observations of Saphir.4
The degrees of change noted in the coronary
orifices and coronary arteries are seen in Table
VI. These degrees are listed as + , + + , + + +
and + + + +. The changes observed in the ori-
fices were narrowing due to the thickened intima
of the aorta. The changes noted in the coronary
arteries were not syphilitic in character but arteri-
osclerotic. L refers to the left orifice or artery
and R to the right. Lo and Ro and L+ + R +
or L+ R++ we considered to be close to the
normal limit, especially to the arteriosclerotic find-
ings in the coronary arteries for the ages of the
groups reported. It is seen that the narrowing of
the coronary orifices is greatest in Type 2 (91.8
per cent) in which death was not due primarily to
congestive cardiac failure but to coronary insuf-
ficiency. Atherosclerosis of the coronary arteries
in all of the types appears not to be greater than
is found in nonsyphilitic cases.
Summary and Conclusions
The incidence of deaths from syphilitic aortitis
with the associated narrowing of coronary orifices,
syphilitic valvulitis, aortic insufficiency and con-
gestive cardiac failure furnishes a fairly good
The general incidence of syphilitic cardiac
deaths (0.83 per cent) in our autopsy material
now ranks less than the deaths from the calcific
aortic valvular deformity (1.35 per cent).
There has been a marked reduction in the fre-
quency of syphilitic cardiac diseases during the
past thirty-four years. The number of cases per
thousand autopsies in people forty years or older
has dropped from a higji of 20.4 to 2.3.
Males predominated in the ratio of nearly 3
to 1 . The greatest number per thousand autopsies
of both sexes died in the fifth and sixth decades.
No deaths occurred in the first and second decades.
The valvular lesions and lesions of coronary
orifices far outnumbered in importance other
involvements as myocarditis and gumma. In fact,
a gumma of the myocardium is so rare that it may
be considered doubtful if a clinical diagnosis of
gumma of the myocardium should ever be made.
The most common manner of death with
syphilitic heart disease is that which follows aortic
insufficiency (58.5 per cent). Deaths due to nar-
rowing of coronary orifices and rupture of a
syphilitic aneurysm are about equal, 18.9 per cent
and 21 per cent, respectively.
An anatomic basis (free marginal thickening
or separation of the commissures of the cusps)
for the aortic insufficiency appears to be present
in more than 90 per cent of the cases in which
insufficiency is present. Evidently a stretching of
the aortic ring, alone, is responsible for the myo-
cardial failure in but a few cases.
Except in a relatively few cases of gumma of
the myocardium few changes other than hyper-
trophy are seen in the myocardium. The hearts
(Continued on Page 479)
440
Minnesota Medicine
REVIEW OF 250 NECROPSY CASES OF HYPERTENSIVE CARDIOVASCULAR
DISEASE
JAMES R. HOUSEHOLDER. M.D.
Duluth. Minnesota
rT,HE general subject of hypertension is no small
medical problem, and the effectiveness of its
treatment is one of the more unsatisfactory chap-
ters in the annals of medical therapeutics. The
purpose of this paper is to briefly review some of
the more important points in its basic pathological
physiology, the most recent theories as to the
etiology of so-called “essential” hypertension,
trends in the newer methods of therapy, and an
analysis of 250 necropsy cases at St. Luke’s Hos-
pital, Duluth, over a five-year period from July,
1943, to July, 1948.
TABLE I. SEX DISTRIBUTION
No. Per cent
Male 150 60.0
Female 100 _ 40.0
Male predominated by a ratio of 3 to 2
Hypertensive cardiovascular disease is more
deadly than malignant neoplastic disease, the for-
mer taking upwards- of 500,000 lives annually.
The total deaths in the United States in 1943 were
1,459,544 with 645,109 or 44 per cent of these
being due to cerebral hemorrhage, cerebral throm-
bosis, hemiplegia, chronic nephritis, and heart dis-
ease (exclusive of rheumatic heart disease). It
has been estimated that at least 583,816 or 40
per cent of these patients had an associated hyper-
tension. Some 90 to 95 per cent of hyperten-
sives fall into the “essential” group so that about
554,625 (37.9 per cent) or slightly more than one-
third of patients were dead from the effects of
“essential” hypertension. Deaths from malignant
neoplasm in 1943 were 169,000, so that hyper-
tension accounted for almost three and one-half
times the number of deaths due to malignancy in
that year.11 Hypertension accounts for about
three-quarters of the deaths due to cardiovascular
renal disease. About one-fourth of deaths over
fifty years of age are due to hypertension in its
various clinical manifestations. Statistically then
we are dealing with a more deadly killer than
most persons would suppose.
From July, 1943, to July, 1948, there were
1,474 deaths at St. Luke’s hospital, of which 374
were attributed to hypertensive cardiovascular dis-
ease. Excluding stillborn deaths, 24.7 per cent
or slightly less than one quarter of deaths during
this period were accounted for by this one dis-
ease complex alone. During this same period
TABLE II. AGE DISTRIBUTION
Decade Group
M
F
No.
Per cent
0-10 yrs.
0
0
0
0
11-20 yrs.
0
0
0
0
21-30 yrs.
0
0
0
0
31-40 yrs.
4
0
4
1.6
41-50 yrs.
12
4
16
6.4
51-60 yrs.
27
26
53
21.2
61-70 yrs.
54
33
87
43.8
71-80 yrs.
35
24
59
23.6
81-90 yrs.
23
8
31
12.4
91-99 yrs.
0
0
0
0
309 ( 20.9 per cent)
deaths were
due
to malig-
nant neoplasms.
It
is apparent
then
that the
percentage of hypertensive deaths follows, but
not too closely, the trend as computed by the U.
S. Bureau of Vital Statistics.” The relation of
cancer deaths as compared with the estimated over-
all national average likewise does not follow too
closely, the ratio at St. Luke’s being more nearly
equal rather than hypertension being two to three
times more predominant. The mortality rate four
years after diagnosis of hypertension is 30 and
42 per cent in grades I and II, and 78 and 98
per cent in grades III and IV, the grading being
on the basis of retinal and physical findings.2 A
particular cause for concern is the apparently
earlier age at which “essential” hypertension is
appearing and becoming fatal. Repeated clinical
observations have shown that hypertensive mem-
bers of a given family succumb earlier with each
succeeding generation. It is not unusual to, find
the following typical family history : “Grand-
father died at age seventy-two from a stroke ; the
mother died at age sixty from Bright’s disease ;
and the son, aged thirty-five, is now suffering
from a severe grade of hypertension.”4 In the
St. Luke’s series data on 172 of the cases showed
that forty-nine (28.4 per cent) had a definite
family history of the disease. This is in contrast
to the figures of other authors in the literature
that give 50 to 60 per cent positive family his-
tory in the majority of the case series, which im-
plies a definite hereditary trend in the perpet-
May, 1950
441
HYPERTENSIVE CARDIOVASCULAR DISEASE— HOUSEHOLDER
uation of the disease. Any physician who takes
refuge in the fact that an occasional patient sur-
vives hypertension for many years and feels that
the disease is not serious is indulging himself
in wishful thinking. That long-time survival is
not common is borne out by the following rates
of survival from the time of diagnosis to death.
Data were available in ninety-six cases.
RATE OF SURVIVAL
No. Per cent
41 42.7
35 36.4 79.1%
16 16.7
4 4.7
Most patients died during the first five years
after diagnosis, with a progressive drop in the
death rate so that there was one patient surviving
eighteen, twenty, twenty-four, and twenty-five
years after diagnosis. At the other extreme of
the scale we find that eight of the patients died
within one year after diagnosis. During the first
ten years after diagnosis 79.1 per cent of patients
were dead.
TABLE III. PREVIOUS EPISODES
No.
Per cent
None previous
129
55.3
Cardiac decomp.
52
22.3
Coronary accident
15
6.4
Cerebral accident
34
14.5
Uremia
3
1.2
Patients with multiple entities
13
5.1
The cardiovascular system is most frequently
involved and usually sustains the greatest amount
of damage, the greatest number of hypertensives
making their exodus from failure of the cardio-
vascular system to maintain physiological states
compatible with life. Elevation of the arterial
pressure may be due to one or a combination of
the following factors: (1) increased blood vol-
ume; (2) increased viscosity of the blood in the
peripheral vessels, (3) increased cardiac output,
(4) increased peripheral resistance due to a
generalized arteriolar constriction. The first
three have not been shown to play a significant
role in “essential” hypertension, but the increased
peripheral resistance has been implicated as the
important factor producing the changes in the
heart and peripheral vascular tree.4 The basic
and primary cause for the increased arteriolar
tone is as yet unknown. Arterioles from hyper-
tensives have shown more severe grades of medial
hypertrophy with and without collagenous degen-
eration and intimal hyperplasia than normoten-
sives of the same age groups. These lesions are
TABLE IV. SUBJECTIVE SYMPTOMS
St.
No.
Luke’s
Per cent
Perera
Per cent
Dyspnea
164
77.3
—
Cardiac pain
97
45.5
18.0
Frequency and nocturia
68
31.1
35.0
Palpitation
65
30.2
—
Headache
62
28.7
78.0
Dizziness
55
25.4
—
Visual disturbance
31
14.4
19.0
Tinnitus
16
7.4
—
found more frequently in sites such as kidneys,
liver and the gastrointestinal tract which are
rarely affected in normotensives.12 These changes
impose increased resistance in the peripheral sys-
tem by virtue of decreased total cross section in
the vascular bed. Whether these changes are due
primarily to an aging process or a tissue response
to long-continued effects of increased intravas-
cular pressure is still unknown. Larger arteries,
too, seem to be affected more frequently in hyper-
tensives, some degree of arteriosclerosis being
found in 115 (46.0 per cent) of this series. The
changes in the hypertensive heart are reflections
of the state of the arterial tree ; the hypertrophy
that eventually results is ascribed to sustained
work against increased peripheral resistance and
cardiac decompensation may eventually result. In
the series of St. Luke’s practically all of the cases
were reported as having some degree of cardiac
hypertrophy. This hypertrophy is relative, how-
ever, depending on the general build and estimated
weight of the patient, a large heart in a small
individual being of more significance than if found
in a large obese or muscular individual. The
majority of the heart weights fell between 400
and 600 grams, relatively few being on either
TABLE V. RANGE OF DIASTOLIC BLOOD PRESSURES
Data on 227 cases
No.
Per cent
Under 100 mm. Hg.
102
44.9
Over 100 mm. Hg.
68
29.9
Over 120 mm. Hg.
57
25.2
Total Over 100 mm. Hg.
125
55.1
side of this range. One weight was reported as
900 grams, the largest found in the series. There
were all grades of dilatation and hypertrophy of
the ventricular walls, the left being most con-
sistently affected. The right ventricle showed far
less incidence of hypertrophy, although dilatation
was seen commonly secondary to decompensation.
Experimental evidence has shown that in hyper-
tension right intraventricular pressure is normal,
indicative of normal arteriolar tone in the pul-
monary bed. Right ventricular filling is not dis-
turbed, and venous hemodynamics are not altered,
venous pressure having been found to be normal
1-5 years
6-10 years
11-15 years
16-25 years
442
Minnesota Medicine
HYPERTENSIVE CARDIOVASCULAR DISEASE— HOUSEHOLDER
TABLE VI. CARDIAC INVOLVEMENT
Clinical Data
No.
Per cent
(Perera)
Per cent
Aortic valve dis.
16
6.4
Mitral valve dis.
12
4.8
—
Myocardial infarct
53
21.2
90
Cardiac decomp.
101
40.4
40.0
unless congestive failure ensues.4 Coronary scle-
rosis and attendant myocardial scarring is also im-
plied in the causation of hypertrophy. The hyper-
tension is felt to be an accelerating factor in the
sclerosing process and to explain the increase of
sclerosis in hypertensives. In our series there was
a total of forty-five (18.0 per cent) with no coro-
nary sclerosis, the remainder of the patients show-
ing some degree of this process. The distribution
of this involvement and severity is shown in the
following table :
DISTRIBUTION AND SEVERITY OF CARDIAC
INVOLVEMENT
No.
Per cent
None
45
18.0
Grade I
42
16.2
Grade II
74
29.6
Grade III
39
15.6
Grade IV
50
20.0
Eighty-two per cent of patients showed some
degree of coronary sclerosis, the majority being
of lesser grades of severity. The large number
of patients so affected may probably be accounted
for by the fact that many of them are in the
older age groups and therefore the ones who are
more likely to display degenerative changes. ECG
data on eighty patients showed 66 per cent to have
myocardial disease. Left axis deviation was diag-
nosed in thirty and left ventricular strain in nine-
teen cases, a total of forty-nine with left ventric-
ular preponderance. Chest x-rays in seventy-nine
patients showed sixty (75.9 per cent) to have
increased size of the cardiac shadow and compares
with the 71 per cent in Perera’s series of 250
cases.
TABLE VII. RENAL INVOLVEMENT
No.
Per cent
Glomerulo hyalin
45
18.0
Glomerulonephritis
7
2.8
Pyelonephritis
23
9.2
Prostatic hypertrophy
89
59.3
Adrenal hyperplasia
2
0.8
Clinical uremia
32
14.7
BUN under 100 mg. %
5
2.2
BUN over 100 mg. %
Uremia (where deemed to be main contribu-
15
6.9
tion to death)
18
7.2
Goldblatt kidney
4
1.8
Kidney involvement severe enough to account
for death from renal failure has been found to
be consistently the least common fate of hyper-
tensives, most authors not reporting an inci-
TABLE VIII. RANGE OF BUN LEVELS
Data on 117 (46.8%) patients
No.
Per cent
10
mg. % and under
5
4.2
10-20
mg. %
45
38.4
20-50
mg. %
28
23.9
50-100 mg. %
23
19.5
100
mg. % and over
15
12.8
200
mg. % and over
1
0.9
Total
patients with BUN elevation
67
57.1
dence of more than 5 per cent. Patients develop-
ing renal insufficiency may, according to Bell,
fall into one of three classes: (1) chronic hyper-
tension with moderate renal insufficiency in which
the patient usually dies from some extra renal
cause; (2) chronic hypertension with slowly de-
veloping uremia, the small arteries showing
marked intimal thickening, and arteriolar and
glomerular hyalinization in varying degrees
(grossly the kidneys are small and contracted) ;
(3) chronic hypertension with acute uremia,
which has been termed malignant because of its
relatively rapid fulminating course and the con-
sistent finding of marked collagenous thickening
of the terminal arterioles and in a lesser number
of cases a necrotizing type of lesion. Of our
series only three were designated as malignant
hypertension, the other cases of renal insufficiency
being of a more chronic nature. The following
table shows the incidence of renal arteriole in-
volvement :
INCIDENCE OF RENAL ARTERIOLE INVOLVEMENT
No.
Per cent
None
85
34.0
Grade I
49
19.0
Grade II
80
32.0
Grade III
26
10.4
Grade IV
10
4.0
Grades III and IV account for 14.4 per cent of
involvement but do not show a consistent posi-
tive correlation with the thirty-two (32.7 per
cent) patients who showed definite clinical signs of
uremia. A total of 66 per cent showed some
signs of nephrosclerosis with and without con-
comitant elevated blood metabolites. The data
in this series is made somewhat invalid because of
the discrepancy in the number of kidneys exam-
ined (all of them in the series) and the number
of patients in whom blood-urea-nitrogen levels had
been performed (117 out of 250 or 46.8 per cent).
Arteriolar involvement seems to be a fairly con-
sistent finding in autopsied cases but there seems
to be no direct relation between the amount of
involvement and the severity of the clinical symp-
toms of the hypertension. Some patients with
May, 1950
443
HYPERTENSIVE CARDIOVASCULAR DISEASE — HOUSEHOLDER
TABLE IX. NERVOUS SYSTEM INVOLVEMENT
No.
Per cent
Cerebral hemorrhage
40
16.0
Cerebral thrombosis
28
1 1.2
Encephalomalacia (105
patients examined)
69
65.7
minimal renal involvement showed severe clinical
symptoms, the converse also being found. In a
study of 100 renal biopsies from surgical patients
53 per cent were found not to have sufficient
organic renal disease to be the sole cause of the
hypertension. After death from chronic hyper-
tension, organic vascular lesions of the kidneys
are found in practically all cases. If these biop-
sies can be assumed to be accurately representa-
tive of the renal vascular bed, it seems that the
degenerative lesions seen after death are secondary
to the hypertension and not a cause of it.3
TABLE X. INCIDENCE OF VARIOUS MODES OF EXODUS
No.
Per cent
(Perera)
Per cent
Myocardi.il infarction
53
21.2
10-20
Cardiac decompensation
Ruptured aneurysm and/or
101
40.4
40-50
tamponade
10
4.0
—
Uremia the cause of death
18
7.2
5
Cerebral hemorrhage
40
16.0
10-20
Cerebral thrombosis
28
11.2
10-20
250
100.0
After chronic renal disease, adrenal tumors,
certain rare basophilic adenomas of the pituitary,
and coarctation of the aorta, which account for
5 to 10 per cent of hypertensives, have all been
excluded, the remaining 90 to 95 per cent fall
into the essential group, which is the one at which
the bulk of research is aimed in a quest for an
etiology. The classical experimental work of
Goldblatt in producing renal ischemia with result-
ant elaboration into the blood stream of vaso-
pressor substances of renal origin the attempts
to establish hyperplasia of the adrenal glands, the
gross and sustained overactivitv of the sympa-
thetic nervous system, the various psychosomatic
disorders with chronic emotional storms and ten-
sions have all failed to explain the basic and incit-
ing causes and mechanisms, and to provide the
basis for development of a specific form of ther-
apy. The most recent of the theories to explain
the increased arterial pressure has been by
Shorr and his associates.15 They describe certain
vasomotor excitor substances (VEM) derived
from renal and hepatic tissues, and certain vaso-
depressor substances (VDM) which are thought
to be derived from spleen, skeletal muscles, and
liver. The VEM is produced as a result of al-
tered kidney metabolism secondary to decreased
renal oxygen tension, and is found in the periph-
eral blood stream during the time that the blood
pressure is rising. The VEM is eventually neu-
tralized by the antagonistic action of VDM by its
appearance in the blood stream, with the eventual
establishment of a neutral equilibrium between
the two circulating factors at a higher level than
prior to its elaboration. The cause for the per-
sistance of the hypertension after this equilibrium
has been established is still undetermined. These
studies are still on an experimental basis and have
no clinical application yet but may form a basis
for the development of a specific anti-pressor sub-
stance. Excluding those very few cases where
unilateral nephrectomy, removal of a pheochro-
mocytoma or other adrenal tumor and in rare cases
of surgery for coarctation of the aorta which may
be of specific benefit, the treatment of hyperten-
sion in both medical and surgical phases is still
basically symptomatic and palliative in type.
There is no need to review the various criteria
by which a patient is evaluated as a satisfactory
candidate for surgery aimed at the ablation of
certain components of the autonomic nervous
system in efforts to break the chain of events lead-
ing to a sustained arterial pressure.9’16 The role
of barbiturates as sedators, the nitrites as tempo-
rary vasodilators, the thiocyanates as a controlled
TABLE XI. ASSOCIATED NEOPLASMS FOUND IN
PATIENTS OF THE SERIES
No.
Breast 5
Stomach 5
Prostate 3
Lymphoblastoma I
Colon 2
Kidney 2
Hypernephroma
Meningioma
Squamous cell 1
Thyroid 1
Bladder 1
Gall bladder 1
Lung 1
25 (10.0%)
long range of vasodepressor type of medication
are all well known. A drug formerly in disrepute
to receive recent clinical reappraisal and being
used bv some recently is veratrum viride.5 It
has been found to be of value in cases of hyper-
tensive encephalopathy and myocardial failure in
acute hypertensive crises. Parenterally and orally
it acts in one to two hours with a peak of action
at four hours, but is disadvantageous because of
the narrow margin between the toxic and thera-
peutic doses. Among the more promising of the
444
Minnesota Medicine
HYPERTENSIVE CARDIOVASCULAR DISEASE — HOUSEHOLDER
new agents are those which have as their common
property a blockage of the sympathetically in-
nervated vaso constrictors, in effect a chemically
induced sympathectomy.5 Dibenamine, a nitrogen
mustard derivative with marked hypotensive
properties but impractical for ambulatory therapy,
and pentaquin, a derivative of plasmochin, have
received experimental trial with equivocal results.
The most promising of these agents has been di-
hydro-ergocornine (DHO 108). Responses with
a drop in blood pressure have been noted with all
routes of administration with sustained effects
noted to be lasting from eight hours to several
days. Toxic and undesirable side effects have
been minimal. This drug is available for inves-
tigative purposes only, clinical experience being
limited at the present time to evaluation of its
potentialities.
Our present methods of therapy, directed as
they are at the relief of symptoms and palliation
are of value in rehabilitating some patients and
allowing them to lead useful lives but at a lower
level of activity. Successful lowering of the blood
pressure must not be construed to be a sign of re-
gression of a disease process which has a sustained
hypertension as a secondary effect. The ultimate
goal of research will be to supply the physician
with a substance which will be as specific for es-
sential hypertension as the present antibiotics are
for the treatment of bacterial infections.
Summary
1. Statistics obtained from the St. Luke’s pa-
tient series and national figures correlate only in-
sofar as showing the incidence and predominance
THREAT TO
There impends today a stupendous threat ... in the
fact that our country, without opportunity for conscious
choice on the part of its people, is rapidly drifting to-
ward the consummation of a false concept — contemptible
to free men — the socialized state. . . .
Tokens of this danger are everywhere and undeniable.
The growing power and expansion of a wasteful Gov-
ernment . . . colossal public debt . . . heavy burden of
taxation . . . ridiculous attempt — by dictating wages,
lours of labor, prices, . . . and by innumerable other
false expedients — to substitute an artificial economy for
the natural economy which alone can function in free-
lom . . . gradual assumption by the state of financial,
of hypentensive cardiovascular disease over ma-
lignant neoplasm as a cause of death.
2. Pathological physiology and possible mech-
anisms of production of essential hypertension
have been discussed.
3. Two hundred fifty necropsy cases at St.
Luke’s Hospital over a five-year period have been
reviewed relative to age groups, incidence of car-
diovascular, renal and central nervous system in-
volvement, clinical manifestations, laboratory
data, and mode of exodus.
4. Several new drugs promising in the treat-
ment of hypertension have been mentioned.
References
1. Allen, E. V., and Adson, A. W. : Treatment of hypertension,
medical versus surgical. Ann. Int. Med., 14:288-307, 1940.
2. Bradley, S. E. : Physiology of essential hypertension. Am.
J. Med., 4:398-415, (March) 1948.
3. Castleman and Smithwick, R. H. : Relation of vascular dis-
ease to the hypertensive state, a study of 100 renal biopsies.
J.A.M.A.. 121:1254, (April 17) 1943.
4. Dexter, L.: Mechanisms of human hypertension. Am. J.
Med., 4:279-284. (Feb.) 1948.
5. Freis, E. D.: Recent advances in the medical treatment of
hypertension with particular reference to drugs. M. Clin.
North America, p. 1247, (Sept.) 1948.
6. Goldblatt, H.: Experimental renal hypertension. Am. J.
Med., 4:100-119, (Jan.) 1948.
7. Goldring, W. : Consideration of human hypertension _ with
respect to origin and therapy. Am. J. Med., 4:875-885,
(June) 1948.
8. Hengstler, W. H. : Psychosomatic aspects of hypertension; a
review of the literature. Minnesota Med., 26:874-876, (Oct.)
1943.
9. Hinton, J. W., and Lord, J. W. : Thoracolumbar sympathec-
tomy in the treatment of hypertension. New York State J.
Med., 46:1223, (June 1) 1946.
10. Kempner, W. : Treatment of hypertensive vascular disease
with rice diet. Am. J. Med., 4:545-577, (April) 1948.
11. Landis, E. M. : Modern concepts of cardiovascular disease.
Essential Hypertension, 12: No. 8, (Aug.) 1943. Published
by the American Heart Association.
12. Page, T. H.: Studies on the mechanism of arterial hyper-
tension. T.A.M.A., 120:757, (Nov. 7) 1942.
13. Perera, G. A.: Diagnosis and natural history of hyperten-
sive vascular disease. Am. J. Med., 4:416-422, (March) 1948.
14. Schroeder, H. A.: Low salt diets and arterial hypertension.
Am. J. Med.. 4:578-587, (April) 1948.
15. Shorr, E. : Participation of hepatorenal vasotropic factors
in experimental renal hypertension. Am. J. Med., 4:120-129,
(Tan.) 1948.
16. Smithwick, R. H. : Surgical treatment of hypertension. Am.
J. Med.. 4:744-759, (May) 1948.
FREEDOM
responsibility for every hazard incident to life, labor, in-
firmity, and old age . . . alignment of economic and social
groups one against the other. . . .
The present semblance of “prosperity” is only the by-
product of the most terrible and destructive war that
ever afflicted the world, and is now maintained onlv by
artifice implemented by folly, fear, and dire forebodings.
. . . we call on all patriotic Americans to denounce
them (these policies and politicians who support them)
and to work energetically and courageously for the re-
establishment and maintenance of free and competitive
enterprise and the restoration of the Republic. — New
York Daily News, March 27, 1950.
May. 1950
445
THE PLANS OF MEDICAL STUDENTS FOR PRACTICE
MYRON M. WEAVER. M.D.
Vancouver, British Columbia
and
HAROLD S. DIEHL, M.D.
Minneapolis, Minnesota
THERE is widespread interest about the plans
of present-day medical students for future
practice. This is to be attributed in part to the
apprehension which has existed for a half-century
or longer® that specialism will eventually eliminate
the general practitioner, a contingency which was ■
thought by some to be fairly imminent when the
postgraduate wishes of medical officers were sum-
marized early in 1945 by Harold C. Lueth.7 His
report and data published subsequently5 lent cre-
dence to the prediction of Weiskotten14’15 in 1932
and earlier, that 70 per cent of the medical gradu-
ates each year will eventually limit their practice
to a specialty. The tendency to limitation of medi-
cal practice within restricted fields exaggerates
the need for adequately trained and experienced
general physicians, according to Walter L. Bier-
ring,1 who feels that this constitutes one of the
most important problems facing the medical pro-
fession and the medical schools, as well as all those
agencies concerned with public health.
There have been various reassurances that the
general practitioner is not “doomed,”2’3’4’8 and his
future appears considerably brighter each day be-
cause his importance is being constantly re-empha-
sized, his relationship to hospitals is improving
and more opportunities are being afforded him
for self-improvement. His own Section on the
General Practice of Medicine in the American
Medical Association and his American Academy
of General Practice will help him to put his own
house in order and to set standards which will be
sufficiently high to cause him to obtain proper sat-
isfaction from his own particular role in medical
practice.
Possibly the brightest aspect of general practice
is the attitude exhibited by recent graduates in
medicine. In the Educational Numbers of The
Journal of the American Medical Association in
1948 and 1949, 9 polls concerning the plans of
medical students were reported. These polls sug-
gested that an idea which has achieved rather wide
Dr. Weaver is Dean of the Faculty of Medicine, University of
British Columbia, Vancouver, B. C.
Dr. Diehl is Dean of Medical Sciences, University of Minne-
sota, Minneapolis.
QUESTIONNAIRE
1. Do you intend to be a practicing physician? Yes
No....
2. If you find yourself able financially, how many
years of hospital training, after internship, will you
undertake? One.... Two.... Three More than
three
3. Do you plan eventually to be certified by a specialty
board? Yes. . . . No
4. Would you prefer to engage in solo practice
small clinic practice...., large clinic practice
industrial medicine...., Government service ,
other ?
5. What annual net income have you set for your
goal? $
6. According to your present inclinations, would you
wish to practice in Minnesota...., the Middle West
or Northwest...., a distant state or in a for-
eign country. . . . ?
7. Is your familv resident in Minnesota? Yes....
No. ._. ..
8. Provided adequate hospital facilities were available
and the prospects for adequate remuneration and
reasonable working hours were good, check the size
of the community in which you would prefer to
practice medicine: 1,000 or less , 1,000 to 5,000
. . . ., 5,000 to 50,000. . . ., over 50,000
9. What was the population of the community in which
you were reared?
10. What form of remuneration would you prefer to
receive: Salary for full-time...., fees from private
practice...., combined part-time salary, or other
steady income, plus part-time private practice ?
11. Would you be averse to participation of government
in the financial and administrative aspects of medical
practice? Yes. . . . No
acceptance should be corrected : this is that few
present-day medical students are planning to enter
general practice.
At the University of Minnesota Medical School,
systematic questioning of senior medical students
was undertaken in June, 1944. A relatively simple
questionnaire was adopted, as shown. Some of
the data collected were mainly of local interest.
This was especially true of the inquiry as to how
many recent graduates plan to remain in their
home state, what types of practices they con-
template, the geographic location and size of com-
munities which they desire for practice, and the
incomes they hope to achieve. After surveying
two classes of senior students it was decided to
determine how the thinking of the fourth-year
students compared with that of first-year stu-
dents.
446
Minnesota Medicine
PLANS FOR PRACTICE— WEAVER AND DIEHL
i oo
90
80
70
— June 1944 —
Senior M
— March 1945 —
s die a 1 Stu
December 1946
dents on £
-August 1947-
roduation
— June 1948 —
— June 1949 —
■
13
' 1
zzd
|
I
1
I
a
1
0
i
IE
1
3
It
Jl
It
mwr i
Freshmen
Medical S
itudents or.
-January 1947-
i admission
September 1947-
September 1948
— April 1946 — ;
a None
J-
1
■
■
- B* -
■
-
i
|
mil
1
H
3
fi
n L
■
1
1
i
m 1 1 1 is
ITW
nun
1 1 n
; 100
j 90
| 80
j 70
' 60
50
40
" 30
§ 20
S’ 10
“ 0
, ° 100
S 90
_ 80
| a! 70
60
— June 1944 —
-Senior M
-March 1945-
Bdical Stu
December 1946
dents on $
- August 1947-
raduat/on -
— June 1948 —
—June 1949—
■
%
ra
ra
1
1
!
1
1
l.o-o,
1
J
B 0 ■ — ■
J
tt— _
1
1 °
a b c d e f a b c d e f a b c d e f a b c d e f
Freshmen
M
i
edical S
April 1946 —
t u d e n t s on admission
-January 1947-j September 1947-j September 1948
r
a Solo practice
b Small clinic practice
■
— d Industrial medicine —
i
_ e Government service
_ f Other
-
P
i-
|
g Undecided
n
n
1
V
i
■
|
L
II
II
1 1 ■ — _
mrm
Pi
a b c d e f g a b c d e f g a b c d e f g a b c d e f g
Fig. 1. Hospital training desired beyond internship.
Fig. 3. Type of practice preferred.
90
80
70
60
50
40
" 30
I 20
£ -10
^ 0
-100
l 90
5 80
70
60
50
40
30
20
10
— June 1944 —
rSe
- Ma
fiior Medical Students on
ch 1945— | December 1946 1— August 1947
roduation
— June 1948 — • - - June 1949 —
r
|
r
1
El
J
L
L_
ULJ
r
t±:
m
_
ji is
Freshmen
Met
Jical S
rH 1946—1
tudents on
k January 1947-
admission
September l947|Septe
mber 1948
a Yes
1.
11
■I
fit...
UN
UN
— June 1944 —
-Senior M
— March 194 5 —
edical Stu
December 1946
dents on $
-August 1947-
roduation -
— June 1948 —
— June 1949 —
tBMHB
■BBfll
-■III
-III!! '!
■III-
oJIll
abode abode abode abode abode abode
Fig. 2. Intentions to seek specialty board certification.
Fig. 4. Income goals.
Intention to be Practicing Physicians. — In the
classes of seniors between 1944 and 1949, 99, 99,
98, 97, 97, and 98 per cent of the students, respec-
tively, 98, stated they intended to engage in medi-
cal practice! Among the first-year students from
1946 to 1948, 93, 93, 96 and 100 per cent, respec-
tively, of those answering the questionnaire stated
they expected to be practicing doctors.
The seniors who responded to the questionnaire
in the years between 1944 and 1949 numbered 117,
93, 97, 73, 61 and 85. The freshmen who respond-
ed to the questionnaire between 1946 and 1948
numbered 82, 97, 119 and 124 respectively.
Hospital Training Desired Beyond Internship.
— Almost without exception, the upper class and
entering students hoped to be able to undertake
an extended period of hospital training beyond
their internship, as shown in Figure 1. This sup-
ports the statement of William A. O’Brien11 that
the majority of recent medical graduates do not
wish to enter any kind of practice without further
training beyond a year’s internship. It was his
belief that graduates in medicine today do not
feel it is possible to master the medical knowledge
they require in five years. This was a determining
factor in the establishment of two-year intern-
ships for general practice under the direction of
the University of Minnesota Medical School.13
Intentions to Seek Specialty Board Certifica-
tion.-— Figure 2 indicates how student interest
in securing specialty! board certification has de-
clined in the postwar period. At all times dur-
ing the past several years the aspirations of
fourth-year and first-year medical students have
corresponded very closely in this respect. An
opinion is ventured that registrants in medical
May, 1950
447
PLANS FOR PRACTICE— WEAVER AND DIEHL
abode abode abode abode
Tig. 5. Intentions as to residence.
schools have well-formulated intentions about
their professional careers in advance of any pre-
sumed influence which results later from the
examples set by clinical medical teachers or ex-
periences gained in specialized hospital services.
Type of Practices Preferred. — One striking
feature of Figure 3 is the popularity of the idea
of practice in a small clinic. This trend in student
preferences becomes increasingly apparent as the
medical course progresses. At the time of ques-
tioning, the senior students in this survey had not
yet participated in the class discussions conducted
by guest lecturers who each year present to the
students the opportunities of solo medical prac-
tice, of small and large clinic practice, of industri-
al practice, and of the governmental services, in-
cluding the Medical Corps of the U. S. Army,
Navy and Public Health Service.
TABLE i
Percentages
Resident and
of Seniors with
Non-Resident in
Families
Minnesota
1944 1945
1946
1947
1948 1949
Resident
83
90
89
96
56 89
Non-resident
17
10
11
4
44 11
Percentages of Freshmen with Families
Resident and Non-Resident in Minnesota
Resident 83 86 87 87
Non-resident 17 14 13 13
TABLE II
Percentages
of Seniors
by Years
1944 1945
1946
1947
1948
1949
Size of
Com munity
Where Reared :
Under 1,000
16
12
12
18
16
1,000 to 5,000
22
18
21
23
37
5,000 to 50,000
23““
20””
23”
26 '
is"
Over 50,000
39
50
44
33
45
Percentages of Freshmen by Years
Under 1,000
12
9
20
13
1,000 to 5,000
12
21
18
18
24
30
38
31
5,000 to 50,000
28
21
18
17
Over 50,000
48
49
44
52
Income Goals. — Upper classmen in the past few
years appear to have developed somewhat greater
financial ambitions than they exhibited formerly,
although the number aspiring to definitely high
incomes has not changed greatly since the war
(Fig. 4).
Intentions as to Residence. — The returns repre-
sented by Figure 5 are consistant except in the
case of the senior class in 1948. This class con-
tained relatively large numbers of non-residents of
Minnesota, and students whose families lived at
a distance (Table I).
Sizes of Communities Desired for Practice. — -
The thinking of seniors and of first-year students
as to the sizes of the communities which they pre-
fer for practice is shown in Figure 6. Table II
shows the sizes of communities in which the stu-
dents of these several classes were reared.
Types of Remuneration Desired. — The inten-
tion was to distinguish the students who contem-
plate salaried positions versus whole-time private
practice, and to reveal those students who aspire
448
Minnesota Medicine
PLANS FOR PRACTICE— WEAVER AND DIEHL
too
90
80
70
60
50
40
» 30
j 20
’ '0
• 0
J00
* 90
. 80
- 70
60
50
40
30
— June 1944 —
Senior Medical Students on ^
— March 1945— (December 1946 (—August 1947-
raduat/on -i
— June 1948 — | — June 1949 —
1
!
0
■
■
51
I
1
1
1
I
0 0 0
M_ .
L
is
1.
la
-Senior Medical Students on graduation
-March 1945 —(December I946L- August 1947 -j — June 1948
Freshmen
Medical Students on admission
o Adverse
b Not odverse T
c Undecided or qualified t —
— i
So
11
1
tl0
1
I
Fig. 7. Types of remuneration desired.
Fig. 8. Attitudes on government participation in medical care.
to a combination of medical teaching and private
practice (Fig. 7).
Attitudes on Government Participation in Med-
ical Care. — The consensus of each class appears
clear (Fig. 8).
Summary
A survey extending over several years was
conducted to determine the plans of medical stu-
dents at one institution and appears to support
the following conclusions :
Nearly every student wishes to undertake con-
siderable hospital training beyond his internship.
The principal limiting factors usually prove to
be the financial stringency and unavailability of
proper hospital appointments, rather than con-
siderations of specialty practice versus general
practice.
The present-day medical student seems fully
to appreciate the advantages of clinic or other
group practice.
In spite of prospects for good hospital facilities
in small communities, recent medical graduates
and students in the earlier years of the medical
course continue to exhibit a preference for urban
centers as they contemplate entering upon their
medical practices.
First-year and fourth-year medical students are
remarkedly alike in their plans and aspirations for
future practice.
References
1. Bierring, Walter L. : Public health and the practicing physi-
cian. Canad. J. Pub. Health, (Sept.) 1947.
2. Davison, Wilbur C. : Opportunities in the practice of medi-
cine. J.A.M.A., 115:2227, (Dec. 21) 1940.
3. Gillespie, W. F. : The training and rewards of the physician.
Diplomate, 19:37, (Feb.) 1947.
4. Johnston, W. V. : The general practitioner of today. Canad.
M. A. J.. 61:168, (Aug.) 1949.
5. Johnson, Victor; Lueth, H. C., and Arestad, F. H. : Educa-
tional facilities for physician veterans. J.A.M.A., 129:28,
(Sept. 1), 1945.
6. Lord Horder of England (1896), quoted by Walter L. Bier-
ring.
7. Lueth, Harold C. : Postgraduate wishes of medical officers.
J.A.M.A., 127:759, (March 31) 1945.
S. Lull, George F. : Medicine in the future. Congress on
Medical Education and Licensure, Chicago, Feb. 11-12, 1946.
9. Medical education in the United States and Canada. J.A.M.A.,
141:41, (Sept. 3) 1949.
10. Miller, M. H.: General practice in a large hospital.
J.A.M.A., 134:15, (May 3) 1947.
11. O’Brien, William A.: The practice of general medicine.
Proc. Ann. Cong. M. Educ., Chicago, Feb. 11-12, 1946.
12. Thompson, S. A., and Thompson, S. B.: The status of the
general practitioner, present and future. J.A.M.A., 131:514,
(June 8) 1946.
13. Weaver, M. M. : Preparing the intern for general practice.
Proc. Ann. Cong. M. Educ., Chicago, Feb. 8-9, 1948.
14. Weiskotten, H. G. : Present tendencies in medical practice.
Bull. A. Am. Med. Col., 2:29, (Jan.) 1927.
15. Weiskotten, H. G. : Tendencies in medical practice: A
study of 1925 graduates. Bull. A. Am. Med. Col., 7:65,
(March) 1932.
SOCIAL AGENCIES AND TUBERCULOSIS CONTROL
The health officer responsible for tuberculosis control
in his area, as an integral part of his work, should
develop an understanding and working relationship with
the social agencies in his community. Such a relation-
ship would certainly benefit both agencies. The social
agency will gain an insight into the specialized medical
and public health problems associated with tuberculosis
control, and the health agency will have an opportunity
to see the positive contributions which social workers
and social agencies can make toward the effective man-
agement of tuberculosis patients. Robt. J. Anderson,
Chief, Div. Tuberc., Public Health Report, Dec. 2, 1949.
May. 1950
449
CHALLENGING PROBLEMS AND DEMANDS OF THE AGED AND
CHRONICALLY ILL
J. A. LEPAK. M.D.
Saint Paul, Minnesota
npHE STUDY of the growth and development
of the human race shows that the percentage
of the population of the earth in the old age group
is gradually increasing. Wars, disease and famine
have, sometimes for short intervals, interrupted
the steady augmentation of the older group. Today
Brazil, India, Japan and U.S.S.R. are considered
young; Canada, Italy, Spain and the U. S. A. are
relatively young ; while England, France, Germany
and the Scandinavian countries are senescent. The
French population suffers most among nations
from old age. Since the aged are more prone to
suffer from chronic disease than the young, the
community must plan to provide ever increasing
facilities for the care of the chronically ill. The
most important or essential needs affecting the
aged and chronically ill doubtless lie in the social,
economic and medical fields. It behooves the medi-
cal profession, therefore, to consider the problems
and demands emanating from the increase in the
chronically ill and aged in order to aid the sociol-
ogists and economists in their solution.
The average life span of prehistoric man was
eighteen years. During the height of the Roman
Empire it rose to twenty-two years. In the
Middle Ages it reached thirty years. In England
it climbed to forty-one years during the middle
of the nineteenth century. In 1900 the average
length of human life in the United States was
forty-nine years ; in 1945, 62.5 years, and in 1949,
over sixty-five years. The span of life varies too
in different countries, depending on the progress
of medical sciences, social welfare and economic
growth and development.
While chronic illness is found in every decade
of life, it is much greater in the later decades. It
is estimated, for the country as a whole, that for
the population over sixty-five years of age its
incidence was 6.8 per cent in 1940, will be 7.9 in
1950, 10.2 in 1960, 11.9 in 1970 and 14.4 in 1980.
The increase in life expectancy is attributed to
reduction in infant and maternal mortality, less
immigration, better living standards and advances
in public health and medical science. The death
Retiring President’s Address, Minnesota Academy of Medicine,
Saint Paul, Minnesota, January 11, 1950.
TABLE I. YOUR LIFE EXPECTANCY, U. S., 1950*
At
birth you
can expect
65.12 years
of life remaining
At
age 1
“
66.80
“
5
“
63.36
“
10
“
58.64
“
15
53.89
20
49.30
25
“
44.87
30
40.42
35
35.97
“
40
31.63
“
45
27.44
50
“
23.45
55
“
19.71
“
60
“
16.24
65
“
13.09
70
10.30
75
7.85
80
5:76
“
’Anticipated minimum expectancy based on current mortality
trends.
“Longevity of the American People in 1944.” Statistical Bul-
letin, Metropolitan Life Insurance Company, 27:1-4, (May)
1946. In “How to Live Longer,” by Justus J. Schifferes.
TABLE II. PRINCIPAL CAUSES OF DEATH, U. S., 1900
1. Tuberculosis — now in seventh place!
2. Pneumonia — now in sixth place!
3. Diarrhea and inflammation of the intestines — now off the list!
4. Heart disease — up.
5. Diseases of infancy and malformations — way down now!
6. Nephritis — up.
7. Unknown and ill-defined diseases — off the list!
8. Cerebral (brain) hemorrhage — up.
9. Accidents — up.
10. Cancer — up.
From the U. S. Bureau of Census. In “How to Live Longer/*
by Justus J. Schifferes.
TABLE III. KILLERS OF AMERICANS, 1949
1947*
Death Rate
per 100,000
No. 1 Heart disease 318.4
No. 2 Cancer 133.4
No. 3 “Stroke” 90.6
No. 4 Accidents l 70.7
No. 5 Kidney disease 55.3
No. 6 Pneumonia and influenza 43.2
No. 7 Tuberculosis 33.4
No. 8 Premature birth 28.3
No. 9 Diabetes 26.1
No. 10 Suicide 11.2
No. 11 Syphilis 8.9
All Causes 1009.9
*Exclusive of stillbirths.
Adapted from Table 4, “Current Mortality Analysis,” Volume
5, Number 13 (August 27, 1948) ; Federal Security Agency,
and National Office of Vital Statistics, Washington 25, D. C.
In “How to Live Longer,” by Justus J. Schifferes.
rate in the United States demonstrates this im-
provement. In 1900, per 1,000 population the
death rate was 17.2 per cent; in 1910, 14.7; in
1920, 11.3; in 1930, 10.7; and in 1947, 10.1 per
cent.
The life expectancy in the United States, as
450
Minnesota Medicine
THE AGED AND CHRONICALLY ILL— LEPAK
TABLE IV. POPULATION UNITED STATES, 1940, BY
AGE GROUPS
Age Group
Population
Per Cent
Under 5
10,541,524
8.0
5-9
16,684,622
8.1
10-14
11,745,935
8.9
15-19
12,333,523
9.4
20-24
11,587,835
8.8
25-29
11,096,638
8.4
30-34
10,242,388
7.8
35-39
9,545,377
7.2
40-44
8,787,843
6.7
45-49
8,255,225
6.3
50-54
7,256,846
5.5
55-59
5,843,865
4.4
60-64
4,728,340
3,806,657
3.6
65-69
2.9
70-74
2,569,532
2.0
75 and over
2,643,125
2.0
Total population :
: 131,669,275
Source : United States Census Bureau.
TARLE VI. ESTIMATED
NUMBER OF INVALIDS DIS-
ABLED BY CERTAIN CHRONIC DISEASES IN U. S.,
1937
Nervous and mental diseases.
269,300
Rheumatism
147,600
Heart disease
144,200
Tuberculosis — all forms
77,900
Arteriosclerosis and high blood pressure
Diabetes mellitus
34,300
Nephritis and other kidney diseases
31,000
Cancer and other tumors. . . .
Diseases of female organs...
28,100
18,500
Source: United States Public Health Service, from “Geriatric
Medicine,’’ edited by Edward J. Stieglitz.
estimated by the Metropolitan Life Insurance
Company, is shown in Table I.
In 1900 deaths from tuberculosis headed the
list. Today tuberculosis is in seventh place.
Pneumonia deaths were in second place ; now,
they are in sixth place (Table II). Cancer,
accidents and cardiovascular diseases, however,
have gone way up as the cause of deaths (Table
III).
From Table V it can be seen that the incidence
of chronic illness and invalidism increase pro-
gressively with age.
The six most common diseases causing
invalidism in sequence are : nervous and mental
diseases, rheumatism, heart disease, tuberculosis,
arteriosclerosis and high blood pressure and
diabetes. If heart disease, arteriosclerosis, high
blood pressure and some cases of nephritic
disease and rheumatism were combined under the
term “cardiovascular diseases,” then this group
would occupy the first place (Table VI).
Chronic disease, except for severe economic
national depressions, is the greatest single factor
forcing people onto public assistance rolls.
TARLE V. INCIDENCE, PER 1,000 POPULATION, OF
CHRONIC DISEASE OR PERMANENT IMPAIRMENT
AND OF INVALIDITY, ACCORDING TO AGE
Age in Years
Chronic Illness or
Permanent Impairment
Invalidity
All ages
177.0
11.4
Under 5
34.2
1.9
5-14
68.3
3.1
15-24
82.9
4.5
25-34
159.2
5.6
35-44
221.0
10.4
45-54
273.4
15.7
55-64
344.3
27.8
65-74
467.1
53.5
75-84
513.6
72.7
85 and over
602.3
106.2
Source: National Health Survey, 1935-36, The Magnitude of
the Chronic Disease Problem in the United States (Preliminary
Reports, Sickness and Medical Care Series, Bulletin No. 6),
Washington, U. S. Public Health Service, 1938 (processed),
p. 14.
TABLE VII. PROBLEMS OF HOSPITAL PROGRAM
1. Quantity for every 1,000 people, 4.5 beds in general hospitals
Quantity for every 1,000 people, 2. beds for chronically ill
Quantity for every 1,000 people, 5. beds for mental patients
Quantity for every 1,000 people, 2.5 beds for tuberculosis pa-
tients
2. In 1948:
Type of Hospital
Existing beds
No. beds needed
General
467,000
260,000
Mental
429,000
307,000
Tuberculosis
84,000
85,000
Chronic
39,000
246,000
Total
1,019,000
904,000
Source : United States Census Bureau.
Although the fate of the chronically ill and
aged is frequently deplorable, it is often worsened
by certain existing discriminatory practices in our
social order. Urban industrialization has enticed
the youth from the country to the cities. Today
the population on the farms is less by 20 per cent
than in 1920. Industry wants, as a rule, the young,
strong and alert. Youth and the old are excluded.
Economic and legislative compulsion have
shortened the years of work.
During the depression, the youngest and oldest
workers suffered most. Despite the excellent
record and enormous capacity of workers in the
fifties and sixties during the war shortage of man-
power, industries continue to place unabatingly
more and more employes on the retired list be-
tween the ages of sixty and sixty-five. Age, rather
than the physical and mental status, too often
determines when a worker is retired. As the
population grows older and older, the gap between
the span of life and working span, likewise,
becomes wider and wider. Today his life expect-
ancy is sixty-seven, working years forty-one and
retirement 5.5 years. In 1975, if the trend per-
sists, the span of retirement will be ten years.
May, 1950
451
THE AGED AND CHRONICALLY ILL— LEPAK
Much has been spoken and written about the
Federal Aid Insurance Program, part of the
Social Security Act (1935) and later amended or
changed by the 1939 Congress, but the benefits
from this source are too small to be effective. In
December 1947 the average benefit was $24.90,
and average worker and wife received $39.60,
widow and two children $48.00, and an aged
widow $20.40. In addition to the inadequate
benefits, the unduly restricted eligibility does not
cover domestic servants, housewives, unskilled
labor, clerks, professional individuals and many
older workers. Current legislative movements
favor coverage for practically all persons, a
liberalized insurance status, a very substantial
increase in benefits and the payment of cash
benefits to the permanently and totally disabled.
If two-thirds of the deaths in the United States
are due to chronic disease and 40 per cent of them
occur under sixty-five years, and two-thirds with
chronic disease are under sixty-five years, re-
duction of chronic disease rates first in the
medical program. The ever increasing number
of the aged only complicates and enlarges the
picture. In different parts of the world, very
different treatments have been accorded to the
old. Chinese society, based on ancestral worship,
stability, continuity and conservation, honored the
period of old age. The Eskimos in the north-
western part of North America, facing a bitter
struggle in a frigid environment, considered the
aged a drain on their provisions and hence
expected or encouraged them to wander off and
die. In Labrador the Eskimos quietly dispatched
the old. In Africa the Bushmen left them behind
when moving camp. The Plottentot carried them
to solitary huts and left them with meager pro-
visions. The United States with its accent on
youth, growth and speed has for the most part
only ignored old age. Since the problems of old
age and the chronically ill are gaining greater and
greater prominence with each decade and the past
solutions appear impractical in this age, it is
necessary to explore means, first, that can be
marshalled for immediate relief, and second, that
can be initiated to meet future needs.
Today one-half of the population is over thirty
years. In 1800 one-half of the population was over
sixteen years. Now 10,000,000 people are over
sixty-four years. By 1975, it is estimated
20,000,000 will be over sixty-five years. In 1975
one-third of the population will be over forty-five
years, while in 1900 only 18 per cent was. Chronic
disease accounts for 75 per cent of all the
invalidism and partial disability in this country
(about 2,500,000 invalids and 10,000,000 partially
disabled). More than one-half of the chronically
ill are under forty-five years. Between the ages
of forty-five to sixty-four, chronic disease is four
times as frequent as between fifteen to twenty-
four years. More than 25,000,000 people or one-
sixth of the population have chronic disease.
About 40 per cent of physicians’ services are
rendered to chronics, while three out of every
four hospital patients in the United States are
hospitalized for chronic physical or mental illness.
Poverty and chronic illness often walk side bv
side. Persons on relief suffer from disability
three times as frequently as persons with family
incomes of $3,000 and over. Facilities for the
chronic and convalescent are developed very
poorly in the United States. In this country in
1930 there were set aside for this purpose 7.1
beds per 100,000 while England enjoyed 53.6
beds. In 1947, there were 12,210 beds in twenty-
nine states, but 70 per cent of them were in four
states, namely, California, New York, New
Jersey and Pennsylvania, while 20 per cent were
in eight states, i.e., Illinois, Maryland, Massa-
chusetts, Michigan, Minnesota, Missouri, Ohio
and Washington.
The aged and chronically ill, it would appear,
ought to interest the medical profession not only
from a strictly scientific aspect, such as improving
health and preventing, curtailing or treating
disease, but also from the fact that if this group
of the population does not receive proper medical
care in the home, nursing home or hospital, the
state and federal government will encroach more
and more on the rights and privileges of the
average medical practitioner. In other words the
medical profession should aim to keep the aged
at work as long as possible and the chronically
ill rehabilitated wherever feasible. At the present
time facilities for retraining, rehabilitation and
occupational, physical and educational therapy are
sadly neglected. These measures should receive
the hearty endorsement of the whole profession.
The aged, too, in an appropriate occupation ought
to be retained by industry or any other employing
agent, despite reaching the usual retirement age
of sixty or sixtv-five, as long as they are capable.
452
Minnesota Medicine
THE AGED AND CHRONICALLY ILL— LEPAK
This change in policy would reduce the span of
years in retirement or unemployment and thus
add more comfort to the old and decrease the
economic burden of maintenance on the com-
munity, state and federal governments.
Recent surveys in various cities and states
reveal a great deficiency of hospitals, physicians
and nurses as well as nursing homes and homes
for the aged with the necessary personnel.
Boarding and custodial homes and various private
institutions for the aged or chronically ill are also
deficient and many need much renovation before
they may be acceptable. A recent New York
survey gives startling figures of deficiency in all
their institutions and personnel.
In 1948 the United States Census Bureau
revealed that 39,000 existing beds were allotted
to the chronically ill, while 246,000 actually were
needed in the various hospitals of the country
(Table VII).
Even this brief, general and very inadequate
exposition of the problems emanating from the
ever increasing number of the chronically ill and
aged demonstrates that an adequate solution will
be difficult, prolonged and expensive. It will call
for a co-operative spirit and effort among all
groups in our social order extending from the
local community and state to the federal levels.
Some parts of the country are awake and aware
of these problems. Cities like Baltimore, Chicago,
Milwaukee, Philadelphia, New York and St.
Louis, as well as the following states — California,
Connecticut, Illinois, Indiana, Maryland, Massa-
chusetts, Minnesota and New York — have already
created definite plans, some of which are either
operating or under study for co-operative action
while others are undergoing construction to meet
the immediate needs and future demands or
contingencies.
Provisions have been made for home care,
nursing homes and hospitals including the training
of the proper personnel for all respective places.
At the hospitals, especially those attached to
teaching institutions or medical schools, a
definitely outlined research program has been
either inaugurated in some or planned for in other
institutions. Every effort has been explored,
studied and undertaken also to educate the public
not only how to cope with the present emergencies
but also to throw light on methods and measures
employed to make chronic disease and old age
more useful and less miserable It is estimated
that early medical services would reduce chronic
disease by 20 to 30 per cent. If physical therapy
and re-occupation or rehabilitation, as its advo-
cates claim, would reduce dependency in chronic
disease by another 20 per cent, then the family,
city, community, state or federal government
would experience a marked financial, reduction in
the care of this group.
Now let us glance at Minnesota.
While some communities and states started
earlier to study and evaluate the various problems
and demands accompanying the chronically ill and
aged, Minnesota made up for the delay once it
undertook the job. The 79th Congress in passing
the Hospital Survey and Construction Program
gave additional impetus to the task. The federal
legislation authorized an annual grant to the
states over a five-year period to assist in con-
structing and equipping needed hospitals and
public health centers, provided a state submitted
an over-all plan for approval. Such an initial
plan was completed in 1948 and revised with
priorities in 1949. In general, the whole project
is financed, two-thirds by the community and state
and one-third by the federal government. The
law provides for Federal-state co-operation and
designates the United States Public Health
Service as the Federal administrative agency. “In
Minnesota, the State Board of Health is charged
by chapter 485, Laws of Minnesota, 1947, with
responsibility for co-operation with the United
States Public Health Service in the conduct of the
program. The Federal law required planning of
facilities in each of the following five categories
of institutions : General and Allied Special
Hospitals, Chronic Disease Hospitals, Mental
Disease Hospitals, Tuberculosis Hospitals and
Public Health Centers.” Accordingly, brief
studies and evaluations of facilities were made;
first, of the homes for the aged and the chronically
ill : second, a rather comprehensive and detailed
report of the existing hospital beds and facilities
followed with a five-year plan for future con-
struction of hospitals and public centers needed
to comply with the Federal regulations and
stipulations.
The homes for the aged numbered forty-eight,
with a bed capacity of 3,228. Only forty-two
homes had a capacity of twenty-five beds or more.
Forty-three homes were maintained by corpora-
tions. The Minnesota Soldiers’ Home, state
owned, had 395 beds for men and 120 beds for
May, 1950
453
THE AGED AND CHRONICALLY ILL— LEPAK
women. Four homes were maintained by
counties, with a total of ninety-eight beds.
There are 174 homes totalling 3,543 beds for
the chronic and convalescent in Minnesota. Only
twenty-nine homes have a capacity of twenty-five
beds or more. Eight homes are maintained by
corporations, 160 by individuals and six by
counties. The counties combined have 275 beds.
It is well to note that some of these homes have
already discontinued to operate since the investi-
gation took place. Others will have to be remodeled
and undergo variable changes to meet the
necessary and minimum requirements of fire
hazards, frequent accidents and health provisions.
Under such circumstances the bed capacity has
been very much reduced and will continue to
decrease as the various public safety departments
get more and more interested and enforce their
respective regulations in the homes and hospitals
for the aged and chronically ill.
In order to understand and appreciate what
hospital facilities are present or planned for the
aged and chronically ill, it is necessary to review
briefly the requirements and demands laid down
for all the health institutions by the United States
Federal Ffealth Services. This legislation specified
that hospitals shall be divided into five categories,
namely: (1) general and allied special hospitals
including orthopedic, pediatric, contagious : ear,
eye, nose and throat, obstetrics and gynecologic
services; (2) mental disease hospitals; (3)
tuberculosis hospitals; (4) chronic disease
hospitals and 15) public health centers.
The General and Allied Special Flospitals,
based on the 1947 census of Minnesota population
of 2,888,000, should contain 12,966 beds, allotting
4.5 beds per 1,000. The state of Minnesota is
divided into eleven regions. In this group the
hospitals are divided into a base hospital, eleven
regional hospitals, seventy-five intermediate area
hospitals and 43 rural hospitals. The most efficient
co-operative and co-ordinative efforts and policies
are to exist among these institutions. The Univer-
sity Hospital with the Twin Cities Hospitals is
designated as the base area. Outside of the Twin
Cities are the eleven regional hospitals dependent
on and co-operating with the base institutions.
The intermediate area hospitals are obliged to
depend on the regional, and the rural again on
the intermediate area hospitals. The base hospitals
with their various research and teaching centers
will enjoy the largest bed capacity. In the rural
parts the hospitals will be small and have only
2.5 beds per 1,000 and take care largely of
common illnesses, injuries and obstetrics. In the
allocation of these various hospitals many factors
were considered such as distance ( forty miles
between hospitals), population guide, bed deaths
and bed births ratios, accessible roads and existing
hospitals. The total beds needed in this group is
12,996. There are now 8,665 acceptable beds.
The Minnesota Mental Disease Hospital Plan,
based on five beds per 1,000, requires 14,440 beds.
At present there are only 7,789 beds.
Tuberculosis Hospital Plan, allotting beds
numbering two and a half times the average
annual number of deaths per 1,000 over a five-year
period, should have 1,630 beds. The inventory
shows 1 ,995 beds. When two institutions which
normally house sixty-five patients are closed, there
will still remain 1,930 beds.
The Minnesota Plan for Public Health Centers
(1949) provides for one center per 30,000.
Appropriate legislation is needed to endorse and
authorize the recommendation. There will then
be eleven centers. There are three at the present
time.
Finally comes the Minnesota Chronic Disease
Hospital plan. These hospitals, wings of a hospital
or segregated units adjoining a general hospital,
are intended to provide medical care for chronic
invalids. Alloting two beds per 1,000 population,
Minnesota is entitled to 5,776 hospital beds. It
has 598 beds. The 1946 hospital survey showed
128 homes and hospitals with a capacity of 2,839
beds. The homes gave only monthly domiciliary
care. In 1948 a final analysis indicated that there
were only 598 beds. In rural areas 1.5 beds per
1,000 will be allocated in existing or to be built
general hospitals. In the Twin Cities 2.5 beds
per 1 ,000 or more will be allowed where research,
teaching and special care can be rendered more
readily when required and necessary. There will
be hospital beds and facilities in sixty-seven
hospitals divided into thirty-seven areas or
locations to meet the convenience of travel,
medical health centers and distribution of popula-
tion. The Ancker and Minneapolis General
Hospitals, as teaching institutions, will pro-
portionately have a substantial increase in bed
capacity. The guiding principles for this plan are
to locate the hospitals as near as possible to those
needing them, to take in account the urgent
desirability of constructing units in conjunction
454
Minnesota Medicine
THE AGED AND CHRONICALLY ILL— LEPAK
with already existing general hospitals for more
efficient diagnosis, treatment and economy and
finally to look forward to superior means, methods
and equipment for administering physical therapy
and occupational rehabilitation.
Since there is not only a shortage of hospital
beds but also of trained personnel for the future
needs in such hospitals, priorities will be given
to the construction of sub-units of general
hospitals and projects operating as units of
teaching hospitals for training personnel for the
future needs in chronic disease hospitals. Next,
regional hospitals will be built, around which later
the remaining units should follow.
When the Minnesota Chronic Disease Plan gets
well under way, and perhaps long before the five-
year period is passed, there will be a tremendous
improvement in the care and welfare of the aged
and chronically ill. Its association with the
University of Minnesota Medical School will
greatly aid the growth and development of the
movement. Research in chronic diseases and old
age should also advance more readily, because of
the proximity of the other various research
medical centers like the cancer, arthritic, pediatric
and cardiac institutions for the exchange of ideas,
facts and experiments.
It is apparent, however, that Minnesota, in
order to give satisfactory care to the aged and
chronically ill, needs more: (1) hospital beds, (2)
physicians, nurses and trained personnel for this
purpose, (3) nursing homes with proper super-
vision and licensing to protect the ill from social,
economic and medical abuses, exploitations or
hardships, (4) housekeepers, social workers,
nurse’s aids, et cetera, who would help the ill and
aged in their homes, (5) research into chronic
disease and the aged, (6j appropriate legislation
extending from the rural districts to the state
capitol to facilitate the aims, means and measures
advocated by those well trained and appointed to
accomplish the task.
Conclusion
1. It has been shown that the percentage of
the chronically ill and aged is increasing with time.
2. The increase is caused largely by a reduced
infant and maternal mortality, improved drugs,
better medical care, more restricted immigration,
better living standards and various scientific
advances.
3. The increase in the chronically ill and aged
creates problems and demands in the community
which are more social and economic than medical.
4. Adequate solution of these problems depend
on several sources : ( 1 ) the community, state or
federal government, (2) education and co-
operation of all the groups in our social order,
(3) medical personnel to serve in hospitals,
nursing homes, rest homes or ordinary homes.
5. A brief account has been given of the
immediate needs and future plans in a few large
cities and states for the chronically ill and aged.
6. Finally, a resume of the Minnesota Plan
for Hospitals and Public Health Centers is dis-
cussed insofar as it concerns primarily chronic
disease hospitals and future plans.
(For discussion, see Page 518)
AUTOMOBILE ACCIDENTS
There were fewer automobile accident deaths on streets
and highways of the nation last year than in 1948, but
more injuries, according to figures released recently by
The Travelers Insurance Companies.
Fatalities in 1949 totaled 31,800, compared with 32,200
in 1948, the companies reported, but injuries last year
soared to an all-time high of 1,564,000. The 1948 figure
was 1,471,000 injured.
These statistics are highlights of “Maim Street,” six-
teenth in an annual series of traffic safety booklets issued
by The Travelers. The Hartford insurance firm main-
tains an accident statistical bureau which collects and
analyzes accident data from the forty-eight states.
Excessive speed headed the list of accident causes in
1949. as it has in most recent years. “Exceeding the
speed limit” caused 10,100 deaths and 398,700 injuries in
1949, according to the booklet. “Speed was a greater fac-
tor in traffic casualties last year than at any time in his-
tory,” the report states.
There were 890 fewer fatalities among pedestrians in
1949 than in 1948, but 180 more persons were killed cross-
ing streets between intersections last year than in 1948.
Last year, for the first time since the war, the per-
centage of 18- to 24-year-old drivers involved in acci-
dents took a downward turn. “Youthful drivers, how-
ever, are still the cause of thousands more deaths and
injuries than their numbers warrant,” the booklet de-
clares.
May, 1950
455
MELANOMATA AND NEVI
ARTHUR H. WELLS, M.D.
Duluth, Minnesota
"VyEOPLASMS of the pigment cells of man
^ have stimulated the interest and imagination
of physicians from the time of Hippocrates.
Dupuytren, Laenec, Norris, Carswell, Paget,
Virchow, Handley, Unna and Pringle are among
the early authorities. Ever increasing numbers
of these two cells. This metaplasia results in a
separation or retraction of the nucleus with a
narrow rim of protoplasm from the outer border
of cytoplasm) frequently leaving the prickles
intact. Thus single or small groups of melano-
blasts are found inside a fused ring of protoplasm
Fig. 1. (left) Melanoma. Arrows indicate prickles of ring of fused cytoplasm of epidermal cells
which have changed to melanoblasts.
Fig. 2. ( center ) Junction nevus. Clear cells in epidermis.
Fig. 3. (right) Intradermal nevus. Clusters of clear cells in the dermis.
of important contributions have appeared in the
first half of the twentieth century. Those of
Masson, Pack, Becker and Allen are particularly
outstanding. Probably no other subject in the
field of oncology has created so much mystery,
misunderstanding and difference of opinion as
that of the “black cancer.” The cloud of ignorance
about this subject is slowly being dissipated.
Histogenesis
Two theories of origin of melanomata are im-
portant. The neuralist concept of Masson21 has
been the most popular. Unna’s theory38 of
epidermogenesis is possibly the most widely
accepted by histopathologists. Repeated critical
analyses of the transitions of epidermal cells into
melanoblasts in melanomata of the skin leaves
little doubt concerning the intimate relationship
From the Department of Pathology, St. Luke’s Hospital, Duluth,
Minnesota.
with the prickles of the original epidermal cells
present (Fig. 1). Melanomata of the skin are
carcinomas in spite of their occasional sarcomatous
appearance.
Melanocytes
Junction Nevus — ? Melanoma
(in basal cell plane)
Fig. 4.' Histogenesis of melanoma.
It is now agreed by the principal authorities
that the “melanoblast,” a matured cell hereinafter
called melanocyte, is the precursor of both pig-
mented nevi and melanomata. The blastomeric
origin of this cell is the point of disagreement.
Melanocytes when stained by Bloch’s “dopa”
technique appear as dendritic cells lying among
456
Minnesota Medicine
MELANOMATA AND NEVI— WELLS
the palisaded basal cells of the epidermis.21 They
can be stimulated to increase in numbers and to
greater pigment production by ultraviolet, alpha,
roentgen and radium rays.9 They are found in
epidermis and rarely if ever in the dermis not
involving the epidermis (Fig. 4).
Classification
Allan’s histologic classification3 of nevi (Table
Fig. 5. {left) Juvenile melanoma.
Fig. 6. ( center ) Blue nevus. Trabeculi of slender black cells running parallel to epidermis are
the melanocytes.
Fig. 7. {right) Basal cell carcinoma. Columns invading the corium.
increased numbers in Addison’s disease and other
maladies. They form pigment granules and
apparently distribute these granules to the basal
and other cells.21 Melanin pigment is a polymer
of oxidized tyrosine and related chemically to
adrenalin.16 When the melanocytes are stained
with hemotoxylin and eosin, they appear as clear
cells “cellules dares” (Fig. 2). It is generally
agreed that this cell is the parent of the nevus cell
in all of its bizarre morphologic forms, including
the whorls sometimes referred to as attempted
formations of Wagner-Meissner nerve endings.
In nevus morphogenesis it is also generally
believed that the nevus cells migrate downward
“abtropfung” from the epidermis into the
dermis.3 A substantial proof of this lies in the
fact that 98 per cent of nevi in children have the
nevus cells in the epidermis, that is, junction nevi
(Fig. 2), while only from 12 to 25 per cent re-
mains as junction nevi in adults.36 In the
remainder the nevus cells are all subepidermal or
intradermal nevi (Fig. 3,). Melanomata of the
skin most often develop in junction or compound
nevi ; occasionally they appear to begin de novo
without a preceding lesion. This transition
originates in the palisading basal cell plane of the
I) is combined with a widely used clinical
classification.30 The junction nevus (lentigo
maligna) has nevus cells confined to the epidermis
TABLE I. CLASSIFICATION OF NEVI
Histologic Clinical __
1. Junction Nevus L N. Spilus-macular
2. Intradermal Nevus 2. N. Verrucosus-warty
3. Compound Nevus 3. N. Pilosus-hairy
4. Juvenile Melanoma 4. N. Papillomatous-pap.
5. Blue Nevus 5. N. Lipomatodes-fatty
6. Blue nevus
(Fig. 2). Those lesions where the nevus cells
are in the dermis alone are intradermal nevi (lTg-
3) while a mixture of the two are compound nevi.
Juvenile melanoma (Fig. 5) has the histologic
characteristics of melanomata of adults yet they
very rarely metastasize.28’ 36 The blue nevus
(Fig. 6) is probably not histogenically related to
the other pigmented nevi but are classified with
them for clinical and morphologic reasons. They
are probably neurogenic in origin and hardly ever
become malignant.23’ 39
There are, then, three distinctly different lines
of benign and malignant neoplasms primary in
the epidermis excluding its appendages (Table
II). The nonmetastasizing basal cell carcinoma
(Fig. 7) stands in sharp contrast to its sister, the
457
May, 1950
M ELANOMATA AND NEVI— WELLS
melanorha (Fig. 8), which is the most widely
metastasizing malignancy known. The epidermoid
or squamous cell carcinoma (Fig. 9) is distinctly
intermediate in its malignant traits and tends to
Fig. 8. Melanoma arising in a nevus. Note basal cell
plane involvement.
remain in lymph nodes near the primary lesion.
Related to the basal cell carcinoma is the benign
neoplasm called senile verruca or benign
epithelioma (Fig. 10). Both the common epider-
moid papilloma and the keratosis (Fig. 11) are
benign neoplasms representing the epidermoid
cells as a whole.
Etiologic Factors
The six principal etiologic factors in the
development of melanomata are: nevi, heredity,
hormones, trauma, skin color and age. At least
50 to 80 per cent of melanomata15’26’40 have been
preceded by nevi. The great bulk of nevi are
present at birth. Those appearing for the first
time in adults carry a greater significance in their
carcinogenic properties.13 Both pigmented nevi
and melanomata of the eye have been described
as having genetic factors.20’ 30 How important
heredity is in the development of either nevi or
melanomata remains for future elucidation.
The effects of hormones on the development of
melanomata is particularly apparent in the contrast
between the rare occurrence of these malignancies
in the prepubertal age group14, 36,40 and the more
frequent and extremely malignant nature of the
TABLE II. NEOPLASMS OF EPIDERMIS
Cells Benign Malignant
Basal Cell Senile Basal Cell
Verruca Carcinoma
Epidermal Cells 1. Keratosis Squamous Cell
2. Papilloma Carcinoma
Melanocytes Pigmented Nevus Melanoma
lesions developing in adolescence and in preg-
nancy.20’31 Cures are very rare in the latter two
groups.
There is almost unanimous agreement10’13’15’25
concerning the relationship between trauma and
the origin of the melanomata, yet much of the
evidence is based upon unscientific data.3,7’11 For
instance, in one group of 162 cases40 practically
one-fourth of the melanomata were considered to
have started as the result of improper medical care
of what was originally supposed to have been a
nevus. There is to my knowledge no histologic
proof that melanomata have resulted from incom-
plete removal of a nevus. The original physician’s
inadequate therapy was not properly guided by a
biopsy. However, one cannot disregard the over-
whelming numbers of authors who point out the
importance of such injuries as bruises, cuts from
shaving, scratches, picking and other traumata to
nevi and to apparently normal skin as an etiologic
factor in the development of melanomata.
Melanomata appear to be relatively more fre-
quent in blond individuals including those with
sandy complexions and in skins which are sensitive
to sunlight.28’31 The incidence of melanomata in
negroes is not more than 30 per cent of that in
the white race.12,24 A high percentage of the
melanomata in the colored race appear in pale
areas such as subunguinal and on palms, soles and
mucous membranes.
When the figures are corrected for population'
distribution, one can say that melanomata become
increasingly frequent with every year of life. The
malignancy has occurred in all ages from birth37
to advanced senility. By far the greatest number
of cases occur between the fourth and seven
decade.
Frequency
Melanomata represent from 1 to 2 per cent of
all malignancies19’ 22 and constitutes approximately
20 per cent of all primary skin cancers.30 There is
an estimated occurrence of two cases per one
hundred thousand population per year.19 There
is approximately the same incidence in the two
458
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MELANOMATA AND NEVI— WELLS
sexes.26 Pack28 has found an average of twenty
visible pigmented moles in adults and states that
every member of the white race has at least one
mole. On special request two local dermatologists8
TABLE III. ANATOMIC- DISTRIBUTION-MELANOMA
^General Location
(1,383 cases)
** Specific. Sites
(851 cases)
Head and neck
28.8%
Toe Nails
2.2%
1 runk
22.2%
Finger Nads
1.2%
3.6%
Upper Extrem.
14.0%
Vulva and Vagina
Lower Extrem.
31.4%
Oro-Nasal
2.6%
No Primary
3.9%
Rectum anus
Male genitalia
1.5%
0.4%
f Eye — Approximately
organs — Rare, if ever.
20%.
Meninges — Very rare.
Internal
1,4,7, 1 1, 14,1 5,19,40.
**28.
1 19.
diligently studied the skins of 240 men and women
in a one-day cancer detection clinic and found
three individuals completely free of visible pig-
mented or non-pigmented nevi. Thus approxi-
mately 1 per cent of the white population may be
free of nevi. This does not alter the possibility
of a melanoma developing in any individual.
The anatomic distribution of melanomata is
shown in (Table III ). There is a considerably
greater frequency of melanomata over nevi on the
genitalia, and on the feet and hands including the
nails. This is of great practical importance in
prophylaxis.
Pathology
Although the bluish and bluish black, raised,
smooth-surfaced lesions are the most common
and easily recognized, light brown, pink or
amelanotic lesions are significantly frequent and
may have their origin in nonpigmented nevi.
There is a wide variety of lesions which must be
TABLE IV. DIFFERENTIAL DIAGNOSIS-MELANOMA
Pigmented Nevi
Pyogenic Granuloma
Nonpigmented Nevi
Hemangioma
Blue Nevi
Lentigo
Seborrheic Keratosis
Adenoma Sebaceum
Papillo-epithelioma
Fibroxanthoma
Verruca Vulgaris
Basal Cell Carcinoma
Chronic Inflammation
differentiated from both the more dangerous
junction nevus and the melanoma. These include
among others the list in Table IV. In the hands
of expert dermatologists, there is an 87 per cent
accuracy in diagnosis of pigmented nevi.7 No
physician can depend entirely upon the clinical
appearance of a “mole” for the diagnosis.2’ 7,28,34
The most experienced experts require routine
microscopic study of every pigmented skin lesion
treated. Contrary to the general opinion, biopsies
probably inhibit the spread of malignant skin
lesions, because the inflammatory reaction set up
by the trauma occludes the lymphatics.7,9
Histologic grading of skin melanomata accord-
ing to the degree of embryonic shift of the
neoplastic cells is possible but not practical for
prognostic or therapeutic purposes. The very
earliest change from a junction nevus to a
melanoma may represent a difficult histologic
diagnostic problem. This is aggravated by the fact
Fig. 9. (left) Squamous cell carcinoma.
Fig. 10. (left center) Benign epithelioma made up of basal cells.
Fig. 11. (right center) Keratosis, a precancerous lesion.
Fig. 12. (right) Juvenile melanoma. Three giant cells present.
May, 1950
459
MELANOMATA AND NEVI— WELLS
TABLE V. PROPHYLAXIS-MELANOMA
I. Excise and Examine Microscopically the following “Nevi”:
1. Feet
2. Hands
3. Subungual
4. Genitals
5. Sites irritation
6. All darkly pigmented nevi of childhood
7. With alteration in size, color, elevation, ulceration, inflamma-
tion, scaling, bleeding, crusting, tenderness, itching and in-
creased vascularity.
8. All gray blue, blue black and black nevi
9. Nevi appearing — adult
II. Conservative Therapy of Nevi only with biopsy
TABLE VI. THERAPEUTIC PRI N CIPLES-MELAN OM AS
1. Wide resection.
2. Excision regional lymphnodes and dissection in continuity
where practical.
3. With node metastases:
(a) Amputate extremity and excise proximal lymphatics if dis-
section in continuity is not practical.
(b) Alternative-quarterectomy.
4. Cosmetic and functional restoration secondary to eradication.
5. Lesions for special consideration:
(a) genitals (b) midline
(c) isolated metastases (d) eye
that already metastasized lesions may appear
histologically innocuous. The great bulk of melan-
omata, however, are diagnosable at a glance be-
cause of the anaplastic changes present. The epi-
dermis is always involved if the lesion is primary
and is generally not invaded in skin metastases.
There is a possibility that rare melanomata of the
skin may exist without metastasizing for years.
Prepubertal melanomata may possibly be differ-
entiated from others by the presence of multi-
nucleated and single nucleus giant cells36 (Fig.
12).
The original extension of melanomata appears
to be predominantly by way of the lymphatics.
There is a frequent local appearance of satellite
lesions which at times demonstrate a retrograde
progression along lymphatics in the skin.30 The
recent brilliant successes with radical surgery only
emphasizes the lymphatic type of spread of these
malignancies.28 The differentiation between
chromophores or phagocytes containing melanin
pigment and true melanoblasts in a regional
lymphnode is a problem of the greatest importance
to the pathologist and surgeon, particularly in
respect to lesions on the distal parts of the
extremities. Potassium permanganate solution or
chlorine fumes are used to fade the melanin pig-
ment, thus permitting greater visibility of the
cellular structure and aiding in this critical
differentiation.
Melanomata of the eye12 and meninges22’35 have
been purposefully avoided in this article because
they are special subjects not closely related to the
skin and nevi. The rare precancerous melanosis
of the conjunctiva occurring between the ages of
forty and fifty years is probably a form of
junction nevus. It is interesting that this lesion
will clear with x-ray therapy.33 If not so treated
it generally progresses to a radioresistant, vicious
melanoma within five years.
Prophylaxis
There is an almost unanimous agreement upon
the importance of prophylactically excising and
studying microscopically pigmented and non-pig-
mented nevi involving the feet, hands, subun-
gual areas and genitals of both male and female
(Table V). These nevi are practically all of the
junction type and are very dangerous. Beyond
this, most authors stress the importance of re-
moving nevi from sites of irritation such as the
shoulders, belt, garter, brassiere, collar and
shaving areas.1 Certainly all nevi which have
alterations in size, color, elevation, ulceration,
inflammation, scaling, bleeding, crusting, tender-
ness, itching or vascularity should be removed and
studied microscopically for the presence of malig-
nancy.1’7,26,34 Some authorities feel that all darkly
pigmented nevi in childhood,29 all gray blue, blue
black and black nevi in adults and all nevi
appearing during adult life should be removed.7
One cannot afford to use conservative therapy on
nevi, that is, electric desiccation, carbon dioxide
snow, cautery, inadequate surgical excision, et
cetera, without having taken a biopsy.
Therapy
The therapeutic principles in cases of melano-
mata (Table VI) take into account the extremely
early metastasis to regional lymphnodes and skin,
the very bad prognosis and the proved curative
value of radical surgery. Only 2.5 per cent of
217 cases responded to radiation therapy.30 The
usual procedure in our experience is that the
physician has removed a dark mole and sent it in
for biopsy study. It proves malignant. Immedi-
ately a much wider excision of the original lesion
is accomplished with a resection of the regional
lymph nodes. Whether the regional lymph nodes
are palpably enlarged or not does not alter the
treatment.18’ 30 If the original lesion is on the
trunk or on a proximal part of the extremities, a
dissection in continuity including all of the skin
and lymphatics in the immediate vicinity and be-
tween the lesion and the regional lymph nodes is
resected.18,27,31’32 If the regional lymph nodes con-
460
Minnesota Medicine
MELANOMATA AND NEVJ— WELLS
tain malignant cells and the original lesion is
beyond the range of possible dissection in con-
tinuity, then the limb is amputated and proximal
lymphnodes are resected.10’11’17’28,32 The alter-
native is a quarterectomy. 11,28 Sufficient experience
with this procedure is not yet recorded for com-
parative evaluation. Both physicians and patients
are frequently blinded by the innocuous appear-
ance of small skin lesions, whereas, as a matter
of fact, they are as dangerous as an osteogenic
sarcoma.
Lesions occurring on the genitals are of the
most serious nature and require a radical vulvec-
tomy or resection of the male genitalia with com-
plete resection of skin and lymphatics to both in-
guinal areas and including lymphatics along the
iliac vessels. Midline lesions frequently extend in
two or more directions. They may require resec-
tion of both axillae or both inguinal areas. If
near the umbilicus, resection of this structure and
the round ligament is indicated. These lesions
can also spread to the axillae and inguinal areas.
Prognosis
As in the case of carcinomata of the breast the
usual five year survival ratings of patients with
melanomata are not accurate. The number of
deaths occurring during each year following the
diagnosis of melanoma in a group of sixty-seven
fatal cases is listed14 in consecutive order: 19, 15,
17, 4, 2, 3, 2, 2, 2, and 1. Thus 15 per cent of
the patients expired as a result of their malignancy
during the second 5-year period.
Prognosis according to age reveals a slight im-
provement with increasing age except for the
prepubertal group in which there are only rare
deaths.28 The puberty and pregnancy cases have
a particularly bad prognosis.
There is a relation of prognosis to anatomical
site.14’31 This is most apparent in the slower grow-
ing subinguinal melanomata.25’28 However,’ the dif-
ference in my opinion is not sufficient to alter the
principles of therapy listed above. Genital lesions
are particularly deadly.28 Very early melanomata
of the skin as evidenced histologically and the rare
“Freckle” type1 have a better prognosis. There
is no significant variation in prognosis in the dif-
ferent histologic forms of skin melanomata as
there is in melanoblastomas of the eye.12
An accurate comparative evaluation of the cure
rates resulting from various methods of surgical
therapy such as : local excision, local resection
with dissection of regional lymphnodes, dissection
in continuity, amputation, quarterectomy, et cetera,
cannot be accurately compiled from the literature.
The recent more radical surgery at the Memorial
Hospital in New York28 has increased the five-
year survival rate for melanomata by 600 per cent.
This improvement is far greater than that ex-
perienced as the result of radical surgery for al-
most any other common variety of malignancy.31
A review of 595 cases from this institution28 re-
veals a five-year survival of 18 per cent of pa-
tients who had no demonstrable regional metas-
tases and a 15 per cent survival of those with
regional metastases.
Conclusions
1. Histogenesis: Melanomata and nevi should
be classed as epidermal neoplasms.
2. Classification : Allen’s division of nevi into
junction, intradermal, compound and blue nevi is
favored.
3. Etiology : The principal etiologic factors in
melanomata are : nevi, heredity, hormones, trau-
ma, skin color and age.
4. Frequency: The frequency of nevi and mel-
anomata make these diseases every physician's
business.
5. Pathology: The crucial diagnostic tool, the
biopsy, is manditory in the care of both nevi and
melanomata.
6. Prophylaxis : The prophylactic excision of
certain pigmented and nonpigmented skin lesions
is important.
7. Therapy : Cosmetic and functional restora-
tion is secondary to immediate eradication of the
black cancer.
8. Prognosis : The prognosis has been greatly
improved by radical therapy. -
References
1. Ackerman, L. V.: Malignant melanoma of the skin. Texas
State J. Med., 45:735-744, (Nov.) 1949.
2. Adair, F. E. : Treatment of melanoma. Surg., Gynec. &
Obst., 62:406-409, (Feb. 15) 1936.
3. Allen, A. C.: A reorientation on the histogenesis and clin-
ical significance of cutaneous nevi and melanomas. Cancer,
2:28-55, (Jan.) 1949. .
4. Arnold, H. L. : Malignant melanoma of the skin. Proc. Staff
Meet. Clin. Honolulu, 14:1-4, (Jan.) 1948.
5. Austin, E. R. : Malignant melanoma of the skin. Proc. Staff
Meet. Clin. Honolulu, 14:11-13, (Mar.) 1948.
6. Bauer, J. T. : Malignant melanoma in the negro. Bull. Ayer
Clin. Lab., Pa. Hosp., 3:57-66, (May) 1934.
7. Becker, S. W. : Diagnosis and treatment of pigmented nevi.
Arch. Dermat, & Syph., 60:44-65. (July) 1949.
8. Becker, F. T., and Schmid, J. F. : Personal communication.
9. Becker, S. W. : Dermatological investigations of melanin
pigmentation. The Biology of Melanoma. Special Publica-
tions of the New York Academy of Sciences, 4:82-125, (Jan.)
1948.
10. Bickel, W. H.; Meyerding, H. W., and Broders, A. C. :
Melanoepithelioma of the extremities. Surg., Gynec. & Obst.,
76:570-576, (May) 1943.
( Continued on Page 465)
May, 1950
461
MANAGEMENT OF THE PYODERMAS
JOHN F. MADDEN, M.D.
Saint Paul, Minnesota
T)YODERMAS include all cutaneous affections
produced by staphylococci, streptococci, or
other pus producing organisms alone or in com-
bination. This group of eruptions is large and
occupies a prominent position in dermatology.
General Considerations
Pyodermas may be superficial or deep. They
may be confined to one of the appendages of the
skin or may not be associated with any particular
structure. In general, the lesions are due to super-
ficial external infection and reinfection. There-
fore all possible precautions must be taken to
eliminate reinoculation. Cleanliness is essential in
prevention and treatment. Macerating procedures
are contraindicated and irritating applications
should be avoided. Excessive dryness and exces-
sive greasiness of noninfected skin favor exten-
sion of pyoderma and must be treated. Obesity,
an excessively high carbohydrate diet and other
improper dietary habits as well as other factors
favoring pyoderma should be corrected. Many
pyodermas are secondary to other dermatoses or
other diseases ; therefore, cure or control of the
predisposing disease is part of the management of
pyoderma.
Value of Antibiotics, Chemotherapy,
and Other Treatment
Topical application is valuable in superficial
processes where effective contact between micro-
organism and remedy is at its optimum. When
inflammation is deep and direct contact between
microorganism and remedy is at a minimum, topi-
cal application is of little or no value.
Penicillin has almost entirely replaced the sul-
fonamides in the treatment of pyoderma because,
in general, it is more effective and less toxic.
Penicillin can be administered topically as a wet
pack, ointment or spray ; as an inhalent ; orally in
liquid, capsule or tablet form ; and parenterally in
several different vehicles. Although the reactions
to penicillin are relatively few and usually of a
minor nature, they may be severe and contra-
From the Department of Dermatology and Synhilology, Ancker
Hospital, Saint Paul, Dr. John F. Madden, director, and the
Division of Dermatology and Syphilology, University of Minne-
sota, Dr. H. E. Michelson, director.
indicate the further use of penicillin. Because of
this fact, penicillin probably should be reserved
for parenteral use where it may be a life-saving
medication.
The sulfonamides, largely replaced by penicillin
in treatment of pyoderma, are penicillin’s foremost
substitutes when systemic administration is indi-
cated. Both penicillin and the sulfonamides are
contraindicated as topical applications for the same
reason ; namely, a reaction from topical application
for an insignificant pyoderma may cause a reaction
which later will prevent their systemic use for a
serious disease. Desensitization to penicillin and
the sulfonamides is theoretically sound but often
has been found to be impractical. There are sev-
eral topical applications that are as effective as
penicillin or the sulfonamides, so that it seems
unnecessary -to use them in this manner.
Bacitracin, in the author’s experience, is the
most efficient topical application in the treatment
of pyoderma. The sensitizing index is also very
low. It is rare to see a reaction from bacitracin.
Until recently it was only used locally, so the
question of systemic use was not considered.
Tyrothricin has been used as a wet dressing
with indifferent results. It appeared to be a mild
medication, but equal or superior results were
obtained in similar cases with boric acid (diluted
one dram to a quart of water) or Darier’s solu-
tion (diluted one part to sixteen parts of room-
temperature water).
Streptomycin and chloromycetin may have a
place in the treatment of pyoderma, but the author
has had little or no experience with their use.
Aureomycin has been used recently with dra-
matic results in cases of sycosis vulgaris which
had resisted the usual forms of treatment. The
drug was given orallv, 250 milligrams four times
a day, and used as an ointment topically. The
cost of aureomycin has been so prohibitive that
one hesitated to use it in superficial infections, but
it may well find a major place in treatment of
pyogenic infections of the skin.
Furacin has been used as a topical application
and has been found to have a very high sensitiza-
tion index. The author has seen more contact
462
Minnesota Medicine
MANAGEMENT OF THE PYODERMAS— MADDEN
dermatitis from furacin than any other topical
application used in the treatment of pyoderma and
has discontinued its use entirely.
Wet packs are probably one of the oldest agents
used in the treatment of skin infections. They
are of value in treatment of both superficial and
deep pyoderma. The packs must be both thick
and allow evaporation. A porous material such as
washed surgical gauze makes an ideal pack. Packs
should never be covered with oiled silk, rubber,
or other impermeable substances because this pre-
vents evaporation and promotes maceration. It is
important that the pack be kept wet, but the degree
of heat is unimportant ; the temperature of the
pack should be regulated to give the patient maxi-
mum comfort. The fluid used to make the pack
should not irritate the eruption or surrounding
skin.
The old topical applications such as cinnabar
(red mercuric sulphide) in a shake lotion, am-
moniated mercury ointment, quinolor compound
ointment alone or with boric acid ointment, equal
parts of diachylon ointment and boric acid oint-
ment, and sulfur or vioform in lotions or oint-
ments still have a prominent place in the treatment
of superficial pyoderma. They should be thought
of and brought to use when the newer remedies
fail.
Autogenous and stock vaccines and staphylococ-
cus toxoid have been very disappointing in this
author’s hands. Alterative procedures such as in-
jections of sterile milk, autohemotherapy, et cetera,
also have been of doubtful value.
Superficial roentgen ray therapy has been of
considerable aid in the treatment of certain pyo-
dermas in the past. Whether the antibiotics and
new drugs will eliminate the use of roentgen rays
remains to be seen. Certainly the newer drugs and
antibiotics should eliminate the mutilating surgi-
cal procedures previously used in the treatment of
furuncles and carbuncles.
Specific Pyodermas
Impetigo contagiosa is the most common of the
superficial pyodermas and usually responds to
topical applications. Bacitracin ointment is the
remedy of choice. If the eruption does not show
evidence of healing after twenty-four hours, one
of the other remedies previously discussed should
be employed. The patients are instructed to use
their own towels, linen, et cetera, and to boil after
use. It is advisable for the patient to sleep alone.
May, 1950
Adhesive tape should not be used to hold bandages
on the skin. This often causes maceration and
spread of the eruption. The involved and sur-
rounding pai'ts are washed twice daily with soap
and water with the hands or a soft cloth. The
ointment is applied .often enough to keep the
lesions covered. Crusts and ointment are removed'
twice daily with cotton or a soft cloth. The hair
is washed every other day if the eruption is on
the head or neck. Cosmetics such as cream, rouge,
powder, or hair oil are prohibited if the head or
neck are involved. Lipstick may be used. The
patients are asked to refrain from physical exer-
cise which causes excessive perspiration. Male
patients are asked not to shave when the beard
is involved. Wet boric acid packs (diluted one
dram of boric acid to a quart of warm or cool
water) are applied to the affected parts fifteen
minutes twice daily.
Impetigo of the newborn is apt to become epi-
demic in nurseries. Strict isolation must be
observed, but even then the nursery may have
to be closed and thoroughly cleansed and painted
before it can be used. Sometimes epidemics are
due to carriers, and it may be necessary to change
nursing personnel and methods. The lesions are
more often bullous and occur in moist flexures.
Oil baths must be stopped and daily baths of
soap and water used. A shake lotion containing
cinnabar or vioform and systemic administration
of penicillin is the treatment of choice. Strict
cleanliness is of the greatest importance.
Furfuraceous impetigo appears as scaly, super-
ficial patches on the face, generally seen in chil-
dren in the winter months. Bacitracin or am-
moniated mercury ointment usually heals the
eruption, but recurrences are common until warm
spring days appear.
Impetigo of Bockhart is follicular impetigo and
closely related to folliculitis, sycosis vulgaris, and
acne necrotica. Remedies mentioned above com-
bined with frequent washing of the scalp often are
sufficient to cure. When accompanied by pedic-
ulosis capitis and large, suppurating cervical
lymph nodes, each component may have to be
treated separately.
Folliculitis must be separated from similar erup-
tions on the scalp where it is called impetigo of
Bockhart or acne necrotica and similar pyodermas
of the beard called sycosis vulgaris. When the
463
MANAGEMENT OF THE PYODERMAS— MADDEN
above are eliminated, folliculitis occurs as an occu-
pational dermatitis with secondary pyoderma in
“wet workers” (dish washers, bartenders, soda
clerks, et cetera), tar, grease, oil, and certain
chemical workers as well as secondary to vitamin
A deficiency. If the causative factor is removed
or treated, the folliculitis will disappear following
the use of the usual local applications.
Sycosis vulgaris is a chronic inflammatory dis-
order involving the hair follicles of the bearded
region. Aureomycin used as an ointment for
topical application and 250 milligrams given orally
four times a day produced miraculous results in
several cases in recent weeks. The cases are too
few to draw any conclusions regarding the effect
of aureomycin on sycosis vulgaris in general.
Furuncles generally result from external infec-
tion and reinfection. They are often secondary to
other cutaneous diseases such as scabies, pedic-
ulosis, eczema and less often to systemic diseases
including diabetes, malnutrition, anemias, et cetera.
The individual lesion and the skin as a whole
must be treated. The skin must be properly
cleansed, lubricated, and all known means used to
prevent spread. The individual furuncle is immo-
bolized, wet packs applied, antibiotics given sys-
temically, the yellow top gently removed with a
scalpel when the lesion fluctuates, and antibiotic
ointment applied to the surrounding normal skin
as long as drainage persists. Adhesive tape should
be religiously avoided. Furuncles of the upper
lip, because of venous drainage into the cerebral
vessels, and carbuncles constitute a much more
serious problem. Here added emphasis must be
placed on all points mentioned above, especially
larger doses and often multiple types of systemic
medication, as well as increased attention to gen-
eral nutrition, care and nursing.
Hydradenitis suppurativa is essentially a sup-
purative inflammation involving the sweat appara-
tus. The eruption is most common in the axillae
and less frequent around the genitalia, perineum
and gluteal cleft. The eruption often does not
respond to any treatment except surgical excision
of the entire involved area. Roentgen rays, sys-
temic antibiotics, and sulfonamides have been
used with indifferent results. This is one of the
deep pyodermas so topical applications are of
little or no value.
Ecthyma is a crusted, ulcerated deeper pyo-
derma which usually follows insect bites, injury,
or scratching. The lesions are usually on the
extremities of children. Ecthyma often responds
to cleanliness and bacitracin ointment, but sys-
temic antibiotics are occasionally necessary.
Vegetating pyoderma can be likened to ecthyma
which produces a warty, elevated, exudating,
crusted lesion rather than an ulcer. These lesions
appear at the same sites as ecthyma for the same
reason and may respond to the same treatment.
The involution is often hastened by roentgen ray
therapy.
Erysipelas responds dramatically to systemic
antibiotics (parenteral penicillin) or the sulfona-
mides as compared to the older treatment of vac-
cine, wet packs, et cetera. Recurrent attacks
generally respond to one of the above drugs.
Gangrenous ulcerating pyoderma usually accom-
panies chronic ulcerative colitis, but has been
known to follow or occur during typhoid fever,
malaria, pneumonia and other diseases. Red. in-
flammatory nodules of various sizes appear, fluc-
tuate, slough, ulcerate, and spread peripherally or
heal with scar formation. The lesions appear in
crops with each exacerbation of the systemic dis-
ease. Treatment is supportive and unsatisfactory.
Pyogenic paronychia and py onychia are very
rare in the author’s experience. Most lesions
thought to be pyogenic prove to be mondial infec-
tions and do not respond favorably to treatment.
A simple pyogenic infection about the nail or
nails should and generally does respond favorably
to local antibiotics and drainage if the pre-existing
cause can be removed. This includes proper pro-
tection in the form of cotton-lined rubber gloves,
hand lotions, elimination of harsh cleansers for
patients who do wet work, such as housewives,
bartenders, soda clerks, meat cutters, et cetera.
Granuloma pyogenicum usually is a solitary,
dark red lesion which appears at the site of injury
and bleeds easily when injured. Treatment is to
excise a portion or the entire lesion for micro-
scopic examination and cauterize the remainder
or base with actual cautery.
Multiple abscesses of infants are comparatively
rare and occur in poorly nourished infants in
unhygienic surroundings. Lowered cutaneous re-
sistance exists and the abscesses may be started
by infection of the sweat glands or rubbing the
skin against dirty linen, et cetera. The abscesses
may be few or many and appear on all parts of
464
Minnesota Medicine
MANAGEMENT OF THE PYODERMAS— MADDEN
the skin surface. Treatment is directed toward
improving nutrition, systemic antibiotics, and
strict cleanliness.
Pyodermas secondary to other diseases such as
diabetes, scabies, chronic dermatitis, fistula or
sinus drainage, discharging ears, sepsis and
pyemia, and acne vulgaris must be treated by
whatever means necessary, with the realization
that the pyoderma will not heal until the primary
disease has been controlled or cured.
Dermatitis exfoliativa neonatorum (Ritter’s dis-
ease) is thought to be a generalized exfoliating
pyoderma in infants which involutes sponta-
neously within a month in about 50 per cent of
cases while the other 50 per cent die. Attempts
have been made to differentiate Ritter’s from
Leiner’s disease. Leiner thought that the diseases
were similar, but stated that Leiner’s disease is
more chronic and associated with seborrheic
eczema of the scalp. The treatment has been sup-
portive and unsuccessful in half the cases-.
Eczematoid pyoderma is the eczematoid process
or contact dermatitis generally due to local treat-
ment superimposed upon pyoderma. Here the
eczematoid process must be treated with soothing,
wet applications before attacking the pyoderma.
Chancriform pyoderma is a solitary lesion re-
sembling a chancre accompanied by lymphadenitis
of the lymph nodes draining the area. It must
be differentiated from a syphilitic chancre and
the primary cutaneous complex of tuberculosis.
The treatment of choice is antibiotics locally and
systematically. If the response is slow, superficial
roentgen ray therapy may be of value.
Summary
The pyodermas and their treatments were dis-
cussed. In my experience Bacitracin ointment is
the topical application and penicillin is the par-
enteral medication of choice in the treatment of
pyodermas.
MELANOMATA AND NEVI
(Continued from Page 461)
11. Bowers, R. F. : Quarterectomy — its application in malignant
melanoma. Surgery, 26:523-548, (Sept.) 1949.
12. Callender, G. R.; Wilder, H. C., and Ash, J. E. : Five
hundred melanomas of the choroid and ciliary body followed
five years or longer. Am. J. Ophth., 25:962-967, (Aug.) 1942.
13. Delario, A. J.: The common non-vascular nevi and their
treatment. Am. J. Surg., 78:53-62, (Jan.) 1949.
14. DeWeese, M. S. : Extraocular malignant melanoblastoma.
J.A.M.A., 138:1026-1029. (Dec.) 1948.
15. Driver, J. R., and MacVicar, D. N. : Cutaneous melanomas.
J.A.M.A., 121:413, (Feb.) 1943.
16. Figge, F. H. : Factors regulating the formation and the phys-
ical and chemical properties of melanin. The Biology of
Melanoma. Special Publications of the New York Academy
of Sciences, 4:405-420, (Jan.) 1948.
17. Handley, W. S.: The pathology of melanotic growths in
relation to their operative treatment. Lancet, 1:927-996, 1907.
18. McCune, W. S. : Malignant melanoma. Ann. Surg., 130:
318-332, (Sept.) 1949.
19. MacDonald, E. J. : Malignant melanoma in Connecticut. The
Biology of Melanoma. Special Publications of the New
York Academy of Sciences, 4:71-82, (Jan,) 1948.
20. Macklin, M. T. : Genetic aspects of pigment cell growth in
man. The Biology of Melanoma. Special Publication of the
New York Academy of Sciences, 4:144-158, (Jan.) 1948.
21. Masson, P. : Pigment cells in man. The Biology of Mela-
noma. Special Publication of the New York Academy of
Sciences, 4:15, (Jan.) 1948.
22. Moersch, F. P. ; Love, J. G., and Kernohan, J. W. : Mela-
noma of the central nervous system. J.A.M.A., 115:2148,
(Dec.) 1940.
23. Montgomery, H., and Kahler, J. E. : Blue nevus; its dis-
tinction from ordinary moles and malignant melanomas.
Am. J. Cancer, 36:521, (Aug.) 1939.
24. Muelling, R. J.: Malignant melanoma. Mil. Surgeon, 103:
359-364, (Nov.) 1948.
25. Newell, C. E. : Malignant melanoma. South. M. J., 31:541-
547, (May) 1938.
26. Pack, G. T. ; Perzik, S. L., and Scharnagel, I. M.: Treat-
ment of malignant melanoma. Calif. Med., 66:2-15, (May)
1947.
27. Pack, G. T. ; Scharnagel, I., and Morfit, M. : Principles of
excision and dissection in continuity for primary and meta-
static melanoma of the skin. Surg., 17:849-866, (June) 1945.
28. Pack, G. T.: Management of pigmented nevi and malignant
melanomas. South. M. J., 40:832-838, (Oct.) 1947.
29. Pack, G. T.: Prepubertal melanoma of the skin. Surg.,
Gynec. & Obst, 86:372-375, (Mar.) 1948.
30. Pack, G. T., and Livingston, E. M.: Treatment of pigmented
nevi and melanoma in the treatment of cancer and allied dis-
eases. Vol. 7, p. 122. N. Y. : Paul B. Hoeber, Inc., 1940.
31. Pack, G. T. : A clinical study of pigmented nevi and mela-
nomas. The Biology of Melajioma. Special Publication of the
New York Academy of Sciences, 4:52-70, (Jan.) 1948.
32. Pringle, J. H. : A method of operation in cases of melanotic
tumors of the skin. Edinburgh M. J., 23:496-499, 1908.
33. Reese, A. B.: Precancerous melanosis and the resulting
malignant melanoma (cancerous melanosis) of conjunctiva and
skin of lids. Arch. Ophth., 29:737-746, (May) 1943.
34. Sach, W. ; MacKee, G. M. ; Schwartz, O. D., and Pierson, H.
S.: Junction nevus-nevocarcinoma. J.A.M.A., 135:216-218,
(Sept.) 1947.
35. Schnitker, M. T., and Ayer, D.: Primary melanomas of the
leptomeninges. J. Nerv. & Ment. Dis., 87:45, (Jan.) 1938.
36. Spitz, Sophie: Melanomas of childhood. Am. J. Path., 24:
591-610, (May) 1948.
37. Traub, E. F. : The pigmented, hairy and warty nevi and
their relationship to malignancy. South. M. J., 40:1000-1005,
(Dec.) 1947.
38. Unna, P. G.: The Histopathology of the Disease of the
Skin. P. 745. New York: Macmillan Co., 1896.
39. Upshaw, B. Y. ; Ghormley, R. K., and Montgomery, H.: Ex-
tensive blue nevus of Jadassohn-Tieche. Surgery, 22:761-765,
(Nov.) 1947.
40. Webster, J. P. ; Stevenson, J. W., and Stout, A. P. : Sur-
gical treatment of malignant melanomas of the skin. S. Clin.
North America, 24:319, (Apr.) 1944.
May, 1950
465
History of Medicine In Minnesota
MEDICINE AND ITS PRACTITIONERS IN OLMSTED COUNTY PRIOR TO 1900
NORA H. GUTHREY
Rochester, Minnesota
(Continued from April issue)
Mrs. J. Brorby settled in Rochester, Minnesota, in the early summer of
18/6. 1 he chief knowledge gleaned about this practitioner is contained in
the following statement by the Reverend Gerk Gjertsen, Pastor of the Scandi-
navian Lutheran Church, in the Rochester Record and Union of July 7, 1876:
Read this: Mrs. J. Brorby, midwife and physician, formerly of Madison, Wisconsin, has
now located at Rochester and can be consulted in her office at her residence on Prospect
Street, one door north of Dr. Galloway. Mrs. Brorby has had fifteen years of experience
at one of the large hospitals of Europe and since her arrival in this country her practice has
been a career of continuous success. Her charges are low. The poor are treated fair ;
the English, German and Norwegian languages are spoken. It has been proved that ailments
of many years standing, given up as hopeless by other physicians, have been cured by her.
I can cordially recommend her to everybody as a conscientious and skillful physician.
By December, 1876, Mrs. Brorby had her office over the Union Drug Store.
In that month appeared a note that Mrs. Brorby, seized with a chill while
preparing for church, had mistakenly poured and drunk a glass of aqua am-
monia, thinking it was wine ; it was stated that she took a large amount
of cod-liver oil to counteract the ammonia, and that she had a narrow escape.
After March 27, 1877, her card did not appear in Rochester newspapers.
Francis Walter Burns 11870-1936), a native of Carrollville, Pligh Forest
lownship, Olmsted County, was born on September 13, 1870, a son of John
Burns and Ellen Buckley Burns, respected citizens of the county. There were
four other children: \\ illiam, Ella (Mrs. John Lawler), Annette (Mrs. A. O.
dew) and Minnie. John Burns’ parents came to the county in 1855; one of
his brothers, Peter Burns, a substantial member of the district, in 1879 was
sent as representative to the state legislature.
Frank’ W. Burns received his preliminary education in the local district
schools and in the schools of Rochester. After finishing business training
and working for a time as a clerk with the Winona and Southwestern Rail-
road at Winona, he entered the medical department of the University of
Minnesota in October, 1892. Later he transferred to the College of Physicians
and Surgeons, in Chicago, from which he was graduated with honor on April
24, 1896; on June 24 he was licensed by examination to practice in the state.
In vacations during his final years at medical school and again before enter-
ing practice he served as an intern at St. Mary’s Hospital, Rochester.
When Dr. Horace H. Witherstine, of Rochester, went to Atlanta in May,
1896, for the meeting of the American Medical Association and»to be away
466
Minnesota Medicine
HISTORY OF MEDICINE IN MINNESOTA
several weeks, he invited Dr. Burns to occupy his office and look after his
patients, excellent experience for the new physician, who already possessed
the good will of the community. Later Dr. Burns had his office over Harges-
heimer’s Drugstore on Broadway; well occupied in practice, it has been noted
that when the autumn elections approached and he was offered the Demo-
cratic nomination for county coroner, he refused it. In March, 1897, he
moved to Stewartville to enter partnership with Dr. Edwin D. Stoddard,
in practice and in the drugstore of Stoddard and Wood. Dr. Stoddard
(1850-1937) was in High' Forest from 1874 to 1890, in Stewartville from
late 1890 into 1903. When Dr. Stoddard retired from practice and removed
to California, Dr. Burns continued alone. His fellow physicians in Stewart-
ville were Dr. Charles E. Fawcett, a graduate of 1893, and Dr. Herman R.
Russell, a graduate of 1899.
On fune 27, 1901, Francis W. Burns was married at Rochester to Mabel
Opal, only daughter of Mr. and Mrs. A. K. Knapp, constructive pioneer set-
tlers of High Forest Township, who later lived in Rochester. In December,
1901, Dr. and Mrs. Burns moved into the beautiful new home, “Red Gables,”
in Stewartville, which for eleven years was their residence and the scene of
thir gracious hospitality.
Esteemed for his personal traits, which included an inimitable sense of
humor, and respected and valued for his ability as a physician and surgeon,
Dr. Burns had a heavy and successful practice. When he was removing
with his familv to California, in the autumn of 1912, the citizens of Stewart-
ville “tendered him a banquet to express their appreciation for his work in
their midst” (Journal- Lancet, November, 1912).
Abreast of his profession from the beginning of his career, Dr. Burns made
numerous trips for postgraduate study at clinics, hospitals and medical
schools, and in California as in Minnesota he was an active member of
county, district, state and national medical associations. In California for
nearly twenty-four years, first in Los Angeles and afterward in Pomona, he
practiced medicine, paying special attention to dermatology. He died on
August 28, 1936, survived by his wife and by three daughters. In 1946 Mrs.
Burns was living in West Los Angeles; Janet Burns (Mrs. Edmund P.)
Stone, in Pomona; Elinor Burns (Mrs. Charles) Gabriel and Jean Burns
(Mrs. Stanley) Reel were in Los Angeles.
Arthur Jay Button, born in 1869, was graduated in medicine from the
University of Minnesota on June 10, 1897, and on the same 'day received
license No. 779 (R) to practice medicine in the state. He was then a resident
of Minneapolis. In the following November he came to Olmsted County
looking for a location, which he found in the hamlets of Genoa, New Haven
Township, and nearby Douglas, in New Haven and Kalmar Townships. A
few months later he removed to Hammond, Wabasha County, but maintained
his professional and friendly relations in the community of his first choice
and elsewhere in Olmsted County. On May 6, 1898, at a meeting of the
Olmsted County Medical Society, in Rochester, Dr. Button was one of five
local physicians, three in counties other than Olmsted, elected to membership.
He became a member of the state medical society and of the American
Medical Association.
Licensed in South Dakota in 1907, Dr. Button practiced medicine in Mo-
bridge until about 1918. When he returned to Minnesota, he practiced (the
following dates are approximate) in Hackensack from 1921 to 1925; in
May, 19S0
467
HISTORY OF MEDICINE IN MINNESOTA
Greenbush from 1927 to 1931; in Pine River between 1934 and 1938; and
was in Walker as late as 1942, according to the directory of the American
Medical Association.
Harry Paul Chambers (1867-1915), a native of Elm Grove, West Virginia,
and a graduate of the University of Virginia and of the Baltimore College
°f ^ hysicians (1891), has erroneously been considered a physician of Roches-
ter, Minnesota, in the late nineties. Although he likely was in Rochester at
some time, he never practiced there, but settled in Florence, Wisconsin, about
1900, where in excellent professional standing he practiced medicine and sur-
gery until his death.
James (sometimes seen “John”) H. Chapman, millwright, farmer and phy-
sician (herb doctor), came to southern Minnesota, in the neighborhood of
I lain\iew, V abasha County, in 1856, and ten years later to section 22 New
Haven Township, Olmsted County. In 1871 he settled with his family in
Rochester.
Born early m 1820 at Ontario, New York, James H. Chapman was the son
°f ^u^us and Harriet Chapman, both of whom were natives of Ohio. First
married m the East, he lived in or near Meadville, Pennsylvania, where a son,
James PI. Chapman, Jr., was born in 1854; two years later Mrs. Chapman
died, in Wabasha County, Minnesota, leaving two children. The following
year Dr. Chapman was married to Sarah E. McCullum, native of McHenry,
Illinois, and daughter of Mr. and Mrs. John McCullum, who had come to
Wabasha County in 1855. Of this marriage there were eight children. Sarah
McCullum Chapman died in Rochester from “gastric” fever on Auerust 26
1889.
Herbalist though he was, without pretension to standing in the regular
medical profession, Dr. Chapman had a considerable following which preferred his
ministrations to those of his professional superiors. His great reliance, it is
recalled by many senior residents of Rochester, was on lobelia, which earned for
him the unlovely sobriquet of the puke doctor.” There were few of the older
physicians of the town who did not have recollections of cases, in all of which
lobelia figured, on which they had been called : sometimes when the herb doctor
had failed to obtain results, and sometimes only to be dismissed in Dr. Chapman’s
favor. There never was question, however, of Dr. Chapman’s sincerity nor of his
position as a reputable member of the community.
During his years in Rochester this practitioner commonly treated patients at
his home, which after 1880 was on Broadway below Elm Street, and he oc-
casionally took a patient into the home as a lodger while treatment was being
carried out. In November, 1888, the Record and Union stated that a blind man
who had lost his sight from smallpox when he was a small child, was so improving
under Dr. Chapman’s care that he could distinguish light from dark, and that
in grateful appreciation of Dr. Chapman s services he voluntarily tendered him
$50.”
Depressed and in poor health after his wife s death, Dr. Chapman died at his
home from a cardiac seizure four months later, on December 11, 1889, when he
was attending a patient in the house. He was nearly seventy years of age. Of
the several surviving children, record has been obtained of one: James H.
Chapman, who did outstanding work in Olmsted County and the state as teacher
in the public schools, county superintendent, advocate of free text books and
originator of summer training schools for teachers. In 1893 he removed from
468
Minnesota Medicine
HISTORY OF MEDICINE IN MINNESOTA
Minnesota to California; after the death of his half-brother, William H. Chapman,
in Rochester in 1899, none of the family was in Olmsted County.
Charles L. Chappie (1869-1927), twenty-sixth appointee, as third assistant
physician, on the staff of the Rochester State Hospital, was born in Beldenville,
Wisconsin, in 1869. He received his early education at Prescott, Wisconsin, and
from the University of Minnesota the degree of bachelor of arts, in 1892, and
the degree of doctor of medicine in 1898; in 1898 he was licensed by examination
to practice in Minnesota. After serving a year’s internship at St. Barnabas Hos-
pital, Minneapolis, and practicing medicine a few months at St. Cloud, Stearns
County, it is believed, he began his work in Rochester on August 31, 1899.
On October 8, 1903, Charles L. Chappie was married at Clintonville, Wis-
consin, to Grace L. Guernsey, daughter of Mr. and Mrs. George Guernsey of
that place. Dr. Chappie had won an enviable place in the esteem of Rochester
citizens, medical profession and laity. Mrs. Chappie, an accomplished musician,
contributed much to the success of the Euterpean Society, a social group organized
for the enjoyment of music, art and literature. Dr. Chappie was a Mason, his
wife a Daughter of the American Revolution.
Dr. Chappie has been described by professional associates as a slight, dark-
complexioned man, keen, quiet, steady and temperate, of excellent abilities and a
high sense of social and moral obligation. He was an active member of ihe
Olmsted Medical Society, its first vice president in 1903. After more than eleven
years of service at the state hospital he resigned his position on April 1, 1911,
and with his wife and a son Guernsey Phillips Chappie, removed to Tieton,
near Yakima, Washington, with the view of becoming fruit rancher as well as
physician in that newly irrigated region where there had begun an ah lost
spectacular growth of orchards on the rich sagebrush land. At Tieton, in 1 H2,
a second child, Helen Chappie, was born.
Licensed in Washington in 1912, Dr. Chappie at Tieton carried on the typical
role of frontier physician, was member of the local school board and civic officer,
and an outstanding worker for horticultural organization. For his orchards that
he planted near Tieton he took first honors among some 400 members of the
Yakima County Horticultural Union ; and in 1919 he took second place for his
orchards just west of Yakima. Subsequently he practiced medicine at Yakima,
Quinault, and Pacific Beach. He was a member of county and state medical
societies and of the American medical Association.
In 1942, some years retired from medical practice, he went to Lacey, near
Olympia, to make his home with his son. He died in Lacey in August, 1942, and
was buried in Takoma Cemetery, Yakima, beside his wife, whose death had oc-
curred in 1927. In 1945 he was survived by his son, G. Phillips Chappie, of
Olympia, instructor in machine shop, automobile and radio at the Olympia High
School, and by his daughter, Helen (Mrs. B. W.) Linze, an accomplished pianist,
of San Bruno, California; and by five grandchildren, Loren, Celia Ann and
Ronald Chappie and Bernard and Mary Linze.
O. Chase, according' to Mitchell’s History of the County of Olmsted, of 1866,
was in that year one of the two physicians (the second, Alexander Grant) in the
village of High Forest, High Forest Township. Other mention of this practi-
tioner has not been discovered.
Stillman Chase, respected “doctor,” presumably a physician, fifty-four
years and three months old, died in Pleasant Grove on September 4, 1860, of
May. 1950
469
HISTORY OF MEDICINE IN MINNESOTA
congestion of the lungs, after an illness of eight days. From Little Valley,
New York, he had been in Pleasant Grove about a year. Funeral services
were conducted at the Baptist Church.
Dr. Cheever in the summer of 1896 was constructing on the grounds of the
Rochester State Hospital “a very commodious and ornamental bird cage in
which all the birds of the hospital will be kept during the summer months,”
and he was contemplating the erection of a new band stand also on the
grounds. Neither records nor memories have given a clue to the status of
Dr. Cheever.
John Seymour Clark, member of the regular profession, late of New York,
came to Rochester, Minnesota, as physician, surgeon and druggist in Septem-
ber, 1881. He had purchased the stock of drugs and medicines of Pierce
Brothers and had store and office in the new building owned by Dr. Edwin
C. Cross on Broadway. It seems probable that Dr. Clark was more druggist
than practitioner. Evidence has not appeared that he was in Rochester after
1889.
Ida Clarke, born in Ohio in 1853, received the degree of doctor of medicine
from the Woman’s Medical College of Pennsylvania, in Philadelphia, in 1878.
After three years of medical practice she came to Rochester, Minnesota, from
Lisbon, Ohio, in September, 1881, to enter partnership with Dr. Mary Jackson
Whitney, who had been in Rochester since January, 1880. The two physicians
specialized in obstetrics and the diseases of women and children. After Dr.
Whitney removed to Minneapolis early in 1882, Dr. Clarke practiced alone as
physician and surgeon. From time to time she changed office location on
Broadway, finally moving into especially equipped rooms over Damon’s
jewelry store.
In Rochester newspapers between 1881 and 1889 Dr. Clarke often was
mentioned : when she had performed surgical operations, assisted by a local
physician, or when she had acted as assistant, usually to Drs. W. W. Mayo
and W. J. Mayo in performing ovariotomy or in carrying out other pro-
cedure ; on one occasion she and Dr. F. L. Beecher, a dentist, helped the
senior Dr. Mayo in an operation on the left upper jaw of a child at Potsdam.
Dr. Clarke possessed the esteem and confidence of profession and laity
alike, and made many personal friends among the conservative residents of
Rochester. After she had returned to her old home in Youngstown, Ohio, in
May, 1889, to make her home with her widowed mother, she often returned
on visits to Rochester and Minneapolis.
In Youngstown Dr. Clarke practiced medicine for thirty-two years. She
was a member of representative medical societies, county and state, and of
the American Medical Association. Her name appeared in the official medical
directory of the Association for the last time in 1921.
Edward M. Clay (1866-1929), a native of Oronoco, Olmsted County, was
born on March 2, 1866, a son of Mark W. Clay and Joanna Stoddard Clay.
Mark W. Clay, pioneer settler in Oronoco Township, was born at Hooksett,
New Hampshire, on March 31, 1835, one of the twelve children of Walter Clay
and Elizabeth Sanborn Clay, both of whom were natives of the state. In 1855
Mark Clay, in search of health, came to Winona, Minnesota, and after a few
weeks to Oronoco, where for the ensuing twenty-nine years he was a leading
citizen: merchant (for a time in partnership with his brother Thomas) ; sometime
470
Minnesota Medicine
HISTORY OF MEDICINE IN MINNESOTA
publisher of the Oronoco Journal, an advertising enterprise ; postmaster, town
officer, and representative member of the Independent Order of Odd Fellows. At
the beginning of the Civil War he organized a company of soldiers, of which he
was chosen captain, which served as Company K, Third Regiment of Minnesota
Volunteer Infantry. He was married on March 1, 1857, to Joanna P. Stoddard,
bQrn in 1832, daughter of Thomas and Clara Stoddard of Scituate, Massachusetts;
at the time of her marriage Joanna Stoddard was living at the home of her
stepfather, Lewis Wilson of Oronoco Township. Mrs. Clay died at Oronoco in
March, 1884, leaving seven children: Ida Augusta, Maggie W., Edward M.,
Harvey I., Wellington S., Zelda May and Charles F. In that year Captain Clay
with the children removed to Hutchinson, McLeod County, Minnesota, where he
died in 1901.
Edward M. Clay obtained his early education in the schools of Oronoco, and
in the eighties engaged in various pursuits, chief of which was the editing of the
Renville Weekly for C. M. Laramie, editor of the Bird Island Union. In 1889 he
entered the Minneapolis College of Physicians and Surgeons, from which, presi-
dent of the senior class, he was graduated in April, 1893. Renville, in Renville
County, was the scene of his first medical practice. He was married in 1893 to
Belle C. Benson of that place.
Although in 1895 Dr. Clay considered returning to Olmsted County, it was
not until late in 1898 that he left Renville for Oronoco, where he practiced
successfully and was active in professional affairs for nearly three years. Early
in this period he became a member of the Olmsted County Medical Society, the
Southern Minnesota Medical Association, the Minnesota State Medical Society
and the American Medical Association.
In June, 1901, Dr. Clay returned to Renville, where he remained twenty-four
years. During his long residence in that city, dating from 1893, as noted, he was
a member of commercial clubs, alderman for several terms, a member of the local
board of health, county coroner for twelve years, and surgeon for the Chicago,
Milwaukee and St. Paul Railroad for twenty years. He was a charter member of
the Camp Release Medical Association. Dr. Clay was a Republican and a mem-
ber of fraternal organizations, among them the Masonic Lodge, Independent
Order of Odd Fellows, Ancient Order of United Workmen, and Modern Wood-
men of America. His recreations were hunting and fishing.
Early in 1925 Dr. Edward M. Clay removed from Renville to Hutchinson,
where for two years he continued his civic and professional work. He died sud-
denly on November 4, 1927, when en route to Maynard to attend. the funeral of
Dr. Reuben Zimback; as Dr. Clay was leaving the train at Olivia to join Dr.
G. H. Mesker for the remainder of the trip, he fell dead. The cause of death was
believed to be cardiac disease, brought on by overwork a few weeks earlier during
an epidemic of influenza. Dr. Clay was survived by his wife, a daughter, Florence,
two brothers, Harvey I. Clay and Wellington S. Clay, both of Hutchinson, and one
sister, Zelda M. Clay Chase, of Saratoga, California. Belle Benson Clay died in
May, 1942, and was buried beside her husband at Hutchinson. In 1945 Florence
Clay (Mrs. John) Davey, a registered nurse, was living in Toledo, Ohio.
Dr. Clay has been described by one who knew him well as a tall, powerfully
built man, outspoken, honorable, loyal, generous to the poor, an uncompromising
enemy to sham and deceit. His patients trusted him. He was an old time doctor of
insight and sympathy, well grounded in fundamentals of human nature. “He did
more to cure the ordinary run of human ailments than he could have done had he
possessed merely technical training.’’
(To be continued in the June issue )
May, 1950
471
A CORDIAL INVITATION
Soon the ninety-seventh annual convention of the Minnesota State Medical
Association will be in session. Will you be there?
If you won’t, here’s what you’ll be missing: scientific sessions on heart surgery,
joint diseases, intravenous treatment, urinary tract infections — all presented by
outstanding physicians in these fields ; lectures on “The Diet and Cardiovascular
Disease,” “The Roentgen Diagnosis of Silicosis,” “The Common Hemorrhagic
Diseases of Childhood,” “Dystocia,” and “Psychosomatic Medicine” ; round table
discussions on a wide range of subjects, carefully selected by the Committee on
Scientific Assembly.
This year, an entire day is being devoted to the consideration of atomic energy
and its effects, both beneficial and destructive. In the morning, there will be
discussions of the medical applications of radioactive isotopes and, in the afternoon,
the public will be invited to hear about atomic energy in war and peace, with
experts speaking on the physics of atomic energy, civilian defense, and medical
aspects of atomic explosion.
If you aren’t there, you’ll miss the special meeting of your group — specialty,
fraternal or social. For, as always, there will be: Sectional programs presented
by the Minnesota Chapter of the American College of Chest Physicians, the
American College of Allergists, the Minnesota Academy of Ophthalmology and
Otolaryngology and the Twin City Orthopedic Association ; as well as a full
program of luncheons and dinners arranged by the American Medical Women’s
Association, the Minnesota Society of Clinical Pathologists, the Minneapolis
General Hospital Surgical Residents Society, the Minnesota Medical Foundation
and Minnesota Medical Alumni, Nu Sigma Nu Alumni Association, the Minnesota
Radiological Society, the Minnesota Chapter of the American Academy of General
Practice, the Medical Veterans Society of Minnesota, the Northwestern Pediatric
Society and former St. Mary’s interns.
You’ll miss also the annual banquet and open house, with special entertainment
arranged by the St. Louis County Medical Society’s Committee on Local
Arrangements.
Sunday, you’ll miss the golf tournament and the trap-shooting contest, with
its three events. And every day of the convention there will be lake fishing
expeditions.
Think over these opportunities for gaining scientific information, meeting with
your colleagues, joining in the social and sports events and viewing the splendid
scientific and commercial exhibits. Remember, the physicians of St. Louis County
have done their utmost to make your stay pleasant, giving special attention to
housing and entertainment.
Now, mark JUNE 12, 13 and 14 on your calendar and plan to be with us in
Duluth.
President, Minnesota State Medical Association
472
Minnesota Medicine
♦ Editorial ♦
Carl B. Drake, M.D., Editor ; George Earl, M.D., Henry L. Ulrich, M.D., Associate Editors
THE STATE MEETING
rP HE ninety-seventh annual meeting of the
■*- Minnesota State Medical Association will be
held in Duluth, June 12, 13, 14, 1950. The early
summer date of the meeting will assure plenty of
accommodations for those who plan to attend.
The Open House planned for Monday evening
and the annual banquet to be held Tuesday
evening are only part of the numerous social
events planned by the Duluth members and their
wives. President Laurence M. Gould of Carleton
College will address the banqueters.
A glance at the program will reveal that such
new developments in medicine and surgery as the
diagnosis of heart lesions amenable to surgery and
their surgical treatment ; cortisone and ACTH in
rheumatoid arthritis ; newer solutions used in
intravenous therapy ; medical applications of
radioactive isotopes ; psychosomatic medicine ; and
atomic energy, all appear on the program.
Question-and-answer periods each morning and
afternoon should prove a most valuable means for
stimulating interest.
The meeting this year in Duluth affords again
an opportunity to combine the attendance at the
meeting of you and your wife with a summer
outing in the northern part of our beautiful state.
This great opportunity does not come very often
and advantage should be taken of this year’s
meeting in Duluth.
MEDICAL EDITORS' CONFERENCE
NE of the most important innovations in the
public relations activities of the Minnesota
State Medical Association is the meeting of news-
paper editors and physicians sponsored by the
Committee on Public Health Education of our
Association. The first meeting was held in
Minneapolis on April 8, 1949, for the purpose of
securing a better understanding between the
profession and newspaper editors. The press had
frequently expressed the opinion that the pro-
fession expects the press to maintain the entire
burden of indirect publicity from the profession
to the public. Physicians until recently have not
been clear in their own minds as to what adver-
tising, if any, on the part of the profession, as-
individuals or a medical society, is ethical.
At the annual meeting of the Minnesota State
Medical Association held in Saint Paul in May,
1949, a resolution approved by the Council of the
Association was passed by the House of Dele-
gates clarifying the subject. This resolution
stated that, with the approval of a local society,
a member may ethically place a professional card
stating only his name, address, telephone number
and office hours and his specialty if he is so
recognized in his community ; likewise, a com-
ponent medical society may sponsor special
greetings, messages or announcements in the
name of the component society or the members
thereof. This action aroused considerable adverse
criticism on the part of some opponents of the
profession and proponents of state medicine. The
newspapers were accused of selling themselves
to the medical profession, and the profession was
accused of unethical practice. Both accusations,
of course, were absurd. As long as the local pro-
fession is agreed as to the procedure of the
insertion of a newspaper advertisement con-
taining the limited data mentioned, there is no
breach of ethics any more than in the case of an
insertion of such information in a classified tele-
phone directory. Furthermore, there is nothing
unethical about physicians or medical societies
expressing their ideas on political or economic
affairs by paid insertions in the form of adver-
tisements, either with the names of physicians or
the county medical society attached.
There are, of course, legal restrictions as to
what political activities organizations like medical
societies can undertake. While a physician has
the privilege and, in fact, the duty as a citizen to
take part in politics and may actively support a
candidate, a medical society may not legally con-
tribute to or expend funds in support of or in
opposition to candidates for office or sponsor any
form of advertising material for a candidate.
Individuals forming political committees must,
further, not make use of any official position or
office which they may hold in any organization to
favor candidates. When it comes to supporting a
May, 1950
473
EDITORIAL
candidate for Federal office, a physician has the
same rights as other citizens to contribute funds
personally up to $5,000 to or on behalf of such
a candidate.
I he first meeting between the newspaper editors
of the state and the physicians having proved such
a success, a second meeting was held again this
year on April 21 at the Saint Paul Hotel. It was
even better attended than last year’s meeting and
was called primarily to consider ways and means
for county societies to express themselves in
local newspapers. Physicians throughout the
state have felt a pressing need of expressing
themselves on medical subjects, most important of
which is so-called compulsory health insurance.
They have felt that the local newspaper is the
logical medium for such an expression on a grass
roots level. 1 he Public Health Education Com-
mittee of the State Association has come to the
assistance of the county medical societies by
having prepared a series of newspaper advertise-
ments written by an advertising specialist. Copies
of these insertions have been sent to the county
societies and to the newspapers of the state. It
was explained at the meeting that the next step
is for the county medical society to arrange for
the publication at its own expense of as much of
this advertising material as it desires. The venture
is to be financed by the members of the local
societies as their special contribution to the pre-
servation of free medical practice. Private
medical practice seems well worth this small
additional investment. As was brought out at
the meeting, these insertions signed by the local
physicians who are known to the readers will
carry much more weight than the name of the
society only. Doubtless, too, a few such adver-
tisements in a large number of newspapers will
be more effective than a larger number in fewer
papers.
It was gratifying to witness the evidence of
interest on the part of the newspaper editors of
the state in conferring with the physicians. News-
paper men long have felt that the medical pro-
fession has been rather stuffy in its relations with
the newspapers lest physicians lay themselves
open to criticism from their confreres on the basis
of unethical conduct. Physicians have long
avoided interviews with newspaper reporters,
even on matters that the latter have felt have
legitimate news value and about which only the
physician is informed. Doubtless, the newspaper
editors feel that these two meetings with the
profession indicate a recognition of the functions
and value of the newspaper as a medium of ex-
pression on the part of the profession to the
public. The acquiring of additional advertising
seemed to play a secondary roll, as far as the
editors were concerned.
Senator John L. McClellan of Arkansas spoke
to the editors and physicians following a dinner
in the evening. Though a Democrat, he sees the
direction his party, with the assistance of some
Republicans, is leading our country. Facing
larger deficits this year than the 5.5 billion deficit
of 1949 and with no hope of balancing the budget
in 1951, there are those in Washington who are
seriously advocating conferring dictatorial powers
on the executive and plunging the country into
further debt of astronomical proportions. Those
who heard this real statesman, one of the few
whom Washington can boast, could not fail to
sense the need for all who believe in maintaining
a free and solvent country to join forces.
STREPTOMYCIN IN TUBERCULOSIS
r I 1 HE USE of streptomycin in tuberculosis has
been given extensive trial during the past two
and a half years since its tuberculostatic effect
was definitely established. Of particular value in
determining the status of streptomycin therapy
have been the co-operative reports made by the
Veterans Administration, the Army and Navy,
to the Council on Pharmacy and Chemistry. The
third report* largely confirms the previous two
and justifies certain conclusions.
Streptomycin cannot be counted on alone to
cure tuberculosis. Even in draining tuberculosis
sinuses and in involvement of the genito-urinary
tract, in which conditions it is specially efficacious,
an appreciable number of relapses occur. In 416
patients with pulmonary tuberculosis observed two
and a half years, who had received streptomycin,
there was a mortality of 21 per cent. During this
period, 67 per cent of some sixty-six patients
with tuberculous meningitis, so treated, have died.
Streptomycin is only an adjunct in the treatment
of tuberculosis. It should not be given to ambulant
patients as is so often done for a few weeks trial.
All the other methods of treatment, such as bed
rest and surgerv where indicated, should be used.
While the use of streptomycin has resulted in
•Council on Pharmacy and Chemistry: Current status of the
chemotherapy of tuberculosis in man. T.A.M.A., 142:650, (March
4) 1950.
474
Minnesota Medicine
EDITORIAL
an increase in the percentage of cures, its use has
its drawbacks. It does not have a favorable effect
in the presence of much necrosis ; it requires daily
intramuscular injections; it produces toxic side
actions such as vertigo and deafness ; and it pro-
duces streptomycin-resistant bqcilli.
The extensive use of streptomycin, however,
has established the fact that the dosage of 1
gram a day is nearly as effective as 2 grams
daily and does not produce nearly as high a per-
centage of toxic manifestations as the larger dose ;
that a single intramuscular injection daily is just
as efficacious as divided doses ; that the develop-
ment of streptomycin-resistance depends rather
on the long period of treatment than on the size of
the dose.
The value of the administration of streptomycin
previous to and following pulmonary excisions
seems definitely established, although its routine
use in thoracoplasty was not thought advisable as
there was only a slight reduction in the incidence
of spreads in the few instances in which it was
tried.
The early promise that dihydrostreptomycin
might replace streptomycin has not materialized.
Although less toxic, the former is less effective
in 1-gram dosage (the established dose at present)
and when given in 2-gram doses may produce a
loss of hearing during or after administration,
a condition rarely observed with streptomycin.
Another drug used rather extensively in Swe-
den in the treatment of tuberculosis in para-amino-
salicylic acid. Its use in this country has been
largely in the treatment of patients in whom the
tubercle bacillus has become streptomycin-re-
sistant. In these patients, although the compari-
son may not be fair, the results from the use of
para-aminosalicylic acid have not warranted ex-
tensive trial. From a limited trial, there is some
indication that there is less development of re-
sistance to streptomycin and that the efficacy of
streptomycin may be enhanced by the simultaneous
administration of para-aminosalicylic acid orally in
conjunction with streptomycin.
MATERNAL MORTALITY STUDY
IN MINNESOTA
N the recommendation of the Maternal
^ ' Health Committee the Council of the Minne-
sota State Medical Association has approved a
state-wide survey of maternal mortality in the
state for the year 1950. The study will ue made
in co-operation with the Minnesota Department of
Health. It will consist of a field investigation by
a trained obstetrician as soon as a maternal death
is reported and an analysis of the findings to
determine the causes of death by the Maternal
Health Committee.
The value of such a study was demonstrated in
the previous study in 1942 as well as by studies
being made in other states. Minnesota has made
great progress in reducing its maternal deaths tec
6/10,000 live births in 1947, the lowest in the
United States. It was 7/10,000 in 1949, but there
is still room for improvement as shown by the fact
that Oregon reduced its rate to a new national low
of 4/10,000 in 1948.
The Council urges that all physicians and
hospitals co-operate in this study. All maternal
deaths should be promptly reported by mail or
telephone, collect (GLadstone 5973, Minneapolis),
to the Division of Maternal and Child Health of
the State Health Department in addition to the
usual report of the death certificate to the Division
of Vital Statistics. This will assist the committee
in making a prompt investigation. The committee
urges that an autopsy be obtained in each maternal
death.
SURVEY OF PHYSICIANS' INCOMES
The AMA Bureau of Medical Economic Research is
co-operating with the Office of Business Economics of
the U. S. Department of Commerce in sending out ques-
tionnaires regarding professional incomes to over 100,000
members of the profession. The purpose of the inquiry
is to obtain accurate estimates of the income of the pro-
fession for determining the cost of rnedical care to the
American people. . .
The survey will cover 62.5 per cent of the 200,000
physicians whose names are contained in punch card
files of the AMA A short form requesting income data
for 1949 will be sent to every other of the 200,000 names.
Of the remaining 100,000 names, every fourth will be
selected; 10,000 short forms and 15,000 long forms will
be sent to these individuals.
Physicians need have no concern lest the replies may
be used by the Bureau of Internal Revenue. The Bureau
has no access to income reports, and for this reason the
present survey is being made. Your co-operation in re-
turning the forms promptly and accurately filled out is
earnestly requested. Results will be published by the De-
partment of Commerce next fall in its monthly publica-
tion, Survey of Current Business.
May, 1950
475
Medical Economics
Edited by the Committee on Medical Economics
of the
Minnesota State Medical Association
George Earl, M.D., Chairman
THE WELFARE STATE— WHAT IS IT?
Many Americans have spoken up against the
socialistic trend in government today. Represent-
atives of these view& from all phases of American
life include an industrialist, an editor, a pro-
fessor, an educator and politician, and a reporter.
From their words come greatly-needed definitions
and explanations of traditional American philoso-
phies— very welcome when such terms have been
so mistreated and misunderstood of late.
Industry Editor Calls a Spade a Spade
Making the most of frequently-used and mis-
used words in the daily news, Art Hood, editor of
the American Lumberman and Building Products
Merchandiser, declares in a recent issue of Sys-
tems Magazine, that the inner battle of Seman-
tics in the cold war has allowed socialists and
communists to twist the meanings of revered
American words and fit them into slogans.
Defining the welfare state, he says :
“Within the cold war is an inner battle of Semantics.
Democracy, Freedom and Liberty have been appropriated
as slogans by socialists and communists.
“And now they’ve done it again! We have been
trapped into calling a leftish government a ‘Welfare
State.’
“Every time the Politburo hears where one of us has
damned the Welfare State they must get a belly laugh.
“It would be laughable if it were not so tragic.
“Socialism is not a ‘Welfare State.’ . . .
“And communism is not a ‘Welfare State.’ . . .
“Russia is a slave state. Let’s call it that !
“England is a regimented state. Let’s call it that !
“The only true welfare state is one with our kind of
a Constitution and Bill of Rights and with a private
enterprise economy.
“Let’s be realists. We can’t win elections and block
socialism by condemning welfare and secwrity.
“We can elect Representatives and Senators who will
block further socialization of our political economy, IF
every one of us will hammer home these truths:
“1. That welfare and security are nothing but words
in Russia and England — while they are facts in America.
4716
“2. That the boasted equality of the socialists and
communists is one of common destitution.
“3. That slavery to the state is the inevitable result of
socialism and communism.
“4. That welfare and security by any government is
money taken from the people and given back, less a 40
to 60 per cent service fee.
“5. That those who want welfare and security in
America can provide it cheaper themselves than by pay-
ing taxes to provide it.
“6. That the Constitution of the United States and
our Bill of Rights provide the highest degree of welfare
and security ever known in the history of man.”
Statism More Than a Scare Word
Dorothy Thompson has a respect for correctly
used words, also. She has shown understandable
concern over President Truman’s recent statement
that statism is merely a scare word. Quoted in
the Kansas City Times, she gives her views on the
welfare state and statism :
“President Truman professes not to know the meaning
of ‘statism,’ by which Senator John Foster Dulles re-
cently defined the tendencies of the Truman administra-
tion. The President said he had looked the word up in
two or three dictionaries and that they were in dis-
agreement. ‘It’s simply a scare word,’ Mr. Truman
concluded.
“There are many words in common use and of general-
ly accepted meaning, which have not found their way
into dictionaries. . . . The dictionary is maintaining a
decorous civilization which has not caught up with what
Winston Churchill described as ‘this grim, ferocious
epoch.’ Its definition of ‘atomization’ is ‘to reduce to
atoms, pulverize, spray.’ Future editions will have to
add ‘vaporization of inorganic and organic matter, in-
cluding human beings, by atom bombs.’ . . .
Rubber-Stamp Citizens
“But the President knew perfectly well what he (Sena-
tor Dulles) meant, and so do we all, without reference
to any dictionary. The Senator meant by ‘statism’ the
tendency of the state to encroach into all the fields
hitherto reserved to the individual and society; to ab-
sorb more and more of the citizen’s earnings ; exercise
increasing control over his life and habits; and reduce
him to becoming a rubber stamp of the state-bureaucratic
apparatus.”
Minnesota Medicine
MEDICAL ECONOMICS
Miss Thompson expands her definition of
statism to include the meaning given by Musso-
lini :
“Everything in the state; nothing outside the state.
“Thus,” she declared, “statism is total state power,
which can be achieved gradually, as well as by revolu-
tion. Its chief psychological weapon is to identify the
state with the people, as though they were the same,
which, of course, they are not.”
Continuing, Miss Thompson avers:
“When society gives powers to the state it is weak-
ened in the same proportion. And that the state is be-
coming everywhere stronger and the people weaker is
visible to the naked eye, even if not visible in the dic-
tionary.”
The debate about which is best, power in the
state or in the people, concerned the writers of
the Constitution and the founders of the first
United States government. Miss Thompson, in
her forthright manner, makes this point in con-
clusion :
“In terms of their own era, Hamilton was a statist, and
Jefferson an anti-statist. It is certain, I think, that if
those two great minds were meditating the same ques-
tion today, in a highly organized industrial society,
which at that time did not exist, they would have other
policies.
“But they would not avoid the issue by a wise crack,
and, neither should the President.
“For one way by which the state shows contempt for
the people, is to reduce all issues to slogans and wise-
cracks.”
Stassen Scores Again in Discussion
on Socialism
Speaking on the Town Meeting of the Air re-
cently, Harold Stassen made a strong case against
the trends of socialistic government. Discussing
with Professor Arthur M. Schlesinger of Har-
vard, the question : “How Will the British Elec-
tions Affect the United States ?”, Stassen pointed-
ly remarked :
“I’ve heard many interpretations of the results, but
this is the first time I’ve heard it interpreted as a ‘stun-
ning victory’ (quoting Professor Schlesinger) for the
socialist state. I think it was a stunning victory in which
the victors were stunned. In fact, the London Times . . .
said that any last-ditch attempt to interpret the meager
Labor new majority as a mandate to go on as before
would be foolish and futile. . . .”
A Distinction Is Necessary
Mr. Schlesinger then posed this question to
Stassen :
“I do believe that it’s essential for us to have in our
own minds the distinction between the welfare state and
socialism. I would ask the Governor, who said in his
speech that the compulsory health program and the
Brannan Plan are both copies from the British Labor
program ... if there is so little difference between the
Fair Deal program and the program on which the Tories
achieved their gains in this last election, what does he
conclude from that as to the future of the welfare
state?”
Out of Professor Schlesinger’s rather drawn-
out and confused question, Mr. Stassen scores his
most important point of the evening :
“Well, that’s a very common misinterpretation of the
Conservative position. It’s not true that they said, ‘Me,
too.’ I quote specifically from their (the conservatives’)
platform, Right Road for Britain: ‘We shall bring na-
tionalization to a full stop here and now. Therefore, we
shall save all those industries such as cement, sugar,
meat distribution, chemicals, water, and insurance which
are now under threat by the Socialists. We shall repeal
the Iron and Steel Act, before it can come into force.
The nationalization of tramways will be halted.
Wherever possible, those already nationalized will be
offered to their former owners, whether private or
municipal. We shall also be prepared to sell back to
free enterprise those sections of the road haulage indus-
try which have been nationalized.’
“In other words, clearly the Conservative position was
against socialism.
“Now the effort of the Socialists is constantly to in-
terpret an opposition to socialism as being a position
against social insurance, which is an entirely different
thing.
“The whole development of unemployment compen-
sation, of old-age assistance, has been advanced by both
parties in England, as it has been advanced by both par-
ties in the United States.
“What we are against — what the Conservative in Eng-
land is against — is taking over, in a great centralized
government, the actual operation, ownership, manage-
ment of the great industries of a country, because that’s
the way to lower the standard and defeat the welfare o£
the people.”
Confusion in Terms Is Answered
During the question and answer period, a man
asked Stassen this question :
“Professor Schlesinger seems to confuse support of
human welfare with support of a welfare state. I won-
der if the Governor would care to comment.”
Stassen realized the man’s understanding of
word-meaning and his concern for clarity, and
went on to expand the statement :
“I think that your question is well put, in that all
parties in both countries want to advance the welfare of
the people. The question is how is it done? The people
May, 1950
477
MEDICAL ECONOMICS
of England are finding that their welfare is not im-
proved, and they are suffering from a lower standard of
living than are the peoples on the Continent vvho’ve
turned away from socialism.
“The whole basic question is why do we have the best
standard of living in the world in America? It’s be-
cause of our tradition of individual freedom — freedom
economic, social, political, and religious. We say let’s
carefully advance the welfare of the people while holding
fast to those individual freedoms.”
BRITAIN HAS NEW PROBLEM PLUS
MORE EXPENSE
Britain’s latest problem, ironic as it seems, is
one of large stocks of food — enough, in fact, to
permit increases in the people’s rations. But,
says a New York Times dispatch quoted in the
Wall Street Journal, “this pleasant development
puts the government in a ‘peculiar situation’.”
In Britain, all foods are supported by heavy
government subsidies. This makes it quite neces-
sary for Sir Stafford Cripps, the budget manager,
to consider seriously if the government can afford
to let the nation eat more. He says the treasury
can’t permit that.
The Wall Street Journal suggests this alterna-
tive :
'“The government could just put the extra food in the
•open market and let folks decide for themselves whether
they wanted to pay more to eat more. That’s a course
the government is ‘very reluctant to take' ; things like
that must be planned, not left to the people."
The editorial goes on to explain that the sub-
sidy program was begun in the first place to help
the people get food during a period of shortages.
Going on, it comments:
“Now the shortages of most foods are ended. Yet the
government cannot let the people have a better diet be-
cause of that self-same rationing and subsidy program.
“So because the government is so solicitous of the
people’s welfare the people can’t have any more to eat.
“Have you ever noticed how planners do wonderfully
well at planning austerity and find nothing so discon-
certing as the least hint of abundance?”
It May Be Strategy
Of course, this depriving the British people of
what they actually take part in producing, whether
directly or indirectly through food production or
buying foods, may prove, to be clever socialist
strategy. This is explained by Stephen C. No-
land, of the Indianapolis News, writing from
England before the election :
“A good example of the strategy of the British Labor
party leaders in promoting their Socialistic program is
the use of the food rationing system to win support for
the steel nationalization project. . . . The steel worker
and his wife . . . are getting a poor food break com-
pared with the miner and his wife. . . . This is the
grievance that the Labor party politicians wanted. It is
in line with their policy of consistently creating small
grievances and then offering Socialism as the way to cor-
rect the evil which angers the people.”
Healing, Also, Too Expensive?
The London Daily Mail furnishes a quote from
a doctor which brings home all too clearly the in-
herent dangers in a socialist control-minded health
system. It speaks for itself :
“Lord Horder, one of the King’s doctors, accused the
labor government today of putting undue controls on the
medical profession. Great Britain’s socialized medicine
program, he said, recently posted a notice in one hos-
pital reading, ‘Operating theatre will not be used except
between the hours of 9 :00 a.m. and 5 :30 p.m.’ Another
example of government control, he said, was an order
to hospitals saying, ‘Use of penicillin in this hospital
must be cut down. It is too expensive.’ ”
Prison Is Paralleled with Domestic Security
If government security is carried to its utmost
point, things may get to the stage where everyone
in this country is guaranteed his food, housing,
clothing and, subservience. Such security is so
like that found in a prison, that it has caused
Harvey S. Firestone, Jr., quoted in the Harding
College Letter, to remark :
“Nobody in this world is more secure than a man in a
penitentiary. He is fed, clothed and housed. But he is
not free to go and come as he pleases. He is watched,
guarded and disciplined. There are millions of people in
other lands who have that same kind of security. But
we Americans have always believed that the only real
security lies in liberty and opportunity.”
MINNESOTA STATE BOARD OF MEDICAL
EXAMINERS
230 Lowry Medical Arts Building
Saint Paul, Minnesota
Julian F. DuBois, M.D., Secretary
MINNEAPOLIS MAN FINED $1,000 FOR VIOLATION OF
FEDERAL FOOD, DRUG AND COSMETIC ACT
Re. United States of America vs. Lafayette M. Gray, an
individual trading as L. M. Gray and Powdr-X-Company.
On March 22, 1950, L. M. Gray, seventy-three years
of age, 5025 Queen Avenue South, Minneapolis, was
sentenced by the Hon. Gunnar H. Nordbye, Judge of
the Linked States District Court, to pay a fine of $1,000
478
Minnesota Medicine
MEDICAL ECONOMICS
following Gray’s entering a plea of nolo contendere to
two counts in an information charging Gray with vio-
lating the Federal Food, Drug and Cosmetic Act. Gray
paid the fine.
Gray had been convicted by a jury in the same Court
on March 27, 1948, of introducing in interstate commerce
at Minneapolis, a number of packages containing a drug
called Powder-X, the Government charging that a letter
accompanied the shipment, which letter contained the
following statement : “In fact it is an ointment that is
splendid for almost any infection, abrasions, or ulcers.”
It was further alleged that the drug was misbranded
in that the above statement was false and misleading
because the drug is not efficacious in cure, mitigation
and treatment of infections, abrasions or ulcers. Follow-
ing his conviction in 1948, Gray appealed to the United
States Circuit Court of Appeals, which Court reversed
the conviction because of errors in the form of verdict
used and remanded the case for a new trial.
The investigation was conducted by representatives of
the Food, Drug and Cosmetics Division of the Federal
Security Agency at Washington and Minneapolis. The
trial was conducted by Clifford F. Hansen, Assistant
United States Attorney of Saint Paul. Mr. Hansen
was assisted by legal counsel representing the Depart-
ment of Justice and the Federal Security Agency.
MINNEAPOLIS WOMAN ORDERED TO SERVE ONE
YEAR FOR MANSLAUGHTER FOLLOWING
CRIMINAL ABORTION
Re. State of Minnesota vs. Rose Vivian Baldwin
On April 21, 1950, Rose Vivian Baldwin, thirty-five
years of age, 825 Chicago Avenue, Minneapolis, was
sentenced by the Hon. Harold N. Rogers, Judge of the
District Court to a term of not less than five, nor more
than twenty years in the Women’s Reformatory at
Shakopee, Minnesota. Mrs. Baldwin had entered a plea
of guilty on March 24, 1950, to an information charging
her with the crime of manslaughter in the first degree,
following a criminal abortion. Judge Rogers, after
hearing from legal counsel for the defendant and the
Minnesota State Board of Medical Examiners, stayed
the sentence for five years but ordered the defendant
to serve one year in the Minneapolis Women’s Detention
Home.
Mrs. Baldwin was arrested on March 2, 1950, when it
was first learned that the patient, a twenty-four-year-old
niece of the defendant, was in critical condition at
Minneapolis General Hospital. The investigation by the
Minneapolis Police Department and a representative of
the Minnesota State Board of Medical Examiners, dis-
closed that an abortion had been performed upon the
patient on January 30, 1950, by the defendant by means
of a catheter, for which the defendant was paid $20.00.
The patient was hospitalized on February 5, 1950, but
the matter was not called to the attention of the Minne-
apolis Police Department until March 2. At that time
it was too late to take a dying statement from the
patient because of the patient’s condition. The patient
died on March 7, 1950. Sufficient evidence was obtained
to warrant the issuance of a criminal complaint and the
subsequent prosecution of the defendant.
In sentencing the defendant, who has no medical
training of any kind, Judge Rogers told her that she was
responsible for the death of her niece and that it would
be a serious mistake for the defendant to go entirely
free of any punishment. A plea for leniency was made
for the defendant on the grounds that she had never
performed any other abortions except on herself. How-
ever, the defendant admitted that she had previously
been investigated by the Minneapolis Police Department
in 1949, for accepting $100 to perform an abortion. That
abortion was not performed, and the $100 was returned
to the patient.
SYPHILITIC CARDIAC DEATHS
( Continued from Page 440 )
in which death was due to the narrowing of the
coronary orifices, except where there was an
associated valvular deformity, showed a minimal
amount of hypertrophy. This fact does not sup-
port the theory that coronary insufficiency, in gen-
eral, is a causal factor in cardiac hypertrophy.
Spirochetes were not found.
The findings in the coronary arteries not in-
cluding the orifices do not show stigmata of
syphilis. There is nothing in this analysis to
suggest that syphilis is a factor in the etiology
of coronary sclerosis. The sclerosis in the arteries
does not appear to be increased in cases of
syphilitic heart disease.
Some useful clinical applications may be drawn
from the analysis of these 422 cases of syphilitic
hearts. The hearts in cases of aortic insufficiency
have the greatest degree of hypertrophy. Infarc--
tion with a resulting friction rub is rare in
syphilitic hearts. The aortic valve is the only valve
involved. The valvular deformity causes insuf-
ficiency but never stenosis. An anatomic basis for
angina and sudden death due to a narrowing of the
coronary orifices is a common finding especially
in Type 2 where death resulted from coronary
insufficiency. It is necessary to differentiate-
syphilitic heart disease from coronary sclerosis
and rheumatic aortic stenosis. Pericarditis either
from infection or as a result of myocardial infarc-
tion is so rare that it hardly needs to be considered
in a diagnosis of syphilitic heart disease.
References
1. Bell, E. T. : Frequency with which syphilitic lesions are-
encountered in post-mortem examinations. Arch. Path., 26:
839, 1938.
2. Giirich: Ueber die syphilitischen Organveranderungen die
unter dem Sectionsmaterial der Jahre 1914-1924 angetroffen
wurden. Miinch. med. Wchnschr., 72:980, 1925.
3. Reid, W. D. : Cardiovascular syphilis. M. Clin. North
America, 5:1319, 1921.
4. Saphir, O. : Syphilitic myocarditis. Arch. Path., 13:266,
1932.
5. Symmers, D. : Anatomical lesions in late acquired syphilis.
J.A.M.A., 66:1457, 1916.
May, 1950
479
MINNESOTA STATE MEDICAL ASSOCIATION
Ninety-Seventh Annual Meeting
Duluth Armory. Duluth, Minnesota
June 12, 13, 14, 1950
ANNOUNCEMENTS
Presiding officers at each session have been instructed
by tbe Committee on Scientific Assembly to show a blue
light on the speakers’ rostrum two minutes before the end
of each speaker’s program time. A red light will show
when his time is up.
Register and Secure Your Badge at the Registration
desk at the Duluth Armory at 8:00 A.M. Admittance-
will be by badge only: Arrangements have been made
with the hospitals to admit interns and key hospital per-
sonnel as guests if previously certified. Out-of-state
physicians can secure guest badges by presenting their
membership cards from their local county and state medi-
cal societies.
Telephone Service: All physicians attending the Annual
Meeting are reminded to tell their home and office secre-
tary how they can be reached during their attendance in
Duluth. Special incoming lines have been installed at the
Armory Registration desk. All local and long distance
calls will be handled promptly if they are directed to the
Minnesota State Medical Association at the Duluth
Armory, Hemlock 8733.
Bring Your Membership Card: There will be no
registration fee for those who present a membership card
■or receipt or other evidence from their county society or
' the state association or the American Medical Associa-
tion, nor for members of associated professions including
dentists, pharmacists, interns, nurses, hospital personnel,
teachers or social welfare workers who present invita-
tions or other identification.
Badges: You are requested to wear your badge while
you are on the convention floor. This is important and
will greatly assist us to eliminate undesirable persons
such as cranks and pickpockets who so frequently try to
take advantage of meetings of this character.
Parking: Good parking space is available next to the
Armory.
Visit the Exhibits: Tn keeping with established custom,
forty-five minute recess periods have been provided each
day, during which time those attending the Annual Meet-
ing are urged to visit the scientific and technical exhibits.
The large exhibit of technical displays is interesting and
educational. Stop and show your appreciation of the
exhibitors’ support in helping to make the 1950 MSMA
Convention successful.
Round Table Luncheons : A series of twenty-one Round
Table Discussion Luncheons have been arranged for this
meeting. One luncheon is scheduled for Monday ; ten
will be held on Tuesday and ten on Wednesday. Tickets
may be purchased in advance for these luncheons, all of
which are held at 12:15 P'.M. at either the Hotel Duluth
or Hotel Spalding. Attendance at each luncheon is
limited ; late-comers are accommodated according to their
choice if limits have not already been reached. Tickets
$1.75, tips included.
Medal: The Southern Minnesota Medical Association
will again award a medal to the individual physician
presenting the outstanding scientific exhibit. The award
will be made at the banquet Tuesday evening, Tune 13,
at Hotel Duluth.
Fifty Club: Members who this year will have com-
pleted fifty years of practice in Minnesota will be honored
by election to Minnesota’s “Fifty Club.” Candidates will
be honor guests at the Ninety-seventh Annual Banquet,
7 :00 P.M., Tuesday, June 13, Hotel Duluth, and will be
presented with lapel buttons and certificates at that time.
Meeting Places: The general sessions Monday, Tues-
day and Wednesday will be held in the Duluth room, on
the second floor of the Armory. The sectional meetings
will be held in the St. Louis room, located in the north-
east corner of the exhibition floor, except the Minnesota
Academy of Ophthalmology and Otolaryngology, which
will meet in the St. Mary’s Hospital Staff Room, and the
Minnesota Society of Clinical Pathologists, at St. Luke’s
Hospital.
Public Meeting: The Wednesday meeting this year will
lie devoted to a consideration of atomic energy, from
medical and defense standpoints. The public is invited
to attend the afternoon meeting, beginning at 2 p.m.
Outstanding speakers — medical and military — will discuss
“Atomic Energy in War and Peace.”
Woman’s Auxiliary: Physicians’ wives attending the
meeting may secure programs for the business and social
sessions of the Woman’s Auxiliary at the Women’s
Registration Desk on the mezzanine of the Hotel Duluth.
All physicians’ wives attending the meeting are cordially
invited to attend the special events arranged by the hos-
tesses of the St. Louis County Medical Auxiliary.
Obstetric Manikin Demonstrations: A discussion of
delivery problems and techniques, with the use of the
manikin, has been arranged through the courtesy of the
Minnesota Department of Health. These discussions will
be held at special luncheons on each of the three days of
the Annual Meeting and at 5:15 in the Armory, Monday
and Tuesday.
480
Minnesota Medicine
NINETY-SEVENTH ANNUAL MEETING
GUEST SPEAKERS
We are indebted to the following societies and organi-
zations for guest speakers at this meeting:
The Minnesota Department of Health — Obstetric Mani-
kin Demonstrators : Rodney F. Sturley, St. Paul, Clini-
cal Instructor in Obstetrics and Gynecology, University
of Minnesota; Ralph A. Reis, Associate Professor of
Obstetrics and Gynecology, Northwestern University,
Evanston, Illinois ; Robert E. McDonald, Assistant Clini-
cal Professor of Obstetrics and Gynecology, Marquette
University, Milwaukee, Wisconsin ; Speaker, Stewart
Wolf, Associate Professor of Medicine, Cornell Univer-
sity Medical College, New York, New York.
The Minnesota Radiological Society-Speaker, Eugene
Pendergrass, Professor of Radiology, University of
Pennsylvania, Philadelphia, who will deliver the annual
Russell D. Carman Memorial Lecture in Radiology.
The Minnesota Society of Clinical Pathologists — Speak-
er, Ancel Keys, Ph.D., Director of Physiological Hygiene
of the University of Minnesota, Minneapolis, who will
deliver the annual Arthur H. Sanford Lectureship in
Pathology.
Northwestern Pediatric Society — Speaker, Armand J.
Quick, Marquette University, School of Medicine, Mil-
waukee, Wisconsin.
Northern Minnesota Medical Association — Speaker,
Robert Elman, Washington University Medical School,
St. Louis, Missouri.
Other visiting speakers at this meeting:
C. Rollins Hanlon, Assistant Professor of Surgery,
The Johns Hopkins Hospital, Baltimore, Maryland.
Howard A. Carter, Ph.D., Secretary, Council on Phy-
sical Medicine and Rehabilitation, AM A.
Colonel Elbert DeCoursey, Office of the Surgeon Gen-
eral, Washington, D. C.
Stephan Epstein, Marshfield Clinic, Marshfield, Wis-
consin.
ROUND TABLES
Duluth and Spalding Hotels
12:15 P.M. Daily
Monday. June 12
Obstetric Manikin Demonstration — Robert E. Mc-
Donald, Milwaukee, Wisconsin
Tuesday, June 13
Massive Upper Gastrointestinal Hemorrhage — Robert
Elman, St. Louis, Missouri
Newer Drugs and their Use — W. W. Spink, University
of Minnesota
Anesthesia — K. E. Latterell, Duluth
Diarrhea and Constipation — William G. Sauer, Roch-
ester
What Can the General Practitioner Do for the Ner-
vous Case? — L. R. Gowan, Duluth
Surgical Treatment of the Injured Hand — Tracy E.
Barber, Austin
Recent Advances in Clinical Obstetrics and Gyne-
cology— W. F. Mercil, Crookston
Allergy and the Antihistaminic Drugs — R. N. Bieter,
University of Minnesota
May, 1950
The Part of the General Practitioner in the Man-
agement of Vesical Neck Obstruction— Frederic E.
B. Foley, St. Paul
Obstetric Manikin Demonstration — Ralph A. Reis,
Evanston, Illinois
Wednesday, June 14
Diabetes — New Insulins and Other Treatment — S.
H. Boyer, Jr., Duluth
Cardiac Emergencies — R. O. Sather, Crookston
The Crosseyed Child — Malcolm C. Pf under, Minneapo-
lis
Disability Evaluation — C. C. Chatterton, St. Paul
Farm Injuries — H. H. Young, Rochester
Menstrual Irregularities — B. F. P. Williams, Duluth
Surgical Management of Varicose Veins — W. J. De-
weese, Bemidji
Postoperative Wound Complications — J. S. Spang,
Duluth
Modern Concepts in the Management of Acne —
Frederic T. Becker, Duluth
Obstetric Manikin Demonstration — Rodney F. Stur-
ley, St. Paul
SOCIAL EVENTS
Monday, June 12
Luncheons
AMERICAN MEDICAL WOMEN'S ASSOCIATION,
INC.
12:15 p.m., Duluth Athletic Club, 402 West First Street.
Dr. Selma Mueller, Duluth, will speak on her medical
experiences in the Orient.
Make reservations with Dr. Mueller, 916 Medical Arts
Building, Duluth. (Open to all visiting women physi-
cians.)
MINNESOTA SOCIETY OF CLINICAL PATHOL-
OGISTS
Guests of hospital at 12:15 luncheon, following San-
ford lectureship.
MINNESOTA CHAPTER OF THE AMERICAN
COLLEGE OF CHEST PHYSICIANS
12:15 p.m., Ballroom Floor, Hotel Duluth.
Dinners
MINNEAPOLIS GENERAL HOSPITAL SURGI-
CAL RESIDENTS SOCIETY
6 :00 p.m., Duluth Athletic Club
MINNESOTA MEDICAL FOUNDATION AND
MINNESOTA MEDICAL ALUMNI
6 :00 p.m., Hotel Spalding - ■
Program will include greetings from alumni and mem-
bers of the Foundation ; address by Donald J. Cowling,
Ph.D., St. Paul, President Emeritus of Carleton College.
Make reservations with Dr. George N. Aagaard, 3411
Powell Hall, University of Minnesota, Minneapolis
NU SIGMA NU ALUMNI ASSOCIATION
6 :00 p.m., Athletic Club
MINNESOTA RADIOLOGICAL SOCIETY
6 :30 p.m., Northland Country Club.
Make reservations with Dr. A. L. Abraham, St. Luke’s
Hospital, Duluth
481
NINETY-SEVENTH ANNUAL MEETING
MINNESOTA CHAPTER OF THE AMERICAN
ACADEMY OF GENERAL PRACTICE
6:00 p.m., Tally-Ho Room, Hotel Holland
Speaker will be Dr. E. C. Texter, Detroit, Michigan,
Past President of the American Academy of General
Practice.
MINNESOTA SOCIETY OF CLINICAL PATHOL-
OGISTS
6 :00 p.m., St. Mary’s Hospital
Tuesday, June 13
Breakfasts
FORMER ST. MARY’S INTERNS
8:00 a.m., St. Mary’s Hospital
Luncheons
MEDICAL VETERANS SOCIETY OF MINNE-
SOTA
12:15 p.m., Main Dining Room, Hotel Holland
Make reservations with Dr. E. Irvine Parson, 815
Fidelity Building, Duluth
NORTHWESTERN PEDIATRIC SOCIETY
12:15 p.m., Kitchi Gammi Club
Dinner
ANNUAL BANQUET— MINNESOTA STATE
MEDICAL ASSOCIATION
7 :00 p.m., Ballroom, Hotel Duluth
SPORT EVENTS
Golf Tournament: The annual Golf Tournament of the
Minnesota State Medical Association will be held Sunday,
June 11, at the Northland Country Club, with the tee-off
at 1 p.m. All medical golfers are invited to enter and
compete for the attractive prizes that have been donated.
Make reservations on the enclosed card immediately.
Robert H. LaBree, Duluth, is tournament chairman.
Lake Fishing: Daily expeditions along the North Shore
of beautiful Lake Superior. Three-hour trips for groups
from four to 12 persons. All fishing gear will be fur-
nished with the boats, but an extra jacket is recommended.
Price will be $1.50 to $3 per person, depending upon the
size of the party. Make reservations in advance with
Karl E. Johnson, 2031 West Superior Street, Duluth.
Trap Shooting: Three events wall be held Sunday, June
11, from 12 noon till 6 p.m., at the Duluth-Mesabi Em-
ployes’ Gun Club, Proctor :
Event I — “Fifty-Bird Event Skeet Shoot ” — for Mal-
colm Pfunder Trophy, donated by Dr. Malcolm Pfunder
of Minneapolis.
Event II — Duck Hunters’ Special “Razzle-Dazzle 25-
Bird Event” — for Leech Lake Trophy, donated by Dr.
Vernon D. E. Smith of St. Paul.
Event III — “Twenty- five Bird Trap Shoot” Lewis
classification if sufficient shooters in attendance. Prizes
will be awarded.
Ammunition and windbirds will be available. A. C.
Kelly, 825 Medical Arts Building, Duluth, is chairman
of these events.
482
BUSINESS SESSIONS
Hotel Duluth
Saturday, June 10
2:00 P.M. — Council English Room
6:00 P.M. — Council English Room
Sunday, June 11
8:00 A.M. — Council English Room
10:00 A.M. — Reference Committees Ballroom Floor
12:00 noon — Council English Room
2:00 P.M. — House of Delegates Ballroom
8:00 P.M. — House of Delegates Ballroom
Monday, June 12
8:00 A.M. — Council and Minnesota
Medical Service English Room
8:00 A.M. — Committee Ballroom Floor
State Health Relations
12:15 P.M. — House of Delegates Ballroom
Tuesday, June 13
8:00 A.M. — Council and Minnesota State
Board of Health English Room
8:00 A.M.- — Committees Ballroom Floor
Anesthesiology
Cancer
Child Health
Diabetes
First Aid and Red Cross
Fractures
General Practice
Maternal Health
Medical Testimony
Public Policy
Rural Medical Service
Vaccination and Immunization
Wednesday, June 14
8:00 A.M. — Council English Room
8:00 A.M. — Committees Ballroom Floor
Editing and Publishing
Heart
Historical
Hospitals and Medical Education
Insurance Liaison
Medical Economics
Military Affairs
Ophthalmology
Public Health Education and Radio
Veterans Medical Service
9:00 A.M.- — Installation of Officers. .. .Duluth Armory
Minnesota Medicine
NINETY-SEVENTH ANNUAL MEETING
Scientific Program
Monday. June 12, 1950
SECTION I — GENERAL SESSION
A.M. ' Morning
8:30 Visit Scientific and Technical Exhibits Armory
9:00 Advances and Investigation in Surgery of the Heart Armory
Diagnosis — Paul F. Dwan, University of Minnesota
Radiology — Joseph Jorgens, University of Minnesota
Catheterization — Forrest H. Adams, Minneapolis
Surgical Treatment — C. Rollins Hanlon, Assistant Professor of Surgery, The Johns
Hopkins Hospital, Baltimore, Maryland
10:00 Question and Answer Period
10:15 Intermission
Visit Scientific and Technical Exhibits Armory
11:00 Arthur H. Sanford Lectureship in Pathology Armory
The Diet and Cardio -vascular Disease — Ancel Keys, Ph.D., Director of Physiological
Hygiene of the University of Minnesota, Minneapolis
Presentation of Speaker — A. H. Wells, Duluth, President, Minnesota Society of
Clinical Pathologists
P.M. Afternoon
12:15 Obstetric Manikin Demonstration Hotel Spalding
Robert E. McDonald, Assistant Clinical Professor of Obstetrics and Gynecology,
Marquette University, Milwaukee, Wisconsin
1:30 Visit Scientific and Technical Exhibits Armory
2:00 New Advances in Treatment of Joint Diseases Armory
Available Treatments in Arthritis — C. W. Fogarty, Jr., Saint Paul
Investigative Study in Arthritis — C. PI. Slocumb, Rochester
Movie — “Effect of Cortisone and ACTLI in Rheumatoid Arthritis”
3 :05 Question and Answer Period
3:15 Intermission
Visit Scientific and Technical Exhibits Armory
4:00 Russell D. Carman Memorial Lecture Armory
The Roentgen Diagnosis of Silicosis — Eugene Pendergrass, Professor of Radiology,
University of Pennsylvania
Presentation of Speaker — J. P. Medelman, M. D., Saint Paul, President, Minnesota
Radiological Society
5:00 Visit Scientific and Technical Exhibits Armory
5:15 Obstetric Manikin Demonstration Armory
Ralph A. Reis, Associate Professor of Obstetrics and Gynecology, Northwestern
University, Evanston, Illinois
Evening
8:00 Open House Ballroom, Hotel Duluth
Duluth Physicians’ Little Symphony Orchestra
Specialty musical numbers by members of orchestra
The Arrowhead Swing Square Dancers (George Gustafson)
9:00-12:00 Dancing
Joe Priley’s Orchestra
Monday, June 12, 1950
SECTION II — SPECIAL SESSION
A.M.
8:30 Minnesota Society of Clinical Pathologists
Tumor Clinic St. Luke’s Hospital
10:15 In termissi on
P.M.
2 :00 Minnesota Society of Clinical Pathologists
Tumor Clinic (Continued) St. Luke’s Hospital
2:00 Scientific Session on Diseases of the Chest. . St. Louis Room, Armory
Surgery of Valvular Heart Disease — Ivan Baronofsky, Minneapolis
Ciliary Action and Atelectasis — Anderson Hilding, Duluth
The Significance of Isolated Nodules in the Lung — David Sharp, Minneapolis;
T. J. Kinsella, Minneapolis
The Clinical Evaluation of Pulmonary Insufficiency — Philip Soucheray, Saint Paul
Perforations of the Esophagus — W. D. Seybold, Rochester
NINETY-SEVENTH ANNUAL MEETING
A.M.
8:30
9:00
10:00
10:15
11 :00
P.M.
12:15
12:15
1 :30
2:00
3:05
3:15
4:00
5:00
5:15
7:00
A.M.
9:00
11 :00
2:00
Tuesday. June 13, 1950
SECTION I GENERAL SESSION
M orning
Visit Scientific and Technical Exhibits Armory
Intravenous Treatment Armory
Blood Transfusions — R. W. Koucky, Minneapolis
Newer Solutions — John S. Lundy, Rochester
Dangers — Robert Elman, Washington University Medical School, St. Louis, Missouri
Question and Answer Period
Intermission
Visit Scientific and Technical Exhibits Armory
Northwestern Pediatric Society Armory
The Common Hemorrhagic Diseases of Childhood — Armand J. Quick, Marquette
University, School of Medicine, Milwaukee, Wisconsin
Presentation of Speaker — Northrop Beach, President, Northwestern Pediatric Society
Afternoon
Obstetric Manikin Demonstration Hotel Spalding
Ralph A. Ries, Associate Professor of Obstetrics and Gynecology, Northwestern
University, Evanston, Illinois
Round Table Luncheons
Visit Scientific and Technical Exhibits Armory
Newer Aspects of Urinary Tract Infections Armory
Diagnosis — Baxter A. Smith, Jr., Minneapolis
Office Treatment — Harold J. Walder, Duluth
Surgery — -Frederic E. B. Foley, St. Paul
Question and Answer Period
Intermission
Visit Scientific and Technical Exhibits Armory
Panel Discussion Armory
Dystocia — Ralph A. Reis, Associate Professor of Obsterics and Gynecology, North-
western University, Evanston, Illinois ; Robert E. McDonald, Assistant Clinical
Professor of Obstetrics and Gynecology, Marquette University, Milwaukee,
Wisconsin ; Russell J. Moe, Duluth
Visit Scientific and Technical Exhibits Armory
Obstetric Manikin Demonstration Armory
Robert E. McDonald, Assistant Clinical Professor of Obstetrics and Gynecology,
Marquette Lhfiversity, Milwaukee, Wisconsin
Evening
Annual Banquet Ballroom, Hotel Duluth
Presiding: L. R. Gowan, President, St. Louis County Medical Society
Introduction of Mrs. Charles W. Waas, St. Paul, President, Woman’s Auxiliary
Presentation of Fifty Club Certificates
Presentation of Southern Minnesota Medical Association Medal
Presentation of Distinguished Service Medal
Presidential Address — F. J. Elias, Duluth, President, Minnesota State Medical
Association
Address — Are We Ashamed of the Things Thai Have Made Us Great?
Laurence M. Gould, Ph.D., President, Carleton College, Northfield, Minnesota
Tuesday, June 13, 1950
SECTION II SPECIAL SESSION
Morning
Orthopedic and Fracture Surgery
Care of Cerebral Palsy — John Pohl, Minneapolis
Elbow Fractures in Children — Donald Lannin, Saint Paul
Plateau Fractures of the Tibia— Donovan McCain, Saint Paul
Intermission
Prolapsed Intervertebral Disc Is Not the Only Cause of Back and Sciatic Pain
H. Herman Young, Rochester
Open Discussion of the Back Problem — John Pohl, E. T. Evans, Herman Young
Flat Feet — Mark Coventry, Rochester
Afternoon
American College of Allergists
Introduction — Fred W. Wittich, Minneapolis, Secretary-Treasurer, The American
College of Allergists
484
Minnesota Medicine
NINETY-SEVENTH ANNUAL MEETING
2:15 Skin Allergy, Newer Trends in Diagnosis and Management — Stephan Epstein,
Marshfield Clinic, Marshfield, Wisconsin, Clinical Associate Professor of
Dermatology, Lfifiversity of Minnesota
10-minute discussion
2:45 Respiratory Allergy
Hay Fever — Including Nonspecific and Specific Therapy — Fred W. Wittich, et al.,
Minneapolis
10-minute discussion
Recess
4:00 Allergic Rhinitis and Bronchial Asthma — Albert V. Stoesser, Lloyd S. Nelson,
University of Minnesota
15- minute discussion
4:45 Status Asthmaticus — William S. Eisenstadt, Minneapolis
Wednesday. June 14, 1950
SECTION I GENERAL SESSION
A.M.
8:30 Visit Scientific and Technical Exhibits Armory
9:00 Medical Applications of Radioactive Isotopes
Physical Background — James Marvin, Minneapolis
The Application of Radioisotopes to Basic Research Problems — Leon Singer, Minne-
apolis
Clinical Applications of Radioisotopes — Howard L. Horns, Minneapolis
10 :00 Question and Answer Period
10:15 Intermission
Visit Scientific and Technical Exhibits Armory
11:00 Psychosomatic Medicine — Stewart Wolf, Associate Professor of Medicine,
Cornell University Medical College, New York, N. Y Armory
11 :50 Question and Answer Period
P.M. Afternoon
12:15 Obstetric Manikin Demonstration Hotel Spalding
Rodney F. Sturley, St. Paul, Clinical Instructor in Obstetrics and Gynecology, Uni-
versity of Minnesota
12:15 Round Table Luncheons
1:30 Visit Scientific and Technical Exhibits Armory
2:00 Atomic Energy in War and Peace Armory
Jan H. Tillisch, Rochester, Presiding Chairman
March of Time Film , — “Atomic Power”
The Physics of Atomic Energy of the Geiger-Mueller Counter — Howard A. Carter,
Ph.D., Secretary Council on Physical Medicine and Rehabilitation, AMA
Medical Aspects of Atomic Explosion — Colonel Elbert DeCoursey, Office of the Sur-
geon General, Washington, D. C.
U. S. Army Film — “Operation Crossroads”
The Minnesota Program — Colonel Ernest B. Miller, State Director, Civil Defense
and Disaster Relief, Adjutant General’s Office, Saint Paul
Wednesday, June 14, 1950
SECTION II — SPECIAL SESSION
A.M.
9:00 Minnesota Academy of Ophthalmology and Otolaryngology — St. Mary’s Hospital
Staff Room
Presentation of Eye, Ear, Nose and Throat subjects by members of the Minnesota
Academy of Ophthalmology and Otolaryngology
May, 1950
485
Minnesota State Medical Association
Roster for 1950
Officers
F. J. Elias, M.D. . . .
W. F. Hartfiel, M.D
C. W. Moberg, M.D. .
B. B. Souster, M.D.
W. H. Condit, M.D. .
C. G. Sheppard, M.D.
H. M. Carryer, M.D.
R. R. Rosell
Councilors*
President Duluth
. . . First Vice President . . . Saint Paul
.. Second Vice President Detroit Lakes
Secretary Saint Paul
Treasurer Minneapolis
Speaker, House of Delegates Hutchinson
Vice Speaker Rochester
. . . Executive Secretary Saint Paul
First District
R. L. J. Kennedy, M.D. (1950) Rochester
Second District
L. L. Sogge, M.D. (1950) Windom
Third District
L. G. Smith, M.D. (1952) Montevideo
Fourth District
H. J. Nilson, M.D. (1951) North Mankato
Fifth District
Justus Ohage, M.D. (1952) Saint Paul
Sixth District
O. J. Campbell, M.D. (1951) (Chairman) Minneapolis
Seventh District
W. W. Will, M.D. (1952) Bertha
Eighth District
W. L. Burnap, M.D. (1951) Fergus Falls
Duluth
Ninth District
A. O. Swenson, M.D. (1950)
House of Delegates, American Medical Association*
Members
J. A. Bargen, M.D. (1950) Rochester
W. A. Coventry, M.D. (1950) Duluth
A. E. Cardle, M.D. (1951) Minneapolis
George Earl, M.D. (1951) Saint Paul
* Terms expire December 31 of year indicated.
Alternates
J. C. Hultkrans, M.D. (1950 Minneapolis
W. L. Burnap, M.D. (1950) Fergus Falls
W. W. Will, M.D. (1951) Bertha
E. M. Hammes, M.D. (1951) Saint Paul
Scientific Committees
COMMITTEE ON SCIENTIFIC ASSEMBLY
F. J. Elias, M.D., General Chairman Duluth
E. M. Hammes, M.D Saint Paul
R. R. Rosell Saint Paul
SECTION ON MEDICINE
J. A. Bargen, M.D Rochester
H. B. Sweetser, Jr., M.D Minneapolis
SECTION ON SPECIALTIES
G. I. Badeaux, M.D Brainerd
C. B. Nessa, M.D Saint Cloud
SECTION ON SURGERY
A. H. Pederson, M.D Saint Paul
M. G. Gillespie, M.D Duluth
LOCAL ARRANGEMENTS
A. J. Spang, M.D Duluth
COMMITTEE ON ANESTHESIOLOGY
R. C. Adams, M.D Rochester
J. W. Baird, M.D Minneapolis
J. H. Crowley, M.D Saint Paul
R. T. Knight, M.D Minneapolis
K. E. Latterell, M.D Duluth
T. H. Seldon, M.D Rochester
COMMITTEE ON CANCER*
A. H. Wells, M.D. (1950) Duluth
D. P. Anderson, Jr., M.D. (1952) Austin
Herbert Boysen, M.D. (1952) Madelia
D. S. Fleming, M.D. (1950) Minneapolis
M. G. Fredericks, M.D. (1950) Duluth
E. C. Hartley, M.D. (1952) Saint Paul
J. A. Johnson, M.D. (1951) Minneapolis
N. L. Leven M.D. (1950) Saint Paul
T. B. Magath, M.D. (1950) Rochester
F. H. Magney, M.D. (1951) Duluth
Martin Nordland, M.D. (1951) Minneapolis
I. L. Oliver, M.D. (1952) Graceville
*Terms expire December 31 of year indicated.
COMMITTEE ON CHILD HEALTH
G. B. Logan, M.D Rochester
S. L. Arey, M.D Minneapolis
F. G. Hedenstrom, M.D Saint Paul
R. J. Josewski, M.D Stillwater
R. L. j. Kennedy, M.D Rochester
E. E. Novak, M.D New Prague
R. E. Nutting, M.D Duluth
W. B. Richards, M.D Saint Cloud
L. F. Richdorf, M.D Minneapolis
A. B. Rosenfield, M.D Minneapolis
V. O. Wilson, M.D Rochester
O. S. Wyatt, M.D Minneapolis
Irvine McQuarrie, M.D. (ex officio) Minneapolis
486
Minnesota Medicine
ROSTER
COMMITTEE ON CONSERVATION OF HEARING
L. R. Boies, M.D Minneapolis
W L. Burnap, M.D Fergus Falls
C. E. Connor, M.D Saint Paul
J. B. Gaida, M.D Saint Cloud
A. V. Garlock, M.D Beraidji
G. J. Halladay, M.D Minneapolis
A. C. Hilding, M.D Duluth
C. L. Lundell, M.D Granite Falls
0. B. Patch, M.D Duluth
R. E. Priest, M.D Minneapolis
K. M. Simonton, M.D Rochester
Andrew Sinamark, M.D Ilibbing
G. E. Strate, M.D Saint Paul
COMMITTEE ON DIABETES
J. R. Meade, M.D Saint Paul
C. N. Harris, M.D Hibbing
J. A. Lepak, M.D Saint Paul
J. K. Moen, Jr., M.D Minneapolis
W. S. Neff, M.D Virginia
B. F. Pearson, M.D Shakopee
R. H. Puumala, M.D Cloquet
E. H. Rynearson, M.D Rochester
R. V. Sherman, M.D Red Wing
C. J. Watson, M.D Minneapolis
COMMITTEE ON FIRST AID AND RED CROSS
J. S. Lundy, M.D Rochester
E. R. Anderson, M.D Minneapolis
G. I. Badeaux, M.D Brainerd
Charles Bagley, M.D Duluth
Paul F. Dwan, M.D Minneapolis
J. W. Edwards, M.D Saint Paul
B. A. Flesche, M.D Lake City
A. F. GiesEn, M.D Starbuck
G. H. Goehrs, M.D Saint Cloud
E. V. Goltz, M.D Saint Paul
COMMITTEE ON FRACTURES
E. T. Evans, M.D Minneapolis
N. H. Baker, M.D Fergus Falls
O. K. Behr, M.D Crookston
W. H. Cole, M.D Saint Paul
B. C. Ford, M.D Marshall
R. K. Ghormley, M.D Rochester
V. P. Hauser, M.D Saint Paul
T. H. Moe, M.D Minneapolis
M. J. Nydahl, M.D Minneapolis
L. G. Rigler, M.D Minneapolis
J. A. Thabes, Jr., M.D ..Brainerd
M. H. Tibbetts, M.D Du|uth
Nels Westby, M.D Madison
COMMITTEE ON GENERAL PRACTICE
R. H. Creighton, M.D Minneapolis
E. C. Bayley, M.D ...Lake City
R. M. Burns, M.D Saint Paul
C. S. Donaldson, M.D Foley
J. F. DuBois, M.D Sauk Centre
R. J. Eckman, M.D Duluth
R. E, Gruys, M.D Windom
W. E. Hart, M.D Monticello
W. W. RiEke, M.D Wayzata
C. H. Sherman, M.D Bayport
HEART COMMITTEE*
F. P. Hirschboeck, M.D. (1951) Duluth
G. N. Aagaard, Jr., M.D. (1950) Minneapolis
C. A. Boline, M.D. (1952) Battle Lake
P. G. Boman, M.D. (1951) Duluth
J. F. Borg, M.D. (1951) Saint Paul
P. F. Dwan, M.D. (1952) Minneapolis
C. N. Hensel, M.D. (1952) Saint Paul
M. M. Hurwitz, M.D. (1950) Saint Paul
Charles Koenigsberger, M.D. (1950) Mankato
R. L. Nelson, M.D. (1952) Duluth
M. J. Shapiro, M.D. (1950) Minneapolis
H. L. Smith, M.D. (1951) Rochester
S. M. White, M.D. (1952) Minneapolis
Arlie R. Barnes, M.D. (ex officio) Rochester
‘Terms expire December 31 of year indicated.
HISTORICAL COMMITTEE
Robert Rosenthal, M.D,
H. M. Weber, M.D
Richard Bardon, M.D..
F. H. Dubbe, M.D
Olga Hansen, M.D
R. C. Hunt, M.D
F. R. Huxley, M.D....
A. G. Liedloff, M.D....
O. F. Mellby, M.D
G. E. Sherwood, M.D..
A. M. Watson, M.D. ...
May. 1950
Saint Paul
Rochester
Duluth
New Ulm
f Minneapolis
Fairmont
Faribault
Mankato
....Thief River Falls
Kimball
Royalton
COMMITTEE ON HOSPITALS AND
MEDICAL EDUCATION
H. S. Diehl, M.D
A. R. Barnes, M.D
T. E. Bratrud, M.D
T. E. Broadie, M.D
E. W. Humphrey, M.D. .
C. C. Kennedy, M.D
A. J. Spang, M.D
H. L. Ulrich, M.D
W. H. Valentine, M.D. .
H. B. ZlMMERMANN, M.D
Minneapolis
Rochester
Thief River Falls
Saint Paul
Moorhead
. . . . . .Minneapolis
Duluth
. . . . . .Minneapolis
Tracy
Saint Paul
i
COMMITTEE ON INDUSTRIAL HEALTH
L. S. Arling, M.D
T. E. Barber, Jr., M.D.
N. W. Barker, M.D
C. C. Bell, M.D
E. E. Christensen, M.D.
L. W. Foker, M.D
G. H. Goehrs, Jr. M.D..
C. W. Jacobson, M.D...
T. A. Lowe, M.D
O'. L. McHaffie, M.D..
J. R. McNutt, M.D....
A. E. Wilcox, M.D.....
J. F. Shronts, M.D....,
A. A. Zierold, M.D
Minneapolis
Austin
Rochester
Saint Paul
Winona
Minneapolis
Saint Cloud
Chisholm
South Saint Paul
Duluth
Duluth
Minneapolis
Minneapolis
Minneapolis
COMMITTEE ON MATERNAL HEALTH
J. J. Swendson, M.D Saint Paul
R. N. Andrews, M.D .*. Mankato
C. J. EhrenbErg, M.D Minneapolis
G. F. Hartnagel, M.D Red Wing
A. D. Hoidale, M.D Tracy
A. B. Hunt, M.D Rochester
J. L. McKelvey, M.D Minneapolis
F. L. Schade, M.D Worthington
J. F. Schaefer, M.D Owatonna
F. J. Schatz, M.D Saint Cloud
A. O. Swenson, M.D Duluth
V. O. Wilson, M.D Rochester
COMMITTEE ON MEDICAL TESTIMONY
E. M. Hammes, Sr., M.D Saint Paul
B. S. Adams, M.D > Hibbing
L. A. Barney, M.D Duluth
H. Z. Giffin, M.D Rochester
S. R. Maxeiner, M.D Minneapolis
L. H. Rutledge, M.D Detroit Lakes
W. G. Workman, M.D Tracy
COMMITTEE ON MILITARY AFFAIRS
J. H. Tillisch, M.D Rochester
M. S. Belzer, M.D Minneapolis
E. G. Benjamin, M.D Minneapolis
J. J. Catlin, M.D Buffalo
R. V. Fait, M.D ....Little Falls
M. G. Gillespie, M.D Duluth
R. P. Griffin, M.D Benson
K. E. Johnson, M.D Duluth
W. P. Ritchie, M.D Saint Paul
A. K. Stratte, M.D Pine City
COMMITTEE ON NERVOUS AND MENTAL
DISEASES
W. P. Gardner, M.D Saint Paul
J. R. Brown, M.D Rochester
S. A. Challman, M.D Minneapolis
L. R. Gowan, M.D Duluth
R. C. Gray, M.D Minneapolis
B. P. Grimes, M.D Saint Peter
E. M. Hammes, Jr., M.D Saint Paul
W. H. Hengstler, M.D Saint Paul
W. L. Patterson, M.D Fergus Falls
COMMITTEE ON OPHTHALMOLOGY
T. R. Fritsche, M.D...
A. F. Adair, Jr., M.D.
W. L. Benedict, M.D.
F. P. Frisch, M.D....
H. W. Grant, M.D. . . .
E. W. Hansen, M.D...
H. C. Johnson, M.D.. .
F. N. Knapp, M.D
L. W. Morseman, M.D.
C. L. Oppegaard, M.D.
C. E. Stanford, M.D. .
W. T. Wenner, M.D..
. .New Ulm
. Saint Paul
. .Rochester
. . . . Willmar
• Saint Paul
Minneapolis
... Mankato
Duluth
. . . . Hibbing
. . Crookston
Minneapolis
Saint Cloud
487
ROSTER
COMMITTEE OX PUBLIC HEALTH XURSIXG
M. McC. Fischer, M.D Duluth
F. S. Babb, M.D Saint Paul
L. V. Berghs, M.D Owatonna
W. C. Chambers, M.D Blue Earth
L. F. Davis, M.D Wadena
J. N. Libert, M.D Saint Cloud
C. E. Merkert, M.D Minneapolis
COMMITTEE OX SYPHILIS AND SOCIAL
DISEASES
P. A. O’Leary, M.D Rochester
J. A. Butzer, M.D Mankato
G. C. Doyle, M.D Duluth
W. E. Hatch, M.D Duluth
H. G. Irvine, M.D Minneapolis
F. W. Lynch, M.D Saint Paul
H. E. Michelson, M.D Minneapolis
C. W. Moberg, M.D Detroit Lakes
S. E. S weitzer, M.D ..Minneapolis
COMMITTEE OX TUBERCULOSIS
J. A. Myers, M.D Minneapolis
R. N. Barr, M.D Saint Paul
R. E. Boynton, M.D Minneapolis
J. F. Briggs, M.D Saint Paul
F. F. Callahan, M.D Saint Paul
S. S. Cohen, M.D Oak Terrace
K. A. Danielson, M.D Litchfield
R. E. Hansen, M.D Hibbing
G. A. Hedberg, M.D Nopeming
C. H. Hodgson, M.D Rochester
L. S. Jordan, M.D Granite Falls
T. J. Kinsella, M.D Minneapolis
Thomas Lowry, M.D Minneapolis
Hilbert Mark, M.D Minneapolis
E. A. Meyerding, M.D Saint Paul
W. E. Peterson, M.D Willmar
K. H. Pfuetze, M.D Cannon Falls
C. G. Sheppard, M.D Hutchinson
S. A. Slater, M.D Worthington
W. H. Ude, M.D Minneapolis
COMMITTEE OX VACCIXATIOX AXD
IMMUNIZATION
R. N. Barr, M.D Saint Paul
E. E. Barrett, M.D Duluth
A. J. Chesley, M.D Saint Paul
W. W. Higgs, M.D Park Rapids
C. O. Kohlbry, M.D Duluth
L. F. Richdorf, M.D Minneapolis
R. B. J. Schoch, M.D Saint Paul
C. S. Strathern, M.D Saint Peter
R. L. Wilder, M.D Minneapolis
Non-Scientific Committees
EDITING AXD PUBLISHING COMMITTEES*
E. M. Hammes, Sr., M.D. (1951) Saint Paul
P. F. Donohue, M.D. (1953) Saint Paul
H. W. Meyerding, M.D. (1954) Rochester
B. O. Mork, Jr., M.D. (1951) Minneapolis
C. L. Oppegaard, M.D. (1950) Crookston
T. A. Peppard, M.D. (1952) Minneapolis
H. A. Roust, M.D. (1953) Montevideo
O. W. Rowe, M.D. (1952) Duluth
H. L. Ulrich, M.D. (1950) Minneapolis
A. H. Wells, M.D. (1954) Duluth
'Terms expire December 31 of year indicated.
1XSURAXCE LIAISOX COMMITTEE
A. W. Adson, M.D Rochester
B. S. Adams, M.D Hibbing
B. J. Branton, M.D Willmar
L. A. Dwinnell, M.D Fergus Falls
B. J. Gallagher, M.D Waseca
P. W. Harrison, M.D Worthington
V. P. Hauser, M.D Saint Paul
R. W. Morse, M.D Minneapolis
A. H. Zachman, M.D Melrose
COMMITTEE OX IXTERPROFESSIOXAL RELATIOXS
W. P. Gardner, M.D Saint Paul
M. J. Anderson, M.D Rochester
J. J. Catlin, M.D Buffalo
E. E. Christensen, M.D Winona
K. A. Danielson. M.D Litchfield
C. O. Estrem, M.D Fergus Falls
K. R. Fawcett, M.D Duluth
M. I. Hauge, M.D Clarkfield
J. M. Hayes, M.D Minneapolis
R. F. Hedin, M.D Red Wing
Arthur Neumaier, M.D Glencoe
F. J. Savage, M.D Saint Paul
L. G. Smith, M.D Montevideo
W. H. Valentine, M.D Tracy
COMMITTEE OX MEDICAL ECOXOMICS
George Earl, M.D. (General Chairman) Saint Paul
Executive
George Earl, M.D Saint Paul
A. W. Adson, M.D Rochester
A. E. Cardle, M.D Minneapolis
R. F. Erickson, M.D Minneapolis
W. H. Hengstler, M.D Saint Paul
R. D. Mussey, M.D Rochester
C. E. Proshek, M.D Minneapolis
Editorial
George Earl, M.D Saint Paul
W. F. Braasch, M.D Rochester
W. L. Patterson, M.D Fergus Falls
H. F. R. Plass, M.D Minneapolis
D. W. Wheeler, M.D Duluth
MEDICAL ADVISORY COMMITTEE
W. H. Hengstler, M.D Saint Paul
B. J. Branton, M.D Willmar
Ivar Sivertsen, M.D Minneapolis
COMMITTEE OX MEDICAL ETHICS
R. D. Mussey, M.D Rochester
H. S. Diehl, M.D Minneapolis
P. E. Hermanson, M.D Hendricks
Harry Klein, M.D Duluth
C. E. Rea, M.D Saint Paul
COMMITTEE OX MEDICAL SERVICE
A. W. Adson, M.D Rochester
F. S. Babb, M.D Saint Paul
J. A. Bargen, M.D Rochester
B. G. Lannin, M.D Saint Paul
C. B. McKaig, M.D Pine Island
R. A. Murray, M.D Hibbing
J. F. Norman, M.D Crookston
G. R. Penn, M.D Mankato
H. F. R. Plass, M.D Minneapolis
R. E. Priest, M.D... Minneapolis
E. J. Simons, M.D Swanville
A. O. Swenson, M.D Duluth
W. W. Will, M.D Bertha
COMMITTEE OX STATE HEALTH RELATIOXS
C. E. Proshek, M.D Minneapolis
Earl Barrett, M.D Duluth
E. C. Bayley, M.D Lake City
R. B. Bray, M.D Biwabik
C. S. Donaldson, M.D Foley
John Earl, M.D Saint Paul
R. R. Heim, M.D Minneapolis
D. L. Johnson, M.D Little Falls
A. G. LiEdloff, M.D Mankato
C. N. McCloud, Jr., M.D Saint Paul
Carl Simison, M.D Barnesville
S. A. Slater, M.D Worthington
COMMITTEE OX PUBLIC HEALTH EDUCATIOX
A. E. Cardle, M.D. (General Chairman) Minneapolis
Executive
A. E. Cardle, M.D Minneapolis
R. M. Burns, M.D Saint Paul
H. M. Carryer, M.D Rochester
C. B. Drake, M.D Saint Paul
(And Chairmen of all Scientific Committees)
Editorial
C. B. Drake, M.D Saint Paul
K. W. Anderson. M.D Minneapolis
R. P. Buckley, M.D Duluth
G. W. Clifford, M.D Alexandria
T. J. Edwards, M.D Saint Paul
H. W. Schmidt, M.D Rochester
RADIO COMMITTEE
R. M. Burns, M.D Saint Paul
G. N. Aagaard, Jr., M.D Minneapolis
R. N. Andrews, M.D Mankato
C. M. Bagley, M.D Duluth
N. W. Barker, M.D Rochester
C. N. Harris, M.D Hibbing
E. A. Heiberg, M.D , Fergus Falls
R. N. Jones, M.D Saint Cloud
F. R. Kotchevar, M.D Eveleth
L. R. Prins, M.D Albert Lea
R. H. Wilson, M.D Winona
m
Minnesota Medicine
ROSTER
SPEAKERS’ BUREAU
COMMITTEE ON RURAL MEDICAL SERVICE
H. M. Carryer, M.D Rochester
G. N. Aagaard, Jr., M.D Minneapolis
J. F. Briggs, M.D Saint Paul
J. W. Duncan, M.D Moorhead
P. J. Hiniker, M.D Le Sueur
P. A. Lommen, M.D Austin
Gordon MacRae, M.D Duluth
J. F. Norman, M.D Crookston
J. D. Van Valkenburg, M.D Flood-wood
M. 0. Wallace, M.D Duluth
COMMITTEE ON PUBLIC POLICY
R. F. Erickson, M.D. (Chairman) Minneapolis
L. L. Sogge, M.D. (Consultant) Windom
A. W. Adson, M.D Rochester
K. W. Anderson, M.D Minneapolis
G. I. Badeaux, M.D Brainerd
L. A. Barney, M.D Duluth
F. W. Behmler, M.D ..Morris
Edward Bratrud, M.D Thief River Falls
R. M. Burns, M.D Saint Paul
O. J. Campbell, M.D Minneapolis
J. F. Du Bois, M.D Sauk Centre
J. M. Hayes, M.D Minneapolis
P. E. Hermanson, M.D Hendricks
V. M. Johnson, M.D Dawson
E. J. Kaufman, M.D Appleton
M. E. Lenander, M.D Saint Peter
J. N. Libert, M.D Saint Cloud
C. J. T. Lund, M.D Fergus Falls
M. O. Oppegaard, M.D Crookston
C. E. Proshek, M.D Minneapolis
R. H. Puumala, M.D Cloquet
L. H. Rutledge, M.D Detroit Lakes
H. R. Tregilgas, M.D South Saint Paul
J. C. Vezina, M.D Mapleton
Magnus Westby, M.D Madison
R. H. Wilson, M.D Winona
MINNESOTA STATE CERTIFICATION BOARD ON
PBULIC HEALTH NURSING
F. J. Savage, M.D Saint Paul
First District
P. C. Leck, M.D. (Chairman) Austin
Second District
V. M. Doman, M.D Lakeheld
Third District
Magnus Westby, M.D Madison
Fourth District
F. J. Traxler, M.D Henderson
Fifth District
A. K. Stratte, M.D Pine City
Sixth District
W. E. Hart, M.D Monticello
Seventh District
E, J. Schmitz, M.D Holdingford
Eighth District
C. W. Jacobson, M.D Breckenridge
Ninth District
J. K. Butler, M.D Cloquet
COMMITTEE ON UNIVERSITY RELATIONS
E. M. Hammes, Sr., M.D Saint Paul
A. E. Cardle, M.D Minneapolis
L. A. Buie, M.D Rochester
E. J. Simons, M.D Swanville
E. L. Tuohy, M.D Duluth
COMMITTEE ON VETERANS MEDICAL SERVICE
R. H. Creighton, M.D Minneapolis
S. H. Boyer, Jr., M.D Duluth
C. J. Fritsche, M.D New Ulm
W. P. Ritchie, M.D Saint Paul
C. A. Wilmot, M.D Litchfield
County Medical Advisory Committees
AITKIN COUNTY
F. C. Closuit Aitkin
H. T. Petraborg Aitkin
I. L. Mitby Aitkin
ANOKA COUNTY
R. J. Spurzem Anoka
R. J. Mork Anoka
Ralph Larson Anoka
CASS COUNTY
O. F. Ringle Walker
C. H. Coombs Cass Lake
CHIPPEWA COUNTY
L. G. Smith Montevideo
M. A. Roust Montevideo
Ludwig Lima Montevideo
M. A. Burns Milan
BECKER COUNTY
H. C. Otto- • Frazee
A. R. Ellingson Detroit Lakes
Arnold Larson Detroit Lakes
BELTRAMI COUNTY
D. H. Garloc Bemidji
T. P. Groschupf.. • Bemidji
D. D. Whittemore Bemidji
BENTON COUNTY
William Friesleben Sauk Rapids
C. S. Donaldson Foley
N. F. Musachio Foley
BIG STONE COUNTY
C. I. Oliver Graceville
IOtto Bergan Clinton
D. M. O’Donnell Ortonville
BLUE EARTH COUNTY
R. N. Andrews Mankato
R. G. HassEtt- ■ Mankato
J. C. Vezina Mapleton
BROWN COUNTY
Albert Fritsche New Ulm
C. A. SaffErt \ New Ulm
W. G. Nuessle Springfield
O. B. Fesenmaier New Ulm
A. P. Goblirsch Sleepy Eye
CHISAGO COUNTY
T. E. Halpin ....
A. E. Holmes. . .
R. G. Swensen . . .
CLAY COUNTY
Allan E. Moe. . .
0. H. Johnson . . .
T. W. Duncan . . .
CLEARWATER COUNTY
L. J. Larson . . . .
W. E. Anderson
COOK COUNTY
W. R. Smith . . . .
COTTONWOOD COUNTY
H. C. Stratte. . .
E. S. Schutz . . . .
J. V. Carlson . . . .
CROW WING COUNTY
. Mountain Lake
V. E. Quanstrom
G. I. Badeaux...
T. B. Nixon
DAKOTA COUNTY
A. D. Field
K. E. Stein
Paul G. Polski..
. South St. Paul
CARLTON COUNTY
J. K. Butler Cloquet
R. M. Eppard Cloquet
E. O. Hanson Cloquet
DODGE COUNTY
C. E. Bigelow Dodge Center
H. R. Baker Hayfield
D. E. Affeldt. . Kasson
CARVER COUNTY
M. B. Hebeisen Chaska
B. H. Simons Chaska
R. E. Pogue Watertown
DOUGLAS COUNTY
G. W. Clifford Alexandria
L. M. Boyd Alexandria
A. R. Blakey Osakis
May, 1950
489
ROSTER
FARIBAULT COUNTY
W. C. Chambers Blue Earth
M. D. Cooper Winnebago
VV. H. Barr Wells
FILLMORE COUNTY
H. M. Skaug
Carl G. Nelson
L. W. Clark
FREEBORN COUNTY
S. A. Whitson
R. A. Demo
C. E. J. Nelson
L. E. Steiner
Chatfield
Harmony
Spring Valley
Albert Lea
Albert Lea
Albert Lea
. Albert Lea
GOODHUE COUNTY
S. H. Anderson Red Wing
W. W. Liffrig Red Wing
G. F. Hartnagel Red Wing
GRANT COUNTY
L. R. Parson Elbow Lake
E. T. Reeve Elbow Lake
A. M. Randall Ashby
RURAL HENNEPIN COUNTY
W. W. Rieke Wayzata
H. E. Drill Hopkins
E. J. LillehEi Robbinsdale
N. T. Norris. . .
L. K. Onsgard.
L. A. Knutson
HOUSTON COUNTY
Caledonia
Houston
Spring Grove
HUBBARD COUNTY
Donald Houston Park Rapids
W. W. Higgs Park Rapids
John Eiler Park Rapids
ISANTI COUNTY
L. H. Hedenstrom Cambridge
W. T. Nygren Braham
Richard Whitney Cambridge
ITASCA COUNTY
E. K. Rowles.
G. M. Erskine
M. J. McKenna
.... Coleraine
Grand Rapids
Grand Rapids
JACKSON COUNTY
J. T. Rose .Lakefield
W. S. Hitchings Lakefield
W. H. Halloran Jackson
KANABEC COUNTY
C. S. Bossert Mora
W. F. Nohdman Mora
MAHNOMEN COUNTY
K. W. Covey Mahnomen
K. A. Danford Mahnomen
MARSHALL COUNTY
A. E. Carlson Warren
I. G. Wiltrout Oslo
C. N. Holmstrom Warren
MARTIN COUNTY
R. C. Hunt Fairmont
O. E. Wandke Fairmont
J. M. Grogan Ceylon
MCLEOD COUNTY
H. H. Holm Glencoe
A. M. Jensen Brownton
E. W. Lippmann Hutchinson
MEEKER COUNTY
H. E. Wilmot Litchfield
John Verby Litchfield
Lennox Danielson Litchfield
MILLE LACS COUNTY
Melvin Vik Onamia
VV. R. Blomberg Princeton
V. T. Kapsner Princeton
MORRISON COUNTY
D. L. Johnson Little Falls
Alex Watson Royalton
E. J. Simons Swanville
MOWER COUNTY
R. S. Hegge Austin
P. A. Robertson Austin
R. R. Wright Austin
L. F. Twiggs i Austin
MURRAY COUNTY
B. M. Stevenson Fulda
R. F. Pierson Slayton
H. D. Patterson Slayton
NICOLLET-LE SUEUR COUNTY
Hobart Johnson North Mankato
L. E. Sjostrom St. Peter
M. E. Lenander St. Peter
NOBLES COUNTY
E. W. Arnold Adrian
E. A. Kilbride Worthington
C. R. Stanley Worthington
NORMAN COUNTY
Eskil Erickson Halstad
Theodore Loken Ada
Bruce Boynton Ada
KANDIYOHI COUNTY
R. J. Hodapp Willmar
R. K. Proeshel Willmar
H. G. Bosland.... Willmar
KITTSON COUNTY
G. A. Knutson Hallock
A. S. Berlin Hallock
R. B. Skogerboe Karlstad
OLMSTED COUNTY
H. F. Polley Rochester
T. O. Wellner Rochester
C. B. McKaig - Pine Island
OTTER TAIL COUNTY
Charles Lewis Henning
W. L. Burnap Fergus Falls
Howard Kaliher Pelican Rapids
R. D. Hanover
David Potek .
C. C. Craig . . .
KOOCHICHING COUNTY
Little Fork
International Falls
International Falls
PENNINGTON COUNTY
O. F. Mellby Thief River Falls
T. E. Bratrud Thief River Falls
M. D. Starekow Thief River Falls
LAC QUI PARLE COUNTY
Magnus Westby Madison
V. M. Johnson Dawson
George Boody, Jr Dawson
LAKE COUNTY
Ralph Papermaster Two Harbors
LAKE OF THE WOODS COUNTY
A. A. Brink • • Baudette
LINCOLN COUNTY
A. L. Vadheim Tyler
P. E. Hermanson Hendricks
George FriedEll Ivanhoe
PINE COUNTY
A. K. StrattE Pine City
E. G. Hubin Sandstone
H. P. Dredge Sandstone
PIPESTONE COUNTY
W. G. Benjamin *. Pipestone
J. G. Lohmann Pipestone
G. Beckehing Edgerton
FOLK COUNTY
C. L. Oppegaard Crookston
J. F. Norman Crookston
George Sather Fosston
LYON COUNTY
B. C. Ford Marshall
A. D. Hoidale Tracy
W W. Yaeger Marshall
POPE COUNTY
Paul SwedenbERG Glenwood
A. F. GiesEn Starbuck
B. A. McIver Lowry
490
Minnesota Medicine
ROSTER
RAMSEY COUNTY
A. G. Schulze
T. S. McClanahan
Earl Black
St. Paul
White Bear Lake
St. Paul
RED LAKE COUNTY
L. M. Dale
James H. Reinhardt
REDWOOD COUNTY
R. A. Peterson
R. J. Cairns
.Red Lake Falls
Red Lake Falls
Vesta
Redwood Falls
RENVILLE COUNTY
J. Dordahl
A. M. Fawcett
J. A. Cosgriff
Sacred Heart
Renville
Olivia
RICE COUNTY
D. W. Francis
P. H. Weaver
Warren Wilson
Morristown
. . Faribault
. . Northfield
ROCK COUNTY
C. L. Sherman Luverne
O. W. Anderson Luverne
F. W. Bofenkamp Luverne
ROSEAU COUNTY
J. L. Delmore, Sr Roseau
D. O. Berge ..Roseau
L. O. Pearson \\ arroad
ST. UOUIS COUNTY
A. G. Athens
M. F. Fellows
H. G. Moehring
SCOTT COUNTY
H. M. Jurgens
B. F. Pearson
F. P. Kortsch
Duluth
Duluth
Duluth
Belle Plaine
. . . Shakopee
. . Prior Lake
SHERBURNE COUNTY
A. B. RoEhlxe Elk River
E. F. Clothier Elk River
G. H. Tesch Elk River
SIBLEY COUNTY
Rolf Hovde Winthrop
Thomas Martin Arlington
D. C. Olson Gaylord
STEARNS COUNTY
R. N. Jones St. Cloud
K. A. Walfred St. Cloud
C. F. Brigham St. Cloud
STEELE COUNTY
D. H. Dewey Owatonna
W. H. Peterson Owatonna
STEVENS COUNTY
M. L. Ransom Hancock
R. A. Rossberg Morris
A. I. Arneson Morris
SWIFT COUNTY
E. J. Kaufman Appleton
R. P. Griffin Benson
Hans Johnson Kerkhoven
M. E. Mosby
J. M. Cook
C. B. Will .
TODD COUNTY
Long Prairie
Staples
Bertha
TRAVERSE COUNTY
A. L. Lindberg Wheaton
A. E. Magnuson Wheaton
W. F. Muir Browns Valley
WABASHA COUNTY
C. G. OchsnEr Wabasha
E. C. Bayley Lake City
E. W. Ellis Elgin
WADENA COUNTY
L. T. Davis Wadena
C. H. Pierce Wadena
W. E. Parker Sebeka
WASECA COUNTY
O. J. Swenson Waseca
H. M. McIntire Waseca
B. J. Gallagher ..Waseca
May, 1950
WASHINGTON COUNTY
W. R. Humphrey
Russell E. Carlson
Stillwater
Stillwater
WATONWAN COUNTY
O. E. Hagen ;
F. L. Bregel
WILKIN COUNTY
W. E. Wray
WINONA COUNTY
R. H. Wilson
R. B. Tweedy
Herbert Heise
Butterfield
• St. James
Campbell
Winona
Winona
Winona
WRIGHT COUNTY
John J. Catlin Buffalo
C. L. Koholt Waverly
YELLOW MEDICINE COUNTY
R. H. Kath
E. R. H udec
Paul Schmidt
M. I. Hauge
. . Wood Lake
Echo
Granite Falls
. . . .Clarkfield
Councilor Districts
First District
R. L. J. Kennedy, M.D Rochester
Counties — Dodge, Fillmore, Freeborn, Goodhue, Hous-
ton, Mower, Olmsted, Rice, Steele, Wabasha, Winona
Second District
L. L. Sogge, M.D Windom
Counties — Cottonwood, Faribault, Jackson, Martin,
Murray, Nobles, Pipestone, Rock.
Third District
L. G. Smith, M.D Montevideo
Counties— Big Stone, Chippewa, Kandiyohi, Lac Qui
Parle, Lincoln, Lyon, Meeker, Pope, Renville, Stevens,
Swift, Traverse, Yellow Medicine.
Fourth District
H. J. Nilson, M.D North Mankato
Counties- — Blue Earth, Brown, Carver, Le Sueur, Mc-
Leod, Nicollet, Redwood, Scott, Sibley, Waseca, Wa-
tonwan.
Fifth District
Justus Ohage, M.D Saint Paul
Counties— Anoka, Chisago, Dakota, Isanti, Kanabec,
Mille Lacs, Pine, Ramsey, Sherburne, Washington.
Sixth District
O. J. Campbell, M.D Minneapolis
Counties — Hennepin, Wright.
Seventh District
W. W. Will, M.D Bertha
Counties — Aitkin, Beltrami, Benton, Cass, Clearwater,
Crow Wing, Hubbard, Koochiching, Morrison,
Stearns, Todd, Wadena.
Eighth District
W. L. Burnap, M.D Fergus Falls
Counties — Becker, Clay, Douglas, Grant, Kittson, Lake
of the Woods, Mahnomen, Marshall, Norman, Otter
Tail, Pennington, Polk, Red Lake, Roseau, Wilkin.
Ninth District
A. O. Swenson, M.D Duluth
Counties — Carlton, Cook, Itasca, Lake, St. Louis.
491
Woman’s Auxiliary
to the
Minnesota State Medical Association
Mrs. H. E. Bakkila
Mrs. Charles W. Waas . . .
Mrs. Harold F. Wahlquist
Mrs. Joseph M. Neal
Mrs. C. L. Sheedy
Mrs. F. P. Moersch
Mrs. F. J. Elias
Mrs. L. A. Stelter
Mrs. Harry Klein
Mrs. John Dordal
Mrs. O. M. Heiberg
Mrs. T. O. Young
Mrs. S. S. Hesselgrave
Mrs. W. A. Merritt
Mrs. Water Benjamin
Mrs. O. B. Fesenmaier
Mrs. A. A. Passer
Mrs. C. Harry Ghent
Mrs. Frederick H. K. Schaaf
Mrs. R. N. Jones
Mrs. C. L. Oppegaard
Mrs. M. C. Gillespie
Officers
President
President-Elect
Past President
First Vice President
Second Vice President
Third Vice President
Fourth Vice President
Recording Secretary
. . . . Corresponding Secretary . . . .
Treasurer
Auditor
Historian
Parliamentarian
Regional Advisors
First District
Second District
Third District
Fourth District
Fifth District
Sixth District
Seventh District
Eighth District
Ninth District
Duluth
. . . . St. Paul
. Minneapolis
. . . . St. Paul
Austin
. . . Rochester
Duluth
. Minneapolis
Duluth
Sacred Heart
Worthington
Duluth
. Center City
. Rochester
. Pipestone
New Ulm
Olivia
. . St. Paul
Minneapolis
. St. Cloud
Crookston
. . . Duluth
Chairmen of Committees
Standing Committees
Advisory — Mrs. A. J. Bianco Duluth
Archives— Mrs. T. N. Fleming St. Cloud
Bulletin — Mrs. W. H. Van der Weyer St. Paul
Cancer — Mrs. Mark Ryan St. Paul
Editor, Minnesota Medicine — Mrs. S. N.
Litman Duluth
Emergency Nursing — Mrs. George L.
Merkert Minneapolis
Finance — Mrs. Henry QulST Minneapolis
Hygeia — Mrs. J. A. Cosgriff Olivia
Legislation — Mrs. L. Raymond Scherer ...Minneapolis
Medical and Surgical Relief — Mrs. Virgil J.
Schwarts Minneapolis
Organization — Mrs. Charles W. Waas St. Paul
Press and Publicity — Mrs. N. O. Pearce. ... Minneapolis
Printing — Mrs. A. Christiansen St. Paul
Program and Health Education — Mrs. David
Halpern Brewster
Public Relations — Mrs. E. W. Miller Anoka
Resolutions — Mrs. H. H. Fesler St. Paul
Revisions — Mrs, George Penn Mankato
Social — Mrs. O. I. Sohlberg St. Paul
Special Committees
Nevus Letter — Mrs. Leonard Arling Minneapolis Roster — Mrs. Harold G. Benjamin Minneapolis
Workshop — Mrs. Reuben Erickson Minneapolis Health Days — Mrs. Harold Wahlquist ...Minneapolis
492 Minnesota Medicine
County Society Roster
Key to Symbols: ^Deceased; f Affiliate, Associate or Life Member;
^Affiliate or Life Membership Pending; iln Service; §Wife is Member of Woman’s Auxiliary.
BLUE EARTH COUNTY MEDICAL SOCIETY
President
Schmitz, A. A Mankato
Secretary
Jones, O. H Mankato
Aga. John Mankato
Andrews, R. N Mankato
jSBatdorf, B. N Good Thunder
SButzer, J. A Mankato
ItDahl, G. A Mankato
SDenman, A. V Mankato
tEdwards, R. T Columbus, Ohio
§Engstrom, Robert Mankato
§Eustermann, J. J Mankato
SFranchere, F. W Lake Crystal
§Fugina, G. R Mankato
Regular meetings, last Monday of each month
Annual meeting in May
Number of Members : 45
§Haes, J. E Mankato
§Hammar, L. M Mankato
Hankerson, R. G Minnesota Lake
IHassett, R. G Mankato
§Hoeper, P. G Mankato
iHoward, E. G Mapleton
§ Howard, M. I Mankato
§Huffington, H. L. Mankato
IJones, O. H Mankato
Ijuliar, R. O St. Clair
§Kaufman, W. B Mankato
§Kearney, R. W Mankato
§Keil, M. A Mankato
§Kemp, A. F Mankato
§Koenigsberger, Chas Mankato
SjLanghoff, A. H Mankato
Liedloff , A. G Mankato
Luck, Hilda Mankato
IMickelson, J. C Mankato
SMiller, V. I. Mankato
§Morgan, H. O Amboy
§Penn, G. E Mankato
SSamuelson, L. G. Mankato
tSchmidt, P. A Monroe, Oregon
ISchmitz, A. A. Mankato
jjSjoding, J. D Mankato
§Smith, P. M .Lake Crystal
StSohmer, A. E Mankato
§Stillwell, W. C Mankato
§Troost, H. B Mankato
IVezina, J. C Mapleton
§Von Drasek, J Mankato
§Wentworth, A. J Mankato
Williams, H. O Lake Crystal
BLUE EARTH VALLEY MEDICAL SOCIETY
Faribault and Martin Counties
Regular meetings, first Thursday of month
Annual meeting, first Thursday in November
Number of Members: 38
President
Hanson, Lewis Frost
Secretary
Boysen, Herbert Madelia
Armstrong, R. S Winnebago
§Bailey, R. B Phoenix, Ariz.
Barr, W. H Wells
SBoysen, Herbert Madelia
SBurmeister, R. O Welcome
Chambers, W. C Blue Earth
Cooper, M.D ...Winnebago
JDrexler, G. W Blue Earth
tFarrish, R. C Sherburn
SGgrdner, V. H Fairmont
SGrogan, J. M Ceylon
Hanson, Lewis Frost
Heimark, J. J Fairmont
tHolm, P. F Wells
fHunt, A. F Alhambra, Calif.
Hunt, R. C Fairmont
§Hunt, R. S Fairmont
Krause, C. W Fairmont
Lester, M. J., Jr Fairmont
McGroarty, J. J Easton
Medlin, C. F Truman
Mills, J. L Winnebago
§Misbach, W. D Fairmont
Parsons, R. L Monterey
§Rollins, T. G Elmore
Rowe, W. H .Fairmont
§Russ, H. H Blue Earth
Shragg, Harry Elmore
Smith, D. V Blue Earth
§Snyder, C. D Kiester
§Thayer, E. A. Fairmont
Vaughan, V. M Truman
SVirnig, M. P Wells
§ Virnig, R. P. Wells
§Wandke, Otto E Fairmont
§ Wenzel, R. E Blue Earth
Wilson, C. E Blue Earth
§Zemke, E. E Fairmont
BROWN-REDWOOD-WATONWAN COUNTY
Regular meetings quarterly
Annual meeting, May
Number of Members : 38
President
Vogel, H. A New Ulm
Secretary
Fesenmaier, O. B New Ulm
Benton, P. C Minneapolis
Bergman, O. B St. James
Black, W. A New Ulm
Bratrude, E. J St. James
§Bregel, F. L St. James
§ Cairns, R. J Redwood Falls
Coulter, H. E Madelia
§Dubbe, F. H New Ulm
§Dysterheft, A. F Gaylord
Esser, O. J New Ulm
§Fesenmaier, O. B New Ulm
Flinn, J. B Redwood Falls
§Fritsche, Albert New Ulm
§Fritsche, C. J New Ulm
§Fritsche, T. R New Ulm
§Gibbons, F. C Comfrey
§Glaeser, J. H Gibbon
Goblirsch, A. P Sleepy Eye
Hovde, Rolf Winthrop
Johnson, A. F Sanborn
Just, H. J Hastings
§Keithahn, E. E Sleepy Eye
SKitzberger, P. J New Ulm
§Kruzick, S. J Sleepy Eye
§Kusske, A. L New Ulm
§Kusske, B. W. . . ....New Ulm
Mattson, A. D. St. James
§Nelson, Glen Fairfax
Nuessle, W. G Springfield
§Penk, E. L Springfield
Peterson, R. A Vesta
IfReineke, G. F New Ulm
§Saffert, C. A New Ulm
Schroeppel, J. E. Winthrop
§ Seifert, O. J New Ulm
Theim, C. E St. Paul
§ Vogel, H. A. L New Ulm
§Wohlrabe, E. J Springfield
CAMP RELEASE MEDICAL SOCIETY
Chippewa, Lac Qui Parle and Yellow Medicine Counties
Regular meetings, Second' and Fourth
weeks of April, May, September, and
October
Number of Members: 28
President
Lima, Ludwig Montevideo
Secretary
Johnson, V. M
Dawson
Andrejek, A. R Milaca
§Boody, G. J., Jr . . .Dawson
§Burns, F. M Milan
§Burns, M. A Milan
Guilbert, G. D Legion, Texas
Hartfiel, H. A Montevideo
§Hauge, M. I Clarkfield
Holmberg, L. J Canby
§Hudec, E. R Echo
SJohnson, V. M ....Dawson
t Jordan, Kathleen Granite Falls
Jordan, L. S Granite Falls
Kath, R. H Wood Lake
Kaufman, W. C Appleton
§Krystosek, Lee A Clara City
tLarson, P. G Cleveland, Ohio
§Lima, L. R., Jr Montevideo
Lundell, C. L
§ Nelson, M. S
§Owens, W. A
§Pertl, A. L
§Roust, H. A......
iSchmidt, P. G., Jr.
§Smith, L. G
Swanson, R. R. .
§Walston, J. H.
IWestby, Magnus..
*Westby, Nels
May, 1950
Granite Falls
Granite Falls
. . .Montevideo
Canby
. . Montevideo
.Granite Falls
. . Montevideo
. . Minneapolis
. . . . Clarkfield
Madison
Madison
493
ROSTER
CLAY-BECKER COUNTY MEDICAL SOCIETY
Regular meetings quarterly
Annual meeting, December
Number of Members: 27
President
Moe, A. E Moorhead
Flancher, L.
Secretary
H Lake Park
tAbom, W. H Hawley
{Bloemendaal, E. J. G Lake Park
Boisclair, Thomas G Detroit Lakes
Bottolfson, B. T Eargo, N. D.
{Bourget, G. E Hudson, Wis.
Carman, J. E Detroit Lakes
§Dodds, Wm. C Detroit Lakes
{Duncan, J. W Moorhead
Ellingson, A. R Detroit Lakes
Flancher, L. H Lake Park
Hagen, O. J Moorhead
Humphrey, E. W Moorhead
Ingebrigtson, E. K Moorhead
Johnson, Olga H Moorhead
§ Larson, Arnold Detroit Lakes
{Midthune, A. S Lake Park
§Moberg, C. W Detroit Laket
{Moe, A. E Moorhead
{Oliver, James Moorhead
{Otto, H. C Frazee
{Rice, H. G Moorhead
§ Rutledge, L. H Detroit Lakes
Saxman, Gertrude Olson ..Georgetown
Seitz, S. B Richardton, N. D.
§Simison, Carl Barnesville
Thysell, F. A Moorhead
Thysell, V. D Hawley
Whitney,
President
R. A
Roehlke, A. B
Secretary
{Albrecht, H. H
Arends, A. L
Berge, H. L
Beyer, E. F
{Blomberg, W. R
Bossert, C. S
{Bunker, B. W
‘Burns, H. A
Clothier, E. F
tDedolph, T. H
EAST CENTRAL MINNESOTA MEDICAL SOCIETY
Anoka, Chisago, Isanti, Kanabec, Mille Lacs, Pine and Sherburne Counties
Regular meetings, February, April, June, August, October, December
Annual meeting, December
Number of Members: 39
. .Cambridge
. . Elk River
Chisago City
.Moose Lake
Mora
Braham
. . . Princeton
Mora
Anoka
Anoka
..Elk River
. Minneapolis
Dredge, H. P
Sandstone
{Gully, R. J...
Halpin, 1. E
Rush City
{Hedenstrom, L. H
Holmes, A. E
Rush City
Hubin, E, G
Kapsner, A. T
Princeton
Krieser, A. E
Mach, R. F
.... Rush City
§McManus, W. F
§ March, K. A
Cambridge
Metcalf, N. B
Onamia
{Miller, E. W
§Nordman, W. F
Nygren, W. T
O’JIa'nlon, J. A Minneapolis
Peterson, C. A Minneapolis
{Petersen, P. C Mora
{Roehlke, A. B Elk River
Sanderson, D. J Princeton
Schlesselman, G. H Minneapolis
{Sherman, H. T Cambridge
Spurzem, R. J Anoka
{Stratte, A. K Pine City
§Swensen, R. G North Branch
{Tesch, G. H Elk River
Trommald, Gladys Anoka
Vik, Melvin Onamia
Waller, J. D Pine City
§ Whitney, R. A Cambridge
FREEBORN COUNTY MEDICAL SOCIETY
Regular meetings quarterly
Annual meeting, December
Number of Members: 28
President
Nesheim, M. O Emmons
Palmerton,
Secretary
E. S Albert Lea
5 Barr, L. C
Burns, Catherine
§Butturff, C. R. . .
tiCalhoun, F. W.
{Demo, Robert A.
{Donovan, D. L. .
Albert Lea
Albert Lea
. . .Freeborn
Albert Lea
.Albert Lea
• Albert Lea
Egge, S. G Albert Lea
{Erdal, O. A Albert Lea
{Folken, F. G Albert Lea
Freeman, J. P Glenville
§Freligh, W. P Albert Lea
tGullixson, A Albert Lea
{Hansen, T. M Albert Lea
Kaasa, L. J St. Peter
f[ Leopard, B. A Albert Lea
{Neel, H. B Albert Lea
{Nelson, Clayton E, J Albert Lea
§Nesheim, M. O.
§ Palmer, C. F
t Palmer, W. L. .
§Palmerton, E. S.
§ Person, J. P
{Prins, L. R
{Rechlitz, E. T. . .
Schmidt, R. F.
HSchultz, J. A. . .
§ Steiner, L. E. . .
§Whitson, S. A...
. . . Emmons
.Albert Lea
Albert Lea
Albert Lea
Albert Lea
.Albert Lea
.Albert Lea
Alden
.Albert Lea
.Albert Lea
Albert Le*
GOODHUE COUNTY MEDICAL SOCIETY
Regular meetings, none
Annual meeting, December
Number of Members: 26
Miller, W.
President
B Red Wing
Secretary
Hartnagel, G. F Red Wing
Aanes, A. M
{Akins, W. M
{Anderson, S. H
Bagby, G. W
{Brusegard, J. F. . . .
. . . .Red Wing
. . . . Red Wing
. . . .Red Wing
. . Cannon Falls
. . . . Red Wing
Claydon, H. F Red Wing
§Cochrane, B. B Red Wing
Mom, M. G Zumbrota
{Graves, R. B Red Wing
{Hartnagel, G. F Red Wing
{Hawley, G. M. B., Ill ... Red Wing
§Hedin, R. F Red Wing
Johnson, A. E Minneaiwlis
t Tones, A. W Red Wing
{Juers, E. H Red Wing
{Kimmel, G. C Red Wing
{Larson, O. E Zumbrota
{Liffrig, W. W Red Wing
{McGuigan, H. T Red Wing
{Miller, W. R Red Wing
{Pfuetze, K. H Cannon Falls
{Reitmann, J. H Hastings
§Sherman, R. V Red Wing
tSmith, M. W Red Wing
{Steffens, L. A Red Wing
§W illiams, M. R Cannon Falls
HENNEPIN COUNTY MEDICAL SOCIETY
meetings, first Monday each month, October through May
Annual meeting, October
Number of Members: 815
Regular
President
McGandy, R. F Minneapolis
Secretary
Aling, Chas. A Minneapolis
Executive Secretary
Cook, Thomas P Minneapolis
§Aagaard, G. N., Jr Minneapolis
{Abramson, Milton Minneapolis
Adams, F. H Minneapolis
tAdkins, C. D Minneapolis
{Ahern, E. E Minneapolis
Alexander, H. A Minneapolis
Alger, E. W Minneapolis
§Aling, C. A Minneapolis
{Altnow, H. O Minneapolis
{Andersen, S. C Minneapolis
494
{Anderson, D. D Minneapolis
{Anderson, E. D Minneapolis
{Anderson, E. R. Minneapolis
{Anderson, F. J Minneapolis
•{Anderson, J. K Minneapolis
{Anderson, K. W Minneapolis
{Anderson, U. S Minneapolis
Anderson, W. II Minneapolis
Anderson, W. T Minneapolis
{Andreassen, E. C .St. Paul
Andresen, K. D Minneapolis
{Andrews, R. S Minneapolis
{Arey, S. L Minneapolis
{Arlander, C. E Minneapolis
{Arling L. S Minneapolis
Arnold, Ann W Minneapolis
Arnold, D. C Minneapolis
{Arvidson, C. G Minneapolis
f{Aune, Martin Minneapolis
tAurand, W. H Minneapolis
Austin, W. E Minneapolis
{Baird, J. W Minneapolis
{Baken, M. P Minneapolis
Baker, A. B Minneapolis
Baker, A. T Minneapolis
{Baker, E. L Minneapolis
t Baker, Looe Minneapolis
{Baker, M. E Minneapolis
{Balkin, S. G Minneapolis
fBank, E. W Fort Howard, Md.
Bank, H. E Portland, Oregon
tBarber, J. 1> Ely
Barr, M. M Minneapolis
Barr, R. N .St. Paul
{Barron, Moses Minneapolis
Barron, S. S Minneapolis
Bateman, Olive L Hopkins
{fBaxter, S. H Minneapolis
Minnesota Medicine
ROSTER
{Beach, Northrop
fBeard, A. H
fBecker, Arnetta M. . .
fBeckman, W. G
{Bedford, E. W
{Beiswanger, R. H....
IBell, E. T
{Bellville, T. P.
{Belzer, M. S
Benesh, L. A.
{{Benjamin, A. E. ...
{Benjamin, E. G
{Benjamin, H. G
IBenn, F. G
Berger, A. G
{Bergh, G. S
Bergh, Solveig M. . .
{Berkwitz, N. J
{Berman, Reuben
{Bessesen, A. N., Jr..
{Bessesen, D. H
Bessesen, W. A
Biddle, C. M
Bieter, R. N
{Blake, Alan
tBlake, James
{Blake, J. A.
tBlake, P. S
{Bloed'el, T. J
{Bloom. N. B
{Blumenthal, J. S
Bockman, M. W. H.
Bodelson, A. H.
{Boehrer, J. J
{Boies, L. R.
tBooth, A. E
Borden, Craig W. .
{Boreen, C. A
{Borgeson, E. J
{Borman, C. N
{Bowers, G. G
Boynton, Ruth E
{Bratrud, A. F
Braude, A. I
Breitenbucher, R. B.
{Brekke, H. J
Brill, Alice K
Brobyn, C. W
Brooks, C. N
tBrown, E. D
tBrown, S. P
Brown, W. D
Brutsch, G. C
{Buchstein, H. F
{Buirge, Raymond
Bulkley, Kenneth....
{Burnham, W. H
{Bushard. W. J
{Buzzelle, L. K
. . . .Minneapolis
. . . .Minneapolis
.... Minneapolis
.Palo Alto, Calif.
.... Minneapolis
.... Minneapolis
. . . . Minneapolis
Minneapolis
Minneapolis
.... Minneapolis
Minneapolis
. . . .Minneapolis
. . . .Minneapolis
LaMessa, Calif.
. . . . Minneapolis
.... Minneapolis
. . . . Minneapolis
. . . .Minneapolis
Minneapolis
. . . . Minneapolis
.... Minneapolis
. . . .Minneapolis
Hastings
.... Minneapolis
Hopkins
Hopkins
Hopkins
.... Minneapolis
Osseo
.... Minneapolis
Minneapolis
. . . . Minneapolis
Hopkins
.... Minneapolis
. . . .Minneapolis
Minneapolis
Minneapolis
.... Minneapolis
Minneapolis
.... Minneapolis
.... Minneapolis
.... Minneapolis
. . . .Minneapolis
.... Minneapolis
. . . Minneapolis
.... Minneapolis
.... Minneapolis
Minneapolis
.... Minneapolis
Paynesville
.... Minneapolis
. . . .Minneapolis
.... Minneapolis
.... Minneapolis
.... Minneapolis
.... Minneapolis
Minneapolis
Minneapolis
.... Minneapolis
{Cable, M. L
{Cabot, C. M
{Cabot, V. S
Cady, L. H
Callerstrom, G. W. . .
Cameron, Isabell L.
*Camp, W. E
Campbell, L. M
{Campbell, O. J
{Caplan, Leslie
{Cardie, A. E
{Carey, J. B
{Carlson, Lawrence. .
{Carlson, L. T
{Caron, R. P
{Caspers, C. G
{Cavanor, F. T
Cedarleaf, C. B
{Ceder, E. T
Chalgren, W. S. . .
Challman, S. A
{Chapman, C. B
Chesley, A. J
{Chisholm, T. C. . .
Christensen, L. E.
‘{Christenson, G. R.
{Christianson, H. W
Clarke, E. K
{Clay, L. B
Cochrane, R. F. . . .
Coe, J. I
{Cohen, B. A
{Cohen, E. B
Cohen, M. M
{Cohen, S. S
Colp, E. A
tCondit, W. H.
Cooper, J. P
{Corbett, J. F
Corniea, A. D
{Correa, D. H
Cowan, D. W
Craig, M. Elizabeth
ICranmer, R. R. . . . .
.Minneapolis
.Minneapolis
■ Minneapolis
. Minneapolis
. Minneapolis
. Minneapolis
. Minneapolis
.Minneapolis
. Minneapolis
.Minneapolis
.Minneapolis
. Minneapolis
.Minneapolis
. Minneapolis
. Minneapolis
.Minneapolis
. Minneapolis
. Minneapolis
. Minneapolis
.Minneapolis
. Minneapolis
. .Minneapolis
. Minneapolis
. Minneapolis
. Minneapolis
. Minneapolis
. Minneapolis
. Minneapolis
. Minneapolis
.Minneapolis
. Minneapolis
. Minneapolis
. .Minneapolis
. Minneapolis
.Oak Terrace
. Robbinsdale
.Minneapolis
.... Excelsior
. .Minneapolis
. .Minneapolis
• Minneapolis
. .Minneapolis
.Minneapolis
.Minneapolis
May, 1950
Cranston, R. W Minneapolis
{Creevy, C. D Minneapolis
{Creighton, R. H Minneapolis
{Culligan, L. C Minneapolis
Culmer, C. U Chicago, 111.
{Cundy, D. T Minneapolis
Cutts, George Minneapolis
Dady, E. E Minneapolis
{Dahl, E. O Minneapolis
{Dahl, J. A Minneapolis
{Daniel, D. H Minneapolis
{Dar^ay, C. P Minneapolis
{Davis, J. C Minneapolis
{Davis, W. I Mound
{del Plaine, C. W Minneapolis
Dennis, Clarence Minneapolis
{Devereaux, T. J Wayzata
{Diehl, H. S ...Minneapolis
Diessner, H. D Minneapolis
{Dorge, R. I Minneapolis
{Dornblaser, H. B Minneapolis
{Dorsey, G. C Minneapolis
Dowidat, R. W Minneapolis
Doxey, G. L. Minneapolis
{Doyle, L. O Minneapolis
{Drake, C. R. .Minneapolis
{Dredge, T. E Minneapolis
{Drill, H. E Hopkins
{Duff, E. R. Minneapolis
t Dumas, A. G ..Minneapolis
{Dunlap, E. H Minneapolis
*{Dunn, G. R Minneapolis
{Dupont, J. A Excelsior
{Duryea, W. M Minneapolis
fDutton, C. E Minneapolis
{Dvorak, B. A Minneapolis
{Dwan, P. F Minneapolis
{Dworsky, S. D. Minneapolis
Eckles, Nylene Minneapolis
{Ehrenberg, C. J Minneapolis
{Ehrlich, S. P Minneapolis
{Eich, Matthew Minneapolis
Eisenstadt, D. H Minneapolis
{Eisenstadt, W. S ...Minneapolis
{Eitel, G. D Minneapolis
{Ellison. D. E Minneapolis
{Emond, A. J Farmington
Emond, J. S Farmington
{Engelhart, P. C Minneapolis
f§Englund, E. F Minneapolis
{Engstrand, O. J Minneapolis
{Erickson, C. O Minneapolis
{Erickson, L. F Minneapolis
{Erickson, R. F. Minneapolis
{Ericson, R. M Minneapolis
{Evans, E. T Minneapolis
Fahr, G. E Minneapolis
{Fansler, W. A Minneapolis
Feeney, J. M Minneapolis
Feigal, D. W Wayzata
{Feinstein, J. Y Minneapolis
{Fenger, E. P. K Oak Terrace
{Fingerman, D. L Minneapolis
{Fink, L. W Minneapolis
{Fink, W. H Minneapolis
{Fisher, I. I Minneapolis
{Fitzgerald, D. F .Wayzata
{Fjeldstad, C. A Minneapolis
{Fleeson, W. H Minneapolis
{Fleming, A. S Minneapolis
Fleming, D. S Minneapolis
Flink, E. B Minneapolis
{Foker, L. W Minneapolis
{Folsom, L. B.. Minneapolis
{Ford, W. H... Minneapolis
{Foster. O. W Minneapolis
‘Foster, W. K Minneapolis
{Fowler, L. H. Minneapolis
{Fox, J. R Minneapolis
{Frane, D. B Minneapolis
Frear, Rosemary R Minneapolis
{Fredericks, G. M Minneapolis
{Fredlund, M. L Minneapolis
Freeman, D. W Minneapolis
{French, L. A Minneapolis
{Fried, L. A. Minneapolis
{Friedell, Aaron Minneapolis
Friedman, Jack Minneapolis
Friedman, II. S Minneapolis
Frisch, D. C Minneapolis
{Frost, J. B Minneapolis
Frykman, H. M Minneapolis
Fuller, Alice H Minneapolis
{Funk, V. K Oak Terrace
tGalligan, Margaret M. D. Minneapolis
{Galloway, T. B Minneapolis
{Gammell, J. H Minneapolis
Garten, J. L Minneapolis
{Gaviser, D Minneapolis
{Gibbs, R. W Minneapolis
{Giebenhain, J. N Minneapolis
{Giebink, R. R Minneapolis
{Giere, J. C. Minneapolis
{Giere, R. W ...Minneapolis
tGiessler, P. W ....Minneapolis
Gilbert, M. G Minneapolis
Gingold, B. A Minneapolis
{Girvin, R. B Minneapolis
{Goldberg, I. M Minneapolis
{Goldman, T. I Minneapolis
{Goldner, M. Z Minneapolis
{Good, H. D Minneapolis
Gordon, P. E Minneapolis
Grais, M. L Minneapolis
{Gratzek, F. R Minneapolis
{Grave, Floyd .Minneapolis
Gray, R. C. . . . Minneapolis
Green, R. A Minneapolis
Greenberg, A. J Minneapolis
Grimes, Marian Minneapolis
{Gronvall, P. R Minneapolis
Grotting, J. K Minneapolis
{Gunlaugson, F. G Minneapolis
{Gushurst, E. G Minneapolis
{Gustason, H. T Minneapolis
Haberer, Helen R. Minneapolis
Hagen, P. S St. Paul
{Hagen, W. S Minneapolis
tHaggard, G. D Minneapolis
Hall, A. M Minneapolis
{Hall, II. B Minneapolis
Hall, W. II.. Minneapolis
Hallberg, C. A Minneapolis
fHammerstad, L. M Salem, Ore.
tHammond, A. T. H Minneapolis
{Hannah, H. B Minneapolis
{Hansen, C. O Minneapolis
{Hansen, E. W...... Minneapolis
Hansen, Olga S Minneapolis
{Hanson, H. J Minneapolis
Hanson, H. V Minneapolis
{Hanson, M. B... Minneapolis
{Hanson, W A.. Minneapolis
{Happe, L. J Minneapolis
{Hart, V. L.. Minneapolis
{Hartig, Heimina. ....... .Minneapolis
fHartzell, T. B Minneapolis
{Hastings, D. R.. ....... . .Minneapolis
{Hastings, D. W Minneapolis
{Hauge, E. T. Minneapolis
{Haugen, G. W. ...Minneapolis
Haugen, J. A. Minneapolis
Hauser, G. W. Minneapolis
{Haven, W. K.... Minneapolis
{Hawkinson, R. P. ....Minneapolis
Haves, E. R Minneapolis
{Hayes, J. M. Minneapolis
{Hayes, A. T Minneapolis
{Head, D. P.. Minneapolis
*t{Head, G. D Minneapolis
IHedback, A. E Minneapolis
{Heim, R. R Minneapolis
Heisler, J. J Minneapolis
Heller, B. I Minneapolis
I Hendrickson, J. F Minneapolis
{Henrikson, E. C Minneapolis
{Henry, C. E Kirksville, Mo.
Henry, M. O Minneapolis
Herbert, W. L Minneapolis
Hermann, H. W Minneapolis
Hesdorffer, M. B Minneapolis
t{Higgins, J. H Minneapolis
{Hill, Allan J., Jr Minneapolis
Hill, Earl Minneapolis
{Hill, E. M. Minneapolis
{fHillis, S. J. St. Paul
Hinckley, R. G Minneapolis
{Hirshfield, F. R Minneapolis
t Hitchcock, C. R. Minneapolis
tHoaglund, A. W. ..Los Angeles, Calif.
Hoffbauer, F. W St. Paul
{Hoffert, H. E Minneapolis
{Hoffman, R. A... Minneapolis
{Hoffman, W. L.. . Minneapolis
{Holmberg, C. J Minneapolis
{Holzapfel, F. C Minneapolis
{Horns, R. C Minneapolis
IHoukom, Bjarne . .T. T. East Africa
Hovland, M. L. Minneapolis
{Howard, S. E Minneapolis
Hudson, G. E Minneapolis
{Huenekens, E. J Minneapolis
t{Hultkrans, J. C Minneapolis
{Hultkrans, R. E Minneapolis
IHurd, Annah Minneapolis
{Hutchinson, C. T. ..Mare Island, Cal.
Hutchinson, Dorothy W..Oak Terrace
{Hymes, Charles Minneapolis
tHynes, J. E Minneapolis
{Idstrom, L. G Minneapolis
Ingalls, E. G., Tr Minneapolis
Irvine, H. G Minneapolis
{Iverson, R. M Minneapolis
495
ROSTER
§ Jacobson, W. E Minneapolis
{James, E. M Minneapolis
{Jensen, Harry Minneapolis
{tjensen, M. J. Minneapolis
{Jensen, N. K. Minneapolis
Jensen, R. A. Minneapolis
Jerome, Bourne Minneapolis
{Johnson, A. B Minneapolis
{Johnson, A. E Minneapolis
i ohnson, Evelyn V Minneapolis
ohnson, E. W Minneapolis
ohnson, H. A Minneapolis
ohnson, J. A Minneapolis
ohnson, J. W Minneapolis
{Johnson, Julius Minneapolis
{Johnson, M. R Minneapolis
j Johnson, N. A. ..Santa Monica, Calif.
Johnson, Norman Minneapolis
{Johnson, N. T Minneapolis
Johnson, R. A Minneapolis
{Johnson, R. E Minneapolis
{Johnson, R. G Minneapolis
Johnson, Y. T Minneapolis
{tjones, H. W., Jr Minneapolis
{Jones, W. R Minneapolis
Josewich, Alexander Minneapolis
{Judd, W. H Washington, D. C.
{Jurdy, M. J Minneapolis
{Kalin, O. T Minneapolis
{Kaplan, J. J Minneapolis
{Karleen, C. I Minneapolis
Karlst.rom, A. E. Minneapolis
{Kaufman, H. J Minneapolis
{Kelby, G. M Minneapolis
{Kelly, J. P Minneapolis
{Kennedy, C. C Minneapolis
t Kennedy, Jane F Minneapolis
{Kerkhof, A. C. Minneapolis
Kertesz, G Minneapolis
Kiesler, F., Jr Minneapolis
tKing, E. A Minneapolis
King, Frances W Oak Terrace
{Kinsella, T. J Minneapolis
{Kistler, A. J Minneapolis
{Knapp, M. E Minneapolis
Knight, R. R Minneapolis
{Knight, R. T Minneapolis
Knudsen, Helen L Minneapolis
{Koepcke, G. M Minneapolis
{Roller, H. M Minneapolis
Roller, L. R Minneapolis
Korchik, J. P Minneapolis
Koszalka, M. F Minneapolis
Kottke, F. J Minneapolis
{Koucky, R. W Minneapolis
{Kremen, A. J Minneapolis
{Kucera, F. J Hopkins
{Kucera, W. J Minneapolis
LaBree, J. W Minneapolis
{Lagaard, S. M Minneapolis
Lajoie, J. M Minneapolis
{Lang, L. A. Minneapolis
{Lapierre, A. P Minneapolis
{Lapierre, J. T Minneapolis
{Larsen, F. W Minneapolis
{Larson, C. M Minneapolis
{Larson, Lawrence M Minneapolis
{Larson, L. M Oak Terrace
{Larson, P. N Minneapolis
Larson, R. H Minneapolis
Lerner, A. Ross Minneapolis
{La Vake, R. T Minneapolis
{Law, S. G Minneapolis
{Laymon, C. W Minneapolis
t Lazar, H. L Excelsior
JLeavitt, H. H Mesa, Ariz.
Lebowske, J. A Minneapolis
Lecklitner, M. D Minneapolis
Leemhuis, A. J Minneapolis
{Leland, H. R Minneapolis
Lengby, F. A Spring Lake Park
{Lenz, O. A Minneapolis
{Leonard, L. J Minneapolis
{Leonard, Sam Minneapolis
Lerner, A. Ross Minneapolis
Lillehei, E. J Robbinsdale
tLind, C. J., Jr. ..Munich, Germany
Lind, C. J Minneapolis
Lindberg, A. C Minneapolis
{Lindberg, V. L Minneapolis
t Lindberg, W. R Minneapolis
{Lindblom, A. E Minneapolis
{Lindgren, R. C Minneapolis
{Lindquist, R. H Minneapolis
{Linner, Gunner Minneapolis
{Linner, H. P Minneapolis
t{Linner, J. H Minneapolis
Linner, P. W Minneapolis
Lippman, E. S Minneapolis
{Lipschultz, Oscar Minneapolis
{Litchfield, J. T Minneapolis
Litman, A. B Minneapolis
{Lofsness, S. V Minneapolis
{Logefeil, R. C Minneapolis
{Loomis, E. A Minneapolis
{Lott, F. H Minneapolis
Lovett, Beatrice R. Oak Terrace
Lowry, Elizabeth C Minneapolis
Lowry, Thomas Minneapolis
Lueck, W. W Minneapolis
{Lufkin, N. H Minneapolis
Lundberg, Ruth I Minneapolis
Lundblad, R. A Minneapolis
Lundblad. S. W Minneapolis
{Lundgren, A. C Minneapolis
{Lundquist, E. F. Minneapolis
fLynch, M. J Minneapolis
Lysne, Henry Minneapolis
{Lysne, Myron Minneapolis
tMacDonald, A. E Minneapolis
{MacDonald, D. A Minneapolis
{Mach, F. B Minneapolis
{MacKinnon, D. C Minneapolis
fMacnie, J. S Minneapolis
{Maeder, E. C. Minneapolis
{Maland, C. O Minneapolis
{Mankey, J. C Minneapolis
{Mariette, E. S Oak Terrace
{Marking, G. H Minneapolis
{Martin, G. R Minneapolis
Martinson, C. J Wayzata
Martinson, E. J Wayzata
fMatchan, G. R Minneapolis
Mathews, J Minneapolis
{Mattill, P. M Oak Terrace
{Mattson, Hamlin Minneapolis
{Maxeiner, S. R Minneapolis
{McCaffrey, F. J Minneapolis
McCann, E. J Minneapolis
McCannel, M. A Minneapolis
McCarthy, Donald St. Paul
McCartney, J. S Minneapolis
{McCormick, D. P Minneapolis
tMcCrimmon, H. P Minneapolis
tMcDaniel, Orianna Minneapolis
{McFarland, A. H Minneapolis
{McGandy, R. F Minneapolis
{McGeary, G. E Minneapolis
{Mclnerny, M. W Minneapolis
McKelvey, J. L Minneapolis
{McKenzie, C. H Minneapolis
{McKinlay, C. A Minneapolis
MMcKinley, J. C Minneapolis
{McKinney, F. S Minneapolis
McLaughlin, B. H Minneapolis
{McMurtrie, W. B Minneapolis
{McPheeters, H. O Minneapolis
tMcQuarrie, Irvine Minneapolis
{Meller, R. L Minneapolis
{Merkert, C. E Minneapolis
{Merkert, G. L Minneapolis
tMerrick, C. T Corvdon, Iowa
t Merrill, Elizabeth Minneapolis
{Meyer, A. J Minneapolis
{Meyer, E. L Minneapolis
Michael, J. C Minneapolis
Michel, H. H Minneapolis
{Michelson, H. E. Minneapolis
fMickelsen, Emma F Minneapolis
Miller, A. L Minneapolis
{Miller, Harold E. Minneapolis
{Miller, Hugo E Minneapolis
{Miller, J. C Minneapolis
{Milton, J. S Minneapolis
{Minsky, A. A Minneapolis
{Mitchell, B. D Minneapolis
Mitchell, E. C Minneapolis
{Mitchell, M. T Minneapolis
{Mixer, Harry W Minneapolis
§Moe, J. H Minneapolis
{Moehn, J. T Minneapolis
{Moen, J. K Minneapolis
tMonahan, Elizabeth S Minneapolis
{Monson, E. M Minneapolis
Moore, I. H Minneapolis
Moorhead, Marie Minneapolis
{Moos, D. J Minneapolis
fMoren, Edward Minneapolis
Mork, A. H Anoka
{Mork, F. E Anoka
Morrison, Charlotte J Minneapolis
Morse, R. W Minneapolis
Mulholland, W. M Minneapolis
Murphy, E. P Minneapolis
*{Murphy, I. J Minneapolis
fMusty, N. J Minneapolis
{Myers, J. A Minneapolis
Mvhre, James Minneapolis
{Naslund, A. W Minneapolis
{Neal, J. M Minneapolis
Neary, R. P Minneapolis
{Nelson, C. B Minneapolis
{Nelson, E. N Minneapolis
tNelson, H. S Los Angeles, Calif.
{Nelson, L. S Minneapolis
{Nelson, M. C Minneapolis
{Nelson, N. Harvey Minneapolis
{Nelson, O. L. N Minneapolis
{Nelson, W. I Minneapolis
{Nesbitt, Samuel Minneapolis
{Nesset, L. B Minneapolis
Nesset, W. D Minneapolis
Noonan, W. T Minneapolis
Noran, A. S. N Minneapolis
{Noran, Harold H Minneapolis
{Nord, Robert E Minneapolis
{Nordland, Martin Minneapolis
Nordland, Martin, Jr. ...Minneapolis
{fNoth, H. W Minneapolis
{Nydahl, M. J Minneapolis
{Nylander, E. G Minneapolis
UNystrom, R. G. ..Malibou Beach, Cal.
t{Oberg, C. M Minneapolis
O’Donnell, J. E Minneapolis
{Olsen, E. G Minneapolis
{Olson, A. C Minneapolis
t{01son, B. G Minneapolis
{Olson, J. W Minneapolis
tOlson, O. A Minneapolis
{Oppen, E. G Minneapolis
tOwre, Oscar Minneapolis
{Palen, B. J Minneapolis
Papermaster, T. C Minneapolis
{Peluso, C. R Minneapolis
{Peppard, T. A. Minneapolis
{Perlman, E. C Minneapolis
{Petersen, G. L Minneapolis
{fPetersen, J. R. Minneapolis
{Peterson, H. W Minneapolis
{Peterson, L. J Minneapolis
Peterson, N. P Minneapolis
Peterson, O. H Minneapolis
{Peterson, P. E Minneapolis
{Peterson, W. C Minneapolis
Peterson, W. H Minneapolis
{Petit, T. V Minneapolis
{Petit, L. J Minneapolis
{Pewters, J. T Minneapolis
{Peyton, W. T Minneapolis
{Pfunder, M. C Minneapolis
{Phelps, K. A Minneapolis
{Plass, H. F. R Minneapolis
{Platou, E. S Minneapolis
{Pleissner, K. W St. Louis Park
{Plimpton, N. C Minneapolis
{Pohl, J. F. Minneapolis
{Pollard, D. W Minneapolis
{Pollock, D. K Minneapolis
{Polzak, J. A Minneapolis
Poppe, F. H Minneapolis
Potter, R. B Minneapolis
Pratt, F. J., Jr Minneapolis
JPratt, F. J., Sr Minneapolis
Preine, I. A Minneapolis
{Preston, P. J Minneapolis
{Priest, R. E Minneapolis
{fPrim, J. A Minneapolis
{Proffitt, W. E Minneapolis
{Proshek, C. E Minneapolis
{Quello, R, O. B Minneapolis
{Quist, H. W., Jr Minneapolis
{Quist, H. W., Sr Minneapolis
{Ransom, H. R Osseo
Reader, D. R. Minneapolis
{Regan, J. J Minneapolis
{Regnier, E. A. Minneapolis
{Reid, L. M Excelsior
{Reif, H. A Minneapolis
{Reiley, R. E Minneapolis
{Resch, J. A Minneapolis
{Rice, C. O Minneapolis
Rice, F. B Minneapolis
{Richdorf, L. F Minneapolis
{Rieke, W. W Wayzata
Rigler, L. G Minneapolis
Riordan, Elsie M Minneapolis
{Risch, R. E Minneapolis
Rizer, D. K Minneapolis
Rizer, R. I Minneapolis
Robb, E. F Minneapolis
{Robbins, O. F Minneapolis
{Roberts, L. J Minneapolis
{Roberts, S. W Minneapolis
t{Roberts, W. B Minneapolis
{Rockwell, C. V Minneapolis
{Rodda, F. C Minneapolis
'{Rodgers, C. L Minneapolis
{Rodgers. R. S Minneapolis
{Rosendahl, F. G Minneapolis
{Rosenfield, A. B Minneapolis
{Rosenow, J. H Minneapolis
{Rosenwald, R. M Minneapolis
{Ross, A. J Minneapolis
{Rucker, W. H Minneapolis
Rud, N. E Minneapolis
Rudell, G. L Minneapolis
{Russeth, A. N Minneapolis
{Rusten, E. M Minneapolis
Ruzicka, F. F Minneapolis
Minnesota Medicine
4%
ROSTER
Rvdburg, W. C Minneapolis
JSadler, W. P Minneapolis
St. Cyr, H. M Minneapolis
§ St. Cyr, K. J Robbinsdale
JSaliterman, B. I Minneapolis
§Samuelson, Samuel Minneapolis
ISandt, K. E Minneapolis
Sanford, R. A Minneapolis
§Sawatzky, W. A Minneapolis
Sborov, A. M Minneapolis
SSchaaf, F. H. K Minneapolis
fSchaar, F. E Minneapolis
SSchaefer, W. G. Minneapolis
tScheldrup, N. H Minneapolis
JScherer, L. R. Minneapolis
IScherling, S. S Minneapolis
§ Schiele. B. C Minneapolis
§Schmidt, G. F Minneapolis
tSchmitt, S. C San Diego, Calif.
tSchneider, J. P Minneapolis
f Schneider, R. A Minneapolis
MSchneidman, N. R Minneapolis
§Schottler, M. E Minneapolis
Schroeder, A. J Minneapolis
§SchuItz, J. H Minneapolis
§Schultz, P. J Minneapolis
§Schulze, W. M Minneapolis
MSchussler, O. F Minneapolis
SSchwartz, V. J Minneapolis
fSchwyzer, Gustav Minneapolis
IScott, F. H Minneapolis
jScott, H. G Minneapolis
§Seaberg, J. A Minneapolis
StSeashore, Gilbert Minneapolis
§Segal, M. A Minneapolis
Seham, Max Minneapolis
SSeifert, M. H Excelsior
§Seljeskog, S. R Minneapolis
ISemsch, R. D Minneapolis
§Shandorf, J. F Minneapolis
Shaperman, Eva P Minneapolis
§Shapiro, M. J Minneapolis
Shapiro, Sidney Minneapolis
Sharp, D. V Minneapolis
§Shea, A. W Minneapolis
Sher, Louis Minneapolis
§Shronts, J. F Minneapolis
SSiegmann, W. C Minneapolis
Silver, J. D Minneapolis
StSimons, J. H Minneapolis
§Simonson, D. B Minneapolis
Simpson, E. D Minneapolis
Sinykin, M. B Minneapolis
Siperstein, D. M Minneapolis
Sisterman, T. J Minneapolis
tSivertsen, Andrew Mound
t§Sivertsen, Ivar Minneapolis
SSkjold, A. C Minneapolis
§Smisek, F. M Minneapolis
Smith, Adam M Minneapolis
SSmith, Archie M Minneapolis
§Smith, B. A., Jr Minneapolis
SSmith, G. G Minneapolis
Smith, H, R Minneapolis
tSmith, Margaret I Minneapolis
SSmith, N. M Minneapolis
§Smith, N. R Minneapolis
SSmith, T. S Minneapolis
Soderlind, R. T Minneapolis
§Solhaug, S. B. Minneapolis
§Solvason, H. M Minneapolis
§Spano, J. P Minneapolis
§ Spink, W. W Minneapolis
fSpratt, C. N Minneapolis
§Stahr, A. C .Hopkins
IStanford, C. E Minneapolis
SSState, David Minneapolis
5 Stein, K. E Lakeville
IStelter, L. A Minneapolis
§Stennes, J. L Minneapolis
Stenstrom. Annette Minneapolis
SStewart, R. I Minneapolis
tStiegler, F. S. .. Nuremberg, _ Germany
SjStoesser, A. V Minneapolis
tStomel, Joseph. .. .Los Angeles, Calif.
§Stone, S. P Minneapolis
tStrachauer, A. C Minneapolis
Strickler, J. H Minneapolis
§Strom, G. W Minneapolis
Stromgren, D. T Minneapolis
§Stromme, W. B Minneapolis
*§Sturre, J. R Minneapolis
tjjSubby, Walter Minneapolis
§Sukov, Marvin Minneapolis
§Sullivan, R. M Minneapolis
Swanson, R. E Minneapolis
tSwanson, V. F Minneapolis
§Sweetser, H. B., Jr Minneapolis
tSweetser, H. B., Sr Minneapolis
SSweetser, T. H Minneapolis
tSweitzer, S. E Minneapolis
§tSwendseen, C. G Minneapolis
§Tangen. G. M Minneapolis
Taylor, J. H Minneapolis
§Tenner, R. J Minneapolis
§Thomas, G. E Minneapolis
fThomas, G. H Minneapolis
§Thompson, W. H Minneapolis
Thomson, J. M Minneapolis
SjThorson, S. V Minneapolis
§Thysell, D. M Minneapolis
§+Tingdale, A. C Minneapolis
§Tinkham, R. G Minneapolis
Titrud, L. A Minneapolis
§Tobin, T. D Minneapolis
Todd, Romona L Minneapolis
§Trach, Benedict Minneapolis
§Trow, J. E Minneapolis
§Trow, W. H Minneapolis
Troxil, Elizabeth B Minneapolis
^Trueman. Ii. S Minneapolis
§Tudor, R. B Minneapolis
fTunstead. H. J Minneapolis
STurnacliff, D. D St. Paul
fTwomey, J. E Minneapolis
§Ude, W. H Minneapolis
t§Ulrich, FI. L Minneapolis
Ulvestad, H. S Minneapolis
SUndine, C. A Minneapolis
Vik, A. E ..Minneapolis
§Wahlquist, H. F Minneapolis
SWaldron, C. W Minneapolis
Walker, S. A Minneapolis
§Wall, C. R Minneapolis
§Walsh, F. M Minneapolis
§Walsh, W. T Minneapolis
Wangensteen, O. H Minneapolis
Ward, P. A Minneapolis
§Watson, C. G Minneapolis
Watson, C. J Minneapolis
Watson, R. E Minneapolis
Weaver, M. M., Vancouver, B. C., Can.
§Webb, E. A Minneapolis
§Webb, R. C Minneapolis
Webber, R. J Minneapolis
§Weisberg, R. J Minneapolis
§Wendland, J. P Minneapolis
W enter, George M inneapolis
tWest, Catharine C Minneapolis
tWestphal, K. F Portland, Ore.
t§Wethall, A. G Minneapolis
Wetherby, Macnider Minneapolis
§Weum, T. W Minneapolis
§White, A. A Minneapolis
SWhite, S. M Minneapolis
§ White, W. D Minneapolis
§Whitesell, L. A Minneapolis
§Widen, W. F. Minneapolis
tWilcox, A. E Minneapolis
t Wilder, K. W Minneapolis
§Wilder, R. L Minneapolis
^Wilder, R. M., Jr Minneapolis
SWilken, P. A Minneapolis
SfWillcutt, C. E Phoenix, Ariz.
t Williams, Robert Carthage, 111.
Winther, Nora M. C Minneapolis
SWipperman, F. F Minneapolis
SWitham, C. A Minneapolis
Wittich, F. W Minneapolis
iWohlrabe, A. A Minneapolis
Wolf, A. H Minneapolis
fWood, R. A Minneapolis
Worden, R. E Minneapolis
Wright, W. S Minneapolis
Wyatt, O. S Minneapolis
Wynne, H. M. N Minneapolis
SYlvisaker, R. S Minneapolis
lYoerg, O. W Minneapolis
§Zaworski, Leo A Minneapolis
Zierold, A. A Minneapolis
§Zinter, F. A. Minneapolis
§Ziskin, Thomas Minneapolis
KANDIYOHI-SWIFT-MEEKER COUNTY MEDICAL SOCIETY
President
Wilmot, C. A Litchfield'
Secretary
Jacobs, D. L Willmar
Anderson, R. E Willmar
Arnson, J. M Benson
Bosland, H. G Willmar
*Branton, B. J Willmar
Chadbourn, W. A Litchfield
tDaignault, Oscar Benson
JDanielson, K. A Litchfield
Danielson, Lennox Litchfield
Dilie, D. E. Litchfield
Eberley, T. S. Benson
Fisher, J. M.... Willmar
Frederickson, Alice C Willmar
Regular meetings, third Thursday of month
Annual meeting, December
Number of Members : 47
Frederickson, G. U. Y Willmar
Frisch, F. P Willmar
tFrost, E. IT Willmar
Giere, S. W Benson
Gilman, L. C Willmar
Griffin, R. P Benson
Herbst, R. F Willmar
Hodapp, R. J Willmar
Hodapp, R. V Willmar
Jacobs, D. L Willmar
STacobs, J. C Willmar
Johnson, Hans Kerkhoven
Kaufman, E. J Appleton
Kelley, K. T Litchfield
Lindley, S. B Willmar
Macklin, W. E., Jr Willmar
McCarthy, Austin M Willmar
Michels, R. P Willmar
Nelson, K. L Balaton
O’Connor, D. C Eden Valley
Penhall, F. W Willmar
Peterson, Willard E Willmar
Porter, O. M Willmar
Proeschel, R. K Willmar
Ripple, R. J New London
Rygh, Harold N Atwater
Sellers, G. K Dassel
Solsem, F. N Spicer
*tScofieId, C. L Benson
Sutherland, W. H Benson
*Telford, V. J Litchfield
Tyler, S. H Raymond
Verby, T. E., Jr Litchfield
Wagenknecht, T. W., Jr. . . .Appleton
Wilmot, C. A Litchfield
Wilmot, H. E. Litchfield
LYON-LINCOLN COUNTY MEDICAL SOCIETY
Regular meetings, first Tuesday of month
Annual meeting, last Tuesday in October
Number of Members: 28
President
Eckdale, J. E Marshall
Secretary
Purvis, G. H Hendricks
Akester, Ward Fergus Falls
Benson, L. M Tracy
Eckdale, J. E. Marshall
Ferguson, W. C Walnut Grove
Ford, B. C Marshall
Friedell, George Ivanhoe
fGrav, F. D Marshall
Hedenstrom, P. C ....Marshall
Helferty, J. K Minneapolis
Hermanson, P. E Hendricks
Hoidale, A. D Tracy
Johnson, C. P Tyler
Kreuzer, T. C Marshall
Monson, L. J Canbv
Murphy, J. E Marshall
Peterson, K. A Marshall
Purves, G. H Hendricks
Remsberg, R. R. .
tRobertson, J. B..
tSanderson, E. T.
Sether, A. F
Smith, L. A. . . .
Thompson, C. O.
§Vadheim, A. L. . . .
§ Valentine, W. H..
Wolstan, S. D.
Workman, W. G. .
Yaeger, W. W. .
May, 1950
T racy
. Minneapolis
. . . Alexandria
Ruthton
Tyler
. . . Hendricks
Tyler
T racy
. . . . Minneota
Tracy
. . . .Marshall
497
ROSTER
President
Neumaier, Arthur Glencoe
Secretary
Kallestad, L. L Brownton
Brink, D. M Hutchinson
tClement, J. B Lester Prairie
§Goss, H. C Glencoe
Goss, Martha D Glencoe
McLEOD COUNTY MEDICAL SOCIETY
Regular meeting, third Thursday of month
Annual meeting, January
Number of Members: 24
§Gridley, J# W Glencoe
SGriebe, Grant Norwood
§Ho!m, H. H Glencoe
§Jensen, A. M Brownton
§Kallestad, L. L Brownton
§Klima, W. W Stewart
Leitschuh, T. H Winsted
§Lippmann, E. W Hutchinson
5 McMahon, M. J Green Isle
fNeumaier, Arthur Glencoe
Peterson, K. H Hutchinson
Sahr, W. G Hutchinson
Scholpp, O. W Hutchinson
SSelmo, J. D Norwood
§Sheppard, C. G Hutchinson
tShrader, E. E Watertown
§Smith, G. R Hutchinson
§Smyth, J. J Lester Prairie
§Truesdale, C. W Glencoe
Trutna, T. J Silver Lake
President
Peterson, S. C Austin
Secretary
Rosenthal, F. H Austin
5 Anderson, D. P., Jr Austin
SBarber, Tracy E Austin
Bellomo, John Grand Meadows
JCronwell, B. J Austin
Fisch, H. M Austin
SFIanagan, L. G Austin
MOWER COUNTY MEDICAL SOCIETY
Regular meeting, last Thursday of each month
Annual meeting, December
Number of Members: 29
§Grise, W. B
5 Robertson, P.
A
Havens, J. G. W
Austin
I Rosenthal. F.
H
tHegge, O. II
§Sargent, E. C.
§Hegge, R. S
Schneider, P. J,
tHenslin, A. E
. . . . Cresco, Iowa
t§Schottler, G.
J
Dexter
§Hertel. G. E
§Seery, T. M.
§Leck, P. C
Austin
SSheedy, C. L..
JLommen, P. A.....
Twiggs, L. F.
Austin
S McKenna, J. K
Van t'leve, II.
P., Jr. . . .
Austin
Melzer, G. R
Lyle
§ Wilson, F. C...
Austin
Morse, M. P
§Peterson, S. C
fWright, R. R.
NICOLLET-LE SUEUR COUNTY MEDICAL SOCIETY
Regular meetings, none
Annual meeting, December
Number of Members: 29
President
Grimes, B. P St. Peter
Secretary
Wilcox, G. C St. Peter
fAitkens, H. B LeCenter
Bodaski, A. A LeCenter
§ Branham, D. S. , St. Peter
SCovell, W. W St. Peter
f Curtis, R. A LeCenter
§Dahlstet, J. P North Mankato
JEricson, Swan Le Sueur
§Giroux, A. A North Mankato
§Grimes, B. P St. Peter
§Hiniker, P. J Le Sueur
SJohnson, H. C North Mankato
Kabrick, O. A St. Peter
{Larson, M. H Nicollet
SLenander. M. E St. Peter
SNilson. H. J North Mankato
JOlmanson, E. G St. Peter
jSOlson, D. C Gaylord
Orwoll, H. S St. Peter
Rossen. R. X Hastings
§Rudie, C. N St. Peter
Schulberg, V. A Arlington
tSherman, A. G Minneapolis
§Sjostrom, L. E St. Peter
ISonnesyn, N. N Le Sueur
§Stoeckmann, A. E St. Peter
Stratliern, C. S St. "Peter
tStrathern, F. P St. Peter
§Traxler, J. F. Henderson
§Wilcox, G. C St. Peter
§Wohlrabe, C. F North Mankato
OLMSTED-HOUSTON-FILLMORE-DODGE COUNTY MEDICAL SOCIETY
Regular meetings, first Wednesday every odd month
Annual meeting, November
Number of Members: 650
President
Heck, F. J Rochester
Secretary
Carryer, H. M Rochester
§Ackerman, R. F Memphis, Tenn.
§ Adams, Neil D Rochester
§Adams, R. C Rochester
§Adson, A. W Rochester
Affeldt, D. E „ . Kasson
SAhlfs, J. J Caledonia
§ Albers, Donald D Rochester
SAlcott, D. L Rochester
'Aldrich. C. A Rochester
i Allen, E. V Rochester
§Alvarez, W. C Rochester
tAmberg, Samuel Rochester
§Andersen, H. A Rochester
§Anderson, A. D Rochester
§Anderson, A. S Rochester
Anderson, Charles D Chicago, III.
§Anderson, James Rochester
§ Anderson, M. J Rochester
SAnderson, M. W Rochester
1 Anderson, Robert L Rochester
§Anderson, Thomas Page Rochester
§ Anthony, Walter P Rochester
§Arata, J. E Rochester
§Arnesen, J. F Rochester
§Ashe, W. M San Francisco, Calif.
SAustin, G. W Rochester
§Baggenstoss, A. H Rochester
StBailey, A. A Rochester
SBair, H. L. Rochester
SBaker, G. S Rochester
§Baker, II. R Hayfield
§Baker, R. L Hayfield
llBalfour, D. C Rochester
§Balfour, D. C., Jr Rochester
IBalfour, W. M Rochester
SBall, Warren P Rochester
§Banner, E. A Rochester
§Bargen, J. A Rochester
SBarker, N. W Rochester
§Barnes, A. R Rochester
§ Bartholomew, L. G Rochester
§Baskin, R. H Rochester
§Bastron, J. A Rochester
§Bateman, J. G Rochester
§Bavrd, F. D Rochester
§Beahrs, O. H Rochester
JBeard, E. F Rochester
§Beck, W. W., Jr. .Salt Lake City, LUah
Becker, S. W., Jr Rochester
Beeler, J. W Rochester
5 Begley, J. W., Jr Rochester
SBelding, If. IL, III Rochester
§Bellegie, N. J Rochester
IBelote, G. B ....Caledonia
^Benedict, W. L Rochester
§Bennett, H. S Rochester
SBennett, W. A Rochester
'Bentson, J. H Rochester
IsBerens, James Rochester
SBerkman, D. M Rochester
UBerkman, J. M Rochester
§Bernatz, P. E Rochester
§ Betts, R. A Seattle, Wash
IBickel, W. H Rochester
Bigelow, C. E Dodge Center
SBilka, P. J Rochester
HBlack, B. M Rochester
IBlackburn, C. M Rochester
SBloek, M. A Rochester
iBlunt, C. P., Ill I.vnchburg, Va.
jjBolger, J. V., Jr Milwaukee, Wis.
tBoothby, W. M Rochester
§Boucek, Robert J Rochester
U Bowing, H. H Rochester
§Boyd, D. A Rochester
flBraasch, W. F Rochester
SBraceland, F. J Rochester
§Brandenburg, R. O Rochester
SBresette, J. E Rochester
§Rrickley, P. M Rochester
§Broders, A. C Rochester
§Brown, A. E Rochester
§Brown, H. A Rochester
§Brown, J. R Rochester
§ Brown, P. W Rochester
§Brunsting, L. A Rochester
§Brzustowicz, R. J Rochester
§Buffmire, D. K Rochester
§Buie, Louis A Rochester
§BurcheIl, H. B Rochester
§Burgert, E. O., Jr Rochester
SBurgess, H. M Rochester
§Burke, E. C Rochester
Bush, R. P Minneapolis
SButin, J. W Rochester
§Butler, D. B Rochester
§Butt, H. R Rochester
SCain, J. C
§Camp, J. D
§Campbell, D. C
*§Cannon, B. W
§Garey, T. M
SCarlander, L. W., Jr.,
§CarIisle, J. C
Carpenter, G. T. ...
§Carr, D. T
SCarroll, T. T
ICarryer H. M
Cashin, J. C
Chance, D. P
§Childs, D. S„ Jr
SC'hristensen, N. A....
SChristie, D. P
SChristoferson, L. A...
ICIagett, O. T
Clark, L. W
§Clark, P. L., Ill
Clifton, T. A
§Colbv, M. Y„ Jr
Cole, J. P
§Comfort, M. W
§Cook, E. N
SCooley, J. C
§Cooper, I. S. ......
SCooper, Talbert
Rochester
Rochester
Rochester
Memphis, Tenn.
Rochester
Rochester
Rochester
Rochester
Rochester
Rochester
Rochester
Rochester
Rochester
Rochester
Rochester
Rochester
Rochester
Rochester
..Spring Valley
Rochester
Chatfield
Rochester
Rochester
Rochester
Rochester
Rochester
Rochester
Rochester
498
Minnesota Medicine
ROSTER
§ Corbin, K. B Rochester
SCorcoran, C. E Chicago, 111.
SCounseller, V. S Rochester
§Coventry, M. B Rochester
§Craig, W. McK Rochester
SjCrehan, E. L Rochester
fCrenshaw, J. L Rochester
SCrenshaw, J. L., Jr Rochester
ICrumpacker, Edgar Rochester
ICurtiss, R. K Rochester
§Dahlin, D. C. Rochester
IDaugherty, G. W Rochester
§Davis, A. C Rochester
Davis, I. G Rushford
§Davis, G. D Rochester
§Davis, R. M Rochester
§Davis, R. E Rochester
Day, L. A St. Paul
IDearing, W. H., Jr Rochester
§Decker, D. G Rochester
§Dederick, G. F., Jr Rochester
DeForest, R. E Rochester
Devine, K. D Rochester
§Devney, J. W Rochester
§DeWeerd, J. H Rochester
§Didcoct, J. W Rochester
§Diessner, G. R Rochester
§Dillard, P. G., Jr Rochester
§Dixon, C. F Rochester
jiDockerty, M. B Rochester
SDodge, H. W., Jr Rochester
§Dodge, Mark Rochester
Dolder, F. C Eyota
§Donoghue, F. E Rochester
§Dornberger, G. R Rochester
§Douglass, B. E Rochester
§Doust, W. C Rochester
{■Drake, F. A Lanesboro
§Drescher, E. P Berkeley, Calif.
flDrips, Della G Rochester
§Dry, T. J Rochester
§Duncan, D. K Rochester
§Dunlap, R. W Rochester
§DuShane, J. W Rochester
§Dworetzky, Murray Rochester
SEarnest, Franklin, III . .Toledo, Ohio
§Eaton, L. M Rochester
§Eby, Lee G Rochester
§Eckstam, E. E Rochester
Edwards, J. E Rochester
lElkins, E. C Rochester
§EIliott, J. A., Jr Rochester
jjEllis, E. J Rochester
§EUis, F. H Rochester
lEmmett, J. L Rochester
§Engel, J. P Rochester
Epperson, D. P Rochester
| Erich, J. B Rochester
lErickson, D. J. . . . .' Rochester
Esser, R. A Rochester
§ Estes, J. E Rochester
flEusterman, G. B Rochester
{■Evarts, A. B Rochester
§Eyster, W. H., Jr Rochester
§Fabtr, J. E Rochester
§Falsetti, F. P Rochester
§Faulconer, A., Jr ....Rochester
iFaulkner, J. W .Rochester
SFerris, D. O Rochester
§Figi, F. A Rochester
§Fisher, C. E Rochester
§Fitzpatrick, T. B Rochester
§Flautt, J. R., Jr Louisville, Ky.
Foss, E. L Rochester
Foulk, W. T., Jr Rochester
§Frank, L. M Rochester
SFreeman, J. G Rochester
SFricke, R. E Rochester
§Fricke, R. W Rochester
§Fuller, B. F., Jr Rochester
§FuIler, J Rochester
§fGambill, C. M Rochester
SGambill, E. E Rochester
Gastineau, C. F Rochester
Geraci, J. E Rochester
§Ghormley, K. O Rochester
SGhormley, R. K Rochester
fGiffin, H. Z Rochester
Giffin, Mary E Rochester
§Gifford, R. W., Jr Rochester
§Gilbert, L. W Rochester
iGoldstein, N. P Rochester
§Good, C. A., Jr Rochester
Goodlad, J. H Rochester
§Graham, G. G Rochester
Gramse, A. E Springfield, Mass.
§Gray, H. K Rochester
May, 1950
Greene, L. F. Rochester
Griffin, G. D. J., Jr Rochester
§Griffith, E. R. Rochester
§Grindlay, J. H Rochester
§Groom, J. J Rochester
SGross, J. B Rochester
§Guernsey, D. E Rochester
Habein, H. C Rochester
IHagedorn, A. B Rochester
§ Haines, S. F. Rochester
§Hall, B. E Rochester
§Hallberg, O. E Rochester
HHallenbeck, D. F Rochester
IHallenbeck, G. A Rochester
Hanlon, D. G Rochester
§Hanson, H. H Rochester
§Hanson, N. O Rochester
IHargraves, M. M Rochester
Harnagel, E. E Rochester
§Harrington, S. W Rochester
SjHarris, L. E Rochester
§Hartman, H. R Rochester
§Hattox, J. S Rochester
§Hauch, E. W Rochester
§Havens, F. Z Rochester
§Hayes, D. W .....Rochester
§Hayles, A. B Lincoln, Nebr.
§Haynes, Allan Rochester
§Heck, F. J. Rochester
§Heck, W. E Rochester
f Heilman, D. H Rochester
Heilman, F. R Rochester
tHelland, G. M Spring Grove
jtHelland, J. W Spring Grove
JHelmholz, H. F Rochester
tHenipstead, B. E Rochester
§Hench, P. S .Rochester
JHenderson, E. D. ........ Rochester
§Henderson, J. W Rochester
Henderson, M. S Rochester
Hennessy, Mary E. . .
Muskegon Heights, Mich
§Herrell, W. E Rochester
iiHetherington, J. A., Indianapolis, Ind.
Hewitt, Edith S Rochester
JHewitt, R. M Rochester
JHeyerdale, O. C Rochester
iHightower, N. C. ...Rochester
^Hildebrand, C. H Seattle, Wash.
§Hill, J. R Rochester
Hills, O. W Rochester
§Hilsabeck, J. R Rochestei
§Hines, C. R., Jr Rochester
§Hines, E. A., Jr Rochester
§Hodgson, C. H Rochester
SjHodgson, T. R Rochester
Hoffman, M. S Rochester
§Hogben, C. A. Rochester
Holland, C. R Rochester
SHollenhorst, R. W Rochester
§Holman, C. B.. .....Rochester
§Hood, R. T Rochester
Horan, M. J„ Jr. ..New York, N. Y.
§Horton, B. T Rochester
§Howell, L. P Rochester
§Hubler, W. L Rochester
§Hugenberg, W. C Rochester
Huizenga, K. A Rochester
§Hunt, A. B Rochester
§Hunter, J. S., Jr Rochester
§Hunter, R. C Rochester
ilvins, J. C Rochester
Ivy, J. H Rochester
§Jackman, R. J Rochester
§Jackson, H. S Richmond, Va.
§ Jamison, R. W. . .Walla Walla, Wash.
ijampolis, R. W Rochester
STanes, J. M Rochester
§Jarrett, P. S Rochester
§Jennings, D. T Rochester
I Jensen, G. L. Rochester
Jeub, R. P Minneapolis
Johnson, A. B., II Rochester
Johnson, A. M Rochester
§Johnson, C. F. Rochester
Johnson, D. A Rochester
Johnson, E. W Rochester
5 Johnson, H. A Rochester
§ Johnson, H. W Rochester
§ Johnson, M. I Rochester
Johnson. R. B Lanesboro
§ Jones, G. W Rochester
§ Jordan, R. A Rochester
ijosselson, A. J Rochester
Joyce, G. L Rochester
§ Joyce, G. T Rochester
§Judd, E. S., Jr Rochester
§Kaplan, J. H Rochester
Keates, A. E Rochester
SKeating, F. R., Jr Rochester
§Keating, J. U. Rochester
§Keith, H. M Rochester
iKeith, N. M. ....Rochester
§Kelley, E. P .Rochester
Kelly, A. H Rochester
§ Kelsey, J. R Rochester
§ Kennedy, R. L. J. Rochester
Kennedy, T. A Rochester
§Kernohan, J. W Rochester
§Kiely, W. F Rochester
SKierland, R. R. Rochester
Kimbrough, R. F Rochester
§Kirby, T. J., Jr Rochester
§Kirklin, B. R Rochester
§Kirklin, J. W Rochester
§Kleckner, M. S., Jr Rochester
Knight, C. D Rochester
§Knisely, R. M. Rochester
§Knutson, J. R. B Rochester
§ Knutson, L. A Spring Grove
§Knutson, R. C Rochester
§Koelsche, G. A Rochester
§Koza, D. W Rochester
§Krakowka, G. F Rochester
§Krusen, E. M., Jr ..Rochester
Krusen, F. H Rochester
§Kulwin, M. H Rochester
iKvale, W. F. Rochester
§Lake, C. F Rochester
§Lamp, C. B., Jr Rochester
§Lang, C. M. Rochester
HLannin, J. C Mabel
§Lay, C. L Rochester
§ Leary, W. V .Rochester
§Leddy, E. T. Rochester
Leden, U. M Rochester
§Lee, M. J Rochester
i Lemon, W. E Rochester
§tLemon, W. S Rochester
Lick, L. C Rochester
iLillie, H. I Rochester
§Lillie, J. C Rochester
5 Lillie, W. I Rochester
SLipscomb, P. R Rochester
§Litin, E. M Rochester
§Livermore, G. R., Jr Rochester
Locke, William Boston, Mass.
SLofgren, K. A Rochester
ULogan, A. H Rochester
§Logan, G. B Rochester
§Longley, J. R Rochester
§Longo, V. T Rochester
§Love, J. G Rochester
§Lowman, E. W Rochester
§Lowy, Alexander, Jr Rocehster
§Lucas, J. E Rochester
§Lundy, J. S.... ..Rochester
SLuttgens, W. F Rochester
§MacCarty, C. S Rochester
JMacCarty, W. C Rochester
§MacFarlane, E. B Rochester
§MacLean, A. R. Rochester
§Magath, T. B Rochester
SMaino, V. J Rochester
§Mankin, H. W Rochester
StMann, F. C Rochester
Mann, Frank D Rochester
§Markle, G. B., IV Rochester
§Marshall, T. M Rochester
Martens, T. G Rochester
§Martin, G. M Rochester
SMartin, W. J Rochester
§Masson, D. M Rochester
JMasson, J. C Rochester
§Masson, J. K Rochester
§Maxiener, S. R., Jr Rochester
§Mayo, C. W.. Rochester
§Maytum, C. K Rochester
SMcBean, J. B Rochester
§McBurney, R. P Rochester
§McConahey, W. M., Jr Rochester
McCorkle, J. K Rochester
§McCormack, L. J Rochester
§McDonald, J. R Rochester
§McElin, T. W Evanston, III.
Mclntire, S. F Rochester
McKaig, C. B... Pine Island
^McMahon, J. M. . .New Orleans, La.
McMillan, J. T. . .Des Moines, Iowa
§McNaughton, R. A Rochester
§McNeil, J. I Rochester
McVay, J. R., Jr Rochester
SMcWhorter, H. E Rochester
SMeadows, E. R. ...Birmingham, Ala.
^Merrill, J. G Littleton, Colo.
§Merritt, W. A Rochester
499
ROSTER
JMeyerding H. W Rochester
SMilburn, G. B Rochester
Miller, E. M Rochester
Miller, J. R Fresno, Calif.
SMiller, R. D Rochester
fMilnar, F. J St. Paul
5 Mills, S. D Rochester
IMoersch, F. P Rochester
SMoersch, H. J Rochester
SMoersch, R. U Rochester
SMonsour, K. J Rochester
5 Montgomery, Hamilton Rochester
SMorgan, E. H Rocehster
SMorlock, C. G Rochester
Morris, C. R Rochester
§Morrison, R. W Rochester
§Morrow, R. P., Jr Rochester
SMorton, G. H Rochester
Mussey, Mary E Rochester
SMdssey, R. D., Jr Rochester
SMussey, W. G Rochester
§ Myers, T. T Rochester
§ Myers, W. P. L Rochester
§Nachtwey, R. A Lansing, Iowa
Nehring, J. P Preston
Nelson, C. G Harmony
Nelson, P. A Rochester
5New, G. B Rochester
SNichols, D. R Rochester
§Nicholson, J. W., Ill Rochester
Norris, N. T Caledonia
Norval, M. A Rochester
§Nowak, D. J Rochester
§Odel, H. M Rochester
liO’Cain, R. K Rochester
fO’Leary, P. A Rochester
SOlsen, A. M Rochester
Olson, E. A Pine Island
Olson, G. E West Concord
§01son, S. W Chicago, 111.
Onsgard, L. K Houston
SOsborn. J. E Rochester
80’Saughnessy, E. J Rochester
§Osterholm, R. S Rochester
§Owen, C. A., Jr Rochester
§Owen, H. W Rochester
§Painter, R. C Grand Forks, N. D.
§ Parker, H. L Rochester
jjParker, R. L Rochester
Parkhill, Edith M Rochester
i Parkin, T. W Rochester
Patton, J. M Rochester
SPatton, Matthew M., Jr Rochester
SPaulson, G. S Rochester
5 Paulson, J. A. Rochester
§ Peabody, H. D., Jr Rochester
Pease, Gertrude L Rochester
SPemberton, J. dej Rochester
§ Pender, J. W. Rochester
§ Perry, Harold Rochester
Peters, G. A Rochester
Petersen, M. C Rochester
Phares, W. S Rochester
flPiper, M. C Rochester
§Polley, H. F Rochester
§Pool, T. L Rochester
§Poore, T. N Rochester
*Popp, W. C Rochester
§Porter, G. E Rochester
§Post, D. B Rochester
Powers, F. H Rochester
§Prangen, A. D Rochester
§ Pratt, J. H Rochester
jPrickman, L. E Rochester
§ Pridgen, J. E. Rochester
§ Priestley, J. T Rochester
§Prough, W. A Ontario, Calif.
§ Pruitt, R. D Rochester
JPugh, D. G Rochester
Pyle, M. M Cannon Falls
§Rae, J. W., Jr Ann Arbor, Mich.
SRagsdale, W. E., Jr Rochester
§Rall, J. E New York, N. Y.
§Ralston, D. E Rochester
§Randall, L. M Rochester
§Randall, R. V Rochester
§Randall, W. H Rochester
5 Rasmussen, W. C Rochester
§Ratke, H. V Rochester
§Reiter, R. A Rochester
SReMine, W. H., Jr Rochester
Retter, Richard Madison, Wis.
SReynolds, J. L Rochester
Rice, R. G Minneapolis
§ Riddell, R. V Rochester
SRidley, Roger W Rochester
SRipley, H. R Rochester
Risser, A. F Stewartville
SRobinson. A. W Rochester
Rogne, W. G Spring Grove
§Rome, H. P Rochester
SiRooke, E. D Rochester
8Rosin, J. D Rochester
Rotnem, O. M Mabel
SRoutley, E. F Rochester
§Rovelstad'. R. A Rochester
Rucker, G. W Rochester
§Ruff, G. C Rochester
Rushton, J. G Rochester
SRydell, J. R Rochester
§Rynearson, E. H Rochester
SSalassa, R. M Rochester
tSanford, A. H Rochester
§Sauer, W. G Rochester
§Saxon, R. F., Tr Rochester
§Saylor, H. L., Jr Huron. S. D.
Sayre, G. P Rochester
Scanlon, P. W Rochester
SScheiflev, C. H Rochester
SScherbel, A. L Rochester
5 Schmidt, H. W Rochester
§Scholz, D. A Rochester
§Schweppe, J. S Rochester
§Scribner, B. H Rochester
SScudamore, H. H Rochester
§Seagle, J. B Rochester
Seale, Ruth A Rochester
Seebach, Lydia M Rochester
SSeldon, T. H Rochester
§Seybold, W. D Rochester
Shands, W. C Rochester
§Shick, R. M Rochester
Shonyo, E. S Milwaukee, Wis.
SSiemon, Glenn Rochester
§Simonton, K. M Rochester
Skaug, H. M Chatfield
Skillern, P. G., Jr Rochester
SSkroch, E. E Rochester
§Sloan, W. P., Jr Rochester
SSIocumb, C. H Rochester
llSmith, F. L Rochester
§ Smith, F. R Rochester
§ Smith, H. L. Rochester
§Smith, L. A Rochester
§Smith, N. D Rochester
§Smith, O. O., Jr. ..Independence, Va.
SSmith, P. L Rochester
§Soule, E. H Rochester
5 Spaulding, C. A Rochester
§Spear, I. M Rochester
Spear, R. C Rochester
SSpence, B. J., Jr Rochester
Spencer, B. T Rochester
SSpencer, J. R Rochester
§Spock, B. M Rochester
§Sponsel, K. H Rochester
§ Sprague, R. G Rochester
§ Spray, P Rochester
§Stapley, L. A., Jr Rochester
§ Stark, D. B Rochester
Starks, W. O Rochester
§ Stauffer, M. H Rochester
§Stickney, J. M Rochester
§Stilwell, G. G Rochester
Stinson, J. C., Jr Rochester
§Storrs, R. P Rochester
§Storsteen, K. A Rochester
Stowe, H. R Rochester
SStroebel, C. F., Jr Rochester
StSutherland, C. G Rochester
§Svien, H. J Rochester
STakaro, Timothy Rochester
§Taylor, A. B Rochester
{jTaylor, B. E Rochester
§Taylor, R. W., Jr Rochester
Teitgen, R. E Rochester
§Thelen, E. P Rochester
SThompson, G. J Rochester
STillisch, J. H Rochester
STobin, J. R., Jr Rochester
§Tondreau, R. L Rochester
§TurnbuIl, T Rochester
SUihlein, Alfred Rochester
SUnderdahl, L. O Rochester
§L!pson, Mark, Jr Rochester
SUzmann, J. W Rochester
§Vadheim, L. A Rochester
§Van Herik, Martin Rochester
§Van Patter, Ward Rochester
§ Vaughn, L. D Rochester
§Wagener, H. P Rochester
SWakefield. E. G Rochester
§fWakim, K. G Rochester
SWalsh, M. N Rochester
§Walters. Waltman Rochester
Wang, Jun-Chuan Minneapolis
§Ward, Louis E Rochester
§ Watkins, C. H Rochester
SiWatson, T. B Rochester
§ Watson, J. R Rochester
§Waugh, J. M Rochester
5 Webb, J. H Rochester
§ Weber, H. M Rochester
§Weed, L. A Rochester
§Weir, J. F Rochester
IWellman, W. E Rochester
W ellner, T. O Rochester
Wente, H. A Rochester
Westrup, J. E Lanesboro
SWeyand, R. D Rochester
IWhitesell, F. B Rochester
SWilder, R. M Rochester
SWilhelm, W. F Rochester
§ Williams, H. L., Jr Rochester
tWilliams, R. V Rushford
SWillius, F. A Rochester
8 Wilson, R. B Rochester
SWinburn, J. R., Jr Rochester
Winchester, E. C Rochester
^Winchester, W. W Rochester
8WoIlaeger, E. E Rochester
SWoltman, H. W Rochester
JWood, H. G Rochester
§Woolling, K. R Rochester
§WooIner, L. B Rochester
§ Young, H. H Rochester
§Zick, L. H Rochester
SZimmer, F. E Rochester
PARK REGION DISTRICT AND COUNTY MEDICAL SOCIETY
Douglas, Grant, Otter Tail and Wilkin Counties
Regular meetings, _ every other month
Annual meeting, December
President
Jacobs, G. C Fergus Falls
Secretary
Daehlin, Rolf Fergus Falls
Arndt, H. W Detroit Lakes
§Baker, A. C Fergus Falls
Baker, J. L Fergus Falls
§Baker, N. H Fergus Falls
Bergquist, K. E Battle Lake
Bigler, Earl E Perham
Bigler, I. E Perham
SBoline, C. A Battle Lake
§Boyd, L. M Alexandria
JBoysen, Peter Austin, Texas
Number of Members : 60
§Burnap, W. L Fergus Falls
Cain, J. H Hoffman
§Carlson, C. E Alexandria
§Clifford, G. W Alexandria
iGombacker, L. C Fergus Falls
Daehlin, Rolf Fergus Falls
fDrought, W. W Fergus Falls
§Dwinnell, L. A Fergus Falls
Emerson, E. E Osakis
*Esser, John Perham
SEstrem, C. O Fergus Falls
Estrem, R. D Fergus Falls
Geiser, P. M Alexandria
Hanson, E. C New York Mills
Harris, E. S Fergus Falls
§Haskell, A. D Alexandria
§ Heiberg, E. A Fergus Falls
Jacobs, G. C Fergus Falls
SJacobson, C. W Breckenridge
SKaliher, Howard Pelican Rapids
SKevern, J. L Henning
§Korda, H. A Pelican Rapids
Leibold, H. H Parkers Prairie
§ Lewis, A. J Henning
§ Lewis, C. W Henning
Love, F. A Carlos
§Lund, C. J. T Fergus Falls
Miller, W. A New York Mills
§Mortensen, N. G Fergus Falls
§Mouritsen, G. J Fergus Falls
500
Minnesota Medicine
ROSTER
§Naegeli, F. A Fergus Falls
Nelson, D. E Alexandria
Nelson, R. A Fergus Falls
§Nelson, W. O. B Fergus Falls
gO'Brien, Louis T Breckenridge
Ostergaard, Erling Evansville
Parson, Lillian B Elbow Lake
Parson, L. R. Elbow Lake
Patterson, W. L Fergus Falls
§Paulson, T. S Fergus Falls
Randall, A. M Ashby
Reeve, E. T Elbow Lake
Rockwood, P. H Fergus Falls
Satersmoen, Theodore .. Pelican Rapids
§Sather, E. R Alexandria
§Schamber, W. F Parkers Prairie
§Stemsrud, H. L..
Sutton, H. R. ...
§Tanquist, E. J. ..
Thompson, H. B.
Warner, J. J.. . . .
SWasson, L. F....
tWrav, W. E.
Alexandria
. .Hoffman
i Alexandria
. . St. Cloud
. . . Perham
Alexandria
. . Campbell
RAMSEY COUNTY MEDICAL SOCIETY
Regular meetings, last Monday in every month excepting June, July, August
Annual meeting, last Monday in January
Number of Members : 436
President
Secretary
§Amerongen, W. W.
§Arnquist, A. S St. Paul
§Arny, F. P St. Paul
§Arzt, P. K St. Paul
§ Aurelius, J. R St. Paul
jiAusman, C. F St. Paul
§Ausman, D. R St. Paul
§Babb, Frank S St. Paul
§Bacon, D. K St. Paul
’fBacon, L. C St. Paul
§Balcome, M. M St. Paul
Barnett, J. M St. Paul
§Barry, L. W St. Paul
tBarsness, N. O. N St. Paul
’Barton, J. C Bethesda, Md.
Bauer, E. L St. Paul
ftBeals, Hugh St. Paul
§ Beech, R. H St. Paul
§Beek, H. O St. Paul
Beer, J. J St. Paul
§Btll, C. C. St. Paul
Bellomo, James St. Paul
§Benepe, J. L St. Paul
tBennion, P. H Isway, Mont.
§ Bentley, N. P St. Paul
§ Bernstein, W. C St. Paul
IBicek, J. F. St. Paul
tBinger, H. E Phoenix, Ariz.
Black, E. J St. Paul
§Bock, R. A. St. Paul
Boeckmann, Egil St. Paul
§Bolender, H. L. St. Paul
Borg, J. F. St. Paul
§Bouma, L. R St. Paul
§Brand, G. D St. Paul
Bray, E. R St. Paul
5 Briggs, J. F St. Paul
§Broadie, T. E. St. Paul
SBrodie, W. D St. Paul
§Brotchner, R. J St. Paul
Brown. J. C St. Paul
Bulinski, T. J St. Paul
5 Burch, E. P St. Paul
fBurch, Frank St. Paul
Burklund, E. C St. Paul
§Burlingame, David A St. Paul
§ Burns, R. M St. Paul
Burton, C. G St. Paul
§Busher. H. H St. Paul
§Cain, C. L St. Paul
Callahan, F. F. St. Paul
SCarley, W. A St. Paul
§ Carroll, W. C. St. Paul
IChadbourn, C. R St. Paul
IChatterton, C. C. St. Paul
§Christiansen, A St. Paul
§Clark, H. B.. Jr Minneapolis
Coddon, W. D St. Paul
Cohen, E. N St. Paul
I Colby, W. L. St. Paul
§Cole, W. H St Paul
tCollie, H. G St. Petersburg, Fla.
§Connolly, C. J St. Paul
§ Connor, C. E. St. Paul
§Cook, C. K St. Paul
§ Cooper, C. C St. Paul
§ Countryman, R. S St. Paul
tCowem, E. W No. St. Paul
§Craig, D. M St. Paul
SCritchfield, L. R St. Paul
Crombie, F. J No. St. Paul
Crowley, J. H. St. Paul
Crudo, V. D St. Paul
SCrump, J. W St. Paul
jjCulligan, J. M St. Paul
I Culver, L. G... St. Paul
*§Dack, L. G St. Paul
tDaugherty, E. B.. . Marine-on-St. Croix
§ Davis, E. V St. Paul
Decker, C. H St. Paul
May, 19S0
§Dedolph, Karl
St.
Paul
.St.
Paul
§Derauf, B. I
St.
Paul
§Deters, D. C
St.
Paul
f Dickson, T. H
St.
Paul
Paul
Donohue, P. F. ..... .
St.
Paul
St
Dovre, C. M.. ...... .
St.
Paul
.St.
Paul
§ Drake, C. B
St.
Paul
.St.
Paul
■ §Dunn, J. N
St.
Paul
.St.
Paul
St.
St
Paul
5 Earl, J. R
St.
Paul
St
Paul
§Edlund, Gustaf
St.
Paul
Edwards, J. W St. Paul
Edwards, Lloyd G St. Paul
5 Edwards, T. J St. Pau'
§Eginton, C. T
St.
Paul
Ely, O. S
....So. St.
Paul
§ Emerson, E. C.
St.
Paul
§Endress, E. K
St.
Paul
Enroth, O. E.
St.
Paul
Ernest, G. C. H. .St.
Petersburg,
Fla.
§Er<5fe*ld, Murray P...
St.
Paul
tEshelby, E. C.
Paul
Evert, J. A., Jr. ...
St.
Paul
tFahey, E. W
St.
Paul
Farkas, J. B
St.
Paul
Fee. J. G
St.
Paul
Felion, A. J
St.
Paul
f§Ferguson, J. C
St.
Paul
§Fessler, H. H St. Paul
Field, A. H Farmington
Fink, D. L
St.
Paul
Fisher, D. W.
......St.
Paul
SFlanagan, H. F
St.
Paul
§Flannery, H. F
St.
Paul
Flom, R. P
......St.
Paul
SfFogarty, C. W
...... St.
Paul
Fogartv, C. W., Tr. . . .
St.
Paul
SFogelberg, E. T
St.
Paul
§ Foley, F. E. B
St.
Paul
Forsythe, J. R
St.
Paul
tFreeman, C. D Balsam Lake, Wis.
Freeman, C. D., Jr St. Paul
Freidman, L. L St. Paul
§Fritz, \V. L St. Paul
§Froats, C. W St. Paul
Frost, Russell H St. Paul
§Garbrecht, A. W St. Paul
Gardiner, D. G St. Paul
§ Gardner, W. P St. Paul
Garrow. D. M St. Paul
*Geer, E. K St. Paul
SGehlen, J. N St. Paul
§Geist, G. A St. Paul
§Ghent, C. H St. Paul
SGibbs. E. C St. Paul
*tGilfillan, J. S St. Paul
Gilkey, S. E St. Paul
IGillespie, D. R St. Paul
§Glea=on, W. A St. Paul
Goldsmith. J. W St. Paul
§Ooltz, E. V St. Paul
Goltz, Neill F St. Paul
Grant, H. W St. Paul
SGratzek, Thomas St. Paul
§Grau, R. K St. Paul
Gruenhagen, A. P St. Paul
Hall, H. H St. Paul
SHammes, E. M St. Paul
§Hammes, E. M., Jr St. Paul
Hammond, J. F St. Paul
SHanson, H. B St. Paul
SHarmon, G. E St. Paul
SHartfiel, W. F .....St. Paul
Hartig, Marjorie St. Paul
SHartley, E. C. St. Paul
SHassett, M. F St. Paul
§Hauser, V. P St. Paul
Havel, R. J Minneapolis
SHaves. A. F. St. Paul
§Heek, W. W St. Paul
Hedenstrom, F. G St. Paul
Henderson, A. J. G St. Paul
Hengstler, W. H St. Paul
§Hensel, C. N St. Paul
Herman, S. M St. Paul
§Heron. R. C St. Paul
§ Herrmann, E. T St. Paul
Hertz, M. J St. Paul
SHUvrr, A. W St. Paul
tHUger, D. D. St. Paul
Hilger, J. A St. Paul
5Hilger, L. D St. Paul
§Hilker, M. D St. Paul
Hiniker, L. P St. Paul
§Hochfilzer, J. J St. Paul
Hodgson, Jane E St. Paul
Holcomb, O. W St. Paul
SHollinshead, W. H St. Paul
SHolmen, R. W St. Paul
SHolt, J. E St. Pau!
f Hopkins, G. W St. Paul
Howard, M. A St. Paul
Howard, W. S St. Paul
§Howe, N. W St. Paul
SHullsiek, H. E St. Paul
§Hullsiek, R. B Minneapolis
SHultgen, W. J St. Paul
Hurwitz, M. M St. Paul
§tlde, A. W St. Paul
Ikeda, Kano St. Paul
Ingerson, C. A St. Paul
Jesion, J. W St. Paul
Sjohanson, W. G St. Paul
5 Johnson, A. M St. Paul
§Tohnson C. E St. Paul
Jones, E. M St. Paul
§ Kamman, G. R St. Paul
Kaplan, D. H St. Paul
Karon, I. M... St. Paul
5 Kasper, E. M St. Paul
§Katz, L. J Hot Springs. S. D.
tKatzovitz, Hyman St. Paul
Keefe, R. E. St. Paul
SKelly, J. V St. Paul
IKelsey, C. M St. Paul
§Kenefick, E. V St. Paul
5 Kennedy, W. A St. Pau!
§Kenyon, T. J St. Paul
$ Resting, Herman St. Paul
King, G. L. St. Paul
§ Klein, H. N St. Paul
SKnutson, G. E St. Paul
jSKugler, A. A St. Paul
§Kuske, A. W St. Paul
Kvitrud, Gilbert St. Paul
§Lannin, B. G St. Paul
Lannin, D. R St. Paul
Larsen, C. L St. Paul
Larson, Eva-Jane St. Paul
Larson, J. T South St. Paul
Larson, K. R St. Paul
Lax. M. H St. Paul
5 Leahy, Bartholomew St. Paul
§ Leavenworth, R. O St. Paul
Lee, N. J St. Paul
§Lei_ck, R. M St. Paul
SLeitch, Archibald St. Paul
SLepak, J. A St. Paul
tLerche, William Cable, Wis.
8Leven, N. L. St. Paul
§T.everenz. C. W St. Paul
Levin, -Bert St. Paul
Levitt, G. X St. Paul
5 Lick, C. L. St. Paul
§Lien, R. J. ..... . St. Paul
§Lightbourn, E. L. St. Paul
I.illeberg, N. T St. Paul
Lippman, H. S St. Paul
§Loken, S. M St. Paul
Lowe, E. R ....So. St. Paul
Lowe. T. A So. St. Paul
SLundholm, A. M St. Paul
SLynch, F. W.. St. Paul
§ Madden, J. F St. Paul
Madland, Robert S St. Paul
Maertz, W. F St. Paul
§Malerieh, J. A St. Paul
Marks, R. W St. Paul
Martin, D. L. St. Paul
§Martineau, T. L. St. Paul
McAdams, J. B St. Paul
McCain, D. L St. Paul
McCarthy, T. J St. Paul
McCarthy, W. R St. Paul
McClanahan, J. H White Bear
McClanahan. T. S White Bear
§McCloud, C. N St. Paul
§McEwan, Alexander St. Paul
t McLaren, Jennette M Minneapolis
5 Meade, J. R St. Paul
§Mears, B. J » St. Paul
501
ROSTER
§MedeIman, J. P St. Paul
Melancon, J. F St. Paul
Menold, W. F St. Paul
Merner, T. B Minneapolis
§Meyerding, E. A St. Paul
Michienzi, L. J St. Paul
Miller, W. T St. Paul
Miller. Z. R St. Paul
§Moga, J. A St. Paul
Molander, H. A St. Paul
Moquin, Marie A St. Paul
Moren, J. A St. Paul
Moriarty, Berenice St. Paul
Moriarty, Cecile R St. Paul
Muller, A. E North St. Paul
§Muller, R. T St. Paul
Murphy, J. T St. Paul
Naegeli, A. E St. Paul
§Nash, L. A St. Paul
fNelson, L. A St. Paul
Nimlos, K. O St. Paul
Nimlos, Lenore O St. Paul
§ Noble, J. F St. Paul
§Noble, J. L St. Paul
Nuebel, C. J Hudson, Wis.
Nye, Katherine A St. Paul
Nye, Lillian L St. Paul
O’Brien, J. C St. Paul
O’Connor, L. J St. Paul
§Ockuly, O. E c't. "aul
§Ogden, Warner St. Paul
§Ohage, Justus St. Paul
O’Kane, T. W St. Paul
SOlsen, R. L ....St. Paul
Olson, C. A St. Paul
Olson, F. P St. Paul
SO’Reilley, B. E St. Paul
§Ostergren, E. W St. Paul
§ Ouellette, A. J St. Paul
§ Pearson, F. R St. Paul
§ Pearson, M. M St. Paul
Pedersen, A. H St. Paul
Peterson, D. B St. Paul
§Peterson, D. H St. Paul
§ Peterson, H. O St. Paul
§ Peterson, J. L. E St. Paul
§Plondke, F. J St. Paul
l’lotke, H. I St. Paul
Polski, P. G South St. Paul
§Prendergast, H. J St. Paul
Quattlebaum, F. W St Paul
Radabaugh, R. C Hastings
§ Ralph, J. R St. Paul
t Ramsey, W. R St. Paul
Rasmussen, R. C St. Paul
Ravits, H. G St. Paul
§Rea, C. E St. Paul
Reid. J. W St. Paul
§ Richards, E. T. F. St. Paul
Richardson, E. J., Jr St. Paul
§ Richardson, H. E St. Paul
§ Richardson, R. J St. Paul
Rick, P. F. W St. Paul
Rinkey, Eugene St. Paul
§Ritchie, W. P St. Paul
§ Ritt, A. E St. Paul
§ Rogers, S. F St. Paul
Rolig, D. H St. Paul
§ Rosenthal, Robert St. Paul
§ Roth, G. C St. Paul
SRothschiid. H. 1 St. Paul
Rowe, C. J., Jr St. Paul
§Roy, P. C St. Paul
fRuhberg, G. N .Tarzoua, Calif.
Rutherford, W. C Nisswa
Ryan, James D St. Paul
§Ryan, J. J St. Paul
§Ryan, J. M St. Paul
§Ryan, M. E St. Paul
SSarnecki, M. M St. Paul
Satterlund, V. L St. Paul
Savage, F. J. St. Paul
§Schmidtke, R. L St. Paul
Schoch, R. B. J St. Paul
ISchons, Edward St. Paul
SSchroeckenstein, H. F St. Paul
§fSchuldt, F. C St. Paul
§ Schulze, A. G St. Paul
§Schwyzer, H. C St. Paul
§Scott, E. E St. Paul
Sekhon, M. S St. Paul
tSenkler, G. E St. Paul
§Setzer, H. J St. Paul
Shannon, W. R St. Paul
Shaw, H. A St. Paul
tShellman, J. L. . Pacific Palisades, Cal.
§Shimonek, S. W St. Paul
Short, Jacob St. Paul
Sickels, E. W St. Paul
Siegel, Clarence St. Paul
§Simons, L. T St. Paul
Singer, B. J St. Paul
tSkinner, H. 0 St. Paul
SSmisek, E. A St. Paul
§ Smith, V. D. E St. Paul
§ Snyder. G. W St. Paul
iiSohlberg, O. I St. Paul
§ Sommers, Ben St. Paul
§Sorem, M. B St. Paul
Soucheray. P. H St. Paul
§Souster, B. B St. Paul
Sprafka, J. I St. Paul
§Sprafka, J. M St. Paul
§Steinberg, C. L St. Paul
Sterner, D. C St. Paul
§Sterner, E. G St. Paul
SSterner, E. R St. Paul
Sterner, J J St. Paul
Sterner, O. W St. Paul
Stewart, Alexander St. Paul
Stolpestad, A. H St. Paul
§Stolpestad, H. L St. Paul
§Strate, G. E St. Paul
Straus, M. L St. Paul
Strem, E. L. St. Paul
SSturley, Rodney F St. Paul
Swanson, J. A St. Paul
Swanson, L. J So. St. Paul
§Swendson, J. J St. Paul
§Teisberg, C. B St. Paul
§Teisberg, J. E St. Paul
Thompson, F. A St. Paul
Thoreson, M. C. Bernice. .So. St. Paul
Thorsen, D. S St. Paul
Tifft, C. R St. Paul
§Tracht, R. R St. Paul
Travis, J. S St. Paul
§Tregilgas, H. R So. St. Paul
Van Bergen, F. H Minneapolis
Varco, R. L. St. Paul
Veirs, Dean St. Paul
Veirs, Ruby J. S St. Paul
§ Venables, A. E St. Paul
*§Von der Weyer, W. H. ..St. Paul
§Waas, C. W St. Paul
§ Walker, A. E St. Paul
fWalsh, E. F St. Paul
§ Walter, C. W St. Paul
ItWard, P. D St. Paul
Warren, C. A St. Paul
Watson, P. T St. Paul
Watson, W. H. A St. Paul
Watson, W. J Newport
Watz, C. E St. Paul
§ Webber, F. L St. Paul
§Weis, B. A St. Paul
§Weisberg, Maurice St. Paul
§ Wenzel, G. P St. Paul
*f Werner, O. S St. Paul
Wesolowski, S. P Minneapolis
tWheeler, M. W Lake Elmo
t Whitacre, J. C St. Paul
Williams, A. B St. Paul
§ Williams, C. K St. Paul
§ Williams, J. A St. Paul
ijWilson, J. A St. Paul
§Wilson, J. V St. Paul
Winnick, J. B St. Paul
§Wold, K. C St. Paul
§Wolff, H. J St. Paul
Wolkoff, H. J St. Paul
Word, H. L St. Paul
Wurdeniann, A. L. .White Bear Lake
Youngren, E. R St. Paul
Zachman, L. L St. Paul
§Zimmermann, H. B St. Paul
Covey, K. W.
President
.Mahnomen
Secretary
Sather, R. O.
§Adkins, C. M
Anderson, W. E. ..
Behling, F. L. . . .
§ Behr, O. K
Berge, D. O
Berlin, A. S
*t Bertelson, O. L.
tBiedermann, Jacob
§ Boyer, G. S. '
§Boynton, Bruce ..
tBratrud, Edward
Bratrud, T. E.
Brink, A. A
* Brown, L. L. . . .
§Cameron, J. H. ..,
§Canfield, A
Carlson, A. E
SCovey, K. W
§Dale, L. M
Danford, K. A. . .
SDelmore, John L.
Hinz, W. E.
RED RIVER VALLEY MEDICAL SOCIETY
Kittson, Mahnomen, Marshall, Norman, Pennington, Polk, Red Lake and Roseau Counties
Regular meetings quarterly — Annual meeting, December
Number of Members: 69
Delmore, R. J Roseau
§ Erickson, Eskil Halstad
Feigal, W. M Thief River Falls
Greene. D. E Thief River Falls
Haberle, C. A ..Duluth
^Hendrickson, R. R Crookston
§Hennev, W. H McIntosh
Hollands, W. H Fisher
§Holmstrom, C. H Warren
Tanecky, A. G Baudette
SJanssen, M. E Crookston
Tetisen, A. R Crookston
Johnson, E. A Thief River Falls
Tohnson, H. C Thief River Falls
Johnson, R. E Mankato
SKinkade, B. R Ada
tKirk, G. P East Grand Forks
§KIefstad, L. H Greenbush
Knutson, G. A Hallock
§Kostick, W. R Fertile
Loken, Theodore Ada
Lynde, O. G Thief River Falls
McLane, W. O. . . .Thief River Falls
tMelbv, O. F Thief River Falls
§ Mercil, W. F. Crookston
Nelson, A. S Thief River Falls
fNelson, H. E Crookston
RENVILLE COUNTY MEDICAL SOCIETY
Regular meetings, second Tuesday of month
Annual meeting, November
Number of Members: 21
§Anderson, Donald C Olivia
IBillings, R. E Franklin
f§Brand, W. A Redwood' Falls
§Ceplecha, S. F Redwood Falls
SCosgriff, J. A Olivia
Cosgriff, J. A., Jr Olivia
JDordal, J Sacred Heart
§ Fawcett, A. M Renville
Flinn, T. E Remer
. Crookston
Thief River Falls
Clearbrook
Oklee
Crookston
Roseau
Hallock
Crookston
Thief River Falls
Crookston
Ada
hief River Falls
'hief River Falls
Baudette
Crookston
Crookston
.Madison, Wis.
Warren
Mahnomen
Red Lake Falls
Mahnomen
Roseau
§Delmore, John L., Jr Roseau
President
.Bird Island
Nickerson, N. D. ...Thief River Falls
Nietfeld, A. B Warren
§ Norman, J. F Crookston
§Oppegaard, C. L Crookston
§Oppegaard, M. O Crookston
fParsons, J. G Crookston
Pearson, L. O Warroad
§Pohl,. D. E Crookston
§Pumala, E. E Warren
Quigley, W. P Thief River Falls
§Reff, A. R Crookston
Reinhardt, J. H Red Lake Falls
§Roholt, H. B Fosston
§Rvdland, A. D Crookston
*f Sather, Allen Fosston
Sather, E. L Fosston
§Sather, G. A Fosston
Sather, R. N Fosston
§Sather, R. O Crookston
§Skogerboe, R. B Karlstad
§Starekow, M. D. . .Thief River Falls
Stewart, D. E Crookston
Stone, Norman F Gonvick
fTorgerson, W. B Oklee
§Uhley, C. G Crookston
Watson, R. M Thief River Falls
fWiltrout, I. G Oslo
t§Gaines, E. C.
Secretary
Knoche, H. A Morgan
*t§Adams, R. C Bird Island
Alcorn, W. J Wabasso
§ Anderson, C. A Hector
502
.... Buffalo Lake
§Hinz, W. E Bird Island
§ Johnson, O. H Redwood Falls
§ Johnson, W. E Morgan
§Knoche, H. A Morgan
Lenz, J. R Morton
McLeod, John Olivia
Potthoff, C. J Washington, D. C.
Priesinger, J. W Renville
Minnesota Medicine
ROSTER
President
Studer, D. J Faribault
Secretary
§Belshe, J. C Northfield
Belshe, J. C Northfield
t §Dungay, N. S Northfield
{Engberg, E. J Faribault
Francis, D. W Morristown
tHanson, A. M Faribault
§Hanson, J. W Northfield
tHuxley, F. W Faribault
^Kennedy, G. L Faribault
RICE COUNTY MEDICAL SOCIETY
Regular meeting, third Tuesday of
Annual meeting, May
Number of Members: 32
Kolars, J. J Faribault
Kucera, L. B Lonsdale
§Lende, Norman... Faribault
Lexa, F. J Lonsdale
Maertz, R. W Faribault
*McKeon, J. O. ..San Angelo, Texas
§Mears, R. F Northfield
Meyer, F. C Kenyon
Meyer, P. F Faribault
§Moses, R. R Kenyon
Navratil, D. R Montgomery
§Neutzman, A. W Faribault
§Nielson, A. M Northfield
Petersen, D. H Northfield
§Robilliard, C. M.. Faribault
Rohrer, C. A. VVaterville
Rumpf, C. W. Faribault
*tRumpf, W. H Faribault
§Stevenson, F. W Faribault
§Street, Bernard Northfield
§Studer, D. J Faribault
Traeger, C. A Faribault
§ Weaver, P. H Faribault
West, E. J Fort Thomas, Ky.
Wilkinson, S. L Faribault
§Wilson, W-. E Northfield
Regular meetings, second Thursday every month except July and August
ST. LOUIS COUNTY MEDICAL SOCIETY
Carlton, Cook, Itasca, Lake and St. Louis Counties
Annual meeting, January
Number of Members: 250
President
Gowan, L. R Duluth
Secretary
Christensen, C. H Duluth
§Abraham, A. L Duluth
| Adams, B. S Hibbing
Addy, E. R Gilbert
fArhelger, Stuart Freeborn
§Arko, J. L Hibbing
§Armstrong, E. L Duluth
§Athens, A. G Duluth
t§Atmore, W. G Duluth
S liachnik, F. W Hibbing
§Backus, R. W Nopeming
§Bagley, C. M ..Duluth
Bagley, Elizabeth C Duluth
SBagley. W. R, Duluth
SBaich, V. M Bovey
SBakkila, H. E Duluth
§Bardon, Richard Duluth
§ Barker, J. D Duluth
Barney, L. A Duluth
§ Barrett, E. E Duluth
§ Becker, F. T Duluth
Benell, O. E Virginia
Bepko, Marie K Cloquet
Berdez, G. L Duluth
§Bergan, R. O Duluth
§ B ianco, A. J Duluth
fBinet, H. E Grand Rapids
§Blackmore, S. C ..Biwabik
Bolz, J. A Grand Rapids
Boman, P. G Duluth
SBooren, J. C Duluth
SBowen, R. 1 Hibbing
fBoyer, S. H., Sr Duluth
Boyer, S. H., Jr Duluth
§Braun, O. C '....Grand Rapids
Bray, K. E Biwabik
§Bray, P. N Duluth
Bray, R. B Biwabik
§Brooker, W. J Duluth
§ Buckley, R. P Duluth
§Butler, J. K Cloquet
§Callan, T. D Eveleth
Cantwell, W. F.. . .International Falls
Chapman, T. L Duluth
§Chermak, F. G International Falls
§Christensen, C. H Duluth
Clark, E. A Duluth
§ Clark, I. T..... Duluth
fColl, J. J Duluth
tCollins, A. N Moose Lake
*tCoilins, H. C Duluth
§Conley, F. W Duluth
Cope, H. B Virginia
§ Coventry, W. A Duluth
§ Coventry, W. D Duluth
Detjen, E. D Bigfork
§Dickson, F. H., Jr Proctor
§ Dittrich. R. J Duluth
Doyle, G. C Duluth
SEekman, P. F Duluth
SEckman, R. J Duluth
SFisenman, Walter Coleraine
SEkblad, J. W ..Duluth
SElias, F. J Duluth
§Emanual, K. W Duluth
Eppard, R. M Cloquet
§F.rskine, G. M Grand Ranids
SEstrem, T. A. Hibbing
SF.wens. H. B Virginia
SFawcett, K. R ....Duluth
§Fellows, M. F Duluth
Ferrell, C. R Grand Rapids
SFischer, M. McC Duluth
§Fisketti, Henry Duluth
. §Flynn, B. F Hibbing
Fortier, R. G Marble
§ Fredericks, M. G Duluth
§Gillespie, M. G Duluth
§Goldish, D. R Duluth
SGoodman, C. E Virginia
§ Gowan, L. R Duluth
§Graham, A. W Chisholm
jjGrahek, J. P Ely
§ Graves, W. N Duluth
§Grinle.y, A. V Grand Rapids
§Haavik, J. E Duluth
§ Halbert, J. J Duluth
Halliday, P. V Duluth
Halme, W. B Cloquet
HHaney, C. L Duluth
§Hansen, R. E Hibbing
tHanson, E. O Cloquet
§ Harris, C. N Hibbing
SHatch, W. E Duluth
§Hayes, M. F Nashwauk
§Hedberg, G. A Nopeming
Heiam, W. C Cook
§Hilding, A. C Duluth
Hill, F. E. . . . Duluth
Hirschboeck, F. J Duluth
§Hoff, H. O Duluth
§Houkom, S. S Duluth
Hutchinson^ Henry Moose Lake
§ Jacobson, Clarence Chisholm
SJacobson, F. C .....Duluth
§ Jensen, T. J Duluth
§ Jeronimus, H. J Duluth
ijessico, C. M Duluth
§Joffe, H. H Duluth
§ Johnson, K. E Duluth
Ijohnsrud, L. W Chisholm
Johnson, R. O Hibbing
§Tolin, F. M Bovey
§Kelly, A. C Duluth
§Klein, Harry Duluth
§KIein, W. A Duluth
§ Knapp, F. N Duluth
§ Knoll, W. V Duluth
§Kohlbry, C. O Duluth
§Koskela, A. L. .Deer River
Koskela, L. E Deer River
SKotchevar, F. R. ...Eveleth
§ Krueger, V. R Nopeming
§La Bree, R. H Duluth
§Laird, A. T Duluth
§LatterreIl, K. E Duluth
fLenont, C. B Virginia
Lepak, F. J Duluth
Lewis, J. S., Jr Nashwauk
§Litman, S. N. Duluth
*tLoofbourrow, E. H Keewatin
§Luth, D. V Duluth
MacDonald, R. A Littlefork
§Macfarlane, P. H Chisholm
§MacRae, G. C Duluth
§Magney, F. H Duluth
Magraw, R. M St. Paul
§Malmstrom, J. A Virginia
tMarcley, W. J Minneapolis
§ Martin, W. C Duluth
§Mayne, R. M Nopeming
tMcCarty, P. D Ely
t McCoy, Mary K Duluth
McDonald, A. L ..Duluth
McDonald, O. G Duluth
SMcHaffie, O. L Duluth
§McKenna, M. J Grand Rapids
McLeod, J. L Grand Rapids
§McNutt, J. R Duluth
Mead, C. H Duluth
SMerriman, L. L Duluth
tMeyer, J. O Grand Rapids
§ Minty, E. W Duluth
§Moe, R. J Duluth
Moe, Thomas Moose Lake
§Moehring, H. G Duluth
Mollers, T. P Soudan
Monroe, P. B Cloquet
Monserud, N. O Cloquet
§Morsman, L. W Hibbing
Mueller, Selma C Duluth
§Murray, R. A Hibbing
Neff, W. S Virginia
§Nelson, R. L... Duluth
§ Nicholson, M. A Duluth
Norberg, C. E Cloquet
§ Nutting, R. E ...Duluth
§01son, A. E Duluth
Olson, A. O. Duluth
§0’Neill, J. C. Duluth
§Paciotti, V. J Hibbing
Palmer, H. A Blackduck
§Papermaster, Ralph Two Harbors
t Parker, O. W Moose Lake
Parker, W. H Chisholm
§ Parson, E. I. Duluth
Pasek, A. W Cloquet
Pasek, E. A Carlton
§ Patch, O. B.. .Duluth
§Patey, R. T Buhl
flPearsall, R. P Virginia
UPederson, R. C Duluth
Pennie, D. F. Duluth
Peterson, E. N ....Virginia
Peterson, J. H. Duluth
§ Power, J. E Duluth
Puumala, R. H. Cloquet
iRqadquist, C. S Hibbing
Raattama, J. W. Keewatin
Raihala, John Virginia
§Raiter, R. F Cloquet
§Retd, Paul Virginia
tRobinson, J. M Goshen, N. Y.
§Rokala, H. E Virginia
ItRood, D. C. .....Duluth
Rowe, O. W Duluth
§Rowles, E. K CoIeTaine
§Rudie, P. S. Duluth
§Runquist, J. M: Duluth
Ryan, W. J ...Duluth
Sach-Rowitz, Alvin.
§Salter, R. A. ...... ,
Sandell, S. T
§Sarff, O. E
Sax, M. H
Sax, S. G
§Schirber, M. J
Schmid, J. F. ...
§ Schneider, L. E. ..
§ Schroder, C.‘ H.. . . .
Schweiger, T. R...
§Seashore, R. T. . .
Sharp, M. C
*fShaw, A. W., . . .
§Sher, D. A
SSiegel, J. S
§Sinamark, Andrew
Sisler, C. E
§ Smith, C. M
Smith, W. R.......
Snyker, O. E
§Spang, A. J
SSpang. J. S
*§Spicer, F. W. . . .
§Strand'jord, N. M.
ll§Strathern, M. L. .
§Strauss, E. C
§Strewler, G. T. ...
§Strobel, W. G
Stuart, A. B
iSutherland, H. N..
. .Moose Lake
Virginia
. . . .Nopeming
T Pduth
Duluth
Duluth
. Grand Rapids
Duluth
Duluth
Duluth
ILhhing
.Duluth
Virginia
Virginia
Virginia
Virginia
Hibbing
• Grand Rapids
Duluth
Grand Marais
Ely
Duluth
Duluth
Duluth
Virginia
Gilbert
Duluth
Duluth
Duluth
Cloquet
.Ely
May, 1950
503
ROSTER
Swedberg, W. A Duluth
§Swenson, A. O Duluth
§tTaylor, C. W Duluth
$Teich, K. W Duluth
((Terrell, B. J Nopemmg
STetlie, J. P Duluth
Tibbetts, M. H Duluth
i'l'ingdale, Carlyle Htbbtng
§Tosseland, Noel E Duluth
IjTuohy, E. L Duluth
§Urberg, S. E Duluth
Van Kyzin, D. J Duluth
§Van Valkenberg, J. D Floodwood
§Walder, H. J Duluth
§t Walker, A. E Duluth
§ Wallace, M. O Duluth
Walter, F. H International Falls
§ Wells, A. H Duluth
§Wheeler, D. W Duluth
§ Williams, B. F. P Duluth
Winter, J. A Duluth
§Ylitalo, W. H Hibbing
(jYoung, T. O Duluth
tZlatovski, M. L Duluth
SCOTT-CARVER COUNTY MEDICAL SOCIETY
Regular meetings, second Tuesday of the alternate months
Annual meeting, June
Number of Members: 27
President
Doherty, E. M New Prague
Secretary
Hass, F. M Jordan
tAhrens, Curtis F. ... Galveston, Texas
Bratholdt, J. W Watertown
Buck, F. H Shakopee
SCervenka, C. F New Prague
§ Doherty, E. M New Prague
§Hass, F. M Jordan
§Hebeisen, M. B Chaska
Heinz, I. B Shakopee
Heinz, L. H Shakopee
§Juergens, H. M Belle' Plaine
Kline, R. F Montgomery
§Kortsch, F. P Prior Lake
§Kucera, S. T Northfield
Larson, Loren J Watertown
Martin, T. P Arlington
Nagel, H. D Waconia
Ninneman, N. N Waconia
t Novak, E. E New Prague
Olson, C. J Belle Plaine
§ Pearson, B. F Shakopee
Pogue, R. E Watertown
§Ponterio, J. E Shakopee
§Rynda, E. R New Prague
Schimdpfenig, G. T Chaska
§ Simons, B. H Chaska
ItWesterman, A. E. Montgomery
§Westerman, F. C Montgomery
SOUTHWESTERN MINNESOTA MEDICAL SOCIETY
Cottonwood, Jackson, Murray, Nobles, Pipestone and Rock Counties
Regular meetings, at call
Annual meeting, October
President
Beckering, Gerrit Edgerton
Secretary
Heiberg, O. M Worthington
Anderson, O. W Luverne
§Amold, E. W Adrian
5 Balmer, A. I Pipestone
•(Basinger, H. P Windom
Basinger, H. R. Mountain Lake
§Beckering, Gerrit Edgerton
((Benjamin, W. G Pipestone
Bofenkamp, F. W Luverne
t Brown, A. H Pipestone
Carlson, J. V Westbrook
((Christiansen. H. A Jackson
§Chunn, S. S Pipestone
fDeBoer, Herinanus Edgerton
§Doman, V. W Lakefield
Dorns, H. C. A Slayton
§Doms, V. A Slayton
Franz, W. M Mountain Lake
§Gruys, R. I Windom
Number of Members: 66
§Hallin, R. P Worthington
§Halloran, W. H Jackson
jjHalpern, D. J Brewster
§Harrison, P. W Worthington
Hebbel, Robert Minneapolis
§Heiberg, O. M Worthington
Hitchings, W. S Lakefield
§Hoyer, L. J Windom
§Hursh, P. W Slayton
Johnson, C. M Jackson
((Johnson, M. A Storden
§Karleen, B. N Jackson
§Kilbride, E. A Worthington
tKilbride, J. S Worthington
§Kotval, R. J Pipestone
Laikola, L. A Adrian
§Lohmann, T. G Pipestone
§Maitland, E. T Jackson
tManson, F. M Worthington
§Minge, R. K Worthington
§Mork, B. O., Jr Minneapolis
§Nealy, D. E Adrian
§Nelson, C. A Worthington
((Nickerson, J. R Heron Lake
§Pankratz, P. J Mountain Lake
§ Patterson, H. D Slayton
Johnson, C. M Jackson
§Minge, R. K Worthington
<! Pierson. R. F Slayton
§ Piper, W. A Mountain Lake
§Robinett, R. W Worthington
§Rose, J. T Lakefield
§Schade, F. L Worthington
Schmidt, J. R Mountain Lake
iiSchutz, E. S Mountain Lake
SSlierman, C. L Luverne
SSlater, S. A Worthington
§Sogge, L. L Windom i
§Sorum, F. T Jasper
§Stam, John Worthington
Stanley, C. R Worthington i
Stevenson, B. M Fulda
Stratte, H. C Windom
Watkins, J. A Windom
§Wells, W. B Jackson
((Williams, C. A Pipestone
Williams, L. A Minneapolis
§Williamson, II. A Heron Lake1'
§Wisness, O. A Slayton i
WolfT, Helen B Worthington
STEARNS-BENTON COUNTY MEDICAL SOCIETY
Regular meetings, third Thursday of month
Annual meeting, third Thursday of December
Number of Members: 59
President
Raetz, S. J
Secretary
Libert, J. N
Anderson, E. M. ......
§ Baumgartner, F. H....
§Beuning, J. B
Brigham, C. F
§Brigham, C. F., Jr
Broker, H. M
§Buscher, J. C
§ Clark, H. B
Cleaves, W. D
§ Donaldson, C. S
Du Bois, J. F
DuBois, Julian F., Jr.
Engstrom, G. F
§ Evans, L. M
§ Fleming, T. N. .
§Friesleben, William....
SGaida, J. B
§Goehrs, G. H
.Maple Lake
...St. Cloud
. . .St. Cloud
Albany
...St. Cloud
.. .St. Cloud
... St. Cloud
.Eden Valley
. . .St. Cloud
...St. Cloud
.Sauk Center
Foley
Sauk Center
.Sauk Center
. . . . Belgrade
Sauk Rapids
... St. Cloud
.Sauk Rapids
. . .St. Cloud
... St. Cloud
President
Kurtin, H. J Blooming Prairie
Secretary
Lundquist, C. W Owatonna
Anderson, F. C Owatonna
Berghs, U V Owatonna
504
Goehrs, H. W St. Cloud
Grant. J. C Sauk Center
§Haberman, Emil Osakis
§Halenbeck, P. L St. Cloud
§Hall, W. E Maple Lake
fHemstead, Werner Minneapolis
Henry, C. J Milaca
Henry, J. E Milaca
Houle, Rollin T St. Cloud
§ Jones, R. N St. Cloud
§ Kelly, J. F Cold Springs
§Koop, S. H Richmond
Kuhlmann, L. B Melrose
t Lewis, C. B St. Cloud
§Libert, J. N St. Cloud
§Luckemeyer, C. J St. Cloud
§Mahowald, A Albany
§McDowell, J. P St. Cloud
Meyer, A. A. Melrose
§Milhaupt, E. N St. Cloud
Musachio, N. F Foley
Myre, C. R Paynesville
§Nessa, C. B St. Cloud
STEELE COUNTY MEDICAL SOCIETY
Regular meeting, every second month
Annual meeting, December
Number of Members : 20
Dewey, D. H Owatonna
Ertel, E. Q Ellendale
Hartung, E. H Claremont
Kurtin, H. J Blooming Prairie
Lundquist, C. W Owatonna
Mahowald, Aloys Albany
McEnaney, C. T Owatonna
McIntyre, J. A. Owatonna
Melby, Benedik Blooming Prairie
((O’Keefe, J. P
O’Leary, J. H
§ Petersen, R. T
St. Cloud
§Phares, Otto C
§ Raetz, S. J
.... Maple Lake
§ Reif, H. J.
§ Richards, W. B
Salk, Richard J. . . .
§Sandven, N. O
§Schatz, F. J
St. Cloud
§Schmitz, E. J
Sherwood, G. E
5 Sisk, If. E
St. Cloud •
§Smith, R. C
Holdingford
Stangl, P. E
Veranth, L. A
St. Cloud
(jVrtiska, F. L
St. Cloud
((Walfred, K. A
Wedes, Deno J
§ Wenner, W. T
((Wetzel, E. V
§Wittrock, L. II
Zachman, A. H
Moorhead, D. E. Owatonna
Nelson, E. J Owatonna
Olson, A. j Owatonna
Peterson, W. H Owatonna
Roberts, O. W Owatonna
Schaefer, J. F Owatonna
Senn, E. W Owatonna
Stransky, T. W Owatonna
§Wilkowske, R. J Owatonna
Minnesota Medicine
ROSTER
UPPER MISSISSIPPI MEDICAL SOCIETY
Aitkin, Beltrami, Cass, Clearwater, Crow Wing, Hubbard, Koochiching,
Lake of the Woods, Morrison, Todd and Wadena Counties
Annual meeting, February
Annual meeting, January
Number of Members: 102
President
Mulligan, A. M.
Brainerd
Secretary
Badeaux, G. I
Adkins, G. H. . . .
Faribault
{Anderson, Werner
§Badeaux, G. I
Brainerd
Beise, R. A
Brainerd
Bender, J. H
Brainerd
Borgerson, A. H. .
Cardie, G. E
Brainerd
Closuit, F. C
Aitken
Cook, T. M
Coombs, C. H
tCorrigan, J. E
Spooner
Craig, C. C
International Falls
§Crow, E. R
Cushing. R. L. . .
Brainerd
Davis, L. F
Wadena
Davis, L. T
*Davis, T. C
Davis, T. L
Wadena
Dewesse, W. J....
Eiler, John
Erickson, Alvin....
Fait, R. V
Little Falls
Fearing, T. E. ...
Minneapolis
Fine, B. A
Fitzsimmons, W. E
Brainerd
§Fortier, G. M. A.
Little Falls
Friefeld, Saul . . .
.Brookings, S. D.
Garlock, A. V. ...
Bemidji
Oarlock, D. H
Ghostley, Mary C..
tGilmore, Rowland..
{Grogan, T. S
Wadena
Groschupf, T. P. ..
Grose, F. N
§Halladay, G. J.
Hanover, R. D
Hartjen, J. K. . . .
Healy, R. T
Hendricks, E. J. .
Higgs, W. W. ...
Hill, W. C
Hoganson, D. E. . .
tHouse, Z. E
§Houston, D. M. .
Hubbard, O. E. . .
t Johnson, C. E. ...
Johnson, D. L
Johnson, E. W. ...
Johnson, K. J. . . .
Johnson, S. M. .
Johnstone, W. W.
Kanne, E. R
Kinports, E. B. .
Knight, E. G
Larson, Leroy . .
Laughlin, J. T. . .
Lee, H. W
Leggett, E. A
§Lenarz, A. J
Longfellow, Helen
Lund, W. J
Mark, Hilbert....
Marshall, C. M.
McCann, D. F. . . .
McGeary, M. D.. . .
Miners, G. A.
Mitbv, I. L
§Mosby, M. E
§ Mulligan, A. M...
Brainerd
Little Fork
Bemidji
Pierz
St. Paul
Park Rapids
Pequot Lakes
Bemidji
. . . . Burbank, Calif.
Park Rapids
Brainerd
St. Paul
Little Falls
Bemidji
Bemidji
Wadena
. . . . Ah-Gwah-Ching
Brainerd
International Falls
Swanville
Bagley
Grey Eagle
Brainerd
. . . . Ah-Gwah-Clnng
Browerville
B Brainerd
Staples
Minneapolis
Crosby
Bemidji
Brainerd
Bemidji
Aitkin
Long Prairie
Brainerd
Nelson, Bernette G Menahga
Nelson, Bernice A Menahga
Nelson, N. P Minneapolis
Nixon, James B Crosby
Nolan, D. E Dayton, Ohio
Olson, Lillian Ah-Gwah-Ching
Parker, C. W Wadena
Parker, Warren E Sebeka
Petraborg, Harvey T Aitkin
Pierce, C. H. Wadena
Pierce, R. B Wadena
Potek, D. M international Falls
§Quanstrom, V. E Brainerd
fRatcliffe, J. J Aitkin
Ringle, O. F Walker
Rozycki. A. T Pine River
§Sanderson, A. G Deerwood
{Schmitz, G. P Little Falls
Schnugg, F. J Brainerd
§ Simons, E. J Swanville
*Smith, B. A Crosby
§Stein, R. J Pierz
Stoy, R. A Little Falls
Thabes, J. A., Sr Brainerd
{Thabes, J. A., Jr Brainerd
Vandersluis, C. W Bemidji
{Watson, A. M Royalton
*fWatson, J. D Minneapolis
Watson, P. T Minneapolis
Watson, S. W Royalton
Whittemore, D. D Bemidji
Wikoff, H. M Bemidji
Will, C. B Bertha
§ Will, W. W Bertha
Williams, M. M Ah-Gwah-Ching
Wilson, V. O Minneapolis
Wingquist, C. G Crosby
Zeigler, C. M Pine River
President
Ekstrand, L. M
Secretary
Wilson, W. F
{Bayley, E. C
§Bouquet, B. J
WABASHA COUNTY MEDICAL SOCIETY
Regular meetings, Spring and Fall
Annual meeting, first Thursday after first Monday in October
Number of Members: 16
. . Wabasha
.Lake City
.Lake City
. .Wabasha
§Bowers, R. N Lake City
Collins, J. S Wabasha
§ Ekstrand, L. M Wabasha
§ Ellis. E. W Elgin
{Flesche, B. A Lake City
§Gjerde, W. P Lake City
Glabe, R. A Plainview
§ Mahle, D. G Plainview
Martin, D. A Wabasha
{Ochsner, C. G Wabasha
t Replogle, W. H...Los Angeles, Calif.
Vaughn, C. G Plainview
Wellman, T. G Clinton, Iowa
t Wilson, W. F Lake City
WASECA COUNTY MEDICAL SOCIETY
Regular meetings, every six months
Annual meeting, January
Number of Members: 9
President
Davis, R. D Waseca
Secretary
Olds, G. H New Richland
{Davis, R. D Waseca
t§Gallagher, B. J Waseca
Gallagher, W. B Waseca
{Hottinger, R. C Janesville
§McIntire, PI. M Waseca
{Oeljen, S. C. G Waseca
{Olds, G. H New Richland
§Swenson, O. J ..Waseca
§Wadd, C. T Janesville
President
Sherman, C. H
Secretary
Boleyn, E. S
{Boleyn, E. S
WASHINGTON COUNTY MEDICAL SOCIETY
Regular meetings, Second Tuesday in each month, except June, July, August
Annual meeting, second Tuesday in December
Number of Members: 17
Bayport
. . . . Stillwater
. . . . Stillwater
Burseth, E. C Forest Lake
§ Carlson, R. E Stillwater
{tHaines, J. H Stillwater
{Holcomb, I. T Marine-on-St. Croix
Humphrey, W. R Stillwater
§Jenson, J. E Stillwater
Johnson, R. G Stillwater
Josewski, R. J Stillwater
Juergens, M. F.
Knudson, R. A. . .
§McCarten, F. M..
Poirier, J. A
Ruggles, G. M....
§Sherman, C. H...
§Stuhr, J. W
Van Meier, Henry
. . . Stillwater
• Forest Lake
. . .Stillwater
Forest Lake
Forest Lake
.... Bayport
. . . Stillwater
. . .Stillwater
WEST CENTRAL MINNESOTA MEDICAL SOCIETY
Big Stone, Pope, Stevens, and Traverse Counties
Regular meetings, March, May, September and November
Annual meeting, November
Number of Members: 29
Acting President
Barnett, G. L Graceville
Secretary
Gericke, J. T Glenwood
Arneson, A. I Morris
{Barnett, G. L. Graceville
{Behmler, F. W Morris
{Bergan, Otto Clinton
fBolsta, Charles Ortonville
Dahle, M. B Olivia
StEberlin, E. A Glenwood
§Eide, O. A Hancock
{Elsey, E. M Glenwood
tElsey, J. R Glenwood
tFitzgerald, E. T Morris
§Gericke, J. T., Jr Glenwood
§Giesen, A. F Starbuck
Hedemark, H. H Ortonville
Hedtmark, T. A Ortonville
§Kam, J. F Ortonville
§Lindberg, A. L Wheaton
ItLinde, Herman Cyrus
§Magnuson, A. E Wheaton
Mclver, B. A. Lowry
{Merrill, R. W Morris
Muir, W. F Browns Valley
O’Donnell, D. M Ortonville
{Oliver, I. L. Graceville
{Plasha, M. K Glenwood
Ransom, M. L. Hancock
{Rossberg, Raymond A Morris
{Swedenburg, P. A Glenwood
Turbak, C. E Herman
{Wagner, N. W Graceville
May, 1950
505
ROSTER
WINONA COUNTY MEDICAL SOCIETY
Regular meeting, first Monday in January, March, July, October
Annual meeting, first Monday in January
Number of Members: 32
President
Heise, Carl
§tRobbins, C. P
Winona
. . . .Winona
§ Heise, Herbert
§Roemer, H. J
Secretary
§Heise, Paul
Heise, Philip
§Rogers, C. W
SRoth, F. D
Lewiston
§tHeise, W. F. C....
Winona
§Satterlee, H. W
Schmidt, H. R
§ Heise, W. V
§ Johnston, L. F
Schaefer, Samuel
§Schmidt, Hilmar
5 Benoit, F. T
§Keyes, J. D
§ Loomis, G. L
§ Steiner, I. W
Blochowiak, N. P
Winona
ItTweedy, G. J
Winona
§Boardman, D. V
§Mattison, P. A
Winona
iTweedy, 1. A
$('anfield, W. W
McLaughlin, E. M. .
Winona
Tweedy, R. B
Winona
§Christensen, E. E
§Meinert, A. E
Winona
§Vollmer, F. J
Winona
Finkelnburg, W. < >
.... Winona
Neumann, C. A. . . .
Winona
§Wilson, R. H
§Hartwich, R. F
. . . .Winona
§Page, R. L
St. Charles
§Younger, L. I
Winona
President
Ryding, V. T Howard Lake
Secretary
Catlin, T. J Buffalo
§ Anderson, W. P Buffalo
§Bendix, L. H Annandale
WRIGHT COUNTY MEDICAL SOCIETY
Regular meeting, not scheduled
Annual meeting, October
Number of Members: 16
§Catlin, J. J Buffalo
§ Catlin, T. J Buffalo
§ Ellison, F. E Monticello
| Greenfield, W. T Delano
Grundset, O. J Montrose
Guilfoile, P. J Delano
*Harriman, Leonard ....Howard Lake
§Hart, W. E Monticello
Horn, L. Y. W Monticello
Peterson, O. L Cokato
§Ridgway, A. M Annandale
§Roholt. C. L Waverly
§Ryding, V. T Howard Lake
*Swezey, B. F Buffalo
§Thielen, R. D St. Michael
Thompson, Arthur Cokato
506
Minnesota Medicine
Alphabetic Roster
Key to Symbols: ^Deceased; fAffiliate, Associate or Life Member;
^Affiliate or Life Membership Pending; |In Service; §Wife is Member of Woman’s Auxiliary.
kagaard, G. N., Jr Minneapolis
^anes, A. M Red Wing
kborn, W. H Hawley
\braham, A. L Duluth
\bramson, Milton Minneanolis
Ackerman, R. F Memphis, Tenn
tdair, A. F., Jr St. Paul
Warns, B. S Hibbing
Warns, F. H Minneapolis
Warns, N. D Rochester
Adams, R. C Bird Island
Warns, Richard C Rochester
Wdy, E. R Gilbert
Adkins, C. D Minneapolis
Wkins, C. M Thief River Falls
Vdkins, G. H Faribault
Wson, A. W Rochester
Vffeldt, D. E Kasson
tga, John Mankato
Vhem, E. E Minneapolis
\hlfs, J. J Caledonia
Wrens, A. E St. Paul
\hrens, A. H St. Paul
Wrens, C. F Galveston, Texas
Vitkens, H. B LeCenter
Wester, Ward Fergus Falls
Wins, W. M Red Wing
Mbers, D. D Rochester
Mbrecht, H. H Chisago City
Ucorn, W. J Wabasso
Vlcott, D. L Rochester
Mden, John F., Jr St. Paul
Mdrich, C. A Rochester
Mexander, H. A Minneapolis
Mger, E. W Minneapolis
Ming, C. A Minneapolis
Allen, E. V. N Rochester
Altnow, H. O Minneapolis
Alvarez, W. C Rochester
Amberg, Samuel Rochester
\merongen, W. W St. Paul
Andersen, H. A Rochester
Andersen, S. C Minneapolis
Anderson, A. S Rochester
Anderson, A. D Rochester
Anderson, C. A Hector
Anderson, C. D Chicago, 111.
Anderson, D. C Olivia
Anderson, D. D Minneapolis
Anderson, D. P., Jr Austin
Anderson, E. D Minneapolis
Anderson, E. M St. Cloud
Anderson, E. R Minneapolis
Anderson, Franklin Owatonna
Anderson, F. J Minneapolis
Anderson, J. J St. Paul
Anderson, J. K Minneapolis
Anderson, J. R Rochester
Anderson, K. W Minneapolis
Anderson, M. J Rochester
Anderson, M. W Rochester
Anderson, O. W Luverne
Anderson, R. E Willmar
Anderson, R. L Rochester
Anderson, S. H Red Wing
Anderson, T. P Rochester
Anderson, U. S Minneapolis
Anderson, W. P Buffalo
Anderson, W. E Clearbrook
Anderson, W. H Minneapolis
Anderson, W. T Minneapolis
Anderson, W. W Brainerd
Atidreassen, Einar C St. Paul
Andrejek, A. R Milaca
Andresen, K. D Minneapolis
Andrews, R. N Mankato
Andrews, R. S Minneapolis
Anthony, W. P. Rochester
Arata, J. E Rochester
Arends, A. L Moose Lake
Arey, S. L Minneapolis
Arhelger, Stuart Freeborn
Arko, J. L Hibbing
Arlander, C. E Minneapolis
Arling, L. S Minneapolis
Armstrong, E. L Duluth
Armstrong, R. Sv Winnebago
Arndt, H. W Detroit Lakes
May, 1950
Arnesen, J. F Rochester
Arneson, A. I Morris
Arnold, Anna W Minneapolis
Arnold, D. C Minneapolis
Arnold, E. W Adrian
Arnquist. A. S St. Paul
Arnson, J. M Benson
Arny, F. P St. Paul
Arvidson, C. G Minneapolis
Arzt, P. K St. Paul
Ashe, W. M San Francisco, Calif.
Athens, A. G Duluth
fAtmore, W. G Rochester
tAune, Martin Minneapolis
tAurand, W. H Minneapolis
Aurelius, J. R St. Paul
Ausman, C. F St. Paul
Ausman, D. R St. Paul
Austin, G. W Rochester
Austin, W. E Minneapolis
Babb, F. S St. Paul
Jiachnik, F. W Hibbing
Backus, R. W Nopeming
Bacon, D. K St. Paul
*tBacon, L. C St. Paul
Badeaux, G. I Brainerd
Bagby, G. W Cannon Falls
Baggenstoss, A. H Rochester
Bagley, C. M Duluth
Bagley, Elizabeth C Duluth
Bagley, W. R Duluth
Baich, V. M Bovey
Bailey, Allen A Rochester
Bailey, R. B Phoenix, Ariz.
Bair. H. L Rochester
Baird, J. W Minneapolis
Baken, M. P Minneapolis
Raker, A. B '.Minneapolis
Baker, A. C Fergus Falls
Baker, A. T Minneapolis
Baker, E. L Minneapolis
Baker, G. S Rochester
Baker, H. R Hayfield
Baker, Jeannette L Fergus Falls
tBaker, Looe .....Minneapolis
Baker-, M. E Minneapolis
Baker, N. H Fergus Falls
Baker, R. L Havfield
Bakkila, H. E Duluth
Balcome, M. M St. Paul
tBalfour, D. C Rochester
Balfour, D. C., Jr Rochester
Balfour, W. M Rochester
Balkin. S. G Minneapolis
Ball, Warren P Rochester
Balmer, A. I Pipestone
tBank, F.. W Fort Howard, Md.
Bank, H. E Portland, Ore.
Banner, Edw. A.. Rochester
fBarber, J. P , Ely
Barber, T. E Austin
Bardon, Richard Duluth
Bargen, T. A Rochester
Barker, J. D Duluth
Barker, N. W Rochester
Barnes, A. R Rochester
Barnett, G. L Graceville
Barnett, J. M St. Paul
Barney, L. A Duluth
Barr, L. C Albert Lea
Barr, M. M Minneapolis
Barr, R. N St. Paul
Barr, W. H Wells
Barrett, E. E Duluth
Barron, Moses Minneapolis
Barron, S. S Minneapolis
Barry, L. W St. Paul
tBarsness, Nellie O. N St. Paul
Bartholomew, L. G Rochester
*Barton, J. C Bethesda, Md.
Basinger, H. P Windom
Basinger. H. R Mountain Lake
Baskin, Roy H Rochester
Bastron, J. A Rochester
Batdorf, B. N Good Thunder
Bateman, J. G Rochester
Bateman, Olive L Hopkins
Bauer, E. L. St. Paul
Baumgartner. F. H Albany
f Baxter, S. H Minneapolis
Bayley, E. C Lake City
Bayrd, E. D Rochester
Beach, Northrup Minneapolis
Beahrs, O. H Rochester
tBeals, Hugh St. Paul
tBeard, A. FI Minneapolis
Beard, E. F Rochester
Beck, W. W., Jr Salt Lake, LItah
tBecker, A. M Minneapolis
Becker, F. T Duluth
Becker, S. W., Jr Rochester
Beckenng, Gerrit Edgerton
tBeckman, W. G.,Palo Alto, California
Bedford. E. W Minneapolis
Beech, R. H St. Paul
Beek, FI. O St. Paul
Beeler, J. W Rochester
Beer, J. J St. Paul
Begley, J. W Rochester
Behlmg, F. L Oklee
Behmler, F. W. Morris
Behr, O. K Crookston
Beise, R. A Brainerd
Beiswanger, R. H. Minneapolis
Belding, H. H., Ill Rochester
Bell, C. C St. Paul
tBell, E. T Minneapolis
Bellegie, N. J. ............. Rochester
Bellomo, James St. Paul
Bellomo, John Grand Meadows
IBellville, T. P Minneapolis
Relote, G. B Caledonia
Belshe, J. C Northfield
Belzer, M. S Minneapolis
Bender, J. H... Brainerd
Bendix, L. H Annandale
Benedict. W. L Rochester
Benell, O. E Virginia
Benepe, J. L St. Paul
Benesh. L. A Minneapolis
tBenjamin, A. E Minneapolis
Benjamin, E. G Minneapolis
Benjamin, H. G Minneapolis
Benjamin, W. G Pipestone
fBenn, F. G LaMesa, Calif.
Bennett, Henry S Rochester
Bennett, W. A Rochester
tBennion, P. H. Isway, Mont.
Benoit, F. T Winona
Benson, L. M Tracy
Rentley, N. P St. Paul
Benton, P. C Minneapolis
*Bentson, J. H Rochester
Bepko, Marie K Cloquet
Berdez, G. L Duluth
Berens, James Rochester
Bergan, Otto Clinton
Bergan, R. O Duluth
Berge, D. O Roseau
Berge, H. L Mora
Berger, A. G Minneapolis
Bergh, G. S Minneapolis
Bergh, Solveig, M Minneapolis
Berghs, L. V Owatonna
Bergman, O. B St. James
Bergquist, K. E Battle Lake
Berkman, D. M Rochester
Berkman, J. M Rochester
Berkwitz, N. J Minneapolis
Berlin, A. S Hallock
§Berman, Reuben Minneapolis
Bernatz, P. E. Rochester
Bernstein. W. C St. Paul
* fBertelson, O. L Crookston
Bessesen, A. N., Jr Minneapolis
§Bessesen, D. H Minneapolis
Bessessen, W. A Minneapolis
Betts, R. A Seattle, Wash.
Reuning. J. B St. Cloud
Beyer, E. F Braham
Bianco, A. J Duluth
Bicek, J. F St. Paul
Bickel, W. H Rochester
Biddle, C. M Hastings
fBiedermann, Jacob ..Thief River Falls
507
ROSTER
Bieter, R. N Minneapolis
Bigelow, C. E Dodge Center
Bigler, Earl E Perham
Bigler, I. E Perham
Bilka, P. J Rochester
Billings, R. E Franklin
tBinet, H. E Grand Rapids
tBinger, H. E Phoenix, Ariz.
Black, B. M Rochester
Black, E. J St. Paul
Black, W. A New Ulm
Blackburn, C. M Rochester
Blackmore, S. C Biwabik
Blake, A. J Hopkins
tBlake, James Hopkins
Blake, James A Hopkins
tBlake. P. S Minneapolis
Blochowiak, N. P — . . . Rushford
Block, Melvin A. Rochester
Bloedel, T. J. G Osseo
Bloemendaal, E. J. G Lake Park
BlombtTg, W. R Princeton
Bloom, N. B Minneapolis
Blumenthal, J. S Minneapolis
Blunt, C. P., Ill Lynchburg, Va.
Boardman, D. V Winona
Bock, R. A St. Paul
Bockman, M. W. H Minneapolis
Bodaski, A. A Le Center
Bodelson, A. H Hopkins
Boeckmann, Egil St. Paul
Boehrer, J. J., Jr Minneapolis
Bofenkamp, F. W Luverne
Boies. L. R Minneapolis
Boisclair, T. G Detroit Lakes
Bolender, H. L St. Paul
Boleyn, E. S Stillwater
Bolger, J. V., Jr.. . .Oconomowoc, Wis.
Boline, C. A Battle Lake
tBolsta, Charles Ortonville
Bolz, J. A Grand Rapids
Boraan, P. G Duluth
Boody, G. J., Jr Dawson
Booren, J. C Duluth
tBooth, A. E Minneapolis
JBoothby, W. M Rochester
Boreen, C. A Minneapolis
Borden. C. W Minneapolis
Borg, J. F St. Paul
Borgerson, A. H Sebeka
Borgeson, E. J Minneapolis
Borman, C. N Minneapolis
Bosland. H. G Willmar
Bossert, C. S Mora
Bottolfson, B. T Fargo, N. D.
Boucek, R. J. Rochester
Bouma, L. R St. Paul
Bouquet, B. J Wabasha
Bourgert, G. E Hudson, Wis.
Bowen, R. L Hibbing
Bowers, G. G Minneapolis
Bowers, R. N Lake City
{Rowing, H. H Rochester
Boyd, David A., Jr Rochester
Boyd, L. M Alexandria
Boyer, G. S Crookston
tBoyer, S. H., Sr Duluth
Boyer, S. H., Jr Duluth
Boynton, Bruce Ada
Rovnton, Ruth E Minneapolis
Bovsen, Herbert .Madelia
tBoysen, Peter Austin, Texas
JBraa ch, W. F Rochester
Braceland, F. J Rochester
Brand. G. D St. Paul
JRrand, W. A Redwood Falls
Brandenburg, R. O Rochester
Branham, D. S St. Peter
•Branton, B. J Willmar
Rratholdt, J. W Watertown
Rratrud. A. F Minneapolis
JBratrud, Edward . .Thief River Falls
Bratrud, T. E Thief River Falls
Bratrude, E. T St. James
Braude, A. I Minneapolis
Braun, O. C Grand Rapids
Brav, F R St. Paul
Bray, K. E Biwabik
Bray, P. N Duluth
Bray, R. B Biwabik
Rregel, F. L St. James
Breitenbucher, R. B Minneapolis
Brekke, H. J Minneapolis
Bresette, J. E Rochester
Brickley, Paul M Rochester
Briggs, J. F St. Paul
Briobam. C. F St. Cloud
Brigham, C. F., Jr St. Cloud
Brill, Alice K Minneapolis
Brink, A. A Baudette
Brink, D. M Hutchinson
Broadie, T. E St. Paul
Brobyn, C. W Minneapolis
508
Broders, A. C Rochester
Brodie, W. D St. Paul
Broker, H. M Eden Valley
Brooker, W. J Duluth
Brooks, C. N Minneapolis
Brotchner, R. J St. Paul
Brown, A. E Rochester
t Brown, A. H Pipestone
t Brown, E. D Paynesville
Brown, H. A Rochester
Brown, J. C St. Paul
Brown, J. R Rochester
•Brown, L. L Crookston
Brown, P. W Rochester
f Brown, S. P Minneapolis
Brown, W. D Minneapolis
Brunsting, L. A Rochester
Brusegaard, J. F Red Wing
Brutsch, G. C Minneapolis
Brzustowicz, R. J Rochester
Buchstein, II. F Minneapolis
Buck, F. H Shakopee
Buckley, R. P Duluth
Buffmire, D. K Rochester
Ruie, Louis A Rochester
Buirge, R. E Minneapolis
Bulinski, T. J St. Paul
Bulkley, Kenneth Minneapolis
Bunker, B. W Anoka
Burch. E. P. II St. Paul
tBurch, F. E St. Paul
Burchell, H. B Rochester
Burgert, E. O., Jr Rochester
Burgess, H. M Rochester
Burke, E. C Rochester
Burkland, E. C St. Paul
Burlingame, D. A St. Paul
Burmeister, R. O Welcome
Burnap, VV. L Fergus Falls
Burnham, W. H Minneapolis
Burns, F. M Milan
Burns, Catherine Albert Lea
•Burns, H. A Anoka
•Burns, L. S St. Paul
Burns, M. A Milan
Burns. R. M St. Paul
Burseth, E. C Forest Lake
Burton, C. G St. Paul
Buscher, J. C St. Cloud
Bush, R. P Minneapolis
Bushard, W. J Minneapolis
Busher, H. H St. Paul
Butin, J. W Rochester
Butler, D. B Rochester
Butler, J. K Cloquet
Butt, H. R Rochester
Butturff, C. R Freeborn
Butzer, J. A Mankato
Buzzelle, L. K Minneapolis
Cable, M. L Minneapolis
Cabot, C. M Minneapolis
Cabot, V. S Minneapolis
Cady, L. II Minneapolis
Cain, C. L St. Paul
Cain, J. C Rochester
Cain, J. H Hoffman
Cairns. R. J Redwood Falls
tCalhoun, F. W Albert Lea
Callahan, F. F St. Paul
Callan, T. D Eveleth
Callerstrom. G. W Minneapolis
Cameron, Isabell L. ....Minneapolis
Cameron, J. H Crookston
Camp, J. D Rochester
*Camp, W. E Minneapolis
Campbell, D. C Rochester
Campbell, L. M Minneapolis
Campbell, O. J Minneapolis
Canfield, Albert Madison, Wis.
Canfield, W. W Houston
Cannon, B. W Memphis, Tenn.
Cantwell, W. F. ... International Falls
Caplan, Leslie Minneapolis
Cardie, A. E Minneapolis
Cardie. G. E Brainerd
Carey J. B Minneapolis
Carey, J. M Rochester
Carlander, L. W„ Jr Rochester
Carley, W. A St. Paul
Carlisle, J. C Rochester
Carlson, A. E Warren
Carlson, C. E Alexandria
Carlson, J. V Westbrook
Carlson, Lawrence Minneapolis
Carlson, L. T Minneapolis
Carlson, R. E Stillwater
Carman, J. E Detroit Lakes
Caron, R. P Minneapolis
Carpenter, G. T Rochester
Carr D T Rochester
Carroll, T. T. Rochester
Carroll, W. C St. Paul
Carryer, H. M Rochester
Cashin, J. C Rochester
Caspers, C. G Minneapolis
Catlin, J. J Buffalo
Catlin, T. J Buffalo
Cavanor, F. T Minneapolis
Cedarleaf, C. B Minneapolis
Ceder, E. T Minneapolis
Ceplecha, S. F Redwood Falls
Cervenka, C. F New Prague
Chadbourn, C. R St. Paul
Chadbourn, W. A Litchfield
Chalgren, W. S Minneapolis
Challman, S. A Minneapolis
Chambers, W. C Blue Earth
Chance, D. P Rochester
Chapman, C. B Minneapolis
Chapman, T. L Duluth
Chatterton, C. C St. Paul
Chermak, F. G International Falls
Chesley, A. J Minneapolis
Childs, D. S., Jr Rochester
Chisholm, T. C Minneapolis
Christensen, C. H Duluth
Christensen, E. E Winona
Christensen, L. E Minneapolis
Christensen, N. A Rochester
•Christenson, G. R Minneapolis
Christiansen, Andrew St. Paul
Christiansen, H. A Jackson
Christianson, H. W Minneapolis
Christie, D. P Rochester
Christoferson, Lee A Rochester
Chunn, S. S Pipestone
Clagett, O. T Rochester
Clark, E. A Duluth
Clark, H. B St. Cloud
Clark, H. B., Jr Minneapolis
Clark, I. T Duluth
Clark, L. W Spring Valley
Clark, P. L., Ill Rochester
Clarke, E. K Minneapolis
Clay, L. B Minneapolis
Claydon, H. F Red Wing
Cleaves, W. D Sauk Centre
tClement, J. B Lester Prairie
Clifford, G. W Alexandria
Clifton, T. A Chatfield
Closuit, F. C Aitkin
Clothier, E. F Elk River
Cochrane, B. B Red Wing
Cochrane, R. F Minneapolis
Cnddon, W. D St. Paul
Coe, J. T Minneapolis
Cohen, B. A Minneapolis
Cohen, E. B Minneapolis
Cohen, E. N St. Paul
Cohen, M. M Minneapolis
Cohen, S. S Minneapolis
Colby, M. Y., Jr Rochester
Colby. W. L St. Paul
Cole, J. P Rochester
Cote. W. H St. Paul
Coll. J. J Duluth
tCollie, H. G St. Petersburg, Fla.
JCollins, A. N Moose Lake
*t Collins, H. C Duluth
Collins, J. S Wabasha
Colp, E. A Robbinsdale
Combacker. L. C Fergus Falls
Comfort. M. W Rochester
tCondit, W. H Minneapolis
Conley, F. W Duluth
Connolly, C. J St. Paul
Connor. C. E St. Paul
Cook, C. K St. Paul
Cook, E. N Rochester
Cook. J. M Staples
Coombs. C. H Cass Lake
Colley, J. C Rochester
Cooper, C. C St. Paul
Cooper, I. S Rochester
Cooper, J. P Excelsior
Cooper, M. D Winnebago
Cooper, Talbert Rochester
Cope, H. B Virginia
tCorbett, J. F Minneapolis
Corbin, K. B Rochester
Carcoran, C. E Chicago, III.
Corniea. A. D Minneapolis
Correa, D. H Minneapolis
tCorrigan, J. E Spooner
Crosgriff, J. A., Sr Olivia
Crosgriff, J. A., Jr Olivia
Coulter, H. E Madelia
Counseller, V. S Rochester
Countryman, R. S St. Paul
Minnesota Medicine
ROSTER
Covell, W. W St. Peter
Coventry, M. B Rochester
Coventry, W. A Duluth
Coventry, W. D Duluth
Covey, K. W Mahnomen
Cowan, D. W Minneapolis
Cowern, E. W No. St. Paul
Craig, C. C International Falls
Craig, D. M St. Paul
Craig, M. E Minneapolis
Craig, W. McK Rochester
Cranmer, R. R Minneapolis
Cranston, R. W Minneapolis
Creevy, C. D Minneapolis
Crehan, E. L. Rochester
Creighton, R. H Minneapolis
Crenshaw, J. L Rochester
Crenshaw, J„ L., Jr Rochester
Critchfield, L. R St. Paul
Crombie, F. J No. St. Paul
Cronwell, B. J Austin
Crow, E. R Ah-Gwah-Ching
Crowley, J. H St. Paul
Crudo, V. D St. Paul
Crump, J. W St. Paul
Crumpacker, E. L Rochester
Culligan, J. M St. Paul
Culligan, L. C Minneapolis
Culmer, C. U Chicago, 111.
Culver, L. G St. Paul
Cundy, D. T Minneapolis
Curtis, R. A Le Center
Curtiss, R. K Rochester
Cushing, R. L Brainerd
Cutts, George Minneapolis
Dack, L. G St. Paul
Dady, E. E Minneapolis
Daehlin, Rolf Fergus Falls
Dahl, E. O Minneapolis
tDahl, G. A Mankato
Dahl, J. A Minneapolis
Dahle, M. B Olivia
Dahlin, D. C Rochestei
Dahlstet, J. P No. Mankato
Daignault, O Benson
Dale, L. N Red Lake Fans
Danford, K. A Mahnomen
Daniel, D. H Minneapolis
Danielson, K. A Litchfield
Danielson, Lennox Litchfield
Dargay, C. P Minneapolis
Daugherty, E. B. .. Marine-on-St. Croix
Daugherty, G. W Rochester
Davis, A. C Rochester
Davis, E. V St. Paul
Davis, G. D Rochester
Davis, I. G Rushford
Davis, J. C Minneapolis
Davis, L. T Wadena
Davis, T-. F Wadena
Davis, R. M Rochester
Davis, Robert E Rochester
Davis, R. D Waseca
Davis, T. C Wadena
Davis, T. L Wadena
Davis, W. I Mound
Day, L. A St. Paul
Dearing, W. H., Jr Rochester
DeBoer, Hermanus Edgerton
Decker, C. H St. Paul
Decker, D. G Rochester
Dederick, G. F., Jr Rochester
Dedolph, Karl St. Paul
Dedolph, T. IT Minneapolis
DeForest, R. E Rochester
Delmore, J. L Roseau
Delmore, J. L., Jr Roseau
Delmore, R. J Roseau
del Plaine, C. W Minneapolis
Demo, R. A Albert Lea
Denman, A. V Mankato
Dennis, Clarence Minneapolis
Derauf, B. I St. Paul
Deters, D. C St. Paul
Detjen, E. D Bigfork
Devereaux, T. J Wayzata
Devine, K. D Rochester
Dtvney, J. W Rochester
DeWeerd, J. H., Jr Rochester
Deweese, W. J Bemidji
Dewey, D. H Owatonna
Dickson, F. H., Jr Proctor
Dickson, T. H St. Paul
Didcoct, J. W Rochester
Diehl, H. S Minneapolis
Diessner, G. R Rochester
Diessner, H. D Minneapolis
Dillard, P. G., Jr Rochester
Dille, D. E Litchfield
Dittrich, R. J Duluth
Dixon, C. F Rochester
Dockerty, M. B Rochester
Dodds, Wm. C Detroit Lakes
/Iay, 1950
Dodge, H. W., Jr. Rochester
Dodge, Mark Rochester
Doherty, E. M New Prague
Dolder, F. C Eyota
Doman, V. W Lakefield
Dorns, H. C. A Slayton
Dorns, Vernon A Slayton
Donaldson, C. S Foley
Donoghue, F. E Rochester
Donohue, P. F St. Paul
Donovan, D. L Albert Lea
Dordal, J Sacred Heart
Dorge, R. I Minneapolis
Dornberger, G. R Rochester
Dornblaser, H. B Minneapolis
Dorsey, G. C Minneapolis
Douglass, B. E Rochester
Doust, W. C Rochester
Dovre, C. M St. Paul
Dowidat, R. W Minneapolis
Doxey, G. L Minneapolis
Doyle, G. C Duluth
Doyle, L. O Minneapolis
Drake, C. B St. Paul
Drake, C. R Minneapolis
tDrake, F. A Lanesboro
Dredge, H. P Sandstone
Dredge, T. E Minneapolis
Drescher, E. P Berkeley, Calif.
Drexler, G. W Blue Earth
Drill, IT. F. Hopkins
HDrips, D. G Rochester
fDrought, W. W Fergus Falls
Dry, T. J Rochester
Dubbe1, F. H New Ulm
DuBnis, J. F. Sauk Centre
Du Bois, Julian F., Jr.... Sauk Centre
Duff, E. R Minneapolis
tDuinas. A. G Minneapolis
Duncan, D. K Rochester
Duncan, T. W Moorhead
tDungay, N. S Northfield
Dunlap, E. H Minneapolis
Dunlap, R. W Rochester
*Dunn, G. R Minneapolis
Dunn, J. N St. Paul
DuPont, T. A Excelsior
Duryea, VV. M Minneapolis
Du Shane, J. W Rochester
t Dutton, C. E Minneapolis
Dvorak, B. A Minneapolis
Dwan, P. F Minneapolis
Dwinnell, L. A Fergus Falls
Dworetzky, M Rochester
Dworsky, S. D Minneapolis
Dysterheft, A. F Gaylord
Earl, G. A St. Paul
Earl, J. R St. Paul
Earnest, F., Ill Toledo, Ohio
Faton, L. M Rochester
Eberley, T. S Benson
tFberlin, E. A Glenwood
Eby, Lee G Rochester
Eckdale. J. E Marshall
Eckles, N Minneapolis
F.ckman, P. F Duluth
F.ckman, R. J Duluth
Eckstam, E. E Rochester
Edlund. Gustaf St. Paul
Edwards, Jessie E Rochester
Edwards, T. W St. Paul
Edwards, L. G St. Paul
tEd wards, R. T Columbus, Ohio
Edwards, T. J St. Paul
Egge, Sanford G Albert Lea
Eginton, C. T St. Paul
Ehrenberg, C. J Minneapolis
Ehrlich, S. P Minneapolis
Eich, Matthew Minneapolis
Eide, O. A Hancock
Eiler, John Park Rapids
Eisenman, Walter Coleraine
Eisenstaedt, D. H Minneapolis
Eisenstadt, W. S Minneapolis
Eitel, G. D Minneapolis
Fkblad, J. W Duluth
Ekstrand, L. M Wabasha
Elias, F. J Duluth
Elkins, E. C Rochester
Ellingson, A. R Detroit Lakes
Elliott, J. A., Jr Rochester
Ellis, E. W Elgin
Ellis, Eugene J Rochester
Ellis, F. H Rochester
Ellison, D. E Minneapolis
Ellison, F. E Monticello
Elsey, E. M Glenwood
tElsey, J. R Glenwood
Ely, O. S So. St. Paul
Emanuel, K. W Duluth
Emerson, E. C St. Paul
Emerson, E. E Osakis
Emmett, J. L Rochester
Emond, A. J Farmington
Emond, J. S Farmington
Endress, E. K St. Paul
Engberg, E, J Faribault
Engel, J. P Rochester
Engelhart, P. C Minneapolis
Engels, E. P Spring Valley
tEnglund, E. F Minneapolis
Engstrand, O. J Minneapolis
Engstrom, G. F Belgrade
Engstrom, Robert Mankato
Enroth, O. E St. Paul
Eppard, R. M Cloquet
Epperson, D. P Rochester
Erdal, Ove A Albert Lea
Erich, J. B Rochester
Erickson, A. O Long Prairie
Erickson, C. O Minneapolis
Erickson, D. J Rochester
Erickson, Eskil • Halstad
Erickson, L. F Minneapolis
Erickson, R. F Minneapolis
Ericson, R. M Minneapolis
Ericson, Swan Le Sueur
Ernest, G. C. H. .St. Petersburg, Fla.
Ersfeld, M. P St. Paul
Erskine, G. M Grand Rapids
Ertel, E. Q Ellendale
tEshelby, E. C St. Paul
*Esser, John Perham
Esser, O. J New Ulm
Esser, R. A Rochester
Estes, J. E Rochester
Estrem, C. O Fergus Falls
Estrem, R. D Fergus Falls
Estrem. T. A Hibbing
Eusterman, G. B Rochester
Eustermann, J. J Mankato
Evans, E. T Minneapolis
Evans, L. M Sauk Rapids
fEvarts, A. B Rochester
Evert, J. A St. Paul
F.wens, H. B Virginia
Eyster, W. H., Jr Rochester
Faber, J. E Rochester
fFahey, E. W St. Paul
Fahr, G. E Minneapolis
Fait, R. V Little Falls
Falsetti, F. P Rochester
Fansler, W. A Minneapolis
Farkas, J. V St. Paul
tFarrish, R. C Sherburn
Faulconer, Albert, Jr Rochester
Faulkner, J. W Rochester
Fawcett, A. M Renville
Fawcett, K. R Duluth
Fearing, J. E Minneapolis
Fee, John G St. Paul
Feeney, T. M Minneapolis
Feigal, D. W. Wayzata
Feigal, W. M Thief River Falls
Femstein, J. Y Minneapolis
Felion, A. J St. Paul
Fellows, M. F Duluth
Fenger, E. P. K Oak Terrace
tFerguson, J. C St. Paul
Ferguson, W. C Walnut Grove
Ferrell, C. R Grand Rapids
Ferris, D. O Rochester
Fensenmaier. O. B New Ulm
Fessler, H. H St. Paul
Field, A. H Farmington
Figi, F. A Rochester
Fine, B. A . Crosby
Fingerman, D. L Minneapolis
Fink, D. L St. Paul
Fink, L. W Minneapolis
Fink, W. H Minneapolis
Finkelnburg, W. O Winona
Fisch, H. M Austin
Fischer, M. McC Duluth
Fisher, C. E Rochester
Fisher, Dan W St. Paul
Fisher, I. I Minneapolis
Fisher, J. M Willmar
Fisketti. Henry Duluth
t Fitzgerald, D. F Wayzata
t Fitzgerald, E. T Morris
Fitzpatrick, T. B Rochester
Fitzsimons, W. E Brainerd
Fjeldstad, C. A Minneapolis
Flanagan, H. F St. Paul
Flanagan, L. G Austin
Flancher, L. H Lake Park
Flannery, Hubert F St. Paul
Flautt, J. R., Jr Louisville, Ky.
Fleeson, W. H Minneapolis
tFleming, A. S. Minneapolis
Fleming, D. S .Minneapolis
Fleming, T. N St. Cloud
509
ROSTER
Flesche, B. A Lake Citv
Flink, E. B Minneapolis
Flinn, J. B Redwood Falls
Flinn, T. E Remer
k loin, M. G Zumbrota
Flom, R. P St. Paul
Flynn, B. F Hibbing
t Fogarty, C-. W St. Paul
Fogarty, C. W., Jr St. Paul
Fogelberg, E. J St. Paul
Foker, L. W Minneapolis
Foley, F. E. B St. Paul
Folken, F. G Albert Lea
Folsom, L. B Minneapolis
Ford, B. C Marshall
Ford, W. H Minneapolis
Forsythe, J. R St. Paul
Fortier, G. M. A Little Falls
Fortier, Rene G Marble
Foss, E. L Rochester
Foster, Orley W Minneapolis
'Foster, W. K Minneapolis
Foulk, W. T Rochester
Fowler, L. H Minneapolis
Fox, James R Minneapolis
Franchere, F. W Lake Crystal
Francis, D. W Morristown
Frane, D. B Minneapolis
Frank, L. M Rochester
Franz, W. M Mountain Lake
Frear, Rosemary R Minneapolis
F'redericks, G. M Minneapolis
Frederickson, Alice C Willmar
Frederickson, G. U. Y Willmar
Fredlund, M. L Minneapolis
Fredricks, M. G Duluth
tFreeman, C. D. ...Balsam Lake, Wis.
Freeman, C. D., Jr St. Paul
Freeman, D. W Minneapolis
Freeman, J. G Rochester
tFreeman, J. P Glenville
Freidman, L. L St. Paul
Freligh, W. P Albert Lea
French, L. A Minneapolis
Fricke, R. E Rochester
Fricke, R. W Rochester
Fried, L. A Minneapolis
Friedell, Aaron Minneapolis
Friedell, George Ivanhoe
Friedman, H. S Minneapolis
Friedman, J Minneapolis
Friefeld, Saul Brookings, So. Dak.
Friesleben, William Sauk Rapids
Frisch, D. C Minneapolis
Frisch, F. P Willmar
Fritsche, Albert New Film
Fritsche, C. J New Ulm
Fritsche, T. R New Ulm
Fritz, W. L St. Paul
Froats, C. W St. Paul
tFrost, E. H Willmar
Frost, T. B Minneapolis
Frost, R. H Oak Terrace
Frykman, H. M Minneapolis
Fugina, G. R Mankato
Fuller, Alice H Minneapolis
Fuller, B. F Rochester
Fuller, Josiah Rochester
Funk, V. K Oak Terrace
Gaida, J. B St. Cloud
tGaines, E. C Buffalo Lake
tGallagher, B. J Waseca
Gallagher, W. B Waseca
tGalligan, Margaret M Minneapolis
Galloway, J. B Minneapolis
tGambill, C. M Rochester
Gambill. E. E Rochester
Gammell, J. H Minneapolis
Garbrecht, A. W St. Paul
Gardiner, D. G St. Paul
Gardner, V. H Fairmont
Gardner, W. P St. Paul
Garlock, A. V Bemidji
Garlock, D. H Bemidji
Garrow, D. M St. Paul
Garten, J. L Minneapolis
Gastineau. C. F Rochester
Gaviser, David Minneapolis
t*Geer, E. K St. Paul
Gehlen, J. N St. Paul
Geiser, P. M Alexandria
Geist, G. A St. Paul
Geraci, J. E Rochester
Gericke, J. T., Jr Glenwood
Ghent, C. H St. Paul
Ghormley, K. O Rochester
Ghormley, R. K Rochester
Ghostley, Mary C Puposky
Gibbons, F. C Comfrey
Gibbs, E. C St. Paul
Gibbs, R. W Minneapolis
Giebenhain, J. N.
Giebink, R. R
Giere, J. C
Giere, R. W.
Giere, S. W
Giesen, A. F
tGiessler. P. W
HGiffin, H. Z
Githn, Mary E
Gifford, R. W., J r.
Gilbert, L. W
Gilbert, M. G
*fGilfillan, J. S
Gilkey, S. E
Gillespie, D. R. . . .
Gillespie, M. G. . . .
Gilrr.an, L. C
tGilmore, Rowland. .
Gmgold, B. A
Giroux, A. A
Girvin, R. B
Gjerde, W. P
Glabe, R. A
Glaeser, J. H
Gleason, W. A. . . .
Gobhrsch. A. P...
Goehrs, 6. H
Goehrs, H. W
Goldberg, I. M. . . .
Goldish, D. R
Goldman, T. I. . . .
Goldner, M. Z
Goldsmith, J. W. . .
Goldstein, N. P
Goltz, E. V
Goltz, Neil F
Good, C. A., Jr
Good, H . D
Goodlad, J. H
Goodman, C. E. . . .
Gordon, P. E
Goss, H. G
Goss, Martha D. . . .
Gowan, L. R
Graham, A. W
Graham, G. G
Grahek, J. P
Grais, M. L
Gfamse, A. E
Grant, H. W
Grant, J. C
Gratzek, F. R. E.
Gratzek, Thomas. .
Grau, R. K
Grave, Floyd
Graves, R. B
Graves, W. N
tGray, F. D
Gray, H. K
Gray, R. C
Green. R. A
Greenberg, A. J. .
Greene, D. E
Greene, L. F
Greenfield, W. T...
Gridley, JT. W
Griebe, Grant
Griffin, G. D. J., Jr.
Griffin, R. P
Griffith, E. R..
Grimes, B. P. ...
Grimes, Marian...
Grindlay, J. H....
Grinley. A. V
Grise. W. B
Grogan, J. M. . . .
{Grogan, J. S
( ironvall, P. R. . . .
Groom, J. J
Groschupf, T. P. . . .
Grose, F. N
Gross, J. B
Grotting, J. K
Grugenhagen, A. P.
Grundset, O. J. . . .
Gruys, R. I
Guernsey, D. E
Guilbert, G. D
Guilfoile, P. J
tGullixson, A
Gully, R. J
Gunlaug on, F. G. . .
Gushurst, F.. G. . . .
Gustason, H. T. . . .
Minneapolis
Minneapolis
Minneapolis
Minneapolis
Benson
Starbuck
Minneapolis
Rochester
Rochester
Rochester
Rochester
Minneapolis
St. Paul
St. Paul
St. Paul
Duluth
Willmar
Bemidji
Minneapolis
No. Mankato
Minneapolis
Lake City
Plainview
, Gibbon
St. Paul
Sleepy Eye
St. Cloud
St. Cloud
Minneapolis
Duluth
Minneapolis
Minneapolis
St. Paul
Rochester
St. Paul
St. Paul
R 'Chester
Minneapolis
Rochester
Virginia
Minneapolis
Glencoe
Glencoe
Duluth
Chisho lm
Rochester
Ely
Minneapolis
.Springfield, Mass.
St. Paul
Sauk Center
Minneapolis
St. Paul
.St. Paul
Minneapolis
Red Wing
Duluth
Marshall
- Rochester
Minneapolis
Minneapolis
Minneapolis
Thief River Falls
Rochester
Delano
Glencoe
Norwood
Rochester
Benson
Rochester
St. Peter
Minneapolis
Rochester
. . . . Grand Rapids
Austin
Ceylon
Wadena
Minneapolis
Rochester
Bemidji
Clarissa
Rochester
Minneapolis
St. Paul
M nntrnse
W’ndom
Rochester
. . . . Legion, Texas
Delano
Albert Lea
Cambridge
Minneapolis
Minneapolis
Minneapolis
Haavik, J. E
Habein, H. C. . . .
Haberer, Helen R.
Haberle, C. A
Haberman. Emil. .
Haes, J. E
Hagedorn, A. B.. .
Duluth
Rochester
Minneapolis
Duluth
Osakis
Mankato
Rochester
Hagen, O. J Moorhead
Hagen, P. S St. Paul
Hagen, W. S Minneapolis
t Haggard, G. D Minneapolis
tHaines, J. H Stillwater
Haines, S. F Rochester
Halbert, J. J Duluth
Halenbeck, P. L St. Cloud
Hall, A. M Minneapolis
Hall, B. E Rochester
Hall, H B Minneapolis
Hall, H. H St. Paul
Hall, W. E Maple Lake
Hall, W. H Minneapolis
Halladay, G. J Brainerd
Hallberg, C. A Minneapolis
Hallberg, O. E Rochester
Hallenbeck, I). F Rochester
Hallenbeck, G. A Rochester
Hall day, P. V Duluth
Hallin, R. P Worthington
Halloran, W. H Jackson
Halme, W. B Cloquet
Halpern, D. J Brewster
Halpin, J. E Rush City
Hammar, L. M Mankato
fHammerstad, L. M Salem. Oregon
Hammes, E. M St. 1’aul
Hammes, E. M., Jr St. Paul
{Hammond, A'. J. H Minneapolis
Hammond, J. F St. Paul
I Haney, C. L Duluth
Hankerson, R. G Minnesota Lake
Hanlon, D. G Rochester
Hannah, H. B Minneapolis
Hanover, R. D Littlefork
Hansen, C. O Minneapolis
Hansen, E. W Minneapolis
Hansen, Olga S Minneapolis.
Hansen, R. E Hibbing
Hansen, T. M Albert Lea
tHanson, A. M Faribault
Hanson, E. O Cloquet
Hanson, E. C New York Mills
Hanson, H. B St. Paul
Hanson, H. H Rochrster
Hanson, H. J Minneapolis
Hanson, H. V Minneapolis
Hanson, J. W Northfield
Hanson, Lewis Frost.
Hanson, M. B Minneapolis
Hanson, N. O Rochester
Hanson, W. A. H Minneapolis
Happe, L. J Minneapolis
Hargraves, M. M Rochester
Harmon. G. F. St. Paul
Hornagel, E. E Rochester
Harriman, Leonard Howard I-akel
Harrington, S. W Rochester.
Harris, C. N Hibbing
Harris, Evelyn S Fergus Falls I
Harris, L. E Rochester
Harrison, P. W Worthington
Hart, V. L Minneapolis
Hart W. E Monticello
Hartfiel, H. A Montevideo
Hartfiel, Vv. F St. Paul
Hartig, Hermina A Minneapolis
Hartig. Marjoiie St. Paul
Hart'en. J. K i Bemidj
Hartley, E. C St. Paul
Hartman, H. R Rochester
Hartnagel, G. F Red Wing
Hartune, E. H Claremont
Hartwi'-h, R. F Winona
tHartzell, T. B Minneapolis
Haskell. A. D Alexandria
Hass, F. M Jordan
Hassett, M. F St. Paul
Hassett, R. G Mankato
Hastings, D. R Minneapolis
Hastings, D. W Minneapolis
Hatch. W. F. Duluth
Hattox, T. S Rochester
Hauch, E. W Rochester
Hauge, E. T Minneapolis
Hauge, M. I Clarkfield
Haugen, G. W Minneapolis
Haugen, L A Minneapolis
Hauser, G. W Minneapolis
Hauser, V. P St. Paul
Havel, R. J Minneapolis
Haven, W. K Minneapolis
Havens, F. Z Rochester
Havens, J. G. W Austin
Hawkinson, R. P Minneapolis
Hawley, G. M„ 111 Red Wing
Hayes, A. F St. Paul
Hayes, D. W Rochester
Hayes, E. R Minneapolis
Hayes, J. M Minneapolis
Hayes, M. F Nashwauk
510
Minnesota Medicine
ROSTER
Hayles, A. B Lincoln, Nebr.
Haynes, A. L Rochester
Hays, A. T Minneatm.is
Head, D. P Minneapolis
‘'Head, D. G Minneapolis
Healey, R. T Pierz
Hebbel, Robert Minneapolis
Hebeisen, M. B Chaska
Heck, F. J Rochester
Heck, W. E. Rochester
Heck, W, W St. Paul
Hedback, A. E Minneapolis
Hedberg, G. A Nopeming
Hedemark, H. H Ortonville
Hedemark, T. A Ortonrille
Hedenstrom, F. G St. Paul
Hedenstrom, L. H Cambridge
Hedenstrom, P. C Marshall
Hedin, R. F Red Wing
Hegge, O. H Austin
Hegge, R. S Austin
Heiam, W. C Cook
Heiberg, E. A Fergus Falls
Heiberg, O. M Worthington
Heilman, D. M. H Rochester
Heilman, F. R Rochester
Heim, R. R Minneapolis
Heimark, J. J Fairmont
"einz, I. B Shakopee
Heinz, L. H Shakopee
Heise, C Winona
Heise, Herbert Winona
Heise, Paul Winona
Heise, P. R Winona
Heise, W. F. C Winona
Heise, W. V .Winona
Heisler, J. J Minneapolis
Helferty, J. K. Minneapolis
Helland, G. M Soring Grove
Helland, J. W Spring Grove
Heller, B. I Minneapolis
Helmholz, H. F Rochester
Hemstead, B. E Rochester
Hemstead, W Minneapolis
Hench, P. S Rochester
Henderson, A. J. G St. Paul
Henderson, E. D. Rochester
Henderson, T. W Rochester
Henderson, M. S Rochester
Hendricks, E. J St. Paul
Hendrickson, J. F Minneapolis
Hendrickson, R. R Crookston
Hengstler, W. H St. Paul
Hennessy, Mary E
Muskegon Heights, Mich
Henney, W. H McIntosh
Henrikson, E. C Minneapolis
Henry, C. J Milaca
Henry, C. E Kirksville. Mo.
Henry, J. E, ...Milaca
Henry, M. O Minneapolis
Hensel, C. N St. Paul
Henslin, A. E Cresco, Iowa
Herbert, W. L Minneapolis
Herbst, R. F Willmar
Herman, S. M St. Paul
Hermann, H. W Minneapolis
Hermanson, P. E Hendricks
Heron, R. C St. Paul
Herrell, W. E Rochester
Herrmann, E. T St. Paul
Hertel, G. E Austin
Hertz. M. J St. Paul
Hesdorffer, M. B.. Minneapolis
Hetherington, J. A. .. Indianapolis, Ind.
Hewitt, Edith S Rochester
Hewitt, R. M Rochester
Heyerdale, O. C Rochester
Lggins. J. H Minneapolis
Higgs, W. W Park Rapids
Hightower, N. C., Jr. ....Rochester
Hildebrand, C. H Seattle, Wash.
Hilding, A. C Duluth
Hilger, A. W St. Paul
Hilger, D. D St. Paul
lilger, J. A St. Paul
Hilger, L. D St. Paul
Hilker, M. D St. Paul
Hill, A. J., Jr Minneapolis
Hill, Earl Minneapolis
Hill, E. M Minneapolis
1 ill, F. E Duluth
Hill, J. R .Rochester
Hill, W. C Pequot Lakes
Hillis, S. J ; St. Paul
Hills, O. W Rochester
Hilsabeck, J. R Rochester
Hinckley, R. G Minneapolis
Hines, C. R., Jr Rochester
Hines, E. A., Jr Rochester
Hiniker, L. P St. Paul
Hiniker, P. J Le Sueur
Hinz, W. E Bird Island
Hirscbboeck, F. J Duluth
Iay. 1950
Hirshfield, F. R .....Minneapolis
JHitchcock, C. R Minneapolis
Hitchings, W. S Lakefield
JHoaglund, A. W. ...Los Angeles, Calif.
Hocnfilzer, J. J St. Paul
Hodapp, R. J Willmar
Hodapp, R. V Willmar
Hodgson, C. H Rochester
Hodgson, J. E St. Paul
Hodgson, J. R Rochester
Hoeper, P. G Mankato
Hoff. H. O Duluth
Hoffbauer, F. W St. Paul
Hoffert, H. E Minneapolis
Hoffman, M. S Rochester
Hoffman, R. A Minneapolis
Hoffman, W. I Minneapolis
Hoganson, D. E Bemidji
Hogben, C. A. M. Rochester
Hoidale, A. D ...Tracy
Holcomb, J. T. . . . Marine-on-St. Croix
Holcomb, O. W St. Paul
Holland, C. R Rochester
tHollands, W. H Fisher
Hollenhurst, R. W Rochester
Hollinshead, W. H St. Paul
Holm, H. H Gkrrne
tHolm, P. F.. ..... .....Wells
Holman, Colin B Rochester
llnlmberg, C. J Minneapolis
llolmberg, L. J Canby
Holmen, R. W St. Paul
Holmes, A. E Rush City
Holmstrom, C. H Warren
Holt, J. E St. Paul
Holzapfel. F. C Minneapolis
Horn, L. Y. W Monticello
Hood, R. T Rochester
t Hopkins, G. W St. Paul
Horan, M. J New York, N. Y.
Horns, R. C Minneapolis
Horton, B. T.... Rochester
Hottinger, R. C Janesville
fHoukom, Bjarne. . . .T. T. East Africa
Houkom. S. S Duluth
Houle, Rollin J St. Cloud
(■House, Z. E. .Burbank, Calif.
Houston, D. M Park Rapids
Ilovde, Rolf Winthrop
Hovland, M. L Minneapolis
Howard, E. G Mapleton
Howard, M. I Mankato
Howard, M. A St. Paul
Howard, S. E. .Minneapolis
Howard. W. S St. Paul
Howe, N. W........ St. Paul
Howell, L. P Rochester
Hoyer, L. J Windom
Hubbard, O. E Brainerd
Hubin, E. G. Sandstone
Hubler, W. L Rochester
Hudec, E. R Echo
Hudson, G. E Minneapolis
Huenekens, E. J Minneapolis
Huffington, H. L Mankato
Hugenberg. W. C Rochester
Huizenga, K. A Rochester
Hullsiek, H. E St. Paul
Hullsiek, R. B. . . . . St. Paul
Hultgen, W. J St. Paul
tHultkrans, J. C Minneapolis
Hultkrans, R. E Minheapolis
Humphrey, E. W Moorhead
Humphrey, W. R ....Stillwater
Hunt, A. B Rochester
Hunt, R. C Fairmont
Hunt, R. S Fairmont
JHunte, A. F Alhambra, Calif.
Hunter, J. S. Rochester
Hunter, R. C Rochester
tHurd, Annah Minneapolis
Hursh, P. W Slayton
Hurwitz, M. M St. Paul
JHutchinson, C. J...Mare Island, Calif.
Hutchinson, D. W Oak Terrace
Hutchinson, Henry Moose Lake
tHuxley, F. R Faribault
Hymes, Charles .Minneapolis
fHynes, J. E Minneapolis
tide, A. W.. . St. Paul
Idstrom, L. G Wayzata
Ikeda, Kano St. Paul
Ingalls, E. G., Jr Minneapolis
lngebrigtson, E. K. G Moorhead
Ingerson, C. A St. Paul
Irvine. H. G Minneapolis
Iverson, R. M Minneapolis
Ivins, J. C Rochester
Ivy, J. H Rochester
Jackman, R. J Rochester
Jackson, H. S Richmond, Va.
Jacobs, D. L Willmar
Jacobs, G. C.. ....... .Fergus Falls
t Jacobs, J. C Willmar
J acobson, Clarence ......... Chisholm
Jacobson, C. W Breckenridge
Jacobson, F. C ....Duluth
Jacobson, W. E Minneapolis
James, E. M..... Minneapolis
Jamison, R. W. ...Walla Walla, Wash.
Jampolis, R. W .....Rochester
Jane^ky, A. G Baudette
Janes, J. M Rochester
Janssen, M. E ....Crookston
Jarrett, Paul S Rochester
Jennings, D. T Rochester
Jensen, A. M Brownton
Jensen, A. R Crookston
Jensen, G. L ...Rochester
Jensen, H. C Minneapolis
t Jensen, M. J Minneapolis
Jensen, N. K. .Minneapolis
Jensen, R. A. Minneapolis
Jensen, T. J Duluth
Jenson, J. E Stillwater
Jerome, B Minneapolis
Jeronimus, H. J Duluth
Jesion, J. W St. Paul
Jessico, C. M Duluth
Teub, R. P Minneapolis
Joffe, H. H. ................ Duluth
.lohanson, W. G St. Paul
Johnson, A. B Rochester
Johnson, A. B Minneapolis
Johnson, A. E Minneapolis
Johnson, August E Minneapolis
Johnson, A. F Sanborn
Johnson, A. M Rochester
Johnson, A. M St. Paul
Johnson, C. E Rochcester
tjohnson, C. E St. Paul
Johnson, C. E St. Paul
Johnson, C. E St. Paul
Johnson, C. P. Tyler
Johnson, C. M Jackson
Johnson, D. A Rochester
Johnson, D. L Little Falls
Johnson, E. A.. Thief River Falls
Johnson, E. W Bemidji
Johnson, E. W., Jr Rochester
Johnson, E. W Minneapolis
Johnson, Evelyn V. ....Minneapolis
Johnson, Hans Kerkhoven
Johnson, H. A. ......... . Minneapolis
ohnson, H. A. Rochester
Johnson, H. C North Mankato
Johnson, H. C. .....Thief River Falls
Johnson, H. W. .Rochester
Tohnson, J. A Minneapolis
Johnson, J. W Minneapolis
Johnson, Julius.. Minneapolis
Johnson, K. E Duluth
Johnson, K. J. Bemidji
Johnson, M. A. Storden
Johnson, M. I Rochester
Johnson, M. R Minneapolis
tjohnson, N. A. ..Santa Monica, Calif.
"Johnson, N. P Minneapolis
Johnson, N. T Minneapolis
Johnson, O. H Redwood Falls
Johnson, Olga H Moorhead
Johnson, R. B Lanesboro
Johnson, R. G..... Minneapolis
Johnson, R. G Stillwater
Johnson, Reuben A Minneapolis
Johnson, R. E Mankato
Johnson, R. E Minneapolis
Johnson, S. M Wadena
Johnson, V. M Dawson
Johnson, W. E Morgan
Johnson, Y. T Minneapolis
Johnsrud, L. W Chisholm
Johnston, L. F Winona
t Johnston, R. O Hibbing
Johnstone, W. W. . . . . Ah-Gwah-Ching
John, F. M Bovey
t Jones, A. W Red Wing
Jones, E. M St. Paul
Jones, G. W. ..Rochester
tjones, H. W., Jr. Minneapolis
Jones, O. H Mankato
Jones, Richard St. Paul
Jones, R. N St. Cloud
Jones, W. R Minneapolis
t Jordan, Kathleen Granite Falls
Jordan, L. S Granite Falls
Jordan, R. A Rochester
Josewich, Alexander Minneapolis
Josewski, R. J Stillwater
Josselson, A. J Rochester
Joyce, G. L Rochester
511
ROSTER
Joyce, G. T Rochester
Judd, E. S., Jr Rochester
Judd, W. H Washington, D. C.
Juergens, H. M Belle Plaint
Juergens, M. F Stillwater
Tuers, E. H Red Wing
Juliar, R. O St. Clair
Turdy, M. J ...Minneapolis
Just, Herman J Hastings
Kaasa, L. J St. Peter
Kabrick, O. A St. Peter
Kahiher, Howard Pelican Rapids
Kalin, O. T Minneapolis
Kallestad, L. L Brownton
Kamman, G. R St. Paul
Kanne, E. R Brainerd
Kaplan, D. H St. Paul
Kaplan, J. H Rochester
Kaplan, J. J Minneapolis
Kapsner, A. T Princeton
Karleen, B. N Jackson
Karleen, C. I Minneapolis
Karlstrom, A. E Minneapolis
Kara, J. F Ortonville
Karon, I. M St. Paul
Kasper. E. M St. Paul
Kath, R. II Wood Lake
Katz, L. J Hot Springs, So. Dak.
fKatzovitz, Hyman St. Paul
Kaufman, E. J Appleton
Kaufman, II. J Minneapolis
Kaufman, W. B Mankato
Kaufman, W. C Appleton
Kearney, R. W Mankato
Keates, A. E Rochester
Keating, F. R., Jr Rochester
Keating, J. U Rochester
Keefe, R. E St. i-aul
Keil, M. A Mankato
Keith, H. M Rochester
Keith, N. M Rochester
Keithahn, E. E Sleepy Eye
Kelbv, G. M Minneapolis
Kelley, E. P Rochester
Kelley, K. J Litchfield
Kelly, A. C Duluth
Kelly, A. H Rochester
Kelly, J. F Cold Spring
Kelly, J. P Minneapolis
Kelly, J. V St. Paul
Kelsey, C. M St. Paul
Kelsey, J. R Rochester
Kemp, A. F Mankato
Kenefick, E. V St. Paul
Kennedy, C. C Minneapolis
Kennedy, G. L Faribault
tKennedy, J. F Minneapolis
Kennedy, R. L. J Rochester
Kennedy, T. V. A Rochester
Kennedy, W. A St. Paul
Kenyon, T. J St. Paul
Kerkhof, A. C Minneapolis
Kernohan, J. W Rochester
Kertesz. G Minneapolis
Resting, Herman St. Paul
Kevern, J. L Henning
Keyes, J. D Winona
Kiely, W. F Rochester
Kierland. R. R Rochester
Kiesler, F., Jr Minneapolis
Kilbride, E. A Worthington
tKilbride, J. S Worthington
Kimbrough, R. F Rochester
Kimmel, G. C., Jr Red Wing
tKing, E. A Minneapolis
King, F. W Oak Terrace
King, G. I St. Paul
Kinkade, B. R Ada
Kinports, E. B International Falls
Kinsella. T. J Minneapolis
Kirby, T. J., Jr Rochester
tKirk. G. P East Grand Forks
Kirklin, B. R Rochester
Kirklin, J. W Rochester
Kistler. A. J Minneapolis
Kitzberger, P. J New Ulm
Kleckner, M. S Rochester
Klefstad, L. H Greenbush
Klein, Harry Duluth
Klein, H. N St. Paul
Klein, Wm. A Duluth
Klima, W. W Stewart
Kline, R. F Montgomery
Knapp, F. N Duluth
Knapp, M. E Minneapolis
Knight, C. D Rochester
Knight, E. G Swanville
Knight, R. R. Minneapolis
Knight, R. T Minneapolis
Knoche, H. A Morgan
Knoll, W. V Duluth
Knudsen, H. L. Minneapolis
Knudson, R. A Forest Lake
Knutson, G. A. Hallock
Knutson, G. E St. Paul
Knutson, J. R. B Rochester
Knutson, L. A Spring Grove
Knutson, R. C Rochester
Koelsche, G. A. Rochester
Koenigsberger, Charles Mankato
Koepcke, G. M Minneapolis
Kohlbry, C. O Duluth
Kolars, J. J Faribault
Roller, H. M Minneapolis
Roller, L. R Minneapolis
Koop, S. H Richmond
Korchik, J. P Minneapolis
Korda, H. A Pelican Rapids
Kortsch, F. P Prior Lake
Koskela, A. L Deer River
Koskela, L. E Deer River
Kostick, W. R Fertile
Koszalka, M. F Minneapolis
Kotchevar, F. R Eveleth
Kottke, F. J Minneapolis
Kotval, R. J Pipestone
Koucky, R. W Minneapolis
Koza, Donald W Rochester
Krakowka, G. F Rochester
Krause, C. W Fairmont
Kremen, A. J Minneapolis
Kreuzer, T. C Marshall
Krieser, A. E Anoka
Krueger, V. R Nopeming
Krusen, E. M Rochester
Kruzick, S. J Sleepy Eye
Krusen, F. H. Rochester
Krystosek, L. A Clara City
Kucera, F. J Hopkins
Kucera, L. B Lonsdale
Kucera, S. T Northfield
Kucera, W. J Minneapolis
Kugler, A. A St. Paul
Kuhlmann. L. B Melrose
Kulwin, M. H Rochester
Kurtin, H. J Blooming Prairie
Kuske, A. W St. Paul
Kusske, A. L New TTlm
Kusske, B. W New Ulm
Kvale, W. F Rochester
Kvitrud, Gilbert St. Paul
LaBree, J. W
LaBree, R. H
Lagaard, S. M
Laikola, L. A
Laird, A. T
Lajoie, T. M
Lake, C. F
Lamp, C. B., Jr
Lang, C. M
Lang, L. A
Langhoff, A. H. ...
Lannin, B. G
Lannin, J. C
Lannin, D. R
Lapierre, A. P.
Lapierre, J. T.
Larsen, C. L
Larsen, F. W.
Larson, Arnold . . .
Larson, C. M. ...
Larson, Eva-Jane . .
Larson, J. T
Larson, K. R
Larson, L. M.
Larson, Leonard M.
Larson, Leroy
Larson, L. J
Larson. M. II. ...
Larson, O. E. H. . .
tLarson, P. G
Larson, P. N
Larson, R. H
Latterell, K. E
Laughlin, J. T
La Vake, R. T. .
Law, S. G
Lay, C. L
Lax, M. II
Laymon, C. W. . . .
tLazar, H. L
Leahy, Bartholomew
Leary, W. V
Leavenworth, R. O.
fLeavitt, H. H
Lebowske, T. A.
Leek. P. C
Lecklitner, Myron D.
Leden, U. M
Leddy, E. T
Lee, H. M
Lee, H. W
Minneapolis
Duluth
Minneapolis
Adrian
Duluth
Minneapolis
Rochester
Rochester
Rochester
Minneapolis
Mankato
St. Paul
Mabel
St. Paul
Minneapolis
Minneapolis
St. Paul
Minneapolis
. . Detroit Lakes
Minneapolis
St. . Paul
. . South St. Paul
St. Paul
Minneapolis
. . . . Oak Terrace
Bagley
Watertown
Nicollet
Zumbrota
..Cleveland, Ohio
M inneapolis
Minneapolis
Duluth
Grey Eagle
Minneapolis
Minneapolis
Rochester
St. Paul
Minneapolis
Excelsior
St. Paul
Rochester
St. Paul
. . . Mesa, Arizona
Minneapolis
Austin
Minneapolis
Rochester
Rochester
Minneapolis
Brainerd
Lee, M. J., Jr Rochester
Lee, N. J. St. Paul
Leemhuis, A. J Minneapolis
Leggett, Elizabeth A. . . . Ah-Gawh-Ching
Leibold, H. H Parkers Prairie
Leick, R. M St. Paul
Leitch, Archibald St. Paul
Leitschuh, T. H Winsted
Leland, H. R Minneapolis
Lemon, W. E Rochester
fLemon, W. S Rochester
Lenander, M. E. L St. Peter
Lenarz, A. J Browtrville
Lende, Norman Faribault
Lengby, F. A Spring Lake
fLenont, C. B Virginia
Lenz, J. R Morton
Lenz, O. A Minneapolis
Leonard, L. J Minneapolis
Leonard, Samuel Minneapolis
Leopard, B. A Albert Lea
Lepak, F. J Duluth
Lepak, J. A St. Paul
fLerche, William Cable, Wis.
Lerner, A. R Minneapolis
Lester, M. J., Jr Fairmont
Leven, N. L St. Paul
Leverenz, C. W St. Paul
Levin, Bert St. Paul
Levitt, G. X St. Paul
Lewis, A. J Henning
tLewis, C. I! St. Cloud
Lewis, C. W Henning
Lewis, Joyce S., Jr Nashwauk
Lexa, F. J Lonsdale
Libert, J. N St. Cloud
Lick, C. L St. Paul
Lick. Louis C Rochester
Liedloff. A. G Mankato
Lien, R. J St. Paul
Liffrig, W. W Red Wing
Lightbourn, E. L. St. Paul
Lilleberg, N. J St. Paul
Lillehei, E. J Robbinsdale
Lillie, H. I Rochester
Lillie, J. C Rochester
Lillie, W. I Rochester
Lima, I.. R., Jr Montevideo
Lind, C. J Minneapolis
Lind, C. J., Jr Munich, Germany
Lindberg, A. L Wheaton
Lindberg, A. C Minneapolis
Lindberg, V. L Minneapolis
t Lindberg, W. R Minneapolis
Lindblom, A. E Minneapolis
tLinde, Herman Cyrus
Lindgren, R. C Minneapolis
Lindley, S. B .Willmar
Lindquist, R. H Minneapolis
Linner, Gunnar Minneapolis
Dinner, H. P Minneapolis
fLinner, J. H Minneapolis
Linner, P. W Minneapolis
Lippman, E. S Minneapolis
Lippman, H. S St. Paul
Lippmann, E. W Hutchinson
Lipschultz, Oscar Minneapolis
Lipscomb, P. R Rochester
Litchfield. J. T Minneapolis
Litin, E. M Rochester
Litman, A. B Minneapolis
Litman, S. N Duluth
Livermore. G. R Rochester
Locke, William Boston, Mass.
I-ofgren, K. A Rochester
Lofsnt'ss, S. V Minneapolis
Logan, A. H Rochester
Logan, G. B Rochester
Logefeil, R. C Minneapolis
Lohmann, J. G Pipestone
I.oken, S. M St. Paul
Loken, Theodore Ada
Lommen, P. A Austin
Longfellow, Helen B. W. ..Brainerd
Longley. J. R Rochester
I.ongo, V. J Rochester
t*Loofbourrow, E. H Keewatin
Loomis, E. A Minneapolis
■Loomis, G. L Winona
Lott, F. H Minneapolis
Love, F. A Carlos
Love, J. G Rochester
Lovett, Beatrice R Oak Terrace
Lowe, E. R So. St. Paul
Lowe, T. A So. St. Paul
Lowman, E. W Rochester
Lowry, Elizabeth C Minneapolis
Lowry, Thomas Minneapolis
Lowy, A., Jr Rochester
Lucas, J. E Rochester
Luck, Hilda Mankato
Luckemeyer, C. J St. Cloud
Lueck, W. W Minneapolis
512
Minnesota Medicine
ROSTER
Lufkin* N. H Minneapolis
Lund, C. J. T Fergus Falls
Lund, W. J ...Staples
Lundberg, Ruth I Minneapolis
Lundblaa, R. A Minneapolis
Lundblad, S. W Minneapolis
Lundell, C. L. Granite Falls
Lundgren, A. C Minneapolis
Lundholm, A. M St. Paul
Lundquist, C. W Owatorma
Lundquist, E. F Minneapolis
Lundy, J. S Rochester
Luth, D. V Duluth
Luttgens, W. F Rochester
Lynch, F. W St. Paul
Lynch, M. J Minneapolis
Lynde, O. G Thief River Falls
Lysne, Henry Minneapolis
Lysne, Myron Minneapolis
MacCarty, C. S. . .
MacCarty, W. C....
MacDonald, A. E. .
MacDonald, D. A.
MacDonald, R. A....
MacFarlane, E. B....
MacFarlane, P. H.
Mach, F. B
Mach. R. F
MacKinnon, D. C.
Macklin, W. E.. Jr..
MacLean, A. R. . . .
Macnie, J. S
MacRae, G. C
Madden, J. F
Madland, R. S. ...
Maeder, E. C
Maertz, R. W
Maertz, W. F
Magath, T. B.
Magney, F. H.
Magnuson, A. E. . .
Magraw, R. M. . . .
Mahle, D. G
Mahowald, A. . . . .
Maino, V. J
Maitland, E. T. . . .
Maland, C. O
Malerich, J. A.
Malmstrom, J. A.
Mankey, J. C
Mankin, H. W
Mann, F. C
Mann, F. D
Manson, F. M. . . .
March, K. A
Marcley, W. J. . .
Mariette, E. S. ...
Mark, Hilbert ....
Marking, G. H. . .
Markle, G. B., IV. . .
Marks, R. W
Marshall, C. M.
Marshall, T. M
Martens, T. G
Martin, D. A
Martin, D. L
Martin, G. R
Martin, G. M
Martin, T. P
Martin, W. C
Martin, VV. J
Martineau, J. L. .
Martinson, C. J. .
Martinson, E. J
Masson, D. M.
Masson, J. C
Masson, j. K
Matchan, G. R.
Matthews, Justus....
Mattill, P. M. ...
Mattison, P. A.
Mattson, A. D
Mattson, H. A. N.
Maxeiner, S. R.
Maxeiner, S. R., Jr..
Mayne, R. M
Mayo, C. W
Maytum, C. K.
McAdams, J. B. .
McBean, J. B
McBurney, R. P....
McCaffrey, F. J. . . .
McCain, D. L. . . .
McCann, D. F. . .
McCann, Eugene J.
McCannel, M. A....
McCarten, F. M.
McCarthy, A. M....
Rochester
Rochester
. . . .Minneapolis
.... Minneapolis
Littlefork
Rochester
Chisholm
.... Minneapolis
Rush City
.... Minneapolis
Willmar
Rochester
Minneapolis
Duluth
St. Paul
St. Paul
Minneapolis
Faribault
St. Paul
Rochester
Duluth
Wheaton
St. Paul
Plainview
Albany
Rochester
Jackson
Minneapolis
St. Paul
Virginia
Minneapolis
Rochester
Rochester
Rochester
Worthington
Cambridge
Minneapolis
Oak Terraqg
Minneapolis
Minneapolis
Rochester
St. Paul
Crosby
Rochester
Rochester
Wabasha
St. Paul
Minneapolis
Rochester
Arlington
: . .Duluth
Rochester
St. Paul
Wayzata
Wayzata
Rochester
Rochester
Rochester
Minneapolis
Minneapolis
Oak Terrace
Winona
St. James
Minneapolis
Minneapolis
Rochester
Nopeming
Rochester
Rochester
St. Paul
Rochester
Rochester
Minneapolis
St. Paul
Bemidji
Minneapolis
Minneapolis
Stillwater
Willmar
McCarthy, Donald St. Paul
McCarthy, J. J St. Paul
McCarthy, W. R .St. Paul
McCartney, J. S Minneapolis
JMcCarty, P. D Ely
McClanahan, J. H White Bear
McClanahan, X. S White Bear
McCloud, C. N. St. Paul
McConahey. W. M., Jr Rochester
McCorkle, J. K Rochester
McCormack, L. J Rochester
McCormick, D Minneapolis
tMcCoy, Mary K ..Duluth
JMcCrimmon, H. P Minneapolis
JMcDaniel, Orianna Minneapolis
McDonald, A. L Duluth
McDonald, J. R Rochester
McDonald, O. G Duluth
McDowell, J. P St. Cloud
McElin, T. W Evanston, 111.
McEnaney, C. T Owatonna
McEwan, Alexander St. Paul
McFarland, A. H Minneapolis
McGandy, R. F Minneapolis
McGeary, G. E Minneapolis
McGeary, M. D Brainerd
McGroarty, J. J Easton
McGuigan, H. T Red Wing
McHaffie, O. L Duluth
Mclnerny, M. VV Minneapolis
Mclntire, H. M Waseca
Mclntire, S. F Rochester
McIntyre. J. A Owatonna
Mclver, B. A Lowry
McKaig, C. B Pine Island
McKelvey, J. L Minneapolis
McKenna, J. K Austin
McKenna, M. J Grand Rapids
McKenzie, C. H Minneapolis
*McKeon, J. O San Angelo, Texas
McKinlay, C. A Minneapolis
f*McKinley, J. C -..Minneapolis
McKinney, F. S Minneapolis
McLane, W. O Thief River Falls
tMcLaren, Jennette M. ..Minneapolis
McLaughlin, B. H Minneapolis
McLaughlin, E. M Winona
McLeod, J. L Grand Rapids
McLeod, J. J Olivia
McMahon, T. M New Orleans, La.
McMahon, M. J Green Isle
McManus, W. F Princeton
McMillan. J. T Des Moines, Iowa
McMurtrie, W. B Minneapolis
McNaughton, R. A Rochester
McNeill, J. I Rochester
McNutt, 'J. R Duluth
McPheeters, H. O Minneapolis
tMcQuarrie, Irvine Minneapolis
McVay. J. R.. Tr Rochester
McWhorter, H.'E Rochester
Mead, C. H Duluth
Meade, J. R St. Paul
Meadows. E. R Birmingham, Ala.
Mears, B. J St. Paul
Mears. R. F Northfield
Medelman, J. P St. Paul
Medlin, C. F Truman
Meinert, A. E Winona
Melancon, J. F St. Paul
Melby, Benedik ..Blooming Prairie
fMelby, O. F Thief River Falls
Meller, R. L Minneapolis
Melzer, G. R Lyle
Menold, Wm. F St. Paul
Mercil, W. F Crookston
Merkert, C. E Minneapolis
Merkert, G. L Minneapolis
Merner, T. B Minneapolis
f Merrick, Charlotte T. . . . Corvdon, Iowa
tMerrill, Elisabeth Minneapolis
Merrill, J. G Littleton, Colo.
Merrill, R. W Morris
Merriman, L. L Duluth
Merritt, W. A Rochester
Metcalf, N. B Onamia
Meyer, A. A Melrose
Meyer, A. J Minneapolis
Meyer, E. L Minneapolis
Meyer, F. C Kenyon
Meyer, P. F Faribault
Meyerding, E. A St. Paul
HMeverding, H. W Rochester
Michael, J. C Minneapolis
Michel, H. H Minneapolis
Michels, R. P Willmar
Michelson, H. E. Minneapolis
tMickelsen, Emma F Minneapolis
Mickelson, J. C Mankato
Michienzi, L. J St. Paul
Midthune. A. S Lake Park
Miiburn, G. B Rochester
Milhaupt, E. N St. Cloud
Miller, A. L Minneapolis
Miller, E. W .Anoka
Miller, E. M Rochester
Miller, H. E Minneapolis
Miller, Hugo E Minneapolis
Miller. J. C Minneapolis
Miller, J. R Fresno, Calif.
Miller, R. D Rochester
Miller. V. I ...Mankato
Miller, W. A. New York Mills
Miller W. R ..Red Wing
Miller, W. T St. Pau
Miller, Z. R •••St. Paul
Mills, J. L Winnebago
Mills, S. D Rochester
Milnar, F. J St. Paul
Milton, J. S Minneapolis
Miners, G. A Bemidji
Minge, R. K Worthington
Minsky, A. A Minneapolis
Minty, E. W Duluth
Misbach, W. D Fairmont
Mitbv, I. L •••■.Aitkin
Mitchell, B. D Minneapo is
Mitchell, E. C Minneapo is
Mitchell, M. T Minneapo is
Mixer, H. W Minneapolis
Moberg, C. W Detroit Lakes
Moe, A. E Moorhead
Moe, J. H Minneapolis
Moe, R. J Duluth
Moe, Thomas Moose Lake
Moehn, J. T.... Minneapolis
Moehring, H. G ••• • -Duluth
Moen, J. K., Jr Minneapolis
Moersch, F. P Rochester
Moersch, H. J Rochester
Moersch, R. U Rochester
Moga, J. A St. Paul
Molander, H. A St. Paul
Mollers, T. P ...Soudan
tMonohan, Eliz. S Minneapolis
Monroe, P. B £ oquet
Monserud, N. O ..Cloquet
Monson, E. M Minneapolis
Monson, L. J F>‘‘?an^
Monsour, K. J .Rochester
Montgomery, Hamilton .... Rochester
Moore, I. H Minneapolis
Moorhead, Marie Minneapolis
Moos, D. J Minneapolis
Moquin, Marie A -St. Paul
Morehead, D. E Owatonna
fMoren, Edward Minneapolis
Moren, J. A PfuI
Morgan, E. H Rochester
Morgan, H. O.
Moriarty, Berenice St. Paul
Moriarty, Cecile R St. Paul
Mork, A. H ...Anoka
Mork, B. O., Jr Minneapolis
Mork, F. E • • • Anoka
Morlock, C. G Rochester
Morris, C. R * * * * • • - Rochester
Morrison, Charlotte J. ..Minneapolis
Morrison, R. W. Rochester
Morrow, R. P Rochester
Morse, M. P "-9.^
Morse, R. W Minneapolis
Morseman, L. W . . . Hibbing
Mortensen, N. G Fergus Falls
Morton, Glenn H Rochester
Mosby, M. E Long Prairie
Moses, R. R .Kenyon
Mouritsen, G. J Fergus Falls
Mueller, Selma C Duluth
Muir W. F Browns Valley
Mulh'olland, W. M Minneapolis
Muller, A. E North Saint Paul
Muller, R. T St. Paul
Mulligan, A. M Brainerd
Murphy, E. P Minneapolis
*Murphy, I. J Minneapolis
Murphy, J. E Marsha 11
Murphy, Tack T Jt. Paul
Murray, R. A Hibbing
Musachio, N. F • • • - Foley
Mussey, Marv E Rochester
Mussey, R. D Rochester
Mussey, W. C. Rochester
tMusty, N. J Minneapolis
Mvers T A Minneapolis
Myers,’ T. T Rochester
Myers, W. P. L .Rochester
Mvhre, James Minneapolis
My re, C. R Paynesville
Nachtwey, R. A Lansing, Iowa
Naegeli, A. E St. Paul
Naegeli, Frank Fergus Falls
ROSTER
Nagel, H. D Waconia
Nash, L. A .St. Paul
Naslund, A. W Minneapolis
Navratil, D. R Montgomery
Neal, J. M Minneapolis
Nealy, D. E Adrian
Neary, R. P Minneapolis
Neel, H. B Albert Lea
Neff, W. S Virginia
Nehring, J. P Preston
Nelson, A. S Thief River Falls
Nelson, Bemette G Menagha
Nelson, Bernice A Menahga
Nelson, C. A Worthington
Nelson, C. B Minneapolis
Nelson, C. E. J Albert Lea
Nelson, C. G Harmony
Nelson, D. E Alexandria
Nelson, E. J j . . . Owatonna
Nelson, E. N Min neapohs
Nelson, G. E Fairfax
tNelson, H. E Crookston
tNelson, H. S. . .i.Los Angeles, Calif.
Nelson, K. L Balaton
tNelson, L. A St. Paul
Nelson, L. S Minneapolis
Nelson, M. C Minneapolis
Nelson, M. S Granite Falls
Nelson, N. H Minneapolis
Nelson, N. P Minneapolis
Nelson, O. L. N Minneapolis
Nelson, P. A Rochester
Nelson, R. A Fergus Falls
Nelson, R. L Duluth
Nelson, W. I Minneapolis
Nelson, W. O. B Fergus Falls
Nesbitt, Samuel Minneapolis
Nesheim, M. O Emmons
Nessa, C. B St. Cloud
Nesset, L. B Minneapolis
Nesset, W. D Minneapolis
Neumaier, Arthur Glencoe
Neumann, C. A Winona
New, G. B Rochester
Nichols, D. R Rochester
Nicholson, J. W Rochester
Nicholson, M. A Duluth
Nickerson, J. R Heron Lake
Nickerson, N. D. ..Thief River Falls
Nielson, A. M Northfield
Nietfeld, A. B Warren
Nilson, H. J North Mankato
Ninneman, N. N Waconia
Nimlos, K. O St. Paul
Nimlos, L. O St. Paul
Nixon, J. B Crosby
Noble, J. F St. Paul
Noble, J. L St. Paul
Nolan, D. E Dayton, Ohio
Noonan, W. J Minneapolis
Noran, A. S. N Minneapolis
Noran, H. H Minneapolis
Norberg, C. E Cloquet
Nord, R. E Minneapolis
Nordin. G. T Minneapolis
Nordland, Martin Minneapolis
Nordland, Martin, Jr Minneapolis
Nordman, W. F Mora
Norman, J. F Crookston
Norris, N. T Caledonia
Norval. M. A Rochester
fNoth, H. W Minneapolis
fNovak. E. E New Prague
Nowak, D. J Rochester
Nuebel, C. J Hudson, Wisconsin
Nuessle, W. G Springfield
Neutzman, A. W Faribault
Nutting, R. E Duluth
Nydahl, M. J Minneapolis
Nye, Katherine A St. Paul
Nye, Lillian L St. Paul
Nygren, W. T Braham
Nvlander, E. G Minneapolis
tNystrom, Ruth G., Malebu Beach, Calif.
tOberg, C. M Minneapolis
O’Brien, J. C St. Paul
O’Brien, L. T Breckenridge
O’Cain, R. K Rochester
Ochsnner, C. G Wabasha
Ockuly, Orville St. Paul
O’Connor, D. C Eden Valley
O’Connor, L. J St. Paul
Odel, H. M Rochester
O’Donnell, D. M Ortonville
O’Donnell, J. E Minneapolis
Oeljen, S. C. G Waseca
Ogden, Warner St. Paul
Ohage, Justus St. Paul
O’Hanlon, J. A Minneapolis
O’Kane, T. W St. Paul
O’Keefe, J. P
Olds, G. H
.....St. Cloud
O’Leary, J. H
O’Leary, P. A
Oliver, I. L
Rochester
Oliver, James
Olmanson, E. G
Olsen, A. M
St. Peter
Olsen, E. G
Olsen, R. L
Olson, A. C
Olson, A. E
. . . Minneapolis
.St. Paul
. . . Minneapolis
Olson, A . J. .
Olson. A. O
Dnlntti
Olson, C. A
Olson, C. J
Olson, D. O. C
Olson, E. A
Olson, Frances P
St. Paul
. . Belle Plaine
Gaylord
. . . Pine Island
Olson, G. E
Olson, J. W
.West Concord
Olson, L. A
fOlson,- O. A
Ah-Gwah-Ching
Olson, S. W
O’Neill, J. C
. .Chicago, 111.
Onsgard, L. K
Oppegaard, C. L. . . .
Oppegaard, M. O. .
Houston
Crookston
Oppen, E. G
O’Reilley. B. E
Orwoll, 11. S
. . . Minneapolis
St. Paul
Osborn, J. E
O’Shaughnessy, E. J...
Rochester
O^tergaard, Erling
Ostergren, E. W
Osterholm, R. S
Otto, H. C
Rochester
Ouellette, A. J
Owen, C. A. J.
Rochester
Owens, W. A
tOwre, Oscar
. . . Montevideo
Paciotti, V. J Hibbing
Page, R. L St. Charles
Painter, R. C Grand Forks, N.D.
Palen, B. J Minneapolis
PalmeT, C. F. Albert Lea
Palmer, IT. A Blackduck
t Palmer, W. L Albert Lea
Palmerton, E. S Albert Lea
Pankratz, P. J Mountain I.ake
Papermaster, R Two Harbors
Papermaster, T. C Minneapolis
Parker, C. W Wadena
Parker, H. L Rochester
JParker, O. W Moose Lake
Parker, R. L Rochester
Parker, W. E Sebeka
Parker, W. H Chisholm
Parkhill, Edith M Rochester
Parkin, T. W Rochester
Parson, E. I Duluth
Parson, Lillian B Elbow Lake
Parson. I.. R Elbow Lake
t Parsons, J. G Crookston
Parsons, R. L Monterey
Pasek, A. W Cloquet
Pasek. E. A Carlton
Patch, O. B Duluth
Patey, R. T Buhl
Patterson, H. D Slayton
Patterson, W. L Fergus Falls
Patton, T. M Rochester
Patton, M. M., Jr Rochester
Paulson, G. S Rochester
Paulson, J. A Rochester
Paulson, T. S Fergus Falls
Peabody, H. D Rochester
t Pearsall, R. P Virginia
Pearson, B. F Shakopee
Pearson, F. R St. Paul
Pearson, L. O Warroad
Pearson, M. M St. Paul
Pease, Gertrude L Rochester
Pedersen, A. H St. Paul
Pedersen, R. C Duluth
Peluso, C. R Minneapolis
Pemberton, J. dej Rochester
Pender. T. W Rochester
Penhall, F. W Willmar
Penk, E. L Springfield
Penn, G. E Mankato
Pennie, D. F Duluth
Peppard, T. A Minneapolis
Perlman, E. C Minneapolis
Perry, Harold Rochester
Person, J. P Albert Lea
Perth A. L Canby
Peters, G. A Rochester
Peterson, D. H Northfield
Petersen, G. L Minneapolis
t Petersen, J. R Minneapolis
Petersen, M. C Rochester
Petersen, P. C Mora
Petersen, R. T St. Cloud
Peterson, C. A Minneapolis
Peterson, D. B St. Paul
Peterson, D H St. Paul
Peterson, E. N Virginia
Peterson, H. O St. Paul
Peterson, H. W Minneapolis
Peterson, J. L E St. Paul
Peterson, J. H Duluth
Peterson, Kenneth Marshall
I eterson, K. H Hutchinson
Peterson, L. J Minneapolis
Peterson, N. P Minneapolis
Peterson, O. L Cokato
Peterson, O. H Minneapolis
Peterson, P. E Minneapolis
Peterson, R. A Vesta
Peterson, S. C ! .'Austin
Peterson, W. C Minneapolis
Peterson, W E Willmar
Peterson, W H Owatonna
Peterson, W. Henry Minneapolis
Petit, J. V Minneapolis
Petit. I.. J. . . . . Minneapolis
Petraborg, H T Aitkin
Pewters, J. T Minneapolis
Peyton, W. T Minneapolis
K. H. Cannon Falls
Plunder, M. C Minneapolis
Phares, Otto C St. Cloud
Phares, W. S Rochester
Phelps, K. A Minneapolis
Pierce, C. H Wadena
Pierce, R. B. Wadena
„p!erson> R- F Slayton
iJPjper, M. C Rochester
^ A Mountain Lake
Plasha, M. K Glenwood
Plass, H. F. R Minneapolis
Platou. E. S Minneapolis
Pleissner, K. W St. Louis Park
Plimpton, N. C., Jr Minneapolis
Pkmdke F J St. Paul
Plotke, H. L St. Paul
D°LiUe’rv®' W atertown
oci’ £ Crookston
Pohl, J. F. M Minneapolis
?°nleo’ JKAYG Forest Lake
Pollard, D. W Minneapolis
Polley, H. F. Rochester
I ollock, I). K. Minneapolis
Polski P G So. St. Paul
Polzak, J. A Minneapolis
Ponterio, J. E Shakopee
Pool, T. L... Rochester
Poore, T. N Rochester
Popp, tV. C Rochester
Poppe, F. H Minneapolis
Porter, G. E Rochester
Porter, CL M Willmar
lost, D. B Rochester
Potek, D International Falls
Potter, R. B Minneapolis
Potthoff, C. J Washington, D. C.
Power, J. E Duluth
Powers, F. H Rochester
Prangen, A. D Rochester
tPratt, Fred J., Sr Minneapolis
Pratt, F. J., Jr Minneapolis
Pratt, J. H., Jr Rochester
Preine, I. A Minneapolis
Preisinger, J. W Renville
Prendergast, H. J St. Paul
Preston, P. J Minneapolis
Prickman. L. E Rochester
Pridgen, J. E Rochester
Priest, R. E Minneapolis
Priestly, T. T Rochester
TPrim, J. A Minneapolis
Prins, L. R Albert Lea
Proeschel, R. K Willmar
Proffitt, W. E Minneapolis
Proshek, C. E Minneapolis
Prough, W. A Ontario, Calif.
Pruitt, R. D Rochester
Pugh, D. G Rochester
Pumula, E. E Warren
Purves, G. H Hendricks
Puumala, R. H Cloquet
Pyle, Marjorie M Cannon Falls
Quanstrom, V. E Brainerd
Quattlcbaum, Frank ........St. Paul
Quello, R. O. B Minneapolis
Quigley, W. P Thief River Falls
JQuist, H. W Minneapolis
Quist, H. W., Jr Minneapolis
514
Minnesota Medicine
ROSTER
Raadquist, C. S Hibbing
Raattama, J. W Keewatm
Radabaugh, R. C Hastings
Rae, J. W., Jr Ann Arbor, Mich.
Raetz, S. J Maple Lake
Ragsdale, W. E., Jr Rochester
Raihala, John Virginia
Raiter, R. F Xloquet
Rail J. E New York, N. Y.
Ralph, J. R St. Paul
Ralston, D. E Rochester
Ramsey, W. R St. Paul
Randall, A. M Ashby
Randall, L. M Rochester
Randall, R. V Rochester
Randall, W. H Rochester
Ransom, H. R. ...Osseo
Ransom, M. L Hancoc k
Rasmussen, R. C St. Paul
Rasmussen, W. C Rochester
Ratcliffe, J. J • - Aitkin
Ratke, H. V Rochester
Ravits, H. G St. Paul
Rea, C. E ...St. Paul
Reader, D. R Minneapolis
Rechlitz, E. T Albert Lea
Reed, Paul Virginia
Reeve, E. T Elbow Lake
Reff, A. R Crookston
Regan, J. J Minneapolis
Regnier, E. A Minneapolis
Reid, J. W St. Paul
Reid, L. M Excelsior
Reif H A Minneapolis
Reif! H. J • -St. Cloud
Reiley, R. E Minneapolis
Reineke, G. F New Ulm
Reinhardt, J. H Red Lake halls
Reiter, R. A Rochester
Reitmann, J. H Hastings
ReMine, W. H., Jr Rochester
Remsberg, R. R ...Tracy
Replogle, W. H. ...Los Angeles, Calif.
Resch, J. A Minneapolis
Retter, Richard Rochester
Reynolds, J. L Rochester
Rice, C. O... Minneapolis
Rice, Frank B Minneapolis
Rice, PI. G Moorhead
Rice’, R. G .Minneapolis
Richards, E. i . F St. Paul
Richards, W. B St. Cloud
Richardson, E. J., Jr St. Paul
Richardson, H. E. . . St. Paul
Richardson, R. J St. Paul
Richdorf, L. F Minneapolis
Rick. P. F. W St. Paul
Riddell, R. V Rochester
Rideway A. M Annandale
Ridley, R. W Rochester
Rieke, W. W Wayzata
Rigler, L. G Mmneapo.is
Ringle, O. F W'alker
Rinkey, Eugene St. Paul
Riordan. Elsie M Minneapolis
Ripley, H. R Rochester
Ripple, R. T New London
Risch, R. E Minneapolis
Risser, A. F Stewartville
Ritchie, W. P St. Paul
Ritt, A. E St. Paul
Rizer, D. K Minneapolis
Rizer, R. I Minneapolis
Robb. E. F Minneapolis
Robbins, C. P Winona
Robbins, O. F Minneapolis
Roberts, L. J Minneapolis
Roberts, O. W Owatonna
Roberts, S. W...., Minneapolis
Roberts, W. B Minneapolis
Robertson, J. B Minneapolis
Robertson, P. A Austin
Robilliard. C. M Faribault
Robinett, R. W .Worthington
Robinson, A. W Rochester
Robinson, J. M Goshen, N. Y.
Rockwell, C. V Minneapolis
Rockwood, Philo H Fergus Falls
Rodda, F. C Minneapolis
Rodgers, C. L Minneapolis
Rodgers, R. S Minneapolis
Rodwell, T. F Mahnomen
Roehlke, A. B Elk River
Roemer, H. J Winona
Rogers, C. W Winona
Rogers, S. F St. Paul
Rogne, W. G Spring Grove
Roholt, C. L Waverly
Roholt, H. B Fosston
Rohrer, C. A Waterville
Rokala, H. E Virginia
vJay, 19S0
Rolig, D. H St. Paul
Rollins, T. G Elmore
Rome, H. P Rochester
tRood, D. C Duluth
Rooke, E. D Rochester
Rose, T. T Lakefield
Rosendahl, F. G Minneapolis
Rosen field, A. B .Minneapolis
Rosenow, J. H Minneapolis
Rosenthal, F. H Austin
Rosenthal, Robert St. Paul
Rosenwald, R. M Minneapolis
Rosin, J. D Rochester
Ross. A. J Minneapolis
Rossberg, R. A Morris
Rossen, R. X Hastings
Roth, F. D Lewiston
Roth, G. C St. Paul
Rothschild, H. J St. Paul
Rotnem, O. M Harmony
Roust, H. A Montevideo
Routley, E. F Rochester
Rovelstad, R. A Rochester
Rowe, C. J., Jr St. Paul
Rowe, O. W Duluth
Rowe, W. H Fairmont
Rowles, E. K Coleraine
Roy, P. C St. Paul
Rozvcki, A Pme River
Rucker, C. W Rochester
Rucker. W. H Minneapolis
Rud, N. E Minneapolis
Rudell, G. L Minneapolis
Rudie, C. N St. Peter
'. s
Duluth
c
....... Rochester
G. M
G. N
. .Tarzona, Calif.
C. W
Faribault
W. H
Faribault
, J. M
J G
Rochester
. H
Blue Earth
A. N
Minneapolis
E. M
Minneapolis
rd, W. C. .
, L. H
. . . Detroit Lakes
F. F
Minneapolis
D
St. Paul
. M
St. Paul
[. E
v T
Duluth
, w. c. ...
Minneapolis
r r
V. T
...HowarH Lake
I. N
R
R'ynearson, E. H Rochester
Sach-Rowitz, Alvan Moose Lake
Sadler W. P., Jr Minneapolis
Saffert C. A New Ulm
Sabr. W. G. C Hutchinson
St. Cvr, PI. M Minneapolis
St. Cyr, K. J Robbinsdale
Sa’lassa, R. M Rochester
Sabterman, B. I Minneapolis
Salk, Richard' T Albany
Salter. R. A Virginia
Samuelson, I.. G Mankato
Samuelson, Samuel Minneapolis
Sandell, S. T Nopemma
Sanderson, A. G Deerwood
Sanderson, D. J Princeton
tSanderson, E. T Alexandria
Sandt, K. E Minneapolis
Sandven. N. O Pavnesville
KSanford, A. H Rochester
Sanford. R. A Minneapolis
Sarff, O. E ...Duluth
Sargent, E. C ■ • • Austin
Sarnecki, M. M. ...St. Paul
Satersmoen. Theodore. . Pelican Rapids
f*Sather. Allen Fosston
Sather. Edgar L Fosston
Sather. E. R Alexandria
Sather, G. A Fosston
Sather, R. N Fosston
Sather, R. O Crookston
Satterlee. H. W T ew,etnti
Satterlund, V. L St. Paul
Sauer, W. C. Rochester
Savage F. J ,-St. Paul
Sawatzky, W. A Minneapolis
Sax, M. H Duluth
qax. S. G Dulutn
Saxman, G. E Georgetown
Saxon. R. F Rochester
Saylor, H. L Huron. S. D.
Sayre, G. P Rochestei
Sborov, A. M Minneapolis
Scanlon, P. W Rochester
Schaaf, F. H Minneapolis
tSchaar, Frances E Minneapolis
Schade, F. L Worthington
Schaefer, J. F Owatonna
Schaefer, Samuel Winona
Schaefer. W. G Minneapplis
Schamber, W. F Parkers Prairie
Schatz, F. J St. Cloud
Scheifley,. C. H ...Rochester
fScheldrup, N. H Minneapolis
Scherbel, A. L Rochester
Scherer, L. R Minneapolis
Scherling, S. S Minneapolis
Schiele, B. C Minneapolis
Schimelpfenig. G. T Chaska
Schirber, M. J Grand Rapids
Schlesselman, G. H Minneapolis
Schmid, J. F Duluth
Schmidt, G. F Minneapolis
Schmidt, H. R Winona
Schmidt, H. W Rochester
Schmidt, J. R Mountain Lake
t Schmidt, Paul Monroe, Ore.
Schmidt, P. G., Jr Granite Falls
Schmidt, R. F Alden
Schmidtke, R. L St. Paul
fSchmitt, S. C San Diego, Calif.
Schmitz, A. A Mankato
■Schmitz, E. J Holdingford
Schmitz, G. P Little balls
tSchneider, J. P Minneapolis
Schneider, L. E Duluth
Schneider, P. J Adams
tSchneider, R. A Minneapolis
j* Schneidman, N. R Minneapolis
Schnugg, F. J Brainerd
Schoch, R. B. J St. Paul
Scholpp, O. W Hutchinson
Scholz, D. A Rochester
Schons, Edward St. Paul
JSchottler, G. J Dexter
Schottler, M. E Minneapolis
Schroder, C. H Duluth
Schroeckenstein, H. F St. Paul
Schroeder. A. T Minneapolis
Schroeppel, J. E Winthrop
Schulberg, V. A Arlington
tSchuldt, F. C St. Paul
t Schultz, J. A Albert Lea
Schultz, J. H Minneapolis
Schultz, P. J Minneapolis
Schulze, A. G St. Paul
Schulze, W. M.... Minneapolis
f*Schussler, O. F Minneapolis
Schutz E. S Mountain Lake
Schwartz, V. J Minneapolis
Schweigrer, T. R PLbbine:
Schweppe, J. S Rochester
tSchwyzer, Gustav Minneapolis
Schwvzer, H. C St. Paul
t*Scofield, C. L Benson
Scott, E. E St. Paul
tScott, F. H Minneapolis
Scott H G Minneapolis
Scribner, B. H... Rochester
Scudamore. H. H Rochester
Seaberg, J. A Minneapolis
Seagle T. B Rochester
Seale, Ruth A Rochester
tSeashore, Gilbert Minneapolis
Seashore, R. T Duluth
Seebach. L. M Rochester
Seery, T. M Austin
Segal, M..A Minneapolis
Seham, Max Minneapolis
Seifert, M. H Excelsior
Seifert. O. J New Ulm
Seitz. S. B Richardton, N. Dak.
Sekhon, M. S St. Paul
Seldon, T. H Dnrti-n.r
Se'ieskog, S. R Minneapolis
Sellers, G. K Dassel
Selmn. J. D Norwood
Semsch, R. D Minneapolis
tSenkler. G. E St. Paul
Senn, E. W Owatonna
Sether, A. F Ruthton
Setzer. H. T St. Paul
Seybold. W. D Rochester
Shandorf, J. F Minneapolis
Shands, W. C. . . Rochester
Shannon, W. R .St. Paul
Shapermap, Eva P Minneapolis
Shapiro, M. J Minneapolis
Shapior, Sidney Minneapolis
Sharp. D. V Minneapolis
Sharp, M. C Virg:nia
Shaw, H. A St. Paul
*JShaw, A. W Virginia
Sheedy. C. L Austin
tShellman, J. L
Pacific Palisades, Calif.
Sheppard, C. G Hutchinson
Sher, D. A Virginia
515
ROSTER
Sher, Lewis Minneapolis
tSherraan, A. G Minneapolis
Sherman, C. H Bayport
Sherman, C. L Luverne
Sherman, H. T Cambridge
Sherman, R. V Red Wing
Sherwood, G. E Kimball
Shick, R. M Rochester
Shimonek, S. W St. Paul
Shonyo, E. S Santa Monica, Calif.
Short, Jacob St. Paul
t Shrader, E. E Watertown
Shragg, Harry Elmore
Shronts, J. F Minneapolis
Sickels, E. W St. Paul
Siegel, Clarence St. Paul
Siegel, J. S Virginia
Siegmann, W. C M inneapolis
Siemon, Glenn Rochester
Silver, J. D Minneapolis
Simison, Carl Barnesville
Simons, B. H Chaska
Simons, E. J Swanville
tSimons, J. H Minneapolis
Simons, L. T St. Paul
Simonson, D. B Minneapolis
Simonton, K. MacL Rochester
Simpson, E. DeW Minneapolis
Sinamark, Andrew Hibbing
Singer, B. J .St. Paul
Sinykin, M. B Minneapolis
Siperstein, D. M Minneapolis
Sisk, E. St. Cloud
SisleT, C. E Grand Rapids
Sisterman, T. J Minneapolis
fSivertsen, A Mound
tSivertsen, Ivar Minneapolis
Sjoding, J. D Mankato
Sjostrom. L. E St. Peter
Skaug, H. M Chatfield
Skillern, P. G., Jr Rochester
tSkinner, H. O St. Paul
Skjold, A. C Minneapolis
Skogerboe, R. B Karlstad
Skroch, E. E Rochester
Slater, S. A Worthington
Sloan, W. P Rochester
Slocumb, C. H Rochester
Smisek, E. A St. Paul
Smisek, F. M. E Minneapolis
Smith, Adam M Minneapolis
Smith, Archie M Minneapolis
'Smith, B. A Crosby
Smith, Baxter A., Jr Minneapolis
Smith, C. M Duluth
Smith, D. V Blue Earth
USinitll, F. L Rochester
Smith, F. R Rochester
Smith, G. G Minneapolis
Smith, G. R Hutchinson
Smith, H. L Rochester
Smith, H. R Minneapolis
Smith, L. G Montevideo
Smith, L. A Rochester
Smith, Loyd A Tyler
tSmith, M. I Minneapolis
fSmith, M. W Red Wing
Smith, N. D Rochester
Smith, N. M Minneapolis
Smith, N. R Minneapolis
Smith, O. O., Jr. ..Independence, Va.
Smith, P. M Lake Crystal
Smith, P. L Rochester
Smith, R. C Holdingsford
Smith, T. S Minneapolis
Smith, V. D. E St. Paul
Smith, W. R Grand Marais
Smyth, J. J Lester Prairie
Snyder, C. D • Kiester
Snyder, G. W St. Paul
Snyder, O. E Ely
Soderlind, R. T Minneapolis
Sogge, L. L Windom
Sohlberg. O. I St. Paul
tSohmer, A. E Mankato
Solhaug, S. B Minneapolis
Solsem, F. N. S Spicer
Solvason, H. M Minneapolis
Sommers, Ben St. Paul
Sonnesyn, N. N Le Sueur
Sorem, M. B St. Paul
Sorum, F. T Jasper
Soucheray, P. H St! Paul
Soule, E. H Rochester
Souster, B. B St. Paul
Spang, A. J. Duluth
Spang, J. S Duluth
Spano, J. P Minneapolis
Spaulding, C. A Rochester
Spear, I. M Rochester
Spear, R. C Rochester
Spence, B. J Rochester
Spencer, B. J Rochester
Spencer, J. R Rochester
'Spicer, F. W Duluth
Spink, W. W Minneapolis
Spock, B. M Rochester
Sponsel, K. H Rochester
Sprafka, J. L St. Paul
Sprafka, J. M St. Paul
Sprague, R. G Rochester
JSpratt, C. N Minneapolis
Spray, Paul Rochester
Spurzem, R. J Anoka
Stahr, A. C Hopkins
Stam, John Worthington
Stanford, C. E Minneapolis
Stangl, P. E St. Cloud
Stanley, C. R Worthington
Stapley, L. A., Jr Rochester
Starekow, M. D. ..Thief River Falls
Stark, D. B Rochester
Starks, W. O Rochester
State, David Minneapolis
Stauffer, M. H Rochester
Steffens, L. A Red Wing
Stein, K. E Lakeville
Stein, R. J Pierz
Steinberg, C. L St. Paul
Steiner, I. W Winona
Steiner, L. E Albert Lea
Stelter, L. A Minneapolis
Stemsrud, H. L Alexandria
Stennes, J. L Minneapolis
Stenstrom, Annette, E Minneapolis
Sterner, D. C St. Paul
Sterner, E. G St. Paul
Sterner, E. R St. Paul
Sterner, J. J St. Paul
Sterner, O. W St. Paul
Stevenson, B. M Fulda
Stevenson, F. W F'aribault
Stewart, Alexander St. Paul
Stewart, 1). E Crookston
Steward, R. I Minneapolis
Stickney, J. M Rochester
tStiegler, F. S. ..Nuremberg, Germany
Stillwell, W. C Mankato
Stillwell, G. G Rochester
Stinson, J. C., Jr Rochester
Stoeckmann, A. E St. Peter
Stoesser, A. V Minneapolis
Stolpestad, A. H St. Paul
Stolpestad, II. I.. . St. Paul
fStomel, Joseph .... Los Angeles. Calif.
Stone, N. F Gonvick
Stone, S. P Minneapolis
Storrs, R. P Rochester
Storsteen. K. A Rochester
Stowe, H. R Rochester
Stoy, R. A Little Falls
JStrachauer, A. C Minneapolis
Strandjord, N. M Virginia
Stranskv, T. W Owatonna
Strate, G. E St. Paul
Strathern, C. S St. Peter
IStrathern, F. P St. Peter
t Strathern, M. L Gilbert
Stratte, A. K Pine City
Stratte, H. C Windom
Straus, M. L St. Paul
Strauss, E. C Duluth
Street, Bernard Northfield
Strem, E. L St. Paul
Strewler, G. J Duluth
Strickler, J. H Minneapolis
Strobel, W. G Duluth
Stroebel, C. F., Jr Rochester
Strom, G. W Minneapolis
Stromgren, D. T Minneapolis
Stromme, W. B Minneapolis
Stuart, A. B Cloquet
Studer, D. J Faribault
Stuhr, J. W Stillwater
Sturley, R. F St. Paul
'Sturre, J. R Minneapolis
fSuhby, Walter Minneapolis
Sukov, Marvin Minneapolis
Sullivan, R. M Minneapolis
t Sutherland, C. G Rochester
Sutherland, H. N Ely
Sutherland, W. H Benson
Sutton, H. R Hoffman
Svien, H. J Rochester
Swanson, J. A St. Paul
Swanson, L. J South St. Paul
Swanson, R. E Minneapolis
Swanson. R. R Minneapolis
tSwanson, V. F Santa Monica, Calif.
Swedberg. W. A Duluth
Swedenburg, P. A Glenwood
Sweetser, H. B., Jr Minneapolis
tSweetser, H. B., Sr Minneapolis
Sweetser, T. H Minneapolis
fSweitzer, S. E Minneapolis
tSwendseen, C. G Minneapolis
Swendson, J. J St. Paul
Swensen, R. G North Branch
Swenson, A. O Duluth
Swenson, O. J Waseca
'Swezey, B. F Buffalo
Takaro, T Rochester
Tangen, G. M Minneapolis
Tanquist, E. J Alexandria
Taylor, A. B Rochester
Taylor, B. E Rochester
tTaylor, C. W Duluth
I aylor, J. H Minneapolis
Taylor, R. W., Jr Rochester
Teich, K. W Duluth
Teisberg, C. B St. Paul
Teisberg, J, E St. Paul
Teitgen, R. E. Rochester
'Telford, V. J Litchfield
Tenner, R. J Minneapolis
Terrell, B. J Nopeming
Tesch, G. H Elk River
Tetlie, J. P Duluth
Thabes, J. A., Jr Brainerd
tThabes, J. A.; Sr Brainerd
Thayer, E. A Fairmont
Thelen, E. P Rochester
Thielen. R. D St. Michael
Thiem, C. E St. Paul
Thomas. G. F. Minneapolis
tThomas, G. H Minneapolis
Thompson, Arthur Cokato
Thompson, C. O Hendricks
Thompson, F. A. St. Paul
Thompson, G. J Rochester
Thompson, H. B St. Cloud
Thompson, W. H Minneapolis
Thomson, J. M Minneapolis
Thorsen, D. S St. Paul
Thoreson, M. C. Bernice.. So. St. Paul
Thorson, S. V Minneapolis
Thysell, D. M Minneapolis
Thysell, F. A Moorhead
Thysell, V. D Hawley
Tibbetts, M. FI Duluth
Tifft, C. R St. Paul
Tillisch, J. H Rochester
tTingdale, A. C. Minneapolis
Tingdale, Carlvle Hibbing
Tinkham, R. G Minneapolis
Titrud, L. A Minneapolis
Tobin, J. D Minneapolis
Tobin, J. R., Jr Rochester
Todd, R. L Minneapolis
Tondreau, R. L Rochester
tTorgerson, W. B Oklee
Tosseland, N. E Duluth
Trach, B. B Minneapolis
Tracht, R. R St. Paul
Traeger, C. A Faribault
Travis, J. S St. Paul
Traxler, L F Henderson
Tregilgas, H. R So. St. Paul
Trommald, G. B. K Anoka
Troost, H.^ B Mankato
Trow, J. E Minneapolis
Trow, W. If.... Minneapolis
Troxil, Elizabeth St. Paul
Trueman, H. S Minneapolis
Truesdale, C. W Glencoe
Trutna, T. J Silver Lake
Tudor, R. B Minneapolis
fTunstead, H. J Minneapolis
Tuohy, E. L Duluth
Turbak. C. E Canby
tTumacliff, D. D St. Paul
Turnbull, T Rochester
tTweedy, G. J Winona
Tweedy, J. A. Winona
Tweedy, R. B Winona
Twiggs, Leo F Austin
fTwomey, J. E Minneapolis
Tyler, S. H Raymond
Ude, W. H Minneapolis
Uhley, C. G Crookston
Uihlein, Alfred Rochester
tUlrich, H. L Minneapolis
LJlvestad, H. S Minneapolis
Underdahl, L. O Rochester
LIndine, C. A Minneapolis
Upson, M., Jr Rochester
Urberg, S. E Duluth
Uzmann, J. W Rochester
Vadheim, A. L Tyler
Vadheim, L. A Rochester
Valentine, W. H Tracy
516
Minnesota Medicine
ROSTER
Van Cleve, H. P., Jr Austin
Vandersluis, C. W Bemidji
\'an Bergen, F. H Minneapolis
Van Herik, Martin Rochester
Van Meier, Henry Stillwater
Van Patter, Ward Rochester
Van Ryzin, D. J Duluth
Van Yalkenberg, J. D Floodwood
Varco, R. L St. Paul
Vaughan, V. M Truman
Vaughn-, C. Gordon Plainview
Vaughn, L. D Rochester
Veirs, D. M St. Paul
Veirs Ruby J. S St. Paul
Venables, A. E St. Paul
Veranth, L. A St. Cloud
Verby, J. E., Jr Litchfield
Veziur, J. C Mapleton
Vik, A. E Minneapolis
Vik, Melvin Onamia
Virnig, M. P Wells
Virnig, R. P Wells
Vogel, H. A. L New Ulm
Voilmer, F. J Winona
rVon der YVeyer, W. H St. Paul
Von Drasek, J Mankato
Vrtiska, F. L St. Cloud
Waas, C. YV St. Paul
VVadd, C. T Janesville
Wagener, H. P Rochester
Wagenknecht, T. W., Jr Appleton
Wagner, N. YV Grnce\ille
Wahlquist, H. F Minneapolis
Wakefield. E. G .Rochester
fWakim, Khalil G Rochester
Walder, H. J Duluth
Waldron C. W .Minneapolis
Walfred, K. A St. Cloud
Walker, A. E Duluth
Walker, A. E St. Paul
Walker, S. A Minneapolis
Wall, C. R Minneapolis
Wallace, M. O Duluth
Waller, J. D Pine City
Walsh, E. F St. Paul
Walsh, F. M Minneapolis
YValsh, M. N Rochester
Walsh, W. T Minneapolis
\\;alston, J. H Clarkfield
Walter, C. W St. Paul
Walter, F. H International Falls
Walters, Waltman Rochester
Wandke, O. E ...Fairmont
Wang, J. C Minneapolis
Wangensteen, O. H Minneapolis
Ward, L. E Rochester
Ward, P. A Minneapolis
Ward, P. D St. Paul
Warner, J. J Perham
YVarren, C. A St. Paul
Wasson, L. F Alexandria
Watkins, C. II Rochester
Watkins, J. A Windom
Watson, A. M Royalton
Watson, C. G Minneapolis
YVatson, C. J Minneapolis
"Watson, J. D Minneapolis
Wat=on, John B Rochester
Watson, J. R Rochester
Watson, P. T Minneapolis
Watson, P. Tlieo St. Paul
Watson, R. E Minneapolis
Watson, R. M Thief River Falls
Watson, S. W Royalton
Watson, W. H. A St. Paul
Watson, W. J Newport
Watz, C. E St. Paul
YVaugh, J. M Rochester
Weaver, M. M., Y’ancouver, B. C., Can.
Weaver, P. H Faribault
Webb, E. A Minneapolis
Webb, J. H Rochester
Webb, R. C Minneapolis
YVebber, F. L St. Paul
Webber, R. J Minneapolis
Weber, H. M Rochester
Wedes, Deno J Belgrade
Weed, L. A Rochester
Weir, J. F Rochester
Weis, B. A St. Paul
Weisberg, Maurice St. Paul
Weisberg, R. J Minneapolis
YVellman, T. G Clinton, Iowa
Wellman, W. E Rochester
Wellner, T. O Rochester
YVells, A. H Dulutn
Wells. W. B Jackson
Wendland, J. P Minneapolis
YVenner, YV. T St. Cloud
YVente, H. A Rochester
Wentworth, A. J Mankato
Wenzel, G. P St. Paul
Wenzel, R. E Blue Earth
Werner, George Minneapolis
t* Werner, O. S St. Paul
Wesolowski, S. P Minneapolis
tWest, Catherine C Minneapolis
West, Elmer J Fort Thomas, Ky.
Westby, Magnus Madison
"Westby, Nels Madison
tYVesterman, A. E Montgomery
YV7esterman, F. C Montgomery
tWestphal, K. F Portland, Oregon
Westrup, J. E Lanesboro
fWethall, A. G Minneapolis
W etherby, Macmder Minneapolis
YY'etzel, E. V St. Cloud
Weum, T. W Minneapolis
Weyand, R. D Rochester
Wheeler, D. W Duluth
fWheeler, M. W Lake Elmo
tWhitacre, J. C St. Paul
VYhite, A. A Minneapolis
White, S. M Minneapolis
White, W. D Minneapolis
Whitesell, F. B., Jr Rochester
Whitesell, L. A Minneapolis
Whitney, R. A Cambridge
Whitson. S. A Albert Lea
YVhittemore, D. D Bemidji
YViden, YV. F Minneapolis
Wikoff, H. M Bemidji
fWilcox, A. E Minneapolis
Wilcox, G. C St. Peter
tWilder, K. YV Minneapolis
Wilder, R. L Minneapolis
Wilder, R. M Rochester
Wilder, R. M., Jr Minneapolis
Wilhelm, \V. F Rochester
Wilken, P. A Minneapolis
fWilkinson, Stella L Faribault
Wilkowske, R. J Owatonna
Will, C. B Bertha
Will, W. W Bertha
tWillcutt, C. E Phoenix, Ariz.
Williams, A. B St. Pan)
YVilliams, B. F. P Duluth
Williams, C. A Pipestone
Williams, C. K St. Paul
Williams, H. L., Jr Rochester
Williams, H. O Lake Crystal
Williams, J. A St. Paul
Williams, L. A Minneapolis
Williams, M. M Ah-Gwah-Ching
Williams, M. R Cannon Falls
t Williams, R. V Rushford
tWilliams, Robert Carthage, 111.
YVilliamson, H. A Lake Heron
Willius, F. A Rochester
YVilmot, C. A Litchfield
YVilmot, H. E Litchfield
YVilson, C. E Blue Earth
YVilson, F. C Austin
Wilson, J. A St. Paul
Wilson, J. V St. Paul
Wilson, R. B Rochester
Wilson, R. H Winona
Wilson, V. O Minneapolis
YVilson, YV. E Northfield
1 Wilson, W. F Lake City
|YY7iltrout, I. G Oslo
Winburn, J. R Rochester
Winchester, E. C. Rochester
Winchester, W. W Rochester
Wingquist, C. G Crosby
Winnick, J. B St. Paul
Winter, J. A. Duluth
YVinther, Nora M. C Minneapolis
Wipperman, F. F Minneapolis
Wisness, O. A Slayton
YVitham, C. A Minneapolis
Wittich, F. W Minneapolis
Wittrock, L. H Watkins
Wohlrabe, A. A Minneapolis
Wohlrabe, C. F No. Mankato
Wohlrabe, E. J Springfield
Wold, K. C St. Paul
Wolf, A. H Minneapolis
Wolff, Helen B Worthington
Wolff, H. J St. Paul
YVolkoff, H. J St. Paul
Wollaeger, E. E Rochester
Wolstan, S. D Minneota
Woltman, H. W Rochester
tWood, H. G Rochester
tWood, R. A ...Minneapolis
Woolling, K. R Rochester
Woolner, L. B Rochester
Word, H. L St. Paul
Worden, R. E Minneapolis
Workman, W. G Tracy
tYVray, W. E Campbell
Wright, R. R Austin
Wright, W. S Minneapolis
\\7urdemann, Alma L., White Bear Lake
Wyatt, O. S Minneapolis
Wynne, H. M. N Minneapolis
Yaeger, W. W Marshall
Ylitale, W. H. Hibbing
Ylvisaker, R. S Minneapolis
Yoerg, O. W Minneapolis
Young, H. H Rochester
Young, T. O Duluth
Younger, L. I Winona
Youngren, E. R St. Paul
Zachman, A. H Melrose
Zachman, L. L St. Paul
Zaworski, L. A Minneapolis
Zeigler, C. M Pine River
Zemke, E. E Fairmont
Zick, L. H Rochester
Zierold, A. A Minneapolis
Zimmer. F. E Rochester
Zimmermann, H. B .St. Paul
Zinter, F. A Minneapolis
Ziskin, Thomas Minneapolis
tZlatovski, M. L Duluth
May, 1950
517
Minnesota Academy of Medicine
Meeting of January 11, 1950
The regular monthly meeting of the Minnesota
Academy of Medicine was held at the Town and
Country Club on Wednesday evening, January 11,
1950. Dinner was served at 7 o’clock, and the meeting
was called to order at 8:10 p.m. by Dr. E. M. Hammes,
Chairman of the Executive Committee.
There were fifty members and two guests present.
Dr. Hammes then showed cartoon drawings of the
living past presidents and read a short poem appropri-
ate to each one, after which each living past president
was presented with his cartoon drawing.
The incoming President, Dr. William Hanson, of
Minneapolis, was then introduced.
Dr. Hammes called on Dr. John A. Lepak for his
address as retiring President, “Challenging Problems
and Demands of the Aged and Chronically 111.” (See
page 450, this issue.)
Discussion
Dr. F. F. Callahan, Saint Paul : I wish to con-
gratulate Dr. Lepak on his excellent survey of one of
our most pressing problems. In 1945, when the State
of Minnesota started its present plan of care of the in-
digent, the cost was approximately $481,000. In 1949,
the cost was $4,000,000, and unless some change is
made, it will be around $5,000,000 for the year 1950. The
greatest part of this money is spent on care for the aged.
Even with the expenditure of these large sums of money,
many of the aged are still improperly cared for. Dr. Le-
pak mentioned the falling death rate from tuberculosis.
Before the 1949 Minnesota Legislature met, it had been
legally impossible to use any of our tuberculosis sana-
toria for any other purpose than the care of the tu-
berculous. The 1949 Legislature passed the Enabling
Act which will allow the commimities in which these
institutions are located to use them for any other use-
ful purpose when they are no longer needed for the
care of the tuberculous. When this time arrives we
believe that these institutions will make desirable homes
for the aged, at a relatively low cost. For many years
Nopeming Sanatorium in St. Louis County has fur-
nished care for the tuberculous in the county with a
population of slightly over 200,000. With the rapid fall
in the mortality and morbidity rate in this county in
the past five years, the Nopeming staff believes that
it will be able to furnish treatment for a population
of 500,000 in another five or six years. If this trend
continues, it is quite possible that approximately 250
beds previously used for tuberculous cases can be
turned over for the care of the aged. While the num-
ber of beds will not take care of the problem completely,
it would be quite a help in many communities.
Dr. Walter P. Gardner, Saint Paul : I wish to ex-
press my appreciation to Dr. Lepak for his fine pres-
entation of these problems. As chairman of the sub-
committee on Chronic Hospitals of the State Advisory
Council on Hospital Survey and Planning under the
Hill-Burton bill, I wish to call attention to the follow-
ing fact. The proposed program for chronic hospitals
in the state of Minnesota, set forth on the slides which
have just been shown, is correct. One should not get
the impression, however, that this program is going to
518
be carried out in the near future. In fact, there is no
possibility of reaching the goals set forth within the
next five years. It is very probable that these goals
will never be reached. If any large part of this pro-
posed program is to be carried out, the funds for so
doing will have to come through taxes rather than
through private subscriptions. This, however, does not
alter the fact that the goals are worthy and that ef-
forts should be continued at all times to secure as
large a part of the program as possible.
Dr. Erling Hansen, Minneapolis : My remarks are
more or less anticlimactic to this paper, but I couldn’t
help being struck with the percentage which Sangamon
County, Illinois, showed in dependent or public aid
because of blindness. In the picture section of a recent
Minneapolis Sunday Tribune, there was a quotation
from Dr. Benedict’s speech before the National Society
for the Prevention of Blindness, in which he called
attention to the fact that many of these people are
living longer and that eye conditions in the aged are
increasing markedly. It is true that cataracts are pri-
marily an affliction of older people; that is not blind-
ness. But it causes a good deal of disability in older
people. Glaucoma, which is one of the primary causes
of blindness, is a major condition which we find in-
creasing with increased longevity. Many of the people
who have been kept alive by our modern treatment for
diabetes have not been insured against diabetic reti-
nopathy, with resultant poor vision or actual blindness.
Also, people with hardening of the arteries have a cer-
tain amount of degeneration in the retina, not actual
blindness, which still causes a good deal of disturbance
of vision. Those are real problems, and the striking
thing in the Sangamon County picture was that over
63 per cent of the people who were dependent on public
aid were there because of blindness. It is very impor-
tant.
Dr. Lepak (closing) : I wish to thank the gentlemen
for their generous discussion of the paper and I want
to say to Dr. Gardner that the plan proposed for the
next five years is subject to change each year.
* * *
The meeting was adjourned.
Wallace P. Ritchie, M.D., Secretary
STATES GET $47 MILLION IN GRANTS IN YEAR
Public Health Service annual report, released recently,
shows grants to states totaled 47 million dollars for year
ended July 1, 1949. The breakdown by millions of dollars
is: general health, 11.2; venereal disease, 12.7; tubercu-
losis, 6.7 ; mental health, 3 ; cancer, 2.3. At end of year,
thirty-five new hospitals had been built under the Hos-
pital Construction Act, an additional 355 were under
construction, and plans had been approved for 500 more.
Minnesota Ml-dicine
Extensive mucosal destruction
and ulceration from chronic
ulcerative colitis with only a
few inflammatory polyps.
SEARLE
In COLITIS MANAGEMENT — In the constipation of spastic, atonic
and even ulcerative colitisjthe smoothage action of METAMUCIL
is of proved value.
METAMUCIL® provides a bland, soft bulk with a
tendency to incorporate irritating particles with the fecal residue
and is thus a valuable adjunct in correcting the constipation and
minimizing irritation of the inflamed mucosa. METAMUCIL is
the highly refined mucilloid of a seed of the psyllium group,
Plantago ovata (50%), combined with dextrose (50%).
[ay, 1950
519
♦
Reports and Announcements ♦
AMERICAN COLLEGE OF CHEST PHYSICIANS
The sixteenth annual meeting of the American Col-
lege of Chest Physicians will be held at the St. Francis
Hotel, San Francisco, California, June 22 through 25.
An interesting scientific program has been arranged
for the meeting.
The board of examiners of the American College of
Chest Physicians announces that the next oral and
written examinations for fellowship will be held in
San Francisco on June 22. Candidates for fellowship
in the College who would like to take the examinations
should contact the Executive Secretary, American Col-
lege of Chest Physicians, 500 North Dearborn Street,
Chicago 10, Illinois.
Dr. Karl H. P'fuetze, Cannon Falls, serves as the
governor of the College for the State of Minnesota,
and Dr. John F. Briggs, Saint Paul, is the residing
president of the Minnesota chapter.
AMERICAN CONGRESS OF PHYSICAL MEDICINE
The American Congress of Physical Medicine will
hold its twenty-eighth annual scientific and clinical ses-
sion August 28, 29, 30, 31 and September 1 at the Hotel
Statler, Boston, Massachusetts. All sessions will be
open to members of the medical profession in good
standing with the American Medical Association. In
addition to the scientific sessions, the annual instruc-
tion seminars will be held. These seminars will be of-
fered in two groups. One set of ten lectures will con-
sist of basic subjects and attendance will be limited to
physicians. One set of ten lectures will be more gen-
eral in character and will be open to physicians as well
as to therapists who are registered with the American
Registry of Physical Therapy Technicians or the
American Occupational Therapy Association. Full in-
formation may be obtained by writing to the Ameri-
can Congress of Physical Medicine, 30 North Michigan
Avenue, Chicago 2, Illinois.
NATIONAL CONFERENCE OF COUNTY
MEDICAL SOCIETY OFFICERS
The seventh National Conference of County Medical
Society Officers will be held at the Palace Hotel, San
Francisco, on June 25, the day preceding the first meet-
ing of the House of Delegates of the AMA. All physi-
cians are urged to attend, particularly county medical
society officers. Each address will be followed by a
discussion period open to those in attendance.
The meeting will begin with registration at 9:00
a.m. and a call to order at 9:20 a.m. by Dr. A. M.
Mitchell, chairman.
A questionnaire on socialized medicine will be given
those in attendance, and the result will be announced
before the lunch period.
Subjects, such as “How to Set Up a County Medical
Society Record System,” “How to Organize a Com-
munity Health Council,” “Providing Special Benefits
through County Medical Society Membership,” will
occupy the morning session.
The evening session will be devoted to a discussion
of “The Third Party in the Practice of Medicine” (In-
surance Companies, Hospital and Medical Care), “Hos-
pitals and the Practice of Medicine.”
This will be a grass roots conference, and physicians
are urged to attend and participate.
INTERNATIONAL ACADEMY OF PROCTOLOGY
The second annual convention of the International
Academy of Proctology will be held at the Bellevue
Hotel in San Francisco, California, June 23, 24, 1950.
The scientific session will consist of the following
papers : “Diverticulosis and Diverticulitis” by Edgar M.
Scott, M.D., Birmingham, Ala. ; “Surgery of Carcinoma
of the Colon and Rectum” by Earl J. Halligan, M.D.,
Jersey City, N. J.; “Skin Covering of the Stoma
Following Resection of the Rectum : Its Value in the
Cases of Patients with Chronic Diarrhea” by H. A.
Springer, M.D., Cincinnati, Ohio; “Psychosomatic
Aspects of Proctology” by William Lieberman, M.D.,
Brooklyn, N. Y. ; “Pectenosis, Illustrated by Colored
Motion Picture and Lecture” by Manuel G. Spiesman,
M.D., Chicago, 111.; “The Nutritional Management of
Patients with Colon Surgery” by Jacob J. Weinstein,
M.D., Washington, D. C. ; “The Preoperative Manage-
ment of the Proctologic Patient” by Charles J. Weigel,
M. D., River Forest, 111. ; “Diagnosis of Ano-Rectal
Fistulae” by Emma L. Bellows, M.D., Southampton,
L. I., N. Y. ; “The Thermal Cutting Unit in Proctologic
Surgery” by Alfred J. Cantor, M.D., Flushing, N. Y.,
and “Routine Proctoscopic Examinations of 1,000 Pre-
sumably Normal Healthy Individuals” by Caesar Portes,
Chicago, 111.
The annual banquet of the Academy will take place on
Friday evening, June 23, 1950.
Further information concerning the convention and a
copy of the program may be obtained by writing to
the Secretary, Dr. Alfred J. Cantor, International
Academy of Proctology, 43-55 Kissena Blvd., Flushing,
N. Y.
VANCOUVER SUMMER SCHOOL CLINICS
Summer school clinics sponsored by the Vancouver
Medical Association will be held in Hotel Vancouver
from May 29 to June 2. The fee for the course is
$10. Complete information can be obtained from Dr.
Gordon C. Large, 203 Medical-Dental Building, Van-
couver, B. C.
Speakers at the clinics will include Dr. A. L. Chute,
pediatrician, Sick Children’s Hospital, and associate
(Continued on Page 522)
520
Minnesota Medicine
/ / /
The First
NEUROLOGIC CENTER FOR CIVILIANS
in the Northwest
Governor Luther Youngdahl formally opened and dedicated our
neurologic center and opened the doors to the public on February
12, 1950, thereby offering the following new services:
1) treatment of the hemiplegic patient
2) multiple sclerosis
3) retraining of speech disorders
4) paraplegia and other paralyses
5) ataxias
Qualified neurologists and neurosurgeons staff this center. The staff
also includes qualified personnel who have been trained in special
therapy, occupational therapy, corrective therapy and physical
therapy.
GLENWOOD HILLS HOSPITALS
3501 GOLDEN VALLEY ROAD MINNEAPOLIS 22, MINNESOTA
Offering a High Standard of Facilities for 25 Years
May. 1950
521
REPORTS AND ANNOUNCEMENTS
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• GICAL UNIT for all minor and
SEESE various major surgery.
Write "Blendtome Folder” on your
prescription blank or clip your letter
head to this advertisement. Reprint of
electrosurgical technic mailed free on
request. Please indicate your specialty.
THE BIRTCHER
5087 Huntington Drive
CORPORATION
Loi Angeles 32, Calif.
The Birtcher BLENDTOME is a surpris-
ingly practical unit for office surgery.
With this lightweight unit, you have all
the electrosurgical procedures of major
units — electro excision, desiccation, ful-
guration and coagulation. While not
meant to be compared to a large hos-
pital unit, the BLENDTOME has been
successfully used in many TUR cases.
Such facility indicates the brilliant per-
formance of the BLENDTOME.
ALL 4 BASIC SURGICAL CURRENTS
1. Tube Generated Cutting Current.
2. Spark-Gap Generated Coagulation Current.
3. A controlled mixed blend of both above
currents on selection.
Mono-polar Oudin Desiccation-Fulguration
Current.
Never before has a surgical unit of
such performance been offered at
the low price of the Blendtome.
Blendtome Dealers
C. F. ANDERSON CO., INC.
Minneapolis
PHYSICIANS <& HOSPITALS SUPPLY CO.. INC.
Minneapolis
522
VANCOUVER SUMMER SCHOOL CLINICS
(Continued from Page 520)
professor, Banting and Best Department of Medical
Research, University of Toronto; Dr. Howard P.
Lewis, professor of medicine, University of Oregon
Medical School; Professor J. Chassar Moir, of the
Nuffield Department of Obstetrics and Gynaecology,
Radcliffe Infirmary, Oxford, England ; Dr. R. L. Sand-
ers, associate professor of clinical surgery, University
of Tennessee; and Dr. Meyer Wiener, honorary con-
sultant in ophthalmology, Bureau of Medicine and
Surgery, United States Navy.
MINNEAPOLIS ACADEMY OF MEDICINE
Dr. Owen F. Robbins was elected president of the
Minneapolis Academy of Medicine at a recent meeting
of the organization. He will succeed Dr. C. O. Hansen
in the office on July 1.
Other officers named include Dr. John Moe, vice
president; Dr. John A. Haugen, secretary; Dr. Karl E
Sandt, treasurer, and Dr. Donald C. MacKinnon, re-
corder.
HENNEPIN COUNTY SOCIETY
Principal speaker at a meeting bf the Hennepin
County Medical Society in Minneapolis on April 3 was
Dr. Robert G. Bloch, professor of medicine and chief
of the division of preventable diseases at the Univer-
sity of Chicago. Dr. Bloch presented the fifteenth an-
nual John W. Bell tuberculosis lecture, sponsored by
the Hennepin County Tuberculosis Association. The
title of his address was “The Relationship of Sarcoid-
osis to Tuberculosis.”
RICE COUNTY SOCIETY
At a meeting of the Rice County Medical Society in
Faribault on March 21, Dr. Donald J. Studer of Fari-
bault was elected president of the organization. Dr.
J. C. Belshe of Northfield was named secretary-
treasurer.
The principal speaker at the meeting was Dr. Ray-
mond N. Bieter, of the University of Minnesota, who
presented a paper on “Chemotherapy.”
ST. LOUIS COUNTY SOCIETY
The St. Louis County Medical Society held its regular
monthly meeting at St. Mary’s Hospital, Duluth, on May
11.
Principal speaker at the meeting was Dr. J. W. Conn,
chief of the division of metabolism and endocrinology
at the Lffiiversity of Michigan Hospital and associate
professor at the University of Michigan Medical School.
Dr. Conn spoke on the subject, “Metabolic Effects in
Man of ACTH and Cortisone.”
Another feature of the meeting was a report by Dr.
M. O. Wallace, Duluth, chairman of the society’s public
relations committee.
Minnesota Medicine
neo
synephrine
HYDROCH LORIDE
BRAND OF PHENYLEPHRINE HYDROCHLORIDE
decongestive for allergic rhinitis,
Attend the Minnesota State Medical Associa-
tion Annual Meeting, Duluth, Minnesota, June
12 to June 14. Visit our Exhibit No. 12.
_
the nasal passages
Swollen nasal mucous
membranes . . . lacrimation .
nasal discharge — the most acutely
annoying manifestations of upper
respiratory tract allergy or
infection — respond quickly
to the vasoconstrictive action of
colds, sinusitis
neo-synephrine is
prompt and prolonged in its decongestive action
effective on repeated application
virtually nonirritating
nonstimulating to central nervous system
Supplied in 34% solution plain and aromatic, 1 oz. bottles.
Also 1% solution (when greater concentration is required), 1 oz. bottles,
and Vi% water soluble jelly, Vs oz.
May, 1950
523
♦
Woman’s Auxiliary
AUXILIARY PLANS ANNUAL MEETING
Mrs. H. E. Bakkila. President
It will be a great privilege for me not only as State
President but also as a member of the St. Louis County
Medical Auxiliary to welcome every one of you to the
twenty-eighth Annual Meeting of the Woman’s Aux-
iliary to the Minnesota State Medical association, in
Duluth, June 12, 13 and 14. The Board of Directors and
our hostesses, members of the St. Louis County Aux-
iliary, extend a most cordial invitation to all.
The Hotel Duluth will be Auxiliary Headquarters.
The registration desk will open each day at 9:00 a.m.
On Monday at 10 :30 a.m. the Executive Board meeting
will be held at the Duluth Athletic Club. This will be
followed at 1 :00 p.m. by the annual Executive Board
luncheon. At 3 :00 p.m. all doctors’ wives attending the
convention will be guests at a tea at Northland Country
Club honoring state officers. St. Louis county auxiliary
members will be hostesses.
Monday evening the Minnesota State Medical associa-
tion and the St. Louis County Medical Society are hold-
ing open house in the ballroom at the Hotel Duluth.
The Physician’s Symphony will play, and a square
dancing group will entertain. There will be dancing from
9 to 12 p.m.
The Annual Meeting will be held Tuesday at 10:00
a.m. in the Hotel Duluth. The election of officers is at
this meeting. The annual luncheon will be at 1 :00 p.m.
in the Harbor Room of the Flame. The new president
will be awarded the president’s pin. A style show will
be presented by Oreck’s store.
At 10 :0O a.m. Wednesday, all visiting members are
invited to be the guests of the St. Louis County Medical
Auxiliary at the annual Roundup Breakfast at the Hotel
Duluth.
The members of the St. Louis County Medical Aux-
iliary and all State officers and board members are
anxious to have the wife of every physician in Minne-
sota present at this convention, so whether or not you
are a member, do join in making this — our twenty-
eighth annual meeting — a great success.
THE IMPORTANCE OF HEALTH DAYS
Mrs. H. F. Wahlquist, Health Day Chairman
Health Days, innovated in Minnesota, have almost be-
come an institution in the state. Since the fall of 1947
when plans began for the first rural area Health Day,
at least fifteen have been held in almost every trade area
of the state. In addition, smaller health meetings have
been held in numerous communities.
Health Days are speeding a growing realization that
community health problems are everyone’s concern. Be-
cause health is a community problem, and is interwoven
in community living with other problems such as educa-
tion and politics, any solution of one would make for
progress in solving the others. But, to be successful in
any undertaking, citizens of a community need to work
together.
Health Days tend to get people to think about health :
problems. Through them the members of a community
learn that health problems are their responsibility. Dur-
ing the meetings they are given accurate information,
learn health truths and receive practical ideas on pre-
venting disease. They are urged to look to reliable
sources for information and are made aware that today
the emphasis is on positive health — preventive medicine.
They learn, too, that various factors like nutrition,
recreation, housing, sanitation, immunization, clothing
contribute to good health and that these are not the sole
responsibilities of physicians, but the responsibilities of
citizens of their respective communities. Finally they
realize that these problems are handled best through
public efforts in their own community.
First of all, successful Health Days are the product
of many minds and hands. It is not strategic for any
one organization in a community to try to put on a large
Health Day alone. Health Days should be arranged and
planned not by a few people, but by many people. They
belong to everyone in the community and everyone must
feel he has had some part in making them a reality, i.e.,
arranging the exhibits, planning the program, registering
the people, writing the radio script, setting up the chairs
or passing out the programs.
Furthermore, the success of Health Days relates direct-
ly to the workable organization which is set up to guide
them, to the leaders participating in committee respon-
sibility, to the publicity, and to the attractiveness of the
program. Co-sponsored by the Minnesota State Medical I
Association, the State Department of Health and the
Woman’s Auxiliary to the state medical association, an
initial planning meeting in the community must include
representatives of all community organizations.
People who really do things should be selected as
leaders in Health Day planning. Acting as heads of
committees, leaders must show real interest and a willing-
ness to give time and effort. They must know how to
work with people. Publicity for Health Days can take
many forms. It can be in the form of letters to heads
of organizations, ministers, city officials, school superin-
tendents ; in the form of announcements in clubs,
churches, schools; or through radio interviews and tran-
scriptions. However, the most effective means of getting
people awakened to the significance of Health Days is by
enthusiastic personal contact — telling neighbors and
friends about Health Days.
Programs for Health Days have various possibilities.
Community needs vary greatly and programs must meet
local needs. It is best to start at borne and learn what
the people can most readily absorb — consider if the
locale is rural or urban, one county or many.
The program may be divided into sessions: morning,
(Continued on Page 526)
524
Minnesota Medicine
A HOMELIKE
HAVEN WHERE
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ACHIEVE
INSPIRATION FOR
RECOVERY
200 acres on the shores
of beautiful Lake Chisa-
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HAZELDEN FOUNDATION
The constructive thinking of a group of Twin Cities men seeking a new approach to the
problem of alcoholism resulted in the organization of the Hazelden Foundation. Some of
the founders are themselves men who have recovered from alcoholism through the proved
program of Alcoholics Anonymous. Their true understanding of the problem has resulted
in the treatment procedures used at the Hazelden Foundation.
BOARD
OF TRUSTEES
-
Mr. T. D. Maier,
Vice President,
First Natl. Bank
St. Paul, Minn.
Mr. Robert M. McGarvey,
President and Treasurer
McGarvey Coffee Co.
Minneapolis 1, Minn.
Mr. A. G. Stasel,
Supt., Eitel Hospital,
Minneapolis 3, Minn.
Dr. Gordon R. Kamman
1044 Lowry Med. Arts
Bldg., St. Paul 2, Minn.
Mr. L. M. Butler,
Owner Star Prairie
Trout Farm
St. Paul, Minn.
Mr. John J. Kerwin,
Manager, Mid-Continent
Petroleum Corp.,
St. Paul 4, Minn.
Mr. Bernard H. Ridder,
Pres., N.W. Pub., Inc.,
Dispatch Building,
St. Paul 1, Minn.
M. R. r. T -illy
Chairman of the Board,
First National Bank,
St. Paul 1, Minn.
Direct inquiries and request for illustrated brochure
to
Mr.
A. A. Heckman,
Mr. L. B. Carroll,
Gen. Sec., Family Serv.,
V. Pres. & Genl. Mgr.
Wilder Building,
Hazelden Foundation,
St.
Paul 2, Minn.
Center City, Minn.
It should be understood that Hazelden Foundation is not officially sponsored by Alcoholics Anonymous
just as Alcoholics Anonymous sponsors no other organization regardless of merit.
The Hazelden Foundation is a nonprofit organization. All inquiries are kept confidential.
HAZELDEN FOUNDATION
Lake Chisago, Center City, Minn.
ay, 1950
Telephone 83
525
WOMAN’S AUXILIARY
IMPORTANCE OF HEALTH DAYS
(Continued from Page 524)
afternoon and evening. The type of community again
should determine whether the program will begin in the
morning and close at 4:30 p.m., with elaborate plans for
an evening session, or whether just morning and after-
noon sessions are better. Some communities may want
to plan only an afternoon or an evening meeting.
Programs may include various methods of presenting
material : round table discussions, a series of short ten-
minute talks, one or two longer talks with a question-
and-answer period, several half hour talks, health movies.
They begin with a proper welcome and keynote address.
If plans include an evening meeting, the speaker should
be dynamic and, preferably, a prominent citizen of the
state.
The members of the program committee should be
representatives of various organizations of the com-
munity. They should be aware of community health
needs, and have varied community interests. They
should be experienced and realize what people in the
community understand and want ; enabling them to work
out a meaningful program for their community.
Further program hints are:
1. Begin to plan the program two months before the
Health Day.
2. Point up the objective of Health Day. Remember
the first object is to study apparent needs, then to arouse
people in the community to learn about those not evident.
A definite plan of action to sol\ e certain problems may
evolve from an enthusiastic and “ready for action"
audience.
3. Fill the program with a variety of health informa-
tion and discussions about health problems.
4. Engage speakers outside of the community to
bring diversity.
5. Put local people on the program to make good
home town news and to help make the day belong to the
community.
6. Use key people who are responsible for legislation
and law enforcement as the presiding officers of the day.
7. Include someone from each county on the program
if several counties combine to have a Health Day — a
public health nurse, superintendent of schools, county
commissioner, teacher, homemaker, minister, judge.
8. Plan a program in which a fair measure of suc-
cess is assured. Start at the experience level of the
people concerned — give them something they can do as
individuals or parents in their community or home.
9. Remember no two Health Day programs can be
alike.
10. Inform the speakers the amount of time they may
have and insist they keep it.
11. Start on time, stop on time.
12. Stress the importance of everyone being friendly
— provide a time for getting acquainted.
13. Keep the sessions peppy.
Many additional features may be included in Health
(Continued on Page 528)
dorestro
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526
Minnesota Medicine
Left coronary artery
Circumflex branch
Anterior descending branch
Small branches
Artery —
normal wall, large
channel for blood
Artery —
thickened wall, small
channel for blood
Semi- schematic drawings by Jean.Hirscb.
Longer life for people past 40
red above is the system of
y blood vessels found in the
human heart. Through this
the blood is conveyed to the
tuscles.
coronary system of most in-
is functions well day in and
t through a full lifetime. In
eases, however, these blood
become impaired through
. thickening of the wall (arteri-
is) and consequent narrow-
:he blood channel. Coronary
s are more prevalent after
occur oftener in males than
ties; have no relation to in-
>r occupation; and have a
:y to run in certain families.
e many people regard coro-
tery disease as a rapidly fatal
actually only about 10% of
so affected succumb to the
ttack. Many survive the first
make an excellent recovery
urn to enjoyable living, with
only limited restriction on their
activities.
Despite a rise in the number of
cases of coronary disease due to in-
creasing age of the population,
medical science is making notable
progress in prolonging the lives of
these people.
Your doctor today has at his dis-
posal many new techniques and
devices for checking on the condition Z>
of your heart and arteries. Periodic
visits to him and observance of com-
mon sense routines in your daily
living give the best assurance that
you will benefit from geriatrics — the
science of helping older people enjoy
life longer.
Northwestern
While advances in medicine may
add many years of physically com-
fortable living, your full enjoyment
of those years calls for financial sol-
vency. This is best attained through
a sound program of savings and life
insurance. Your NWNL agent, paid
not primarily for how much in-
surance he sells you but for what you
keep in force, has a strong incentive to
provide you with the insurance you
need and can afford. He can help
you plan wisely a financially com-
fortable future through life insurance.
FREE PAMPHLET: 11 Consider Your
Coronaries'1'1 describes what you can do to
minimize the possibility or the effect of
this heart disorder. Sent free on request.
fAfhtional Life
INSURANCE fim
Minneapolis
COMPANY
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( This is the latest in NWNL’s series of national magazine advertisements )
WOMAN’S AUXILIARY
IMPORTANCE OF HEALTH DAYS
(Continued from Page 526)
Day plans. Voluntary health organizations are eager to
co-operate. They seek earnestly the opportunity to co-
operate and will set up exhibits and man their own
booths. Noon sack lunches in smaller communities are
helpful. They provide, while people are eating together,
the surroundings for friendly visits among neighbors.
Essay or poster contests on current health topics stimu-
late local school interest in Health Days and increase at-
tendance. Band concerts give young people a chance to
do something toward Health Day planning.
Through Health Days, citizens have learned many
things. They have learned how to prevent wasteful
duplication of effort. They have discovered their own
local health needs and found out that, through their
own local resources, they can do a good public health
job. The speakers and movies have helped them sub-
stitute truth for mistaken and distorted ideas about
health. Finally they have come to know one another
better and enjoyed the privilege of working with one
another for the good of their community.
It is important to recognize that Health Days are only
the first step. What grows out of them is what counts.
County health councils have been formed, food handlers’
schools organized, county public health nurses employed,
dental clinics held, weekly radio programs on health ar-
ranged, emotional health committees organized. Today
these are carrying on where Health Days left off.
Through these channels the community interest in health
is being kept alive and functioning.
Great opportunities are open to wives of physicians
today. The cause of medicine definitely needs support.
Through untiring effort and co-operating, a contribution
will be made toward public education in the closely re-
lated fields of medical science and medical economics.
SOUTHWESTERN AUXILIARY HEARS SPEAKER
Mrs. D. J. Halpern, President
Members of the Southwestern Medical Auxiliary heard
Miss Laura Hegstad, Cancer Nursing Consultant, Min-
nesota Department of Health, speak on “How Can We
Help in the Cancer Control Program in Our Com-
munities?”
Miss Hegstad spoke at a dinner meeting on April 10
at Worthington.
The hostess was Mrs. F. L. Schade. She was assisted
by Mrs. E. A. Kilbride, Mrs. P. J. Pankratz and Mrs.
E. S. Schutz.
The great physicians of all time have understood that
medicine is not a study of disease, but a study of man:
an individual who is a member of a family and who is
part of a community. . . . The purpose of medicine is
to make available to all the people, in the greatest pos-
sible degree, the achievements of science as they relate
to the promotion of health and to the prevention and
treatment of disease. — W. G. Smillie, M.D., New Eng-
land J. Med., January 12, 1950.
OjoLtL a L
the Pro^eSAion
Se
line ^JeruLce
N. P. BENSON OPTICAL COMPANY
Since 1913
Main Office and Laboratory: Minneapolis, Minnesota
Branch Laboratories Serving Minnesota
Duluth Rochester Brainerd Albert Lea
Bemidji New Ulm W inona
Also branch laboratories in other principal cities of the Upper Midwest
528
Minnesota Medicine
DOCTOR, YOUR OWN
NOSE PROVES IN SECONDS
PHILIP MORRIS
ARE LESS IRRITATING!
YOU KNOW of the published clinical and laboratory
studies* which have shown Philip Morris Cigarettes
to be less irritating. BUT NOW— in seconds — YOU
CAN MAKE YOUR OWN TEST . . . simple but
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\ HERE IS ALL YOU DO:
•
#
•
•
•
•
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1
A , . . light up a Philip Morris
Take a puff - DON’T INHALE. Just
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m
m
%
4
A
*
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md . . . light up your present brand
DON’T INHALE. Just take a puff and
s-l-o-w-l-y let the smoke come through your
nose. Notice that bite, that sting? Quite a
difference from Philip Morris.!
With proof so conclusive, ii'ould it not be good practice
to suggest Philip AIorris to your patients who smoke?
Philip Morris
Philip Morris & Co., Ltd., Inc.
100 Park Avenue, New York 17, N. Y.
*Proc. Soc. Exp. Biol, and Med.. 1934, 32, 241-245; N. Y. State Jonrn. Med.,
Vol. 35, 6-1-25, No. 11, 590-592; Laryngoscope. Feb. 1935, Vol. XLV, No. 2,
149-154; Laryngoscope. 1937, Vol. XLVII, No. 1, 58-60
Ay. 1950
529
In Memoriam
JAMES KERR ANDERSON
Dr. James Kerr Anderson of Minneapolis died on
March 27, 1950 at the age of fifty-eight.
Dr. Anderson was born in East Liverpool, Ohio, July
11, 1891. He received his liberal arts degree from Wash-
ington and Jefferson College at Washington, Pennsyl-
vania, in 1913 and his medical degree from Johns Hop-
kins Medical School in 1917.
He came to Minneapolis to intern at the Minneapolis
General Hospital in 1917, after which he entered the
Army in World War I as a First Lieutenant. After the
war he spent the years 1920 to 1924 as a patient in Glen
Lake, Sanatorium, after which he acted as superintendent
of Pokegama Sanatorium for a year and of Sunnyrest
Sanatorium at Crookston from 1925 to 1929. Pie then
began practice in Minneapolis.
Dr. Anderson was a fellow of the American College
of Surgeons, a fellow of the American Proctologic So-
ciety, a diplomate of the American Board of Surgery in
Proctology, a member of the Minnesota Academy of
Medicine, the Minneapolis Academy of Medicine and
the Hennepin County Medical Society. He was a Clinical
Associate Professor of Surgery at the University of Min-
nesota and a co-author with Dr. H. O. McPheeters of
a book entitled “Injection Treatment of Varicose Veins
and Hemorrhoids.” He was also a past national president
of the medical fraternity, Phi Beta Pi.
Dr. Anderson is survived by his widow, Clara; a
daughter, Mrs. Robert Osgood of Arlington, Massa-
chusetts, and his mother, Mrs. Nettie Anderson of Pitts-
burgh, Pennsylvania.
JOHN CURRER BARTON
Dr. John Currer Barton of Washington, D. C., died
February 12, 1950, following an illness of several
months.
Dr. Barton was born in Two Harbors, Minnesota,
July 8, 1906, and attended the University of Minnesota
Medical School from which he was graduated in 1934.
After his internship at Milwaukee County Hospital he
was on the staff of the Independence State Hospital,
Independence, Iowa, for several years.
Holding a reserve commission since graduation he
was called to active duty in 1940 and served five years,
separating with the rank of colonel in command of
the 131st General Hospital overseas. He then became
medical consultant to the Claim Service of the Veterans
Administration in St. Paul and was transferred to
Washington in 1949.
Dr. Barton was a member of Acacia, Phi Beta Pi,
Ramsey County Medical Society, Minnesota State
Medical Association, the American Medical Association
and the American Psychiatric Association.
He is survived by his wife, Helen Brockman Barton,
who was also his classmate ; a daughter, Sandra, and
two sons, John and Craig, of Bethesda, Maryland.
Leo A. Nash, M.D.
WILLIAM K. FOSTER
Dr. William K, Foster, for many years a figure in
athletics at the University of Minnesota and in Min-
neapolis high schools, died following a heart attack
February 25, 1950.
Dr. Foster was born at White Plains, Alabama, De-
cember 1, 1878. He attended the University of Minne-’
sota from which he obtained the degrees of LL.B.,
LL.M., A.B., M.B., and M.D., the last in 1920. He in-
terned at the Minneapolis General Hospital.
He was medical examiner for Minneapolis high
school athletics for twelve years and served as Dr.
Cooke’s assistant at the University of Minnesota for
sixteen years. Gymnastics was his favorite sport, and
he had just completed writing a book on the history of
that activity at Minnesota.
Dr. Foster is survived by his widow, one daughter,
Mrs. Willis E. Dugan of Minneapolis; four brothers,
Dr. James M. Foster of Minneapolis and Dr. John,
Mark and Oscar, all of Ruston, Louisiana, and two sis-
ters, Mrs. Elizabeth Doss and Mrs. Eula Fuller, both
of Ruston.
GEORGE DOUGLAS HEAD
Dr. George Douglas Head, dean of Minneapolis inter-
nists, died at his home, 55 Dell Place, on December 19,
1949, after fifty-three years of medical practice, in his
eightieth year.
He was born in Elgin, Minnesota, on September 10,
1870. His parents, Mary Elizabeth Douglas and Newell
Samuel Head, were of Scotch-English extraction. He
received his elementary education in the schools of Plain-
view and Elgin, Minnesota. He graduated from Fargo
high school and received his B.S. and M.D. degrees from
the University of Minnesota in 1892 and 1895. He
pursued postgraduate study under William Osier in
1902 at Johns Hopkins. In 1905 and 1908, he engaged in
further postgraduate work at the University of Vienna
and the University of Edinburgh.
His first early years, after graduation from medical
school, were divided between assisting Dr. William
Hunter, then head of the Department of Medicine at the
University of Minnesota medical school, and building a
general practice in southeast Minneapolis at the corner
of Washington and Oak Street. After the inspiration of
Sir William Osier’s contact and teaching, Dr. Head
decided to devote his life to the specialty of internal
medicine, and thus became the first physician in Minne-
apolis to confine himself strictly to this field.
After completion of his medical course in 1895, he con-
tinued his academic career by serving his alma mater in
the teaching capacities of Assistant in the Dispensary
1895-97; Instructor of Clinical Microscopy 1895-1906;
Assistant Professor of Clinical Medicine and Micro-
scopy 1905-10; and Associate Professor of Medicine
1910.
(Continued on Page 532)
530
Minnesota Medicine
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531
IN MEMORI AM
GEORGE DOUGLAS HEAD
(Continued from Page 530)
From 1902 to a year before his death, he engaged
actively in the specialty of internal medicine, and his
special interests were diseases of the heart and lungs.
Current literature received some fifty-two scientific con-
tributions, and he was the author of a monograph, “Con-
cealed Tuberculosis,” published by Blakiston. He will be
well remembered for his diagnostic acumen, his careful
painstaking physical examinations, and his kindly, and at
times, remarkable patience — an attribute that endeared
him to patients and students alike — for he was a great
teacher in the art and science of medicine. In therapy,
he was fundamentally a nihilist, holding that nature must
be relied upon, and that simple drugs might be used to
encourage her if they offered little or no risk of hamper-
ing her.
The last forty years of Dr. Head’s life were greatly
influenced by the development of diabetes mellitus in
1910, undoubtedly inherited from his mother who died of
the disease. He was forced to give up his medical teach-
ing at the University, resign from several public positions
and curtail his social activities. At this time, he was con-
vinced that he had no more than five to ten years to live.
He adhered with Spartan tenacity to a Newburgh-Marsh
high fat, high protein diet for the next twenty years,
which kept up his body weight, almost eliminated the
urinary sugar, but produced chronic ketonuria with ace-
tone usually three to four plus. This, together with in-
creased rest and daily regular physical exercise, enabled
him to keep on with his professional work.
In 1918, Dr. Head and his diabetes volunteered for
service in World War I, but he was rejected on three
different occasions. Finally, in October of the same year,
the Surgeon-General, desperate for doctors, accepted him
for service within the continental limits. Dr. Head then
served for eight months as Major and Chief of the Medi-
cal Service at the base hospitals in Camp Wheeler,
Georgia, and Camp Devons, Massachusetts. It is an
interesting sidelight that his army service with its regular
hours and relative freedom from nerve tension proved to
be of salutary effect on his disease. In 1921, Dr. Head
contracted a mild virus encephalitis from which he re-
covered in a few months, but which left him with para-
lysis agitans in his later years. He first found it neces-
sary to take insulin in 1930 when it probably saved his
life, for diabetic coma set in as a result of a severe
pyelonephritis associated with right kidney stones. In
1938, insulin and sulfathiazole enabled him to success-
fully undergo a right nephrectomy, and in the subsequent
years, he found it necessary to take sulfadiazine once a
week to curb his left pyohydronephrosis. Dr. Head’s
anginal syndrome started with mild transient attacks
three years before his death. His blood pressure was
always normal. He suffered three attacks of coronary
thrombosis with the final lethal episode — a femoral artery
embolus. The findings were substantiated by postmortem
examination.
Dr. Head’s honors were many, and he was a member
of many scientific societies. He was president of the
Hennepin County Medical Society in 1922 and the Min-
(Continued on Page 534)
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532
Minnesota Medicine
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IN MEMORIAM
GEORGE DOUGLAS HEAD
(Continued from Page 532)
nesota State Medical Association in 1926. He was chief
of staff of Abbott Hospital in 1928. His fraternities were
Nn Sigma Nu, Delta Tau Delta, Sigma Xi, and Alpha
Omega Alpha. However, one of his most cherished
memories was his activity as founder and later as presi-
dent of the Minnesota Society of Internal Medicine.
Dr. Head is survived by his wife, Sarabel Parry, his
son, Douglas Parry, and five grandchildren.
CHARLES HARCOURT JOHNSON
Dr. Charles H. Johnson of Spring Valley, Minnesota,
passed away March 16, 1950 at Worrall Hospital in
Rochester.
Dr. Johnson was born January 26, 1886 in Spring
Valley, Minnesota. He obtained his medical degree from
the University of Illinois in 1912. He served as a Lieu-
tenant in the Medical Corps of the Army in World
War I.
Dr. Johnson was united in marriage to Lillian Low,
February 7, 1912. He is survived by his widow and four
children: Dr. Ross H. Johnson of Austin, Miriam John-
son of Los Angeles, Charles Wayne Johnson of Colome,
South Dakota, and Dr. William D. Johnson of Spring
Valley.
WALTER W. NAUTH
Dr. Walter W. Nauth, one of the founders of the
Winona Clinic at Winona, Minnesota, died from a heart
attack at Sarasota, Florida, on February 22, 1950.
Born in Mitchell, South Dakota, July 5, 1884, Dr.
Nauth moved as a boy to Milwaukee and graduated
from Marquette Medical School in 1907. He practiced
in Minneiska, Minnesota, for nine years, Stanbaugh and
Penboga, Michigan, each for a year. He became a
medical officer in the army during World War I but in
1917 received an honorable medical discharge because
of a heart lesion.
Dr. Nauth began practice in Winona in 1917 and in
1920 with Dr. E. S. Muir and Dr. E. M. McLaughlin
founded the Winona Clinic. In recent years, because of
a heart ailment, he spent much time in his workshop in
the basement of the Clinic.
Dr. Nauth was a 32nd degree Mason and member of
the Winona Scottish Rites bodies and of Osman Temple
of the Shrine at Saint Paul. He was also a member of
the Winona Elks Lodge, the Improved Order of Red
Men, the Fraternal Order of Eagles, the Winona County
medical society and the Minnesota State and American
Medical Associations.
Dr. Nauth is survived by his widow, a son, Bernard,
and four grandchildren.
ALBERT W. SHAW
Dr. Albert W. Shaw of Buhl, Minnesota, died April
16, 1950, in Virginia Municipal Hospital after an illness
of eight weeks. He was seventy-nine years of age.
Dr. Shaw was born in Levant, Maine, February 25,
1871. He acquired his early education at Levant and
in the grade schools and a preparatory school in Cam-
bridge, Massachusets. He came to Minneapolis in 1888
and engaged in the grocery business to accumulate
funds to acquire a medical education. He graduated
from the University of Minnesot Medical School in 1899
and interned three years at Eveleth Hospital. On
September 9, 1901, he went to Buhl as company physician
for the Sharon Ore Company and the Drake-Stratton
Company.
In September, 1918, he built a handsome brick
hospital with modern laboratory facilities which was
later sold to St. Louis County for use as a county
institution for the chronically ill. He retired eighteen
years ago from general practice and fifteen years ago
moved to Virginia.
Dr. Shaw married Anne Laura Purdy of Logansport,
Indiana, on September 24, 1902. She preceded him in
death on November 24, 1947. 'Uiree children survive.
FRANK WILLIAM SPICER
Frank William Spicer, A.B., M.D., was born in Blairs-
town, Iowa, November 30, 1878. He died in Duluth,
Minnesota, on January 21, 1950. Graduating from the
University of Pennsylvania Medical School in 1908 and
serving internship at the Methodist Hospital in Phila-
delphia, he practiced medicine for a period in Crystal
Falls, Michigan. He moved to Duluth, Minnesota, in
1912 where, except for his service in the United States
Army Medical Corps which included an assignment
overseas, he spent the rest of his active career.
He received his preliminary education in Iowa and
graduated from Coe College in 1899. He gave several
years to teaching; first in Northfield, Minnesota, where
he taught Greek and History in the high school. In
1903 he accepted the call and a teaching assignment in
the Philippines, a period after the Spanish-American
War when under American guidance a notable plan of
advanced education was inaugurated. In later life he
frequently referred to his experience in the Philippines
and without question it greatly helped to broaden the
life already capable of encompassing the best of our
American traditions, scholastic, social, moral and
intellectual. Frank’s father was a doctor and it was his
experience in the Philippines and later on visits to
China, Japan and Guam that he developed the interest
and the urge to return to the States and study medicine.
Frank Spicer was one of the first physicians in
Northeastern Minnesota to devote all his time to
internal medicine. He cemented interest in his field by
obtaining membership in the American College of
Physicians (Fellow 1922) ; membership in the Minne-
sota Society of Internal Medicine; and through his
years of activity in establishing the medical staffs of
both St. Mary’s and St. Luke’s Hospitals in Duluth. At
one time he served as chief of medical service in each
hospital and did much to wisely and conservatively
guide his fellows. He was also active in the work of
the American Legion and gave to the legion and to the
rehabilitation of disabled veterans a fine personal service.
In 1939, he published “Trauma and Internal Disease”
(J. B. Lippincott & Company.) To the writing of this
work he gave several years of research and review of
the extensive literature. The book has found a favor-
able reception among critics and a place in many private
534
Minnesota Medicine
IN MEM0R1AM
to*
5^
ft.0
VRJP^
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r/C/A
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general
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If these or other questions concern you pertaining to municipal securities as an in-
vestment for the individual, we shall be pleased to discuss them with you during
the coming convention.
BOOTH 68 DULUTH ARMORY
97th Annual Session
MINNESOTA STATE MEDICAL ASSOCIATION
June 12-13-14, 1950
JURAN & MOODY
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and public medical libraries. He was a member of the
First Presbyterian Church, in Duluth, where he met
and married Madeline Miller, the church organist, in
1915. To them were born four children: Dr. Frank
W. Spicer, Jr., Buffalo, New York; Richard G. Spicer,
Duluth, Minnesota; Mrs. Thomas G. Bell, Jr., Duluth,
Minnesota, and Mrs. Clark MacGregor, Wayzata, Minne-
sota. In addition, three grandsons and two grand-
daughters survive him.
Frank W. Spicer was an earnest, conscientious
student and citizen all his life. In his later years he
used to be commended for his very particular and
specific guidance of an appreciative clientele, teaching
them the while “to grow gracefully.” In him they
found the best of examples and the most wholesome
of guidance.
E. L. Tuohy, M.D.
JULIUS R. STURRE
Dr. Julius R. Sturre, physician of Minneapolis and
president of the Minnesota division of the Izaak Walton
League of America, died March 28, 1950 at the age of
fifty-five.
Dr. Sturre was born in St. Cloud, Minnesota, August
7, 1894. He attended Central High School in Saint
Paid and obtained his M.D. degree from the University
of Minnesota in 1918. After serving with Base Hos-
pital 26 during World War I, he practiced for a short
May, 1950
535
IN MEMORIAM
time in Saint Paul and in Watkins before coming to Min-
neapolis in 1926. He was mayor of Watkins from 1923
to 1926, and president of the Meeker County Medical
Society in 1924.
Dr. Sturre, who had served on the national board of
directors of the Izaak Walton League, became state
president last December. He was for years interested in
movements to conserve soil, eliminate water pollution and
protect wild game. He was a member of the Minne-
sota Conservation Federation and a past president of
the National Wild Life Federation and of the Fur, Fin
and Feathers Club. He was a member of the Business
and Professional Men’s post of the American Legion,
Knights of Columbus and of Phi Beta Pi, medical fra-
ternity. He was also a fellow of the International Col-
lege of Surgeons and a member of the Hennepin County
medical society.
Dr. Sturre is survived by his wife, Winifred; a
daughter, Mrs. Arthur Engstrom ; a son, Richard; and
his mother, Mrs. Gerhard Sturre of St. Cloud. One
son, Julius, was tragically killed in 1940 at the age of
sixteen in an automobile accident.
JOHN DOUGLAS WATSON
Dr. John D. Watson, a practitioner at Holdingford,
Minnesota, from 1915 to 1940, passed away February 13,
1950, in a Saint Paul hospital.
Dr. Watson was born at Socorro, New Mexico, No-
vember 19, 1885. He attended high school in London,
Ontario, and obtained his medical degree from the Uni-
versity of Western Ontario at London in 1907.
He practiced at Welton, Iowa, from 1907 to 1915 be-
fore moving to Holdingford. He served as a first lieu-
tenant in the Army during World War 1, having been
stationed at Fort Douglas, Salt Lake City.
Dr. Watson is survived by his wife, Edith; a daughter,
Mrs. Peter Holliday of Chicago; a son, Dr. William J.
Watson of Saint Paul and a sister, Mrs. George Carmen
of Battle Creek, Michigan.
Dr. Watson was a member of the Upper Mississippi
Medical Society, the Minnesota State Medical Associa-
tion and American Medical Association.
OLAF S. WERNER
Dr. Olaf S. Werner, for more than a half century a
practitioner at Lindstrom, Center City and Cambridge,
Minnesota, passed away March 24, 1950 at the home of
his daughter, Mrs. Roy T. Sorensen, in Saint Paul.
Dr. Werner was born in Konga, Sweden, November
10, 1866. He received his Bachelor of Arts degree from
Lund University in 1890. He came to the United States
and continued his studies at Augustana College, Rock
Island, Illinois, where he was ordained a Lutheran min-
ister. He received his M.D. degree from Milwaukee
Medical College in 1897. He was naturalized in 1898.
He practiced in Manistique, Michigan, from 1897 to
1899, in Lindstrom, Minnesota, from 1899 to 1921, in
Saint Paul from 1924 to 1928 and in Cambridge from
1928 to 1942.
Dr. Werner is survived by his wife, a son, Dr. Robert
Werner of Los Angeles, and a daughter, Mrs. Floyd F.
Brennen of Saint Paul.
536
Minnesota Medicine
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537
♦
Of General Interest
A method for locating a brain tumor by means of
extremely high frequency sound waves has been de-
veloped in Minneapolis by Dr. John J. Wild and
Dr. Lyle A. French, assistant professor of neuro-
surgery at the University of Minnesota.
The method makes use of an “ultrasonascope,”
which, when connected to radar equipment, sends
ultrasonic pulses into tissue and then picks up their
echoes as they bounce back. The echoes are con-
verted into electrical impulses and made to appear
as a fluorescent pattern on a screen. With tumor
tissue denser than the tissue around it, the waves
take a longer time to pass through the tumor and
echo back. Differences in echo time can readily be
seen on the screen.
Still in experimental stages, the method apparent-
ly produces no injury to the brain.
* * *
Dr. Gaylord Anderson, director of the University
of Minnesota School of Public Health, has been
elected chairman of a state poliomyelitis planning
committee.
* * *
Dr. M. J. McKenna, Grand Rapids, attended the
annual four-day clinical conference of the Chicago
Medical Society which was held in Chicago early
in March.
* * *
The Austin Clinic announced on March 21 that
Dr. H. P. Van Cleve, formerly of Dodge Center, had
become a member of the clinic staff. A graduate of
the University of Minnesota Medical School, Dr.
Van Cleve interned at Minneapolis General Hospital,
then completed a residency at Swedish Hospital,
Minneapolis. His addition to the Austin Clinic staff
fills the vacancy created when Dr. Paul Hauser left
the clinic on January 1 to resume postgraduate
studies.
* * *
Dr. E. M. Hammes, Saint Paul, spoke on “The
Medical Expert Witness” at the annual meeting of
the Iowa State Medical Society in Burlington, Iowa,
on April 24. His talk was presented with special
reference to the work of the Medical Testimony Com-
mittee of the Minnesota State Medical Association.
* * *
Dr. H. H. Russ of Blue Earth has been invited
to serve as a member of the National Cerebral Palsy
Parents Advisory Council for one year. The honor
was given the physician because of his work with the
Spastic Club and the numerous speeches he has made
on cerebral palsy problems. The council is appointed
on an annual basis to act in an advisory capacity in
the development of the national society’s program.
* * *
Three Duluth physicians were on the program at
the regional meeting of the American College of Sur-
geons in Winnipeg on April 3. The three were Dr.
Arthur H. Wells, Dr. O. E. Sarff and Dr. Mark
Tibbetts.
* * *
Dr. Harold W. Hermann, formerly of Caledonia,
has moved to Minneapolis to practice in the field of
pediatrics. Dr. Hermann was graduated from the
University of Minnesota Medical School in 1946.
* * *
After forty-three years of practice in Bird Island,
Dr. Ralph C. Adams announced his retirement from
active practice late in March. His practice will be
conducted until July 1 by Dr. George H. Mesker,
formerly of Olivia but now staff member of the Cam-
bridge State Hospital. Dr. Adams announced that on
July 1 he will sell his practice to a young man who
is currently completing his internship.
A graduate of the Jefferson Medical School in
Philadelphia, Dr. Adams was one of the pioneer
physicians in Bird Island and Renville County. Al-
ways interested in social, civic and fraternal activi-
ties, he helped to organize the Renville County
Medical Society and participated in numerous local
civic events. He has served as surgeon for the Mil-
waukee Railroad since 1909.
For several months prior to the anouncement of
his retirement, Dr. Adams had been practicing only
on a part-time basis due to ill health, r
* * *
Dr. Lois A. Day, formerly on the staff of the Mayo
Clinic, left Rochester late in March to become asso-
ciated for six months in private practice in Saint
Paul with Dr. Frank W. Quattlebaum and his wife,
Dr. Jane Hodgson. A graduate of the University of
Chicago, Dr. Day interned at University Hospitals,
Minneapolis, and entered the Mayo Foundation as
a fellow in obstetrics and gynecology in 1934. She
became a member of the clinic staff in 1938.
* * *
Dr. S. A. Slater, superintendent of the Southwest-
ern Minnesota Sanitorium, located near Worthington,
was a guest at a meeting of the Jackson Kiwanis
Club on March 6.
* * *
Major Jules O. Meyer, a former Grand Rapids
physician, is in Europe and is stationed with the
546th Medical Clearing Company in Frankfurt, Ger-
many, as chief of professional services, it was an-
nounced on March 30. Dr. Meyer was graduated
from the University of Minnesota in 1938.
* * *
Guest speaker at a meeting of the junior-senior
high school Parent-Teachers Association in Still-
water on April 18 was Dr. Albert V. Stoesser, Min-
neapolis. Dr. Stoesser discussed physical develop-
ment of teen-agers and requirements for normal
growth.
538
Minnesota Medicine
OF GENERAL INTEREST
WELCOME!
We desire to extend welcome to the
delegates and members of the Minne-
sota State Medical Association at its
Annual Convention to be held in Du-
luth, June 12, 13 and 14.
We trust that your Convention will be
a most successful one and that you
will enjoy your visit to Duluth.
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Dr. William L. Benedict, of the section on ophthal-
mology at the Mayo Clinic, has been named a con-
sultant and member of the advisory committee of
:he National Society for the Prevention of Blindness.
* * *
The principal speakers at a medical seminar held
in Mankato on March 14 were Dr. Arnold J. Kremen,
assistant professor of surgery at the University of
Minnesota, and Dr. Forrest H. Adams, assistant pro-
fessor of pediatrics at the University. The meeting
was the second of a series of eight being conducted
in Mankato for physicians of the area. The title of
Dr. Kremen’s address was “Cancer of the Gastro-
intestinal Tract,” and Dr. Adams’ subject was
'‘Rheumatic Fever.”
* * *
Dr. Joseph E. McCoy, Thief River Falls, celebrated
his eightieth birthday in February. A graduate of the
University of Louisville, Kentucky, in 1897, Dr. Mc-
Coy has practiced medicine for fifty-three years.
Lately he has been devoting his attention mainly to
the manufacture and distribution of a compound
for treating ulcers.
* * *
Members of the Oliver Clinic in Graceville were
busy attending various meetings during the early
part of March. Dr. I. L. Oliver attended the annual
meeting of the Chicago Surgical Sosiety in Chicago.
Dr. N. W. Wagner spent a few days at the Univer-
sity of Minnesota’s Center for Continuation Study,
participating in a course of pediatrics. Dr. G. L.
Barnett attended the county medical society officers’
meeting in Saint Paul. Dr. Barnett had previously
advanced from vice president to president of the
West Central Minnesota Medical Society, upon the
resignation of Dr. Wayne Rydhag of Brooten, who
had moved to Minneapolis.
* * *
On April 1, Dr. Robert Estrem returned to his
post at the Estrem Clinic in Fergus Falls. He had
been on leave of absence from the clinic for three
and one-half years while studying surgery at the
University of Minnesota and Minneapolis Veterans
Hospital. Back at the Estrem Clinic he is limiting
his practice to surgery.
* * *
Dr. Ralph Rossen, state commissioner of mental
health, gave a talk at a meeting of members, hus-
bands and friends of the University of Minnesota
Faculty Women’s Club in the Coffman Memorial
Union on March 16. A motion picture on mental
health, entitled “Let There Be Light,” was also pre-
sented.
* * *
The marriage of Miss Constance M. Otten and
Dr. Jack V. Wallinga took place in St. John’s Luth-
eran Church at Twin Lakes on March 18. Dr. Wal-
linga, son of the late Dr. John H. Wallinga of Saint
Paul, is a graduate of the University of Minnesota
Medical School and is now studying under a fellow-
ship in psychiatry at the University.
May, 1950
539
OF GENERAL INTEREST
Dr. Richard M. Magraw, who quit private practice
three years ago to study psychiatry, recently had an
article published in the Bulletin of the University of
Minnesota Hospitals and Minnesota Medical Founda-
tion. In the article, which was entitled “Psychological
Medicine in a General Medical Setting,” Dr. Magraw
pointed out that the use of psychiatric medicine, or
the “human approach,” does not require more time
than the average practitioner has to spare, and that
this “comprehensive approach” makes possible quick-
er, and in many cases more accurate, diagnosis and
treatment.
A graduate of the University of Minnesota Medical
School in 1943, Dr. Magraw completed a year of
surgical training and then practiced medicine at Two
Harbors for two and one-half years. He recently
completed a three-year fellowship in psychiatry at
the University Hospitals.
* * *
Dr. Arthur H. Wells, Duluth, president of the Min-
nesota division of the American Cancer Society, dis-
cussed recent developments in cancer research at a
school for cancer work volunteers in Pine City on
March 29.
* * *
Dr. L. G. Smith, Montevideo, announced on March
28 that Dr. R. E. Risch of Minneapolis would soon
become associated in practice with him and with
Dr. M. A. Burns and Dr. Floyd Burns. Dr. Risch,
it was stated, would move to Montevideo as soon as
he could dispose of his practice in Minneapolis, !
where he has practiced medicine since his graduation '
from the University of Minnesota Medical School.
* * *
It was announced on April 11 that Dr. Henry B.
Blumberg, formerly of Saint Paul, would open offices
the following week in Fairmont for the practice of
medicine. A graduate of Northwestern University
Medical School, Dr. Blumberg joined the Army in
1942 and served both in the South Pacific area and
in Europe. Later he spent three years at the Boston
City Hospital and the Pratt Diagnostic Center. He
then returned to Saint Paul and became affiliated
with the Earl Clinic. He has taken postgraduate
work at the University of Minnesota.
* * *
Dr. Adrian R. Jensen, Crookston, attended a meet- '
ing of the state poliomyelitis planning committee in
Minneapolis on March 31. He was appointed a mem-
ber of the committee by the State Board of Health.
* * *
Three Saint Paul physicians were guest speakers at
a meeting of the Saint Paul Surgical Society on
March 15. Dr. Abbott Skinner presented a paper on
“Perforated Peptic Ulcer.” Dr. E. M. Jones dis-
cussed the same topic. Dr. Wallace H. Cole spoke
on “Intermedullary Fixation of Fractures.”
* * *
Among Minnesota physicians participating in the
regional meeting of the American College of Sur-
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Attending Psychiatrists
Dr. L. R. Gowan Dr. C. M. Jessico
Dr. J. E. Haavik Dr. L. E. Schneider
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540
Minnesota Medicine
OF GENERAL INTEREST
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3. $100/300,000 Limits of Liability — $71.35 (annual),
4. Request your Agent or Broker to explain your personal lia-
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jeons at Winnipeg on April 3 and 4 were three
Mayo Clinic staff members: Dr. Joseph M. James,
Dr. Virgil S. Counseller and Dr. Paul R. Lipscomb.
Dr. James spoke on arterial lesions of the extrem-
ties; Dr. Counseller conducted a panel discussion on
:esarian section and uterine prolapse; Dr. Lipscomb
;poke on stenosing tenosynovitis at the radial styloid
trocess and was moderator at a panel discussion on
surgery of the hand.
* * *
Dr. Ralph Papermaster, Two Harbors, supervised
i cancer detection clinic held in Two Harbors on
March 18. The clinic was for all of Lake County,
which is said to have one of the highest cancer death
■ates in Minnesota. Fifteen physicians and seventy-
rve volunteer workers helped to conduct the clinic.
H* * *
On' March 1, Dr. Reynold A. Jensen, associate pro-
fessor of psychiatry and pediatrics at the University
}f Minnesota, discussed psychosomatic medicine
when he spoke at the sixth of a series of medical
seminars held in St. Cloud.
^ ^ ^
“The Value of Relaxation’’ was the title of a talk
given by Dr. C. M. Jessico, Duluth, at the annual
meeting of the Duluth Health Council on March 20.
The meeting was open to the public.
Hi Hi *
The quarterly meeting of the Consultation Com-
mittee of the Minnesota Trudeau Society was held at
Sunnyrest Sanatorium, Crookston, on March 25.
Cases from Sunnyrest Sanatorium and from Oak-
land Park Sanatorium at Thief River Falls were re-
viewed by the committee.
Members of the committee are Dr. Ejvind Fenger,
of Glen Lake Sanatorium, Minneapolis, chairman;
Dr. William D. Seybold, Mayo Clinic, Rochester; Dr.
S. T. Sandell, of Nopeming Sanatorium, Duluth; Dr.
M. M. Williams, of the Minnesota State Sanatorium,
Walker; Dr. George C. Roth, of Saint Paul; Dr. H.
Falk, of Minneapolis Veterans Hospital, and Dr.
R. R. Hendrickson, superintendent of Sunnyrest
Sanatorium, Crookston.
H« * H:
Dr. John Stam, of the Worthington Clinic, dis-
cussed the development of eating habits of the pre-school
child at a meeting in Brewster on March 28. The meet-
ing was the second of a series for mothers of children
of pre-school age.
* * *
Two Minneapolis physicians will present reports
at the Sixth International Congress of Pediatrics in
Zurich, Switzerland, July 24 to 28. Dr. John M. Adams,
associate professor of pediatrics at the University of
Minnesota, will discuss the relationship of the common
cold in adults to pneumonia in babies. Dr. Leonard A.
Titrud will describe the surgical treatment of certain
types of epilepsy.
* * *
Dr. Matthew J. Weir, formerly of Mankato, has
been commissioned a first lieutenant in the Regular Army
Medical Corps. A graduate of the University of Min-
May, 1950
541
OF GENERAL INTEREST
WJeicome to 2) u (util
Boyce Drug Store
Gail R. Freeman and C. H. Young
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335 West Superior Street
Melrose 1G3 Duluth 2, Minn.
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325 West Michigan St.
Duluth. Minn.
nesota Medical School in 1948, Dr. Weir interned at
Minneapolis General Hospital.
* * *
Minnesota Cancer Detection Center. — Physical ab-
normalities requiring medical attention were found in
more than one-half of the 3,265 examinations conducted
in the University of Minnesota’s Cancer Detection Cen-
ter during the first two years of its operation.
Cancer was detected in thirty-four persons — fifteen
men and nineteen women. Thirty cases of cancer were
diagnosed on the first visit, while four were discovered
during a second examination, one year after the first.
In the 1,732 examinations (53 per cent) which revealed
conditions requiring medical attention, examining phy-
sicians found, in addition to cancer, 776 pre-cancerous
conditions, 564 benign tumors, and 2,149 instances of
other abnormal conditions, non-cancerous but calling
for immediate treatment. Most common of the pre-
cancerous conditions were rectal polyps, which account-
ed for 369 of the 776 instances of pre-cancerous lesions.
Of the 3,265 examinations conducted at the center in
its first two years, 2,226 were initial examinations and
1,039 were annual check-ups. Slightly more than half of
the persons examined were women.
Dr. David State, director of the center, announced at
the time the two-year report was released, “Results of
our first two years of operation have been better than
we anticipated. Apart from the fact that we were able
to detect thirty-four cancers, we were able to catch most
of them extremely early, and, accordingly, treatment of
these tumors was more successful than the average.
Without discounting the importance of detecting these
cancers, we feel that it was of much more practical
value that we found such a large number of pre-can-
cerous lesions, which are relatively simple to treat.”
The cancer detection center is open to Minnesota men
and women aged forty-five or over, who are unaware
of any cancer symptoms in themselves. Admission is b>
appointment only, and more than 21,000 applications for
appointments have already been received.
* * *
Dr. Mario Fischer, Duluth, St. Louis County health
officer, was named a member of a temporary committee
to handle preparation of the new St. Louis County in-
firmary at Virginia. The committee was appointed to
function until a county agency could be named to assume
charge.
* * *
It was announced on March 30 that Dr. J. T. Bos-
well would move to Wanamingo in July and open
offices for the practice of medicine. A graduate of the
University of Ohio, Dr. Boswell at the time of the an-
nouncement was serving his internship at the U. S. Naval
Hospital at Great Lakes, Illinois. Wanamingo has been
without the services of a resident physician since last
August when Dr. C. N. Rudie moved to St. Peter to
become a staff member of the state hospital there.
*
Two Saint Paul physicians were speakers at a pub-
lic meeting in St. Cloud on March 13. Dr. John F.
Briggs, president of the Minnesota Heart Association,
spoke on “Your Heart,” and Dr. Paul C. Benton, in-
542
Minnesota Medicine
OF GENERAL INTEREST
An Observation on the Accuracy of Digitalis Doses
Withering made this penetrating observation in
lis classic monograph on digitalis: "The more I
;aw of the great powers of this plant, the more it
seemed necessary to bring the doses of it to the
greatest possible accuracy.”1
Io achieve the greatest accuracy in dosage and at
the same time to preserve the full activity of the
leaf, the total cardioactive principles must be iso-
lated from the plant in pure crystalline form so
that doses can be based on the actual weight of the
active constituents. This is, in fact, the method by
which Digilanid® is made.
Clinical investigation has proved that Digilanid is
"an effective cardioactive preparation, which has
the advantages of purity, stability and accuracy as
to dosage and therapeutic effect.”2
Average dose for initiating treatment: 2 to 4 tab-
lets of Digilanid daily until the desired therapeutic
level is reached.
Average maintenance dose: 1 tablet daily.
Also available: Drops, Ampuls and Suppositories.
1. Withering, W An account of the Foxglove, London, 1785.
2. Rimmerman, A. B.: Digilanid and the Therapy of Congestive
Heart Disease, Am. J. M. Sc. 209: 33-41 (Jan.) 1945.
Literature giving further details about Digilanid and Physician’s Trial
Supply are available on request.
Digilanid contains all the initial glycosides from
Digitalis lanata in crystalline form. It thus truly
represents "the great powers of the plant” and
brings "the doses of it to the greatest possible
accuracy”.
Sandoz
i Pharmaceuticals
DIVISION OF SANDOZ CHEMICAL WORKS, INC.
68 CHARLTON STREET, NEW YORK 14, NEW YORK
You are invited to visit the Sandoz Booth No. 27 during the coming state convention.
tructor in child psychology at the University of Minne-
□ta, discussed “Emotional Problems in Children.” The
leeting was sponsored by the St. Cloud Health Council.
* * *
The first of eight weekly medical seminars was held
1 Austin on March 15. Twenty-five physicians from
he surrounding area attended the meeting, at which
he principal speakers were Dr. George N. Aagaard
nd Dr. Richard L. Varco, of the University of Minne-
ota.
* * *
One of the speakers at a session of the Duluth and
Arrowhead Health Day on April 14 was Dr. Earl E.
Sarrett, Duluth, who spoke on the topic “The Doc-
or.”
* * *
Dr. and Mrs. H. O. McPheeters, Minneapolis, spent
he month of March vacationing in the West Indies and
Venezuela. Much of the time was used in visiting hos-
itals and medical centers.
* * *
Plans for the establishment of a rehabilitation
linic in Saint Paul for patients released from mental
.ospitals were announced by Dr. Ralph Rossen, state
ommissioner of mental health, at a joint meeting on
larch 14 of the Saint Paul Area Public Health Coun-
il and the Ramsey County Citizen’s Mental Health Com-
littee. The clinic, he said, would be like the one re-
ently set up in Minneapolis. Counselors would help
patients get suitable employment, handle difficult rela-
tions with employers, check patients’ progress and help
to prevent the need for readmission to an institution.
Said Dr. Rossen, “It is hoped that with careful follow-
up programs operated by such clinics, patients could be
released from institutions sooner, and consequently more
patients could be handled.”
* * *
Dr. Christopher Graham, Rochester, celebrated his
ninety-fourth birthday anniversary on April 3.
* *
Announcement was made on March 23 that Dr.
Roberta G. Rice of Minneapolis would assist Dr.
George Friedell in his practice at Ivanhoe while Dr.
Friedell was recovering from injuries sustained in an
automobile accident.
* * *
An Upper Midwest industrial health conference was
held on May 10 in Minneapolis under the joint spon-
sorship of the Minneapolis Chamber of Commerce
and the Hennepin County Medical Society. General
chairman of the event was Dr. Leonard S. Arling,
Minneapolis.
* * *
The newly constructed Mork Clinic in Anoka
opened its doors to the public on March 27. Construc-
tion work was begun last August. The two-story build-
ing houses the offices of Dr. Frank E. Mork and Dr. A.
Harold Mork, and contains examining rooms, treat-
Aay, 1950
543
OF GENERAL INTEREST
Eprt.VTaene: Iivx»iaxa\
Professional Protection
Exclusively
since 1899
MINNEAPOLIS Office:
Stanley J. Werner, Rep.
5026 Third Avenue South
Telephone Pleasant 8463
Cook County Graduate School of Medicine
ANNOUNCES CONTINUOUS COURSES
SURGERY — Intensive Course in Surgical Technic, two
weeks, starting May 15, June 19, July 24.
Surgical Technic, Surgical Anatomy and Clinical Sur-
gery, four weeks, starting May 1, June 5, July 10.
Personal Course in General Surgery, two weeks, start-
ing September 25.
Surgery of Colon and Rectum, one week, starting May
15, June 5.
Esophageal Surgery, one week, starting June 5.
Breast and Thyroid Surgery, one week starting June 26.
Thoracic Surgery, one week, starting June 12.
Gallbladder Surgery, ten hours, starting June 19.
Fractures and Traumatic Surgery, two weeks, starting
June 12.
Basic Principles in General Surgery, two weeks, start-
ing September 11.
GYNECOLOGY — Intensive Course, two weeks, starting
June 19, September 25.
Vaginal Approach to Pelvic Surgery, one week, start-
ing May 15.
OBSTETRICS — Intensive Course, two weeks, starting
June 5, September 11.
PEDIATRICS — Personal Course in Cerebral Palsy, two
weeks, starting July 31.
Personal Course in Diagnosis and Treatment of Con-
genital Malformations of the Heart, two weeks, start-
ing June 5.
MEDICINE — Intensive General Course, two weeks,
starting October 2.
Electrocardiography and Heart Disease, two weeks,
starting July 17.
Liver and Biliary Diseases, one week, starting June 5.
Gastroscopy, two weeks starting May 15, June 12.
UROLOGY — Intensive Course, two weeks, starting Sep-
tember 25.
Cystoscopy, Ten Day Practical Course, every two
weeks.
General, Intensive and Special Courses in all Branches of
Medicine , Surgery and the Specialties.
TEACHING FACULTY— ATTENDING
STAFF OF COOK COUNTY HOSPITAL
Addre’ss : REGISTRAR, 427 South Honore Street
Chicago 12, Illinois
544
ment rooms, laboratories, x-ray room, business office and
a reception room. The clinic has been furnished almost
entirely with new equipment.
Also housed in the building are two additional office
suites, one of which is occupied by a dentist and the
other, on Mondays and Thursdays, by Dr. Donald T.
Cundy of Minneapolis, an ophthalmologist.
* * *
A recent addition to the staff of the Willmar State'
Hospital is Dr. Kenneth W. Douglas, formerly of St.
Peter, who began his duties at the hospital late , in
March.
* * *
A new program of protection against radiation
hazards was started at the University of Minnesota on
April 5, when all faculty members working with radio-
active materials met to discuss methods of avoiding in-
jury caused by radiation. The protective program, which
utilizes four different types of instruments for detecting
radioactivity, was developed by a committee headed by
Dr. Wallace D. Armstrong, head of physiological chem-
istry at the University. At the meeting the detection in-
struments were demonstrated and an eight-page pamph-
let prepared by the committee was given to the faculty
members.
* * *
Community co-operation has provided Oklee with
its first resident physician in more than five years.
About two years ago the people of Oklee, a community
of 500-plus population, started a campaign to persuade
a physician to come to the town. Learning that physi-
cians would be interested if modern working facilities
were available, the people formed an organization and
began planning the construction of a modern, well-
equipped medical clinic.
The result is a $34,000 structure with quarters for a
medical office, a dental office and an ambulance garage.
The one-story building, of modern design, was opened
for public inspection on March 16.
Now occupying the medical office is Dr. F. L. Behling,
who moved to Oklee from Moorhead. As for the rest
of the building, the Oklee organization is looking for a
resident dentist for the town and is hoping that an am-
bulance for the garage can be acquired soon.
* * *
Dr. Paul M. Smith, Lake Crystal, and his wife and
two sons narrowly escaped injury on March 30 when
their car was struck on the highway by a heavy truck.
The collision ripped off the left side of Dr. Smith’s car
but injured no one. The truck driver was charged by
police with careless driving.
* * *
The American Cancer Society’s new motion pic-
ture, “Breast Cancer: The Problem of Early Diag-
nosis,’ was shown to members of the medical pro-
fession in Minneapolis on March 16 and in Saint Paul
on March 17. Dr. Robert A. Huseby, William A.
O’Brien professor at the University of Minnesota, pre-
sented a talk after the showing in Minneapolis. Dr. J.
M. Culligan, Saint Paul, introduced the motion picture
at the Saint Paul showing.
The film, second in a series of teaching films spon-
Minnesota Medicine
OF GENERAL INTEREST
>ored by the American Cancer Society and the National
Cancer Institute of the U. S. Public Health Service, is
low available for showing throughout the state. It can
ie secured by contacting the Minnesota Division of the
American Cancer Society at 622 Commerce Building,
Saint Paul.
The new motion picture emphasizes the steps neces-
sary for early diagnosis of breast cancer. Normal breast
development, the early signs of cancer, and the complete
sechnique for breast examination are shown in detail.
iOSPITAL NEWS
Louis E. Weiner Memorial Hospital, Marshall. —
\t a meeting held in the new Louis E. Weiner Memorial
Hospital in Marshall on March 27, the physicians of
Marshall adopted by-laws, rules and regulations to form
he medical staff of the hospital. In an election, Dr.
vV. W. Yaeger was elected president; Dr. B. C. Ford,
,'ice president, and Dr. K. A. Peterson, secretary.
It was announced that physicians living outside of
Marshall would be accepted on the courtesy staff of the
lospital through application to the administrator and
vould be accorded the same privileges of the hospital
is the active staff members.
* * *
Fairview Hospital, Alinneapolis. — Dr. Silas C. An-
lerson was elected chief-of-staff at the annual meeting
ff the medical staff of Fairview Hospital in March.
Dther new officers include Dr. Myron Lysne, vice chief-
ff-staff ; Dr. Louis J. Roberts, secretary, and Dr. Glenn
i,. Peterson, treasurer. New members of the executive
:ommittee are Dr. I. C. Giere, Dr. R. T. Soderlind, Dr.
[chn Moe, and Dr. D. B. Frane.
% 5{C *
Charles T. Miller Hospital, Saint Paul. — Ground
vas broken for the six-story addition to the Charles T.
Miller Hospital on March 6. The addition is expected to
it completed in about eighteen months. It will provide
lew operating rooms, x-ray and physical therapy depart-
nents and an additional 125 beds.
JLUE CROSS— BLUE SHIELD
Both Blue Cross and Blue Shield subscribers used
nore benefits in February than in January this year.
Doctors submitted 747 more claims in February for
services to Blue Shield subscribers, and received
|>34,973 more in Blue Shield payments compared with
January. Hospitals reported fewer Blue Cross cases
n February, but provided more days of hospital care
ind received $57,349 more in Blue Cross payments for
services to Blue Cross subscribers. Altogether, Blue
Shield benefits in February totalled $132,242 and Blue
Dross benefits in February totalled $798,441. Blue Shield
oenefits during the first two months of 1950 amounted to
j>229,51 1.62, an increase of 95 per cent over the $117,811.-
76 paid to doctors during the first two months of 1949.
Of the total 3,322 Blue Shield claims submitted in
February, 2,569 were for surgical, medical and obstetri-
cal care given subscribers in hospitals, 737 for care
May, 1950
BROWN & DAY, INC
St. Paul 1, Minnesota
ACCIDENT * HOSPITAL • SICKNESS
INSURANCE
FOR PHYSICIANS, SURGEONS, DENTISTS EXCLUSIVELY
f PHYS1CIANS\
SURGEONS
\ DENTISTS J
ALt
CLAIMS Z
$5,000.00 accidental death $8.00
$25.00 weekly indemnity, accident Quarterly
nun c
$10,000.00 accidental death, $16.00
$50.00 weekly indemnity, accident Quarterly
$15,000.00 accidental death $24.00
$75.00 weekly indemnity, accident Quarterly
nun c
$20,000.00 accidental death $32.00
$100.00 weekly indemnity, accident Quarterly
and sickness
Cost has never exceeded amounts shown.
ALSO HOSPITAL POLICIES FOR MEMBERS
WIVES AND CHILDREN AT SMALL
ADDITIONAL COST
85c out of each $1.00 gross income used for
members’ benefits
$3,700,000.00 $16,000,000.00
INVESTED ASSETS PAID FOR CLAIMS
$200,000.00 deposited with State of Nebraska for protection of our members.
Disability need not be incurred in line of duty — benefits from
the beginning day of disability
PHYSICIANS CASUALTY ASSOCIATION
PHYSICIANS HEALTH ASSOCIATION
48 years under the same management
400 First National Bank Bldg., Omaha 2, Nebr.
545
OF GENERAL INTEREST
1909 1950
Physiotherapy for the relief
of Arthritis and related con-
ditions. Complete physical
examinations and laboratory
procedures given every pa-
tient. Roy T. Pearson,
M.D., Medical Director. B.
F. Pearson, M.D., associate.
AKOPEE
MINNESOTA
U.S. Hwy. 212
anitarium
AT YOUR CONVENIENCE,
DOCTOR . . .
you are cordially invited to visit our new
and modern prescription pharmacy located on
the street floor of the Foshay Tower, 100 South
Ninth Street.
With our expanded facilities we will be able
to increase and extend the service we have
been privileged to perform for the medical pro-
fession over the past years.
Exclusive Prescription Pharmacy
Biologicals Pharmaceuticals Dressings
Surgical Instruments Rubber Sundries
JOSEPH E. DAHL CO.
(Two Locations)
100 South Ninth Street, LaSalle Medical Bldg.
ATlantic 5445 Minneapolis
given subscribers in doctors’ offices, and sixteen foi
care given subscribers in homes. Participating Blu<
Shield doctors submitted 3,172 of the total claims, anc
non-participating doctors submitted 150 claims, of whicl
seventy-one claims were from doctors practicing outsidf
the state of Minnesota.
Surgical cases accounted for 1,971 or 59 per cent of
the total claims in February, medical cases for 1,016 oi
31 per cent of the total claims, and obstetrical cases foi
291 or 10 per cent of the total claims in February. The
payment of claims in February were made for service;
rendered to 230 subscribers prior to November 1, 1949
to 336 subscribers in November, to 713 subscribers ir
December, to 1,577 subscribers in January and to thirty-
one subscribers in February.
One reason for delays in payment is the increasing
number of claims presented by medical doctors listing
surgery performed but giving no indication that another
doctor actually performed the surgery. The Blue Shield
payment is naturally paid to the doctor submitting the
original claim. When at some later time the surgeon’s
claim is presented, the Blue Shield office must request
a refund from the first doctor paid, since the Blue
Shield contract requires that payment be made to the
doctor performing the surgery. This problem is called
to the attention of the doctors in Minnesota so that
these unintentional errors may be avoided and Blue
Shield payments can be accurate and prompt.
A report from the Blue Cross Commission, co-ordi-
nating agency for the ninety Blue Cross plans in the
United States and Canada, indicated that hospitalization
benefits to Blue Cross subscribers during 1949 drew a
larger share of the Blue Cross plans yearly income than
ever before.
Total income for all Blue Cross plans in 1949 was
$388,193,814. Of this amount, hospitals received $327,-
857,819 or 84.46 per cent for service to Blue Cross
members — an increase of almost $57,000,000 over the
amount paid hospitals during 1948.
During January and February, 1949, Minnesota Blue
Cross payments to hospitals totalled $1,327,287. This
year, hospitalization benefits for the first two months
totalled $1,529,534.
Enrollment in Minnesota Blue Cross totalled 989,591 as
of February' 28, 1950, and Blue Shield enrollment to-
talled 292,455.
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Don't iust buy eye glasses, but eye care . . .
Consult a reliable eye doctor and then . . .
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25 W. 6th St. St. Paul CE. 5767
546
Minnesota Medicine
BOOK REVIEWS
BOOK REVIEWS
Books listed here become the property of the Ramsey,
Hennepin and St. Louis County Medical Libraries when
reviewed. Members, however, are urged to write reviews
of any or every recent book which may be of interest
to physicians.
ULTIPLE SCLEROSIS AND THE DEMYELIN ATING DIS-
EASES. Proceedings of the Association for Research in Nerv-
ous and Mental Diseases, December 10 an 11, 1948. 675 pages.
Illus Price $12.00, cloth. Baltimore: Williams & Wilkins
Co., 1950.
ARVEY CUSHING— Surgeon, Author, Artist. Elizabeth H.
Thomson. Foreword by John F. Fulton. 347 pages. Illus.
Price $4.00, cloth. New York: Henry Schuman, 1950.
DME CONTEMPORARY THINKING ABOUT THE EXCEP-
TIONAL CHILD. Proceedings of a Special Conference on
Education and the Exceptional Child of the Child Research
Clinic of the Woods Schools. 64 pages. Langhorne, Pa. : The
Woods Schools, 1949.
AW-GE-MAH (Medicine Man). Louis J. Gariepy, M.D. 326
pages. Price $3.00, cloth. St. Paul, Minnesota: Northland
Press, 1950.
AY’S MANUAL OF THE DISEASES OF THE EYE FOR
STUDENTS AND GENERAL PRACTITIONERS. Revised
and edited by Charles A. Perera, M.D., Assistant Clinical Pro-
fessor, College of Physicians and Surgeons, Columbia University,
New York; Associate Attending Ophthalmologist, Presbyterian
Hospital, New York. 512 Pages. Illus. $5.00. 20th ed. Bal-
timore: Williams & Wilkins Co., 1949.
The popularity of this text is attested by the fact
lat this is the twentieth edition (the first having ap-
eared in 1600). A total of 378 illustrations, including
lirty-two plates with ninety-three colored figures, makes
ris the most widely illustrated small work on ophthal-
lology that has come to my attention. Many of the
ntiquated illustrations have been replaced with ex-
silent new ones. The colored plates constitute a valuable
tlas of the external diseases of the eye, of the affections
f the anterior segment, and of the changes in the ocular
undus.
The new and revised material includes the treatment
f conjunctivitis, the classification and therapy of dis-
ases of the optic nerve, the use of the newer antibiotics,
he surgical correction of oculomotor anomalies and the
icular manifestation of systemic diseases.
The large amount of material included within the
overs of this manual is amazing. It is small wonder
hat this text his remained for years the standard man-
lal on diseases of the eye for students and general prac-
itioners.
Harold J. Rothschild, M.D.
jUINIDINE IN DISORDERS OF THE HEART. By Harry
Gold, M.D., Professor of Clinical Pharmacology at Cornell
University Medical College, Attending-in-Charge of the Cardio-
vascular Research Unit at the Bethel Israel Hospital, Attending
Cardiologist at the Hospital for Joint Diseases, Managing
Editor of the Cornell Conferences on Therapy. 115 pages.
Price, $2.00. New York: Paul B. Hoeber, Inc., 1950.
“Quinidine in Disorders of the Heart” is a concise,
•eadable little manual of 100 pages by a physician with
vide experience both in pharmacology and clinical
nedicine. Indications, dosage, toxic reactions are well
iresented, and the various arrhythmias are capably
lescribed. Case histories enliven the discussion. How-
:ver, those of us who use Quinidine to prevent or
lelay the onset of permanent auricular fibrillation and
“DEE”
NASAL SUCTION PUMP
Contact your wholesale druggist or
write direct for information
“DEE" MEDICAL SUPPLY COMPANY
P.O. Box 501, St. Paul, Minn.
RADIUM RENTAL SERVICE
2525 INGLEWOOD AVENUE
MINNEAPOLIS 5, MINNESOTA
TEL. ATLANTIC 5297
Radium element prepared in
type of applicator requested
ORDER BY TELEPHONE OR MAIL
PRICES ON REQUEST
May, 1950
547
BOOK REVIEWS
to prevent ventricular tachycardia and ventricular
fibrillation in acute myocardial infarction, will be dis-
appointed in Dr. Gold’s treatment of this subject. A
separate paragraph might well have been included on
contra-indications. Ben SommerSj M D
obstetrical and gynecology
I ATHOLOGY. By Robert L. Faulkner, M.D., F.A.C.S., As-
sistant Professor of Gynecology, The Western Reserve Medical
School; Associate Gynecologist, University Hospitals of Cleve-
land, Ohio, and Marion Douglass, M.D., formerly Assistant
I rofessor of Gynecology, The Western Reserve Medical School.
2d ed. 3^7 p. Illus. Price $8.75. St. Louis: The C. V. Mosby
Co., 1949.
It was a privilege and I derived a great amount of
pleasurable reading in reviewing this book. The wealth
of fundamental knowledge contained in such a book is
invaluable to anyone, and it certainly helped me in my
thinking and understanding of the basic problems in
obstetrical and gynecological pathology.
The book is well organized and each chapter is devoted
to the specific structure being discussed. The first
chapter explains the proper methods of obtaining and
processing surgical specimens and biopsies so as to
facditate the rendering of a more accurate diagnosis by
the pathologist which in turn will aid the gynecologist to
a more concise understanding of the problem which con-
fronts him. Succeeding chapters describe the histology,
physiology and pathology pertinent to the female
anatomy in this order : vulva, vagina, cervix, endo-
metrium, myometrium, fallopian tube, ovary and the
pathology relative to pregnancy.
In order to understand more fully the pathological
physiology involved each chapter is preceded by a brief,
concise, discourse of the physiology, histology and em-
bryology involved, which gives one the basic facts
stripped of non-essentials and eliminates dull reading
material. There are many illustrations of macroscopic
and miscroscopic pathologic specimens interspaced
throughout the chapters, plus several color plates.
To criticize the book adversely, I feel that the authors
should have included a bibliography. Very often, when
investigating a particular problem, valuable leads are
obtained from a book such as this which may assist an
investigator to find further information utilizing the
various indices. Surely, the bibliography which Drs.
Faulkner and Douglass possess and incorporated into
their text would make the book of inestimable value.
I also believe that a chapter on the pathology and
pathological physiology of the toxemias of pregnane
should be included and the material organized in th
same style as the other chapters in the book.
This text can be highly recommended as a hand
reference to anyone interested in gynecological an
obstetrical pathology bearing in mind that the book i
primarily concerned with the essentials of this subjec
matter. For anyone preparing for board examinations
the book should be a time saver in reviewing basic knowl
edge in this speciality.
T. F. Melancon, M.D.
UROLOGICAL SURGER\ . By Austin Ingram Dodson, M.D I
F.A.C.S., Professor of Urology, Medical College of Virginia
Urologist to the Hospital Division, Medical College of Vii
ginia; Urologist to Crippled Children’s Hospital; Urologist t
St. Elizabeth’s Hospital; Urologist to St. Luke’s Hospital an
McQuire Clinic. 2d ed. 855 pages. Illus. Price $13.5(
St. Louis: C. V. Mosby Co., 1950.
This revised edition is probably the best single refer
ence for open urological procedures. It is not intended
as a textbook of urology, although surgical anatomy anil
basic principles of diagnosis and treatment are reviewei
briefly. No attempt is made to cover the field of endo
scopic urology. There is an excellent concise chapter 01
endocrinology as related to the prostate.
Although a number of valuable operative procedure
are necessarily omitted, Dr. Dodson’s book is a highh
useful reference for both the postgraduate student ii I
urology and for those practitioners who do open uro I
■Miigen. Murray P. Ersfeld, M.d J
REVIEWS OF MEDICAL MOTION PICTURE
1 lie Committee on Medical Motion Pictures of tin I
American Medical Association has completed the secornl
revised edition of the booklet entitled “Reviews o
Medical Motion Pictures.” This booklet now contain I
225 reviews of medical and health films reviewed ii I
The Journal AM A to January 1, 1950. Each film ha: I
been indexed according to subject matter. The purpose!
of these reviews is to provide a brief description ancl
an evaluation of motion pictures which are available tel
the medical profession. Each film is reviewed by com- 1
petent authorities and every effort has been made tel
publish frank, unbiased comments. Copies are available!
at a cost of 25 cents each from: Order Department!
American Medical Association, 535 North Dearborn!
Street, Chicago, 10, Illinois.
DANIELSON MEDICAL ARTS PHARMACY, INC.
PHONES: 10'14 Arcade' Medical Arts Building hours:
ATLANTIC 3317 Nicollet Avenue — Two Entrances — 78 South Ninth Street WEEK DAYS 8 to 1
ATLANTIC 3318 MINNEAPOLIS SUN. AND HOL.— 10 TO 1
PHYSICIANS AND HOSPITALS SUPPLY CO., Inc.
414 SOUTH SIXTH ST., MINNEAPOLIS, MINN.
INSTRUMENTS • TRUSSES • EQUIPMENT • PHARMACEUTICALS • DRUGS
MAIN 2494
548
Minnesota Medicine
mi iiiimiiii inn limit mmmiimnm mi mi ml mi
THE VOCATIONAL HOSPITAL |
TRAINS PRACTICAL NURSES
Nine months Residence course. Registered Nurses and |
Dietitian as Teachers and Supervisors. Certificate from 1
Miller Vocational High School. VOCATIONAL NURSES |
always in demand. |
EXCELLENT CARE TO CONVALESCENT AND
CHRONIC PATIENTS
Rates Reasonable. Patients under the care of their own physicians, |
who direct the treatment. |
5511 Lyndale Ave. So. LO. 0773 Minneapolis, Minn. |
mini in nun in mi mnmnn in nnininninnin in mi
HOMEWOOD HOSPITAL is one of the
Northwest's outstanding hospitals for the
treatment of Nervous Disorders — equipped
with all the essentials for rendering high-grade
service to patient and physician.
Operated in Connection with
Glenwood Hills Hospitals
HOMEWOOD HOSPITAL
Corner Penn and Plymouth Avenues North
Minneapolis Minnesota
RADIUM & RADIUM D+E
(Including Radium Applicators)
FOR ALL MEDICAL PURPOSES
Est. 1919
Quincy X-Ray and Radium
Laboratories
(Owned and Directed by a Physician-
Radiologist)
Harold Swanberg, B.S., M.D., Director
W.C.U. Bldg. Quincy, Illinois
RELIABILITY!
For years we have maintained the
highest standards of quality, expert
workmanship and exacting conform-
ity to professional specifications . . .
a service appreciated by physicians
and their patients.
ARTIFICIAL LIMBS, TRUSSES,
ORTHOPEDIC APPLIANCES,
SUPPORTERS, ELASTIC HOSIERY
Prompt, painstaking service
Buchstein-Medcalf Co.
223 So. 6th St. Minneapolis 2, Minn.
PATTERSON SURGICAL SUPPLY COMPANY
103 East Fifth St., St. Paul 1, Minn.
HOSPITAL AND PHYSICIANS SUPPLIES AND EQUIPMENT
Cedar 1781-82-83
COSMETIC DERMATITIS?
Clinical tests confirm the use of
AR-EX Cosmetics for hyper-sen-
sitive skins. Scented or Unscent-
ed. Send for Free Formulary.
AR-EX COSMETICS, INC., 1 036 W. VAN BUREN ST.,
FREE FORMULARY
OR.
ADDRESS
CITY
STATE _
CHICAGO 7, ILL.
May, 1950
549
Classified Advertising
Replies to advertisements with key numbers should be
mailed in care of Minnesota Medicine, 2642 University
Avenue, Saint Paul 4, Minn,
FOR SALE — Bargain to close a business, X-Ray West-
inghouse complete equipment. See it and give me a
bid. Write for complete details. C. P. Robbins, M.D.,
Winona, Minnesota.
FOR SALE — Saint Paul general practice with con-
siderable surgery. Gross $50,000 plus, last year.
Address E-205, care Minnesota Medicine.
FOR SALE — $15,000 cash practice in county seat of
14,000, with two hospitals, for price of office equip-
ment, which is complete and in perfect condition.
Forced to retire on account of health. Address E-200,
care Minnesota Medicine.
WANTED — Medical assistant to well-established F.A.
C.S. Suburban town of Twin Cities. Good hospital
facilities. Apartment available. Address E-206, care
Minnesota Medicine.
PHYSICIAN WANTED— Well-established firm in
northern Minnesota desires young man for general
practice and obstetrics — deliveries in hospital. Good
income from start. Full information given and inter-
view arranged upon receipt of inquiry. Address E-192,
care Minnesota Medicine.
WANTED — Second hand Green’s Refractoscope andi
stand. Must be in good condition. Address E-196,
care Minnesota Medicine.
WANTED — Catholic doctor to associate with older
physician in city of 20,000 population. General
practitioner interested in obstetrics, gynecology and
children. Will turn over office when established.
Address E-203, care Minnesota Medicine.
USED X-RAY EQUIPMENT FOR SALE— Acme
Vertical Cassette Changer. Horizonal Bucky Table*
complete with L-F Bucky Diaphragm, attached Rails
and Tubestand. Self-rectified X-Ray Generators, 30
and 50 M.A. at 85 KV. Standard X-Ray Sales Com-
pany, 458 Lowry Medical Arts Bldg., Saint Paul 2,
Minnesota.
EXCELLENT OPPORTUNITY FOR PHYSICIAN-
Well-established practice available in South Central
Minnesota town ; 52-bed hospital 8 miles distant. Res-
idence with fully equipped office adjoining available
at reasonable price. Address E-207, care Minnesota:
Medicine.
WANTED — Young general practitioner to assist two
general practitioners in county seat city in Minnesota.
Excellently equipped offices and hospital. Write full
personal and professional qualifications. Address
E-208, care Minnesota Medicine.
POSITION WANTED — Laboratory technician with
office training and experience desires position in
Minneapolis. Available immediately. Address E-204,
care Minnesota Medicine.
WANTED — Young general practitioner to become asso-
ciated with young practitioner in northern Minnesota
community. Large practice. New hospital to be built
this year. Salary $500.00 monthly. Must have car.
Address E-209, care Minnesota Medicine.
WANTED — Locum Tenens for June and/or July.
General practice. $600.00 a month. Address E-201,
care Minnesota Medicine.
PHYSICIAN NEEDED — College town, 7 miles from
St. Cloud, in good German farming community, is in
need of a physician. Former physician established 50
years. Excellent opportunity. Address O. D. Jaren,
St. Joseph, Minnesota.
WANTED — Young Physician to become associated with
two general practitioners in new clinic building and
new 30-bed hospital in Northern Minnesota. Rather
extensive surgery. Terms open. Address E-202, care
Minnesota Medicine.
* * POSITIONS AVAILABLE * *
Locum Tenens: Physician in Lowry Bldg., St. Paul wants
physician to care for practice July, August, September.
Minnesota Clinic: Wants young physician with some
experience in Ob and Pediatrics. Assured income $12,000
a year.
Association: With Minnesota doctor. Office in 20-bed
hospital. $600 a month to start.
Partnership: Young physician needs partner to help with
practice. One hour’s drive from Twin Cities.
* * MEN AVAILABLE * *
Internist: Registered Mayo Man; Minnesota graduate wants
association with Clinic or established Internist.
Hospital Administrator: Master’s degree in Hosp. Ad., U.
of Minn. Experienced.
MEDICAL PLACEMENT REGISTRY
Campus Office, 629 S.E. Washington Ave., Telephone
Gladstone 9223, Minneapolis, Minnesota
a
LHLCOL
The Geiger Laboratories
l Services jor f^liysictans op the Islpper Iddiddle WJedt
ujSiciani of ine uipper
Mailing tubes and price lists supplied upon request.
1111 NICOLLET AVENUE MINNEAPOLIS 2
MAIN 2350
550
Minnesota Medicine
PHYSICIANS AND HOSPITALS SUPPLY CO.f Inc.
414 SOUTH SIXTH ST., MINNEAPOLIS, MINN.
INSTRUMENTS • TRUSSES • EQUIPMENT • PHARMACEUTICALS • DRUGS
MAIN 2494
Practical Nursing School
Approved 1 by Minnesota State Board of Nurses
Examiners
Twelve months course open to High
School Graduates or women with equiv-
alent education.
For further information apply to
DIRECTOR OF NURSES
FRANKLIN HOSPITAL
501 W. Franklin Avenue, Minneapolis 5, Minn.
TAILORS TO MEN SINCE 1886
The finest imported and domestic wool-
ens such as SCHUSLER'S have in stock
are not too fine to match the hand tailor-
ing we always have and always will
employ.
I. T. SCHUSLER CO., INC.
379 Robert St. St. Paul
DO YOU HAVE CHILDREN?
Train them in the habit of sav-
ing money regularly through a
SAVINGS ACCOUNT with
this bank. . . . They’ll always
thank you. OPEN AN AC-
COUNT FOR THEM TO-
DAY.
THE AMERICAN NATIONAL BANK
OF SAINT PAUL
Bremer Arcade Robert at 7th CE 6666
Member Federal Deposit Insurance Corporation
Radiological and Clinical
Assistance to Physicians
in this territory
MURPHY LABORATORIES
Minneapolis: 612 Wesley Temple Bldg. - - At. 478*
St. Paul: 348 Hamm Bldg. ------ Ce. 7125
If no answer, call Ne. 1291
Hall & Anderson
PRESCRIPTION PHARMACY
BIOLOGICALS
PHYSICIANS’ SUPPLIES
SAINT PAUL, MINN.
LOWRY MEDICAL ARTS BUILDING
TELEPHONE: CEDAR 2735
\
UNUSUAL LENS GRINDING
CATARACT,
M YO-THIN
and other difficult
and complicated
lenses are ground to
extreme thinness and
accuracy by our
expert workmen.
0RTHQRFWILLIAW5 SSKS
l J
Insurance
at a
Saving
MINNESOTA
Druggists Mutual Insurance Company PromP‘
OF IOWA. ALGONA, IOWA LOSS
Fire - Tornado - Automobile Insurance Service
REPRESENTATIVE-S. E. STRUBLE, WYOMING, MINN.
iIay, 1950
551
'"eluding thiamine, and nutritionally ,f"f
‘,r°n. copper, calcium, and phosphorus)-
°ugh cooking and drying, Pabena is e0i
datable, convenient to prepare, econorr
PABENA
NET
: ^ ,&:%•:
- -V v
PRECOOKED OATMEAL
v'tamin-ond-mineral-enrich«<l
so^i C0nsists of oatmeal, malt syrup, powdered
y P'epared for human use, sodium chloride, po*
o\», ’ an,d rec,uced iron. Pabena furnishes ^*amLn»
E QUIRES no COOKING ♦ Add «"'1 °
W0,".h«. or cold. Serve with milk « ^
&*ad John
•VAN S V I LLE.
precooked oatmeal
companion to Pablum
Growing in favor with physi
Pabena* is oatmeal . . . and has the rich,
full oatmeal flavor.
Like PABLUM * PABENA is enriched
with important vitamins and minerals
and is thoroughly cooked and dried.
In addition, PABENA is valuable for in-
fants and children who are sensitive to
wheat. It is an ideal first solid food.
PABENA and PABLUM provide variety
of cereal flavor that is welcomed by both
mother and child.
PABENA and PABLUM, like all Mead’s
products, are not advertised in lay pub-
lications. *T.M. Reg. U.S. Pat. Off.
Mead Johnson & co.
EVANSVILLE 2 l, I N D., U.S. A.
dans
552
Minnesota Medicine
u. C MEDICAL LIBRARY
Published Monthly by the Minnesota State Medical Association
Volume 33 JUNE, 1950 Number 6
Printed in U.S.A.
40c a copy — $3.00 a year
This prescription abbreviation for "a sufficient quantity”
provides us, we believe, with an opportunity to point out bow
the widespread availability of Lilly products works to
your advantage.
Any pharmacy to which your prescription may go is
conveniently near one of the many wholesale distributors
carrying a complete assortment of Lilly preparations. A Lilly
specification, therefore, is a demand which can be readily executed
without disappointment. Your chosen course of treatment
may thus be faithfully followed without delay.
AND COMPANY • INDIANAPOLIS 6, INDIANA, U.S.A.
ELI LILLY
' •
BENADRYL
This is the season when bleary-eyed,
sneezing patients turn to you for the rapid,
sustained relief of their hay fever
symptoms which BENADRYL provides.
Today, for your convenience and ease of administration,
BENADRYL Hydrochloride
(diphenhydramine hydrochloride,
Parke-Davis) is available in a
wider variety of forms than ever
before, including Kapseals®,
Capsules, Elixir and Steri-Vials®.
I'VltKIi. DAVIS & COMPANY
N
E ft
Wait .1 Minute
Haven’t you forgotten something? You work like a nailer striv-
ing to make and save enough for your standard of living and
unforeseen needs, yet both income and savings can be wiped
out even to the point of putting you in debt — all because you
put off securing income protection.
Don’t procrastinate longer. Send in your application. Why
not call us today. The best value in non-cancellable Accident
and Sickness insurance is through the Plan available to you
as a member of the Minnesota State Medical Association.
ACT NOW!
CASWELL-ROSS AGENCY
Minneapolis 2, Minnesota
St. Paul— ZE 2341
St. Paul District Dental Society
Minneapolis District Dental Society
St. Cloud Dental and Stearns County
Medical Society
Duluth District Dental Society
East Central Medical Society
St. Louis County Medical Society
1177 N. W. Bank Building
Minneapolis — MA 2585
Insurors to:
Minnesota State Bar Association
Minnesota State Dental Association
Minnesota State Medical Association
Minnesota Society of C.P.A.
Minnesota State Pharmaceutical Assn.
Minnesota Auto Dealers Association
Hennepin County Medical Society
Hennepin County Bar Association
554
Minnesota Medicine
QHmessk Qfledicine
Journal of the Minnesota State Medical Association, Southern Minnesota Medical Association, Northern Minnesota
Medical Association, Minnesota Academy of Medicine and Minneapolis Surgical Society
Volume 33
June. 1950
No. 6
Contents
Advantages and Limitations of the Quantitative
VDRL Slide Test.
Anne C. Kimball, Ph.D., and Henry Bauer, Ph.D.,
Minneapolis, Minnesota 573
Editorial :
The VDRL Test for Syphilis 613
Industrial Commission Reports 613
George E. Fahr 614
The Clinical Application of Quantitative Re-
ports of Serologic Tests for Syphilis.
Francis IV. Lynch, M.D., Saint Paul, Minnesota.. 579
Progress in Maternal and Infant Health in
Minnesota.
A. B. Rosenfield, M.D., Minneapolis, Min-
nesota, and /. W. Brower, M.A., Saint Paul,
Minnesota 582
Solitary Pyogenic Liver Abscess.
Lazvrence M. Larson, M.D., Ph.D. (Surg.), and
John H. Rosenozv, M.D., MS. (Surg.), Minne-
apolis, Minnesota 588
Subfascial Fat Abnormalities and Low Back
Pain.
R. J. Dittrich, M.D., Duluth, Minnesota 593
Hemolytic Transfusion Reaction in Obstetrics.
Ann IV. Arnold, M.D., Minneapolis, Minnesota.. 597
Placental Polyp Simulating a Chorion-
ephithelioma.
F. H. Maguey, M.D., F.A.C.S., Duluth, Minnesota 601
History of Medicine in Minnesota :
Medicine and Its Practitioners in Olmsted County
Prior to 1900. (Continued).
Nora H. Guthrey, Rochester, Minnesota 603
President’s Letter :
Dr. Potts Would Be Surprised 612
Medical Economics :
Polls Show Opposition to Socialized Medicine.... 615
Medicine Continues to Thrive on Truth 615
Socialism — A Step Toward Communism 616
Britain’s Socialism — A Frankenstein Monster???.. 616
Of Mice and Men 617
Administration Called a “Playing Referee” 617
Minnesota State Board of Medical Examiners.... 617
A4inneapolis Surgical Society :
Meeting of November 3, 1949 618
The Postthrombotic Syndrome.
Nathan C. Plimpton, M.D., Minneapolis, Min-
nesota 618
Venography in the Postphlebitic Syndrome.
Clarence V. Kusa, M.D., Minneapolis, Minnesota 619
The Return of “Vein Stripping.”
Frank W. Quattlebaum, M.D., Saint Paul,
Minnesota 623
Fundamental Principles in the Treatment of Vari-
cose Veins.
FI. A. Alexander, M.D., Minneapolis, Minnesota 626
Resume of Present-Day Care and Treatment of
Varicose Veins and Their Complications.
H. O. McPheeters, M.D., Minneapolis, Min-
nesota 628
In Memoriam 630
Reports and Announcements 634
Woman’s Auxiliary - 640
Of General Interest 642
Book Reviews 652
Contents of Minnesota Medicine copyrighted by Minnesota State Medical Association, 1950
Entered at the Post Office in Saint Paul as second class mail matter. Accepted for mailing at the special rate of postage provided
for in Section 1103. Act of October 3, 1917, authorized July 13, 1918.
June, 1950
555
MINNESOTA MEDICINE
Official Journal of the Minnesota State Medical Association
Published by the Association under the direction of its Editing and Publishing Committee
Office of Minnesota State Medical Association,
493 Lowry Medical Arts Bldg., Saint Paul 2, Minnesota.
EDITING AND PUBLISHING COMMITTEE
E. M. Hammes, Saint Paul
Philip F. Donohue, Saint Paul
H. W. Meyerding, Rochester
B. O. Mork, Jr., Minneapolis
C. L. Oppegaard, Crookston
T. A. Peppard, Minneapolis
H. A. Roust, Montevideo
O. W. Rowe, Duluth
Henry L. Ulrich, Minneapolis
A. H. Wells, Duluth
EDITORIAL STAFF
Carl B. Drake, Saint Paul, Editor
George Earl, Saint Paul, Associate Editor
Henry L. Ulrich, Minneapolis, Associate Editor
BUSINESS MANAGER
J. R. Bruce
Annual Subscription — $3.00. Single Copies — $0.40. Foreign and Canadian Subscriptions — $3.50.
The right is reserved to reject material submitted for editorial or advertising columns. The
Editing and Publishing Committee does not hold itself responsible for views expressed either in
editorials or other articles when signed by the author.
Classified advertising — ten cents a word; minimum charge, $2.00. Remittance should ac-
company order.
Display advertising rates on reauest.
Address all communications concerning the journal to Minnesota Medicine, 2642 University
Avenue, Saint Paul 4, Minnesota. Telephone Nestor 2641.
ST. CROIXD ALE ON LAKE ST. CROIX
PRESCOTT, WISCONSIN
MAIN BUILDING— ONE OF THE 8 UNITS IN “COTTAGE PLAN”
A Modern Private Sanitarium for the Diagnosis, Care and Treatment of Nervous and Mental Disorders
Located on beautiful Lake St. Croix, eighteen miles from the T win Cities, it has the advantages of both
City and Country. Every facility for treatment provided, including recreational activities and occupational
therapy under trained personnel. Close personal supervision given patients, and modern methods of
therapy employed. Inspection and cooperation by reputable physicians invited. Rates very reasonable.
Illustrated folder on request.
NEUROPSYCHIATRISTS
PRESCOTT OFFICE
Prescott, Wis.
Howard J. Laney, M.D.
Tel. 39 and Res. 76
Hewitt B. Hannah, M.D.
Andrew J. Leemhuis, M.D.
Howard J. Laney. M.D.
511 Medical Arts Building
Minneapolis. Minnesota
Tel. MAin 1357
SUPERINTENDENT
Dorothy M. Most, R.N.
Prescott, Wisconsin
Tel. 69
556
Minnesota Medicine
Resistant
Bacterial Infections
AU R E O M VC IN
Aureomycin is now widely used for the treat-
ment of infections that have proven resistant to
other chemotherapeutic agents, or combinations
of such agents. Aureomycin does not commonly
provoke resistance in bacteria, and its ability to
penetrate cell membranes and diffuse through
the body fluids assures the presence of the
therapeutic material everywhere it is needed.
H YDROCHlORlbE LEDERIE
Aureomycin has been found effective for the
control of the following infections: African tick-
bite fever, acute amebiasis, bacterial and virus-
like infections of the eye, bacteroides septicemia,
boutonneuse fever, acute brucellosis, gonorrhea
resistant to penicillin, Gram-positive infections
(including those caused by streptococci, staph-
ylococci, and pneumococci), Gram-negative
infections (including those caused by the coli-
aerogenes group), granuloma inguinale, H. in-
fluenzae infections, lymphogranuloma venereum,
peritonitis, primary atypical pneumonia, psit-
tacosis (parrot fever), Q, fever, rickettsialpox.
Rocky Mountain spotted fever, subacute bac-
terial endocarditis resistant to penicillin, tula-
remia and typhus.
LEDERLE LABORATORIES DIVISION
AMERICAN Gjmuunid COMPANY
30 Rockefeller Plaza, New York 20, New York
Capsules: Bottles of 25, 50 mg. each capsule. Bottles of 16, 250 mg. each capsule.
Ophthalmic: Vials of 25 mg. with dropper; solution prepared by adding 5 cc. of distilled water.
June, 1950
557
PURODIGIN is available in three strengths: Tablets of 0.1 mg.,
0.15 mg., and 0.2 mg. This facilitates closer adjustment of main-
tenance dosage to the patient’s requirements . . . minimizes need
to “stagger” larger and smaller doses or to prescribe irregular
intervals between doses.
For reliable, efficient cardiotherapy, specify PURODIGIN—
pure crystalline digitoxin, Wyeth.
and
precision
Cardiac
Therapy
558
Minnesota Medicine
A POSITIVE MEANS OF
Whenever the need for dietary supple-
mentation arises — as in anorexia, per-
verted food habits, during and following
illness, and in gastrointestinal disease
— the regular use of Ovaltine in milk
can be of signal value. Taken daily, this
well-rounded multiple dietary supple-
ment gives virtual assurance of nutri-
tional adequacy.
As indicated in the table, Ovaltine
in milk provides virtually all essential
THE WANDER COMPANY, 360 N.
nutrients in balanced, generous
amounts. Its protein is biologically
complete. It supplies not only B com-
plex vitamins, but also vitamins A and
D as well as ascorbic acid and essential
minerals.
The delightful taste and easy digest-
ibility of this food beverage is relished
by patients, hence the recommended
three glassfuls daily are taken without
resistance.
MICHIGAN AVE., CHICAGO 1, ILL.
June, 1950
559
Make Our
Doctors’ Lounge
Your dub
You'll find it on the main floor . . . designed
for your comfort. Drop in. Rest . . . read . . .
smoke ... or just chat.
If you like, have your mail addressed c/ o
Philip Morris Doctors’ Lounge, Civic Audi-
torium. San Francisco.
Ask at the Lounge for any service that
you fancy. We can’t promise to deliver, but
we certainly promise to try.
Philip Morris
& CO., LTD., IIVC., lOO PARK AVE., NEW YORK
Be sure to visit the Philip Morris Exhibit . . . Space H-2 and 1-1
"In general, symptomatic improvement
[of menopausal symptoms] was striking within
7 to 14 days after treatment.. /’with
"Premarin.”
Gray, L.: J. Clin. Endocrinol. 3:92 (Feb.) 1943.
Many clinicians have found that “Premarin” therapy usually brings about
prompt relief of distressing menopausal symptoms. Furthermore, sympto-
matic improvement is followed by a gratifying sense of well-being in a
majority of cases. This is the “plus” in “Premarin” therapy which tends
to quickly restore the patient’s normal mental outlook.
Four potencies of “Premarin” permit flexibility of dosage: 2.5 mg.,
1.25 mg., 0.625 mg., and 0.3 mg. tablets; also in liquid form, 0.625 mg.
in each 4 cc. (1 teaspoonful).
While sodium estrone sulfate is the principal estrogen in “Premarin”
other equine estrogens. . .estradiol, equilin, equilenin, hippulin...are
probably also present in varying amounts as water-soluble conjugates.
Estrogenic Substances ( water-soluble ) also known as
Conjugated Estrogens ( equine )
Ayerst, McKenna & Harrison Limited
22 East 40th Street, New York 16, N. y.
June, 1950
561
. . . .YES! JCLLts new
Give you COMPLETE
Here is how the
Keleket Add-A-Unit
Combinations Work
Choose the combination
to suit your practice!
You purchase the new standard (not a reduced)
size Keleket Tilt Table and Tubestand. Then add
either 15, 30 or 100 MA tube and generating
equipment. You can advance from 15 to 30 and
to 100 MA but still retain the original table and
tubestand. As a result, this investment is never
lost when you step up to higher power tubes and
generating equipment.
Illustration above shows 100 MA Combination with the
basic table and Floor-To-Ceiling tubestand. This com-
bination includes the famous Keleket Multicron Gen-
erator.
Illustration below shows 30 MA combination with
the same basic table and Floor-To-Ceiling tube-
562
Minnesota Medicine
kdd-a-Unit Combinations
[-RAY EQUIPMENT
. for FULL RANGE Fluoroscopy and Radiography
ieket scores again, with a new approach to the use and
rchase of X-ray equipment. Keleket has developed a
ILL SIZE Standard Tilting Table with a completely
w, highly flexible floor to ceiling tubestand. This basic
ray equipment is equally adaptable for either 15, 30
100 MA tube and generating units.
IOWS WITH YOUR REQUIREMENTS
in equipment — new table and tubestand costs as you step
up your tube capacity and power.
In addition, your original investment is never lost —
Keleket offers you generous allowance values on the
equipment you interchange.
FULL RADIOGRAPHIC-FLUOROSCOPIC FACILITIES
trt out with the simplest 15 MA tubehead; then at a
:ure date change to a 30 MA tubehead, if you desire,
henever you’re ready, step up to a 100 MA generating
it. As a result, your Keleket equipment grows with
irr requirements.
IROUGHOUT ALL INTERCHANGES YOU RE-
UN THE SAME KELEKET “ ADAP”-T ABLE AND
JBESTAND.
TURE COSTS SAVED
iis means you eliminate one of the biggest cost factors
Any of these combinations will fully meet your current
needs for full range radiography and fluoroscopy. Per-
form radiography in horizontal and trendelenburg posi-
tions, vertical and horizontal fluoroscopy. The tubestand,
for example, is so flexible that you can swing the tube-
head away from the table and radiograph stretcher cases
on the opposite side.
And if you want a bucky diaphragm, even the lowest cost
unit is equipped to accommodate one.
Write or phone for more information
Keleket X-Ray Sales Corporation
of Minnesota
1225 Nicollet Avenue Minneapolis 3, Minnesota
June, 1950
563
WHEN OBESITY IS A PROBLEM
S. H. CAMP and COMPANY
JACKSON, MICHIGAN
World's Largest Manufacturers
* of Scientific Supports
Offices in New York • Chicago
Windsor, Ontario • London, England
Clinicians have long noted
that the forward bulk of the
heavy abdomen with its fat-
laden wall moves the center
of gravity forward. As the
patient tries to balance the
load, the lumbar and cervical
curves of the spine are in-
creased, the head is carried
forward and the shoulders
become rounded. Often there
is associated visceroptosis.
Camp Supports have a long
history among clinicians for
their efficacy in supporting
the pendulous abdomen. The
highly specialized designs and
the unique Camp system of
controlled adjustment help
steady the pelvis and hold the
visceraupward and backward.
There is no constriction of
the abdomen, and effective
support is given to the spine.
Physicians may rely on
the Camp-trained fitter for
precise execution of all in-
structions.
If you do not have a copy of
the Camp “Reference Book
for Physicians and Surgeons’ ’ ,
it will be sent on request.
o4athou]Cd
c/y\AP
Scientific Suppolt£
THIS EMBLEM is displayed only by reliable merchants
in your community. Camp Scientific Supports are never
sold by door-to-door canvassers. Prices are based on
intrinsic value. Regular technical and ethical training of
Camp fitters insures precise and conscientious attention
to your recommendations.
Minnesota Medicine
hether the sneeze
is seasonal or perennial
Trimeton® offers more patients greater symptomatic relief. In
severe hay fever Trimeton was found to be the most effective
antihistamine among six drugs tested, affording relief to 75 per
cent of patients.1 In mild hay fever, benefit is obtained by 90 per
cent of patients.
In perennial allergic rhinitis, “Trimeton ... is distinctly supe-
rior . . . and . . . was strikingly effective. . . . The figure of 85 per
cent satisfactorily treated patients is impressive.”2
TRIMETON
(brand of prophenpyridamine)
Trimeton, a potent, well tolerated antihistamine is also indicated for
symptomatic control of urticaria, angioedema, atopic eczema and derma-
titis, antibiotic sensitivity reactions and some cases of asthma.
Trimeton is available in 25 mg. scored tablets. Bottles of 100 and 1000.
Bibliography: 1. Loveless, M. H., and Dworin, M.: J. Am.
M. Women’s A. 4:105, 1949. 2. Schiller, I. W., and Lowell,
F. C.: New England J. Med. 240: 215, 1949.
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566
Minnesota Medicine
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568
Minnesota Medicine
-* IT WAS GOOD TO J
HAVE THE DOCTOR’S WORD
ON IT, BUT I KNEW CAMEL
MILDNESS AGREED WITH ^
MY THROAT FROM THE
START. THEY'RE A
GREAT SMOKE/
ACCORDING TO A NATIONWIDE SURVEY:
MORE DOCTORS SMOKE CAMEtS
THAN ANY OTHER CIGARETTE
Yes, doctors smoke for pleasure, too! In a nationwide survey, three independent research organi-
zations asked 113,597 doctors what cigarette they smoked. The brand named most was Camel*
THROAT SPECIALISTS REPORT
ON 30-DAY TEST OF CAMEL SMOKERS:
7m one sfygfe a® of
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Personnel Director
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June, 1950
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571
June, 1950
When
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increase the energy output and impart a feeling of well-being
which encourages dietary adherence.
Smaller dosage is possible because weight for weight Desoxyn is more ^
potent than other sympathomimetic amines. One 2.5-mg. tablet
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.572
Minnesota Medicine
Qtlmes&k QHeJicme
Journal of the Minnesota State Medical Association, Southern Minnesota Medical Association, Northern Minnesota
Medical Association, Minnesota Academy o) Medicine and Minneapolis Surgical Society
Volume 33 June, 1950 No. 6
ADVANTAGES AND LIMITATIONS OF THE QUANTITATIVE VDRL
SLIDE TEST
ANNE C. KIMBALL, Ph.D., and HENRY BAUER, Ph.D.
Minneapolis, Minnesota
i
i CTARTING July 1, 1950, it is planned that
^ blood specimens giving positive VDRL sero-
logical slide tests for syphilis will be reported
quantitatively. This test has been studied in the
Minnesota Department of Health Medical Labo-
ratories since October 1, 1949. The following
summary of results is presented as an indication
of the value and limitations of this added test
procedure.
by Pangborn3 in 1941. The antigen emulsion is
prepared with buffered saline and an alcoholic so-
lution of 0.03 per cent cardiolipin and 0.9 per cent
cholesterol and sufficient lecithin to give “stand-
ard” sensitivity. Basically this antigen is similar
to other lipiodal antigens used prior to this time.
The major advantage is in its reproducibility.
The qualitative tests are performed using 0.05
c.c. undiluted serum and 1 drop (60 drops per
TABLE I. CORRELATION OF KOLMER-WASSERMANN WITH QUANTITATIVE VDRL SLIDE TEST RESULTS
ON 3227 SPECIMENS
VDRL Test
Kolmer-Wassermann Test Result
Total VDRL Tests
Positive/Dilution
Negative
Doubtful
i or 1 +
Positive
2 +
Positive
3 +
Positive
4 +
Anticomple-
mentary
No.
%
fl 1:1024
2
2
4
.12
.2 1:512
2
1
3
.09
■g 1:256
19
6
25
.77
■3 1:128
50
11
61
1.89
Q 1:64
126
12
138
4.27
1 :32
158
12
170
5.26
0 1:16
8
3
3
1
249
5- -
269
8.33
.£ 1:8
32
10
12
10
298
5
367
11.37
'S \
87
27
22
24
382
6
548
16.98
0 1 :2
236
84
32
39
365
11
767
23.78
~H Undiluted Only
386
98
67
61
247
16
875
27.15
Total
No.
749
222
136
135
1898
87
3227
100%
Results
%
23.21
6.88
4.21
4.18
58.82
2.70
100%
Technique of the Test
The VDRL slide test for syphilis was origi-
nally published by the Venereal Disease Research
Laboratories of the United States Public Health
Service, Staten Island, in 19461, after the isola-
tion of cardiolipin from beef heart was published
From the Minnesota Department of Health, Section of
Medical Laboratories.
The authors are indebted to H. G. Irvine, M.D., Acting Direc-
"t°r of the Division of Venereal Diseases, Section of Prevent-
able Diseases, for helpful suggestions in preparing this paper.
1 c.c.) of antigen emulsion, and the results are
read and reported as negative, weakly positive or
positive. The quantitative test is done on all spec-
imens giving a positive qualitative test on undi-
luted serum. Serial twofold dilutions of each
specimen are prepared with saline and each one is
tested in the same manner as in testing undiluted
serum. The highest dilution giving a positive re-
action is reported as follows :
June, 1950
573
QUANTITATIVE VDRL SLIDE TEST— KIMBALL AND BAUER
Dilution Report
Spec.
No.
1 :2
1 :4
1 :8
1 :16
1 :32
1 :64
, 103
176
572
W.P.*
Pos
Pos
Neg
Pos
Pos
Neg
Pos
W. P.*
Neg
Pos
W.P.»
Neg
Pos
Neg
Neg
W.P.*
Neg
Positive Undiluted Only
Positive Diluted 1 : 32
Positive Diluted 1 :4
’Weakly Positive.
The major advantage of such quantitation is
that it measures the strength of positivity into a
much higher range than the usual gradation of
1+ through 4+ on testing only undiluted serum.
For example, in the above table specimens No.
176 and 572 would both have been read positive
4+ by the older gradation method, but the quanti-
tative tests show specimen 1 76 to be eight times
more positive than specimen 572.
During the six-month period October, 1949,
through March, 1950, 3227 specimens giving a
positive result on undiluted serum with the VDRL
slide test have been quantitated. Approximately
200 additional specimens gave positive VDRL
slide tests, but there was insufficient serum to per-
form the quantitative test. We mention this group
only to emphasize the importance of submitting a
full vial of blood.
In the last two columns of Table I the number
and percentage of specimens giving a positive re-
sult in the various dilutions is shown. Sixteen
hundred and forty-two or 51 per cent of the speci-
mens are positive only undiluted or in dilution 1 :2.
We can expect to find a considerable number of
false positives in this group although many of
these are specimens from treated cases of syphilis.
No statement can be made in regard to exact spec-
ificity since clinical data is not available. The cor-
relation of quantitative results with the Kolmer-
Wassermann test results is also shown on Table I.
In 993 of these 1642 specimens the Kolmer-
Wassermann test also shows some reaction.
In 915 specimens, or 28 per cent, the VDRL
tests are positive in dilutions 1 :4 and 1 :8. False
positives will be unusual in this group. The Kol-
mer test shows some reaction in 785 of these 915
specimens.
In 670 specimens, or 21 per cent, the VDRL is
positive in dilutions 1 : 16 or higher. False posi-
tives in this group will be exceedingly rare.
Weakly positive and negative VDRL slide tests
are not shown in Table I since the quantitation
procedure is not applicable to this group. Such
specimens may show a reaction in the Kolmer test.
'TABLE II. QUANTITATIVE VDRL SLIDE TESTS
Results on retesting 100 positive specimens .
Tests done
the same day
Second tests
done 1 or 2
days later
Exact agreement
71
59
Second test one dilution higher
13
16
Second test one dilution lower
16
21
Second test two dilutions higher
0
1
Second test two dilutions lower
0
3
TABLE III. QUANTITATIVE VDRL SLIDE TESTS
Results on pairs of specimens from 210 individuals
collected within one week.
No.
%
Exact agreement
113
53.8
Second specimen 1 dilution higher
33
15.7
Second specimen 1 dilution lower
54
25.7
Second specimen 2 dilutions higher
7
3.3
Second specimen 2 dilutions lower
2
1.0
Second specimen 3 dilutions higher
1*
0.5
*Early case of syphilis — see text.
Retesting Specimens
Table II is a summary of results on retesting
100 positive specimens the same day, and one or
two days later. As shown in the first column,
when these specimens were retested the same day
there was exact agreement in 71 per cent. Dis-
agreement greater than one dilution was not en-
countered. Variables which contribute to the
29 per cent disagreement in results are as follows:
1. Variation in reading by two technicians.
2. Deviations from ideal mixing. (It is not
practical to use separate pipettes for each
dilution.)
3. Variation in serologic pipettes.
4. Variation in time elapsed since inactivation
of the serum.
As shown in the second column of Table II,
when the retesting was done one or two days later
only 59 per cent gave exact agreement, 37 per cent
differed by one dilution, and 4 per cent gave re-
sults differing by two dilutions. For this group
additional variables contributing to disagreement
are as follows :
574
Minnesota Medicine
QUANTITATIVE VDRL SLIDE TEST— KIMBALL AND BAUER
TABLE IV. CORRELATION OF QUANTITATIVE KAHN AND QUANTITATIVE VDRL TESTS ON 628 SPECIMENS
Standard
Kahn
Result
Serum
Dil.
Quanti-
tative
Kahn
Units
VDRL Test Results *
T otal
No.
Neg.
W.P.
Pos.
Undil.
Only
Positive in Dilutions
1:2
1:4
1:8
1:16
1:32
1:64
1:128
1:256
Pos 4 +
1:150
600
1
1
2
Pos 4 -j-
1:100
400
1
2
3
Pos 4 +
1:80
320
1
1
Pos 4 +
1:60
240
3
3
6
Pos 4 +
1:40
160
1
1
1
3
Pos 4 -j-
1:20
80
1
3
9*
9
22
Pos 4 -j-
1:10
40
14
18*
12
1
45
Pos 4 +
1:5
20
1
4
20
19*
5
3
52
Pos 4 -j-
1:2.5
10
1
9
37
36*
17
2
102
Pos 4 +
0
4
8
7*
3
1
19
Pos 3 +
0
3
7
29
34*
4
2
76
Pos 2 +
0-
2
1
4
28
25*
9
2
69
Dbt 1 +
0
1
8
32*
12
5
1
58
Dbt ±
0
Yl Unit
4
9*
2
2
17
Neg
0
Neg
76
40*
29
7
1
153
Number
79
56
105
92
99
66
54
29
26
14
8
628
*Median Titre (see text)
1. Slight variation in the antigen emulsion pre-
pared on different days.
2. Effect of reinactivation on the specimens.
Study of Second Specimens
From 210 individuals we have received two
specimens collected within one week. Within seven
days we would seldom expect to see significant
changes in titre of positivity except in progressing
primary syphilis. An analysis of the agreement
and disagreement of quantitative tests on these
pairs of specimens from 210 individuals is pre-
sented in Table III. Exact agreement was ob-
tained in 53.8 per cent. The percentage of speci-
mens showing disagreement to the extent of one
dilution or two dilutions is very similar to the
results obtained with testing the same specimen on
different days, as shown in Table II. From this
we conclude that differences of one dilution on
two specimens cannot be considered to indicate
any significant change in titre of positivity, and in
a small percentage of cases even two dilutions may
be due to technical variations. In only one pair
of specimens was there disagreement in excess of
two dilutions. These specimens were from a case
of primary syphilis (see Case D, Table VI). The
first specimen was positive in dilution 1 :8, the
second, collected seven days later, was positive in
dilution 1 :64. A third specimen, received from
this individual four months later, gave negative
VDRL and Kolmer-Wassermann test results.
Comparison with the Quantitative Kahn
Quantitative Kahn tests and quantitative
VDRL slide tests have been done on 628 speci-
mens. In Table IV the number of specimens giv-
June, 1950
ing each grade of quantitative Kahn test result is
shown, as well as the dilutions positive by the
quantitative VDRL slide test. The median titre
for the quantitative VDRL test is starred for
each type of quantitative Kahn reaction except the
five highest titres. Too few specimens fall into
these groups to permit designating a median titre.
The quantitative A^DRL tests gave the median ti-
tre indicated or varied only one dilution in 91
per cent of the specimens. Only five specimens
varied by more than two dilutions from the me-
dian titres indicated. Three of these five speci-
mens were from the same individual and gave
quantitative Kahn titres of 20 units, 10 units, and
2 units, respectively. The VDRL, Kolmer-Was-
sermann, and Hinton tests were all negative on
these three specimens. This individual is not a
reported case of syphilis, and these are probably
false positive Kahns.
Table IV clearly indicates the greater sensitiv-
ity of the VDRL test as compared with the Kahn.
The dilutions used for the quantitative Kahn are
given to bring out this difference. For example,
forty-five specimens gave quantitative Kahns of
40 units. These Kahn tests are positive in a se-
rum dilution of 1 :10. When these forty-five spec-
imens were tested by the quantitative VDRL
test, fourteen were positive in dilution 1 :16, eight-
een positive in dilution 1 :32, twelve in dilution
1 :64, and one in dilution 1 : 128. With the 153
specimens giving negative Kahn tests the VDRL
test results were negative in seventy-six, weakly
positive in forty, positive “undiluted only” in
twenty-nine, positive diluted 1 :2 in seven, and
positive diluted 1 :4 in one.
Taking into consideration the technical varia-
575
QUANTITATIVE VDRL SLIDE TEST— KIMBALL AND BAUER
TABLE V. CORRELATION OF SPINAL FLUID TEST RESULTS WITH QUANTITATIVE VDRL
SLIDE TEST RESULTS ON BLOODS FROM 168 KNOWN CASES OF SYPHILIS
VDRL Slide Test Results on Blood
Spinal Fluid
Neg
Wk Pos
Pos
Undil.
Pos
Pos
Pos
Pos
Pos
Pos
Pos
Pos
Total
Only
1:2
1:4
1:8
1:16
1:32
1:64
1:128
1:256
1. Kolmer and VDRL
positive
1
2
5
7
10
10
7
8
7
1
4
62
2. Kolmer or VDRL test
positive*
3. Kolmer and VDRL tests
1
3
3
6
3
2
0
2
4
1
1
26
negative
1
3
8
13
23
12
6
6
4
4
0
80
*Kolmer positive, VDRL test negative on 9 specimens.
Kolmer negative, VDRL test positive on 7 specimens.
Kolmer positive, insufficient material for VDRL test on 10 specimens.
tions in test procedure in these two methods of
quantitation, the correlation of the results is good.
Quantitation by both procedures adds little, if
any, significant information.*
Spinal Fluid Test Results Compared with
VDRL Blood Test Results
Both spinal fluid and blood specimens have been
tested on 168 known cases of syphilis. These re-
sults are presented in Table V classified into three
groups according to the results on the spinal
fluids : ( 1 ) Kolmer and VDRL tests both posi-
tive; (2) Kolmer or VDRL test positive; and (3)
Kolmer and VDRL tests both negative. The
quantitative VDRL tests on the blood serum show
an equally wide range of titre in all three groups.
In group 1 with both tests positive on the spinal
fluid, 24 per cent of the blood specimens are posi-
tive diluted only 1 :2 or show even weaker results.
In group 2 with one test positive on the spinal
fluid, 32 per cent of the bloods are positive diluted
1 :2 or weaker.
Colloidal gold curves have also been done on the
majority of these specimens. In group 1 the gold
curves were positive on forty-one specimens
(thirty-six gave “paretic” type curves) and nega-
tive on twenty. Nine positive colloidal gold
curves were on spinals from the fifteen persons
with low titre (1:2 or less) quantitative tests in
the blood. In group 2, positive gold curves were
obtained on ten spinal fluids (eight gave “paretic”
type curves) and fifteen were negative. Four of
the positive gold curves were on spinals from the
thirteen persons with low titre ( 1 :2 or less) quan-
titative tests in the blood. One specimen in group
^^Quantitative Kahn tests have ’been done on special request in
these laboratories. The quantitative Kahn test is to be discon-
tinued after September 30, 1950. Both quantitative Kahns and
VDRL slide tests will be done when the quantitative Kahn is
requested during the transition period, July, August, and Sep-
tember, 1950, providing the volume of serum is sufficient. Two
full vials will be necessary for the battery of tests (VDRL, Kol-
mer, Kahn, Hinton, and quantitative Kahn and VDRL).
576
1 and one in group 2 was insufficient for the gold
curve. In the negative group (3) one positive
gold curve was obtained ; forty-eight gave nega-
tive gold curves. This test was not done on the
thirty-one remaining specimens. f
The important point brought out by the data in
Table V is that, if the blood serum shows only a
low titre positivity, this is no assurance that the
spinal fluid will be negative, nor is a high titre
suggestive that the spinal fluid will be positive.
Consequently the quantitation of positivity in
blood serum is of no value in predicting the reac-
tion in spinal fluids. Whenever indicated, spinal
fluid should be examined regardless of the re-
sults on the blood.
Illustrative Cases
*
In Table VI are given the serologic findings on
a few selected individuals. Additional data on
these patients follow.
(A) This individual is not syphilitic. The di-
agnosis was infectious mononucleosis, which fre-
quently gives false positive tests for syphilis. The
heterophile antibody titre was positive in dilution
1 :640 on the first blood specimen tabulated.
(B) This is not a case of syphilis. The indi-
vidual was vaccinated for smallpox “shortly” be-
fore the collection of the first blood specimen.
Several times each year we see false positives fol-
lowing smallpox vaccination, which on occasion
show stronger positivity than Case B.
(C) Primary syphilis. Penicillin treatment
given in the interval between the two blood spec-
imens.
(D) Primary syphilis. Penicillin, neoarsphen-
amine, and bismuth administered between the sec-
ond and third specimens.
tThe colloidal gold test is done only on request and on those
spinal fluid specimens showing a positive serological test for
syphilis.
Minnesota Medicine
QUANTITATIVE VDRL SLIDE TEST— KIMBALL AND BAUER
TABLE VI. ILLUSTRATIVE CASES
Patient
Lues
Days after
1st spec
Results on
Serological Tests for Syphilis
VDRL
Quantitative
VDRL
Kolmer
Standard
Kahn
Hinton
A
No
0
Pos
1:2
Pos 4 +
6
Pos
Undil. only
Dbt ±
Neg
Neg
B
No
0
Pos
1:2
Dbt 1 -f-
3
Pos
Undil. only
Neg
Pos 3 +
Pos 4 +
14
Pos
Undil. only
Neg
Pos 2 +
Pos 3
34
Neg
Neg
C
Primary
0
Pos
1:16
Neg
Pos 4 +
Pos 4 +
68
W.P.
Neg
Neg
Neg
D
Primary
0
Pos
1:8
Pos 4 +
7
Pos
1:64
Pos 4 +
Pos 4 +
Pos 4 +
143
Neg
Neg
E
Secondary
0
Pos
1:128
Pos 4 +
6
Pos
1:64
Pos 4 -|-
Pos 4 +
Pos 4 +
80
Pos
1:8
Dbt 1 +
Pos 2 4-
Pos 2 +
F
Early Latent
0
Pos
1:16
Pos 4 +
18
Pos
1:8
Pos 4 +
F'
No
0
Pos
1:2
Pos 4 +
Pos 3 +
Dbt =t
13
Pos
Undil. only
Pos 4 -j-
Pos 2 +
Dbt ±
21
W.P.
Pos 4 +
Neg
Neg
40
W.P.
Pos 4 +
Dbt ±
Dbt ±
51
Neg
Pos 4 -j-
Neg
Neg
71
Neg
Neg
Neg
Neg
G
Early Latent
0
Pos
1:4
Dbt 1 +
Pos 3 +
Pos 4 +
43
Pos
1:2
Pos 4 +
Pos 3 +
Pos 4 +
127
Pos
1:2
Pos 4 +
Pos 3 +
Pos 3 +
189
Pos
1:2
Pos 2 -j-
Pos 3 +
Pos 4 -j-
H
Cardio-
0
Pos
1:2
Pos 4 +
vascular
49
Pos
1:2
Pos 4 -j-
60
Pos
1:2
Pos 4 -j-
62
Insuff*
Pos 4 +*
I
Secondary
0
Pos
Dbt ±
With Relapse
5
Pos
Dbt ±
Pos 3 +
Pos 4 +
11
Pos
Pos 3 +
Pos 4 +
Pos 4 +
93
Neg
Neg
Neg
Neg
160
Neg
Neg
279
Neg
Neg
366
Pos
1:2
Dbt 1 +
Neg
Pos 3 +
476
Pos
1:32
Pos 4 +
Pos 4 +
Pos 4 -j-
494
Pos
1:32
Pos 4 +
Pos 4 +
Insuff.
*Spinal Fluid.
(E) Secondary syphilis. Source of infection
to Case C above. Penicillin treatment given in the
interval between the second and third specimens.
(F) Early latent syphilis. First specimen col-
lected five days prior to delivery of infant. Syph-
ilis diagnosed and treated two months prior to
delivery.
(F') Infant of Case F. One month old when
first blood was submitted. According to our rec-
ords, no treatment was administered to the infant,
and the case has not been reported.
(G) Early latent syphilis was diagnosed in 1943.
Irregular and inadequate treatment for several
years. Adequate treatment regime in 1947 and
1948, completed nine months prior to the first
specimen tabulated. Spinal fluid negative in 1947.
No change in positivity in the seven-month period
covered. This patient’s blood will probably not
become negative.
(H) Cardiovascular syphilis. Diagnosed and
treated six years ago. Spinal fluid examination
June, 1950
requested but not done at that time. Positive spi-
nal fluid collected two days after the third blood
specimen tabulated.
(I) Originally reported as secondary syphilis.
Adequately treated with penicillin, arsenic and
bismuth for eight months. Attending physician
evaluates the later change as a relapse.
Discussion
Requesting repeat specimens (two full vials)
on all diagnostic problems will be continued. The
results on the Kahn and Hinton tests, in addition
to the VDRL and Kolmer, will frequently aid in
diagnosis or exclusion of syphilis. (See patients
A and D in Table VI.)
There is no evidence establishing that the height
of titre of any quantitative tests for syphilis cor-
relates directly with clinical activity. The value of
the quantitation is that the higher the titre is, the
stronger the serological evidence is for supporting
a diagnosis. In addition, the change in titre can be
577
QUANTITATIVE VDRL SLIDE TEST— KIMBALL AND BAUER
noted during treatment which can, on occasion,
give an earlier warning of relapse than would
be possible with qualitative tests.
Referring to Table I, the greater incidence of
anticomplementary Kolrner test results in very
high titred specimens is apparent. It is well es-
tablished that anticomplementary reactions occur
frequently in specimens giving very high titred
quantitative tests and in contaminated specimens.
Also, blood serum from some individuals is anti-
complementary because of unknown factors. Be-
cause bacterially contaminated specimens are asso-
ciated with anticomplementary reactions, the
quality of any anticomplementary specimen may
be questioned. As a result, the two basic recom-
mendations ( 1 ) that all positive blood tests be re-
peated before diagnosis and (2) that bloods be
collected with sterile technique, both become even
more important when considering an anticomple-
mentary result.
When an anticomplementary result is reported
and when serological results are for any reason
questionable, it will frequently be necessary to
submit several specimens over a period of months,
and a spinal fluid, before a sound conclusion can
be reached as to diagnosis or exclusion of syphilis.
As is readily understandable, we have no clini-
cal data on a large percentage of patients in this
study. We hope that none the less the data here
presented will prove valuable. Quantitative
VDRL tests have been reported to Dr. F. W.
Lynch, Saint Paul, and he is presenting his evalu-
ation of the procedure in this issue.2
Summary
Starting July 1, 1950, it is planned to report all
positive VRDL slide test results quantitatively.
Quantitation has the following advantages :
1. The higher the dilution in which the test is
positive, the less is the possibility of a false
positive.
2. Changes in titre can be followed during
treatment. This is most important in early
syphilis.
Limitations :
1. Regardless of the quantitation, all positive
tests should be repeated. Two full vials of
blood for the “battery of tests” are desirable
on second specimens.
2. Variations of one dilution (first specimen
positive diluted 1 :4, second specimen positive
diluted 1 :8) have no significance, since such
change can be due to several technical vari-
ations in the test procedure.
3. Strength of positivity as indicated by the di-
lution does not correlate with the clinical
activity of the infection.
4. Spinal fluid examination should be made
whenever indicated, regardless of the quan-
titative result, since over 25 per cent of
patients with positive spinal fluids have low
titre positive reactions in the blood (positive
diluted 1 :2 or weaker.)
5. Approximately 6 per cent of our specimens
have been insufficient for quantitation. One
full vial (6.0-7.0 c.c.) is requested.
The quantitative Kahn test (done only on spe-
cial request) will be discontinued on October 1,
1950.
Bibliography
1. Harris, A., Rosenberg, A. A., and Riedel, L. M. : A
Microflocculation test for syphilis using cariolipin antigen.
J. Ven. Dis. Inf., 27:169-174, (July) 1946.
2. Lynch, F. C. : The clinical application of quantitative re-
ports of serologic tests for syphilis. Minnesota Med., 33:
579 (June) 1950.
3. Pangborn, M. C. : A new serologically active phospholipid
from beef heart. Proc. Soc. Exp. Biol, and Med., 48 :484-
486, 1941.
FALL IN TUBERCULOSIS DEATH RATE
The annual death rate from tuberculosis dropped 10
per cent in 1948 to 30.0 per 100,01X1 population, Federal
Security Administrator Oscar R. Ewing said today. He
cited an article, “Tuberculosis Mortality in the U. S.
1948,” which appears in the current Tuberculosis Control
Issue of Public Health Reports, published by the Public
Health Service, Federal Security Agency.
The decline in the tuberculosis mortality rate, the
article points out, has accelerated during the postwar
years. The rate dropped 5 per cent from 1945 to 1946,
and 7 per cent from 1946 to 1947.
The tuberculosis death rate for the population as a
whole has been steadily declining for the past twenty
years, so that the 1948 rate was less than half the 1930
rate, according to the article. The decline is sharper in
some sections of the population than in others — sharpest
of all in children under fifteen years of age. In persons
over sixty-five years of age, on the other hand, the de-
cline has been slow, and indeed in white males over
sixty-five the tuberculosis death rate was higher in 1948
than in 1941.
In general, the article points out, the tuberculosis death
rates for women have fallen more rapidly than those for
men. The 1948 rate for females was about half of that
for males. Mortality rates from this disease continue
to be more than three times as high for the nonwhite
groups as for the white, the article says.
The state with the lowest tuberculosis death rate in
1948 was Iowa with a rate of 9.5 per 100,000 population.
The state with the highest rate, Arizona, dropped from
100 in 1947 to 82.4 in 1948. — Public Health Senice Re-
lease April 12, 1950.
578
Minnesota Medicine
THE CLINICAL APPLICATION OF QUANTITATIVE REPORTS OF SEROLOGIC
TESTS FOR SYPHILIS
FRANCIS W. LYNCH, M.D.
Saint Paul, Minnesota
SINCE the Serologic Laboratories of the Min-
nesota Department of Health will soon re-
port quantitatively on reactions in serial dilu-
tions of specimens tested with the VDRL antigen,
this paper is presented in the hope of familiariz-
ing Minnesota physicians with the expected ad-
vantages of such reports. Syphilis is not common
in Minnesota but this fortunate fact does not les-
sen the need for offering these syphilitic patients
the best possible care. The discussion is based on
the results of studies on specimens submitted to
the Minnesota Department of Health from pri-
vate practice and from Ancker Hospital from Oc-
tober 1, 1949, to April 1, 1950, attempting to eval-
uate the limitation and advantages of such tests.*
Capable clinicians may immediately ask whether
these detailed reports may not encourage over-
dependence upon laboratory procedures and there-
by diminish clinical acumen and effort. While
this paper points out certain advantages to be
gained from quantitative studies, the author wish-
es first to warn against too great dependence upon
tests and his purpose is to assist in their cautious
and correct application.
The most clearly evident limitations of quanti-
tative tests are :
1. Quantitative studies do not eliminate the
possibility of technical or clerical errors and one
must not depend on results obtained on a single
specimen.
2. Serial dilution of serum does not increase
the specificity of a serologic reaction.
3. There is no dependable relation between the
amount of reagin and severity of syphilis or the
need for treatment.
Specificity
The VDRL antigen has increased the specificity
of serologic tests for syphilis and quantitative re-
porting! will increase diagnostic accuracy in some
Presented before the Minnesota Academy of Medicine, May 10,
1950, at St. Paul, Minnesota.
*This study was carried out with the generous co-operation of
the Medical Laboratories of the Minnesota Department of Health,
and consists of clinical observations relating to approximately 4
per cent of the positive serologic reactions studied in detail by
Drs. Kimball and Bauer and reported in this issue of Minne-
sota Medicine.
tDetails regarding the quantitative VDRL technic and method
of reporting are discussed by Dr. Kimball.
June, 1950
“The interpretation of serologic tests for syphilis
is of paramount importance in the diagnosis of
syphilis and the follow-up of treated patients.”
Evan W. Thomas in
“Syphilis, Its Course and Management.”
cases since reactions occurring at higher dilutions
are more likely to be specific than those observed
only in undiluted serum. Just as before, in doubt-
ful cases the VDRL report must be correlated
with others since the likelihood of a false reaction
is increased when there is conflict (e.g., VDRL
negative, Kolmer positive, or the reverse). Varia-
tions in intensity of reaction may be reported in a
series of tests at intervals of one or several weeks.
While slight variations may be of no signifi-
cance,! greater ones suggest lack of specificity,
and sustained upward trends are likely to be sig-
nificant of increasing specific activity. Since time
to observe the serologic trend may be of great help
in diagnosis, it is fortunate that in the absence of
clinical evidence or spinal fluid changes, there sel-
dom is need for haste. The addition of quanti-
tative study does not change the general princi-
ples that through physical examination, accurate
personal and familial history, spinal fluid study,
and patience are necessary for the accurate diag-
nosis of syphilis.
In this series diagnostic help from quantitation
was obtained in several cases. Diagnosis had long
been delayed in one case because of numerous
variable and conflicting reports, but after several
years a specimen was reported as 4-plus in all
tests and VDRL positive in dilution of 1 :8, and
later at 1 :16, the higher dilutions suggesting that
the progressive serologic change had been great
rather than slight in degree, as might have been
suspected if the VDRL test had been reported
only as positive.
In another instance a false diagnosis of syphilis
may have been averted in the case of a penile le-
sion closely resembling a chancre. A series of
tests was reported as follows :
Kline 2-plus 2-plus 4-plus
VDRL pos. pos. pos.
undiluted undiluted
tDr. Kimball’s Tables II and III illustrate the variations to be
expected in results on repeated testing of single specimens or on
repeated specimens.
579
SEROLOGIC TESTS FOR SYPHILIS— LYNCH
Too much importance was not placed upon the
4-plus report since the VDRL reaction occurred
only in low titre. Only a few days later both tests
reverted to negative. (Fortunately the Kolmer re-
action had remained negative throughout the pe-
riod of observation.)
In serial studies of several patients the VDRL
reaction ranged from negative to positive in dilu-
tion of 1 :2 in cases where other tests were report-
ed negative to 4-plus, and no diagnosis of syphilis
was made. Dr. Kimball’s illustrative cases A and
P> further demonstrate these points.
Activity of Infection
Rising serologic titres must be appraised as
possible evidence of early, untreated syphilis (ac-
quired or congenital). Negative reactions occur
during the first four or five weeks of infection,
then follows a rather rapidly progressive rise in
titre to a peak during the “secondary stage” of
the disease, after which the serologic titre de-
creases and within a year or two becomes fairlv
stable, at levels which vary greatly from patient
to patient and seem to have little or no relation
to the severity of the disease. Though the sero-
logic level is not directly related to the activ-
ity of the disease, negative serologic reactions are
rare in active late syphilis. Clinical evidence of
previously active inflammation may or may not be
accompanied by serologic activity (e.g., cutaneous
or osseous scars or inactive— “burned-out” — tabes
with residual neurologic changes).
The following examples from this series show
how undependable is the titre as an indicator of
activity of infection and need for treatment:
Titre
Nature of the Syphilis
1 : 128
old,
previously treated for cutaneous gumma.
1 :64
old,
previously treated slightly
1 :64
old,
untreated, cardiovascular syphilis.
1 :32
late,
active cutaneous syphilis.
1 :16
late,
active neurosyphilis.
1 :8
late,
persistent spinal fluid changes, recently
re-treated.
1 :2
late,
treated, seroresistance in spinal fluid.
undil.
active interstitial keratitis.
Such examples clearly illustrate that quantita-
tive reports must not be used as direct indications
of the necessity for, or the character or amount
of, treatment. The data presented by Dr. Kimball
in Table 5 (and her Case H) clearly shows a lack
of positive correlation between the degree and ac-
tivity of neurosyphilis (as shown by spinal fluid
changes) and the degree of reaction to the VDRL
test.
Response to Treatment
The greatest advantage of quantitative serologic
study is in the evaluation of results of modern,
rapid, intensive therapy for early syphilis. Here
one expects a rapid, progressive drop in titre to
negativity in one to four months. (When treat-
ment has been instituted before serologic reac-
tions have become positive, or while they are still
increasing in intensity, there may be a transitory
rise immediately after starting to treat — a “sero-
logic Herxheimer reaction”). Even when treat-
ment has been started as early as one or two
months after infection, one will observe some pa-
tients whose serologic response progresses stead-
ily to a point just above negativity (e.g., weak
positive, or positive undiluted only, or in dilution
of 1 :2) and then persists at that level, fluctuates
slightly, or diminishes verv slowly. Treatment
has not failed ; these patients have had adequate
therapy and need not be re-treated. After treat-
ment of early syphilis the blood should be tested
monthly for a year, every two or three months the
second year and semi-annually thereafter. The
spinal fluid must be examined six to twelve
months after completion of treatment, and ab-
normal changes require immediate therapeutic at-
tention.
Tn this series a serologic Herxheimer reaction
was noted in a patient with late congenital syphilis
with doubtful serologic reactions, given penicillin
therapy because of interstitial keratitis. Before
treatment, on two occasions the Kolmer reaction
was negative and the VDRL positive undiluted
only, but following treatment the Kolmer re-
action was doubtful 1 plus-minus and the VDRL
positive when diluted 1 :2.
In other instances the serologic reaction be-
came less intense following treatment. A woman
treated late in pregnancy gave birth to an infant
who later developed evidence of osseous syphilis,
and serologic reactions of Kline 4-plus, Kolmer
4-plus, VDRL positive in dilution of 1 :2. Peni-
cillin therapy was begun five weeks after birth and
all the serologic reactions were completely nega-
tive three months later. Dr. Kimball’s cases C.D.
and E. illustrate similar response to treatment.
After rapid intensive treatment for early
syphilis seroresistance at relatively high levels is
rare (e.g., dilutions of 1:8 or greater). When
580
Minnesota Medicine
SEROLOGIC TESTS FOR SYPHILIS— LYNCH
there is no clinical evidence of active inflamma-
tion and the spinal fluid is normal, the significance
of such seroresistance is questionable. Perhaps
there may be small foci of slowly progressive in-
fection or equally possibly the high level of anti-
gen represents a favorable degree of immunity.
At any rate there is little risk if such patients are
re-treated after six months and then closely ob-
served but given no therapy thereafter, unless the
titre rises further.
The greatest benefit of quantitative tests is the
early demonstration of serorelapse or re-infection
(illustrated by Dr. Kimball’s Case I) . Serological-
ly the two are indistinguishable. It must be em-
phasized that such setbacks are proved only when
noted on two or more tests and never on a rise
of serologic titre demonstrated on a single speci-
men. Clinically, the chancre of reinfection pre-
cedes the rise in titre while the mucocutaneous in-
fectious relapse follows serorelapse. Frequently,
it is important to distinguish the sequence and
this can hardly be done without a series of tests
with quantitative reports.
Early latent syphilis may respond less rapidly
as in the patient whose reactions at start of
therapy were Kline 4-plus, Kolmer 4-plus, VDRT.
positive 1 : 1 6 and were the same one month later.
At four months the Kline and Kolmer remained
4-plus, but the VDRL was positive only in 1 :8
dilution, offering evidence of some favorable ef-
fect from the treatment (See also Dr. Kimball’s
case F. )
In a patient with previously treated asympto-
matic neurosyphilis the giving of penicillin failed
to modify a VDRL positive reaction at 1 :8 dilu-
tion. However, in clinically progressively active
neurosyphilis similar treatment was followed by
a change from VDRL positive at 1 :16 to positive
only when undiluted. (The Kolmer reaction re-
mained 4-plus and the Kline changed from 4-plus
to 3-plus).
Conclusions
Serologic study is increasingly important in
syphilis, with quantitative reports offering cer-
tain advantages, which have been illustrated by
examples selected from reports on a recently ob-
served series of patients.
1. With reference to the recognition of false
reactions, positivity in higher dilutions increases
the likelihood that the reaction is specific.
2. Steadily rising titres may be demonstrated
in early, acquired syphilis and in early, congenital
syphilis (regardless of whether treatment was
given the mother during pregnancy).
3. Transitory increase in titer may be found
immediately after the institution of treatment
(serologic Herxheimer reaction).
4. Falling titres are expected as a result of
treatment, especially after modern intensive treat-
ment for early syphilis. The most significant ap-
plication of quantitative reports occurs in early
syphilis with an initially favorable serologic re-
sponse to treatment but later showing progressive
increases in titre (serorelapse). Recognition of
this serologic change allows institution of re-
treatment before clinical, infectious relapse exerts
its disastrous influences on patient, family or
other persons.
5. Quantitative reports are of considerably
less significance in all other circumstances and the
clinician must not base decisions on insignificant
changes. It must be particularly remembered, for
example, that positive in 1 :64 dilution does not
mean “twice as much syphilis” as in 1 :32 dilution,
but only that one more dilution of the serum al-
lowed demonstration of a positive reaction which
may have been due to technical error, extrinsic
changes after collection of the serum, or normal
and natural variation in the serum content of
syphilitic reagin, without significance on the ulti-
mate course of the disease.
6. It may be pertinent to point out a sequence
not observed in this series. When gonorrhea and
syphilis’ are acquired simultaneously, the former
is often treated by penicillin before the latter is
serologically or clinically demonstrable. The
syphilitic infection may be aborted, masked or
delayed in its appearance but frequently repeated
serologic tests will aid in its early recognition and
rising quantitative titers have obvious significance.
Health education and sanatorium treatment are our
two greatest weapons in fighting tuberculosis. We must
remember that each patient with active tuberculosis
presents a medical problem, a social and welfare prob-
June, 1950
lem, an economic problem and. let us never forget, a
public health problem. — R. D. Johnson, M.D., Bull.
Nat. Tuber. A., Jan., 1950.
581
PROGRESS IN MATERNAL AND INFANT HEALTH IN MINNESOTA
A Statistical Study of the Decade 1939-1949
A. B. ROSENFIELD, M.D., M.P.H.
Minneapolis, Minnesota
and
J. W. BROWER, M.A.
Saint Paul, Minnesota
Maternal Mortality
ATIONALLY, during the past decade the
^ maternal mortality rate has dropped from 4
per 1,000 live births in 1939 to approximately 1
per 1,000 in 1949, a reduction of 75 per cent. In
Minnesota the 1939 maternal mortality rate of 2.7
decreased to 0.7 per 1,000 live births in 1949, a
similar reduction of 74 per cent. This period in-
cluded the war years with their rising birth rates
and reduced medical and nursing personnel. Dur-
ing the past five years, 1945-1949 inclusive, there
was a reduction of 50 per cent, from 1.4 to 0.7
per 1,000 live births.
In 1947, at the peak of our birth rate (75,468
live births), Minnesota’s mortality rate dropped
to a new United States low of 0.6 per 1,000 live
births. While we may well be proud of this ac-
complishment, which appears to have brought us
to an almost irreducible minimum, it is apparent
that a still greater reduction is possible when we
consider that Oregon reduced its rate to a new
national low of 0.4 per 1,000 live births in 1948.
The possibility of further reduction in maternal
mortality is also indicated bv a preliminary study
of the recent EMIC program in Minnesota. Dur-
ing the four full years of the program, 1944-1947,
a total of 18,457 live births occurred, with a ma-
ternal mortality rate of 0.7 per 1,000 live births.
During this same period, 232,207 live births oc-
curred in Minnesota outside the program, with a
mortality rate of 1.1 per 1,000 live births, a very
significant difference of 36 per cent. It should be
noted, however, that the live births in the EMIC
program constituted only 7 per cent of the total
live births in the state during the four years men-
tioned. No data are available in our records as to
parity of the mother. A preponderance of moth-
ers were, however, in the safest age group of
fifteen through twenty-nine years (88 per cent in
contrast to the usual state proportion of only
about 68 per cent), and the group was a more
favored one economically, since medical and hos-
pital care were provided for the asking. Never-
Dr. Rosenfield is Director, Division of Maternal and Child
Health, Minnesota Department of Health.
Mr. Brower is Director, Division of Vital Statistics, Minnesota
Department of Health.
theless, the value of adequate and competent pre-
natal care, good obstetrical and postpartum care,
hospitalization, consultation, and the use of blood
and antibiotics, as well as public health programs,
cannot be overlooked.
Because of the small number of maternal deaths
in each county, there may be quite marked varia-
tions in rates from year to year. For this reason,
maps were prepared for five-year periods. Map
1 includes all maternal deaths from 1935 through
1939, by counties. Map 2 includes deaths for 1945
through 1949. These maps show five years of re-
corded maternal deaths rather than the usual resi-
dent figures, in order to allocate deaths to the
county of occurrence rather than the county where
the prospective mother was given prenatal care.
It is realized that this approach may influence
rates adversely in some counties, but it may also
indicate the areas where periodic study of their
own maternal problems may be of value to com-
munities in reducing preventable deaths. A com-
parison between maps 1 and 2 provides a graphic
presentation of the improvement in maternal mor-
tality during the period covered.
The state maternal death rate for the five-year
period 1935-1939 was 3.5 per 1,000 live births.
Twenty counties had rates less than 2.0; forty-
three had rates between 2.0 and 4.0; twenty-four
had rates over 4.0. Ten years later, in the five-
year period of 1945-1949, rates were strikingly
lower. The state maternal deaths rate was 0.85
per 1,000 live births. Eighty-one counties had
rates less than 2.0 ; only five had rates between 2.0
and 3.9; only one county had a rate of 4.0 (5.3,
to be exact) .
The chief causes of maternal deaths are infec-
tion, toxemia, and hemorrhage. Table I shows
the changes in percentage of deaths due to these
causes during the ten-year interval under discus-
sion.
In 1939, thirty-two (24 per cent) of the 136
maternal deaths were due to infection; twenty-six
(19 per cent) to toxemia and a similar number to
hemorrhage; and fifty-two (38 per cent) to other
causes. In 1949, fifteen of the fifty-four maternal
582
Minnesota Medicine
MATERNAL AND INFANT HEALTH— ROSENFIELD AND BROWER
deaths were due to infection (28 per cent), an in-
crease of 4 per cent over the 1939 figures.
Toxemia caused eleven deaths (20 per cent) ;
hemorrhage was responsible for ten deaths (18.5
During the period from July 1, 1941 through
June 30, 1942, the maternal mortality committee
of the Minnesota State Medical Association in
co-operation with the Minnesota Department of
TABLE I. MATERNAL DEATHS BY CAUSES AND PER
CENT OF CHANGE PER 10,000 LIVE BIRTHS
Minnesota, 1949 and 1939
Causes
Number
Rates
Per Cent of
1949
1935
1949
1939
Change
All causes
54
135
7.0
27.0
-74
Infection
1 5
32
2.u
6.3
-65
Toxemia
ii
26
1.4
5.2
-73
Hemorrhage
10
26
1.3
5.2
-75
All others
18
52
2.3
10.3
-78
per cent) ; and eighteen (33 per cent) were due
to other causes. From 1939 to 1949, there was a
74 per cent reduction in all causes;* death from
infection decreased 65 per cent ; the other causes
of maternal deaths decreased approximately 75
per cent.
The decrease in mortality for the three main
causes of maternal deaths has undoubtedly been
due to a number of interrelated factors. These
include better obstetrical practice, more extensive
and more adequate prenatal care, early transfu-
sions, sulfonamides and antibiotics, increased hos-
pitalization (more than 97 per cent in Minne-
sota), improved hospitalization facilities, and an
increasing awareness by the public of the im-
portance of adequate care, which has been pro-
moted through public health education.
June, 1950
Health conducted an intensive study of the 112
maternal deaths that occurred in that period. In
its report the committee pointed out the extent to
which the physician was responsible for maternal
deaths, as well as the importance of adequate pre-
natal care. It is felt that the study was a sig-
nificant factor in the subsequent reduction of
maternal mortality in this state. The Council of
the Minnesota State Medical Association has ap-
proved a similar study by its maternal health com-
mittee for the year of 1950 in an effort to reduce
maternal mortality still further.
The largest number of births occurred in the
age groups twenty to twenty-four and twenty-
five to twenty-nine. These made up 59 per cent
of the total in' 1939 and 61 per cent of the 1947
total (Table II). Risks in childbearing were low-
583
MATERNAL AND INFANT HEALTH— ROSENFIELD AND BROWER
TABLE II. MATERNAL MORTALITY BY AGE GROUPS
Minnesota, 1947 and 1939
Age
at
Death
TOTAL
Live Births
1947* 1939
75,577 50,237
Maternal
Deaths
1947 1939
47 136
Rates per 10,000
Live Births
1947 1939
6.0 27.0
Per Cent
of
Change
—78
10-14 yrs.
15-19 “
20-24 “
25-29 “
30-34 “
35-39 “
40-44 “
45-49 “
50 and Over
Not Stated
25 13
5,325 3,876
23,662 15,107
22,444 14,446
14,480 9,541
7,373 5,255
2,044 1,832
127 158
15 3
82 6
1 7
11 20
9 32
3 31
16 28
7 15
0 3
1.9 18.1
4.7 13.2
4.0 22.1
2.1 32.5
21.7 53.3
34.2 81.9
189.9
—89
—64
—82
—66
—59
—58
— 100
‘Maternal age groups for 1948 and 1949 are not yet available.
TABLE III. LIVE BIRTHS, INFANT DEATHS, AND STILLBIRTHS
Minnesota, 1949 and 1939
Number
1949 1939
Per Cent of
Change
Rate per 1,000 l.b.
1949 1939
Live Births
Infant Deaths
Stillbirths
73,627 50,237
1.922 1,798
1,215 1,217
+47
+7
0
26.1 35.8
16.4 24.2
Per Cent of
Change
—27
—32
TABLE IV. TOTAL MINNESOTA AND INDIAN LIVE BIRTHS AND INFANT DEATHS
Minnesota, 1939 and 1949
Year
Live Births
Minnesota
Indian
Infant Deaths
Minnesota
Indian
No.
No.
No.
Rate/1,000 l.b.
No.
Rate/1,000 l.b.
1939
50,228
537
1,798
35.8
22
41.4
1949
73,627
574
1,922
26.1
32
55.7
est in the age group twenty to twenty- four in
1939 with a mortality rate of 13.2 per 10,000 live
births. For mothers fifteen to nineteen years old
and twenty-five to twenty-nine years old the
death rates were below those for all ages. Among
mothers thirty years of age and over these rates
increased in each succeeding age group, with a
peak of 189.9 per 10,000 live births among moth-
ers in the forty-five to forty-nine year group.
In 1947 the entire group of mothers aged fifteen
to thirty-four years had a mortality rate of 4.7 or
less, with a marked rise in the thirty-five to forty-
four year group. The highest mortality occurred
in the forty to forty-four year group (34.2 per
10,000). The lowest rate of 1.9 was in the fifteen
to nineteen year age group. In the thirty to
thirty-four year age group it was 2.1 per 10,000
live births. A comparison of maternal deaths in
1939 and 1947 shows that the greatest reduction
took place in the fifteen to nineteen age group,
where there was a decrease of 89 per cent. In the
twenty-five to twenty-nine year age group the re-
duction was 82 per cent. A 66 per cent decrease
occurred in the thirty to thirty-four year age
group and a 64 per cent drop in the twenty to
twenty-four year group. There was a 59 per cent
decrease in the thirty-five to thirty-nine year
group and a 57 per cent decrease in the forty to
forty-four year group. No deaths occurred be-
tween forty-five and fifty years, although this
group had the highest mortality rate in 1939. In-
terestingly enough, the safest childbearing age
groups were fifteen to nineteen and thirty to
thirty-four in 1947 instead of the usual twenty to
twenty-four year age group.
Infant Mortality
(Deaths Under One Year of Age)
In 1939, a total of 1,798 infants died before
reaching their first birthday. In 1949, the number
increased to 1,922. But this 7 per cent increase in
deaths was accompanied by a 47 per cent increase
in live births during the decade. The infant mor-
tality rate, however, decreased from 35.8 to 26.1
per 1,000 live births — a reduction of 27 per cent
(Table III). Incidentally, infant deaths (under
one year of age) constitute from 70 to 75 per
cent of all deaths under the age of fifteen in Min-
nesota. The number of stillbirths has remained
about the same, but there has been a substantial
reduction in the rate from 24.2 per 1,000 live
births in 1939 to 16.4 in 1949, a 32 per cent de-
584
Minnesota Medicine
MATERNAL AND INFANT HEALTH— ROSENFIELD AND BROWER
crease. The stillbirth rate has actually decreased
5 per cent more than the infant mortality rate.
A comparison of infant death rates by county
of occurrence during 1935-1939 (Map 3) with
the rates for 1945-1949 (Map 4) graphically il-
lustrates the reduction in infant mortality during
this decade. In the five-year period 1935-1939,
the state rate was 40.6 per 1,000 live births.
Nineteen counties had rates below thirty-five.
Fifty-two had rates between thirty-five and fifty ;
sixteen had rates of fifty and over. Ten years
later, during the period 1945-1949, the state rate
decreased to 28.2. Seventy-three counties had
rates less than thirty-five ; eight counties had rates
between thirty-five and 49.9 ; and only six had
rates of fifty and over per 1,000 live births.
The non-white population in Minnesota con-
stitutes less than 1 per cent of the total state
population. There are approximately 14,000 In-
dians, constituting about 0.5 per cent of the popu-
lation, a small number of Negroes, and compara-
tively few Mexicans, Chinese, and Japanese. The
1949 infant death rate among our Indians was
more than twice as great as the overall state rate —
55.7 in contrast with 26.1 per 1,000 live births
(Table IV). The Indian rate increased more than
one-third in 1949 over that of 1939. The high in-
cidence of communicable disease among the In-
dians undoubtedly influences the infant death rate
materially. Another factor is prematurity. While
prematurity was the eighth leading cause of death
in Minnesota in 1949, it was the sixth leading-
cause among the Indians.
It should be pointed out that the rates in the
Indian group are less stable, since they are based
on a relatively small number of mothers. Since
the Indian population constitutes less than 0.5 per
cent of the state population, such rates have no
real significance and do not materially increase the
state rate. There are, however, serious health
problems in the Indian population.
The causes of infant deaths in 1939 and 1949
are shown in Table V. The. four leading causes of
death constituted over 75 per cent of all deaths
during the first year of life in both 1949 and 1939.
The leading cause was premature birth, which was
responsible for more than one-third of all deaths
in both 1949 (37.4 per cent) and 1939 (35.7 per
cent). Congenital malformations were respon-
sible for almost one-fifth of all deaths in infancy
(19.4 per cent) in 1949, and one in every twelve
deaths in 1939 (12.7 per cent). The third leading
cause of death was birth injuries, and pneumonia
and influenza were fourth.
The relative importance of the causes of death
and the percentage of change during the past ten
years is brought out more clearly when it is re-
lated to the number of live births. This is the
June, 1950
585
MATERNAL AND INFANT HEALTH— ROSENFIELD AND BROWER
TABLE V. CAUSES OF DEATH IN THE FIRST YEAR OF LIFE
Minnesota, 1949 and 1939
Deaths in the first year of life
Cause of Dealth
1949
Number
1939
1949
Rate /1,000 l.b.
1939
%
1949
Distribution
1939
All Causes
1,922
1,798
26.1
35.8
100.0%
100.0%
Premature birth
718
640
9.8
12.7
37.4
35.6
Congenital malformations
372
229
5.1
4.6
19.4
12.7
Birth injuries
245
259
3.3
5.2
12.7
14.4
Pneumonia and influenza
189
223
2.5
4.4
9.8
12.4
Congenital debility and other
disorders of early life
169
127
2.3
2.5
8.8
7.1
External causes
65
35
0.9
0.7
3.4
1.9
Diarrhea and enteritis
51
70
0.7
1.4
2.6
3.9
Acute infectious diseases
5
18
0.07
0.4
0.3
1.0
Other causes
108
197
5.6
11.0
TABLE VI. INFANT, NEONATAL AND ONE MONTH-ONE YEAR MORTALITY
Minnesota, 1949 and 1939
Number
1949
1939
1949
Rate
1,000
per
l.b.
1939
Per Cent of
Change
Infant deaths
1,922
1,798
26.1
35.8
—27
Neonatal deaths
1,440
1,258
19.5
25.0
—22
1 mo.-l yr.
482
542
6.6
10.8
—39
TABLE VII. DEATHS UNDER ONE YEAR BY AGE
PERIODS WITH PERCENTAGE OF DISTRIBUTION
Minnesota, 1949 and 1939
Age at death
1949
1939
% Change
Under 1 day
37.1%
38.7%
—4
1 day to 1 week
28.7%
21.7%
+32
1 week to 1 month
9.1%
4.5%
— 4
Under 1 month
74.9%
69.9%
+ 7
1 month to 1 year
25.1%
30.1%
—16
TABLE VIII. NEONATAL DEATHS FOR SELECTED
CAUSES BY PERCENTAGE OF DISTRIBUTION
Minnesota, 1949 and 1939
—
Per Cent
of
Deaths
Distribution
1949
1939
1949
1939
Total
1,440
1,258
100.0%
100.0%
Prematurity
707
625
49.1
49.7
Congenital malfor.
245
143
17.0
11.4
Birth injuries
Cong, debility and
242
257
16.8
20.4
other diseases of
early infancy
156
112
10.8
8.9
Pneumonia & influ.
Diarrhea & enter-
40
46
2.8
3.6
itis
15
8
1.0
0.6
External causes
14
16
1.0
1.3
Other causes
21
51
1.5
4.1
comparison of the death rate for selected causes
per 1,000 live births. The 1939 death rate of 12.7
per 1,000 live births for premature births, the
leading cause of death, decreased to 9.8, a reduc-
tion of 23 per cent. The rate for congenital mal-
formation, the second leading cause, increased 1 1
per cent. It was the tenth leading cause of death
in both 1948 and 1949. The relationship of Ger-
man measles in the first trimester of pregnancy to
the development of congenital malformations de-
serves serious consideration. A preliminary study
of mortality in Minnesota due to congenital mal-
formations, however, has shown no significant
variation in relation to the incidence of German
measles.
Deaths from injury at birth, the third leading
cause, decreased 37 per cent. This fact would in-
dicate better trained physicians and more com-
petent obstetrical care. Pneumonia and influenza,
the fourth leading cause of death, were respon-
sible for 43 per cent fewer deaths. This reduc-
tion was due, no doubt, to the use of sulfonamides
and antibiotics. Among other relatively less im-
portant causes of infant mortality, diarrhea and
enteritis showed a reduction of 50 per cent, and
deaths due to acute infectious diseases showed an
even greater reduction of over 80 per cent. On
the other hand, accidental deaths in this early age
group increased 29 per cent in the past decade.
The greatest mortality occurs during the first
thirty days of life — the so-called neonatal period —
and this period shows the least reduction from
1939 to 1949. The infant mortality rate in that
period decreased 27 per cent, the neonatal mor-
tality decreased 22 per cent, but the rate for the
age group from one month to one year decreased
39 per cent, almost double the neonatal rate re-
duction (Table VI). It is in the neonatal period
that our serious problem lies. Incidentally, there
are as many stillbirths as there are neonatal
deaths. This is another problem of great concern
and is closely associated with neonatal mortality.
586
Minnesota Medicine
MATERNAL AND INFANT HEALTH— ROSENFIELD AND BROWER
TABLE IX. PERCENTAGE DISTRIBUTION OF INFANT DEATHS BY CAUSES
Minnesota, 1949 and 1939
Under 1 Year
Under 1 Month
Under 1 Week
Under 1 Day
1949
Prematurity
1939
Other prenatal
natal causes
1949
and
1939
All Others
1949
1939
37.4
35.6
40.9
34.2
21.7
30.2
49.0
50.6
33.3
31.4
17.7
18.0
S3.0
54.4
32.6
33.0
14.4
12.6
57.7
62.3
32.5
29.3
9.8
8.4
In 1939, 70 per cent of all infant deaths oc-
curred during the neonatal period, with more than
half this number occurring under one day of life
(38.7 per cent). A total of 21.7 per cent died be-
tween one day and one week, and 9.5 per cent
died between one week and one month (Table
VII). In 1949, there was an increase in the
deaths during the neonatal period to 75 per cent
with a marked increase occurring in the age group
one day to one week. These deaths were due
chiefly to prematurity. Only 25 per cent of all
infant deaths occurred between one month and
one year but this age group showed the greatest
reduction.
The chief causes of neonatal deaths are the
same as the infant deaths except that prematurity
is now responsible for one-half instead of only
one-third of all deaths during the first thirty days
of life, both in 1949 and 1939 (Table VIII).
Congenital malformations and birth injuries make
up one-third of the deaths in this period, with an
increase in malformations but a decrease in birth
injuries in 1949.
The percentage of deaths due to prematurity
and other prenatal and natal causes increases
progressively from those occurring in the group
“under one year” (78.3 per cent) in 1949 (Table
IX) to the highest percentage in the group “under
one day” (90.2 per cent). A similar progressive
increase occurred in 1939.
A Program for Further Reduction of Maternal
and Infant Deaths
1. Further reduction in maternal mortality re-
quires :
(a.) Continued emphasis on competent ob-
stetrical care.
(b.) More extensive and more adequate pre-
natal care which must include good
nutrition practices.
(c.) Modern hospital facilities with ade-
quately trained personnel.
(d.) Periodic surveys of maternal mortality
to determine causes of, and respon-
sibility for, such deaths. These find-
ings will be utilized by medical so-
cieties, hospital staffs, and teaching in-
stitutions for undergraduate and post-
graduate instruction in the further re-
duction of preventable maternal deaths.
2. A consideration of infant mortality leads to
one of the most important problems in pre-
ventive medicine ; namely, a reduction in the
number of deaths during the prenatal and
neonatal periods which, of course, include
stillbirths.
(a.) A study of infant deaths, perhaps
limited to the neonatal period, similar
to the survey now being carried out on
maternal mortality by the State Med-
ical Association, may be helpful in re-
ducing infant mortality by emphasizing
the problems requiring more concerted
attention.
(b.) Consideration of the problems of pre-
maturity in developing a statewide
program to reduce the mortality from
this leading cause of infant deaths.
(c.) Study of the relationship of viral dis-
eases and various dietary factors dur-
ing pregnancy ; improved surgical skill
and pediatric care to a possible reduc-
tion in mortality due to congenital
malformations.
(d.) Decrease in birth injuries by competent
obstetrical care.
(e.) Increased use of the newer antibiotics
in pneumonia.
(f.) Refresher courses in obstetrics and
pediatrics at the Center for Continua-
tion Study and/or regional seminars,
(g.) Modern hospital facilities in rural
areas, adequate pediatric nursing, con-
(Continued on Page 651)
June, 1950
587
SOLITARY PYOGENIC LIVER ABSCESS
Review of Literature and Report of Case
LAWRENCE M. LARSON. M.D.. Ph.D. (Surg.)
and
JOHN H. ROSENOW, M.D., M.S. (Surg.)
Minneapolis, Minnesota
A BSCESSES of the liver may be classified
-*■ into two main groups : ( 1 ) amoebic, which
are usually single and which are associated with
intestinal amebiasis, and (2) pyogenic. The lat-
ter are single or multiple and are usually due to:
(1) infection in areas drained by the portal sys-
tem; (2) spread from contiguous structures, e.g.,
acute cholecystitis, gastric or duodenal ulceration,
or subphrenic space infection; (3) trauma by
penetration from without or by infection in a
hematoma with organisms already present in the
liver; and (4) blood-borne infections via the
hepatic arteries.
Some authors make no attempt to separate mul-
tiple from single liver abscesses but most feel that
such a distinction is important, mainly on the basis
of the prognosis and the therapy of this condi-
tion. Rothenberg and Linder, in reporting twenty-
four cases of solitary pyogenic abscesses, ex-
pressed the conviction that the single liver abscess
is most often of unknown or doubtful etiology,
usually cannot be proven of portal vein origin,
and only rarely is associated with pylephlebitis or
portal vein thrombosis.
Some authors such as Ochsner, DeBakey and
Murray do not separate pyogenic abscesses into
two such groups in their analysis of forty-seven
personal and 139 collected cases of pyogenic
abscess of the liver. Yet they do state that from
the prognostic and therapeutic standpoints it is
important to make this differentiation if possible.
It is also extremely important to differentiate
if possible the pyogenic hepatic abscess from
amebic abscess, especially before the amebic
abscess becomes secondarily infected. After such
secondary infection has occurred, the clinical pic-
ture, the prognostic and therapeutic implications
become similar to those of the pyogenic abscess.
Bacteriology
In the majority of the non-amebic abscesses the
most commonly found organisms are the strepto-
cocci, staphylococci and bacillus coli, although al-
Presented before the Minneapolis Surgical Society, March 2,
1950.
most every type of bacteria has been found in
isolated instances. In almost half of the reported
cases the pus has been sterile. Blood cultures in
pyogenic abscesses are usually sterile.
Pathogenesis
The mode of origin of a solitary abscess in the
liver according to most authors is considered to be
a blood or lymph stream infection, probably by
way of the hepatic artery from a focus such as
an upper respiratory infection, carbuncle, influ-
enza, et cetera. In Rothenberg and Linder’s cases
such a condition accounted for about one half of
the individuals. In the other half no etiologic fac-
tors could be determined. In only two of their
twenty-four cases was a portal vein or bile duct
infection responsible. In other words the process
is comparable to that of the production of a car-
buncle of the kidney or osteomyelitis. Practically
all these solitary abscesses occur in the right lobe
and most of them involve the dome of the liver.
In multiple abscesses of the liver, the etiological
process is one of suppuration in the portal system
or biliary system such as suppurative appendicitis
or cholecystitis, chronic ulcerative colitis, et cetera.
In other words, the infection reaches the liver
through the portal blood stream.
Diagnosis
Usually in the case of solitary pyogenic abscess
of the liver there is a history of two to four weeks
duration, with fever and occasional chills. Malaise
and asthenia are pronounced. Indefinite, dull pain
in the right lower thoracic region or right upper
abdominal quadrant frequently gives the first hint
of localization of the pathologic process. Localized
intercostal pain is quite often present. Liver tend-
erness is usual, either on deep pressure with a
single finger in an intercoastal space, or on palpa-
tion of the edge of the frequently enlarged liver,
below the costal margin. This pain is usually
directly over the abscessed area, and is non-radiat-
ing and constant. It may be dull or sharp, but
rarely is it necessary to use heavy percussion to
elicit this tenderness. Rapid loss of weight and
588
Minnesota Medicine
PYOGENIC LIVER ABSCESS— LARSON AND ROSENOW
strength are prominent features, but interestingly,
nausea and vomiting are present in only a small
percentage of cases. As a matter of fact, nausea
and vomiting are a rather rare accompaniment of
this disease, and this is of special significance since
so few surgical abdominal conditions lack this
symptom. Therefore, this absence of nausea and
vomiting is an important diagnostic feature. The
liver is usually enlarged ; a few cases have a pal-
pable right upper abdominal mass ; some spasticity
of the rectus muscle on the right is usually noted,
but is not marked. Limited expansion of the right
chest is occasionally seen, and an elevated, fixed
diaphragm seen on fluoroscopy is the rule. Other
pulmonary signs present are rales at the right base
and a small right pleural effusion. Rarely, a palp-
ably enlarged spleen is found. Usually no evi-
dence of ascites is noted. A leukocytosis of 16,000
to 28,000 is the rule and the neutrophiles may
average 86 per cent.
In multiple liver abscesses, the symptoms, as one
would expect, are more severe as a rule than
those in which there is a solitary abscess. The
fever is higher and more spiking, jaundice is more
common, the liver is larger, and tenderness and
spasm of the overlying muscles is greater. The
diagnosis in this type can usually be made on the
history of a preceding infection in the intestinal
tract, whereby the offending organisms have op-
portunity to reach the liver via the portal or biliary
system.
The amebic abscess can usually be distinguished
by the previous history and findings of the ameba.
In this disease the liver abscess (which occurs in
4 to 5 per cent of individuals with amebiasis in
this country) has a characteristically slow onset
over months or years, and there is present a mini-
mum of constitutional reaction such as chills,
fever and pain. It is true that in many cases the
Endamoeba histolytica cannot be demonstrated, yet
the history, a trial on antiamebic therapy, and
other features of the disease will differentiate this
condition from the other types of liver abscess,
single or multiple. Of course after an amebic
abscess becomes secondarily infected, it must be
regarded as a pyogenic one.
Liver abscess must be differentiated from chol-
ecystitis, subphrenic abscess, suppurative lesions
of the right kidney and early pneumonia. Dis-
ease of the gall bladder can usually but not
always be differentiated by a carefully taken his-
tory. Previous attacks of pain, intolerance of fatty
foods, jaundice and difference in location and the
type of pain and tenderness are usually of great
help. The pain in liver - abscess is steady and
directly over the liver substance and not over
the gall-bladder area. That in gall-bladder disease
is intermittent, radiates to the back and is unbear-
able. Of course in acute cholecystitis the differ-
ential diagnosis is confusing although the enlarged
gall bladder can usually be palpated as a tender
mass. Subphrenic abscess tends to produce pain
on deep inspiration, it usually radiates to the
scapular region, and is frequently preceded by an
infection within the abdomen. X-ray findings of
pus beneath the diaphragm should make the diag-
nosis. However, when there is an abscess that
points to the right dome of the liver, the diagnosis
may be difficult. Suppurative lesions of the kidney
may be difficult to differentiate from those cases in
which the liver abscess involves the lower portions
of the right lobe of the liver, because of the
pain produced in the right loin. However urinary
findings will be of assistance in this differentia-
tion. Early pneumonia may give rise to pain in
the right lower chest, fever and chills, but with
rapid development of roentgenologic signs in the
lungs, and the absence of enlarged liver, et cetera,
one may usually differentiate the two conditions.
In the differential diagnosis of liver abscess one
should always remember that nausea and vomiting
are most frequently absent probably because of the
lack of peritoneal irritation. In practically all
other surgical conditions of the abdomen this
symptom is present. Constipation and diarrhea
are also almost always absent.
Complications
Since most of these abscesses are on the dome
of the liver, the infective process is likely to
advance upward and involve the pleura or lungs.
Consequently pleurisy with effusion, empyema
and even rupture into the lung itself may occur.
If the spread is downward the abscess ruptures
into the peritoneal cavity. The resulting peritonitis
is especially dangerous and the condition then
presents the picture of a major abdominal catas-
trophe.
Prognosis
This varies of course with the location of the
lesion, its early recognition, the type of organism
responsible, and the multiplicity of the abscesses
present. If removal of the pus is not carried out,
the mortality rate is 100 per cent. In large series
June, 1950
589
PYOGENIC LIVER ABSCESS— LARSON AND ROSENOW
of cases, various authors report all the way from
37.5 to 60 per cent mortality. With the advent of
antibiotics it can reasonably be expected that great
improvement in results will be achieved. No large
series of cases has been reported since these drugs
have been used.
Treatment
lhe classical treatment of solitary pyogenic
abscess is incision and drainage. It is repeatedly
emphasized in the literature and considered highly
important that contamination of either the peri-
toneal or pleural cavities be carefully avoided,
since it has been shown that the mortality rate
rises sharply whenever this occurs. If there is
evidence of localization of the abscess in the
anterior or antero-inferior surface of the liver,
the technique described by Clairmont may be used.
Briefly, this consists of using a subcostal incision,
with mobilization of the parietal peritoneum from
the lower surface of the diaphragm, when drain-
age of the abscess can usually be done extraperi-
toneally. If it cannot, adherence to the visceral
and parietal peritoneum should be induced by
packing with iodoform or other gauze, and drain-
age done through this area at a subsequent stage,
two to three days later.
If there is no evidence of localization anteriorly,
the retroperitoneal approach described by Ochsner
may be employed. The twelfth rib is resected
subperiosteally. A transverse incision is made
through the bed of the resected rib at the level of
the spinous process of the first lumbar vertebra.
The reason for this is that the pleura never
extends below the level of the spinous process of
the first lumbar vertebra. The retroperitoneal
space between the upper pole of the right kidney
and the inferior surface of the liver is entered.
The parietal peritoneum is mobilized from the
under surface of the diaphragm, and the abscess
drained.
Reports of the treatment of solitary liver
abscesses since the advent of the antibiotics have
been few. Kisner’s cases are of great interest in
this connection. In the second of his three cases,
while waiting for adequate adhesions to wall off
the disease process, penicillin was given parentally
and also injected into the abscess following aspira-
tion. At the second stage operation, several days
later, the abscess cavity was found to contain
only a few cubic centimeters of bloodv fluid. His
third case received penicillin for forty-eight hours
pre-operatively. At operation, the pus evacuated
was found to be sterile on culture.
Case Report
The patient is a thirty-six-year-old married white man
who was first admitted to tine hospital on April 20, 1948,
with the chief complaint of severe steady pain in the
epigastrium and right upper abdominal quadrant* of one
day’s duration.
Past History. — This patient had had a long history of
pain in the lumber portion of his back dating back to
1936. In 1939 removal of the inferior portions of the
spinous processes of the first, second and third lumber
vertebrae with accompanying ligaments was performed.
In 1942 a protruded fourth lumbar intervertebral disc
was removed. In 1943 a recurrent protruded interverte-
bral disc was removed and a spinal fusion performed.
However, he continued to have difficulty with his back.
He had also had a history of recurrent spells of
diarrhea during periods of severe nervous strain dating
back about two years, consisting usually of watery stools
after each meal. In 1947 he had been studied from this
standpoint at the Mayo Clinic at the time of one of his
many admissions there for his back trouble, and it was
felt that the cause of the diarrhea was on a functional
basis. The investigation at that time included many
negative stool examinations.
Present Illness. — The day before admission the patient
noted an intermittent, vise-like severe pain in the epigas-
trium and right upper abdominal quadrant, not crampy
or colicky. It occasionally radiated through to the middle
portion of the right back at about the level of the eighth
to the twelfth thoracic vertebrae. This he stated was
separate and different from his old back complaint. He
had noted a slight fever in the preceding twenty-four
hours, but no chills. He had been mildly nauseated, but
had not vomited. There had been no jaundice, nor any
diarrhea or abnormalities of the stools. He had had a
mild “head cold” about three to four days before admis-
sion with a mild dry cough.
On entrance into the hospital, the patient’s temperature
was 102° F., the pulse was 100, respirations were 18.
The blood pressure was 132/70. He was flushed and
perspiring and was in acute distress. A general examina-
tion revealed a diffuse tenderness and moderate rigidity
in the right upper abdominal quadrant. No rebound tend-
erness w*as elicited, and no masses were palpated. There
was moderately hyperactive peristalsis heard upon auscul-
tation of the abdomen.
X-rays of the chest and abdomen were interpreted
preoperativelv as negative. On critical review* of the
chest x-ray postoperatively in conference with the roent-
genologist, it w*as felt that there was a minimal infiltra-
tion at the left base and left cardiac border, consistent
with a mild broncho-pneumonia. The diphragm shadows
were clear and at normal levels. The white count was
22,100, with 86 per cent neutrophiles. The sedimentation
rate showed a fall of 45 mm. in one hour. A urine exami-
nation was entirely negative except for a faint trace of
albumin. The serum amylase was 305 mg. per cent,
590
Minnesota Medicine
PYOGENIC LIVER ABSCESS— LARSON AND ROSENOW
somewhat above the 200 mg. per cent considered normal
at this laboratory. This moderate elevation of the serum
amylase was considered to be suggestive, but not diag-
nostic enough to warrant ignoring what appeared to be
a quite typical picture of acute inflammatory disease of
the gall bladder. A tentative diagnosis of acute cholecys-
titis was made and the patient was operated upon seven
hours after admission.
The abdomen was opened through a long right rectus
incision. A complete exploration of the abdomen was
made but revealed only the presence of a chronic
inflammation of the gall bladder, which was thereupon
removed. The common duct appeared entirely normal.
Palpation of the pancreas revealed no abnormalities.
Pathologic examination of the gall bladder showed evi-
dence of a mild inflammation characterized microscopi-
cally by lymphocytes and fibrotic changes in the wall.
Postoperatively, the patient was carried on continuous
nasal suction for the first three days. The rectal tem-
perature ran from 100° to 101° F. for the first four days
and was normal thereafter. He was given large doses
of antibiotics daily for ten days. The infiltrative process
at the base of the left lung was shown to have disap-
peared completely by a chest x-ray taken two days before
his discharge from the hospital on the eleventh post-
operative day. An electrocardiogram on the fourth post-
operative day was interpreted as being within normal
limits.
Four weeks later, the patient was re-admitted to the
hospital on May 27, 1948, giving the historj' that for a
short time after returning home he had done well, but
in about one week had begun to pursue a downhill
course, with malaise, anorexia, recurring fever, and
gradual loss of 20 pounds in weight. In the week prior
to admission he had suffered from nausea and vomiting
and had been unable to retain anything solid taken by
mouth. He had felt quite distended and had belched
frequently. No spontaneous stool had been passed in
this week.
When first seen, he presented evidence of weight loss
and severe dehydration. He appeared acutely ill, and
complained of a steady rather severe pain in his right
upper abdomen. His temperature was 99.8° F., the pulse
92, the respirations 16. The blood pressure was 108/68.
A firm rounded tender mass was palpable in the mid-
portion of the upper epigastrium. It was non-movable
and seemed semi-fluctuant. Tt was approximately 6 to 8
cm. in diameter, although its edges could not be clearly
defined.
A scout film of the abdomen showed no evidence of
intestinal obstruction, gastric dilatation, or other path-
ologic conditions and a chest x-ray was negative. The
hemoglobin was 14.9 gm., the red count was 4,800,000,
the white count 13,500 with 78 per cent neutrophiles. The
sedimentation test showed a fall of 96 mm. in one hour.
The blood urea nitrogen was 16 mg. per cent, the C02
combining power was 73 vol. per cent, and the chlorides
were 4% mg. per cent. The urine was entirely negative.
A blood culture showed no growth in forty-eight hours.
For the first two days after admission, he was allowed
only small amounts of liquids by mouth, and he was
given intravenous fluids in large amounts with supple-
June, 1950
mentary parenteral vitamins, followed by distinct im-
provement. He had a daily afternoon elevation of tem-
perature, varying from 100.6° to 101.2°. During this
time the mass described in the upper abdomen increased
somewhat in size, and became excruiatingly tender.
Under general anesthesia, forty-eight hours after ad-
mission, an incision was made directly over the above-
mentioned mass. The tissues of the various layers of the
abdominal wall were moderately edematous and quite
indurated. The peritoneum was opened and in the an-
terior edge of the right lobe of the liver a rounded mass
was seen covered with whitish, thickened liver capsule.
An incision was made into the mass, and about 300 to
400 c.c. of thick cream colored pus were evacuated. The
pus was not the cholocate color described as being charac-
teristic of an amebic abscess. A cautious digital explora-
tion of the abscess cavity was done. Further general
exploration was not done although it might have been
well to have taken a biopsy of the wall of this abscess.
A soft Penrose drain was placed deep in the abscess
cavity and brought out through the incision which was
then closed about it in layers.
In twenty-four hours the patient’s temperature dropped
to normal and remained so thereafter. For the first three
days, he was carried on parenteral fluids, large doses of
antibiotics, a gradual increase in oral intake and by the
eleventh postoperative day, the patient was feeling fine,
eating well, and had gained eight pounds in weight.
A direct culture from the contents of the liver abscess
at the time of surgery showed streptococcus viridians.
No amebac were seen on fresh direct smear. Postopera-
tively, four successive stool cultures were negative for
pathogenic bacteria and for entameba histolytica in either
vegetable or encysted forms. A proctoscopic examina-
tion showed a perfectly normal rectum and rectosigmoid
for a distance of 25 cm. A fresh smear taken from the
bowel wall during this examination was negative for
entameba histolytica. Roentgenologic studies of the colon
gave negative results.
The drainage from the wound was surprisingly small
and was purulent for the first few days only. The drain
was gradually shortened and was removed on the four-
teenth postoperative day.
When seen about a month later, the patient stated that
he was eating well, his strength was excellent, and he had
had no symptoms referable to his abdomen. The wound
healed normally.
Six weeks postoperatively the patient was in excellent
health, except that he had been having occasional loose
stools after meals for a few days. As in the past, these
symptoms coincided with a period of excessive nervous
tensions.
Discussion
The exact etiological basis for the ovo^enic liver
abscess in this individual is still a matter of some
conjecture, although the possibility of its being
amebic in origin has been pretty well eliminated.
The most likely explanation is that the abscess was
primarily a so-called solitary pyogenic abscess
probably of metastatic origin, such as those de-
591
PYOGENIC LIVER ABSCESS— LARSON AND ROSENOW
scribed by Rothenberg and Linder possibly arising
from a respiratory infection. Its incipient stages
may have been responsible for the symptoms that
led to his cholecystectomy.
A number of other possibilities might be devel-
oped, for which there is only little evidence, and
certainly no definite proof.
1. Cholecystic disease might have initiated the
disorder. This is unlikely. In a single reported
case where biliary tract disease was the etiological
agent, the abscess resulted from direct extension
of an acute suppurative or gangrenous cholecy-
stitis, quite the contrary to this case. In a review
of all the available literature from 1930 to the
present dealing with complications and mortality
following biliary surgery, only one case of liver
abscess was described (Doran et al). The articles
consulted represented about 45,000 cases. How-
ever it is readily understandable that many of
these complications would go unreported.
2. A branch of the right hepatic artery might
have inadvertently been ligated at the original
cholecystectomy, producing an infarct which be-
came secondarily infected, with abscess formation.
This is unlikely because one would have expected
in the postoperative period more immediate signs
and symptoms of something drastic taking place,
whereas the patient made a normal recovery. Also,
this theory offers no explanation for the definite
signs and symptoms that led to the cholecystec-
tomy.
3. Amebiasis may have been the underlying
factor all along, with an amebic hepatitis having
been present for several years prior to the first
admission, which progressed to abscess formation,
and the abscess becoming infected with secondary
invaders producing the symptoms and signs lead-
ing to his cholecystectomy. The ubiquitous post-
prandial loose stools seem to favor this amebic
theory, but the following facts are rather good
evidence against this: (a) The presence of the
regularly occurring “diarrhea” so suggestive of
an exaggerated gastro-colic reflex, yet the patient
maintained his normal weight and general good
health, (b) The failure on many stool examina-
tions, properly secured, to demonstrate the para-
site. The presence of a diarrhea in amebic infesta-
tion usually means left colon involvement, and
there should have been some positive evidence in
the many stool examinations, repeated procto-
scopic examinations and colon fluoroscopic exami-
nation. (c) The failure to demonstrate any amebae
in the pus from the abscess. These should have
been found since the abscess was a recent one,
and it has been shown that the organisms are
usually present in this type of abscess. In long
standing cases where the abscess wall is fibrotic
it is necessary to scrape the wall to obtain the
organism. Furthermore the pus was creamy in
color and not the typical “chocolate sauce” variety
which is so characteristic of amebic abscess, (d)
The failure of the patient’s symptoms to be af-
fected in any way by a therapeutic trial of specific
anti-amebic medications, carried out some months
later at home.
4. A mild chronic relapsing pancreatitis with
secondary cholangiocholecystitis and hepatitis may
have started the sequence of events. This possi-
bility has much to be recommended it, but again
there is no definite proof. The moderately elevated
serum amylase at the time of cholecystectomy is
not very good evidence. In this connection, Pem-
berton, Musgrove and others have recently shown
that involvement of the pancreas by an adjacent
pathologic process may produce a moderate eleva-
tion of the serum amylase.
Summary
1. A case of solitary pyogenic abscess in the
anterior right lobe of the liver is hereby presented
which was cured by incision and drainage.
2. The pathogenesis of this abscess was most
likely a metastatic infection through the hepatic
artery arising from a pre-existing respiratory
infection.
3. The symptomatology in this case so closely
simulated that of an acute cholecystitis, that chole-
cystectomy was done, only to find that four
weeks later the abscess in the liver became obvious.
4. From the prognostic and therapeutic stand-
point, it is important to differentiate between soli-
tary and multiple pyogenic abscesses. The solitary
types have less violent constitutional manifesta-
tions, less pain, and less leukocytosis than do the
multiple. In addition, the multiple liver abscesses
usually have a pre-existing infection in that part
of the abdomen drained by the portal system.
Jaundice is more common in the latter type.
5. In the differential diagnosis of pyogenic
liver abscess, the most likely conditions to be con-
sidered are cholecystitis, subphrenic abscess, sup-
purative lesions of the right kidney and early
pneumonia.
(Continued on Page 596)
592
Minnesota Medicine
SUBFASCIAL FAT ABNORMALITIES AND LOW BACK PAIN
R. I. DITTRICH. M.D.
Duluth. Minnesota
T N recent years several investigators have called
attention to the importance of fat tissue in
the subfascial spaces as factors in painful syn-
dromes. Our former concept of fibrositis as a
clinical or pathological entity involving muscle or
fibrous tissue has been dispelled by the discovery
that the painful lesions which were interpreted as
“fibrositic” nodules are, in reality, masses of fat
tissue which have undergone changes and are
causing varying degrees of disability.
The principal contributors to our knowledge of
the painful lesions of fat tissues are Copeman and
his associates.1’2 The original studies were made
in cases of painful disabilities of the back. After
charting the location of the trigger-points, usually
represented by a tender nodule of tissue, dis-
sections of the muscular and fibrous tissues in
the painful areas were undertaken. It was revealed
that the deep fascia of the back was frequently
defective or very thin, permitting the fat tissue
underneath the fascia to herniate through the
defect. Three types of herniation are described :
the pedunculated, the non-pedunculated and the
foraminal, the latter occurring through the foram-
ina of the lumbar nerves as they pierce the deep
fascia. Another form of abnormality in fat tissue
is edema of individual lobules, causing pain pre-
sumably by tension of the tissues.
Within the confines of the basic fat pattern
described by Copeman,1 the site of predilection
for herniation is a narrow strip along the lateral
border of the sacrospinalis muscle from the lower
costal margin to the iliac crest. Tension syndromes
due to edema are likely to arise from the region
of the sacrum, from the area of residual fat
situated immediately below the rim of the ilium,
and from the dorsal fat pad, a diamond-shaped
area in the upper part of the back, corresponding
roughly to the outline of the trapezius muscle
which lies beneath it.
An additional abnormality of fat tissue is
described by Copeman as panniculitis, which
occurs in abnormally deposited fat, mostly in
predictable sites.
Among the etiological factors mentioned by
Copeman1 are endocrine disorders, sodium balance,
heredity and exposure to cold environment.
Treatment is discussed from the standpoint of
diet, endocrines, diuresis and dehydration, physio-
therapy, injection and surgery.
Herz3 reported thirty-one cases in which treat-
ment consisted of surgical removal of the painful
lesion. In a later report (quoted by Hucherson
and Gandy) his series consisted of 229 cases, of
which sixty-seven were subjected to operation.
Hucherson and Gandy5 report thirty-two cases in
which surgical treatment was employed. They
state that operation was considered necessary in
approximately one-fourth of the patients ; in the
remainder, adequate relief was obtained by
injection with local anesthetic. Orr, Mathers and
Butt12 described fibrolipomatous lesions as sources
of somatic pain and directly responsible for
clinical manifestations which suggest disease of
the kidney or ureter. A form of fat abnormality,
episacroiliac lipoma, has been described by
Hittner4 who reported a series of fifty cases in
which the lesions were removed by operation.
Relief of pain in the lower part of the back was
obtained in forty-five instances.
In all these reports there seems to be general
agreement regarding the nature and the location
of the painful structures, the methods of
identification, and the high percentage of success-
ful results following treatment.
From personal observations on patients with
painful back, it is possible to agree with many
points discussed by Copeman and others. Of
those who were treated by injection of local
anesthetic into the painful or tender sites of the
back, it was possible to obtain varying degrees
of relief from pain in the majority of cases. In
some instances relief was complete and apparently
permanent ; in others it was incomplete, and re-
currence was not uncommon. Efforts were
directed toward locating the primary source of
the pain, as manifested by localized tenderness.
By careful palpation it is usually discovered that
the tenderness is distributed over a large area of
the lower part of the back, though frequently
localized in more clear-cut intensity at certain
sites.
Referred pain is a common subjective mani-
festation. This is frequently noted in the lower
June, 1950
593
SUBFASCIAL FAT ABNORMALITIES— DITTRICH
extremities, although it may also occur in other
portions of the lower part of the back. It is more
often unilateral. It is generally accepted that
referred pain has a segmental pattern ; it occurs
within the distribution of the same spinal nerve
as that from which the primary pain arises. It is
also agreed that sensory innervation of the deep
skeletal structures differs greatly from the pattern
of dermatomic supply. Our knowledge of these
characteristics of deep somatic pain is derived
largely from the investigations of Lewis and
Kellgren,10 Kellgren, 7,3,9 Inman and Saunders,6
Sinclair, Weddell and Feindel,13 Wolff and
Wolf,14 and many others. The practical signifi-
cance of referred pain lies in calling attention to
a primary focus of pain elsewhere. The source
of pain of this nature is rarely located by the
patient with any degree of accuracy. If on
examination the trigger-point is irritated, refer-
ence of pain serves as a valuable aid in identifying
the algogenic region.
Referred tenderness is a characteristic of deep
somatic pain which, although it suggests a
similarity to referred pain, is vastly different in
its mechanism of development and usually in its
topographic location. This term is applied to sites
of hyperalgesia, resulting as secondary phenomena
to the primary source of pain. Thus it is possible
in many instances to elicit tenderness at numerous
points in the lower part of the back or the
buttocks, in locations remote from the trigger-
point. The degree of tenderness is variable.
Where numerous sites of this nature becomes
evident, it is often confusing and difficult to locate
the trigger-point. It is frequently necessary to
determine the point of origin of the pain by a
process of elimination -by injection of local
anesthetic into successive tender regions. Thus,
by a successful injection of the trigger-point, all
pain and all tenderness can be abolished ; on the
other hand, injection of a secondary site of pain
is usually effective only in relieving the tenderness
at the treated area.
The status of our knowledge of referred pain
has recently been defined as follows : “Stated
broadly, then, the numerous shades of opinion
can be reduced to two opposing beliefs. The first
of these is that some mechanism located in the
central nervous system is responsible for all the
phenomena of referred pain, and the second is
that these phenomena are produced by events
taking place in the periphery. It is no doubt
possible that by considerable amplification of om-
or other of these theories a hypothesis might be
arrived it, which would adequately overcome the
objections which could be levelled against it.
Nevertheless, the fact remains that, as they are
at present stated, neither hypothesis is capable of
explaining all the observed facts . . .”13
Sinclair, . Weddell and Feindel13 suggested,
further, the following hypothesis for occurrence
of referred pain and tenderness in somatic
structures : "The anatomical basis of the physio-
logical processes concerned in the production of
referred phenomena is the branched axon. In
any given case there are two main mechanisms at
work ; the first of these is the misinterpretation
by the central receiving apparatus of the source
of the painful impulses, and the second is the
production in the periphery, as a result of anti-
dromic impulses, of metabolites w'hich at first
stimulate the nerve endings there and later
damage them. It is probable that the operation
of the first of these mechanisms gives rise chiefly
to referred pain, while the chief result of the
operation of the second is referred tenderness,
but both mechanisms must be considered in
relation to either phenomenon.”
“Anesthetization of the area of reference will
affect the second mechanism in two ways, first by
the interruption of the painful impulses arising
there on their way to the central nervous system,
and secondly, by the blocking of the antidromic
impulses which are activating and perpetuating
these painful impulses. The result of this pro-
cedure is therefore to abolish the pain and tender-
ness resulting from the operation of the peripheral
chemical mechanism.”
A study of records indicates that the most
common manifestation found in cases of painful
back is tenderness in the sacral paraspinal region.
This may involve one or both sides of the mid-
line. In case of a bilateral site of tenderness in
the sacral region, usually only one side harbors
a lesion which is sufficiently painful to cause
disability and therefore require treatment. In
many instances when the trigger-point of pain
is located in that area, injection with local
anesthetic will provide relief for indefinite periods
of time, varying from weeks to months and some-
times permanently. When pain recurs after short
intervals or in cases where no relief is obtained
beyond the duration of the local anesthetic effect,
surgical removal of the painful lesion is indicated.
594
Minnesota Medicine
SUBFASCIAL FAT ABNORMALITIES— DITTRICH
Another location in which abnormalities of fat
tissue develop as primary sources of pain is the
ilio-lumbar area, along the lateral margin of the
sacrospinalis muscle. The most common condition
at this site is a herniation of fat lobules through
the deep fascia.
It is necessary to mention that the apparent
ease with which other observers are able to
identify the painful lesions represents an under-
statement or a misunderstanding of the total
picture of such abnormalities. Most patients do
not present the typical clinical manifestations,
consisting of a history of pain and a palpable,
sensitive nodule, so easily located and treated ;
many patients, in fact, do not present any nodule
or enlargement which is significant. In addition,
tenderness is often elicited only on heavy pressure
and after meticulous search in the suspected
location. When multiple sites of tenderness are
encountered, it becomes necessary to determine
the primary source of the pain. Apparently
Moes11 has recognized similar situations in the
subcutaneous nodules lacking the trigger-point
tenderness and the typical relief on injection. The
procedure of local anesthetization is necessary in
all cases for positive identification of the primary
source of the pain ; it is especially useful when
pain and/or tenderness are widespread and where
a clear-cut radiation of pain cannot be elicited so
that the patient is able to identify it as that which
he experiences.
The technique of injection consists of locating
the painful area with the point of the needle. This
requires the patient’s co-operation. The site of
the pain is infiltrated and, after anesthesia is
obtained, the point of the needle is manipulated
to disrupt the tissues from which the pain arises.
It is advisable to warn the patient that the pain
may be aggravated temporarily after the local
anesthetic is absorbed.
Surgical treatment, when necessary, is carried
out under local anesthesia. In this, the patient’s
co-operation is needed. After infiltration of the
skin, the incision is made and dissection is carried
out down to the fascia. The fascia is examined
visually and by probing with a needle for the
purpose of identifying the location of the ab-
normal tissues. It is sometimes possible to incise
the fascia without causing excessive pain. It is
always desirable, if possible, to locate the trigger-
point accurately prior to anesthetization of the
deep tissues. The deep fascia is then incised and
the abnormal tissues are removed. As there is
frequently a prolonged and a persistent accumula-
tion of blood and serum from the surgical field, it
has become a practice to leave a small drain in
the wound for a period of five to seven days,
after which a sinus is formed. This usually heals
in three to four weeks. Ordinarily patients need
not be hospitalized.
Surgical treatment consisted of eleven opera-
tions on ten patients. In three the operative site
was the ilio-lumbar region, at the lateral margin
of the sacrospinalis muscle. In one of these, the
abnormality consisted of swelling of several fat
lobules underneath a very thin portion of the
lumbodorsal fascia, which was bulging but not
ruptured. In a second, a bilateral operation showed
on each side small herniations through the fascia.
In a third case, a marked sciatic scoliosis and
pain in the gluteal region were associated with
tenderness in the ilio-lumbar area at the level of
the iliac crest. These features were satisfactorily
corrected on two different occasions by pre-
operative injection of procaine. At operation, the
painful area was identified by the patient in a
small patch of the lumbo-dorsal fascia. This was
incised. The only feature which appeared
significant as an abnormality was a firm adherence
of several small masses of fat tissue to the ventral
surface of the fascia. This was resected. Post-
operative progress was satisfactory for five days,
after which the pain and the curvature reappeared.
These manifestations were relieved by evacuation
of a small hematoma. During the next two weeks
a firm swelling, suggesting a cyst, developed in
the operative site, and with this, a recurrence of
the pain and the scoliosis.
In seven patients the sacral region was ex-
plored ; the operation was bilateral in four. The
findings here consisted of swollen lubules of fat
tissue underneath the deep fascia. The enlarged
lobules or “bubbles” of fat were removed
together with other portions of fat tissue in the
operative field which were apparently normal. The
swelling was the only significant abnormality
which was encountered. Microscopic examination
showed normal fat tissue.
All these patients were afflicted with varying
degrees of disability due to pain in the lower part
of the back. In the majority of these, the pain
was referred elsewhere, most commonly to the
lower extremity. In one case the back pain was
associated with coccygodynia. In two cases pain
June, 1950
595
SUBFASCIAL FAT ABNORMALITIES— DITTRICH
referred to the upper portion of the back was
relieved following the operation. In four patients,
headache was a prominent symptom, apparently
related to the pain in the lower part of the back.
These unusual phenomena require a more detailed
analysis which is planned at a later date.
The immediate postoperative results have been
uniformly satisfactory. Relief from pain has
been prompt in all cases and, with one exception,
has been maintained during the period of
observation, varying from two to twelve months.
Summary
From a review of the literature and observations
on ten patients, it is evident that abnormalities of
subfascial fat tissue constitute an important factor
in the development of painful disabilities of the
back. The principal features responsible for
clinical manifestations are edema and herniation
of the fat tissue. A knowledge of the principles
and the mechanism of referred pain is essential
for adequate evaluation of the clinical phenomena.
References
1. Copeman, W. S. C. : Fibro-fatty tissue and its relation to
“rheumatic” syndromes. Brit. M. J., 2:191-197, (July 23)
1949.
2. Copeman, W. S. C., and Ackerman, W. L, : Edema or
herniations of fat lobules as a cause of lumbar and gluteal
“fibrositis.” Arch. Int. Med., 7 9:22-35, (Jan.) 1947.
3. Herz, R.: Herniation of subfascial fat as a cause of low
back pain. Results of surgical treatment in thirty-one cases.
J. Internat. Coll. Surg., 9:339-346, (May-June) 1946.
4. Hittner, V. J. : Episacroiliac lipomas. Am. J. Surg., 78:382-
383, (Sept.) 1949.
5. Hucherson, D. C., and Gandy, J. R.: Herniation of fascial
fat. Am. J. Surg., 76:605-609, (Nov.) 1948.
6. Inman, V. T., and Saunders, J. B. de C. M.: Referred pain
from skeletal structures. J. Nerv. & Ment. Dis., 99:660-667,
(May) 1944.
7. Kellgren, J. H.: Sciatica. Lancet, 1:561, (May 3) 1941.
8. Kellgren, J. H.: Somatic simulating visceral pain. Clin. Sc.
4:303-309, (Oct.) 1940.
9. Kellgren, J. H.: Deep pain sensibility. Lancet, 1:943-950,
(June 4) 1949.
10. Lewis, T., and Kellgren, J. H.: Observations relating to
referred pain, viscero-motor reflexes and other associated
phenomena. Clin. Sc., 4:47-71, (June) 1939.
11. Moes, R. J.: Nodulation or herniation of fat as a cause of
low back pain. Ann. Western Med. & Surg.. 1:15-17,
(March) 1947.
12. Orr, L. M.; Mathers, F., and Butt, T. C. : Somatic pain
due to fibrolipomatous nodules, simulating uretero-renal
disease: a preliminarv report. T. Urol., 59:1061-1069, (June)
1948.
13. Sinclair, D. C. ; Weddell, G., and Feindel, W. H.: Referred
pain and associated phenomena. Brain, 71:184-211, 1948.
14. Wolff, H. G., and Wolf, S.: Pain. Springfield: Charles C.
Thomas, 1948.
SOLITARY PYOGENIC LIVER ABSCESS
(Continued from Rage 592)
6. The complications of these abscesses are
concerned with rupture of the abscess into the *•
nleural or peritoneal cavities, lungs or surrounding
viscera.
7. With proper treatment, the prognosis in the 3
solitary type of liver abscess is much better than
that in the multiple. In large series of cases the 4-
former carry a mortality rate of 37.5 to 60 per
cent, while in the latter it is usually given as 90 to 5.
95 per cent. Without treatment the mortality rate
in either type closely approaches 100 per cent. 6.
8. Treatment consists of early incision and 7.
drainage of the abscess either anteriorly or poste-
8
riorly in such a fashion as to avoid contamination
of the pleural or peritoneal cavities.
9.
9. With the present day advantage of the anti-
biotic drugs much improvement may be expected
in the prognosis of these abscesses, since most of 10'
them are due to the staphylococcus, streptococcus n
and colon bacillus.
Bibliography
Clairmont, P., and Meyer, M. : Erfalirungen fiber die Be-
handlung der Appendicitis. Acta chir. Scandinav., 60:55-134,
1926.
Doran, W. T. ; Hanssen, E. C. ; Lewis, K. M., and Spier,
L. C. B. : Gallbadder surgery: a ten years statistical review,
including 410 operated cases. Am. T. Surg., 53:41-54, (Tuly)
1941.
Eliason, E. L. ; Brown, R. B., and Anderson, D. P. ; Pyo-
genic liver abscess. Pennsylvania M. T., 41:1147-1153,
(Sept.) 1938.
Flynn, J. E. : Pyogenic liver abscess. Review of the litera-
ture and report of a case successfully treated by operation
and penicillin. New England T. Med., 234:403-407, (March
21) 1946.
Gambill, E. C. ; Comfort, M. W., and Baggenstoss, A. H. :
Chronic relapsing pancreatitis: an analysis of 27 cases asso-
ciated with disease of the biliary tract. Gastroenterology, 11:
1-33, (July) 1948.
Kisner, W. H. : Solitary pyogenic abscess of the liver. Am.
J. Surg., 73:510-518, (April) 1947.
Musgrove, J. E. : Elevated serum amylase levels associated
with perforated gastroduodenal lesions. Proc. Staff Meet.
Mayo Clin., 25:8-10, (Jan. 4) 1950.
Ochsner, A.; DeBakey, M., and Murray, S. : Pyogenic ab-
scess of the liver. An analysis of forty-seven cases with re-
view of the literature. Am. J. Surg., 40:292-319, (April)
1938.
Ochsner, A., and DeBakey. H. : Amebic hepatitis and hepatic
abscess. An analysis of 181 cases with review of the litera-
ture. Surgerv, 1^:460-493, (March) and 612-649 (April),
1943.
Pemberton, A. H.; Grindlay, J. H., and Bollman, J. L. :
Serum amylase levels after acute perforations of the duo-
denum. Proc. Staff Meet. Mayo Clin., 25:5-8, (Jan. 4) 1950.
Rothenberg, R. E., and Linder, W. : The single pyogenic
liver abscess. A study of twenty-four cases. Surg., Gynec.,
& Obst., 59:31-41, (July) 1934.
596
Minnesota Medicine
HEMOLYTIC TRANSFUSION REACTION IN OBSTETRICS
Report of Case
ANN W. ARNOLD, M.D.
Minneapolis, Minnesota
T^\ OUBTLESS hemorrhage is now the most
important complication of obstetrics. Trans-
fusion is the immediate stop-gap in treatment and
no doubt accounts for decreasing mortality.
Nevertheless, in practice one is at times sharply
made to feel the inherent danger of this now
commonly used procedure. These dangers are
illustrated by the following case.
The case is that of a twenty-seven-year-old woman,
gravida III, who came into the hospital in the fifteenth
week of her pregnancy bleeding profusely and having
severe cramps and faintness. She had not to her knowl-
edge passed her fetus. Examination showed a very
pale young woman with a pulse of 108, and blood
pressure of 100/52. The uterus was soft and the size
of a three and a half months’ gestation. Her hemo-
globin was 13 grams on admission and leukocytes 3,150.
In a few hours the hemoglobin dropped to 9.9 grams,
and 500 c.c. of whole blood, type AB, Rh positive
(homologous), was given with 1000 c.c. of 5 per cent
glucose and saline. Ergotrate also was given intra-
venously. She was then taken to the operating room.
Under 24 c.c. of pentothal anesthesia intravenously,
examination showed the vagina filled with 500 c.c. of
clots. Fetal membranes and large pieces of placenta
were removed and the cavity of the uterus thoroughly
cleaned. The report of the pathologist was “incomplete
abortion.” The patient’s condition was satisfactory
except for pallor and a pulse of 104 and blood pressure
of 92/66.
That evening her hemoglobin had dropped to 7.8
grams, and a second transfusion was ordered. On the
third hospital day a second transfusion of O positive
blood was started at 4 :30 p.m. and discontinued at 5 :40
p.m. Soon thereafter she was noted to have headache,
backache, and an indescribable tense feeling in her trunk
as though she would burst. Her pulse was now 130 and
regular. She vomited considerable cherry colored liquid
flecked with blood. This was chemically positive for
blood. Soon there was diarrhea with gross blood. She
presented an appearance of profound shock. She was
given atropine and benadryl with no apparent change.
At 8:15 she was catheterized and 100 c.c. of bile-stained
urine obtained. This showed destroyed red cells — loaded
— and 4-plus albumin. She received 500 c.c. of sodium
lactate solution at three different intervals in an attempt
to keep the urine alkaline. The day following trans-
fusion, 165 c.c. of urine was obtained in three
catheterizations. On the second ,day following trans-
fusion, no urine whatever was passed ; on the third day
she passed 5 c.c. of very thick urine ; on the fourth
day no urine was passed ; on the fifth day 5 c.c. was
passed ; on the sixth day she passed four small speci-
mens, a total of 10 c.c. ; on the seventh day she passed
38 c.c. in four voidings ; on the eighth day she passed
140 c.c. on two occasions, and by the eleventh day she
had increased her output to 2485 c.c. of urine. The first
two urines showed 4-plus albumin and were positive
chemically for occult blood. Albumin was 4-plus to the
sixth post-transfusion day. On the eighth post-trans-
fusion day there was 1-plus albumin and thereafter it
contained no albumin. On the day of reaction, the
direct Van den Bergh was 1.3 mg. per cent, and the
indirect Van den Bergh was 3.4 mg. per cent. The
next day it was 0.13 mg. per cent, and 1.85 mg. per cent.
The blood urea nitrogen on the day following reaction
was 29 mg. per cent. It rose rather evenly to a high
of 110 mg. per cent on the tenth post-transfusion day
and was 84 mg. per cent on the day of discharge.
Several weeks later it was 11 mg. per cent.
The C02 was 75 vol. per cent on the day following
her reaction and varied from 51 to 63 per cent and was
still 51 vol. per cent on the day of discharge.
The blood chlorides were rather stable. On the third
day their value was 542 mg. per cent; was lowest (482)
on the fifth day, and 572 mg. per cent on the day of
discharge.
The hemoglobin dropped to 7.4 grams following trans-
fusion reaction, was 8 grams on the seventh day,, and
again 7.8 grams on the fourteenth day.
The white cell count was highest on the third day when
it was 32,520, and gradually dropped to 12,300 on the
tenth day.
The blood pressure remained remarkably stable after
being at shock level of 80/55 some nine hours after
reaction. There was one recording of hypertension on
the thirteenth day of 150 systolic and 85 diastolic. This
promptly returned to a normal level.
Her weight normallly was about 128 pounds. When
taken on the third post-transfusion day it was 136
pounds, and reached 141 pounds on the seventh day. It
then orderely receded with increase in urine volume to
120 pounds on discharge.
Except for the post-transfusion fever reading of 103°
the temperature promptly came down and remained at
100° or less for the rest of her hospital stay. The pulse
likewise, except for the early reaction, remained mostly
around 80.
Her gastrointestinal tract had an immediate convul-
sive session of vomiting and diarrhea. This quieted down
to occasional vomiting of small amounts of brown or
greenish fluids. She was willing to co-operate in food in-
take. The most acceptable food seemed to be the pellets
of butter and sugar, as suggested by Dr. C. D. Creevy.
Normal appetite came back in about two weeks.
The general attitude of this woman throughout this
gruelling experience was quiet, even lethargic. She talked
very little and at first moved very little. She stated she
June, 1950
597
HEMOLYTIC TRANSFUSION REACTION IN OBSTETRICS— ARNOLD
had soreness especially in the lumbar region. She was
kept in bed eleven days. She was very pale and had
some trunk and facial edema before the diuresis, but
never any pitting edema of the extremities.
The treatment, as indicated in the chart, was aimed at
adequate nutrition, water, and electrolyte balance during
the time it takes for the damaged kidney to recover.
Diathermy to the kidney areas twice daily was given
empirically, believing it might stimulate circulation in
the kidney through relaxation of vasospasm.
There seems to be little hesitancy to place this
dramatic case as one of transfusion reaction. Of
the three types of reaction there are: (1) physical
and chemical reaction, (2) allergic or urticarial
reaction, (3) hemolytic reaction. Among the lat-
ter there are: (a) intra-group type of Rh reaction
or “cold” hema-agglutinins, (b) gross incompat-
ibility, (c) dangerous “universal” group O donor.
Strumia stated that when using group O blood
it would seem desirable to use those blood with
titers of less than 1 :60 isoagglutinins. Witebsky
et al, feel that this precaution is unnecessary if
purified A and P> substances are added to the blood
in order to neutralize the isoagglutinins. Strau-
mia further suggests that in need of extreme pre-
caution one may use the biological test of giving
100 c.c of the blood and comparing five hours later
the serum bilirubin of the patient’s blood then with
the pre-transfusion level.
The seriousness of this condition, in Strumia’s
opinion, is modified by several factors. In general,
in those with previous kidney damage, the out-
look is unfavorable. Those receiving less than
250 c.c. of blood will usually recover. Those re-
ceiving 500 c.c. «r who have had previous trans-
fusion reactions will usually die.
The incidence and death totals are best illustrat-
ed by the groups and statistics collected bv Wiener
and shown in Table I.
In considering some of the literature on this
subject, the most interesting discussion is on the
pathogenesis of the sequelae of hemolytic reaction
in the kidney. The varieties of theory on kidney
pathology are briefly four : ( 1 ) blockage of renal
tubules, (2) anaphylaxis, (3) nephro-toxic sub-
stances released from hemolysis, (4) ischemia of
kidney from vasoconstriction.
The theory, from the laboratory studies of
Dodds, DeGowin and Richards, of blockage by
acid hematin crystals seems not to be substantiated
clinically, as in a number of deaths there were
few with blocked tubules. Strumia states that in
four of his cases there were none blocked.
TABLE I. TRANSFUSION STATISTICS
No. of
No. of
Year of
Trans-
Hemolytic
Report
fusions
Reactions
Deaths
Fresh Blood
Wiener*
1917-1941
19,275
39
Kilduffe and De Bakey 1917-1941
43,284
80
45
Stored Blood
Weiner*
N. E. Deaconess
1939-1941
8,236
9
Blood Bank
Mass. Mem.
1942-1946
13,000
2
1
Blood Bank
Hartford Hosp.
1940-1946
6,464
1
0
Blood Bank
Mass. Gen. Hosp.
1941-1946
16,000
2
0
Blood Bank
Peter B. Brigham
1942-1946
28,588
8
2
Blood Bank
Children’s Hos.
1945-1946
2,140
3
0
Boston Blood Bank
Boston Lving-In
1946
1,200
1
0
Blood Bank
1946
452
1
0
Total
76,080
18
12
*These are the totals of a group of statistics collected by
Wiener and presented in his book.
The theory of anaphylaxis is opposed by two
facts : one is that hemolytic transfusion reaction
usually follows a single dose of whole blood ; and,
second, urticaria has never been seen with fatal
post-transfusion reaction.
That there is a nephro-toxic substance released
from blood hemolysis is difficult to prove. Hemo-
globin of itself is nontoxic. But the protein sub-
stances contained in the red cell stroma is likely
to be the toxic factor. This toxic factor leads us
into fascinating current work that is being done
on renal mechanisms and particularly renal cir-
culation as under control of a neurovascular re-
flex.
Raldwin Lucke, in a monumental work, studied
a series of 538 cases from the clinicopathological
viewpoint. He states : “It is appropriate to desig-
nate all cases exhibiting these renal disturbances
no matter what their etiologic background by a
single term.” This he gave the name of “lower
nephron nephrosis.” The various causes of. this
lesion he lists as follows :
1. Crush syndrome
2. Thermal burns
3. Heat stroke
4. Black water fever
5. Chemical poison or sensitivity
6. Alkalosis
7. Hemolytic transfusion reaction
8. Non-traumatic muscular ischemia
9. Toxemia of pregnancy
10. LUero-placental damage
At present, the exact pathogenesis is not too
well known. Lucke states : “Several factors are
concerned in combination. Among those impli-
598
Minnesota Medicine
HEMOLYTIC TRANSFUSION REACTION IN OBSTETRICS— ARNOLD
cated are : degradation products of myoglobin
and hemoglobin, products of tissue breakdown,
physiochemical alteration of blood and body fluids,
shock and disturbances of renal blood flow re-
sulting in ischemia of the kidney and anuria.”
In a recent article by Mauzy and Donnelly, who
studied nine cases of urinary depression in the
toxemia of pregnancy, they advance the theory
that both the liver and kidney are involved. One
detoxifies, the other excretes. The liver is the first
line of defense and, in case of damage here, the
kidney or second line of defense takes over. They
have made a diagram in simple explanation
(Fig. 1).
Initiating Factor
Tissue Destruction
I
Liver I Kidney
Secondary Factors
Removal and
Detoxification
of Products
Liver damage
with
Retention
High Concen- Moderate
tration of po- Concentration
tentially toxic of potentially
chemicals toxic chemicals
i
1
i
Injury to Cells
of Lower Nephron
Excretion or Normal
Re utilization Loss of Selective Excretion
Resorption
Urinary Suppression
Fig. 1.
This article and diagram bring back to mind
the term hepato-renal syndrome seen in the litera-
ture a number of years ago.
Ward O’Donnell, in 1949, reported three cases
to show proof between lower nephron nephrosis
and abortion. There was jaundice in two of the
three cases and the third had hepatic zonal ne-
crosis. All three had the typical renal pictures.
All three had similar uterine findings, namely, ne-
crotic decidua and chorionic epithelium. He says :
“In our cases it is probable that the theoretic sub-
stances had origin in the retained placental tissue.
. . . It is also possible that both factors — a hypo-
thetic vasonconstrictive humoral substance from
the ischemic placenta and toxins from invading
bacteria — might, by synergistic effect, act on a
susceptible neurovascular mechanism to produce
reduced cortical flow, a result not obtainable by
either acting separately. The role of bacterial
toxins may be that of producing hepatic damage
sufficient to produce hepatocellular dysfunction
and inability to detoxify circulating placental
products. These substances would then be free
to act unfavorably on the kidneys.”
Obstetricians will be particularly interested in
the work of British pathologists and physiologists.
The syndrome was first noted in the first World
War and then forgotten for nineteen years. In the
early part of the World War II, Bywate'rs and
Dible in 1942 noted the syndrome in war injuries
and called it the “crush syndrome.” They reported
a characteristic lesion in the lower nephron man-
ifested by degeneration of the epithelium and de-
posits in the tubules of crystals of blood pigments.
Identical pathological changes were noted by
Bratton and James Young in obstetrical anurias
associated with abruptio placentae. J. F. Smith, of
London Hospital, in examining seventeen necrop-
sy cases of eclampsia, found pigment casts in the
second convoluted tubules and ascending limbs of
Henle in three. In two of the three cases there had
been oliguria. Abruptio has long been believed
to have a background of toxemia. Evidence now
suggests that abruptio and toxemias (in certain
cases) and crush injuries may have a common
picture in this lower nephron nephrosis.
From Nuffield Institute (Oxford) comes an im-
portant monograph by Josef Truetta et al,
“Studies of the Renal Circulation.” Here he pos-
tulates by animal study that normally the renal
cortex receives most of the blood and the medulla
the smaller part. The blood reaching the kidney
has two potential routes. The path of the greater
circulation is through the cortical glomeruli. When
blood follows this route, the glomeruli are well
filled, urine flow is normal, and the blood in the
renal vein is venous. Thy pathway of the lesser
circulation of the vessels is to the medulla and to
the juxta-medullary glomeruli. When vascular
spasm shunts blood through this route, the flow
of urine is decreased and the blood in the renal
vein is largely arterial. The primary cause of low-
er nephron nephrosis is this cortical ischemia due
to a shunting of the blood and its toxic products
by a neurovascular reflex into the medulla.
It is further postulated that this neurovascular
mechanism of the kidney is largely protective.
Though there may be complete desquamation of
these tissues, they can regenerate in four to ten
days, showing the reparative power of the kid-
neys provided the individual can survive the re-
pair period. Mr. T. L. T. Lewis believes that if
there is a sudden release of toxic products into
Junk, 1950
599
HEMOLYTIC TRANSFUSION REACTION IN OBSTETRICS— ARNOLD
the circulation, as in uterine muscle breakdown
from abruptio placentae, the kidney deals first in
the protective mechanism of the “Truet a Shunt”
so as to save the cortex. If this mechanism is
overwhelmed or fails, the delicate cortical vessels
are injured, paralyzed, engorged and finally
blocked. In the first, we have lower nephron
nephrosis and possible recovery. In the second,
we have cortical necrosis and inevitable death.
The cause of death in these cases is not uremia.
More properly it involves electrolyte balance, acid
and base equilibrium and water distribution. The
diminution of urine, as studied by Bywaters and
Dible, “is now due to excessive, but unselective
reabsorption of the glomerular filtrate through the
tubules — in other words, leakage back into the
blood stream.” The kidneys are involved in pro-
tein metabolism as they can form urea. Therefore,
breakdown in kidney function may give rise to
toxic protein metabolites. Uremic death is more
than an accumulation of urea, uric acid and cre-
atinine.
Prof. K. J. Franklin and his co-workers have
shown what a hair-trigger mechanism the renal
shunt can be. Stimulation of a sciatic nerve end
or the nerve plexus about the renal artery, the
injection of staphylococcus toxin or pituitary ex-
tract can instantly bring about the cortical ische-
mia. Another field that can reflexly evoke the
“Oxford shunt” is the so-called “stretch stimuli.”
This is the distension of hollow organs composed
of smooth muscle. Distending the bladder with
normal saline solution, stretching the intestine or
parts of the pregnant and nonpregnant uterus,
similarly are followed by this renal neurovascular
response. He advances the hypothesis that the
toxemia of pregnancy is, or includes, a progres-
sively increasing tendency for the renal shunt to
be brought into operation and that cortical necrosis
represents the maximal irreversible result of this
tendency.
Conclusions
Though constantly minimized by basic research,
transfusion is still a dangerous procedure requir-
ing rigid observation of the known rules. Pre-
vention is paramount. The syndrome of lower
nephron nephrosis seems to underlie such clini-
cally diverse conditions as shock, burns, eclampsia,
chemical poisoning, muscle injury and intra-
vascular hemolysis.
Recent clinico-pathology and physiological re-
research have revealed some of the facts regarding
the cellular pathology and the neurovascular me-
chanisms in the kidney. Furthermore, those facts
seem to apply to body defense mechanisms which
heretofore were not thought to be related. These
mechanisms are probaly basic to homeostasis.
Though many extravagant methods have been
tried in the treatment, the simple maintenance of
adequate nutrition and water and electrolyte bal-
ance best serves the body in the period of the
fourth to the tenth day when, if possible, the
kidney cellular damage is repaired. The case
reported was followed on this basis, with for-
tunate results.
,<TV',v 'U--\
PSYCHIATRIC EXPLANATION OF BALDNESS
The April, 1950, issue of Modern Medicine condenses
“A Theory of the Pathogenesis of Ordinary Baldness”
from Archives of Dermatology and Sy philology.1 This
ingenious explanation relates baldness to tension of scalp
muscles creating shearing stresses in the dermis, with
subsequent ischemia and alopecia. “This muscular ac-
tivity probably survives from a once useful defense mech-
anism in man’s phylogenetic past, when the ears were
drawn against the head for protection during attack.”
The authors believe that anxiety in connection with at-
tacks on personal integrity may elicit this basic defensive
attitude.
For years we have carried on personally in our absent-
minded way beneath a cranial dome from which, like
the Parsee’s hat, the rays of the sun are reflected with
more than oriental splendor. To us, in our simplicity,
it has heretofore been merely a carefree bald head need-
1 Szasz, T. S., and Robertson, A. M. : Arch. Dermat. & Syph.,
61:34 (1950).
ing no brush and eliciting only the usual good natured
“kidding.” In summer it has served as a portable landing
field for flies, mosquitoes, and the like, but that it was
a survival “from a once useful defense mechanism” in
our phylogenetic past in which our musculature slicked
our ears back has never occurred to us, especially as we
have never been able to wiggle our ears, thereby in our
youth having lost considerable face in the presence of
those who could and did practice this delightfully enter-
taining sport.
Our personal integrity has been at times attacked, but
our defense mechanism, pinned hack ears and low wind
resistance on top, has worked well on the whole, now
we think about it.
The authors say also “The facial expression associated
with early baldness is a fixed smile which indicates
hyperactivity of the occipitalis.” Until now we had con-
sidered it only as an expression of good nature, but that
was in our preindoctrination period. Ah, well; live and
learn. — Editorial N. Y. State J. of MM., May 15, 1950.
600
Minnesota Medicine
PLACENTAL POLYP SIMULATING A CHORIONEPITHELIOMA
Report of Case
F. H. MAGNEY, M.D.. F.A.C.S.
Duluth. Minnesota
A PLACENTAL polyp is a rare finding.
Only a few cases have been reported, and
these have not been diagnosed clinically but have
had to await a careful study by the pathologist in
order to rule out malignancy. Dorsy3 reported a
case in which the tissue was sent to the third
pathologist before a definite diagnosis was ob-
tained. In this case, as well as that reported by
Hagstrom,4 the bleeding was so severe that it
threatened the patient’s life. This also occurred
in the patient being reported in this presentation.
A patient reported from the records of the
Massachusetts General Hospital5 had severe
hemorrhages but this case was also complicated
by an acute and chronic salpingo-oophoritis.
According to Curtis,1 the designation of
“placental polyps” has been given to portions of
placental tissue of varying size, which may be
retained within the uterus for an indefinite period
after an abortion or full-time parturition. If the
retention be for a considerable time, the placental
tissue still attached to the uterine wall becomes
slowly incapsulated by concentric layers of blood
and fibrin, forming the polyp tumor. On section,
such a tumor will present a central nodule of more
or less well-formed chorionic villi, with pro-
liferating chorionic epithelium, covered by layer
upon layer of organized blood clot and fibrin,
together with round cell infiltration. Portions of
trophoblast will serve to prolong the pregnancy
reaction of the uterus for an indefinite period.
Thus, placental polyps are productive of con-
tinuous slight uterine bleeding, and they keep the
uterus in a state of subinvolution.
The following description is found in Principles
and Practice of Obstetrics by DeLee-Greenhill2 :
“If bits of placenta or decidua do not become
infected, blood is deposited upon them in succes-
sive layers, and a fibrinous or placental polyp
results. They cause irregular hemorrhage until
they are removed, or they become infected, break
down, and are discharged piecemeal with fetid
discharge and fever, sometimes with hemorrhage.
The polyps may produce sufficient gonadotrophic
hormone to give a positive reaction to a pregnancy
test.”
Report of Case
A forty-year-old woman was admitted to St. Mary’s
Hospital giving a history of irregular menstruation for
one year, but more marked during the last five months.
The bleeding had been profuse for two days, and just
before entering the hospital she had passed a large
amount of blood and clots which, she thought, amounted
to nearly a quart.
The past history was of no special significance. She
began menstruating at thirteen years of age. Periods
were always regular up to one year ago, normal in
amount, and caused no discomfort. She had given birth
to eight children, all of whom were living and well, and
had had one miscarriage three years ago. She had not
been conscious of being pregnant since that time.
Previous surgery consisted of an appendectomy and a
thyroidectomy for a toxic adenoma.
The physical examination revealed a well-developed
and poorly nourished woman, very pale. The pulse rate
was 90 beats per minute. The temperature was 98.2°.
The respirations were 20. The blood pressure was 102
mm. of mercury systolic and 75 mm. diastolic. She
appeared older than the chronological age. A mass
could be palpated in the midline of the lower abdomen,
which was firm and smooth and had the contour of an
enlarged uterine fundus. Vaginal examination revealed
a normal cervix. The body of the uterus was about four
times the normal size, firm in consistency, in good
position and freely movable. Erythrocytes numbered
2,880,000, and leukocytes 6,600, per cubic millimeter of
blood.
The bleeding subsided shortly after admission. She
was transfused and prepared for operation, which was
done five days later. Through a lower midline incision,
a subtotal hysterectomy was done, and the specimen
sent to the pathologist, who reported that there was
evidence of malignancy, possibly a chorionepithelioma ;
so the cervix, fallopian tubes, and ovaries were also
removed. For diagnostic purposes, a catheterized speci-
men of urine was obtained while the patient was still
on the operating table. This gave a positive pregnancy
test.
The convalescence was uneventful. The wound healed
by first intention, and the patient left the hospital on the
ninth postoperative day.
Pathologist's Report
Macroscopic. — A uterine fundus which measures 9.5
cm. in length by 7 cm. in transverse and 6.5 cm. in
anteroposterior diameter. The specimen weighs 210
Presented before the Duluth Surgical Society.
June, 1950
601
PLACENTAL POLYP— MAGNEY
grams. On being opened, there is a large, sessile nodule
attached to the posterior aspect of the endometrium. This
nodular mass presents a hemorrhagic, slightly necrotic
surface, which is moderately irregular. On section
Fig. 1. Low power photomicrograph. (X’s) Degenerated
chorionic viln endowed in librods connective tissue. (Y) Dilated
atropic endometrial glands. (Z) Myometrium.
through this mass, it is difficult to note a line of
demarcation between the tumor mass and the myo-
metrium. The latter, however, contains numerous large
blood vessels. Further sections through this structure
show some areas in which the line of demarcation
between the tumor and myometrium is demonstrable.
The tumor tissue is highly hemorrhagic and in some
portions moderately spongy. A few foci of necrosis are
present.
Microscopic. — Permanent sections of the tumor mass
within the uterus show a border of endometrial mucosa
which is average in appearance. The mucosa grades
into decidual tissue which is moderately fibrous and,
in part, hyalinized. There are also localized patches of
hyperplasia of the large decidual cells. Along the margin
of the tumor mass, there are numerous chorionic villi,
some of which contain calcarious foci. Some sections
show a moderately diffuse infiltration of mononuclear
Cells and neutrophils. The chorionic villi do not in-
filtrate into the muscular tissue of the uterus. In some
sections, masses of partially organized decidual tissue
separate the villi from the myometrium. A slight
amount of trophoblastic proliferation is noted in the
myometrium. Otherwise, the latter is not unusual.
Diagnosis. — Placental polyp.
Novak gives the following description : “The gross
appearance of the placental polyp, together with its
grumous hemorrhagic appearance is not unlike that of
the chorionepithelioma, and I know of several instances
in which such a diagnosis was made in spite of the total
different microscopic structure of the two lesions.”
Summary
A placental polyp of the uterus is a rare con-
dition and cannot be differentiated from chorion-
epithelioma except by microscopic study. Both
conditions produce gonadotrophic hormone which
can be detected in the urine. A case is presented
of a forty-year-old woman whose symptoms and
whose pathological tissue, both gross and micro-
scopic, correspond to that of the few reported
cases.
References
1. Curtis, Arthur Hale: Obst. & Gynec., 2:978, 1934.
2. DeLee-Greenhill : Ninth edition, p. 734. Philadelphia: W. B.
Saunders Co., 1947.
3. Dorsey, Charles W. : Placental polyp with severe late puer-
peral hemorrhage. Am. J. Obst. & Gynec., 44:591, 1942.
4. Hagstrom, Henry T. : Late puerperal hemorrhage due to
placental polyp. Am. J. Obst. & Gynec., 39:879, 1940.
5. Massachusetts General Hospital: Case 33162. New England J.
Med.. 236:601, 1947.
6. Novak, Emil: Gynecological and Obstetrical Pathology. Pp.
150-151. Philadelphia: W. B. Saunders Co.
EARLY DETECTION OF DISEASE
A little arithmetic convinces one that elaborate annual
physical examinations involving complicated procedures
and consuming much time of physicians are not the
answer to early detection of conditions such as tuber-
culosis, cardio-vaseular disease, cancer, syphilis, and
diabetes. The cost is too great and there are not enough
physicians.
The answer may lie in multi-phasic rapid screening
conducted at the technician level. A number of such
experimental programs are now being conducted. In
only a few minutes, the person being examined will have
a chest x-ray (which may reveal heart abnormalities or
lung tumors as well as tuberculosis and certain other
lung infections), and a blood specimen will be taken for
determination of the blood sugar level and presence of
syphilis antibodies. Perhaps other serologic tests will be
made. Although physicians will be needed to interpret
the tests, the tests themselves will be conducted by
technicians.
Such a program will fail completely unless the medi-
cal profession is made to understand thoroughly the
philosophy of the program, namely, that it does not
take the place of the physician in making a diagnosis.
In fact, no diagnosis will be made. Only suspected ab-
normalities will be screened out in this first procedure;
the diagnosis will be made later in the physician’s office
and, it is hoped, at a stage when the physician may be
more effective in administering treatment than would
have been the case if the patient had waited until the
development of full-fledged svmptoms forced him to
consult a physician. — James £. Perkins, M.O., Bull.
Nat. Tuberc. A., January, 1950.
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Minnesota Medicine
History of Medicine In Minnesota
MEDICINE AND ITS PRACTITIONERS IN OLMSTED COUNTY PRIOR TO 1900
NORA H. GUTHREY
Rochester, Minnesota
(Continued from May issue)
Housen H. Clifton, “cancer doctor,” was born in Kentucky in 1830. After
the outbreak of the Civil War he enlisted, on August 2, 1862, in Company H of
the 72nd Indiana Volunteer Regiment of Infantry and received his discharge on
June 26, 1865. In 1866 with his wife Permelia Seeley Clifton and his son William
W. Clifton, then eighteen years old, he came to Rochester Township, Olmsted
County, and settled on a farm in Section 8, four miles southwest of Rochester on
what is still known as the Salem road. Leonard stated that Permelia Clifton also
had served her country during the Civil War, as a nurse. Tn 1887 Dr. Clifton
became a member of the local Custer Post of the Grand Army of the Republic,
of which for a time he was post surgeon.
What Dr. Clifton’s medical training had been is not known ; although he treated
patients for “la grippe” and other ailments, he concentrated on a domestic remedy,
since described as an escharotic agent, for skin cancer. For many years he was
called locally the “plaster doctor” or the “cancer doctor.” Patients came to him
from considerable distances, one at least from Lake Benton, Minnesota. In 1886
recommendations of Dr. Clinton’s painless, nonsurgical cancer cure began to
appear in the Rochester newspapers and for seven years thereafter there were
published also numerous news items about patients he had treated for cancer ot
the head, face or breast. The most detailed statement, on October 22, 1886, in the
Record and Union , was as follows:
Dr. Clifton of Rochester has been for the past sixteen years experimenting on a remedy to
cure cancers. He claims to have finally succeeded in producing a remedy that takes out
cancers in from seven to fourteen days. All he does is to paint the affected part an t e
medicine does the work. It does not affect the sound flesh, but destroys the fungus growth ot
the cancer and it dries up and is easily removed.
Another note, on another subject, was: “Dr. H. Clifton of Rochester has a
genuine madstone. Should any one be unfortunate enough to be bitten by a mad
dog, the doctor would be glad to let him use the stone.
Housen H. Clifton died suddenly on September 21, 1893, in his sixty-fourth
year, from overexertion in fighting a fire which destroyed his home, a few miles
from Rochester, on that day. He was buried from the Methodist Episcopal Church
of Rochester under the auspices of the Grand Army of the Republic. After his
death, his son, William W. Clifton, continued the manufacture and use of the
cancer remedy.
William W. Clifton, who was born at Fountain City, Indiana, on December
9, 1848, came to Rochester Township, Olmsted County, in 1866 with his parents,
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HISTORY OF MEDICINE IN MINNESOTA
Housen H. Clifton, farmer and medical practitioner, and Permelia Seeley Clifton.
Leonard stated that William Clifton became an ordained minister of the Methodist
Episcopal Church but never followed the calling; that he studied medicine under
his father and at the Metropolitan School of Physicians and Surgeons (Metro-
politan Medical College, Chicago?), from which he was graduated; that he was a
Republican “with a strong leaning to prohibition and other reforms tending
toward the general good of the country.” After his father’s death he succeeded
to the practice in treatment for skin cancers, as noted, and until the early nineteen
hundreds his card appeared in Rochester newspapers : “Cancers cured without
cutting. Dr. Clifton’s Celebrated Cure. Call on the doctor. W. W. Clifton,
Rochester, Minnesota.” Subsequently, it is said, he became a veterinarian.
William W. Clifton was married to Miss Alti Wagoner, daughter of respected
pioneer settlers who came to New Haven Township in 1856; one of Mrs. Clifton’s
brothers, Joseph H. Wagoner, was for many years a successful dealer in organs
and pianos in Rochester. Dr. and Mrs. Clifton had four children, Nettie, Walter,
George and Sadie. Nettie G. Clifton, a graduate of Hamline University, was a
teacher in the public schools of Minnesota and North Dakota. She was married, in
September, 1902, at the home of her parents, on the old Clifton homestead, to
Professor Earl G. P>erich, a biologist, of Fargo.
Alexander Brodie Cochrane, graduate of the Minnesota College Hospital on
March 24, 1882, came to Rochester, Minnesota, on August 1, 1883, as assistant
physician to Dr. J. E. Rowers at the Second Minnesota Hospital for Insane. He
was the third physician to be appointed to the hospital staff and was successor to
Dr. W. A. Vincent, who in 1881 came as the first junior physician appointed in the
institution. On October 11, 1883, under the new state law to regulate medical
practice, Dr. Cochrane received certificate No. 46 (R).
Dr. Cochrane’s musical ability added to his value as physician : The hospital
choir, made up of employes and patients, under the direction of Dr. Cochrane as
organist, furnished the music at special services and holiday celebrations. His
name has not appeared in connection with a local medical society, for the reason
that the Olmsted County Medical Society, inactive at that time, was not re-
organized until December, 1885, after Dr. Cochrane had gone. In newspaper
accounts Dr. Cochrane was mentioned as one of an operating team, with Dr. J. E.
Bowers, who assisted Dr. W. W. Mayo in removal of ovarian tumors.
Dr. Cochrane resigned his position as assistant physician early in December,
1884, and on December 10, after a week’s visit with friends in Chicago, he sailed
for “his old home in England.” He was succeeded at the state hospital by Dr.
Homer Collins.
E. G. Cole, professedly a skillful oculist, came to Rochester, Minnesota,
early in 1862 for the purpose, he said, of restoring “the blind to sight,” no cure,
no pay, and remained probably several months. His headquarters were at I. S.
Woodard’s drugstore. The chief note concerning him was under “Common
Council Proceedings” in the Rochester Republican: Dr. Cole’s bill for services
to a certain indigent patient on whose eyelid he had operated, was taken up for
reconsideration and it was decided to appropriate fifteen dollars, to be paid when
cure should have been effected. Dr. Cole’s professional cards in the local news-
papers were typical of the notices used by the numerous traveling medical fra-
ternity of the time.
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HISTORY OF MEDICINE IN MINNESOTA
J. C. Cole (1813-1890), an honorable and benevolent man, was the first
physician, surgeon and druggist of the village of Marion, Marion Township,
Olmsted County, and was in active practice there from 1856 into 1866, under
the rigorous conditions of pioneer life.
Born in Butternuts, Otsego County, New York, on January 5, 1813, J. C. Cole
was a son of Mr. and Mrs. Richard Cole, who were the parents of nine children,
eight sons and a daughter. In 1836 J. C. Cole traveled west to Illinois, where he
spent twelve years before removing to Wisconsin. At Plainfield, Will County,
Illinois, he was married on September 7, 1848, to Mary Ruth Dupuy ; of this
marriage there were three children, William, Mary and Helen. Mrs. Cole died
on December 10, 1852, and Helen on the following day, both at the family home
in Rosendale, Fond du Lac County, Wisconsin. Two years later Dr. Cole
traveled from his Wisconsin home to Butternuts, New York, where on January
18, 1854, he was married to Mrs. Almira E. Safford. Of the second marriage there
was one child, C. J. Cole.
Dr. Cole first arrived in Marion, Minnesota, on April 11, 1856. After taking
up a government claim, he went back to Wisconsin for his family and returned
with them one month later. To the settlement, which then comprised a small
tavern, a store, a scattering of cabins and the groundwork of a schoolhouse he
added a new residence and a drugstore. For a few months in 1863 Dr. Cole had
an office on Broadway in Rochester, for the practice of medicine, it was an-
nounced, on the most scientific principles of the day. A newspaper note of 1860
indicates that he made an occasional trip east for professional study.
In 1866 there occurred the first of many attacks of the nervous and mental
disturbance that made Dr. Cole’s hospitalization necessary at intervals the
remainder of his life. He died in Minneapolis on January 6, 1890, survived by
three children, Mary and William, and C. J. Cole, of Marion, and was buried at
Marion; his funeral services were conducted by the Reverend Frank Doran, of
Rochester. Mrs. Cole had died in Marion on December 6, 1872.
Two of Dr. Cole’s brothers were early settlers in Minnesota : B. M. Cole, of
Pleasant Grove, and Dr. G. H. Cole, a dentist of Marion and sometimes of
Rochester, from 1859 to 1866. Later Dr. G. H. Cole practiced dentistry in
Owatonna, Winnebago City and, after 1882, in Mankato. He was born on May 24,
1832, at Butternuts, New York; was married on April 17, 1861, to Clementine E.
Rossman of Rochester ; served in Company D of Brackett’s Battalion of Cavalry
during the Civil War, from January 5, 1864, until he was mustered out in March,
1865, as sergeant, because of disability. He died in Mankato on January 1, 1885.
Homer Collins (1859-1949) was the fourth appointee, the third to serve as
the assistant physician on the staff of the Second Minnesota Hospital for
Insane at Rochester, succeeding Dr. Alexander Brodie Cochrane late in 1884.
The son of Nelson and Isabella Collins, Homer Collins was born in 1859 in
Perinton Township, Monroe County, New York, just ouside the little city of
Fairport. Orphaned by the death of his mother when he was a month old and the
death of his father less than a year later, he was brought up by his paternal grand-
father and two aunts, sisters of Nelson Collins.
He received his early education in the public schools of Rochester, New York,
and his academic courses at the Rochester Free Academy and at Cornell Uni-
versity; from Cornell he was graduated in “natural history,” and received the cash
prize awarded in the department of Dr. Faw. In 1882 he entered the College of
Physicians and Surgeons of Columbia University, from which he was graduated
in 1884 with the degree of doctor of medicine. After taking his degree, he held a
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HISTORY OF MEDICINE IN MINNESOTA
service of several months at the Presbyterian Hospital of New York; attended
lectures at the New York Eye and Ear Infirmary, and at the New York Ophthalmic
and Aural Institute (after 1913 the Hermann Knapp Memorial Eye Hospital),
under the instruction of Dr. Herman Knapp, one of New York’s great ophthal-
mologists and otologists ; and took several courses of lectures at the New York
Post-Graduate Medical School.
On December 1, 1884, Dr. Collins began his work at the state hospital in
Rochester, Minnesota. The physicians of the hospital were an important part of
the city and Dr. Collins was no exception. He made many friends and com-
manded the respect of fellow physicians. On occasion he was one of a varying
group, which often included Dr. J. E. Rowers, superintendent of the state hospital,
who assisted Dr. W. W. Mayo in performing surgical operations of special in-
terest.
Dr. Collins was a charter member of the Olmsted County Medical Society when
it was reorganized in December, 1885. and he became a member of the Minne-
sota State Medical Society. On April 15, 1887, he received his state license No.
1359 (R) to practice in Minnesota. When he resigned his position at the state
hospital in October, 1889, to enter private practice, he was honored by the officials
and the attendants, who presented him with a diamond ring and a gold-headed
cane. On leaving Rochester, Dr. Collins returned to Rochester, New York, with
the idea of entering practice there, but by the early autumn of 1890 he had de-
cided on the Middle West, and after considering Superior, Wisconsin, as a
location he settled in Duluth.
In June, 1895, Homer Collins was married to N. Gertrude Sloan of Duluth.
Dr. and Mrs. Collins had four children, a son, Homer Collins, Jr., and three
daughters, Cordelia, Gertrude and Patricia, all of whom, in 1945, were living in
Duluth. Of the four grandchildren, one was in service in the United States Army
Air Forces during World War II. (Dr. Collins died on July 31, 1949, at the
Duluth Hospital, aged ninety years.)
Discussion of Dr. Collins’ long and distinguished professional career in the
special fields of ophthalmology, otology, rhinology and laryngology belongs pri-
marily to the history of medicine in Duluth and St. Louis County.
Franklin Judson Cressy, born in 1849, was the son of Mr. and Mrs. F. C.
Cressy, who long were respected residents of Olmsted County.
Details of Dr. Cressy’s early life and education are lacking. On September 2,
1910, however, he was referred to by the Olmsted County Democrat as an “old
time resident of Rochester and a grade school pupil here in the Central School the
first year it was opened” (1868). He received the degree of doctor of medicine
from the College of Physicians and Surgeons of Keokuk, Iowa, in 1877. Earlier,
in April, 1876, the Rochester Post had referred to him as Dr. Cressy and cited
a case in which he had given aid. In March, 1877, this newspaper commented as
follows: “The Howard Lake, Stearns County, Minnesota, paper says that Dr. F. J.
Cressy, formerly of this city, has entered into partnership with Dr. Knowles of
that village for the practice of his profession. Dr. Cressy is a young man of
superior qualification and good character and we wish him much success in his
new field of endeavor.”
Well before 1890 Dr. Cressy was established in practice at Granite Falls, Yellow
Medicine County. His state license, No. 581 (R), was issued on December 31,
1883. He was a member of medical societies, county, state and national; his name
appeared in the directory of the American Medical Association from 1906 to 1918,
inclusive.
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Minnesota Medicine
HISTORY OF MEDICINE IN MINNESOTA
W. J. Conan, physician and surgeon, came from Fond du Lac, Wisconsin, to
Rochester, Minnesota, in January, 1879, and for about five months, as indi-
cated by his professional card published in the Rochester Post, practiced medicine
in the city. His office, advertised as open night and day, was over a millinery
store, in H. A. Brown’s block, on Broadway.
Edwin Childs Cross (1824-1894), one of the earliest and best educated of
the pioneer physicians and surgeons of Olmsted County, came in May, 1858, from
Brattleboro, Windham County, Vermont, to Rochester, Minnesota, which then
was a frontier settlement. His younger brother, Dr. Elisha Wild Cross, had
visited Rochester two years earlier and on his return east had described the growing
community and its need for physicians. There were in Rochester in 1858 a few
inactive practitioners, Dr. M. T. Perrine, the earliest, Dr. L. H. Kelley, Dr. J. N.
McLane and Dr. C. S. Younglove, and Dr. I. H. Bardwell, who in 1859 removed
to Pleasant Grove. By 1860 Dr. Cross was so well established that he sent for his
brother to join him in practice. Although there was a difference of only four
years in their ages, Dr. Cross was always called “Old Dr. Cross,” and Dr. Elisha,
“Young Dr. Cross.” The partnership was interrupted in December, 1861, when
Dr. E. W. Cross became a surgeon in the Union Army. In later years, it is said,
although the brothers consulted each other professionally and part of the time
shared offices, in the main they practiced independently.
Edwin C. Cross, born on April 6, 1824, at Bradford, Vermont, was the eldest
living child of Peter Cross (1785-1858), farmer and well borer, and his second
wife, Dorcas Wild Cross (1797-1839), both of English descent and early settlers
in New Hampshire. Peter Cross was the son of Stephen Cross and Margaret
Bowen Cross, both of whom were born in the United States. The sisters and
brothers of Edwin C. Cross, all of whom, in 1946, were long since dead, were:
Abigail W., Elisha Wild, Amos E. (died in Rochester in 1866), Sarah G. (Mrs.
Ed. Elliott, of Rochester), Henry and Mary L. Cross. By the first marriage of
Peter Cross there were the following half brothers and half sisters: John G.,
Caroline M., Michael C. M., Dolly G. and Elbridge O. Cross.
At the age of fourteen years Edwin C. Cross decided to become a physician,
and in the next eight years, earning his way, he acquired an education, academic
and scientific. After early years in common schools and at Bradford Academy, he
finished his classical course at Dartmouth College ; later, after completing a year’s
study under Dr. John Poole, of Bradford, an alumnus of the medical depart-
ment of Dartmouth, he returned to the college to begin his formal medical course.
There are in the possession of Miss Louise Cross, granddaughter of Dr. Cross,
his cards of admission, in 1844, to classes in surgery, obstetrics, anatomy and
physiology, on the recommendation of the New Hampshire Medical Society. Sub-
sequently he attended lectures at Castleton Medical College, in Castleton, Vermont,
at the Vermont Medical College, in Woodstock, and at the “College of Physicians
and Surgeons” (College of Medicine and Surgery?), in Philadelphia. In 1846
he was graduated in medicine from Norwich University, in Norwich, Vermont.
Dr. Cross had an initial practice of four years in Leyden, Massachusetts, was
three years in Guilford, Vermont, and nearly four years in Brattleboro. He
was married on October 1, 1849, at Charlemont, Massachusetts, to Fanny E.
Marcy, who was born at Coleraine, Massachusetts, on August 15, 1827. Fanny
Marcy was a teacher of French at Mount Holyoke Female Seminary (after 1893
Mount Holyoke College), and was the youngest of a family of eleven children,
many of whom distinguished themselves in the fields of letters, theology and
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HISTORY OF MEDICINE IN MINNESOTA
science; her brother, Oliver Marcy, LL.D., in the late eighteen seventies was
acting president of Northwestern University. Dr. and Mrs. Cross, after the
death of their first child and, a few weeks later, loss of their home by fire, set out
early in 1858 for Minnesota.
For thirty-four years in Rochester, Olmsted County, Dr. Cross, cultured, pro-
gressive, of many interests, was an influential physician and citizen. Tall, heavy
and muscular, he was dark-complexioned, had black hair, heavy brows over deep-
set eyes, and wore a mustache and chin whiskers. Handsome and dignified as a
young man, in later decades he was bowed and rugged, of stern appearance, and
of sterner manner which, however, belied his heart. Dr. W. J. Mayo once said of
him, "1 he Old Doctor certainly had a stern exterior, but I have seen him hand a
man who was out of luck a thousand dollars and say, ‘Here, start over again’.”
His patients relied on him, his family were devoted to him.
Although, as his grandson has said, he came to the new country “with his
two hands, and for professional aids a few surgical instruments, quinine, chloro-
form, laudanum or opium, castor oil, and whiskey for a heart stimulant,” he soon
achieved well-earned and increasing prosperity. Practicing in an era marked by
inconvenience and hardship, Dr. Cross in saddle, wheeled vehicle, or sleigh, as
season demanded, made the long laborious trips throughout the countryside that
his extensive practice called for, and gave aid in all the illnesses and accidents
peculiar to the times and region. Venerable citizens in various communities have
recalled of him and his brother, “The Crosses did all the doctoring in our neighbor-
hood.” In emergency he was quick and resourceful, in daily general practice his
methods of treatment were perhaps less drastic than those of some of his col-
leagues.
In his earliest years in the county there were yet Indians of dubious friend-
liness in the community. Dr. Cross had no fear of sober Indians because they
knew and respected him as a “medicine man,” but for possible defense against
drunken Indians of clouded judgment he carried on saddle or in rig a sawed-off,
muzzle-loading, single-shot rifle. In later years he used the gun to shoot fish in the
Zumbro River ; there was so much metal between the bore and the periphery that
he could fire the gun with its barrel under water without danger of its exploding.
Educated as a member of the regular profession in conservative schools, Dr.
Cross while in the East became interested in homeopathy, and when he arrived in
Rochester he announced himself through the local press as a homeopathic and
hydropathic physician and surgeon. For several years after 1860, part of the
time in partnership with his brother, he had the Rochester Infirmary, which served
as his headquarters, and there made available the homeopathic pharmacopoeia and
a variety of soft water baths. By 1867 he had returned to the regular school.
Dr. Cross had a long and honorable record in official medical organizations.
A founder of the early Olmsted County Medical Society on April 15, 1868, he
was prominent in its activities, and when, on December 4, 1885, the society was
reorganized formally, he was a charter member. On June 16, 1869, he became a
member of the Minnesota State Medical Society, soon after its reorganization, and
well into the eighteen eighties he was a faithful worker, as correspondent, mem-
ber of committees, and delegate to meetings of the American Medical Association.
His Minnesota state certificate to practice, No. 905 (R), was issued on May 9,
1884.
When Dr. Cross arrived in Rochester in 1858, existing conditions of health
and sanitation in the city left much to be desired. Presently the newspapers began
to print graphic descriptions of straying livestock, muddy, slimy streets, alleys
blocked with refuse, and of polluted wells. In 1864 Dr. Cross became a member
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Minnesota Medicini
HISTORY OF MEDICINE IN MINNESOTA
of the local board of health and served on it, often as chairman, for more than
twenty years. After 1872, in co-operation with the state board of health, he gave
detailed reports on outbreaks of disease in surrounding rural districts, and during
the smallpox epidemic of 1876-1878 acted as an official vaccinator.
A student of medicine and allied sciences as well as of literature, Dr. Cross
possessed a fine library and subscribed to the current medical journals, which he
read faithfully. Frequently he was out of town for several days on a series of
professional calls in the country, — word would be left at one place for him to come
on to another, — and on his return home there would often be awaiting him an ac-
cumulation of new medical literature. In order to keep himself up-to-date, it was
the doctor’s custom on such occasion to retire to his room with books and journals,
a pitcher of milk and a plate of bread, and by the light of a student lamp at his
bedside, to read all night. As a preceptor he contributed to medical education.
Perhaps the first medical student to come under his instruction was his brother
Elisha, whose education he sponsored and directed in the late forties in Massa-
chusetts and Vermont. In Rochester, among the young men who studied under
him and his brother were Sylvester L. Bedal, from Eyota, Edwin D. Stoddard,
of the vicinity of Rochester, and William A. Vincent, an easterner, later of Iowa.
Although Dr. Cross did not seek civic office, and on one occasion declined
the nomination for mayor of Rochester, he was active in movements for public
welfare. When the Olmsted County Volunteers were organized at the beginning
of the Civil War, he was delegated to tender the services of the company to the
governor of the state ; and in the offices of the Drs. Cross were held organizational
meetings of Sanborn’s Guards (Oronoco Home Guards). Dr. E. C. Cross was one
of the first examiners appointed when, in 1862, the United States Bureau of Pen-
sions was instituted in Minnesota. In March, 1865, he succeeded Dr. W. W. Mayo
as surgeon on the Board of Enrollment of the First Congressional District. It is
told of Dr. Cross that he was clever in detecting malingerers, especially those who
pretended to be deaf. He would listen sympathetically and would seem to be con-
vinced. As such an applicant for exemption was turning to leave the office, Dr.
Cross would ring a silver half dollar down onto the floor ; two thirds of the “deaf”
applicants on whom this device was tried whirled at the sound. In later years Dr.
Cross was medical examiner of candidates for training at the United States Mili-
tary Academy at West Point, was often called as expert witness in medico-legal
cases, and was examiner of persons up for commitment to the state hospital for
insane at St. Peter and, after 1879, at Rochester.
He was interested in city real estate to the extent, in 1869, of improving a
section of northeast Rochester with a group of new cottages, and, in 1878, together
with leading business men, of building a large brick block on Broadway in which
he and his brother had offices. His chief hobby, however, was a fine farm,
“Chesterland,” near Chester in Marion Township, stocked with high-grade cattle,
where he perfected a model dairy, a rare enterprise in that time. He was in-
fluential in organizations for the furtherance of improved agriculture, horticulture,
dairying and buttermaking. In 1882, when he welcomed a convention of the
Butter and Cheese Association, at its first annua! meeting, he gave a keen analysis
of farming, dairying and stockraising in the region ; he stressed the importance
of converting grain farms into livestock farms, and expressed the belief that the
time was at hand when many of the grain elevators on the line of the railroads
must give place to stock yards, and that cattle cars must become more common on
the great lines of transportation from the Northwest. Dr. Cross brought in from
Kentucky fine shorthorn beef cattle, raised improved strains of sheep, bred beauti-
ful Morgan horses as well as horses from famous racing and trotting stock, one
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HISTORY OF MEDICINE IN MINNESOTA
of which was the well-remembered Ada Wilkes. He did not race his horses, but
privately he tried to beat the track record and often did; when in 1887 he bought
from Eleazer Damon, pioneer jeweler, a stop watch for $170, a local newspaper
reported the purchase and stated, “A stop watch is getting to be a necessity for all
ihe breeders of fast horses in the city.” (In 1947 this watch, still in the possession
of the family, was in good condition.) Dr. Cross’s sulky was a familiar sight
about Rochester, as were his carriages and, in winter, his cutter and his handsome
double-seated sleigh generously equipped with buffalo robes. It is said that he
brought into the county the first Gordon setters seen here and that Irish setters
were another of his favorite canine breeds. One Irish setter, Denny, he trained
to ride with him in winter, the dog usually lying across the doctor’s feet as a
footwarmer, but sometimes taking a turn as driver ; on signal Denny would sit
with his head resting on the doctor’s knee ; Dr. Cross would arrange the lines and
place them in the dog’s mouth, and Denny would hold them firmly while the doctor
took time out to warm his hands.
Dr. Cross and his brother in the seventies were among the founders of the
Sportsman’s Club and the Rifle Club of Rochester. And when the Marrowfats
and the Stringbeans, social # groups of business and professional men, were
organized for the formation of baseball teams that were friendly rivals, the Drs.
Cross, each weighing more than 200 pounds, qualified for the Marrowfats.
Dr. Cross was a Republican, a supporting member of the Universalist Church,
an early member of the Masonic Lodge in Rochester (once Worshipful Master),
holder of the Thirty-second Degree of Masonry, and an officer in the Grand
Commandery of Knights Templar. He traveled extensively, combining clinical
visits and attendance at medical conventions with conclaves of fraternal organi-
zations.
On the morning of July 4, 1894, occurred the tragic accident that ended the
life of this outstanding physician and citizen. Dr. Cross was driving a team of
spirited young horses on Main Street and as he neared the southern end of the
street he passed some boys who were out to celebrate the Fourth. The boys waited
until the team had gone a half block or more before they threw some lighted
firecrackers into the road, but the horses heard the explosion and started to run.
Dr. Cross succeeded in quieting the horses and pulling them to a dead stop, when
at another explosion they lunged and both of the bits broke. In those days Main
Street curved to the left at the southern end where a road came in from the right.
While trying to guide the running horses to the left. Dr. Cross attempted to
swerve them slightly to the right to avoid a pedestrian ; the horses swung sharply
right, the buggy struck a large tree, throwing the doctor out against a board side-
walk that stood eight or ten inches high, and on into a picket fence that paralleled
the walk. Although his injuries were mortal, severe cuts about the head, broken
ribs, a shattered femur and a mangled thigh, Dr. Cross remained conscious to
the end of his life and told his family the details of the accident. He died on the
evening of July 5, 1894. At his funeral services Rochester, and the Olmsted
County Medical Society as a group, paid him tribute.
Edwin Childs Cross was survived by his wife, Fanny Marcy Cross, and by
three children: Anna Dorcas (1860-1937), Mary Almira (Mrs. Fred. C.) Van
Dusen (1863-1938), and John Albert Grosvenor Cross (1870-1928). Three
sons had died young: Edwin (1855-1857, Frank Dean (1857-1866) and Edwrard
(1868-1869). The death of Mrs. Cross occurred on September 21, 1901. In
1946 there were living twenty-five descendants of Dr. and Mrs. E. C. Cross.
Minnesota Medici
HISTORY OF MEDICINE IN MINNESOTA
Elisha Wild Cross (1828-1899), younger brother of Edwin Childs Cross,
came to Rochester, Minnesota, as a visitor in 1856 and as a resident in April, 1860,
when he joined his brother in the practice of medicine and surgery. It was then
that he received the title “Young Dr. Cross,” by which he thereafter was dis-
tinguished.
Born at Bradford, Vermont, on January 31, 1828, Elisha W. Cross obtained
his early education at Bradford Academy and at the Wesleyan Seminary at Wil-
braham, Massachusetts. His first medical training he received under his brother’s
preceptorship, and subsequently he took medical courses at the Castleton Medical
College, in Castleton, Vermont, and at the Vermont Medical College, in Wood-
stock, from the latter of which he was graduated with the degree of doctor of
medicine in 1851. In that year he began a five years’ medical practice in Reeds-
borough, Vermont, after which he practiced in Guildford Center, Vermont, until
he came with his wife and two children to Rochester. He was married on October
5, 1849, at Bradford, Vermont, to Martha Peckett, who was born in that village
on June 24, 1829.
In December, 1861, Dr. Cross was appointed Assistant Surgeon of the Fourth
Regiment of Minnesota Veteran Volunteers in the Union Army; on August 9,
1863, he was promoted to major and surgeon and so served until he resigned,
because of impaired health, on December 22, 1864. Throughout his service, which
took him into famous battles, among them Iuka, Vicksburg, Chattanooga, Look-
out Mountain and Altoona, and on Sherman’s march to the sea, his record was one
of efficiency and skill enhanced bv kindness to the sick and wounded and won him
their gratitude and affection.
Beginning early in 1866, Dr. Cross, although in close association with his
brother, Dr. E. C. Cross, practiced independently of him. For a time Dr. E. W.
Cross had his office at his residence on East Fifth Street (East Center Street).
His was the heavy general practice, in town and country, of pioneer times. There
is record that in the seventies he and Dr. W. W. Mayo together performed various
major surgical operations and that in December, 1876, they entered partnership,
sharing three offices over Geisinger and Newton’s Drugstore on Broadway. This
association ended in June, 1878.
Dr. E. W. Cross, like his brother, was tall, dark and strongly built ; Dr. Elisha
wore a mustache, minus the chin whiskers that his brother affected, and in later
years, as ill health forced him into inactivity, he became corpulent. Although each
brother had his special bent, the careers of the two, in profession, avocations and
recreations, were parallel. “Young Dr. Cross” was a Mason, a member of the
Knights of Honor and of other fraternal organizations and of the Military Order
of the Loyal Legion of the United States, a supporting member of the Universalist
Church, an agriculturist, a founder of the Minnesota Horticultural Society, and a
raiser of fine horses and cattle on his large farm “Heathiola” near Chester. Active
in all that went to improve the city of Rochester, he was once commissioner at
large, long a school commissioner and for many years president of the board
of education. For even longer he was the able president of the Rochester National
Bank and a director of the Union National Bank.
(To be continued in the July issue.)
une, 1950
611
President s better
DR. POTTS WOULD BE SURPRISED
The excellence of Minnesota medical conventions is an established fact. We
look forward to the sessions each year, well aware on the basis of past experience
that we will attend stimulating scientific meetings and round-table discussions,
that we will be renewing friendships with colleagues that we see, perhaps, only on
this once-yearly basis, that we will have an opportunity to view scientific and
commercial exhibits of great interest and value.
The 1950 convention was no exception. For myself, and I think I speak for
all the physicians who attended, it was an outstanding conference.
But Dr. Thomas Potts would have been surprised if he had been there.
For him, the 1950 convention would have been amazing, far beyond the reach
of his imagination when, in 1853, he and nineteen other pioneer Minnesota
physicians held the first and organizational convention of the Minnesota State
Medical Association.
This little band of professional men that, today, would represent, numerically,
only one of our round-table discussion groups, has given us a great heritage —
one of the most tangible evidences of which is the annual convention, where learn-
ing and recreation are balanced to prepare and refresh us for the arduous pro-
fessional duties that the coming year brings.
It was a pleasure for Duluth physicians to be hosts to so many of our friends
from all over the state and to feel that our efforts, in a small way, helped to carry
on the noble traditions established by Dr. Potts and his fellow practitioners nearly
a century ago.
President, Minnesota State Medical Association
612
Minnesota Medicine
♦ Editorial ♦
Carl B. Drake, M.D., Editor; George Earl, M.D., Henry L. Ulrich, M.D., Associate Editors
THE VDRL TEST FOR SYPHILIS
"DEGINNING July 1, 1950, the laboratory of
the Minnesota Department of Health will
report the quantitative VDRL blood and spinal
fluid tests for syphilis. The articles by Drs. Kim-
ball and Bauer and by Dr. Lynch explaining the
laboratory and clinical aspects of this new sero-
logical test appear in this issue. Physicians would
do well to read both articles in order to be able
to correctly evaluate the new serologic report.
Although there are advantages to the quantita-
tive reporting of the positivity of the VDRL test,
it does not follow that the height of the titre cor-
relates with the clinical activity of the disease. On
the other hand, the higher the titre, the stronger
the serological evidence is for supporting the diag-
nosis of syphilis. Further, the height of the titre
gives no indication of the likelihood of a positive
spinal fluid or a paretic curve in the colloidal gold
test.
The desirability of a repetition of the test before
a diagnosis of syphilis is made still holds. Other
factors, such as the presence of infections mono-
nucleosis and smallpox vaccination, may produce
false positives. When the serological test is ques-
tionable, two full vials of blood should be sub-
mitted in order that all the tests may be run. As
the new test requires more blood, one would be
playing safe in submitting a full vial on each
occasion.
INDUSTRIAL COMMISSION REPORTS
UR ATTENTION has been called by the
Industrial Commission of Minnesota to the
fact that while most physicians comply with the
law in the matter of reporting workmen’s com-
pensation cases to the Commission promptly
when so requested by the Commission, a few do
not. These reports are necessary in order that
the injured employe may receive the quick and
speedy remedy by way of compensation and other
benefits provided by statute. Such offending
physicians are not only doing an injustice to their
patients, but they are also violating the laws of
the State of Minnesota and are subject to a civil
June, 1950
penalty of $50.00 for each such failure to report.
The law as it applies to the reporting of Work-
men’s Compensation Cases to the Industrial
Commission is reproduced verbatim below. It is
the wish of the Minnesota State Medical Associa-
tion and the Minnesota State Board of Medical
Examiners to co-operate with the Industrial
Commission of Minnesota in having physicians
make these reports as provided by law. The
Industrial Commission has been requested to
furnish the names and addresses of physicians
who are repeatedly in violation of the law referred
to, to the Minnesota State Board of Medical
Examiners for disciplinary action such as is used
for failure to comply with the laws of the State
regarding the reporting of births and deaths.
The Industrial Commission seeks first of all the
co-operation of all the physicians in the State in
this matter. If the report is not forthcoming,
the names of the offenders will be referred to
the Minnesota State Board of Medical Examiners
for disciplinary action.
DUTY OF PHYSICIANS IN REPORTING WORKMEN’S
COMPENSATION CASES TO THE INDUSTRIAL
COMMISSION OF MINNESOTA
“Section 176.32 * * * Every physician or surgeon who
shall examine, treat, or have special knowledge of, any
injury to any employe compensable under this chapter,
shall, within ten days after receipt of any request therefor
in writing made by the industrial commission, report to
the commission all facts within his knowledge relative
to the nature and extent of any such injury and the
extent of any disability resulting therefrom, upon a
form to be prescribed by the commission.
It is hereby made the duty of the commission, from
time to time and as often as may be necessary, to keep
itself fully informed as to the nature and extent of any
injury to any employe compensable under this chapter,
and the extent of any disability resulting therefrom, and
the rights of such employe to compensation ; to request
in writing and procure from any physician or surgeon
examining, treating, or having special knowledge of
any such injury, a report of the facts within his knowl-
edge relative thereto.
Any employer or physician or surgeon who shall fail
to make any report required by this section, in the
manner and within the time herein specified, shall be
liable to the State of Minnesota for a penalty of
613
EDITORIAL
$50.00 for each such failure, and such penalty shall be
recovered in a civil action brought in the name of the
state by the attorney general in any court having
jurisdiction thereof, and it shall be the duty of the
commission when any such failure to report occurs to
immediately certify the fact thereof to the attorney
general, and upon receipt of any such certification the
attorney general shall forthwith commence and prose-
cute such action. All penalties recovered by the state
hereunder shall be paid into the state treasury.
No such report or part thereof, nor any copy of the
same or part thereof, shall be open to the public, nor
shall any of the contents thereof be disclosed in any
manner by any official or clerk or other employe or
person having access thereto, but the same may be used
upon the hearings under this chapter or for state
investigations and for statistics only, and any such dis-
closure is hereby declared to be a misdemeanor and
punishable as such.
For the purpose of determining the merits of a
compensation claim the commission may permit examina-
tion of its file in a compensation case by an attorney at
law upon the furnishing to the commission written
authorization therefor, signed by the employe, his
dependent or dependents, the employer or insurer, as the
case may be.
Any employer or insurer or injured employe shall,
upon request of the commission, file with the com-
mission all medical reports in the possession of such
employer or insurer having any bearing upon the case
or showing the nature and extent of disability ; provided,
that duly certified copies of such reports may be filed
with the commission in lieu of the originals.”
Section 176.32 Minnesota Statutes for 1945.
GEORGE E. FAHR
pv N JUNE 15, 1950, Dr. George E. Fahr is
retiring from the Medical Staff of the
University of Minnesota Medical School. For
years he has been in charge of the Medical
Department at the Minneapolis General Hospital,
and the great demand for a residency in his
department attests to his ability as a teacher. In
his knowledge of the heart and electrocardiog-
raphy, Dr. Fahr has no peer. He was associated
with Dr. Einthoven at the University of Leyden
in developing the first electrocardiograph, and the
first electrocardiogram taken in this country was
taken bv Dr. Fahr on his father. Through the
years, Dr. Fahr has kept a buoyancy and en-
thusiasm that is the desire of all medical men. In
the future, he plans to do medical consultation
in private practice, the Veteran Hospital and
also in the Minnesota medical care program with
Dr. Ralph Rossen.
In years past, retirement from a teaching post
meant the word in its literal sense. Now, sue!
retirement means freedom from administrate
responsibilities, time to engage in research, an(
sharing more fully clinical experience am
judgment. We know Dr. Fahr plans to retire ir
this sense.
THE SAME GUY PAYS
One curse of the Welfare State is the illusion it create;
that the people are getting something for nothing.
Take Britain’s National Health Service. It was mucl
advertised as the “free” health plan. The British peoplt
were to be able to visit the doctor, the dentist, or th<
wig maker and have their needs cared for without pay-
ing anything except a nominal “insurance” premium.
Obviously these payless visits had to be paid by some
one but the complications of a 1950 model governmen
budget often obscure where the money comes from1
Budget developments in Britain the past couple of weeks
however, shed some light on how these “free” service;
are financed.
On April 18 Chancellor of the Exchequer Cripps pre
sented to the House of Commons the government’s budget
for the year which began April 1. The major item oi
increased spending was for socialized medicine. The
amount of that increase was about $363 million, bringing
the total to approximately $1 billion for the new fisca
year.
To keep revenues up with expenses, Sir Stafford pro-
posed among other things that the gasoline tax be raisec
to 20 cents a gallon, from 10 cents, and that a 33 l/s per
cent levy be imposed on the sale of trucks.
Much of the burden of those taxes would fall on truck
operators. So the beneficiary of health service might
say : “That’s fine, let the truck owner pay for it.”
But it doesn’t work that way, as our Mr. Evans re-
ported in this newspaper’s “London Cable” yesterday. H(
says; “The butcher, the baker and the highway freightet
are all racing to shift new transport costs to the con-
sumer. They contend they have no other choice aftei
Chancellor of the Exchequer Cripps’ double-barrelec
budget attack on road travel — a 100 per cent increase it
the gasoline tax and a new 33 Ej per cent purchase (sales)
tax on commercial vehicles.”
Meat traders want to impose an extra delivery charge
a subterfuge for a rise in the price of meat which i;
government-controlled. Green grocers are ready to raist
their prices. Fruit and potato men talk of a 10 per cent
price rise. Bakers are stirred up, too.
So the higher cost of “free” medicine will go right or
the consumer’s grocer bill. He may not have to pay the
doctor, but he pays, just the same.- — Editorial, Wall Strep
Journal, May 2, 1950.
614
Minnesota Medicini
Medical Economics
Edited by the Committee on Medical Economics
of the
Minnesota State Medical Association
George Earl, M.D., Chairman
POLLS SHOW OPPOSITION TO
SOCIALIZED MEDICINE
There is mounting evidence that the public
iderstands the dangers in a scheme of govern-
ent medicine. The Washington office of the
merican Medical Association reports that over-
helming public opposition to compulsory health
surance has been registered in three polls con-
icted by Representatives.
Representative J. Harry McGregor of Ohio,
impling his district on this and other subjects.
Hind that only 10 per cent of the people wanted
icialized medicine. The vital question which Mr.
IcGregor asked on his questionnaire was, “Do
>u favor any type of federal legislation placing
ie medical and dental profession and operation
: our hospitals under Federal control?” The
Washington office reports the results:
“Two thousand replies were received. Mr. Mc-
Gregor does not give the numerical totals but lists
the replies as ten per cent yes, 90 per cent no. A
breakdown by professions shows opposition from 99
per cent of the businessmen, salesmen, professional
and retired people. Next in line in opposition were
housewives, 98 per cent opposed ; farmers 97 per
cent, and attorneys and barbers 96 per cent. So-
cialized medicine had its strongest support among
school teachers, 12 per cent of whom answered
yes.”
Representative Thomas E. Martin of Iowa
ade a similar survey which showed only about
1 per cent in favor of compulsory health insur-
tce. Sending out approximately 25,000 ques-
onnaires, Mr. Martin received 4,221 replies,
hich is regarded as a reliable sample.
Included in the eighteen questions asked, was
lis : “Do you favor socialized medicine ?” Re-
)onses totaled overwhelmingly against — 3,409 no
id 575 yes. It is significant that the districts
impled are almost evenly divided between rural
id urban residents.
Representative Henry J. Latham of New York
included two important questions in his inquiry :
(1) Do you favor socialized medicine? and (2)
Do you favor a national health program which
would not socialize health services but would sup-
ply Federal grants and aids to the States and com-
munities for health purposes? Mr. Latham sent
out 95,000 questionnaires and has received 20,000
back, but only 5,000 have been tabulated thus far.
In Queens district, only 13 per cent (753 per-
sons) answered yes to the first question; 4,424
said no. The second question brought a more
evenly divided answer: 3,009 said yes and 2,136
answered no.
Seeking their constituents’ opinion on the mat-
ter shows that these representatives are among
those actively concerned over this administration
measure.
The narrow margin by which the British so-
cialists won the election in February was triumph-
antly dubbed a “victory” and a “mandate from the
people.” If such a narrow margin is a mandate,
these polls, showing such a large margin against
compulsory health insurance, furnish these legis-
lators with a mandate far more significant than
any claimed by the British socialists.
MEDICINE CONTINUES TO THRIVE
ON TRUTH
The Journal of the Oklahoma State Medical
Association recently made an observation on the
perennial threat against the advances made by
medicine. Linder the title, “Medicine Perennially
Under Fire,” the publication comments :
“All this agitation about medicine is nothing new.
It runs throughout the ages : from 1950 B.C. in
Mesopotamia, to 1950 Washington, D. C. ; from the
shifting sands of the Euphrates to the grass clad
shores of the Potomac; from Nebuchadnezzar to
President Truman; from Hippocrates, the father of
medicine, to Oscar R. Ewing, who . . . wants to be
father of us all, thus giving every doctor an oath.
“Through it all there has never been any excuse
JNE. 1950
615
MEDICAL ECONOMICS
for the medical profession to depart from the truth.
Even political pressure can be met with nothing as
effective as the plain truth about medicine’s unfailing
service to humanity. It has weathered the rise and
fall of all governments and all civilizations. If left
alone it will help save and stabilize our own; if
subjected to the rule of bureaucracy it will witness
the inevitable decline and yet survive to help build
another civilization according its wont.”
Truth Can Thwart Progress of Socialism
The Federal Security Agency argues that
“about 30 per cent of our people cannot afford to
pay for their own health services.” In the same
breath the same agency reports that the death
rate for the United States in 1948 was the lowest
in the history of the country. Also, since 1935
the percentage of total births delivered in hos-
pitals has more than doubled, being 84.8 per cent
as of 1947. Maternal mortality has decreased to a
new low. General health conditions in the United
States are excellent, and are still improving.
After presenting these truths, The Journal of
the Michigan State Medical Society remarks,
“This gives the bureaucrats a logical (?) reason
for changing the program of health service.”
Continued medical progress is one of the best
ways to combat compulsory health insurance. The
above journal says:
“The government now is responsible for an un-
known number of our people, variously estimated
from 20 to 30 million, who receive complete health
service, and the government is having difficulty get-
ting more doctors on its various hospital staffs. If
the National Health Service Program were adopted,
the number of doctors available would be so in-
adequate that even Ewing estimates it would take
twenty years to get the program operating. More
doctors cannot be created by passing a law! They
need many years of education and training.
“James F. Byrnes, former Associate Justice of the
Supreme Court, former Secretary of State, in a
recent article in Collier’s Magazine (March 4), says:
‘If the P'oliticians will let the doctors alone, the
government will be able to continue its boasts about
improving health conditions.’ ”
SOCIALISM A STEP TOWARD
COMMUNISM
Socialism is often thought of as the form of
government which will, if left to function and
grow, most likely develop into communism. To
speed the evolution from capitalism to commu-
nism, leftists are now advocating establishment of
socialism as an essential step on the way to com-
munism. Les Arends, writing in “Inside News of
Congress,” comments :
“Those arguing for the Truman program have
been heard to say that ‘A little socialism is a good
thing . . . socialism is the best insurance against
communism.’ An answer to this comes from no less
a person than the new War Minister in Britain’s
socialistic government, John Strachey.
“In 1936 Strachey wrote : ‘It is impossible to
establish communism as the immediate successor to
capitalism. It is accordingly proposed to establish
socialism which can be put in the place of our
present decaying capitalism. Hence communists work
for the establishment of socialism as a necessary
transition stage on the road to communism.’”
BRITAIN'S SOCIALISM— A FRANKENSTEIN
MONSTER???
As would be expected, the cost of Britain’s
socialism is far beyond original estimates. The
millions of extra pounds being spent annually
may prove to be like Frankenstein’s monster and
turn against those who helped create the system.
Yet, the British people are not receiving extra
benefits for that money, because it is now being
spent only to keep this system which won out so
narrowly in the last election, and which does not
improve its services, but only eats more money.
Raymond Moley, writing in Newsweek recent-
ly, quotes convincing figures about the high cost
of socialism :
“In the first fiscal year during which people fully
appreciated that they could get something for noth-
ing, 1948-49, the original estimate of cost to the
government was 200,000,000 pounds. The cost proved
to be 278,000,000 pounds. Presumably Health Min-
ister Bevan and his colleagues thought that a total
of 261,000,000 pounds would be enough for 1949-50.
The final figure it now seems will be 359,000,000
pounds. But the health service has also drawn 41,-
000,000 pounds from the national insurance fund
and 16,000,000 pounds from ratepayers. So the
health service will really cost 416,000,000 pounds,
and it is believed that next year it will go to 450,-
000,000 pounds.”
Mr. Moley quotes the London Times’ dry com-
ment on this situation, that before the final sup-
plementary appropriations are made, Bevan will
have to convince Parliament “that he is running
and not being run by the service he has created.”
The conflict within the concept of a welfare
state is then explained by Mr. Moley :
“At that point (when the ‘monster’ gets out of
hand) the Socialist faces an uncomfortable dilemma.
616
Minnesota Medicine
MEDICAL ECONOMICS
He can completely tighten his control over all con-
cerned— doctors, patients, and local authorities. Or
he must surrender his socialism and accept the Con-
servative principle of a minimum standard based
upon proven need.
“Something of the same problem is bound to face
all socialistic services. Socialism by embracing a
program of fair shares, which really means equal
shares, must, if it assures liberty of choice, reach
the point where the means no longer exist to permit
every recipient to be the judge of his needs. Then
government must impose iron controls if it is to
keep its socialism. For there can never be equality
of demand or equality of productive capacity. When
equality is enforced, liberty disappears. That is the
irreconcilable conflict within the concept of a wel-
fare state.”
OF MICE AND MEN
The lowly mouse is a definite parallel to those
rho would nibble or gulp down the “free cheese”
f socialism, according to the General Electric
'ommentator, quoted in the Harding College
-etter :
“Could the mouse, by any chance, get the answer
by observing what’s happened to others around him?
“Sure, but he won’t. Being a mouse, he’ll grab —
or maybe just timidly nibble — and die!
“What about men? How do too many of us sup-
posedly superior animals act?
“Just like the mouse, just like we had been study-
ing up to be half-wits.
“And we do so in the face of vivid examples — -
right under our noses and all over the world — that
show us we shouldn’t.
“Some men have grabbed at something-for-noth-
ing, or ‘free cheese,’ in sudden and violent com-
munist revolutions.
“Others have only nibbled at ‘free cheese’ in
timid and supposedly harmless collectivist bites —
one after another — that will always spring the trap
and result in lower living standards and loss of
liberty, dignity, and spiritual well-being . . .
“Are we going to prove we’re mice — or men?”
ADMINISTRATION CALLED
A "PLAYING REFEREE"
With primaries over in some states and still to
ause much discussion in others, the Pennsyl-
'ania Medical Journal urges voters to register and
ote, using a sports analogy to emphasize its im-
portance :
“What a furore such a violent reversion of the
rules of the game would occasion at a football con-
test. How the paying spectators would overrun the
field to eliminate the referee who claimed a touch-
down.
“Why don’t the American taxpayers overrun the
political field on election day and eliminate the ad-
ministration that as a ‘playing referee’ carries the
ball with tax money and runs the potato and the
egg business, utilities, etc.?
“The answer is that (1) too many taxpayers don’t
understand the Constitutional limitations against
governmental interference with ‘free enterprise’; (2)
too many of those who do understand don’t speak
out to their neighbors, don’t register to vote, and
don’t support candidates for office who do support
the Constitution of the United States.”
MINNESOTA STATE BOARD OF MEDICAL
EXAMINERS
230 Lowry Medical Arts Building
St. Paul, Minnesota
Julian F. DuBois. M.D., Secretary
Waterloo, Iowa, Physician Sentenced for Attempted
Abortion on Minneapolis Woman
Re. State of Iowa vs. Gabriel Bickley Lichty.
On April 27, 1950, Dr. Gabriel B. Lichty, 401 G W.
4th St., Waterloo, Iowa, entered a plea of guilty in the
District Court of Black Hawk County, Iowa, to a charge
of attempted abortion, and was sentenced to five years
in the State Prison at Fort Madison, Iowa. The sentence
was imposed by Judge E. T. Evans. Dr. Lichty, who
was born in 1903, graduated from the Medical School of
the University of Minnesota, in 1927. He is not licensed
in Minnesota, but was licensed in Iowa, in 1928.
On October 30, 1949, the Minneapolis Police Depart-
ment notified the Minnesota State Board of Medical
Examiners that a 21-year-old Minneapolis woman was
seriously ill in Minneapolis General Hospital following
a criminal abortion. Subsequent investigation disclosed
that the abortion was performed by Dr. Lichty on Octo-
ber 28, 1949, at his office in Waterloo, and that he was
paid $200 for his services. Statements were also ob-
tained from a 26-year-old Minneapolis woman that Dr.
Lichty had performed an abortion on her on July 7,
1949, and received $400 for his services. The signed
statements were forwarded to the Iowa State Depart-
ment of Health, and the prosecution of Dr. Lichty fol-
lowed.
The Minnesota State Board of Medical Examiners
wishes to acknowledge the excellent work done by the
Minneapolis police officers who were assigned to the
case by Mr. Thomas Jones, Superintendent of the Min-
neapolis Police Department, and also the splendid co-
operation received from Mr. Michael J. Dillon, County
Attorney of Hennepin County, in arranging for the ap-
pearance in Court at Waterloo, Iowa, of the various
witnesses in Minneapolis who had knowledge of the
facts in both abortion cases.
Minneapolis Man Pleads Guilty in Fake Abortion
Racket
Re. State of Minnesota vs. Walter F. Catterson.
On June 1, 1950, Walter F. Catterson, fifty years of
age, residing at 624 8th Avenue So., Minneapolis, was
sentenced by the Hon. William C. Larson, Judge of the
District Court of Hennepin County, to a term of two to
eight years in the State Prison at Stillwater. Catter-
son had entered a plea of guilty on April 27, 1950, to
(Continued on Page 652)
Iune, 1950
617
Minneapolis Surgical Society
Meeting of November 3, 1949
The President. Ernest R. Anderson. M.D., in the Chair
THE POSTTHROMBOTIC SYNDROME
NATHAN C. PLIMPTON. M.D.
Minneapolis, Minnesota
Deep venous thrombosis of the femoral and iliac veins
produces permanent changes in the limb that affect the
physiology of the venous circulation. This altered
physiology results in the gradual development of a
syndrome climaxed by pain, edema, varicose veins, in-
duration of the subcutaneous tissues above the internal
malleolus, pigmentation, a chronic dermatitis of the skin
of the lower leg, and chronic ulceration. These
symptoms usually develop in this order as early as one
to two years or as long as fifteen to twenty years after
thrombosis.
It remained for the acumen of John Homans3 to
differentiate between ulcers due to varicose veins and
those secondary to thrombophlebitis. In a paper pub-
lished in 1917, he pointed out that the effect of phlebitis
following childbirth, fevers, and intra-abdominal
operations is to destroy the valves of the veins in which
the inflammation occurs. After recanalization, the lumen
remains as a hard, straight, palpable cord through which
back pressure is maintained from above as in the case
of the typical varicose veins. He proposed radical
excision of the ulcer with subsequent skin grafts as a
type of treatment. This procedure met with fair
success, although in the light of our present knowledge,
it was not designed to correct the pathological physiology
of the posthrombotic extremity.
Buxton,1 in 1945, and Buxton and Coffer,2 in 1946,
were the first to report interruption of the superficial
femoral vein for the treatment of the postthrombotic
extremity. They reported a series of twenty-one patients
with twenty-three ligations. Of fourteen patients with
ulceration, thirteen healed satisfactorily. In the group
of seven patients without ulceration, the improvement
was not as dramatic; the relief of pain was the most
striking result.
Homans,4 in 1945, was the first to report the division
of both the superficial femoral and greater saphenous
veins in the treatment of the postthrombotic extremity.
He recommended this form of treatment in those cases
presenting venous congestion yet with little or no edema.
It was from this group of patients that surgery had been
withheld in the past because all the distended veins were
stiff considered capable of carrying blood uphill and must
not be disturbed. In another group of patients in which
there was pain, edema and ulceration, Homans was
content to treat more conservatively with sympathetic
blocks.
Last year, Linton and Hardy5 of Boston published a
rather impressive report based on forty-nine patients
with thrombotic sequelae who were treated by division
of the superficial femoral vein and stripping the greater
and lesser saphenous veins and their larger tributaries.
The incidence of bilateral involvement was 47 per cent.
The symptoms of ulceration, stasis dermatitis and pain
showed most spectacular improvement. Stasis cellulitis
was the least satisfactorily handled. However, none of
the patients was worsened by surgery.
An understanding of the pathological physiology
underlying the postthrombotic syndrome is essential to
satisfactory treatment. Linton makes two important
points. First, it is believed that with the exception of
pain and edema, the symptoms of this condition do not
appear immediately, but only after the veins have be-
come canalized. He observed that 58 per cent of the
ulcers in his series occurred between one and ten years
after the attack of phlebitis. Second, that post-
thrombotic ulcerations, unless extremely large, can be
healed merely by best rest and elevation. This rather
impractical method of correcting the increased venous
pressure reduced also the lymphedema, thus establishing
a more normal venous and lymphatic circulation.
It has been shown experimentally that after a vein
canalizes following thrombophlebitis, the valves are
incompetent. It has also been shown experimentally that
when the saphenous valves are incompetent, a high
pressure is maintained in that vein during muscular
activity, whereas with a normal competent valvular
system, exercise reduces the venous pressure. A com-
parable situation undoubtedly exists in the post-
thrombotic extremity in which the valves of the deep
veins are incompetent. The pressure in the veins under
these conditions is far above the colloid osmotic pressure
of blood, resulting in an increase in lymph formation.
As a result of the previous phlebitis, the lymphatics have
been damaged so that they do not function normally in
the postthrombotic state.
The induration seen over the inside of the lower leg
is believed to be secondary to the increased venous
pressure. The brown pigmentation of the skin of this
area is due to the capillary hemorrhages also secondary
to the increased venous pressure. The varicose veins
are thought to be secondary to the incompetent com-
municating veins which transmit the raised pressures to
the saphenous systems. With these thoughts in mind,
it is easy to understand how necessary it is to interrupt
both the saphenous as well as the superficial femoral
veins in order to eliminate both channels that make the
increased venous pressure a possibility. Linton has
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recommended that the results with the stripping of the
saphenous veins are better than when they are merely
ligated and injected with a sclerosing solution. It is his
thought that with these veins gone, the old channels are
much less likely to be opened up. Ele further states
that in his hands lumbar sympathetic blocks are an
unsatisfactory approach to this problem, although Alton
Oschner does claim success.
The diagnosis of patients suitable for the ligation
treatment of this condition is determined by physical
examination as well as the history of an attack of
thrombophlebitis. The most important part of the
examination is to ascertain the competency of the valves
of the deep-communicating and superficial venous
systems. This is done by the Trendelenburg test. The
veins are emptied by elevating the extremity, a rubber
tourniquet is applied to the leg just distal to the knee
and sufficiently tight to occlude the superficial veins.
The patient then stands up. If the superficial veins fill
quickly from below the tourniquet, an incompetency is
demonstrated in the valves of the deep and com-
municating veins.
Report of Case
A man, aged forty-eight, gave the story of developing
bilateral thrombophlebitis in 1945 during an attack of
pericarditis. The first symptom that followed this com-
plication was a persistent swelling that accompanied
the original condition. Associated with this were pain
and fatigue in his legs on exercise. Walking as little as
two blocks never failed to produce considerable dis-
comfort in his calves. Approximately one year after
his phlebitis, he noted a gradual enlarging of the super-
ficial veins of both legs. During this postphlebitic
period, the symptoms in his left leg have been noticeably
worse than the right. With the aid of elastic bandages
and stockings he was able to control the swelling, but
the subjective symptoms were not markedly altered.
During the summer of 1948, approximately three years
after his thrombophlebitis, he developed pigmented areas
below each malleolus. These were considered to be
potential ulcers. Associated with this was an induration
of the surrounding subcutaneous tissue with burning
and itching of the colored skin.
My first treatment consisted of injecting some of the
more dilated varicosities and the application of elastic
bandages. The article bv Linton and Hardy suggested
what seemed to me a rational approach to this problem,
for her was a typical case of the postthrombotic
syndrome. Accordingly, on December 30 of last year,
the patient was subjected to the following, operation.
Under general anesthesia, the left superficial femoral
vein distal to the profunda femoris and upper greater
saphenous veins was exposed. The intraluminal pressure
of the former after it had been occluded proximally was
observed to be 15 centimeters of water. After the
saphenous was occluded, it rose to 24 centimeters. If
the latter is over 30, it is advised to divide the saphenous
at a later date. Accordingly, these veins were divided
and ligated. The diameter of the superficial femoral
was observed to be approximately 7 millimeters.
Following this, all of the larger varicosities were stripped
by means of an intraluminal vein stripper. Multiple
short incisions were necessary to accomplish this.
The same operation was done on the right side. There
was more scarring and fibrosis of the superficial femoral
vein than on the left. The lumen was only 2 millimeters
in diameter which accounted for my inability to find the
lumen with the exploring needle. Consequently, no
pressures were taken. It was conjectured at the time
that the reason for the fewer symptoms on the right
than on the left might be due to smaller caliber of the
superficial femoral vein. The superficial varicosities
were then stripped on the right side. Pressure
dressings were applied from the groins to the meta-
tarsals. The postoperative course was uneventful except
for a lymphorrhea that occurred in the right inguinal
incision and lasted for nearly four weeks.
The patient states that since the operation his legs
feel better than they have at any time since his original
attack of thrombophlebitis. The subjective symptoms of
fatigue in his calves and burning and itching below the
malleoli are gone. The pigmented areas persist, but the
induration in the subcutaneous tissues is no longer
present. A few rather moderate sized varicosities that
were missed in the stripping have enlarged, but they are
being satisfactorily handled by injections. There was
some residual lymphedema which required elastic
bandage support. This has gradually improved until at
present his left leg requires no support, but his right
will swell slightly without it.
Summary
1. A brief review of the literature on the post-
thrombotic syndrome is presented.
2. The pathological physiology of this condition is
discussed along with the rationale for a proposed method
of treatment.
3. A case of the postthrombotic syndrome is presented
along with the results of surgical treatment.
References
1. Buxton, R. W., Farris, J. M., Meyer. C. M., and Coller,
F. A. : Surgical treatment of long-standing deep phlebitis of
the leg. Preliminary report. Surgery, 15 :749, 1944.
2. Buxton, R. W., and Coller, F. A.: Surgical treatment of long-
standing deep phlebitis of the leg. Supplementary report. Sur-
gery, 18:663, 1945.
3. Homans, J.: The etiology and treatment of varicose ulcers of
the leg. Surg., Gynec. & Obst., 24:300, 1917.
4. Homans, J.: Late results of femoral thrombophlebitis and
their treatment. New England J. Med.. 235:249, 1946.
5. Linton, R. R., and Hardy, I. B.: Postthrombotic syndrome of
the lower extremity. Surgery, 24:452, 1948.
VENOGRAPHY IN THE POSTPHLEBITIC SYNDROME
CLARENCE V. KUSZ, M.D.
Minneapolis, Minnesota
Iliofemoral thrombophlebitis is usually followed in
months to years by a syndrome characterized by edema,
pain, recurrent cellulitis, pigmentation and ulceration.
Collectively, this is known as the postphlebitic syndrome.
/
Published with permission of the Chief Medical Director, Depart-
ment of Medicine and Surgery, Veterans Administration, who
assumes no responsibility for the opinions expressed or conclusions
drawn by the author.
June, 1950
The pathological physiology of the postphlebitic
syndrome and a means by which this may be corrected
were set forth by Homans in 19414 He stated that the
femoral system once thrombosed must suffer the loss
of all its valves so that when the body is erect the
venous return must take collateral valved pathways.
Blood must pour down a valveless vein, and it is, there-
619
MINNEAPOLIS SURGICAL SOCIETY
Fig. 1. A — Normal femoral venogram, showing a normal valve
in the superficial femoral vein and a normal valve in the profunda
femoris vein.
B — The superficial femoral vein has been ligated in this
patient in the acute stage. The position of injection is shown.
Also the competent valves in the saphenous and in the profunda
femoris veins are shown.
cannulated the superficial femoral vein directly, after !
surgical exposure. Radio-opaque material was then
introduced into the superficial femoral vein while the
patient was in a 45-degree upright position on an x-ray
apparatus. X-ray exposures were then made. Bauer
was able to show that following an iliofemoral thrombo- I
phlebitis in patients with the postphlebitic syndrome, !
recanalization had taken place in the superficial femoral |
vein and that the radio-opaque substance would flow
downward even into the popliteal vein and occasionally
into the veins of the calf. In the normal superficial
femoral vein, the material would be held by competent
valves and w'ould pass upward. No dye was seen to
reflux into the deep veins of the thigh.
We have been able to simplify the technique of direct
femoral venography and have been aide to demonstrate
incompetency in the deep femoral vein as well as in
the superficial femoral vein. By means of a popliteal
venogram, we have been able to show that many times |
there exists in the postphlebitic leg a gross com-
munication between the superficial femoral vein and the
profunda femoris vein above the knee. Because of
these findings, we have thought it to be more logical
that ligation of the popliteal instead of the superficial
femoral vein be carried out in the postphlebitic syn-
drome.
Fig. 2. A — Femoral venogram, showing reflux into the superficial femoral vein.
B — Popliteal venogram on patient in A, showing recanalization of the superficial femoral and profunda
femoris veins and showing a gross communication between the superficial femoral vein and profunda femoris
vein above the knee.
C — One-minute popliteal venogram, showing presence of opaque material which is evidence of slowing of
circulation.
fore, reasonable to assume that an old sclerosed and
canalized femoral vein or external iliac vein is better
divided.
Bauer1 w'as probably the first to demonstrate the patho-
logical physiology of the deep venous system that
followed an iliofemoral thrombophlebitis. In 1948, he
reported his findings using direct venography. Bauer
The technique used for direct femoral venography is
essentially the same as Bauer’s, except that a per-
cutaneous entrance into the femoral vein is carried out.
Femoral venography is carried out as a diagnostic aid
before any operative procedure is decided upon.
The patient is placed on a tilted x-ray table in a 45-
degree upright position. After infiltration with novo-
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Fig. 3. A — Femoral venogram on patient with postphlebitic syn-
[rome but without history of iliofemoral thrombophlebitis. This
hows the reflux into a dilated vein and the presence of incom-
letent valves.
B — Popliteal venogram on patient in A, showing gross communi-
ation between profunda and superficial femoral veins.
:aine, a direct puncture is made into a common femoral
•ein just below the inguinal ligament. A 19-gauge needle
s used. Thirty cubic centimeters of 35 per cent diodrast
ire then injected rapidly. An x-ray exposure is made
mmediately following the injection, and a second
exposure is made one minute later.
The popliteal venogram is carried out in the 54-degree
tpright position with the patient 'face downward on the
c-ray table. A direct entrance is made into the popliteal
'ein at the level of the upper border of the patella,
md 30 cubic centimeters of 35 per cent diodrast are
njected. X-ray exposures are made immediately and
)ne minute following the injection.
Each patient is tested for sensitivity to diodrast before
njection. The occular test has been used. In over 100
njections, about 25 per cent of the patients had nausea
)ut only six patients actually vomited following the
njection. The nausea is usually completely gone in
ibout three minutes.
We have reached the following conclusions after more
ban 100 femoral and popliteal venographic studies :
1. In the normally functioning femoral vein, valves
ire usually present and they will prevent the radio-opaque
naterial from flowing downward (Fig. 1, A and B).
2. In the normal femoral venogram, the iliac vein is
►veil filled and the one-minute exposure will show a
:omplete absence of radio-opaque material except in the
/alve sinuses where it will remain for as long as five
minutes.
3. In the absence of valves or in a recanalized femoral
ran, femoral venography will show that the opaque
substance has refluxed into the veins of the thigh, at
:imes even into the veins of the calf (Figs. 2 A, 3 A and
1 A).
4. In patients with the postphlebitic syndrome who
show absence or incompetence of the valves, the one-
Fig. 4. A — Femoral venogram showing reflux into superficial
femoral and profunda femoris veins.
B — One-minute film, showing remaining dye in the femoral
veins.
Fig. 5- — Femoral venogram, show-
ing reflux into profunda femoris
/ein alone.
minute exposure will show the presence of the radio-
opaque material in the veins of the thigh. The amount
remaining depends upon the degree of slowing of the
return circulation and the presence of adequate
functioning collaterals (Fig. 4 B).
5. In patients who present the picture of a post-
phlebitic syndrome without a history of iliofemoral
thrombophlebitis, the femoral venogram will show
reflux. In these patients, the veins will be seen as a
large dilated straight tube without valves. Occasionally,
valves are present but are incompetent (Fig. 3 A).
6. The profunda femoris vein can be incompetent
either alone (Fig. 5) or together with the superficial
femoral vein (Fig. 4).
7. By the use of the popliteal venogram, we have been
able to show that often there exists a gross communi-
June, 1950
621
MINNEAPOLIS SURGICAL SOCIETY
I'iJv 6. A — Femoral venogram, showing evidence of recanaliza-
tion in iliac vein and femoral vein. At this time, it was thought
Fig. 7. The incision used to ligate the popliteal vein.
that the superficial femoral vein was involved, and a superficial
femoral vein ligation was carried out without relief of pain or
healing of ulcer in spite of two skin graftings.
B — Popliteal venogram on patient four months after superficial
femoral vein ligation. The gross communication between the
superficial femoral and profunda femoris is clearly shown.
C — Femoral venogram on patient in A and B , four months after
superficial femoral vein ligation. This shows that the profunda
femoris vein is incompetent. A popliteal vein ligation was carried
out. A skin graft was then applied to the ulcer which healed well,
and the patient had complete relief of pain following the popliteal
ligation.
cation between the profunda femoris vein and the super-
ficial femoral vein just above the popliteal space. Liga-
tion of the superficial femoral vein in these patients will
not benefit the leg because the pressure is then trans-
ferred to the profunda vein which in turn transfers the
increased pressure again into the popliteal vein and into
the lower leg. This is especially true in patients in
whom the profunda vein is incompetent at the time. In
this type of patient, ligation of the superficial femoral
vein and the profunda femoris vein could be carried out
with benefit to the lower leg, but we have found in-
creased edema in the thigh in two patients in whom this
was done. The popliteal vein is the logical site of liga-
tion. This will stop the reverse pressure from both the
superficial femoral and the profunda femoris vein and
will not interfere with collateral channels in the thigh
(Figs. 2 B, 3 B and 6 B).
8. In the popliteal venogram, as in the femoral veno-
gram, the one-minute film will show the veins of the
thigh to be cleared of dye in the normal vein, but still
present in the incompetent vein.
Superficial femoral vein ligation for the postphlebitic
syndrome was first reported by Buxton2 in 1944. He
found that in many cases ulcers could be healed, but
that pain and edema were not uniformly relieved. Lin-
ton5 reported 80 per cent healing of ulcers and 63 per
cent relief of pain following ligation of the superficial
femoral vein. Glasser3 reported one recurrence of ulcer
in six patients who were followed for five years following
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MINNEAPOLIS SURGICAL SOCIETY
a. superficial femoral vein ligation for the postphlebitic
syndrome. However, he reports a SO per cent recurrence
in those followed for only two years. Bauer1 reports
relief of pain and healing of ulcers in all patients fol-
lowing ligation of the popliteal vein. Our results fol-
lowing popliteal vein ligation compare closely with those
found by Bauer. However, our longest follow-up has
been only eight months. Relief of pain following the
ligation is dramatic in those patients who give a history
of a pressure pain and in whom reflux is shown by veno-
graphic studies.
Together with the popliteal vein ligation, we have
ligated and stripped, with the intraluminal vein stripper,
all patients who had an incompetent saphenous system.
Superficial varicosities that remained were then treated
by injections.
Summary
The technique of direct femoral venography and
popliteal venography and the findings as they refer to
:he postphlebitic syndrome are presented. Incompetency
of the valves of the femoral venous system accounts for
a large part of the postphlebitic syndrome. Not only
can the superficial femoral vein be incompetent alone,
but the pathologic physiology may extend into the pro-
funda femoris vein as well. The femoral venogram is
used to study this pathological physiology. By means
of the popliteal venogram, the anatomy of the venous
system of the thigh can be studied, and it has been found
that in a large number of cases there exists a gross
communication between the superficial femoral vein and
the profunda femoris vein just above the popliteal
space. Because of the venographic findings, we have
felt that a popliteal vein ligation should be performed
in preference to the superficial femoral vein ligation in
the postphlebitic syndrome. Results have been encour-
aging, especially in relief of pain and healing of ulcers.
References
1. Bauer, G. : The etiology of leg ulcers and their treatment by
resection of the popliteal vein. J. Internat. Chir., 8:937, 1948.
2. Buxton, R. W. : Treatment of long-standing deep phlebitis of
the leg. Surgery, 15:749, 1944.
3. Glasser, S. T. : The postphlebitic leg. Surg., Gynec. & Obst.,
89:541, 1949.
4. Homans, J. : Exploration and division of femoral and iliac
veins in treatment of thrombophlebitis of leg. New England
J. Med., 224:179, 1941.
5. Linton, R. and Hardy, I. B.: Posthrombolic syndrome of the
lower extremity. Surgery, 24:452, 1948.
THE RETURN OF "VEIN STRIPPING"
FRANK W. QUATTLEBAUM, M.D.
Saint Paul. Minnesota
Ligation and retrograde injection are currently the most
widely used method of treating varicose veins. Quite re-
cently the so-called “stripping procedure,” a method used
Fig. 1.
many years ago, is gaining popularity. The current
method of treatment was preceded by many frustrating
efforts in other avenues.
Throughout the ages, many procedures such as liga-
tion, incision, excision, cautery, bleeding, compression
sutures, etc., were suggested, tried and abandoned.
Around 1850 attempts were made to obliterate vari-
cose veins by injection alone. LInsatisfactory fluids for
injection purposes plus the lack of understanding of the
fundamental physio-pathologic condition at fault, doomed
this form of therapy to failure.
From 1880 to the early twenties, it was the vogue to do
extremely radical procedures. It would seem that the
symptoms sometimes did not warrant such extreme
measures. Schede made multiple circular incisions down
to the fascia from the groin to the calf, ligating all
veins encountered. In 1884, Modelung8 extirpated the
entire saphenous vein through a long vertical incision
from the groin to the ankle. In 1908, Friedel4 described a
long spiral incision from the groin downward, encircling
the leg several times, packed wide open and allowed to
granulate. Needless to say, the “vein stripping” pro-
cedure as introduced by Mayo9 in 1906 and by Babcock2
in 1907, were accompanied by too many complications.
With the other radical procedures, it was abandoned as
soon as a safer procedure was available.
The procedure became available in 1916 when John Ho-
man6 described the reverse flow phenomena in the saphe-
nous vein, designated the saphenofemoral junction as the
proper site of ligation and stressed ligation of all col-
lateral branches. The operation is today performed as he
described it in 1916. Further refinement was added in
1930 when Higgins and Kettel developed “sodium mor-
rhuate” for retrograde injection. This was the first
solution available with a high sclerotic index and yet
relatively safe for the patient.
June, 1950
623
MINNEAPOLIS SURGICAL SOCIETY
Gradually, then, a simple procedure evolved, easily
performed with a high degree of effectiveness and a
relatively low incidence of complications. It was to be
our impression, however, that the recurrence rate is
definitely less with the “stripping” than with the con-
ventional methods. Hodge et al,5 Stalker,13 Linton7 and
Fig. 2. Fig. 3.
expected that the ligation-retrograde injection technique
quickly caught the fancy of all surgeons and has been
done the past three decades almost to the exclusion of
all other methods.
Thus we have gone through many phases and find our-
selves repeating the cycle again by reviving one of the
older, more radical procedures, namely, the “stripping”
procedure. Why is this procedure being revived? Is it
now a safer operation than it was in 1910? Is it a more
effective operation, associated with fewer recurrences
than the conventional ligation injection technique?
The “stripping” procedure is unquestionably safer than
it was between 1910 and 1920. During that period the pa-
tients were left in bed for one to two weeks. They are
now ambulated the evening of operation. The extensive
openings into tissue planes are not as hazardous with
better surgical and operating room care and with the
antibiotics as adjuncts. Whereas the thromboembolic
complications were quite common in the earlier days of
“stripping,” they are almost unknown today, and the
availability of anticoagulants leaves one much more se-
cure as to this complication. In approximately 200 cases
of “stripping” at the Minneapolis Veterans Hospital,
only one questionable case of calf phlebitis was observed
and ho embolic phenomena.
It is apparent that one should have a two-year fol-
low-up to determine recurrences in varicose veins. It is
McElwee and Maisel10 now prefer to treat varicose
veins by “stripping.”
Some space should be devoted to the dangers of retro-
grade injections with the conventional method of han-
dling varicose veins. This hazard, of course, is not
present when the veins are “stripped.” Hodge,5 Slevin,12
Atlas,1 Witter,14 and Boyd and Robertson3 do not use
retrograde injections because of the dangers of intro-
ducing a deep phlebitis. When the vein only is ligated,
one has done a rather incomplete operation. Boyd, et al3
and McPheeters11 have both demonstrated the presence
of the radiopaque material in the femoral vein quite soon
after it was injected into the superficial saphenous vein.
One is then depending upon the size and rate of flow in
the deep vein to prevent or minimize the phlebitis. I have
been particularly impressed in obtaining a history in the
long-standing post-phlebitic syndromes that many of these
people unequivocally volunteered that the symptoms of
their deep vein involvement gradually began after super-
ficial vein ligation and retrograde injection. Figure 1
demonstrates the amount of dye that sometimes passes
immediately into the deep circulation after being injected
into the distal end of the divided saphenous vein. When
the injected material is an irritating solution, it is obvious
that deep vein damage can result.
Indications for stripping are variable. I believe the
following would be acceptable in any quarter :
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1. Extremely large veins (Fig. 2).
2. Inactive deep phlebitis with incompetent superficial
veins (Fig. 3).
3. Multiple previous injections.
4. Recurrence following previous adequate ligations
and retrograde injection.
Fig. 4.
In my own private work, however, I go beyond the
above indications and use the “stripping” procedure
almost to the exclusion of all other methods. To date,
I have been satisfied with the immediate and late results.
Technique
A question of technique in this procedure always be-
gins with the type of “stripper” used. We have been
satisfied with the Babcock intraluminal stripper with
the occasional use of a small Mayo extraluminal strip-
per for small tributaries (Fig. 4). Several other types
of instruments with various innovations are available.
Of these the Myers stripper, devised by Dr. Tom Myers
of Rochester, Minnesota, is an excellent intraluminal
stripper. It permits one to strip the vein upward from
the ankle to the divided segment in the groin. An ade-
quate ligation of the saphenous vein at the juncture with
the femoral vein, including all collateral branches, is
mandatory. The saphenofemoral juncture should be clear-
ly dissected and the femoral vein clearly identified com-
June, 1950
pletely around the juncture. Stripping of the distal seg-
ment proceeds according to the individual technique.
The patient should always be placed on the operating
table in slight Trendelenburg position. This so lowers
the pressure in the femoral vein that the torn ends of
the communicators bleed into the femoral vein lumen
rather than into the subcutaneous tissues. One is
amazed often at the minimal bleeding encountered from
this procedure which appears on the surface so traumatic.
In stripping the distal segment of the saphenous vein
from the groin, one can often go to the ankle and
withdraw the vein in one long segment. Sometimes, a
communicator at the knee traps the tip of the stripper,
and one has to divide the vein here and proceed again.
With open ulcers at the ankle, one should strip down to
the ulcer if possible. The ulcer does not have to be
healed, but should be free from infection and covered)
by clean granulations.
With the patient still in Trendelenburg position at the
completion of the procedure, two longitudinal folded
towels are incorporated as pressure dressings over the
bed of the excised saphenous vein by using two 4-inch
Ace bandages from ankle to groin over the towels. The
patient walks the evening of the operation. He is
given a daily dose of procaine penicillin and can be
dismissed in one or two days. With proper care regard-
ing subcutaneous bleeding these patients have remark-
ably little post-operative disability. They are much more
comfortable than following a retrograde injection of
one of the sclerosing solutions.
Postoperatively, these patients must be followed un-
til all residual veins are obliterated by office injections.
These are not started for one month because often an
enlarged residual vein is actually filled with soft clot
and in a few weeks will begin to contract down. These
patients on an average will require fewer postoperative
injections than following other procedures. Often they
require not a single injection, but are all instructed to
return for routine six-month check-up and at periodic
intervals thereafter.
References
1. Atlas, L. N. : Hazard connected with the treatment of varicose
veins. Surg., Gynec. & Obst., - 77 : 136-140, 1943.
2. Babcock, W. W. : A new operation for the extirpation of vari-
cose veins of the leg. New York State J. Med., 86:153-156,
(July 27) 1907.
3. Boyd, A. M., and Robertson, 1). J.: Treatment of varicose
veins. Possible danger of injection of sclerosis fluids. Brit.
Med. J., 2:452-454, (Sept.) 1947.
4. Friedel, G. : Operative Behandlung der Varicen, Elephantiasis
und Ulcus cruris. Arch. f. klin, Chir., 86:143-159, 1908.
5. Hodge, H., Crimson, K., and Schiebel, H. M. : Treatment of
varicose veins by stripping, excision, and avulsion. Ann.
Surg., 121:737, 1945.
6. Homans, J.: Varicose veins and ulcers: Methods of diagnosis
and treatment. Boston M. & S. J., 187:258, 1922.
7. Linton, R. R. : Surgery of veins of the lower extremity.
Minnesota Med., 32:38-53, 1949.
8. Madelung: Ueber die Ausschalung cirsoider Varicen an den
unteren Extermitaten. Verhandl. d. deutsch. Gesselsch f.
Chir., 13:114-118, 1884.
9. Mayo, C. H. : Treatment of varicose veins. Surg., Gynec. &
Obst 2:385-388, (April) 1946.
10. McElwee, R. S., Jr., and Maisel, B.: A study of the results
of the surgical treatment of varicose veins. Ann. Surg., 126:
350-357, 1947.
11. McPheeters, H. O.: Injection Treatment of Varicose Veins
and Hemorrhoids. Philadelphia: F. A. Davis Company, 1946.
12. Slevin, J. G. : New test in diagnosis and surgical treatment
of varicose veins. Am. J. Surg., 75:469-474, 1948.
13. Stalker, L. K. : Management of recurrent varicose veins.
Am. J. Surg., 75:688, 1948.
14. Witter, J. A.: Varicose veins. J. Michigan M. Soc., 46:321,
1947.
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MINNEAPOLIS SURGICAL SOCIETY
FUNDAMENTAL PRINCIPLES IN THE TREATMENT OF VARICOSE VEINS
H. A. ALEXANDER. M.D.
Minneapolis. Minnesota
One often hears this complaint : “There is so much
confusion and contradictory advice about vascular con-
ditions that it is impossible for the average doctor to
know what is best for his patient.” It is my purpose
to emphasize that there is general agreement on basic,
fundamental principles, and these fundamental principles
are very simple and easily understood. The differences
of opinion are chiefly as regards which of two or more
procedures will produce the best results.
There is general agreement that heredity and phlebitis
are probably the two most important etiological factors
in the development of varicose veins. Any varicose vein,
whether degenerative or postphlebitic, can be eradicated,
but the tendency to form new veins will still be present.
This tendency to form new veins can be modified by prop-
er care, but cannot be eliminated. Any doctor who accepts
a patient with this tendency and eliminates the existing
veins has only fired the opening gun in a war that will last
as long as the patient lives. The patient must thoroughly
understand, before any treatment is started, that there
are several different types of treatment but that none
of them is perfect ; that regardless of which type of
treatment is used, he will need regular care, in the
average case once a year, as long as he lives. Help him
to understand by explaining that it is exactly the same
type of continued deterioration that requires his going
to the dentist at regular intervals.
There is general agreement on the fundamental prin-
ciples of treatment of superficial varicose veins. Small
veins can be destroyed by injection of a sclerosing so-
lution. Larger veins, especially those veins which are
subjected to considerable intravenous pressure, are best
treated operatively and here again there is important
agreement. The two essentials are, first, a high ligation,
and second, destruction or removal of the varicosed
segments. 1 am speaking about superficial veins. I be-
lieve that judgment on the femoral and popliteal vein
ligations should be held in reserve until we see how long
the good results last. In those deep vein ligations, a
fundamental principle is violated; the distal segment is
not eradicated.
There are three generally accepted groups or types of
varicose vein surgery: (1) high ligation plus stripping;
(2) high ligation plus multiple incisions for ligation of
perforators; and (3) high ligation plus retrograde in-
jection.
All three groups have a high ligation as an essential
part. Any one of the three types of treatment fails if
the long saphenous vein is not ligated proximal to the
tributaries that join it very close to the femoral vein.
I am sure that this is the most common cause of failure.
The only way one can be sure he is ligating proximal to
these tributaries is to continue the dissection until he
can ligate the saphenous flush at the junction with the
femoral.
The second essential of varicose vein surgery, after
high ligation has been completed, is the destruction or
removal of the remaining varicose segments. This can
be accomplished by three or more methods. No one
method is ideal or perfect. Stripping works well if the
veins are straight and tubelike. Retrograde injection is
better if the veins are extremely tortuous. Separate in-
cisions for ligation of incompetent perforators may be
indicated even in the extremity having one of the above-
mentioned types of treatment. Injections of sclerosing
agent, to eliminate remaining varices, can be used as a
follow-up treatment, regardless of the type of original
surgery.
There are advantages and disadvantages in all three
methods. I do not believe we should be committed ex-
clusively to one method but should determine, in each
case, which method will best eliminate the varices in that
particular case. An internist does not prescribe the same
kind of diet for all his patients ; neither should a vein
surgeon commit himself to one procedure, regardless of
what type of veins his patient has.
The stripping procedure is described elsewhere on the
program.
Multiple incisions for ligation of incompetent per-
forators are advocated and described by Sherman in the
August 1949 issue of Annals of Surgery. Sherman
uses a high ligation plus retrograde injection of a small
amount of sclerosing agent, but he feels that this “often
fails to produce maximum benefits.” In an attempt to
improve his results, he studied the anatomy of the lower
extremity intensively. He dissected 229 lower extremities
on cadavers, and made about 1500 radical surgical dis-
sections. From these extensive studies, he came to the
conclusion that there are perforator veins, at fairly uni-
form locations, that can become incompetent. He advises
multiple incisions for ligation of these incompetent per-
forators, emphasizing that, to be successful, such liga-
tions must be made deep under the fascia, deep in the
muscle, if possible at the junction with a major vessel
of the deep venous system. He describes fhe stripping
procedure as “futile,” because it leaves the collateral
and accessory perforator veins undisturbed. “The re-
flux of blood through the incompetent leg perforators
is not altered, and the procedure fails to accomplish its
purpose.” He finds from one to fourteen incompetent
perforators in a single leg. Seven mild embolisms oc-
curred in his series. His operative time for one ex-
tremity is three hours.
Obviously, his system is not ideal for several reasons.
1. A general anesthetic is required and active motion
cannot start until the anesthetic wears off.
2. Numerous scars constitute a cosmetic objection.
3. At least in our experience, what appears to be a
perforator often turns out to be just a dilated vein.
4. Any surgical procedure that takes an experienced
specialist three hours for one leg will require a longer
time for a surgeon who does that procedure only occa-
sionally. In other words, a patient with bilateral varicose
veins will require perhaps 6 or 8 hours for the average
surgeon, exclusive of preoperative study and postopera-
tive care.
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MINNEAPOLIS SURGICAL SOCIETY
The third, and I believe one of the best methods, is
high ligation with retrograde injection. With teamwork,
the patient with bilateral varicose veins can be operated
upon in one hour. Only local anesthesia is necessary, and
the patient is ambulatory immediately. Fast walking
at frequent intervals is essential ; it increases the safety
and decreases the discomfort. The majority of these
patients do not require a hospital bed and this, combined
with the shorter time required for operation, makes the
procedure less expensive. Dr. McPheeters can look back
on several thousand consecutive ligations without a
fatality or even a proven embolus. Gunnar Bauer, during
his recent visit here, stated that he favors this method.
It should be noted that if the surgeon suspects the
presence of one or two incompetent perforators, he can
easily care for them by novocaine infiltrations and a sec-
ondary incision immediately following the regular pro-
cedure. The retrograde injection can be made more ef-
fective by means of the “empty vein technique” in which
the extremity is first elevated to drain the blood from the
leg into the abdomen. Then, as the leg is lowered and
the table is tilted so the patient’s body is partially up-
right, the retrograde injection is made and gravity helps
the solution go toward the foot. We are often able to
get obliteration of varicose veins in the lower calf and
ankle by this empty vein technique, and we believe it
eliminates the need for the ureteral catheter sometimes
employed to get the solution into the lower leg.
This retrograde infection method also is not perfect
for several reasons.
1. The chemical phlebitis causes pain and soreness for
several days.
2. A thin-walled vein, close to the skin, may produce
a pigmentation. This can be minimized by draining pock-
eted areas of half clotted blood and by supportive
bandaging to compress such veins.
3. Any sclerosing agent can cause an allergic reaction
in a sensitized patient, varying from a mild urticaria to
severe shock. It is wise to have ready an emergency
box, with adrenalin, aminophyllin, anti-histaminics, et
cetera.
4. The sclerosing solution, conceivably, could precipi-
tate an acute phlebitis, especially if the patient has a
thrombotic tendency. It should be used with care in any
patient with a history of phlebitis, and not used at all,
if the phlebitis is still active. But there is no justifica-
tion for any doctor’s telling a phlebitis patient “never let
any doctor touch that leg.” We repeatedly see large, foul-
smelling, painful ulcers that have been present on swollen,
pigmented legs, for months and sometimes years, be-
cause of a very positive order from the attending doctor :
“Don’t ever let any doctor touch that leg; if you do, you
will probably lose the leg and perhaps lose your life.”
Just as bad is another almost unbelievable order,
“Never put an elastic bandage on that leg.” These two
instructions are probably based on the supposition that
the deep venous system has been closed by the phlebitis,
and that it stayed closed. That is not correct. Intravas-
cular clotting in an artery seldom recanalizes, but in a
vein it often does so. The obstruction of the deep phle-
bitis is temporarily compensated for by dilated, super-
ficial veins, but within a few months a new canal in
the deep vein can make the dilated superficial veins a
liability instead of an asset. These dilated or varicosed
veins then need at least conservative management. In
that term is included three things: (1) activity; (2) oc-
casional elevation during the day, and (3) supportive
bandaging. It is advisable that patients with varicose
vein tendency should lead an active rather than a seden-
tary life. A quick contraction of the calf muscles, such
as occurs in walking briskly, will force the blood up-
ward; thus the calf muscles act like a second heart,
helping the return flow of blood to the trunk. Pro-
longed standing or sitting in one position such as occurs
among dentists, barbers, elevator operators and street-
car motormen is not good. Edema gradually develops
late in the day. The condition is usually progressive, and
as time goes by the patient finds he develops the swelling
earlier and earlier during the day. Also, it disappears
less completely at night. This edema is a danger signal.
If there is one fundamental principle that is generally
agreed upon, it is this : edema is detrimental and must
be prevented if possible. It is advisable for patients
with a varicose vein tendency to lie down and elevate their
legs at least twice a day. The length of the elevated
period varies from five minutes to an hour, depending
on the severity of the condition. While the legs are
elevated above the level of the heart, gravity will help
the return flow of blood, and the swelling should dis-
appear. We advise our patients to examine their ankles
each night at bedtime. If there is any swelling, it is a
warning signal. If swelling has developed in spite of
activity, and in spite of regular leg elevation, an elastic
supportive bandage should be worn at least part time.
“Wrap around” bandages give better support than the
stocking type. They should be 4 inches wide for the
average leg; a 2-inch width is almost useless. They
must be applied snug enough to give firm pressure.
Stasis is even more important if the patient becomes
ill or is confined to bed for any reason. Blood flowing
slowly through a vessel is much more likely to clot
than blood flowing rapidly. Frequent motion, especially
of the lower extremities, will increase the rate of blood
flow and decrease the possibility of phlebitis and em-
bolism. Many hospitals have established vascular com-
mittees to recommend routine measures and emergency
procedures for vascular complications. Such a commit-
tee can make a detailed study of each complication that
occurs, and be ready to make suggestions when the case
is discussed at the monthly staff conference.
There is one very important consideration that should
be emphasized. A patient with varicose veins has a
progressive condition. Those patients in the late forty-
year-old and early fifty-year-old groups, especially, tend
to become worse and to develop complications. Some
of them, on first examination, seem to need only con-
servative management, but, in view of the progressive
nature of their disease, actually require radical treat-
ment. The admittedly imperfect treatment for varicose
veins must aim not only to relieve the symptoms now
present but also to prevent more serious trouble in the
future. In weighing the merits and the possibilities of
each type of treatment, we must consider not only the
immediate improvement but the duration of that im-
June, 1950
627
MINNEAPOLIS SURGICAL SOCIETY
provement. How good will that leg be twenty-five years
from now?
In conclusion, I would like to emphasize these points:
1. We can destroy any vein we can reach, but there
is still no method by which we can prevent new veins
from forming. This tendency to form new varicose
veins makes regular follow-up care imperative, regard-
less of the type of treatment.
2. The essential feature of the surgical treatment of
varicose veins is a good, high ligation. The dilated seg-
ment distal to the ligation can be destroyed or eliminated
by several methods, each of which has advantages and
disadvantages that should be considered in the light of
the requirements of each individual case.
3. Stasis and edema are dangerous and detrimental.
The co-operation of the patient in wearing supportive
bandages and frequently contracting the calf muscles
will minimize the dangers.
4. The “empty vein technique’’ for either retrograde
injection or follow-up office injection allows greater con-
centration of the sclerosing agent and gives better results.
5. Untreated varicose veins become progressively
worse. Treatment should not only relieve present symp-
toms but should also prevent future trouble. It is pre-
ventive medicine.
RESUME OF PRESENT-DAY CARE AND TREATMENT OF VARICOSE VEINS
AND THEIR COMPLICATIONS
H. O. McPHEETERS, M.D.
• Minneapolis, Minnesota
It certainly must be apparent by this time that the
proper method of treating varicose veins is anything
but a settled one. It would seem that such a common
clinical disturbance would lend itself to the rapid develop-
ment of a perfect, simple and complete cure. Such is not
the case. A review of the medical literature of the past
year shows that an article on some phase of the problem
appeared in almost every journal published. After having
cared for 25,000 varicose vein patients and having done
ligations with retrograde injections on 6,400 of these
patients, I have not yet settled on the right method.
Because of this unsettled state of affairs and knowing
that all new ideas on this subject are supposed to origi-
nate in the East, I arranged for a personal visit to
Boston and spent four days with Dr. R. R. Linton, one
day with Dr. Gerald Pratt in New York and one day
in Chicago. After all the discussion generated by such a
trip in addition to my own experience, I have now
formed some very definite conclusions.
As Dr. Alexander has so clearly said, there are basic
fundamentals in this treatment on which we all do agree.
We must accept the fact that this is a degenerative
process developing as the years pass by and that our
patients will have more varicose veins regardless of what
method of treatment is used or how thoroughly it is
carried out.
At the risk of repetition, I want to emphasize the fact
that today all authorities agree that a definite reverse
flow of blood has developed in any well-advanced and
extensive case of varicose veins, and that any successful
treatment must seek to check this at its source, wherever
that may be.
As the other speakers have pointed out, this reverse
flow of blood usually begins at the sapheno-femoral
junction. This means at the junction and not 3 inches
or 2 inches or even one-half inch below. The most
common cause of failure in this work is the lack of
appreciation of this fact. It is true that in many cases
a simple ligation of the great saphenous vein may hold
the process in check for a while, even without injections.
Yet, it is also true that there is a large variation in the
arrangement of the tributaries or branches of the saphe-
nous vein near the foramen and that the reverse flow may
develop through any of these as well as, or in addition
to, the main saphenous vein itself. If this is true, then
the ligation must be above all these tributaries and flush
with the wall of the femoral vein, if we hope for a
good result. As Dr. Sherman has pointed out in his
classical dissections, there are many communicating
branches throughout the entire leg, and a recurrence may
develop through these, even though a high ligation has
been well done. It is with the idea of closing these com-
municating veins that I have done my retrograde injec-
tions, while other men chose to remove the saphenous
vein in one way or another. Sherman does the high liga-
tion and injects sodium morrhuate distally and then pro-
ceeds to do his dissection. At times he injects the veins in
the lower leg several days preoperatively. He says that
this all lessens the hemorrhage at the time of dissection.
He may spend three hours on the dissection of one leg
and often four hours on a bilateral. His dissection is
carried out with spreading dissection and incisions down
the leg. Few men use the Mayo stripper any more.
The Babcock stripper is also being replaced by the more
flexible type, the Linton and Meyers.
I believe the best stripping is done by Linton and his
students. He uses a soft, flexible intraluminal wire and
strips or pulls out all the varicosed segments he can find.
He does both the long and short saphenous veins at the
same time. If the short saphenous is varicosed, he carries
the stripping right down to the ankle. Many times the
vein will be found to go directly under the old ulcer,
or at the foot internally or externally directly into an
open ulcer.
The stripping is carried out under pentothal or spinal
anesthesia by preference. The table is tilted to 10 to 15
degrees. The Trendelenburg position is utilized during
the operation, and there is but little hemorrhage. Post-
operative pads are bandaged along the course of the
stripped veins and an ace or adhesive bandage wrapped
628
Minnesota Medicine
MINNEAPOLIS SURGICAL SOCIETY
about the entire stripped area. The foot of the bed is
raised on shock blocks, with each leg on a pillow. The
iegs are kept so for two days. The patient is told to
get up and start walking twelve hours postoperative and
at two-hour intervals after that. When not walking, the
legs are supposed to be elevated. The bandages are
removed on the fourth day and continued after that on
the lower leg, only as long as the legs swell. The absence
of postspinal headaches is attributed to the small needle
used, 22 gauge, and the technique as well as the small
amount used (12 mg. of Pontocaine, as a rule).
After having done 6,400 varicose vein ligations with
retrograde injections of the sclerosing solution, I admit
that the retrograde injection following the high ligation
falls short of perfection in that the communicating veins
in the large and extensive cases cannot be adequately,
completely and permanently closed. They often recanalize
and become the source of a recurrence or a new varicose
rein development. If the vein in the superficial fat is
torn off and removed, this cannot happen. When suffi-
cient sclerosing solution is injected to sclerose the vein
well, the chemical phlebitis that develops is so severe
and painful in the extensive case with large varices, that
the patient is almost incapacitated. The veins are so
sore, the patient can hardly walk, and yet he must walk
to avoid emboli. As the large thrombosed segments
liquefy, they must be drained or the soreness will persist,
the pigmentation will be severe, and they will be the
source of new varicose veins. For these reasons, I believe
the thorough stripping is the best procedure in all the
extensive cases, and because of the extensive collaterals
I plan to use it for all bad cases of the short saphenous
group. I have seen many cases of varicose veins in
patients who have been stripped, but there should be
fewer varices develop subsequently in any patient well
ligated and stripped than by any other method.
I hardly feel able to comment on the work of Dr.
Kusz because he is so far ahead of the field that I have
not caught up with him as yet. Much of it is very
logical. It follows the ideas of Homans and Bauer.
It was Homans, you will remember, who first was rash
enough to suggest the ligation of the femoral vein for
this reflux flow in the femoral vein years ago. His slides
are beautiful and the result of much effort. I have seen
some of his fine results. I am eager to see how they
are five years from now. That will be the answer. He
must surely be congratulated on his fine work.
Dr. Plimpton is to be congratulated on his excellent
discussion of thrombophlebitis. His resume of the litera-
ture is very comprehensive.
In cases of an acute thrombophlebitis of extensive
large superficial varicose veins, Dr. Linton prefers to
excise the entire inflamed mass and then do a high
sapheno-femoral ligation. Most men prefer to put the
patient to bed with the application of extensive hot wet
packs applied locally. The patient should continue to
walk briefly twice daily. Anticoagulants should be given
and the prothrombin percentage should be kept down
about 35 per cent of normal. One never needs to fear
a hemorrhage at that level. I have had two patients in
whom the phlebitis extended to the femoroiliac region
where I did not use the anticoagulants. Dicumarol is
sufficient.
Most men agree with the idea and use of the lumbar
sympathetic block for any severe case of deep phlebitis
with the resultant edema, cyanosis and cold foot. This
should be used early and there should be no delay for
several days or weeks. It should be repeated at twenty-
four-hour intervals, if needed, to keep the leg and foot
warm and dry. Many times I have seen it give much
help, even though not used for several weeks after the
onset of the phlebitis. In cases having a history of a
severe deep phlebitis years before, I often use the block
to see if any help could be expected following a sympa-
thectomy. There is no point in using a block for the
swollen but warm and dry leg and foot. It will not help.
Linton does not advise a sympathectomy for the post-
phlebitic case. In his experience, the immediate good
result has disappeared in two years. I cannot agree with
this. Homans has urged a sympathectomy for the old
postphlebitic with extensive dermatitis over a cold and
clammy lower leg and foot. The ligation of the femoral
or popliteal vein may give additional help. Time alone
will tell.
I cannot urge too strongly the use of the routine, hot,
wet pack for all these cases. Drinker has definitely
shown that the hotter the pack to the point of tolerance,
the more relaxation of the vessels and the greater the
lymphatic drainage. The patient will not get burned if
the blankets are wrung dry as with the Kenny pack’ for
poliomyelitis, but they must not be put on with the cloths
soaked and sopping wet.
BLUE CROSS PAYS MILLIONS TO HOSPITALS
Nearly a hundred million dollars, representing more than 88 per cent of income, was paid to
hospitals by the voluntary, non-profit Blue Cross Plans for care of members during the first
quarter of 1950, Richard M. Jones, Chicago, director, Blue Cross Commission of the American
Hospital Association, recently announced
From a total income of $109,801,301, the ninety Blue Cross Plans of the United States and
Canada paid $96,989,972 for member’s care and used only $9,184,564 (8.37 per cent) for
operating expenses.
There are more than 38,000,000 persons enrolled in the Blue Cross Plans in the United States
and Canada, representing more than 24 per cent of the United States population and 21 per
cent of the Canadian people.
June, 1950
629
In Memoriam
RALPH CRAWE ADAMS
Dr. Ralph C. Adams, a practitioner at Bird Island
since 1906, died April 25, 1950. He was seventy years
of age.
Dr. Adams was born at Utica, Pennsylvania, June 7,
1879. He was a graduate of Jefferson Medical College,
Philadelphia, having received his M.D. in 1906.
Dr. Adams is survived by his wife, Hertha ; a son,
Jack, who is in the military service ; a daughter,
Margaret, of Denver, Colorado, and two sisters.
FREDERICK H. ROLLINS
Dr. F. H. Rollins, a prominent practitioner at St.
Charles, Minnesota, since 1898, died at Rochester April
27, 1950, after a brief illness.
Dr. Rollins was born near Caledonia, Minnesota,
September 30, 1867. He graduated from Rush Medical
College in 1897 and practiced for a year in South
Dakota before locating at St. Charles.
During World War I, Dr. Rollins served as com-
manding officer of a convalescent camp base hospital in
France. He served as state senator from 1928 to 1934.
He was a member of the Masonic Order and of the
Order of Eastern Star.
Dr. Rollins is survived by his wife, Mary, two sons,
Keith of Chicago and Pat of Minneapolis ; one daughter,
Mrs. C. D. (Margaret) Thompson of Chicago; and one
stepson, Murray Olsen of Rock Rapids, Iowa.
Dr. Rollins was honored at a civic dinner in St.
Charles in May, 1947, on the occasion of his fiftieth
anniversary as a practicing physician. All his life he was
an ardent fisherman and hunter and was most active in a
variety of community projects.
CHARLES L. SCOFIELD
Dr. C. L. Scofield of Benson, Minnesota, died April 23,
1950, at the age of eighty-five years. He was born on
a farm in Cannon Falls, Minnesota, on April 16, 1865,
and in all of the years of his life he showed the results
of his early background in his fine attitude towards the
people among whom he practiced. He graduated from
the University of Iowa in 1886 and began his practice
in Saint Paul the same year but in 1890 he moved to
the town of Benson where he practiced up to the time
when he suffered a cerebral hemorrhage on March 29,
1947.
He had his first office in the Security State Bank
building, and in 1900 he moved to the Colby block where
he practiced until he built his own office building a
number of years after that.
Dr. Scofield was almost a legend in the entire area
surrounding Benson. He was truly the old type of
country doctor braving the blizzards and winter weather
and driving many miles with horse and buggy. No
family was too lowly to receive administrations, at his
hands, when he was called.
In 1936, when he completed fifty years in the practice
of medicine, a testimonial banquet was given at which
he w'as honored for the fine medical practice which he
had carried on. Practically everyone who assisted in
putting on the dinner had been brought into the world
through his help.
His fine attitude towards the public is shown by the
fact that during his lifetime he w:as elected President
of the first council ; he was a long time member of the
School Board ; he was for years Chairman of the City
Park Board ; and was made Chairman of the Charter
Commission which drew up the Charter for Benson,
making it a city in 1908. At one time he was a member
of the volunteer fire department, the manager of the
baseball team and for many years was Chairman of
the Board of Directors of the Benson Cemetery
Association.
He took an active part in the business life of the
city. He was at one time President of the Swift County
Telephone Company and Security State Bank. He was
a member of the Sons of the American Revolution;
belonged to the Swift Lodge No. 129, A.F. & A.M. ; and
the Modern Woodmen of America, the AOUW, the
Knights of Pythias, the Isaak Walton League, and the
Woodmen of the World. His interest in children and
young people in his home town shows him as Chairman
of both the District and Local Boy Scout committees
for several years. His interest in the early history of
Swift County finds him the organizer and President of
the Swift County Historical Society. His activities were
not limited to the locality in which he lived but we find
his honors coming from statewide Organizations. In
October, 1948, we find him awarded an honorary member-
ship in the Minnesota Public Health Conference for
distinguished service in public health. He served several
years as president of the Swift County Health Associa-
tion and helped organize the Minnesota Public Health
Association and was its president from 1919 to 1923.
He was a member of the State Tuberculosis Com-
mission and was most active in the various tuberculosis
committees in the Minnesota State Medical Association.
He was a member of the Kandiyohi-Swift-Meeker
Medical Society of which he was secretary for
approximately twenty-five years, and a member of the
Minnesota State Medical Association of which he was
at one time vice president. He was a member of the
American Medical Association. He was a Great Northern
Railroad surgeon for forty-five years, and in 1936 he
received a life membership in the Great Northern
Veterans Association. He was a lifetime member of
the Pilgrim Congregational Church of Benson, and a
member of the building committee which had charge of
the erecting of the beautiful cburch edifice which houses
this congregation.
He is survived by his wife, Mrs. Bertha Scofield,
together with four grandchildren.
(Continued on Page 632)
630
Minnesota Medicine
PULMONARY EDEMA
AND PAROXYSMAL
CARDIAC DYSPNEA
"The development of pulmonary-
edema at night may in certain cases
be prevented and in addition effec-
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administration of aminophyllin in
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searle AMINOPHYLLIN
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*Contains at least 80% of anhydrous theophylline.
SEARLE RESEARCH IN THE SERVICE OF MEDICINE
1. Barach, A. L.: Edema of the Lungs, Am. Pract. 3:27
(Sept.) 1948.
June, 1950
631
IN MEMORIAM
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CHARLES L. SCOFIELD
(Continued from Page 630)
Charles L. Scofield was a man of unusual talents,
revered by all for his good works, and in his passing,
those of us who knew him well feel a deep sense of
loss and a keen hope that we may carry on in some
manner the fine impressions which he made on the lives
of us all. He was the finest type of American citizen,
an honor to his profession, and a friend to all — truly a
man among men. — B. J. Branton, M.D.
NELS WESTBY
Dr. Nels Westby, well-known and highly esteemed
physician of Madison, Minnesota, died April 21, 1950,
following a heart attack. He observed his sixty-fourth
birthday the day before his death.
Dr. Westby was born April 20, 1886 in Brown County,
South Dakota. He attended Augustana Academy in
Canton, South Dakota, the University of Minnesota and
St. Olaf College, where he graduated in 1909.
On August 29, 1909 he was married to Gusta Locken,
and to this union eight children were born.
Dr. Westby received bis medical degree from Cornell
Medical College in New York in 1913 and served his
internship at the Methodist Hospital in Brooklyn, New
York.
In January, 1915, he entered into partnership with Dr.
W. N. Lee in the Madison Clinic and became chief of
staff of Ebenezer Hospital.
Dr. Westby was a member of the Camp Release Medi-
cal Society, the Minnesota State Medical Association and
the American Medical Association. He was a Fellow
of the American College of Surgeons and had recently
been appointed to the National Christian Medical So-
ciety. He was mayor of Madison, had been a member
of the Board of Education School District No. 74 since
1927, and was the present chairman. He was a charter
member of the local Kiw'anis Club.
Dr. Westby had served as trustee and deacon of the
Madison Lutheran church. He served as president of the
Brotherhood of the Evangelical Lutheran church in its
formative years and had been a member of the Church
Council of the Evangelical Lutheran church for the
Southern Minnesota District.
He is survived by his wife, Gusta, one son, Norval,
anil five daughters : Mrs. Aubrey Edmonds of Grand
Marais, Minnesota; Mrs. Norris Skogerboe of Brook-
lyn, New York; Mrs. Gunnar Pederson of Saint Paul;
Mrs. Max Barzee of Moro, Oregon ; Mrs. William
Gualtieri, and Mary Westby, both of Madison.
One of the most persistently discouraging facts about
cancer of the lung, is the long interval of ten months
that elapses, on the average, between the patient’s first
visit to the doctor and the time when the diagnosis is
made. — Overhoi.t, R. H., and Schmidt, I. C., New Eng-
land J. Med., Nov., 1949.
632
Minnesota Medicine
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In addition to the highly qualified neurologists and
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includes qualified personnel who have been trained
in special therapy, occupational therapy, corrective
therapy and physical therapy.
GIENWOOD HILLS HOSPITALS
June, 1950
633
* Reports and Announcements ♦
AMERICAN CONGRESS OF
PHYSICAL MEDICINE
The American Congress of Physical Medicine will
hold its twenty-eighth annual scientific and clinical
session August 28, 29, 30, 31 and September 1 at the
Hotel Statler, Boston, Massachusetts. All sessions
will be open to members of the medical profession in
good standing with the American Medical Associa-
tion. In addition to the scientific sessions, the annual
instruction seminars will be held August 28, 29, 30
and 31. These seminars will be offered in two groups.
One set of ten lectures will consist of basic subjects
and attendance will be limited to physicians. One
set of ten lectures will be more general in character
and will be open to physicians as well as to therapists,
who are registered with the American Registry of
Physical Therapy Technicians or the American Oc-
cupational Therapy Association. Full information
may be obtained by writing to the American Con-
gress of Physical Medicine, 30 North Michigan
Avenue, Chicago 2, Illinois.
AMERICAN COLLEGE OF PHYSICIANS
The American College of Physicians will conduct
its 32nd Annual Session at St. Louis, Mo., April 9-13,
inclusive, 1951. Dr. Ralph Kinsella of St. Louis is
the general chairman and will be responsible for local
arrangements and for the program of clinics and
panel discussions. Dr. William S. Middleton, presi-
dent of the College, Madison, Wis., will be in charge
of the program of morning lectures and afternoon
general sessions.
Secretaries of medical societies are especially
asked to note these dates and, in arranging meeting
dates of their societies, to avoid conflicts with the
College meeting for obvious mutual benefits.
AWARD FOR RESEARCH IN INFERTILITY
The American Society for the Study of Sterility
offers an annual award of $1,000' known as the Ortho
Award, for an outstanding contribution to the sub-
ject of infertility and sterility. Competition is open
to those in clinical practice as well as individuals
whose work is restricted to research in the basic
sciences. Essays submitted for the 1951 contest must
be received not later than March 1, 1951. The prize
essay will appear on the program of the 1951 meeting
of the society. For full particulars, address the
American Society for the Study of Sterility, 20 Mag-
nolia Terrace, Springfield, Mass.
(Continued on Page 636)
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634
Minnesota Medicine
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HAZELDEN FOUNDATION
The constructive thinking of a group of Twin Cities men seeking a new approach to the
problem of alcoholism resulted in the organization of the Hazelden Foundation. Some of
the founders are themselves men who have recovered from alcoholism through the proved
program of Alcoholics Anonymous. Their true understanding of the problem has resulted
in the treatment procedures used at the Hazelden Foundation.
BOARD
OF TRUSTEES
Mr. T. D. Maier, Mr. Robert M. McGarvey,
Vice President, President and Treasurer
First Natl. Bank McGarvey Coffee Co.
St. Paul, Minn. Minneapolis 1, Minn.
Mr. A. G. Stasel,
Supt., Eitel Hospital,
Minneapolis 3, Minn.
Dr. Gordon R. Kamman
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Bldg., St. Paul 2, Minn.
Mr. L. M. Butler, Mr. John J. Kerwin,,
Owner Star Prairie Manager, Mid-Continent
Trout Farm Petroleum Corp.,
St. Paul, Minn. St. Paul 4, Minn.
Mr. Bernard H. Ridder,
Pres., N.W. Pub., Inc.,
Dispatch Building,
St. Paul 1, Minn.
M. R. C. Lilly
Chairman of the Board,
First National Bank,
St. Paul 1, Minn.
Direct inquiries and request for illustrated brochure
to
Mr. A. A. Heckman,
Mr. J_*. B. Carroll,
Gen. Sec., Family Serv.,
V. Pres. & Genl. Mgr.
| Wilder Building,
Hazelden Foundation,
St. Paul 2, Minn.
Center City, Minn.
It should be understood that Hazelden Foundation is not officially sponsored by Alcoholics Anonymous
just as Alcoholics Anonymous sponsors no other organization regardless of merit.
The Hazelden Foundation is a nonprofit organization. All inquiries are kept confidential.
HAZELDEN FOUNDATION
Lake Chisago, Center City, Minn. Telephone 83
Iune, 1950
635
REPORTS AND ANNOUNCEMENTS
(Continued from Page 634)
COURSE IN POSTGRADUATE GASTROENTEROLOGY
The National Gastroenterological Association an-
nounces that its course in postgraduate gastroenter-
ology will be given at the Hotel Statler in New York
City on October 12, 13, 14.
The course, which will again be under the personal
direction of Dr. Owen H. Wangensteen, professor of
surgery, University of Minnesota Medical School,
will cover the following subjects: diseases of the
mouth, diseases of the esophagus, peptic ulcer dis-
eases of the stomach, diseases of the pancreas, chole-
cystic disease, psychosomatic aspects of gastroin-
testinal disease, disease of the liver, diseases of the
colon and rectum, and other miscellaneous subjects
including pathology and physiology, radiology, gas-
troscopy, et cetera.
The distinguished faculty for the course has been
chosen from medical schools in New York City as
well as out of town.
For further information and enrollment write to
the National Gastroenterological Association, Dept.
GSJ, 1819 Broadway, New York 23, N. Y.
PLASTIC SURGERY AWARD
The Foundation of the American Society of Plastic
and Reconstructive Surgery is offering awards of
$300 (first prize) and $200 (second prize) and a
certificate of merit for essays on some original un-
published subject in plastic surgery.
Competition is limited to residents in plastic sur
gery in recognized hospitals and to plastic surgeon:
who have been in such specific practice for not mon
than five years. The first-prize essay will appear ot
the program of the forthcoming annual meeting o
the American Society of Plastic and Reconstructs
Surgery, to be held in Mexico City November Z
through 29, 1950. Essays must be received befori
August 15, 1950.
Full information can be obtained from the secre
tary, Dr. Clarence R. Straatsma, 66 East 79th Street
New York, N. Y.
FELLOWSHIP IN MEDICINE AVAILABLE
1 he American College of Physicians announces
that a limited number of fellowships in medicine will
be available from July 1, 1951 to June 30, 1952. These
fellowships are designed to provide an opportunity
for research training either in the basic medical
sciences or in the application of these sciences to clin-
ical investigation. They are for the benefit of phy-
sicians who are in the early stages of their prepara-
tion for a teaching and investigative career in inter-
nal medicine. Assurance must be provided that the
applicant will be acceptable in the laboratory or
clinic of his choice and that he will be provided with
the facilities necessary for the proper pursuit of his
work.
The stipend will be from $2,200 to $3,200. Applica-
tion forms will be supplied on request to the Amer-
(Continued on Page 638)
For the reduction of edema, to diminish dyspnoea and to strengthen
heart action, prescribe Theocalcin, beginning with 2 or 3 tablets t.i.d.,
with meals. After relief is obtained, the comfort of the patient may
be continued with smaller doses. Well tolerated.
Theocalcin, brand of theobromine-calcium salicylate.
Trade Mark reg. U. S. Pat. Off.
Available in 7z£
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I •
636
Minnesota Medicine
Service
in a “pinch”
It could happen to you; that "now-what-have-I-done” feeling that raced through the GE
salesman’s mind as the Lynchburg, Virginia, officer curbed him with screaming siren.
But read the story behind it. An emergency service call came in from
Lynchburg to the Richmond office. The GE salesman in that area was enroute to
take care of a previous call which took him through Lynchburg. GE immediately
phoned the Chief of Police in Lynchburg and enlisted his cooperation in stopping
the salesman as he entered town. Needless to add, emergency service was soon
effected and a Lynchburg hospital’s X-ray equipment was back in service in minutes!
This story is typical of the hundreds of documented GE service reports in our
files. A service which proudly lends a new, broader conception to the guarantee
that stands back of every GE installation.
GENERAL ELECTRIC
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Duluth. ...3006 West First Street
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REPORTS AND ANNOUNCEMENTS
FELLOWSHIPS IN MEDICINE AVAILABLE
(Continued from Page 636)
ican College of Physicians, 4200 Pine Street, Phila-
delphia 4, Pa., and must be submitted in duplicate
not later than October 1, 1950. Announcement of
awards will be made in November, 1950.
MISSISSIPPI VALLEY ESSAY CONTEST
The tenth annual essay contest of the Mississippi
Valley Medical Society which provides a cash prize
of $100, a gold medal and a certificate of award for
the best unpublished essay on any subject of general
medical interest (including medical economies and
education) and practical value to the general prac-
titioner of medicine will again be held in 1950. The
winner will be invited to present his contribution be-
fore the fifteenth annual meeting of the Mississippi
Valley Medical Society in Springfield in September,
1950. Further details may be obtained from Dr.
Harold Swanberg, Secretary, 209 YV.C.U. Building,
Quincy, Illinois.
MINNESOTA SOCIETY OF INTERNAL MEDICINE
The spring meeting of the Minnesota Society of
Internal Medicine was held in Duluth on May 27.
Program chairman for the event was Dr. Paul G.
Homan, Duluth. Eighteen papers on various topics in
internal medicine were presented during the one-
day session.
MINNESOTA SURGICAL SOCIETY
The Minnesota Surgical Society held its annual
meeting in Rochester on May 12. Clinics in various
phases of surgery were held at Colonial, St. Mary’s,
Kahler and Worrall Hospitals in the morning. The
afternoon session consisted of presentation of papers.
Elected president of the society was Dr. Willard
D. White, Minneapolis. Other officers elected in-
clude Dr. E. Starr Judd, Jr., Rochester, vice presi-
dent, and Dr. M. G. Gillespie, Duluth, secretary-
treasurer.
BROWN-REDWOOD-WATONWAN COUNTY SOCIETY
A talk on the Minnesota medical publicity program
was a feature of the annual meeting of the Brown-
Redwood-Watonwan County Medical Society held in
New Ulm on May 18. Dr. E. J. Nielson, Mankato,
discussed the publicity program prepared by the
Minnesota State Medical Association. A discussion
was also held on the possibilities of forming blood
banks in the various cities of Brown County.
SOUTHWESTERN MINNESOTA SOCIETY
The regular monthly meeting of the Southwestern
Minnesota Medical Society was held in Pipestone on
May 8. Principal speaker at the meeting was Dr.
Clarence Dennis, professor of surgery at the Univer-
sity of Minnesota, who spoke on “The Acute Ab-
domen.”
( Continued on Page 640)
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faulty procedure is eliminated. Both tests are ideally suited for office
use, laboratory, bedside, and “mass-testing.” Millions of individual
tests for urine sugar were carried out in Armed Forces induction and
separation centers, and in Diabetes Detection Drives.
The speed, accuracy and economy of Galatest and Acetone Test
(Denco) have been well established. Diabetics are easily taught
the simple technique. Acetone Test (Denco) may also be used for
the detection of blood plasma acetone.
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Bibliography
Joslin, E. P., et al: Treatment
of Diabetes Mellitus — 8 Ed.,
Phila., Lea & Febiger, 1946 —
P. 241, 247.
Lowsley, O. S. & Kirwin, T. J.:
Clinical Urology — Vol. 1, 2
Ed., Balt., Williams & Wil-
kins, 1944 — P. 31.
Duncan, G. G.: Diseases of Me-
tabolism— 2 Ed., Phila.. W. B.
Saunders Co., 1947 — P. 735,
736, 737.
Stanley, Phyllis: The American
Journal of Medical Tech-
nology— Vol. 6, No. 6, Nov.,
1940 and Vol. 9, No. 1,
Jan., 1943.
638
Minnesota Medicine
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Depo-Heparin Sodium, with or without vaso-
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639
REPORTS AND ANNOUNCEMENTS
SOUTHWESTERN MINNESOTA SOCIETY
(Continued from Page 638)
During the business session the society’s executive
committee was instructed to consider the formation
of a grievance committee to review criticism and
complaints which might arise concerning medical
care.
WASHINGTON COUNTY SOCIETY
The Washington County Medical Society held its
regular monthly meeting at Forest Lake on May 9.
At the meeting, which was for business only, mem-
bers considered requests from the Social Welfare De-
partment of the State of Minnesota and acted on the
recommendations of the Committee on Public Edu-
cation of the Minnesota State Medical Association
concerning medical publicity.
A special meeting with the Welfare Board was
planned for June 6 at Stillwater to consider fees.
The “forty education posters,” recommended at the
medical-press conference in Saint Paul on April 21,
were the subject of a lively discussion that became
fairly warm at times. Representatives of the four
county newspapers also took part in the discussion.
The final result: it was moved that all forty posters
be run by the four newspapers in the county, to be
paid for by members of the county medical society.
The society members also voted to establish a
grievance committee, to be administered by the ad-
visory committee.
Woman’s Auxiliary
AUXILIARY HEARS NURSE
RECRUITMENT PROGRAM
The Auxiliary of the Southwestern Minnesota Medical
Society met at the home of Dr. and Mrs. F. L. Schade
in Worthington on April 24 for a program on nurse
recruitment.
Guest speaker was Marlene Erickson of Northwestern
Hospital, Minneapolis. She spoke on methods of nurse
recruitment through the local schools. Miss Erickson
was introduced by Mrs. Marion Neilson, program chair-
man.
Mrs. David Halpern, Brewster, discussed what local
communities and the medical auxiliary can do to en-
courage girls to enter the profession.
Dorothy Petsch, Worthington Hospital superintendent,
told of plans for the nurse procurement program at the
Worthington high school career day.
Special guests at the meeting were the new student
nurses from Fairview Hospital in Minneapolis. The four
girls went on duty in April. They are participating in
the rural nursing affiliation program conducted through
a local hospital.
The girls are Delores and Doris Johnson, twin sisters
from Litchfield; Aida Hoff of Grantsburg, Wisconsin,
and Erma Hellickson of Scobey, Montana.
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Minnesota Medicine
on your ACCOUNTS RECEIVABLE
Usually the last one to be paid is the family doctor, and very often,
no attention is given by him to the very important matter of commenc-
ing collection work promptly after due date. Too many doctors are
going “hog wild” on this point and fail to realize its significance.
Though startling as they may be, the figures shown in the following
table are the factual result of authoritative studies, and they apply
to the doctor as well as to the businessman.
COLLECTIBILITY OF ACCOUNTS-BASED ON AGE
Accounts 60
Accounts 90
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Accounts
Accounts
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Accounts
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days past due are 85% collectible.
6 months past due are 70% collectible,
year past due are 40% collectible,
years past due are 25% collectible,
years past due are 18% collectible,
years past due are practically lost.
THE OUTLOOK ISN'T BRIGHT. More business and professional
men look for lower profits than hope for higher earnings this year.
That’s because of lower prices and higher costs. Proper credit control
is more important today than at any time since the war. Jobless at
present are at a postwar high of 4% million. Unemployment is
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Of General Interest
The directory issue of Graphics, the official publi-
cation of the Association of Medical Illustrators,
contains the name, address, training, professional ex-
perience and reference to major published work of
each member. The issue, which was published on
June 1, is available to persons requiring medical
illustration service and will be sent, free of charge,
upon request to the editor, Miss Helen Lorraine,
5212 Sylvan Road, Richmond 25, Virginia.
Hi
Captain Eugene V. Meyerding, M.C., U.S.A.F.,
son of Dr. and Mrs. E. A. Meyerding of Saint Paul,
was married on May 19 to Patricia Elliot Lord,
daughter of Colonel and Mrs. Wilbur Storn Elliot
of Honolulu. Captain Meyerding is surgical resi-
dent at the Triplet General Hospital in Honolulu.
He is a graduate of St. Thomas Military Academy
and the University of Minnesota Medical School.
* * *
Dr. Alan Challman, Minneapolis, was scheduled to
return on June 26 from a six-week tour of Army
hospitals in Germany and Austria. He was selected
by the Surgeon General of the Army to make the
visits, which were for purposes of teaching and con-
sultation.
* * *
Four physicians, comprising the Litchfield Clinic,
are now conducting their practices in a newly con-
structed clinic building in Litchfield. The physicians
are Dr. H. E. Wilmot, Dr. C. A. Wilmot, Dr. D. E.
Dille and Dr. W. A. Chadbourn.
Their new clinic building, which was completed
earh' this spring, is a one-story structure of modern
design and construction. It houses four physicians’
suites, each one consisting of an office and two treat-
ment rooms, plus a laboratory, x-ray room, operat-
ing room, business office, and pharmacy. The build-
ing measures 55 by 66 feet, has a full basement for
storage and other facilities, and is designed so that
the flat roof can be flooded with a layer of water for
cooling in the summer.
An open house, at which the clinic’s facilities were
open for public inspection, was held on April 1 and
was attended by a large number of local residents.
* * *
Members of the Scott-Carver County Medical So-
ciety heard an address by Dr. Edward T. Evans,
Minneapolis, at their meeting on April 18. Dr. Evans
presented an illustrated lecture on the differential
diagnosis of back pains, stressing the diagnosis of
slipped intervertebral disc.
* * *
Dr. Paul Carpenter, formerly of Kansas City, Kan-
sas, has become a staff member of the Oliver Clinic
in Graceville. He began his duties at the clinic on
April 3. .
Dr. Gordon R. Kamman, Saint Paul, has been
named deputy commissioner of mental health in
Minnesota by Dr. Ralph Rossen, commissioner. Dr.
Lawrence R. Gowan, Duluth, has been appointed
supervisor of the consultative services. Both men
will serve on a part-time basis while continuing the
private practice of pyschiatry.
* * *
Dr. Clyde A. Undine, Minneapolis, attended the
convention of the American College of Physicians
in Boston, Massachusetts, April 17 through 21.
* * *
It was announced in May that Dr. Robert M.
Lundblad, Duluth, planned to begin the practice of
medicine in Clara City on July 1. Dr. Lundblad is
a graduate of the University of Minnesota Medical
School.
* * *
Dr. Andrew Sinamark, Hibbing, was a member
of a three-man panel discussion on socialized medi-
cine at a meeting of the Parent-Teachers’ Associa-
tion in Nashwauk on May 23.
* * *
Thirty-nine former fellows and residents of Dr.
Henry E. Michelson gathered for a testimonial din-
ner to him at the Minneapolis Club on May 5. The
guest list included dermatologists from Chicago,
Cincinnati and the Mayo Clinic. Dr. Michelson had
completed twenty-five years of service as chief of
the division of dermatology at the University of
Minnesota. He was presented with a silver service
at the dinner, which was arranged by Drs. Lavmon,
Lynch, Madden and Rusten.
Previously, on April 15, Dr. Michelson was elect-
ed president of the American Board of Dermatology
and Syphilology at a meeting held in Washington,
D. C.
* * *
Dr. S. A. Slater, superintendent of the Southwest-
ern Minnesota Sanatorium, was re-elected to the
board of directors of the National Tuberculosis As-
sociation at a meeting in Washington, D. C., on
April 28 and 29. Dr. Slater’s new term as a director
will be his twelfth.
* * *
On May 6, Dr. Joseph Kurtin was married to Miss
Ruth Witkowski in Cudahy, Wisconsin. Dr. Kurtin
is now practicing medicine in Blooming Prairie with
his brother, Dr. H. J. Kurtin.
* * *
Dr. Albert J. Schroeder was guest pediatric speak-
er at a meeting of the American Society of Dentistry
for Children on April 18. The meeting was held in
Coffman Memorial Union at the University of Min-
nesota.
(Continued on Page 6-P4)
642
Minnesota Medicine
SUCCESSOGRAPH
REG. U. S. PAT. OFFICE
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318 Bradley Bldg.
Duluth, Minn.
Melrose 859
THE MINNESOTA MUTUAL LIFE INSURANCE COMPANY
1880 — 70th. Anniversary — 1950
une, 1950
643
OF GENERAL INTEREST
(Continued from Page 642)
A plaque in memory of Dr. Justus Ohage, who
performed the first successful operation in this coun-
try for the removal of a gall bladder, was presented
to St. Joseph’s Hospital, Saint Paul, at a staff meet-
ing on May 10. The presentation was made by Dr.
Ohage’s son, Dr. Justus Ohage, Jr., of Saint Paul.
The gall-bladder operation was performed at St.
Joseph’s Hospital on September 24, 1886, and was
a milestone in gall-bladder surgery in this country.
* * *
Early in May Dr. W. R. Miller, Red Wing, at-
tended a two-day meeting of the Henry Ford Hos-
pital Medical Association at Detroit, Michigan. Dr.
Miller presented a paper entitled, “The Effect of
Radioactive Phosphorus on Gastric Acidity.”
* * *
A “good citizenship” medal and a citation were
presented to Dr. Karl Pfuetze, medical director of
the Mineral Springs Sanatorium, at an Americanism
Day program in Cannon Falls on May 1. The pre-
sentation was made by the Nelson-Scofield post of
the Veterans of Foreign Wars, sponsors of the pro-
gram.
j|c % :jc
Dr. Leo G. Rigler, chief of the radiology depart
ment at the University of Minnesota, will be one of
the medical mission sponsored by the Unitarian
Service Committee to visit Japan in July to present
present-day medical advances to representatives (
forty-six Japanese medical schools.
* * *
Dr. Burton Rosenholtz has returned to Saint Pai
and resumed the practice of pediatrics, with office
at 1999 Ford Parkway.
* * *
Dr. H. M. Wikoff, Bemidji, has been named chaii
man of the local county medical society, followin
the resignation of Dr. Charles W. Vandersluis. O
May 8, Dr. Wikoff attended a meeting of the eco
nornics committee of the Upper Alississippi Medica
Society at Brainerd.
* * *
Dr. and Mrs. M. C. Piper( Rochester, left on Apri
22 for La Canada, California, where they are nov
living. Shortly before leaving Rochester, Dr. Pipe
had retired as a staff member of the Mayo Clinic.
* * *
A talk on socialized medicine was given by Dr
Roy C. Pedersen, Duluth, at a meeting of the Men’
Brotherhood of the First Lutheran Church in Dulutl
on April 18.
* * *
After practicing in Grove City for a year and a half
Dr. Kenneth J. Kelley moved his office to Litchfielc
on April 1. A graduate of the University of Min.
nesota Medical School in 1944, Dr. Kelley internee
at Swedish Hospital, Minneapolis, and then server
dorestro
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644
Minnesota Medicine
OF GENERAL INTEREST
Minnesota State Medical Association's
Annual Convention
Duluth, Minnesota
June 12, 13, & 14, 1950
OFFICIAL REGISTRATION FIGURES
Doctors 1,053
Nurses, Dietitians, Technicians, Social Workers
and Medical Secretaries 457
Scientific Exhibitors 42
Commercial Exhibitors 235
Women's Auxiliary 330
Guests (Miscellaneous) 176
TOTAL 2,293
Over 10% of the doctors registered attended our booth to discuss the general
features of municipal bonds, the most ideal fixed income security for the
professional man.
Write us for additional information concerning municipal bond investment for
safety of principal and tax exempt income.
JURAN & MOODY
MUNICIPAL SECURITIES EXCLUSIVELY
TELEPHONES GROUND FLOOR
St. Paul: Cedar 8407, 8408, 3841 Minnesota Mutual Life Bldg.
Minneapolis: Nestor 6886 St. Paul 1, Minnesota
there. Before beginning his practice at Mabel, he
served in the Army.
i}c jji ijC
Dr. D. M. Simonetti, formerly located at 328 East
Hennepin, Minneapolis, has moved his office to 510
Physicians and Surgeons Building.
* * *
“Tuberculosis Control in Institutions for the Men-
tally 111” is the title of a paper being presented by
Dr. Edmund W. Miller, superintendent of the Anoka
State Hospital, at the annual meeting of the Ameri-
can College of Chest Physicians in San Francisco
on June 25.
l the Navy until late in 1946. He then practiced in
>ig Fork before moving to Grove City.
#
Among the speakers at the annual meeting of the
linnesota Society of Medical Technologists in Min-
eapolis on May 19 was Dr. Lyle A. Weed, Roches-
jr, who discussed the bacteriological examination of
issues.
% * *
Dr. Orville Rotnem, formerly of Mabel, is now
onducting his practice in Harmony. A graduate of
he University of Minnesota Medical School, Dr.
lotnem served his internship at Milwaukee County
lospital, after which he became a surgical resident
une, 1950
645
OF GENERAL INTEREST
Principal speaker at a St. Luke's Hospital fund
drive dinner in St. Paul on April 25 was Dr. Owen
H. Wangensteen, chief of surgery at the University
of Minnesota. The hospital was starting a campaign
to raise $750,000 for a modernization program.
* * *
Dr. Gerald N. Hofmann, Cannon Falls, was mar-
ried to Miss Ardis Nolda Hougo in Cannon Falls on
April 12. Dr. Hofmann is assistant medical director
at the Mineral Springs Sanatorium.
* * *
It was announced on April 17 that Dr. Nels G.
Mortenson had resigned from the staff of the Fergus
Falls State Hospital to accept a position on the staff
at the Minnesota Soldier’s Home in Minneapolis. Dr.
Mortenson had been affiliated with the Fergus Falls
hospital since November, 1944.
* * *
Dr. Frederic F. Wippermann, Minneapolis, was
elected president of the North Central Alumni As-
sociation of Phi Beta Pi, medical fraternity, at the
association’s annual meeting in Minneapolis in April.
Other officers elected include Dr. Karl Sandt, vice
president, and Dr. Howard Frykman, secretary-
treasurer, both of Minneapolis. Dr. Norbert O. Han-
son, Rochester, and Dr. Phillip Hollenbeck, St.
Cloud, were elected members-at-large.
Hi H1 Jfc
Two Red Wing physicians presented papers at a
meeting of the Saint Paul Surgical Society on April
19. Dr. E. H. Juers spoke on “X-Ray Diagnosis of
Abnormalities of the Veins of the Arms.’’ Dr. R. F
Hedin discussed the results of an investigation intc
the effect of radioactive substances on stomach acid-
ity.
At a meeting in Albert Lea on May 10 sponsored
by the Freeborn County Public Health Society, Dr,
Benjamin Spock, director of the Child Guidance
Clinic in Rochester, spoke on “The Emotional versus
the Democratic Way of Dealing with Emotional
Problems in Childhood.”
* * *
Dr. William B. Gallagher, Waseca, discontinued
his practice on April 20 and reported to Valley Forge
General Hospital, Phoenixville, Pennsylvania, on May
1 for indoctrination into the Army. A graduate of
the University of Minnesota in 1947, Dr. Gallagher
served his internship at Milwaukee County Hospital.
His term of service in the Army is expected to be
two years.
Hi * *
At a meeting of the Crookston Rotary Club on
May 4, Dr. D. E. Pohl of Crookston talked on the
subject of heart disease.
Hi H* H5
Dr. Martin O. Wallace, Duluth, was moderator at
a panel discussion on “The Whole Child” at the
Duluth and Arrowhead Health Day on April 14.
(Continued on Page 648)
646
Minnesota Medicine
North Shore
Health Resort
Winnetka, Illinois
on the Shores of
Lake Michigan
A completely equipped sanitarium for the care of
nervous and mental disorders, alcoholism and drug addiction
offering all forms of treatment, including electric shock.
SAMUEL LIEBMAN, M.S., M.D.
225 Sheridan Road Medical Director Phone Winnetka 6-0211
Cook County Graduate School of Medicine
ANNOUNCES CONTINUOUS COURSES
SURGERY — Intensive Course in Surgical Technic, two
weeks, starting June 19, July 24, August 21.
Surgical Technic, Surgical Anatomy and Clinical Sur-
gery, four weeks, starting July 10, August 7, Sep-
tember 11.
Personal Course in General Surgery, two weeks,
starting September 25.
Surgery of Colon and Rectum, one week, starting
September 11.
Esophageal Surgery, one week, starting October 16.
Breast and Thyroid Surgery, one week, starting June
26, October 2.
Thoracic Surgery, one week, starting June 12, October
9.
Gallbladder Surgery, ten hours, starting June 19, Oc-
tober 23.
Fractures and Traumatic Surgery, two weeks starting
June 12, October 9.
Basic Principles in General Surgery, two weeks start-
ing September 11.
GYNECOLOGY — Intensive Course, two weeks, starting
June 19, September 25.
Vaginal Approach to Pelvic Surgery, one week, start-
ing September 18.
OBSTETRICS — Intensive Course, two weeks, starting
September 11.
MEDICINE — Intensive General Course, two weeks,
starting October 2.
Electrocardiography and Heart Disease, two weeks,
starting July 17.
Gastroscopy, two weeks, starting July 17, September
25.
DERMATOLOGY — Formal Course, two weeks, starting
October 16. Informal Clinical Course every two
weeks.
UROLOGY — Intensive Course, two weeks, starting
September 25.
Cystoscopy, Ten Day Practical Course, every two
weeks.
General, Intensive and Special Courses in all Branches of
Medicine, Surgery and the Specialties.
TEACHING FACULTY— ATTENDING
STAFF OF COOK COUNTY HOSPITAL
Address: REGISTRAR, 427 South Honore Street
Chicago 12, Illinois
(Complete Ophtha L
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N. P. BENSON OPTICAL CO.
Laboratories in Minneapolis
and
Principal Cities of Upper Midwest
ste, 1950
647
OF GENERAL INTEREST
(Continued from Page 646)
Dr. Thomas J. Dry, Rochester, will be the new
president of the Minnesota Heart Association, suc-
ceeding Dr. John F. Briggs, Saint Paul. He will
begin his new duties at the annual meeting of the
association in July. Secretary of the organization
is Dr. Earl E. Barrett, Duluth.
* * *
A survey of facilities available for care of the
chronically ill in Ramsey County was made during
May by the Saint Paul Area Public Health Council
and the Women’s Auxiliary of the Ramsey County
Medical Society. Dr. Ralph L. Olsen, chairman of
the council’s committee on chronic and convalescent
care, said that the information compiled would be
used by hospitals, rest and nursing homes and other
institutions in planning for helping the chronically
ill.
* * *
Dr. John M. Adams, associate professor of pedi-
atrics at the University of Minnesota, has been
named chairman of the department of pediatrics in
the new medical school now being organized at the
University of California at Los Angeles. Although
classes at the new school will not begin until 1952,
Dr. Adams will assume his duties there this fall.
A graduate of Columbia University College of
Physicians and Surgeons, Dr. Adams interned at
New Haven General Hospital, then obtained a Ph.D.
degree at the University of Minnesota in 1937. H
was in private practice in Minneapolis for six year*
then joined the staff of the University on a full-tim
basis in 1943.
* * *
It was announced on April 21 that Dr. S. B. Seit
planned to return to Barnesville to practice early ii
May. Dr. Seitz moved from Barnesville to Richard
ton, North Dakota, last fall.
* * *
Dr. O. F. Mellby, Thief River Falls, left on Ma-
6 for New York City, from where he planned to fh
to Norway for six weeks of visiting relatives an<
sightseeing.
^ >K ❖
At the annual meeting of the North Central Sec
tion of the American College Health Association
held at the University of Wisconsin on April 28
Dr. J. W. Hanson, di rector of Carleton Collegi
health service, was installed as president of the or
ganization.
* * *
Dr. Robert W. Wheeler has joined the staff of the
Edina Medical Center. Formerly on the staffs of the
University and Veterans Hospitals in Minneapolis
Dr. Wheeler will specialize in otolaryngology.
* * *
Dr. Merton A. Johnson, Storden, was elected chair
man of the Cottonwood County Health Council a1
its annual meeting in Storden on April 25.
THE VOCATIONAL HOSPITAL j
TRAINS PRACTICAL NURSES
Nine months Residence course, Registered Nurses and i
Dietitian as Teachers and Supervisors. Certificate from i
Miller Vocational High School. VOCATIONAL NURSES i
always in demand.
EXCELLENT CARE TO CONVALESCENT AND
CHRONIC PATIENTS
Rates Reasonable. Patients under the care of their own physicians, |
who direct the treatment. |
5511 Lyndale Ave. So. LO. 0773 Minneapolis, Minn. |
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Ill 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 II 1 1 1 1 1 1 1 1 1 II 1 1 1 1 1 1 II 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 II 1 1 U 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 II 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 M 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 M 1 1 1 1 1 1 1 1 1 1 1 II 1 1 II 1 1 II 1 1 II 1 1 1 It 1 1 1 1 1 1 1 1 II 1 1 1 1 1 1 1
TTOMEWOOD HOSPITAL is one of the
Northwest's outstanding hospitals for the
treatment of Nervous Disorders — equipped
with all the essentials for rendering high-grade
service to patient and physician.
Operated in Connection with
Glenwood Hills Hospitals
HOMEWOOD HOSPITAL
Corner Penn and Plymouth Avenues North
Minneapolis Minnesota
648
Minnesota Medicine
OF GENERAL INTEREST
The American Cancer Society recognized Min-
esota’s leadership in cancer detection at an award
inner in Minneapolis late in April. The Minnesota
>ivision of the American 'Cancer Society was pre-
ented with a plaque honoring Minnesota for its
rogress in detecting internal cancer. The plaque
'as accepted on behalf of the organization by Dr.
.rthur H. Wells, Duluth, president of the Minne-
Dta Division.
* * *
On May 15, Dr. Norman Pullman, formerly of
.ake City, Iowa, began practice in Valley Springs,
ius giving the community its second physician.
During most of April and May, Dr. and Mrs. F. H.
frusen, Rochester, were in Europe where Dr. Krus-
n delivered six lectures on various phases of physi-
al medicine and rehabilitation. Among cities in
Fich he spoke were Copenhagen, Edinburgh, Lon-
on and Dublin.
* * *
Dr. Charles W. Parker, Wadena, presented a talk
n socialized medicine at a meeting of the Wadena
dons Club on May 8. He described the bad situation
iroduced by socialized medicine in England.
* * *
The engagement of Dr. E. Harvey O’Phelan to
liss Kathleen Elizabeth Bartl was announced on
/lay 7. Their wedding was planned for June 10 in
laint Paul. Dr. O’Phelan, a graduate of the Uni-
ersity of Minnesota Medical School, is a fellow in
irthopedic surgery at Minneapolis Veterans Hos-
itai. ’ ; ■ ’J
* * *
Dr. George H. Olds, New Richland, was named
ecretary-treasurer of the Waseca County Medical
Society on May 2. Dr. Olds was named to fill the
inexpired term of Dr. William Gallagher, who was
ailed into military service.
Announcement was made on May 4 that Dr. Don
Jucher of Sioux City, Iowa, would begin the prac-
ice of medicine in Starbuck about July 1.
* * *
The Minnesota Branch of the American Medical
Vomen’s Association had a luncheon meeting at the
Duluth Atheletic Club on June 12, the first day of
he State Convention.
Dr. Selma Mueller of Duluth gave an interesting
alk of her medical experience in China. Dr. Nellie
Barsness of Saint Paul, who is regional director, is
ilso the Minnesota delegate to the annual meeting
)f the American Medical Women’s Association in
Pebble Beach, California, June 19-22.
* * *
It was announced on May 13 that Dr. Hector
Brown, formerly of Bemidji and recently of New
Tork State, had purchased the private hospital at
Walker belonging to Dr. O. F. Ringle and would
:ake possession on June 1.
INGLEWOOD
NATURAL* OR DISTILLED
SPRING WATER
jon Lome a*uSt o^ice
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ACCIDENT • HOSPITAL ' SICKNESS
INSURANCE
FOR PHYSICIANS, SURGEONS, DENTISTS EXCLUSIVELY
PREMIUMS
COME FROM
$5,000.00 accidental death $8.00
$25.00 weekly indemnity, accident Quarterly
n rf c iVpMiJpf
$10,000.00 accidental death $16.00
$50.00 weekly indemnity, accident Quarterly
n /l cirbnpsc
$15,000.00 accidental death $24.00
$75.00 weekly indemnity, accident Qn-arterly
and sickness
$20,000.00 accidental death $32.00
$100.00 weekly indemnity, accident Quarterly
and sickness ■
Cost has never exceeded amounts shown.
ALSO HOSPITAL POLICIES FOR MEMBERS
WIVES AND CHILDREN AT SMALL
ADDITIONAL COST
85c out of each $1.00 gross income used for
members’ benefits
$3,700,000.00 $16,000,000.00
INVESTED ASSETS PAID FOR CLAIMS
$200,000.00 deposited with State of Nebraska for protection of our members.
Disability need not be incurred in line of duty — benefits from
the beginning day of disability
PHYSICIANS CASUALTY ASSOCIATION
PHYSICIANS HEALTH ASSOCIATION
48 years under the same management
400 First National Bank Bldg., Omaha 2, Nebr.
June, 1950
649
OF GENERAL INTEREST
HOSPITAL NEWS
At a special meeting of the Gaylord Community
Club on April 27, a resolution was passed to con-
struct during the summer a municipal hospital for
Gaylord and the surrounding area. The quick action
was prompted by an announcement by Dr. D. C.
Olson that he planned to close his hospital perman-
ently. Dr. Olson agreed to keep his hospital open
until the new hospital was completed, probably this
coming fall.
° * * *
St. Lucas Deaconness Hospital, Faribault. — Dr.
Paul F. Meyer, Faribault, was elected president of
the St. Lucas Deaconness Hospital medical staff
at a meeting held on May 9. Other officers elected
include Dr. C. A. Rohrer, Waterviller, vice presi-
den; Dr. J. J. Kolars, Faribault, secretary, and Dr.
F. R. Huxley, Faribault, member-at-large on the
executive committee.
* * *
Kanabec Hospital, Mora — Dr. C. S. Bossert of
Mora was elected chief-of-staff of the Kanabec Hos-
pital at an organizational meeting of the staff on
May 11. * * *
Dedication of the new Louis Weiner Memorial
Hospital in Marshall took place on May 25. When
completely furnished, the new hospital will have ap-
proximately fifty beds, 12 bassinettes and four cribs.
The dedication ceremonies included a presenta-
tion of the hospital staff and an address by Governor
Luther W. Youngdahl.
BLUE CROSS-BLUE SHIELD NEWS— June. 1950
Blue Shield enrollment more than doubled in or I
year’s time. On March 30 of this year there wei I
315,226 Minnesotans enrolled in Blue Shield compare
with 151,711 enrolled on March 30 a year ago. Enrol '
ment in March was especially high with 22,771 Minm
sotans added to Blue Shield rolls; of these, 12,367 ar
non-group subscribers whose contracts went into effei <
March 1.
Also more than doubled are the Blue Shield benefit
subscribers received during the first quarter of this yea
compared with the same period in 1949. This year, Blu
Shields benefits amounted to $411,133 during the firs!
quarter compared with $191,116 subscribers receive1
in Blue Shield benefits during this same three-montl
period in 1949. Payments to doctors during March fo
services to Blue Shield subscribers totalled $181,62
which is $49,380 more than the payments made tc
doctors during February.
Of the total 10,289 claims submitted during the firs
quarter of this year, representing 12,679 medical
surgical services to Blue Shield subscribers, 79 per cen
or 8,132 claims were for Blue Shield services subscriber;
received in hospitals; 20.6 per cent or 2,118 claims wert
for services received in doctors’ offices, and .4 per cen
or 39 claims were for Blue Shield services subscriber;
received in homes.
Blue Shield benefits for surgical procedures during
this three-month period totalled $255,174.53. Of these
surgical procedures, benefits for appendectomies wert
The Birches Sanitarium. Inc.
2391 Woodland Avenue
Duluth 3, Minnesota
A hospital for the care and treatment of
Nervous and Mental disorders. Quiet, cheer-
ful environment. Specially trained personnel.
Recreational and occupational therapy.
Dr. L. R. Gowan, M.D., M.S., Medical Director
Attending Psychiatrists
Dr. L. R. Gowan Dr. C. M. Jessico
Dr. I. E. Haavik Dr. L. E. Schneider
REST HOSPITAL
2527 Second Avenue South, Minneapolis
A quiet, ethical hospital with therapeutic facilities
lor the diagnosis and treatment of nervous and
mental disorders. Invites co-operation of all repu-
table physicians. Electroencephalography avail-
able.
PSYCHIATRISTS IN CHARGE
Dr. Hewitt B. Hannah
Dr. Andrew J. Leemhuis.
650
Minnesota Medicine
OF GENERAL INTEREST
te highest, amounting to $48,525; gynecology second
ghest, amounting to $33,916; bones, joints and tendons
ird highest, amounting to $30,550; tonsillectomies
iurth highest, amounting to $19,512 in Blue Shield
nefits.
Medical care to Blue Shield subscribers during this
ree-month period amounted to $89,711 and obstetrical
re amounted to $47,335 in benefits. Of the related
rvices provided by Blue Shield, endoscopy accounted
,r $7,840, x-ray for $7,204, anesthesia for $2,647,
sisting and after care for $1,220 of the Blue Shield
■nefits provided during this three-month period.
Persons in the lower income group who receive un-
nited subscriber benefits incurred 31.5 per cent of
e total Blue Shield claims during the first three
onths of this year.
Blue Shield and Blue Cross plans were explained to
)ctors, hospital administrators and trustees at meetings
dd in Glenwood, Redwood Falls, Owatonna, Duluth,
smidji, and the Twin Cities in conjunction with
eetings of the Minnesota Hospital Association during
arch and April.
Arthur M. Calvin, executive director of the Blue
ross and Blue Shield plans, also gave lectures to
niversity of Minnesota hospital administration and
mr-year medical students concerning these non-profit
ans. Blue Cross and Blue Shield will also be dis-
issed at medical staff meetings of various hospitals
iring the next several months.
Blue Cross enrollment as of March 31, 1950, reached
e million mark with 1,004,084 Minnesotans enrolled.
ROGRESS IN MATERNAL AND
IF ANT HEALTH IN MINNESOTA
(Continued from Page 587)
sultation service, and postmortem
studies.
(h.) More adequate, strategically located
public health services.
3. A concerted, co-operative effort by all con-
cerned is essential in a program for conserv-
ing the lives of our mothers and infants.
RADIUM & RADIUM D+E
(Including Radium Applicators)
FOR ALL MEDICAL PURPOSES
Est. 1919
Quincy X-Ray and Radium
Laboratories
(Owned and Directed by a Physician-
Radiologist)
Harold Swanberg, B.S., M.D., Director
W.C.U. Bldg. Quincy, Illinois
DANIELSON MEDICAL ARTS PHARMACY. INC
10-14 Arcade. Medical Arts Building hours:
ATLANTIC 3317 825 Nicollet Avenue — Two Entrances — 78 South Ninth Street WEEK DAYS — 8 to 7
ATLANTIC 3318 MINNEAPOLIS SUN. AND HOL.-10 TO l
PHYSICIANS AND HOSPITALS SUPPLY CO., Inc.
414 SOUTH SIXTH ST., MINNEAPOLIS, MINN.
INSTRUMENTS • TRUSSES • EQUIPMENT • PHARMACEUTICALS • DRUGS
MAIN 2494
une, 1950
651
of General interest
1909 1950
Physiotherapy for the relief
of Arthritis and related con-
ditions. Complete physical
examinations and laboratory
procedures given every pa-
tient. Roy T. Pearson,
M.D., Medical Director. B.
F. Pearson, M.D., associate.
U. S. Hwy. 212
anitarium
BROWN & DAY, INC.
St. Paul 1, Minnesota
BOOK REVIEWS
Books listed here become the property of the Ramsey,
Hennepin and St. Louis County Medical Libraries when
reviewed. Members, however, are urged to write reviews
of any or every recent book which may be of interest
to physicians.
BOOKS RECEIVED FOR REVIEW
BREAST DEFORMITIES AND THEIR REPAIR. Jacques W1
Maliniac, M.D. Clinical Professor of Plastic Reparativ
Surgery, and Associate Attending Plastic Reparative Surgeon
New York Polyclinic Medical School and Hospital, New Yorl
City; Attending Plastic Surgeon, Sydenham Hospital; Iliplo
mate, American Board of Plastic Surgery. 193 pages. Illus
Price $10.00, cloth. New York: Grune & Stratton, 1950.
THE MANAGEMENT OF THE PATIENT WITH SEVER1
BRONCHIAL ASTHMA. Maurice S. Segal, M.D. Assistan
Professor of Medicine, Tufts College Medical School; IJirecto
Department of Inhalational Therapy, Boston City Hospital
Boston, Massachusetts. 158 pages. Illus. Price, $3.50, cloth
Springfield, Illinois: Charles C. Thomas, 1950.
PARKINSON’S DISEASE. Walter Bitchier. 79 pages. Prict
$1.00, paper cover, $2.00, cloth. London, England: Waited
Buchler, 1950.
MINNESOTA STATE BOARD OF MEDICAL EXAMINERS
Minneapolis Man Pleads Guilty
(Continued from Page 617)
an information charging him with the crime of swind-
ling. Judge Larson stayed the sentence and placet
the defendant on probation for five years.
Catterson, who has no medical education of ant
kind, obtained $100 from a north Minneapolis famih
on or about June 24, 1949. Catterson had offered tc
perform an abortion but disappeared after obtaining the
money. Catterson was not located until April 7, 1950:
at which time he was placed under arrest. Catter-
son readily admitted obtaining the $100, but stated
that he never intended to do an abortion and had used
those representations for the purpose of obtaining money
Nevertheless, Minneapolis police officers found a specu-
lum and a syringe in Catterson’s room. Catterson also
admitted that he had two or three catheters in his pos-:
session, but these were not found.
Catterson stated to the Court that he was born in
1899; that he had been married and divorced four
times. Catterson also admitted having a previous con-
viction in Lancaster County, Pennsylvania, for the crime
of adultery. Judge Larson, in sentencing the defendant,
told him that the Court was not optimistic about Cat-
terson making good on probation ; nevertheless, it was
the opinion of every one concerned, that in view of the'
fact that twenty-four years had elapsed between Cat-i
terson’s first conviction and his present violation of thei
law, an opportunity should be given him to demonstrate
that he could comply with the laws of the State of
Minnesota.
SCIENTIFIC DESIGN
ARTIFICIAL
LIMBS
ORTHOPEDIC
APPLIANCES
TRUSSES
SUPPORTERS
ELASTIC
HOSIERY
Our mechanics correctly fit
artificial limbs and ortho-
pedic appliances, conforming
to the most exacting profes-
sional specifications.
Our high type of service
has been accepted by phy-
sicians and surgeons for
more than 45 years, and is
appreciated by their pa-
tients.
BUCHSTEIN-MEDCALF CO.
223 So. 6th Street Minneapolis 2, Minn.
652
Minnesota Medicine
PATTERSON SURGICAL SUPPLY COMPANY
103 East Fifth St., St. Paul L Minn.
HOSPITAL AND PHYSICIANS SUPPLIES AND EQUIPMENT
Cedar 1781-82-83
a
iruca
THE GEIGER LABORATORIES
/ ddderuLcei por j-^Li^sician.5 op the Upper Twiddle IdJe^t
1111
eruuceS for ^ rufMaani of ine Ulpper
Mailing tubes and price lists supplied upon request.
NICOLLET AVENUE MINNEAPOLIS 2
MAIN 2350
'CjDDcL Ul&IofL &L (P'JIOOJUA,
When your eyes need attention . . .
Don't iust buy eye glasses, but eye care . . .
Consult a reliable eye doctor and then . . .
Let Us Design and Make Your Glasses
Jdctlxbj J(uU-/^Lunxtn
Dispensing Opticians
25 W. 6th St. St. Paul CE. 5767
RADIUM RENTAL SERVICE
2525 INGLEWOOD AVENUE
MINNEAPOLIS 5, MINNESOTA
TEL. ATLANTIC 5297
Radium element prepared in
type of applicator requested
ORDER BY TELEPHONE OR MAIL
PRICES ON REQUEST
Index to Advertisers
Dott Laboratories 572
erican National Bank 655
ierson, C. F., Co., Inc 640
srst, McKenna & Harrison, Ltd 561
ison, N. P., Optical Co 647
tiuber-Knoll Corporation 636
ches Sanitarium 650
tcher Corporation 632
iwn & Day, Inc 652
chstein-Medcalf Co 652
np, S. H., & Co 564
iwell-Ross Agency 554
ssified Advertising 654
:a-Cola 646
itinental Casualty Co 567
)k County Graduate School of Medicine 647
hi, Joseph E., Co 654
nielson Medical Arts Pharmacy 651
nver Chemical Mfg. Co., Inc 638
Liggists Mutual Insurance Co 655
aid Bros Inside Back Cover
et. C. B., Co., Inc 570
mklin Hospital 655
iger Laboratories 653
neral Electric X-Ray Corporation 637
:nwood Hills Hospital 633
mwood-Inglewood 649
11 & Anderson 655
zelden Foundation 635
mewood Hospital 648
an & Moody 645
lley-Koett Sales Corporation of Minnesota 562, 563
JNE, 1950
Lederle Laboratories 557
Lilly, Eli, & Co Front Cover
Insert facing page 572
Mead Johnson & Co 656
Medical Placement Registry 654
Medical Protective Co 651
Milwaukee Sanitarium Back Cover
Minnesota Mutual Life Insurance Co 643
Mounds Park Hospital Back Cover
Mudcura Sanitarium 652
Murphy Laboratories 655
North Shore Health Resort 647
Parke, Davis & Co . Inside Front Cover, 553
Patterson Surgical Supply Co 653
Philip Morris & Co., Ltd., Inc 560
Physicians Casualty Association 649
Physicians & Hospitals Supply Co., Inc 568, 634. 651, 655
Professional Credit Protective Bureau 641
Quincy X-Ray and Radium Laboratories 651
Radium Rental Service 653
Rest Hospital 650
Reynolds, R. J., Tobacco Co 569
Roddy-Kuhl-Ackerman 653
St. Croixdale Sanitarium 556
Schering Corporation 565
Schmid, Julius, Inc 566
Schusler. J. T., Co., Inc 655
Searle, G. D., & Co 631
Smith-Dorsey Co 644
Upjohn 639
Vocational Hospital 648
Wander Co 559
Williams, Arthur F 655
Winthrop-Stearns, Inc 571
Wyeth, Inc 558
6S3
Classified Advertising
Replies to advertisements with key numbers should be
mailed in care of Minnesota Medicine, 2642 University
Avenue, Saint Paul 4, Minn.
WANTED — Young M.D. for general practice in a clinic,
with emphasis on internal medicine; $1,000 a month.
Address E-211, c/o MINNESOTA MEDICINE.
FOR SALE — $15,000 cash practice in county seat of
14,000, with two hospitals, for price of office equip-
ment, which is complete and in perfect condition.
Forced to retire on account of health. Address E-200,
care Minnesota Medicine.
FOR SALE — Eye, ear, nose and throat and some surgi-
cal instruments, belonging to the late Dr. C. D’A.
Wright. 1 elephone Kenwood 6501, Minneapolis, after
6 P.M. ’
WAN 1 ED — General Practitioner (permanent or locum
tenens) by 5-man clinic. Annual guarantee: $7,000, 4
weeks’ vacation and 2 weeks’ study leave. Write : M. S.
Rayman, M.D., Community Clinic, Two Harbors, Min-
nesota.
WANTED — Second hand Green’s Refractoscope and
stand. Must be in good condition. Address E-196,
care Minnesota Medicine.
FOR SALE — Medical library, surgical and diagnostic
instruments, and a large number of orthopedic and
fracture splints, formerly owned by the late Dr. Henry
C. Cooney. For prices and further information write
Mrs. H. C. Cooney, Princeton, Minnesota.
FOR SALE — Bargain to close a business, X-Ray West
inghouse complete equipment. See it and give me :
bid. Write for complete details. C. P. Robbins, M.D
Winona, Minnesota.
WANTED — Medical assistant to well-established F.A
C.S. Suburban town of Twin Cities. Good hospita
facilities. Good future. Apartment available. Addres:
E-206, care Minnesota Medicine.
LOCATION WANTED — General Practice. Age 26
married. Eighteen month internship — one year genera
surgery including urology and orthopedics. Wants tc
make career of general practice. Address E-210, can
Minnesota Medicine.
LOCUM TENENS WANTED— Physician, aged 26
Grade A school, two years of surgical training, wishes
locum tenens, assistantship, associateship for four tc
six weeks after July 15. Address E-201, care Min-
nesota Medicine.
FOR RENT — St. Louis Park, suburb of Minneapolis,
modern air-conditioned offices in new shopping center
Finest location. Heavy residential area. Ample
parking. Will bear closest inspection. Medical Place-
ment Registry. Gladstone 9223.
GENERAL PRACTITIONER WANTED: Old estab-t
lished seven-man group in southeastern Minnesota de-i
sires a young general practitioner. Excellent possi-
bilities for the right man. Address E-212, care MIN-'
NESOTA MEDICINE.
AT YOUR CONVENIENCE,
DOCTOR . . .
you are cordially invited to visit our new
and modern prescription pharmacy located on
the street floor of the Foshay Tower, 100 South
Ninth Street.
With our expanded facilities we will be able
to increase and extend the service we have
been privileged to perform for the medical pro-
fession over the past years.
Exclusive Prescription Pharmacy
Biologicals Pharmaceuticals Dressings
Surgical Instruments Rubber Sundries
JOSEPH E. DAHL CO.
(Two Locations)
100 South Ninth Street, LaSalle Medical Bldg.
ATlantic 5445 Minneapolis
NEW POSITIONS FOR PHYSICIANS
• Pathologists for Wisconsin association. Some teach-
ing. Large number of autopsies.
• Radiologists for Michigan, South Dakota, Texas,
Missouri.
• General Practitioner. Mostly industrial work, Minne-
sota. Should make around $8, C00. Guarantee of
$5,000. Various positions for GP’s in Minnesota.
• Anesthesiologists. New hospital. Midwest.
• Surgeon, Chief of Staff, North Dakota. Also, a gen-
eral surgeon, heart of the oil country.
• Internist for town of 30,000. Doctor will gradually
retire. Another position in the Midwest with oppor-
tunity to teach in the University.
• Locations: Several excellent locations in the Twin
Cities.
• Orthopedist, Utah. Good climate. Good set-up.
• Urologist, Obstetrician and Gynecologist wanted for
clinic in Oklahoma.
This is just a sampling of the wide variety of openings \
now available.
For detailed information on current opportunities con-
tact the nearest Registry by letter, or better yet, in
person.
The Registry is, of course , completely confidential.
The Medical Placement Registry
916 Medical Arts, Minneapolis
629 Washington Ave. S.E.
Minneapolis Campus Office
480 Lowry Medical Arts, St. Paul
Kahler Hotel, 11th Floor
Rochester, Minnesota
654
Minnesota Medicine
PHYSICIANS AND HOSPITALS SUPPLY CO.f Inc.
414 SOUTH SIXTH ST., MINNEAPOLIS, MINN.
INSTRUMENTS • TRUSSES • EQUIPMENT • PHARMACEUTICALS • DRUGS
MAIN 2494
Practical Nursing School
Approved by Minnesota State Board of Nurses
Examiners
Twelve months course open to High
School Graduates or women with equiv-
alent education.
For further information apply to
DIRECTOR OF NURSES
FRANKLIN HOSPITAL
501 W. Franklin Avenue, Minneapolis 5, Minn.
Radiological and Clinical ]|
Assistance to Physicians j;
in this territory f
MURPHY LABORATORIES !j
Minneapolis: 612 Wesley Temple Bldg. - - At. 478* !|
St. Paul: 348 Hamm Bldg. Ce. 7125
If no answer, call Ne. 1291 j!
TAILORS TO MEN SINCE 1886
The finest imported and domestic wool-
ens such as SCHUSLER'S have in stock
are not too fine to match the hand tailor-
ing we always have and always will
employ.
I. T. SCHUSLER CO., INC.
379 Robert St. St. Paul
Hall & Anderson
PRESCRIPTION PHARMACY
BIOLOGICALS
PHYSICIANS’ SUPPLIES
SAINT PAUL, MINN.
LOWRY MEDICAL ARTS BUILDING
TELEPHONE: CEDAR 2735
DO YOU HAVE CHILDREN?
Train them in the habit of sav-
ing money regularly through a
SAVINGS ACCOUNT with
*T T this bank. . . . They’ll always
4^ thank you. OPEN AN AC-
COUNT FOR THEM TO-
DAY.
THE AMERICAN NATIONAL BANK
OF SAINT PAUL
Bremer Arcade Robert at 7th CE 6666
Member Federal Deposit Insurance Corporation
r
UNUSUAL LENS GRINDING
I CATARACT,
MYO-THIN
V l T GX and other difficult
^ and complicated
LX — lenses are ground to
extreme thinness and
\ y accuracy by our
expert workmen.
0KMREWILLIACI5 “ESS
L J
Insurance
at a
Saving
MINNESOTA
Druggists' Mutual Insurance Company Pr°n'Pt
OF IOWA. ALGONA, IOWA LOSS
Fire - Tornado - Automobile Insurance Service
REPRESENT ATIVE-S. E. STRUBLE. WYOMING, MINN.
une, 1950
655
Special formula products
of wide interest
to physicians
To aid in solving the perplexing
infant feeding problems encountered
in daily practice. Literature,
including formula tables,
available on request.
Mead Johnson & co.
EVANSVILLE 2 I , I N D., U. S. A.
Alacta* — Powdered half-skim milk, for use
when fat tolerance is low or gastric emptying pro-
longed, as in hot weather or during bouts of infec-
tious disease. An outstanding milk product for
prematures.
Casec* — A concentrated (88%) protein supple-
ment highly useful in dietary management of diar-
rhea and colic. Valuable for increasing the pro-
tein content of the formula or diet.
Mead’s Powdered Lactic Acid Milk No. 2 —
Acidified whole milk. Valuable when a milk of
exceptional digestibility is indicated, as for mal-
nourished or undernourished infants and in cer-
tain digestive disorders.
Mead’s Powdered Protein Milk — Powdered
lactic acid milk of high protein, low carbohy-
drate and average fat content. Highly useful in
celiac disease and in diarrhea.
Nutramigen* — A nutritionally adequate truly
hypoallergenic food — containing a nonantigenic
casein hydrolysate combined with carbohydrate,
fat, minerals and crystalline B vitamins. Inval-
uable for infants sensitive to milk or other foods.
*T.M. Reg. U.S. Pat. Off.
^ PBVSMKS
PROTEIM Mil*
Tic Acm Mtt*
ntu/
r'? Johnson *
/V* Johnson *;
656
Minnesota Medicine
That’s what more and more families
are doing every day in Minneapolis
and its suburbs
There are worthwhile reasons, too, for this swing
to Ewald’s and Golden Guernsey. First, there is the
extra health value ( richer in bntterfat and non-fat
milk solids ) you’ll get for yourself and your family
in this famous product. Second, you have the assur-
ance of quality and purity backed by 63 years of
Ewald family tradition. Third, you know that
you’re getting only milk from selected herds of
the world’s finest dairy cows, produced and han-
dled under the strict supervision of the American
Guernsey Breeders’ Association.
If you live in Minneapolis or its suburbs and
would like to see for yourself why Ewald’s Golden
Guernsey is called the World's Finest Milk, just
phone CHerry 3601 for prompt home delivery.
We’re sure you and your family will enjoy this
naturally finer, better tasting milk.
Call CHERRY 3601
GOLDEN GUERNSEY
For nearly 65 years, a family owned, independent dairy
serving Minneapolis and neighboring suburbs
The MOUNDS PARK HOSPITAL
SAINT PAUL, MINNESOTA
THE ESSENTIALS for Treatment of Nervous and Mental Diseases
1 Specialists in diagnosis and care.
2 Hospital care partial or complete isola-
tion from former environment.
3 A staff of consulting physicians and
surgeons.
Approved by the American College of Surgeons
4 Especially trained graduate nursing staff.
5 Hydrotherapy and occupational therapy.
6 An atmosphere of cheerfulness.
Upon request, the Hospital mill be pleased to send the
details of its sendee and rates.
MILWAUKEE SANITARIUM Wauwatosa, Wis.
Arthur
Consi
G. H. Schroeder,
Business Manager
COLONIAL HALL-
One of the 14 Units in “Cottage Plan.”
Patek, M.D.
Itant
For NERVOUS DISORDERS (
Chicago Office — 1117 Marshall Field Annex
Telephone: Central G-1102
Wednesdays, 1-3 P.M.)
Maintaining highest standards
for more than half a century, the
r Milwaukee Sanitarium stands for
all that is best in the care and
treatment of nervous disorders.
Photographs and particulars sent
on request.
Josef A. Kindwall, M.D.
Carroll W. Osgood, M.D.
William T. Kradwell, M.D.
Benjamin A. Ruskin, M.D.
Lewis Danziger, M.D.
Russell C. Morrison. M.D.
James L. Baker, M.D.
Robert A. Richards, M.D.
' •
BENADRYL
This is the season when bleary-eyed,
sneezing patients turn to you for the rapid,
sustained relief of their hay fever
symptoms which BENADRYL provides.
\ Today, for your convenience and ease of administration,
BENADRYL Hydrochloride
(diphenhydramine hydrochloride,
Parke-Davis) is available in a
wider variety of forms than ever
before, including Kapseals®,
Capsules, Elixir and Steri-Vials®.
IT S YOUR BUSINESS
IT’S AMAZING the number of professional people who ignore the
law of averages hoping that their income will continue uninter-
rupted.
THE RECORD in this office shows that during last year $49,077.91
was paid to one out of eight of the doctors in the Minnesota State
Medical Association.
IT’S YOUR BUSINESS!
WITH THAT probability facing you in 1950, it’s sage advice to
suggest that you apply for the Minnesota State Medical Association
plan of income protection.
DELAY OFFERS NO ADVANTAGE.
CASWELL-ROSS AGENCY
1177 N. W. Bank Building
Minneapolis — MA 2585
lnsurors to:
Minnesota State Bar Association
Minnesota State Dental Association
Minnesota State Medical Association
Minnesota Society of C.P.A.
Minnesota State Pharmaceutical Assn.
Minnesota Auto Dealers Association
Hennepin County Medical Society
Hennepin County Bar Association
Minneapolis 2, Minnesota
St. Paul— ZE 2341
St. Paul District Dental Society
Minneapolis District Dental Society
St. Cloud Dental and Stearns County
Medical Society
Duluth District Dental Society
East Central Medical Society
St. Louis County Medical Society
658
Minnesota Medic
irrutl of the Minnesota State Medical Association, Southern Minnesota Medical Association, Northern Minnesota
Medical Association, Minnesota Academy of Medicine and Minneapolis Surgical Society
lume 33
July, 1950
No. 7
Contents
re Emotional Problems of the Chronically III. President’s Letter :
Jeorge Saslow, M.D., St. Louis, Missouri 673 No Agenda of Promises 712
:mangiopericytoma.
Harry E. Bacon, M.D., F.A.C.S., Lloyd F. Sher-
man, M.D., and William N. Campbell, M.D.,
Philadelphia, Pennsylvania 683
inical Observations of Experiments of Nature.
7. A. McKinlay, M.D., Minneapolis, Minnesota... 685
rBERCULOSIS IN SELECTEES DISQUALIFIED FOR THE
\rmy, 1943-1945.
'Valter J. Marcley, M.D., Minneapolis, Minnesota 689
r Unusual Type of Pulmonary Disease Involv-
ng Six Members of a Family.
L. H. Rutledge, M.D., F.A.C.S., Detroit Lakes,
Minnesota 694
ute Inversion of the Uterus.
Harry Shragg, M.D., Elmore, Minnesota, Marcus
Keil, M.D., and John Mikkelson, M.D.,
Mankato, Minnesota 700
roxysmal Tachycardia with Attacks of
Jnconsciousness.
Vfelvin D. Mills, M.D., and Harry L. Smith, M.D.,
Rochester, Minnesota 703
story of Medicine in Minnesota :
Medicine and Its Practitioners in Olmsted County
Prior to 1900 (Continued from June issue.)
Nora H. Guthrey, Rochester, Minnesota 705
Editorial :
State Officers Elected 713
Terramycin 713
Cloaking of Signs and Symptoms by Cortisone and
ACTH Administration 714
A Rose by Any Other Name 714
General Practice and GP 715
The American Journal of Proctology 716
Medical Economics :
Senator McClellan Blows Away the Fog 717
Purchasing Power Now Less Than in 1931 717
Dewey Advises Avoiding Never-Never Land 718
Committee Quotes Words of Wisdom 718
Minnesota State Board of Medical Examiners.... 719
Minnesota Academy of Medicine:
Meeting of February 8, 1950 720
Recent Advances in the Bronchoscopic Study of
Pulmonary Disease.
Robert E. Priest, M.D., Minneapolis, Minnesota. 720
External Fixation of Facial Fractures.
Jerome Hilger, M.D., Saint Paul, Minnesota. . . . 726
In Memoriam 730
Reports and Announcements 734
Woman’s Auxiliary 736
Of General Interest 738
Book Reviews 747
Contents of Minnesota Medicine copyrighted by Minnesota State Medical Association, 1950
tered at the Post Office in Saint Paul as second class mail matter. Accepted for mailing at the special rate of postage provided
for in Section 1103. Act of October 3, 1917, authorized July 13, 1918.
LY, 1950
659
MINNESOTA MEDICINE
Official Journal of the Minnesota State Medical Association
Published by the Association under the direction of its Editing and Publishing Committee
Office of Minnesota State Medical Association,
493 Lowry Medical Arts Bldg., Saint Paul 2, Minnesota.
EDITING AND PUBLISHING COMMITTEE
E. M. Hammes, Saint Paul
Philip F. Donohue, Saint Paul
H. W. Meyerding, Rochester
B. O. Mork, Jr., Minneapolis
C. L. Oppegaard, Crookston
T. A. Peppard, Minneapolis
H. A. Roust, Montevideo
O. W. Rowe, Duluth
Henry L. Ulrich, Minneapolis
A. H. Wells, Duluth
EDITORIAL STAFF
Carl B. Drake, Saint Paul, Editor
George Earl, Saint Paul, Associate Editor
Henry L. Ulrich, Minneapolis, Associate Editor
BUSINESS MANAGER
J. R. Bruce
Annual Subscription — $3.00. Single Copies — $0.40. Foreign and Canadian Subscriptions- — $3.50.
The right is reserved to reject material submitted for editorial or advertising columns. The
Editing and Publishing Committee does not hold itself responsible for views expressed either in
editorials or other articles when signed by the author.
Classified advertising — ten cents a word; minimum charge, $2.00. Remittance should ac-
company order.
Display advertising rates on reauest.
Address all communications concerning the journal to Minnesota Medicine, 2642 University
Avenue, Saint Paul 4, Minnesota. Telephone Nestor 2641.
ST. CROIXD ALE ON LAKE ST. CROIX
PRESCOTT. WISCONSIN
MAIN BUILDING— ONE OF THE 8 UNITS IN “COTTAGE PLAN”
A Modern Private Sanitarium for the Diagnosis, Care and Treatment of Nervous and Mental Disorders
Located on beautiful Lake St. Croix, eighteen miles from the T win Cities, it has the advantages of both
City and Country. Every facility for treatment provided, including recreational activities and occupational
therapy under trained personnel. Close personal supervision given patients, and modern methods of
therapy employed. Inspection and cooperation by reputable physicians invited. Rates very reasonable.
Illustrated folder on request.
NEUROPSYCHIATRISTS
PRESCOTT OFFICE Hewitt B. Hannah. M.D SUPERINTENDENT
Prescott, Wis. Andrew J. Leemhuis, M.D. Dorothy M. Most, R.N.
Howard J. Laney, M.D. Howard J. Laney. M.D. Prescott, Wisconsin
Tel. 39 and Res. 76 511 Medical Arts Building Tel. 69
Minneapolis, Minnesota
Tel. MAin 1357
660
Minnesota Medicine
in Surgical and
Other Infections
N
AU R EO
M VC I
Surgeons are now generally coming to the conclusion
that the use of aureomycin preoperatively and post-
operatively in all cases is worthwhile insurance against
infection. This is particularly true in infections in-
volving the peritoneum.
Aureomycin has also been found effective for the con-
trol of the following infections: African tick-bite fever,
acute amebiasis, bacterial and virus-like infections of
the eye, bacteroides septicemia, boutonneuse fever,
acute brucellosis, Gram-positive infections (including
those caused by streptococci, staphylococci, and pneu-
mococci), Gram-negative infections (including those
caused by the coli-aerogenes group), granuloma in-
guinale, H. influenzae infections, lymphogranuloma
venereum, primary atypical pneumonia, psittacosis
(parrot fever) , Q fever, rickettsialpox, Rocky Moun-
tain spotted fever, subacute bacterial endocarditis re-
sistant to penicillin, tularemia and typhus.
Capsules: Bottles of 25, 50 mg. each capsule.
Bottles of 16, 250 mg. each capsule.
Ophthalmic: Vials of 25 mg. with dropper,- solution
prepared by adding 5 cc. of distilled water.
LEDERLE LABORATORIES DIVISION American Cuanamid company 30 Rockefeller Plaza, New York 20, N. Y-
jly, 1950
661
sequence in
biliary tract
surgery
preoperatively - Decholin
brand of dehydrocholic acid stimulates an abundant flow of thin bile, helping to
“clear the arena” for surgery by the removal of inspissated bile, mucus, small
stones and other accumulations from the choledochus. This powerful hydro-
choleretic action also produces functional distension of the gallbladder and ducts,
aiding in identification and surgical procedure.
postoperatively - Decholin
provides an effective means of flushing out the biliary tract. Used together with
antispasmodics such as atropine and nitroglycerin, Decholin helps to remove
blood clots, residual debris and hidden, small calculi. This method, recently re-
emphasized by Best,1 is useful with or without T tube drainage. In reflex biliary
stasis, Decholin serves to prompt an adequate secretion of bile.
For more rapid and intense hydrocholeresis, Decholin Sodium, brand of sodium
dehydrocholate, is given intravenously, followed by a course of Decholin tablets.
Decholin
brand of dehydrocholic acid
Dccholltl (brand of dehydrocholic acid) Tablets of 3 ft grains, in bottles of 25, 100, 500
and 1000.
Decholin Sodium (brand of sodium dehydrocholate) 20% solution, in ampuls of
3 cc., 5 cc. and 10 cc., boxes of 3 and 20.
1. Best, R. R.: Ann. Surg. 128: 348 (Sept.) 1948.
DECHOLIN and DECHOLIN SODIUM: Trademarks registered in U. S. and Canada-
AMES COMPANY, INC.
ELKHART, INDIANA
662
Minnesota Medicine
WYETI \ Incorporated
July, 1950
663
CHRONIC ASTHMATIC
• Many chronic asthmatics have been restored to activity —
and maintained that condition — by controlling attacks
with Norisodrine powder inhalation.
Using the Aerohalor®, Abbott’s powder inhaler, and a
cartridge containing Norisodrine Powder, the patient
inhales three or four times and the bronchospasm usually
ends quickly. This take-it-with-you therapy is effective
against mild as well as severe forms of asthma.
Proved by clinical investigation1’2, Norisodrine is a
bronchodilator with relatively low toxicity. Few side-effects
result when the drug is properly administered and these
are usually minor. Before prescribing Norisodrine,
however, please write to Abbott Laboratories,
North Chicago, Illinois, for literature. This tells how to
establish individual dosage and precautions to be taken.
Norisodrine Sulfate powder 10% and 25% is supplied
~ in multiple-dose Aerohalor* Cartridges, with rubber
caps, three to an air-tight vial. The () 0 , ,
r- " Aerohalor is prescribed separately. VJTTUXSTX
♦ Trade Mark for Abbott Sifter Cartridge
1. Krasno, L.R., Grossman, M l., and Ivy.
A.C. (1949), The Inhalation of l-(3',4'-Di-
hydroxyphenyl)-2-Isopropylaminoethanol
(Norisodrine Sulfate Dust), J Allergy,
20:111, March. 2. Krasno, D.R., Gross-
man. M., and Ivy, A.C. (1948), The In-
halation of Norisodrine Sulfate Dust,
Science. 108:476. Oct. 29.
NOTE
THE NAME
(Isopropylarterenol Sulfate, Abbott;
ALWAYS READY FOR USE WHEN THE NEED ARISES
664
Minnesota Medicine
"The . . . estrogen
preferred by us is
f Premarin,’ a mixture
of conjugated estrogens,
the principal one
of which is
estrone sulfate.
Hamblen, E.C.: North Carolina M.J. 7:533 (Oct.) 1946.
In treating the menopausal syndrome
with “Premarin!’ Perloff* reports that
“Ninety-five and eight tenths per cent
of patients treated with 3.75 mg.
or less daily obtained complete relief
of symptoms”; also, “General tonic
effects were noteworthy and the greatest
percentage of patients who expressed
clear-cut preferences for any drug
designated ‘Premarin! ”
Thus, the sense of “well-being”
usually imparted represents a “plus” in
“Premarin” therapy which not only
gratifies the patient but is conducive to
a highly satisfactory patient-doctor
relationship.
Four potencies of “Premarin”
permit flexibility of dosage: 2.5 mg.,
1.25 mg., 0.625 mg. and 0.3 mg. tablets;
also in liquid form, 0.625 mg. in
each 4cc. (1 teaspoonful).
•Perloff. W. H.: Am. J. Obsl.& Gynec. 58:684 (Oct.) 1949.
While sodium eslrone sulfate is the principal estrogen in
“Premarin” other equine estrogens. ..estradiol, equilin,
equilenin, hippulin...are probably also present in varying
amounts as water-soluble conjugates.
Estrogenic Substances (water-soluble) also known as Conjugated Estrogens ( equine )
Ayerst, McKenna & Harrison Limited
22 East 40th Street, New York 16, N. Y.
1950
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672
Minnesota Medicine
ournal of the Minnesota State Medical Association, Southern Minnesota Medical Association, Northern Minnesota
Medical Association, Minnesota Academy of Medicine and Minneapolis Surgical Society
Volume 33
July. 1950
No. 7
THE EMOTIONAL PROBLEMS OF THE CHRONICALLY ILL
GEORGE SASLOW, M.D.
St. Louis. Missouri
T the present time (and I say at the present
time because things may change in the next
:en years about tuberculosis), we must regard
uberculosis as a chronic disease requiring treat-
nent for an unknown number of months or years,
[t is a chronic disease, the treatment of which
lsually requires a number of different forms of
herapy : treatment at home, involving bed rest
md the avoidance of contagion for others; treat-
nent in a sanatorium where there is bed rest and
he same care about contagion, and where there
ire also surgical procedures such as collapse ther-
ipy and thoracoplasty ; and where there may be
ised, in either place, antibiotics like streptomycin.
Different kinds of treatment may have to be
ised from time to time in the course of a patient’s
:uberculosis treatment. The patient has to be
prepared for these changes. It may be that one
<ind of treatment has not been beneficial, or that
:t must be continued longer. Perhaps he must
shift temporarily to some other more drastic
xeatment.
All of these changes involve a high degree of
:o-operation on the part of the patient. To make
natters worse there is no quick, easy or sure cure
for tuberculosis and out-patients soon get to know
Tat. Furthermore, bed rest (that is, an extremely
'ow level of activity for a long period of time) is
still the major reliance of therapy. To make
natters still more difficult for the patient with this
illness, he soon learns or he witnesses, in other
patients, that he may be subject to unpredictable
Tuberculosis Lecture given at a meeting of Third District,
Minnesota Nurses Association, November 9, 1949.
Dr. Saslow is Associate Professor of Psychiatry, Washington
University School of Medicine, Psychiatric Consultant to the
Student Health Service of Washington University, and Director
of the Division of Psychosomatic Medicine.
July, 1950
relapses. For him to be successfully treated under
these conditions it is most important that the
patient have the capacity to sustain co-operation
with the physician and other persons who are part
of the medical team. In this regard, he has to sus-
tain co-operation with medical personnel for a
long period of time in diverse kinds of therapy
and with possibly various kinds of discouragement
and no certain result. He is thus in the same
situation as patients with other chronic, inter-
mittent diseases, such as diabetes. Here, where we
have an important therapeutic chemical substance,
insulin, exactly the same problems are found. In
the cases of persons with structural heart disease,
such as rheumatic fever, we have the same prob-
lems of ups and downs, of different kinds of treat-
ments, from limitation of work to surgery. People
with epilepsy must be followed all their lives.
Thus, in the treatment of various chronic, inter-
mittent diseases, there are common general prob-
lems.
Apparently it is extremely difficult for people
with tuberculosis (as with other diseases) to sus-
tain a co-operative relationship with medical per-
sons or a medical team. This difficulty is high-
lighted by some recent studies, published in 1948.
I refer to the issue of the Public Health Report,
November 5, 1948, Tuberculosis Control Issue,
Number 33, in which the main article “Irregular
Discharge of the Tuberculous” covered the prob-
lem of irregular discharge, meaning discharge be-
fore the person had received maximal benefit from
hospital treatment.
In this article there is the statement that over
50 per cent of tuberculous patients in Veterans
Administration sanatoria left before they had
673
EMOTIONAL PROBLEMS— SASLOW
received maximal benefits from hospitalization.
More than half the patients in these VA tuber-
culosis sanatoria failed to receive what they should
have from modern medical knowledge. You might
think that this might have had something special
to do with the way VA sanatoria are operated
but study of other hospitals showed it had nothing
whatever to do with the way VA hospitals, as
such, are operated. A survey was made of this
sort of thing in hospitals throughout the country
including public and private sanatoria, of various
sizes, and in diverse locations. In one such survey
made some years ago of a sanatorium in Ten-
nessee, for example, 70 per cent of the hos-
pitalized tuberculous patients left against medical
advice, that is, before they received maximum
benefits. .So the figures run for over a hundred
sanatoria throughout the country which have been
studied during the past ten or fifteen years, right
up to the present time. Taking all the figures
together, from about 30 to over 70 per cent of
hospitalized tuberculosis patients do not complete
their course of treatment. A fair number of these
are dead within a year, having in the meantime
spread infection to an unknown number of other
persons in that year. It must, therefore, be very
difficult to sustain the kind of co-operation which
I mentioned, and from that point of view, I don’t
think it is exaggerating to say that tuberculosis
had best be regarded not only as a disease of the
infected parts of the body (the lungs for ex-
ample), but also as a disorder involving the entire
personality. Unless the person is treated in a
certain way, we cannot give him the benefits of
our best medical and surgical knowledge.
From this point of view, which will be basic to
the rest of what I have to say, I shall discuss
certain points in the course of our professional
contacts with a tuberculosus patient. If we have
a greater sensitiveness to him as a person, we
may help him sustain the necessary co-operation
with a medical team. There are ways of helping
a patient sustain such co-operation. The knowl-
edge and skill to secure this co-operation are not
widely enough spread throughout the medical
team. We can bring out this kind of knowledge by
discussing how to help a tuberculous patient :
( 1 ) at the time of diagnosis, when the patient is
told he has the disease, (2) at the time when he
is to have active therapy, as in a sanatorium, and
(3) at the time when he is ready for discharge
and ready to resume ordinary life.
Let’s take the first point, the time of diagnosis.
Consider what happens at this time, which, if we
consider the patient as a person, we might turn
to his advantage. It is important to remember
that his inner ability to stand up under this strain
is decreased by his illness.
The patient comes to see a physician for a
general examination because he hasn’t been feel-
ing quite up to par, his complaints are vague, and
his work efficiency has fallen off. Perhaps he j
tires a little more easily but that is about as much
as he knows. Let us suppose next that the ex-
aminations, which are necessary, are done, the
physician picks out some clues, perhaps a chest
x-ray film indicates that tuberculosis must be con-
sidered seriously. Then suppose he finds tubercle
bacilli in the sputum or in the gastric washings.
The x-ray reading indicates tuberculosis with-
out question. The physician is certain of the
diagnosis. I his is completely unsuspected by the
patient up to this point.
Now the physician has to communicate the seri-
ousness of the condition to the patient. And in
giving the patient the diagnosis, no matter how
he does it, he must make the seriousness of the
illness understood. The patient reacts in one of
a number of ways to which the physician can pay .
much or little attention. The patient may show no
reaction at all, may look apathetic, just listen and !
show nothing. It is incredible, I think, for all of
us who have seen patients with tuberculosis, to
believe that they really feel nothing.
One’ 's guess is that when a patient shows apathy
on receiving such serious news, there is something
about it that is so painful that he is stunned by
the words, just as some persons suffering the
bereavement of a close relative may show no
outward emotion whatever. The very person that
was expected to be most disturbed by the death
of a father, mother, a husband or wife, may reg-
ister no reaction. It is perfectly possible for him
to be so startled by serious news as to appear as
though nothing had happened. The physician,
after he tells the tuberculosis patient of his di-
agnosis, may go on to explain about treatment.
He may talk for IS or 20 minutes. He may find
to his surprise, some days or weeks later, or when
some one else talks to the patient, that a quite in-
telligent patient has remembered nothing what-
soever of what has been said to him.
There are many variations in reaction to emo-
tional shock. One may simply remain stunned
674
Minnesota Medicine
EMOTIONAL PROBLEMS— SASLOW
and unaware. There may be the reaction of cry-
ing, or with men (who aren’t supposed to cry in
our society except in the presence of their moth-
ers), there may be tears in the eyes. Other reac-
tions include intense fear which the physician
usually describes as shock. The physician may
pay no attention to these reactions, or absence of
reactions, but may keep on explaining what the
disease is and what will happen to his patient.
The patient, in his intense anxiety, may assert
that the physician is wrong in his diagnosis, may
go on telling himself that he can't possibly have
the disease, and his thoughts may follow one of
various common courses. Some patients may
never want to see another physician again and, in
consequence, become seriously ill, or report to
a hospital too late, or may die. Others may go
from doctor to doctor, hoping to find one who will
tell them they do not have tuberculosis. If there is
any question about the diagnosis, or if the physi-
cian does not have time to discuss the findings or
make a careful study, these patients will seek-
assurance from persons who are not physicians,
who are willing to differ.
Another kind of reaction that is not so com-
mon, for some reason or other, is the sudden
outburst of anger on the part of the patient,
against the person whom he blames for having in-
fected him — some one in the neighborhood or in
the family, perhaps, who is known to have had
tuberculosis or is thought to have had the disease
Many other things may take place in the think-
ing and feeling of patients at the time the diag-
nosis is communicated to them. Some people may
think that having tuberculosis is punishment for
personal misbehavior. They reason : “I stole
something, I was unfaithful to my wife or my
husband, or I acted too arrogantly. This, then,
is my punishment.” Since some patients regard
this news as being a punishment for something
and since no one likes to be sentenced to jail, talk
about being in a sanatorium for a year to such
a person is the equivalent of a jail sentence. Such
a person may decide, ‘‘before I go to jail I’ll
have my last fling and have a fine time night after
night.”
In one such instance, reported by Dr. Jules
Coleman of Denver, who has had a very wide ex-
perience with tuberculosis patients, the following
occurred : a young man who had unilateral mini-
mal tuberculosis received the news of his diag-
nosis as the equivalent of a jail sentence. He de-
cided to have that last fling. Eight days trans-
pired between the time of the communication of
the diagnosis and his admission to the hospital.
At the end of this interval, having had a high,
wide, handsome time, day and night, he came in
with advanced bilateral pulmonary tuberculosis.
This is perfectly possible — one’s physiological
condition can deteriorate thus rapidly, permitting
the spread of the tubercle bacilli.
Other persons, when the diagnosis is communi-
cated to them, believe that if they carry out the
prescribed treatment, such as going to a sana-
torium, their friends will never again want to
have anything to do with them. They feel, in
short, they will be as rejected by everyone as
though they had leprosy. Nobody will want to as-
sociate with them, everyone will be afraid of them.
This is their obsession. Thus, the communication
of the diagnosis to some people means “I’ve lost
all my friends. I’ll have to move away.”
To other people, the main thought which occurs
is “I’ll be on my back, helpless, not earning any-
thing for a year or more. I’ll be completely de-
pendent.” To persons who have always been self-
reliant, dependency is the cause of intense emo-
tional distress. They find it difficult to accept the
diagnosis chiefly because it involves complete de-
pendency for a fairly long period.
To still other people, the diagnosis of tuber-
culosis may come at a time when they are in the
mid-stream of developing their career. Such
people may feel as if everything, life itself, will
now be interrupted and that opportunity for ad-
vancement may never return. Sometimes, of
course, this is true.
Thus, the news of the diagnosis of tuberculosis
may have any one of a variety of serious mean-
ings to a patient. The doctor himself may know
nothing of these meanings unless he learns them
from the patient. The usual custom in the past
has been to attempt to get nothing from the pa-
tient. The patient’s reactions thus remained un-
known to the physician.
Some of the things which physicians do in
communicating diagnosis are known to be very
ineffective. What I say here about doctors ap-
plies also to nurses and other members of the
medical team. Both doctors and nurses must
work together on this job. Doctors are usually
the first to communicate the diagnosis. Among
the ineffective procedures that doctors use at the
July, 1950
675
EMOTIONAL PROBLEMS— SASLOW
time they communicate the serious news are these :
They may minimize the seriousness of the news
and talk in a very vague and casual way about it.
“Oh, you have a spot on your lung, but you’ll be
all right.’’ Giving the patient this kind of false
reassurance is no kindness whatever. The pa-
tient really must be prepared for what is going
to happen to his life during the next year or two
years. Not telling him what this is, not only leaves
him open to a greater disappointment when he
finds out what he is really up against, but may
make him distrustful, first of all, of his doctor and
later on, of any doctor or nurse, in fact of any
member on the medical team. Thus, we have
poisoned a very important source of security for
him at the hospital, as will be discussed later.
Another thing the doctors could do, when in-
dicating diagnosis and discussing what has to be
done, is not to be overly optimistic about the du-
ration of treatment for this disease. Very com-
monly doctors say, when communicating the di-
agnosis, “you will have to be in a sanatorium or
in bed for six months or so, and then you will
be all right. Tuberculosis is too unpredictable
for that. Six months is almost universally felt
to be too short a time for treatment — certainly
until we have much better antibiotics than we have
now. These patients look forward to recovery
at the end of the specified time and the more they
feel the disease has messed up their lives, the
more anxiously they count on recovery by the
exact day the doctor mentioned in his casual state-
ment. When that day passes and they realize
they are still ill, they tend to neglect themselves
and to violate hospital rules. If at home, they
go out and pay no attention to rest, and so on,
and tend to have a rapid progression of the dis-
ease.
Another thing doctors tend to do is to give
the tuberculosis patient a very optimistic por-
trayal of a year in a hospital, away from home
and family. They talk about freedom from re-
sponsibilities, about freedom from worry and
bills, and they minimize the difficulties of sana-
torium life.
It is important to mention that the physician
is usually pleased by a patient who accepts news
of his diagnosis very readily and with a smile.
The doctor thinks : “This is a good fellow, this is
a good patient, he takes it with a smile — he’ll go
right ahead.” There are a number of instances on
record, some of these also described by Dr. Cole-
man of Denver, of persons who really have ap-
peared eager to accept the news of the diagnosis.
They agree with the doctor while in his presence.
They give him no hint of what they are thinking,
but they may never see a doctor again, they may
never enter a sanatorium. Perhaps they put this
smile on to conceal how hurt they are. Their
behavior remains unpredictable after they leave
his office.
Now what are some of the more effective ways
of managing this total situation?
The doctor usually doesn’t know what the pa-
tient is thinking or feeling. He certainly doesn’t
usually know what the patient’s circumstances are
or what this interruption in his life at this par-
ticular moment may mean to him. There seems to
be no way out of this situation. But there is a
kind of help which works in many other unalter-
able life situations. When a person has a difficulty
to surmount, it helps him to define that difficulty
bv expressing himself. The difficulty he experi-
ences is an emotional disturbance, emotional dis-
tress or anxiety fit makes no difference what you
call it). He is temporarily disorganized. The
best way to help the patient handle a difficult situ-
ation when he is emotionally disturbed does not
seem to be to minimize the situation for him or
to preach to him about what he should do. He
seems to be unable to do the thing that is the best
for him to do unless something else happens first.
That something is that he seems to have to dis-
charge the emotion which is in him. Afterward,
he can often face his problem and plan more
realistic action.
The person who has been unable to solve a
problem when intensely disturbed may be able
to solve it when he has discharged the emotion
he feels. The job the physician has to do for,
if the physician begins the job, the nurse has to
complete it) could be put like this: When an-
nouncing the diagnosis, one should wait to see
what the patient will do and whether he does
nothing, or a lot, or smiles acceptance. It is then
up to the physician, after a brief pause, to allow
the patient to react spontaneously, in an effort to
find out what this news has meant to him. The
physician could begin by saying: “What do you
think about this” — a simple question, or “what
does the disease, tuberculosis, mean to you?” or
“what will this do to your life?” or, “who will
take care of your family or children (if it is a
woman who has children) if you have to go to
676
Minnesota Medicine
EMOTIONAL PROBLEMS— SASLOW
a hospital ?” The doctor must ask these questions
and other obviously related questions — he must
ask them briefly— and when he asks the question
he must give the patient plenty of time to reply
either by words or by expressed emotion.
If the patient wishes to cry for five minutes,
that’s what he should be allowed to do. If the
patient wishes to talk and then break down and
cry, that’s what he must do. The doctor must not
interfere with his emotional reaction. The doctor
will then not only get some of these emotional
disturbances out of the patient by this kind of
technique, but after some of these disturbances
have been expressed the doctor will usually have
learned many things the patient has to face in
his treatment. Furthermore, the patient is then
more ready to confide other significant attitudes
and fears, since that is the usual result of sharing
an emotional experience. The two individuals
have become closer. A doctor can hardly do a
thing like this in less than fifteen minutes of
continuous time in privacy with a person. He
can’t be interrupted by phone calls every few
minutes, or people walking into the office — either
the nurse or other patients. It requires some un-
derstanding of the fact that people do not com-
municate matters of emotional intensity unless
they have privacy. It takes a few minutes for
one person to warm up enough to tell another
person something as important as what this news
does to his life. Physicians need to understand
that they have to allow time for the patient to
go through this process — maybe only 15 minutes
— that they have to allow this time in a setting
of privacy where the patient feels he has the
complete attention and interest of the doctor.
The physician may decide that he wants to
have another session the next day, so he may
say, “I’d like to talk with you more about this
tomorrow.” He doesn’t have to make any promises
up to that point. He doesn’t have to describe any-
thing in detail about what is going to happen
concerning the treatment of the disease; just, I
want to talk to you some more tomorrow” is all
he has to say, and the patient will come back.
Now if this procedure is followed, whether two
or three times by the physician, or in the begin-
ning by the physician and then by the nurse, it
can be very helpful because the patient feels that
more than one person understands him. If this
has been done properly something very important
has happened. The patient has shared a very
important kind of emotion, a very special kind
of experience, with at least one other person.
And what is accomplished by this sharing of
an important emotion with another person? The
two people become tied together. In this case the
patient becomes tied to the physician. The patient
develops more confidence in his physician because
of the sharing of an important experience, just
as buddies at war formed life-long friendships
not because they had pleasant experiences to-
gether necessarily, though that, too, can be true,
but because they had escaped death together and
talked about it. Once this close relationship is
formed, the patient trusts his physician. The
patient then has a much greater internal ability to
stand discouragement, the long period of inactivity
in the sanatorium, and the isolation from home
which will be necessary for him to get his best
chance to get well. So a strong patient-doctor re-
lationship is established which the patient remem-
bers and benefits from.
The social worker is another person who can
contribute to this process of helping the patient
sustain his internal stability until he gets well.
She can be very helpful if there are children to
be provided for or matters of family finances to
be attended to while the sick person is away. This
kind of assistance should be managed in the same
way as above described, not only with the patient
but also with the involved members of the family.
Persons involved in the emotional distuibance
of a patient can be treated exactly as the patient,
by not minimizing the true situation, by not giv-
ing false reassurance, by not saying “buck up
or “be a brave person,” but by finding out what
it all really means to them and by allowing their
emotional reactions free expression. Then these
people are ready to discuss what to do if any-
thing can be done. What can be done after this
emotional discharge has taken place? Much more
than we usually give people credit for.
The next phase in the course of the patient s
adjustment to treatment follows admission to a
tuberculosis sanatorium. Several factors may in-
fluence him to leave the hospital. With the proper
understanding on the part of the medical team,
he may remain in the hospital. Important to re-
member about the hospital situation is the fact
that the patient is isolated from all the people
that he loves and from all his friends. On ac-
count of this isolation — the fact that he is cut off
from persons on whom he has relied for affection,
July, 1950
677
EMOTIONAL PROBLEMS— SASLOW
understanding, friendship and so on — several
things may happen. The patient may become ex-
traordinary sensitive to anyone who shows
special interest in him in the hospital. If the
doctor takes interest in a patient cut off from
any other afifectional support, the doctor im-
mediately becomes extremely important to the
patient. The nurse, similarly, becomes very im-
portant, the occupational therapist, the recreation-
al worker, the librarian, any one of these can be-
come equally important to the person whose affec-
tional life has become practically nothing in the
sanatorium while he had a normal social life and
companionship outside. Thus a doctor who is
very pleasant to the patient one day and pretty
cold to him the next (because he himself has been
up late the night before or is bothered about his
own problems) has an overpowering effect on a
patient who has become extraordinarily dependent
upon that doctor’s attitudes. The same applies to
other members of the medical team, from nurses
to attendants. If they have problems in their own
personal lives, which they bring to their work, so
that their behavior towards these patients, to
whom they mean so much, goes up and down in
an unpredictable way, the patient’s emotional re-
action also goes up and down in an unpredictable
way, because he feels that he has been alternately
indulged and deserted. Such unpredictable de-
sertion may be the time when the pateint leaves
the hospital.
The hospital personnel is extraordinarily im-
portant in sustaining the morale of the person
isolated from friends. Often hospital personnel
are completely unaware of this. They may not be
doing a good professional job. They may not be
especially interested in this patient. But, because
he has nobody else, they are now the most import-
ant figures in the patient’s world. What they do is
of extreme importance, and they must learn to
behave in a sustained friendly way toward such
patients, as is necessary in a hospital situation. It
doesn’t do for them to behave as Bettv MacDon-
ald described in her book, “The Plague and I,”
to come in one day to find a patient disagreeable
and say, “Well, if you don’t like it here, you can
go home any time ; there are thousands who would
be glad of the chance to have your bed.” That
will solve nothing, the patient may very well go
home, and some other patient will take that bed,
and behave similarly. Nothing is gained by that.
One thing that one can do in the hospital to
make the patient’s stay more productive for him
is to realize that it is difficult for him to be
separated from his usual personal supports. How
does one learn of these difficulties? Beginning at
the time of diagnosis, an attempt should be made
to find out from the patient exactly how he feels
about being away from his family for the first
time — or for so long — from friends and from his
work satisfactions. In other words, let the pa-
tient express how he feels about his isolation.
I hen discuss with him the pros and cons of
“should I go back or should I stay here ?” Let '
him discuss this freely and he will be helped to1
come to the conclusion: “if I want to live, I’d
better stay here under treatment.” But he may
have to go through this entire process.
Another major point of importance during the
hospital stay has to do with the enforced inactivity
of bed rest. Most of us have no idea how hard
it is to reduce our activities to the level the doc-
tors characterize as absolute bed rest. Most of
us have no conception whatever of what bed rest
involves. Doctors and nurses themselves are ex-
traordinarily poor patients in this respect. This
is well known in any hospital where doctors have
been patients.
What happens when a patient who is really able
to be active is told to be completely inactive? He
often becomes extremely restless and hyperki-
netic. As they say in the army, he does “ten miles
a day in his sack.” What does the doctor gain by
this? Nothing. If you will measure such a pa-
tient’s cardiac activity, respiratory activity, and
other kinds of nervous system activity, you will
find that he is probably no less active than if
you permitted him certain standardized kinds of
co-ordinated muscular activity which he could
easily do.
It is very common that when a patient's ac-
tivity is reduced below a level he can stand easily,
he becomes preoccupied with old thoughts, old
fears, anxieties over things long past. He will re-
call evil things that he did in the past which have
never bothered him before. Such thoughts may
be of events of -five, ten, or fifteen years ago.
Suddenly now they come to the surface and he is
constantly obsessed by them. Such a patient often
becomes extremely anxious about dying, fearing
that his disease is about to kill him. He may have
exaggerated fears in relation to the demonstrable
stage of his tuberculosis. Such exaggerated fears
may occur in any kind of disease, just by making
678
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EMOTIONAL PROBLEMS— SASLOW
. man inactive. Inactive patients tend to become
rery hypochondriacal, noting every kind of sensa-
ion in their bodies and wondering if these symp-
oms indicate they are getting worse. They be-
:ome increasingly skilled at observing their sen-
,ations, since by the doctor s orders, they have
lothing else to do. They ask for remedies foi
hese various sensations to such an extent that the
loctors characterize them as demanding, whining,
:omplaining. All this talk with doctors and nurses
ibout symptoms, real or imagined, contradicts the
mrpose of bed rest, and they are being just about
is active, it seems to me, as though they were per-
nitted some activity. The patient soon becomes
irejudiced against the doctor because of his at-
itude toward these reported symptoms. It is im-
jortant that the doctors recognize that while these
symptoms are not bona-fide in the sense that they
:an be treated with medicine, they are significant.
Because the doctor is in a position not to accede
:o the demands of the patient, the patient gets
nad at the doctor. He talks against the doctor
:o him or to other people about him. He usually
:alks a lot and in a loud voice and again he isn’t
getting bed rest.
In tuberculosis hospitals, when the routine
x-ray period comes around, say every month,
some of the patients who take inactivity hard, tend
to have a fever the night before x-rays, x-ray
fever.” Or, they may develop sudden chest pain.
Their temperatures actually may rise a little.
There is known to be increased instability of the
temperature regulating mechanism when people
are upset.
Again, the attempts to maintain bed rest may
be interfered with by bad news from home. A
person who is doing as well as might be expected
suddenly becomes hyperkinetic on receiving a
letter about some family problem.
The sex drive is also a problem for patients
who are kept inactive. The majority of tubercu-
losis patients, until recently, when the age range
has been going up, have been in the younger age
group. They have not worked out their sexual
life in marriage. They are young and vigorous.
They find themselves deprived of all muscular
activity, social life, emotional life, and sexual
life, and they tend to experience difficulties with
sexual fantasy, masturbation and the like, again
contradicting the purpose of bed rest.
Thus, it seems to me, that the whole problem of
bed rest needs more reasonable handling. One
can determine to what level a patient’s inactivity
can be reduced. Surprising discoveries can be
made by asking simple questions. There are pa-
tients who will report that as far back as anybody
has ever told them about, from the earliest days
of childhood, they never sat still. You can’t ex-
pect such a patient to lie down for a year and not
move. There are patients who never had a nap
at any age in their lives for more than a couple of
minutes, and so on. It is, therefore, necessary to
find out what the capacity for inactivity is for
the individual patient.
It might be more effective to permit certain
kinds of muscular activity, such as sitting up in
bed for meals, getting out of bed into a chair
regularly three times a day, or bathroom privileges
once or twice a day. The patient could thus be
permitted to discharge a considerable amount of
muscular energy, which discharge might enable
him to be inactive for most of the day. Occupa-
tional therapy in bed is also helpful. Combina-
tions of such measures would actually achieve the
kind of results doctors aim at, and believe they
are getting, but which often are not really being
obtained.
The patient needs special help and understand-
ing when there is necessity for surgical treatment.
He must be told that the relatively simple meas-
ures which it had been hoped would help him are
inadequate and that something more drastic must
be done. Again the physicians behave somewhat
as they usually do when they communicate the
diagnosis. They tend to promise magical relief as
a result of treatment such as thoracoplasty and
collapse therapy. They tend to pay no attention
to the patient’s concern about the results of some
of these operations. They have no idea what the
patient understands when they announce that he
needs an operation. They don’t bother to find
out what the term “a collapsed lung” means to a
patient. Some patients apparently believe that the
doctor will literally crush their lung, that they will
lose one lung completely.
In general, the surgeon should follow the same
procedure previously outlined for the physician in
communicating the diagnosis. When he announces
the news, he should allow for a type of emotional
blackout and allow time for the overt expression
of whatever reaction is occurring. He can then
discuss the possible alternatives to the operation.
This is a type of psychological preparation for
operation which every surgeon ought to know
679
July, 1950
EMOTIONAL PROBLEMS— SASLOW
how to do in three or four minutes. Because the
patient knows the surgeon is going to have his
life in his hands, he is in a strategic position to
do this job well — a position far superior to that
of the person whom the surgeon regards as better
qualified, the psychiatrist. The psychiatrist does
not have this strategic relationship with the pa-
tient. The psychiatrist, atempting to do this job,
after the person already has become very upset,
needs as much as ten to twenty minutes more
time if the interview is to be successful. Some-
times he is never successful. The patient may
leave the hospital through his fear of the opera-
tion.
Now, when the time to discharge a patient
comes, one of the problems to consider is that the
patient may have adjusted too well to inactivity.
He may have been impressed with the dangers of
activity. He has become aware of the tiniest un-
usual sensation, when he moves around in bed,
and feels guilty because he is violating bed rest
rules. So, when we say, bed rest is over, you
can get up and move around, he may experience
a return of these sensations, and is constantly
fearful of a relapse. It is not uncommon, here
and there, to meet patients who have been dis-
charged from the sanatorium with arrested tuber-
culosis and who, fifteen or twenty years later, are
living as though they still had active tuberculosis.
I hey are unable to make a move, without expe-
riencing various disagreeable sensations, rapid
heart, coughing, sweating and so on, which they
mistakenly attribute to tuberculosis. These are
properly to be attributed to poor physical condi-
tion due to prolonged inactivity. Such people re-
main invalids for the rest of their lives. We have
conditioned them too well to inactivity. There is
a special hazard at this time as they go from in-
activity, which was necessary for their treatment,
to resume normal life. When, under supervision,
we increase their activity level up to the point
where they can stand these unusual sensations
without fear, people who have been invalids for
some time can be rehabilitated. Physical therapists
can do this alone if the patient understands his
own reactions and wants to become stronger.
There is the question of what the patient shall
do when he leaves the hospital — he may have to
look about for a different kind of occupation. It
is necessary to understand how important this
may be to a patient. One of the problems is how
to prepare a person for an entirely different occu-
pation under physical limitations relatively new to
him. Many of these patients need, in addition to
help on becoming more active, special vocational
training, vocational hardening for their old occu-
pations, or vocational retraining and hardening
until they reach their maximum work capacity.
Then they are better prepared to leave the hos-
pital. There are some patients who will always
do less than the work they could do, fearful that
if they do too much they will become ill again.
There are patients who will overdo at this stage,
in an effort to prove to everybody that they are
going to be successful at the new job and as a
well person. There are patients who are so upset
as they face the problems of active, normal Hfe,
that they experience many symptoms such as fa-
tigue, slight temperature rise, and sweating. Of-
ten it is obvious that these symptoms have noth-
ing to do with tuberculosis. Sometimes it is not
so obvious because the body has an extraordinary
capacity to reactivate symptoms of a sickness un-
der new stresses. So it is not always clear what
these symptoms are anil often such patients are
suspected of actual relapse.
Many of these people are actually afraid to re-
turn to normal life after being in the hospital for
a while. A University student realizes he is a year
or two behind his previous classmates. It may
be unpleasant to return. A man in business, real-
izing he has lost a year or two, may fear that he
may not be able to compete with others who had
no such setback. This may cause enough emo-
tional disturbance so that he doesn’t co-operate in
the process of rehabilitation. Again, the patient’s
difficulties should not be minimized. They can’t
be just labeled “oh, that’s just in your head.” Al-
though these reactions are psychological, they are
none the less real and must be considered care-
fully in the process of aiding the patient to be-
come a well and healthy person again. Again,
the method is the same : help the patient to ex-
press his difficulty fully. Encourage him to re-
veal exactly how he feels about it. Then, and
not until then, you can discuss effectively how to
face the real issues and help give him courage to
go ahead.
One vital point relating to discharge has to do
with relapse after discharge. When a patient who
has done pretty well under treatment returns to
the sanatorium after discharge as a relapsed case,
it is always worth while to find out what happened
in his life during the interval between discharge
680
Minnesota Medicine
EMOTIONAL PROBLEMS— SASLOW
and relapse. There may have been some special
difficulty when the person tried to work out his
life outside the hospital. That difficulty may have
been too great for him to master and he has re-
sponded to that difficulty by a loss of appetite,
insomnia, taking too much alcohol, staying away
from home or quarrels with his family. Any one
of a number of these things, when carried on, for
a number of weeks or months may have the end
result of depleting him physiologically and then
the relapse may occur. So it is always well to in-
vestigate how a person who has a relapse has
lived following his discharge with arrested tuber-
culosis.
There is one more variation of this general
problem of treating the sanatorium patient which
involves special consideration. I refer to the per-
son who has never thought he had tuberculosis,
who may have no symptoms at all but a test shows
something suspicious. The diagnosis is uncertain
but points to a possible tuberculous infiltrate.
How long should a doctor keep on having experts
do various kinds of tests before he says forget
about it, or sends the patient to the sanatorium ?
What happens to the patient without a definite
diagnosis of tuberculosis who goes to a sanator-
ium, stays there a year, and then is told he never
had the disease? The impact of such news after
undergoing treatment may be disastrous.
The problems which I have mentioned, which
seem so important for sustaining the co-operation
of the tuberculous patient with his medical ad-
visors, have aroused only the occasional interest of
medical personnel. By and large, there has not
been anything like the interest in this aspect of
chronic disease, including tuberculosis, which the
subject and the number of relapses warrant.
When proper attention is given to the emotional
problems of the chronically ill, astounding results
are observed. We already know from a few expe-
riences that when this sort of attention is given
to the patient as a person, discharges against med-
ical advice fall markedly below their previous rate.
In some VA hospitals where for two years, they
have tried to treat patients in this way by in-
creasing their social work staff, a 20 or 25 per cent
decrease was shown in the percentage of patients
who walk out of the hospital without receiving
maximum benefit.
In a report to which I have previously referred
— the November 5, 1948, U. S. Public Health
Reports, Tuberculosis Control Issue No. 33, we
have all the data to support us if we attempt to
carry out a program along these lines.
How to carry out such a program in a sanator-
ium is the next thing to discuss. First of all, there
won’t be enough psychiatrists in our life time to
do this job. They can’t be trained that fast. Many
psychiatrists aren’t interested in work of this
kind. But I am not certain that we need psychi-
atrists for most of this job. Actually, many other
personnel of the medical team have more influ-
ential contact with the patient than have the doc-
tors, so this is a problem for every member of the
medical team responsible for the care of a person
with chronic illness, such as tuberculosis. Every
person on such a team, from the attendants at the
hospital up, should understand some of these basic
principles about how to help people who must face
and are facing difficult situations. And if the
team really does understand these problems of
patients, and acts as a team, they can do much
toward their solution. Perhaps the best use of a
psychiatrist is as a member of this medical team
and not in an individual relationship with the pa-
tient— that is a real possibility. How could we
better use the help of one individual with the kind
of psychiatric skill which I have been describing
than by having him impart some of his “know
how” to those handling patients daily?
How can we get these skills more widely dis-
tributed? Various methods have been discussed.
One way which seems feasible — the VA way, is to
put more social workers on the hospital staff. We
can’t do that in every hospital; there just aren’t
enough social workers. Another way which seems
feasible would be to extend as far as possible the
knowledge of the especially interested psychia-
trists. They are the only ones the doctors would
listen to, if they would listen to anybody. They
won’t listen to a social worker or let a social work-
er run a medical staff conference in a tuberculosis
sanatorium, but they might permit a psychiatrist
to attend conferences as a consultant.
If we could then have one competent psychia-
trist in an area where this kind of program is
desired, the best way to use whatever time he had
available, I think, would be to have him come to
regular conferences of the staff weekly. The
doctors, social workers, occupational therapists,
recreational workers and school rehabilitation and
hospital counselors and attendants could then
study a single patient in detail and much could
be accomplished. The psychiatrist could rapidly
July, 1950
681
EMOTIONAL PROBLEMS— SASLOW
raise the level of understanding between staff and
patient. The result might well be a change in the
whole atmosphere of the hospital. We have seen
this happen a number of times with student nurses.
We have seen whole wards where there had been
conflict between patients and nurses (especially
when the nurses were beginners) become quite
harmonious places, with patients attending to their
proper routines and getting well. We have seen
the nurses much happier and understanding their
patients much better. I am sure this could be
done elsewhere just as well as in a general hos-
pital.
The VA recommendation as to how to solve this
kind of problem, based on their experience, is
very simple : a large increase in the number of
social workers and psychiatrists for all hospitals.
It is very easy to suggest this, but they can’t do
it any more easily than we can. I think we will
have to be more ingenious. We will have to find
other ways of raising the general level of skills of
the medical team in dealing with the patient. We
may even learn to make more skillful use of group
conferences of patients in various stages of the
disease and hospitalization.
Finally, I would like to say there is nothing
that I have said that is limited to tuberculosis.
Any chronic illness, even a personality illness like
a psychoneurosis or a psychosis that goes on for
years, improves if handled by exactly this same
method — sustained co-operation with the person
with whom one has a special kind of relationship
based upon sharing important experiences and
upon a belief in his competence. This seems to be
the chief weapon. More understanding and prac-
tice of this particular technique will solve many
problems of the chronically ill.
The use of this technique will be just as neces-
sary even in the years to come when tuberculosis
sanatoria may no longer be needed. Some of the
experts in the field of tuberculosis believe that
if streptomycin is reasonably successful as an anti-
biotic in treating tuberculosis, improved antibiotics
will be discovered and that within ten years or so
it is not impossible that tuberculosis will be treated
on an ambulant basis. The tubercle bacillus, how-
ever, is so tough chemically that it is unlikely that
treatment can be shortened, so again we will have
the problem of long cooperation with our ambulant
patients. This could be simpler than the hospital
situation, of course, but again long co-operation —
the ups and downs of treatment — the different
kinds of treatment that may be necessary if the
antibiotic alone doesn’t work. Again we have
the fundamental importance of building up the
kind of relationship between the patient and doc-
tor which makes sustained co-operation of the
patient easy and natural instead of handicappingly
difficult.
Summary
For the chronically ill person to utilize the best
knowledge and skill, he needs to be able to sus-
tain co-operation with medical personnel, often
under discouraging conditions. Principles found
effective in psychotherapeutic medicine can be
used to help him achieve this capacity for co-oper-
ation to a satisfactory degree.
TYPHOID FROM ABROAD
During the first five months of 1950, only five cases
of typhoid and paratyphoid fevers were reported to the
Minnesota Department of Health. The same number of
cases had been reported at the same time last year.
However, the total number of cases in the state in 1949
was twenty-one, with one death. Some of these cases
were brought into Minnesota by visitors from foreign
countries or by returning vacationers who had traveled
abroad, says Dr. C. B. Nelson, director of the Division
of Epidemiology, Minnesota Department of Health. In
1948, we had twenty-eight cases of typhoid and para-
typhoid fevers, with four deaths. This was a rather
high percentage of deaths, which usually occur in about
one out of ten cases.
With the vacation season now in full swing, Dr. Nel-
son advises inoculations for all persons going to areas
where typhoid fever is prevalent or sanitation is poor.
Several cases previously reported here have been brought
in from Mexico and Central America. France has also
been a source. A caravan of college students and faculty
people from Saint Paul went on a tour of Mexico in the
summer of 1947, and three of them later came down with
typhoid fever.
The health department also urges travelers going
abroad to obtain vaccination against smallpox and im-
munization against any other diseases they may encoun-
ter for which preventive measures are available. — Min-
nesota Health, June, 1950.
682
Minnesota Mebicine
HEMANGIOPERICYTOMA
An Unusual Extrarectal Tumor
HARRY E. BACON. M.D., F.A.C.S., LLOYD F. SHERMAN. M.D., and
WILLIAM N. CAMPBELL, MD.
Philadelphia, Pennsylvania
'Cj' XTRARECTAL tumors occur relatively in-
frequently. Yet, if one were to judge the
incidence of these tumors by the number of cases
reported and articles that are published in the lit-
erature relative to thier occurrence, a false im-
pression would surely be gained. Of 2,100 oper-
ative procedures performed on the anus, rectum,
and adjacent structure (excluding the colon prop-
er), in the department of proctology at Temple
University Hospital during the three-year period
from January 1, 1947 to January 1, 1950, only
three of these procedures were for the extirpa-
tion of primary extrarectal neoplasms.
Tumors which originate in or occur anterior to
the sacrum constitute the most frequently reported
extrarectal lesions. Here dermoids, teratomas,
and chordomas lead other neoplastic lesions in in-
cidence. The occurrence of ependymomas, neuro-
fibromas, fibrosarcomas, giant cell tumors, and
Ewings tumors have been reported.1’3,5
Neoplastic lesions may occur lateral to the
rectum in the ischioanal fossae. These lesions are
even more uncommon than those that occur in the
retrorectal area. Chavelet2 in 1908, was able to
collect only eleven reports of neoplasms in this
location. Sheddon6 in 1934, reported three cases
of sarcoma in the ischioanal region ; however,
from the descriptions given the specific types
could not be ascertained. Jackman4 in 1940, re-
ported four neoplasms in this area from the Mayo
Clinic files. They were a “lipomyxoma,” a lipoma,
fibroma, and a dermoid cyst.
Tumors may have their origins lateral to the
rectum in the supralevator or pelvirectal spaces.
However, this is probably the least common site
of all extrarectal tumors. Fibromas, neurofibro-
mas, neurilemomas, angiomas, and their malig-
nant counterparts are the usual types of tumors
found within this area.
It is the purpose of this paper to report the
occurrence of a tumor having the cytologic fea-
tures of a “hemangiopericytoma” in the pelvi-
rectal space. Until this time no other tumor of
From the Department of Proctology and the Department of
Patholopv, Temple University Hospital Medical School, Phila-
delphia, Pennsylvania.
this histologic description has been reported to
have occurred in this location. According to
Stout,7,8,9’10 who, with Murray in 1942, first called
attention to this lesion, approximately thirty-five
“hemangiopericytomas” have been recorded to
date in the literature. Tumors fitting the de-
scription of “hemangiopericytoma” may behave
in either a benign or malignant fashion. Stout
cited definite proof of malignancy with metastasis
in six of the thirty-five lesions that he reviewed,
while seven other tumors of the thirty-five showed
aggressive growth without metastasis. Many of
the other cases were followed inadequately af-
ter operation. In most instances it was not pos-
sible to distinguish between the benign and ma-
lignant tumors histologically.
It is only fair to state that much disagreement
exists about the exact nature of these neoplasms.
Whether they actually constitute a distinct entity
remains to be ascertained. Diagnosis rests en-
tirely on the histological finding of well formed
capillaries surrounded by a varying number of
ovoid or spindled tumor cells. Silver staining to
accentuate the connective tissue sheaths of the
capillaries is said to be of aid in diagnosis, but
any highly vascular undifferentiated mesenchymal
tumor might show similar feature.
Case Report
The patient (M.B.) is a white man, fifty-six years old,
a barber by trade, who presented himself to his family
physician in August 1949, because of a mild exacerba-
tion of bronchial asthma. The patient requested a com-
plete physical check up ; so the family physician, being
an astute practitioner, complied with the patient’s re-
quest and incidentally discovered an extrarectal tumor
mass. The patient was admitted to the proctologic
service of Temple University Hospital on October 12,
1949.
Further questioning disclosed a history of normal
bowel habits, with no history of bleeding or pain. He
had had no previous rectal or extrarectal complaints,
treatment, or surgical procedures. In fact there were
no symptoms whatsoever referable to the tumor mass.
His past history was not significant except for mild
bronchial asthma for eleven years prior to this admis-
sion.
Physical examination revealed a well developed, mod-
.Tuly, 1950
683
HEMANGIOPERICYTOMA— BACON ET AL
Fig. 1. Gross appearance of tumor.
erately obese white male, 5 feet 4 inchs tall, weighing
155 pounds. He was ambulatory and appeared to be
in good health. The chest was clear to ausculation.
Physical examination otherwise presented essentially nor-
mal findings, except for the rectum. Here, a digital
examination revealed the presence of a firm, discrete,
golfball sized mass lateral to the rectum in the left
pelvirectal* space. The lower margin of this mass was
located eight centimeters from the anal verge. The
mass was not mobile, and pressure did not cause any
unusual sensation of pain. The mucous membrane over
the lesion was freely movable. Proctoscopic examina-
tion revealed slight bulging of the rectal wall in the
region of the palpated mass. No intrinsic pathology
was noted in the rectum and sigmoid colon to 25 cen-
timeters on sigmoidoscopic examination.
Laboratory Findings : — Hemoglobin — 15.3 gins; red
blood count — 5,300,000 cmm. ; white blood count — 8,500
cmm. ; differential — within normal limits; urinalysis —
normal; blood urea nitrogen — 11 mgm/100 ml; serum
chlorides — 343 mgm/100 ml; total serum protein — 5.3
gms/100 ml; prothrombin concentration — 100 per cent
of normal.
X-Ray Findings. — Films of the lower abdomen and
pelvis showed no abnormalities. Chest roentgenogram
showed mild emphysema, but no other abnormality was
noted. A double contrast barium enema revealed no
evidence of any abnormality anywhere along the course
of the colon. However, the rectum did not seem to
possess its usual capaciousness. The rectal ampulla
did not appear as wide and as ballooned out as is nor-
mally seen, but no discrete filling defects were observed.
Operative Procedure. — A suspension of sulfathaladine
was administered orally for seven days and a solution
of streptomycin for 48 hours preoperatively. On October
19, 1949, the left pelvirectal space was explored. Under
spinal anesthetic of pontocaine (6 mgm.), dextrose (100
Fig. 2. Microscopic appearance of tumor X85 H. & E. stain.
mgm.), and neosynephrine (2 mgm.), the patient was
placed in jackknife position and the left ischiorectal
fossa was entered via a 10 centimeter curvilinear inci-
sion midway between the anal canal and the left ischial
tuberosity. The levator ani muscle was spread by a
long hemostat and retracted to expose the left pelvi-
rectal space. Here a firm, yet somewhat cystic mass,
approximately the size of a golfball, was palpated.
This mass was situated midway between the rectum
and the left sacroiliac joint. It was well encapsulated,
but rather firmly fixed in place by fibrous and areolar
tissue. The lesion was extirpated by combined sharp
and blunt dissection. The wound was then packed lightly
with iodoform gauze and left open. The postoperative
course was uneventful and the wound was completely
healed in two months.
Pathologic findings. —
' Gross Description — The specimen is a fairly well en-
capsulated tumor mass approximately 4 centimeters in
diameter. It is moderately firm. Cut surfaces present
occasional minute cystic areas, and a hemorrhagic ap-
pearance.
Microscopic Description — The tissue is extremely cel-
lular and composed of numerous oval and spindled cells
whose nuclei are relatively uniform in appearance. The
cells have a paucity of pink staining cytoplasm. These
tumor cells appear to surround numerous tiny capillary
channels. In some areas dilated vascular channels pre-
dominate. Here and there are pigment-laden macro-
phages. Silver stain reveals the tumor cells to be out-
side of the sheaths of the capillaries. Trichrome stain-
ing was not significant.
Comment
The slides on our specimen were sent by our path-
ologist (Dr. Peale) to Dr. A. Purdy Stout of Columbia
University who is Professor of Pathology. In his let-
ter of May 15 he states, “the silver impregnation slide
(Continued from Page 693)
684
Minnesota Medicine
CLINICAL OBSERVATIONS OF EXPERIMENTS OF NATURE
C. A. McKINLAY, M.D.
Minneapolis. Minnesota
HP HE practicing physician, although denied the
role of the scientist in following research, may,
if sufficiently curious, participate vicariously in
the experimental method. Every physician has
the opportunity to observe those experiments of
Nature that are set up by the influence of disease
of one system or organ upon another. Sir Wil-
liam Osier13 once said “As clinical observers we
study the experiments which Nature makes upon
our fellow creatures.”
The interpretation of the physiopathologic train
of events set in motion by such experiments of
Nature challenges the ingenuity of the clinical
observer. Because many of these sequences can-
not be duplicated in the animal laboratory, the
physician should be alert to the unique opportunity
for study of factors which may not only give re-
lief to the patient but which may give leads to the
investigator in the laboratory sciences who is
studying the nature of disease and searching for
etiologic and therapeutic agents. Witness the
years of careful clinical study by Hen$6h10 of
rheumatoid arthritis and his emphasis on its re-
mission during jaundice and pregnancy. This em-
phasis gave leads to Kendall,10 the biochemist, in
producing cortisone and other compounds which
have broadened our concepts of disease and its
treatment even before the mechanism of action of
such compounds upon the collagen and other
diseases has been clarified.
Furthermore, clinical analysis must precede the
use of laboratory procedures if the laboratories
are to be kept from creaking under their over-
load. Any analysis of cases reported is made
from clinical data personally observed. The cases
reported concern chiefly certain diseases of the
thyroid gland, the blood and kidneys as related to
the circulation, also to pulmonary infiltrations re-
lated to hypersensitivity.
Of particular interest to the internist and sur-
geon has been the relation of diseases of the thy-
roid to disturbances of the circulation. It may be
stated that the opportunities for early clinical ob-
servation and treatment of thyrocardiac disease
have tended to keep that disease a clinical rather
President’s address read in part before the Minnesota Path-
ological Society, at its meeting of April 18, 1950.
than a pathological entity. The thyroid has lent
itself to clinical study because of its accessibility
to physical examination, to surgical extirpation
and because apparently quantitative disturbances
of its function produce not only well-defined clin-
ical syndromes but also measurable metabolic
variations. Parry,8 in the first reported case of
hyperthyroidism observed in 1786, some fifty
years before ..Graves and Basedow, drew attention
to the relation between the thyroid and heart ; his
patient had cardiac insufficiency and probably
auricular fibrillation and angina pectoris.
Griswald and Keating9 in a recent study of 810
cases of hyperthyroidism found that 12.5 per
cent had thyrocardiac disease. Of those with
thyrocardiac disease, 52 per cent had coexisting
cardiovascular disease. Toxic nodular and hyper-
plastic glands had about equal dispersion in the
group of thyrocardiacs. Personal experience in-
dicates that nodular goiter of very moderate
toxicity is more likely to be overlooked and to
become a provocation of thyrocardiac disease.
No characteristic pathologic change in the myo-
cardium may be said to occur. Clawson5 found
only eleven thyroid deaths, one with myxedema,
in the 9,934 cardiac cases which comprised 19.9
per cent of 50,730 autopsies from the Department
of Pathology, University of Minnesota. Of in-
terest is the finding of Dearing6 and co-workers
that extensive degenerative changes occurred in
the myocardium of hyperthyroid animals which
received toxic doses of digitalis.
Ablation of the normal thyroid to alleviate
coronary insufficiency was reported in 1933 by
Blumgart3 and co-workers and performed by sur-
geons in this community. While having a rational
physiologic basis of reducing cardiac work, the
operation has fallen into desuetude to the best of
the writer’s knowledge, probably because it ac-
complished too little for too much surgery.
The place of the thyroid in the internal milieu
influencing all tissues of the body is especially
important as its behavior is related to the circu-
lation and the nervous system. From the physio-
logic standpoint it is commonly believed that the
extra burden due to acceleration of the circula-
July, 1950
685
EXPERIMENTS OF NATURE— McKINLAY
tion of blood and increased cardiac output for
oxygen transport leads to cardiac insufficiency
particularly in the presence of associated organic
heart disease. A conflicting opinion has been
expressed by Rasmussen16 who, on the basis of
careful animal experimentation, believes that the
chief deleterious effect of increased thyroid
hormone is not the creation of cardiac overwork,
but is the causation of a variation in cardiac
rhythm, that is, a functional heart disease, the
essential features of which are paroxysms of
tachycardia and auricular fibrillation, which leads
to failure. This observer believes that the power
of evoking paroxysms of sinus tachycardia is a
peculiar and characteristic property of the thyroid
hormone. Clinical experience also emphasizes
the baneful influence of arrhythmia, particularly
auricular fibrillation, upon the circulation. In
cases of hyperthyroidism with decompensation,
sustained auricular nbrillation was frequently
present. The slow heart of an animal deficient in
thyroid hormone or the rapid heart of the hyper-
thyroid individual has also been said to be due to
a series of metabolic events some of which may
be under hypothalamic regulation. Extrasystolic
arrhythmia has also been associated with the
stimulation of the posterior hypothalamus. To
digress, in hibernation, which simulates an exag-
gerated state of myxedema, the marmot, studied
by Benedict,2 had a heart rate of 4 to 6 per
minute; respiration varied from 1 in five minutes
to 1 per minute. Arrhythmia of the heart during
hibernation was noted which disappeared when
the minimal normal rate of about 80 beats per
minute was restored out of hibernation.
In cases of hyperthyroidism personally ob-
served, particularly those in the fifth decade and
beyond, auricular fibrillation or flutter has fre-
quently supervened at some time, usually par-
oxysmally and when of short duration tended to
disappear after thyroidectomy. Below forty years
of age, decompensation has been infrequent. It is
suggested that degenerative diseases are factors
which indeed often determine the effects of the
circulatory overwork factor of hyperthyroidism
and also the pathologic anatomy of the heart. The
frequency with which cardiac compensation has
been maintained for years after thyroidectomy in
thyrocardiac disease is noteworthy and speaks for
early functional disturbance rather than for my-
ocardial damage at that stage.
For illustration, Mrs. C., aged eighty, was in 1
cardiac decompensation of brief duration with
auricular fibrillation associated with hypertensive'
cardiac disease. Twenty-four years previously at
the age of fifty-six, cardiac decompensation had
occurred in association with exophthalmic goiter.
Following thyroidectomy and recession of the !
hypermetabolism, cardiac compensation was re-
stored and maintained through the years until
the present episode of failure following an upper
respiratory infection.
Following thyroidectomy in cases observed over
a twenty-year period or longer, some of the in-
dividuals with the best health records have been
those in whom the surgically induced hypometab-
olism has required replacement therapy with thy-
roid extract to maintain normal energy levels
and basal metabolism. Miss I. M., aged sixty-one,
observed for twenty-three years following thyroid-
ectomy, has been well maintained on replacement
therapy with grains ii to iii of thyroid extract
daily and has had normal circulation. Incidental- 1
ly, the removal of hyperfunctioning adenomatous
goiter when an interloper in, or associated with,
essential hypertension, has not materially influ-
enced the course of the latter. Not referred to in i
this connection is the slight systolic hypertension
and increased pulse pressure noted not infrequent-
ly in hyperthyroidism.
In contrast to the usual responsiveness to thy-
roidectomy is the experience of the nineteen-year-
old girl with recurrent hyperthyroidism and
severe exophthalmos, whose three operative scars
attest to the inadequacy of that procedure. Radio-
active iodine, given under careful direction else-
where, was likewise ineffective. Reports of suc-
cessful therapy with radio-active iodine in a con-
siderable number of cases of diffuse hyperthy-
roidism suggest that such treatment may be the
one of choice. The influence first of hyperthy-
roidism before thyroidectomy and later of post-
operative hypothyroidism in precipitating decom-
pensation has been observed and reported.14
Acute renal insufficiency related to disease of
other systems was strikingly illustrated in the
prechemotherapeutic era by the case of L. W.,
a young woman, who, working on research with a
virulent staphylococcus culture known to be a
high producer of exotoxin, became accidentally
infected following a skin scratch and had rapidly
developing lymphangitis, accelerated shock re-
686
Minnesota Medicine
EXPERIMENTS OF NATURE— McKINLAY
iction, extreme hypotension, and anoxia. Oligu-
-ia, anuria, and death occurred within hours,
rhe hypoxia on the basis of overwhelming toxe-
nia and resultant acute renal failure appeared to
)e the mechanism of death.
Mrs. J. N. appeared at the hospital with ure-
nia and moderate azotemia and right pleural ef-
:usion. The blood showed increased serum pro-
eins, reversal of albumin-globulin ratio, high
sedimentation rate and rouleaux formation. The
Indings suggested consideration of multiple mye-
oma. This diagnosis was established by the find-
ng of myeloma cells in the sternal biopsy mate-
-ial by the pathologist. Recovery ensued from
he uremia and there was restoration of normal
-enal function although two years later death oc-
;urred with anemia and circulatory failure as
prominent features. Uremia was the initial mani-
'estation of disease. Bell1 has stated in his text
hat renal insufficiency is frequently observed in
idvanced stages of multiple myeloma and that
ieath may result from uremia. What factor was
iccountable for reversal of the uremia, which was
;he initial manifestation of the disease, remains
.rnknown.
The following sequence of disease occurred in
:he case of J. H., a male aged thirty-six, married,
,vho first appeared with erythema nodosum which
occurred ten days after an attack of acute ton-
sillitis, and is deemed worthy of notation. About
}ne year later diabetes mellitus developed and was
recognized after a six weeks’ period of weight
oss. Appropriate insulin therapy was given.
Approximately one year later myxedema with
expressionless facies and skin changes developed
(BMR minus 22 per cent) and responded to
;hyroid replacement therapy within three months.
During the period of myxedema, clinical evidence
of diabetes disappeared except for transient gly-
cosuria during an upper respiratory infection.
Seven months later acute infectious hepatitis
developed and subsided. Diabetes mellitus reap-
peared, requiring 20 to 24 units of insulin daily
for control. The trigger mechanism of acute
pharyngitis appeared to precipitate erythema no-
dosum. Whether that mechanism was related to
later sequences of diseases is speculative.
Apparently in this case imbalance between the
activity of the pancreatic beta cells in the produc-
tion of insulin on the one hand and of the anti-
insulin or hyperglycemic factors of the thyroid,
July, 1950
pituitary, adrenals, liver and diet on the other,
mediated in part through the parasympathetic and
sympathetic systems respectively, accounted for
the development and temporary recession of the
diabetes mellitus on the one hand and of the
development and subsidence of myxedema on the
other.
Physiologic adaptability of the body to anemia
has presented a great variety of intersystem ef-
fects dependent, to a great degree, upon the extent
and rate of development. H. L., aged forty-three,
a housewife, consulted a throat specialist because
of difficulty in swallowing. Other complaints of
headaches, paresthesias in the extremities, and
weakness appeared to be of secondary importance
although first noted years previously. The throat
examination was negative and further investiga-
tion was advised and revealed quite profound
anemia ( hemoglobin 6.3 grams, red cells 3,200,-
000), primary hypochromic anemia (hematologic
study by Dr. H. Downey). Due to the insidious
development of the anemia, the gradual physiologic
adaptations were adequate enough until the primi-
tive act of swallowing was interfered with. Re-
covery followed iron therapy. There was no
spasm in the upper esophagus and the Plummer-
Vinson syndrome was not suggested.
C. S., a male, aged sixty, a cook, neglected the
treatment of pernicious anemia for ten months,
entered the hospital complaining of cough, pain in
the chest and weakness. The typical pallor had
its counterpart in a hemoglobin of 4.5 grams, with
1,050,000 red cells per c.mm. When the anoxia
conditioned by the low hemoglobin was success-
fully combated by the parenteral use of liver ex-
tract, the angina and cardiac decompensation tend-
ed to disappear while under hospitalization as the
hemoglobin reached 11.2 grams. Electrocardio-
graphic change supported the diagnosis of coro-
nary insufficiency which became clinically manifest
due to high grade anemia and anoxia of the myo-
cardium.
Hypersensitivity of tissues has no more strik-
ing manifestation than that caused when the lung
acts as a shock organ with huge infiltrations, pre-
sumably eosinophilic, with blood eosinophilia due
to one of numerous chemical, infectious and/or
foreign protein antigenic agents, the syndrome
first described by Loeffler.12 In a case reported by
Dr. Ellis and myself7 in 1941, the exciting agent
was prontosil. In a second case, M. B., a farm
687
EXPERIMENTS OF NATURE— McKINLAY
housewife, aged thirty-six, similar infiltrations
persisted for three years with blood and sputum
eosinophilia. No provocative agent was found.
A third case, recently under observation, is being
reported elsewhere.
In the discussion of a group of cases in which
multiple etiological factors may have elicited the
same change, reference is made to the general
adaptation syndrome emphasized by Selye,17 with
the stages of alarm reaction, the stage of resistance
and the stage of exhaustion. If, as he states,
conditions such as nephritis, rheumatic fever and
acute peptic ulcer in some instance, occurred as the
result of acute infection and in others could be
traced to exposure to intense cold, an intoxication,
or an emotional stimulus, the difficulty of inter-
preting the comparatively uniform response to
diverse agents is no longer insuperable if it is
assumed that certain lesions are produced by the
response of the body to damage as such, rather
than to one specific pathogenic agent. Hume11
recently has presented evidence that the anterior
hypothalamus constitutes an important link in the
reaction of the body to stress. Included in the
findings was the preparation of an effective ex-
tract of the hypothalamus which suggests a hor-
monal mechanism which, when activated in stress,
is capable of causing increased secretion of
ACTH.
Correlating the work of Cannon4 on homeosta-
sis, and the work of Selye17 on the general resist-
ance syndrome, Williams18 suggests a phylogenetic
concept which appears to make sense and which
presents allergy not as an unprecedented kind of
injurious mechanism which the animal organism
has developed and preserved but rather as a
gradual growth from the unicellular to the multi-
cellular stage. Following the lead of Cannon4
and as stated bv Petersen16 and Milliken,15 the au-
tonomic system, viewed as consisting of the semi-
permeable membranes of the individual cells, the
hormonal system and the autonomic nervous sys-
tem, is considered to be the physiologic mecha-
nism by which the organism adjusts itself to all
changes in its external and internal environment.
The case reports cited are an incomplete glimpse
of the parade of the intersystem relationships
which present themselves to the practicing physi-
cian. On the one hand, the clinician may be struck
with the constancy, for instance, of the funda-
mental nature of the inflammatory reaction.
whether called forth by viral or bacterial agent
as in chickenpox and as in typhoid fever, respec l
tively. On the other hand, host variation to this 01 1
that disease will always present multiple combina
tions of possibilities, conditioned by factors, be
ginning with heredity, that influence physiopatho
logic response.
With the thought that each case represents in
some way a new experience and with the hope that
as we continue to study medicine throughout our
lives we may be more and more able to distinguish
the significant from the unimportant, I wish to
put in the mouth of the clinician, the words of
Ulysses by Alfred Lord Tennyson,
“I am a part of all that I have met ;
Yet all experience is an arch wherethro’
gleams that untravell’d world, whose
margin fades
For ever and for ever when I move.”
References
1. Bell, E. T. : Textbook of Pathology. Philadelphia: Lea and
Febiger, 1947.
2. Benedict, Francis G., and Lee, Robert C. : Hibernation and
Marmot Physiology. Carnegie Institute of Washington pub-
lication No. 497. Washington, D. C. : The Institute.
3. Blumgart, H. L. ; Riseman, J. E. F. ; Davis, D., and Berlin.
D. D. : Therapeutic effect of total abiation of normal thyroid
on congestive heart failure and angina pectoris; early results
in various types of cardiovascular disease and coincident
pathologic states without clinical or pathologic evidence of
thyroid toxicity. Arch. Int. Med., 52:165-225, (Aug.) 1933.
4. Cannon, W. B.: The Wisdom of the Body. New York: W.
W. Norton and Company, Inc., 1932.
5. Clawson, B. J.: Incidence of types of cardiac deaths in
50,730 autopsies. Journal-Lancet, 70:15-17, (Jan.) 1950.
6. Dearing, William H.; Barnes, Arlie R., and Essex, Hiram
E. : Myocardial lesions produced by digitalis in the presence
of hyperthyroidism: an experimental study. Circulation, 1:
394-403, (March) 1950.
7. Ellis, Ralph V., and McKinlay, C. A.: Allergic pneumonia.
J. Lab. & Clin. Med., 26:1427-1432, (June) 1941.
8. Ginsburg, A. M. : The historical development of the present
conception of cardiac conditions in exophthalmic goiter. Ann
Int. Med., 5:505-517, (Oct.) 1931.
9. Griswold, Dwight, and Keating, John H.. Jr.: Cardiac dys-
function in hyperthyroidism: a study of 810 cases. Am.
Heart J., 38:813-822, (Dec.) 1949.
10. Hench, Philip S. ; Kendall, Edward C. ; Slocumb, Charles H.,
and Polley, Howard F. : The effect of a hormone of the
adrenal cortex ( 1 7-hydroxy- 1 1-dehydrocorticosterone : com-
pound E) and of pituitary adrenocorticotropic hormone on
rheumatoid arthritis; preliminary report. Proc. Staff Meet.,
Mayo Clin., 24:181-197, (April 13) 1949.
11. Hume, D. M. : The role of the hypothalamus in the
pituitary-adrenal cortical response to stress. T. Clin. Invest.,
28:790, 1949.
12. Loeffler, W. : Zur Differential-Diagnose der Lugeninfiltrierun-
gen t)ber fliichtige Succedaninfiltrate (mit Eosinophilie).
Beit. z. Klin, d, Tuberk., 79:368, 1932.
13. Quoted by McQuarrie, Irvine: The Experiments of Nature
and Other Essays. Lawrence, Kansas, University Extension
Division, University of Kansas, 1944.
14. Myers, J. Arthur, and McKinlay, C. A., eds.: The Chest
and the Heart. Vol. 2. Springfield, III.: Charles C
Thomas, 1948.
15. Petersen, W. F., and Milliken, Margaret E. : The Patient
and the Weather. Vol. 2. Ann Arbor, Mich.: Edwards
Bros., Inc., 1934.
16. Rasmussen, H. : Influence of the thyroid hormone on heart
and circulation. Acta med. Scandmav., (Suppl.), 115:1,
1941.
17. Selye, Hans: The general adaptation syndrome and the dis-
eases of adaptation. Practitioner, 163:393-405, (Nov.) 1949.
18. Williams, Henry L. . A phylogenetic concept of allergy.
Proc. Staff Meet,, Mayo Clin., 24:516-524, (Sept. 28) 1949.
688
Minnesota Medicine
TUBERCULOSIS IN SELECTEES DISQUALIFIED FOR THE ARMY
1942-1945
The Record in Minnesota
WALTER I. MARCLEY. M.D.
Minneapolis, Minnesota
THE Selective Training and Service Act, which
established the Selective Service System
throughout the country, was passed by Congress
in September, 1940. On October 16 the first
draftees in Minnesota were registered and were
subject to examination by the physicians of the
local boards.
Previous to January 1, 1942, the local board
examiner gave the registrant a complete physical
examination (a roentgenogram of the chest was
not made), and upon the findings of the examiner
the board was authorized to disqualify the regis-
trant for military service, or if he was considered
by the examiner to be qualified for service, he was
sent to the Induction Station for induction. At
the Induction Station he was given another phys-
ical examination by the Army, including a 4 x 10
inch stereoscopic photofluorographic roentgeno-
gram of the chest and a 14 x 17 inch roentgeno-
gram as indicated.
General J. E. Nelson, former state director,
Minnesota Selective Service System, refers to this
procedure in a personal communication as follows :
“This double examination created many problems,
due to the fact that registrants, having been ex-
amined by their local board examiners and found
qualified, expected to be accepted by the Army,
and many of them, upon examination at the In-
duction Station, were found not physically quali-
fied and were, therefore, returned to their homes
as rejected.”
Beginning January 1, 1942, the examination of
the local board examiner was limited to an in-
spection of the registrant, and upon the finding
of any obvious physical defect, the board was au-
thorized to disqualify him. If the registrant ap-
peared to be without physical defect, he was sent
to the Induction Station where he was given a
complete examination.
However, the Federal Act authorized the local
board to defer from service at any time certain
registrants, as expressed in the Act, “whose em-
ployment in industry, agriculture, or other occu-
pation or employment, or whose activity in other
Dr. Marcley is Consultant in Tuberculosis, Minnesota Depart-
ment of Health.
endeavors is found to be necessary to the main-
tenance of the national health, safety or interest.”
Early in 1942 arrangements were completed for
the reporting by the Army Induction Station of
all Minnesota men examined and disqualified be-
cause of tuberculosis. The reports and also the
chest roentgenograms made in the examinations
were sent to the Division of Preventable Diseases,
Minnesota Department of Health. These reports
were received promptly day by day following the
examinations. Among the first reports received
were those of fourteen men examined in 1940
and 1941.
Dr. Leo G. Rigler, professor and chief of the
Department of Radiology, University of Minne-
sota, was very much interested in the follow-up
problem and volnteered to interpret the roentgen-
ograms. The first reports were received March
8, 1942. From that day, and continuing through
1945, Dr. Rigler gave, without compensation, this
most valuable professional service.
With the passage of the Selective Training
and Service Act, the standards of physical exam-
ination as given in the War Department’s Mobili-
zation Regulations became effective.
The following specifications are taken from
the Army Standards of Physical Examination
dated August 31, 1940:
“The chest examination will include the usual method
of physical diagnosis supplemented when indicated by
radiographic and laboratory studies.”
Listed as “non-acceptable”
Lupus vulgaris.
Tuberculosis either active or healed of any portion of
the vertebral column, of cervical glands, of ribs or other
parts of the chest wall, of a bone or joint.
Fibrinous or serofibrinous tuberculous pleurisy and
pleurisy with effusion of unknown origin.
Tuberculosis of the lungs or tracheobronchial lymph
nodes except as defined as follows :
Arrested pulmonary tuberculosis consisting of lesions
appearing in x-ray examination as small apical scars,
small calcified nodules or localized fibrous strands, in no
case exceeding minimal extent as defined in (he classifi-
cation of the National Tuberculosis Association, and
when, in addition, in the opinion of the examining physi-
cian, this lesion is not likely to be reactivated under con-
ditions of military service.
July, 1950
689
TUBERCULOSIS IN SELECTEES— MARCLEY
In later issues of the Army Standards of Physi-
cal Examination, reference is made only to tuber-
culosis of the lungs or tracheobronchial lymph
nodes. In the issue of October IS, 1942, there
are specified arbitrary limits in the size and num-
ber of calcified lesions that would be acceptable ;
and in the issue of April, 1944, there appears this
general statement descriptive of an acceptable con-
dition : “Calcified residuals of primary tubercu-
losis in the pulmonary parenchyma or hilum lymph
nodes, provided the size, number and character of
such lesions are not such as to suggest the pos-
sibility of reactivation.”
The age limits acceptable for the armed serv-
ices were changed from time to time, but the
lower limit (twenty-one years in the original Act)
remained constant until November 16, 1942, when
it became eighteen years, and this continued
through 1945. The upper age limit varied between
twenty-five and thirty-seven years except that
forty-five was the limit during nine months of
1942, and forty-four was the limit for almost one
month of the same year.
In March, 1943, the Governor of Minnesota
appointed the following named physicians as mem-
bers of a “Tuberculosis Review Committee, Min-
nesota Selective Service System” :
J. Richards Aurelius, radiologist, Saint Paul,
clinical assistant professor of radiology ; Malcolm
P>. Hanson, radiologist, Minneapolis, clinical as-
sistant professor of radiology; Everett K. Geer,
Saint Paul, clinical assistant professor of medi-
cine; Thomas Lowry, Minneapolis, clinical asso-
ciate professor of medicine; Leo G. Rigler, pro-
fessor and head of the Department of Radiology
— all of the University of Minnesota — and the
writer, who is greatly indebted to the other mem-
bers for their helpful suggestions in our follow-
up activities and in the preparation of this report.
From March 8, 1942, to December 31, 1945,
the Army Induction Station reported 1,758 reg-
istrants examined for the Armed Services and dis-
qualified temporarily or permanently because of
tuberculosis (including ten “suspected tubercu-
losis”). This number is made up of the follow-
ing groups: 520 previously reported to the Min-
nesota Department of Health as cases of tubercu-
losis, 983 “ new cases" permanently disqualified
(sixty-three were non-residents), and 255 disqual-
ified temporarily (deferred) and to be re-exam-
ined in six months.
Of the deferred group, seventy-five were later
re-examined and accepted for service and fifty !
were re-examined and permanently disqualified.
The remaining 130 (over 80 per cent were ex-
amined in 1944 and 1945) were not re-examined
because of age or occupation.
The number permanently disqualified — 520
known cases, 983 “new cases,” and fifty perma-
nently disqualified by re-examination, total 1,553
— was 0.52 per cent of the total number of reg-
istrants examined during this period, estimated as
300,000.
Purvine and Erickson6 reported in February,
1946, that of 117,598 men examined for service in
Oregon, 0.8 per cent were disqualified as “possible
pulmonary cases.” Plunkett5 has reported that of
the men examined from November 25, 1940, to
March 14, 1941, in Albany, Syracuse and Buffalo,
New York, 0.9 per cent were disqualified because
of "roentgen evidence of tuberculosis.” Verstand-
ing7 has reported the findings in 100,000 photo-
roentgenograms in Connecticut as reinfection or
primary tuberculosis in 0.67 per cent. Hyde and
Sacks2 have stated “of selectees examined at Bos-
ton Armed Forces Induction Station from Decem-
ber, 1940, to early in 1943, 0.9 per cent were found
by x-ray examination to have pulmonary tuber-
culosis.” Wile8 reports that in 1941, of the men
examined in the United States, 0.57 per cent were
rejected because of tuberculosis; and Karpenos3
has given the rejection rate for the entire country
for 1945 as 0.71 per cent. Adamson1 in 1945
wrote, “One and one-half million prospective
members of the forces have been x-rayed and
examined for tuberculosis in Canada,” and that
1 per cent were found to have pulmonary tuber-
culosis.
Long4 reviews in full the experience with refer-
ence to tuberculosis in World War II, and, in dis-
cussing the problems met by the examiners at the
Army Induction Stations, he concludes : “But it
is a fair estimate that 90 per cent of the signifi-
cant lesions that should have been seen were dis-
covered.” Further on he states: “The cases of
tuberculosis that escaped detection at Induction
Stations were found in high proportion within a
relatively short time by the medical personnel of
army posts.”
This study is concerned only with the “new
cases,” 920 Minnesota residents disqualified by the
690
Minnesota Medicine
TUBERCULOSIS IN SELECTEES— MARCLEY
TABLE I. COMPARISON OF DIAGNOSIS AT INDUCTION STATION, INTERPRETATION OF ROENTGENOGRAM,
AND THE SUBSEQUENT DIAGNOSIS BY PRIVATE PHYSICIANS OR PUBLIC HEALTH OR SANATORIUM
CLINICS
Diagnosis at Induction Station— Pulmonary Tuberculosis, Reinfection Phase 864.
Interpretation of
Roentgenograms received
Section I
Section II
Subsequent Diagnosis by
Physicians*
No record of
subsequent
Diagnosis
Reinfection
phase
Primary
phase
Other lung
pathology
Negative
Total
Reinfection phase (631)
3 rimary phase (54)
Other lung pathology (98)
Negative (14)
492
5
33
1
14
24
5
?’
19
1
27
7
20
7
542
37
77
9
89
17
21
5
Total (797)
Roentgenograms not received (67 )
531
58
43
2
30
1
61
2
665
63
132
4
Grand Total (864)
589
45
31
63
728
136
♦Private physicians or Public Health or Sanatorium Clinics.
TABLE II. COMPARISON OF DIAGNOSIS AT INDUCTION STATION, INTERPRETATION OF ROENTGENOGRAM,
AND THE SUBSEQUENT DIAGNOSIS BY PRIVATE PHYSICIANS OR PUBLIC HEALTH OR SANATORIUM
CLINICS
Diagnosis at Induction Station— Pulmonary Tuberculosis, Primary Phase 91
Interpretation of
Roentgenograms received
Section I
Section II
Subsequent Diagnosis by Physicians*
No record of
subsequent
diagnosis
Reinfection
phase
Primary
phase
Other lung
pathology
Negative
Total
Reinfection phase (8)
Primary phase (69)
Other lung pathology (7)
Negative (3)
2
1
34
1
1
1
3
3
1
2
5
39
3
2
3
30
4
1
Total (87)
Roentgenograms not received (4)
3
35
3
2
9
49
3
38
1
Grand Total (91)
3
38
2
9
52
39
♦Private physicians or Public Health or Sanatorium Clinics.
first examination and fifty by re-examination —
total 970.
The diagnosis at the Induction Station was :
Pulmonary tuberculosis, reinfection phase.... 864
Pulmonary tuberculosis, primary phase 91
Extrapulmonary tuberculosis 5
Suspected tuberculosis 10
970
The age groups were as follows :
18-19 years 52
20-24 years 135
25-29 years 212
30-34 years 242
35-39 years 211
40-44 years 83
45- years 19
No age given 16
Total 970
In Tables I and II, the diagnosis at the Induc-
tion Station, made after physical as well as x-ray
examination, is compared with the diagnosis based
on the interpretation of the roentgenograms of
the chest only, and with the subsequent diagnosis.
As shown in Table I, of the 864 cases of the
reinfection phase reported by the Induction Sta-
tion, there are no records of subsequent examina-
tions of 136; and of the remaining number (728),
roentgenograms of sixty-three were not received
for interpretation. It is - of interest to note to
what extent the diagnosis made by interpreta-
tion of roentgenograms only, and by subsequent
examinations are in agreement with the diagnosis
made at the Induction Station. This comparison
can be made in only 665 of the reinfection cases
as follows :
Interpretation of Roentgenograms
Reinfection phase in 81% )
Primary phase in 6% 99%
Other lung pathology in 12%
Negative in 1%
July, 1950
691
TUBERCULOSIS IN SELECTEES— MARCLEY
Subsequent Diagnosis
Reinfection phase in 80% )
Primary phase in 6% 91%
Other lung pathology in 5% j
Negative in 9%
Of the primary cases (ninety-one) reported by
the Induction Station, as may be seen in Table II
there are no records of subsequent examinations
in thirty-nine; and of the remaining number
(fifty-two), roentgenograms of three were not
received for interpretation. Comparison of diag-
nosis can be made in only forty-nine cases as fol-
lows :
Interpretation of Roentgenograms
Reinfection phase in 10% )
Primary phase in 80% J 96%
Other lung pathology in 6%
Negative in 4%
Subsequent Diagnosis
Reinfection phase in 6% ]
Primary phase in 72% J. 82%
Other lung pathology in 4% |
Negative in 18%
Our follow-up activities have been carried on
by correspondence, or other means of communi-
cation with physicians ; school, city, and county
public health nurses ; sanatorium or public health
clinics ; and with many of the 970 Minnesota res-
idents who were disqualified for military service.
Many have been checked up in the mass x-ray
surveys which are being conducted throughout the
state. Many have been interviewed by an epi-
demiologist of the Minnesota Department of
Health. Of those who have left the state and
whose new addresses have been known, reciprocal
notifications have been sent to the Health Depart-
ments of the other states.
Follow-up Record to June 30, 1949
Subsequent Diagnosis. — Reinfection phase: 592 (589
in Table I and 3 in Table ID-
276 admitted to sanatoria. Stage of disease on admis-
sion : minimal 61, moderately advanced 131, far advanced
77, pleurisy with effusion 3, admitted for observation 4.
30 died in sanatoria.
33 are in sanatoria June 30, 1949.
213 discharged, average period of treatment 13 months.
Status on discharge : 35 arrested, 60 apparently arrest-
ed, 48 quiescent, 37 improved, 24 unimproved, 2 others (1
admitted minimal discharged not tuberculosis, Loeffler’s
692
syndrome ; 1 admitted far advanced discharged not tuber-
culosis, probably sarcoidosis) ; 3 tuberculous pleurisy I
with effusion (2 discharged apparently arrested and 1
improved) ; 4 admitted for observation (final diagnosis I
reinfection phase stable 2, diagnosis not established 2).
122 are stable and working, 13 stable and working in
1947 or 1948, 5 stable not working, 8 continue treatment 1
at home, 2 have been accepted by the Army, 11 have
died (6 of tuberculosis), 30 have left the state (16 report
well and working), of 22 we have no record since dis- !
charge from sanatoria.
316 of the 592 reinfection cases were apparently not
thought to be in need of sanatorium treatment. 194
are well and working, 45 well and working in 1947 or
1948, 1 has been accepted by the Army, 9 have died
(4 of tuberculosis), 44 have left the state (16 report
well and working), of 23 we have no further record.
Subsequent Diagnosis. — Primary phase: 83 (45 in
Table I and 38 in Table ID-
66 are stable and working, 1 has died of coronary
occlusion, 3 have left the state (1 is in a sanatorium),
of 13 we have no further record.
Subsequent Diagnosis. — Other lung pathology: 23
(31 in Table I and 2 in Table ID-
12 definite diagnosis made : 2 atypical pneumonia, 1
bronchiectasis, 3 bronchitis, 1 cystic disease, 2 histo-
plasmosis, 1 Loeffler’s syndrome, 2 silicosis. 1 left the
state, died, and cause of death unknown.
20 diagnosis not established, no further record.
Subsequent Diagnosis. — Negative: 72 (63 in Table I
and 9 in Table II)-
Only 9 were negative by interpretation of roentgeno-
grams and of 2 others roentgenograms were not received
for interpretation.
51 are well and working, 7 well and working in 1947
or 1948, 1 has died (nephritis), 3 have left the state (1
reports well and working), of 10 we have no further
record.
No Record of Subsequent Diagnosis: 175 (136 in
Table I and 39 in Table II)-
Of this number (175), roentgenograms were not re-
ceived for interpretation in 5 cases.
Interpretation of Roentgenograms Only. — 170.
Reinfection phase: 92 (89 in Table I and 3 in Table
II)- 37 stable and working, 15 stable and working in
1947 or 1948, 4 have died (not of tuberculosis), 1 has
been accepted by the Army, 19 have left the state (2
have died of tuberculosis and 4 report well and work-
ing), of 16 we have no further record.
Primary phase: 47 (17 in Table I and 30 in Table
II)- 27 stable and working, 1 has died (not tubercu-
losis), 1 has been accepted for the Army, 6 have left
the state (1 reports well and working), of 12 we have
no further record.
Other lung pathology: 25 (21 in Table I and 4 in
Minnesota Medicine
TUBERCULOSIS IN SELECTEES— MARCLEY
Table II). 14 well and working, 5 have left the state,
of 6 we have no further record.
Negative: 6 (5 in Table I and 1 in Table II). All
are well and working.
Roentgenograms not received for interpretation : 5
(4 in Table I and 1 in Table II). 4 well and working,
of 1 we have no further record.
Extrapulmonary Tuberculosis: 5.
Of the 5 cases, 3 were of the spine, 1 of the leg and
1 of the ankle. We have no record of subsequent diag-
nosis. The disease in all of them is apparently stable.
Three report well and working.
Suspected Tuberculosis. — 10.
3 admitted to sanatoria for observation : 2 diagnosis
reinfection phase far advanced (1 died at the sanatorium,
1 in the sanatorium 1 year left the state following dis-
charge, no further record) ; 1 diagnosis moderately ad-
vanced, in sanatorium 14 months now well and working.
3 subsequent diagnosis : 1 cystic disease, 1 bronchiec-
tasis, 1 healed tuberculous pleurisy. All well and work-
ing.
1 subsequent diagnosis negative, no further record.
3 diagnosis not established, no further record.
Summary. June 30, 1949
In 659 the disease is stable or apparently stable.
528 stable and working.
80 stable and working in 1947 or 1948, no re-
cent record (many of these two groups
have continued in their former occupa-
tions).
8 stable, not working.
5 have been accepted by the Army.
38 have left the state and report well and
working.
70 have left the state, no record regarding work.
43 have died of tuberculosis (31 in sanatoria).
18 have died of other causes.
34 are in sanatoria.
8 continue treatment at home.
22 no record since discharge from sanatoria.
81 have had follow-up examinations, no further
record.
35 have not had follow-up examinations, no fur-
ther record.
Total 970 selectees disqualified for the Army because of
tuberculosis or suspected tuberculosis, 1942-
1945.
Acknowledgments
The writer wishes to record his appreciation of the
courtesies and ready assistance of General T. E. Nelson,
former director, and Col. L. E. Lilygren, present direc-
tor of the Minnesota Selective Service System, and their
associates, Col. R. A. Rossberg, Col. Richard B. Hull-
siek, and Col. Robert B. Radi. (The latter two officers
were successively chief of the Medical Division, Min-
nesota State Headquarters.) He is also deeply grateful
for the interest and the advice of Alan E. Treloar, pro-
fessor of biostatistics, University of Minnesota, in the
presentation of the statistical material.
Jui.y, 1950
References
1. Adamson, J. D.: Tuberculosis in World War II in the
Canadian Army. Dis. Chest, 11:272, (May-June) 1945.
2. Hyde, R. N., and Zacks, David: Socioeconomic aspects of
disease; community study of pulmonary tuberculosis in
selectees. New England J. Med., 229:811-817, (Nov. 25)
1943.
3. Karpinos, B. D.: Induction experience of 1943. Bull. U. S.
Army Med. Dept., 6:263-275, (Sept.) 1946.
4. Long, E. R. : The tuberculosis experience of the United
States Army in World War II. Am. Rev. Tuberc., 55:28-37,
(Jan.) 1947.
5. Plunkett, R. E. : Tuberculosis among army selective service
men in New York state. War Med., 1:611-623, (Sept.) 1941.
6. Purvine, R. E., and Erickson, H. M.: Results of four years
of tuberculosis screening by Selective Service and Armed
Forces Induction Stations. Northwest Med., 45:98-100, (Feb.)
1946.
7. Verstandig, C. C.: Pulmonary pathology in rejectees; sur-
vey of 100,000 photoroentgenograms performed at induction
station in Connecticut. Connecticut M. J., 10:103-105^
(Feb.) 1946.
8 Wile, J. S. : Public health and the draftees. M. Rec., 155:
335-339, (June) 1942.
HEMANGIOPERICYTOMA
(Continued from Page 684)
shows nicely the reticulum sheaths of the many blood
vessels so that I feel satisfied that the pattern is correct
for a hemangiopericytoma. Of the two Laidlaw impreg-
nations and the one Masson trichrome stain, it will be
noted that the last shows the absence of myofibrils in
the tumor cells, thus excluding the possibility that the
tumor cells are ordinary smooth muscle cells. The stain
is adequate for smooth muscle by observing the red-
dened myofibrils in the walls of the few veins present
in the tumor.”
Comment. — The tumor has the appearance of a highly
vascular, mesenchymal neoplasm. The problem presented
is whether the vessels are an integral part of the tumor,
or whether they represent merely the blood supply of the
neoplasm. Because of the cytologic appearance of the
tumor, and its striking vascularity, it would seem that
the neoplasm most probably is of an angiomatoid nature.
As such it may belong in the group of so-called “heman-
giopericytomas.” The course may be benign since the
tumor appears to have been completely removed, both
grossly and histopathologically.
Diagnosis — Vascular mesenchymal tumor, probably
“hemangiopericytoma.”
Summary. — An unusual extrarectal tumor is reported.
Bibliography
1. Brindley, G. J. : Sacral and presacral tumors. Ann. Surg.,
121:721, 1945.
2. Chavelet, Charles: Des tumeurs de la fosse ischiorectale.
Paris Theses, 1908-9 No. 296.
3. Gentil, F., and Coley, B. L. : Sacrococcygeal chordoma.
Ann. Surg., 127:432, 1948.
4. Jackman, R. J. : Tumors originating in the ischioanal fossa.
Am. J. Surg., 49:296, 1940.
5. Love,' J. G., and Moersch, F. P. : Sacrococcygeal teratoma in
the adult. Arch. Surg., 37:949, 1938.
6. Shedden, W. M. : Neoplasms originating in the ischiorectal
fossa with particular reference to sarcomata. New England
J. Med., 210:696, 1934.
7. Stout, A. P., and Murray, M. R. : Hemangiopericytoma — -
A vascular tumor featuring Zimmerman’s pericytes. Ann.
Surg., 116:28, 1942.
8. Stout, A. P. : Hemangiopericytoma — A study of twenty-five
cases. Cancer, 2:1027, 1949.
9. Stout, A. P., and Cassel, C. : Hemangiopericytoma of the
omentum. Surgery. 13:578. 19^3.
10. Warren, S., and Ackerman, L. V.: Hemangiopericytoma of
retroperitoneal space. J. Missouri M. A., 45:380, 1948.
693
AN UNUSUAL TYPE OF PULMONARY DISEASE INVOLVING SIX MEMBERS
OF A FAMILY
L. H. RUTLEDGE, M.D., F.A.C.S.
Detroit Lakes, Minnesota
HPHIS UNUSUAL pulmonary disease in-
volved an entire family of six people of Scan-
dinavian ancestry. The father, J. P. L., aged
seventy-six, was a rather debilitated old man ;
Mrs. J. P. L., aged sixty-seven, the mother, was
a healthy, well-nourished, well-preserved wom-
an ; T. L., the older daughter, aged forty-one,
was a well-nourished, middle-aged spinster ; R. L.
aged thirty-one, the older son, was a husky, well-
built, physically rugged specimen ; D. L., aged
twenty-four, the younger son, was only slightly
less robust than his older brother ; and lastly
M. L., aged twenty-seven, the younger daugh-
ter, was a fine specimen of young womanhood.
All lived in a good, clean, roomy farm home in
rural Becker Countv, near Detroit Lakes, Min
nesota.
The father, J. P. L., was critically ill for a
long period of time. R. L., the older son, was
acutely ill for nearly two months, made a good
recovery, but still showed residual of the disease
in the radiograph of his lungs twenty-five months
after its inception. T. L., the older daughter,
had a prolonged illness requiring nearly complete
bed rest for over a year and developed some
very unpleasant nervous symptoms during con-
valescence. Mrs. J. P. L. was not very ill and
made a good recovery in a shorter length of
time. D. L., the younger son, was ill a short
time, was not hospitalized, and would not have
been seen had he not come in over a year later
with a cold. M. L., the younger daughter, was
not examined until March, 1950. Cases are of-
fered here in the order that they were seen.
Case Histories
Case 1. — R. L., male, aged thirty-one, became sud-
denly and acutely ill at noon, January 26, 1948, with
severe chills, a sharp rise of temperature and a dry,
unproductive cough. He had general malaise but no
acute or localizing pain. The family reported a tem-
perature of over 103° F. the night before admission,
and the patient himself stated that he had a “bad case
of flu.” There was no nausea, vomiting or other gas-
trointestinal symptoms. There were no upper respira-
tory symptoms and no associated urinary complaints.
His past history was noncontributory and he had
enjoyed very good health until the day before his
admission, having never been hospitalized until Jan-
uary 27, 1948.
Physical examination showed a young, white man,
well nourished, well developed, height 5 feet 10 inches,
weight 180 pounds, lying quietly in bed perspiring
profusely but in no immediate distress. He was alert
and there was no delirium. The temperature was
103.6° F., pulse 84, respirations 20, blood pressure was
125 systolic and 65 diastolic. There was no acute
tonsillar infection and there was no exudate in the
throat or nasopharynx. The breath sounds were a
little more distant at the base of the right lung. There
were no rales ; fremitus and percussion were normal.
The heart showed no evidence of disease.
Course. — The patient ran an irregular temperature
for eight days, varying from 100° to 104° F., then
the fever gradually subsided, reaching normal on the
thirteenth hospital day. He went home, against advice,
on the fifteenth hospital day because he felt so well.
He was home five days, and on the twentieth day of his
illness he was readmitted to the hospital with a tem-
perature of 101° F., and pain in the right lower chest,
aggravated by deep breathing or coughing. Physical
findings were much the same as on the former admis-
sion except that respirations were grunting, painful
and shallow ; the rate was 32 as compared with 20
per minute on previous admission. The percussion
note over the right lower chest was less resonant, and
tactile and vocal fremitus were decreased over the same
area. The acute symptoms subsided in five days and a
small amount of fluid was obtained at this time by
thoracentesis. The fluid was serosanguinous and no
bacteria were found by direct smear. From this point
on, he ran a favorable course with a low grade tem-
perature up to 100° F. until the thirty-fifth day of
his illness and after that his temperature never rose
above 99° F. On the twenty-eighth day of illness he
developed a thrombophlebitis of the left femoral vein.
Recovery from this was good and did not affect his
hospital stay. He was discharged from the hospital on
the fifty-fourth day after the initial onset and, except
for a dry cough and being a little weak, was asympto-
matic. The dry cough is still present in the morning
after twenty-five months.
The routine laboratory tests were followed closely
during the first two months with the hope of finding
some trend or clue that would throw light on the actual
diagnosis or yield something that was characteristic in
this series of cases. The urine examinations were the
same as would be found in any febrile, respiratory in-
fection. Routine blood examinations with differential
counts showed normal hemoglobin and red count find-
ings in all cases, the white blood count was normal
or slightly elevated and the differential was variable with
no definite pattern. Repeated agglutination tests failed
to show evidence of typhoid, paratyphoid, brucellosis
and tularemia. Complement fixation tests were nega-
694
Minnesota Medicine
UNUSUAL TYPE OF PULMONARY DISEASE— RUTLEDGE
Fig. 1. ( Upper left ) Case 1. Radiograph of lungs taken on
second day of illness. There is some infiltration of both lungs.
Shadows about hili.
Fig. 3. ( Lower left) Case 1. At the end of two months
(March 31, 1948) radiograph shows definite clearing of both
lungs. Pleurisy at right base evident.
tive for “Q" fever and ornithosis. The Kline exclu-
sion test for syphilis was negative. Sputum was not
obtained until the twenty-third day of illness when it
showed many red blood cells, leucocytes and Gram-
positive cocci occurring in pairs and chains. No acid-
fast bacilli and fungi were found. Special cultures
showed yeast-like organisms which were morphologic-
ally and culturally identical to Candida (monilia) abli-
cans. Guinea pig inoculations from the sputum were
negative for acid-fast bacilli.
The radiographs (Figs. 1 to 4) taken of this patient’s
lungs at the onset and followed for twenty-five months,
as in Case 4, tell an interesting story of minimal pul-
monary infiltration initially, gradual development, pleu-
risy, massive involvement of both lungs with gradual
clearing and partial resolution. The first film of the
lungs on admission, the second day of the disease,
showed an increase in the bronchovascular markings
Fig. 2. (Upper right ) Case 1. Radiograph taken on thirteenth
day of illness. There is extensive involvement of all lobes in
both lungs, definite nodular infiltration with coalescence of nodules,
much like Case 2 and more rapid than Case 4.
Fig. 4. (Lower right) Case 1. Radiograph taken March 13,
1950, or twenty-five and a half months after inception of disease.
There is almost complete recovery but a few nodular areas are
visible with fibrosis, particularly at right base.
throughout both lungs with a few tiny nodules on the
right side and a few on the left side in the middle
portion. A week later there ‘were numerous nodular
densities extending from the apex to the base on both
sides. Later, at the second admission, there was marked
coalescence of the process with fluid in the right pleural
cavity and diffuse nodular and infiltrative processes in
both lungs from apex to base. Two months after on-
set, on March 31, 1948, radiographs showed the first
clearing of the pulmonary condition. From then on,
improvement was gradual but steady, and after twenty-
five months the last radiographs of the lungs showed
practically complete resolution of the old inflammatory
process in the lung -fields. Fibrosis was present in the
right lower lung field, but nodularity had cleared.
Case 2. — Mr. J. P. L., aged seventy-six, was admit-
ted to the hospital January 30, 1948. He was taken
July, 1950
695
UNUSUAL TYPE OF PULMONARY DISEASE— RUTLEDGE
ill one day earlier, just three days after the onset of
R. L. s illness (older son). He had a rise of tempera-
ture, a dry cough, was weak and confused. His past
history was of no consequence, except that he had had
pneumonia following influenza in 1918; otherwise, he
has always been well.
Examination showed his temperature to be 103.6°
F., pulse rate 100, respiratory rate 40. The respira-
tions were shallow with rales at the end of inspira-
tion heard at the posterior bases of both lungs with
more involvement on the right side. Vocal fremitus
was decreased at the right base. His blood pressure
was 150 systolic and 90 diastolic with marked arryth-
mia ; peripheral sclerosis was considerable. The urine
was involuntary with a residual urine of 30 c.c. The
skin showed a red, indurated area on the bridge of
the nose which spread out on the cheeks in a circle 2
inches in diameter and gave the impression of being
erysipelas and not connected with the respiratory condi-
tion. He had a marked hypertrophic arthritis with gen-
eral distribution. He was conscious most of the time
but acutely ill with the outcome in doubt for several
weeks. He was in no pain but presented the appear-
ance of an exhausted, worn out, old man.
The course of disease was prolonged. This was par-
tially due to heart disease, advanced arteriosclerosis and
poor general condition. The first two days in the hospi-
tal, his temperature was 103.6° F., all readings being
rectal in this case. From then on the readings were
101 to 102c F. writh one chill. The temperature re-
ceded on the twenty-first day and reached normal on the
twenty-seventh hospital day. At this period he did very
well for ten days, but on the thirty-seventh day of
hospitalization, he had a chill, with a sharp rise of
temperature to 103° F. The elevation of temperature
persisted with a daily low of 100° F. and daily high
of 102c F. On his fiftieth hospital day it began to
recede slowly and on the seventieth hospital day he
became afebrile. His improvement was slow but con-
stant and he went home on the ninety-eighth day of ill-
ness in fair condition. His general health is now good
at the end of twenty-five months.
I he laboratory findings in this case were noncontribu-
tory to the diagnosis. LYine examinations were well
within normal limits. The blood examinations showed
a negative Kline exclusion test. Red blood count was
4,600,000; hemoglobin, 14.4 gm. ; white blood count,
clear ; polymorphonuclear, 65 ; lymphocytes, 32 ; mono-
nuclear 3. Serum protein, 6.4 gm. ; albumen, 2.4 gm. ;
globulin, 4.0 gm. Serological tests were negative for
“Q” fever and ornithosis. Agglutination tests were neg-
ative for typhoid, paratyphoid, brucellosis, and tularemia.
The sputum yielded nothing significant on direct smears
or guinea pig inoculation.
The radiographs (Figs. 5 and 6), taken at frequent
intervals, showed a well developed, diffuse infiltrative
process with definite nodules as seen in Case 1 (Figs. 1
to 4) and Case 4 (Figs. 7, 8 and 9). This involved
all lobes of both lungs, reaching a peak at about the
end of six weeks, and began clearing slightly at the be-
ginning of the ninth week, with marked clearing at
the end of three months.
Case 3. — Mrs. J. P. L., aged sixty-seven, became ill
January ,29, and was admitted to the hospital on Feb-
ruary 10, 1948. 1 he onset of her illness was gradual
with a nonproductive cough, chills and rise of tempera-
ture. The chills were not severe and usually occurred
in the afternoon on succeeding days. She was gradually
weakened by the disease and was hospitalized on the
thirteenth day of her illness. Physical examination
showed a white female, well developed, well nourished
with no evidence of being severely ill or prematurely
old. The temperature at admission was 98.6° F., heart
rate 80, respiratory rate 20 with good mobility of the
lungs and diaphragm. There was a moderate nonpro-
ductive cough with rales heard at the left posterior
base during the entire inspiratory phase. There were
scattered rales at the right base. The blood pressure
was 140 systolic and 80 diastolic. The heart findings
were normal. There was a moderate degree of hyper-
trophic arthritis.
She remained in the hospital sixteen days and did
very well, running a much milder course than Cases 1
and 2. Her improvement continued at home and when
last seen, in December, 1949, felt quite well and general
physical examination was normal.
The same laboratory procedure was followed as in
previous cases with essentially the same results. In
this patient no sputum could be obtained.
Radiographs were obtained on admission, at the end
of the first month’s illness, near the end of the first year,
and a last film on March 4, 1949. The findings were
similar to cases previously recorded, but less extensive
although all lobes of both lungs were involved. The
last film taken March, 1949, showed considerable clear-
ing as compared to films taken in 1948. The shadows
at the lung roots were less dense.
Case 4. — T. L., aged forty-one, an unmarried, older
daughter, was taken ill the last week of January, 1948,
three days after R. L. (Case 1). The onset was not
so acute as his. She went to bed with chills, fever,
night sweats, malaise and general weakness. She im-
proved after two weeks and was doing well until the
first of March, 1948, when she reported to the office
with a severe dry, nonproductive cough and pain in the
right side of the chest. Radiographs of the lungs
(Figs. 7, 8 and 9) at that time indicated findings simi-
lar to her brother, R. L., with nodular infiltration into
both lungs. This, however, was not extensive at this
first examination. Her temperature was 98.2° F. in
the afternoon and the pulmonary findings were well
within normal limits. During the following month
(April, 1948) the cough grew worse, developed into
severe paroxysms but was nonproductive and all at-
tempts to collect sputum failed. The treatment was rest
in bed at home until May 13, when she entered the hos-
pital as she was having slight rises of temperature up
to 100°F. with chills and night sweats.
Physical examination at admission showed tempera-
ture 100° F., pulse 90, respirations 22, blood pressure
112 systolic and 70 diastolic. She was well developed
and well nourished, coughing and apprehensive but in
no great distress. No rales were heard. All other phys-
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Minnesota Medicine
UNUSUAL TYPE OF PULMONARY DISEASE— RUTLEDGE
Fig. 5. ( Upper left ) Case 2. Radiograph taken four and a
half weeks after manifestation of symptoms shows extensive
nodular infiltration in all lobes of both lungs.
Fig. 7. ( Lower left) Case 4. Radiograph taken March 31,
1948, a little over two months after onset of symptoms shows
lesions similar to Cases 1 and 2 but not extensive. I he two
later cases showed resolutions at a similar period in the dis-
ease.
Fig. 6. ( Upper right) Case 2. Radiograph taken April 30,
1948, shows good resolution after three months. Patient left hos-
pital a week later. ,
Fig. 8. ( Lower right) Case 4. Radiograph taken June 30,
1948, near the height of disease, and five months after symp-
toms began.
ical findings of the respiratory system were well within
normal limits. The laboratory and x-ray findings are
summarized below.
She remained in the hospital thirty-two days and was
sent hojne on bed rest except for bathroom privileges.
Through June and July (1948) she showed slight im-
provement but still had night sweats and an afternoon
temperature of 99.6° F. There was little change in
August and September, and the last week of the latter
month she was sent to the University Hospital for
further consultation and study to see if the cause of
this unusual condition could be found. From there
Dr. Wesley Spink reported the following: Lirine nor-
mal ; blood : Hemoglobin, 13.7 gm. ; white blood count,
6.700 ; polymorphonuclear, 63 ; lymphocytes, 29 ; mononu-
clear, 7; eosinophil, 1. Sedimentation rate was nor-
mal. The tuberculin skin test was negative; a skin test
carried out with triple antigens of histoplasmin, blas-
tomycin, and coccidioidin gave a one plus reaction. The
vital capacity was 3200 c.c. Electrocardiogram showed
a tendency towards right axis deviation ; otherwise it
was normal. X-ray showed a definite subsiding of the
nodular lesion as compared to- previous films. Dr. Spink
gave the following impressions: “I reviewed the x-rays
of the whole family with Dr. Leo Rigler and he is of
the opinion that this family had a pulmonary fungus
infection, probably aspergillosis. He felt the nodular
type of lesion was in favor of a fungus infection rather
than a complication of a virus pneumonia. I feel abso-
lutely certain this patient will recover from her illness,
with little or no residual.”
Following the consultation with Dr. Spink and Dr..
Rigler (September, 1948) the sweats and cough con-
tinued to improve but she became extremely nervous,,
apprehensive and developed a severe insomnia which-,
seemed to be related to her thoughts regarding sex nd
suppression of the sex impulse. She frequently ex-
pressed a fear of insanity and was greatly depressed
697
July, 1950
UNUSUAL TYPE OF PULMONARY DISEASE— RUTLEDGE
Fig. 9. {Upper left ) Case 4. Last radiograph taken on
March 13, 1950, twenty-five and a half months after patient
became ill. Fibrosis and nodules remain. The hilar shadows
are prominent.
Fig. 11. ( Lower left ) Case 5. Radiograph taken June 25,
1949, as patient improved. This shows the hilar shadows are
improved.
Fig. 10. ( Upper right ) Case 5. Radiograph taken April 13,
1949, about fifteen months after beginning of family epidemic.
There are nodules as in other cases, and considerable hilar
shadows.
Fig. 12. ( Lower right ) Case 6. Radiograph taken March
1950. The patient was asymptomatic but showed fibrosis and
nodules seen in other cases in family. This corresponds to
findings in radiographs of Cases 1 and 4 taken at the same time.
during the winter of 1948-1049. She had a daily rise
of temperature to about 99.5° F. until June, 1949. After
that she became less nervous, gained a little weight (the
loss had not been great) and the rises of temperature
were less frequent. By the last of August, 1949, she ad-
mitted she was definitely improved and radiographs of
the lungs confirmed this. By the last of November,
twenty-two months after her illness began, she still had
an occasional rise of temperature in the afternoon, as
high as 99.7° F., had a slight aching pain in her
chest and abdomen, a dry cough in the morning, but
was able to be up most of the day and to do light
housework in the farm home. She weighed 142 pounds
which was about five pounds more than she weighed
when she first came to the hospital. The nervous
symptoms were much improved. The lungs were normal
to physical examination and there were no sweats dur-
ing the day or night. By March, 1950, she felt she was
entirely recovered except that she admitted a mild dry
cough on arising in the morning.
All laboratory tests used in Case 1 were tried and
were devoid of positive results. The sputum could
not he obtained.
Radiographs of the lungs showed the same nodular
densities as in the other five cases and perhaps were
more like Case 1 than any other member of the family.
However, there was a difference in the progress of the
pulmonary shadows. In Cases 1 and 2, a peak of the
698
Minnesota Medicine
UNUSUAL TYPE OF PULMONARY DISEASE— RUTLEDGE
disease seemed to be reached in about six to eight weeks,
and at the end of the two months resolution began. In
this case, the maximum findings in radiographs of the
lungs occurred in June and July, 1948, about five or
six months after the inception of the disease and there
was no resolution noted until the last of August, 1948
(seven monhs). The last radiograph taken was in March,
1950, and showed nodular infiltration in the lung fields
had almost cleared, some fibrosis and nodularity re-
maining but resolving. The hilar shadows were still
prominent.
Case 5. — D. L., younger brother, aged twenty-four,
was first seen in April, 1949, about fifteen months after
Case 1. He complained of a racking nonproductive
cough, had slight rises of temperature, felt weak and
tired. His past history was significant. He was taken
ill in January, 1948, three days after his brother R. L.
(Case 1). At that time, he -was in bed at home for one
week, was convalescent at home for a week and had
been well until the present complaint. A Mantoux
skin test gave a positive reaction and radiographs of
the lungs taken April 14, 1949, were strongly suggestive
of the same nodular infiltration shown in Cases 1 to 4.
The findings in Case 5 were much less extensive. He
ran a temperature of 99.5° F. for six weeks but by
the first of July, 1949, was afebrile and asymptomatic.
The laboratory findings failed to throw any light on the
family epidemic. His sputum was negative for acid-
fast bacteria, and the study for the various fungus in-
fections revealed nothing. This may well have been a
new respiratory infection superimposed on the old one
that had occurred simultaneously with the other five
cases in January, 1948, and the new infection provoked a
slight flare of the previous symptoms as the radiographs
(Figs. 10 and 11) indicated the old process was there and
had been for a considerable length of time. He still
had a mild, dry cough in March, 1950.
Case 6. — M. L., the younger daughter, aged twenty-six,
was not seen until March, 1950, over twenty-five months
after the family epidemic occurred. She gave the history
that she had been taken ill three days after her brother
(Case 1) and was ill with something resembling the
“flu” for over a week. She was in bed at home the
greater part of ten clays. She was married four months
later and now has a baby ten months old, that is well
so far as the mother and her family physician know.
A radiograph (Fig. 12) of the lungs on March, 1950,
showed some fibrosis and nodularity of the lung fields,
particularly on the right. These lesions are similar to
the disease shown in radiographs taken of the other pa-
tients at this same time.
Treatment
Aside from the routine nursing care and symp-
tomatic treatment accorded these patients, they
were given first sulfadiazene or sulfamerazine in
one gram doses every four hours. Later potas-
sium iodine in saturation doses was given alone
and with the sulfa drugs. Then penicillin and
streptomycin were tried in the usual doses. The
iodine was given on the ground that Monilia
were present in the sputum. R. L. (Case 1) felt
that he was benefited by the sulfadiazene potas-
sium iodine combination, but my personal obser-
vations lead me to believe that all the treatment as
given above was ineffective, except the bed rest
and general nursing care.
Comment
All six members of the same family who con-
stituted the entire household living on this farm
had the same epidemic, pulmonary disease. It
should be remembered that the family lived in a
clean, well-kept farm home. R. L. (Case 1), aged
thirty-one, became ill first and on the third and
fourth day following, the other five patients were
stricken. The symptoms were similar to influenza,
consisting of a temperature rise of varying degree,
a rasping nonproductive cough, chills and general
malaise. The symptoms may be severe and acute
as in Cases 1 and 2, or rather slow with an insid-
ious onset as in Cases 3 and 4. Case 4 reached a
peak five months after inception. Recovery from
symptoms was slow in three of these patients,
Cases 1, 2 and 4. A dry morning cough has per-
sisted in three patients, Cases 1, 4, and 5, for over
two years. Radiographs of the lungs show that
resolution was slow in all patients followed during
the twenty-five months of observation. The nod-
ular infiltration was gradually replaced by linear
fibrosis, noted in Cases 1 and 4. R. L. (Case 1),
showed yeast-like organisms which were morpho-
logically and culturally identical to Candida (mo-
nilia) albicans. In reviewing radiographs of the
family. Dr. Leo Rigler decided that they had a
pulmonary fungus infection, probably aspergil-
losis. He felt that this diagnosis wqs preferable
to monilia or virus pneumpnia. These cases may
well have been aspergillosis with monilia present.
Monilia albicans is the only fungus thought path-
ogenic to man (Smith of Duke) and is frequently
an incidental, finding in the sputum without caus-
ing any apparent disease.
Acknowledgment
Appreciation is expressed by the author to Drs. Wesley
Spink; Leo Rigler, S. .Friefeld and C. W. Parker for
their interest and assistance, in tb.e diagnosis and care
of these patients.
July, 1950
699
ACUTE INVERSION OF THE UTERUS
Report of Case
HARRY SHRAGG. M.D.
Elmore, Minnesota
MARCUS KEIL, M.D. and JOHN MIKKELSON. M.D.
Mankato, Minnesota
/~\NE of the difficulties encountered in country
practice is treatment of serious obstetrical
complications. Inversion of the uterus, though
rare, may prove most difficult to handle, especially
outside a hospital.
This condition probably occurs more often
than is readily apparent from the figures usually
quoted. Figures vary from Findley’s estimates5
ranging from an incidence of one in 400,000 to
one in 23,000 labors, and McCullogh’s15 of one
in 30,000 down to the statistics at New York
Lying-in-Hospital,15 where inversion of the
uterus occurred once in 3,992 deliveries.
There are various degrees of inversion, des-
ignated respectively as incomplete, complete, and
prolapse of the inverted organ through the in-
troitus. It may also be classified as acute, sub-
acute, and chronic inversion.0
There is a diversity of opinion as to the etiology
of uterine inversion, but there are several factors
involved, such as marked relaxation or thinness
of the uterine walls, excessive pressure on the
fundus, and traction on the umbilical cord. How-
ever, these factors do not explain the occurrence
of inversion in those cases where the placenta
is delivered with no assistance.4 Its occurrence is
also favored by fundal insertion of the placenta,
and it may perhaps occur spontaneously as the
result of intraabdominal pressure, or from mere
weight of the intestines.4,15 McKeown and
Rankin11 reported two cases where inversion oc-
curred, in one case on the fifth postpartum day
following prolonged efforts to empty a distended
bladder, and in the other case on the thirteenth
postpartum day while attempting to expel a dif-
ficult stool. Usually, however, inversion occurs
immediately after delivery.
Complete inversion is usually simple to diag-
nose, but incomplete inversion may remain un-
recognized, unless careful abdominal palpation
reveals tbe absence of the fundus, or shows a
crater-like depression above or behind the sym-
physis. Unexplained shock following delivery
should suggest this possibility, and make im-
perative immediate vaginal examination by which
means the diagnosis is readily established.
Mortality rates have been excessively high.
If the condition is recognized and the uterus
replaced immediately, the prognosis is good.6
However, if strangulation or gangrene occur, the
outlook is very grave, with the cause of death
usually due to shock with or without hemorrhage.
Immediate vaginal reposition of the inverted
uterus may be accomplished relatively easily at
first, if the patient is not in shock;4 however, if
several hours have elapsed, it may be very dif-
ficult. If reposition is not possible, immediate
treatment of shock is essential.
Barrett1 and Henderson and Alles7 in their
articles state that shock with its attending mor-
bidity and mortality can be avoided in the ma-
jority of cases. Barrett emphasizes and re-
emphasizes the point that there is usually a period
immediately after the inversion when immediate
manual reposition can be performed before severe
shock and hemorrhage have taken place, but if one
does not take advantage of this very short period
of time, unfavorable circumstances develop ex-
tremely rapidly and dramatically with a very poor
prognosis. An excellent prognosis follows im-
mediate reposition of the uterus.
Clahr and Wurzbach3 reported a case of their
own and of only one other previously reported
case where, coincidentally, the uterus was reduced
following intravaginal packing for control of the
bleeding. It was suggested that where vaginal
packing was indicated, a large amount of packing
be employed.
O’Sullivan14 reported his experience in two
cases, where the uterus was replaced by hydraulic
pressure, when attempts at simple replacement
failed, by distending the vagina to capacity by
means of a dettol-and-proflavine douche, retained
bv blocking the vaginal outlet with his forearm
aided by his assistant’s hands.
Several operative procedures for acute and
chronic inversion have been devised for vaginal
and abdominal reposition of the uterus.8’12'13
700
Minnesota Medicine
INVERSION OF THE UTERUS— SHRAGG ET AL
Recently, however, more conservative manage-
ment has been advocated, when immediate reposi-
tion was not possible, consisting of treatment of
shock, control of bleeding and infection, and
postponement of surgical correction of the ab-
normal uterus for some weeks.2’* 9 10 *’12’10
The following is the report of a recently treated
case, which we present as an addition of one more
case of this very uncommon obstetrical complica-
tion :
Mrs. O. H., aged thirty-five, para 2, was seen on
August 16, 1948, and complained of vaginal itching, in-
termittent spotting, and “morning sickness” of three
to four weeks’ duration. Because of this intermittent
spotting, she did not remember the exact date of her
last menstrual period. Her periods previously were reg-
ular but always very scanty and of only two to three
days’ duration. Examination revealed the uterus to be
enlarged in size consistent with a two months’ pregnancy.
The patient’s past history is as. follows: On August
9, 1943, she was delivered of her first child, a full-
term infant, followed by a normal convalescence. She
began bleeding profusely after getting up on the ninth
postpartum day, and was soon transferred to a larger
hospital, exhibiting marked pallor, weakness, cold ex-
tremities, weak pulse, and a blood pressure of 78/?.
The patient was given 500 c.c. of whole blood followed
by 1,000 c.c. of 5 per cent glucose during the dilatation
and currettage, which yielded a piece of placental tis-
sue 3x4x5 cm., reported by the pathologist to be
degenerative decidual and placental tissue. Postopera-
tively, her temperature ranged from 102 to 105 degrees,
for which she received sulfadiazine until it fell gradual-
ly to normal on September 1. Following transfusion,
because of a persistent anemia, she was discharged on
September 7.
On November 2, 1945, she was delivered of an infant
weighing 4 pounds 9 ounces after seven and a half
months’ gestation. Very little bleeding followed, but
the physician who attended her previously, packed her
uterus and transferred the patient to the same hospital,
with the statement that “only half of the placenta was
expressed following a normal delivery.” With a sus-
picion of a retained placenta, a dilatation and currettage
was performed, and the surgeon stated, “Many small
fragments of placental tissue were removed, but no
large pieces of tissue were found.” The pathologist
reported the tissue from the uterus to be blood clots,
so we are left with the possibility either that the entire
placenta was delivered initially, or that any remaining
fragments were removed on the pack. Postoperatively,
her temperature rose to 104° which quickly subsided
with the administration of penicillin, and the patient
was dismissed from the hospital on November 11.
At the time of her last pregnancy the patient intended
to be delivered at the hospital and by the group to
which she was referred before. As a result, she was
followed prenatally by them as well as by myself. Her
prenatal course was normal. On March 16, 1949, a
flat plate of the abdomen revealed a breech presentation
with the placenta on the posterior wall of the upper
uterine segment. Attempted external version by them
that day was unsuccessful.
At 2:15 a.m., on March 21, 1949, the patient’s mem-
branes ruptured following one pain, and almost im-
mediately, pains of moderate intensity continued to
recur every four minutes. Not having time enough to
go to the hospital of her choice, she entered the local
community hospital. Examination was negative except
for the breech presentation. Using drop ether anes-
thesia and 1 per cent novocaine infiltration at the site
of the left mediolateral episiotomy, a complete breech,
S.L.A., was delivered without too much difficulty, at
3 :45 a.m. The baby, a normal male infant, breathed
spontaneously ; bleeding was average.
A few minutes later, while I was attending the baby,
the patient complained of more severe “labor-like” pains.
The placenta was presenting at the introitus and was
delivered easily with minimal gentle massage of the
uterus, but it was followed by the completely inverted
uterus, through the vagina. The placenta was separated
a little and the uterus bled moderately. After giving
the patient 1 c.c. of ergonovine intravenously, the pla-
centa was removed without any apparent increase in
bleeding. However, in about one minute, the patient
began complaining of severe abdominal and back pain,
at which time she turned pale, became pulseless, her
blood pressure was unobtainable, and she became very
dyspneic, fighting for air. There being only the nurse
and myself present, the nurse administered oxygen while
I replaced the uterus, still inverted, into the vagina, and
concentrated my attention solely on treating the shock.
I started plasma intravenously, since there was no blood
immediately available, and hastily and temporarily re-
paired the episiotomy. The slight manipulation of the
uterus aggravated the shock. The patient was also given
morphine sulfate gr. J4 and atropine sulfate gr. 1/150
intramuscularly, another cubic centimeter of ergonovine
intravenously, and 1 c.c. of pitocin intramuscularly.
After about an hour and a half, during which time
the patient received 1,250 c.c. of plasma intravenously,
the blood pressure finally began to rise to 70-80 systolic,
pulse became perceptible but thready at 120 per minute,
and she was breathing easier. She was then transferred,
by ambulance, to a larger hospital 45 miles away, where
we arrived about 6:15 a.m., her pulse and blood pressure
remaining the same during the trip.
When we arrived at the hospital, the patient's blood
pressure was 94/50, pulse was 120 and thready, hemo-
globin was 44 per cent (17 gms. 100 per cent), and
she was breathing fairly easily. The foot of the bed
was elevated and her blood pressure rose to 110. While
waiting for cross matching, the patient suddenly became
dyspneic again, passed more blood vaginally, her blood
pressure began to fall, and the pulse became weaker,
so plasma was started. During the transfusion, she
continued to do poorly and continued to bleed. It was
then decided that the patient needed surgery, even
July, 1950
701
INVERSION OF THE UTERUS— SHRAGG ET AL
though she was in shock, and she was taken to the
operating room at 9:15 a.m.
A low midline incision was made and the inverted
uterus converted to a normal position by grasping the
uterus with a ring forceps, beginning at the edge of the
crater until the apex was reached, and applying both
traction from above and pressure from below. The
ovaries and tubes had not been drawn into the crater,
but there was marked hemorrhage into the left broad
ligament with some difficulty in establishing landmarks.
A subtotal hysterectomy was accomplished. Anesthetic
used was ether by drop method as well as by machine.
During the operation, the patient received 3,000 c.c. of
citrated whole blood, 250 c.c. of plasma, and 500 c.c. of
10 per cent glucose in normal saline. Time for nar-
cosis was two hours and thirteen minutes, and time for
the operation was one hour and twenty-four minutes.
No stimulants were given.
Her blood pressure which was unobtainable during
the entire procedure, suddenly rose to 110/60 during
the last fifteen minutes of the procedure, and her pulse
suddenly slowed down to 80 to 92 per minute, but be-
came intermittent and remained weak. When the pa-
tient was returned to her room, her hemoglobin was
66 per cent and respirations were 18 to 24 per minute.
An additional 2,000 c.c. of normal saline was given in-
travenously, and within one-half to one hour, the pa-
tient passed about 1,000 c.c. of clear urine.
She was given penicillin and streptomycin and re-
mained afebrile except for the day following the op-
eration, when her temperature rose to 99.6°. The pa-
tient made an uneventful recovery, and was discharged
on March 30, 1949, the ninth postoperative day.
Pathological examination of the uterus revealed no
malignancy, but there was some intergrowth of the
placental and muscle fibers consistent with retained
placenta.
Summary
Acute inversion of the uterus is a rare obstet-
rical complication representing a very acute
emergency. Its etiology and treatment are still
controversial subjects. Tf immediately recognized,
it can usually be manually reposed to its normal
position relatively easily with an excellent prog-
nosis ; but if delayed for only a short time, the
prognosis becomes very poor, with the necessity of
shock being treated immediately, thereby delaying
surgical reposition of the uterus for from several
days to several weeks.
This is the case of a woman, with a history of
having had a retained placenta with her first preg-
nancy and a clinical suspicion of a retained pla-
centa with her second one, who had a breech de-
livery followed by an acute and complete spon-
taneous inversion of the uterus. Plasma and oxy-
gen were the only things available for treatment
of shock until the patient was transferred to a
larger hospital, where she remained in shock for
more than five hours, when operation as a despera-
tion measure was attempted, and a subtotal hys-
terectomy successfully accomplished. The patient
received about 3,000 c.c. of type A and type O
blood without the slightest suggestion of renal
impairment, and made a very rapid, successful,
and uneventful recovery.
References
1. Barrett, C. W. : Inversion of the uterus. Western J. Surg.,
53:146-152, (May) 1945.
2. Burwig, H.: Conservative treatment of acute inversion of
the uterus. Surg. Gynec. & Obst., 78:211-12, 1944.
3. Clahr, J., and Wurzbach, F. A.: Reduction of an inverted
uterus following intravaginal packing. Am. J. Obst. &
Gynec., 48:729-732, (Nov.) 1944.
4. Cosgrove, S. A.: Management of acute puerperal inver-
sion of the uterus. Am. J. Obst. & Gynec., 38:912-25, 1939.
5. Findley, P. : Acute inversion of the uterus. Am. J. Obst.
& Gynec., 18:587-591, (Oct.) 1929.
6. Harer, W. B., and Sharkey, J. A.: Acute inversion of the
puerperal uterus. J.A.M.A., 14:2289-92, 1940.
7. Henderson, H., and Alles, R. W. : Puerperal inversion of
the uterus. Am. J. Obst. & Gynec., 56:133-142, (July) 1948.
8. Huntington, J. 1-., Irving, F. C., andd Kellogg, F. S.:
Abdominal reposition in acute inversion of the puerperal
uterus. Am. J. Obst. & Gynec., (Jan.) 1928.
9. Kellogg, F. S.: Puerperal inversion of the uterus. Classifi-
cation for treatment. Am. T. Obst. & Gynec., 18:815-17,
(Dec.) 1929.
10. McClennan, C. E., and McKelvey, J. L. : Conservative
treatment of inversion of the uterus. J.A.M.A., 120:679,
(Oct. 31) 1942.
11. McKeown, R. M., and Rankin, J.: Inversion of the
puerperal uterus. Northwest Med., 46:953-956, (Dec.) 1947.
12. I'haneuf, L. E. : Inversion of the uterus. Surg. Gynec. &
Obst., 71:106-09, 1940.
13. Ocejo, J.: Two cases of inversion of the uterus, treated
by anterior abdominal colpo-cervicohysterotomy with the au-
thor’s technic. Rev. Med. Cubana, 58:427-445, (June) 1947.
14. O’Sullivan, I. V.: Acute inversion of the uterus. Brit.
M. J., 2:282-283, (Sept.) 1945.
15. Stander, H. J. : Textbook of Obstetrics. 3rd rev. ed. New
York: D. Appleton-Century Company, 1945.
16. Wilson, K. M. : The Haultain operation for inversion of
the uterus. Am. J. Obst. & Gynec., 28:738-43, (Nov.) 1934.
CHRONIC ILLS STUDIED
Chronic illness was designated “the nation’s number
one health problem” by a group of experts meeting in
Chicago in May to discuss the prevention and treatment
of such ailments as heart diseases, cancer, tuberculosis,
hardening of the arteries, apoplexy, diabetes, arthritis,
rheumatism, paralysis, and long-term disabilities re-
sulting from disease or accident. Community-wide plan-
ning and action were recommended for the better control
of chronic diseases.
Such diseases constitute one of the major health prob-
lems in Minnesota today, since they include six of our
ten leading causes of death--heart disease, cancer, and
intracranial vascular lesions being the first three, and
diabetes, nephritis, and arteriosclerosis ranking sixth,
seventh, and eighth, respectively.
The group meeting in Chicago was the Commission on
Chronic Illness, established in May, 1949, by the Ameri-
can Medical Association, American Hospital Association,
American Public Welfare Association, and American
Public Health Association. Information on the chronic
disease programs now in operation in various states and
cities may be obtained from the Commission offices at
535 North Dearborn Street, Chicago 10, Illinois. —
Minnesota’s Health. June, 1950.
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Minnesota Medicine
PAROXYSMAL TACHYCARDIA WITH ATTACKS OF UNCONSCIOUSNESS
Report of a Case
MELVIN D. MILLS, M.D., and HARRY L. SMITH, M.D.
Rochester, Minnesota
SYNCOPE with prolonged unconsciousness is
an infrequent manifestation of paroxysmal
rapid heart action. Seldom does it occur in
youth in the presence of a normal heart. Such
a situation came under our observation recently,
and we felt it of sufficient interest to warrant a
report. A review of the literature reveals only
occasional mention of this particular occurrence.
Barnes1 credited Savini with speaking of a syn-
copal form of paroxysmal tachycardia in 1912. In
1926, Barnes called attention to cerebral symptoms
as manifestations of rapid heart action when he
reported fifteen instances in a review of 104 cases
of paroxysmal tachycardia. Four of these pa-
tients had syncopal attacks during seizures.
In reviewing the general subject of syncope,
Williams3 commented on a series of 100 cases
of paroxysmal tachycardia, Fifteen patients had
cerebral symptoms ; of these, four experienced
syncopal attacks ; two had convulsions.
White,2 without giving figures to indicate in-
cidence, mentioned convulsions along with angina
pectoris, congestive failure and persistent electro-
cardiographic changes as manifestations of par-
oxysmal rapid heart action.
Wolff,5 in an extensive review of the cardinal
manifestations of paroxysmal tachycardia, re-
ported on a series of 253 patients. Of these, forty
(16 per cent) experienced vascular collapse.
Twelve patients of this group had normal hearts.
Only one patient was in an age group under the
fourth decade. The factor of age was not con-
sidered important, except that circulatory fail-
ure may be induced by somewhat slower rate in
the aged than in younger patients. In 1942, in
an earlier report, Wolff4 reviewed six cases of
central nervous system manifestations secondary
to paroxysmal rapid heart action. Four of the
patients had hypertension and two had coronary
heart disease. Unconsciousness occurred as a
transitory phenomenon in two cases.
Dt. Mills is a Fellow in Medicine, Mayo Foundation, and Dr.
Smith is in the Division of Medicine, Mayo Clinic, Rochester,
Minnesota.
Report of a Case
A farmer and former high school athlete, twenty-one
years old, came to the clinic for evaluation of “con-
vulsions.” The patient was accompanied by his father
(the father had witnessed three of nine attacks). During
the three years prior to his registration at the clinic
the patient had experienced nine attacks of unconscious-
ness, with loss of memory for the event. Sedative agents
had been tried without benefit. An aunt had migraine.
There was no familial history of allergy or of a con-
vulsive disturbance. Previous infliction of trauma to the
head was denied.
The initial attack had occurred in May, 1946. At
the end of a 100-yard dash in h'gh-school competition,
the patient had collapsed and fallen motionless to the
ground. In the ensuing half-hour to an hour, repeated
efforts to arouse him were unsuccessful. He was flushed
and breathed heavily. The pounding of his heart was
noted by his coach, but no undue significance was attached
to it. He recovered spontaneously. He was “groggy,”
but after ten to fifteen minutes felt able to remain at the
field to watch further competition, and did so. The
episode was dismissed as “runner’s fatigue.”
Five months later while the patient was playing bas-
ketball, a second episode occurred. The patient sensed
that there was “something wrong” because his heart
abruptly started to beat unusually fast. He left the
game of his own volition ; on reaching the sidelines he
slumped to the floor. He was motionless, and remained
unconscious for ten to fifteen minutes. When he aroused,
he was assisted to the showers. The pounding of the
heart continued for an additional ten to fifteen minutes,
then suddenly and spontaneously returned to its usual
rate.
A review of each subsequent episode then disclosed
that rapid heart action and exertion or excitement were
consistently present. At no time had there been loss of
sphincteric control, an aura or an observed convulsive
movement. No attacks had occurred during sleep. In-
jury had been limited to a laceration of the scalp received
at the time of the initial attack when the patient had
fallen on the cinders of the track. Readings of blood
pressure had been taken during attacks, but they were
not available.
On several occasions rapid heart action, characterized
by a precipitous onset and sudden return to normal, last-
ing three minutes to three hours, had occurred without
syncope. An occasional attack had been accompanied
by a dull aching sensation in the left part of the thorax,
without extension. During one attack the patient’s
local physician had been unable to terminate the attack
by “neck or eyeball” pressure. An electrocardiogram
made at the time of the attack was interpreted as show-
July, 1950
703
PAROXYSMAL TACHYCARDIA— MILLS AND SMITH
ing “the lower half of the heart’ beating twice as
fast as the upper half.” We did not witness an attack,
nor were we fortunate enough to get an electrocar-
diogram during a period of rapid heart action. No
other significant symptoms were elicited.
Examination revealed a husky, muscular, 6-foot, 177-
pound youth in no apparent distress. The blood pres-
sure was 114, systolic, and 80, diastolic, expressed in
millimeters of mercury. The heart was not enlarged.
No murmurs were heard. An occasional premature con-
traction was noted. Results of funduscopic examination
and examination of the gross visual fields were normal.
A neurologic examination did not reveal significant ab-
normalities.
Leukocytes numbered 6,800 per cubic millimeter of
blood. The value for hemoglobin was 13.7 gm. per 100
c.c. of blood. Serologic tests gave negative results for
syphilis. Urinalysis disclosed nothing significant. A
roentgenogram of the thorax revealed the size and con-
tour of the heart to be normal. An electrocardiogram
showed a rate of 56, sinus arrhythmia with an occasional
ventricular premature contraction, low amplitude QRS
waves in leads I, II and III, inverted T waves in leads
III, V-l and V-3 and positive T waves in lead V-5.
The pattern of the electro-encephalogram was essentially
normal, with a regular and well-defined alpha rhythm
of 10 cycles per second. There was no change with
hyperventilation.
The patient was dismissed from our care on July 11,
1649, and advised to take 3 grains of quinidine four times
a day. He was re-examined seven months later, on
February 8, 1950. He had taken quinidine for four
months, but had had none for three months prior to
the last examination. At this time he complained chiefly
of exhaustion, that his heart beat hard when he worked
and that it was difficult for him to take a deep breath.
He had had no episodes of fast heart or of unconscious-
ness since the first admission. We felt that his com-
plaints at the time of his last admission were largely
due to an anxiety state.
Summary
A case of syncope with attacks of prolonged
unconsciousness, in which the heart was normal,
has been presented. The clinical history and
course were consistent with a diagnosis of par-
oxysmal tachycardia. The relative infrequency
of occurrence of this manifestation of paroxysmal
rapid heart action is of interest.
References
1. Barnes, A. R.: Cerebral manifestations of paroxysmal
tachycardia. Am. J. M. Sc., 171:489-495, (Mar.) 1926.
2. White, P. D.: Heart Disease. (Macmillan Medical Mono-
graph.) Ed. 3, pp. 870-871. New York: The Macmillan
Company, 1944.
3. Williams, R.D. : Syncope: a review. Ann. Int. Med., 30:
1143-1 155, (June) 1949.
4. Wolff, Louis: Clinical aspects of paroxysmal rapid heart
action. New England J. Med., 226:640-648, (Apr. 16) 1942.
5. Wolff, Louis: The cardinal manifestations of paroxysmal
tachycardia. I. Anginal pain. II. Vascular collapse. New
England T. Med., 232:491-495, (May 3); 527-530, (May 10)
1945.
PHYSICIANS' OBLIGATION TO REDUCE COSTS
A tangible service to patients is within the control of
many physicians ; namely, lowered costs for laboratory
work. Says the President of New York County Medical
Society, in part:1
Many a patient finds that his total bill for an illness may
involve a very considerable charge for a battery of tests per-
formed to accumulate a voluminous mass of diagnostic data. The
new trend, too, is to have the patient undergo an entire “checkup”
in diagnostic centers — even when critical illness is not at hand
— as a measure of preventive medicine. This, again, is as it
should be. Yet, again, there is no doubt that such a com-
prehensive series of laboratory procedures all adds to the price
paid by someone for medical care ... by the public, by health
agencies, by the hospitals, or by the private patients.
Without trying to fly against the advancing winds of medi-
cal progress, one may reasonably ask for a bit of reflection
on the blanket orders sometimes issued for laboratory tests
which — on second thought — promise to aid the diagnostician only
slightly, which may sometimes by their very abundance confuse
the issue, and which always increase the cost of illness for the
patient.
There is an understandable emphasis on elaborate clinical diag-
nostic procedures among younger physicians — fresh perhaps from
a residency in a major university teaching hospital where they
had only to lift a finger to have harassed technicians turn out
the work. That was part of their postgraduate medical edu-
cation and gave them the training and experience they will
need later. Moreover, this reliance on the objective information
thus available is a desirable thing ... as information.
But diagnosis is a mixture of information plus judgment. As
these younger physicians come to work with their own patients
in their private practice, they gradually learn that a second and
a third look at the patient and their experience in physical
1 New York Medicine , April 5, 1950, p. 22.
diagnosis will often reap rewards in attaining the correct
decision without confusing the issue with a host of laboratory
data and at a considerable saving in cost to their patients.
Never forget that the cost of medical care is a major issue
of medicine today.
One must add, immediately, that laboratory work, if it is
truly needed, must never be sacrificed merely on the basis of
cost. Admittedly, too, the margin between enough laboratory
work and an overabundance is sometimes a narrow one. Never-
theless, for those who err on the side of ordering too much
laboratory work it is well to remember that the world had good
diagnosticians before they were born.2
While no one contends that the patient’s financial in-
terest is paramount, it is a definite and, we believe, a
growing, obligation of the physician to assist in cutting
costs in his patient’s behalf wherever possible. This
cannot be emphasized too often. Excessive fees and in-
discriminate prescribing of expensive drugs, as well as
unnecessary laboratory procedures, open the profession
to justifiable criticism. There is, as Dr. Keating re-
marks, an art and science to the practice of medicine.
The best over-all care of the patient — medically and eco-
nomically— is the proper blending of the two.
Anything which physicians can do to help lower the
cost to the patient without sacrificing the quality of medi-
cal care is most meritorious. Sensible planning in the
numbers and types of diagnostic tests to be ordered for
the patient is one starting place to achieve this end.— -
Editorial, N. F. State J. Med., July 1, 1950.
2 106:315 (April) 1950.
704
Minnesota Medicine
History of Medicine In Minnesota
MEDICINE AND ITS PRACTITIONERS IN OLMSTED COUNTY PRIOR TO 1900
NORA A. GUTHREY
Rochester, Minnesota
(Continued from June issue)
Elisha Wild Cross (continued)
His professional record was without blemish. W ell educated, a student and
traveler at home and abroad in the interest of professional improvement, he
faithfully and generously gave his best in the nearly thirty years of his practice
in Olmsted County. He held the affection of children and grown persons alike, and
to his patients he was as much friend and temporal adviser as physician. He was
a preceptor of medical students, medical examiner for fraternal lodges, and often
a county physician. He served on the city board of health, for seveial terms as
health officer, and in 1887 was a member of the Minnesota State Board of Health.
A founder of the early Olmsted County Medical Society, in 1868, he was m
that year vice president, head of the committee on surgery and, with his brothei
and other members, a drafter of the first fee bill ; when the society was reorgan-
ized in December, 1885, he was a charter member. Enrolled in the Minnesota
State Medical Society from February 1, 1869, he was an active worker, several
times a delegate to annual meetings of the American Medical Association. Under
the “Diploma Law” of 1883 of Minnesota he held certificate No. 674 (R), dated
December 31, 1883.
A progressing nervous disability that dated from the rigors of military service
was aggravated by the demands of pioneer practice and in 1894 resulted in
invalidism. A fall in January, 1899, while Dr. Cross was walking in his rooms,
hastened his death, which occurred on the following November 21. At the funeral
services the pallbearers were Dr. Cross’s friends of many years : Drs. F. R. Mosse,
H. H. Witherstine and Christopher Graham, of Rochester, and Dr. E. D. Stoddard,
then of Stewartville, who had been one of his students. Special tribute to the
memory of Major Cross was paid by Colonel John B. Sanborn, of the Fourth
Minnesota Regiment : “One of the best of men and most faithful of officers ;
and by the Loyal Legion, Commandery of Minnesota. Tribute to him as citizen,
businessman and physician was paid by the Olmsted County Medical Society ;
the memorial, drafted by Drs. Witherstine, W. J. Mayo, and F. J. Halloran (of
Chatfield), ended, “He was a good man. As such he will live in our memories.
Elisha Wild Cross was survived by his wife, Martha Peckett Cross, and by
a son and a daughter. Mrs. Cross was a woman of culture and intelligence ; she
was a founder of the Rochester City Library in the sixties and until her retire-
ment, in 1903, when her daughter succeeded her, she was a member of the board
of directors ; she died on February 19, 1907. The son, Maitland E. Cross, engaged
in business in Rochester and later in Minneapolis ; he was married in July, 1885, to
Elva C. Daniels, of Rochester. Martha Helen Cross, the daughter, a graduate
of Vassar College, was married on December 21, 1880, to Henry M. Nowell, a
banker of Rochester, and spent her life in this city. She died on April 27, 1941,
July, 1950
705
HISTORY OF MEDICINE IN MINNESOTA
survived by a son, Reuben Nowell, of Rochester, and a daughter, Kate Theodate
(Mrs. George Chute) Reid, of Rome, New York. The late Dr. G. C. Reid was
from 1905 to 1908 a surgical assistant in what was soon to be known as the
Mayo Clinic. The children of Dr. and Mrs. Reid are (1946) Dr. Henry Nowell
Reid, a surgeon of Rome, New York, and Louise Reid Smith, of Gorham, Maine.
John Albert Grosvenor Cross (1870-1928) the sixth and youngest child of
Dr. and Mrs. Edwin Childs Cross, was born in Rochester, Minnesota, on May
8, 1870, and there spent his youth and the first seven years of his profes-
sional career. His early education he acquired in the grade schools, high
school and Niles Academy in Rochester ; the degree of bachelor of science
he received from the University of Minnesota in 1892 and, honor student and
second in his class, the degrees of master of science and doctor of medicine
from Northwestern University in June, 1895. One of four graduates appointed
on the basis of scholarship to internship at Mercy Hospital, Chicago, under
Dr. Frank Billings, he refused the opportunity because of his mother’s failing
health, and returned to Rochester, accompanied bv his wife, to begin general
medical practice. He was married on September 4, 1894, to Frances Mont-
gomery; Mrs. Cross was a native of St. Cloud, Minnesota, a graduate of
the University of Minnesota in 1891 with the degree of master of science, and
previous to her marriage was a teacher and a supervisor of primary instruction
in the schools of Saint Paul.
Dr. Cross became a member of the Olmsted County Medical Society in
1895, was secretary and treasurer in 1896-1900, and president in 1902. In
1897 he was enrolled in the Minnesota State Medical Society and in 1898 in
the Southern Minnesota Medical Association.
An outstanding feature of his seven years as a physician in Olmsted County
was his study and clinical application of the x-rays, which were announced
to the world by Roentgen in 1895. The first physician in Rochester to give
serious attention to the discovery, by the early summer of 1896 Dr. Cross
had assembled a workable “apparatus for using x-rays in photography”;
his first successful picture, which had wide publication, was of his wife’s
hand; Mrs. Cross sat for three hours while the picture was made. At the
August, 1896, meeting of the Southern Minnesota Medical Association he
gave a showing of x-ray pictures in diagnosis. His new science repeatedly
was put to clinical use by local surgeons to determine skeletal defects and to
locate foreign bodies. Taken with his sound professional knowledge and
personal integrity, his initiative and ability in roentgenography attracted
attention in the Northwest and brought him due recognition.
In October, 1902, relinquishing his practice to Dr. John E. Crewe, who
had been his partner since May of that year, Dr. Cross left Rochester with
his family for Europe, where he spent a year, studying in many different
cities but chiefly in Vienna with Edmund von Neusser. On his return to
Minnesota he began his career as an internist in Minneapolis. The detailed
story of his subsequent work belongs to the history of medicine in Hennepin
County.
Dr. Cross was a cultured gentleman of personal charm, sympathy and warm
sense of humor, a musician and student, a member of the Episcopal Church.
He was a skilled physician, a sound writer on medical subjects, a worker
for medical education and organization and the elevation of medical ideals
and standards. For several years he was on the teaching staff of the rned-
706
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HISTORY OF MEDICINE IN MINNESOTA
ical school of the University of Minnesota ; long on the clinical staff of
four hospitals, Northwestern, Hillcrest, Abbott and St. Mary’s, some time
with St. Barnabas Hospital, and chief of the medical staff of the City Hos-
pital. He was a member of the college fraternities C hi Psi and Nu Sigma Nu
(medical) and of many medical societies, county, state, national and special.
John Grosvenor Cross died on March 3, 1928, at the age of fifty-seven
years, from a cerebral hemorrhage brought on by an automobile accident, and
was survived by his wife, a daughter and two sons. In 1946 Mrs. Cross and
Miss Louise Cross, the latter a sculptor, medical illustrator and writer, were
living in New York. Grosvenor Montgomery Cross, a mechanical engineer,
was in New York and Connecticut, in work that took him into Latin America;
Roderic Marcy Cross, an engineer, was in Torrington, Connecticut, a member
of the board of directors of Torrington Manufacturing Company ; during
World War II both sons were engaged in defense work. Mrs. J. G. Cross
died in New York on February 20, 1949. She was survived by the three
children and by nine grandchildren, six girls and three boys, of whom one
was John Grosvenor Cross.
Nathaniel (commonly Nathan) S. Culver, a small, energetic man, who was
born in Rock Countv, Wisconsin, about 1843, came to Minnesota in 1866
and to Rochester in early 1867. His first announcement, published in the
Rochester Post of June 15, 1867, served to introduce him:
Dr. N. S. Culver, Eclectic Physician. Office : Broadway, opposite Heaney’s Brick Block.
Special attention given to Chronic Diseases, such as rheumatism, liver complaint, throat dis-
eases, dyspepsia, bronchitis, diabetes, diseased kidneys, scrofula, weak spines, asthma, loss
of voice, and nervous debility.
Mild medicinal remedies will be used, and each patient will be insured the proper treatment,
whether by Magnetism, Electricity, or - Eclectic Medicine.
Tape worms successfully removed. A cure warranted.
Patients at a distance can send for circular and copy of “Questions to Invalids.” References :
Dr. A. Castleman, Milwaukee ; Dr. R. W. Hathaway, Milwaukee ; Dr. N. G. Storrs, Mil-
waukee; E. G. Crandall, Esq., W. S. Alexander, Esq.
In September, 1868, Mr. J. D. Blood, an established druggist of Rochester,
took Dr. Culver into partnership in the Union Drugstore on Broadway.
After Mr. Blood’s death in 1870 Dr. Culver carried on the expanded drugstore
with great success, first alone, and later with his brothers George and John.
He traveled considerably and often brought back objects of interest, Avhich he
exhibited in the drugstore ; on his return from a clinical visit to Chicago in
November, 1871, he displayed a collection of curious specimens of- fused metal
and glass from the ashes of the Great Fire. Dr. Culver’s drugstore, incidental-
ly, was one of the pharmacies in Rochester in which Henry W. Wellcome
(later Sir Henry, of London, England) worked for a time as a clerk. An
elderly lady of Rochester, then a young girl, has said of Henry Wellcome,
“I didn’t know the word personality then, but he had personality if any one ever
did.”
Dr. Culver was among the eclectic practitioners who met in Owatonna on
May 26 and 27, 1869, to organize the Minnesota State Eclectic Medical So-
ciety ; he was elected recording secretary and at the next annual meeting,
in June, 1870, also at Owatonna, he was re-elected. Although Dr. Culver
thus furthered eclectic medicine, and made trips to Chicago and Philadelphia
to attend medical lectures for the improvement of his knowledge, it is be-
Iuly, 1950
707
HISTORY OF MEDICINE IN MINNESOTA
lievable that his undoubted success and popularity were due as much to his
personal traits and his activities as business man, church worker and ardent
exponent of temperance, as to his skill as a physician.
Nathaniel S. Culver was married on May 19, 1870, to Mattie A. Nicholson,
only daughter of B. Nicholson, of Watertown, Wisconsin, and brought his
wife and his father-in-law to a new home at the corner of Grove and Third
Streets. Mr. Nicholson died in April, 1871 ; Mrs. Culver died in August,
1872, at the age of twenty-nine years, leaving an infant son. In the winter of
1873-1874 Dr. Culver because of his own failing health and the child’s illness,
sought the salubrious climate of Colorado, which had begun to attract popular
attention, in company with other citizens of Rochester.
By October, 1874, he was established in Colorado Springs, although he con-
tinued for some years to own his drugstore in Rochester, and thereafter for
seventeen years, during which he made periodic visits in Rochester, reports
came back of his multiple interests and his prosperity. He discovered fire
opals near Colorado Springs; struck a bonanza gold vein, the Ute Pass Lode,
at Manitou ; organized a stock company for silver mining. In 1875 he pre-
sented to the Rochester High School a large collection of mineralogic and
geologic specimens that he had gathered in Colorado and had exhibited in the
Union Drugstore in Rochester. In 1876 he was candidate for alderman on
the temperance ticket; in 1878 he was elected state treasurer of Colorado.
On January 30, 1891, the Rochester Post made the following announcement:
“Dr. Nathaniel S. Culver, at one time a resident of this city, died recently
at Colorado Springs, Colorado, aged forty-eight years. His business in that
state was that of mining director. For some years he was one of the directors
of the First National Bank of that city and was president of the First Con-
gregational Church of Colorado Springs.”
Eugene C. Davis, son of Mr. and Mrs. Ezra Davis, of Viola Township,
Olmsted County, and at one time a medical student under Dr. Hector Gal-
loway, of Rochester, returned home from New York City in March, 1876, a
qualified doctor of medicine. After practicing in the community of Viola a
few weeks, he rented his farm ( Rochester Post, April 15, 1876) and removed to
the village of Plainview, Wabasha County, to enter partnership with Dr.
Nathaniel S. Tefift, a highly respected pioneer physician.
Dr. Davis was married on January 2, 1881, to Miss Mattie Champine,
daughter of Mr. and Mrs. C. Champine, of Plainview.
The career of this young physician was cut short by his untimely death,
in Plainview, from typhoid fever on November 27, 1881.
A Dr. Davis, of Rochester, in April, 1885, cut a cancer from the lip of a
citizen of Marion. “It was a neat job and left a little of the lip.” Other than
this item, information about this Dr. Davis is lacking.
Paul G. Denninger (1848-1927), a homeopathic physician, practiced medicine
in various localities of southern Minnesota between 1870 and 1890. Eckman
mentioned him, in 1941, in an article on homeopathic and eclectic medicine in
Minnesota. A sketch of this practitioner appeared in an article on the history
of medicine in Fillmore County (Guthrey).
A native of Germany, born in 1848, Paul G. Denninger in 1862 came with
his parents to the United States. In 1870, twenty-two years old and a physi-
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HISTORY OF MEDICINE IN MINNESOTA
cian, he arrived in Minnesota, and in Eyota, Olmsted County, began the prac-
tice of medicine, succeeding Dr. Benjamin F. La Rue. His office first was
in the building of C. S. Andrews, later over the Wagner shoe store, and
finally in his residence on the corner of Fourth and Lafayette Streets, op-
posite the Presbyterian Church.
In Eyota Dr. Denninger was married on June 12, 1871, to Susie A.
Wagner, of Eyota, daughter of the local shoe merchant. In 1876 he removed
to Spring Valley to enter partnership with his brother-in-law, Dr. C. H. Wag-
ner. After a few years in Fillmore County during which he took a degree,
in 1879, at the Hahnemann Medical College and Hospital of Chicago, he
settled in Faribault about 1881. From Faribault he removed to California
in 1890 and there practiced successfully at various places; he died in San
Jose on December 10, 1927.
William M. Dodd (1853-1883), of brief professional career, was born in
Cortland County, New York, on December 20, 1853, the eldest of the three
children of Isaac Dodd and Margaret Johnston Dodd. Both Isaac Dodd
and his wife were natives of Cumberland County, England, who came to the
United States in their youth ; they were married in Elgin, Illinois, later farmed
in Cortland County, New York, where Isaac Dodd first had settled, in 1849.
In the spring of 1855, members of a group of travelers seeking new homes,
they arrived in southern Minnesota and opened a farm in section 23, Kalmar
Township, Olmsted County. Margaret Dodd died in 1858, and in 1862 Isaac
Dodd was married to Helen Ranson, a relative of the Ranson family of
Dodge County, three members of which have been well known in Minnesota
medicine. Of this second marriage there were ten children, of whom four
were living in 1883.
William Dodd, after attending the district school near his home, studied
academic branches at Niles Academy in Rochester and medicine under
Dr. Hector Galloway of that city, preliminary to a formal medical course.
In March, 1880, he returned home, a qualified graduate of the Chicago
Medical College, and for the next three months practiced medicine in Byron,
as locum tenens for Dr. Isaac Hall Orcutt, who was taking a postgraduate
medical course at the University of Pennsylvania. From Byron Dr. Dodd
went to Austin and soon after to Brownsdale, also in Mower County, where
he practiced until his health failed : an attack of lung fever in August, 1882,
was followed by tuberculosis. In January, 1883, with his wife, Nona
Hitchcock Dodd, to whom he had been married at Milan, Minnesota, in
July, 1880, he went to Napa City, California, the home of Mrs. Dodd’s parents,
seeking a beneficial climate. The only child of the young couple, a little boy,
died en route. Dr. Dodd’s death occurred at Napa City on April 20, 1883.
William Doms (1858-1928), who was born on July 15, 1858, and who held
an exemption certificate to practice medicine in Minnesota under the medical
practice act of 1887, died in Woodstock, Minnesota, on July 21, 1928, after
a residence there of twenty-six years. A note has appeared that he was
married on March 19, 1879, to Anna Ingle, of Rochester, Olmsted County,
and that in the following October he removed to Pipestone.
Rollo Carlton Dugan (1865-1927), a son of Elijah S. Dugan and Calista
Griffis Dugan, was born in Eyota Township, Olmsted County, on February
Iuly, 1950
709
HISTORY OF MEDICINE IN MINNESOTA
12, 1865. Elijah Dugan was a native of Ohio, Calista Griffis, of New York.
After their marriage Mr. and Mrs. Dugan in 1857 went to Stark County,
Illinois, where their two elder sons, Nathan F. and Charles, were born. In
1862 the family came to Minnesota and settled on a farm near Eyota. At
one time Mr. Dugan operated a traveling merchandise van; in the seventies
this rig, an enclosed vehicle drawn by a pair of sturdy roan ponies with black
manes and tails, was a familiar and welcome sight to farm families in
various parts of the county. Mr. Dugan and his wife in their last years
made their home at Compton, California.
Rollo C. Dugan went to district and village schools of Eyota Township,
to high school in Rochester, and to the University of Minnesota. He took
his degree of doctor of medicine in 1890 and returned to his native locality,
with his headquarters in Dover, to begin a general medical and surgical
practice. In near-by Eyota, from 1873 to 1892, Dr. Augustus W. Stinchfield
with distinguished success carried on a practice that was for those years
unusual in size and scope. When, in February, 1892, he removed to Rochester
on the invitation of the Drs. Mayo to join their group, young Dr. Dugan
transferred to Eyota, to take the older doctor’s practice and to carry on
in his tradition. At the same time Dr. Dugan held his practice in Dover,
avowedly for the benefit of his undergraduate friend, Melvin S. Millet
(M.D., University of Minnesota, 1895), whom he encouraged and coached
in the study of medicine.
On February 20, 1892, Rollo C. Dugan was married at Dover to Isabelle
Stvles, daughter of William and Elizabeth Styles, pioneer settlers in Dover
Township. Mrs. Dugan’s sister Agnes was Mrs. Nathan F. Dugan; a
second sister, Miss Lucy Styles, a trained nurse, was Dr. Dugan’s personal
assistant for more than thirty years. Dr. and Mrs. Dugan had four children :
Rollo C., Jr., Catherine, Nathan Clay, and Melvin Millet.
Well-qualified, well-liked, ethical and progressive, with a bent for surgery,
Dr. Dugan became an outstanding member of Olmsted County’s medical
profession. Fie was of medium height, heavy, possessed a keen sense of
humor and a notably guarded tongue. When he started practice, it was
said locally that he would not be a success because he would not talk;
when unduly pressed for information about a case, his defense mechanism
was to mutter amiably and indistinctly, edging the while to the door and,
apparently about to make a decisive statement, make his escape. It is re-
called by his relatives that Dr. Dugan spent as many mornings as possible
each week in Rochester observing and studying the work of his friends
Drs. W. J. and C. H. Mayo at St. Mary’s Hospital ; he always said that he
learned surgery from the Drs. Mayo. By 1896 Dr. Dugan had equipped
part of the old Dugan home in Eyota, which was his residence and office,
as a small surgical hospital, although it was not until October, 1900, that he
increased its capacity to eight beds and called it the Eyota Hospital.
Dr. Dugan was a member of the Olmsted County Medical Society, the
Southern Minnesota Medical Association, the Minnesota State Medical So-
ciety, the American Medical Association, and other professional groups,
among them the American Association of Railway Surgeons. He took an
active part in the work of all, serving on committees and contributing scien-
tific papers on a wide range of subjects. Concerning one paper an incident,
still cited, occurred at a meeting of the American Medical Association,
710
Minnesota Medicine
HISTORY OF MEDICINE IN MINNESOTA
when Dr. Dugan was to make his first appearance before the surgical section
of that assembly : Dr. W. J. Mayo was chairman of the section, Dr. Dugan
was on the program for one o’clock, Dr. Mayo had introduced him and he
was starting to read, when there was a rush at the door and a murmur
through the hall that Dr , a famous surgeon of Chicago, listed
on the program much later, was here, wished to read his paper now, could
not wait. Dr. Dugan, paper in hand, was much embarrassed and turned to
leave the platform as the Chicago surgeon walked confidently forward amid
enthusiastic applause. Dr. Mayo quietly announced once more that Dr.
Rollo C. Dugan, of Eyota, Minnesota, would now give his paper, and the
country surgeon gave it.
Dr. Dugan was health officer and county physician, postmaster at Eyota
from 1903 to 1904, and was active in civic and social organizations. He was
a Republican, a member of high standing in Masonry in St. Charles and
Winona lodges. He drove fine horses, was a member and founder of the
Eyota Driving Park Association, enjoyed fishing, was a good shot and an-
nually went hunting in the years when prairie chickens were plentiful in
Minnesota and the Dakotas.
In 1913 Dr. Dugan and Dr. Dorr F. Hallenbeck, then of Goodhue, planned
to enter partnership for practice in Nebraska, and Dr. Dugan was to be re-
placed in Eyota by Dr. Fred L. Smith, then of Chatfield (since 1917 Dr.
Smith has been with the Mayo Clinic in Rochester). Because of unavoidable
delay in arrangements, Dr. Dugan urged Dr. Hallenbeck to take an op-
portunity that offered with the Drs. Mayo at Rochester. He himself was in
Valentine, Nebraska, briefly, later was a few months in Winona. In 1914,
“after making a success of a stirgical hospital for eighteen years in a town
of less than 500 inhabitants” (Eyota), he settled in Ottawa, Kansas, where he
spent the remaining thirteen years of his life in active surgical practice, the
greater part of that period with the Ransom Memorial Hospital. He was
a member of the Franklin County Medical Society and the Kansas State
Medical Society and continued to be a worker for civic improvement.
Rollo Carlton Dugan died at Ottawa, Kansas, on June 10, 1927, aged -sixty-
two years, from carcinoma of the jaw and throat, survived by his wife, four
children, several grandchildren, and nieces and nephews. The one daughter
died some years later. In 1945 Mrs. Dugan and her son Melvin Millet Dugan,
a chemist, were in Chicago; Nathan Clay Dugan was in Wichita, Kansas;
and Rollo C. Dugan, in Fort Wayne, Indiana. A nephew, William j". Dugan,
was a resident of Rochester, Minnesota.
M. N. Dyer, aged forty years, died in Rochester, Minnesota, on April 18,
1863. The Rochester City Post of May commented as follows: “Dr. Dyer was
a physician of large practice and great skill and during his brief residence
in this city he had won by his generous impulses and warm heart a large
circle of friends.”
(To be continued in the August issue)
uly, 1950
711
Pi esideH.Cs feUel
NO AGENDA OF PROMISES
Totalitarianism, it has been said, begins with promises, ends with control. The
American people have been looking closely at this historical truth during the last
several years, as promises of security have beckoned them down the path to
government control.
Dominant have been the promises of universal medical care, promises which
apparently entail no thought or effort on the part of the recipients in making them
reality.
The American Medical Association, meeting in annual session at San Francisco,
made no promises, offered no effortless solution to the problems that remain in the
field of medical care and those that will emerge with the shiftings of economic,
sociologic and political developments. But in seventy-four definitive and aggressive
actions, American medicine offered the public an opportunity to work with the pro-
fession in raising even higher the standards and application of medical science.
Medicine demonstrated again its acceptance of the responsibilities of leadership
contingent upon the practice of this profession.
This recently concluded meeting of the nation’s physicians has been an historic
one, particularly from the standpoint of public interest and participation. As Dr.
Elmer Henderson, AMA’s new president, said June 27 :
“There is a vital reason for this new policy. Our affairs are no longer just medical affairs.
They have become of compelling concern to all the people.
“American medicine has become the blazing focal point in a fundamental struggle which
may determine whether America remains free, or whether we are to become a Socialist State,
under the yoke of a government bureaucracy, dominated by selfish, cynical men who believe
the American people are no longer competent to care for themselves.”
We have taken the public into our confidence, setting forth our ideals, our objec-
tives, the methods we feel to be most effective, as well as most analagous to the
traditional freedom-respecting and evolutionary action that has characterized this
nation and made it unique in progress and strength.
The results of combined medical thinking at the AMA meeting are of profound
importance, and every physician should familiarize himself with the policies which
have been developed so that these policies will culminate in early, unified action.
President, Minnesota State Medical Association
712
Minnesota Medicine
♦ Editorial ♦
Carl B. Drake, M.D., Editor; George Earl, M.D., Henry L. Ulrich, M.D., Associate Editors
STATE OFFICERS ELECTED
T the annual meeting of the Minnesota State
Medical Association, convened at Duluth
lune 12, 1950, the following officers for 1951
vere elected by the House of Delegates :
President-Elect — Dr. J. F. Norman, Crookston.
First Vice-President— Dr. Willard White, Min-
leapolis.
Second Vice-President — Dr. A. E. Brown,
Rochester.
Secretary (reelected) — Dr. B. B. Souster,
Saint Paul.
Treasurer (reelected) — Dr. W. H. Condit,
Vlinneapolis.
Speaker of House of Delegates ( reelected)
Dr. C. G. Sheppard, Hutchinson.
Vice-Speaker of House of Delegates (reelected)
—Dr. Haddon Carryer, Rochester.
Dr. John Francis Norman, the newly chosen
yresident-elect is a native of Minnesota and re-
vived his medical degree from Hamline Medical
College in 1907. He has practiced surgery at
Srookston since graduation and has been active
n local and state medical affairs, having served
an numerous state medical committees.
TERRAMYCIN
A NEW ANTIBIOTIC, terramycin, has been
added to the list of agents used in the treat-
ment of infectious diseases. Terramycin was iso-
lated from cultures of Streptomyces rimosus and
first reported by Finlay and his colleagues in
January of this year. Its name was derived from
the fact that the growth presented a cracked ap-
pearance on the surface of the agar medium.
Terramycin is a yellow crystalline amphoteric sub-
stance which is highly stable in the dry form. It
was established that this antibiotic possesses anti-
microbial activity against a wide range of patho-
genic organisms, and at the same time a low
degree of toxicity in laboratory animals was
demonstrated. In March, Hobly and co-workers
published reports containing more detailed in-
formation concerning the antimicrobial activity
of this drug. It was found to be effective against
a wide variety of aerobic and anaerobic Gram-
negative and Gram-positive bacteria and certain of
the rickettsiae. The observation that this sub-
stance possesses an extremely low degree of
toxicity was again affirmed. Extensive studies on
absorption and excretion in animals reported at
the same time indicated that terramycin is ab-
sorbed readily after either oral or parenteral ad-
ministration and is excreted in a biologically active
form. The first studies directed toward the use of
terramycin in man were reported in April from
the Mayo Clinic. It is apparent from this re-
port that terramycin is readily absorbed after
oral administration of 1 gm. and that rather con-
stant blood levels are maintained for approxi-
mately six hours. After this six-hour period
there is a gradual decline with minimal activity
still demonstrable in some instances after twenty-
four hours. The therapeutic adult dose was there-
fore established at 1 or 1.25 gm. administered
orally every six hours.
Terramycin for intravenous use is under in-
vestigation at present. It was found that this an-
tibiotic diffuses readily through the placenta into
the fetal circulation and into the pleural fluid ;
however, unlike aureomycin, little or no terramy-
cin crosses the barrier between the blood and the
brain.
Farge quantities of terramycin are excreted in
the urine. Smaller but significant amounts appear
in the bile. When administered by the oral route
large amounts are not absorbed but are excreted
in the feces.
Clinical experience based on the report by Her-
rell and co-workers and on recent reports in the
Journal of the American Medical Association in-
dicate that this antibiotic is therapeutically ef-
fective in a wide variety of infectious diseases.
In this respect its action is similar to that of
aureomycin. It is apparent, however, that al-
though these drugs are similar in many respects
there are significant differences. Many of the
common infections of the upper part of the
respiratory tract including septic sore throat, acute
July, 1950
713
EDITORIAL
follicular tonsillitis anti acute laryngotracheitis
have responded to its use. Terramycin is ex-
tremely efficient in the treatment of the bacterial
pneumonias, and the results in whooping cough
are promising. Infections of the urinary tract
due to susceptible organisms are rapidly brought
under control ; these organisms to date include
Escherichia coli and Aerobacter aerogenes. Un-
doubtedly, with further clinical experience more
of the bacteria causing infections of the urinary
tract will be added to the list of those already
mentioned as being effective. Similarly, pyelone-
phritis responds in a satisfactory manner to the
action of this drug. Septicemia owing to Escher-
ichia coli and bacteroides has been treated with
excellent results. Terramycin produced no de-
monstrable effect in one case of herpes zoster. It
is certain that as clinical experience with this new
antibiotic widens it will be found that its therapeu-
tic range of activity is much greater than indicated
above.
Terramycin is a relatively nontoxic substance.
This statement is supported by the fact that to
date the only toxic reaction ascribed to its use
is occasional gastrointestinal irritation manifested
by nausea and, on occasion, vomiting. Usually
these symptoms can be obviated by the simultane-
ous administration of milk. Furthermore, it has
been established that milk does not interfere with
the absorption of this drug.
W. E. Wellman, M.D.
CLOAKING OF SIGNS AND SYMPTOMS
BY CORTISONE AND ACTH
ADMINISTRATION
'T1 HE wonder drugs, Cortisone and ACTH,
are finding a limited place in therapy. There
is accumulating evidence that the acute reaction to
rheumatic fever may be limited in extent of in-
vasion and distortion (valves of the heart or its
musculature) ; and the obvious allergic reactions
of hay fever are held in abeyance while the sea-
son passes over. No one, so far, has indicated
clearly whether this withholding of the symptoms
and signs of such definite entities as rheumatic
fever has any limiting influence upon their natural
course, or the development of natural remissions
and immunity. Whatever these sequences are that
restore body balances and constants in the sense
of Walter B. Cannon’s homeostasis, the supposi-
tion has been that this interaction of attacking
agent (whatever type) and the mechanisms of
bodily resistance (fever, leukocytosis, connective
tissue reaction and healing) represents on the
whole a salutary conflict.
Now come reports from various sources, con-
spicuously from McGill University,* Montreal,
Canada, presenting some unlooked-for side-effects
in terms of the masking of common disease enti-
ties and the possible inhibition of healing due to
faulty collagenous tissue activity. Two instances 1
of diffuse peritonitis developed while the patients 1
were under treatment with ACTH. The first was i
an instance of Hodgkin's lymphoma where an up-
per respiratory infection developed into a ques- 1
tionable pneumonia of the right lower and middle
lobes. While the patient’s symptoms and reac-
tions were mild, nevertheless at post-mortem a
‘‘heavy growth of pneumococci” was cultured
from the blood of the heart and the fluid in the
peritoneum was part of a diffuse peritonitis. In
another instance, a patient under treatment with
ACTH for severe asthma suffered a vague ab-
dominal attack where it was found that an ulcer
of the duodenum had perforated.
Such experiences may call for extra watchful-
ness in the exhibition of Cortisone and ACTH.
Indeed, our entire concept of nosology may need
revamping. When the symptoms of pneumonia
abate meanwhile systemic bacteremia develops ;
and when there is a response to conditions as dif-
ferent as is Addisonian anemia (responding in an
exacerbation quite as definitely as does the rheu-
matoid arthritic), it would appear that these novel
agents need the closest checking, not only when
used therapeutically but in investigative research.
E. L. Tuohy, M.D.
A ROSE BY ANY OTHER NAME
TN AN EDITORIAL entitled ‘‘Defeat of Reor-
ganization Plan No. 1,” which appeared in our
September, 1949, issue, we explained how Plan
No. 1 was defeated by vote of the Senate on
August 16, 1949, largely, we believe, as a result
of what amounted to a pilgrimage to Washington
by representatives of the State Medical Associa-
tions throughout the nation. Plan No. 1 provided
for the establishment of a Welfare Department
in our Federal Government to be headed by a
layman and to include social security, education
and most health activities of the Federal Govern-
ment. The medical profession has been ad-
714
‘Beck, J. S., et al: Canadian M. As. J., 62:423, (May) 1950.
Minnesota Medicine
EDITORIAL
ocating for years a separate Federal Department
ncompassing the health activities of the Federal
iovernment with a medical man in charge as a
lember of the Cabinet. We believe that the
ealth activities of the Federal Government affect
nough people and are important enough to
warrant such treatment as recommended by the
'ask Force of the Hoover Commission. We
ielieve that to include health activities with social
ecurity and education at present with the idea of
ater effecting a separation is not likely to be
ccomplished, and the profession does not want a
ayman and someone who is so obviously a
ocialist, like Oscar Ewing, to handle govern-
nental health activities.
In spite of the opposition of the medical pro-
:ession — so forcibly expressed in Washington
ast August — the President has submitted his
Reorganization Plan No. 27 to Congress which is
substantially the same as last year’s Reorganiza-
ion Plan No. 1 and, as a matter of fact, the
same as S. 140 in the 80th Congress. Does the
President think the profession has changed its
nind, or does he expect to wear us down until
ve are ready to cry quits ? This matter of legis-
ation was important enough last summer to
warrant a special trip to Washington of repre-
sentatives from the State Medical Associations to
make our ideas known, buch action is expensive,
but if need be will undoubtedly be repeated.
* * *
As we go to press, the announcement comes that
the House, on July 10, vetoed President Tru-
man’s proposal for a new Department of Health,
Education and Security by the overwhelming vote
of 249 to 71. On the same date, the Senate execu-
tive expenditures committee voted 6 to 3 to reject
the new department and was set to kill the bill on
July 12. It will not be necessary now for the
Senate to take action. It remains to be seen
whether this demonstration of opposition to Presi-
dent Truman’s plan which was the same as that
defeated last August under another name will
prevent future attempts to cram this undesirable
legislation down the throats of the people con-
trary to the recommendation of the Hoover Com-
mission and the advice of the medical profession.
It should be noted that Representatives Mc-
Carthy and Blatnik voted for the proposal and
Representatives Andersen, Andresen, Hagen,
Judd and O’Hara were opposed.
GENERAL PRACTICE AND GP
GENERAL practitioners outnumber special-
ists two to one and constitute the backbone
of the profession. It merits repetition and em-
phasis that the challenge of general practice from
the standpoint of service to humanity and pro-
fessional interest, though less spectacular, is fully
as appealing as that of specialization. The im-
possibility of acquiring and keeping up with the
mass of medical knowledge already recorded and
published yearly has necessitated specialization.
Only the most talented and industrious specialist
can hope to keep up with the literature in his
limited field. The general practitioner must be a
voracious reader, indeed, and be able to pick and
choose and digest the medical literature available
and suited to his needs in order to keep pace with
medical progress. This requires an intelligence
of no mean caliber.
The general practitioner, especially if he be
located in a rural district, probably has the op-
portunity of knowing his patients better and for
longer periods of time than can the specialist.
Knowing more of a patient’s home environment,
habits, and peculiarities is a distinct advantage to
the patient and his physician in gauging the sig-
nificance of early symptoms. Such knowledge
has not infrequently warded off unnecessary treat-
ment, both surgical and medical.
In recent years, definite steps have been taken
not only to recognize the importance of the place
of the general practitioner in providing medical
care but in raising their quality. Special post-
graduate training for those planning to take up
general practice, refresher courses, the mid-winter
AMA meeting devoted to the general practitioner,
a general practice section in the AMA, and finally,
the formation of the American Academy of Gen-
eral Practice devoted to the improvement of the
general practitioner, may be mentioned.
The American Academy of General Practice
• held its second annual meeting at St. Louis in
December, 1949. This meeting was attended by
over 5,000 general practitioners who exhibited
even more enthusiasm and earnestness than at the
first meeting in 1948. For some time it has been
felt that the Academy should publish its own
journal devoted to the needs of the general prac-
titioner. The first issue in attractive format ap-
peared in April, 1950. Just as Volume I was
ready to go to press, the editor, Dr. F. Kenneth
Albrecht, died suddenly as a result of an auto-
715
July, 1950
EDITORIAL
mobile accident. This tragic ending of a talented
man in his prime before he could see the results
of his last labor was particularly distressing. By
an especially good stroke of fortune, the services
of Dr. Walter C. Alvarez, well-known gastro-
enterologist and writer, a member of the Mayo
Clinic for the past twenty-four years and editor
with distinction of Gastroenterology and The
American Journal of Digestive Diseases were
obtained. He has moved to Chicago and his name
appears as editor in the June issue. The journal
has a long list of eminent specialists on its Edi-
torial Advisory Board and in the capacity of Man-
aging Publisher, the able Mac F. Cahal. Dr.
Stanley R. Truman of Oakland, California, is
chairman of the Publication Committee as well as
president of d he Academy. The first articles to
appear in GP are of high calibre, and the section
on Practical Therapeutics is of very special value
to the general practitioner. We extend our best
wishes for the success of GP,* the launching of
which, though beset with tragedy, has been nev-
ertheless most auspicious.
THE AMERICAN JOURNAL OF PROCTOLOGY
he American Journal of Proctology made its
debut in March of this year. It claims to be
the first authoritative journal of proctology and
allied subjects and is owned and published quar-
terly by the International Academy of Proctol-
ogy, Inc., with editorial office at 43 Kissena
Boulevard, Flushing, New York, and business
office at 1819 Broadway, New York 23, New
York. Subscription price is $2.50 per year.
Members of the International Academy of Proc-
tology receive the journal in return for the pay-
ment of membership dues.
As explained editorially in volume one of this
new publication, the International Academy of
Proctology was formed on June 9, 1948, to unite
in one association, physicians who are interested
in this specialty. The American Board of Proc-
tology incorporated in 1935 has remained dor-
mant ever since but was approved by the Coun-
cil on Medical Specialties at a recent meeting.
Thus this Board becomes the eighteenth Exam-
ining Board in the specialties. An organization
meeting was held in conjunction with the Ameri-
can Medical Association meeting in Atlantic City
in June, 1949. The Academy’s first sceientific
meeting also was held on this occasion and its
•Editorial and Business Office, Broadway at Thirty-fourth
street, Kansas City 2, Missouri. Subscription price, $10.00 (to
members, $5.00).
716
second meeting was held at the Hotel Bellevue
in San Francisco on June 23, 24, 1950.
I he articles and abstracts appearing in the
first number of this infant journal indicate the
worthy purpose of the editors. Minnesota
Medicine extends its best wishes for the growth
and success of The American Journal of Proc-
tology.
BE JUST BEFORE YOU ARE GENEROUS
The various communities of the State, ranging from -
hamlets to large cities, face a serious problem of financial
drainage. It is a matter of great pride to self-respecting
citizens to be able to assist in the maintenance and better- ,
ment of local charitable enterprises and institutions such
as district nursing associations, the local hospitals, day
nurseries or child care centers, for example, as well as
various local religious institutions. Latterly, it seems to
be more and more difficult to raise sufficient money to
keep them going, even on a restricted basis, in spite of
unremitting labor by interested citizens. What are the
reasons for this difficulty?
High taxes for one thing, increased cost of living for
another. Yet another is the multiplicity of organizations
other than local whose appeals for aid siphon away small
community resources. This is to state a fact and in no
way to impugn the worthiness of these larger groups.
Physicians will be interested both as citizens and doc-
tors to know why financial support is increasingly hard
to obtain for local hospitals, district nursing associa-
tions, and other aids to medical practice as well as com-
munity assets.
A check by the National Information Bureau on national non-
profit organizations, nearly all of which solicit public aid, shows
an astounding number in existence.
There are, for example, no less than 75 national associations
dealing with public health, ranging alphabetically from those
concerned with Alcoholism through Hay Fever, Parenthood, So-
cial Diseases, and Veterans.
I here are 24 national organizations dealing with the problems
of Youth.
There are 31 which are solicitous for continuance of “Free
Enterprise” and the “American Way of Life” and the like.
There are five which are anxious about the American Indian
Welfare, 10 concerned with Conservation, 19 aroused over Civic
Affairs, 29 which deal with International Relations, 23 interested
in General Welfare, and no less than 72 seeking to help on mat- :
ters connected with Foreign Relief Aid and Rehabilitation, with
practically every other nation in the world on the receiving end i1
of American charity.
These are not fly-by-night organizations, mind you. Every
one of the more than 400 organizations listed by the bureau is
either national or international in scope.1
It has come to a point where drives for this and that
have begun to overlap each other. It is a rare morning
when the mail does not contain at least one and often
two or three appeals from various sources. To the more
than 400 organizations of national or international scope
must be added those of less than national but not purely
local character. There is, apparently, no limit.
In an expanding economy it is quite possible that all
of these appeals can somehow be met, but it is to be
kept in mind that the financial assistance asked is in
addition to the steady, enormous drain through taxes
to provide governmental subsidies to specially favored
groups, either domestic or foreign. Matters would be
much worse if any serious effort were to be made by
government to reduce the national debt of some $1,700
for every man, woman, and child in the nation. It will
have to be done sometime, somehow.
Meanwhile we hope that some thought will be given
to a return to the time-proved maxim, “Be just before
you’re generous.” Be sure your purely local institutions
do not lack the financial assistance they merit. — Editorial
N. Y. State J. Med., June 15, 1950.
1Ossining Citizen Register, April 20, 1950.
Minnesota Medicine
Medical Economics
Edited by the Committee on Medical Economics
of the
Minnesota State Medical Association
George Earl, M.D., Chairman
ienator McClellan blows away the
FOG
Senator McClellan, who spoke at the second
nnual Minnesota Medical Press conference in
tpril, recently reported to Congress on federal
pending. His report is the subject of an editorial
a the Wall Street Journal, which credits him with
learing away some of the fog surrounding the
overnment-stated reasons for increased federal
xpenditures. The Journal says :
“In recent weeks there have been repeated suggestions
rom Administration officials at Washington that the
Treasury deficit is due to tax cuts made by the Re-
mblican Congress in 1948. Also, there have been hints
hat the fight against Communism accounts for rising
Government expenditures.
“Now Senator McClellan of Arkansas comes along
vith a report that blows away the fog that settled
tround the fiscal situation as a result of such suggestions.
The Senator should know about such matters ; he’s chair-
nan of the Senate Committee on Expenditures in the
executive Department. And, of course, he’s a Demo-
:rat, which removes any possibility that he’s only having
i political tiff with the Administration.”
Spending Increases in Four Categories
The Senator’s report shows that in the coming
fiscal year spending in four categories that can’t
possibly be related to fighting Communism, will
account for a rise of more than $4 billion. The
four categories are : social welfare, housing, farm
price supports and public works. Spending for
social welfare will be $845 million greater mostly
due to grants to states for public assistance, public
health and hospital construction. Spending for
housing accounts for a $1,247 million increase.
Spending for farm price supports and other aid-
the-farmer efforts means an increase of $1,632
million. Spending for public works will rise $458
million due chiefly to river and harbor work.
The Journal "Heartily Agrees"
Seconding the report of Senator McClellan, and
realizing where taxes go and why the government
is involved so deeply in deficit spending, the Wall
Street Journal concludes:
“Those figures add up to $4,182 million. And that
would about equal the deficit that’s being incurred in
the present fiscal year. When a Government is bent on
spending money as fast as it can it’s almost certain to
find excuses for the red ink created. The tax cut of
the 1948 Congress is an easy alibi ; so is the anti-
Communist effort. But the real truth of the fiscal situa-
tion is that spending is on the rise almost everywhere
you look.
“In submitting his report to the Senate, Mr. McClellan
warned that ‘this tremendous rising cost (of Govern-
ment) is indicative of a fixed permanent trend that can-
not be ignored or remain unchallenged.’ And he added
that this provides a ‘warning of compelling force against
our proceeding with reckless indifference to enact more
and more laws expanding present governmental services
and instigating new programs creating additional gov-
ernmental obligations that will add billions annually to
the already swollen costs of government.’
“We heartily agree.”
PURCHASING POWER NOW LESS THAN
IN 1931
Due to taxes and inflationary prices, it was
shown in a recent bulletin of Insurance Eoconom-
ics Surveys, that although dollar salaries in 1950
are considerably greater than those of 1931, the
purchasing power of 1950’s salary is only a
little more than half that of the salary of 1931.
Citing the news story of baseball player Ted
Williams’ recent signing with the Red Sox for a
record pay of $125,000, the Survey compared his
salary with that of Babe Ruth in 1931.
In a graphic presentation, the article showed
that, while the salary of Babe Ruth in 1931 was
only $80,000, his take-home pay amounted to more
than Williams takes home today — Ruth $68,535,
Williams, $62,028. This compares the two after
taxes were removed. The Survey says :
“Inflation has shrunk the buying power of the dollar
since 1931, so Williams’ real take-home pay is only a
little over half of Ruth’s — 57 per cent. ... If Ted Wil-
liams were to have as much buying power in 1950 as
Babe Ruth had in 1931, he would have to be paid
$327,451.”
Thus, more facts help convince tax-burdened
Americans that proposed government bills would
July, 1950
71 7
MEDICAL ECONOMICS
increase taxes, thereby lowering take-home pay
and lowering the buying power of American sala-
ries.
DEWEY ADVISES AVOIDING NEVER-NEVER
LAND
Governor Thomas E. Dewey, speaking recent-
ly at Princeton university, took a sober look at the
situation causing some people to advocate adoption
of compulsory government medicine, and charged
that the administration is “making a strong polit-
ical issue out of support of a compulsory national
health bill.”
By this bill,” Dewey said, “heavy additional
payroll deductions or comparable taxes would be
imposed on the entire population. Everyone
would then get so-called ‘free’ medical, dental, sur-
gical and hospital care, as in Great Britain. Mr.
Truman says this is not socialized medicine. The
British admit that it is. They ought to know.”
Believing that not all is perfect in medicine, or
in any field, Dewey declared that socialized medi-
cine is not the way to remedy ills which are far
less obvious than medical advances :
“Of course, there are urgent problems still to be
met in the field of medical care. There always will be.
Many communities need hospitals. The cost of illness
can often be disastrous to an individual family. Med-
ical schools are having a tough time meeting their budg-
ets— as who is not? In many areas we could use more
doctors and dentists. But to leap from these admissions
to the conclusion that socialized medicine is the only
cure, is like cutting off your head because you have a
headache.
“Let’s take a sober look at where we are before we
jump into the Never-Never Land.
“The simple fact is that American medicine is' today
the finest in history. - Our entirely free medical profes-
sion and its allied scientists have conquered scourges such
as diphtheria, smallpox, typhoid and scarlet fever, which
once wreaked terror over whole nations. Even pneu-
monia is on its way out as a killer and significant prog-
ress has been made with such stubborn problems as
leprosy, infantile paralysis, heart disease and cancer.
“The life expectancy of Americans has been increased
twenty years in just the past half century. In the last
third of a century the rate of infant mortality has been
cut by three-quarters. Insofar as medical personnel is
concerned, we have more doctors per capita than any
other great nation in the world.”
Lenin An Expert on Subject
Dewey then made his to-the-point conclusion :
“I cannot prove that compulsory medicine is the key-
stone of the arch of a totalitarian state, but Lenin said
that it was and he was an expert on the subject.”
718
COMMITTEE QUOTES WORDS OF WISDOM
Proving again that the wisdom of freedom is
time-honored, the committee for Constitutional
Government quotes the following:
IT If AS WISDOM AGES AGO: Men too often,
in their revenge, set the example of doing away with
those general laws to which all alike can look for salva-
tion in adversity. — Thucydides, 426, B. C.
“IT WAS WISDOM TWO GENERATIONS AGO:
All socialism involves slavery. What is a slave? We
primarily think of him as one who is owned by another.
The essential question is: How much is he compelled
to labor for other benefit than his own? The degree
of his slavery varies according to the ratio between that
which he is forced to yield up and that which he is !
allowed to retain ; and it matters not whether his mas-
ter is a single person or society. If, without option,
he has to labor for society and receives from the gen-
eral stock such portion as the society awards him,
he becomes a slave to society. Socialistic arrangements
necessitate an enslavement of this kind. — Herbert Spencer,
The Man Versus the State, 1884.
“II IS WISDOM TODAY: The chief threat to hu-
man rights is no longer one of too little government.
Freedom’s greatest threat today is too much govern-
ment, that all limits to government action may be
swept away. Is there to be no line beyond which gov-
ernment shall not go, as it is in Soviet Russia, and
becoming so in socialistic England? The plunder of
our natural resources has been largely checked. Are
we now to have a system of plunder of the national
treasury? Is the old ‘let me alone’ philosophy to be
replaced by nothing better than ‘gimme mine’ philosophy?
• — Bernard M. Baruch.”
And, additional quotes on freedom from gov-
ernment interference are meaningful and relevant :
“Today, federal taxation and government borrowing
against the future are not merely . . . nuisances, they
are major determinants of business policy, and they
dominate and shape the course of our economic develop-
ments, the level of our prices and the extent of our
national wealth. They are a lien of enormous size upon
our past savings and upon our future production. —
Monthly Digest of Business Conditions.
“Freedom exists only where the people take care of
the government.— Woodrow Wilson.
“In a socialistic state, all men are theoretically equal
financially. This country has already qualified with :
Income taxes, final equalizer of all incomes.
Social Security, misnomer for another tax.
Federal grants, money taken from you, then you match
it, and part of it comes back. . . .
Estate and inheritance taxes, they get you after you’re
gone. — Berea (Ohio) Enterprise.”
Minnesota Medicine
MEDICAL ECONOMICS
MINNESOTA STATE BOARD OF MEDICAL
EXAMINERS
230 Lowry Medical Arts Building
Saint Paul, Minnesota
Julian F. Dubois, M.D., Secretary
UNLICENSED MASSEUSE PLEADS GUILTY TO
CRIMINAL ABORTION
Re: State of Minnesota vs. Florence Fossnm
On June 15, 1950, Florence Fossum, fifty-eight years
of age, residing at 3133 Oakland Avenue, Minneapolis,
was sentenced by the Hon. Rolf Fosseen to a term
of not to exceed four years in the Women’s Reforma-
tory at Shakopee. Mrs. Fossum had pleaded guilty on
May 3, 1950, to an information charging her with the
crime of abortion. Judge Fosseen, following a state-
ment by legal counsel for the Minnesota State Board of
Medical Examiners and the County Attorney’s office
of Hennepin County, stayed the sentence for three
years and placed Mrs. Fossum on probation, one of the
conditions being that the defendant is to refrain from
the practice of healing and specifically is forbidden to
engage in the practice of massage or the operation of
a health food store.
Mrs. Fossum was arrested by Minneapolis police offi-
cers on March 24, 1950, following the admission of a
forty-year-old married Minneapolis woman to a Min-
neapolis hospital. The patient was seriously ill with
an infection following a criminal abortion. Upon being
questioned, the patient stated that the abortion was per-
formed by a woman by the name of “Florence” who
operated a store at 215 W. Lake Street, Minneapolis.
The defendant was promptly arrested and upon being
arraigned in the Municipal Court at Minneapolis, de-
manded a preliminary hearing which was set for April
12. However, Mrs. Fossum changed her mind, waived
the preliminary hearing and entered a plea of guilty in
the District Court. At the time of Mrs. Fossum’s arrest
Minneapolis Police Officers seized medical and surgical
equipment used in the performing of abortions. Mrs.
Fossum stated that she was a masseuse. However, she
admitted that she holds no license to practice massage
or any other form of healing in the State of Minnesota.
OPERATOR OF MEAT MARKET AND GROCERY STORE
PLEADS GUILTY TO ABORTION
Re: State of Minnesota vs. Paul C. Schwedc
On June 20, 1950, Paul C. Schwede, forty-five years
of age, who operates a grocery store and meat market at
259 Cedar Ave., Minneapolis, was sentenced by the Hon.
Rolf Fosseen, Judge of the District Court of Hennepin
County, to a term of not to exceed four years in the
State Prison at Stillwater for the crime of abortion.
Judge Fosseen stayed the sentence for three years and
placed the defendant on probation after Schwede has
served three months in the Minneapolis Workhouse.
Judge Fosseen also ordered Schwede’s surgical instru-
ments confiscated and turned over to the Minneapolis
General Hospital.
Schwede, who holds no license to practice any form
of healing in Minnesota, was arrested on May 23, 1950,
following the hospitalization of a nineteen-year-old di-
vorcee who was suffering from an infection from a
criminal abortion. Minneapolis police officers found
a practically new medical kit containing three speculums,
a dozen catheters, surgical instruments and seven bot-
tles of . various medicinal preparations at Schwede’s place
of business at the time of his arrest. The investigation
July, 1950
disclosed that the abortion was performed at the home
of a former employe of Schwede’s. A fee of $400 was
paid for the abortion but Schwede’s former employe con-
cealed from him the fact that she withheld $250 of the
fee. The accomplice was not prosecuted because she
disclosed the facts leading to Schwede’s arrest.
Judge Fosseen questioned Schwede carefully about
his prior activities and he stated to the Court that, while
he lived at 2084 Roblyn Avenue, Saint Paul, he had been
in business in Minneapolis for a number of years. He
admitted to the Court that he had performed a total
of seven criminal abortions since the fall of 1949. When
asked by Judge Fosseen as to how he learned to do
abortions, he replied : “By reading medical books.”
Schwede said that he had been in financial difficulties
and for that reason sought to supplement his income.
The records of the United States District Court in Min-
neapolis disclose that on November 4, 1946, Schwede
was fined $200 following a plea of nolo contendere to an
information charging him with a conspiracy against the
United States in connection with the illegal use of coun-
terfeit sugar stamps.
PAN AMERICAN SANITARY BUREAU TO ASSIST
VENEZUELA IN PLAGUE SURVEY
Commander Julius M. Amberson, of the U. S. Navy,
Bureau of Medicine and Surgery, left Washington early
in July for Venezuela to lend assistance to health au-
thorities in making a survey of plague in that country,
it was announced by the Pan American Sanitary Bureau,
Regional Office of the World Health Organization.
Commander Amberson is accompanied by Dr. Ernst
Schwarz, also of the Bureau of Medicine and Surgery.
A small focus of plague in Venezuela has caused
sporadic outbreaks of human cases over a period of
years. This plague reservoir recently became active
again, and the Ministry of Health requested the technical
assistance of the Pan American Sanitary Bureau in
making a thorough study of this problem with a view to
the elimination of the center of infection.
The Bureau obtained the collaboration of Commander
J. M. Amberson of the U. S. Navy. Commander Am-
berson has had considerable experience on field surveys
of rodent and flea populations, and will make an epi-
demiological rodent and insect survey of the infected
area. The site chosen for the study is the Campamento
Rafael Rangel, 4,132 feet above sea level, and the study
unit will spend from six to eight weeks in this endemic
area of Venezuela.
ALL-INCLUSIVE CHEST SERVICE
The care, the study and the teaching of tuberculous
disease today should be the responsibility of the broadly
trained medical internist-investigator in close association
with the highly proficient, experienced chest surgeon as
part of the larger problem of the better understanding
and control of all cardiopulmonary diseases involving the
chest. Such an all-inclusive chest service should be an
integral part of every large general hospital and medical
teaching center, in the best interests of patients, physi-
cians, undergraduate medical students and resident staff.
This means medical center segregation in the future,
rather than sanatorium isolation as in the past, with the
tuberculous patient receiving equal acceptance and com-
plete attention, including prompt recognition and specific
treatment of his nontuberculous complications which oft-
times threaten his existence more seriously than does the
tuberculosis, itself. — Chari.es A. Doan, M.D., Ohio Pub-
lic Health, May, 1950.
719
Minnesota Academy of Medicine
Meeting of February 8, 1950
The regular monthly meeting of the Minnesota Acad-
emy of Medicine was held at the Town and Country Club
on Wednesday evening, February 8, 1950. Dinner was
served at 7 o’clock and the meeting was called to order
at 8:10 p.rn. by the President, Dr. William A. Hanson.
Minutes of the January meeting were read and ap-
proved.
The Secretary then read the annual report of the
Treasurer and this was accepted.
The Executive Committee reported that it had ap-
proved the transfer to the Senior List of the names of
Drs. Benjamin, Ulrich, White and Benedict.
The Executive Committee also reported that it felt
the Constitution of the Academy should be studied and
changes recommended ; Dr. Lepak and others will go over
this carefully and the recommended changes will be
voted on at a future meeting.
The scientific program then followed.
RECENT ADVANCES IN THE BRONCHOSCOPIC STUDY OF PULMONARY
DISEASE
ROBERT E. PRIEST, M.D.
Minneapolis, Minnesota
Rapid advances in the surgical management of intra-
thoracic disease have been made recently. One phase
of this advance has included refinement of bronchologic
methods. Accurate and simplified nomenclature to de-
note various parts of the lung, the use of bronchoscopic
of one or more members of the thoracic surgical team.
This team includes the physician who originally sus-
pects and diagnoses the pulmonary disease, the thoracic
surgeon, the radiologist who has special knowledge and
interest in pulmonary topographic anatomy and pa-
BRONCHOSCOPIC REPORT
Lob*
Upper
Lower
L1&2 Apical-
R1
Apical
Upper Division
posterior
Upper
R2
Posterior
(L3
Anterior
R3
Anterior
Lower Division
[L4
Superior
(R4
Lateral
(lingular)
LS
Inferior
Middle
R5
Medial
L6
Superior (apical)
R6
Superior (apical
L7&8 Anterior-medial Basal
R7
Medial Basal
L9
Lateral Basal
Lower
R8
Anterior Basal
L10
Posterior Basal
R9
Lateral Basal
RIO
Posterior Bas
Fig. 1. Bronchoscopic report form using simple descriptive names and numbers to
designate bronchi. (Adapted from Jackson and Huber, Overholt, and from Boyden.)
telescopes, and improvement in the collection of speci-
mens for cytologic and histologic study have been devel-
oped. Each of these procedures entails the participation
Dr. Priest is Clinical Assistant Professor of Otolaryngology,
University of Minnesota Medical School, and Chief of Ear, Nose
and Throat Service, Minneapolis General Hospital.
thology, the pathologist who is trained in pathologic cy-
tology as well as histology, the anesthesiologist and the
bronchoscopist. Each member of the team must of
necessity be familiar with much of the knowledge and
with the thought processes of other members of the
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Minnesota Medicine
MINNESOTA ACADEMY OF MEDICINE
Fig. 2. ( Upper left) Normal right bronchogram showing upper,
middle and lower lobe bronchi and their subdivisions outlined by
lipiodol.
Fig. 4. ( Lower left) Cyst of right upper lobe showing fluid
level.
team; the patient is best. served when the entire group is
closely integrated. Several phases of bronchology will
now be examined more closely.
The use of accurate simple nomenclature enables the
Fig. 3. ( Upper right ) Normal left bronchogram showing good
lower lobe filling. Upper lobe demonstration on this particular
film is not especially good but all lobes; can seldom be demon-
strated on a single film.
Fig. 5. ( Lower right) Cyst of right upper lobe with lipiodol
outlining bronchi and entering cyst.
radiologist, bronchoscopist and thoracic surgeon to dis-
cuss pulmonary conditions with great accuracy. Early
bronchial anatomic classifications were confusing and
complex. Boyden1'2 and Brock3 have published excellent
July, 1950
721
MINNESOTA ACADEMY OF MEDICINE
Fig. 6. ( Upper left ) Carcinoma of right upper lobe.
Fig. 8. ( Lower left ) Postero-anterior chest film showing mot-
tled density of right middle lobe area. (See figure 9.)
reviews of the papers on this subject. In 1943 Jackson
and Huber8 outlined a simple descriptive classification.
In 1945 Boyden7 further simplified this system by adding
numbers to the names of the main branch bronchi.
Boyden’s numbering system extends beyond the ten pri-
mary bronchi ; he uses letters and numbers to designate
arteries and veins in the same way. Overholt and
Fig. 7. ( Upper right ) Same case as Figure 6, lipiodol out-
lining closed upper iobe bronchus by tumor biopsied broncho-
scopically.
Fig. 9. ( Lower right ) Same as Figure 8 but bronchiectatic
cavities of right middle lobe are now filled with lipiodol. Left
lung normal.
Danger'1 emphasize the facility with which the surgeon
can use numbers to designate certain bronchi.
Numbers are easy to use, and the classification is kept
from becoming complex by numbering only those
bronchi seen by the bronchoscopist either by direct vision
or through the bronchoscopic telescope. A combination
of the two methods with the diagram of the lung turned
722
Minnesota Medicine
MINNESOTA ACADEMY OF MEDICINE
Fig. 10. ( Upper left ) Same case as Figures 8 and 9; bron- Fig. 11. ( Upper right) Same as Figure 10 with addition of
:hiectatic cavities in right middle lobe seen from the side without lipiodol to outline bronchiectatic cavities,
ontrast medium.
Fig. 12. ( Lower left) Another case of bronchiectasis and Fig. 13. ( Lower right) Increased density of right lower lobe
itelectasis of right middle pulmonary lobe outlined by lipiodol. due to carcinoma biopsied bronchoscopically.
ipside down to coincide with the bronchoscopist’s point
}f view is the method used here. Figure 1 illustrates
:he bronchial naming system. With all members of the
:horacic surgical team using the same names for parts
of the lung it is obvious that accuracy is greatly in-
creased.
Complete mapping of the main branches of the bron-
chial tree can be done when the bronchoscopist and radi-
July, 1950
723
MINNESOTA ACADEMY OF MEDICINE
Fig. 14. Same case as Figure 13 showing filling defect of
right lower lobe bronchus ( sec arrow).
Fig. 15. Same as Figure 14 but “spot” film showing filling
defect at junction of right lower and middle lobes.
Fig. 16. The right angle bronchoscopic telescope is shown.
This instrument allows the bronchoscopist to look directly into
the right and left upper lobe bronchi and the dorsal apical divi-
sions of the lower lobes. The bronchi run at right angles from
the main bronchi and cannot be seen through the bronchoscope
alone.
./V
t
\ /
Fig. 17. Three angles of vision are possible through the right
angle, forablique and retrograde telescopes.
Fig. 18. Specimen collectors permitting aspiration of material into detachable suc-
tion tips where the specimens are trapped on cotton.
ologist unite their efforts. Poor and incomplete broncho-
grams are often seen. They do not permit accurate un-
derstanding of the extent and nature of the pulmonary
disease process under consideration, and like all poor
radiographs give a false sense of security to the patient.
Completely adequate topical anesthesia of the bronchial
mucosa, fluoroscopic visualization during instillation of
the contrast medium, and the proper use of “spot” and
conventially made films produce excellent maps of the
pulmonary airways. (Figs. 2-15). A recent complete
treatise on radiologic bronchial study is that of Di Rien-
zo.5
The use of telescopes for magnified, brilliantly illumin-
ated visualization of the bronchial tree has been possible
recently. Broyles of Johns Hopkins University devel-
oped telescopes for bronchoscopic use by modifying
cystoscopic telescopes. The bronchoscopist can now
make accurate visual examination of bronchi whose
axes are at right angles and at various obtuse and
acute angles to the main bronchi. Accurate diagnoses
can be made by visualizing pathologic processes lying
entirely outside the range of the ordinary tubular bron-
choscope (Figs. 16 and 17).
The collection of specimens for bacteriologic and
cytologic study has been improved as better aspirating
devices have come into being. The collector devised by
724
Minnesota Medicine
MINNESOTA ACADEMY OF MEDICINE
erf of Jefferson University Medical School has per-
iled selective aspiration of various bronchial lobes
d segments (Figs. 18 and 19).
The cytologic study of such aspirated material has
Discussion
Dr. L. R. Boies, Minneapolis : The excellence of this
presentation makes any discussion rather superfluous.
Recently, I have been re-reading “The Life of Cheva-
Fig. 19. Clerf aspirator in which specimen is trapped in glass tube. Detachable
aspirating tips are shaped so that they may be introduced into various bronchi for
aspiration from a particular segment of the lung.
:come an important subspecialty in the field of pa-
ology. Bronchial washings submitted for study must
: evaluated on a basis of cytology rather than micro-
opic tissue anatomy. The pathologist must be familiar
ith changes in individual cells and does not have the
iportunity to base his diagnosis on abnormal tissue
chitecture. Foot6 says, “The cytologic method has
oved to be extraordinarily reliable.” He quotes Fre-
ont-Smith, Graham and Meigs7 who said, “A negative
port does not rule out cancer. Confirmation by biopsy
almost obligatory. False positive reports can be very
nbarrassing to the cytologist.” One may remark par-
ithetically that the embarrassment is not limited to
e cytologist !
When all of the methods discussed here are applied
a particular patient having pulmonary disease an ac-
lrate diagnosis and proper therapy are likely to result.
References
. Boyden, E. A.: The intrahilar and related segmental anat-
otny of the lung. Surgery, 18:706-731, (July-Dee.) 1945.
!. Boyden, E. A.: A synthesis of the prevailing patterns of the
brorcho-pulmor.ary segments in the light of their variations.
Dis. of Chest, 15:657-668, (June) 1949.
i. Brock. R. C.: The Anatomy of the Bronchial Tree. Oxford
Medical Publications. London: Oxford University Press,
1947.
r. Diggs, L. W. : Use of Wright’s stain in diagnosis of malig-
nant cells in bronchial aspirations. Am. J. Clin. Path., 18:
293-302, (April) 1948.
I. Di Rienzo, S.: Radiologic Exploration of the Bronchus.
Springfield. Illinois. Charles C Thomas, 1949.
i. Foot, N. F. : Evaluation of exfoliative cytology from the
viewpoint of the pathologi=t. 1948 Yearbook of Pathology,
pages 40-45. Chicago: Yearbook Publishers, Inc., 1949.
'. Fremont-Smith, M.; Graham, R. M., and Meigs, J. V. :
Early diagnosis of cancer by study of exfoliated cells.
J.A.M.A., 138:469, (Oct. 16) 1948.
S. Jackson, C. L., and Huber, J. F. : Correlated applied
anatomy of the bronchial tree and lungs with a system of
nomenclature. Dis. of Chest, 9:1-8 (July-Aug.) 1943.
). Overholt, R. H., and Langer, L. : A new technique for
pulmonary segmental resection. Surg., Gynec. & Obst., 84:
257-268, (March 1 1947.
ULY, 1950
ier Jackson.” I recommend it to you as an inspiring
account of the accomplishments of a great man. Dr.
Jackson’s contributions are often thought of in terms
of instruments and technique, but he was more than a
technician; he knew medicine. Though many have tak-
en brief courses in endoscopic technique at his clinics
he has inspired a few to follow in -his footsteps. Clerf,
Tucker, his son C. L. Jackson, and Holinger are his
well-known pupils. The presentation by Dr. Priest to-
night puts him in a class with- these men.
I have always contended that it would be logical for
the internist or surgeon who carries out the treatment
of chest diseases to do endoscopic examinations. There
has been a trend this way but it apparently has not
persisted and a majority of endoscopic work is still in
the hands of the laryngologist. The probable reason
for this is that the laryngologist who is doing a lot
of this work develops a technique and finesse which
make of it a relatively simple and minor procedure,
whereas the occasional endoscopist finds that for both
the patient and himself there are some tribulations.
The modern resident in otolaryngology acquires a good
experience in this work. In 1947, one of our residents
who has now returned to Iceland reported his experi-
ences at the University Hospital for a two-year period
in which he had participated in 306 endoscopic proce-
dures. A recent checkup at the University Hospital
showed that we are now doing 25 to 30 endoscopic exam-
inations per month. I have just had a report from our
service at the U. S. Veterans Hospital which indicates
that for the year ending February 1, 1950, a total of
479 endoscopic procedures were done. Approximately
90 per cent of these procedures are on the tracheobron-
chial tree. These figures indicate the increased demand
for endoscopy and they give you some idea of the op-
portunity the modern resident in laryngology has to
acquire skill and judgment.
Dr. T. J. Kinsella, Minneapolis : I wish to con-
gratulate Dr. Priest upon this presentation. It is quite
typical of him and the type of work that he does. Tho-
racic surgery requires the co-operative effort of the
internist, roentgenologist, pathologist, bronchoscopist,
725
MINNESOTA ACADEMY OF MEDICINE
anesthetist and thoracic surgeon for its success. Endo-
scopic examination is very important in arriving at a
proper diagnosis. Endoscopy requires more than a me-
chanic if maximum information is to be obtained from
the examination and the operator must know a great
deal about pulmonary disease in order to interpret what
he sees through the bronchoscope. We do not do our
own bronchoseopic examinations because Dr. Priest fur-
nishes us with the precise information we need in order
to evaluate the patient’s difficulties. Good teamwork
between the various groups is what makes most of our
thoracic surgery possible.
Dr. L. G. Rigler, University of Minnesota: As 1
watched Dr. Priest present this paper, I began to wonder
whether we had a radiologist or a bronchoscopist giving
this thesis. As you noted, Dr. Priest used the x-ray
studies very well in demonstrating the points he wanted
to make. Because x-ray examination gives such a vivid
portrayal of the gross pathology it is possible to do
this particularly in diseases of the chest, and I am sure
Dr. Priest utilized it to its best advantage.
I would be interested in knowing if these new types
of endoscopes have advanced the diagnosis of tumors
of the bronchi. There is a great variation in the data
as to the bronchoseopic demonstration of tumors. At
one time many years ago Graham said he would never
do a resection of the lung without a positive biopsy
made through the bronchoscope. He said that they had
had cases in which they did as many as eighteen bron-
choscopies until they finally got a positive. Obviously,
over this period of time it is possible that the tumor
grew up to the bronchoscope. I recently heard Cheva-
lier L. Jackson say that they were running about 72 per
cent positive biopsies in cases of bronchogenic carci-
noma. Most other bronchoscopists give a figure of 50
per cent or less. Wbat I would like to know is whether
there are any data to indicate that the telescopic right
angle lenses have improved the percentage of positive
diagnoses possible by bronchoscopy. In our experience,
upper lobe carcinomas have been much more frequent
than the lower lobe ones, and in those cases bronchos-
copy has not been very useful in making a definitive
diagnosis.
Dr. Priest, in closing : I appreciate the nice things
that have been said. In answer to Dr. Rigler’s question,
I haven’t any figures to tell you what the rise in per-
centage of efficiency has been. There are certain parts
of the lung which can’t be seen wfithout the various
telescopes. The upper lobe of both the right and left
lungs are completely out of reach without telescopes
unless there is deformity in the bronchus. The same
is true of the apical segments of both lower lobes. You
have to have a right angle telescope to see them.
In answer to the second question: there is a telescope
made with which you can get a biopsy. It only passes
through an adult bronchoscope so cannot be used on
children. You can biopsy without the telescope if you
have clear vision. The place where we could use the
telescope with forceps is in very small children. You
have to depend on experience and your proprioceptive
sense when you apply forceps in a small child.
EXTERNAL FIXATION OF FACIAL FRACTURES
JEROME HUGER, M.D.
Saint Paul, Minnesota
A major facial injury usually results in fracture of
one or more of the thirteen bones of the facial skeleton.
Soft tissue laceration is frequently present. The facial
derangement, however, is not a matter of first impor-
tance in a fresh injury. It is vital, first, that the airway
be maintained, and second, that the patient s blood
volume be restored.
A face-down, head-dependent position minimizes
aspiration of blood and secretions. If the mandible is
severely shattered it may be necessary to pull the tongue
forward by manual or safety pin traction. Oral suction
is helpful. A tracheotomy for ventilation and aspiration
should be elected readily rather than denied fear-
fully — particularly in an unconscious patient lacking ade-
quate reflexes.
Bleeding from major vessels provides the only justi-
fication for immediate meddling with the wound. Clamp
and tie is then proper but ligatures must be left long
so they can be replaced during definitive care and de-
bridement. A sterile dressing with modest elastic
pressure is proper first care in all other instances. Nasal
bleeding will be no problem if left alone. Edema of
the nasal mucosa quickly provides an adequate pressure
hemostasis. Adequate whole blood replacement should
be provided promptly.
The interval for transfusion affords an excellent
period for taking stock of the patient as a whole. Ex-
tremities,' thoracic cage or pelvic frame may be frac-
tured. A high per cent of jackknifing injuries have
compression fracture of vertebrae. Abdominal viscera
may be ruptured. A neurological examination is
essential. The middle ears should be viewed relative to
basal skull fracture.
The facial derangement should properly wait on the
patient’s general condition. When it justifies reparative
work, the whole restorative program should be already
visualized. The reparative surgical procedures should
be grouped. It is embarrassing to find primary bone
plating of humerus or femur is indicated when the jaws
have already been approximated with intermaxillary
wares, and a general anesthetic is no longer possible with-
out deranging everything so far accomplished.
Soft tissue lacerations need not be fclosed for forty-
eight hours. Approximation with sterile tape and main-
tenance of modest elastic pressure is adequate emergency
care. It is often distinctly advantageous to have an
open wound for direct access for wire or screw fixations.
It is sometimes necessary to take down an over eager
or hurried primary apposition to provide access or allow
more deliberate apposition under unhurried conditions.
The primary soft tissue repair is not as vital to an
excellent result as is the primary skeletal repair. The
facial skeleton does not lend itself well to late adjust-
ment or secondary revision. Blood supply is excellent
and periosteal surfaces plentiful. Bone union is early
and firm.
( Continued on Pago 728)
726
Minnesota Medicine
“Dramamine . . . has been found
to exert a temporary
therapeutic and prophylactic
action in motion sickness.”1
Dramamine
Unusually satisfactory results
have been obtained with Dramamine*
for the Prevention
or Treatment of
Motion Sickness
(brand of dimenhydrinate) as a pro-
phylactic or active therapeutic agent
for the relief of nausea, vomiting or
dizziness, which many individuals
experience in travelling by ship, air-
plane, train and other vehicles.
1. Council on Pharmacy & Chemistry: New and Non-
official Remedies, 1950, Philadelphia, J. B. Lippincott
Co., 1950, p. 460.
*Trademark of G. D. Searle & Co., Chicago 80, 111.
RESEARCH IN THE SERVICE OF MEDICINE
ruLY, 1950
727
MINNESOTA ACADEMY OF MEDICINE
EXTERNAL FIXATION OF FACIAL FRACTURES
(Continued from Page 726)
In the primary reparative procedure reposition of
displaced parts should be effected or authority over
irreplaceable parts should be established. This authority
must be adequate to allow application of traction to
the part or of support to a part that will not maintain
itself in reposition. Reposition can then be effected at
will in the postoperative period. The appliances by
which one can command the movement and realignment
of fragments are legion. The simplest appliance that
will properly align and fix is the best. Unfortunately
some fractures are comminuted and complex. The
screws, pins, and wires commanding individual fragments
may give the superficial appearance of a Rube Goldberg
creation. The component parts, however, should always
represent the simplest mechanical solution to the problem.
Mandibular or lower third fragments are approximated
to the maxilla or middle third. When fragments of
the middle facial third are freely movable, they are
supported to a plaster head cap.
Traction is used to reposition obstinate displaced
fragments. It may be by elastics between maxilla and
mandible, or between any fragment and head cap. Bed
frame, pully, and hanging weight are occasionally
necessary to disimpact fragments or correct delayed
malposition.
Middle facial third fragments may take weeks and
lower third fragments months to establish self-supporting
bone union.
Application of various external fixation techniques are
illustrated.
Discussion
Dr. C. E. Connor, Saint Paul : The fundamental
principle underlying the treatment of maxillo-facial
fractures is that involved in the treatment of all fractures,
e.g., the best possible repositioning of fragments as soon
as feasible. Two end results must be kept in mind, the
cosmetic and the functional. I know of no part of the
body in which the final cosmetic result is subjected to as
exact scrutiny as is the face, a factor often disregarded
by the family in their intense concern over the patient’s
chances of survival, but a consideration which the
surgeon must bear in mind from the beginning of treat-
ment, not just when the patient is well on the road to
recovery and the subsidence of swelling and edema gives
a preview of the final cosmetic end-result.
The functional end-result is even more important. In-
adequate positioning of structures such as the mandible,
maxilla, nasal bones, septum, zygomatic arch, and orbital
margin can produce not only non-pleasing cosmetic results
but also functional disabilities which affect the patient’s
health.
Plastic surgeons of wide experience in facial injuries
have long endeavored to persuade automobile designers
and builders to make the instrument panel a less lethal
structure by the removal of protruding knobs, handles
and sharp edges but have so far met with but little
success.
Dr. Wallace P. Ritchie, Saint Paul : I was very
fortunate to see Dr. Hilger do some of these cases. He
has mentioned that they are frequently combined opera-
tions, and in several instances a combined intracranial and
facial operation was carried out at the same time. One
of the complications of these cases is a persistent cere-
brospinal rhinorrhea. As a rule, this will stop if the
bones are realigned properly, but occasionally it persists
and an intracranial approach with covering of the dura ;
tear is necessary.
Dr. Hilger, in closing : I have been fortunate in asso ;
dating with Dr. Ritchie in the combined care of a num
ber of the cases having intracranial as well as extra
cranial injury. Many of these cases demand combinec
effort. It is frequently possible and distinctly advan-
tageous to do the intracranial repair at the time oi
the facial repair. In all the cases I was fortunate enough
to share with him in three years of overseas servict
we had no death from postoperative intracranial
infection. There were no repaired cases which had per-
sistence of cerebrospinal fluid leak.
It is purposeful in closing to make special point that
old thinking on severe injuries with fracture of the
cribiform plate and cerebrospinal fluid leak needs revi-
sion in the light of modern antibiotic therapy. It has
been customary in the past to put this type of case to
bed until the cerebrospinal fluid leak ceases and then
to proceed with the repair of the facial injury. Not
uncommonly the facial injury in this type of case is
already past the optimum time for repair by the time
the cerebrospinal rhinorrhea has ceased. As one can
appreciate, the thin bony floor of the anterior cranial
fossa will heal by fibrous union much more promptly
if the bone fragments are realigned early and placed
in a near-abutting position. The marked distortion re-
sulting from trauma oftentimes will leave a wide gap
between bone fragments. This prolongs the healing
period and may even result in incomplete healing and
a persistent cerebrospinal fluid leak. With the use of
an adequate antibiotic shield and the prior restoration
of the patient’s blood volume this type of combined in-
jury should be repaired as promptly as the patient’s
general circumstances will permit. This actually affords
earlier opportunity for healing of the anterior cranial
fossa floor and thereby minimizes the opportunity for
intracranial extension of infection.
I wish to thank Dr. Connor and Dr. Ritchie for their
kind discussion.
The meeting adjourned.
Wallace P. Ritchie, Secretary.
THEY DON'T DIE YOUNG NOW
A remarkable change in the tuberculosis picture in
Minnesota is evident from a comparison of the 1949 fig-
ures showing the ages at death from all forms of this
disease with those of thirty years ago.
In 1919, the median (mid-point) for deaths attributed
to tuberculosis was in the age group thirty to thirty-nine
years. In other words, half the total deaths from this
disease occurred before thirty-nine years of age. In the
short period of a single generation, this situation has i
materially altered. Today the median for deaths from
tuberculosis is in the age group fifty to fifty-nine years.
Tuberculosis in a young person is still a very serious dis-
ease. But the number of young people in Minnesota who
are exposed to tuberculosis has been greatly reduced
during recent years, with a resulting reduction in num-
ber of deaths. Last year only forty-three persons under
thirty years of age died from this disease in our state,
compared with 180 deaths among persons aged sixty or
over. The latter number was more than one-third of all
the deaths from tuberculosis in 1949.
This change has been brought about by the tremen-
dous reduction in the incidence of tuberculosis, particu-
larly among young people. The reduction in deaths has
been accomplished by reducing exposures to the disease
through isolation of infectious cases in sanatoria; by
finding and treating cases early before they become se-
rious enough to cause death ; and by the improved
methods of treatment now available. — Minnesota Health,
June, 1950.
728
Minnesota Medicine
/ / / /
Tfatv /fvLaiCa&Ce
Complete, modern facilities of the Glenwood Hills Hospitals; co-ordin-
ated to give an accurate diagnosis and proper treatment to the neuro-
psychia.ric patient.
These unique facilities include:
• The outstanding staff of neurologists and psychi-
atrists in the United States
• The new Electroencephalograph
• The new Electrocardiograph
• An ultra-modern laboratory
• A completely equipped x-ray room
• Occupational therapy and Hydrotherapy
• A new physical education department
• Nurses specially trained in our own neuropsy-
chiatric training school
One year course — tuition free
me oepiemoer class ior me ocnooi oi neuro-
psychiatric Nursing. Prospective candidates
should apply and register immediately.
GLENWOOD HILLS HOSPITALS
3901 GOLDEN VALLEY ROAD
MINNEAPOLIS 22, MINN.
Offering a High Standard of Facilities for 25 Years
1950
In Memoriam
DUMA CARROLL ARNOLD
Dr. D. C. Arnold of Minneapolis died June 12, 1950,
when he collapsed while walking across the campus of
the University of Pennsylvania at Philadelphia.
Dr. Arnold was born January 9, 1892, in North Caro-
lina. He received his medical degree from the Univer-
sity of Pennsylvania in 1920 and practiced in Roebling,
New Jersey, for several years before coming to Minne-
apolis in 1925. Both Dr. Arnold and his wife, Dr. Ann
W. Arnold, were obstetricians. They met in medical
school and were married May 16, 1925. They had at-
tended the graduation of their daughter Nancy from
Vassar College shortly before, and were attending a
reunion at their Alma Mater when he was stricken.
Dr. Arnold was a member of the Hennepin County
Medical Society, the Minnesota State Medical Associa-
tion and the American Medical Association. He was a
clinical instructor in obstetrics and gynecology at the
University of Minnesota.
Dr. Arnold is survived by his wife; a daughter, Nancy,
and a son, Thomas B., who is a junior at Dartmouth
College.
ERNEST WILLIAM COWERN
Dr. Ernest W. Cowern, a practitioner at North Saint
Paul since 1903, passed away at St. John’s Hospital,
Saint Paul, on June 22, 1950, after a long illness.
Dr. Cowern was born in Wolverhampton, England,
March 3, 1871. He obtained his medical degree from
Dartmouth medical school in 1902, and after practicing
for a brief time in Massachusetts and New Hampshire
he came to North Saint Paul. He married Fannie
Wallace Schofield of Wolfville, Nova Scotia, in 1903.
She died in 1938.
Dr. Cowern served as school physician at North Saint
Paul for a number of years. He was chief of staff at
St. John’s Hospital, Saint Paul, at one time. He was a
member of Ramsey County Medical Society, the Minne-
sota State Medical Association and the American Medical
Association. During World War I, he was medical
instructor at Fort Oglethorpe, Georgia.
In 1946, Dr. Cowern was honored by a party staged
in the North Saint Paul Masonic Temple. On this occa-
sion he stated he had brought 1,360 babies into the world.
Many of those at whose birth he had officiated attended
the party.
Dr. Cowern is survived by three daughters : Mrs. Les-
lie Webster of North Saint Paul, Mrs. Donald Swift of
Port Washington, New York, and Constance of Seattle.
Four brothers, among them J. F. Cowern of North Saint
Paul and three sisters also survive him.
EVERETT K. GEER
Dr. Everett Kinne Geer died in his home in Saint Paul
on May 3, 1950, following a protracted illness.
Dr. Geer was born in Saint Paul on January 14, 1893,
the son of Dr. Ethelbert F. Geer and Helen Hazen Geer.
After graduating from Central High School, he attended
the University of Minnesota, where he obtained a B.S.
degree in 1915 and M.D. degree in 1917. He served his
internship in the Minneapolis General Hospital in 1916-
1917 and did postgraduate work in the Trudeau School
for Tuberculosis at Saranac Lake, New York.
In the first World War, he did his tour of duty as
a Lieutenant in the Medical Corps of the U. S. Navy.
In 1918, Dr. Geer married Olive Barnett Lewis. Mrs.
Geer as well as a daughter, Mrs. John Donahower, and
a son, Thomas, survive. His eldest son, Everett K. Geer,
Jr., was killed in action in World War II.
Dr. Geer held many important positions in his special
field of training. He was Chief Physician of the
Tuberculosis Division at Ancker Hospital in Saint Paul
from 1922 until his resignation terminated the appoint-
ment in 1949. In 1932, he was made Medical Director
of the Children’s Preventorium, Ramsey County, and took
an active role in the management of this institution. He
was consultant for Pokegama Sanatorium, Pine County,
from 1920 to 1943 when the institution closed. The
LIniversity of Minnesota Medical School recognized his
ability by making him Instructor of Medicine in 1921
and Assistant Professor in 1934. He was a diplomate i
of the American Board of Internal Medicine and a fel-
low of the American College of Physicians.
Dr. Geer was a member of the following societies:
American Heart Association, American Sanatorium As-
sociation, American Trudeau Society, Central Society for
Clinical Research, International Union against Tuber-
culosis, Minnesota Academy of Medicine, Minnesota
Society of Internal Medicine, Minnesota Pathological
Society, Minnesota State Medical Association, Minne-
sota Trudeau Society, National Tuberculosis Association,
Ramsey County Medical Society, Minnesota Public i
Health Association and the Ramsey County Health Asso-
ciation.
A number of these societies added to Dr. Geer’s re-
sponsibilities by giving him official position. He was a
council member of the American Trudeau Society from
1941 to 1943. In addition he served as president of the
Minnesota Trudeau Society in 1934-35 and of the Ram-
sey County Public Health Association in 1944.
The Index Medicus, lists fourteen papers by Dr. Geer
on problems of chest disease. In 1932, he read a paper
entitled “Primary Tuberculosis Among Nurses” before
the National Tuberculosis Association. This was fol-
lowed by four papers on the same theme and introduced
his work in the prevention of tuberculosis infection in
nurses employed in institutions for the care of tuber-
culous patients. This contribution was outstanding, and
his technique has been adopted in many sanatoria here
and abroad. Dr. Geer’s influence outside the United
(Continued on Page 732)
730
Minnesota Medicine
!
■
■
In fodema TofmdiM
", . . the diuretic drugs not only promote fluid loss but in many instances also
effectively relieve dyspnea ... not only may the load on the heart be decreased
but there may also occur an increase in the organ’s ability to carry its load . . .
With good average response the patient perhaps voids about 2000 cc. of
urine daily, but in exceptional instances the amount rises to as high as 8000 cc."'
"Not only are the diuretics of immense value in cases of left ventricular failure
. , . but where edema is marked, as it is most likely to be in failures occurring
in individuals with chronic nonvalvular disease with or without hypertension
and arrhythmia, their employment is often productive of an excellent response.
In [edematous patients with] active rheumatic carditis (rheumatic feverjthe
use of these drugs may be life-saving.’’1 2
Salyrgan-Theophylline is effective by muscle, vein or mouth.
■ ®
salyrgan-
THEOPHYLLINE
BRAND OF MERSALYL AND THEOPHYLLINE
TIME TESTED • WELL TOLERATED
” ftlnn Vnni/ *1 *V U/uinCAD Al.IV
NEW YOKK, N. Y.
Windsor, Ont.
AMPULS (1 cc. and 2cc.) • AMPINS (lcc.) • TABLETS
1. Beckman, H.: Treatment in General Practice. Philadelphia, Saunders, 5th ed., 1946, 704-705.
2. Beckman, H.: Treatment in General Practice Philadelphia, Saunders, 6th ed., 1948, 744 .
Salyrgan, trademark reg. U. S. & Canada — Ampins, reg. trademark of Strong Cobb & Co., Inc
(JLY, 1950
731
IN MEMORIAM
EVERETT K. GEER
(Continued from Page 730)
States is illustrated by a paper in Spanish on prevention
of tuberculosis infection which appeared in El dia
Medico (Buenos Aires). He will long be remembered
by those who pay attention to the prevention of tuber-
culosis.
WILLIAM HENTY GOUGH
Dr. William H. Gough of Granada, Minnesota, died
December 7, 1949, at the Fairmont County Hospital,
Fairmont, Minnesota. He was ninety years of age.
Dr. Gough was born July 24, 1859. He graduated
from the Ensworth Medical College at St. Joseph, Mis-
souri, in 1884. He was formerly a member of the Blue
Earth Valley Medical Society.
JUSTUS MATTHEWS
Dr. Justus Matthews, well known specialist in the
treatment of nose and throat diseases in Minneapolis,
died May 21, 1950, at St. Mary’s Hospital, Rochester.
Dr. Matthews was born at Foster, Minnesota, Sep-
tember 27, 1877. He attended the Ortonville High School.
At the age of twenty-one, he joined the Minnesota Thir-
teenth Volunteer Regiment which fought in the Philip-
pines during the Spanish-American war.
Starting a civil engineering course at the University
of Minnesota, he switched to medicine and obtained his
M.D. degree in 1905. After a year’s internship at Min-
neapolis General hospital, he joined the Mayo Clinic
staff where he headed the nose and throat section.
In 1917, Dr. Matthews came to Minneapolis where he
practiced his specialty until his death. Besides being a
member of the Hennepin County Medical Society, the
Minnesota State Medical Association and the American
Medical Association, he was a fellow of the American
College of Surgeons, a member of the American Laryn-
gological, Rhinological and Otological Society, the Amer-
ican Academy of Ophthalmology and Otolaryngology,
the Metropolitan club of New York and the Alpha
Kappa Kappa medical fraternity.
Dr. Matthews was a bachelor and lived with his sister,
Harriet. He was a member of the Minneapolis Club,
the Minikahda Club, the Woodhill Country Club and the
Chicago Club.
JOSEPH G. PARSONS
Dr. Joseph G. Parsons, formerly an associate at the
Crookston Clinic, died May 14, 1950, at Hampton Falls,
New Hampshire. He retired last year and moved to
Hampton Falls.
Dr. Parsons was born at Pawlet, Vermont, January
24, 1877, and attended Bowdoin College before studying
medicine at the University of Minnesota, where he
received his M.D. in 1898. He practiced at Sioux Falls,
South Dakota, for sixteen years, at Brookings, South
Dakota, for nine years, and at Lewiston, Montana, for
six years before coming to Crookston in 1930.
Dr. Parsons was a member of the American Academy
of Ophthalmology and Otolaryngology, a fellow of th
American Association for the Advancement of Scienc
and a member of the Red River Valley Medical Society
the Minnesota State Medical Association and the Ameri
can Medical Association.
Dr. Parsons is survived by his wife, a son, Seth, an.
a daughter, Mrs. V. A. Turner of Virginia.
JOHN J. RATCLIFFE
Dr. John J. Ratcliffe, for more than forty years :
practitioner at Aitkin, Minnesota, died May 29, 195C
at the Northern Pacific Hospital in Saint Paul. He wa
seventy-eight years of age.
Dr. Ratcliffe was born April 18, 1872, at Waukor
Iowa. He obtained his medical degree from Rush Medi
cal College in 1897. He was health officer in Aitkii
County for many years and was a member of the Uppe
Mississippi Medical Society, the Minnesota State Medi
cal Association and the American Medical Association
Dr. Ratcliffe is survived by his wife, one son am
three daughters.
SAMUEL SCHAEFER
Dr. Samuel Schaefer of Winona, Minnesota, died Ma;
30, 1950, following a brief illness.
Dr. Schaefer was born at Wykoff, Minnesota, Decern i
ber 23, 1880. After taking a year of premedical worl
at the University of North Dakota, he studied medi-
cine at the University of Michigan, graduating in 1904
Editor-in-chief of the medical school’s yearbook, the
young medical student won a place for himself in Ph
Alpha Gamma, an honorary medical society. He internee,
in the hospital now known as Bellevue in New Yorl
City and moved to Winona in 1905.
He joined the Army at the time of the Mexicar
border trouble and was a captain in the medical corps
in 1916 when his marriage to Ann Ahern of Winona
took place at Fort Snelling. He accompanied the 131st
Infantry as .major in going overseas.
In 1923 Dr. Schaefer was elected alderman-at-large,
an office he held for twelve years. In 1927, he was
named president of the board of aldermen, an office he
held for eight years. During this period, many public
improvements were carried out.
Dr. Schaefer was a member of the Winona County
Medical Society, the Minnesota State Medical Association
and the American Medical Association. From 1936 to
1938 he was president of the staff of the Winona Gen-
eral Hospital.
Dr. Schaefer is survived by his wife; one son, Samuel
Schaefer, Jr., a graduate student at the University of
Michigan ; three daughters, Dr. Jane Schaefer, an ob-
stetrician in San Francisco, Mrs. Grayson Bryan of
Santa Monica, California, and Sally Ann, at home.
JOHN P. SCHNEIDER
Dr. John P. Schneider, well-known internist of Min-
neapolis, died June 15, 1950, at the age of seventy-one.
Dr. Schneider was born in Lewiston, Minnesota, April
732
Minnesota Medicine
IN MEMORIAM
Why Should You Own Municipal Bonds?
BECAUSE _Your monev is invested in a class of security that has been proved to be second
only to U. S. Government bonds in certainty of payment.
It has been authoritatively reported that less than 2% of all municipal ksues
defaulted during the depression and nearly all of the 2% were cleared up with-
out loss of principal.
BECAUSE- . Your money earns in income that is not subject to current federal income taxes
- — you are not adding to your tax burden from your investment income.
Income from state and municipal bonds has never been subject to the levy of
federal income taxes.
BECAUSE- Your money is securely invested and you need not be concerned with “Day-to-
day market fluctuations.”
Municipal bond investors buy bonds for interest income to maturity without
market worries in the meantime.
★ ★ ★ ★
Here is a typical example of a municipal bond that
we are currently offering to individual investors:
The Hennepin County Independent Consolidated School Dis-
trict No. 11, Minnesota, recently issued bonds for the con-
struction of a new high school building because of the heavy
influx of people into this suburban area. This is a recently
consolidated District in Western Hennepin County that covers
approximately forty square miles (over 25,000 acres) with an
estimated population of 6,000. The area includes Crystal Bay,
Long Lake, Maple Plain and much fine dairy and agricultural
land as well as some Lake Minnetonka shore line.
The bonds are in denominations of $1,000 each and are se-
cured by taxes levied upon all the taxable real estate and
personal property within the District. As you probably realize,
such taxes are a claim against the property even ahead of any
mortgage. The actual value of the property is difficult to de-
termine since, though the bulk of the population is situated
in high-value residential areas (lake shore property is valued
at $100 per foot in some cases) practically 90% of the area is
rich agricultural land used for dairying, truck and fruit farm-
ing. The total debt, however, represents an average of only
$34.60 per acre.
We own and are offering, subject to prior sale, bonds of this
District returning as much as 2.35% per annum, depending
upon the maturity purchased. When you are considering this
investment remember that, to an individual in the $10,000
taxable income bracket, a tax-exempt 2.35% income is equiva-
lent to more than 3.50% income subject to federal income
taxes. In addition this 2.35% is exempt from present Min-
nesota State Income Taxes when received by an individual.
A complete descriptive circular describing
these bonds will be sent you on request.
JURAN & MOODY
GROUND FLOOR
Minnesota Mutual Life Bldg.
St. Paul 1, Minnesota
MUNICIPAL SECURITIES EXCLUSIVELY
TELEPHONES
St. Paul: Cedar 8407, 8408. 3841
Minneapolis: Nestor 8886
, 1879. He attended the Winona Normal School and
e University of Minnesota where he received his medi-
1 degree in 1906. Following his internship in Minne-
olis General Hospital, he practiced in Green Isle, Min-
sota, for seven years. He then took postgraduate work
Vienna and Berlin before establishing himself in
inneapolis. He was one of the co-founders of the
collet Clinic in 1920 and was an Assistant Clinical
■ofessor of Medicine at the University of Minnesota.
Dr. Schneider was a member of the Hennepin County
edical Society, the Minnesota State Medical Associa-
>n and the American Medical Association, the Minne-
la Society of Internal Medicine, the Minnesota Acad-
iy of Science, the Interurban Clinical Society, Sigma
Xi, Nu Sigma Nu and the Minneapolis Athletic Qub.
Dr. Schneider is survived by his wife, five daughters,
Mrs. Francis Reese, Milwaukee, Wisconsin; Mrs. Jerome
Speltz, Winona, Minnesota; Mrs. Alfred Speltz, Mrs.
Alphonse Walch and Barbara, all of Minneapolis ; and
three sons, Dr. John of Philadelphia; Dr. Robert of New
York, and Paul of Iowa City. He retired from active
practice in 1929.
The most important factor in the development of the
infant mortality rate is the standard of nutrition of the
people and the most important factor in the tuberculosis
rate is the standard of overcrowding. — S. Leff, Med.
Officer, Feb. 4, 1950 — Ouoted in Ant. J. Pub. Health,
April, 1950.
:ly, 1950
733
♦
Reports and Announcements
FOURTH PAN-AMERICAN CONGRESS
ON OPHTHALMOLOGY
Plans are now under way for the Fourth Pan-Ameri-
can Congress on Ophthalmology to meet in Mexico City
from January 6 to 12, 1952. Dr. Luis Sanchez Bulnes,
Gomez Farias 19, Mexico 4, D.F., is Secretary General.
INTERNATIONAL COLLEGE OF SURGEONS
The International College of Surgeons, United States
Chapter, will hold its fifteenth annual assembly and
convocation in Cleveland, Ohio, October 31, November
1. 2, 3.
The program will include scientific sessions on sub-
jects in the fields of general surgery; eye, ear, nose
and throat surgery; gynecology and obstetrics; urology;
and orthopedic, thoracic, plastic and neurological surgery.
In addition, an extensive technical and scientific exhibit
will be presented. Special entertainment for the doctors'
ladies has been planned.
All doctors of medicine interested in surgery and its
advancement are invited to attend, and can obtain a
program upon request to Arnold S. Jackson, M.D., Sec-
retary, Jackson Clinic, Madison 5, Wisconsin. For hotel
reservations, contact Committee on Hotels, International
College of Surgeons, U. S. Chapter, 511 Terminal Bldg.,
Cleveland 13, Ohio.
AMERICAN COLLEGE OF PHYSICIANS
On November 18, the American College of Physicians
North Central Regional Meeting will be held in Madi-
son, Wisconsin. Registration will begin at 8 :00 a.m.,
and the meeting will consist of a series of scientific
papers presented throughout the day. A scientific ex-
hibit of wide general interest is planned in connection
with the meeting.
This gathering will be held in the Wisconsin Union
Theater on the campus of the University of Wisconsin.
A luncheon will be served in the Wisconsin Union at
noon for all registrants wishing to participate.
This postgraduate instructional session is open to all
interested Physicians, whether or not they are members
of the American College of Physicians. Members of
the College are urged to bring along their colleagues as
guests.
AMERICAN MEDICAL WRITERS' ASSOCIATION
The seventh annual meeting of the American Medical
Writers’ Association will be held at the Elks Club,
Springfield, Illinois, Wednesday, September 27, during
the fifteenth annual meeting of the Mississippi Valley
Medical Society. In the afternoon there will be papers
by Frank G. Dickinson, Ph.D., Director of the Bureau
of Medical Economic Research, American Medical Asso-
ciation and Theodore R. Van Dellen, M.D., Health
Editor, Chicago Tribune, with appropriate discussions.
In the evening Walter C. Alvarez, M.D., Professor of
Medicine, Mayo Foundation, Rochester, Minn., and
editor of the new publication, General Practice, will take
over, to be followed by a stag entertainment conducted
by the Sagamon County Medical Society.
A program may be secured from the Secretary, Har-
old Swanberg, M.D., 209-224 W.C.U. Bldg., Quincy,
Illinois.
MISSISSIPPI VALLEY MEDICAL SOCIETY
The fifteenth annual meeting of the Mississippi Valley
Medical Society will be held at the Elks Club, Spring-
field, Illinois, September 27, 28, 29 under the presidency j
of Dr. N. G. Alcock of Iowa City, Iowa, immediate past-
president of the Iowa State Medical Society. Over
thirty clinical teachers from the leading medical schools
will conduct this great postgraduate assembly whose
entire program is planned to appeal to general practi-
tioners. There will be over fifty scientific and technical
exhibits. No registration fee will be charged and every I
ethical physician is cordially invited and urged to attend.
The entire program and all exhibits will be held in the
newly remodeled, air-conditioned Elks Club of Spring-
field. Program may be obtained from Harold Swanberg,
M.D., Secretary, 209-224 W.C.U. Bldg., Quincy, Illinois.
COURSE IN NEUROLOGIC ROENTGENOLOGY
The L diversity of Alinnesota announces a continuation
course in neurologic roentgenology to be presented at
the Center for Continuation Study October 30 to Novem-
ber 4. Distinguished visiting physicians who will par-
ticipate as faculty members of the course include Drs.
Arthur E. Childe, Winnipeg; Philip J. Hodes, Philadel-
phia ; Dabney Kerr, Iowa City ; and Knut Lindblom,
Stockholm, Sweden. Clinical and full-time members
of the staff of the LTniversity of Minnesota and Mayo
Foundation will complete the faculty for the course.
Presentations on the anatomy and pathology of the
central nervous system will be given early in the course.
Emphasis will be placed throughout on different tech-
niques available for the roentgen examination of the
central nervous system. Correlation of clinical and roent-
genologic findings will be emphasized.
SCOTT-CARVER COUNTY SOCIETY
Election of officers highlighted the meeting of the
Scott-Carver County Medical Society in New Prague
on Tune 7.
Dr. E. H. Simons, Chaska, was elected president ; Dr.
Richard F. Kline, Montgomery, vice president, and Dr.
E. Roger Rynda, New Prague, secretary-treasurer.
Dr. H. Nilson, Mankato, discussed the educational
campaign being carried on to point out the dangers of
socialized medicine.
( Continued on Page 736)
734
Minnesota Medicine
A HOMELIKE
HAVEN WHERE
ALCOHOLICS
ACHIEVE
INSPIRATION FOR
RECOVERY
200 acres on the shores
of beautiful Lake Chisa-
go where gracious living,
homelike atmosphere and
understanding compan-
ionship contribute to suc-
cessful rehabilitation.
HAZELDEN FOUNDATION
The constructive thinking of a group of Twin Cities men seeking a new approach to the
problem of alcoholism resulted in the organization of the Hazelden Foundation. Some of
the founders are themselves men who have recovered from alcoholism through the proved
program of Alcoholics Anonymous. Their true understanding of the problem has resulted
in the treatment procedures used at the Hazelden Foundation.
BOARD OF TRUSTEES
Mr. T. D. Maier,
Vice President,
First Natl. Bank
St. Paul, Minn.
Mr. L. M. Butler,
Owner Star Prairie
Trout Farm
St. Paul, Minn.
Mr. Robert M. McGarvey,
President and Treasurer
McGarvey Coffee Co.
Minneapolis 1, Minn.
Mr. John J. Kerwin,
Manager, Mid-Continent
Petroleum Corp.,
St. Paul 4, Minn.
Mr. A. G. Stasel,
Supt., Eitel Hospital,
Minneapolis 3, Minn.
Mr. Bernard H. Ridder,
Pres., N.VV. Pub., Inc.,
Dispatch Building,
St. Paul 1, Minn.
Dr. Gordon R. Kamman
1044 Lowry Med. Arts
Bldg., St. Paul 2, Minn.
M. R. C. Lilly
Chairman of the Board,
First National Bank,
St. Paul 1, Minn.
Direct inquiries and request for illustrated brochi
Mr. A. A. Heckman,
Gen. Sec., Family Serv.,
Wilder Building,
St. Paul 2, Minn.
Mr. L. B. Carroll,
V. Pres. & Genl. Mgr.
Hazelden Foundation,
Center City, Minn.
It should be understood that Hazelden Foundation is not officially sponsored by Alcoholics Anonymous
just as Alcoholics Anonymous sponsors no other organization regardless of merit.
The Hazelden Foundation is a nonprofit organization. All inquiries are kept confidential.
HAZELDEN FOUNDATION
Lake Chisago, Center City, Minn.
Telephone 83
July, 1950
735
REPORTS AND ANNOUNCEMENTS
(Continued, from Page 734)
NORTHERN MINNESOTA MEDICAL ASSOCIATION
The annual meeting of the Northern Minnesota Med-
ical Association will be held at Bemidji on Friday and
Saturday, September 8 and 9. The program for the
meeting is as follows:
Friday, September 8
"Some Aspects of Abdominal Pain in Children”— Dr.
Allan J. Hill, Minneapolis.
“New Developments in Antibiotics”— Dr. Wendell H.
Hall, Minneapolis.
“The Significance of the Intestinal Polypoid Lesion"
—Dr. Harry M. Weber, Rochester.
“The Surgical Management of Common Pulmonary
Problems”- — Dr. Nathan K. Jensen, Minneapolis.
“Fracture Clinic”— Dr. Daniel J. Moos, Dr. Maynard
C. Nelson and Dr. Earl C. Henrikson, Minneapolis.
Banquet, 7 :00 p.m. Speaker : Roy E. Dunn, Repre-
sentative, 50th District.
Saturday. September 9
“Clinico-Roentgen-Pathological Conference” — Dr. E. L.
Tuohy, Dr. H. G. Moehring and associates.
Officers of the association, who will be in charge at
the meeting, are Dr. W. J. Deweese, Bemidji, president;
Dr. George Sather, Fosston, vice president, Dr. C. L.
Oppegaard, Crookston, secretary-treasurer.
Woman’s Auxiliary
A MESSAGE FROM THE NEW PRESIDENT
The annual session held in Duluth, June 12 to 15, was
not only very successful from the standpoint of Auxiliary
work, but it was one of the most beautifully planned
and conducted conventions it has been my good fortune
to attend. The past State Auxiliary president and her
convention chairman, together with their committee mem-
bers are to be congratulated.
It is the plan of the new administration that Auxiliary
work shall be carried on, as always, to promote in
every way all plans supporting and furthering the na-
tional Auxiliary program. I know that all county presi-
dents will carry back to their groups good reports of
the meetings and to every county member I make a plea
for help and sympathetic understanding. Again a group
of outstanding and capable women are serving as Board
members, but unless each county member and our mem-
bers at large are sincerely interested and active, we
cannot hope for a successful year. Board members can
plan and advise, but it is to the individual member we
must look for promotion of Auxiliary work.
Public relations is of first importance. The war
against government controlled medicine and insurance
must go on. More and more of our fellow citizens
The Birches Sanitarium, Inc.
2391 Woodland Avenue
Duluth 3, Minnesota
A hospital for the care and treatment of
Nervous and Mental disorders. Quiet, cheer-
ful environment. Specially trained personnel.
Recreational and occupational therapy.-
Dr. L. R. Gowan, M.D., M.S., Medical Director
Attending Psychiatrists
Dr. L. R. Gowan Dr. C. M. Jessico
Dr. I. E. Haavik Dr. L. E. Schneider
REST HOSPITAL
2527 Second Avenue South, Minneapolis
A quiet, ethical hospital with therapeutic facilities
for the diagnosis and treatment of nervous and
if
mental disorders. Invites co-operation of all repu-
table physicians. Electroencephalography avail-
11 j ■ H SET igEjflj
able.
y -tj. ^
PSYCHIATRISTS IN CHARGE
tit}.-.-.?.
Dr. Hewitt B. Hannah
Dr. Andrew J. Leemhuis.
"Sera
736 Minnesota Medicine
WOMAN’S AUXILIARY
North Shore
Health Resort
Winnetka, Illinois
on the Shores of
Lake Michigan
A completely equipped sanitarium for the care of
nervous and mental disorders, alcoholism and drug addiction
offering all forms of treatment, including electric shock.
SAMUEL LIEBMAN, M.S., M.D.
225 Sheridan Road Medical Director Phone Winnetka 6-0211
must be told the truth and understand the danger to
our American way of life which a small group is trying
to force upon us.
We are happy that plans for two Health Days, to
take place soon, are well under way. The programs
which have already been given have been very success-
ful and have been very well received. Health Days can
mean so much in promoting understanding among our
fellow citizens in all walks of life and certainly they
are of unlimited educational value. We do hope that
several more counties will promote Health Day pro-
grams during the year.
Vacation time is here, but may I ask each county
president to keep on the alert, ascertaining the needs
of her group and, too, the needs of her own community,
as far as educational campaigns are concerned. If you
have articles of interest, please send them to the Chair-
man of Minnesota Medicine, Mrs. Benjamin Souster,
1333 Bohland Place, Saint Paul 5, Minnesota. I do not
refer to personal items, but to those which might be
of help in planning programs for county work starting
in the fall. Let us give unselfishly of our time and
our effort to make this year one of which we can be
proud and one which will be gratifying to the Min-
nesota State Medical Association.
President, Woman’s Auxiliary
BROWN & DAY, INC.
St. Paul 1. Minnesota
July, 1950
Mrs. Charles W. Waas.
737
Of General Interest
♦
♦
A voluntary committee composed of fellows who
have served under Dr. George E. Fahr have estab-
lished a George E. Fahr Lectureship in Cardiology
at the University of Minnesota Medical School. Dr.
Fahr retired from his position as full-time super-
visor of the University medical service at Minneapolis
General Hospital on June 15, 1950, after some twenty-
eight years of service in that capacity. A dinner was
held in honor of Dr. and Mrs. Fahr at the Campus
Club in the Coffman Memorial Union at which the
lectureship which has already reached $8,000, was
presented to the Medical School. It is the purpose
of the committee in charge of raising funds, of which
Dr. Arthur Kerkoff is chairman, to raise a consider-
ably larger fund to provide a suitable income for the
purposes of a lectureship. Contributions made pay-
able to the George E. Fahr Lectureship or to the
Minnesota Medical Foundation, earmarked for the
lectureship, may be sent to Dr. George N. Aagaard,
secretary-treasurer of the Foundation, 3411 Powell
Hall, University of Minnesota, Minneapolis 14, Minne-
sota.
* * *
Dr. Paul J. Bilka has opened offices at 500 Physi-
cians and Surgeons Building, Minneapolis, for the
practice of rheumatology. Dr. Bilka was graduated
from Columbia University Medical School and served
an internship and assistant residency at the Hartford
Hospital, Connecticut. He was discharged from the
Army as a captain in January, 1947. He recently
completed a fellowship at the Mayo Clinic.
* * *
Open house was held on June 11 at the offices of
Dr. I. W. Steiner and Dr. W. O. Finkelnburg, Wi-
nona, to announce completion of remodeling and re-
furnishing the offices. The redecorating work includ-
ed increasing the number of rooms, installing new
lighting and new furniture.
* * *
Dr. Vincent T. M. Ryding, Howard Lake, closed
his offices late in June and left on June 27 for Dallas,
Texas, tO’ become affiliated with the Methodist Hos-
pital of that city. He was scheduled to be replaced
at Howard Lake on July 1 by Dr. William Thomas
of Minneapolis, who had purchased Dr. Rvding’s
equipment.
% s|s sjc
After being asociated with the Bratrud Clinic in
Thief River Falls since January, 1947, Dr. Alfred S.
Nelson left on June 8 for Baltimore, Maryland,
where he had accepted an appointment as resident
in internal medicine at Union Memorial Hospital.
* * *
It was announced on June 8 that Dr. Donald Buch-
er, of Sioux Falls, South Dakota, planned to begin
practice in Starbuck about July 15.
Dr. J. J. Coll, Duluth, was elected president of the
Minnesota Society for the Study of Diseases of the
Heart and Circulation at a meeting in Minneapolis
on June 3 and 4.
Dr. Bernard S. Nauth, a member of the staff of the
Winona Clinic for the last five years, announced on
June 10 that he had resigned to enter private prac-
tice in Bemidji. He said that he planned to leave
for Bemidji sometime before July 15. Dr. Nauth
entered the Winona Clinic as a staff member in
1942, practiced for several months before joining the
Army, then returned to Winona after his discharge
from service.
■%.
Miss Olive V. Seibert, Minneapolis, director of
medical publications at the Bruce Publishing Com-
pany, Saint Paul, and well known to the medical pro-
fession throughout the state,, was elected president
of the Quota Club International at its annual con-
vention at Mackinac Island, Michigan, in June.
Quota Club International has 226 chapters in the
United States, Canada, Australia and Mexico, and an
active membership of over 7,000. Members are se-
lected from women executives of a community, one
from each business or professional activity. Quota
is organized to advance the interests of women, culti-
vate friendship and serve country and community.
Miss Seibert served Quota International as lieuten-
ant governor, district governor, director, third vice
president and first vice president before being elected
president.
* * *
Dr. Julian F. DuBois, Sauk Centre, secretary of
the Minnesota State Board of Medical Examiners,
was elected a member of the National Board of
Medical Examiners at its recent annual meeting.
This is the first time a member of our state board
has been honored with a membership in the national
board.
* * *
The Colvin Memorial Surgical Fund, to carry on
a research and teaching program at Ancker Hospital,
Saint Paul, has been established in memory of Dr.
Alexander R. Colvin, who died on March 22, 1948.
Dr. Colvin was associated with Ancker Hospital for
over fifty years and was chief of the surgical serv-
ices at the hospital for more than thirty years.
Dr. Wallace P. Ritchie is director of the fund, and
members of the advisory committee include Dr. E.
M. Jones, chairman, Dr. Thomas E. Broadie, Dr.
Ivan D. Baronofsky and Dr. Logan Leven. Contri-
butions to the fund have so far been made by doc-
tors who practice at Ancker but will be accepted
from any who are interested in the welfare and
(Continued on Page 740)
738
Minnesota Medicine
SUCCESS-O-GRAPH
REG. U. S. PAT. OFFICE
Two words:
Success
Failure
Both have:
Seven letters
"U" appears once in each word
BUT :
Only Success is full of
$'s and c's
Our exclusive
"Success-o-graph'' will show you
HOW TO REMAIN HEALTHY FINANCIALLY!
W. L. ROBISON
Agency
318 Bradley Bldg. Duluth, Minn.
Melrose 859
THE MINNESOTA MUTUAL LIFE INSURANCE COMPANY
1880 — 70th Anniversary — 1950
July, 1950
739
OF GENERAL INTEREST
. . . for the removal of
skin growths, tonsil
tags, cysts, small tu-
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and for other technics
by electrodesiccation,
fulguration, bi-active
coagulation.
Now, completely re-
designed the new
HYFRECATOR
provides more power
and smoother control
. . . affording better cos-
metic results and great-
er patient satisfaction.
Doctors who have used
this new unit say it pro-
vides for numerous new
technics and is easier,
quicker to use.
$45°° COMPLETE
Write "Hyfrecator Folder"
on your prescription blank
or clip your letterhead to
this advertisement. Re-
print of Hyfrecator tech-
nics mailed free on request.
HYFRECATOR DEALERS
C. F. ANDERSON CO., INC.
• Minneapolis
PHYSICIANS & HOSPITALS SUPPLY CO.. INC.
Minneapolis
BROWN & DAY, INC.
St. Paul
(Continued from Page 738)
progress of medical teaching and research at the
hospital. Contributions, which are tax deductible,
should be made payable to the Colvin Memorial
Surgical Fund and sent to Dr. Thomas E. Broadie,
Superintendent, Ancker Hospital, Saint Paul.
* * *
Dr. R. H. Wilson has been named by the Winona
city council to fill the unexpired term of the late Dr.
Samuel Schafer as city health officer. Dr. Wilson’s
term expires in April, 1952.
* * *
Dr. Martin O. Nesheim, Emmons, was among up-
per Midwest physicians who attended a continuation
course in proctology at the University of Minnesota
May 22 through 27.
* * *
A farewell reception was given by employes of
the Willmar State Hospital on June 21 in honor of
Dr. and Mrs. Stanley B. Lindley and family. About
200 persons gathered to say farewell to Dr. Lindley,
who has been superintendent of the Willmar State
Hospital for the past six and one-half years. Dr.
Lindley planned to leave the following week to be-
come a chief physician at the Veterans Hospital in
Knoxville, Iowa. At his new post he expects to de-
vote most of his time to research and clinical work in
psychiatry.
* * *
Dr. John Adams, who for the past ten years has
been with the pediatrics department of the Univer-
sity of Minnesota Medical School, will spend six
weeks in Europe visiting various medical centers
before taking up his duties as director of the pe-
diatrics department at the University of California
Medical School in Los Angeles. Dr. Adams will
read a paper on virus pneumonia at the sixth Interna-
tional P'ediatrics congress o be held at Zurich, Switz-
erland in July. Mrs. Adams, who is also a pediatri-
cian, will accompany Dr. Adams.
*
*
As part of the program being developed by Dr.
Ralph Rossen, state mental health commissioner, his
staff will be augmented by Dr. Frances Barnes, be-
ginning July 1, who will direct pediatric care in state
institutions caring for children. In addition, Dr.
R. H. Engel, who has recently come to this country
from Germany and who has specialized in convulsive
disorders of children, has been named clinical pe-
diatrics director at the Cambridge State School and
Hospital, and Dr. H. H. Brul has been placed in
charge of the pediatrics service at the Minnesota
School and Colony at Faribault. The two state insti-
tutions have already been allied with the University
Medical School, receiving part-time services from
four senior staff members and four residents of the
University Hospital.
* * *
(Continued on Page 742)
740
Minnesota Medicine
We have been appointed agents in this territory
for the well-known XifaL line of
SWEDISH STAINLESS STEEL
Surgical Instruments
We invite your interest
C. F. ANDERSON CO., Inc.
Surgical and Hospital Equipment
901 MARQUETTE AVENUE MINNEAPOLIS 2, MINNESOTA
Cook County Graduate School of Medicine
ANNOUNCES CONTINUOUS COURSES
SURGERY — Intensive Course in Surgical Technic, two
weeas, starting July 24, August 21, September 25.
Surgical technic. Surgical Anatomy and Clinical Sur-
gery, four weeks, starting July 10, August 7, Sep-
tember 11.
Personal Course in General Surgery, two weeks,
starting September 25.
Surgery of Colon and Rectum, one week, starting
September 11.
Esophageal Surgery, one week, starting October 16.
Breast and Thyroid Surgery, one week, starting Oc-
tober 2.
Thoracic Surgery, one week, starting October 9.
Gallbladder Surgery, ten hours, starting October 23.
Fractures and Traumatic Surgery, two weeks, starting
October 9.
Basic Principles in General Surgery, two weeks, start-
ing September 11.
GYNECOLOGY — Intensive Course, two weeks, starting
September 25.
Vaginal Approach to Pelvic Surgery, one week,
starting September 18.
OBSTETRICS — Intensive Course, two weeks, starting
September 11.
MEDICINE — Intensive General Course, two weeks,
starting October 2.
Gastro-enterology, two weeks, starting October 16.
Gastroscopy, two weeks, starting July 17, September 25.
DERMATOLOGY — Formal Course, two weeks, starting
October 16.
Informal Clinical Course every two weeks.
UROLOGY — Intensive Course, two weeks, starting
September 25.
Cystoscopy, Ten Day Practical Course, every two
weeks.
General, Intensive and Special Courses in all Branches of
Medicine, Surgery and the Specialties.
TEACHING FACULTY— ATTENDING
STAFF OF COOK COUNTY HOSPITAL
Address: REGISTRAR, 427 South Honore Street
Chicago 12, Illinois
AT YOUR CONVENIENCE,
DOCTOR . . .
you are cordially invited to visit our new
and modern prescription pharmacy located on
the street floor of the Foshay Tower, 100 South
Ninth Street.
With our expanded facilities we will be able
to increase and extend the service we have
been privileged to perform for the medical pro-
fession over the past years.
Exclusive Prescription Pharmacy
Biologicals Pharmaceuticals Dressings
Surgical Instruments Rubber Sundries
JOSEPH E. DAHL CO.
(Two Locations)
100 South Ninth Street, LaSalle Medical Bldg.
ATlantic 5445 Minneapolis
ui.y, 1950
741
OF GENERAL INTEREST
(Complete OpLtLa L
r
Untc
Sc
erutce
^ or ^Jli ,
Profession
N. P. BENSON OPTICAL CO
Laboratories in Minneapolis
and
Principal Cities of Upper Midwest
ACCIDENT * HOSPITAL ' SICKNESS
INSURANCE
FOR PHYSICIANS, SURGEONS, DENTISTS EXCLUSIVELY
PREMIUMS
f PHYSICIANS\
SURGEONS
\ DENTISTS /
ALL
CLAIMS 7
$5,000.00 accidental death $8.00
$25.00 weekly indemnity, accident Quarterly
and sickness
$10,000.00 accidental death $16.00
$50.00 weekly indemnity, accident Quarterly
$15,000.00 accidental "death $24.00
$ 75.00 weekly indemnity, accident Quarterly
and sickness
$20,000.00 accidental death $32.00
$100.00 weekly indemnity, accident Quarterly
and sickness
Cost has never exceeded amounts shown.
ALSO HOSPITAL POLICIES FOR MEMBERS
WIVES AND CHILDREN AT SMALL
ADDITIONAL COST
85c out of each $1.00 gross income used for
members’ benefits
$3,700,000.00 $16,000,000.00
INVESTED ASSETS PAID FOR CLAIMS
$200,000.00 deposited with State of Nebraska lor protection of our members.
Disability need not be incurred in line of duty — benefits from
the beginning day of disability
PHYSICIANS CASUALTY ASSOCIATION
PHYSICIANS HEALTH ASSOCIATION
48 years under the same management
400 First National Bank B4dg., Omaha 2, Nebr.
(Continued from Page 740)
Dr. Orien B. Patch, Duluth, has opened new offices
in the Providence Building, 332 West Superior Street,
Duluth. Dr. Patch restricts his practice to otolaryn-
gology.
Jj: Jjc %
Dr. Joseph L. Garten, Minneapolis, has moved his
offices to 308 Doctors Building, where he is conduct-
ing his practice of ophthalmology and otolaryngol-
ogy. He was formerly located in the Medical Arts
Building.
* * *
Announcement was made on Tune 24 that Dr. Wil-
liam A. Black, New Ulm, had been certified by the
American Board of Surgery.
5jC * Jjt
Three papers on cortisone were presented by Mayo
Clinic staff members at the recent meeting of the
AMA in San Francisco. Dr. A. R. Barnes presented
a paper written in collaboration with Drs. H. L.
Smith, C. H. Slocumb, H. F. Polley and Philip S.
Hench. Dr. Hench presented two other papers on
the status of cortisone and related compounds in
general medicine and in rheumatic diseases.
* * *
The marriage of Dr. Edward A. Pasek, Carlton, to
Miss Marjorie Jeanne Gradine, formerly of Superior,
Wisconsin, took place at Cloquet on May 27.
* * *
Dr. James H. Walston left Clarkfield about June
14 for Grattinger, Iowa, where he planned to estab-
lish a private practice. Dr. Walston practiced in
Clarkfield for one year.
* * *
Dr. Gordon Erskine and Dr. C. R. Ferrell, Grand
Rapids, have moved into their newly completed office
building. The one-story modern structure contains
three suites of offices, including a dental suite.
* * *
Two former Rochester physicians. Dr. Albert M.
Snell and Dr. Harry A. Wilmer, have become as-
sociates in the Palo Alto Clinic at Palo Alto, Cali-
fornia. Dr. Snell, a former Mayo Foundation profes-
sor of Medicine, is an associate in the clinic’s depart-
ment of internal medicine. Dr. Wilmer, a former
Mayo Foundation fellow, is an associate in the de-
partment of neurology and psychiatry.
* * *
Dr. Wallace H. Cole, Saint Paul, director of the
division of orthopedic surgery at University of Min-
nesota Medical School, has accepted appointment to
the newly created position of chief of orthopedic serv-
ice at Elizabeth Kenny Institute for polio patients,
in Minneapolis.
The appointment, effective immediately, was an-
nounced by Dr. E. 1. Huenekens, chief of staff at
Kenny Institute and national medical director of the
Sister Elizabeth Kenny Foundation, which maintains
headquarters offices in Minneapolis. Dr. Huenekens
is also clinical professor of pediatrics at the Univer-
sity of Minnesota.
742
Minnesota Medicine
OF GENERAL INTEREST
FOR INFANT FEEDING
IN HOT WEATHER „
at home
away
Hot summer months need bring no infant
feeding problems. Lactogen fed babies
keep happy, healthy. When refrigeration
is not available feedings maybe prepared
as needed.
COMPANY.* INC.. HE*
■11
LACTOGEN® + WATER
= FORMULA
1 level 2 fl. ozs.
2 fl. ozs.
tablespoon
(20 Cals, per
(40 Cals.)
fl. oz.)
Dr. Cole, who for more than a year has been a
onsulting orthopedist at Kenny Institute, was
.mong the medical men who originally observed the
vork of Sister Kenny when she first came to Min-
teapolis and Saint Paul in 1940.
5fC
Dr. R. F. Hedin, of the Interstate Clinic in Red
iVing, was a speaker at a meeting of the St. Croix
md Pierce Counties Medical Society in Ellsworth
>n June 13. He spoke on “Hand Infections.’’
^ ^ H5
Eighty physicians who interned at St. Mary’s
rlospital, Duluth, between 1901 and 1950 held a re-
mion breakfast in Duluth on June 13. Dr. R. P.
Buckley, hospital chief-of-staff, presided at the gath-
ering.
He * *
It was announced in June that Dr. J. T. Boswell
would begin practice in Wanamingo early in July.
Dr. Boswell recently completed his internship at
:he U. S. Naval Hospital at Great Lakes, Illinois.
* * t-
Dr. Samuel H. Boyer, Sr., Duluth, was presented
with the distinguished service award of the Minne-
sota State Medical Association at the association’s
meeting in Duluth on June 13.
A graduate of the University of Pennsylvania
Medical School, Dr. Boyer first came to Duluth in
1891. During his years there he has been active both
in politics and in the pioneering medical practice in
the area, die is a former member of the state board
of health and past president of the Minnesota State
Medical Association. A son, Dr. Samuel H. Boyer,
Jr., is now associated with him in practice in Duluth.
* =t= *
Dr. Reuben F. Erickson, mayor of Edina, filed on
June 17 as a candidate for the Republican nomination
for Congress in the third district. A graduate of the
University of Minnesota Medical School’in 1926, Dr.
Erickson is president-elect of the Hennepin County
Medical Society. Always interested in politics, he was
a member of the 1941 session of the state legislature
from the 36th district.
* * *
Dr. C. G. Nelson, Harmony, spent Tune and July
at the University of Iowa, taking a postgraduate
course in medicine. During his absence, Dr. O. M.
Rotnem of Harmony conducted his practice.
* * *
Announcement was made early in June that Dr.
J. A. Guy would begin practice in New London on
July 1.
Hs
Four Mayo Clinic physicians received certificates
of merit from the University of Minnesota at a
ceremony in the Coffman Memorial Union on June
6. The four were Dr. John L. Crenshaw, Dr. George
B. Eusterman, Dr. James C. Masson and Dr. Arthur
H. Sanford.
* * *
Dr. D. E. Greene, formerly of David City, Ne-
braska, has become affiliated with the Starekow Clinic
July, 1950
743
OF GENERAL INTEREST
1909. ...1950
Physiotherapy for the relief
of Arthritis and related con-
ditions. Complete physical
examinations and laboratory
procedures given every pa-
tient. Roy T. Pearson,
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U. S. Hwy. 212
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Exclusively
since 1899
MINNEAPOLIS Office:
Stanley J. Werner, Rep.
5026 Third Avenue South
Telephone Pleasant 8463
in Thief River Falls. A graduate of the University
of Nebraska Medical School in 1943, Dr. Greene in-
terned at the University Hospital in Omaha, then
served for two years in the Army.
* * *
The marriage of Dr. Hubert Theissen and Miss
Armory-1 Keeney, both of Minneapolis, took place in
Minneapolis on May 20. Dr. Theissen, a graduate of
Marquette University Medical School, is affiliated
with St. Mary’s Hospital, M inneapolis.
* * *
Dr. F. L. Bregel, St. James, was elected president
of the Redwood-Watonwan County Medical Society
at a meeting in New Ulm on May 23. Other officers
named were Dr. O. B. Fesenmaier, New Ulm, vice
president, and Dr. Bradley Kusske, New Ulm, sec-
retary-treasurer.
Minnesota’s mental health program was discussed
by Dr. F. J. Braceland, head of the psychiatry sec-
tion at the Mayo Clinic, at a meeting of the Meth-
odist Men’s Club in Rochester on June 2.
sjs sfc
Dr. Grant F. Hartnagel, of the Interstate Clinic
in Red Wing, attended a one-week session of the
International Congress on Obstetrics and Gynecology
in New York late in May.
* * *
Dr. Harvey Nelson, Minneapolis, was elected pres-
ident of the Minnesota Alumni Association at a
meeting in Minneapolis on May 20.
* * *
Dr. F. M. MacDonald arrived in Nashwauk on
May 15 to begin medical practice at the Itaska
Clinic. He recently returned from Germany, where
he had been with the Army of Occupation for two
years.
* * *
After a year of practice in Spring Valley, Dr. E. P.
Engels left on May 14 to take postgraduate work in
medicine at the Llniversity Hospitals, Minneapolis.
He was replaced at Spring Valley by Dr. W. H. Pe-
terson, formerly of Owatonna.
* * *
Dr. Christopher Graham was again honorary chair-
man of the Rochester Art Festival in Rochester on
May 20.
* * *
Eight persons trained in foreign medical schools
have qualified to practice medicine in Minnesota, it
was announced on May 17. Fourteen others are now
taking twelve months of graduate study in clinical
medicine in approved hospitals. This progress has
been made since Minnesota modified its licensing regu-
lations for displaced physicians in February, 1949.
Only one applicant for license has been rejected by
the state board of medical examiners.
* * *
Dr. Howard L. Horns, assistant dean of the Uni-
versity of Minnesota Medical School, was the principal
speaker at the annual spring dinner meeting of the
St. Thomas Aesculapian Club in Saint Paul on May
17.
744
Minnesota Medicine
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Physicians and Hospitals Supply Co., Inc., Minneapolis, Minn.
Dr. Herbert F. Plass, Minneapolis, representing
the Hennepin County Medical Society, discussed the
society’s attitude toward socialized medicine at a
meeting of the Commonwealth Club in Minneapolis
on May 19.
^ ^
After twenty-one years of practice in Houston,
Dr. W. W. Canfield left on May 14 to become a
staff member of the St. Peter State Hospital.
* * *
The transformation of an eighty-two-year-old house
into a modern medical office was completed in Le
Sueur in June. The entire first floor of the house has
been remodeled and redecorated to form a suite of
medical offices for Dr. N. N. Sonnesyn of Le Sueur.
The offices now include a reception room, examining
room, x-ray room, emergency treatment room, pri-
vate office and business office.
ifc
Principal speaker at a meeting of the Saint Paul
Surgical Society on May 17 was Dr. Richard L.
Varco, of the department of surgery of the Univer-
sity of Minnesota. Dr. Varco discussed carcinoma
of the lung.
:{C ^
Dr. John Van Duyn, formerly of Duluth, has be-
come surgeon for the Community Health Center and
hospital in Two Harbors. He succeeds Dr. Joseph
Bloom, who has moved to Duluth to conduct his
practice.
Physicians named to membership in the “Fifty
Club” at the annual meeting of the Minnesota State
Medical Association in Duluth in June include the
following:
Dr. Samuel Amberg, Rochester; Dr. J. B. Clement,
Lester Prairie; Dr. W. H. Condit, Dr. A. E. Booth,
Dr. Annah Hurd, Dr. James F. Kennedy, Dr. 'C. M.
Oberg, Dr. J. W. Olson, Dr. S. M. White, Dr. A.
E. Wilcox, all of Minneapolis; Dr. W. A. Coventry,
Dr. A. T. Laird, Dr. C. W. Taylor, all of Duluth; Dr.
Oscar Daignault, Benson; Dr. J. P. Freeman, Glen-
ville; Dr. E. C. Gaines, Buffalo Lake; Dr. F. D. Gray,
Marshall; Dr. A. D. Haskell, Alexandria; Dr. F. R.
Huxley, Faribault; Dr. G. P. Kirk, East Grand
Forks; Dr. F. M. Manson, Worthington; Dr. G. R.
Matchann, Dr. F. J. Plondike, both of Saint Paul;
Dr. O. W. Parker, Moose Lake; Dr. E. A. T. Reeve,
Elbow Lake; Dr. T. F. Rodwell, Mahnomen; Dr.
M. W. Smith, Red Wing; Dr. F. P. Strathern, St.
Peter, and Dr. W. H. Valentine, Tracy.
* * *
It was announced on June 22 that Dr. I. G. Davis,
Rushford, had sold his medical practice and would
retire on July 1 because of ill health. Dr. Davis has
practiced in Rushford for thirty-one years. A grad-
uate of Rush Medical College, he interned at Luth-
eran Hospital, La Crosse, Wisconsin. He served in
the Army during World War I.
Dr. Davis is succeeded by Dr. Myron J. Woltjen,
OF GENERAL INTEREST
who recently completed his internship at Asbury
Hospital, Minneapolis. He is a graduate of the LTni-
versity of Minnesota Medical School.
* * *
HOSPITAL NEWS
Opening ceremonies for the new Swift County-
Benson Hospital were held at Benson on June 18.
Principal speaker at the event was Dr. Walter
Kvale, consultant in the division of medicine at the
Mayo Clinic. Ceremonies also included a victory din-
ner, a band concert and presentation of the kevs for
the hospital.
^ ^
Fourteen staff members of St. Barnabas Hospital,
Minneapolis, formed a special band, the “Barnabas
Barn Burners,” to entertain their fellows at the an-
nual hospital picnic in early June. Costumes for the
players were green surgical caps and white operating-
room shirts and trousers. Audience response to their
efforts was enthusiastic.
* * *
BLUE CROSS-BLUE SHIELD NEWS
The Blue Shield Board held its annual meeting in
Duluth in conjunction with the Minnesota State Med-
ical Association’s annual meeting, June 12-14. All offi-
cers were re-elected. They include: Dr. Olof I. Sohl-
berg, Saint Paul, president; Dr. Richard R. Cranmer,
Minneapolis, vice president; Dr. C. A. McKinlay, Min-
neapolis, secretary; and Dr. W. A. Coventry, Duluth,
treasurer.
RELIABILITY!
For years we have maintained the
highest standards of quality, expert
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223 So. 6th St. Minneapolis 2, Minn.
Re-elected to the board of directors for three years
were Dr. Coventry ; Dr. E. M. Hammes, Saint Paul ;
Dr. P. G. Hoeper, Mankato, and Dr. McKinlay.
Blue Shield enrollment totalled 332,288 as of April 30,
and Minnesotans received over half-a-million dollars in
Blue Shield benefits during the first four months of this
year. By April 30, benefits to Blue Shield subscribers
this year amounted to $580,645, of which $536,312 was
for medical-surgical care subscribers received in hos-
pitals, $43,383 for care received in doctors offices.
Of the total 14,422 claims submitted during this four-
month period, 11,524 were incurred by subscribers in
hospitals, 2,849 in doctors’ offices, and 49 in homes, rep- !
resenting 17,860 medical-surgical services in all.
During April, Blue Shield benefits totalled $169,512
for 4,133 claims submitted, representing 5,181 Blue Shield
services. Persons in the lower income group, who receive
unlimited benefits under Blue Shield, presented 1,267 or
30.7 per cent of the total claims paid during April. Dur-
ing the first four months of this year, 4,513 unlimited
subscriber claims were paid, representing 31.3 per cent
of the total number of claims paid.
Participating Blue Shield doctors provided services
for 3,963 or 96 per cent of the claims paid in April, .
and for 13,818 or 96 per cent of the claims paid during
the first four months of 1950.
Over 13,000 Minnesotans enrolled in Blue Cross during
April, making a total Blue Cross enrollment of 1,017,602
in Minnesota. More than a million-and-a-half persons
enrolled in the 90 Blue Cross hospital service plans
during the first three months of this year, making this
the second highest quarterly enrollment in Blue Cross
history. Over 37,444,000 persons were enrolled in Blue
Cross at the end of March, representing 24 per cent of
the LTnited States population and 21 per cent of the
Canadian people.
National enrollment in Blue Shield plans during the
first quarter of this year has not been reported as yet.
The wise doctor has always considered his patient as
a man or woman who is suffering from, say, a growth
or a tuberculous infection, rather than the uninteresting
container in which some morbid process happens to be
placed. Norman B Capon, M.D., F.R.C.P., Brit. M.J.,
April 15, 1950.
DANIELSON MEDICAL ARTS PHARMACY, INC
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414 SOUTH SIXTH ST., MINNEAPOLIS, MINN.
INSTRUMENTS • TRUSSES • EQUIPMENT • PHARMACEUTICALS • DRUGS
MAIN 2494
746
Minnesota Medicine
BOOK REVIEWS
BOOK REVIEWS
Books listed here become the property of the Ramsey,
Hennepin and St. Louis County Medical Libraries when
reviewed. Members, however, are urged to write reviews
of any or every recent book which may be of interest
to physicians.
PRACTICE OF MEDICINE. Fifth Edition. Jonathan Camp-
bell Meakins, C.B.A., M.D., LL.D., D.Sc. Formerly Pro-
fessor of Medicine and Director of the Department of Medi-
cine, McGill University; formerly Physician-in-Chief, Royal
Victoria Hospital, Montreal; formerly Professor of Therapeu-
tics and Clinical Medicine, University of Edinburgh; Fellow
of Royal Society of Edinburgh; Fellow of Royal Society of
Canada; Fellow of the Royal College of Physicians, London;
Fellow of the Royal College of Physicians, Edinburgh; Hon-
orary Fellow of the Royal College of Surgeons, Edinburgh;
Fellow of the Royal College of Physicians, Canada ; Fellow
of the American College of Physicians; Honorary Fellow of the
Royal Society of Medicine. 1,558 pages. Illus. Price $13.50,
cloth. St. Louis: C. V. Mosbv Co., 1950.
HE MERCK MANUAL OF DIAGNOSIS AND THER-
APY. Eighth Edition. 1,592 pages. Il'lus. Price $4.50, regu-
lar edition, $5.00, thumb indexed edition. Rahway, N. J. :
Merck & Co., Inc., 1950.
ESSENTIALS OF OPHTHALMOLOGY. Roland I. Pritikin,
M.D., F.A.C.S., F.I.C.S., Eye Surgeon, Rockford Memorial,
Winnebago County and Swedish-American Hospitals; Consult-
ing Ophthalmologist, St. Anthony Hospital, Rockford, Hospital.
561 pages. Illus. Price, $7.50, cloth. Philadelphia: J. B.
Lippincott Company, 1950.
AINTS, SINNERS AND PSYCHIATRY. Camilla M. Ander-
son, M.D. Assistant Clinical Professor of Psychiatry. Uni-
versity of Utah. 206 pages. Price $2.95, cloth. Philadelphia:
J. B. Lippincott Company, 1950.
HE MASK OF SANITY. (Second edition). Hervey Cleck-
ley, M.D., Professor of Psychiatry and Neurology, University
of Georgia School of Medicine, Augusta, Ga. 569 pages. Price,
$6.50, cloth. St. Louis: C. V. Mosby Co., 1950.
LINICAL ELECTROCARDIOGRAPHY. Francis F. Rosen-
baum, M.D. Assistant Clinical Professor of Medicine, Marquette
University School of Medicine; Staff, Milwaukee County Hos-
pital; Associate Staff, Columbia Hospital; Adjunct Staff, Mil-
waukee Children’s Hospital; Cardiac Consultant and Attendant,
Cardiac Clinic, Milwaukee Children’s Hospital, Milwaukee,
Wisconsin; Edited by Henry A. Christian, A.M., M.D., LL.D.,
Sc.D. (Hon.), M.A.C.P., Hon.F.R.C.P.(Can.), D.S.CM.(A.-
M.A.). (Reprinted from Oxford Loose-Leaf Medicine with the
same page numbers as in that work.) 200 pages. Illus. Price,
$4.50, cloth. New York: Oxford University Press, 1950.
LINICAL LABORATORY METHODS AND DIAGNOSIS.
By R. B. H. Gradwohl, M.D., Director of the Gradwohl School
of Laboratory Technique, St. Louis, Mo. 4th Edition, 3275
pages. Price $40.00. St. Louis: C. V. Mosby Company, 1948.
This three-volume work on “Clinical Laboratory meth-
ds and Diagnosis” is a fourth edition of the original
ingle volume textbook of the same name on “Laboratory
’rocedures with their Interpretation,” later enlarged to
wo volumes, to which has been added in the present edi-
ion, a third dealing entirely with medical parasitology.
The author is well known among laboratory workers,
ot so much as a pathologist, but as a successful
roprietor of a widely advertised school, established to
rain people who wish to work as technical assistants and
:chnicians in the clinical laboratory. The first edition
ras published in 1935, presumably as an outgrowth of a
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ULY, 1950
747
BOOK REVIEWS
compendium on clinical laboratory methods, specially
prepared for the use of the students in the training
school and, as such, represented a compilation of tech-
niques and procedures employed in the contemporary
clinical laboratories and found in textbooks of labora-
tory diagnosis and clinical pathology, and in current
technical journals.
Naturally, a number of methods and procedures de-
scribed are obsolete or not in current use, and merely
help to swell the volume, making it appear more impos-
ing, and adding to its cost. Therefore, it is the reviewer’s
opinion that the first and second volumes might have
been made more useful if the obsolete and discarded
methods and procedures had been omitted and refer-
ences thereto dropped.
Illustrations are plentiful. A majority of them are
copied from other publications, and are so indicated.
The original photographs and drawings are not impres-
sive.
The present edition has been thoroughly revised, re-
written in many instances, and new materials have been
added. This is particularly evident in chapters on blood
chemistry, hematology, blood groups and transfusion,
bacteriology, toxicologic technique, crime laboratory
methods, and electrocardiography. The third volume,
devoted to parasitology and tropical medicine, by Pedro
Konri, Professor of Parasitology of the Faculty of
Medicine, Havana University, Havana, Cuba, represents
a complete treatise on medical parasitology, and probably
ranks as one of the most comprehensive and best illus-
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trated on medical parasitology. It is a pity that this I
volume cannot be purchased without the burden of the
other two.
In size, the book is the largest ever attempted among
the textbooks of clinical laboratory procedures and
diagnosis, and covers the field of medical laboratory
diagnosis more profusely than any in print in the English
language. It may well be added as a reference in the
library of a clinical laboratory, as well as in general
medical libraries.
Kano Ikeda, M.D.
BRUCELLOSIS (UNDULAXT FEVER): CLINICAL AND
SUBCLINICAL. By Harold J. Harris, M.D, F.A.C.P, with
the assistance of Blanche L. Stevenson, R.N. 544 pages. Ill |
illustrations — 12 in color. Price $10.00. 2nd Edition, revised :
and enlarged. New York; Paul B. Hoeber, Inc., 1950.
This book deals with the author’s experiences in 700
cases of brucellosis supplemented by other information
based upon other cases in the literature. It is an enlarged :
and revised edition of the previous volume published in
1941. There are 544 pages and 111 illustrations, includ-
ing 12 colored plates, which are interspaced in the read-
ing matter to bring the points discussed more clearly .
home.
A cursory glance through the text reveals a foreword,
eleven chapters, and a large bibliography which is not 1
complete.
The foreword is written by Walter M. Simpson, M.S.,
M.D, F.A.C.P.
Chapter I — Introduction. Deals with the history, no-
menclature, and definition of brucellosis.
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HOSPITAL AND PHYSICIANS SUPPLIES AND EQUIPMENT
Cedar 1781-82-83
UNSCENTED COSMETICS
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regularly stocked by pharmacies. To be certain that your perfume
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Minnesota Medicine
BOOK REVIEWS
Illlllllllllllllllll IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Ill 11111(1 1 1 'if
THE VOCATIONAL HOSPITAL j
TRAINS PRACTICAL NURSES \
Nine months Residence course. Registered Nurses and 1
Dietitian as Teachers and Supervisors. Certificate from |
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5511 Lyndale Ave. So. LO. 0773 Minneapolis, Minn. 1
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Homewood hospital is one of the
Northwest's outstanding hospitals for the
treatment of Nervous Disorders — equipped
with all the essentials for rendering high-grade
service to patient and physician.
Operated, in Connection with
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HOMEWOOD HOSPITAL
Corner Penn and Plymouth Avenues North
Minneapolis Minnesota
Chapter II — Etiology. Discusses the bacteriology,
morphology, serology, and other characteristics of the
:hree known species bringing out the fact that knowledge
s still far from complete as to the pathogenicity of the
:hree species for various animals.
Chapter III — Epidemiology. Concerns itself with the
nfectiousness, methods of transmission, and the incidence
}f brucellosis in the United States and in other parts of
:he world.
Chapter IV — Pathology. Bears out the author’s state-
ment that because of the comparatively few deaths from
brucellosis most observers have had to content themselves
with operative findings, radiographic changes and clinical
reservations to study pathology. An attempt is made
:o show that the disease affects every organ in the body.
The relationship of brucellosis and Hodgkin’s disease is
ilso discussed.
Chapter V — Symptomatology. In this chapter the au-
hor states that the only symptom common to all cases is
atigue. Numerous case histories of the disease with
marked emphasis on the mimicry of brucellosis with so
many other diseases.
Chapter VI — Diagnosis. This brings out at length the
difficulties encountered in diagnosis. A positive blood
:ulture is the only true method of diagnosis. In all
patients, a suspicion of the disease should be entertained
md the reliance upon cultures, agglutination reactions,
skin tests, opsonocytophagic tests, and occasional biopsy
bf lymph gland, and their interpretation will aid in the
diagnosis of latent and chronic cases. The author at-
taches great significance to the opsonocytophagic test as
i prognostic aid in the treatment.
July, 1950
Chapter VII — Psychologic Studies in Chronic Brucel-
losis.
Chapter VIII — Prognosis points out the fact that bru-
cellosis is not a self limited disease, and one cannot say
a patient is cured because of the spontaneous remissions
and exacerbations of the disease. It demonstrates the
low mortality of 3.4 per cent among the cases reported
and speculates over the actual morbidity of the disease.
Chapter IX — Treatment. Discusses the role of rest,
diet, psychotherapy, diathermy, x-ray and neoarsphena-
mine. Results of combined sulfadiazine and strepto-
mycin therapy, the transfusion of immune blood, of anti-
sera, and some information on the use of newer anti-
biotics such as aureomycin and Chloromycetin are dis-
cussed. The author spends a great deal of space on Bru-
cella antigen therapy and places a great deal of value,
on its use.
Chapter X — Prophylaxis. Stresses the fact that pas-
teurization of milk and the removal of infected animals
will do a great deal. Some speculations on immuniza-
tions in individuals are also discussed.
Chapter XI — Addenda. The newer aspects of brucel-
losis in relation to other diseases are described, and a
more thorough discussion on aureomycin and Chloro-
mycetin, bringing it up to date, is included.
The book is a thorough, detailed treatise on brucellosis
and covers the latest diagnostic methods, prognosis, pro-
phylaxis, and treatment in concise terms. It is well
written and is recommended to those who have any in-
terest in brucellosis.
James Bellomo, M.D.
749
Classified Advertising
Replies to advertisements with key numbers should be
mailed in care of Minnesota Medicine, 2642 University
Avenue, Saint Paul 4, Minn.
FOR SALE — Reasonable terms, or might consider leas-
ing, 13-bed hospital and clinical building in Deer River,
Minnesota. In heart of Itasca County fishing and hunt-
ing region. Perfect location for two general prac-
titioners who want to do a lot of general surgery, OB,
etc. Each man should be able to make $12,000 to
$18,000 per annum if willing to work. Contact Dr. A.
L. Koskela, Deer River Clinic, Deer River, Minnesota.
Telephone 70.
EXCELLENT OPPORTUNITY FOR PHYSICIAN
— -Well established practice available in Northeast Min-
neapolis ; fully equipped office ; reasonable terms. Ad-
dress E-213, care Minnesota Medicine.
WANTED — Locum tenens beginning in August for at
least six months. General practice near Twin Cities.
Permanent association if desired. Address E-214, care
Minnesota Medicine.
WANTED — Young physician to become associated with
very busy general M.D., near Twin Cities, with view
of partnership or buying practice. Address E-215, care
Minnesota Medicine.
WANTED — Physician who is interested in surgery and
will gradually take over surgical part of small group
practice. Address E-216, care Minnesota Medicine.
FOR SALE — Northwest Washington — General practice,
$20,000 gross. Six-room office building with four-
room apartment under same roof. Centrally heated.
Selling for reasons of health. Address E-217, care
Minnesota Medicine.
FOR SALE — General practice and office equipment.
Population 9,000. Will introduce. Open staff hos-
pital. Available September 1. Address E-218, care
Minnesota Medicine.
FOR RENT — New building being completed for medical
profession. Highland Park district, Saint Paul ; plenty
of parking space, main floor. 611 South Snelling Ave-
nue, phone DeSoto 2856 ; evening phone Emerson 4559.
FOR SALE — 30 milliampere Picker vertical fluoroscope.
Like new. A bargain. Address E-219, care Minnesota
Medicine.
WANTED — Young man, obstetrical training. Small
group practice in North Dakota. Excellent future. Ad-
dress E-220, care Minnesota Medicine.
Index to Advertisers
Abbott Laboratories 664
American Meat Institute 670
American National Bank 751
Ames Co., Inc 662
Anderson, C. F., Co 741
Ar-Ex Cosmetics, Inc 748
Ayerst, McKenna & Harrison, Ltd 665
Benson, N. P., Optical Co 742
Birches Sanitarium 736
Birtcher Corporation 740
Borden Co 666
Brown & Day, Inc 737
Buchstein-Medcalf Co 746
Caswell-Ross Agency 658
Classified Advertising 750
Cook County Graduate School of Medicine 741
Dahl, Joseph E., Co 741
Danielson Medical Arts Pharmacy, Inc 746
“Dee” Medical Supply Co 748
Druggists Mutual Insurance Co 751
Ewald Bros Inside Back Cover
Franklin Hospital 751
Glenwood Hills Hospitals 729
Glenwood-Inglewood Co 747
Hall & Anderson 751
Hazelden Foundation 735
Homewood Hospital 749
Juran & Moody 733
Kelley-Koett X-Ray Sales Corporation 672
Lederle Laboratories 661
Lilly, Eli, & Co Front Cover & 672
Mead Johnson & Co 752
Medical Placement Registry 750
Medical Protective Co 744
Milwaukee Sanitarium Back Cover
Minnesota Mutual Life Insurance Co 739
Mounds Park Hospital Back Cover
Mudcura Sanitarium 744
Muller Corset Co., Inc 667
Murphy Laboratories 751
Nestle Co 743
North Shore Health Resort 737
Parke, Davis & Co Inside Front Cover, 657
Patterson Surgical Supply Co 748
Physicians Casualty Association 742
Physicians & Hospitals Supply Co 668, 745, 746, 751
Professional Credit Protective Bureau 671
Quincy X-Ray and Radium Laboratories 748
Radium Rental Service 747
Rest Hospital 736
Roddy-Kuhl-Ackerman 747
St. Croixdale Sanitarium 660
Schering Corporation 669
Schusler, J. T., Co., Inc 751
Searle, G. D., & Co 727
Vocational Hospital 749
Williams, Arthur F 751
Winthrop-Stearns, Inc 731
Wyeth, Inc 663
We have scores of positions for general practitioners in
the Twin Cities, in this state and many other states.
We need general practitioners for locum tenens.
We have several locations and several practices for sale.
Among our many attractive openings for board men are the
following :
Pathologist for 600-bed midwest hospital;
Orthopedic surgeon for excellent set-up in the Medical
Arts Building in an Arkansas City, practice and all equip-
ment for sale for price of equipment, by widow.
Write or visit us at one of our offices.
MEDICAL PLACEMENT REGISTRY
Saint Paul
Suite 480 Lowry Medical
Arts Bldg.
Minneapolis Campus Office
629 S. E. Washington
Gladstone 9223
Rochester, Minnesota
11th Floor Kahler Hotel
Minneapolis
916 Medical Arts Bldg.
750
Minnesota Medicine
PHYSICIANS AND HOSPITALS SUPPLY CO., Inc.
414 SOUTH SIXTH ST., MINNEAPOLIS, MINN.
INSTRUMENTS • TRUSSES • EQUIPMENT • PHARMACEUTICALS • DRUGS
MAIN 2494
Practical Nursing School
Approved} by Minnesota State Board of Nurses
Examiners
Twelve months course open to High
School Graduates or women with equiv-
alent education.
For further information apply to
DIRECTOR OF NURSES
FRANKLIN HOSPITAL
501 W. Franklin Avenue, Minneapolis 5, Minn.
TAILORS TO MEN SINCE 1886
The finest imported and domestic wool-
ens such as SCHUSLER'S have in stock
are not too fine to match the hand tailor-
ing we always have and always will
employ.
J. T. SCHUSLER CO., INC.
379 Robert St. St. Paul
DO YOU HAVE CHILDREN?
Train them in the habit of sav-
ing money regularly through a
SAVINGS ACCOUNT with
this bank. . . . They’ll always
thank you. OPEN AN AC-
COUNT FOR THEM TO-
DAY.
THE AMERICAN NATIONAL BANK
OF SAINT PAUL
Bremer Arcade Robert at 7th CE 6666
Member Federal Deposit Insurance Corporation
Radiological and Clinical
Assistance to Physicians
in this territory
MURPHY LABORATORIES
Minneapolis: 612 Wesley Temple Bldg. - - At. 478*
St. Paul: 348 Hamm Bldg. ------ Ce. 712S
If no answer, call ......... Ne. 1291
Hall & Anderson
PRESCRIPTION PHARMACY
BIOLOGICALS
PHYSICIANS’ SUPPLIES
SAINT PAUL, MINN.
LOWRY MEDICAL ARTS BUILDING
TELEPHONE: CEDAR 2735
UNUSUAL LENS GRINDING
flRTOREWlLLMWJ
CATARACT,
MYO-THIN
and other difficult
and complicated
lenses are ground to
extreme thinness and
accuracy by our
expert workmen.
SAINT PAUL
MINNESOTA
insurance Druggists' Mutual Insurance Company Pr**mpt
at a OF IOWA, ALGONA, IOWA \ LOSS
Saving Fire - Tornado - Automobile Insurance Service
MINNESOTA R E P R E S E N T A T I V E- S. E. STRUBLE, WYOMING, MINN.
at a
Automobile Insurance
Service
STRUBLE, WYOMING, MINN.
July, 1950
751
• /If; M.dU''*''
M*(k UtjV.i /Jtil.-r Folk
with arSdcd v»torr<n
evdpof/iti^J. • «*» »'♦
LACTUM
new evaporated milk
and Dextri-Maltose
formulas for infants
DALACTUM
Convenient
Simple to
Prepare
Nutritionally
Sound
Generous in
Protein
EVAPORATED
WHOLE MU K and DEXTBI MM-TO
FORMULA FOR INFANTS
Meao Johnson
t V A N ft V I I I. r.. I N »
JfWt.MVi 0/
Liquid
Formulas
evapor Ait n
10W FAT Mil H and DUTRI MAUOSt
FORMULA FOR INFANTS
13 fLLMOCl iV'ii '..n'cl*
wd, svapstoitfd. ' .Aoooti >
Mkau Johnson a co.
t V A N X V I 1 > 1 1 N " ’
CO
X
For almost FOUR decades physicians have recognized the merits
of infant-feeding formulas composed of cow’s milk, water and
Dextri-Maltose*.
In LACTUM and DALACTUM. Mead’s brings new convenience
to such formulas— for LACTUM and DALACTUM are prepared for
use simply by adding water.
LACTUM, a whole milk formula, is designed for full term infants
with normal nutritional needs. DALACTUM is a low fat formula
for both premature and full term infants with poor fat tolerance.
Both are generous in protein. *t. m. Reg. u. s. Pat. off.
Mead Johnson & co.
AIinnesota Medicine
oAekafm:
BENADRYL'
This is the season when bleary-eyed,
sneezing patients turn to you for the rapid,
sustained relief of their hay fever
symptoms which BENADRYL provides.
\ Today, for your convenience and ease of administration,
BENADRYL Hydrochloride
(diphenhydramine hydrochloride,
Parke-Davis) is available in a
wider variety of forms than ever
before, including Kapseals®,
Capsules, Elixir and Steri-Vials®.
'AKKE, DAVIS & COMPANY
$
bl
P
N
E ft
I here Is No Magic
YOU CANNOT expect to retain your profits from your
Practice as a Doctor regardless of taxation unless you provide
yourself with income protection. You daily strive to make and
save enough for unforeseen needs, then along comes an accident
or illness taking everything, even to the point of putting you in
debt — all because you procrastinate about securing income pro-
tection.
YOU CAN expect to secure the best value in non-cancellable
Accident and Sickness insurance through the plan available to
you as a member of the State Medical Association. DELAY
holds no increased value — ACT NOW.
CASWELL-ROSS AGENCY
1177 N. W. Bank Building Minneapolis 2, Minnesota
Minneapolis — MA 2585 St. Paul — ZE 2341
Insurors to:
Minnesota State Bar Association
Minnesota State Dental Association
Minnesota State Medical Association
Minnesota Society of C.P.A.
Minnesota State Pharmaceutical Assn.
\
Minnesota Auto Dealers Association
Hennepin County Medical Society
Hennepin County Bar Association
St. Paul District Dental Society
Minneapolis District Dental Society
St. Cloud Dental and Stearns County
Medical Society
Duluth District Dental Society
East Central Medical Society
St. Louis County Medical Society
Minnesota State Veterinarian Medical
Society
754
Minnesota Medicine
Journal of the Minnesota State Medical Association, Southern Minnesota Medical Association, Northern Minnesota
Medical Association, Minnesota Academy of Medicine and Minneapolis Surgical Society
Volume 33 AUGUST, 1950 No. 8
Contents
A Better Rural Transfusion Program.
A. H. Borgerson, M.D., Long Prairie, Minnesota 773
Psychological Medicine in a General Medical
Setting.
Richard M. Magraw, M.D., Minneapolis, Minne-
sota 776
The 1949 Cancer Statistical Study.
N. O. Pearce, M.D., and D. S. Fleming, M.D.,
M.P.H., Minneapolis, Minnesota 782
Infant Methemoglobinemia in Minnesota Due
to Nitrates in Well Water.
A. B. Rosenfield, M.D., M.P.H., and Roberta
Huston, B.Ch.E., Minneapolis, Minnesota 787
Pituitary Adrenocorticotropic Hormone (ACTH)
in Asthma.
/. S. Blumenthal, M.D., F.A.C.P., Minneapolis,
Minnesota 797
Renal Tumors.
Henry Fisketti, M.D., Duluth, Minnesota 799
History of Medicine in Minnesota :
Medicine and Its Practitioners in Olmsted County
Prior to 1900. (Continued from July issue)
Nora H. Guthrey, Rochester, Minnesota 804
President’s Letter :
Postponed Health Problems 811
Editorial :
Regulation of Drugs and Materials Used in the
Home 812
Advertising Program 813
Shoe-Fitting Fluoroscopes 813
AMA Meeting 814
Suggestions for the Diagnostic Study of a Patient
with an Abnormal X-Ray Shadow of the Chest 814
BCG Vaccination 816
Medical Economics :
Graduates Warned of Deficit Spending 817
Posterity Still Bears Burden 817
AMA President Hits State Socialism Issue 818
Industry Leaders Sanction “Rights of Free Men” 818
The Interurban Academy of Medicine — Cancer
Teaching Clinic 819
Minnesota Academy of Medicine :
Meeting of March 8, 1950 820
Meeting of April 12, 1950 820
Current Mortality of Transurethral Resections.
(Abstract) Donald Creevy, M.D 820
Treatment of Fractures with the Intramedullary
Nail.
Wallace Cole, M.D. (Discussion only) 821
Minnesota State Medical Association — House of
Delegates — Summary of Proceedings 822
Reports and Announcements 828
In Memoriam 836
Woman’s Auxiliary 841
Of General Interest 842
Book Reviews 850
Contents of Minnesota Medicine copyrighted by Minnesota State Medical Association, 1950
Entered at the Post Office in Saint Paul as second class mail matter. Accepted for mailing at the special rate of postage provided
for in Section 1103. Act of October 3, 1917, authorized July 13, 1918.
August, 1950
755
MINNESOTA MEDICINE
Official Journal of the Minnesota State Medical Association
Published by the Association under the direction of its Editing and Publishing Committee
Office of Minnesota State Medical Association,
493 Lowry Medical Arts Bldg., Saint Paul 2, Minnesota.
EDITING AND PUBLISHING COMMITTEE
E. M. Hammes, Saint Paul T. A. Peppard, Minneapolis
Philip F. Donohue, Saint Paul H. A. Roust, Montevideo
H. W. Meyerding, Rochester O. W. Rowe, Duluth
B. O. Mork, Jr., Minneapolis Henry L. Ulrich, Minneapolis
C. L. Oppegaard, Crookston A. H. Wells, Duluth
EDITORIAL STAFF
Carl B. Drake, Saint Paul, Editor
George Earl, Saint Paul, Associate Editor
Henry L. Ulrich, Minneapolis, Associate Editor
BUSINESS MANAGER
J. R. Bruce
Annual Subscription — $3.00. Single Copies — $0.40. Foreign and Canadian Subscriptions — $3.50.
The right is reserved to reject material submitted for editorial or advertising columns. The
Editing and Publishing Committee does not hold itself responsible for views expressed either in
editorials or other articles when signed by the author.
Classified advertising — ten cents a word; minimum charge, $2.00. Remittance should ac-
company order.
Display advertising rates on reauest.
Address all communications concerning the journal to Minnesota Medicine, 2642 University
Avenue, Saint Paul 4, Minnesota. Telephone Nestor 2641.
ST.
CROIXD ALE ON LAKE ST. CROIX
PRESCOTT. WISCONSIN
MAIN BUILDING— ONE OF THE 8 UNITS IN “COTTAGE PLAN”
A Modern Private Sanitarium for the Diagnosis, Care and Treatment of Nervous and Mental Disorders
Located on beautiful Lake St. Croix, eighteen miles from the Twin Cities, it has the advantages of both
City and Country. Every facility for treatment provided, including recreational activities and occupational
therapy under trained personnel. Close personal supervision given patients, and modern methods of
therapy employed. Inspection and cooperation by reputable physicians invited. Rates very reasonable.
Illustrated folder on request.
NEUROPSYCHIATRISTS
PRESCOTT OFFICE
Prescott, Wis.
Howard J. Laney, M.D.
Tel. 39 and Res. 76
Hewitt B. Hannah, M.D
Andrew J. Leemhuis, M.D.
Howard J. Laney, M.D.
511 Medical Arts Building
Minneapolis. Minnesota
Tel. MAin 1357
SUPERINTENDENT
Dorothy M. Most, R.N.
Prescott, Wisconsin
Tel. 69
756
Minnesota Medicini!
U R EO M YCI N
CRYSTALLINE
in Infections
of the Puerperium
During the past year, obstetricians have become in-
creasingly impressed with the ability of aureomycin to
prevent or arrest infections of the puerperium. Where
infection is feared, or has appeared, this broadly
effective antibiotic is highly useful. Drug fastness and
allergy are very rare following aureomycin. It is be-
lieved that this new crystalline form of aureomycin
obviates nearly all side reactions.
Capsules:
Bottles of 25, 50 mg. each capsule.
Bottles of 16, 250 mg. each capsule.
Ophthalmic:
Vials of 25 mg. with dropper;
solution prepared by adding
5 cc. of distilled water.
Aureomycin haS'zilso been found effective for the con-
trol of the following infections:
Acute amebiasis, bacterial infections associated
with virus influenza, bacterial and virus-like infections
of the eye, bacteroides septicemia, boutonneuse fever,
brucellosis, chancroid, Friedlander infections (Kleb-
siella pneumonia), gonorrhea (resistant), Gram-nega-
tive infections (including those caused by some of the
coli-aerogenes group), Gram-positive infections (in-
cluding those caused by streptococci, staphylococci,
and pneumococci), granuloma inguinale, H. influenzae
infections, lymphogranuloma venereum, peritonitis,
pertussis infections (acute and subacute), primary
atypical pneumonia, psittacosis (parrot fever), Q, fever,
rickettsialpox, Rocky Mountain spotted fever, sinusitis,
subacute bacterial endocarditis resistant to penicillin,
surgical infections, tick-bite fever (African), tularemia,
typhus and the common infections of the uterus and
adnexa.
August, 1950
LEDERLE LABORATORIES DIVISION
American Cuanamid company
30 Rockefeller Plaza, New York 20, N. Y.
757
Two
Instruments
of hope
/ic/eY
Mice
■/
.For four years, there was one high note of hope for
the 100,000 or more victims of petit mal. This was offered by
Tridione, the first Abbott-developed, synthetic anticonvulsant.
Its dramatic therapy restored many children, once seizure-
ridden, to happy, normal lives. Soon after introduction,
it was called "clearly the drug of choice in the treatment of
the petit mal triad.”1
But then, in 1949, Paradione — homologue of
Tridione — emerged from three years of clinical testing as an
equally effective agent for the symptomatic control of
petit mal, myoclonic jerks and akinetic seizures. Although
similar in action to its predecessor, Paradione proved
successful in many instances where lack of response or
intolerance had made Tridione therapy infeasible.
The value of both drugs is well documented in medical journals.
— ■— ^-r-. Please see the literature, however, before administering
either Tridione or Paradione. There are certain
techniques, precautions which must be observed. Just
drop us a card. All prescription pharmacies have Tridione
and Paradione in tablets, capsules, solutions, q *
Abbott Laboratories, North Chicago, Illinois. vAATITOXC
758
Minnesota Medicin
PHOSPHO-SODA (FLEET
Gentle, Effective Action
Phospho-Soda (Fleet)'s* action is prompt and thorough, free
from any disturbing side effects. That's why so many modern
authoritative clinicians endorse it... why so many thousands
of physicians rely on it for effective, yet judicious relief of con-
stipation. Liberal samples will be supplied on request.
*Phospho-Soda (Fleet) is a solution containing in each 100 cc. sodium biphosphate 48 Gm. and sodium
phosphate 18 Gm. Both 'Phospho-Soda' and 'Fleet' are registered trade marks of C. B. Fleet Company, Inc.
C. B. FLEET CO., INC. • lynchburg, Virginia
[August, 1950
759
///>
■w \\w
Before Treatment (P
days prior to Dihydro-
streptomycin therapy )
Diffuse lobular tubercu-
lous pneumoniat lower
half of left lung; thin-
walled cavity above hilus
( 3 x 3.5 cm.).
^\\ w
v// r
After 3 Mos. Treat-
ment (2 days after dis-
continuance of Dihydro-
streptomycin) Consider-
able clearing of acute
exudative process in the
diseased lung; cavity
smaller and wallthinner.
Preferred Adjuvants in the
treatment of
Dihydrostreptomycin and Streptomycin are unquestionably the most
potent antibiotics now available for use against tuberculosis. Extensive
clinical results have defined the important role of these antibiotics in
suppressing the activity of the tubercle bacillus.
Detailed literature including in-
dications, pharmacology, dosage,
and administration is available
upon request.
MERCK & CO., Inc.
Manufacturing Chemists
Rahway, new jersey
Streptomycin Crystalline
Calcium Chloride^v Dihydrostreptomycin
Complex Merck Sulfate Merck
760
Minnesota Medicine
*
Hamblen, E. C. : Some Aspects
of Sex Endocrinology
in General Practice,
North Carolina M. J.
7:533 (Oct.) 1946.
"Nowhere in medicine are
more dramatic therapeutic effects
obtained than those which
follow estrogen therapy in the
girl who has failed to develop
sexually, A daily dose of 2.5 to
3.75 mg. of Tremarin’ given in a
cyclic fashion for several months
may bring about striking adolescent
changes in these individuals.”*
Estrogenic
Substances
(water-soluble)
also known as
Conjugated
Estrogens
(equine).
“Premarin”— a naturally conjugated estrogen— long a choice
of physicians treating the climacteric— has been earning
further clinical acclaim as replacement therapy
in hypogenitalism.
In the treatment of hypogenitalism, “Premarin” supplies
the estrogenic factors that are missing, and thus tends to
eliminate the manifestation of the hypo-ovarian state. The
aim of therapy is to develop the reproductive and accessory
sex organs to a state compatible with normal function.
Four potencies of “Premarin” permit flexibility of
dosages: 2.5 mg., 1.25 mg., 0.625 mg., and 0.3 mg. tablets;
also in liquid form, 0.625 mg. in each 4 cc. (1 teaspoonful).
While sodium estrone sulfate is the principal estrogen
in “Premarin” other equine estrogens... estradiol, equilin,
equilenin, hippulin . . . are probably also present in
varying amounts as water-soluble conjugates.
Ayerst, McKenna & Harrison Limited
22 East 40th Street, New York 16, New York
soos
\ugust, 1950
761
new and different salt substitute
tastes like salt
looks like salt
sprinkles like salt •
hypertension
CO-SALT tastes so much like table salt that low so-
dium diet patients can actually enjoy their food again.
With CO-SALT in place of sodium chloride, they will
cooperate more fully in following your diet... will
be better nourished .. .and intake of edema-causing
sodium will be held to a minimum.
CO-SALT CONTAINS NO LITHIUM ... is not bitter,
metallic, or disagreeable in taste. It is the only salt
substitute that contains choline.
Professional Samples
Upon Request
Available:
2 oz. shaker
top package
8 oz. economy
package
CO-SALT — for use at the table or in cooking — will
be a joy to low-sodium diet patients.
INGREDIENTS: Choline, potassium chloride, ammo-
nium chloride and tri-calcium phosphate.
4
Accepted for advertising in
the Journal of the American
Medical Association.
Casimir Funk Laboratories, Inc.
affiliate of U. S. VITAMIN CORPORATION
250 E. 43rd St. • New York 17, N. Y.
762
Minnesota Medicini
Small
Amount
National Research
Council Allowances,
Sedentary Man
(154 lbs.)
Ovaltine in Milk,
3 Servings*
; of N. R- C.
Provided by
of
Milk
Percentages
Allowances I
3 Servings*
Ovaltine in I
of whole milk-
of Ovaltine
* Each serving
A sure step to dietary adequacy
The aim of the dietary at all
times and under all conditions is to provide ample
amounts — not just minimum amounts — of all nutrient
essentials. Only when the daily nutrient intake is fully
adequate, based on the most authoritative nutritional
criteria, can the possibility of adequate nutrition be
assured. It is for this reason that a food supplement
assumes great importance in daily practice. It should
be rich in those nutrients most likely deficient in pre-
vailing diets or in restricted diets during illness and
convalescence.
The multiple nutrient dietary food supplement , Ovaltine
in milk, is especially suited for transforming even
poor diets to full nutritional adequacy. This is clearly
shown by the data in the table above.
Note in particular the high percentages of the
dietary allowances for nutrients and the relatively low
percentage of the total calories furnished by the serv-
ings of Ovaltine in milk. Thus, without unduly in-
creasing the caloric intake, Ovaltine in milk greatly
increases the contribution of nutrient essentials. En-
ticing flavor and easy digestibility are other important
features of this dietary supplement.
Two kinds, Plain and Sweet Chocolate Flavored.
Serving for serving, they are virtually
identical in nutritional content.
THE WANDER COMPANY, 360 N. MICHIGAN AVE., CHICAGO 1, ILL.
August, 1950
763
the probability
of thrombi ...
Both morbidity and mortality from post-
operative venous thrombosis and embo-
lism, frequent sequelae to surgery, have
been dramatically reduced by early insti-
tution of anticoagulant therapy. Studies
of anticoagulants by Upjohn research
workers have led to the development of
many Heparin Sodium preparations, in-
cluding long-acting Depo*-Heparin So-
dium, with or without vasoconstrictors.
Heparin Sodium preparations provide
promptly effective and readily controlla-
ble anticoagulant therapy.
*Trademark, Reg. U. S. Pat. Off.
with care... Designed for health
THE UPJOHN COMPANY. KALAMAZOO 99. MICHIGAN
764
Minnesota Medicine
a
long
and
stinguished
career
in
ographg
NEO-IOPAX
(brand of sodium iodomethamate)
An 18 year history of dependable roentgenograms obtained without harm to the
patient distinguishes the career of Neo-Iopax as a diagnostic urographic agent.
Since 1932, hundreds of thousands of doses of Neo-Iopax have been injected with
virtual freedom from serious untoward reactions. No other urographic contrast
medium has equalled the safety' record of Neo-Iopax. No agent, experience with
which is limited to a relatively small number of patients, can be deemed to be as safe.
Because the patient’s life and welfare take precedence over all other considerations in
diagnostic investigation of the urinary tract, urologists and roentgenologists will
continue to rely— as always— on Neo-Iopax.
Available as a stable, crystal-clear solution of disodium N-methyl-3, 5-diiodo-chelidamate in 10,
20 and 30 cc. ampuls of 50% concentration. Neo-Iopax 75% concentration in 10 cc. ampuls, box
of 5 ampuls; 20 cc. boxes of 1, 5 and 20 ampuls.
CORPOR AT I O N • B LO O M F I E LD, NEW JERSEY
NEO-IOPAX
Steelta+ie
* A NEW STEEL SUITE OF MODERN DESIGN
In this outstanding suite, you will find steel equipment at its finest. Massive and
attractive in appearance, the chair-table is extra large with counter balanced, ad-
justable top, disappearing stirrups, five spacious drawers, the Hide-A-Roll attach-
ment, pull-out leg slide, concealed treatment basin, and ample storage space. The
large instrument cabinet can be had with either solid or glass doors, as preferred.
There is superior engineering and workmanship in this suite which makes STEEL-
I ONE equipment outstanding for design and long, practical service. It will be
appreciated by your patients for its beauty and quality . . . Available in
gleaming white or softly-tinted cream white, chip-proof Du Pont Dulux.
Write for our Hamilton Steeltone Catalog M-850
Distributed by
PHYSICIANS AND HOSPITALS SUPPLY C0.# Inc.
MINNEAPOLIS MINNESOTA
766
Minnesota Medicine
tor the BUSY RADIOLOGIST
KELEKET
220KV
THERAPY UNIT
Telephone or write for complete details.
Kelley-Koett X-Ray Sales Corporation
of Minnesota
1225 Nicollet Avenue Telephone — AT. 7174
Minneapolis 3, Minnesota
In a range of 100 to 220KVP, busy radiologists
find that the Keleket 220KV Therapy Unit saves
them time and effort in treatment of servix, breast
and axilla, and mouth and throat, as well as other
therapy permitted by this range. Easy, precise angulation
permits quick positioning and protected treatment without
strain . . . never requires patients to assume
awkward positions difficult to treat.
All meters and control switches are arranged on a vertical
panel in the Keleket 220KV Control Unit. Desired
settings are made quickly, conveniently and accurately
Safety devices are provided for utmost protection
of patient and equipment. Automatic compensations
and adjustments save time and assure optimum results.
For All Therapeutic
Technics . . . For Superficial-
Intermediate - Deep Therapy
August, 1950
767
BIRDS ahSL dsiAawjtfajcL fiwm, h opt Ho a
and, like these ancestors, they do not perspire:
but many a doctor is, as they say, "sweating blood"
over his collections. (Or, if he isn't, his secretary is.)
Leaving ornithology and herpetology out of it and getting down to sheer economics
the fact is that while we know nothing about medicine we do know ACCOUNTS
RECEIVABLE. With your permission we would like to deal with your secretary —
or with you if you have the time — and take off your hands all accounts more
than six months past due. One hour spent plucking those accounts from your ledger
now and turning them over to
PROFESSIONAL CREDIT PROTECTIVE BUREAU
for deft, tactful, conscientious, firm and effective approach and consummation of
collection may save you hundreds of dollars, hours of distraction and a tremen-
dous amount of consideration as to whether or not you are going to sacrifice any
goodwill. These are days of tension. Old accounts aren't going to be any easier
to gather in during the winter than now or early fall, maybe not as easy. It's
time to take action.
PRO-
This is a personalized, completely proved procedure. We have no black magic,
no inspired touch, but what we do have is a know-how on professional debits,
a background in getting in the outstanding, a technic of careful analysis of
each account, a knack of taking it over as your representative in the same
decent way in which you would function. The returns flow to you direct
and not through us. This kind of faithful service and understanding
treatment has brought in hundreds of thousands of dollars to other
practitioners and we would like very much to put ourselves
FESSIONAL \ at your disposal and become one of the effectives of your
CREDIT PROTECT- office. Send us 35 accounts which we will handle for $35;
IVE BUREAU 105 accounts for $100: we to receive 20% for all monies
724 Metropolitan Life Bldg., 'X. paid to you. AND THE ACCOUNTS CAN BE ' TOUGH
Minneapolis, Minn. X. ONES " TOO!
We will take collection service
Tear off the corner of this page and fill in
your name and address. We will send you
the required forms and a written guar-
anty. And be assured that we do
all the work.
on 35 accounts, $35
on 105 accounts, $100
.(check
. which)
You to send us necessary forms and written
guaranty, you to do all the work;
we to pay you 20% of all amounts collected.
Name
Firm.
Address .
(BuL . . .
CkL Thaw!
768
Minnesota Medicine
^ LONG BEFORE I
GOT THE DOCTOR'S
report: I knew
CAMELS AGREED WITH
MY THROAT. THEY
SMOKE SO MILD—
AND THEY ARE SO
GOOD-TASTING !
Throat Specialists report on
30-day test of Camel smokers:
44
Not one
single case of
throat irritation
due to smoking
Camels!”
Yes, these were the findings of throat spe-
cialists after a total of 2,470 weekly exami-
nations of the throats of hundreds of men
and women who smoked Camels — and only
Camels — for 30 consecutive days.
*
Elaine Bassett, television stylist, is one of hundreds, coast to coast, who made the
30-Day Test of Camel Mildness under the observation of throat specialists.
mmmm m
ACCORDING TO A NATIONWIDE SURVEY:
R. J. Reynolds Tobacco Co., Winston-Salem, N. C.
More Doctors Smoke Camels
THAN ANY OTHER CIGARETTE
August, 1950
Yes, doctors smoke for pleasure, too! In a nationwide survey, three independent research organi-
zations asked 113,597 doctors what cigarette they smoked. The brand named most was Camel.
769
' - ■
;
,V ■. '
*
j .•< v<
FATTY DEGENERATION RECOVERY AFTER DIETARY THERAPY
. . under good dietary treatment the acute progressive histologic
features of the hepatic parenchymal cell degeneration, even in a
severely chronically diseased liver, may disappear within a few
tUCc/cS.”— Volwiler, W.; Jones, C. M., and Mallory, T. B.: Gastroenterology 11:164, 1948
The amino acid essential
for liver regeneration
dl-methionine Wyeth
In the dietary management of liver damage due to
pregnancy, or to malnutrition, allergy, alcoholism,
or chemo-toxic agents.
MEONINE TABLETS: 0.5 Cm., bottles of 100 for
oral therapy.
CRYSTALLINE MEONINE: Bottles of 50 Gm. for
preparation of intravenous solutions.
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772
Minnesota Medicine
Journal of the Minnesota State Medical Association, Southern Minnesota Medical Association, Northern Minnesota
Medical Association, Minnesota Academy of Medicine and Minneapolis Surgical Society
Volume 33
AUGUST. 1950
No. 8
A BETTER RURAL TRANSFUSION PROGRAM
A. H. BORGERSON, M.D.
Long Prairie, Minnesota
'T'HE RURAL SURGEON visiting the larger
medical and surgical centers looks with envy
upon the unlimited supply of blood available to
insure safety, speed convalescence and extend
the range of surgical effort. He, too, needs blood
to treat traumatic shock and hemorrhage, bleed-
ing peptic ulcer, ectopic pregnancy and obstetrical
blood losses, as well as for preparing his anemic
patients more promptly for elective surgery. He
often hopes that somehow the advantages of a
blood bank may be brought to the small town
hospital where he works.
The problem in closely spaced urban centers
differs from that where smaller groups of people
are separated by long distances or geographic bar-
riers at times aggravated by inclement weather.
The solution must be planned to -fit the terrain
to which it applies, and this paper will describe
the program we have worked out in a typical,
average small town in Minnesota.
Our village of 3,000 people, about 120 miles
north of Minneapolis, serves an agricultural pop-
ulation of about 12,000 within a radius of 15
miles. Our twenty-three-bed hospital, soon to
be replaced by a new one about twice its size, is
well equipped and served by an excellent medical
and nursing staff. All types of medical, obstetric
and surgical emergencies are handled. The more
common types of major surgery are taken care
of locally, while the rare and more specialized
cases of a non-urgent nature are referred to
specialists in the Twin Cities or Rochester. A
consulting pathologist furnishes prompt tissue
diagnosis and helpful discussion of our surgical
To be read at the third annual meeting of the American
Association of Blood Banks, Chicago, Illinois, October 12-14,
1950.
August, 1950
and autopsy specimens. He takes an active in-
terest in our laboratory and administrative prob-
lems, and our blood banking plan was first sug-
gested by him during one of our periodic confer-
ences.
Until this year our solution of the blood prob-
lem has followed a pattern common to most small
town hospitals. When the need for blood was
anticipated in non-emergency cases the friends
and relatives were examined, grouped and cross-
matched and the blood drawn and refrigerated
until needed. A “walking blood bank’’ was or-
ganized several years ago. The information on
group, Rh, hemoglobin, physical fitness, history,
serology, address and phone number of each vol-
unteer was filed and cross indexed. From this
list a donor could be obtained, the blood drawn
and cross-matched within a reasonably short time
to meet the need for blood in emergencies. Plas-
ma from commercial sources and other parenteral
fluids were used while waiting for the blood.
Although this scheme had worked well and had
saved lives in dramatic fashion, it could never-
theless be improved upon.
Accidents and emergencies occur at night, on
Sunday and on holidays when the technical team
trained to carry out the procedure in efficient
and orderly fashion is not on duty. Delay in as-
sembling personnel and substitution of less ex-
perienced people results in the loss of critically
important time. Donors may be hard to locate
and often are not properly prepared. They may
have eaten recently. Serology may be too old to
be reliable. The commercial plasma used to con-
trol the situation until blood becomes available
is expensive and the Blue Cross does not cover
773
RURAL TRANSFUSION PROBLEM— BORGERSON
its cost. Impecunious patients need blood and
plasma as often as the wealthy. The lavish use
of expensive materials adds to the already heavy
financial burden of the hospital. Nevertheless,
it is our moral obligation to meet the needs of the
sick and injured without regard to their ability
to pay. The soul-searching reconsideration of
the case that might have been saved had plasma
and blood been more readily available has its
effect upon the doctor’s peace of mind and per-
haps on his coronary arteries as well. It was
obvious to the medical group of our community
that an improvement upon our old transfusion
habits was urgently needed.
In addition to the high cost of commercial plas-
ma, another obstacle to the successful operation of
a small hospital blood bank is the inability to pre-
dict the need for blood in any given short period
of time. On some occasions a dozen bloods might
be used in a single night, while at another time
no blood may be required for many days and the
entire refrigerated supply wasted through too long
storage.
Elements of an Ideal Rural Transfusion
Program
An ideal transfusion program in a small hos-
pital requires three provisions in addition to the
ordinary procurement of blood for elective trans-
fusion :
1 . There must be available an adequate supply
of plasma which the physician can use in emer-
gency without any hesitation about the patient’s
ability to pay.
2. There should be a moderate supply of fresh
whole blood drawn and ready for administration
in emergencies as soon as the patient can be
grouped and the blood matched.
3. There must be a volunteer “walking blood
bank” which can be activated whenever the sit-
uation indicates that the reserve of plasma and
refrigerated whole blood might be exhausted.
The community must be locally self sufficient
so that this program is in effect continuously, and
cannot be disrupted by storms, sleet and other
conditions which might interfere with the delivery
of blood from a distant point. It is true that such
a program requires attention and effort on the
part of the medical staff. The program is vital to
them and it is only proper and wise for them
to give' enough of their time to supervise and
retain control of this phase of their medical prac-
tice.
During a discussion of these problems our con-
sulting pathologist, Dr. R. W. Koucky, suggest-
ed that we contact the Minneapolis War Memorial
Blood Bank. In conjunction with Dr. G. A.
Mattson, the director of this bank, the Long
Prairie Community worked out the program
which I wish to outline.
The Long Prairie Plan
With the able help of the Long Prairie Leader
and its public spirited editor, Mr. Carl C. Carl-
son, a planned campaign of publicity was used to
initiate the program. The community problem
and the proposed solution were repeatedly em-
phasized. A goal, both as to numbers and as to
closing date, was set. The total, to date, and the
names of new volunteers were published each
week. Requirements for, and contraindications
to, donation were printed to minimize the number
of rejected prospective donors. In a surpris-
ingly short time, hundreds of citizens had called
to give their names, addresses and telephone num-
bers, and to receive appointments for screening
examination and donation.
Our technician, Mrs. Dorothy Robertson, spent
a few days at the Minneapolis War Memorial
Blood Bank, and received there instruction in
the meticulous methods of screening, registration,
collection, preparation, storage and shipment re-
quired to meet the exacting standards of the
National Institute of Health.
Finally, the plan received its auspicious start
on the appointed day in February, 1950, when
fifty donors were screened, registered, and made
their donations. Dr. G. A. Mattson, director of
the Minneapolis War Memorial Blood Bank,
came to Long Prairie for the occasion and
brought with him an extra registrar and tech-
nician from his staff, both to insure that the ini-
tial effort would go off smoothly and to satisfy
himself that his standards and those of the Na-
tional Institute of Health were met. Fifty flasks
of citrated blood were soon on their way to the
Minneapolis bank in specially refrigerated ham-
pers, and within a few days twenty-five units
of irradiated plasma were on hand at the hos-
pital.
The Long Prairie community had been offered
774
Minnesota Medicine
RURAL TRANSFUSION PROBLEM— BORGERSON
two alternatives. We could send our blood to be
converted into plasma at a fixed cost per unit,
or we could receive one unit of plasma for each
two units of blood sent, without any other cost.
We chose the latter plan because for our commu-
nity it seemed simpler and more practical. It
enables us to furnish all the blood and plasma
needed, to those volunteers who have established
membership by blood donation, without monetary
cost to them.
Since opening day, six or more bloods have
been drawn each week. Our aim is to keep on
hand enough blood to serve the needs of any
ordinary emergency. Three or four group O
bloods, together with whatever happens to come
in among the less common groups, form a small
reserve instantly available, and serve in other
ways to exchange with and supplement the bloods
drawn during that week for elective transfusion.
We do not hesitate to use group O blood for
emergency recipients in other groups, with the
addition of the Witebsky substance, provided the
donor’s cells are not agglutinated in the recipient’s
serum.
The unused bloods, or those taken in exchange,
are shipped to the Minneapolis War Memorial
Blood Bank each week. Our credit there may
be used to provide blood for Long Prairie patients
referred to hospitals in the Twin Cities, to the
Veterans Administration or University hospitals,
to Rochester or Duluth, or even for Long Prairie
travelers in such distant places as Seattle or
Miami. This credit will also be used to provide
additional plasma and such special preparations
as washed cells, packed red cells or bloods of
unusual group, which we may wish to order from
the central blood bank.
Now, six months after its start, the local blood
bank has become almost self-sustaining. Only
occasionally is the community called upon to make
a few more voluntary donations.
Patients who have previously donated blood to
the community project are entitled to receive
blood or plasma without making any replacement.
Those patients who did not previously contribute,
and who now receive blood or plasma from the
bank, must make a replacement. They replace
one unit of blood for each unit of blood received,
and two units of blood for each unit of plasma
received from the bank. Those who fail to make
their replacement of blood must pay for it at the
standard commercial rate. To make a replace-
ment, the required number of donors are given
appointments on our schedule, and as soon as the
blood is collected the charge is cancelled. The
blood thus received as replacement helps keep the
bank solvent, and the cash paid for blood and
plasma not replaced is used to defray the few in-
cidental expenses of the bank.
Since we have had blood and plasma so readily
available, we have used it so freely that we now
wonder how we ever got along without our blood
bank. Doctors and patients alike appreciate the
convenience and safety made possible by this
community project. The virtually unlimited sup-
ply of plasma, the buffer of fresh whole blood and
the privilege of calling on the central bank for
rare blood types, typing sera, washed red cells and
consultation on our transfusion problems, has
proved invaluable to us.
We are proud that this has been accomplished
without help from either governmental or char-
itable organizations and has been done without
adding to the financial burden of our hospital, our
patients or our community.
It is possible that this type of program will soon
be instituted in other communities within our
section of the state, and that through a co-ordi-
nated system of exchange directed through a
central supervising agency, such as the Minne-
apolis War Memorial Blood Bank, still greater
safety and convenience will be provided for the
hospitals, patients and doctors of our area.
♦
HEALTH AND DISEASE
Little attention is paid to health, and it is often con-
sidered in the negative sense of absence of disease. It is
challenging to current thought to point out that health
and disease are not static entities but are phases of life
. . . Health, in a positive sense, consists in the capacity
of the organism to maintain a balance in which it may
be reasonably free of undue pain, discomfort, disability,
or limitation of action including social capacity. — John
Romano, M.D., J.A.M.A., June 3, 1950.
August, 1950
775.
PSYCHOLOGICAL MEDICINE IN A GENERAL MEDICAL SETTING
RICHARD M. MAGRAW, M.D.
Minneapolis, Minnesota
/^\NE of the phenomena of contemporary medi-
cine is the upsurge of psychiatry. Some doc-
tors feel that psychiatry is, if anything, too pop-
ular, and few will doubt that the pendulum of
opinion, at least with regard to some lay thinking,
has swung past dead center in appraising the ac-
complishments and promises of psychiatry, and
that time will see further shifts in this opinion.
In medical thinking, too, more time will pass
before psychiatry’s ultimate place as a medical
specialty will have stabilized, and also before
the contributions of psychiatry which are appli-
cable to general medicine have been sorted and
winnowed by experience and integrated into the
general practice of medicine. In this second re-
gard, psychiatry can be thought of not as a med-
ical specialty, but almost as a basic science —
a basic science which for want of another name
might be called psychological medicine or the
human approach.20
My subject is not what psychiatry’s niche as a
medical specialty may ultimately be, but is rather
how psychiatry can contribute to, and psychiatric
information be integrated into general medical
practice.
Much of what has been said on this question is
speculative, since usually those physicians who
are most conversant with psychiatry have had
little opportunity to apply this in the practice of
medicine, and, to some extent, the converse is true.
I am going to use my experiences in the Uni-
versity Hospitals Medical Clinic during the past
year as a basis for discussing this question. But
there are obvious difficulties to drawing any very
dogmatic conclusions on this basis. For one
thing, a year is not a very long time. More-
over, an analysis of one’s own work is apt to be
rather subjective, and the fact that the factors
we are analyzing are subtle doesn’t make it any
less so. Furthermore, while the Medical Clinic £
I wish particularly to express my indebtedness to Dr. Robert
D. Mooney of Saint Paul with whom I share an interest in this
aspect of medicine. He and I have discussed this subject so
extensively that it is impossible for me to tell where my ideas
leave off and his begin.
Acknowledgment is also made to Drs. Donald W. Hastings,
Cecil J. Watson, C. Knight Aldrich, and the staff of the Medical
Clinic for their support.
This article appeared in The Bulletin of the University of
Minnesota Hospitals and Minnesota Medical Foundation for
March 17, 1950.
is the closest approach we have in this institu-
tion to the actual practice of medicine, it is not
entirely comparable to the practice of medicine
as I have known it at least. For example, the
case load there is heavily weighted by special
problems referred to the University, such as cat-
aracts, malignancies, and prostatism. Then, too,
we don’t, as a rule, know as much about our clinic
patients as the family doctor does. My findings
in the Medical Clinic are therefore not pre-
cisely comparable to what might happen in prac-
tice.
While I am talking about difficulties in pre-
senting the subject, there are two other points
that ought to be made. In this day of the pop-
ularization of psychiatry, of psychoanalytically
tinged comic strips and movies, and when the
term psychosomatic has become a household by-
word, we all have had to develop ideas (one
might almost say convictions) about the role of
emotions in the genesis of disease and about the
psychological aspects of treatment. As far as
I have been able to tell, everybody has developed
a different philosophy about this, and one of the
difficulties in discussing the subject is that I am
confronted by almost as many different points
of view as there are readers of this article.
To some of us, psychiatric pronouncements in
this regard seem a little fantastic and slightly
improper. Others are prone to rather uncritically
accept psychiatric theorizing and are in this
sense “more Royalist than the King.” To most
of us some of the psychiatric inferences drawn
from behavior touch too close to our inner feel-
ings for us to be entirely able to view the ideas
objectively.
One other thing which makes a discussion of
this subject difficult is the extent of the “psycho-
logical dimension” in practice. As Menninger
said, discussing “emotional factors” in medicine
“is comparable to a discussion of chemical fac-
tors”10 in medicine.
When I started working in the Medical Clinic
a year ago after a little better than two years in
psychiatry and neurology, I had the usual mis-
givings about what I had forgotten in medicine.
776
Minnesota Medicine
PSYCHOLOGICAL MEDICINE— MAGRAW
I remember the near panic I experienced when I
realized that I couldn’t remember which lung had
three lobes. However, I found, as others of you
have with a similar experience, that what was
forgotten quickly came back.
But these were not the only misgivings I had.
There were in my own mind (and in the minds
of the people with whom I had discussed this
departure from the beaten path) questions as to
just how what I had learned in psychiatry would
apply in general practice. I intend to discuss
my subject by restating those questions about
whether what one can learn in psychiatry is ap-
plicable in medical practice and then giving the
answers that have emerged in the Medical Clinic
the past year. Before I do that, however, I
think it would be wise to clarify a little what these
things are that one can learn from psychiatry.
You are all familiar with some of the things
which are learned in psychiatric training, such
as the characteristics of behavior in the various
psychoses, the procedures of insulin and electric
shock. These things are associated with psychia-
try as a specialty.
There are other skills and attitudes which psy-
chiatry teaches for use in both its functions as a
medical specialty and as a basic science, of which
you are less apt to be aware.
For example, psychiatric training should bring
an understanding of the limitations of psychiatry
and a recognition that one’s goals may have to be
fairly modest. It must have been a psychiatrist
who first said, “You can’t make a silk purse out
of a sow’s ear.” The student must come to
recognize that bilateral far-advanced tuberculosis
with cavitation of the psyche or carcinomatoses
of the soul are far more frequent than their or-
ganic analogues, and he reluctantly comes to see
that it is no more possible completely to remake
the personality than it is to remake the body.
Furthermore, the student should get an aware-
ness of unconscious motivations and thinking.
Psychiatric training can equip the trainee with a
working knowledge of this domain wherein ap-
pears to lie that majority of our thought processes
of which we ourselves are completely unaware.
From this awareness of unconscious feelings
comes an understanding of symbolism in thought
and symptom. I am sorry I do not have more
time to discuss this since it is hard to overesti-
mate the importance of understanding unconscious
feelings in understanding the “Language of
Symptoms.” In the few cases I am going to
describe later I think the symbolic expression of
unconscious feelings will be quite evident.
Another set of skills which are particularly dif-
ficult to explain, but which are especially pertinent
to what we are talking about, are those which give
the doctor clues as to what kind of a person
the patient has been and what his present men-
tal state is. This kind of skill has long been
identified in medicine as “the Art of Medicine.”
All psychiatry has done here is to refine and
bring up to a level of thought where we can talk
about and study them, things which we have
used intuitively for years.
It would be nice if the psychiatrist could carry
with him a stethoscope especially designed for
hearing emotional overtones. For one thing it
might be easier for some of us to believe that he
does hear the things he claims to. I am sure that
I need not point out to you that the psychiatrists
walk these halls unencumbered by such diagnostic
appliances as stethoscopes, ophthalmoscopes, and
without even a percussion hammer, although this
is an heretical thought.
In the absence of such mechanical aids in
diagnosis, the doctor must rely on his own senses
to get an understanding of the patient’s feelings.
He must “listen with the third ear”14 and read
between the lines to catch the shades of feeling
which are his clinical facts. It is well to remember
that when we are dealing with another person in
any face-to-face situation, there are many kinds
of communication involved other than the words
spoken. We can see things in a patient’s posture,
demeanor, and expression which speak eloquent
volumes about him. Thus we learn, for example,
how he feels about us and conversely, he divines
whether we like him.
Lumped together in a structure called an “in-
terview,” these subtle skills compose the tools a
psychiatrist carries about in his side pocket. Fur-
ther, this is the equipment he uses in treatment
as well as in diagnosis.
Now these points we have been considering
are what we ask about when we raise questions as
to how or to what extent psychiatric skills and
knowledge can be incorporated into general med-
ical practice.
One of the questions which was brought up
when I was going to start in the Medical Clinic
August, 1950
777
PSYCHOLOGICAL MEDICINE— MAGRAW
a year ago was the question of time. Would it
be practicable, simply from the standpoint of
time, to include in the usual medical workup more
than an intuitive assessment of the patient’s per-
sonality and of his background? Moreover, again
from the standpoint of time, would it be possible
in ordinary medical therapy to go further in the
treatment of patients than just to say, “You’re
nervous,” “It’s your nerves,” or “There’s nothing
organically wrong with you. Go home and for-
get it”? Experience in the Medical Clinic clearly
indicates that the answer to these questions is
“yes.”
It has been possible to practice this kind of
medicine there and to carry a full clinic load with-
out getting bogged down in any way. In fact in
the Medical Clinic it has seemed to me that
diagnosing and treating patients using the conn
prehensive approach is actually quicker than using
other approaches. So what might at first glance
be thought to be the long way around, appears to
be the short way through. This is what we
might expect since in every phase of medicine
the quickest way to complete things is to get at
the core of the difficulty.
The saving of time is especially evident when
we are dealing with patients with functional com-
plaints. We have all experienced the time-con-
suming chase of “will-o’-the-wisp” complaints up-
one diagnostic by-way and down another, only to
wind up with nothing to show for our efforts but
strained relationships with the patient. I am
not suggesting that this comprehensive approach
is going to obviate the “diagnostic impasse” we
reach with such complaints, but it has been my
experience that it has held the key to a surprising
number of such situations. I would like to cite
some recent cases to emphasize these points.
Case 1. — This patient, a forty-year-old unmarried
schoolteacher, came in for a checkup complaining of
tightness and drawing over the left precordium with
radiation to the left shoulder and down the left arm to
the hand. The pain was not clearly related to exertion
and had been present intermittently for about two years.
During this period the patient had not been working.
Physical examination was normal except that the pa-
tient was manifestly depressed.
By picking up and following out clues in the manner
I described earlier the following story was brought out.
The patient indicated that she had thought she might
have cancer of the breast. Indeed the manner in
which she said this suggested that she might welcome
that diagnosis.
At the time of onset of the present complaints two
years before, the patient’s mother had died of breast
cancer. (In explaining this the patient gestured toward
her own left breast.) At that time the patient had ex-
perienced a similar feeling of tightness in her left hand
and in fact her left hand had been clenched for two
weeks then so that she could not voluntarily relax it,
but had to pry her fingers open with her right hand.
In her second visit to the clinic this patient was able
with a little help to express some of the deep anger she
felt toward her mother with considerable subjective and
objective improvement. She remembered that three
years before her mother had died, at a time when she
herself had been sick with pneumonia, she had had
thoughts of violence toward her mother and a young
nephew living with her mother at that time. For years
she had supported her mother, had in fact purchased a
home for the mother, only to see the mother devote
her substance and efforts to the care of her sons, who
always came first. She spoke with deep feeling of the
senseless beatings she had received as a girl while her
stepbrothers got off with little more than a reprimand.
The patient had been placed in an orphanage twice in
her childhood for a period of about a year each time.
The first time was as a very young child when her
father abandoned the family and the second was at the
age of twelve when her stepfather died. During the
patient’s hospital stay with pneumonia, she looked for-
ward to convalescing at home under the care of her
mother. As she said, she had been counting on “getting
close to mother at last” only to find when she got home
that the mother’s interests were centered in the nephew.
She explained her unemployment in the past two years
by saying that she guessed she had just become “tired
of being the breadwinner for the family.”
Case 2. — This patient, a thirty-two-year-old mother
of three, was first seen on the same morning as Case 1.
Her complaints were superficially similar to Case 1 in
that she also suffered pain in the left chest, shoulder,
arm, and hand. On physical examination there was ten-
derness in these areas most marked over the left humerus.
This patient also was obviously depressed. It needed
no questioning or indirection to elicit from her a con-
cern that she might have a cancer of the breast.
Her complaints dated back eight weeks to about the
time when she had decided to divorce her husband.
About one year previously her husband had beaten her
severely on the left side of the body as she lay in hed.
She was also seen on one other clinic visit after the
initial examination. During the second visit the almost
overwhelming self-doubts and self-accusations she felt
over many things in her life and especially over the
divorce came out. She felt that it was somehow all
her fault and brought forth a good many rationaliza-
tions as to wrhy she shouldn’t go through with the
divorce. I suggested that she was really being rather
unrealistic in taking on all the blame for this and that
apparently she didn’t really have a very good opinion
of herself. I suggested further that perhaps one of the
reasons she found the idea of divorce so disturbing was
778
Minnesota Medicine
PSYCHOLOGICAL MEDICINE— MAGRAW
that it only served to heighten her sense of failure and
strengthen her inner convictions of her own unworthi-
ness. Coincident with this discussion the patient’s
demeanor and expression changed. She became more
relaxed and left saying she felt better already. The pa-
tient was seen again ten days later and to all intents
and purposes was well.
Part of the concern which was felt about wheth-
er this approach would require too much time
came from the assumption that psychological
medicine was something that had to be done in
addition to and separate from the rest of the doc-
tor’s job rather than right along with it. In Med-
ical Clinic I learned again that a thorough med-
ical workup of history taking and physical ex-
amination is the best routine way of establishing
rapport. Similarly I learned that the opportunities
for quick evaluation of personality are better in
this setting than any other I know of. Conse-
quently it has been interesting and gratifying
to find that this kind of handling of emotional
problems can be done almost with the back of one’s
hand and with an over-all saving of time to the
physician. It can be done in an unobtrusive
fashion wherein the patient is not entirely aware
of what is happening and hence the usual resist-
ance to psychiatric treatment does not arise.
The question of how much time it is going to
take to practice medicine in this way depends in
part on how deeply one goes in treating emotional
problems. What I have been saying is that there
is a level of psychotherapy other than that of a
thorough “vacuuming and dredging of com-
plexes”1 which experience has thus far shown to
be particularly effective in a general medical set-
ting, and to which medical practice is peculiarly
adapted.
This has a different but not necessarily inferior
goal to that long-term, time-consuming, expensive
type of therapy which has come to represent to
some the “sine qua non” of psychiatric treatment.
This level of psychotherapy can be compared to
incision and drainage of an abscess with evacua-
tion of the collection of emotional pus as its goal.
In this treatment the physician not only drains
the abscess but may help the patient avoid similar
future accumulations of pus if the patient’s own
native powers of resistance do not appear ade-
quate.
Oftentimes it is surprisingly easy to do this kind
of psychotherapy. However, before I cite addi-
tional cases, I would like to digress a moment to
emphasize that in handling emotional problems, as
in other problems in medicine, we expect different
patients to achieve varying therapeutic goals. One
cannot expect a perfect or even satisfactory result
in many cases here just as one cannot expect to
restore certain cardiac cases to anything like full
activity. Consequently, there is a lot of room in
the handling of emotional problems for therapeu-
tic conservatism and the light touch. It is well to
avoid the error that Rogerson described as “un-
wise therapeutic push-fullness.”15
I would like to use additional cases for illus-
tration. These cases I am using are samples
rather than selections or exceptions since a good
portion of the patients coming to the Medical
Clinic for their initial examinations present this
kind of problem.
Case 3. — This patient was a middle-aged woman who
in addition to slight anorexia complained of a constant
right upper quadrant abdominal pain which was not
related to food intake but tended to be accentuated by
activity (in her case, usually housework). In response
to a question as to what the pain made her think about
she said that once years ago she had been kicked in that
area by an adolescent daughter. The daughter had been
a thorn in her side from her earliest years because of
a convulsive disorder and as a behavior problem. The
patient then indicated that she was waiting the daughter’s
return from the Cambridge Epileptic Colony where she
had been treated for several years. Further it devel-
oped that on the day her abdominal pain started she had
received a letter from this institution stating that her
daughter was to be discharged to her home as it was
felt that she could now make some sort of an ad-
justment outside of the institution.
Case 4. — This patient was a forty-four-year-old mar-
ried woman, mother of ten children, who complained of
palpitation and of numbness and stiffness of her hands
and fingers. She first developed these symptoms in
the summer of 1949. They came on one night when
she was in bed nursing her two-months-old baby. At
that time she became faint and felt as though she was
losing consciousness. She suffered palpitation and her
hands became numb and stiff. She described and
demonstrated this to me by saying she felt she “couldn't
close them together.” Her husband was not living at
home at the time except for weekends as he had taken
a job in Minneapolis. Shortly before this episode the
patient had learned of his affair with a woman in
Minneapolis and had felt a burning resentment about it
which she had largely been unable to express to him.
While we don’t really know the answer, the things I
have told you and the rest of the evidence available
indicated that this symptom portrayed this conscientious
August, 1950
779
PSYCHOLOGICAL MEDICINE— MAGRAW
mother’s horrified repression of vengeful thoughts about
her husband and/or their youngest child.
I have pointed out that uncovering and treating
the psychological factors in these cases did not
require any extra part of the doctor’s time in the
Medical Clinic. I think it is important to explain
that this conserving of time in the Medical Clinic
was not done at the expense of added work for
the specialty clinics or for the laboratory. In
fact, I think the opposite was true. It has been my
impression that using a comprehensive approach
in the Medical Clinic resulted in considerable
economy in laboratory and x-ray procedures and
in hospitalization.
I do not mean to imply that such economies are
the reason for applying psychological medicine, for
I think the improvement in medical care inherent
in its use is obvious. However, I do feel that such
economies are an inevitable result and a welcome
result, too, in this day when the rising cost of
care is one of medicine’s major problems.
Similarly, the use of this approach seemed to
necessitate fewer of the “rule out disease” variety
of referrals to the specialty clinics. I felt that
fewer patients needed to be started off on the clinic
merry-go-round in the hope that they would come
back labeled. Fewer, too, wound up as “floaters,”
drifting vaguely through the clinics. Those who
have worked in any of the out-patient specialty
clinics know what a burdensome and frustrating
load this kind of patient makes.
Some of you may be wondering whether I
didn’t find it necessary to get what might be re-
garded as unnecessary consultations and labora-
tory tests anyway in order to establish rapport
and convince the patient. I have become con-
vinced that while it is sometimes necessary to
use these stratagems in this way, in general, they
do not work as well as we like to think they do.
Perhaps this is a good time to point out that when
we order a plethora of laboratory and x-ray pro-
cedures ostensibly to convince the patient, more
often than not we are ordering these procedures
to bolster our own confidence in our diagnoses.
When we have facts such as are apparent in the
case histories given, we need less of such reas-
surance. With regard to using a profusion of
laboratory tests to impress the patient with the
thoroughness of the examination and thus estab-
lish rapport, I can only say that there are easier
780
ways of establishing better rapport inherent in
psychological medicine.
This brings us to a consideration of the second
question that came up in regard to integrating
psychological medicine into medical practice. That
question was asked in various ways. “Is this fac-
tual ?” “How accurate are these guesses about pa-
tients’ feelings?” “How much can we rely on our
impressions of emotional aspects of cases in pro-
ceeding in treatment?” “Is this information exact
enough so that we can really bank on it and be
safe in not pushing our diagnostic armamentarium
to the utmost?”
The answer that I have found is that these
facts can be used with the same confidence that
we use any other facts gathered in our medical
workup. However, just as the radiologist can
see facts on a film that the uninitiated have not
learned to see, so skills such as we described
earlier enable one to gather from a patient psy-
chological facts which may not be evident to
someone less sensitive in this regard. Because
of our almost exclusively materialistic background,
it is easier for doctors to see the radiologist’s
“facts” derived from the film than to see psycho-
logical facts derived from equally good evidence.
It is hard for us to make confident use of clinical
information obtained through skills in interper-
sonal dealing. We have all seen carefully correct
medical workups which omit nearly all of the real-
ly relevant information for this reason. Thus we
might see duly recorded in a history of a patient
with gynecological complaints, for example, the
fact that the patient had measles at age four but
find no mention of the fact that living her early
years with a brutal, indifferent father had colored
all her subsequent feelings about and reactions to
sex.
The question here, then, is not so much “Is this
material factual?” as it is “How can we doctors
overcome our own blind spots and mental sets so
as to be able to accept this material as factual and
act on it ?” It seems to me that a doctor’s ability
to recognize and integrate these facts into medical
practice is a measure of his working understand-
ing of the total organism point of view that we
all pay lip service to these days.
Given a set of facts such as in the case of the
woman whose daughter had kicked her long ago,
the question is no longer whether we are justified
in not working to the limit our diagnostic instru-
Minnesota Medicine
PSYCHOLOGICAL MEDICINE— MAGRAW
merits, our special departments, and the patient
in an attempt to pin something organic on the
patient, but rather whether we are justified in do-
ing so.
There is still a third question. “Does becom-
ing interested in psychological medicine make
one more likely to miss organic disease?” I think
it is evident that an exaggerated development or
interest in this regard might have the same effect
as a distorted interest in any special part of medi-
cine, including the usual extra interest in organic
disorders with which medical training has en-
dowed most of us.
As I have indicated earlier, an awareness of
emotional factors does not exclude an awareness
of organic factors. There is no more excuse for
slighting organic factors while paying attention to
emotional factors than for neglecting to examine
the patient’s heart irrespective of the demonstra-
tion of pathology during examination of his lungs.
I think the question has been well answered by
Weiss in the quotation, “Somebody usually re-
minds me that in becoming interested in psycho-
somatic medicine one may overlook organic dis-
ease, not mentioning that an exclusive organic
orientation leads to equally serious consequences
in overlooking neurotic illness. Of course, as
long as we are human, we are going to make mis-
takes. But if we plant one foot firmly in tissue
pathology and the other foot firmly in psycho-
pathology, then I think we have the correct bal-
ance for this approach.”17
These are the main questions which came up
before I started on the Medical Clinic regarding
the feasibility of integrating psychiatry into
medical practice, and these, too, are the observa-
tions I made in the Medical Clinic in answer to
them.
While in the Clinic I have learned some other
things about this kind of practice which I would
like to talk about briefly before I conclude.
I was surprised to learn how frequently de-
pressions occurred as the primary difficulty in
patients consulting a doctor in a general medical
practice. At first T thought this might be peculiar
to the University Hospitals, but I learned that
other doctors in practice have had the same ex-
perience. It was interesting to see how few of
these patients expressed depression in psycho-
logical terms. Almost all were disguised by
physical complaints. Out of the last ISO new
patients I saw in the Medical Clinic prior to
January 1, 1950, depression was the sole or ma-
jor problem in eighteen. It was impressive to
observe that among the patients seen, persons who
developed symptoms of peptic ulcer for the first
time during middle age were all in a depression
at the time they had their symptoms.
One very pleasant thing I discovered about this
kind of practice was that the practice of medicine
was more satisfying than it had ever been before.
You all know how we tend to get the major part
of our pleasure in medicine out of making a dif-
ficult organic diagnosis and competing in the
diagnostic game, the kind of satisfaction that
makes us push hard and stretch points to diagnose
a rare condition such as Cushing’s Syndrome, et
cetera. Obviously this attitude is hard on the
neurotic. Whitehorn called attention to this fact
when he said that “the neurotic runs the consid-
erable risk of being reacted against emotionally
as if he or she were cheating in the diagnostic
game.” I no longer feel that neurotic complaints
are merely unavoidable chaff to be waded through
to get at the organic nuggets mixed in. It seems
to me now that almost every case has the poten-
italities of enthusiastic interest which I used to
reserve for diagnosing multiple myeloma ectopic
pregnancy, and the like. Incidentally, I think
this new frame of mind makes it easier to treat
the kind of problems that make up the bulk of
practice since an ability to feel friendly interest
in the patient is the cornerstone of therapy.
I am a little afraid that what I have been say-
ing might leave you with the impression that
psychological medicine is something to be applied
only in dealing with functional complaints. Ac-
tually, it is a universally useful instrument in our
relationships with all patients.
References
1. Braceland, F. J. : The practice of psychiatry. Quart. Bull.,
Northwestern Univ. M. School, 22:312, 1948.
2. Casson, F. R. C. : Some interpersonal factors in illness.
Lancet, 2:681-684, (Oct. 15) 1949.
3. Cobb, Stanley: Border-Lands of Psychiatry. Cambridge,
Mass.: Harvard Univ. Press, 1943.
4. Halliday, J. L. : Principles of aetiology. Brit. T. M. Psychol.,
19:367-380.
5. Halliday, J. L. : Concept of a psychosomatic affection. Lancet,
2:692-696, (Dec. 4) 1943.
6. Halliday, J. L. : Psychosocial Medicine. New York: Norton,
1948.
7. Hamman, Louis: The relation of psychiatry to internal
medicine. Am. Assn. Ad. of Sci., Pub. No. 9, 431-437.
8. Leif, A.: The Common Sense Psychiatry of Adolph Meyer.
New York: McGraw Hill Publishing Co., 1948.
9. Masserman, J.: Principles of Dynamic Psychiatry. Philadel-
phia: William Saunders, 1946.
(Continued on Page 796)
August, 19S0
781
THE 1949 CANCER STATISTICAL STUDY
Minnesota Department of Health
N. O. PEARCE. M.D.
Acting Director, Division of Heart Disease and Cancer Control
and
D. S. FLEMING. M.D., M.P.H.
Chief, Section of Preventible Diseases
Minneapolis, Minnesota
TN 1948, the Divi sion of Cancer Control of the
Minnesota Department of Health began a
statistical study of reported cases of cancer
among patients in hospitals throughout the state.
Findings accumulated during the initial year of
the study were published in the January, 1950,
issue of Minnesota Medicine.2 That pre-
liminary study was based on 3,798 case reports
collected under a State Board of Health regulation.
In order to assure legal protection for those par-
ticipating in the study, cancer reporting was in-
augurated into a statute by the 1949 State
Legislature. The total cases reported during 1948
were 5,176. The number of cases included in the
present ( 1949) report, total 5,473, an increase of
297 over the 1948 total. The rate at which cases
are being reported for the first six months of 1950
would indicate a further substantial increase by
the time the 1950 study is terminated as of April
15, 1951.
The number of hospitals reporting has also
increased. During 1949, thirty-five additional
hospitals came into the program, making a total
of 178 hospitals reporting cancer cases as of
December 31, 1949. This total is 90' per cent of
the hospitals in Minnesota requested to participate.
In respect to percentage of hospitals reporting,
Minnesota compares very favorably with other
states in which there is a program of statistical
reporting on cancer. This fact is brought out in
a recent study by the Cancer Control Division of
the Pennsylvania Department of Health.1. In that
study, letters and questionnaires were sent to
fifty-three state and territorial departments of
health to find out what methods were used and
what measure of success was achieved in different
sections of the country. Of the forty-four states
replying, nineteen favored voluntary reporting by
hospitals. Among states that depend upon this
system, the percentage of hospitals cooperating is
not impressive. Pennsylvania compares favorably
with other states, with only 30 per cent of Penn-
sylvania hospitals reporting.
CANCER AMONG MINNESOTA RESIDENTS
Reported during 1949
Cancer
Cases * * excluding Leukemia and Hodgkins diseases
The method used in Minnesota is voluntary
reporting by hospitals. Two field workers are
employed to visit hospitals and aid recorders in
making their reports on cancer cases as complete
as possible. Excellent cooperation has been given
by practically all hospitals. The chief problem
encountered in any voluntary reporting system is
the difficulty in obtaining complete histories on
patients hospitalized with cancer. The two most
important questions asked are these :
How long after noticing his symptoms did the patient
delay before seeing his doctor?
How long after the first visit to the first physician was
the patient hospitalized?
Answers to these questions depend upon
histories contained in hospital medical records.
These histories in turn depend upon the memories
of both the doctor and the patient, which cannot
always be relied upon. It is hoped that, during
1950 , more accurate reports can be obtained
through more intensive field work.
Despite an increase in number of reports — 162
more among males in 1949 than in 1948, and 135
782
Minnesota Medicine
1949 CANCER STATISTICAL STUDY— PEARCE AND FLEMING
TABLE I. CANCER CASES REPORTED ACCORDING TO
COUNTY OF PATIENT’S RESIDENCE
COUNTY
TOTAL NUMBER OF
REPORTS RECEIVED
1948 1949
Aitkin
24
28
Anoka
31
18
Becker
45
66
Beltrami
31
36
Benton
17
17
Big Stone
19
16
Blue Earth
91
89
Brown
53
57
Carlton
42
45
Carver
20
27
Cass
31
20
Chippewa
34
37
Chisago
24
Clay
23
Clearwater
16
13
Cook
5
3
Cottonwood
13
23
Crow Wing
50
52
Dakota
49
68
Dodge
5
4
Douglas
42
32
Faribault
22
20
Fillmore
7
9
Freeborn
30
40
Goodhue
57
66
Grant
10
19
Hennepin
132
109
Houston
4
10
Hubbard
15
25
Isanti
15
21
Itasca
68
65
Tackson
18
13
Kanabec
21
9
Kandiyohi
36
31
Kittson
13
17
Koochiching
28
35
Lac Qui Parle
24
14
Lake
19
26
Lake of the Woods
9
8
Le Sueur
30
41
Lincoln
11
16
Lyon
41
25
McLeod
21
28
Mahnomen
10
8
Marshall
22
12
Martin
27
29
Meeker
40
28
Mi He Lacs
44
37
Morrison
53
48
Mower
47
61
Murray
21
14
Nicollet
31
23
Nobles
23
36
Norman
24
21
Olmsted
3
3
Otter Tail
75
73
Pennington
34
29
Pine
24
37
Pipestone
9
10
Polk
79
73
Pope
16
13
Ramsey
21
23
Red Lake
17
16
Redwood
27
27
Renville
28
38
Rice
45
42
Rock
5
3
Roseau
26
16
St. Louis
214
237
Scott
20
27
Sherburne
17
12
Sibley
25
23
Stearns
126
146
Steele
23
19
Stevens
14
23
Swift
30
22
Todd
47
33
Traverse
7
6
Wabasha
25
20
Wadena
24
18
Waseca
8
12
Washington
45
56
Watonwan
26
23
Wilkin
17
16
Winona
44
54
Wright
40
25
Yellow Medicine
22
19
Minneapolis
1358
1416
St. Paul
701
844
Duluth
289
327
Unknown
7
36
TOTAL
5176
5473
DIGESTIVE CANCER AMONG RESIDENTS OF MINNESOTA
Reported during 1949
CASES
220
210
200
190
180
170
160
150
140
130
120
1 10
100
90
80
70
60
50
40
30
20
10
more among females — morbidity percentages for
cancers in both male and female patients are
altered very little, whether one considers the over-
all picture or those representing cancers at specific
sites. Peak year and age-range pictures are also
similar for 1948 and 1949. Table 1 compares the
number of cancer cases reported in 1948 with the
corresponding figures for 1949, by patients’
counties of residence.
The cancer cases reported as discharged by
Minnesota hospitals during the period from
January 1 to December 31, 1949 — a total of 5,473
cases — are used as the basis for the graphs pre-
sented in this report. Regarding sites of cancer,
as shown in the graphs, the following situations
may be noteworthy :
Cancer of the digestive tract, with a total of
1847 cases, including esophagus, bowel, rectum
and other sites in the digestive organs, comprises
the largest single group of reported neoplasms in
the Minnesota study. In digestive tract cancer,
cases among males are more frequent than among
females, the peak year for both sexes being sixty-
seven and the age range from forty-two to eighty-
seven years.
In cancer of the breast, most of the cases are
found between the ages of forty-two and seventy-
two years, as in the 1948 picture. Cancer of the
male breast is negligible.
According to the study, cancer of the uterus,
including the cervix, occurs mostly between the
August, 1950
783
TABLE II. CANCER REPORTED AMONG MINNESOTA RESIDENTS BY SITE AND AGE — 1949
1949 CANCER STATISTICAL STUDY— PEARCE AND FLEMING
784
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Minnesota Medicine
1949 CANCER STATISTICAL STUDY— PEARCE AND FLEMING
BREAST CANCER AMONG RESIDENTS OF MINNESOTA
Reported during 1949
ages of thirty-two and eighty-two years, and is
much more prevalent than cancers of the other
female genital organs.
From the reports, cancer of the prostate hardly
ever occurs before the age of fifty-two years, with
the bulk of the cases appearing between fifty-seven
and ninety-two. Cancer of other male genitalia is
insignificant.
A few cases of urinary tract cancer were re-
ported as early as the age of two years. Both
males and females begin to show urinary cancers
in greater numbers at the age of thirty-seven
years and continue to age ninety-two ; more cases
are found among males.
The 297 cases of respiratory tract cancer re-
ported make up 5 per cent of the total. This type
of cancer appears nearly three times as often in
the male as in the female. The age range is from
forty-two years to eighty-two years for both sexes.
Buccal cancer is more prevalent in our reports
among males than females. While both groups
reach a peak at age sixty-two, cases range from
thirty-two to eighty-seven years of age. No buccal
cancer is recorded before the age of twenty-seven.
With only eighty-eight '"eases of skin cancer
reported, no consistent pattern is found. Cancers
of the skin occur as early as seventeen years and
manifest themselves in greater numbers toward
the latter part of life. This holds true for both
male and female, with cases predominating
among males.
CANCER OF MALE GENITALIA
among Minnesota Residents reported during 1949
CANCER OF FEMALE GENITALIA
AGE
Reports show that the majority of cases of can-
cer of the brain and central nervous system occur
earlier in life than most other true cancers. The
female age range continues a little later in life than
the male.
Leukemia is chiefly a disease of the very young;
60 per cent of the cases reported are under fifteen
years of age. Most of the leukemias in later life
are found in the age groups forty-two to eighty-
two.
Although reported cases range from age seven
to eighty-seven, no real pattern of occurrence can
be demonstrated for Flodgkin’s disease Flowever,
August, 1950
785
1949 CANCER STATISTICAL STUDY— PEARCE AND FLEMING
URINARY CANCER AMONG RESIDENTS OF MINNESOTA
Reported during 1949
CASES
this conclusion is based on only eighty-one cases,
or 2 per cent of the total.
Tn 1949, as in 1948, it was demonstrated that
patients with cancer of the mouth and skin are
the last to seek medical advice, while leukemia,
Hodgkin’s, and cancer of the central nervous
system are the types of malignancy that send
patients to their physicians earliest.
Over half of the patients with cancer of the
digestive tract, female genital organs, breast,
respiratory tract, and male genital organs (other
than prostate) representing 68 per cent of the
total cases reported, were hospitalized in less than
a week after first seeing a physician.
Comparison was made, by site, of the Minne-
apolis, Saint Paul, and Duluth cases with the total
picture. No significant difference was observed.
Summary and Conclusions
1. A statistical analysis of 5,473 cancer cases
reported as discharged by Minnesota hospitals
during the period January 1 to December 31, 1949,
is presented. This represents an increase of 297
cases over the 1948 total of 5,176.
RESPIRATORY CANCER AMONG RES I DENTS OF MINNESOTA
Reported during 1949
CASES
2. The current (1949) report represents
voluntary participation by 90 per cent of Minne-
sota’s hospitals. In the reporting of cancer cases,
Minnesota ranks very high among states using
a voluntary hospital reporting system.
3. Despite an increase in number of cases re-
ported in 1949 over 1948, incidence of cancer, by
site, among Minnesota hospital patients was virtu-
ally the same in 1949 as in 1948.
4. More accurate reporting is desirable re-
garding duration of delay by patients in reporting
symptoms to physicians and by physicians in
hospitalizing patients.
5. Much more intensive education of the public
is desirable regarding the recognition of symptoms
of cancers of the mouth and skin, which offer the
best prognosis yet are usually the latest to be
reported to physicians.
References
1. Bristol, Leverett D., and Smith, Ada L. : Statistics in cancer
control. Pennsylvania's Health, 2:3-14-16, (Jan. -Mar.) 1950.
2. Pearce, N. O., and Fleming D. S.: Results of the 1948
cancer statistical research service, Minnesota Med., 33:42-45,
(Jan.) 1950.
The final diagnosis in pulmonary tuberculosis rests
upon the demonstration of the tubercle bacillus just as
that of carcinoma of the lungs depends upon histologic
proof. A reasonable certainty of predicted diagnosis
can be obtained in about four-fifths of the cases with
only the usual x-ray examination such as posteroanterior,
oblique or lateral films. — Merrill C. Sosman, M.D.,
New England J. Med., June 1, 1950.
786
Today, because of procedures which have become
routine, the private physician’s office is a bulwark against
such diseases as smallpox and diphtheria. In like man-
ner, it can become one of the most effective agencies for
tuberculosis control. By promoting such a public health
measure, the general practitioners of the nation would
be acting in line with the great tradition of the. profes-
sion as a force for prevention as well as cure of disease.
- — A. C. Christie, M.D., Pub. Health Rep., June 2, 1950.
Minnesota Medicine
INFANT METHEMOGLOBINEMIA IN MINNESOTA DUE TO NITRATES
IN WELL WATER
A. B. ROSENFIELD, M.D., and ROBERTA HUSTON. B.Ch.E.
Minneapolis. Minnesota
T T should be emphasized at the outset that this
is not primarly a clinical study. Comparatively
few infants were examined and none was treated
by the State Health Department. The data were
furnished by the attending physicians but many
physicians were visited to obtain more complete
information. Most of the field work, however,
was devoted to the engineering aspects of the
water supplies. This was basically a study of a
public health problem. The study was inaugurat-
ed to determine whether methemoglobinemia due
to nitrates in well water had occurred in the past,
whether it was still occurring, its frequency and
its distribution. In addition, information was de-
sired as to the characteristic signs and symptoms,
the diagnosis and the treatment, particularly the
preventive treatment. This information was made
available to all physicians so that they might more
readily recognize this disease and more adequate-
ly treat it. Toward this end the services of a
pediatric consultant were made available as well
as certain laboratory procedures not readily avail-
able in the rural areas. This study was a joint
undertaking by the Division of Maternal and
Child Health interested in the infants, and by the
Section of Environmental Sanitation concerned
with the toxic chemical in the water, its concen-
tration, its variations, its distribution, and in
methods of reducing or eliminating the chemical
(nitrate) from the water. The subject will there-
fore be discussed from these two aspects.
It has been known for some time that the in-
gestion or absorption of various drugs such as
sulfonamides, nitrobenzene compounds, acetanilid,
bismuth subnitrate, sulphates, nitrates, and chlo-
rates is capable of producing a cellular type of
methemoglobinemia.1 This is the acquired type, in
contrast to congenital idiopathic methemoglobin-
emia, of which fifteen proved cases have been re-
ported.6 When no toxic agent could be detected
Aided in part by a grant from the United States Children’s
Bureau.
Dr. Rosenfield is director of the Division of Maternal and
Child Health, Minnesota Department of Health.
Miss Huston is assistant public health engineer, Minnesota De-
partment of Health.
Presented at University of Minnesota General Staff Meeting,
March 10, 1950 and published in Bulletin of the University of
Minnesota Hospitals and Minnesota Medical Foundation , March
10, 1950.
August. 1950
in the acquired type, it was usually spoken of as
idiopathic cyanosis.
In 1940, Schwartz and Rector24 reported a
case of methemoglobinemia of unknown origin in
a two weeks’ old infant living in Montana, fed on
diluted evaporated milk formula, which was suc-
cessfully treated- with methylene blue solution. The
physical examination was negative except for
abnormal color of the skin. The blood contained
57 per cent methemoglobin, but the water used in
the formula was not examined for nitrates. This
may have been, however, a case of nitrate poison-
ing from well water, as such cases have since been
reported in Montana.
In 1945, Comly5 discovered the etiologic factor
in two Iowa infants about one month of age who
probably would have been considered as cases of
idiopathic cyanosis. Interestingly enough, the
father of the first infant pointed out the answer
by suggesting the possibility of a peculiar reaction
between the well water and the soy bean prepara-
tion used in the formula, producing a poison which
caused the infant’s condition. An open-minded-
ness on the part of the admitting physician to
what appeared to be a “cock and bull” theory led
to analysis of the well water. This showed a high
nitrate content and thus the etiologic factor was
discovered.
Following Comly’s report of two proved cases
and seven suspected cases from rural Iowa, Fau-
cett and Miller8 reported three cases in Kansas,
and Ferrant9 reported two cases from Belgium.
Since then, cases have been reported from rural
Manitoba,15,16 Ontario,15 and Saskatchewan,22 Il-
linois,29’30 Iowa,2,11 Nebraska,23’27 Michigan,18’21
Kansas10 and several other states. New York
State reported its first two cases in July, 1949.20
The condition, therefore, is apparently quite wide-
spread in certain rural parts of the United States
and Canada.
Medical Aspects
The first case of methemoglobinemia in Min-
nesota was reported in January, 1947, by a physi-
cian at Tyler, in southern Minnesota. Since then.
787
METHEMOGLOBINEMIA— ROSENFIELD
a total of 146 cases, including fourteen deaths,
have been voluntarily reported to the Minnesota
Department of Health, since methemoglobinemia
is not a reportable disease.
METHEMOGLOBINEMIA CASES
STATt OMMHtHT MtALTM
Fig. 1. Location by county of methemoglobinemia cases in Min-
nesota, 1941-1949.
As physicians in Minnesota became more fa-
miliar with this condition, methemoglobinemia
was considered more often in differential diag-
nosis as evidenced by requests for methemoglobin
determinations in cyanotic infants as well as fre-
quent requests for analysis of suspected farm
wells. Doubtless, many mild cases which cleared up
promptly were never reported. Familiarity with
this condition by physicians as well as rural par-
ents has apparently been responsible for a mark-
edly decreasing incidence of reported cases in
1949, only twelve cases out of a three-year total
of 129 cases in 1947, 1948, and 1949. The last case
was reported in July, 1949.
Distribution of Cases. — Before discussing the
findings, it might be well to point out the distri-
bution of cases in this series. As can be seen
from the spot map of Minnesota (Fig. 1) prac-
tically all of the cases have occurred in the south-
ern half of the state and most of them in south-
western Minnesota. There have been only three
cases north of the midline of the state, with De-
troit Lakes, in Becker County, the most north-
erly reported case. No cases have been reported
in the northern section of the state.
Seasonal Incidence. — The incidence of cases of
methemoglobinemia varied from month to month.
In 139 cases out of our 146 reported cases with
reliable date of onset, the highest incidence oc-
curred in June with nineteen cases, October with
eighteen and April with sixteen cases ; the lowest
number occurred in November with six cases.
The seven cases omitted above were seen by physi-
cians between 1941 and 1946 before our study be-
gan, which accounts for the lack of data.
Of the 129 cases that occurred in 1947, 1948,
and 1949, almost one-third occurred in the second
quarter — April, May and June — (31.8 per cent).
The balance of the cases were more or less equal-
ly distributed in the other three quarters. The
actual percentage of births in Minnesota during
the same quarters were 25.0, 24.6, 26.3 and 24.1
respectively. There was a marked increase in the
percentage of cases in the second quarter in com-
parison with the percentage of births in the same
quarter. Any significance is, however, question-
able because of the small number of reported
cases, totaling forty-one, in comparison with the
births which totalled 54,415.
It should be stated that it has not been possible
to demonstrate any significant seasonal variations
in the concentration of nitrate nitrogen in farm
or municipal wells by periodic samplings carried
out on a number of water supplies. This will be
discussed in more detail under water supply as-
pects.
Sex. — There were eighty males and sixty-six
females in the study.
Age. — As to age at onset of symptoms, over
half occurred between two and four weeks of
age ; almost three fourths occurred between two
and six weeks of age ; over 90 per cent occurred
under two months ; and only 8.3 per cent were
between two and five months of age. The young-
est case was seven days old and the oldest was
five months old.
Feeding. — There were twenty-one infants who
were breast fed for a variable period of from one
788
Minnesota Medicine
METHEMOGLOBINEMIA— ROSENFIELD
to four weeks before being changed to a formula
containing well water. These infants, therefore,
developed symptoms at an age from one to four
weeks later than the non-breast fed infants.
The number of days the infant was on well
water before symptoms developed was dependent
on a number of factors, such as the nitrate nitro-
gen content of water, the amount of water in
formula, amount and frequency of feeding, sup-
plemental water feeding, length of time water
was boiled, various physiologic considerations, and
probably other unknown factors.
More than half of the 114 infants on whom
this information is available (sixty-one cases) de-
veloped symptoms in one to three weeks after
being on a formula requiring considerable water
as a diluent Eighteen per cent of these infants
were on well water more than thirty days, the
longest period being sixty days ; about 1 5 per
cent developed symptoms in less than seven days.
The shortest period before symptoms developed
was one day, in a two-month-old infant, on an
evaporated milk formula diluted with water con-
taining 140 parts per million of nitrate nitrogen.
In this case the water was boiled for over thirty
minutes to make sure all the “bugs” were killed.
As a result, the nitrates were concentrated almost
threefold by evaporation of water. This was
demonstrated in the laboratory by boiling a sample
of water from this particular well for thirty min-
utes. Before boiling, the nitrate nitrogen content
was 140 parts per million ; after thirty minutes
boiling it was 410 parts per million as a result
of evaporation.
Symptoms. — The characteristic symptom is a
grayish blue or brownish blue cyanosis which be-
gins around the lips, spreads to the fingers and
toes, the face, and eventually covers the entire
body. This occurred in all cases. When well de-
veloped, it is quite obvious. In early or mild
cases the mother may not notice the cyanosis
until her attention is called to it by a relative or
neighbor. Incidentally, farmers who have become
familiar with this condition call these infants
“blue water babies.” In several cases a physician
making a routine periodic physical examination
first noted the cyanosis.
The formulas used are of special interest. Evap-
orated and powered milk, which require large
amounts of water as diluent, were used in 75 per
cent of 116 cases with this information available.
TABLE I. INFANT FORMULAS IN 116 CASES OF
METHEMOGLOBINEMIA
Type of Milk Cases
in Formula No. Per Cent
Evaporated 46 39.7
Powdered . 41 35.3
Cows’s 29 25.0
Breast fed 0 0
*Balance of 146 cases did not report formula used.
Diluted cow’s milk was used in 25 per cent. No
cases occurred among infants in this group who
were breast fed, with only one possible exception.
This was a three weeks’ old infant who was breast
fed, but during the four days preceding the on-
set of cyanosis was given, in addition, a formula
of liquid SMA diluted with 1 to 1J4 ounces of
well water on only three occasions, plus 1
ounces of water daily. On examination, in addi-
tion to the cyanosis there was a loud systolic
murmur over the entire chest, diagnosed as con-
genital heart disease, from which he died some
time later. Methemoglobin totaled 1.57 grams
per 100 ml. of blood which constituted 11.5 per
cent of the hemoglobin, and the well water con-
tained 196 parts per million of nitrate nitrogen.
It is difficult to understand how methemoglobi-
nemia could be present with such a small quantity
of formula and water and in view of the pathology
present. In spite of this one possible exception,
this would appear to be another reason for urging
breast feeding during the first two months of life,
especially in rural areas, as Medovy has sug-
gested.15
Differential Diagnosis. — In the differential di-
agnosis certain serious conditions must be ruled
out. Among them are congenital heart disease,
abnormalities of the respiratory tract such as
pneumonia, atelectasis, pneumothorax, diaphrag-
matic hernia and congenital pulmonary and tra-
cheal malformations, as well as “thymic syn-
drome.” It should be remembered, as Ferrant9 has
pointed out, that there is a striking difference
between the cyanosis and the alarming condition
of the patient on the one hand and the normal
pulse and respiration and lack of physical findings
on the other.- If the cyanosis is severe and per-
sistent, systemic effects are producted due to
anoxemia, and death may occur.1’31
Diagnosis of Methemoglobinemia. — The diag-
nosis of methemoglobinemia may be presumptive
or absolute. In either case, however, it must first
August, 1950
789
METHEMOGLOBINEMIA— ROSENFIELD
be suspected. A presumptive diagnosis may be
made, if on removal of venous blood for a hemo-
globin determination the blood is chocolate col-
ored, and if there are more than 10 to 20 parts
per million of nitrate nitrogen in the water used
in the formula. If the blood is not examined, a
presumptive diagnosis is justified if there is a
spontaneous disappearance of cyanosis in twenty-
four to forty-eight hours on changing the water
in the formula, and the nitrate nitrogen content
of the water used exceeds the suggested maximum
of 10 to 20 parts per million. In either case the
history and physical finding should be typical. An
absolute diagnosis is made by demonstrating a
definite methemoglobin line on spectroscopic
examination1 or by the chemical analytic method
of Evelyn and Malloy.7
TABLE II. METHEMOGLOBIN DETERMINATIONS*
• Mhb.
Gm/100 ml.
of Blood
NO3N ppm.
in Well
Water
Days on
Formula
Formula and
Well Water
Age at
Onset
in Days
0.355
66
19
SMA
24
0.65
40
11
Evap.
25
0.97
100
49
Biolac
56
0.985
140
It
Evap.
64
2.5
73
18
SMA
24
3.00
110
47
SMA plus Biolac
58
3.05
110
20
2/3 dil. cow’s milk
36
4.95
500
9
1/2 dil. cow’s milk
45
*By method of Evelyn and Malloy.
fWater was boiled for over 30 minutes.
In the above eight cases the diagnosis was con-
firmed by methemoglobin determinations by the
method of Evelyn and Malloy,7 using an electric
colorimeter which was transported to the bedside
of the patient on long distance telephone request
to the State Health Department from the attend-
ing physician. Facilities for methemoglobin de-
termination were not available in the rural areas
where cases occurred. The readings varied from
a low of 0.35 grams per 100 ml. of blood two days
after hospitalization, to a high of 4.95 grams per
100 ml. of blood.
Treatment. — Treatment in most cases consisted
of changing the water used in the formula to an
approved municipal supply, with prompt recovery.
In forty-six infants oxygen was used, but most of
the physicians did not think it was of any benefit.
Furthermore, removal of the infant to a hospital
automatically changes the water supply and is
probably responsible for the recovery in twenty-
four to forty-eight hours. In severe cases more
active treatment becomes necessary. One per
cent methylene blue solution, 1 to 2 mg. per kg.
intravenously, may be life saving.30 It was used
in nine cases with prompt recovery, the cyanosis
clearing up in less than half an hour.
Mortality. — There were fourteen deaths, a mor-
tality rate of 9.6 per cent. No specific treatment
was used in these cases since the condition was
either not recognized or methylene blue solution
was not readily available. It is of interest to note
that four deaths were ascribed to thymic hyper-
trophy or syndrome, notwithstanding the fact
that the symptoms were characteristic of methe-
moglobinemia, and the well water used inMhe in-
fant’s formula contained 70, 120, 150, and 200
parts per million of nitrate nitrogen, respectively.
There were no autopsies done on these four in-
fants. In Minnesota during 1947 and 1948, fifteen
infant deaths were reported as due to hyper-
trophy of the thymus, of which the four men-
tioned above were actually deaths from methe-
moglobinemia. Many cases of cyanosis in early
infancy in rural areas have probably been incor-
rectly treated for hypertrophy of the thymus in
the past. Donahoe5 reported five cases of cyanosis
in babies on farm well water who had been given
from two to eight x-ray treatments for suspected
thymus enlargement, but which were cases of ni-
trate cyanosis. Two of the thymic deaths in this
series received x-ray treatment. Several infants
who recovered also received x-ray treatments. Dr.
G. R. Logan, Section of Pediatrics at the Mayo
Clinic, states,13 “I do not believe that an enlarged
thymus is a cause of death unless it can be shown
by autopsy examination.”
Typical Case Histories
Case 1. — Female infant, born October 1, 1948, and
discharged from hospital October 6, 1948. The formula
consisted of SMA and well water, equal parts, a total
of 24 ounces daily and 4 to 5 ounces of supplemental
water between feedings. At age of twenty-four days,
vomiting occurred; on twenty-fifth day of life, cyanosis
developed. The following day a physician made a diag-
nosis of congenital heart disease. Five days later the
infant w'as hospitalized at a nearby clinic where a diag-
nosis of methemoglobinemia due to nitrates was made.
Changing the w-ater in the formula to an approved
municipal supply resulted in recovery in two days.
Blood examination showed the presence of methemo-
globin to the extent of 2.5 grams/200 ml. of blood. Anal-
ysis of the well water showed nitrate nitrogen 73 ppm.,
790
Minnesota Medicine
METHEMOGLOBINEMIA— ROSENFIELD
sulphates 70 ppm. and chlorides 28 ppm. The formula
was changed to 24 ounces pasteurized milk, 8 ounces
water from municipal supply and Karo. There was no
recurrence.
Case 2. — A female infant was discharged from the
hospital to the farm home on an evaporated milk mix-
ture. At the age of ten days vomiting developed and
persisted for several days. At the age of twenty days
a generalized grayish-blue cyanosis developed. On the
twenty-second day of life the infant was hospitalized
when fluoroscopic examination of the chest resulted in
a diagnosis of hypertrophic thymus. Oxygen was given
as well as x-ray treatments daily for three days. Symp-
toms cleared up and the infant was discharged. Three
days later, while on the same formula containing well
water, cyanosis became marked and the infant was
hospitalized again. The physical examination of the
heart, lungs, and thymus was negative and the cyanosis
cleared up in three days without any treatment, other
than the change of the water. Analysis of the water
from a shallow farm well showed nitrate nitrogen 90
ppm., nitrite nitrogen 4 ppm., sulphates 100 ppm. and
chlorides 140 ppm. The water used in the formula was
changed and there was no recurrence.
Case 3. — Female infant, born August 10, 1947, weight
7 pounds, discharged from hospital August 16, 1947, on
a Lactogen formula, 16 ounces daily. On twenty-sec-
ond day of life, infant developed diarrhea. On the
twenty-ninth day the infant was seen by a physician
who found cyanosis of the face and chest, made worse
on crying. Admitted to hospital with diagnosis of
“infection of the stomach.” Infant was discharged on
fifth day when symptoms had cleared up. On return
to the farm home the same well water was used and
four days later diarrhea and cyanosis returned. The
physician changed the water to a municipal supply with
recovery and no further recurrence. The farm well
water contained nitrate nitrogen 37 ppm., sulphates 14
ppm., and chlorides 33 ppm.
Case 4. — Male infant, born August 29, 1948, dis-
charged September 3, 1948. The infant was breast-fed
but on September 10, three days before symptoms ap-
peared, the mother added a formula consisting of cow’s
milk 12 ounces and water 4 ounces. In addition, 8
ounces of supplemental water were given daily. On
September 13 at the age of two weeks the infant de-
veloped fussiness, excessive crying, and cyanosis of lips
during crying spells. Heart, lungs and thymus negative,
temperature 96°. Diagnosis was methemoglobinemia.
Treatment consisted of oxygen, with recovery in twenty-
four hours. Hemoglobin 69 per cent, white cells 11,000,
methemoglobin 4.95 grams/100 ml. Well water contained
nitrate nitrogen 500 ppm., sulphates 980 ppm., chlorides
480 ppm.
Case 5. — Female infant, born November 1, 1948, birth
weight 7 pounds IV2 ounces, discharged on seventh day.
The formula consisted of Biolac 1 ounce and 1^4 ounces
of water, 4 ounces per feeding, five times daily, plus 10
August, 1950
ounces of supplemental water. The water was boiled
five minutes. At the age of seven weeks diarrhea and
fussiness developed. The mother then diluted the formu-
la with additional well water. Three days later a gray-
ish-blue cyanosis began around the lips and hands and
became generalized, accompanied by listlessness. The
following day the infant was- sent to the hospital. The
physical examination was negative except for a duski-
ness of the skin. A diagnosis was made of methemo-
globinemia. On the physician’s request a methemoglobin
determination was made at the bedside that evening which
showed 0.97 grams/100 ml. of blood and 10 grams of
hemoglobin per 100 ml. of blood. Twelve hours later
(the following morning) the methemoglobin had dropped
to 0.49 grams/100 ml. with clearing of the cyanosis.
The mother was advised to use water from a neighbor-
ing municipal supply. The well water previously used
contained nitrate nitrogen 100 ppm., sulphates 1200 ppm.
and chlorides 210 ppm. Five minutes of boiling in-
creased the nitrate nitrogen content to 166.25 ppm. No
recurrence of symptoms.
Case 6. — Female infant born June 3, 1947, weight 7
pounds 15 ounces, discharged from hospital June 12,
1947, on formula of Carnation milk 14 ounces, water
21 ounces, and dextromaltose 7 tablespoons, with 5
ounces of supplemental water, boiled for ten minutes.
At routine physical check-up at age of three weeks a
physician noted cyanosis. City water was substituted
with recovery in twenty-four hours and no recurrence.
Analysis of farm well water showed nitrate nitrogen
62 ppm., sulphates 360 ppm., and chlorides 84 ppm.
Discussion
The question as to why only young infants,
usually under two months of age, and not older
members of the family develop cyanosis is diffi-
cult to answer. Incidentally, not all young in-
fants develop this condition. There have been a
number of instances in this series where one in-
fant developed cyanosis, whereas a sibling, born
one or two years previously, fed on a simliar
formula and using water from the same well,
failed to develop cyanosis. Older children and
adults, drinking the same water, did not develop
this condition.
According to Comly,3 there are a number of
factors which make an infant more susceptible
to nitrate cyanosis than older persons. The most
important single factor, in his opinion, is that the
infant has less oxidizable hemoglobin than an
adult. Other factors suggested are : that there is
a high fluid intake with greater turnover of water
in proportion to body weight ; that the intestinal
flora may contain more nitrite converters ; that the
infant’s intestinal mucosa is more easily damaged
and favors absorption of nitrites ; that the limited
791
METHEMOGLOBINEMIA— ROSENFIELD
excretory power of the young infant’s kidney may
favor nitrogen retention ; and that nitrate ions
may be more firmly bound by infantile hemo-
globin because of immaturity of certain enzymes.
According to Ferrant9 nitrates in well water are
probably more toxic for newborn infants than
for adults, especially if the infants have diges-
tive disorders. This may be a factor, as 14 per
cent in this series had diarrhea.
Cornblath and Hartmann,4 however, claim that
only younger infants develop methemoglobinemia
upon ingestion of water containing nitrates, be-
cause of the low gastric acidity characteristic of
the neonatal period.19 As a result of experimental
work, they postulate that if there is no free acid
in the stomach and the pH of the gastric juice is
over 4.0, nitrite-producing organisms can exist
high in the gastrointestinal tract in sufficient num-
ber to reduce nitrates to nitrites before the former
can be completely absorbed. In their control
group of infants, the gastric acidity was increased
by lactic acid milk feeding. In these cases they
were unable to produce methemoglobinemia with
mixtures containing high nitrate content. This
appears to be a reasonable explanation. In three
cases of methemoglobinemia in this reported series
the pH was 4.S, 5.0 and 5.5, respectively.
One final factor must be mentioned. Apparent-
ly, the cyanosis may clear up spontaneously when
the infant becomes older. This may be due to the
fact, as pointed out by Cornblath and Hartmann4
and others,39’25 that the gastric acidity increases in
older infants. This was illustrated in this series
where three cases occurred in one family, one
case in 1941, one in 1942 and one in 1944. All
three infants developed cyanosis, vomiting, diar-
rhea and excessive crying at the age of one week
while on a SMA formula. In the first two cases
the symptoms cleared up at the age of three
months with no treatment and with no change in
the farm well water used in the formula. The
infant born in 1944 was hospitalized when cya-
nosis developed, and this cleared up in a few days.
On returning to the farm home the cyanosis re-
curred. Nothwithstanding the skepticism of the
family physician, the parents changed the water,
with prompt clearing up of all symptoms.
There are undoubtedly, however, other factors,
and these are all debatable theories.
In passing, it might be of interest to mention
a veterinary disease of similar nature as an in-
teresting sidelight. In the spring of 1949 a herd
792
of cattle in rural Manitoba became ill after eat-
ing sugar beet tops.27 Cyanosis was a prominent
symptom, giving the appearance of “purple cows.”
The blood was chocolate-brown in color and
methemoglobin was demonstrated. Methylene
blue solution was successfully used in treatment
but a number of cows died. Analysis of the sugar
beet tops showed a high nitrate content but the
water contained no nitrates.
While no such cases in farm animals have been
reported in Minnesota, this condition is not new.
In 1937 a review14 was made of similar appearance
of “purple cows” which had occurred in Colorado
and Wyoming due to eating oathay or straw. This
condition has occurred since 1923 and has been
called “oathay disease.” Methemoglobin was
demonstrated in the blood, and the oathay and
oats contained large amounts of potassium nitrate.
Unfortunately, the water used was not analyzed
for nitrate. Apparently horses and sheep may also
suffer from this type of poisoning. In certain
areas in these two states, other plants such as cer-
tain weeds, wheat, barley, and cane sorghum some-
times contain sufficient nitrates to cause methemo-
globinemia. It has also been reported in sheep in
South Africa.
Resume of Water Supply Aspects*
Nitrate determinations on samples from water
supplies were made in the earlier days of the
Minnesota Department of Health but were gradu-
ally discontinued as a part of the sanitary analysis
with the advent of modern bacteriological methods.
The health department’s interest in the nitrate con-
centrations of water supplies in the state has been
renewed since the first suspected case of methemo-
globinemia was reported at Tyler, Minnesota, in
January, 1947. From January, 1947, to January,
1950, investigations were made of all water sup-
plies which were reported to be, or suspected of
being, involved in cases of methemoglobinemia.
In many instances physicians were interviewed in
an attempt to determine whether the problem was
more widespread than existing information would
indicate. The results of these interviews showed
that there were, undoubtedly, many cases of
methemoglobinemia which were either not being
properly diagnosed or were not reported.
In January, 1949, a communication was sent to
all physicians in the state asking them to report
any suspected case of methemoglobinemia that
*Certain tables, charts and graphs have been omitted.
Minnesota Medicine
METHEMOGLOBINEMIA— ROSENFIELD
TABLE III. NITRATE NITROGEN CONCENTRATION IN
WELLS CONCERNED IN METHEMOGLOBINEMIA
CASES*
NO3N ppm.
Type
Dug
of Well
Drilled
Less than 10
0
0
10-20
2
0
21-50
25
1
51-100
52
2
Over 100
50
1
*The phenoldisulfonic method described in the ninth edition of
“Standard Methods of the Examination of Water and Sewage”
was used for determining the NO3N concentration for these tests
and all others reported in this paper.
had come to their attention in the past several
years. The physicians were also asked to notify
the department immediately of any new cases.
A study was made of the 146 old and new
cases reported as a result of this communication.
Each study consisted of accumulating all epidemi-
ological data and obtaining all pertinent informa-
tion on the water supply involved. Dug wells were
found to be the source of water in 129 cases, and
drilled wells in four cases. Eleven of the wells
were involved in more than one case and two wells
caved in before samples were obtained. None of
the wells contained less than 10 ppm. nitrate nitro-
gen (NOsN) as shown in Table III. (A con-
centration of 10' ppm. is the maximum recom-
mended by most workers.3,27’29)
Only two wells contained between 10 and 20
ppm. N03N. Insufficient clinical data were avail-
able on both of these cases, and they are consid-
ered questionable. The samples from many of the
26 wells which contained 21 to 50 ppm. were col-
lected a year or more after a methemoglobinemia
case had occurred, and in some instances the well
had been abandoned subsequent to the case of
methemoglobinemia. The lowest nitrate nitrogen
on a sample collected at the time of the infant’s
illness was 36 ppm. ; the highest was 500 ppm.
From the information obtained on the cases re-
ported early in the study and from data published
by other workers, 2,10,11,: 23,27.2s ^ was considered de-
sirable to determine what factors might influence
the nitrate concentration of water from wells.
Among the questions which occurred in this con-
nection were the effects on nitrate concentration
of pumping, seasonal variations, location and con-
struction, depth and type of wells, and the geology
of the area.
Effects of Pumping on Nitrate Concentration. —
In order that sampling errors might be elimi-
nated insofar as possible, it was considered neces-
August, 1950
sary that the effect of pumping and the time of
sample collection on the nitrate concentration be
determined.
Four test runs were made on three different
wells. Three of the runs were made over periods
of one hour each, with samples being collected
every minute for the first five minutes, and every
five minutes thereafter. The fourth run was made
with samples being collected every hour for a
period of six hours. It was concluded from these
pumping tests that no significant change in the
nitrate concentration is noted with length of
pumping, and that the time of collection of the
sample after pumping begins is not critical.
Effects of Seasonal Variation on Nitrate Con-
centration.— To determine the effects of seasonal
variation on nitrate concentration, arrangements
were made to have samples submitted from cer-
tain specified municipal and private wells at rou-
tine intervals.
Municipal Supplies. — During this study, twenty-
eight (5.4 per cent) of the 514 municipal sup-
plies in the state were found to contain over
5 ppm. N03N ; sixteen (3.1 per cent) of these
contained 10 ppm. or more. The highest concen-
tration was 27 ppm. in a dug well used as the
source for a municipal supply in the section of
the state from which most of the methemo-
globinemia cases have been reported. The health
officer of this community advised all residents not
to use this water for infant formulas. No cases of
methemoglobinemia have been reported from this
supply. Eight supplies, ranging in nitrate nitro-
gen from 5 to 27 ppm., were selected for bi-weekly
sampling which was begun in February, 1949.
Samples were collected from the sources of supply
and from the distribution- system in each instance.
Private Supplies.- — Four of the wells involved in
cases of methemoglobinemia were sampled bi-
weekly beginning in February, 1949. These
included two wells which were later reconstructed.
The remaining two were dug wells, one at Tyler
(Lincoln County), and the other at Woodstock
(Pipestone County), both of which were located
satisfactorily. A fifth supply, a drilled well
located one-half mile west of the reconstructed
well at Luverne, was also sampled, although this
well was not involved in a case.
These periodic samplings were continued for
793
METHEMOGLOBINEMIA— ROSENFIELD
TABLE IV. PHYSICAL FEATURES AND NITRATE CON-
CENTRATIONS OF WELLS INVOLVED IN CASES
Number surveyed : 133
Physical Features
10 - 20*
Dug Dri
NOaN Concentrations — ppm
21 - 50 51 - 100 Over 100
lied Dug Drilled Dug Drilled Dug Drilled
Location :
Satisfactory .... 1
5
16
13
Unsatisfactory . .
19 1
30 2
34
1
No Data 1
1
6
3
Construction :
Curbing:
Wood
6
15
13
Concrete tile . . 1
12
29
28
Rock or brick.
3
3
Metal
1
2
1
No data 1
4
8
6
Platform :
Wood 1
23
39 2
42
1
Concrete
6
5
Metal
1
None
1
No data 1
2
6
3
Depth — in feet:
Less than 20 ... .
3
3
5
20-40 1
7 1
20
17
41-60
5
3
6
61-75
i
5
3
1
76-100
4 1
3
101-150
i
1
1
Over 150
1 1
No data 1
8
15
15
*No wells contained
less than 10 ]
ppm.
a period of one year. From the data obtained, it
is concluded, within the limits of this study, that
the nitrate concentration of a well water remains
fairly constant and that seasonal variations do not
occur.
Effects of Location and Construction on
Nitrate Concentration. — An analysis of the data
obtained on the location and construction of the
133 wells investigated in connection with cases of
methemoglobinemia showed that none was both
located and constructed satisfactorily as judged
by the standards of the Minnesota Department of
Health. (These standards for safe water supplies
specify that a well should be located at least 50
feet from all sources of contamination such as
barnyards, privies, et cetera. The well should be
provided with a water-tight casing which extends
at least 10 feet below and 1 foot above the
grade. Vitreous and concrete tile, wood, and
galvanized sheet metal curbings are not accept-
able. A reinforced concrete platform which
extends at least 2 feet from the well casing in
all directions should cover the well. A tight seal
at the pump base and a stuffing box head on the
pump are also specified. Pit construction is not
approved.)
None of the drilled wells and only thirty-five
of the dug wells were located satisfactorily as
shown in Table IV. Seventy-four wells were
located within 50 feet of a source of animal con-
tamination (barnyard, hog pen, et cetera) and
thirteen within 50 feet of a source of human
contamination (privy or cesspool). No data
were obtained on eleven supplies.
Wood curbing was used in thirty-four wells,
concrete tile in seventy. All but thirteen of the
121 wells on which data were obtained had
wooden platforms.
Since no conclusions could be reached from
the preceding data on the significance of location
and construction on nitrate concentration, a survey
was undertaken of all school wells in Nobles and
Kandiyohi Counties. Wells at farms adjacent to
the schools were also surveyed and used as a
basis of comparison, since it was believed that
the school environment afforded well locations
which are normally free of gross organic
pollution as contrasted with sites generally found
in farmyards.
In the Nobles County Survey, thirty rural
school and sixty-four farm wells were studied.
The nitrate concentration in the school wells was
lower than in the nearby farm wells in all but
three instances.
Sixty-eight school and fifteen farm supplies
were studied in the Kandiyohi County Survey.
Only one of the school wells and six of the farm
supplies contained over 10 ppm. N03N. Wells
for the most part were of drilled or driven con-
struction as contrasted with a preponderance of
dug wells in the Nobles County Survey.
From the data obtained on these two surveys,
it appeared that school wells containing over 10
ppm. NO,N occur less frequently than do com-
parable farm wells. It also appears that in the
case of dug and of drilled wells, the location
factor does not have too much bearing on whether
the water will yield a high nitrate content or not.
In an attempt to further determine the effects
of construction on the nitrate content of a well,
two wells which were high in nitrate and which
had been sampled over a period of at least six
months, were reconstructed. The wells chosen
were a satisfactorily located dug well of 30-foot
depth located outside the city limits of New Ulm
in Brown County, and a poorly located drilled
well, 71 feet deep, located three miles southwest
of Luverne in Rock County.
The upper ten feet of each well were recon-
structed so as to eliminate the possibility of con-
tamination entering the well from surface
drainage. Sampling of the wells after recon-
struction did not show a significant reduction in
794
Minnesota Medicine
METHEMOGLOBINEMIA — ROSEN FIELD
the nitrate concentration. Therefore, contrary to
work done by Sangor,23 good construction for a
depth of ten feet failed to exclude nitrate.
Effect of Depth and Type on Nitrate Concen-
tration.— From a tabulation of the data obtained
from all the well studies, it was apparent that
there is a greater probability of high nitrate
concentration occurring in shallow wells than in
deep wells. Dug wells are more frequently the
source of water high in nitrate than are drilled
wells. It is significant that in the dug wells, a
very large percentage (62 per cent) of the wells
showing nitrates in excess of 10 parts per million
were less than 75 feet in depth. In general, it
can be said that, within the limits of this study,
nitrate can be expected to occur more frequently
in the shallow wells (75 feet or less) than in the
deep wells.
Effect of Geology on Nitrate Concentration. —
During the period January 1, 1947, to August 1,
1949, the laboratory made nitrate determinations
on 2,912 water samples. Approximately 800 were
submitted specifically for nitrate determination ;
the remainder were collected primarily for some
other reason. Of these samples, 441 (15 per
cent) collected from wells in fifty-five counties
contained over 10 ppm. NOaN. The highest con-
centration found in each county is charted in
Figure 2. The white areas indicate counties in
which the highest N03N concentration of samples
included in this study is less than 10 ppm. The
vertical-lined area, predominating in the south-
west corner, indicates the occurrence of NOaN
concentrations of over 100 ppm. The south-
western section is the area from which most of
the methemoglobinemia cases have been reported.
A review of the geology of the State of Minne-
sota shows that it is, for the most part, a heavily
glaciated area, and that most instances where
high nitrates have been encountered have been
in wells drawing water from the drift. One
characteristic common to the western portion of
the state where high nitrates have been en-
countered is the heavy soil. Those counties which
show less than ten parts per million nitrate
nitrogen in the northern portion of the state very
frequently have lighter soils containing consider-
able quantities of sand. At the present time, there
are approximately ten counties in the southern half
of the state which show no wells with concen-
trations of NOsN over ten parts per million. It is
not known whether more extensive studies would
show similar results. Because of the peculiar
distribution of water high in nitrates in Minne-
Fig. 2. Nitrate nitrogen concentration in well water. Highest
concentration found in county, 1947-1949.
sota, it would appear that there are certain
geological factors which are involved. What these
factors are, and the nature of their operation,
has not been established by this study.
Summary
1. One hundred forty-six cases of methe-
moglobinemia, including fourteen deaths, due to
nitrates in farm well water supplies in Minnesota
are reported.
2. Dry and evaporated milk formulas as well
as diluted cow’s milk formulas which require
large amounts of water as diluent are most
dangerous.
3. Since no infants who were breast-fed, with
one possible exception, developed methe-
moglobinemia, this would appear to be another
argument in favor of breast feeding during the
first two months of life, especially in rural areas.
4. Data are presented on water supplies
suspected of being implicated in cases on infant
methemoglobinemia in Minnesota. In all but two
of these cases, the nitrate nitrogen content of the
water was in excess of 20 ppm. In the two
August, 1950
795
METHEMOGLOBINEMIA— ROSENFIELD
exceptions mentioned, the clinical histories of the
suspected cases were inconclusive.
5. Test runs on several wells did not show a
significant change in the nitrate concentration
with length of pumping.
6. Periodic sampling of municipal and private
supplies over a one-year period indicate that the
nitrate concentration of a well remains fairly
constant and that significant seasonal variations
do not occur.
7. Studies of rural school wells and similarly
constructed nearby farm wells indicate that the
nitrate content of the school well water was less
than that of water from the farm wells.
8. Reconstruction of two wells failed to show,
as some workers thought, that good well con-
struction for a depth of ten feet could be expected
to exclude nitrates.
9. Nitrates seem to occur more frequently in
shallow wells (75 feet or less), than in deep wells.
10. No method was found by which nitrates
could be removed from water. Recently
Krueger12 reported using the resin IRA-400 to
remove nitrates from water. This resin works on
the anion exchange principle which is similar to
the cation exchange that takes place in zeolite
softeners.
11. None of the cases of methemoglobinemia
in Minnesota on which sufficient data were ob-
tained occurred from using water containing less
than 30 ppm. NOsN in feeding an infant. How-
ever, 10 ppm. has been generally accepted as the
point above which the water should be viewed
with suspicion because of the possibility of a
dangerous level being reached through other
factors such as boiling.
* * *
Since this paper was written, four additional
cases of methemoglobinemia have been reported
to the Minnesota Department of Health.
Acknowledgment
H. M. Bosch, F. L. Woodward and H. R. Shipman
of the Section of Environmental Sanitation, participated
in the study. John Stam, M.D., Worthington Clinic,
acted as Pediatric Consultant.
References
1. Best, Charles Herbert, and Taylor, Norman Burke: Physio-
logical Basis of Medical Practice. Baltimore: Williams and
Wilkins Co., 1945.
2. Borts, I. H. : Water-borne diseases. Am. T. Pub. Health,
39:974-978, (Aug.) 1949
3. Comly, H. H. : Cyanosis in infants caused by nitrates in
well water. J.A.M.A., 129:112-116, (Sept. 8) 1945.
4. Cornblath, M., and Hartmann, A. F. : Methemoglobinemia in
young infants. J. Pediat., 33:421-425, (Oct.) 1948.
5. Donahoe, W. E. : Cyanosis in infants with nitrates in drinking
water as cause. Pediatrics, 3:308-311, (March) 1949.
6. Eder, H. A. ; Finch, D., and McKee, R. W. : Congenital
methemoglobinemia; a clinical and biochemical study of a
case. J. Clin. Investigation, 28:265-272, (Mar.) 1949.
7. Evelyn, K. A., and Malloy, H. T.: Microdetermination of
oxyhemoglobin, methemoglobin, and sulfhemoglobin in a
single sample of blood. J. Biol. Chem., 126:655-662, 1938.
8. Faucett, R. L., and Miller, M. C. : Methemoglobinemia occur-
ring in infants fed milk diluted with well water of high nitrate
content. J. Pediat., 29 :593-596, (Nov.) 1946.
9. Ferrant, M.: Methemoglobinemia; two cases in new-born
infants caused by nitrates in well water. J. Pediat., 29:585-
592, (Nov.) 1946.
10. Harrison, J. : High nitrate waters. Kansas Engineer, 33:7,
(March) 1949. (Condensed from a paper by D. F. Metzler,
Chief Engineer, Kansas State Board of Health.)
11. Johnson, G. ; Kurz, A.; Cerny, J.; Anderson, A., and Mat-
lack, G. : Nitrate levels in water from rural Iowa wells; a pre-
liminary report. J. Iowa M. Soc., 36:4-7, (Jan.) 1946.
12. Krueger, G. M.: Method for removal of nitrates from water
prior to use in infant formula. J. Pediat., 35:482-487, (Oct.)
1949.
13. Logan, G. B.: Personal communication, (Sept. 29) 1949.
14. Maynard, L. A. : Relation of soil and plant deficiencies and
of toxic constituents in soils to animal nutrition. Ann. Rev.
Biochem., 10:449-470, 1941.
15. Medovy, H.: Well water methemoglobinemia in infants; its
occurrence in rural Manitoba and Ontario. Journal-Lancet,
68:194-196, (May) 1948.
16. Medovy, H.; Guest, W. C., and Victor, M. : Cyanosis in
infants in rural areas. Canad. M. A. J., 56:505-508, (May)
1947. '
17. Medovy, H.: Personal communication, (May 14) 1949.
18. Methemoglobinemia due to well water. J. Pediat., 33:506-507,
(Oct.) 1948.
19. Miller, R. A.: Observations in gastric acidity during first
month of life. Arch. Dis. Childhood, 16:224, 1941.
20. Nitrite poisoning recognized in Plattsburg infants. New York
State Dept. Health Bulletin Weekly, 2:31, (July 11) 1949.
21. Pollution believed cause of “blue baby” disease. The Ameri-
can City, (Oct.) 1948.
22. Robertson, H. E.., and Ridell, W. A.: Cyanosis of infants
produced by high nitrate concentration in rural waters of
Saskatchewan. Canad. J. Pub. Health, 40:72-77, (Feb.) 1949.
23. Sanger, L. A., and De Frain, O. D.: Contaminated private
water supplies. Better Health, 8:2, (May-June) 1949.
24. Schwartz, A. S., and Rector, E. J.: Methemoglobinemia of
unknown origin in a two-week-old infant. Am. J. Dis. Child.,
60:652-659, (Sept.) 1940.
25. Smith, Clement A.: Physiology of the Newborn. Springfield:
Charles C Thomas, 1946.
26. Sollmann, Thorald : Manual of Pharmacology. Sixth ed.
Philadelphia: W. B. Saunders Co., 1942.
27. Stafford, G. E. : Methemoglobinemia in infants from water
containing high concentrations of nitrates. Nebraska M. J.,
32:392-394, (Oct.) 1947.
28. Waring, F. H.: Significance of nitrates in water supplies. J.
Am. Water Works A., 41:147-150, (Feb.) 1949.
29. Weart, J. G. : Effect of nitrates in rural water supplies on
infant health. Illinois M. J., 93:131-133, (March) 1948.
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senger, 20:48, (June 15) 1948.
31. Wiggers, Carl J. : Physiology in Health and Disease. Phila-
delphia: Lea and Febiger, 1937.
PSYCHOLOGICAL MEDICINE
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10. Menninger, W. C.: Emotional factors in organic disease.
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11. Mooney, Robert D. : Personal communication.
12. Peabody. Francis W. : Doctor and Patient. New York: Mac-
millan Co., 1930.
13. Peabody, Francis W. : The care of the patient. J.A.M.A.,
88:877-882, 1927.
14. Reik, T. : Listening with the Third Ear. New York: Farrar
and Strauss, 1948.
15. Rogerson, C. H.: Psychology in General Practice. Edited by
A. Moncrief. London: Eyre and Spottiswoode, Ltd., 1946.
16. Thomas, H. M.: What is psychotherapy to the internist?
J.A.M.A., 138:878-880, (Nov. 20) 1948.
17. Weiss, E. : Psychotherapy in everyday practice. J.A.M.A.,
137:442-448, (May 29) 1948.
18. Whitehorn, J. C. : Psychotherapy in general practice. Bull.
Johns Hopkins Hosp., 82:10-19, (Jan.) 1948.
19. Whitehorn, J. C. : Modern Medical Therapy in General
Practice. Borr, David P., editor. Baltimore: Williams and
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20. Yellowlees, H.: The Human Approach. London: Churchill,
1946.
796
Minnesota Medicine
PITUITARY ADRENOCORTICOTROPIC HORMONE (ACTH) IN ASTHMA
J. S. BLUMENTHAL. M.D., F.A.C.P.
Minneapolis, Minnesota
'C’OLLOWING the elaboration and use of any
therapeutic agent, extravagant claims are
made. Certainly this has been the case with cor-
tisone and pituitary adrenocorticotropic hormone
(ACTH). The very grandeur of the vista un-
folded by these agents and the possibilities inher-
ent in them would make exaggeration almost
impossible. It is the more advisable, therefore,
to report failures as well as successes in their
use.
Animals that have had an adrenalectomy show
extreme susceptibility to anaphylactic shock as is
well known and was long ago demonstrated but
when these animals are given cortisone they are
protected; and pretreatment injections of ACTH
result in only minor reactions.2 While we know
comparatively little about the fundamental proc-
esses by which the adrenal corticosterones affect
the great changes noted in the body, it is suffi-
cient here to state that there is early in the course
of treatment with ACTH or cortisone, physio-
logical changes due to induced hyperactivity of
the adrenal cortex ; a fall in the eosinophile count ;
leukocytosis ; sodium and chloride retention and
associated water retention or excretion ; elevated
serum carbon-dioxide — combining powers ; de-
creased sodium and chloride in the sweat ; in-
creases in urinary histamine, corticoides and
seventeen keto steroids ; increased gluco-
neogenesis with hyperglycemia ; a diabetic-type
of dextrose tolerance curve and increased
deposition of liver glycogen; decreased inorganic
serum phosphorous ; increased uric acid excre-
tion ; decreased free serum cholesterol ; increased
calcium excretion ; and a negative nitrogen bal-
ance.4’5 In considering the effect of ACTH on
allergic persons, in particular, we must also con-
sider the euphoria induced, and the increased
appetite and neuropsychiatric changes.5 Inter-
ference with acetyl-choline cycle as reported by
Torda and Wolff9’10 with at times deficiency and
at other times enhancement of in vitro synthesis
is another important factor. Large doses of ster-
oids have also been reported, by Selye,8 as hyp-
From the Department of Internal Medicine, Allery Clinic,
University of Minnesota.
notic in effect while Archer1 in a recent letter
in the A.M.A. Journal stresses the relationship of
the pituitary adrenal axis to fat metabolism and
to fatty infiltration of the liver — changes also asso-
ciated with pregnancy and jaundice — conditions
which at times benefit arthritis as well as asthma.
While the conditions treated with ACTH have
included almost all serious ones the body is heir
to, some of the most dramatic results have been
reported in the field of allergy with just about
100 per cent at least encouraging though tempo-
rary results. Rose treated six patients with se-
vere asthma.7 The first two patients received 150
mg. of ACTH daily for two days and 100 mg.
daily for two more days. The next four received
100 mg. daily for three days, 75 mg. daily for two
days and 25 mg. the sixth day. He reports com-
plete success in relief of asthma in four patients
within forty-eight hours. The other two patients
while not completely free of symptoms were de-
cidedly improved. Though apparently only re-
missions, the results were certainly striking for
the type of patients reported. Bordley3 treated
five patients with severe asthma with daily doses
of 30 to 100 mg. of ACTH given at six hour
intervals. Here also marked relief was obtained
in four to forty-eight hours. Total ACTH given
varied from 360 to 775 mg. Not only was the
asthma relieved but in two patients nasal polyps
disappeared though they recurred in twenty-three
days and one month respectively. Randolph6
reports thirteen cases of very serious asthma, two
seasonal ragweed asthma and eleven perennial
advanced cases of this disease. The majority
would certainly be included in that terribly dis-
couraging class of asthmatics referred to by
Rockemann as “intrinsic and were further com-
plicated by nasal polyps and aspirin sensitivity.
As he points out these cases were chosen because
of their very difficulty as diagnostic and thera-
peutic problems. Ten of these eleven severe asth-
matics obtained marked relief of symptoms and
remissions for from one week to five months fol-
lowing treatment with ACTH. Total dosage was
125 to 325 mg., while one patient could not be
treated with the usual method and dosage due
August, 1950
797
PITUITARY ADRENOCORTICOTROPIC HORMONE— BLUMENTHAL
to fluid retention. The degree of relief varied
from 50 per cent to complete comfort — the more
satisfactory results being in patients with no
clinical or x-ray evidence of emphysema, empyema
or scarring. Even in those having recurrence of
bronchial asthma after treatment, symptoms were
“readily relieved following the inhalation of small
amounts of epinephrine spray” — in decided though
temporary contrast to the pretreatment condition.
Their general status improved markedly — a con-
dition not due to suggestion as placebos did not
work in the same manner.
Because of these reports, it is to be understood
that the privilege of being able to use this drug
was greeted by me with great enthusiasm and
anticipation. The first two patients, I decided,
would be really “tough ones” — whom I had fol-
lowed, and used up my total therapeutic arma-
mentarium as well as that of other men in the
field. As the material was to be given every six
hours and in order to follow the response to treat-
ment especially as to the eosinophile count (to
be sure the adrenals did respond) the patients
were placed in a hospital. This was done in spite
of the fact that, as is well known, hospitalization
and rest are often great therapeutic agents in
themselves which could very easily confuse one
as to the real agent responsible for improvement.
In these people, however, because of the length
of previous observation, I believed I could easily
detect real improvement if it resulted as promised.
Case 1. — This patient, a man, aged forty-five, married,
working in a furniture shop, has had asthma for twenty
years. He has had a perennial associated stuffy nose
with “sinusitis” for fifteen years. His asthma is aggra-
vated by exertion, excitement, laughing, and changes of
temperature. For the past ten years, he has had attacks
at least once a night and he uses adrenalin by spray and
aminophyllin suppositories with only partial relief. He
was not appreciably improved by a stay in Arizona.
Iodides, ephedrin, dietary regimes, desensitization with
dust, fungi, vaccine, histamine have all been of little
help. He has been hospitalized on many occassions and
for varying periods for status asthmaticus. His past
history is not remarkable except for nasal surgery fifteen
years ago with poor results. His routine blood and
urine were negative. The sedimentation rate was six.
X-ray of the chest and electrocardiogram gave negative
findings. This patient has been under my care since
May 1949, and all usual procedures, including the anti-
histamine, antibarium, and antibiotic drugs were of no
help. He was given 260 mg. of ACTH for a period of
seventy-two hours with no marked benefit, on either the
symptoms or vital capacity while in the hospital. That
the adrenals did respond was shown by the drop in the
total eosinophile count from 90 to 0. The drug was
given every six hours.
Case 2. — This patient, a woman, aged forty-nine, mar-
ried, a former nurse and present hotel proprietor, gives
a history of asthma since 1943. She also had a perennial
stuffy nose in 1947 and 1948 but no asthma at that time.
The condition is aggravated by hard work, dust, colds,
and cold air. Partial relief is at times obtained by
aminophyllin, ephedrin, and adrenalin by hypo. The
past history is not remarkable except for irrigation
of the sinuses in 1949. The physical examination,
x-ray, and electrocardiograms were normal. Routine
blood and urine examination were not helpful. This
patient has been under my care since January, 1950, and
the usual procedures including elimination diets ; seda-
tion ; desensitization with dust, fungi, vaccine, histamine ;
antihistamine, antibarium, and antibiotic drugs were tried
but in May 1950, she became very seriously incapacitated
by her condition and a trial of ACTH was advised.
ACTH was given for 96 hours for a total of 360 mg.
with no marked effect. The total eosinophile count
showed the adrenalin stimulation by a marked drop from
16090 to 680 to 90 to 0. As a matter of fact she required
repeated hypos of adrenalin and aminophyllin while being
given ACTH as well as after treatment. The drug
was given every six hours.
Case 3. — This patient, a man, aged fifty-six, married,
is a patient of Dr. Henry Ulrich. He has had asthmatic
attacks since January, 1950, and had a particularly dif-
ficult period while in Houston, Texas. His past history
is lion-contributory except that he has had nasal polyps
for many years which have been removed periodically
every six months. Duodenal ulcer in 1949 improved
under diet. He is extremely sensitive to aspirin. He
claims he is allergic to tomatoes. Physical examination
was practically negative, except for nasal polyps. His
chest, whenever examined, was clinically free from
asthma. The usual therapy (bronchodilators) including
rest and sedation improved the patient somewhat.
After one week of hospitalization he was discharged on
May 25, 1950. His routine blood and urine exami-
nations were negative. The eosinophile count was 5
per cent. On June 2 and 3, he received 80 mg. of
ACTH at twelve-hour intervals for four days. Three
days later he reported no improvement in his attacks
but he said his cough seems less and his polyps “were
gone.”
It is difficult for me to understand the effect of
ACTH in these three cases of asthma — a disease
in which therapy is very difficult to assay in view
of the tremendous psychic factors. The dosage
was as reported ; the response of the adrenals was
certainly there, as noted in the eosinophile counts.
It also seems that, if relief is to be obtained,
(Continued on Page 803)
Minnesota Medicine
798
RENAL TUMORS
HENRY FISKETTI, M.D.
Duluth, Minnesota
HP HE FOLLOWING material resolves itself
into a generalized discussion of renal tumors,
which is a group none too common but most inter-
esting. It is far from being exhaustive or even a
beginning review of the literature on the subject,
but if it does nothing more than give a brief
review of their clinical and pathological features,
their incidence, etiology, symptomatology and so
forth, its aim will have been fulfilled. It is also
an attempt to evaluate and correlate the pertinent
facts about all the cases in the hospital records.
The cases surveyed were those dating back
twenty-six years in the records of St. Mary’s
Hospital, Duluth, and include all kidney tumors
that have been classified since the inception of
adequate record room files. The cases in this
survey include only those that have been proven
to be kidney tumors, either by surgical removal
and pathological specimen or at autopsy. Up to
1936, there were only twenty-five proven cases
listed. So we see that over half of the cases
have been recorded since that time. Better inves-
tigative urology and more autopsies have brought
many to light, no doubt. The total series is not
large but sufficiently comprehensive to justify
some conclusions and we must not lose sight of
the fact that their incidence in the realm of neo-
plasm is comparatively rare. Some of the cases,
it is admitted, were not diagnosed clinically but
were incidental findings in routine autopsies.
The classifications of renal tumors are almost as
multiple as those of arthritis and much recently
acquired knowledge as to their pathology has
cleared up this phase considerably. There are
both the malignant and the benign. From a
standpoint of interest, a typical classification of
renal new growths about thirty years ago was
chiefly a pathological one. They were divided into
three groups.
Group I — Composed of those that took their origin
from the cells of the adult or fetal kidney.
These were called “homologous” growths and
consisted of :
A. Benign
(fibroma
1. Connective tissue origin ^i'Pon?-a
° (hbrohpoma
(angioma
2. Epithelial origin ^Pilloma
° (adenoma
B. Malignant
1. Connective tissue origin
(a) round cell (
(b) spindle cell )
2. Epithelial origin — epitheliomata or car-
cinoma.
resodermal
Group II — Composed of those that take their origin
from cells or tissues that do not belong to
the kidney proper, but which have been in-
cluded in this organ during its development.
These were called “heterologous” growths
and included :
A. Large fatty tumors, the “struma lipomatoides
aberrata renis” of Grawitz which he de-
scribed in 1883 and which are now termed
hvpernephromata, the name coined by Lu-
barsch in 1894.
B. Mixed growths
(1) of muscle, bone, or cartilage.
(2) . rests from Wolffian body.
(3) mesodermal rests — so-called Wilms’ tu-
mors.
Group III — Comprised of those enlargements which
are tumors in a clinical sense only, and
which form a pathological standpoint are
retention cysts due to a non-patency of
renal tubules.
1. Single solitary cysts.
2. Congenital cystic kidneys.
This is essentially an outmoded and bulky
classification based on embryological etiology and
derivation. Since iGrawitz’s paper of 1883, a tre-
mendous amount of literature has accumulated
dealing with classification, but most of the discus-
sions are concerned with either disproving or
proving the etiological adrenal rest theory of Gra-
witz. The latter’s supporting arguments are :
1. Their position under the capsule of the kidney
where adrenal rests are often found normally.
2. The cells of hypernephroma are similar in type to
adrenal cells.
3. Characteristic fatty infiltration of the cells which is
never found in kidney epithelium.
4. The presence of a limiting capsule around the
tumor.
5. The arrangement of cells is similar to that in the
adrenal cortex.
The opposition to Grawitz’s hypothesis as ad-
vanced chiefly by Stoerck in 1908 and by Glynn
in 1911 believe that:
August, 1950
799
RENAL TUMORS— FISKETTI
1. Grawitz tumors are more frequent in the lower
pole where adrenal rests are not found.
2. So-called fat cells of the hypernephroma are not
fat but vacuolization related to the glycogen content of
the cells.
3. It is a tumor of the cortex and not the capsule in
which adrenal rests are formed.
4. That renal tumors never influence the growth of
sexual characteristics as one would expect from super-
fluous adrenal tissue.
5. Finally, why should adrenal rests which are com-
TABLE I.
BENIGN
MALIGNANT
Adenoma
Hypernephroma-adenocarcinoma of renal
Fibroma
cortex
Li poma
Carcinoma
Angioma
1 . Adenocarcinoma-hypernephroma
Papilloma
2. Papillary carcinoma
(includes pelvis)
3. Squamous cell or Epithelioma
Cysts
Sarcoma
1. Round
2. Spindle
3. Mixed
Embryoma or Wilms* tumor
1. Teratoma
2. Rhabdomyoma
3. Mixed tumors
TABLE II. PATHOLOGICAL INCIDENCE
Garceau
(Mass. Gen.)
Wilson
(Rochester)
Smith
(Mass. Gen.)
St. Mary’s
Perirenal Sarcoma
1
Papilloma
1
3
1
Hypernephroma
45— (53%)
71— (77 % )
16— (40%)
34— (58%)
Carcinoma
3
5
7
2
Papillary Cystadenoma
4
Papillary Adenomata
11
Sarcoma
2
7
3
3
Lipoma
5
2
Fibroma
14
1
2 unknown
Embryomata
3
i
6
Adenomata
i
Adenocarcinoma
10
4
Papillary Carcinoma
3
4
Adenosarcoma
Cystic Tumor
1
(Reniculus)
1
Totals
86
91
42
58
TABLE III.
Barney
Braasch
Senator
Creevy
St. Mary’s
Male
43 (58.1%)
51 (61%)
199 (65%)
59 (63%)
34 (59%)
Female
31 (41.9%)
32 (39%)
106 (35%)
35 (37%)
24 (41%)
paratively rare in the kidney produce hypernephroma
which is the commonest kidney tumor while rests in other
localities, although comparatively common, so rarely
produce tumors?
At present, it may be stated that hypernephro-
mas are peculiarly different histologically and
stand out as a separate group. Their exact origin
is still unsettled but there is now a fairly general
acceptance of its renal rather than adrenal origin.
The best grouping of kidney tumors to our mind,
is not one which is on a pathological or etiological
basis but a practical one of value clinically to the
average practitioner who has forgotten a very
liberal amount of pathological detail.
Table I constitutes a more simple and workable
classification.
In incidence, hypernephroma is by far the most
common in the adult while in children the em-
bryomata or Wilms’ tumor comprises the ma-
jority. Table II presents the incidence of tumor
types for three other series in addition to our own.
It will be noted that in Smith’s cases, the
tumors are all malignant except two which were
thought to be fibromas and, furthermore, that
hypernephroma is the most common in all series.
The percentage of these in our series, that is
58 per cent, is similar to the others. The average
percentage of incidence in the four series is 57 per
cent. The incidence of other tumor types in the
various series differ widely sometimes, but this is
probably due, in part, to the fact that different
pathologists, each having their own individualities
in pathological judgment and criteria, made the
diagnoses. A microscopic section to one may ap-
pear as an adenocarcinoma while by another it
may be interpreted as a cystadenocarcinoma, etc.
Let us consider incidence from the standpoint
of sex. Most writers state that males are affected
more than females, offering no explanation for
this difference (Table III).
Heredity and trauma are not causative factors
but trauma may be a precipitating cause of hemor-
rhage in a tumor already existent. Kraft reports
a case of a man being struck by a plow following
which he developed a mass in the flank. This
remained the same for eighteen years but later
800
Minnesota Medicine
RENAL TUMORS— FISKETTI
at operation, there proved to be a superimposed
medullary carcinoma. In our series, a man kicked
by a cow nine months previously developed a car-
cinoma of the renal pelvis, but, of course, this
may have been coincidental. It could be significant.
hematuria in only one of forty-one in children
and two French writers in 39 and 29 per cent
respectively. As far as I could determine, no
gross hematuria was recorded in our small group
of children.
TABLE IV.
Years
Senator
Koster’s
Table (Keyes)
Creevy
St. Mary’s
0-9
157
169
7
10-19
15
1
1
20-29
34
3
1
30-39
45
2
40-49
42
125
22
8
50-59
96
22
17
60-69
57
128
30
18
70-79
13
1
5
80-89
1
459
422
81
58
In Table IV, it will be seen that renal tumors
are most prevalent during childhood and late adult
life. At St. Mary’s forty-nine of the fifty-eight
cases were in patients over forty years of age.
Kelynack has also tabulated 160 cases, more
than half of which occurred in the first decade of
life ; only fifteen between the ages of nine and
thirty-five ; and of the rest, over 50 per cent be-
tween the ages forty-five and sixty. Walker re-
ports that almost all sarcomas occur in children
before the fifth year (116 out of 138 cases). At
St. Mary’s three sarcomas occurred in adults and
three in children.
Symptoms
The symptomatology of renal - tumor is well
defined. Hematuria, pain and tumor mass are the
classical triad but it is not obligative that all these
be present. When all are present, the growth is
far advanced and beyond cure. Hematuria is the
most important symptom. In eighty-three cases,
Braasch found the first presenting symptom
to be hematuria in 47 per cent, pain in
32 per cent and tumor in 15 per cent. Hinman
found all three sypmtoms in 38 per cent. At St.
Mary’s, pain was present in 58 per cent, hema-
turia in 45 per cent and mass both subjectively or
objectively palpated in 48 per cent. All three
symptoms were found in only 6 per cent of the
St. Mary’s group. Hematuria in the beginning
may be only microscopic but gross hemorrhage
often results in clot formation with ensuing renal
colic as the clots pass down the ureter. Bleeding
may be spontaneous, and recur at long intervals of
time which may lead to procrastination as to
timely and proper investigation. In children,
hematuria is notoriously absent. Dexter found
The second striking symptom is tumor mass
which on palpation may be hard and nodular or
soft and smooth. Many of the patients are aware
of this mass and others experience only abdom-
inal discomfort or fullness. Before extension
outside the kidney, it is usually movable. With
proper technique, that is, bimanual pressure, at the
end of deep inspiration, with the patient in the
lateral prone position, Israel was able to palpate
enlargement in sixty-two of sixty-eight cases and
Smith in sixty-eight of eighty or 84 per cent.
“Ballotment renale” or Guyon’s sign is sometimes
elicited. In the St. Mary’s series, tumor was
found in 48 per cent.
Pain is probably the least diagnostic symptom.
When not due to clot-passing with typical renal
colic, a constant dull ache may be due to hydro-
nephrosis, pull on the renal pedicle, or to involve-
ment of adjacent nerves. There may also be pres-
sure symptoms such as varicocele, due to com-
pression of the spermatic veins or ascites and
edema of extremities by pressure on the larger
intro-abdominal veins. Intestinal obstruction may
be caused by tumor pressure. Other associated
symptoms, and sometimes the presenting symp-
toms, are gastrointestinal disturbances such as
anorexia, indigestion, constipation, or diarrhea.
Jaundice may be present if a right sided growth
has extended to the liver. In the late stages,
anemia and cachexia predominate. Patients pre-
senting these symptoms are the ones in whom
valuable time has been lost in arriving at a diag-
nosis and the ultimate prognosis thereby made
worse. In a few cases, the symptoms from me-
tastases to lungs and bone may be the first indica-
tion of the presence of the lesion. In one of our
August, 1950
801
RENAL TUMORS— FISKETTI
cases, a pyelonephritis of the opposite kidney ob-
scured the true diagnosis for several months.
Fortunately, rapid avdances in the betterment
of cystoscopic instruments and technique, have
greatly facilitated the diagnosis of renal tumors.
Before the development of intravenous pyelog-
raphy, many cases of tumor were not diagnosed
early because more troublesome cystoscopy was
repeatedly postponed. It must be emphasized that
all hematurias, painless or otherwise, should have
exhaustive investigation and not be lightly passed
off with the admonition that “if it happens again
we’ll look into it more thoroughly.” It may be too
late then for permanent cure. Retrograde pye-
lography has no peer but the intravenous tech-
nique is helpful as corroborative evidence and as
a screening test. A negative intravenous pyelo-
gram, however, should not be considered conclu-
sive.
Too much reliance, on the other hand, must not
be placed on a definite diagnosis from a pyelogram
alone. Few show absolutely typical pictures with
“spider leg” deformity of the calices, but the
greater number show only partial filling defects of
the pelvis. In practically all of our series, the
x-ray diagnosis was merely “filling defect of the
renal pelvis.” Therefore, we see that the history
and clinical findings, cystoscopy with pyelography
and renal function determination are equally in-
dispensable for early diagnosis.
A few more facts about the St. Mary’s series.
Presenting symptoms had been present for an
average of about forty weeks. There were twenty-
seven cases with proven metastases, or 49 per cent.
These metastases were chiefly to the lung in thir-
teen cases or 45 per cent, to the bones in eleven
cases or 40 per cent, to the lymph glands in eight
cases or 30 per cent, and to the liver in five cases
or 22 per cent. The bone metastases were chiefly
to the spine and pelvis ; one to the jaw and sev-
eral to the ribs. Lymph gland involvement is usu-
ally to the retroperitoneal, cervical or mediastinal
nodes. Renal function determinations such as
P.S.P., indigo carmine, and blood chemistries
were done in only twenty-seven or 47 per cent. It
would seem that these procedures should have
been done more frequently as part of a thorough
urological investigation, even though not much
information is usually gleaned from this source.
Generally speaking, these function tests were
usually reduced on the side of the lesion but rarely
were the blood metabolites elevated, which is what
we would expect with the other remaining kidney
present and normal. Blood chemistries were done
in only twenty-five cases. It is amazing that more
blood chemistries were not done prior to nephrec-
tomy because the latter would certainly be contra-
indicated in a semiuremic or uremic surgical risk.
One such instance occurred where a nephrectomy
was done in a case with an admission blood urea
nitrogen of 76 and a creatinine of six- with death
on the first postoperative day. Certainly, this was
poor surgical judgment.
Associated diseases were irrelevant and com-
monplace but hypertension and urinary tract in-
fection were quite prevalent. Varicoceles were
present in two patients, and it is interesting to
note that one case of adenosarcoma in a three-
year-old was superimposed on a horseshoe kidney.
The average hemoglobin was 62 per cent and the
red blood cells 3.36. Positive urinary findings,
either r.b.c., w.b.c. or albumin were present in
64 per cent. Three biopsies of a cervical gland, of
bone and of the liver confirmed the diagnosis of
hypernephroma in three instances. In one patient,
simple pyelotomy was done for palliation.
Concerning the treatment of renal neoplasms,
suffice it to say that early surgery plus preopera-
tive or postoperative radiation or both, offers the
only chance of complete cure. And, of course,
it must be taken for granted that the kidney func-
tion in the remaining kidney is compatible with
life. A thorough study should be made for me-
tastases and many writers feel that even the
presence of small or early metastases does not
necessarily contraindicate nephrectomy.
Creevy believes that irradiation of metastases
and recurrences is of definite value. Whether life
is prolonged is debatable but there can be no doubt
as to its palliative values in reducing pain. Dean
believes that pulmonary metastases are radio sen-
sitive and that bone lesions are not. Creevy be-
lieves they both respond equally. Most men feel
that x-ray generally does not appreciably affect
the percentage of cures. One point of note is that
preoperative radiation may reduce a tumor in size
to the point where it may be operable, whereas
previously it was not. It seems to be rather gen-
erally agreed that x-ray treatment is most useful
and is the best treatment for Wilms’ tumor. Many
men state that surgery is of no avail but it seems
to me that every early case should have the benefit
of surgery. Better results from x-ray therapy at
802
Minnesota Medicine
RENAL TUMORS— FI SKETTI
the present day is expected because of improved
techniques; high voltage machines, et cetera.
The percentage of five-year cures by all types
of therapy are not too encouraging. The over-all
average of five-year cures in percentage from a
series of cases reported by Walters, Priestly,
Braasch, Hyman and about five other authors is
23 per cent. This low percentage certainly speaks
eloquently for early diagnosis. I could find no
report of a five-year cure for a Wilms’ tumor.
In the cases at St. Mary’s, nephrectomy was
done in 55 per cent. X-ray therapy was used in
only 21 per cent of the cases. It was not possible
to arrive at any definite percentage of five-year
cures because of the insufficiency of follow-up
data on the charts.
Conclusions
1. Much progress has been made in the classi-
fication and etiology of renal neoplasms in the last
twenty years. The renal origin of hypernephroma
is more tenable.
2. The classical symptomatic triad is pain,
hematuria and mass and when all are present, the
tumor is beyond all hope of cure.
3. Generally speaking, our cases compare fa-
vorably with other series reported as to age,
incidence, tumor types and symptoms.
4. Surgery, if it is to be of any avail, must be
done early and small metastases do not necessarily
preclude surgery.
5. X-ray is a valuable adjunct to surgery and
that it reduces pain, also.
6. Every case presenting one or more of the
classical renal symptom triads should be cysto-
scoped immediately and studied urologically.
7. The charts studied in the series at St. Mary’s
were deficient chiefly in two categories :
( 1 ) Poor follow-ups for evaluation of therapy
and estimation of five-year cures.
(2) Many tests and investigative procedures
done before admission had not been recorded and
were, therefore, unknown. Incorporation on the
hospital chart of such data would be of inestima-
ble value in any statistical analysis.
PITUITARY ADRENOCORTICOTROPIC HORMONE
(Continued from Page 797)
we should get it fairly soon, as has been reported.
Furthermore these patients did not have em-
physema or other pulmonary diseases. Perhaps
more prolonged or more intensive treatment is
indicated. At any rate, here are three patients
with severe asthma who did not respond to
ACTH — a rarity, at least at present, in the litera-
ture of this remarkable drug.
Acknowledgment
I wish to thank Dr. Henry Lfirich for the use of the
data on his case, and Dr. Edmund Flink for furnishing
the ACTH.
Bibliography
1. Archer, B. H. : Pituitary adrenocorticotropic hormone.
J.A.M.A., 143:6, (June) 1950.
2. Brown, Ethan Allan: ACTH; Preliminary considerations.
Quart. Rev. Allergy & Appl. Immunol., 4:1, 1950.
Bordley, J. E. ; Carey, R. A.; Harvey, A. M. ; Howard, J.
E. ; Katus, A. A.; Newman, E. V.; and Winkerwerder, W. L. :
Preliminary observations on effect of adrenocorticotropic
hormone (ACTH) in allergic diseases. Bull. John Hopkins
Hosp., 85:396, 1949.
4. Donahue, W. L. : Pituitary adrenocorticotropic hormone
(ACTH) therapy in eosinophilic leukemia. J.A.M.A., 143:2,
(May) 1950.
5. Hoefer, P. F. A., and Glaser, G. H.: Effects of pituitary
adrenocorticotropic hormone (ACTH) therapy. J.A.M.A.,
143:620 (June) 1950.
6. Randolph, T. G., and Rollins, J. P. : Adrenocorticotropic
hormone (ACTH) Its effects in bronchial asthma and rag-
wood hay fever. Ann. Allergy 8:2, 1950.
7. Rose, B.; Pare, J. A. P. ; Pump K. ; and Stanford, R. L. :
Preliminary report on adrenocorticotropic hormone (ACTH)
in asthma. Canad. M.A.J. 62:6, (Jan.) 1950.
8. Selye, H. : Studies concerning anesthetic action of steroid
hormones. J. Pharmacol & Exper. Therap., 73:127-141, 1941.
9. Torda, C. and Wolff, H. G. : Effects of adrenotropic hor-
mone of pituitary gland on ability of tissue to synthesize
acetylcholine. Proc. Soc. Exper. Biol. & Med., 57:137-139,
1944.
10. Torda, C. and Wolff, H. G. : Effects of steroid substance on
synthesis of acetylcholine. Proc. Soc. Exper. Biol. & Med.,
57:327-330, 1944.
585 40th Ave. N. E.
August, 1950
803
History of Medicine In Minnesota
MEDICINE AND ITS PRACTITIONERS IN OLMSTED COUNTY PRIOR TO 1900
NORA H. GUTHREY
Rochester, Minnesota
(Continued from July issue )
Lucy J. Bolt (Mrs. James H.) Easton, “magnetic healer’’ and “clairvoyant
healer,” holder of state exemption certificate No. 179-3 (hied in Olmsted
County on October 23, 1883), was from the early eighteen sixties into the
first decade of the twentieth century a practitioner in Olmsted County, in
and near Rochester. She was a handsome woman, tall, large and blonde,
kindly and sincere, an interesting character. Although conflicting state-
ments are heard as to her merits as a practitioner, there is agreement that
she had a large clientele who believed in her healing powers, and that certain
established physicians of the regular school, although they would not
consult with her, nevertheless on occasion advised patients to go to her,
not for physical healing but “for the psychologic effect.” As a highly
respected person has said, “She really was magnetic and had a sense of
diagnosis and treatment.” One has only to mention her to old residents
to hear anecdotes about her procedures and beliefs as a healer, and about
her eccentricities; for example, she raised innumerable canaries, using the
family living rooms as an aviary.
Lucy J. Bolt was born in New York State and came with her parents,
pioneer farmers, to St. Charles Township, Winona County, in the early fifties.
In 1856 she was the second teacher to preside over the district school of
the township; in the autumn of that year she was married to James H.
Easton, who was by turns innkeeper, farmer and photographer. Mr. Easton
was a native of Massachusetts, it is said, the son of an itinerant herb doctor
and journeyman carpenter, who sometimes was employed as a workman in
the East by Henry Wadsworth Longfellow. The only child of James and
Lucy Easton was James Hamlet Eugene Bolt Easton, born about 1859,
whose magnificent baritone voice gave him place at social, church and public
functions and supported him during his seven years as a law student (non-
graduate) at Harvard University. In that period, the late seventies and early
eighties, he once was a guest at the Longfellow home; the poet was interested,
the story goes, in hearing from a native Minnesotan how “Hiawatha” was
regarded in its locale.
In 1860 Mr. and Mrs. Easton established “the first art gallery” in St.
Charles; in December, 1862, in Rochester, they were erecting a building on
Broadway to house their photographic equipment. In the next decades, with
Lucy Easton always her husband’s assistant as well as a practitioner, they
were in different locations. Sometimes the gallery was their home, and for
many years they lived on their farm, three miles south of town on what is
now Highway No. 63. By the eighties the Eastons had become the owners,
and Hamlet the driver, of blooded horses, which they entered in races over a
804
Minnesota Medicine
HISTORY OF MEDICINE IN MINNESOTA
wide circuit of noted tracks in many states, with varying profit and loss. Of
their horses, Badge, a splendid black pacer, “put Rochester on the map as
far as turfmen’s eyes were concerned.” Others were Lebbius I. (originally
from Eyota and named for Lebbius I. Ingham, a leading citizen of that
village), Hal Crags and Pico. In August, 1896, the American Sportsman, quoted
by the Rochester Post, declared that on every day that Badge was to race, Mrs.
Easton would hold a seance and would telegraph her son the spirits’ dictum,
so that he might govern his pool of tickets accordingly.
From her ealiest arrival in Rochester, it has been recalled, Mrs. Easton
held seances and began her magnetic healing, but it was not until later that
she styled herself a practitioner of medicine and probably not until the eighties,
after she had received her state exemption certificate, that she assumed the
title of “doctor.” In August, 1887, when her controversy with the city
council was being aired in the Rochester Post, she stated, “Although I have prac-
ticed the healing art in this city upwards of seven years, I have never, nor
have friends of my patients had occasion (except in a single instance) to
send for an undertaker where the case has terminated in my hands.” This
was with regard to her alleged opinion on the condition of a young man who
had been injured on July 4 by a gunpowder explosion when a cannon was
fired during a civic celebration. The patient’s mother had rejected the services
of Dr. W. W. Mayo, “would have nobody but Mrs. Easton.” Mrs. Easton,
it was stated, had declared the patient dead and had sent for the undertaker,
and had in due time presented a bill of $20 to the city. The report continued,
“The council would pay for a physician, but would not pay for Mrs. Easton.”
An additional note was that when Mrs. Easton had left the patient’s home,
Dr. E. W. Cross was called, and that the patient was restored to health.
Many of Mrs. Easton’s patients consulted her at the studio or the home, but
often she was called into the city and the countryside. An early resident of
Rochester, Oliver J. Niles, of Grand Rapids, then a boy in his teens, has said
that when the Eastons were living on the farm, he often was sent out by dif-
ferent Rochester citizens, persons of comfortable circumstances and unques-
tioned judgment, to summon Mrs. Easton. In the office she conducted her
treatments unaided; whenever she was called to the home of a patient, her
husband accompanied her, and his knowledge of medicinal herbs that he had
gained from his father was combined with her magnetic powers.
In the last years of the Eastons’ life in Rochester their fortunes declined.
In 1909 the noble racehorse Badge died. Before 1911 the family had removed
to Florida.
Roswell Eaton (1823-1884), a resident of Rochester, Minnesota, from 1867
to 1884, did not practice his profession actively in the city. He was born in
Sardinia, Erie County, New York, in 1823, and in 1841 removed with his par-
ents to Walworth, Wisconsin. At Geneva, Wisconsin, he studied medicine
with a Dr. Palmer, before attending lectures “at the medical college, Chicago,
from which institution he graduated in 1856.” He practiced medicine in
Sharon, Wisconsin, for the next ten years, and in 1867 came to Rochester ac-
companied by his wife, Patience Matteson Eaton, a native of Shaftsbury, Ver-
mont, to whom he was married at Sharon in 1857. There were no children of
the marriage.
In Olmsted County, living on a tract of land at the northern limits of Roch-
ester, Dr. Eaton had his chief interest in farming and dairying. His name ap-
August, 1950
805
HISTORY OF MEDICINE IN MINNESOTA
peared often in the newspapers of the city in connection with the Farmers
Institute, a creamery in Rochester, and so forth. In the great cyclone of
August 21, 1883, his house and barn were demolished and Dr. Eaton, carried
several rods with the debris, was injured severely. On September 14, 1884,
while helping a threshing crew on his place, he died suddenly from heart failure.
In his obituary he was described as having been a Baptist, an upright citizen, a
scholarly and well-informed man. Patience Matteson Eaton survived him
twenty years, dying in early March, 1904, at the age of eighty-three years;
her only surviving relative was her brother, Langford Matteson, a farmer north
of Rochester.
Cyrus Bowers Eby (1872-1934) was the fifteenth appointee, in July, 1893,
as an assistant physician on the staff of the Rochester State Hospital, Olm-
sted County.
It is well known that Dr. Cyrus B. Eby for nearly thirty-three years, from
1901 until his death, was a loved and honored physician of Fillmore County. It
perhaps is not so well known that for nine years, three as a medical student
and six as a physician, he was associated with Olmsted County. In an article,
“Notes on the History of Medicine in Fillmore County Prior to 1900” (Guth-
rey) there appeared a sketch of Dr. John Robert Eby, elder brother of Dr.
Cyrus B. Eby, which included detailed information on the Eby family and tribute to
Dr. C. B. Eby as a physician of Fillmore County after 1900.
The fifth of seven children, Cyrus Bowers Eby was a son of Aaron Eby,
M.D., physician and writer, and Matilda Croft Bowers Eby. He was born in
Sebringville, Perth County, Ontario, Canada, on December 9, 1872, and re-
ceived his early education in the public school at Sebringville. Later he at-
tended Stratford Collegiate Institute, Stratford, Ontario, from which he was
graduated in 1889. Soon afterward he came with his brother John Robert to
Minnesota, where his uncle, Dr. Jacob Eton Bowers (q.v.) a distinguished
alienist, had been established since 1868 (the first superintendent and chief
physician of the state hospital in Rochester from January, 1879, to October,
1889).
During the summer of 1889 and during vacations in subsequent summers,
Cyrus B. Eby was employed as a clerk, as was his brother before him, in the
drug room of the state hospital. In the autumn of 1889 the brothers matric-
ulated in the medical department of the University of Minnesota for a course
of three years, which they completed in 1893. Cyrus B. Eby, an honor student
and a member of medical fraternity Nu Sigma Nu, was then only twenty years
old, so that he was obliged to wait until his majority to obtain his Minnesota
state license to practice medicine.
Dr. Eby came to Rochester on graduation and, it is said, was employed at
the state hospital as an intern until his appointment as an assistant physician
could become effective. His years in Rochester were marked by able pro-
fessional work and study and by the activity in medical societies that con-
tinued all his life. He was in due time a member of the official medical societies
of Olmsted County and of Fillmore County and of the Olmsted-Houston-Fill-
more-Dodge County Medical Society, and of the Southern Minnesota Medical
Association, the state medical association and the American Medical Asso-
ciation.
On July 8, 1896, Cyrus B. Eby was married to Laura Blanche Bamber, of
Rochester. Mrs. Eby was one of the eight children of Dr. Archibald Bamber,
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HISTORY OF MEDICINE IN MINNESOTA
a pioneer dentist of Rochester, and Susan L. House Bamber, who was a native
of Dixon, Illinois, a daughter of John W. House and Mary A. House. The
parents of Archibald Bamber were John Bamber and Lucy Whitney Bamber,
who came to Rochester from Ohio in December, 1854, and pre-empted farm
lands bordering the Zumbro River near the city; John Bamber was the son
of David Bamber, native of Londonderry, Ireland, who came to Herkimer
County, New York, in 1798.
Early in 1898, Dr. Eby took a postgraduate course in the diseases of chil-
dren, at the New York Polyclinic Medical School and Hospital. In February,
1899, he resigned his position at the state hospital and entered private practice
at Hospers, Iowa. Later in 1899 he went into northern Minnesota, where for
a time he was mine physician at Mountain Iron. Early in July, 1901, Dr. and
Mrs. Eby with their young daughter and their infant son settled in Spring
Valley, Fillmore County, Minnesota.
For many years Dr. Eby was a member of the board of health of Spring
Valley and a county physician. During World War I he carried the burden
of practice while other local physicians were in military service, and was
medical examiner for the local draft board. He was a member of fraternal or-
ganizations, among them the Masonic Lodge (A. F. and A. M.), and was an
active worker in the Baptist Church. A talented and enthusiastic gardener,
he beautifully landscaped the grounds of the church as well as the grounds of
his home. His chief happiness was in his family and home, his recreation in
nature study and fishing.
Dr. Eby’s hesitancy to send bills or to ask payment of his fees was common
knowledge. A favorite story in his family was of the almost unique occasion,
in the lean years of the early nineteen thirties, on which he determined to ask
a certain farmer for a payment on bill of long standing. When he called at the
home, the farmer was away, and Dr. Eby therefore explained his errand to the
man’s wife. She said, “Oh, I am sure Tony couldn’t pay you anything now,
because he had trouble 'getting money together to go on this fishing trip.” Dr.
Eby said no more; probably he felt some little sympathy with his fellow en-
thusiast.
Kindly, even-tempered, and selfless in his devotion to his work, an able and
ethical member of his profession, a general practitioner of the highest type,
Dr. Eby held the friendship and esteem of his colleagues as a man and their
respect as a physician. To his patients he was friend and much sought ad-
viser in their personal affairs as well as doctor. He is remembered perhaps
especially for his consideration of the needy sick and for his love of little
children and his skill in caring for them.
Dr. Eby died on January 20, 1934. Although not well, he had answered a
call some ten miles in the country; the road was blocked with drifts, he was
alone in his automobile, and in order to get through had to shovel snow and
to apply tire chains and, when one chain was lost, to wind rope around the
tire. When he arrived at his destination he tried to conceal his exhaustion.
As he sat in a chair drawn up to the patient’s bedside, he remarked that he
had “a little heart trouble,” and fell forward in death. In a memorial tribute
published in Minnesota Medicine it was written of him “Words cannot add to
the nobility of Dr. Eby’s life. Most doctors would envy the way of his life
and its ending.”
Dr. Cyrus Bowers Eby was survived by his wife, Blanche Bamber Eby; a
daughter, Esther E. Eby, member of the faculty of the University of Houston,
August, 1950
807
HISTORY OF MEDICINE IN MINNESOTA
Houston, Texas; a son, Robert A. Eby, of Duluth; two brothers, John Robert
Eby, M.D., of Elko, Nevada, and Frederick Eby, Ph.D., LL.D., of Austin,
Texas; and two sisters, M. Dorothy and Grace D. Eby, both of Trenton, New
Jersey. Mrs. C. B. Eby died on April 20, 1941. Of the relatives named here,
there were living in 1946, at the addresses given, Miss Esther E. Eby, Robert
A. Eby, Frederick Eby, and Miss Grace D. Eby.
Alexander Elder around 1865 relinquished his medical practice in New York
City and came to Rochester, Minnesota, where his brothers James and William
had established a mercantile business. A third brother, John, was a farmer
near by in Cascade Township. Dr. Elder practiced medicine in Rochester
perhaps two or three years before he removed to Eyota to make his home
with his daugher, Mrs. C. Smith Andrews. Later he divided his time between
Minnesota and New Jersey.
A reference to him as a physician is that of Charles Nicholas Ainslie, in
his privately printed memoirs, At the Turn of a Century (1938). Charles
Ainslie never forgot a morning on which the temperature was 20 degrees be-
low zero, when he, a small boy, “was bundled up to walk more than two miles
on a road drifted during the night, to get word to Dr. Elder ... to come and
relieve father,” who had suffered all night. “Father” was the Reverend
George Ainslie, as stated earlier, the first Presbyterian minister in Rochester;
the Ainslie family then lived in a farm home at the foot of Indian Ridge north
of town.
Early in 1875 the Rochester Post carried a notice of the sudden death of Dr.
Alexander Elder, from heart disease, on February 3, at the home of his daugh-
ter at Westfield, New Jersey: “He was a gentleman of superior scholastic
acquirements and sterling character.”
Ziba H. Evans, a graduate of the Medical Department of the University of
Buffalo (New York) in 1872, practiced medicine briefly in Rochester, Minne-
sota, in the summer of 1879; in August, after six weeks, he left for Elk River,
Michigan, to take the position of physician and surgeon for a large rolling mill
in that city. Official medical directories show that he was licensed in Michigan
in 1902 and that from 1906 or earlier, through 1916, he was a practitioner in
Traverse City, Michigan.
L. E. (Leo Ervin Oscar) Evens, a graduate of the St. Louis College of Phy-
sicians and Surgeons early in 1897, came that spring from Alexandria, Min-
nesota, to Rochester. For several weeks in May and June, resident at the
Rochester Hotel, he served as locum tenens for Dr. H. H. Witherstine while
the doctor was in the East at a meeting of the American Medical Association
and on vacation. When Dr. Evens left for Iowa in September, the Olmsted County
Democrat stated that he had been several months “at St. Mary’s” and, as stated,
in charge of Dr. Witherstine’s office. During his stay in Rochester he became
a member of the Southern Minnesota Medical Association, at the sixth annual
meeting, at Winona, on August 5, 1897. Dr. Evens was licensed in Iowa in
1897 and in the next twenty years practiced at different towns in the state,
Osage, Cedar Rapids and Waterloo. Subsequently he was in Chicago and in
Hartford, Connecticut. His death occurred suddenly in California in April,
1934, when he was in his early sixties.
David Sturges Fairchild (1847-1930), a pioneer physician in the village of
High Forest, Olmsted County, from 1869 into 1872, lived most of his distin-
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HISTORY OF MEDICINE IN MINNESOTA
guished professional life in Iowa: in Ames from 1872 to 1893, in Clinton from
1893 to 1930. He was honored in life and has been commemorated since death
for his great contributions to the art and science of medicine and surgery and
to their literature. Dr. Fairchild’s History of Medicine in Iowa (1927) is a
monument to him. Certain of his special articles, inimitable reminiscences,
give a graphic picture of early conditions of practice in southern Minnesota
and particularly in the Olmsted County of the early seventies.
The son of Eh Fairchild and Grace Diamond Sturges Fairchild, David
Sturges Fairchild was born on a Vermont farm near the village of Fairfield
on September 16, 1847. He came of fine lineage and was reared in a fine tra-
dition. He received his earliest schooling near home and in his fifteenth year
began his formal education at Franklin Academy, in a Vermont village near
the Canadian border. Two years at Franklin were followed by a year at Barre
Academy, a year of teaching district school (“The conditions and compensa-
tions of a Vermont district school teacher were less attractive than of a farm
laborer.”), and a period as apprentice to an established physician during which
he read anatomy, physiology and materia medica as set forth by Gray, Dalton
and Wood respectively. In the autumn of 1866 he entered the medical school
of the University of Michigan, which he found crowded by 525 students, many
of them resuming medical study that had been interrupted by military service
during the Civil War. He returned to Ann Arbor in September, 1867, for a
second term but, finding the school temporarily disrupted by a dispute over
homeopathy, he transferred to the Albany (New York) Medical College, from
which he was graduated on December 23, 1868.
Following the advice of his friend, Dr. Burney J. Kendall, who had studied
with a physician in a neighboring community in Vermont and was now
practicing medicine in the village of Marion, Olmsted County, Minnesota, Dr.
Fairchild in April, 1869, came to Olmsted County and by May 1 had settled
in High Forest. Twenty-three years old, very blond, carefully groomed, his
costume made impressive'by a plug hat and a Prince Albert coat, he arrived in
High Forest on horseback. He was courteous, friendly and tolerant, in a
reserved New England way, and was obviously of culture and education
superior to that of most of the local settlers. He was needed and welcomed in
the community but withal he was eyed with some skepticism and was greeted
with greater familiarity than he could at first enjoy; the title “Doc” had no
virtue in his ears. Until then the community either had accepted the uncertain
services of the local incumbents (one qualified but inactive, one a bluff army
surgeon of sketchy training), or sent when in real need for one of the estab-
lished physicians of Rochester, fifteen miles away. The new “doc” had not
an easy role.
Dr. William W. Mayo, of Rochester, proved to be a kind and helpful friend
who initiated the young physician into country practice and on occasion so
maneuvered as to concentrate attention on the boy’s professional ability, in a
generous spirit that Dr. Fairchild never forgot. At the older man’s suggestion
he joined the Olmsted County Medical Society, attending the meetings in
Rochester when roads and practice permitted : “The most important events
so far as my memory goes were the occasional invitations to dinner at Dr.
Mayo’s home, where I saw W. J. and C. H. running about in short pants.”
These brothers in their adult years were among his closest friends to the end
of his life. In June, 1871, at Minneapolis, Dr. Fairchild became a member of
the Minnesota State Medical Society, and he was present at three other meet-
August, 1950
809
HISTORY OF MEDICINE IN MINNESOTA
ings semi-annual and annual, within the next year. From those sessions he
recalled with affection many men whose names are known throughout the
state, from the Twin Cities and from various southern counties; here are
mentioned only men from Olmsted County, Drs. Edwin C. and Elisha W.
Cross, Dr. Hector Galloway, and Dr. W. W. Mayo, all of Rochester.
In those years “there was no science of medicine.” Dr. Fairchild possessed
a few established works, he later said, on the practice of medicine, on materia
rnedica and therapeutics and obstetrics, which he read more or less secretly,
“for it was believed by many people that a doctor must know all about medicine
from experience and natural gifts in understanding of the mysteries of dis-
ease.” Because he felt the need of further knowledge he joined medical so-
cities and subscribed to the best medical journals available.
At High Forest on May 1, 1870, David S. Fairchild was married to Wil-
helmina C. Tattersall of that village, a daughter of Captain William K. Tat-
tersall, one of Olmsted County’s earliest and most notable citizens. William K.
Tattersall (1814-1893), a native of England, when an infant came to New York
State with his parents; in 1856 he traveled to Minnesota and settled in High
Forest and in that year built the Tattersall House, which for decades was to
be a famed hostelry (the building was razed in 1946). He was a Civil War
veteran, civic officer, postmaster, and member of the Minnesota legislature.
In 1872, after a little more than three years, Dr. Fairchild had become well
established in the confidence, liking and respect of the community and of the
profession of county and state. He had his own drugstore and he took part
in civic affairs; in June, 1872, he served as grand juror from the county to the
TTnited States Circuit Court at Saint Paul. But he realized, and his wife con-
curred, that High Forest, past its zenith and without likelihood of gaining a
railroad, held no future for a professional man, and he cast about for a new
location. At this time Dr. Albert Richmond, of Ames, Iowa, a college class-
mate of Dr. Fairchild at Ann Arbor, was returning to his early home in
Rochester, Vermont, and he wrote urging Dr. Fairchild to settle in Ames, to
succeed him in practice. So it was that on July 10, 1872, Dr. and Mrs. Fair-
child with their infant son, David S. Fairchild, Jr., started with a horse and
buggy for Ames. The story of that eventful trip is well told in Dr. Fairchild’s
memoirs. The story of his subsequent life and work is well known and is
recorded in the annals of medicine in Iowa.
When Dr. David S. Fairchild died in Clinton, Iowa, on March 22, 19,30, from
thrombosis, he was survived by his wife, Wilhelmina Tattersall Fairchild, by
their son Dr. David S. Fairchild, Jr., of New York City, and two daughters,
Margaret Fairchild Reynolds, wife of Dr. H. R. Reynolds, of Battle Creek,
Michigan, and Gertrude Fairchild Brown, wife of A. W. Brown, of Davenport,
Iowa, and Tucson, Arizona. Mrs. Fairchild died in Clinton on April 23, 1943,
at the age of ninety-two years. Earlier, on November 18, 1940, Dr. D. S. Fair-
child, (r., died in an automobile accident, at the age of sixty-nine years. A
colonel in the United States Army Medical Reserve Corps, he had been recalled
to service and was on his way to Washington, D. C., when the accident hap-
pened; his service during World War I, as chief surgeon to the famed Rain-
boy Division, is a matter of record. In 1945 David S. Fairchild, III, son of
Colonel Fairchild, was with the United States Army in Germany; Mrs. Rey-
nolds and Mrs. Brown were in their former places of residence. A grandson
of Mr. and Mrs. Brown is David Fairchild IV Salter.
(To be continued in the September issue.)
810
Minnesota Medicine
President s better
POSTPONED HEALTH PROBLEMS
Postponement of health needs is one of the most dangerous and deeply rooted
problems confronting the medical profession today.
Patients defer a visit to the family doctor because they’re “sure to feel better
tomorrow” ; and the price they pay, in suffering and extended convalescences, does-
n’t seem to change this practice of procrastination.
The same habit, with one variation, applies to the children of these “wait-and-see”
patients. The exception is that medical supervision of infants has become an ac-
customed rule — Minnesota’s outstanding record of maternal and infant health
bears out this truth here — but after the child is old enough to walk, he apparently
is considered safely on his way to maturity. The regular health check-up is for-
gotten ; the youngster is given medical attention only when he is clearly and un-
mistakably ill.
The lapse in medical supervision between the ages of two and five or two and
six is still a critical problem ; but its consequences have been mitigated by the
annual summer round-up. Through this school health program, the diagnostic
tools of medical science operate with speed and assurance to help junior citizens
reach and enjoy healthy maturity.
Useful by-products of the round-up include the children’s recognition of the
necessity for good nutrition, adequate rest and clothing, cleanliness and regular
check-ups. They gain valuable knowledge of body mechanism and, often most
important of all, they learn to accept the physician as a friend, someone whose
help is to be welcomed, not feared.
If the school health program is beginning now in your community, it deserves
your co-operation. If your locality hasn’t developed a round-up plan for health
examinations, why not help to organize one ?
President, Minnesota State Medical Association
gust, 1950
811
♦ Editorial ♦
Carl B. Drake, M.D., Editor ; George Earl, M.D., Henry L. Ulrich, M.D., Associate Editors
REGULATION OF DRUGS AND MATERIALS
USED IN THE HOME
~\X T E NOTE that our Senator Humphrey has
submitted a bill to the Senate (S 3852)
permitting oral authorization for the dispensing
and refilling of certain prescriptions, providing a
written prescription is supplied later. At pres-
ent, it is illegal for a druggist to fill a first pre-
scription for a narcotic or barbiturate without
having the written prescription in his hands.
What is also irritating to the physician and, doubt-
less, more so to the druggist is that while a pre-
scription containing a barbiturate can be refilled
by the druggist upon verbal authority from the
physician over the telephone, this is not allowed
for refills containing a narcotic. A written pre-
scription must be in the hands of the druggist be-
fore he can dispense an original or a refill of a
narcotic prescription.
As a result of such a stringent regulation, which
is so often impractical to observe, the law is bro-
ken right and left. Imagine a dentist called by
telephone after office hours for relief of a tooth-
ache. In order to provide a remedy containing a
narcotic, some arrangement has to be made to
transport a written prescription from the dentist
to the druggist before the druggist is allowed le-
gally to dispense the drug. A physician is called
upon during the day or, as so often happens, in
the evening to supply a cough syrup which, in his
opinion, should contain more than the maximum
grain to the ounce allowed without the narcotic
prescription. The mechanism of supplying the
druggist with a written prescription before the
patient obtains the remedy, as provided by regula-
tion, is most cumbersome and irritating to every-
one concerned.
Admittedly stringent regulations of habit-form-
ing drugs, such as the opiates and barbiturates,
are necessary. Their use, particularly the use of
the barbiturates with suicidal intent, has become
so common as to constitute a problem. Perhaps
one-seventh to one-fifth of suicides are due to
barbiturates. These are not the only drugs, how-
ever, which may be lethal when taken in over-
dosage. A drug dispensed by written prescrip-
tion is just as lethal as one authorized by telephone
pending the mailing of the prescription. Because
a druggist has been occasionally duped by a drug
addict impersonating a physician over the tele-
phone scarcely justifies this stringent regulation,
the full observance of which seems unreasonable
to expect. Although we agree, one hundred per
cent, that regulation of drug traffic is necessary,
laws however strict cannot wholly prevent the
intentional overdosage of certain drugs with sui-
cidal intent.
When it comes to accidental poisoning, particu-
larly of young children who help themselves to'
pills and solutions found within and without the
medicine cabinet, the list is long. It is surpris-
ing to note that not so many years ago strychnine
poisoning constituted about half of the fatal poi-
sonings in children under five.* The Aloin
Strychnine and Belladonna pill and the Hinkle
pill were largely to blame. The 1946 National
Formulary has eliminated the strychnine from the
Hinkle pill but has doubled the strychnine (from
1/120 to 1/60 grain) in the A.S. and B. pill. The
ingestion of ten to fifteen of these by a small
child might well prove fatal.
The physicians, called upon to advise the par-
ents when a child has ingested one of the many
household materials which may or may not be
poisonous, is frequently in a quandry whether
there is need for treatment or not. As suggested
by Gold,* something should be done to insure
that the label on the container contains the name
and amount of chemical present in the prepara-
tion. A lot of unnecessary treatment might then
be obviated. Here is an opportunity for some
constructive legislation.
We mention the obvious conclusion that un-
used and poisonous drugs be discarded or at least,
be kept in a place inaccessible to children.
’Conference on Therapy, Household poisoning. Am. J. Med.,.
6:237, 1949.
812
Minnesota Medicine
EDITORIAL
ADVERTISING PROGRAM
A T A combined meeting of the Board of Trus-
tees and the Campaign Co-ordinating Com-
mittee of the AMA held on May 28, 1950, it
was decided to undertake a nationwide advertising
program in October. Emphasis is to be made on
the importance of voluntary health insurance —
not of any special type but the kind that fits the
individual case — in contradistinction to compul-
sory state-provided and tax-supported medical
care. It was at first thought impractical to use the
usual media of advertising, such as newspapers,
magazines and radio but this is exactly what will
be used this fall in a concentrated educational
drive. The total advertising budget of $1,110,000
will be allocated, $560,000 to some 11,000 daily
and weekly newspapers throughout the country,
$300,000 to radio, and $250,000 to about thirty
national magazines. The medical profession may
have been slow in taking up the challenge to their
very existence as a private enterprise but if the
wave of socialism which has spread over the
country is stemmed and private industry saved,
the medical profession will deserve much credit.
The medical profession would welcome a show-
down vote in Congress on the proposal to nation-
alize the profession in order to clear the atmo-
sphere and settle the question whether the people
of this country wish this change. Until such time
as the issue is settled, our efforts which so far
have been successful beyond expectation will have
to be continued to assure the existence of medical
care as a private enterprise.
The AMA requires the support of every phy-
sician in the country. Have you done your part
financially by sending your check, made payable
to the AMA for $25.00, to the Minnesota State
Medical Association office at 496 Lowry Medical
Arts Building, Saint Paul? Last year the per-
centage of our state members who paid the vol-
untary assessment of $25.00 for this same pur-
pose was nothing to be proud of.
This advertising program is entirely education-
al in nature, though it will be called by other
names by our opponents. Financial support to
the extent of $25.00 is the least each member can
do in defense of his practice. Just as important
is the personal education he carries out on his
patients and friends in his everyday contacts.
Since the above was written, our attention has
been called to the address* of our national presi-
dent, Dr. Ernest E. Irons, before the AMA House
of Delegates at San Francisco on June 26, 1950.
The address deals with the modern trend towards
a nationalistic government and should be read by
every member.
SHOE-FITTNG FLUOROSCOPES
"VT7E ARE ADDING our voice to those raised
y y elsewheref in issuing a warning of the
possible danger from the indiscriminate use of
the fluoroscope for fitting shoes. All such ap-
paratuses are not of equal strength, are not built
with the x-ray tube at the same distance from the
foot, and are not regulated for the same period
of exposure.
It is perhaps not generally appreciated that re-
peated exposures from such innocent machines
can affect the growth of bones in the feet of chil-
dren, especially by their action on the epiphyses
of the bones of the feet, to stunt their growth
without showing evidence of affecting the skin —
in other words, from less than an erythema dose.
Repeated exposures may cause skin lesions at a
later date without evidence of deleterious effect
while the exposures are being received.
Most machines provide sufficient protection to
the shoe clerk. The chief danger lies in the re-
peated exposure of the foot and particularly that
of a child. They are not playthings for children
or adults and should be kept under lock and key
and be used only under the direction of an at-
tendant who knows the possible dangers from
overexposure to the x-rays.
Although no reports have appeared of untoward
or severe injury having been caused by these shoe-
fitting x-ray machines during the past two decades
during which they have been used, warnings were
issued some ten years ago by the New York
Roentgen Society, in the Monthly News Letter
of the American College of Radiology in Febru-
ary, 1948, and again in March, 1950, also in an
editorial sponsored by the College in the / ournal
of the American Medical Association of April 9,
1949.
*J.A.M.A. 143:977-979 (July 15) 1950.
f Hem'plemann, L. H. : Potential dangers in the uncontrolled
use of shoe-fitting fluoroscopes. New England T. Med.,
241:335, (Sept. 1) 1949.
Williams, Charles R. : Radiation exposures from the use of shoe-
fitting fluoroscopes. New England T. Med., 241:333, (Sept. 1)
1949.
August, 1950
813
EDITORIAL
As a result, regulations have been made regard-
ing the use of these machines in certain cities.
The New York City Health Department has
specified that the maximum permissible dose per
exposure shall not exceed two roentgens as far as
the machine is concerned, and that not more than
three exposures in one day or twelve in one year
shall be allowed. An easily readable sign to this
effect is required to be posted on the machine.
The New York City Sanitary Code makes further
specifications for the protection of the operators
and attendants.
AMA MEETING
Q OME 10,119 physicians registered at the an-
^ ual meeting of the American Medical As-
sociation in San Francisco, June 26-30, 1950.
Of this number, 5,517 were from California, 455
from Illinois, 311 from New York, and 154 from
Minnesota. The attendance compares favorably
with the second largest registration of 13,221 at
Atlantic City last year and the largest registration
in history, that at Atlantic City in 1947, the Cen-
tennial meeting of the Association, when 15,667
physicians registered.
Continuation of the National Education Cam-
paign during 1951 with the firm of Whittaker and
Baxter as directors was approved. In 1951, a
subscription to The AMA Journal will be in-
cluded in the dues of $25.00.
The following officers were elected by the
House of Delegates :
John W. Cline, San Francisco, President-Elect
R. B. Robins, Camden, Arkansas, Vice Presi-
dent
George F. Lull, Chicago, Secretary (re-elected)
J. J. Moore, Chicago, Treasurer (re-elected)
F. F. Borzell, Philadelphia, Speaker of the House
of Delegates (re-elected)
James R. Reuling, Bayside, New York, Vice
Speaker (re-elected)
Leonard Larson, Bismarck, N. D., Trustee
Thomas P. Murdock, Meriden, Conn., Trustee.
Doctors like fees no doubt — ought to like them ; yet if
they are brave and well-educated, the entire object of
their lives is not fees. They, on the whole, desire to cure
the sick ; and if they are good doctors, and the choice
were fairly put to them, would rather cure their patient
and lose their fee than kill him and get it. — John
Ruskin.
SUGGESTIONS FOR THE DIAGNOSTIC STUDY OF A
PATIENT WITH AN ABNORMAL X-RAY
SHADOW OF THE CHEST
The mass chest x-ray surveys have increased the
number of patients consulting physicians about chest
diseases. In these survey films, as well as in other chest
films taken routinely, abnormal shadows may be found.
The roentgenologist reports these shadows as he sees
them and he then interprets the findings in the light of
his past experience. It must be emphasized that the
roentgenologist is not able to give either a bacteriological
or histological diagnosis from the x-ray film. He can,,
however, give very accurate diagnosis in many of the
films that he reads. The absolute diagnosis, however,
still remains the responsibility of the clinician. The
following suggestions are .made to aid the physician in
making a diagnosis of chest lesions. It is apparent that
these suggestions are minimal in character and that the
physician may and can add to them.
1. What constitutes the clinical history in a case of
chest disease? The history should be detailed and in the
patient’s own words. In addition leading questions should
bring out in particular —
(a) What diseases are endemic in the patient’s local-
ity?
(b) Has the patient been exposed to tuberculosis and
if so, when, where, and to what extent? Has there been
a family history of tuberculosis and was the patient ex-
posed to the members of his family who suffered from
the disease ?
(c) The occupational history should emphasize the
possible exposure to irritating dusts, vapors, et cetera.
(d) Was it possible for the patient to have been ex-
posed to fungi or has the patient resided in or traveled
through known endemic areas?
(e) What is the racial extraction of the patient? It
is well known that certain races are more prone to
tuberculosis than are other races.
(f) Has the patient ever had a chest x-ray before?
If so, for what purpose, and can it be obtained for com-
parison purposes?
(g) Has the patient ever had a tuberculin test? What
was the result?
(h) Has the patient ever had any previous chest dis-
eases?
2. What constitutes the physical examination?
The physical examination should be made with the
patient completely disrobed and in a well-illuminated
room. It should include the examination of all organs
and systems in the body and every orifice should be ex-
amined.
3. What is the minimum amount of laboratory work
indicated ?
It is suggested that the minimum amount of laboratory
work should be —
(a) Hemoglobin
(b) White blood count
(c) Sedimentation rate
Report of the Committee on Tuberculosis, Minnesota State
Medical Association.
814
Minnesota Medicine
EDITORIAL
(d) Urinalysis
(e) Wassermann test
(f) Agglutination test for undulant fever
Other laboratory procedures should be ordered when
indicated.
4. What is the role of the tuberculin test (Mantoux
test) ?
This is the most valuable test known to determine ex-
istence of an infection by tuberculosis. The test for
accuracy is dependent upon — •
(a) Potent material
(b) Proper intradermal injection
(c) Proper interpretation of the test at the end of 48
to 72 hours.
The test should be read then by the degree of indura-
tion and not by the zone of erythema. For practical
purposes it is not necessary to give the degree of re-
action but rather to report the test as either positive or
negative. Any induration exceeding 5x5 mm. is con-
sidered a positive reaction. The tuberculin material in
Minnesota is supplied free of charge by the 'Minnesota
State Board of Health. The committee would like to
emphasize that every patient consulting the physician for
any purpose whatsoever, should have a routine Mantoux
test. Should the test prove positive, the patient should
have a chest x-ray and this should be repeated once
yearly if no active disease is found on the original film.
Those people who have a negative Mantoux reaction
should be retested not less than once yearly. The com-
mittee also suggests that the patch test not be used. When
indicated, other skin tests may be applied. A positive
Mantoux test does not mean clinical tuberculosis.
5. What is the role of the roentgenologist?
The roentgenologist has an important role in the
screening of chest x-ray films. In making his report he
should not be too positive in his diagnosis but rather
describe the lesions seen and then suggest the possible
diagnosis. When indicated, the roentgenologist should
feel at liberty to suggest other specialized x-ray pro-
cedures to help in making the diagnosis. Wherever pos-
sible, both he and the clinician should determine whether
other chest x-ray films have previously been made on
the patient in question, and if so, an effort should be
made to obtain the films for comparison. It must be
emphasized that serial x-ray films of the chest are often
more valuable than a single film. Follow-up x-ray films
should be made on every patient who has a chest lesion
and/or who has a positive Mantoux test. The maximum
period between films should not exceed one year. X-ray
films should always be required at the time of discharge
of patients from the hospital after apparent recovery
from acute chest diseases. Most important, make use of
the roentgenologist as your consultant.
6. What is the minimal laboratory work indicated to
determine the presence of the tubercle bacillus?
It is necessary to know that the material being sub-
mitted for examination actually has come from the lungs
and that it is not simply saliva or nasal discharge. The
committee suggests that three successive 24 hour sputum
specimens be submitted for smears, culture and/or guinea
pig inoculation. If the attending physician suspects that
other organisms than the tubercle bacillus are causing
the chest lesion, he should so inform the laboratory
personnel. When the patient is not raising sputum,
gastric washes should be done and the material submitted
for both guinea pig and/or cultural investigation. The
gastric washes may be obtained —
(a) As a result of an over-night stay in the local
hospital
(b) In the local tuberculosis sanatorium after the
proper arrangements have been made with the medical
director
(c) In the physician’s office
(d) In the patient’s home with the help and assistance
of the local public health nurse.
It is essential that exact technique be used in obtaining
of the .material. The information concerning the tech-
nique may be obtained either from the local sanatorium
or from the State Flealth laboratories. Exudates, such
as pleural fluid, et cetera should also be submitted for
laboratory investigation. Do not overlook the possibility
of finding malignant cells in sputum, exudates, et cetera.
7. What should be the follow-up care of the tubercu-
losis patient recently discharged from the sanatorium?
The committee suggests that the private physician
consult the sanatorium director for detailed information
concerning the patient’s sanatorium course and what
suggestions the medical director may give for the follow-
up care of the patient. Here again, it is important to
remember that the sanatorium medical director is your
consultant ; make use of him in the management of the
sanatorium’s discharged patient.
8. How shall the patients with indetermined chest
lesions be classified?
If the patient has been thoroughly studied, the com-
mittee feels that the attending physician’s classification
should be accepted for the record. The diagnosis of
tuberculosis remains a presumptive or suspected diag-
nosis until the tubercle bacillus has been demonstrated.
If a positive diagnosis has been made, have you re-
ported the case to the Health Department?
9. What other procedures may be used to diagnose
chest lesions?
There are a great many highly specialized investiga-
tions that assist in making the diagnosis of a chest
lesion. Some of these, such as bronchoscopy, broncho-
grams, kymography, and the like, can only be done in
centers especially equipped for such studies. When
these specialized studies are indicated, the attending
physician should refer his patient to a physician or to an
institution equipped to carry out such investigations.
10. What should be the follow-up procedure in the
patient in whom chest lesions have been found?
The committee recommends that the private physician
make every effort to see that such patients be re-
examined periodically. It is the duty of the private physi-
cian to use every facility at his command to have his
August, 1950
815
EDITORIAL
patients return for chest and x-ray examinations. When-
ever necessary, he should call upon the public health
nurse in his locality or the public health officer to aid him
in the periodic follow-up of the patient with a chest
disease.
BCG VACCINATION
Considerable attention has recently been given to
BCG vaccination in the public press. From this pub-
licity the impression might be gained that this procedure
alone holds promise of real control of tuberculosis.
Since such an impression might postpone indefinitely
the establishment and extension of accepted control
measures, this statement of the status of vaccination in
tuberculosis control programs is issued.
1. Control measures in tuberculosis should be directed
at eradication of the disease as a major cause of death
or disability.
2. The marked improvement in tuberculosis mortality
figures, particularly for the ages under thirty, demon-
strates the effectiveness of the present control program.
3. The low rate in children and the continuing high
rates in adults over fifty emphasize the location of the
problem at the older age levels rather than in children.
Under these circumstances, the efficiency of a method
of tuberculosis control would be measured by its effect
on the mortality fi'om tuberculosis in the older age
group, rather than in children.
4. The addition of a vaccine to the present control
program requires both careful and adequate consid-
eration. Of the vaccines proposed, BCG has been used
most widely and is the one most often discussed.
5. This has been used for more than twenty-five years
and recently many millions of people have been vaccinat-
ed. However, it must be stated that there is no evidence
that meets strict scientific requirements demonstrating
that BCG effects the control of tuberculosis, despite the
very suggestive results of a few studies.
6. Because of the above fact and because there is no
general agreement among investigators anywhere in the
world on such fundamental matters as the preparation
of vaccine, the method of vaccination, what constitutes
a successful vaccination, how resulting immunity may
be measured, how long such immunity lasts, et cetera, the
procedure would seem to be still in the investigational
period.
7. It is therefore recommended that investigation of
vaccination in tuberculosis be continued and increased
under standard and stringently controlled conditions.
This investigation should be designed to determine if
the vaccine is indeed effective and what the limitations
of its use may be. It would seem desirable that in
each country, one agency, preferably the official health
agency, should have control of the investigation.
8. Until this has been determined and until these con-
trolled studies are completed, the use of BCG vaccine
should be limited to such investigative studies.
Report of the Council on the Management anti Treatment of
Diseases of the Chest, American College of Chest Physicians.
816 .
9. At the present time the methods which have been
proved effective in tuberculosis control should be in-
creasingly applied to all segments of the population,
regardless of decreasing mortality figures, so long as
tuberculosis remains an important cause of death. These
measures include mass x-ray case finding, early diagnosis,
rapid institution of treatment, isolation of open cases,
and the restoration of the patient to normal life.
WHO IS HARDEST HIT?
Doctors should be aware of the fact that the families
under their care who earn under $5,000 a year pay most
of the tax bills. Family physicians in many instances
could bring this realization to those in that bracket
whom they attend. Curiously, many people do not
comprehend this simple truth. Why do these families
pay most of the tax bills? Because there are so many
of them. The Federal Reserve reports that 8,250,000
families receive more than $5,000 a year, that 29,250,000
families get less.
But these 29,250,000 families pay most of the taxes
because they consume the most products. For products
pay taxes ! There is a hidden tax on every product
that moves from mine or farm or forest or fishery, or
from factory to wholesaler, from wdiolesaler to retailer,
from retailer to consumer — and transportation taxes
every time the product moves. By sheer force of
numbers, the smaller income group pays most of these
taxes.
The 38 per cent of net income that a corporation is
taxed is paid by consumers who buy the corporation’s
products. Families with incomes of less than $5,000 buy
72 per cent of the nation’s automobiles, wear most of
the clothes sold, use most of the electricity, and eat most
of the food. Every time they buy a new automobile,
the $400 which taxes represent give them less automobile
and more tax burden than they think. They smoke 70
per cent of all tobacco; about 50 per cent of what they
pay for tobacco and gasoline is in taxes.
Families of under $5,000 income bought 64 per cent
of the food in Denver, 69 per cent in Detroit, and 71
per cent in Houston, according to a Labor Depart-
ment study of these typical cities. Of course, they must
have paid about that proportion of corporation taxes
levied on food companies in those cities. What is true
of these products holds true for almost all family con-
sumption. And since taxes can be paid only out of
products, it is the total family spending of these 29,-
250,000 families that pays the bulk of our taxes.
* * *
Many young physicians and their families are in this
income bracket as they start out. Do they realize what
deficit spending is doing to them? Would it not be well
to think about that? Especially in view of coming Con-
gressional and Presidential elections.
* * *
No matter what party achieves power, the principle
holds good that deficit spending and high taxation bear
most heavily on those who can least afford these
luxuries, until finally ruin brings despair to all alike.
Editorial Comment — New York State Journal of Medi-
cine, August 15, 1950.
Minnesota Medicine
Medical Economics
Edited by the Committee on Medical Economics
of the
Minnesota State Medical Association
George Earl, M.D., Chairman
GRADUATES WARNED OF
DEFICIT SPENDING
The Wall Street Journal recently gave gradu-
ates a commencement address on the evils of
deficit spending — a subject all Americans could
study with grave concern. The Journal says:
“No one could blame these young people, then, if
they were to regard Treasury deficits as a normal way
of life. Some folks much older seem to regard red
ink in the budget as nothing to worry about. A few
even contend that through deficits lies the road to pros-
perity. And a handful have argued that a huge Gov-
ernment debt is no cause for concern — after all, ‘we
owe it to ourselves.’ ”
Showing the fallacy of these ideas, the Jour-
nal quoted the campaign speech of Franklin D.
Roosevelt :
“If a nation is living within its income, its credit is
good. If in some crisis it lives beyond its income for
a year or two, it can usually borrow temporarily on rea-
sonable terms. But if, like the spendthrift, it throws
discretion to the winds, is willing to make no sacrifice
at all in spending, extends its taxing up to the limit
of the people’s power to pay, and continues to pile up
deficits, it is on the road to bankruptcy.”
The editorial then described what the giver of
such good advice did about it, revealing that in
every year since Roosevelt’s election, there was a
mounting government deficit. The debt has not
stopped climbing during this present administra-
tion— in fact, it is bigger than ever. The J ournal
has this to say:
“There is in the Administration at Washington no real
will to save — to trim unnecessary expenditures, to fore-
go housing subsidies and farmer subsidies and bigger
welfare programs. Yet the fiscal figures show the
Government can’t afford them.
“There is no will to fiscal sanity at Washington be-
cause the Administration still follows the political advice
of the late Harry Hopkins to tax and spend and elect.
Whenever there is criticism of deficits then there is an
excuse : why, we’re fighting a cold war and we can’t
balance the budget because we must build our defenses
and help Europe in the battle against Communism.
“It’s a good alibi but it’s not the reason. A recent
Senate committee study showed that a large part of the
rise in expenditures the past couple of years has been
due to strictly domestic projects. Farm price support-
ing and home mortgage financing are examples.”
Another President Quoted
Giving sound advice, the Journal remarks that
those college graduates will do well to recall the
history they’ve been studying. They’ll remember
that no nation has ever succeeded in spending its
way into permanent prosperity. “The deficit roads
of past centuries are studded with collapsing na-
tions.” Concluding, the Journal reminds the grad-
uates that it might be a good idea to throw this
quotation of George Washington’s at any candi-
date who thinks deficits are good :
“As a very important source of strength and security,
cherish public credit. One method of preserving it is
to use it as sparingly as possible, avoiding occasions
of expense by cultivating peace, but remembering, also,
that timely disbursements, to prepare for danger, fre-
quently prevent much greater disbursements to repel it ;
avoiding likewise the accumulation of debt, not only by
shunning occasions of expense, but by vigorous exer-
tions, in time of peace, to discharge the debts which
unavoidable wars may have occasioned, not ungenerously
throwing upon posterity the burden which we ourselves
ought to bear.”
Graduates might also note the words of Dwight
D. Eisenhower :
“Since government takes about one-fourth of every
worker’s income, and still can’t make ends meet, he
should have sense enough to insist that the government
do what he himself has to do in the same circumstances
— cut its spending by a like amount, at least.”
POSTERITY STILL BEARS BURDEN
That same burden which concerned President
Washington apparently has not been bothering
those who control present-day government spend-
ing. Placing the burden squarely on the shoul-
August, 1950
817
MEDICAL ECONOMICS
ders of taxpayers, the government still spends lav-
ishly, the federal debt now amounting to about
278 billion dollars.
But, due to hundreds of hidden taxes paid
daily, the average taxpayer has a difficult time
knowing how much he actually pays the govern-
ment in taxes. A recent pamphlet from the
Minnesota Taxpayers Association has brought to
light the enormous amount of hidden taxes paid
on ordinary items :
“But what about the hidden taxes — the taxes that
build up all the way along from raw material to the
finished goods on the shelves of retail stores?
“There are 206 taxes levied during the rnanufacture
and sale of that new Chevrolet and covered in the price
you pay your dealer. Or, if you buy a new suit of
clothes, you’re paying 116 taxes. A new hat for your
wife, 150 taxes. A loaf of bread, 151 taxes. And a
dozen eggs, 100 taxes.
“You’ll probably be surprised to learn that these hid-
den taxes are costing you and your family some $700
this year — at least, that’s the national average. Nine
out of 10 families pay more in hidden taxes than they
do in income tax.”
Illustrating other hidden taxes, the pamphlet
states that the smoker pays 1 1 cents taxes on
every package of cigarets bought. Of this amount,
7 cents is federal, 4 cents is in state taxes. “If
you smoke a pack a day, you’re paying $40 a year
tax. With more than half the selling price going
for taxes, cigarets are among the most ruthless
tax collectors the government has.”
The Taxpayers Association has also discovered
that Americans pay more annually to be governed
than they pay for food. Combined cost of all
government functions last year was 56 billion
dollars. The national food bill came to 53 billion
dollars — convincing enough figures to cause
Americans to take an active interest in the
amounts being spent by the people elected to
represent them in Washington.
AMA PRESIDENT HITS STATE
SOCIALISM ISSUE
Making his initial speech as president of the
American Medical Association, Dr. Elmer L.
Henderson called American medicine only the
first socialization goal of “a comparatively small
group of little men — little men whose lust for
power is far out of proportion to their intellec-
tual capacity, their spiritual understanding, their
economic realism or their political honesty.”
Government Medicine — A Step to Socialism
Dr. Henderson cited these little men for at-
tempting to bring all fields of human endeavor
under government control :
“These men of little faith in the American people
propose to place all our people — doctors and patients
alike — under a shabby, Government-dictated system which
they call ‘Compulsory Health Insurance.’ And this,
factually, is Socialized Medicine, regardless of how hard
they try to disclaim it.
“But it is not just ‘socialized medicine’ which they
seek; that is only their first goal.
“Their real objective is to gain control over all fields
of human endeavor. Their real objective is to strip the
American people of self-determination and self-govern-
ment and make this a Socialist State in the pathetic
pattern of the socially and economically-bankrupt Na-
tions of Europe which we, the American people, are
seeking to rescue from poverty and oppression.”
Dr. Henderson warned doctors throughout the
nation that socialism differs from communism
only in one particular. He said :
“This we must all recognize :
“There is only one essential difference between Social-
ism and Communism. Under State Socialism human
liberty and human dignity die a little more slowly, but
they die just as surely!”
INDUSTRY LEADERS SANCTION
"RIGHTS OF FREE MEN”
Helping to sustain these human liberties and
human dignities, some of the nation’s leading in-
dustrial men, meeting recently in Boston, en-
dorsed the following “rights of free men” so
that the individual American “may face the fu-
ture with confidence” :
“1. The right to personal initiative; to choose freely;
to lead but not to dictate ; to follow but not to be
driven.
“2. The right to opportunity ; to have a chance to
forge ahead by his own efforts; to succeed or fail; and
if he fails to try again.
“3. The right to personal dignity; to be protected
from those impositions of others which they would not
impose on themselves.
“4. The right to participate in affairs of common
concern ; to hear and be heard ; to stand alone or to be
one among equals.
“5. The right to provide for the future ; to save or
to spend; to advance dr hold still; to be judge of his
own welfare.”
(Continued on Page 853)
818
Minnesota Medicine
THE INTERURBAN ACADEMY OF MEDICINE
INVITES YOU TO ATTEND A
CANCER TEACHING CLINIC
Duluth, Minnesota October 18, 1950
Clinic Sponsored by the
Minnesota State Medical Association
Minnesota Division, American Cancer Society
Minnesota Department of Health
Wisconsin State Medical Society
Wisconsin Division, American Cancer Society
Wisconsin State Board of Health
No Registration Fee — Program furnished through funds of the American Cancer So-
ciety and its Minnesota and Wisconsin Divisions.
Afternoon Session — Saint Mary's Hospital, Duluth
P.M.
2 :00 Motion picture — “Breast Cancer — The Problem of Early Diagnosis.”
2:30 “Cytological Diagnosis of Malignancies”
John R. McDonald, M.D., Associate Professor of Pathology, University of Minne-
sota Graduate School, Minneapolis-Rochester, Minnesota.
3 : 10 Recess
3 :20 “Office Diagnosis of Malignancies”
Carl W. Eberbach, M.D., Associate Clinical Professor of Surgery, Marquette Uni-
versity School of Medicine, Milwaukee.
4 :00 “The Problem of Carcinoma of the Lung”
Richard L. Varco, M.D., Associate Professor of Surgery, University of Minnesota
Medical School, Minneapolis.
4:4€ General symposium and question and answer period.
Evening Session — Gitchie Gammi Club, Duluth
P.M.
5 :30 Social hour
6 :30 Dinner
“Radical Surgery in Advanced Cancer of the Female Genital Tract”
Alexander Brunschwig, M.D., Professor of Clinical Surgery, Cornell University
Medical College, New York.
DETACH AND MAIL IN ENVELOPE
RESERVATION BLANK
Detach and Mail Today
to
Minnesota State Medical
Association
496 Lowry Medical Arts Bldg.
St. Paul 2, Minnesota
Arthur H. Wells, M.D., Chairman, Committee on Cancer
496 Lowry Medical Arts Building
St. Paul 2, Minnesota
Dear Dr. W'ells :
Please enter my reservation for the CANCER CLINIC
to be held in DULUTH on Wednesday, October 18.
I will attend: The AFTERNOON SESSION only □
The DINNER MEETING only □
All sessions □
(Check Functions You Will Attend, Please)
SIGNED
(Please print)
ADDRESS
August, 1950
819
Minnesota Academy of Medicine
Meeting of March 8, 1950
The regular monthly meeting of the Minnesota
Academy of Medicine was held at the Town and
Country Club on Wednesday evening, March 8, 1950.
Dinner was served at 7 o’clock, and the meeting was
called to order at 8:10 p.m. by the President, Dr.
William A. Hanson.
There were forty members and two visitors present.
Dr. Hanson announced the election of new members
for the April meeting. Dr. Lepak announced that
recommended changes in the Constitution and By-Laws
of the Academy would go out with the program of the
April meeting, to be voted on at a later date.
Dr. J. K. Anderson introduced Dr. Vernon Waite, of
Honolulu, who gave a short talk. Dr. Burch then pre-
sented Dr. Donald Hastings of the University of Min-
nesota Medical School.
Dr. Ritchie requested that proposals for new mem-
bers be sent in very soon so that they could be con-
sidered by the Executive Committee before the April
meeting.
The scientific program followed.
Dr. Harold Diehl, of the University of Minnesota,
gave a report on his recent trip to Britain, entitled
“Medical Education in Britain,” after which he answered
several questions by the members present.
The meeting was adjourned.
Wallace P. Ritchie, M.D., Secretary
Meeting of April 12, 1950
The regular monthly meeting of the Minnesota
Academy of Medicine was held at the Town and
Country Club on Wednesday evening, April 12, 1950.
Dinner was served at 7 o’clock, and the meeting was
called to order at 8 p.m. by the President, Dr. William
A. Hanson.
There were sixty members and four guests present.
The President announced that Dr. Donald MacKinnon
had been elected to active membership in the Academy
and the secretary was instructed to notify Dr. Mac-
Kinnon of his election.
The President appointed a Memorial Committee to
draw up a Memorial to Dr. James K. Anderson, to be
presented at the May meeting.
Upon ballot, the following were elected as candidates
for membership in the Academy:
Minneapolis Dr. E. T. Evans
Minneapolis Dr. Thomas Lowry
St. Paul Dr. Harold Flanagan
University Dr. Donald Hastings
The scientific program followed.
CURRENT MORTALITY OF TRANSURETHRAL RESECTIONS
DONALD CREEVY, M.D.
Dr. Creevy, of the LTniversity of Minnesota, gave a
paper on the above subject. Lantern slides were shown.
Abstract
Free hemoglobin, formed in the bladder when blood
and water mix during transurethral resection, may be
driven into the open prostatic veins and lead to a
hemoglobinuria (lower nephron) nephrosis which may
be fatal. This is particularly likely to occur if the
kidneys have been damaged previously, or if renal vaso-
spasm is produced during operation by excessive loss
of blood, by prolonged hypotension, or by bacteremia,
which has been shown to occur in 45 per cent of trans-
urethral resections.
Hemoglobinuric nephrosis during transurethral re-
section can be prevented by using an isotonic, non-
hemolytic irrigating fluid such as 4 per cent glucose,
1.1 per cent glycine, or 3 per cent mannitol.
In transurethral resection in one thousand consecutive
cases done with the aid of isotonic solutions, Creevy,
Webb and Smith have had a hospital mortality of 0.6
of 1 per cent.
Despite statements in the literature to the effect that,
with modern use of antibiotics, transfusions, and anes-
thesia, the mortality of open enucleation of the prostate
is now no greater than that of transurethral resection,
the author found, in some 2400 retropubic, perineal, and
suprapubic enucleations reported in the literature be-
tween 1945 and 1950 the average mortality was 5.3 per
cent, or nearly nine times that of the author’s series of
1000 cases, while the mortality of 3500 cases reported up
to 1938 of open enucleation was 6.6 per cent. In con-
trast to this, Thompson has reported over 11,000 trans-
urethral resections with a mortality of 1.5 per cent.
It seems reasonable to conclude that a well-done trans-
urethral resection is a good deal safer than a well-done
enucleation.
Discussion
Dr. Frederic E. B. Foley (St. Paul) : There is one
most important thing for me to say about this excellent
820
Minnesota Medicine
MINNESOTA ACADEMY OF MEDICINE
paper. I have known Dr. Creevy for a long time, he is
honest, he tells the truth and if he tells you he has had
an operative mortality of 0.61 per cent in 1000 cases of
transurethral resection, you can depend on it that is just
what he had.
Dr. Creevy’s accomplishment and low mortality in
these 1000 cases are remarkable.
The whole business of transurethral prostatic re-
section is remarkable. The enterprise began 20 years
ago. At first there was wild enthusiasm. Then there was
disillusionment. Now finally, among the enlightened,
it is recognized as the operation of choice in a large
proportion of cases. What that proportion will be in
different hands does not depend on the “cases” so much
as it depends upon the “doctor,” and his honest ap-
praisal of his own talent and ability as a resectionist.
More should be said — than Dr. Creevy said — about
the effects of modern developments on tire choice of op-
eration for vesical neck obstruction. Mortality has dic-
tated the choice, while morbidity and other undesirable
accompaniments of extensive resections have been over-
looked. Sulfa drugs, antibiotics, multiple transfusions
and other improvements of modern surgery have made
of suprapubic prostatectomy, perineal prostatectomy —
and now retropubic prostatectomy — entirely different
matters from what they were formerly. Through benefit
of these improvements these operations nowadays — if
properly applied and well performed — are just as safe as
transurethral resection, will give a mortality no greater
than Dr. Creevy reports for transurethral resection and
will be accompanied by a hospital stay no longer than
with transurethral resection. Besides that they are devoid
of the morbidity, blood loss and other undesirable effects
that go with “transurethral prostatectomy” in cases of
very large prostates.
Transurethral resection in the hands of the casual re-
sectionist will not give any such mortality as Dr. Creevy
has had. The unfavorable morbidity and other bad effects
will be even worse than the mortality. Transurethral re-
section is a highly specialized procedure and belongs only
in the hands of the specialist. I confidently and sincerely
believe that in other hands all patients with vesical neck
obstruction will be better off with enucleation than with
transurethral resection, even in the cases of small pros-
tate not requiring large tissue removals.
If Dr. Creevy feels that his patients and he are better
off taking out 80 to 100 grams by transurethral resec-
tion than they would be with enculeation it must be a
good conclusion for him and has my approval.
A lot of people don’t have that same conclusion about
themselves. I for one do not. I can make a decent trans-
urethral resection with removal of up to 50 grams of
tissue and feel I have taken advantage of all the merit of
the operation. When I go beyond that extent of tissue
removal, all merit of the operation rapidly diminishes
and with the very large prostates is completely lost.
The choice of operation is an individual matter for the
surgeon and is conditioned by his skill and ability in the
use of the different operations and the results he has had
with them.
There is indeed such a thing as the status of a sur-
geon in the use of any operation. There is no such thing
as the “present status” of any operation in the hands of
thousands of different surgeons.
For me it works out this way : if it is a big gland —
too big for a good resection in my hands — and he is a
husky, good risk patient, I make a suprapubic prosta-
tectomy. That operation is foolproof, always gives a
good result and has no morbidity. If the big prostate is
in a dilapidated old crock not fit for any operation I
make a perineal prostatectomy. There may be some in-
continence with perineal prostatectomy, in my hands,
and other difficulties which affect more my vanity as an
operator than the results obtained. But I know it is
almost impossible to kill a patient by the operation. In
cases of very large prostates in old poor risk patients I
am glad to accept these disadvantages of the perineal
operation rather than the greater morbidity of an ex-
tensive transurethral resection or the greater mortality
of suprapubic prostatectomy.
With suprapubic prostatectomy as we do it now, the
patient is out of bed, voiding normally and with a com-
pletely healed wound on the fourth to eighth day and
usually is ready to leave the hospital by the tenth day.
At the meeting of the Southern Minnesota Medical
Association recently we presented the results in the last
previous 100 consecutive operations for vesical neck ob-
struction. There was one death. The difference between
that and Dr. Creevy's mortality is .39 per cent, which is
insignificant.
All in all, I think the functional result and morbidity
is better with suprapubic prostatectomy than it is with
transurethral resection.
Dr Philip F. Donohue (St. Paul) : I wish to con-
gratulate Dr. Creevy on his fine report. The remarkably
low mortality in his large series is a tribute to the care
in the selection and preparation of patients for operation
and to the skill of the resectionists. Certainly such a
record could scarcely be equaled by the occasional and
unskilled operator. This highly specialized procedure
carries with it the possibility of technical mishaps which
will probably occur more frequently in inexperienced
hands. But, even under the best of care and perform-
ance, some deaths will occur. The great difficulty is in
the proper appraisal of operability. This is particularly
true of cases in the cardiovascular group where it may
be impossible to foresee the sudden collapse that oc-
casionally occurs in the immediate postoperative period.
But the risk must be taken when there is a real need
for surgical relief.
Dr. Creevy (in closing) : I want to thank the dis-
cussants for their kind remarks. Obviously, one could
go on at great length about the details of prostatic
surgery and about the advantages and disadvantages of
the various operations when they are compared to one
another. All I can say about transurethral resection
is that one has to have an earnest desire to do a good
job and to keep eternally at it just as the good golfer
does. When the transurethral operation is well done, it
is perfectly safe to say that it is safer, from the patient’s
point of view, than any of the open operations.
TREATMENT OF FRACTURES WITH THE INTRAMEDULLARY NAIL
WALLACE COLE, M.D.
Dr. Cole, of St. Paul, gave a paper on the above sub-
ject.
Discussion
Dr. Vernon L. Hart (Minneapolis) : Dr. Cole has
considered almost every phase of this fascinating sub-
ject of the intramedullary nail. I first became acquainted
with this method of internal fixation when I was in the
Army at Fitzsimons General Hospital in Denver, dur-
ing 1944. I saw mv first cases of the Kuntchner intra-
medullary nail in German prisoners of war who were
brought to this country. They clean wounds, no serious
complications, and free joint motions. We were im-
pressed at that time because there at Fitzsimons
General Hospital I was in charge of 187 patients who
(Continued on Page 853)
August, 1950
821
MINNESOTA STATE MEDICAL ASSOCIATION
House of Delegates — Summary of Proceedings
Duluth Session — June 11-12, 1950
First Meeting, Sunday, June 11, 1950
The Ballroom, Hotel Duluth
Duluth, Minnesota
The Ninety-seventh Annual Session of the House of
Delegates of the Minnesota State Medical Association
was held in the Ballroom, Hotel Duluth, Duluth, Minne-
sota, beginning at 2 p.m., Dr. C. G. Sheppard, Hutchin-
son, Speaker, presiding.
Dr. Sheppard called the meeting to order. After
approval of the minutes of the 1949 session, Dr.
Sheppard introduced Dr. W. A. Wright, president of
the North Dakota State Medical Association, who
brought greetings from his state.
Dr. Sheppard then called for the report of Dr. O. J.
Campbell, chairman of the Council.
Report of the Council
Dr. Campbell: The first meeting of the Council of
the Minnesota State Medical Association was held on
June 10, 1950, at 2 p.m. in the English Room of the
Hotel Duluth, Duluth, Minnesota, for the transaction )f
routine business. The minutes of the previous meeting
held on March 5, 1950 were approved . . . Your chair-
man will give a fairly detailed report of the Finance
Committee later in the absence of Dr. Kennedy.
. . . the Council approved a resolution authorizing Dr.
R. L. J. Kennedy, chairman, and the Finance Committee
to dispose of the Nicollet Avenue Properties Corpora-
tion Bonds, if, after due consideration and proper
advice, it was found to be advisable.
. . . the following applications for Temporary Affiliate
Membership were approved : Arne D. Rydland, Crooks-
ton and William G. Atmore, Duluth.
. . . the following applications for Affiliate Member-
ship were approved : Brand A. Leopard, Albert Lea ;
Ruth G. Nystrom, Malibu Beach, California, formerly
of Minneapolis; Walter M. Boothby, Rochester; Arthur
H. Sanford, Rochester; Frederick L. Smith, Rochester;
John L. Crenshaw, Rochester ; Della G. Drips,
Rochester; Irving George Wiltrout, Oslo; John S.
Grogan, Wadena; and Rufus O. Johnston, Hibbing.
Applications for Life Memberships were approved :
Frank W. Calhoun, Albert Lea; J. Albert Schultz,
Albert Lea; Arthur E. Benjamin, Minneapolis; Herbert
B. Aitkens, Le Center; Herbert Z. Giffen, Rochester;
Claude L. Haney, Duluth ; Robert P. Pearsall, Virginia ;
and Moses L. Strathern, Gilbert.
Honorary Membership was granted to Myron M.
Weaver, Vancouver, B. C., who is now Dean of the
Medical School at the University of Vancouver, B. C.
The Council recommended that H. W. Leibold, Public
Relations Director of the Minnesota Association of
Chiropodists, be advised that, in any program involving
general physical examinations of Ramsey County school
children in which it is considered advisable to include
the feet, the Minnesota State Medical Association
would welcome the co-operation of the Association of
Chiropodists, provided that such a program were tinder
the supervision or direction of the orthopedic surgeons
and that the entire survey had the approval of the
Ramsey County Medical Society.
In accordance with action by the Council of the Minnesota
State Medical Association in 1944, publication of the proceedings
of the House of Delegates is limited to summary.
The Council voted to accept the reports of the In-
surance Liaison Committee and the Committee on
Medical Service.
The Council voted to recommend to the House of
Delegates that Chapter One, Section Three of the By-
Laws be revised to include the following stipulation in
the second paragraph :
“An active member who is delinquent in the pay-
ment of such dues for one year shall forfeit his active
membership in the Minnesota State Medical Associa-
tion if he fails to pay the delinquent dues within
thirty days after notice of his delinquency has been
mailed (by registered mail, return receipt requested)
by the secretary of his component medical society.”
The Council voted to request that the House of Dele-
gates appoint a committee to study the advisability of
establishing a special Minnesota State Medical Associa-
tion membership classification for interns, to be known
as an Intern or Junior Membership.
The Council voted to recommend the establishment
of a permanent committee on Hospitals and Professional
relations and a committee on Chronic Illness and
Geriatrics.
The Council voted to contribute $100 to the National
Society for Medical Research.
The Council recommended that members of the press
be admitted to general sessions of the House of Dele-
gates, reserving the right to call an Excutive Session.
'Fhe Council voted to recommend to the House of
Delegates that it take cognizance of the honor bestowed
on the medical profession by the selection of Dr. C. G.
Sheppard, Hutchinson as the physician chosen by the
Ladies’ Home Journal for its “How America Lives”
series. Also, it should be noted that Dr. Sheppard
required some persuasion before he agreed to so repre-
sent the profession, and the Council wishes to express
its appreciation to him and to his family for this co-
operation.
Two resolutions were approved by the Council for
recommendation to the House of Delegates :
1. A resolution reaffirming the association’s well-
considered and unhesitating opposition to socialistic
infiltrations in any field of American thought and
endeavor.
2. A resolution sanctioning and supporting the
elimination of waste, duplication and inefficiency in the
federal medical services of our country.
The Council voted to recommend to the House of
Delegates that a resolution be drawn, instructing Minne-
sota delegates to the American Medical Association
convention to support the Ohio State Medical Associa-
tion’s resolution for the establishment of a single
membership classification in the American Medical
Association.
Dr. Campbell then read the report of the Finance
Committee which was approved by the Council. The
report called attention to the fact that during 1949,
there was an increase in net worth of the association of
$4,126.45.
The House of Delegates approved the report of the
Council, including the Financial Committee report, and
Speaker Sheppard called for the report of the Reference
822
Minnesota Medicine
SUMMARY OF PROCEEDINGS
Committees. Dr. Sheppard called first upon Dr. L. E.
Steiner, Albert Lea, Chairman of the Reference Com-
mittee on Medical Education Reports.
Medical Education Reports
Dr. Steiner: The Reference Committee for Medical
Education Reports met in the Norse Room on June 11,
1950. The following Medical Education reports were
considered :
Committee on Cancer — A. H. Wells, M.D., Duluth,
Chairman.
Committee on Conservation of Hearing — L. R. Boies,
M.D., Minneapolis, Chairman.
Committee on First Aid and Red Cross — John S.
Lundy, M.D., Rochester, Chairman.
Heart Committee — F. J. Hirschboeck, M.D., Duluth,
Chairman.
Committee on Hospitals and Medical Education — H.
S. Diehl, M.D., Minneapolis, Chairman.
Committee on Public Health Nursing — Mario Fischer,
M. D., Duluth, Chairman.
Committee on Syphilis and Social Diseases — Paul A.
O’Leary, M.D., Rochester, Chairman.
Committee on Tuberculosis — J. A. Myers, M.D.,
Minneapolis, Chairman.
Committee on Vaccination and Immunization — Robert
N. Barr, M.D., St. Paul, Chairman.
The Committee accepted these reports, together with
the committee recommendations and comments : chang-
ing the term “free blood,” as used in the report of the
Committee on First Aid and Red Cross, to something
more suitable ; further inquiry into the adequacy of the
reasons given by the Committee on Hospitals and
Medical Education for the lengthening of the medical
school year to ten months ; approval of the statement
that there should be some definite proposals given to
doctors on immunization procedures to be followed to
serve as a guide for instructors, nurses, etc. ; discussion
of the problem of caring for old syphilitic cases with
the usual therapy of penicillin, and it was recommended
that the House of Delegates adopt a proposal to have
all practitioners check their positive blood patients with
further examination by spinal fluid test to bring about a
more efficient and complete record of these syphilitic
patients.
The House of Delegates accepted the Report of the
Reference Committee on Medical Education Reports as
a whole with the Committee’s recommendations.
Dr. Sheppard then called for the report of the
Reference Committee on Miscellaneous Scientific
Reports, Dr. R. F. Hedin, Red Wing, Chairman.
Miscellaneous Scientific Reports
Dr. Hedin : The Reference Committee for Mis-
cellaneous Scientific Reports met in the Ballroom on
June 11, 1950 and considered the following reports:
Committee on Anesthesiology — R. C. Adams, M.D.,
Rochester, Chairman.
Committee on Child Health — G. B. Logan, M.D.,
Rochester, Chairman.
Committee on Diabetes — J. R. Meade, M.D., St. Paul,
Chairman.
Committee on Fractures — E. T. Evans, M.D., Minne-
apolis, Chairman.
Committee on General Practice — R. H. Creighton,
M.D., Minneapolis, Chairman.
Historical Committee — Robert Rosenthal, M.D., St.
Paul, Chairman.
Committee on Industrial Health — L. S. Arling, M.D.,
Minneapolis, Chairman.
August, 1950
Committee on Maternal Health — J. J. Swendson,
M.D., St. Paul, Chairman.
Committee on Medical Testimony — E. M. Hammes,
M.D., St. Paul, Chairman.
Committee on Military Affairs — J. H. Tillisch, M.D.,
Rochester, Chairman.
Committee on Nervous and Mental Diseases — W. P.
Gardner, M.D., St. Paul, Chairman.
Committee on Ophthalmology — T. R. Fritsche, M.D.,
New Ulm, Chairman.
Committee on Public Health Education — A. E. Cardie,
M.D., Minneapolis, Chairman.
Committee on Radio — R. M. Burns, M.D., St. Paul,
Chairman.
Speakers’ Bureau — Haddon M. Carryer, M.D.,
Rochester, Chairman.
Editorial Committee — C. B. Drake, M.D., St. Paul,
Chairman.
The Committee approved the above reports, and
recommends the following be added to the report of
the Committee on Ophthalmology :
1. That it be considered unethical for any member of
our association to accept fees or other remunerations in
the form of rebates, refunds, or gratuities.
2. That publicity be given this policy, so that the
public will be informed as to the policy of this associa-
tion.
3. That any savings that may be incurred from the
adoption of this new policy will be in favor of the
patient.
4. That it be suggested that if any county medical
society find a member violating this recommendation, he
shall be subject to disciplinary action for infraction of
the above.
5. That the Committee on Ophthalmology meet with
various optical companies to standardize a policy re-
garding the dispensing of glasses.
The Committee recommends that efforts be continued
along the lines of the Public Health Education Com-
mittee ; that continued use of Speakers’ Bureau, radio,
advertising and literature distribution be encouraged.
The question of cost, particularly the advertising
campaign, is a matter for definite consideration. The
Committee finds that there has been inequitable dis-
tribution of cost, and recommends that this be rectified.
The Committee suggests that the Council consider this
matter in the year ahead.
The Committee recommends that the University of
Minnesota attempt to gear post-graduate education to
that of general practice ; that, in an issue of Minnesota
Medicine, the Committee on Maternal Health publish
a routine satisfactory office procedure for RH testing ;
that the Committee on Medical Testimony continue to
see to it that all medical testimony given in the courts
continue on its present high plane.
The House of Delegates accepted the report with the
exception of the reports of the Committees on General
Practice, Maternal Health, Medical Testimony,
Ophthalmology and Public Health Education, which
were then discussed separately.
A manual on the establishment and operation of the
Department of General Practice in hospitals was added
to the report of the Committee on General Practice and
accepted by the House.
The House accepted the recommendations of the
committee regarding the report of the Committees on
Ophthalmology, Maternal Health, Medical Testimony
and Public Health Education.
Dr. Sheppard then called for Medical Economics
Reports, Dr. H. E. Wilmot, Litchfield, Chairman.
823
SUMMARY OF PROCEEDINGS
Medical Economics Report
Dr. Wilmot : The Reference Committee for the
Medical Economics Reports met in the Hotel Duluth,
June 11, 1950. The committee considered the following
reports :
Editing and Publishing Committee — E. M. Hammes,
M.D., St. Paul, Chairman.
Committee on Interprofessional Relations — W. P.
Gardner, M.D., St. Paul, Chairman.
Medical Advisory Committee — W. H. Hengstler,
M.D., St. Paul, Chairman.
Committee on Medical Economics — George Earl,
M.D., St. Paul, Chairman.
Committee on Medical Ethics — R. D. Mussey, M.D.,
Rochester, Chairman.
Committee on Public Policy — R. F. Erickson, M.D.,
Minneapolis, Chairman.
Committee on University Relations — E. M. Hammes,
M.D., St. Paul, Chairman.
The committee accepted all the reports, with the
following recommendations :
That an independent State Board of licensing
practical nurses be recommended to the state legislature ;
That, when issuing membership cards, the State
association make some mention that the section which
is to be sent to the Medical Advisory Committee in case
of a malpractice suit does not mean that assistance is
automatically forthcoming from the Medical Advisory
Committee ;
That the ads in the educational series be set off more
distinctly in the newspapers.
The House accepted the report as a whole, referring
the question of a state board on licensing practical
nurses back to committee for consideration. Dr.
Sheppard then called for the report of the Reference
Committee on Miscellaneous Medical Economic Reports,
Dr. L. E. Sjostrom, St. Peter, Chairman.
Miscellaneous Medical Economic Reports
Dr. Sjostrom : The Reference Committee for Mis-
cellaneous Medical Economic Reports met in the
Arrowhead Room on June 11, 1950 and considered the
following reports :
Insurance Liaison Committee — A. W. Adson, M.D.,
Rochester, Chairman.
Committee on Medical Service — A. W. Adson, M.D.,
Rochester, Chairman.
Committee on Rural Medical Service — Paul C. Leek,
M.D., Austin, Chairman.
Committee on State Health Relations — C. E. Proshek,
M.D., Minneapolis, Chairman.
Committee on Veterans Medical Service — R. H.
Creighton, M.D., Minneapolis, Chairman.
The Committee accepted all reports.
The report was accepted by the House and the
Speaker called for the report of the Officers and Coun-
cilors, Dr. C. E. Rea, St. Paul, Chairman.
Officers' and Councilors' Reports
Dr. Rea : The Reference Committee for Officers and
Councilors met on June 11, 1950, and the committee
discussed the following reports:
Secretary's and Executive Secretary’s Report, Coun-
cilor Reports from Districts One through Nine.
The committee wishes to commend the Medical Press
Conference. The committee makes the following recom-
mendation : That the designation of practical nurses be
changed and the name “nurses’ aide” be submitted for
the term “practical nurse.”
The House of Delegates accepted the report as a
whole and referred its recommendation concerning
practical nurses to the committee on Interprofessional
Relations. The meeting adjourned at 5 :30 p.m.
Second Meeting, Sunday, June 11, 1950
The Ballroom, Hotel Duluth
Duluth, Minnesota
The meeting of the House of Delegates of the Minne-
sota State Medical Association reconvened in the Ball-
room of Hotel Duluth, Duluth, Minnesota at 8 p.m., Dr.
Charles G. Sheppard, presiding.
The first order of business was a unanimous accept-
ance by the Home of a 1949 recommendation of the
Finance Committee that the $10 assessment, then in
force, be continued for 1950, and, thereafter, dues be
raised to $30 and the Constitution be thus amended.
The next item was a report from John Poor,
substituting for Jarle Leirfallom, on the activities of
the Division of Social Welfare. Mr. Poor reported
that the number of people receiving old age assistance
increased from 9,621 in 1946 to 14,256 in 1949. The
total cost in 1949 was $4,973,000. Mr. Poor also ex-
plained the controversial Medical Estimate Form, the
prior authorization form used by practitioners in
estimating the amount of medical care needed by persons
receiving old age assistance. The problem of the
shortage of beds in rest homes and the shifting of the
burden of caring for older folks, from their children
to the county and state, were discussed by Mr. Poor,
who recommended that doctors should not allow them-
selves to be talked into recommending rest home care
unless the patient actually needs medical treatment. Mr.
Poor stated :
“. . . we are certain that in order to bring about a
satisfactory medical program in public assistance, we,
in public welfare, will require more and more co-
operation from the medical profession. We can only
achieve a successful program through the active partici-
pation of advisory committees made up of medical
practitioners. We hope that our County Welfare or-
ganizations can come to the medical practitioners and
ask for advice and help and they can get your co-
operation in running their program locally. In an effort
to control rising medical cost, we require follow-up
checkups of recipients by the doctors attending these
people. If the doctor indicates that the recipient no
longer needs medical care, our County Welfare Board
staff will be required to move these patients to other
facilities as soon as possible.
“For the staff of the Division of Social Welfare, I
would like to convey our most sincere thanks to the
medical profession of Minnesota for their interest and
co-operation in helping us meet the problems of furnish-
ing medical care to the aged of this state.”
Supplementary remarks were made by Dr. F. F.
Callahan, St. Paul, and Dr. A. W. Adson, Rochester.
Dr. Sheppard next called for a report on Minnesota
Medical Service, which was given by Dr. McKinley.
Dr. McKinley reported that Blue Shield, as of April,
1950, has an enrollment of 322,288. He said that “the
success of the plan could not have been possible with-
824
Minnesota Medicine
SUMMARY OF PROCEEDINGS
out the wholehearted support of the physicians of the
state on the individual level, as well as on the or-
ganization level . . .”
Following this, the Speaker asked for a report of
the Minnesota State Board of Medical Examiners by
Dr. Julian Dubois. Dr. Dubois was not present, and
the report was read by Dr. Magney, Duluth. Dr.
Magney reported that during 1949 the Board licensed
320 doctors ; the largest number ever to be licensed
in a single year being 420 in 1947. The problem
of licensing Displaced Persons to practice medicine
in Minnesota has proved to be one which takes time
and careful consideration. The Board of Medical
Examiners,, said Dr. Magney, wishes to continue to
enlist the aid of members of the medical profession
in this difficult job of processing applicants for the
privilege of practicing medicine in this state.
Dr. Sheppard then called for the report of the Minne-
sota Department of Health, given by Dr. A. J. Chesley.
Dr. Chesley reported that during 1949, Minnesota had
73,000 live births. He said that the incidence of tuber-
culosis is decreasing and that deaths from the disease
are also much lower. Dr. Chesley also stated that the
nursing service is going on well.
Speaker Sheppard asked for Jhe report of the Board
of Basic Science, presented by Dr. Tregilgas who ex-
plained the work of the Board in reviewing applications
for certificates.
Speaker Sheppard adjourned the House at 11 p.m.
until June 12 at 12:15 p.m. for a luncheon, to be
followed by the regular meeting at 1 :30.
Third Meeting, Monday, June 12, 1950
The Ballroom, Hotel Duluth
Duluth, Minnesota
The House of Delegates reconvened at 1 :30 p.m.,
Monday, June 12, 1950.
The first order of business was the final report of
the Council by Dr. Campbell.
The Council voted to withhold approval of the
Kellogg Plan, now proposed for Minnesota hospitals,
until such time as the objectionable features were
eliminated. The Council voted to refer to the Com-
mittee on First Aid and Red Cross a proposal to set
up a separate committee on blood and its uses and the
preparation of a brochure on blood use to be distributed
to association members.
The Council considered a “Guide for Industrial Health
Practice in Minnesota.” Action on the Guide was tabled
until the meeting on Tuesday, June 13, with the Minne-
sota Department of Health. Also, the Council referred
to the Committee on Industrial Health the matter of
investigating ways and means of effecting a waiver to
that portion of the' Workman’s Compensation Law in-
volving liability incurred in connection with employment
of rehabilitated persons, thereby assisting the Depart-
ment of Rehabilitation in the re-employment of such
persons.
The Council accepted the recommendation of the
Committee on State Health Relations that the county
medical societies be urged to ask members of their
August, 1950
societies to run for the office of coroner, as an act of
public service, as this position was often found to be
held by unqualified persons.
Also included in the final report of the Council were
these recommendations : Dr. J. Arnold Bargen of
Rochester re-elected as a Delegate to the American
Medical Association; Dr. R. H. Creighton, to succeed
Dr. J. C. Hultkrans as an Alternate Delegate to the
American Medical Association, taking office in January,
1951 ; Dr. F. J. Elias to succeed Dr. W. A. Coventry as
a Delegate to the American Medical Association ; Dr.
W. L. Burnap re-elected as an Alternate Delegate to
the American Medical Association.
The Council voted to endorse and support the pro-
gram of the Minnesota State Nutrition Council for the
enrichment of flour and breads.
The Council recommended approval of a printed
guide, “Medical and Dental Practices for Schools,”
contingent on approval by the Committee on Child
Health.
The Council recommended that Mr. Rosell contact Dr.
H. M. Carryer to discuss the invitation of the Olmsted-
Houston-Fillmore-Dodge County Medical Society to
hold the 1951 convention in Rochester.
The Council voted fo convey to the State Health
Relations Committee its approval of their recommenda-
tions that consideration be given to suitable licensing
laws for Physical and Occupational Therapists in the
state, and also recommended that the Committee on
State Health Relations contact the Committee on Public
Policy and Mr. Manley Brist, relative to the proper
drafting of this matter for presentation to the legis-
lature.
The Council referred to the Committee on Inter-
professional Relations the recommendation of the
American Pharmaceutical Association that a label “See
your Physician” be placed on all preparations which
carry the legend, “This preparation to be sold only on
prescription.”
The Council recommended that the House of Dele-
gates pass a resolution supporting Senator Cain’s
resolution to investigate the administration of the office
of social security, a resolution opposing Reorganization
Plan No. 27 and H. R. 6000. Dr. Campbell then asked
Dr. Reuben F. Erickson, Chairman of the Committee on
Public Policy, to explain any proposed resolutions. Dr.
Erickson explained that the association was not opposed
to social security, per se, but only to weaknesses in
administration of financial matters, etc. He then read
Senator Cain’s resolution, which suggests the creation
of a Social Security Commission to advise the Congress
and to provide the impartial technical knowledge re-
quired. Dr. Erickson urged members of the House
of Delegates to return to their communities and write
many individual letters to Senators, opposing the
adoption of Reorganization Plan No. 27.
The report of the Council was accepted by the House.
At this time, Dr. Sheppard asked Dr. Elias to intro-
duce two guests. Dr. Elias introduced Mrs. Henry E.
Bakkila, Duluth, President, Woman’s Auxiliary to the
Minnesota State Medical Association, and Mrs. David B.
Allman, Atlantic City, New Jersey, President, Woman’s
Auxiliary to the American Medical Association.
825
SUMMARY OF PROCEEDINGS
Next was the report of the Resolutions Committee,
Dr. Wilson, Chairman.
Resolutions Committee Report
Whereas, the House of Delegates acknowledges and
appreciates the valuable contributions of many groups
and individuals to the success of the ninety-seventh
annual meeting of the Minnesota State Medical
Association,
Now, therefore be it resolved, that specifically the
House of Delegates extends thanks :
To the officers and members of the St. Louis County
Medical Society, the St. Louis County Medical
Auxiliary and the Committee on Local Arrangements
for their constant efforts in arranging many parts of the
program and in imparting the hospitality of the con-
ference city ;
To the management of the Hotel Duluth, Hotel
Spalding, Hotel Holland, Hotel 5th Avenue, Hotel
Lenox, Hotel McKay, Hotel Lincoln, Hotel Cascade,
Hotel Arrowhead and Hotel Hamilton for prompt and
courteous attention and service to convention guests
and delegates ;
To Radio Stations KDAL, WEBC and WREX for
making available their facilities for the schedule of
broadcasts in connection with the meeting ; and
To the Duluth Herald News-Tribune, the Minneapolis
Star, the Minneapolis Tribune, the St. Paul Dispatch,
the St. Paul Pioneer Press, tire Associated Press and
the United Press for their fine advance notices and
excellent coverage of the annual meeting.
* * ^
Whereas, since the federal food and drug adminis-
tration released the anti-histamine drugs, for the pre-
vention and treatment of the common cold and hay
fever, for sale over the drug store counter, without a
physician’s prescription, there has been an enormous and
very promiscuous use of these drugs, and
Whereas, several of the manufacturing drug con-
cerns have recently been cited by the federal govern-
ment for misrepresenting their products, as the drug
supreme in the prevention and treatment of the common
cold and hay fever, and
Whereas, it is known to the medical profession that
the promiscuous use of anti-histamine drugs, has re-
sulted in many untoward reactions, many times serious,
causing personal and industrial accidents ; and in some
instances, deaths have been reported throughout the
United States, due to sensitization of over-dosage of
these drugs, now therefore,
Be it resolved that the House of Delegates of the
Minnesota State Medical Association, in session at the
annual meeting in Duluth, Minnesota, June 12, 1950, go
on record as opposed to further over-the-counter dis-
tribution of these anti-histamine drugs, in order to
protect the general public against the continued
promiscuous use of these drugs, and
Be it further resolved, that we also inform the
federal food and drug administration of this action and
ask them to stop the uncontrolled use of such drugs and
that their use be limited to the written prescription of
the patient’s physician.
* * *
Whereas, the Reference Committee on Medical
Economic Reports has considered the report of the
standing Committee on Interprofessional Relations and
Whereas, in spite of prolonged and diligent efforts
on the part of the Interprofessional Relations Committee
in the years past, no rapprochement with committees
from other interested organizations has yet been reached,
and
Whereas, no relief of the nursing shortage has so far
been obtained, particularly in rural hospitals, and
Whereas, the public is becoming increasingly critical
of the high cost of hospital care and the deteriorating
service due to lack of trained nursing help, and
Whereas, present existing hospitals can and would
train so-called practical nurses if a statewide uniform
minimum curriculum were established, and
Whereas, the term “practical” nurse is generally
unsatisfactory,
Therefore be it resolved that the Minnesota State
Medical Association go on record as recommending
First, the training of an adequate number of practical
nurses, the training period of these nurses not to exceed
two years,
Second, that this group of nurses shall have a special
title to distinguish them from registered nurses,
Third, that the legislature of Minnesota be requested
to create a board separate and distinct from the
present Registered Nurses board, to supervise the
training and licensing of this group of nurses.
Be it further resolved that our committee on Inter-
professional Relations together with the committee on
Public Policy be instructed to further this action by
sponsoring and supporting appropriate legislation at
the next session of the state legislature.
* * *
Whereas, the Honorable Oscar Swenson of Nicollet
County, a member of the Minnesota Legislature for
more than thirty years, has had the misfortune of being
temporarily incapacitated because of illness; and
Whereas, the said Honorable Oscar Swenson has
always been an ardent advocate of the highest standards
in medicine, including sponsorship of the Minnesota
Basic Science Law and reasonable appropriations for
the teaching of medicine and the allied healing arts;
NOW, THEREFORE,
Be it hereby resolved that the Minnesota State
Medical Association, in annual session assembled, does
hereby, through its House of Delegates, express our
sincerest wishes for the early and complete recovery of
the said Honorable Oscar Swenson and assure him of
our appreciation for the many contributions that he
has made, as a statesman, for the well-being of the
people of our state ; and
Be it further resolved that a copy of this resolution
be forwarded to the Honorable Oscar Swenson, as a
small token of the esteem in which we hold him.
The House of Delegates approved all of the
resolutions.
Election of Officers
The next order of business was the election of officers.
The House of Delegates elected the following:
President-Elect — I. F. Norman, M.D., Crookston.
First Vice President — Willard White, M.D., Minne-
apolis.
Second Vice President — A. E. Brown, VI. D.,
Rochester.
Secretary — B. B. Souster, M.D., St. Paul.
Treasurer — W. H. Condit, M.D., Minneapolis.
Speaker, House of Delegates — C. G. Sheppard, M. D.,
Hutchinson.
Vice-Speaker — H. M. Carryer, M.D., Rochester.
Councilor, First District — John Waugh, M.D.,
Rochester.
Councilor, Second District — Roscoe C. Hunt, M.D.,
Fairmont.
Councilor, Ninth District — A. O. Swenson, M.D.,
Duluth.
Meeting Place 1951 Convention
The final order of business was the selection of the
meeting place for the 1951 annual meeting. The House
of Delegates voted to accept the invitation from the
Olmsted - Houston - Fillmore - Dodge County Medical
Society to hold the meeting in Rochester.
At 3 p.m. the Ninety-seventh Annual Meeting of the
House of Delegates of the Minnesota State Medical
Association was adjourned.
826
Minnesota Medicine
Constipation
in the Aged . ..
The commonly encountered constipation of the older age group
may result from reduced activity, lack of appetite for bulk-pro-
ducing foods and inadequate ingestion of fluids.
By providing hydrophilic "smoothage” and gently distending
bulk, Metamucil encourages normal physiologic evacuation with-
out straining or irritation.
METAMUCIL |s the highly refined mucilloid of
Plantago ovata (50%), a seed of the psyllium group, combined
with dextrose (50%) as a dispersing agent. G. D. Searle & Co.,
Chicago 80, Illinois.
RESEARCH IN THE SERVICE OF
MEDICINE
SEARLE
AUGUST, 1950
827
* Reports and Announcements ♦
SYMPOSIUM ON HYPERTENSION
A Symposium on Hypertension will be presented by
the University of Minnesota in honor of Drs. Elexious
T. Bell, Benjamin F. Clausen and George E. Fahr on
September 18, 19 and 20, 1950.
Monday, September 18
Morning
Greetings
Anatomical Considerations of Hypertension
Harry Goldblatt
Experimental Studies on Hypertension
Arthur Groli.man
The Relationship of Renin to Experimental Hypertension
in the Rabbit
G. W. Pickering
The Renin-Angiotonin Pressor System
Irvine H. Page
Afternoon
The Participation of Hepatic and Renal Vasotropic
Principles in Experimental Renal Hypertension
Ephraim Shorr
Blood Volume and Volume of Extracellular Fluid in
Experimental Hypertension
Eduardo Braun-Menendez
The Role of the Adrenal Cortex in the Pathogenesis of
Experimental Hypertension
Hans Selye
The Mechnasim of Hypertension Due to Desoxycorti-
costerone
Eduardo Braun-Menendez
Sympatho-Adrenal Factors in Hypertension
Mark Nickerson
Evening
Experimental Hypertension
Eduardo Braun-Menendez
Tuesday, September 19
Morning
Pathologic Anatomy in Essential Hypertension
Elexious T. Bell
Some Observations on Renal Vascual Disease in Hyper-
tensive Patients Based on Biopsy Material Obtained
at Operation
Reginald H. Smithwick
The Mechanism of Development of Hypertension in
Chromic Genuine Nephrosis
George E. Fahr
Renal Hemodynamics in Essential Hypertension
Herbert Chasis
The Heart in Essential Hypertension
Benjamin J. Clawson
Afternoon
The Adrenal Cortex and Hypertensive Vascular Disease
George A. Perera
The Participation of Hepatic and Renal Vasotropic
Principles in Essential Hypertension in Man
Ephraim Shorr
Pulmonary Hypertension
Richard V. Ebert
Life Situations, Emotions, and Arterial Hypertension
Harold G. Wolff
Vascular Reactivity in Essential Hypertension
E. A. Hines
Evening
The Pathogenesis of Hypertensive Encephalopathy
G. W. Pickering
Wednesday, September 20
Morning
The Natural History of Hypertensive Vascular Disease
George A. Perera
Blood Lipid Transport in Hypertensive Patients and
Its Relationship to Atherosclerotic Complications
John W. Gofman
The Hemodynamic Effects of Various Types of Therapy
in Hypertensive Patients
Robert W. Wilkins
Sympathetic Blockade in the Therapy of Hypertension
Mark Nickerson
The Effect of Sympathectomy upon Mortality and Sur-
vival Rates of Patients with Hypertensive Cardiovas-
cular Disease
Reginald H. Smithwick
Afternoon
The Consideration of Life Situations and Emotions in
the Management of Patients with Hypertension
Harold G. Wolff
Recent Experiences with Pharmacologic Treatment of
Hypertension
Robert W. Wilkins
The Dietary Treatment of Hypertension
Carleton B. Chapman
Pyrogens in the Treatment of Malignant Hypertension
Irvine H. Page
Physicians desiring to attend should address Dr.
George N. Aagaard, 3411 Powell Hall, University of
Minnesota, Minneapolis 14, Minnesota.
TWIN CITY BLOOD BANKS
ARRANGE RECIPROCAL “POOL"
Patients in need of Red Cross blood in either Saint
Paul or Minneapolis can now get it easier and faster
than before because of a new reciprocal blood “pool”
program set up between the Saint Paul Red Cross Re-
gional Blood center and the Minneapolis War Memorial
Blood Bank.
Linder the new arrangement, patients in Minneapolis
or Saint Paul hospitals from counties participating in
the Red Cross program can now receive blood immedi-
ately when needed from the blood bank in the city in
which they are hospitalized. Such patients are under
no obligation to have friends or relatives replace this
blood, because it will be furnished by the blood bank
in which their donor club takes part.
For instance, a patient in a Minneapolis hospital
from a county which participates in the Red Cross blood
program and which has credit for blood in Saint Paul,
can receive blood when needed from the Minneapolis War
Memorial Blood Bank. It will be replaced by the Saint
Paul Regional Blood Center. Likewise, members of
donor clubs in the Minneapolis War Memorial Blood
Bank who may become patients in Saint Paul hospitals
(Continued on Page S30)
828
Minnesota Medicine
NOW BEGINNING—
The September class for the School of Neuro-
psychiatric Nursing. Prospective candidates
should apply and register immediately.
One year course — tuition free
GLENWOOD HILLS HOSPITALS
'7t&UA rfvaiCa&te . . . .
Complete, modern facilities of the Glenwood Hills Hospitals; co-ordin-
ated to give an accurate diagnosis and proper treatment to the neuro-
psychiatric patient.
These unique facilities include:
• The outstanding staff of neurologists and psychi-
atrists in the United States
• The new Electroencephalograph
• The new Electrocardiograph
• An ultra-modern laboratory
• A completely equipped x-ray room
• Occupational therapy and Hydrotherapy
• A new physical education department
• Nurses specially trained in our own neuropsy-
chiatric training school
3901 GOLDEN VALLEY ROAD MINNEAPOLIS 22, MINN.
Offering a High Standard of Facilities for 25 Years
August, 1950
820
REPORTS AND ANNOUNCEMENTS
TWIN CITY BLOOD BANKS ARRANGE
RECIPROCAL "POOL''
(Continued from Page 828)
can receive blood there from the Saint Paul Red Cross
Regional Blood Center. The blood will be replaced from
the particular donor club’s credit at the Minneapolis War
Memorial Blood Bank.
The new program, set up through the efforts of Dr.
E. V. Goltz, Medical Director of the Saint Paul Red
Cross Regional Blood Center and G. Albin Matson, Di-
rector of the Minneapolis War Memorial Blood Bank,
was developed because of various complications in the
previous system.
With the new system, the patient from a Red Cross
participating county, hospitalized in either city, receives
the same benefits as are received by patients who are
members of donor clubs in the Twin Cities.
INTERNATIONAL COLLEGE OF SURGEONS
The fifteenth annual assembly of the United States
Chapter of the International College of Surgeons will
be held in Cleveland, Ohio, October 31 to November 3,
with headquarters at the Cleveland Hotel.
Surgical clinics will be held in several Cleveland hos-
pitals on Monday, October 30. All scientific sessions
will be held at the Cleveland Public Auditorium 9:00
a. m. to 5 :00 p.m., Tuesday through Friday. A most
excellent program has been arranged at which dme
some of the most prominent surgeons of America, and
some foreign speakers, will discuss the current con-
temporary surgical scene.
Through the courtesy of Smith, Kline and French
Laboratories, a fine colored television program of sur-
gical procedures, originating from the St. Vincent’s
Charity Hospital, Cleveland, will be shown daily in the
auditorium from 9 :0C) a.m., to 1 :00 p.m. Motion pic-
tures will also be presented each day depicting many
of the recent advances in surgery and surgical tech-
nique.
One of the highlights of the meeting will be the an-
nual banquet at the Statler Hotel on Thursday evening
when America’s great surgeon, Dr. Frank Lahey of Bos-
ton, will talk on “Some of the Recent Advances in Sur-
gery." Dr. Elmer Henderson, President of the Ameri-
can Medical Association, will deliver an address . on
“The Importance of International Co-operation in Sur-
gery.”
Reservations may be secured by writing to the Com-
mittee on Hotels, International College of Surgeons, 511
Terminal Tower, Cleveland 13, Ohio. Preliminary pro-
grams may be obtained from the central office, 1516 Lake
Shore Drive, Chicago 10.
AMERICAN ROENTGEN RAY SOCIETY
The American Roentgen Ray Society will hold its
fiftieth anniversary meeting in St. Louis, September
26-29.
The scientific sessions and the scientific and commer-
cial exhibits will be held in the Hotel Jefferson in St.
Louis.
I his year’s Caldwell Lecture will be delivered on
September 27 by Dr. Henry L. Bockus, professor and
chairman of the Department of Internal Medicine in
the Graduate School of Medicine, University of Penn-
sylvania, Philadelphia. His subject will be “The Role of
Roentgenology in Gastroenterology.”
The convention program is being arranged by a com-
mittee headed by President-elect B. P. Widmann, M.D.,
of Philadelphia.
The society president is Dr. U. V. Portmann, of
Cleveland.
NEW FILM ON CANCER
“Self-Examination of the Breast” is the name of a
new sound, color, 16 mm. film that has been produced
by the Cancer Institute and the American Cancer So-
ciety.
This film demonstrates how women can and should
systematically examine their breasts to detect changes
that may be due to early cancer. Change of contour,
size dimpling, and lumps are stressed, with advice to
make examinations of the breasts periodically and go to
the doctor at once if anything unusual is detected. This
film will be shown widely to groups of women through-
out Minnesota.
“All practicing physicians should see this film so that
they will be familiar with the instructions in self-exami-
nation their patients are attempting to carry out and
have an understanding attitude towards the many wom-
en who will come to their office because they think they
have discovered something wrong,” says Dr. A. H.
W ells, president of the Minnesota Division, American
Cancer Society.
The Minnesota Division of the American Cancer So-
ciety and the Minnesota Department of Health have
prints of the film, and arrangements can be made to
show it at county medical society meetings or hospital
staff meetings.
RESEARCH IN ARTHRITIS
The Arthritis and Rheumatism Foundation is offering
fellowships for research in the basic sciences related to
the study of arthritis. These fellowships carry a stipend
of from $4,000 to $6,000, depending upon the needs and
ability of the worker, and run for a period of one year.
The fellowships would begin in July, 1951, although
earlier appointments would be considered by the commit-
tee.
The Foundation is eager to back a candidate, rather
than a project, an institution, or a hospital. It hopes to
arouse interest in arthritis in a wider circle of medical
investigators and to encourage able, inquiring minds.
Applications should be sent to the Arthritis and Rheu-
matism Foundation, 535 Fifth Avenue, New York 17,
New York, by January 1, 1951. Notification of the fel-
lowships granted will be made March 1, 1951.
If any applications are received by September 15, 1950,
they will be acted on at that time and notification made
immediately.
830
Minnesota Medicine
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August, 1950
831
REPORTS AND ANNOUNCEMENTS
CRIPPLED CHILDREN SERVICES
The 1950 Fall Clinic Schedule of the Division of
Social Welfare, Medical Services Unit, Crippled Chil-
dren Services, is as follows:
Place
Date
Building
Counties
Winona
September 9
Central School
Winona
W abash a
Olmsted
Fillmore
Houston
Marshall
September 16
High School
Lyon
Lincoln
Redwood
Yelow
Medicine
Lac qui Parle
Fergus Falls
September 23
High School
Otter Tail
Wilkin
Bemidji
September 30
High School
Beltrami
Clearwater
Hubbard
Virginia
October 7
Technical
High
St. Louis
Crookston
October 14
High School
Polk
Mahnomen
Norman
Little Falls
October 21
High School
Morrison
Todd
Mille Lacs
Willmar
October 28
Auditorium
Kandiyohi
Swift
Chippewa
Renville
Meeker
McLeod
Mankato
November 4
Franklin
School
Blue Earth
S i bl< y
Nicollet
LeSueur
Watonwan
Brown
Waseca
Martin
Faribault
Anoka
November 1 1
Lincoln
School
Anoka
Isanti
Chisago
W ash'ngton
Hennepin
Ramsey
MINNESOTA SOCIETY OF CLINICAL PATHOLOGISTS
I he annuual session of the Minnesota Society of
Clinical Pathologists was held in Duluth, June 12,
1950, during the annual meeting of the Minnesota State
Medical Association. It was featured by the Society’s
annual A. H. Sanford Lecture before a general session
of the association by Ancel Keys, Ph.D., on the subject
of “Diet and Cardiovascular Disease,” and by an all-day
tumor seminar under the direction of Dr. Robert Hebbel
of the University of Minnesota, and his associates, Drs.
John McDonald and Malcolm Dockerty of the Mayo
Clinic. The seminar was made possible by a grant of
$300.00 contril luted by the Minnesota Division of the
American Cancer Society, and attended by thirty mem-
bers who expressed enthusiastic approval of the man-
ner in which it was conducted, and of the material
presented. rl he Society voted to make the seminar an
annual feature event. The fall meeting is scheduled in
Minneapolis. The officers elected for the ensuing year
are: President, John F. Noble; Vice president, James
McCartney; Secretary-Treasurer, Kano Ikeda; Council-
lors, John McDonald, William Knoll, and Nathaniel
Lufkin.
COURSE IN POSTGRADUATE GASTROENTEROLOGY
The National Gastroenterological Association is again
offering a course in postgraduate gastroenterology on
October 12, 13, and 14, at the Elotel Statler in New
York City, immediately following the fifteenth annual
convention, to be held at the same place on October 9,
10 and 11.
The course will be under the personal direction of Dr.
Owen El. Wangensteen, of the University of Minnesota
Medical School, who will be the surgical co-ordinator,
and Dr. I. Snapper, of Mt. Sinai Elospital and the Col-
lege of Physicians and Surgeons, Columbia University,
who will be the medical co-ordinator. They will be as-
sisted by a distinguished faculty.
The course is open to members and non-members of
the Association who have had adequate preliminary train-
ing. However, preference in registration will be given to
members of the Association. The course will not be
available under the provisions of the GI Bill of Rights
because of the many difficulties in obtaining certificates
of eligibility and other necessary Veterans Administra-
tion forms.
The fee is $25 for the three days for those affiliated
with the National Gastroenterological Association, and
$35 for non-members. Registration blanks may be ob-
tained from Mr. Daniel Weiss, 1819 Broadway, New
York 23, N. Y.
POSTGRADUATE SEMINARS
The University of Minnesota School of Medicine in
conjunction with the Minnesota State Medical Associa-
tion and the Minnesota Department of Health will hold
six professional medical postgraduate seminars through-
out Minnesota during 1950-1951.
The areas, together with approximate attendance dates,
are these:
1950
Crookston — September 13 to November 1
Virginia — September 21 to November 9
1951
Moorhead — January 3 to February 21
Willmar — January 11 to March 1
Worthington — March 6 to April 24
Albert Lea — March 14 to May 2
The seven courses held throughout the state in 1949-50
were extremely well received and professional attendance
and interest was excellent.
Heart disease, cancer control, and mental health will
be the subjects of this year’s programs. Latest informa-
tion on the diagnosis, treatment, and management of
diseases in these three fields will be presented by leading
medical lecturers from the University of Minnesota
School of Medicine. Professional films and literature
will in some instances be used to augment the speakers.
(Continued on Page 834)
832
Minnesota Medicine
HAZELDEN FOUNDATION
HAVEN WHERE
ALCOHOLICS
ACHIEVE
INSPIRATION FOR
RECOVERY
200 acres on the shores
of beautiful Lake Chisa-
go where gracious living,
homelike atmosphere and
understanding compan-
ionship contribute to suc-
cessful rehabilitation.
A HOMELIKE
The constructive thinking of a group of Twin Cities men seeking a new approach to the
problem of alcoholism resulted in the organization of the Hazelden Foundation. Some of
the founders are themselves men who have recovered from alcoholism through the proved
program of Alcoholics Anonymous. Their true understanding of the problem has resulted
in the treatment procedures used at the Hazelden Foundation.
BOARD
OF TRUSTEES
Mr. T. D. Maier,
i Vice President,
First Natl. Bank
St. Paul, Minn.
Mr. Robert M. McGarvey,
President and Treasurer
McGarvey Coffee Co.
Minneapolis 1, Minn.
Mr. A. G. Stasel,
Supt., Eitel Hospital,
Minneapolis 3, Minn.
Dr. Gordon R. Kamman
1044 Lowry Med. Arts
Bldg., St. Paul 2, Minn.
Mr. L. M. Butler,
Owner Star Prairie
Trout Farm
St. Paul, Minn.
Mr. John J. Kerwin,
Manager, Mid-Continent
Petroleum Corp.,
St. Paul 4, Minn.
Mr. Bernard H. Ridder,
Pres., N.W. Pub., Inc.,
Dispatch Building,
St. Paul 1, Minn.
M. R. C.. Lilly 1
Chairman of the Board,
First National Bank,
St. Paul 1, Minn.
Direct inquiries and request for illustrated brochure
to
Mr.
A. A. Heckman,
Mr. L. B. Carroll,
Gen.
Sec., Family Serv.,
V. Pres. & Genl. Mgr.
Wilder Building,
Hazelden Foundation,
St. Paul 2, Minn.
Center City, Minn.
It should be understood that Hazelden Foundation is not officially sponsored by Alcoholics Anonymous
just as Alcoholics Anonymous sponsors no other organization regardless of merit.
The Hazelden Foundation is a nonprofit organization. All inquiries are kept confidential.
HAZELDEN FOUNDATION
Lake Chisago, Center City, Minn. Telephone 83
August, 1950
833
REPORTS AND ANNOUNCEMENTS
POSTGRADUATE SEMINARS
(Continued from Page 832)
Each seminar, as last year, will consist of eight con-
secutive weekly meetings, with each session about two
hours long. Ordinarily two speakers, each on a different
subject matter, will appear.
There is no charge for this series of lectures unless
local physicians voluntarily assess themselves $2.00 each
to obtain a certificate of attendance.
County medical societies are actively cooperating in
the organization and conduct of these significant medical
education events.
Coincident with these medical seminars, dentists and
nurses of the area will hold eight sessions of their own,
patterned generally after the physicians’ courses, with
subject matter tailored to their specific interests. The
University of Minnesota Schools of Dentistry and Nurs-
ing, the Minnesota State Dental Association, the Min-
nesota State Nurses’ Association, and local dental and
nursing groups sponsor the seminars.
Other co-sponsors of the seminars are : The Min-
nesota Division of the American Cancer Society, the
Minnesota Heart Association, and the Minnesota Mental
Hygiene Society.
CONTINUATION COURSE
Female and male infertility will be the subject of the
continuation course to be presented by the University of
Minnesota on September 28-30. The course, intended for
physicians specializing in obstetrics and gynecology, will
be presented at the Center for Continuation Study. Dis-
tinguished visiting physicians who will participate as
faculty members will include Dr. Warren O. Nelson,
University of Iowa College of Medicine; Dr. Isador C.
Rubin, Mount Sinai Hospital and New York University
College of Medicine; and Dr. Fred A. Simmons, Harvard
University Medical School. Staff members of the Uni-
versity of Minnesota and the Mayo Foundation will
complete the faculty for the course.
Key topics which will be discussed during the three-
day course include psychosomatic aspects of sterility, the
investigation and management of the infertile couple, the
management of amenorrhea, and artificial insemination.
SOUTHERN MINNESOTA MEDICAL ASSOCIATION
The Southern Minnesota Medical Association will
hold its annual meeting on Monday, September 11, at
Mankato, Minnesota. All physicians are welcome at the
meeting, and applications for membership will be con-
sidered during the business meeting.
The program for the meeting is as follows :
“Hospital Management of Asthma” by Dr. Giles
Koelsche of Rochester.
“Basic Facts About Gallbladder Surgery for General
Physicians” by Dr. David P. Anderson of Austin.
“Common Injuries of the Knee Joint” by Dr. E. D.
Henderson of Rochester.
“Thrombocytogenic Purpura” by Dr. Charles Stroebel
of Rochester.
“Antabuse in the Treatment of Alcoholism” by Dr.
J. C. Michael of Minneapolis.
“Trauma to Urethra and Bladder in Association with
Pelvic Fractures” by Dr. E. J. Richardson of St. Paul.
“Urinary Acetone: Its Detection and Value in Treat-
ing Ambulatory Diabetics” by Dr. B. J. Mears of St.
Paul.
“Management of Spontaneous Pneumothorax” by Dr.
W. R. Schmidt of Minneapolis.
“Differential Diagnosis of Low Back and Sciatic Pain”
by Dr. H. J. Svien of Rochester.
“Operative Measures to Improve Circulation in Arterio-
sclerosis Obliterans” by Dr. F. W. Quattlebaum of
St. Paul.
“Emergencies in the Newborn Period” by Dr. L. E.
Harris of Rochester.
“Acute Yellow Atrophy of Liver from S. H. Virus,
Transmitted by a Blood Bank” by Dr. Winston R.
Miller of Red Wing (Case Report).
“Shattered Kidney in Four-year-old Child” by Dr. R. I.
Gruys of Windom (Case Report).
"Low Backache with Sciatic Pain” by Dr. L. 1. Younger
of Winona (Case Report).
PENNINGTON COUNTY SOCIETY
The Pennington County Medical Society was organ-
ized at a dinner meeting in Thief River Falls on June
29. It was announced that officers would be elected at
a later meeting.
The initial meeting was highlighted by six guest speak-
ers from the University of Minnesota Medical School
who were on their way to Lake of the Woods for a
brief fishing expedition. The six speakers were Dr. Clar-
ence Dennis, Dr. Howard Horns, Dr. Arnold J. Kremen,
Dr. Lvle Hay, Dr. Robert Hebbel and Dr. Robert Huse-
by.
SOUTHWESTERN MINNESOTA
MEDICAL SOCIETY
The Southwestern Minnesota Medical Society held its
regular monthly meeting at Worthington on June 26.
Principal speaker of the evening was Dr. Rudolph W.
Koucky, Minneapolis, who discussed advances in the
diagnosis and treatment of diseases of the blood.
Dr. and Mrs. F. M. Manson, Worthington, were hon-
ored guests at the dinner meeting in recognition of the
physician’s having just become a member of the Fifty
Club of the Minnesota State Medical Association.
The BCG vaccination campaign against tuberculosis
is progressing throughout the world. As of March 1,
twenty million children and young adults have been
tested, and about ten million vaccinated against tuber-
culosis. Mass vaccination campaigns were completed in
Czechoslovakia and Finland last summer, and will finish
in Poland this spring. Work is under way in Austria,
Greece, Yugoslavia, Morocco, Ceylon, India, Pakistan,
Algeria, Tunisia, Italy, Egypt, Israel and Lebanon.
Campaigns will soon begin in Syria, Malta, Mexico and
Ecuador. BCG vaccination campaigns are a joint enter-
prise of UNICEF, Scandinavian relief societies and
WHO. — WHO Newsletter, February-March, 1950.
834
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August, 1950
835
In Memoriam
ERNEST L. BAKER
Dr. Ernest L. Baker of Minneapolis passed away July
20, 1950, just five days after celebrating the fortieth
anniversary of his practice in Minneapolis.
Dr. Baker was born in Ithaca, Michigan, January 9,
1880. He attended the University of Michigan at Ann
Arbor and the North Dakota Agricultural College and
taught for five years as principal of grade and high
schools in North Dakota, Iowa City and Fairmont. He
then attended medical school at the University of Min-
nesota, where he received his medical degree in 1909.
He was the first intern at the University Hospital, where
he served from March 10, 1909 until July, 1910, in the
building on Washington Avenue which had been con-
verted from a former residence into a hospital and
was used as such until the construction of the first
unit of the present University Hospitals.
While in general practice, Dr. Baker maintained an
office in Southeast Minneapolis. He was associated
with Dr. George Douglas Head for a number of years.
Dr. Baker was a member of the Hennepin County
Medical Society, the Minnesota State Medical Associa-
tion and the American Medical Association. He was
also a member of Alpha Omega Alpha, honorary med-
ical society, and Nu Sigma Nu, undergraduate medical
fraternity.
Dr. Baker is survived by his wife, Ethel Bliss Baker;
a son, Dr. Milton E. Baker ; a daughter, Priscilla Baker
Cross ; a brother, Henry C. Baker, Portland, Oregon ;
a sister, Mrs. William Newell, Onstet, Michigan, and
four grandchildren. A son, Douglas Baker, preceded his
father in death. Mrs. Baker had the distinction of
being desigated “Minnesota Mother” in 1944.
BERTON I. BRANTON
Dr. B. J. Branton, mayor of Willmar commonly known
as B. J., died on May 9, 1950. He was president of the
Minnesota Public Health Association and was in the
midst of the x-ray campaign being conducted in Kandi-
yohi County 'when stricken.
Dr. Branton was born in Willmar, September 20, 1883.
He graduated from the University of Minnesota medical
school in 1905 and interned at the Budd Hospital at Two
Harbors and at St. Barnabas Hospital in Minneapolis.
Dr. Branton founded the Willmar Hospital in 1937.
He was most active in local affairs. At the time of his
death he was vice president of the Bank of Willmar.
a member of the Board of the Kandiyohi County Fair,
president of the Willmar Shrine Club, as well as mayor
of Willmar. He had been Coroner of Willmar for a
period of twelve years and was a past president of the
Elks and the Kiwanis clubs. He had been president of
the Willmar Chamber of Commerce and chairman of the
836
Kandiyohi County Historical pageant held in 1949. He
had been president of the Kandiyohi-Swift County
Medical Society, president of the Northern Minnesota
Medical Association, and in 1941 was president of the
Alinnesota State Medical Association. He was also a
member of the American College of Surgeons, the
Kandiyohi-Swift County Medical Society, the Minne-
sota State Medical Association and the American Medi-
cal Association. He was head of the Willmar Clinic,
which he established at the time the Rice Hospital
opened. He also headed the Branton Properties and the
Branton Foundation. According to newspaper accounts,
he was Willmar’s leading citizen.
On July 11, 1906, he was married to Alice A. Brown.
Surviving are one son Calvin F. Branton of Saint Paul
and two daughters, Alice (Mrs. Clifford Marlow) of
Willmar and Elizabeth (Mrs. Chester I. Miller) of
Minneapolis.
* * *
It is a great privilege to pen a tribute to our recently
departed comrade, Bertram J. Branton. Nothing would
be added by enumerating again the many honors be-
stowed upon him and the distinguished services he
rendered in various capacities; so briefly I shall mention
some of the characteristics which distinguished him.
He lived an efficient well-balanced life from youth to
maturity.
He was a man of high intelligence, and one who had
his mind under control, constantly holding it to some
worthwhile endeavor.
He was a shrewd businessman, but never allowed his
personal desires to overbalance the public good.
He was an ambitious man, but his ambitions were
chiefly directed towards the public interests.
He was an able physician and surgeon, using his skill
not so much for personal aggrandizement as for the
public welfare.
He was public spirited, giving of his time and talents
to advance the interest of his community and to promote
the welfare of the state and country.
He was a moral man and lived by bis ideals day in
and day out.
Bertram J. Branton is one of the rare examples of a
man who throughout life had courage and force of
character sufficient to live each day in the best way pos-
sible. He died with no worry about what he should or
should not have done.
We physicians are justified in a feeling of pride that,
as a group, we have produced more men of this type
than any other group ; and in particular, the Minnesota
State Medical Association can be proud that it has con-
tributed more than its share of such men. May we ever
hold high the standard of service exemplified by Bertram
J. Branton.
W. L. Burnap, M.D.
Minnesota Medicine
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August, 1950
837
IN MEMORIAM
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838
ARCHIBALD E. CARDLE
On June 23, 1950, in the worst air disaster in Amer-
ican history, Medicine lost one of its most able and
distinguished members, and one of its most sincere
and untiring servants. The entire medical profession,
his friends and patients mourn the death of Dr. A. E.
Cardie.
Dr. Cardie was born in El Reno, Oklahoma, April
27, 1899. He was graduated from the University of
Iowa medical school in 1923, served an internship at
Maryland General Hospital and a residency at the
Minneapolis General Hospital. He entered practice in
Minneapolis, associating himself with Dr. J. G. Cross
in the practice of internal medicine. After Dr. Cross’
death, he continued alone.
Dr. Cardie had been a delegate to the House of
Delegates of the Minnesota State Medical Association,
Councilor for the Sixth District for six years before
becoming President of the Minnesota State Medical
Association in 1948, the Association’s youngest President.
Since 1946 he had been Secretary of the Minnesota
Academy of Medicine.
He had been named a delegate from Minnesota to
the 1950 meeting of the American Medical Association
and was returning from the East preparatory to leaving
for San Francisco when he died, one of fifty-eight
lost that stormy night over Lake Michigan.
In final tribute to a fine man and a good doctor, may
I say in behalf of those who knew him well that to
work with “Arch” was a joy and a privilege.
His excellent judgment helped steer Medicine through
some turbulent times. He had a rare faculty for un-
derstanding the public’s reaction toward the medical
profession and was unexcelled in interpreting Medicine’s
accomplishments and objectives to the public.
In his capacity as chairman of the Public Health
Education Committee, Arch played the leading role in
our successful efforts to swing an enlightened public
against compulsory health insurance.
The advertising campaign now being so extensively
conducted in the newspapers throughout the state is
largely Arch’s “brain child,” and was prepared under
his direction by an experienced and talented public
relations expert. In national medical circles, he was
receiving increasing recognition for his sincere and
effective efforts in public education and, had he been
spared, unquestionably he would have been called upon
to expand his activities beyond our own state.
Arch’s modest demeanor, his exceptional kindliness,
unfailing optimism and good humor will be sorely
missed by all who have been privileged to enjoy bis
friendship.
He is survived by his wife, Edith, and two children,
Mary and John.
Orwood J. Campbell, M.D.
Minnesota Medicine
IN MEMORIAM
North Shore
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offering all forms of treatment, including electric shock.
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225 Sheridan Road Medical Director Phone Winnetka 6-0211
OSCAR J. ESSER
Dr. Oscar J. Esser, of New Ulm, a specialist in eye,
ear, nose and throat diseases, died July 7, 1950, at the
age of forty-eight.
Oscar Esser was born September 27, 1901, in Dane
County, Wisconsin. He moved with his parents to New
Ulm as a child. His medical education was obtained
from Marquette University medical school where he
graduated in 1927.
He practiced for short periods at Ossian, Iowa, and
later at Gibbon and New Ulm, maintaining offices in
both towns. He then practiced at Tracy for a time.
Two years ago he entered the New York City Poly-
clinic and took a special course in eye, ear, nose and
throat diseases. He returned to New Ulm to practice
but maintained his home at Gibbon.
Dr. Esser was a member of the Brown County Med-
ical Society, the Minnesota State Medical Association
and the American Medical Association.
Dr. Esser married Florence Stadtherr of Gibbon
November 27, 1924. He is survived by his widow, two
sons and a daughter. His mother, three brothers and
three sisters also are living.
JOHN S. KILBRIDE
Dr. John S. Kilbride of Canby, Minnesota, passed
away June 5, 1950, following an injury received in an
August, 1950
automobile accident shortly before Christmas in 1949.
He was eighty-four years of age.
Dr. Kilbride was born at Zwingle, Iowa, December
23, 1865. He attended high school at Dubuque, Iowa,
and the Iowa State Academy at Iowa City. He received
his M.D. degree from the College of Physicians and
Surgeons at the University of Illinois in 1893. He took
postgraduate work at the New York and Chicago Post-
graduate schools and in 1910 continued his studies in
Vienna.
He began practice in Dawson, Minnesota, in 1898 and
after a year went to Sleepy Eye, where he practiced for
a year before going to Canby. After returning from
Vienna in 1910 he practiced at Watertown, South Da-
kota, for four years. In 1915 he and Dr. L. J. Holm-
berg formed a partnership in Canby which continued
until 1936 when he joined his son, Dr. Edwin Kilbride,
in Worthington. In 1943 he returned to Canby to prac-
tice until the war ended in 1945, when he returned to
Worthington.
He was a former member of Nobles County Medical
Society, the Minnesota State Medical Association and
the American Medical Association.
Dr. Kilbride is survived by his son, Dr. Edwin Kil-
bride of Worthington, Linnae Kilbride, an attorney in
Hastings, Zylpha Kilbride of Evanston, Illinois, and
Kathleen (Mrs. Nelson Knoop) of DesPlaines, Illinois.
839
IN MEMORIAM
VERNON L. HART
Dr. Vernon L. Hart, well-known orthopedic surgeon
of Minneapolis, drowned in Cedar Lake, Minneapolis, on
July 12, 1950. He was fifty -one years of age.
I)r. Hart was born in Huron, Ohio, October 24, 1898.
He obtained his M.D. degree from the University of
Michigan in 1924 and took further training in surgery
at the University Hospital, Ann Arbor, from 1924 to
1932.
Dr. Hart practiced at Dayton, Ohio, from 1932 to
1933, when he moved to Minneapolis to take over the
orthopedic practice of the late Dr. Emil Geist. He
was known for his work on congenital dislocation of the
hip before he moved to Minneapolis.
Dr. Hart was a Fellow of the American College of
Surgeons, a diplomate of the American Board of Ortho-
pedic Surgeons, a member of the American Academy
of Orthopedic Surgeons, the Clinical Orthopedic Society,
the Minnesota Academy of Medicine, the Hennepin
County Medical Society, the Minnesota State Medical
Association and the American Medical Association.
Dr. Hart held the rank of Lieutenant Colonel in World
War II and headed the orthopedic service at several
army hospitals. He was also a member of the National
Research Council and was a civilian consultant to the
Surgeon General of the United States Army on a six-
weeks inspection of the American Zone of Germany in
in 1948.
Survivors are his wife and daughter, Louisa K. ; a
sister, Airs. Vanessa Campbell of Huron, Ohio, and a
brother, Vincent, of Cleveland, Ohio.
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HORATIO B. SWEETSER
Dr. Horatio B. Sweetser, a prominent surgeon of Min-
neapolis until his retirement in 1933, died May 23, 1950,
at the age of eighty-eight.
Dr. Sweetser was born in Brooklyn, New York, July
13, 1861. He graduated from St. John’s College in
Brooklyn in 1877 and received his medical degree from
the College of Physicians and Surgeons in New York
in 1885. After interning at St. Francis Hospital, New
York City in 1885-1886 he practiced in New York City
for a brief period before coming to Minneapolis in 1887.
He was professor of anatomy and surgery at Hamline
University Medical School and later at the University of
Minnesota Medical School after the two schools were
merged. He was a charter member of St. Alary’s Hos-
pital in Minneapolis, having been a member since 1887
and was chief of stall for many years.
Among the many organizations of which Dr. Sweetser
was a i ember may be mentioned: the American College
of Surgeons, the Western Surgical Association, the Min-
nesota Academy of Medicine of which he was president
in 1919, the Minneapolis Surgical Society of which he
was president in 1927, the Hennepin County Aledical
Society of which he was president in 1899-1900, the
Minnesota State Medical Association and the American
Medical Association.
He belonged to Phi Rho Sigma, the undergraduate
medical fraternity and was a member of the Minneapolis
( Iub, the Minneapolis Auto Club and the Bloomington
Golf Club.
Dr. Sweetser is survived by two sons, Dr. Theodore
H. Sweetser and Dr. Horatio B. Sweetser, Jr., oj Alin-
neapolis ; and two daughters, Mrs. Frank Preston of
Minneapolis and Airs. Elizabeth Albrecht of Belle Plaine.
Dr. Sweetser was a fine gentleman and an expert sur-
geon. His pleasing personality and character won him a
multitude of friends.
KENNETH G. WILSON
Word has been received of the death of Dr. Kenneth
G. Wilson on June 19, 1950.
Dr. Wilson, who was a former fellow in ophthal-
mology and aviation medicine at the Mayo Foundation,
was born in Minneapolis on August 27, 1915. He re-
ceived his M.D. from the University of Minnesota and
interned at St. Luke’s Hospital in San Francisco. He
entered the Alayo Foundation as a fellow in ophthal-
mology in July, 1941; later, he became interested in,
and transferred his major subject to, aviation medicine.
He left the Mayo Foundation in February, 1943, to go
to Cleveland to practice aviation medicine and later
moved to San Diego. At the time of his death he was
residing in Laguna Beach, California.
Dr. Wilson was a member of the Psi Upsilon and
Nu Sigma Nu fraternities.
Tuberculosis rates . . . rose in every European
country seriously affected by the war, and there is now
a growing realization in Europe that tuberculosis is our
main public health problem. — Marc Daniels, M.R.C.P.,
D.P.H., British Medical Journal, Nov. 12, 1949.
AflNNESOTA AlEDICINE
WOMAN’S AUXILIARY
Woman's Auxiliary
AUXILIARY REPORTS AT
AMA CONVENTION
The Woman’s Auxiliary to the Minnesota State Medi-
cal Association reported to the national convention in
San Francisco in June. Mrs. Charles W. Waas, the new
president, read the report of the immediate past presi-
dent, Mrs. H. E. Bakkila.
Highlights from the report state that Minnesota has
twenty-nine auxiliaries and one branch, all working close-
ly with their medical societies. Area health and guest
days are gaining in popularity. Lay groups assist in plan-
ning and all voluntary health organizations are exhibitors.
A book on health day procedure has been written with
the aid of the State Department of Health. The Aux-
iliary sponsored the nineteenth annual State High School
radio contest on tuberculosis.
A Public Relations Workshop, co-sponsored by the
Minnesota State Medical Association, was held, consisting
of a panel discussion of “Fundamentals of Community
Health Education Program.” Such media as press re-
lations, distribution of literature, speakers bureau, radio,
exhibits, personal contacts and health days were dis-
cussed. A new project is a “Five-Point Basic Program
for Improvement of School Health Services.”
During the year, the Auxiliary was visited by Mrs.
David Allman, national president, and Mrs. Paul Craig,
national public relations officer.
All county auxiliaries have had health education as
their main project. One auxiliary had a study group,
presenting such topics as “Your Hospital Dollar and
Where It Goes,” and “Co-operative Medicine.” The pres-
ident of the Minnesota State Medical Association ad-
dressed them. Another auxiliary sponsored a weekly
radio program, “Your Health Hour.” Most auxiliaries
have volunteered their services, as well as financial aid,
to the Cancer Society, Christmas seal sales, Red Cross
drives, the Society for the Prevention of Blindness, the
Mental Hygiene Society, the Nurses Scholarship and the
Heart Association. The Auxiliary has a representative on
the State Nutrition Committee, also many members are
serving on boards and as officers of clubs throughout the
state. One member is president of the state branch of the
American Association of University Women.
Cooperation of officers and the aid of every indi-
vidual member have combined to produce a successful
year for the Woman’s Auxiliary to the Minnesota State
Medical Association.
Mrs. Benjamin B. Souster
Saint Paul
August, 1950
841
♦
Of General Interest
Ground-breaking ceremonies for the twenty-two-
story Mayo Memorial Medical Center at the Univer-
sity of Minnesota were held on July 5. Dr. J. L.
Morrill, president of the University, turned the first
shovelful of earth at the site of the structure in the
quadrangle in front of the University Hospitals.
Principal speaker for the occasion was Dr. Donald
J. Cowling, chairman of the committee of founders
of the Mayo Memorial.
It is expected that the $12,000,000 structure will
be ready for occupancy in 1953. When completed,
it will contain laboratories classrooms, staff offices,
three auditoriums, an underground garage, operating
and hospital rooms, medical library, and quarters for
research animals. The tower section will rise 250
feet above the ground.
t- * *
Dr. Murray H. Hunter, formerly of Ancker Hos-
pital, Saint Paul, has become associated in practice
with Dr. A. H. Field of Farmington. A graduate of
the University of Marquette Medical School, Dr.
Hunter recently completed his internship at Ancker
Hospital.
* * *
A testimonial dinner was given for Dr. W. H. Val-
entine, of Tracy, on May 27 by patients and fellow
physicians in recognition of Dr. Valentine’s fifty
years of medical service to Tracy. The dinner was
attended by 350 friends from Wisconsin and South
Dakota as well as Minnesota.
Mr. William R. Mitchell presided as master of
ceremonies, and the principal address was given by
Dr. Roscoe C. Webb, of Minneapolis, a native of
Amiret, who paid tribute to Dr. Valentine’s service to
the community. Other members of the profession
called upon for remarks were Dr. H. J. Nielson, Dr.
J. K. Helferty, Dr. W. G. Workman, Dr. G. W.
Ferguson and Dr. R. R. Remsberg. Dr. S. A.
Slater, Worthington, presented the honored guest
with a certificate of recognition for his part in tu-
berculosis control and his work as president of the
Lyon County Public Health Association for twenty-
nine years. Congratulations were received from Gov-
ernor Youngdahl and prominent medical and edu-
cational leaders in the state. Especially cherished
was a telegram from the Sisters of St. Joseph, St.
Mary’s Hospital, Minneapolis. Dr. Valentine is the
oldest living ex-intern of that hospital.
* * *
Dr. Wesley W. Spink, of the University of Minne-
sota Medical School, has been elected to the board
of governors of the American College of Physicians.
He will be governor for the organization in Min-
nesota until 1953. Dr. Spink was also given an hon-
orary degree of Doctor of Science from Carleton
College in June.
842
Dr. Richard A. Knudson, Forest Lake, announced
late in June that he planned to leave his practice in
Forest Lake about July 30 and move to Black River
Falls Wisconsin. Dr. Knudson began bis practice
in Forest Lake in August, 1948. He was associated
with Dr. J. A. Poirier for almost two years.
* * *
At a meeting of the North Dakota State Pediatric
Society in Grand Forks on May 29, Dr. Albert V.
Stoesser, Minneapolis, gave a talk at a luncheon and
conducted a round-table discussion on “Modern
Drug Therapy in Allergy.” On the same day he
spoke at the sixtv-third annual meeting of the North
Dakota State Medical Association in Grand Forks,
discussing “Respiratory Allergy in Children.”
In June, Dr. Stoesser attended the annual session
of the AMA in San Francisco and spoke before
the Section on Pediatrics on June 28. His subject
was “Antihistamines in the Treatment of Allergic
Diseases in Children.”
jji :{C jjs
After ten years of association with the Gamble
Clinic in Albert I.ea, Dr. E. S. Palmerton left on
July 1 to specialize in ophthalmology at the Uni-
versity of Minnesota. Also on July 1, the Gamble
Clinic changed its name to Nelson and Erdal, Phy-
sicians and Surgeons. It was announced that on
August 1, Dr. Leonard M. Ellertson of Muncie, Indi-
ana, would join the group in Albert Lea.
* * *
Dr. John L. Juergens has become associated with
his father, Dr. H. M. Juergens, in the practice of
medicine in Belle Plaine. A graduate of the Harvard.
Medical School, the younger Dr. Juergens interned
at Minneapolis General Hospital.
:)« 5fc j{C
On the evening of June 3, the medical department
of the University of Minnesota Medical School, some
100 strong, attended a banquet at the Minneapolis
Club in honor of three professors of medicine who
have contributed outstanding service to the school —
Dr. Henry Ulrich, Dr. S. Marx White and Dr. George
Fahr.
It was Dr. Henry Ulrich who, as clinical profes-
sor of medicine, built up the University medical
service at the Minneapolis General Hospital before
it was taken over by Dr. George Fahr as full-time
professor of medicine and chief of the medical serv-
ice in 1927. More recently Dr. LHrich taught at the
University Hospitals until his retirement as emeritus
professor in July, 1944. Dr. Fahr became emeritus
professor on June 15 of this year. Dr. S. Marx
White has given many years to teaching medicine at
the LTniversity and was head of the department from
(Continued on Page 844)
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843
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(Continued from Page 842)
January, 1921, to November, 1925. He became emeri-
tus professor in July, 1942.
Dr. Reuben Johnson, as toastmaster, entertained
the banqueters with an apparently inexhaustible
supply of stories, and tribute was paid to the honor
guests by Drs. Lowry, Watson and Schaaf.
Dr. Gordon R. Kamman, Saint Paul, presented a
paper on June 21 before the AMA Section of Ner-
vous and Mental Diseases. His subject was “Trau-
matic Neurosis, Compensation Neurosis, or Attitudi-
nal Pathosis?’’
* * *
Dr. J. R. Harrie, formerly of Eveleth, began a
three-year residency in radiology at the University
of Michigan on July 1. Dr. Harrie became associat-
ed with the More Hospital in February, 1949, main-
tained offices in the More-Ewens Clinic in Virginia,
and was city health officer at Mountain Iron.
* * *
Two Rochester couples sailed from New York on
July 8 for a two-month trip through Europe. They
were Dr. and Mrs. B. E. Hall and Dr. and Mrs. J.
M. Stickney. For the two physicians, however, the
trip was not planned to be just a vacation. Both
Dr. Hall and Dr. Stickney were scheduled to speak
at a meeting of the International Society of Hema-
tology in England during August. In addition, Dr.
Stickney spoke at the Fifth International Cancer
Congress in Paris late in July, and Dr. Hall was
scheduled to be on the program at the First Inter-
national Congress of Internal Medicine in Paris dur-
ing September.
* * *
An editorial in the Crookston Daily Times on July
11 paid tribute to Dr. M. O. Oppegaard as he began
his fortieth year in the practice of medicine. After
ten years of practice in various hospitals in the
East, in New London and in Minneapolis, Dr. Op-
pegaard moved to Crookston in 1920. During his
years there he has served in numerous civic and
professional capacities, usually managing to handle
several tasks simultaneously. He has been mayor
of the city for three terms and holds that office at
present.
* * *
Grants for cancer research announced by the Pub-
lic Health Service on July 7 total $1,160,818. These
awards will support cancer research in hospitals, uni-
versities and other non-federal institutions in thirty
states and the District of Columbia. The grants
were made by the National Cancer Institute follow-
ing recommendations by the National Advisory Can-
cer Council and approval by Dr. Leonard A. Scheele,
Surgeon General of the Public Health Service. In-
cluded are the following grants to the University of
Minnesota: $8,023 to Dr. Edward Eaton Mason for
investigation of gastric secretion and stomach can-
cer; $3,978 to Dr. Sheldon C. Reed for the study
of biology of human breast cancer with particular
emphasis upon heredity; $7 685 to Dr. Claude R.
Hitchcock for chemical induction of stomach cancer
in inbred strains of mice; $14,040 to Dr. Julian Wild
for studying normal and malignant tissues by the
use of ultrasound.
* * *
Dr. Robert L. Merrick has become associated
with Dr. Wallace P. Ritchie at 917 Lowry Medical
Arts Building, Saint Paul, for the practice of neuro-
surgery. Dr. Merrick is a native of Corydon, Iowa,
and received his medical degree at the University
of Minnesota in 1945. After serving in the Army for
two years, he completed a residency in neurosurgery
first at the Neurological Institute of New York and
recently at the University Hospitals in Minneapolis.
* * *
Dr. Ralph Buesgens has opened offices in Water-
ville for the practice of medicine. A graduate of
Creighton University, Dr. Buesgens recently com-
pleted his internship at St. Mary’s Hospital, Minne-
apolis.
* * *
Two Mayo Clinic staff members, Dr. Lyle A.
Weed and Dr. L. B. Woolner, were awarded silver
medals by the AMA for their exhibit on cancers
of the mouth at the annual meeting of the AMA
in San Francisco during June.
* * *
Frederick J. Tenuto (alias Leonard Durham,
Leonard Durken, John Thomas Lastella, Frank Pin-
to, Durso Thornberry, etc.) has escaped from the
state of Pennsylvania to avoid confinement after
conviction for the crime of murder. He is believed
to be armed and is considered dangerous. Tenuto
is thirty-five years of age, 5 feet 5 inches tall, weighs
143 pounds. He is stocky in appearance, has black
hair, dark brown eyes and a dark complexion. He
has an imperfect tattoo, S.J., on his left forearm and
an imperfect tattoo, ANA, ANNA or AMA on his
right forearm, a small brown mole on his right cheek
and a one-and-one-half-inch scar over the right
eye. A recurring skin eruption may lead him to
seek medical care. The office of the F.B.I. in Min-
neapolis, Lincoln 6963, should be notified.
« * * *
Dr. Gerald E. Larson and Dr. Raymond C. Mag-
nuson opened offices in Cambridge on July 12 for
the practice of medicine. Both physicians are 1949
graduates of the University of Minnesota Medical
School and both served their internships in Duluth.
* * *
Miss Elsie T. Berdan has been appointed chief of
the Nursing Branch, Division of Hospitals, Public
Health Service. Miss Berdan is a native of Sleepy
Eye. She graduated from St. Mary’s Hospital School
of Nursing in Minneapolis and later obtained both the
Bachelor of Science and Master of Science degrees
in nursing education at the Catholic University of
America in Washington, D. C. Prior to her present
appointment she served as associate chief of the
Nursing Branch in the Division of Hospitals under
Miss M. Constance Long, who has resigned.
* * *
Announcement was made on July 7 that Dr. Wil-
liam T. Hudspeth would become associated with the
844
Minnesota Medicine
OF GENERAL INTEREST
Municipal Bonds Have a Prime Security
Have you ever stopped to analyze the basic security of a municipal bond? This can be
done most easily by following the general procedure in the issuance of municipal bonds.
Let us assume a Minnesota School District desires to issue bonds to provide money for the
construction of a new school building.
A School District is an instrumentality of the State, administered by a Board elected by
the voters within the territorial limits of the District. Once the Board has determined the
necessity of a new school building and an estimate of the cost involved is known, an election
is held on the question of issuing bonds.
If the election carries by the necessary majority, then the Board may sell the bonds and
pledge as security the full faith and credit of the taxing district (the School District). At
the time the bonds are issued the Board certifies a tax levy to the County Auditor to be
levied during each of the years the bonds are outstanding which levy will be made automati-
cally unless sufficient funds are on hand from other sources.
Funds derived from the collection of taxes for bonds and interest must be used only
for that purpose and, should they prove to be insufficient, any other available funds must be
used to meet bond payments. If necessary, additional taxes must be levied. There is no limit-
ation on the taxes which may be levied on any taxable property based on its assessed valuation
for Minnesota School Districts but the total school district taxes in any one year may not
exceed an amount equal to $40 per capita of all persons residing in the District.
Taxes levied to pay principal and interest on these bonds are collected at the same time
and as a part of other property taxes against all taxable property, both real and personal, in
the District. These taxes have priority and come ahead of any other lien or claim on this
taxable property. It is no exaggeration, therefore, for the holder of one of the School District’s
bonds to drive through the District, past the dairy and grain farms, past the factory and pro-
duction plants in the community, along the railroad track, past the stores, bank, homes, etc.,
and say, “All of this property is security for my bond.”
We shall be pleased to send you information and descriptive circulars of municipal bonds we are currently
offering.
JURAN & MOODY
MUNICIPAL SECURITIES EXCLUSIVELY
TELEPHONES GROUND FLOOR
St. Paul: Cedar 8407, 8408, 3841 Minnesota Mutual Life Bldg.
Minneapolis: Nestor 6886 St. Paul 1, Minnesota
Vladison Clinic in Madison on July 14. A graduate
:>f Cornell University, Dr. Hudspeth served his in-
:ernship and a one-year residency in surgery at Syra-
:use University Medical Center. He then studied
mrgery for one year at the University of Minnesota
md for two years at Swedish Hospital, Minneapolis.
He served in the Army for three years.
* * *
After completing his third year of postgraduate
nedical study at Methodist Hospital, Dallas, Texas,
Dr. George T. Van Rooy returned to Thief River
Falls on July 3 and resumed his affiliation with the
Bratrud Clinic there.
The December Clinical Session of the AMA, which
was to have been held in Denver, will be held in-
stead in Cleveland on December 5 through 8. Labor
trouble in the building of the Denver Auditorium,
with work stoppage, forced the change in plans.
The local committee on arrangements had prepared
an excellent program, which will now have to be
scrapped and new committees appointed and a new
program arranged.
$ $ $
Two additional physicians recently became asso-
ciated with a Saint Paul group of roentgenologists,
Drs. Schons, Medelman, Peterson and Nash, with
offices at 572 Lowry Medical Arts Building and also
August, 1950
845
OF GENERAL INTEREST
Cook County Graduate School of Medicine
ANNOUNCES CONTINUOUS COURSES
SURGERY — Intensive Course in Surgical Technic, two
weeks, starting August 21, September 25, October
23.
Surgical Technic, Surgical Anatomy and Clinical Sur-
gery, four weeks, starting August 7, September 11,
October 9.
Personal Course in General Surgery, two weeks, start-
ing September 25.
Surgery of Colon and Rectum, one week, starting Sep-
tember fl.
Esophageal Surgery, one week, starting October 16.
Breast and Thyroid Surgery, one week, starting Octo-
ber 2.
Thoracic Surgery, one week, starting October 9.
Gallbladder Surgery, ten hours, starting October 23.
Fractures and Traumatic Surgery, two weeks, starting
October 9.
Basic Principles in General Surgery, two weeksA start-
ing September 11.
GYNECOLOGY — Intensive Course, two weeks, starting
September 25.
Vaginal Approach to Pelvic Surgery, one week, start-
ing September 18.
OBSTETRICS — Intensive Course, two weeks, starting
September 11.
MEDICINE — Intensive General Course, two weeks,
starting October 2.
Gastro-enterology, two weeks, starting October 16.
Gastroscopy, two weeks, starting September 11 and
October 23.
Electrocardiography and Heart Disease, four weeks,
starting October 2.
DERMATOLOGY — Formal Course, two weeks, starting
October 16.
Informal Clinical Course every two weeks.
UROLOGY — Intensive Course, two weeks, starting Sep-
tember 25.
General, Intensive and Special Courses in all Branches of
Medicine , Surgery and the Specialties.
TEACHING FACULTY— ATTENDING
STAFF OF COOK COUNTY HOSPITAL
Address: REGISTRAR, 427 South Honore Street
Chicago 12, Illinois
ACCIDENT • HOSPITAL ' SICKNESS
INSURANCE
FOR PHYSICIANS, SURGEONS, DENTISTS EXCLUSIVELY
ML /'""'C'A ALL
^ PREMIUMS ^>1 SURGEONS l<^ CLAIMS <
\ DENTISTS J
$5,000.00 accidental death $8.00
$25.00 weekly indemnity, accident Quarterly
and sickness
$10,000.00 accidental death $16.00
$50.00 weekly indemnity, accident Quarterly
and sickness
$15,000.00 accidental death $24.00
$75.00 weekly indemnity, accident Quarterly
and sickness
$20,000.00 accidental death $32.00
$100.00 weekly indemnity, accident Quarterly
and sickness
Cost has never exceeded amounts shown.
ALSO HOSPITAL POLICIES FOR MEMBERS
WIVES AND CHILDREN AT SMALL
ADDITIONAL COST
85c out of each $1.00 gross income used, for
members’ benefits
$3,700,000.00 $16,000,000.00
INVESTED ASSETS PAID FOR CLAIMS
$200,000.00 deposited with State of Nebraska for protection of our members.
Disability need not he incurred in line of duty — benefits from
the beginning day of disability
PHYSICIANS CASUALTY ASSOCIATION
PHYSICIANS HEALTH ASSOCIATION
48 years under the same management
400 First National Bank Bldg., Omaha 2, Nebr.
846
at 211 Midway Medical Arts Building, Saint Paul.
The two new associates are Dr. Barnard Hall and
Dr. John B. Coleman.
Dr. Hall, a graduate of the University of Oregon
Medical School in 1942, interned at the University
of Wisconsin. During his service in the Army he
\\ as associated with the Army School of Roentgen-
ology and recently was a fellow in radiology at the
University of Minnesota.
Dr. Coleman, who graduated from Northwestern
University Medical School in 1943, interned at the
L\anston Hospital. During his Army service he was
at the Army School of Roentgenology, and from
1946 to 1949 he served a fellowship in radiology at
the LTniversitv of Minnesota. During the past year
he has been associated with Dr. Richard Schatzki
at Cambridge, Massachusetts.
* * *
Dr. and Mrs. E. P. Frisch, Willmar, sailed from
New \ ork on July 8 for a two-month trip through
Europe. Dr. Frisch planned to attend the Interna-
tional Medical Congress in France late in July. The
couple expected to return home on September IS.
*k »k -J:
Dr. Paul Carpenter, a staff member of the Oliver
Clinic in Graceville, left on June 28 for Kansas City
to begin a four-year residency in surgery at St. Mar-
garet’s Hospital.
* Jk *
The Board of Trustees and the AM A Council on
Foods and Nutrition selected Dr. Fuller Albright,
associate professor of medicine at Harvard Medical
School, as the 1950 recipient of the Joseph Goldber-
ger award in clinical nutrition.
1 he award was established in 1948 for the purpose
of honoring physicians who have contributed impor-
tantly to the world’s knowledge of nutrition. In ad-
dition, the award is made annually by the AMA to
stimulate and encourage research in the field of nu-
trition. 1 he award, which consists of a gold medal
and $1,000 in cash, will be made at a meeting some
time in the fall. The meeting site has not yet been
selected.
Dr. Albright, who is connected with the Massa-
chusetts General Hospital, received his medical de-
gree from Harvard in 1924. He is best known for
his studies of human metabolism as influenced by
the endocrine glands. He studied the parathyroid
glands and their influence on the body’s use of cal-
cium. He devoted most of his time to studying min-
eral metabolism.
* 5k sk
The use of German physicians to help solve the
medical staff shortage in Minnesota mental institu-
tions was proposed by Dr. S. Alan Challman, Minne-
apolis, following his return from Europe early in
July. Dr. Chall man, who went on a sixty-day tour
of Germany as a consultant to the Army Surgeon
General, said that some German physicians are now
assisting Americans in many Army hospitals in Ger-
many. He stated that they would all like to come to
the United States and that they probably would be
of great use in our mental hospitals. “I hope to pre-
Minnesota Medicine
OF GENERAL INTEREST
sent to Governor Youngdahl a suggestion that Min-
nesota might change its medical licensing regula-
tions enough to admit these men and perhaps limit
them to practice in specific hospitals,” he said. Dr.
Challman is a clinical associate professor in psychi-
atry at the LTniversity of Minnesota.
j{i j{c Jjs
Dr. George W. Snyder, Saint Paul, director of
social hygiene for the Saint Paul Department of
Education, has been named a trustee of the Ameri-
can Legion Hospital Association of Minnesota. The
association arranges for the care of needy veterans
and their dependents at the Mayo Clinic.
;fc ^ ^
It was announced on July 8 that Dr. and Mrs.
Howard Kaliher had decided to leave Pelican Rapids
to travel and to take up duties in foreign countries.
Their main plan, it was stated, was to locate in
northern India and do mission work.
3-1 >jc
Dr. and Mrs. O. T. Clagett and Dr. and Mrs.
L. M. Eaton, Rochester returned home on June 27
after a three-month trip through the Pacific area.
During the journey the two physicians spoke before
groups in several cities in Australia, New Zealand
and Hawaii.
* * *
Dr. Frances King-Salmon, resident physician at
Glen Lake Sanatorium, was named a fellow of the
American Medical College of Chest Surgeons at a
meeting of the organization in San Francisco early
this summer.
;jj ifc jfs
Dr. Donald C. Balfour, emeritus staff member of
the Mayo Clinic, was awarded an honorary fellow-
ship in the Royal College of Surgeons of Edinburgh
in June. He delivered a series of lectures at the
University of Edinburgh as part of his three-month
tour of European cities.
* * *
Dr. John Bussman, formerly of St. Peter, was
married in Minneapolis on June 17 to Miss Muriel
Koenck, formerly of Wall Lake, Iowa. A graduate
of the* University of Minnesota Medical School, Dr.
Bussman is now completing a fellowship in pediatrics
at the University.
ijc 5>C jjl
Wadena acquired a new physician when Dr. James
H. Kelly, formerly of Saint Paul, arrived in Wadena
on June 30 to become an associate of the Davis
Clinic. Dr. Kelly, a graduate of the University of
Minnesota Medical School, served his internship at
Ancker Hospital, Saint Paul. He has completed a
general residency at St. Luke’s Hospital, Saint Paul,
and a residency in internal medicine at Ancker
Hospital.
ijC 5{C
Dr. and Mrs. L. G. Idstrom and family, of Way-
zata, sailed on July 12 for an extensive tour of
Europe. While in England, Dr. Idstrom planned
to attend the International Radiological Congress
being held in London.
^04 lta+m and
rftn , !
0j,ENWOOjj
INGLEWOOD
NATURAL* OR DISTILLED
SPRING WATER
MINNEAPOLIS Office:
Stanley J. Werner, Rep.
5026 Third Avenue South
Telephone Pleasant 8463
August, 1950
847
OF GENERAL INTEREST
1909 1950
Physiotherapy for the relief
of Arthritis and related con-
ditions. Complete physical
examinations and laboratory
procedures given every pa-
tient. Roy T. Pearson,
M.D., Medical Director. B.
F. Pearson, M.D., associate.
U. S. Hwy. 212
anitarium
AT YOUR CONVENIENCE.
DOCTOR . . .
you are cordially invited to visit our new
and modern prescription pharmacy located on
the street floor of the Foshay Tower, 100 South
Ninth Street.
With our expanded facilities we will be able
to increase and extend the service we have
been privileged to perform for the medical pro-
fession over the past years.
Exclusive Prescription Pharmacy
Biologicals Pharmaceuticals Dressings
Surgical Instruments Rubber Sundries
JOSEPH E. DAHL CO.
(Two Locations)
100 South Ninth Street, LaSalle Medical Bldg.
ATlantic 5445 Minneapolis
Dr. Clarence Arlander, Minneapolis, announced
late in June that, beginning July 1, Dr. Carl Olson
would be associated with him with offices at 2300
Central Avenue. A graduate of Northwestern Uni-
versity Medical School, Dr. Olson interned at Min-
neapolis General Hospital.
* * *
Dr. Alois M. Scheidel, formerly of Minneapolis,
has moved to Cokato and become a staff member of
the Cokato Hospital.
* * *
Public contributions to the Minnesota Heart As-
sociation Fund during the 1950 campaign totaled
$99,649, it was announced on July 11. Of the
amount, $41,000 was contributed by Hennepin
County.
* * *
Dr. William A. Bessesen, Minneaolis, sailed from
New York on July 13 for Buenos Aires to attend
the seventh biennial assembly of the International
College of Surgeons, held August 1 to 7.
* * *
Dr. Charles Slocumb, Rochester, was elected presi-
dent of the American Rheumatism Association at its
annual meeting in San Francisco on June 24.
* * *
Dr. Arnold A. Anderson opened offices for the
practice of medicine in Hopkins on July 1. A grad-
uate of the Lfniversity of Minnesota Medical School
in 1943, Dr. Anderson interned at the San Diego
County Hospital, California, and then completed a
residency in internal medicine there. He served in
the Army from 1945 to 1947. He recently com-
pleted three years of pediatric training at the Mayo
Clinic.
* * *
Four hundred persons attended a reception hon-
oring Dr. I. G. Davis of Rushford on July 7. The
reception, which was given by Dr. R. V. Williams,
Rushford, was to pay tribute to Dr. Davis on the
occasion of his retirement from active practice. Dr.
Davis practiced in Rushford for thirty-one years.
His practice has been taken over by Dr. M. J. Wolt-
jen.
* * * »
Dr. Henry P. Staub, Minneapolis, received a mas-
ter’s degree in pediatrics from the University of
Minnesota in June. A graduate of the University of
Illinois, Dr. Staub has been a resident of Minneapolis
for ten years. For the past two years he has been
studying pediatrics at University and Minneapolis
General Hospitals.
* * *
Ten young physicians, all war veterans and all
wi th Uni versity of Minnesota postgraduate training,
are building a $150,000 medical clinic in St. Louis
Park (Minneapolis).
The large, one-story, modern building is expected
to be ready for occupancy in 1951. The clinic will
be able to offer the services of specialists in internal
medicine, surgery, obstetrics and gynecology, and
otorhinolaryngology. Most laboratory procedures
will be handled by technicians in the building.
848
Minnesota Medicine
OF GENERAL INTEREST
The group includes Dr. Richard Webber, Dr.
Arnold Anderson, Dr. Donald Freeman, Dr. Alex
Barno, Dr. Robert Green, Dr. David Anderson, Dr.
John LaBree, Dr. Rovert Giebink, Dr. Sewell Gor-
don, and Dr. Wyman Jacobson.
* * *
Dr. Ellery M. James, formerly pathologist at St.
Joseph’s Hospital, Saint Paul, has opened a medical
laboratory at 657 Lowry Medical Arts Building, Saint
Paul.
* * *
Dr. Samuel Miller has moved to Albert Lea to be-
come radiologist at the Naeve Hospital. He recently
completed a residency in radiology at the University
Hospitals.
HOSPITAL NEWS
The Zumbrota Community Hospital was officially
dedicated at ceremonies held on June 30. The dedi-
catory address was delivered by Dr. Viktor Wilson,
Rochester. Open house was held at the hospital on
July 2.
BLUE CROSS-BLUE SHIELD NEWS
Minnesota Blue Shield paid 4,625 claims during May,
1950 and 4,788 claims during June, 1950. The May pay-
ment totaled $189,611.93, the June payment $184,427.37.
Total payments to participating doctors for May cover-
ing 4,420 claims was $179,403.50. The June total to par-
ticipating doctors was 4,601 claims in the amount of
$176,052.
Minnesota Blue Shield was among the seven plans
adding more than 50,000 new members during the first
three months of 1950 and have the second greatest in-
crease in percentage of population enrolled. By May
31, an additional 30,774 Minnesotans had enrolled in
Blue Shield making a net growth of 85,499 new sub-
scribers in 1950 and a total enrollment of 346,000 as of
May 31, 1950. The 69 member Blue Shield Medical Care
Plans throughout the country reported a net growth of
975,872 new members bringing the total membership to
13,276,597 ; the ten non-member plans reported a net gross
of 178,157 new members and a total membership of 2,-
106,213 making a combined membership of 15,382,810
in the 79 Medical Care Plans as of March 31, 1950.
In checking the payment during June of 1950, the
bulk of payments were for cases initiated during May;
however, the records still show a considerable number
of cases outstanding from the last half of 1949 and also
the first quarter of 1950. The Blue Shield office at-
tempts to contact the doctors on these old unfinished
cases ; however, it would expedite the payment of all
such cases if each doctor’s office would submit a report
on any and all outstanding Blue Shield claims. In so far
as possible, the Blue Shield office would like to have
all Blue Shield cases reported within thirty days after
service is initiated. The cooperation of the doctor in
sending Medical Service Report forms to this office at
the earliest possible opportunity would assist in at-
taining this objective.
The Blue Shield office receives an ever-increasing
number of calls from patients who are not quite clear as
to whether or not the payment by Blue Shield has been
deducted from the statement which the doctor sends
to his patient. It is suggested that in so far as possible
all monthly statements show the net amount payable less
a credit for the Blue Shield allowance. This minor book-
keeping detail will eliminate many questions which I am
sure the doctor’s office receives and also give the Blue
Shield subscriber a better idea as to the value of his
Blue Shield on each doctor bill.
Enrollment of participating doctors with Minnesota
Blue Shield totals 2,660 as of the end of June. The Min-
nesota Blue Shield is still attempting to attain as com-
plete participation of the doctors with the Medical Serv-
ice Plan as is possible. Any of you who have not as yet
enrolled with this Voluntary Medical Care Plan are re-
quested to do so at your earliest opportunity.
RADIUM & RADIUM D+E
(Including Radium Applicators)
FOR ALL MEDICAL PURPOSES
Est. 1919
Quincy X-Ray and Radium
Laboratories
(Owned and Directed by a Physician-
Radiologist)
Harold Swanberg, B.S., M.D., Director
W.C.U. Bldg. Quincy, Illinois
REST HOSPITAL
2527 Second Avenue South, Minneapolis
A quiet, ethical hospital with therapeutic facilities
for the diagnosis and treatment of nervous and
mental disorders. Invites co-operation of all repu-
table physicians. Electroencephalography avail-
able.
PSYCHIATRISTS IN CHARGE
Dr. Hewitt B. Hannah
Dr. Andrew J. Leemhuis.
August, 1950
849
BOOK REVIEWS
BOOK REVIEWS
Books listed here become the property of the Ramsey,
Hennepin and St. Louis County Medical Libraries when
reviewed. Members, however, are urged to write reviews
of any or every recent book which may be of interest
to physicians.
CLINICAL APPLICATIONS OF SUGGESTION AND
HYPNOSIS. William T. Heron, M.A., Ph.D. Professor
of Psychology, University of Minnesota, Minneapolis. 116
pages. Price, $3.00, cloth. Springfield, Illinois: Charles C
Thomas, 1950.
PRACTICAL PHYSIOLOGICAL CHEMISTRY — Twelfth Edi-
tion. Ev Philip B. Hawk, Pli.D., President, and Bernard L.
Oser, Ph.D., Director, Eood Research Laboratories, Inc., New
York; and William. H. Summerson, Ph.D., Associate Professor
of Biochemistry, Cornell LTniversity Medical College, New
York. 1323 pages. Illustrated. Price $10.00. Philadelphia: The
Bakiston Company, 1947.
When an average person tries to review a book on
Physiological Chemistry, lie must expect to give only a
general idea of the usefulness of such a book to his
readers. The detailed material presented in this book
is styled just as in the previous editions. Some of the
newer advances in medicine are included in the material
presented. Probably the newest, discussion of the isotopes
as used in research when elements are tagged to deter-
mine their physiologic life in the body.
The chapter dealing with vitamins and deficiency dis-
eases is especially good and I would suggest that it be
given careful attention.
A particularly valuable discussion is that dealing with
the experiments on steroid hormones.
The latter chapters deal with antibiotics which also
indicates the current thought that is carried throughout
the book. In general, I would say that this twelfth
edition is a definite improvement over the previous ones
and should be in every medical library.
Joseph M. Ryan, M.D.
* * *
BREAST DEFORMITIES AND THEIR REPAIR. By Jacques
W. Maliniac, M.D., Clinical Professor of Plastic Reparative
Surgery and Associate Attending Plastic Reparative Surgeon,
New York Polyclinic Medical School and Hospital, New York
City; Attending Plastic Surgeon, Sydenham Hospital; Diplo-
mate, American Board of Plastic Surgery. 193 pages. Illus.
Price, $10.00. New York: Grune & Stratton, 1950.
Written with the purpose of presenting a complete and
accurate account of the present status of mammaplastic
surgery, this monograph should go far towards a better
understanding of the problems associated with breast
deformities and to encourage their repair. In a field
understood well by only a few specialists in plastic sur-
gery, it will be an invaluable reference for those encount-
ering these problems in every day practice.
The author has made an exhaustive study of the
historical backgrounds of mammaplasty, the miscon-
ceptions as well as facts of breast anatomy and blood
supply, the essential elements of repair of deformities,
and the numerous procedures designed to correct them.
Not only are his own techniques presented in detail but
also those of other surgeons past and present who have
contributed to this interesting field. Numerous detailed
drawings and convincing photographs supplement the
text.
This book deserves a place on the shelves of all refer-
ence libraries as well as those who attempt the surgical
treatment of these deformities.
Edward W. Sickels
* * *
AMUSING QUOTATIONS FOR DOCTORS AND PA-
TIENTS. Edited by Noah D. Fabricant, M.D. 149 pages.
Price $3.00. New York: Grune and , Startton, Inc., 1950.
As its title indicates, this book is a collection of quo-
tations about virtually every subject that is remotely
related to medicine. The subjects run from Accidents
to Youth, and include such diverse topics as Buttocks,
Fees, Measles, Nurses, and Snoring. Though many of
the quotations are bitter, cleverly worded attacks on the
practice of medicine, most physicians should derive a
PATTERSON SURGICAL SUPPLY COMPANY
103 East Filth St.# St. Paul L Minn.
HOSPITAL AND PHYSICIANS SUPPLIES AND EQUIPMENT
Cedar 1781-82-83
Homewood hospital is one of the
Northwest's outstanding hospitals for the
treatment of Nervous Disorders — equipped
with all the essentials for rendering high-grade
service to patient and physician.
Operated in Connection with
Glenwood Hills Hospitals
HOMEWOOD HOSPITAL
Corner Penn and Plymouth Avenues North
Minneapolis Minnesoto
850
Minnesota Medicine
BOOK REVIEWS
""
The Birches Sanitarium, Inc.
2391 Woodland Avenue
Duluth 3, Minnesota
A hospital for the care and treatment of
Nervous and Mental disorders. Quiet, cheer-
ful environment. Specially trained personnel.
Recreational and occupational therapy.
Dr. L. R. Gowan, M.D., M.S., Medical Director
Attending Psychiatrists
Dr. L. R. Gowan Dr. C. M. Jessico
Dr. J. E. Haavik Dr. L. E. Schneider
large number of smiles and chuckles while thumbing
through the book. The contents of this volume would
probably be most useful to physicians who do a consider-
able amount of public speaking.
A few samples will illustrate, better than any review,
what the book is like :
Mark Twain on the Gastrointestinal Tract: “Only
presidents, editors, and people with tapeworms have the
right to use the editorial ‘we.’ ”
Henrik Ibsen on Antivisisection : “It is inexcusable for
scientists to torture animals ; let them make their ex-
periments on journalists and politicians.”
Ambrose Bierce on Diagnosis : “A physician’s fore-
cast of disease by the patient’s pulse and purse.”
George Bernard Shaw on Experts : “No man can be
a pure specialist without being in the strict sense an
idiot.”
William Osier on the Art of Medicine : '“Look wise,
say nothing, and grunt.”
M. A. Perlstein on Pediatricians: “Pediatricians eat
because children don’t.”
Morris Fishbein on Tobacco: “He is an expert sur-
geon, brilliant pathologist, and an uncanny diagnostician,
but he is somewhat rusty on advanced cigarette testi-
monials.” — J.H.L.
THE MERCK MANUAL OF DIAGNOSIS AND THERAPY: A
SOURCE OF READY REFERENCE FOR THE PHYSICIAN.
8th ed. 1592 pages. Regular edition. $4.50: Thumb-Index edi-
tion, $5.00. Rahway, N. J. : Merck & Co., Inc., 1950.
Ten years have elapsed since a new edition of the
Merck Manual has appeared; and, now, following exten-
sive preparation, the eighth or Golden Anniversary, edi-
tion has been published.
The Manual needs no introduction to those who have
been in practice for some time; but to the newcomer in
the practice of medicine a few words of explanation may
be in order. The Manual is a convenient handbook of
diagnosis and treatment of a multitude of conditions in
all branches of medicine and surgery.
Each disorder is briefly defined, and then follows a
concise discussion of its etiology, incidence, pathology,
symptoms and signs, diagnosis, prognosis and treatment.
At the end of each section into which the chapters are
grouped are the prescriptions most commonly used in the
disorders discussed in that section.
For example, examine the section on the Ear, Nose
and Throat. The material is intended primarily for the
general practitioner and is a helpful aid regarding the
most common ear, nose and throat conditions. In this
section is presented, first, the frequent diseases of the
external ear, namely, furunculosies, otomycosis, cerumen,
foreign bodies, trauma, herpes zoster, impetigo conta-
giosa, and tumors; then, of the middle ear diseases, such
as myringitis, eustachian salpingitis, otitis media and
mastoiditis; and of the inner ear, including labryinthine
disease and otosclerosis. Tinnitus and deafness are dealt
with as far as time and space will permit.
The commonest disorders of the external nose are
summarized in one paragraph with suitable cross refer-
ences to other pages. Rhinosclerma is the only condition
here described. As to the internal nose, conditions of the
septum, i.e., deviation, ulcer and perforation, are dealt
with. Rhinitis (acute, allergic, chronic and atrophic) and
polyps complete the discussion on nasal passages. The
paranasal sinuses with their acute and chronic disturb-
ances are handled adequately. Nasal trauma, fractures
and foreign bodies are mentioned ; and epitaxis is given
ample space.
Pharyngeal diseases, including tonsillitis, peritonsillar
abscess, hypertrophied adenoids, acute and chronic
pharyngitis, are next in order. Then, in logical sequence,
follows laryngeal problems, i.e. acute and chronic laryn-
gitis, tuberculous and luetic laryngitis and, also, the
general complaint of hoarseness. Last but not least, there
is a full list of common useful prescriptions for ear,
nose and throat problems.
Some one hundred pages of the Manual are devoted to
common procedures and routines and to such useful bits
of information as the essential contents of the physician’s
bag, a list of alternative proprietaries, and conversion
formulas. A good index facilitates the use of this handy,
ready reference tool.
E. L. Bauer, M.D.
AM A DIRECTORY — Eighteenth Edition. A Register of Physi-
cians. Edited by Frank V. Cargill. 2913 pages. Price $25.00.
Chicago: American Medical Association, 1950.
The eighteenth edition of the Directory of the Ameri-
can Medical Association is now available after three
years of work. This is the first edition since 1942. The
August, 1950
851
BOOK REVIEWS
BROWN 6k. DAY, INC
St. Paul 1. Minnesota
long interval was caused by the war and printing diffi-
culties.
The new directory contains 2,913 pages, and lists infor-
mation on 219,677 physicians in the United States, its
dependencies, and Canada. It also lists American gradu-
ates and licentiates located temporarily abroad. Since the
1942 directory, thousands of changes of address have
been made; 51,984 names have been added, and 28,242
names dropped from the book on account of death or
for other reasons.
In the 1942 directory, the total number of physicians
listed in the United States was 180,496; in the 1950
edition, the number is 201,277, or a gain of 20,781, an
average yearly gain of 2,598 during the last eight years.
The Pacific States show the largest increase in physi-
cians, the Atlantic and Great Lakes States a moderate
incerase, and the West Central States the greatest losses.
California leads in the number gained, with 16,688 physi-
cians in 1950 as compared with 12,365 in 1942, a gain of
4,303. New York state shows a gain of 2,284, Texas
a gain of 772, Pennsylvania 704, Florida 634 and Massa-
chusetts 603.
For the first time, postal zone numbers appear after the
residence and office addresses of physicians in cities where
they are required by the Post Office Department. A new
feature is the inclusion of data on the World Medical
Association.
The directory costs $25. Orders can be placed by writ-
ing to Frank V. Cargill, Directory Department, Ameri-
can Medical Association, 535 North Dearborn St., Chi-
cago 10, Illinois.
^.«IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII»II|||||||||||||||||||||||||||||IIII||||||||||IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII||||||||||||||||||UIIIIIIIIIIIMIIIIIIIIIIIIMIIII*I;
THE VOCATIONAL HOSPITAL
TRAINS PRACTICAL NURSES
Nine months Residence course, Registered Nurses and |
Dietitian as Teachers and Supervisors. Certificate from 1
Miller Vocational High School. VOCATIONAL NURSES |
always in demand.
EXCELLENT CARE TO CONVALESCENT AND
CHRONIC PATIENTS
Rates Reasonable. Patients under the care of their own physicians,
who direct the treatment.
5511 Lyndale Ave. So. LO. 0773 Minneapolis. Minn.
DANIELSON MEDICAL ARTS PHARMACY, INC
PHONES:
ATLANTIC 3317
ATLANTIC 3318
10-14 Arcade, Medical Arts Building
825 Nicollet Avenue — Two Entrances — 78 South Ninth Street
MINNEAPOLIS
HOURS:
WEEK DAYS— 8 to 7
SUN. AND HOL.— 10 TO 1
PHYSICIANS AND HOSPITALS SUPPLY C0.; Inc.
414 SOUTH SIXTH ST., MINNEAPOLIS, MINN.
INSTRUMENTS • TRUSSES • EQUIPMENT • PHARMACEUTICALS • DRUGS
MAIN 2494
852
Minnesota Medicine
MEDICAL ECONOMICS
MEDICAL ECONOMICS
(Continued from Page 818)
Liberty Termed "Perishable"
Believing that liberty far outshines security, if a
choice is required, James A. Farley nevertheless
believes that liberty and security are compatible.
He states :
“We have got to get rid of the fixed idea that lib-
erty is imperishable on our continent. If the choice is
given to us of liberty or security, we must scorn the
latter with the proper contempt of free men who know
that liberty and security are not incompatible in the lives
of honest men.”
Poets, too, have carved verses dedicated to stop-
ping the spoilage of this perishable, commodity,
human liberty. For instance, the words of Walt
Whitman :
“To the States or any one of them, or any city of
the States, Resist much, obey little.
“Once unquestioning obedience, once fully enslaved,
“Once fully enslaved, no nation, state or city of this
earth ever afterward resumes its liberty.”
MINNESOTA ACADEMY OF MEDICINE
TREATMENT OF FRACTURES
( Continued from Page 821 )
were in traction with fractures of the fe.mur. I had one
trained assistant, the other men who were helping me
were gynecologists, obstetricians and pediatricians.
Naturally we wished that we had the Kuntchner nails at
that time because the treatment and responsibility of
187 fracture cases in traction was rather tremendous.
Dr. Cole has covered this subject very thoroughly and
evaluated it very properly. It is a procedure which has
merit and I am very glad that he ended his presentation
with one or two complications. I have seen many pa-
tients and I have seen many complications. I have
seen osteomyelitis, soft tissue infection, non-union, de-
layed union, broken nails and nails protruding from the
wound because the surgeon wasn’t able to drive it within
the distal fragment or remove it at the time of opera-
tion. I mention these many complications not to con-
demn the procedure because I agree that it is a valuable
procedure ; I mention them merely to emphasize the
importance of fracture training. When there are
emergencies and great numbers of fractures, we should
be prepared with fracture teams, so that they can be
treated with internal fixation without complications so
that they will not require many months of bed treat-
ment. Many phases of this problem are worthy of dis-
cussion but, because of the time, I will not continue.
Dr. Verne C. Waite, of Honolulu, Hawaii, then gave
a talk (by invitation) on “General Surgical Practice in
Hawaii.”
The meeting was adjourned.
Wallace P. Ritchie, M.D., Secretary
RELIABILITY!
For years we have maintained the
highest standards of quality, expert
workmanship and exacting conform-
ity to professional specifications . . .
a service appreciated by physicians
and their patients.
ARTIFICIAL LIMBS, TRUSSES,
ORTHOPEDIC APPLIANCES,
SUPPORTERS, ELASTIC HOSIERY
Prompt, painstaking service
Buchstein-Medcalf
223 So. 6th St. Minneapolis 2, Minn.
UTILITY • EFFICIENCY • SIMPLICITY
At your wholesale druggist or write for
further information
"DEE" MEDICAL SUPPLY COMPANY
P.O. Box 501, St. Paul, Minn.
1}jOjOjcL Ui&lotL &L (pMCWJUA.
When your eyes need attention . . .
Don't iust buy eye glasses, but eye care . . .
Consult a reliable eye doctor and then . . .
Let Us Design and Make Your Glasses
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Dispensing Opticians
25 W. 6th St. St. Paul CE. 5717
RADIUM RENTAL SERVICE
2525 INGLEWOOD AVENUE
MINNEAPOLIS 5, MINNESOTA
TEL. ATLANTIC 5297
Radium element prepared in
type of applicator requested
ORDER BY TELEPHONE OR MAIL
PRICES ON REQUEST
August, 1950
853
Classified Advertising
Replies to advertisements with key numbers should be
mailed in care of Minnesota Medicine, 2642 University
Avenue, Saint Paul 4, Minn.
WANTED — Locum tenens beginning in August for at
least six months. General practice near Twin Cities.
Permanent association if desired. Address E-214, care
Minnesota Medicine.
WANTED — Young physician to become associated with
very busy general M.D., near Twin Cities, with view
of partnership or buying practice. Address E-215, care
Minnesota Medicine.
WANTED — Young man, obstetrical training. Small
group practice in North Dakota. Excellent future. Ad-
dress E-220, care Minnesota Medicine.
WANTED IMMEDIATELY — By midwestern group —
Urological Assistant. Salary $4(30.00 per month. Mini-
mum requirements : Rotating internship. Address
E-221, care Minnesota Medicine.
FOR SALE — Northwest Washington — General practice,
$20,000 gross. Six-room office building with four-
room apartment under same roof. Centrally heated.
Selling for reasons of health. Address E-217, care
Minnesota Medicine.
FOR SALE — General practice and office equipment.
Minnesota county seat. New hospital. Practice avail-
able October 1. Retiring. Address E-223, care Minne-
sota Medicine.
FOR SALE — One Hamilton examination table, good as
new. Also National cautery and light, good as new —
only one tip used. Cheap. Address E-224, care Min-
nesota Medicine.
FOR RENT — Part-time office space, Highland area,
Saint Paul. Three jnoderate sized rooms and large
waiting room furnished. Address E-222, care Minne-
sota Medicine.
V\T E have scores of positions for general practitioners in
the Twin Cities, in this state and many other states.
We need general practitioners for locum tenens.
We have several locations and several practices for sale.
Among our many attractive openings for board men are the
following :
Pathologist for 600-bed midwest hospital ;
Orthopedic surgeon for excellent set-up in the Medical
Arts Building in an Arkansas City, practice and all equip-
ment for sale for price of equipment, by widow.
Write or visit us at one of our offices.
MEDICAL PLACEMENT REGISTRY
Rochester, Minnesota
11th Floor Kahler Hotel
Minneapolis
916 Medical Arts Bldg.
Saint Paul
Suite 480 Lowry Medical
Arts Bldg.
Minneapolis Campus Office
629 S. E. Washington
Gladstone 9223
Index to Advertisers
Abbott Laboratories 758
American National Bank 855
Anderson, C. F., Co., Inc 837
Ayerst, McKenna & Harrison 761
Benson, N. P., Optical Co 840
Bilhuber-Knoll Corporation 837
Birches Sanitarium 851
Birtcher Corporation 838
Brown & Day, Inc 852
Buchstein-Medcalf Co 853
Caswell-Ross Agency 754
Classified Advertising 854
Coca-Cola 841
Cook County Graduate School of Medicine 846
Dahl, Joseph E., Co 848
Danielson Medical Arts Pharmacy 852
“Dee” Medical Supply Co 853
Druggists Mutual Insurance Co 855
Ewald Bros Inside Back Cover
Franklin Hospital 855
Fleet, C. B., Co., Inc 759
General Electric X-Ray Corporation 771
Glenwood Hills Hospitals 829
Glenwood-Inglewood Co. 847
Hall & Anderson 855 i
Hazelden Foundation 833
Homewood Hospital 850
Juran & Moody 845
Kelley-Koett Mfg. Co 767
Lederle Laboratories 757
Lilly, Eli, & Co Front Cover; Insert facing page 772
Mead Johnson & Co 856
Medical Placement Registry 854
Medical Protective Co 847
Merck & Co 760
Milwaukee Sanitarium Back Cover
Minnesota Mutual Life Insurance Co 843
Mounds Park Hospital Back Cover
Mudcura Sanitarium 848
Muller Corset Co 835
Murphy Laboratories 855
North Shore Health Resort 839
Parke, Davis & Co Inside Front Cover, 753
Patterson Surgical Supply Co 850
Physicians Casualty Association 846
Physicians & Hospitals Supply Co 766, 852, 855
Professional Credit Protective Bureau 768
Quincy X-Ray & Radium Laboratories 849
Radium Rental Service 853 j
Rest Hospital 849
Reynolds, R. J., Tobacco Co 769 j
Roddy-Kuhl-Ackerman 853
St. Croixdale Sanitarium 756
Schering Corporation 765
Schmid, Julius, Inc 831
Schusler, J. T., Co., Inc 855
Searle, G. D., & Co 827
U. S. Vitamin Corporation 762
Upjohn 764
Vocational Hospital 852
Wander Co 1 763
Williams, Arthur F 855
Winthrop-Stearns, Inc 772
Wyeth, Inc 770
854
Minnesota Medicine
PHYSICIANS AND HOSPITALS SUPPLY CO.f Inc.
414 SOUTH SIXTH ST., MINNEAPOLIS, MINN.
INSTRUMENTS • TRUSSES • EQUIPMENT • PHARMACEUTICALS • DRUGS
MAIN 2494
Practical Nursing School
Approved by Minnesota State Board of Nurses
Examiners
Twelve months course open to High
School Graduates or women with equiv-
alent education.
For further information apply to
DIRECTOR OF NURSES
FRANKLIN HOSPITAL
501 W. Franklin Avenue, Minneapolis 5, Minn.
TAILORS TO MEN SINCE 1886
The finest imported and domestic wool-
ens such as SCHUSLER'S have in stock
are not too fine to match the hand tailor-
ing we always have and always will
employ.
I. T. SCHUSLER CO., INC.
379 Robert St. St. Paul
DO YOU HAVE CHILDREN?
Train them in the habit of sav-
ing money regularly through a
SAVINGS ACCOUNT with
this bank. . . . They’ll always
thank you. OPEN AN AC-
COUNT FOR THEM TO-
DAY.
THE AMERICAN NATIONAL BANK
OF SAINT PAUL
Bremer Arcade Robert at 7th CE 6666
Member Federal Deposit Insurance Corporation
Radiological and Clinical
Assistance to Physicians
in this territory
MURPHY LABORATORIES
Minneapolis: 612 Wesley Temple Bldg. - - At. 4781
St. Paul: 348 Hamm Bldg. - Ce. 7125
If no answer, call - Ne. 1291
Hall & Anderson
PRESCRIPTION PHARMACY
BIOLOGICALS
PHYSICIANS’ SUPPLIES
SAINT PAUL, MINN.
LOWRY MEDICAL ARTS BUILDING
TELEPHONE: CEDAR 2735
f \
UNUSUAL LENS GRINDING
CATARACT,
MYO-THIN
and other difficult
and complicated
lenses are ground to
extreme thinness and
accuracy by our
expert workmen.
SAINT PAUL
MINNESOTA
J
Insurance Druggists- Mutual Insurance Company p^mPl
at a OF IOWA, ALGONA, IOWA LOSS
Saving Fire - Tornado - Automobile Insurance Servick
MINNESOTA R E P R E S E N T A T I V E- S, E. STRUBLE. WYOMING, MINN.
August, 1950
855
Mead Johnson
EVA N 8 V I HI 1 N»
Mead Johnson
IVANIVI I II. I *«>
lactum
new evaporated milk
and Dextri-Maltose
formulas for infants
DALACTUM
EVAPORATED
LOW FAT MU K ami 01 X1R1 MAlTOSt
FORMUtA FOR INFANTS
13 fUllOST iwarti*l!onnvi'.'l<' :n.;k ..k m ‘'.uk S
14 *.ii- .«W-l V.I.V.I- t' HJ""*,
Liquid
Formulas
•
Convenient
•
Simple to
Prepare
•
Nutritionally
Sound
•
Generous in
Protein
evaporated
WHOLE MILK and DF XT HI MAlTOSl
FORMULA FOR INFANTS
Irom whiilis mill hkI I ‘
with add<?d vihimm D ilw,**/* /
♦vapwatfcd, canned atvi ^‘*0
For almost four decades physicians have recognized the merits
of infant-feeding formidas composed of cow’s milk, water and
Dextri-Maltose*.
In LACTUM and DALACTUM, Mead’s brings new convenience
to such formulas— for LACTUM and DALACTUM are prepared for
use simply by adding water.
LACTUM, a whole milk formula, is designed for full term infants
with normal nutritional needs. DALACTUM is a low fat formula
for both premature and full term infants with poor fat tolerance.
Both are generous in protein. *t. m. Reg. u. s. Pat. off.
Mead Johnson & co.
E V A N S V I L L E 2 1, I N D.f U. S. A.
Minnesota Medicine
CHLOROMYCETIN® is the first and only antibiotic to be
prepared synthetically on a commercial scale.
)
, a CHLOROMYCETIN is rapidly effective in a wide range of
infectious diseases, including urinary tract infections, bacterial and
atypical primary pneumonias, acute undulant fever, typhoid fever, other
enteric fevers due to salmonellae, dysentery (shigella). Rocky Mountain
spotted fever, typhus fever, scrub typhus, granuloma inguinale,
lymphogranuloma venereum.
!. CHLOROMYCETIN is well tolerated
The progress of the patient is, therefore, unhindered by serious side reactions.
L CHLOROMYCETIN is administered by mouth or by rectum*
Since the need for injection therapy is eliminated, treatment is
simple and convenient.
■
im CHLOROMYCETIN controls many diseases unaffected by
other antibiotics or the sulfonamides.
CHLOROMYCETIN’s remarkable antibiotic activity results in
quick recovery, smooth convalescence, and rapid return of the
patient to his customary activities. The end result is greater economy.
packaging
Chloromycetin,
( chloramphenicol, Parke-Davis ),
is supplied in Kapseals® 250 mg.,
and in capsules of 50 mg.
E
DO YOU KNOW
It is only on a Group Basis that you can have Accident and
Health Insurance with all these features
1. Individually non-cancellable
2. Renewable to age 70
3. Free of all objectionable exclusions
4. Low cost
5. No increase in premium for advance in age
6. Pre-existing conditions covered
7. No requirement of House Confinement
8. World Wide Coverage
Therefore, it would be well to give consideration to the Group
policy made available to you through your Association.
CASWELL-ROSS AGENCY
1177 N. W. Bank Building
Minneapolis — MA 2585
Insurors to:
Minnesota State Bar Association
Minnesota State Dental Association
Minnesota State Medical Association
Minnesota Society of C.P.A.
Minnesota State Pharmaceutical Assn.
Minnesota Auto Dealers Association
Hennepin County Medical Society
Hennepin County Bar Association
Minneapolis 2, Minnesota
St. Paul— ZE 2341
St. Paul District Dental Society
Minneapolis District Dental Society
St. Cloud Dental and Stearns County
Medical Society
Duluth District Dental Society
East Central Medical Society
St. Louis County Medical Society
Minnesota State Veterinarian Medical
Society
858
Minnesota Medicine
Journal of the Minnesota State Medical Association, Southern Minnesota Medical Association, Northern Minnesota
Medical Association, Minnesota Academy of Medicine and Minneapolis Surgical Society
Volume 33 SEPTEMBER. 1950 No. 9
Contents
Medical Practice on Level Four.
F. J. Elias, M.D., Duluth, Minnesota 877
Surgical Treatment of Mitral Heart Disease.
Ivan D. Baronofsky, M.D., Minneapolis, Minne-
sota, and John F. Briggs, M.D., Saint Paul,
Minnesota 881
The Significance of the Isolated Pulmonary
Nodule.
David V. Sharp, M.D., and Thomas J. Kinsella,
M.D., Minneapolis, Minnesota 886
Clinical Detection of Pulmonary Emphysema
from Respiratory Tracings.
Philip H. Soncheray, M.D., Minneapolis, Minne-
sota „ 889
Respiratory Allergies in Children.
Lloyd S. Nelson, M.D., and Albert V. Stoesser,
M.D., Minneapolis, Minnesota 893
Cancer of the Large Bowel.
Henry Fisketti, M.D., Duluth, Minnesota 897
Berylliosis.
Robert A. Nachtwey, M.D., Malcolm B. Dock-
erty, M.D., and Corrin H. Hodgson, M.D.,
Rochester, Minnesota 904
Benign Tumors, Nevi and Precanceroses.
Carl IV. Laymon, M.D., Minneapolis, Minnesota . . 908
The Emergency Maternity and Infant Care
Program in Minnesota (EMIC).
A. B. Rosenfield, M.D., M.P.H., Minneapolis,
Minnesota 910
History of Medicine in Minnesota.
Medicine and Its Practitioners in Olmsted
County Prior to 1900. ( Continued ).
Nora H. Guthrey, Rochester, Minnesota 914
President’s Letter :
Are You an 18 Per Center? 924
Editorial :
More Physicians in Service 925
Blood Banks 925
Medical Economics :
FSA Called Seed Bed of Socialism 927
Congressman Discusses Socialism — American
Variety 928
Minnesota State Board of Medical Examiners . . 929
American Medical Association — House of Dele-
gates— Summary of Proceedings 930
Reports and Announcements 934
In Memoriam 942
Of General Interest 944
Book Reviews 955
Contents of Minnesota Medicine copyrighted by Minnesota State Medical Association, 1950
Entered at the Post Office in Saint Paul as second class mail matter. Accepted for mailing at the special rate of postage provided
for in Section 1103. Act of October 3, 1917, authorized July 13, 1918.
September, 1950
859
MINNESOTA MEDICINE
Official Journal of the Minnesota State Medical Association
Published by the Association under the direction of its Editing and Publishing Committee
Office of Minnesota State Medical Association,
493 Lowry Medical Arts Bldg., Saint Paul 2, Minnesota.
EDITING AND PUBLISHING COMMITTEE
E. M. Hammes, Saint Paul
Philip F. Donohue, Saint Paul
H. W. Meyerding. Rochester
B. O. Mork, Jr., Minneapolis
C. L. Oppegaard, Crookston
T. A. Peppard, Minneapolis
H. A. Roust, Montevideo
O. W. Rowe, Duluth
Henry L. Ulrich, Minneapolis
A. H. Wells, Duluth
EDITORIAL STAFF
Carl B. Drake, Saint Paul, Editor
George Earl, Saint Paul, Associate Editor
Henry L. Ulrich, Minneapolis, Associate Editor
BUSINESS MANAGER
J. R. Bruce
Annual Subscription — $3.00. Single Copies — $0.40. Foreign and Canadian Subscriptions — $3.50.
The right is reserved to reject material submitted for editorial or advertising columns. The
Editing and Publishing Committee does not hold itself responsible for views expressed either in
editorials or other articles when signed by the author.
Classified advertising — ten cents a word; minimum charge, $2.00. Remittance should ac-
company order.
Display advertising rates on reauest.
Address all communications concerning the journal to Minnesota Medicine, 2642 University
Avenue, Saint Paul 4, Minnesota. Telephone Nestor 2641.
ST. CROIXD ALE ON LAKE ST. CROIX
PRESCOTT, WISCONSIN
MAIN BUILDING— ONE OF THE 8 UNITS IN “COTTAGE PLAN”
A Modern Private Sanitarium for the Diagnosis, Care and Treatment of Nervous and Mental Disorders
Located on beautiful Lake St. Croix, eighteen miles from the Twin Cities, it has the advantages of both
City and Country. Every facility for treatment provided, including recreational activities and occupational
therapy under trained personnel. Close personal supervision given patients, and modern methods of
therapy employed. Inspection and cooperation by reputable physicians invited. Rates very reasonable.
Illustrated folder on request.
NEUROPSYCHIATRISTS
PRESCOTT OFFICE
Prescott, Wis.
Howard J. Laney, M.D.
Tel. 39 and Res. 76
Hewitt B. Hannah, M.D
Andrew J. Leemhuis, M.D.
Howard J. Laney. M.D.
511 Medical Arts Building
Minneapolis, Minnesota
Tel. MAin 1357
SUPERINTENDENT
Dorothy M. Most, R.N.
Prescott, Wisconsin
Tel. 69
860
Minnesota Medicine
“Premarin”— a naturally oc-
curring conjugated estrogen
which has long been a choice of
physicians treating the climac-
teric—is earning further clinical
acclaim in the treatment of
functional uterine bleeding.
The aim of estrogenic therapy
in functional uterine bleeding
is to bring about cessation of
bleeding, and to produce sub-
sequent regulation of the cycle.
Once hemostasis is achieved,
the maximum daily dosage of
“Premarin” must be continued
to prevent recurrence of bleed-
ing. This schedule forms part
of cyclic estrogen-progesterone
treatment for attempted salvage
of ovarian function.
While sodium estrone sulfate
is the principal estrogen in
“Premarin” other equine estro-
gens... estradiol, equilin, equi-
lenin, hippulin...are probably
also present in varying amounts
as water-soluble conjugates.
An "estrogen of choice
for hemostasis
is Tremarin’
in tablets of 1.25 mg. . . .
The usual dose for hemostasis
is 2 tablets three times a day.
If bleeding has not decreased
definitely by the third day of
treatment the dosage level
may be increased by
50 per cent.”"
*Fry, C. 0.: J. Am. M. Women’s A. 4:51 (Feb.) 1949
Estrogenic Substances ( water-soluble)
also known as Conjugated Estrogens (equine)
Four potencies of “Premarin” permit flexibility of
dosage: 2.5 mg., 1.25 mg., 0.625 mg., and
0.3 mg. tablets; also in liquid form, 0.625 mg. in each
4 cc. ( 1 teaspoonful ) .
Ayerst, McKenna & Harrison Limited
22 East 40th Street, New York 16, N. Y.
5009
September, 1950
861
Cl"><jnr f oZ7
CAQTiCMt Ct, '
Handier
than euer
UNIVERSAL MODEL
CLINITEST
(BRAND)
urine-sugar
analysis set
Optional Tablet Refill
Sealed in Foil t illustrated)
or Bottle of 36
• complete • compact
• clinically dependable
The attractive new plastic case, hardly larger
than a cigarette package, includes complete facilities
for urine-sugardetection. Your diabetic patients, long
accustomed to depend upon the rapidity, accuracy
and convenience of Clinitest (Brand) Reagent Tab-
lets, will find the new Universal Model (No. 2155),
with optional tablet refills, handier than ever.
Clinitest, reg. trademark
1 CLINITEST Urine-sugar Analysis Set
UNIVERSAL MODEL No. 2155
Contents:
10 CLINITEST (Brand) Reagent Tablets
(Sealed in Foil)
Instructions and Analysis Record
Test tube and Dropper
CLINITEST (Brand) Color Scale
may be refilled with:
Scaled in Foil tablets (from No. 2157)
or bottle of 36 tablets (No. 2107)
Clinitest (Brand) Urine-sugar Analysis Set (No. 2106) with
the bottle of 36 tablets will continue to be available.
AMES COMPANY, INC., ELKHART, INDIANA
Ames Company of Canada, Ltd., Toronto
Minnesota Medicine
a
new
drug . . .
for the treatment of ventricular arrhythmias
PRONE ST YL Hydrochloride
Squibb Procaine Amide Hydrochloride
Oral administration of Pronestyl in doses of 3-6 grams
per day, for periods of time varying from 2 days to
3 months, produced no toxic effects as evidenced
by studies of blood count, urine, liver function,
blood pressure, and electrocardiogram. Pronestyl
may be given intravenously with relative safety.
Pronestyl Hydrochloride Capsules, 0.25 Gm., bottles of 100 and 1000.
Pronestyl Hydrochloride Solution, 100 mg. per cc., 10 cc. vials.
For detailed information on dosage and administration , write for
literature or ask your Squibb Professional Service Representative .
MANUFACTURING CHEMISTS TO THE MEDICAL PROFESSION SINCE 1858
Again, Keleket sets the pace with a
money-saving development. NOW — ALL
UNITS— 200 MA, 300 MA and 500 MA
use the SAME TRANSFORMER and CON-
TROL which can be produced at a savings...
passed on to you!
By standardizing many parts of the world-
famous Multicrons, Keleket is able to offer
custom-built units . . . which fit your individ-
ual requirements exactly ... at most attrac-
tive prices.
Every unit is equipped with the same func-
tionally designed cabinet, finished in hand-
some Kelekote.
new-
CUSTOM-BUILT
This unit may be installed permanently, even
in a wall, with no worry about alterations
. . . should your future technic requirements
call for the higher capacity Multicrons.
All units . . . 200 MA, 300 MA and 500 MA...
include the features which have made Keleket
Multicron Controls so popular with radiolo-
gists . . . for flexibility, convenience and
accuracy.
the
200 MA
vertical
control
The controls are rated as follows:
DIAGNOSTIC
200 MA unit — 125KVP al any MA from 25 to 200
300 MA unit— 125 KVP of any MA from 25 to 300
500 MA unit— 125 KVP at any MA from 25 to 500
THERAPY
All units— 140 KVP to 10 MA
An optional Photo-Timer and Photo-Timing
pushbutton control can be mounted in the verti-
cal controls. Unit is so designed and engineered
that only minor alterations are required to effect
increased capacity and timer changes.
Telephone or write for complete details
KELLEY-KOETT X-RAY SALES CORP. OF MINN
1225 NICOLLET AVE.
TEL. AT. 7174
MINNEAPOLIS 3, MINNESOTA
864
Minn esota Medicine
VERTICAL CONTROLS...2QO MA...300 MA...500 MA
r the SAME
TRANSFORMER
and CONTROL
...adaptable for
ALL CAPACITIES
the
300 MA
vertical
control and
transformer
■■■ _
timer
exchange
September, 1950
865
BIRDS ahSL dsLixwjdsuL pwm , h opt Ho a
and, like these ancestors, they do not perspire:
but many a doctor is, as they say, "sweating blood"
^ over his collections. (Or, if he isn't, his secretary is.)
Leaving ornithology and herpetology out of it and getting down to sheer economics
the fact is that while we know nothing about medicine we do know ACCOUNTS
RECEIVABLE. With your permission we would like to deal with your secretary — -
or with you if you have the time — and take off your hands all accounts more
than six months past due. One hour spent plucking those accounts from your ledger
now and turning them over to
PROFESSIONAL CREDIT PROTECTIVE BUREAU
for deft, tactful, conscientious, firm and effective approach and consummation of
collection may save you hundreds of dollars, hours of distraction and a tremen-
dous amount of consideration as to whether or not you are going to sacrifice any
goodwill. These are days of tension. Old accounts aren't going to be any easier
to gather in during the winter than now or early fall, maybe not as easy. It's
time to take action.
PRO-
This is a personalized, completely proved procedure. We have no black magic,
no inspired touch, but what we do have is a know-how on professional debits,
a background in getting in the outstanding, a technic of careful analysis of
each account, a knack of taking it over as your representative in the same
decent way in which you would function. The returns flow to you direct
and not through us. This kind of faithful service and understanding
treatment has brought in hundreds of thousands of dollars to other
practitioners and we would like very much to put ourselves
FESSIONAL \ at your disposal and become one of the effectives of your
CREDIT PROTECT- n. office. Send us 35 accounts which we will handle for $35;
IVE BUREAU \ 105 accounts for $100; we to receive 20% for all monies
724 Metropolitan Lite Bldg., 'X. paid to you. AND THE ACCOUNTS CAN BE TOUGH
Minneapolis, Minn. X. ONES " TOO!
We will take collection service
Tear off the corner of this page and fill in
your name and address. We will send you
the required forms and a written guar-
anty. And be assured that we do
all the work.
on 35 accounts, $35
on 105 accounts, $100.
-(check
. which)
You to send us necessary forms and written
guaranty, you to do all the work;
we to pay you 20% of all amounts collected.
Name
Firm
Address
(BuL . . .
CkL View!
866
Minnesota Medicine
in Childhood
Now is the season for children to enter upon
their scholastic labors, and in most commu-
nities to receive either primary, or booster,
immunization against several of the common
childhood infections. Reliance must be placed
upon antibiotics to control the secondary in-
vaders which may follow these infections. Pe-
diatricians are increasingly turning to aureo-
mycin for this purpose, because of its wide
range of activity against the common Gram-
positive and Gram-negative organisms.
Aureomycin is also indicated for the con-
trol of the following infections:
Acute amebiasis, bacterial infections asso-
ciated with virus influenza, bacterial and
virus-like infections of the eye, bacteroides
septicemia, boutonneuse fever, brucellosis,
chancroid, Friedlander infections (Klebsiella
pneumonia), gonorrhea (resistant), Gram-
negative infections (including those caused by
some of the coli-aerogenes group), Gram-
positive infections (including those caused by
streptococci, staphylococci, and pneumococci) ,
granuloma inguinale, H. influenzae infections,
lymphogranuloma venereum, peritonitis,
pertussis infections (acute and subacute),
primary atypical pneumonia, psittacosis
(parrot fever), Q fever, rickettsialpox, Rocky
Mountain spotted fever, sinusitis, subacute
bacterial endocarditis resistant to penicillin,
surgical infections, tick-bite fever (African),
tularemia, typhus and the common infections
of the uterus and adnexa.
Capsules: Bottles of 25, 50 mg. each capsule. Bottles of 16, 250 mg. each capsule.
Ophthalmic: Vials of 25 mg. with dropper; solution prepared by adding 5 cc. of distilled water.
LEDERLE LABORATORIES DIVISION American Cijnnnmul company 30 Rockefeller Plaza, New York 20, N. Y.
September, 1950
867
868
Minnesota Medicine
For Safe Symptomatic Relief
During the “Late” Hay Fever Season
1 here are good reasons why many al-
lergists consider “late” hay fever a more
serious threat than the Spring and Sum-
mer types of seasonal allergy: ragweed
pollens cause a greater incidence of hay
fever than all other pollens combined;
more pollens are in the air during the
ragweed season than at any other time;
and since “the United States is the fa-
vorite habitat of ragweed, it has the du-
bious distinction of harboring more hay
fever victims than all the rest of the
world together.”1
Fortunately, more and more patients
each year are enjoying the therapeutic
benefits of Neo-Antergan® Maleate. Be-
cause of its safe and strikingly effective ac-
tion in relieving the distressing symptoms
of allergy, Neo-Antergan has become a
favorite antihistaminic with physicians
and patients — in every season of the year.
Neo-Antergan is advertised exclu-
sively to the medical profession. Y our
patients can secure its benefits only
through your prescription.
Neo-Antergan Maleate is stocked by your
localpharmacy in25mg. and 50 mg. tablets.
Complete information concerning its
clinical use will be sent on request.
iCooke, R. A.: Allergy in Theory and Practice.
Philadelphia: W. B. Saunders Company, 1947, p. 186
MERCK & CO., Inc.
Atanufa during Chemists
RAHWAY, NEW JERSEY
Neo-Antergan'
MALEATE Cy
(Brand of Pyranisamine Maleate)
(N-p-methoxybenzyl-N',N'-diinethyl-N-a-pyridylethylenediamine maleate)
COUNCIL ACCEPTED
September, 1950
869
hen all signs point
foods .
• When he’s hungry — when his
gourmand’s soul begins to rebel against the
dull, plodding pace of the reducing diet —
this is when physician and patient
alike welcome a relatively safe,
effective central stimulant. • With
Desoxyn Hydrochloride, small
doses are sufficient to produce
the desired cerebral effect —
anorexia, elevation of mood
and desire for activity —
with relative freedom from undesir-
able side-effects. Smaller dosage
is possible because, weight
for weight, Desoxyn is more
potent than other sympatho-
mimetic amines. Other
advantages are Desoxyn’s
faster action, longer effect.
One 2.5-mg. tablet before break-
fast and another about an hour
before lunch are usually sufficient.
A third tablet may be taken about
3:30 in the afternoon, but after 4 p.m.
it may cause insomnia in some persons.
With small oral doses, no pressor effect
has been observed. • Why not give
Desoxyn a trial? Unless contraindicated,
small doses are harmless. And small doses
well placed may mean the difference between
success and failure in the out-
come of the reducing regimen. UjjtKfiL
the name
DESOXYN
hgdrochloride
(METHAMPH ETAMINE HYDROCHLORIDE, ABBOTT)
870
Minnesota Medicine
to florida
in december
ollens may invade the air as early as January in
alifornia and last through December in Florida.
vherever hay fever may be
id whatever the pollens, a valued measure of symptomatic
dief can be expected in most patients with
Trimeton*
(brand of prophenpyridamine)
Packaging: Trimeton Tablets
(prophenpyridamine) 25 mg.
Bottles of 100 and 1000 scored tablets.
Trimeton Maleate Elixir containing
7.5 mg. per teaspoonful is available
in bottles of 4 and 16 oz.
Patients taking Trimeton should be
informed of the nature of side effects
common to all antihistamines.
UMETON,® one of the first of the more
(tent antihistaminic compounds,
mtinues to be, as always, a reliable
eans of making the hay fever sufferer
ore comfortable. Because the
cidence of side effects is relatively
w, it is rarely necessary to
scontinue Trimeton.
CORPORATION • BLOOMFIELD, NEW JERSEY
TRIMETON *
from head to toe
Cere vim,
CEREALS + VITAMINS + MINERALS
1. "A Study of Enriched Cereal in Child Feeding'' Urbach,
C.; Mack, P. B., and Stokes, Jr., J: Pediatrics 1:70, 1948.
♦Cerevim contains neither vitamin A nor C but possibly
exercises an A-and-C sparing effect attributed to its
high content of protein and major B vitamins.
CEREViM-fed children showed greater
clinical improvement, in the following
nutrition-influenced categories, than
children fed on ordinary unfortified
cereal or no cereal at all:1
hair lustre
recession of corneal invasion
retardation of cavities
condition of gums
condition of teeth
skin color
skeletal maturity
skeletal mineralization
*blood plasma vitamin A increase
*blood plasma vitamin C increase
subcutaneous tissues
dermatologic state X
urinary riboflavin output
musculature
plantar contact
Here’s why: Cerevim is not just a cereal.
Much more: Cerevim provides 8 natural
foods: whole wheat meal, oatmeal, milk
protein, wheat germ, corn meal, barley,
Brewers’ dried yeast and malt — PLUS
added vitamins and minerals.
SIM1LAC DIVISION
w
V
M Sc R DIETETIC
LABORATORIES, Columbus 1G, Ohio
872
Minnesota Medicine
Now Proof.. . in an instant, Doctor,
Philip Morris are less irritating
Just Make This Simple Test:
A
. . . light up a
Philip Morris
Take a puff -DON'T INHALE. Just
s-l-o-w-l-y let the smoke come through
your nose. Easy, isn't it? AND NOW. . .
. . . light up your present brand
DON'T INHALE. Just take a puff and
s-l-o-w-l-y let the smoke come through
your nose. Notice that bite, that sting?
Quite a difference from Philip Morris!
YES, your own personal experience confirms the results of the clinical
and laboratory tests.* With proof so conclusive, would it not be good practice to
suggest Philip Morris to your patients who smoke?
Philip Morris
Philip Morris & Co., Ltd., Inc.
100 Park Avenue, New York 17, N. Y.
*Proc. Soc. Exp. Biol, and Med., 1934, 32, 241-245; N. Y. State Journ. Med., Vol. 35, 6-1-35, No. 11, 590-592;
Laryngoscope, Feb. 1935, Vol. XLV , No. 2, 149-154; Laryngoscope, ]an. 1937, Vol. XLV11, No. 1, 58-60
September, 1950
873
The Seal of Acceptance de-
notes that the nutritional state-
ments made in this advertise-
ment are acceptable to the
Council on Foods and Nutri-
tion of the American Medical
Association.
That a nutritious breakfast providing generous amounts of high quality
protein prevents late morning hypoglycemia has been amply demon-
strated. As shown by Thorn and co-workers,1 and later confirmed by
Orent-Keiles,2 . . breakfast high in protein and low in fat and carbo-
hydrate was followed by an improved sense of well-being and no symp-
toms of hypoglycemia.”
Meat for breakfast— ham, sausage, bacon, breakfast steaks— is an
appetizing means of increasing the protein content of the morning meal.
Its biologically complete protein contains all essential amino acids,
and serves well in complementing less complete proteins from other
sources. Furthermore, muscle meat is an outstanding source of B
complex vitamins and of iron.
(1) Thorn, G.W.; Quinby, J.T., and Marshall, C., Jr., Ann. Int. Med. 18:913 (June) 1943.
(2) Orent-Keiles, E., and Hallman, L. F., Circular No. 827, United States Department of
Agriculture, Bureau of Human Nutrition and Home Economics, Agricultural Research
Administration, Dec., 1949.
American Meat Institute
Main Office, Chicago... Members Throughout the United States
874
Minnesota Medicine
PHYSICIANS AND HOSPITALS SUPPLY CO./ Inc.
MINNEAPOLIS MINNESOTA
PHYSICIAN'S DESK
combines attractive comfort with working efficiency
• Spring seat construction
• Plastic or genuine leather upholstery
• Walnut, mahogany or wheat finish on
birch
• Width between arms — 19"
• Depth of seat — 18"
• Height of back above seat — 19"
A COMBINATION OF ATTRACTIVE DESIGN, COMFORT AND DURABILITY
Write for Prices M-950
• Height quickly and easily adjustable —
58" width
• Eye-comfort, engineered finish
9 Drawers completely interchangeable —
quickly adjustable drawer partitions
• Drawer depth for 5" x 8 file with tabs
• Recessed back panel — leg room for sec-
retary or visitors
• “Levelmatic" floor controls prevent vi-
bration and "wobble"
• Permafit drawers — no swelling, warping
or binding. Turn of key unlocks all
drawers immediately
o Knee posts are mar-proof, snag-proof
• All hardware recessed
P&H desks are also available in conference, secretarial, typist and interviewer
models with matching tables and other accessories.
MODERN
ufihol&JtsiAJuL
OFFICE CHAIRS
September, 1950
875
not “food allergy”. . . but “casein allergy”
Inability to tolerate milk casein is one of the most frequent causes of allergy
in infants. Casein allergy, as manifested by such symptoms as gastrointestinal
upsets and atopic eczema, may follow the ingestion of any animal milk. In true
casein allergy, all animal milks, including goat’s milk, must be avoided.
In such cases Mull-Soy provides the answer. Mull-Soy compares closely with cow's
milk in nutritional values of protein, fat, carbohydrate, and minerals.
Mull-Soy is a liquid, pleasant-tasting, homoge-
nized, stable (vacuum packed) food, high in unsat-
urated fatty acids.
At drugstores in 15’/, fluidounce tins
For hypoallergenic diets in infants and adults look to
MULL-SOY*
The Borden Company
Prescription Products Division
350 Madison Avenue, New York 17
Mull-Soy diluted with equal volume of water
Average whole cow’s milk
20 calories
per fl. oz.
876
Minnesota Medicine
Journal of the Minnesota State Medical Association, Southern Minnesota Medical Association, Northern Minnesota
Medical Association, Minnesota Academy of Medicine and Minneapolis Surgical Society
Volume 33
SEPTEMBER. 1950
No. 9
MEDICAL PRACTICE ON LEVEL FOUR
F. I. ELIAS, M.D.
Duluth, Minnesota
npHE ninety-seventh annual meeting of the
Minnesota State Medical Association is a sig-
nificant occasion in significant times — but it is
obvious now to all of us that history has not
stopped long enough to allow us to catch our
breath.
We are on level four of our cultural develop-
ment and, in many ways, we are unable to cope
with the discoveries that led us to levels two and
three.
“What is level four?” you may ask. “How did
we get there and where is it?”
Customarily we reckon time in years' or centu-
ries. We may stop and reflect that we are now
halfway through the twentieth century. But the
students of cultural growth tell us that we have
developed by stages . . . according to the time it
has taken us to discover that we could turn the
sun and the fossilized products of the earth and,
finally, matter, mysterious, formulae-ridden mat-
ter, into energy for use in supplying our needs.
Our struggles to capture free energy have
brought us to level four, the here and now. It’s
the mutable, shifting, disconcerting, challenging
present that alternately fills us with optimism and
despair. It is a state of mind and a state of
culture. It is — and not incidentally — the level on
which we are trying to keep our discoveries from
destroying us.
For it is inevitably true that our possibilities
have outdistanced our needs, and our knowledge
is too far ahead of our reason.
Medical science has established its own peaks
and plateaus on this level four of atomic living.
Presidential address given at the annual banquet of the
Minnesota State Medical Association, Duluth, Minnesota, June
13, 1950.
We know that the foundations for medical ad-
vances were laid, in many cases, before the first
atomic explosion catapulted us onto level four.
But they were waiting to come into fruition.
Now we have the dual prospect of longer and
longer life or immediate mass suicide. Will the
life-lengthening discoveries of science be can-
celled out by the life-extinguishing discoveries of
science? Or will man’s greater maturity, that
longer life is bringing, be able to shift the direc-
tion of our discoveries into channels of greater,
more productive and pleasanter living?
Medicine must assume its responsibilities in this
crisis of scientific, sociological and economic de-
velopment, if ,the outcome is to be a fortunate
one.
And to gauge those responsibilities, we must
look back, across the years, to a time when life
was simpler because so many of its consequences
could safely be termed “inevitable,” and so many
of its problems, “insoluble.”
Our general knowledge and, more especially,
our scientific knowledge have changed our lives
more in the past twenty years than in the pre-
vious fifty — more in that fifty years than in the
previous two hundred. We may then, for all
practical purposes, take the first half of the twen-
tieth century as our quantity X.
In that time we have reaped the rewards of
the germ theory of disease, for, with chemo-
therapy and public sanitation, we have all but mas-
tered many disease micro-organisms — as signifi-
cant a development as stone age man’s successful
battle with external organisms — the animals that
preyed upon him until, with superior intelligence,
he outwitted them.
September, 1950
877
MEDICAL PRACTICE ON LEVEL FOUR— ELIAS
I he doctor of yesterday, who hurried to his
patients with about equal amounts of sympathy
and science, was welcomed by the anxious fami-
lies, although they knew his limitations almost as
well as he knew them, himself. But he was there,
a friend and confidante, who yielded with them
to the inevitable, when his meager science failed.
But the doctor of today and, with greater
truth, the doctor of tomorrow, is welcomed by
the anxious families because he is the master of a
mysterious science, a twentieth century worker
of miracles who is not expected to yield, but to
conquer the inevitable.
Thus, our responsibilities as doctors have be-
come greater . . . the further we crowd back the
barriers of disease and death, the further we are
expected to push them. And, at the same time,
more is expected of us as interpreters of this
science, as leaders in the thought patterns that are
emerging from scientific discoveries that consti-
tute the very core of our civilization.
In administering the heady potion of longer
living, we have incurred an obligation of helping
to direct the use of these added years and to form
logical answers to the questions that stand between
man and a clear title to his new longevity.
Science has multiplied upon itself, like the mold
of penicillin develops in a culture tube. Discov-
ery has spawned upon discovery. One man has
supplied the clue to another’s experiment and that,
in turn, has led to yet another development . . .
as exemplified bv Dr. Banning’s idea for insulin,
prompted by reading an article by Dr. Barron of
Minneapolis — or the investigations of Whipple,
which were followed by the work of Minot, Mur-
phy and Castle and finally of Cohn, and resulted
in liver extract. And now we have a further de-
velopment in pernicious anemia therapy — vitamin
B , 2 — which, injected in such infinitesimal amounts
as one microgram daily, will cause a remission in
this once-fatal disease. Fleming, followed by
Morey, was, of course, responsible for penicillin,
now being produced at the rate of something
like four thousand billion units per month in the
United States.
And scientific discoveries have generated new
forms of application. By continuous and flexible
interpretations of medical science, Minnesota, for
instance, has cut its tuberculosis death rate from
106.4 per 100,000 in 1900 to 13.8 in 1949.
Duluth represents a striking example of prog-
ress in sanitation. In the early years it had the
highest mortality rate in the cities of its class, as
a result of typhoid fever. For a number of years
now it has occupied a distinctive position in its
freedom from this disease.
Within the span of my own life, I have ob-
served medical science in headlong progress. I
remember the ponderous static machine for the
development of an unstable potential to energize
a similarly unstable gas-filled x-ray tube, acquir-
ing with these, if we were fortunate, an exposure
on a glass plate comparable to that of Roentgen’s.
Similar in antiquity was the apparatus used in an
assignment with the British Expeditionary Forces
in the hirst World War, with equipment ener;
gized by an induction coil and, for interruptions
of the current, electrodes separated in a cham-
pagne bottle! In the field of chemotherapy, the
first administration of salvarsan was attended by
procedure and preparation of major surgical pro-
portions. Likewise, precisely prepared Dakin’s
solution was once accepted as the final answer to
the control of sepsis in wounds. And there has
been an ebbing of lay and medical confidence in
the prevention of colds by antihistamines similar
to the rejection of chlorine inhalation.
It may sound pretentious or provincial to say
this, but, in Minnesota, the problems relating to
science are perhaps at a high point in the nation.
For here we have concentrated so deeply on their
primary phases. I have recounted to you our
progress in a few special fields of disease. Min-
nesota has distinguished itself, medically, through
the endeavors of such men as Dr. Justus Ohage,
who performed the first successful cholecystec-
tomy in America; Dr. Charles Hewitt, pioneer
public health worker; Dr. Edward Bockman, who
introduced a new type of surgical suture . . . and
. . . this is interesting . . . Dr. Hillard Holm, who
performed one of the few successful operations
separating Siamese twins.
I might remind you, too, of our record-break-
ing strides in maternal and infant health. And
there begins the broad, general problem. We are
giving the citizens of our state a head start in
health. With low infant mortality figures, with
subsequent control over communicable diseases
and skilled corrective surgery, we are saving hun-
dreds of persons who will eventuallv become
geriatric problems.
In between, of course, there are broad areas for
study and investigation. We need to turn our
attention to the patient as a whole, not just as
878
Minnesota Medicine
MEDICAL PRACTICE ON LEVEL FOUR— ELIAS
a person suffering from one or more particular
maladies. As physicians, we should consider the
subject of health as a whole, interesting ourselves
in maintaining the individual’s health as well as
curing him of a disease.
And. too. there is the relatively uncharted field
of bodv chemistry. Why does the body react so
strangely to certain hormones, to emotional
shocks, to the barely discernible scars of earlier
illnesses? When we know, we may be in a po-
sition to add another twenty or fifty years to the
average life span.
Always, concurrently with the question of
“What can we do to extend life?” comes the ques-
tion of “What will the added years mean ?”
We have left the orderly, unalarming scientific
patterns of the nineteenth century. We have
ceased to regard the lighted areas of science as
the onlv known world . . . instead we spend most
of our time in the shadowy patches of near
knowledge and the dark of unexplored territory.
Our scientific creativity is no longer subject to
the old accepted rules. Everv day we make new
rules for ourselves and, in so doing, we find that
many times our previous thinking and experimen-
tation fall into place and another pattern of prog-
ress is complete.
But, in the process, just as we have. subjected
every rule, every supposed truth to restudy, so
have we abandoned our belief that progress is nec-
essarily and automatically for the best.
Progress, we observe, is what we make of it.
And nowhere is there a better example than in
the development of atomic energy. This is prog-
ress, ves, but a double-edged progress that can
add new dimensions to life or. wielded in reverse,
will mean obliteration of all life.
Fissioning atoms are providing medical men
with, among other things, such important tools
as radioactive tracers, which are being put to
use in the fight against cancer and are revolution-
izing biology and medical research. The pros-
pects for atomic energy . . . and for the newer
explorations in hydrogen . . . are limitless, as we
see them now. Or they may be strictly limited
by the production of a few highly accurate, in-
finitely destructive bombs.
With the increased leisure afforded by mecha-
nization and our highly complex industrial civili-
zation, man has supposedly more time to think,
to mature, to devote a larger portion of his life to
the arts . . . and with the gift of twenty addi-
tional years . . . man should be approaching the
most exemplary period of human history.
But can we hope for realization of this theory ?
Probably not. For hasn’t the machine super-
ceded the man? Hasn’t science outspaced con-
science ?
It would appear that our most perplexing and
immediate puzzle is one of understanding. We
must think our way to the formation of a philos-
ophy sturdy enough and flexible enough to with-
stand the impacts of level four living.
The comprehension of the man who lives on
level four does not seem adequate. He cannot
understand even the relatively basic fundamentals
of his own existence . . . and the prospect of
lengthening life appears terrifying, instead of
inviting, to him because he feels that in his later
years he may be more vulnerable to the perils of
an economically dependent existence.
What can we, as the practitioners and spokes-
men of one scientific profession, do to help?
Our duties as physicians at this time are akin
to our duties as citizens, it would seem to me.
I will not reiterate our continual responsibilities
to become better doctors, to search for and re-
tain the knowledge and skills we need to per-
form our scientific tasks to the best of our ability.
We are inescapably aware of that necessity.
But, it is in the somewhat broader science of
human relationships that our obligations some-
times fail to appear in sharp focus and personally
applicable. We do not seem to keep an alert atti-
tude in that field ... to seize, as in medical
science, upon an idea, a thought, the dawning com-
prehension of a truth and to build on it with our
own interest and observation and experience ; in
short, to be as skilled in the epidemiology of
sociological and political and economic diseases
as we are in the epidemiology of physical disease.
I do not know why we fail so often here, but
I assume that it is because we consider our lives
well spent if we have given full devotion to our
profession. And, while, categorically, we may
divide this discipline into prevention, diagnosis
and treatment, we do not realize that in the per-
formance of this duty, we are bringing other
duties upon ourselves which cannot be postponed
or evaded.
First, let’s not add to the mystery surrounding
science. Let’s explain scientific advances in sim-
ple terms to our patients. Let’s help them to
understand their physical selves and to have a
September, 1950
879
MEDICAL PRACTICE ON LEVEL FOUR— ELIAS
general idea of the workings of the human body
and, if they are ill, to understand why they are
ill, how seriously ill, and what is being done to
remedy the damage done by malfunction or
micro-organisms.
Through understanding of one science, the
people with whom we come in contact will be
less unwilling to attempt at least a partial, out-
line understanding of other sciences that affect
and influence their lives. With comprehension
of the basic principles of all, will come a more
satisfactory adjustment to environment, a firmer
stand on the shifting grounds of atomic level four.
Then, we must initiate a re-evaluation of the
longer life span that is unfolding for us all. Is
it a valuable gift or a Pandora’s box that will
loose great economic and social evils in the world ?
Its potentialities are all for good. Coupled
with the expanding educational system — which
has enabled 40 per cent of our children to go
through high school and 7 per cent through col-
lege— longer life should mean better, happier
life — more expressive and more complete.
We’re being better trained and educated, mech-
anized industry gives us more leisure and more
luxuries for our leisure, and we have a longer
time in which to enjoy the good things of the
world. Why then, has the assurance of longer
life made us so uncertain of our abilities to
utilize it?
It is partly because the economically self-suf-
ficient individual has all but disappeared from
twentieth century, level four America. We are
dependent upon each other, and yet we don’t
know how to be profitably dependent upon each
other.
We are looking for an impersonal leaning post
— like the government — fearful of trusting our-
selves or each other.
This, then, is the crucial decision point we
reach in mid-twentieth century. As physicians,
we can and must help to turn the tide of public
thinking.
Nor can we rely on the easy, status quo atti-
tude of “peace or plenty or tolerance in our
time.” We must face our problems now . . . for
the heritage we pass on should not include the
fears and distrust and political shif tings of today.
These are the causes — understanding, and the
development of a self-reliant and mutually help-
ful philosophy — to which we must assign our-
selves. We must be just as fanatical about good
as the Leninists are fanatical about evil. We must,
to paraphrase Lenin himself, find within our
ranks people who will devote not just their spare
evenings, but the whole of their lives, to the ad-
vancement of the principles we have chosen to
abide by.
COMPOUND F SYNTHESIZED
A synthesized adrenal hormone chemically similar to
cortisone and known as Compound F is proving effective
against rheumatoid arthritis, researchers of the Mayo
Clinic, Rochester, Minnesota, report.
Announcement of the synthesis of Compound F was
made recently by a pharmaceutical company (Upjohn
Company, Kalamazoo, Mich.) The company did not
say what this synthesis will mean in terms of produc-
tion, other than to emphasize that the amount of Com-
pound F available does not allow distribution for other
than limited clinical testing at the present time.
The report of trial of Compound F against rheuma-
toid arthritis was made by Dr. Howard F. Polley (one
of the group from the Mayo Clinic who originally re-
ported the effects of cortisone and ACTH against the
disease) and Harold L. Mason, Ph.D., in the (August
26) Journal of the American Medical Association.
“Significant antirheumatic activity was possessed by
17-hydroxycorticosterone (Compound F),” they say.
“Minor structural alteration from cortisone occurs in 17-
hydroxycorticosterone. Our supply in the last year has
permitted trial on one patient, a woman forty-nine years
old, whose severe rheumatoid arthritis had been present
three years and who had responded well to cortisone and
to ACTH.
880
Minnesota Medicine
SURGICAL TREATMENT OF MITRAL HEART DISEASE
IVAN D. BARONOFSKY, M.D.
Minneapolis, Minnesota
and
JOHN F. BRIGGS, M.D.
Saint Paul, Minnesota
f I ’HE NEED for a safe technical approach to
-*■ the surgical treatment of chronic valvular dis-
ease of the heart has been recognized for many
years. The idea is not new, as the surgical treat-
ment of mitral stenosis was first suggested by
Brunton3 in 1902. In 1912, Tuffier22 attempted
actual dilatation of a stenosed aortic valve. In
1929, Cutler and Beck4 summarized their personal
experiences in the surgical treatment of 8 cases
of mitral stenosis, the mortality for the group
being 83 per cent. Since that time much progress
has been made in the field of thoracic surgery.
These advances, combined with recent develop-
ments in chemotherapy and the sound present-day
concept of the prevention and treatment of shock
minimize many of the former hazards, and should
permit reapplication of certain methods with
significant reduction of mortality.
Before entering into any discussion of a new
surgical procedure or a new surgical approach to
an old procedure, one must justify somewhat any
increased mortality in the beginning. ' It is to be
expected that as one operates in or around the
heart, there will be a mortality. As a matter of
fact Elliot Cutler5 stated that though the majority
of his patients died following operation, it was his
feeling that the experiences gained would be of
great benefit in future reduction of mortality. It
may be recalled that the mortality figures in early
operations on the stomach now considered rela-
tively simple, as collected by Dr. W. W. Keen12
for his Cartwright lectures, were quite high. Fol-
lowing the first twenty-eight gastrostomies col-
lected in 1875, all the patients died, and in a
series of thirty-five gastroenterostomies in 1885,
the operative mortality was 65.7 per cent. More-
over, it took years for these figures to improve.
In 1884, the mortality for gastrostomy was still
81.6 per cent.
It is not our intention at this time to present an
extensive collected series of personal cases in
which operation was performed for mitral steno-
From the Departments of Surgery and Internal Medicine
The University of Minnesota and The Ancker Hospital
Read in symposium on Diseases of the Chest, sponsored by
the Minnesota Chapter of the American College of Chest Physi-
cians at the annual meeting of the Minnesota State Medical As-
sociation, Duluth, Minnesota, June 12, 1950.
sis. Indeed, it is our intention as a combined team
of surgeons and internists to present some of the
material that has been accumulating in the litera-
ture. It is our main intention to present some of
the indications for operation, the methods used
and some of the results.
Without question, there is no necessity of stat-
ing that the clinical evaluation of any patient by
an experienced cardiologist is a must. In the past
years, medical management of mitral heart disease
has become a clinical laboratory picture, and I am
sure all of you know the methods that are used
currently. There are certain basic questions that
must be answered before operation is indicated :
1. Does the patient have evidence of active
heart infection? The report of Hench and his co-
workers on compound E may indicate that per-
haps in active infections the treatment of choice is
compound E.
2. Is the deformity of such a nature that the
patient can survive a normal span of life with
moderate activity ? Perhaps catheterization studies
of the heart, and lung biopsies may indicate the
value of an operative procedure. In co-operation
with Dr. John LaBree at the University we have
been attempting to correlate intracardiac pressure
studies with lung biopsies. Will a surgical pro-
cedure which permits more blood to reach the left
ventricle, be of benefit to patients in whom arterio-
sclerosis of the lungs is already present, is a
question that still remains unanswered. Our
studies are still too few to warrant any definite
conclusions on this point.
3. When shall a patient be subjected to opera-
tion, if at all? Shall we wait until the patient is
a poor operative risk, when he is in failure, or
when severe hemoptysis and dyspnea are present ?
4. Is mitral regurgitation worse than a mitral
stenosis? Is it a gradual regurgitation that is im-
portant, or are we to believe that regurgitation is
an unimportant factor completely? Is merely the
relief of pressure in the left auricle the important
thing, so that an interatrial septal defect would
suffice ?
All these questions still remain to be answered.
Were we to have a tool by which mitral stenosis
September, 1950
881
MITRAL HEART DISEASE— BARONOFSKY AND BRIGGS
could be produced consistently in an experimental
animal, we are sure that most of the questions
could be answered on a physiologic basis. All the
procedures that will be described in the future
paragraphs would then be subjected to critical
evaluation. In the meantime, until a method is
obtained, human experience will be our sole
method of evaluation.
Surgical Considerations
Mitral Valve
The methods that we have been using in the
approach of the problem’s of mitral stenosis seem
to take one of the following three courses :
1. Methods of direct surgical attack upon the
stenotic valve.
2. Methods of relieving the associated pulmo-
nary hypertension.
3. Methods of by-passing the stenotic mitral
valve.
Methods of Direct Surgical Attack Upon the
Stenotic Valve
1. Simple incision of a valve cusp. — Cutler,
Levine and Beck2 * 4 first attempted this procedure
in 1924. Their results were not encouraging.
However, it must be stated that we have since
made some advances in pre- and postoperative
care and, perhaps, if nothing else, these authors
have given us some valuable experience that is
being used today. Anatomically, the stenosed
mitral valve can be reached by a suitable instru-
ment by way of either the left ventricle or left
auricle. It is not yet entirely clear as to which is
the better approach.
2. Excision of a portion of the mitral ring.—
Cutler, Levine and Beck5 * * also reported some cases
in which a piece of the fused valves was removed,
since it was felt that the only hope in mitral steno-
sis was to replace it by a regurgitant type of
lesion. Results seem to indicate that although
there has been some objection to this procedure,
there are indications for it. Smithy,18 this year,
reported seven cases subjected to eight operations
with two deaths, a mortality of 28.6 per cent. He
has approached the valve and resected a portion
by means of the ventricle and the auricle. His
preference at the time the paper was published
was by the transventricular method. It is inter-
esting to remark that one of the successful re-
sults is a technician now working in a Saint Paul
Hospital. In a recent conversation, she stated
that she would be willing to convince anybody of
its value to her. Time will provide the answer as to
how well these patients will carry on with their
increased, though limited, regurgitation. It must
be remembered that Powers,15 in an attempt to
produce a mitral stenosis in dogs and then resect
the stenosed valves, stated that in all probability,
a sudden regurgitation is very harmful. He sug-
gested that a much better approach to the problem
would be had if a gradual increase in the amount
of reflux of blood into the left auricle wrere ob-
tained.
3. Digital dilatation of the stenotic orifice. —
Souttar20 in 1925 first performed this procedure
with success in one case. Recently Bailey8 and
his co-workers have performed three such dilata-
tions with one success. Death within three days
in one of the cases was due to clotting at the torn
commissures.
4. Valvuloplasty. — Harken8 has coined this term
for a method which involves the resection of por-
tions of the valve ring at the commissures. It is
his feeling and that of many others, that the
antero-lateral and the postero-medial commis-
sures should be resected. A selective type )f
valvular resection is thus done, and regurgitation
of blood from the aorta into the ventricle is thus
prevented.
5. Commissurotomy. — Bailey8 and his co-work-
ers have recently suggested that, instead of re-
section of a piece of the fused valves, a slit into
the antero-lateral commissure, and at times into
the postero-medial commissure, be done. This is
done under direct digital control, a procedure
which lie has called commissurotomy. Ideally, sur-
gical intervention should restore perfect valvular
action ; then the correction of obstruction in the
light of the associated degree of insufficiency
that is immediately produced would not come
under consideration. He has recently reported
thirty patients with six deaths. In twenty-one,
the results have been satisfactory to date, both
subjectively and objectively as measured by car-
diac catheterization studies.
In summary, therefore, of all the procedures
used in direct attack on the mitral valve it would
seem that either resection or cutting of the com-
missures is a valuable procedure. If surgery is
considered, either one of these two methods should
be contemplated.
882
Minnesota Medicine
MITRAL HEART DISEASE— BARONOFSKY AND BRIGGS
Methods of Relieving the Associated
Pulmonary Hypertension
The interesting observation first reported by
Lutembacher, that patients with mitral stenosis
who have a co-existing patent interatrial septal
•defect, do not usually suffer from paroxysms or
pulmonary edema, has led to the suggestion that
such a defect might be created artificially in cases
of mitral stenosis. Harken has created a defect
in humans by means of a specially devised valvu-
lotome. Blalock2 has attempted this procedure,
and used it in cases of transposition of the great
vessels. One of us (I.D.B.) experimentally used
the approach of anastomosing the auricular ap-
pendages, either directly or by means of a vein
graft.17 By this method the interatrial defect,
which is in effect produced, can be made under
direct vision and can be broken down immediately,
should the condition of the patient warrant it.
Sweet19 has used still another approach. He has
anastomosed the superior segment branch of the
inferior pulmonary vein to the azygos vein, thus
creating a communication between the systemic
and pulmonary circulations. Whereas the pul-
monic circulation is a closed circuit, the systemic
venous return is not ; thus the pressure within the
left auricle can be distributed over a greater area.
Methods of By-Passing the Stenotic Mitral Valve
In 1913, Jeger11 thought that a valved vein
might be grafted to serve as an anastomosis be-
tween the pulmonary vein and the left ventricle
and thus adequately side-tracking the stenotic
mitral valve. Recently Gross’s efforts at using
grafts of vessels may in the future be an answer
to this problem.8 Rappaport16 has recently also
implanted the tip of the auricular appendage into
the ventricle. By this method the stenotic valve
will be by-passed.
In summary, it might be said that methods of
by-passing the stenotic valve are still very much
in the experimental stage and should be dis-
carded as a procedure in humans.
Indications and Selection of Patients
Indications that have been put into the litera-
ture are at this time more verbal than salted with
experience. We are not saying this in a critical
way, but rather to suggest that perhaps more
operative procedures should be done in an effort
to obtain the true criteria for operation. Harken9
suggests a preliminary classification of patients
into three groups :
Septemjier, 1950
Group A— This group includes patients with a
low resting cardiac output which is unchanged or
even decreased on exercise and with an elevated
pulmonary-artery pressure. Signs of right ven-
tricular failure may appear in addition to the pul-
monary symptoms. For such patients, the opera-
tion of “valvuloplasty” may be helpful since the
available evidence indicates that mitral obstruction
is of major importance in this clinical condition.
Group B — In this group are patients whose
resting cardiac output is within normal limits and
usually increases with exercise. In spite of the
adequate cardiac output, they often have as severe
pulmonary symptoms as those in Group A, and
the pulmonary-artery pressure is also elevated.
The pathophysiologic mechanism in these cases
may be a predominance of mitral regurgitation
over the element of stenosis, or it may be that a
high left auricular pressure maintains How
through narrowed mitral orifices to an adequate
level. Secondary organic pulmonary vascular
changes may also occur as an important element
in producing the pulmonary symptoms. These
patients may be benefited by the production of an
artificial interatrial septal defect, which will de-
compress the left auricle and the pulmonary
venous hypertension, especially at high peaks dur-
ing periods of strain. This operation is probably
not suitable for patients who have had right ven-
tricular failure because of the added burden pro-
duced in the right ventricle by the recirculation of
blood through this chamber and the pulmonary
circuit. Such an operation may be contraindicated
for patients in Group A, in whom too great a
proportion of blood may be diverted through the
shunt, and with decreased left pressure, blood
flow through the stenotic mitral orifice would be
reduced still further to a level incompatible with
life.
Group C — This category includes patients
whose incapacitating symptoms, particularly at-
tacks of pulmonary edema, are associated with
rapid heart action that cannot be controlled by
medical measures. The cardiac output may be
normal or low, and the pulmonary-artery pressure
elevated. The patients are not deemed suitable
candidates for either of the operations men-
tioned above because of the extent and severity
of their disease. The occasional patient with
mitral stenosis who has attacks of severe chest
pain, especially “hypercyanotic angina,” may also
883
MITRAL HEART DISEASE— BARONOFSKY AND BRIGGS
fall into this group. For these patients, a pallia-
tive procedure may be the removal of the cardiac
sympathetic accelerator and afferent nerves.
Glover and Bailey6 classify the indications as
follows :
1. Most favorable group :
(a) Excessive fatigability.
Increasing exertional dyspnea.
(b) No rheumatic activity.
Normal sinus rhythm.
Lesion predominantly stenosis.
Evidence of significantly increased pul-
monary hypertension.
2. Less favorable group : The above plus
(a) Recurrent bouts of hemoptysis.
(b) Arterial embolic phenomena.
(c) Auricular fibrillation without failure.
Hemoptysis in more than amounts necessary to
stain the sputum is of grave import. Wolf and
Levine23 point out that in their series of cases the
average duration of life following the onset of
severe hemoptysis is 35.5 months. Levine14 stated
that the average duration of life following the
initial attack of congestive failure is 4.6 years.
The development of auricular fibrillation is usual-
ly permanent and irreversible. In this state throm-
bus formation not infrequently occurs along the
endocardium of the dilated and relatively im-
mobile auricular walls. Some 75 per cent of these
occur within the lumen of the auricular appendage
(left), a common site for the origin of arterial
embolization.
Bailey and his co-workers contraindications
would be: (1) active rheumatic infection; (2)
presence of superimposed subacute bacterial endo-
carditis; (3) cardiac failure uncontrollable by
medical means; (4) presence of marked associ-
ated mitral regurgitation or other valve (aortic)
deformities.
Smithy18 states that the ideal candidate for
operation is a patient in the younger range of
years having a high grade of mitral stenosis, with-
out evidence of more than minimal involvement
of the other valves, and with severe disability
from mechanical obstruction but little or no evi-
dence of cardiomegaly, hepatomegaly, venous dis-
tention, and chronic fluid retention. Disability in
cases of this nature is characterized by a definite
group of complaints common to each : chronic
weakness and fatigue, dyspnea on mild exertion,
orthopnea with acute nocturnal exacerbations, per-
sistent, exhausting cough with or without hemop-
tysis, palpitation, and periodic bouts of acute
pulmonary edema. In the absence of much cardiac
enlargement, venous engorgement, hepatomegaly,
and peripheral edema, he considers such patients
to be suffering almost entirely from mechanical,
obstruction to the flow of blood through the heart.
It is apparent from this discussion of the in-
dications and contraindications that the internists
and surgeons should get together soon and a pre-
liminary effort at determining the indications for
surgery, which later may be modified, should be
made as the surgical patients are evaluated post-
operatively.
Auricular Ligation for Recurrent Embolization
One of the most common causes of peripheral
arterial emboli is rheumatic mitral stenosis. This
disease occasions a slowing of blood within the
left atrium and left auricular appendage. This
stasis of blood, coupled with auricular fibrillation,
leads to frequent thrombus formation in the left
atrium. These thrombi are the most common
antecedents of peripheral emboli in rheumatic
heart disease. Our associates, Drs. Chester
Thiem, Ben Sommers, and John Noble21 have re-
cently studied a series of cases for location of
emboli within the heart of rheumatic mitral dis-
ease. Their figures indicate that the most com-
mon source of thrombi is in both auricular ap-
pendages. Previous to this study, we had ligated
three left appendages in patients with recurrent
embolization and mitral disease.1 It is our feel-
ing that this procedure may prove to be a very
useful one in the prevention of future emboliza-
tion. Our indications at present for doing this
procedure are as follows :
1. The patient should be fifty-five years of age
or younger.
2. There should be no evidence of severe coro-
nary disease by clinical study and electro-
cardiogram.
3. The patient should not be in congestive
heart failure at the time of operation.
4. The patient should have had evidence of
embolic phenomena.
5. There should be no evidence of subacute
bacterial endocarditis.
Perhaps the anticoagulants may control the
formation of future thrombi, but certainly they
do not dissolve any thrombi that are already pres-
884
Minnesota Medicine
MITRAL HEART DISEASE— BARONOFSKY AND BRIGGS
ent in the auricular appendage. As a matter of
fact, we would like to suggest that both auricular
appendages be ligated.
Aortic Stenosis
An additional word at this time on relief of the
aortic stenosis associated with mitral disease. At-
tempts have been made in the past to dilate the
aortic ring when stenosed. Recently it has been
reported in the American Surgical Association
by Glover7 and his co-worker that a section of the
aortic ring has been accomplished by means of a
knife placed down through the carotid artery in
the neck and impinging upon the aortic valve.
At the present time it might be stated that we are
not clear as to the indications and contraindica-
tions for such an operation. However, it is our
belief that operations of this type should and will
be done in the immediate future as soon as the
indications are clear.
Summary
In summary, therefore, it is our belief that
operative procedure for mitral stenosis should be
carried out. A more definite set of indications
and contraindications should be established. Until
the advent of the experimental production of
mitral stenosis is with us, human material should
be used and the results compiled and information
obtained for future reference.
Addendum
Since this paper was submitted for publication,
two patients with mitral stenosis have been op-
erated upon successfully. In both instances the
mitral orifice was enlarged by way of the left
auricle.
Bibliography
1. Baronofsky, I. D. and Skinner, A.: Ligation of left auricular
appendage for recurrent embolization. Surgery, 27 :848, 1950.
2. Blalock, A. and Hanlon, C. R.: The surgical treatment of
complete transposition of the aorta and the pulmonary artery.
Surg. Gynec. & Obst., 90:1, 1950.
3. Brunton, Lauder: Preliminary note of the possibility of treat-
ing mitral stenosis by surgical methods, Lancet, 1:352, 1902.
4. Cutler, E. C. and Beck, C. S.: Present status of surgical
procedures in chronic valvular disease of heart: Final re-
port of all surgical cases. Arch. Surg., 18:403, 1929.
5. Cutler, E. C., Levine, S. A. and Beck, C. S.: The surgical
treatment of mitral stenosis, experimental and clinical studies.
Arch. Surg., 9:689, 1924.
6. Glover, R. P., O’Neill, T. J. E., Bailey, C. P. : Commissurot-
omy for mitral stenosis. Circulation, 1:329, 1950.
7. Glover, R. P., O’Neill, T. J. E„ Bailey, C. P. : Abstract
presented at meeting of American Surgical Association,
Colorado Springs, April, 1950.
8. Gross, R. E. : Coarctation of the Aorta. Circulation, 1:41,
1950.
9. Harken, D. E., Ellis, L. B., Ware, P. F. and Norman, L. R. :
The surgical treatment of mitral stenosis. New England J.
Med., 239:801, 1948.
10. Hench, P. S., Kendall, E. C., Slocumb, C. H. and Polley,
H. F. : Effects of cortisone acetate and pituitary ACTH on
rheumatoid arthritis, rheumatic fever and certain other con-
ditions. Arch. Int. Med., 85:545, 1950.
11. Jeger, Ernst: Die Chirurgie der Blutgefosse ur.d des
Herzens, Berlin: Herschwald, August, 1913.
12. Keen, W. W. : Quoted by Cutler, 1924.
13. LaBree, John and Baronofsky, Ivan D. : Unpublished obser-
vations, 1950.
14. Levine, S. A.: Clinical Heart Disease. Ed. 3. Philadelphia:
W. B. Saunders, 1945.
15. Powers, J. H.: Surgical treatment of mitral stenosis. Arch.
Surg., 25:555, 1932.
16. Rappaport, A. M. and Scott, A. C.: Valvular anastamoses
of the heart cavities. Ann. Surg., 131:449, 1950.
17. Skinner, A. and Baronofsky, Ivan D.: Unpublished observa-
tions, 1949.
18. Smithy, H. G., Boone, J. A. and Stollworth, J. M. : Surgical
treatment of constructive valvular disease of the heart.
Surg. Gynec. & Obst., 90:175, 1950.
19. Sweet, R. H., and Bland, E. F. : The surgical relief of con-
gestion in the pulmonary circulation in cases of severe mitral
stenosis. Ann. Surg., 130:384, 1949.
20. Souttar, H. S. : The surgical treatment of mitral stenosis.
Brit. Med. J., 2:603, 1925.
21. Thiem, C., Sommers, B., Noble, J. F.: Unpublished obser-
vations, 1950.
22. Tuffier, T. : LaCherurgie de coeur. Cenqixeme Congres de la
Soc. Int. Chirurgie, Paris. 19-24, duly) 1920.
23. Wolff, L. and Levine, H. B. : Hemoptyses in rheumatic
heart disease. Am. Heart J., 21:163, 1941.
COURSE IN PROBLEMS OF HUMAN INFERTILITY
Problems of human infertility will be discussed by
gynecology specialists at the University of Minnesota’s
Center for Continuation Study Thursday through Satur-
day, September 28-30. The three-day course is open to
all physicians in the state.
Fields to be discussed at the continuation course- will
cover such topics as the physiology of ovulation, various
endocrine studies, the psychosomatic effects of sterility
and artificial insemination.
Among the visiting faculty members who will direct
some of the sessions will be Dr. Isador C. Rubin, clinical
professor of gynecology, New York university college
of medicine, New York City, and Dr. Fred A. Sim-
mons, research assistant in gynecology, Harvard uni-
versity medical school, and assistant in surgery, Tufts
university, Boston.
Dr. Warren O. Nelson, professor of medicine, anatomy
and histology, University of Iowa college of medicine,.
Iowa City, is another of the out-of-state specialists who.
will head discussion groups.
Present from the staff of the Mayo Foundation at
Rochester to give one of the lectures, will be Dr. Law-
rence M. Randall, professor of obstetrics and gynecology.
Also leading parts of the meeting will be Dr. John
L. McKelvey, professor and head of obstetrics and
gynecology at the University.
September, 1950
88S
THE SIGNIFICANCE OF THE ISOLATED PULMONARY NODULE
DAVID V. SHARP. M.D., and THOMAS J. KINSELLA. M.D.
Minneapolis, Minnesota
r I ' HE INCREASING USE of chest roentgeno-
grams in community surveys and routine
physical examinations has confronted physicians
with a variety of unsuspected chest conditions
including the isolated pulmonary nodule. This
condition, variously designated as the “pulmonary
coin lesion," the peripheral nodule, and commonly
dismissed as a "tuberculoma, ” presents diagnostic
and therapeutic implications far out of propor-
tion to the seemingly insignificant nodule itself.
We have studied, over a period of the past
four years, a total of ninety-six such nodules in
patients from twelve to eighty-five years of age.
The sexes were about equally divided and all
were of the white race except one Indian girl
twelve years of age.
These nodules differ widely in appearance.
They have been found in all segments of the
lung with their location of no special diagnostic
value. Their size varies from 1 to 4 centimeters
in diameter, thereby excluding the large bron-
chiogenic carcinomas and the smaller calcified
areas (Gohn tubercles). They may be round or
ovoid in contour with edges smooth, fuzzy or ir-
regular. Their density varies from very soft in-
filtrates to extremely dense nodules with or with-
out calcium deposits. The presence of calcium
does not establish the benign or malignant nature
of the process. The degree of calcification dis-
cernible on x-ray films, as Bloch1 has shown, is
indeed arbitrary and is largely dependent upon
special x-ray techniques for its demonstration.
The growth of a nodule is not necessarily a sign
of cancer for it has been noted in fibroma, hamar-
toma, adenoma and the granulomas, while lack
of growth may occasionally be noted in carcinoma
over many months. All nodules observed in this
series were entirely asymptomatic with two ex-
ceptions (bleeding from pulmonary cysts).
When confronted with a patient whose x-ray
films reveal an isolated pulmonary nodule, careful
studies should be instituted at once to attempt to
determine the nature of the lesion. A careful
history and complete physical examination should
be supplemented by special diagnostic procedures
as indicated. An exhaustive search must be made
Read in symposium on Diseases of the Chest, sponsored by
the Minnesota Chapter of the American College of Chest
Physicians, at the annual meeting of the Minnesota State
Medical Association, Duluth, Minnesota, June 12, 1950.
for primary tumors elsewhere and for underlying
disease which might produce a local lung lesion.
Laboratory studies of blood, urine, sputum, gas-
tric washings, bone marrow, et cetera, may at
Fig. 1. An Isolated Pulmonary Nodule.
times give a clue to the etiology of the nodule.
Results to date in attempting to establish a diag-
nosis in an obscure pulmonary infiltration have
suggested the desirability of skin testing par-
ticularly for tuberculosis, histoplasmosis, blasto-
mycosis, coccidiomycosis and ecchinococcous dis-
ease.7 Originally some, at least, of these infec-
tions were considered of local interest only, but
more recently the migration of large numbers of
people and modern air travel have rapidly dis-
pelled our ideas regarding a so-called local habi-
tat of certain yeast and fungus infections. Our
experience from the studies in this series would
seem to indicate, however, that skin test reactions
possess suggestive rather than absolute diagnostic
value in the case of isolated pulmonary nodules.
The relative frequency of tuberculosis and its
tendency to involve the lung and to produce
nodular areas of disease must place it high on
the list of suspected causes of such nodules.
Sputum, if any, must be carefully studied for
mvcobacterium tuberculosis. In its absence, bron-
chial secretions or washings obtained broncho-
scopically or gastric washings may be studied cul-
886
Minnesota Medicine
ISOLATED PULMONARY NODULE— SHARP AND KINSELLA
turally or by guinea pig inoculation in an at-
tempt to recover the organisms. However, the
relatively high incidence of malignancy in this
series (27.3 per cent) and the usual rapid growth
of bronchial malignancy makes one seriously
doubt the wisdom of delaying definitive action
six or eight weeks for such laboratory reports.
As these nodules, even if tuberculous, are fre-
quently closed lesions, failure to recover orga-
nisms from secretions does not rule out tuber-
culosis.3 The old idea that all granulomas and
calcifications in the lung were the result of tu-
berculosis has definitely been disproven.5’7 Our
efforts to demonstrate pathologic yeasts and fungi
from similar material have been quite disappoint-
ing. The presence of malignant cells in bron-
chial secretions is, of course, diagnostic, but small
peripheral primary carcinomas and metastatic tu-
mors do not throw off recognizable cells as regu-
larly as carcinoma in the larger bronchi and,
hence, positive cell studies in patients with iso-
lated pulmonary nodules are but rarely found.
Negative reports, however, do not in any way
rule out the presence of a malignant tumor.
X-ray studies are valuable not only in discover-
ing the nodule originally, but also in localizing its
position and may, through special techniques or
planigraphy, demonstrate calcification, fluid level,
cavitation or other suggestive diagnostic infor-
mation. Cavitation with or without fluid level
may suggest a tuberculous abscess but may also
be seen with other granulomas, in pulmonary
cysts or even in malignant lesions. Perhaps the
most valuable x-ray study may lie in a comparison
of the recent with older films if available. Evi-
dence of growth of the lesion is certainly an indi-
cation for its prompt removal. Conversely, lack
of growth over a period of even a year does not
prove the nodule to be benign. Certainly the com-
mon practice of recommending another film in
three to six months has nothing medically to
recommend it and could easily in the presence
of malignancy seal the patient’s doom.
While in the early portion of this series, we
made extensive studies of all types listed in an
attempt to gain information which might help us
to arrive at a correct clinical diagnosis, we have,
as a result of the experience gained by these
studies, reached the conclusion that the only re-
liable and accurate diagnostic procedure is explor-
atory thoracotomy with excision and prompt path-
ological examination of the mass. When, with
the lung exposed and in the surgeon’s hand, it is
often impossible to accurately state the nature of1
the nodule, how can indirect studies be expected
to furnish the answer ?
TABLE I. ISOLATED PULMONARY NODULES.
Proven 55
Malignant 15 (27%)
Bronchogenic Carcinoma 11
Lymphosarcoma 1
Metastatic (Breast, Colon, Testicle) 3
Inflammatory 22 (40%)
Granuloma
Ecchinococcus 1
Tuberculosis
(Proven) 6
(Suspected) 5
Unproven 10
Benign Tumors 18 (33%)
Hamartoma 5
Chondroma 1
Adenoma 2
Fibroma 2
Bronchial Cyst 8
Undiagnosed Nodules 41
TOTAL 96
From this series of ninety-six nodules listed
above, fifty-five have been definitely proven by
surgical operation (forty-nine) or by medical
means (six). We have accepted as final medical
proof the positive bronchoscopic biopsy of malig-
nancy or the progression of such a lesion to fatal
termination, the recovery of tubercle bacilli or the
demonstration of a proven primary tumor else-
where. Fifteen (27.3 per cent) of the fifty-five
proven nodules were malignant. Eleven were due
to primary bronchiogenic carcinoma, one to a
primary lymphosarcoma in the periphery of the
lung and three to solitary metastatic nodules from
carcinoma of the breast, colon and testicle.
Eighteen ( 32.7 per cent) were found to be benign
tumors of the types listed in the table above.
The number of pulmonary cysts and hamartomas
in this group is somewhat higher than in the
average reported series. Twenty-two (40 per
cent) of the nodules proved to be inflammatory
lesions or granulomas. Formerly erroneously
called tuberculomas under the mistaken idea that
all were tuberculous in nature, we now know that
a variety of infectious agents may produce them.
Granulomas may vary widely in gross and micro-
scopic appearance from an abscess, a blocked or
inspissated cavity full of soft caseous material,
through all stages of attempted healing to the very
mature granuloma showing the concentric rings
resembling the growth rings of a tree. The myth
of the harmless “tuberculoma” which need not be
disturbed is easily dispelled by viewing a few of
these excised granulomas which are caseous areas
either primary or secondary or blocked or inspis-
sated cavities whose contents, often teeming with
September, 1950
887
ISOLATED PULMONARY NODULE— SHARP AND KIN SELLA
bacilli, only await bronchial communication to
spread infection widely throughout the lung.
The microscopic picture of most granulomas of
varying etiology is strikingly similar and the only
positive proof of the tuberculous or other specific
etiology of such a lesion is the demonstration of
the specific organism from it. The number of
proven tuberculous granulomas (six of twenty-
two) is rather small for this reason. We have
listed five others as suggestive of tuberculosis
because of the clinical findings and microscopic
picture in and about the nodule and have wondered
if the preoperative forty-eight-hour administra-
tion of streptomycin may have been a factor in
negative cultures reported in this group. To date,
our attempts to isolate other organisms from a
group of these nodules through the co-operation of
the mycologists at the University of Minnesota
and the State Board of Health have been dis-
appointing, hence, the ten nodules of undeter-
mined etiology. Perhaps studies with other tech-
niques and media may reveal more in future
specimens. The fact that some of these nodules
unquestionably represent completely mature and
burned out lesions must also be considered. The
forty-one undiagnosed nodules listed represent a
group of patients who have either not completed
their work up or have refused or postponed ex-
ploratory thoracotomy as recommended to the
physician.
There has been no surgical mortality or com-
plication in this series of surgically treated pa-
tients. The usual procedure has been, at open
thoracotomy, to excise the local nodule by means
of a wedge resection and suturing the lung behind
clamps while the pathologist is making his exami-
nation of the excised nodule. This technique has
been preferred to local enucleation which works
very nicely with hamartoma and a few of the
lesions but which can lead to gross contamination
if abscess or active tuberculosis is encountered.
The procedure has been extended to segmental
resection, to lobectomy or even to pneumonectomy
as local conditions and the pathologist’s findings
warrant.
This experience and the published reports of
others have convinced us that an accurate pre-
operative diagnosis of the nature of an isolated
pulmonary nodule is impossible in the vast ma-
jority of instances. Exploratory thoracotomy and
immediate pathological examination provide the
only accurate means of determining the exact
nature of the lesion. The low calculated risk of
such a procedure and the relatively high incidence
of malignancy (27.3 per cent) in this series (40
per cent in other reported articles) 2,4,8 makes it the
only safe and logical method of treating the iso-
lated pulmonary nodule.
References
1. Bloch, Robert G. : Tuberculous calcification: a clinical and
experimental study. Am. T. Roentgenol., 59:853-864, (June)
1948.
2. Editorial: Pulmonary coin lesions. Radiology, 54:116-117,
(Jan.) 1950.
3. Feldman, William H. and Baggenstoss, Archie H.: The
residual infectivity of the primary complex of tuberculosis.
Am. J. Pathol., 14:473-489, 1938.
4. Graham, Evarts A., and Singer, J. J. : Three cases of re-
section of calcified pulmonary abscess (or tuberculoses) simu-
lating tumor. J. Thoracic Surg., 6:173-183, (Oct.) 1936.
5. Greer, Sam J., Forsee, James H., and Mahon, Hugh W. :
The surgical management of pulmonary coccidiomycosis in
focalized lesions. J. Thoracic Surg., 18:591-604, (Oct.) 1949.
6. Long, Esmond R. : Antigenic sensitivity of pulmonary in-
filtrations of obscure origin. Pub. Health Rep., 63:1567-
1568, (Dec. 3) 1948.
7. Moersch, Herman S., Weed, L. A., and McDonald, John R.:
Bacteriologic examination of tissues surgically removed as an
aid in the diagnosis of diseases of the chest. Dis. Chest,
15:125-141, (Feb.) 1949.
8. O’Brien, E. J., Tuttle, William M., and Ferkaney, Joseph
E. : Management of pulmonary coin lesions. Surg. Clin.
North America, 28:1313-1322, (Oct.) 1948.
ARMY AUTHORIZES APPOINTMENT OF WOMEN DOCTORS AS RESERVE CORPS
OFFICERS
Appointment and concurrent assignment to active duty
as Reserve Officers of women physicians, dentists, and
allied specialists, has been authorized, it was announced
August 30 by the Department of the Army.
They will be brought on duty under regulations cur-
rently providing for the commissioning of male officers
in these Corps. Some women did serve in the Army as
physicians and technicians during World War II, but
their commissions have expired and legislation perrnit-
ing their commissioning expired in 1947.
As Reserve officers on active duty, these women will
be given opportunities for clinical practice and advance-
ment which are now available to male officers in com-
parable grades, Major General R. W. Bliss, Surgeon
General of the Army, pointed out. Appointments will
be in grades from first lieutenant to colonel, depending
upon age, experience, and professional qualifications.
The pay, allowances, dependency and retirement bene-
fits which accrue to male officers will apply to the women
medical reservists. Women physicians and dentists will
also draw the $100 a month professional pay allowed
above the base pay of their commissioned rank. They
will be eligible for service in every type of military
medical facility, with the exception of forward medical
installations in combat zones.
General Bliss said his office had received numerous
letters during the past year from women physicians de-
siring military service.
Minnesota Medicine
CLINICAL DETECTION OF PULMONARY EMPHYSEMA FROM
RESPIRATORY TRACINGS
PHILIP H. SOUCHERAY, M.D.
Minneapolis, Minnesota
TN THIS DISCUSSION, I should like to at-
attempt to illustrate the irrationality of at-
tempting to estimate pulmonary functional reserve
or determine the cause of functional disability
from any single measurement of respiratory activ-
ity. The respiratory system is more than a mech-
anism for moving air in and out of the body : air
must be moved in order to ventilate terminal pul-
monary alveoli, but the lung itself exists mainly
to support a vascular bridge between the right
ventricle and left auricle.4 This vascular bridge,
made up of nets of capillaries in the alveolar
walls, must accommodate the greatly varying min-
ute output of the heart in a manner quite differ-
ent from that in which an increased flow is han-
dled by the general circulation. As the flow across
the pulmonary bridge increases the pressure, the
rate of flow in the lesser vessels normally does
not rise, but rather the blood diffuses out into
previously unopened capillary beds where respira-
tory gas exchange may then take place in the
usual leisurely manner.
Figure 1 is borrowed from an excellent article
on determination of pulmonary insufficiency5
where it appeared recently, and illustrates the
processes occurring within a normal lung. The
air flow through the upper U-tube, the ventilatory
phase of the respiratory process, might be meas-
ured with a clinical spirometer, and ordinarily
amounts to between 4.5 and 6 liters per minute.
The total volume of air that could be moved
through the tube in one breath represents the
vital capacity while the actual volume of the
circuit constitutes the residual air or dead space
within the lung. The dotted line between the
opposed U-tubes represents the capillary-alveolar
interface, and respiratory gas exchange takes
place across the cross-hatched area. The area
of the circuit marked “dead space” represents
the fact that not all of the air ventilated reaches
the capillary-alveolar interface. This “dead space”
From the Veterans Administration Hospital, Minneapolis, Min-
nesota, and the Department of Internal Medicine, University
of Minnesota.
Published with the permission of the Medical Director, Vet-
erans Administration, who assumes no responsibility for the
opinions expressed, or conclusions drawn, by the author.
Read in Symposium on Diseases of the Chest at the annual
meeting of the Minnesota State Medical Association, Duluth,
Minnesota, June 12, 1950. Sponsored by the Minnesota Chapter
of the American College of Chest Physicians.
or residual air volume has been studied extensive-
ly,1 and it has been found to be slightly less than
28 per cent of the total lung volume in a healthy
Fig. 1. Normal ventilation. Normal circulation.
man. Any increase in the residual air practically
always indicates the presence of pulmonary em-
physema.
The inverted U-tube represents the pulmonary
circulation. The dynamics of this segment of the
circulatory system have been investigated only
since the advent of cardiac catheterization through
a peripheral vein. By this means the pressures
in the right ventricle and pulmonary artery have
been measured, and from the rate of oxygen
utilization the rate and volume of blood flow
through the lung have been determined. It is
important to remember that normally the pres-
sure never rises in this system despite increases in
minute volume of flow. Any increase in flow is
accommodated by the opening of non-perfused
capillary beds. If the necessary volume of new
beds is not available because of some obliterative
disease, then the pressure within the system must
rise, and flow is speeded through the capillaries,
or shunted around the beds completely.
Figure 2 represents the conditions which pre-
vail when the airway is obstructed but the pul-
monary circulation is left intact. The diagram
might represent the picture of acute bronchial
asthma, suffocation, spontaneous pneumothorax,
or some types of pulmonary fibrosis. The causes
of acute obstruction of the respiratory tract are
September, 1950
889
PULMONARY EMPHYSEMA — SOUCHERAY
usually apparent, but before one could be sure
that a chronic pulmonary disease was due solely
to ventilatory dysfunction the dynamics of the
pulmonary circulation would have to be investi-
gated by cardiac catheterization.
Figure 3 represents the conditions which might
prevail in cases of pulmonary hypertension due
to pulmonary arteriosclerosis, either primary or
secondary to some other disease such as mitral
stenosis or some types of pulmonary fibrosis.2
These diseases are certainly diseases of the pul-
monary system and may present the picture of
undue fatigue or dyspnea on exertion, cough, or
hemoptysis. But without actual measurements of
the dynamics of the pulmonary circulation, the
real disease may lie undisclosed and, perhaps, un-
suspected. Measurements of the ventilatory func-
tion alone would probably be normal and thus
might even serve to turn one’s attention away
from the pulmonary system as the seat of dis-
ease.
Finally, Figure 4 illustrates a combination of
circumstances in which there is both diminished
ventilation of the alveoli and impaired perfusion
of the capillary beds. This is the functional pic-
ture of pulmonary emphysema whether it be ihe
hypertrophic bullous type, senile degenerative
type, or the compensatory type seen surrounding
a contracted scar of tuberculous inflammation or
in portions of a lung distorted by the retraction of
fibrous pleuritis. All chronic pulmonary emphy-
sema is characterized by distention or distortion
of alveolar spaces, loss of interstitial elastic fi-
bers, and hypertrophy of the muscular layers of
the arterioles with obliteration of associated capil-
lary beds. To be able to detect or even suspect
the presence of this type of combined ventilatory
and circulatory disease would be a distinct advan-
tage to the clinician because people harboring this
type of pathology have lost a great deal of their
ability to adapt either to an increased demand for
oxygen-carbon dioxide exchange, or to an in-
creased rate of blood flow through the pulmonary
vascular bed. They are in a poor position to
withstand any operative procedure within the
thorax, they are more than usually susceptible to
the pulmonary infections that so frequently fol-
low general surgical procedures under anesthesia,
and they suffer from a real disability which is
often differentiated from malingering only with
great difficulty.
In a recent study of pulmonary disability in
cases of anthrasilicosis6 through a comprehensive
battery of both clinical and physiological tests
two important conclusions were brought forth :
first, pulmonary emphysema is the pathological
process associated with most disabling pulmonary
disease and, second, about one-half of the cases
of advanced pulmonary emphysema may evade
a competent examiner and be found only after
extensive examinations of pulmonary function far
beyond the scope of any clinical laboratory. It
890
Minnesota Medicine
PULMONARY EMPHYSEMA— SOUCHERAY
Respiratory rote = 16
Fig. 5. Normal vital capacity.
September 1950
Fig. 6. Vital capacity in emphysema.
891
PULMONARY EMPHYSEMA— SOUCHERAY
TABLE I. SEPARATION OF CASES OF EMPHYSEMA
By Means of Measurement of Lung Volume and from Consideration of the Character of the Respiratory Tracing
Vital
Capacity
Alveolar
Nitrogen Vol. %
Residual Air
Distribution of
Patients by Lab-
oratory Meas-
urement
Distribution Within
Each Group from Con-
sideration of Tracings
Only
Classification
Total Lurg Volume
Group 1
Over
Less than
Less than
9
All of the 18 patients
Normal
Group 2
3500 c.c.
2.5
28%
in Groups 1 and 2 fell
into the “grossly nor-
mal” classification.
Slight emphysema
Group 3
2500-3500
2.5-3
28-35
9
18 of the 19 patients
who were in Groups 3
Moderate emphysema
Group 4
1800-2500
3-5
35-45
2
and 4 fell into the
“grossly abnormal” clas-
sification as did one pa-
tient from Group 2.
Severe emphysema
Less than
1800 c.c.
Over 5
Over 45%
17
also seemed apparent that symptoms of pulmonary
insufficiency were dependent not so much on the
silicosis or fibrosis as on the degree of pulmonary
emphysema present.
Some years ago Christie described the breath-
ing patterns of some organic as well as functional
diseases. Figure 5 is a normal respiratory trac-
ing. Note that the rate and depth of the breathing
action are quite regular, and that the resting or
mid-position of the chest is constant. The com-
plemental air is over half the vital capacity and
as it is expired, notice that the expiration line is
not curved. Notice too that the chest returns to
the mid-position after either deep inspiration or
deep expiration. Figure 6 is a respiratory tracing
illustrating moderately severe emphysema. The
respiratory rate is rapid but not always regular,
and there is some variation in depth of breath-
ing. This case of emphysema was probably of
moderate severity because the complemental air
is little diminished. Two things, however, do in-
dicate loss of pulmonary elasticity: (1) the curved
expiratory lines as rate of expiration slows to-
ward the end when more and more accessory
muscles are called into play, and (2) the failure to
return to a constant mid-position after either a
deep inspiration or forced expiration.
An attempt has been made here to evaluate
Christie’s indications of emphysema in respiratory
tracings by recording the impression gained from
considering the vital capacity as well as other
characteristics in spirometric tracings made by
thirty-seven patients, most of whom were suffer-
ing from some cardiac or pulmonary disease.
These impressions were then compared with actual
measurements of the ratio of residual air to total
lung volume made on the same patients. In
many there was also available the measurement
892
of the nitrogen concentration in the alveolar air
after the patient hail been breathing pure oxygen.
This type of measurement was developed by Cour-
nand and associates as an indication of thorough-
ness of ventilation of all the alveoli. In a nor-
mal well-ventilated lung less than 2.5 volumes
per cent of nitrogen remain in the alveolar air
after the subject has breathed pure oxygen for
seven minutes. Any increase in the residual ni-
trogen usually signifies poor ventilation, most of-
ten due to the distended alveoli of pulmonary em-
physema.
The thirty-seven cases were divided into a
group of normals and three groups representing
emphysema of varying degrees of severity. Divi-
sion on the basis of laboratory examination alone
included as normals any patients who had a resid-
ual air to total lung volume ratio of less than
28 per cent and an index of alveolar ventilation of
2.5 volumes per cent or less of nitrogen in the
alveolar air. On the basis of inspection of the
respiratory tracings, the normal group had a vital
capacity in excess of 3500 c.c., showred rapid ex-
piratory rate, and readily returned to the resting
position after either a forced inspiration or forced
expiration.
From Table I it is apparent that the two meth-
ods do not give parallel results, but notice that
there is complete separation of normals and bor-
derline cases from cases of severe emphysema.
The clinical impression failed to detect only one
case of slight emphysema but called five normal
persons slightly abnormal.
Thus, with an adjunct system of examination
only one abnormal person was missed. If exami-
nation of the respiratory tracings had been a
part of the general physical examination which
(Continued on Page 896)
Minnesota Medicine
RESPIRATORY ALLERGIES IN CHILDREN
LLOYD S. NELSON, M.D., and ALBERT V. STOESSER, M.D
Minneapolis, Minnesota
"p ESPIRATORY allergies are present in the
young child more frequently than are com-
monly diagnosed. A persistent nasal discharge
in an infant is often casually attributed to irrita-
tion of the nasal mucosa by regurgitated vomitus,
or to lint from bed clothes and fuzzy garments,
or it may be dismissed as a common cold. The
underlying possibility of allergy is not even con-
sidered until numerous repetitions of these symp-
toms have occurred or until true asthma develops.
In a study of 164 cases of asthma, Buffin2
showed that 20 to 30 per cent of these children
exhibited their first allergic symptoms before two
years of life. The onset of bronchial asthma in
the young child may be gradual or sudden. In
those cases of gradual onset, frequent episodes of
croup occur. Later, bronchitis with a chronic per-
sistent cough develops. This cough is provoked
by sticky secretions which initiate paroxysms of
coughing that simulate pertussis. Wheezing ap-
pears next, usually in the presence of superim-
posed respiratory infection, and finally true asth-
ma develops. The onset of asthma in the young
child may be sudden and dramatic. -The initial
attack is rapid and appears immediately after the
ingestion of some offending food or exposure to
some irritating inhalant. In this group of cases
there is usually no history of antecedent nasal
symptoms. These patients frequently reveal iso-
lated wheal formations upon skin testing. The
management and treatment is simpler and more
rewarding than in the gradual type of onset. Un-
fortunately, the number of cases of this type are
in the minority. Asthma which develops early
in life is likely to be more severe than that origi-
nating later.
In comparing asthma of the infant with that of
the adult, some very startling differences are
noted. The asthmatic infant does not manifest
the same degree of dyspnea as the adult. The
wheezing, with prolongation of expiration which
is so common in the adult, is never seen in the
same degree in the infant. These differences are
probably due to the softer thoracic wall and the
predominantly abdominal respirations of the in-
From the Department of Pediatrics, Medical School, University
of Minnesota.
Presented at the ninety-seventh annual session of the Minne-
sota State Medical Association, Duluth, Minnesota, June 13,
1950.
September, 1950
fant. The young child does not exhibit the same
degree of anxiety which is characteristic in the
older patient. It is common to find children play-
ing unconcerned, and yet on auscultation of the
chest, there are present definite wheezes and
rales.
Older children with nasal allergy present symp-
toms of recurrent nasal congestion, mouth breath-
ing, watery-clear nasal discharge, and an associ-
ated hacking cough which is usually more prom-
inent at night and disappears shortly after awak-
ening. These children are irritable, restless, often
temperamental individuals, and are erroneously
labeled behavior problems.
Too many of these cases are subjected to ton-
sillectomies in the hope that fewer so-called
“colds” will develop. Piness,9 as early as 1925,
warned that tonsillectomies, when performed for
the relief of allergic symptoms, end in failure.
Bullen3 reviewed a series of 1000 children with
allergic manifestations who had had tonsillecto-
mies, and concluded that this procedure was of
no help in the treatment of allergic children.
Clein4 also studied this problem and showed that
in the majority of those cases in which lymphoid
tissue reappeared in the pharynx following ton-
sillectomy there was present an underlying un-
diagnosed allergy.
Where sound surgical indications for tonsillec-
tomies and adenoidectomies are present, the opera-
tion should be done, but not until the underlying
allergic problem is properly diagnosed and under
competent management. There is proof that if
this procedure is done during the pollen season,
a latent pollinosis, or asthma, may develop. A
few of these children with abundant lymphoid
tissue in the oral and naso-pharynx are benefited
by radiation therapy.
If nasal symptoms are not controlled early in
childhood serious disturbances of growth and de-
velopment may occur. An obstructed nasal pas-
sage leads to mouth breathing with poor aera-
tion of the sinuses resulting in their maldevelop-
ment, and thus permanently affecting the facial
contours. The low grade obstruction to the
eustachian tube predisposes to frequent attacks
of otitis and inevitable hearing loss.
The diagnosis of allergy in the infant and child
893
RESPIRATORY ALLERGIES— NELSON AND STOESSER
is extremely important because if the symptoms
are controlled early, the likelihood of major aller-
gic disease in adulthood with the irreversible
anatomical changes such as palatine and facial
deformities, emphysema and bronchiectasis is
decreased. Children, when correctly diagnosed,
usually respond dramatically to allergic control.
It is a fallacy to assume that the child will out-
grow his allergies. Clein5 followed 100 cases of
allergic children over a period of 10 to 15 years
and discovered that the majority of these cases
revealed their first symptoms before the first year
of life. What is more startling is that 98 per
cent of these 100 cases developed major allergic
symptoms before their tenth birthday. This means
that most of the major allergic symptoms in chil-
dren are preschool problems.
The differential diagnosis of allergic rhinitis is
relatively easy and will be discussed later, but
the differential diagnosis of asthma is consider-
ably more complex. Glaser7 cautions that not
all wheezing can be attributed to asthma. The
differential diagnosis must include congenital stri-
dors, foreign bodies, bronchial stenosis, laryngo-
tracheo-bronchitis, pertussis, and pneumonitis.
The possibility of a tumor mass, tuberculosis, or
even fibro-cystic disease of the pancreas should
be considered. Tracheal vascular anomalies and
laryngo-spasm, due to tetany, must be differentiat-
ed in the young infant. A roentgenogram of the
chest, or fluoroscopy, should be requested where
any doubt of the diagnosis exists.
The presence of a concomitant allergic manifes-
tation such as eczema or urticaria makes the diag-
nosis simpler. In diagnosing allergy, the family
background is extremely important. Numerous
studies concerning the hereditary factors in al-
lergy have appeared. In general, the antecedent
family history is positive in from 50 to 75 per
cent of allergic individuals. This high incidence
of family allergic history is in contrast with the
low .antecedent family history found in normal
non-allergic persons of only 7 per cent.
Vaughan12 points out that the majority of allergic
individuals who have a history of allergy in both
parents will show evidence of their disease before
ten years of age.
The history, properly taken, is the most valu-
able tool in considering an allergic problem. It
should include the type of environment, habits of
the child, and a chronological order of the symp-
toms. It is important to inquire concerning any
seasonal relationship to the symptoms.
The investigation of the allergic patient should
include a thorough physical examination. The
general state of health must be evaluated, endo-
crine disturbances ought to be ruled out, and the
foci of infection eliminated. The routine urine,
blood count, and Mantoux tests should be re-
quested. Upon examination of the nose, the air-
way is found to be narrow and inadequate. The
nasal mucosa is a pale blue-grey color and varied
degrees of edema and discharge are present. The
presence of polyps is rare in children, but is seen
frequently in the young adult. The pharyngeal
wall is often studded with islands of lymphoid
tissue giving a cobblestone-like appearance. In
some of the older children the nasal mucosa, in-
stead of being pale gray, is a deep red color. Ob-
struction of the nasal airway in these patients is
the presenting symptom. Incidentally, this group
of children do not respond well to the antihista-
mine group of drugs. The nature and the amount
of the nasal secretion vary considerably. In the
uncomplicated patients with allergic rhinitis these
secretions are thin and clear, but, if an associated
infection is present, the secretions are purulent
and viscid. In either case, smears of the nasal
secretions should be made. In the thin secretions,
numerous eosinophiles will be seen. In the puru-
lent secretions there will be clumps of polymor-
phonuclear cells present in addition. Roentgeno-
grams of the sinuses frequently show thickening
of the sinus mucosae, but in most cases this is
due to edema and not to infection. The emphy-
sematous chest, with flattened diaphragm and
accentuated bronchovascular markings in the asth-
matic individual, needs no further comment.
Investigation by cutaneous skin tests is indi-
cated where definite allergy has been diagnosed,
but a patient should never be skin tested in the
hope of diagnosing an allergic condition. The
method of performing skin tests has been the sub-
ject of considerable controversy, but in children
the puncture technique is the method of choice.
The application must be uniform, and fresh anti-
gens are a necessity.
The mere performance of skin testing does not
constitute a diagnostic procedure. In the inter-
pretation of these tests, the child’s age, food hab-
its, environment, and severity of symptoms must
be considered. The tests are of immense value
if the limitations of this procedure are appreciat-
ed. Stoesser1" stresses the fact that there is no
correlation between the intensity of the skin reac-
tion and the allergen’s clinical significance. The
894
Minnesota Medicine
RESPIRATORY ALLERGIES— NELSON AND STOESSER
l
complete elimination of the offending allergens
would be ideal. In the young infant, in whom the
diet is simple, and in whom the environment can
be controlled, elimination of allergens is usually
more successful. This is not possible in the older
child.
The successful management of allergic diseases
depends upon the thoroughness of the allergic in-
vestigation, the co-operation of child and parents,
and the choice of medication. The majority of
the failures in treatment are due to the fact that
physician and patient alike expect a cure by the
simple elimination of a few isolated allergens or
by a few weeks of dietary restriction. A great
deal of time and effort must be expended if good
results are to be expected. Frequent interviews
with the parents are necessary. The importance
of such allergens as household pets, animal dan-
ders, insecticides, blooming plants, orris root, and
smoke must be stressed. Adequate rest is a neces-
sity. It is necessary to restrict physical activity.
Swimming is usually curtailed because of irrita-
tion by water in the nose. The possible harm
from long rides in the country during the pollina-
tion season must be pointed out.
Because of these restrictions, the psychological
stresses on the already chronically ill child are
increased. Bakwin and Bakwin1 have empha-
sized the emotional factors in asthma'. The al-
lergic child may become overprotected and con-
sequently become extremely dependent on the
mother. One must constantly stress substitution
in the child’s management, and the need for out-
lets in activities which do not jeopardize the aller-
gic condition.
Hyposensitization yields the best results in pol-
linosis and in the treatment of pollen asthma.
Only mediocre results are obtained with inhalants
Molds are poor antigens, and in children hypo-
sensitization with these antigens is of doubtful
value. The attempt to hyposensitize to foods is
usually disappointing.
The use of nose drops in the allergic individual
is justifiable only for temporary relief. In chil-
dren 0.25 per cent neosynephrin, 0.5 to 1 per cent
propadrine hydrochloride, 0.5 to 1 per cent clo-
pane, and 1 per cent onethyl sulfate may be em-
ployed. The antihistamine drugs are of value in
allergic rhinitis. Stoesser11 classified these drugs
according to their general effectiveness. Antis-
tine, neohetramine, and neoantergan give fewer
side reactions but are also relatively weak drugs.
Thephorin, chlor-trimeton, pyrrolozote pyriben-
zamine and benadryl are the more powerful mem-
bers of this group. Thenylene, diatrin, histadyl,
tagathen, chlorathen and decapryn are interme-
diary in action. In some children a sedative effect
is desired and for these patients drugs such as
decapryn or benadryl are particularly suited. A
few children need added stimulation and this can
be accomplished by thephorin. Some of the anti-
histamines have a very decided atropine-like ac-
tion and are harmful in that they tend to dry the
secretions and thereby precipitate asthma.
The use of antihistamines in the treatment of
bronchial asthma has been highly overrated. Fein-
berg6 makes this statement, “In the last three to
four years as a result of high-powered publicity,
the substitution of the antihistamines for the more
efficient anti-asthmatic remedies and allergic man-
agement by physicians and patients has resulted in
an actual deterioration of the management of
asthma.” The use of the antibiotics in the acute
attack of asthma is abused. This may be due to
the misconception that the asthmatic attack is
caused by the infection alone. If the concept of
underlying allergy with superimposed infection
were clearly understood, a more reasonable plan
of treatment would be followed. One must re-
member that these drugs, particularly penicillin
and aureomycin, and to a lesser degree terramycin,
are capable of sensitization.
The primary disturbance in bronchial asthma
is obstruction of the bronchial tree by edema,
smooth muscle spasm, and retained secretions.
The main objective is to clear the bronchial tree
of obstruction. Expectorant cough mixtures in-
corporating potassium iodide, sodium or potas-
sium citrate, ammonium chloride or ipecac are
essential in good management. Numerous mix-
tures of these drugs in combination with seda-
tives and antihistamines are available. Hy-
dration in the asthmatic patient is extremely im-
portant. The ill child tends to become dehydrated
thus further concentrating the secretions and
often dramatic results by simple administration of
fluids are obtained. The sympathomemitic drugs
such as orthoxine, racephedrine, propadrine hy-
drochloride, benzylphedrine, isuprel and epineph-
rine are needed for their bronchodilator effect.
These drugs may be used alone, but usually in
conjunction with a sedative and/or an antihista-
mine. Syrup of orthoxine works well in the
young infant, while franol, amodrine, tedral or
amesec can be used in the child capable of swal-
lowing a tablet. Epinephrine is the best drug in
September, 1950
895
RESPIRATORY ALLERGIES— NELSON AND STOESSER
\
the treatment of the acute attack. Rubin, in
Mitchell-Nelson’s textbook,8 states that small
doses of adrenalin injected hypodermically may
be given at frequent intervals for many days
without harmful effects. Doses of 2 or 3 min-
ims give just as effective relief as larger doses
and the side effects are minimal. Epinephrine in
oil or in gelatin may be employed for a more
lasting effect, but be careful that the child is not
sensitive to the vehicle used.
The xanthine drugs are also bronchodilators
and of this group aminophylline works well. It
may be used orally, rectally, or intravenously. In
children, this drug frequently produces nausea
and vomiting.
Conclusions
1. Allergic diseases of the respiratory system
are common in the young child, but because of
their insidious onset they are commonly misdiag-
nosed.
2. The most important factors in allergic man-
agement are a thorough allergic history, a detailed
examination including skin tests and a complete
orientation of both the parent and the patient.
3. Allergic children are commonly subjected to
needless tonsillectomies.
4. The use of the antibiotics in allergic diseases
has been abused.
5. The antihistamine drugs are of some help in
children with allergic rhinitis. However, their
value in the treatment of asthma has been highly
overrated.
6. A return to a more rational form of therapy
in asthma, using expectorants, hydration and
bronchodilator drugs is indicated at this time.
References
1. Bakwin and Bakwin: The child with asthma. J. Pediat.,
32:320-323, 1948.
2. Buffin, Wm. : Characteristics of asthma in infancy. Rhode
Island M. J., 30:859, 1947.
3. Iiullen, S.: The effect of tonsillectomy in allergic condi-
tions. J. Allergy, 2:310, 1931.
4. Clein, N. W. : Allergy and the tonsil problem in children.
Allergy, 7: (May-June) 1949.
5. Clein, N. W. : The growth and development of allergy.
Ann. Allergy, 3: (Jan. -Feb.) 1945.
6. Feinberg: The anti-histamine drugs — five years of experi-
ence. Illinois M. J., 97:54, 1950.
7. Glaser, G. : The diagnosis and treatment of bronchial asth-
ma in pediatric practice. Journal-Lancet, 70 :183, (May)
1950.
8. Mitchell-Nelson : Textbook of Pediatrics. 4th Edition.
Philadelphia: W. B. Saunders Co., 1946.
9. Piness and Miller: Allergy — a non-surgical disease of the
nose and throat. J.A.M.A., 85:339, 1925.
10. Stoesser, A. V.: New interpretations of the allergy cu-
taneous tests. Journal-Lancet, 64:145-147, (May) 1944.
11. Stoesser, A. V.: What can be done for the hay fever
patient? Modern Med., (Aug.) 1949.
12. Vaughan, W. T. : Practice of Allergy. St. Louis: C. V.
Mosby Co., 1939.
CLINICAL DETECTION OF PULMONARY EMPHYSEMA FROM
RESPIRATORY TRACINGS
(Continued from Page 892)
included fluoroscopic examination of the chest,
I feel certain that separation of persons with all
degrees of emphysema from the normal group
would be nearly complete. As part of a screening
examination attempting to detect the presence of
combined ventilatory and circulatory impairment
in persons with pulmonary disease, consideration
of respiratory tracings made on the ordinary clin-
ical spirometer may be a very simple yet reward-
ing procedure.
Bibliography
1. Birath, G.: Lung volume and ventilation efficiency. Acta
Med. Scandinav., Supp. 154, pps. 1-215, 1944.
2. Borden, C. W., Ebert, R. V., Wilson, R. H., and Wells,
H. S. : Pulmonary hypertension in heart disease. New
England J. Med., 242:529, 1950.
3. Christie, R. V. : Respiratory tracings in the various neu-
roses. Quart. J. Med., 4:427, 1935.
4. Macklin, C. C. : Changes in volume of pulmonary blood
vessels after collapse therapy. Dis. Chest, 14:534, 1948.
5. Riley, R. L. : The measurement of pulmonary function.
V. A. Tech. Bull., TB 10-58, 1949.
6. Theodos, P. A., Gordon, B., Lang, L. P., and Motley,
H. L. : Studies in the clinical evaluation of disability in
anthrasilicosis. Dis. Chest, 17:249, 1950.
896
Minnesota Medicine
CANCER OF THE LARGE BOWEL
HENRY FISKETTI, M.D.
Duluth, Minnesota
/^ANCER of the large bowel is reported in suf-
ficient frequency at St. Mary’s hospital, Du-
luth, to make it a subject of interest and to war-
rant a review of all cases that have been treated
in the years 1938-1947 inclusively. The fact that
there are approximately 16,000 cases of cancer of
the large bowel in the country annually poses a
tremendous surgical problem. Such factors as
better medical training in the various medical
schools, the education of the public by the cancer
control programs, more refined methods of diag-
nosis, and so forth, have no doubt contributed to
its greater incidence in recent years. But, not-
withstanding, there are still too many cancers of
the large bowel that are seen at a stage of inopera-
bility. This is especially true of cancer of the
right colon, where obstruction is not an early oc-
currence. The disease is insidious to the point
of hopelessness in some cases. Careful attention
to history and a good physical and rectal examina-
tion will lend to early diagnosis. Over 50 per
cent of lesions of the rectum and sigmoid are
within reach of the average index finger, and still
this simple but admittedly not too esthetic clinical
maneuver is too often omitted. Extirpation of
the lesion is possible in most cases, and in com-
parison with the survival rate of cancer in other
organs, cancer of the colon is one of the most
favorable for cure. Early diagnosis is of the
essence, the responsibility being that of the at-
tending physician, and not entirely the roentgen-
ologist. To be well versed in proctoscopy is to
diagnose cancer of the sigmoid early, but too few
are skilled in the use of the proctoscope. To pass
the same blindly, without caution, and without
experience or some training is often disastrous,
and seldom revealing. The patient is entitled to
a careful consideration of abdominal discomfort,
change in bowel habits, melena, fatigability, weight
loss, and so forth, and unexplained symptoms
warrant further study or periodic observations.
In most series, the average delay from the onset
of symptoms to hospitalization is about six
months, which is far too long. However, once
the diagnosis is made, the responsibility for com-
petent care is that of the good surgeon whose sur-
gical judgment will be guided by the absence or
September, 1950
presence of obstruction, infection, and the general
condition of the patient.
Surgical judgment means not only if and when
to operate but what type of procedure should be
done with minimal risk to the patient. A resume
of the indicated surgical procedures thought best
by some of the recent writers on the subject
will be cited a few paragraphs later.
TABLE I. NUMBER OF CASES PER YEAR
Year
No.
Per Cent
1938-42
24
23.1
1942-47
84
76.9
Total . . . .
108
100
TABLE
II. SEX INCIDENCE
Sex
No.
Per Cent
Male
45
41.7
Female
63
58.3
Total ....
108
100
Incidence
Carcinoma of the colon comprises
10 per cent
of all carcinomas
and approximately
one half of
these are in the rectum. The sigmoid is next, the
cecum is third.
An attempt is
made to compare
the site of
predilection of cancer of the large bowel with
other series of the larger clinics, and
we see that
the St. Mary’s series corresponds rather closely.
TABLE III
1931-45 1936-44 1907-28 1937-47
Hines
Source
Vets. Lahey Mayo
St. Mary’s
No. of Cases
1,330 1,457 3,542
108
Involved Sites and
Percentages:
20 cases
Cecum
7.7 6.5 6
18.5
Ascending Colon
9 cases
Hepatic Flexure
7 cases
Transverse Colon
1 1 cases
Splenic flexure
6 cases
Descending Colon
6 cases
15.9 17.1 17
36.1
Sigmoid
13.0 12.4 13.55
54 cases
Rectosigmoid
63. .5 62.8 62.8
50.
The remarkable consistency of the above fig-
ures certainly belies any belief that geography,
climate, social strata, and so forth have any in-
fluence on the incidence of carcinoma of the
bowel. In fact, it would seem that this constancy
897
CANCER OF THE LARGE BOWEL— FISKETTI
of predilection depends more on basic anatomical
structures and on local physiology.
At this point it is apropos to review the in-
trinsic blood supply of the large bowel and rec-
tum, as the success of an anastomosis depends
primarily on the blood supply. A beautiful anas-
tomosis in a bloodless segment means nothing but
disaster, but a good blood supply may minimize
the dangers of the not too competent juncture.
Investigation into the blood supply of the colon
has been stimulated by failures in colonic surgery,
and injection of the arteries in cadavers has been
the chief method of study. It is noted that the
lymphatic supply is abundant and that the lymph
channels follow closely the blood vessels to the
origin of the mesenteric arteries. The extent of
possible removal of the lymphatics is often limited
because to remove them is to sacrifice vital blood
vessels. In one’s zeal to accomplish permanent
cure, large vascular trunks may be ligated, en-
dangering the circulation to the ileum and to long-
er colon lengths than anticipated.
The blood supply to the large bowel is from
three major sources:
1. Superior mesenteric artery.
2. Inferior mesenteric artery.
3. Internal iliac branches:
a. Middle hemorrhoidal.
b. Inferior hemorrhoidal.
c. Pudendal artery.
Also, a better understanding of the colonic cir-
culation may be had if we consider it in this light:
1. Main arteries.
2. Marginal artery, so-called the artery of Drummond
and the vasa- recta.
3. The vessels within the bowel wall.
The marginal artery of Drummond joins the cir-
culation from both mesenteries. This can be
demonstrated by injecting media into either mes-
enteric artery and recovering it from the other.
The vasa brevia are both long and short and enter
the bowel on the mesenteric side naturally. The
omentum with its good supply may have a part
in colon surgery. Its blood comes from the gas-
tric vessels, mainly the gastroepiploic. Its power
of rapidly becoming adherent to the peritoneal
surface, sealing over areas of questionable circu-
lation and reinforcing suture lines is well known.
Although there are disadvantages in the ar-
rangement of the blood supply to the colon, it still
has some good points. We should be aware of
the fact that all its arteries come from the center
of a rectangle formed by the loops of the colon
and radiate peripherally from the center. This
means that the peritoneal reflection on the lateral
aspect of both the descending and ascending colon
898
Minnesota Medicine
CANCER OF THE LARGE BOWEL— FI SKETTI
may be freely incised without encountering ves-
sels and permits easy delivery of these segments
of bowel from the abdomen, thus facilitating re-
section. The splenocolic ligament at the splenic
flexure may require ligation for bleeding, but the
attachment at the hepatic flexure may be severed
with impunity.
Symptoms
A few points about symptoms. Usually an av-
erage from six to ten months elapses from the
onset of symptoms until something medical is
done. The first symptom may be sudden obstruc-
tion or perforation. Lahey states that at his clinic
the time interval for all cases averages nine
months with no betterment in recent years.
Unfortunately, many patients still undergo trial
medical treatment too long: hemorrhoidectomies,
appendectomies, and other surgical procedures
before diagnostic studies are instituted. This is
bad because the resectability of the tumor varies
directly with the time of its existence. The fol-
lowing are the symptoms most frequently associat-
ed with tumors of the large bowel :
Abdominal Distress. — This is frequently more
marked in the region of the descending colon,
although often obstruction of the left colon will
cause most distress in the dilated right bowel.
Tenderness is chiefly on an inflammatory basis
due, most likely, to degeneration of the tumor
with secondary infection. The amount of dis-
tress depends upon the degree of obstruction and
is usually aggravated by eating and relieved by a
bowel movement. In about 8 per cent of the left
colon lesions, acute obstruction is the first symp-
tom. It is said that 5 per cent of the sigmoid
tumors begin this way. Carcinoma of the cecum
frequently is first diagnosed at appendectomy
when the true pathology is usually noted by the
surgeon. Further radical surgery at this time is
done without the benefit of good preoperative
preparation.
Change in Bowel Habits. — This is very im-
portant. A careful history may reveal alternat-
ing constipation and diarrhea. It is the conten-
tion of many that unfortunately this is not too
early a sign and that it signifies considerable
change in the mucosa or lumen of the bowel.
Mass in the Abdomen. — Many times this is
the presenting complaint. Ten per cent of pa-
tients with carcinoma of the cecum discover a
TABLE IV. DURATION OF SYMPTOMS
Duration
Number
Per Cent
Under 6 months
62
57.4
Over 6 months
16
14.8
Uncertain
30
27.8
Total
108
100
TABLE V. CLINICAL SYMPTOMS AND FINDINGS
Neg.
Pos.
No. Inf.
Weight Loss
19
48
41
Anemia
22
23
63
Pain
Upper Abdomen
11
Lower Abdomen
35
Both
32
20
Palpable Mass
51
37
Occult Blood
26
31
51
Obstruction
8
66
34
Gross Hemorrhage
5
2
101
Perforation
5
3
100
+ X-Ray
37
34
37
Proctologic Exam
28
80
lump before the doctor. These patients are nat-
urally thin ones, whose sigmoid and cecal areas
can be easily palpated.
Weight Loss. — Contrary to the usual belief,
this is often an early sign and is nearly always
present.
Blood, in the Stools. — Found in about one-third
of the patients with lesions in the left half, but
in only 8 per cent with right colon involvement.
Other Complaints. — Anemia is characteristic
of cecal involvement. The mechanism of the
early anemia in cecal carcinoma is not clearly
understood. Nausea, vomiting, weakness, ano-
rexia, are other symptoms that are found and
indicate some wasting disease.
From the standpoint of incidence, we note that
in this series the three most important symptoms
and findings are :
1. Pain
2. Obstruction
3. Weight loss
Pathology
The character of the lesion was proved by mi-
croscopic studies in a very high percentage of
the series either by biopsy, removal of the tumor,
or autopsy. Adenocarcinoma or a colloid modi-
fication of such is usually found ; occasionally an
undifferentiated carcinoma. Removed nodes can
not be labeled malignant or benign grossly, and
at operation frozen sections should be done before
determining with conviction that the case is inop-
erable.
Multiple polyposis has been noted in about 2
September, 1950
899
CANCER OF THE LARGE BOWEL— FISKETTI
TABLE VI
Pathology Diagnoses
Adenocarcinoma
Carcinoma Simplex
107
2
0
2
Total
m
per cent of the cases of carcinoma
of the bowel
and the incidence of multiple carcinoma is rather
rare.
Operability or Resectability
The above terms are relative ones. The atti-
tude towards resectability has materially changed
in recent years with gradual improvement in sur-
gical principles, chemotherapy, preoperative prep-
aration, et cetera. Operability has been extend-
ed to a remarkable degree, and even bearing in
mind radical removal of possibly involved tissue,
we have now arrived at the point where if the
area can be mobilized, it may be removed rather
safely. On the other hand, some have questioned
the justification of radical operation in the pres-
ence of liver metastases. Nevertheless, a stormy
convalescence in either of these cases is often
justified by incredible periods of good health and
well-being in a patient who is doomed.
Segments of the parietes are now removed
with impunity but of course with a resultant
higher mortality. The morbidity will also be
greater, and both patient and doctor will some-
times wonder whether the effort to prolong life
is worth while. The rate of cure is also decreased
proportionately by the inclusion of these exten-
sive operations. On the other hand, there is much
to be said for a radical attitude. Not only does
the patient have the best chance for a respite
and a possible cure, but there is implanted in the
mind of the young surgeon the correct viewpoint
toward the increasing scope of surgery. In con-
clusion, resectability is probably a better term
than operability.
The last chart was made to determine if the
operative mortality has improved any in the last
five-year period. The sulfonamides were in use
in the first group and the second group had the
additional aid of penicillin, sulfasuxadine, et cet-
era. Without any doubt, also, in the second five-
year period there was better and more thorough
preoperative and postoperative care.
Active interest in surgical management of ma-
lignancy of the large bowel has been more evident
in the last twenty years. Anatomy and physiol-
ogy, of course, have not changed, nor have all
surgeons suddenly become experts, but no one
doubts that surgical technique has increased the
scope of resectability. Further benefits must
come from earlier diagnosis, which obviously is
lagging far behind surgical advances.
TABLE VII. NUMBER OF RESECTIONS OF CARCINOMA
OF COLON AND OPERATIVE MORTALITY.
0 20 40 60 80 100
1917-42
Resections 8:23 34.8%
1942-47
Resections — —
16:83 19.2%
Multiple Stage 39
Single Stage 69
Anesthetic
Spinal 52
Others (Inhalation, Local, Intravenous).. 56
Number of Surgeons 25
There are admittedly many different ways of
attaining a certain surgical goal in a specific seg-
ment of bowel. The main prerequisite, however,
is to do as extensive and radical an operation as
possible without unduly jeopardizing the patient.
Stating it differently, first the patient’s life must
be safeguarded ; and second, the patient’s health
must be restored. This, if done by the open or
closed method, by the one-stage or two-stage
procedure, or by any other technique, makes lit-
tle difference, provided the surgeon can show
that his results from the standpoint of mortality
and morbidity are equal to those of other tech-
niques. Perfecting one technique is better than
trying out every new surgical wrinkle that comes
along. This is not the type of surgery that should
be attempted alone by the occasional operator,
but the aid of one experienced should be enlisted.
If the 16,000 cases of carcinoma of the bowel
were parcelled out equally to all surgeons, few
would have sufficient experience to deal with them
properly.
There are a variety of well thought-out opera-
tive procedures for patients with cancer of the
colon. Those who champion one-stage proce-
dures are apt to lay great emphasis on the bene-
fits derived from prompt removal. This doesn’t
condone too great urgency. Obstruction, sub-
acute perforation, or fixation must alter the course
of the staunchest one-stage advocate. Graded pro-
cedures are needed for safety in this group. Many
non-resectable lesions can be made operable by
preliminary bowel drainage, and consideration
900
Minnesota Medicine
CANCER OF THE LARGE BOWEL— FISKETTI
must be given to exteriorization methods. So-
called aseptic anastomosis versus open sutures
must be critically weighed in each individual case.
In the final analysis, the main controversies in
surgery of the colon revolve around : ( 1 ) the one
or multiple stage procedure, and (2) the open
and aseptic or closed method of anastomosis.
Broadly speaking, as someone aptly stated, “less
depends on the method than the manner of its
execution.”
Since there is considerable difference in the
technique and the mortality rates in the extirpa-
tion of growths in the various segments of colon,
it is desirable to discuss these regions separately.
The right colon is involved in this series in 30
per cent. Obstruction is seldom a problem here,
and therefore decompression procedures seldom
are necessary. The chance of survival is good
due to the anatomic arrangement which makes it
easier to include the entire lymph and vascular
area in the resection. The terminal ileum and
the right half of the colon must be included in the
resection. The operative mortality in this group
is relatively high. Charles W. Mayo does a one-
stage with open anastomosis with a mortality of
8.4 per cent instead of the usual about 20 per cent.
Lahey champions a Mikulicz type of resection as
a primary operation, and closure of the complete
fistula at a later date. His mortality is 13 per cent.
Stone prefers a one-stage resection with aseptic
anastomosis, and those operating at Massachusetts
General have found that the mortality is less in the
two-stage procedure. It is well to delay the pre-
liminary ileo-transverse colostomy until the pa-
tient is in fine fettle, from a preoperative stand-
point. Sulfasuxadine or succinylsulfathiazole is
a must and the Miller- Abbott tube should be used.
Dangers of this operation are : ( 1 ) the usual
double risk to two operations, and (2) obstruc-
tion of small bowel from herniations through the
trap left by the ileocolostomy. This can be les-
sened by placing the anastomosis more than 12
inches from the ileocecal valve, thereby making
the trap larger. Various methods have been sug-
gested to manage the large, often infected, dead
snace resulting from resection of a large growth.
Good drainage is very essential. The Mikulicz
pack has enjoyed recent publicity and popularity.
Several procedures most commonly used for
lesions of the transverse colon are resection and
primary anastomosis, extraperitoneal resection,
resection after preliminary cecostomy. Prelim-
inary ileosigmoidostomy may be considered rare-
ly, but may lead to an unnecessarily wide resec-
tion or may leave behind sizable de'functionalized
segments of bowel. Primary resection is best
adapted to lesions of the midcolon, and if the
lesion is in the proximal third of the transverse
colon, it can best be treated by the method used
for the right colon.
We must always bear in mind the paucity of
arterial blood at the distal end of the transverse
colon, and if the resection is done in this virgin
field, the bowel ends should be tested for via-
bility.
The distal transverse, splenic flexure, and up-
per descending colon afford an ideal situation for
a preliminary cecostomy followed by resection
and aseptic anastomosis. A transverse incision
is used well in this region. One may in some
cases prefer Rankin’s obstructive resection but
immediate resection with anastomosis without
preliminary drainage appears relatively hazard-
ous in this region that is often obstructed.
The descending colon is involved the least.
Representing one of the fixed areas of the colon,
one cannot exteriorize the segment involved as
easily as the sigmoid. Mobilization can be en-
hanced by dividing the suspensory ligaments to
the splenic flexure. Obstructive resection has
been popular at the Massachusetts General Hos-
pital. Preliminary cecostomy, followed in ten
days by resection and aseptic end-to-end anasto-
mosis is the method of choice. There is some
effort expended in closing the colostomy follow-
ing obstructive resection, but preliminary cecos-
tomy rarely requires surgical closure. In the
absence of obstruction, resection with or with-
out complementary cecostomy may be done. Com-
plementary cecostomies heal more promptly than
preliminary ones, due to the use of a small tube
and shorter period of need for it.
For lesions of the sigmoid, although the oper-
ability is high and the operative mortality is low,
the cure rate is considerably less than for the
right colon. Lymphatic spread and earlier liver
metastases account for this discrepancy. Many
methods have been suggested to relieve the fre-
quent and severe obstruction found at this site.
The simplest and safest is cecostomy. If the
growth G large or has produced an abscess by
perforation, the cecostomy should be followed a
few days later by a complete transverse colostomy.
The Devine colostomy is rather well accepted in
this country, but simple loop colostomy is becom-
Septembek, 1950
901
CANCER OF THE LARGE BOWEL— fISKETTI
ing more popular. At any rate it is necessary to
rest the infected bowel, and when possible to
cleanse it preoperatively by means of irrigations.
The only price paid for safety and operability
Fig. 3. The area of resection of the cecum with ligation
of the ileocolic artery near the superior mesenteric at A. B indi-
cates the main branch of the superior mesenteric which may
be ligated inadvertently when an attempt is made to remove
the lymphatic glands and which would result in death of a large
part of the small intestine.
is the increased morbidity of additional hospital
days. Many may be prepared for surgery with-
out decompression and catharsis and enemas may
be sufficient. Sulfasuxadine and succinylsulfa-
thiazole are laxatives per se. Although it is the
feeling of some that nothing more than such
preparation is necessary before resection, many
surgeons prefer decompression anyway. Whip-
ple uses decompression frequently and Allen and
Lahey do a preliminary tube cecostomy followed
in about ten days by a Rankin obstructive resec-
tion. The use of a small catheter vent in the
proximal segment placed near the clamp has been
found helpful in this case.
The history of surgery of the rectosigmoid and
rectum is varied and interesting. Littre, in 1710,
was one of the first to do a colostomy. Sixty
years later a cecostomy was done, and in 1783,
Duret successfully performed a left ilio-lumbar
colostomy for an imperforate anus in a three-dav
infant. Then colostomy was not used in opera-
tions for extirpation of malignant lesions of the
rectum till 100 years later when, in 1887, Shede
did a preliminary colostomy for removing a tu-
mor posteriorly and re-establishing bowel con-
tinuity. Until Miles presented his technique, in
1908, the surgical objective was extirpation and
anastomosis of remaining segments to preserve
the sphincteric mechanism. The emphasis was
placed on the method of approach, i.e., perineal,
Fig. 4. In a certain number of cases where the left colic
artery does not anastomose too freely with the middle colic
part the splenic flexure, resection of the cecum and hepatic
flexure may result in extensive devitalizing of the transverse
colon when arteries are tied at A and B.
sacral, anal, et cetera, and the degree of removal
of the sacrum. The Kraske and Hochenegg pro
cedures were in vogue. The Kraske was an end-
to-end anastomosis of the sigmoid or rectum
through a posterior approach without colostomy.
The Hochenegg method was based on the prin-
ciple of pulling the upper segment out through
the anus and fixing it there with sutures. Colos-
tomy was seldom done during this surgical era
because the closure of a temporary colostomy
was then accomplished by end-to-end anastomosis
and carried a high mortality. Maunsell, in 1892,
combined abdominal resection and perineal exci-
sion with sphincter preservation and posterior
anastomosis. Miles modified the entire objective
by minimizing the necessity for maintaining the
sphincter mechanism and emphasized radical re-
moval. He predicated this on the studies of the
lymphatics of the rectum and concluded that the
tumor also spread downward towards the anus.
The compatibility of a colostomy with routine
social, economic, and athletic activity was prop-
agandized. Gradually, his teaching became uni-
versal. Nevertheless, in the past thirty-five years
there have been sporadic attempts to develop oper-
ative procedures that would answer the need for
wide excision and yet preserve anal continence.
Lockhart- Mummery and Balfour in 1910 report-
ed their experiences of anastomosis over a rectal
tube.
A new drive for eliminating the permanent
colostomy was initiated in 1935 by Devine whose
special transverse colostomy completely defunc-
902
Minnesota Medicine
CANCER OF THE LARGE BOWEL— FISKETTI
tionalized the distal colon, permitting later resec-
tion and anastomosis followed by closure of the
colostomy. In 1937 Horsely resected the recto-
sigmoid after preliminary cecostomy and did an
open anastomosis deep in the pelvis. Since
1939 reports have come from Babcock, Dixon,
Fallis, Wangensteen and others, all with varying
techniques but all with a common desire to elimi-
nate permanent colostomy. This seems hopeful
in the light of new interpretations in the mode
of spread of carcinoma of the bowel. A half
dozen investigators reveal that seldom is the
spread by lymphatics or direct extension toward
the anus. They think that a clearance of two
inches below the tumor is sufficient. However,
abdominoperineal resection is definitely indicated :
( 1 ) in widespread involvement of the sigmoid
necessitating wide resection ; (2) when the sphinc-
ters or levator muscles are involved; and (3)
when the lesion is within three inches of the
anus and encircles the canal (this may be debat-
able).
Summarizing, the temptation to make re-estab-
lishment of continuity the sole objective of the
operation is one that must be guarded against if
the surgeon is to avoid the most grievous of sur-
gical sins, namely, fitting the patient to the opera-
tion rather than the operation to the patient.
General Complications
Complications of colon surgery are best
brought out by another chart : Table VIII.
In closing, some general considerations to be
stressed in bowel surgery may be briefly men-
tioned. Chemotherapy has proven a boon and
preoperative sulfa and penicillin are a therapeutic
necessity. Less sulfa is being used in the perito-
neal cavity because of the liver damage often
ensuing. Sulfasuxadine is a fine drug in this field
because of its low absorption and toxicity and
because of its laxative properties. Because of
the antibiotics, complications such as abscess for-1
TABLE VIII
Complications
Number
Per cent
of 49
Per cent
of Total
Peritonitis
6
13
5.5
Wound Infection . . . .
16
7.4
Pneumonia
9
IS
8.3
Thrombosis
1
2
.92
Obstruction
9
18
8.3
Embolism
2
4
1.8
Others
14
29
12.8
(1) Coronary
(2) Heart failure
(3) Cerebral
Total
49
100%
45.02
mation and wound infection are slow to appear
and should be vigilantly watched for. The use of
the Wangensteen and Miller-Abbott tube is in-
disputable and is only equaled by preliminary
temporary cecostomy or colostomy. Intelligent
use of the Miller-Abbott tube is paramount but
a discussion of this is not within the scope of this
paper.
Delayed wound closure has been emphasized
in this field. No matter how great care is exer-
cised in the technique, these wounds have a rela-
tively high incidence of infection. Coller’s tech-
nique is to place the sutures, and then tie them
and close the wound under pentothal anesthesia
when no sepsis is assured, usually within seventy-
two hours after resection. This practice has sel-
dom been used at St. Mary’s. Naturally, all the
niceties and proprieties of preoperative and post-
operative care are equally pertinent to this type
of surgery.
In conclusion, bowel surgery will continue to
pursue certain trends in the future as it has in
the past. New techniques will replace the old.
Many new drugs are just over the horizon, and
consequently the tendency in recent years has
been and in the future will be a steady decline
in morbidity and mortality from the surgical
aspect. May some panacea for early diagnosis
be attained soon so that an ever increasing num-
ber of unfortunates will be spared the lot of death
from cancer of the bowel.
September, 1950
903
BERYLLIOSIS
Brief Discussion and Presentation of a Case with Pulmonary, Digital
and Axillary Node Involvement
ROBERT A. NACHTWEY, M.D., MALCOLM B. DOCKERTY, M.D.
and
CORRIN H. HODGSON, M.D.
Rochester, Minnesota
BERYLLIOSIS is a truly modern disorder.
Though the metal beryllium was discovered in
1797, the first recognition of toxic effects was
made in 19333 and the first report of beryllium
toxicity in the United States was that of Van
Ordstrand and associates in 1943. Beryllium was
not extensively used until World War II. Be-
cause it resists corrosion and fatigue and increases
the tensile strength of alloys, it is used in precision
instruments, carburetors, airplane pipe lines and
electrical instruments and in the coating of fluo-
rescent tubing. Toxicity apparently does not arise
from exposure to the ore beryl itself but from
the fumes and dust encountered in extracting and
processing beryllium. Therefore, toxic effects are
seldom observed except in industries engaged in
this work. Exposure to the occasional breakage
of a fluorescent lamp is not a hazard unless one
is cut by a piece of the glass which may cause a
beryllium ulcer to form. Since June, 1949, all
the major manufacturers of fluorescent lamps
have discontinued the use of beryllium ; so that
this source of danger will eventually be eliminated.
Because of the infrequency of berylliosis the
condition is likely to be overlooked.
A brief review of the clinical aspects of beryl-
liosis will here be given.
Dermatologic Manifestations
Within three to ten days after the initial ex-
posure to beryllium fumes or dust, some cuta-
neous manifestations will develop in more than 25
per cent of the workers. A dermatitis may ap-
pear on the exposed parts of the body or a more
or less generalized urticarial reaction mav de-
velop. The patient experiences a burning sensa-
tion or pruritus of the affected areas. The lesions
respond well when the patient is removed from
the offending environment and with the use of
soothing and antipruritic lotions. The antihista-
minic drugs are also thought to be helpful. Con-
junctivitis may be associated with contact derma-
titis of the face, but heals without complications.
Dr. Nachtwey is a Fellow in Medicine, Mayo Foundation; Dr.
Dockerty is with the Division of Surgical Pathology and Dr.
Hodgson is with the Division of Medicine, Mayo Clinic, Ro-
chester, Minnesota.
A beryllium ulcer of the skin may develop if a
minute crystal of beryllium enters through a cut
or abrasion. A foreign body tissue reaction takes
place which tends to ulcerate, heal and recur.
This reaction evidently continues until the beryl-
lium crystal is extruded or removed. Enlarge-
ment of the regional lymph nodes may be as-
sociated with the ulcer. Cuts from pieces of
broken fluorescent tubing are a common source
of beryllium ulcer. The treatment of this condi-
tion is excision of the region involved or incision
and curettage to remove all traces of beryllium.
Respiratory Manifestations
Nasopharyngitis is an acute response to ex-
posure to certain beryllium compounds. It consists
of hyperemia and swelling of the mucous mem-
brane of the nose and throat, and the patient
notices soreness and bleeding. Ulceration, some-
times with perforation, of the nasal septum has
been noted. The nasopharyngitis responds well
when the worker is removed from the offending
environment. It varies in severity.
Tracheobronchitis is an important develop-
ment. It may exist without demonstrable pul-
monary changes but it always precedes the de-
velopment of pneumonitis. The symptoms as-
sociated with it are cough, dyspnea, occasional
blood-streaked sputum, anorexia and loss of
weight. N,o specific treatment is recommended,
but failure to remove the worker from further
exposure and failure to institute a strict rest pro-
gram may lead to pneumonitis. When not com-
plicated by pulmonary involvement the tracheo-
bronchitis usually clears in four weeks or less.
Pneumonitis
Two forms of pneumonitis due to exposure to
beryllium compounds are recognized, the acute
and the chronic form. The acute form presum-
ably results from a heavy exposure during a short
period. The onset of symptoms is usually within a
few hours or a few days after exposure. The pa-
tient complains of cough, dyspnea and substernal
pain. The cough may be productive of small
amounts of blood. With increase in the severity of
904
Minnesota Medicine
BERYLLIOSIS— NACHTWEY, DOCKERTY AND HODGSON
symptoms, the patient becomes extremely short of
breath, cyanotic and bedridden, requiring oxygen.
Anorexia and loss of weight are nearly always
present. Unless influenced by complications the
temperature and leukocyte count remain near nor-
mal. The acute pneumonitis runs a fairly rapid
course ending in death or recovery in a few
weeks or a few months. The mortality rate ex-
ceeds 10 per cent. At first no roentgenographic
abnormalities are observed in the lungs. Later
diffuse bilateral changes appear, progressing from
a haziness to irregular areas of infiltration and
then to conglomerate nodules before complete
resolution takes place. Pulmonary fibrosis may
remain after recovery.
Chronic pneumonitis follows prolonged ex-
posure to beryllium compounds. It may appear
after years of exposure and may fail to become
manifest until a long time after exposure has
terminated. The early symptoms, usually pro-
gressive, are severe dyspnea, anorexia, loss of
weight, cough, fatigue and weakness. With the
development of extensive pulmonary changes,
notably fibrosis, cor pulmonale develops. If fever
is present it is usually low-grade. Little if any
alteration from the normal is noted in the labora-
tory examinations of the urine, erythrocyte and
leukocyte counts, sedimentation rate, protein, or
urea nitrogen. With the advent of right heart
failure, secondary polycythemia may develop.
Roentgenographic abnormalities of the lungs are
described2,3 as progressing from the earliest
changes consisting of a “diffuse fine granularity”
to a later distinctly nodular type of lesion. Some
enlargement of the mediastinal lymph nodes is
frequently present.
The treatment of both the acute and the chronic
pneumonitis is the same and consists of rest in
bed, oxygen when indicated, and supportive meas-
ures. Removal from exposure to beryllium com-
pounds, of course, is essential. Antihistaminic
drugs are said to be helpful. Penicillin may be
effective in preventing secondary infection or in
treating infection if it supervenes. BAL has
been used in the treatment of berylliosis without
appreciable effect.
Pathology of Berylliosis
Hardy and Tabershaw in 1946 studied necrop-
sy material from a case of fatal chronic beryl-
liosis and called attention to the presence of
granulomatous reactions in the lungs, liver and
lymph nodes. However, for the life history of
the lesions as studied in the acute and chronic
phases we are indebted to Dutra, who, in 1948,
detailed the necropsy findings seen in some twenty
cases in which patients had died from the effects
of berylliosis. Death in the acute phase was
brought about as a result of interstitial pneumo-
nitis and hemorrhagic edema which effected a
marked interference with the exchange of alveo-
lar gases. Superimposed infections and failure
of the right cardiac ventricle were precipitating
factors.
Microscopically the lesions were not highly
specific, although a peculiar fibrinoid change was
described, the material being brightly eosinophilic
and arranged in irregular or serpentine strands.
In a few cases there were scattered giant cells
and fibroblasts which in Dutra’s opinion pre-
saged the formation of granulomas and bridged
the gap between the acute and the chronic lesions.
In “chronic” cases terminating fatally, there
were, in addition to pulmonary fibrosis, sclerosis
of the pulmonary vessels and emphysema, nodu-
lar lesions in the pulmonary parenchyma. Mi-
croscopically these nodularities featured tubercle-
like structures of the so-called hard variety re-
sembling more those seen in sarcoid than the
ones which are typical of tuberculosis. In a
matrix of brightly eosinophilic material, probably
representing the fibrinoid substance previously
referred to, were scattered fibroblasts, lympho-
cytes, histiocytes and giant cells. Histiocytes
tended to be round rather than ovoid like the
epithelioid cells of sarcoidosis. Prominent in the
tubercules were peculiarly whorled or laminated
purplish-staining structures which were termed
“conchoidal bodies.” Some of these bodies were
located within giant cells while others were seen
to be lying free. Caseation was absent. There
was no increased content of silicon and, most
importantly, analyses for beryllium gave positive
results. The regional hilar nodes and occasionally
the liver contained granulomas similar to those
seen in the lungs.
Though one cannot make an absolute diagnosis
of beryllium pneumonitis except by recovering
beryllium from the lesion produced in the tissues,
nevertheless, with a history of sufficient exposure,
a characteristic clinical course, and typical roent-
genographic findings, there should be no more
question of the diagnosis than in obvious cases
of silicosis.
The following case is one with typical beryl-
lium pneumonitis, a “healed” beryllium ulcer of
the finger and an associated enlarged axillary
September, 1950
905
BERYLLIOSIS— NACHTWEY, DOCKERTY AND HODGSON
lymph node from which beryllium was recovered
by spectrographic analysis.
Report of Case
The patient, a white man aged thirty-five years who
lived in southern Minnesota, was admitted to the Mayo
Clinic on April 7, 1949. He was engaged in the whole-
Fig. 1. Roentgenogram of the thorax of April 8, 1949
showing irregular consolidation in the peripheral portions of
both lungs with enlargement of the hilar nodes.
sale electrical business and stated that since 1936 he
had spent much time in making fluorescent lamps, hav-
ing blown the glass and coated the tubes.
His previous illnesses included an attack of what may
have been rheumatic fever in childhood; pleurisy, drop-
sy and heart trouble in 1923; and pneumonia in 1923
and 1939.
For many years he had had a nonproductive cough
which had increased in severity during the few months
before admission. During the late fall of 1948 he had
begun to notice dyspnea on exertion and fatigue. These
symptoms had become progressively worse. He also
had bilateral thoracic pain of pleuritic nature, and
had noted pain in the lower dorsal region which was
most noticeable in the morning and improved with
activity. For several months before coming tO' the
clinic he had noticed slight edema of the ankles, and
for the previous two months, tachycardia and palpita-
tion on exertion. He had never coughed up blood or
experienced nocturnal dyspnea. During the two weeks
before admission there had been a wheezing during
inspiration. His weight had decreased from 205 pounds
(about 93 kg.) to 187 pounds (about 85 kg.) in the
preceding three months. Diuretics had been administered
at home without appreciable effect on the edema or
his symptoms. In 1945 while the patient was in the
army a thoracic roentgenogram had been taken and ap-
parently had been considered not to show any abnor-
mality of the lungs. He presented a card from the
chest x-ray survey reporting a film in 1948 as “nega-
tive.”
His appearance when he was seated quietly did not
suggest ill health. The color of his face and neck
would darken when he lowered his head. He would
become noticeably short of breath with slight exertion.
There was no dilatation of the superficial veins of the
neck. His heart was regular, the heart rate was 90
beats per minute, no murmur was detected, and there
was no cardiac enlargement. Persistent fine rales were
heard over the lower two-thirds of both lung fields.
There was no clubbing of the finger nails, but a slight
cyanosis of the nail beds could be seen. The liver and
spleen were not enlarged and he had no edema of the
extremities. At the base of the nail on the left fourth
finger there was a healed scar which he said was the
result of a lesion which would occasionally swell, drain
some material, and then heal over. He thought this
lesion had followed a cut by a piece of fluorescent
glass. An abnormally enlarged lymph node was found
in the left axillary space.
Laboratory examinations gave the following results :
Hemoglobin, 14.8 gm. per 100 c.c. of blood ; erythrocytes
numbered 4,910,000 per cubic millimeter; leukocytes
6,600 per cubic millimeter, of which 51 per cent were
neutrophils, 14 per cent monocytes, 27 per cent lympho-
cytes, 7.0 per cent eosinophils, 0.5 per cent basophils,
and 0.5 per cent myelocytes. A smear of peripheral
blood was reported to show a mild monocytosis but
otherwise was not diagnostic of disease. Routine analy-
sis of the urine gave normal findings. Though very
little sputum could be obtained, examination of acid-fast
stained smears showed no tubercle bacilli to be present.
No tubercle bacilli grew on culture of two different
specimens of gastric contents. No reaction occurred
following the intradermal injection of 0.0001 mg. of
tuberculin (PPD). The electrocardiogram was inter-
preted as follows: Rate 85, sinus rhythm; slurred
QRS I, slight right axis deviation, diphasic P III, di-
phasic T III; V-l, inverted T; V-3, diphasic T; V-5,
diphasic T. A roentgenogram of the chest was reported
to show an irregular consolidation in the peripheral
portions of both lungs and some enlargement of the
hilar lymph nodes (Fig. 1).
On April 23, 1949, the enlarged left axillary lymph
node was removed for pathologic study. Grossly the
node exhibited a firmness suggestive of metastatic scir-
rhous carcinoma. The dry-appearing cut surface was of
a mottled grayish-white color and it did not bulge.
Microscopically, under low magnification (Fig. 2)
there was complete loss of nodal architecture and re-
placement by noncaseous tubercle-like structures, in a
picture immediately identifying the lesion as a granu-
loma. The tubercles, which varied greatly in size,
were isolated in some regions and conglomerate in
others. With hematoxylin and eosin the bright pink
staining of the tubercles stood out in marked contrast
to that of the dark cords of lymphocytes in the sur-
rounding nodal tissue. About every fifth tubercle con-
906
Minnesota Medicine
BERYLLIOSIS— NACHTWEY, DOCKERTY AND HODGSON
tained one or more refractile dark purple staining acel-
lular structures, the so-called conchoidal bodies. Giant
cells were few.
Under higher magnifications (Fig. 3) most of the
spectrographic analysis for beryllium. Dr. Dutra re-
ported that his analysis of the specimen, which weighed
0.3 gm., showed the presence of 0.04 microgram of
beryllium in the entire specimen.
Fig. 2. The photomicrograph of the enlarged lymph node is typical of a granu-
loma with numerous “hard” tubercles which are pale-staining and lacking in necrosis.
Giant cells are few. Conchoidal bodies appear in the clear zones (hematoxylin and
eosin X125).
Fig. 3. Details of a tubercle showing the pale-staining histiocytes and one lami-
nated dark-staining conchoidal body (hematoxylin and eosin X285).
pale cellular elements were seen to be histiocytes in a
fibrinoid matrix which also incorporated a few plasma
cells and lymphocytes. The conchoidal bodies appeared
to be formed of a laminated particulate substance hav-
ing some of the staining properties of calcium. They
appeared similar to the structures occasionally seen in
sarcoid, tuberculosis and regional enteritis, and they
were not regarded as being specific for berylliosis. A
portion of this lymph node was submitted to Dr. Frank
Dutra of the Kettering Institute, Cincinnati, Ohio, for
September, 1950
The patient was advised to remove himself from all
contact with beryllium powder or fumes, to undertake
a rather strict rest program, and to avoid overexertion.
He was last heard from in August 1950, at which time
his condition was the same.
Because berylliosis is an uncommon disorder
its presence is not likely to be suspected by the
(Continued on Page 929)
907
BENIGN TUMORS, NEVI AND PRECANCEROSES
CARL W. LAYMON, M.D.
Minneapolis, Minnesota
T TERRUCAE (warts) are of several different
* types, one of the most common of which is
verruca vulgaris. These lesions occur most fre-
quently in children on the exposed parts of the
body, especially the hands. They may be single
or multiple. In adults they tend to be fewer in
number. Verrucae may occur any place on the
body, even on the tongue and oral mucosa. Ordi-
nary warts may occur under and about the nails in
which locations they are especially difficult to
eradicate.
Verruca plana (flat or juvenile warts) occur as
pin-head sized or slightly larger, smooth, flat le-
sions which are usually multiple and occur on the
face, neck, hands and knees. They are most
common in children although they may occur in
adults.
V erruca plantaris may be also single or multiple
and unilateral or bilateral. The so-called mosaic
wart represents multiple, contiguous lesions form-
ing a plaque with a granular surface. The black
dots on the surface of plantar warts represents
capillary loops.
Acuminate warts are small, pointed projections
which when multiple and coalescent form a large,
vegetating mass. This type usually occurs in moist
areas such as the ano-genital region, axillas or
under pendulous female breasts.
Treatment : — Ordinary warts are best removed
by destructive measures such as the actual cautery
or electrodesiccation. In certain cases of peri-
ungual or subungual warts x-rays may be prefer-
able. Other methods, usually less reliable, include
chemicals such as acid nitrate of mercury, tri-
chloracetic acid and salicylic acid. In multiple
warts intramuscular injections of bismuth salicy-
late may be helpful. In flat, juvenile warts de-
structive measures are usually impractical. In
these cases injections of bismuth, mercury protio-
dide orally and exfoliating topical applications
such as lotia alba or sal alcohol may be effective.
Plantar warts are best treated by means of x-rays
(1500 to 2000r) sharply localized to the lesions.
Destructive measures such as cauterization or
From the Department of Dermatology, Minneapolis General
Hospital, Carl W. Laymon, M.D., Director; and the Division of
Dermatology, University of Minnesota, H. E. Michelson, M.D.,
Director.
desiccation may occasionally be necessary. Most
acuminate warts respond favorably to a 20 per
cent solution of podophyllin in alcohol or acetone.
Cleanliness and dryness is important to prevent
recurrences.
Fibroma
Fibromas are benign, connective tissue growths
which occur as single or flat, sessile or peduncu-
lated lesions of pinkish, ivory or brownish color.
I hey may be soft or hard. Most cutaneous fi-
bromas originate in the perineurium of the periph-
eral nerves, hence are in reality neurofibromas.
Some develop from connective tissue fibers of the
corium. The term Von Recklinghausen’s disease
has been applied to multiple neurofibromas. Ex-
cision is the preferred treatment for single lesions.
Glomus Tumor
These are peculiar vascular tumors usually lo-
cated in the nail bed at the site of arteriovenous
anastomoses which regulate the local and general
temperature. Clinically the tumors are small,
bluish and extremely tender and painful. The
most satisfactory treatment is thorough excision.
Sebaceous or Epidermal Cysts
These lesions occur chiefly on the scalp, back
and scrotum. They are usually fluctuant, tense
swellings the size of marbles. The overlying skin
is usually smooth and shiny. The content of
lesions is cheesy in nature. Secondary infection is
rather frequent. Some observers have claimed
that malignant degeneration occurs in a small per-
centage of cases. Although there are various
methods of treatment, surgical excision is effec-
tive.
Nevus Pigmentosus (Pigmented Mole)
Pigmented moles are of various sizes, shapes
and colors. Hairs may or may not be pres-
ent and the surface may be smooth or rough.
Quiescent moles may be removed for cosmetic
reasons or because they occur at sites of irrita-
tion. The term junction nevus has been applied
to that type in which nevus cells occur at the
epidermo-dermal junction. Clinically they are
flat, smooth, hairless and usually dark. They are
considered potentially malignant and should be
908
Minnesota Medicine
BENIGN TUMORS— LAYMON
excised. Most benign moles can be adequately re-
moved by means of destructive measures such as
cauterization or desiccation. If a mole presents
any sudden change in size, color or surface it
should be widely excised.
Epithelial (Verrucous) Nevi
Such nevi are of epidermal origin and vary
greatly in size, distribution, appearance and color
pigment. Most of them are hairless. They fre-
quently present a linear distribution. The term
ichthyosis hystrix has been applied to localized
multiple verrucous nevi, which are usually ex-
tensive and arranged in complex pattern. The
preferred treatment is surgical removal whenever
possible.
Vascular Nevi (Hemangiomas)
There are several types of vascular nevi. The
port wine stain (nevus flammeus) is frequently
unilateral and occurs usually on the face and neck,
although it may appear anywhere. The lesions oc-
cur chiefly in infants and children, may be single
or multiple and range in color from red to dark
purple. They vary greatly in size and shape.
They are usually smooth, but may be nodular on
the surface. The general opinion prevails that the
hazards of any effective treatment of port wine
stains are so great that it is best not to treat them
at all. There are certain preparations on the
market which adequately cover them.
Strawberry marks (hemangioma simplex) are
nevi in which large vessels are involved. They
vary in size from a millimeter to several centi-
meters and in color from light red to scarlet or
purple. They usually occur on the face, shoulders,
scalp and neck, but may be found anywhere on
the body. They tend to grow but frequently
undergo spontaneous involution. Various methods
of treatment have been used including injections
of sclerosing solutions such as quinine-urethane,
x-rays and radium, and solid carbon dioxide.
Since so many of these lesions undergo spon-
taneous involution any form of treatment should
be mild and expectant. Heavy doses of x-rays and
radium are to be thoroughly condemned.
Cavernous hemangiomas are usually round,
bright red or deep purple and spongy. As in other
hemangiomas they occur most frequently on the
head and neck but may be in other places. The
lesions may be nodular, lobulated, polypoid or
flat. Larger vessels are involved in this type of
September, 1950
hemangioma. In general, the treatment is similar
to that for strawberry nevi.
Leukoplakia
This is a precancerous lesion which represents
a whitish thickening of the epithelium of the
mucous membranes, especially of the lips, tongue
and buccal mucosa. The lesions occur as super-
ficial patches of various sizes and shapes. The
surface is usually glistening and opalescent and
often reticulated. There may be verrucous
changes, erosions or fissures. Leukoplakia occurs
chiefly in individuals past forty. Syphilis is only
rarely an etiologic factor. Other predisposing
factors are excessive smoking, poorly fitting den-
tures, jagged teeth and electrogalvanic currents
between fillings and dentures.
In many cases observation is the only treatment
necessary. Active treatment should be under-
taken only if there is ulceration, erosion, Assuring
or verrucous changes. Leukoplakia is radiore-
sistant. Destruction with the cautery or desiccator
under local anesthesia is frequently effective.
Radiodermatitis
Radiodermatitis must be regarded as a pre-
cancerosis. First degree burns are characterized
by erythema with slight burning and itching which
disappears after a few days or weeks. In second
degree radiodermatitis there is edema, intense
erythema and vesiculation followed in a few days
by exudation and erosion and crusting. There
is a loss of hair which may be permanent. Months
later there may be atrophy and telangiectasia with
excessive dryness of the skin followed by pig-
mentation, the formation of keratoses and later
malignant degeneration. In third degree acute
radiodermatitis there is extreme necrosis and
ulceration with extremely slow healing which may
take months.
In chronic radiodermatitis the skin is dry, thin,
smooth, shiny and sensitive to trauma. There may
be hyper or hypopigmentation. As the dermatitis
progresses telangiectasia, keratoses and intense
atrophy may develop. Ulceration which frequent-
ly develops into carcinoma is not uncommon.
Other disorders which may be complicated by
malignant change include ulcers following burns
or varicosities, lupus erythematosus and lupus
vulgaris.
(Continued on Page 913)
909
THE EMERGENCY MATERNITY AND INFANT CARE PROGRAM IN
MINNESOTA (EMIC)
A. B. ROSENFIELD, M.D., M.P.H.
Minneapolis, Minnesota
h I 1 HE Emergency Maternity and Infant Care
-*■ Program for the wives of servicemen in the
four lowest grades, and for their infants during
their first year of life, was developed as a part
of the war effort during World War II. It was
financed through the United States Children’s
Bureau and administered by the State Health De-
partments. In Minnesota, the program began in
July, 1943. The maternal part closed in August,
1948, and the infant care part ended in June, 1949.
A total of 23,057 maternity cases received care
in Minnesota at a cost of $2,238,050.10. The
average cost per case was $97.07. There were
22,394 cases completed after delivery at an aver-
age cost of $46.44 for physicians’ services and
$54.25 for hospital care. Physicians attended all
cases except for twenty-five attended by osteo-
paths, fifteen by midwives, and eight by others.
There were 347 consultations, a ratio of sixteen
per 1,000 cases, and fifty-eight cases required bed-
side nursing, a ratio of 2.6 per 1,000. Of all
deliveries, 98.3 per cent took place in hospitals,
with an average stay of nine days per case. This
compares favorably with the state rate of 97.3 per
cent but is lower than the hospitalization rates in
the three large cities for 1948 — Duluth 99.7 per
cent, Minneapolis 99.4 per cent and St. Paul 99.0
per cent.
All medical and hospital care and immunization
for infants were limited to the first year of life.
The program provided for 7,515 infants at a
total cost of $388,272.33, an average cost per
case of $51.67. The average cost for physicians’
services was $35.26 per case; for hospitalization
it was $90.61 per case. Consultations were pro-
vided in 307 cases, a rate of forty per 1,000
cases. Bedside nursing was provided in thirty-
nine cases or five per 1,000 cases. The average
stay in the hospital was fifteen days.
Material and Method
The present study is based on a 10 per cent
sampling of the 22,394 completed maternal cases,
selecting every tenth application but excluding any
From the Minnesota Department of Health, Division of Maternal
and Child Health.
TABLE I. MATERNAL APPLICATIONS
AND SAMPLE, BY YEARS
Applications
Cases in Sample
Julv 6, 1943— July 5, 1944
8,440
547
■July 6, 1944 — July 5, 1945
7,912
725
July 6, 1945 — Julv 5, 1946
6,374
703
Julv 6, 1946— Julv 5, 1947
1,775
224
July 6, 1947 — August 1948
301
41
Total
24,802
2,240
incomplete or ineligible case. It should be noted
that the number of applications is considerably
greater than the completed cases, due to the fact
that some incomplete cases were completed in
other states and some applications were found to
be ineligible under the regulations (Table I). This
was especially true during the first year of the
program. The entire data were obtained from the
physicians’ reports submitted to the State Depart-
ment of Health. Neither the physicians’ office
records nor the hospital records were studied. The
sample under consideration consists of 2,240 com-
pleted maternal cases. Infant cases are omitted
because the services available were limited in
extent and no follow-up was possible.
TABLE II. SAMPLE OF 2,240 CASES FOLLOWED TO
TERMINATION OF PREGNANCY
Received care in Minnesota 2,136
Known to have received care in another state... 70
Termination before 20th week 33
False pregnancy 1
Total 2,240
The sample contains 2,136 cases that received
full care in Minnesota (Table II), seventy that
received part of the care in another state, thirty-
three that terminated before the twentieth week,
and one case of false pregnancy.
Consideration of the age of the mothers is quite
interesting (Table III). Mothers in the age group
of twenty to twenty-four years totalled 1,083 cases
or 48 per cent of the sample. The usual pro-
portion of maternal cases in this age group in
Minnesota is about 30 per cent.
The fifteen to nineteen year age group included
14.5 per cent of the cases, in contrast to the usual
7 per cent in the state ; 25 per cent in the twenty-
910
Minnesota Medicine
EMERGENCY MATERNITY AND INFANT CARE PROGRAM— ROSENFIELD
TABLE III. AGES OF MOTHERS IN MINNESOTA
EMIC Program
No. Percent
Statewide
Percent
Under age 15
0
15 years
21
16 years
14
17 years
48 1325
14.5%
7.0%
18 years
9.5 |
19 years
166)
20-24 years
1,083
48.4%
30.0%
25-29 years
554
24.7%
28.0%
30-34 years
142
6.3%
19.0%
35-39 years
30
1.3%
10.0%
40 +
1
0.1%
3-4 0%
Not stated
105
47%
Total
2,240
100.0%
five to twenty-nine year age group, quite similar
to the state proportion of 28 per cent ; 6 per cent
in the thirty to thirty-four year age group, com-
pared with the state proportion of 19 per cent, and
only one case in the age forty-or-over group, in
which there are usually 3 to 4 per cent in Minne-
sota. The safest age groups are considered to be
from fifteen through twenty-nine years of age.
In the EMIC program, 88 per cent of all maternity
cases were in this age group, whereas the state
group contains only 67 to 68 per cent. On the
other hand, in the age groups of thirty years and
older, where the maternal mortality rises pro-
gressively, there were only 12 per cent in the
EMIC program but 32 per cent in the state
maternal cases. This factor was undoubtedly im-
portant in the low maternal mortality rate in the
EMIC program.
TABLE IV. STAGE OF PREGNANCY AT FIRST
ANTEPARTUM VISIT
Stage
No.
77
73
84
Ill
135
104
12th wk
108
350
17-20 wk
319
21-24 wk
267
2^-28 wk
230
29-32 wk
197
126
■*7-40 wk
Total
2,240
The mother’s place of residence was in com-
munities of 10,000 or more in 1,230 cases (55 per
cent) and in communities of less than 10,000
population in 1,010 cases (45 per cent).
The records on stage of pregnancy at the date
of the first antepartum visit are based on attending
physicians’ statements (Table IV). These records
are of special interest, since such data are not
readily available for obstetrical cases in Minne-
sota. Seventy-seven women visited their physician
by the sixth week or earlier. The first prenatal
examination was given in 695 cases (31 per cent)
within the first three months of pregnancy.
Within the first four and a half months preg-
nancy, 1,210 (54 per cent) had prenatal examina-
tions. By the sixth month there were 1,631 or
73 per cent. On the other hand, 609 (27 per cent)
did not have their first antenatal examination until
after the sixth month, and fifty-six (2.5 per cent)
until the ninth month of pregnancy, in spite of
availability of medical care and the fact that the
medical bill was being paid by the Federal govern-
ment. Allowance must be made for the fact that
prenatal care may have been obtained in another
state, but this information was not supplied by
the mother.
TABLE V. NUMBER OF ANTEPARTUM VISITS
Not clear 6
No visit before delivery 14
1 visit 48
2 visits 73
3 visits 129
4 visits 150
5 visits 181
6 visits 239
7 visits 314
8 visits 277
9 visits 219
10 or more 590
Antepartum visits to a physician totalled four
or fewer in 400 cases, approximately 18 per cent
of the sample (Table V). In 1,820 cases (81 per
cent), five or more visits were made. Seven or
more visits were made in 1,400 cases (62.5 per
cent). Ten or more visits were made in 590 cases
(26 per cent). Prenatal care was paid for
separately with a required minimum of seven
visits for the maximum fee. This factor may have
contributed to the number of such visits. In the
fourteen cases listed as having made no ante-
partum visits, five were first seen by the physician
as “abortions,” and eight were first examined at
forty weeks. It is possible that prenatal care was
given earlier outside of the state.
The duration of pregnancy was determined by
the “expected date of confinement” which the
physician entered on his report to the State Health
Department (Table VI).
Thirty-seven cases terminated in an abortion at
the twentieth week or earlier, and twenty-four
cases terminated between the twenty-first and
twenty-eighth weeks. A total of 1,911 cases (85
per cent) terminated between the thirty-ninth
September, 1950
911
EMERGENCY MATERNITY AND INFANT CARE PROGRAM— ROSENFIELD
TABLE VI. DURATION OF PREGNANCY TO
TERMINATION
No. weeks
No. cases
Not known
2
20 or less
37
21-28
24
29-37
163
38
116
39
260
40
499
41
576
42
319
43
141
44
44
45
25
46
14
47
6
48
6
49
3
50
1
51
1
52
2
56
1
Total
2,240
TABLE VIII. TYPE OF DELIVERY
T ype No. Per Cent
Abortion 33 (1.5%)
Spontaneous, including episiotomy 1,681 (75.0%)
Forceps — low or outlet* 229 (10.2%)
forceps (type not specified) .... 82 (3.6%)
middle or high 49 (2.2%)
Version and extraction 23 (1.0%)
Caesarian 39 (1.7%)
Operation for ectopic 1
Not clear or not reported 103 (4.6%)
* “Outlet” specified in 67 cases.
No complications occurred in 1,884 cases (84
per cent). There were 204 obstetric complications
(9 per cent), 127 non-obstetric complications (5.7
per cent) and twenty-two both obstetric and non-
obstetric complications. Details are shown in
Table IX.
TABLE VII. ESTIMATED AND ACTUAL DURATION OF PREGNANCY
IN FOUR “LONG PREGNANCIES”
Duration of Pregnancy
52 weeks
52 weeks
55 weeks
56 weeks
First antepartum visit
4-18-44
10-19-44
6-12-46
5-10-44
Estimated date of delivery
9-28-44
4-16-45
1- 2-47
8- 9-44
Actual date of delivery
12-21-44
7- 5-45
4-16-47
11-28-44
Duration of pregnancy on birth certificate
Term
40 weeks
Term
Term
Birth weight of infant
7 lb. 6 oz.
7 lb. 1 oz.
8 lb. 15 oz.
7 lb. 5 oz.
and forty-third weeks of pregnancy. It is of
interest to note that in 103 cases (4.6 per cent),
the duration of pregnancy was apparently from
the forty-fourth to the fifty-sixth week. The
frequent unreliability of the expected date of con-
finement by Naegele’s rule, based on the last men-
strual period, is evidence by a study of Table VII
on the four longest pregnancies in comparison
with a study of the birth certificates in these cases.
According to the physician’s statement, there
were 113 premature infants, or 5 per cent of the
sample. Twenty pairs of twins were born, 0.9
per cent, or approximately one in ninety births,
the usual ratio. There were no triplets nor quad-
ruplets.
The type of delivery was not clear or not re-
ported in 103 cases (Table VIII). Thirty-three
were designated as “abortion” by the physician.
Spontaneous delivery occurred in 1,681 cases or
75 per cent. If low or outlet forceps deliveries
totalling 229 are added, plus eighty-two forceps
deliveries where the type was not specified, about
89 per cent of the sample could be classed as
spontaneous deliveries. There were forty-nine
middle or high forceps cases, twenty-three
versions and extractions, thirty-nine caesarian
sections, and one operation for ectopic preg-
nancy.
912
TABLE IX. COMPLICATIONS
Not clear or no report 3
No complication of any sort 1,884 (84.1%)
Only non-obstetric complications 127 (5.7%)
Only obstetric complications 204 (9.1%)
Any obstetric complication except in-
fection, toxemia or hemorrhage . . 60
Infection only 45
Toxemia only 34
Hemorrhage, shock or trauma .... 44
Any combination of infection, toxemia
or hemorrhage alone 7
Any combination of infection, toxemia
or hemorrhage wich other obstetric
complications 14
Both obstetric and non-obstetric complications 22 (1.0%)
Infection, toxemia or hemorrhage in-
volved 17
No infection, toxemia or hemorrhage
involved 5
Malformations were reported in thirty-one
cases (2.8 per cent) and birth injuries in ten
cases (0.8 per cent). Deaths from malformations
and from birth injuries have averaged over the
past years approximately 0.3 to 0.4 per cent of
all births in Minnesota. The reporting in this
series, therefore, appears valid for congenital mal-
formations, but the number of birth injuries is
probably considerably under-reported.
Blood tests for syphilis were negative in 2,059
cases (Table X). There were seven cases giving
positive tests, and these women were given anti-
syphilitic treatment. In 109 cases or 5 per cent,
no blood test was made, even though such tests
are made by the State Department of Health free
of charge.
Minnesota Medicine
EMERGENCY MATERNITY AND INFANT CARE PROGRAM— ROSENFIELD
TABLE X. ANTEPARTUM TESTS FOR SYPHILIS
Not clear or no report 65
Syphilis test not made 109
Syphilis test made:
Negative 2,059
Positive and
Treatment given 7
Treatment not given 0
One or more postpartum examinations were
made in 97 per cent of all cases. No postpartum
examination was made in seventy cases (3 per
cent of the sample).
In this 10 per cent sample there were two ma-
ternal deaths. It would appear that by multiply-
ing by ten we should get the full picture of the
EMIC program. This is not true, however — at
least not in the case of maternal deaths. Since
two deaths occurred in the 10 per cent sample,
there would be a total of twenty deaths in the total
program or a maternal mortality of 0.9 per 1,000
live births. Actually, a total of only twelve
maternal deaths occurred. In order to be able
to compare the EMIC maternal mortality rate
with the state rate, the four full years of the pro-
gram (1944-47 inclusive) were studied. During
this period the EMIC maternal death rate was 0.7
per 1,000 live births in contrast with a rate of
1.1 for the maternal cases in the state but not in
this program, a significant difference of 36 per
cent. It should be noted, however, that the EMIC
live births included only 7 per cent of the total
state births. A preponderance of mothers were
in the safest age group of fifteen through twenty-
nine (88 per cent in contrast to the usual 68 pei
cent), and the group was a favored one econom-
ically, since medical and hospital care were pro-
vided for the asking. Nevertheless, there is no
question that adequate prenatal care, good ob-
stetrical and postpartum care, consultations, blood,
antibiotics, hospitalization, and public health pro-
grams play a significant role in the reduction of
maternal mortality.
As a war effort, this program was actively sup-
ported by Minnesota physicians and hospitals.
The excellent training of the physicians, the com-
petent care rendered, and the adequacy of facili-
ties are evident in the good results obtained
There was considerable complaint about the bur-
densome paper work involved, a natural concom-
itant of government medicine, even though a
determined effort was made by the State Depart-
ment of Health to minimize the required work in
this area.
BENIGN TUMORS, NEVI AND PRECANCEROSES
(Continued from Page 909)
Keratoses
There are several types of keratoses. The in-
gestion of inorganic arsenic may cause discrete,
warty lesions which are usually symmetrical and
occur most commonly on the palms and soles. Such
lesions may or may not appear for several years
after the drug has been taken. Arsenical carci-
noma may complicate arsenical keratoses.
Verruca senilis (seborrheic keratosis) occurs
as multiple, slightly raised light brown or dark
brown, rough lesions which usually involve the
face, back and chest. They are usually flat and
covered by loosely attached, greasy scales which
when removed show a raw pulpy base. Epitheli-
omatous degeneration is extremely unusual. Such
lesions may be adequately treated by destructive
measures such as cauterization or desiccation.
Senile keratoses occur chiefly in old people,
especially those who have been exposed to the
elements over long periods of time. This type of
keratosis occurs especially on the exposed parts,
namely, the hands and face. They may be single
or multiple, discrete, flat, keratotic, grayish-brown
or black lesions. They are much firmer, more dis-
crete and more raised than verruca senilis. It has
been said that squamous cell epithelioma develops
in 20-25 per cent of the cases. Senile keratoses
may be destroyed by desiccation or cauterization.
They are radioresistant.
Cutaneous horns may resemble the horns of
animals. In reality they are similar to senile
keratoses except that there is an excessive develop-
ment of horny material. They occur mostly on the
scalp and face, although they may appear in other
areas. Squamous cell epithelioma is not infre-
quently found at the base. The best method of
treatment is by surgical excision.
September, 1950
913
History of Medicine In Minnesota
MEDICINE AND ITS PRACTITIONERS IN OLMSTED COUNTY PRIOR TO 1900
NORA H. GUTHREY
Rochester, Minnesota
(Continued from August issue)
John N. Farrand (1843-1880), “physician, surgeon and accoucheur,” recently
graduated from the medical school of the University of Michigan, arrived in
Oronoco, Olmsted County, in the autumn of 1870.
A native of Franklin County, Vermont, John N. Farrand was born on a farm
near Fairfield on August 2, 1843. He received his academic education in
Fairfield, taught local schools for a time, and studied medicine under a physi-
cian of Fairfield. About 1868, on leaving for medical college in Michigan, he
was married at Fairfield to Helen A. Butler, a daughter of E. S. and S. A.
Butler of that place. His wife accompanied him to Ann Arbor.
At Oronoco Dr. Farrand bought a farm in Section 17 of Oronoco Township
and there established his home, just outside the village. The house still
stood in 1947, although changed from its original appearance. The first child
of Dr. and Mrs. Farrand, Corydon Butler Farrand, was born in Ann Arbor.
Four other children, Thomas S., Helen S., Albert M. and John were born at
Oronoco.
Dr. Farrand was an able physician, a fine man and citizen, who won con-
fidence and esteem in a widespread territory. Social-minded and public-
spirited, he was a frequent speaker at public gatherings, an ardent Repub-
lican, a member of Oronoco Lodge No. 52 of the Independent Order of Odd
Fellows, and for a time clerk of the independent school district of Oronoco.
On June 23, 1880, in his thirty-seventh year, Dr. Farrand died by accident.
He and Dr. Marshall T. Bascomb, an Oronocan home on a visit, were fishing
from a rowboat in Lake Shady, which was formed, then as now, by damming
the Zumbro River at Oronoco. The water was high and the current strong.
When Dr. Bascomb suddenly discovered that the boat had drifted and was
at the verge of the falls above the old village millsite, he warned his com-
panion and jumped. He escaped but Dr. Farrand was carried over the dam
and was drowned. The funeral was conducted at Oronoco by the Odd Fellows
of that village, Rochester, Zumbrota and Mazeppa in the presence of nearly
200 persons from surrounding countryside and villages.
In September, 1882, Helen Butler Farrand was married to M. M. Clark,
of Oronoco, and she later removed with him to Canada. After the death
of Mr. Clark the widow was married to an old acquaintance from Vermont.
She spent the remainder of her life in California. The daughter, Helen S.
Farrand, was married to George Echer, of Oronoco, in July, 1882. The
sons, named in a former paragraph, for many years were residents of south-
ern Minnesota.
In Oronoco the immediate professional successors of Dr. Farrand were
914
Minnesota Medicine
HISTORY OF MEDICINE IN MINNESOTA
Dr. 'William A. Vincent, Dr. Edgar A. Holmes and Dr. Hamilton P. Board-
man.
Corydon Butler Farrand (1870-1912), born on July 17, 1870, at Ann Arbor,
Michigan, was the eldest of the five children of Dr. John N. Farrand and
Helen Butler Farrand who came to Oronoco, Olmsted County, in the autumn
of 1870.
Corydon B. Farrand, of brilliant native abilities and engaging personality,
“a born doctor,” as old friends have said, received his early education in
the schools of Oronoco and Rochester. For a few years in the late eighties
he taught district schools near Oronoco and in the autumn of 1890 he matric-
ulated at the medical school of the University of Minnesota, from which
he was graduated in 1893. In that day local newspapers commonly mentioned
medical students as “doctors,” so that during his undergraduate years fre-
quent notes appeared in the press about the activities of Dr. C. B. Farrand.
During vacations he studied and practiced medicine with Dr. Charles Hill,
of Pine Island; on June 16, 1892, the Olmsted County Democrat stated that he
had formed a partnership with Dr. R. C. Banks of Pine Island and would
“hold forth in and around Oronoco.”
In January, 1893, Corydon Farrand was married to Daisy Williamson, of
Oronoco, who was then a high school student in Rochester. Mrs. Farrand
continued her school work, in Minneapolis during her husband’s last term
at the university, and in Rochester. In later years she was a proficient
teacher in the county schools.
On graduation Dr. Farrand began medical practice in Oronoco, in the
honorable tradition of his late father. In that year, 1893, he spent some
months in New York in postgraduate work, became a member of the Olm-
sted County Medical Society and the Southern Minnesota Medical Associa-
tion and was appointed county physician in the townships of Oronoco, New
Haven and Farmington. After 1894 Dr. Farrand practiced intermittently
and at various places : in the East, at Red Wing, Goodhue County, at Ham-
mond’s Ford, Wabasha County, in South Dakota and in Minneapolis. He
died in Minneapolis in 1912 at the age of forty-two years.
Lloyd Anson Faulkner, of Saint Paul, born in 1862, was graduated from
the Bennett College of Eclectic Medicine and Surgery of Chicago in 1885
and was licensed in Minnesota on June 6, 1885, receiving certificate No.
1063 (E). He was in Rochester, Olmsted County, briefly in October, 1889,
as the eighth appointee, as an assistant physician, to the staff of the Second
Minnesota Plospital for Insane. His appointment was made during the
reorganization of the hospital after the resignation of the superintendent,
Dr. J. E. Bowers, and some of the assistant physicians. Dr. Faulkner, who
had come well recommended by members of the medical profession of Saint
Paul, began his work but after two weeks resigned and returned to Saint
Paul. A few years prior to 1907 he was practicing in Lonsdale, Rice County;
later he was in Hanley Falls, Yellow Medicine County; before 1916 he was
again in Saint Paul, where he resided into the early nineteen thirties.
Charles Edward Fawcett (1869-1939), for forty-six years a leading physi-
cian of Olmsted County, at Stewartville, was born in the county, at Marion,
in Marion Township, on October 13, 1869. Descended from Thomas Faw-
cett a Quaker who came to America in 1736, he was a son of John Henry
September 1950
915
HISTORY OF MEDICINE IN MINNESOTA
Preston Fawcett and Emily J. Wooldridge Fawcett and a grandson of Thomas
Fawcett and Delia McCullock Fawcett.
In 1856 Mr. and Mrs. Thomas Fawcett came from Newcastle, Flenry
County, Indiana, to a farm home near Mabel, Fillmore County, Minnesota,
accompanied by their four unmarried children, John Mahlon, Adoniram
and Margaret, and by an older daughter, Mary, her husband Obadiah Still-
well and their two children. In 1858 the family group settled in Marion
Township, Olmsted County. Thomas Fawcett died in 1878, his wife in
1888. Their son John H. P. Fawcett, born in Henry County, Indiana, on
September 6, 1840, operated a farm one mile east of Marion for ten years;
in 1866 he settled in the village, where for thirty-five years, an upright and
useful citizen, he was a successful merchant and the village postmaster. The
service he rendered the community as a dentist and as a helper to physicians
from Rochester who attended the sick in Marion, was told earlier in this
history. His marriage to Emily J. Wooldridge, native of Clearfield County,
Pennsylvania, took place in 1867 in Sumner Township, Fillmore County.
In 1900 Mr. and Mrs. Fawcett removed to Stewartville ; their three children
were Charles E., Arthur C. and Myrta (Mrs. George Leonard, of Harlingen,
Texas, who died on December 6, 1944). Dr. Arthur C. Fawcett, who died
in 1948, had been for forty-seven years a leading practicing dentist in
Rochester.
Charles E. Fawcett was educated at the public schools of Marion, at
Darling’s Business College, in Rochester, and at the Winona State Teachers
College. After teaching rural schools for two years, he began the study
of medicine with Dr. Horace H. Witherstine, of Rochester, in the summer
of 1891 ; that autumn he matriculated at the medical school of Northwestern
University, for a course of three years. During vacations in that period
he continued to work with Dr. Witherstine and he also spent considerable
time as observer and occasionally as helper in the operating rooms of the
Drs. Mayo at St. Mary’s Hospital. He was graduated from Northwestern
University with the degree of doctor of medicine on April 24, 1893.
Dr. Fawcett spent his first three months as a practicing physician in
Austin, Mower County, and on December 18, 1893, took up his residence
in Stewartville. On November 29, 1894, he was married to Myrta A.
Phelps, of Marion, a daughter of Nathan S. Phelps and Margaret Waldron
Phelps; Mr. Phelps and his wife were members of families wdio early set-
tled in Olmsted County. To Dr. and Mrs. Fawcett were born four children:
Gale C., Lois M., Frances E. and Donald N. Mrs. Fawcett died on July
7, 1910, aged thirty-nine years. In 1913 Dr. Fawcett was married to Mabel
Bates Slater, of Stewartville.
Representative of the highest type of general practitioner and family
physician, Dr. Fawcett was respected, trusted and loved. He gave unfail-
ing response to all who needed him, was guide, philosopher and friend as
well as physician to his patients, and was all his life a constructive citizen.
He long served on the local board of education, for many years as president,
and to him has justly been credited in large part the excellence of the Stew-
artville school system. His business acumen was evidenced during the
thirty-two years (1907-1939) that he was president of the First National
(later Stewartville National) Bank in the village. A loyal Methodist, like
his forebears, he served on the official church board at Stewartville for
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Minnesota Medicine
HISTORY OF MEDICINE IN MINNESOTA
forty-four years. He was an active Mason (A. F. and A. M.), Worshipful
Master of the local lodge for four years, and a member of the Modern Wood-
men of America. On December 18, 1933, the fortieth anniversary of his
coming to Stewartville, the community honored him at a large reception, an
account of which, with a summary of the tributes paid him by the men and
women of the community and by Fellow physicians, is preserved in the
Stewartville Star of December 21, 1933.
Dr. Fawcett, ethical, and loyal to his profession, was a member of the
Olmsted County Medical Society from 1893, through its affiliation with other
•county medical societies, the Southern Minnesota Medical Association, the
Minnesota State Medical Association and the American Medical Association.
He served as village health officer and as county physician for his section.
During World War I he was a captain in the United States Army Medical
Corps from July 25, 1918, to January 3, 1919; at the Medical Officers’ Train-
ing Camp, Fort Riley, Kansas, until August 12, 1918; then at Camp Beaure-
gard, Alexandria, Louisiana; thereafter on assignment with the Seventeenth
Sanitary Train. A charter member of the Ivan Stringer Post of the Ameri-
can Legion, at Stewartville, he served many years, until his death, as post
chaplain. When death came, the captain, as was fitting, was accorded full
military funeral rites, at Woodlawn Cemetery in the village.
Dr. Charles E. Fawcett died at his home, from coronary thrombosis, on
December 8, 1939, survived by his wife and four children. In 1947 Mrs.
Fawcett continued to reside at the family home in Stewartville; Gale C.
Fawcett, credit man with the Standard Oil Company, was in Minneapolis;
Lois M. Fawcett was head of the reference department of the Minnesota His-
torical Society, Saint Paul; Frances E. Fawcett (Mrs. J. R. Illingworth), a
nurse, was in Spokane, Washington; and Donald N. Fawcett was general
purchasing agent, the Flintkote Company, in Ridgewood, New Jersey.
F. L. Fletcher, physician and surgeon, who had his office in his residence
on College Hill (the address, in 1947, was 406 Fifth Street, S. W.) prac-
ticed his profession in Rochester, Minnesota, from around 1860 to his death
on January 22, 1870, at the age of sixty-two years. That his professional
card appeared for the first time in the Rochester City Post of December 2,
1862, is not necessarily evidence of recent arrival: “The doctor is an experi-
enced physician, well acquainted with the many diseases incident in the
community, his treatment of which is already proved.” Other notes bring
out that he was a Presbyterian and a tireless worker for temperance. A
final note is, “By the decease of Dr. Fletcher, a devoted circle of kindred has
been deprived of one to whom they were most tenderly attached. The
church has been bereaved of one of its most worthy and constant members
and the community has lost a citizen whose character was without reproach
and whose modest worth and many excellencies were appreciated most
by those who knew him best.” Mrs. Fletcher died in April, 1874, at Win-
dom, Minnesota, where she had lived with her daughter Mary (Mrs. John
Hyatt) since the doctor’s death ; her grave is in Rochester beside that of
her husband.
In his reminiscences, several times quoted in this article, the late Charles
Nicholas Ainslie traced the relationship between the families of Fletcher,
Ainslie and Hagaman, all well known in Rochester and vicinity. The Rev-
September, 1950
917
HISTORY OF MEDICINE IN MINNESOTA
erend George Ainslie, Indian missionary, and pioneer Presbyterian minister
in Rochester, first came to the city in December, 1861. His first wife, Mary
Jane Hagaman, of Holland Dutch descent, the daughter of Nicolas Hagaman,
of Hagaman’s Mills, near Amsterdam, New York, had died in January, 1861,
leaving two small sons. In September, 1862, Mr. Ainslie returned to Rochester
from a trip east, bringing with him his bride, Mary Elizabeth Denny, of Thet-
ford, Vermont, and his two boys, John and Charles. On arrival, because
their home on a farm two miles north of Rochester was not completed, the
Ainslies went to the home of Dr. Fletcher for a week or two. “In the
Fletcher family were three grown children, Nick, deaf and dumb, Susan,
who later (February 16, 1864) married my uncle Charles, [Mary] and Violet
a younger sister . . Of the three sons of Charles E. Hagaman and
Susan Fletcher, two became farmers in Olmsted County; the third, Dr.
Edwin A. Hagaman, a dentist, in 1947 long had been established in prac-
tice in Rochester and, like his grandfather, had his office in his home on
College Hill.
Dr. Fletcher’s medicine and instrument chest for many years after his death
was stored in the attic of the Hagaman farm home. Dr. Hagaman has
described it as a “Boxlike affair made of boards over an inch thick, cov-
ered with cowhide, hair on, bound with leather strips fastened on with
big brass tacks. The instruments and bottles of pills we used as playthings
— sometimes we took a pill to see how it tasted or what it did to us.
They were sugar-coated and tasted good.”
Daniel O. Fosgate for a time in the late seventies lived on Cascade Road,
Rochester, Minnesota, and was proprietor of the Rochester Dispensary,
in the Williams and Pierce Block at the corner of Third and Main Streets.
There he ga\re treatments for catarrhal colds and diseases of the throat and
lungs. Dr. Fosgate’s professional cards from August, 1878, into March,
1880, stated that he was the only regular, educated physician in Minnesota
devoting exclusive attention to these affections, that he had the only
known cure for catarrh. He was perhaps more successful as an inventor than
as a physician. In 1878-1879 he perfected and patented a sulky plow, which
at first was manufactured by the Rochester (Minnesota) Plow Works and
later by the New York Plow Company. Three thousand of the machines
were made in 1880 for Australian trade. The plow was followed imme-
diately by Fosgate’s Challenge Harness Buckle, duly patented, and pro-
duced by the O. B. North Company of New Haven, Connecticut. At this
period Dr. and Mrs. Fosgate were much in the East and the doctor’s cards
disappeared from the Rochester press.
Frederick Edouard Franchere (1866-1934), eleventh appointee, as an assist-
ant physician on the staff of the Second Hospital for Insane, came to
Rochester, Minnesota, in the autumn of 1890 and served until the summer
of 1892, when he resigned to enter private practice.
A son of Evariste and Martha Franchere, of French descent, Frederick
E. Franchere was born at North San Juan, California, on July 14, 1866.
He was graduated from the high school at Fake Crystal, Minnesota, in 1882,
attended the state normal school at Mankato in 1883 and 1884, was grad-
918
Minnesota Medicine
HISTORY OF MEDICINE IN MINNESOTA
uated from the medical department of the University of Minnesota in 1890,
and served as intern at the Minneapolis City Hospital.
In Rochester Dr. Franchere, dark, slender, keen, talented, of fine per-
sonality, made friends socially and professionally. As an able, ethical and
humane physician he did valuable work at the state hospital and in leavng
was honored by the entire personnel. In March, 1891, he became a member
of the Olmsted County Medical Society; on his initial appearance before
the group he read a paper on chloroform and ether as an anesthetic mix-
ture.
From Rochester Dr. Franchere went to Sioux City, Iowa, where he
remained three years before returning to Minnesota to practice general
medicine and surgery, with special attention to the eye, ear, nose and throat,
at St. James, from 1895 to 1902. In this period he was a railroad sur-
geon for two different roads and coroner of Watonwan County. In 1902
he returned to Sioux City to specalize in eye, ear, nose and throat work,
a field in which he achieved distinguished success, as he did in the field
of nervous and mental diseases.
Although Dr. Franchere’s story from 1902 to 1934 belongs to the history
of medicine in Iowa, a few points of interest are mentioned here. A con-
stant student of medicine, Dr. Franchere traveled at home and abroad and
contributed consistently to the medical literature. He was a member of
county, state, district, national and special medical societies; a member and
the secretary of the faculty of the old Sioux City College of Medicine,
serving at different times as professor of neurology and professor of oph-
thalmology and otolaryngology ; and he was on the staffs of four Sioux City
hospitals. He was a member of St. Thomas Episcopal Church, of civic asso-
ciations and fraternal organizations, and long was the director and secretary
of the Sioux City Fine Arts Society. He was a skilled musician, an artist
of note in oils and water colors, a student of astronomy, paleontology,
ethnology and anthropology. Admired and respected for his abilities, he
was loved for the warm kindliness and generosity toward his fellow crea-
tures that distinguished him as early as his Olmsted County days.
Frederick E. Franchere was married on April 30, 1895, to Helen Catlin
Hoyt, of Sioux City; he died on April 28, 1934, survived by his wife, two
daughters and one son. In 1945 Mrs. Franchere was living in Sioux City.
Mabel Catlin Franchere was the wife of Henry L. Kamphoefner, Profes-
sor of Architecture, University of Oklahoma, at Norman. Margaret Parrish
Franchere was instructor in French in the Sioux City High School. Hoyt
Catlin Franchere was associate professor of English at the University of
Oregon at Eugene; Professor Franchere and his wife Ruth Frances have
one daughter, Julie Victoire. Dr. Frederick W. Franchere, a native of Lake
Crystal, Minnesota, and a nephew of Dr. F. E. Franchere, since 1911 has
been (1947) a well-known practitioner in that city.
Hector Galloway (1828-1899), representative of the best in medicine and
surgery of his day, was the first resident physician in Olmsted County and
for twenty-four consecutive years was a leading member of the medical pro-
fession of the county. In the spring of 1855 he established his residence in
the village of Oronoco, having first visited the site in March, 1854, with the
three men from Allamakee County, Iowa, who founded Oronoco. In Octo-
ber, 1864, he came to Rochester.
September, 1950
919
HISTORY OF MEDICINE IN MINNESOTA
Born in Mansfield Township, Cattaraugus County, New York, on June
28, 1828, Hector Galloway received his earlv education in the local schools.
At the age of eighteen years he began teaching school at Ellicottville, and
for several years taught in winter and studied medicine under a preceptor the
remainder of the year. In 1852 he entered the Geneva Medical College, at
Geneva, New \ork, from which he was graduated on completion of the
required two courses of lectures. Shortly afterward he came to McGregor,
Iowa, on the Mississippi River, where he practiced medicine until his removal
to Oroncco.
Dr. Galloway spent nine useful years in Oronoco, practicing medicine ably
under pioneer conditions and otherwise serving the region. A talented
writer, he was chief editor of the Oronoco Courier , a seven column newspaper
established by a group of Oronoco businessmen in the autumn of 1856, the
first paper published in Olmsted County and conceded to be one of the best
country newspapers in the state. The depression of 1857 together with the
election the next year of Dr. Galloway and the local editor, E. Allen Power,
as state senator and representative respectively, brought the paper to an
end. Although the legislature did not convene that term, Dr. Galloway held
his office and reported for work in January, 1860. He became superin-
tendent of schools of Oronoco Township when the schools changed to the
township system in 1860. With the coming of the Civil War he played an
active part in local military affairs. When the citizens of Oronoco on April
25, 1861, met to organize the Oronoco Guards, of the Olmsted County Volun-
teers, Dr. Galloway was chairman, and later was fifer of the guards. On
May 21, 1864, he was appointed surgeon of the Thirteenth Regiment, Min-
nesota State Militia, with rank of major, and thereafter was official examiner,
at Oronoco, of persons claiming exemption from military dutv. After he set-
tled in Rochester, in October, 1864, he was for a time on duty on the
Enrollment Board of the First Congressional District.
In Rochester Dr. Galloway first had his office in his home, a roomy frame
house on Prospect Street (now Third Avenue, S. W.) opposite the site
of the present post office. By June, 1866, he had rooms over the Woodard
and Ells Drugstore on Broadway; again in his home in 1869; and from
1875 to 1879, in partnership with Dr. Francis A. Sanborn, in rooms facing
on Zumbro Street, back of Hargesheimer’s Drugstore.
Tall, handsome, vigorous, weighing 212 pounds (a weight that qualified
him for membership in the social “Marrowfats,” mentioned earlier in this
chronicle), gentle and kindly, of superior culture and fine feeling, deliberate
in diagnosis, on excellent terms with his colleagues, Dr. Galloway captured
the fancy and won the affection and respect of the community. Venerable
citizens recall, as do descendants of early residents, that he was the first
physician who attended their families. His practice was comprehensive.
He and Dr. W. W. Mayo often consulted together professionally and assisted
each other in performing surgical operations. Today the consensus is
that Dr. Galloway was a good physician and surgeon of unquestioned
integrity. His sense of ethics was such, in fact, that it led to impatience
with well-meaning persons who inquired too solicitously after their sick
neighbors: Once in the Oronoco days as the doctor was returning with
team and driver from a call at Genoa, a farm resident came running to the
road, his arms flailing, to stop the carriage. “How is Mrs ?” he called.
“She’s sick; drive on, Sam,” said Dr. Galloway.
920
Minnesota Medicine
HISTORY OF MEDICINE IN MINNESOTA
“His one fault,” it is said, “was an incapacity to push himself forward
to the station to which he was justly entitled.” In 1866, for the second time
a candidate for senator, he lost the campaign because, as he said, he could
not travel around admiring pigs and kissing babies. He served, however, in
various civic and professional capacities : member of the city board of health
of Rochester with Drs. J. S. Allen and W. W. Mayo ; county coroner at inter-
vals from 1865 to 1873 ; school commissioner and member of the board of
education from 1865 to 1867 ; a physician to the Olmsted County Poor Farm
in 1870 and in county work thereafter; and as preceptor of medical students.
He was a Mason, member of Rochester Lodge No. 21 (A. F. and A. M.)
and a Knight Templar; he had the sword and probably the rest of the
appropriate regalia and wore a Knight Templar charm on his watch chain.
Dr. Galloway’s name figured in records of medical organizations. He
was a founder, on April 15, 1868, of the original Olmsted County Medical
Society; head of the committee on theory and practice of medicine and
one of the committee to devise the first fee bill; and was a faithful contrib-
utor to discussions and debates, which covered a range of subjects from
medicine and surgery to ethnology and physics. At a meeting on February
13, 1869, he read an essay on the philosophy of disease, in which, the Rochester
Post reported, he announced “novel theories respecting the origin and
progress of disease ; the exposition abounded in apt illustrations and logical
arguments in their support. Maintaining that all diseases have their source
in interruptions of the process of nutrition, the doctor divided them into
two classes, viz : first, those springing from causes extraneous to the sys-
tem ; and, secondly, those proceeding from vicious qualities of the organ
itself . . .” Cancer, scrofula and consumption he named as examples of
disease caused by imperfections of the oragnism in the task of nutrition. It
was at this meeting that Dr. Galloway made his prophecy, still quoted locally
in 1947, that the time would come when medical science would find remedies
for all diseases but cancer.
Dr. Galloway became a member of the Minnesota State Medical Society
on February 1, 1870, and for seven years was an active member, serving
on various standing and special committees, submitting reports on typhoid
fever, intermittent fever, diphtheria and German measles, and giving occa-
sional reports of unusual cases seen in his practice. When the society met
in Rochester in June, 1872, Dr. Galloway was active in the proceedings.
After 1876 his name did not appear on the roster.
Not long after his arrival in Oronoco Hector Galloway was married there
to Clarissa Alice Paige, one of the nine children of Mr. and Mrs. Foster
Paige, pioneer settlers from St. Albans, Vermont. Two other Paige daugh-
ters were married to men who at some time were associated with medicine
in Olmsted County; Caroline was the wife of George B. Ayres, of
Rochester, a student of medicine under Dr. Galloway and later a prom-
inent physician of Omaha, Nebraska; and Augusta, of Dr. Charles E.
Teel, who from 1865 to 1880 was a leading physician of Olmsted County
resident in Eyota.
Dr. and Mrs. Galloway had one child, Lucretia (Lulu) Maria Galloway,
a beautiful and talented girl, who was married in Rochester, in October, 1878,
to Dr. John Henry Spaulding, a native of Maine who came to Rochester
from Sauk Center, Minnesota, a dentist who studied under Dr. J. M. Wil-
liams, Rochester’s earliest dentist. In 1879 Dr. and Mrs. Spaulding removed
September, 1950
921
HISTORY OF MEDICINE IN MINNESOTA
to Fargo, Dakota Territory; their only child, Hector Galloway Spaulding,
was born in Fargo on August 2 of that year. In October, 1879, Dr. and
Mrs. Galloway also settled in Fargo, and there Dr. Galloway entered prac-
tice; On March 16, 1886, he was licensed under the territorial medical practice
law of 1885. After some years in successful practice and in profitable spec-
ulation in lands in Dakota and western Minnesota he removed with his wife,
about 1890, to Tacoma, Washington.
ddie fortunes of Dr. and Mrs. Spaulding affected the lives of Dr. and
Mrs. GallowTay. In 1886 Dr. Spaulding with his wife and his son went to
Paris, France, for graduate study (his son has said, on the advice and
encouragement of Dr. W. W. Mayo), and there remained, achieving a
distinguished career as practicing dentist and professor of operative dentistry
at the “Dental School of France.” He retired in 1917. During World War
I he was associated with the American Hospital in Paris and also worked
with the Red Cross, as a captain, in a rehabilitation hospital for American
soldiers which was housed in a castle near Bordeaux. He died in Nice
in March, 1938. Lucretia Galloway Spaulding preceded her husband in
death by forty-seven years; when she died in Paris in March, 1891, her
husband and her son brought her body to Minneapolis for burial in Lake-
wood Cemetery. After her daughter’s death Mrs. Galloway embraced
theosophy and psychial research and in her investigations over a period
of years traveled alone into many countries. Later she studied osteopathy
in Chicago and became a licensed osteopath in Iowa and South Dakota
and elsewhere, until in 1921 she went to Washington, D. C., to make her
home with her grandson.
Dr. Galloway in the autumn of 1894 came back alone to Rochester,
renewed his membership in the county medical society, and here again
practiced medicine until May, 1895, when he returned to Oronoco, after an
absence of thirty-one years. Failing in health and fortune, for about two
years he made Oronoco his headquarters, spending winters with Dr. and
Mrs. Ayres in Omaha. In 1897 he returned to Fargo, and early in 1899
to his boyhood home in New York. Dr. Galloway died on March 4, 1899,
at the home of his brother in Otto, New York. His body wTas brought for
burial beside his daughter’s grave in Lakewood Cemetery, Minneapolis.
His wife, Clarissa Alice Paige Galloway, died in Washington, D. C., in
February, 1922; her ashes rest beside the graves of her husband and her
daughter.
It has been said of Dr. Galloway, “If one can leave such a memory
as he left in Rochester, his life is a success, though he dies in poverty and
on charity. He instinctively practiced the precept, ‘What we do for our-
selves dies with us ; what we do for others lives and is eternal.’ He may
have felt without realizing it that he was the only textbook that some
people would ever read.”
In 1946 Dr. Galloway had two living descendants: a grandson, Hector
Galloway Spaulding and a great-grandson, John Henry Spaulding, II.
Hector G. Spaulding, whose career was of absorbing interest to the doctor,
was educated at the Lvcee Janson de Sadly in Paris; at the Minneapolis
Central High School and the University of Minnesota; and the Harvard
Law School, from which he was graduated cum laude in 1903. After ten
years of practice of law in New York, Minnesota and Illinois he taught
law at Stanford University. Since 1920 he has been professor of law at
Minnesota Medicine
922
HISTORY OF MEDICINE IN MINNESOTA
George Washington University. He was married in 1922 to Augusta de
Laguna of Oakland, California ; Mrs. Spaulding, a graduate in law, was
in 1945 a lawyer for the National Labor Relations Board. John Henry
Spaulding, II, in that year was with the American Army of Occupation
in Japan.
Eric Olonzo Giere (1868-1942) was the twelfth appointee, in 1892, as an
assistant physician on the staff of the Second Hospital for Insane at
Rochester.
Dr. Giere, an eminent physician and surgeon of Minnesota, died on Febru-
ary 12, 1942, in Minneapolis, after fifty years in active practice. Many
detailed accounts of his career have been published : in state histories, in
records of numerous medical organizations and, particularly, in Minnesota
Medicine, at the time of his death, and in the chronicle of medicine in
Dodge County by Eckman and Bigelow. The present notes serve to link
him to Olmsted County.
Born near Deerfield, Dane County, Wisconsin, on April 10, 1868, Eric
O. Giere was a son of Ole Nelson Giere and Inger Himle Giere, both of
whom were natives of Norway. His great-grandfather, Erick C. Himle,
had been a physician at Voss. Inger Himle came to America in 1846 and
Ole Giere in 1850; they were married in this country and made their
first home on a farm near Deerfield, Wisconsin. In 1869 they came to
southern Minnesota and settled in Vernon Township, Dodge County, adjoin-
ing Rock Dell Township, Olmsted County; in this community Eric O.
Giere spent his youth and obtained his early education at the district school
of Rock Dell a mile from his home.
Immediately on graduation from the University of Minnesota College
of Medicine and Surgery on June 2, 1892, Dr. Giere came on appointment
to the state hospital at Rochester, where he served three months. On
July 6, 1892, at a meeting at the office of Dr. H. H. Witherstine, he became
a member of the Olmsted County Medical Society. While in Rochester, on
October 7, 1892, he received his license, No. 273 (R) to practice medicine
in the state. In Rochester the young physician, ethical and loyal, made
friendships among the local profession that were to be lifelong.
On leaving Rochester to enter private practice, Dr. Giere was first in
Madison, Lac Qui Parle County; and subsequently in Hayfield, Dodge
County; again in Madison, for seventeen years; in Watertown, South
Dakota; in Saint Paul from 1921 to 1927; and in Minneapolis from 1927
until his death. He was survived by his wife, four daughters and four
sons. The three sons who became physicians, Richard Waldorf Giere, Joseph
Christianson Giere and Carl Norman Giere were associated with their father
in the Giere Clinic, in Minneapolis, and since his death have continued
the work. During World War II Dr. C. N. Giere and Dr. J. C. Giere
were captains in the United States Army Medical Corps.
(To be continued in October issue)
September, 1950
923
Pt esi dent’s Hettel
ARE YOU AN 18 PER CENTER?
After the unpredicted 1948 election results, some of the political leaders in
Ohio decided to pick a typical county and study the returns in an attempt to
ascertain how and why the balloting went as it did. What they found out was what
political scientists have constantly observed : that a light vote is not a representative
vote, nor, more important, is it analogous with the principles of "by the people ’
government.
They discovered that many “responsible” citizens were irresponsible concerning
this vital obligation of citizenship — among them 18 per cent of the physicians
of that county and 22 per cent of the physicians’ wives. This happened in Ohio ;
undoubtedly its counterpart was experienced throughout the country.
From an un American vote has evolved an un American shift to security planning,
over-government and a decline in traditional personal freedom and initiative.
Now we have an opportunity to rectify some of the mistakes and omissions
we have made in the last few years. It is possible, through individual responsi-
bility and freedom to avoid collective security and control. Now and in the im-
mediate future, the nation will be subjected to tremendous ideological assaults.
We must have state and national legislatures composed of honest alert intelligent
senators and representatives, who will be quick to recognize threats to our way
of life and government and will move to avert those evils.
Your vote and the votes of your family and friends may be the pivotal point
upon which an election return will swing. And, from there the consequences
widen out into almost unbelievable areas ; what began as a simple task — the mark-
ing of an election ballot — could well be the most important contribution you have
ever made to the cause of democracy and good government.
924
Minnesota Medicine
♦ Editorial ♦
Carl B. Drake, M.D., Editor; George Earl, M.D., Henry L. Ulrich, M.D., Associate Editors
MORE PHYSICIANS IN SERVICE
YT7 ITH the onset of hositilities in Korea in
* ’ June and the evident need for more fight-
ing men, it became perfectly clear that Uncle Sam
would need more medical officers. How many
will eventually be needed is anyone’s guess. The
most equitable way of obtaining the additional
medical personnel is a difficult problem to solve.
As has been frequently said those young phy-
sicians who have received their medical education
at government expense have a moral, if not a
legal obligation to enlist now that there is a press-
ing need. If all the members of this group were
to enlist — an eventuality not likely to occur — the
services would still need a certain number of re-
serve officers of experience in the various special-
ties and of various ranks.
By October 1, the Army will have recalled 1,-
582 reserve officers of the Army Medical Service,
which will include 734 physicians. Recall quotas
have been assigned to each of the six Army areas
in the United States based on professional popu-
lation rather than on the number of reserve offi-
cers in the area. Volunteers will be credited to
the quota of the Army area in which they reside.
To stimulate voluntary enlistment, medical offi-
cers who enlist will receive $100 a month above
the usual pay for each rank.
Additional calls for enlistments in the near and
and distant future will require additional profes-
sional personnel. To care for the 95,000 more
men to be called to service in November an esti-
mated 300 to 400 more doctors will be needed.
More economy in the use of doctors in service
than was evident in World War II will be em-
ployed ; in the case of a 1000-bed general hospital
only three physicians and two nurses will initially
be called, the balance to stay in civilian life until
receipt of warning orders for hospital deployment.
It is perhaps not surprising that enlistment of
physicians has not supplied the need. Those who
served in World War II and have only* recently
resumed private practice are naturally loath to
pull up stakes and again don a uniform. Those
who have never served have only a vague idea
of the present and future need of their services.
The present crisis does not have the appeal that
a future need for an all-out effort may soon
present.
It is not surprising that the AMA Board of
Trustees went on record on August 12 approv-
ing the doctor-draft bills in principle. They,
however, approve the drafting of physicians only
for service in the war effort — not to care for
veterans, civilian employes except outside the con-
tinental limits of the United States, or dependents
of military personnel, except in case of depend-
ents outside the country or in areas where ade-
quate medical care cannot otherwise be provided.
To meet the present pressing need, Minnesota
is required to furnish twenty reserve army doc-
tors— a certain number of different ranks. Every
effort is being made in the selection of these
officers not to disrupt the civilian supply, nor
intern, resident or postgraduate training. A com-
mittee of the Minnesota State Medical Associa-
tion has been appointed to co-operate with the
Military in order to cause as little disruption of
medical training and practice as possible.
We may as well face the facts, however, that
we must be strong in a military way, if we are to
preserve our freedom and support the United
Nations in its guarantee of the freedom of its
member nations. A strong military force requires
physicians.
BLOOD BANKS
HP HE EXTENT to which blood transfusion has
come to be used therapeutically is strikingly
brought out by the Survey of Blood Banks in
the United States recently completed by the Bu-
reau of Medical Economic Research of the Amer-
ican Medical Association under the direction of
Frank G. Dickinson and Everett L. Welker.
At the time of this report, there were 1,648
blood banks located in 951 different cities in the
country. In this number are included 1,571
hospitals,. 46 non-hospital blood banks, and 31
Regional Red Cross Blood Centers. These cen-
September, 1950
925
EDITORIAL
ters have been increased from 31 to 34, accord-
ing to last report. While about half of the hospi-
tal blood banks purchase blood and sell it to re-
cipients, about two-thirds of these banks allow
for replacement of blood from donors in lieu of
payment for blood used. Some of the non-
hospital blood banks make only nominal charges
for the processing of the blood and count on vol-
untary donations of blood by members of civic
groups for maintenance. The Red Cross Blood
Centers do not purchase or sell blood and depend
entirely upon donors for maintaining their sup-
ply. None of the centers administers blood, but
distribution is free to hospitals which are allowed
to make a nominal charge for handling. The cost
of the processing and handling of the blood is
borne by the Red Cross, which, of course, is sup-
ported by thousands of contributors.
The estimate of blood dispensed in a year is
2,532,452 units of 500 c.c. by the hospital banks,
306,130 units by the non-hospital banks and 427,-
565 units by the Red Cross. No estimate was
made of the amount of plasma used. It is fur-
ther estimated that all the blood banks and centers
now have the equipment and personnel to bleed
5,500 donors simultaneously, or 440,000 in a
forty-hour week. Thus the country seems pret-
ty well supplied with facilities for obtaining and
processing blood which can be easily expanded
in case of an emergency. Possible future war need,
of course, was in part responsible for the continua-
tion of the Red Cross Centers. In case of a wide
extension of the present Korean conflict, all the
present facilities for handling blood would be vital.
The co-operation of the various agencies in
Minnesota has been most satisfactory. Unfortu-
nately, this has not been the case throughout the
country. It is positively disgraceful that there
should have been rivalry to the point of opposi-
tion between the American Association of Blood
Banks and the Red Cross and that the Associa-
tion has tried to put pressure on many State Med-
ical Associations to instruct their AMA delegates
to vote against approval of the Red Cross pro-
gram. And this in spite of the precautions taken
by the Red Cross of having the approval of the
local medical societies before centers were estab-
lished and in spite of the fact that in each state
the program is controlled by a committee of the
State Medical Association. The charge has been
made that the Red Cross program smacks of
socialized medicine. Since the program is super-
vised bv medical societies and closelv resembles in
operation many of the independent blood centers,
there would seem to be little excuse for the criti-
cism. Fortunately, no resolution to discredit the
Red Cross was even submitted to the meeting of
the House of Delegates at San Francisco.
The wisdom of the establishment of the Red
Cross centers would seem to be convincingly
confirmed by the recent designation of the Red
Cross as the official agency for the procurement
of blood for the armed forces as in World War
II.
Some ten years ago the Hennepin County Med-
ical Society began discussing the possibility of
establishing a central community blood bank in
Minneapolis. Through the co-operation of a
number of civic agencies, funds were collected, a
building purchased and remodeled at 1914 La-
Salle Avenue and on November 11, 1948, dedi-
cated as a memorial to the service men of World
War If who did not return. The bank began
operating December 1, 1948, as the Minneapolis
War Memorial Blood Bank. It is an independent
non-profit organization. Blood is not bought or
sold, and its supply is maintained in part by
blood replacement on the part of relatives and
friends of the recipients. Donor clubs have been
formed, membership entitling the member and his
family to free supply in case of need. The Cen-
ter stocks the refrigerators of the hospitals of
Minneapolis with various types of blood. A
service fee only is charged for typing, Rh deter-
mination, and serology testing. The Minneapolis
Blood Bank is willing to assist in setting up banks
in neighboring communities with the approval of
the local medical society and civic groups. How
this was done in one specific instance is well old
by Dr. Borgerson in the August issue of Min-
nesota Medicine (p. 773). Co-operation be-
tween such outlying centers and the Minneapolis
War Memorial Blood Bank would be to mutual
advantage.
Recently, arrangements have been made be-
tween the Red Cross Blood Center in Saint Paul
and the Minneapolis War Memorial Blood Bank
whereby an interchange of credit will be allowed
between the two banks to patients entitled to
blood from either bank. This example of a fine
spirit of co-operation between two banks is high-
ly commendable. After all, both institutions have
the same* purpose of providing a costly remedy,
valuable in peace and war, at a nominal price
wdthin the reach of everyone.
926
Minnesota Medicine
Medical Economics
Edited by the Committee on Medical Economics
of the
Minnesota State Medical Association
George Earl, M.D., Chairman
FSA CALLED SEED BED OF SOCIALISM
Beginning a new series on seed beds of social-
ism, a recent issue of Nation s Business calls the
Federal Security Agency an “unknown visitor in
the life and home of every American . . . well on
its way toward changing the individual thinking
as well as the social, economic and political struc-
ture of the nation.”
Comparing it to other federal departments to
convey the scope of the agency’s control, the arti-
cle says :
“It reaches every citizen, either in benefits or in taxes.
Among older departments, State is concerned with for-
eign affairs, Commerce with trade, Labor with workers
and employers, National Defense with military security
and Agriculture with one class of producers. Only
Federal Security is all-embracing in its relation to the
human beings who make the nation.
“Other nations are solicitous for the welfare of their
people from the cradle to the grave, but this agency goes
farther. It gives prenatal advice for babies, guides them
later through childhood, cares for workers and aged
and succors the relicts of the departed.”
Aim to Create Socialist State
Unpopular as the idea of socialism is, some
of the key supporters of the agency and what it
stands for have shamelessly confessed that its
chief goal is to establish a welfare state :
“Some of its key employes and ardent supporters
have declared frankly the final goal of this pretentious
agency is to abolish the present democratic form of
government and to create a socialist state where officials
will be dominant over the individual and his activities —
in the home, in trade or in security — the attractive
name so often used — while the youth are indoctrinated
for the future.”
The List Grows Longer
Helping this “all-embracing” agency to indoc-
trinate youth is a budget in 1950 which is larger
than that of any other federal department except
National Defense — $1,591,000,000. Its organiza-
tion includes 35,363 full-time and 4,127 part-time
workers ; it has twelve regional offices and many
National Institutes of Health and Health Work-
shops in cities and towns.
The number and variety of divisions and bu-
reaus which it administers seems phenomenal,
and, if the most ardent supporters of government
control have their way, the list can extend almost
endlessly. The Federal Security Agency admin-
isters Social Security which includes Public As-
sistance, Old-age and Survivors Insurance, the
Children’s Bureau, and Federal Credit Un-
ions ; Employes’ Compensation ; Public Health
Service including quarantine and 20 odd hospi-
tals ; a printing house for the blind in Louisville ;
Food and Drug Administration ; Vocational Re-
habilitation, and the Office of Education. In
Washington it operates two big public hospitals- —
St. Elizabeth’s and Freedmen’s — Howard Univer-
sity for Negroes, Gallauaet College and Kendall
School for the Deaf.
Keynote Found
With these and many more institutions and
agencies under its wing, and with an annual dis-
tribution of $1,000,000,000 to states, “FSA is in
position to punish any state — almost any citizen
— that dares to challenge any of its policies or
directives.” Looking through the manual of the
Social Security Agency, the keynote of these poli-
cies is made clear :
“Social security and public assistance are a basic es-
sential for attainment of the socialized state envisioned
in democratic ideology, a way of life which so far has
been realized only in slight measure.”
If this is “only in slight measure,” Americans
can well ask, “What is considered a completely
full measure?”
September, 1950
927
MEDICAL ECONOMICS
CONGRESSMAN DISCUSSES SOCIALISM
—AMERICAN VARIETY
Adding warning and emphasis to the example
of the type of controls which the Federal Security
Agency is slyly developing, Congressman Ralph
W. Gwinn, New York, spoke at a meeting of the
Medical Society of New York recently, quoting
noted witnesses to testify that socialism is creeping
surely into American life.
Mr. Gwinn quoted “America’s greatest living
Socialist, Norman Thomas,” whose words un-
derscore the fact that socialist trends are the
greatest threat ever to come on the American
scene. Running for the presidency since 1928,
Mr. Thomas was somewhat pleased in 1936, after
four years of the New Deal, that it “had in some
fashion carried out our immediate demands.”
Mr. Gwinn cited the words of Communist lead-
er, Earl Browder, declaring that American cap-
italism can deteriorate into socialism, thence to
communism, unless Americans are vigilant :
“State capitalism leaped forward to a new high point
in America in the decade 1939-1949. It became over-
whelmingly predominant in every major phase of eco-
nomic life, and changed the face of politics. State
capitalism has progressed further in America than in
Great Britain under the Labor Government, despite
its nationalization of certain industries, which is a for-
mal stage not yet reached in America ; the actual,
substantial concentration of the guiding reins of nation-
al economy in governmental hands is probably on a
higher level in the U. S. A.
“The general trend to state capitalism signifies a yield-
ing of capitalist private ownership for more socialized
forms of the economy and results in a more socially
organized economy. . . . Each important measure of
state capitalism is a part of the whole movement which
results in the socialist transformation.
“State capitalism is the invasion of planned produc-
tion and points the way to Socialism. . . . The LI. S.
Government has emerged as the greatest trust of all,
the super-trust wdiose economic operations dwarf the
largest private corporation. . . . The trend to state
capitalism marked the final monopolistic stage. After
monopolistic capitalism the only higher stage possible is
the fully-socialized society.”
And, the late leader of British Socialists, long
noted for his authoritative statements on social-
ism and what causes it, was also quoted by Mr.
Gwinn. Harold J. Laski says:
“Since it is the Socialist belief that the central prin-
ciples of the New Deal have come to stay, the Socialist
Government in Britain can have the confidence that
America will advance in a collective direction and at
an increasing tempo.”
928
Another of the greatest contemporary authori-
ties on the subject of economic socialism and
communism has declared that leftist policies are
more evident in America than in western Europe.
John Strachey, England’s War Minister, helps
Mr. Gwinn’s argument by saying:
“Outside the United Kingdom and the Scandinavian
countries, the U. S. Administration today is probably
more to the left in general economic policy and point
of view than any of the governments of western
Europe.”
The “Scare Words" Again
Supporters of federal medicine, increasing so-
cial security and the whole gamut of expanding
government control measures can ridicule the use
of such terms as the “welfare state” and “social-
ism” by calling them mere “scare words,” like
President Truman did, not long ago. Many of
them would think twice after reading a new book-
let written by former Senator Joseph H. Ball
entitled “Where Does Statism Begin?” The
pamphlet points out that the welfare state is a
state in which the government assumes and tries
to carry out the responsibility of assuring a cer-
tain standard of living and economic security for
everyone in terms of housing, food, clothing,
health services and education, regardless of the
individual’s age, ability, productive effort or moral
deserts.”
Words which have gained new definitions
through common usage receive comment in the
pamphlet :
“Statism is the concentration of more and more power
in the hands of government as an inevitable result of
trying to substitute government planning of production,
distribution, and pricing for the free market mechanism
of capitalism.
“Socialism, welfare state and statism are interchange-
able to this extent : their political and economic prom-
ises can't be carried out without new and extensive
concentration of power in the hands of the central gov-
ernment.”
Defining Not Enough
Individual Americans, states New York Medi-
cine recently, will realize that mere definition of
words is only the beginning of understanding:
“There is a price tag on human liberty and freedom
in any human endeavor. That price is the willingness
to assume the responsibility of being free men. Pay-
ment of this price is a personal matter with each of
Minnesota Medicine
MEDICAL ECONOMICS
us. It is not something we, can get others to pay for
us. There is a very human impulse to let others carry
the responsibility of freedom, and the work and worry
that accompany it — while we share only in the benefits !
“In these present days, power is, wittingly or unwit-
tingly, conferred by a people upon others. Ofttimes it
appears as if this power were forcibly wrested away, but
it is not. People give their freedom away. By vote
we give away our hard-won rights. Factors, which
bring a change, most frequently go unnoticed because
of apathy. Only when an evil is firmly entrenched do
we become aware of its insidiousness. While an evil
is quietly and unobtrusively establishing itself, people
go about their business, performing their daily tasks
saying: ‘This can’t do that to us,’ and all the time it
is being done . . . right under their noses!”
MINNESOTA STATE BOARD OF MEDICAL
EXAMINERS
230 Lowry Medical Arts Building
Saint Paul, Minnesota
Julian F. Dubois, M.D., Secretary
MINNEAPOLIS MAN PAYS $100 FINE FOLLOWING
CONVICTION FOR VIOLATING FEDERAL FOOD,
DRUG AND COSMETIC ACT.
Re. United States of America vs. Otto IV. Dressier , an
individual trading as Gold Seal Laboratories.
On Tune 12, 1950, Otto W. Dressier, seventy-two years
of age, 204^2 10th Street South, Minneapolis, paid a fine
of $100 in the United States District Court at Min-
neapolis, following his conviction by the Hon. M. M.
Joyce, of violating the Federal Pure Food and Drug
Act. Dressier was convicted of “having unlawfully
shipped in interstate commerce a certain device, to-wit,
Polizer, in violation of the Federal Food, Drug and
Cosmetic Act, in that said device was misbranded within
the meaning of 21 U.S.C. 352 (a).” The information
filed by the Government alleged that accompanying the
device was a circular entitled: “The Pol-izer (Miracle
of the Age) Why Suffer.” The information also al-
leged that the statement represented and suggested that
Polizer was efficacious in the cure and treatment of over
60 ailments from arthritis to heart trouble. It was the
contention of the Government that the device w'as mis-
branded because it was not in fact efficacious in the
treatment of such ailments.
In finding Dressier guilty, Judge Joyce stated that
expert witnesses of the highest rank in the State of
Minnesota had studied and tested the device and found
it wholly useless and of no therapeutic value. Judge
Joyce further stated that not one scintilla of evidence
was produced by the defendant that there is any pene-
tration into the human body of any of the so-called ele-
ments of the Polizer or of polized water.
The case was tried for the Government by Mr. Clif-
ford Hansen, Assistant United States Attorney of Saint
Paul. The preliminary work in the case was done under
the direction of Mr. Chester T. Hubble, Chief, Minne-
apolis District Pure Food and Drug Administration.
MINNEAPOLIS WOMAN SENTENCED FOR CRIMINAL
ABORTION
Re. State of Minnesota vs. (Mrs.) V al A. Ramer.
On August 22, 1950, Mrs. Val A. Ramer, seventy-six
years of age, 809 Douglas Avenue, Minneapolis, was
sentenced by the Hon. Rolf Fosseen to a term of not to
September, 1950
exceed three years in the Women’s Reformatory at
Shakopee, Minnesota. Mrs. Ramer had entered a plea
of guilty on Tune 6, 1950, to an information charging
her with the crime of abortion. Mrs. Ramer also ad-
mitted a previous conviction in 1936. Because of the
defendant’s age, Judge Fosseen suspended the sentence
and placed the defendant on probation for a period of
five years. Judge Fosseen warned Mrs. Ramer that not
even her age would save her from going to the Wom-
en's Reformatory if she became involved, in any manner,
in any further violation of the laws of the State of
Minnesota.
Mrs. Ramer was arrested on May 4, 1950, by Min-
neapolis police officers following the hospitalization of a
tw'enty-one-year-old Minneapolis woman suffering from
the aftereffects of a criminal abortion. The Minnesota
State Board of Medical Examiners was asked to assist
in the case and legal counsel for the Medical Board
obtained a signed statement from Mrs. Ramer in which
she admitted having performed the abortion by means
of a probe and packing the cervix with gauze. Mrs.
Ramer also admitted receiving $150 for her services.
The abortion w'as performed in Mrs. Ramer’s apartment.
Mrs. Ramer also admitted that she had performed other
abortions averaging about one per month. Mrs. Ramer
was convicted by a jury in the District Court of Hen-
nepin County on April 24, 1936, of the crime of abortion.
At that time, a Minneapolis physician, now' deceased, was
also convicted with Mrs. Ramer. Mrs. Ramer holds no
license to practice any form of healing in the State of
Minnesota.
BERYLLIOSIS
(Continued from Page 907)
clinician. Failure to recognize the cause of the
trouble and failure to remove the patient from
further exposure may result in irreparable dam-
age to his health or cause his death.
References
1. Dutra, F. R. : The pneumonitis and granulomatosis pecu-
liar to beryllium workers. Am. J. Path., 24:1137-1166,
(Nov.) 1948.
2. Hardy, Harriet L., and Tabershaw, I. R.: Delayed chem-
ical pneumonitis occurring in workers exposed to beryllium
compounds. J. Indust. Hyg. & Toxicol., 28:197-211, (Sept.)
1946.
3. Pascucci, L. M. : Pulmonary disease in workers exposed to
beryllium compounds: Its roentgen characteristics. Radi-
ology, 1 :23-36, (Jan.) 1948.
4. Van Ordstrand, H. S., Hughes, R., and Carmody, M. G.:
Chemical pneumonia in workers extracting beryllium oxide;
Report of three cases. Cleveland Clin. Quart., 10:10-18,
(Jan.) 1943.
5. Weber, H. H. : Quoted by Hardy, Harriet L., and Ta-
bershaw, I. R.2
HEALTH RESOURCES ADVISORY COMMITTEE
Dr. Harold S. Diehl, dean of the medical sciences at
the LTniversity of Minnesota, has been named to the
new' Health Resources Advisory Committee of the
National Security Resources board. The appointment
w'as made by W. Stuart Symington, chairman of the
board.
Purpose of the committee is to assist and advise the
National Security Resources board on problems of the
nation’s health relating to national mobilization and in
the event of an atomic w'ar.
The coxnmitee also may be given the added responsi-
bility of advising Selective Service in the drafting of
doctors.
Dr. Diehl attended a meeting of the committee in
Washington Thursday and Friday, September 7 and 8.
929
American Medical Association
House of Delegates — Summary of Proceedings
San Francisco — June 26-30, 1950
First Meeting, Monday, June 26
Morning Session
The House of Delegates convened in the Concert
Room of the Palace Hotel, San Francisco, and was
called to order at 10 a.m. by the Speaker, Dr. F. F.
Borzell.
After preliminary proceedings including adoption of
the minutes of the interim session, roll call, appointment
of a Vice Speaker pro tern, in the absence of the Vice
Speaker, invocation and the appointment of tellers for
the session, the House heard the address of the speaker
giving general directions for reference committees and
delegates. He then presented the reference committees
to the House.
The House then chose Dr. Everts A. Graham, St.
Louis, as the recipient of the Distinguished Service
Award for 1950. This was followed by the address of
President Ernest E. Irons who summed up the progress
made against infiltration of socialistic trends by saying,
“We as physicians and citizens shall not relax until,
with other patriotic groups in business, on the farm, in
the other professions and labor, we shall have rolled
back the socialist flood that threatens to engulf our
American freedom and our solvency.”
The Chairman of the Board of Trustees, Dr. Louis
H. Bauer, presented the report of the Board. Ordinary
income in 1949 exceeded costs and expenses by $106,-
817.56; this amount was credited to the capital account
of the Association, which now totals $4,240,197.81.
The report of the Board of Trustees also included
reports of, and concerning, the Committee on Displaced
Persons, Committee on General Practice, Council on
National Emergency Relief, Student American Medical
Association, Commission on Chronic Illness, Co-ordina-
tion Committee on Legislation, Treasurer, Auditor.
All recommended resolutions were referred to refer-
ence committees.
Dr. Elmer L. Henderson, chairman of the co-ordinat-
ing Committee, presented the report of his committee.
This was followed by the report of the Council on
Medical Service, given by Dr. James R. McVay.
Dr. Harvey B. Stone, acting chairman, presented the
report of the Council on Medical Education and Hospi-
tals.
The House recessed at 12 :30 p.m.
Afternoon Session
The House reconvened at 1 :45 p.m. and heard a sup-
plementary report of the Board of Trustees, read by
Dr. Bauer, which included the report of the Committee
on Hospitals and the Practice of Medicine.
This was followed by a Report of the Committee on
Chronic Diseases. In view of the work of the Com-
mission on Chronic Illness, there had been suggestions
that the functions and work of the two bodies had been
overlapping. After hearing evidence of the necessity
of both bodies, the House voted continuance of the
committee.
The House then heard the proposed resolutions, all
of which were referred to their respective reference
committees for study and such committees will report
the resolutions to the House for approval or rejection.
The House recessed at 3 :45 p.m.
Second Meeting, Tuesday, June 27
Afternoon Session
The meeting convened at 1 :20 p.m. The House
adopted a report of the Committee on Executive Session,
which stated that an executive session to discuss a reso-
lution on expenditure for advertising was not necessary.
Dr. Bauer read a message wishing the House a suc-
cessful meeting from Dr. T. C. Routley, Secretary Gen-
eral of the Canadian Medical Association. The House
requested the Secretary to wire appreciation to Dr.
Routley.
The House recessed at 1 :30 p.m.
Third Meeting, Wednesday, June 28
Morning Session
The meeting reconvened at 9:10 a.m. The House
adopted the report of the Reference Committee on
Reports of Officers which included a recommendation
from the Speaker's address that an interim committee
on constitution and by-laws 'be appointed.
The House adopted a resolution eliminating oral read-
ing of its voting, substituting the use of tellers’ reports
directly to the speaker who then announces the vote.
The House next considered the report of the Reference
Committee on Reports of the Board of Trustees and Sec-
retary. The report of the Board was considered by
section :
Section 1. Financial statement — approved.
Section 2. Committee on Displaced Physicians — ap-
proved.
Section 3. Student American Medical Association —
approved and established.
Section 4. Survey of Physicians’ Incomes — approved
with minor amendments.
Section 5. Surveys of Medical Education and Medical
Practice in Great Britain — approved with commendation.
Section 6. Hearings on Taft and Hill Bills — approved.
Section 7. Resolution on Free Choice of Physicians
for Federal Employes — approved recommendation for
more study and information.
Section 8. Expansion of Washington Office — approved
action to increase efficiency and continue implementation.
Section 9. Bulletin for Woman’s Auxiliary — approved
cancellation of bulletin.
Section 10. Treasurer’s and Auditor’s reports — ap-
proved.
Section 11. Quality of Medical Care in a National
Health Program — approved Board’s action in expressing
strong opposition to the socialist blueprint for medical
care of the recommendations of the Subcommittee on
930
Minnesota Medicine
AMERICAN MEDICAL ASSOCIATION
Medical Care of the Committee on Administrative Prac-
tice of the American Public Health Association.
Section 12. Resolutions on Medical Care of Veterans
— approved statement that this resolution reaffirms pre-
vious similar resolutions of the House in opposing un-
justified care being given to non-indigent veterans for
non-service-connected disabilities.
Section 13. Resolutions on Purveyal of Medical Serv-
ice, Resolutions on Report of Committee on Hospitals
and the Practice of Medicine, Resolutions on Enforce-
ment of Principles of Medical Ethics and Resolutions on
Practice of Medicine by Hospitals — approved all these
resolutions having to do with the purveyal of medical
sendees and the practice of medicine in hospitals.
Section 14. Report of the Committee on Hospitals
and the Practice of Medicine — approved report which
provides that if a physician is found to be unethical
through proper authorities and is still retained on the
staff of any hospital approved for resident or intern
training, it shall be the duty of the Judicial Council to
show cause why hospital should not be removed from
the approved list, assuming the hospital is just as unfit
for the training of physicians for unethical reasons as
it is unfit if it does not have proper filing systems.
The report also recommended recognition of the practice
of anesthesiology, pathology, physical medicine and
roentgenology' as practice of medicine.
The House next considered the report of the Refer-
ence Committee on Medical Education which was adopt-
ed as a whole and recommended that particular spe-
cialties in which residents are being trained should be
represented on the staff by well qualified people, whether
or not they are members of “special societies and col-
leges, or are certified in their specialty” ; that it is not
essential that all hospital residencies should adopt the
same program, but it is essential that all hospitals par-
ticipating in graduate training be able to meet funda-
mental essential requirements ; that attendance at hospital
staff meetings is not mandatory ; that state medical
societies be urged to use their influence with various
state boards to give proportionate consideration to pe-
diatrics as is given to other fields of medicine; that the
practice of some hospitals making specialty board rat-
ings a requirement for appointment or promotion be
disapproved.
At this time Dr. Bauer announced that the Board
of Trustees had extended the contract of Whitaker and
Baxter for another year, stating, “We have very great
hopes that we can carry on in a very greatly reduced
tempo from what we have during the past year. On
the other hand, we feel that it would be a great mistake
to break up our organization which we have established
and which has been so successful, because we don’t
know what may happen.”
The House of Delegates heard the report of the
Reference Committee on Sections and Section Work.
The resolution requesting an appropriation for section
delegates was referred to the Board of Trustees. The
House approved recommendation that the Council on
Scientific Assembly consider creation of a Section on
Military Medicine and Surgery and a Section on Medi-
cine in Industry.
The House next considered the report of the Ref-
erence Committee on Amendments to the Constitution
September, 1950
and By-Laws and approved appointment of an Interim
Committee of the House of Delegates on Amendments
to the Constitution and By-Laws; setting amounts of
annual dues at the annual meeting; giving the Board of
Trustees specific authority with respect to remission of
membership dues ; allowing Associate Fellows privilege
to participate in the Scientific Assembly, without the
right to vote or hold office ; allowing member or service
fellows, active members, associate, affiliate or honorary
fellows, invited guests, medical students of approved
schools, and interns and residents of approved hospitals
to register.
The House next heard the report of the Reference
Committee on Hygiene and Public Health and approved
resolutions providing earlier detection of diabetes through
self-testing for sugar ; and earlier detection of cancer
through use of all recognized facilities for the initial
diagnosis, including examination of tissues, exudates and
bodily excretions.
The House approved the resolution on Medical Rela-
tions in Workmen’s Compensation reported by the Ref-
erence Committee on Industrial Health, providing : that
the Council on Industrial Health investigate the present
status of medical relations under the Workmen’s Com-
pensation laws of the states, territories and federal gov-
ernment and report back to the House of Delegates in
June, 1951.
The House recessed at 12 noon.
Afternoon Session
The House reconvened at '2:05 p.nr. and considered
the report of the Reference Committee on Legislation
and Public Relations. The House approved a resolution
opposing H.R. 5865, declaring “that it would place local
health units in the country under substantially direct
and complete control of the Surgeon General of the
Public Health Service”; opposing again S. 1411 as long
as Section C still remains in the bill. The House ap-
proved the committee’s opinion that, as a general prin-
ciple, the American Medical Association should not take
a position favoring or opposing legislation which does
not bear directly on medicine ; approved expansion and
strengthening of the Washington office ; approved ap-
pointment of a committee to study the 12-Point program
with the idea of making changes which may be indi-
cated.
The House approved the report of the Committee on
Training of Interns which recommended the inaugura-
tion of a 2-year rotating internship program covering
the main branches of medicine, surgery, obstetrics and
gynecology.
The House heard the report of the Reference Com-
mittee on Emergency Medical Service and approved a
resolution urging immediate passage of Federal and
state enabling legislation for a civil defense organiza-
tion ; a resolution urging appointment of a medical ad-
visory committee to function at the top level of the
Chairman of the National Security Resources Board.
The House next considered the report of the Reference
Committee on Miscellaneous Business and approved res-
olutions providing better co-ordination of scheduling
American Medical Association council meetings ; contin-
uation of National Education Campaign, endorsing work
of the World Medical Association; declaring as ethical
931
AMERICAN MEDICAL ASSOCIATION
for members to engage in lectures, demonstrations, the
preparation of pamphlets and other measures suitable
for the dissemination of information designed to pre-
vent blindness and directed to any non-medical groups.
The House then heard the report of the Committee
on Veterans Affairs. The resolution to recommend more
stringent rules regarding treatment of non-service-con-
nected illness was tabled.
Dr. Bauer explained an additional change necessary
in the By-Laws concerning payment of dues and Fellow-
ship classification, which was laid over for twenty-four
hours to be brought up at the next meeting. Dr. Bauer
also announced that the Clinical Session will be held
in Cleveland, December 5 to 8.
The House then considered the report of the Reference
Committee on Insurance and Medical Service. The
House approved the report which provided recommen-
dations of expansion of medical prepayment plans for
graduate nurses ; recommendation for further extension
of service-connected medical care for veterans through
existing channels and home-town medical programs ;
recommendation to the Council on Medical Service that
detailed procedural directions be given for action on
the local level ; approval of the work of the Commis-
sion on Chronic Illness.
The House recessed at 4:10 p.m.
Fourth Meeting — Thursday, June 29
Afternoon Session
The House reconvened at 1 :30 p.m. and heard the
report of the Reference Committee on Emergency Medi-
cal Service and approved a resolution recommending
continued co-operation with the medical .services of the
Armed Forces and the National Security Resources
Board to the end that the most effective utilization of
medical personnel be achieved for the maximum protec-
tion of the nation.
The House adopted an amendment to the By-Laws
providing that dues shall include subscription to The
Journal of the American Medical Association beginning
January 1, 1951.
The proposed change in the By-Laws regarding clas-
sification of fellows was referred to the Interim Com-
mittee on Amendments to the Constitution and By-Laws
for study and report at the Clinical Session in Cleveland.
The House approved membership dues for 1951 at
$25.00.
The House instructed the Secretary and General Mana-
ger to have the report of the Reference Committee on
Reports of Board of Trustees and Secretary mimeo-
graphed and mailed to each member of the House of
Delegates at the earliest possible time.
The House passed a resolution requesting the Board
of Trustees to expedite adequate appropriations by the
Congress to help control tuberculosis among the Indians.
The House heard the address of Rear Admiral Joel
T. Boone, United States Navy.
The election of officers followed :
President-Elect — John W. Cline, M.D., San Francisco,
California.
Vice President — R. B. Robins, M.D., Camden, Ar-
kansas.
Secretary — George F. Lull, M.D., Chicago.
The House heard addresses by Dr. Cline and Dr.
Robins and theft elected Dr. Josiah J. Moore, Chicago,
as 1 reasurer, and Dr. F. F. Borzell, Philadelphia, as
Speaker, both succeeding themselves.
Dr. James R. Reuling, Bayside, N. Y„ was elected
Vice Speaker.
The House elected two new trustees : Dr. Thomas
P. Murdock, Meriden, Conn., to succeed Dr. James R.
Miller, Hartford, and Dr. L. W. Larson, Bismarck,
N. D., to succeed Dr. John H. Fitzgibbon of Portland,
Oregon.
1 he speaker appointed the following as members of
the Interim Committee on Amendments to the Consti-
tution and By-Laws: Drs. Joseph D. McCarthy, Omaha;
Floyd S. Winslow, Rochester, N. Y. ; B. E. Pickett,
Sr., Carrizo Springs, Texas; Louis A. Buie, Rochester,
Minn., and Stanley H. Osborn, Hartford, Conn.
Dr. Bauer announced that the annual session for
1951 will be held in Atlantic City, N. J., and that the
1952 session will be held in Chicago. The House heard
the invitation of New York City, given by Dr. J.
Stanley Kenney, to hold the 1953 session there. Ballots
were spread.
Dr. Louis A. Buie, Rochester, Minn., was elected to
succeed himself for five years as a member of the
Judicial Council, Dr. J. B. Lukins, Louisville, Ky., was
also elected a member.
Dr. Edgar V. Allen, Rochester, Minn. ; Dr. James
Stevenson, Tulsa, Okla., and Dr. Julian P. Price, Flor-
ence, S. C., were appointed as members of the Com-
mittee on Distinguished Service Awards, Dr. Allen as
chairman.
Dr. Henry R. Viets, Boston, was elected to succeed
himself as a member of the Council on Scientific Assem-
bly and Dr. Russell L. Haden, Crozet, Va., was elected
to succeed himself as a member of the Council on
Medical Education and Hospitals.
Dr. George F. Lull, Secretary, presented the names
of applicants for Associate Fellowships. Minnesota
Associate Fellowships were granted to: Nellie O. N.
Barsness, St. Paul; Edgar D. Brown, Paynesville;
Frank D. Gray, Marshall; J. C. Hultkrans, Minneapolis;
Oscar F. Mellby, Thief River Falls; F. P. Strathern,
St. P'eter.
The House voted, by plurality, that the annual session
for 1953 be held in New York City.
Dr. James R. McVay, Kansas City, Mo., was elected
by acclamation to succeed himself on the Council on
Medical Service, and the ballot was spread to elect a
successor to Dr. Jesse D. Hamer, Phoenix, Ariz.
Dr. Bauer introduced Dr. Pedro Nogueira, Secretary
of the Cuban Medical Association, who brought greet-
ings from his country, and Dr. Jose Angel Bustamante,
Secretary of the Pan-American Medical Association,
who also brought greetings.
The House passed a resolution of appreciation to the
State of California, the San Francisco County Medical
Association and the California Medical Association, and
a resolution of appreciation to the city of San Fran-
cisco.
Dr. Jesse D. Hamer was elected to succeed himself as
a member of the Council on Medical Service.
The House of Delegates to the American Medical As-
sociation adjourned at 3:30 p.m.
932
Minnesota Medicine
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pulmonary edema or paroxysmal dyspnea of con-
gestive heart failure Aminophyllin is also useful
in the control of Cheyne-Stokes respiration and for
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status asthmaticus.”
Council on Pharmacy and Chemistry: New and Non-
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933
♦
Reports and Announcements ♦
AMA CLINICAL SESSION
The fourth clinical session of the AMA, designed
primarily for the general practitioner, will be held in
Cleveland, December 5 through 8. The scientific ses-
sions and the scientific exhibits will be presented in the
Cleveland Municipal Auditorium. The House of Dele-
gates will meet at the Statler Hotel.
Outstanding clinical teachers will appear on the pro-
gram. Clinical sessions will be limited to an attendance
of 100 physicians. Obstetric, pediatric and geriatric
problems, traumatic surgery, cancer and diabetes will be
among the subjects of interest to the general practitioner
which will be discussed. This midyear meeting aids
the general practitioner in keeping abreast of medical
progress.
AMERICAN COLLEGE OF CHEST PHYSICIANS
The fifth annual Postgraduate Course in Diseases of
l he Chest, sponsored by the Council on Postgraduate
Medical Education and the Illinois State Chapter of
the American College of Chest Physicians, with co-
operation of the members of the staffs of the medical
schools and hospitals of Chicago, will be held at the
St. Clair Hotel, Chicago, October 16 through 20.
Addresses on medical and surgical phases of chest
diseases will be given at the morning and afternoon ses-
sions, with round-table discussions each noon. The eve-
ning of October 19 will be given over to a banquet,
to be followed by a meeting of the Illinois chapter of
the College.
The number of registrants for the course is limited.
Applications, with a remittance of $50, should be sent
to the American College of Chest Physicians, 500 North
Dearborn Street, Chicago 10, Illinois.
AMERICAN COLLEGE OF PHYSICIANS
The Midwest Regional Meeting of the American Col-
lege of Physicians will be held at the Memorial Union
Theatre on the campus of the University of Wisconsin
in Madison, Wisconsin, Saturday, November 18, 1950.
Physicians of Minnesota, Illinois, Indiana, Iowa, Ohio,
Michigan and Wisconsin, whether members of the Col-
lege or not, are urged to attend.
Registration at 8 A.M. will be followed by fifteen-
minute papers on a wide variety of medical subjects, the
afternoon session terminating at 5 P.M. A social hour
follows at 5 :30 P.AL In addition, a scientific exhibit
will be presented in the foyer of the Memorial Union
Theatre.
For further information, address Dr. H. M. Coon,
1300 University Avenue, Madison 6, Wisconsin.
AMERICAN COLLEGE OF SURGEONS
A sectional meeting of the American College of Sur-
geons will be held in St. Louis on January 22 and 23.
All physicians who wish to attend are invited. A regis-
tration fee of $5 for nonmembers can be expected.
Minnesota is included among the midwestern states in
the section of the country for which this meeting has
been arranged.
Headquarters will be at Hotel Statler, and an extra .
day of operative clinics will be conducted in addi-
tion to the two days of addresses. Further informa-
tion can be obtained from Dr. Barrett Brown, -UIO
Metropolitan Building, Grand Avenue and Olive Street,
St. Louis 3, Missouri.
NATIONAL GASTROENTEROLOGICAL ASSOCIATION
The National Gastroenterological Association will hold
its fifteenth annual convention and scientific sessions at
the Hotel Statler in New York City, October 9 through
11.
At the annual banquet of the Association, to be held
at the Hotel Statler on October 10, the winner of the
National Gastroenterological Association 19a0 Prize ;
Award Contest for the best unpublished contribution on
gastroenterology and allied subjects, will receive the
prize of $100 and a certificate of merit.
Immediately following the convention, the Association :
is conducting a course in postgraduate gastroenterology
at the Hotel Statler in New York City on October 12 j
through 14.
Further information concerning the i rogram and de-
tails of the course may be obtained by writing to the I
Secretary, National Gastroenterological Association, i
1819 Broadway, New York 23, N. Y.
VAN METER PRIZE AWARD
The American Goiter Association again offers the
Van Meter Prize Award of $300 and two honorable
mentions for the best essays submitted concerning origi-
nal work on problems related to the thyroid gland. 1 he
award will be made at the annual meeting of the As- j
sociation which will be held in Columbus, Ohio, May 24,
25 and 26, 1951, providing essays of sufficient merit are
presented in competition.
The competing essays may cover either clinical or re- j
search investigations, should not exceed three thousand
words in length, must be presented in English, and a
typewritten double spaced copy in duplicate sent to the J
Corresponding Secretary, Dr. George C. Shivers, 100
East Saint Vrain Street, Colorado Springs, Colorado, ■
not later than March 1, 1951. The committee who will
review the manuscripts is composed of men well quali-
fied to judge the merits of the competing essays.
A place will be reserved on the program of the an-
nual meeting for presentation of the Prize Award Es-
say by the author, if it is possible for him to attend.
The essay will be published in the annual Proceedings of
the Association.
934
Minnesota Medicine
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eptember, 1950
935
REPORTS AND ANNOUNCEMENTS
THE Bl RICHER CORPORATION
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MINNESOTA PUBLIC HEALTH CONFERENCE
Physicians and health officers of Minnesota municipali-
ties will meet on September 25 and 26 in the Hotel
Nicollet in Minneapolis to discuss general sanitary prob-
lems of municipalities. This meeting is being held in
conjunction with the fourth annual meeting of the Min-
nesota Public Health Conference, an organization with a
membership of over 600 lay and professional health
w-orkers in Minnesota.
Authorities on sanitary problems will join with the
health officers and physicians in discussions of municipal
solutions of waste disposal, rodent control and other
problems. The conference is also featuring a second day
full program of interest to physicians. Mary Switzer of
the Federal Security Agency will report on the activities
of the World Health Organization. A general afternoon
session features a discussion of health problems in in-
dustry, the use of mass media to get a message across to
people, and techniques used in social welfare to win pub-
lic support of the programs. The banquet session of the
program features an address by Dr. William Sheppard
of the Metropolitan Life Insurance Company, who is
president elect of the American Public Health Associa-
tion.
All physicians and health officers in Minnesota are
invited to attend the two-day program which brings to-
gether all health interests in Minnesota.
CONTINUATION COURSES
Cortisone and ACTH. — The University of Minnesota
announces a continuation course for physicians on cor-
tisone and ACTH to be presented at the Center for
Continuation Study on October 4.
Subject matter for the course will include pituitary
adrenal interrelationships, the alarm reaction, and tests
of adrenal cortical function. The use of cortisone and
ACTH in allergic states, rheumatic fever, rheumatoid
disease, and eye disorders will highlight the therapeutic
section of the course.
Faculty for the course will include members of the
staffs of the Mayo Clinic and the Phiiversity of Minne-
sota Medical School.
Medical Technologists. — The University of Minnesota
announces a continuation course for medical technolo-
gists on October 10 and 11. The course will be pre-
sented at the Center for Continuation Study and will be
devoted to problems in clinical chemistry. Among the
subjects to be discussed will be the reliability and valid-
ity of methods in clinical chemistry, the use of the flame
photometer and spectrophotometer, technique and in-
terpretations of liver function tests, plasma protein de-
termination, and serum cholesterol determination, tech-
niques, and interpretation. The visiting faculty mem-
ber for the course will be Dr. Olaf Michelsen, bio-
chemist of the Division of Chronic Disease of the United
States Public Health Service. Members of the faculty
of the University of Minnesota will complete the staff
for the course. Graduates in technology are eligible to
attend.
936
Minnesota Medicine
HAZELDEN FOUNDATION
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A HOMELIKE
The constructive thinking of a group of Twin Cities men seeking a new approach to the
problem of alcoholism resulted in the organization of the Hazelden Foundation. Some of
the founders are themselves men who have recovered from alcoholism through the proved
program of Alcoholics Anonymous. Their true understanding of the problem has resulted
in the treatment procedures used at the Hazelden Foundation.
BOARD
OF TRUSTEES
Mr. T. D. Maier,
Vice President,
First Natl. Bank
St. Paul, Minn.
Mr. Robert M. McGarvey,
President and Treasurer
McGarvey Coffee Co.
Minneapolis 1, Minn.
Mr. A. G. Stasel,
Supt., Eitel Hospital,
Minneapolis 3, Minn.
Dr. Gordon R. Kamman,
1044 Lowry Med. Arts
Bldg., St. Paul 2, Minn.
Mr. L. M. Butler,
Owner Star Prairie
Trout Farm
St. Paul, Minn.
Mr. John J. Kerwin,
Manager, Mid-Continent
Petroleum Corp.,
St. Paul 4, Minn.
Mr. Bernard H. Ridder,
Pres., N.W. Pub., Inc.,
Dispatch Building,
St. Paul 1, Minn.
M. R. C. Lilly, |
Chairman of the Board,
First National Bank,
St. Paul 1, Minn.
Direct inquiries and re
quest for illustrated brochure
to
Mr.
A. A. Heckman,
Mr. L. B. Carroll,
Gen.
Sec., Family Serv.,
V. Pres. & Genl. Mgr.
Wilder Building,
Hazelden Foundation,
St. Paul 2, Minn.
Center City, Minn.
It should be understood that Hazelden Foundation is not officially sponsored by Alcoholics Anonymous
just as Alcoholics Anonymous sponsors no other organization regardless of merit.
The Hazelden Foundation is a nonprofit organization. All inquiries are kept confidential.
HAZELDEN FOUNDATION
Lake Chisago, Center City, Minn. Telephone 83
September, 1950
937
REPORTS AND ANNOUNCEMENTS
POSTGRADUATE SEMINARS
Two preliminary planning meetings for the conduct
of professional postgraduate seminars were held recently.
On July 26 members of the different professions, as
well as interested lay persons, met at the St. Francis
Hospital, Crookston, to discuss plans for the forthcom-
ing seminar.
Dr. R. O. Sather of Crookston, secretary of the Red
River Valley Medical Society, and Dr. O. K. Behr,
also of Crookston, represented the local medical profes-
sion.
Dr. R E. Siman and Dr. H. F. Jung were there
representing the dental group. Miss Margaret Sherman,
Miss Ruby Gregerson, Miss Blanche Ingvalson, Mrs.
Eva Brown, and Miss Ida Twedten were from the
nursing profession.
Dr. George N. Aagaard, director of postgraduate med-
ical education at the University of Minnesota; Mr.
Thomas A. Morrow, executive secretary of the Minne-
sota Heart Association; Dr. William A. Jordan, direc-
tor, Division of Dental Health, and Mr. E. W. Eagle,
pharmacist in Crookston, were also present. Sister
Mary Charitas, as administrator, represented St. Francis
Hospital.
The Crookston seminar, scheduled for September 13
to November 1, is a joint undertaking of the University
of Minnesota Medical School, the Minnesota State Medi-
cal Association, and the Minnesota Department of
Health. It is one of six planned for Minnesota com-
munities during the 1950-51 season.
On July 27 a similar planning meeting for a seminar
to be held at Virginia was conducted at the Virginia
Municipal Hospital. This seminar, with the same spon-
sors, will start September 21 and end November 9.
Dr. J. A. Malmstrom, president, Range Unit of the
St. Louis County Medical Society; Dr. E. N. Peterson,
chief of staff, Virginia Municipal Hospital; Dr. R. P.
Pearsall, city health officer, Virginia, Minnesota; and
Dr. N. M. Strandfjord represented the physicians. Dr.
L. C. Krause represented the dental profession.
Mrs. Inez Christen, president, Tenth District Minne-
sota Nurses Association; Mrs. Madeline Takala, St.
Louis County public health nurse, Virginia; Miss Esther
Hakko, St. Louis County public health nurse, Virginia;
and Mrs. Barbara Rodorigo, St. Louis County P.H.N.,
Virginia, Minnesota, were present for the nursing
group.
Dr. George N. Aagaard, Mr. Thomas A. Morrow,
Dr. William A. Jordan, and Mr. Charles C. Crosby,
pharmacist from Virginia, were present. Mr. John
Alexon, superintendent, represented the Virginia Munici-
pal Hospital.
The other seminar areas, together with approximate
attendance dates in 1951 are:
Moorhead
Willmar
Worthington
Albert Lea
January 3 to February 21
January 1 1 to March 1
March 6 to April 24
March 14 to May 2
(Continued on Page 940)
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September, 1950
939
REPORTS AND ANNOUNCEMENTS
POSTGRADUATE SEMINARS
(Continued from Page 938)
The seven courses held throughout the state in 1949-
50 were extremely well received, and professional at-
tendance and interest was excellent.
Heart disease, cancer control and mental health will
be the subjects of this year’s programs. Latest informa-
tion on the diagnosis, treatment, and management of
diseases in these three fields will be presented by lead-
ing medical lecturers from the University of Minnesota
Medical School. Professional films and literature will
in some instances be used to augment the speakers.
Each seminar, as last year, will consist of eight con-
secutive weekly meetings, with each session about two
hours long. Ordinarily two speakers, each on a dif-
ferent subject matter, will appear.
There is no charge for this series of lectures unless
local physicians voluntarily assess themselves $2 each
to obtain a certificate of attendance.
County medical societies are actively co-operating in
the organization and conduct of these significant medical
education events.
Coinciding with these medical seminars, dentists and
nurses of the area will hold eight sessions of their own,
patterned generally after the physician’s courses, with
subject matter tailored to their specific interests. The
University of Minnesota Schools of Dentistry and Nurs-
ing, the Minnesota State Dental Association, the Minne-
sota State Nurses Association, and local dental and
nursing groups sponsor the seminars.
Other co-sponsors of the seminars are the Minnesota
Division of the American Cancer Society, the Minnesota
Heart Association, and the Minnesota Mental Hygiene
Society.
LYON-LINCOLN MEDICAL SOCIETY
The forty-second semi-annual clinic course of the
Lyon-Lincoln County Medical Society began on Sep-
tember 5 and will end on October 10. All meetings are
held at the New Atlantic Hotel in Marshall and begin
with dinner at 6 :30 p.m. The program for the course is
as follows:
Sept. 5 — “Diagnosis and Treatment of Head Injuries”—
Dr. Wallace P. Ritchie, Saint Paul.
Sept. 12 — “Some Practical Aids in Prolonged Labor”- —
Dr. E. A. Banner, Rochester.
Sept. 19 — “Psychosomatic Medicine” — Dr. Gordon Kam-
man, Saint Paul.
Sept. 26 — “Emergency Surgery of the Abdomen” — Dr.
O. H. Beahrs, Rochester.
Oct. 3 — “Cardiovascular Renal Emergencies” — Dr.
T. W. Parkin, Rochester.
Oct. 10. — "Rheumatic Fever in Children with Special
Emphasis on the Differential Diagnosis”- — Dr.
Albert Stoesser, Minneapolis.
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941
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BROWN & DAY, INC
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In Memoriam
FRANK I. BRABEC
Dr. Frank J. Brabec, a practitioner at Perham, Alin-
nesota, since 1893, died July 29, 1950, at the age of
eighty-one.
Dr. Brabec was born at Watertown, Minnesota, Janu- ,
ary 31, 1869. He received bis medical degree from the
University of Minnesota in 1893. After graduation, he
took his internship at Asbury Hospital, Minneapolis,
and St. Joseph’s Hospital, Saint Paul. On his return trip
from Butte, Alontana, where he had accompanied Dr.
Charles Wheaton of Saint Paul to assist in an operation
on Senator Carter of Alontana, the train was delayed at 1
Perham and Dr. Brabec was so impressed with the
surrounding country that lie decided to practice there.
Dr. Brabec was instrumental in persuading the Fran-
ciscan Sisters to establish a hospital at Perham. He also
donated a farm to the village for the benefit of a library
addition.
Dr. Brabec is survived by his wife; two sons, Dr.
Leonard Brabec, an educator in New York, a child by !
his first wife who died a number of years ago, and Dr.
Paul Brabec of Forsythe, Montana, and a daughter,
Katheryn, of Saint Paul.
He was a former member of the Park Region Medical
Society, the Alinnesota State Medical Association and the
American Aledical Association.
KENNETH G. WILSON
Dr. Kenneth G. Wilson, formerly of Minneapolis, died
at Laguna Beach, California, June 19, 1950, at the age
of thirty-four.
Dr. Wilson was born in Minneapolis, August 27, 1915.
He attended Washburn High School in Minneapolis and
received the degree of B.S. from the Llniversity of Min- j
nesota in 1938 and an M.D. in 1940. After interning at
St. Luke's Hospital in San Francisco, he took post- !
graduate work at the Mayo Foundation specializing in
aeronautical medicine.
During World War II, he was a flight surgeon at
General Motors bomber plant, Cleveland, and at Con-
solidated Vultee Corporation, San* Diego, California.
He was a member of Psi Llpsilon and Nu Sigma Nu 1
fraternities.
Dr. Wilson is survived by his parents, Mr. and Mrs.
Alfred E. Wilson of Minneapolis, a brother, John R.,
of Sa'n Francisco and a sister, Mrs. Cora J. Compton,
of Alinneapolis.
My duty (men have duty; and, if I would be a man,
Then I must bow to duty) is to do the best I can,
In ev’ry way, and ev’ry day, till I grow big enough
To realize the best of men are diamonds in the rough.
Time has a way of telling man its truths before he dies;
He profits most who serves the best. My job — there it
lies.
942
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943
Of General Interest
♦
♦
The annual Leo G. Rigler lecture in radiology
will be given at the University of Minnesota on
November 2 by Dr. Knut Lindblom of the Karolinska
Institute in Stockholm, Sweden. Dr. Lindblom will
speak on “Backache” at 8:15 p.m. in the ampitheater of
the University Medical Sciences Building. The lecture
will be given in connection with a course in neuro-
radiology held October 30 through November 3 at tbe
University Center for Continuation Study.
* 5|C *
Dr. L. E. Steiner, Albert Lea, was elected secre-
tary of the Freeborn County Medical Society at the
June 1 meeting of the organization. He succeeds Dr.
E. S. Palmerton, who is taking a residency at the Uni-
versity Hospitals.
* * *
Dr. William S. Chalgren opened an office in Man-
kato on July 1 for the practice of neurology and psy-
chiatry. A graduate of the University of Minnesota
Medical School in 1943, Dr. Chalgren served his intern-
ship and a residency in neuropsychiatry at the Uni-
versity Hospitals. After a period of service in the Army,
he returned to the University department of neuropsy-
chiatry, and in 1949 he received a Pli.D. degree in neu-
rology and was certified by the American Board of Psy-
chiatry and Neurology. Formerly an assistant professor
of neuropsychiatry at the University, he is now on the
staff as a clinical assistant professor. He is also con-
sultant in neurology at the St. Cloud Veterans Hospital
and consultant in neuropsychiatry at the Nicollet Clinic,
Minneapolis.
* * *
Dr. and Mrs. John Briggs, Saint Paul, left on
August 21 to attend the International Congress of Cardi-
ology, scheduled to open in Paris September 3. Dr.
Briggs will address the International Congress of Chest
Physicians at the Foralani Institute in Rome on Septem-
ber 20.
* * *
Dr. Burton C. Ostling began the practice of
medicine in Kerkhoven on August 1. A graduate of the
University of Michigan, Dr. Ostling has practiced for
a year at Hastings.
* * *
Announcement of the appointment of Dr. Robert
B. May as clinical director and assistant superinten-
dent of the Fergus Falls State Hospital was made during
the middle of July. At the time of the appointment Dr.
May was serving in a similar capacity at the Willmar
State Hospital.
Dr. May’s previous experience includes work at the
Hastings State Hospital in Nebraska and at the Grey-
stone Park Hospital in Trenton, N. J. He has also been
clinical director in one of the Maryland state hospitals
and superintendent of the Eastern Shore State Hospital
in Maryland.
* * *
After almost a year without the services of a local
944
physician, Wanamingo acquired a resident physician
late in July when Dr. J. T. Boswell opened offices
there for the practice of medicine. A native of Okla-
homa, Dr. Boswell served his internship at the U. S.
Naval Hospital at Great Lakes, Illinois.
* * *
Dr. Paul Wendt, formerly of Sauk Rapids, be-
came associated with the Johnson Clinic in Thief River
Falls early in July. A graduate of the University of
Minnesota Medical School, Dr. Wendt recently completed
his internship at the Milwaukee County Hospital, Wis-
consin.
* * *
Dr. Virgil J. P. Lundquist has opened offices at
829 Medical Arts Building, Minneapolis. He was recently
affiliated with the University Hospitals and the Minne-
apolis Veterans Hospital.
* * *
Dr. J. A. Malerich and Dr. William T. Miller have
moved into new offices at 914 South Robert Street, West
Saint Paul. * * *
Dr. C. L. Roholt left Waverly on July 21 to take
a postgraduate course in general surgery in Chicago.
* * *
It was announced on July 20 that Dr. Francis J.
Braceland, Rochester, had been appointed chairman
of the governor’s advisory council on mental health.
Dr. Braceland, chief of the psychiatric section of the
Mayo Clinic, succeeds Dr. Alexander G. Dumas, Min-
neapolis, who resigned as chairman because of ill health.
Dr. Dumas retains a seat on the council, however.
Dr. Braceland has been a member of the council since
1947. In 1949 he was named co-consultant to the Di-
vision of Public Institutions in the development of Min-
nesota’s mental health program. He has been head of
the section on psychiatry and the department of neu-
rology and psychiatry at the Mayo Clinic since April,
1947. '
* * *
Dr. F. C. Dolder was presented with a lifetime
membership in the Eyota Businessmen’s Association at a
meeting of the group in Eyota on July 13. Dr. Dolder
was honored for his enthusiasm and activity in the as-
sociation’s projects during the past years.
* * *
Dr. David R. Philip has become associated in
practice with Dr. L. H. Hoyer in the Windom Clinic.
Dr. Philip has had postgraduate training in obstetrics and
pediatrics. He is a former resident of Mankato.
* * *
It was announced on July 14 that Dr. and Mrs.
Louis H. Stahn had returned from Spokane, Wash-
ington, and that Dr. Stahn planned to open an office for
the practice of medicine in Minneapolis.
* * *
Two new physicians have joined the staff of the
Itasca Clinic. They are Dr. Larry E. Karges, lo-
(Continued on Page 946)
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cated at Grand Rapids, and Dr. Roy R. Juntunen,
who is with the clinic at Nashwauk. Both are graduates
of the University of Minnesota Medical School. Dr.
Karges interned at Ancker Hospital, Saint Paul, and
Dr. Juntunen served his internship at St. Mary’s Hos-
pital, Duluth.
* * *
Dr. O. L. McHaffie, Duluth, has been named St.
Louis County Medical Society representative to the
Duluth Rehabilitation Center board of directors.
* * *
Dr. F. Donald Bucher opened offices for the prac-
tice of medicine in Starbuck on July 24. A graduate of
the University of Nebraska, he served his internship at
St. Joseph Hospital, Sioux City, Iowa. He has spent
two years in service with the Navy.
* * *
Dr. W. W. Will, Bertha, is one of several physi-
cians to be heard on a special radio broadcast this fall
sponsored by the University of Minnesota as part of its
centennial celebration. On the broadcast, which has been
tape-recorded, Dr. Will is interviewed as he describes his
experiences as a “country doctor.” He is also heard in a
typical office interview with a person imitating a patient.
The title of the broadcast is “Minnesota Mid-Century,”
and the interviews with physicians are part of the
medicine and health portion of the program.
* * *
Dr. Anthony L. Ourada, who recently completed
a residency in surgery at Swedish Hospital, Minneapolis,
began medical practice in Waseca on July 17. A gradu-
ate of the University of Minnesota Medical School in
1946, Dr. Ourada served his internship at St. Elizabeth’s
Hospital in Youngstown, Ohio. He then spent sixteen
months in the Army in Germany.
* * *
Dr. A. M. Ridgway, Annandale, said to be the old-
est practicing physician in Minnesota, observed his
sixtieth year of practice on July 15.
* * *
Dr. Lewis Thomas, former professor of pediatrics
and medicine at Tulane University, has been appointed to
the American Legion memorial research professorship in
rheumatic fever and heart disease at the University of
Minnesota Medical .School. The professorship was es-
tablished through funds provided by the Minnesota
American Legion and its auxiliary. Dr. Thomas, a
graduate of Harvard LTniversity in 1937, will study causes
and treatment of rheumatic fever and heart disease and
will direct special research teams.
* * *
Dr. and Mrs. R. V. Williams left Rushford on
July 25 for a trip to Norway. They planned to spend two
months visiting various points in Norway before re-
turning to Rushford.
* * *
Two physicians specializing in the practice of
internal medicine opened a new medical office in
Mankato on July 27. Dr. Robert H. Conley and
Dr. Benjamin R. Guers, who had been in Mankato
since June, announced that their new offices had been
completely remodeled and equipped.
Both physicians are graduates of the University of
Minnesota Medical School and both recently completed
three years of postgraduate work at the University
Hospitals and Minneapolis Veterans Hospital. Dr. Con-
ley served his internship at Rochester General Hospital,
Rochester, New York, and then spent three years in the
Navy. Dr. Guers interned at Ancker Hospital, Saint
Paul, and served in the Army for three years.
* * *
Dr. Bernard S. Nauth opened offices for the prac-
tice of medicine in Bemidji on July 31. A graduate of
the University of Minnesota Medical School in 1941, Dr.
Nauth served in the Army for two and one-half years.
He spent the past five years as a general practitioner in
the Winona Clinic.
* * *
Dr. John R. Zell, a native of Mankato, has ac-
cepted an appointment for a three-year residency in
neuropsychiatry at the United States Veterans Hospital
at Coatsville, Pennsylvania. Dr. Zell recently completed
his internship at the U. S. Naval Hospital in Phila-
delphia.
* * *
Dr. Arthur H. Borgerson, Long Praire, has been
invited to speak at a meeting of the American Associa-
tion of Blood Banks in Chicago October 12 through 14.
He has been asked to describe the methods used in
establishing a blood bank in Long Prarie, which was the
first community in Minnesota, outside of the metropolitan
centers, to set up such a blood bank system.
* * *
On July 24 the residents of Northome could again
obtain the services of a local physician after being
without them for almost two years. On that day
Dr. Gordon Franklin opened offices for the practice
of medicine in Northome.
A native of Vernon Center, Dr. Franklin is a gradu-
ate of the College of Medical Evangelists. He interned
at the Glendale Sanatorium and Hospital in Los Angeles
and took additional training at St. Luke’s Hospital, Saint
Paul.
During the past two years Dr. Roger MacDonald of
Littlefork served the Northome community two days
each week.
* * *
Dr. Yngve Hakanson, after a year and one-half
of study in cell research and biochemistry at the Karo-
linska Institute in Stockholm, Sweden, joined the de-
partment of obstetrics and gynecology at the University
of Minnesota on August 1.
* * *
Dr. B. O. Mork, formerly of Worthington, has been
appointed medical director of one of the Los Angeles
eight public health districts. He will combine his new
activities with his work on the faculty of the University
of California at Los Angeles.
* * *
Mrs. Horace Newhart, wife of the late Dr. New-
hart, died in Minneapolis on August 14. Long active in
(Continued on Page 948)
946
Minnesota Medicine
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947
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(Continued from Page 946)
church and women's groups, she was also president of the
Minneapolis Society for the Hard of Hearing. She had
been a director of Northwestern Hospital, Minneapolis,
for more than forty years.
% * %
On August 7 the Rochester city council approved
a health department resolution hiring Dr. George
Williams, Saint Paul, as psychiatrist with the de-
partment’s counseling clinic. Dr. Williams, affiliated at
present with the University of Minnesota, will replace
Dr. Robert Fawcett as the clinic psychiatrist on January
1.
^
Dr. Wallace R. Anderson joined the staff of the
Austin Clinic on August 1. A graduate of the Uni-
versity of Minnesota Medical School, he interned at Min-
neapolis General Hospital, following which he took two
years of postgraduate training in pediatrics. His practice
at Austin will be limited to this specialty.
* * *
Dr. and Mrs. Rudolph B. Skogerboe and family
returned home to Karlstad on July 25 from a three-week
vacation, two weeks of which were spent in New York
and one at Lake Andrusia.
* * *
Dr. Nelson J. Bradley has been appointed superin-
tendent of the Willmar State Hospital, succeeding Dr.
Stanley B. Lindley, who had resigned to join the staff
of the Veterans Administration Hospital in Knoxville,
Iowa. At the time of his appointment, Dr. Bradley was
acting superintendent of the Hastings State Hospital, a
position he had held since the former superintendent,
Dr. Ralph Rossen, was appointed state mental health
commissioner last January.
A graduate of the University of Alberta, Dr. Bradley
has taken postgraduate work at the University of Min-
nesota. He joined the Hastings State Hospital staff in
1048.
5|C
Dr. Alphonse Cyr, Barnesville, was appointed Clay
County health officer at a commissioner’s meeting in
Moorhead early in July. Dr. Cyr replaces Dr. Olga H.
Johnson, Moorhead, who resigned from the office.
9(c J|e
Dr. Cherry B. Cedarleaf has become associated in
practice with Dr. L. H. Rutledge and Dr. C. W. Mo-
berg in Detroit Lakes. A graduate of the University of
Minnesota Medical School, Dr. Cedarleaf interned at the
Waterbury Hospital, Waterbury, Connecticut, and then
spent two years in resident graduate work at North-
western Hospital, Minneapolis.
* * *
Dr. George W. Heine became associated in prac-
tice with Dr. G. M. A. Fortier at the Little Falls Clinic
on August 1. A graduate of the University of Minne-
sota Medical School in 1948, Dr. Heine interned at St.
Luke’s Hospital, Duluth, and then spent one year at the
Oakland Naval Hospital.
* * *
Dr. and Mrs. Edmund Miller and their son, Robert,
returned home to Anoka in July from a trip to the West
Coast. While in California, Dr. Miller presented a paper
on the care of tuberculosis patients in institutions at a
meeting of the American College of Chest Physicians in
San Francisco on June 25.
•fa
Dr. L. E. Gallett, formerly of Pulaski, Wisconsin,
has opened offices for the general practice of medicine
at 2131 West Old Shakopee Road, Bloomington (Min-
neapolis). A graduate of the Lhiiversity of Wisconsin
Medical School, Dr. Gallett practiced at Pulaski for
eight years. He recently completed a year of postgradu-
ate study in allergy at the Cook County Graduate School
of Medicine.
J{s * *
Three Rochester physicians will present papers at
the eighty-fifth annual session of the Michigan State
Medical Society in Detroit September 20 through 22.
Dr. Louis A. Brunsting will speak on “The Present
Status of the Syphilis Problem.” Dr. John R. McDonald
will discuss “The Clinical Importance of Early Cancer,”
and Dr. James T. Priestley’s subject will be “Surgical
Lesions of the Stomach.”
* Jjc %
Dr. David Hoehn and his wife, Dr. Bernice An-
drews, have replaced Dr. E. J. Schmitz in Holding- j
ford. Dr. Schmitz, gave up his practice to become a
fellow in surgery at the University of Washington at
Seattle. Graduates of the University of California in
1937, Dr. Hoehn and Dr. Andrews have practiced for
nine years in the interior of Alaska, for two years in
Tennessee, and for one year in North Dakota.
* * *
Goodhue acquired a new physician early in July j
when Dr. James W. Halvorson opened offices there
for the practice of medicine. A graduate of the Uni-
versity of Minnesota Medical School in 1948, Dr. Halvor-
son served his internship at St. Mary’s Hospital in
Winona. He then spent one year at the U. S. Naval
Hospital at Great Lakes, Illinois.
* * *
Dr. Hendrik De Kruif, formerly of Minneapolis,
has moved to Fergus Falls and has become associated
with the Fergus Falls Clinic.
* * *
Dr. Marshall J. Melius, formerly of Saint Paul,
joined the Henry Clinic in Milaca on August 7. A
graduate of the University of Minnesota Medical School,
Dr. Melius served his internship at the Milwaukee
County Hospital, Wisconsin. He recently completed some
postgraduate training at St. Joseph’s Hospital, Saint
Paul.
* * *
The first meeting of the Minnesota Clinic Managers
was held at the Androy Hotel in Hibbing on July 28 and
29. The organization consists of the managers of medical
clinics in the state.
* * *
Dr. F. R. Ritzinger has become associated in
practice with the Rose and Doman Clinic in Lakefield.
A graduate of the Lhiiversity of Illinois Medical School, j
Dr. Ritzinger served his internship at Ancker Hospital, |
Saint Paul. He has completed a one-year surgical resi-
dency at Miller Hospital, Saint Paul.
948
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St. Paul: Cedar 8407, 8408
Minneapolis: Nestor 6886
It was announced late in July that Dr. John Reit-
mann had left his position at the Hastings State
Hospital to become supervisor and chief medical officer
it the Sandstone State Hospital.
^ ^ ^
Dr. Anthony C. Gholz, a former resident of Worth-
ington, has announced the opening of offices in associa-
tion with Dr. William D. Cleland, Jr., in Port Huron,
Michigan. Dr. Gholz is limiting his practice to pediatrics.
A graduate of the University of Minnesota Medical
School, Dr. Gholz recently completed a residency at the
Children’s Hospital, Detroit, Michigan.
3*C Jfc
The Clarkfield Clinic announced late in July that
Dr. Curtis M. Johnson, of Jackson, would join its
staff about September 1.
September, 1950
The National Committee for a Free Europe, Inc.,
is an organization of public-spirited American citizens
who operate Radio Free Europe as an independent
counterpart of the government-operated Voice of Ameri-
ca. Unhampered by government control, Radio Free
Europe broadcasts anti-Communist programs from a
short-wave transmitter beamed from western Germany
to behind the Iron Curtain. The freedom station carries
the voices and messages of exiled leaders back to the
satellite countries from which they escaped.
The National Committee for a Free Europe is sponsor-
ing a Crusade for Freedom, to be undertaken this fall
to enroll Americans on Freedom Scrolls, which will be
permanently enshrined in the base of a ten-ton Freedom
Bell to be hung in Berlin next October.
949
OF GENERAL INTEREST
I909....1950
Physiotherapy for the relief
of Arthritis and related con-
ditions. Complete physical
examinations and laboratory
procedures given every pa-
tient. Roy T. Pearson,
M.D., Medical Director. B.
F. Pearson, M.D., associate.
U. S. Hwy. 212
anifarium
Cook County Graduate School of Medicine
ANNOUNCES CONTINUOUS COURSES
SURGERY — Intensive Course in Surgical Technic, Two
Weeks, starting September 25, October 23, Novem-
ber 27.
Surgical Technic, Surgical Anatomy & Clinical Sur-
gery, Four Weeks, starting September 11, October
9, November 6.
Personal Course in General Surgery, Two Weeks,
starting September 25.
Surgery of Colon & Rectum, One Week, starting
September 11, October 9.
Esophageal Surgery, One Week, starting October 16.
Breast Thyroid Surgery, One Week, starting Octo-
ber 2.
Thoracic Surgery, One Week, starting October 9.
Gallbladder Surgery, Ten Hours, starting October 23.
Fractures & Traumatic Surgery, Two Weeks, starting
October 9.
Basic Principles in General Surgery, Two Weeks, start-
ing September 11.
GYNECOLOGY — Intensive Course, Two Weeks, start-
ing September 25, October 23.
Vagin,al Approach to Pelvic Surgery, One Week, start-
ing September 8, November 6.
OBSTETRICS — Intensive Course, Two Weeks, starting
September 11, November 6.
MEDICINE — Intensive General Course, Two Weeks,
starting October 2.
Gastro-enterology, Two Weeks, starting October 16.
Gastroscopy, Two Weeks, starting September 11, Octo-
ber 23.
Electrocardiography & Heart Disease, Four Weeks,
starting October 2.
DERMATOLOGY — Formal Course, Two Weeks, start-
ing October 16. Informal Clinical Course every
two weeks.
UROLOGY — Intensive Course, Two Weeks, starting
September 25.
Cystoscopy, Ten-day Practical Course, starting every
two weeks.
General, Intensive and Special Courses in all Branches of
Medicine, Surgery and the Specialties.
TEACHING FACULTY— ATTENDING
STAFF OF COOK COUNTY HOSPITAL
Address: REGISTRAR, 427 South Honore Street
Chicago 12, Illinois
The Mesalia Clinic staff was increased in July with
the addition of Dr. Wesley Tomhave, who had just
completed his internship at Minneapolis General Hos-
pital. A graduate of the University of Minnesota in 1942,
Dr. Tomhave served in the Navy for two and one-half
years before returning to Minnesota to study medicine.
He received his bachelor of medicine degree from the
University Medical School in 1949.
* * *
Dr. Hans Johnson was re-elected president of the
Kerkhoven school board at the annual reorganization
meeting on July 5. Dr. Johnson has held the office for
many years.
Physicians from five states announced on August
5 plans for a “mutual assistance disaster program”
for exchange of whole blood and plasma in case of
an atomic bombing. Meeting in Minneapolis, physicians
from Minnesota, North and South Dakota, Iowa and
Wisconsin emphasized the need for decentralization of
blood collection so that if one center were destroyed by
bombs supplies would be available elsewhere. A blood
procurement and planning committee was organized to
work on the problem.
* * *
In Mankato, Dr. Roger G. Hassett has been oc-
cupying temporary quarters while work is progressing
on his new medical center building. The project involves
remodeling the present structure and constructing an
87-foot two-story addition. When completed, the center
will contain offices for physicians, dentists and attorneys,
as well as space for a commercial firm.
* * *
It was announced on August 3 that two new physi-
cians were moving to Pelican Rapids. Dr. Lawrence
Pearson planned to> arrive on September 1 to be as-
sociated in practice with Dr. H. A. Korda in the Pelican
Valley Clinic. Dr. Pearson, who was graduated from the
Lhiiversity of Minnesota Medical School and interned at
Miller Hospital, Saint Paul, has practiced medicine at
Warroad for the past nine years.
Dr. H. K. Helseth, of Mott, North Dakota, and
formerly of Fergus Falls, was also planning to move to
Pelican Rapids as soon as suitable office space could be
found.
* * *
At a meeting of the Exchange Club in Winona on
July 18, Dr. R. H. Wilson discussed the operational
problems of the Winona General Hospital. He stated
that hospital rates in Winona were high, not because of
inefficient management or because somebody was trying
to make a lot of money, but because of poor local patron-
age, inefficiency of the present physical plant, and lack
of subsidization of any type. He suggested, as a solu-
tion, acquainting the public with the facts, constructing
a new hospital, and converting the present structure to a
convalescent and chronic disease home.
* * *
Dr. Edwin J. Simons, prominent practitioner in
Swanville for more than twenty-five years, has sold his
practice to Dr. Edwin G. Knight, his associate for the
past eight years, and has moved to Edina (Minneapolis).
950
Minnesota Medicine
OF GENERAL INTEREST
An Observation on the Accuracy of Digitalis Doses
Withering made this penetrating observation in
his classic monograph on digitalis: "The more I
saw of the great powers of this plant, the more it
seemed necessary to bring the doses of it to the
greatest possible accuracy.”1
To achieve the greatest accuracy in dosage and at
the same time to preserve the full activity of the
leaf, the total cardioactive principles must be iso-
lated from the plant in pure crystalline form so
that doses can be based on the actual weight of the
active constituents. This is, in fact, the method by
which Digilanid® is made.
Clinical investigation has proved that Digilanid is
"an effective cardioactive preparation, which has
the advantages of purity, stability and accuracy as
to dosage and therapeutic effect.”2
Average dose for initiating treatment: 2 to 4 tab-
lets of Digilanid daily until the desired therapeutic
level is reached.
Average maintenance dose: 1 tablet daily.
Also available: Drops, Ampuls and Suppositories.
1. Withering, W An account of the Foxglove, London, 1785.
2. Rimmerman, A. B.: Digilanid and the Therapy of Congestive
Heart Disease, Am. J. M. Sc. 209: 33-41 (Jan.) 1945.
Literature giving further details about Digilanid and Physician’s Trial
Supply are available on request.
Digilanid contains all the initial glycosides from
Digitalis lanata in crystalline form. It thus truly
represents "the great powers of the plant” and
brings "the doses of it to the greatest possible
accuracy”.
Sandoz
Pharmaceuticals
DIVISION OF SANDOZ CHEMICAL WORKS, INC.
68 CHARLTON STREET, NEW YORK 14, NEW YORK
The transfer of practice became effective September 1.
During his years at Swanville Dr. Simons compiled
an outstanding record of service to the public and to the
medical profession. He has served as president of the
Minnesota State Medical Association and the Upper
Mississippi Medical Society. He was senior physician at
the state tuberculosis sanatorium at Walker and served as
chief of the medical services unit of the Minnesota Divi-
sion of Social Welfare. He was one of the twenty-one
state physicians who organized the Blue Shield medical
insurance plan, and is still one of its directors. He is at
present a trustee of the Minnesota Medical Foundation at
the Llniversity of Minnesota. In addition to these duties
he conducted his private practice at Swanville for over
twenty-five years and even found time to serve as mayor
for several years.
Jfc ^ :fc
Dr. E. M. James, who has opened a medical lab-
oratory at 657 Lowry Medical Arts Building, Saint
Paul, is also continuing his work as pathologist for
St. Joseph’s Hospital, Saint Paul.
* * *
Dr. Justin C. Lannin, Mabel, was honored for his
thirty-nine years of service at ceremonies held in Mabel
on July 16 and attended by more than 1,000 persons. Dr.
Lannin was presented with a scroll commemorating the
occasion and was given luggage and a wrist watch by
Mabel businessmen and other friends. Present during
the ceremonies were Dr. Lannin’s wife and his two sons,
both physicians, Dr. Bernard G. Lannin and Dr. Donald
R. Lannin, of Saint Paul.
A graduate of McGill University in Montreal, Canada,
Dr. J. C. Lannin came to the United States in 1910 and
located at Caledonia. After a year there, he moved to
Mabel, where he has since practiced.
HOSPITAL NEWS
At the organizational meeting of the medical staff
of the new Zumbrota Community Hospital, held in
Zumbrota on June 29, Dr. M. G. Flom was elected
chief-of-staff, and Dr. Oliver E. H. Larson, secretary.
¥ ¥ T
First steps in the organization of a women’s auxil-
iary unit for the new Community Memorial Hospital
in Blue Earth were taken on July 21 when more than
seventy-five women met at the hospital at the invita-
tion of Mrs. Dora McKee, the superintendent. Fol-
lowing organization, the group planned to supply the
various needs of the hospital. Its first project was to
prepare new hospital linens. Future projects may
include raising funds, providing volunteer workers,
and canning food for hospital use.
•S'
The Valleyview Hospital and Sanitarium near Jor-
dan was dedicated on July 16. A chronic-disease in-
stitution, the hospital was renovated and remodeled
through the efforts of Dr. Joseph C. Michael of Min-
neapolis.
* * T
A meeting of men of the St. WenceslauS parish
in Jackson was held on July 23 to discuss the com-
muinty hospital situation and to find ways to assist
the Sisters of Charity in the operation of the Hal-
September, 1950
951
OF GENERAL INTEREST
loran Hospital. A committee was formed to try to
solve the problem of the lack of proper facilities due
to the hospital’s crowded condition.
* * ▼
Cornerstone-laying ceremonies for the new St.
Louis County Infirmary, adjoining St. Luke’s Hos-
pital, Duluth, were held on July 18 by the Minnesota
Grand Lodge of AF&AM. Among lodge officials
taking part in the ceremonies was Dr. B. S. Adams,
Hibbing, past grand master of the lodge.
* * *
The blessing and dedication ceremony of the site
for the St. John’s Hospital, to be built at Red Lake
Falls, was held on July 9. Among physicians taking
part in the ground-breaking ceremonies were Dr. L.
N. Dale, Red Lake Falls, and Dr. C. G. Uhley and
Dr. O. K. Behr, both of Crookston.
^
The dedication of the new St. Michael’s Hospital
in Sauk Centre was held on July 9. The size of
the crowd attending the ceremonies, in spite of
overcast skies, was estimated at from 3,000 to 5,000
persons. As principal speaker on the dedicatory
program, Dr. Alfred W. Adson, Rochester, predicted
that within five years the $700,000 institution would
be doubled in size. “Someone was smart,” he stated,
“when they planned this institution to provide for
fifty additional beds. With an area serving 18,000
people, in five years you’re going to need them.”
* * *
Three new operating rooms and one for application
of casts have been constructed at St. Mary’s Hospital,
Rochester. The rooms include two for major and one
for minor orthopedic surgery. Their construction
is part of a $215,000 renovation plan for the fifth
and sixth floors of the hospital’s east surgical wing.
The addition of the four rooms brings the total of
operating rooms at the hospital to twenty.
(Complete Ophthalmic
Service
Oor Ohe
Profession
N. P. BENSON OPTICAL CO.
Laboratories in Minneapolis
and
Principal Cities of Upper Midwest
BLUE SHIELD NEWS
During recent months members of the Blue Shield and
Blue Cross staff have been invited to attend hospital
staff meetings to discuss how the doctor can assist Blue
Cross and Blue Shield. The purpose of such meetings
has been to secure the full co-operation of staff physi-
cians in correcting serious situations that have arisen re-
garding both non-profit plans. Due to the close affiliation
of Blue Cross with Blue Shield, the physician’s own
plan of prepaid medical care, the problems which af-
fect one plan will likewise affect the other. Blue Cross
and Blue Shield cannot exist without the support and
co-operation of the doctors and the hospitals. For the
benefits of those who have not attended a hospital staff
meeting where these problems have been discussed,
briefly these are the problems.
Minnesota Blue Cross paid to hospitals for subscriber
care approximately $400,000 more in 1949 than was
anticipated. The final analysis shows that this increase
of hospital utilization was caused by various items.
Perhaps the largest single item that affected this in-
crease was the fact that many patients were being
hospitalized solely for services which appear to be in
many instances purely health examinations. It is
952
Minnesota Medicine
OF GENERAL INTEREST
LACTOGEN
CLOSELY APPROXIMATES
BREAST MILK
Advertised to
ihe Medical Profession only.
COMPANY,' INC., NW
LACTOGEN + WATER
1 level tablesDoon 2 fl. ozs.
FORMULA
2 fl. ozs.
(20 Cals, per fl. oz.)
1 level tablespoon
(40 Cals.)
realized that some of these hospitalized cases are a result
of undue pressure placed on the doctor by the patient
who feels that he has a hospital contract that does pro-
vide for diagnostic work. It was not the original intent
of Blue Cross to provide for serviced of this type which
in most instances do not require an overnight stay in
the hospital and Blue Cross does not provide benefits
for outpatient care except for accidents and minor sur-
gery including such service which cannot be provided in
the doctor’s office. A new Blue Cross contract has been
approved and will supersede the one now in existence.
This contract excludes benefits for diagnostic work ;
however, it will not replace the present contract until
the expiration date of each contract. In the meantime,
we can only request the doctors to advise their patients
that diagnostic services which do not require an over-
night stay in the hospital should be done in the doctor’s
office or paid for by the patient if outpatient care is
necessary in the hospital.
The Blue Cross problem is .mainly that diagnostic
cases are kept in the hospital over night whereas former-
ly they were outpatient cases.
The hospital drug bills for 1949 increased over 1948
by $1.37 per case resulting in an over-all increase of
$200,000 for the year. Laboratory work increased $1.47
per case or approximately $210,000 for the year.
It is not the intent of either Blue Cross or Blue Shield
to advise the medical profession or the hospitals as to
how they should practice medicine or operate the hos-
pitals. It is merely the intent to point out some of the
situations that have arisen and ask the co-operation of
the medical profession in attempting to eliminate abuses
September, 1950
so that the cost to Blue Cross can be reduced, and there-
by keep the rates within the means of the low income
groups of people. Many people have the erroneous im-
pression that Blue Cross and Blue Shield lower the cost
of medical care. They do not and cannot lower it one
penny. They only spread it. Doctor Hawley, director
of the American College of Surgeons, says : “The utili-
zation rate of Blue Cross has been rising steadily for the
past six or seven years. Also, during this same period,
hospital charges have increased tremendously. So Blue
Cross has been caught between the upper and nether
millstones of spiraling costs and increasing utilization.
We cannot keep this up forever. One of these days
Blue Cross is going to be too expensive for poor people.
When that day comes, we are going to have compulsory
health insurance. Poor people can vote, you know, even
if they cannot afford Blue Cross.”
Both the Blue Cross and Blue Shield contracts specify
that no allowance will be made for the treatment of any
condition which was known by the subscriber or any
of his family dependents to exist at the time the contract
application is received in the Blue Cross, Blue Shield
office until ten months after the contract has been in
effect. It has been the policy of this office to consult the
subscriber’s physician regarding this informaiton ; it is
believed that the physician is in the position to furnish
such information and also that he would assist in govern-
ing the control of this factor which is of vital importance
to the success of the Plans.
In some instances it is becoming increasingly difficult
to obtain specific information. Much of the information
relative to foreknown conditions is inclined to be vague
953
OF GENERAL INTEREST
rather than specific enough to establish a date of knowl-
edge of t he condition. It is realized that in many in-
stances it is difficult to make a definite statement con-
cerning this matter ; however, it is believed that the
physician in obtaining a history is in a position to know
whether that condition could or could not have been
present for a specified length of time.
Information which is difficult to interpret could result
in increased utilization. For example, if Blue Shield
were to make allowances for ten cholecystectomies in the
course of a month which rightfully should not be paid,
utilization for that month would increase by $1,250.
This may not appear to be very much in an over-all
picture of approximately $200,000 allowed for a month ;
however, if this situation continues to increase it is
easily possible to foresee an excessive increase in utiliza-
tion. The same situation also applies to Blue Cross and
it is reasonable to assume that if allowances were made
on ten cholecystectomies the utilization would run from
$1,500 to $2,000 per month. The co-operation of the
medical profession in furnishing correct and specific in-
formation on this question is requested for it is assumed
that the medical profession does not wish to place un-
necessary burdens on these two non-profit plans.
Blue Shield payments for Line totaled $184,427.37
bringing the total for the first six months to $954,685.20.
Enrollment of new Blue Shield subscribers shows an in-
crease for this year of 99,528, enrollment as of June 30,
1950 is 360,029. Blue Cross enrollment as of the same
date totaled 1,033,139 participant subscribers. The
average fee per Blue Shield claim for the first six
months of 1950 is $40.05 as compared with $38.92 for
1949. June payments covered 4,788 Blue Shield claims;
23,385 claims were paid for the six month’s period.
October will mark the opening of the second Blue
Cross-Blue Shield non-group enrollment campaign which
will run from October 1 through October 22, 1950. A
total of 495 advertisements in twenty-six non-metropoli-
tan (out-state) dailies, eighty-five county weeklies, the
Minneapolis Sunday Tribune and the Si. Paul Sunday
Pioneer Press will tell the people of Minnesota why and
how they should enroll in Blue Shield and Blue Cross.
To create interest in the campaign and to help people in
each area get information quickly since there is a definite
time limit on the campaign, the doctors are being re-
quested to display non-group literature and a poster in
tlieir waiting rooms.
SCIENTIFIC DESIGN
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Our mechanics correctly fit
artificial limbs and ortho-
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Our high type of service
has been accepted by phy-
sicians and surgeons for
more than 45 years, and is
appreciated by their pa-
tients.
BUCHSTEIN-MEDCALF CO.
223 So. 6th Street Minneapolis 2, Minn.
The Birches Sanitarium, Inc.
2391 Woodland Avenue
Duluth 3, Minnesota
A hospital for the care and treatment of
Nervous and Mental disorders. Quiet, cheer-
ful environment. Specially trained personnel.
Recreational and occupational therapy.
Dr. L. R. Gowan, M.D., M.S., Medical Director
Attending Psychiatrists
Dr. L. R. Gowan Dr. C. M. Jessico
Dr. I. E. Haavik Dr. L. E. Schneider
REST HOSPITAL
2527 Second Avenue South, Minneapolis
A quiet, ethical hospital with therapeutic facilities
for the diagnosis and treatment of nervous and
mental disorders. Invites co-operation of all repu-
table physicians. Electroencephalography avail-
able.
PSYCHIATRISTS IN CHARGE
Dr. Hewitt B. Hannah
Dr. Andrew J. Leemhuis.
954
Minnesota Medicine
BOOK REVIEWS
BOOK REVIEWS
Books listed here become the property of the Ramsey,
Hennepin and St. Louis County Medical Libraries when
reviewed. Members, however, are urged to write re-
views of any or every recent book which may be of
interest to physicians.
THE ESOPHAGUS AND PHARYNX IN ACTION. William
Lerche, M.D. Fellow American College of Surgeons; Founder
Member and Honorary Member of the American Association
for Thoracic Surgery; formerly Associate Professor of Sur-
gery, University of Minnesota, Minneapolis. 222 pages.
Ulus. Price $5.50, cloth. Springfield, Illinois: Charles C
Thomas, 1950.
TPIE ANTIHISTAMINES— THEIR CLINICAL APPLICA-
TION. Samuel M. Feinberg, M.D., Associate Professor of
Medicine, Chief of Division of Allergy and Director of Allergy
Research Laboratory; Saul Malkiel, Ph. D., M.D., Assistant
Professor of Medicine Director of Research, Allergy Research
Laboratory; Alan R. Feinberg, M.D., Clinical Assistant in
Medicine, Attending Physician in Allergy Clinic. 291 pages.
Ulus. Price, $4.00, cloth. Chicago: Year Book Publishers,
1950.
PHYSICIAN’S HANDBOOK. Sixth Edition. Marcus A.
Krupp, M.D., Assistant Clinical Professor of Medicine, Stan-
ford University School of Medicine, Director Clinical Pathol-
ogy, Veterans Administration Hospital, San Francisco; Nor-
man J. Sweet, M.D., Assistant Professor of Medicine, Uni-
versity of California School of Medicine, San Francisco;
Ernest Jawetz, Ph.D., M.D., Associate Professor of Bacteriol-
ogy and Lecturer in Medicine and Pediatrics, University of
California School of Medicine, San Francisco; and Charles
D. Armstrong, M.D., Clinical Instructor in Medicine, Stanford
University School of Medicine. 380 pages. Ulus. Price
$2.50, paper cover. Palo Alto, California: LTniversity Medical
Publishers, 1950.
SAINTS, SINNERS AND PSYCHIATRY. Camilla M. An-
derson, M.D., Assistant Clinical Professor of Psychiatry, Uni-
versity of Utah. 206 pages, including index. Price $2.95.
Philadelphia: J. B. Lippincott Company, 1950.
This is a well-written book in about the simplest and
most understandable language possible, and can be highly
recommended to general practitioners and to intelligent
laymen.
It clearly describes the dynamics of behavior by
showing how everyone has his individual self-image,
both physical and psychological. This self-image is
composed of many parts, and each part is conceived of
as having both structure and function, that is, anatomy
and physiology. Each organ does a specific job. Every
character trait carries with it the expectation of a result
to be obtained through the use of it.
The psychological self-image is formed %arly in life
as a result of the child’s experiences with the significant
people in his environment. Once a character trait has
been formed, that is, becomes structuralized, it becomes
compulsive, and its functional results are taken for
granted.
Natusudlif, Minetodiyedt, NcdiVudLf. JleaUltful
RADIUM & RADIUM D+E
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Laboratories
(Owned and Directed by a Physician-
Radiologist)
Harold Swanberg, B.S., M.D., Director
W.C.U. Bldg. Quincy, Illinois
PATTERSON SURGICAL SUPPLY COMPANY
103 East Fifth St., St. Paul 1, Minn.
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955
September, 1950
BOOK REVIEWS
UTILITY • EFFICIENCY • SIMPLICITY
At your wholesale druggist or write for
further information
"DEE" MEDICAL SUPPLY COMPANY
P.O. Box 501, St. Paul, Minn.
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ORDER BY TELEPHONE OR MAIL
PRICES ON REQUEST
Every individual has as his motivation as well as
his road map for living, the maintenance of his self-
concept, and lives out a compulsive and therefore unreal-
istic and neurotic pattern of behavior through his need
to maintain his self-concept. As long as he can do this
successfully, he feels comfortable. But whenever he
feels that there is a threat to the integrity of any portion
of his self-structure (physical or psychological), or
whenever a part of his structure does not function in
the anticipated manner, he will experience a psychic
pain which is anxiety.
Whenever the structure of the psychological self-
image is broken, the pain or anxiety felt is known as
guilt (sinners).
Whenever the function of the psychological self-image
is disturbed, the anxiety feeling aroused thereby is felt
as helplessness, frustrated entitlement, or outraged virtue
(saints).
Anxiety may be experienced in pure form, but more
commonly in the form of one or more of three reac-
tions: (1) reaction against or attack upon the anxiety-
provoking situation with some degree of rage or re-
sentment, (2) withdrawal from the situation or paralysis
of all attack resources, (3) conversion of the attack
forces into any type of physical symptom.
These reactions do not constitute the neurotic illness
but are merely symptomatic of the presence of anxiety.
The essence of neurosis may be found in one’s self-
concept, which in turn is to be found in one’s assump-
tions, the things- one takes for granted, one’s beliefs.
And the severity of the neurotic disability is determined
not by the discrepancy between the assumptions and
reality, but rather by the discrepancy between one’s as-
sumptions and the assumptions of culture with which
one tries to identify.
Psychotherapy involves two processes. One, the clari-
fication of the individual’s assumptions ; the other, estab-
lishment of new assumptions more realistically oriented.
.Mental health becomes a fact as habitual defense mecha-
nisms are discarded and one can accept himself as he is
( psychiatry).
Herbert Busher, M.D.
•
HANDBOOK OF OBSTETRICAL AND DIAGNOSTIC GYN-
ECOLOGY. Leo Doyle, M.S., M.D. 240 pages. Ulus
Price $2.00. Palo Alto, California : University Medical Pub-
lishers, 1950.
Dr. Doyle has organized a vast amount of obstetrical
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INSTRUMENTS • TRUSSES • EQUIPMENT • PHARMACEUTICALS • DRUGS
MAIN 2494
956
Minnesota Medicine
BOOK REVIEWS
and gynecological information in his handbook which
can be used to refresh one’s memory on a specific prob-
lem utilizing a minimum of time.
The book contains charts for normal hematological
values, normal blood chemistry values, normal renal func-
tion and urine values, hematological changes during preg-
nancy, blood chemistry values during pregnancy, mis-
cellaneous laboratory values, cardio-vascular changes
during pregnancy, tables of approximate equivalents and
an obstetrical calender. The above information is on
the inner side of the front and back covers.
There are two sections to the handbook. Section I
has twenty-nine chapters ; each chapter is in outline
form, plus charts, pictures and diagrams regarding the
specific problem of obstetrics under discussion. Section
II contains ten short chapters on Diagnostic Gynecology.
Space does not permit a detailed analysis of each chapter;
however, the chapter regarding Emotional Aspects of
Pregnancy is one which merits special citation. This
phase of obstetrics is one which is often neglected in
medical texts and not too seriously considered by busy
practitioners.
The author has included standard obstetrical infor-
mation and procedures in the text. He also describes
some of his personal techniques and “tricks of trade.”
The book is pocket size and could be used as a handy
reference for emergency information, for hospital work,
at home deliveries and at the office.
J. F. Mei.ancon, M.D.
AT YOUR CONVENIENCE,
DOCTOR . . .
you are cordially invited to visit our new
and modern prescription pharmacy located on
the street floor of the Foshay Tower, 100 South
Ninth Street.
With our expanded facilities we will be able
to increase and extend the service we have
been privileged to perform for the medical pro-
fession over the past years.
Exclusive Prescription Pharmacy
Biologicals Pharmaceuticals Dressings
Surgical Instruments Rubber Sundries
JOSEPH E. DAHL CO.
(Two Locations)
100 South Ninth Street, LaSalle Medical Bldg.
ATlantic 5445 Minneapolis
TT OMEWOOD HOSPITAL is one of the
■L -*■ Northwest's outstanding hospitals for the
treatment of Nervous Disorders — equipped
with all the essentials for rendering high-grade
service to patient and physician.
Operated in Connection with
Glenwood Hills Hospitals
HOMEWOOD HOSPITAL
Corner Penn and Plymouth Avenues North
Minneapolis Minnesota
HMiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiMimiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiimiiiiiimiitiiiiiimiiiiiiiiiiiiiirtiiiimiiiiiiiimiiiiiiiiiiiiiiiimiiiiiimiiiiiiiimin^
THE VOC/mOMl HOSPITAL I
TRAINS PRACTICAL NURSES
riiiiiiiiiiiiimimiiiiiiimimiiiiifiiiiiiiiiiiiiiiiiitiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiimmiiiiiiiiiiiiiiiiimiiiiiiimiitiiiiiiibiiiiiiiiiiiiiiiiniiiiiiiiiiiiiM^
Nine months Residence course. Registered Nurses and |
Dietitian as Teachers and Supervisors. Certificate from |
Miller Vocational High School. VOCATIONAL NURSES |
always in demand.
EXCELLENT CARE TO CONVALESCENT AND
CHRONIC PATIENTS
Rates Reasonable. Patients under the care of their own physicians, i
who direct the treatment. =
5511 Lyndale Ave. So. LO. 0773 Minneapolis, Minn. I
September, 1950
957
Classified Advertising
Replies to advertisements with key numbers should be
mailed in care of Minnesota Medicine, 2642 University
Avenue, Saint Paul 4, Minn .
FOR SALE — Solid mahogany table 31 inches high, in-
dented for glass top 29x27 inches. Two full depth
drawers and bottom shelf. Suitable for laboratory or
reception room. Telephone EMerson 7263 (Saint
Paul) or address E-226, care Minnesota Medicine.
FOR SALE — Complete modern Westinghouse x-ray
equipment, basal metabolism machine, other electrical
equipment, instruments, examining table, furniture, et
cetera. Will sell at sacrifice for quick disposal. Re-
tiring. Address Charles P. Robbins, M.D., S.W.
Corner Third and Center Streets, Winona, Minnesota.
FOR SALE — $15,000 cash practice in county seat of
14,000, with two hospitals, for price of office equip-
ment, which is complete and in perfect condition.
Forced to retire on account of health. Address E-200,
care Minnesota Medicine.
FOR RENT — Desirable ground floor space, heavily
populated hill district, Saint Paul. Inquiries invited.
McDermott Realty Company, 714 New York Bldg.,
Saint Paul 1, Minnesota. Telephone CEdar 2400.
FOR SALE — Excellent general practice in Lowry Med-
ical Arts Building, Saint Paul, well established, over
$2,000 gross monthly, priced at just cost of equipment.
Address E-227, care Minnesota Medicine.
WANTED — General Practitioner, age thirty, protestant,
married, two chddren, desires location within 150
miles from the Twin Cities. Four years’ experience
in private practice. Address E-228, care Minnesota
Medicine.
WANTED — Young physician to become associated with
very busy general M.D., near Twin Cities, with view
of partnership or buying practice. Address E-215, care
Minnesota Medicine.
FOR RENT — Established doctor’s office in growing
district. Dentist and Super Market in building. One
block from church and school. Oil heat. Address
John T. Peisert, 1169 Rice Street, Saint Paul 3, Min-
nesota.
DOUBLESEAL rubber insulator closes gaps under
sectional type overhead doors. Stops drafts, dirt, snow,
driving rain. Edwards Industries, Dept. 2462, 4268
Shenandoah Avenue, St. Louis 10, Missouri.
WANTED — Woman Physician to do Obstetrics and
Pediatrics, assist older well-established F.A.C.S. Ex-
cellent hospital facilities. Salary and percentage from
start. Minnesota license or National Boards Parts 1
and 2. Located in suburb of Twin Cities; apartment
available. Wonderful opportunity for future. Address
E-225, care Minnesota Medicine.
OFFICE SPACE FOR RENT — Elliott Building, Min-
neapolis. Two rooms and share in waiting room with
doctors and dentists. X-ray, EKG and clinical labora-
tory available. Free parking space for doctor and
patients. Address FI. W. Quist, M.D., 732 Chicago
Avenue, Minneapolis 4, Minnesota.
Index to Advertisers
Abbott Laboratories 870
American Meat Institute 874
American National Bank 959
Ames Co. 862
Anderson, C. F., Co 938
Ar-Ex Cosmetics 955
Ayerst, McKenna & Harrison, Ltd .• 861
Benson, N. P., Optical Co 952
Birches Sanitarium, Inc 954
Birtcher Corporation 936
Borden Co 876
Brown & Day, Inc 942
Bruce Publishing Co 947 j
Buchstein-Medcalf Co 954
Camp, S. H., & Co 939 j
Caswell-Ross Agency 858
Classified Advertising 958
Cook County Graduate School of Medicine 950
Dahl, Joseph E., Co 957
Danielson Medical Arts Pharmacy 956
“Dee” Medical Supply Co 956
Druggists Mutual Insurance Co 959
Ewald Bros Inside Back Cover
Franklin Hospital 959
Glenwood Hills Hospitals 935
Glenwood-Inglewood 955
Hall & Anderson 959
Hazelden Foundation 937
Homewood Hospital 957
Juran & Moody 949
Kelley-Koett X-Ray Sales Corp. of Minnesota 864, 865
Lederle Laboratories Division 867
Lilly, Eli & Co Front Cover, Insert facing page 876
M. & R. Dietetic Laboratories 872
Mead Johnson & Co 960
Medical Placement Registry 958
Medical Protective Co 952
Merck & Co., In.c 869
Milwaukee Sanitarium Back Cover
Minnesota Mutual Life Insurance Co 945
Mounds Park Hospital Back Cover
Mudcura Sanitarium 950
Murphy Laboratories 959
Nestle Co 953
North Shore Health Resort 943
Parke, Davis & Co Inside Front Cover, 857
Patterson Surgical Supply Co 955
Philip Morris & Co., Ltd 873
Physicians Casualty Association 942
Physicians & Hospitals Supply Co 975, 956, 959
Professional Credit Protective Bureau 866
Quincy X-Ray and Radium Laboratories 955
Radium Rental Service 956
Rest Hospital 954
Rexair Division, Martin-Parry Corporation 943
Roddy-Kuhl-Ackerman 956
St. Croixdale Sanitarium 860
Sandoz Pharmaceuticals 951
Schering Corporation 871
Schusler, J. T., Co 959
Searle, G. D., & Co 933
Smith-Dorsey Co 940
Squibb 863
Vocational Hospital 957
Williams, Arthur F 959
Winthrop-Stearns, Inc 941
Wyeth, Inc 868
V\T E have scores of positions for general practitioners in
the Twin Cities, in this state and many other states.
We need general practitioners for locum tenens.
We have several locations and several practices for sale.
Among our many attractive openings for board men are the
following :
Pathologist for 600-bed midwest hospital;
Orthopedic surgeon for excellent set-up in the Medical
Arts Building in an Arkansas City, practice and all equip-
ment for sale for price of equipment, by widow.
Write or visit us at one of our offices.
MEDICAL PLACEMENT REGISTRY
Rochester, Minnesota
11th Floor Kahler Hotel
Minneapolis
916 Medical Arts Bldg.
Saint Paul
Suite 480 Lowry Medical
Arts Bldg.
Minneapolis Campus Office
629 S. E. Washington
Gladstone 9223
958
Minnesota Medicine
PHYSICIANS AND HOSPITALS SUPPLY CO., Inc.
414 SOUTH SIXTH ST., MINNEAPOLIS, MINN.
INSTRUMENTS • TRUSSES • EQUIPMENT • PHARMACEUTICALS • DRUGS
MAIN 2494
Practical Nursing School
Approved by Minnesota State Board of Nurses
Examiners
Twelve months course open to High
School Graduates or women with equiv-
alent education.
For further information apply to
DIRECTOR OF NURSES
FRANKLIN HOSPITAL
501 W. Franklin Avenue, Minneapolis 5, Minn.
TAILORS TO MEN SINCE 1886
The finest imported and domestic wool-
ens such as SCHUSLER'S have in stock
are not too fine to match the hand tailor-
ing we always have and always will
employ.
J. T. SCHUSLER CO., INC.
379 Robert St. St. Paul
DO YOU HAVE CHILDREN?
Train them in the habit of sav-
ing money regularly through a
SAVINGS ACCOUNT with
this bank. . . . They'll always
thank you. OPEN AN AC-
COUNT FOR THEM TO-
DAY.
THE AMERICAN NATIONAL BANK
OF SAINT PAUL
Bremer Arcade Robert at 7th CE 6666
Member Federal Deposit Insurance Corporation
Radiological and Clinical
Assistance to Physicians
in this territory
MURPHY LABORATORIES
Minneapolis: 612 Wesley Temple Bldg. - - At. 4786
St. Paul: 348 Hamm Bldg. ------ Ce. 7125
If no answer, call > Ne. 1291
Hall & Anderson
PRESCRIPTION PHARMACY
BIOLOGICALS
PHYSICIANS’ SUPPLIES
SAINT PAUL, MINN.
LOWRY MEDICAL ARTS BUILDING
TELEPHONE: CEDAR 2735
”””” ^ •—
UNUSUAL LENS GRINDING
CATARACT,
MYO-THIN
and other diiiicult
and complicated
lenses are ground to
extreme thinness and
accuracy by our
expert workmen.
0r™rEWillia«5 "SSSS
— — ■ -r^
Insurance
at a
Saving
MINNESOTA
Druggists' Mutual Insurance Company PromPt
OF IOWA. ALGONA. IOWA LOSS
Fire - Tornado - Automobile Insurance Service
REPRESENT ATIVE-S. E. STRUBLE, WYOMING, MINN.
September, 1950
959
Convenient . . . Simple to prepare. . . Nutritionally sound.. . Generous in protein
Infant feeding formulas of cow’s milk ,
water and Dextri-Maltose* have been
prescribed for almost four decades, by
two generations of physicians.
LACTUM and DALACTUM bring new
convenience to such formulas. They are
prepared for use simply by adding
water. A one-to-one dilution supplies
20 calories per fluid ounce and is suit-
able for most infants.
LACTUM is a whole milk formula de-
signed for full term infants with normal
nutritional requirements.
DALACTUM is a low fat formula for
both premature and full term infants
with poor fat tolerance.
•T. M. Reg. U. S. Pat. Off.
Minnesota Medicine
CHLOROMYCETIN is the only antibiotic produced on a practical
scale by chemical synthesis. It is a pure, crystalline compound of
accurately determined structure. It is free of extraneous material
that might be responsible for undesirable side effects. Its compo-
sition does not vary. These features contribute to the dramatic thera-
peutic results which physicians associate with CHLOROMYCETIN.
PACKAGING: CHLOROMYCETIN (chloramphenicol, Parke-Davis) is sup-
plied in Kapseals® of 250 mg., and in capsules of 50 mg.
C A Af
A
1 1 irniy to tost* money in a hurry
When you are flat on your back with your income cut off and
with bills accumulating in increasing amounts as a result of a
sickness or accident it’s mighty easy to lose money — and in a
hurry. In addition to that, the expense of maintaining you and
your dependents continues.
The bright thing about the picture is that it's easy to insure
your income assuring stability and maintenance of saved capital.
It would be smart to insure in an investigated and tested plan,
one that is available through your own Society. Apply now !
CASWELL-ROSS AGENCY
Minneapolis 2, Minnesota
St. Paul— ZE 2341
St. Paul District Dental Society
Minneapolis District Dental Society
St. Cloud Dental and Stearns County
Medical Society
Duluth District Dental Society
East Central Medical Society
St. Louis County Medical Society
Minnesota State Veterinary Medical
Society
1177 N. W. Bank Building
Minneapolis — MA 2585
Insurors to:
Minnesota State Bar Association
Minnesota State Dental Association
Minnesota State Medical Association
Minnesota Society of C.P.A.
Minnesota State Pharmaceutical Assn.
Minnesota Auto Dealers Association
Hennepin County Medical Society
Hennepin County Bar Association
962
Minnesota Medicine
Journal of the Minnesota State Medical Association, Southern Minnesota Medical Association, Northern Minnesota
Medical Association, Minnesota Academy of Medicine and Minneapolis Surgical Society
Volume 33
OCTOBER. 1950
No. 10
Contents
Milk-Borne Brucellosis in Minnesota.
C. B. Nelson, M.D., and Mary Giblin, MS.
Minneapolis, Minnesota 981
The Management of Status Asthmaticus.
William Sawyer Eisensladt, M.D., Minneapolis,
Minnesota 983
The Roentgen Diagnosis of Silicosis.
Eugene P. Pendergrass, M.D., Philadelphia,
Pennsylvania 988
The Prediction and Prevention of Coronary
Thrombosis in the Younger Age Groups.
R. L. Parsons) M.D., Monterey, Minnesota, and
J. J. Heimark, M.D., Fairmont, Minnesota 999
The Heart in Friedreich's Ataxia.
M. Eugene Flipse, M.D., Thomas J. Dry, M.D.,
and Henry W. Woltman, M.D., Rochester,
Minnesota 1000
Chronic Leukemic Infiltration of the Gastric
Wall Simulating Peptic Ulcer.
Robert H. Conley, M.D., Mankato, Minnesota, and
J. Allen Wilson, M.D., Ph.D., Saint Paul, Min-
nesota 1004
Ciliary Action and Atelectasis.
A. C. Hilding, M.D., Duluth, Minnesota 1009
Transfusion Problems.
R. W. Koucky, M.D., Minneapolis, Minnesota 1015
History of Medicine in Minnesota.
Medicine and Its Practitioners in Olmsted County
Prior to 1900 (Continued).
Nora H. Guthrey, Rochester, Minnesota 1017
President's Letter :
Medical Emergency: World Size 1024
Editorial :
Civil Defense 1025
Symposium on Hypertension 1026
Coronary Thrombosis in Early Life 1027
Medical Economics :
AMA Gets Report on British Medical Association
Conference 1028
Committee Studies British Medical Education ...1028
Lobby Investigations Bring Acid Comments ....1029
Journal Questions More Security 1029
Minnesota State Board of Medical Examiners. ... 1030
Minneapolis Surgical Society.
Meeting of December 1, 1949 1031
Controlled Respiration in Thoracic and Upper
Abdominal Operations.
John H. Gibbon, Jr., M.D., Philadelphia, Penn-
sylvania 1031
Communication 1034
Woman’s Auxiliary , 1036
In Memoriam 1038
Reports and Announcements 1040
Of General Interest 1048
Book Reviews 1060
Contents of Minnesota Medicine copyrighted by Minnesota State Medical Association, 1950
Entered at the Post Office in Saint Paul as second class mail matter. Accepted for mailing at the special rate of postage provided
for in Section 1103. Act of October 3, 1917, authorized July 13, 1918.
October, 1950
963
MINNESOTA MEDICINE
Official Journal of the Minnesota State Medical Association
Published by the Association under the direction of its Editing and Publishing Committee
Office of Minnesota State Medical Association,
493 Lowry Medical Arts Bldg., Saint Paul 2, Minnesota.
EDITING AND PUBLISHING COMMITTEE
E. M. Hammes, Saint Paul
Philip F. Donohue, Saint Paul
H. W. Mf.yerding. Rochester
B. O. Mork, Jr., Minneapolis
G. L. Oppegaard, Crookston
T. A. Peppard, Minneapolis
H. A. Roust, Montevideo
O. W. Rowe, Duluth
Henry L. Ulrich, Minneapolis
A. H. Wells, Duluth
EDITORIAL STAFF
Carl B. Drake, Saint Paul, Editor
George Earl, Saint Paul, Associate Editor
Henry L. Ulrich, Minneapolis, Associate Editor
BUSINESS MANAGER
J. R. Bruce
Annual Subscription — $3.00. Single Copies — $0.40. Foreign and Canadian Subscriptions — $3.50.
The right is reserved to reject material submitted for editorial or advertising columns. The
Editing and Publishing Committee does not hold itself responsible for views expressed either in
editorials or other articles when signed by the author.
Classified advertising — ten cents a word; minimum charge, $2.00. Remittance should ac-
company order.
Display advertising rates on reauest.
Address all communications concerning the journal to Minnesota Medicine, 2642 University
Avenue, Saint Paul 4, Minnesota. Telephone Nestor 2641.
ST. CROIXD ALE ON LAKE ST. CROIX
PRESCOTT. WISCONSIN
MAIN BUILDING— ONE OF THE 8 UNITS IN "COTTAGE PLAN”
A Modern Private Sanitarium for the Diagnosis, Care and Treatment of Nervous and Mental Disorders
Located on beautiful Lake St. Croix, eighteen miles from the Twin Cities, it has the advantages of both
City and Country. Every facility for treatment provided, including recreational activities and occupational
therapy under trained personnel. Close personal supervision given patients, and modern methods of
therapy employed. Inspection and cooperation by reputable physicians invited. Rates very reasonable.
Illustrated folder on request.
NEUROPSYCHIATRISTS
PRESCOTT OFFICE
Prescott, Wis.
Howard J. Laney, M.D.
Tel. 39 and Res. 76
Hewitt B. Hannah, M.D
Andrew J. Leemhuis, M.D.
Howard J. Laney. M.D.
511 Medical Arts Building
Minneapolis, Minnesota
Tel. MAin 1357
SUPERINTENDENT
Dorothy M. Most, R.N.
Prescott, Wisconsin
Tel. 69
964
Minnesota Medicine
c»vST.LL,
in Tularemia
Tularemia , which is a serious problem in many parts of
this country, can be successfully treated with aureomycin.
All types of tularemic infection, with or without complications ,
respond promptly to the administration of this antibiotic.
A ureomycin has also been found effective for the control of the following
infections: acute amebiasis, bacterial and virus-like infections of the eye,
bacteroides septicemia, boutonneuse fever, acute brucellosis, common infec-
tions of the uterus and adnexa, resistant gonorrhea, Gram-positive infections
(including those caused by streptococci, staphylococci, and pneumococci),
Gram-negative infections , (including those caused by the coli-aerogenes
group), granuloma inguinale, H. influenzae infections, lymphogranuloma ve-
nereum, primary atypical pneumonia, psittacosis (parrot fever), Q, fever,
rickettsialpox, Rocky Mountain spotted fever, subacute bacterial endocarditis
resistant to penicillin, surgical infections, tick-bite fever (African), and typhus.
Capsules: Bottles of 25, 50 mg. each capsule. Bottles of 16, 250 mg. each capsule.
Ophthalmic: Vials of 25 mg. with dropper; solution prepared by adding 5 cc. of distilled water.
LEDERLE LABORATORIES DIVISION america.v Cflmamid compahy 30 Rockefeller Plaza, New York 20, N.Y.
October, 1950
965
the
200 MA
vertical
control
new
CUSTOM-BUILT
A.GAIN, Keleket sets the pace with a
money-saving development. NOW — ALL
UNITS— 200 MA, 300 MA and 500 MA
use the SAME TRANSFORMER and CON-
TROL which can be produced at a savings...
passed on to you!
By standardizing many parts of the world-
famous Multicrons, Keleket is able to offer
custom-built units . . . which fit your individ-
ual requirements exactly ... at most attrac-
tive prices.
Every unit is equipped with the same func-
tionally designed cabinet, finished in hand-
some Kelekote.
This unit may be installed permanently, even
in a wall, with no worry about alterations
. . . should your future technic requirements
call for the higher capacity Multicrons.
All units . . . 200 MA, 300 MA and 500 MA...
include the features which have made Keleket
Multicron Controls so popular with radiolo-
gists ... for flexibility, convenience and
accuracy.
The controls are rated as follows:
DIAGNOSTIC
200 MA unit— 125KVP at any MA from 25 to 200
300 MA unit — 125 KVP at any MA from 25 to 300
500 MA unit — 125 KVP at any MA from 25 to 500
THERAPY
All units — 1 4G KVP to 10 MA
An optional Photo-Timer and Photo-Timing
pushbutton control can be mounted in the verti-
cal controls. Unit is so designed and engineered
that only minor alterations are required to effect
increased capacity and timer changes.
Telephone or write for complete details
KELLEY-KOETT X-RAY SALES CORP. OF MINN
1225 NICOLLET AYE.
TEL. AT. 7174
MINNEAPOLIS 3, MINNESOTA
966
Minnesota Medicine
VERTICAL CONTROLS...200 MA...300 MA...500 MA
increasing
capacity
requires
only
timer
exchange
October, 1950
967
If You Are Called Into Service—
If You Are Too Old to Be Called Into Service—
In either event the rebellion in Korea affects your pocketbook in a major
way, which will be reflected in your accounts receivable.
Soldiers Relief from their financial obligations has again been invoked
making it impossible to enforce collection against anyone in the Armed
Forces.
With our many years of valuable experience in handling the accounts
for over 1,000 professional men, there is now an influx of professional
accounts to this office due from patients about to enter Military Service
where the possibility of immediate collection appears very problem-
atical.
Out GecwmenJatfoM
Based upon our experience in liquidation of accounts prior to, during, and after World War II [j'J jj
(1) Concentrate effort on the collection of accounts against patients who
may be called in the Armed Forces.
(2) THE TIME TO COLLECT IS NOW because with inevitable continued in-
flation, increased salaries and wages, farm prices, commodity prices,
there will be more money in circulation.
(3) That if you already have been called into the service or anticipate being
called that you permit this qualified organization to act as your liqui-
dating agent.
Our many years of experience handling accounts in the professional
field plus our contractual relationship with fifty trade associations ex-
tending from coast to coast, proves we are rendering outstanding serv-
ice.
Professional , commercial trade associations, and bank recommendations furnished.
Professional Credit
Protective Bureau
Division of
Thel.C. System
724 Metropolitan Bldg.
Minneapolis, Minn.
Further Inquiry Invited
FILL OUT AND MAIL COUPON NOW
Professional Credit Protective Bureau
724 Metropolitan Bldg.
Minneapolis. Minn.
Gentlemen:
Without obligation, please send complete in-
formation regarding this service.
Name
Address
City State
968
Minnesota Medicine
“In addition to the relief of hot
flashes and other undesirable
symptoms (of the climacteric),
a feeling of well-being or tonic ef-
fect was frequently noted” after
administration of “Premarin!’
All patients (53) described a
sense of well-being” following
“Premarin” therapy for meno-
pausal symptoms.
Neustaedter, T. : Am. J. Obst. &
Gynec. 46:530 (Oct.) 1943.
‘It (‘Premarin’) gives to the pa-
tient a feeling of well-being’.’
Glass, S. J., and Rosenblum, G.:
J. Clin. Endocrinol. 3:95 (Feb.) 1943
the clinicians’ evidence
“General tonic effects were note-
worthy and the greatest percent-
age of patients who expressed
clear-cut preferences for any
drug designated ‘Premarin! 1
Perloff, W. H.: Am. J. Obst. &
Gynec. 58:684 (Oct.) 1949.
pour potencies of “Premarin”
permit flexibility of dosage: 2.5
mg., 1.25 mg., 0.625 mg., and
0.3 mg. tablets; also in liquid
form, 0.625 mg. in each 4 cc. (1
teaspoonful).
of the "phis” in
i
While sodium estrone sulfate is the
principal estrogen in “Premarin!’
other equine estrogens. ..estradiol,
equilin, equilenin, hippulin...are
probably also present in varying
amounts as water-soluble conju-
gates.
TIT?} ®
therapy
Estrogenic Substances ( water-soluble )
also known as Conjugated Estrogens ( equine )
Ayerst, McKenna & Harrison Limited
22 East 40th Street, New York 16, N. Y.
^j|||
October, 1950
969
for the treatment
of ventricular arrhythmias
tEFORE
Lead II. Ventricular tachycardia persist-
ing after six days of oral quinidine therapy
(8 Gm. per day).
AFTER
Lead II. Normal sinus rhythm after oral
Pronestyl therapy.
Effective in some patients with ventricular
tachycardia who failed to respond to quinidine
PRONESTYL Hydrochloride
Squibb Procaine Amide Hydrochloride
Squibb
*r«ON£srvL" a tkadcmaw* of t. a aouisa a rtxrs
970
Minnesota Medicine
new product brief
PRONESTYL Hydrochloride
Squibb Procaine Amide Hydrochloride
for the treatment of ventricular arrhythmias
What is it? denced by studies of the blood count, urine, liver
Pronestyl Hydrochloride is Squibb procaine amide
hydrochloride. Structurally, Pronestyl differs from
procaine only by the presence of the amide group-
ing (.CO.NH.) in Pronestyl where procaine has the
ester grouping (.CO.O.)
How does it act?
The action of Pronestyl is probably due to a direct
depressant action on the ventricular muscle. In au-
ricular arrhythmias, preliminary observations in-
dicate that Pronestyl slows auricular rate but
usually does not re-establish normal sinus rhythm.
At present, Pronestyl is not recommended in the
treatment of auricular arrhythmias.
When is it indicated?
In conscious patients, for the treatment of ventric-
ular arrhythmias.
During anesthesia, to correct cardiac arrhythmias.
What are its advantages in ventricular arrhythmias?
As compared with quinidine: Unlike quinidine, no
important toxic symptoms have been reported fol-
lowing the use of Pronestyl orally. In therapeutic
dosage, Pronestyl orally does not produce the nau-
sea, vomiting, and diarrhea often caused by quini-
dine. At high oral dosage, these symptoms may appear.
Whereas intravenous administration of quinidine
is hazardous and unpredictable, Pronestyl may be
given intravenously with relative safety.
Pronestyl has been found effective in some patients
who failed to respond to quinidine.
As compared with procaine: For arrhythmias, pro-
caine is used only in anesthetized patients because
its dose in unanesthetized patients is too toxic for
clinical use. Pronestyl can be used in conscious.and
anesthetized patients.
Intravenously, Pronestyl is much less toxic than
procaine. In the recommended intravenous dosage,
Pronestyl does not cause the central nervous system
stimulation typical of procaine in conscious pa-
tients.
Procaine is unstable, being rapidly hydrolyzed in
the plasma to para-aminobenzoic acid and diethyl-
aminoethanol. Pronestyl is not affected by the
plasma procaine esterase, consequently it is much
longer acting than procaine.
Procaine is not used orally because of its instability
in the organism ; Pronestyl can be used orally and
intravenously.
What are its side effects?
Oral administration of Pronestyl in doses of 3-6
grams per day, for periods of time varying from 2
days to 3 months, produced no toxic effects as evi-
function, blood pressure, and electrocardiogram.
Intravenous administration to patients without
ventricular tachycardia produced only a moderate
and transient hypotensive effect in about one-third
of the subjects. However, during intravenous ad-
ministration to patients with ventricular tachycar-
dia, a striking hypotensive effect was almost invar-
iably present. This disappeared concurrently with
the establishment of a normal rhythm. Further
studies are in progress to see whether the drug may
be given intravenously over a period of time longer
than five minutes so as to revert the ventricular
tachycardia without causing hypotension. That
this may be possible is indicated by the fact that
some episodes of ventricular tachycardia have been
successfully treated by oral administration without
significant change in blood pressure. Electrocardio-
graphic changes: prolongation of QRS and QT in-
tervals and occasional diminution in voltage of QRS
and T waves have occurred.
What is the dosage?
IN CONSCIOUS PATIENTS
For the treatment of ventricular tachycardia :
ORALLY : 1 Gm. followed by 0. 5-1.0 Gm. every four
to six hours as indicated.
INTRAVENOUSLY: 200-1000 mg. (2 to 10 cc. Pro-
nestyl Hydrochloride Solution). Cauticm-administer
no more than 200 mg. (2 cc.) per minute.
Hypotension may occur during intravenous use in
conscious patients. As a precautionary measure,
administer at a rate no greater than 200 mg. (2 cc.)
per minute to a total of no more than 1 Gm. Elec-
trocardiographic tracings should be made during
injection so that injection may be discontinued
when tachycardia is interrupted. Blood pressure
recordings should be made frequently during injec-
tion. If marked hypotension occurs, rate of injec-
tion should be slowed or stopped.
F or the treatment of rune of ventricular extrasystoles :
ORALLY: 0.5 Gm. (2 capsules) every four to six
hours as indicated.
IN ANESTHESIA
During anesthesia, to correct ventricular arrhythmias-.
INTRAVENOUSLY: 100-500 mg. (1 to 5 cc. Pronestyl
Hydrochloride Solution). Caution — administer no
more than 200 mg. (2 cc.) per minute.
How is it supplied?
Pronestyl Hydrochloride Capsules, 0.25 Gm., bottles
of 100 and 1000.
Pronestyl Hydrochloride Solution, 100 mg. per cc.,
in 10 cc. vials.
Squibb
October, 1950
971
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IMPORTANT — Permit no agent to substitute — IMPORTANT
972
Minnesota Medicine
Priodax, Schering’s brand of iodoalphionic acid, is available in tablets of 0.5 Cm. Envelopes
of six tablets in boxes of 1, 5, 25 and 100 envelopes; and Hospital Dispensing Package
containing 4 rolls of 250 tablets each.
CORPORATION • BLOOMFIELD, NEW JERSEY
at
face
value
Priodax cholecystograms can be accepted at face value. A diseased gallbladder
visualizes faintly or not at all. With Priodax, a poor shadow means lack of
ability to concentrate the contrast medium. Because Priodax is well tolerated,
the likelihood of loss through the gastrointestinal tract by vomiting or diarrhea
is minimal. Thus interpretation is made simpler and more certain.
PRIODAX
(brand of iodoalphionic acid)
VAGINA
JELLY
\
PROVIDES PROTECTION WITHOUT IRRITATION
Evidence obtained by direct-color photog-
raphy shows that the cervix remains
occluded for as long as ten hours after an
application of “RAMSES”* Vaginal Jelly.
“RAMSES” Vaginal Jelly immobilizes
sperm in the fastest time recognized under
the authoritative Brown and Gamble
method of measuring the spermatocidal
power of vaginal jellies or creams. This has
been established by repeated tests for
spermatocidal activity conducted by an
accredited independent laboratory.
Clinical observation of patients receiving
daily applications of “RAMSES” Vaginal
Jelly for three-week periods reveals no evi-
dence of irritation or other untoward effect.
“RAMSES” Vaginal Jelly is acceptable to
even the most fastidious patient because
it provides efficient protection without
leakage or excessive lubrication. It is avail-
able at all pharmacies in regular and large
tubes; the regular tube is also available in
a package containing a measured appli-
cator.
active ingredients: Dodecaethyleneglycol Mono-
laurate 5%, Boric Acid 1%, Alcohol 5%.
quality first since 1883
*The word "RAMSES" is a registered trademark of Julius Schmid, Inc.
974 i
Minnesota Medicine
REGARDLESS OF INDICATED THERAPY
hether the condition under
treatment is an acute infec-
tion, a bowel upset, an injury or a
metabolic derangement, nutrition is
always a primary factor in therapy.
Regardless of other indicated measures,
nutritional adequacy is essential for
prompt recovery.
When dietary supplementation is the
indicated means of increasing the nutri-
ent intake, the food drink, Ovaltine in
milk, can prove highly beneficial. Pro-
viding significant amounts of all nutri-
ents considered essential, it virtually
assures dietary adequacy when the rec-
ommended three glassfuls daily are
taken in conjunction with even a fair
diet.
Temptingly delicious and readily
digested, this dietary supplement fits
well into the framework of most indi-
cated diets, and finds ready patient
acceptance. Its generous nutrient con-
tent is detailed in the table below.
THE WANDER COMPANY, 360 N. MICHIGAN AVE., CHICAGO 1, ILL.
Three servings of Ovalline, each made of
V2 oz. of Ovaltine and 8 oz. of whole milk,* provide:
PROTEIN 32 Gm.
FAT 32 Gm.
CARBOHYDRATE 65 Gm.
CALCIUM 1.12 Gm.
PHOSPHORUS 0.94 Gm
IRON 12 mg.
COPPER 0.5 mg.
*Based on average reported values for milk.
VITAMIN A 3000 I.U.
VITAMIN B, 1.16 mg.
RIBOFLAVIN 2.0 mg.
NIACIN 6.8 mg.
VITAMIN C 30.0 mg.
VITAMIN D 417 I.U.
CALORIES 676
Two kinds, Plain and Chocolate Flavored. Serving for
serving, they are virtually identical in nutritional content.
October, 1950
975
Ti/6e*t iittCe featieat&
turn a esM
by prescribing Dulcet Penicillin Tablets. These small, easy-to-take cubes
taste like a confection, yet pack a potent antibiotic wallop — 50,000 or
100,000 units penicillin G potassium per tablet. Each Dulcet Tablet is
buffered with 0.25 Gm. calcium carbonate to minimize loss of therapeutic
value through destruction in the stomach. From first to last in every
bottle, the tablets are carefully standardized for accurate dosage, stable
indefinitely at room temperature. • Dulcet Penicillin Tablets are in
pharmacies everywhere, in bottles of 12 and 100.
Prescribe them the next time penicillin is indicated.
d&fett
See that
the
Rx reads
DULCET
Potassium Tablets (Buffered)
"MEDICATED SUGAR TABLETS, ABBOTT
976
Minnesota Medicine
PHOSPHO-
of its
Authoritative Endorsement
Phospho-Soda (Fleet)'s* endorsement by modern clinical
authorities stems in great measure from its gently thor-
ough action— free from disturbing side effects. That, too,
is why so many practitioners are relying increasingly on
this safe, dependable, ethical medication for judicious
laxative therapy. Liberal samples on request.
* Phospho-Soda (Fleet) is a solution containing in each 100 cc. sodium biphosphate 48 Gm. and
sodium phosphate 18 Gm. Both 'Phospho-Soda' and 'Fleet' are registered trade marks of
C. B. Fleet Company, Inc.
C. B. FLEET CO., INC. • Lynchburg, Virginia
October, 1950
977
curd tension of
Similac — 0 grams
truly a fluid food
SIMIIjAC
so similar to human breast milk that
there is
no closer
equivalent*
Similac protein has been so modified
Similac fat has been so altered
Similac minerals have been so adjusted
that
There is no closer approximation to
mother’s milk.
curd tension of
breast milk — 0 grams
truly a fluid food
SIMILAC DIVISION • M t R DIETETIC LABORATORIES. INC.
curd tension of
a powdered milk
especially prepared
for infant feeding —
12 grams
COLUMBUS 16. OHIO
978
Minnesota Medicine
tibiotics
an
d c
hem0'
amvci^
, . iauonio^^eS;
X*'A\ ava^ab\epsPonse- c daVs
^oftl o daft? lot
age^
Gw
. \)V 2nd
„ „mvcW, *■ f, Yi. tor?- vn^at'S“p0od”-
\3twef utYent. f
lies
STol weatwe
1
c«vstalUne
erram
7VW f,
°uricil -
yt'ii}
l - i
j
vCSaes* ' ■■■■5
* ' -it*
; i4^ ' f "t Z -
0raHv pff . acceP*ed iroart
} effectl^ - well „ , ^P^um ant;. .
1 tolerated lntlOiotic
erramycin m ,
I. T(
^O/ai As^V 2
erranjycin amiii°tics fail.t
eve”^^S::taw
LS are nof.2
•;
baZZasiX^>M- ,onsim,is;
lions, including eryst ?* ‘ v ,/ . bacillary injections,
acute mfe(,lvns due to E.
!3*
oil.tr r«rromrd»-s'"“»“ “J"'”,,,; i afecmrs;ccMe
(abortus, mehtensis, sui ) ’ \ granllloma venereum ,
gonococcalinfectionsJym^B { moma,
granuloma mguma e P™ ; b) ; rickettsialpox.
•yphT:::t
Dosage 2 to 3 Gm. {or acute infections.
q. 6 h. is suggested for ac ^ ^ 1Q0;
1. King, E. Q.; Lewis, C.N.; Welch, H.;
Clark, E.A., Jr.; Johnson, J. B.;
Lyons, J. B.; Scott, R.B., and Comely,
P. B.: J. A. M. A. 143:1 (May 6) 1950.
2. Herrell, W. E.; Heilman, F. E.;
Wellman, W. E„ and Bartholomew, L. A.:
Proc. Staff Meet. Mayo Clin.
25:183 (Apr. 12) 1950
I i
Pfizer
A ntibiotic Division
CHAS. PFIZER tf CO.. INC., Brooklyn 6. A . Y.
October, 1950
979
fyl BABY'S HAVEN
The <VLslw &IL VYlsdaL multipurpose unit
r/?hdiipMApoASL
(P&/i$ectwtL
• Incubation of the premature infant
• Reception of the new born in the delivery room
° Clean infant room for babies born outside or
returned to the hospital
• A miniature nursery for the complete care of
the infant "rooming-in"
• Facility for the care and treatment of respira-
tory infections
• Isolation of contagious illness
Baby's Haven units are private, individually controllable rooms
for infants. The old open type wet bed clothes technique, is sup-
planted by enclosed type crib which provides positive control
over the infant's needs. The new born or sick baby is permitted a
maximum of comfort and freedom without the problems of kicked
covers, drafts, or chills. In modern hospitals you'll find Baby's
Haven used for infant care.
Write for M-1050 Baby's Haven Literature
distributed by
PHYSICIANS AND HOSPITALS SUPPLY CO./Inc.
MINNEAPOLIS MINNESOTA
980
Minnesota Medicine
Journal of the Minnesota State Medical Association, Southern Minnesota Medical Association, Northern Minnesota
Medical Association, Minnesota Academy of Medicine and Minneapolis Surgical Society
Volume 33
OCTOBER. 1950
No. 10
MILK-BORNE BRUCELLOSIS IN MINNESOTA
C. B. NELSON, M.D., and MARY G1BLIN, M.S.
Minneapolis, Minnesota
npHERE have been 3,074 cases of human brucel-
losis reported to the Minnesota State Depart-
ment of Health in the ten-year period, 1940-1949.
It is estimated that approximately 25 per cent of
the reported cases in this state are due to the in-
gestion of raw dairy products, chiefly raw milk
and cream.5 Therefore it can be assumed that in
approximately 767 of the cases reported during
this period infection with Brucella organisms has
occurred in this manner.
The presence of viable Brucella organisms in
market milk, including milk from certified herds,
has been demonstrated on numerous occasions.
Outbreaks of human brucellosis due to Brucella
suis in raw milk from cows have been reported
by Beattie and Rice,1 Horning,4 and Borts.2 Beat-
tie and Rice state that outbreaks of brucellosis due
to Brucella abortus (bovine) on raw milk routes
are relatively uncommon, and that the occurrence
of more than four or five cases on a single raw
milk route is rare. Steele and Hastings7 report an
outbreak of twenty-eight cases of human brucel-
losis traceable to raw milk. Brucella abortus
(bovine) was isolated from blood cultures from
two of the cases. They state that this is the first
large brucellosis epidemic due to Brucella abortus
(bovine) that has been reported. Damon3 reports
the isolation of Brucella melitensis from milk of
cows.
The Minnesota State Health Department rec-
ords of cases of human brucellosis attributed to
consumption of raw milk indicate that the source
of raw milk usually is the herd on the patient’s
Dr. Nelson is Director, Division of Epidemiology, Minnesota
Department of Health.
Miss Giblin is Director, Division of Microbiology, Minnesota
Department of Health.
farm or herds belonging to friends or relatives.5
However, during the ten-year period, 1940-1949,
there were 450 reported cases of brucellosis in
which the source suspected by the reporting physi-
cian was raw milk from a supply other than the
herd on the patient’s farm. Included in these 450
cases were ninety-six cases attributed to a com-
mon source in forty-one dairies. Twenty-eight
dairies were the source of two cases each ; nine
dairies, three cases each ; two dairies, four cases
each, and one dairy, five cases. In most instances
the cases were spread over a considerable period
of time.
The outbreak of three known cases of brucel-
losis in patrons of a raw milk dairy is reported in
more detail since Brucella abortus (bovine) was
isolated from raw milk purchased at a store selling
milk from the suspected supply (Table I).
Case
Age
Date
of Onset
Agglutination
with
Brucella
antigen
Blood
Culture
1
65
8-15-49
(9-23-49)
+ 1:1280
(9-23-49)
No growth
2
25
1-50
(4-19-50)
+ 1:1280
(5-2-50)
+ 1 :1280
(4-23-50)
Br. abortus
(bovine)
3
42
2-24-50
(3-4-50)
+ 1:5120
(4-10-50)
No growth
These three patients all had symptoms com-
patible with the diagnosis of acute brucellosis.
The diagnosis was confirmed in Case 2 by the
isolation of Brucella abortus (bovine) from a
blood culture, and in Cases 1 and 3 by high ag-
glutination titers with Brucella antigen. The pos-
sibility of sources of infection other than raw milk
from the suspected supply was ruled out by his-
tory.
October, 1950
981
MILK-BORNE BRUCELLOSIS— NELSON AND GIBLIN
The dairy owner was not co-operative but
volunteered the information that he supplied ap-
proximately 400 quarts of raw milk daily to his
patrons through retail and wholesale trade. In-
formation from the State Live Stock Sanitary
Board revealed that the suspected herd had been
tested for Bang’s disease in 1947. One “reactor”
and three “suspects” were found, and the reactor
was removed from the herd. At the time of the
present investigation the owner refused to have
his herd tested or to make arrangements for
pasteurization of the milk.* A quart of the sus-
pected raw milk labeled “Natural Milk” was pur-
chased March 29 in the hope of obtaining irrefu-
table proof that the milk from the herd contained
viable Brucella organisms. A sample of this milk
examined by Dr. M. H. Roepke, Professor of
Veterinary Medicine, University of Minnesota,
showed a strongly positive ring test. A portion
of the milk was also submitted to the Section of
Medical Laboratories, Minnesota Department of
Health. Two guinea pigs were inoculated sub-
cutaneously on March 31, 1950, one with the
sediment of the centrifuged specimen, the other
with cream of the centrifuged specimen. The pigs
were sacrificed on May 17, 1950, at which time
agglutination was present 1 :640 with Brucella
antigen in blood from both animals. Cultures
from the spleen of both pigs showed Gram-nega-
tive, non-motile organisms identified as Brucella
abortus (bovine) on June 15, 1950.
The above report was sufficient evidence to
justify the Live Stock Sanitary Board’s placing a
quarantine on the herd. This provided that no
raw milk could be sold. The owner then arranged
for Bang testing of the herd, which disclosed
* As of July 1, 1950 the sale of raw milk in Minnesota is
prohibited by law,6 except as purchased for personal use at the
dairy farm where it is produced.
twenty-nine negative animals and two reactors.
The reactors were removed from the herd and the
quarantine was raised by the Live Stock Sanitary
Board.
Summary and Conclusions
An outbreak of three cases of human brucellosis
traceable to a commercial raw milk supply is
briefly reported. The causative organism, Brucel-
la abortus (bovine), was isolated from the market
supply of raw milk. The outbreak demonstrates
the difficulty that is encountered from time to
time by official agencies in obtaining compliance '
with good public health practice.
Although the cases of human brucellosis that
are traceable to raw milk purchased from com-
mercial raw milk dealers will be eliminated by the
amended pasteurization law, the cases traceable to
private sources of raw milk will not be decreased.
For this reason, public health education must con-
tinue until universal pasteurization of milk is
practiced, including home supplies and milk pur-
chased by the consumer directly from the farm.
Apparently, reduction in the number of cases of
human brucellosis from all sources in Minnesota
continues to be dependent on the reduction of
brucellosis in the animal reservoir, namely the live-
stock population of the state.
References
1. Beattie, C. P. and Rice, R. F. : Undulant fever due to
brucella of the porcine type — Brucella suis. J.A.M.A., 102:
1670-1674, (May 19) 1934.
2. Borts, I. H., Harris, D. M., Joynt, M. F., Jennings, J. R.,
and Jordan, C. F. : Milk borne epidemic of brucellosis caused
by porcine type of Brucella in raw milk supply. J.A.M.A.,
121:319-322, (Jan. 30) 1943.
3. Damon, S. R. and Fagan, R.: Isolation of Brucella meli-
tenis from cow’s milk. Pub. Health Rep., 62:1097-1098,
(July 25) 1947.
4. Horning, B. : Outbreak of undulant fever due to Brucella
mis. J.A.M.A., 105:1978-1979, (Dec. 14) 1935.
5. Magoffin, R. L., Kabler, P., Spink, W. W., and Fleming,
1). S. : An epidemiologic study of brucellosis in Minnesota.
Public Health Reports, 64:1021-1043, (Aug. 19) 1949.
6. State Session Laws of 1949, Section 1 of Chapter 403.
7. Steele, J. H. and Hastings, J. W., Sr.: Report of brucel- ;
losis outbreak at Federalsburg, Maryland. Public Health
Reports, 63:144-145, (Jan. 30.) 1948.
THE RIGHTS OF THE COMMUNITY
Every community is entitled to safe water, food, and
milk, and protection from unsafe disposal of wastes; to
as safe an environment as we know how to provide in-
cluding pure air; safe streets, homes, places of work,
and places of education and recreation ; to the best pro-
tection we know how to provide from the contagious
diseases, including tuberculosis and the venereal diseases;
access to good medical care and hospitalization when
needed ; to the best protection w-e known how to provide
against the special hazards of maternity and infancy;
to the best facilities we know howr to provide for the
healthy development of our children, including correc-
tion of crippling physical and mental defects; recog-
nition and treatment of rheumatic fever and other
heart disease, and to the knowledge and facilities neces-
sary to prevent as many deaths as possible from cancer,
heart disease, diabetes, and the other degenerative dis-
eases.— William P. Shepard, M.D., National Tuber-
culosis Association Bulletin, October, 1949.
982
Minnesota Medicine
THE MANAGEMENT OF STATUS ASTHMATICUS
WILLIAM SAWYER EISENSTADT, M.D.
Minneapolis. Minnesota
O TATUS ASTHMATICUS is an acute condi-
^ tion of severe, continuous asthma, unrelieved
by injections of epinephrine even when repeated
frequently and in increased dosage. When an acute
asthmatic attack fails to subside and becomes re-
fractory to the usual sympathomimetic medica-
tions which in the past gave relief, the dyspnea
becomes more severe, the cough unproductive and
the patient remains in a constant asthmatic state.
The patient is critically ill and may die unless
the attack of asthma is broken. When this oc-
curs, its treatment taxes the ingenuity of the best
clinician.
The above condition must not be confused with
intractable asthma,9 a chronic process usually as-
sociated with chronic bronchitis, bronchiectasis
and pulmonary emphysema. These patients are
usually difficult to control by the usual allergic
management. The intervals between the acute
paroxysms of asthma are seldom free of wheez-
ing. t
Status asthmaticus may occur in the acute ex-
trinsic asthmatic as well as in the chronic in-
tractable asthmatic. It occurs more frequently in
the chronic intractable asthmatic (1) because of
the difficulty in controlling the asthma adequate-
ly and (2) because the usual associated pulmonary
pathology makes one more susceptible to bron-
chitic infection. This condition occurs less fre-
quently in the extrinsic asthmatic and then it is
usually due to specific sensitivities. When status
asthmaticus occurs in the extrinsic asthmatic, the
solution of the problem may be relatively simple,
representing nothing more than the removal of
the offending agent or agents from the patient’s
environment, or the removal of the patient from
them.
Most of the fatalities in bronchial asthma oc-
cur in status asthmaticus. Death may be due to
asphyxia or cardiac failure, but just as often,
perhaps, it is due to exhaustion and dehydration.
The most consistent pathological finding in
patients who have died in status asthmaticus15 is
the presence in the small, medium or large bronchi
of thick, tenacious, gelatinous secretions which
the patient was unable to raise. Much of the
Read before the annual meeting of the Minnesota State
Medical Association, Duluth, Minnesota, June 13, 1950.
bronchial tree may be entirely occluded. In addi-
tion to these mucous plugs, edema of the bron-
chial walls and bronchospasm contribute to this
bronchial occlusion.
When these patients are first seen, they give
the classical picture3 of severe asthma. They are
usually in a sitting position with the body bend-
ing slightly forward from the waist, their hands
grasping the edge of the bed or chair. The ac-
cessory muscles of respiration are forcibly in
use, the face is drawn and ashen. The pallor may
at times give way to cyanosis. Perspiration is
profuse, for these patients are laboring for breath.
Unconsciousness or disorientation may occur sud-
denly. The patient is terrified because of the re-
peated failure of the usual therapeutic medica-
tions. In addition, the family is anxious. There
is a generalized spirit of hopelessness present and,
not infrequently, the physician shares this feeling.
This period of intense dyspnea may last from a
few days to a week or two.
Examination of the chest elicits surprising
findings to the uninitiated. Everyone is familiar
with the “bandbox” heard in mild cases of asthma
where there is only partial but wide-spread oc-
clusion of the bronchi, as a result of which the
sounds are widely distributed. In status asth-
maticus, one finds areas of diminished and absent
breath sounds, areas of quiet that to the ex-
perienced observer are ominous. In these pa-
tients, areas of the lungs have ceased to function
normally because the bronchi serving those por-
tions may be partially or totally occluded by thick,
tenacious, gelatinous plugs of mucous. When one
listens to such a chest, the need for prompt and
vigorous therapeutic measures is immediately ap-
parent.
The basic principles involved in a proper ther-
apeutic approach in the treatment of status asth-
maticus are (1) to increase the lumen of the re-
spiratory passageway, and (2) to decrease the
minute volume of respiration.
The following discussion sets forth a routine
for the treatment of status asthmaticus which has
produced the most favorable response.
Hospitalization. — Hospitalization should be in-
sisted upon immediately. This will accomplish
October, 1950
983
STATUS ASTHMATICUS— EISENSTADT
several indispensable purposes. First, the patient
is removed from intimate contact with over-
anxious relatives. Further, the hospital offers
trained personnel, equipment and medicinal
agents not readily available in the home.
Although most of the patients fall in the
chronic intractable or infectious group, environ-
mental factors should not be overlooked. Thus,
the removal of the patient from the environment
in which this condition developed may frequent-
ly be beneficial. If the status asthmaticus is due
to pollen in the air, air conditioning with filtra-
tion is desirable if available. The ordinary pre-
cautions for the preparation of a dust-free room
should be adhered to. It is wise to cover both the
pillows and mattress with non-allergenic encas-
ings. Flowers should be prohibited.
Reassurance. — As stated earlier, the patient is
both terrified and panicky. This in turn will in-
crease his exertional dyspnea. The patient fears
that every breath may be his last. He must be
reassured that the attack is controllable and that
his cooperation is necessary to obtain results. A
friendly, sympathetic and reassuring attitude on
the part of the attending physician is a most vital
and helpful therapeutic aid.
Cessation of all Epinephrine and Ephedrine
Compounds. — We believe that this is the most im-
portant procedure employed. If nothing else can
be done, this is the one thing to do. These pa-
tients have already received epinephrine, epineph-
rine-like, ephedrine and ephedrine-like com-
pounds, to the point of nervous irritability and
toxicity. They are “epinephrine-fast.” Further
epinephrine will only increase the patient’s ir-
ritability and nervousness, produce tachycardia,
palpitation, headache, pallor and weakness, with
no effect on the dyspnea itself. The continuance
of status asthmaticus proves the medication to
have been ineffective, and a new start should be
made. All sympathomimetic medications should
be removed for a period of forty-eight to seventy-
two hours, preferably the latter, and only then
reintroduced. During this interval there is a
strong temptation to reintroduce epinephrine,
especially when the patient continues in relatively
severe asthma and substitute therapy is of rela-
tively little value. However, the discontinuance
of epinephrine should be adhered to strongly
during this interval.
984
When reintroduced, small quantities should be
given, 0.3 to 0.5 c.c. (5 to 8 minims), and re-
peated as often as necessary, even within fifteen
or thirty minutes. The smaller quantities will
obviate the side effects of epinephrine and will
produce the same therapeutic effect as larger
quantities. It is preferable to use the aqueous
(1-1000) epinephrine, rather than the prolonged
type (1-500) in sesame oil, peanut oil, or gelatin.
In a hospital there is no particular advantage in
using the prolonged acting preparations for there
is always the danger of overdosage from too rapid
absorption, especially if the syringe is wet, with
resultant side effects.
The problem in the treatment of status asth-
maticus resolves itself into keeping the patient
alive and as comfortable as possible for the next
forty-eight to seventy-two hours following ad-
mission, for whatever the cause, when epineph-
rine is again introduced, invariably the pa-
tient will respond, especially if the other meas-
ures recommended in this paper are adhered to.
If there is no accompanying infection in the
bronchi, or the infection is minimal, the response
will usually be immediate and fairly complete.
If the accompanying infection is moderate, the
response to epinephrine will be modified. The
greater the accompanying infection, the less the
response, but there will be a response. In the
presence of infection, methods to combat the in-
fection should be instituted immediately. The use
of antibiotics, which are of great importance here,
will be discussed subsequently.
Hydration. — This extremely important phase
of treatment is almost always neglected. These
patients are dehydrated.12 They have been sick
for a number of days without sleep, food or
Huids. This is evidenced on admission by the
very noticeable relative increase of the blood
hemoglobin, red blood cell count, white blood cell
count with a normal differential, along with a
minimal increase of body temperature of about
a degree. These soon return to normal after ade-
quate hydration within twenty-four to forty-eight
hours.
We routinely give 2 to 3 liters of 5 per cent
glucose in distilled water and in isotonic sodium
chloride solution alternately during the first two
or three days of hospitalization. The addition of
fluids will replace lost body water and bring about
a positive water balance. They tend to thin out
Minnesota Medicine
STATUS ASTHMATICUS— EISENSTADT
the bronchial secretions and thus promote ex-
pectoration of the thick, gelatinous, inspissated
mucous plugs in the bronchi. The dextrose used
in hydration therapy will supply needed calories
and replace liver glycogen, badly depleted because
of the previous repeated injections of epinephrine
and the failure of the patient to take adequate
nourishment. Glaser4 suggests that this deple-
tion of glycogen may be a factor in the develop-
ment of epinephrine fastness.
In the past, hypertonic dextrose6,8 solutions up
to 50 per cent, given in quantities from 50 to
100 c.c., at intervals of six to eight hours, have
been recommended. The idea was to produce de-
hydration of the lungs and thus lessen the edema
of the bronchi. However, its accompanying effect
of dehydrating the patient generally and thicken-
ing the bronchial secretions defeated one of the
major objectives of treatment — the evacuation
of the thick, inspissated mucous plugs. Because
of this effect, the use of hypertonic dextrose
solutions should be discarded.
Aminophyllin (Theophylline with Ethylene-
diamine). — The bronchodilating effect of amino-
phyllin intravenously at times is life-saving. Ini-
tially, the patient should receive 0.25 gram (3^4
grains) in 10 c.c. of diluent given slowly, prefer-
ably through a fine needle. If this dose is suf-
ficient for symptomatic relief, it can be repeated
every four to six hours. If relief is only partial,
the dosage may be increased to 0.5 gram (7f4
grains) in 20 c.c. of diluent. When given slowly
and regulated to the patient’s tolerance, the toxic
effects of aminophyllin, such as vertigo, faint-
ness, headache, tachycardia, palpitation, extreme
flushing and sense of heat, substernal distress, and
nausea and vomiting may be obviated. If they do
occur, they may be minimal. In uncomplicated
asthma, aminophyllin is not a dangerous drug.
However, in the presence of cardiac complica-
tions caution must be used. The need for repeated
intravenous injections of aminophyllin may be
lessened by inserting 0.5 gram of aminophyllin
per liter of fluid during the period of venoclysis.
The drug is also moderately effective when
given rectally, either in suppository form or as
a retention enema. The suppository contains 0.5
gram of aminophyllin. One-half gram of amino-
phyllin powder dissolved in 30 to 60 c.c. of tap
water may be used as a retention enema. Given
in this manner, it can be repeated every 6 to 8
hours.
Continuous intravenous aminophyllin in status
asthmaticus has recently been introduced by Good-
all and Unger.5 Dosage consisted of up to 2 or 3
grams of aminophyllin dissolved in 2,000 c.c. of
5 per cent glucose in physiological salt solution
or distilled water. The solution is given continu-
ously over a twenty-four-hour period for several
days until relief is afforded.
We see no particular advantage to this method,
because the same coverage can be achieved by
employing repeated intravenous injections of
aminophyllin togther with rectal suppositories or
retention enemas, without the extreme incon-
venience to the patient of having a needle in his
vein continuously for three or four days. This
is extremely important when considering that the
patient in status asthmaticus is already in extreme
discomfort because of his marked dyspnea
Occasionally patients may become refractory to
the intravenous administration of aminophyllin.
Recently Prigal10 has recommended the aerosoli-
zation of aminophyllin when this occurs. The con-
tents of a 10 c.c. (0.25 gram) or 20 c.c. (0.5
gram) ampule are nebulized at six- to eight-hour
intervals. We have employed this procedure in a
limited number of patients. Definitive judgment
as to its relative value remains to be determined.
As in the case of “epinephrine fastness,” when
patients become refractory to aminophyllin by
intraveous injection or aerosolization, its use
should be discontinued, as further dosage will
serve only to increase its toxic effects.
The use of intravenous aminophyllin in the
treatment of children may be employed in the
same manner, the dosage being .006 gram per
kgm. (1/20 grain per pound).
Inhalation Therapy. — Inhalation therapy is di-
rected toward decreasing the minute volume of
respiration. It rarely of itself will interrupt
status asthmaticus, one must be extremely careful
to make the patient more comfortable by dimin-
ishing the extreme respiratory effort caused by
the anoxia, bv enriching the surrounding air with
oxygen.
Oxygen may be employed with a tent, nasal
catheter, or B.L.B. mask. At times, patients will
rebel against the use of a tent because of a feel-
ing of claustrophobia. This may increase their
October, 1950
985
STATUS ASTHMATICUS— EISENSTADT
anxiety and nervousness, with resultant increase
■of their exertional dyspnea.
Barach1 introduced a mixture of 80 per cent
helium and 20 per cent oxygen, a mixture which
has one-third the density of air. It therefore
should diffuse more readily through the partially
obstructed bronchioles. Its cost, however, is a
limiting factor and, in our personal experience,
oxygen has been equally as good.
Sedation. — In employing sedation, one must
guard against over-sedation. However, measures
to insure sleep and to overcome nervous tension
are very necessary. We have used Demerol re-
peatedly, but with considerable caution. Used
judiciously, it has proven to be a most effective
■drug. Its action2 has apparently been twofold,
sedation and a direct bronchodilating effect. In
status asthmaticus, one must be extremely careful
about respiratory depression and depression of
the cough reflex, effects which are relatively
minimal with Demerol as compared to the opiates.
In this connection, mention should be made con-
cerning the use of morphine. In the past it has
been used extensively, occasionally beneficially.
However, one can say it should never be used
in asthma, and especially so in status asthmaticus,
where the patient is anoxic, exhausted and battling
for life. Morphine depresses the respiratory cen-
ter, diminishes the cough reflex and dries the
bronchial secretions (especially if given with
atropine). Thus, morphine actually promotes
further anoxia — to the point of asphyxia — which
is the very thing we are trying to combat. Be-
cause of the stagnation of the bronchial mucous
plugs, the patient literally drowns in his own
bronchial secretions. Vaughan14 and Lamson7
have shown that in many deaths due to asthma
during status asthmaticus, morphine was given
prior to death. The use of all other opiate deriva-
tives should also be avoided.
The dosage of Demerol should be regulated
with extreme care. Adults should never be given
an initial dose exceeding 50 mgm. intramuscular-
ly. It may later be necessary to increase to 75
mgm., and only rarely to 100 mgm. This can be
repeated at six- to eight-hour intervals. It should
be used for relatively short periods, three, four or
five days, because of the possibility of addiction.14
The routine use of Demerol for the relief of the
usual acute attacks of bronchial asthma, as has
been advocated, is to be condemned because of
986
its properties of addiction. When using Demerol
we have avoided using other sedatives, because
of the possibility of over-sedation and the de-
pression of all body functions.
Other sedative measures have been advocated
by others.15 Our experience with them is limited,
but we will mention them briefly.
(1) Paraldehyde may be given rectally, 15 c.c.
in 100 c.c. of olive oil at twelve-hour intervals.
2. Barbiturates may be given at four- to eight-
hour intervals.
3. Chloral hydrate, 1 gram, and sodium bro-
mide, 4 grams, may be given at four-hour inter-
vals until the patient becomes drowsy ; then stop.
4. A mixture of ether, 2 oz., and olive oil, 4
oz., mixed thoroughly, may be administered as a
retention enema.
If any of the above are employed, only one
should be used and not a combination. If used
properly and carefully, sedation is extremely
beneficial and life-saving. Its drastic use in an
already exhausted and anoxic individual may be
dangerous and disastrous.
Expectorants. — Methods which will thin out
bronchial secretions and thus will help clear the
bronchi of their mucous plugs are highly de-
sirable. The best medication to achieve this is
potassium iodide. It has been shown by Tuft13
that the iodides are excreted in the bronchi in high
concentration. Ten to fifteen drops of a saturated
solution of potassium iodide taken orally are rec-
ommended four times daily until the patient is
free of expectoration. If the patient is unable to
take the drug orally, it may be given intravenous-
ly as sodium iodide. One gram may be added to
a liter of the solution for intravenous administra-
tion by the drip method. If there is an intolerance
to potassium iodide, enteric coated ammonium
chloride tablets in 0.5 gram doses may be given
four times daily.
In children, emetic doses of ipecae will produce
forceful emesis and with it expectoration of
mucous and clearing of the bronchial tree.
Manual Elevation of the Diaphragm. — In the
presence of status asthmaticus physiological pul-
monary emphysema is present. There is trapped
air because of the partially and completely oc-
cluded bronchioles. Manual elevation of the di-
Minnesota Medicine
STATUS ASTHMATICUS— EISENSTADT
aphragm, as suggested by Gay,2 is often followed
by subjective relief as well as an increase in the
vital capacity from 200 to 1000 c.c. The procedure,
is carried out as follows : the palm of either hand
is placed underneath the ribs on one side and
pushed upward and inward during the latter
half of expiration. Then this is repeated on the
other side. The escape of trapped air may fre-
quently be heard as a wheeze. This procedure
should be repeated three to four times daily.
Bronchoscopy. — Although we have not had
occasion to use bronchoscopy, its use should not
be overlooked. The mechanical removal of thick,
tenacious mucus from the bronchi would appear
to be a most reasonable treatment. Bronchoscopy
has undoubtedly been restricted in its use be-
cause patients seem so gravely ill that any pro-
cedure which places a greater strain upon them
would almost appear to be inadvisable. In skilled
hands it is a relatively safe procedure and the
risk is much less than that of possible asphyxia
from the disease. However, preoperative medica-
tion should be kept at a minimum. Morphine and
opiate derivatives are definitely to be avoided.
Antibiotic Therapy. — With the advent of anti-
biotic therapy, another powerful weapon has been
added. As stated earlier, most patients in status
asthmaticus belong in the chronic intractable or
infectious group. Frequently an accompanying
infection of the bronchi has been the cause of the
status asthmaticus. The presence of infection is
noted clinically by an increase in body tempera-
ture, elevated sedimentation rate, the presence of
muco-purulent or purulent sputum, and leuco-
cytosis with an increase in the polymorphonu-
clears.
Our routine is to use combined parenteral and
aerosol penicillin therapy, so that the penicillin
may reach the more superficial and deeper lying
tissues of the bronchi in high concentration. Fifty
thousand units of penicillin in 1 c.c. of distilled
water, to which 3 or 4 drops of glycerin are added
to stabilize the aerosol, are nebulized every three
hours, with a six-hour interval during the sleep-
ing hours. If the penicillin aerosol is to be con-
tinued after the epinephrine-fastness has been
broken, it is advisable to precede the inhalation
of penicillin by the inhalation of a few breaths
of 1 :100 epinephrine, or 1 :200 isuprel, so as to
widen the lumen of the lung. Very often, this
October, 1950
therapy will have to be prolonged for five to ten
days following responsiveness to epinephrine
until the patient’s bronchial secretions are free
of discoloration and are at a minimum. At the
same time, penicillin is administered parenterally
with daily injections of 300,000 units of prolonged
acting penicillin.
Because of the possible toxic effects of strep-
tomycin and dihydrostreptomycin, its routine or
combined use with penicillin is initially avoided.
It is added only when the sputum remains puru-
lent or in the presence of peneillin-resistant or-
ganisms in the sputum. Dihydrostreptomycin, be-
cause of its lower incidence of toxic effects, is
then given by aerosolization in seven divided doses
of 1 c.c. each per twenty-four-hour period in a
similar manner as penicillin. The total dose per
day ranges from 0.5 gm. to 1.5 gm. Its parenteral
use is withheld. In our experience it has rarely
been necessary to use streptomycin or dihydro-
streptomycin.
As yet we have had no opportunity to use
bacitracin aerosol, used successfully by Prigal,11
and the newer orally administered antibiotics,
aureomycin, Chloromycetin, and terramycin.
Antihistaminics. — The recently introduced an-
tihistaminic drugs are of little or no value in this
condition. In fact, they are contraindicated, as
they possess an atropine-like effect in drying up
bronchial secretions, and thus aid in producing
mucous plugs. Before substituting these medica-
tions, the action of which is neither so certain nor
so prolonged, it is well to remember that epineph-
rine and epinephrine-like compounds are the
most powerful antihistaminic agents now in use.
In summary, when one is confronted with a
patient in status asthmaticus, the danger of death
is ever present. The judicious use of the above
procedures may be lifesaving.
Bibliography
1. Barach, A. L., and Eckman, M. : The use of helium in
the treatment of asthma and obstructive lesions in the
larynx and trachea. Ann. Int. Med., 9:739, 1935.
2. Barach, A. L. : Treatment of intractable asthma. J. Allergy,
17:352, 1946.
3. Bubert, Howard M., and Cook, Sarah : Status asthmaticus.
Southern M. J., 41 :146, 1948.
4. Glaser, J. : The symptomatic treatment of bronchial asthma
in infancy and childhood. Am. Practitioner, 1 : 1 85 , 1946.
5. Goodall, R. J., and' Unger, L. : Continuous intravenous
aminophyllin in status asthmaticus. Ann. Allergy, 5:196,
1947.
6. Kibler, C. S. : Management of intractable asthma. South-
western Med., 21 :196, 1937.
7. Lamson, R. W., Butt, E. M., and Stickler, M. : J. Allergy,
14:396, 1943.
(Continued on Page 1016)
987
THE ROENTGEN DIAGNOSIS OF SILICOSIS
EUGENE P. PENDERGRASS. M.D.
Professor of Radiology, University of Pennsylvania
Philadelphia, Pennsylvania
T AM GRATEFUL for the honor and conscious
of the responsibility of speaking to you on this
occasion, a period dedicated to the memory of
Russell D. Carman. This is not the time for me
to attempt to refresh your minds concerning Dr.
Carman’s contributions to medicine. Many of
these are a matter of record. Dr. Carman was a
physician, scientist and teacher. He possessed
such qualities as understanding, honesty, reason
and justice, which were a source of inspiration and
satisfaction to those of us who were privileged to
know him. Honorary lectures such as this provide
an opportunity for all to pause and contemplate
the achievements of one of our great physicians,
an opportunity for us to rededicate our lives to
those things that will stimulate our greatest efforts
toward improving medicine and through it provid-
ing greater service to our fellow man.
The subject which T have chosen for presenta-
tion is one of timely interest, although some of
the symptoms and changes in the lungs produced
by inhalation of dust in certain occupations were
described by medical writers many centuries ago.
Our ideas concerning the prevention and con-
trol of disease have undergone a remarkable
transformation during the past fifty years. The
modern doctor, according to the late David Ries-
man, is no longer being called upon to treat ill-
nesses which have disappeared or are rapidly
vanishing. His work is to take on new orienta-
tion, that of guardian of the health rather than
curer of ills for after all, “to guard is better than
to heal; a shield is better than the spear.”
Today in this industrial age, as never before,
many of the forms of occupational disease fall
within the province of the family doctor as well
as the industrial physician. Our task is to be
aware of the hazards affecting our working people
in order that we may help make the industrial
population a source of strength and not a source
of weakness. We have to insure that as a result
of modern industry and commercial procedure
From the Department of Radiology, Hospital of the University
of Pennsylvania.
Russell D. Carman Memorial Lecture presented at the annual
meeting of the Minnesota State Medical Association, Duluth,
Minnesota, June 12, 1950.
and environment, we do not saddle ourselves with
a number of disintegrated and therefore unhappy,
discontented men and women.
One of the earlier references concerned with
dangers of dust exposure is Pliny’s61 description
of the devices used by refiners to prevent inhala-
tion of the “fatal dust.”
In 1556, Agricola1 described the perils of
mining and the pestilential air breathed by miners.
Ramazzini03 in 1700 called attention to the pos-
sible relationship between dust inhalation and con-
sumption. In the Renaissance, physicians and
mining engineers were aware that the metal
miners suffered from shortness of breath and
died prematurely. Anatomists had described
“heaps of sand” in the lungs of stonecutters and
they called the condition phthisis. Thackrah,74 in
1831, noted that sandstone workers died before
forty, but there was no unusual instance of lung
diseases in brick and limestone workers. Although
the effect of various dusts in the lungs was recog-
nized previously by other writers, Zenker84 in
1867 is given credit for having coined the word
“pneumonokoniosis.” Shortly thereafter, in 1870,
Visconti77 described a pathological condition of
the lungs resulting from inhalation of silica which
he called “silicosis.” In more recent years, nu-
merous studies and investigations have been car-
ried out in many countries. In the United States,
the investigations carried on at the Saranac
Laboratory under the direction of the late LeRoy
U. Gardner25 have added tremendously to our
knowledge of the development of pneumono-
coniosis and silicosis in the experimental animal.
Pneumoconiosis
Pneumoconiosis is a broad generic term used
to describe all forms of pulmonary reaction to
dust lodging within the lungs, with no implication
as to character, severity, or effect on function.
Certain of these reactions may be demonstrated by
a roentgen examination of the chest, but in most
instances they are entirely non-specific, are un-
accompanied by formation of progressive fibrosis,
and are of no clinical significance. In the light
988
Minnesota Mf.dicinf.
THE ROENTGEN DIAGNOSIS OF SILICOSIS— PENDERGRASS
of present knowledge, however, we recognize at
least two clinically important specific pneumo-
conioses, namely, silicosis and asbestosis, as well
as a number of benign pneumoconioses resulting
from the inhalation of a variety of inert but
radiopaque dusts. The former may be productive
of disability, whereas the latter are of clinical
significance only because they may lead to errors
in diagnosis through their ability to produce upon
the roentgenogram a nodular pattern at times in-
distinguishable from that occurring in silicosis.
Silicosis
Silicosis is a form of pneumoconiosis which is
thought to be due to the specific action upon the
lung tissue of chemically free silicon dioxide in
finely divided form and which produces changes
that can be demonstrated in many instances on a
roentgenogram. It is probable that all dusts, with
the exception of chrome, free silica and certain
silicates, produce very few changes in the lung
that can be recognized with assurance on the
roentgenogram.
In order to produce lung changes it is necessary
for the silica dust to reach the lung alveoli, to get
into the interstitial tissues either through the
agency of macrophages (dust cells) or by way of
alveolar pores, and to be deposited in sufficient
concentration at some spot where either through
its inherent physicochemical properties or to-
gether with some other factor or factors, as yet
unknown, an abnormal amount of fibrous tissue
formation may be stimulated.
In the early days, the tissue reaction to quartz
dust was considered to be due to the sharp-pointed
particles. This concept was invalidated when dia-
mond dust and carborundum were shown to be
benign. Then came the solubility theory of sili-
cosis. This concept considers silica as slightly
soluble, which in turn stimulates the formation of
fibrous tissue. Although this theory has served
as an excellent working hypothesis, several in-
consistencies have been pointed out by Evans and
Kascht.20 These include :
1. A local concentration of ions, or a dissolu-
tion of the dust deposit has not been demonstrated.
2. Several benign silicates supply a greater
number of soluble ions to the local tissue than
does quartz.
3. There does not appear to be a constant rela-
tionship between solubility and the degree of
fibrous tissue formation.
4. Silica in solution in the tissues would be
precipitated as sodium silicate, which is benign.
5. It would appear that a fibrotic nodule would
offer little functional defense to a substance in
solution, as diffusion would progress through such
a barrier.
In view of the above objections, Evans and
Kascht20 recently have examined various sub-
stances commonly responsible for the production
of the pneumoconioses. They failed to find any-
thing in the nature of a common chemical or
physical property, such as solubility, hardness,
sharpness, or known chemical reactivity, in the
tissues that could explain the production of the
characteristic fibrotic nodule. They found that the
dusts known to produce fibrosis were composed
of substances whose most stable form was that
of an asymmetric crystal, and therefore, poten-
tially piezoelectric. The benign dusts were either
amorphous or of crystalline classes which are not
piezoelectric.
Piezoelectricity is defined as being that prop-
erty possessed by certain asymmetric crystals
which allows a transformation of energy, in either
direction, mechanical and electrical energy, Evans
and Kascht.20 If such a crystal is distorted by
pressure, an electric polarity is produced, and
conversely, if such a crystal is placed in the prop-
er electric field, a distortion of the crystal surfaces
is produced. There may be many related second-
ary effects. Evans and his associates have car-
ried out a number of experiments which seem to
support the thesis that asymmetric crystalline
crystals under certain circumstances produce
fibrosis.
Although many problems present themselves
for future clarification, Evans and his co-work-
ers,19’21’22 have shown the following :
1. The ability of foreign materials to produce
fibrogenesis is correlated with their crystalline
structure.
2. Those tested amorphous materials and ma-
terials whose crystalline state possesses a central
point of molecular symmetry (symmetrical crys-
tals) are nonfibrogenic.
3. Those tested crystals which do not possess
a central point of symmetry (asymmetrical crys-
tals) and possess piezoelectric properties are
fibrogenic.
4. Several materials previously untested bio-
October, 1950
989
THE ROENTGEN DIAGNOSIS OF SILICOSIS— PENDERGRASS
logically, selected for their physical properties,
were tested and shown to be fibrogenic.
5. Fibrous tissue reactions are considered to
be stimulated by releases of energy in mechanical
or electrical states within tissue.
Parmeggiani,51 in 1947, writing on the same
subject states that since silica nodules also are
formed in organs free from any mechanical ac-
tivity, such as the spleen, liver, and lymphatic
glands, it is not possible to explain the tissue dam-
age by piezoelectric action due to pressure on the
crystals.
I am not well enough informed about the bio-
logical effect of piezoelectricity on tissues to have
an opinion as to whether the theory being tested
by Evans and his co-workers is correct, but I en-
thusiastically believe that their investigations
should be encouraged and supported. If their
present concepts prove to be right, many of the
baffling problems concerned with the control of
silicosis may be explained and some of them
solved.
Pathogenesis
Although it cannot be stated with certainty
whether the effect theory is responsible for the
tissue responses in silicosis, chronic pulmonary
disease of the type under consideration is de-
pendent upon an adequate concentration of dust
exposure maintained for a sufficient period of
time. The rate of development will be influenced
by the adequacy of the drainage system of the
.lung.
The process by which the phagocytes and
macrophages carry off the dust particles has been
well described by Gardner30’32 and others.
Inhaled dust first exerts its influence on living
cells primarily within the bodies of the alveolar
phagocytes, and it is here that fundamental dif-
ferences due to the physicochemical composition
of the irritant become evident. Inert substances,
in which category the great majority of dusts be-
long, provoke no structural changes within the
cells. In contradistinction, free silica exerts a
specific effect. Degenerative changes, easily con-
fused with those in the “epithelioid cells of tuber-
culosis, quickly become evident. The enlarged
cells contain visible lipoid. Their nuclei repeated-
ly divide, and giant cells comparable to the Lang-
hans’ giant cells of tuberculosis are formed.
Eventually these migrating phagocytes concen-
trate the silica in and about the pulmonary lynr-
-990
phatics, where the toxic particles, either directly or
indirectly stimulate connective-tissue proliferation,
with the resultant formation of microscopic sili-
cotic nodules situated in the immediate vicinity
of the lymphatic trunks.
At this stage the only general influence of the
disease thus far discovered is the increased like-
lihood that the more advanced changes of silicosis
will result from the continued inhalation of silica-
laden dust. After sufficient reaction has developed
in the lymphoid tissues, the flow of lymph is re-
tarded. The alveolar phagocytes, however, con-
tinue to take up fresh particles of dust but, due to
their apparent inability to enter the lymphatic
vessels, collect upon the walls of the air spaces
proper. Once again, the silica exerts its specific
effect, causing proliferation of connective tissue
and the formation of parenchymal silicotic
nodules. Microscopically the nodules are seen to
be composed of hyaline collagen fibers and are
evenly distributed throughout the lungs (Gard-
ner.32) Such, in brief, is the pathology of simple
silicosis.
Tissue reactions occur along the lymphatics ac-
companying the pulmonary vessels and bronchi,
within the interstitial tissues and along the pleura.
From an examination of the mineral particles
which have gained access to the lung it seems that
the protective mechanisms of the respiratory tract
exclude most of the particular material greater
than 10 microns in diameter. Likewise it is ac-
cepted generally that the smaller silica particles,
0.5 to 2.5 microns in size, are more likely to pro-
duce lung damage than are the larger particles.
It is believed by some investigators that certain
dusts (diluents or contaminating dusts) may have
modifying effects upon the action of free silica in
the lung tissues ; for instance, carborundum and
aluminum oxide may retard and alkaline soap
powders may accelerate the usual reaction to free
silica. There is some uncertainty about this hypo-
thesis, however, as Gardner30 says that “definite
proof of accelerators to the action of silica is yet
lacking; it has been suggested that cases of ‘rapid
silicosis’ in human beings may be due to exces-
sive exposures to silica or unusual fineness with
or without associated infection.” It is evident,
therefore, that in order to evaluate a dust hazard
one must have a knowledge of the behavior of the
dust in the course of its production and while it is
suspended in the air, and its behavior in the
respiratory system, as well as an understanding
Minnesota Medicine
THE ROENTGEN DIAGNOSIS OF SILICOSIS— PENDERGRASS
of its specific action in the lung tissue (Hatch.37)
The knowledge that a workman is exposed to dust
released in the processing of a material containing
free silicon dioxide is insufficient evidence in it-
self to justify one in stating that the atmosphere
at the breathing level contains harmful quantities
of free silica dust.
The reasons for this observation are supported
by ventilation and sanitary engineers familiar
with many of the differences in the behavior of
dusts and some of the factors concerned may be
abstracted as follows :37
1. The composition of the air borne dust may
differ from that of the parent material.
2. The composition of the dust retained in the
deeper portions of the lung may differ from that
of the air borne dust.
3. The amount of dust retained in the respira-
tory system and the relative amounts retained in
the upper portion of the tract and that found in
the alveoli vary with different dusts.
4. The particle size of the alveoli dust differs
from that of the air borne material.
5. The flocculating properties of dust vary and
this affects the retention in the respiratory tract,
its penetration to the alveoli, and the behavior of
phagocytes toward the dust. >
6. The rate of phagocytosis varies from one
dust to another.
7. The toxicity of silica is apparently reduced
in the presence of certain other materials.
According to Hatch37 the relative significance
of these several aspects of dust behavior is not
fully understood but their importance has been
demonstrated both in the laboratory and in indus-
trial experience.
The modifications occurring from the inhalation
of dusts containing mixtures of free silica and
other minerals may be quickly passed. The pri-
mary pathology is the same, the essential differ-
ences being simply the result of co-existing sili-
cosis and a benign pneumoconiosis, each of which
alters to some extent the appearance of the other.
It should be recalled, however, that some inert
dusts, when mixed with free silica, cause varying
degrees of retardation in the development of the
silicotic process. At this time the use of aluminum
deserves brief but special mention. Denny, Rob-
son, and Irwin14 were the first to announce the
specific inhibitory effect of aluminum. Their
October, 1950
animal experiments and those of others,33 some
of which were conducted simultaneously in an-
other laboratory, have demonstrated conclusively
that metallic aluminum and aluminum hydrate,
when given by inhalation, will prevent the fibrous
reaction to quartz. The possible clinical applica-
tions of such a discovery are obvious, and have
already stimulated considerable investigative work
from the standpoint both of prophylaxis and of
therapeusis. While a complete discussion of their
present status is beyond the scope of this paper, it
may be said that further evaluation is required
and that aluminum therapy should in no circum-
stances be applied as a substitute for other and’
already recognized methods of dust control.
As evidence of the necessity for caution, are
the lung changes associated with the manufacture
of alumina abrasives reported by Shaver,72 and-
the experimental observations of Evans and Zeit21*
on aluminum phosphate.
The alteration of the silicotic process when
complicated by the presence of infection is not
nearly so simple.58 The increased susceptibility
to tuberculosis in man recorded by Merewether,48
and proved by the classic animal experiments of
Gardner,25,28 needs no recapitulation. Two facts,
however, must again be emphasized : ( 1 ) that it
is the presence of associated infection which ac-
counts for most of the disability arising from
silicosis, and (2) that infection, when it occurs,
may manifest itself in either of two ways, namely,
by the development of tuberculo-silicosis or of
silicosis with tuberculosis.
ruberculo-silicosis is common and according to
Brumfiel and Gardner,® whose observations are
adequately substantiated both clinically and path-
ologically, it is “a distinct disease entity with cer-
tain characteristics peculiarly its own, in that it is
neither silicosis nor tuberculosis nor is it a simple
summation of the two.” It is the result of the
interaction of tubercle bacilli and silica in the
same area, with the resultant formation of tuber-
culous granulation tissue together with a modified
type of silicotic reaction. Pathologically, it is
characterized by the formation of slowly develop-
ing, well defined, hard or rubber-like areas of
massive conglomerate fibrosis surrounded by a
marked degree of emphysema. On microscopic
section, nodules are found embedded within dense
hyaline fibrous tissue which virtually obliterates
the normal pulmonary structures. The tuberculous
component of the process sometimes is identified
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THE ROENTGEN DIAGNOSIS OF SILICOSIS— PENDERGRASS
easily by the presence of widespread caseation, but
not infrequently it is only after painstaking search
that isolated, non-caseous tubercles or occasional
clumps of acid-fast bacilli are discovered.
Silicosis with tuberculosis, by comparison to
tuberculo-silicosis, is rare, but it does occur in one
of two forms: either (1) as the result of infec-
tion superimposed upon a progressive and still
active silicosis or (2) as the result of infection
superimposed upon an old and already stabilized
silicotic process.
In the first instance the infection becomes acute,
and its course is usually one of uncontrollable
extension. In the second, tuberculosis develops
upon a background of an already stabilized sili-
cosis in which the quartz particles are presumably
completely isolated within their fibrous nodules
and thus exert no effect upon the superimposed
infection. We have then simply the coexistence
of silicosis and tuberculosis within the same in-
dividual, but without modification or acceleration
of either disease process by the other.
The effect of silicosis upon non-tuberculous in-
fection is less well documented. It cannot be de-
nied with finality that non-specific inflammatory
reactions within silicotic lungs occasionally may
be the precursors of conglomerate areas of
fibrosis. Proof, however, is lacking, and the
meager available evidence is opposed to such an
assumption. Pierpont60 has demonstrated that in
his iron-mining area the incidence of pneumonia
is no greater than in the general population, and
that the behavior of the disease when it does oc-
cur is unaltered by an underlying silicosis.
Similarly in rabbits it has been shown that silicosis
exerts no effect upon their susceptibility to in-
fection with Type III pneumococcus.78
On the other hand, Gardner,32 after micro-
scopic examination, was able to discover in only
60 per cent of cases showing massive conglomerate
fibrosis, indisputable evidence of tuberculous in-
fection. Perhaps in most if not all of the re-
mainder, the sdicotic fibrosis had obscured the
tuberculous component of the process, and it was
his feeling that an underlying tuberculosis was
the etiologic factor accounting for at least the
majority of massive fibrous lesions.
Roentgen Considerations '5
It is generally conceded that the roentgeno-
graph ic examination, properly done, is the most
precise method at our command for demonstrat-
ing pathological changes produced by pneumo-
coniosis or silicosis in the living individual. There
are, however, many other conditions that produce
shadows in the roentgenogram which may simulate
some of the various shadows found in pneumo-
coniosis.54 In order to evaluate correctly the
various shadows observed in a roentgen study of
the chest, it is necessary for one to possess some
knowledge and experience concerning such an ex-
amination, and certain information about the pa-
tient being studied. Some of the more important
requirements may be enumerated as follows :
1. A knowledge of the anatomy of the chest
and some of the physiological manifestations of
the various structures contained therein ; an un-
derstanding of the histology of the lungs and of
their lymphatic system.
2. A thorough familiarity with roentgenoscopic
and roentgenographic appearances of the normal
structures of the chest and their permissible varia-
tions.
3. A clear perception of the pathology of pneu-
moconiosis and of lesions that give a somewhat
similar roentgenographic appearance.
4. Some knowledge of the history of the in-
dividual, especially the occupational record and
familiarity with the physical signs in the particular
patient.
5. Some information concerning the industrial
process that is responsible for the production of
the dust. Dust counts at breathing levels and
chemical analyses of the dust are exceedingly
important when available.
If all of the above information is available, one
should be able to render a diagnosis which al-
though presumptive is likely to be correct in the
majority of instances. Very often, however, one
gives an opinion on insufficient data and in so
doing referring physicians become confused and
injustices occur.
I have always regarded the roentgen examina-
tion as a consultation, and used as such it is likely
to be more valuable. An ideal program for the
diagnosis of pneumoconiosis in the living would
include a study by a group, the members of which
would be a general physician, a rhinologist, a
bronchologist, a clinical pathologist, a specialist in
tuberculosis, a physiologist interested in pul-
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THE ROENTGEN DIAGNOSIS OF SILICOSIS— PENDERGRASS
monary function, an engineer expert in industrial
hygiene and a general roentgenologist. Such a
program is ambitious. Thus, in the majority of
instances the referring physician tells the indi-
vidual that he has pneumoconiosis or silicosis on
the basis of a history of dust exposure, a physical
examination which is thought to exclude other
conditions that might produce similar symptoms,
and the presence of abnormal shadows in roent-
genograms of the chest which are compatible with
those found in pneumoconiosis. The fact that
diagnoses are made in this manner places a tre-
mendous responsibility on the roentgenologist, for
he must not only describe the roentgen appear-
ances, but after he has done so, he must cor-
relate other information which has been supplied
to him with the roentgen observations, and arrive
at a tentative or presumptive diagnosis. This is a
safe procedure if we, as radiologists, fulfill our
obligations to the referring physician and patient.
Criteria for Diagnosis53
The diagnosis of silicosis rests primarily upon
a positive history of sufficient exposure to free
silica dust plus the roentgenologic demonstration
of characteristic deviations from the normal
within the lungs. Physical and laboratory exam-
inations are then required to exclude other condi-
tions producing similar roentgenographic changes.
Once the diagnosis is established, physical exam-
ination is required to determine the general
physiological effect of the pulmonary condition
and to determine whether any disability has re-
sulted therefrom. Differences in individual in-
centive to work, the natural retardation of physi-
ological responses with advancing age, and the ac-
crued evidence to show that ordinary, slowly de-
veloping, simple silicosis is usually in itself non-
productive of a diminution in ventilatory capacity,
all combine to make an accurate estimate of the
latter an extremely difficult problem.
Machle,44 however, has shown that the inhala-
tion of the more active dusts results in certain
changes in the behavior of the lung which favor
retention of the very fine particles in larger num-
bers than would be expected to occur on a the-
oretical basis alone. The change is one of bron-
chiolar constriction, which leads to reduction in
pulmonary volume and if continued leads to stasis
with its attendant pathological changes. This is
the type of observation which we hope to learn
more about from pulmonary function studies.
October, 1950
Classification
Before discussing the roentgenographic ap-
pearances, it is necessary to say a few words about
classification of silicosis as observed in the roent-
genographic studies. There are many different
ones in use. The most recent has been described
by Fletcher24 and his associates, who state that it
may be necessary to have systems of classification
for the various types of pneumoconiosis in men
exposed to different dusts in various industrial
processes. We have given the subject of classi-
fication or roentgen appearances considerable
thought and feel that any classification used should
not place too much emphasis on the roentgen ob-
servations, except in those instances in which
there is good evidence of infection complicating
the silicosis. A simple classification that has
worked well for us for the last ten years is : simple
silicosis and silicosis with infection. It should be
borne in mind that one cannot from a study of
the chest by present roentgen methods give any
reliable opinion as to the extent of disability.
Simple Silicosis
The characteristic lesion in silicosis is a cir-
cumscribed nodule of hyaline fibrosis. The earliest
lesions are invisible or are recognizable only
microscopically or with a magnifying glass.30
They are deposited along or within the lymph
channels where they may impede lymphatic
flow.26’79 Gardner32 states that when the lymph
flow is retarded the phagocytes do not enter the
lymphatics but collect here and there over the
walls of the air sacs. Parenchymatous nodules
may then develop which ultimately reach a size of
3 to 4 mm. in diameter. Pathologically, the
nodules have well defined borders except when
there are accumulations of non-siliceous dusts.
The earliest roentgen lesion that I accept as
evidence of simple silicosis is the small, discrete,
multiple shadow, 2-6 mm. in diameter, which is
more or less uniform in size and density and does
not disappear in a roentgenogram made with
slight rotation. Shadozvs that disappear with
slight rotation are likely to be vascular. The blood
vessel shadows are denser and their borders are
more sharply defined than are those of nodules.
The shadows of the silicotic nodules are usually
distributed along the vascular channels and the
bronchial tree of both lungs, and at times they
may be limited largely to one lobe. Not infre-
quently, even though a bilateral distribution of the
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THE ROENTGEN DIAGNOSIS OF SILICOSIS— PENDERGRASS
shadows occurs, one does not see them in the
apical, peripheral and lower portions of the lung
fields.
The roentgen appearance of the shadows of the
silicotic nodules are not as characteristic as one
would wish. Some are round, some oval, some ir-
regular, some large and some small. Most of the
lesions have a uniform density, but some have
shadow densities in their centers simulating that
produced by calcium. The shadows of these
lesions are called nodulation, which unwittingly
implies that they can be distinguished from
mottling due to tuberculosis or some other infec-
tious process. I frequently have found that the
periphery of the nodular shadows (silicotic) is so
ill defined that in itself it cannot be differentiated
from mottling in miliary and other types of tuber-
culosis and small shadows due to a generalized
metastatic malignancy. In most instances, how-
ever, a correct diagnosis can usually be arrived
at by correlating the roentgen findings with the
history and clinical data.
One of the interesting questions that arises
concerning the silicotic individuals as seen by the
roentgenologist is that not all of them develop
generalized nodulation that can be seen on the
roentgenogram. This apparently is true even
when individuals are working under similar con-
ditions in the same industry, and up to the present
time, no adequate explanation has been made.
When nodulation occurs, the nodules may or
may not show progressive changes. In a few
patients who have been followed for fifteen years,
we have observed the pattern of nodulation re-
placed by massive shadows with either complete
or almost complete disappearance of visible nodu-
lar shadows on the roentgenogram. Just how
often this occurs will be determined only after
years of serial studies.
I have always been interested in whether nodu-
lation is more likely to develop in the younger or
the older individual. This question is likely to be
answered as more experience with serial studies
is obtained. My observations in one industry
(almost pure silica) over a period of fifteen years
tends to show that nodulation does occur more
frequently in the young individual. These nodules
have been observed in individuals who have had
a silica dust exposure of five to ten years. One
wonders whether the nodulation seen in some of
the older individuals who have worked for longer
periods may likewise have developed during the
five to ten years’ exposure period and in certain
instances failed to progress.
Generalized nodulation is often present with
very little, if any, clinical evidence of disability.
Such an observation is extremely important to
keep in mind for it will help to prevent such in-
dividuals from being thrown out of work and
placed on compensation. Experience with such
individuals has shown that if they are allowed to
continue to work in a healthy atmosphere, the
lesion may not progress, no unusual disability de-
velops, and a family catastrophe or hardship due
to loss of adequate compensation and unhappiness
is prevented.
These nodules, uniformly distributed through-
out the pulmonary parenchyma, form a charac-
teristic shadow pattern, and the demonstration
upon the roentgenogram of this generalized nodu-
lation is, from the radiologist’s point of view,
fundamental to the diagnosis. There may or may
not be associated enlargement of the hilar lymph
nodes, despite the fact that it is in the lymphatic
tissues that the earliest silicotic nodules have been
shown to develop. These early nodules, however,
by their very fibrous nature, are destined to cause
eventual contraction, and in cases of slowly de-
veloping silicosis it may no longer be possible to
demonstrate hilar lymph node enlargement by the
time the parenchymal nodules are grossly visible.
Another lesion generally included under the
classification of simple silicosis is the small con-
glomerate lesion. Such lesions may result from a
combination or coalescence of discrete nodules or
the lesion may occur as such primarily.
Conglomerate lesions are usually localized and
do not occur in the same portion of the lung in
every individual. On the other hand, roentgen-
ographic studies of individuals with such lesions
more frequently show them in the upper half of
the lung fields. Microscopic examination32 of the
tissues from such areas oftentimes reveals no
evidence of infection. The nodules seem to be
closer together than in other portions of the lung;
they are less uniform in size, and they are em-
bedded in a matrix of diffuse, fibrous tissue hav-
ing the same characteristic appearance as that
forming the nodules themselves. It is possible that
the conglomeration may have occurred because the
portion of the lung in question was previously
damaged by a localized, inflammatory process oc-
curring before or during the early period of the
dust exposure.32 More dust would tend to ac-
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THE ROENTGEN DIAGNOSIS OF SILICOSIS— PENDERGRASS
cumulate in such an area and possibly the nodules
would develop irregularly and closer together.
Another explanation is that the scar contraction
of the silicotic process may be sufficient to pro-
duce the conglomerate lesion.
The shadow of the conglomerate lesion in sim-
ple silicosis is often difficult to distinguish from
that found in silicosis with infection. From the
roentgenological standpoint they may be impos-
sible to differentiate in a single examination,
whereas serial examinations may or may not
show slight changes in the extent of the shadows
of lesions that are complicated by an active in-
fection.
The roentgen observations in simple silicosis
may be summarized as follows :
Trachea: Its shadow is in a normal position.
Heart and aorta: Their shadows are not
noticeably affected by the silicotic process.
Domes of the diaphragm: The shadow and
movement of the domes of the diaphragm are not
affected by the silicotic process unless a coincident
emphysema is present.
Hila: The shadows of these structures are as
a rule not noticeably changed.
Trunk shadows and linear markings :- Slight to
moderate variations in these shadows are difficcult
to evaluate.
Lung changes, nodulation and conglomerate
lesions: The shadows of nodulation (2 to 6 mm.
in size) are usually bilateral in distribution.
Variations may occur such as a lobar or unilateral
distribution.
Shadows of nodules may be difficult to differen-
tiate from those occurring in some types of tuber-
culosis, metastatic malignancy and fungus infes-
tations, et cetera.54
Conglomerate lesions: These shadows are
usually found in the upper half of the lung fields
and are difficult to evaluate in single examinations.
Superimposed metastatic malignancy and lesions
due to an active infection may produce similar ap-
pearances.
Hyperventilation and emphysema: Such con-
ditions may be present and demonstrable by the
roentgen examination. Their evaluation, as to
cause and effect from dust exposure, however, is
more difficult and does not fall within the province
of the roentgenologist.
Silicosis With Infection
In this group are included all cases of silicosis
with detectable evidence of infection. It is not
always possible in the living patient to determine
whether the infection is active or inactive even in
instances when conventional clinical and labora-
tory examinations are available. Under such cir-
cumstances, mistakes will occur, but if one exer-
cises good judgment, the affected individual can
be protected by taking the necessary precautions.
The lesions (either some or all) that have been
described as occurring in simple silicosis may be
modified by infection. Other lesions that may be
found include cavities (usually thick walled)
tuberculous in origin, cavities occurring as a re-
sult of necrosis of anemic infarcts, massive
lesions, mottling, soft nodulation, various degrees
of emphysema and bleb formation, pleural thick-
ening, pleural collections, pneumothoraces and
deformations of the domes of the diaphragm. The
roentgenologist is rarely able to predict whether
the infection is due to the tubercle bacillus or
some other organism. One suspects, however, that
in the majority of instances, the super-imposed in-
fection is tuberculosis, for Gardner32 states that
the postmortem examinations showed an element
of tuberculosis in 60 per cent of the cases.
The changes occurring in the various struc-
tures of the respiratory and cardiovascular tracts
as demonstrated by the roentgen examination may
be summarized as follows :
Trachea. — Its shadow may be in a normal posi-
tion, especially if a tuberculous process or some
other infection is superimposed upon an already
established silicotic process. In some instances the
trachea is found displaced to one side. At such
times, it is my feeling that the silicotic process has
occurred either simultaneously with tuberculosis,
or the tuberculous lesion was probably estab-
lished before the silicotic changes became mani-
fest, or the traction of the fibrotic changes pro-
duced by a tuberculous and silicotic lesion one
side was greater than that of the silicotic process
of the opposite side.
Heart and Aorta. — In some instances evidence
of cor pulmonale is observed in the advanced sili-
cotic individual. Some clinicians17 have regarded
this condition as a complication of silicosis. The
relation between cause and effect is difficult to
establish in this instance and cardiologists who
October, 1950
995
THE ROENTGEN DIAGNOSIS OF SILICOSIS— PENDERGRASS
have given thought to the question find themselves
unable to express an opinion. Many of us who
have been interested in silicosis for years, have
not been impressed with the incidence of cardiac
complications. On the other hand, it is possible
that with increased use of the electrocardiograph
in the well advanced silicotic, more evidence of
slight heart changes may be found. But even if
such evidence is found, it is well known to the
cardiologist and the general pathologist that in
the older age group not exposed to harmful dust,
which come to autopsy, cardiac complications are
not uncommon. Even in the advanced silicotic
with well established emphysema, Gardner32 states
that "hypertrophy of the right side of the heart
without arteriosclerosis and even greater involve-
ment of the opposite side is a rarity.”
Occasionally, the heart and aorta are displaced
to one side or backward by the contracting scar
of a tuberculous infection and silicotic process.
As in the case of the trachea and in the absence
of data to the contrary, such displacement is
thought to occur for the same reasons.
Domes of the Diaphragm. — If considerable
emphysema is present, the domes of the diaphragm
may be depressed and limited in their movements.
At times it is necessary to have the patient cough
in order to demonstrate, roentgenoscopically, evi-
dence of diaphragmatic excursion.
Individualization of the costal components of
the domes of the diaphragm is quite marked when
there is considerable basal emphysema.
Another abnormal appearance is multiple peak-
ing of the domes of the diaphragm. It may be
impossible to differentiate the peaking caused by
pleural adhesions from that due to inelasticity of
certain structures of the lung. Both conditions
may be present.
Hila. — The shadows of the hila may or may not
be within normal limits. The hilum shadow may
be enlarged or its shadow may be partly or totally
obscured by a larger shadow produced by a lung
lesion. The hilum may be displaced upward, later-
ally or backward by a contracting scar of a sili-
cotic process plus an infection (similar to that
causing displacement of the trachea).
Lung Changes. — Mottling is a term that is ap-
plied to the small and poorly defined shadows pro-
duced by an acute or chronic infection. The roent-
gen manifestations of mottling and nodulation
may be identical and exceedingly difficult or im-
possible to differentiate. The shadows of mottling
often lack a uniformity of distribution and are
more likely to change in form in subsequent ex-
aminations than are the shadows of nodules.
Mottling usually occurs as a result of a broncho-
genic spread of a tuberculous lesion or the result
of a fungus infestation.
S.oft Nodulation.- — The shadows of soft nodula-
tion are much larger than those produced by nodu-
lation and mottling, but are smaller than the con-
glomerate shadow. The description of such a
roentgenologic shadow is provided in order to
emphasize a perinodular cellular reaction that is
observed by the pathologist. These, shadows are
much more likely to change in character in sub-
sequent examinations than in the shadow pro-
duced by nodules, and change less than those due
to mottling.
N odulation. — The shadows of nodulation are
similar to those described under “simple silicosis.”
Soft nodulation and nodulation cannot be demon-
strated by a roentgen examination in every case
of modified silicosis with infection. This is par-
ticularly true in certain industries such as hard
coal mining and granite cutting. In cases where
there is only roentgen evidence of massive or
conglomerate shadows one is more likely to make
errors in interpretation.
Massive Shadows. — These shadows vary from
3 to 20 cm. in size. Some are round, some oval
and some wedge shaped. These lesions are usual-
ly due to extensive areas of fibrosis and are found
in the upper third or upper two-thirds of the lung
field. Occasionally it is possible with overexposed
films, body section roentgenograms or a Potter-
Bucky roentgenogram to show some of the details
of a massive lesion, such as distorted and ob-
literated bronchi, cavities and areas of calcification
and caseation.
A few years ago, most of these lesions were
thought to be due to silicosis with infection. Rid-
dell,65 Gardner,32 McCloskey45 and others ques-
tion whether this is always true. Gardner32 thinks
that a “third essential factor may be minerals
other than free silica.”
From a rontgenologic standpoint, I have at-
tempted to determine whether the massive lesion
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THE ROENTGEN DIAGNOSIS OF SILICOSIS— PENDERGRASS
extended to the periphery of the involved lobe of
the lung and have used this information as evi-
dence for or against the presence of an active in-
fection. For instance, if a lesion extends to the
interlobar fissure or the thoracic wall, such a lesion
would be regarded as the seat of an active infec-
tion. If the massive lesion were situated in the
center of the affected lobe, the roentgen evidence
would not necessarily be in favor of an active in-
fection. I realize that such deductions by them-
selves are of very little value, but in the absence
of more convincing clinical and pathological proof
attention to this detail may prove to be helpful.
The massive lesions do not tend to displace the
midline structures (trachea, hila, heart and aorta)
by scar contraction. When displacements of those
structures occur, the lesion which produces them
is more likely to be either a tuberculous or Fried-
lander baccillus infection which has preceded or
occurred simultaneously with the silicotic process.
It should be possible however, for the contracting
scar of a tuberculo-silicotic process of one lung
to overcome that of an uncomplicated silicotic
process on the opposite side.
Occasionally, one sees a lesion which by roent-
gen methods is diagnosed as a massive lesion,
which at autopsy turns out to be a necrotic, anemic
infarct or a cavity in which there is no micro-
scopic evidence of infection and which is filled
with a syrup-like material. I know of no way to
diagnose the true nature of these lesions by the
roentgen examination.
We have observed a migration of massive
lesions toward the hilum in certain instances.
This observation has been very helpful, and ex-
plains the prominent shadows adjacent in certain
patients in whom there are large masses simulating
greatly enlarged hilum lymphnodes.
The rationale for further division into the sub-
groups tuberculo-silicosis and silicosis with tuber-
culosis has already been explored, with emphasis
placed upon the concept that tuberculo-silicosis is
a separate and distinct, chronic disease entity re-
sulting from the prolonged interaction of two dis-
ease processes, but differing radically in its be-
havior from either occurring alone.
The roentgen manifestations of tuberculo-
silicosis are protean and yet distinctive. Early in
its evolution there are characteristically present
linear strands of fibrosis, presumably the result
of previous infection, which however may be so
fine as to be almost or completely obscured by
the accompanying nodulation. In due course,
serial roentgenograms reveal evidence first of con-
centration and later of coalescence of the nodula-
tion about these foci of fibrosis. Newly developed
areas of coalescence may extend to the pleural
surface of the lungs, but if the disease remains
chronic they inevitably contract to form the dense,
well delineated “massive shadows” or areas of
conglomerate fibrosis so typical of tuberculo-
silicosis. These are located most often in the
upper lung fields, but may radiate outward from
the region of the hilum, occur as rounded masses
deep within the lungs, or appear as wedges with
their bases directed peripherally. Commonly,
these areas of conglomerate fibrosis continue over
the years to increase slowly in size, incorporating
within- themselves more and more of the individual
silicotic nodules from other portions of the lungs,
until finally one may have as the end-result either
single or multiple, unilateral or bilateral massive
shadows of conglomerate fibrosis. These may be
so extensive as to destroy completely the ordinary
identifying characteristics of both the tuberculosis
and the silicosis, and they are invariably produc-
tive of an advanced degree of surrounding pul-
monary emphysema. Since the affected individuals
are not toxic, it is this latter which accounts for
their obvious and often high degree of disability.
Only rarely is one sufficiently fortunate to see
the evolution of the entire process in a given in-
dividual. It would seem however, that the path-
ologic evidence is sufficient, and that adequate
numbers of cases have now been followed by
means of serial roentgenograms over a period of
years, to warrant a presumptive diagnosis of
tuberculo-silicosis either upon the visualization of
nodulation with concentration, coalescence or con-
glomeration, or, when bilateral, upon the demon-
stration by themselves of large areas of conglom-
erate fibrosis. Limited reservation must of neces-
sity be entertained, however, until the case for or
against non-tuberculous infection as the etiologic
agent in the production of conglomerate fibrosis is
definitely proved.
The behavior of many cases of tuberculo-sili-
cosis would make it appear that the tuberculous
component of the process is for a time held in
check by the surrounding fibrosis. It remains a
potential source of danger, however, and may
become active at any time. Such activity manifests
itself on the roentgenogram by the development
of mottling and, once established, alters, by ac-
•October, 1950
997
THE ROENTGEN DIAGNOSIS OF SILICOSIS— PENDERGRASS
celeration of the fatal outcome, the entire course
of the disease. It is still true, therefore, that a
high percentage (though by no means all) of per-
sons with tuberculo-silicosis ultimately die of
tuberculosis.
Silicosis with tuberculosis, as previously indi-
cated, may occur in either one or two forms, the
clinical course and roentgen behavior of which
are as distinctively different as is their pathology.
Early ;n their development they may present an
extremely difficult problem in diagnosis because of
one’s inability, except upon the basis of preceding
serial roentgenograms, to formulate any estimate
of the activity of the underlying silicotic process.
In both groups the infectious component is first
identified by the presence on the roentgenogram
of single or multiple, usually apical, ill-defined
areas of infiltration or mottling, superimposed
upon a background of discrete nodulation. The
subsequent behavior, however, is radically dif-
ferent.
In the first group — those in which we have
fresh infection, either new or arising from the
reactivation of a latent focus, superimposed upon
a progressive and still active silicosis — the quartz
is incompletely encapsulated by the still immature
silicotic fibrosis and retains its ability to exert its
specific effect. When the silica concentration is
high, tiny foci of necrosis within the nodules oc-
cur, providing an ideal medium for the growth of
tubercle bacilli ; but even when the silica content
is not excessive there is in some occult manner
produced an environment eminently favorable to
their multiplication.28 Serial roentgenograms ex-
hibit new areas of mottling and local extension of
the original foci, about which the silicotic nod-
ules may become extremely abundant.29 In some,
the so-called “perinodular type,” there occurs,
probably as a result of massive superinfection, a
rapid enlargement with loss of definition of each
nodule throughout both lungs, due to the develop-
ment of an intense surrounding zone of collateral
inflammatory reaction. Minute foci of caseation
are usually present, and cavitation does occur, but
by comparison with the general evolution of the
process it is a relatively late phenomenon. While,
rarely, several years may elapse before toxic
symptoms supervene, the general tendency is to-
ward uncontrollable extension to death before
there is opportunity for the chronic changes of
tuberculo-silicosis to occur.
In the second group are the unusual but ex-
istent cases in which silicosis and tuberculosis
occur together but act independently. As previ-
ously indicated, it is presumed that in these cases
the silicosis has healed with the formation of such
densely fibrous nodules that the quartz is com-
pletely walled off and thus cannot exert its pe-
culiar effect upon the superimposed tuberculous
infection. The infection, observed by means of
serial roentgenograms, is seen to behave typically
as it does in non-silicotic subjects.
(To be concluded in the November issue.)
PAN-PACIFIC SURGICAL ASSOCIATION
The Fifth Congress of the Pan-Pacific Surgical As-
sociation will be held in Honolulu, November 10-21, 1951.
The object of the Pan-Pacific Surgical Association is
to bring together surgeons from countries bordering on
the Pacific Ocean so as to permit the exchange of sur-
gical ideas and methods and to develop a spirit of good
fellowship among the various races represented. Al-
though it was planned that meetings would be held every
three years, world events have permitted but four con-
ferences since the organization was conceived — the first
in 1929 and the last in 1948.
The Fifth Congress provides an opportunity for doc-
tors to combine a delightful vacation in Hawaii with at-
tendance at a scientific meeting, the program of which
will be presented by topflight surgeons from the Pacific
area countries, as planned by the program committee.
Doctors are urged to bring their families with them and
are promised luxurious accommodations.
Dr. F. J. Pinkerton, president of the Association, has
been officially appointed as travel agent for those coming
to the meeting. To be assured of preferred accommo-
dations, travel and hotel reservations should be made
through Dr. Pinkerton.
Further information may be obtained by writing the
Pan-Pacific Surgical Association office, Suite 7, Young
Building, Honolulu, T. H.
998
Minnesota Medicine
THE PREDICTION AND PREVENTION OF CORONARY THROMBOSIS
IN THE YOUNGER AGE GROUPS
A Suggestion for Further Study
R. L. PARSONS, M.D.
Monterey, Minnesota
and
J. J. HEIMARK, M.D.
Fairmont, Minnesota
A NEIGHBORING doctor dies at thirty-seven
L from coronary heart disease; a farmer has a
coronary infarction at thirty-four ; a buttermaker
has a coronary heart attack at forty-eight ; the
editor of a daily newspaper has a fatal attack at
fifty-two. A World War veteran suffers an in-
farction at 53 ; another farmer, the same at fifty-
two — all proven cases. These are by no means
isolated instances but are selected at random from
our small community within a short period of
time.
We are not concerned here with coronary deaths
among the aged or prematurely diseased. Those
we may leave to their proper study in geriatrics.
We are interested in the factors that produce
coronary incapacity, causing such a high mortali-
ty in people in the fourth, fifth and sixth decades
of life.
The purpose of this paper is to suggest a pos-
sible method of predicting coronary, catastrophes
and of possible prophylaxis for those people who
are in their most productive years and who should
be of most value to society.
The factors causing a coronary complex in the
people in these earlier decades differ markedly
from those in the aged. In older people, the pri-
mary cause of this trouble is an extensive intimal
damage in the coronary arterial tree. Secondary
factors are sedentary life, improper diet, and
probably disease. In the younger years this
initial damage is usually only moderate to minor.
Several other factors apparently combine in vary-
ing importance to cause an infarction. Among
these are prolonged nervous tension, the pro-
thrombin time level, diet, and smoking. It is
generally conceded that coronary constriction
from chronic over-stimulation due to high nervous
tension, worry, and overwork plays an important
role in the foregoing disease entity. Therefore,
we shall not add further comment. However, it
is different with the other factors mentioned.
In the patients with coronary heart disease
whom we have observed, we have been impressed
by the low prothrombin time uniformly present.
TABLE I. PROTHROMBIN TIME BEFORE AND AFTER
MIXED
MEAL
After Meal
Before Meal
( 1 Hour)
Name
Approx. Age
(Seconds)
(Seconds)
G.P.
24
60*
55
A.G.
SS
75 +
60
S.L.
22
90i
75
B.J.
19
70* '
65
A.R.
24
70t
60
*Light
meal
fModerate to
"heavy meal
TABLE II.
PROTHROMBIN TIME BEFORE
AND AFTER
ALL-VEGETABLE MEAL
Before Meal
After Meal
Name
Approx. Age
(Seconds)
(Seconds)
B.T.
19
SS
45
A.G.
SS
45
45
S.L.
24
45
40
L.K.
22
50
45
A.R.
24
45
50
TABLE
III.
PROTHROMBIN TIME BEFORE AND
AFTER SMOKING
Fasting
y2 Hour After
Fasting 7 a.m.
smoking
No Liquids
2 Cigarettes
Name
Approx. Age
(Seconds)
(Seconds)
B.J.
49
60
45
C.T.
40
70
60
J.C.
40
45
35
G.A.
45
65
50
A.R.
24
60
45
Likewise, we have been impressed by the fairly
prompt relief of pain in the non-fatal cases when
the prothrombin time has been quickly elevated by
the use of the anti-coagulants, heparin and di-
cumarol. We also noted that the pain did not often
recur if the prothrombin time level was sustained
at a sufficient height. Pain, however, was most
likely to recur following a meal. Knowing of no
explanation for this, we ran a short series of pro-
thrombin time levels (Smith bedside whole blood
method) on normal individuals immediately be-
fore eating and again an hour afterwards. The
results are shown in Table I.
As a variation, we also ran a series before and
after an all-vegetable meal (Table II).
These tests suggest diet as an important factor
in precipitating the coronary syndrome.
(Continued on Page 1003)
October, 1950
999
THE HEART IN FRIEDREICH'S ATAXIA
M. EUGENE FLIPSE, M.D., THOMAS J. DRY. M.B.. and HENRY W. WOLTMAN, M.D.
Rochester, Minnesota
TIJ’ATTY infiltration of the heart was noted by
Friedreich in the original description of the
disease that still bears his name. This was in
1863. The hearts in which he noted these changes,
however, were those of patients who had died of
typhoid fever, and there is no way of knowing
whether the changes which were noted were due
to Freidreich’s ataxia or to typhoid fever. The
occurrence of cardiac failure as a terminal event
in this disease was emphasized by Pitt as early
as 1886. From this time on, scant reference8’9
was made to the cardiac manifestations of Fried-
reich’s ataxia until the report by Loiseau in 1938.
He reviewed the literature and found reports of
40 cases in which there were cardiac abnormali-
ties. It was his belief that these cardiac abnor-
malities were incidental in some cases and specific
to the disease in others.
In 1942, Evans and Wright reviewed the liter-
ature and reported on the electrocardiographic
findings in Friedreich’s ataxia. Russell in 1946
gave a detailed and accurate account of the path-
ologic changes found in the hearts of persons
affected with this disease. Since then, scattered
reports5’10,17 have further emphasized the involve-
ment of the heart in Friedreich’s ataxia. From
the evidence that is available, it is clear that cer-
tain cardiac abnormalities are definitely related to
Friedreich’s ataxia. These do not include such
disorders, either acquired or congenital, which
exist coincidentally, or the myocarditis secondary
to intercurrent viral or bacterial infection which
may occur in persons who have Freidreich’s
ataxia.
The usual clinical manifestations indicative of
myocardial involvement are disturbances of
rhythm and myocardial insufficiency terminating
in congestive heart failure. Complete heart block
with Stokes-Adams syndrome has been observed
by Evans and Wright in siblings aged eighteen
and twenty-two years. Piron believed angina
pectoris was present in two brothers he observed.
Examination of the heart may reveal any of
the cardiac arrhythmias alone or in various com-
Dr. Flipse is a Fellow in Medicine, Mayo Foundation, Dr.
Dry is with the Division of Medicine, and Dr. Woltman with
the Department of Neurology and Psychiatry, Mayo Clinic,
Rochester, Minnesota.
binations. The heart may or may not be en-
larged, and, in those patients who have acquired
a kyphoscoliosis, it is displaced. Systolic and
diastolic murmurs have been observed infrequent-
ly. Hejtmancik, Bradfield and Miller emphasized
the diastolic murmurs heard in their twro cases and
in several cases reported in the literature, but
murmurs of any type, especially diastolic, are the
exception rather than the rule and are due to
cardiac dilatation rather than to valvular disease.
The roentgenologic appearance of the heart is
variable. The heart may be of normal contour
or it may be globular ; it may show varying de-
grees of left ventricular enlargement or general-
ized dilatation. In general, cardiac enlargement or
dilatation is seen only late in the disease, and in
association with far-advanced neurologic disease.
The electrocardiographic abnormalities are of
two distinct groups :11,1S those showing disturb-
ances in impulse initiation and transmission, and
those showing alteration of the ventricular com-
plex. The former group includes such arrhyth-
mias as paroxysmal auricular tachycardia, ven-
tricular tachycardia, auricular fibrillation, auricu-
lar flutter, varying degrees of auriculoventricular
block including first degree, second degree and
complete heart block and the Wenckebach phe-
nomenon, right bundle branch block, and various
combinations of these disorders. The recorded
observations are not sufficient to permit one to
make a statistical analysis, but paroxysmal auricu-
lar tachycardia and auricular fibrillation are more
commonly encountered than any other arrhythmia.
The modifications of the ventricular complex
include slurring or low voltage of the QRS com-
plex, deep Q waves, elevation or depression of
the ST segment, and sharp, pointed, iso-electric
diphasic or inverted T waves in one or more
leads. These abnormalities may occur alone or in
any combination. Great emphasis has been placed
on the occasional finding of a Q± Tx or Q3 T3
pattern simulating that found with anterior and
posterior myocardial infarction, respectively, and
on Tj or T3 patterns with “coronary type” T
waves. However, when studies with multiple pre-
cordial leads were made,6’17 evidence of a local
myocardial lesion was always lacking.
1000
Minnesota Medicine
THE HEART IN FRIEDREICH'S ATAXIA— FLIPSE ET AL
The study of Evans and Wright of 38 patients
with Friedreich's ataxia is significant in that they
included patients whose disease from the neuro-
logic standpoint was less far advanced than that
of patients reported by other authors. They
found definite abnormalities in the electrocardio-
gram of twelve of these patients, and, in all but
one, who had complete heart block, the abnormali-
ties were confined to the QRS complex. The
changes were chiefly inversion of the T wave
in one or more leads. Occasionally, all the limb
leads showed these changes, and, in addition,
some abnormalities occurred in widely separated
precordial leads. They found that absent tendon
reflexes and extensor responses of the plantar
reflex, indicating more advanced neurologic dis-
ease, were more common in patients with abnor-
mal electrocardiograms. Generally speaking, neu-
rologic signs were more widespread in the pa-
tients who had the most conspicuous electrocar-
diographic changes. Electrocardiographic abnor-
malities also occurred more frequently in cases
in which there was a family history of Fried-
reich’s ataxia, and, finally, there was a marked
tendency for members of the same family to
have similar electrocardiographic patterns.
The pathologic changes considered by Russell
to be characteristic although not pathognomonic
consist of patchy loss of muscle fibers, infiltra-
tion with round cells and leukocytes, hypertrophy
of muscle fibers, and separation of these fibers
by an increase in fibrous or collagenous inter-
stitial tissue. Pericarditis, endocarditis or or-
ganic valvular deformity was not noted by her.
The presence of an interstitial myocarditis had
been mentioned in a few reports before12,13’16’18
and since5’10 this study by Russell. She ex-
pressed the opinion that a focal, piecemeal coagu-
lation necrosis of the muscle fibers takes place
and is followed by cellular infiltration. As a re-
sult, the fibers are ultimately replaced by collag-
enous tissue, and the surviving muscle fibers un-
dergo compensatory hypertrophy. This continues
over a long period of time, until heart failure
develops. At this terminal stage, a severe fatty
degeneration is usual.
The theories advanced concerning the etiology
and pathogenesis of the myocarditis and arrhyth-
mias include the bulbar, the coronary artery, the
infectious and the toxic theories.11,15
The bulbar theory, favored by the French,1’2’8,9’19
is based on the occasional association of injury
October, 1950
of the vagal nuclei and evidence of imbalance
of the autonomic nervous system, such as paroxys-
mal cardiac arrhythmias, Cheyne-Stokes respira-
tion, episodes of acute abdominal pain with ileus,
and disturbances in temperature control, urine
formation and sweating mechanism. However,
these clinical findings are not present in the ma-
jority of cases, and Russell was unable to find
evidence of injury of the vagal nuclei in her cases.
The coronary artery theory is based on the
superficial resemblance of the described electro-
cardiographic changes* to the patterns seen in myo-
cardial infarction.4 However, complete electro-
cardiographic studies with multiple precordial
electrodes show no evidence of the focal type of
myocardial injury6’17 seen in myocardial infarc-
tion. Coronary artery disease was not evident at
necropsy,5’10’12’13’16’18’20 and injection of the coro-
nary vessels showed no obstruction in even the
finer ramifications of the coronary vessels.14
While it is impossible to prove that the myo-
carditis is not the result of either old or a recent
infection so mild as to escape notice, its high in-
cidence in patients with Friedreich’s ataxia and
its complete absence in unaffected members of the
same family suggest that this is not the case. The
progressive nature of the myocarditis over a pe-
riod of several years is more suggestive of the
continued action of some unknown agent than
it is of the single insult of an acute infection.
On the basis of pathologic findings, Russell, Fam-
brior, and Lannois and Porot concluded that the
myocarditis is a result of toxins instead of infec-
tion. Available evidence suggests that the most
valid theory is that the myocarditis is due to the
action of an unknown toxin on heart muscle which
may be abnormally susceptible to that toxin be-
cause of hereditary influences. It cannot be
denied that purely neurogenic influences could be
a factor in the production of the arrhythmias3 but
it is not necessary to postulate this mechanism in
view of the presence of diffuse morphologic
changes in the myocardium.
Contrary to current teachings that patients with
Friedreich’s ataxia die of intercurrent infection,
it would seem that death due to an associated
myocarditis is not infrequent. The appearance
in these patients of any cardiac abnormality,
either clinical, radiographic or electrocardiogra-
phic, is probably indicative of a poor prognosis.
Certainly, cardiac enlargement, a major arrhyth-
mia or congestive heart failure usually means
1001
THE HEART IN FRIEDREICH’S ATAXIA— FLIPSE ET AL
death within a year or two. The course of the
disease moreover does not seem to be influenced
by the usual measures which are ordinarily ef-
fective in the control of congestive heart failure.
& b
Fig. 1. a , Electrocardiogram of patient in case 1; b , electro-
cardiogram of patient in case 2
Despite this a trial of therapy including digitaliza-
tion, diuretics and quinidine in selected cases
seems worth while.
Report of Cases
Case 1. — An eighteen-year-old white man, who was
a high school graduate, was brought to the Mayo Clinic
on August 4, 1949, because of difficulty in walking.
He had been delivered with the aid of forceps but
his neonatal and infancy development had been normal.
At the age of six years, it had teen noted that he
was unable to run, jump or hop and that he had diffi-
culty in walking because of unsteadiness and inco-ordi-
nation of the ankles. Soon thereafter, slight inco-ordi-
nation of the upper extremities had been noted. These
difficulties had progressed gradually without remission
during the subsequent twelve years. His general health
had been excellent. He had not had any cardiorespiratory
symptoms, or indeed any symptoms except those refer-
able to the neurologic disorder.
Physical examination revealed an adequately developed
and nourished white male of 18 years with moderate
kyphoscoliosis but no deformity of the feet. The car-
diorespiratory system was completely normal as were
the results of the remainder of the general examination.
Neurologic examination revealed a marked ataxia, ab-
sence of all tendon reflexes, and bilateral extensor re-
sponses of the plantar reflex. It also revealed gross
inco-ordination with dysmetria and adiadokocinesis.
Romberg’s sign was present. The joint sense in the
great toe was absent, and there was delayed pain sense
in the feet. Nystagmus was absent. The ocular fundi
were normal.
The results of routine laboratory tests and roentgeno-
graphic examination of the heart, lungs, head and
pelvis were normal except for the presence of kyphosco-
liosis. The electrocardiogram (Fig. 1 a) was abnormal,
for it showed right axis deviation, occasional auricular
extrasystoles, notched QRSj, slurred QRS3, inverted
T, and T3 and diphasic T in lead 'Vg. The T wave
was positive in leads V and V3.
A diagnosis of Friedreich’s ataxia with myocarditis
was made.
Case 2. — The twelve-year-old brother of the patient
in Case 1 was also seen at the same time. He had
nearly identical but milder symptoms. The onset of his
disease was uncertain but it probably had occurred when
he was between 6 and 8 years of age. It then had
been noticed that he was awkward in running and walk-
ing and often stumbled or fell. There had been little
or no progression of his symptoms since they first had
been noted. As with the brother, there was complete
absence of cardiorespiratory and other symptoms.
The results of general physical examination were
normal except for the presence of slight lumbar scoliosis.
Neurologic examination revealed less marked ataxia and
inco-ordination, but the same reflex changes as were
present in the older brother, namely, absent tendon re-
flexes and bilateral extensor plantar reflexes. Sensa-
tion, however, was normal. There were slight nystag-
moid motions but definite nystagmus was not present.
The results of routine laboratory tests and roent-
genographic examination of the heart, lungs, head and
spinal column were normal except for the presence of
slight lumbar scoliosis. The electrocardiogram (Fig.
lb) was even more abnormal than that of his brother.
It showed right axis deviation, slurred Q'RS , inverted
P3, inverted T, and T , inverted T and elevation of the
ST segment in leads V and V and diphasic T in lead
Vg.
The diagnosis in this case also was Friedreich’s ataxis
with myocarditis.
The parents and two remaining siblings, aged thirteen
and sixteen years, were then examined. None had
symptoms of neurologic or cardiorespiratory disease.
There was no evidence of Friedreich’s ataxia, pes cavus
or cardiac disease. Their electrocardiograms were all
normal.
Comment
Our observations on these two brothers are
partly in agreement with those of Evans and
Wright in that the two neurologic signs most fre-
quently seen in patients with electrocardiographic
1002
Minnesota Medicine
THE HEART IN FRIEDREICH’S ATAXIA— FLIPSE ET AL
abnormalities, namely, an absence of tendon re-
flexes and an extensor response of the plantar re-
flex, were present in both cases.* They represent
another example of the observation that afflicted
members of one family tend to have similar elec-
trocardiographic patterns. We have no explana-
tion for the finding of more marked electrocardio-
graphic changes in the younger of the two patients
in whom neurologic damage was less marked,
but emphasize it because it is contrary to previous
experience. The extension of electrocardiographic
abnormalities across the entire precordium in this
latter case gives further support to the belief that
most, if not all, of the cardiac abnormalities as-
sociated with Friedreich’s ataxia are due to a
diffuse myocarditis. The cause of this myocardi-
tis is unknown but it is probably of toxic cause.
*Since this paper was completed, the report of G. W.
Manning (Cardiac Manifestations in Friedreich’s Ataxia.
Am. Heart J., 39:799-816 [June] 1950) has been pub-
lished. It emphasizes the clinical and electrocardio-
graphic aspects of the cardiac arrhythmias and heart
failure noted in four of six patients with Friedreich’s
ataxia. Myocarditis similar to that described by Russell
was found at necropsy in one case.
References
1. Benet, E. : Un caso de asociacion de enfermedad de Fried-
reich con cardiopati'a. Rev. clfn. espan., 12:332-335, (Mar.
15) 1944.
2. von Bogaert, A., and von Bogaert, L. : A propos des
alterations de l’electrocardiogramme dans la maladie de
Friedreich. Arch. d. mal. du coeur., 29:630-642, (Oct.)
1936.
3. von Bonsdorff, Bertel: Neurogenic heart lesions. Acta
med. Scandinav., 100:352-389, 1939.
4. Debre, Robert; Marie, Julian; Soulie, P., and de bont-
Reaulx, P. : Modifications ele^trocardiographioues chez un
enfant, atteint de maladie de Friedreich, et chez son iiere.
Type coronarien du trace electrique chez l’enfant (5). Bull,
et mem. Soc. med. d. hop. de Paris, 1 : 749-7 56, (May) 1936.
5. Ellwood, W. W. : Friedreich’s ataxia with unusual heart
complications. California Med., 68:296-298 (Apr.) 1948.
6. Evans, William and Wright, Gordon: The electrocardiogram
in Friedreich disease. Brit. Heart J., 4:91-102, 1942.
7. Friedreich, N. : Ueber degenerative Atrophie der spinalen
Hinterstrange. Virchows Arch. f. path. Anat., 26:391-419;
433-459, 1863.
8. Guillain, Georges, and Mollaret. Pierre: Le syndrome car-
diobulbaire de la maladie de Friedreich. Une des causes
frequentes de la mort dans cette affection. Presse med.,
2:1621-1624, (Oct.) 1932.
9. Guillain, Georges, and Mollaret, Pierre : Maladie de Fried-
reich avec alterations electrocardiographiques progressives et
solitaires. Bull. et. mem. Soc. med. d. hop. de Paris,
2:1577-1581, (Nov.) 1934.
10. Hejtmancik, M. R.; Bradfield, J. Y., Jr., and Miller, G. V. :
Myocarditis and Friedreich’s ataxia. A report of two cases.
Am. Heart J., 38:757-765, (Nov.) 1949.
11. Joselvich. Miguel: Las manifestaciones cardiovaseulares
de la enfermedad de Friedreich. Prensa med. argent, 28:
1160-1167, (May 28) 1941.
12. Lambrior, A. A.: Un cas de maladie de Friedreich avec
autopsie. Revue neurol., 22: (19 pt. 2) :52^-540, 19*11.
13. Lannois, M., and Porot, A. : Le coeur dans la maladie
de Friedreich. Revue, med., 853-861, 1905.
14. Laubry, C., and de Balsac, R. H. : A propos des troubles
cardiaques de la maladie de Freidreich (1). Bull, et mem.
Soc. med. d. hop. de Paris, 1 : 7 5 6 - 7 5 9 , (May) 1936.
15. Loiseau, J. : Les troubles cardiaques dans la maladie de
Friedreich. Theses de Paris. Jouve and Cie, Editors.
102 pp. 1938.
16. Pic, A., and Bonnamour, S.: Un cas de maladie de
Friedreich avec autopsie. Nouv. iconog. de la Salpetriere.,
17:126-135, 1904.
17. Piron, A.: La cardiopathie de la maladie de Friedreich.
Acta cardiol., 1:305-311, 1946.
18. Pitt, G. N. : On a Case of Friedreich’s Disease: Its Clini-
cal History and Postmortem Appearances. Guy’s Hosp.
Rep., 29:369-394, 1886-1887.
19. Rathery, F. ; Mollaret, P., and Stetne, J. : Lin cas sporadique
de maladie de Fr’edreich avec arythmie cardiaque et respira-
tion de Chevne-Stokes. Etude biologiaue et electrocardio-
graphique (1). Bull. et. mem. Soc. med. d. hop. de Paris,
2:1382-1388, (Oct.) 1934.
20. Russell, D. S. : Myocardits in Friedreich’s ataxia. J.
Path. & Bact., 58:739-748, (Oct.) 1946.
CORONARY THROMBOSIS IN THE YOUNGER AGE GROUPS
(Continued from Page 999)
This further observation was made. If the pa-
tient was allowed to smoke cigarettes, he frequent-
ly was threatened with a syndromal attack. On
suspicion, these few tests were run on normal
people (Table III).
From this meager evidence, it may be that cig-
arette-smoking acts not only to constrict the ar-
terial lumen but, what may be more dangerous,
to lower the prothrombin time level.
It is known, of course, that a high percentage
of people subjected to these same conditions, ten-
sion, dietary indiscretions, and smoking, survive
into an older age group. There must, then, be
some common factor that determines the precipi-
tation of coronary attacks at different ages. We
believe this factor to be the difference in pro-
thrombin time level. We believe that this differ-
ence in level is a hereditary factor, and that it
plays an important role in coronary attacks.
Therefore, we believe that coronary attacks are
predictable and preventable.
Assuming, then, that this reasoning is correct,
should it not be reasonable to assume that by rou-
tine testing, individuals prone to coronary disease
could be detected and prophylactically treated with
dicumarol to elevate the prothrombin time to a
satisfactory and safe level just as the diabetic in-
dividual can be detected and treated?
We realize, of course, that a prolonged research
would be required to establish the proof of this
reasoning. Even a few hundred selected people
tested and followed through the years should
establish the veracity of this, contention. We be-
lieve, however, that such research in prothrom-
bin time levels would be justified in an attempt to
prevent the colossal cost in heart deaths exacted
by our modem high-geared society.
October, 1950
1003
CHRONIC LEUKEMIC INFILTRATION OF THE GASTRIC WALL SIMULATING
PEPTIC ULCER
ROBERT H. CONLEY, M.D.
Mankato, Minnesota
and
J. ALLEN WILSON, M.D., Ph.D.
Saint Paul, Minnesota
np HE FIRST description of gastric involve-
meat in a case of apparent leukemia was given
by Briquet in 1838 and published in Cruveilhier’s
Atlas of Anatomy. In this case, the mucosa of
the stomach and bowel was thrown into folds
resembling cerebral convolutions. Since then, as
reported by Pearson, Stasney and Pizzolato,11 in
all descriptions of autopsies on lymphatic leu-
kemia patients, various authors have stressed
the diffuse involvement of the mucosa and sub-
mucosa of the stomach, usually without involve-
ment of the deeper layers. These authors report-
ed two similar cases.
Various pathologists since Cohnheim have rec-
ognized anatomical changes in various organs,
in leukemia, without changes in the blood. Cohn-
heim2 suggested the name "pseudoleukemia.”
Warthin15 designated the condition a generalized
or localized “aleukemic lymphocytoma.” Ewing3
observed : “The gastrointestinal tract is a seat of
a remarkable form of primary lymphoid hyper-
plasia which lacks the destructive character of
lymphosarcoma and fails to give lymphocytosis
of the blood. The process may be chiefly limited
to a portion of, or involve the whole of, the gas-
trointestinal tract, or it may be associated with
widespread lesions of most of the other lymphoid
structures.” Ewing3 designated this as “aleuke-
mic lymphomatosis.” Ikedar’ in 1931 described a
case of gastric tumor and infiltration thought to
be carcinoma, on whom a gastro-enterostomy Was
done. After five years the patient died of almost
generalized lymphatic leukemia and heart failure.
The entire gastrointestinal tract was involved.
In this case the infiltration extended out into the
muscularis and serosa. The mucosa in the upper
part of the stomach showed the thickened rugae
From the Department of Medicine, University of Minnesota
Medical School and the U. S. Veterans Hospital, Minneapolis.
Published with approval of Chief Medical Director. The
statements and conclusions published by the authors are the
result of their own study and do not necessarily reflect the
opinion or policy of the Veterans Administration.
Dr. Conley is former resident physician in internal medicine,
U. S. Veterans Hospital, Minneapolis, and University of Minne-
sota Medical School.
Dr. Wilson is Clinical Assistant Professor of Medicine, Uni-
versity of Minnesota Medical School, and consultant in internal
medicine, U. S. Veterans Hospital, Minneapolis.
described by Briquet. Ikeda5 found, in 12,396
autopsies at the University of Minnesota, seventy-
seven cases of leukemia of which fifty-one were
of the lymphatic type and twenty-six of the mye-
logenous type. Of the former, only two cases
showed local nodular elevation or thickening of
the gastric wall, and two showed ulcers. In the
myelogenous type, only one showed a local thick-
ening of the mucosa. Grossly these lesions could
not be differentiated from those of Hodgkin’s
disease or of lymphosarcoma. Ikeda5 recom-
mended abandoning use of the term “pseudo-
leukemia gastro-intestinalis” since it included all
of the above types of lymphoblastomata. Accord-
ing to Mead,8 the pathologic character of lympha-
tic leukemia of the gastro-intestinal tract varies
from slight swelling of the mucous membrane and
lymph follicles to extensive hyperplasia of the
lymphoid tissue of the entire gastro-intestinal
tract, with associated generalized lympadenopathy.
The process may be limited to one organ or to the
whole gastro-intestinal tract. Polypoid formations
anywhere in this tract are common. The stomach
mucosa often exhibits enlarged convolated rugae.
Ulceration of the mucosa is infrequent. Mead8
states that the muscularis is uniformly uninvolved.
Gastro-intestinal Hodgkins Disease is uncommon
but ulceration is relatively common in this dis-
ease as it is in lymphosarcoma. In the leukemias,
as recorded by Paul and Hendricks,10 one often
finds small areas of thickening and infiltration
of the mucosa, and in such thickened areas the
mucosa may become denuded resulting in shallow
ulceration and hemorrhage.
Forkner4 states that pseudoleukemia (aleuke-
mia) seems more likely to give gastro-intestinal
involvement than do cases where the blood pic-
ture is positive for leukemia. He also emphasized
the difficulty of differentiating the gross altera-
tions in the gastro-intestinal tract caused by leu-
kemia, aleukemia, lympho-sarcoma and Hodgkin’s
Disease. In contrast to the infrequentcy of leu-
kemia of the gastro-intestinal tract, O’Donohue
and Jacobs9 collected a series of 100 cases of
1004
Minnesota Medicine
SIMULATED PEPTIC ULCER— CONLEY AND WILSON
lymphosarcoma of the stomach reported by vari-
ous authors from 1937 through 1946. Poer12,
Macchi7 and Koucky, Beck and Atlas6 have given
separate descriptions of acute perforations of
lymphosarcomatous ulcers of the stomach and
duodenum which presented clinically as peptic
ulcers. This is extremely rare in leukemia.
The intensity of symptoms in lymphatic leu-
kemia of the gastro-intestinal tract seems to have
no constant relationship to the extent of the
pathologic changes. The most extensive lesions
may be symptomless. Achlorhydria is an occa-
sional finding. Areas of hemorrhage or small
ulcers due to secondary infection may occur in
some cases. There may be profuse hematemesis,
bloody diarrhea, loss of appetite, weight loss
and weakness. An abdominal mass may be pres-
ent. These symptoms cannot be differentiated
from those of other lymphoblastomata or of car-
cinoma. The x-ray is of little value in diagnos-
ing any lymphoblastoma ; most cases have been
called carcinoma. Ikeda5 states that the demon-
stration of deep heavy rugal impressions on the
x-ray, together with a postive blood picture or
biopsy, may be helpful in diagnosis of gastric
leukemia but he emphasized that there is no pa-
thognomonic roentgen picture of the stomach in
the gastric manifestation of lymphatic leukemia.
The use of the gastroscope in the diagnosis of
lymphoblastoma of the stomach was introduced
by Schindler14' in 1922. However, he stated in
his first edition in 1937 that no case of leukemia
or aleukemia of the stomach had ever been ob-
served gastroscopically. In his 1950 edition he
states that gastroscopy often yields important re-
sults in leukemia. Hypertrophic gastritis may be
seen in myeloid leukemia and atrophic gastritis is
more apt to be seen in lymphatic leukemia. Leu-
kemic infiltrations are visible at times. Schind-
ler14 finds that the differentiation between Hodg-
kin’s disease, lymphosarcoma, leukemia, some
types of gastritis, carcinoma or syphilis of the
stomach cannot be made from the gastroscopic
picture alone. The diagnosis can be made only
if biopsy of a lymph node reveals the typical pic-
ture and a diffuse stiff infiltration is seen. Leu-
kemic infiltration and Hodgkin’s disease of the
stomach will be suspected only if other signs of
these conditions are present elsewhere. In diffi-
cult cases, Schindler14 recommends biopsy at
laparotomy without the intent of resection. The
biopsy should be taken from the area which
was suspicious at gastroscopy. The abdomen then
is closed and paraffin microscopic studies of the
biopsied tissue are run. In lymphoblastoma, ir-
radiation then is used. If syphilis is found, treat-
ment is started. Carcinoma is promptly resected.
Renshaw and Spencer,13 in 1947, found no
reports available of the gastroscopic appearance
of leukemic, pseudoleukemic or Hodgkin’s infil-
trations of the stomach, but judging from autopsy
descriptions of such lesions, these authors were
of the opinion that the lesions would be indis-
tinguishable from carcinoma or lymphosarcoma.
They described the gastroscopic appearance of
eight cases of gastric lymphosarcoma, in six
of which a diagnosis of infiltrating or ulcerative
carcinoma was made. In the other two cases, cer-
vical lymph nodes pointed to the proper diag-
nosis. They state that there is no characteristic
gastroscopic picture of lymphoblastoma.
The gastroscopic examination of patients with
malignant lymphomata at the University of Iowa
has been well described by Paul and Hendricks.10
All patients at that institution who are found to
have any type of lymphoma are routinely gastro-
scoped. From 1941-1947, 53 patients with ma-
lignant lymphoma were found by such examina-
tion to show characteristic involvement of the
stomach while during this same period only fif-
teen cases were found at autopsy to have gastric
lymphomatous lesions. Of these fifty-three pa-
tients, twenty-two had chronic lymphatic leukemia,
ten had myelogenous leukemia, one had monocy-
tic leukemia, and twenty had Hodgkin’s disease.
There was no correlation in these cases between
the type and duration of symptoms, degrees of
free HC1 or the extent of involvement. The
ages ranged from nineteen to seventy-five years.
The authors state that the gastroscopic picture
was no indication of the type of hematopoietic
neoplasm present. The most frequent gastroscop-
ic finding was a granular mucosa suggestive of
“goose pimples,” seen usually on the anterior
wall near the angulus (Depth II). The next most
common site was the posterior wall of the antrum.
These granular elevations appear as highlights
on a dry mucosa and at times are 1 mm. in diam-
eter and large enough to project above the sur-
face. The same appearance was found in some
of these patients in the mucosa of the rectum and
sigmoid. Here they differ from the mucosal
findings in chronic ulcerative colitis in being
fewer in number and of larger size. The color
October, 1950
1005
SIMULATED PEPTIC ULCER— CONLEY AND WILSON
of the gastric mucosa in these cases varied with
the degree of anemia present and the mucosa
often presented gelatinous areas of edema with
small hemorrhages. The second type of lesion
Fig. 1. Large penetrating gastric ulcer on the lesser curvature
just above the incisura. It appeared benign both to the roentgen-
ologist and to the gastroscopist.
seen through the gastroscope in these lymphoma
cases was a nodular mass, not over 1 cm. in diam-
eter, surrounded by abnormal appearing mucosa,
often hemorrhagic. These usually were near the
cardia, more often on the posterior wall. One
such nodule was later examined at necropsy and
found to be an infiltration of lymphatic leukemia.
The third, and least common type of lesion seen
in these cases was an ulceration. Two such ulcers
were found, both in Hodgkin’s disease, and both
were on the greater curvature. The authors con-
clude that hematopoietic neoplasms involve the
stomach with greater frequency than the medical
literature would indicate. Since the mucosa and
submucosa are involved, gastroscopic evaluation
is made possible and is very helpful.
Very recently, Benedict1 has reported on the
use of the flexible operating gastroscope in the
diagnosis of lesions of the stomach. He reported
such biopsies to be of definite value in the diag-
nosis of lymphoma, carcinoma and gastritis. Six-
ty-three biopsies had been done without accident
1006
or complications. For obvious reasons, the meth-
od has not been used or recommended for dif-
ferentiation of benign from malignant gastric
ulcers. Since lymphoma is usually a diffuse
process, Benedict1 thinks that a negative biopsy
probably excludes this diagnosis with reasonable
certainty. (In view of the work just described,
by Paul and Hendricks,10 such an assumption
might be open to question.) If doubt exists and
lymphoma seems likely clinically, gastroscopy and
biopsy should be repeated, taking the latter from
a new area of the gastric mucosa.
As to treatment of the gastric lesions of hema-
topoietic neoplasm, Paul and Hendricks10 report
that irradiation and nitrogen mustard had little,
if any, effect on the gastric involvement. In
some cases the lesions progressed after these
agents were used. Watkins,16 however, has found
considerable benefit from the use of nitrogen mus-
tard in adequate dosage. Schindler14 recommends
surgical biopsy and if this is positive for lympho-
ma, irradiation is then given. Mead8 stated that
the best results in treating lymphatic leukemia of
the stomach were obtained by combined surgery
and x-ray therapy.
Case Report
A white, retired postal employe, aged fifty-nine, was
admitted to the Minneapolis Veterans Hospital on Octo-
ber 7, 1949. The patient was complaining of general-
ized malaise, sore throat of two weeks’ duration, rhini-
tis and sinusitis of three weeks’ duration and inability
to maintain himself on his ulcer regime at home.
Past history revealed that his first admission to die
hospital was in 1931 at which time a diagnosis of chronic
duodenal ulcer was made; the diagnosis was confirmed
by roentgenologic study. In 1940, he was readmitted
because of persistent vomiting, epigastric pain and a
weight loss of 25 pounds. A duodenal ulcer was again
demonstrated and the symptoms promptly subsided
with conservative therapy. Precordial pain and short-
ness of breath were listed as additional complaints.
A severe attack of precordial pain, with radiation of
pain into the left arm and hand, associated dyspnea and
profuse diaphoresis necessitated emergency hospitaliza-
tion in 1945. Therapy was exercised in keeping with
a diagnosis of acute coronary occlusion. However, serial
electrocardiograms failed to reveal infarction, or evi-
dence for coronary insufficiency. Numerous electrocard-
iographic studies done since that date have continued to
demonstrate normal tracings.
Precordial pain of ten days’ duration, partially re-
lieved by sublingual nitroglycerine, was the inciting
cause of his readmission in June, 1947. Laboratory
studies at this time revealed a persistently elevated
white blood cell count ranging between 17,000 and 32,000.
Biopsy of a small node in the right axilla revealed
Minnesota Medicine
SIMULATED PEPTIC ULCER— CONLEY AND WILSON
chronic lymphatic leukemia ; this was confirmed by
bone marrow biopsy. X-ray films of the upper gastro-
intestinal tract were again made, which revealed a
filling defect in the midportion of the body of the
stomach. This was thought to be of questionable
ately edematous and only slight injection surrounded
the rim of edema. Gastroscopy and x-ray studies
were carried out at two-week intervals. Examinations
done seven weeks after the first examination revealed
complete healing of the previously reported ulcer.
Jy
Fig. 2. Microscopic section through the base of the gastric
ulcer. Necrotic debris, proliferating fibroblasts, and an under-
lying diffuse lymphocytic infiltration are noted.
Fig. 3. One of the large collections of lymphocytes found in
the submucosa. Others were found in the muscular layer and in
the serosa.
significance; duodenal deformity was again noted. From
June, 1947, until January, 1949, follow-up studies at three-
month intervals were carried out. At the time of each
reexamination, precordial pain and epigastric distress
continued to be the main complaint. During this in-
terval the spleen and liver became palpable and the
lymph nodes became more prominent. Repeated white
blood cell counts were in the range between 60,000 to
80,000 with 80 to 90 per cent mature lymphocytes ; oc-
casional immature lymphocytes were observed.
During the latter part of January, 1949, the patient
was again admitted as an emergency because of nausea,
vomiting, 10 pound weight loss, epigastric distress, and
precordial pain. An upper gastro-intestinal study was
done and a gastric ulcer was observed on the lesser
curvature and posterior wall (Fig. 1). A crater in the
duodenal bulb was also noted. Gastroscopy was car-
ried out and a large penetrating gastric ulcer on the
lesser curvature about one inch above the incisura was
observed. The crater was approximately 1.75 cm. in
diameter. The membrane lining the crater had a smooth
greyish white color. The rim of the crater was moder-
Despite visits at two months’ intervals, the patient
sought emergency readmission in August, 1949, because
of intractable epigastric distress, nausea, vomiting and
a 15-pound weight loss, which had occurred in a period
of four days. Fluid balance was restored and ulcer
management was continued. Nightly aspirations were
carried out and residual retention ranged from 50 c.c.
to 300 c.c. The patient was taught to use an Ewald
tube. It was decided that with lymphatic leukemia, and
coronary insufficiency, surgery should be deferred until
it was actually imperative to relieve obstruction. Gastro-
intestinal studies at this time demonstrated a minimal
residual of the gastric ulcer on the lesser curvature and
a duodenal deformity.
At the time of admission on October 7, 1949, physical
examination revealed a thin, undernourished male who
appeared acutely ill. The blood pressure was 142/76,
pulse 116, respirations 22, temperature 101.4° Fahrenheit.
The mucous membrane of the nose and throat were
congested and a purulent post-nasal drip was observed.
Signs of right upper lobe consolidation were present.
A soft systolic murmur was heard at the apex and the
October, 1950
1007
SIMULATED PEPTIC ULCER— CONLEY AND WILSON
heart was enlarged to the left. The liver and spleen
were palpable on deep inspiration. Tenderness and
muscle guarding were present in the midepigastric re-
gion. Shotty nodes were found in the cervical chains
bilaterally and both axillary and inguinal regions.
The hemoglobin was 12.1 grams, white blood cell
count 83,000 with 15 per cent neutrophils and 85 per
cent mature lymphocytes, sedimentation rate 98 mm.
per hour, serum proteins 6.7 grams With 4.4 grams of
albumen and 2.3 grams of globulin. Prothrombin time
was 100 per cent of normal. Bromsulfalein : 2 per cent
retention in 45 minutes. Serum bilirubin : 1 minute,
0.2 mg. per cent ; total, 0.5 mg. per cent. Gastric
analysis : total acid 44°, free acid 36°. Stools were
negative for ova, parasites and occult blood. Urinalysis
showed a trace of albumen and an occasional white
blood cell. Sputum cultures revealed the usual mouth
organisms. X-ray studies of the chest revealed a dif-
fuse infiltration in the right upper lobe. Electrocardio-
gram again showed a normal tracing.
The patient was placed on penicillin and the fever
promptly subsided ; however, pleural effusion developed
and required repeated aspirations. Cultures of the
aspirated fluid were repeated negative. Following sub-
sidence of the inflammatory process an upper gastro-
intestinal study was carried out and an ulcer crater was
visualized on the lesser curvature. Gastroscopic study
at this time demonstrated a one cm. crater, penetrating
in nature, 2 cm. above the incisura slightly to the pos-
terior wall side on the lesser curvature. The ulcer crater
was covered by a smooth glistening gray membrane.
No heaping up of the ulcer margin was seen ; a slight
rim of edema surrounded the crater.
In spite of intensive therapy the crater continued to
enlarge and the patient was transferred to the surgical
service. Two days prior to scheduled surgery, the
patient became faint, weak and passed numerous tarry
stools. The hemoglobin level dropped to 7.9 grams.
Three thousand c.c. of whole blood were required to
restore his hemoglobin level to 14 grams. Subtotal
gastrectomy wfas carried out and the postoperative
course was uneventful.
Examination of the resected portion of the stomach
l'evealed a depressed area on the lesser curvature wdiich
appeared to be a healed ulcer. Immediately adjacent to
this area, an elliptical ulcer with slightly rolled edges
1.2 by 2.5 cm. was present. The base of the ulcer was
necrotic but was not indurated. In the pyloric portion
of the stomach, on the anterior wall and midway between
the greater and lesser curvature, an old healed ulcer
was represented by puckering at this spot.
Microscopic studies revealed the base of the ulcer to
be composed of necrotic debris and some slight pro-
liferating fibroblastic tissue (Fig. 2). The ulcer was
relatively superficial, extending only into the inner
muscular coat. The mucosa became thinner and just
faded off at the edge of the ulcer. Underlying the
ulcer was a diffuse lymphocytic infiltration which ex-
tended through the musculature and became particularly
heavy in the serosa. Large collections of lymphocytes
were found in the submucosa, musculature and serosa
of the stomach wall near the ulcerated area, (Fig. 3)
and similar collections were found in all portions of the
stomach sectioned, Whether near or far from the area
of ulceration. These masses of lymphocytes were found
diffusely throughout the stomach wall and were arranged
in such discrete units that they did not give the ap-
pearance of an inflammatory process, but rather of leu-
kemic infiltration of the stomach wrall. Abdominal nodes
removed at the time of surgery showed the normal
architecture to be completely wiped out by a homo-
geneous sheet of lymphocytes consistent with a diag-
nosis of lymphatic leukemia.
Conclusions
1. The literature is reported describing the
gastric manifestations of lymphatic leukemia.
2. Ulceration of the gastric mucosa is extreme-
ly rare in lymphatic leukemia of the stomach.
When present it is almost always of a superficial
type, amounting only to small erosions. Deeper
ulcers, resembling peptic ulcers in a nonleukemic
stomach, have not been described in the literature.
3. A case is reported where recurrent ulceration,
resembling peptic ulceration, both by x-ray and
gastroscopy, was found on the lesser curvature
of the stomach in a patient with proved systemic
lymphatic leukemia. Gastric resection was finally
performed. The pathological examination of the
resected specimen revealed typical chronic lym-
phatic leukemia infiltration of all layers of the
gastric wall.
References
1. Benedict, E. B. : The differential diagnosis of benign and
malignant lesions of the stomach by means of the flexible
operating gastroscope. Gastroenterology, 14:275-279, 1950.
2. Cohnheim, J. : Ein Fall von Pseudoleukamie. Virch. Arch. f.
Path. Anat., 33:451-454, 1865.
3. Ewing, James: Neoplastic Diseases. Philadelphia: W. B.
Saunders Co., 1922.
4. Forkner. C. E. : Leukemic Manifestations in the Gastro-
intestinal Tract. Leukemia and allied disorders. New York:
The Macmillan Co., 101-104, 1938.
5. Ikeda, K.: Gastric manifestations of lymphatic aleukemia
(Pseudoleukemia gastro-intestinalis) . Am. T. Clin. Path.,
1:167-185, 1931.
6. Koucky, J. D., Beck, W. C., and Atlas, J.: Acute perfora-
tion of lvmpho-sarcomatous ulcer of the stomach. Ann.
Surg., 114:1112-1116, 1941.
7. Macchi, E. : Gastroenteric lymphosarcomatosis with initial
syndrome of gastric ulcer. Chirurgia (Milan), 1:145-158,
1946.
8. Mead, C. H.: Chronic lymphatic leukemia involving the
gastro-intestinal tract. Radiology, 21:351-365, 1933.
9. O’Donoghue, J. B., and Jacobs, M. B. : Primary lymphosar-
coma of the stomach; statistical summary and case report of
five-year cure. Am. J. Surg., 74:174-179, 1948.
10. Paul, W. D., and Hendricks, A. B.: Involvement of the
stomach in malignant lymphoma. Gastroenterology, 11:854-
860, 1948.
11. Pearson, B., Stasny, J., and Pizzolato, P. : Gastro-intestinal
involvement in lymphatic leukemia. Arch. Path., 35:21-28,
1943.
12. Poer, D. PL: Lymphosarcoma of the gastro-intestinal tract.
Surgery, 23:354-3 62, 1948.
13. Renshaw, R. J. F., and Spencer, F. M. : Gastroscopy and
lymphoma of the stomach. Gastroenterology, 9:1-5, 1947.
14. Schindler, R. : Gastroscopy, (Revised). University of Chi-
cago Press, pp. 250-350, 1950.
15. Warthin, A. S. : The neoplasm theory of leukemia with
report of a case supporting this view. Tr. A. Am. Phvs.,
19:421-432, 1904.
16. Watkins, C. H. (Mayo Clinic): Personal communication to
one of authors (J.A.W.)
1008
Minnesota Medicine
CILIARY ACTION AND ATELECTASIS
A. C. HILDING. M.D.
Duluth, Minnesota
'"THE physiology and physics of the movement
of oxygen and other gases in the lungs seem
to be well understood. The partial tensions of the
gases in alveolar air have been measured, and the
observed physiologic steps are consistent \vith the
known laws of physics. Removal of entrapped air
under pathologic conditions in the lungs and else-
where is not so completely understood. For in-
stance, it seems to be, generally believed that the
air from a lung portion which becomes atelectatic
is removed by absorption alone. It is held that a
plug of mucus, of such great viscosity that the
cilia are unable to handle it, corks a bronchus and
that the air behind it is completely absorbed.5’9’10-11
Sometimes the opinion is ventured (seemingly
without any direct evidence) that ciliary action is
subnormal or has ceased entirely.
In many respects, this view appears to be es-
sentially correct. There seems to be no doubt that
air can be removed from an obstructed lung by
absorption alone. This has been demonstrated ex-
perimentally1’2-3 and seemingly happens in the
presence of tumors and some foreign bodies.
There are, however, discrepancies which make one
suspect that other factors are involved. Pathol-
ogists and endoscopists sometimes find masses of
very viscid mucus, but, more often, it is soft. The
negative pressure associated with atelectasis may
be considerable — 34 mm. of mercury has been
measured. It is sufficiently strong to move the
mediastinum to one side or the other and to prac-
tically immobilize the chest wall. One would sup-
pose that the soft mucus would slide down into
the area of negative pressure, but this it does not
do. The absorption of air experimentally requires
sixteen hours,1,2’3 and postoperative atelectasis de-
velops much more rapidly than that ; surgeons
have told me that it develops on the table. Thick,
viscid casts of mucus, which are incorporated in
the bronchial wall, do form in asthma and are
demonstrable at necropsy. The result, however, is
not atelectasis but rather the opposite, emphysema.
That cilia cannot handle viscid mucus appears to
be in error also. Tests which I made in the open
frontal sinus of an anesthetized dog indicated
Presented at the annual meeting of the Minnesota State Medical
Association, Duluth, Minnesota, June 12, 19S0.
that viscid mucus can be removed more readily
than very thin mucus. In these experiments, it
was lifted en masse from the bottom of the sinus
and carried to and through the ostium, occluding
the latter completely during its passage.
It has been taught that the bronchial tree in-
creases its cross-sectional area with each sub-
sequent branching and that a composite bronchial
tree would look like an inverted funnel. If this
concept were accurate it might be possible that a
viscid plug of mucus, carried upward in the bron-
chial tree, would become lodged in the narrowed
stream bed. My son and I made some measure-
ments, however, of the bronchial tree which in-
dicated that the concept of the inverted funnel
applied to the bronchial tree is not correct, at
least in bronchi larger than 1.5 mm.
The question arises whether, according to the
known laws of physics, it would be possible for
the air to be completely absorbed from an ob-
structed lobe subjected to a negative pressure of
the magnitude found in atelectasis.
It may be of value to review the steps by which
air is absorbed from different portions of the body
in the light of known physical laws. We natural-
ly think of the lungs first. The tidal respiratory
flow while at rest is about 500 c.c. ; 150 c.c. of
each breath remain in the dead space of the bron-
chial tree; the other 350 c.c. flow into a residual
volume of 2,500 c.c. Here a rather complex situa-
tion is set up due to the differences in the partial
gas tensions in alveolar air and atmospheric air.
Diffusion is a necessary step in bringing the fresh
oxygen to the alveolar wall where exchange of
gases with the blood takes place. Oxygen mole-
cules move at the rate of about 200 meters per
second at room temperature ; however, they bump
into other molecules so frequently that the diffu-
sion rate is very much smaller.
A physicist friend has given me the following
formula for the diffusion of air at standard con-
ditions of temperature and pressure: r = 3.5 x
the square root of t (“r” represents the average
mean distance in centimeters traveled by the mole-
cules as though they emerge from a point and
move outward in all directions without obstruc-
October, 1950
1009
CILIARY ACTION AND ATELECTASIS— HILDING
tion and “t” is the time in seconds). Working
this out, r = about 35 mm. per second. The
alveoli are approximately 0.2 mm. in diameter or
0.1 mm. in radius. This means that, during the
Fig. 1. Diagram representing an air bubble injected into the an-
terior chamber of the eye. The figures in the column under Bi
are the partial pressures of the various gases contained in the
injected air. Column VB gives the values in venous blood. It is
assumed, for the purposes of this, study, that the values are the
same in the aqueous humor of the eye, although they probably
differ somewhat. Since CO2 diffuses more rapidly than the other
gases, this gas would pass from the aqueous into the bubble
faster than O2 would dissolve. Therefore, at first, the pressure
would increase, as indicated in Bx, if the volume should remain
unchanged. The exchange of the other gases would soon take
place as indicated between Bx and VB. Equilibrium would be
established at 705 mm. of pressure — if the volume should remain
constant. The volume, however, does not remain constant since
the yielding walls of the eye are subject to an atmospheric pres-
sure of 760 mm. The volume would shrink until the pressure
was equalized. Then the gas tensions would all be too high, as
in Bj, and movement of molecules would continue into the aqueous,
again causing a further fall in pressure. Equilibrium could not
be attained and all of the air would be absorbed.
one second which the air remains in the alveolus
during inspiration, an oxygen molecule starting
from the center of an alveolus could make the
trip to the wall about 350 times. The picture then
of the gases from the inflowing air (oxygen, car-
bon dioxide, nitrogen and water vapor) is that of
the contained molecules flying rapidly in all direc-
tions and making contact with the walls of the
alveolus from 1 to 400 times a second. The rate
of absorption into the blood would depend upon,
first, the nature of the interposed membranes ;
second, the comparative pressures of the gases in
the blood and in the alveolus and, third, the rela-
tive solubility of the gases in the blood plasma.
Let us take a simpler example, for the moment,
than that of the alveolus. In cataract surgery, we
sometimes inject air into the anterior chamber at
the end of operation in order to prevent adhesions
between the iris and the incision. From four to
six days are required for such a bubble in the
anterior chamber to be absorbed. Let us follow
the steps as we feel they must be, according to
physical law (Fig. 1).
The partial gas pressures in the atmosphere are
given about as follows: oxygen 158 mm. of mer-
cury, carbon dioxide 0.03 mm., nitrogen 597 mm.
and water vapor 5 mm. (water vapor, of course,
varies widely) making a total of 760 mm. of pres-
sure. The partial pressures of the aqueous are
between those of the arterial and the venous
blood ; oxygen is given at 40 to 45 mm. and car-
bon dioxide about 45 mm. The aqueous is pro-
duced in the ciliary body through a combination
of dialysis, filtration and secretion. Oxygen,
nitrogen and carbon dioxide molecules are rough-
ly about the same size as water and would, there-
fore, probably pass through the capillary walls,
the stroma and the endothelium of the ciliary body
about as rapidly as water, and, therefore, the con-
centrations would be much the same as in arterial
blood. (Again, a reservation must be made, re-
membering'that filtration may be interfered with
by the processes of secretion). The aqueous
serves the metabolic needs of the lens, portions of
the cornea and iris and probably other structures
as well. In this metabolism, it undoubtedly loses
oxygen and picks up carbon dioxide, as in the
metabolism of tissues everywhere. It leaves the
eye by several different routes, including the canal
of Schlemm, through which the aqueous is in
direct contact with venous blood with no inter-
vening membranous barrier.
Let us assume, for our purposes, that the gas
tensions present in the aqueous are the same as
those in the venous blood. Those given for the
venous blood are : oxygen 40 mm. of mercury,
carbon dioxide 46 mm., nitrogen 572 mm. and
water 47 mm., making a total of 705 mm., or 55
mm. less than that of the atmosphere. The fol-
lowing steps would occur during absorption of the
air bubble in the anterior chamber : The 0.03 mm.
of carbon dioxide would be rapidly increased to
46 mm., because the movement of carbon dioxide
is some thirty-five times as fast as that of' oxygen.
Meanwhile, the 158 mm. of oxygen would be re-
duced more slowly to 40 mm. The bubble would
first increase in size or pressure because of the
rapid movement of the carbon dioxide ; the nitro-
gen moves much more slowly than either oxygen
or carbon dioxide and, for purposes of simplifica-
tion, can be assumed to stand practically still. The
carbon dioxide, having reached equilibrium be-
fore the oxygen, would find itself at a higher ten-
sion in the bubble as the latter moved out. If the
bubble remained constant in size, the carbon
Minnesota Medicine
1010
CILIARY ACTION AND ATELECTASIS— HILDING
dioxide would move back into the aqueous and the
oxygen would continue to move into the aqueous
until equilibrium would be established with a net
loss in pressure of 72 mm. However, since the
eye is subjected to atmospheric pressure, dis-
regarding for our purposes the intraocular pres-
sure, the air bubble would not remain the same in
size but would shrink until the pressure again
equalled 760 mm. As soon as this happened, then
the tension of the carbon dioxide, oxygen and
the nitrogen would be greater in the bubble than in
the aqueous, so all three would again move from
the bubble into the aqueous — the carbon dioxide
very rapidly, oxygen much more slowly and the
nitrogen still more slowly. This would once more
be followed by shrinkage of volume and the whole
process would be repeated. Equilibrium would
never be established, and eventually all of the
gases in the bubble would be dissolved in the
aqueous.
Taking another example from our field of work,
negative pressure sometimes develops within the
sinuses. Assuming that the ostium should become
completely blocked while the sinus was still full of
air, through what physical steps would the gases
of the air pass and what would be the eventual
pressures? Conditions in the sinuses are far dif-
ferent from those in the alveolus of the lung or
those in the anterior chamber of the eye. In the
eye, the air is in direct contact with the aqueous,
there being no interposing membranes. In the
alveolar wall, there is at least one interposing
membrane — the capillary wall. In the sinus, there
is the capillary wall, a connective tissue stroma
and a cuboidal type of epithelium, which is at
least two cells deep. It would seem that these in-
terposing structures would increase the time of
the passage of gas molecules from the interior of
the cavity into the blood stream. Moreover, the
blood supply to the sinuses is normally very
meager, and still another factor is that the sinus
wall carries both oxygenated arterial blood and
venous blood, while all of the blood entering the
lungs is venous blood, from the standpoint of gas
content.
Despite these handicaps, carbon dioxide would
eventually find its way from the capillaries into
the sinus cavity, oxygen would move less rapidly
from the cavity into the venous blood, and, still
more slowly, nitrogen would find its way into the
blood stream. The total pressure within the sinus
would rise at first because of the inflow of carbon
dioxide molecules, but, eventually it would begin
to fall, as was the case in the eye. However, the
sinus walls being rigid, there would be no decrease
in volume and, therefore, the pressure, after the
initial rise, would fall progressively until equilib-
rium would be established. If there were only
venous blood present in the capillaries, the pres-
sure theoretically would fall to 705 mm. of mer-
cury, the same as the gas pressure of the venous
blood. However, the gas pressure of the arterial
blood is 757 mm., therefore, the gas molecules
would escape from the arterial blood into the
cavity as they were removed from the cavity into
the venous blood. Theoretically, equilibrium
should be established at a pressure somewhere be-
tween 705 and 757 mm., probably in the neighbor-
hood of 725 mm. The volume would remain the
same as when closure of the ostium began (ex-
cluding, of course, such things as edema and
secretion ) .
As a further illustration, the middle ear fur-
nishes an example of conditions between those in
the eye and in the sinus. Herbert,6 of Upsala, on
introducing rubber balloons into the nasopharynx
and inflating them in such a way as to close the
eustachian tubes, has found that in about thirty
minutes there is a marked retraction of the ear
drum, which he assigns to the reduced pressure
following oxygen absorption. Here are conditions
midway between those in the eye, where there is
an external positive pressure and yielding soft
walls, and those of the sinus, where the walls are
rigid and there can be no reduction in volume.
That portion of the lateral wall of the middle ear
which is comprised of the tympanic membrane is
more or less yielding and the volume of the space
is reduced somewhat. Therefore, the air in the
middle ear would be more completely absorbed
than that in the sinus. Still it is not possible for
all of the air* to be absorbed ; equilibrium would
eventually be established at a pressure somewhere
between the gas pressures of the arterial and the
venous blood. One would infer the time required,
as in the case of the sinus, would be long com-
pared with that of the lung.
In the thorax, too, the tissues about an ob-
structed lobe of the lung are not free to yield as
completely as those about the bubble in the eye
(Fig. 2). The wall of the thorax is more or less
rigid and a negative pressure develops within it.
*Again, excluding such things as secretion, edema and other
changes in the lining epithelium.
October, 1950
1011
CILIARY ACTION AND ATELECTASIS— HILDING
However, absorption can go on until the negative
pressure equals the difference between the gas
pressures in the alveolus and the gas pressures in
the venous blood. This difference approximates
401 46 -* — 47 co*.
47 47 < 51 46 HiP
7 60 7 05 760 7 71
Fig. 2. Absorption of air from an ob-
structed lobe of the lung and the effect of
negative pressure. AA represents the gas
tensions in alveolar air and VB the gas
tensions in venous blood. When a lobe be-
comes obstructed exchange of O2 and CO2
would take place as indicated between AA
and VB. If the volume (Vi) remained un-
changed, equilibrium would be established at
705 mm. It would not remain constant,
however. It would yield to the pressure of
760 mm. (atmospheric pressure) in the sur-
rounding tissues and shrink to V2. All of
the values would then be too high and gas
molecules would pass from AAi to VB. If
a negative pressure of 732 mm. should de-
velop within the thorax, as a result of
shrinkage of the lobe (such pressures have
been measured), then there would be further
shrinkage in volume until the pressure with-
in the lobe was also 732 (Vx). The gas ten-
sion would still be somewhat above venous
blood and would move from AA2 to VB.
Equilibrium would not be possible unless the
negative pressure within the thorax should
drop to 705 mm. (venous blood) or below.
If the intrathoracic pressure should remain
above 705 mm., theoretically absorption
could be complete.
55 mm. of mercury. Theoretically then, there
could be established a negative pressure of 55 mm.
of mercury before equilibrium would be estab-
lished and the absorption of gases would cease.
The greatest negative pressure which has been
measured in collapse of the lung is about 34 mm.
of mercury,4 so, theoretically, all of the air from
an obstructed lobe of the lung could be completely
absorbed, provided 55 mm. of negative pressure
is not exceeded. However, a certain amount of
time is required for absorption of gases, even
from the lung. Coryloss and Birnbaum1’2,3 report
experiments in which individual gases were in-
jected into the obstructed lung of a dog (i.e., a
portion of the lung had been tied off). Absorption
was accomplished for carbon dioxide in four
minutes, oxygen fifteen minutes, nitrogen sixteen
hours and air sixteen hours. As these experiments
indicate, nitrogen and air require about the same
amount of time for absorption.
Attempts were made to compare the absorption
rate from the lung with that from the anterior
chamber of the eye. The volume of the anterior
chamber of the eye has been estimated to be about
1/20,000 of that of the lungs. The volume of
blood flowing through the lungs at rest is estimat-
ed at about 4,600 c.c. per minute; through 1/20,-
000 part of the lung, this would be 230 cubic mil-
limeters. The rate of circulation of aqueous
through the eye is unknown ; measurements have
been variable (from 2 to 40 cu. mm. /minute) but
even the maximum would be only a small frac-
tion of the 230 cu. mm. in the lungs. There are
several other factors which make comparison dif-
ficult. Although there is no interposing mem-
brane between the bubble and the aqueous in the
eye, the bubble is all in one mass and exposes
the minimum of surface for absorption, whereas
an equal volume of air in the lungs is divided into
hundreds of little spheres, each of which is sur-
rounded by blood How, presenting an area of
about 500 square centimeters. In the aqueous,
there are no blood cells to aid in the quick pick-up
of the gas molecules, as there are in the blood sur-
rounding the alveoli. It is difficult also to compare
the time of absorption in the sinuses and ear with
that in the lungs ; in the former the air masses ex-
hibit a small area for absorption compared with
the latter. Moreover, the blopd flow is only a
small fraction of that in the lungs and the inter-
posing membranes are very much denser and
thicker. If sixteen hours are required to absorb
a volume of air from an obstructed lobe of a
lung, probably several days would be required to
absorb an equal volume from an obstructed sinus.
To summarize, air injected into the anterior
chamber of the eye absorbs completely, but the
time is comparatively long; it takes four to five
days to absorb 0.1 c.c. It requires several days for
air to be completely absorbed from the pleural
cavity or the subcutaneous tissue and several
weeks from the peritoneal cavity. The only ex-
periments bearing directly on the time factor in
the case of the lungs, which I have seen reported,
are those by Coryloss and Birnbaum, where six-
teen hours were required to absorb air from the
normal lung of a dog. These facts concerning the
time of absorption would seem to indicate that
1012
Minnesota Medicine
CILIARY ACTION AND ATELECTASIS— HILDING
some factor in addition to absorption is acting in
the removal of air in postoperative atelectasis,
which develops very promptly after operation.
In all of the articles in the literature on post-
operative atelectasis, the matter of ciliary action
is almost entirely overlooked. It seems to me that
ciliary action cannot be ignored in the respiratory
tract any more than heart action can be disregard-
ed in the circulation or peristalsis in studying the
physiology of the gastrointestinal tract. There is
no evidence that ciliary action in postoperative
atelectasis is subnormal.
Some years ago I performed some experiments
on the tracheas of freshly killed hens for the pur-
pose of determining a possible relationship be-
tween ciliary action and postoperative atelectasis.
If an occluding mass of mucus is introduced into
the lower end of such a trachea, it will pass
through to the upper end by ciliary action in the
course of a few minutes. In these experiments
the lower end was connected to a water manometer
immediately after introducing the mucus ; as the
mucus advanced toward the laryngeal end, by
ciliary action, a negative pressure developed rapid-
ly, reaching a maximum in less than twenty min-
utes. This experiment was done on nineteen
tracheas with the same result in all. The recorded
negative pressures varied from 5 to .40 mm. of
water.
In order to be certain that this phenomenon
was not due to absorption of oxygen in the fresh
tissue, another series of experiments was per-
formed connecting the laryngeal or upper end of
the trachea to the manometer. In each of these in-
stances a positive pressure developed of about the
same magnitude, namely up to 40 mm. of water.
Having in mind the probability that many masses
of mucus in the longer tubes of a patient suffering
from atelectasis might produce a cumulative effect,
resulting in a higher pressure, another series of
experiments was performed.8 Three, and some-
times four, tracheas were arranged in tandem and
each was connected to a water manometer at its
upper end. Connections which could be opened
and closed at will joined the tracheas so that the
pressure resulting in each could be individually
measured, and, when desired, all of them could be
connected as a single tube and the cumulative
pressures recorded. These experiments demon-
strated clearly that the effect is cumulative and
pressures as high as 150 mm. were obtained in this
way. This is comparable to the pressures meas-
ured in postoperative atelectasis.
Several series of experiments were done
on the frontal sinuses of dogs. In the first of
these, two needles were forced into the frontal
sinus of an anesthetized dog, one was connected
to a water manometer and through the other a
quantity of mucus was injected. A negative pres-
sure began to develop after a few minutes, reach-
ing a maximum in about twenty minutes ; some of
these pressures were as high as 60 mm. of water.
In order to rule out the factor of absorption, a
second series was done in which the dog was bled
to death through the femoral artery in the middle
of the experiment, and then decapitated. Neither
procedure caused any significant variation in the
pressure. Still other experiments were done on
the decapitated heads of freshly killed dogs.
These recorded the same phenomenon of a rapid-
ly forming negative pressure.
These experiments on the trachea of the hen
and the sinus of the dog demonstrate another
mechanism for the removal of air and the de-
velopment of negative pressure. It is essentially
a piston-cylinder action motivated by ciliary
power, the masses of mucus acting as the pistons.
If this factor is acting in the development of post-
operative atelectasis, we would have the explana-
tion for the failure of the soft mucus to slide into
the area of negative pressure and for the seeming
inaction of the cilia. When the cilia have pushed
the masses of mucus up a bronchus as far as they
are able, against atmospheric pressure, the mass
of mucus becomes stalled. This explains the fact
that very soft mucus can seemingly act like a
cork ; the cilia are holding it in position and at-
tempting to push it further. The negative pres-
sures of 200 to 400 mm. of water, which have
actually been measured in postoperative atelectasis,
might readily be explained on the basis of a series
of mucus pistons in tandem being pushed upward
in the bronchial tree by ciliary action. This nega-
tive pressure could, theoretically, be produced en-
tirely by ciliary action independent of absorption.
The negative pressure is probably maintained by
ciliary power only.f One can say that the effec-
tTliere is another mechanism possible which should be men-
tioned. If the occluding mucous piston occurs in a membranous
bronchus, it is quite possible that the bronchus may collapse be-
hind the piston, due to the negative pressure. If this were to
happen, the apposing walls of the bronchus might adhere together
because of the cohesiveness of the normal mucous film. In this
case, the atelectasis might conceivably be maintained without the
presence of an abnormally great quantity of mucus.
October, 1950
1013
CILIARY ACTION AND ATELECTASIS— HILDING
tive power of the cilia equals the atmospheric
pressure minus the pressure in the affected lobe
and is the magnitude of the negative pressure.
This pumping action of the ciliary mechanism is
similar in principle to that of a mercury vacuum
pump.
It was found in the experiments on the trachea
of the hen that if the procedure were carried on
for an hour or more the cilia continued to whittle
away at the periphery of the mucus piston, grad-
ually carrying it upward and depositing it at the
end of the trachea. Theoretically, the cilia could
remove the piston maintaining the negative pres-
sure in atelectasis also, if given sufficient time,
provided no more mucus formed. However, if
production of excessive mucus should continue,
then the atelectasis might be maintained.
We have spoken of absorption of air from the
sinuses as though it were the usual thing for the
ostium to be obstructed while the cavity is still
full of air. It is more likely that in conditions re-
sulting in vacuum headache the air was initially
displaced more or less completely by the first
secretion which formed. It seems likely that the
heavy mucus, which forms large viscid masses
toward the end of an attack of sinusitis, might
produce a negative pressure in a manner similar
to that in the experimental dogs. This could very
readily be the explanation for the clinical condi-
tion known as vacuum headache.
This last suggests another possibility for the
rapid removal of air from the lobe of a lung in a
surgical patient during operation. It is quite pos-
sible that the air is largely displaced by a secre-
tion and that a negative pressure soon follows due
to ciliary action.
The negative pressure which occurs in the
middle ear might very likely be on the basis of
ciliary action moving pistons of mucus down the
eustachian tube. Repeated attempts to demon-
strate it experimentally have failed to date. Just
how the air is removed from the middle ear
in blockage of the eustachian tube remains an
open question.
Summary
The absorption of air from the anterior cham-
ber of the eye, from the sinuses, from the ear and
from obstructed portions of the lung follows the
principles of well-known laws of physics such as
those governing diffusion, solubility, partial pres-
sures and molecular combination. It seems that
air can be completely absorbed from almost any
space or tissue in the body, such as those just
mentioned, as well as the peritoneum, pleural
cavity and subcutaneous tissues, provided suffi-
cient time is allowed and provided the space con-
taining the air can collapse. If the space contain-
ing the air cannot collapse or can do so only par-
tially, a negative pressure develops, depending
upon the gas pressures present in the absorbing
fluid.
In postoperative atelectasis, there are at least
three mechanisms by which the air could be re-
moved, namely, (1) absorption, (2) displacement
by secretion, and (3) the pumping action of cilia
and moving masses of mucus. The negative pres-
sure in most cases of postoperative atelectasis is,
in all probability, maintained solely by ciliary ac-
tion. It is probable that the mechanism involved
in the pumping action of the cilia and moving
masses of mucus is the one which causes vacuum
headache and possibly also negative pressure in
the middle ear following otitis media.
References
1. Coryloss, P. N.: Postoperative apneumatosis (atelectasis) and
postoperative pneumonia; experimental evidence. J.A.M.A.,
9.1:98-99, (Tuly) 1929.
2. Coryloss, P. N., and Birnbaum, G. L. : Bronchial obstruc-
tion; its relation to atelectasis, bronchopneumonia and lobar
pneumonia; roentgenographic, experimental and clinical study.
Am. J. Roentgenol., 22:401-430, (Nov.) 1929.
3. Coryloss, P. N., and Birnbaum, G. L.: Circulation in com-
pressed, atelectatic and pneumonic lung (pneumothorax —
apneumatosis — pneumonia). Arch. Surg. 19:1346-1424, (Dec.)
1929.
4. Habliston, Charles C. : Intrapleural pressures in massive col-
lapse of the lung. Am. J. M. Sc., 176:837, 1928.
3. Henderson, Yandell: The physiology of atelectasis. J.A.M.A.,
93:96-98, 1929.
6. Herbert, C.: Personal communication.
7. Hilding, A. C., and Hilding, David: The volume of the
bronchial tree at various levels and its possible physiologic
significance. Ann. Otol., Rhin. & Laryng., 57:324, (June)
1948.
8. Hilding, A. C. : Some further experiments in production of
negative pressure in the trachea and the frontal sinus by
ciliary action. Ann. Otol., Khin. & Laryng., 54:725-738,
(Dec.) 1945.
9 Marshall, James M.: Postoperative pulmonary atelectasis.
U. S. Nav. M. Bui., 42:601-606, (March) 1944.
10. Schmidt, Herbert W. ; Mousel, Lloyd H., and Harrington,
Stuart W. : Postoperati ve atelectasis: clinical aspects and re-
view of cases. J.A.M.A., 120:859-900, (Nov.) 1942.
11. Seybold, Wm. D.: Physiologic disturbance underlying the
development of earlv postoperative atelectasis after lobectomy.
S. Clin. North America, 28:871-888, (Aug.) 1948.
1014
Minnesota Medicine
TRANSFUSION PROBLEMS
R. W. KOUCKY, M.D.
Minneapolis, Minnesota
TOURING the past twenty years there has been
-‘—'Da remarkable increase in the use of blood
transfusions. In one hospital with which I am
connected the increase has been exactly twenty-
fold. There are many reasons for this striking
increase. The changes in surgical methods and
the improvements in anesthesia together with the
development of the antibiotics have made surgical
procedures commonplace which a decade ago were
rarely done. Generally this type of surgery neces-
sitates the use of a large amount of blood. The
introduction of the ACD solution as a preserva-
tive permits the storage of blood for periods of
about three weeks, and contributes greatly to
making blood more available and hence used more
often. Probably the greatest factor in promoting
the increased use of blood is the safety of the
modern transfusion. The discovery of the Rh
factor initiated a tremendous amount of research
which has for the most part eliminated the fre-
quent and severe transfusion reactions which
were so common prior to 1940.
The safety of a transfusion and its frequent
use paradoxically creates a problem. The use of
blood is so ordinary and so commonplace that
there is today a tendency to look upon a trans-
fusion as a benign procedure much like the ad-
ministration of saline or glucose. A transfusion
always carries with it a definite danger. Dis-
respect for the lethal possibilities involved can
and still does lead to tragic results. Let me cite
one example.
In one hospital a unit of blood was ready for an
eight o’clock operation. However, it was not used,
and it was left in the room after the operation
was over. The second operation in this room re-
quired a transfusion, and when the anesthetist de-
cided to start the blood she picked up the bottle
standing on the side table, and over 400 c.c. was
administered before she read the label and realized
that that blood was intended for the prior surgical
patient. We must continuously teach our hos-
pital personnel the tragic results which may come
from carelessness and negligence in the use of
blood.
Or. Koucky is Medical Executive, Minneapolis War Memorial
Blood Bank.
Read at the annual meeting of the Minnesota State Medical'
Association, Duluth, Minnesota, June 13, 1950.
Another problem evolves around the question,
“Does the patient actually require a transfusion?”
Physicians sometimes forget the normal range of
hemoglobin. In this section of the country the
lower limit of average hemoglobin is about 12
grams. This means that 70 per cent on a 17 gram
standard is a low normal. It is very probable that
hemoglobin is adjusted by the body to the par-
ticular activity and physiology of the individual.
A hemoglobin of 13 grams in one individual may
be just as normal as 16 grams in another. If
blood is transfused into such an individual having
a physiologically normal hemoglobin of 13 grams,
that blood is an excess and cannot be utilized and
will be eliminated by hemolysis.
There is a tendency today to use a transfusion
as an accessory to many operative procedures.
Individuals undergoing operations of modern
magnitude, for example a cholecystectomy, are
not necessarily candidates for a transfusion.
Prior to the operations, these same individuals,
being in good nutrition and having no anemia,
could have been used as blood donors and as such
would have lost 500 c.c. of blood. Surely in such
individuals an operation with a blood loss of 200
to 400 c.c. does not necessitate a transfusion ex-
cept perhaps for psychological reasons. It would
seem that a transfusion is too dangerous to be
used as a dramatic accent in the care of a patient
or a patient’s relatives.
On the other hand, there are occasions where
there has been significant or massive loss of blood,
and transfusion is the life-saving therapy. When
such occasions arise, the treatment with blood
must be prompt and must be generous. Adminis-
tration of one unit of blood over a period of
twenty to forty minutes to an invidual bleeding
critically is not adequate treatment. Two, three,
or four units of blood should be given simultane-
ously using each arm and leg as portals, or pref-
erably, the blood should be forced in by pressure.
When a patient is losing blood rapidly it is prob-
ably impossible to replace the blood too fast. Five
hundred c.c. of blood can be given by pressure in
four to seven minutes. There should be no hesi-
tation in giving two, three or more units in suc-
OCTOBER, 1950
1015
TRANSFUSION PROBLEMS— KOUCKY
cession as long as there is evidence that the pa-
tient is bleeding.
Every hospital should have available in sur-
gery, in obstetrics, and in its supply room the
equipment for giving blood under pressure, and
everyone should know how to use it. Most of the
commercial companies handling transfusion equip-
ment now have such pressure sets for sale, and
their people are happy to give instructions as to
its use and the precautions to take.
In hospitals without a large blood bank, the
selection of the kind of blood to use during an
acute emergency presents a difficult problem.
For example, should time be taken to do Rh
typing? Today, because of the reliable typing sera
now available Rh grouping can be done in a few
seconds. It would be a rare situation wherein
blood must be given without knowledge of the Rh
grouping of the recipient. If the patient is Rh
positive, the problem is simple because blood of
either Rh type can be given. The question of
sensitization to the Hr antigen in Rh-negative
blood can be disregarded because of its great
rarity. If the patient is Rh-negative and a suffi-
cient amount of Rh-negative blood is not im-
mediately available, it is necessary to pause for a
few moments and evaluate the situation. If the
patient is a male, the question must be asked,
“Has he been transfused before?” If so, he may
have been sensitized by this prior transfusion, in
which case these questions must be asked : “Is
the emergency great enough to warrant taking any
chance on a prior sensitization ? Can the emer-
gency be controlled by plasma until Rh-negative
blood is available?” The physician must balance
the urgency against this risk. If the patient is an
Rh-negative female, the problem is much more
difficult. Because of the very adverse effect on
future pregnancies, no female should ever be de-
liberately sensitized by a transfusion of Rh-posi-
tive blood except as a life-saving measure. Any
Rh-negative woman who has had children may
be sensitized, and if her obstetrical history sug-
gests that she may have had erythroblastotic
babies she most likely is sensitized. Transfusion
of Rh-positive blood to these sensitized Rh-nega-
tive women results in extremely severe reactions
with a very high mortality. In all such cases of
possible sensitization, plasma must be used until
Rh-negative blood can be obtained. Every com-
munity should make arrangements so that the
Rh-negative individuals in its population are
known and have "been organized so that they may
act as donors for each other in emergencies.
The use of Group O blood as a universal blood
for transfusion does carry with it a certain small
chance of reaction. An instance of this type was
studied recently by Dr. Matson and will be re-
ported in Minnesota Medicine. However, the
incidence of this type of reaction is very small,
and a patient’s life should never be endangered by
hesitating to use Group O blood for other groups
and to do so, if necessary, without cross matching.
The addition of the Witebsky substance to such
Group O blood takes only a few seconds and still
further lessens the danger. The material is puri-
fied Group A and Group B blood substance.
When this is added to Group O blood, the anti-A
and anti-B agglutinins are neutralized, making the
blood a truly universal blood.
As a general pathologist, I have had contact
with transfusion work for many years and I know
that we never bad such transfusion safety as we
now have. Most of this safety is due to the study
and research of men who are devoting their full
time to transfusion problems. I am sure that the
practitioner owes such men considerable gratitude
and support.
THE MANAGEMENT OF STATUS ASTHMATICUS
(Continued from Page 987)
8. Lepak, J. A. : The relief of acute asthma by the intra-
venous administration of concentrated glucose solutions.
Report of cases. Minnesota Med., 17 : 442, 1934.
9. Piness, George: Status asthmaticus, J.A.M.A., 142:785,
1950.
10. Prigal, S. J., Brooks, A. M., and Harris, R. : The treat-
ment of asthma by inhalation of aerosol of aminophvllin.
J. Allergy, 18:28, '1947.
11. Prigal, S. J., and Furman, Moses L. : The use of baci-
tracin, a new antibiotic in aerosol form. Ann. Allergy,
7:662, 1949.
12. Sheldon, J. M. : Intravenous use of fluids in bronchial
asthma. J.A.M.A., 139:506, 1949.
13. Tuft, Louis, and Lebin, Nathanial, M. : Studies of the ex-
pectorant action of iodides. J. Allergy, 12:416, 1941.
14. Vaughan, W. T., and Graham, W. R. : T.A.M.A., 119:556,
1942.
15. Weisman, Joseph R. : Status asthmaticus. Regional
Course, American College of Allergists, 1945.
16. Wieder, H. : Addiction of meperadine hydrochloric acid:
Report of three cases. J.A.M.A., 132:1066, 1946.
1016
Minnesota Medicine
History of Medicine In Minnesota
MEDICINE AND ITS PRACTITIONERS IN OLMSTED COUNTY PRIOR TO 1900
NORA H. GUTHREY
Rochester, Minnesota
(Continued from September issue)
Seth (Septimus) Watkins Gould (1847-1891), a native of Canada, was a
resident of Olmsted County the greater part of the time from about 1873
into 1891. There is some evidence that he was in Oronoco, this county, in
1873, and that during 1874 he was in Zumbrota, Goodhue County. He prob-
ably came to Rochester in 1875, for on April 21, 1876, the Rochester Record and
Union stated that Dr. Gould, who for some time had been associated with Dr.
W. W. Mayo, had gone to reside and to practice medicine in Mazeppa, Goodhue
County. In July, 1880, well liked, considered to be a capable practitioner, he
returned from Mazeppa to Rochester, again to be an associate of Dr. Mayo. The
agreement between Dr. Mayo and Dr. Gould was dated July 24, 1880, and was
witnessed by William J. Mayo and W. Logan Brackenridge. It was stated in the
newspapers at that time that Dr. Gould was a graduate of Rush Medical College,
class of 1866, and that in addition to the duties of an associate physician he would
have charge of all patients requiring the services of an electrician, that he had
made a successful study of electrical therapeutics. The first official register of
physicians of Minnesota (1883-1890), however, listed Dr. Gould as a graduate
of the Bennett Eclectic Medical College of Chicago in 1870 ; he was licensed in
Minnesota on December 31, 1883, when he received state certificate No. 665 (E).
During his second period of practice in Rochester, it is said, Dr. Gould was
married to Miss Oaks of that place. From May, 1881, until late December, 1881,
when he removed to Pleasant Grove, he was secretary of the Rochester Board of
Health, during the presidency of Dr. E. W. Cross. In Pleasant Grove Dr. Gould
bought the property of a Mrs. Hill, established a drug store and entered his final
practice of medicine. His professional contemporary in the village was Dr. Alonzo
W. Hill, who practiced there from 1878 to 1889.
On January 1, 1886, Dr. Gould, thirty-nine years of age, was committed by his
wife to the Second Minnesota Hospital for Insane at Rochester. The origin of
his illness was ascribed locally to sunstroke suffered while working over a gun
during his military service (reputedly as a lieutenant during the Civil War), and it
was said that a second soldier, working with him, also succumbed to sunstroke and
became insane. Dr. Gould died in the state hospital on October 27, 1891, from
“general paresis with asphyxia,” and was buried in Oakwood Cemetery, Rochester.
Christopher Graham (1856- ), venerable physician emeritus of Roch-
ester, a practitioner of medicine from 1894 to his retirement in 1919, arrived in
Olmsted County early in July, 1856, when he was three months old.
The sixth of the thirteen children of Joseph Graham and Jane Twentyman
Graham, he was born on April 3, 1856, near Truxton, Cortland County, New
York. His parents were natives of Cumberland County, England; Joseph Graham
October, 1950
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HISTORY OF MEDICINE IN MINNESOTA
was born near the village of Dalston, fane Twentyman in Great Orton Parish.
The Twentyman family came to America in 1840; Mr. Graham came in 1844 when
he was twenty-two years old. Mr. and Mrs. Graham were married in Cortland
County in 1847 and lived there until May, 1856, when with their six small children
and a few worldly goods in a horse-drawn wagon they started for Minnesota.
Although heavy rains forced them to take a boat from Buffalo to Milwaukee,
they finished their journey by wagon into Kalmar Township, Olmsted County, and
there founded a new home about five miles northwest of Rochester. After forty
years at Grahamholm, which they had first called “The Willows,’’ they removed to
Rochester to spend their last years. Their thirteen children were : Mary Elizabeth,
William Beck, Thomas Chambers, John, Manfred Davis, Christopher, Joseph,
Dinah Frances, Margaret Anne, Frank Charles, Edith Maria, Arthur Frederick
and Jennie. In 1949 there were living, Joseph Graham, on a farm near Stewart-
ville, and Dr. Christopher Graham, of Rochester.
d he story of the Graham family should be chronicled as a saga and the group
commemorated for intelligence, fortitude, integrity and good citizenship. Under
the severest hardships of pioneer days parents and children surmounted lack of
means and opportunity. Joseph Graham was a kind father, although a strict
disciplinarian in the home, and an indefatigable worker who had unusual capacity
for taking pains. Jane Twentyman Graham was a woman of rare courage, deep
religious faith, warm sympathy and a natural talent for soothing the sick and
making them comfortable. Always giving, never asking, as since has been said
of her physician son, she nursed without material recompense all in her vicinity
who needed her. Perhaps she gave greatest aid in obstetrical cases, in which her
knowledge and skill were equal to those of most physicians of the day. In later
years her children estimated that she aided in the birth of 243 babies, without
medical counsel and without loss of a mother or a child. Two of her daughters,
Dinah Frances and Edith Maria (Mrs. Charles H. Mayo) inherited her natural
ability in nursing; Dinah Frances, the elder, in her early teens helped her mother
in cases of all types. Both of these daughters received accredited training and
followed the profession of nursing before marriage. Edith Graham was the first
trained nurse in Rochester.
It will require an abler pen and a more suitable vehicle than the present to
portray rightly the life of Christopher Graham. Under conditions so difficult that
today they are hard to picture, he obtained his education by patient, persistent
effort. Until he was twenty years old he worked on the home farm, as did his
brothers and sisters, and received only the teaching available in the local district
school during terms of a few weeks at most. Books were few, money was too
scarce to buy them, and sense of responsibility forbade borrowing them. In vhe
winter of his twenty-first year “Kit” Graham achieved four continuous months of
study at the private school of Mr. Loofborough, in Rochester; he then had covered
approximately the work of the present day junior high school. The next winter he
taught district school and in the following year studied a full term of nine months
at Niles’ Academy (The Rochester English and Classical School, staffed by Mr.
and Mrs. Sanford Niles and their assistants). The next four years were filled
with farm work, rural school teaching and, in spring and autumn, further study at
Niles Academy. Always Christopher walked from home to school and back.
In the autumn of 1882, aged twenty-six years, Christopher Graham entered the
University of Minnesota as a subfreshman and special student. On arrival, doubt-
ful of his eligibility, he told President William Watts Folwell of his meager
schooling and explained that he probably could attend the university only a year
or so, that he loved domestic animals and the land and wanted to be a farmer.
1018
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HISTORY OF MEDICINE IN MINNESOTA
President Folwell assured him that his lack of formal preparation was not a
drawback, that his age was an advantage. For the ensuing five years he was a
student at the university, dropping out frequently to repair his finances. There-
after, for two school years, from 1887 into 1889, he taught chemistry and natural
philosophy at Shattuck School at Faribault. In the autumn of 1889 he entered the
class of veterinary medicine at the University of Pennsylvania and in June, 1892,
took his degree ; it was then that he received the Lippincott Prize, awarded to the
member of the graduating class who had attained the highest general average in
the course of three years. After one year as veterinarian to the Experiment Sta-
tion and Agricultural College of the University of Minnesota, he realized that
clinical medicine was his true calling, and he returned to the University of Pennsyl-
vania as a medical student. When in June, 1894, aged thirty-eight years, he re-
ceived his degree of doctor of medicine, he returnd at once to Rochester, to ac-
cept the invitation of Drs. William J. Mayo and Charles H. Mayo to join them in
practice. These brothers he has credited with giving him encouragement and op-
portunity.
The following twenty-five years saw his fulfillment as a physician. He was the
first to serve as intern in St. Mary’s Hospital (opened in 1889) and he became
and remained an attending physician. Throughout the years he studied and ob-
served, visiting hospitals and clinics at home and abroad and taking special courses
of study, particularly with regard to the blood. In his earlier period he was an
obstetrician of ability ; today mature practitioners of this specialty who studied as
young physicians with Dr. Graham, express their debt to his wisdom and con-
servatism. Gradually he fixed his chief interest on diseases of the digestive tract
and their differential diagnosis and here he achieved his most brilliant success.
The papers which he contributed to the medical literature on chronic appendicitis,
gastric ulcer and gastric cancer and gallbladder disease retain their value. His
paper on disease of the gallbladder, written before the perfection of certain labora-
tory tests and the initiation of roentgen examination of the gallbladder, is a classic
in diagnosis by case history, signs and symptoms. Dr. W. J. Mayo once said of
Dr. Graham : “I have never met his equal as an internist and a diagnostician.”
Senior associates and junior, alike, recall Dr. Graham as at all times modest and
unassuming, distinguished for his insight and acumen, sympathy, patience and
delightful humor.
Dr. Graham early became a member of the Olmsted County Medical Society
(once its president), the Southern Minnesota Medical Association, the Minnesota
State Medical Society and the American Medical Association, and was active in
them throughout his professional career. Interested in public health and sanitation,
he was a member of the state board of health for several years during the ad-
ministrations of Governor John A. Johnson (1904-1909), and retired from the
work only because of professional duties in Rochester. He was appointed associate
in medicine with the Drs. Mayo in 1904 and head of the Division of Medicine of
the Mayo Clinic in 1914. He was Professor of Medicine on the Mayo Foundation
for Medical Education and Research of the University of Minnesota from 1915
until his retirement in 1919. He is a member of the Alumni Association of the
Mayo Foundation.
Christopher Graham’s love of farming, horticulture and animal husbandry in-
creased with the years, leading him to distinguished achievement and honor in these
fields. He was a leader in introducing Orpington chickens into the country, and
at one time had flocks of these fowls, black, white, and buff, second to none in the
world. He started the development of what was probably the first purebred
Holstein-Friesian herd in this part of the state and he became internationally known
October, 1950
1019
HISTORY OF MEDICINE IN MINNESOTA
as a breeder and importer of blooded livestock. For more years than any other
person he was a member of the board of trustees of the Holstein-Friesian As-
sociation. His scientific contributions have been recorded in the archives of the
Minnesota Livestock Breeders Association and elsewhere.
Dr. Graham is a Mason and an enthusiastic member of the Rotary Club. The
latter organization, he has said, has helped him more than has any other influence
to understand men and to obtain a broad comprehension of social and civic needs
and responsibilities. His support of the Olmsted County Fair Association and his
generous gifts of real estate to that association and to the city of Rochester and
St. Mary’s Hospital evidence his constructive interest in public welfare. He is a
supporting member of the Calvary Episcopal Church.
On January 4, 1899, Christopher Graham was married to Elizabeth Blanche
Brackenridge, member of a family long notable in Olmsted County and the state.
Walter Lowry Brackenridge, of Scotch ancestry, a lawyer, came in 1856 from
Pennsylvania to Rochester, Minnesota, with his wife, Margaret McC. Logan
Brackenridge. 1 he three children of the family were William Logan, Madge and
Elizabeth Blanche; the son, who died in 1905, was a lawyer in Rochester; Madge
was married to George D. Parmalee.
For many years Dr. and Mrs. Graham have made their home in East Rochester,
in the beautiful brick residence, surrounded by parklike grounds, that was built
by the Honorable Walter L. Brackenridge in the early seventies. They have two
children, Malcolm Brackenridge Graham and Elizabeth Blanche (Mrs. George M.)
Lowry, both of Rochester, two grandchildren, Margaret Brackenridge (Mrs.
Calvin T.) Slatterly and Louise Lowry, and two great-grandchildren.
The esteem in which Dr. Graham is held by his fellow citizens cannot be
measured, but it is indicated by an inscribed scroll that was presented to him on
his eighty-fifth birthday on April 3, 1941 :
Diplomate in both veterinary and regular medicine, authority on diseases of the upper part
of the gastro-intestinal tract, practical farmer, patron of animal husbandry, public-minded
citizen, unannounced doer of good to scores of his fellowmen, on this the occasion of his
eighty-fifth birthday, his many friends and townsmen present this scroll in token of affection
and esteem.
Charles Topliff Granger (1870-1939) practiced medicine in Rochester.
Olmsted County, from 1892 into 1939, with the exception of two years in Mc-
Gregor, Minnesota, from 1928 to 1930. For thirty-five years he had his office
over the Quale Drug store on Broadway.
Born on July 30, 1870, at the farm home of his parents in Cascade Township.
Olmsted County, near Rochester, Charles T. Granger was the second son of Abner
Granger and Louise Topliff Granger. Abner Granger was the son of Julius
Granger and grandson of Seba Granger, who was descended from a Granger who
settled in New England long before the American Revolution ; Seba Granger re-
moved from Massachusetts to Otsego County, New York, and there established
the family home. Abner Granger was married to Louise Topliff, of Otsego County,
on February 25, 1867, and in that year came with his wife to Olmsted County,
Minnesota, where for many years he was a highly respected citizen and a sub-
stantial farmer and pioneer dairyman.
Charles T. Granger received his early education in rural schools and in the
schools of Rochester. He spent a year in the medical department of the University
of Iowa and two years at the Hahnemann Medical College, of Chicago, from which
he was graduated on March 23, 1892. Returning immediately to Rochester, he
entered into partnership with Dr. Wilson A. Allen, in offices in the Leland Block,
1020
Minnesota Medicine
HISTORY OF MEDICINE IN MINNESOTA
on Broadway. At first he devoted himself to treatment of diseases of the eye and
ear, but proceeded soon to the general practice for which he became well known.
In the autumn of 1892 Dr. Allen and Dr. Granger established the Riverside Hos-
pital, in East Rochester; this institution functioned three years.
From the summer of 1896 Dr. Granger practiced alone for eight years, extend-
ing his practice from the city into the county and adjoining counties, until it be-
came, by 1904, according to the Rochester Post and Record of June 24, that year,
“probably the largest individual practice of any physician outside the Mayos.” In
the earlier years, before automobiles, it sometimes required four consecutive days
of driving to make his rounds.
In 1904 Dr. Granger took into partnership one of his former students, Dr.
George T. Joyce, newly graduated in medicine from the University of Illinois,
and like himself a native of Olmsted County. After this association ended, Dr.
Granger for many years maintained a corps of assistant physicians, replacing them
as, after a year or two of work with him, they went on to independent practice.
In his earliest years as a physician Dr. Granger was active in the Minnesota
State Homeopathic Institute. After 1900 he was a member of the Olmsted County
Medical Society (its secretary, 1905; its president, 1906-1907); the Southern
Minnesota Medical Association, the Minnesota State Medical Association, and the
American Medical Association. In 1935 he published in the St. Paul Dispatch a
series of articles, The Saga of a Country Doctor, which attracted much attention.
Although he refused the nomination for county coroner on the Republican ticket
in 1896, he served from 1894 to 1899 as county physician for the city of Rochester
and the townships of Rochester, Marion, Haverhill and Cascade. He was active
in the Methodist Church (he later became a convert to the Catholic faith, it is
said), and in civic affairs, serving as alderman, alderman-at-large, mayor, presi-
dent of the city council two terms, and as member of the city library board.
On March 8, 1898, Charles T. Granger was married to Katherine Cornelie, of
Minneapolis. Mrs. Granger, a woman of outstanding personality and ability, was a
trained nurse who for a year or more had been the supervisor of nursing at the
Riverside Hospital. Dr. and Mrs. Granger first lived in East Rochester, later in the
southwestern part of the city, in a home known for its gracious hospitality. In
1928 they removed to McGregor, Minnesota, where for two years they conducted
their own clinic and hospital. Mrs. Granger died in McGregor on March 7, 1929,
survived by her husband and by four children, Louise, Virginia, Charles and
Gordon. Dr. Granger was married on May 2, 1930, to Bertha P. Irish, widow
of Dr. H. R. Irish, of Forest City, Iowa; Bertha Irish Granger, a former resident
of Rochester, was a graduate of the nurses training school, since discontinued, of
the Rochester State Hospital.
In 1930 Dr. Granger resumed the practice of medicine in Rochester, limited bv
his gradually failing health. He died in Rochester on October 4, 1939, at the home
of his niece, Ophelia Granger (Mrs. E. D.) Ridgeway, survived by his wife and
his four children and by his sister, Kate E. Granger, of Rochester. His brother,
the Honorable George W. Granger, a distinguished attorney of this city, had died
a few months previously. In an obituary in the Minneapolis Tribune of October 6,
1939, Dr. Granger was credited with having diagnosed the first case each of
epidemic infantile paralysis, Spanish influenza and pellagra in Minnesota, and the
first case of trichinosis in Rochester.
In 1945 there were living of Dr. Granger’s immediate family: Mrs. Granger,
in Rochester; Louise Granger (Mrs. Edward B.) Lynch, in Minneapolis; Virginia
Granger (Mrs. Raymond T.) Busch, in Gaylord; Charles T. Granger, a news-
October, 1950
1021
HISTORY OF MEDICINE IN MINNESOTA
paperman, of Milwaukee, Wisconsin; and Major Gordon A. Granger, United
States Army Medical Corps, in England.
Dr. Charles T. Granger is remembered for his keenness, cleverness and social
charm, and for certain of his hobbies ; namely, his blooded saddle horses and
racers of the earlier years, among them Gipsy Wilkes and Kentucky Prince, and
his hunting lodge, Granger’s Camp, in the beautiful Genoa Woods of Olmsted
County, where he was host to his friends among businessmen and physicians
of Rochester.
Gertrude Booker Granger (1871-1928) was born Gertrude Booker on March
13, 1871, at Quincy, Olmsted County, Minnesota, the daughter of James A.
Booker, a native of Brunswick, Maine, and Jane Short Booker, a native of
Waddington, New York. She had four brothers, O. W., Frank Daniel, F. A., and
W. Allison Booker. After the death of Mr. and Mrs. Booker, in 1887 and 1889,
respectively, Frank Daniel Booker went to Brunswick, Maine, to live with an
uncle. He received his education in the East and in 1901, a qualified dentist,
graduate of the dental department of the University of Pennsylvania, he settled
in Rochester, Minnesota, where for many years he was a leading dentist. The
other brothers became farmers of Olmsted County.
Gertrude Booker received her early education in the country schools of Olm-
sted County and at the Winona High School. In October, 1892, she entered the
newly established Asbury Methodist Hospital, in Minneapolis, as a student nurse,
and in June, 1894, was graduated. The following September she matriculated
in the medical department of the University of Minnesota, from which she re-
ceived the degree of doctor of medicine in June, 1897. Her license, No. 776 (R),
to practice in the state, she received from the Medical Examining Board of the
State of Minnesota on June 10, 1897. For the next six months, living in Dover,
she practiced medicine in the communities of Dover and Eyota. On January 1,
1898, she joined the staff of the Drs. Mayo, Graham and Stinchfield in Rochester,
primarily as assistant to Dr. Charles H. Mayo in the treatment of diseases of the
eye, ear, nose and throat ; a little later she was given charge of the work on
refractions of the eye.
On February 14, 1900, Gertrude Booker was married to George W. Granger, of
Rochester, at the home of her brother, F. A. Booker, at Quincy. Mr. Granger,
later Judge Granger, as mentioned earlier, was a native of Olmsted County and a
brother of Dr. Charles T. Granger; he first was married to Ophelia Cook, a native
of Rochester, on June 24, 1896. Mrs. Granger died on April 5, 1898, leaving an
infant daughter, Ophelia C. Granger.
After her marriage Dr. Booker Granger managed the dignified home on Third
Street, S.W., and carried on her professional work. She was on the staff of the
Drs. Mayo until March 1, 1914, when she became a full time health officer in the
city of Rochester, again as assistant to Dr. Charles H. Mayo, who since May 1,
1912, had been city health officer. She resigned from public health work after two
years to conduct a limited practice as consulting refractionist, with an office on
Broadway. In this work she continued until shortly before her death, which oc-
curred at Rochester on July 5, 1928. She was survived by her husband and by
relatives in Olmsted County and elsewhere.
Dr. Booker Granger was a member of the Southern Minnesota Medical Associa-
tion, the Minnesota State Medical Association and the Alumni Association of the
Mayo Foundation. A respected citizen of Olmsted County all her life, she pos-
sessed the esteem of associates and the many who profited by her skill, and the
high regard of friends who were privileged to know her well.
1022
Minnesota Medicine
HISTORY OF MEDICINE IN MINNESOTA
G. W. Green, an eclectic physician, a native of New York born in 1827,
came to Minnesota in 1856 because of “a disposition to pulmonary complaint,” and
settled in Pleasant Grove, Pleasant Grove Township, Olmsted County. He re-
gained his health and, like many of his contemporaries, in addition to practicing
medicine ran a general store and engaged in public service. For the term of
1859-1861 he was a member of the Minnesota House of Representatives.
In September, 1861, Dr. Green removed with his wife and four children to
Lake City, Wabasha County, where he developed a good practice. It is said that
he was briefly in Goodhue County prior to going to Lake City. In 1871 a heavy
cold resulted in his prolonged illness, and the summer and autumn of 1872 he
spent in California in the hope of improvement. He died on Thanksgiving Day,
November 28, 1872, in Lake City. The funeral services were conducted at the
Methodist Church, of which he was a member, under the auspices of the local
Masonic Lodge.
Stewart V. Groesbeck (1841-1908), an eclectic physician, a native of Otselic,
Chenango County, New York, was in High Forest, Olmsted County, the greater
part of the time from 1868 into 1872. Earlier, for about a year and a half, into
1865, he had been in Houston County, associated with Dr. P. T. Bowen, who at
one time was in Houston. From High Forest Dr. Groesbeck went to Marshall,
Minnesota, and thence, after about fourteen years as a citizen and practitioner of
some success and importance, he went to Dakota Territory. On June 23, 1887, he
received his license to practice medicine in Dakota, having passed the official
examination. He was then living in Watertown; by 1906 he was in Spearfish.
Later he became surgeon to the National Home for Disabled Volunteer Soldiers at
Hot Springs, South Dakota, and he died in that institution on December 31, 1908.
He was at the time of his death a member of the American Medical Association.
Biographical notes on Dr.' Groesbeck appeared in an article by Eckman, in 1941,
on homeopathic and eclectic medicine in Minnesota, and in a paper by Guthrey, in
1945, on the history of medicine in Houston County. Eckman, citing Neill, stated
that Dr. Groesbeck in 1871 received a license to practice medicine in Minnesota,
and inferred that the doctor had been affected by the Medical Practice Act of
March 4, 1869 (soon afterward repealed). Recent information has confirmed this
inference: When in May, 1869, the late Dr. David Sturges Fairchild (1847-1930)
of Clinton, Iowa, arrived in High Forest with the ink scarcely dry on his diploma
from the Albany Medical College, of New York, he found there two physicians,
of whom one was Dr. Alexander Grant, well qualified but inactive professionally.
The other was an “army doctor,” bluff and jovial and popular in the community,
who did not possess a record of formal medical study, almost certainly Dr.
Groesbeck. Long afterward Dr. Fairchild wrote, in part : “The Medical Practice
Act . . . which had created so many vacant places by suppressing the uneducated
doctor, was repealed and brought back my predecessor. The doctor . . . who was
only theoretically barred from practice, remained in the background and could
easily be found. It was humiliating to see a man with no medical training get the
patients, but I could only wait.” Dr. Fairchild remembered this practitioner as a
vender of homeopathic remedies.
(To be continued in the November issue.)
October, 1950
1023
Pi esihent’s £ette\
MEDICAL EMERGENCY: WORLD SIZE
With the Korean conflict has come our second world medical emergency in ten
years — an emergency of indeterminable length and intensity. What we learned, in
the process of discharging our World War II responsibilities, is valuable in assist-
ing us to assume our obligations during this critical period ; but the organizational
blueprint falls short of 1950 requirements.
As in World War II, a Committee on Procurement and Assignment has been or-
ganized within the Minnesota State Medical Association. The committee will work
with representatives of the military service in obtaining the necessary number of
physicians for duty with the armed forces without inequitable hardship to the com-
munities they serve.
Medical reservists are being summoned by direct call ; and the new amendment to
the Selective Service Act provides for the induction of men needed in medical,
dental and specialist categories. These men, under fifty years of age, will be called
initially from the group of ASTP and V-12 students and others deferred to con-
tinue their education who have had less than 90 days active service.
But the role of the profession will assuredly not be confined to war service, vital
as that duty is. The threat of atomic bombing demands that we become proficient in
the care of radiation victims so that a war in our own backyards does not find us
hopelessly vulnerable.
Difficult and challenging days lie ahead of us, as we strive to do our part in the
prosecution of war without losing our perspective on the continuing problems of
America’s health.
Nor should we be led, blindly, into a patriotic acceptance of controls that are in-
consistent with the freedoms for which the nation is fighting. Certain controls may
be necessary, of course, but Americans have built a great nation on the basis of in-
dividual responsibility and this same quality of responsibility should be able to carry
us through the exigencies of war.
$4 'fjL. >*>•
President, Minnesota State Medical Association
1024
Minnesota Medicine
♦ Editorial ♦
Carl B. Drake, M.D., Editor; George Earl, M.D., Henry L. Ulrich, M.D., Associate Editors
CIVIL DEFENSE
TT IS to be hoped that no atom bomb will ever
-*-be dropped on any of our cities. We must
admit, however, that the greatest danger facing
our country at this moment is a concerted attack
on our large centers of population by Russian
bombers. Incidentally, the airplane is not the only
way an atom bomb could gain entrance to the
country. Is there anything to prevent the importa-
tion of the component parts of an atom bomb
through the Russian Embassy in Washington and
its assembling at vital points ? There is also no
reason for expecting any such warning as a
declaration of war as a prelude to atom bombing.
As an indication that the Russians have bombing
our country in mind is the fact that they them-
selves are preparing defenses against bombing of
vital points in their own country. It is argued that
inasmuch as the Russians must know we would
never resort to bombing- unless we had bombs
dropped first on us, their defense preparations in-
dicate that at sometime they will drop atom bombs
on us.
It seems a foregone conclusion that any de-
fense against Russian airplanes bearing atom
bombs cannot be 100 per cent effective. Any de-
fense measures must of necessity be on a national
scale, and a large air force strategically placed and
ever on the alert must be relied upon to minimize
the possible damage. Airplane defense is being-
supplemented by the construction of radar and
control stations. The establishment of local
Ground Observers Corps to implement radar and
the Civil Air Raid Warning, System is in process
in the U. S. Minnesota has completed organiza-
tion of 264 posts in the 35 counties involved and
is now field checking for a test to be conducted by
the Air Force in November.
When a bomb is dropped, defense methods
planned in advance by each locality will be called
into play. If a bomb were to be dropped today,
we can be sure no one would know what to do and
panic would result. It is high time each unit of
population, such as a municipality, city and state,
make civil defense plans in case a bomb is
dropped.
Much progress has been made in organizing for
civil defense on a state basis. An office for Civil
Defense for Minnesota has been established at
1003 Commerce Building, Saint Paul (Telephone
Garfield 7356). Colonel E. B. Miller is Director
and David Harrison, Assistant Director. This
office deals directly with the elected heads of local
governments and encourages municipalities
throughout the state to create local civil defense
planning bodies to meet disasters in time of peace
or war. Some 250 Minnesota municipalities have
already organized planning groups and are in va-
rious stages of planning. No community is too
small to plan because of the possibility of being-
called upon to contribute individuals and teams in
inter-community co-operation. Stricken areas
must receive outside help. Local planners should
take inventory at once of existing resources of
major importance to disaster relief, such as public
utilities, alternate routes and means of transpor-
tation, emergency shelters, feeding and clothing of
evacuated persons, medical, nursing and hospital
facilities, fire fighting equipment, policing, first
aid, sanitation, availability of plans and blue-
prints of existing water, gas, power and light
facilities. The various agencies which will be
called upon to perform certain duties following
a bomb explosion should be informed in advance
in order to avoid confusion. The medical profes-
sion will be called upon, along with other groups,
to perform certain duties and should be prepared.
On October 8, 1948, Governor Youngdahl ap-
pointed a Civil Defense Commission which in-
cluded Dr. A. J. Chesley, secretary of the Minne-
sota State Board of Health, as chairman of the
State Health Section of the Civil Defense. This
section is made up of the secretaries of the Min-
nesota State Medical, Dental, Nurses, Hospital,
and Pharmaceutical Associations, the Minnesota
Veterinary Medical Society and the Minnesota
Public Health Conference. The state has been
divided into nine District Health Sections which
are actually the same as our Councillor districts.
October, 1950
1025
EDITORIAL
Each Councillor of the State Medical Association
is chairman of his District Health Section which
includes representatives of the dental, nursing,
hospital, pharmaceutical, and veterinary profes-
sions and the M.P.H. Conference. It is the func-
tion of each chairman to keep in close touch with
the chairman of the city .and county Defense
Councils and the Red Cross in his district. The
Civil Defense Councils of the municipalities are
responsible for the execution of the general orders
of the Civil Defense Director, and the Medical
Health Officers of the eighty-seven counties of the
state are members of the local councils. The
duties of the councils include co-ordination of
health and defense activities locally.
On August 31 a short course on Civil Defense
was arranged by Colonel Miller at the University
which was attended by about 150 individuals, in-
cluding councillors, health officers, sheriffs and fire
department chiefs. The program included: Ef-
fects of Shock and Blast and Fire Attacks on
Structures ; Mob Psychology and Mass Hysteria ;
Defense against Atomic Weapons, Using the
Geiger Counter, et cetera.
This is a good beginning, but there is an obvious
need for the medical profession to inform itself
not only on the treatment of victims of atomic
bombing, but to make plans in each locality for
not only the treatment of bomb victims but their
transportation and hospital care.
Dr. Jan H. Tillisch, chairman of the Committee
on Military Affairs of the MSMA, in his report
to the Council emphasized the need for self-
education of the physicians and urged that each
county medical society arrange a meeting on Civil
Defense to be addressed by someone who has
taken a short course such as that mentioned. He
also recommended the sending of articles on the
treatment of bombing victims to the members by
the State Association.*
In meeting such a catastrophe as one caused
by an atom bomb, it is obvious that the American
Red Cross is not equipped to handle the situation
alone. While it functions well in case of floods,
tornadoes, fires, earthquakes and epidemics, the
Red Cross is too limited in funds to assume large
responsibilities in war disasters. Because of its
experience with the handling of disasters, how-
ever, it can give valuable assistance. The Red
*The following two publications are recommended to the pro-
fession: Medical Aspects of Atomic Weapons, Supt. of Docu-
ments, U. S. Government Printing Office, Washington 25, 1). C.
(Price 10 cents) and Effect of Atomic Weajxms, same address,
(Price $1.25) issued in September, 1950.
Cross has agreed to assist in the program of civil
defense in training in first aid and in home care
of the sick and injured, in providing food and
clothing and temporary shelter, and in partici-
pating in a war-time nation-wide blood program.
Truly, such a catastrophe as one caused by an
atom bomb would require the co-ordinated efforts
of everyone planned in advance.
SYMPOSIUM ON HYPERTENSION
nr HE SYMPOSIUM on Hypertension present-
■*- ed September 18-20, 1950, by the University of
Minnesota, with the generous financial support of
the Mayo Foundation for Medical Education and
Research and the Variety Club of the Northwest,
passed expectations as far as interest and attend-
ance were concerned. Presented in honor of
Drs. Elexiousr T. Bell, Benjamin J. Clawson and
George E. Fahr, the attendance was so great that
the Nicholson Hall Auditorium proved inadequate
and the main hall of Northrop Memorial Audi-
torium had to be utilized. An estimated 400 to
500 physicians were in attendance at each session.
The printed program contained the names of
many scientists, including physicians and sur-
geons who have been interested in the subject
of hypertension. Opportunity was given for those
not on the program to take part in the discus-
sions, and in this group were many whose names
are prominently associated with the problem of
hypertension.
The various morning, afternoon and evening
sessions were presided over by University profes-
sors, some located in Minneapolis and others
at the Mayo Foundation in Rochester. Doctors
Bell, Clawson and Fahr each presided over a
session and also appeared on the program.
The dinner in honor of Doctors Bell, Clawson
and Fahr was held on the evening of the last day
of the session at the Minneapolis Club. Some
1 50 physicians attended and paid tribute to 'ffie
retired physicians. Presided over by Dr. George
N. Aagaard, Director of Postgraduate Medical
Education at the University of Minnesota, ro
whose efforts the success of the meeting was
largely due, the dinner guests were addressed by
Dean Harold S. Diehl, Victor Johnson, head of
the Mayo Foundation, Dr. Elexious T. Bell and
Arthur W. Anderson, president of the Variety
Club of the Northwest.
Fortunately, the material presented at the three-
1026
Minnesota Medicine
EDITORIAL
day meeting will be published by the University.
Although there is general agreement that the
cause of hypertension is unknown and there is no
general agreement as to the treatment of the dis-
ease, a symposium of this sort at which frankness
typified the remarks of the speakers offered a fine
opportunity for the exchange of ideas. The pub-
lished proceedings will afford the reader present-
day opinions on the subject of hypertension in a
condensed form.
CORONARY THROMBOSIS IN EARLY LIFE
HP HERE appears in this issue a report by Drs.
Parsons and Heimark on the effect of diet and
smoking on the prothrombin blood level of a small
number of normal individuals. They report that
the prothrombin level is lowered after eating a
full mixed meal more than after an all-vegetable
meal, and by smoking. The authors are searching
for a means of detecting such individuals as may
be susceptible to coronary thrombosis at an early
age and possibly developing measures for pre-
vention.
The authors present their findings and a sug-
gestion for further study. If their findings are
confirmed it would not justify a vegetable diet
and abstinence from smoking for everyone. The
problem of selecting those most likely to develop
coronary trouble would still exist.
A low prothrombin time does not produce coro-
nary thrombosis. This is due to sclerotic changes
in the coronary arteries, the cause of which is not
known but runs in some families. Just what is in-
herited is not known. Some have incriminated the
handling of cholesterol, but blood levels of choles-
terol do not correspond with the ingestion of
certain fats. Blood pressures are regulated by
reflex nerve impulses. If excessive reflex impulses
result in hypertension, what is inherited? And
does repeated elevation of blood pressure lead to
arteriosclerosis? Should those who show an in-
creased blood pressure on using tobacco refrain
from its use because of the danger of developing
arteriosclerosis of the coronaries?
The authors believe that the difference in pro-
thrombin levels — that is, the low prothrombin
time — is what precipitates the coronary attack.
That they have not proven. Do some normal per-
sons have a more marked lowering of their pro-
thrombin time by heavy eating and smoking? If
further investigation proves this to be the case,
should these individuals be put on an anticoagu-
lant constantly — a rather difficult and costly pro-
cedure fraught with some danger? And further,
will the maintenance of a normal or high pro-
thrombin time prevent 3. coronary thrombosis ?
To advise a patient with evidence of coronary
arterial disease to abstain from overeating and
tobacco is good advice. Whether individuals likely
to develop coronary arteriosclerosis can be identi-
fied by their prothrombin-time reactions to eating
and smoking remains to be proven. The article is
provocative of thought and investigation.
REHABILITATION OF HANDICAPPED CHILDREN
Approximately five to seven out of every 100 chil-
dren who return to school this fall will have a physical
limitation, predicts Dr. Alfred R. Shands, Jr., medical
director of the Alfred I. duPont Institute of the Ne-
mours Foundation, Wilmington, Delaware.
In an article published in the August, 1950, issue of
The Crippled Child' Magazine, official publication of the
National Society for Crippled Children and Adults, the
Easter Seal Agency, Dr. Shands says that few people
realize the tremendous number of children with physical
limitations. If proper care is not given to these children
in their early years, the greater number of them will
grow into adult life — handicapped both in mind and
body.
As Dr. Shands says, “The great majority of these
children must look to the public school system for their
education, hence, the importance of every classroom
teacher knowing what the problem is and how to meet
it.”
“If time is taken to analyze the child’s defects, and if
he is guided accordingly, many times the teacher will
undoubtedly be the principal factor in the success or
failure of the child’s life.”
Dr. Shands adds that the classroom teacher who knows
which children have physical limitations should find out
from the parents what has already been done for them
and ask the school nurse and doctor what she can do
to aid in the child’s rehabilitation.
“The teacher’s approach to the child should be one of
friendliness, warmth, interest, patience, kindliness, and
an honest liking for the child,” continues Dr. Shands.
“The teacher should understand his handicap, realize
what his abilities are, and guide him in the pathway
of learning and then see that he has the confidence in
himself to successfully carry on in life.”
The child must come to the realization that, although
life is hard, he must face the world. Dr. Shands points
out that the crippled child should be given neither ex-
cess sympathy nor pity. As early as possible, he ought
to learn to do everything he can for himself, and should
not be assisted unless absolutely necessary or ask need-
less favors of others.
“It is inevitable,” concludes Dr. Shands, “that the
teacher can be truly effective only if she understands
the physical needs of the child and can help him toward
the best use of his abilities.”
October, 1950
1027
Medical Economics
Edited by the Committee on Medical Economics
of the
Minnesota State Medical Association
George Earl, M.D., Chairman
AMA GETS REPORT ON BRITISH MEDICAL
ASSOCIATION CONFERENCE
David Clayton, AMA’s London representative,
recently reported that the theme of the British
Medical Association annual conference was “the
ever-present dissatisfaction and frustration felt
by the majority of the nation’s general practition-
ers under the National Health Act.” Mr. Clayton
noted that sixteen resolutions were passed warning
the Labour government that if better treatment in
remuneration and a decrease in ever-increasing
bureaucratic control were not forthcoming, then
British doctors should walk out of the scheme in
a body.
Mr. Clayton reports that the conference was
sparked by a small but extremely vocal body of
doctors, the Fellowship of Freedom in Medicine.
This group is working hard to try to recover lost
ground. Their main line of attack is to “bring
before the British public the more flagrant abuses
under the scheme, and to keep on plugging away
inside the parent body, the B.M.A.”
COMMITTEE STUDIES BRITISH
MEDICAL EDUCATION
After making a thorough study of the back-
ground and evolution of the National Health
Service in Great Britain and its relation to medi-
cal education there, a special committee of the
American Medical Association has submitted its
report. The committee, which did its research
during December, 1949 and January, 1950, con-
sisted of deans of American medical schools :
Harold S. Diehl, M.D., Minneapolis; Loren R.
Chandler, M.D., San Francisco; and Stanley E.
Dorst, M.D., Cincinnati.
Speaking of the general practitioner and his
role in the education picture, the committee re-
ports :
“Even before the National Health Service Act the
lot of the general practitioner in Britain was not too
happy, and today it is demoralizing. We do not refer
to overwork hut rather to the fact that he seems destined
to a routine life which does not offer the necessary
facilities to practice good medicine and which fails ut-
terly to offer the professional incentives which lead to
continued growth of the physician. ... If we really
believe that the general practitioner is the ‘backbone of
medicine,’ then let us prepare him for the most difficult
task m medicine. After our experience in England, we
are confident that this is the most important job facing
the medical schools of the United States during the next
decade.”
The committee report concludes, saying :
“Finally, we would emphasize again the all-important
social, economic and geographic background against
which British socialism developed. The National Health
Service Act is only one facet of British socialism ; the
welfare state does not exist except as a part of the
whole. Furthermore, conditions in Great Britain are so
different from those in the United States that it would
be folly to contend that what may be necessary for
Britain today should be admirable for transfer to the
United States. We, fortunately, have the time that is
necessary to evolve an adequate medical service for our
people without resorting to the centralization of author-
ity in a welfare state.”
Takes Stronger View
Taking a more forceful view of the evils evi-
dent in European socialism, Dr. William C. Black,
former president of the Association of American
Physicians and Surgeons, gives first-hand ac-
counts of the detrimental results of the National
Health Service in England :
“Stayed in Kenilworth, England for a couple of
days. . . . Found out the proprietor of the hotel was
an anesthetist — specialist — and had quit a year ago, not
because of pay, but because under the regulations of
the National Service Act he was not permitted the
freedom of judgment and action essential to the best
interests of the patient. . . . Rather than do sub-standard
work he just quit and now makes a living from the
hotel.”
This same doctor told Dr. Black, “This Act had
the same effect on me, as a physician, as though
I had lost an arm or gone blind or developed some
1028
Minnesota Medicine
MEDICAL ECONOMICS
other physical disability which would make it im-
possible for me to do my work properly.”
LOBBY INVESTIGATIONS BRING
ACID COMMENTS
After Oscar Ewing recently bragged of his
right to crusade for Truman’s compulsory medical
insurance plan, the Chicago Tribune reminded its
readers that “Ewing is the most vigorous propa-
gandist of the day in the cause of political medi-
cine.” Said the Tribune:
“Ewing proclaimed that ‘it was not only his right, but
his duty’ to propagandize in favor of the Truman com-
pulsory medical insurance plan. In this mission he
admitted to having the assistance of sixty-five full-time
publicity men, paid by the taxpayer.”
Magazine Adds Its Voice
Defending the right of the Committee on Con-
stitutional Government to spend $40,000 a month
for printing and distributing John Flynn’s The
Road Ahead, the Saturday Evening Post avers
that the government is the biggest lobby in the
country and spends much more than $40,000 to
influence legislation. The Post quotes Frank
Chodorov in Human Events :
“Peanuts and fiddlesticks. Every hour of the day the
agencies of the Government spend more than that month-
ly average to influence legislation, and the legislation
they plug is to lengthen their tenure, increase their ap-
propriations, better their emoluments, strengthen their
hold on the public purse. . . . The biggest, more per-
nicious, most unscrupulous and entirely selfish lobby in
Washington is the Government. ... Its list of contribu-
tors includes every man, woman and child in the United
States. And yet it has the effrontery to point the finger
of scorn at an organization that digs up a piddling $40,-
000 a month for printing and distribution of litera-
ture. . . .”
Suggests a Positive Attack
The Post then suggests a more vigorous attack
against the aggressions of the Buchanan investi-
gating committee :
“We challenge your authority under the Constitution,
but we are not embarrassed or ashamed of what we are
doing. John Flynn’s The Road Ahead is an angry book,
with here and there an excess of zeal, but it does expose
the socialist nature of the Fair Deal program, an
analysis already accepted by the British Labor Party.
If there is any restriction in America on the right of
persons, including corporations, to challenge the pre-
tensions of a political group in this country, it hasn’t yet
been put in the form of law. Until freedom of speech
has been outlawed by Congress, we intend to support
October, 1950
our ideas by whatever authorities seem to us likely to
arouse the people to their danger.
“The only way the battle for a free economy will be
won is by forthright resistance in terms that can be
understood, not exclusively by demurrers and legal
responses and applications for injunctions, important as
these are. If the fight can be staged in an arena where
people can see what punches are being thrown, free
enterprise may have a chance. It certainly has none if
its protagonists always make themselves look like bad
boys talking their wa.y out of something sly and dis-
creditable.”
American medicine has certainly not been one
of those “bad boys” in its open battle against the
infiltration of political medicine and the remaining
gamut of socialistic schemes.
JOURNAL QUESTIONS MORE SECURITY
Now that President Truman has signed the bill
promising social security to some ten million more
persons and boosted benefits to those already
under its wing, the Wall Street Journal can only
ask, “What security?”
The most that a family can draw is the promised
$150 a month for life, after all principal wage
earners have retired. And, the Journal says :
“We can hope, too, that the one hundred and fifty
dollar bills will fulfill the real promise to these old
people, that it will buy for them what they now dream
of. We can hope. But in all candor we must say it is a
slim hope.
“Before this new $150-a-month level, the maximum for
the same family wa,s $85 a month. Five years, ten years
ago $85 a month would have bought more security than
the $150 will today. At the very best, the raised maxi-
mums do no more than catch up with the cheapening
of the dollar. To talk about ‘increased benefits’ in the
new law, as the promisers do, is sheer balderdash.
“This time the ink will hardly dry on the new promises
before they begin to fade. A hundred and fifty dollars
today won't buy what it would have bought last week.
And this same government which promises so much is,
at the same time, engaged in the same practices — reck-
less spending and calculated credit inflation — that have
in ten years torn the paper dollar in two.”
For Instance —
A short, but pointed editorial also appears in the
Journal, showing by example, the duplication in
the numerous bureaus, agencies, boards and com-
mittees which carry on the big business of federal
government :
“President Truman will add a ‘panel’ of three members
to the existing Loyalty Review Board. It will not re-
place the Board, but will have the duty of reexamining
1029
MEDICAL ECONOMICS
the examination of F.B.I. files by the Board. So the
Washington correspondents tell us, on the best anony-
mous authority they can get. That is to say :
Great fleas have little fleas on their back to bite ’em,
And little fleas have lesser fleas, and so ad infinitum.
And the great fleas themselves, in turn, have greater
fleas to go on ;
While these again have greater still, and greater still,
and so on.”
MINNESOTA STATE BOARD OF MEDICAL
EXAMINERS
230 Lowry Medical Arts Bldg.
Saint Paul 2, Minnesota
J. F. DuBois, M.D., Secretary
District Court oi Ramsey County, Minnesota, Declares
Vitamins to Be Drugs and Medicines
Sale by Grocers and Food Stores Declared Illegal
Re: Milton Culver doing business as Culver’ s Food
Market vs. John Nelson, John J. Pastenacki, Victor
E. Feit, J . Norman French, B. A. Deterling and F. IV.
Moudry (Minnesota State Board of Pharmacy) .
In a test case involving the sale of vitamins in tablet,
capsule or liquid form, in grocery stores, meat markets,
food stores and other similar places, the Hon. Albin
S. Pearson, Judge of the District Court of Ramsey
County, Minnesota, on August 7, 1950, made an order
denying the motion of the plaintiff in the above entitled
action for amended findings of fact, conclusions of law,
order for judgment or for a new trial. Judge Pearson
granted a stay until October 2, 1950, to permit the plain-
tiff to appeal from the order, or to avail himself of any
other legal remedies that he might have.
Mr. Culver, the plaintiff, operating a retail food store
in St. Paul, Minnesota, instituted the action against the
members of the Minnesota State Board of Pharmacy
to have judicially determined the construction and va-
lidity of the Pharmacy Act of 1937. The plaintiff alleged
that he brought the action for his own benefit and all
other retail food stores of the State of Minnesota, simi-
larly situated. The plaintiff alleged that he had a lawful
right to sell, in his food store, articles commonly re-
ferred to as food vitamins and food supplement vita-
mins. It was the claim of the plaintiff that such vita-
mins were sold in the original labeled packages and
were for the purpose of supplementing or fortifying the
ordinary or usual diet, and that such vitamins were not
sold for medicinal purposes or for the purpose of treat-
ing or curing any disease of man. The case was tried
before Judge Pearson without a jury commencing May
24, 1948. Among the witnesses for the plaintiff were
Dr. Bernard Oser, a chemist of New York City, and
Dr. Norman Jolliffe, a physician and surgeon of New
York City. Among the witnesses for the Minnesota
State Board of Pharmacy were Dr. Russell M. Wilder
of the Mayo Clinic, Rochester, Minnesota, Dr. Ole
Gisvold, Dr. Ancel Keyes and Dr. Raymond Bieter, all
of the University of Minnesota, and Dr. Charles Hensel,
a physician of St. Paul. Doctors Wilder, Bieter and
Hensel testified that vitamins are drugs and medicines.
Following the trial the Court permitted each side to
submit written briefs outlining their respective positions
and setting forth various citations to sustain their re-
spective claims. After thorough consideration of the
matter, Judge Pearson, on April 19, 1950, filed the
Court’s findings of fact, conclusions of law and order
for judgment in favor of the defendants.
In his decision Judge Pearson found that vitamins
when prepared in tablets, capsules or liquids composed
of pure or concentrated vitamins, natural or synthetic,
are drugs within the definition of the term “drug” under
the laws of the State of Minnesota. The Court also
found that such vitamins when offered for sale in the
original boxes are not common household preparations
sold for nonmedicinal purposes. The Court also found
that such vitamins are not harmless proprietary medi-
cines within the meaning of the laws of the State of
Minnesota.
Judge Pearson’s decision is of the utmost importance,
not only to members of the pharmaceutical profession,
but to the medical profession and the public generally.
The Pharmacy Board was represented in the case by
the Hon. J. A. A. Burnquist, Attorney General of the
State of Minnesota, and his Chief Deputy George B.
Sjoselius.
Surgical Instruments Found in Possession of Albert Lea
Man Arrested on Traffic Charge
State of Minnesota vs. Tracy A. King
Early in the morning of September 13, 1950, Richfield,
Minnesota, police arrested Tracy A. King, thirty-five
years of age, 524 Park Avenue, Albert Lea, Minnesota,
on a charge of careless driving. King was driving an
Oldsmobile four-door sedan with Minnesota license
plates No. 152-808. In the car police found a doctor’s
medical bag containing numerous surgical instruments,
a stethoscope and various medicinal preparations. A
receipt was also found made out to “Dr.” King. The
Minnesota State Board of Medical Examiners was im-
mediately notified by Sheriff Ed Ryan of Hennepin
County, and a lawyer for the Medical Board interviewed
King. King admitted that he had been representing
himself as a doctor; that he had told conflicting stories
of having gone to medical schools in Canada and also
in Europe. During the questioning, King stated he was
born February 2, 1915, at Winnipeg, Manitoba; that he
was a Canadian citizen and entered the United States
at Noyes, Minnesota, August 15, 1949. He stated that
he was a tile setter by trade and had no medical educa-
tion. He denied that he had actually treated any pa-
tients. King stated that his family name was Stroppa,
and that he had lawfully changed his name in court at
Winnipeg. The matter has been investigated further at
Albert Lea, and it has been ascertained that King has an
application on file in the District Court there, to become
a citizen of the United States. King claimed that he
had the surgical instruments and the medicinal prepara-
tions in his possession merely for the purpose of “im-
pressing people.”
On September 18, 1950, King pleaded guilty in the
Municipal Court of Richfield, to a charge of careless
driving and was fined $50.00 by Judge Joseph J. Poitras;
the fine was paid. The Minnesota State Board of
Medical Exanimers is continuing the investigation, and
anyone who has any information in reference to King,
or any of his medical activities, is respectfully requested
to communicate with the Minnesota State Board of
Medical Examiners at 230 Low'ry Medical Arts Bldg.,
Saint Paul, Minnesota.
Modern public health does not prevent death alone. It
also prevents disease. For every life preserved by a
tuberculosis program, scores of individuals are saved
from invalidism. For every life saved from malaria,
hundreds of individuals are maintained as active pro-
ducers in the population. — Am. J. Pub. Health, August,
1950.
1030
Minnesota Medicine
Minneapolis Surgical Society
Meeting of December 1, 1949
The President, Ernest R. Anderson, M.D., in the Chair
CONTROLLED RESPIRATION IN THORACIC AND UPPER ABDOMINAL
OPERATIONS
JOHN H. GIBBON, JR., M.D.
Professor of Surgery, Jefferson Medical College
Philadelphia. Pennsylvania
THE PREVENTION of pain has become the least
important part of modern anesthesia. Similarly,
muscular relaxation for abdominal operations presents
no problem to the modern anesthetist. With the solution
of these two difficulties modern anesthesia is properly
concerned with avoiding disturbance of pulmonary and
cardiac function. The function of the lungs is, briefly,
to provide entry to the body of the oxygen which is re-
quired for metabolic processes and to furnish exit for
the carbon dioxide which accumulates as a result of these
same processes. The function of the heart is simply to
move the blood through the lungs and then to all parts
of the body so that these fundamental gas exchanges
which take place in the tissues can be compensated for
by the reverse process in the lungs.
In the present surgical era the diaphragm has ceased
to divide surgeons into the two air tight compartments,
as it does the organs of the body. Many upper ab-
dominal operations can be performed with greater ease
through a thoracic, or a combined thoracic-abdominal
incision. It thus becomes a concern of most surgeons to
be interested in this important aspect of modern anes-
thesia, i.e. the maintenance of normal cardiorespiratory
function during operations.
In the absence of adhesions between the lung and the
chest wall, opening of one pleural cavity results in the
collapse of the lung on that side to about one third of
its former volume. This is due to the contraction of the
elastic tissue of the lungs. If this elastic tissue were not
present and the enormous filming surface, forty square
meters, were maintained by stiff alveolar walls, as in a
marine or rubber sponge, most of the disturbances of
pulmonary function which I am about to discuss, would
not occur. With one pleural cavity widely opened the
respiratory movements do not result in a normal ex-
change of gases between the alveoli and the outside air.
In addition the respiratory movements, which under
these circumstances are greatly increased in magnitude,
produce movement of air back and forth between the
two lungs instead of in and out of the trachea. The
oxygen content and tension of the alveolar gases rapidly
declines while the carbon dioxide content and tension
rapidly increases. The anoxemia and acidosis which <5c-
cur are rapidly fatal.
Two ways have been proposed to overcome the col-
lapse of the lung when the pleural cavity is opened. One
is to keep the lung exposed to pressure slightly below
atmospheric. The other is to maintain a pressure within
the lungs which is slightly above that of the surround-
ing atmosphere. To accomplish the former, Sauerbruch,7
around the turn of the century, constructed a large cham-
ber maintained at an air pressure slightly below atmos-
pheric, in which the surgeon and his assistants operated.
The patient's head projected outside the chamber through
a tightly fitting rubber collar. This ingenious but cum-
bersome apparatus was not widely adopted because of
its obvious drawbacks. To accomplish the second method
of maintaining expansion of the lungs a positive pressure
cabinet was devised. This consisted of a box in which
the patient’s head was placed through a snug rubber
collar which fitted around the neck. The air pressure in
this box was maintained' slightly above that of the at-
mosphere. Samuel Robinson5’6 of Boston, between 1900
and 1910, demonstrated the efficacy of such a positive
pressure cabinet in animal experiments and devised one
for use with human patients. A simpler method of
maintaining positive pressure by the use of a tightly
fitting face mask soon replaced the more cumbersome
positive pressure cabinet.
Stimulated by Chevalier Jackson’s development of the
bronchoscope, intratracheal tubes in human patients have
now been widely adapted for maintaining a positive pres-
sure within the lungs during intrathoracic operations.
These intratracheal tubes ensure an adequate air way at
all times and permit the aspiration of any material that
may accumulate in the tracheobronchial tree. The great
value of these tubes has become so well established that
their advantages do not need to be stressed here. Some
anesthetists employ these tubes for positive pressure by
placing a tightly fitted face mask over them. Others
draw the outside end of the tracheal tube through a rub-
ber diaphragm in the face mask and then connect the
tube directly with the anesthetic circuit. The drawback
to either of these procedures is that, with the use of
positive pressure, air passes down the esophagus and
enters the stomach, producing gastric distention which
requires decompression by stomach tube during the
operation or postoperatively. An inflatable rubber cuff
around the outside of the lower end of the tracheal tube
was soon developed to obviate this difficulty. Gentle
distention of this rubber cuff produces for all practical
purposes an air-tight system between the air in the lungs
October, 1950
1031
MINNEAPOLIS SURGICAL SOCIETY
and that in the anesthesia circuit, without the interposi-
tion of a face mask. Such a system is that most com-
monly employed today for intrathoracic operations. The
problem of preventing collapse of the lungs has thus
been satisfactorily solved. Adequate ventilation of the
lungs still remains a problem.
Even with the lung inflated, it is still necessary for the
carbon dioxide, which is given off from the blood in the
alveoli, to pass from the alveolar air to the atmospheric
air. Similarly it is necessary to provide for constant re-
placement of oxygen in the alveolar air which is taken up
by the blood. Pure physical diffusion of gases in the
closed air circuit is not enough. There must be a rhyth-
mic movement of gases back and forth between the
rubber bag in the anesthetic circuit and the alveoli in
the lungs. With one pleural cavity widely opened the
normal action of the muscles of respiration do not pro-
duce an adequate exchange of gases between the alveolar
air and the external anesthetic circuit. The increase in
size of the thoracic cage which occurs with normal in-
spiration merely results in air passing into the pleural
cavity of the opened side of the chest, with relatively
small amounts of air entering the lungs through the
tracheal tube. Expiration similarly lacks effectiveness.
The lack of effective ventilation was not apparent at
first, because by the use of a high percentage of oxygen
in the rebreathing circuit it has been possible to main-
tain normal oxygenation of blood during the course of
prolonged intrathoracic operations. Thus, if ether is the
anesthetic agent, and oxygen is used instead of room
air, the oxygen tension in the alveoli can be more than
quadrupled. Under these circumstances ventilation may
be greatly reduced without affecting the oxygenation of
the blood. The story however is quite different with
carbon dioxide. Here the question is not one of supply-
ing a gas to the alveoli, but of removing a gas from
them. Only adequate ventilation can achieve such re-
moval of carbon dioxide. Probably the fact that cyanosis
can be avoided by using a high concentration of oxygen
in a closed rebreathing system with an open thorax has
drawn attention away from the inadequate ventilation
which occurs under these conditions. Unfortunately an
increase in the carbon dioxide tension of the arterial
blood does not produce any change in the color of skin
and mucous membranes, as does the accumulation of
reduced hemoglobin in the blood. That the ventilation
is inadequate under these conditions of positive pressure
breathing has recently been demonstrated by Beecher.1
He has shown that while adequate oxygenation of the
blood can be maintained in the course of long intra-
thoracic operations, the carbon dioxide tension in arterial
blood and alveolar air can rise to quite alarming heights
with a concomitant profound drop in the pH of the
arterial blood.
Some realization that the ventilation is inadequate
under these circumstances has led anesthetists to assist
the respiratory movements by gently squeezing the bag
with inspiration. This increases somewhat the exchange
between the alveoli and the external anesthetic circuit.
However, even in these circumstancs, Beecher states that
he is only able to prevent a rise in the carbon dioxide ten-
sion in about one third of his patients. The reason prob-
ably lies in the fact that expiration is not assisted in any
way ; in fact, the pressure in the external circuit with
positive pressure breathing increases with expiration,
thus hindering the passage of gas out of the lungs into
the breathing bag. Thus with positive pressure breathing
unassisted by compression of the breathing bag by the
anesthetist, the pressure in the rubber bag and hence in
the external circuit decreases with inspiration and in-
creases with expiration. These fluctuations of pressure
directly oppose the movement of air from the alveoli to
the external circuit, and vice versa. By compression of
the rubber bag one phase is helped, but not the other.
Stephens et al8 in 1947, advocated the use of curare in
intrathoracic operations and a maintenance of normal
ventilation by manual compression of the rubber breath-
ing bag in the closed circuit. If the bag be kept par-
tially collapsed under these circumstances there is no re-
sistance to expiration, and inspiration is effected by
manual compression of the bag. If the bag be kept tense,
however, ventilation again becomes impaired due to the
increase in pressure with expiration. Such manual con-
trol of respiration is a tiresome and repetitive task for
the anesthetist in operations lasting many hours, and in-
terferes with his other occupations, such as controlling
the depth of the anesthesia, taking the blood pressure,
recording the pulse rate and supervising the adminstra-
tion of fluids.
Crafoord2 in 1939, advocated the use of a mechanical
apparatus for compressing the rubber bag by air pres-
sure to provide adequate ventilation. He stressed the
importance of avoiding any resistance to expiration. He
demonstrated in dogs that the accumulation of carbon
dioxide in arterial blood could be avoided by this means.
Mautz,3-4 in this country, has made a similar demonstra-
tion in animals and has developed a simpler apparatus
for the compression of the bag in the respiratory circuit
by air pressure. Even more recently Mautz has de-
veloped a method of direct mechanical compression of
the rubber bag.
Using curare and both Crafoord’s apparatus and
Mautz’s machine, in a large series of intrathoracic and
upper abdominal operations, we have been impressed
with the very adequate ventilation obtained, as indicated
by a study of the arterial blood gases in a small series of
patients. With a few exceptions the marked increase in
carbon dioxide tension and fall in pH, reported by
Beecher, has been avoided. The advantages of the use
of such a mechanical apparatus over manual compression
of the rubber bag may be listed as follows :
1. The ventilation is adequate enough to avoid a pro-
found drop in pH and marked rise in carbon dioxide
tension in the arterial blood.
2. The ventilation is continuous and can be easily ad-
justed as to rate and depth.
3. The anesthetist is relieved from a manual test
which is better carried out by mechanical means.
References
1. Jieecher, H. K., and Murphy, A. J.: Respiratory acidosis
during thoracic surgery. Read before the Twenty-ninth An-
nual Meeting of the Association for Thoracic Surgery, New
Orleans, March 1949.
2. Crafoord, C.: Pulmonary ventilation and anesthesia in major
chest surgery. J. Thoracic Sure., 9:237, 1940.
3. Mautz, F. R.: A mechanism for artificial pulmonary ven-
tilation in the operating room. J. Thoracic Surg., 10:544,
1941.
1032
Minnesota Medicine
MINNEAPOLIS SURGICAL SOCIETY
4. Mautz, F. R., Beck, C. S., and Chase, H, F. : Augmented
and controlled breathing in transpleural operations. J.
Thoracic Surgery, 17:283, 1948.
5. Robinson, Samuel : Experimental surgery of the lungs.
1. Thirty animal operations under positive pressure. Ann.
Surg., 47:184, 1906.
6. Robinson, Samuel : A positive pressure cabinet for thoracic
surgery. Surg., Gyn. and Obst., 10:287, 1910.
7. Sauerbruch, F. : Ueber die Ausschaltung der schadlichen
Wirkung des Pneumothorax bei intrathorakalen Operationen.
Zentralb. f. Chir. Leipz., 31:146, 1904.
8. Stephens, H. B., Harroun, P., and Bechert, E. F. : The use
of curare in anesthesia for thoracic surgery. J. Thoracic
Surg., 16:50, 1947.
Discussion
Dr. Ralph T. Knight : By coincidence, we had chosen
the same subject for surgical physiological conference at
the University when I learned that Dr. Gibbon was to
speak on the subject of the “Physiology of Controlled
Respiration.” We were, therefore, very fortunate in
having Dr. Gibbon discuss the subject with us there this
afternoon.
Dr. Gibbon should not apologize for talking on this
subject, for these problems of physiology associated with
anesthesia must be of deep concern to the surgeon and
the more familiar he is with them, the better will be the
liaison between the surgeon and the anesthesiologist. I
am sure that Dr. Gibbon’s visit will further increase the
prestige of anesthesiology in this community.
Do you not feel, Dr. Gibbon, that the negative pressure
chamber and the positive pressure chamber to which you
referred were far less physiologically effective than the
intermittent positive pressure as we use it today?
You spoke of the elasticity of the lung creating the
problem of ventilation by collapsing the lung when the
chest is open. However, this same elasticity helps us in
ventilation by expelling the gas each time after we in-
flate the lung.
You spoke of possible damage to the tracheal mucosa
by too much pressure in the inflated cuff on the tracheal
tube. We had that happen twice. Dr. Dennis then sug-
gested that we inflate the cuff under control by a water
manometer and made the first manometer for us. We
now make our own cuffs out of contraceptive condoms.
These are large enough in diameter to fill the trachea
without stretching the rubber and, therefore, the ma-
nometer registers to true air pressure against the tracheal
mucosa. We do not use more than 10 mm. mercury or
14 cm. water. However, this pressure in the cuff allows
us to expand the lungs up to 10 mm. of mercury pres-
sure with each intermittent expansion. More lung pres-
sure than this blocks the pulmonary capillaries and
brings pressure upon the heart, interfering with cardiac
output.
Dr. Gibbon has been especially interested in adequate
pulmonary ventilation to accomplish adequate elimination
of carbon dioxide and to keep the pH of the blood at a
normal level. I agree with him completely. It is of spe-
cial interest to me that he found the Mautz machine
with the circle type CCb absorber to be the most efficient.
AVe have always believed this to be true.
We believe that a frequent test of the tension of CCb
in the exhaled gas would help us to regulate the con-
trolled respiration to the proper rate and depth. We have
not yet been able to obtain an apparatus which will do
this as frequently, quickly, conveniently and accurately
as we need. Within a month we are to have a mass
■spectrometer in the operating room which has been pre-
pared by Dr. Nier in our Physica Department. This will
do the job, but the apparatus has cost about $15,000. We
hope for a simpler and cheaper method.
Up to now we have depended upon the manual
manipulation of the breathing bag to control and aug-
ment the respiration. A machine such as Dr. Gibbon
has used would be a great physical relief, and we are
stimulated to try it to see if it will meet the changing
demands of the patient and the situation as well as the
manual method. Our surgeons seem to need the lung
October, 1950
entirely collapsed much of the time in lung surgery, but
inflated often enough to keep it inflatable. In heart
surgery, we never cease the manual respiration.
Dr. Gibbon’s talk has been an inspiration, and we ap-
preciate it very much.
Dr. Nathan Kenneth Jensen: I have enjoyed Dr.
Gibbon’s excellent presentation of this very timely prob-
lem. We have all thought of respiration in much too
limited a sense, our concern being primarily with pul-
monary ventilation in relation to oxygen exchange. Dr.
Gibbon’s paper this evening graphically illustrates the
necessity of also giving serious attention to the require-
ments of carbon dioxide exchange.
In thoracic surgery, we are frequently harder pressed
to meet the requirements of carbon dioxide exchange
than of oxygenation. The administration of high oxygen
concentration will provide adequate oxygenation with
very limited pulmonary ventilation, but there is no way
to provide for adequate CO2 elimination except by
maintenance of good pulmonary ventilation.
The problem goes much deeper than this however, as
respiration for the tissue cells is dependent upon a bel-
lows, the lungs; a pump, the heart; and a distribution
system, the circulation. Failure in any of these results
in diminished respiratory exchange with resultant
respiratory acidosis and anoxia. The anoxia is easier
recognized and we are better equipped to correct it than
the hypercarbia. An example is the surgical patient with
emphysema and deficient pulmonary circulation. This
patient will tax the skill of the most experienced medi-
cal anesthetist and still may be in severe respiratory
acidosis at the termination of a long surgical procedure.
We have encountered severe diffuse capillary bleeding
in several patients with inadequate pulmonary reserve
who have slipped into respiratory acidosis after several
hours of operating time. I would like to ask Dr. Gibbon
if he has noted any tendency in patients known to be in
respiratory acidosis to bleed excessively?
Dr. Clarence Dennis : In the course of his discus-
sion this afternoon and this evening, Dr. Ralph Knight
has pointed out that he felt that sudden emptying of the
lungs after full inflation would be a very disturbing
thing to a surgeon working inside the chest. Have you
noted that the motion of the Crafoord respirator is in
fact a source of difficulty in doing surgery with the em-
ployment of this machine?
I understand, Dr. Gibbon, that you have done some
studies on oxygen saturation with continuous tracings
throughout induction and performance of a considerable
number of operative procedures. Would it be possible
for you to tell us anything of your findings in this
regard?
Dr. Gibbon (closing) : I appreciate very much the
remarks of Drs. Knight, Jensen and Dennis. With re-
gard to Dr. Knight’s comments, I certainly agree that
intermittent positive pressure when the thorax is widely
opened is more physiologically effective as regards ven-
tilation than the older negative or positive pressure cham-
bers. It is quite true that the elasticity of the lung helps
ventilation by aiding expiration with the thorax open.
One should remember, however, that this elastic tension
is very slight, being equal to the normal negative intra-
pleural pressure. Consequently the rubber rebreathing
bag should not be kept distended as this will interfere
with expiration. Dr. Dennis’s manometric control of the
air pressure in the inflated cuff of the tracheal tube is an
excellent one, and should be widely adopted. If the ten-
sion of carbon dioxide in the exhaled gas could be
rapidly and simply determined during the course of pro-
longed intrathoracic operations, it would of course be of
great assistance in avoiding respiratory acidosis. I trust
(Continued on Page 1034)
1033
Communication
PARATHION POISONING
To the Editor :
Parathion (0,0-diethyl O-p-nitrophenyl thiophos-
phate) has proved so highly efficient as an insecticide
or pesticide that its importance economically is apparent
and its usage is rapidly becoming widespread in agri-
cultural communities. Unfortunately parathion is highly
toxic for man as well as for insect life. It may be
handled and applied safely if, and only if, stringent
precautions are strictly observed. However, in spite of
the emphasis placed on the need for such precautions
excessive absorption may occur through relaxation of
these precautions or through accidental heavy exposure.
Physicians may therefore be confronted with cases of
poisoning from this compound. The management of
acute poisoning by a cholinesterase inhibitor is a medical
emergency of a type seldom if ever up to this time en-
countered in medical practice. The following summary
of information now available should therefore be of in-
terest to physicians. From this it will be apparent that
in this medical emergency the proper timing and dosage
of the antidote atropine may be life saving.
The systemic effects of parathion are qualitatively
similar to those of other cholinesterase inhibitors, and
to the effects of the acetylcholine analogues (pilocarpine,
muscarine, arecoline, mecholyl, doryl). Effects of para-
thion are interpreted as the result of accumulation of
endogenous acetylcholine at synapses of the nervous sys-
tem. They include giddiness, headache, nausea, vomiting,
abdominal cramps, diarrhea, miosis, sweating, salivation,
lachrymation, confusion, weakness, and muscular fasci-
culations. A sense of tightness is felt in the chest as the
bronchi constrict and fill with mucus. Fatalities appear
to result from constriction and secretions in the bronchi
or arrest of the heart. On the other hand, recovery from
the acute poisoning is usually complete and uneventful.
There has been no evidence of permanent injury in such
cases.
Treatment may be effective if atropine grains 1/100 to
1/50 ( 0.65 to 1.3 milligrams) is given at once and every
hour or oftener as needed to keep the patient fully
atropinized (mouth dry, pupils dilated). If the lungs
have filled before the atropine takes effect, clear the
bronchi by postural drainage. Oxygen is then indicated.
Morphine is contraindicated. Muscular fatigue and weak-
ness may reach a degree requiring artificial respiration.
Following even mild symptoms no additional exposure to
parathion or other phosphateesters should be allowed
until time for cholinesterase regeneration has been al-
lowed.
Intoxication by parathion or other CE inhibitors is an
acute episode of 24 to 48 hours. It is terminated by
cholinesterase regeneration and is followed by period of
gradually decreasing susceptibility to small exposures.
Successive parathion exposures may deplete cholinester-
ase reserves progressively and create a susceptibility to
small doses of tetraethyl pyrophosphate or vice versa.
Since CE is regenerated rather slowly in man, patients
who have suffered parathion poisoning should not be
permitted to experience further possible exposures to this
compound until it has been established that CE blood
levels have returned to normal. Parathion and other
phosphate insecticides are not locally irritating, but they
produce local cholinergic effects. There has been no
chronic or cumulative action other than that on CE as
previously described. Dangerous parathion residues have
not been detected on food crops sprayed at the proper
stage before harvest.
Very truly yours,
American Cyanamid Company
D. O. Hamblin, M.D.
Medical Director
MINNEAPOLIS SURGICAL SOCIETY
(Continued from Page 1033)
that Dr. Knight’s efforts to accomplish this will prove
fruitful.
With regard to Dr. Jensen’s question concerning pro-
fuse capillary bleeding with respiratory acidosis, I might
state that we have not made this observation. However,
as I stated earlier, we have been able to avoid any seri-
ous respiratory acidosis by using mechanical ventilation
of the lungs during prolonged intrathoracic operations.
Finally, with regard to Dr. Dennis’s questions, I would
like to say that we have had no difficulty whatsoever
from motion of the lungs using the Crafoord or the
Mautz type of mechanical insufflation. With the gentle
insufflation pressures used, it is a simple matter to pack
the lung out of the way with a moist gauze swab. At
intervals during the operation the pressure of the swab
is released, and atelectatic portions of the lung are al-
lowed to reexpand. As Dr. Dennis says, we have made
some continuous tracings of the oxygen saturation of the
blood, using an improved form of the Milliken oxymeter
devised by Dr. B. j. Miller of our laboratory. We found
little practical use for such continuous recording during
the operation but we did learn something, as Dr. Dennis
suggests, concerning the induction phase and also con-
cerning the changes which occur in the immediate post-
operative period. Because of a momentary period of
rather marked unsaturation of blood with oxygen which
occurs when sodium pentothal is used to induce anesthe-
sia before introduction of the intratracheal tube, we have
discontinued this practice. We now routinely insert the
intratracheal tube under local anesthesia, and then with
the tube in place we induce anesthesia with a small dose
of sodium pentothal continuing with ether and oxygen.
Using this procedure we have no period in which the
arterial blood is inadequately saturated with oxygen. We
have also learned that in the immediate postoperative
period, when the patient begins to breath room air, the
arterial oxygen saturation tends to decline. This has
taught us that it is advisable in patients with poor
respiratory reserve to continue the administration of
oxygen in the immediate postoperative period until the
patient has been returned to his bed and placed in an
oxygen tent.
I appreciate the honor of having been invited to speak
before the Minneapolis Surgical Society. It has been a
great pleasure to be here.
The meeting adjourned.
William H. Rucker, M.D., Recorder
1034
Minnesota Medicine
When there is a tendency toward hemorrhoids, when hemorrhoids
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AUXILIARY MEMBERS URGED TO VOTE
Mrs. L. R. Scherer Legislative Chairman
All members of the Woman’s Auxiliary to the Minne-
sota State Medical Association are urged to vote in the
November elections. Auxiliary members, as individuals,
should support and work for individual candidates.
For information about any candidate, write to Mrs. L.
Raymond Scherer, 1930 Irving Avenue South, Minne-
apolis.
Also of help in keeping Auxiliary members informed
will be the radio programs soon to be released by the
American Medical Association.
BULLETIN SUBSCRIPTION CALLED IMPORTANT
Mrs. Peter S. Rudie, Bulletin Chairman
The RIGHT and WRONG questions about The Bulle-
tin of the Woman’s Auxiliary' to the American Medical
Association :
It is RIGHT to subscribe to The Bulletin because:
1. It is to the Auxiliary member what The Journal is
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4. It is helpful to auxiliaries because it gives new ideas
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5. Every county officer and auxiliary member should
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It is wrong :
1. NOT to subscribe to The Bulletin!
The Bulletin is issued quarterly — August, December,
March and May. Subscription price is one dollar a year.
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NOW. Names and addresses should be sent in IM-
MEDIATELY.
PROBLEMS IN TUBERCULOSIS
Even after clinical follow-up in minimal tuberculosis
has confirmed the interpretation of the ill-defined x-ray
shadow, the physician is faced with another and per-
haps more serious problem. He must then cope with
the question of the lesion’s significance, and must decide
upon the course of action to be taken in its management.
Will the patient need to undergo hospitalization and
surgical procedure? Can the lesion be managed under a
home-care regimen? Or will it be sufficient to place the
patient under long-term observation, imposing only
token limitations upon normal activity? It will be most
urgent that these questions be resolved properly and
decisively.
These are but a few of the problems which our screen-
ing survey experiences in communities and hospitals pose
for us and for the medical profession generally. Meet-
ing them directly and fully is the best assurance of ef-
fective tuberculosis control. — Robert J. Anderson, M.D.,
Journal-Lancet, April, 1950.
1036
Minnesota Medicine
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1037
IN MEMORIAM
In Memoriam
CHARLES ANTHONY REED
Dr. Charles A. Reed, well known orthopedist of Min-
neapolis, died August 22, 1950, at Eitel Hospital. He
was seventy-eight years of age.
Dr. Reed was born February 2, 1872, at Hastings,
Minnesota. He received his medical degree from the
University of Minnesota Medical School in 1898. He
first practiced medicine at Kalispell, Montana, and in
1903 and 1904 studied orthopedic surgery in Germany.
He began practicing medicine in Minneapolis in 1909.
In 1920, he helped organize the Nicollet Clinic and
became associated with the staff of Eitel Hospital. He
held an appointment as associate clinical professor of
orthopedic surgery at the University of Minnesota Medi-
cal School and was assistant chief surgeon at the
Shriner’s Hospital for Crippled Children in Minneapolis.
During World War I, Dr. Reed served as a major
with Base Hospital 26 in France. He was a member
of the American College of Surgeons and a fellow
of the American Academy of Orthopedic Surgeons. He
was a member of the Hennepin County Medical Socie-
ty, the Minnesota State Medical Association, and the
American Medical Association.
Dr. Reed’s wife, the former June Clarke Dickey of
Minneapolis, died in 1947. They were married in 1916.
He is survived by a stepdaughter, Mrs. S. B. Marantz.
MARK E. RYAN
Dr. Mark E. Ryan of Saint Paul, Minnesota, died fol-
lowing a coronary attack on August 16, 1950. He was
sixty years of age.
Dr. Ryan was born at Delafield, Wisconsin, May 4,
1890. He attended school at Oconomowoc, Wisconsin,
and obtained a B.S. degree from the University of Wis-
consin in 1918. He attended medical school at the Uni-
versity of Wisconsin and at the University of Minnesota,
graduating from the latter in 1921. He interned at Cleve-
land General Hospital in 1921 and began practice in
Saint Paul with his brother, Dr. John J. Ryan, in 1922.
Dr. Ryan was a member of the Ramsey County Medi-
cal Society, the Minnesota State Medical Association
and the American Medical Association. He had been a
member of the Ancker Hospital staff for many years
and had been active in medical, religious and civic
circles in Saint Paul.
Dr. Ryan is survived by his wife, Isabel Perry Ryan;
four sons, Mark E., James P., Lawrence P., and Paul
W. ; a daughter, Sister Mary of St. Mark of the House
of Good Shepherd; two brothers, Dr. John (., of Saint
Paul, and Dr. William, of Duluth.
The continued responsibility for the care of a chroni-
cally sick person adds immeasurably to the education of
a physician. It requires maturity to be able to recognize
limitations, to avoid becoming angry because the patient
does not get well, to avoid becoming discouraged or dis-
couraging, and to continue to wish to help within the
limits of one’s ability.— John Romano, M.D., J.A.M.A. ,
June 3, 1950.
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. . . it holds Vs more!
The famous patented “OPN-FLAP” feature, de-
signed with the advice of physicians, permits
opening of Hygeia Bag to the full length and
width of top, thus allowing more space
for packing. Hygeia is the only medical bag that
can be packed to the very top and easily zipped
closed without crushing or jamming the con-
tents. Made of the finest top grain leathers by
luggage craftsmen, the “OPN-FLAP” Hygeia
Medical Bag is preferred by doctors everywhere.
C. F.
901 MARQUETTE AVENUE
ANDERSON CO., Inc.
Surgical and Hospital Equipment
MINNEAPOLIS 2. MINNESOTA
1038
Minnesota Medicine
FOR ALL BASIC
OCTOBER 16-21
Communities throughout the nation ore preparing to mark
this important event in popular health education. A series
of full color posters are nationally distributed in schools,
colleges, factories, Y's, clinics, health centers and other in-
stitutions. These two heavily illustrated booklets have been
widely accepted by physicians everywhere for distribution to
their patients. Their titles are: "Blue Prints for Body Balance"'
and "The Human Back ... its relationship to Posture and
Health."' Ask for samples or the quantity you need on your
letterhead. Write to SAMUEL HIGBY CAMP INSTITUTE FOR
BETTER POSTURE, Empire State Building, New York 1, N. Y.
Founded by S. H. Camp and Company, Jackson, Mich.
SCIENTIFIC SUPPORT NEEDS
Prenatal • Postoperative • Postnatal
Pendulous Abdomen • Breast Conditions
Hernia • Orthopedic • Lumbosacral • Sacro-iliac
Dorsolumbar • Visceroptosis » Nephroptosis
• Developed and improved over four decades of close
cooperation with the profession, basic CAMP designs
for all basic scientific support needs have long earned
the confidence of physicians and surgeons here and
abroad. All incorporate the unique CAMP system of
adjustment. Regular technical and ethical training of
CAMP fitters insures precise and conscientious attention
to your recommendations at moderate prices.
If you do not have a copy of the latest CAMP "REF-
ERENCE BOOK FOR PHYSICIANS AND SURGEONS,"
it will be sent on request.
S. H. CAMP and COMPANY, Jackson, Michigan
World's Largest Manufacturers of Scientific Supports
New York • Chicago • Windsor, Ontario • London, England
YOU MAY RELY on the merchants in your community who
display this emblem. Camp Scientific Supports are never
sold by door-to-door canvassers. Prices are always based
on intrinsic value.
October, 1950
1039
♦ Reports and Announcements ♦
OMAHA MID-WEST CLINICAL SOCIETY
The Omaha Mid-West Clinical Society will hold its
eighteenth annual assembly at Hotel Paxton, Omaha,
Nebraska, October 23 to 27, inclusive.
The general program plan for 1950 will be much the
same as in previous years. Distinguished guest speakers
who are eminent in their particular specialty fields will
present addresses, clinics and question-and-answer pe-
riods ; members of the society will present lectures,
panel discussions and scientific exhibits; a guest panel
on the antibiotics has been scheduled for Friday morn-
ing. Scientific motion pictures will open the daily pro-
gram, and technical exhibits will again be on display.
The annual sessions of the Omaha Mid-West Clinical
Society have received a Class A rating from the Ameri-
can Academy of General Practice. This means that
Academy members who attend the sessions will receive
credit toward the fifty hours of formal postgraduate
study required of them every three years.
Further information may be obtained by writing to
the executive office of the Society, 1031 Medical Arts
Building, Omaha, Nebraska.
INSTITUTE OF INDUSTRIAL HEALTH
The Institute of Industrial Health of the University
of Cincinnati will accept applications for a limited
number of fellowships which are being offered to quali-
fied candidates who wish to pursue a graduate course of
instruction which will qualify them for the practice of
industrial medicine. Candidates who complete satis-
factorily the course of study will be awarded the degree
Doctor of Industrial Medicine. Any registered physician,
who is a graduate of a Class A medical school and who
has completed satisfactorily two years of residency (in-
cluding internship) in a hospital accredited by the
American Medical Association may apply for a fellow-
ship in the Institute of Industrial Health. The course of
instruction consists of a two-year period of intense
preliminary training in the basic phases of industrial
medicine followed by one year of practical experience
under adequate supervision in industry. During the first
two years, the stipends for the fellowships vary from
$2,100 to $3,000. In the third year the candidate will be
compensated for his service by the industry in which he
is completing his training. Recpiests for additional in-
formation should be addressed to the Institute of In-
dustrial Medicine, College of Medicine, Cincinnati 19,
Ohio.
UROLOGY AWARD
The American Urological Association offers an annual
award of $1000 (first prize of $500, second prize $300
and third prize $200) for essays on the result of some
(Continutd on Page' 1042)
HAZELDEN FOUNDATION
Lake Chisago, Center City, Minn. Telephone 83
WHERE
ALCOHOLICS
ACHIEVE
INSPIRATION
FOR
RECOVERY
Where gracious living, a
homelike atmosphere and
understanding compan-
ionship contribute to suc-
cessful rehabilitation.
200 acres on the shores of beautiful Lake Chisago
The methods of treatment used at the Hazelden Foundation are based on a true understanding of the
problem of alcoholism. Among the founders of the nonprofit Hazelden Foundation are men who have re-
covered from alcoholism through the proved program of Alcoholics Anonymous and who know the problems
of the alcoholic. All inquiries will be kept confidential.
1040
Minnesota Medicine
(
* Trademark , Reg. U. S. Pat. Off.
Rapid anticoagulant effects are
available with Heparin Sodium
preparations, developed by Upjohn
research workers. In a matter of
minutes, coagulation time can be
lengthened to offset danger from
thrombosis and embolism. With
Depo*-Heparin Sodium, prolonged
effects lasting 20 to 24 hours may be
obtained with a single injection.
Therapy with these Upjohn anti-
coagulants is distinguished by
promptness of action, simplicity of
supervision, and ready controlla-
bility.
measured in minutes
Upjohn
Medicine ... Produced with care ... Designed for health
THE UPJOHN COMPANY, KALAMAZOO 99, MICHIGAN
October, 1950
1041
REPORTS AND ANNOUNCEMENTS
North Shore
Health Resort
Winnetka, Illinois
on the Shores of
Lake Michigan
A completely equipped sanitarium for the care of
nervous and mental disorders, alcoholism and drug addiction
offering all forms of treatment, including electric shock.
SAMUEL LIEBMAN, M.S., M.D.
225 Sheridan Road Medical Director Phone Winnetka 6-0211
UROLOGY AWARD
( Continued from Page 1040)
clinical or laboratory research in urology. Competition
shall be limited to urologists who have been in such
specific practice for not more than five years and to men
in training to become urologists.
The first prize essay will appear on the program of the
forthcoming meeting of the American Urological Asso-
ciation, to be held at the Palmer House, Chicago, Illinois,
May 21 to 24, 1951.
For full particulars write the secretary, Dr. Charles H.
de T. Shivers, Boardwalk National Arcade Building,
Atlantic City, New Jersey. Essays must be in his hands
before February 10, 1951.
POSTGRADUATE CONFERENCE
IN OTOLARYNGOLOGY
The annual Postgraduate Conference in Otolaryn-
gology at the State University of Iowa, will be conducted
November 27 to December 2 at the University Hospitals,
Iowa City, Iowa. Further information may be obtained
from the Director of Medical Postgraduate Studies,
Medical Laboratory Building, Iowa City, Iowa.
RADIOLOGICAL SOCIETY OF NORTH AMERICA
The Radiological Society of North America will hold
its thirty-sixth annual meeting in Chicago, December 10
through 15. Headquarters will be at the Palmer House
where scientific and technical exhibits and sessions will
be held. All members of the profession are welcome and
are invited to attend.
CONTINUATION COURSES
Diseases of the Chest. — A continuation course for phy-
sicians in diseases of the chest will be presented at the
University of Minnesota Center for Continuation Study,
October 26 to 28. The course is intended for general
physicians and is presented with the sponsorship and
financial support of the Minnesota Trudeau Society.
Distinguished visiting physicians who will participate as
faculty members of the course include Dr. O. A. Sander,
associate in medicine, Marquette University Medical
School; Dr. John H. Skavlem, president of the American
Trudeau Society, and associate professor of medicine,
Cincinnati University Medical School ; and Dr. James J.
Waring, professor and chief of medicine, University of
Colorado. The remainder of the faculty for the course
will be made up of members of the staff of the Univer-
sity of Minnesota, the Mayo Foundation, and the Minne-
sota Trudeau Society.
Child Psychiatry. — A continuation course in child psy-
chiatry for pediatricians and physicians will be presented
at the Center for Continuation Study, November 27 to
December 1. Dr. Ralph D. Rabinovitch and Dr. John
Waterman will participate as lecturers and group discus-
(Continued on Page 1044)
1042
Minnesota Medicine
AMPHOJEL'S ANTACID GEL
raises gastric pH to
noncorrosive levels
AMPHOJEL’S
DEMULCENT GEL
coats gastric
mucosa with
protective film
For the Peptic Ulcer Patient
“Double gel” action
AMPHOJEL
ALUMINUM HYDROXIDE GEL WYETH
Provides prompt relief.. . no alkalosis
or acid rebound. For sustained
benefit, prescribe AMPHOJEL LIQUID
for home and office therapy,
supplemented with AMPHOJEL TABLETS
for handy “between times" therapy.
LIQUID: Bottles of 12 fl. oz. TABLETS: 10 gr.,
boxes of 60; 5 gr., boxes of 30, bottles of 100
Incorporated
Philadelphia 3,
October, 1950
1043
REPORTS AND ANNOUNCEMENTS
CONTINUATION COURSES
(Continued from Page 1042)
sion leaders. Dr. Reynold A. Jensen, head of the Child
Psychiatry Service of the University of Minnesota, is in
charge of the arrangements for the course and will also
act as lecturer and group discussion leader.
Poliomyelitis. — A continuation course on poliomyelitis
will be presented at the University of Minnesota Center
for Continuation Study on November 9 to 11, with the
sponsorship of the Elizabeth Kenny Institute. The course
is intended for doctors of medicine engaged in general
practice and for such specialists as pediatricians, physia-
trists, orthopedic surgeons, and neurologists. Dr. Harold
A. Sofield, associate professor of the Department of
Bone and Joint Surgery, Northwestern University Medi-
cal School, will be the visiting faculty member for the
course.
NORTHERN MINNESOTA MEDICAL ASSOCIATION
Approximately fifty physicians attended the two-day
annual meeting of the Northern Minnesota Medical Asso-
ciation in Bemidji on September 8 and 9. The meeting
was held under the direction of Dr. W. J. DeWeese,
president of the group during the past year.
Officers elected during the business session include the
following: Dr. L. W. Johnsrud, Chisholm, president;
Dr. G. A. Sather, Fosston, re-elected vice president ; Dr.
C. I.. Oppegaard, Crookston, re-elected secretary-
treasurer.
SOUTHERN MINNESOTA MEDICAL ASSOCIATION
At the annual meeting of the Southern Minnesota
Medical Association in Mankato on September 11, Dr.
R. F. Hedin, Red Wing, was elected president of the
organization. He succeeds Dr. Warren E. Wilson of
Northfield.
Other officers named at the meeting are Dr. C. W.
Rumpf, Faribault, first vice president ; Dr. H. G. Nilson,
Mankato, second vice president, and Dr. W. A. Merritt,
Rochester, secretary-treasurer.
The 1951 meeting of the association will be held in
Rochester.
MINNESOTA SOCIETY OF NEUROLOGY
AND PSYCHIATRY
The Minnesota Society of Neurology and Psychiatry
held its regular meeting in Saint Paul on September 12.
Dr. J. C. Michael, Minneapolis, presented a discussion of
“Antabus Therapy in Alcoholism,” and Dr. Harold F.
Buchstein, Minneapolis, spoke on “Prefrontal Lobotomv
in the Relief of Pain.”
PENNINGTON COUNTY SOCIETY
In the first election of officers conducted by the recently
organized Pennington County Medical Society, at a meet-
ing in Thief River Falls on August 23, Dr. O. F. Mellby
was elected president of the group. Other officers elected
include Dr. Harold C. Johnson, vice president, and Dr.
George T. Van Rooy, secretary-treasurer. All are of
Thief River Falls.
(Continued on Page 1046)
1044
Minnesota Medicine
the
quieting
hand
— in preoperative apprehension,
postoperative restlessness . . .
insomnia . . .
epilepsy . . .
dysmenorrhea . . .
vomiting of pregnancy . . .
eclampsia . . .
hypertension
pyloric spasm
INC.
New York , N. Y. Windsor, Ont.
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neuroses . .
Sedative . . . Hypnotic . . . Antispasmodic
In conditions of excitement of the nervous system,
as well as in certain spasmodic affections, Luminal
Sodium acts as a soothing, quieting agent to tran-
quilize hyperexcitability or to curb convulsive
paroxysms. Small doses have a pronounced
sedative and antispasmodic action. Large doses
are markedly hypnotic.
For oral use . . . tablets of 1 6 mg. (!4 grain), 32 mg.
f/2 grain) and 0.1 Gm. (1 Vl grains).
For parenteral use . . . solution in propylene glycol
0.32 Gm. (5 grains) in 2 cc. ampuls;
powder 0.1 3 and 0.32 Gm. (2 and 5 grains) in ampuls.
NEW,
EASILY OPENED
SERRATED AMPUL
— Luminal Sodium Powder is
available in a new , constricted
neck ampul — serrated for
easy opening. Only moderate
pressure is required to
< make the file cut.
October, 1950
1045
REPORTS AND ANNOUNCEMENTS
During the scientific part of the meeting Dr. A. E.
Culmer of Grand Forks, North Dakota, presented a
paper on the operative treatment of fractures.
RED RIVER VALLEY SOCIETY
The Red River Valley Medical Society held a meet-
ing in Crookston on July 22. Principal speaker at the
afternoon session was Dr. Richard E. Reiley, Minne-
apolis, who discussed fractures and fracture problems
as the orthopedist sees them referred by the general
practitioner.
A feature of the evening session was a discussion of
the Minnesota medical educational campaign by Lyle A.
Limond, field secretary of the Minnesota State Medical
Association.
WASHINGTON COUNTY SOCIETY
At the regular monthly meeting of the Washington
County Medical Society held at Stillwater in September,
Dr. Emmerson Ward of Rochester spoke on “Cortisone
in Therapeutics.” Visitors attending the meeting included
Dr. D. A. Burlingame, Saint Paul, Dr. Campbell of New
Richmond, Dr. Cornwall of Andover, and Dr. Bourget
of Hudson, Wisconsin.
CEREBRAL PALSY CLINIC
The Cerebral Palsy Council, Inc., of Minnesota, 279
Rice Street, Saint Paul, is endeavoring to develop a
cerebral palsy registry. Its purpose is to acquaint families
of these persons with groups in various vicinities who
are studying the problem. Registry cards were sent out
last spring to secretaries of all county medical societies.
Secretaries are urged to return these cards with necessary
information on each as quickly as possible.
SALT WATER ORALLY FOR SHOCK
A group of leading American surgeons has advised
the Public Health Service, Federal Security Agency,
that salt water taken by mouth, in a vast majority of
cases, is as effective as blood plasma in the emergency
treatment of shock from serious burns and other in-
juries.
The recommending surgeons are members of the
Surgery Study Section, an advisory body to the Na-
tional Institutes of Health and to the Surgeon Gen-
eral of the Public Health Service.
In general terms, the treatment calls for approximate-
ly one level teaspoonful of table salt and one-half tea-
spoonful of baking soda for each quart of water. A
number of quarts are required each day. The only
limitations on the amount consumed is the ability of the
patient to consume the saline solution. Since great
thirst accompanies serious burn injury, it has been
found that patients will voluntarily consume a sufficient
amount of the solution, which is quite palatable. No
other drinking fluid is permitted in the first few days
following injury.
In releasing the recommendation, Surgeon General
Leonard A. Scheele said :
“Salt water offers an easy, practical method for the
treatment of shock which follows serious burns and
other injuries. It is particularly important in any period
of large scale disaster. Unless the patient is disoriented,
is in acute collapse or is among the very small per-
centage who become nauseated by drinking large quanti-
ties of the salt solution, the sodium chloride formula will
be effective when administered by mouth.”
iTletrazol
COUNCIL ACCEPTED
Metrazol, pentamethylentetrazol
Ampules, I cc. and 3 cc.
Sterile Solution, 30 cc. vials
Tablets and Powder
A DEPENDABLE, QUICK-ACTING
CEREBRAL AND MEDULLARY
STIMULANT
Metrazol is indicated for narcotic depression,
for instance, in poisoning with barbiturates
or opiates, in acute alcoholism and during the
operation and postoperatively when respiration
becomes inadequate because of medullary de-
pression due to the anesthetic.
Inject 3 cc. Metrazol intravenously, repeat if
necessary, and continue with I or 2 cc. intra-
muscularly as required.
L Bilh liber-
Knol
■ , .A.
1 Cor
p. Orange, h
'• |
1
1046
Minnesota Medicine
Service while rts hot!
GE MOTTO!
And that’s exactly what we mean. GE X-Ray service is on the spot as
soon after your S O S as w'e can get to your office.
Take for instance the fire that put the x-ray department of a Long Island hospital
Out of commission . . . damaging beyond repair their diagnostic x-ray panel. Prepared
GE X-Ray service.
It took all night and two crews of servicemen to do it, but by dawn — the
hospital’s x-ray department was back in full operation.
This story is typical of the hundreds of documented GE service reports in our files.
A service which proudly lends a new, broader conception to the guarantee that stands
back of every GE installation.
MINNEAPOLIS — 808 Nicollet Avenue MANKATO — J. F. Van Osdell, 123 Blue Earth
DULUTH — 3006 W. First Street ST. PAUL — R. H. Holen, 153 W. Robie
SIOUX FALLS — H. L. Norlin, 1908 S. Sixth Avenue
for any contingency, the hospital pressed a mobile unit into action and called
GENERAL^ ELECTRIC
V-RAY CORPORATION
Direct Factory Branches :
Resident Representatives :
DETROIT LAKES — Eric Nelson, North Shore Dr.
October, 1950
1047
Of General Interest
♦
*
Dr. John F. Pohl, Minneapolis orthopedic surgeon,
is the author of a recently published book entitled
“Cerebral Palsy.” The book, which is said to be the
first complete medical text on cerebral palsy, was
published bv the Bruce Publishing Company, Saint
Paul and Minneapolis.
* * *
Dr. Titus C. Kreuzer, of Marshall, who recently
returned from a several months’ tour of Europe,
writes that there was a considerable difference of
opinion in England concerning the national medical
service. “It was very definite,” he writes, “that the
working class seemed to be in favor of the ‘free
medical care,’ as they called it, because it didn’t cost
them anything. However, the white-collar class was
very bitter about the plan, stating that they had
always been able to care for their own needs and
could continue to do so. They said they did not want
to get into the queue but wanted service when they
needed it.”
Dr. Kreuzer adds that “in Germany, Italy and
France it was very evident that a preponderance of
the lay people, as well as physicians, wanted to get
to America if possible.”
* * *
Dr. Conrad I. Karleen, formerly associated with
I )r. Carl W. Waldron of Minneapolis, has announced
the removal of his office to 402 Medical Arts Build-
ing, Minneapolis. His practice is limited to plastic
and reconstructive surgery.
* * *
Dr. William H. Inglis has joined the staff of the
Dr. R. J. Cairns clinic in Redwood Falls. Dr. Inglis
was graduated from the University of Minnesota
Medical School in 1949.
* * *
Red Lake Falls acquired a new physician in
August when Dr. Allan McKaig arrived from Bir-
mingham, Alabama, to be associated in practice with
Dr. Lester N. Dale. A graduate of the University of
Syracuse, Dr. McKaig spent two years in the armed
services and then practiced at Birmingham for two
years. Dr. McKaig and Dr. Dale will practice in
newly remodeled offices in a building which Dr. Dale
purchased in August.
* * *
Dr. Kenath Herrick Sponsel has moved his offices
to 321 Medical Arts Building, Minneapolis, to con-
tinue the practice of the late Dr. Vernon L. Hart.
Dr. Sponsel’s practice will be limited to orthopedic
and traumatic surgery.
* * *
Dr. Valentine O’Malley has opened offices for the
practice of internal medicine at 541 Lowry Medical
Arts Building, Saint Paul.
1048
Since 1948 the American Diabetes Association has
conducted and financed a yearly detection drive
through its special Diabetes Detection Committee. It
is estimated that there are a million unknown cases
of diabetes in the country. Early detection means
better control and more normal lives for those so
afflicted. Last year about 7,500 unknown diabetics
were uncovered during Diabetes Week. It is ex-
pected that Diabetes Week this year, scheduled for
November 12 through 18, will be even more suc-
cessful.
The American Diabetes Association has prepared
a special article designed for use in company pub-
lications and those of labor organizations, with the
aim of facilitating acceptance of the campaign by
employes. Copies of the article may be obtained
from the office of the American Diabetes Association,
11 West 42nd Street, New York, N. Y.
The campaign is a program of the medical pro-
fession, approved by the AMA, and needs the sup-
port of the community. Last year, through the co-
operation of the local county medical society and the
Chamber of Commerce in Virginia, Minnesota, 9,791
residents of the city were tested and at least fifty
new cases of diabetes were discovered.
* * *
Dr. Gordon R. Kamman, Saint Paul, spoke on
“Psychosomatic Medicine” at the monthly meeting of
the Lyon-Lincoln Medical Society at Marshall on
September 19.
* * *
Dr. Harry W. Christianson and Dr. Robert J.
Tenner, Minneapolis, have announced their associa-
tion with Dr. Lloyd F. Sherman, who was formerly
associated with Dr. Harry E. Bacon of Philadelphia
in the practice of proctology.
* * *
The American Dermatological Association is of-
fering a prize of $300 for the best essay submitted on
original work not previously published relative to
some fundamental aspect of dermatology or syphil-
ology. Manuscripts, double spaced, should be sub-
mitted in triplicate not later than February 1, 1951,
to Dr. Louis A. Brunsting, Secretary, American
Dermatological Association, 102 Second Avenue
S.W., Rochester, Minnesota.
* * *
Dr. John S. Hamlon has become a member of the
staff of the state hospital at Fergus Falls. A gradu-
ate of the University of Minnesota Medical School,
Dr. Hamlon served for five years in the Army in
Africa and Europe. Following his release from the
Army he practiced at St. Charles until his move to
Fergus Falls in August.
(Continued on Page 1050)
Minnesota Medicine
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Our exclusive
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318 Bradley Bldg. Duluth, Minn.
Telephone 2-0859
THE MINNESOTA MUTUAL LIFE INSURANCE COMPANY
1880 — 70th Anniversary — 1950
October, 1950
1049
OF GENERAL INTEREST
EXCLUSIVE WITH qC^UIT
Fully Guaranteed by a 69- Year-Old Company
OVER 1,000,000 SATISFIED USERS
It was announced on August 24 that Dr. Joseph C.
Belshe planned to leave Northfield by September 15
to become associated in practice with Dr. Fred B.
Riegel at St. Croix Falls, Wisconsin. Dr. Belshe
has been associated in practice in Northfield with
Dr. Robert F. Mears.
* * * *
In August the Clearwater Clinic of Bagley pur-
chased a clinic building at Gonvick and announced
that a physician would be secured to replace Dr.
Norman F. Stone, of Gonvick. who had received
orders to report for duty in the Navy. It was ex-
pected that Dr. Stone would leave Gonvick about
November 1.
* * *
Dr. G. T. Schimelpfenig and Dr. B. H. Simons,
Chaska, attended a meeting in Shakopee on August
24 at which plans for a tri-countv community hos-
pital project were discussed.
* * *
The engagement of Dr. Jack Gordon Olsen, form-
erly of Edina, and Miss Nancy Elizabeth Harris,
Durham, North Carolina, was announced on August
27. The wedding is scheduled for October 27. Dr.
Olsen is a graduate of the University of Minnesota
Medical School.
* * *
The following statement on prophylaxis against
subacute bacterial endocarditis was approved at the
annual meeting of the American Council on Rheu-
matic Fever on June 12:
Following dental extractions and removal of tonsils
and adenoids, bacteria are frequently present in the
blood stream for short periods of time. In rheu-
matic individuals or in patients with congenital heart
disease these bacteria may lodge in the heart valves
and cause bacterial endocarditis. Although a variety
of bacteria cause this disease, the majority of cases
are due to alpha streptococci (Streptococcus viri-
dans). Alpha streptococci are usually resistant to
sulfa drugs. Penicillin is, therefore, recommended
for prophylaxis.
1. Except in emergencies, operative procedures in
rheumatic individuals should be deferred until there
is no clinical evidence of rheumatic activity and
laboratory tests indicate that the rheumatic process
is subsiding.
2. Patients should be free of upper respiratory
infection.
3. Minimum dosage of penicillin: (a) 300,000 units
of aqueous penicillin injected intramuscularly thirty
to sixty minutes before extraction or operation;
(b) 300 000 units of procaine penicillin in oil injected
intramuscularly at the same time in a different site.
Penicillin prophylaxis is not necessary for the
extraction of deciduous incisors or bicuspids unless
infection of the gum is present. It should be used
for the extractions of deciduous molars, all perma-
nent teeth and for tonsillectomy and adenoidectomy.
In most instances it is best to extract one tooth at a
time; multiple extractions should be avoided. In
cases of extensive gum infection or severe root in-
fections (apical abscesses) it is advisable to give
several doses of penicillin, starting the day before
(Continued on Page 1052)
1050
Minnesota Medicine
^ I ENJOYED THE M
TEST — EVERY PUFF OF IT 1
AND MY DOCTOR'S
REPORT CONFIRMED WHAT
I FOUND- CAMELS
AGREE WITH MY ^
IT THROAT !
Yes, doctors smoke for pleasure, too! In a nationwide survey, three independent research organi-
zations asked 113,597 doctors what cigarette they smoked. The brand named most was Camel.
THROAT SPECIALISTS REPORT
ON 30-DAY TEST OF CAMEL SMOKERS...
Not one single case of
throat irritation due
to smoking Camels!”
Yes, these were the findings of throat specialists
after a total of 2,470 weekly examinations of
the throats of hundreds of men and women
who smoked Camels — and only Camels—
for 30 consecutive days.
SECRETARY
ACCORDING TO A NATIONWIDE SURVEY:
More Doctors Smoke Camels
THAN ANY OTHER CIGARETTE
R. J. Reynolds
Tobacco Co.,
Winston-Salem, N. C.
October, 1950
1051
OF GENERAL INTEREST
1909. ...1950
Physiotherapy for the relief
of Arthritis and related con-
ditions. Complete physical
examinations and laboratory
procedures given every pa-
tient. Roy T. Pearson,
M.D., Medical Director. B.
F. Pearson, M.D., associate.
U. S. Hwy. 212
anitarium
Cook County Graduate School of Medicine
ANNOUNCES CONTINUOUS COURSES
SURGERY — Intensive Course in Surgical Technic, two
weeks, starting October 23, November 27.
Surgical Technic, Surgical Anatomy and Clinical
Surgery, four weeks, starting October 9, November 6.
Surgical Anatomy and Clinical Surgery, two weeks,
starting October 23, November 20.
Surgery of Colon and Rectum, one week, starting
October 16, November 27.
Breast and Thyroid Surgery, one week, starting Octo-
ber 2.
Thoracic Surgery, one week, starting October 9.
Gall-Bladder Surgery, ten hours, starting October 23.
Fractures and Traumatic Surgery, two weeks, starting
October 9.
GYNECOLOGY — Intensive Course, two weeks, starting
October 23.
Vaginal Approach to Pelvic Surgery, one week, start-
ing November 6.
OBSTETRICS — Intensive Course, two weeks, starting
November 6.
MEDICINE — Intensive General Course, two weeks,
starting October 2.
Gastro-enterology, two weeks, starting October 16.
Gastroscopy, two weeks, starting October 23.
Electrocardiography and Heart Disease, four weeks,
starting October 2.
DERMATOLOGY — Formal Course, two weeks, starting
October 16.
Informal Clinical Course every two weeks.
CYSTOSCOPY — Ten Day Practical Course every two
weeks.
PEDIATRICS — Informal Clinical Course every two
weeks.
General, Intensive and Special Courses in all Branches of
Medicine, Surgery and the Specialties.
TEACHING FACULTY— ATTENDING
STAFF OF COOK COUNTY HOSPITAL
Address: REGISTRAR, 427 South Honore Street
Chicago 12, Illinois
(Continued from Page 1050)
operation and continuing one or two days thereafter.
Women with rheumatic or congenital heart disease
should receive penicillin prophylaxis at the time of
delivery. It is also recommended for patients re-
quiring gastrointestinal surgery.
* * *
Dr. J. J. Ahlfs, Caledonia, has announced that Dr.
Hildegard J. Virnig, formerly of Mount Morris,
Illinois, has become associated in practice with him.
A graduate of the University of Minnesota, Dr.
Virnig has done postgraduate work in pediatrics and
gynecology.
* * *
A chest clinic was conducted in Austin on August
28 by Dr. Karl H. Pfuetze, director of Mineral
Springs Sanatorium, Cannon Falls.
* * *
At a meeting of the South Dakota Medical Society
in Spearfish, South Dakota, during the middle of
August, Dr. William H. Bickel, Rochester, presented
a paper entitled “Acute Fracture Complications.”
* * *
Dr. and Mrs. L. R. Parson, Elbow Lake, were
honored on the occasion of their thirtieth wedding
anniversary at a dinner party given by friends at
Sandy Point on August 31.
* * *
Dr. Roger F. Hartwich, who has practiced in
Winona for more than a year, joined the staff of the
Winona Clinic on September 5.
* * *
Dr. J. Arthur Myers, professor of public health
and preventive medicine at the University of Min-
nesota, left for Rome on September 12 to speak at
the first International Congress on Diseases of the
Chest. He also was scheduled to lecture at the He-
brew Medical School in Jerusalem.
* * *
Dr. Malcolm J. Lester, formerly of Fairmont,
has taken over the general practice of Dr. C. F.
Medlin in Truman. Ill health forced Dr. Medlin to
retire from active practice.
Dr. Lester, a graduate of the University of Louis-
ville, interned at Swedish Hospital, Minneapolis, then
was associated in practice with Dr. Harold Coulter
in Madelia. Before moving to Truman he was prac-
ticing with Dr. R. S. Hunt and Dr. R. C. Hunt in
Fairmont.
* * *
After practicing in Jackson for a year, Dr. Curtis
M. Johnson left during the first week of September
to begin practice elsewhere. Before leaving Jackson,
Dr. Johnson stated that his plans were somewhat
uncertain because of the changing military situation.
* * * #
The offices of Dr. F. W. Behmler and Dr. R. A.
Rossberg in Morris have been completely remodeled
and enlarged. The changes were made to provide ac-
commodations for Dr. J. C. Kooda, who, it was
(Continued on Page 1054)
1052
Minnesota Medicine
Concise
Vitamin
Facts
MERCK VITAMINS are available under the labels
of leading Pharmaceutical Manufacturers in
appropriate pharmaceutical forms
From Merck & Co., Inc.
— where many of the
individual vitamins
were first synthesized.
These six Merck Vitamin Reviews are yours for
the asking while the editions last. These concise
reviews contain up-to-date, authoritative facts
and can be most useful for quick reference. Please
address requests for copies to Merck & Co., Inc.,
Rahway, N. J.
Partial Index of Contents
• ^ Factors that produce avitaminosis.
Signs and symptoms of deficiency.
Daily requirements and dosages.
» > Distribution in foods.
» > Methods of administration.
* ^ Clinical use in specific conditions.
October, 1950
1053
OF GENERAL INTEREST
(Complete Op lit ha (,
Service
Oor Oh
iPro^eiiion
mic
N. P. BENSON OPTICAL CO.
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(Continued from Page 1052)
announced, was moving from Eagle Bend to prac-
tice in Morris.
* * *
It was announced on August 31 that Dr. Harold J.
Stoen was planning to open offices for the practice
of medicine in Anoka about September 18. A
graduate of Rush Medical School in 1934, Dr. Stoen
interned at Fresno General Hospital, California, and
then completed a one-year residency in surgery at
the Home Hospital, Lafayette, Indiana. After three
years as a staff member of the U. S. Marine Hos-
pital at Cleveland, Ohio, he began general practice
in Lafayette in 1940. With the exception of four
years with the Army Air Force during World War
II, he practiced continually at Lafayette until 1950.
* * *
Dr. Robert Nash Evert and Miss Doreen Alma
Nerlund were married on September 29 in the Como
Park Lutheran Church, Saint Paul. Dr. John Evert,
the brother of the groom, was best man. The bride-
groom is the son of Mrs. John Evert and the late Dr.
John Evert of Glendive, Montana.
* * *
Dr. Lawrence J. Swanson has opened offices for the
practice of medicine at 950 South Robert Street,
West Saint Paul. Dr. Swanson was graduated from
the LTniversity of Minnesota Medical School in 1946.
* * *
Dr. Alvin Erickson of the Long Prairie Clinic spent
two weeks in September at the Cook County Hos-
pital, Chicago, taking postgraduate courses.
* * *
Dr. F. R. Heilman and Dr. W. E. Herrell,
Rochester, have been named to the editorial board
of a new medical journal, “Antibiotics,” which will
make its first appearance in January. Dr. Heilman is
with the bacteriology division of the Mayo Clinic,
and Dr. Herrell is with the diagnostic divisions of
general medicine and surgery.
* * *
Dr. Frank J. Hill, Minneapolis health commis-
sioner, has been named to the founders group of the
American Board of Preventive Medicine and Public
Health.
* * *
Dr. Mark Anderson, Jr., Rochester, a fellow in
surgery in the Mayo Foundation, reported for active
duty with the Navy on September 5. He was the
first fellow from the foundation to be called into
active service.
* * *
Dr. Evelyn E. Hartman, formerly with the depart-
ment of baby clinics in Finland, has joined the staff
of the Minneapolis city health department to serve
as maternal and child health physician.
* * *
Dr. Howard Kaliher left Pelican Rapids late in
September to move to Tillamook, Oregon, where he
had accepted an appointment to the staff of the
Tillamook County Hospital.
1054
Minnesota Medicine
OF GENERAL INTEREST
An ^Observation on the Accuracy of Digitalis Doses
Withering made this penetrating observation in
his classic monograph on digitalis: "The more I
saw of the great powers of this plant, the more it
seemed necessary to bring the doses of it to the
greatest possible accuracy.”1
To achieve the greatest accuracy in dosage and at
the same time to preserve the full activity of the
leaf, the total cardioactive principles must be iso-
lated from the plant in pure crystalline form so
that doses can be based on the actual weight of the
active constituents. This is, in fact, the method by
which Digilanid® is made.
Clinical investigation has proved that Digilanid is
"an effective cardioactive preparation, which has
the advantages of purity, stability and accuracy as
to dosage and therapeutic effect.”2
Average dose for initiating treatment: 2 to 4 tab-
lets of Digilanid daily until the desired therapeutic
level is reached.
Average maintenance dose: 1 tablet daily.
Also available: Drops, Ampuls and Suppositories.
1. Withering, W An account of the Foxglove, London, 1785.
2. Rimmerman, A. B.: Digilanid and the Therapy of Congestive
Heart Disease, Am. J. M. Sc. 209 : 33-41 (Jan.) 1945.
Literature giving further details about Digilanid and Physician's Trial
Supply are available on request.
Digilanid contains all the initial glycosides from
Digitalis lanata in crystalline form. It thus truly
represents "the great powers of the plant” and
brings "the doses of it to the greatest possible
accuracy”.
Sandoz
Pharmaceuticals
DIVISION OF SANDOZ CHEMICAL WORKS, INC.
68 CHARLTON STREET, NEW YORK 14, NEW YORK
Among the speakers at the annual meeting of
the Idaho State Medical Association at. Sun Valley,
Idaho, during the first week of September were Dr.
John S. Lundy and Dr. Robert Kierland.
* * *
Dr. Mitrofan Smorszczok, Polish displaced person
who was granted his medical license in Minnesota
this summer, began practice in Monticello in mid-
August. He is associated with Dr. William E. Hart
of Monticello. It was Dr. Smorszczok’s arrival in
Minnesota in 1948 that started a controversy about
the state rules barring foreign-trained physicians
from licensure.
* * *
Dr. Leonard M. Ellertson, a graduate of the Uni-
versity of Iowa Medical School, has become associ-
ated in practice with Dr. C. E. J. Nelson and Dr.
O. A. E. Erdal in Albert Lea. Dr. Ellertson has
served in the Navy and has been a resident physician
at the Ball Memorial Hospital, Muncie, Indiana.
* * *
Dr. and Mrs. J. F. Weir, Rochester, left during the
first week of September for a two-month trip to
Europe. In addition to sightseeing, Dr. Weir, who is
head of a section in medicine at the Mayo Clinic,
attended the First International Congress of Internal
Medicine at the University of Paris during the mid-
dle of September.
Dr. Hector M. Brown, medical director of the
Walker Hospital at Walker, has opened a branch
office in Backus for the practice of medicine. The
office is open on Saturday mornings.
* * *
After forty-six years of medical practice, forty-two
of which were spent in Northfield, Dr. I. F. Seeley
retired from active practice and moved to Tucson,
Arizona, on August 27.
On the day of departure a reception was held at the
Northfield Masonic Hall in Dr. Seeley’s honor.
Representatives from surrounding cities were present
to pay tribute to Dr. Seeley for his years of service.
A few days earlier, on August 24, Dr. and Mrs.
Seeley were honored at a dinner given by Northfield
physicians and the Northfield Hospital board and
nursing staff.
A graduate of the University of Iowa in 1904, Dr.
Seeley began his practice in Elysian. After a year
there he spent two years as a physician with con-
struction companies building the Milwaukee Rail-
road through the Rocky Mountains. He settled in
Northfield and opened his practice there in 1908.
For the past two years Dr. Stanley T. Kucera has
been associated in practice with him.
^ ^
Dr. J. W. Janes, Rochester, spoke on “Common
Bone Malignancies” at a meeting of the Iowa State
Medical Society at Carroll, Iowa, on September 7.
October, 1950
1055
OF GENERAL INTEREST
The Birches Sanitarium, Inc.
2391 Woodland Avenue
Duluth 3. Minnesota
A hospital for the care and treatment of
Nervous and Mental disorders. Quiet, cheer-
ful environment. Specially trained personnel.
Recreational and occupational therapy.
Dr. L. R. Gowan, M.D., M.S., Medical Director
Attending Psychiatrists
Dr. L. R. Gowan Dr. C. M. Jessico
Dr. J. E. Haavik Dr. L. E. Schneider
Dr. Willis E. Lemon, Rochester, a fellow in radi-
ology in the Mayo Foundation for the past three
and one-half years, joined the x-ray department of
the Chesapeake and Ohio Railroad Flospital in Clif-
ton Forge, Virginia, on September 12. Dr. Lemon
is the son of Dr. and Mrs. Willis S. Lemon of
Rochester.
j};
Dr. Ernest M. Hammes, Jr., Saint Paul, participated
in the postgraduate course for general practitioners held
at Charles City, Iowa, September 18, through the pres-
entation of a paper entitled “Common Neuroses and
Their Management.” The course was presented under
the auspices of the Iowa State Medical Society.
* * *
Dr. Gordon M. Martin, Rochester, was named fifth
vice president of the American Congress of Physical
Medicine at the organization’s twenty-eighth annual
meeting in Boston during the last week of August.
* * *
Dr. Leon L. Adcock and his wife, Madeline S.
Adcock, have decided to dedicate themselves to the
work of medical missions. They will establish a dis-
pensary at Berekum on the Gold Coast of Africa
under the direction of the Medical Mission Sisters.
Until recently they served as resident physicians at
St. Joseph’s Hospital, Saint Paul.
* * *
Dr. H. L. Smith, Rochester, presented a paper
entitled “The Movements and Sounds of Heart
Valves in Various Laboratory Animals” at the Inter-
national Cardiologic Congress in Paris on September
9.
* * *
The Golden Anniversary Dinner of the American
Journal of Nursing was held on October 10, 1950, at the
Waldorf-Astoria Hotel, New York.
Otto L. Wiese, editor and publisher of McCall’s Maga-
zine, acted as toastmaster. Serving on the Committee of
Sponsors for the occasion were : Helen Hayes ; Dr.
Elmer L. Henderson; Senators Irving M. Ives and
Herbert H. Lehman; Henry R. Luce, editor of Time,
Life and Fortune; General George C. Marshall, and
Mary Martin, star of South Pacific. Mrs. Eleanor
Roosevelt addressed the guests on the subject, “The
Nurse and the World of Tomorrow.”
* * *
The Health Insurance Council, made up of the lead-
ing trade associations in the life and casualty in-
surance fields, has reported great gains in voluntary
health insurance in 1949.
At the year’s end 44 per cent of the entire population
was covered by hospital insurance and nearly 60 per cent
of the employed civilian population was protected against
loss of income because of disability.
The total number of persons covered under voluntary
accident and health insurance plans for hospital expense
increased in 1949 to 66,044,000 from 60,995,000 a year
earlier, a gain of 8 per cent. Those covered for surgical
expense increased to 41,143,000 from 34,060,000, an in-
crease of 21 per cent.
Coverage for medical expense increased from 12,895,-
000 to 16,862,000, a gain of 31 per cent.
REST HOSPITAL
2527 Second Avenue South, Minneapolis
PSYCHIATRISTS IN CHARGE
Dr. Hewitt B. Hannah
Dr. Andrew J. Leemhuis.
A quiet, ethical hospital with therapeutic facilities
for the diagnosis and treatment of nervous and
mental disorders. Invites co-operation of all repu-
table physicians. Electroencephalography avail-
able.
1056
Minnesota Medicine
OF GENERAL INTEREST
This may be a
coupon you wont
to write us for information concerning coupons
that you will be glad to clip
We refer, of course, to the semiannual interest coupons attached to municipal bonds. Such
coupons, when due, may be deposited for credit in your own bank and the income they
represent is not subject to present Federal Income Taxes.
You invest savings in municipal bonds for security and income. The investment is made for
a definite length of time (each bond has a maturity date) therefore day to day market fluc-
tuations are of little concern to you.
Your primary concern is to reinvest your savings as the bonds mature and to remember
to clip the right coupons.
We shall be pleased to send you information and descriptive circu-
lars pertaining to municipal bonds that we have currently available.
JURAN & MOODY
MUNICIPAL SECURITIES EXCLUSIVELY
TELEPHONES GROUND FLOOR
St. Paul: Cedar 8407, 8408 Minnesota Mutual Life Bldg.
Minneapolis: Nestor 6886 St. Paul 1, Minnesota
bother to clip
BUT
We invite you
JURAN & MOODY
Ground Floor, Minnesota Mutual
Life Bldg., St. Paul, Minn.
Gentlemen:
□ Please put my name on your mailing list to receive your munic-
ipal offerings.
□ Please send me a copy of your chart showing comparison of
Tax free vs. taxable income.
NAME
ADDRESS
CITY STATE 1
The following men trained in the Division of Derma-
tology at the University of Minnesota passed recent
examinations of the American Board of Dermatology
and Sy philology: Robert W. Goltz, Melvin Grais,
Stanley Huff, Harold Hurst, and Wm. Macauley. Dr.
Henry E. Michelson, Minneapolis, is president of the
American Board of Dermatology and Syphilology.
ijt
HOSPITAL NEWS
Officers were elected at staff meetings recently of
the following hospitals:
St. Michael’s Hospital, Sauk Centre. — Dr. J. F.
DuBois, Sr., Sauk Centre, was elected president of
the medical staff of St. Michael’s Hospital at a
meeting on August 29. Other officers include Dr.
A. H. Zachman, Melrose, vice president, and Dr.
John C. Grant, Sauk Centre, secretary-treasurer. The
new hospital, a fifty-bed institution, was formerly
opened on September 1.
St. Francis Hospital, Shakopee. — Dr. M. B. Hebei-
sen, Chaska, was named chief-of-staff of St. Francis
Hospital at a meeting of the hospital staff on August
25. Dr. J. E. Ponterio, Shakopee, was named vice-
chief-of-staff, and Dr. P. J. Stahler, Jordan, secre-
tary-treasurer.
Windom Hospital, Windom. — Dr. L. L. Sogge,
Windom, has been named the first president of the
newly formed medical staff organization of Windom
October, 1950
1057
OF GENERAL INTEREST
IVANHDE SANITARIUM
of Milwaukee
announces the affiliation of
JAMES R. HURLEY, M.D.
as staff psychiatrist and medical director of
adjunctive therapy indicated in the
successful treatment of
PROBLEM DRINKING
R. A. JEFFERSON, M.D.
Consulting Psychiatrist
GEOFFREY C. MAPES
Executive Director
2203 East Ivanhoe Place
Milwaukee 2, Wis.
Telephone
Marquette 8-4030
BROWN & DAY, INC
St. Paul 1, Minnesota
Hospital. Dr. John A. Watkins, Windom, has been
made secretary of the group.
Northwestern Hospital, Minneapolis. — Dr. Claude
J. Ehrenberg is the new president of the medical
staff of Northwestern Hospital. Other officers in-
clude Dr. Hewitt B. Hannah, vice president; Dr.
Norman E. Rud, secretary-treasurer; Dr. Robert E.
Priest, chief of surgery; Dr. Harold E. Miller, chief
of medicine; Dr. William P. Sadler, chief of obstet-
rics and gynecology, and Dr. Donald H. Daniel, chief
of general practice. In addition to the officers, mem-
bers of the executive committee include Dr. Albert
T. Hays, with Dr. Cyrus Hansen, radiologist, and
Dr. Stanley V. Lofsness, pathologist.
* * *
A new thirty-five bed convalescent hospital was
opened on September 1 at 2200 Park Avenue, Min-
neapolis. Manager and director of the hospital is
Mr. T. W. Donohue. Dr. Archa E. Wilcox is medical
advisor to the hospital.
* * *
An appropriation of $30,000 to maintain a surgical
research unit at Ancker Hospital, Saint Paul, was
approved for 1951 by the Ramsey County Welfare
Board and the Saint Paul City Council. The labora-
tory, which will concentrate primarily on developing
heart operations, will be built by private subscription
and maintained by the county and city.
* * *
A campaign to raise $168,000 for the construction
of a new fifty-bed St. Francis Hospital in Shakopee
was launched early in September. Getting the cam-
paign off to a good start, a total of $12,000 was
pledged by eight physicians in the area.
It is estimated that the completed hospital, fully
equipped, will cost about $675,000. The Sisters of
St. Francis, who will operate the hospital, will pro-
vide $250,000, and a grant from the federal govern-
ment will provide an additional $303,750.
* * *
Dr. B. W. Mandelstam, administrator of Mount
Sinai Hospital, being completed in Minneapolis, an-
nounced on September 2 that Twin Cities physicians
were invited to apply for part-time staff positions at
the hospital. He also announced three full-time ap-
pointments: Dr. S. Steven Barron, pathologist; Dr.
Jack Friedman, radiologist, and Dr. Irving Green-
field, anesthesiologist.
RADIUM & RADIUM D+E
(Including Radium Applicators)
FOR ALL MEDICAL PURPOSES
Est. 1919
Quincy X-Ray and Radium
Laboratories
(Owned and Directed by a Physician-
Radiologist)
Harold Swanberg, B.S., M.D., Director
W.C.U. Bldg. Quincy, Illinois
1058
Minnesota Medicine
OF GENERAL INTEREST
BLUE CROSS-BLUE SHIELD NEWS
More than $5,000 a day including Saturdays, Sundays
and holidays is being paid to licensed and registered doc-
tors of medicine by the Minnesota Medical Service, Inc.,
for services rendered to Blue Shield subscribers. An
average of $5,439.65 was paid each of the 243 days be-
tween January 1 and August 31, 1950. Each of the 171
work days in the first eight months of 1950 show $7,-
730.03 going to doctors of medicine for services rendered
Blue Shield subscribers. Doctors’ services totaling 40,-
679 were' paid during this eight-month period as com-
pared with 21,698, an increase of 19,981 services or 49.1
per cent over the same period of 1949. Excluding
Saturdays, Sundays and holidays, the number of checks
made ready for mailing each day was 121.
Every effort is being made by the Blue Shield to
process doctors’ Medical Service Reports promptly so
that the physicians will receive their checks in the short-
est possible time.
For Your Inlormation
At the end of August, there were 2,691 Blue Shield-
participating doctors of medicine in Minnesota. The
Blue Shield office is attempting to contact all nonpar-
ticipating doctors of medicine, however it would be ap-
preciated if doctors who are at the present time non-
participating would contact the Blue Shield office rela-
tive to enrolling as participating doctors. Also, if you
know a colleague who does not participate why not men-
tion it to him for the more participating physicians, the
stronger the plan.
To help speed up the processing of Blue Shield cases
it would be appreciated if full information could be
listed on the reports when first submitted. This infor-
mation would include the subscriber’s group and con-
tract number, the patient’s birth date, the diagnosis,
type of services rendered the subscriber and other per-
tinent data. Any information omitted from the report
form only tends to delay the processing of that case.
The Minnesota Blue Shield office is receiving an
increasing number of requests from licensed and regis-
tered doctors of medicine in Minnesota for Blue Shield
contracts for themselves and their families. It is regret-
ted that at the present time it is the ruling of the Board
of Directors of the Minnesota Blue Shield that phy-
sicians cannot apply for and receive Blue Shield con-
tracts. Briefly, the reason is that due to medical ethics
physicians tend to render each other medical care on a
courtesy basis and to allow licensed and registered doc-
tors of medicine to have a Blue Shield contract would
mean that they were using their own organization,
Blue Shield, for reimbursement of a service that is
ordinarily not reimbursed. Blue Cross, however, is
available to doctors in the State of Minnesota and if any
physician should desire a Blue Cross contract for him-
self and his family it is suggested that the request be
sent to the Enrollment Department of Minnesota Blue
Cross and Blue Shield.
INGLEWOOD
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and modern prescription pharmacy located on
the street floor of the Foshay Tower, 100 South
Ninth Street.
With our expanded facilities we will be able
to increase and extend the service we have
been privileged to perform for the medical pro-
fession over the past years.
Exclusive Prescription Pharmacy
Biologicals Pharmaceuticals Dressings
Surgical Instruments Rubber Sundries
JOSEPH E. DAHL CO.
(Two Locations)
100 South Ninth Street, LaSalle Medical Bldg.
ATlantic 5445 Minneapolis
October, 1950
1059
BOOK REVIEWS
BOOK REVIEWS
Books listed here become the property of the Ramsey,
Hennepin and St. Louis County Medical Libraries when
reviewed. Members, however, are urged to write reviews
of any or every recent book which may be of interest
to physicians.
PRACTICAL GYNECOLOGY. Walter J. Reich, M.D.,
F.A.C.S., F.I.C.S. Attending Gynecologist. Cook County
Hospital; Professor of Gynecology, Cook County Graduate
School of Medicine; Attending Gynecologst, Fantus Clinics
of the Cook County Hospital; Assistant Professor of Gyne-
cology, Chicago Medical School; Attending Gynecologist and
Obstetrician, Grant Hospital; Attending Gynecologist, Fox
River Tuberculosis Sanatorium; Consulting Gynecologist, Hazel-
crest General Hospital; and Mitchell J. Nechtow, M.D.,
Associate Attending Gynecologist, Cook County Hospital and
the Fantus Gynecologic Clinic; Assistant Clinical Professor
of Gynecology, Cook County Graduate School; Associate in
Gynecology and Obstetrics, Chicago Medical School; Attend-
ing Gynecologist and Obstetrician, Norwegian-American Hospi-
tal. 449 pages. Illus. Price $10.00, cloth. Philadelphia:
J. B. Lippincott Co., 1950.
RENAL DISEASES. Second Edition. E. T. Bell, M.D.,
Professor of Pathology in the University of Minnesota, Min-
neapolis. 448 pages. Illus. Price $8.00, cloth. Philadelphia:
Lea & Febiger Co., 1950.
THE PROSTATE GLAND. Herbert R. Kenyon, M.D., As-
sociate Clinical Professor, Department of Urology, New York
University, Bellevue Medical Center. 194 pages. Illus. Price
$2.95, cloth. New York: Random House, 1950.
CEREBRAL PALSY. By John F. Pohl, M.D., 224 pages. Illus.
Price $5.00. Saint Paul: Bruce Publishing Company, 1950.
For quite a number of years a great deal of interest
has been focused on cerebral palsy, especially in children.
We have witnessed the organization of many groups
whose main interest lies in this condition, which claims
about half a million victims in the United States. Re-
habilitation centers and special schools for handicapped
children have sprung up, and many other groups dealing
with crippled children have shown increased interest in
cerebral palsy, all of which proves the recognition of the
importance of this condition and the necessity of using
all possible methods for its relief. For these reasons, the
appearance of this book is particularly timely and im-
portant.
The first chapter states concisely the medical problem.
The pathologic anatomy, the different types of cerebral
palsy are described, also the diagnostic problems and the
evaluation of the mentality. The next chapter goes into
the general plan of treatment — muscular relaxation, train-
ing of voluntary muscle control and building of develop-
mental patterns. Portions of this chapter deal briefly
with drugs, braces, surgical manipulations and outright
surgery (brain, cord, nerves, muscles, tendons and
skeleton). One chapter is devoted to the important
principle of relaxation, while four chapters are needed
for neuromuscular training of the various parts of the
body. Here we find specific methods to help the patient
in gaining voluntary control of muscles by establishing
muscle-consciousness, by securing muscle function and
co-ordination. The directions are described in detail for
the various muscle groups, always complemented by
good, instructive photographs. Chapter VIII takes up
the training for developmental patterns, taking as an
example the progress of such patterns in the normal in-
fant (rolling over, creeping, et cetera) with walking as
its ultimate goal (Chapter IX). The last two chapters,
which are rather extensive, deal with occupational
therapy and speech. The importance of the occupational
therapy is very obvious, not only as a means for
strengthening and increasing the control of muscles, but
as these are “accomplishments for which the child can
see a definite purpose, and because they are of im-
mediate usefulness, will attract his co-operation in treat-
ment.” The variety of work exercises is remarkable,
and these exercises are presented in excellent, clear form.
This part includes an important portion on teaching the
palsied child to eat by himself and the special eating
utensils which are very helpful for the badly handicaped
patient. Much space is given to teaching and correcting
the speech. This part of the book is most explicit and
complete in the discussion of the various defects en-
countered in these cases and the therapy needed to correct
them. As in all the other chapters, many instructive
photographs are a helpful feature.
This small volume of 224 pages (which includes an
index of 11 pages) is remarkably complete and in-
structive. The division of the material is good, and
each chapter is worked out to such an extent that it
gives full information and instruction to anyone inter-
ested in this field as a whole or any part of it. The 131
illustrations increase the value of this book considerably.
It should be studied most thoroughly by all workers in
this field of occupational therapy and speech teachers,
hut it should also be of great value to physicians and
medical students, especially in the branches of pediatrics,
orthopedics and neurology. The palsied child owes thanks
to the author for the help it will receive through better
information and training of his teachers by this work.
R.R.
DANIELSON MEDICAL ARTS PHARMACY, INC
10-14 Arcade. Medical Arts Building UOM1,Q
PHONES: HOURS:
ATLANTIC 3317 825 Nicollet Avenue — Two Entrances — 78 South Ninth Street WEEK DAYS — 8 to 7
ATLANTIC 3318 MINNEAPOLIS SUN. AND HOL.— 10 TO 1
PHYSICIANS AND HOSPITALS SUPPLY CO., Inc.
414 SOUTH SIXTH ST., MINNEAPOLIS, MINN.
INSTRUMENTS • TRUSSES • EQUIPMENT • PHARMACEUTICALS • DRUGS
MAIN 2494
1060
Minnesota Medicine
^^1 i llllllll]llllllltllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllIllli1lllilllllllllllll||IIIIIIt||||||||||||||||||||t|||||||i|||||||||||||||||||||lllllllllllllllllllllllllllllllllM ^
THE VOCATIONAL HOSPITAL |
TRAINS PRACTICAL NURSES
Mine months Residence course. Registered Nurses and |
Dietitian as Teachers and Supervisors. Certificate from |
Miller Vocational High School. VOCATIONAL NURSES |
always in demand. I
EXCELLENT CARE TO CONVALESCENT AND
CHRONIC PATIENTS |
Rates Reasonable. Patients under the care of their own physicians, |
who direct the treatment. |
5511 Lyndale Ave. So. LO. 0773 Minneapolis, Minn. |
riiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiLiiiiiiiiiiiiiimiiiiiiimim
l lootL Oi&iotL 9a, (phsudouA,
When your eyes need attention . . .
Don't iust buy eye glasses, but eye care . . .
Consult a reliable eye doctor and then . . .
Let Us Design and Make Your Glasses
Dispensing Opticians
25 W. 6th St. St. Paul
CE. 5767
SKILL AND CARE!
Combine with quality materials in
all Buchstein-Medcalf orthopedic ap-
pliances. Our workmanship and
scientific design conform to the most
exacting professional specifications.
Accepted and appreciated by physi-
cians and their patients for more
than 45 years.
ARTIFICIAL LIMBS, TRUSSES,
ORTHOPEDIC APPLIANCES,
SUPPORTERS, ELASTIC HOSIERY
Prompt, painstaking service
Buchstein-Medcalf Co.
223 So. 6th St. Minneapolis 2, Minn.
UTILITY • EFFICIENCY • SIMPLICITY
CLEANS ABILITY • PRACTICALITY
DEE
NASAL SUCTION
PUMP
At your wholesale druggist or write for
further information
“DEE" MEDICAL SUPPLY COMPANY
P.O. Box 501, St. Paul, Minn.
RADIUM RENTAL SERVICE
2S2S INGLEWOOD AVENUE
MINNEAPOLIS S, MINNESOTA
TEL. ATLANTIC 5297
Radium element prepared in
type of applicator requested
ORDER BY TELEPHONE OR MAIL
PRICES ON REQUEST
TJomewood HOSPITAL is one of the
Northwest's outstanding hospitals for the
treatment of Nervous Disorders — equipped
with all the essentials for rendering high-grade
service to patient and physician.
Operated in Connection with
Glenwood Hills Hospitals
HOMEWOOD HOSPITAL
Corner Penn and Plymouth Avenues North
Minneapolis Minnesota
October, 1950
1061
ACCIDENT • HOSPITAL - SICKNESS
INSURANCE
FOR PHYSICIANS, SURGEONS, DENTISTS EXCLUSIVELY
ML /ThYS.CIANSS,
> PREMIUMS 2>( SU,SE0NS 1<^
\ DENTISTS /
ALL
CLAIMS *7
S5.000.00 accidental death $8.00
$25.00 weekly indemnity, accident Quarterly
and sickness
$10,000.00 accidental death . $16.00
$50.00 weekly indemnity, accident Quarterly
and sickness
$15,000.00 accidental death $24.00
$75.00 weekly indemnity, accident Quarterly
and sickness
$20,000.00 accidental death $32.00
$100.00 weekly indemnity, accident Quarterly
and sickness
Cost has never exceeded amounts shown.
ALSO HOSPITAL POLICIES FOR MEMBERS
WIVES AND CHILDREN AT SMALL
ADDITIONAL COST
85c out of each $1.00 gross income used for
members’ benefits
$3,700,000.00 $16,000,000.00
INVESTED ASSETS PAID FOR CLAIMS
$200,000.00 deposited with State of Nebraska for protection of our members.
Disability need not be incurred in line of duty — benefits from
the beginning day of disability
PHYSICIANS CASUALTY ASSOCIATION
PHYSICIANS HEALTH ASSOCIATION
48 years under the same management
400 First National Bank Bldg., Omaha 2, Nebr.
t fiiuf tBondbu
POSITIONS AVAILABLE
INTERNIST Doctors in town of 10,000 will refer work to one
internist. Good setup.
Minneapolis Internist desires board eligible man for
a partner.
Internists needed for Texas, Louisiana. South Dakota,
Nebraska, Florida. Ohio, Missouri, and Idaho.
GENERAL PRACTITIONERS wanted for partnership, Minne-
apolis doctor; also for locum tenens and many locations
where a doctor is essential.
PATHOLOGIST wanted in a large California Clinic.
OBSTETRICIAN-GYNECOLOGIST board eligible. Minnesota.
Beginning salary $1,000.
PHYSICIANS AVAILABLE
SURGEON board eligible, available now.
DOCTOR woman wants industrial position in city or an
association.
MEDICAL PLACEMENT REGISTRY
480 Lowry Medical Arts GA. 6718
St. Paul. Minnesota
Classified Advertising
Replies to advertisements with key numbers should be
mailed in care of Minnesota Medicine, 2642 University
Avenue, Saint Paul 4, Minn i.
WANTED — Woman Physician to do Obstetrics and
Pediatrics, assist older well-established F.A.C.S. Ex-
cellent hospital facilities. Salary and percentage from
start. Minnesota license or National Boards Parts 1
and 2. Located in suburb of Twin Cities; apartment
available. Wonderful opportunity for future. Address
E-225, care Minnesota Medicine.
FOR SALE — Complete modern Westinghouse x-ray
equipment, basal metabolism machine, other electrical
equipment, instruments, examining table, furniture, et
cetera. Will sell at sacrifice for quick disposal. Re-
tiring. Address Charles P. Robbins, M.D., S.W.
Corner Third and Center Streets, Winona, Minnesota.
OPPORTL?NITY — Newly remodeled physicians’ suite
suitable for two doctors ; fourteen efficient rooms over
modern pharmacy on University Avenue, Saint Paul.
For information, call Mr. M. L Collatz, United Prop-
erties, Garfield 4303.
WANTED IMMEDIATELY — Young assistant for busy
young general practitioner, must have one year intern-
ship, rapidly developing industrial community in
Northern Minnesota. Salary and commission. House
available. Small hospital. Good schools. Address
E-229, care Minnesota Medicine.
WANTED — Young man for permanent position with
small clinic group ; to do primarily obstetrics. Extra
training in this field desirable but not essential. Ad-
dress E-230, care Minnesota Medicine.
WANTED — Ophthalmologist, preferably EENT, by
well-established South Minneapolis Clinic. Clinic group
occupies own new building. For particulars, write E-
231, care Minnesota Medicine.
Mass case finding in hospitals can be effective if ap-
plied to two groups — admissions and personnel. It is
known that our medical and nursing personnel are only
too often exposed to active cases of unknown tuber-
culosis. This is especially hazardous in the general hos-
pital since the prophylactic nursing techniques usually
fall short of those required in a communicable disease
institution. The incidence of tuberculosis among doc-
tors and nurses is already several times that of com-
parable age groups in the general populations, and they
should not be needlessly exposed when the method of
detection is so readily available. — Hospital Council of
Greater New York and Tuberculosis and Health As-
sociation, 1950.
PATTERSON SURGICAL SUPPLY COMPANY
103 East Fifth St., St. Paul 1, Minn.
HOSPITAL AND PHYSICIANS SUPPLIES AND EQUIPMENT
Cedar 1781-82-83
1062
Minnesota Medicine
PHYSICIANS AND HOSPITALS SUPPLY CO., Inc.
414 SOUTH SIXTH ST., MINNEAPOLIS, MINN.
INSTRUMENTS • TRUSSES • EQUIPMENT • PHARMACEUTICALS • DRUGS
MAIN 2494
Practical Nursing School
Approved 1 by Minnesota State Board of Nurses
Examiners
Twelve months course open to High
School Graduates or women with equiv-
alent education.
For further information apply to
DIRECTOR OF NURSES
FRANKLIN HOSPITAL
501 W. Franklin Avenue, Minneapolis 5, Minn.
TAILORS TO MEN SINCE 1886
The finest imported and domestic wool-
ens such as SCHUSLER'S have in stock
are not too fine to match the hand tailor-
ing we always have and always will
employ.
I. T. SCHUSLER CO., INC.
379 Robert St. St. Paul
DO YOU HAVE CHILDREN?
Train them in the habit of sav-
ing money regularly through a
SAVINGS ACCOUNT with
this bank. . . . They’ll always
thank you. OPEN AN AC-
COUNT FOR THEM TO-
DAY.
THE AMERICAN NATIONAL BANK
OF SAINT PAUL
Bremer Arcade Robert at 7th CE 6666
Member Federal Deposit Insurance Corporation
Hall & Anderson
PRESCRIPTION PHARMACY
BIOLOGICALS
PHYSICIANS’ SUPPLIES
SAINT PAUL, MINN.
LOWRY MEDICAL ARTS BUILDING
TELEPHONE: CEDAR 2735
r \
UNUSUAL LENS GRINDING
CATARACT,
MYO-THIN
and other difficult
and complicated
lenses are ground to
extreme thinness and
accuracy by our
expert workmen.
PmEWlLLIAMJ “ESS
L
v**",f'*
Insurance Druggists' Mutual Insurance Company Pr°mPl
a * a OF IOWA. ALGONA. IOWA LOSS
Saving Fire - Tornado - Automobile Insurance Service
MINNESOTA R E P R E S E N T A T I V E- S, E. STRUBLE, WYOMING, MINN.
October, 1950
1063
JANUARY
FEBRUARY
MARCH
APRIL
MAY
JUNE
JULY
AUGUST
SEPTEMBER
DECEMBER
OCTOBER
OltUM
WRCOMOKPHOM
am©* v»oin*Oi
PERCOMOHf1*1
*'1» am!* (IS* LIVES 3>-‘
IIS (IBSItSH
J*l*o Jomnsov * J'
Sunshine . . .
every day . . . every month
Mead’s Oleum Percomorphum permits a happy
independence of the sun as a source of vitamin D.
Neither rain nor clouds nor shorter winter days
interfere with the child’s receiving his daily quota
of vitamin D when dependable Mead’s Oleum
Percomorphum is administered.
Highly potent. Mead’s Oleum Percomorphum
is economical, too. It provides your patients
with year-round protection against
deficiency of vitamins A and D
Mead’s Oleum Percomorphum is available in liquid
form in bottles of 10 and 50 cc„ accompanied by a
dropper for easy dosage measurement.
Easy-to-take Mead’s Oleum Percomorphum Capsules,
ideal for older children and adults, are available in
bottles of 50 and 250.
1064
Minnesota Medicine
rHEELIN
AQUEOUS SUSPENSION
and
rHEELIN
IN OIL
in STERI -VIALS*
When prolonged estrogenic therapy is required,
as in the treatment of the menopausal
syndrome, increased economy is achieved
With STERI-VIALS THEELIN IN OIL and
sTERI-VIALS THEELIN AQUEOUS SUSPENSION.
Steri-Vials are rubber-diaphragm-capped
LO cc. vials from which repeated doses can
be withdrawn under sterile precautions.
Further advantages result from the high
potency and chemical purity of TIIEELIN.
It effectively relieves menopausal symptoms,
is well tolerated, and confers a sense of
well-being associated with naturally-occurring
estrogens. Its availability as oily solution or
watery suspension permits flexibility in
administration and individualized therapy.
THEELIN IN OIL is quickly absorbed and its
therapeutic action is promptly manifested.
Absorption of THEELIN AQUEOUS SUSPENSION
is slower and more sustained.
F
JL i n a if c i a l tv o #* #• 1/
We hope that you will never have to use what we have to offer
for sale. Strange, isn’t it? But to view it from a different angle
we certainly have no desire to see you have a misfortune such
as a fire — a robbery — an accident or some sickness. Yet the law
of average is moving your way. The really strange thing is that
few people do what they should to eliminate worries over
financial loss. Just check yourself.
This misfortune might never happen to you. But isn't it wise
to put away a little money each year into a plan of Accident
and Health Insurance that has been critically investigated by
your Association so that you won’t have to worry about financial
loss?
Delay offers no advantage!
CASWELL-ROSS AGENCY
1177 N. W. Bank Building Minneapolis 2, Minnesota
Minneapolis — MA 2585 St. Paul — ZE 2341
Insurors to:
Minnesota State Bar Association
Minnesota State Dental Association
Minnesota State Medical Association
Minnesota Society of C.P.A.
Minnesota State Pharmaceutical Assn.
Minnesota Auto Dealers Association
Hennepin County Medical Society
Hennepin County Bar Association
St. Paul District Dental Society
Minneapolis District Dental Society
St. Cloud Dental and Stearns County
Medical Society
Duluth District Dental Society
East Central Medical Society
St. Louis County Medical Society
Minnesota State Veterinary Medical
Society
1066
Minnesota Medicin
Journal of the Minnesota State Medical Association, Southern Minnesota Medical Association, Northern Minnesota
Medical Association, Minnesota Academy of Medicine and Minneapolis Surgical Society
Volume 33 NOVEMBER, 1950 No. 11
Contents
The Radioactive Effects of Atomic Weapons.
Asher A. White, M.D., Minneapolis, Minnesota. . . . 1085
Health — An International As Well As Local
Problem.
F. JF. Behmler, M.D., Morris, Minnesota 1088
Flatfoot, with Special Consideration of
Tarsal Coalition.
Mark B. Coventry, M.D., Rochester, Minnesota. .. 1091
The Common Hemorrhagic Diseases of Childhood.
Armamd J. Quick, M.D., Milwaukee," Wisconsin. . .1098
Depropanex in Post-Surgery.
/. /. Heimark, A.M., M.D., Fairmont, Minnesota,
and R. L. Parsons, B.A., M.D., Triumph, Min-
nesota 1102
The Roentgen Diagnosis of Silicosis. (Continued
from October issue.)
Eugene P. Pendergrass, M.D., Philadelphia, Penn-
sylvania 1104
Case Report
Infantile Cortical Hyperostosis.
Harold W. Hermann, M.D., Ames W . Naslund,
M.D., and Arthur E. Karlstrom, M.D., Min-
neapolis, Minnesota 1113
History of Medicine in Minnesota :
Medicine and Its Practitioners in Olmsted County
Prior to 1900. (Continued from October issue.)
Nora H. Guthrey, Rochester, Minnesota 1115
President's Letter :
Arms and the Medical 1123
Editorial :
Registration and Induction of Physicians, 1124
Good Doctors and Bad Medicine 1124
Luetic Aortitis 1126
Less Syphilis 1127
Saline Solution in Treatment of Burn Shock 1127
Medical Economics :
Newspaper Complains of Too Many Zeros 1129
Industrialists Explain Demand for Pensions 1129
AMA Rises Again to Answer Ewing 1130
Doctors Get Small Fraction of Country’s Money. .1130
American Doctor Studies British Health Service. .1130
Minnesota State Board of Medical Examiners. . 1131
Minnesota Department of Health :
Methemoglobinemia in Infants 1132
Birth and Stillbirth Certificates 1132
Minneapolis Surgical Society :
Meeting of January 5, 1950 1133
Acute Conditions of the Abdomen.
L. A. Stelter, M.D., Minneapolis, Minnesota 1133
Problems in Acute Intestinal Obstruction.
Leo C. Culligan, M.D., F.A.C.S., Minneapolis,
Minnesota 1136
Woman’s Auxiliary 1142
Reports and Announcements 1144
In Memoriam 1146
Of General Interest 1148
Book Reviews 1161
Contents of Minnesota Medicine copyrighted by Minnesota State Medical Association, 1950
Entered at the Post Office in Saint Paul as second class mail matter. Accepted for mailing at the special rate of postage provided
for in Section 1103. Act of October 3, 1917, authorized July 13, 1918.
November, 1950
1067
MINNESOTA MEDICINE
Official Journal of the Minnesota State Medical Association
Published by the Association under the direction of its Editing and Publishing Committee
Office of Minnesota State Medical Association,
493 Lowry Medical Arts Bldg., Saint Paul 2, Minnesota.
EDITING AND PUBLISHING COMMITTEE
E. M. Hammes, Saint Paul
Philip F. Donohue, Saint Paul
H. W. Meyerding. Rochester
B. O. Mork, Jr., Minneapolis
G. L. Oppegaard, Crookston
T. A. Peppard, Minneapolis
H. A. Roust, Montevideo
O. W. Rowe,, Duluth
Henry L. Ulrich, Minneapolis
A. H. Wells, Duluth
EDITORIAL STAFF
Carl B. Drake, Saint Paul, Editor
George Earl, Saint Paul, Associate Editor
Henry L. Ulrich, Minneapolis, Associate Editor
BUSINESS MANAGER
J. R. Bruce
Annual Subscription — $3.00. Single Copies — $0.40. Foreign and Canadian Subscriptions — $3.50.
The right is reserved to reject material submitted for editorial or advertising columns. The
Editing and Publishing Committee does not hold itself responsible for views expressed either in
editorials or other articles when signed by the author.
Classified advertising — ten cents a word; minimum charge, $2.00. Remittance should ac-
company order.
Display advertising rates on request.
Address all communications concerning the journal to Minnesota Medicine, 2642 University
•Wernip. Saint Paul 4, Minnesota Telephone Nestor 2641.
ST. CROIXD ALE ON LAKE ST.
PRESCOTT, WISCONSIN
CROIX
MAIN BUILDING— ONE OF THE 8 UNITS IN "COTTAGE PLAN”
A Modern Private Sanitarium for the Diagnosis, Care and Treatment of Nervous and Mental Disorders
Located on beautiful Lake St. Croix, eighteen miles from the Twin Cities, it has the advantages of both
City and Country. Every facility for treatment provided, including recreational activities and occupational
therapy under trained personnel. Close personal supervision given patients, and modern methods of
therapy employed. Inspection and cooperation by reputable physicians invited. Rates very reasonable.
Illustrated folder on request.
NEUROPSYCHIATRISTS
PRESCOTT OFFICE
Prescott, Wis.
Howard J. Laney, M.D.
Tel. 39 and Res. 76
Hewitt B. Hannah, M.D
Andrew J. Leemhuis, M.D.
Howard J. Laney. M.D.
511 Medical Arts Building
Minneapolis. Minnesota
Tel. MAin 1357
SUPERINTENDENT
Dorothy M. Most, R.N.
Prescott. Wisconsin
Tel. 69
1068
Minnesota Medicine
"In general, symptomatic improvement
[of menopausal symptoms] was striking within
7 to 14 days after treatment... ’’with
"Premarin.”
Gray, L.: J. Clin. Endocrinol. 3:92 (Feb.) 1943.
Many clinicians have found that “Premarin” therapy usually brings about
prompt relief of distressing menopausal symptoms. Furthermore, sympto-
matic improvement is followed by a gratifying sense of well-being in a
majority of cases. This is the “plus” in “Premarin” therapy which tends
to quickly restore the patient’s normal mental outlook.
Four potencies of “Premarin” permit flexibility of dosage: 2.5 mg.,
1.25 mg., 0.625 mg., and 0.3 mg. tablets; also in liquid form, 0.625 mg.
in each 4 cc. (1 teaspoonful).
While sodium estrone sulfate is the principal estrogen in “Premarin”
other equine estrogens... estradiol, equilin, equilenin, hippulin...are
probably also present in varying amounts as water-soluble conjugates.
Estrogenic Substances ( water-soluble) also known as
Conjugated Estrogens ( equine )
Ayerst, McKenna & Harrison Limited
22 East 40th Street, New York 16, N. Y.
November, 1950
1069
from the liver parenchyma
to the sphincter of Oddi
The area surveyed in the Fifth Edition of
“Biliary Tract Disturbances,” now available,
is the entire, ramified biliary tree — its anatomic
and physiologic background and the diagnosis
and therapy of its disorders.
Physicians and surgeons acquainted with previous
editions of this monograph will find the newly
revised, enlarged and illustrated edition even more
practical. The brochure concisely presents
basic concepts of biliary tract disease, and reviews
recent progress in the management of biliary
disorders with hydrocholeretics and other
measures. You may receive your copy
on request from the Medical Department, i
Ames Company, Inc., Elkhart, Indiana.
A
BILIARY TRACT
DISTURBANCES
AMES COMPANY, INC,
ELKHART, INDIANA
brand of dehydrocholic add
3 Vi gr. tablets in bottles of 25, 100, 500, 1000 and 5000.
Decholin Sodium (brand of sodium dehydrocholate)
3 cc., 5 cc. and 10 cc. ampuls in boxes of 3 and 20.
Decholin and Decholin Sodium, Trademarks Reg. U.S. and Canada
1070
Minnesota Medicine
a
new
drug . . .
for the treatment of ventricular arrhythmias
PRONESTYL Hydrochloride
Squibb Procaine Amide Hydrochloride
[±rtj t M'j ! __r_
; f * ; * ~ '
Lead II. Ventricular tachycardia persisting after six days of oral
quinidine therapy (8 6m. per day).
- -- • - — f 1 — - — i— — —
Lead II. Normal sinus rhythm after oral Pronestyl therapy.
Oral administration of Pronestyl in doses of 3-6 grams
per day, for periods of time varying from 2 days to
3 months, produced no toxic effects as evidenced
by studies of blood count, urine, liver function,
blood pressure, and electrocardiogram. Pronestyl
may be given intravenously with relative safety.
Pronestyl Hydrochloride Capsules, 0.25 Gm., bottles of 100 and 1000.
Pronestyl Hydrochloride Solution, 100 mg. per cc., 10 cc. vials.
For detailed information on dosage and administration, write for
literature or ask your Squibb Professional Service Representative.
Squibb
MANUFACTURING CHEMISTS TO THE MEDICAL PROFESSION SINCE 1868
November, 1950
1071
DEGREES FAHRENHEIT
PRIMARY ATYPICAL
VIRUS
PNEUMONIA
C It VST ALLIN E
“Prompt fall in temperature occurred in every patient within thirty-
six hours after the first dose of terramyein, and in no case was there
a febrile relapse."
“Demonstrable clinical improvement was usually evident within a
few hours after institution of therapy."
1072
Minnesota Medicine
■
■ -
//'
“The response to terramycin therapy was considered excellent in
every case, and there were no cases in which treatment failed.
Melcher, G. W.; Gibson^ C. D.; Rose, H. M., and
Kneeland, Y.:J . A. M. A. 143:1303 (Aug. 12) 1950. .
Dosage: On the basis of findings obtained in over 150 leading medical
research centers, 2 Gm. daily by mouth in divided doses q. 6 h.
is suggested for most acute infections.
Supplied: 250 mg. capsules, bottles of 16 and 100;
100 mg. capsules, bottles of 25 and 100;
50 mg. capsules, bottles of 25 and 100.
Terramycin may be highly effective
even when other antibiotics fail.1
Terramycin may be well tolerated
even when other antibiotics are not.2
1. Blake, F. G.; Friou, C.J., and Wagner , R. R. ; Yale J. Biol, and Med. 22:495 (July) 1950.
2. Herrell, W. E.; Heilman, F. R. ; Wellman, W. E.,and Bartholomew, L. A.: Proc. Staff Meet.
Mayo Clin. 25:183 (Apr. 12) 1950.
CHAS. PFIZER & CO., INC., Brooklyn 6, N. Y.
November, 1950
1073
from head to toe
CEREViM-fed children showed greater
clinical improvement, in the following
nutrition-influenced categories, than
children fed on ordinary unfortified
cereal or no cereal at all:1
hair lustre
recession of corneal invasion
retardation of cavities
condition of gums
condition of teeth
skin color
skeletal maturity )
skeletal mineralization /
*blood plasma vitamin A increase
*blood plasma vitamin C increase
subcutaneous tissues
dermatologic state
urinary riboflavin output
musculature
plantar contact
Here’s why: Cerevim is not just a cereal.
Much more: Cerevim provides 8 natural
foods: whole wheat meal, oatmeal, milk
protein, wheat germ, corn meal, barley,
Brewers’ dried yeast and malt — PLUS
added vitamins and minerals.
CEREVims
CEREALS + VITAMINS + MINERALS
1. "A Study of Enriched Cereal in Child Feeding Urbach,
C.; Mack, P. B., and Stokes, Jr., J: Pediatrics 1:70, 1948.
•Cerevim contains neither vitamin A nor C but possibly
exercises an A-and-C sparing effect attributed to its
high content of protein and major B vitamins.
S1M1LAC DIVISIONS a
R I)1E I El IC LABORATORIES, Coluntbns 16, Ohio
1074
Minnesota Medicine
SIMPLE TEST PROVES INSTANTLY
Philip Morris are less irritating
• V^ith proof so conclusive . . . with
your own personal experience added
to the published studies* . . . would
it not be good practice
to suggest Philip Morris
to your patients who smoke?
Now you can confirm fior yourself,
Doctor, the results of the
published studies*
HERE IS ALL YOU DO:
light up a
Philip Morris
Take a puff - DON'T INHALE.
Just s-l-o-w-l-y let the smoke come
through your nose. AND NOW
. . . light up your
present brand
DON’T INHALE. Just take a puff
and s-l-o-w-l-y let the smoke come
through your nose. Notice that bite,
that sting? Quite a difference from
Philip Morris!
Philip Morris
Philip Morris & Co., Ltd., Inc., 100 Park Avenue, New York 17, N. Y.
*Proc. Soc. Exp. Biol, and Med., 1934, 32, 241-245 ; N. Y. State Journ. Med., Vol. 35, 6-1-35, No. 11, 590-592;
Laryngoscope, Feb. 1935, Vol. XLV , No. 2, 149-154; Laryngoscope, Jan. 1937, Vol. XLVIl, No. 1, 58-60
November, 1950
SUREISET. . „ for your office
Complete Emergency Suture Assortment
IN STERILE PACK JARS, READY TO USE
You don’t waste time boiling tubes
when you have the Surgiset. The
germicide in the jars keeps tubes
sterile.
Surgiset contains 3 dozen Atra-
loc eyeless needle sutures: 5-0 mon-
ofilament nylon on small cutting
needle for facial repair; 3-0 der-
mal on medium cutting needle for
normal skin repair; 2-0 dermal on
heavy cutting needle for heavy
skin.
Surgiset contains an extra jar for
storing your other sutures.
Supplied complete with chrome-
plated rack for the regular price
of 3 dozen emergency sutures.
(Jars and rack given without
charge.)
order M-1150-EK3 $18.75
distributed by
PHYSICIANS AND HOSPITALS SUPPLY CO., Inc.
MINNEAPOLIS MINNESOTA
1076
Minnesota Medicine
a
long
and
stinguished
career
in
•ographg
NEO-IOPAX
(brand of sodium iodomethamate)
An 18 year history of dependable roentgenograms obtained without harm to the
patient distinguishes the career of Neo-Iopax as a diagnostic urographic agent.
Since 1932, hundreds of thousands of doses of Neo-Iopax have been injected with
virtual freedom from serious untoward reactions. No other urographic contrast
medium has equalled the safety record of Neo-Iopax. No agent, experience with
which is limited to a relatively small number of patients, can be deemed to be as safe.
Because the patient’s life and welfare take precedence over all other considerations in
diagnostic investigation of the urinary tract, urologists and roentgenologists will
continue to rely— as always— on Neo-Iopax.
Available as a stable, crystal-clear solution of disodium N-methyl-3, 5-diiodo-chelidamate in 10,
20 and 30 cc. ampuls of 50% concentration. Neo-Iopax 75% concentration in 10 cc. ampuls, box
of 5 ampuls; 20 cc. boxes of 1, 5 and 20 ampuls.
CORPORATION’ BLOOMFIELD, NEW JERSEY
I
NEO-IOPAX
Nothing
Competes
with the
Lure of Sweets
ro, fit
<#'A;
^hero
Use W ^
S°
\V*
# Reactions ranging from mild antagonism to overt
>0. rebellion are to be expected when children are con-
fronted with bad-tasting medicine. Contrast this with
juvenile enthusiasm for Duozine Dulcet Tablets.
Here’s medicine that sweets-loving small fry (and
many adults) really enjoy — sulfadiazine-sulfamerazine
disguised in orange-colored, candy-flavored cubes.
Mothers find Duozine Dulcet Tablets easy to admin-
ister in exactly the prescribed dosage. You'll find them
effective in many systemic infections. The combined sul-
fonamides are independently soluble in the urine, with the
result that high blood levels can be maintained with small
likelihood of crystalluria and renal damage.
Duozine Dulcet Tablets, sulfadiazine-sulfamerazine in
equal parts, are available in 0.3-Gm. and 0.15-Gm. potencies,
bottles of 100. Mighty "take-able” med-
ication when sulfonamides are indicated.
Gj&febtt
See that the Kx reads
DUOZINE Dulcet' Tablets
(SULFADIAZINE-SULFAMERAZINE COMBINED, ABBOTT)
®MEDICATED SUGAR TABLETS, ABBOTT
1078
Minnesota Medicin
The Seal of Acceptance de-
notes that the nutritional state-
ments made in this advertise-
ment are acceptable to the
Council on Foods and Nutri-
tion of the American Medical
Association.
That a nutritious breakfast providing generous amounts of high quality-
protein prevents late morning hypoglycemia has been amply demon-
strated. As shown by Thorn and co-workers,1 and later confirmed by
Orent-Keiles,2 . . breakfast high in protein and low in fat and carbo-
hydrate was followed by an improved sense of well-being and no symp-
toms of hypoglycemia.”
Meat for breakfast — ham, sausage, bacon, breakfast steaks — is an
appetizing means of increasing the protein content of the morning meal.
Its biologically complete protein contains all essential amino acids,
and serves well in complementing less complete proteins from other
sources. Furthermore, muscle meat is an outstanding source of B
complex vitamins and of iron.
(1) Thom, G.W.; Quinby, J.T., and Marshall, C., Jr., Ann. Int. Med. 18:913 (June) 1943.
(2) Orent-Keiles, E., and Hallman, L. F., Circular No. 827, United States Department of
Agriculture, Bureau of Human Nutrition and Home Economics, Agricultural Research
Administration, Dec., 1949.
American Meat Institute
Main Office, Chicago. .. Members Throughout the United States
November, 1950
1079
Again from Keleket....
Tilt table for lumbar myelogram.
Take 45° stomach radiography.
45° TRUE TRENDELENBURG
The “C” Supertilt Table offers a range of angulation
never before available. The table can be angulated 135°
from 45° true Trendelenburg through horizontal to the
vertical. Permits improved diagnostic technics, easier op-
eration for fluoroscopy, radiography and fluorography.
All procedures involving encephalograms, ventriculo-
grams, myelography and genito-urinary work are per-
formed with ease and safety never before possible.
Actually, dozens of new features results of years of re-
search and field testing with eminent radiologists -makes
the “C” Supertilt table years in advance of any table yet
developed.
Illustrated here, are just a few of the many advantages
the “C” Supertilt Table offers.
Telephone or Write for Complete Details
Kelley-Koett X-Ray Sales Corp. of Minnesota
1225 Nicollet Avenue, Minneapolis 3, Minnesota
Telephone: Atlanta 7174
Two centering points always as-
sure centering of bucky with fluoro-
scopic image, eliminating guess-
work or extra effort.
Table is same height as standard
stretcher to assure safe and easy
transfer of patient.
1080
Minnesota Medicine
SAFI . . .
Petrogalar,® given at bed-
time— not with meals — has
no adverse effect on absorp-
tion of nutritive elements. It
provides a relatively small
but highly effective dose of
mineral oil augmented by a
bland, hydrophilic colloid
base. The result is a soft-
formed, easily passed stool,
permitting comfortable
bowel movement.
If preferred, Petrogalar
may be given thinned with
water, milk, or fruit juices —
with which it mixes readily.
BOWEL
EM ENT
®
Wyeth Incorporated, Phila. 3, Pa.
November, 1950
1081
more physicians are satisfied
The development of the new improved Biolac supplies a long-sought need in infant
nutrition. To accomplish this, Borden scientists surveyed our present nutritional knowledge.
They then tested more than 500 formulations. Having decided on the formula that
would best supply the normal infant’s nutritional requirements in their most assimilable
form, a modern plant was constructed in 1949 so that the new formula could
also benefit from the most up-to-date techniques and control in processing equipment.
A Biolac formula that is both new and improved is thus made available.
Biolac is intended for prescription by every physician with infants among his patients.
It satisfies the physician’s demand for a complete
food to which only vitamin C need be added.
That means it is simplicity itself to prepare
and provides the maximum in formula
safety for the infant.
And yet, for
Biolac costs
all
no
these advantages, -
infant nutrition, prescribe
new improved
Biolac
a development of
The Prescription Products Division
The Borden Company
Ingredients: skim milk,
dextrins-maltose-
dextrose, lactose, coconut oil,
destearinated beef fat, lecithin,
sodium alginate, disodium phosphate,
ferric citrate, vitamin Bj ,
concentrate of vitamins A and D
from fish liver oils, and water.
Homogenized and sterilized.
Dilution: one fluid ounce to one and a half
ounces of boiled water for each
pound of body weight.
Biolac is available in 13 fluid ounce tins.
The Borden Company, Prescription Products Division
350 Madison Avenue, New York 17
1082
Minnesota Medicine
CRYS TA LLINE
The chemotherapy of
primary atypical pneumonia
has until recently been
unsatisfactory. Aureomycin,
which favorably influences
the course even of severe
cases, is now accepted
as a treatment of
choice in this disease.
in Primary
Atypical
Pneumonia
Capsules: Bottles of 25, 50 mg. each capsule.
Bottles of 16, 250 mg. each capsule.
Ophthalmic: Vials of 25 mg. with dropper;
solution prepared by adding 5 cc. of distilled
water.
virus-like infections of the eye, bacteroides septicemia,
boutonneuse fever, acute brucellosis, common infections
of the uterus and adnexa, resistant gonorrhea, Gram-
positive infections (including those caused by strepto-
cocci, staphylococci, and pneumococci), Gram-negative
infections (including those caused by the coli-aerogenes
group) , granuloma inguinale, H. influenzae infections, lym-
phogranuloma venereum, psittacosis (parrot fever), Q
fever, rickettsialpox, Rocky Mountain spotted fever, sub-
acute bacterial endocarditis resistant to penicillin, surgical
infections, tick-bite fever (African), tularemia and typhus.
LEDERLE LABORATORIES DIVISION American Gwwmid company 30 Rockefeller Plaza, New York 20, N. Y.
November, 1950
1083
Pure Crystalline
Vitamin B12
PREFERRED BECAUSE
potency, purity, and lack of toxicity of
crystalline vitamin B12 are clearly estab-
lished.
Potency: Potency of this U.S.P. product is accu-
rately determined by precise weight.
Purity : Pure anti-anemia factor.
Efficacy : Produces, in microgram dosage, maxi-
mum hematologic and neurologic effects.
Tolerance: Extremely well tolerated; “no evidence
of sensitivity” has been reported.
Toxicity Studies:
In recent pharmacologic investigations,
extremely large doses of crystalline vita-
min B12 (1,600 mg./Kg.) caused no toxic
reactions in any of the animals treated.
In contrast, 3 mg./Kg. of a “concentrate”
caused fatal reactions in 100 per cent of
the animals treated.
Merck — first to isolate and produce vita-
min B12 — supplies Crystalline Vitamin
B12 in saline solution under the trade-
mark Cobione.* Your pharmacist stocks
Cobione in 1 cc. ampuls containing 15
micrograms of crystalline vitamin B12.
The Only Form
Of This Important
Vitamin
Official In The U. S. /*.
*
Cobione is the registered
trade-mark of Merck & Co., Inc.
fur its brand of Crystalline
Vitamin B12.
B 1 i , COBIONE®
Crystalline Vitamin BI2 Merck
New York, N. Y. • Philadelphia, Pa. • St. Louis, Mo. • Chicago, 111. • Elkton, Va. • Danville, Pa. • Los Angeles, Calif.
In Canada: MERCK & CO. Limited. Montreal • Toronto • Valleyfield
1084
Minnesota Medicine
Journal of the Minnesota State Medical Association, Southern Minnesota Medical Association, Northern Minnesota
Medical Association, Minnesota Academy of Medicine and Minneapolis Surgical Society
Volume 33 NOVEMBER. 1950 No. 11
THE RADIOACTIVE EFFECTS OF ATOMIC WEAPONS
ASHER A. WHITE, M.D.
Minneapolis, Minnesota
TN discussing the physiologic effects of
radiation, consideration must be given to
the manner in which radioactivity is encoun-
tered. Man has for many years had intimate
and reasonably accurate knowledge of the radio-
activity emanating from x-ray machines and
from radium. More recently work with cyclotrons
has given rise to radioactive forms of many of the
common elements. During the late war, in con-
nection with the operation of the plutonium
producing piles at Richland, Washington, and
Oak Ridge, Tennessee, immense amounts of
radioactivity were encountered which required
enormous work in planning and building for
protection of personnel against such radioactivity.
It was not, however, until the explosion of the
first atomic bomb in July, 1945, with the sub-
sequent explosions over Japan in August of 1945,
that radioactivity became important in civil
defense planning.
In present planning various factors must be
given consideration. Several atomic bombs have
been exploded in the air and one bomb has been
exploded under water. The effects of the air or
water bursts are entirely different, both practically
and in relation to human contact with radio-
activity. Atomic bomb explosions in air are a
very poor and ineffective way of utilizing radio-
activity for destruction. A much more effective
way of such utilization was found at Bikini in the
underwater explosion. In this instance the intense
heat of the bomb explosion, totaling several
million degrees centigrade, turned many thousand
Presented at the short course on Civil Defense, Minneapolis,
Minnesota, August 31, 1950.
tons of sea water into steam, in which the
enormous radioactivity of the fission products was
trapped and rained back to earth as the radio-
active steam condensed. These radioactive fission
products fell out over an area roughly five miles
in diameter and so contaminated the target ships
that all had ultimately to be sunk. The presence
of radioactive sludge at the bottom of Bikini
Lagoon continues to make that lagoon un-
inhabitable for humans. The A.E.C. has reported
that almost all biological organisms living in the
lagoon are radioactive. It is considered, however,
by civil defense planners that such water ex-
plosions are an inefficient use of the energies
available in time of war, and that we need not
therefore be concerned with this particular type
of explosion.
The term, “radiological warfare” is one which
has occasionally been used and one for which some
definition should be supplied. It refers to the
concept that radioactive substances might be used
to contaminate the air, the water, the food or
the ground upon which people live. Water
soluble substances might be put into municipal
water systems, radioactive substances might be
sprayed by planes over selected areas of land, and
other means could be used to disseminate such
radioactive substances. Here again the phenome-
nologist concedes that such use of radioactivity
will be inefficient in terms of destruction, and
therefore advises that radioactivity encountered
through this means will be unlikely. We will
therefore confine ourselves in this discussion to
the effects of an atomic bomb exploded in the
air above a given area.
November, 1950
1085
RADIOACTIVE EFFECTS OF ATOMIC WEAPONS— WHITE
The explosion of the bomb in the air above
a target gives rise to four successive waves of
destructive activity. The first wave travels with
the speed of light and includes the components
of the electromagnetic spectrum such as light,
heat, x-rays and gamma rays. The second wave
travels somewhat more slowly and contains
myriads of atomic particles and fission products,
including neutrons. Third comes the shock wave,
which travels with the speed of sound, and fourth
the blast wave following immediately after the
shock wave. At Hiroshima and Nagasaki the
dangerously radioactive fission products rose into
the stratosphere harmlessly. Biological damage
came from the heat, the ultraviolet energies, the
gamma rays and neutrons which were liberated
at the instant of explosion but which instantly
dissipate and are lost. Relatively very little
radioactivity is left upon the ground after such
an explosion. The injuries produced by the heat,
light and gamma rays are produced at the instant
of dissemination and before the blast effect can
strike.
One must also consider the areas over which
biological effects can be produced. From the point
immediately underneath the bomb or target center
to one thousand yards in all directions is the
zone in which almost all biological organisms will
die of radioactive burns. The only animals re-
maining alive in this zone would be those who had
been screened by some effective radiological
screening substance such as concrete. In the
zone next furthest out, from one thousand yards
to 1,250 yards, the survivors of the Japanese
blasts were relatively few and those who did sur-
vive showed maximum radiological effects. The
third zone, from 1,250 to 1,500 meters, gave rise
to far fewer deaths, but in most persons in this
area the radiological burns were severe. In the
area from 1,500 to 1,750 yards from target
center, severe superficial burns were produced,
but no immediate radiological effects were
noticed, although many individuals suffered de-
layed effects. In the zone 1,750 yards to 2,000
yards, even these delayed effects were few,
although many superficial burns were encountered.
In this connection the experience of the
Japanese in Hiroshima and Nagasaki are our best
examples. In the Japanese, the injuries produced
were a composite of flash burns from heat and
radiation burns. In addition to these effects many
survivors experienced blast injuries. The manner
TABLE I. RADIATION SENSITIVITY OF TISSUE
IN DECREASING ORDER
a.
Lymphocytes
h. Connective tissue
b.
Erythroblasts
i. Bone
c.
Germinal epithelium of testis
j. Liver
d.
Myeloblasts
k. Pancreas
e.
Epithelium of intestinal crypts
1. Kidney
f.
Germinal cells of ovary
m. Nerve
g.
Basal layer of the skin
n. Brain
o. Muscle
of injuries can be well understood if one
imagines that the place of bomb explosion a few
hundred feet above the ground produces in effect
a small sun. At that height the heat from this
sun will be sufficient to burn severely those who
are close enough to the center. In addition to the
heat the ultraviolet light will produce a severe
burn, and finally the rays of shorter wavelength
such as x-rays and gamma rays will reach the
body, penetrate directly through it, and cause
injuries to most of the cells through which they
pass. The individual thus receives his total injury
all in a flash and may die immediately from the
combined effects. If further away from target
zero, he may die more slowly within the first day
or two, or if the injury was mild enough, may
survive to show the effects of internal damage
of one kind or another as permanent late results.
If the exposure were very light, the damage may
heal with no sequelae whatever. It is not our
purpose to consider the burn and blast effect, since
these are older subjects and are more thoroughly
understood.
At the instant of explosion, gamma rays
and neutrons are produced, which travel with
infinite speed to the target which it is in-
tended they destroy, and penetrate these targets
as deeply as the energies which they carry allow.
As the gamma rays and neutrons fly through the
body they produce their damage by disrupting the
various tiny atoms of which body cells are com-
posed. In the course of passage of one neutron
through the body, probably many thousands of
atoms are disrupted. The amount of total body
damage produced depends upon the total number
of neutrons and gamma rays which penetrate the
body and the degree of sensitiveness of the body.
The degree of sensitiveness in turn varies with
the species of animal, varies between different
individuals of the same animal species, and varies
greatly from one tissue to another. The most
sensitive tissues in the animal organism are always
those tissues which are in most active growth
1086
Minnesota Medicine
RADIOACTIVE EFFECTS OF ATOMIC WEAPONS— WHITE
TABLE II. RADIATION SENSITIVITY OF MAN AND
ANIMALS. NUMBER OF ROENTGENS (r) REQUIRED
TO KILL 50 PER CENT OF SUBJECTS
Fruit fly eggs 150 r
Guinea pig 200 r
Dog 325 r
Goat 350 r
Man 450 r
Mice 530 r
Rats 600 r
Rabbits 800 r
Bacteria 1,000-100,000 r
such as bone marrow, blood cells, sexual tissues
and other tissues in decreasing order.
The dose of radioactivity received by any given
individual varies as we have described with the
distance from the blast and with the thickness of
screening material between such individual and
the blast.
Acute radiation sickness may take several
forms, according to the severity of the exposure.
The survivors in zone two will usually exhibit
the fulminating form of the disease, which is
characterized by the onset of nausea, vomiting,
prostration and mild diarrhea within two to six
hours after exposure and soon afterward of in-
tractable diarrhea with delirium, tremors and
finally death. In the early Japanese deaths there
was very little evidence of external effect. Death
occurred from the fifth to the tenth day. This
fulminating type occurs in individuals who have
received very large amounts of radiation. The
hemorrhagic form of the disease occurs in those
individuals who have been less hard hit with
radiation. Vomiting, prostration and diarrhea
occur early, lasting one or two days, and then
there may be a period during which the individual
seems well, lasting about five days, but this is
followed bv profound prostration, bloody
diarrhea, and increasing fever. Bleeding into the
skin and into the body orifices or cavities takes
place and ulcers of mucuous membrane become
more and more expansive. If the patient dies,
it is usually in from three to six weeks after the
exposure.
The third form of the disease is known as the
pancytopenic, and is composed largely of patients
in the hemorrhagic group who survive the six
weeks period but continue to exhibit weakness,
pallor and ulceration. Blood counts on these
people show a severe diminution in all the formed
blood elements. In those patients who are doomed
to die from this form of the disease, loss of
weight becomes more and more pronounced.
November, 1950
A most interesting phenomenon in connection
with radiation sickness is the loss of hair from
the scalp. It occurs equally in both sexes and
appears about two weeks after the exposure. New
hair of the same texture and color as the original
hair grew in all individuals who survived.
Complications. — Acute radiation sickness in the,
Japanese was usually accompanied by severe blast
and burn injuries, many persons dying from these
injuries before the evidence of radiation sickness
developed. Because of the skin and intestinal
ulcers produced, bacterial infections were
common, including bacterial invasion of the blood
stream, pneumonia, lung abscesses and tuber-
culosis.
Sequelae. — Various late complications of acute
radiation sickness seem possible, but as yet no
extensive clinical experience with these has been
obtainable in man. An extensive program of
study of the Japanese survivors has been in-
stituted in order to follow up these possibilities.
If the human reacts like the experimental animal,
genetic changes will be observed in the offspring
of the Japanese victims but may not be observable
for two, three, or more generations. Various
experimental evidence indicates that malignant
growths may be made to occur by heavy body
radiation. A late development which has recently
been found to occur in the Japanese victims is
cataracts of the eyes.
Treatment. — No specific and curative treatment
has yet appeared. Treatment in general depends
upon rendering every possible form of support.
One then hopes that the dose of radiation which
the patient has received will not be sufficient to
overwhelm his body defenses. Frequent trans-
fusions of fresh blood are perhaps the most useful
agent of support. Close attention to the salt and
water balance will be instituted by the physician
attending such a patient. Bacterial invasion may
be combatted by the use of the newer antibiotic
agents. Rest is important for several weeks for
those patients receiving large doses of radiation.
The Atomic Energy Commission announces that
it is spending about one million dollars a year in
studying the acute radiation syndrome. It is
hoped that this study will yield some additional
and more effective means of dealing with
(Continued on Page 1114)
1087
HEALTH— AN INTERNATIONAL AS WELL AS LOCAL PROBLEM
F. W. BEHMLER. M.D
Morris, Minnesota
"PROBABLY all of us here tonight have worked
with microscopes. Whether we are physicians,
dentists, veterinarians, nurses, bacteriologists, en-
gineers, or health educators, we have all studied
biology. The study of life, if it is to amount to
anything more than theory, requires the use of
the microscope. Most of us became acquainted with
this useful instrument in our high school days,
and some of us have continued to use it in our
work ever since. Every public health person
realizes how potent the microscope has been in
our fight on disease. Without it, we would not
possess a fraction of our present knowledge of
tuberculosis, syphilis, typhoid fever, and all the
other bacterial diseases. By long and careful
study, we have been able to learn many of the
secrets of the minute forms of life that cause
disease.
All of us, too, have had the experience of find-
ing our eyes grow tired with long concentration on
some such tiny particle as a pathogenic organism
or a blood cell. In our school days we sought
relief by looking away from the microscope and
out of the window — over the tree tops — up at the
far-away sky. But how many of us, I wonder,
have gone beyond that ? How many of us have
ever studied the worlds beyond our own, as re-
vealed by a giant telescope ?
It may seem to you that looking at the universe
through a telescope has little meaning for the
public health worker. Yet at all times, and par-
ticularly at a time like the present, we may need to
give our eyes and our minds a rest from the close
study of immediate problems. We need to take
note of what is happening in the broader world
that lies beyond the scale of our microscopes.
Tonight marks the close of the fourth year of
the Minnesota Public Health Conference. At each
previous annual meeting, your president and other
speakers have stressed the need for developing
local health services. I know that in earlier ses-
sions of this present conference, you have all dis-
cussed that matter and many problems related to
it. We doctors, for instance, talked about the
duties of the health officer in a small town. In a
Retiring president’s address presented at the annual meeting of
the Minnesota Public Health Conference, September 26, 1950.
manner of speaking, we looked at our health
problems through a microscope. Then Mr. Stow-
man* took us up on a hilltop and gave us a view
of public health as it looks from the standpoint of
the World Health Organization. He made us
realize that you can’t always pin down health and
disease under an oil-immersion lens. You also
need to look at it through the great, world-sweep-
ing eye of a telescope.
Meeting local health needs is important — vitally
important. But we must beware of developing the
complacent attitude that, .if we take care of our
home-town problems, we need do nothing more.
Our old Minnesota friend, Dr. Herman Hilleboe,
has reminded us that “There can be no isolation-
ism in the field of health. The fight against dis-
ease is not a national or racial problem ; it is a
task for the whole of humanity.” And at the 1946
meeting of the American Public Health Associa-
tion, just after the close of that war that we
fondly hoped was the last one for our generation,
Dr. Thomas Parran told us that “by force of
events we have become citizens of the world.”
Our world citizenship in matters of health has
become even more apparent during the last few
years. Within the lifetime of most of us, our
world has shrunk to such a degree that we scarcely
need a telescope to see into its remotest corners.
Time and again we are reminded that disease is
no respecter of international boundaries — that
health problems in any part of the world are our
problems.
In the United States, particularly in our own
Middle West, we enjoy long life, and our general
death rate is low. Our children’s expectation of
life at birth today is close to seventy years. Dis
eases that attacked us frequently in the early days
— smallpox, typhoid fever, cholera — are now al-
most unknown in Minnesota and our neighboring
states. Yet only the thinnest film of protection
lies between us and many potential epidemics. As
Dr. Frank Boudreau puts it, “A yellow fever
mosquito may easily travel to this country as a
stowaway on a plane from South America. A rat
infected with plague may find its way from China,
*Kund Stowman, Chief, Research and Technical Advisory
Branch, National Health Division, U. S. Public Health Service.
1088
Minnesota Medicine
HEALTH— BEHMLER
India, or South America. An apparently healthy
passenger may be a carrier of cholera or other
intestinal disease.” And no longer can we depend
upon quarantine to safeguard us. That system
worked pretty well when travel was slow and the
plague spots of the world were far away. In
1950, the European refugee infected with typhus,
the Brazilian with malaria, the Korean with
cholera, are right outside our doors. We must
combat these diseases at their source in order to
prevent their spread into our own vulnerable
territory.
Some people live in daily fear of bacteriologi-
cal warfare. If they only realized it, a sporadic,
undirected bacteriological warfare is being waged
against us all the time. Bacteria menace us far
more widely and more constantly than bombs.
Our only defense against such warfare is the
building up of international co-operation. In a
world in which co-operation on the political level
seems at present an unrealizable dream, it is
heartening to recall that it has existed for a long
time in the field of health. Widespread public
health is both an instrument and a condition of
any lasting peace. In that same 1946 address by
Dr. Parran from which I quoted earlier, there is
also this assertion : ‘‘The World Health Organiza-
tion brought together for the first time after the
war, representatives of virtually all nations, in-
cluding certain ex-enemy nations. It is worth
while recalling that after the first World War, a
conference on health was the first to bring to-
gether representatives of nations which a few
months before had been at each other’s throats.”
And note this comment by Raymond B. Fos-
dick, former president of the Rockefeller Foun-
dation :
“An American soldier wounded on a battle-
field in the Far East owes his life to the Japanese
scientist, Kitasato, who isolated the bacillus of
tetanus. A Russian soldier saved by a blood
transfusion is indebted to Eandsteiner, an Aus-
trian. A German soldier is shielded from typhoid
fever with the help of a Russian, Metchnikoff.
A Dutch marine in the East Indies is protected
from malaria because of the experiments of an
Italian, Grassi ; while a British aviator in North
Africa escapes death from surgical infection be-
cause a Frenchman, Pasteur, and a German, Koch,
elaborated a new technique. . . Our children are
guarded against diphtheria by what a Japanese and
a German did; they are protected from smallpox
by an Englishman’s work ; they are saved from
rabies because of a Frenchman; they are cured
of pellagra through the researches of an Austrian.
From birth to death they are surrounded by an
invisible host — the spirits of men who never
thought in terms of flags or boundary lines and
who never served a lesser loyalty than the welfare
of mankind.”
Well, there you have two admirable examples of
the telescopic view of public health. You may
agree with that view in principle. But you may
say that it doesn’t exactly solve your local medi-
cal, nursing, or sanitation problems, and it doesn’t
throw much light on what we ought to do in the
present situation, when those needs are being
ominously underscored by the threat of total war.
Whether or not that threat materializes, it is likely
that many public health people will be called upon
for special services, thus jeopardizing our local
health programs. I should be doing you no service
if I brought my year as your president to a close
with nothing more than the request that you try
from now on to take a broader view of all health
problems. So, let me try to round out this vale-
diction with a few concrete suggestions.
First, we must realize that the requisites for
individual, public, and world health are all inter-
dependent. One individual’s sinusitis or migraine
may cause him to make a rash judgment, a wrong
decision, a costly mistake. I should not be sur-
prised if a future autopsy on Stalin were to
reveal evidence of a gnawing gastric ulcer. Nor
is it beyond the bounds of belief that nations were
plunged into war a decade ago chiefly because a
surly little boy named Adolf Schickelgruber was
kicked around by a frustrated father and nagged
by a neurotic mother. I am not suggesting that
any one of us here this evening could precipitate
a global war by neglecting a decayed tooth or an
ingrowing toenail, but it is by no means impos-
sible that such a thing could lead, through a series
of chain reactions, to far-reaching and fatal con-
sequences, not only for the individual concerned
but also for many other persons.
Viruses are not the only things that spread with-
out being noticed. The same process takes place
with states of mind. We can infect other people
from our own despondency or hostility, just as
easily as from a cold in the head. Hence our first
responsibility is to ourselves — to gain and main-
November, 1950
1089
HEALTH— BEH MLER
tain that condition of “complete physical, mental,
and social well-being” that constitutes the World
Health Organization’s definition of health.
Second, in taking the long view we must not
overlook our local needs. In learning to use the
telescope we must never entirely substitute it for
the microscope. Our goal, to be sure, is optimal
health for every human being. But in order to
attain that goal we must secure the active partici-
pation of as many people as possible. As Dr.
Brock Chisholm points out, “Health cannot be
given as a gift. It must be obtained through con-
stant vigilance and increasing action.” To main-
tain that vigilance, to guarantee that action, we
must have broad participation in all worthwhile
health measures. I have said little tonight about
that phase of our responsibilities, because anything
I might say is already well known to most of you.
Talking about local health organization in Minne-
sota is like talking about the eradication of tuber-
culosis. We know all the facts necessary to do the
job. All that remains for us now is to do it. So,
may I urge upon all of you once again to take
stock of your local health services and needs, and
to talk about your problems with your own com-
munity leaders. Effective action in this respect
will stem only from many groups of well-informed
people who have a clear idea of what they need
and are determined to get it and make it work.
That’s how local health services have come into
being in other states. Ask them how they did it,
and the answer always boils down to the simple
statement that a lot of people wanted it. When
enough people want something, they eventually
get it.
No matter what the immediate future may hold,
public health services in our state should not be
curtailed. Whatever defensive measures may be
set up against possible attack, those measures will
be centered in and directed by our public health
organization. In that task, as in many others, this
Minnesota Public Health Conference is now in a
position to give strong leadership. It is true that
we are a young organization. But in times of
crisis, young people often have to grow up pretty
fast. The fact that we have already gained recog-
nition by the American Public Health Association
speaks well for our progress toward maturity.
That progress will be aided, and our ability to
carry responsibility will be increased, by the addi-
tion to our membership of more members of the
health professions and more lay people who have
an intelligent and active interest in community
health.
We see before us today, as we have seen in
previous years, the spectacle of many nations that
have fallen under the heel of dictators because
they did not know or did not care enough to hold
on to their liberties. We will not join them unless
we allow our democratic processes to lapse. One
way of maintaining those democratic processes is
to build up associations in which, as in this con-
ference of ours, we work for the benefit of every-
one through the active participation of all qualified
people.
We have talked tonight about science — about
using the instruments of science for the discovery
of truth and the promotion of health. Our genera-
tion has learned through hard experience the
tragic neutrality of science. It may be used to save
life or to destroy it. But we have not abandoned
science for that reason. Nor do we have any
intention of doing so. Through the gradual spread
of knowledge, we may hope to bring about the
end that we so greatly desire — the attainment of
universal peace and security. Improvement of the
physical, mental, and social health of all nations
is essential to that end. We need to establish in
every country a nucleus of workers who have the
necessary training and skill to promote all aspects
of health.
This is not a one-sided missionary endeavor for
the American people. Let us never make the mis-
take of assuming that all knowledge and all truth
are in our possession. There is much that we can
learn from other countries, even as they have
much to learn from us. We need to pool all
health knowledge — to work with all people of good
will everywhere toward the achievement of world-
wide health. To do this effectively we must con-
tinue to use both the microscope and the telescope
— to study intensively our own health needs and
those of our home communities, our state, and
our nation, but at the same time to look beyond
these immediate concerns to those of all the na-
tions of the earth.
1090
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FLATFOOT. WITH SPECIAL CONSIDERATION OF TARSAL COALITION
MARK B. COVENTRY, M.D.
Rochester, Minnesota
"OLATFOOT is one of the common causes of
foot pain.2 Certain types of flatfoot are more
disabling than others. Flatfoot causes more dis-
comfort in adolescence than in later life. The
patient tends to modify his life to his disability
as he gets into the twenties and thirties. Canadian
Army statistics, based on examination of 3,600
young men, disclosed that 8 per cent of the men
had some form of disabling flatfoot.
A new concept regarding the cause of rigid flat-
foot recently has been advanced by Harris and
Beath.5 This has changed the thinking about this
particular type of flatfoot. It is, therefore, felt
that a review of flatfoot, particularly rigid flatfoot,
will be timely.
Classification of Flatfoot
Flatfoot may be divided into three main types,
which are listed in Table I.
TABLE I. CLASSIFICATION OF FLATFOOT
I. Flattened longitudinal arch. This is a structural and asymp-
tomatic derangement; it is not a pathologic condition.
II. Relaxed flatfoot. Hypermobile flatfoot with short tendo
achillis.
III. Rigid flatfoot.
A. Coalition of the tarsus.
1. Classification as to type of union.
a. Fibrous.
b. Cartilaginous.
c. Bony.
2. Classification as to site.
a. Talocalcaneal.
b. Calcaneonavicular.
c. Involvement of other tarsal bones.
B. Arthritis of tarsal joints.
Flattened Longitudinal Arch
The most common type of flatfoot is a simple
flattening of the longitudinal arch. This type of
flatfoot is not painful. It is an individual
characteristic, like the shape of the head or the
length of the arms, and is familial. Ankle valgus
is not present, and there is no rigidity or hyper-
mobility. This type of flatfoot is not affected by
weight bearing, and it does not produce any
roentgenographic changes except a depression of
the longitudinal arch.
It is extremely important to recognize this
entity for what it is — a symptomless, nonpatho-
logic, individual characteristic. If the patient has
Read at the meeting of the Minnesota State Medical Society,
Duluth, Minnesota, June 12 to 14, 1950.
From the Section on Orthopedic Surgery, Mayo Clinic, Roch-
ester, Minnesota.
November, 1950
foot pain, one must search elsewhere for its
cause.
Relaxed Flatfoot
Relaxed flatfoot also has been designated by the
term “hypermobile flatfoot with short tendo
achillis,” which is lengthy but descriptive. This
type of flatfoot is pathologic and fs a well-known
clinical entity. Examination disclosed that
approximately 6 per cent of 3,619 recruits for
the Canadian Army had mild or severe flatfoot
of this type.4’5 The deformity exists from child-
hood, but pain does not occur until adolescence.
Three basic theories have been advanced to ex-
plain the cause of relaxed flatfoot : ( 1 ) congenital
relaxation of the supporting tarsal ligaments; (2)
congenital shortening of the triceps surae group
of muscles resulting in shortening of the tendo
achillis, which pulls on the calcaneus and causes
a valgus position of this bone, and (3) congenital
deficiency in the skeletal support of the talus.
Harris and Beath4 expressed the opinion that
the basic cause of this type of flatfoot is improper
support of the talus by the anterosuperior portion
of the calcaneus. This results in a dropping
downward and inward of the talus, which, of
course, flattens the longitudinal arch and produces
a prominence of the head of the talus on the
medial side of the foot, and valgus of the ankle.
Shortening of the tendo achillis occurs second-
arily. Pain is caused by excessive ligamentous
strain, and traumatic arthritis frequently develops
in later years.
The characteristics of the relaxed flatfoot with
a short tendo achillis are ankle valgus, flattening
of the longitudinal arch, and a medial prominence
of the foot (Fig. la and b). The normal contour
of the longitudinal arch is restored when the
weight of the body is removed from the feet (Fig.
lc). A shortened tendo achillis is shown in Fig.
lrf. Dorsiflexion beyond 90 degrees is not possible.
When testing the extent of dorsiflexion, the
patient’s knee should be in a neutral position, not
in a flexed or hyperextended position. A further
characteristic, emphasized by Harris and Beath,4
is hypermobility of the midtarsal joints which can
1091
FLATFOOT— COVENTRY
be elicited by holding the calcaneus in the palm
of the left hand and moving the fore part of the
foot medially and laterally.
Roentgenographic examination is helpful, al-
Treatment of relaxed flatfoot is directed toward
support of the talus. Active support is laudable
but seldom possible. In cases in which the
deformity is not severe, exercises to strengthen
Fig. 1. Hypermobile flatfoot with short tendo achillis. a, Front view; b, rear view; c, appear-
ance of arch without weight bearing; d, maximal dorsiflexion obtainable; e, anteroposterior roent-
genogram; f, lateral roentgenogram.
though not diagnostic. The talus is seen to be
placed medially and interiorly on the calcaneus.
A lateral deviation of the fore part of the foot
on the talus also occurs (Fig. le and /). One
should read the Army Foot Survey by Harris
and Beath3 for accurate measurements of the
tarsal bones and for a description of relaxed
flatfoot.
the supporting muscles of the foot are sometimes
of value if the patients are co-operative. A
passive form of support usually is necessary,
however. In these cases longitudinal arch sup-
ports of metal, cork, sponge rubber, felt, leather
or other material usually will relieve the symp-
toms. In addition, a wedge may be placed on the
inner part of the heel of the shoe if there is much
1092
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FLATFOOT— COVENTRY
ankle valgus. In cases in which relaxed flatfoot
causes considerable disability and is not relieved
by this form of treatment, operation often is
necessary. Many operations have been devised
<Ca.Lca.aeonavicular coalition
view.
for relief of pain in the relaxed flatfoot.
Lengthening of the tendo achillis alone has been
advocated by some surgeons. Stabilization of the
talonavicular, naviculocuneiform and cuneiform-
metatarsal joints alone or in combination has been
advocated. Plication of the medial tarsal liga-
ments combined with tendon transplantation with
or without arthrodesis, also has been used. How-
ever, if operation is indicated, triple arthrodesis,
that is, calcaneotalar, calcaneocuboidal and talo-
navicular arthrodesis, probably is the procedure of
choice. Operation should be done, as a rule, when
patients are in the teens or early twenties. As
mentioned previously, the patients usually adjust
Fig. 3. Calcaneonavicular coalition (Case 4). a.
Appearance of feet; bony coalition on right side
(shaved): fibrous coalition on left side (unshaven);
b, limitation of inversion.
to a sedentary life after they reach the twenties,
and operation is seldom indicated then.
Rigid Flatfoot
Except in a very few cases of tarsal arthritis
resulting from rheumatoid arthritis, infection or
trauma, rigid flatfoot is due to tarsal coalition.
Coalition, by definition, means the growing to-
gether, or union of. Applied specificially in this
case, it denotes the union of two or more tarsal
bones. The union may be fibrous, cartilaginous
or bony (Table I), and it may^occur between the
calcaneus and the talus, between the calcaneus and
the navicular (Fig. 2a, b, and c) , or rarely be-
tween other tarsal bones.
Rigid flatfoot has been most commonly called
“peroneal spastic flatfoot” in the past. Owing
chiefly to the writings of Harris and Beath,5 this
concept is being discarded. The rigidity of this
November, 1950
1093
FLATFOOT— COVENTRY
type of flatfoot is caused by actual union of the
tarsal joints, and not by spastic peroneal muscles.
The peroneal muscles are not spastic, but simply
tight because the tarsal rigidity prevents their
Fig. 4. Positioning for making special roentgeno-
grams (“coalition views”) to demonstrate calcaneotalar
coalition.
of cases of calcaneonavicular coalition appeared in
the literature in 1921, 7 19236 and 1927, 1 but the
entity calcaneotalar coalition was not described
clinically until Harris and Beath5 published their
significant report in 1948.
The incidence of tarsal coalition was 2 per cent
among 3,600 men who were examined for enlist-
ment in the Canadian Army.5 Operation dis-
closed tarsal coalition in five cases which were
observed at the Mayo Clinic in 1948 and 1949. In
three of these cases, the coalition involved the
calcaneus and talus ; in the remaining two cases,
it involved the calcaneus and navicular. The
anomaly undoubtedly was pre'sent but was not
recognized in other cases which were observed
in the same period. We are recognizing more
and more cases as our knowledge of the subject
increases.
Like hypermobile flatfoot, tarsal coalition is
congenital and produces symptoms in the teens.
Fig. 5. Roentgenograms in case of calcaneotalar coalition in right foot (Case 1).
Lateral roentgenogram of right foot; b, lateral roentgenogram of left foot: no change
is evident in either a or b; c, sustentaculum tali-talar joint faintly visible in medial
portion of left foot; d, obliteration of sustentaculum tali-talar joint of right foot; e ,
appearance of right foot one year after calcaneotalar arthrodesis.
stretching in a normal fashion. Inversion of the
foot is impossible in cases of rigid flatfoot. Harris
and Beath said that anatomists have known of
tarsal coalition for fifty years. Sporadic reports
Fig. 3 a shows the characteristic appearance of the
feet in a case of tarsal coalition. This anomaly
causes flattening of the longitudinal arch, a
medial prominence of the tarsus in the region of
1094
Minnesota Medicine
FLATFOOT— COVENTRY
the head of the talus, and ankle valgus. The
arch of the foot is not affected by weight bearing.
In Figure 3b one can see that the patient is
unable to invert the foot. The patient illustrated
strated. In cases of calcaneotalar coalition,
routine roentgenograms often will disclose
spurring of the anterior-superior lip of the talus
and a “fuzziness” of the subtalar joint, when
Fig. 6. Roentgenograms in case of calcaneotalar coalition in right foot
(Case 2). a, Lateral roentgenogram of right foot showing spurring of
supero-antcrior lip- of talus; by lateral roentgenogram of left or normal foot;
c, lateral roentgenogram of right foot made nineteen months after triple
arthrodesis; d , anteroposterior roentgenogram of left or normal foot made at
same time as the one shown in c.
has a complete bony coalition on the right or the
shaved side but only a partial coalition on the
left or unshaved side. Although the peroneal
muscles and tendons appear tight, they are not
in true spasm.
In cases of tarsal coalition, roentgenographic
examination is of . real value if properly used.
The presence of this anomaly always can be
suspected on the basis of the clinical findings. If
examination discloses rigid flatfoot, one should
attempt to prove the presence of tarsal coalition
by roentgenographic examination. Routine
anteroposterior and lateral roentgenograms always
will reveal the presence of calcaneonavicular
coalition. Although routine roentgenograms
sometimes will suggest the presence of cal-
caneotalar coalition, a special roentgenogram,
which Harris and Beath3 have designated the
“coalition view” (Fig. 4), is necessary if the
presence of this anomaly is to be proved. By
the use of this roentgenogram, obliteration of the
sustentaculum tali-talar joint can be demon-
November, 1950
Fig. 7. Roentgenograms in case of calcaneonavicular bar (Case
3). a and b, anteroposterior and lateral roentgenograms of right
foot showing calcaneonavicular bar; c and d, anteroposterior and
lateral roentgenograms of right foot made twenty months after
triple arthrodesis.
1095
FLATFOOT— COVENTRY
Fig. 8. Calcaneonavicular bar removed in Case 3.
be performed. This was illustrated in one of
our cases (Case 4), in which the patient had
calcaneonavicular coalition. Most of the pain
was centered in the region of the calcaneocuboidal
joint, and the patient obtained complete relief of
his pain when triple arthrodesis was performed.
As in the treatment of disabling relaxed flatfoot,
operation should not be undertaken until the
patient has reached the age of ten or twelve years.
Report of Cases
Case 1. — A girl, aged eighteen years, came to the
clinic because of pain in the right foot. The pain had
been present for one year. Examination disclosed the
usual signs of tarsal coalition including inability to in-
vert the foot, a prominence on the medial portion of
the foot, and flattening of the longitudinal arch. Lateral
roentgenograms did not disclose any definite change in
either foot (Fig. 5 a and b) . In a special roentgenogram
(“coalition view”) of the left foot, the sustentaculum
tali-talar joint could be seen faintly in the medial
Fig. 9. Roentgenograms in case of calcaneonavicular coalition (Case 4). a and b, Lateral
and anteroposterior roentgenograms of right foot showing bony coalition of the calcaneus and
navicular; c and d, anteroposterior and lateral roentgenograms of left foot showing fibrous
coalition of the calcaneus and navicular.
compared with similar roentgenograms of the
opposite or normal foot.
Treatment of rigid flatfoot should be directed
toward the cause of the condition, which, except
in a very few cases, is coalition of two or more
of the tarsal bones. Triple arthrodesis usually is
the treatment of choice. Calcaneotalar and
talonavicular arthrodesis probably are inadequate.
In addition, calcaneocuboidal arthrodesis should
portion of the fool (Fig. 5c). A similar roentgenogram
of the right foot disclosed obliteration of this joint (Fig.
5(f). The presence of calcaneotalar coalition was proved
at operation. The calcaneotalar bridge was excised and
calcaneotalar arthrodesis was performed. This procedure
produced partial relief of the symptoms. Figure 5c
shows the roentgenographic appearance of the foot one
year after the operation. As our experience has in-
creased, we feel that a better result would have been
obtained if triple arthrodesis had been performed in
this case.
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FLATFOOT— COVENTRY
Case 2. — A girl, aged thirteen years, had had pain in
her right foot for several years. Examination revealed
a prominence of the medial part of the right tarsus
and inability to invert the foot. A lateral roentgenogram
of the right foot (Fig. 6 a) disclosed a finding frequently
observed in cases of calcaneotalar coalition, namely,
spurring of the superior-anterior lip of the talus. It
also revealed “fuzziness” of the subtalar joint when it
was compared with a similar roentgenogram of the left
or normal foot (Fig. 6b). The presence of calcaneotalar
coalition was proved at- operation. Figure 6c is a lateral
roentgenogram of the right foot which was made nine-
teen months after triple arthrodesis was performed, and
Figure 6 d is a similar roentgenogram of the opposite
foot which was made at the same time. At that time,
the patient did not have any symptoms which were
referable to the right foot and the appearance of the
foot was good.
Case 3. — A boy, aged ten years, was brought to the
clinic because of disabling pain which had been present
in his right foot since he had fallen six months previously.
Examination disclosed tarsal rigidity, medial prominence
of the tarsus, and ankle valgus, which are the usual
findings in cases of tarsal coalition. Anteroposterior and
lateral roentgenograms disclosed a calcaneonavicular bar
(Fig. 7a and b) . Figure 8 shows the bar which was
removed in the course of triple arthrodesis. The bar
extended across the “sinus tarsi” in the usual manner
and resulted in bony union between the calcaneus and
navicular. When this paper was written, the patient
did not have any pain in his right foot. Figure 7c and d
shows the roentgenographic appearance of the foot
twenty months after the operation.
Case 4. — A man, aged twenty-four years, had had
pain in his feet for ten years. The pain had been more
severe in the right foot than it had been in the left
foot. He had been rejected for service in the Army
Fig. 10a, Calcaneonavicular bar filling “sinus tarsi” of right foot
in Case 4: b, triple arthrodesis has been performed with metal
staples and hone chips.
Fig. 11a and b, Lateral and anteroposterior roentgenograms of right foot
made six months after triple arthrodesis in case of calcaneonavicular coali-
tion (Case 4).
in World War II, and he had been unable to obtain
regular employment. The appearance of his feet is
shown in Figure 3a and b. Roentgenographic examina-
tion disclosed bony coalition of the calcaneus and
navicular of the right foot (Fig. 9a and b) and fibrous
or cartilaginous coalition of the same bones of the left
foot (Fig. 9c and d). “Fuzziness” of the subtalar joint
is more noticeable on the right side than it is on the left.
Figure 10a shows the calcaneonavicular coalition at the
time of operation. Triple arthrodesis was performed,
utilizing metal staples for fixation (Fig. 10b). Figure
11a and b shows the roentgenographic appearance of the
foot six months after the operation. Nine months after
( Continued on Page 1103)
November, 1950
1097
THE COMMON HEMORRHAGIC DISEASES OF CHILDHOOD
ARMAND J. QUICK. M.D.
Milwaukee, Wisconsin
r"p HE pediatrician is probably less certain in his
approach to the hemorrhagic disorders than
to almost any other group of childhood diseases.
This is due largely to the inadequate and imprac-
tical presentation of the bleeding diatheses in
standard textbooks, which in turn can be ac-
counted for by the lack of a sound concept to
explain the physiology of hemostasis.
The control of hemorrhage is so perfected that
abnormal bleeding is relatively uncommon. When
it does occur, it is due to either one of two basic
causes: (1) a defective hemostatic response fol-
lowing injury of a blood vessel, or (2) a hyper-
permeability of the capillaries. The first is gen-
erally the result of faulty coagulation or more
explicitly of an inadequate formation of thrombin.
The second is due probably to one or more
unknown agents or factors that affect the per-
meability of the capillaries. Blood is lost by
diapedesis and it manifests itself as purpura,
which involves principally the skin and mucous
membranes.
Hemorrhagic Disease Due to Defective
Coagulation
It is now being gradually recognized that the
coagulation mechanism consists of at least three
separate steps or reactions which can be expressed
by the following equations :
Thromboplastinogen + platelet activity = thromboplastin
Thromboplastin + calcium T labile factor + prothrom-
bin thrombin
Fibrinogen + thrombin = fibrin.
It is important to emphasize that one important
reaction not expressed in these equations is the
labilization of platelets by thrombin which brings-
about a chain reaction designated as the throm-
binogenic cycle. The lysis of platelets is not only
essential for the formation of thrombin, but it
also is responsible for the liberation of a vaso-
constrictor which the writer considers the key
agent in hemostasis. Whenever the formation of
thrombin is diminished to the critical level, a
bleeding tendency develops. The most important
From the Department of Biochemistry, Marquette University
School of Medicine.
Read at the annual meeting of the Minnesota State Medical
Association, Duluth, Minnesota, June 13, 1950.
causes of decreased thrombin production are lack
of platelets, thromboplastinogen, labile factor or
prothrombin. On this basis a simple classification
of the common hemorrhagic diseases due to defec-
tive coagulation can be outlined.
I. Hypothromboplastinemia
A. Thrombocytopenia
B. Hypothromboplastinogenemia
1. Congenital (hemophilia)
C. Anti-platelet activator.
II. Hypoprothrombinemia
A. Congenital
1. Type 1 (diminished free prothrombin)
2. Type 2 (diminished free and total prothrom-
bin)
3. Type 3 (diminished labile factor)
B. Acquired
1. Dietary deficiency of vitamin K
a. Hemorrhagic disease of the newborn
b. Diarrhea
2. Faulty absorption of vitamin K from intes-
tine
a. Congenital atresia or absence of biliary
ducts
3. Toxins (dicumarol, salicylates, et cetera)
Thrombocytopenia
Since deficiency of platelets is generally asso-
ciated with purpura, it will be discussed under
that heading.
Hypothromboplastinogenemia (Hempohilia)
Thromboplastinogen which is the precursor of
thromboplastin is a constituent of the plasma.
Normally its concentration is sufficient to supply
enough free thromboplastin to activate most of the
prothrombin of the blood. By measuring the pro-
thrombin remaining in the blood after coagula-
tion under standardized conditions, the concen-
tration of thromboplastinogen can be quantita-
tively estimated. This procedure is called the
prothrombin consumption test.
In hemophilia a congenital lack of thrombo-
plastinogen is present at birth and apparently
remains unchanged throughout life. In severe
hemophilia, only a trace of this clotting factor is
present in the blood, whereas in the milder cases
the concentration is higher but still below the
minimum requirement for effective hemostasis.
Changes in the apparent severity of the disease
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HEMORRHAGIC DISEASES OF CHILDHOOD— QUICK
and the occurrence of bleeding episodes do not
appear to be caused by changes in the basic
defect, but by a secondary factor such as an
alteration in the vascular response which is super-
imposed on the primary deficiency.
On the basis of this concept of hemophilia, both
the diagnosis and treatment can be rationalized.
In the past the diagnosis depended on a history
of heredity, a prolonged coagulation time and a
bleeding tendency. Since a positive family history
is obtainable only in about one-half of the cases,
and since the other two findings are not specific
for hemophilia, it is easy to see that the diagnosis
was far from exact ; and since the clotting time in
mild hemophilics is only slightly prolonged many
cases assuredly remained undiagnosed. With the
development of the prothrombin consumption test
which measures the amount of prothrombin re-
maining in the serum after coagulation, a specific
diagnostic procedure for hemophilia became avail-
able. This test measures the available thrombo-
plastin of the blood. When normal blood clots,
little prothrombin remains in the serum ; whereas
when hemophilic blood clots, little thromboplastin
is available and therefore little prothrombin is
consumed ; hemophilic serum as a consequence still
contains a high concentration of prothrombin. In
severe hemophilia the serum prothrombin time is
as low as eight seconds and the hemophilic range
is eight to fourteen seconds whereas the normal
range is eighteen to thirty seconds.
A low prothrombin consumption time with a
normal platelet count and a normal plasma pro-
thrombin time, makes the diagnosis of hemophilia
almost certain. The one important condition which
is not ruled out is the hemophilic-like disease
which is caused by the presence of a plasma factor
which apparently inhibits the platelet activator of
thromboplastinogen. This disease which is rare
in childhood will be briefly discussed later.
The nature of the bleeding tendency in hemo-
philia is helpful in the diagnosis. Abnormal bleed-
ing following circumcision should immediately
arouse suspicion, and a persistent tendency to
bruise always deserves careful study. Charac-
teristically these bruises in hemophilia are actually
small hematomas. Only when these hematomas are
superficial, do they discolor the skin. The deeper
hematomas can only be palpated and they are
occasionally mistaken for abscesses.
The severe case of hemophilia with a positive
family history and a markedly prolonged coagu-
lation time offers no diagnostic problem ; but the
mild case, with a negative family history and a
coagulation time that is nearly normal even when
done meticulously, could not be diagnosed with
any degree of certainty until the prothrombin
consumption test was developed. But it is the mild
case that deserves particular attention since such
an individual may without warning have severe
hemorrhage from even a minor operation such as
a tonsillectomy or the extraction of a tooth. Fur-
thermore, a hemophilic, no matter how mild, trans-
mits the defect to all his daughters and the
severity of the disease in their offsprings is un-
predictable.
The treatment of hemophilic bleeding should be
guided by the basic fact that these patients rarely
die from exsanguination but that the pressure
effects from internal bleeding accounts for nearly
all the injurious results. The bleeding usually
comes from arterioles and small arteries.
The immediate therapeutic approach is local,
and the important measures are cold, pressure and
rest. Cold, preferably an ice bag, should be
applied immediately after injury. By this means,
the vessels in the injured area become contracted
and the blood flow becomes diminished, thereby
producing conditions favorable for stanching.
Pressure likewise is exceedingly helpful in limit-
ing bleeding ; in fact, it appears fairly certain
that most hemophilic bleeding is eventually
stopped by the pressure exerted by the hematoma
on the injured vessel. Complete rest obviously is
indicated. It should be emphasized and re-em-
phasized that heat should never be applied to the
area of bleeding, for it causes dilatation of blood
vessels which accentuates the hemorrhage. One
must be guarded in not mistaking a hematoma for
a deep infection and then treating it with a poul-
tice and heat.
By means of prompt local treatment hemarth-
roses may often be aborted or minimized. Much
of the crippling in hemophilia can be prevented,
but this requires education of both the physician
and the parents. The treatment of deformed joints
can often be benefited by physicotherapy.
d he only known reliable systemic treatment is
blood transfusion. By this means thrombo-
plastinogen, which the hemophilic blood lacks, is
supplied, and the hemostatic efficiency is tempo-
rarily increased. Transfusions are far more
efficient prophylactically than curatively. In fact
November, 1950
1099
HEMORRHAGIC DISEASES OF CHILDHOOD— QUICK
a patient properly prepared with a large plasma
transfusion may undergo major surgery without
abnormal bleeding. Fresh plasma is preferable
to whole blood since it is twice as effective and
can be given repeatedly and in large volumes.
Transfusions should not be given indis-
criminately, but only when local measures have
failed or when a patient is prepared for an
operation. There is suggestive evidence that
transfusions may cause the formation of an in-
hibitory agent in the blood which apparently acts
on the platelet activator. The condition thus pro-
duced will be discussed in the following section.
Hemophilic-like Disease
The disease is very similar to hemophilia
clinically as well as regards laboratory findings.
The coagulation time is prolonged and the pro-
thrombin consumption time is low. The disease
can, however, be readily distinguished from true
hemophilia by determining the effect on the
clotting when the blood is mixed with an equal
volume of normal blood. A mixture of normal
and hemophilic blood will have a normal clotting
time, while an equal mixture of hemophilic-like
blood and normal blood will have a delayed
clotting time. The disease is caused by a factor
which inhibits the platelet activator of thrombo-
plastinogen. As stated before, transfusions may
cause the condition, and recently it has been found
that plasma fractions are even more prone to
induce the formation of this so-called “circulating
anticoagulant.” The disease is important because
the hemostatic defect cannot be corrected by
transfusions. It becomes necessary therefore in
studying hemophilic blood to determine what effect
it has when mixed with normal blood. Hemophilia
may be complicated by the coexistence of hemo-
philia-like disease, and when this occurs trans-
fusions have no therapeutic efficacy. Fortunately
the hemophilic-like disease is rare in children, and
its production can be minimized by avoiding the
injection of plasma protein fractions, and by
giving blood or plasma transfusions only when
urgently needed.
Hypoprothrombinemia
Deficiency of prothrombin may be congenital
or acquired. There are three known types of
congenital hypoprothrombinemia. To explain how
this is possible, it is necessary to discuss briefly
the new concept of the prothrombin complex. In
human blood prothrombin is present partly in a
reactive form and partly in a precursor state.
Only free prothrombin can be converted to
thrombin and this requires its interaction with
thromboplastin, calcium and an agent discovered
by the writer in 1943, which he named labile
factor. This substance is closely related to
prothrombin, and for convenience can be con-
sidered to be part of the prothrombin complex.
In one type of congenital hypoprothrombinemia,
both the free and total prothrombin levels are
low ; in the second the free prothrombin is
diminished but the total is normal ; while in the
third the labile factor is deficient. Clinically these
three conditions are very similar to hemophilia
but can readily be distinguished by the prolonged
prothrombin time. None of the three responds
to vitamin K, but all can be temporarily corrected
by blood or plasma transfusions. Since the labile
factor is destroyed by storage, only fresh blood
or plasma should be employed in treating the
third type. The bleeding can often be controlled
by the local measures which are effective in
hemophilia.
The most important acquired type of hypo-
prothrombinemia for the pediatrician is the
hemorrhagic disease of the newborn. The fetus
is far more susceptible to vitamin K deficiency
than the adult, and if the mother’s nutrition is
defective, the newborn child often develops a
marked hypoprothrombinemia during the first few
days of life. During this period the baby is a
potential bleeder protected only by the intactness
of its vascular system. Any trauma may pre-
cipitate a hemorrhage which may lead to dire
results if prompt combative measures are not
immediately instituted. A plasma transfusion
becomes effective immediately, and vitamin K
given intravenously restores the prothrombin level
in four hours. By supplying the mother with a
few cents worth of vitamin K during the last
week or two of pregnancy, the hypoprothrom-
binemia of the newborn can be almost completely
abolished. It is a pity that a few physicians
belittle the efficacy of vitamin K. Anyone who
has seen a fullblown case of hemorrhagic disease
of the newborn saved only bv prompt and heroic
measures is willing to use vitamin K prophy-
lactically even though only one baby in ten
thousand may require this measure.
Obstructive jaundice, which is an important
cause of hypoprothrombinemia in the adult, often
1100
Minnesota Medicine
HEMORRHAGIC DISEASES OF CHILDHOOD— QUICK
causes little or no decrease of the prothrombin
level of infants. The writer has seen a number
of babies with complete atresia of the biliary
ducts and complete absence of bile from the
intestines for months without a significant drop
in the prothrombin level. In persistent diarrhea
vitamin K deficiency may occur. The use of
antibacterial agents which sterilize the intestinal
tract may accentuate the lack of vitamin K.
Certain drugs depress the synthesis of pro-
thrombin and cause a drop in prothrombin
sufficiently marked to cause a bleeding state. The
most common group of compounds having this
prothrombinopenic action are the salicylates. By
improving the nutritional state of the child this
danger can generally be averted. There is no
justification for using a salicylate preparation
fortfied with a synthetic compound having
vitamin K activity.
Hypoprothrombinemia in childhood is not
common, but the possibility that it may occur
should never be ignored. Whenever there is a
possibility for its occurrence, a prothrombin time
determination will furnish the correct answer.
The study of any bleeding condition is not com-
plete unless this test is done. Therapeutically it
is well to remember that vitamin K is only
effective if a deficiency of this vitamin causes
the bleeding condition. In all other conditions
of hypoprothrombinemia, plasma or whole blood
transfusions only are effective.
Thrombocytopenic Purpura
Purpura is one of the most common forms of
hemorrhage in childhood and one of the most
difficult to cope with. It seems fairly clear that
there are two separate but closely related com-
ponents that account for the hemorrhagic state.
The two are the lack of platelets and a vascular
factor. Thrombocytopenia alone does not cause a
purpuric condition. On the one hand, one sees
repeatedly in cases of lymphatic leukemia a
platelet count of 10,000 or less with no signs of
purpura and a normal bleeding or tourniquet test.
On the other hand, purpura with typical petechiae
may appear with a normal platelet count. Bleeding
as a rule is more severe in thrombocytopenic than
in non-thrombocytopenic purpura. It seems
logical to conclude that the purpura is due to a
vascular factor, the nature of which is not under-
stood. If there is a co-existence of thrombopenia.
a coagulation defect is superimposed, since the
activation of prothrombin is very incomplete when
the platelets are low.
The recognition of thrombocytopenic purpura
offers no difficulties, but the vexing problem is
finding the cause. Probably the most common
occurrence is as a complication of an infectious
disease, and frequently the severity of the latter
bears no relation to the intensity of the purpura.
A mild case of rubella or chicken pox may induce
a pronounced thrombocytopenic purpura with
profuse bleeding. Blood dyscrasias, especially
acute leukemia, are often complicated by purpuric
bleeding. Allergy and drug sensitivity can cause
purpura, and it appears that the emotional state
may have some influence. Depression of bone
marrow causes a fall in the platelet count. In
addition to these secondary purpuras, a number
of cases remain in which no specific cause can be
found. These are designated essential, primary
or idiopathic.
The treatment of thrombocytopenic purpura
remains uncertain. The majority of cases recover
spontaneously. Usually transfusions are given,
but other than restoring erythrocytes and hemo-
globin, probably little benefit is obtained. In a
few cases, the writer has found that folic acid
appeared to diminish the bleeding tendency with-
out affecting the platelet count. Toluidine blue
and protamine are disappointing in acute
thrombocytopenic purpura.
When to do a splenectomy remains a rqoot
question. Since a spontaneous and permanent
recovery is frequent in children, the removal of
the spleen should never be considered impetuously.
To be sure, it is a serious responsibility to
manage a case of thrombocytopenic purpura since
the possibility of a spontaneous cerebral hemor-
rhage is ever present, but it is to be remembered
that a splenectomy in the acute stage is likewise
not without danger. Before a splenectomy is
performed, all possible causes should be ruled out,
a period of several weeks allowed to see whether
a spontaneous recovery may occur, and a careful
bone marrow study be made. If the marrow is
aplastic, no benefit need be expected from the
operation.
Since the bleeding in non-thrombocytopenic
purpura (the Henoch-Schonlein types) is usually
much less of a problem than the other symptoms,
no special measures generally are necessary to
(Continued on Page 1165)
November, 1950
1101
DEPROPANEX IN POST-SURGERY
I. I. HEIMARK. A.M.. M.D.. Fairmont. Minnesota, and
R. L. PARSONS, B.A., M.D.. Triumph. Minnesota
O INCE before the last war, the writers have
^ been routinely using the deproteinated pan-
creatic extract, Depropanex, post-surgically. As
is well known, this drug is used in cases where
smooth muscle spasm is present. In renal colic
where it has been used for a considerable time it,
in conjunction with other sedation, has been ob-
served by some to produce great relief. What
prompted us to try Depropanex post-surgically
was the observation that, before Depropanex was
administered in renal colic, there was a very dis-
tressing paralytic ileus present; following Depro-
panex injections, this condition was very shortly
improved and relieved. It was so impressive to us
that we then wondered what Depropanex would
do in patients with the same distressing condition
following abdominal operations. We therefore
decided to give Depropanex routinely to all out-
patients following operations. The first injection
of 4 c.c. is given the surgical patient upon his re-
turn to his room, even before he is awake. A sec-
ond dose of 4 c.c. is given in the evening. These
two doses of Depropanex are then given routinely
twice daily for three to five days, depending upon
the progress and the condition of the patient, as
well as on the type of operation performed. A
patient having only the appendix removed may not
need the Depropanex more than twice daily for
three days, while one who has had both gall
bladder and appendix removed is usually given
Depropanex for four to five days. The same ap-
plies to other major abdominal operations.
Now that approximately a decade has passed
during which time we have used Depropanex
post-operatively, we feel that the results have been
so uniformly encouraging that it warrants a report
on what we have experienced. Before we go into
the details of what we have observed, we wish to
state that we have been most fortunate in having
an anesthetist who was trained for a year at the
University of Minnesota Hospitals in Minneap-
olis. The anesthesia she has used almost exclu-
sively for induction is Penthothal Sodium, fol-
lowed by Cyclo-Propane gas. Curare has also
been used to overcome peritoneal spasm and ten-
sion.
In acute gallbladder colic, Depropanex in con-
junction with sedation has been found to be effi-
cacious in relieving the spasm, pain and distress,
as it does in renal colic. Following gallbladder
surgery, it is reasonably safe to assume that
Depropanex will reduce the spasm in the common
duct as well as in the sphincter of Oddi. Reliev-
ing this spasm will, in turn, relieve the bile back-
pressure created in the liver, ducts, and on the cys-
tic stump. This relief of spasm, with resultant
early flow of bile, is definitely an adjunct in the
smooth recovery of the patient. The diminution
of nausea and vomiting in these cases leads us to
conclude that Depropanex is the aiding factor in
this smooth post-operative recovery.
But the outstanding improvement we have ob-
served on patients routinely given Depropanex
post-operatively has been the control of paralytic-
ileus. The abdomen remains uniformly soft all
through the critical post-operative days. When
gas pains begin, the patient states that the pain
will travel along in the bowel as if he had taken
a laxative, and the gas pain never becomes dis-
tressing. There does not appear to be any notice-
able abdominal distention ; the abdominal wall
does not feel tense nor rigid ; the distressed facies
is absent ; the patient tolerates sips of water and
invariably impresses us as being comfortable.
When an enema is given on the third day the
nurses report good results, while rarely do they
have to use a rectal tube to siphon off the enema.
On various occasions we have stopped the Depro-
panex to observe what takes place. The following
day the patient will complain of distressing gas
pains, but when we give Depropanex again, the
gas pain soon becomes relieved and begins to
move on in the bowel.
The above results have led us to speculate on
the physiological action of Depropanex. It is ad-
vertised as relieving spasm. But we are wonder-
ing whether, if it relieves spasm, it does not also
supply the smooth muscle with something that
brings about a normal tone and natural power
which thereby overcomes the muscle weakness
which may eventually lead to a paralytic bowel
with resultant distention? This uniformly good
tone to the bowel all through the post-operative
period has led us to notice that there is less vom-
iting as well as less acute dilatation of the stom-
ach which ordinarily follows all types of opera-
1102
Minnesota Medicine
DEPROPANEX IN POST-SURGERY — HEIMARK AND PARSONS
tions, especially the major ones. Rarely do we
resort to the nasal suction apparatus, and since
there is very little vomiting we do not need to
resort to intravenous fluids. Since these two ad-
juncts have been practically eliminated in respect
to these patients, it is an obvious economy to the
patient, while the floor nurses are thereby given
more time for their daily floor routine. The same
is true for the time-consuming work and anxiety
the paralytic bowel causes when repeated enemas
must be given for relief, to say nothing of the
distress the rectal tube and enemas cause the ail-
ing patient. The rarity of these distressing com-
plications naturally leaves the patient in a much-
desired frame of mind during these post-surgical
days. In fact, we have had some patients who
have given us the impression by their silent looks :
"When is the tough time following this operation
going to strike?”
We encourage our patients to get out of bed as
soon as possible post-operatively. Since they make
such a smooth recovery, the distress by their so
doing is not too great for them.
In summing up our observations on these pa-
tients to whom we have routinely given Depro-
panex following surgery, we have observed the
following :
1. No ill after-effects from the use of Depro-
panex.
2. Practically a complete elimination of post-
operative paralytic ileus.
3. Less nausea and vomiting; therefore, less
dehydration and acute dilatation of the stomach.
4. A smoother, easier, more pain-free recov-
ery ; therefore, a less anxious patient.
5. Intravenous fluids seldom used ; therefore,
economy to the patient.
6. Nasal suction and repeated enemas elimi-
nated ; thus, less punishment for the patient.
7. Patients over fifty years make as smooth a
recovery as do the younger ones.
We believe that the beneficial effect of Depro-
panex on patients throughout the post-operative
period has been convincingly demonstrated.
Has this deproteinated pancreatic extract,
Depropanex, been fully researched ?
The authors are cognizant of the fact that oth-
ers have found so-called “hypotensive” extracts
such as Depropanex without demonstrable intrin-
sic therapeutic merit in the dosage and methods
of administration recommended. (J.A.M.A.,
March 3, 1945, p. 522.) We are also informed of
the fact that Depropanex has not been submitted
to the Council on Pharmacy and Chemistry for
approval. We have used this preparation, how-
ever, in post-surgery patients and feel it has been
of definite therapeutic value. This report is made,
therefore, in the hope that our experience may be
of value to others.
FLATFOOT, WITH SPECIAL CONSIDERATION OF TARSAL COALITION
(Continued from Page 1097)
the operation, the patient was walking on his right foot
and was not having any pain on the right. It is antici-
pated that a similar operative procedure eventually may
have to he performed on the left foot.
Summary
There are three main types of flatfoot. The
most common is an asymptomatic flattening of
the longitudinal arch. This is an individual
characteristic. The two types of symptomatic
flatfoot are relaxed flatfoot and rigid flatfoot.
Recent advance in the knowledge of rigid flatfoot
seems to indicate that in most cases the feet are
rigid because of coalition existing between the
November, 1950
calcaneus and talus or between the calcaneus and
the navicular.
References
1. Badgley, C. E. : Coalition of the calcaneus and the navicular.
Arch. Surg., 15:75-88, (July) 1927.
2. Coventry, M. B.: Diagnosis of foot pain. S. Clin. North
America, 28:1079-1086, (Aug.) 1948.
3. Harris, R. I., and Beath, Thomas: Army Foot Survey: an
Investigation of Foot Ailments in Canadian Soldiers. Ottawa:
National Research Council of Canada, 1947. J-68 pp.
4. Harris, R. I., and Beath, Thomas: Hypermobile flat-foot with
short tendo achilli. J. Bone & Joint Surg., 30-A : 1 16-138,
(Jan.) 1948.
5. Harris, R. I., and Beath, Thomas: Etiology of peroneal spastic
flat foot. J. Bone & Joint Surg., 30-B :624-634, (Nov.) 1948.
6. Nove-Josserand : Quoted by Key, J. A.: Anatomic forms of
flat foot. J. Bone & Joint Surg., 21:847, (Oct.) 1923.
7. Slomann: On coalitio calcaneo-navicularis. J. Orthop. Surg.,
3:586-602, (Nov.) 1921.
1103
THE ROENTGEN DIAGNOSIS OF SILICOSIS
EUGENE P. PENDERGRASS. M.D.
Professor of Radiology. University of Pennsylvania
Philadelphia, Pennsylvania
(Continued from the October Issue)
Pneumoconiosis and Silicosis Occurring in
Various Industries
All of the roentgen manifestations that have
been described above have taken into considera-
tion the hypothesis that the lesions in many or
all instances have been produced by free silica
and modified by other dusts (contaminants). As
stated before, it is probable that very few oppor-
tunities are afforded to study lung changes in
which pure silica is the only dust present. One
should therefore bear in mind that the manifes-
tations of silicosis in the various industries are
likely to be different. For instance, the roentgen
findings in the slate and talc workers are likely to
be different from those occurring in hard and
soft coal miners. The roentgen findings may dif-
fer even in different foundries. In most instances
it requires many years (six to fifteen) of expos-
ure before one can demonstrate roentgen evidence
of silicosis. The exceptions to this rule are clas-
sified under the head of “rapidly developing
silicosis.”
Rapidly developing silicosis has been described
by Gardner.27 When individuals are exposed to
excessive quantities of finely divided silica, an
unusual kind of reaction develops. The over-
whelming deposits of silica seem to stimulate
connective tissues in every part of the lung at the
same time. The nodules are of microscopic pro-
portions and in most cases there have been com-
plicating infections.
I have seen a great many roentgenograms
(some single, a few stereoscopic) of individuals
who were diagnosed as having rapidly developing
silicosis. In the advanced cases lobar consolida-
tions, due largely to the superimposed infection,
obscured the changes due to silicosis. In the ear-
lier cases the roentgenographio manifestations
were those sometimes observed in an interstitial
type of pneumonitis of ill-defined shadows similar
to that produced by a prominent pectoral fold. In
a few cases in which I made roentgenoscopic ob-
servations, the costal and diaphragmatic excur-
sions seemed to be limited. A number of the in-
dividuals that I saw had lost weight, were pale
and dyspneic. Experience in this country was
similar to that in England,49 in that most of the
fatal cases were associated with tuberculosis.
Another consideration having to do with sili-
cosis is concerned with what might be called in-
dividual susceptibility. Physicians interested in
this subject have noticed that not all individuals
exposed to dust in the same industry, and appar-
ently in the same manner, develop silicosis. Why
such a difference is manifest no one knows. Many
explanations have been offered, but none of them
are completely satisfactory. Lanza42 feels that
the question of individual susceptibility has been
overworked and is not as significant as the ques-
tion of dust exposure (dosage). There seems to
be a general agreement that when a tuberculous
infection is present, the actions of the silica and
the infection are enhanced.
Asbestosis
Asbestosis is the second of the recognized spe-
cific pneumoconioses. Since, however, its roent-
gen manifestations in no way simulate those oc-
curring in silicosis, the criteria for its diagnosis
are not reviewed.
Differential Diagnosis
Any exposition of the criteria applicable to the
diagnosis of the specific pneumoconioses, and of
silicosis in particular, must include other condi-
tions which not infrequently make the problem
of differential diagnosis extremely difficult. Some
of these are so familiar as to require but brief
mention ; others, either because of their unusual
interest or because of the frequency with which
they are misdiagnosed as silicosis, will be consid-
ered in some detail.
First in order of consideration are the benign
pneumoconioses, and second, the many pulmon-
ary diseases productive of roentgen changes simi-
lar to those of silicosis but unassociated with the
inhalation of dust.
not
Minnesota Medicine
ROENTGEN DIAGNOSIS OF SILICOSIS— PENDERGRASS
The Non-specific Pneumoconioses
Under the heading “non-specific pneumoconio-
ses,” attention is directed to the pulmonary reac-
tions resulting from the inhalation of all types of
mineral dust which are incapable of stimulating
within the lungs the development of progressive
fibrosis. Anthracosis, siderosis, as well as the re-
actions to the inhalation of cement, gypsum, and
the various silicates, with the exception of asbes-
tos and possibly talc, are all included.
The alveolar phagocytes, regardless of the com-
position of the inhaled dust, tend to concentrate
the particles within the lymphoid tissues of the
lungs and mediastinum as well as in the areolar
tissues about the perivascular lymphatic trunks.
Excessive accumulations may excite a low-grade
chronic inflammatory reaction which is non-pro-
gressive but which may be productive of small
amounts of grossly invisible cellular connective
tissue. The only secondary efifect is the appear-
ance of emphysema, microscopic in its propor-
tions and of no clinical significance.32 Roentgeno-
graphically there may be some increase in promi-
nence of the normal linear pulmonic markings,
but with the exception of those “roentgenologic
conditions” productive of a pseudo-nodulation
and resulting from the inhalation of inert but
radiopaque dusts, no specific deviations from the
normal can be identified. Increasing experience
will doubtless lead to the recognition of others,
but to date those in the latter category to receive
consideration are baritosis, siderosis, and the
changes occurring in silver polishers, and those
due to the inhalation of tin oxide.
Baritosis, originally described by Arrigoni,3
results from the inhalation of barium sulfate, and
occurs chiefly among the baryta miners in Italy.
I reported a small incidence among workers in a
Pennsylvania plant.55 In baritosis there is no re-
spiratory incapacity, the only evidence of the
presence of the mineral being the demonstration
upon the roentgenogram of sharply circumscribed
nodules evenly distributed throughout the lung
fields.56 Duplication of the condition in the ex-
perimental animal is unproductive of fibrosis, in-
dicating that the nodulation demonstrable in
roentgenograms results from the direct visualiza-
tion of compact collections of radiopaque particles
within the lungs.32
Sider,osis, an analogous condition occurs as the
result of a number of industrial processes, chief
among which are electric arc-welding, metal-
grinding, silver finishing, and possibly boiler-
scaling. Collis,s in 1923, suggested that errors in
the diagnosis of silicosis in iron miners might be
made, due to the radiopacity of iron oxide. Sub-
sequently, but without the benefit of clarifying
pathological material, Doig and McLaughlin,15 in
1936, reported the occurrence of fine nodulation
in 6 of 16 electric arc-welders. In 1938, Enzer
and Sanderis described similar findings in 5 of 26
electric arc-welders, who had worked for an av-
erage of nineteen years using bare metal rods
containing 99 per cent iron and 1 per cent free
silica, and in one case presented necropsy findings
to indicate that the roentgen changes were a di-
rect consequence of the collection of radiopaque
iron oxide particles within the lungs. Sander69
states that Enzer has since obtained three addi-
tional and confirmatory autopsy cases.
In 1945, entirely similar roentgen findings were
reported by Pendergrass and Leopold56 in four of
ten metal-grinders who had worked from twelve
to seventeen years in a plant shown to be free of
a silica hazard. The metal ground was used in the
manufacture of bearings and was identified as
chrome vanadium and chrome molybedenum tool-
steel containing about 98 per cent iron, 1.8 per
cent alloy, and 0.2 per cent silica. For the grind-
ing process, artificial abrasive wheels, recognized
as innocuous from the standpoint of a silica haz-
ard and composed of bakelite, carborundum, and
aluminum oxide, were used exclusively through-
out the occupational lives of the affected persons.
More recently, the occurrence of identical
roentgen findings in silver-polishers has been re-
ported from England.46 Quite pure and finely
divided iron oxide in the form of either “rouge”
or “crocus” is used in the final finishing of silver,
and when applied to revolving “dollies” is pro-
ductive of considerable dust, consisting primarily
of iron oxide contaminated with metallic silver,
the latter also being radiopaque. Four men, em-
ployed as silver-finishers for periods of twenty to
forty years, were examined. Chest roentgeno-
grams of all presented the changes to be described
below, and a subsequent autopsy on one revealed
only particulate collections of iron oxide with
small amounts of silver within the lungs.
A similar condition has been described as oc-
curring in boiler-scalers. 9’16,75 Here, however,
there may be an associated silica hazard, the elim-
November, 1950
1105
ROENTGEN DIAGNOSIS OE SILICOSIS— PENDERGRASS
ination of which is required before the changes
seen can be properly attributed to siderosis.
Pathologically, in siderosis there is gross evi-
dence of pigmentation, the ferrous nature of
which may be demonstrated by proper staining.
Histologic sections show' the pigment to be dis-
tributed chiefly in the perivascular lymphatics, the
subpleural spaces and the interalveolar septa. It
is the heavy accumulation in the perivascular
lymphatics of the iron oxide pigment, in itself
radiopaque, which accounts for the roentgen find-
ings. At no time have any reactive phenomena,
provocative of fibrosis within the cells, been de-
scribed.
The pulmonary changes in siderosis, as re-
flected in the chest roentgenogram, cannot from
the film alone be distinguished from those already
described in detail as occurring in simple silicosis.
They are, therefore, simple of definition and con-
sist of discrete nodular densities distributed uni-
formly throughout both lungs, without hilar en-
largement but in some cases with an associated
reticulation resulting from an increased promi-
nence of the linear markings.
Pseudo-nodulation due to inhalation of tin
oxide has been reported by Pendergrass and
Pryde57 and Bartak et al.4 Pendergrass and Pryde
recorded a case which had been studied by Dr.
Hollis E. Potter of Chicago. The patient was a
man, aged forty-five, who had worked at a single
job of bagging tin oxide for fifteen years. There
was no disability. The roentgenogram showed
diffuse dense pseudo-nodulation throughout both
lungs similar to that observed in baritosis and
considered to be a benign pneumoconiosis. Chem-
ical analysis of the tin oxide showed it to be 96.5
per cent tin oxide, while the remaining 3.5 per
cent contained aluminum, iron, and sodium. No
silica was found. Experimental studies of the ma-
terial placed in a dog’s lung and in phantoms
showed that its density was sufficiently great to
produce shadows equal to or greater than those
produced by iron. The pseudo-nodulation pro-
duced by tin oxide is not to be confused with the
pneumoconiosis reported in the tin miners of
Cornwall ;35 the industrial hazard among them
was one of silicosis.
It seems quite obvious that a detailed occupa-
tional history is fundamental to the differential
diagnosis of silicosis and the pseudo-nodular types
of the benign pneumoconioses.
Talc Pneumoconiosis
It has already been indicated that the silicates,
with the exception of asbestos and possibly talc,
belong in the category of inert dusts. Asbestos, a
fibrous silicate, is productive of a specific pneu-
moconiosis characterized by the formation of a
progressive interstitial pulmonary fibrosis. Talc,
also a -silicate, with certain physical characteristics
in common with asbestos, requires more specific
evaluation (Hobbs.39).
The available experimental evidence would in-
dicate that talc alone is incapable of producing a
progressive fibrosis.31,38 The criticism has been
advanced, however, that the inhalation experi-
ments were of insufficient duration to define con
clusively the effect of long continued industrial ex
posure, this latter being fundamental to the de-
velopment of specific changes.73 Siegal reports no
case with less than ten years’ exposure, but then
records an incidence of 14.5 per cent “talc pneu
moconiosis.”
Roentgenograms are described as showing a
bilateral diffuse haziness or “ground-glass” ap
pearance, with some tendency to parahilar and
subapical localization, and, in some cases, with
the presence of an ill defined nodulation and/or
conglomerate areas of fibrosis leading to a suspi-
cion, as yet unproved, of underlying infection.62’73
Siegal73 further directs attention to an occasional
right-sided predominance and to a rarely demon-
strable blurring or “shagginess” of the cardiac
silhouette, reminiscent of asbestosis. He also de-
scribes in detail the occurrence of “pleural
plaques,” long associated with the inhalation of
talc.
The similarity of the described roentgeno-
graphic manifestations to those of asbestosis is
quite striking, but the occurrence of an asbestosis-
like reaction following prolonged industrial ex-
posure to talc would seem unlikely. Further con-
trolled investigation, designed to eliminate the pos-
sible complicating factors of quartz-contaminated
dust and infection, is, however, imperative before
concluding with finality that the roentgen changes
are the reflection of a specific and progressive
fibrosis, and that talc is the sole etiologic agent in
their production. In this regard, it seems quite
probable that the described coexistent nodulation
may be silicotic in origin. In the reported autopsy
cases62 there had been other opportunities for the
inhalation of dusts presumably contaminated with
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ROENTGEN DIAGNOSIS OF SILICOSIS— PENDERGRASS
silica, and in the mining of talc itself similar ex-
posures have not been excluded.
Lung Changes Associated With Alumina
Abrasives (Shaver's Disease)
This disease was first observed71 in February,
1942, in a thirty-three-year-old man, who for a
period of eight years was engaged in manufactur-
ing an abrasive, the main ingredient of which was
bauxite. Since that time Shaver72 has observed
thirty-four well-established and thirty-eight early
cases of lung involvement associated with the in-
dustry.
Occupational History ,71 — The process involved
has been in operation for years and was believed
to be innocuous. No one before had been dis-
covered suffering with unusual lung involvement
resulting from or associated with their occupation.
The abrasive being manufactured is corundum.
It is an aluminum oxide of great hardness which
is used as an abrasive.
The processing is done in electric arc furnaces.
The material being treated consists of a mixture
of bauxite, iron and coke. The bauxite is ground
and mixed with other ingredients and then
shoveled into large metal pots. The electrodes are
lowered into the pots and the material is fused at
temperatures of approximately 20Q0°C. During
operation dense fumes are elaborated. The fumes
contain alumina and silica and other materials in
a finely divided state (Al2 0:1 50 per cent and Si
0;, 35 per cent).
Symptomatology. — The symptoms are varied
but dyspnea is the most outstanding. Sudden at-
tacks of extreme breathlessness are frequently de-
scribed. There is a history of cough and a frothy
sputum.
In the advanced cases, substernal discomfort
and tightness of chest, and occasional pleuritic
type of pain is described. Weakness, fatigue and
sleeplessness are associated with advancing
dyspnea.
Physical Findings. — Most cases have weight-
loss associated with a loss of appetite. The chest
signs vary with the presence or absence of pneu-
mothoraces. Cyanosis, limited chest expansion,
harsh breath sounds, variable rales and tachy-
cardia are some of the signs found.
Pathology. — Overwhelming fibrous tissue for-
mation, alveolar wall thickening and profound
emphysema are characteristic findings.
Roentgen Findings. — -In well-established cases,
a widened mediastinal shadow may partially ob-
scure the shadows of the hila. The domes of the
diaphragm are usually irregular. The domes may
be elevated and tented. The distortions of the
mediastinum and diaphragm become less marked
and may disappear when pneumotherax occurs.
Lace-like granular shadows occur bilaterally in
the upper halves of each lung, especially pro-
nounced toward the hila. Conglomerate shadows
are seen in the more advanced cases. In advanced
cases, emphysematous blebs are seen. Pneu-
mothorax, either unilateral or bilateral, and, with
or without a pleural collection not infrequently
occurs.
Vanadium Pentoxide
There is another industrial disease due to the
toxic effects of vanadium pentoxide ,82 I have no
personal experience with this but a short discus-
sion is included for completeness.
Vanadium is a silvery white metal rarely en-
countered in its pure state. The ores are dis-
tributed mainly in Peru, South Africa, and Rho-
desia.82 The chief uses of vanadium are to raise
the hardness and malleability of steel and to in-
crease its fatigue-resisting properties. Vanadium
pentoxide, a yellowish red powder, is used as an
oxidizing agent in the conversion of naphthalene
to phthalic anhydride and in place of platinum in
the modified contact process of sulfuric acid
manufacture.82
It had long been known that vanadium pent-
oxide dust would cause bronchitis among work-
ers, but the full significance of the condition was
not appreciated until the report of Wyers82 ap-
peared. He has observed at least fifty workers,
men and women, some of whom showed reticulat-
ed shadows in the lower lung fields. It is not
known whether these shadows are due to ac-
cumulation of dust in the air sacs or fibrosis.
Vanadium ■ workers complain of paroxysmal
cough and pains in the chest, and have a tenacious
sputum, which may be blood-streaked. They may
develop emphysema. Other signs of the condition
are those of systemic intoxication, which may be
evidenced by diarrhea, anorexia, emaciation, visual
defects, paralysis, vertigo, and convulsions.
Other and Confusing Clauses of Nodular
Densities Within the Lungs
Tuberculosis. — Tuberculosis, following an he-
matogenous dissemination, presents on the roent-
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1107
ROENTGEN DIAGNOSIS OF SILICOSIS— PENDERGRASS
genogram evenly distributed nodular densities
throughout both lungs, occasionally indistinguish-
able from those occurring in simple silicosis. Ex-
cept in these cases, difficulty in the differential
diagnosis between tuberculosis and silicosis sel-
dom occurs, but in them the distinction must be
made upon the basis of history, physical examina-
tion, and laboratory findings. Frequently an ad-
ditional aid is the identification, in tuberculosis,
of an accompanying localized infiltrate or cavity,
without, however, evidence of conglomerate
fibrosis of the type already described as occurring
in tuberculo-silicosis.
Histoplasmosis. — Darling,10’11’12 in 1906 and
1907, recorded three cases of a generalized and
fatal protozoan infection, subsequently identified
as histoplasmosis, which produced pseudo-tuber-
cles in the lungs and areas of focal necrosis in
the liver, spleen, and lymph nodes. Further re-
ports7’11’50’52’60’67’81’83 in more recent years have
shown the disease to be world-wide in distribu-
tion, but most common in the east-central portion
of the United States ; have adequately documented
its pathology and clinical course ; and have offered
evidence in support of the thesis that it is not in-
variably fatal but that it in all probability exists
most commonly in a benign and asymptomatic
form. DeMonbreun13 in 1932 proved its fungous
origin by identifying Histo plasma capsulatum as
the causative organism.
The symptoms of histoplasmosis, when it is
clinically manifest, are protean, being those of a
generalized infection of the reticulo-endothelial
system, for which Meleny47 suggests the name
“reticulo-endothelial cytomycosis.” Of primary
interest in this presentation, however, is the 20
per cent41 occurrence of significant lung lesions.
In some of these the roentgen findings closely
simulate those of pulmonary tuberculosis, con-
sisting of apical infiltrations with or without
cavity ; in others, miliary lesions 5 to 15 mm. in
diameter are evenly distributed throughout both
lungs. It is these latter which may resemble sili-
cosis, and make necessary the inclusion of histo-
plasmosis in the differential diagnosis of the
nodular pneumoconioses.
Also, in the areas endemic for histoplasmosis,
the incidence of “disseminated miliary calcifica-
tions” is relatively more frequent than in the coun-
try at large.43 While in such cases the nodules
characteristically vary slightly in size, are of ir-
regular distribution, and lack an uncalcified
periphery, their appearance is such that they may
rarely require differentiation from silicosis with
central calcification of the nodules.
The Mycotic Infections. — There are a number
of conditions, such as fungus infestations, that
may simulate the various manifestations of sili-
cosis. One of the important points in arriving at
the diagnosis is for the radiologist to bear these
in mind. Some of the more frequent infestations
seen by us are mentioned.
In moniliasis, in which the chief pathogen has
been found to be Manilla albicans, the roentgeno-
gram shows irregular areas of infiltration which
tend to become nodular. The appearance is similar
to that in simple silicosis with nodular predomi-
nance. Fawcitt23 has called attention to finding
bronchomycoses as a complication in hematite
iron-ore workers.
Sporotrichosis is due to a Streptothrix. In the
cases that we have observed, the appearance is
identical with nodular silicosis.
The roentgen appearance in actinomycosis may
be that of a bronchopneumonia. The process may
be diffuse or localized to one lobe. It may be con-
fused with silicosis with infection.
It is sometimes difficult to establish the true
diagnosis of a fungus disease, but every effort
must be made to exclude the lesions that simulate
silicosis before making a definite diagnosis of the
latter.
Pulmonary Hemosiderosis. — Pulmonary hemo-
siderosis clearly demonstrable in roentgenograms
as diffuse nodulation,2 similar to that produced by
silicosis, is said to occur in some patients with
mitral stenosis.56’59’70 Scott,70 in an excellent
paper, has discussed the subject in detail and has
shown, I believe, that hemosiderin is responsible
for the shadows in the roentgenograms. In our
patients there was a preceding rheumatic fever.
The shadow pattern is similar to that produced by
silicosis or the pseudo-nodulation of benign pneu-
moconiosis.
Polycythemia Vera. — Polycythemia vera in pa-
tients with cyanosis and vascular engorgement
may present a markedly increased prominence of
the vascular shadows in the lung. Vessels seen in
an axial plane simulate the nodulation found in
silicosis. There are other shadows in polycythe-
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ROENTGEN DIAGNOSIS OF SILICOSIS— PENDERGRASS
mia vera of unknown origin which simulate the
shadows produced by conglomerate fibrosis. The
history, physical examination, and blood count
will assist in the differential diagnosis.
Carcinoma of the Lung. — Carcinomatous metas-
tases may resemble the nodular and conglomerate
shadows of silicosis with and without infection.
Primary carcinomas arising in the gastrointes-
tinal tract and kidney tumors account for the
great majority of such metastases, but carcinomas
arising from other sites may be responsible. Here
again the history and clinical findings should as-
sist greatly in determining whether a malignant
process is responsible for the abnormal shadow
pattern.
Recently we have had two cases that were
diagnosed primary carcinoma of the lung on the
basis of a roentgen finding of an isolated mass
shadow within one lung. There was a history in
each instance that the patient was a hard coal
miner for years. The only clinical history of
significance was hemophysis. In one patient the
lung lesion was due to a carcinoma, in the other,
silicosis.
Mediastinal Enlargement. — In many silicotic
patients, there are massive shadows, that coalesce
with the mediastinal shadow. On the single pos-
teroanterior roentgenogram, the appearance sim-
ulates that produced by lymphoblastoma. I have
no doubt that many of these patients have been
treated for a malignant process. These massive
shadows adjacent to the mediastinum, may be
due either to massive lesions in the apices of the
lower lobes or to massive lesions in the upper
lobes which have migrated to the mediastinum.
Boeck’s Sarcoid. — Boeck’s sarcoid is primarily
a systemic disease, classically presenting wide-
spread involvement of the lymph nodes, viscera,
osseous system, and skin. Commonly, however,
its clinical manifestations occur in various com-
binations, leading to its separation into types, as
the uveoparotid fever of Heerfordt and Mikulicz’s
syndrome. Similarly, there is a fairly large group
— seventeen in Reisner’s series of thirty-five
cases64 — in which associated lymphadenopathy and
pulmonary involvement constitute either the most
conspicuous or the only discernible manifestation.
The manifestations in chest roentgenograms are
in turn extremely variable as to extent, distribu-
tion, and character, depending largely upon the
phase of evolution of the. disease process at the
time of examination. For convenience of descrip-
tion, and without implication that the process is
at any time static, both Reisner64 and Bernstein5
have subdivided the roentgen findings into several
types. In attempting to identify the various forms
of the disease, a free use of both classifications
is made.
1. In some cases the only abnormality demon-
strable on the roentgenogram is a bilateral, usual-
ly symmetrical enlargement of hilar and tracheo-
bronchial lymph nodes.
2. The so-called “miliary sarcoidosis” is char-
acterized by the presence of widespread nodular
densities throughout the lungs which are usually
quite uniform in size and distribution, but . may
at times exhibit a moderate tendency to coalesce
and be most dense in the middle thirds. Common-
ly there is easily demonstrable hilar lvmphade-
nopathy but, depending upon the phase of the dis-
ease, this may or may not be present.
3. A third group includes those .cases in which
there is hilar lymphadenopathy together with a
string-like infiltration radiating outward from the
hila into the pulmonary parenchyma. These
string-like shadows appear perivascular in dis-
tribution and may be combined with a Generalized
nodulation such as has already been described.
4. A fourth type presents roentgenographically
diffuse parenchymal infiltrations visualized as well
demarcated but irregular and often . contracted
areas of increased density, having therappearance
of fibrosis. Hilar lymphadenopathy is a variable
finding, , as is an associated background of -in-'
creased linear markings and nodulation.
In all fonns,,of . this, .disease,. the pathological
legion is the non-caseating tubercle. The clinical
course, however, is variable though inevitably
chronic. The first and second types above de-
scribed may represent, an early and reversible
stage, and both show a pronounced tendency to
resolution. King40 has, reported complete clearing
within an average of twenty-two months in
twenty-three of thirty-seven cases of pulmonary
sarcoidosis, but does not specify the type of in-
volvement. In the: third and fourth types the
changes -are at least partially irreversible. Sofn’e
degree of resorption may occur, but there in-
evitably remains a residuum of increased linear
markings and at times a massive contracting
fibrosis. The latter leads to varying degrees of
November, 1950
1109
ROENTGEN DIAGNOSIS OF SILICOSIS— PENDERGRASS
disability, and in some cases to a fatal termina-
tion, the commonest causes of which are the de-
velopment of or transition into a typically caseat-
ing pulmonary tuberculosis or the development of
cor pulmonale.34’64
The roentgen appearance of Boeck’s sarcoid
and certain of the pneumoconioses, including sili-
cosis, is occasionally identical. The nodulation in
the miliary form may be indistinguishable from
that of silicosis and the pseudo-nodular types of
the benign pneumoconioses, and the late fibrous
reactions may rarely simulate the picture of
tuberculo-silicosis. In all such cases, the differen-
tiation rests upon a critical evaluation of the his-
torical, clinical, and laboratory data. The distinc-
tion, however, is usually not difficult, since in
sarcoidosis one is commonly led to the correct im-
pression by the presence of marked lymphade-
nopathy, by irregularities in the distribution and
character of the pulmonary lesions, or by the
presence of other and extrapulmonary lesions.
Chronic Pulmonary Granulomatosis in Beryl-
lium Workers. — The recognition of a new pul-
monary disease appearing in workers engaged ir
certain industrial processes requiring the use of
beryllium, or one of its compounds, is attracting
increasing attention. This condition may present
in the roentgenogram a pattern strikingly similar
to that seen in silicosis. Affected individuals have,
as a rule, been employed in the manufacture of
fluorescent lamps, fluorescent powder, neon signs,
or beryllium copper alloys, or have been engaged
either in the extraction of beryllium from the ore
or in projects of a research nature requiring the
use of its compounds.
At least two rather distinctive and entirely dif-
ferent reactions have been described. The first of
these, with which Van Ordstrand and his as-
sociates76 in Cleveland have had the widest ex-
perience, is an acute chemical pneumonitis. Its
roentgenographic characteristics, however, are en-
tirely different from those of silicosis and require
no elaboration in a discussion of the differential
diagnosis.
The second type of reaction, recently labeled
at the Sixth Saranac Laboratory Symposium as
“chronic pulmonary granulomatosis occurring in
beryllium workers,” has been well described by
Sosman and Wilson in a report from Hardy and
Tabershaw,36 by Pascucci,53 and more recently
again by Wilson,80 and by Robert.68 Its roentgen
manifestations are extremely protean and for
adequate description require some attempt at
classification. As a consequence, two53 or three36
types or stages — granular, reticular, and nodular
— are recognized. Granting the possibility that
the various bizarre forms of the disease may rep-
resent different phases in its evolution, subdivision
into types rather than stages would seem wiser
until more extended observation enables us to de-
tect a certain general pattern in the developmental
cycle. To date, in most cases one is unable to
demonstrate a distinct transition from one form
to another, and there is no clear-cut gamut of
stages through which any given case must pass.
In contradistinction, there is some indication, as
yet meager, that the types now recognized are all
late manifestations and that, prior to the develop-
ment of chronic granulomatosis, there may be a
preliminary and perhaps transitory stage com-
parable to the acute form but so mild in degree
that it escapes recognition.
In all types, the involvement is diffuse through-
out both lungs. The granular form presents a
generalized stippled or “fine sandpaper”' appear-
ance suggestive of pulmonary edema, but closer in-
spection demonstrates that the changes are dis-
tinctly particulate in nature. There is usually no
accompanying hilar node enlargement. In cer-
tain instances this granularity may serve as a
background for a generalized reticulation, com-
prising the reticular form of Sosman and Wil-
son.36 Tn these there may be an accompanying
slight to moderate enlargement of the hilar lymph
nodes.
The nodular type, which is of primary concern
in the differential diagnosis of silicosis, is charac-
terized by the presence on the roentgenogram of
evenly distributed nodular densities throughout
the lungs. These vary from 1 or 2 mm. to 4 or
5 mm. in diameter in different persons, but in a
given case are generally uniform in size. The
tendency to coalescence is usually not well defined,
although in some cases there may be a quite defi-
nite concentration of the nodulation in the upper
lung fields. The hila are frequently indistinct,
and may be the site of a pronounced lymphade-
nopathy.
At the risk of digressing, a brief resume of the
symptoms and clinical course of this so recently
recognized disease is offered. Dyspnea, cough,
and weight loss, together with a long latent period
varying from months to several years prior to
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ROENTGEN DIAGNOSIS OF SILICOSIS— PENDERGRASS
onset, are cardinal features. A study of the ven-
tilatory function in advanced cases reveals marked
respiratory incapacity, which is in turn regularly
accompanied by a secondary polycythemia. Hardy
and Tabershaw,36 report a mortality rate of 35 per
cent, but the outcome is not invariably fatal, and
some of those cases which it has been our privilege
to follow have remained relatively stationary over
a period of several years, while others have shown
varying degrees of improvement. Too short a
time has elapsed to warrant final conclusions, and
the ultimate result to be expected in the non-fatal
cases is still a matter of conjecture. In any given
case, however, attention should be directed to the
fact that there is apt to be a striking lack of cor-
relation between the clinical and the roentgen
findings.
In autopsy material there is grossly apparent
a diffuse thickening of the alveolar septa, usually
most marked in the hilar portion of each lobe.
Microscopically this is seen to have occurred
secondary to a widespread cellular infiltration bv
macrophages and lymphocytes, with the associated
formation of focal lesions in which there has been
an obliteration of the alveolar spaces. Multi-
nucleated giant cells of the Langhans’ type are
usually demonstrable, and the irregular deposition
of fibrous tissue within the lesions is a common
occurrence.
As long as the granularity so characteristic of
the granular and reticular forms of the disease
persists, the differentiation of the various nodular
pneumoconioses from chronic pulmonary gran-
ulomatosis of the type seen in beryllium workers
does not present a difficult problem. In the
nodular form, however, the roentgen appearance
may simulate exactly that of siliocisis and those
benign pneumoconioses which exhibit a nodular
predominance. In these cases recourse must again
be taken to the occupational history and to con-
sideration of the clinical and laboratory findings.
Comment
The remarks above are but a brief account of
the story of silicosis and some of the conditions
with which it may be confused. There are many
avenues of research concerning silicosis still to be
explored. The new work of Evans19 in this coun-
try and Bartak et al1 in Italy may provide new
approaches to this exceedingly important subject.
Every year brings new answers to old problems
and new problems to be answered. Until we
know the answers to all of the problems con-
cerned with this subject, it behooves us to plan for
the worker. Such a plan should include the fol-
lowing requirements :
1. A healthy atmosphere in which individuals
work.
2. Preemployment and annual physical and
roentgen examinations of the chest in order to
demonstrate early tuberculous lesions and ex-
clude such individuals from participating in work
that may be harmful to them and their fellow
workers.
Summary
1. Attention is directed to the fact that a
fluoroscopic and roentgenographic examination of
the chest is the most precise method available for
demonstrating in the living individual the path-
ological changes produced within the lungs by the
silicosis. The necessity, however, for correlating
the roentgen findings with all other essential data
before making a definite diagnosis is emphasized.
2. The roentgen manifestations of simple sili-
cosis and of silicosis complicated by the presence
of coexisting infection, are detailed. The demon-
stration upon the roentgenogram of a generalized
nodulation throughout the lungs is considered as
fundamental to tht diagnosis of silicosis.
3. The differential diagnosis of silicosis and
other conditions which may be productive of
nodular densities within the lungs is reviewed.
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Pub. Health Bull. No. 187. U. S. Gov. Printing Office,
Washington. July, 1929.
27. Gardner. L. U. : Pathology of so-called acute silicosis. Am.
J. Pub. Health, 23:1240-1249, 1933.
28. Gardner, L. L’. : Inhaled silica and its effect on normal and
tuberculous lungs. J.A.M.A., 103:743-748, (Sept. 8), 1934. .
29. Gardner, L. \J. : Silicosis and its relationship to tuberculosis.
Am. Rev. Tuberc., 29:1-7, 1934.
30. Gardner. L. U. : Etiology of pneumoconiosis. T.A.M.A.,
111:1925-1936, (Nov. 19), 1938.
31. Gardner, L. U. : Reaction to inert dusts. Fourth Saranac
Laboratory Symposium on Silicosis, pp. 143-146, 1939.
32. Gardner, L. U. : Pathology and roentgenographic manifesta-
tions of pneumoconiosis. J.A.M.A., 1 14:535-545, 1940.
33. Gardner, L. U., Dworski, M., and Delahant, A. B.: Alu-
minum Therapy in silicosis; and experimental study. Donald
E. Cummings Memorial Lecture, j. Indust. Hyg. & Toxicol.
26:211-223, 1944.^
34. Hagn-Meincke, F.: Boeck’s sarcoid and its relation to
tuberculosis. Acta, tuberc. Scandinav., 18:1-19, 1944.
35. Haldane, J. S., Martin, J. S., and Thomas, R. A.: Report
to the Secretary of State for the Home Department on the
Health of Cornish Miners. Cd. 2091, His Majesty’s Stationery
Office, London, 1904.
36. Hardy, H. L., and Tabershaw, I. R.: Delayed chemical
pneumonitis occurring in workers exposed to beryllium com-
pounds. J. Indust. Hyg. & Toxicol., 28:197-211, 1946.
37. Hatch, Theodore: Behavior of dust in respiratory system
and its significance in etiology of silicosis. Paper read before
Philadelphia Roentgen Ray Society. Feb. 6, 1941.
38. Haynes, F. : Experimental dust inhalation in guinea pigs.
J. Hyg., 31 :96-123, 1931.
39. Hobbs, A. A., Tr . : A type of pneumoconiosis. Am. T.
Roentgenol., 63:488-497, 1950.
40. King, D. S. : Sarcoid disease as revealed in the chest
roentgenogram. Am. J. Roentgenol., 45:505-512, 1941.
41. Kuzma. J. F. : Histoplasmosis — The pathologic and clinical
findings. Dis. of Chest, 13:338-344, 1947.
42. Lanza, A. J. : Silicosis. Wisconsin M.J., 40:923-925, 1941.
43. Long, E. R.. and Stearns, W. H.: Physical examination at
induction: Standards with respect to tuberculosis and their
application as illustrated by a review of 53,400 x-ray films
of men' In the Army of the United States. Radiology, 41 :
144-149, 1943.
44. Machle, Willard: Pathogenesis of industrial pulmonary dis-
ease. Radiology, 50:755-759, 1948.
45. McCloskey, Bernard J. : Personal communication.
46. McLaughlin, A. T. G., Grout, J. L. A., Barrie, H. T., and
Harding, H. E. : Iron oxide dust in the lungs of silver
finishers. Lancet, 1:337-341, March 17, 1945.
47. Meleney, H. E. : Histoplasmosis (Reticulo-Endothelial Cy-
tomycosis) : Review with mention of thirteen unpublished
cases: Am. J. Trop. Med., 20:603-616, 1940.
48. Merewether, E. R. A.: A rViemorandum on asbestosis.
Tubercle, 15:109-118, 1933; 15:152-159, 1934.
49. Middleton, E. L. : Industrial pulmonary disease due to the
inhalation of dust, with special reference to silicosis. Lancet,
2:1-9, 59-65, 1936.
50. Palmer, C. E. : Geographic differences in sensitivity to
histoplasmin among student nurses. Pub. Health Rep., 61 :
475-487, April 5, 1946.
51. Parmeggiana, Luigi (Univ. of Milan): Observations on the
piezoelectric theory of valicogna on the pathogenesis of sili-
cosis. Med. d. lavoro, 38:115-122, 1947.
52. Parsons, R. J., and Zarafonetis, C. J. D. : Histoplasmosis in
man; report of seven cases and review of seventy-one cases.
Arch. Int. Med., 75:1-23, 1945.
53. Pascucci, L. M. : Pulmonary disease in workers exposed to
beryllium compounds: Its roentgen characteristics. Radiology,
50:23-35, 1948.
54. Pendergrass, E. P. : The Roentgen diagnosis of silicosis and
asbestosis. Chapter III. In: Silicosis and Asbestosis. A. J.
Lanza, Editor. Oxford Medical Publications, Oxford Univer-
sity Press, New York, 1938.
55. Pendergrass, E. P. : Some considerations concerning the
roentgen diagnosis of pneumoconiosis and silicosis. Am. J.
Roentgenol., 48:571-594, 1942.
56. Pendergrass, E. P., and Leopold, S. S. : Benign pneu-
monoconiosis. J.A.M.A., 127:701-705, March 24, 1945.
57. Pendergrass, E. P., and Pryde, A. W. : Benign pneu-
moconiosis due to tin oxide. T. Indust. Hyg. & Toxicol.,
30:119-123, March 1948.
58. Pendergrass, E. P., and Robert, A. G. : Some considerations
of the roentgen diagnosis of silicosis and conditions that may
simulate it. Radiology, 50:725-745, 1948.
59. Pendergrass, E. P., Lane, E. L., and Ostrum, H. W. :
Hemosiderosis of the lung due to mitral disease. Am. J.
Roentgenol., 61:443-456, 1949.
60. Pierpont, D. C. : Is acute lobar pneumonia a complication of
silicosis? J. Indust. Hyg. & Toxicol., 24:238-239, 1942.
61. Plinius Secundus, C. : Selections of chemical portions of
“Naturalis Historiae,” translated by Kenneth C. Bailey under
the title “The Elder Pliny’s Chapters on Chemical Sub-
jects,” Parts 1 and 2, Edward Arnold & Co., London, 1929.
62. Porro, F. W., Patton, J. R., and Hobbs, A. A., Jr.: Pneu-
moconiosis in the talc industry. Am. J. Roentgenol., 47:507-
524, 1942.
63. Ramazzini, B. : DeMorbis Artificum Diatriba (a treatise on
the diseases of tradesmen). Translated by Dr. James together
with Frederick Hoffman’s “A Dissertation on Endemial Dis-
eases.” London: Thomas Osborne, 1746.
64. Reisner, D. : Boeck’s sarcoid and systemic sarcoidosis (Bes-
nier-Boeck-Schaumann disease) : A study of thirty-five cases.
Am. Rev. Tuberc., 49:289-307; 437-462, 1944.
65. Riddell, A. R. : Clinical and radiological aspects of silicosis.
Canad. Pub. Health J., 27:67-72, 1936.
66. Riley, W. A., and Watson, C. J. : Darli ng’s histoplasmosis
in the United States; the possibility of further occurrence
of cases. Minnesota Med., 9:97, 1926.
67. Riley, W. A., and Watson, C. J.; Histoplasmosis of Darling;
case originating in Minnesota. Am. T. Trop. Med., 6:271-282,
1926.
68. Robert, A. G. : A consideration of the roentgen diagnosis. of
chronic pulmonary granulomatosis of beryllium workers. Am.
J. Roentgenol., 63:467-487, 1930.
69. Sander, O. A.: Further observations on lung changes in
electric arc welders. J. Indust. Hyg. & Toxicol., 26:79-85,
1944.
70. Scott, L. D. W., Park, S. D. S., and Lendrum, A. C. :
Clinical, radiological and pathological aspects of pulmonary
haemosiderosis. Brit. J. Radiol., 20:100-107, 1947.
71. Shaver, C. G., and Riddell, A. R. : Lung changes associated
with the manufacture of alumina abrasives. J. Indust. Hyg.
& Toxicol., 29:143-157, 1947.
72. Shaver, C. G. : Further observations of lung changes as-
sociated with the manufacture of alumina abrasives.
Radiology, 50:760-769, 1948.
73. Siegal, W., Smith, A. R., and Greenburg, L. : The dust
hazard in tremolite talc mining, including roentgenological
findings in talc workers. Am. J. Roentgenol., 49:11-29, 1943.
74. Thackrah, C. Turner: The Effects of Arts, Trades and Pro-
fessions on Health and Longevity. Second edition. Leeds:
Baines and Newson, 1832.
75. Todd, P. G., and Rice, D.: Pneumoconiosis in boiler-
scalers. Lancet, 1:309, March 4, 1944.
76. Van Ordstrand, H. S., Hughes, R., DeNardi, J. M., and
Carmody, M. G. : Beryllium poisoning. J.A.M.A., 129:1084-
1090, 1945.
77. Visconti. Reported by Rovida, C. L. : Un case di silicosi del
pulmone, con analist chimica. Pilli Annalli di chimica, 1871.
78. Vorwald, A. J., Delahant, A. B., and Dworski, M.: Silicosis
and Type III pneumococcus pneumonia; an experimental
study. J. Indust. Hyg. & Toxicol., 22: 64-78, 1940.
79. Watt, A. H., Irvine, L. C., Johnson, I. P., and Stewart,
W. : Silicosis (miners’ phthisis) in the Witwatersrand. Ap-
pendix No. 6 of the Miners’ Phthisis Prevention Committee
of South Africa, Pretoria, 1916.
80. Wilson, S. A.: The beryllium problem — the chronic or de-
layed disease — roentgenological aspects. To be published in
the proceedings of the Sixth Saranac Laboratory Symposium.
See also Delayed chemical pneumonitis or diffuse granuloma-
tosis of the lung due to beryllium. Radiology, 50:770-779,
1948.
81. Worgan, D. K. : Histoplasmosis: A summary of the known
facts about the disease; Report of case. Bull. School Med.
Univ. Maryland, 30:69-79, 1945.
82. Wyers, II.: Some toxic effects of vanadium pentoxide.
Brit. J. Indust. Med., 3:177-182, 1946.
83. Zarafonetis, C. J. D., and Lindberg, R. B. : Histoplasmosis
of Darling: Observations on the antigenic properties of the
causative agent. Preliminary report. Univ. Hosp. Bull. Ann
Arbor, 7:47-48, 1941.
84. Zenker, F. A.: Ueber Staubinhalationskrankheiten der
Lungen. Deutsches Arch. f. klin. Med., 2:116, 1867.
1112
Minnesota Medicine
Case Report
INFANTILE CORTICAL HYPEROSTOSIS
HAROLD W. HERMANN, M.D., AMES W. NASLUND, M.D., and ARTHUR E. KARLSTROM, M.D.
Minneapolis, Minnesota
IN July, 1945, Caffey and Silverman3 made a prelim-
inary report of four cases with a syndrome they
designated infantile cortical hyperostosis. We wish to
report another case believed to be of the same clinical
entity.
Case Report
M. R., a baby girl, was born at term on January 4,
1950, after a normal spontaneous labor and weighed 7
pounds 2l/2 ounces. The gestation was accompanied by a
mild hyperemesis on the part of the mother in the first
five months with consequent dietary restrictions. The
last four months antepartum were uneventful and without
disease.
The infant was healthy and gained normally the first
three months at home. Ascorbic acid and Drisdol had
been added at one month. At three months the child
was noted to be very irritable and anorexic. Soon there-
after, the parents noted a swelling of the right cheek.
There was no known fever at this time. In spite of
penicillin therapy, the hyperirritability and mandibular
swelling persisted for nearly one month, then receded.
Before the mandibular swelling had disappeared, the
irritability and anorexia again returned, followed by
swelling of the right forearm.
The infant was first seen at our office on July 27,
1950, which was a few days after the left forearm had
noticeably enlarged. The mandibular . swelling was
scarcely palpable, whereas the forearms were tensely
swollen and tender. There was no hyperemia or dis-
coloration of the areas involved. They were not fluctuant.
The child moved her arms slowly and infrequently.
She cried when the swollen areas were palpated.
Examination of the heart and lungs was negative. The
spleen and liver were not enlarged. There was no
adenopathy. Rectal temperature was 1 00. 4°F. There
were no palpable abnormalities of the thorax or lower
extremities.
Laboratory examination revealed a hemoglobin of 55
per cent with 3.03 million red cells. The white count
was 11,800 with 33 per cent polymorphonuclear cells, 60
per cent lymphocytes, 4 per cent monocytes and 3 per
cent eosinophils. The urine was normal. Sedimentation
rate was 8 mm. per hour by the Westergren method.
Serology and Mantoux (1 : 1,000 dilution) were negative.
Serum calcium was 9.8 mg. per cent and phosphorus was
5.6 mg. per cent. Alkaline phosphatase was 23.0 King-
Armstrong units. Blood ascorbic acid level was .99 mg.
per cent.
Roentgen examination revealed massive hyperostosis in
the bones of both forearms and moderate hyperostosis
of the right mandible. There was no other area of
involvement discovered from complete skeletal films.
Lung fields were clear and heart size normal.
Mandible films of a three-year-old sibling were also
normal.
As of November 9, 1950, the previous areas of hyper-
ostosis have, returned to normal size without specific
treatment.
Comment
The clinical features, laboratory data and x-ray
findings of the case conform with those of cases
presented by Caffey and Silverman3 and Smyth, et al.12
Basic features are hyperirritability, fever, and roent-
genologic evidence of external thickening of the cortex.
This syndrome is usually manifest during the first
three or four months of life with the mandible most
often the primary site of involvement. From there the
distribution and magnitude of swellings varies greatly.
More recently Caffey2 reported two cases which
developed during the second year of life (eighteen
months and twenty months). Neither of these young
children had mandibular hyperostosis. Of a total of
twenty-seven cases reported, the average age of onset
is the twenty-fifth week.
The cause and pathogenesis remain undetermined.
Bacterial infections, scurvy, rickets, trauma and neo-
plastic diseases appear to be excluded as causal agents.
Infection as an etiology, is supported by leukocytosis,
fever and, in some cases, elevated sedimentation rate, but
treatment with the sulfonamides or the antibiotics has
met with no significant response. Ross et ah reported
blood cultures and febrile agglutinations to be negative
in ten cases. They also had complete virus studies by
the National Institute of Health which all proved
negative. Tuberculosis is ruled out by a negative
Mantoux and roentgenological findings. Similarly
syphilis is ruled out by serology. Also, biopsy specimens
have not supported infection as a causal agent but simply
show hyperplasia of normal lamellar bone.10 X-rays fail
to show similarity of this syndrome to scurvy or rickets.
There is an absence of a zone of rarefaction beneath the
epiphyseal line leaving the terminal segments of the
shaft unaffected. Also, the age at onset, adequate
vitamin C intake and lack of response to cevitamic acid
speak against scurvy.
No noncomitant blood dyscrasias have been reported.
Neoplastic disease is ruled out by absence of sar-
comatous lesions in reported biopsy specimens and the
benign course followed by all reported cases.
Shuman11 found the disease refractory to antihistaminic
preparations and allergy elimination diets.
Delano and Butler5 report a case occurring within ten
days after a smallpox vaccination and postulated that
infection was the basis somewhat similar to that of
osteomyelitis variolosa. In most of the reported cases,
however, there has been no history of antecedent
vaccination or immunizations.
There was no evidence of a hereditary factor in this
case or previous reported cases except for that of Van
Zeben15 who suggests the possibility in a description of
three patients in one family with typical periosteal
lesions.
Sherman and Hillyer,10 in an extensive review of the
syndrome in February, 1950, found only twenty-seven
November, 1950
1113
INFANTILE CORTICAL HYPEROSTOSIS— HERMANN ET AL
Fig. 1. Showing thickening and increased Fig. 2. X-ray of right forearm showing Fig. 3. X-ray of left forearm showing
opacity of right mandible. a thickening of both radius and ulna. a marked thickening of left ulna alone.
cases reported, of which fifteen were males and twelve
were females. There was no preference of race or
geographical location. They postulated that the initial
disturbance was of the muscle tissue with secondary
stimulation of periosteum. Supporting their theory is
the lack of periosteal inflammation or hemorrhage and
presence of vascular changes and degeneration of over-
lying muscles.
The soft tissue changes causing tenderness and
pseudoparalysis appear to be limited to the muscle groups
adjacent to the involved bones and do not extend to
the subcutaneous layers.
The sites of predilection seem to be the mandible,
clavicles, scapulae, extremities and ribs. Associated with
rib involvemment is pleural thickening. Whipple4 re-
ported a case with the more infrequent site of
hyperostosis in the calvarium.
In the absence of any known specific treatment, it is
fortunate that all reported preceding cases have run a
benign although protracted course to complete recovery.
Treatment is symptomatic only. There are frequent
remissions and exacerbations during the progress of the
disease. However, complete recovery may be expected
in three to six months.
References
1. Berry, B. H.: Postinfantile cortical hyperostosis with sub-
dural hematoma. Pediatrics, 6:78, 1950.
2. Caffey, J.: Infantile cortical hyperostosis. J. Pediat., 29:541,
1946.
3. Caffey, J., and Silverman, \V. A.: Infantile cortical hyper-
ostosis: preliminary report on a new syndrome. Am. J. Roent-
genol., 54:1, 1945.
4. Conference of infantile cortical hyperostosis (Caffey-Smith
syndrome). J. Pediat., 32:441, 1948.
5. Delano, P. J., and Butler, C. I).: Etiology of infantile cortical
hyperostosis. Am. I. Roentgenol., 58:633, 1947.
6. Dickson, D. D. ; Luckey, C. A., and Logan, N. H.: Infantile
cortical hyperostosis. J. Bone & Joint Surg., 29:224, 1947.
7. Fisk, C.: Infantile cortical hyperostosis. J. Iowa M. Soc.,
37:529, 1947.
8. Kane, S. H., and Borzell, F. F. : Infantile cortical hyper-
ostosis. Am. J. Roentgenol., 58:629, 1947.
9. Rothman, P. E., and Leon, E. Eliz.: Hypervitaminosis A.:
report of two cases in infants. Radiology, 51:368, 1948.
10. Sherman, M. S., and Hellyer, I). T. : Infantile cortical hyper-
ostosis. Am. J. Roentgenol.. 63:212, 1950.
11. Shuman, H. H.: Infantile cortical hyperostosis. I. Pediat.,
32:195, 1948.
12. Smyth, F. S.; Potter, A., and Silverman, VV. A.: Periosteal
reaction, fever, and irritability in young infants: a new syn-
drome? Am. J. Dis. Child., 71:33.3. 1946.
13. Thomas, W. S., and Murphy, R. E. : Infantile cortical hyper-
ostosis. Radiology, 54:735, 1950.
14. Thompson, C. G.: A case of infantile cortical hyperostosis.
Connecticut M. J., 13:28, 1949.
15. Van Zeben, \V. : Infantile cortical hyperostosis. Acta Pediat.,
35:10, 1948.
16. Whipple, R. K. : Infantile cortical hyperostosis; case. New
England J. Med., 236:239, 1947.
THE RADIOACTIVE EFFECTS OF ATOMIC WEAPONS
(Continued from Page 1087)
radiation sickness. It must be recalled, however,
that radiation sickness is responsible for only a
small percentage of the deaths occurring after or
at the time of a bomb blast. Sixty per cent of the
Japanese deaths were said to be from blast, thirty
per cent from burns and only ten to twenty per
cent to radiation sickness. Much work is being
done on blast and burns, so that it may be antici-
pated that if better methods of treatment for
these injuries are at hand, a larger percentage will
survive these injuries and the effects of radiation
sickness will be more apparent.
Recommended for Supplementary Reading
1. Hiroshima, U. S. A. Colliers Magazine, p. 11, August 5,
1950.
2. Must we Hide? Dr. Ralph E. Lapp, Addison- Wesley Press.
3. City of Washington and an Atomic Bomb Attack. A.E.C.
Press Release No. 216, Nov. 4, 1949.
4. Radiological Defense. Armed Forces Special Weapons Proj-
ect, P.O. Box 2610, Washington, 1). C. January, 1948.
5. The Atomic Bombings of Hiroshima and Nagasaki. Man-
hattan Engineer District.
6. Photographs of the Atomic Bombings of Hiroshima and
Nagasaki. Manhattan Engineer District.
7. Medical Aspects of Nuclear Energy. Armed Forces Special
Weapons Project, 1949.
8. The Effect on Embryos and Young of Rainbow Trout from
Exposing- the Parent Fish to X-rays. Foster et al: Growth
XIII, pp. 110-142, 1949.
9. Statements for the Public Hearing of the Joint Congressional
Committee on Atomic Energy on March 17, 1950. A.E.C.
Press Release.
10. Atomic Bomb Casualty Commission to Continue Studies of
Japanese Atomic Bomb Survivors. A.E.C. Press Release No.
289, June 18, 1950.
11. Effects of Atomic Weapons. A.E.C., August, 1950.
1114
Minnesota Medicine
History of Medicine In Minnesota
MEDICINE AND ITS PRACTITIONERS IN OLMSTED COUNTY PRIOR TO 1900
NORA H. GUTHREY
Rochester. Minnesota
(Continued fro}>i the October Issue )
Alexander Grant (1825-1907), of Scotch descent, was born and reared on a
farm in New York. He acquired an excellent academic education, studied medi-
cine for a time at the University of Michigan, and in 1858 was graduated from the
Buffalo Medical College, of the University of Buffalo, New York. Shortly after-
ward he again came west and, after teaching school and practicing medicine in
Wisconsin, arrived in High Forest, Olmsted County, in 1859, and there established
himself as a physician. He was to remain for twenty-two years. Record indicates
that he perhaps came in the hope of improving his health in Minnesota’s much
advertised climate, for in 1864 he was exempted from military service because
of “feeble constitution,” and in 1866, appointed as enrolling clerk to the state senate,
he was obliged to resign because of ill health.
In the middle sixties, on the failure of Coe and Huddleston, pioneer merchants
of High Forest, Dr. Grant bought* their stock of goods and thereafter kept a
general store as well as practiced his profession, but with less emphasis on medi-
cine as years went by. Other physicians, O. Chase, S. V. Groesbeck, W. G. Both-
well and D. S. Fairchild, .came and went between 1866 and 1873. In 1869 Dr.
Grant built a two story frame building on the west side of the village green, a
structure imposing for the time and place. His store and living quarters were on
the ground floor ; the large room above became the lodge room of the High Forest
Masons. From then well into 1945, when it was razed, the building was known as
the Masonic Temple. The mercantile business prospered and for a time in 1872 the
doctor published a four-column advertising sheet, the High Forest Illustrated Sen-
sation, describing his stock, a publication that the Rochester Post praised as a
readable and spicy budget of business.
Of keen intellect and scholarly tastes, Dr. Grant was interested in music, litera-
ture and floriculture. He wrote and spoke well, was public-spirited, and took active
interest in all matters of local enterprise and welfare. He not only organized
patriotic celebrations, but was in demand throughout the county and beyond its
borders as an eloquent speaker at community meetings, patriotic, political and
agricultural. Although he commonly talked extemporaneously, some of his ad-
dresses were prepared; namely, certain ones on rabies and hydrophobia, the life
and services of Horace Greeley, and the life of Abraham Lincoln. The Rochester
City Post of July 13, 1867, carried in full his Fourth of July Oration of that year.
A devoted Republican, he was a member of the local central committee and
regularly was a representative from the township to the party conventions of
county and district. He was an organizer and the secretary of the local National
Loyal League, in 1863, and an active member of the local Grant (Ulysses S.) and
Wilson Club in 1872. Until 1875 he served as a petit juror of the United States
District Court in St. Paul.
For some eight years he was known in medical circles, as a member of the
Novembeh, 1950
1115
HISTORY OF MEDICINE IN MINNESOTA
Olmsted County Medical Society from 1868, and of the Minnesota State Medical
Society from 1872 through 1876. He was admitted to the state society together
with Dr. G. W. Nichols, of Rochester, and Dr. A. W. Stinchfield, then of Dundas,
at a meeting held in Rochester on June 11 and 12, 1872, during the presidency of
Dr. W. W. Mayo.
Dr. Grant has been described by an early resident of High Forest who knew
him well, as a short, slight, wiry man, of medium coloring and keen gray-blue eyes,
who wore a small mustache and short side whiskers that terminated in a small
goatee. His invariable formal costume was a suit of pepper-and-salt worsted with
black velvet collar and cuffs, worn with a white collar and black tie. As time went
on, certain eccentricities in his manner of living and a disregard of the niceties in
his bachelor housekeeping became ingrained. In later years, when the doctor had
removed to Dakota, an old friend from High Forest stopped off to see him. He
was living in a dingy little general store. The combination heating and cooking
stove in the center of the room was surrounded by the traditional basebox filled
with sand, and the sand was covered with little heaps of coffee grounds and egg
shells; the doctor told his caller that he cleaned it up periodically. In High Forest,
although the citizens were amused by his peculiarities, they had affection for him
and respect for his intellectual attainments.
In the summer of 1880 Dr. Grant made his first trip to Dakota Territory and
in the autumn of 1881 he left permanently for the “Jim River country.” After a
few years in Groton, Brown County, he moved a few miles west to Bath, in the
same county, where he spent the remainder of his life. He registered as a physician
in Dakota on December 10, 1887, then in Bath. He died in 1907; he had never
married.
George A. Gustine, a graduate physician and surgeon of some years’ ex-
perience, came to Rochester, Minnesota, with his wife and children from Saratoga
Springs, New York, in May, 1881, primarily to benefit his health and to visit his
relatives who were established here. Liking the place and the climate, he entered
medical practice, at first having his office and residence in rooms on the second
lloor of the Heaney Block, on Zumbro Street, over G. Stocking’s Crockery and
Glassware Store. Later the residence was on Grove Street. In April, 1882, Dr.
Gustine returned with his family to Saratoga Springs.
Dr. Gustine was one of the seven children of Francis Gustine and Sophrinia
Sexton Gustine, who for many years were respected citizens of Rochester. Mr.
and Mrs. Gustine were pioneers in New England, living first in Winchester, New
Hampshire, and later in Medford, Massachusetts; subsequently they were in
Luzerne, New York. From Luzerne they came to Minnesota in 1879 accompanied
by several of their children. A son, Levi S. Gustine, spent his life in Rochester
and is survived by resident children and grandchildren. A daughter of Mr. and
Mrs. Francis Gustine, who was married to A. D. Twiss, in Luzerne, came with
her husband to Plainview, Wabasha County, in 1880 and to Rochester in 1881 ;
survivors of Mr. and Mrs. Twiss in the city are a daughter, Mrs. C. M. Judd, a
son, A. G. Twiss, and four grandchildren. A younger daughter, Sadie Gustine,
was married in Rochester in the eighties to Nevin C. Pollock. Mr. and Mrs.
Pollock, after eleven years in Evansville, Minnesota, returned to Rochester and
lived there the remainder of their lives. They were survived by three children,
all of Rochester: Madge (Mrs. Vernon) Gates (since deceased), Laura (Mrs.
Frank C.) Jacobs, and Dr. Lee W. Pollock (1887-1947), of the staff of the
Mayo Clinic.
1116
Minnesota Medicine
HISTORY OF MEDICINE IN MINNESOTA
John Haggard (1809-1875) was one of the earliest physicians in south-
eastern Minnesota, briefly in Olmsted County, near Rochester, in late 1856, and in
that year and for some time subsequently at Fairpoint, Cherry Grove Township,
Goodhue County, across the border from Concord, Dodge County. Biographical
notes about him properly belong in a story of early medicine in Goodhue County ;
because information regarding him did not come to light until late in 1947, several
years after notes on physicians of Goodhue County had been published, a brief
sketch appears here. The writer is indebted to Dr. George D. Haggard, of Min-
neapolis, a nephew of Dr. John Haggard, for helpful response to her inquiry.
John Haggard, born on October 30, 1809, in Madison County, Kentucky, was
the eldest child of David Haggard, a farmer, and Elizabeth Gentry Haggard, who
came from a prominent Kentucky family. Both Mr. and Mrs. Haggard were of
English extraction. They and their thirteen children were Baptists ; later they all
became Disciples of Christ. From Kentucky David Haggard moved with his
family, in 1839, to a farm home two miles north of Peosta, Iowa, in Dubuque
County.
In giving something of family history Dr. George D. Haggard wrote : “My
father and mother, David and Mary Haggard, came to the Territory of Minne-
sota in November, 1856, stopping first near the present location of Rochester.
While her husband turned back of necessity, she waited there in a tent with her
three boys, with an axe at hand on the tent flap. The wolves serenaded her for
three nights.” When the husband returned, he was accompanied by his brother,
Dr. John Haggard, who went on with the family to Fairpoint, Goodhue County ;
in that little community several other families, of Haggard brothers, and sisters,
soon settled. There, in January, 1857, the doctor officiated at the birth of his
nephew, George D. Haggard (the fourth child in a family of ten) who was born
during a raging blizzard, in a log cabin that as yet lacked a roof. Mary Haggard,
her son recalled, “had considerable skill in the use of herbal remedies and in the
cure of the sick. She answered the calls of her neighbors on the frontier but did
not consider herself a practitioner nor did she charge for her services.” In those
days there was much freighting from Red Wing and Pine Island, and David
Haggard had the fastest team of oxen in his community. During his residence at
Fairpoint he was postmaster, under President Buchanan. This family in 1862
returned to Iowa and in 1863 settled in Eau Claire, Wisconsin. In 1893 George
D. Haggard was graduated in medicine from the University of Minnesota and in
that year began his long practice of more than fifty-five years in Minneapolis.
About his uncle, Dr. G. D. Haggard continued :
I do not remember my Uncle John. I do not know about his academic and professional
training, but he was a man of ability and integrity. He practiced in Fairpoint and vicinity
in 1856-1857 (perhaps longer), and made a number of amputations because of frozen hands
and feet in that severe winter.
Dr. Haggard, according to his sister, Nancy Haggard Smith, was in the Black Hawk War.
Two younger brothers, Thomas and James, were in the Civil War; the father in the W^ar of
1812; and the grandfather in the War of the Revolution.
His oldest son, David, who died in 1931, spent his latest years in Algona, Iowa; one of
the doctor’s grandsons, John W. Haggard, son of David Haggard, is editor of a newspaper
there, the Algona Upper Des Moines.
Dr. John Haggard was married to Elizabeth Lyman on February 27, 1837, and to Irena
Shaw in 1849. He died on February 18, 1875.
L. Hall was listed in the Minnesota State Gazetteer and, Business Directory
from 1880 through 1885 as a physician of High Forest, Olmsted County.
Actually the Reverend Levi Hall came to High Forest some time in 1878 as a
November, 1950
1117
HISTORY OF MEDICINE IN MINNESOTA
Methodist clergyman. In 1879 he became one of the instructors at the High
Forest Seminary, a Methodist school of merit in its day.
Born in Delaware County, Ohio, on October 26, 1833, the son of a farmer,
Levi Hall obtained a college education and at the age of twenty years became an
ordained minister and revivalist. He was one of the original circuit riders of
southern and southeastern Ohio. In 1872 he was transferred to the Minnesota
Methodist Conference, and in the next years served pastorates at Austin, Minne-
apolis, Litchfield, Dover and High Forest.
In his circuit-riding days he often found it necessary to give aid to the sick,
and the need for such treatment and his natural aptitude for healing led him to
study medicine privately for many years. In 1881, then in his forty-eighth year,
on taking superannuated relations in his conference (A History of the Methodist
Episcopal Church in Minneapolis and St. Paul. By the Rev. J. Wesley Hill.
1895.), he determined to complete his medical education. He enrolled that year
at the Hahnemann Medical College of Chicago, from which he received his degree
of doctor of medicine in 1882 ; a fellow graduate in the same class was his son,
Dr. Pearl M. Hall. Dr. Levi Hall returned to Minneapolis, where he had estab-
lished his home in 1881, and in that city for the next thirty years he was a well-
known and respected physician. He died at his home on March 22, 1911.
H. H. Herzog was the sixteenth appointee, as an assistant physician, on
the staff of the Rochester State Hospital, in Rochester, Minnesota. A graduate
of Rush Medical College in 1893, he came to Rochester from Minneapolis, where
he had been serving as an intern at St. Mary’s Hospital, and entered on his duties
on December 1, 1893.
After he had been six months in Rochester, it was announced in the local press
that Dr. Herzog had resigned his position to accept a similar place at the Wis-
consin State Hospital for Insane at Mendota, Wisconsin. Apparently he changed
his plans, since he continued for some years as a member of the hospital staff in
Rochester. At a meeting of the Southern Minnesota Medical Association held at
Rochester on August 1, 1895, Dr. Herzog was unanimously elected to member-
ship ; since a prerequisite to admission was membership in a local county medical
society, it is assumed that he earlier had become a member of the Olmsted County
Medical Society.
On March 27, 1899, Dr. Herzog resigned from the state hospital to enter
private practice. Rochester newspapers commented that his home was in Racine,
Wisconsin ; that he would attend clinics at St. Mary’s Hospital, Rochester, for a
month ; that he had been offered a position as lecturer at the Chicago Medical
College but that he was doubtful about accepting because he was resigning to
practice privately. “He is a physician of exceptional ability as well as one
possessed of mental qualifications of no ordinary kind.” In April, 1899, he went
to Waterville, Minnesota, as locum tenens for Dr. O. M. Justice, who at one
time had been an orderly at the Rochester State Hospital, with the idea of
remaining in Waterville or of settling in Minneapolis.
Dr. Herzog is remembered well by citizens of Rochester. It is said that he
died from angina pectoris. Probably his death occurred prior to 1906, since his
name does not appear in the first edition of the directory of the American Medical
Association, which was compiled in that year.
Oscar C. Heyerdale (1873 ), who was born in La Crosse, Wisconsin,
on May 6, 1873, has been ( 1950) a resident of Rochester, Minnesota, with the
exception of one year, since he was eleven years old. Since 1898 he has been
1118
Minnesota Medici nt
HISTORY OF MEDICINE IN MINNESOTA
a physician of Minnesota, and since 1899, of Olmsted County. The twenty-fifth
appointee, as an assistant physician on the staff of the Rochester State Hospital,
he began his work in the institution on July 13, 1899; from August, 1912, to
July, 1937, he was assistant medical superintendent.
The parents of Oscar C. Heyerdale were born in Norway. His father, Hjalmar
Heyerdale, was educated as a pharmacist in Oslo, came as a young man to the
United States, and settled in La Crosse, Wisconsin. There he was married to
Sophie Wilhelmina Emerson. Some years later he moved with his family to Blue
Earth, Minnesota, where he owned and operated a drug store. In the summer of
1884, after her husband’s death, Mrs. Heyerdale with her three sons, Elmer W.,
Oscar C. and Frederick, came to Rochester ; she died in Rochester on July 19,
1926. Of the sons, Oscar, as stated, and Frederick became permanent residents
of the city; Elmer W. Heyerdale, a pharmacist, in 1947 had been for many years
in Minneapolis.
Oscar C. Heyerdale obtained his preliminary education in the grade schools
and the high school of Rochester. Before entering on his medical training, he
was for four years a clerk and assistant pharmacist at the Weber and Heintz Drug
store in the city. After one year at the medical school of the University of
Minnesota, he transferred to the medical department of Northwestern University,
making the change on the persuasion of his friend and classmate, Henry S.
Plummer, of Racine, Minnesota, who insisted that they both go to Northwestern
to take advantage of the extensive clinical material and the excellent training
available there. At that time Northwestern University was one of the few
institutions in the country offering a medical course of four years. The two
friends were graduated in June, 1898, in a class of eighty-six students.
Immediately out of medical school Dr. Heyerdale began his initial practice in
Plainview, Wabasha County, in association with the well-known pioneer physician,
Dr. Nathaniel S. Tefft. He received his Minnesota license on October 11, 1898.
At the end of a year’s general medical and surgical experience Dr. Heyerdale
accepted his appointment to the staff of the Rochester State Hospital. A memor-
able assignment early in his work with the insane resulted from an abrupt change
in arrangements for returning two patients to their homes abroad, one to Norway,
the other to Sweden ; on one day’s notice the young physician started with the
two insane persons on an eventful trip of seven weeks and 13,000 miles.
After twelve years as physician in charge of the wards for women at the state
hospital, Dr. Heyerdale became assistant medical superintendent, succeeding Dr.
Robert McE. Phelps, resigned, and in this capacity he served ably for twenty-five
years. Gradually failing eyesight over a long period ultimately caused his retire-
ment, in July, 1937, from his official position and from the scientific field in which
he had won distinguished recognition as physician and humanitarian.
Throughout his professional career Dr. Heyerdale has been active in medical
organizations. While in Plainview he became a member of the Wabasha County
Medical Society and the Southern Minnesota Medical Association. Soon after
coming to Rochester he was enrolled in the Olmsted County Medical Society (was
once its president), the Minnesota Southwestern Medical Association, the Minne-
sota State Medical Association, the American Medical Association and the
American Psychiatric Association. He is a Mason, member of the Halcyon
Chapter (Worshipful Master in 1907-1908, High Priest in 1911) and of the
Knights Templar. He is a vestryman of the Calvary Episcopal Church. For
many years he served on the Rochester Park Board.
On June 10, 1903, Oscar C. Heyerdale was married to Gertrude Wentworth,
of Rochester. Gertrude Wentworth was born in Janesville, Wisconsin, a daughter
November, 1950
1119
HISTORY OF MEDICINE IN MINNESOTA
of W illiam Cooledge Wentworth, a native of Madison County, New York, and
Mary Elizabeth Moran Wentworth, a native of Jamestown, Ohio. Mr. Went-
worth, at one time a railroad man, was for many years a hotel proprietor in
various states of the Middle West and the West; for a few years prior to his
death, in February, 1907, he lived in Spring Valley, Fillmore County. Mrs.
Wentworth survived him thirty-two years and died in Rochester on September
21, 1939.
Dr. and Mrs. Heyerdale had three children, Elizabeth, who died in infancy
in 1904, William Wentworth, and Louise. Dr. William Wentworth Heyerdale, a
physician on the staff of the Mayo Clinic, served in World War II as a captain
in the United States Army Medical Corps. He died on New Caledonia Island, in
the South Pacific, on March 11, 1944; he is survived by his wife, Melanie R.
Heyerdale, and three children, Melanie Anne, Sally and William S. Heyerdale.
Louise Heyerdale (died, January, 1948) was married to Dr. William J. Martin
(Lieutenant Commander, United States Navy, during World War IT), of Louis-
ville, Kentucky. Dr. and Mrs. Martin had three children, William J. Martin, HI,
Robert Heyerdale Martin, and Louise Wentworth Martin.
Mrs. Mary Hicklin, an eclectic practitioner, came to Rochester from Red
Wing, Minnesota, in August, 1863. In her professional card, in the Rochester
City Post of August 22, 1863, she announced to the public that she expected to
treat all diseases with success, especially typhoid fever and dysentery ; that she
would treat all chronic diseases with electricity; and that she possessed one of
Prof. W. P. Well’s Electropathic Flatteries. Her headquarters were at the Stevens
House. It is assumed that her stay in Rochester was not long.
Alonzo Ward Hill (1851-1924), an early physician of Olmsted County,
Minnesota, was born on December 7, 1851, near Logansport, Indiana, a son of
Levi Pervine Hill and his second wife, Christena Tilden Hill. In 1856 Mr. and
Mrs. Levi P. Hill came to southern Minnesota with their four children, John
W., Alonzo Ward, Margaret and Sarah. In Dodge County, where they first
settled, a third son, Benjamin Franklin was born. In 1860 the family estab-
lished their home in Oronoco, Olmsted County. Early Oronocans have recalled
that Mrs. Hill was a capable practical nurse, who gave much aid to the com-
munity in those years when physicians were few. Her father, William I ilden,
practiced medicine in Ohio and in Peru, Indiana, and came to Minnesota in 1855 :
record has not appeared that he was a practitioner in this state.
In 1856 the Hill family had been pioneers for generations. John Hill, father
of Levi P. Hill, was born in the East and came early to Indiana; his wife was
Sarah Watt, who came to America with her parents, William and Unity Brown
Watt, from Balygonney, North Ireland, in 1791 when she was three years old.
John Hill was killed by a falling tree on his farm near Logansport, Indiana, on
February 14, 1842, in his fifty-third year, and was buried in the churchyard o^
Spring Creek Christian Church, near Logansport ; in the same plot are the graves
of his daughter, Unity Melissa Hill Thompson, who died in 1860, and of his
daughter-in-law (first wife of Levi P. Hill), who died in 1849. Some years after
her husband’s death Sarah Watt Hill joined her relatives in Oronoco, Minnesota;
her grave is in the village cemetery.
Alonzo Ward Hill was educated at the village school of Oronoco and at the
high school and Niles Academy in Rochester, as were other members of the
family. After his graduation from the University of Michigan with the degree
of doctor of medicine, in March, 1876, Dr. FI i 11 spent a few months in Oronoco
1120
Minnesota Medicine
HISTORY OF MEDICINE IN MINNESOTA
before entering into medical practice in the village of Pickwick, Winona County.
From Pickwick he removed to Pleasant Grove, Olmsted County, some time in
1878; in November of that year he was married to Mattie Doris Cox, daughter of
Ferdinand Cox, pioneer merchant, in 1855, of Pickwick.
In Pleasant Grove Dr. Hill operated a drug store and for eleven years practiced
medicine in the village and its surrounding community. In 1882 he served as
county physician for his region ; on May 7, 1884, he received his Minnesota State
license, No. 900 (R), under the medical practice act of the preceding year. There
have been noted occasional references to his activities as a delegate to Republican
county conventions.
In the late autumn of 1889 Dr. and Mrs. Hill and their only child, Mabel lone,
departed for Oregon, where they lived first in Milton and subsequently in Free-
water, returning to Minnesota occasionally on business. In 1913 Dr. Hill retired
from medical practice to operate his drug store. He died at Freewater on June
26, 1924. His wife, Mattie Cox Hill, died on July 31, 1944. In 1945 the sur-
vivors of Dr. and Mrs. Hill were their daughter Mabel lone Demory, six grand-
children and six great-grandchildren.
Edgar Augustus Holmes (1852-1897) was a physician and surgeon in Olm-
sted County from June, 1880, to April, 1888, for a few weeks in Eyota, his
boyhood home, and for eight years in Oronoco.
Born on January 20, 1852, in Chilmark, Martha’s Vineyard Island, Massa-
chusetts, he was the son of Augustus Holmes and Almira Daggett Cottle Holmes.
Augustus Holmes was a sea captain on one of the old time whaling ships and
made long voyages, once from New England around the Cape and north to
Alaska, that were sometimes years in duration. He did not see his son until the
child was two and a half years old and then, family anecdote relates, the little boy
said to his mother, “Who is that strange man, Mum?”
When Edgar Holmes was a small boy, the family immigrated to the vicinity of
Sheboygan, Wisconsin, where the father became a farmer and the son attended
the grade schools and the high school of the town. About 1868 a second remove
was made, to Eyota, Olmsted County, Minnesota, and there at the age of sixteen
years Edgar Holmes began teaching country school ; in 1876 he was one of the
three teachers in Eyota’s new school building. After nine years of pedagogy he
entered on the study of medicine under the preceptorship of Dr. A. W. Stinch-
field, of Eyota, who in his long career inspired and helped many young men to
qualify for the medical profession. In June, 1880, Dr. Holmes was graduated
from the Chicago Medical College and returned to Eyota for a few weeks before
going to Oronoco, where a practice was being held for him by his undergraduate
classmate and roommate at medical school, William A. Vincent (q.v.). On the
death of Dr. John N. Farrand, of Oronoco, by drowning on June 23, 1880, Dr.
Vincent, who was employed for the summer at the state hospital for insane at
Rochester (later as assistant physician), hastened to hang out his shingle at
Oronoco, both to serve the people and to hold the field for Dr. Holmes.
By August, 1880, Dr. Holmes was established in Oronoco with his wife and
their two small daughters ; a third daughter was born in Oronoco in 1887. He
had been married in 1873 to Harriet Eckles, of Eyota, one of the thirteen children
of William Eckles, who originally was a skilled shoemaker, and Mary Ann Pears
Eckles, early pioneer farmers in the township. Mr. and Mrs. Eckles and two
small children came from Yorkshire, England, to America in 1850 by sailing
vessel, a tedious voyage of twelve weeks and of many hardships. They settled
November, 1950
1121
HISTORY OF MEDICINE IN MINNESOTA
first on a farm near Ripon, Wisconsin; there Harriet Eckles was born on May 4,
1854; two years later the family came by wagon to a homestead claim in Eyota
Township.
In Oronoco Dr. Holmes had an arduous practice of medicine, surgery and,
occasionally, dentistry, under all the difficulties of the time, in a territory that soon
extended as far as Genoa and Greenwood Prairie in Olmsted County, and to
Elgin and Mazeppa in Goodhue County ; for a while in the late eighties he main-
tained an office tw'o days a week at Mazeppa. Early in the Oronoco years his
office was in James Barnett’s drug store; later and for the greater period, in his
own residence. In surgical emergencies his wife sometimes acted as his assistant.
Dr. Holmes has been described as a tall, well-built man weighing 215 pounds,
of medium coloring, with curly brown hair and clear gray eyes, and pre-eminently
as kind, sympathetic, quiet, dependable, tolerant and charitable. He won con-
fidence and affection and, although he refused public office except as a member of
the school board, it is said that the community never was more united than in the
years that he was a resident of Oronoco. He neither smoked nor drank ; his
temper was always under control; if he said something was “cussed," it was
recognized that matters were serious. He and his wife were members and
generous supporters of the Presbyterian Church and for some years Mrs. Holmes
was superintendent of the Sunday school. The doctor was a member of the local
Masonic lodge and of other fraternal organizations. In the late eighties he was
for several years co-editor of the Pine Island Journal, of Goodhue County.
Dr. Holmes held the esteem of the medical profession of county and state as
a physician of ability and integrity. He was an active member of the Olmsted
County Medical Society, the Minnesota State Medical Society (from 1882; elected
third vice president in 1886) and the American Medical Association. Among his
contributions to the medical literature was a paper, “Lithaemia," which he read
on November 9, 1886, before the county society. It was published in the North-
western Lancet of December 1, 1886; the original manuscript remains in the
possession of his family. During much of his residence in Oronoco he served
as county physican in Oronoco, New Haven and Farmington Townships. He
was licensed in Minnesota on January 10, 1884, receiving certificate No. 679 (R).
On April. 1888, because of better professional and financial opportunity, Dr.
Holmes removed to North St. Paul to enter partnership with Dr. Nathaniel S.
Lane, who from 1882 to 1888 practiced medicine in Eyota; after 1894 for some
years Dr. Lane was in Winona. Oronoco, in July, 1888, advertised for a good
doctor at an early date; in December Dr. Charles O. Scoboria, from Elk River,
settled in the village.
After nine useful years as citizen and physician in North St. Paul Dr. Edgar
A. Holmes died on August 8, 1897. He had been in failing health since 1895,
when he had suffered a paralytic stroke. Mrs. Holmes lived to the venerable
age of ninety years and died at her home in North St. Paul on May 23, 1944.
One daughter Stelle Mabel, had died in 1889. In 1946 there survived two
daughters, Myra May (Mrs. Edward) Michel, of North St. Paul, and Lulu Irene
(Mrs. Roy) Allis, of Oronoco, four grandchildren and two great-grandchildren.
(To Be Continued in the December Issue)
1122
Minnesota Medicine
Plestc) ent's £.ette\
ARMS AND THE MEDICAL
Post-Korean problems and the continuing war of preparedness require that the
medical profession assume a heavy share of responsibility in the months and, per
haps, years ahead.
Never before, in the history of our country, has it been found necessary to pass
a special law, providing for the registration, classification and induction of physi-
cians and other allied specialist groups ; but Public Law 779 is now on tin-
statutes, by Presidential Proclamation of October 10. Minnesota’s first registra-
tion, October 16, brought some 400 names on the Selective Service list, and future
registrations, slated to be held before January 16, 1951, will bring in hundreds more
of prospective draftees.
A chain of advisory committees, beginning with the National Advisory Com-
mittee, appointed by the President, has been established. The National Committee,
in turn, appointed state advisory committees and, in Minnesota, the state advisory
committee requested the Minnesota State Medical Association to establish a central
committee and for each county medical society to establish a committee.
The county medical society advisory committees are to serve as liaison groups
with local selective service boards, as well as to advise these boards regarding
individual classifications and the policies established by the National Advisory
Committee.
In outline, this chain of advisory groups will operate in much the same manner
as Procurement and Assignment procedures of World War II.
If the system is to prove efficient and in the best interests of each community,
the state as a whole, and the profession, it will require the co-operation of even-
physician.
Questionnaires have been mailed to registering physicians and these are being
returned to the State Office for referral to advisory committees. Facts about the
physician and the community he serves will have a bearing on his classification.
Complete information will aid these committees in giving the greatest assistance to
the military services without impairing the health of the civilian populace.
President, Minnesota State Medical Association
November, 1950
1123
♦ Editorial ♦
Carl B. Drake, M.D., Editor ; George Earl, M.D., Henry L. Ulrich, M.D., Associate Editors
REGISTRATION AND INDUCTION OF
PHYSICIANS
T)HYSICIANS as well as laymen can be ex-
cused for their lack of enthusiasm for
exchanging their civilian life for the military.
Those who served during the war and had their
normal peaceful lives disrupted have the feeling
they have done their duty and are loath to don
the military after a mere five years of civilian
re-establishment. Those who have never served
having also been loath to volunteer a program
had to be developed which would be as fair an
apportionment of a distasteful job as was
possible. Those who have never served are to be
called first and those in the reserve last — as far
as is reasonably possible. The present plan
seems as equitable as possible although there are
bound to be inequalities develop here and there.
* On October 16 physicians (and dentists) who
had obtained their medical (and dental) education
through ASTP or V-12 or who were deferred
for educational reasons and who had had less
than twenty-one months of service were required
to register.
According to newspaper reports 113 physicians
registered in Hennepin County, forty-one in
Ramsey, ninety-seven in Olmsted (Rochester),
nine in Cook (Duluth) and one in Blue Earth
County (Mankato) on this date.
The World War II system of procurement
and assignment of physicians has been revived,
and each state will have its committee composed
of a physician, dentist and representative of the
state public health department (the physician to
be chairman) to work with the National Advisory
Committee in the selection of doctors, dentists
and allied specialists in Washington.
Those who received their training at the ex-
pense of the government and who have served
less than ninety days are First Priority. Those
who have served more than ninety days and less
than twenty-one months are classed as Second
Priority. Although both First and Second Priority
groups registered, the First Priority will be
processed first. Registration dates for all other
physicians under fifty and not in military
reserves will be sometime before January 16,
1951, and will constitute a future priority.
Indications are that inductions will not be made
in large numbers until late in December, and
registrants will be allowed twenty-one davs to
settle personal affairs before being inducted.
Fewer World War II reserves than anticipated
will be called into active duty within the next
few months and these for only three or four
months in most cases rather than for the full
twenty-one months. World War II reserves will
be utilized only until non-veteran replacements
can be mustered into service and it is said that
an effort will be made to return veteran reservists
to civilian life as fast as possible. Exceptions to
this relaxed policy will be certain senior officer
specialists and senior command and staff officers
whom it will be difficult to replace.
The army is undertaking to offer a reserve
commission to every registrant at the time he
takes his physical examination and before his
induction. Further, physicians can volunteer for
any military service before they are inducted and
receive the $100 monthly bonus pay which goes
with volunteers.
This seems to be the present status as to Uncle
Sam’s requirements of the medical profession.
What the future weekly bulletins will contain or
what the future will require is unpredictable. One
thing is certain. We must arm for defense on
such a scale that none will dare attack us. If
the enemies of free people eventually see the
futility of living in a world armed to the teeth,
we shall all be able to revert back to a peaceful
footing.
GOOD DOCTORS AND BAD MEDICINE
TT should be unnecessary to state that the most
important function of the American Medical
Association is the preservation of the nation’s
health. The Association endeavors to carry out
this objective in many ways. Probably the most
valuable of these is protection of the public against
exploitation of remedies that are worthless or of
1124
Minnesota Medicine
EDITORIAL
doubtful value. This function is carried on by the
Council on Pharmacy and Chemistry which care-
fully investigates the therapeutic value of all drug
products submitted to them. If a therapeutic
product is found to meet the claims made for it
by the producer, it receives the Council’s seal of
approval and the drug is so advertised in official
medical journals. This would seem to be a simple
and practical way to protect the public by guiding
the physician in selecting drugs of proven merit.
One might expect that the medical profession
would be unanimous in supporting the AMA in
this most important activity. Sad to relate, how-
ever, this is not the case.
Although most state medical journals advertise
only those drugs which have been approved by
the Council of the AMA, there are several state
and county medical associations which do not. In
fact, in some of these medical journals a large
part of their advertising columns is taken up with
unapproved remedies. The reason for this is
obvious. Instead of balancing the budget of state
and county medical societies by adjusting member-
ship dues, the officers stoop to accept income from
questionable advertising in their medical journals.
Advertising of pharmaceutical products that are
not accepted by the AMA is not confined to state
and county medical journals. The official publica-
tions of several national societies also contain
many pages of sub-standard advertising. In re-
cent numbers of the official journal of a well-
known society, more than 60 per cent of the
advertisements were unapproved by the AMA.
Even more reprehensible is the fact that this
same medical organization permits the display of
these doubtful remedies in the commercial exhibits
at its annual meetings. The contrast between
information offered by excellent scientific articles
in some of these journals and misinformation con-
tained in the advertising pages should arouse the
callous editorial conscience.
There are also the so-called “throw-awav”
medical journals. These periodicals are printed
bv commercial publishers who distribute them
gratis to members of the medical profession. They
depend entirely upon their advertising columns
for income. It is no wonder that they are lucra-
tive since their pages are filled with ads of reme-
dies unapproved by the AMA as well as some that
are so shady that even lay newspapers might
hesitate to accept them. Members of the medical
profession are lured to read these journals by
means of handy abstracts of recent medical papers
dished up in attractive form or by articles on
economic problems of medical practice. One
might expect the intelligent physician reader
would disregard doubtful advertisements. The
astute publishers know, however, that the medical
reader fails to distinguish the approved products
from the unapproved and falls for catchy adver-
tisements just like his lay brother.
One of the phenomenal developments of our
time is the enormous number of new drugs and
therapeutic agents that are constantly being of-
fered to the physician by drug manufacturers and
by research laboratories. Some of these products
have the therapeutic merit claimed for them by
the producers ; others do not. Some are definitely
harmful and these should be so labeled before
they are put on the market. The need for an
impartial and disinterested authority to examine
new drugs and verify the claims made for them by
the manufacturers is self-evident. The AMA gen-
erously assumed this function at no little cost to
itself by creating the Council on Pharmacy and
Chemistry in 1905. The Council consists of seven-
teen outstanding scientists and a full-time secre-
tary. It has an extensive chemical laboratory avail-
able in AMA headquarters. In order to expedite
their investigations and render their decisions
more accurate, the Council has been aided in
recent years by a representative group of special-
ists called the Therapeutic Trials Committee.
The members of the Council work without remu-
neration and have faithfully carried out their
responsibilities over the years at a great sacrifice
of time and effort on their part.
The average physician does not realize how
much the Council has done to raise the standard
of American medicine to its present high level.
It is constantly offering practical as well as scienti-
fic information concerning every new pharmaceu-
tical product that has therapeutic value. Tt has
been responsible for many special articles, giving
a summary of wide clinical experience. It has
embodied this mass of information in several
books such as “New and Non-official Remedies”
and others. The Council also has encouraged re-
search for new and better therapeutic products.
In fact, it has been the stimulant for the outstand-
ing research carried on in many scientific labora-
tories including those of the American Pharma-
November, 1950
1125
EDITORIAL
ceutical Industry. It may well be said that the
work of the Council alone would justify the
existence of the American Medical Association.
Let us see first if there is any logical reason
why approval of drugs by the Council on Phar
macy and Chemistry should be disregarded. Is
it true, as has been claimed, that legitimate prod
nets have been turned down? Is it true that the
delay sometimes caused by thorough examination
of a drug is unfair to its manufacturer? Is it
necessary to depend on the Council for investiga-
tion in order to determine the value of a drug?
Would not the experience of a practitioner who
employed the drug be of equal value? These are
some of the critical questions put by commer-
cially minded medical organizations and by manu-
facturers of unapproved products. Although for-
merly there was some delay on the part of the
Council in completing its investigation of a prod-
uct, that has been corrected. Prolonged delays
almost invariably are due to failure on the part
of the manufacturer to submit sufficient data to
substantiate their claims or that are necessary to
carry on investigation. A product which is sub-
mitted with necessary information can be accepted
by the Council within a period of six to ten weeks.
In fact, if necessary, the Council can complete
consideration of a drug within two or three weeks.
The claim that the limited personal experience of
a practitioner, without laboratory control, is just
as good as the thorough clinical and laboratory
investigation made by the Council, aided by a
group of experts in the field involved, is of course
ridiculous.
Many of the larger and well-established pro-
ducers of pharmaceutical products co-operate with
the Council and abide by its rules in obtaining
acceptance of their new preparations. In fact the
American drug industry deserves great credit for
the scientific methods employed in the manufac-
ture of their products and for the high standards
of research conducted in their laboratories. Un-
fortunately, however, there are many members of
the drug industry who do not abide by the Coun-
cil’s rules of acceptance. In fact, the group of
drug manufacturers who flagrantly disregard the
Council’s efforts are increasing in number and in
influence. Aided by officers of medical societies
who place profit above principle and by throw-
away medical journals, they find that they are
able to bootleg their wares successfully. Unless
their efforts are blocked, they threaten to under-
mine the work of the Council.
There are many loval members of the AMA
who recognize the need and value of the Council
and yet they sabotage it by prescribing unapproved
drugs. There are physicians with outstanding
professional reputations who allow their names to
appear on editorial boards of medical journals
which are loaded with advertisements of unap
proved drugs. Other outstanding physicians allow
their names to be listed as officers of medical
associations that sponsor such journals. These
men are used as fronts, and in that capacity they
indirectly lend endorsement to the character of the
journal including the advertising pages.
The medical profession can limit traffic in
uncertified drugs by refusing to prescribe am
drug that does not have the seal of approval. The
officers of transgressing medical associations, tin-
editors, the scientific contributors, and even tin-
subscribers to mercenary medical journals should
scrutinize the advertising columns, and if unap
proved drugs are displayed, they should register
their objections. A wide-spread movement of that
kind would soon correct the misleading and mer-
cenary advertising now published in many medical
journals. The public would approve of such action
and it would be a tremendous boost to our public
relations. Such action also would be of great aid
in starting a sadly needed house cleaning in tin-
advertising columns of the lay press and in tin-
radio. These lay transgressors can point in defense
to similar conditions now existing in the adver-
tising pages of medical journals. The medical pro
fession must proceed immediately to clean its own
house. It can do so by two ways: by prescribing
only those pharmaceutical products that are cer-
tified by the Council and by forbidding advertise-
ment of unapproved drugs in its medical journals.
William F. Rraasch, M.D.
LUETIC AORTITIS
TTENTION has been called of late to
another sign which is apparently quite
diagnostic of luetic aortitis. Jackman and Lubert
were the first to call attention to the significance
of a linear appearing calcification in the ascending
aorta in the x-ray film. It has been shown by
these authors,1’2 and others3 that a large per-
centage of individuals showdng this type and
location of calcification have luetic aortitis.
1126
Minnesota Medicine
EDITORIAL
It is known that lues has a predilection for the
root of the aorta. Whether the calcification in
this area represents a healing of the luetic process
in this area or is a sequel of an arteriosclerotic
process in this area initiated by syphilis is not
known and is perhaps not important. The im-
portant point in differentiation is that calcification
accompanying simple arteriosclerosis appears
blotchy in the x-ray film and is located beyond
the root of the aorta.
While this linear appearing calcification in the
root of the aorta is practically diagnostic of late
syphilitic aortitis, its absence is not significant.
In the presence of this x-ray shadow the diagnosis
of syphilitic aortitis can be accepted until proven
otherwise.
1. Jackman, J., and Lubert, M.: Significance of calcification of
the ascending aorta as observed roentgenologically. Am. J.
Roentgenol., 53:432, (May) 1945.
2. Jackman, J.: Syphilitic aortitis. Pennsylvania M. J., 53:972,
(Sept.), 1950.
3. Leighton, R. S. : Calcification of the ascending aorta as a sign
of syphilitic aortitis. Radiology, 51:257, (Aug.) 1948.
LESS SYPHILIS
r"PHE report of the Committee on Syphilis and
Social Disease of the Minnesota State
Medical Association submitted to the House of
Delegates at Duluth in June merits emphasis not
only because it indicates a marked reduction in
the incidence of syphilis in Minnesota in recent
years but because it emphasizes one very im-
portant point in the medical care of syphilitics.
All patients treated for syphilis should have a
spinal Wassermann test performed during or at
the conclusion of treatment. A spinal examina-
tion becomes a “must” for any patient whose
blood Wasserman persists as positive after an
adequate course of treatment or over a period of
five years. This is, of course, the only way
asymptomatic neurosyphilis can be diagnosed, and
the importance of making the diagnosis lies in
the fact that asymptomatic neurosyphilis can in
many instances be successfully treated with
penicillin. Such successful treatment obviates the
necessity in these instances of long periods of
hospitalization for tabes and paresis at a later
date and constitutes a great saving financially for
the state, to say nothing of a much better outcome
for the patient.
The reduction in the incidence of syphilis in
Minnesota during the past thirty years — the in-
cumbency of Dr. H. G. Irvine as director of the
Division of Venereal Diseases of the State De-
partment of Health — is almost unbelievable and
is a tribute to Dr. Irvine and his associates. In
1925 some 4,300 cases of syphilis were reported
in the state. Since then the number reported
yearly has shown a steady decline, except for an
occasional increase, until last year when only
sixty-nine cases of early syphilis were reported.
Since 1940 the average number of new cases
reported yearly has been 301, the higher than
average number reported in 1946 being doubtless
due to the return of the soldiers from the war.
On the other hand not enough spinal Wasser-
mann tests are being performed. In 1948 a total
of 488 latent or late syphilis cases was reported
but only 202 had any record of a spinal fluid test.
In 1949 out of a total of 422 such cases only 160
had spinal tests.
While there were thirty-one cases of congenital
syphilis reported in 1949, only one of these was a
child born in 1949, thirty having been born
previous to that year. Only one congenital
syphilitic out of 73,627 live births in 1949 is
something to be proud of.
So satisfactory is the penicillin treatment of the
disease in all its phases that the state is willing to
provide this antibiotic for those unable to afford
the cost. Office treatment to the extent of 3,000,-
000 to 6,000,000 units over a period of fifteen days
is highly satisfactory and fully as effective as larg-
er doses. The early treatment of syphilis is pre-
ventive in nature, and the assumption of the cost
of medication by the state when the individual is
unable to afford it is justified from a realistic
standpoint.
SALINE SOLUTION IN TREATMENT OF BURN SHOCK
The Surgery Study Section of the National Institutes
of Health has recommended to the Surgeon General of
the Public Health Service that the use of oral saline
solutions be adopted as standard procedure in the treat-
ment of shock due to burns and other injuries in the
event of large-scale civilian catastrophe.
The recommendation followed action taken at the
January, 1950, meeting of the Surgery Study Section,
when such treatment was approved in principle. Dr.
Carl A. Moyer, a member of the Study Section, was
designated at that time to prepare a memorandum suit-
able for submission to Dr. Norvin A. Kiefer, Director,
Health Resources Division (now Health Resource^
Office), National Security Resources Board.
Editor’s Note: The above article calls attention to a simple
adjunct in the treatment of shock due to burns and other injuries
which has been found to be of value. It is, therefore, being pub-
lished for the information of the profession of Minnesota.
November, 1950
1127
EDITORIAL
Dr. Moyer’s memorandum, which was submitted to
Dr. Kiefer on February 15, 1950, reads as follows :
“Since the publication of the experimental work of
Dr. Rosenthal, Dr. .Toiler, et al, orally administered salt
solutions have been employed in the treatment of burns
at the University of Michigan Hospital, Ann Arbor,
Michigan ; at the Wayne County General Hospital, Eloise,
Michigan; and at Parkland Hospital, Dallas, Texas.
Personal clinical experience, in the above-named hospitals,
has convinced me that the orally administered salt
solutions are valuable adjunctive agents in the treatment
of shock incident to burns, fractures, peritonitis, and
acute anaphylactoid reactions. Certain factors are im-
portant in governing the effectiveness of the oral ad-
ministration of salt solutions. They are as follows :
“1. The composition of the salt solution: The
most palatable salt solution is made by dissolving 3 to 4
grams of sodium chloride and 2 to 3 grams of sodium
citrate in each liter of water. If sodium citrate is not
available, ordinary baking soda may be substituted for it.
“2. The concentration of salt should not be in excess
of 140 milliequivalents of sodium per liter. If the con-
centration is above this, vomiting and diarrhea become
important complicating factors.
“3. Whenever profound peripheral circulatory collapse
is present, the intravenous route of administration must
be used until peripheral blood flow has been reestab-
lished. The salt solutions that we have found most
satisfactory for this purpose are Hartmann’s solution
(Lactate-Ringer’s solution) or plasma. In addition to
the salt solution or plasma intravenously, whole blood
is given concurrently whenever peripheral circulatory
collapse exists. This materially implements the effective-
ness of salt solutions.
“The slightly hypotonic salt solution is the only
drinking fluid permitted the injured individual until the
edema of the injured parts begins to subside. Certain
exceptions to this rule have to be made during the hot
weather of summer when it is sometimes necessary to
permit the partaking of some non-salty water.
“A much as 10 liters of the hypotonic salt solution
have been drunk in the twenty-four-hour period by adults
who have been severely burned. Since salt solution has
been substituted for water, as a drinkable fluid, no
burned person who has lived for longer than three hours
after being admitted to the hospital has suffered from
anuria. The ‘early toxemia phase’ of the burns has also
failed to appear and the osmotic concentration of the
plasma electrolytes has been well maintained.
“We feel that much more clinical observation and
actual experimental work should be undertaken regarding
the effectiveness of the basic principles of the supportive
therapy of burns that have been so beautifully demon-
strated by Dr. Rosenthal. It is obvious that the adoption
of a more active program of investigation into the
relative effectiveness of simple measures to combat shock
would be of extreme importance to the Armed Forces
and to the civilian population in the event of another
war.”
Because of the sharpened national emergency that
developed during the summer of 1950, the Surgery Study
Section, in approving Dr. Moyer’s memorandum at its
meeting on September 16, changed the last paragraph
to read :
“While further clinical research concerning the
effectiveness of oral salt solution in the treatment of
burns and other injuries is certainly in order, there is
already sufficient evidence to suggest that this form of
treatment should be used in any large-scale disaster
involving the civilian population.”
The Surgery Study Section letter to the Surgeon
General, dated September 16, 1950, reads as follows:
“It is my understanding that one of the functions of
the Study Sections is to offer advice to the Surgeon
General in fields of medicine lying within the special
competence of the Study Section members. At the
January, 1950, meeting of the Surgery Study Section,
there was considerable discussion concerning the use of
oral saline solutions in the treatment of burns and other
serious injuries. It was the consensus of the Section
at that time that, on the basis of the animal work which
had been done by Dr. Rosenthal of the National
Institutes of Health, and the clinical work which had
been done by Dr. Carl A. Moyer, by the undersigned,
and by others, the efficacy of such treatment had been
definitely demonstrated and that, while there is need to
stimulate additional research in this field, our present
knowledge is sound enough so that action can be taken
on this basis. Dr. Moyer was designated to draft a
short memorandum expressing our point of view on this
subject. Such a memorandum was prepared and
furnished to Dr. Norvin C. Kiefer, Director, Health
Resources Division, National Security Resources Board,
on February 15, 1950. A copy of Dr. Moyer’s
memorandum is attached.
“In view of the more acute national emergency that
has developed since Dr. Moyer wrote this memorandum,
the Study Section, at its meeting on September 16, 1950,
voted to recommend that the principles of treatment
outlined in his memorandum be adopted for widespread
use in any large-scale disaster involving the civilian
population. Because of the present emergency situation,
we have modified the last paragraph of Dr. Moyer’s
memorandum to read, ‘While further clinical research
concerning the effectiveness of oral salt solution in the
treatment of burns and other injuries is certainly in order,
there is already sufficient evidence to suggest that this
form of treatment should be used in any large-scale
disaster involving the civilian population.’
“You are at liberty to transmit this recommendation
of the Surgery Study Section to the National Security
Resources Board or to other proper agencies, and, if
you see fit, to publish it. We feel strongly that it is
important for the medical profession of the country and
for those planning for the handling of potential disasters
to be informed of the value of this simple and easily
carried out form of treatment.”
The letter was signed by Frederick A. Coller, M.D.,
University of Michigan, Chairman of the Surgery Study
Section.
1128
Minnesota Medicine
Medical Economics
Edited by the Committee on Medical Economics
oi the
Minnesota State Medical Association
George Earl, M.D., Chairman
NEWSPAPER COMPLAINS OF
TOO MANY ZEROS
Using its familiar method of sly kidding with
a serious undertone, the Wall Street Journal
recently found that the “billion dollar era” makes
it rather uncomfortable. The Journal , and
probably most Americans, finds that figures of
the national debt and federal spending are a little
difficult to understand, and too many zeros can
have ominous implications. The paper says :
“Frankly, we’ve never felt at home in the billion
dollar era. A dozen ciphers added onto a digit or
combination of digits blurs our economic compre-
hension.
“We can easily grasp five cents for a pack of
chewing gum or one dollar for a haircut or even
seventy-five dollars for a new suit. But 40,000,000,000
or 45,000,000,000 as a measurement of dollars brings
on a sort of myopic miscomprehension that leaves us
not quite sure what it means.”
The Explanation — Simple?
The Journal had hopes of being able to count
the costs of government after the second world
war, but now has to try to see the figures of
spending in a proportionate light — giving each
second an amount to spend. The result is :
“After a World War II spending spree that left
endless zeros whirling wildly through our head, we
hoped things might settle down where we could see
and count the cost of government. But that hasn’t
happened and now the cost is on the rise again.
“To try to bring the spending down to our size
we’ve taken this fiscal year’s prospective spending,
some $40,000,000,000 to $45,000,000,000 and translated
it into so much per second — through the year. That
comes out to a minimum $1,720. What that means is
that while we smoke one cigarette $228,000 disappears.
And in the time it takes us to commute from home
to office each morning $6,000,000 is gone.”
There's a Moral
In the time it takes to smoke away $6,000,000,
the average taxpayer stops to realize that his
money is going altogether too swiftly. The more
the government spends, the more it has to spend,
and the more control it wields. The Journal
wisely advises that tax money should be more
carefully spent, and not squandered on schemes
which are unnecessary to the citizens’ good :
“We know that wars are costly. But a lot of those
dollars have nothing to do with war or defense. They
go to subsidize housing and buy ‘surplus’ potatoes and
dried eggs and a lot of things we could do without.”
The moral to the whole story seems to be that
if American voters choose the correct members of
Congress, less lavish spending will begin to be
evident in the Eighty-second Congress beginning
in January.
INDUSTRIALISTS EXPLAIN DEMAND
FOR PENSIONS
The key factor behind the demand for pensions
was explained recently by a speaker before the
National Association of Cost Accountants.
Percival F. Brundage, of Price Waterhouse & Co.,
sounded the warning that, “Debasement of the
dollar is a key factor behind the demand for
pensions. This is so,” he said, “because inflation
discourages personal savings by reducing their
value as time goes by.”
Adding his note of warning that continued
decreased value of the dollar will make savings
for old age smaller in purchasing power, Robert
C. Tyson, comptroller for United States Steel
Corp., said :
“Thus, if there is a continuing debasement of the
money, with resulting price and wage inflation, then
the dollar amounts to the pension based upon the
level of wages of the last ten years of service will
be greater than were provided for during the earlier
years of service at lower levels of dollar wages. The
dollars set aside during these earlier periods therefore
may prove insufficient and have to be made up at
higher costs than were previously calculated.”
November, 1950
1129
MEDICAL ECONOMICS
Mr. Tyson’s remarks had been limited to
private pension plans, but he then stated,
“Government Social Security plans are similarly
complicated, but the Government can always
manipulate the currency.”
Those falling under the new social security
groups, will wonder if the government will use
its power to manipulate the currency once again,
thus exercising more control over more people
than ever before in peace time. Mr. Tyson
remarks :
“Can you think of a handier and more popular
device for power-hungry people to employ in ob-
taining support than promises to take good care of
people when they get old — that is, later on? The
'later on’ is very important to the promiser ; he gets
the popularity he seeks today. As for paying up to-
morrow— well, tomorrow is another day, and if
necessary the currency can be debased. It has been
in other times and places. In this country it already
has been debased by nearly one-half since social
security was first promised to numerous voters.”
AMA RISES AGAIN TO ANSWER
EWING
Oscar R. Ewing, in his own little way, has
again reverted to smear tactics in a new vicious
attack on the American Medical association. By
injecting the racial issue into his blows, Ewing
belittled himself more than usual by accusing
medical schools of practicing discrimination
against Jews. The American Medical association
replied with the following news release :
“The American Medical association in a blistering
indictment of Federal Security Administrator Oscar
Ewing, which stated that he had twice been given a
vote of ‘no confidence’ in Congress, today characterized
him as a ‘disappointed, embittered bureaucrat, who
should be removed from office before he does further
harm to the country.’
“Dr. George F. Lull, Chicago, general manager of
the A.M.A., who issued the statement, declared:
‘Mr. Ewing, in his speech . . . before the American
Jewish Congress, descended to the depths of political
demagoguery when he falsely implied that the
American Medical Association was practicing dis-
crimination against Jews . . . The two Houses of
Congress, in successive years, have given Mr. Ewing
a decisive vote of no confidence, by rejecting his
attempts to gain Cabinet stature and control over the
medical profession through the creation of a Depart-
ment of Health, Education and Security.
‘President Truman should finish the job and dismiss
Mr. Ewing from the public service before be does
further harm to the country.’ ”
DOCTORS GET SMALL FRACTION
OF COUNTRY'S MONEY
People who are inclined to think that American
doctors make money hand over list should
realize that much of the doctor’s time is given
gratis and that twice as much is spent for other
health services as for physicians’ fees.
According to a government survey, made
public recently, only about one-third of the money
spent for health purposes goes to physicians in
payment for their services.
Citing the figures in the Commerce depart-
ment’s “Survey of Current Business,” The
Bulletin of the Academy of Medicine of Cleve-
land says :
“During the 12 months (1949) physicians received
$2,267,000,000. During the same 12 months Americans
were spending $1,391,000,000 on drugs, $105,000,000 on
private nurses, $416,000,000 on ophthalmic products
and orthopedic appliances and $1,631,000,000 on private
hospitals. (Incidentally, if non-private hospitals were
included — U. S., state and local — the hospital cost
figure would be several times as high, with a sub-
sequently greater difference between payments to
physicians and payments for other health services.)
“Several other comparisons are interesting. For
instance, $395,000,000 went for such burial items a>
cemeteries, crematories, monuments and tombstones.
This figure, according to the survey, just about equals
tbe ‘net amount’ spent for accident and health insur-
ance. It is almost four times as great as expenditures
for private nurses, and it is found to total almost
half the amount paid to dentists . . .”
AMERICAN DOCTOR STUDIES
BRITISH HEALTH SERVICE
An American doctor, recently returned from
Great Britain, made a comparison of medical care
and costs under national health service in
England, and medical care and costs under the
American medical system.
While admitting that the American system of
medicine, good though it is, has many faults,
Dorothy V. Whipple, M.D., quoted in The
Survey, remarks, “Frankly, as an American
doctor, T was shocked at the quality of medical
care given by the English urban general
practitioners.”
Reporting on differences between the British
and American systems, Dr. Whipple says :
“In the United States, distinctions between genera!
practitioner and specialist are not sharp. Often a
patient may not be quite sure whether or not his
1130
Minnesota Mf.dicini
MEDICAL ECONOMICS
doctor is a specialist.” (This would never happen in
England.)
Dr. Whipple also studied the fee system and
how it works :
“The general practitioner receives a capitation fee
— that is a flat sum per year for each name on his
registry, regardless of how many times the doctor
sees the patient. Specialists are paid salaries varying
with their skill.
“To an American observer the disadvantages of the
old British system seem more firmly established under
the new scheme, which reinforces the wall between
general practitioner and specialist.”
More Patients, Poorer Care
With the advent of National Health Service,
Dr. Whipple states, most doctors found they had
more work to do. “Even though a doctor served
exactly the same area and the same families as
before, he had more calls as soon as no direct
payment was required. Part of the increased load
represented persons who had put off medical care
because they could not pay the bill. Some of the
increased load was foolishness — people who
wanted what they could get because it was
•free.’ ”
The kind of medical care received is described
by Dr. Whipple :
“But what of the care these people receive? The
general practitioner’s income depends not on the number
lie treats but the number registered with him. The law
says he may not have more than 4,000 on his list.
Obviously no doctor can give much care to each of
4,000 men, women and children, even if only half
of them actually require his services in any one year.
Calls GP a "Clearing House"
“The more patients the general physician has, the
greater is his tendency to refer cases to the hospital
and the specialist. As a result, he becomes increasingly
a clearing house, less and less a real practitioner of
the healing art. He is so busy he has little time for
preventive medical service. All too often he prescribes
the customary bottle of sedative and allows the pa-
tient to go along to see whether anything serious de-
velops.”
DECREASE IN TUBERCULOSIS
In 1937, Wade H. Frost concluded that the point had
been reached in the United States where there is a
gradual downward trend in the incidence of tuberculosis,
and that, barring major upsets in civilization, the eventual
eradication of the disease can be expected. The con-
tinued decline in the annual number of deaths from tuber-
culosis during the past twelve years, in spite of the
adverse conditions caused by a great war, is ground for
confidence in the accuracy of Frost’s conclusion. A. C.
Christie, M.D., Pnb. Health Reports, June 2, 1950.
November, 1950
MINNESOTA STATE BOARD OF MEDICAL
EXAMINERS
230 Lowry Medical Arts Bid?.
Saint Paul 2, Minnesota
J. F. DuBois, M.D., Secretary
St. Paul Woman Sentenced to fail Term for
Criminal Abortion
Re State of Minnesota z's. Helen A. Heck.
On October 13, 1950, Helen A. Heck, forty-three
years of age, 809 Iglehart Ave., Saint Paul, Minnesota,
was sentenced by the Hon. Gustavus Loevinger, Judge
of the District Court of Ramsey County, Minnesota, to
a term of not to exceed eight years in the Women’s
Reformatory at Shakopee. The defendant Heck had
previously entered a plea of guilty on September 19,
1950, to an information charging her with the crime of
abortion and to having a prior conviction in 1947, also
for the crime of abortion. Following a statement by
the attorney for the defendant, and legal counsel for
the Minnesota State Board of Medical Examiners, Judge
Loevinger ordered the case continued to April 6, 1951,
at 2 :00 p.m., the defendant, however, to remain in the
custody of the Sheriff of Ramsey County. This means
that the defendant will have to serve the first six
months of her sentence in the Ramsey County Jail and
the Court will then determine whether or not the
balance of the sentence should be stayed and the
defendant placed on probation. Judge Loevinger
cautioned the defendant that probation was hardly
indicated by her past record. The Court also stated that
the defendant “undertakes to practice medicine and
surgery without having the necessary qualifications.”
The defendant Heck, who has no medical training
of any kind, was arrested by Saint Paul police officers on
September 10 ,1950', following the admission of a twenty-
two-year-old Minneapolis divorcee to Minneapolis Gen-
eral Hospital suffering from the after effects of a crim-
inal abortion. The police also discovered another patient,
a twenty-one-year-old unmarried Saint P'aul girl, in the
apartment of the defendant Heck upon whom the defend-
ant had attempted an abortion. The investigation disclosed
that the defendant received $265 for her services in the
Minneapolis case, and $425 for her services in the Saint
Paul case. Police also seized one speculum, 14 rubber
catheters and numerous medicinal preparations in the
apartment of the defendant. On September 18, 1950, a
complaint was filed against the defendant in the Munici-
pal Court of Saint Paul, charging the defendant with
the crime of abortion in the Minneapolis case. On Sep-
tember 19, the defendant was arraigned in the Municipal
Court, waived a preliminary examination, and was held
to the District Court. On the same date, the defendant
was arraigned in the District Court on an information
charging her with the crime of abortion, and to that
information she entered a plea of guilty. The Court then
continued the matter to October 13, for sentence as out-
lined above.
The records in the office of the Clerk of the District
Court of Ramsey County disclose that the defendant
Heck has a prior conviction for the crime of abortion.
On August 21, 1947, the defendant, together with one
Assunda Willner entered a plea of guilty in the District
Court of Ramsey County, to an information charging
both with the crime of abortion. For that offense Judge
Parks sentenced the defendant to a term of not to exceed
four years in the Women’s Reformatory at Shakopee but
stayed the sentence after the defendant served sixty days
in the Ramsey County Jail.
1131
Minnesota Department of Health
METHEMOGLOBINEMIA IN INFANTS
During 1947, 1948, and 1949, 146 cases of methemoglob-
inemia in infants due to nitrates in well water were re-
ported. This included fourteen deaths. For a period of
ten months no cases were reported but during the past
five months fourteen cases have been reported, with two
deaths. As physicians became familiar with this condi-
tion during the study carried out by the Minnesota De-
partment of Health, parents with newborn infants were
warned to use only approved municipal water supplies
or safe private water supplies. In recent months, how-
ever, physicians have apparently neglected to inform
parents of the danger of using questionable well water
in infant formulas, especially in southwestern Minnesota.
A brief resume of the study of methemoglobinemia in
infants due to nitrates in well water is given to remind
physicians that this disease must be kept in mind. Ninety
per cent of the infants were under two months of age
and about 8 per cent were between two and five months
old. The youngest infant was seven days old and the
oldest was five months old. More than half of the infants
developed symptoms in one to three weeks after being
on a formula requiring considerable water as a diluent.
Fifteen per cent developed symptoms in less than seven
days, the shortest period being one day. No breast-fed
infant developed cyanosis. Evaporated milk mixtures
were responsible for 40 per cent of the cases, powdered
milk formulas for 35 per cent and diluted cow’s milk
for 25 per cent. The characteristic symptom is a grayish
blue or brownish blue cyanosis accompanied frequently
by listlessness or lethargy, diarrhea, or fussiness. Most
of the private water supplies involved were shallow dug
or bored wells within 50 feet of a source of pollution and
contained from 25 to 50 parts per million of nitrate
nitrogen, the average being from 50 to 75 ppm.
A presumptive diagnosis may be made if on removal
of venous blood for hemoglobin determination the blood
is chocolate colored and if there are more than 10 to 20
parts per million of nitrate nitrogen in the water used
in the formula. Such a diagnosis is justified if there is
spontaneous disappearance of the cyanosis in 24 to 48
hours on changing the water in the formula to an ap-
proved water supply and the nitrate nitrogen content of
the water used in the formula exceeds 10 to 20 parts
per million. In either case the history and physical find-
ings should be typical. An absolute diagnosis is made by
demonstrating a definite methemoglobin live on spectro-
scopic examination or by the chemical analytic method of
Evelyn and Malloy.
In the differential diagnosis certain serious conditions
must be ruled out, including congenital heart disease,
pneumonia, atelectasis, pneumothorax, diaphragmatic
hernia, congenital pulmonary, and tracheal malformations,
and “thymic syndrome.” It is well to remember Ferrant’s
observation, that there is a striking difference between the
cyanosis and the alarming condition of the infant on the
one hand, and the normal pulse and respiration and lack
of physical findings on the other.
In mild cases, treatment consists of changing the water
used in the formula to an approved municipal supply.
Many physicians use oxygen but there is considerable
doubt as to its value in this condition. Ascorbic acid has
been used successfully. In severe cases, one per cent
methylene blue solution, one to two mg. per kg. intra-
venously, may be life saving.
It is requested that physicians notify the Minnesota
Department of Health, University Campus, when such
infants are seen, and that samples of well water be mailed
to the department for nitrate analysis. A copy of the
reprint of the article on methemoglobinemia which ap-
peared in the August, 1950, issue of Minnesota Medi-
cine is available on request.
BIRTH AND STILLBIRTH CERTIFICATES
Revised certificates of death, live birth, and stillbirth
have been developed and were first used in Minnesota
beginning January 1, 1950. A discussion of these new
forms of vital records by Casady and Brower appeared
in the December, 1949, issue of Minnesota Medicine.
The importance of exactness in reporting was pointed out
and emphasis was given to the necessity for accurate
data on birth weight, prematurity, and congenital mal-
formations. Since prematurity was the ninth leading
cause of death and congenital malformations in tenth
place in Minnesota in 1949 such information is needed
in the development of programs related to the care and
survival of premature infants as well of problems in-
volved in congenital malformations.
A preliminary review of 20,000 birth certificates indi-
cates that there is some confusion as to the definitions
of live birth, stillbirth, and prematurity. The following
definitions should clarify the situation. The international
definition of a live' birth is the complete expulsion or ex-
traction from its mother of a product of conception,
irrespective of the duration of pregnancy, which after
such separation, breathes or shows any evidence of life
such as beating of the heart, pulsation of the umbilical
cord, or definite movements of voluntary muscles,
whether or not the umbilical cord has been cut or the
placenta is attached.
Full term pregnancy varies from 220 to 330 days, with
an average of 270 days. This is the equivalent of nine
calendar months of thirty days each or approximately ten
lunar months of twenty-eight days, computed on the
basis of Naegele’s rule, from the date of onset of the
last menstrual period to delivery. A full-term pregnancy
is, therefore, not thirty-six weeks but is actually forty
weeks of gestation.
A stillbirth is a delivery of a fetus showing no evi-
dence of life after complete birth (no action of heart,
breathing, or movement of voluntary muscle), after
(Continued on Page 1165)
1132
Minnesota Medicine
Minneapolis Surgical Society
Meeting of January 5. 1950
The President, Ernest R, Anderson. M.D., in the Chair
ACUTE CONDITIONS OF THE ABDOMEN
L. A. STELTER. M.D.
Minneapolis, Minnesota
The reason for the common pitfalls in the diagnosis
of acute abdominal conditions is that we think of the
multitude of possibilities rather than the few outstand-
ing conditions which confront us in everyday surgery.
To elaborate on all the possible catastrophes of an
abdomen only adds to confusion with wasted time and
words. In order to make our job more practical and
efficacious, let us have a definite plan of attack by com-
bining our anatomic location of disease, clinical, and
laboratory findings in such a way that the diagnosis
may be reached more easily and then treat the pa-
tient accordingly.
First, for simplicity, let us divide the abdomen in
two planes : the upper abdomen, that part lying in the
plane above a line drawn transversely through the um-
bilicus, and the lower abdomen, that part lying beneath
this same line.
Let us consider the most common conditions which
may occur in these planes. Next we shall combine our
history, present complaints (male or female), physical
findings, laboratory and x-ray findings in such a way
that a conclusion may be reached.
Those conditions occurring in the upper abdomen are:
1. Acute Cholecystitis. — It has been said that certain
people develop certain diseases and this seems to hold
here; the gall-bladder type are fair, fat, and forty,
though occasionally a very thin patient under forty
years of age may develop the most severe gall-bladder
disease. The chief complaints of the patient are pain,
food distress, food dyscrasia, belching, and bloating.
The four foods most offensive are fried and fatty foods,
raw apples, cucumbers, and cabbage. Thorek calls such
people the 7 F’s — female, fair, fat, forty, flatulent,
flabby, and fertile.
The pain may be intense and constant or intermittent
and colicky. Colicky pain indicates an obstructive lesion
or the passage of a stone. The pain is located in the
right upper quadrant and radiates along the costal
nerves to the back and scapular region. Occasionally it
may be referred along the splanchnic nerves which sup-
ply the stomach and must not be confused with ulcer
or carcinoma of the stomach. Gall-bladder pain does
not refer to the shoulder. Shoulder pain is due to
phrenic nerve irritation and is due to a different mechan-
ism.
The temperature, pulse and respiration are elevated.
The temperature of the acute gall bladder rises to
101° -102° in the first twenty-four hours. The pulse in-
creases at the rate of about 10 beats per degree of
temperature. The respiration rate increases because of
chest pain and painful breathing and may lead to con-
fusion with early pleurisy or pneumonia. The gall-
bladder area is tender to touch. The point most marked-
ly tender is beneath the right costal margin. If the
tenderness is lower or near the umbilicus, it is due to
inflammation in a low lying gall bladder or a retro-
cecal appendicitis. Here Ligat’s sign will be of help.
Rectal and recto-vaginal and vaginal examinations are
made always. Laboratory examinations consist of com-
plete blood count and urinalysis. The differential count
is most important as a high polymorphonuclear count
indicates an infectious process, and a low polymorphonu-
clear count in the presence of a low total white blood
cell count means poor resistance and a bad prognosis.
A few blood cells in the urine may be misleading and
a negative urine erroneous. A scout x-ray film of every
acute abdomen is taken in the upright and flat position
as much information is obtained in this manner.
2. Perforated Peptic Ulcer. — This is rare in the fe-
male. The perforation may be the first symptom, but
usually there is a history of peptic ulcer, gastric hem-
orrhage or food distress. The pain is severe and sudden
and so intense that the patient doubles up and may drop
to the floor. The pain causes the abdomen to become
board-like rigid and the patient shows signs of shock.
About one-fourth of the patients have shoulder pain due
to phrenic nerve irritation. The abdomen is tense and
tender, and point tenderness early will be above the
umbilicus. Later it will be in the right lower abdominal
quadrant. Appendicitis is frequently mistaken for rup-
tured peptic ulcer. Auscultation reveals a silent abdomen.
The temperature is normal or subnormal at first. With
peritonitis it rises. The pulse increases moderately and
the respirations are 24 to 30 per minute, shallow and
costal in character. The leukocyte count averages 15,000,
and polymorphonuclear cells average 80 per cent. Leu-
kopenia may be present. The urine is normal.
In 1908 Weinberger observed on x-ray film the ac-
cumulation of gas under the diaphragm, and Popper
in 1915 reported a case in which he observed gas under
the diaphragm by fluoroscopy. In about 70 per cent of
the cases air can be demonstrated under the right
diaphragm by fluoroscopy with the patient lying on the
left side.
November, 1950
1133
MINNEAPOLIS SURGICAL SOCIETY
3. Acute Pancreatitis. — There are two types — acute
hemorrhagic and acute edematous pancreatitis. The
latter is the more mild and recovery usually occurs with-
out therapy, while the former is associated with hemor-
rhage in the pancreas and fat necrosis, and prompt
treatment is necessary. The history is usually similar
to that of acute cholecystitis and it occurs more fre-
quently in females of the stout type over forty years
of age. It appears following the ingestion of a heavy
meal. The onset of pain is dramatic, sudden, excruciat-
ing, and radiating to one or both loins. The pain is
relieved when the patient sits up or lies on his abdomen.
Reflex vomiting and retching occurs. Examination
shows the patient to be in extreme pain, in semi-shock,
with subnormal temperature, rapid, thready pulse, epi-
gastric tenderness associated with muscular defense
localized to the organ, most marked between the
xiphoid and umbilicus ; occasionally ecchymosis in one
or both loins or at times around the navel due to ex-
travasation of blood around the retroperitoneal space.
Abdominal auscultation, a helpful diagnostic agent,
usually reveals a quiet but not silent abdomen. Gage
blocks the upper lumbar region with procaine and gets
immediate relief for his patients and considers the
procedure of positive diagnostic help. Laboratory work
shows an elevated leukocyte count and glycosuria. A
blood sugar above 300 milligrams per cent may be
indicative of a fatal outcome. Elevated blood amylase
is a positive test and becomes present in two to three
hours after the onset of the attack. X-ray studies are
not very helpful but separation of the upper and lower
limb of the duodenum represents thickening of the pan-
creas.
4. Ruptured Viscus (Liver or Spleen). — If there is a
history of accident or trauma, the patient may or may
not present signs of shock and shoulder pain, either right
or left, due to phrenic nerve irritation. Signs of internal
hemorrhage are present and a diagnostic puncture of the
abdomen is an important aid in deciding on urgent sur-
gical interference. Liver dullness or splenic dullness
is increased and x-ray will give evidence of an enlarged
organ with displacement. The patient must be watched
for late secondary hemorrhage. Laboratory findings
suggest peritoneal irritation with leukocytosis and low-
ered hemoglobin values due to hemorrhage. LTrinalysis
will be negative.
5. Coronary Disease. — The surgeon cannot afford to
make the fatal error of confusing an acute coronary dis-
ease with an acute abdominal condition. The coronary
condition is more common in men past the age of forty,
with a history of previous dyspnea and chest pain occur-
ring during exertion. The pain may be sudden or gradual,
increasing in severity, involving the upper abdomen and
chest and radiating to the left arm or both arms or up
the neck. There is fear and fright associated with the
pain. There is a history of indigestion, belching, and
bloating not related to foods. The attack may appear
after a heavy meal.
Examination reveals possibly an enlarged heart, a soft
slow pulse, low blood pressure, dilated neck veins, a
flaccid abdomen and no point tenderness or muscle
spasm. An elevated leukocyte count and sedimentation
rate and a positive electrocardiogram reading are diag-
nostic, and these findings may be present the first twenty-
four to forty-eight hours after the onset of the attack.
X-ray reveals a negative abdomen and an enlarged heart.
Urinalysis will be negative.
Common pathologic conditions occurring in the lower
abdomen are :
1. Acute appendicitis is found more frequently in in-
dividuals under forty years of age and is somewhat
more common in females. The patient usually first no-
tices a “stomach-ache” and the druggist or good friend
has prescribed a cathartic. If given the Two Question
Test — (1) “Where was your pain when it started?” and
(2) “Where does it hurt you now?” — the patient usually
points to the epigastrium in answer to the first question
and to the right lower quadrant in answer to the second
question. This simple method will frequently diagnose
the case.
Text books that teach that acute appendicitis can be
diagnosed by pain, temperature, nausea, vomiting, and
leukocytosis may be erroneous. Nausea and vomiting
are the exception, not the rule, in appendicitis. Loss of
appetite is a more constant sign and is due to early dis-
tention of the appendix. Wyatt states that a child with
abdominal pain who can eat does not have appendicitis.
Diarrhea and chills are rare in acute appendicitis and
constipation is the rule. Fever is not an early finding
but is present after peritoneal irritation has taken place.
When the temperature has risen to 101° or 103°, local-
ized or beginning generalized peritonitis has started al-
ready. Point tenderness is the most important sign in the
diagnosis. With the patient lying on his back, pressure
in the region of the inflamed organ will cause the pa-
tient to wince with pain and cause muscle spasm (both
recti) due to a defense mechanism. Ligat’s sign will be
helpful and Rovsings’ sign may be elicited by pressure
on the left lower quadrant which forces gas along
the colon against the cecum, causing pain over the cecum.
It is found in 60 to 70 per cent of the cases. Rectal
and vaginal examinations are important. Laboratory
examination reveals a leukocyte count of 14,000 to 15,-
000 with a high polymorphonuclear cell count. How-
ever, occasionally, a gangrenous appendix will te asso-
ciated with a normal count. Urinalysis may show oc-
casional pus cells due to ureteral irritation. Flat plate
of the abdomen helps in ruling out other abdominal
conditions.
2. Renal Colic. — This may be due to stones, blood
clots, urates or ureteral kink. The condition is most
frequent in males and there may be a history of pre-
vious attacks, family tendencies, a story of gout or
parathyroid pathology. The pain is sudden, severe and
colicky, starting in the lumbar region, right or left, and
radiating to the vulva or testicle. There is restlessness
and thrashing about while the patient with peritonitis lies
quiet. Vomiting and urinary frequency are common.
During urination the colicky pain may be altered.
Physical examination rarely reveals an elevated tern-
1134
Minnesota Medicine
MINNEAPOLIS SURGICAL SOCIETY
perature. Bradycardia is a common finding. A clean
tongue and slow pulse in an acute abdomen is a renal
condition until proven otherwise. Murphy percussion
and tap is very painful.
Leukocytosis may be present. Blood, pus, and albu-
min are found in the urine. However, a stone may
block completely a ureter and produce a negative urine.
X-ray examination may reveal a stone present though
non-opaque substances may cause the renal colic.
3. Gynecologic Disorders. — In considering other con-
ditions of the lower abdomen, the general surgeon must
be bold enough to invade the field of the gynecologist.
Here such conditions as acute salpingitis, twisted
ovarian pedicle and ruptured ectopic pregnancy are most
frequent. The diagnoses are made by the same plan
of attack.
4. Diverticulitis. — There is a history of irregularity of
bowel habits and at times colicky intestinal cramps and
pain in the lower abdomen. The condition is more
common in males. Course and rough foods cause in-
testinal irritation. During an attack there is leukocytosis,
moderate fever, distention of the abdomen and bloating.
X-ray examination with a small amount of barium will
prove the diagnosis.
Case 1. — Mrs. E. M., a white woman, aged sixty-six,
had a history of repeated attacks of right kidney infec-
tion for fifteen years. At one time she passed a kidney
stone. Present illness started two days previous to hos-
pital admission with pain in the right kidney region and
frequency and burning of urination. There was no his-
tory of any food distress but there was nausea. Tempera-
ture was 102°, pulse 80 on admission.
Examination revealed a somewhat distended though
flaccid abdomen. There was no point tenderness except
the tenderness over the right kidney on Murphy percus-
sion. There was some tenderness on deep palpation over
a lower right rectus scar. Vaginal examination was
negative.
The urinalysis showed two plus albumin, 40 to 50 pus
cells, and 5 to 10 red cells. The white blood cell count
was 19,800, 85 per cent polymorphonuclear cells, 15 per
cent lymphocytes. X-ray revealed definite distention of
the large and small bowel. The kidney shadows were
normal but some calcifications in the right pelvis which
might te phleboliths. The impression was acute pyelitis,
possibly kidney stone passing. On the third day in the
hospital the patient became very distended and com-
plained of severe pain in the right costal region with
point tenderness. Exploratory laporotomy revealed a
perforated gall bladder full of stones, free bile in the
peritoneal cavity. Drainage was instituted. The pa-
tient ran a ' stormy course. She developed pneumonia
with empyema. Death ensued. The autopsy revealed
localized peritonitis, sub-diaphragmatic abscess, empyema,
and pyelitis.
Case 2. — Mr. M. S., a white man, aged sixty-three,
had a negative past history as to stomach distress or in-
digestion. The present illness started shortly after aris-
ing in the morning with an acute upper abdominal pain.
This was his first attack of stomach trouble. He vomited
several times. Examination revealed a board-like, rigid
upper abdomen. There was localized tenderness above
the navel line. Negative urinalysis. There were elevated
white cell and polymorphonuclear cell counts. X-ray
findings and fluoroscopy of the abdomen revealed a small
amount of air under the right diaphragm. Laporotomy
verified the diagnosis of a perforated duodenal ulcer.
The post-operative course was uneventful.
Case 3. — Mr. N. H., a white man, aged forty-nine,
was seen in consultation the second day after his ad-
mission to the hospital. He had a distended abdomen.
There was moderate tenderness in the left pelvic region.
Rectal examination revealed a mass in the left pelvic
region. The urinalysis was negative. The white cell
count was 15,900, with 80 per cent polymorphonuclear
cells. The x-ray revealed loops of distended bowel with
gas in the colon and lower bowel. Conservative treat-
ment was continued. Twenty-four hours later the pa-
tient became worse and exploratory laparotomy revealed
a ruptured appendix with ileum obstructed due to an
abscess and exudate in the pelvis. Appendectomy was
done, leaving an indwelling ileostomy tube. The post-
operative course was stormy, but the patient recovered.
Case 4. — Master W. M., a white boy, aged six, was
struck by an automobile and received a concussion,
bruises to the lower right chest and upper abdomen.
He entered the hospital semi-comatose Examination
revealed multiple abrasions on the boy’s head and lower
chest. The urinalysis was negative. Hemoglobin was
74 per cent. The white cell count was 14,000, with 78
ner cent polymorphonuclear cells. X-ray of the abdo-
men on admission showed nothing of note. When seen
in consultation two days later the lower right chest
revealed dullness. There was increased liver dullness.
The hemoglobin was 66 per cent. The red cell count
was 3,100,000 and the white count was 15,600. X-ray
showed the liver to be increased in size. A needle was
introduced in the abdomen and revealed no intraperi-
toneal blood. The boy was transfused and treated con-
servatively and recovery was uneventful. A diagnosis
of intracapsular hemorrhage of the liver was made.
Case 5. — Mr. A. S., a white man, aged fifty, had been
under my observation for several years with a duodenal
ulcer which had been inactive for the past fifteen
months. Present illness of stomach distress had ap-
peared five days prior to hospital admission while on a
hunting trip. Four hours before entering the hospital
he developed severe abdominal pain around the navel
with nausea and vomiting. His wife said he nearly
fainted because the pain was so severe.
Examination revealed a board-like abdomen above the
navel and along the right side with point tenderness in
the right lower quadrant. The urinalysis was negative.
The white cell count was 16,500, with 80 per cent poly-
morphonuclear cells. Flat plate of the abdomen was
negative for air. A diagnosis of ruptured appendicitis
was made and a lower right rectus incision revealed a
retrocecal ruptured appendix. Appendectomy without
drainage was performed. The postoperative course was
uneventful.
Case 6. — Mrs. O. S., a white woman, aged thirty-
seven, had been bleeding for two weeks prior to hos-
pital admission. When seen by myself she gave a his-
tory of no missed periods or irregularity until the present
bleeding episode. She had had two children living and
well, the youngest being fifteen years of age. Examina-
tion revealed the patient in severe pelvic pain. The
pulse was soft and rapid. Blood pressure was 100/80.
There was marked tenderness in the right lower quadrant.
Pelvic examination revealed a retroverted uterus and a
tender, boggy mass in the right cul-de-sac. The patient
refused needle puncture. The white cell count was 22,-
500, with 86 per cent polymorphonuclear cells. A flat
plate of the abdomen gave no information. A laporot-
omy verified the diagnosis of a ruptured ectopic preg-
nancy. The postoperative course was uneventful.
Case 7. — Mrs. K. A., a white woman, aged fifty, had
been admitted thirty-six hours prior to the time I saw
November, 1950
1135
MINNEAPOLIS SURGICAL SOCIETY
her in consultation. She gave the history of intermittent
cramps of the lower abdomen associated with the ap-
pearance of menstrual blood. She had been operated
upon twice in the past for appendicitis in childhood and
had had a pelvic laporotomy eight years previously.
Nasal suction had been started on her admission to the
hospital, which gave her a small amount of relief until
6 :00 a.m. of the day I examined her. When seen at
10 :00 a.m., her pulse was 140 and blood pressure was
80/50. The skin was cold and clammy. The abdomen
was moderately distended and there was a tender pal-
pable mass in the left lower quadrant the size of a
child’s head. There was a right rectus and midline scar.
Pelvic examination revealed a bloody discharge and a
tense, tender palpable mass filling the left pelvis. A
catheterized specimen of urine was normal. The white
cell count was 18,600, with 88 per cent polymorphonu-
clear cells. A flat plate of the abdomen revealed a mass
in the left lower abdomen and two large stones in the
bladder. A diagnosis of twisted ovarian pedicle with
gangrene or gangrenous bowel from an obstruction or
mesenteric thrombosis was made. The patient’s condi-
tion was critical and in spite of multiple portals of blood
and fluid she remained in shock. Emergency explora-
tory under spinal anesthesia revealed multiple pelvic ad-
hesions. Three loops of gangrenous small bowel, 72 cm.
in length, held in the pelvis by an adhesive band to an
ovarian cyst were liberated, resected, and an end-to-
end open anastomosis was performed. As soon as the
grangrenous bowel was excised the patient’s condition
improved. Her pulse lowered to 110 and a gradual
rise in her blood pressure changed the entire picture.
The abdominal tissue, which had been cold, began to
warm. She left the operating room in fair condition
and her postoperative course was uneventful.
Summary
1. Pitfalls in acute abdominal diagnosis are made
when we confuse the more common disorders with the
many possible abdominal catastrophies.
2. I have tried to simplify diagnostic procedures by a
planned method :
(a) Dividing the abdomen in two planes.
(b) Correlating the clinical and laboratory findings.
3. A case report has been given to represent each of
the more common acute abdominal conditions.
References
1. McNealy, R. W., and Houser, John W. : Perforation in peptic
ulcer. Internat. Coll. Surgeons, (March-April) 1942.
2. Wangensteen, O.: Indust. Med., 5:244, 1946.
3. Meyer, Karl, and Shapiro, Philip: The treatment of abdomi-
nal injuries; Internat. Abst. Surg., 66:245-257, (March)
1938.
4. Tliorek, Philip: The differential diagnosis of acute abdomen.
Indiana M. A., 39:625-629, (Dec.) 1946.
5. Spivak, Julius L. : Urgent Surgery. Vol. I.
6. Vaughn, R. T., and Singer, H. A.: The value of radiology in
the diagnosis of perforated peptic ulcer. Surg., Gynec. &
Obst., 49:593-599, 1929.
7. Elman, R. : Acute interstitial pancreatitis. Surg., Gynec. &
Obst., 57:291, 1933.
8. Fallis, L. S., and Plain G. : Acute pancreatitis. Surgery,
5:358, 1949.
9. Elman, R. : The variation of blood amylase during acute
transit disease of the pancreas. Am. J. Surg., 105:379, 1947.
10. Snead, L. F.: Treatment of acute pancreatic neurosis. Am.
J. Surg., 32:487, 1936.
Discussion
Dr. Hamlin Mattson : Development of chemotherapy
and antibiotics has permitted more deliberation in cases
where the diagnosis is obscure in acute abdominal con-
ditions. In some instances nonoperative treatment is
possible where before operation was considered impera-
tive.
An example in point is perforated duodenal ulcer.
When sulfonamides only were available, slow leaks on
an empty stomach were treated occasionally with suction
siphonage and chemotherapy.
In February, 1939, I saw a woman, aged forty-five,
who had a fairly typical history and findings of ruptured
duodenal ulcer with gas demonstrable under the right
diaphragm. The rupture occurred about four hours
after a meal, the area of peritoneal irritation was limited
and with some temerity I treated her nonoperative as
indicated above.
Infections have accounted for most of the fatalities
in ruptured peptic ulcer. In 1937, Bergh, Bowers, and
Wangensteen made one centimeter long incisions in the
stomachs of animals. Those incised when the stomach
contained food showed an 86 per cent mortality. Of
those incised with empty stomachs only 6.8 per cent
died. The mortality rate from perforated peptic ulcer
has declined rapidly in the past years. Trieger in 1947
reported a 33 per cent mortality in 73 cases from 1930
to 1944 and no deaths in seventeen cases from 1944 to
1946. Others have reported similar results.
In 1946, Taylor of London reported trial of non-
operative treatment. In twenty-eight cases there was a
14.3 per cent mortality. Seeley in 1949 reported thirty-
four cases with no mortality.
About a year ago, Bingham set forth the following
criteria for non-operative treatment of ruptures :
1. Less than eight hours old, or more than three days
2. More than one hour since last meal.
3. Duodenal rather than gastric.
4. Small perforation.
5. Where the differential diagnosis is uncertain.
PROBLEMS IN ACUTE INTESTINAL OBSTRUCTION
LEO C. CULLIGAN. M.D., F.A.C.S.
Minneapolis
In discussing acute intestinal obstruction there are
several physiological considerations that should be taken
up. The first of these is fluid and electrolyte loss.
When the obstruction is high and vomiting is profuse
this loss may be enormous. A patient may lose up to
8,000 c.c. daily with a corresponding loss of sodium and
chlorides. When obstruction is at the pylorus, profuse
vomiting may throw a patient into alkalosis and even
into gastric tetany. Fluid replacement containing as
high as 20 to 30 grams of salt may be necessary to
Minnesota
replace the loss of electrolytes. The response in these
cases is dramatic.
The farther down the intestinal tract that the ob-
struction is located, the less one need worry about
electrolyte loss. Then one must consider primarily the
effects of distention. In an obstructed bowel the first
thing that occurs is the accumulation of large amounts
of gas. This gives the characteristic x-ray of small
bowel obstruction. Later the accumulation of fluid in
the distended loops may replace the gas almost entirely
1136
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MINNEAPOLIS SURGICAL SOCIETY
and often gives a confusing x-ray picture unless one
gets an upright film which will show fluid levels in the
small bowel loops.
Distention is the most lethal factor in simple (non-
strangulating) obstruction. If prolonged, it can initiate
mucosal degeneration as shown by hemorrhage, erosion
and ulceration. Marked distention can so compromise
intramural blood flow as to endanger viability of the
bowel. While the exact mechanism is not known, dis-
tention is thought to have much to do with the absorp-
tion of toxins from the obstructed bowel, for the relief
of distention improves the general condition of the pa-
tient markedly.
The third most important physiological consideration
is the effect of interference with the blood supply of a
loop of bowel producing a strangulation obstruction.
It is this factor that makes hazardous the non-operative
or conservative treatment of mechanical obstruction by
means of gastrointestinal tubes. It is often difficult to
recognize strangulation obstruction even when the pa-
tient is being carefully watched and the surgeon is on
the lookout for it. Interference with the blood supply to
a loop of bowel is soon followed by loss of viability of
the mucosa with resulting invasion of bacteria into the
intestinal wall and through the serosa into the peritoneal
cavity. Later frank necrosis and perforation may occur
with gross peritoneal contamination.
In strangulation obstruction there is often enough
blood loss into the lumen of the bowel and into the
peritoneal cavity to account for some of the shock as-
sociated with intestinal obstruction.
While it is difficult to lay down any general rules of
treatment because of the many varied causes of ob-
struction, it is pretty well agreed that acute obstructions
of the small bowel requiring resection should be treated
by immediate end-to-end anastomosis whereas acute ob-
struction of the large bowel should be best treated by
colostomy — transverse colostomy if possible. An ex-
ception to this is acute obstruction of the right side of
the colon which also can be treated safely by immediate
resection and end-to-end ileo-colostomy.
Causes of Intestinal Obstruction
(In order of frequency)
A. Small Bowel
1. Adhesive bands
2. External hernia
3. Intussusception
4. Obturator
a. Gallstones
b. Foreign body
c. Worms
B. Large Bowel
1. Neoplasm
2. Volvulus
5. Vascular
a. Thrombosis
b. Embolus
6. Congenital atresia
7. Volvulus
8. Neoplasm
9. Internal hernia
3. Diverticulitis
4. Adhesive bands
The manifestations of acute intestinal obstruction are
so varied and complex that I felt that the subject could
be best covered by concrete examples of cases illustrat-
ing diagnostic and therapeutic problems.
%
Case 1. — A man, aged seventy, early on the morning
of August 13, 1949, experienced a pain and swelling in
the right groin. He vomited and had what he described
as a gas pain.
November, 1950
In mid-afternoon a strangulated right inguinal hernia
was reduced by his physician. The pain persisting, he
was sent to the hospital.
Late in the afternoon when he was seen in consultation,
there was no swelling and no pain. Operation was not
advised.
Three days later the patient was discharged from the
hospital, a flat plate of the abdomen having been negative
and the leukocyte count being normal.
This patient had a strangulated hernia with symptoms
of bowel obstruction for a period of eight to ten hours.
He had gas pains, vomiting, local tenderness and swelling.
The patient was much opposed to an operation, and in
view of the fact that he had reached the age of seventy
before the hernia had caused him any symptoms, and
because at the time I examined him, about one hour
after the hernia had been reduced, he was completely
free of symptoms, I agreed to forego an operation and
instead we elected to observe him.
We kept him in the hospital and ran daily leukocyte
counts for four days. These were normal. On the
third day we had a flat plate of the abdomen which was
entirely negative so the patient was discharged. If con-
fronted with the same problem, I believe that one should
strongly urge an operation. The uncertainties regard-
ing the viability of the strangulated loop are too much
to risk even when the patient is watched carefully.
When contrasted with the next patient, this case takes
on a more special interest.
Case 2. — A woman, aged sixty-six, a poor cardiac
risk, had been operated upon by another surgeon on
October 10, 1948, for a strangulated femoral hernia.
A loop of bowel of questionable viability had been left.
A leukocytosis of 20,900, 20,850, and 18,700 persisting
on October 12, 13 and 14, and a flat plate taken Oc-
tober 14 showing the small bowel distended with gas,
the patient was reoperated upon. A necrotic loop of
small bowel was resected and an end-to-end anastomosis
made.
The patient died suddenly of a heart attack while out
of bed on the fourth day following the second opera-
tion. An autopsy showed the anastomosis patent and
the peritoneum clean.
Here again we are confronted with the problem of
determining the viability of a loop of bowel inside the
abdomen. The patient was an extremely bad heart risk
who had been treated many times for cardiac decom-
pensation by the surgeon who operated upon her for
the strangulated femoral hernia. At the time of opera-
tion, after observing the bowel for some time, he felt
that it would be viable and dropped it back. He was,
however, worried about its status and asked me to fol-
low her progress with him.
In such a situation you usually have a few days be-
fore an inviable bowel will rupture. Dady leukocyte
and differential counts were taken. As shown in the
case report these remained consistently high, around
20,000. Clinically there was some distention and ten-
derness, although the patient was quite obese and
examination was unsatisfactory. A flat plate of the
abdomen on the fourth day showed small bowel dis-
tention. In view of these findings, the patient was re-
operated upon on the fourth day. The loop of bowel
1137
MINNEAPOLIS SURGICAL SOCIETY
was found to be necrotic — so soft that we feared it
would rupture as we removed it.
A closed type of end-to-end anastomosis was carried
out. The patient was out of bed. Suddenly, on the
fourth day after her second operation she had a heart
attack and expired.
The lesson to learn from these two cases is that if you
drop back a loop of questionable viability, order daily
leukocyte counts and get frequent flat plates of the ab-
domen. If the white counts remain persistently high for
a few days, and if you can rule out any other com-
plication which might raise the leukocyte count, you had
better open up the patient and look again.
In addition to the usual signs of determining bowel
vialibility at the time of operation, such as the return
of color, arterial pulsations and active peristalsis, there
are a few other aids that have proven helpful. Fluorescein
solution given intravenously will show up as a green
fluorescence in a viable bowel observed under ultraviolet
light. Laufman and Method measured the surface
temperature of the bowel and found that the
temperature of a strangulated bowel was subnormal.
When the strangulated mechanism was released, if the
bowel was viable, the temperature would return to normal
or above. If, however, the bowel was inviable, the
temperature would remain subnormal. They also found
that papaverine given at the time was helpful in over-
coming venospasm and aided in the recovery of the
bowel if it could survive. Arnold Kremen has called
attention to the fact that the return of peristalsis is not
always a reliable guide, for it may be simulated by active
muscle contractions due to anoxemia.
Case 3. — A man, aged sixty-two, who was diabetic,
was admitted to tbe hospital on January 16, 1949, six
days following strangulation of an umbilical hernia.
The patient was very obese and distended on admis-
sion. A large umbilical hernia was red and phlegmo-
nous and suggested a strangulated and necrotic bowel.
The same day the hernia was removed in toto with-
out entering the sac. An aseptic end-to-end anastomosis
of the distended and collapsed loops as they entered and
left the hernia sac was made (method of Dennis and
Varco).
Recovery was uneventful.
This patient lost a leg in a railroad accident and had
been retired for years, during which time he had be-
come extremely fat. Tie had an umbilical hernia for a
long time which had given him no trouble. Six days
prior to admission to the hospital this could no longer
be reduced and his bowels stopped moving. The swell-
ing slowly became red and tender. Examination showed a
large umbilical hernia the size of a grapefruit that was
red, edematous and septic from the enclosed gangrenous
bowel. The rest of the abdomen was distended but
soft. X-ray showed distended loops of bowel. We
knew that if we once opened into this septic ; sac our
patient would probably die of peritonitis. So using the
method described by Dennis and Varco for strangulated
femoral hernia, we encircled the hernia with our inci-
sion, excised the hernia in toto, resected the bowel as
it entered and left the sac, removing the hernia with
its encircling ring without any contamination whatso-
ever. An end-to-end anastomosis was carried out. To
take pressure off the suture line we asked Dr. Wild to
pass an intestinal tube following the operation. The post-
operative convalescence was normal.
Case 4. — A woman, aged twenty-seven, had a normal
delivery on September 28, 1945. Vague abdominal pains
began on October 4, 1945, and occasionally emesis oc-
curred. Temperature and pulse were normal.
On October 10, 1945, the patient suddenly went into
shock. She was seen in consultation that day and ap-
peared in moderate shock, with the abdomen rigid and
distended. X-ray of the abdomen showed small bowel
distention. The leukocyte count was 17,000, with 92
per cent polymorphonuclear cells.
The same day the abdomen was opened, and a strang-
ulated loop of gangrenous small bowel, 129 cm. in
length, was found caught under a band of adhesions.
Resection was performed and an aseptic end-to-end anas-
tomosis made.
This case illustrates the difficulty in diagnosing intes-
tinal obstruction that develops during the postpartum
period. During that time both the physician and the
patient expect that she will have a certain amount of
abdominal pain. This patient’s postpartum period was
normal up to the sixth day. She then began having
crampy abdominal pains that persisted for four days,
never severe until during the night of the tenth post-
partum day. Then suddenly she went into shock. When
I was asked to see her, the abdomen was rigid and dis-
tended, pulse w'as rapid and blood pressure low.
As soon as shock was corrected she wras operated
upon. A loop of bowel, 60 inches long, was found under
a band. This was black and inviable. A closed type
of end-to-end resection was done about 3 inches from
the ileocecal valve. Postoperative convalescence was
uneventful except for loose stools that persisted for
about two months.
Case 5. — A woman, aged forty-six, was found to have
a carcinoma of the transverse colon in the course of an
operation on December 23, 1948, for supposed appen-
dicitis. I was asked to assist and found a greatly dis-
tended cecum due to the obstructing carcinoma.
The carcinoma and proximal transverse colon and
cecum were removed, and an aseptic end-to-end anasto-
mosis between the ileum and distal transverse colon was
made.
The patient was discharged on January 10, 1949, in
good condition.
Complete obstructions of the right colon present a most
acute emergency and require immediate surgical relief.
The cecum is thin-walled and with the ileocecal valve
usually remaining competent ; it then becomes a closed
obstruction comparable to a strangulated loop, and blow-
outs occur early and frequently.
Ordinarily it is generally agreed that definitive sur-
gery should not be carried out in acute obstructing
lesions of the large bowel. Acute obstructions of the
right colon, however, are an exception to this rule.
Here it is possible to remove all the obstructed portion
of the colon together with the growth and make our
anastomosis "between normal collapsed distal colon and
the terminal ileum. This can be done even if the small
bowel is distended, for we know that there is usually
no difficulty encountered suturing into the wall of
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MINNEAPOLIS SURGICAL SOCIETY
obstructed small bowel. Removal of the tense cecum
may be facilitated and distention of the terminal ileum
may be relieved by using the aseptic suction enterostomy
of Wangensteen, inserting it after the abdomen has been
opened through the wall of the terminal ileum down
through the ileocecal valve into the cecum. If one has
already passed a gastrointestinal tube into the lower
ileum this may be passed through the ileocecal valve
into the cecum and thus decompress it.
Case 6. — A man, aged sixty-seven, experienced colicky
lower abdominal pain at hourly intervals beginning Au-
gust 13, 1945. On the following day there was marked
abdominal distention with rigidity. A flat x-ray plate
of the abdomen showed a coffee-bean distention of the
sigmoid.
At operation on August 14 a volvulus of the sigmoid
colon at the peritoneal reflection was resected and a
primary end-to-end anastomosis made.
The patient was discharged on October 5, 1945.
This patient whom I operated upon at General Hospital
is interesting for several reasons. His gas pains were
characteristic of colon obstruction. His colics, instead
of coming every five to ten minutes as they usually oc-
cur in small bowel obstruction, came hourly. His flat
plate was beautifully characteristic of volvulus and his
local findings of tenderness and marked rigidity and dis-
tention gave one no choice as to proceedure. At opera-
tion the volvulus was completely black and gangrenous
and extended from the pelvic floor to the left rib margin.
The twist was located at the peritoneal reflection and
was too low to allow exteriorization so an end-to-end
anastomosis was carried out. This patient’s plasma
proteins were very low and he completely eviscerated
on the eighth day. He was taken back to the operating
room and the abdominal wall was resutured. His sub-
sequent convalescence was normal.
A couple of years ago Dr. Brunsgaard of Norway
spent some time at the University and interested those
who heard him speak before this society in his method of
reducing volvulus by means of a proctoscope with the
insertion of a soft rubber tube into the volvulus. He
reported 136 successful treatments with four deaths.
He cautioned that one must not try the method where
there is any indication or question of impaired circulation
or gangrene. While exteriorization by Michulitz pro-
cedure has usually been recommended as the operative
procedure of choice in volvulus, he contends that the
twist is usually too low to permit this type of operation,
as was true in our case, and he recommends the inversion
and burying of the distal stump and the making of a
colostomy of the proximal end with re-anastomosis later.
In every obstruction of the colon, volvulus must be
considered. It causes about 16 per cent of colon ob-
structions and, unless relieved, gangrene with perforation
will usually result. It can easily be overlooked if one
makes a transverse colostomy to relieve sigmoid obstruc-
tion and assumes that the obstruction there is due to
carcinoma. A flat plate usually gives a characteristic
picture, as does also a barium enema.
Dr. Baronofsky has been interested in this problem
at the University of Minnesota. His feeling is that if
there is evidence of gangrene that it is not safe to reduce
by tube and proctoscope and that one should do an im-
mediate resection and end-to-end anastomosis. If there
is no evidence of gangrene, he feels that the volvulus
should be reduced by Brunsgaard’s method, and after
several days, one should resect and do an end-to-end
anastomosis.
These last five cases where bowel resection was car-
ried out in the face of acute obstruction due to va-
ried causes recommend strongly the closed type of
anastomosis.
Throughout the country there is still considerable
argument between the proponents of the open and the
closed types of bowel resection. Personally I have used
the closed method of resection in practically every case
of bowel resection that I have done during the last ten
years, and I am convinced that anyone who gets ac-
customed to using it will not abandon it' for the open
type of resection.
While the antibiotics have given the open type of
resection a greater degree of safety, one should not
rely on them completely for protection. I recently op-
erated for a ruptured appendix. In spite of massive
doses of penicillin, streptomycin and intravenous aure-
omycin, the p?tient developed three intra-abdominal
abscesses that had to be drained. Moreover, experi-
mental work has shown that there is firmer healing
where there is no serosal contamination at the time of
operation. Also, contamination of the peritoneal cavity,
while it may not be serious in the unobstructed case,
may attain real magnitude in the acutely obstructed pa-
tient, for that patient does not tolerate soiling of any
degree. Moreover, when it is necessary to anastomose
loops of bowel of different sizes, as is necessary in doing
an end-to-end anastomosis between a large distended
loop of small bowel to a small collapsed bowel, or when
one unites small bowel to colon end-to-end, this can be
done very easily when one does it over clamps. By
varying the angle that the clamp is placed on the
two loops of bowel, one can easily make the opening
the same size in the ends to be joined together.
The arguments of those who advocate the open anas-
tomosis hold true for the most part only in those cases
where one has the time and opportunity to preoperatively
sterilize the bowel content. In the five cases which we
have just presented we had no chance to prepare the
bowel. In all of these, done in the face of acute ob-
struction where haste was essential, the closed type of
resection stood us in good stead. To me, they represent
situations where the closed type resection attains its
greatest value and gives your patient a protection from
infection that you cannot give him in any other way.
Since Dennis published his artcile in 1943, I have used
his method in bowel resection almost routinely and I
like it very much. Using it, no end-to-end anastomosis
has failed to open on scheduled time, and except for the
patient cited here who died of a heart attack four days
after operation, I have had no deaths. His method dif-
fers from others in that it requires a 45° rotation of
each end of the bowel in opposite directions so that
the mesentery of the distended loop will be on the op-
posite side to that of the collapsed loop. This means
that in an end-to-end anastomosis instead of ending up
November, 1950
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MINNEAPOLIS SURGICAL SOCIETY
with a junction witli a 90° angle as is customary, one
ends up with a straight tube.
Case 7. — A woman, aged thirty-nine, for two weeks
ran a septic course with right abdominal pain and devel-
oped a mass in the right side of the abdomen.
On October 19, 1948, she was admitted to the hos-
pital. The pain, mass and septic temperature persisted.
Sulfasuxidine was started. A flat x-ray plate showed a
mass on the right side and a dilated small bowel.
A barium enema on October 20 showed a narrowed
terminal ileum. A flat plate on October 22 showed in-
creasing small bowel distention.
At operation on October 22 a regional ileitis was found,
with an abscess between the ileum and cecum. This was
resected. An end-to-end anastomosis was made between
the ileum and the transverse colon.
The postoperative temperature never went over 99.2°
and the patient was discharged on January 30, 1948.
We present this case because it allowed us to accom-
plish something which was unique in our experience.
At the time of operation we found dilated loops of small
bowel terminating in a mass between the last foot of
small bowel and the ascending colon. There, protected
by the agglutinated bowels anteriorly and laterally and
sealed by the parietal peritoneum posteriorly, was an
abscess. Starting along the lateral wall of the ascending
colon and getting into a line of cleavage behind the
visceral peritoneum, we were able to remove the terminal
ileum, cecum, ascending and right part of transverse
colon which enclosed the abscess without rupture. An
end-to-end anastomosis was carried out. Her tempera-
ture subsequent to operation never going over 99.2° is
indicative of her uneventful convalescence. It is only
on the rarest occasions that the anatomy makes it pos-
sible to remove an intra-abdominal abscess intact.
The results of surgical treatment of regional enteritis
are notably poor. There is much argument whether one
should do only a short circuiting operation or a radical
resection of the diseased tissue. Operation should be
postponed until the late stages of the disease and should
be used primarily in the treatment of complications —
obstruction, abscess, hemorrhage, fistulas, et cetera.
Case 8. — A woman, aged seventy-six, had a sudden
onset of colicky abdominal pains with vomiting on No-
vember 24, 1947.
The colicky pains persisted the next day without
flatus being expelled.
A flat x-ray plate of the abdomen taken November 26
showed a distended small bowel.
On November 28 a flat plate showed gas in the
biliary tract.
On November 30 a flat plate showed the gas in the
small bowel practically gone but much in the colon.
On that day a gallstone 1.5 inches in diameter was ex-
tracted from the rectum.
An x-ray on December 1 showed that barium, taken
orally, appeared in the biliary tract. The patient was
discharged that day.
In the diagnosis of gallstone obstruction the most
important thing is that it be considered as a possibility.
If one thinks of it, it may be possible to work out a
preoperative diagnosis. Until recent years the diagnosis
preoperatively was indeed a rarity. Rigler and Borman
called attention to air in the biliary passages as indicat-
ing the presence of a fistula between the bowel and the
biliary tract. Clinically an obstruction that relents and
recurs should suggest obturator obstruction. Tender-
ness is often present when gangrene is starting over the
gallstone at the site of obstruction.
Treatment is usually early surgery though occasional-
ly, as in this case, it is not necessary. There is no
doubt in my mind that many gallstones pass through the
fistula and the bowel, causing only partial obstruction
without many symptoms.
Case 9. — A woman, aged forty, had an ovarian cyst
removed by a gynecologist on November 25, 1947.
On December 1, 1947, she experienced mild gas pains.
They became more severe two days later and were ac-
companied by emesis. A flat x-ray plate showed dis-
tended loops of small bowel.
On December 3, 1947, the patient was seen in con-
sultation. A second operation was performed, and about
two feet of the middle portion of the ileum were found
glued together by firm adhesions. These were separated.
Convalescence was uneventful.
Obstructions occurring during the postoperative period
always present a most difficult problem. This case is
presented because it not only is unusual that such firm
plastic adhesions should have formed so early, on the
ninth day following operation, but also to show the
change that has taken place in my feeling about the
treatment of simple small bowel obstruction. A few
years past we probably would have been content to treat
this patient conservatively by an indwelling Levine or
gastrointestinal tube — at least for a day or two. Instead,
we operated on this patient within a few hours after see-
ing her. On finding the firm plastic adhesions that caused
marked obstruction we had no regrets for doing so.
It is my feeling that in spite of the progress that has
been made in making more efficient gastrointestinal tubes
and better methods of getting them through the pylorus,
that there is a definite trend away from the conserva-
tive therapy of intestinal obstruction. While conserva-
tive therapy using intestinal intubation often relieves the
obstructing mechanism in adhesive obstruction, it is a
blind uncertain method even when followed carefully
with flat x-ray plate and leukocyte counts. Using this
type of therapy one can very easily miss a necrosing
adhesive band, a gallstone obstruction, an internal hernia,
mesenteric thrombosis, intussusception, volvulus, et
cetera. That this change of policy is taking place at the
University of Minnesota which has been the center of
conservative therapy in simple small bowel obstruction
is shown by the following two quotations. Dennis in
October 25, 1946, in the Bulletin of the University of
Minnesota Staff Meeting states, “the general policy at
the University hospital is to treat these cases of small
bowel obstruction which appear simple, by nasal suction
syphonage without operative interference.” Dennis in
October, 1949, in Surgical Clinics of North America
states, “with our recent adoption of exploration of
nearly all cases of small bowel obstruction, early recog-
nition of strangulation has assumed less importance.”
And there are good reasons for this change of attitude.
For while the hazards of conservative therapy in simple
mechanical obstruction remain constant, the dangers of
operation have steadily lessened. Better anesthesia, the
antibiotics, and the use of blood have been helpful here
as in all types of surgery. Specifically, however, there
1141)
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MINNEAPOLIS SURGICAL SOCIETY
are three major advances which have had a real influ-
ence. One of these is the aseptic suction enterostomy of
W angensteen which allows one to deflate distended loops
of bowel so that one can see the obstructing point and
can get at it without injuring distended loops of bowel.
This is particularly useful in dealing with adhesive bands
located in the pelvis.
The second is the aseptic resection method of Dennis
which permits of easy end-to-end anastomosis in loops
of bowel of different size. This can be used with little
danger of peritonitis in acute obstructions where there
has been no chance to prepare the bowel.
The third factor is the development of a better type
of gastrointestinal tube and better methods of introduc-
ing same. Dr. John Wild has brought out a gastro-
intestinal tube that is a real improvement. The chief
reason for this is that it has only one large suction open-
ing protected on one side by the mercury sac and on
the other by the air balloon so that the wall of the bowel
is not sucked into the opening, thus plugging it. When
this tube is used as an adjunct to the operative treat-
ment of acute small bowel obstruction, it lends a margin
of safety that really is a factor. For there is no ques-
tion but that a well functioning gastrointestinal tube
can overcome the toxic effects of distention better than
any other method, and it has been amply demonstrated
that distention is the major lethal factor in the cause
of death in acute intestinal obstruction. For it has been
shown, that even in the face of complete obstruction
that toxemia and shock are not likely to occur if disten-
tion is controlled. Unless a well functioning gastroin-
testinal tube is used in conjunction with surgery, the
toxic effects of distention may persist several days be-
fore the bowel can sufficiently regain its tone of func-
tion again.
One trouble in the past has been that we have used
the tube to treat the obstruction instead of using the
tube merely as a means to relieve distention. The fact
that at times adequate decompression may so alter the
obstructing mechanism so as to allow the obstruction to
relent does not alter the fact that suction drainage is
actually a means of controlling distention and as such it
should be used.
If we keep this thought in mind we can place the in-
testinal tube in its proper place in our armamentarium
used in the treatment of intestinal obstruction. As men-
tioned above, it has real value when used as an ad-
junct to the operative treatment of intestinal obstruction.
Here it may be either introduced before operation where
we may be able to quickly decompress distended loops
and thus make our operation easier, or continuing with
it or introducing it after operation, we can use it to
offset the toxic effects of distention until such time as
the bowel can take over its normal function again, often
a matter of 4 to 5 days.
Intestinal intubation is the treatment of choice in
neurogenic ileus. Here it has almost completely replaced
catheter enterostomy for it functions better and is far
safer. By a well functioning tube the patient is protected
from the lethal factor of distention until such time as the
bowel has recovered from the shock that has upset its
nervous mechanism and has again started to function.
Another ideal place for the use of the intestinal tube
is where an inflammatory mass or a diffuse peritonitis
may cause either ileus or mechanical obstruction. In
these cases if we can protect our patients from disten-
tion, we can tide them over while we use the powerful
antibiotics that we now have at our command to control
infection.
Dr. Grafton Smith has a new gastrointestinal tube
with a removable obturator made up of three wires one
of which is used to stiffen the tube and the other two
are used to guide the tip in various directions. Using this
under fluoroscopic guidance or on the operating table it
is possible to direct the tip of the tube in practically any
direction. It looks like the best yet.
Case 10. — A woman, aged fifty-eight, dated the onset
of lower abdominal pain to the time she had been cathe-
terized at the office of a urologist (November 5, 1948).
She was admitted to the hospital on November 8,
1948. There was marked abdominal distention. A cyst-
ogram failed to show any perforations of the bladder.
A flat plate showed small and large bowel distention.
A barium enema failed to show any obstruction in the
colon.
A diagnosis of ileus was made and a Wild intestinal
tube was inserted. The bowel was deflated in six
hours, after which a mass could be felt in the appendix
region.
No operation was performed and the mass subsided.
This last case represents a situation where the gastro-
intestinal tube demonstrated its effectiveness as a means
of combating ileus secondary to an inflammatory mass.
It had so well decompressed a markedly distended bowel
in about six hours time that we were able to feel the
appendicial mass and make a definite diagnosis.
In conclusion, if I were to make one plea or to leave
one thought it would be for the more judicious use of
both Levine and gastrointestinal tubes. A tube should
never be put down before you make your diagnosis.
As soon as a tube is inserted the picture changes, the
patient improves and the physician relaxes. Let the
clinical picture develop until you can make a diagnosis.
Use every clinical and laboratory and x-ray help that
you can command. Then, if you use a gastrointestinal
tube, you should do it with a definite therapeutic purpose
in mind. If you elect to treat a mechanical obstruction
with a gastrointestinal tube, do it realizing that you are
walking on thin ice and that you can easily fall into
deep trouble.
Meeting of February 3, 1950
At this meeting, the twenty-eighth anniversary din-
ner meeting, Dr. Warren H. Cole, professor of sur-
gery, University of Illinois, presented a paper entitled
“Benign and Malignant Goiter.”
Meeting of March 2, 1950
At this meeting Dr. Lawrence M. Larson and Dr.
John H. Rosenow presented “Solitary Pyogenic Liver
Abscess — Review of Literature and Report of Case.”
Dr. A. A. Zierold presented “Operating Room Cho-
langiograms.”
Officers were elected as follows : Dr. Harvey Nelson,
president ; Dr. Robert P. Caron, vice president ; Dr.
Albert T. Hays, recorder for three years, and Dr.
Robert F. McGandy, member of Council for five years.
William H. Rucker, M.D., Recorder
November, 1950
1141
Woman’s Auxiliary
DR. JUDD SPEAKS AT AUXILIARY WORKSHOP
Mrs. Leonard S. Arling
Approximately 100 county officers and state board
members of the Woman’s Auxiliary to the Minnesota
State Medical association attended the third annual
Workshop meeting, October 16, at the Saint Paul hotel.
After the morning board meeting, Auxiliary members
heard an inspiring address by Dr. Walter H. Judd, Con-
gressman from the Fifth District, “A Prescription for a
Healthy Government.” Highlights of Dr. Judd’s talk are
these :
“I have been thinking much lately of Abe Lincoln’s
remark at Gettysburg — ‘We are engaged in a great Civil
War, testing whether that nation, or any nation, so
conceived and so dedicated can long endure.’ Early
Americans knew what made this country great, but do
the succeeding generations understand what made the
American system of government strong? Never has our
system of government — the system our forefathers left
Europe to found — been in such danger. Our system of
government puts primary concern upon the many — gov-
ernment from the bottom up. Our system releases the
great creative capacities in each individual. Would a
bureaucratic dictatorship select a half-illiterate garage
mechanic (Henry Ford) to put the world on wheels?
Or would a half-deaf butcher (Edison) have been
asked to light the world and produce the phonograph
and the movies?
“We are in the midst of a great world conflict and
also a conflict within America — the struggle between two
philosophies of life : one, that the state should guaran-
tee happiness, security, and keep absolute control of the
individual, and two, that the state should only guarantee
the right of the individual to pursue happiness, to have
the freedom to take risks, to make his own decisions.
“Doctors and their wives have an obligation as citizens
of our republic —
Six Obligations
“1. Don’t be a radical who says that three-fourths of
Americans can afford adequate medical care, one-fourth
cannot, therefore let’s throw out the whole thing and
start over with compulsory health insurance.
“2. Don’t be a conservative and say that nothing is
wrong.
“3. Be a progressive conservative and strive to keep
what is good, continuing to improve what is bad.
“4. Work night and day to show that which is good
in our government.
“5. Speak out for the things we believe.
“Karl Marx’ ideas changed the world. We can do it
constructively as others do it destructively.
“6. Doctors and their wives should help select candi-
dates, work in county and district and state caucuses to
nominate candidates. Doctors and their wives should help
elect candidates by voting themselves and seeing that
others get out and vote.”
Mrs. Waas Prerides
Afternoon speakers were Mrs. Harold F. Wahlquist,
Minneapolis, president-elect, Woman's Auxiliary to the
American Medical Association : “Medicine’s Educational
Program Miss Helen K. Johnson, Saint Paul, assistant
medical claims manager, Minnesota Medical Service :
“Growing Pains Allan Stone, Saint Paul, executive
director, Minnesota Division, American Cancer Society;”
Mrs. James P. Tyrell, Saint Paul, chairman, Board of
Directors, Antone Guild : “Our Lady of Good Counsel
Cancer Home;” and the main speaker, Mrs. Leo J.
Schaefer, Salina, Kansas, first vice president, Woman’s
Auxiliary to the American Medical Association : “The
Auxiliary at Work.”
The educational film “Breast Self-Examination” was
shown.
Mrs. Charles W. Waas, president, Woman’s Auxiliary
to the Minnesota State Medical Association, presided at
the meeting. Mrs. Roger S. Countryman was chairman.
BLUE EARTH COUNTY AUXILIARY
HELPS SPONSOR HEALTH DAY
Mankato’s second Health Day, held October 11, was a
“Community Mental Health Day,” sponsored by the Blue
Earth County Medical Society and Auxiliary, Blue
Earth-Nicollet Counties’ Citizens’ Mental Health Com-
mittee, District Health Unit No. 2 of the Minnesota
Department of Health, Mankato State Teachers College,
and the Mankato Branch, American Association of Uni-
versity Women.
Dr. H. T. Nilson, councilor of the Fourth District,
Minnesota State Medical Association, presided during
the afternoon session.
Outlines State Program
Minnesota’s Mental Health Program was outlined by
Dr. Ralph Rossen, commissioner of mental health, and
Justin Reese, acting secretary, Minnesota Mental Health
Council. Two films were shown: “Life With Junior”
and “Preface to a Life.” The afternoon session concluded
with the panel discussion, “The Emotional Development
of the Child,” Dr. William S. Chalgren, Mankato neurol-
ogist and psychiatrist, moderating; Mrs. J. E. Wettleson
and Dr. Harry R. Meyering, both of Mankato Teachers
College; Rev. Charles L. Duxburv, pastor, First Chris-
tian Church, Mankato; Emil M. Meurer, juvenile proba-
tion officer, Blue Earth. Nicollet and Le Sueur counties;
participating.
How Parents React
Dr. A. A. Schmitz, president, Blue Earth County
Medical Society, presided at the evening meeting. Dr.
Roger W. Howell, associate professor of neuropsychiatry,
LTniversity of Minnesota, talked on “Parents’ Reactions
to Their Children.”
Dr. A. G. Liedloff, medical director of District Health
Unit No. 2, Minnesota Department of Health, was gen-
eral chairman. Miss Alberta Marshall of the A.A.U.W.
and Mrs. W. B. Kaufman were co-chairmen of general
arrangements with a committee made up of members of
the medical auxiliary and Citizens Mental Health Com-
mittee.
A MESSAGE FROM THE CHAIRMAN
Mrs. Benjamin B. Souster
This year, as in the past, the editors of Minnesota
Medicine are being most generous in the space given us
for Auxiliary news. For the continued interest of read-
ers, the Woman’s Auxiliary to the Minnesota State
(Continued on Page 1146)
1142
Minnesota Medicine
Constipation
in the Postsurgical
or Bedridden Patient
The combined effects of enforced inactivity, poor appetite and
dietary restrictions frequently result in bowel sluggishness.
By adding bland "smoothage” and assuring a normal fecal
consistency and volume, Metamucil gently initiates reflex peri-
stalsis and encourages a return of normal bowel function.
METAMUCIL8 is the highly refined mucilloid of
Plantago ovata (50%), a seed of the psyllium group, combined
with dextrose (50%) as a dispersing agent. G. D. Searle & Co.,
Chicago 80, Illinois.
RESEARCH
IN THE SERVICE OF MEDICINE
SEARLE
November, 1950
1143
♦ Reports and Announcements ♦
MINNESOTA SOCIETY OF NEUROLOGY
AND PSYCHIATRY
The regular meeting of the Minnesota Society of
Neurology and Psychiatry was held at the Town and
Country Club, Saint Paul, on November 14. The
scientific program consisted of the presentation of the
following papers: “Treatment of Subarachnoid Hemor-
rhages and Aneurysms” by Dr. Paul S. Blake, Hopkins,
and Dr. Lyle A. French, Minneapolis; “Clinical Applica-
tion of the Electroencephalogram” by Dr. V. Richard
Zarling, Minneapolis.
CONTINUATION COURSES
Clinical Chemistry. — The University of Minnesota an-
nounces a continuation course in clinical chemistry for
internists, pediatricians, and general physicians, Decem-
ber 7 to 9. Dr. John T. Merrill of Boston, Massachusetts,
will be the visiting faculty member for the course.
Obstetrics. — A continuation course in obstetrics will be
presented at the University of Minnesota on December
15 and 16. The course is intended for general physicians.
Visiting faculty members for the course will include
Dr. Emil G. Holmstrom, University of Utah Medical
School,, Salt Lake City, Utah; Dr. Curtis J. Lund,
Louisiana State University Medical School, New Or-
leans, Louisiana, and Dr. Charles E. McLennan, Stanford
LIniversity Medical School, San Francisco, California.
Geriatrics. — The University of Minnesota announces a
continuation course in geriatrics for internists and general
physicians January 4 to 6. Distinguished visiting physi-
cians who will participate as faculty members for the
course include Dr. E. V. Cowdry, St. Louis, Missouri ;
Dr. William Dock, Brooklyn, New York; Dr. Nathan
Shock, Bethesda, Maryland ; Dr. E. J. Stieglitz, Washing-
ton, D. C., and Dr. E. L. Tuohy, Duluth, Minnesota.
Clinical Neurology. — Distinguished physicians who will
participate as faculty members in a continuation course
in clinical neurology to be presented by the University
of Minnesota at the Center for Continuation Study from
January 29 to February 10 are as follows : Dr. Pearce
Bailey, Georgetown University School of Medicine,
Washington, D. C. ; Dr. H. W. Magoun, University of
California Medical School ; Dr. Henry Schwartz, Wash-
ington University School of Medicine, St. Louis, and
Dr. S. Bernard Wortis, New York University Medical
Center. Dr. Magoun will also deliver the annual T. B.
Johnston lecture on the subject, “Wakefulness and
Sleep.”
PARKINSON'S DISEASE FOUNDATION
Plans of the newly organized Parkinson’s Disease
Foundation, with national headquarters at 744 Broad
Street, Newark, N. J., were recently announced. Officials
stated that plans are being made for setting up units of
the Foundation in the major cities of the United States,
to provide treatment for persons afflicted with the disease,
of whom there are estimated to be one million sufferers.
Medical advisors for the Foundation include Dr. John
C. Button, Jr., medical director of the Button Neuro-
logical Institute, Orange, N. J., Dr. Thomas Meyers of
the Meyers Clinic, and Dr. K. G. Bailey, neurosurgeon
of the Los Angeles County Hospital, both of Los
Angeles, California.
RICE COUNTY SOCIETY
Dr. J. J. Kolars, Faribault, was elected secretary-
treasurer of the Rice County Medical Society at a meet-
ing held in Faribault on September 26. The post of
secretary-treasurer was the only office for which an
election was held.
The principal topic for discussion at the meeting was
the problem of civil defense in the area. Dr. C. W.
Rumpf, Faribault, was the principal speaker and mod-
erator in the discussion.
STEARNS-BENTON COUNTY SOCIETY
At the October meeting of the Stearns-Benton County
Medical Society, Dr. Gordon R. Kamman, Saint Paul,
presented a talk on “Psychosomatic Medicine.”
Dr. Reuben F. Erickson, Minneapolis, chairman of the
Policy Committee of the Minnesota State Medical Asso-
ciation, was also a guest speaker at the meeting.
WABASHA COUNTY SOCIETY
The eighty-second annual meeting of the Wabasha
County Medical Society was held at Wabasha on Oc-
tober 5.
During the afternoon business session officers were
elected to serve as follows : Dr. William P. Gjerde,
Lake City, president ; Dr. Doreen A. Martin, Wabasha,
vice president ; Dr. W. F. Wilson, Lake City, secretary,
and Dr. B. A. Flesche, Lake City, assistant to the
secretary. The society members also discussed and en-
dorsed participation in the current educational campaigns
and public health programs.
Preceding the evening scientific session, Dr. A. J.
Chesley, executive officer of the Minnesota State Board
of Health, discussed medical preparedness in civil de-
fense.
The scientific session consisted of the following pre-
sentations: President’s Address, “Acute Pancreatitis” by
the retiring president, Dr. L. M. Ekstrand, Wabasha;
“A Review of the More Common Neurologic Disorders”
by Dr. L. M. Eaton, Rochester; a color motion picture,
“An Improved Technique for the Operative Treatment of
Common Anorectal Lesions.”
Thirty-two persons attended the dinner held between
the business and scientific sessions. During the evening
the ladies attending were entertained at the home of Dr.
and Mrs. Ekstrand.
WRIGHT COUNTY SOCIETY
Dr. W. E. Hall, Maple Lake, was elected president of
the Wright County Medical Society at its meeting at
Buffalo on October 10. Also named to office were Dr.
Waldo Anderson, vice president, and Dr. Theodore
Catlin, secretary-treasurer, both of Buffalo.
1144
Minnesota Medicine
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November, 1950
1145
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City
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In Memoriam
OTIS O. BENSON. SR.
Dr. Otis O. Benson, Sr., eighty-three, of Willmar,
Minnesota, died in Minneapolis on October 16 following
a protracted illness. Uremia was given as the immediate
cause of his death. Funeral services were conducted in
Minneapolis on October 19 with final interment at Jeffer-
sonville, Ohio.
Dr. Benson was born in 1867 at Jeffersonville. He took
his B.A. degree from Ohio Northern University at Ada,
Ohio. He also graduated from the University of Iowa
in 1898, and from Rush Medical College in 1902. A
life-long member of the American Medical Association,
he retired in 1947 after more than forty-five years
practice.
He is survived by two children : Brig. Gen. Otis O.
Benson, Jr., Commandant of the U. S. Air Force School
of Aviation Medicine, Randolph AFB, Texas, and Mrs.
L. A. Utrecht of South Charleston, Ohio.
NIMROD A. JOHNSON
Dr. Nimrod A. Johnson, a surgeon in Minneapolis
prior to his retirement in 1936, died at his home in Santa
Monica, California, September 6, 1950, following a
cerebral hemorrhage.
Dr. Johnson was born in Saint Paul, October 1, 1880.
He graduated from the University of Minnesota medical
school in 1905, and interned at Swedish Hospital, Min-
neapolis. He practiced general surgery in Minneapolis
and with his brother, Dr. Norton T. Johnson, founded
the Bloomington-Lake Clinic.
Dr. Johnson was an affiliate member of the Hennepin
County Medical Society, the Minnesota State Medical
Association, the American Medical Association and the
American College of Surgeons. He was also a Mason
and a member of the Scottish Rite and Zuhrah Temple
of the Shrine.
Besides his brother, Dr. Johnson is survived by his
wife, Florence, and two daughters, Mrs. Clifford F.
Traff, Minnetonka Beach, and Mrs. Jerome Hiniker,
Falls Church, Virginia.
WOMAN'S AUXILIARY
( Continued from Page 1142)
Medical association is eager to hear from every county
in the state.
Articles on newly organized Auxiliaries and plans for
the coming year will be greatly appreciated, as well as
information about local meetings, programs and Health
Days. These may be sent to Mrs. B. B. Souster, 1333
Bohland Place, Saint Paul 5, Minnesota. Personal news
items may be sent to the chairman of the Newsletter,
Mrs. L. S. Aiding, 2310 E. 43rd St., Minneapolis, Min-
nesota.
1146
Minnesota Medicine
promotes
aeration . . . free drainage
I
L
Nasal engorgement and hypersecretion
accompanying the common cold and sinusitis are
quickly relieved by the vasoconstrictive action of
Nasal membrane showing increased
leukocytes with denudation of cilia.
Normal appearing nasal epithelium.
NEOSYNEPH RINE
HYDROCHLORIDE
Brand of Phenylephrine Hydrochloride
The decongestive action of several drops in each
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Relatively nonirritating . . . Virtually no central
stimulation.
Supplied in 14% solution (plain and aromatic),
1 oz. bottles. Also 1% solution (when greater con-
centration is required), 1 oz. bottles, and Vi%
water soluble jelly, s/s oz. tubes.
November, 1950
Neo-Synephrine, trademark reg. U. S. & Canada
1147
Of General Interest
♦
♦
Dr. Philip S. Hench and Dr. Edward C. Kendall,
of the Mayo Clinic, and Dr. Jadeusz Reichstein, of
the University of Basel, have been awarded the
Nobel Prize in medicine for 1950. The prize money,
amounting to 164,303 crowns ($31,715), will be
divided between the three doctors and presented to
them at Stockholm on December 10. It was Dr.
Kendall who discovered cortisone about ten years
ago and Dr. Hench who applied it clinically in the
treatment of rheumatoid arthritis. Dr. Reichstein
shared in the development of the chemistry of the
extracts.
* * *
Word has been received that Dr. Alexander M.
Boysen, a graduate of the University of Minnesota
Medical School in 1948, was reported on July 12
as missing in action in Korea. Six weeks later noti-
fication was received by his wife that Dr. Boysen
was being held as a prisoner of war.
A native of Minnesota, Dr. Boysen served his
internship at St. Francis Hospital, Pittsburgh, Penn-
sylvania. He then accepted a three-year Army
clinical residency and was assigned to Madigan
General Hospital at Fort Lewis, Washington. He
was sent to Yokohama, Japan, in May of 1950 for
ninety days of temporary duty. While there he was
assigned to the 24th Infantry Division and sent to
Korea. At the time of his capture by the North
Koreans he held the rank of captain in the medical
corps.
* * *
On October 4, Dr. John F. Madden, Saint Paul,
spoke before the permanent and consulting staffs of
the Veterans Hospital at Lincoln, Nebraska, on the
subject, “Cutaneous Manifestations of Internal Dis-
eases.”
* * *
Dr. C. G. Uhley, Crookston, spoke on a radio pro-
gram entitled “Cancer on Trial,” which was presented
over station KROXj Crookston, on September 20.
Dr. Uhley is the local chairman for the Minnesota
Division of the American Cancer Society.
* * *
Dr. William F. Braasch of Rochester was named
president of the Minnesota Public Health Associa-
tion at its annual meeting in Coffman Memorial
Union, October 24. He succeeds Edward A. Knapp,
Saint Paul attorney, who has been president for
several years.
* * *
Dr. John M. Fallon of Wooster, Massachusetts, was
elected president of the Mayo Foundation Alumni
Association at the annual meeting on October 20.
Other officers elected were Dr. John L. Kleinhechsl,
Wichita, Kansas, first vice president; Dr. Nat H.
Copenhaver, Bristol, Tennessee, second vice presi-
dent; Dr. James F. Weir, Rochester, secretary, and
Dr. Edward S. Judd, Rochester, associate secretary
and treasurer.
Dr. Thomas J. Kinsella, Minneapolis, is retiring
president.
* * *
Six nurses with many years of service to the cause
of tuberculosis were honored with a dinner in Coff-
man Memorial Union on October 24. Two Saint
Paul nurses are Sibba Axford, chief nurse at Mineral
Springs Sanatorium at Cannon Falls from 1924 to
1948 and who is now a supervisor at St. Luke's hos-
pital in Saint Paul, and Margaret Weikert, resident
director of the Ramsey County Childrens Preven-
torium and a staff member there for thirty-three
years. The four others are: Mrs. Sue T. Naysmith,
head of t lie department of nursing at Glen Lake
Sanatorium from 1920 until her retirement in 1941;
Mathilda Hallberg, who is now employed at South-
western Minnesota Sanatorium in Worthington;
Alice Sorenson, chief nurse at Granite Falls; and
Lulu Healy, who was chief nurse at Minnesota
State Sanatorium, Ah-Gwah Ching, from 1917 until
1940.
More than 200 Christmas seal workers from all
Minnesota counties attended the dinner and were
addressed by Leigh Mitchell Hodges, Philadelphia
columnist and one of the founders of the Christmas
seal campaign. Dr. E. M. Hammes, Sr., presided
at the meeting which was in connection with a
course in tuberculosis control for lay persons given
at the University.
* * *
Dr. Dewey E. Moorehead of Owatonna was elected
grand high priest of the Minnesota Royal Arch Ma-
sons at the annual meeting of the organization in
Saint Paul on October 10.
* * *
Dr. Lloyd S. Nelson, Minneapolis, spoke on
“Rheumatic Fever in Children, with Special Em-
phasis on the Differential Diagnosis” at a meeting
of the Lyon-Lincoln County Medical Society at
Marshall on October 10, The meeting was part of
the forty-second semi-annual clinic course sponsored
by the society.
* * *
Dr. Carl J. Lind, formerly of Minneapolis, has
been promoted from lieutenant colonel to colonel
at the Brooke Army Medical Center, Fort Sam
Houston, Texas, where he is chief of the laboratory
service. A graduate of the University of Minnesota
Medical School, Dr. Lind took four years of post-
graduate work in surgery and roentgenology at the
university. He also specialized in pathology.
* * *
Dr. W. F. Mercil was away from Crookston dur-
ing the last two weeks of September while he at-
(Continued on Page 1150)
1148
Minnesota Medicine
TAY healthy financially
by
AVING that part of each dollar
that belongs to you
Our exclusive
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THE MINNESOTA MUTUAL LIFE INSURANCE COMPANY
1880 — 70th Anniversary — 1950
November, 1950
1149
OF GENERAL INTEREST
(Continued from Page 1148)
tended meetings of the Central Obstetrical and
Gynecological Society at Milwaukee and at Chicago.
Efe also attended a three-day conference at the Uni-
versity of Minnesota Center for Continuation Study.
* * *
September 16 was Dr. Farrish Day at Sherburn.
On that day Dr. Robert C. Farrish, who has com-
pleted fifty years of medical practice, celebrated his
eighty-third birthday and received congratulatory
messages from his friends. The day was proclaimed
in his honor by the mayor of Sherburn.
* * *
Dr. John J. Bittner, director of cancer biology at
the University of Minnesota and George Chase
Christian professor of cancer research, was presented
with the second annual Minnesota award of the
American Cancer Society at a dinner in Coffman
Memorial Union on September 22.
* * *
Technicians, nurses, bookkeepers, secretaries and
receptionists employed by members of the Henne-
pin County Medical Society have organized a new
group, the Medical Assistants of Hennepin County.
First president of the organization is Dorothy Reid.
Civil defense volunteer work with the Red Cross is
one of the first projects of the group.
* * *
Dr. Russell J. Moe, Duluth, became president of
the Central Association of Obstetricians and Gyn-
ecologists at its annual meeting in Milwaukee late in
September. Dr. Moe was named president-elect at
the 1949 meeting of the group in St. Louis. He has
been a member of the executive committee since 1941.
* * *
Late in September Dr. Chester J. Olson moved his
office and residence into his newly constructed, com-
bination office-and-home building in Belle Plaine.
The modern structure contains twelve rooms, six
used for the office and six for living quarters. The
entire building is heated by a radiant heating system.
%
The private duty nurses of the Minnesota Nurses
Association decided at their meeting held in the
Nicollet Hotel, Minneapolis, in October, to raise
their rates, effective in the near future. The fee for
the eight-hour periods from 7 a.m. to 3 p.m. and
11 p.m. to 7 a.m. will be increased from $10 to $12,
and the shift from 3 p.m. to 11 p.m., from $11 to $13.
They also decided that when more than one patient
is being nursed the rate will be $16 for the shifts of
7 a.m. to 3 p.m. and 11 p.m. to 7 a.m., and $17 for
the 3 p.m. to 11 p.m. shift. Also, types of nursing
which formerly required an additional dollar, such
as the nursing care of a mother and baby, tubercu-
losis patients and those with contagious diseases,
drug addicts, alcoholics and mentally ill now will re-
quire two dollars additional.
* * *
Dr. Harold S. Diehl, dean of medical sciences at
the University of Minnesota, was appointed by the
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1150
Minnesota Medicine
OF GENERAL INTEREST
Municipal Bonds and Inflation
Perhaps the most common problem confronting an investor today concerns the problem of
inflation and its eventual effect upon his savings. Mr. Phillips Barbour, Editor of the Bond
Buyer, addressed the Municipal Forum of the National Security Traders Association recently
on this problem — the quotations below are from this address:
“No sure way to avoid the ravages of inflation, if present, has yet been discovered. Our
discussion today is not intended to find a cure for the malady, however, but to point out
some of the reasons municipal bonds, in my opinion, will aid the American investor greatly
in maintaining an investment portfolio in as healthy a condition as is possible in the present
inflation and why he should not put all his eggs in the equity basket.
“Investments of many kinds have been suggested as suitable in these circumstances . . .
none supplies the perfect solution in practice. The more popular suggestions include real
estate, farm lands, growing trees, aging liquor, breeding live stock, jewels and precious stones,
works of art and, of course, commodities and common stocks or equities.
“The ideal investment, under present conditions, is one which provides:
( 1 ) Safety of principal — that is the most important requisite.
(2) Dependability of income — the larger the better, but regardless of size, it should be
dependable.
(3) Opportunity for growth — in both principal and interest.
(4) It must be realistic. There is a limit to the number of investors who can breed cattle,
for instance.
“Obviously, the majority of the suggestions I have mentioned do not fit entirely satisfactorily
into the pattern of requirements specified. Where they may possess one good feature, they
are deficient in others.
“Even after determining the category to be used, the problem of choosing the particular unit,
or units, to be bought is often the block over which the buyer stumbles. A decision must be
made as to the particular farm, commodity, work of art, or stock, which should be bought
after the die is cast, as to the category which is practicable for the investor to employ. All
oil stocks don’t invariably go up or all real estate always improve in value.”
That portion of Mr. Barbour’s address showing how municipal securities meet the require-
ments of the ideal investment outlined above, will appear in the next article.
We have reprints of Mr. Barbour’s address available and will be pleased to send you one.
without obligation, upon request.
JURAN & MOODY
MUNICIPAL SECURITIES EXCLUSIVELY
GROUND FLOOR
Minnesota Mutual Life Bldg.
St. Paul 1, Minnesota
TELEPHONES
St. Paul: Cedar 8407, 8408
Minneapolis: Nestor 6886
President on October 4 to a seven-member com-
mission to advise Selective Service on the drafting
of physicians and dentists for the armed forces. The
commission is headed by Dr. Howard Rusk, physi-
cian-writer for the New York Times.
* * *
Dr. Russell O. Sather, Crookston, presented one
of the panel discussions on practical problems of
health officers at a meeting of Minnesota health of-
ficers in Minneapolis on September 25. Dr. Sather’s
topic was “Small Town Housing.”
* * *
Excavation for construction of a new office build-
ing in North Saint Paul began late in September.
When completed, the building will house the offices
of Dr. A. E. Muller of North Saint Paul.
* * *
The city council of Biwabik on October 2 accepted
the resignation of Dr. R. B. Bray as health officer
and approved the hiring of Dr. S. C. Blackmore as
health officer. Dr. Bray’s resignation followed his
announcement that he had sold his hospital and was
moving to Rapid City, South Dakota (see Hospital
News).
* * *
This year, as in previous years, the RamSey County
Medical Society, not content to let the Community
Chest campaign alone, sent letters to all members
November, 1950
1151
OF GENERAL INTEREST
of the society, urging them to contribute generously
to the Community Chest. In addition, a special com-
mittee of the society organized speeches by campaign
leaders to the medical staffs of the city’s hospitals.
Such direct solicitation by the medical society, it was
announced, has raised the percentage of participa-
tion of doctors in Saint Paul to 86, in contrast to
a 64 per cent average in thirty-one selected cities.
* * *
It was announced on September 14 that Dr. George
L. Stuhler had become associated in practice with
Dr. N. T. Norris of Caledonia. Dr. Stuhler, it was
stated, would remain in Caledonia until the time
arrives for him to begin his fellowship at the Mayo
Clinic. A graduate of the University of Minnesota
Medical School, he served his internship at the De-
troit Receiving Hospital.
* * *
Dr. Frederick L. Behling, Oklee, attended a short
course in diseases of children at the Children’s
Memorial Hospital in Chicago during the middle of
September.
* * *
Dr. William S. Chalgren, Mankato, was the prin-
cipal speaker at a meeting of the fifth district of
the Minnesota Nurses’ Association in Mankato on
September 11. Dr. Chalgren’s topic was “Mental
Mechanism.”
* * *
Appointment of Dr. Charles W. Mayo, Rochester,
to the board of judges for the annual Dr. C. C.
Criss award was announced on October 25 by the
Mutual Benefit Health and Accident Association of
Omaha, Nebraska. The award, named for the
founder of the firm, consists of $10,000 and a gold
medal and goes to the individual who, in the judges’
opinion, has made the greatest contribution to public
health and/or safety during the year.
* * *
Dr. Lloyd C. Gilman, Willmar, left for Chicago
on October 9 to take a two-week postgraduate course
in fractures at the Cook County Hospital.
* * *
Sanborn lost its only physician on October 21
when Dr. Aldridge F. Johnson moved to Indianapolis
to become assistant superintendent of the Sunny-
side Tuberculosis Sanitorium there. Dr. Johnson,
who formerly was on the staff of the state sanitorium
at Roseau, practiced at Sanborn for almost two years.
* * *
Dr. A. J. Chesley, director of the Minnesota Health
Department, and his assistant, Dr. Robert Barr,
attended the United States Public Health Service
Conference in Washington, D. C., October 23
through 27. Medical aspects of civil defense were
discussed at the conference.
* * *
An address by Dr. John E. Haavik, Duluth, was
a feature of a meeting of the Duluth Multiple
Sclerosis Club on September 19.
* * *
Dr. Karl R. Lundeberg, former resident of Min-
neapolis and a graduate of the University of Min-
nesota Medical School, has been named director of
preventive medicine at the Army’s medical field
service school, Fort Sam Houston, Texas.
* * *
The Mayo Clinic emeritus staff now numbers
thirty-one members, seven of whom no longer live
in Rochester.
* * *
Construction has been completed on the new office
building of Dr. E. E. Zemke and Dr. William Mis-
bach in Fairmont. The modern-designed structure
houses two consultation rooms, four examining
rooms, laboratory, first aid room, pediatric room,
rooms for x-ray and other diagnostic apparatus, and
an office suite for a dentist.
* * *
Both the Hennepin County and Ramsey County
Medical Societies now offer a telephone answering
service to enable the public to obtain immediate
medical attention at any hour of the day or night.
The service is designed to aid persons who cannot
reach their own physician — or do not have one —
when a medical emergency arises. The service is
especially valuable to persons who have recently
moved to Minnapolis or Saint Paul and who do not
know a physician.
The telephone number of the service in Saint Paul,
conducted by the Ramsey County Medical Society,
(Continued on Page 1154)
Homewood hospital is one of the
Northwest's outstanding hospitals for the
treatment of Nervous Disorders — equippec
with all the essentials for rendering high-grade
service to patient and physician.
Operated in Connection with
Glenwood Hills Hospitals
HOMEWOOD HOSPITAL
Corner Penn and Plymouth Avenues North
Minneapolis Minnesota
1152
Minnesota Medicine
If You Are Called Into Service—
If You Are Too Old to Be Called Into Service—
In either event the rebellion in Korea affects your pocketbook in a major
way, which will be reflected in your accounts receivable.
Soldiers Relief from their financial obligations has again been invoked
making it impossible to enforce collection against anyone in the Armed
Forces.
With our many years of valuable experience in handling the accounts
for over 1,000 professional men, there is now an influx of professional
accounts to this office due from patients about to enter Military Service
where the possibility of immediate collection appears very problem-
atical.
Our tfeccfflinehdaticnd
Based upon our experience in liquidation of accounts prior to, during, and after World War II
(1) Concentrate effort on the collection of accounts against patients who
may be called in the Armed Forces.
(2) THE TIME TO COLLECT IS NOW because with inevitable continued in-
flation, increased salaries and wages, farm prices, commodity prices,
there will be more money in circulation.
(3) That if you already have been called into the service or anticipate being
called that you permit this qualified organization to act as your liqui-
dating agent.
Our many years of experience handling accounts in the professional
field plus our contractual relationship with fifty trade associations ex-
tending from coast to coast, proves we are rendering outstanding serv-
ice.
Professional, commercial trade associations, and bank recommendations furnished.
Professional Credit
Protective Bureau
Division of
Thel.C. System
724 Metropolitan Bldg.
Minneapolis, Minn.
Further Inquiry Invited
FILL OUT AND MAIL COUPON NOW
Professional Credit Protective Bureau
724 Metropolitan Bldg.
Minneapolis, Minn.
Gentlemen:
Without obligation, pleasfe send complete in-
formation regarding this service.
Name
Address
City State
November, 1950
1153
OF GENERAL INTEREST
(Continued from Page 1152)
is CEdar 5751. The number of the Minneapolis
exchange, operated by the Hennepin County Med-
ical Society, is Fillmore 1411.
Any patient who is cared for by a physician on
one of these emergency calls is billed only by the
individual physician. There is no charge for the
special telephone service, which is offered to each
community as a public service by the members of
the two medical societies.
* * *
Dr. A. G. Sanderson has resigned as superintendent
of the Deerwood Sanatorium and has accepted a
position on the staff of the Anoka State Hospital.
* * *
Dr. Raymond C. Magnuson and Miss Janet Joyce
Widen, daughter of Dr. W. F. Widen of Minneapolis,
were married in Minneapolis on September 16. They
are now living in Cambridge. Dr. Magnuson is a
graduate of the LTniversity of Minnesota Medical
School.
Sfc $ %
Dr. F. Lionel Pickett, a general practitioner in
England, was guest speaker at a meeting of the
Kiwanis Club in Duluth on September 13. He
stated that he disliked the British medical plane
“intensely,” and he pointed out that the program is
defective because: (1) it will probably ruin England
financially since it already operates at a loss of
$900,000,000 annually; (2) the health of British peo-
ple is deteriorating under the plan; (3) specialists
have a far too heavy patient load and are being
forced to become general practitioners.
* * *
Dr. Curtis M. Johnson, formerly of Jackson, has
become affiliated in practice with Dr. M. I. Hauge
at the Clarkfield Clinic.
* * *
A law providing for vitamin and mineral enrich-
ment of all bread offered for public sale was urged
by Dr. Russell M. Wilder, Rochester, at a meeting
of the American Bakers Association in Chicago on
October 17. Dr. Wilder said that the dietary qualities
of enriched bread should be improved through the
use of more non-fat milk solids.
* * *
Dr. Walter H. Judd, Representative from Minne-
sota’s Fifth District, was a featured speaker at the
third annual Workshop of the Woman’s Auxiliary
to the Minnesota State Medical Association in Saint
Paul on October 16. The title of his talk was “A
Prescription for a Healthy Government.”
* * *
Four Rochester physicians were guest speakers at
the fifteenth annual assembly of the United States
Chapter, International College of Surgeons, in Cleve-
land from October 31 to November 3. The four
speakers were Dr. Virgil S. Counseller, Dr. Stuart
W. Harrington, Dr. John S. Lundy, and Dr. Gershom
J. Thompson. President-elect of the organization is
Dr. Henry W. Meyerding of Rochester.
iiiiiiiiiiiiiii,|||iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiimiiiiiiiiiiiiiiimiiiiiiiiiiiiiiiiimmiiiiiiiiimitiiiiiiiiiiiiiiiiimiiiiiiiii)£
THE VOCATIONAL HOSPITAL J
TRAINS PRACTICAL NURSES 1
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Miller Vocational High School. VOCATIONAL NURSES §
always in demand. 1
EXCELLENT CARE TO CONVALESCENT AND
CHRONIC PATIENTS
Rates Reasonable. Patients under the care of their own physicians, f
who direct the treatment. |
5511 Lyndale Ave. So. LO. 0773 Minneapolis, Minn. §
I II I II 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 II 1 1 1 1 1 1 1 1 1 1 II 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 11 1 1 II 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 L 1 1 1 1 1 1 1 1 1 1 1 II 1 II 1 1 1 1 1 1 1 II II M 1 1 1 1 1 1 II 1 1 1 1 1 1 1 1 1 1 1 II 1 1 II I II II M 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 11 II 1 1 1 1 1 1 1 M 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 11 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
The Birches Sanitarium, Inc.
2391 Woodland Avenue
Duluth 3, Minnesota
A hospital for the care and treatment of
Nervous and Mental disorders. Quiet, cheer-
ful environment. Specially trained personnel.
Recreational and occupational therapy.
Dr. L. R. Gowan, M.D., M.S., Medical Director
Attending Psychiatrists
Dr. L. R. Gowan Dr. C. M. Jessico
Dr. J. E. Haavik Dr. L. E. Schneider
1154
Minnesota Medicine
OF GENERAL INTEREST
* M}u MODIFIED
Rlfra with .*
^•maltose & dextro»
«Quj¥*ue»r to itf 'tUf0
*U? C0Mp«^nEO BY It S *■
umpm} INC., NEW Jjl
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Dextrogen®+ Water = Formula
T 1 fl. oz. l'/j fl. ozs. 2Vi fl. ozs.
(50 Cals.) (20 Cal.
per fl. oz.)
W ADVERTISED TO THE MEDICAL PROFESSION ONLY.
The late Dr. E. H. Loofbourrow, former Keewatin
school physician, was honored at a memorial pro-
gram staged by Keewatin students cm September 21.
A feature of the program was the presentation of a
picture of Dr. Loofbourrow to the school by the
Keewatin High School Class of 1950. Dr. Loof-
bourrow, who was school physician from 1915 to
1948, died last year.
Dr. Loren J. Larson moved to Buffalo during the
middle of October and became associated in practice
with Dr. John J. Catlin and Dr. Theodore J. Catlin.
A graduate of the University of Minnesota Medical
School, Dr. Larson has practiced in Watertown for
the last two years.
* * *
Dr. David P. Anderson, Austin, was elected to the
state board of directors of the Minnesota Division
of the American Cancer Society at a meeting of the
group in Minneapolis on September 22.
* * *
Dr. Maurice N. Walsh, formerly of Rochester, has
become chief of medical neurology for the Veterans
Administration in Topeka, Kansas, and a training
candidate in the Topeka Institute of Psychoanalysis,
Menninger Foundation.
Dr. Walsh, a graduate of the Detroit College of
Medicine and Surgery, moved to Rochester in 1934
where he became a fellow in medicine at the Mayo
Clinic. Later he transferred to neurology and
became a member of the staff in 1937. During World
War II he served as a psychiatrist with the Army
Air Force in the South Pacific area.
It was announced on September 22 that Dr. Joseph
S. Emond of Farmington was moving his offices to
a new location in the city. The new offices, in the
Feely Building, were being completely remodeled and
redecorated.
* * *
The two new geriatrics buildings at the Rochester
State Hospital were dedicated on November 2, with
Governor Luther W. Youngdahl as the principal
speaker. At the ceremonies, held in the administra-
tion building’s auditorium, thirty-six persons who
have been employed at the hospital for twenty-five
years or more were also honored.
* * *
In Blackduck, Dr. Harry A. Palmer has moved his
offices into his newly completed building, the Black-
duck Clinic. The modern-designed structure con-
tains eleven rooms, including reception room, treat-
ment rooms, x-ray room, private offices, and a den-
tal suite. The dental suite is occupied by Dr. S. L.
Conley.
* * *
Two former fellows in the Mayo Foundation were
awarded alumni association prizes at a reunion in
Rochester on October 19. Dr. C. A. M. Hogben,
now a National Research Council fellow in medical
sciences in Denmark, was given a prize for a paper
entitled “The Renal Excretion of Phosphate.” Dr.
November, 1950
1155
OF GENERAL INTEREST
AT YOUR CONVENIENCE,
DOCTOR . . .
you are cordially invited to visit our new
and modern prescription pharmacy located on
the street floor of the Foshay Tower, 100 South
Ninth Street.
With our expanded facilities we will be able
to increase and extend the service we have
been privileged to perform for the medical pro-
fession over the past years.
Exclusive Prescription Pharmacy
Biologicals Pharmaceuticals Dressings
Surgical Instruments Rubber Sundries
JOSEPH E. DAHL CO.
(Two Locations)
100 South Ninth Street, LaSalle Medical Bldg.
ATlantic 5445 Minneapolis
B. H. Scribner, now a first assistant in medicine at
the Mayo Clinic, was awarded a prize for research
on the application of water chloride balance tech-
nique to the clinical management of problems of
fluid balance.
* * *
Before Dr. Edwin Rose, chief medical officer of the
Minneapolis Veterans Hospital, was transferred to
the Washington office of the Veterans Administra-
tion, he was honored at a dinner in Minneapolis on
October 18 given by members of the Minneapolis
chapter of the Disabled American Veterans.
* * *
Dr. Ralph J. Gampell, former British physician,
discussed socialized medicine under bureaucratic con-
trol at a meeting of the Saint Paul Association of
Commerce on October 20. Dr. Gampell, who left
England in April, 1949, “to find freedom in medicine
as well as freedom as an individual,” as he states,
spoke under the auspices of the national education
campaign of the AMA. He is now a resident of
San Francisco, where he recently completed an in-
ternship and was licensed to practice.
* * *
Almost immediately after moving to Bagiev to be
associated in practice with Dr. L. J. Larson, Dr.
George Miners left for North Carolina in September
to complete a ten-week course for a degree for
which he had been working. Following completion
of the course, he expects to return to Bagiev to
begin permanent practice.
His colleague, Dr. L. J. Larson of Bagiev, was
honored for his twenty-five years of service in the
community at a banquet given by the Bagley Civic
and Commerce Association on September 12. Dr.
K. W. Covey, Mahnomen, was the principal speaker
at the banquet.
* * *
Dr. O. K. Behr, Crookston, discussed the subject,
“Know Your Heart,” on a radio broadcast over sta-
tion KROX, Crookston, on October 18.
* * *
A cancer teaching clinic for members of the med-
ical profession from Minnesota and Wisconsin was
held in Duluth on October 18. The principal speaker
at the meeting was Dr. Alexander Brunschwig, pro-
fessor of clinical surgery at Cornell LTniversity Med-
ical College, who spoke on “Radical Surgery in Ad-
vanced Cancer of the Female Genital Tract.” The
clinic was sponsored by medical societies of Minne-
sota and Wisconsin and by the state health depart-
ments and the state divisions of the American Cancer
Society.
* * *
Dr. Edwin G. Knight, Swanville, who was injured
in an automobile accident on September 1, returned
to his home on September 17, expecting to be back
in his office on a limited basis within a short time.
It was expected, however, that a few weeks would
pass before his fractured right arm would heal suf-
ficiently to enable him to assume his full duties.
(Continued on Page 1158)
1156
Minnesota Medicine
An Observation on the Accuracy of Digitalis Doses
Withering made this penetrating observation in
his classic monograph on digitalis: "The more I
saw of the great powers of this plant, the more it
seemed necessary to bring the doses of it to the
greatest possible accuracy.”1
To achieve the greatest accuracy in dosage and at
the same time to preserve the full activity of the
leaf, the total cardioactive principles must be iso-
lated from the plant in pure crystalline form so
that doses can be based on the actual weight of the
active constituents. This is, in fact, the method by
which Digilanid® is made.
Clinical investigation has proved that Digilanid is
"an effective cardioactive preparation, which has
the advantages of purity, stability and accuracy as
to dosage and therapeutic effect.”2
Average dose for initiating treatment: 2 to 4 tab-
lets of Digilanid daily until the desired therapeutic
level is reached.
Average maintenance dose: 1 tablet daily.
Also available: Drops, Ampuls and Suppositories.
1. Withering, W.: An account of the Foxglove, London, 1785.
2. Rim-merman, A. B.: Digilanid and the Therapy of Congestive
Heart Disease, Am. J. M. Sc. 209: 33-41 (Jan.) 1945.
Literature giving further details about Digilanid and Physician’s Trial
Supply are available on request.
Digilanid contains all the initial glycosides from
Digitalis lanata in crystalline form. It thus truly
represents "the great powers of the plant” and
brings "the doses of it to the greatest possible
accuracy”.
Sandoz
Pharmaceuticals
DIVISION OF SANDOZ CHEMICAL WORKS, INC.
68 CHARLTON STREET, NEW YORK 14, NEW YORK
dorestro
ESTROGENIC SUBSTANCES
(WATER -INSOLUBLE)
the name which signifies
• CONTROL
• UNIFORMITY
• MANUFACTURING
EXCELLENCE
T)
COUNCIL ACCEPTED
orseu
THE SMITH-DORSEY COMPANY • LINCOLN, NEBRASKA
Branches af Los Angeles and Dallas
MANUFACTURERS OF FINE PHARMACEUTICALS SINCE 1908
COMPLIANCE with the
highest scientific standards,
plus years of use by thou-
sands of physicians, have es-
tablished beyond doubt the
dependability of dorettro Es-
trogenic Substances, Water-
Insoluble. Supplied in 1 cc.
ampoules and 10 cc. vials in
aqueous suspension or persic
oil. Units from 5,000 to
20,000 per cc. in oil; up
to 50,000 per cc. in aqueous
suspension.
November, 1950
1157
OF GENERAL INTEREST
Cook County Graduate School of Medicine
ANNOUNCES CONTINUOUS COURSES
SURGERY — Intensive Course in Surgical Technic, two
weeks, starting November 27, January 22.
Surgical Technic, Surgical Anatomy and Clinical Sur-
gery, four weeks, starting November 6, February 5.
Surgical Anatomy and Clinical Surgery, two weeks,
starting November 20, February 19.
Surgery of Colon and Rectum, one week, starting
November 27.
Gall-Bladder Surgery, ten hours, starting April 23.
GYNECOLOGY — Intensive Course, two weeks, starting
February 19.
Vaginal Approach to Pelvic Surgery, one week, start-
ing March 5.
OBSTETRICS — Intensive Course, two weeks, starting
March 5.
RADIATION PHYSICS — Intensive Review Course,
four days, starting November 29.
ROENTGENOLOGY — Diagnostic and Lecture Course
first Monday of every month.
Clinical Course third Monday of every month.
X-Ray Therapy every two weeks.
DERMATOLOGY — Informal Clinical Course every two
weeks.
CYSTOSCOPY — Ten Day Practical Course every two
weeks.
PEDIATRICS — Informal Clinical Course every two
weeks.
General, Intensive and Special Courses in all Branches of
Medicine, Surgery and the Specialties.
TEACHING FACULTY— ATTENDING
STAFF OF COOK COUNTY HOSPITAL
Address: REGISTRAR, 427 South Honore Street
Chicago 12, Illinois
ACCIDENT * HOSPITAL ' SICKNESS
INSURANCE
FOR PHYSICIANS, SURGEONS, DENTISTS EXCLUSIVELY
ah /Thys,c,anX AH
^ PREMIUMS ^>1 SU»SEONS j<f CLAIMS <
V DENTISTS J
$5,000.00 accidental death $8.00
$25.00 weekly indemnity, accident Quarterly
and sickness
$10,000.00 accidental death $16.00
$50.00 weekly indemnity, accident Quarterly
and sickness
$15,000.00 accidental death $24.00
$75.00 weekly indemnity, accident Quarterly
and sickness
$20,000.00 accidental death $32.00
$100.00 weekly indemnity, accident Quarterly
and sickness
Cost has never exceeded amounts shown.
ALSO HOSPITAL POLICIES FOR MEMBERS
WIVES AND CHILDREN AT SMALL
ADDITIONAL COST
85c out of each $1.00 gross income used for
members’ benefits
$3,700,000.00 $16,000,000.00
INVESTED ASSETS PAID FOR CLAIMS
$200,000.00 deposited with State of Nebraska for protection of our members.
Disability need not be incurred in line of duty — benefits from
the beginning day of disability
PHYSICIANS CASUALTY ASSOCIATION
PHYSICIANS HEALTH ASSOCIATION
48 years under the same management
400 First National Bank Bldg., Omaha 2, Nebr.
(Continued from Page 1156)
Dr. Viktor O. Wilson, health officer of the Roches-
ter-Olmsted County Public Health Unit, was elected
president of the Minnesota Public Health Conference
in Minneapolis on September 25 and 26. He succeeds
Dr. F. W. Behmler of Morris.
HC 5fC %
Dr. Kenneth L. Buresh, formerly of Baxter, Iowa,
moved to Westbrook early in September and began
practice. He and Dr. John V. Carlson, the only
other physician in Westbrook, are occupying new
offices in a recently remodeled building in the city.
Dr. Buresh is a graduate of the University of Iowa.
^ ^ jjs
Forty-three years of medical practice in Detroit
Lakes were ended late in October when Dr. James
E. Carman closed his offices and moved to Glendale,
California. A graduate of the University of Minne-
sota Medical School, Dr. Carman began his Detroit
Lakes practice in 1907, a few years after his gradua-
tion.
* * *
The week of November 12 to 1 8 was designated
as Diabetes Detection Week, during which the
American Diabetes Association and its affiliates con-
ducted the annual diabetes detection drive with the
co-operation of the nation’s physicians. All persons
were asked to go to their own physicians for free
diabetic examinations. In many cities arrangements
were made with the city health department to ex-
amine urine specimens, and drug stores were des-
ignated as collection depots for the specimens. By
such methods members of the national organization
expected to discover about a million persons through-
out the country who have diabetes without knowing
it.
* * *
More than 200 guests attended an open house given
for Dr. Gustave L. Rudell, Minneapolis, in honor of
his seventy-fifth birthday on September 24. Born in
Sweden, Dr. Rudell came to America in 1892 and
attended the University of Minnesota Medical School.
He is still actively engaged in his medical practice.
HOSPITAL NEWS
It was announced in Biwabik late in September
that the Biwabik Hospital had been sold by Dr.
Robert B. Bray to Dr. Sidney C. Blackmore. Dr.
Blackmore, who has been associated in practice with
Dr. Bray for the past five years, said that the op-
eration of the hospital would continue in the same
manner as in the past.
Dr. Bray, who has been owner and manager of
the hospital for the past thirteen years, since the
death of his father, the late Dr. C. W. Bray, planned
to remain in Biwabik until an assistant could be
found for Dr. Blackmore. He then planned to move
to Rapid City, South Dakota.
The hospital, one of the first to he built on the
Mesabi Range, was originally constructed about
(Continued on Page 1160)
1158
Minnesota Medicine
200 acres on the shores of beautiful Lake Chisago
WHERE
ALCOHOLICS
ACHIEVE
INSPIRATION
FOR
RECOVERY
Where gracious living, a
homelike atmosphere and
understanding compan-
ionship contribute to suc-
cessful rehabilitation.
The methods of treatment used at the Hazelden Foundation are based on a true understanding of the
problem of alcoholism. Among the founders of the nonprofit Hazelden Foundation are men who have re-
covered from alcoholism through the proved program of Alcoholics Anonymous and who know the problems
of the alcoholic. All inquiries will be kept confidential.
HAZELDEN FOUNDATION
Lake Chisago, Center City, Minn. Telephone 83
EXCLUSIVE WITH qH/UHT
Fully Guaranteed by a 69- Year-Old Company
OVER 1,000,000 SATISFIED USERS
November, 1950
1159
OF GENERAL INTEREST
(Continued from Page 1158)
1892. The building was destroyed by fire in 1906
and was rebuilt by Dr. C. W. Bray. The Bray family
has owned the hospital since that time.
* * *
Dr. D. E. Stewart, a member of the Northwestern
Clinic staff in Crookston, was elected president of
the medical staff for Bethesda Hospital, Crookston,
at a meeting on September 26. Other officers include
Dr. G. S. Boyer, vice president, and Dr. A. R. Jen-
sen, secretaryj both members of the Northwestern
Clinic staff.
* * *
Dedication ceremonies for the new twenty-one
bed Wheaton Community Hospital were held in
Wheaton on October 2. Ceremonies included a
program at the school auditorium and a tour of the
hospital.
* * *
Construction of a million-dollar addition to St.
John’s Hospital, Saint Paul, is expected to begin
about March 1. The new wing will house seventy-
five beds, a children’s section, physical therapy de-
partment, a new chapel, and increased surgical, ob-
stetrical, laboratory, administrative and service space.
* * *
An organizational meeting of the medical staff of
the new Wells Hospital was held in Wells on Oc-
tober 5. Officers were elected as follows: Dr. Rich-
ard P. Virnig, chief of staff; Dr. William H. Barr,
vice president, and Dr. Mark P. Virnig, secretary-
treasurer, all of Wells.
BLUE CROSS-BLUE SHIELD NEWS
Enrollment in Minnesota Medical Service, Inc., as of
August 31, 1950, was 372,187, an increase of 111,686 to
date this year. Blue Cross enrollment as of the same date
totaled 1,029,718 participant subscribers.
Payments to doctors for the month of August totaled
$193,848 or 66.8 per cent of cash earned income and to
date this year payments total $1,321,836 or 71 per cent
of the cash earned income compared with $676,694 or
73.8 per cent for the same period last year. Blue Shield
claims for the month of August totaled 4,911 and pro-
vided payment for 5,877 medical-surgical services, an
increase of 299 claims or 405 services over the July pay-
ment. The total amount paid during the month amounted
to $193,847.65, an increase of $20,544.33 over the month
of July. The first eight months of 1950 Blue Shield
claims totaled 33,358 cases in the amount of $1,321,836.17.
Payments to unlimited subscribers amounted to 28.3
per cent of the total payments to doctors during August.
The payments to doctors for unlimited subscriber claims
paid during the first eight months of 1950 totaled
$391,443.52 or 29.6 per cent of the total payments com-
pared with 19.3 per cent during the same period of 1949.
During the month of August payment was made for
466 tonsillectomies. The number of surgical services paid
during the month increased from 3,123 or 57.1 per cent
in July to 3,285 or 55.9 per cent in August. 3,776 claims
or 76.9 per cent of the total paid were incurred in hos-
pitals during August compared with 77.1 per cent during
July. Payments for these hospitalized cases totaled
$176,850.15 compared with the July total of $158,448.07.
Claims for services rendered in doctor’s offices totaled
1,121 or 22.8 per cent of total compared with 22.3 per
cent during July.
On the year to date figures we show that 32,015 claims
have been paid to participating doctors in a total amount
of $1,258,173.37 with 652 claims being paid to non-
participating doctors in the amount of $33,864.08 and 691
claims in the amount of $29,798.72 being paid to out-of-
state doctors.
RELIABILITY!
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highest standards of quality, expert
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ARTIFICIAL LIMBS, TRUSSES,
ORTHOPEDIC APPLIANCES,
SUPPORTERS, ELASTIC HOSIERY
Prompt, painstaking service
Buchstein-Medcalf Co.
223 So. 6th St. Minneapolis 2, Minn.
RADIUM & RADIUM D+E
(Including Radium Applicators)
FOR ALL MEDICAL PURPOSES
Est. 1919
Quincy X-Ray and Radium
Laboratories
(Owned and Directed by a Physician-
Radiologist)
Harold Swanberg, B.S., M.D., Director
W.C.U. Bldg. Quincy, Illinois
In (2helLlti5 from LIPSTICK
Intractable exfoliative lip dermatoses may often be traced to eosin
lipstick dyes. Remove the offending irritants, and the symptoms
often disappear. In lipstick hypersensitivity, prescribe AR-EX NON-
PERMANENT LIPSTICK — so cosmetically desirable, yet free from all
known irritants. Send for Free Formulary.
PRESCRIBE
<8c
AR-EX
NON-PERMANENT
LIPSTICK
AR-EX COSMETICS, INC. 1036 w. van buren st. Chicago 7, ill.
1160
Minnesota Medicine
BOOK REVIEWS
North Shore
Health Resort
Winnetka, Illinois
on the Shores of
Lake Michigan
A completely equipped sanitarium for the care of
nervous and mental disorders, alcoholism and drug addiction
offering all forms of treatment, including electric shock.
SAMUEL LIEBMAN, M.S., M.D.
225 Sheridan Road Medical Director Phone Winnetka 6-0211
BOOK REVIEWS
Books listed here become the property of the Ramsey,
Hennepin and St. Louis County Medical Libraries when
reviewed. Members, however, are urged to write re-
views of any or every recent book which may be of
interest to physicians.
PRINCIPLES AND PRACTICE OF SURGERY. Jacob K. Ber-
man, A.B., M.D., F.A.C.S., Associate Professor of Surgery,
Indiana University School of Medicine; Associate Professor of
Oral Surgery, Indiana University School of Dentistry; Chief
Consultant in Surgery, Billing’s Veterans Administration Hos-
pital, Fort Benjamin Harrison, Indiana; Director of Surgical
Education and Surgical Research, Indianapolis General Hospital.
1378 pages. Illus. Price $15.00, cloth. St. Louis: C. V. Mosby
Co., 1950.
PROGRESS IN GYNECOLOGY. Volume II. Edited by Joe V.
Meigs, M.D., Clinical Professor of Gynecology, Harvard Medical
School; Chief of Staff of Vincent Memorial Hospital, the
Gynecological Service of the Massachusetts General Hospital :
Surgeon, Pondville Hospital; Gynecologist, Pamer Memorial
Hospital; and Somers H. Sturgis, M.D., Clinical Associate in
Gynecology, Harvard Medical School ; Assistant Surgeon,
Massachusetts General Hospital, Boston. 821 pages. Illus.
Price $9.50, cloth. New York: Grune & Stratton, 1950.
MANAGEMENT OF OBSTETRIC DIFFICULTIES. Fourth
Edition. Paul Titus, M.D. Obstetrician and Gynecologist to
St. Margaret Memorial Hospital, Pittsburgh; Consulting Ob-
stetrician and Gynecologist to the Shadyside Hospital, Pitts-
burgh; Secretary of the American Board of Obstetrics and
Gynecology; Member Reserve Consultants Advisory Board,
Bureau of Medicine and Surgery, LTnited States Navy (Captain,
MC, USNR). 1046 pages. Illus. Price $14.00, cloth. St.
Loth*.: C. V. Mosby Co., 1950.
OSLER APHORISMS, From His Bedside Teachings and Writ-
ings. Collected by Robert Bennett Bean, M.D. ; edited by
Will am Bennett Bean, M.D. 158 pages. Price $2.50, cloth,
New York: Henry Shuman, Inc., 1950.
November, 1950
NATIONAL FORMULARY — Ninth Edition. 877 pages. Illus.
Price $8.00 ($8.75 outside United States), cloth. Washington,
D. C.: American Pharmaceutical Association, 1950.
THE ANTIHISTAMINES; THEIR CLINICAL APPLICA.
TION, by Samuel M. Feinberg, M.D., Associate Professor of
Medicine, Chief of Division of Allergy and Director of Al-
lergy Research Laboratory; Saul Malkiel, Ph.D., M.D., As-
sistant Professor of Medicine, Director of Research, Allergy
Research Laboratory; Alan R. Feinberg, M.D., Clinical As-
sistant in Medicine, Attending Physician in Allergy Clinic,
Northwestern University Medical School. 291 pages. $4.00.
Chicago: The Year Book Publishers, Inc., 1950.
“The Antihistamines” by Drs. S. M. Feinberg, S. Mal-
kiel and A. R. Feinberg is a concisely written book
covering the subject adequately. The monograph is di-
vided essentially into two divisions. The first section
deals with experimental studies in relation to histamine
and antihistamines, while the second section deals with
clinical observations as noted by the authors and other
investigators. In the section dealing with experimental
studies, the following subjects are covered sufficiently,
but each topic is not delved into deeply: (a) Ffistamine
and its role in allergy, (b) The chemistry of the anti-
histamines, (c) The pharmacology of the antihistamines,
(d) The antihistamines in experimental hypersensitiv-
ities, and (e) The bioassay of antihistamines in man. In
the section discussing the clinical observations the fol-
lowing factors and conditions are covered : (a) Respira-
tory allergy, (b) Dermatoses, (c) Miscellaneous medical
manifestations, ( d) Administrations and recommended
dosage of the various drugs, (e) and The toxic effects
of the commonly used antihistamines. Besides the two
1161
BOOK REVIEWS
1909... .1950
Physiotherapy for the relief
of Arthritis and related con-
ditions. Complete physical
examinations and laboratory
procedures given every pa-
tient. Roy T. Pearson,
M.D., Medical Director. B.
F. Pearson, M.D., associate.
U. S. Hwy. 212
anitarium
(^ompiete Opbtha L
Service
^jbor Uh
true
N. P. BENSON OPTICAL CO
Laboratories in Minneapolis
and
Principal Cities of Upper Midwest
main divisions in the book, there is a lengthy, complete
(to date), useful appendix that lists all American-
produced antihistamines (prescription, not over the
counter packages) along with their accepted dosage,
and the name of the pharmaceutical company that mar-
kets them. The bibliography lists 583 references which
represents a good sampling of the over-abundant cur-
rent and historical literature on the subjects discussed
in the text.
The book itself is well-organized and follows a defi-
nite pattern ; however, each chapter could be read inde-
pendently without disrupting any continuity of thought.
There is a tendency toward repetition in some of the
clinical as well as the experimental chapters, and this
might detract partially if one reads the book through
from cover to cover. However, if one uses the book as a
reference manual, this fault then becomes a benefit, as
one is able to find a more complete scope of information
by reading oidy the chapter in which he might be in-
terested at the time.
This manuscript is one that is well worth having on
any library shelf, but like so many books written on a
subject that changes rapidly and progresses quickly, its
clinical value is lost and outmoded soon after being re-
leased from the press, and it readily becomes a historical
reference rather than a current digest.
Irvine M. Karon, M.D.
PARKINSON’S DISEASE. Advice and Aid for Suf-
ferers of Parkinson’s Disease and Other Physical
Disabilities. By Walter Buchler. 75 pages. Price $1.00
and $2.00 cloth. Mr. Walter Buchler 101, Leeside
Crescent, London, N. W. 11, England.
This little book is the author’s account of his ex-
periences as a patient with Parkinson’s disease and his
recommendations, advice, and philosophy arising there-
from. Most of the chapters are written in the second
person. The book covers a wide range of subjects — aids
in walking* care of the feet, manner of dress and style
of clothing most suitable to the sufferer, diet, “table
tactics” housing, furniture, planning for work, enter-
tainment, and social events.
The information in this book is not new, but it re-
minds the physician that treating a patient with physical
disability involves much more than drug therapy. The
importance of management of the patient as a person is
the primary consideration, and some helpful topics for
consideration are found here. For the patient, this book
offers some helpful hints as well as sympathetic insight
into living with a disabling illness.
R.D.M.
PEPTIC ULCER. A. C. Ivy, M. I. Grossman, and W. H.
Baehrach. 1144 pages. Price $14.00. Philadelphia and Toron-
to: The Blakiston Co., 1950.
Doctor Ivy and his associates have made an outstand-
ing contribution to Medical Science in this volume. An
enormous amount of material, summarizing the most
significant experimental and clinical studies relating to
1162
Minnesota Medicine
BOOK REVIEWS
gastric and duodenal ulcer, has been skillfully organized
and well presented.
The volume is divided into four sections : Introduc-
tion to the Problem of Peptic Ulcer; Pathogenesis;
Diagnosis, and Treatment.
Each chapter in the book is concluded with a sum-
mary, and each section is concluded with a summarizing
chapter. This device adds much to the clarity of the
presentation and assists the reader to a better under-
standing of the ulcer problem as a whole.
The authors, conversant as they are with the subject,
are eminently qualified to present such a critical review.
The value of the book is emphasized by Dr. A. J. Carl-
son who has said: “This is a must book, not only for
our colleagues in general practice but also for our col-
leagues in internal medicine, surgery, psychiatry and
physiology.”
George S. Bergh, M.D
OUT OF MY LIFE AND THOUGHT. Albert Schweitzer. New
York: Henry Holt & Co., 1933 and 1949.
This autobiography of a remarkable theologian, musi-
cian and physician — all in one — first appeared in 1933 but
attracted little attention. The 1949 printing of a revised
volume with a postscript by Everett Skilling, close friend
of Dr. Schweitzer and chairman of the Albert Schweitzer
Fellowship, has had several printings.
Albert Schweitzer, an Alsatian, had already acquired
distinction as a theologian, philosopher and musician
when at the age of thirty he decided to study medicine
after hearing of the great need for physicians in Lam-
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for the diagnosis and treatment of nervous and
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table physicians. Electroencephalography avail-
able.
PSYCHIATRISTS IN CHARGE
Dr. Hewitt B. Hannah
Dr. Andrew J. Leemhuis.
November, 1950
1163
BOOK REVIEWS
BROWN & DAY, INC
St. Paul 1, Minnesota
barane, Africa. Against the advice of friends who
argued he was throwing away his great talents, he
acquired a medical degree and fulfilled his ambition of
establishing a hospital on the edge of an African jungle
for the care of natives. The relation of the seemingly
insurmountable obstacles he encountered, his method of
maintaining his organ playing technique, his eventual
triumph through eliciting the interest and support of
citizens of many countries proves fascinating reading.
That anyone could have the stamina to accomplish so
much in a lifetime makes the ordinary industrious
individual seem a sluggard. Truly Dr. Schweitzer’s life
is a demonstration of the truth that “he that loseth his
life for my sake shall find it.”
— C. B. D.
SURGICAL AND MAXILLOFACIAL PROSTHESIS. Oscar
Edward Beder, D.D.S. 51 p. Ulus. Photo offset printing. Paper
bound. New York: King’s Crown Press, Columbia University,
1949. Price, $3.00.
In a brief, concise manner the author, who is dental
surgeon in charge of the Surgical and Maxillofacial
Prosthesis Clinic at Columbia University-Presbyterian
Medical Center, defines and sets forth techniques, step by
step, in splints, stents, protective shields in radiation
therapy, obturators, corrective appliances for missing
portions of the mandible, extraoral impressions, somato-
prosthesis and cranial prosthesis. It is a practical and
well-organized aid-book if one already has some basic
knowledge of prosthetic materials.
Jerome A. Hilger, M.D.
'SoodL UlAWfL 9x L fl/lA CJUDULiu
When your eyes need attention . . .
Don't just buy eye glasses, but eye care . . .
Consult a reliable eye doctor and then . . .
Let Us Design and Make Your Glasses
'J^vdcLj -j/^c£eUna/i
25 W. 6th St.
Dispensing Opticians
St. Paul
CE. 5767
HARVEY CUSHING: SURGEON, AUTHOR. ARTIST. Eliza-
beth H. Thomson. Foreword by John F. Pulton. 347 p. Illus.
New York: Henry Schuman, 1950. Price, $4.00.
Haney Cushing’s friendship with Minnesota’s John
Fulton, professor of physiology at Yale’s Sheffield Sci-
entific School, is elaborated upon in this biography. Ful-
ton wrote a long, detailed life of Cushing in which his
own friendship with Cushing is depreciated. Hence, this
friendship is examined in this book, which is shorter to
save the reader time and spare him detail.
Cushing was a man of tremendous energy and gigantic
accomplishments. He was such a giant among his fellow-
surgeons that his behavior in the operating room was
widely imitated. Cushing was a great surgeon, great
author and a splendid artist. He was a friend to all the
DANIELSON MEDICAL ARTS PHARMACY, INC.
10-14 Arcade. Medical Arts Building un,IBS.
PHONES: HOURS:
ATLANTIC 3317 825 Nicollet Avenue — Two Entrances — 78 South Ninth Street WEEK DAYS — 8 to 1
ATLANTIC 3318 MINNEAPOLIS SUN. AND HOL.-10 TO 1
PHYSICIANS AND HOSPITALS SUPPLY CO., Inc.
414 SOUTH SIXTH ST., MINNEAPOLIS, MINN.
INSTRUMENTS • TRUSSES • EQUIPMENT • PHARMACEUTICALS • DRUGS
MAIN 2494
1164
Minnesota Medicine
BOOK REVIEWS
great surgeons of the last half century — Kocher, Crile,
the Mayo Brothers, Lord Moynihan, Fritz, Halsted,
Lewis and Dean.
This book reveals Cushing as an intensely hard work-
ing, ambitious, courageous, hot-tempered surgeon who
was tremendously interested in, and had tremendous
identification with, his patients. He was moody, easily
depressed and always overworked. His capacities were
amazing. He was a bibliophile, collector of incunabula,
an artist, a Pultizer Prize winner for his Sir William
Osier biography ; his monographs on brain tumors are the
foundation stones for modern neurosurgery. He did make
many trips to Europe, visiting historic medical sites,
clinics and attending meetings. He rarely left the East-
ern area of the United States, however, to visit the West.
Coleman L Connolly, M.D.
THE COMMON HEMORRHAGIC
DISEASES OF CHILDHOOD
(Continued from Page 1101)
control the hemorrhage. Pseudo-hemophilia (Von
Willebrand’s disease) may occur in children but
it is a rare clinical entity.
Summary
The hemorrhagic diseases occurring in children
may be congenital or acquired. The most common
congenital disease is hemophilia. The diagnosis
of this entity has been facilitated by the
prothrombin consumption test. The importance
of local treatment in controlling hemophilic
bleeding is stressed. Congenital hypoprothrom-
binemia simulates hemophilia. Of the acquired
hemorrhagic diseases, the hypoprothrombinemia
of the newborn deserves recognition since it can
be prevented by giving vitamin K to the mother.
Thrombocytopenic purpura is a commonly
acquired hemorrhagic disease. Usually recovery
is spontaneous, but a small number of cases
require splenectomy.
BIRTH AND STILLBIRTH CERTIFICATES
(Continued from Page 1132)
twenty weeks of gestation has been completed. Instead
of the previously required birth and death certificate only
a single stillbirth form is now necessary.
The Committee of Fetus and Newborn of the Amer-
ican Academy of Pediatrics defines a premature infant as
one whose weight is 5 pounds, 8 ounces, (2500 grams) or
less, regardless of estimated period of gestation and other
criteria. In weeks of gestation, prematurity is the period
from the beginning of the twenty-eighth week to the
end of the thirty-seventh week. However, the period of
gestation is notoriously unreliable and hence, birth
weight is the more generally accepted definition.
A study of birth certificates shows a considerable
discrepancy between the birth weight and full term or
prematurity. Some 300 certificates listed infants weigh-
ing less than 5p2 pounds as full term, while a similar
number listed infant’s with weights of from 6 to 9
pounds as premature infants.
During the last twenty years a great and increasing
interest has been taken in the incidence of tuberculosis in
nurses and the methods to be used in an endeavour to
reduce this. It is now clearly recognized that nurses,
even in general hospitals where tuberculosis is rigidly ex-
cluded, run a far greater risk of developing this disease
than do comparable members of the general population.
Geoffrey Bewley, M.D. Dubl., The Lancet, March 25,
1950.
UTILITY • EFFICIENCY • SIMPLICITY
At your wholesale druggist or write for
further information
“DEE" MEDICAL SUPPLY COMPANY
P.O. Box 501, St. Paul, Minn.
PATTERSON SURGICAL SUPPLY COMPANY
103 East Fifth St., St. Paul 1, Minn.
HOSPITAL AND PHYSICIANS SUPPLIES AND EQUIPMENT
Cedar 1781-82-83
QomplsJtsL Jjabo^aJt&uf S&wi cc in
Deep X-Ray Therapy Radium Treatment Clinical Biochemistry Tissue Examination
Roentgen Diagnosis Radium Rentals Clinical Pathology Clinical Bacteriology
Interpretation of YOUR E.K.G. records Toxicological Examinations
MURPHY LABORATORIES— Ej*. 1919
Minneapolis: 612 Wesley Temple Bldg.. At. 4786; St. Paul: 348 Hamm Bldg.. Ce. 7125; It no answer call: 222 Exeter PI., Ne. 1291
November, 1950
1165
Classified Advertising
Replies to advertisements zvith key numbers should be
mailed in care of Minnesota Medicine, 2642 University
Avenue, Saint Paul 4, Minn,
WANTED — Woman Physician to do Obstetrics and
Pediatrics, assist older well-established F.A.C.S. Ex-
cellent hospital facilities. Salary and percentage from
start. Minnesota license or National Boards Parts 1
and 2. Located in suburb of Twin Cities; apartment
available. Wonderful opportunity for future. Address
E-225, care Minnesota Medicine.
FOR SALE — Complete modern Westinghouse x-ray
equipment, basal metabolism machine, other electrical
equipment, instruments, examining table, furniture, et
cetera. Will sell at sacrifice for quick disposal. Re-
tiring. Address Charles P. Robbins, M.D., S.W.
Corner Third and Center Streets, Winona, Minnesota.
WANTED — Young man for permanent position with
small clinic group ; to do primarily obstetrics. Extra
training in this field desirable but not essential. Ad-
dress E-230, care Minnesota Medicine.
FOR SALE — Microscope, pneumothorax, and a Burdick
portable diathermy machine, used very little. Write
Dr. Spicer Estate, 202 Hawthorne Road, Duluth, Min-
nesota.
POS11ION WANTED: Registered Laboratory and
X-ray Technician. Seven years’ experience. Married
and family. Not subject to draft. Address E-235, care
Minnesota Medicine.
WAN i ED — Otolaryngologist — large clinic composed of
twenty-one American Board members — directly adja-
cent to hospital— starting salary, $15,000.00. Address
E -232, care Minnesota Medicine.
FOR SALE — One Army table unit, 30 ma. Picker x-ray,
with fluoroscope, cassettes, and complete darkroom
equipment. In good condition, priced for immediate
sale. Also colorimeter, metabolar, and several other
office items at bargain prices. Address David Hoehn,
M.D., Holdingford, Minnesota.
PHYSICIAN’S OFFICE FOR RENT— Located in new
neighborhood — 1410 White Bear Avenue, Saint Paul.
Dentist, drug store, hardware store in same building.
Present physician leaving for Army service. Telephone
Viking 3404.
OFFICE SUI'l E FOR RENT — Three rooms or more.
Over drug store, corner 50th and France South, in
Edina. Will decorate to suit renter. Lease, if desired.
Address A. L. Stanchfield, 4424 W. 44th Street, Min-
neapolis. Telephone : MAin 3371 or WAlnut 4806.
Index to Advertisers
Abbott Laboratories 1078
American Meat Institute 1079
American National Bank 1167
Ames Co., Inc 1070
Anderson, C. F., Co., Inc 1150
Ar-Ex Cosmetics, Inc 1160
Ayerst, McKenna & Harrison 1069
Benson, N. P., Optical Co 1162
Birches Sanitarium 1154
Birtcher Corporation 1146
Borden Co 1082
Brown & Day, Inc 1164
Buchstein-Medcalf Co 1160
Caswell-Ross Agency 1066
Classified Advertising 1166
Cook County Graduate School of Medicine 1158
Dahl, Joseph E., Co 1156
Danielson Medical Arts Pharmacy 1164
“Dee” Medical Supply Co 1165
Druggists Mutual Insurance Co. 1167
Employers Overload Co 1163
Ewald Bros Inside Back Cover
Franklin Hospital 1167
Glenwood Hills Hospitals 1145
Glenwood-Inglewood 1163
Hall & Anderson 1167
Hazelden Foundation 1159
Homewood Hospital 1152
Juran & Moody 1151
Kelley-Koett X-Ray Sales Corp. of Minnesota 1080
Lederle Laboratories Division 1083
Lilly, Eli & Co Front Cover
Insert facing page 1084
M. & I*. Dietetic Laboratories 1074
Mead Johnson & Co 1168
Medical Placement Registry 1166
Medical Protective Co 1156
Merck & Co., Inc 1084
Milwaukee Sanitarium Back Cover
Minnesota Mutual Life Insurance Co 1149
Mounds Park Hospital Back Cover
Mudcura Sanitarium 1162
Murphy Laboratories 1165
Nestle Co 1155
North Shore Health Resort 1161
Parke, Davis & Co Inside Front Cover, 1065
Patterson Surgical Supply Co 1165
Pfizer, Chas., & Co., Inc 1072, 1073
Philip Morris & Co., Ltd 1075
Physicians Casualty Association 1158
Physicians & Hospitals Supply Co 1076, 1164, 1167
Professional Credit Protective Bureau 1153
Quincy X-Ray 8c Radium Laboratories 1160
Radium Rental Service 1167
Rest Hospital 1163
Rexair Division, Martin-Parry Corporation 1159
Roddy-Kuhl-Ackerman 1164
St. Croixdale San’tarium 1068
Sandoz Pharmaceuticals 1157
Schering Corporation 1077
Schusler. T. T., Co., Inc 1167
Searle, G. D., & Co 1143
Smith-Dorsey Co 1157
Squibb 1071
U. S. Vitamin Corporation facing page 1080
Vocational Hospital 1154
Williams, Arthur F 1167
Winthrop-Stearns, Inc 1147
Wyeth, Inc 1081
POSITIONS AVAILABLE
INTERNIST Doctors in town of 10,000 will refer work to one
internist. Good setup.
Minneapolis Internist desires board eligible man for
a partner.
Internists needed for Texas, Louisiana, South Dakota,
Nebraska, Florida- Ohio, Missouri, and Idaho.
GENERAL PRACTITIONERS wanted for partnership, Minne-
apolis doctor; also for locum tenens and many locations
whore a doctor is essential.
PATHOLOGIST wanted in a large California Clinic.
OBSTETRICIAN-GYNECOLOGIST board eligible. Minnesota.
Beginning salary $1,000.
PHYSICIANS AVAILABLE
SURGEON board eligible, available now.
DOCTOR woman wants industrial position in city or an
association.
MEDICAL PLACEMENT REGISTRY
480 Lowry Medical Arts GA. 6718
St. Paul, Minnesota
1166
Minnesota Medicine
PHYSICIANS AND HOSPITALS SUPPLY CO., Inc.
414 SOUTH SIXTH ST., MINNEAPOLIS, MINN.
INSTRUMENTS • TRUSSES • EQUIPMENT • PHARMACEUTICALS • DRUGS
MAIN 2494
Practical Nursing School
Approved by Minnesota State Board of Nurses
Examiners
Twelve months course open to High
School Graduates or women with equiv-
alent education.
For further information apply to
DIRECTOR OF NURSES
FRANKLIN HOSPITAL
501 W. Franklin Avenue, Minneapolis 5, Minn.
TAILORS TO MEN SINCE 1886
The finest imported and domestic wool-
ens such as SCHUSLER'S have in stock
are not too fine to match the hand tailor-
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DO YOU HAVE CHILDREN?
Train them in the habit of sav-
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SAVINGS ACCOUNT with
this bank. . . . They’ll always
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THE AMERICAN NATIONAL BANK
OF SAINT PAUL
Bremer Arcade Robert at 7th CE 6666
Member Federal Deposit Insurance Corporation
RADIUM RENTAL SERVICE
2525 INGLEWOOD AVENUE
MINNEAPOLIS 5, MINNESOTA
TEL. ATLANTIC 5297
Radium element prepared in
type of applicator requested
ORDER BY TELEPHONE OR MAIL
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Hall & Anderson
PRESCRIPTION PHARMACY
BIOLOGICALS
PHYSICIANS’ SUPPLIES
SAINT PAUL, MINN.
LOWRY MEDICAL ARTS BUILDING
TF.I EPHONE: CEDAR 2735
UNUSUAL LENS GRINDING
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Fire - Tornado - Automobile Insurance Service
REPRESENT ATIVE-S. E. STRUBLE, WYOMING, MINN.
November, 1950
1167
“Truth never grows old” Thomas Fuller , 1639
With the passing years, ideas, theories and conceptions
may change with new discoveries and growing knowledge.
But truth never grows old.
No matter how widely the pendulum may swing, truth
remains the center of its path.
Because of its inherent soundness, Dextri-Maltose® is
the carbohydrate of choice in more hospitals than ever
before. It enjoys the confidence of ever-growing
thousands of physicians.
And the physician who prescribes Dextri-Maltose in infant
feeding follows a course confirmed by a great mass
of evidence, for no other carbohydrate enjoys so rich and
enduring a background of authoritative clinical experience.
However the pendulum may swing, facts remain facts, and
truth never grows old.
Mead Johnson & co.
EVANSVILLE 21.IND..U. S. A.
1168
Minnesota Medicine
obar pneumonia with bacteremia
fter initiation of Chloromycetin therapy the temperature returned
) normal within forty-eight hours, and prompt subsidence of the
ough and chest pain occurred. ” 1
bronchopneumonia
;linically, the child improved rapidly and was out of the oxygen
3nt in 24 hours and afebrile in 36 hours.” 2
trimary atypical (virus) pneumonia
)n the first evening of Chloromycetin treatment the subjective symptoms
fere less severe, and within 24 hours his fever began to settle.”3
Chloromycetin is effective against practically all pneumonia-
ausing organisms. Response is strikingly rapid, temperature drops,
he lungs clear . . . and your patient is convalescent.
Chloromycetin is unusually well tolerated. Side effects
ire rare, severe reactions almost unknown.
libliography
. Hewitt, W. L„ and Williams, Jr., B.: New England J. Med. 242: 119, 1950.
. Recinos, Jr., A.; Ross, S.; Olshaker, B., and Twible, E.: New England
J. Med. 241: 733, 1949.
. Wood, E. J.: Lancet 2:55, 1949.
I N wishing you a Merry Christmas this year we
would capture for you as much of the old time hol-
iday spirit as possible. Accept our sincere thanks
for your generous patronage, which has been a
source of real encouragement to us in 1950.
CASWELL-ROSS AGENCY
1177 N. W. Bank Building
Minneapolis — MA 2585
Minneapolis 2, Minnesota
St. Paul— ZE 2341
Insurors to:
Minnesota State Bar Association
Minnesota State Dental Association
Minnesota State Medical Association
Minnesota Society of C.P.A.
Minnesota State Pharmaceutical Assn.
Minnesota Auto Dealers Association
Hennepin County Medical Society
Hennepin County Bar Association
St. Paul District Dental Society
Minneapolis District Dental Society
St. Cloud Dental and Stearns County
Medical Society
Duluth District Dental Society
East Central Medical Society
St. Louis County Medical Society
Minnesota State Veterinary Medical
Society
1170
Minnesota Medicine
Journal of the Minnesota State Medical Association, Southern Minnesota Medical Association, Northern Minnesota
Medical Association, Minnesota Academy of Medicine and Minneapolis Surgical Society
Volume 33
DECEMBER, 1950
No. 12
Contents
Hypoplasia of Thoracic Aorta Clinically Simu-
lating Coarctation.
Allan L. Ferrin, M.D., and John F. Briggs, M.D.,
Saint Paul, Minnesota, and Ivan D. Baronofsky,
M.D., Minneapolis, Minnesota 1193
Treatment of Auricular Fibrillation from the
Standpoint of the General Practitioner.
Robert H. Conley, M.D., Mankato, Minnesota, 1196
“Antabuse” (Tetraethylthiuram Disulfide) in
the Treatment of Alcoholism.
/. C. Michael, M.D., Minneapolis, Minnesota .... 1200
Emergencies in the Newborn Period.
Lloyd E. Harris, M.D., Rochester, Minnesota ...1204
The Rana Pipiens Frog Test for Pregnancy.
Jane E. Hodgson, M.D., and Reiko Tagnchi, B.S.,
Saint Paul, Minnesota 1208
Acute Yellow Atrophy of the Liver from SH
Virus Transmitted by a Blood Bank.
Winston R. Miller, M.D., R. V. Sherman, M.D.,
and G. N. Hoffman, M.D., Red Wing, Minne-
sota 1211
Practical Considerations in the Diagnosis and
Treatment of Ectopic Pregnancy.
Charles H. McKenzie, M.D.. F.A.CS., Minne-
apolis, Minnesota 1215
Common Injuries of the Knee Joint.
Edward D. Henderson, M.D., Rochester, Minne-
sota 1217
Editorial :
NPH Insulin 1230
World Medical Association 1230
Poliomyelitis in Minnesota 1231
Maternal Mortality Study in Minnesota 1232
Christmas Seals 1233
Advisory Committees to Selective Service 1233
Medical Economics :
Election Offers New Challenge 1234
Canadian Doctor Reports on British Health Serv-
ice 1234
Legislator Assails Federal Lobbying 1235
Government Debt Bigger Than Ever 1235
Health Insurance Book Issued by Committee . . 1235
Michigan Doctor Hits Government Medicine 1236
Minnesota State Board of Medical Examiners . .1236
Licentiates 1950 1237
Minnesota Academy of Medicine:
Meeting of May 10, 1950 1244
In Memoriam — J. C. McKinley 1244
The Present Status of Surgery of the Spleen.
John M. Culligan, M.D., and John A. CuUigan,
M.B., Saint Paul, Minnesota 1245
Minneapolis Surgical Society-:
Meeting of April 6, 1950 1250
Vagotomy in the Treatment of P'eptic Ulcer.
Frederick M. Owens, Jr., M.D., F.A.C.S.,
Chicago, Illinois 1250
Reports and Announcements 1252
History of Medicine in Minnesota :
Medicine and Its Practitioners in Olmsted County
Prior to 1900. (Continued from November issue.)
Nora H. Guthrey, Rochester, Minnesota 1219
President’s Letter :
Thought and Celebration 1229
Woman’s Auxiliary 1258
In Memoriam 1260
Of General Interest 1264
Book Review 1274
Index to Volume 33 1277
Contents of Minnesota Medicine copyrighted by Minnesota State Medical Association, 1950
Entered at the Post Office in Saint Paul as second class mail matter. Accepted for mailing at the special rate of postage provided
for in Section 1103, Act of October 3, 1917, authorized July 13, 1918.
December, 1950
1171
MINNESOTA MEDICINE
Official Journal of the Minnesota State Medical Association
Published by the Association under the direction of its Editing and Publishing Committee
Office of Minnesota State Medical Association,
493 Lowry Medical Arts Bldg., Saint Paul 2, Minnesota.
EDITING AND PUBLISHING COMMITTEE
E. M. Hammes, Saint Paul
Philip F. Donohue, Saint Paul
H. W. Mf.yerding. Rochester
B. O. Mork, Jr., Minneapolis
C. L. Oppegaard, Crookston
T. A Peppard. Minneapolis
H. A. Roust, Montevideo
O. W. Rowe, Duluth
Henry L. Ulrich, Minneapolis
A. H. Wells, Duluth
EDITORIAL STAFF
Carl B. Drake, Saint Paul, Editor
George Earl, Saint Paul, Associate Editor
Henry L. Ulrich, Minneapolis, Associate Editor
BUSINESS MANAGER
J. R. Bruce
Annual Subscription — $3.00. Single Copies— $0.40. Foreign and Canadian Subscriptions — $3 50.
The right is reserved to reject material submitted fot editorial or advertising columns. The
Editing and Publishing Committee does not hold itself responsible for views expressed either in
editorials or other articles when signed bv the author.
Classified advertising — ten cents a word; minimum charge, $2.00. Remittance should ac-
company order.
Display advertising rates on reauest.
Address all communications concerning the journal to Minnesota Medicine, 2642 University
Avenue, Saint Paul 4, Minnesota Telephone Nestor 2641.
ST. CROIXD ALE ON LAKE ST. CROIX
PRESCOTT, WISCONSIN
MAIN BUILDING— ONE OF THE 8 UNITS IN "COTTAGE PLAN”
A Modern Private Sanitarium for the Diagnosis, Care and Treatment of Nervous and Mental Disorders
Located on beautiful Lake St. Croix, eighteen miles from the Twin Cities, it has the advantages of both
City and Country. Every facility for treatment provided, including recreational activities and occupational
therapy under trained personnel. Close personal supervision given patients, and modern methods of
therapy employed. Inspection and cooperation by reputable physicians invited. Rates very reasonable.
Illustrated folder on request.
NEUROPSYCHIATRISTS
PRESCOTT OFFICE
Prescott, Wis.
Howard J. Laney, M.D.
Tel. 39 and Res. 76
Hewitt B. Hannah. M D
Andrew J. Leemhuis, M.D.
Howard J. Laney. M.D.
511 Medical Arts Building
Minneapolis, Minnesota
Tel. MAin 1357
SUPERINTENDENT
Dorothy M. Most. R.N.
Prescott, Wisconsin
Tel. 69
1172
Minnesota Medicine
PHENEEN "ULMER"
The Fast-acting germicide-fungicide
Preferred by doctors for cold-disinfection
of surgical instruments
• non-toxic
® non-staining
• non-corrosive
• non-irritating
i
The germicidal ability of this specialized brand of high molecular alkyl-dimethyl-benzyl ammonium
chloride 1% is well established. Tests on Staphylococcus aureus and Salmonella typhosa exposed one
minute show no growth on resubculture. PHENEEN “Ulmer” contains rust inhibitants which prevent
rust and corrosion. It has a pleasant odor, contains no phenol, formaldehyde, iodine, mercury or other
metals and does not leave residues on glass containers. May be diluted 1 to 40 for removing odors in
lavatories, kitchens, laboratories and operating rooms. Available in quart, gallon, 4 gallon, and 12
gallon lots.
PHYSICIANS AND HOSPITALS SUPPLY CO., Inc.
MINNEAPOLIS
Pheneen Tincture
"ULMER"
Recommended for preoperative
skin sterilization and first aid
work. Easily removed from linens.
December, 1950
MINNESOTA
SEND COUPON! ,
Physicians and Hospitals Supply Company, Inc.
414 South Sixth Street, Minneapolis, Minnesota i
Please send me, at no cost, your generous trial bottle of PHENEEN .
“Ulmer" the fast-acting germicide-fungicide, M-1250.
Name .
Street Address
City State .
I '
1173
peulic agents^ ^ wml terbamycin
uretero-
therapy
ic agents
resistam w
chernothera
F.. male, age
Pyelonephritis
p [{.: 1 \
cutaneous i-
with all avail
without r
Urinary
al>. dnta: a^)US and enter
• 9 (
Terramycm a
Therapy: ^ q. 6 h.
„ Urine cultures
Result! oi treatment. 1
report abstracted
of 1% years <
implants (mixed ir
ilable antibiotics u
esponse.
cultures positive lor
ococci.
(im. daily lor
vulgaris.
divided
except lor t •
described as g
*■ 0.etal.:JAMA-
Um°coccal infection. s, inc
aCUtG strePtococcaI in,
'throa-<ommuu;acute
tfections, including anihi
4- aerogenes, Staphylocoi
■“’nsilive orSanisms: m
U,S>: hem°PMus infectio
U‘°ma Ve^um; granul
typlms (marine,
6 UOar Pneumonia,
mS’ lndudinS crysiPe!as ,
hlococcal infections;
UriUary tract Elions due
!>US aureus, and other
ruce/losis (abortus,
2CUte gonococcal infecti0ns.
finale; primary
ub>i rickettsialpox.
tract infection
1174
Minnesota Medicine
^cbical
' may he Hghly effect;
°tIler antibiotics fail'.'
may be well tolerated
,ther antibiotics are
i, „f findings obtained at over It* «»
fi centers, 2 Gm. daily by mouth m d.»
suggested for acute infections.
50 mg. capsules, bo.rfes of
00 mg. capsules, bottles of 25 <mi ICO:
50 mg. capsules, boules of 2, end M.
in, w. E., and Bartholomew. I
or. 12) 1950.
1. King, E.Q.;hewta.-s
Lyons, J. B.; Scott, K. B.
2. Herrell, W. E.; Heilman
Proc. Staff Meet. Mayo <
Antibiotic Division
CHAS. PFIZER & CO., INC., Brooklyn 6, N .Y.
December, 1950
1175
a significant advance in the
treatment of ventricular arrhythmias
• • • •
Effect of a single oral dose of PRONESTYL
in ventricular premature contractions
Lead II.
Control tracing:
normal sinus rhythm,
ventricular extrasystole.
Lead II.
Tracing 30 minutes after
1 Gm. ProneStyl orally.
No ventricular premature
contractions present
Lead II.
Tracing 1V2 hours
later shows
persistent effect.
Lead II.
Tracing 24 hours later
shows return of
ventricular premature
contractions.
1176
Minnesota Medic ini
....PRONESTYL Hydrochloride
less toxic than quinidine
IN CONSCIOUS
PATIENTS
IN ANESTHESIA
Indications and Dosage
For the treatment of ventricular tachycardia:
Orally : 1 Gm. (4 capsules) followed by 0.5-1. 0 Gm. (2 to 4 capsules) every
four to six hours as indicated.
Intravenously : 200-1000 mg. (2 to 10 cc.). Caution— administer no more than
200 mg. (2 cc.) per minute.
Hypotension may occur during intravenous use in conscious patients. As a
precautionary measure, administer at a rate no greater than 200 mg. (2 cc.)
per minute to a total of no more than 1 Gm. Electrocardiographic tracings
should be made during injection so that injection may be discontinued when
tachycardia is interrupted. Blood pressure recordings should be made fre-
quently during injection. If marked hypotension occurs, rate of injection
should be slowed or stopped.
For the treatment of runs of ventricular extrasystoles:
Orally: 0.5 Gm. (2 capsules) every four to six hours as indicated.
During anesthesia, to correct ventricular arrhythmias :
Intravenously : 100-500 mg. (1 to 5 cc.). Caution — administer no more than
200 mg. (2 cc.) per minute.
Pronestyl Hydrochloride Capsules, 0.25 Gm., bottles of 100 and 1000.
Pronestyl Hydrochloride Solution, 100 mg. per cc., 10 cc. vials.
Supply
Hydrochloride
SQUIBB PROCAINE AMIDE HYDROCHLORIDE
Sqjjibb
December, 1950
1177
and mortality, early diagnosis of venous
thrombosis and prompt anticoagulant
therapy also protect against femoral vein
destruction for . . the instantaneous
action of heparin nearly always puts an
end to upward spreading of the process,”!
with its later sequelae of valvular incom-
petence, venous stasis, pain, chronic ed-
ema and ulceration. Effective and readily
controllable anticoagulant therapy is
available with these Upjohn prepara-
tions: : ^
diagnosis
Heparin Sodium, Sterile Solution vHS’
Depo* -Heparin Sodium, Sterile Solution
* Trademark, Reg. U. S. Pat. Off.
1. Bauer, G.: Anaioloay 1: 161-169 (Apr.) 1950.
Upjohn
Medicine • . . Produced with care . . . Designed for health
1178
Minnesota Medicine
Note the
of OVALTINE
As the bar chart so vividly indicates, Ovaltine is an excep-
tionally economical source of many essential nutrients.
Using whole milk as the basis for comparison, the chart con-
trasts the relative amounts of nutrients supplied by 8 cents’
worth of Ovaltine granules (3 servings) and by 8 cents’
worth of whole milk. In 8 of the 13 nutrients listed,
Ovaltine supplies greater amounts, and in the remaining 5,
high proportions of the amounts found in milk.
It should be noted that Ovaltine specially enriches milk
in those nutrients in which milk is low. Thus Ovaltine is
not only economical in use but constitutes with milk an
ideal protective supplementary food drink. It finds wide
usefulness whenever dietary supplementation becomes
necessary, either because of poor appetite, inability to con-
sume a normal diet, or illness which often makes normal
eating difficult or impossible.
THE WANDER COMPANY
360 N. MICHIGAN AVE., CHICAGO 1, ILL.
Two kinds. Plain and Chocolate Flavored.
Serving for serving, they are virtually
identical in nutritional content.
117*)
December. 1950
NOTE THE NAME
4/
Nembutal
(PENTOBARBITAL, ABBOTT)
Your stairs would be crowded pj
IF ALL THE PATIENTS CAME AT ONCE WHO
REPRESENT EACH OF THE MANY CONDITIONS FOR
WHICH SHORT-ACTING NEMBUTAL IS EFFECTIVE
T
Lhere d be at least 44 on hand, Doctor, for that s how many
clinical uses for short-acting Nembutal have been reported
in the literature. No matter what degree of cerebral depression
you desire — from mild sedation to deep hypnosis — you can
achieve it with short-acting Nembutal. Dosage required is
small, only about one-half that of many other barbiturates. Small
dosage means less drug to be inactivated, shorter effect,
wider margin of safety and less possibility of "hangover.”
Pharmacies everywhere have short-acting
Nembutal as capsules, tablets, supposi-
tories, elixir and solution prepared from
the Nembutal acid, or the sodium or
calcium salts. Convenient small-dosage
sizes simplify administration. For a
40-page booklet, "44 Clinical Uses
for Nembutal,” just drop a line now to
Abbott Laboratories,
North Chicago, 111. CUM jott
In equal oral doses, no other barbiturate
combines QUICKER, BRIEFER,
MORE PROFOUND EFFECT.
1180
Minnesota Medicine
L
GANAL
in active rheumatoid
arthritis , the “best
agent. . . that is
readily available.
Many therapeutic agents have been
advocated for the treatment of
active rheumatoid arthritis, with varying
degrees of success. Among those
now generally available, gold is
“the only single form of therapy which
will give significant improvement.”"
Solganal® for intramuscular injection is
practical and readily available therapy.
It acts decisively, inducing “almost complete
remission of symptoms” in fifty per cent
of patients and definite improvement
in twenty per cent more.3
Detailed literature available on request.
Suspension Solganal in Oil 10, 25 and
50 mg. in 1.5 cc. ampuls; boxes of 1 and
10 ampuls. Multiple dose vials of 10 cc.
containing 10, 50 and 100 mg. per cc.;
boxes of 1 vial.
(aurothioglucose)
BIBLIOGRAPHY (1) Holbrook, W. P.: New York Med. (no. 7)
4:17, 1948. (2) Ragan, C., and Boots, R. H.: New York Med. (no. 7) 2: 21, 1946.
(3) Rawls, W. B.; Gruskin, B. J.; Ressa, A. A.; Dworzan, H. J.; arid
Schreiber, D.: Am. J. M. Sc. 207:528, 1944.
i
,
; "
29 features
for better technic
c
easier operation
greater safety
years in advance
of any table
m
1182
Minnesota Medicii
zk z-n
i
with 45° TRUE TRENDELENBURG
You’ll concur with the radiologists who helped design this great new
table and tested it for five years preceding introduction. Keleket’s
“C-Supertilt” Table offers more facility, far greater convenience in
every technic, fluoroscopy, radiography and fluorography procedures
such as encephalography, ventriculography, myelography and genito-
urinary work are performed with greater ease and safety.
Among more than a score of time and effort saving advantages is this
fable’s rapid travel . . . just 21 seconds from horizontal to vertical.
Ekicky travels to within 3" of foot end. Full angulation, more than
ev^r before available, is 135° . . . from true Trendelenburg — through
horizontal to vertical.
Confirm the enthusiastic approval of noted practitioners and technicians.
Telephone or Write for Complete Details
KELLEY-KOETT X-RAY SALES CORP. OF MINN.
1225 NICOLLET AVE.
TEL. AT. 7174
MINNEAPOLIS 3, MINNESOTA
December, 1950
1183
WHEN OBESITY IS A PROBLEM
Clinicians have long noted
that the forward bulk of the
heavy abdomen with its fat-
laden wall moves the center
of gravity forward. As the
patient tries to balance the
load, the lumbar and cervical
curves of the spine are in-
creased, the head is carried
forward and the shoulders
become rounded. Often there
is associated visceroptosis.
Camp Supports have a long
history among clinicians for
their efficacy in supporting
the pendulous abdomen. The
highly specialized designs and
the unique Camp system of
controlled adjustment help
steady the pelvis and hold the
viscera upward and backward .
There is no constriction of
the abdomen, and effective
support is given to the spine.
Physicians may rely on
the Camp- trained fitter for
precise execution of all in-
structions.
If you do not have a copy of
the Camp “Reference Book
for Physicians and Surgeons’ ’ ,
it will be sent on request.
S. H. CAMP and COMPANY
JACKSON, MICHIGAN
World's Largest Manufacturers
of Scientific Supports
Offices in New York • Chicago
Windsor, Ontario * London, England
THIS EMBLEM is displayed only by reliable merchants
in your community. Camp Scientific Supports are never
sold by door-to-door canvassers. Prices are based on
intrinsic value. Regular technical and ethical training of
Camp fitters insures precise and conscientious attention
to your recommendations.
11S4
Minnesota Medicine
A U R EO M YCI N
HYDROCHLORIDE CRYSTALLINE
in Brucellosis
The chronic ill health and mortality associated with
undulant fever, caused by one of the strains of
brucellae organisms, has been a serious medico-
social and economic problem in this country. The
treatment of these infections in man can now be
satisfactorily carried out with aureomycin.
Capsules:
Bottles of 25 and 100, 50 mg. each capsule.
Bottles of 16 and 100, 250 mg. each capsule.
Ophthalmic :
Vials of 25 mg. with dropper; solution pre-
pared by adding 5 cc. of distilled water.
Aureomycin has also been found effective for
the control of the following infections: acute ame-
biasis, bacterial and virus-like infections of the eye,
bacteroides septicemia, boutonneuse fever, gon-
orrhea, Gram-positive infections (including those
caused by streptococci, staphylococci, and pneu-
mococci), Gram-negative infections (including
those caused by the coli-acrogenes group), granu-
loma inguinale, H. influenzae infections, Klebsiella
pneumoniae infections, lymphogranuloma venereum,
primary atypical pneumonia, psittacosis, puerperal
infections, Q fever, rickettsialpox, Rocky Mountain
spotted fever, surgical infections, subacute bacte-
rial endocarditis resistant to penicillin, tick-bite
fever (African), trachoma, tularemia and typhus.
LEDERLE LABORATORIES DIVISION American Gjmmmid company 30 Rockefeller Plaza, New York 20, N.Y
December, 1950
1185
A Complete, Protective Infant Food . . .
S-M-A, diluted and ready
to feed, provides in each
quart the following propor-
tions of the minimum daily
requirements for infants.
VITAMIN A
5,000 U.S.P. units
333%
VITAMIN D
800 U.S.P. units
200%
THIAMINE
0.67 mg.
250%
RIBOFLAVIN
1 mg.
200%
VITAMIN C
50 mg.
500%
NIACINAMIDE
5 mg.
-
Ready-to-feed S-M-A is the most complete formula for
infants. Its protective vitamins are administered in the most
satisfactory way — right in the food and in each feeding.
No danger of forgetting, no extra burden for busy mothers.
No infant food is more like breast milk than S-M-A — in
content of protein, fat, carbohydrates and ash, in chemical
constants of the fat and in physical properties.
S-M-A CONCENTRATED LIQUID— cans of 13 fl. oz.
S-M-A POWDER— 1 lb. cans
S-M-A*
vitamin C added
builds husky babies
Wyeth Incorporated, Philadelphia 3, Pa.
1186
Minnesota Mewctnk
If You Are Called Into Service—
If You Are Too Old to Be Called Into Service—
In either event the rebellion in Korea affects your pocketbook in a major
way, which will be reflected in your accounts receivable.
Soldiers Relief from their financial obligations has again been invoked
making it impossible to enforce collection against anyone in the Armed
Forces.
With our many years of valuable experience in handling the accounts
for over 1,000 professional men, there is now an influx of professional
accounts to this office due from patients about to enter Military Service
where the possibility of immediate collection appears very problem-
atical.
Our (ZeccmwndaticHA
Based upon our experience in liquidation of accounts prior to, during, and after World War II
(1) Concentrate effort on the collection of accounts against patients who
may be called in the Armed Forces.
(2) THE TIME TO COLLECT IS NOW because with inevitable continued in-
flation, increased salaries and wages, farm prices, commodity prices,
there will be more money in circulation.
(3) That if you already have been called into the service or anticipate being
called that you permit this qualified organization to act as your liqui-
dating agent.
Our many years of experience handling accounts in the professional
field plus our contractual relationship with fifty trade associations ex-
tending from coast to coast, proves we are rendering outstanding serv-
ice.
Professional, commercial trade associations, and bank recommendations furnished.
Professional Credit
Protective Bureau
Division of
Thel.C. System
724 Metropolitan Bldg.
Minneapolis. Minn.
Further Inquiry Invited
FILL OUT AND MAIL COUPON NOW
Professional Credit Protective Bureau
724 Metropolitan Bldg.
Minneapolis, Minn.
Gentlemen:
Without obligation, please send complete in-
formation regarding this service.
Name
Address
City State
December, 1950
1187
NOW AVAILABLE
for your daily practice
WITHOUT RESTRICTION
CORTONE* (Cortisone) is now available, through your usual source of
medicinal supplies, without restriction. Pharmacists are prepared
to fill your prescriptions for use of this remarkable hormonal
substance in your daily practice. Hospitalization of individual patients
is at the discretion of the physician.
Key to a New Era in Medical Science
ACETATE
(CORTISONE Acetate Merck)
(11 -Deliydro-17-hydroxycorticosterone-21 -acetate )
MERCK & CO.. Inc.
Manufacturing Chemists
Rahway, new jersey
*CORTONE is the registered
trade-marl: of Merck & Co.,
Inc. for its brand of cortisone.
118 8
Minnesota Medicine
AW DOCTOR'S REPORT
CONFIRMED WHAT I KNEW
FROM THE START- CAM ELS
AGREE WITH MY THROAT.
AND 1 LIKE CAMEL'S
7 RICH, FULL FLAVOR!
THROAT SPECIALISTS REPORT
ON 30-DAY TEST OF CAMEL SMOKERS...
&& (ft /rinafe
* dtudo/tovt* <f
Yes, these were the findings of throat specialists
after a total of 2,470 weekly examinations
of the throats of hundreds of men and women
who smoked Camels — and only Camels
— for 30 consecutive days.
HARRY SOUTHWELL,
lawyer, is one of hundreds,
coast to coast, who made
the 30-Day Test of Camel
Mildness under the observa-
tion of throat specialists.
ACCORDING TO A NATIONWIDE SURVEY:
C4(ke,7tocl8i4r
THAN ANY OTHER CIGARETTE
Yes, doctors smoke for pleasure, too! In a nationwide survey, three independent
research organizations asked 113,597 doctors what cigarette they smoked. The
brand named most was Camel.
It. J. Reynolds Tobacco Company. Winston-Salem, N. C.
December, 1950
1189
PHOSPHO-SODA (FLEET
of its
Broad Clinical Acceptance
Phospho-Soda (Fleet)'s* wide acceptance by physicians
everywhere is a tribute to its prompt, gentle laxative
action — thorough, but free from disturbing side effects.
Leading modern clinicians attest its safety and depend-
ability as a pre-eminent saline eliminant for judicious
relief of constipation. Liberal office samples on request.
k Phospho-Soda (Fleet) is a solution containing in each 100 cc. sodium biphosphate 48 Gm. and
sodium phosphate 18 Gm. Both 'Phospho-Soda' and 'Fleet' are registered trade marks of
C. B. Fleet Company, Inc.
C. B. FLEET CO., INC. •"lynchburg, Virginia
1190
Minnesota Medicine
1.25 mg., 0.625 mg. and 0.3 mg. tablets
also in liquid form, 0.625 mg. in
each4cc. (1 teaspoonful).
‘Period, W. H.: Am. J. Obsl. & Cynec. 58:684 (Oct.) 1949.
While sodium estrone sulfate is the principal estrogen in
“Premarin” other equine estrogens. ..estradiol, equilin,
equilenin, hippulin...are probably also present in varying
amounts as water-soluble conjugates.
The . , . estrogen
preferred by us is
r Premarin,’ a mixture
of conjugated estrogens,
the principal one
of which is
estrone sulfate,”
Hamblen, E. C.: North Carolina M.J. 7:533 (Oct.) 1946.
In treating the menopausal syndrome
with “Premarin” Perloff* reports thr.t
“Ninety-five and eight tenths per cent
of patients treated with 3.75 mg.
or less daily obtained complete relief
of symptoms”; also, “General tonic
effects were noteworthy and the greatest
percentage of patients who expressed
clear-cut preferences for any drug
designated ‘Premarin!”
Thus, the sense of “well-being”
usually imparted represents a “plus” in
“Premarin” therapy which not only
gratifies the patient but is conducive to
a highly satisfactory patient-doctor
relationship.
Four potencies of “Premarin”
nprmit flpYiKililv nf rlncacp • 9 mar
Estrogenic Substances [water-soluble) also known as Conjugated Estrogens (equine)
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1192
Minnesota Medicine
Journal of the Minnesota State Medical Association, Southern Minnesota Medical Association, Northern Minnesota
Medical Association, Minnesota Academy of Medicine and Minneapolis Surgical Society
Volume 33 DECEMBER, 1950 No. 12
HYPOPLASIA OF THORACIC AORTA CLINICALLY SIMULATING
COARCTATION
ALLAN L. FERRIN, M.D., and JOHN F. BRIGGS, M.D.
Saint Paul, Minnesota
IVAN D. BARONOFSKY, M.D.
Minneapolis, Minnesota
\\ 7"ITH the current interest in cardiac and vas-
cular surgery, it is felt advisable to report
what is believed to be an unusual abnormality in
the aorta. A thorough review of the American
literature fails to reveal a previously reported case
similar to this. Clinically our patient presented
most of the findings of coarctation, and thoracot-
omy proved him to have narrowing of the thoracic
aorta beginning at a point just distal to the liga-
mentum arteriosum.
Case Report
R. L., a twenty-five-year-old, single, white man, was
first seen at Ancker Hospital on January 25, 1948, after
sustaining a nasal fracture. He had known that he had
a “heart murmur” since the age of eighteen and had
been told that he probably had coarctation of the aorta
after one physician had used intravenous-medications to
relieve a blood pressure of “about 190.”
On April 28, 1949, he was admitted to the hospital
at the request of one of us (J. F. B.) for operation,
again with diagnostic findings of coarctation of the aorta.
At that time he was relatively asymptomatic except for
extreme palpitation and some exertional dyspnea and
fatigue. He gave no history of orthopnea, cough, or
ankle edema and had no urinary complaints. As a child
he had been able to exercise and swim without appre-
ciable difficulty.
His past history revealed that he had developed tuber-
culosis of the thoracic spine and left hip at the age of
three. The spine and hip were immobilized until he was
seven years of age using a Bradford frame and casts.
At eighteen years of age his left hip was ankylosed.
Other operations included a tonsillectomy and an appen-
dectomy. He had the usual childhood diseases (measles,
Dr. Ferrin is chief surgical resident, Ancker Hospital, Saint
Paul, Minnesota. Dr. Briggs i9 clinical associate professor of
medicine at the University of Minnesota. Dr. Baronofsky is assist-
ant professor of surgery at the University of Minnesota.
Presented before the Minnesota Society of Internal Medicine
on May 27, 19S0, at Duluth, Minnesota.
December, 1950
mumps and chickenpox). Several years prior to admis-
sion he had pneumonia involving the left lung.
Physical examination revealed an asthenic, intelligent,
young white man in no acute distress. His temperature
was 98.7° F. and his pulse 60. A blood pressure record-
ing in the right arm was 160/110 and in the left arm
162/94; in the right and left legs 110/90. There were
scars over the left hip area from previous surgery and
draining sinuses. There was a dorsal kyphoscoliosis with
increased anteroposterior diameter of the chest (Fig. 1).
Examination of the heart revealed cardiac enlargement
with the apex at the sixth left intercostal space at the
anterior axillary line. The rhythm was regular. There
was a long harsh systolic murmur heard best in the left
second interspace, and one observer (J. F. B.) heard a
diastolic murmur over the base of the heart. Femoral
pulsations were diminished in quality, but present. Pop-
liteal, posterior tibial, and dorsalis pedis pulsations were
not felt. Pulsations in the upper extremities were normal.
The left hip joint was ankylosed and both legs were
small in calibre and less muscular than normal.
Laboratory studies showed normal urinalyses with
specific gravities between 1.010 and 1.025. The hemo-
globin was 14.1 grams and red blood cell count 5.65 mil-
lion. The white count was 7400 with 56 per cent
polymorphonuclear cells, 39 per cent lymphocytes, 4 per
cent monocytes and one per cent eosinophil. The eryth-
rocyte sedimentation rate was 5 mm. in one hour. The
blood urea nitrogen was 11.2 mg. per cent.
Chest fluoroscopy showed left ventricular cardiac en-
largement and rib notching (Fig. 2). The aorta was not
well visualized because of the marked spinal deformity
consisting of acute angulation in the upper third of the
dorsal spine. Films taken in this area showed destruction
of several vertebral bodies, probably dorsal four, five,
six, and seven. There was a minimal amount of calcifi-
cation present and it was felt that the destructive process
was probably due to tuberculosis.
The electrocardiogram showed sinus bradycardia and
left axis deviation interpreted as probably being within
normal limits. Renal flow studies preoperatively by Dr.
John LaBree were also within normal limits.
1193
HYPOPLASIA OF THORACIC AORTA— FERRIN ET AL
Fig. 1. Oblique x-ray chest showing the dorsal kyphoscoliosis.
Fig. 2. Anteroposterior view of the chest showing left ventric-
ular cardiac and rib notching.
On May 9, 1949, he was taken to the operating room
but operation was postponed after the anesthesiologists
were unable to introduce an endotracheal tube. Nine days
later, on May 18, intubation was successful and an
exploratory thoracotomy was performed under pen-
tothal-curare-nitrous oxide anesthesia. The pleural cavity
was entered through the left posterolateral aspect of the
chest with excision of the sixth rib. The vessels around
the scapula were markedly dilated. The left subclavian
artery was found to be dilated to a diameter of 3 cm.
The arch of the aorta also measured 3 cm. in diameter
(circumference 9.42 cm.). After incising the mediastinal
pleural covering the aorta, a narrowing was found in the
aorta just distal to the ligamentum arteriosum and also
to the point of most marked dorsal kyphosis. The aorta
at this point measured only 1.5 cm. in diameter, and
exposure of the thoracic aorta by dissection down to the
diaphragm failed to reveal any change in its size. A good
flow of blood was felt going through this portion of the
aorta.
Because of the nature of the abnormality, further oper-
ation was deemed inadvisable. After introducing two
rubber catheter drains into the pleural space, the chest
wall was closed in layers with interrupted silk sutures.
His postoperative recovery was uneventful.
Discussion
Hypoplasia of the aorta was described first in
1761 by Morgagni, and by 1907, according to
Ikeda,8 over 100 cases bad been reported in the
literature. Recently the reports have been more
sporadic and all have concerned themselves with
narrowness of the entire aortic system or well-
localized areas (coarctation). Burke,5 Apelt,2
Ikeda,8 and Werley, Waite, and Kelsey13 give
excellent descriptions of hypoplasia involving the
entire aortic system.
Coarctation was first recognized, according to
Abbott,7 in dissecting room specimen by Paris in
1791. In the past two decades the literature has
contained numerous reports and reviews which
need not be discussed here. The surgical treat-
ment of this condition was introduced independ-
ently by Gross and Crafoord in 1945. Bahnson,
Cooley and Sloan3 reported two cases of coarcta-
tion below the ductus arteriosus and added ten
from the literature. Parker and Dry11 reported
a case of aortic stenosis between the left common
carotid and left subclavian arteries. Maycock10
and Kondo et al9 presented cases with complete
occlusion in the mid-abdominal aorta.
From the available literature, then, our case
seems unusual in that it combines the clinical pic-
ture and pathological findings of both coarctation
and hypoplasia. Unfortunately we do not know
the calibre of the abdominal aorta, but must as-
sume that it, too, is hypoplastic.
The incidence of hypoplasia of the aorta varies
1194
Minnesota Medicine
HYPOPLASIA OF THORACIC AORTA— FERRIN ET AL
in several reports. Ikeda8 states that out of 14,305
autopsies at the University of Minnesota there
were eight cases ; he also states that V on Ritook
reported fifty-seven cases in 395 autopsies and
Cabot reported nineteen cases in 1846 autopsies.
Werley et al13 found twenty-five cases in 4500
autopsies. Paul White14 states that simple hypo-
plasia of the aorta is probably the commonest of
the congenital aortic anomalies, but in high degree
is relatively rare and then usually associated with
other cardiovascular defects. Maude Abbott7
found twenty-one cases of hypoplasia among the
200 cases of coarctation which she reviewed. She
commented that since the ascending aorta is so
commonly secondarily dilated as a result of co-
arctation. the original narrowing at this point
(ascending and aortic arch) may be obscured in
patients attaining adult life. Thus she concludes
that the association of congenital hypoplasia of
the arterial tract with coarctation may be more
frequent than is apparent from reports.
In normal males between the ages of twenty and
thirty years, the average circumference of the
thoracic aorta studied at necropsy was 4.4 cm.,
according to Ikeda.8 According to these figures
our case, with a circumference of 4.7 (diameter
1.5 cm.) falls within normal limits. However, our
measurement seems to be near the lower limits of
normal and was taken on an aorta distended with
blood so that the size is not well comparable with
the size of the aorta found at necropsy. Further-
more, Werley, Waite and Kelsey13 state that the
normal internal circumference of the aorta at its
widest point equals 5.5 cm., and they present one
case of hypoplasia in which the thoracic aorta
measured 1.37 cm. in internal diameter and two
others in which the measurements were 1.11 in
diameter. Inasmuch, then, as our measurements
were taken of the outside diameter and on a liv-
ing patient, we feel that for practical purposes this
aorta must be considered hypoplastic.
In considering an explanation for the hyper-
tension in the upper extremities in our case, sev-
eral factors seem important. According to the
laws of the dynamics of circulation4,13 we find we
have increased resistance due to the long narrow-
ing of the aorta. Since the volume of flow is pro-
portional to the fourth power of the diameter
(Poiseuille law), there is reduced flow to the
lower extremities. In compensating for this, the
collateral circulation proximal to the narrowing
developed. The gradual dilatation of the aorta.
acting much like an aneurysm, produced a vicious
cycle following the principle that in a tube of
varying diameter the velocity varies inversely and
the lateral pressure directly with the sectional area
of the tube. Abramson1 feels that the increased
systolic blood pressure in the upper extremities is
largely the result of arteriolar vasoconstriction, al-
though the resistance to blood flow through the
narrowest portion of the aorta probably plays a
role. The renal blood flow studies which were
within normal limits tend to eliminate the kidneys
as a factor in the hypertension.
This case allows interesting speculations as to
pathogenesis in view of the associated healed ( ?)
tuberculosis of the thoracic spine and marked
kyphoscoliosis. Certainly one must admit that
failure of the aorta to have developed normally
might well be secondary to the marked spinal
deformity, particularly since the area of narrow-
ness began immediately adjacent to the point of
greatest projection of the spine into the thorax.
Burke,5 in 1902, interestingly enough, discussed
the etiological relationship of aortic hypoplasia
and tuberculosis. He concluded that arterial in-
sufficiencv tended to predispose to the infectious
process. Here we feel that mechanical effects may
have been more important. Certainly, however,
we cannot deny that the coexistence of these two
entities may have been purely coincidental.
Angiographic studies of this case would cer-
tainly have been of value, but unfortunately at
the time he was submitted for operation, the
technique of angiography at our hospital had not
been perfected to the point where the risk of the
procedure seemed justified.
The question of whether or not this lesion is
congenital or acquired arises. In favor of this
being congenital are the associated cardiac mur-
murs and possibly the extent of the hypoplasia.
On the other hand, the fact that the narrowing
began adjacent to the point of most marked dorsal
kyphoscoliosis is in favor of its being acquired.
We do not feel that there is sufficient evidence to
answer this question completely.
Summary
1 . A case of an unusual abnormality in the
thoracic aorta which clinically simulated true
coarctation of the aorta has been presented.
2. A brief review of the literature on coarcta-
tion and hypoplasia of the aorta is included.
(Continued on Page 1203)
December, 1950
1195
TREATMENT OF AURICULAR FIBRILLATION FROM THE STANDPOINT
OF THE GENERAL PRACTITIONER
ROBERT H. CONLEY, M.D.
Mankato, Minnesota
HTHE highest degree of auricular disturbance is
'L called auricular fibrillation. In this condition,
the number of auricular impulses is very great,
400 to 600 per minute. Total irregularity (dele-
rium cordis) has been thoroughly evaluated by
Thomas Lewis7 and other early cardiologists. The
classical theory of circus movement to explain this
abnormality has been universally accepted and has
only recently been challenged by Pranzmetal of
Los Angeles who photographed exposed hearts of
dogs using high speed colored film reproducing
the heart action in slow motion.
Auricular fibrillation is the most common
cardiac irregularity requiring treatment encount-
ered in hospital records. It probably ranks third
in frequency as a disturbance of rhythm, prema-
ture beats and paroxysmal auricular tachycardia
ranking first and second. White and Jones13
analyzed 3,000 patients with cardiac symptoms
and signs in 1928. They found 376 of this group
(12.5 per cent) with auricular fibrillation; 309
(82.2 per cent) were permanent and 67 (17.8 per
cent) paroxysmal in type.
Auricular fibrillation is rare in infants and
children and is most commonly found in individ-
uals over forty years of age. It is usually asso-
ciated with organic heart disease, but may occur
in the absence of heart disease associated with
excessive use of alcohol, tobacco, or with excite-
ment, trauma, operations (particularly thoracic),
acute infections (pneumonia) or chronic infec-
tions such as cholelithiasis. White states that the
condition is fundamentally a functional disorder
and is not in itself to be classified as heart disease.
However, in hospitalized cases auricular fibrilla-
tion is associated with organic heart disease in a
high percentage of cases. Auricular fibrillation
occurs frequently in rheumatic valvular heart dis-
ease. The triad of rheumatic heart disease, mitral
stenosis and auricular fibrillation is a common
occurrence. Auricular fibrillation is less frequent
in rheumatic heart disease with aortic valvular
deformities. In rheumatic heart disease the fibril-
lation is generally paroxysmal and disappears
spontaneously only to recur when valvular de-
Read at the annual meeting of the Southern Minnesota Medical
Association, Mankato, Minnesota, September 11, 1950.
formities are present. It is unusual in congenital,
subacute bacterial and syphilitic forms of cardiac
involvement and in chronic cor pulmonale, al-
though it does occasionally appear in these condi-
tions. In an analysis of 575 cases of auricular
fibrillation by McEacheon and Baker8 the chief
etiologic relationships were : rheumatic heart dis-
ease 34.4 per cent, arteriosclerotic heart disease
31.1 per cent, hypertension 16.9 per cent, thyro-
toxicosis 7.5 per cent, emphysema 5 per cent,
syphilis 3 per cent, and miscellaneous 2.1 per cent.
On observation of the fibrillating heart the
auricles appear dilated and inco-ordinated. Con-
traction is replaced by quivering of the auricular
surfaces, while the ventricles beat at totally
irregular intervals. There is a decrease in cardiac
output per minute and diliatation of the heart
irrespective of whether or not heart disease is
present, and the state of compensation. Kerkhofif5
utilizing the acetylene method of determining
cardiac output found the efficiency of the heart
in mitral stenosis with auricular fibrillation in-
creased 25 per cent when regular rhythm was
restored bv quinidine even though prior to con-
version the rate was kept at 60 to 70 beats per
minute with digitalis. No one, as yet, has reported
a series of cases studied by means of right heart
catheterization before and after conversion.
During tachycardia there is so little blood in the
ventricles when systole occurs, that some con-
tractions fail to open the aortic valve and to expel
enough blood to form a radial pulse, accounting
for the pulse deficit. At the next systole there
will be a greater accumulation of blood, so that
the radial pulse will be barely palpable or larger,
which accounts for variations in pulse volume.
The pulse deficit represents expenditure of cardiac
energy which is wasted.
Symptoms vary with auricular rate, the under-
lying functional state of the heart, and the dura-
tion of the auricular fibrillation. In the paroxysmal
form, when the ventricular rate is rapid, the pic-
ture is similar to that seen in paroxysmal tachy-
cardia except for the arrhythmia and other diag-
nostic signs of auricular fibrillation. In the
chronic form, no symptoms may be present or, if
present, they range from palpitation, fluttering,
1196
Minnesota Medicine
AURICULAR FIBRILLATION— CONLEY
skipping, pounding and anxiety, to pallor, cya-
nosis, breathlessness, syncope, faintness and col-
lapse. Congestive heart failure may be coincidental
with, contributed to, or entirely caused by the
rapid irregular ventricular rhythm. While angina
pectoris is uncommon in chronic auricular fibrilla-
tion, it may occur in the paroxysmal form with
a rapid ventricular rate when the patient has a
predisposing underlying chronic coronary insuffi-
ciency. The patient may show distress or fear,
may complain of the tumultous action, may be
irritable or may have vague pain. The symptoms
are exaggerated when the patient is hypersensi-
tive.
The clinical diagnosis is not difficult ; and it is
easier if the ventricular rate is quite rapid or
before digitalization. On ausculation the rhythm
is usually totally irregular. Attempts at discern-
ing any regular sequence of heart beats is met
with failure. The pulse is usually slower, and is
irregular and of variable volume. Simultaneous
auscultation of the heart and palpation of the
radial pulse reveals the magnitude of the pulse
deficit. The ventricular rate and pulse deficit
increase with moderate exercise while the irregu-
larity due to premature contractions is likely to
disappear. The ventricular rate may be 180, but
usually is 130 to 160, and occasionally is as low
as 70 or 80 even without digitalis. Carotid sinus
pressure retards the ventricles transiently by
depressing the A-V conductivity, bringing out the
irregularity at slow rates. The enhancement of
A-V conductivity and the acceleration of the ven-
tricular rate by exercise, atropine and amyl ni-
trate may disclose the irregularity of the beating
heart. The cardinal signs of auricular fibrillation
in the electrocardiogram are : ( 1 ) the absence of
P waves, (2) the presence of irregular ventricular
beating, except in complete A-V block, and (3)
the presence of undulations (F waves) of varying
amplitude, contour and spacing, whose rate usu-
ally falls between 350-600 per minute.
Sudden death from auricular fibrillation is rare
except in the forms associated with coronary dis-
ease or an embolus. The formation of thrombi in
the auricles, especially in the auricular append-
ages, is Common and may result in emboli to the
vascular beds especially evident in the lung, brain,
extremities, mesentery, and heart. Sudden death
may be caused by emboli or by a ball thrombosis
in the mitral wave. When the ventricular rate is
slow, patients maintain an adequate circulation for
years without progressive cardiac enlargement or
failure. Others carry on satisfactorily when the
rate is controlled. The paroxysmal form may lead
to no apparent harm in the course of years.
Chronic fibrillation does not in itself afford a seri-
ous prognosis, but as a complication of heart dis-
ease, it comes on usually toward the end of the
natural history of the disease.
The treatment of auricular fibrillation is not a
standard procedure. Each individual needs to be
evaluated clinically and a thorough understanding
of the basic cardiac disease should be sought out
before therapeutic measures are instituted. Since
emotion and exertion tend to speed up the rate of
the ventricles, they should be minimized as far as
practicable.
If the ventricular rate is slow, if it accelerates
only moderately on exercise, and if the patient is
without symptoms, special treatment is not indi-
cated, although the use of quinidine should be con-
sidered. If the rate is rapid, especially if the
patient has heart disease, rest in bed is indicated
if possible until it is retarded, and is required
if there is failure.
Digitalis is by far the best drug to administer
in auricular fibrillation ; in fact, its reputation as- a
cardiac drug rests primarily on the brilliant results
obtained when the condition is attended by a rapid
ventricular rate and congestive heart failure. The
faster the ventricular rate, the more urgent the
necessity for therapy to retard the beating of the
ventricles. Digitalis acts primarily to reduce the
number of impulses passing to the ventricles by
depressing A-V conduction, but aside from that
it also relieves congestive failure. Digitalis is
given either to build up the concentration of the
drug in the heart (digitalization) or to maintain
the concentration once established. The rate of
digitalization varies with the urgencv of the case.
Digitalis should be given until the desired effect
is obtained or mild toxic symptoms appear. The
chief toxic manifestations of digitalis are anor-
exia, nausea, vomiting, diarrhea, yellow or colored
vision, frequent premature beats, sino-auricular
block and sinus standstill.
In determining the amount of digitalis to be
used the goal of 60 to 80 beats per minute at the
apex should be kept in mind. If the patient is in
bed and digitalis has not been given in three
weeks, digitalization may be undertaken rapidlv by
giving in twenty-four hours by mouth a total of
1.8 gm. of the powdered leaf (U.S.P. XII). In
December, 1950
1197
AURICULAR FIBRILLATION— CONLEY
the average case, digitalis folea (U.S.P. XII)
0.2 gm., or digitoxin 0.2 mg. orally three times
daily for three days is recommended. This is a
rough guide and the patient should be placed on
a maintenance dose earlier if the desired thera-
peutic effect is obtained sooner and conversely
should be delayed until more digitalis bas been
given if the patient responds poorly to the above
dosage. The amount of digitalis required is in-
fluenced by the body weight, the status of the myo-
cardium, the rate of ‘absorption, the speed of
mobilization and excretion, and the amount of
edema fluid. These factors operate to affect the
levels of digitalis concentration in the myocardial
tissue and the level required for therapeutic
response. The lowering of the ventricular rate
to 70 to 80 beats per minute and the lowering in
pulse deficit are valuable indices of the therapeutic
response to digitalis. Similarly the disappearance
of edema, increased urinary output, weight loss
and disappearance of other signs and symptoms
of congestive failure should be used. Individuals
who reach the full therapeutic or toxic level before
four or five days usually require smaller mainte-
nance doses (0.1 gm. of leaf, 0.1 mg. digitoxin).
and those who take longer than a week usually
require more digitalis as a maintenance dose. The
appearance of toxic signs and symptoms calls for
discontinuation of the drug. However, it should
be resumed and administered cautiously follow-
ing disappearance or evidence of toxicity.
In the treatment of ventricular paroxysmal
tachycardia caused by digitalis excess, quinidine,
papaverine, potassium or magnesium have been
used to sooth the ectopic pacemaker.
Tn more urgent cases digitalization may be
carried out more rapidly, the full digitalization
dose being given in one, two or three doses. Tt
may be given in the form of digitoxin (Digitaline
nativellc) 1.2 mg. The entire dose or portions
thereof may be given orally, intravenously or
intramuscularly. Orally the medication is absorbed
totally and gives a full effect in a matter of three
to four hours, the effect lasts for several days and
this drug does not irritate the intestinal tract in
therapeutic doses. Its effect parenterally (intra-
venously or intramuscularly) is similar to oral
administration, and the parenteral route is to be
used when the oral route is not available. In giv-
ing such large doses of this or any other digitalis
preparation, extreme caution should be exercised
if the patient has received digitalis recently, espe-
cially if edema is present, because ventricular
fibrillation can readily be caused. Edema fluid con-
tains digitalis in digitalized patients, and when
absorbed the digitalis re-enters the blood stream
for distribution together with that administered.
It takes two weeks or more for digitalis to be
excreted.
If more rapid effects are essential, quicker act-
ing digitalis preparations are to be used intra-
venously with the same care as with large doses
of digitoxin to avoid overdigitalization. The
purified crystalline glucoside, lanatoside C, may be
used. It is faster in speed of action and rate of
excretion when given intravenously than digitoxin.
Its effect intravenously begins within an hour.
The digitalizing dose of lanatoside C intravenously
is 2 mg. It should be mentioned that strophanthin
intravenously has been used for rapid digitaliza-
tion ; however, it is rarely being used at the pres-
ent time.
Occasionally it is desirable to treat auricular
fibrillation on an ambulatory basis. Dosage sched-
ules should be calculated on total digitalization
plus the total maintenance dose over a given
number of days. It is advisable to carry out the
digitalization over a period of several days with
smaller amounts being given at the end of the
schedule. Ambulatory therapy intimates loss of
direct supervision, therefore, the patients should
be closely instructed in regard to the toxic effect
of the medication.
Paroxysmal auricular fibrillation is not an un-
common finding in a general practitioner’s office.
Tf paroxysms are infrequent or brief in an other-
wise well subject, specific treatment is not re-
quired, beyond avoidance of precipitating factors.
If, however, the attack has persisted for several
hours, if tachycardia prevails, or if the patient
is uncomfortable, reassurance, bed rest and seda-
tion should be prescribed. Lack of response to the
above treatment indicates the necessity for digi-
talization which should then be carried out. Tf the
normal rhythm has not been restored by digitali-
zation, quinidine is indicated. Recurrent fibrilla-
tion is occasionally prevented by digitalization fol-
lowed by maintenance doses.
When auricular fibrillation occurs in hyper-
thyroidism, the ventricular rate is reduced with
digitalis. Larger than the average amounts may
be required for adequate slowing. Maintenance
1198
Minnesota Medicine
AURICULAR FIBRILLATION— CONLEY
doses are continued during treatment with propyl-
thiouracil, iodine, et cetera. After operation in
most instances, a few days to many weeks, the
rhythm reverts to normal spontaneously. When
this occurs, digitalis is discontinued if heart fail-
ure does not require its continued use. If normal
rhythm has not recurred after an adequate post-
operative period the use of quinidine is considered.
Recent myocardial infarction followed by auric-
ular fibrillation with a rapid ventricular rate is
a situation calling for heroic therapy. Rapid digi-
talization is carried out followed by quinidine
therapy. Quinidine is advisedly first preceded bv
digitalis in order to avoid further ventricular
acceleration which quinidine may bring on as it
slows auricular activity.
Quinidine is a far more effective drug in re-
establishing sinus rhvthm than digitalis. Wencke-
bach first introduced quinidine in 1914 for the
treatment of paroxysmal auricular fibrillation.
Most authorities agree that patients with auricular
fibrillation should be digitalized and well com-
pensated before conversion with quinidine should
be attempted; however, in recent articles Mc-
Millan and Welfare” and Askey1 state that in
patients with congestive failure persisting after
complete digitalization, rest, diuretics, and low
sodium diet, administration of quinidine to abol-
ish auricular fibrillation at times produces remark-
able results.
According to recent articles the only absolute
contraindication to quinidine is idiosyncrasy to
the drug itself A’ 1,9 Relative contraindications are
pronounced cardiac enlargement, congestive fail-
ure, heart block, subacute bacterial endocarditis
and angina relieved by fibrillation.
Symptoms of toxicity include the symptoms of
einchonism such as tinnitis, vertigo, visual dis-
turbance, headache, confusion, syncope, fever,
nausea, vomiting, diarrhea, cutaneous rash and
angioneurotic edema. Serious hazards include
ventricular fibrillation, cardiac asystole or respira-
tory arrest.
At the present time most cardiologists agree that
the incidence of embolic accidents with conversion
has been greatly overemphasized. Vika, Marvin
and White12 stated that it seemed justifiable to
conclude that embolism occurs less frequently
under quinidine therapy than under ordinary
treatment. Tn 200 cases of auricular fibrillation
without quinidine therapy, these investigators
observed nine instances of embolic phenomena
(4.5 per cent) whereas in 484 cases of auricular
fibrillation treated with quinidine emboli accured
in fifteen cases (3.1 per cent).
Before attempting the restoration of normal
rhythm with quinidine the patient should be
placed on bed rest and adequately digitalized.
Fahr2 recommends a test dose of 3 grains be
given. The following morning 3 grains are given
at 8, 9, and 10 a.m. Each succeeding day 3 grains
are added to the previous dose (Ex. ; 6 grains, 3
grains, 3 grains, et cetera). If necessary the total
dosage may be raised to 36 grains. He reports a
total conversion to normal rhythm in 65 per cent
of cases (over 500 cases of fibrillation and flutter).
Levine6 recommends 0.2 gm. of quinidine to
start and this is increased by 0.1 gm. with each
dose. Medication is given three times, a day. Up
to 1.5 gm. in a single dose have been given but
this is not advisable under ordinary circumstances.
Following digitalization, Katz3 uses a schedule
of 0.4 grams every two hours until the arrhythmia
is broken or until five doses have been given.
This may be repeated for two or three days, the
dose being increased each day by 0.2 gm.
If normal rhythm is restored, a maintenance
dose of 0.2 gm., one to three times daily, may be
used. If normal rhythm is restored once, but
fibrillation recurs wTiile quinidine is being given,
further attempts are not recommended. After
normal rhythm is restored prophylactic mainte-
nance dosage should be given for a period of
weeks and then stopped, in order to determine
whether the ectopic pacemaker is inactive.
References
1. Askey, J. : Quinidine in the treatment of auricular fibrillation
in association with congestive failure. Ann. Tnt. Med., 24:
371, 1946.
2. Fahr, G. : The treatment of cardiac irregularities. J.A.M.A.,
111:2268, 1938.
3. Katz, L. : Electrocardiography. 2nd ed. Philadelphia: Lea &
Febiger, 1946.
4. Katz, L. : Modern management of heart disease, quinidine.
J.A.M.A., 136:1028, 1948.
5. Kerkhof, A. : Minute volume determinations in mitral
stenosis. Am. Heart J., 11:206, 1936.
6. Levine, S. A.: Clinical Heart Disease. 3rd ed. Philadelphia:
W. B. Saunders Co., 1945.
7. Lewis, T. : The Mechanism and Graphic Registration of the
Heart Beat. London: Shaw & Sons, 1925.
8. McEachern, D., and Baker, B. M.: Auricular fibrillation, its
etiology, age, incidence and production of digitalis therapy.
Am. J. M., Sc., 183:35. 1932.
9. McMillan, R., and Welfare, C. : Chronic auricular fibrillation.
J.A.M.A.. 135:1132, 1947.
10. Orgain, E. : Wolff, L.. and White, P.: Uncomplicated auric-
ular fibrillation and flutter; frequent occurrence and good
prognosis in patients without other evidence of cardiac disease.
Arch. Int. Med., 57:493, 1936.
11. Stewart, H. J. : Cecil’s Textbook of Medicine. 7th ed. Phila-
delphia: W. B. Saunders Co.. 1947.
12. Vika, L. ; Marvin, H., and White, P. : Clinical report on the
use of quinidine sulfate. Arch.. Int. Med., 31 :345, 1923.
13. White, P. : Heart Disease. 3rd ed. New York: Macmillan,
1944.
I wish to acknowledge extensive use of References 3, 6 and 13
in the preparation of this paper.
December, 1950
1199
"ANTABUSE” (TETRAETHYLTHIURAM DISULFIDE) IN THE TREATMENT
OF ALCOHOLISM
I. C. MICHAEL. M.D.
Minneapolis, Minnesota
r | 1 0 the list of modifications of the treatment of
alcoholism proposed in recent years, Jacobsen
and Martinsen-Larsen of Denmark contributed
clinical reports two years ago on the combined
effect of alcohol and Antabuse® (tetraethylthiuram
disulfide). Pharmacological and toxicological in-
vestigations and animal experiments were outlined
by Hald, Jacobsen, Larsen, Asmussen, Jorgensen
and others.
The purpose of this presentation is to outline
preliminary considerations and to record clinical
experiences with the treatment of twenty-six pa-
tients during the past year.
Preliminary Considerations
Cyanamides were shown by Koelsch in 1914 to
produce toxic effects in workers handling those
chemicals when they imbibed alcohol even in small
amounts. The symptoms included redness of the
face, feeling of giddiness, headache, heightened
pulse and respiratory rates. Continuing for thirty
to ninety minutes, these were terminated by
fatigue and somnolence.
Another sensitizing agent, a fungus termed
coprinius atramentarius, had been found to be
toxic to humans only when alcohol was consumed.
Accounts of non-fatal poisoning in a family are
referred to by Hald, Jacobsen and Larsen.
Toxicity of tetraethylthiuram disulfide is rela-
tively low ; the drug is not soluble in water and is
not excreted by the kidneys. A dose of 2 to 3
grams per kilogram of body weight has been
proved fatal to dogs and rabbits. Prominent
symptoms preceding death include progressive de-
pression, ataxia, slowing of the pulse rate and
respiration. Kidney degenerative processes were
found to exceed those in the lungs and liver. On
the other hand, the continued daily administration
of 1 milligram to rats and 60 milligrams to rab-
bits for ten months failed to reveal impairment of
growth, of body weight or of the elements of the
blood. Single doses of 3 grams, or of continued
Read at the annual meeting of the Southern Minnesota Medical
Association, Mankato, Minnesota, September 1 1, 1950-
Presented at Southern Medical Association Meeting, Mankato,
September 11, 1950.
“Antabuse" trade mark for brand of Antabus (tetraethylthiuram
disulfide) as manufactured by Ayerst, McKenna and Harrison
Limited, who furnished a supply of “Antabuse” employed in this
investigation.
dosages of 0.25 to 1 gram daily in man induced
no deleterious results in most instances. Danish
workers found that within twelve hours following
the ingestion of 1 gram of antabuse, the intake
of alcohol produced, after the elapse of five to
fifteen minutes, first a feeling of heat in the face
and soon thereafter observable reddening of the
face, neck and chest. The pulse rate rose to 120
and higher, blood pressure declined slightly, the
alveolar carbon dioxide was decreased, cardiac
output was increased up to 50 per cent in the
resting person, and up to 15 per cent if the sub-
ject was moderately active.
Nausea, if at all present, occurs within an hour
after the intake of alcohol. Vomiting is less fre-
quent. Dizziness and coma appear to be the re-
sult of relatively higher doses of alcohol. Blood
pressure falls significantly in these instances.
There is the noteworthy observation that inhala-
tions of pure oxygen eliminate the effects upon
respiration and cardiac output.
Antabuse administration combined with alcohol
consumption brings on a five- to ten-fold rise of
the blood acetaldehyde level above that determined
when the antabuse is omitted ; exact reactions con-
cerned are unknown. A concentration of 5 to 10
milligrams per hundred cubic centimeters in the
blood suffices to induce a rise in skin temperature.
Coma appears when these figures rise to 100
milligrams or more. Tolerance, apparently rela-
tively high in heavy drinkers, at first decreases
gradually. In doses of an average drink, alcohol
tends to remain in the blood for some sixty to
ninety minutes following intake, and during this
period of time antabuse continues capable of pro-
ducing characteristic symptoms, which are fol-
lowed by a short period of fatigue and som-
nolence. The saturation dose of antabuse in hu-
mans is not determined. Rabbit experiments are
reported to have shown that acetaldehyde forma-
tion is augmented as the dosage of alcohol and the
drug, the latter up to 0.3 gram per kilogram of
body weight, are increased. Hypersensitivity to
alcohol is observed to begin three to four hours
after antabuse administration in a single dose and
to continue for the following twenty-four hours.
1200
Minnesota Medicine
'ANTABUSE” IN THE TREATMENT OF ALCOHOLISM— MICHAEL
Clinical Experiences with Twenty-six Patients
Of our twenty-six patients, six were treated at
the Minneapolis General Hospital and twenty in
private hospitals. There were twenty-two males
and four females. Ages ranged from the mid-
twenties to the early fifties, about half in the fifth
decade. Nineteen listed themselves as married,
one as single, five divorced, one widowed. About
one-half of this group of alcoholics gave a history
of drinking for their past fifteen to twenty years.
With few exceptions, all preferred whiskey and
beer. Two preferred beer alone, and one re-
ported that he confined himself to gin. Wine and
rum were resorted to by several on some oc-
casions. Other interesting factual material con-
cerning personal history, education, vocational
achievements, familial and other interpersonal re-
lationships, hereditary accounts, range of indi-
vidual abilities and other psychologic test records,
behavior in conflict with the law, previous treat-
ments, et cetera, cannot be detailed here. Essen-
tially these data reveal no uncommon deviations.
Objective examinations by bodily systems, psy-
chiatric interviews, special psychologic tests and
the following technical examinations were made :
(1) routine urine and blood, including the sedi-
mentation rate, (2) fasting blood sugar and sugar
tolerance curve, (3) C02 combining power, (4)
urine concentration and dilution, (5) phenolsul-
fonphthalein, (6) electrocardiograms, (7) liver
function, (8) x-ray of chest, (9) basal metab-
olism rate, (10) electroencephalogram, and ad-
ditional procedures in some instances when
indicated.
Significant visceral disease, if present, was re-
garded as a contraindication to antabuse therapy.
Naturally, the patient to be treated was expected
to feel an unwavering desire to stop drinking
liquor and to plan satisfactory co-operation in the
long therapeutic program for the future, of which
the first two weeks or more in the hospital were
to be regarded only as a relatively minor or intro-
ductory feature.
Antabuse administration is routinely as fol-
lows: On the first day one 0.5 gram tablet is
given four times ; three times on the second day,
twice on the third day, and once in the morning
of the fourth day. Three hours following the last
dose, the patient takes an ounce to an ounce and
a half of whiskey. The attending hospital per-
sonnel is expected to have at hand medicinal and
mechanical aids to combat possible symptoms of
shock. In addition to general observations, pulse,
respiratory and blood pressure notations are made
every five minutes for thirty to forty-five or more
minutes after the ingestion of whiskey.
The following is an illustrative case report :
Case 1. — J. S., a male, aged forty-eight, married, a
construction worker, gave a history of excessive periodic
drinking for eighteen years. He had been under Al-
coholics Anonymous guidance for some time. There was
a history of a “bleeding gastric ulcer” on one occasion in
January, 1949. Physical and laboratory data had been
negative. He was started on antabuse regime, as out-
lined above, and on September 6, 1949, he was given 40
c.c. of whiskey, the fourth day. Blushing to a moderate
degree appeared five minutes later, preceded by two
minutes of a feeling of heat in the head and neck.
Slight dyspnea started also in five minutes and perspira-
tion was obviously increased at the same time. Head-
ache of a moderate intensity was complained of within
fifteen to forty-five minutes. His pulse rate rose from
80 to 100 after a ten-minute interval ; to 125 after twenty-
five minutes. Blood pressure fell from 128/86 to 110/80
after twenty-five minutes. There was a slight feeling of
dizziness and precordial pain from ten to twenty-five
minutes after taking the whiskey. Acetaldehyde odor
was also detected during the same period. After mod-
erate somnolence for a half-hour the patient was free of
distress.
In two patients of the Minneapolis General
Hospital series the state of shock was encountered.
The next two reports concern these subjects.
Case 2. — J. C. G., a male, aged forty-seven, divorced, a
railroad freight conductor, entered the hospital with his-
tory of drinking three bottles (fifths) of whiskey per
day for the last six weeks. Food intake had been
minimal during that time. Also, during this period he
had been seeing “gremlins” ; he seemed to realize that
these visions were not real. Except for an appendectomy
and herniorrhaphy his history had been negative. On ad-
mission, his sensorium was found to be clear, he was
oriented and co-operative, but he was noted to be en-
gaged in kicking the gremlins down the drain ! On Sep-
tember 9 he was given 2 grams of antabuse at 8:00
a.m. ; on the 10th, 1.5 grams; on the 11th, 1 gram; on
the 12th, 0.5 gram at 8:00 a.m.; on the 14th, 0.5 gram at
10:30 a.m. At 2:25 p.m. on the 14th 1 ounce of whiskey
was given. In ten minutes a slight increase in pulse
rate and flush of face began to appear. This subsided
without other phenomena. The next morning he was
given 1.5 grams of antabuse and the following four days
another 1.5 grams of antabuse, this at variance from the
subsequently established routine. At 10 :45 a.m. on the
19th, 40 c.c. of whiskey were given. At 11:10 a.m. his
face appeared flushed; blood pressure, normally 118/80,
fell to 70/50 in thirty minutes, and the pulse rate rose to
132 in fifteen minutes. The patient became unconscious.
Thereupon coramine and caffeine sodium benzoate were
December, 1950
1201
“ANTABUSE” IN THE TREATMENT OF ALCOHOLISM— MICHAEL
injected intravenously and oxygen was administered
oilier, pressure. By 12:15 p.m. the patient began to re-
spond, he appeared tremulous, his face was still flushed.
He refused the food tray at 12 :30 p.m. By 2 :00 p.m. his
condition appeared to be improved. At 2 :30 the patient
drank 200 c.c. of milk. By 3:00 p.m. he walked out in
the dayroom but still seemed shaky. The next morning
he awakened still complaining of some nausea and there
was some emesis. At noon time he ate well and felt well
until time of discharge.
The third case report indicates, furthermore,
what may be expected when sugar metabolism is
impaired. In the presence of such an abnormality,
we would not again allow antabuse administration.
■ j'.',’ ;. . ) ■:
Caw 3. — R. P., a male, aged thirty-one, was confined
at the General Hospital from July 1-6,' 1049. He was ad-
mitted in a stuporous condition, tremulous, with a his-
tory of drinking one quart of whiskey with “all the beer
i can hold for the last three months.” He had not eaten
for the past week. He became more and more incoherent
and had hallucinations of bugs crawling on the ceiling
and walls. Physical examination revealed a tachycardia,
sonorous type of breathing, liver enlarged 2 centimeters
below the right costal margin in the medial costal line.
Hh was re-admitted seven days following his discharge,
which made the fifth admission because of delirium
tremens. At this time the patient agreed to take antabuse
treatment. An extensive physical check-up was per-
formed and numerous tests were made with the following
results: An electroencephalogram showed low voltage
and fast waves; conclusion, borderline electroencephalo-
gram. The basal metaboli-m rate was minus 20 per
cent. An electrocardiogram was within normal limits.
The fasting blood sugar was 75 mg. per cent. Tbe
glucose tolerance test was performed on two occasions,
both showing gross abnormalities. On tbe first occasion
the blood sugar level was lit), after one-half hour 300,
alter one hour 430, after two hours 150, and after three
hours 40. Kidney dilution and concentration test yielded
specific gravities varying from 1.001 to 1.030. The PSP
test indicated a total of 70 per cent. The blood albumin
was 4.09, globulin 2.21. Bromosulfalin test of liver func-
tion : “No dye retained.” The patient was given 200 mg.
•of vitamin B1 and 40 units of insulin on admission be-
cause of extreme restlessness, gross tremor and visual
hallucinations. At first being quiet, he suddenly jumped
out of bed and, then returning to bed, developed a gen-
eralized spontaneous Convulsion. Following this he was
more quiet and expressed no hallucinations. The anta-
buse treatment was started on July 27 with the usual de-
creasing doses of antabuse, starting with 2 grams. On
the fourth day he was given 40 c.c. of whiskey. He de-
veloped mild dyspnea and complained of suffocating.
After approximately one-half hour of oxygen, caffeine
and insulin had to be administered. The patient de-
veloped a very marked fear and anxiety. His pulse be-
came imperceptible and the skin was an ashen gray. The
patient stated that he felt as if “the DT’s were coming.”
Oxygen under pressure was administered for twenty
minutes and gave good relief. This was repeated twice.
The blood sugar then was 150 mg. per cent and the urine
was negative for sugar and acetone. Following this oc-
currence, the patient was put on a cautious daily antabuse
dosage of 0.25 gram and was discharged on this dose
after a second trial of whiskey, which caused only mild
reactions. Though the patient was quite impressed by the
reaction of whiskey, he returned to drinking soon after
his discharge. He failed to accept follow-up outpatient
management.
The following ease is reported to illustrate a
marked influence on the blood pressure.
Case 4. — B. M., aged thirty-six, a farmer’s wife, had
drunk to excess periodically since the time she was mar-
ried to her first husband, from whom she obtained a
divorce five years previously. All preliminary clinical
and laboratory investigations proved negative, except that
her red blood cell count was 3,600,000 and hemoglobin
76 per cent. Besides drinking excessively four months
prior to admission to Glenwood Hills Hospital she had
taken twelve capsules of 1.5 grains of nembutal daily. A
thyroidectomy had been performed in 1946. She was
given whiskey at 10 :00 a.m. on the fourth day of routine
antabuse administration. Her normal blood pressure of
116/72 changed as follows: 10:20, 116/70; 10:30, 102/30;
10:35, 98/28; 10:40, 70/28; 10:45, 84/2 2; 11:00, 80/30;
11:05, 74/40; 11:30, 78/30; 12:15, 72/42; 12:45, 90/34;
6 :00, 120/79. During the first four hours she complained
of headache. Two days later whiskey was again ad-
ministered. One and three-quarters hours later the hlood
pressure reading was 68/34 ; the pulse and also breathing
continued to be strong. Again a slight headache was com-
plained of for a period of several hours.
Case 5. — M. S., a widow, aged fifty-one, had been a
heavy lone drinker for seven years who was started on
the antabuse regime three weeks following recovery from
her last debauch. No physical nor psychic stigmata were
noted until the third day of antabuse administration.
Then first signs of memory defect were noted. Antabuse
was then discontinued. During the following two weeks
it appeared that memory weakness and some degree of
reduction in general interests and activity were changing
for the better. Antabuse was again prescribed in the
amount of 0.5 gram each day. In four or five days there
again appeared more signs of psychic deterioration. In
the course of the following month without antabuse
there has been no change. No signs of peripheral
neuritis have been established.
This case is presented because of the suggestion
that antabuse might be a factor in hastening cen-
tral nervous system degeneration. Satisfactory
proof that this may be so is lacking. However, the
mere suggestion is viewed worthy of future at-
tention.
1202
Minnesota Medicine
‘ANTABUSE” IN THE TREATMENT OF ALCOHOLISM— MICHAEL
Results of Treatment
At the time of this writing, the twenty-'six pa-
tients can be characterized as follows : (1) eleven,
no drinking; (2) eight, significant improvement
but return to one or more brief bouts of drinking ;
(3) three, slight improvement; (4) four, no im-
provement. If we limit our review to the twenty
more promising private practice group, we can say
that 40 per cent have abstained from drinking and
another 40 per cent have done well most of the
time. These 80 per cent have lived useful lives
socially and economically. Naturally, as more
time elapses these figures may change to some
degree — probably a reduction of the number in
the first group and a corresponding rise in the
second, now 40 per cent of the total series. In the
small General Hospital group treatment results
ended in failure in two-thirds of the six patients,
whereas one-third are significantly improved. In
the instances when there was a return to drinking,
the patients who maintained much sobriety, we can
say, alone or more often with the help of the
spouse or other relative succeeded in terminating
their fling in short order. Patients in this group,
as indeed all those taking antabuse, require con-
tinued psychotherapeutic care for many, many
months.
Antabuse, in the last analysis then .does not re-
move the personality problem from the alcoholic
who still must deal with his restlessness and tense
inner feelings, particularly at intervals. The de-
teriorated alcoholic is not a favorable subject for
antabuse treatment ; the patient with visceral dis-
order must be rejected lest likelihood of fatal
terminations face the therapist. Furthermore, no
patient should be accepted for treatment unless he
has a convincing willingness and determination to
prepare for an ever sober life. With the drug
taken in 0.5 gram doses once per day in tablet
form, the patient is given an extra handle, so to
speak, with which to combat safely the inevitable
wavering at some time or another in his future.
The therapist can derive deep pleasure when, as
happens occasionally, a patient comes to report
frankly and proudly that he, though taking his
medicine regularly, did want to just try a swig
and adds, “Oh, Doc, it didn’t taste right, I just did
not want any more of it — I guess T will make it.”
Summary
Historial notes and experimental work de-
scribed in the literature, as well as reports on
early clinical experiences by Danish physicians
concerning tetraethylthiuram disulfide in the
treatment of alcoholism, are reviewed. Thera-
peutic procedures with twenty-six patients are
described. Results reported show a significantly
higher improvement rate in the treatment of pa-
tients in private practice than in those cared for
in a public hospital service. The greater incidence
of physical and mental deterioration in the latter
group served to limit the extent of antabuse treat-
ment. The dangers encountered are described in
illustrative case reports ; these are reduced effec-
tively by rejection of patients with physical and
psychic defects. There were no fatal terminations
in this series. The importance of adjunct psy-
chotherapy is stressed.
Bibliography
1. Hald, J.; Jacobsen, E., and Larsen, V.: Sensitizing effect
of tetraethylthiuram disulphide (antabuse) to ethyl alcohol.
Acta pharmacol. et toxicol., 4:285, (Dec.) 1948.
2. Asmussen, E, ; Hald, J. ; Jacobsen, E., and Jorgensen, G.:
Studies on the effect of tetraethylthiuram disulphide (antabuse)
and alcohol on respiration and circulation in normal human
subjects. Acta pharmacol. et toxicol., 4:297, (Dec.) 1948.
3. Hald, J., and Jacobsen, E. : Formation of acetaldehyde in the
organism after ingestion of antabuse and alcohol. Acta phar-
macol. et toxicol., 4:305, (Dec.) 1948.
4. Asmussen, E. ; Hald, J., and Larsen, V. : The pharmaco-
logical action of acetaldehyde on the human organism. Acta
pharmacol. et toxicol., 4:311, (Dec.) 1948.
5. Larsen, V.: Effect of antabuse in combination with alcohol
on experimental animals. Acta pharmacol. et toxicol.', 4:321,
(Dec.) 1948.
6. Jacobsen,, E., and Martensen-Larsen, O. : Treatment of al-
coholism with tetraethylthiuram disulfide (antabuse).
J.A.M.A., 139:918, (April 2) 1949.
HYPOPLASIA OF THORACIC AORTA
(Continued from Page 1195)
References
1. Abramson, David I.: Vascular Response in the Extremities
of Man in Health and Disease. Chicago: University of Chi-
cago Press.
2. Apelt, F. : Ueber die allgemeine Enge des Aortensystems
Deutsch. med. Wchnschr., 31:1186-1189 and 1233-1236, 1905.
3. Bahnson, H. T. ; Cooley, R. N., and Sloan, R. D. : Coarcta-
tion of the aorta at unusual sites. Am. Heart J., 38:905-913,
(Dec.) 1949.
4. Best, C. H., and Taylor, N. B.: Physiological Basis of Medi-
cal Practice. 53 ed., Chap. 14. Baltimore: Williams and Wil-
kins, 1950.
5. Burke, Joseph: Congenital narrowness of the aortic system.
New York State J. Med., 2:286-297, 1902.
6. Goodson, W. H. : Coarctation of the aorta (a report of two
unusual cases). New England J. Med., 216, 339 (Feb.) 1937.
December, 1950
7. Plamilton, W. F., and Abbott, Maude E. : Coarctation of the
aorta of the adult type. Am. Heart J., 3:381, 1928.
8. Ikeda, K. : Hypoplasia of the aorta as possible cause of
cardiac hypertrophy. Minnesota Med., 16:172-186, (March)
1933.
9. Kondo, B.; Winsor, T. ; RoulsQn, B., and Kuroiwa, D.: Con-
genital coarctation of the abdominal aorta. Am. Heart 1 .
39:306-313, (Feb.) 1950.
10. Maycock, W., Congenital stenosis of the abdominal aorta.
Am. Heart J., 13:633-646, (June) 1937.
11. Parker, R. L., and Dry, T. J. : Coarctation of the aorta at
an unusual site associated with congenitally bicuspid aortic
valve. Am. Heart J., 15:739, (Dec.) 1938.
12. Valentine, N., and Nicholl, R. J.: Aortic hypoplasia with
associated vascular and genitourinary anomalies. Am. Heart
J., 30:514-19, (N?v.) 1945.
13. Werley, G. : Waite, W. W., and Kelsey, M. P. : Aortic
hypoplasia. Texas State J: Med.. 39:467-70, (Jan.) 1944.
14. White, Paul : Cited by Ikeda.8
1203
EMERGENCIES IN THE NEWBORN PERIOD
LLOYD E. HARRIS, M.D.
Rochester, Minnesota
A DISCUSSION of all of the emergencies
which might occur during the newborn pe-
riod is beyond the scope of this paper. The more
common problems will be covered briefly. The
discussion will be primarily related to the present-
ing symptom, differential diagnosis, and treat-
ment.
Cyanosis and Abnormal Respiration
Cyanosis is probably the most frequent alarm-
ing symptom prompting the nurse in charge to call
the physician. The cyanosis is usually associated
with some abnormality of respirations. In Table I
are listed the conditions one must consider in the
differential diagnosis when called to see a newly
born cyanotic infant who may or may not have ab-
normal respirations or who may present abnormal
respirations as the primary symptom.
Many newborns may evidence a venostatic type
of cyanosis of the face and distal parts of the ex-
tremities during the first hours after birth. No
treatment is required and clearing is spontaneous.
During the first three days after birth most in-
fants have episodes of vomiting and retching.
While retching, the infant may become moderately
cyanotic as any of us would do under similar cir-
cumstances. There may even be transient convul-
sive twitchings. These are similar to those seen in
an older child in association with a paroxysm of
crying following an injury. No treatment is indi-
cated except the turning of the baby face down to
avoid aspiration of the vomitus. One is tempted
to aspirate the nasopharynx vigorously, but this
only stimulates the gag reflex more and accom-
plishes little. Can you imagine how it would feel
to have a large syringe vigorously poked about
your throat when you are vomiting?
Before proceeding in the differential diagnosis,
one should, as a general rule, administer oxygen
continuously to all infants evidencing cyanosis.
One may then make every effort to determine the
cause of the difficulty. Oxygen may be provided
by any one of many methods, ranging from the
tube held close to the infant’s face to the very
elaborate oxygen chambers. We have found a
From the Section on Pediatrics, Mayo Clinic, Rochester, Minne-
sota. Read at the annual meeting of the Southern Minnesota
Medical Association, Mankato, Minnesota, September 11, 1950.
TABLE I. CYANOSIS AND ABNORMAL RESPIRATIONS
IN THE NEWBORN
A. “Normal” cyanosis of face and extremities
B. “Cyanotic spell” associated with retching
C. Oversedation from anesthesia of delivery
D. Inadequate respirations nlue to:
1. Obstruction to airway
a. Nasal
b. Nasopharyngeal: tongue, cyst
c. Laryngeal: lesions of false and true cords, congenital
laryngeal stridor
d. Large bronchi: web, plug
e. Vascular ring
f. Tetany
g. Tracheo-esophageal fistula
2. Lesions diminishing vital capacity
a. Atelectasis
b. Pneumothorax
c. Pneumomediastinum
d. Diaphragmatic hernia
e. Congenital anomalies of lung
f. Cysts: lung, mediastinum
3. Neuromuscular disturbance
a. Cerebral hemorrhage
b. Massive adrenal hemorrhage
c. Amytonia congenita
d. Hematomyelocele
E. Congenital heart disease
1. Abnormal shunt
2. Heart block
3. Paroxysmal tachycardia
4. Anomalies of coronary arteries
F. Poisoning
1. Aniline dyes
2. Nitrites
G. Unexplained: failure to establish adequate respirations
homemade boxlike hood with clear plastic sides to
work very well.
Slow and shallow respirations may occur in the
infant if heavy sedation of the mother has been
necessary in a complicated delivery. Resuscitation
may have been difficult. Oxygen and stimulants
such as caffeine sodiobenzoate may be given. The
infant should be in a heated crib or incubator.
Cyanosis as a result of inadequate respirations
secondary to obstruction of the airway is usually
accompanied by suprasternal and infracostal re-
tractions and by inspiratory stridor of some de-
gree. The most frequent cause of this type of
respiratory difficulty in the newborn is obstruc-
tion of the nares. It is not at all uncommon to see
an infant, especially a premature infant, with cya-
nosis and marked retractions completely relieved
by the simple removal of mucous plugs deep in the
nares. This cause of respiratory obstruction,
though the most common, is very frequently over-
looked.
Lesions of the tongue such as idiopathic macro-
glossia, micrognathia or a cyst of the cecal fora-
men of the tongue or epiglottis may produce
marked obstructive symptoms. Supraglottal ob-
struction is usually characterized by a coarse in-
1204
Minnesota Medicine
EMERGENCIES IN THE NEWBORN PERIOD— HARRIS
spiratory stridor with a clear cry, and often a dim-
inution or absence of the stridor when the infant
is held face down or the tongue and mandible are
thrust forward. Lateral roentgenograms of the
soft tissue of the cervical region may demonstrate
the lesion. Definite diagnosis can usually be made
by direct laryngoscopy. Tracheotomy may be
necessary as an emergency measure and removal
or correction of the obstruction deferred. If one
is not prepared to do a tracheotomy, an intratra-
cheal catheter or a small Mosher cannula may be
passed until tracheotomy can be done. Oxygen
should be given continuously.
Lesions of the true or false vocal cords will
produce marked obstructive symptoms and are
characterized by a very hoarse cry or aphonia, and
by lack of change in the stridor when the position
of the infant is altered.
Obstruction of the main bronchi may be due to
a thick plug of mucus, or to a congenital web.
Physical examination will usually suggest this
type of obstruction and a roentgenogram of the
chest will substantiate the diagnosis. Primary
lobular atelectasis of a degree great enough to
cause marked respiratory embarrassment is un-
common. Aspiration of the mucous plug or dila-
tion of the web is usually accomplished by a
single bronchoscopic examination.
A vascular ring, tetany or tracheo-esophageal
fistula may produce abnormal respirations. Early
diagnosis of tracheo-esophageal fistula has become
especially desirable since corrective surgical meas-
ures have been developed for this anomaly. The
diagnosis is usually not made until the infant is
offered a feeding, and vomiting follows. There
are three points that should make one suspicious
of this anomaly even before the infant is offered
his first feeding. First, there is usually a rather
noisy gurgling type of respiration. Second, the
vomiting is not the usual spitting up and retching
associated with the expulsion of swallowed air but
is a rather continuous “spilling out.” Third, the
vomitus is clear mucus in contrast to the usual
vomitus stained dark with swallowed amniotic
fluid, blood and bile. If one is at all suspicious
of an esophageal atresia, he may simply attempt to
pass a small gavage tube, usually a 10 F. catheter.
If obstruction is encountered, then the infant
should be examined fluoroscopically and a small
amount of radiopaque material instilled through
the catheter. Once the diagnosis has been estab-
lished, an operation should be done as soon as
possible, and under no circumstances should any-
thing be offered by mouth. Aspiration pneumonia
is the complicating factor in these infants, and
every effort should be made to avoid it.
Lesions diminishing the vital capacity may be
the cause of cyanosis and abnormal respirations.
When infants are examined routinely, it is not
unusual to detect a lobar atelectasis which is
proved by roentgenogram. There may be very
little in the way of respiratory difficulty. Ordi-
narily these conditions clear up spontaneously in
a few days, and bronchoscopic aspiration is rarely
indicated unless there is definite respiratory em-
barrassment. Another type of atelectasis is the
diffuse patchy type which may or may not be
shown roentgenographically. The only physical
finding may be a generally decreased exchange of
air accompanied by cyanosis and labored respira-
tions. Bronchoscopic aspiration is of little value
in this instance as the obstruction is diffuse and
in the smaller bronchioles. Oxygen, feedings by
gavage to conserve the infant’s energy, and as lit-
tle manipulation as possible are indicated. Carbon
dioxide and oxygen inhalations may be given at
intervals primarily to decrease the viscosity of the
intrabronchial mucus. They are of questionable
value. My colleagues and I have used a saturated
solution of potassium iodide at the rate of 3 to 4
drops every three hours for six doses to attempt
the liquefaction of the mucus. It is extremely dif-
ficult to say whether this has been of real value
or not.
Spontaneous pneumothorax may decrease the
vital capacity to the extent of respiratory embar-
rassment and even death. We recently encoun-
tered such a case in which immediate withdrawal
of air, even before roentgenograms were taken,
was a lifesaving procedure. Spontaneous pneu-
mothorax is discovered frequently, as is atelec-
tasis, when physical examinations of the newborn
are done routinely. It is only the very rare one
that requires aspiration of air. The usual physical
findings of hyperresonance, diminution of breath
tones and possible displacement of the heart are
present. Roentgenograms show the pneumothorax.
Pneumomediastinum may present a difficult di-
agnostic problem. A fullness of the anterior part
of the chest, hyperresonance over the mediasti-
num, and distant muffled heart tones with fairly
marked respiratory distress will suggest the diag-
nosis. A roentgenogram of the chest in the lateral
position will show the air in the anterior medias-
Deckm bkr, 1950
1205
EMERGENCIES IN THE NEWBORN PERIOD— HARRIS
tinal space. Needle aspiration of the trapped air
will give relief.
Diaphragmatic hernia, cysts of the mediastinum
and cysts of the lung may diminish the vital ca-
pacity enough to cause respiratory embarrassment.
The diagnosis is usually made by roentgenogram,
and, if indicated, a small amount of barium may be
given to discern the location of the stomach. The
treatment is usually surgical.
Cyanosis with suppression of respirations and
no evident obstructive lesions may be due to intra-
cranial hemorrhage or collapse secondary to a
massive adrenal hemorrhage. Our general policy
in both diagnostic and therapeutic procedures
when intracranial bleeding is suspected is to be
guided by the patient’s general condition and
whether benefit may reasonably be expected from
the procedure undertaken. Treatment and diag-
nosis of intracranial bleeding will be discussed
further in relation to the presenting symptom of
convulsions.
Congenital heart disease may be the cause of
cyanosis. There is usually no respiratory distress
associated. A murmur may or may not be present.
The cardiac silhouette in the roentgenogram may
be abnormal, and the electrocardiogram may be of
some assistance. If the cyanotic infant is fairly
vigorous, presents no neurologic symptoms and
evidences no respiratory distress, one will usually
think of a congenital abnormality of the heart.
Paroxysmal tachycardia, with a rate of more than
200, and possible hepatomegaly should not be
overlooked. A heart rate of less than 60 should
suggest heart block, and this will be confirmed by
an electrocardiogram. Digitalization may be indi-
cated in the treatment of the paroxysmal tachy-
cardia ; there is usually nothing specific to do for
the infant with heart block. We have recently ob-
served an infant with complete auriculoventricular
dissociation. The heart rate has consistently been
between 40 and 50 beats per minute. The infant
is now approximately six months old and doing
well. Anomalies of the coronary arteries may be
the cause of sudden unexplained death in the
newborn period.
Poisoning with the aniline dyes occasionally
used by the laundry in marking diapers and shirts
is mentioned as a rare cause of cyanosis. We in
Minnesota are particularly aware of the methemo-
globinemia due to an excessive amount of nitrites
in the water, although this will rarely be seen
during the newborn period.
1206
TABLE II. CONVULSIONS IN THE NEWBORN PERIOD
A. Occasional convulsive twitchings associated with retching and
gagging
B. Cerebral edema
C. Intracranial hemorrhage
D. Meningitis
E. Tetany
F. Kernicterus
G. Massive adrenal hemorrhage
H. Toxoplasmosis
I. Unexplained
The last group listed is termed "unexplained.”
Failure to establish adequate respirations seems
at present to state the fact without necessitating a
primary diagnosis such as atelectasis. The role of
the so-called hyaline membrane as a factor in the
failure to establish adequate respirations is cer-
tainly open to question. If it is found in as many
as 50 per cent of prematures who fail to survive,
why isn’t it found in the other 50 per cent? How
often was it present in that group who survive?
Atelectasis is a frequent diagnosis made both
clinically and at postmortem examination in pre-
mature infants who fail to survive. Atelectasis
by definition means imperfect expansion, so this
diagnosis is usually correct just as heart failure
would be correct in this or any other death. What
is the cause of the imperfect expansion? Imma-
turity does not seem to be a satisfactory explana-
tion in all cases. The problem of the establish-
ment of adequate respiration is the one great pri-
mary problem in the care of the premature infant.
Feeding, protection from infection and general
nursing care are obviously of secondary impor-
tance to adequate respirations.
Convulsions
Convulsions occurring during the newborn pe-
riod usually require emergency attention just as
they do at any age period. The causes of convul-
sions at this age are listed in Table II in descend-
ing order of frequency of occurrence.
The “blue spells” discussed previously as oc-
curring during the first few days and associated
with gagging and retching are occasionally accom-
panied by transitory convulsive twitchings of the
extremities and facial muscles. No treatment is
required and there are no sequellae.
How may one proceed to make a differential
diagnosis and then offer treatment when called to
see a newborn infant having convulsions? A gen-
eral evaluation of the infant’s condition may give
some clues. If it has gray cyanosis, has the ap-
pearance of deep shock and is generally flaccid, the
lesion is probably a massive intracranial or adre-
Minnesota Medicine
EMERGENCIES IN THE NEWBORN PERIOD— HARRIS
nal hemorrhage. What is the infant’s position?
An infant with head retracted, arms and legs ex-
tended and a staring expression is suggestive of
an intracranial lesion. A high-pitched cry much
like a short scream and the adder-like protrusion
of the tongue are both associated with cortical ir-
ritation. Are the convulsions localized to one ex-
tremity or one side? Persistent unilateral convul-
sions suggest the possibility of a subdural hemor-
rhage. Is there generalized hyperirritability, mus-
cular twitching or carpopedal spasm ? These may
suggest tetany.
The general physical examination may yield
little in the way of positive information. The
fontanelle may be bulging and the sutures sep-
arated. This finding is rarely present. If opthal-
moscopic examination is done by an experienced
person, the knowledge of absence of retinal hem-
orrhages may be of more diagnostic value than
their presence. Retinal and subconjunctival hem-
orrhages are seen in 20 to 30 per cent of all new-
born infants. Retinal hemorrhage is often one
of the findings in subdural hematoma, so the ab-
sence of retinal hemorrhage might aid one in rul-
ing out the presence of a subdural hematoma.
Nuchal rigidity is not a dependable sign in the
newborn. The pulmonary exchange may be ade-
quate but shallow and irregular, and slow respira-
tions may be due to intracranial bleeding. The
heart tones may be weak and the rate rapid. Ab-
dominal examination usually does not disclose any
abnormality but may reveal large masses which
might be polycystic kidneys, with secondary ure-
mia and convulsions.
Examination of the extremities for spasticity or
flaccidity may be of some help. If there are posi-
tive findings, spasticity is usually the more fre-
quent. Evaluation of the deep reflexes may be of
some aid, but in the newborn period they are so
variable that they often are misleading.
If there is any suggestion that the disease is tet-
any, one should not hesitate to^ immediately give
calcium gluconate intravenously. If the convuR
sions are due to hypocalcemia, there will be a
rapid response. One does not ordinarily treat a
condition blindly but in this case such action seems
justifiable. It does not seem wise to wait for the
laboratory report on the blood calcium before
giving calcium when there is apparently little risk
involved in giving the calcium slowly in the ab-
sence of hypocalcemia. Our practice has been,
when possible, to withdraw blood for determina-
tion of the concentration of calcium and then give
4 to 5 c.c. of a 10 per cent solution of calcium glu-
conate while the needle is in place.
The next decision to make is in regard to lum-
bar, cisternal, subdural or ventricular puncture.
As always, one must ask himself, will this benefit
the patient ? It does not seem wise to attempt these
procedures for the sake of diagnosis only, unless
it will be of aid in guiding subsequent therapy.
There are some who are quite conservative and
feel that lumbar puncture should be done rarely
and others who feel that repeated lumbar punc-
tures should be done in cases of intracranial hem-
orrhage. 1 personally prefer the more conserva-
tive regime and do lumbar punctures as diagnostic
procedures or rarely to relieve intracranial pres-
sure w'hen indicated. If difficulty is encountered
in doing a lumbar puncture and the urgency of the
situation warrants, cisternal puncture may be
done. If there are localizing neurologic findings
or other symptoms suggestive of subdural bleed-
ing, subdural puncture may easily be done in the
newborn. Ventricular puncture may be indicated.
I should like again to emphasize that the posi-
tive diagnosis of intracranial hemorrhage in the
newborn is not a simple diagnosis to make. The
condition is found frequently at postmortem ex-
amination when there was no suggestion clini-
cally. The presumptive diagnosis is often made
clinically and not substantiated at postmortem ex-
amination. This causes one to be extremely cau-
tious in making a positive diagnosis of intracra-
nial bleeding during the newborn period and espe-
cially hesitant to attribute subsequent neurologic
abnormalities, such as a cerebrospastic palsy, to
intracranial bleeding during the newborn period
without definite evidence.
Convulsions may be the only symptom sug-
gestive of meningitis at this age. Neurologic
symptoms associated with intracranial bleeding
are usually manifest within the first day or two of
life. Convulsions occurring after this period may
more frequently suggest an infectious process.
Fever and leukocytosis may or may not be present.
A definite diagnosis can usually be made only bv
examination of the spinal fluid.
Massive adrenal hemorrhage may present a
clinical picture similar to that of massive intra-
cranial hemorrhage. Hyperthermia and deep
shock are the usual manifestations, and yet re-
cently we have seen an infant with convulsions
(Continued on Page 1214)
December, 1950
1207
THE RANA PIPIENS FROG TEST FOR PREGNANCY
JANE E. HODGSON, M.D., and REIKO TAGUCHI, B.S.
Saint Paul, Minnesota
TN the practice of obstetrics and gynecology, a
rapid, simple, accurate office test for pregnancy
is extremely desirable. Such criteria will appar-
ently be met by the new Rana pipiens frog test,
first introduced only two years ago by Wiltberger
and Miller20 and Robbins and Parker.16’17 During
the past six months, I have performed in my office
eighty-seven pregnancy tests according to the tech-
nique of Cutler,4 in an attempt to evaluate the ac-
curacy of this test, as well as to aid in clinical
diagnosis and treatment. My results have sub-
stantiated those of previous writers. As a clini-
cian, I have found it extremely satisfactory, and,
compared to the Friedman test, far more rapid, re-
quiring only two to four hours, as compared to
forty-eight. It is less expensive and equally re-
liable, provided its limitations are well recognized
and strict adherence to certain technique standards
noted. These I will outline briefly, attempting to
explain the reasons why certain modifications of
the test are of such importance in maintaining a
high degree of accuracy.
The principle of the Rana pipiens frog test is
based upon the Mainini reaction, which was first
described by Galli Mainini in 1947. 9 This reac-
tion is the release of sperm in the urine of South
American male toads following the injections of
gonadotrophic hormones. Injection of pregnancy
urine into the male North American frog, Rana
pipiens, produces the same reaction, provided the
level of chorionic gonadotropin is sufficient.
Technique
Adult male frogs are shipped by air from Wis-
consin at a reasonable cost. The animals are main-
tained in a covered enameled pan in an electric
refrigerator maintained at a temperature of 10
degrees Centigrade. By this means, the frogs are
kept in a state of hibernation and require no food
or attention. The bottom of the pan is covered
with fresh water, which is changed daily. During
the spawning season in the spring and early sum-
mer, a spontaneous mortality was rather fre-
quent; but prior to and since that season, the
animals have remained in the refrigerator in a
healthy state for as long as four weeks at a time.
Read at the annual meeting of the Southern Minnesota Medical
Convention, Mankato, Minnesota, September 11, 1950.
When the urine arrives at the laboratory, the
animal is removed from the refrigerator and
placed in a beaker to “thaw out” for thirty minutes
prior to injection. The Scott kaolin adsorption
methed4 of concentration of urine is used. This
technique of urine concentration is a relatively
simple procedure which can be performed by any
qualified laboratory technician. No elaborate
equipment is required, and it does not consume
over thirty minutes. Sex of the frog should be
carefully noted. The male is distinguished by
large pigmented thumbs, inflated air sacs and
croaking (Fig. 1). One c.c. of the final product
is injected into the dorsal lymph sac of the frog
(Fig. 2). The animal is then replaced in the
beaker. After thirty minutes, the frog’s urine is
obtained upon a slide, and a drop examined for
sperm (Fig. 3). A positive response usually ap-
pears within thirty to forty minutes after injec-
tion, never later than three hours. There are
usually large numbers of sperm actively motile
and easily recognized under low or high dry mag-
nification. The sperm of Rana pipiens are con-
siderably larger than human sperm. Their heads
are cylindrical or cigar-shaped. Absence of sperm
for three hours constitutes a negative test. Ani-
mals showing negative responses may be reused
after three to four days, but should be promptly
returned to the refrigerator in the interim. Ani-
mals showing positive responses are destroyed.
Discussion
Chorionic gonadotropin appears in the urine of
pregnant women a few days following implanta-
tion of the ovum between the twenty-second to
the twenty-fifth cycle days. By cycle days, we
refer to the number of days following the last
menstrual period. By the thirty-second cycle day,
chorionic gonadotropin has risen to 200 to 500
rat units per liter. It is at this point that hormonal
pregnancy tests may become positive. The earliest
positive frog test reported occurred on the thirty-
fourth cycle day. Our earliest positive reaction
was noted on the thirty-fifth cycle day. Chorionic
gonadotropin excretion rapidly rises thereafter to
reach a peak between the fifty-second to the sixty-
fifth day of 133, OCX) to 400,000 rat units per liter.
After the sixty-seventh day, the excretion of
1208
Minnesota Medicine
FROG TEST FOR PREGNANCY— HODGSON AND TAGUCHI
Fig. 1. Male frog is distinguished by large Fig. 2. One c.c. hormonal concen- Fig. 3. Frog’s urine is obtained upon a
pigmented thumbs and air sac. trate is injected into dorsal lymph slide by flexion of legs.
sac of frog. Injection should be
made just beneath the skin. Care
should be taken not to puncture the
lung.
chorionic gonadotropin drops sharply, reaching
low levels around the sixth month, rising slowly
again towards the end of pregnancy. Inasmuch
as the positivity of this test is dependent upon
there being a certain amount of chorionic gonado-
tropin in the injected urine, probably around 10
rat units, a positive response cannot be obtained
with certainty before the fourth week of preg-
nancy (forty-second cycle day). Therefore no
negative test should be accepted before the forty-
second cycle day. However, a positive response
is dependable at any time of gestation, inasmuch
as we know of no condition under which false
positives occur. Physiologically in the frog it is
the luteinizing hormone secreted by the anterior
pituitary gland which produces the release of
sperm. Follicle stimulating hormone does not have
this effect. The fact that follicle stimulating hor-
mone does not release the sperm gives the frog
test a definite advantage over the Friedman test,
inasmuch as false positive reactions are eliminated
in testing menopausal urines. The Friedman test
does not have this advantage. False positive
Friedman tests are frequently noted in the meno-
pause, due to the large amount of follicle stimulat-
ing hormone in menopausal urine which produces
follicle formation in the rabbit.
Another big advantage of the male frog
pregnancy test is the rapidity with which the
response becomes negative after the separation of
the chorionic villi when abortion becomes inevi-
table. This fact was pointed out by Wiltberger
and Miller, who state that the male frog test be-
comes negative ten to twelve hours after the
termination of pregnancy. In four threatened
abortion cases, we noted a change in response
from positive to negative even before the abortion
was completed. With the Friedman test, a positive
reaction may persist seven to ten days after
pregnancy is terminated.
Results
Mainini utilized his reaction in the detection
of pregnancy by injecting 10 c.c. of whole urine
into South American toads and examining their
cloacal specimens for sperm. In over 2,000 tests,
he reported no false positives and an accuracy of
99.01 per cent through the fifth month of preg-
nancy. Shortly after Mainini’s report, two articles
appeared in this country by Wiltberger and
Miller20 and Robbins and Parker.16’17 These
workers substituted the North American frog,
Rana pipiens, with equally good results. The
North American toad, the British toad, and
British frog, Rana esculenta, have also been re-
ported as being entirely satisfactory animals for
this test. Since the first article in 1948, a number
of laboratories have reported their experiences
with the Rana pipiens test. There is a wide
variation in technique among the different authors.
December, 1950
1209
FROG TEST FOR PREGNANCY— HODGSON AND TAGUCHI
All agree as to the absence of false positive re-
actions. The accuracy of this test is reported as
being extremely high by all but three writers2’10’18
who report a rather large number of false nega-
tives. It is noted in their articles that unconcen-
trated urine was used and in small amounts, that
all stages of gestation were included in their final
figures, that the frogs were not refrigerated and
were re-used. As stated previously, this is a test
for the presence of chorionic gonadotropin in the
urine, and there is a definite threshold at which
the test becomes positive. Obviously, the incidence
of false negative responses will be lower in those
laboratories where the urine was concentrated or
where larger amounts of urine were injected and
when pregnancy urine in the first trimester only
was tested. Improved results are also noted where
the animals are not re-used, at least those animals
which have previously shown positive responses.
One is prohibited from using large doses of whole
urine because of the high frog mortality which
results. Use of the Scott kaolin adsorption method
allows for the injection of the hormonal content
of 20 c.c. of urine by injecting only 1 c.c. of
detoxified hormonal concentrate. In only three
reports of the Rana pipicns test to date has con-
centrated urine been used, and in these reports,
the results have been extremely encouraging
(Cutler,4 Brody,3 Maier13). Our results with the
urine concentrate confirm the work of these
writers. In performing our tests, we have
followed closely the technique of Cutler. He re-
ported a 99 per cent accuracy and no false
positives in 200 cases. His two false negatives
resulted from the re-use of frogs. After dis-
continuing the re-use of frogs which have
previously shown positive reactions, there were no
more false negative responses. In our eighty-seven
consecutive tests performed to date to aid in the
diagnosis and treatment of difficult clinical
problems, there were two false negatives. One
test was performed before the fourth week of
pregnancy, and the specific gravity of the urine
was less than 1.010. Only one animal was used
in this test. We have since instituted the policy
that all negative responses must be corroborated
by the use of two frogs. Our second false nega-
tive was a test performed upon a woman on her
supposedly fifty-seventh cycle day. A repeat test
one week later was positive. This patient gave a
history of recurrent episodes of amenorrhea, and
it is possible that the first test was performed
actually earlier in gestation than the fifty-seventh
cycle day would indicate. Moreover, only one frog
was used in the first test. The policy which we
have arrived at to eliminate as many false negative
responses as possible and yet to conserve our
technician’s time and our laboratory animals are
as follows :
Two and one-half c.c. of filtered whole urine are in-
jected into one frog. The urine must be a morning
specimen with specific gravity of at least 1.010, providing
there are 100 c.c. If the volume of urine is less than
100 c.c., a specific gravity of 1.015 is necessary. If the
response is positive, the test is completed, usually within
one to two hours. If the test is negative after three
hours, the urine is then concentrated and injected into
two additional animals. If the response is still negative
but less than two weeks have elapsed since the patient’s
last menstrual period (less than the forty-second cycle
day), the test is repeated in one week. A negative re-
sponse should never be accepted before the forty-second
cycle day.
Summary
I have found the Rana pipicns frog test for
pregnancy an excellent and indispensable aid in
clinical practice. The work of Cutler, Brody and
Maier has been herewith confirmed. In the per-
formance of the test, I should like to stress the
importance of meeting the following criteria :
1. Refrigeration of healthy frogs.
2. Careful differentiation as to sex.
3. Duplication of animals (at least in negative
responses) .
4. No re-use of animals that have shown
positive responses.
5. Morning urine specimens of no less than
1 .010 specific gravity.
6. Concentration and detoxification of urine
(Scott kaolin adsorption method).
7. Non-acceptance of negative responses before
the forty-second cycle day.
Bibliography
1. Bach, I., and Szmuk, I.: Male toads in pregnancy tests.
Lancet, 2:218, 1949.
2. Bodine, C. D.; Kline, R. F. ; Rogers, R. A.; Smith, D. C.,
and Tinker, F. X. P. : The male frog {Rana pipiens) as a
test aminal for determining the level of urinary chorionic
gonadotropin during pregnancy. Am. J. Obst. & Gynec., 59:
649, 1950.
3. Brody, H.: The use of the male leopard frog (Rana pipiens)
as a pregnancy test animal. Am. J. Obst. & Gynec., 57:581,
1949.
4. Cutler, J. N.: An appraisal of the male North American frog
(Rana pipiens) pregnancy test with suggested modification of
the original technique. J. Lab. & Clin. Med.. 34:554, 1949.
5. Farris, E. J.: A twenty-four hour rat test for the diagnosis
of early pregnancy and as an aid in predicting abortion.
Fertility & Sterility, 1:76, 1950.
6. Frazer. J. F. D., and Wohlzagen, F. X.: Male toad pregnancy
test. Lancet, 2:134, 1949.
7. Frazer, J. F. D., and Wohlzagen, F. X.: Use of the male
British toad as a pregnancy test animal. Brit. M. J., (Aug.
5) 1950.
8. Galli Mainini, C.: Pregnancy test using male batrachia.
J.A.M.A., 138:121, 1948.
(Continued on Pape 1218)
Minnesota Medicine
1210
ACUTE YELLOW ATROPHY OF THE LIVER FROM SH VIRUS TRANSMITTED
BY A BLOOD BANK
WINSTON R. MILLER, M.D., R. V. SHERMAN, M.D., and G. N. HOFFMAN, M.D.
Red Wing, Minnesota
r I 1 HE condition formerly referred to as acute
catarrhal jaundice was clarified during the
war as a virus disease which occurs in two closely
similar forms : ( 1 ) the naturally occuring
epidemic or sporadic hepatitis, and (2) the arti-
ficially produced serum hepatitis (commonly
called homologous serum jaundice).4 The chief
differences in the two forms lie in the mode of
transmission and the incubation period. Serum
hepatitis is transmitted by parenteral injections of
blood, plasma or biological products containing
human serum, or by improperly sterilized syringes,
needles or medications.7’8,9 The incubation period
of sixty to 160 days is in marked contrast to the
ten to forty day incubation period of sporadic or
epidemic hepatitis. Tests with human volunteers
have shown that specific immunity develops after
infection and there is no cross protection be-
tween the two forms of the disease.3,5 These tests
have also shown that as little as 0.01 c.c. of serum
from a case of serum hepatitis contains sufficient
SH virus to transmit the disease.4 -
Clinically and pathologically, serum hepatitis
and sporadic or epidemic hepatitis are almost in-
distinguishable after the onset of the disease.
There are two anatomical (or rather histological)
types of infectious hepatitis: (1) the hepatocel-
lular type, and (2) the periacinar or cholangiolitic
type.10 Both types occur equally from the sporadic
and epidemic virus (IH virus) and from the
serum virus (SH virus). In the hepatocellular
type the dominant pathological change is a de-
generation of the liver cells. Fulminating cases of
infectious hepatitis are usually of this type and
show extensive diffuse necrosis of the liver cells9
— the picture of acute yellow atrophy of the liver.
In the cholangiolitic type, described in detail by
Watson and Hoffbauer,10 there is an intense in-
flammatory reaction around the bile ducts with
intrahepatic biliary obstruction, and only transient
involvement of the liver cells. Severe cases of this
type progress to an hypertrophic (Hanots) or
sometimes atrophic (Laennec’s) biliary cirrhosis,
with prolonged regurgitation jaundice.10
Read at the annual meeting of the Southern Minnesota Medical
Association, Mankato, Minnesota, September 11, 1950.
December, 1950
The combined results of a number of liver func-
tion tests gives an accurate differential diagnosis
between the hepatocellular type of infectious hepa-
titis and extrahepatic biliary obstructive jaundice
due to stones or carcinoma.4 However, in the pure
cholangiolitic type of infectious hepatitis, the liver
function tests may show only the picture of ob-
structive jaundice, and the differential from extra-
hepatic biliary obstruction can be made only by
laparotomy in some cases.10 The decision to ex-
plore the extrahepatic biliary tract is of great im-
portance since it is well known that surgery has a
deleterious effect on infectious hepatitis.
A patient suffering from pulmonary tuber-
culosis developed a severe serum hepatitis with a
combination of the cholangiolitic and hepatocel-
lular types of pathological change.
Case Report
A. B. ]., a man, aged twenty-seven, was admitted to
the Mineral Springs Sanatorium, Cannon Falls, Minn.,
December 21, 1943, because of hemoptysis on December
15, 194-3. He had had a moderately productive cough
and had lost 10 pounds in weight in the past six months.
Chest films showed soft infiltration between the first and
third ribs on the right. The diagnosis was moderately
advanced pulmonary tuberculosis, active. Cultures and
guinea pig inoculation of gastric washings were positive.
The patient left the sanatorium against advice on De-
cember 24, 1943, and refused to return even when he was
told of the positive cultures. He continued to live with
his wife and two small children and resumed his regular
occupation.
The patient was admitted the second time to Mineral
Springs Sanatorium on November 24, 1945. Chest x-ray
showed soft infiltration had spread to most of the right
lung and to the fourth interspace on the left. There was
cavitation in the apex of the right lung. He was treated
with pneumothorax, pneumolysis, phrenic crush and later
oleothorax and pneumoperitoneum. He left the sana-
torium a second time against advice on April 1, 1947.
Within a few months he was back at full-time work.
He did continue pneumoperitoneum refills.
The patient was admitted the third time to Mineral
Springs Sanatorium on August 3, 1949, after having
more hemoptysis. Sputum smears were positive and
x-ray showed further progression in the right upper lobe
with increase in the cavitation. He was transferred to
Colonial Hospital in Rochester, Minnesota, where a right
upper and middle lobectomy was performed on Septem-
ber 23, 1949. Four 500 c.c. bottles of blood from the
1211
ATROPHY OF THE LIVER— MILLER ET AL
blood bank were given during the operation. . One addi-
tional pint of blood from the bank was given on Septem-
ber 24, 1949. No plasma or human serum products were
given. He was treated also with streptomycin and para-
aminosalicylic acid. A one-stage thoracoplasty was per-
formed at Mineral Springs Sanatorium on October 12,
1949. He received one pint of blood during the opera-
tion, another on October 14, and another on November
15. Recovery from the operation was rapid and un-
eventful. He left the sanatorium against advice for the
third time on December 5, 1949.
The patient (now aged thirty-three) was admitted to
St. John’s Hospital in Red Wing, Minnesota, on Decem-
ber 15, 1949, with complaints of nausea, vomiting and
jaundice. He reported he noticed nausea first on Novem-
ber 25, 1949, but did not vomit. He had anorexia and
occasional nausea between November 25 and December
10. On December 10 he had nausea and vomiting, and
he noted a slight yellow color to the skin. On December
12 he noted clay-colored stools and dark urine. He had
no pain and no chills or fever.
Physical examination on admission showed a thin,
white male with moderately severe jaundice. Tempera-
ture, pulse, respiration and blood pressure were normal.
Examination of the chest showed a partial collapse of the
right chest with relative dullness and absent breath
sounds in the apex. The chest was otherwise negative.
The heart was normal in size and rhythm, but was
shifted slightly to the right. The liver was palpable two
fingers below the costal margin in the mid-clavicular line
and was firm and non-tender. It did not move with
respiration due to right phrenicotomy. The remainder
of the physical examination was unremarkable.
Laboratory examinations are shown in Table I. Diag-
nostic duodenal drainage showed no bile in the first
specimen, 1-|- test for bile thirty minutes after one
ounce of magnesium sulfate and 2+ test for bile thirty
minutes after a second ounce of magnesium sulfate.
Clinical Course. — From the onset of definite symptoms
(December 10) until death (January 16) the patient had
completely acholic stools. He was treated with a high
protein high carbohydrate diet (P 100, C 250, F 80),
1 to 2 liters of 10 per cent glucose intravenously daily,
therapeutic vitamins orally and intravenously, methionine
4 grams daily, crude liver extract 2 to 4 c.c. intramus-
cularly daily, crude liver intravenously later, vitamin K
parenterally, and choline chloride orally for a short time.
For the first two weeks in the hospital treatment was
effectively administered, and his general condition was
only a little worse than it was at the onset. He took the
full diet and medications and in spite of frequent nausea
he did not vomit. He was even able to go home to be
with his family on Christmas day. From December 28
on, his course was more rapidly downhill, and severe
anorexia, nausea, and occasional vomiting made diet and
oral medication much less adequate. Jaundice became
progressively more intense and anorexia became so severe
the patient had to literally force the food down. At no
time was the temperature above 98.6° and there was no
pruritis. The liver regressed in size until the edge was
above the rib margin. Hepatic fetor developed and in-
TABLE I. RESULTS OF LABORATORY EXAMINATIONS
Normal 7
13
Day
14
of Disease
21 27
31
38
Hemoglobin
14.5 gni. 13.2
11.2
Urinalysis
neg.
neg.
Icteric index
4-6 u.
150
224
277
Cephalin floculation
0 3 +
3 +
Thymol turbidity
0-4 u.
20
76
100
Prothrombin %
100
67
Plasma protein
6.4-8%
6
a
A/G ratio
1. 5-2.0
1.14
W
Quantitative fecal
100-150
3.5
urobilinogen
mg.
Bleeding time
1-3 min.
1.5
Coagulation time
1-7 min.
3.5
creased progressively. With the fecal urobilinogen and
clinical evidence of complete biliary obstruction per-
sisting after thirty days, faith in our own convictions
waned and exploratory laparotomy was performed on
January 10, 1950, for a possible complicating extra-
hepatic biliary obstruction. The extrahepatic biliary pas-
sages were collapsed but patent. The liver was slightly
smaller than normal and showed a blotchy yellow nut-
meg appearance. A biopsy was reported by the hospital
pathologist, Dr. Noble, as follows : “Section of biopsy
of the liver shows the liver lobules to be encompassed
by thin bands of fibrous connective tissue. There is a
dense peri-cholangitic reaction. Conclusions : cirrhosis
of the liver.” For the next four days the patient seemed
to improve slightly. On January 15, 1950, he became
severely agitated, lost contact with reality and later in
the day lapsed into a comatose state. The coma per-
sisted and on January 16, 1950, he died.
Autopsy. — General Observations : The body is that of
a thirty-three-year-old, thin, white, male, about 70 inches
long and weighing about 120 pounds. The skin has a
deep yellowish brown color. There are recent scars of
the right rib resection and right upper quadrant laparo-
tomy, and old scars from right phrenecotomy and multi-
ple pneumoperitoneum punctures. The peritoneal cavity
contains only about 200 c.c. of clear yellow fluid. All
organs and relationships are normal. The liver edge is
about two fingers above the costal margin. The thoracic
cavity shows about 100 c.c. of yellow clear fluid in each
pleural space. The right chest cavity is collapsed in the
upper portion and the upper five ribs have been re-
moved. The right parietal pleura is very thick in the
apex. Cut section measures 1 centimeter and consists of
thick fibrous tissue with diffuse calcium deposits. Only
the right lower lobe remains and this has assumed a
semi-conical shape but does not ascend to the apex of
the thoracic cavity. The heart is shifted slightly to the
right. The left lung relationships are normal. There are
many scattered adhesions in the apex and posteriorly.
Organs : Cut sections of the left lung show only de-
pendent posterior congestion. The right lower lobe is a
dark, dirty brown color and has a solid consistency.
Crepitation is moderately reduced. Cut section shows
marked diffuse fibrosis. A small amount of serous
mucoid secretion is present in the cut section. No nodules
or caseation necrosis is seen. The right hilar nodes are
surgically absent. The left hilar and mediastinal nodes
are enlarged and fibrous in character.
The liver is about half normal size and is quite firm.
The surface is smooth and there are no adhesions. The
1212
Minnesota Medicine
ATROPHY OF THE LIVER— MILLER ET AL
organ is deeply yellow in color and shows an exaggerated
mottling or nutmeg appearance. Cut section shows ex-
tensive fibrosis and complete distortion of the normal
architecture with a marked nutmeg appearance.
The gall bladder is thin walled and contains a small
Comment
At the time of onset this case was similar to
most cases of serum hepatitis with combined
cholangiolitic and hepatocellular involvement. The
Fig. 1. Photomicrograph of the periphery of a typical liver lobule. Note (1) the intense
pericholangiolitic inflammatory reaction with round cell infiltration and fibroblastic proliferation,
(2) the marked regeneration of bile ducts, and (3) the liver cell necrosis and large multi-
nucleated liver cell regeneration.
amount of thick greenish brown bile. The bile ducts are
intact and are patent throughout. The ampulla of Vater
is completely normal in appearance.
The remainder of the organs are normal or show the
usual postmortem changes.
The gross anatomical diagnoses are: (1) acute yel-
low atrophy of the liver, (2) diffuse pulmonary fibrosis
of the remaining right lower lobe.
Microscopic Pathological Changes: The significant
microscopic pathological changes are limited to the right
lung and the liver. The lower lobe of the right lung
shows many small tuberculous lesions with the typical
microscopic characteristics. No cavitation is present.
The liver shows extensive destruction of the normal
architecture (Fig. 1). There is a great deal of degenera-
tion and frank necrosis of the liver cords. In many areas,
however, there are multiple foci of large multinucleated
regenerating liver cells. There is an intense peri-
cholangitic inflammatory reaction with fibrosis and round
cell infiltration. The bile ducts are patent and the
epithelium shows little change. Many minute regenerat-
ing bile ducts are present indicating a considerable at-
tempt at regeneration of the intrahepatic biliary system.
Only occasional biliary thrombi are seen.
The microscopic diagnoses are: (1) subacute hepatitis
with necrosis of liver cells and regeneration of bile ducts,
(2) caseous pulmonary tuberculosis.
incubation period, if figured from the first five
transfusions until the onset of definite symptoms,
was seventy-nine days. If it is figured from the
second group of two transfusions it was fifty-
seven to fifty-nine days. Since the patient re-
ceived no plasma or serum preparations and the
mode of onset and clinical manifestation were
typical of serum hepatitis, it was concluded that
he undoubtedly received the SH virus from one
of the blood donors. All the donors had denied
a history of jaundice when the blood was donated.
It is therefore probable that one of the donors
either was in the incubation period of serum
hepatitis or was a chronic carrier of the virus
after a non-icteric serum hepatitis infection. Until
tests are devised to detect the virus in the blood
of persons who are otherwise well, this type of
accidental transmission of serum hepatitis is un-
avoidable. Current methods of sterilizing plasma
with 2537 A unit ultraviolet irradiation cannot be
applied to whole blood.
For the first three weeks of illness the cholan-
giolitic type reaction was dominant with complete
December, 1950
1213
ATROPHY OF THE LIVER— MILLER ET AL
intrahepatic biliary obstruction and only moderate
hepatic cellular involvement. This was indicated
by the clinical course, the return of prothrombin
function to normal and the liver biopsy showing
the intense periacinar reaction. From then on,
however, the course was that of severe hepatic
necrosis and the patient had a typical hepatic
death.
This case represents a combination of the two
histological types of infectious hepatitis — first, the
intense cholangiolitic reaction with persistent com-
plete intrahepatic biliary obstruction, and second,
the hepatocellular degeneration with extensive
necrosis, atrophy, hepatic fetor and hepatic death.
Summary
A case of serum hepatitis transmitted by a
blood bank is presented. The patient showed a
predominant cholangiolitic hepatitis with complete
intrahepatic biliary obstruction and early biliary
cirrhosis, and then developed marked hepatocel-
lular degeneration and died with the characteristics
of acute yellow artrophy of the liver.
The authors are indebted to Dr. J. R. McDonald of the
Mayo Clinic for the microscopic pathological studies and
for the photomicrograph of the liver.
References
1. Broun, G. O. : Treatment of hepatic cirrhosis. Postgrad.
Med:, 4:203-207, (Sept.) 1948.
2. Havens, W. J., Jr.: Experiment in cross immunity between
infectious hepatitis and homologous serum jaundice. Proc.
Soc. Exper. Biol. & Med., 59:148-150, 1945.
3. Havens, \V. P., Jr.: The etiology of infectious hepatitis.
J.A.M.A., 134:653-655, 1947.
4. Havens, W. P., Jr., and Paul, J. R.: Viral and rickettsial
Infect ons of Man. (Edited by T. M. Rivers) Pp. 269-283.
Philadelphia: J. B. Lippincott Co., 1948.
5. Neefe, J. R.; Gellis, S. S., and Stokes, J., Jr.: Homologous
.cerum hepatitis and infectious (epidemic) hepatitis; studies
in volunteers bearing on immunological and other charac-
teristics of etiological agents. Am. J. Med., 1:3-22, 1946.
6. Robinson, J. W. ; Twaddell, I). N., and Havens, W. P., Jr.:
Homologous serum hepatitis. Ann. Int. Med., 32 : 1019-1027,
(June) 1950.
7. Scheinberg, I. H.; Kinney, T. D., and Janeway, C. A.:
Homologous serum jaundice; a problem in the operation of
blood banks. J.A.M.A., 134:841-848, (July 5) 1947.
8. Stokes, J., Jr., and Neffe, J. R.: The prevention and alter-
nation of infectious hepatitis by gamma globulin. J.A.M.A.,
127:144-146, (Jan. 20) 1945.
9. Turner, R. H.; Snavely, J. R. : Grossman, E. B.; Buchanan,
R. N., and Foster, S. O.: Some clinical studies of acute
hepatitis occurring in soldiers after inoculation with yellow
fever vaccine, with especial consideration of severe attacks.
Ann. Int. Med., 20:193-218, (Feb.) 1944.
10. Watson, C. J., and Hoffbauer, F. W. : The problem of
prolonged hepatitis with particular reference to the cho-
langiolitic type and to the development of cholangiolitic cir-
rhosis of the liver. Ann. Int. Med., 25:195-227, (Aug.) 1946.
EMERGENCIES IN THE NEWBORN PERIOD
(Continued from Page 1207)
and hyperthermia but no shock until a few min-
utes before death. Massive adrenal hemorrhage
was the only positive finding at postmortem ex-
amination.
Convulsions may also be evidence of a kernic-
terus developing in an infant with erythroblasto-
sis fetalis. Convulsions with evidence of hydro-
cephalus or microcephalus may suggest toxoplas-
mosis.
There are many other conditions during this
period of life which require immediate action :
atresias of the bowel, a large omphalocele, imper-
forate anus and other anomalies requiring surgical
treatment should be operated upon as soon as
possible. Surgical procedures are best tolerated
in the newborn if done within the first twelve to
eighteen hours after birth. Birth paralyses, con-
genital dislocation of the hip, clubfeet and meta-
tarsus varus of severe degree will all benefit by
treatment instituted during the newborn period.
It is not within the scope of this paper to discuss
vomiting, diarrhea, infections, abnormalities of
the blood and other illnesses of the newborn
period.
Summary
Emergencies arising during the newborn period
and manifested by cyanosis or abnormal respira-
tions, or both, and those associated with convul-
sions are discussed in respect to differential diag-
nosis and treatment.
1214
Minnesota Medicine
PRACTICAL CONSIDERATIONS IN THE DIAGNOSIS
AND TREATMENT OF ECTOPIC PREGNANCY
CHARLES H. McKENZIE, M.D., F.A.C.S.
Minneapolis, Minnesota
'C’CTOPIC pregnancy is a gestation in which the
fertilized ovum implants itself in some other
site than the usual endometrium. The incidence is
about four ectopic pregnancies for every 1,000
live births. An ectopic pregnancy, by definition,
may occur in a tube, ovary, abdomen, rudimentary
uterine horn or endometriotic pocket, and in a
tube after hysterectomy.
There are many conjectures as to the cause of
ectopic pregnancy. It is noteworthy, however, that
in the majority of cases there is a history of
sterility and previous pelvic infection involving
pelvic operation or appendectomy.
Diagnosis
A woman in the childbearing age who after an
anomalous menstrual period has a sudden sharp
pain in the lower abdomen, often accompanied by
a feeling of fainting, and who on examination
has a tender cervix and a tender adnexal mass,
most often presents the picture of an ectopic
pregnancy rupturing at its commonest site, the
outer third of the tube.
Unfortunately the symptoms of ectopic preg-
nancy vary with the site of implantation, and the
classical picture may have all the fuzziness of
modern art and be as difficult of interpretation
as a surrealist painting. In a series of 1732 col-
lected cases, only 63 per cent were diagnosed
correctly preoperatively.
With the classical picture as a background we
might attempt to consider the diagnosis of ectopic
pregnancy of three types: (1) the explosive type,
(2) the unruptured ectopic, and (3) the atypical
ectopic.
The Explosive Type. — Occasionally the first
intimation of an ectopic pregnancy is massive
intra-abdominal hemorrhage, which comes on so
suddenly that the site of hemorrhage cannot be
determined. Generalized abdominal tenderness,
rigidity, rebound tenderness, increasing shock,
may simulate a perforated ulcer, mesentric throm-
bosis, splenic rupture. Clues to the site of hemor-
rhage may be the gradual development of shoul-
Read at the annual meeting of the Southern Minnesota Medical
Association, Mankato, Minnesota, September 11, 1950.
December, 1950
der-strap pain and the bulging cul-de-sac. In gen-
eral, the nearer the uterus, the more explosive the
rupture of ectopic pregnancy. An interstitial preg-
nancy may rupture with fatal massive hemorrhage
even before a missed or anomalous period.
First, one should treat the shock. Glucose, sa-
line, plasma and blood may all be used intraven-
ously in arms and legs. As soon as the patient is
recovering from shock, then emergency abdom-
inal operation preferably under local infiltration
anesthesia supplemented when necessary by pento-
thal, is indicated to find and ligate the source of
the hemorrhage.
Unruptured Ectopic Pregnancy. — About 10 per
cent of ectopic tubal pregnancies are diagnosed
before rupture. The following signs and symp-
toms are suggestive of unruptured ectopic tubal
pregnancy. A woman in childbearing age who
has been sterile for some years misses a period
and begins to have nausea and engorging breasts.
On pelvic examination the uterus is found soft-
ened and enlarged and a pelvic mass is found in
one adnexa. The Friedman test is positive. Cul-
doscopy shows enlarged engorged uterine tube.
There is no expectant treatment for unruptured
ectopic pregnancy.
Atypical Ectopia Pregnancy. — All too frequent-
ly the correct interpretation of the symptoms and
signs requires all one’s diagnostic acumen and
hunch. It has been estimated that 15 to 30 per cent
of ectopic pregnancies are so atypical in symp-
toms and signs that a correct diagnosis is not
made preoperatively. The different sites of im-
plantation, the varying amounts of intra-abdom-
inal bleeding, survival or death of the fetus —
all tend to produce bizarre findings which, in
such atypical cases, may persist or may vary over
days, weeks or months.
T. Symptoms
1. Bleeding. — Uterine bleeding follows a few days
after an early period and recurs with crampy lower
abdominal pains.
2. Pain. — Lower abdominal unilateral pain, usually
crampy, is often the first complaint. Sometimes however,
the pain shifts to various quadrants with varying posi-
1215
ECTOPIC PREGNANCY— McKENZIE
tions of the patient and may simulate gall-bladder colic,
perforated ulcer pain, or produce the inspiratory “grunt”
of basal pneumonia.
II. Signs
1. Ileus. — Slight to moderate ileus is almost invariably
present and is frequently overlooked.
2. Abdomen. — Abdominal tenderness, usually in the
lower abdomen, varies with the amount and activity of
bleeding and the position of the patient.
3. Pelvic Examination. — When present, the excruciat-
ing tenderness of the cervix is diagnostic, but the rupture
may be so old that little tenderness is elicited. A uni-
lateral tender mass may be found but the enlarged corpus
luteum of early pregnancy — tingling breasts, nausea, fre-
quency— suggest gestation but do not locate it.
Differential Diagnosis
In arriving at a diagnosis of ectopic pregnancy
one should consider the following : ( 1 ) abortion,
in progress or incomplete, (2) salpingitis, (3)
appendicitis, (4) ruptured or bleeding corpus
luteum cyst or ovarian follicle, (5) ovarian cyst
with torsion of pedicle, (6) endometriosis, (7)
gall-bladder colic, (8) pleurisy, (9) perforated
peptic ulcer, and (10) any abdominal emergency.
Since “commonest things are still commonest,”
and abortion results in one out of every four or
five conceptions, one must consider abortion as
the most likely probability.
Onset of pain :
Site:
Bleeding :
Shock :
Onset :
Other signs of
pregnancy :
Tenderness :
Pelvic findings :
Abortion
Gradual
Generalized lower
abdominal pain
Profuse and external
Proportional to
blood loss
Appendicitis
Sudden
None
At McBurney’s point
Minimal
Ectopic Pregnancy
Sudden, often with
fainting
Severe and unilateral
Slight external
Out of proportion to
external bleeding
Ectopic Pregnancy
Nausea and vomiting,
if present, have been
for sometime and
are typical of
pregnancy
Present
Lower abdomen
Tenderness
III. Other Diagnostic Aids
Temperature, pulse, blood pressure, white blood count
and sedimentation rate may be of value but are all equiv-
ocal in atypical ectopic pregnancy.
Pregnancy tests, if positive, are helpful.
Spectroscopic demonstration of hematin in the patient’s
serum denotes blood in a serous cavity.
Endometrial biopsy, or curettage, which reveals
chorionic villi, shows that the pregnancy is or w'as intra-
uterine; but when the fetus in an extra-uterine pregnancy
dies, the endometrium may show almost any picture.
Cul-de-sac puncture which reveals free blood is diag-
nostic, and usually, only confirmatory.
Culdoscopy, a relatively simple procedure, is of real
value in the diagnosis of atypical ectopic pregnancy,
enabling one to visualize the tubes, ovaries, and blood if
present.
Points in Treatment
It is advisable not to operate until shock is
under control or is being controlled.
Local anesthesia, supplemented with pentothal
if necessary, is usually preferable.
The whole tube should be removed, for stumps
of tubes tend to be the sites of recurrent ectopics.
Auto-transfusion using the blood found in the
abdomen is not very feasible. Its use should be
attempted when no other blood is available.
Concomitant operations, such as appendectomy,
are usually desirable, depending, however, on the
condition of the patient. Such additional surgery
apparently does not add to morbidity or mortality.
1216
Minnesota Medicine
COMMON INJURIES OF THE KNEE JOINT
EDWARD D. HENDERSON, M.D.
Rochester, Minnesota
XTTATSON- JONES made the statement that
’ * the most important single factor in the
successful treatment of all knee injuries is the
maintenance of good quadriceps tone and power.
In addition to this might be added the paramount
importance of early and accurate diagnosis. If the
exact nature and extent of the injury is ascer-
tained, it is usually possible to apply rational
treatment at an early time. The aim of treatment
of all injuries to the knee not involving fractures
is to avoid a weak and unstable knee. The func-
tion of stability is that of the four principal liga-
ments of the joint plus the quadriceps mechanism.
The quadriceps mechanism consists of the four
anterior muscles of the thigh converging into the
patella and through an aponeurosis on either side
into the patellar tendon. It not only provides the
power of extension for the knee but also is an
important factor in the stability while in active
motion and weight bearing.
The four principal ligaments from the func-
tional standpoint are the two collateral ligaments,
medial and lateral, and the anterior and posterior
cruciate ligaments. The collateral ligaments pre-
vent abduction and adduction of the knee and are
most efficient when the knee is fully extended.
Testing for the continuity of these ligaments
should be done only with the knee fully extended.
The anterior cruciate ligament prevents forward
displacement of the tibia on the femur, while the
posterior cruciate ligament prevents backward
displacement of the tibia. These functions should
be tested with the knee flexed to 90 degrees. The
first procedure which should be done when con-
fronted with the problem of diagnosis in cases of
acute injury of the knee is to secure good antero-
posterior and lateral roentgenograms of the knee
joint. Special views such as oblique, intercondylar
notch, or special patellar views may be necessary
to rule out fractures absolutely. If a fracture is
not present, it may not be possible to determine
for the first twenty-four hours the exact extent of
the injury to the joint.1 If there is any doubt, it
seems the best policy to put the patient to bed with
Dr. Henderson is Assistant to the staff, Section on Ortho-
pedic Surgery, Mayo Clinic, Rochester, Minnesota.
Read at the annual meeting of the Southern Minnesota Medical
Association, Mankato, Minnesota, September 11, 1950.
the affected leg elevated and to apply ice to the
knee joint to reduce as much as possible the edema
and hemorrhage. It is thus essential to test care-
fully all the ligamentous functions which have
been described. If there is real doubt because of a
low pain threshold or other reasons, it may be
necessary to anesthetize the patient to determine
whether the ligaments are intact.
A contusion, with or without traumatic syno-
vitis and hemarthrosis, is the least serious of in-
juries to the joint. If no swelling occurs and if
ligamentous stability is normal, the injury is mini-
mal, but even in this case the patient must be
observed closely and the preservation of good
quadriceps tone and power must he maintained by
exercise to ensure prompt recovery and avoid-
ance of later disability due to instability.
If swelling of the joint occurs within an hour,
hemorrhage into the joint or surrounding tissues
is present. If the fluid is intra-articular, it will
be possible to palpate a fluid wave. If blood is
present in the joint, it should be aspirated and a
tight pressure dressing should be applied to pre-
vent further hemorrhage.
On the other hand, if swelling does not occur
until several hours after the injury, the fluid is
an effusion due to traumatic synovitis. In this
case, aspiration should not be carried out, but the
joint should be wrapped with a pressure dressing
and quadriceps exercises should be begun imme-
diately.
More serious injuries to the knee joint, exclud-
ing fractures, involve the collateral or cruciate
ligaments and the menisci or semilunar carti-
lages. Perhaps the most frequently injured liga-
ment is the medial collateral ligament. This liga-
ment is injured by a blow on the lateral side of the
knee or by any other force which tends to abduct
the joint.4 Football is the sport most prolific in
the production of such injuries. The severity of
the ligamentous damage varies from a simple
sprain, with tearing of a few fibers but with nor-
mal lateral stability, to complete rupture of the
ligament with excessive lateral mobility of the
joint. If a sprain is diagnosed, the treatment
should be conservative. Protection of the liga-
ment by a tight bandage and by raising of the
December, 1950
1217
COMMON INJURIES OF THE KNEE JOINT— HENDERSON
inner border of the heel is considered adequate.
The importance of early institution of quadriceps
and other nonweight-bearing exercises cannot be
overstressed.
If there is a complete rupture of the ligament,
either plaster immobilization or early operation
with surgical suture of the ruptured ligament and
inspection of other joint structures should be
used. Watson- Jones favored a two or three
months’ trial of conservative therapy, but most
American authors favor early operation for sev-
eral reasons. One of these is that repair of the
ligament is much easier soon after injury. Sec-
ondly, it is possible to inspect the joint lo find
torn menisci and remove them if indicated.
The same principles of treatment apply to in-
juries to the lateral collateral ligament and to
those of the cruciate ligaments. If fracture of the
tibial spine occurs with clinical evidence of rup-
ture of the anterior cruciate ligament, an open
reduction should be performed. This injury should
be regarded as an avulsion of the anterior cruciate
ligament at its attachment to the tibia.
Whereas injuries of the collateral ligament
occur by application of lateral force on the ex-
tended knee, injuries of the menisci occur when
weight-bearing rotation forces are applied to the
flexed knee, as when a halfback pivots sharply on
one leg to avoid a tackier. Medial meniscus tears
are several times commoner than those of the
lateral meniscus, but the latter are not as rare as
had been the common conception several years
ago.2’3 There are two types of meniscus tears. The
first is the longitudinal or “bucket handle” tear,
and the second is the transverse tear in the pos-
terior horn. The classic sign of the “bucket handle”
tear is locking, or inability to extend the knee
fully. In addition, there is usually swelling of
the knee with pain over the involved meniscus.
There may also be a history of sudden “unlock-
ing” with or without manipulation. If it is the
first locking, conservative treatment by manipula-
tion, traction or splinting with active quadriceps
exercises is in order. However, if repeated lock-
ing occurs, the offending meniscus should be ex-
cised surgically. The often held misconception
that removal of menisci is often followed by a
stiff knee is, fortunately, not true, especially if
proper attention is paid to exercising the quad-
riceps mechanism.
Posterior horn tears of either meniscus are
more difficult to evaluate. There is no locking but
only an uneasy feeling of instability and fear that
the knee might lock. The MacMurray sign, that
is, the elicitation of a click by rotation of the tibia
in the extreme flexed position, is the only reliable
sign, but is not always present. Surgical excision
of the meniscus is the treatment of choice.
In conclusion, it may be stated that the common
ligamentous injuries of the knee joint should be
treated according to the structure affected and
according to the seriousness of the injury. The
most important single factor and the common
denominator in the treatment of all these injuries
is the active, vigorous exercise of the quadriceps
muscle. If this muscle is kept strong, a grave
ligamentous instability may be entirely asympto-
matic.
References
1. Barnes, Roland: Injuries of knee. Practitioner, 160:183-190.
(Mar.) 1948.
2. Coventry, M. B. : Internal derangement of knee. Minnesota
Med., 30:42, (Jan.) 1947.
3. Lipscomb, P. R., and DeForest, R. E. : Internal derangements
of the knee. Collect. Papers Mayo Clin. & Mayo Found.,
38:508-512, 1946.
4. Quigley. T. B. : The management of knee injuries incurred in
college football. Surg., Gynec. & Obst., 87:569-575, (Nov.)
1948.
5. Watson-Jones, Reginald: Injuries of the knee. In: Fractures
and Other Bone and loint Injuries. Ed. 2. chapt. 30, pn.
524-565. Baltimore: The Williams and Wilkins Company,
1949.
THE RAN A PIPIENS FROG TEST FOR PREGNANCY
(Continued from Page 1210 )
9. Gal li Mainini, C. : Pregnancy test using male toad. J. Clin.
Endocrinol., 7:653, 1947.
10. Gardner, H. I... and Harris, N. B.: Use of the male frog
(Rana pipiens) in a biological pregnancy test. Am. J. Obst.
& Gynec., 59:350, 1950.
11. Haines, M. : The male toad — test for pregnancy. Lancet 2:
923, 1948.
12. Klopper, H., and Frank, H. : The use of English male toads
in pregnancy tests. Lancet, 2:9, 1949.
13. Maier, E. C. : The use of the male Rana pipiens frog in the
diagnosis of pregnancy and the differential diagnosis of
abortions. West. J. Surg., 57:558, 1949.
14. McCallin, P. F., and Whitehead, R. W. : A study of native
species of male toads as test animals in the diagnosis of early
human pregnancy. Am. J. Obst. & Gynec., 59:345, 1950.
1218
15. Miller, D. F., and Wiltberger, P. B.: Some peculiarities of
the male frog test for early pregnancy. Ohio J. Sc., 48:89,
1948.
16. Robbins, S. L., and Parker, F., Jr.: The reliability of the
male North American frog (Rana pipiens) in the diagnosis
of pregnancy. New England J. Med., 241:12, 1949.
17. Robbins, S. L.. and Parker, F., Jr.: Use of male North
American frog (Rana pipiens) in diagnosis of pregnancy.
Endocrinology. 42:237, 1948.
18. Sharnoff. J. G., and Zaino, E. C. : An evaluation of the male
frog pregnancy test. Am. J. Obst. & Gynec., 59:653, 1950.
19. Soucy, L. B.: The use of ordinary toads and frogs for
pregnancy tests. Am. J. M. Technol., 15:184, 1949.
20. Wiltberger, P. B., and Miller, D. F. : Male frog, Rana pipiens,
as new test animal for early pregnancy. Science, 107:198,
194S.
Minnesota Medicine
History of Medicine In Minnesota
MEDICINE AND ITS PRACTITIONERS IN OLMSTED COUNTY PRIOR TO 1900
NORA H. GUTHREY
Rochester, Minnesota
(Continued from the November Issue)
M. Holterman, of Rock Dell, Olmsted County, was listed as a physician in
the 1878-1879 edition of the Minnesota State Gazetteer and Business Directory.
Other information has not been available. It is possible, but not proved, that this
practitioner was the Dr. N. S. Holterman, a Norwegian physician, who between
1874 and 1878 was in Kasson, Dodge County.
Joel H. Horton, an eclectic physician, practiced medicine in Rochester,
Olmsted County, eight years or more beginning in 1881.
Born in Portage County, Ohio, on April 29, 1830, Joel H. Horton received his
early education at Hiram Academy, Hiram, Ohio, and in 1852 took his degree of
doctor of medicine at the Eclectic Medical College of Rochester, New York. In
the next thirty years he practiced in various places, first in Wooster, Ohio, later
in Michigan, in Iowa City, Iowa, and in Hiram, Ohio. From Ohio he came to
Rochester, Minnesota, in the summer of 1881 and shortly afterward entered
partnership with Dr. E. X. Sedgwick, also an eclectic, with offices in the Olds and
Fishback Block on Broadway ; Dr. Sedgwick had come to Rochester late in 1879
from Zumbrota. When this association ended, after three months, Dr. Horton
took an office in the Heaney Block. In November, 1882, local newspapers stated
that his daughter, Frances D. Horton, had come from Springfield, Ohio, to keep
house for him at his residence on College Hill; and, a year or two later that Miss
Horton had been married in Ohio to Harry Corey, of Fremont, that state.
Dr. Horton was an active member of the Minnesota State Eclectic Medical
Society, attending meetings and presenting papers, notably one on eclecticism in
medicine, at the fifteenth annual session of the society in June, 1883, at Owatonna ;
at that meeting he was elected a member of the board of censors. Under the
medical practice act of 1883 he received Minnesota state license No. 693 (E),
dated December 31, 1883, which he filed in Olmsted County on January 12, 1884.
This practitioner’s name appeared occasionally in Rochester newspapers and in
certain county records into 1890 and in successive issues of a state gazetteer and
business directory from 1884 through 1891. It was not included in the first issue
(1906) of the official directory of the American Medical Association nor there-
after.
Dr. Hunt was early in Pleasant Grove, Olmsted County. On March 6, 1869,
the Federal Union of Rochester, in commenting on the prosperous village of
Pleasant Grove, in the township of that name, and its fine class of people, said in
part, “For instance, where will you find a more accomplished gentleman than
Capt. Mills, Dr. Bardwell and the venerable and the good Dr. Hunt?” Dr. Hunt’s
name appeared in Mervin’s Business Directory of 1869-1870, in relation to
December, 1950
1219
HISTORY OF MEDICINE IN MINNESOTA
Pleasant Grove, and an early settler of Rochester who is now very old has ex-
pressed the belief that Dr. Hunt at some time lived in Stewartville, seven miles
from Pleasant Grove.
A. T. Hyde, “doctor” perhaps by courtesy, one in a large category through-
out the country, was in Rochester, Minnesota, a few years in the late eighteen
sixties. Sometimes described as botanist and chemist, he had his headquarters in
the grocery store of S. H. Daniels, with whom he was for a time in partnership
in the manufacture of Hyde’s Gopher State Bitters. The Rochester Post of
August 15, 1868, quoted the following comment from the Chicago Republican:
“Rochester is meeting Pittsburgh half way and a bitter contest is on between the
bitters produced in the two places. Hostetter has had the field in Chicago but
Hyde’s Gopher State Bitters are supplanting them. The inventor of these bitters,
an experienced botanist, claims to have effected a combination of roots and herbs
from western prairies that contain medicinal properties. It has recently been
patented and is now manufactured by the laboratory of Daniels and Co. at
Rochester. It is meeting with large sale in Minnesota and is gradually working
its way into adjacent states. The bitters are highly recommended by those who
have tried them.” A few months later a grateful patient presented an especially
engraved medal to Dr. Hyde as a token of his appreciation of the medical worth
of the celebrated bitters; not long after that Dr. Hyde won a silver medal in a
bitters competition. In November, 1869, it was announced that S. H. Daniels had
purchased the interest of Dr. A. T. Hyde in the late firm of Daniels and Co. and
would continue the drug and grocery business.
W. A. Hyde was in Rochester, Olmsted County, probably about three
years. Through the summer and autumn of 1863 he announced himself in the
local newspapers as physician and surgeon, residence with W. H. Mitchell,
opposite the Stevens House, and office over the Union Drug Store (O. W.
Anderson and A. F. Childs, proprietors), on Third Street. He asked a fair share
of patronage, “having had ten years experience in the practice of his profession,
and spent the last year as surgeon in the United States Service, in the Land of
Dixie.” In December, 1863 Dr. Hyde was appointed by the city council to take
care of a smallpox patient, who was isolated in a disused log house on the edge
of the city. Later it appeared that Dr. Hyde protested that the house was cold
and unsuitable and he consequently was absolved of criticism when the patient
died and was said to have frozen to death. For many weeks an acrimonious
exchange, mentioned in the foregoing narrative, wTas carried on between news-
papers, editors in near-by counties stressing various unpleasant points. Ultimately
it became clear that the controversy arose primarily from political differences
among editors.
In January, 1864, Dr. Hyde joined Dr. W. W. Mayo in a partnership that
lasted less than four months. In June of that year Dr. Hyde was describing
himself as an eclectic physician and surgeon, with office and residence upstairs on
Broadway, opposite Dr. Cross. In the same month he was appointed city
physician, to serve under the council until May 1, 1865.
In September, 1865, stating that he was about to cease the practice of medicine,
Dr. Hyde gave “fair notice” and desired all those indebted to him for professional
services to call and settle their accounts without delay, and shortly afterward he
offered his house and lots for sale. His card continued to appear, nevertheless,
and presently he was announced as practicing medicine in Eyota, where he
remained some months. By December, 1865, he again was. in Rochester and,
1220
Minnesota Medicine
HISTORY OF MEDICINE IN MINNESOTA
indiscriminate as to school, was stating that he was a homeopathic physician and
surgeon, office and residence on Broadway the first door north of Woodard and
Fdls Drugstore, his charges “no more than others practicing in this place. Old
family medicine cases refilled or altered.” In the same issue of the newspaper
that carried this card appeared a paragraph, apparently from his hand, extolling
the merits of homeopathy.
After July, 1866, although this practitioner may still have been in Rochester,
notes about him did not appear in the press. Considerable detail regarding him
has been given here because he seems to have been one of a numerous class,,
peculiar to the time, in claims of experience and abilities, and in changes of
location and professed methods of practice.
The Rochester Post of July 7, 1893, in an item presumably authorized, stated
that Dr. Jackman, of Jacksonville, Illinois, had accepted a position on the
corps of assistant physicians at the Rochester State Hospital and that Dr. Jackman
and Dr. Cyrus B. Eby, another new appointee, would complete the staff of
assistant doctors. In none of the detailed published reports of the hospital nor
in M. K. Amdur’s “A Psychiatric Bulletin in Minnesota of Half a Century Ago”
(Minnesota Medicine, September, 1942), in all of which are mentioned the
physicians who would have been Dr. Jackman’s immediate associates, does the
name of Dr. Jackman appear.
Frank M. Johnson was in southern Minnesota as a general practitioner of
medicine and surgery from 1883 into 1896 and in Olmsted County the last six
years of that period.
Born at Fort Atkinson, Jefferson County, Wisconsin, on August 29, 1854,
Frank M. Johnson when a child removed with his parents to Vernon County,
that state, and there grew up. Fie attended the high school at Viroqua, took an
academic course at Wayland Academy in 1876, and in the three years immediatelv
following studied medicine with Dr. William Gott of Viroqtia. Soon afterward
he matriculated at Rush Medical College, from which he was graduated in 1882.
The scene of his first practice, for a year and a half, was Ontario, Vernon
County, Wisconsin, and there he was married to Ida De Lapp, a native of
Ontario, born on December 2, 1860.
In September, 1883, Dr. and Mrs. Johnson and their infant son, Lee F.
Johnson, removed to Brownsdale, Mower County, Minnesota. Dr. Johnson was
licensed in Minnesota on December 31, 1883, receiving certificate No. 958 (R).
From Brownsdale he transferred after two or three years to Grand Meadow,
where he practiced and ran a drug store until January, 1890, when he settled in
Byron, Olmsted County ; Dr. Carlos R. Keyes had left Byron a few weeks earlier
for Stillwater, where he was an assistant physician at the state prison.
The record in Byron is brief. Dr. Johnson and his family occupied the E. M.
Gilbert residence after a few weeks at the Commercial House. A third child, a
son, was born while they were in Byron, in December, 1890. Newspaper notes
indicate that Mrs. Johnson had relatives in Plainview whom she visited; that the
doctor was a Baptist and a prohibitionist, and that in June, 1890, he was
nominated for coroner by the prohibition group.
Early in 1892 Dr. Johnson sold his practice to Dr. Amos L. Baker, who was
coming to Byron from Pleasant Grove, and in April removed to Dover, where
opportunity existed. Dr. A. W. Stinchfield* of Eyota, had joined the Drs. Mayo
in Rochester, and Dr. Rollo C. Dugan, of Dover, had succeeded him in Eyota.
Before entering the new field and occupying the former quarters of Dr. Hiram
December, 1950
1221
HISTORY OF MEDICINE IN MINNESOTA
C. Bear who had left Dover two years previously, Dr. Johnson took a post-
graduate medical course in Chicago. He early became a member of the Southern
Minnesota Medical Association, which was founded in July, 1892. Occasional
local items concerning him have been noted : that he brought a patient to Rochester
for the opinion of the Mayos ; that he assisted Dr. William A. Chamberlain, of
St. Charles, in surgical operations on various occasions; that Dr. Horace H.
Witherstine of Rochester, went to Dover to see a patient with Dr. Johnson; that
the latter had been called to Stewartville.
In May, 1896, the Dover correspondent of the Rochester Post stated that Dr.
F. M. Johnson and his family had departed for Springfield, Missouri, where they
intended to make their home. That residence has been confirmed by the official
directory of the American Adedical Association, in successive issues of which
from 1906 to 1931, inclusive, Dr. Johnson was listed as of Springfield.
C. H. Johnston might be classed as an itinerant practitioner, at least in
the years when he first came to Rochester, Minnesota. In November, 1878, he
ran notices in the local newspapers that he would be available for consultation
at the Pierce House on certain days in November and December. There is
evidence, however that later he had his home in Rochester. In February, 1880,
the Rochester Post, mentioning Dr. Johnston as formerly of this city, reported
the birth of a daughter to Dr. and Mrs. Johnston, who then were living near
Dodger Center. And in May, 1880, the same paper stated that Dr. Johnston, “a
formerly well-known practitioner in this city,” had built up a large practice in
Minneapolis and Wisconsin and had chosen Minneapolis as a convenient location
from which to meet the numerous calls made upon him from all points.
Lewis Halsey Kelley (1808-1872) was from 1857 to 1863 a respected
physician and surgeon in Rochester, Olmsted County, and from 1860 to the end
of his life a representative newspaper owner, editor and publisher, first in
Rochester and subsequently in Owatonna, Northfield and Faribault. After leaving
Rochester he practiced medicine to only a limited extent.
Born in Ovid, Seneca County, New York, on October 13, 1808, Lewis H.
Kelley received his academic and medical education in schools and colleges in
the East, and was married, about 1840, to Angeline E. Rich, of Richford, New
York. Data are not exact but it is known that for some time he practiced medicine
at Marathon, New York, and that in the middle eighteen forties the family
removed to Painesville, Lake County, Ohio; there in 1847 a son, one of the family
of eight children, was born. In the early summer of 1857 Dr. Kelley came with
his wife and children to Rochester from Painesville in the hope that the Alinne-
sota climate would benefit Mrs. Kelley, who was in failing health; she died in
Rochester a few years later.
On arrival in Rochester Dr. Kelley began the practice of his profession. A
year later, when the settlement had been incorporated as a city, he began the
construction of his Brick Block, the first brick building in Rochester, at the
northeast corner of Broadway and College Streets (the latter now Fourth Street,
S. W. ). Broadway in that day extended two blocks north of the building site, to
lose itself in a hazel thicket. Brick for the block was burned in Whitcomb’s kiln
in East Rochester and was hauled by ox teams across the Zumbro River ford a
stone’s throw away from the chosen corner. This building of two stories, 22 x
70 feet, stood out in the irregular cluster of small buildings, of logs or boards,
that predated it and formed the nucleus of the city. It gave stimulus to civic
pride and ambition in Rochester and was for some time the center of activities
1222
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HISTORY OF MEDICINE IN MINNESOTA
in the settlement. The Kelley living quarters were on the ground floor rear of
the new building; the lower front space was rented to various local merchants in
turn : William McCullough, and F. W. Andrews, and Upman and Poole,
druggists. The upper space was rented to Messrs. David and Cyrene Blakely,
who in 1859 founded Rochester’s first newspaper, the Rochester City Post. To
this home Dr. Kelley brought the first piano ever owned in Rochester, an instru-
ment fascinating to the entire community and most of all to the Indians who
thronged the valley and the settlement. When the eldest Kelley daughter (later
Mrs. Walter Crocker) played on the “music box,” the red men crowded at the
windows to watch and listen, grunting their amazement and approval.
Dr. Kelley’s professional and training experience are best stated by him-
self : When in December, 1860, he returned to Rochester after a long absence, he
published in the Rochester Republican (which he had established that year) his
professional card and the following notice :
Ho ! Ye Afflicted ! The undersigned would respectfully announce that on return from
southern parts after nearly a year, he has made up his mind to locate permanently in the
city of Rochester as a
PHYSICIAN AND SURGEON.
He would further state, for the information of the afflicted, that he received the degree
of M. B. from the City of Albany, New York, while attending the Medical College of
Geneva, New York, and subsequently received the Addendum Degree of his profession
at the State Medical College of Indiana; is also a member of the New York State Medical
Society and of the College of Physicians and Surgeons, Geneva, New York. And from
his extensive practice in the healing art in the East, South, and West, for nearly twenty
years, he has made himself acquainted with all the variations and . grades of diseases, and
feels that all confidences imposed on him in his profession will not be misplaced. He
can be found at his office on the corner of Broadway and College Streets, between the
hours of 9 a.m. and 3 p.m., on each day, for medical counsel.
An additional note from- authentic source indicates that he was graduated from
the Geneva Medical College in 1838 and from the Albany Medical College in
1840.
Dr. Kelley was a patriotic and public-spirited citizen who during the Civil War
was “an unqualified terror to Copperheads of either side,” and a generous helper
to the loyal. His notice in his own paper and in other Rochester publications in
August, 1862, expressed his wish to serve:
Medical Notice. The undersigned, desirous of doing something for those who have left
their wives and children at home in this city or county, and have volunteered or may
volunteer in the service of the Army of the United States, for the purpose of defending
the flag of our union and the liberties of our citizens from the ruthless hands of tyrants
and traitors ; to all such wives and children residing in this city, to them or any of them
requiring medical attendance while their husbands and fathers are in actual service in the
war now existing in this union, I hereby pledge to all such needful medical services when
called upon, free of charge, — and to such persons residing in the county for one half of
the usual fee for such services. Dated at the city of Rochester, Minnesota, August 12,
1862.
This physician had various special interests and affiliations. He and his wife
were members and supporters of the local Methodist Church which was organized
in 1856. Dr. Kelley in August, 1857, was an organizer and the first Worshipful
Master of Rochester Lodge No. 21 (A. F. and A. M.). In 1860 “Senator” Kelley
was a leader in a movement to improve the public schools of Rochester. In 1861
he was a founder, and the first president, of the Olmsted County Temperance
Society.
December, 1950
1223
HISTORY OF MEDICINE IN MINNESOTA
As noted, Dr. Kelley early became a newspaper editor and publisher. In 1860
he bought (in partnership with his son-in-law W. H. Mitchell, who in 1866
published the first history of Olmsted County), the Rochester City News and
converted it into the Rochester Republican, of which he became local editor in
1861. In the autumn of 1863 he sold the Republican and removed his printing
equipment to Owatonna, Steele County, where he established the Plain Dealer,
the first newspaper in that city. In 1868 he removed to Northfield, Rice County,
and took over the Northfield Recorder, a little later the Northfield Enterprise ;
in 1870 he was in Faribault, publisher of the Faribault Leader.
in the summer of 1872, again living in Owatonna, Dr. Kelley lay seriously ill,
having been in poor health for nearly a year, “with some disease that seems to
baffle the skill of physicians; the doctor from a strong robust man weighing
nearly 300 pounds, has gradually pined away . . Lewis Halsey Kelley died in
Owatonna on September 9, 1872, aged sixty-four years. His funeral rites were
conducted at Rochester with full Masonic ceremonies, and he was buried in Oak-
wood Cemetery beside his wife.
Of Dr. Kelley’s family, one son James A. Kelley, died of tuberculosis in 1864
at the age of twenty-three years, at Bowling Green, Kentucky, where he had
gone in hope of recovery. Lewis H. Kelley and Pembroke S. Kelley became well
known in printing and newspaper circles of the state ; in the early eighties they
published the Rochester Post in the absence of the owner, the Hon. J. A. Leonard.
Lewis died in 1892 at Wilmot, South Dakota, where he was publishing a news-
paper; Pembroke died in 1929 in Rochester, where he long had had a job printing
office. A note on the family appeared in the summer of 1906: the Kelley Brick
Block, having become unsafe, was undergoing reconstruction, and the Olmsted
County Democrat, in giving the history of the building, paid tribute to Dr. Kelley.
There were in that year four of the family living: Pembroke; Mrs. Helen Kelley
Hart, of California ; Mrs. H. M. Lovell, of Minneapolis ; and Mary Georgiana,
wife of William H. Knapp, of Rochester. W. H. Knapp was for many years a
prominent citizen of the city, merchant, business manager of the Rochester State
Hospital, and finally executive officer of the Rochester Milling Company. In
1946 descendents of Dr. Lewis H. Kelley, resident in Rochester, were two grand-
sons, Harold W. Knapp and Spencer M. Knapp (died, 1947), and several great-
grandchildren.
Patrick Nicholas Kelly (1858-1903), a native of Olmsted County, Minne-
sota, was from 1883 into 1890 a physician and surgeon, but chiefly physician and
obstetrician, in Rochester.
Born in 1858 at a farm home in High Forest Township, in the vicinity of
Carrollville, Patrick Nicholas Kelly was the son of James Kelly and Mary Rooney
Kelly. Both parents were natives of Ireland, James Kelly of County Ros
common and Mary Rooney of County Leitrim ; both came to America in the
early fifties and west to Iowa, where they met and were married, in 1856, at
Dubuque. Shortly after their marriage they settled in High Forest Township
among neighbors of their own nationality and religious faith ; they were among
the organizers, in 1859, of St. Bridget’s Roman Catholic Church. Their home-
stead lay about a mile and a half west of the church site. When their five
children, Ellen, Mary, Alice, Bridget and Patrick Nicholas, were approaching
their teens, Mr. and Mrs. Kelly rented the farm for a few years and removed to
Austin to place them in school ; later the family returned to the farm, and
eventually made their home in Rochester.
1224
Minnesota Medicine
HISTORY OF MEDICINE IN MINNESOTA
Patrick Kelly early went to school in the home district and in Austin. His
academic education he received at St. John’s College, Collegeville, Minnesota,
and at St. Francis Seminary, Milwaukee ; his medical training at McGill Univer-
sity, Montreal, from which he took his degree of doctor of medicine in 1883
(sometimes erroneously stated as 1884). He received his Minnesota state license
No. 298 (R) on November 10, 1883. Unlike many of his contemporaries, he
did not study with a preceptor preliminary to taking his medical course, but
during at least his first summer vacation from McGill he read medicine with Dr.
Francis A. Sanborn, of Rochester, in offices at the back of the Hargesheimer
Drug store on the corner of Broadway and Zumbro Streets, offices that served
many different Rochester physicians, preceding and following Dr. Sanborn s
occupancy.
On his return to Rochester after some months of postgraduate work in Mont-
real, Patrick N. Kelly, M.D., C.M., opened an office over Poole’s Drug Store and
there in April, 1884, he was joined in partnership by his classmate Dr. Robert B.
Struthers (M.D., C.M., 1883). Dr. Struthers had come on a visit but within
two weeks he took out his state license, No. 871 ( R ) ; he remained with Dr.
Kelly several months before returning east. After a few years Dr. Kelly occupied
larger offices in the Cook Hotel Block.
Six feet tall, slender, blue-eyed, well groomed, dignified by mustache and small
side whiskers, the young physician in his twenty-fifth year began his career under
good auspices. He came of a family well known and highly respected, possessed
excellent native ability, was a brilliant student and had received the best of
scientific training. Recollections of persons who knew him and the comments of
the local press indicate that early in his professional life his health, probably
never robust, began to be affected by the strenuous conditions of practice of time
and place. There is more than one account of his country trips, his hazardous
crossing of the Zumbro River in flood, of his losing his horse and almost his life
in an icy freshet of Willow Brook south of town. Serious illness, accompanied
by pulmonary hemorrhage, occurred in 1884, again in 1885, and in subsequent
years, in which he was attended by his colleagues the Drs. Mayo and other
physicians in the city. He nevertheless continued in active practice ; was elected
coroner of Olmsted County in 1886, and was for several years a member of the
United States board of pension examiners. He was a member of the Catholic
Order of Foresters. He was a constant student of biography, history and
medicine ; his large library was distinguished by many first editions, chiefly Bibles
and medical works, in English, French, German and Norwegian.
In the summer of 1890, again having suffered from pulmonary hemorrhage,
Dr. Kelly went abroad, to recuperate his health and to improve his knowledge,
and studied for three months in London, Berlin and Paris. On his return to
Minnesota he announced his removal to Wabasha, Wabasha County, where he
occupied the offices previously used by Dr. W. H. Lincoln.
Dr. Kelly was a member of the Minnesota State Medical Society from 1884, a
charter member of the Olmsted County Medical Society when it was revived in
December, 1885, and a member of the Wabasha County Medical Society (its
secretary, 1892-1894, and its vice president, 1900). His contribution of scientific
papers to all these groups has been noted, particularly an article on diphtheria,
which Dr. W. J. Mayo cited before the state society in 1886, and one on
puerperal eclampsia. In Wabasha County, as in Olmsted County, it is said, he
was coroner and member of the United States pension board.
Patrick N. Kelly was married in Wabasha on April 21, 1896, to Clara Ginther
December. 1950
1325
HISTORY OF MEDICINE IN MINNESOTA
of that place. The only child of the marriage, a son, died on June 9, 1901. Mrs.
Kelly’s death occurred on March 9, 1902. At that time Dr. Kelly had been
several years in ill health, obliged to spend periods of rest in the south and else-
where. After his wife’s death he returned to Olmsted County and in the summer
and autumn of 1902 he lived near Simpson, practicing medicine when able. In
December, 1902, he was taken to the farm home of his sister Bridget, wife of
M. A. Keane, in Olmsted County, near Pine Island, Goodhue County.
Patrick Nicholas Kelly died at the Keane home on March 11, 1903, at the
age of forty-five years, “a man of strictest integrity; as a son, a brother, hus-
band, father, citizen and friend, he fulfilled his duty most faithfully.” There
were many breaks in the family circle within a few years. James Kelly, the
father, died at the home of Mr. and Mrs. Keane in May, 1903. Bridget Kelly
Keane died a few weeks later on July 23. Mary Rooney Kelly survived her hus-
band until January, 1907, when she died at her home in Rochester. Bridget and
Alice Kelly had been successful teachers in St. Paul ; Alice gave up her work to
take care of her mother. Ellen, the eldest daughter, had died in girlhood from
tuberculosis; Mary became Sister Mary Irene, of the Franciscan Order, in
Rochester.
In 1946 there were living of Dr. Kelly’s relatives, one sister, Alice Kelly (Mrs.
William H.) McGraw, a widow of Grand Forks, North Dakota; a nephew, John
C. Keane a chemist, since 1944 general superintendent of the Utah-Idaho Sugar
Company, of Salt Lake City, and three grand-nephews, sons of Mr. Keane and
Isabelle Langer Keane, M.D. ; Mrs. Keane before her marriage was a pediatrician
in Minneapolis. A niece, Helen Keane, wife of J. C. Schilleter, who was con-
nected with the Iowa State College, at Ames, died in 1931.
Burney J. Kendall (1848?-1926), physician and surgeon, who practiced in
Olmsted County in the period of 1868-1870, was a native of Enosburg Falls,
Franklin County, Vermont. Knowledge of him has been derived chiefly, from
the reminiscences of the late Dr. David S. Fairchild of Clinton, Iowa, who in
1869-1872 conducted his initial practice of medicine in the village of High
Forest, Olmsted County; Dr. Fairchild came to Minnesota from Vermont on
the advice of Dr. Kendall, a friend of his youth in a neighboring village.
Dr. Kendall studied medicine under a preceptor in Vermont (it is not known
w'hether he was a graduate of a medical school ) and soon afterward came to
Minnesota and settled in Marion, with his office in the home of Henry H. Beach
of that village. During his stay in the county, Dr. Kendall was a member of the
Olmsted County Medical Society and a physician to the Olmsted County poor
farm.
After about two years, Dr. Fairchild recalled, Dr. Kendall, convinced that
routine practice of regular medicine would not lead to fortune, returned to Ver-
mont, where he began to experiment in concocting patent medicines: "In the
course of time he fell on a combination of drugs which was thought to have a
beneficial effect on spavin in horses, and by skillful advertising gained a consider-
able reputation among farmers and horsemen. For many years ‘Kendall’s Spavin
Cure’ had a wide reputation. The pictures of fine horses and handsome women
ornamented the walls of drug stores everywhere, and fine teams of horses and
wagons could be seen on all important highways and ‘Kendall’s Spavin Cure’ Was
a household name far and wide.” Dr. Kendall was not skilled in high finance,
however, and was forced by a combine to sell out his interest for some $200,000.
This considerable fortune, for that day, he invested in drug interests in Saratoga,
New York, and in real estate in Omaha during boom time, with ultimate financial
1226
Minnesota Medicine
HISTORY OF MEDICINE IN MINNESOTA
disaster. Dr. Fairchild said, “I saw Kendall but once after he left Marion in
1870. In 1926 I saw a notice of his death in an obscure Minnesota town.”
Staunton B. Kendall (1808-1897), a homeopathic physician who for forty
years was well known over a large portion of southern Minnesota, in 1883 was
described as the pioneer physician of the region of Byron, Olmsted County.
Born on March 17, 1808, at Ira, Rutland County, Vermont he was the son of
Ephraim Kendall and Lucinda Brown Kendall, who a few years earlier had come
from England to the United States. Ephraim Kendall served with the American
troops in the War of 1812.
When Staunton Kendall was thirteen years old he accompanied his parents to
Canton, Bradford County, Pennsylvania, and there and at Wellsborough, in
adjacent Tioga County, received his early education. On coming of age he
learned carriage making, a trade which he followed until ill health forced him to
abandon it. At the age of thirty-two years, he took up the study of medicine
and after two years under Dr. Welles, a homeopathic physician, he began inde-
pendent practice.
Staunton B. Kendall was married on December 18, 1832, to Fanny Fellows, a
native of Shelburne, Franklin County, Massachusetts, born on March 15, 1815.
In 1853 Dr. and Mrs. Kendall came west with their children. In Wyanet, Bu-
reau County, Illinois, the doctor practiced medicine for three years. In 1856
he came to Dodge County, Minnesota, and took up land in Ashland Township.
Six years later he sold the farm and bought land near Byron, Kalmar Town-
ship, Olmsted County, and after three years established the family home in By-
ron. In 1867 Dr. Kendall built Byron’s first hotel, which he ran for eight years,
after which his son, Joseph B. Kendall, took it over. In 1869 Dr. Kendall
opened a drug department in his son’s general store and there dispensed his own
drugs. Eckman and Bigelow, in writing of early medicine in Dodge County,
mentioned Dr. Kendall and quoted his granddaughter, Miss Aurilla Kendall, of
Byron : “The older settlers say that they could get prescriptions filled in Byron
when they couldn’t get them in Rochester.”
At all times Dr. Kendall practiced his profession in addition to following other
occupations. He became well known to settlers living within a radius of fifty
miles of Byron, and it was said that at the height of his work as a physician,
in a year in which 700 patients came under his care, he lost only two, one from
diphtheria and one from cerebral meningitis. Exceedingly active, abstemious,
a Methodist, a Whig in early times and later a Republican, he was always hon-
ored and respected.
When the Southern Minnesota Homeopathic Medical Society was organized
at Owatonna in October, 1871, Dr. Kendall was present with other homeopathic
physicians from Olmsted County, and the following year he became a member.
This society was an active component of the state homeopathic society. On May
28, 1883, Dr. Kendall received state exemption certificate No. 428-3 (H), on the
basis of proved years of practice.
In the eighteen eighties Dr. Kendall gave up his long ride, as the expression
was those days, but continued to practice in the village and to maintain his inter-
est in local affairs. His wife died on March 25, 1885, at the age of seventy-two
years. When Dr. Kendall died on November 9, 1897, in his ninetieth year, he
was survived by four of the large family of children : two sons, Joseph B. Ken-
dall of Byron, John Kendall, formerly of Dodge Center, then of Phoenix, Ari-
zona; and two daughters, Mary Kendall (Mrs. George) Dearborn, of Hudson,
Wisconsin, and Aurilla Kendall (Mrs. G. H.) Stevens, of St, Paul. In 1946
December, 1950
1227
HISTORY OF MEDICINE IN MINNESOTA
surviving Minnesota relatives of this pioneer physician were seven grandchildren:
Miss Aurilla Kendall, of Byron; Mrs. M. F. Little, of Rochester; Miss Calla
Kendall, of Minneapolis; all daughters of the Hon. Joseph B. Kendall, who, like
his father, was long an influential figure in Olmsted County, in private business
and in public affairs. Leonard Dearborn and George Dearborn were in St. Paul ;
Mrs. Helen Dearborn Huelster was in White Bear Lake; and Mrs. Ruth Dear-
born was in San Francisco, California.
Carlos (sometimes given Charles) Royal Keyes (1856-1938) was from
early 1882 into 1889 a resident physician and surgeon of Byron, Olmsted County,
active in professional and civic affairs.
Born on April 21, 1856, at Chelsea, Orange County, Vermont, Charles R.
Keyes was a son of Samuel M. Keyes and Olive Hanson Keyes, both of whom
were natives of Chelsea, as were their parents. His maternal grandfather served
on the American side in the War of 1812. Charles Keyes grew up on the home
farm near Chelsea, attended the district school and Chelsea Academy, was a stu-
dent at Dartmouth College, and on completion of two years at the medical depart-
ment of the University of Vermont, at Burlington, he received the degree of doc-
tor of medicine in 1881.
After practicing medicine a few months in Chelsea, Dr. Keyes came to Olmsted
County, in February, 1882, and soon entered partnership with Dr. Isaac Hall
Orcutt, of Byron. Dr. Orcutt was then relinquishing his professional ride and
limiting himself to an office schedule. In January, 1883, Dr. Orcutt retired from
practice, and as Dr. Staunton B. Kendall, venerable pioneer physician of Byron,
was reducing his work, the young doctor was needed. Dr. Keyes was licensed in
Minnesota on November 24, 1883, receiving certificate No. 383 (R).
In Byron, Dr. Keyes spent seven years that were filled with general village and
country practice and active participation in community affairs. An old resident
recalls him as short and slender, always kind, the finest of men. He was married
on December 5, 1885, to Ella V. Sinclair, one of the six children of George
Sinclair, farmer and native of Maine, who settled in Kalmar Township in 1856.
Dr. Keyes’ professional card appeared in various newspapers of Dodge and
Olmsted Counties. For a time he was local correspondent for the Kasson Vindi-
cator, relaying news of Byron and Kalmar Township. He was a Baptist and a
Republican; a member of the village council, its recorder and sometime president;
president of the Byron Library Association, for which Mrs. Keyes was librarian.
From 1882, succeeding Dr. Orcutt, through 1889, he was county physician for
the village of Byron and the townships of Salem and Kalmar, and also was local
health officer.
In December, 1889, Dr. Keyes accepted an appointment as assistant physician
at the state prison at Stillwater, to begin on January 1, 1890. When he left By-
ron, the village announced its need of a physician, with the result that within
a few weeks Dr. Frank M. Johnson came from Grand Meadow, Mower County.
Early in 1891 Dr. Keyes removed from Stillwater to West Duluth, where he
spent the remainder of his long life, continuing in his tradition of professional
and civic activity. He was a member of the Olmsted County Medical Society, the
Minnesota State Medical Society, from 1888, the St. Louis County Medical So-
ciety and the American Medical Association. His favorite recreations in the
Duluth era were hunting and curling.
After fifty-seven years as physician and surgeon Dr. Keyes died on August 10,
1938, at the Webber Hospital, Duluth, from coronary thrombosis, in his eighty-
third year. Mrs. Keyes survived him.
(To be continued in the January issue)
1228
Minnesota Medicine
THOUGHT AND CELEBRATION
With the holiday season — the religious significance of Christmas and the extended
implication of new hope and new life that is inherent in New Year’s celebrations —
we come inevitably to a re-evaluation of fundamental values and objectives.
For, no matter how obscured with mythology and tinseled superficiality our
observance of Christ’s birthday becomes, still in some thoughtful and reflective
moment we experience anew the inspiration that is centuries old and resolve to
empower our lives wdth this moving force, rather than with the selfish personal
ambitions that we often rationalize as independence and initiative.
It is a time for gratitude, humility and rededication to the principles of Christian
living and, as physicians, we seek to applv those attitudes toward the conduct of
our professional lives, so that our work may make its contribution to the advance-
ment of humankind.
As physicians and as inhabitants of a world fraught with fear, frustration and
suffering, we can be thankful, during this time of contemplation, for the miraculous
discoveries of science that have been given us to use for the greater good of our
fellow men. We can be grateful that freedom and human dignity, the God-given
qualities that can make man godlike, have been preserved and regarded in a new
light of reverence.
In wishing you the blessing of a joyous holiday, may I add, too, my appreciation
for the opportunity of serving as your president this year and my thanks for the
fellowship and co-operation you have unfailingly offered me.
President, Minnesota State Medical Association
December, 1950
1229
♦ Editorial ♦
Carl B. Drake, M.D., Editor ; George Earl, M.D., Henry L. Ulrich, M.D., Associate Editors
NPH INSULIN
HP HE IDEAL INSULIN would be one that
had its maximum effect at the height of diges-
tion of the three meals and minimum from mid-
night on.
The action of plain insulin is very fleeting. Tt
was Hagedorn and his group in Denmark who
discovered that the addition of protamine pro-
longed the action of insulin. The addition of zinc
further prolongs the action. The addition of 1.25
mg. of protamine and 0.2 mg. of zinc per 100
units as in protamine zinc insulin prolongs the
action of the insulin much longer than twenty-
four hours and its initial action is so slight that
frequently regular insulin must be added to pro-
vide early action after injection. The conversion
of some of the regular insulin into protamine in-
sulin by this mixing makes the amount of each in
a mixture uncertain.
NPH insulin (neutral protamine Hagedorn) is
an insulin with the addition of 0.5 mg. of pro-
tamine per 100 units and a'so zinc. Its action is
said to last from twenty-six to thirty hours so
that there is very little overlapping of dosage
from day to day. Although it is not as prompt in
its action as plain insulin, it is more prompt than
protamine insulin, its maximum action coming
seven to eleven hours after infection, and its ac-
tion during the night being minimal. The new
NPH insulin has been found to control the gly-
cosuria in many diabetics who formerly required
protamine and plain insulin mixtures. The elimi-
nation of the need for mixing two insulins is of
course an advantage. It is claimed that plain
insulin can be added to the NPH insulin without
disturbing the prompt action of the plain because
of the lesser content of protamine available for
combination.
The NPH insulin is being widely used. Tt
would seem that it represents a distinct advance in
the insulin treatment of diabetes.
WORLD MEDICAL ASSOCIATION
G OME 500 medical leaders from twenty-eight
^ nations of the world met in New York in Oc-
tober to discuss world medical and health prob-
lems. The World Medical Association is a volun-
tary organization of the national medical asso-
ciations of forty-one countries. This is the fourth
annual meeting and the first to meet in the United
States.
Dr. Louis H. Bauer, chairman of the board of
trustees of the AMA, is also secretary-general of
the World Medical Association with headquarters
in New York City.
Russia has never been represented in the WMA,
and at present the countries in the Russian bloc
also do not send representatives.
On October 17, Dr. Elmer L. Henderson of
Louisville was inaugurated as president of the
WMA. Last June he was inaugurated as presi-
dent of the AMA and thus he holds the presi-
dency of the two largest medical associations in
the world. At his inauguration, he called atten-
tion to the fact that “physicians by their thinking,
spirit and effort can set an example for govern-
ments, diplomats and people everywhere to pre-
serve the peace.”
Dr. Charles Hill of London, retiring president,
was unable to attend, but in his message he ex-
pressed serious dissatisfaction with the present
British National Health Service. He wrote that
the general practitioner in England is losing both
patients and prestige and that, if it becomes clear
that no prospect for satisfactory settlement is
in sight, “preparations should be made for a with-
drawal of general practitioners from the National
Health Service.”
At one spirited session, delegates voted “to con-
demn the practice of euthanasia under all circum-
stances” as “contrary to the public interest and
to medical principles as well as to natural and
civil rights.” Dr. S. G. Sen of India and Dr.
E. A. Gregg of Great Britain favored “mercy
death with the consent of the patient and the
state to bring an end to intolerable suffering.”
Delegates from the United States, Ireland and
Vinnesota Medicine
1230
EDITORIAL
France were strongly opposed. Dr. Marcel Pou-
mailloux of France declared that approval of
euthanasia would “open the door to all possible
crimes and criminal practices.”
WMA delegates voted to authorize the council
to consider any applications of doctors of Western
Germany and Japan to membership, despite the
protests of two Israeli physicians on the grounds
that many doctors in Germany had been involved
in such human experiments as forced sterilization
and vivisection of humans.
Scientific sessions included addresses on the
latest advances in endocrinology, gastroenterology
and the therapeutic uses of blood and its deriva-
tives.
Dr. Dag Knutson of Djursholm, Sweden, was
unanimously chosen president-elect of the asso-
ciation to take office at the fifth general assembly
of the WMA to be held in Stockholm, Sweden,
September 15 to 20, 1951.
One courteous gesture in connection with this
year’s meeting was the defraying of the cost of
meals for the foreign physicians during their
five-day attendance by fourteen American busi-
ness firms. Other prominent business concerns
presented each of the 120 wives accompanying
their physician husbands from all over the world
with a gift package containing a variety of Ameri-
can products.
The World Medical Association surely offers
a medium for promoting understanding through-
out the world and has so far utilized its oppor-
tunities
POLIOMYELITIS IN MINNESOTA
HP HROUGFI the courtesy of Dr. D. S. Flem-
-*■ ing, chief of the Section of Preventable Dis-
eases of the Minnesota Department of Health,
we are able to report the incidence and mortality
of poliomyelitis in Minnesota this year from Jan-
uary 1 to October 31.
The Minnesota Department of Health received
reports of 418 cases of poliomyelitis, including
seventeen deaths in Minnesota residents during
this period. Sixty-two cases, including four deaths
in out-of-state residents, were also reported.
It has long been recognized that poliomyelitis,
while appearing sporadically in the winter months,
has its greatest incidence in August, September
and October. Poliomyelitis acted in this respect
true to form again this year, as the following
figures attest. The 418 cases had their onset as
follows: January — 9, February — 1, March — 2,
April — 1, May — 4, June — 11, July — 34, August
— 120, September — 140, October — 96.
By sex, 239 (57 per cent) were male and 179
(43 per cent) were female. Of the seventeen
deaths, ten patients were male.
According to age, 100 occurred in the first four
years of life, 165 in the 5 to 14-year age group
and 153 in the 15-year and older group. Three
deaths occurred in the first age group (0 to 4
years) ; four in the second group (5 to 14 years) ;
and ten in the third group (15 years and over).
By type, 206 were paralytic (75 bulbar and 131
spinal) ; 165 were non-paralytic, and 47 were not
stated.
The 418 cases and seventeen deaths have been
reported from fifty-eight counties, as follows :
County Cases
Aitkin 2
Anoka 7
Becker 1
Beltrami 0
Benton 3
Big Stone 0
Blue Earth 12
Brown 10
Carlton 18
Carver 5
Cass 0
Chippewa 2
Chisago 2
Clay 1
Clearwater 1
Cook 0
Cottonwood 0
Crow Wing 4
Dakota 2
Dodge 0
Douglas 2
Faribault 9
Fillmore 0
Freeborn 27
Goodhue 4
Grant 1
Hennepin, excl. of 22
Minneapolis 80
Houston 1
Hubbard 1
Isanti 2
Itasca 0
Jackson 2
Kanabec 0
Kandiyohi 5
Kittson 0
Koochiching 0
Lac qui Parle 0
Lake 2
Lake O’ Woods 0
Le Sueur 2
Lincoln 0
Lyon 0
Deaths
1
2
3
1
1
Decembek, 1950
1231
EDITORIAL
McLeod 2
Mahnomen 0
Marshal! 1
Martin 3
Meeker 1
Mille Lacs 1
Morrison 5
Mower 13
Murray 0
Nicollet 2
Nobles 1
Norman 0
Olmsted 7
Otter Tail 2
Pennington 0
Pine 1
Pipestone 2
Polk 1
Pope 5
Ramsey, excl. of 7
St. Paul 35
Red Lake 0
Redwood 9
Renville ]
Rice 2
Rock 0
Roseau 0
St. Louis, excl. of 12
Duluth 30
Scott 0
Sherbu rue 2
Sibley 0
Stearns 9
Steele 9
Stevens 0
Swift 0
Todd 0
Traverse 4
Wabasha 0
Wadena 1
Waseca 3
Washington 2
Watonwan 1
Wilkin 0
Winona 8
Wright 5
Yellow Medicine 1
1
1
1
2
1
1
Although the figures quoted are for the first ten
months of 1950 only and a number of additional
cases have already been reported since October
31, it is obvious that Minnesota has been fortunate
this year in
comparison with the ten
worst years
since 1915
as listed below :
Year
Cases
Deaths
1916
912
105
1921
702
102
1925
955
145
1930
479
37
1931
811
66
1939
564
53
1944
530
37
1946
2,881
226
1948
1,387
110
1949
1,715
110
1232
MATERNAL MORTALITY STUDY IN
MINNESOTA
The state-wide survey of maternal mortality
being conducted by the Committee on Maternal
Welfare of the Minnesota State Medical Associa-
tion with the co-operation of the Minnesota De-
partment of Health has been in progress since
April 1, 1950. Up to this time, twenty maternal
deaths have been reviewed. As a result of the
study so far, it has become apparent to the Com-
mittee that several matters need to be emphasized
and called to the attention of everyone concerned.
Physicians and personnel in charge of hospitals
are urged again to report all maternal deaths
promptly by telephone to the Division of Maternal
and Child Health of the State Health Department
at GLadstone 5973 (Minneapolis), reversing the
charges for such calls. Early interviewing of phy-
sicians, nursing staff and immediate relatives con-
cerned would be facilitated if this were done and
would make for more accurate evaluation of
mortality responsibility.
Physicians and hospitals are reminded that the
study includes all female deaths where pregnancy
is present, even though the pregnancy is not the
cause of death. Furthermore, it includes all deaths
occurring during a postpartum period of three
months following delivery. To clarify the report-
ing of maternal deaths, therefore, the words
“pregnancy” or “postpartum,” whichever term
applies, should be written on all death certificates
to be included in this study, even though neither
condition is the cause of death.
The need for adequate office and hospital rec-
ords becomes increasingly apparent as the study
progresses. Current notations on the case history
of symptoms, findings, treatment, and progress of
the case are extremely valuable in evaluating and
placing the responsibility for a maternal death.
Physicians are reminded again that a copy of
the Committee’s findings in each maternal death
may be obtained by the particular physician con-
cerned upon his request.
The Committee is deeply appreciative of the
excellent co-operation received thus far from all
physicians and hospitals concerned in the present
survey and believes that the findings of this study
will be a potent influence in further reducing
maternal mortality in Minnesota.
James J. Swendson, Chairman,
Committee on Maternal Welfare
Minnesota Medicine
EDITORIAL
CHRISTMAS SEALS
The tremendous cost of tuberculosis in terms of lives,
suffering, and dollars is emphasized in the 1949-50 an-
nual report of the National Tuberculosis Association.
Killing more than 40,000 persons a year, tuberculosis
is responsible for more deaths in this country than all
other infectious diseases combined and leads all diseases,
infectious or not, as a cause of death in the age group
from 15 to 34.
While the tragic cost of tuberculosis in broken lives
and broken homes cannot be calculated, the report states
that the monetary cost of tuberculosis is estimated at
more than $350,000,000 a year. Included in this sum
is the cost of care and service for the quarter of a
million people known to have the disease and the search
for an equal number believed to be tuberculosis victims
but unknown to health departments. The sum does
not include hospital construction costs.
Since the median age at which tuberculosis kills is
48, the report brings out that the disease each year is
robbing the people of this country of 1,500,000 potential
years of life, one million of which are working years.
(These estimates are based on a life expectancy at birth
of 65 and a working age limit of 65 years.)
Yet tuberculosis, a communicable disease, is also a
preventable disease, the report states, and can be brought
under complete control if the present campaign of the
medical profession, the voluntary tuberculosis associa-
tions, and official health agencies is stepped up and re-
lentlessly pursued.
Cited among the outstanding requirements to fight tu-
berculosis are a program geared to the needs of the day ;
further medical advances in the research and educa-
tional fields as well as in the diagnosis and treatment
of the disease ; more local health units to serve the
health needs of all the people ; a public better educated
in the prevention and control of tuberculosis ; more wide-
spread efforts to find people with tuberculosis while the
disease is still in an early stage; more hospital beds
for tuberculosis patients ; more nurses trained in the
care of the tuberculous ; improved services for tuber-
culosis patients, and international control of the disease.
While the prediction may be made that at some time
in the future tuberculosis may become a medical rarity,
the report stresses that close vigilance will always have
to be maintained against it. It has already been the
target, according to the report, of the “most widely or-
ganized, longest sustained, most productive campaign
ever directed against a disease.” The campaign was
launched in 1904 with the organization of the National
Tuberculosis Association, which today has 2,987 af-
filiated associations in the 48 states, the District of
Columbia, Alaska, the Canal Zone, Hawaii, and Puerto
Rico. The state Christmas Seal organization is the Min-
nesota Public Health Association.
Ninety-four per cent of the Christmas Seal funds
raised is retained within the state where it was con-
tributed to support state and local programs. Six per cent
goes to the National Tuberculosis Association for medical
research and other activities.
ADVISORY COMMITTEES TO SELECTIVE SERVICE
Instructions were sent out under date of November
17, 1950, to the members of the County Medical Advis-
ory Committees to Selective Service. These commit-
tees in the the county medical societies are held respon-
sible for carrying out the procedures set up by the
National Advisory Committee to Selective Service. It
is their duty to advise local Selective Service Boards
within the county medical society area concerning classifi-
cation of individual members of the local medical pro-
fession and, although the local Selective Service Boards
are the final authority on deferments, they are expected
to follow closely the recommendations of advisory com-
mittees.
The Presidential order says that registrants shall be
deferred as hardship cases “only if it is determined that
(their) induction into the armed forces would result
in extreme hardship and privation to a wife, child, or
parent with whom he maintains a bona fide family
relationship in their home.” The order says defer-
ment because of essential service to community shall
be granted only “when his induction would cause the
availability of essential health services to fall below
reasonable minimum standards” in his community.
In addition to the above, State and National Advis-
ory Committee policy, at the present time, is to rec-
ommend deferment on the following basis :
(a) Physicians who have not completed at least one
year of intern training.
(b) Senior residents prior to the completion of the
current year’s training.
(c) Full time postgraduate medical students until com-
pletion of the current academic year.
(d) Physicians in teaching or research whose activi-
ties are considered necessary to the national health,
safety or interest.
As we have mentioned before :
First priorities are ASTP or V-12 students or others
who were deferred during World War II to continue
their education and who subsequently served less than
ninety days.
Second priorities constitute those similarly deferred
but who served more than ninety days and less than
twenty-one months.
First priorities will be processed first.
State and local quotas will be based on the number
of registrants in the various categories rather than on the
total registration.
The Army is undertaking to offer a reserve commis-
sion to every registrant at the time he takes his phys-
ical examination and before his induction. However,
physicians can volunteer for any military service up to
the time they are inducted. Under the law, men in-
voluntarily inducted may not receive the $100 monthly
pay bonus which goes to volunteers.
December, 1950
1233
Medical Economics
Edited by the Committee on Medical Economics
of the
Minnesota State Medical Association
George Earl, M.D., Chairman
ELECTION OFFERS NEW CHALLENGE
Now that election noise has calmed down con-
siderably, Americans can reflect upon and analyze
the outcome.
Regardless of legislative implications, citizens
should not sit back content and complacent, but
should continue their vigilance of civic affairs.
This public-spirited vigilance will maintain an
America where all are free to elect or defeat
candidates. Doctors, in their primary role as
citizens, should continue their efforts to help keep
America among the free nations of the world.
CANADIAN DOCTOR REPORTS ON BRITISH
HEALTH SERVICE
Adding his voice to the many who are speaking
out against the evils in the British national health
service, Dr. A. W. H. Challis of Fort Frances,
Canada, told Rotarians in International Falls,
Minnesota, recently that “Britain’s national health
program has resulted in a record-breaking de-
mand for medical and dental service at govern-
ment expense.” Dr. Challis, who reported on the
British program from firsthand experience with
it, stated that “about 80 per cent of the people
who crowd doctors’ waiting rooms probably don’t
need attention at all but must see a doctor to
obtain permits for larger rations, discounts or
special services.”
Cites Overwork of M.D.'s
Dr. Challis stated that the role of “form-filler”
isn’t pleasing to Britain’s doctors because they
are trained “to do a special job and do it well.”
He said :
“Of the remaining 20 per cent of Britishers who avail
themselves of the public health service, about 10 per cent
are really sick and the other 10 per cent have minor ail-
ments and disorders that they would have treated them-
selves in the days before the practice of medicine was
nationalized.
“As a result of the heavy patronage, doctors of Britain
are terrifically overworked and unable to render the high
quality personalized service that the profession normally
demands.
“The average British doctor in the national health
service will see as many as 100 patients during evening
office hours. Much of his time is spent in filling out
forms and permits for those not especially in need of
attention, at a sacrifice for those who are seriously ill.”
Paper Work Overwhelming
Citing the tremendous amount of paper work
entailed in the daily operation of the British health
system, Dr. Challis told Rotarians that a British
doctor must carry as many as forty-two different
kinds of government certificates in order to cope
with any emergency he may be called upon to
handle. “New demands for health service have
crowded the hospitals to overflowing, just as they
have burdened the individual practitioner. Hos-
pital waiting lists are long and growing longer
constantly,” he said.
According to Dr. Challis, important surgical
cases often have to wait from nine to twelve
months. Lesser operations, such as tonsillectomies,
have been known to be postponed eighteen to
twenty-four months because hospital beds weren’t
available.
Warns of Mounting Costs
Dr. Challis cited a common fallacy about the
cost of the program :
. . the ordinary citizen considers the service cheap,
if not free, but actually the program is very expensive.
The high costs are reflected in very high taxes on in-
comes and almost everything else.”
The quality of Britain’s health service, Dr.
Challis concluded, has suffered under the na-
tionalized system. He said, “Britain would have
benefited more by raising the general standard
of health service under the private practice plan
than by offering a lower grade of service on a
wholesale scale to everybody, all at once.”
1234
Minnesota Medicine
MEDICAL ECONOMICS
LEGISLATOR ASSAILS FEDERAL LOBBYING
Representative Henry J. Latham of New York
recently issued a charge that “certainly the fed-
eral lobby is the largest and most powerful with
which congress must contend.” His charge, that
the government spends a billion dollars a year to
lobby for its proposals, was a countercharge after
the lobby investigation committee reported that
152 corporations spent over thirty million in the
last three years to influence legislation.
Representative Latham, using studies showing
that government lobbying far exceeded that of
business, stated that the most conspicuous ex-
amples of federal lobbying are the “campaigns
for the Brannan plan and compulsory medical in-
surance.”
Latham attacked the trip to Europe of Federal
Security Administrator Oscar Ewing and a party
of assistants, as “an effort to spread propaganda
for the proposed Truman medical program.”
Government Printing Tremendous
Studies on government printing alone show
that costs run to over $50,000,000 a year, accord-
ing to Representative Latham. He referred to a
study made by Representative E. H. Rees of
Kansas, showing sixty-one separate government
printing and duplicating plants in Washington,
twenty-three in Philadelphia, and sixteen in Chi-
cago, and their respective operating costs.
GOVERNMENT DEBT BIGGER THAN EVER
Almost simultaneously, the Commerce Depart-
ment issued a statement saying that the “federal
government entered this year deeper in debt than
all the private firms and individuals put together.”
The total net federal debt was put at $218,600,-
000,000, with state and local governments owing
another $18,000,000,000.
With the government spending more for lobby-
ing than private interests spend, and involved in
more debt than “private firms and individuals
put together,” some of those individuals might
wonder how they would finance the more than
$1,500 they would be slated for if the amount were
divided evenly among American men, women and
children.
HEALTH INSURANCE BOOK
ISSUED BY COMMITTEE
The most extensive summary of the arguments
for national compulsory health insurance yet as-
sembled, is contained in the new book issued by
the Committee for the Nation’s Health entitled,
“National Health Insurance Handbook — A Prac-
tical Guide for Leaders.”
The handbook is picayunish, calls names and is
based on a false premise. Arguments that com-
pulsory health insurance is not socialized medicine
are useless from the start, because any personal
service, like medicine, that is administered in
compulsory form from the government down to
the individual, is, by nature, socialistic.
The book attempts to convince the reader that
health insurance is desirable by saying, “NA-
TIONAL HEALTH INSURANCE is a sound
American plan of insurance — like Social Secur-
ity.” Obviously, Social Security is not like insur-
ance : almost everyone pays for Social Security,
yet there are countless restrictions, rules and reg-
ulations on who can and who cannot receive bene-
fits.
In reporting on Americans who favor the plan,
the book points proudly to men like Dr. Harold
S. Diehl, dean of the University of Minnesota
Medical School, twisting his words to put him in
the position of favoring the British plan. The
book claims Diehl as a national health insurance
partisan, but does it through inaccurate and in-
complete quotes. What his report really con-
cluded was this :
“The National Health Service Act is only one facet
of British socialism ; the welfare state does not exist
except as a part of the whole. Furthermore, conditions
in Great Britain are so different from those in the
United States that it would be folly to contend that
what may be necessary for Britain today should be
admirable for transfer to the United States. We, for-
tunately, have the time that is necessary to evolve an
adequate medical service for our people without re-
sorting to the centralization of authority in a welfare
state.”
Misused Words
The book makes flagrant misuse of many words.
Among them : “American critics of the British
program talk about ‘bureaucracy’ but avoid ac-
tual facts and figures on administration costs.”
When “critics of the British program” speak of
bureaucracy, they are speaking of inevitable costs.
They ask “How can costs of bureaucracy be
avoided?” and “How can full and complete esti-
mates of cost be made before any administration
of the plan is done?” Whenever a middleman is
set up between the individual and the goods and
services he needs, the costs of those goods and
services are bound to rise.
December, 1950
1235
MEDICAL ECONOMICS
The new booklet presents a “Fact vs. Fiction”
section with the warning for the reader to “Re-
member— the loaded questions are theirs” (mean-
ing the AMA’s). One of the questions presented
is this :
“WILL PEOPLE WHO DO NOT WISH TO USE
THE GOVERNMENT SERVICE HAVE TO PAY
THE TAX?
“Lobbyists say :
“Yes. Everybody with a paycheck will pay the tax,
whether he uses the service or not.’
“The truth is :
“Yes, just as we support our police and fire depart-
ments though we may not need help.
“Similarly, we also support our public schools, whether
we send children there or not.”
But obviously, thinking Americans will know
that compulsory medicine, with everyone forfeit-
ing a tax out of his paycheck, is the real beginning
of more and more compulsion in more and more
fields. It is no more difficult, nor more disturbing
to think of socialization of the dairy industry, the
grocery industry, the lawyers, the steel industry
or the clothing industry. Then, Americans would
be taxed to get “free” handling of law cases, or
“free” steel girders, needed or not.
In such a case, the greatest blow of all would be
suffered by traditionally American individual ini-
tiative.
Comparing an individual service like medicine
to a standardized service like public schools, fire
and police departments, is illogical thinking. It
opens the way for government control of other
individual and personal phases of American life.
MICHIGAN DOCTOR HITS
GOVERNMENT MEDICINE
To help combat the forces which make socialistic
schemes like government medicine seem favor-
able to unsuspecting Americans, physicians like
Dr. L. Fernald Foster, secretary of the Michigan
State Medical Society, are giving the actual facts
to the American people. Recently Dr. Foster based
a radio talk on the idea that truth is stronger than
falsehood, proceeding from there to express the
ideas that many doctors would like to put to their
patients as aptly. Refuting many of the falsehoods
used against American medicine, he said :
“Fortunately for scientific medicine and perhaps unfor-
tunately for your future health, doctors of medicine are
not propagandists. They do not know the art of the ‘Big
Lie,’ which, I am told, if repeated often enough, becomes
1236
accepted as truth. They do not practice the art of spread-
ing malicious rumor for they are trained, as you want
them to be, in keeping inviolate your confidence and your
trust. Doctors of medicine are not generally great writers
or speakers. They could not from the rigorous demands
of medical education conscientiously devote sufficient time
to become masters of the spoken word and engage in
malicious propaganda techniques. This the doctors of
medicine do know : they know how to keep you healthy ;
they know how to care for you when you are sick ; they
recognize and are intensely aware of those factors, both
economic and social, that can and do affect your health
and well being.”
Medicine "Fighting Mad"
Dr. Foster told listeners that because the above
things are true, the medical profession is “fighting
mad today and is assuming a militant attitude
against the purveyors of malicious lies. The pro-
fession has no quarrel with Mr. Taxpayer. It is
angered because your tax money is being used
freely by the propagandists to spread brutal false-
hoods which hurt you and your chances for con-
tinued good health.”
MINNESOTA STATE BOARD OF MEDICAL
EXAMINERS
230 Lowry Medical Arts Building
Saint Paul, Minnesota
Julian F. DuBois, M.D., Secretary
Fake Doctor Committed to Minneapolis Workhouse
for Ten Months
Re: State of Minnesota vs. Frank Herman Gold , also
known as “Dr.” Frank H. Gould.
On October 25, 1950, Judge John A. Weeks of the
District Court of Hennepin County, made an order com-
mitting Frank Herman Gold, also known as “Dr.” Frank
H. Gould, thirty-three years of age, to the Minneapolis
Workhouse to serve the balance of a one-year sentence
imposed upon Gold by Judge Weeks on January 24, 1950.
Gold had been released from the Minneapolis Workhouse
on March 21, 1950, on his plea that he had been ade-
quately punished and that he desired to rejoin his family
in the State of Washington. Subsequent investigation
disclosed that Gold was working in a drug store on Uni-
versity Avenue in Saint Paul. This was in violation of
the Court’s order releasing Gold.
The Minnesota State Board of Medical Examiners
learned that Gold was also representing himself as “Dr.”
Gould and advising people that he was going into part-
nership with a physician and surgeon, notwithstanding the
fact that he has no medical training of any kind.
Through the assistance of Mr. James F. Lynch, County
Attorney of Ramsey County, and Saint Paul Police
officers, Gold was apprehended on October 23, 1950. At
the time of his arrest, Gold attempted to dispose of a
stethoscope and other medical articles. The matter was
called to the attention of Judge Weeks, who promptly
issued an order vacating the order made by the Court
on March 21, 1950, and ordering Gold returned to the
Minneapolis Workhouse to serve the balance of his
sentence.
(Continued on Page 1275)
Minnesota Medicine
MINNESOTA STATE BOARD OF MEDICAL EXAMINERS
230 Lowry Medical Arts Bldg., Saint Paul, Minnesota
Julian F. DuBois, M.D., Secretary
Name
BANNON, William Gregory
BENDER, Leonard Franklin
BENZ, Edward John
BRAUN, Robert A.
BRUHL, Heinz Herbert
CHRISS, John William
CLAYBURGH, Bennie James
COHEN, Maynard M.
COULTER, Patrick Trevor
DEAN, Carleton Robert
ENGEL, Rudolf C. H.
ESTES, Hubert Ross
HARTMAN, Emma Evelyn E.
HENDERSON, James Alexander
JUDGE, Dom Joseph
KELLY, Patrick Joseph
KLOTZ, Maurice
KURTIN, Joseph James
LAZARTE, Jorge A.
MANLOVE, Tr., Charles Henry
MASSA, David John
McCARRAN, Samuel Patrick
MOSSER, Donn Gordon
PETRAKIS, Nicholas Louis
RUSTED, Ian E. L. H.
SCHWEINFURTH, James Paul
SIMMONS, Daniel Harold
TAUBERT, Ralph Thomas
TAYLOR, William Eugene
THOMAS, William Henry
TIHEN, Edward Nelson
UTZ, John Philip
ASTROM, Algot
BRODERS, Charles William
ERNST, Roland Percy
GREENE, Daniel Edward
HLTBBARD, Theodore Franklin
KEARNS, Thomas Pryor
MILLER, Ross Hays
MYERS, III, Cortland
PATRICK, Robert Thornton
PRICE, Richard Dean
PLTRCELL, Howard Malcolm
RE MINE, Philip Gordon
SCHELL, Robert Frank
STEPHENS, William Edward
THURINGER, Carl Bernard
WALTON, Jr., William Henry
December, 1950
PHYSICIANS LICENSED FEBRUARY 10, 1950
January 1950 Examination
School
Indiana U.
MD
1945
Jefferson Med. Col.
MD
1948
U. of Pittsburgh
MD
1946
U. of Vienna,
MD
1937
Austria
Albert Ludwigs U.
MD
1928
Freiburg, Germany
U. of Texas
MD
1944
Temple U.
MD
1949
Wayne U.
MD
1944
Queen’s U.
MD
1943
Wayne U.
MD
1945
Friedrich Wilhelms
U., Bonn, Germany
MD 1929
U. of Minn.
MD
1949
Northwestern U.
MB
MD
1947
1949
U. of Helsinki,
MD
1945
Finland
U. of Wisconsin
MD
1947
Georgetown U.
MD
1945
St. Louis U.
MD
1949
LT. of Illinois
MD
1934
Marquette U.
MD
1949
U. de San Marcos,
Lima, Peru
MD
1940
LL of Oregon
MD
1946
St. Louis U.
MD
1948
Georgetown U.
MD
1946
U. of Kansas
MD
1946
Washington U.,
MD
1946
St. Louis, Mo.
Dalhousie U., Can.
MD
1948
Northwestern U.
MB
MD
1946
1947
U. ,of So. Cal.
MD
1949
U. of Michigan
MD
1949
U. of Minnesota
MB 1948
MD 1949
St. Louis U.
MD
1949
Northwestern U.
MB
MD
1947
1948
Northwestern U.
MB
MD
1946
1947
Reciprocity Candidates
Boston U.
MD
1924
U. of Nebraska
MD
1947
Washington U.
MD
1946
Lh of Nebraska
MD
1943
U. of Nebraska
MD
1946
U. of Louisville
MD
1946
U. of Oklahoma
MD
1946
LT. of So. Cal.
MD
1949
LT. of Louisville
MD
1944
U. of Oklahoma
MD
1946
U. of Tennessee
MD
1946
Med. Col. of Va.
MD
1946
Stanford U.
MD
1947
U. of Wisconsin
MD
1947
U. of Oklahoma
MD
1946
Creighton U.
MD
1947
Address
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
State Hospital, Rochester, Minn.
Minn. School & Colony, Faribault, Minn.
Mayo Clinic, Rochester, Minn.
St. Luke’s Hospital, St. Paul, Minn.
Veterans Adm. Hospital, Minneapolis,
Minn.
Mayo Clinic, Rochester, Minn.
204 TWH Phys. Med., U. of Minn.
Hospitals, Minneapolis, Minn.
State School & Hosp., Cambridge, Minn.
Mayo Clinic, Rochester, Minn.
Div. of Pub. Health, City Hall, Minne-
apolis, Minn.
Ancker Hospital, St. Paul, Minn.
Mayo Clinic, Rochester, Minn.
Minneapolis Gen. Hospital, Minneapolis,
Minn.
Veterans Adm. Hospital, St. Cloud, Minn.
Blooming Prairie, Minn.
State Hospital, Rochester, Minn.
Ancker Hospital, St. Paul, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
U. of Minn. Hospitals, Minneapolis, Minn.
Mpls. Gen. Hospital, Minneapolis, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
318 Millard Hall, U. of Minnesota, Min-
neapolis, Minn.
4317 Webber Pkwy., Minneapolis, Minn.
1068 Lowry Med. Arts Bldg., St. P'aul,
Minn.
Howard Lake, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
State Hospital, Fergus Falls, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
309 LaBree Ave. N., Thief River Falls,
Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
609 Med. Arts Bldg., Minneapolis, Minn.
Mayo Clinic, Rochester, Minn.
Ancker Hospital, St. Paul, Minn.
1237
PHYSICIANS LICENSED
Name
WHITE, Jr., Roy
WILLIAMS, George Edward
BROADBENT, James Curtis
COLE, Leon Rykoff
DENTON, Clarence
DOANE, III, Joseph Chapman
ELIOT, Johan Wijnbladh
HERBERT, Jr., Carl Morse
JOHNSON, William Edward
JONES, Jr., Robcliff Vesey
LASSER, Elliott Charles
MANN, Richard Hess
WATTIKER, Bernard John
Name
AUGUSTSSON, Hreidar
ALEXANDER, William Harold
BAKER, Perren Laurence
BALOGH, Charles Joseph
BENUA. Richard Squier
BRAZOS, Tohn Charles
BRODIE. Ir., Walter Douglas
BUESGENS, Ralph Hubert
COURTIN, Raymond Frank
EKLUND, Carl D.
FERGESON, James Oliver
FLANAGAN, John Richard
FORRER. Gravdon Randolph
GRAHEK, Anthony Stephen
GUY, Jack A.
HOOVER, Phyllis Rosander
JEROME, Elizabeth K. Brumbaugh
JOHNSON, DeLores Evelyn
JUNTUNEN, Roy Raymond
KELLY, Edward Horan
LANDRETH, Eugene William
I.UNDQUIST, James Andrew
MARLOW, Gordon Vernon
McCAMPBELL, Malcolm Douglas
NELSON, Lillian Sonia
NELSON, Maxine Olive
OLSON, Carl John
PAP1LSON, Wallace James
PAYNTER. Camen Russell
RITZINGER. Jr.. Frederick Ramsay
TALLAKSON, Alloys Harold
TOMHAVE, Wesley George
WARD, Berl Brant
WELCH, John Stanley
BOSTWICK, Tackson Leonard
CTVIN. W. Harold
FLAGG. Jr.. Geddes Broadwell
GWTNN, John Lemuel
School
Tulane U.
St. Louis U.
Address
MD 1945 Mayo Clinic, Rochester, Minn.
MD 1945 Veterans Adm. Hospital, Minneapolis,
Minn.
National Board Candidates
Stanford U.
Columbia U.
Long Island Col.
of Med.
Temple U.
Harvard U.
Johns Hopkins U.
Harvard U.
Columbia U.
U. of Buffalo
Yale U.
N. Y. Med. Col.
MD
1947
Mayo
MD
1946
U. of
MD
1943
Mayo
MD
1948
Mayo
MD
1946
Mayo
MD
1946
Mayo
MD
1945
Mayo
MD
1946
Mayo
MD
1946
U. of
MD
1946
U. of
MD
1944
Mayo
Clinic, Rochester, Minn.
Minn. Hospitals, Minneapolis, Minn.
Clinic, Rochester, Minn.
Clinic, Rochester, Minn.
Clinic, Rochester, Minn.
Clinic, Rochester, Minn.
Clinic, Rochester, Minn.
Clinic, Rochester, Minn.
Minn. Hospitals, Minneapolis, Minn.
Minn. Hospitals, Minneapolis, Minn.
Clinic, Rochester, Minn.
PHYSICIANS LICENSED MAY 12, 1949
April 1950 Examination
School
U. of Iceland
MD
1944
U. of Manitoba
MD
1949
U. of Alberta
MD
1948
FT. of Kansas
MD
1946
Johns Hopkins
MD
1936
U. of Illinois
MD
1949
U. of Michigan
MD
1949
Creighton U.
MD
1949
St. Thomas Hospital,
London, Eng.
LRCP’
1935
MRCS
1935
U. of Minnesota
MB
1949
MD
1950
U. of Arkansas
MD
1945
U. of Alberta
MD
1948
T T. of Michigan
MD
1949
U. of Minnesota
MB
1949
MD
1950
Col. of Med. Evang. MD
1950
U. of Minnesota
MB
1949
MD
1950
IT. of Illinois
MD
1947
U. of Minnesota
MB
1949
MD
1950
U. of Minnesota
MR
1949
MD
1950
U. of Minnesota
MR
1949
MD
1950
1 T. of Oregon
MD
1948
Cornell U.
MD
1949
Lh of Wisconsin
MD
1949
Ohio State U.
MD
1948
Woman’s Med. Col
. MD
1948
U. of Minnesota
MB
1949
MD
1950
Northwestern U.
MB
1948
MD
1940
N. Y. Med. Col.
MD
1945
U. of Illinois
MD
1946
U. of Illinois
MD
1948
U. of Minnesota
MB
1949
MD
1950
U. of Minnesota
MB
1949
MD
1950
Indiana U.
MD
1946
Northwestern U.
MR
1946
MD
1947
Reciprocity Candidates
Tulane U.
MD
1939
LL of Nebraska
MD
1940
Tulane U.
MD
1942
U. of Louisville
MD
1946
Address
953 Med. Arts Bldg., Minneapolis. Minn.
Grey Nun’s Hospital, Regina, Sask., Can.
Mayo Clinic, Rochester. Minn.
Mpls. Gen. Hospital, Minneapolis, Minn.
Mayo Clinic, Rochester, Minn.
115/2 Main St., Watertown, Wis.
665 Montcalm Place, St. Paul, Minn.
Waterville, Minn.
Mayo Clinic, Rochester, Minn.
State Hospital, Moose Lake, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mpls. Gen. Hospital. Minneapolis, Minn.
619 E. Chapman St., Ely, Minn.
New London, Minn.
636 LaSalle Bldg., Minneapolis, Minn.
608 Oliver Ave. S., Minneapolis, Minn.
Mpls. Gen. Hospital, Minneapolis, Minn.
Nashwauk, Minn.
1835 Fairmont Ave., St. Paul, Minn.
Ancker Hospital, St. Paul, Minn.
520 LaSalle Bldg., Minneapolis, Minn.
934 Lowry Med. Arts Bldg., St. Paul,
Minn.
Mpls. Gen. Hospital, Minneapolis. Minn.
3411 N. 4th St., Minneapolis, Minn.
5327 41st Ave. S., Minneapolis, Minn.
2300 Central Ave., Minneapolis, Minn.
U. of Minn. Hospitals, Minneapolis, Minn
Mavo Clinic, Rochester, Minn.
Lakefield, Minn.
753 E. McDowell, Phoenix, Ariz.
Mesaba Clinic, Chisholm, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester. Minn.
Mayo Clinic, Rochester. Minn.
645 Med. Arts Bldg., Minneapolis, Minn
Mayo Clinic, Rochester, Minn.
1238
Minnesota Medicine
PHYSICIANS LICENSED
Name
HETRICK, Matthew Adam
HICKEY, Alice Marie
KROACK, Kalman John
MANDEYILLE, John Weston
MAY, Robert Bertrand
PARSONS, Jr.. William Belle
WELLBORN, Jr., Walter Horry
School
Jefferson Med. Col. MD 1942
Creighton U. MD 1948
U. of Iowa MD 1943
U. of Michigan MD 1946
U. of Iowa MD 1936
U. of Pittsburgh MD 1948
Emory U. MD 1946
Address
Mayo Clinic, Rochester, Minn.
Maternity Hospital, Minneapolis, Minn.
New Albin, Iowa
Mayo Clinic, Rochester, Minn.
State Hospital, Fergus Falls, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
ADAMS, Reta
ALDRICH, Alvin Scott
BAHN, Robert C.
BROWN, Hector Mason
CLARK, Malcolm David
DeREAMER, John Wesley
FALCONE, Alfonso Benjamin
FREEDMAN, Marshall Arthur
FREY, Harry Bradford
GIBB, Robert Pearse
HOLT, Allen Howard
HOPKINS, George Terome
KLETSCHKA, Harold Dale
LUDWIG, Tames Behan
MADISON, Mitchell Stanley
NEUMAN, Harold Wilfred
QUER, Erich Alfred
RIGLER, Robert Gardiner
SAUNDERS, Jr., Benjamin H.
SAXTON, George Albert
SIEKERT, Robert George
SPEAR, Harold Charles
TAYLOR, Lloyd McCully
National Board Candidates
N. Y. Vied. Col.
MD
1936
Harvard U.
MD
1946
U. of Buffalo
MD
1947
Cornell U.
MD
1948
Harvard U.
MD
1948
Duke U.
MD
1946
Temple U.
VID
1947
U. of Pennsylvania
MD
1944
U. of Iowa
MD
1947
Washington U., Mo.
VID
1948
Syracuse U.
MD
1948
Geo. Washington U.
MD
1946
U. of Minnesota
MB
VID
1947
1948
Washington U., Mo.
MD
1947
U. of Rochester
VID
1946
Queen’s U.
MD
1946
Albany Med. Col.
MD
1946
U. of Iowa
MD
1948
Harvard U.
VID
1946
Harvard U.
MD
1946
Northwestern U.
MB
MD
1947
1948
Harvard U.
MD
1947
Duke U.
MD
1946
Sate Hospital, Fergus Falls, Minn.
Veterans Adm. Hospital, Minneapolis,
Minn.
Mayo Clinic, Rochester, Minn.
Walker, Minn.
4638 Fremont Ave. S., Minneapolis, Minn.
Mayo Clinic, Rochester, Minn.
Dept. Internal Med., U. of Minn. Hospi-
tals, Minneapolis, Minn.
Mayo Clinic, Rochester, Minn.
Veterans Adm. Hospital, Minneapolis,
Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
1918 S. Robert St., South St. Paul, Minn.
Lake Hubert, Minn.
LTniversity Hospital, Ann Arbor, Mich.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
PHYSICIANS LICENSED JULY 14, 1950
June 1950 Special Examination
Name
ALLEN, John Howard
ALLISON, David Duberg
AUSTRIAN, Sol
AUTREY, William Albert
BERGQUIST, James Russell
BILLINGS, Harry H.
BONELLO, Frank Julius
BRISBIN, Charles Seamans
BRODERICK, William Claire
CARLSON, Charles Vincent
CAVERT, Henry Mead
CHRISTENSEN, Philip Dixon
CHRISTOFERSON, Kent William
COHEN, Henry W.
COLLE, Eleanor
CULLIGAN, John Austin
DONATELLE, Edward Patrick
DWYER, John Joseph
EASTMAN, Henry Victor
ELLISON, Evan Sherman
FIFIELD, Malcolm McLean
FINK, Lewis Darwin
FLORINE, Martin Clifford
FUNKE, Toyce Lucille
GAULT. Jr., N. L.
GILSDORF, Donald Andrew
GOLDMAN, Leonard William
GRUBER, Matthew
School
u:
of
Vlinnesota
VI B
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
VI B
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
u.
of
Vlinnesota
MB
1950
u.
of
Minnesota
VI B
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
VI B
1950
u.
of
Minnesota
MB
1950
u.
of
Vlinnesota
MB
1950
u.
of
Minnesota
VI B
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
M B
1950
u.
of
Minnesota
MB
1949
VID
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
VI B
1950
u.
of
Minnesota
VI B
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
Marquette U.
VID
1949
U.
of
Vlinnesota
MB
1950
u.
of
Vlinnesota
MB
1950
u.
of
Vlinnesota
MB
1950
u.
of
Vlinnesota
VI B
1950
u.
of
Vlinnesota
MB
1950
u.
of
Minnesota
MB
1950
Address
Ancker Hospital, St. P'aul, Minn.
Ancker Hospital, St. P'aul, Minn.
U. S. Marine Hospital, Galveston, Texas
St. Luke’s Hospital, Duluth, Minn.
Mpls. Gen. Hospital, Minneapolis, Minn.
Tripler Gen. Hospital, Moanalua, Hawaii
U. S. Marine Hospital, 4141 Clarendon
Ave., Chicago, 111.
Sacramento Co. Hosp., Sacramento, Cal.
University Hospital, Oklahoma City, Okla.
U. S. Naval Hospital, Oakland, Cal.
Dept. Phys., U. of Minn. Med. Sch.,
Minneapolis, Minn.
Emanuel Hospital, Portland, Ore.
Mary Hitchcock Mem. Hospital, Hanover,
N. H.
Strong Mem. Hospital, Rochester, N. Y.
4204 Beard Ave. S., Minneapolis, Minn.
U. of Pa. Hospital, Philadelphia, Pa.
Tripler Gen. Hospital, Hawaiian Islands
St. Luke’s Hospital, Duluth, Minn.
U. S. Naval Hospital, Oakland, Cal.
Milwaukee Co. Hospital, Milwaukee, Wis.
U. S. Naval Hospital, Bremerton, Wash.
4089 Lhiion Bay Circle, Seattle, Wash.
Gorgas Hospital, Ancon, Canal Zone
Mpls. Gen. Hospital, Minneapolis, Minn.
Mpls. Gen. Hospital, Minneapolis, Minn.
Miller Hospital, St. Paul, Minn.
Wayne Co. Gen. Hospital, Eloise, Mich.
Bremerton Naval Hosp., Bremerton,
Wash.
December, 1950
1239
PHYSICIANS LICENSED
Name
GULL, Hymie Arnold
HAYES, John Burton
HOLM, Donald F.
HOUGLUM, Arvid Jerome
HOWE, Gerald Everett
HUDSON, Heber Scott
INDIHAR, Jr., John Edward
INGLIS, William Hicks
IENSEN, Warren Douglas
TOHNSON, Jr., Chester W.
JOHNSON, Edward Alfred
JOHNSON, Roger Stanley
KIEFFER, Sherman Newton
KOCHSIEK, Robert Donald
LANGSJOEN, Per Harald
LARSON, Donald Marvin
LARSON, Leighton Walter
LEAVENWORTH, Jr., Richard
Ormond
LEWIS, Barton Leonard
LUND, Naomi Gene
MEADE, Robert Cullings
MEYER, Robert John
MIKKELSON, T r., Vernon Edward
MILLER, Charles Frederick
MORAN, John Patrick
NORMAN. David Dean
NORMANN, Jr., Stephen Theodore
NOVICK, Rosalind
O’LEARY, John B.
ODLAND, Mark Eugene
OPPEN, Melvin Gerhard
PALM. Neil Merald
PEAKE. Eugene F.
PETERSON, Jr., Paul Andrew
PREM, Konald Arthur
PREMER, Robert Frederick
ROLLINS, Pat
ROMNESS. Kenneth Berton
ROSANDER, John Elihu
RYSGAARD, George Nielsen
SELLS, Richard John
SEMBA, Thomas
SHELANDER, Marcus Ignatius
SMITH, Harry John
SPAIN, W. Thomas
SPURZEM, Robert Raymond
STADEM, Clifford Jennings
STRAND, Jack Warren
VIX, Vernon Albert
WALONICK, Albert L.
WEBSTER, David D.
ZAHRENDT, O. Lewis
ZIEGLER, Robert G.
BOSWELL, J. Thornton
TONES, Richard Frank
MI REE, Jr., James
VANDERGON, Keith Gordon
1240
School
U. of Minnesota
U. of Minnesota
U. of Minnesota
U. of Minnesota
U. of Minnesota
U. of Minnesota
U. of Minnesota
U. of Minnesota
U. of Minnesota
U. of Minnesota
U. of Minnesota
U. of Minnesota
U. of Minnesota
U. of Minnesota
U. of Minnesota
U. of Minnesota
U. of Minnesota
U. of Minnesota
Address
MB 1950 U. S. Marine Hospital, Staten Island,
N. Y.
MB 1950 Chas. S. Wilson Mem. Hosp., Johnson City,
N. Y.
MB 1949 1515 Charles Ave., St. Paul, Minn.
MD 1950
MB 1950 Denver Gen. Hospital, Denver, Colo.
MB 1950 San Diego Co. Gen. Hosp., San Diego,
Cal.
MB 1950 Grasslands Hospital, Valhalla, N. Y.
MB 1950 St. Mary’s Hospital, Duluth, Minn.
MB 1949 Redwood Falls, Minn.
MD 1950
MB 1950 Baptist Mem. Hospital, Memphis, Tenn.
MB 1950 Gorgas Gen. Hospital, Ancon, Canal Zone
MB 1950 Ancker Hospital, St. Paul, Minn.
MB 1950 Ancker Hospital, St. Paul, Minn.
MB 1950 U. S. Marine Hospital, San Francisco,
Cal.
MB 1950 L. A. Co. Gen. Hospital, 1200 N. State
St., Los Angeles, Cal.
MB 1950 Letterman Army Hosp., San Francisco,
Cal.
MB 1950 Detroit Rec. Hospital, Detroit, Mich.
MB 1950 St. Luke’s Hospital, Chicago, 111.
MB 1950 Ancker Hospital, St. Paul, Minn.
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1949
MD 1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
u.
<of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
u.
of Pennsylvania
MD
1949
u.
of
Minnesota
MB
1950
u.
of Minnesota
MB
1950
u.
of
Minnesota
MB
1950
u.
of
Minnesota
MB
1950
San Francisco Hosp., San Francisco, Cal.
U. S. Naval Hospital, Oakland, Cal.
Milw. Co. Gen. Hospital, Milwaukee, Wis.
St. Luke’s Hospital, Duluth, Minn.
Ancker Hospital, St. Paul, Minn.
Marine Hospital, Seattle. Wash.
Wesley Mem. Hospital, 250 E. Superior
St., Chicago, 111.
Miller Hospital, St. Paul, Minn.
Ancker Hospital, St. Paul, Minn.
Deer River, Minn.
St. Mary’s Hospital, Minneapolis, Minn.
Mpls. Gen. Hospital, Minneapolis, Minn.
Oak Knoll Naval Hosp., Oakland, Cal.
Mpls. Gen. Hospital, Minneapolis, Minn.
Santa Clara Co. Hosp., San Jose, Cal.
Ancker Hospital, St. Paul. Minn.
Mpls. Gen. Hospital, Minneapolis, Minn.
Detroit Rec. Hospital, Detroit, Mich.
St. Luke’s Hospital, Chicago, 111.
Oak Knoll Naval Hosp., Oakland, Cal.
Mpls. Gen. Hospital, Minneapolis, Minn.
Mpls. Gen. Hospital, Minneapolis, Minn.
Mpls. Gen. Hospital, Minneapolis, Minn.
Detroit Rec. Hospital, Detroit, Mich.
St. Mary’s Hospital, 2500 S. 6th St.,
Minneapolis, Minn.
Milw. Gen. Hospital, Milwaukee, Wis.
Swedish Hospital. Minneapolis, Minn.
San Diego Co. Gen. Hosp., San Diego,
Cal.
Mpls. Gen. Hospital, Minneapolis, Minn.
Ancker Hospital, St. Paul, Minn.
7904 St. Charles Ave., New Orleans, La.
Mpls. Gen. Hospital, Minneapolis, Minn.
Mpls. Gen. Hospital, Minneapolis, Minn.
Swedish Hospital, Minneapolis, Minn.
St. Luke’s Hospital, Duluth, Minn.
Reciprocity Candidates
Ohio State U. MD 1949 Wanamingo, Minn.
U. of Oregon MD 1946 Mayo Clinic, Rochester, Minn.
Howard U. MD 1941 Dept. Rad., U. of Minn. Hospitals,
Minneapolis, Minn.
Washington U., Mo. MD 1949 Mpls. Gen. Hospital, Minneapolis, Minn.
Minnesota Medicine
PHYSICIANS LICENSED
Name
AGNEW, Suzanne
ANDERSON, Chester A.
BAARS, Coenraad J. M. W.
BARBER, John Roland
BROWN, Roland Graeme
CESNIK, Robert John
CULP, Ormond Skinner
GIBERSON, Raymond George
GIBSON, Marvin McCall
GOLD, David
HOOVER, Norman Winfred
KENNEY, Francis David
KULSTAD, Oscar S.
MacKENZIE, Donald Alexander
MUHICH, Ralph Anthony
POST, Edmund A.
SHELDON, Warren Noble
SMORSZCZOK, Mitrofan
WILLIAMS, Robert Reiff
ANDREWS, Bernice Fern
ARMSTRONG, Wilbur August
BERNDT, Allen Emanuel
BUCHER, Foster Donald
CARSON, Willis Thomas
ELSTON, Lynn Wickwire
FISCHER, John Robt. Burr
GALLETT, Lester Edward
MATTHEWS, James Hall
MILLS, Robert Teffrey
PETERSEN, Arthur B.
VEASY, Lloyd George
WRIGHT, Samuel Martin
BARNES, Frahces Page Shaw
BRINK, William Richard
CARLETON, Henry Guy
FIELD, Charles Wiltsie
FRANKLIN, Gordon William
HOEHN, David
JUERGENS, John Louis
KARGES, Laurel Eugene
KIELY, Joseph Michael
PRIOLETTI, Mario Joseph
RANDALL, Osmer Samuel
SHOLL, Philip Richard
SYMMONDS. Richard Earl
VAN VLEET, Mary Elizabeth
WEHR, Maurice Burton
WILKINSON, Paul Fredrick
PHYSICIANS LICENSED JULY 14, 1950
June 1950 Examination
School
U. of Minnesota
MB
1949
MD
1950
Temple U.
MD
1949
U. of Amsterdam,
MD
1945
Netherlands
U. of Western Ont.
MD
1947
Canada
U. of Minnesota
MB
1950
Marquette U.
MD
1949
Johns Hopkins U.
MD
1935
Dalhousie U., Can.
MD
1947
Duke U.
MD
1944
U. of Minnesota
MB
1949
MD
1950
U. of Minnesota
MB
1949
MD
1950
Rush Med. Col. of
U. of Chicago
MD
1941
U. of Minnesota
MB
1949
MD
1950
U. of Western Ont.,
MD
1946
Canada
U. of Minnesota
MB
1949
MD
1950
U. of Arkansas
MD
1949
U. of Minnesota
MB
1949
MD
1950
Stefan Batory U.,
MD
1939
Wilno, Poland
U. of Louisville
MD
1946
Reciprocity
Candidates
Col. of Med. Evang.
MD
1938
U. of Iowa
MD
1942
Loyola U.
MD
1943
U. of Nebraska
MD
1949
Southwestern LT.
MD
1947
U. of Illinois
MD
1916
Washington U., Mo.
MD
1949
U. of Wisconsin
MD
1940
U. of Arkansas
MD
1947
Western Reserve U.
MD
1946
U. of Oregon
MD
1947
U. of Utah
MD
1946
U. of Pennsylvania
MD
1946
Address
Bellevue Hospital, New York 16, N. Y.
Madison, ' Minn.
State Hospital, Anoka, Minn.
Mayo Clinic, Rochester, Minn.
L. A Co. Gen. Hospital, Los Angeles,
Cal.
4005/2 E. St. Germain St., St. Cloud,
Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Veterans Adm. Hospital, Minneapolis,
Minn.
U. of Minn. Hospitals, Minneapolis, Minn.
Mayo Clinic, Rochester, Minn.
Dodge Center, Minn.
Mayo Clinic, Rochester, Minn.
Letterman Army Hosp., San Francisco,
Cal.
2034 Lincoln Ave., St. Paul, Minn.
3718 Noble Ave., Robbinsdale, Minn.
Monticello, Minn.
Mayo Clinic, Rochester, Minn.
Holdingford, Minn.
Mayo Clinic, Rochester, Minn.
533 Higley Bldg., Cedar Rapids, la.
Starbuck, Minn.
Mayo Clinic, Rochester, Minn.
620-26 Wayne Pharmacal Bldg., Fort
Wayne, Ind.
124 E. Broadway, Owatonna, Minn.
2131 W. Old Shakopee Rd., Minneapolis,
Minn.
U. of Minn. Hospital, Minneapolis, Minn.
1829 Med. Arts Bldg., Minneapolis, Minn.
Mayo Clinic, Rochester, Minn.
U. of Minn. Hospitals, Minneapolis, Minn.
Mayo Clinic, Rochester, Minn.
National Board Candidates
Geo. Washington MD 1945
U„ D. C.
Duke U. MD 1946
Harvard U. MD 1947
U. of Rochester MD 1946
Col. of Med. Evang. MD 1949
Col. of Med. Evang. MD 1938
Harvard U. MD 1949
U. of Chicago MD 1949
U. of Illinois MD 1947
Syracuse U. MD 1947
Johns Hopkins U. MD 1927
Harvard U. MD 1946
Duke U. MD 1946
Northwestern U. MB 1948
MD 1949
Geo. Washington MD 1947
U„ D. C.
Northwestern U. MB 1947
MD 1949
State Hospital, Cambridge, Minn.
Mayo Clinic, Rochester, Minn.
Mpls. Gen. Hospital, Minneapolis, Minn.
163 Orlin Ave., Minneapolis, Minn.
Northome, Minn.
Holdingford, Minn.
Belle Plaine, Minn.
410 Pokegama Ave. E., Grand Rapids,
Minn.
Mayo Clinic, Rochester, Minn.
5601 Grand Ave., Duluth, Minn.
3/2 E. Kemp, Watertown, S. D.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
St. Joseph’s Hosp., St. Paul, Minn.
December, 1950
1241
PHYSICIANS LICENSED
PHYSICIANS LICENSED NOVEMBER 3, 1950
October 1950 Examination
Name
ABERNATHY, Robert Shields
ABERNATHY, Rosalind G. Smith
BAIN, Robert Clark
BAKER, Jr., Hillier Locke
BERG, Roger Milton
COLE, James Sharpley
GAULT, Sarah Jane
GILLESPIE, Andrew Erroll
GRATTAN, Robert Thomas
GUSTAFSON, Maynard B.
HALVORSEN, Daniel Kasberg
HASSETT, Gerard Roger
HELLER, Edgar Elwood
H INDERAKER, Harris Paul
HOILUND, Lucille Jeannette
KAISER, Irwin Herbert
KROUT, Robert Melvin
KUNKEL. Jr., William Minster
MEINCKE. Ralph Frederick
MILLER, John Palmer
MYRE, Theodore Thomas
NAKAMURA, James Yuzo
NELSON. Jr., Louis Alan
OLTVE, Tr., John Thomas
POWERS, Wilson Watkins
ROMNESS, Joseph Oliver
ROSS, Willard Berg
SCHWEINFURTH. Joseph David
SIMON, Werner
STREET, John Paul
TANI, George Tadashi
TOMPKINS, Robert George
VALENTI, Dan Anino
VISHER, John Sargent
WARNER, Homer Richards
School
Duke U.
MD
1949
Duke U.
MD
1949
Northwestern U.
MB
1949
MD
1950
Lb of Chicago
MD
1947
U. of Minnesota
MB
1950
Indiana U.
MD
1947
U. of Minnesota
MB
1950
McGill U., Can.
MD
1948
Loyola Lb
MD
1949
Lb of Minnesota
MB
1942
MD
1944
Yale U.
MD
1949
Creighton U.
MD
1950
Bowman-Gray U.
MD
1950
Northwestern U.
MB
1949
Lb of Minnesota
MB
1948
MD
1949
Johns Hopkins U.
MD
1942
U. of Pennsylvania
MD
1948
Johns Hopkins U.
MD
1946
U. of Minnesota
MB
1950
New York Med. Col.
MD
1950
Northwestern U.
MB
1947
MD
1948
Col. of Med. Evang.
MD
1950
U. of Rochester
MD
1949
St. Ix>uis U.
MD
1948
Lb of Tennessee
MD
1945
Northwestern U.
MB
1947
MD
1949
Rush Med. Col. of
Lb of Chicago
MD
1941
Northwestern U.
MB
1949
MD
1950
Lb of Berne, Switz.
MD
1937
Lb of Minnesota
MB
1950
Lb of Minnesota
MB
1950
Northwestern U.
MB
1947
MD
1049
Lb of Illinois
MD
1943
Indiana U.
MD
1944
U. of Utah
MD
1949
ABBOTT, Albert Riley
AKLAND, Leonard Rudolph
AYRES, Roland Wayne
BARRON, David Baer
BEIRSTEIN, Samuel
BOONE, Ervin Stanley
FTNEGOLD. Mary Saunders
FINEGOLD, Sydney Martin
GREENFIELD, Irving
HANNA, Richard Ewert
KNUTSSON, Katherine Hegland
LOGAN, James O.
MAHON, Nathan Hall
MILLETT, Douglas Keith
REITEMEIER, Richard Joseph
SIKKEMA, Stella Madge Hazen
Reciprocity Candidates
U. of Nebraska MD 1949
Southwestern Med. MD 1949
Col.
Northwestern U. MB 1943
MD 1943
Lb of Minnesota MB 1946
MD 1946
Long Island Col.
of Med. MD 1929
U. of Wisconsin MD 1949
U. of Texas MD 1949
U. of Texas MD 1949
Temple U. MD 1939
Washington U., Mo. MD 1949
Vanderbilt U. MD 1949
Med. Col. of S. Car. MD 1943
Rush Med. Col. of MD 1942
Lb of Chicago
Northwestern U. MB 1945
MD 1946
Colorado Lb MD 1946
U. of Michigan MD 1941
Address
U. of Minn. Hospitals, Minneapolis, Minn.
3101 Univ. Ave. S.E., Minneapolis, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mpls. Gen. Hospital, Minneapolis, Minn.
Ancker Hospital, St. Paul, Minn.
221 Walnut St. S.E., Minneapolis, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
124 W. Bridge St., Owatonna, Minn.
Creighton Mem. Hospital, Omaha, Neb.
St. Barnabas Hosp., Minneapolis, Minn.
Ancker Hospital, St. Paul. Minn.
St. Barnabas Hosp., Minneapolis, Minn.
Lb of Minn. Med. Sell., Minneapolis, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
626 Aldrich Ave. N., Minneapolis, Minn.
2516 11th Ave. S., Minneapolis, Minn.
Mayo Clinic, Rochester, Minn.
St. Luke’s Hospital, St. Paul, Minn.
Miiler Hospital, St. Paul, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
722 W. Johnson St., Madison. Wis.
Mayo Clinic, Rochester, Minn.
Veterans Adm. Hospital, Minneapolis,
Minn.
Ancker Hospital, St. Paul, Minn.
Ancker Hospital, St. Paul, Minn.
Mayo Clinic, Rochester, Minn.
318 LaBree Ave. N., Thief River Falls,
Minn.
U. of Minn. Hospitals, Minneapolis, Minn.
Veterans Adm. Hospital, Minneapolis,
Minn.
Mayo Clinic, Rochester, Minn.
Veterans Hospital, Sioux Falls, S. D.
Box 424, Alger, Ohio
Veterans Adm. Hospital, Minneapolis
Minn.
506 Phys. & Surg. Bldg., Minneapoli'
Minn.
Veterans Adm. Hosp., Sioux Falls. S. 1"
5757 24th Ave. S., Minneapolis, Minn
5757 24th Ave. S., Minneapolis, Minn
Mt. Sinai Hospital, Minneapolis, Mir
U. of Minn. Hospitals, Minneapolis, Mir
Mayo Clinic, Rochester, Minn.
805 Jefferson, Wadena, Minn.
4749 Grand Ave. S., Minneapolis, Mirr
R. 3, Box 878, Mesa, Ariz.
Mayo Clinic, Rochester, Minn.
Stud. Health Serv., U. of Minnesota,
Minneapolis, Minn.
1242
Minnesota Medicine
PHYSICIANS LICENSED
Name
SIMMONS, William Henry
STORK, Robert Mulkey
WINTER, Jr., Lewis Stuart
WINTERRINGER, Tames R.
ZEE, Urban H.
AUFDERHEIDE, Arthur Carl
BENEDICT, Walter Hanford
BRAASCH, John William
BRADY, Joan Veronica
BREIDENBACH, Jr., Warren
Conrad
BRINDLEY, Clyde Owens
COONEY, James Francis
ELLIOTT, Harold James
FIFER, William Richard
FREEDMAN, Robert
FUTCH, William Dumas
HANSON, Stephen Martin
JOHNSEN, David Strand
KIELY, James Patrick
KROBOTH, Jr., Frank James
LISS. Henry Robert
LOFTUS, Lawrence Robert
LOWE, Charles Upton
MANGER, William Muir
MARTIN, Franklin
McKAIG, Alan Manning
McMORRIS, Rex Ofal
MELLINS, Harry Zachary
PRATT, George Francis
REISER, Milton Paul
SYVERTON, Jerome Theda
VERNON, Sidney
WATSON, Eleanor Jane
WILLIAMS, Lawrence Burton
ZHEUTLIN, Norman
School
Northwestern U.
MB
MD
1949
1950
Stanford U.
MD
1947
U. of Nebraska
MD
1944
U. of Oklahoma
MD
1945
Creighton U.
MD
1937
Address
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Veterans Adm. Hospital, Minneapolis,
Minn.
Mayo Clinic, Rochester, Minn.
U. of Minn. Med. Sch., Dept. Ophthal.,
Minneapolis, Minn.
National Board Candidates
U. of Minnesota
MB
1946
U. of Michigan
MD
MD
1946
1946
Harvard U.
MD
1946
Long Island Col.
of Med.
MD
1949
Harvard U.
MD
1944
Duke U.
MD
1943
Yale U.
MD
1946
U. of Buffalo
MD
1938
Columbia U.
MD
1949
New York Med. Col.
MD
1945
Tulane U.
MD
1942
Marquette U.
MD
1948
Geo. Washington
U„ D. C.
MD
1944
U. of Illinois
MD
1947
Syracuse U.
MD
1946
Tefferson Med. Col.
MD
1948
Duke U.
MD
1949
Yale U.
MD
1945
Columbia U.
MD
1946
McGill U.. Can.
MD
1941
Syracuse U.
MD
1944
U. of Nebraska
MD
1949
Long Island Col.
of Med.
MD
1944
Harvard LT.
MD
1948
U. of Michigan
MD
1948
Harvard U.
MD
1931
Long Island Col.
of Med.
MD
1930
U. of Michigan
MD
1949
U. of Iowa
MD
1948
Albany Med Col.
MD
1948
2728 1st Ave. S., Minneapolis, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Veterans Adm. Hospital, Minneapolis,
Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
508 Grove St., Austin, Minn.
U. of Minn. Hospitals, Minneapolis, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
1707 Main St., La Crosse, Wis.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
U. of Minn. Hospitals, Minneapolis, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
Red Lake Falls, Minn.
Mayo Clinic, Rochester, Minn.
46 Barton Ave. S.E., Minneapolis, Minn.
Mayo Clinic, Rochester, Minn.
U. of Minn. Hospitals, Minneapolis, Minn.
227 Millard Hall, U. of Minnesota, Min-
neapolis, Minn.
Two Harbors, Minn.
Mayo Clinic, Rochester, Minn.
Mayo Clinic, Rochester, Minn.
U. of Minn. Hospitals, Minneapolis, Minn.
QUESTIONS ON DRAFT LAW
Certain physicians, holding a degree of Bachelor of
Medicine or of Doctor of Medicine, are presently liable
for actual induction into the Army as recruits if they
do not hold reserve commissions as medical officers in
one of the armed services, whether in practice or not.
Non-veteran physicians, under twenty-six, were eligi-
ble for the draft before passage of the recent amend-
ment to the Selective Service Act.
As a result of this amendment, physicians who were
deferred from service and who thus continued their edu-
cations during World War II, whether at government
expense or their own expense, and who have not served
since then on active duty as medical officers for a period
of twenty-one months, are subject to active duty as medi-
cal officers for twenty-one months.
Whether or not these physicians will be inducted into
the Army as recruits or whether they will be deferred
from service is entirely up to their local draft boards.
Selective Service does not recommend deferment until
completion of twelve months of internship.
These physicians, in other words, must apply for com-
missions as reserve officers or run the risk of induction
as recruits. A physician who receives his actual induc-
tion notice may not then apply for a reserve commission
and must enter service just as any other inductee. This
December, 1950
does not apply to the notice to report for a pre-induc-
tion physical examination. Once he has been inducted
into the Army as an enlisted man he may apply for a
commission, but he will not be eligible for the extra
$100 a month that is paid to all other medical officers.
None of the three military departments orders its
reserve medical officers to active duty until they have
completed at least twelve months of internship. In addi-
tion, reserve officers in their senior year of residency
training will not be called to active duty until they com-
plete their training, if at all possible.
It is rarely possible for a physician to apply for a
reserve commission in the service of his choice.
Physicians now eligible for the draft who do not pass
their physicals for commissions as reserve officers will
not be inducted into the Army at a later time.
It is now possible to apply for a reserve commission
without applying for active duty at the same time.
It is also possible now to apply for a reserve commis-
sion at the headquarters of military or naval districts,
Army areas or numbered Air Forces.
Whether ordered to active duty as a medical officer
or inducted for service as an enlisted man, the period
of service is the same — twenty-one months. — Excerpt
from AMA Secretary’s Letter.
1243
Minnesota Academy of Medicine
Meeting of May 10, 1950
The regular monthly meeting of the Minnesota Acad-
emy of Medicine was held at the Town and Country
Club, Saint Paul, on May 10, 1950.
Dinner was served at 7 :00 o’clock and the meeting was
called to order at 8:00.p.m. by the President Dr. William
A. Hanson.
There were fifty-two members and one guest present.
Dr. Hammes read the following memorial to Dr. J.
C. McKinley.
I. c. McKinley
1891-1950
Dr. J. C. McKinley was born in Duluth, Minnesota, on
November 8, 1891. He died on January 3, 1950, after an
illness of four and one-half years.
He was the son of John and Alice (Frizzell) McKin-
ley. He received his preliminary and high school educa-
tion in Duluth, Minneapolis and New York City. He
was graduated from the University of Minnesota in 1915
with a B.S. degree; in 1917 with an M.A. degree in
anatomy; in 1919 with an M.D. degree; and in 1921 with
a Ph.D. degree in nervous and mental diseases. His thesis
was “The Intraneural Plexus of Fasciculi and Fibers in
the Sciatic Nerve.” He was a Diplomate of the Ameri-
can Board of Psychiatry and Neurology and a member
of the Board of Directors of the American Board of
Psychiatry and Neurology from 1941 to 1945. He was
secretary-treasurer of the Minnesota State Board of
Examiners in the Basic Sciences from 1931 to 1945.
He held the following appointments during his academic
career: 1915-1917, student assistant in anatomy; 1917-
1918, instructor in pathology; 1918-1921, teaching fellow
in neuropsychiatry ; 1921-1925, associate professor of
neuropathology; 1925-1929, associate professor of neurol-
ogy— all at the University of Minnesota. In 1928-1929 he
received a John Simon Guggenheim Fellowship and
studied in Europe at Breslau and Munich. He returned
from Europe in 1929, and from that time until 1945 he
held the position of professor of neuropsychiatry at the
University of Minnesota. In 1932 he became acting
head of the entire Department of Medicine at the Uni-
versity of Minnesota, a position which he held through
1943. From 1943 to 1945 he was head of the Department
of Neuropsychiatry and director of the Psychopathic
Unit at the University of Minnesota Hospitals. From
June, 1946, until the time of his death he was professor
1244
emeritus of psychiatry and neurology at the University
of Minnesota.
Dr. McKinley, during his academic career, held many
important positions. He was chairman of the Committee
on Nervous and Mental Diseases in the Minnesota State
Medical Association from 1943 to 1945. He was presi-
dent of the Minnesota Pathological Society from 1946 to
1947, and president of the Central Neuropsychiatric Asso-
ciation in 1939. Dr. McKinley was a member of many
societies, among which might be listed : Minnesota So-
ciety of Psychiatry and Neurology, Central Clinical Re-
search Club, Central Neuropsychiatric Association, Fel-
low of the American Afedical Association, Society of
Experimental Biology and Medicine, Fellow of the
American Association for the Advancement of Science,
and American Neurological Association. He was elected
to the Minnesota Academy of Medicine on October 8,
1930, and the title of his thesis was “Familial Diffuse
Sclerosis of the Brain.”
Dr. McKinley, during his career, published a large
number of scientific articles. He was editor of the Out-
lines of Neuropsychiatry and co-author with Dr. S. R.
Hathaway of the Minnesota Multiphasic Personality In-
ventory. He was listed in Who’s Who in America, Who’s
Who in American Men of Science, Who’s Important in
Medicine, Biographical Encyclopedia of the World,
Who’s Who in American Education, and Who’s Who, in
Minnesota.
He was married to Doris I. Swedien on April 29, 1944.
He also had four children by a previous marriage. Mrs.
Leland Phelps, Mrs. George W. Miners* Mrs. Fernando
Machado, and John Charnley McKinley.
Dr. McKinley was an outstanding scientist and teach-
er in his chosen field. Fie was beloved by his students and
the entire medical faculty. He exerted tremendous in-
fluence in developing the Department of Neurology and
Psychiatry at the University of Minnesota to its high
standing at the present time. His guiding influence, his
scientific ability, and his kind and co-operative spirit to
his fellow workers will be remembered by and be
helpful to all of us who were closely associated with him.
E. M. Hammes, M.D.
The scientific program followed.
Dr. John M. Culligan, of Saint Paul, read his inaugural
thesis.
Minnesota Medicine
MINNESOTA ACADEMY OF MEDICINE
THE PRESENT STATUS OF SURGERY OF THE SPLEEN
JOHN M. CULLIGAN, M.D.. and JOHN A. CULLIGAN, M.B.
Saint Paul, Minnesota
The spleen is a mysterious organ of the body, possess-
ing manifold functions. The complexity of its cell struc-
ture in an organ composed principally of lymphoid tissue
confuses its physiology and makes a study of its func-
tions extremely difficult. As the result of this complex
nature, conclusions have had to be reached mainly by a
process of trial and error. The multiplicity of different
kinds of blood dyscrasias is only limited by the number
of different blood cells. Whereas years ago many types
of dyscrasias were lumped together under such diagnoses
as splenic anemia or leukemia, we are now breaking these
anemias down into more accurate terms depending on fine
distinctions of the one type of blood cell involved. As
more precise diagnoses are made, more exact indications
for splenectomy will be achieved. Whereas splenectomy
helped some of the old cases of splenic anemia, it failed
in others completely. This no doubt was due to the fact
that splenic anemia was a “catch-all” diagnosis. With
the breakdown of this “catch-all” we learn which specific
blood cell dyscrasias respond to splenectomy and which
ones do not. Splenectomy has now been tried for every
kind of anemia and splenomegaly and in sufficient num-
bers to arrive at some definite conclusions as to when
it is indicated.
Among the conditions for which surgery of the spleen
has been tried are the following: infections of the spleen
from septicemia, pernicious anemia, myelogenous and
lymphatic leukemia, Hodgkin’s disease, aplastic anemia,
polycythemia, luetic spleens,' tuberculous spleens, spleno-
megaly due to malaria, splenic anemia, Banti’s disease,
sarcoidosis, trauma of the, spleen, hemolytic icterus, con-
genital or acquired, thrombocytopenic purpura, splenic
neutropenia, primary splenic panhematocytopenia, Felty’s
syndrome, thrombosis or anomalous obstruction of the
portal vein with portal hypertension, cysts of the spleen,
parasitic invasion of the spleen, abscesses, Gaucher’s dis-
ease and ptosis. In many of the above-listed diseases,
surgery of the spleen has been abandoned because of
poor results or because some better treatmnet has been
developed.
The physiology of the spleen is complex and must be
studied from two angles, the normal and the abnormal.
The spleen is primarily an organ composed of lymphoid
and reticulo-endothelial cells and as such possesses all
the normal functions peculiar to lymphoid tissue. Nor-
mally it acts as a reservoir for red blood cells, and helps
destroy old red blood cells by phagocytosis and so forms
bilirubin. It stores hemosiderin, phagocytes bacteria and
foreign body particles. It produces lymphocytes and
monocytes, and in embryonic life and in certain types of
anemia in adults it produces red blood cells and leuko-
cytes. When abnormal physiology in the spleen occurs,
diseases result which arouse the interest of clinicians
and which may necessitate surgical intervention. The
function of increasing the fragility of the red blood cells
is one. This increased fragility leads to the development
of hemolytic icterus due to the rapid destruction of the
red blood cells and the accumulation of bilirubin in the
blood. The abnormal physiology of inhibitory function
on the bone marrow reduces the platelets to the point
that thrombocytopenic purpura results. If the inhibition
of granulocytes occurs, panhematocytopenia or splenic
neutropenia result. At times all of these conditions may
be present simultaneously, or any combinations of the
above. In spite of the manifold and complex functions
of the spleen, it is remarkable that so little change
results generally in the body from removal of a nor-
mally functioning organ. Aside from some increase in
erythrocytes, leukocytes and blood platelets, there seems
to be little or no effect on the body generally. This is no
doubt due to the fact that there is still an abundance of
lymphoid and reticulo-endothelial tissue elsewhere in the
body. As these tissues assume the functions of the
spleen, the increase in the blood components returns to
normal. Removal, however, of an abnormally function-
ing spleen gives almost startling curative effects in cases
carefully selected with certain characteristic changes in
the blood or other organs. The close co-operation be-
tween the internist and the surgeon is most essential, and
it is only by this means that splenic syndromes amenable
to surgery can be sifted. A trained hematologist with
ability to obtain accurate bone marrow studies is abso-
lutely essential in arriving at the fine differential diag-
noses necessary to obtain good surgical results.
The technique of splenectomy is not up for discussion
in this paper, but we wish to make just one or two
remarks relative to it. Either a left upper rectus or
transverse incision may be used. Delivery of the spleen
through this wound should be accomplished before the
pedicle is clamped. This may be best accomplished by
incising the parietal peritoneum just lateral to the spleen.
A search for accessory spleens should always be made as
they are very common. In cases where gross spleno-
megaly is present, preoperative shrinkage by x-ray
therapy may facilitate its removal.
I have divided the cases under consideration in this
paper into four groups.
1. Those in which splenectomy now offers nothing or
is contraindicated due to the fact that failure has re-
sulted from removal in the past or some other type of
treatment has given better results.
2. Conditions in which splenectomy may palliate though
it may not be regarded as a cure.
3. Conditions in which splenectomy is definitely indi-
cated and give on the whole excellent results.
4. Rare conditions with which we have had no experi-
ence but are enumerated here so that they may be con-
sidered and evaluated as experimental to complete the
record.
December, 1950
1245
MINNESOTA ACADEMY OF MEDICINE
The first group includes the following conditions :
Infections of the spleen resulting from generalized
septicemia or endocarditis have never responded to any
surgical procedure. The sulfonamides and the antibiotics
have replaced surgery.
Pernicious anemia was at one time thought to be
influenced favorably by splenectomy but the discovery of
liver therapy proved so much more efficacious that it
naturally has superceded all operative measures.
Myelogenous and lymphatic leukemia never responded
in any satisfactory manner to surgical intervention.
Hodgkin’s disease responds better at least temporarily
to Roentgen therapy and aplastic anemia has never given
any gratifying results.
Polycythemia was once thought to be partially bene-
fited but further study and observations has led to the
conclusion that surgery on the spleen offers little or
nothing. In fact in this condition it is now the consensus
of opinion that surgery is contraindicated.
In the second group are cases which may receive some
palliation from splenectomy. Certain types of infections
of the spleen, such as luetic gumma, tuberculosis and
even malaria, may produce such enlargement of the
spleen that removal makes the patient much more com-
fortable though no change in the course of the disease
may be obtained. Splenectomy therefore may be indi-
cated when the spleen is so large or painful as to be
annoying to the patient.
Lymphosarcoma may involve the spleen along with
other abdominal or retroperitoneal organs. Removal of
the spleen and as much as possible of the rest of the
involved tissue may give palliation. This should be aug-
mented with deep roentgen therapy.
A case in point is that of K. T., a twenty-three-year-
old, single man seen in April, 1948, who first noted symp-
toms of pain in the left upper quadrant of his abdomen
in the fall of 1944. This recurred in the spring of 1947
and a mass developed in the left upper quadrant of his
abdomen. On April 10, 1948, splenectomy and removal of
much other sarcomatous tissue was performed. His re-
covery was good, and following this, roentgen therapy
shrank the mass considerably. He remained fairly well
until December 5, 1948, when he died. Postmortem
examination revealed death was due to a large intra-
abdominal hemorrhage.
Sarcoidosis of the spleen is rare and is usually asso-
ciated with evidence of sarcoid disease elsewhere in the
body. This peculiar hobnailed spleen may give the
patient extreme pain. The organ may increase in size
until it weighs 1500 to 2000 grams. Whereas splenectomy
may not effect the course of the disease, the relief of the
pain is enough to warrant operation.
An illustrative case is M. C., a thirty-six-year-old,
single woman who suffered extremely severe left upper
quadrant pain associated with extreme spells of vomit-
ing, lassitude, weakness and joint pains and a 33 pound
weight loss in the preceding year. Examination revealed
a large hard spleen. Exploration disclosed a hobnailed
spleen which was removed. It weighed 2.5 pounds and
the pathological report by Dr. John Noble was sarcoidosis
of the spleen. She has been much improved since her
operation, but once or twice a year still has attacks of
colicky left upper quadrant pain. There is no evidence of
progression of sarcoidosis elsewhere in the body.
Splenic anemia has been a catch-all diagnosis into
which many obscure blood dyscrasias have been placed
and some of which have been benefited by splenectomy.
In more recent years certain rather distinct clinical syn-
dromes such as panhematocytopenia and splenic neutro-
penia have been sifted out and will be considered later
under group three. However, we think it is justifiable
to advocate splenectomy for primary splenic anemia
which does not fall into definite classifications because
sometimes very startling cures result and no other treat-
ment has been advanced which is better.
Banti’s disease with its splenomegaly, fibrosis or cir-
rhosis of the liver and portal thrombosis presents pic-
tures of such a varied nature that it is difficult to draw
conclusions about the disease in its entirety. Treatment
must be guided by the stage of the disease. We feel that
we can conclude that in the early stages of Banti’s disease
before changes have taken place in the liver or the portal
vein, splenectomy is beneficial. It certainly has a pallia-
tive effect and some observers believe that in real early
stages it is curative. After the disease is well established,
palliation is all that can be hoped for. In the late stages
where collateral circulation is established, splenectomy
carries a very high mortality from hemorrhage and
shock but it may even be harmful because some of the
collateral circulation may be destroyed. Because of
these considerations splenectomy may be even contra-
indicated in this disease.
The case of R. K. was that of a twenty-year-old boy
who had suffered from splenomegaly since the age of
fourteen years. During these six years he suffered from
two episodes of gastrointestinal hemorrhage probably
arising from esophageal varices. The spleen had en-
larged so that it extended low into the left lower quad-
rant of the abdomen. Splenectomy was performed in
October, 1946, and a spleen weighing 1310 grams re-
moved. The pathological report was Banti’s disease. The
patient received definite palliation from his symptoms
but has had one spell of gastrointestinal hemorrhage since
surgery. Otherwise he feels well three and one-half years
after his operation. Perhaps if this spleen had been
removed four or five years earlier we might have had
a complete cure.
The third group contains those cases in which splenec-
tomy is highly beneficial or curative :
Trauma of the spleen results usually from three
causes: (1) injury caused by heavy dull or crushing
blows to the abdomen, (2) perforating wounds, and (3)
injury at a surgical procedure. The first type results
most frequently from automobile accidents, sliding and
bobsledding in which the injured strikes a firmly fixed
object such as a tree, and occasionally in falls from any
type of perch. The symptoms are generalized abdominal
pain usually more marked on the left side, sometimes
referred downward or to the left shoulder (Kehr’s sign),
pallor, occasionally vomiting, anxious appearance, sweat-
ing, thoracic breathing, splinting of the abdomen. Physi-
cal findings usually show evidence of shock, rapid
1246
Minnesota Medicine
MINNESOTA ACADEMY OF MEDICINE
thready pulse, clammy skin, abdominal rigidity, and
rebound tenderness more marked on the left side. The
skin seems to take on a yellowish tint, the blood pressure
findings are usually low to normal, and at times there is
fixed dullness in the left upper quadrant (Ballance’s
sign). This was present in two of our nineteen cases
of ruptured spleen. But was probably not looked for
routinely. With such a picture,, immediate exploration
is indicated. One complication of rupture of the spleen
which must always be remembered is delayed hemor-
rhage. A history of abdominal trauma is obtained but
the patient does not have the shock symptoms of one
with a frank rupture and intra-abdominal hemorrhage.
No indication for explorations is present. However, any
time up to ten to fourteen days later, sudden shock
symptoms appear and the typical picture of a ruptured
spleen sets in. This is caused by a tear in the splenic
pulp which is loosely sealed over and the capsule holds
the hemorrhage in abeyance until it reruptures later as
the clot in the spleen increases in size. This was present
in two of our nineteen cases.
A case in point is B. T., a thirteen-year-old girl who
was hit just below the left costal margin by the handle-
bar of a bicycle. She had some pain in the left flank
with nausea at the time, but was able to attend school
the next day and for the rest of the week. Pain was
present in the left side only upon twisting her body or
breathing deeply. During the night of the fifth day fol-
lowing the accident she was awakened by a severe pain
in her left side, constant and worse upon breathing. She
was brought to the hospital where she was found to have
considerable tenderness in the left upper quadrant and
left flank, with rigidity of the entire abdomen, most
pronounced in the left upper quadrant There was a
moderate amount of distention. The hemoglobin was 48
per cent and shortly later 42 per cent. She was operated
upon and a subcapsular hemorrhage and hematoma found
with free bleeding into the peritoneal cavity. Recovery
was uneventful.
Another case is that of S. L., a young man, aged
twenty, who, while playing basketball ten days prior to
admission, was hit in the left side of the abdomen by
the head of another player. For the next five days he
had considerable malaise, tenderness around his umbi-
licus, and pain upon respiration. On the sixth day he
felt fairly well and went to work, but on the following
two days had a recurrence of the pain which necessitated
his staying in bed. Again on the ninth day he returned
to work but while there developed profuse sweating,
dizziness, and nausea and vomiting. He was brought to
the hospital where examination of the abdomen showed
diffuse tenderness with moderate rigidity. Blood pressure
was 95/54. The hemoglobin was 68 per cent, red blood
count 3,520,000, and the white blood count 13,200. At
operation the spleen was ruptured and markedly enlarged.
Pathological examination did not disclose the reason for
the splenomegaly, but the pathologists suggested a blood
dyscrasia or some such severe infection as bacterial
endocarditis. Blood studies and cultures, stool cultures,
and agglutination tests were all negative. After a very
stormy course during which he developed bronchopneu-
monia with pleural effusion, subphrenic abscess, and evis-
ceration of his wound, he died upon the thirty-sixth
postoperative day. Autopsy showed areas of ulceration
corresponding to the location of Peyer’s patches, and the
microscopic picture was compatible with a diagnosis of
typhoid fever.
One of the difficulties in arriving at a diagnosis of rup-
ture of the spleen is that frequently extensive injuries
are present eleswhere which mask the symptoms. That
is, the patient may be unconscious from concussion or
skull fracture, he may be intoxicated, he may have a
crushing injury to his chest with fractured ribs, pneumo-
thorax or hematothorax, he may have fractured arms or
legs, he may have rupture or perforation of other abdom-
inal organs, or he may have rupture or perforation of
the left kidney with hematuria. Any combination of the
above listed injuries may be present and will have to be
treated at the same time. However, as a general rule
the other injuries may be more safely temporized with
than the spleen injury because an untreated ruptured
spleen is always fatal, whereas treatment of many of the
other injuries may be delayed. Rupture of the spleen in
extensive injuries should always be considered. It has
often been referred to as the organ of shock in abdom-
inal ■ injuries, and where shock is present, rupture of
the spleen and other abdominal organs should be con-
sidered. In our series of cases we had to remove the
spleen and left kidney on four patients, two for simul-
taneous rupture of the spleen and left kidney due to the
dull blows and twice for perforating bullet wounds which
punctured both the spleen and kidney. This brings us to
the second type of injury to the spleen, namely, perforat-
ing wound. These usually result from gunshot and stab
wounds. The dictum of immediate exploration holds for
this type of injury along with repairing any other type
of injury which is present.
There was the case of T. O., a twenty-two-year-old
man, with suicidal intent, placed the butt of a shotgun
on the floor, leaned over the muzzle and reached down
and pulled the trigger. The shot tore away the left
upper quadrant of his abdomen and lower ribs and
diaphragm. He was brought to the hospital gasping for
breath because of a pneumothorax. The bowel was
eviscerated. The patient was in shock. Supportive meas-
ures were instituted. Through the gaping wound the
diaphragm was sutured to the lateral chest wall in a
position higher than its normal attachment with through-
and-through catgut sutures. Breathing immediately im-
proved. The shredded ends of the tenth and eleventh
ribs were removed. A splenectomy was performed. More
than forty perforations of the large and small bowel
were closed. The left kidney was not removed though
shot could be felt in the capsule. A large retroperitoneal
hemorrhage had occurred. The wound was closed as well
as possible. For a time it seemed as though the patient
might recover, but death occurred on the sixteenth post-
operative day. The cause of death reported at post-
mortem was local peritonitis, subdiaphragmatic abscess,
left empyema, abscess of left lung, multiple abscesses of
left kidney. It is interesting to speculate on how the
defect in the abdominal wall could have been repaired
had the patient recovered.
Another case is that of H. I., a nineteen-year-old clerk
December, 1950
1247
MINNESOTA ACADEMY OF MEDICINE
in a drug store who was held up and shot in the abdomen
by a bandit. The patient was in extreme shock. Suppor-
tive measures were instituted. The bullet had entered
the abdomen in the left upper quadrant and lodged in
the lumbar muscles. On exploration through a left
rectus incision, it was found that the bullet had per-
forated the spleen, left kidney and transverse mesocolon.
The spleen and kidney were removed and the rent in the
mesocolon repaired. After three weeks the bullet was
removed from the lumbar muscles. Convalescence was
uneventful.
Thromocytopenic purpura is a disease which responds
to splenectomy. Characterized by excessive bleeding be-
neath the skin, from the nose, from the bowel, from the
genito-urinary tract, or from any skin laceration or
needle puncture, these patients frequently become very
anemic and the hemorrhages are at times uncontrollable.
Before treatment by splenectomy the disease was at times
fatal. The diagnosis is made from the history and find-
ings as noted above and the presence of a low blood
platelet count. This count may have dropped from a
normal of 200,000 plus to 35,000 or even as low as 2000.
As soon as the diagnosis is made, splenectomy should be
performed, as treatment by transfusion or intramuscular
injections of blood only gives at best only temporary
relief.
The case of P. T. was a child of eighteen months of
age, whose parents gave the history of a sudden gen-
eralized ecchymosis which continued for four days but
cleared spontaneously in ten days under treatment with
calcium. A second episode occurred at the age of two
years and four months, which cleared up following the
injection of coagulose, but a large hematoma occurred at
the injection site. Her platelet count was 75,000. She
cleared again and had no recurrence until the age of six
years when another attack occurred. This was in Sep-
tember and October of 1927. During this attack seventeen
platelet counts were done. The highest count was 33,000
and the lowest was 10,000. On October 18, 1927, splenec-
tomy was performed. All bleeding ceased, and at 3 :00
p.m. on the day of surgery the platelet count rose to
38.000. The patient was discharged October 31, 1927,
considerably improved. She has had no recurrence since
and is now twenty-nine years old, and in November, 1949,
her platelet count was 175,000.
There is also the case of Mrs. M. W., who was first
seen February 6, 1941, at the age of forty-seven with
typical petechial hemorrhages and melena. Platelet counts
taken at intervals for the next seven months varied from
215,000 down to as low as 2000. It is significant that the
hemorrhages and the low platelet counts coincided. On
September 27, 1941, splenectomy was performed. Con-
valescence was uneventful and on November 17, 1941,
two months after operation, her platelet count was
250.000. However her platelets have not always remained
up and have been as low as 7000 since her operation, but
in spite of this she has never had a recurrence of hemor-
rhage. We suppose an accessory spleen could account
for this.
Congenital hemolytic jaundice is another disease which
responds to splenectomy. This condition frequently occurs
in several members of a family and is characterized by
mild jaundice and secondary anemia. Symptoms are
usually due to the anemia. Enlargement of the spleen
occurs early, and gallstones are a frequent complica-
tion. The diagnosis is confirmed by the presence of in-
creased fragility of the red blood cells in hypotonic salt
solution. On the other hand acquired hemolytic jaundice
usually does not respond to splenectomy and usually does
not show increased fragility of the red blood cells.
Treatment in the acquired type should be directed at the
underlying cause of the jaundice. If this is removed, the
jaundice will clear up. In true congenital hemolytic
jaundice the response to splenectomy is spectacular when
the red-blood-cell-destroying spleen is removed. The in-
crease in the red blood count is immediate almost before
the operation is completed. Operation should be per-
formed immediately even in the face of the poor condi-
tion of the patient as it offers the only cure.
The case of J. C. was a twenty-seven-year-old-boy ad-
mitted to the hospital January 17, 1942, complaining of
weakness and a yellow pallor of his skin. He was
extremely ill. His hemoglobin was 22 per cent, red blood
count 986,000, white blood count 11,450. His red blood
cells showed increased fragility to hypotonic salt solu-
tion. His spleen was palpable. Splenectomy was per-
formed January 18, 1942, in spite of his poor condition.
Citrated blood was given during the operation. Two
hours after the operation his red blood count had risen
to 1,750,000 and his hemoglobin to 38 per cent. Part of
this rise was no doubt due to his transfusion but if the
spleen had not been removed his transfused blood would
not have been maintained. He left the hospital twelve
days following operation, and in May, four months later,
his hemoglobin was 85 per cent and bis red blood count
was 4,230,000. He has remained well since.
Panhematocytopenia and splenic neutropenia are pri-
mary hypersplenic conditions that have been sifted out of
the catch-all of splenic anemia. In fact the differentiation
between panhemotocytopenia and splenic neutropenia is
so confusing that they are considered at times as vary-
ing degrees of the same disease. Bone marrow studies
are essential as a prognostic factor in determining the
advisability of splenectomy. Where the laboratory studies
of the bone marrow show a myeloid hyperplasia and a
normal or increased number of granulocytes which do
not reach the blood and also a destruction of the erythro-
cytes, and at times a low platelet count, splenectomy is
indicated and gives a good result.
The case of J. N. B. was that of a seventy-five-year-
old man who in March, 1938, was found to have an
abnormal blood count with his hemoglobin 9.8 grams, red
blood count 2,500,000 and a white blood count of 2,200
of which 767 were granulocytes. Repeated counts re-
mained approximately the same and transfusions were
the only means by which his hemoglobin could be main-
tained. Another count showed his hemoglobin to be 6.8
grams, red blood count 1,800,000 and white blood count
1,700. His platelet count was 160,000. His spleen was
palpable. Bone marrow studies showed myeloid hyper-
plasia, increased erythropoiesis. A diagnosis of pan-
hematocytopenia was made on a hypersplenism basis.
1248
Minnesota Medicine
MINNESOTA ACADEMY OF MEDICINE
His spleen was removed on October 28, 1949. One month
later his hemoglobin was 11.9 grams, his red blood
count 4,390,000, and his white blood count 4,200 with 47
per cent granulocytes. His platelet count was 242,000.
Felty’s syndrome is another splenic condition which
has characteristics of splenic neutropenia and panhema-
tocytopenia, secondary anemia and a low platelet count
with splenomegaly. However, associated with these find-
ings are painful joints due to arthritis deformans, skin
pigmentation and generalized adenopathy. At times an
associated thrombocytopenic purpura may be present.
We have never operated upon a patient with this syn-
drome but have had one under observation since Novem-
ber, 1949. At no time did her complaints seem to justify
operation.
The case of Mrs. J. P. D. was that of a forty-eight-
year-old, white woman who was admitted to the hospital
on November 8, 1949, complaining of nausea, vomiting
and abdominal pain. She had been in her usual state of
health until November 6, 1949, when she first noticed
crampy abdominal pain following a meal of sauerkraut
and spareribs. During the interval between onset of pain
and admission she had several bouts of emesis. Bowels
moved normally twice the day before admission. She had
had a previous episode in August, 1949, which cleared
up without medical attention. Past history revealed that
she had had rheumatoid arthritis with severe deformities
of hands and arms for approximately twenty years, a
myomectomy and uterine suspension in 1934, and a
subtotal hysterectomy in 1943. Examination on admission
revealed a white woman in considerable pain. Her hands
showed typical rheumatoid deformities and she was
unable to extend her elbows. Her tongue was smooth,
red and dry. The left lobe of her thyroid was somewhat
enlarged. The abdomen was mildly distended and there
was voluntary muscle guarding present. Tenderness was
present in both lower quadrants. Bowel sounds were
active but not high pitched. The spleen could not be
palpated but x-ray examination revealed splenomegaly
and small bowel distention. Blood pressure was 130/80,
pulse rate 100, temperature 100.2. Blood counts on ten
successive days revealed an average hemoglobin of 11
grams. Red blood counts averaged 3,500,000 and white
blood counts averaged 3,000, the lowest being 2,200. There
was an increase in the granulocytes, averaging about 80.
Her platelet count was 120,000. Fragility test was normal.
Bone marrow studies showed a myeloid hyperplasia.
Her abdominal symptoms disappeared under intravenous
medication and enemata and nasal suction. This patient,
we believe, has a typical mild Felty’s syndrome, and
splenectomy is being considered if she has any recurrence
of her abdominal complaints or if her blood picture
changes progress. We do not feel, however, that it will
affect her rheumatoid arthritis.
There are several other conditions associated with dis-
eases of or enlargement of the spleen which respond to
surgical treatment better than to medical. We mention
them here so as to complete the record of surgical condi-
tions of the spleen even though we have had no personal
experience in cases of this kind. They, if encountered,
should be given surgical consideration. Cole, Walter and
Limarzi mention some of them.
Thrombosis or anomalous obstruction of the splenic
vein may be reason for splenectomy. We appreciate that
some of these cases may be early, ill-defined cases of
Banti’s disease. The diagnosis is made by the finding of
splenomegaly, secondary anemia, leukopenia and throm-
bopenia. This condition no doubt was also included under
the old splenic anemia group at one time. Hemorrhage
from the gastrointestinal tract may be present, arising
from esophageal varices which can at times be identified
in roentgenograms. The consensus of opinion is that
where obstruction of the vein exists primarily and no
other complicating factors are present, splenectomy will
cure. This no doubt accounts for some cures in so-called
early Banti’s disease where no liver damage or complica-
tions are present. The other group where the portal
block- is intrahepatic, such as in cirrhosis of the liver or
advanced Banti’s disease, no result can be obtained. The
resulting portal hypertension has given rise to numerous
procedures for its relief. Splenectomy will relieve or
cure in early cases where the pathology is primarily an
extrahepatic block in the portal vein itself. Nature tries
to establish collateral circulation by dilating veins of the
falciform ligaments, the veins of the cardia connecting
with azygos and diaphragmatic veins, the hemorrhoidal
veins and through veins of the retroperitoneal glands and
appendages. Procedures other than splenectomy have
been tried, some with some success at times. Talma
devised anastomoses of various intra-abdominal organs,
principally the omentum to the abdominal wall and
between the liver, spleen and diaphragm and the anterior
abdominal wall. Anastomosis of the superior mesenteric
vein to the caval circulation was tried by Bogaras. Lear-
month anastomosed the splenic vein to the left renal vein
after splenectomy and nephrectomy with indifferent suc-
cess and a surgical mortality of 33 per cent in fifteen
cases. At any rate he has now discontinued the proce-
dure. Ligation of some gastric arteries has been tried.
Gastric resection has been tried by Wagensteen with a
50 per cent operative mortality and uncertain results.
So we think it may be concluded that good results will
be obtained in early extrahepatic portal obstruction with
portal hypertension by splenectomy. Uncertain results in
late cases is the rule where blood diverting operations of
any type are tried, and these procedures carry a high
operative mortality. We have had no personal experience
with any other surgical procedure other than splenectomy
for this condition.
Cysts of the spleen, abscesses or parasitic invasion of
the organ, Gaucher’s disease and even simple ptosis may
at times occur which, if giving symptoms, should be
treated by splenectomy. All of these conditions are rare.
Conclusions
1. We have attempted to summarize the conditions for
which splenectomy has been tried and found worthless or
for which some other procedure has been developed
which has been proven superior.
2. We have summarized the conditions which splenec-
tomy palliates.
3. We have presented the conditions in which splenec-
tomy cures or gives good results.
( Continued on Page 1275)
December, 1950
1249
Minneapolis Surgical Society
Meeting of April 6, 1950
The President, Ernest R. Anderson, M.D., in the Chair
VAGOTOMY IN THE TREATMENT OF PEPTIC ULCER
FREDERICK M. OWENS, JR., M.D., F.A.C.S.
Saint Paul, Minnesota
TEN to 20 per cent of patients with peptic ulcer are
referred to the surgeon for the treatment of some
complication of the ulcer. The complications for which
surgical treatment is sought are: (1) perforation, (2)
hemorrhage, (3) pyloric stenosis, (4) intractible symp-
toms. In general, the choice of operation lies between
gastric resection and vagotomy for these cases. It is not
my intention to discuss the pros and cons of the two
operations, but to present the results of a group of
vagotomies done at the University of Chicago.
The discussion will be limited to the treatment of
duodenal ulcer, for when operation is undertaken for
gastric ulcer, there are definite advantages to gastric
resection. The good results from vagotomy in the treat-
ment of jejunal ulcer are recognized by even the most
severe critics of the procedure; thus there is little indi-
cation for including this category in the discussion.
There are three groups of patients in which I feel
vagotomy has distinct advantage over gastric resection ;
these are herein enumerated. First, the patient who has
difficulty maintaining his normal weight, or the asthenic
patient, is an excellent candidate for vagotomy inasmuch
as following vagotomy such a patient is better able to
maintain his weight or to gain weight than after gastric
resection. Weight record studies in both groups of pa-
tions have borne out this contention quite consistently.
Second, the patient with a severely scarred duodenum
can be treated with a lower mortality and morbidity by
vagotomy than by gastric resection. Admittedly, the an-
tral exclusion operation may be done in these cases, but
the mortality and morbidity in the group is significantly
greater than with vagotomy. This is true, in general, of
the difference in the morbidity and mortality between
gastric resection and vagotomy, as will be discussed later.
Third, the patient who is a problem insofar as his per-
sonality make-up is concerned tends to develop rather
severe symptoms following operation. This patient may
be considered for vagotomy and gastroenterostomy as he
is less likely to develop severe disturbances after this
operation than after gastrectomy.
During the past few years there has been considerable
discussion as to the detrimental effects produced upon the
other abdominal viscera by vagotomy, but all such fears
are unfounded. Thorough study of the viscera of three
patients who died many months following vagotomy have
failed to reveal any microscopic evidence of change in
the duodenum, jejunum, ileum, colon, kidneys, liver,
pancreas or adrenals. These organs were considered to
be completely normal by microscopic examination. Fur-
thermore, when gastrectomy is carried out, there is ef-
fected a vagotomy of varying degree. Following total
gastrectomy or esophagogastrectomy or esophagectomy
there results a complete vagotomy. Certainly no one has
demonstrated any concern as to the effect of these
operations on the abdominal viscera.
The physiology of vagotomy is well understood at the
present time. Suffice it to say that there is a decrease of
total volume of gastric secretion, a decrease of the acid
output of the stomach, and a decrease of the tonus and
motility of the stomach.
As first described by Dragstedt,1 the operation was
done transthoracically, but at the present time the ma-
jority of the operations are being done transabdominally.
Not only does the abdominal route permit examination
of the ulcer area and other abdominal viscera, but it al-
lows for more complete division of the vagus nerves. At
the same time a gastroenterostomy may be done to
facilitate drainage of the stomach. At least 20 to 25 per
cent of patients having vagotomy require accessory
drainage of the stomach either at the time of the vago-
tomy or at a later date. At the present time it is my
feeling that gastroenterostomy should be done in all
cases of vagotomy, and I believe that the results in this
group of patients will bear out this contention.
The technique of operation employed is to enter the
abdominal cavity through a high left paramedian in-
cision. The viscera are explored, and then the triangular
ligament of the left lobe of the liver is exposed by the
surgeon and cut by his assistant so that the left lobe can
be retracted well to the right. The left lobe is then held
out of the field with a stockinette covered Deaver or
Harrington retractor. The esophagus is identified by
palpation, and an incision is made in the peritoneum
across the lower portion of the esophagus. This incision
is enlarged bluntly, and the index finger is inserted into
the mediastinum behind the esophagus. Gradually the
exposure is increased so that it is possible to insert the
index and middle fingers behind the esophagus and all
adventitious tissue is brought toward the esophagus with
the fingers while working higher and higher into the
mediastinum. Finally, it is possible to bring at least three
inches of esophagus down out of the mediastinum. The
vagus nerves are felt as tight strands, resembling violin
strings, along the esophagus. The nerves are picked up
as high as possible and dissected distally, then clamped
and ligated as high as possible. A segment of nerve an
inch or two in length is then removed and the distal
transected ends are ligated. Meticulous search is made
for additional vagus fibers along the esophagus and also
in the mediastinum.
1250
Minnesota Medicine
MINNEAPOLIS SURGICAL SOCIETY
TABLE I. CLASSIFICATION OF RESULTS
Good — healing of the ulcer, patient asymptomatic, return to
previous occupation or its equivalent.
Fair — healing of ulcer, hut distressing symptoms such as late chest
pain, bowel distress, mild obstructive symptoms, or mild
diarrhea.
Poor — recurrence of ulcer, severe obstructive symptoms, disabling
side effects such as dumping or protracted diarrhea; death.
When one is satisfied that he has divided all possible
fibers, the opening in the peritoneum is carefully closed
with interrupted sutures and the left lobe of the liver is
fixed in place by suturing the divided triangular liga-
ment. At this point a small gastroenterostomy is made
between the posterior wall of the stomach and the first
part of the jejunum. This is a retrocolic anastomosis
and should measure 2.5 to 3 centimeters in length. A
small gastroenterostomy stoma is advisable for reducing
the likelihood of dumping symptoms.
The postoperative management of the patient following
vagotomy is important. Constant gastric suction is main-
tained for three or four days ; then the tube is removed,
and during the first day without the tube the patient is
allowed 30 c.c. of water every hour. He is aspirated at
night to determine the presence of retention, if any. In
the absence of retention the patient is allowed 60 c.c. of
water an hour the second day after withdrawal of the
tube and is again aspirated at night. The third and fourth
days clear liquids are given ad lib. The fifth and sixth
days six feedings of full liquid are given and the stomach
is aspirated once at night to determine retention. The
seventh and eighth day six feedings of soft diet are given.
The ninth day clear liquids are given and a twelve-hour
secretion test is run at night, and in the morning before
removal of the tube, an insulin gastric secretion test is
carried out. The patient is discharged on the tenth day
and instructed that he should not allow his stomach to
become distended. His diet is restricted to readily di-
gestible foods for three weeks after discharge. Another
insulin gastric test is done three months after discharge
from the hospital.
The clinical results of the operation are classified ac-
cording to the outline in Table I.
An ulcer was not classified as healed unless there was
roentgenographic evidence of healing and freedom from
ulcer symptoms. Table II classifies the results according
to the type of operation performed.
There is definite superiority of the results in the
group treated by vagotomy and gastroenterostomy over
the other groups.
In the transthoracic group those patients considered as
fair results were patients whose ulcers healed, but who
continued to have mild symptoms of delayed emptying of
the stomach. These symptoms were distressing, but not
disabling. The poor results in this group include one
death, six cases of recurrent ulcer, and six cases of ob-
struction severe enough to warrant operation. Five pa-
tients had gastroenterostomy with good result, one with
fair result.
In the group of patients operated upon via the ab-
dominal route who had vagotomy without any adjunct
operation, the fair results are listed as two cases with
diarrhea, one case with what is described as “dumping,”
and sixteen cases with mild obstructive symptoms. Those
TABLE IT. RESULTS IN 465 VAGOTOMIES FOR
DUODENAL ULCER
Transthoracic vagotomy — 57
Good— 37—65%
Fair— 7—12.2% Mortality— 1— ( 1.7% )
Poor— 13—22.8%
Abdominal vagotomy — 148
Good— 104— 70.2%
Fair — 19 — 12.8% Mortality — 3 — (2.0%)
Poor— 25—17.0%
Abdominal vagotomy and gastroenterostomy — 260
Good— 239— 91.9%
Fair — 11 — 4.2% Mortality — 1 — (0.38%)
Poor— 10— 3.9%
classified as poor results include three deaths, eleven re-
current ulcers and ten patients who underwent subse-
quent gastroenterostomy for obstruction (eight with good
results and two with fair results), and one case with
severe obstruction who refused gastroenterostomy for a
long time and later had partial gastrectomy elsewhere.
Finally, in ' the group having vagotomy via the ab-
dominal route and gastroenterostomy, there were eleven
fair results (4.2 per cent), with four patients having
“dumping,” one being a drug addict, four having bowel
distress, and two patients having mild diarrhea. In the
poor result category there was one death, one Mann-
Williamson ulcer ; five recurrences of ulcer — one had
second operation with lysis of adhesions and subsequent-
ly a fair result. One patient was re-explored for per-
sistent symptoms and a duodenal diverticulum was re-
moved with good results. One patient subsequently had
hemorrhage of undetermined origin.
The statistics in this group of patients are self-
explanatory, and it should be noted that the over-all
mortality rate was 1.3 per cent. In the group of patients
with vagotomy and gastroenterostomy the mortality rate
was 0.38 per cent in a group of 260 patients. The results
with this operation in the treatment of duodenal ulcer
have been satisfactory ; the mortality and morbidity has
been low, and the clinical course of the patients such as
to justify its continued use.
Summary
1. A group of 465 patients treated for duodenal ulcer
by vagotomy alone or in conjunction with gastroenteros-
tomy is presented.
2. A comparison between the results of operation in
three different categories is made. The categories repre-
sent the type of operation, i.e., transthoracic, transab-
dominal, or transabdominal with gastroenterostomy.
3. The superiority of the results in the group with
abdominal vagotomy and gastroenterostomy is significant.
4. The results suggest that this operation has a definite
place in the treatment of duodenal ulcer.
Reference
1. Gragstedt, L. R., and Owens, F. M., Jr. : Supra-diaphrag-
matic section of vagus nerves in treatment of duodenal ul-
cer. Proc. Soc. Exper. Biol. & Med., 53:152-154, 1943.
Dr. Carter W. How'ell, Minneapolis, presented a paper
entitled “Observations on ‘The Common Channel
Theory’ in Pancreatitis.”
Dr. Lyle J. Hay, Minneapolis, presented a paper en-
titled “Polyethylene Wrapping of Abdominal Aneurysm.”
William H. Rucker, M.D., Recorder
December, 1950
1251
♦ Reports and Announcements ♦
AMERICAN COLLEGE OF CHEST PHYSICIANS
A postgraduate course in diseases of the chest, spon-
sored by the Council on Postgraduate Medical Educa-
tion and the Southern Chapter of the American College
of Chest Physicians, will be held at Vanderbilt Univer-
sity School of Medicine, Nashville, Tennessee, January
22 to 27. The fee for the course is $50. Further infor-
mation can be obtained from the American College of
Chest Physicians, 500 North Dearborn Street, Chicago
10, Illinois.
AMERICAN COLLEGE OF SURGEONS
SECTIONAL MEETING
A cordial invitation is extended to physicians and sur-
geons in the State of Minnesota to attend a three-day
sectional meeting of the American College of Surgeons
in St. Louis on January 22, 23 and 24. The Statler Hotel
will be headquarters for the meeting and requests for
hotel accommodations should be directed to the Statler
Hotel in St. Louis.
The program for this meeting will include new sur-
gical motion pictures, a special program on trauma, a
cancer symposium, and panels or papers on vascular
surgery, chest injuries, fractures about the ankle joint,
hematuria following trauma, neck surgery, osteomyelitis,
ulcerative colitis, cancer of the stomach, and emergencies
arising during operation. The first two days of the pro-
gram will be presented at the headquarters hotel, and on
January 24 the hospitals in St. Louis will offer a full
day of surgical clinics for those in attendance at the
meeting.
A $5 registration fee will be required, except from
Fellows and members of the Junior and Senior Candi-
date Groups of the College, and interns and residents.
Additional information may be obtained by writing to
Dr. James Barrett Brown, American College of Sur-
geons, 40 E. Erie Street, Chicago 11, Illinois.
AMERICAN DERMATOLOGICAL ASSOCIATION
PRIZE ESSAY CONTEST
The American Dermatological Association is offering a
prize of $300 for the best essay submitted of original
work, not previously published, relative to some funda-
mental aspect of dermatology or syphilology. The pur-
pose of this contest is to stimulate younger investigators
to original work in these fields.
Manuscripts typed in English with double spacing as
for publications, together with illustrations, charts and
tables, are to be submitted in triplicate not later than
February 1, and should be sent to Dr. Louis A. Brun-
sting, Secretary, American Dermatological Association,
102-110 Second Avenue, Southwest, Rochester, Minne-
sota.
Competition in this prize contest is open to scientists
generally ; not necessarily physicians.
The award will be made by a committee of judges
selected to pass on the essays by the Research Aid Com-
mittee of the American Dermatological Association and
the decision of the judges shall be final. This contest is
planned as an annual one, but if in any year, at the dis-
cretion of the Research Aid Committee and judges, no
paper worthy of a prize is offered, the award may be
omitted.
The prize-winning candidate may be invited to present
his paper before the annual meeting of the American
Dermatological Association, with expenses paid in ad-
dition to the $300 prize. Further information regarding
this essay contest may be obtained by writing to the
secretary of the American Dermatological Association.
The next annual meeting of the American Dermatolog-
ical Association will be the Diamond Jubilee Observance
of its founding and will be held May 23 to 26, 1951, at
the Homestead, Hot Springs, Virginia.
CLEVELAND HEART SOCIETY
A practical course for resuscitation of patients in the
operating room will be presented in Cleveland January
25 to 27, February 15 to 17, and March 15 to 17 by Dr.
Claude S. Beck under the sponsorship of the Cleveland
Heart Society.
Those interested, surgeons and anesthetists particularly,
may contact Mrs. Jerry II. Bruner, executive secretary,
Cleveland Heart Society, 613 P'ublic Square Building,
Cleveland 13, Ohio.
NEW ORLEANS GRADUATE MEDICAL ASSEMBLY
The fourteenth annual meeting of the New Orleans
Graduate Medical Assembly will be held March 5 to 8,
with headquarters at the Municipal Auditorium, New
Orleans.
Nineteen outstanding guest speakers will participate,
and their presentations will be of interest to both spe-
cialists and general practitioners. The program will in-
clude a panel discussion on ACTH and cortisone, a
series of talks on trauma and neoplastic disease, a review
of the application of radio-active isotopes in medical
practice, clinicopathologic conferences, round-table lunch-
eon discussions and many other features.
Another feature of the meeting will be daily demon-
strations of medical and surgical procedures in color
television. This program will he a telecast from Charity
Hospital to the auditorium.
The Assembly has planned a postclinical tour to fol-
low the 1951 meeting. On March 10 a party composed
of doctors and their families will leave by plane for
Panama. The itinerary also includes Medellin and Cali,
Colombia; Quito, Ecuador, and Lima, Peru. Medical
programs and visits to hospitals have been arranged, to-
gether with a full schedule of sightseeing. The group
will return to New Orleans on March 25. Details and a
complete itinerary are available at the office of the As-
sembly, Room 103, 1430 Tulane Avenue, New Orleans 12,
Louisiana.
1252
Minnesota Medicine
®
DR AM AMI N E Brand of Dimenhydrinate — for the prevention or
treatment of motion sickness — is supplied in 50 mg. tablets and in liquid form.
RESEARCH
N THE SERVICE OF
MEDICINE
SEARLE
December, 1950
1253
REPORTS AND ANNOUNCEMENTS
Clnnjouncinq^
THE FOURTEENTH ANNUAL MEETING
of
THE NEW ORLEANS GRADUATE MEDICAL ASSEMBLY
Conference Headquarters — Municipal Auditorium
March 5-8, 1951
GUEST SPEAKERS
Dr. Theron G. Randolph, Chicago, 111.
Allergy
Dr. Marshall Brucer, Oak Ridge, Tenn.
Atomic Medicine
Dr. Donald M. Pillsbury, Philadelphia, Pa.
Dermatology
Dr. lerome W. Conn, Ann Arbor, Mich.
Endocrinology
Dr. H. Marvin Pollard, Ann Arbor, Mich.
Gastroenterology
Dr. John L. McKelvey, Minneapolis, Minn.
Gynecology
Dr. Arlie R. Barnes, Rochester, Minn.
Medicine
Dr. Cornelius P. Rhoads, New York, N. Y.
Medicine
Dr. George S. Baker, Rochester, Minn.
Neurosurgery
Dr. Austin I.
Urology
Dr. Newell W. Philpott, Montreal, Can.
Obstetrics
Dr. John M. McLean, New York. N. Y.
Ophthalmology
Dr. Harold A. Sofield, Chicago. 111.
Orthopedic Surgery
Dr. Henry B. Orton, Newark, N. J.
Otolaryngology
Dr. Stanley P. Reimann, Philadelphia, Pa.
Pathology
Dr. Albert V. Stoesser, Minneapolis, Minn.
Pediatrics
Dr. Paul C. Hodges, Chicago, 111.
Radiology
Dr. Nathan Womack, Iowa City, la.
Surgery
Dr. Charles S. Welch, Boston, Mass.
Surgery
Dodson, Richmond, Va.
Lectures, symposia, clinicopathologic conferences, round-table luncheons, surgical and medical procedures in color
television and technical exhibits (All-inclusive registration fee — $15.00)
The Postclinical Tour to Panama, Colombia, Ecuador and Peru — March 10-25
For information concerning the Assembly meeting and the tour, write
Secretary, Room 103, 1430 Tulane Avenue, New Orleans 12, La.
AMERICAN MEDICAL WRITERS' ASSOCIATION
The eighth annual meeting of the American Medical
Writers’ Association will be held at the Pere Marquette
Hotel, Peoria, Illinois, September 19 during the six-
teenth annual meeting (September 19, 20, 21) of the
Mississippi Valley Medical Society in that city.
The association will publish its 1951 membership book-
let in February and is desirous of securing as members
all physicians interested in any phase of medical writing.
Any AMA member who has published two ore more
articles, indexed by the Quarterly Cumulative Index
Medicus, is eligible for membership. Further details
may be secured from the secretary, Dr. Harold Swan-
berg, 510 Maine Street, Quincy, Illinois.
MISSISSIPPI VALLEY MEDICAL SOCIETY
ESSAY CONTEST
The eleventh annual essay contest of the Mississippi
Valley Medical Society will offer a cash prize of $100, a
gold medal, and a certificate of award for the best un-
published essay on any subject of general medical in-
terest, including medical economics and education. Con-
testants must be members of the American Medical
Association who are residents and citizens of the United
States. The winner will be invited to present his contri-
bution at the sixteenth annual meeting of the Mississippi
Valley Medical Society to be held in Peoria, Illinois,
September 19, 20, 21, 1951. All contributions must be
typewritten in English in manuscript form, submitted in
five copies, not to exceed 5,000 words, and must be re-
ceived not later than May 1.
Further details may be secured from Dr. Harold
Swanberg, secretary, Mississippi Valley Medical Society,
209-224 W.C.U. Building, Quincy, Illinois.
CONTINUATION COURSE
The University of Minnesota announces a continua-
tion course in ophthalmology for physicians specializing
in this field. The course will be presented at the Cen-
ter for Continuation Study, January 22 to 26. Dr.
Alson E. Braley, professor and head of the Department
of Ophthalmology, University of Iowa, and Dr. A. D.
Ruedemann, professor and head of the Department of
Ophthalmology at Wayne University, Detroit, will be
the visiting faculty members for the course. Staff
members of the Mayo Foundation and University of
Minnesota Medical School will complete the faculty
for the course. The course is given under the direc-
tion of Dr. Erling W. Hansen, clinical professor of
Ophthalmology and director of the Division of Oph-
thalmology.
(Continued on Page 1256)
1254
Minnesota Medicine
In treating the disorders that exist in the minds of men.
psychiatric nursing plays a vital role. Proper care can
be given patients only by properly trained psychiatric
nurses.
In view of the present shortage .of such trained nurses,
and the desperate need for them, the Glenwood Hills
Hospitals School of Nursing, Neurology and Psychiatry
is appealing to you physicians for aid in solving this
problem.
By sending us the name of a promising nursing candi-
date in your community — a girl aged seventeen or
over, with a high school education — you will be doing
your part to alleviate this critical nursing shortage.
Our one-year course in psychiatric nursing is tuition-
free. Our graduates have an excellent professional
career before them.
Please send the name of a potential nursing recruit to
GLENWOOD HILLS HOSPITALS
3501 GOLDEN VALLEY ROAD
MINNEAPOLIS 22, MINNESOTA
December. 1950
1255
REPORTS AND ANNOUNCEMENTS
ANNUAL CLINICAL CONFLUENCE
OIK' AGO MEDICAL SOCIETY
March 6, 7, #, 9, 1951 • Palmer House , Chicago
A conference planned to keep physicians abreast of the new things which are developed from year to
year.
Special feature of the 1951 Conference — DAILY TEACHING DEMONSTRATION PERIODS from 11:00 to
12:00 noon and 1:30 to 3:00 P.M. Demonstrations will cover:
Amputations and Prostheses
Patients Treated with ACTH and Cortisone
Dermatologic Clinic
Organization of a Blood Bank
Neurological Clinic
Sterility Tests
Speech Without Larynx
Thirty-four outstanding teachers and speakers will
both general practitioner and specialist.
Proper Application of Casts and Splints in Fractures
Local Anesthesia
Fluid and Electrolytic Balance in Surgery
Use and Misuse of Obstetrical Forceps
Common Problems in X-Ray Interpretations
Laboratory Tests (Diabetes. Proper use of Insulin.
Prothrombin Tests)
present half-hour lectures on subjects of interest to
Four PANELS on timely topics
Scientific exhibits worthy of real study and helpful and time-saving technical exhibits.
The CHICAGO MEDICAL SOCIETY ANNUAL CLINICAL CONFERENCE should be a MUST on the calendar
of every physician. Plan now to attend and make your reservation at the Palmer House.
(Continued from Page 1254)
MINNESOTA SOCIETY OF INTERNAL MEDICINE
At the annual meeting of the Minnesota Society of
Internal Medicine at Rochester on October 30, Dr. A. E.
Brown of Rochester was elected president of the organ-
ization. He succeeds Dr. Frederick H. K. Schaaf, Min-
neapolis, in the office. Also named as officers were Dr.
Sam Boyer, Jr., Duluth, vice president, and Dr. Robert
L. Parker, Rochester, secretary-treasurer.
SAINT PAUL SURGICAL SOCIETY
The Saint Paul Surgical Society held its regular meet-
ing at the Minnesota Club, Saint Paul, on November 15.
The principal speaker of the evening was Dr. Richard
A. Telinde, chief of gynecology at Johns Hopkins Uni-
versity, Baltimore, who discussed “Endometriosis.”
SOUTHWESTERN MINNESOTA MEDICAL SOCIETY
At the annual meeting of the Southwestern Minnesota
Medical Society at Pipestone on October 30, Dr. P. J.
Pankratz of Mountain Lake was elected president of the
organization. Other officers named were Dr. S. S. Chunn,
Pipestone, president-elect ; Dr. W. B. Wells, Jackson, vice
president, and Dr. O. M. Heiberg, Worthington, secre-
tary-treasurer.
The principal speaker at the meeting was Dr. A. H.
Wells, Duluth, who discussed the value of having the
services of a pathologist in the southwestern Minnesota
area.
1256
Minnesota Medicine
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Woman’s Auxiliary
PRESIDENT URGES
MEMBERSHIP DRIVE
Mrs. Charles W. Waas
It is not my intention at this time to give you a report
on the Conference of Presidents held in Chicago last
month from which 1 have just returned. However, there
are some suggestions which 1 should like to pass on to
you. First, 1 should like to tell you that there were only
five presidents who were absent. It was thrilling to be a
part of such a large group of presidents and their
presidents-elect, and our national president, Mrs. Herold,
was so appreciative of the large attendance. Our own
Mrs. Wahlquist, national president-elect, presided at the
two-day session. We are justly proud of her.
Membership in a medical auxiliary is a privilege ex-
tended to us by our husbands. Why, then, are there so
many doctors’ wives in our own state who do not
belong? Is it the fault of auxiliary members? Have we
extended a truly friendly invitation? The cost of member-
ship is so small that it never enters into the question.
Increased membership is one of our greatest aims this
year. Won’t you do your share? Don’t forget the
doctors’ wives who live in counties where there are no
auxiliaries. Members at large are invaluable. Our par-
ent organization is eager to have them. Ask them to
join now and then invite them to attend your next meet-
ing. Here let me say that at the next state board meet-
ing which will be held in Minneapolis, probably during
the month of January, all members of the state auxiliary
will be most welcome. It will not be confined to board
members. Invite new members to attend with you.
In your drive for subscriptions to Today’s Health,
have you thought about contacting young mothers? There
is a wealth of information in this authentic magazine for
them, and when they become acquainted with it they will
surely want to carry on their subscription year after year.
We are neglecting our friends and neighbors if we
deprive them of the opportunity of reading this worth-
while periodical. Have you thought about giving sub-
scriptions for gifts? Perhaps in your community
there are mothers of families who would be happy
to receive such a' gift. A copy of the magazine
should be found in every doctor’s reception room, in
every high school, community center, club, beauty shop,
barber shop and countless other stations. There is room
for much improvement. Won’t you do your share?
What kind of programs have you planned? Sometimes
during membership drives we are told that our programs
are not interesting. Why aren’t they? There are many
suggestions for programs, many films and much litera-
ture to be had for the asking. Have your program
chairmen contact our state program chairman and with
her help, you can have a splendid program at every meet-
ing. Plan one or two meetings to which you can invite
your lay friends.
Public relations! Every doctor’s wife should be a com-
mittee of one ! We have a marvelous opportunity to
spread the truth and clarify matters for lay people. Our
husbands have met the challenge hurled at them and
they are fighting honestly and fearlessly for the Ameri-
can way of life. Auxiliary members — be well informed !
Do your share !
DRIVE STARTED TO
COLLECT SAMPLE DRUGS
Mrs. Bernard E. O'Reilley, Chairman
Committee on Medical and Surgical Relief
Sample drugs received in doctors’ offices can help fill
the need of many institutions whose budgets don’t allow
purchase of many of these drugs. Auxiliary members are
urged to arrange to spend a few hours twice or more a
year to collect the sample drugs. Members should ask
their husbands to save these drugs for collection. Office
girls will be glad to have a box or large paper bag placed
in the office for the samples. The orphanages, rest homes,
county homes, missionary societies throughout the state
will welcome boxes of drugs for distribution. Auxiliary
members are asked to start now saving the samples for
this worthwhile work. In the next issue of Minnesota
Medicine the names of organizations that will accept
instruments and drugs for shipment overseas will be
listed.
Drugs may be separated into groups, such as vitamins,
baby foods, salves, headache medicine, et cetera. Don’t
let valuable drugs be wasted.
PROMINENT AUXILIARY
MEMBER DIES
Mrs. William J. Byrnes died in Minneapolis October
21, 1950. Mrs. Byrnes was the widow of Dr. William J.
Byrnes, who died in November, 1929. Dr. Byrnes was of
a pioneer family, coming from New York in 1851.
Mrs. Byrnes was the organizing president of Hennepin
County Medical Auxiliary in October, 1910. She has held
the office of parliamentarian several times for the Wom-
an’s Auxiliary to the Minnesota State Medical Associa-
tion.
She was a life member of the Minnesota Historical
Society, a member of the Minneapolis Woman’s Club,
the Lewis Parliamentary Law Club, the American Legion
Auxiliary and the Oak Park Study Club. She is sur-
vived by three daughters: Miss Lyle Byrnes, Mrs. Hallan
Huffman, and Mrs. Robert Seiberlich.
The experience of two great wars and studies of the
mortality figures of tuberculosis in relation to environ-
ment have shown that when the standard of living
falls tuberculosis rises. — Frederick Heap, British Medical
Journal, November 5, 1949.
1258
Minnesota Medicine
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SIOUX FALLS — H. L. Norlin, 1908 S. Sixth Avenue
December, 1950
1259
In Memoriam
JOHN PHINEAS BARBER
Dr. John P. Barber, a Minneapolis physician for more
than fifty years, died October 13, 1950, at the age of
ninety-three.
Dr. Barber was born near Bardstown, Kenutcky, Oc-
tober 27, 1857. He graduated from Cecilian College in
1881 and from the University of Louisville Medical
School in 1886. He interned at SS. Mary and Elizabeth
Hospital in Louisville, after which he moved to Min-
neapolis.
He was a member of the Hennepin County Medical
Society, the Minnesota State Medical Association and
the American Medical Association, the Knights of Co-
lumbus, the Sons of the American Revolution and the
Hibernians.
Surviving are his wife, Alice W., five sons and five
daughters.
GUSTAF WILLIAM DAHLQUIST
Dr. G. VV. Dahlquist, formerly of Lancaster, Min-
nesota, died October 25, 1950, at the Minnesota Soldier's
Home. He was eighty-six years of age.
Dr. Dahlquist obtained his M.D. degree at the Uni-
versity of Minnesota in 1893 and practiced at Lan-
caster, Minnesota, from 1907 to 1917 when he enlisted
in the Army. After World War I, he returned to Lan-
caster and several years later went to Fargo, North
Dakota, where he was on the medical staff of the Vet-
erans Administration for ten years.
Mrs. Dahlquist passed away last winter. Dr. Dahl-
quist is survived by six children.
ALEXANDER G. DUMAS
Dr. Alexander G. Dumas, Chief of the Neuropsychia-
tric Service, Veterans Administration Facility, Minneap-
olis, Minnesota from 1922 to 1944, died October 2,
1950.
Dr. Dumas was born in Minneapolis, May 11, 1896.
He obtained a B.S. degree from St. Thomas College
in Saint Paul in 1916, and an M.D. from Creighton
University Medical School, Omaha, Nebraska in 1921.
After interning at St. Joseph’s Hospital in Omaha,
Nebraska, he took postgraduate study at the State Hos-
pital for the Insane at Osawatomie, Kansas, for eight-
een months. He was a veteran of World War I.
Dr. Dumas was a member of the Hennepin County
Medical Society, the Minnesota State Medical Asso-
ciation, the American Medical Association, and the
American Psychiatric Association. He was an Asso-
ciate Professor of Psychiatry and Neurology in the
University of Minnesota Medical School. He was one
of the founders of the Governor’s Advisory Commit-
tee on Mental Health and former chairman of that
committee.
He was formerly Chief of Staff at Glenwood Hills
and Homewood hospitals in Minneapolis, neuropsychiat-
ric consultant to municipal courts in Hennepin County,
medical director of Minnesota Mental Hygiene Society,
Inc., and member of former Governor Stassen’s crime
commission.
Dr. Dumas married Octavia Dyke of Minneapolis in
1921. He is survived by his wife; a daughter, Mrs.
Keith Brueckner, Princeton, New Jersey; three sons,
James A., Cody, Wyoming, Frederick G., Stamford,
Connecticut, and John C., Saint Paul ; two grandchil-
dren ; his father, George A. ; three brothers, Fred, Roy
and Delbert, and one sister, Mrs. Kenneth Smith, all of
Minneapolis.
Dr. Dumas was an outstanding leader in his field and
an honor to his profession. His life was characterized
by his devotion to his family and friends from all walks
of life. His passing is a real loss to the medical pro-
fession and to the community.
I. GRANT DAVIS
Dr. I. Grant Davis, a practitioner at Rushford, Minne-
sota, until he sold his practice July 1, 1950, died at the
home of Mr. and Mrs. Edward Reishus, Rushford, Sep-
tember 29, 1950. ,
Dr. Davis was born at Arcadia, Wisconsin, October
30, 1887. He obtained a B.S. degree from the University
of Wisconsin in 1912 and an M.D. from Rush Medical
College in 1914. His internship was served at La Crosse
Lutheran Hospital at La Crosse, Wisconsin.
Dr. Davis practiced at Duluth in 1916, at Little Falls
in 1917 and 1918, and served as a lieutenant in the Army
in 1918 and 1919.
He was a member of the Olmsted-Houston-Fillmore-
Dodge County Medical Society, the Minnesota State
Medical Association and the American Medical Associa-
tion. For many years he was health officer at Peterson
and Rushford. He was active in the Masonic order,
serving as secretary of the local lodge for many years.
Dr. Davis never married.
JOSEPH ELLSWORTH McCOY
Dr. J. E. McCoy, formerly of Ironton and lately of
Thief River Falls, died September 22, 1950.
Dr. McCoy was born at Hillsboro, Ohio, February 4,
1870. He studied at Lebanon College in Ohio before at-
tending I fospital College of Medicine at Louisville, Ken-
tucky, where he graduated in 1897. In 1910 he came to
Ironton, Minnesota, where he practiced until he moved
to Thief River Falls in 1937.
In 1902 he married Clara Steiner, who died in 1929.
Dr. McCoy married Julia Johnson in 1936. He is sur-
vived by Mrs. McCoy and two sons, Vernon of Minne-
apolis and Homer of Los Angeles.
Dr. McCoy was a former member of the Lyon-Lincoln
Medical Society, the Minnesota State Medical Associa-
tion and the American Medical Association.
1260
Minnesota Medicine
IN MEMORIAM
Municipal Bonds and Inflation
The problem of inflation and its eventual effect upon an investor’s savings was discussed in
our last article by quoting from an address of Mr. Phillips Barbour, editor of the BOND
BUYER, given before the Municipal Forum of the National Security Traders Association. The
quotations below are from the same address under the section entitled, “How Municipals Fit
Into the Picture.”
(1) They are secure: Municipals are the only form of investment among those mentioned, that
the investor can be as sure, as he can be about anything these days, that he will have his prin-
cipal returned to him in full on a specified date in future.
(2) Income is dependable: With few exceptions among those mentioned, municipals alone,
provide a regular income.
(3) They are the only income-producing investment in which the investor can know not only
the number of dollars he will receive on a certain date, but how many of those dollars he may
keep for himself to use as he wishes.
(4) There is opportunity for growth in market value of municipals, because as inflation grows
taxes usually grow, as a result the value of the municipal income grows because it is tax-exempt.
Thus, tax exemption tends to compensate for loss of purchasing power.
(5) Municipals are easy to buy or sell. Banks and brokers everywhere are accustomed to
handling such transactions.
(6) They are an ideal collateral for making quick loans and banks are in no way restricted in
making such loans.
(7) While municipals may not be bought blindly, the problem of picking a satisfactory in-
vestment in that category is simpler than in any other I know of, because the fundamental
security underlying all municipals is substantially the same.
(8) Most municipals are paid out of taxes and taxes must be paid before dividends. Thus these
securities have a prior claim, as it were, over dividends. When not paid out of taxes they are
paid from revenues received for vital services rendered, such as sale of water, on which they
have a monopoly.”
We have reprints of Mr. Barbour’s address available and will be pleased to send you one with-
out obligation, upon request.
JURAN & MOODY
MUNICIPAL SECURITIES EXCLUSIVELY
TELEPHONES GROUND FLOOR
St. Paul: Cedar 8407. 8408 Minnesota Mutual Life Bid?.
Minneapolis: Nestor 6886 St. Paul 1, Minnesota
ERNEST S. MARIETTE
Dr. Ernest S. Mariette, who completed thirty-three
years of service as superintendent of Glen Lake Sana-
torium before his retirement, November 1, 1949, because
of ill health, died October 29, 1950. He was sixty-two
years of age.
Dr. Mariette was born January 3, 1888, in Blue Earth
County. He graduated from the University of Minne-
sota Medical School in 1913 and interned at the Univer-
sity of Minnesota Hospital. From 1913 to 1916 he was
on the staff of Nopeming Sanatorium.
Under his direction, Glen Lake Sanatorium, Hennepin
County’s hospital for the tuberculous, became nationally
recognized as one of the great tuberculosis sanatoria of
the United States. It was the first tuberculosis hospital
in the country to receive a Class A rating from the
American College of Surgeons.
A member of the board of directors of the National
Tuberculosis Association, Dr. Mariette served as presi-
dent of the Mississippi Conference on Tuberculosis, as
president of the Minnesota Trudeau Society and, from
1946 through 1948, as president of the Hennepin County
Tuberculosis Association. He was a member of the
Hennepin County Medical Society, the Minnesota State
Medical Association, the American Medical Association,
and the American Hospital Association, and was an as-
sistant professor of medicine at the University of Minne-
sota Medical School.
December, 1950
1261
IN MEMORIAM
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Many outstanding physicians in tuberculosis work were
trained under his direction at Glen Lake Sanatorium. A
special contribution of Dr. Mariette was his pioneer use
of BCG vaccine in the protection of nurses and in
initiating an in-sanatorium program for the rehabilitation
of tuberculosis patients.
Dr. Mariette is survived by his wife, Anna ; a son
Sidney of Hopkins, and a daughter, Grace L. of Maple-
wood.
FRANK LYNAM
Dr. Frank Lynam, a resident surgeon at the Duluth
shipyards during both World Wars, died at his home in
Minneapolis, October 8, 1950. He was eighty-four years
of age.
Dr. Lynam was a graduate of Bowdoin College and
the Harvard Medical School. He was administrator of
the American Relief Administration in Russia in 1922.
At one time he was a member of the University of Michi-
gan Medical School faculty and was a medical super-
visor for the British in the Bahama Islands.
Surviving are his wife, Hazel, and two daughters.
WILLIAM ARNOLD MEIERDING
Dr. W. A. Meierding, who practiced in Springfield,
Minnesota from 1911 to 1927 and in Mankato from 1927
to 1931, died October 12, 1950 in Corona, California, at
the age of seventy.
Dr. Meierding was born at New Ulm, July 6, 1880.
He graduated from the LTniversity of Minnesota Medical
School in 1907 and interned at the Metropolitan Hospital
in Newr York City' and the Fergus Falls State Hospital.
In June, 1912, he married Alma Bendixen. They had
two sons, William and Robert. During World War I,
Dr. Meierding served as a lieutenant in the Medical
Corps.
EDWIN ELMER SHRADER
Dr. E. E. Shrader, formerly of Winsted, Minnesota,
died at Watertown, Minnesota, October 21, 1950. He
was eighty-eight years of age.
Dr. Shrader obtained his medical degree from the
University of Minnesota Medical School in 1893, and that
same year began practice in Watertown. In 1928 he re-
tired and moved to California. In 1935 he returned to
Winsted, where he practiced until 1950. On January 22,
1950, on the occasion of his retiring from practice and
moving to Watertown, he was tendered a farewell party
by his many friends.
Dr. Shrader was a life member of the Wright County
Medical Society, the Minnesota State Medical Associa-
tion and the American Medical Association.
In a world in which co-operation on the political level
seems at present an unrealizable dream, it is heartening
to recall that it has existed for a long time in the field
of health. Widespread public health is both an instru-
ment and a condition of any lasting peace. — Dr. F. W.
Behmler, Minnesota's Health, October, 1950.
1262
Minnesota Medicine
North Shore
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December, 1950
1263
Of General Interest
♦
4
Thirteen Minnesota physicians were inducted into
the American College of Surgeons at a meeting
in Boston on October 27. The physicians are Dr.
Charles F. Brigham, Jr., St. Cloud; Dr. Tague C.
Chisholm, Minneapolis; Dr. Walter K. Haven, Min-
neapolis; Dr. Richard C. Horns, Minneapolis; Dr.
Karl E. Johnson, Duluth; Dr. Malcolm R. Johnson,
Minneapolis; Dr. Donald R. Lannin, Saint Paul;
Dr. Donald P. McCormick, Minneapolis; Dr. Ray-
mond K. Minge, Worthington; Dr. Siegfried G. G.
Oeljan, Waseca; Dr. John H. Rosenow, Minneapolis;
Dr. Melvin Schlemenson, Saint Paul; Dr. Donald
E. Stewart, Crookston.
* *
Dr. A. L. Arends, formerly on the staff of the
state hospital at Moose Lake, has opened offices
for the practice of medicine in Cokato.
* * *
On November 16, Dr. C. R. Stanley of Worthing-
ton attended a meeting of the Eye, Ear, Nose and
Throat Society of Omaha and Council Bluffs. The
meeting was held in Omaha.
* * *
The thirtieth anniversary of the founding of the
Northwestern Clinic in Crookston was observed on
November 11 at the annual dinner for the staff and
employes. Fifty-two persons attended, in contrast
to the first dinner at which the attendance was five.
The clinic was founded thirty years ago by Dr.
M. O. Oppegaard, Dr. C. L. Oppegaard and the
late Dr. O. E. Locken.
* * *
Dr. Paul F. Brabec, formerly of Forsyth, Montana,
has opened offices for the practice of medicine in
Detroit Lakes.
3*C ^
Dr. J. Arthur Myers, professor of medicine, pre-
ventive medicine, and public health at the LTniversity
of Minnesota was awarded the Hoyt E. Dearholt
Medal given annually bv the Mississippi Valley Con-
ference on Tuberculosis for outstanding contribu-
tions to tuberculosis control. Presentation was made
to Dr. Myers at the annual Christmas Seal Dinner
of the Minnesota Public Health Association on Oc-
tober 25.
* * *
Dr. Charles W. Fogarty, Jr., of Saint Paul, ad-
dressed the Stearns-Benton County Medical Society
at St. Cloud on November 16. His subject was “The
Use of Cortisone and A'CTH in the Treatment of
Arthritis.”
* * *
The CARE-UNESCO Book Fund celebrated its
first anniversary on September 26 by announcing it
had received nearly a million dollars in contributions
and pledges to provide new books and scientific
equipment for educational institutions overseas.
The report showed that 378 educational institu-
tions in twenty-four countries have benefited by
deliveries of text and reference works purchased
with contributions of various amounts sent to the
Book Fund at CARE headquarters, 20 Broad Street,
New York City, and local CARE offices throughout
the United States, Canada and South America.
Poland and Czechoslovakia closed all CARE serv-
ice during the year, and deliveries to Korea have
had to be suspended because of the military situa-
tion. When conditions permit, the Korean operation
will be resumed.
Contributions in any amount are accepted by the
Book Fund. Sums under $10 are pooled in the gen-
eral fund. Donors of $10 or more may designate the
institution, country and category of book; CARE
returns to them a receipt signed by the recipient and,
on request, their name is inscribed on the special
CARE-UNESCO book plate in each volume. CARE’s
purchases are based on extensive book lists com-
piled by a committee of U. S. librarians and scien-
tists headed by Dr. Luther Evans, U. S. Librarian of
Congress.
* * *
Dr. Richard Utne of Northfield reported for serv-
ice at San Antonio, Texas, on November 1.
* * *
Dr. Stewart W. Shimonek, Saint Paul, announces
the association of Dr. Mentor H. Christensen in the
practice of orthopedic surgery at 942 Lowry Medi-
cal Arts Building. Dr. Shiminek has returned tem-
porarily to duty with the United States Navy.
* * *
Dr. Francis J. Savage and Mrs. Mary Watson
Blodgett were married on November 1, and are
at home at 719 Linwood Avenue, Saint Paul.
* * *
Christmas Seals — Again the Minnesota Public
Health Association is conducting its yearly sale of
Christmas Seals to assist in the fight against tuber-
culosis. While each year shows a drop in the tuber-
culosis death rate in the state, tuberculosis continues
to be first as a cause of death in the age group of
fifteen to thirty-five.
The funds collected through the sale of seals
finance educational programs, make possible tuber-
culosis testing surveys in our schools and assist in
paying for county-wide mass x-ray surveys.
It is imperative that the Christmas Seal Sale be
supported each year until tuberculosis is eradicated
from the human race.
* * *
Mrs. Donald S. Branham, the wife of Dr. Donald
S. Branham, staff member of the St. Peter State
Hospital, died in Mankato on October 31.
(Continued on Page 1266)
1264
Minnesota Medicine
FAY health/ financially
by
AVING that part of each dollar
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318 Bradley Bldg. Duluth, Minn.
Telephone 2-0859
THE MINNESOTA MUTUAL LIFE INSURANCE COMPANY
1880 — 70th Anniversary — 1950
December, 1050
1265
OF GENERAL INTEREST
1909. ...1950
Physiotherapy for the relief
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BROWN & DAY, INC.
St. Paul 1. Minnesota
(Continued from Page 1264)
Three Minnesota physicians were on the program
as Mankato held its special community Health Day
on October 11. Dr. Ralph Rossen, commissioner of
mental health in Minnesota, discussed the state’s
mental health program. Dr. William S. Chalgren,
Mankato, conducted a panel discussion on “The
Emotional Development of the Child.’’ Dr. Roger
W. Howell, associate professor of neuropsychiatry
at the University of Minnesota, spoke on “Parents'
Reaction to Their Children.”
* * *
Dr. Arthur H. Wells, Duluth, was re-elected presi-
dent of the Minnesota Division, American Cancer
Society, at its annual meeting in Saint Paul early in
November. He will be serving his third one-year
term in the office.
* * *
It was announced early in October that Dr. Keith
D. Larson had opened offices for the practice of med-
icine in White Bear. A graduate of Northwestern
University Medical School, Dr. Larson served his
internship at Presbyterian Hospital in Chicago. He
completed residencies in pathology and heart dis-
eases at Cook County Hospital, Chicago, and then
spent nearly five years at the Mayo Clinic.
* * *
Dr. and Mrs. R. V. Williams, Rushford, returned
in October from a three-month tour of Europe. Al-
though most of the trip was spent in Norway, they
also visited eight other countries.
❖ * *
Dr. Clyde A. Undine, Minneapolis, attended the
Midwest regional meeting of the American College
of Physicians at Madison, Wisconsin, on November
18.
* * *
Robert foyer, M.D., assistant medical director of
the Saint Paul Red Cross Regional Blood Center,
has resigned, effective December 1, to accept the
medical directorship of the Omaha Regional Blood
Center, according to an announcement by Dr. E. V.
Goltz, Saint Paul director.
The resignation leaves a vacancy at the center and
creates an opportunity for a young physician who
wishes to make a life work in hematology and pub-
lic health. Dr. Goltz pointed out that the program
is still in its infancy and that there are unlimited
opportunities in the field.
♦Thirty-five Red Cross blood centers are now in
existence and the schedule calls for the establish-
ment of fifteen additional centers within a five-year
period.
* * *
At the annual meeting of the Governors and Fel-
lows of the American College of Surgeons held in
Boston, October 26, Dr. Alton Ochsner, New Or-
leans, was elected president; Dr. Thomas H. Lan-
man, Boston, first vice president, and Dr. Joel W
Baker, Seattle, second vice president. These officers
(Continued on Page 126X)
1266
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December, 1950
1267
OF GENERAL INTEREST
REST HOSPITAL
2527 Second Avenue South, Minneapolis
A quiet, ethical hospital with therapeutic facilities
lor the diagnosis and treatment of nervous and
mental disorders. Invites co-operation of all repu-
table physicians. Electroencephalography avail-
able.
PSYCHIATRISTS IN CHARGE
Dr. Hewitt B. Hannah
Dr. Andrew I. Leemhuis.
(Continued from Page 126 6)
will be installed at the 1951 Clinical Congress to be
held in San Francisco. Dr. Owen H. Wangensteen,
Minneapolis, was elected to fill the unexpired term
of Dr. Dallas B. Phemister, resigned, on the Board
of Regents.
* * *
Under the teaching grant program, inaugurated
two years ago, the Public Health Service’s National
Heart Institute has awarded to date $1,463,814 to
forty-nine medical schools in twenty-nine states and
the District of Columbia to provide better teaching
equipment and wider instruction in heart disease.
Twenty-one new grants plus renewal of forty-four
earlier grants, making a total of $855,740, have been
approved for mental health research upon recom-
mendation of the National Advisory Mental Health
Council of the National Institute of Mental Health,
Public Health Service, according to a recent an-
nouncement of Oscar R. Ewing. One of the re-
search problems is the attempt to identify the dif-
ferent personality structure of the pre-diabetic. The
May Institute for Medical Research, Cincinnati,
Ohio, will make a three-year study of the mental,
emotional and physical make-up of a selected group
of pre-diabetic individuals before these people actual-
ly become ill. How this will be accomplished before
diabetes develops is not made clear, but doubtless,
tax dollars will solve the problem.
One hundred sixty-six grants, totaling $1,915,-
708 were awarded through the Public Health Serv-
ice’s National Institute of Mental Health to help
the expansion of teaching programs in medical
schools, universities and other training centers. In
addition, an allocation of $1,179,003 will make pos-
sible the award of about 560 stipends to graduate
students of psychiatry, clinical psychology, psychiat-
ric social work and psychiatric nursing. For these
purposes $158,248 goes to the University of Minne-
sota.
* * *
Dr. E. C. Kendall, director of the Mayo Clinic
biochemistry laboratory at Rochester, received the
medal of honor of the Canadian Pharmaceutical
Manufacturers Association at Ottawa on October
31 for his work in isolating cortisone and ACTH.
* * ' *
Dr, Gordon R. Kamman, Saint Paul, presented
the closing lecture at the Regional Postgraduate
Seminar in Gynecology held at Worthington. His
subject was “Psychosomatic Problems in Gyneco-
logic Practice.”
* * *
One of the series of articles entitled “How Ameri-
ca Lives,” which have been appearing in the Ladies
Home Journal, is a description of a country doctor
in the November issue. The editors of the publica-
tion chose Dr. Charles Sheppard of Hutchinson
from among several practitioners as being typical of
a small-town American doctor. Although hesitant
The Birches Sanitarium, Inc.
2391 Woodland Avenue
Duluth 3, Minnesota
A hospital for the care and treatment of
Nervous and Mental disorders. Quiet, cheer-
ful environment. Specially trained personnel.
Recreational and occupational therapy.
Dr. L. R. Gowan, M.D., M.S., Medical Director
Attending Psychiatrists
Dr. L. R. Gowan Dr. C. M. Jessico
Dr. I. E. Haavik Dr. L. E. Schneider
1268
Minn esota .\ I eihcin f.
OF GENERAL INTEREST
HAZELDEN FOUNDATION
Lake Chisago, Center City, Minn. Telephone 83
WHERE
ALCOHOLICS
ACHIEVE
INSPIRATION
FOR
RECOVERY
Where gracious living, a
homelike atmosphere and
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200 acres on the shores of beautiful Lake Chisago
The methods of treatment used at the Hazelden Foundation are based on a true understanding of the
problem of alcoholism. Among the founders of the nonprofit Hazelden Foundation are men who have re-
covered from alcoholism through the proved program of Alcoholics Anonymous and who know the problems
of the alcoholic. All inquiries will be kept confidential.
at first about lending his name to this type of pub-
licity, when he was assured that lie would be be-
yond criticism on the part of his confreres, Dr.
Sheppard agreed to co-operate with the magazine’s
representative. The result is an interesting article
about a small-town doctor and his family.
* * *
Dr. William B. Stromme, Minneapolis, spent a
week at the Cornell Medical Center, New York, from
November 11 to 18. He lectured at Cornell on the
subject, “Management of Abortion.’’
* * *
Dr. A. J. Chesley, executive officer of the Minne-
sota Department of Health, was given one of the
four Arthur Thomas McCormick awards for merito-
rious service in public health at the annual conference
of the Association of State and Territorial Health
Officers in Washington, D. C., on October 27.
* * *
Dr. Gaylord W. Anderson, director of the School
of Public Health at the University of Minnesota, was
named president-elect of the American Public Health
Association at its annual meeting in St. Louis,
October 30 to November 3.
* * *•
Dr. Betty St. Cyr Gilson, formerly of Robbins-
dale, has been named “Woman of the Year” by the
Great Falls, Montana, Busitiess and Professional
Women’s Club. Dr. Gilson received her award for
her work at the Western Foundation for Clinical
Research and as director of the Cascade County
rheumatic fever pilot program. A graduate of the
University of Minnesota, Dr. Gilson studied for five
years at the Western Reserve University Hospital.
She is married to Dr. John Gilson and is the mother
of two children.
* * *
Dr. Don E. Nolan, a native of Beardsley and a
graduate of the University of Minnesota Medical
School, has been named manager of a 325-bed Vet-
erans Administration hospital being built at Seattle,
Washington.
* * *
It was announced on November 16 that Dr. Dan-
iel K. Halvorsen, formerly of Minneapolis, had be-
come associated in practice with Dr. Ernest J. Nel-
son in Owatonna. A graduate of Yale University
Medical School, Dr. Halvorsen served his internship
at the University of Minnesota Hospitals. During
the past year Dr. Halvorsen was a fellow in surgery
at the University of Minnesota and served as a resi-
dent surgeon at Northwestern Hospital, Minneapolis.
i|c
Dr. Walter M. Boothby, professor emeritus of
the Mayo Foundation, has joined the staff of the
School of Aviation Medicine, Randolph Field, Texas,
as research advisor. While with the Mayo Founda-
tion, Dr. Boothby was chief of the section on met-
abolic research and he organized the aero-medical
December, 1950
1269
OF GENERAL INTEREST
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ACCIDENT * HOSPITAL ' SICKNESS
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All f fHYSlC,ANS \
\ PREMIUMS SU*GE0NS 1<^
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$10,000.00 accidental death $16.00
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$15,000.00 accidental death $24.00
$75.00 weekly indemnity, accident Quarterly
and sickness
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$100.00 weekly indemnity, accident Quarterly
and sickness
Cost has never exceeded amounts shown.
ALSO HOSPITAL POLICIES FOR MEMBERS
WIVES AND CHILDREN AT SMALL
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85c out of each $1.00 gross income used for
members’ benefits
$3,700,000.00 $16,000,000.00
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the beginning day of disability
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48 years under the same management
400 First National Bank Bldg., Omaha 2, Nebr.
unit for research in aviation medicine. For the past
two years lie has been advisor on research in avia-
tion medicine and physiology to the Swedish Avia-
tion Medicine ‘Council at the University of Lund,
Sweden.
❖ * *
Dr. Peter C. Peterson, formerly of Mora, has
moved into the offices of the late Dr. E. L. Baker
at 1517 Como Avenue S. E., Minneapolis. Dr. Pe-
tersen has been in practice since 1934, practicing
medicine at Braham, Mora, and Northwestern Hos-
pital, Minneapolis.
* * *
After practicing at Bird Island since 1946, Dr.
Walter E. Hinz has moved to Willmar and opened
offices for the practice of medicine there. A gradu-
ate of the Northwestern University Medical School,
Dr. Hinz served in the Army for three years during
World War II.
* * *
The second annual David L. Tilderquist memorial
lecture wras presented before the St. Louis Count\
Medical Society on November 9 by Dr. Heinrich G.
Kobrak, associate professor of otolaryngology at the
University of Chicago. The lecture, which was en-
titled “Going Behind the Iron Curtain of the Ear,"
included motion pictures showing the bones of the
ear in actual vibration. The pictures, taken with
high-speed photographic and stroboscopic equip-
ment, slow the vibrations to one per second and
show for the first time the actual function of the ear.
* * *
A grant by the government of $15,058 to the Uni-
versity of Minnesota for cancer research was an-
nounced on November 13. The grant is for a project
directed by Dr. George E. Moore, clinical instructor
in surgery at the University.
5{C
Five Minnesota physicians were certified as fellow--
of the International College of Surgeons at the an-
nual assembly of the United States Chapter in Cleve-
land early in November. They are Dr. Herbert H.
Busher and Dr. Wallace L. Fritz, both of Saint
Paul; Dr. Collin S. McCarty, Rochester; Dr. W. C.
Stillwell, Mankato, and Dr. Leonard A. Titrud,
Minneapolis.
* * *
Dr. B. J. Cronwell, Austin, attended the Utah re-
gional meeting of the American College of Physi-
cians at Salt Lake City early in November.
* * *
Dr. A. Mason Randall, Ashby, was paid tribute by
residents of the Ashby area at a special meeting held
in his honor on November 13. The program was
plannned in recognition of Dr. Randall's forty-one
years of service to the people of Ashby and vicinity.
j{j
Dr. C. H. Holmstrom, Warren, was elected presi-
dent of the board of education of the new Warren
Consolidated Independent District No. 2J at the
organizational meeting of the board in Warren late
in September. Dr. Holmstrom has served as presi-
dent of the Warren district for several years.
1270
Minnesota Medicine
OF GENERAL INTEREST
Dr. Charles W. Mayo, Rochester, was one of the
speakers at the dedication on November 5 of the
Lovelace Foundation’s million-dollar ' medical build-
ing in Albuquerque, New Mexico. Dr. W. Randolph
Lovelace II, a former member of the Mayo Clinic
staff, is now a member of the board of trustees of
the foundation.
Dr. Albert D. Corniea, Minneapolis, was guest of
honor at a dinner meeting of Maternity Hospital
medical staff and board members in Minneapolis on
October 30. Dr. Corniea has been a staff member
of Maternity Hospital for twenty-five years.
sjc
At a showing of the motion picture “Breast Self-
examination" in Crookston on November 6, Dr.
C. G. Uhley of Crookston acted as commentator for
the picture and conducted a question-and-answer ses-
sion following the picture. The showing of the film
was sponsored by the local American Legion post
and auxiliary and the First District of the Minne-
sota Nurses Association.
* * ❖
Dr. Henry W. Meyerding, Rochester, took office
as president of the United States Chapter of the
International 'College of Surgeons at the group’s
assembly in Cleveland, Ohio, on November 3.
It was announced on October 27 that Dr. Ber-
nard Nauth of Bemidji would practice in Gonvick
three afternoons each week, to substitute partly for
Dr. Norman F. Stone, who has gone back into mili-
tary service.
* ❖ *
The American College of Physicians held a post-
graduate course in peripheral vascular diseases in
Rochester, November 27 through December 2. Dr.
Walter F. Kvale, of the Mayo Clinic staff, was direc-
tor of the course.
* * *
Dr. Donald C. Anderson, formerly of Olivia, has
purchased the practice of Dr. W. E. Hinz in Bird
Island and has begun practice there. Dr. Hinz is
now practicing in Willmar.
* * *
Principal speaker at the dedication dinner for the
new student health service building at the Univer-
sity of Minnesota was Dr. William P. Shepard, presi-
dent of the American Public Health Association. At
the dinner, held in the University’s Coffman Memor-
ial Union, on November 6, Dr. Shepard spoke on
“Student Health and Public Health."
* * *
The counseling clinic of the Rochester-Olmsted
County Public Health Department acquired its first
full-time director during the first week of October
when Dr. George Williams accepted appointment to
the office. Dr. Williams was formerly on the staff
of the Minneapolis Veterans Hospital. A graduate
of St. Louis University, he interned at the St.
Mary’s group of hospitals in St. Louis.
December, 1 050
1271
OF GENERAL INTEREST
r<iiuMiiuiiiiiiiiiiiMiiiiMiiiiiHiiiMiiiMiiiiniiiiuiiiniMiiniiiiiiiniiiiiiiiiiiiiiiiiiiiiNiMniiiiiiiiiiiiiMiiniiiiiMiiiiiiiiiiiiiiiniiiiMiiiiiiiMiiiiiiiiiiiiiiiiiinHiiiiiiiiiiiiiiiniiiiiiiiinMiiiiMiiiiiiiiMiniiiiiUHMiiiMiMiiiiniMiiiiniiiiiiiiMiitiiiiiiii>r-
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5511 Lyndale Ave. So. LO. 0773 Minneapolis, Minn. =
Approximately 250 friends and relatives attended
an open house celebration of the golden wedding of
Dr. and Mrs. J. A. Thabes, Sr., Brainerd, last month.
Dr. Thabes and his wife are widely known in the
Brainerd area for their long and selfless service in com-
munity affairs. Dr. Thabes came to Brainerd in 1882
and has practiced medicine in that city for fifty-three
years. Dr. Thabes was honored by the Minnesota State
Medical association for completing fifty years of service
in medicine by being elected to membership in its
“Fifty Club” three years ago.
Recently Dr. Thabes was honored by the Elks and
Masons for having been an active member of each or-
ganization for fifty years. He is a charter member of
each. He has just completed serving as chairman of the
Crow YVing-Aitkin Sanitorium commission, a position
he has held for the past thirty-two years. He has been
a member of the Upper Mississippi Medical society for
30 years, since its organization ; was president of the
State Board of Health for eleven years and has been a
member of the American College of Surgeons for thirty
years.
Mrs. Thabes has also led an extremely active life, hav-
ing taught school a number of years, and working along
education and health lines. She has served as president
of the State Medical auxiliary for many years, and
headed the Red Cross in Crow Wing county for thirty
years. She has also been a member of the executive
committee of the Minnesota Public Health association
for twenty-five years, and has the distinction of being
the only woman president of that organization, serving
as such in 1947 and 1948. She was Republican stale
chairwoman in 1932-1933.
Dr. Thabes and his wife, among Brainerd’s leading
citizens, have served the community not only as a doctor
and his wife, but have been two of its most public-
spirited residents, giving much of their time to working
with and for the people of the locality.
HOSPITAL NEWS
Dedication of the new Ely-Winton Memorial Hos-
pital took place on November 12. Principal speaker
at the dedication of the thirty-five bed hospital was
Dr. Vernon D. E. Smith of Saint Paul.
* * *
Dedication services for the new 141-bed addition
to St. Luke’s Hospital, Duluth, were held on Novem-
ber 17. A box filled with articles and information
about the hospital, to be “of interest 200 years
hence,” was sealed in the cornerstone of the addi-
tion.
* * *
At a meeting of the commission for the Aitkin-
Crow Wing County sanatorium late in October, a
resolution was adopted recommending that the Deer-
wood Sanatorium be closed. It was pointed out that
modern surgical procedures cannot be carried out
in small sanatoriums, and that due to the limited
number of patients the cost of running a small
institution is proportionately too high. It was stated
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1272
Minnesota Medicine
OF GENERAL INTEREST
that if the patients at Deerwood Sanatorium had
been transferred to a large institution, there would
have been a saving to the counties of $13,000 last
year.
* * *
A new half-million-dollar building at the Roches-
ter State Hospital was dedicated on November 2.
The structure, which is part of a twenty-two-million-
dollar group of buildings being constructed under
the new mental health program, will house 150 aged
women patients with mental illness. Principal speak-
er at the dedication ceremonies was Governor Luther
Youngdahl. Dr. Magnus C. Petersen is superin-
tendent of the hospital.
* * *
The Valley view Hospital, near Shakopee, opened
its doors to patients on November 16. The five
buildings comprising the institution have been com-
pletely remodeled during the past two years under
the supervision of Dr. J. C. Michael, Minneapolis,
medical director of the hospital. Forty-four beds
were available at the time of opening, but when the
main structure is completed, the capacity will be
102 beds. The hospital will care for long-term
chronic and convalescent patients.
BLUE CROSS-BLUE SHIELD NEWS
More than 100,000 claims have been adjudicated by
Minnesota Medical Service, Inc. This represents some-
thing of a milestone in the progress of Blue Shield and
1 tears evidence of our increasing usefulness and value to
I lie contract holder.
Minnesota Blue Shield payments for September, 1950,
totaled $231,979.03, providing allowances on 6065 cases
covering 27,535 days of hospital care. Of these cases
4576 were for services rendered hospitalized patients ;
1465 for office cases and twenty-four for services ren-
dered in the patient’s home. Of the total payment for the
month, $210,590.91 was for hospitalized cases, $21,069.12
for office cases and $319.00 for home cases. Major surgi-
cal procedures totaled 818 representing 7004 days in the
amount of $85,282.82 ; minor procedures totaled 5247,
representing 20,531 days’ care with payment of $146,696.21.
Payments to participating doctors totaled $220,169.27,
representing 3517 surgical cases in the amount of $143,-
227.67; 1583 medical cases in the amount of $38,517.60,
and 720 obstetrical cases in the amount of $38,424.00.
Nonparticipating doctors in the state received payment
for fifty-eight surgical cases in the amount of $4,347.64 ;
thirty-eight medical cases totaling $960.50 and five
obstetrical cases in the amount of $318.00. Out-of-state
doctors received payments totaling $6,183.62 covering 144
cases.
Blue Shield enrollment increased during the month to
378,105 participant subscribers; 2001 new Blue Shield
contracts became effective. Blue Cross enrollment as of
September 30, 1950, totaled 1,027,701.
In order that insofar as possible all 1950 business can
be cleared during January, 1951, it is requested that each
of you submit claims on any unreported Blue Shield
cases. In addition if there are any claims which have
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been reported prior to October 1, 1950, on which no Blue
Shield action has been taken, it is suggested that these
cases again be reported, bearing the notation “duplicate.”
To enable the Blue Shield office to continue its effec-
tive operation, you, the doctor of medicine in Minnesota,
can immeasurably assist us by bearing in mind the im-
portance of submitting complete and accurate reports at
the earliest opportunity, giving all pertinent information
as to the patient, and also the type of service rendered.
In the adjudication and adjustment of Blue Shield
claims, Minnesota Medical Service, Inc., is pleased to
announce that Dr. Edwin J. Simons, formerly of Swan-
ville, Minnesota, as of November 1, 1950, assumed the
position of medical director.
December, 1950
1273
BOOK REVIEW
BOOK REVIEW
Books listed here become the property of the Ramsey,
Hennepin and St. Louis County Medical Libraries when
reviewed. Members, however, are urged to write re-
views of any or every recent book which may be of
interest to physicians.
THE MANAGEMENT OF OBSTETRIC DIFFICULTIES. By
Paul Titus, M.D., Obstetrician and Gynecologist to the St. Mar-
garet Memorial Hospital, Pittsburgh; Consulting Obstetrician
and Gynecologist to the Shadyside Hospital, Pittsburgh; Secre-
tary of the American Board of Obstetrics and Gynecology;
Member Reserve Consultants Advisory Board, Bureau of Medi-
cine and Surgery, United States Navy (Captain, MC, USNR).
4th ed. 1046 pages. Illus. Price $14.00. St. Louis: The C. V.
Mosby Company, 1950.
The purpose of this edition, as has been the purpose
of the other editions that Titus has written on manage-
ment of obstetric difficulties, is to provide information
that can be made quickly available to aid one’s judgment
in the proper management of obstetrical problems and
emergencies. It is therefore, very useful to the general
practitioner as well as the obstetric specialist. Funda-
mentals and theories have been eliminated to make the
material more concise. Emphasis has been placed on
diagnosis and treatment. The book covers by sections,
the topics on sterility, difficulties in diagnosis of preg-
nancy, complications of pregnancy, complications of
labor, obstetric operation, complications of the puer-
perium, the newborn infant, special supportive measures.
Many advancements have been made since the third
edition was published in 1945. These perhaps can be best
summarized in the word of Paul Titus himself in his
preface to the fourth edition ;
“New developments in sterility studies and treatment,
the current management of threatened and habitual abor-
tions, the changes in management of placenta previa, pres-
ent views on toxemia of pregnancy, the prevention and
management of hemorrhage and shock, are some of the
additions in revision. Changes in technique including,
induction of labor, preparation for delivery, perineor-
rhaphy, the management of third stage labor and of
retained placenta are described. The chapter on general
diseases complicating pregnancy has been added to and
revised. The chapter on pelvic mensuration and evalua-
tion by x-ray has been extensively revised and rewritten.
New methods of analgesia and anesthesia are discussed.”
In an attempt to maintain uniformity of terms before
this book was written, a conference was held between
Greenhill, Eastman and M. McCormick. Uniform terms
were decided upon by these men, and Titus has carried
out the use in this edition.
The book is a “must” on the new book list for general
practitioners in the country where immediate consultation
is not available. It should also be of considerable comfort
and interest to the resident staff members to help them
in their obstetric problems as they arise. To the specialist
it is an important reference book for the unusual com-
plications that arise during pregnancy and labor. The
book is well indexed to make the material readily avail-
able and also has many references for further study.
P. Theodore Watson, M.D.
Homewood hospital is one of the
Northwest's outstanding hospitals for the
treatment of Nervous Disorders — equipped
with all the essentials for rendering high-grade
service to patient and physician.
Operated i n Connection with
Glenwood Hills Hospitals
HOMEWOOD HOSPITAL
Corner Penn and Plymouth Avenues North
Minneapolis Minnesota
PATTERSON SURGICAL SUPPLY COMPANY
103 East Fifth St., St. Paul L Minn.
HOSPITAL AND PHYSICIANS SUPPLIES AND EQUIPMENT
Cedar 1781-82-83
fompkJtsL Jjcib&wkfu^ $sUwUsl in
Deep X-Ray Therapy Radium Treatment Clinical Biochemistry Tissue Examination
Roentgen Diagnosis Radium Rentals Clinical Pathology Clinical Bacteriology
Interpretation of YOUR E.K.G. records Toxicological Examinations
MURPHY LABORATORIES— E-rt 1919
Minneapolis: 612 Wssley Temple Bldg.. At. 4786; St. Paul: 348 Hamm Bldg.. Ce. 7125; Ii no answer call: 222 Exeter PI.. Ne. 1291
1274
Minnesota Medicine
MINNESOTA STATE BOARD OF MEDICAL EXAMINERS
(Continued from Page 1236)
Gold has three convictions in the District Court of
Hennepin County, Minnesota, for practicing healing with-
out a basic science certificate. He was first convicted
May 21, 1946, and placed on probation for one year. In
1948, he was arrested a second time and was sentenced
on March 8, that year, to serve one year in the Minne-
apolis Workhouse. Gold served the entire sentence less
time off for good behavior. Gold was convicted a third
time in January, 1950. According to Gold’s statement,
he was born in New York City and worked in a hospital
there as an orderly. When he first came to Minneapolis
he was, likewise, employed in a hospital in the capacity
of an orderly.
Minneapolis Woman Sentenced to Three-year Prison
Term for Fraud in Obtaining Narcotic Drugs
Re: United States of America vs. Helen Geneva Rudd.
On November 7, 1950, Mrs. Helen Geneva Rudd, aged
fifty-two, 4426 42nd Avenue South, Minneapolis, was
sentenced by the Hon. Matthew M. Joyce, Judge of the
United States District Court at Minneapolis to three
years in a Federal penal type institution. Mrs. Rudd will
serve her sentence at the Federal Women’s Reformatory
at Alderson, West Virginia.
Mrs. Rudd was arrested by Federal narcotic agents on
October 17, 1950, following an investigation which dis-
closed that she had given a false name to a Hennepin
County physician in obtaining dilaudid. Mrs. Rudd has
a long record of drug addiction. On September 27, 1934,
she was given a suspended sentence in the United States
District Court at Minneapolis, of eighteen months in a
Federal penal institution for violating the Harrison nar-
cotic law. Airs. Rudd violated her probation and on May
1, 1936, was ordered committed to serve her sentence.
Following her release, she was again arrested in July,
1938, for a similar offense, but was acquitted by a jury.
In January, 1943, Mrs. Rudd was again arrested for
violating the Harrison narcotic act,, and on March 2,
1943, entered a plea of guilty at Minneapolis. The charge
involved the forging of medical prescriptions. Mrs. Rudd
was placed on probation on condition that she take treat-
ment at the Government Hospital at Lexington, Ken-
tucky. She entered the Hospital and was released on
March 24, 1945. One week later she was arrested for
again attempting to obtain narcotic drugs. Her previous
probation was revoked and she was ordered committed
to serve her sentence.
In the present case, Mrs. Rudd persuaded a physician
to issue fourteen prescriptions for dilaudid and one for
codeine in a period of less than one month. The physi-
cian who prescribed the narcotic drugs has been ordered
to appear before the Minnesota State Board of Medical
Examiners at its next regular meeting.
MINNESOTA ACADEMY OF
MEDICINE
(Continued from Page 1249)
4. Cases have been mentioned in which variable results
are obtained, depending on the stage of the disease or
where surgery is still in the experimental stage.
5. Along with this discussion we have presented cases
with which we have had personal experience.
Dr. Francis W. Lynch, of Saint Paul, read a paper on
“The Quantitative VDRL Test for Syphilis.”
The meeting was adjourned.
Wallace P. Ritchie, M.D., Secretary
RADIUM & RADIUM D+E
(Including Radium Applicators)
FOR ALL MEDICAL PURPOSES
Est. 1919
Quincy X-Ray and Radium
Laboratories
(Owned and Directed by a Physician-
Radiologist)
Harold Swanberg, B.S., M.D., Director
W.C.U. Bldg. Quincy, Illinois
At your wholesale druggist or write for
further information
“DEE" MEDICAL SUPPLY COMPANY
P.O. Box SOI, St. Paul, Minn.
AMERICA’S AUTHENTIC
HEALTH
MAGAZINE
AMERICAN MEDICAL ASSOCIATION
3 YEARS $6.50
2 YEARS $5.00
1 YEAR $3.00
December, 1950
1275
Classified Advertising
Replies to advertisements zvith key numbers should be
mailed in care of Minnesota Medicine, 2642 University
Avenue, Saint Paul 4, Minih
LOCATION AVAILABLE— North of Twin Cities.
Clinic building owned by community. Reasonable rent.
For sale for price of equipment. Address E-233, care
Minnesota Medicine.
FOR SALE— Recently deceased well-established FACS
doctor’s general and surgical practice. 25 years in
present location. Only Protestant doctor in city of
7,000 near Twin Cities. Completely equipped modern
office. Living quarters available. Address E-239, care
Minnesota Medicine.
FOR SALE — Complete modern Westinghouse x-ray
equipment, basal metabolism machine, other electrical
equipment, instruments, examining table, furniture, et
cetera. Will sell at sacrifice for quick disposal. Retir-
ing. Address Charles P. Robbins, M.D., 67 W. Sixth
Street, Winona, Minnesota.
LOCATION WANTED — Young recent graduate, at
present in general practice, would like similar position
in Twin Cities. Available about February, 1951. Ad-
dress E-234, care Minnesota Medicine.
WANTED — General practitioner to take over practice
by lease or purchase, at very reasonable terms, in
prosperous western North Dakota community within
next six weeks. Full particulars by mail. Correspond-
ence solicited. Address E-236, care Minnesota Medi-
cine. '
WANTED — Young physician for general practice or
locum tenens in good farming community near Twin
Cities. $1,000 a month income. Address E-237, care
Minnesota Medicine.
WANTED — Physician, capable of doing refractions, for
general practice with small clinic in Northern Minne-
sota. Well-equipped clinic and hospital. Salary and
partnership. Address E-238, care Minnesota Medi-
cine.
WANTED — Locum tenens, three months or more.
$600.00 per month, or take over entire practice. Hos-
pital 12 miles. Address Box 165, Grey Eagle, Min-
nesota.
OFFICE SL1ITE FOR RENT — Three rooms or more.
Over drug store, corner 50th and France South, in
Edina. Will decorate to suit renter. Lease, if desired.
Address A. L. Stanchfield, 4424 W. 44th Street, Min-
neapolis. Telephone: MAin 3371 or WAlnut 4806.
FOUR-ROOM SUITE FOR RENT— White Bear Ave-
nue and W. Seventh Street, in St. Paul’s Hazel Park
District. Above drug store; dentist, hardware, and
bakery in same building. Will decorate to suit your
requirements. Formerly occupied by Dr. George L.
King. For further information, call or write Clapp-
Thomssen Company, 605 Minnesota Building, St. Paul
1, Minnesota. Cedar 7311.
PHYSICIAN WANTED — Draft creating vacancy for
M.D. in modern, fully equipped clinic in small north-
ern Minnesota town. Write Joe Dufault, secretary,
Oklee Community Hospital Association, Oklee, Min-
nesota.
PHYSICIAN WANTED — Excellent opportunity in
Southwestern Minnesota town located in good trade
territory. Hospital within ten miles on paved high-
way. Office space and equipment, including x-ray
machine, available at reasonable price. Address San-
born Community Club, Sanborn, Minnesota.
SCIENTIFIC DESIGN
ARTIFICIAL
Our mechanics correctly fit
LIMBS
artificial limbs and ortho-
pedic appliances, conforming
ORTHOPEDIC
to the most exacting profes-
APPLIANCES
sional specifications.
TRUSSES
Our high type of service
has been accepted by phy-
SUPPORTERS
sicians and surgeons for
more than 45 years, and is
ELASTIC
appreciated by their pa-
HOSIERY
tients.
BUCHSTEIN-MEDCALF CO.
223 So. 6th Street
Minneapolis 2, Minn.
POS’TIONS AVAILABLE
INTERNIST Doctors in town of 10,000 will refer work to one
internist. Good setup.
Minneapolis Internist desires board eligible man for
a pa tner.
Internists needed for Texas, Louisiana, South Dakota.
Nebraska. Florida. Ohio, Missouri, and Idaho.
GENERAL PRACTITIONERS wanted for partnership, Minne-
apolis doctor; also for locum tenens and many locations
where a doctor is essential.
PATHOLOGIST wanted in a large California Clinic.
OBSTETRICIAN-GYNECOLOGIST board eligible. Minnesota.
Beginning salary $1,000.
PHYSICIANS AVAILABLE
SURGEON board eligible, available now.
DOCTOR woman wants industrial position in city or an
association.
MEDICAL PLACEMENT REGISTRY
480 Lowry Medical Arts GA. 6718
St. Paul. Minnesota
Employers
OVERLOAD
Company
0{$ic.<L — Office Help at Hourly Rates
Our Employees are experienced, top qualified Steno's — Dictaphone Operators — Typists
— Bookkeepers — and are available for a minimum of four hours. We are the employers —
We pay all taxes and insurance — We keep all payroll records. You pay an invoice billing.
2800 Foshay Tower
Minneapolis: Li 0511
St. Paul: ZE 2700 (No Toll)
1276
Minnesota Medicine
UNIVERSITY OF CALIFORNIA
Medical Center Library
THIS BOOK IS DUE ON THE LAST DATE STAMPED BELOW
Books not returned on time are subject to a fine of 50c per volume after
the third day overdue, increasing to $1.00 per volume after the sixth day.
Books not in demand may be renewed if application is made before ex-
piration of loan period.
. IS. z ;30
|ov?5PM
S&P gfr 19JS
7 DAY
SEP - 1 1965
l?£TURNECS
AUG 3Q..1966
I im
|\tU JL Cj j
DrrT,lRMi.iJ
AUG 2 1967
5m-3,’47(A2646s2)4128
81958
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