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other line of human endeavor where you will find such a sum total of human benefit as is found in the accomplishments of Scientific medicine." The times demand progress. Then if we expect to have, and want to have an ideal Medical society, we must take an inventory of ourselves. Have we been doing our share in the advancement of medicine or have we been too content with ourselves, so selfcentered that we feel we are the Alpha and Omega of all things? Have we been practicing medicine along the lines of least resistance, or have we been alert to the continual advancement of our profession by attending clinics, Medical societies and reading our medical journals? A merchant, in order to sell his goods, must have his stock on the shelf in plain view for the people to see to buy, and the larger the stock the larger the store, the more customers and the more profit. Our investment is knowledge, plus the ability plus the ability to put it into active use to help the sick and afflicted, and the greater our knowledge and ability, the greater our returns, for there is no comparison between a business life and our professional life. In business you deal in hard, cold facts while in our profession we deal in human life, and that life is more dear to someone than all that money can buy. Sickness levels all distinctions, the rich and the poor are then equal and come to us for assistance.

I know in the last few years a great many men have become concerned because they think the standard of medicine is too high. They would have us make the Medical course easier and not so long, stating as their reason that it is taking the men from the rural districts and causing too many men to specialize and to locate in cities. To my mind such thoughts are wrong and not in harmony with the progress of the times. If we expect to educate the public against cults, fads and fancies, we cannot do so by lowering our standards, but by keeping them high and above reproach. In deciding upon what is necessary for the proper training of a medical student there should be but one question, i. e., what kind of training does a student need to make him a doctor who will live up to the high standards and traditions of medicine?

By letting down the bars through a shortened Medical course, the profession will immediately be flooded with men who are seeking financial gain and the social position which are assured by the title of "Doctor of Medicine." Through a stringent course such as we have at present, the profession is enabled to select for its members only those who look upon it as something sacred, and who are willing to make any sacrifice necessary. It is natural

that only those with such ideals will go through the hardships of the present long period of training.

Then there is the great increase in medical knowledge in the past thirty-five years, such as the discoveries of Pasteur, Lister and others. Medical science covers a larger field today than ever in the past, so we must enlarge our course of study rather than curtail it. Why aren't the rural districts entitled to the same high standards of education as the city? The shortage of doctors in rural communities has been greatly exaggerated. With our present good roads, the automobile and the telephone, one doctor is able to do the work of several who practiced under the old conditions. Also the rural hospital allows the modern doctor to centralize his patients, thus resulting in the saving of time. It does not take long to educate a community and as soon as the people find out a physician is capable, or in other words, "knows his stuff," they will give him their love and respect and help him on to prosperity.

If a community does not have a doctor, I believe it is invariably for the reason that it cannot keep the doctor busy enough to make even the most modest sort of living. The invasion of the small town by cult practitioners offers serious competition to the regular physician. The chief reason that the various cults, fads and fancies flourish, is because we do not act as a unit to educate the public against such things and demand from our Legislatures justice. It is high time we were taking some concerted action and demand that these parasites be denied the privilege to barter and sell their wares at the expense of human lives. If we could know of one single instance where they have given anything to Science or done anything worth while for suffering humanity then we could be more considerate, but they never have. Their chief mission is graft and they are making the public like it.

During the last war, on the battle fields of France, the world was not asking for Christian Science to relieve pain, or the Chiropractor to take care of the boys, nor did they ask any faddist to look after the sanitation of those great armies. NO. They asked for men of our profession to do that job and they got them freely and willingly, every man giving the best he had, with the one thought of doing his bit by helping the boys who had offered their lives in that great cause.

So then, if we have proven ourselves worthy in the times of great crises, then we must be worthy in private life. We need men of the profession who will go out and teach the public the real truths and we should demand from our law-making bodies a square deal and we

should see to it that real men represent us to demand our just rights against such cults. The only reason for the success of any cult is because it works overtime on the patient's mental state. I do not wish to be understood that I think we should adopt their methods, but I do believe we should pay a little more attention to the mental conditions of our patients. We have been too content with the material side of life and have not awakened to

the importance of psychology. Every physician must nowadays realize that to some extent there are mental factors in every complex disease and we should take time enough with our patients to explain to them their troubles and treat their mental as well as their physical condition.

Another point worthy of discussion is that of mal-practice suits. Before the days of the compensation law, the mentally abused injured workman and shyster lawyer usually got their graft money from the corporation for which he worked, but as the law now provides just amounts for his permanent disability, they are looking elsewhere for graft money and our profession is the object of their attack. Many malpractice suits are being brought about against men of the highest standing and integrity with absolutely no cause or foundation. It is simply obtaining graft money from the doctor who, although he has done everything within his power to bring about the best results possible, would rather pay a few hundred dollars than have newspaper notoriety. They know this and use it as a club over our profession. The time has come when we must take a stand against this injustice. We are going to have to fight in the open instead of trying to protect our good name with hush money. Why should we be ashamed of publicity if we have done our duty? We cannot stand idly by and let this nefarious work continue until it blights the onward progress of our profession. We must unite in one great mass and demand that such things be stopped. We do not demand these rights for ourselves. alone, but for the standards and traditions of medicine.

So, then, let us first place our own house in order.

Let us make a firm resolution to be bigger, better men.

Let us forget petty jealousies and resolve to be united in the common cause of humanity and the advancement of Scientific Medicine.

Let us not lower the standards of our profession but keep them on a high plane, ever remembering our duty to society, with deep reverence to the Great Physician who is the inspiration of all things worth while.

Let us demand justice against cults, fads and malpractice suits.

Never has there been a time when we have been in greater need of real men. God give us men with the courage of their convictions to carry on so that Scientific Medicine shall continue to be looked upon as the highest and most noble profession given to mankind.

REPORT OF COMMITTEE ON HIGH FREQUENCY CURRENTS

I

A. DAVID WILLMOTH, Chairman
Louisville, Ky.

N making this report the committee feels that it is quite within its rights to ask your indulgence for a few moments to the rapid changing of professional sentiment regarding physiotherapy as a whole and more especially High Frequency Currents. Where only a few years ago electrical treatments were decried they are today welcomed as part of the physician's armament. To the true physician who is endeavoring in every way possible to relieve suffering, the above agent has found an advocate after its use was explained and its virtues tried and the results noted not only by the physician but the patient as well.

Most of the prominent journals of the country are now glad to give space to articles on physiotherapy and the public at large demand its use for conditions they find are benefited by its use.

It is believed that in the past year or more, that to some extent, high frequency currrents have gained ground on the time-honored galvanic. Painful nerve involvements, etc., are being treated now by high frequency when formally they were given galvanism. This may be due to more physicians having machines for high frequency than galvanism, hence the report of more cases receiving this frequency has gained popularity in the past particular energy. In gynecology again high

year.

So many menstrual disorders are benefited by warm applications, that physicians having high frequency machines have logically gone to them seeking an agent that would best serve the purpose to reach the painful organs.

In painful joints from injury, nothing serves the purpose so well as properly applied diathermy. The patient is pleased with his treatment and is ever ready to come again for another.

So also in chronic biliary disease, the physician has found diathermy helpful in relieving a conditon that heretofore he suggested opera

Read at the Seventh Annual Session of the Western Physiotherapy Association, Kansas City, Mo., April 17, 1925.

tion. Combined with medication it holds a place worthy of trial.

As to new developments, we are approaching near to the time when glass electrodes will seldom be used. The danger of breakage alone being sufficient to attract attention to

other and more correct methods of applying this agent, and the results obtained by electrodes have proven their superiority over the old way.

In medical cases, pneumonia has attracted most attention and while the treatment is still in process of development, it has proven its rights to live and to serious consideration.

While commercialism practiced by manufacturers and from their viewpoint justly so, many unqualified users will bring the agent bad repute to a certain degree, yet your committee feels that the fields are broadening, and High Frequency is slowly gaining ground, and that its place in the practice of medicine is sure and certain. That it has already supplanted the time-honored cautery is well known to all. Few cases are now treated by cauterization, but electro-coagulation and dessication.

The committee feels it should again call attention to the number of oscillations, believing, as in the report of last year, that for diathermy a machine must be under a million in oscillation to penetrate the deep tissues and joints.

Again, pads have been studied and found to require about 10 to 12 minutes to heat and overcome their resistance, and recommend that their use be discarded except in thin patients where bony prominences make impractical the placing of block tin against the skin. Soaps and various other agents offer the same resistance as do pads and should, as a rule, be discarded.

ENSWORTH MEDICAL COLLEGE ALUMNI

The Alumni Association of the Ensworth Medical College was formed in Kansas City in October, with a membership of forty-three. Dr. Charles Geiger of St. Joseph was elected president of the association. The writer is very anxious to have enrolled all the graduates of Northwestern, Central and Ensworth Medical College. The dues are $1.00 per year. We hope to have 100 in attendance at the meeting next fall. All graduates of the three colleges mentioned above are urged to send in their names to the secretary for enrollment at once.

CHARLES WOOD FASSETT, M. D., Secretary. 115 East Thirty-first Street, Kansas City, Mo.

THE ROENTGENOLOGIC DIAGNOSIS OF
PEPTIC ULCER

THE COMPLICATIONS OF BRAIN
SURGERY

J. JAY KEEGAN, M. D.
University of Nebraska, College of Medicine,

Omaha.

the complications of delayed brain surg HE chief points of general interest are

ery and of ill-advised brain surgery. Speaking first from the medical viewpoint, nothing is more tragic than to have consultation delayed until irrecoverable blindness has occurred. I have in mind a young woman who developed severe headaches, projectile vomiting and sudden blindness after a week's illness. She came for surgical consultation a month later, with complete blindness, cerebellar syndrome and stupor. A cerebellar decompression revealed a healed basilar meninHer cerebellar symptoms gitis and block.

and stupor were entirely relieved by the operation and she recovered enough light perception to enable her to find her way about her home. Unquestionably, an earlier operation would have saved her sight.

Another handicap often placed upon the brain surgeon is delay by the physician until the patient with intracranial pressure goes into coma. The localizing reactions and reflexes of a patient in coma are largely masked by the general pressure, and a localizing diagnosis is impossible or made from history alone. A temporizing and usually very unsatisfactory decompression must be done if relief is attempted. Frequently, the patient has developed symptoms of medullary collapse. when any operative interference is useless.

or

A third cause of delay in the treatment of brain tumor is the removal of tonsils, drainage of nasal sinuses for relief of a choked disc of 5-7 diopters and spinal pressure of 40 to 50 m. of mercury. Although focal infection, and particularly a posterior ethmoiditis, may cause swelling of the optic disc, it is exceedingly rare for this to be more than 2-3 diopters.

I have in mind a case with marked choked disc but without localizing symptoms, who developed alarming intracranial pressure following tonsillectomy and sudden complete blindness a week later, relieved only partially by a hasty decompression.

The only way to avoid such complications is for every competent physician to recognize the early cardinal symptoms of intracranial pressure, which are persistent headaches, vomiting and visual disturbance. Even a rough test of the visual fields may indicate serious defect and a competent ophthalmolo

Dr. Russell D. Carman, Rochester, Minn. (Journal gist usually is available to examine the fundus

A. M. A., Oct. 31, 1925), gives a critical outline of the roentgen-ray examinations in ulcers of the stomach and duodenum and in cancer of the stomach.

of the eye and recognize choked disc.

Read before the Medical Society of the Missouri Valley, September 30, October 1-2, 1925.

The surgical complications of brain surgery are still sufficiently numerous to be quite discouraging. Many excellent general practitioners consider brain surgery futile and feel justified in letting death take its natural course. Many people still have a superstitious dread of brain surgery and cannot be convinced about even a very minor and comparatively safe operative interference. Under such circumstance it is hardly fair to leave the decision to them. The fairest argument for brain surgery, which applies particularly to brain tumor, is that without surgical interference the outcome will almost certainly be fatal, whereas there is a fair percentage of such cases that can be relieved by operation. A case in mind to illustrate this point showed a distinct left frontal lobe syndrome, rather rapidly increasing to stupor, coma and Cheyne Stokes respiration. It was thought to be an inoperable frontal lobe tumor and operation was not urged. However, the family preferred exploration and a large subdural hematoma was found and quite easily evacuated, with complete relief.

Spinal puncture is a dangerous procedure in brain tumor, particularly when the tumor is located in the cerebellum. Release of fluid often results in a jamming of the medulla and cerebellum down into the foramen magnum, with sudden cessation of respiration, and death. I prefer not to do spinal punctures in the presence of intracranial pressure and choked disc, for I have seen several deaths directly due to this procedure.

The first danger of a brain operation is the anesthetic. General anesthesia, particularly ether, increases intracranial pressure, and it may be impossible to maintain respirations under anesthesia. Local anesthesia then must be used or artificial respiration instituted until the intracranial pressure is relieved by puncture of a lateral ventricle or decompres

sion.

The technical complications of a brain operation are numerous. The most constant difficulty is hemorrhage, which cannot be controlled by clamps. The vessels of the scalp are imbedded in dense connective tissue, are held open by this tissue when cut, and bleed for a long period of time. They cannot be clamped with hemostat and must be controlled by pressure. This is applied by the fingers along the cut edges, by a special pedicle clamp at the base of the usual horseshoe shaped boneflap incision, and by hemostats on the aponeurosis beneath the scalp, reflected back over the scalp edge.

The next difficulty with hemorrhage arises From the emissary and diploetic veins in the

bone.

Intracranial pressure obstructs the usual flow of venus blood through the dura! sinuses into the internal jugular vein, forcing it out through the bone to the scalp veins. Bone wax is used for control of this, with partial success, for hemorrhage continues to some degree as removal of bone proceeds.

The third difficulty with hemorrhage arises from the meningeal vessels and dural sinuses The middle meningeal artery can give con siderable trouble when torn by the trephine, separation of dura, or breaking of bone in the temporal region. When dural sinuses begin to bleed, pressure and waiting for blood to clot are the chief resorts. It has been my experience that at some time in nearly every major brain operation there arises a when the blood from venous sinuses wells up to such a degree that it would seem impossible to control and necessitate discontinuance of the operation. However, a patient rarely bleeds to death, for with a drop in blood pressure, most venous bleeding stops. Closure may then have to be hurriedly made and a second stage operation planned a week or two later. In the beginning of brain surgery many operations had to be done in two stages on account of bleeding. Greater skill and familiarity with control of such hemorrhage. has less frequently necessitated this resort. Bleeding from the brain tissue incident to removal of a tumor also must be controlled

largely by hot packs as sutures rarely car be placed except on the surface.

When the dura is found extremely tense from intracranial pressure, it is not safe to open it, for the soft brain tissue will herniate thru the opening, causing bleeding and maceration and preventing closure. In such circumstance, puncture of a lateral ventricle is attempted before opening. If successful, sufficient cerebrospinal fluid is released to recomplications incident to this puncture. The duce the pressure. However, there may be depth and direction of the needle must be carefully controlled. I have seen a needle inserted into the mid-brain centers, causing paralysis and death. The lateral ventricle may be obliterated by pressure and no fluid can be obtained. In such a case, one usually regrets opening the dura.

Acute brain edema following an operation is a much dreaded complication. It is more likely to occur following an unsuccessful exploration but may follow when a tumor has been removed and relief of intracranial pressure expected. It is due to the sudden relief of a high grade pressure and to traumatization of the brain. It usually causes a fatality within 48 hours but sometimes can be relieved by intravenous injection of hypertonic solutions.

DIATHERMY IN MEDICAL KIDNEY the kidneys, thus producing an active hypere

DISEASES

G. KOLISCHER, M. D., CHICAGO, ILL.

Senior G. U. Surgeon, Michael Reese and Mount Sinai Hospitals

CON

ONDITIONAL with the successful employment of diathermy in medical renal diseases is the proper grouping of the cases and the judicious approach to the organs to be heated.

For elucidating these points it may be helpful to make a few remarks concerning the physiology of the kidney and the pathology

of the maladies under discussion.

It is the task of the kidney to maintain the concentration of the blood at a level most fa

vorable for the absolving of the bodily functions. Therefore the kidney has to eliminate the end-products of the metabolism which either are of no further use to the system or if retained may act as noxae to the organism. All these products are eliminated in a watery

solution.

Consequently the kidney has to produce these end-products and also has to furnish the water necessary for dissolving them. For this duel purpose the kidney is equipped with a dual apparatus, the vascular system functionally mainly represented by the glomeruli, and the tubular system with its secreting epithelia.

The glomeruli furnish the urinary water and eliminate the nitrogen compounds, while the tubular system produces the urinary solids clinically prominent among them the chlorides.

Under the scope of medical diathermy nephritis and nephrosis only are considered. Inflammatory changes in the vascular system of the kidney are denominated as nephritis, degenerative processes in the tubular epithelia are subsumed under the term nephrosis. That a persistent nephritis will eventually lead to the establishment of nephrotic changes is obvious.

The tubuli depend in their nutrition upon the arterioles emanating from the glomeruli and therefore will suffer from glomerular ischemia, the extent of the damage being governed by the number of glomeruli involved and by the duration of this disorder.

The indications for diathermic applications have to be formed according to the character of the renal pathology.

Glomerulonephritis being a disorder of an ischemic character calls for local diathermy of

Abstract of paper prepared for the Seventh Annual Session of the Western Physiotherapy Association, Kansas City, Mo., April 13, 1925.

mia where it is most needed.

The objection to diathermy, that if used in nephritis, may increase the hematuria, especially in acute cases, is not well founded.

The bleeding is to a certain extent a curative agent, it reduces the congestion within the glomeruli thus relieving the principal pathologic feature, the ischemia. The only restriction to be placed on the diathermic application concerns the amperage in treating the left kidney. The heart in nephritis is always involved to a greater or less. extent. strained heart is very sensitive toward heating, consequently one has to be rather careful in choosing the dosage while diatherming the

left side.

In selecting the place for applying diathermy in cases of nephrosis a very important factor in normal and pathologic renal physiology has to be considered.

It is now a very well established fact that the metabolic end products are not immediately by the blood stream carried for elimination to the kidneys, but at first, in normal cases only temporarily, are deposited in other structures and later on are picked up again and transported to the kidneys for final disposal. Among these temporary depositories the subcutaneous fibrous tissue plays such an important role that it is called the adventitious in the subcutaneous tissue and on account of kidney. If for instance chlorides are deposited disturbances in its capillary system the chlorides are not carried off but remain there, they will attract water and retain it, producing edema.

This consideration will establish the point of attack for diathermic treatment.

A local application of heat to the kidneys based upon a renal vascular disturbance but we will not mean much because nephrosis is not will endeavor to stimulate the general circulation and particularly and the capillary activity in the subcutaneous tissues. Therefore we will use auto-condensation and local diathermy on the lower extremities.

If already edema of the lower limbs prevails low amperage has to be employed, because an edematous skin is rather vulnerable.

It has to be understood however that diathermy is not a cure all or the cure for medical kidney diseases, it is only a powerful aid and all the other known methods for dealing with these disorders have to be employed simultaneously.

THE COMEBACK

Fare (to driver of senile taxi)-Make a very good hearse, that taxi of yours.

Driver-'Appy to take you at any time, sir.

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