normalize fat metabolism ... protect the liver ... LIPOLIQUID Each tablespoonful (15 cc.) contains: Cholinet- (equivalent to 9.15 Gm. of choline dihydrogen citrate) 3.75 Gm. Vitamin B1~ U.S.P. . 4.20 mcg. Inositol . . . • • • . , - 75.00 mg. *As tricholine citrate, Pint bottles. Dosage: 1 to 2 tablespoonfuls daily for adults. LIPOLIQUID is sugar- and alcohol-free, In your diabetic, cirrhotic, overweight and geriatric patients liver damage may be aggravated by dietary restrictions and other factors which reduce intake of lipotropics essential for liver protection. LIPOCAPS and LIPOLIQUID provide the massive doses of choline and~ other important lipotropics needed to improve hepatic function, facilitate mobilization and transport of fat and curb fatty infiltration of the liver. LIPOCAPS® Each orange capsule contains: Choline bitartrate di-Methionine Inositol . Bottles of 100. Dosage: One capsule three times daily. 450 mg. 150 mg. 100 mg. wal!eMC!e ~a6m-aam:&J, INC., MILWAUKEE 1, WISCONSIN of the MAHONING COUNTY MEDICAL SOCIETY The superiority of Vitamin B Complex derived from natural sources has been well established. Jolliffe 1 has attached special importance to this subject and Lewey and Shay 2 have stressed the necessity for natural substances. Samples on Request formula: E ac h T easpoonful (4 cc.) c on tains: T hiamine Hydrochloride 2 .1 mg. R iboflavin 3.S m g. N iac inamide ... .. 25.0 m g. Pyrid ox ine (BG ) 0.0 56 m g . Calci um P antothenate .. 2.5 m g. p lus Chol in e, a n d oth e r factors of the B-Com plex p r esent in t he n a tural base. The Ribo flavin content is der ived entirely from nat u ra l sou1 ..: cs. BASE: Rice Bra n , Cor n, Liver Conce ntra te. SUPPLIED : in 4 -oz. R x size. / NOW CONTAINS "'VITAMIN B 12 - lmcg Each Capsule Contains: · Thiam ine H ydrochloride 10 mg. IS mg. Riboflavm Nia cina mide ................... 100 mg. P y r idoxine ... ... . Calcium. Pantothenate C holine Dihy drogen Citra te lnositol Fol ic Acid Liver Ex t ract (secondary) Brewe r s' Yeast E x cracc pl us othe r f actors of the B-Complcx present in Whole Liver. BASE: Live r and Yeasc. SUPPLIED : in 50's and IOOO's. 1 mg. 10 mg. 20 m g. 20 m g . ... 0. 25 m g. . .. . 100 m g . .. . 100 m g. 1. Jolliffe, N., Special Article, Council on Foods and Nutrition: The Preventive and Therapeutic Use of Vitamins, J.A.M.A., 129:618, Oct. 27, 1945. 2. Lewey and Shay, Dietotherapy, Philadelphia, W. B. Saunders Co., 1945, p. 850. 26 CHRISTOPHER STREET NEW YORK 14, N. Y. THE MAHONING COUNTY MEDICAL SOCIETY OFFICERS AND COUNCIL OFFICERS 363 J. D. BROWN, President 706 Home Savings I. C. SMITH, President-Elect 210 Home Savings G . E. DeCICCO, Secretary 1008 Market Street & Loan Bldg. & Loan Bldg. A . K. PHILLIPS. Treasurer 2SO Lincoln Avenue Censors Delegates MRS. MARY B. HERALD. Executive Secretary l2S West Commerce Street E. J. WENAAS ('S4) W . M. SKIPP ('S4 ) Alternate Delegates ASHER RANDELL ('S4) E. R. McNEAL ('S4) C. A. GUSTAFSON ('SS) V. L. GOODWIN ('S6) S. W. ONDASH ('SS ) M. W. NEIDUS ('S6) FRED G. SCHLECHT ('S4) J. D. BROWN THE COUNcn C. A . GUSTAFSON A . K. PHILLIPS ASHER RANDELL FRED G. SCHLECHT W. M. SKIPP G. E. DeCICCO A . A . DETESCO V. L. GOODWIN E. R. McNEAL M. W . NEIDUS S. W. ONDASH I. C. SMITH E. J. WENAAS Representative to the Associated Hospital Service H. E. PATRICK TABLE OF CONTENTS VoL XXIV-No. 7 Dean's Page Editorial Page Do's and Don'ts With Narcotics Why Some Doctors Take Dope Keeping Up With The A.M.A. - Agency As It Affects Physicians Gynecological Operations - St. Elizabeth Hospital Ex-Intern Reunion Trends and Events Miscellany - July, 1954 364 365 366 367 3.$9 387 391 $93 39S 397 Why Not Encourage the Self-Employed to Build Their Own Retirement Funds - 400 From The Bulletin- 20 Years Ago-10 Years Ago Proceedings of Council 401 402 A Nightmare 403 Periodical Pearl 40S ADVERTISERS' LIST Blair Dry Cleaning Co. . . 380 Lester's Pharmacy . ... . .. . . .......... 394 Borcherdt Malt Extract Co. 380 Lilly. Eli & Co. . ....... ........... 370 Bowman Bros. Co. . ... . . . 390 Lyons Physician Supply Co. . . 376-382 Ciba . . .. ... .. ..... 394-396 Merrell. Wm. S. Co. . . 390 Columbus Pharmacal Co. . . . 388 O'Linn's Drugs .. . . ... . . ..... 376 Cross Drugs .. 386 Overlook Sanitarium ..... 404 Endo Products . . . . . . . . . . . . . 390 Parke-Davis . . . . . . . . . . . . . . . . . . . . . . 37 4 Fellows ..... 362 Renner's ...... .. ....... 388 Geigy Pharmaceuticals ... . ... ... .... 372 Scott Co. . . . .. . .. . ..... 378 Harvey Co. . . . . . . . . . . . .. 390 Squibb ... 368 James & Weaver .394 Laeri's Pharmacy. . . .. 388 Stillson & Donahay 382 Thornton Dry Cleaning Co. . .......... 386 Lakeside Laboratories Cover Yo. Com. for Education on Alcoholics .. 380 Leder le . . . 378-386 Zemmer Company . .... . ..... 388 l 9 s 4 The superiority of Vitamin B Complex derived from natural sources has been well established. Jolliffe 1 has attached special importance to this subject and Lewey and Shay 2 have stressed the necessity for natural substances. Samples on Request formula: Each Teaspoonful (4 cc.) contains: Thiamine Hydrochloride 2.5 mg. Riboflavin 3.S mg. Niacinamide ..... 25 .0 mg. Pyridoxine (Bs) 0.056 mg. Calcium Pantothenate ... 2.5 mg. plus Choline, and other factors of the B-Com plex present in the natural base. The Ribo £lav1n content is derived entirely from nat ural sou1..:es. BASE: Rice Bran, Corn, Liver Concentrate. SUPPLIED : in 4-oz. Rx size. / NOW CONTAINS "'VITAMIN B 12 - lmcg fach Capsule Contains: . Thiamine Hydrochloride Riboflavm I 0 mg. IS mg. Niacinamide .................. 100 mg. Pyridoxine .... .. . Calciun1 Pantothenate Chol in e Dihydrogen Citrate Inositol ...................... . Fol ic Acid Liver Ex tract (secondary) Brewers' Yeast Extract pl us other f a ctors of the B·Complex present in Whole Liver. BASE : Liver and Yeast. SUPPLIED : in 50's and IOOO's. 1 mg. .. 10 mg. 20 mg. 20 mg. ... 0 . 25 mg. ..... 100 mg. ... 100 mg. 1. Jolliffe, N., Special Article, Council on Foods and Nutrition: The Preventive and Therapeutic Use of Vitamins, J.A.M.A., 129:618, Oct. 27, 1945. 2. Lewey and Shay, Dietotherapy, Philadelphia, W. B. Saunders Co., 1945, p. 850. 26 CHRISTO!>HER STREET NEW YORK 14, N. Y. THE MAHONING COUNTY MEDICAL SOCIETY OFFICERS AND COUNCIL OFFICERS 363 J. D. BROWN, President 706 Home Savings I. C. SMITH. President-Elect 210 Home Savings G . E. DeCICCO, Secretary 1008 Market Street & Loan Bldg. & Loan Bldg. A. K. PHILLIPS. Treasurer 2SO Lincoln Avenue Censors Delegates MRS. MARY B. HERALD. Executive Secretary l2S West Commerce Street E. J. WENAAS ('S4) W . M. SKIPP ('S4) Alternate Delegates ASHER RANDELL ('S4) E. R. McNEAL ('S4) C. A. GUSTAFSON ('SS) V. L. GOODWIN ('S6) S. W. ONDASH ('SS) M. W. NEIDUS (' S6 ) FRED G. SCHLECHT ('S4) J. D. BROWN THE COUNcn C. A . GUSTAFSON A. K. PHILLIPS ASHER RANDELL FRED G. SCHLECHT W. M. SKIPP G. E. DeCICCO A. A . DETESCO V. L. GOODWIN E. R. McNEAL M. W. NEIDUS S. W. ONDASH I. C. SMITH E. J. WENAAS Representative to the Associated Hospital Service H. E. PATRICK TABLE OF CONTENTS Vol. XXIV-No. 7 Dean's Page Editorial Page Do's and Don'ts With Narcotics Why Some Doctors Take Dope Keeping Up With The A .M.A. . Agency As It Affects Physicians Gynecological Operations - St. Elizabeth Hospital Ex-Intern Reunion Trends and Events Miscellany · July, 1954 364 365 366 367 3.$9 387 391 ~93 39S 397 Why Not Encourage the Self-Employed to Build Their Own Retirement Funds . 400 From The Bulletin- 20 Years Ago-10 Years Ago Proceedings of Council 401 402 A Nightmare Periodical Pearl Blair Dry Cleaning Co. Borcherdt Malt Extract Co. Bowman Bros. Co. Ciba Columbus Pharmacal Co. Cross Drugs Endo Products Fellows Geigy Pharmaceuticals Harvey Co. . .. . .... . . 403 40S ADVERTISERS' LIST .. 380 380 . ....... 390 ..... 394-396 . .. 388 386 .390 . . . 362 ... 372 . .. 390 ... .... 394 Lester's Pharmacy .............. ..... 394 Lilly, Eli & Co. . .................. 370 Lyons Physician Supply Co. . . 376-382 Merrell. Wm. S. Co. . .. 390 O'Linn's Drugs ....... .. ..... 376 Overlook Sanitarium ..... 404 Parke-Davis . . . . . . . . . . . . . . . . 374 Renner's ....... 388 Scott Co. . . . . 378 Squibb ... 368 Stillson & Donahay . 382 James & Weaver Laeri's Pharmacy . . Lakeside Laboratories Lederle . . ... ... ....... 388 Thornton Dry Cleaning Co. . ........ . . 386 1 9 S 4 Cover .. . 378-386 Yo. Com. for Education on Alcoholics .. 380 Zemmer Company ........... 388 364 BULLETIN Northwestern University extends greetings to its many alumni in Ohio. There are over 2,000 general alumni of whom 122 are graduates of the Medical School. Ohio stands fourth among the states in the number of applications and accepted students enrolled at Northwestern University Medical School. Also, the performance of Ohio students has been excellent; this speaks well for the superior training afforded by Ohio's undergraduate colleges. Northwestern University Medical School was organized in 1859 as the Medical Department of Lind University of Chicago; its first annual course of medical instruction began October 9, 1859. The Medical School has occupied the beautiful Montgomery Ward Building since 1926 and uses the first 7 floors, the 14th and 15th floors and all of the tower of this building. The Archibald Church Library, located in the east wing of the first floor, contains over 125,000 bound volumes, which make this Medical Library one of the largest in the country. The Outpatient Clinics occupy the first 3 floors. Affiliated with the Medical School for its clinical teaching are Wesley Memorial Hos pital (560 beds), Passavant Memorial Hospital (260 beds), Evanston Hospital, (296 beds), Veterans Administration Research Hospital (523 beds), and Chil dren's Memorial Hospital (233 beds). Other hospitals not directly affiliated with the Medical School and not in the Medical Center are St. Luke's Hospital (579 beds), Chicago Maternity Center and Cook County Hospital (3,500 beds). Northwestern has gained an outstanding reputation for producing well rounded clinicians and, in addition, has an envious record for its production in research and its training of academic personnel. Richard H. Young, M.D. Dean, Northwestern University Medical School, Chicago, Illinois This message was written expressly for the Mahoning County Medical Society Bulletin JULY THE MAHONING COUNTY MEDICAL SOCIETY 365 BULLETIN of the Mahoning County Medical Society Published Monthly at Youngstown, Ohio Annual Subscription, $2.00 The opm1ons and conclusions expressed herein do not necessarily represent the views of the Editorial Staff or the official views of the Mahoning County Medical Society. VOLUME 24 JULY, 1954 NUMBER 7 Published for and by the Members of the Mahoning County Medical Society EDIT:::lR P. B. Cestone J. L. Fisher R. A. Jenkins A. A. DETESCO 2921 Glenwood Ave. ASSOCIATE EDITORS E. R. McNeal F. W . Morrison S. W. Ondash EDITORIAL DO UNTO OTHERS C. W . Stertzbach R. L. Tornello D. H. Levy There has been much written and said lately in an attempt to undermine public confidence in the medical profession. While we have been busy beating off attacks frcm wi1hout we have overlocked the fifth column within our own ranks. This is that group of physicians who, usually in a subtle manner, destroy public faith in the profession by degrading their colleagues in an attempt to aggrandize themselves. This is done by innuendo, inflection a nd half truths. Many remarks are made which disparage the diagnostic and therapeutic ability of other physicians. Let us be honest and fair with each other and let us recall and para phrase what Adlai Stevenson recently said, "he who throws dirt always loses a little ground." Andrew A. Detesco, M.D.-Editor. 1 9 5 4 364 BULLETIN Northwestern University extends greetings to its many alumni in Ohio. There are over 2,000 general alumni of whom 122 are graduates of the Medical School. Ohio stands fourth among the states in the number of applications and accepted students enrolled at Northwestern University Medical School. Also, the performance of Ohio students has been excellent; this speaks well for the superior training afforded by Ohio's undergraduate colleges. Northwestern University Medical School was organized in 1859 as the Medical Department of Lind University of Chicago; its first annual course of medical instruction began October 9, 1859. The Medical School has occupied the beautiful Montgomery Ward Building since 1926 and uses the first 7 floors, the 14th and 15th floors and all of the tower of this building. The Archibald Church Library, located in the east wing of the first floor, contains over 125,000 bound volumes, which make this Medical Library one of the largest in the country. The Outpatient Clinics occupy the first 3 floors. Affiliated with the Medical School for its clinical teaching are Wesley Memorial Hos pital (560 beds), Passavant Memorial Hospital (260 beds), Evanston Hospital, (296 beds), Veterans Administration Research Hospital (523 beds), and Chil dren's Memorial Hospital (233 beds). Other hospitals not directly affiliated with the Medical School and not in the Medical Center are St. Luke's Hospital (579 beds), Chicago Maternity Center and Cook County Hospital (3,500 beds). Northwestern has gained an outstanding reputation for producing well rounded clinicians and, in addition, has an envious record for its production in research and its training of academic personnel. Richard H. Young, M.D. Dean, Northwestern University Medical School, Chicago, Illinois This message was written expressly for the Mahoning County Medical Society Bulletin JULY THE MAHONING COUNTY MEDICAL SOCIETY 365 BULLETIN of the Mahoning Count~ Medical Societ~ Published Monthly at Youngstown, Ohio Annual Subscription, $2.00 The opinions and conclusions expressed herein do not necessarily represent the views of the Editorial Staff or the official views of the Mahoning County Medical Society. VOLUME 24 JULY, 1954 NUMBER 7 Published for and by the Members of the Mahoning County Medical Society EDIT:rn P. B. Cestone J. L. Fisher R. A. Jenkins A. A. DETESCO 2921 Glenwood Ave. ASSOCIATE EDITORS E. R. McNeal F. W . Morrison S. W. Ondash EDITORIAL DO UNTO OTHERS C. W. Stertzbach R. L. Tornello D. H. Levy There has been much written and said lately in an attempt to undermine public confidence in the medical profession. While we have been busy beating off a ttacks from wiihout we have overlooked the fifth column within our own ranks. This is that group of physicians who, usually in a subtle manner, destroy public faith in the profession by degrading their colleagues in an atte mpt to aggrandize themselves. This is done by innuendo, inflection a nd half truths. Many remarks are made which disparage the diagnostic and therapeutic ability of other physicians. Let us be honest and fair with each other and let us recall and para phrase what Adlai S tevenson recently said, "he who throws dirt always loses a little ground." Andrew A. Detesco, M.D.- Editor. 1 9 5 4 366 BULLETIN DO'S AND DON'TS WITH NARCOTICS There is no worse trouble a doctor can get into than trouble with the Treasury Department over narcotics. There is no need to if he follows the rules laid down by the Harrison Act. Yet, a doctor sometimes does get in trouble innocently or carelessly and the result is most damaging to his prestige and his pocketbook. Never hesitate to prescribe a narcotic for a bona fide patient who needs it. Narcotics are valuable drugs mostly used for the relief of pain and relief of pain is one of the greatest services· a doctor can give. Write your prescription legibly, specify the amount, the dose and the time; put your licensed number on it (don't have it printed) =d give it to the patient. If the patient needs mere, see and examine him and write a new prescription. Don't call the druggist and ask him to refill and you will send the prescription later, even for codeine in a cough syrup. That makes both you and the druggist liable for infro:ction of the law, and inspectors are sticklers for the law. When you need narcotics for personal administration fill out a narcotic order blank and get it from a supply house which holds a wholesale license. Don't write a prescription for some patient and keep the drugs yourself. You don't have to keep a record of narcotics you personally administer but if you leave a supply with a patient you have to make a record of it and keep the record on file for two years. Don't be fooled by addicts. They have the most convincing stories. You can spot them when they say ··Nothing helps me but a hypodermic." A bona fide patient in great pain says "For heaven's sake do something" but an addict says "I always have to have a half a grain." One time a nurse came in my office clutching her abdomen, all bent over and said, "I think I have a kidney stone, give me a hypodermic quickly. Dr. Smith took care of me the last time I had one and he gave me morphine." I gave her a container and showed her to the toilet to get a specimen. She brought it back and it had blood in it. I gave her a hypo, put her in my car and took her home. The next day I called Dr. Smith and he said "She is an addict, don't let her fool you." She took me in that time but not again. Another story they give is "I am on my way to a Sanitarium for cure of my habit but I ran out of drugs. Just give me two or three tablets so I can get there." The answer is "no." If you are soft and easy, the word gets around and you will have many more of these phony emergencies. Don't try to treat addicts by the withdrawal method, or any method out side of an established institution. You can't do it at home nor in a general hospital. Leave it to the experts who work in sanitaria where there is close supervision. They advertise in the medical journals, so leave it to them. Don'i give an addict a supply of narcotics io reach his destination. He will use it up and appear in your office for more. They are the most unreliable people in the world. Last but not least, fill out your inventory and get your renewal of your license in on time with the M.O. for a dollar. If you don't, you will be asked to explain why you have been dispensing narcotics without a license, and may be requested to make a cash offer in settlement for your infraction of the law. Your forms are sent a month in advance and that should be plenty of time. Follow the letter of the law and you will have no trouble with narcotics. J. L. F. THE MAHONING COUNTY MEDICAL SOCIETY 367 WHY SOME DOCTORS TAKE DOPE The following is a paraphrasing of an article by ]. DeWitt Fox, M .D. Editor. The American public is opening its eyes to the dope menace. We abhor the crime stories of teen-age youth having marijuana parties then hot-rodding down our highways at 80 per. We shudder at the thought of some "pusher" seducing our sons and daughters into houses of ill-fame. But all too often the man nearest the narcotic needle overlooks the menace in his own little black medical bag. Dr. Hanis Isbell, Director of the U. S. Public Health Service Hospital in Lexington, Kentucky, the Nation's leading treatment center for addiction, says, "Scarcely a week passes that a physician who is a Demerol addict is not admitted to our institution." (Since Demerol made its appearance most new physician addicts take to it rather than morphine.) Of course, all physician addicts are individuals, and their stories con cerning the onset of addiction are different, but there are three common patterns into which physician addicts fall. According to Dr. Isbell these are: 1. Alcoholic physicians who relieve hangovers with opiates. 2. Tired doctors who habitually blot out fatigue with a narcotic. 3. Doctors suffering pain from disem:e, who overdose themselves with opiates. What most physicians need is a good night's sleep, more vacation time, release from tension, a quiet place for meditation. Yet few of us are willing to take time from a busy practice. When a person gets wound up tight nervously he may do a lot of reckless things. Even a doctor is not immune to the temptations that lure the layman in search of nervous release. In fact, a physician is in greater danger than any layman, because of the tense, tiring life he lives, and because of his easy access to the drugs. Yet little or no instruction on narcotic dangers is given among physicians or in medical schools. It is high time that medical schools begin telling students the dangers and pitfalls they will face once they get a narcotic license, and have easy access to morphine, Demerol, codeine, and the other narcotic drugs. The outstanding feature of these cases of physician addicts appeared to be a lack of warning of young doctors before they went out to practice. To avoid this insidious "disease," remember: 1. You are human, subject to the temptations of laymen. 2. Never let easy access to narcotics be an excuse for your first "shot." 3. Don't get overly tired and fatigued. When you are worn out, take a vacation. It's a lot safer, and a lot more fun. 4. Don't drink. Alcoholism can lead to drug addiction. 5. If you have surgery or get sick, don't ever take narcotics on your own. Keep i.n mind what Benjamin Franklin said: "The man who treats himself has a fool for a doctor." 6. As a monitor against easy escape from an emotional problem, always think of your family, your future, and your prestige. Best of all breathe a prayer for God to keep your hand off any narcotic during time of stress. 7. Take time to relax each day and meditate on the many blessings God has given you. This will "up" your spirits. Only depressed doctors take dope. Keep a happy msntal outlook, and you do much to prevent the world's most insidious and most hopeless habit. I 9 5 4 366 BULLETIN DO'S AND DON'TS WITH NARCOTICS There is no worse trouble a doctor can get into than trouble with the Treasury Department over narcotics. There is no need to if he follows the rules laid down by the Harrison Act. Yet, a doctor sometimes does get in trouble innocently or carelessly and the result is most damaging to his prestige and his pocketbook. Never hesitate to prescribe a narcotic for a bona fide patient who needs it. Narcotics are valuable drugs mostly used for the relief of pain and relief of pain is one of the greatest services· a doctor can give. Write your prescription legibly, specify the amount, the dose and the time; put your licensed number on it (don't have it printed) and give it to the patient. If the patient needs mere, see and examine him and write a new prescription. Don't call the druggist and ask him to refill and you will send the prescription later, even for codeine in a cough syrup. That makes both you and the druggist liable for infraction of the law, and inspectors are sticklers for the law. When you need narcotics for personal administration fill out a narcotic order blank and get it from a supply house which holds a wholesale license. Don't write a prescription for some patient and keep the drugs yourself. You don't have to keep a record of narcotics you personally administer but if you leave a supply with a patient you have to make a record of it and keep the record on file for two years. Don't be fooled by addicts. They have the most convincing stories. You can spot them when they say '"Nothing helps me but a hypodermic." A bona fide patient in great pain says "For heaven's sake do something" but an addict says "I always have to have a half a grain." One time a nurse came in my office clutching her abdomen, all b ent over and said, "I think I have a kidney stone, give me a hypodermic quickly. Dr. Smith took care of me the last time I had one and he gave me morphine." I gave her a container and showed her to the toilet to get a specimen. She brought it back and it had blood in it. I gave her a hypo, put her in my car and took her home. The next day I called Dr. Smith and he said "She is an addict, don't let her fool you." She took me in that time but not again. Another story they give is "I am on my wa y to a Sanitarium for cure of my habit but I ran out of drugs. Just give me two or three tablets so I can get there." The answer is "no." If you are soft and easy, the word gets around and you will have many more of these phony emergencies. Don't try to treat addicts by the withdrawal method, or any method out side of an established institution. You can't do it at home nor in a general hospital. Leave it to the experts who work in sanitaria where there is close supervision. They advertise in the medical journals, so leave it to them. Don'i give an addict a supply of narcotics io reach his destination. He will use it up and appear in your office for more. They are the most unreliable people in the world. Last but not least, fill out your inventory and get your renewal of your license in on time with the M.O. for a dollar. If you don't, you will be asked to explain why you have been dispensing narcotics without a license, and may be requested to make a cash offer in settlement for your infraction of the law. Your forms are sent a month in advance and that should be plenty of time. Follow the letter of the law and you will have no trouble with narcotics. J. L. F. THE MAHONING COUNTY MEDICAL SOCIETY 367 WHY SOME DOCTORS TAKE DOPE The following is a paraphrasing of an article by ]. DeWitt Fox, M .D. Editor. The American public is opening its eyes to the dope menace. We abhor the crime stories of teen-age youth having marijuana parties then hot-rodding down our highways at 80 per. We shudder at the thought of some "pusher" seducing our sons and daughters into houses of ill-fame. But all too often the man nearest the narcotic needle overlooks the menace in his own little black medical bag. Dr. Harris Isbell, Director of the U. S. Public Health Service Hospital in Lexington, Kentucky, the Nation's leading treatment center for addiction, says, "Scarcely a week passes that a physician who is a Demerol addict is not admitted to our institution." (Since Demerol made its appearance most new physician addicts take to it rather than morphine.) Of course, all physician addicts are individuals, and their stories con cerning the onset of addiction are different, but there are three common patterns into which physician addicts fall. According to Dr. Isbell these are: 1. Alcoholic physicians who relieve hangovers with opiates. 2. Tired doctors who habitually blot out fatigue with a narcotic. 3. Doctors suffering pain from disease, who overdose themselves with opiates. What most physicians need is a good night's sleep, more vacation time, release from tension, a quiet place for meditation. Yet few of us are willing to take time from a busy practice. When a person gets wound up tight nervously he may do a lot of reckless things. Even a doctor is not immune to the temptations that lure the layman in search of nervous release. In fact, a physician is in greater danger than any layman, because of the tense, tiring life he lives, and because of his easy access to the drugs. Yet little or no instruction on narcotic dangers is given among physicians or in medical schools. It is high time that medical schools begin telling students the dangers and pitfalls they will face once they get a narcotic license, and have easy access to morphine, Demerol. codeine, and the other narcotic drugs. The outstanding feature of these cases of physician addicts appeared to be a lack of warning of young doctors before they went out to practice. To avoid this insidious "disease," remember: 1. You are human, subject to the temptations of laymen. 2. Never let easy access to narcotics be an excuse for your first "shot." 3. Don't get overly tired and fatigued. When you are worn out, take a vacation. It's a lot safer, and a lot more fun. 4. Don't drink. Alcoholism can lead to drug addiction. 5. If you have surgery or get sick, don't ever take narcotics on your own. Keep i.n mind what Benjamin Franklin said: "The man who treats himself has a fool for a doctor." 6. As a monitor against easy escape from an emotional problem, always think of your family, your future, and your prestige. Best of all breathe a prayer for God to keep your hand off any narcotic during time of stress. 7. Take time to relax each day and meditate on the many blessings God has given you. This will "up" your spirits. Only depressed doctors take dope. Keep a happy mental outlook, and you do much to prevent the world's most insidious and most hopeless habit. I 9 5 4 368 BULLETIN whole-root Raudixin: safe, smooth, gradual reduction of blood pressure Raudixin is the m os t-prescribed of rauwolfia preparations. It is powdered whole root of Rauwolfia serpentina not just one alkaloid, but all of them. Most of the clinical experience with rauwolfia has been with Rau dixin. "A sense of well-being, decrease in irri tability, 'improvement in personality' and relief of headache, fatigue and dyspnea" are frequently described by patients. 1 R audixin is base-line therapy. In mild or moderate cases it is usually effective alone. 50 and 100 mg. tablets, bottles of 100 and 1000. Raudi xin alone and combined with other hyootensive agents ·······• Ra udixin --- Rau dixin and ve ratrum --. Raud ixi n, veratr um and hex amethonium Raudixin 2 0 ~ ••• • •••• • • · ······· · ····· · ··- · -·-· - · - · 2 6 0 ~ ! ::::: ....... ::::::::::::······,,_ ~s ::: = E "=··"' "'I."~ i '· ... ·-·-·-·~·-·--;00 Water-dispersible polyvitamin drops Each 0.6 cc. (as marked on dropper) provides the following vitamins in a clear aqueous dispersion: A 5000 U.S.P. units, D 1200 U.S.P. units, C 60 mg., B 1 1.8 mg., B 2 0.4 mg., niacinamide 3 mg., B 6 0. 3 mg., calcium pantothenate 1.2 mg. Sup plied in 15 and 30 cc. dropper bottles. Vitamin A from Vifort is better ab sorbed a nd utilized tha n vitamin A from fish liver oil. Clinical superior ity has been evidenced in norma l children and in patients with im paired absorption. ENDO PRODUCTS INC. Richmond Hill 18, New York THE BOWMAN BROS. DRUG CO. Service Centers Akron, Canton, Lima, Chillicothe A. C. K. Blue Ribbon Therapy for Arthritis G. F. Harvey Company Rep. Harold Galliher ST-8-1052 JULY THE MAHONING COUNTY MEDICAL SOCIETY 391 GYNECOLOGICAL OPERATIONS The following advice by Dr. R. W. TeLinde is deemed worthy of repro duction here.-Editor. Probably one of the greatest surgical sins of our qeneration is the unnecessary removal of the asymptomatic fibroid uterus. There are definite indications for removal of the fibroid uterus. These are limited to the following: Excessive bleeding. Discomfort from pressure of the tumor or evidence of damage to an organ such as the kidney from pressure on the ureter and occasionally pain from a tumor twisting on its pedicle. Distortion of the abdomen due to the size of the fibroid. Effect of the tumors on past, present or future pregnancies. Evidence suggesting malignant change. Uncertainty in making a differential diagnosis between a fibroid and an ovarian tumor. Let us consider these symptoms individually. Excessive bleeding at the time of the period may be and often is due to fibroids, but the excessive bleeding in the presence of a fibroid uterus does not necessarily indicate that the bleeding is due to the fibroid. Other pathological lesions, such as an endometrial polyp, may be the cause and the fibroids may be incidental. After all, how frequently does one encounter even large fibroids with normal or even scanty menstruation! Hence, frequently when there is menorrhagia, and especially of only a month or two duration, a curettage should be done instead of rushing into a hysterectomy. Curettage may accomplish several important things: It may remove an endometrial polyp and cure the pa tient's symptom. It will remove hyperplastic endometrium and temporarily or permanently relieve the patient. If will tell you whether the uterine cavity ha s become irregular due to the submucous position of a fibroid. This in formation will be of great value to you in deciding on hysterectomy in the future in case there is a recurrence of the bleeding. By curettage, combined with cervical biopsy, a diagnosis of malignancy of the endometrium or cervix can be made or excluded. It is particularly important to carry out this simple diagnostic procedure when there has been intermenstrual bleeding, for this symptom is not usually dependent upon the fibroid. Curettage may often suffice in the woman with a small bleeding fibroid who is approaching her menopause. Having excluded malignancy by curettage, the patient may in a short time undergo her menopause after which no further treatment will be necessary. When a fibroid is large enough to give rise to symptoms due to pressure on pelvic nerves or on other organs such as the bowel or bladder it had best be removed. However, one often sees some rather large fibroids which sur prisingly give no pressure symptoms. Before advising the patient to keep such a tumor it is well to have intravenous pyelograms done to determine whether there is ureteral obstruction. When there is ureteral or kidney pelvic dilatation due to tumor pressure the uterus had best be removed. Surprisingly, this may often occur without any discomfort to the patient. Often a fibroid of considerable size gives rise to no symptoms except abdominal distention. No woman should be required to appear as though perpetually pregnant or to have a permanently distorted figure and I believe this constitutes a reason for surgery even without other symptoms. 1 9 54 3SO BULLETIN SUPERIOR VITAMIN A ABSORPTION VIFORT Water-dispersible polyvitamin drops Ralph Cullinan Phone 93585 Each 0.6 cc. (as marked on dropper) p rovides the following vitamins in a clear aqueous dispersion: A 5000 U.S.P. units, D 1200 U.S.P. units, C 60 mg., B 1 1.8 mg., B 2 0.4 mg., niacinamide 3 mg., B 6 0.3 mg., calcium pantothenate 1.2 mg. Sup plied in 15 and 30 cc. dropper bottles. Vitamin A from Vifort is better ab sorbed and utilized than v itamin A from fish liver oil. Clinical superior ity has been evidenced in normal children and in patients with im paired absorption. Representing ENDO PRODUCTS INC. Richmond Hill lB, New York THE BOWMAN BROS . DRUG CO . Service Centers Akron, Canton, Lima, Chillicothe A. C. K. Blue Ribbon Therapy for Arthritis G. F. Harvey Company Rep. Harold Galliher ST-8-1052 JULY THE MAHONING COUNTY MEDICAL SOCIETY 39 1 GYNECOLOGICAL OPERATIONS The following advice by Dr. R. W . TeLinde is deemed worthy of repro duction here.- Editor. Probably one of the greatest surgical sins of our generation is the unnecessary removal of the asymptomatic fibroid uterus. There are definite indications for removal of the fibroid uterus. These are limited to the following: Excessive bleeding. Discomfort from pressure of the tumor or evidence of damage to an organ such as the kidney from pressure on the ureter and occasionally pain fr om a tumor twisting on its pedicle. Distortion of the abdomen due to the size of the fibroid. Effect of the tumors on past, present or future pregnancies. Evidence suggesting malignant change. Uncertainty in making a differential diagnosis between a fibroid and a n ovarian tumor. Let us consider these symptoms individually. Excessive bleeding at the time of the period may be and often is due to fibroids, but the excessive bleeding in the presence of a fibroid uterus does not necessarily indicate th at the bleeding is due to the fibroid. Other pathological lesions, such as an endometrial polyp, may be the cause and the fibroids may be incidental. After all, how frequently does one encounter even large fibroids with normal or even scanty menstruation! Hence, frequently when there is menorrhagia, a nd especially of only a month or two duration, a curettage should be done instead of rushing into a hysterectomy. Curettage may accomplish several important things: It may remove an endometrial polyp and cure the pa tient's symptom. It will remove hyperplastic endometrium and temporarily or permanently relieve the patient. If will tell you whether the uterine cavity ha s become irregular due to the submucous position of a fibroid. This in formation will be of great value to you in deciding on hysterectomy in the future in case there is a recurrence of the bleeding. By curettage, combined with cervical biopsy, a diagnosis of malignancy of the endometrium or cervix ca n be made or excluded. It is particularly important to carry out this simple diagnostic procedure when there has been intermenstrual bleeding, for this symptom is not usually dependent upon the fibroid. Curettage may often suffice in the woman with a small bleeding fibroid who is approaching her menopause. Having excluded malignancy by curettage, the patient may in a short time undergo her menopause after which no further treatment will be necessary. When a fibroid is large enough to give rise to symptoms due to pressure on pelvic nerves or on other organs such as the bowel or bladder it had best be removed. However, one often sees some rather large fibroids which sur prisingly give no pressure symptoms. Before advising the patient to keep such a tumor it is well to have intravenous pyelograms done to determine whether there is ureteral obstruction. When there is ureteral or kidney pelvic dilatation due to tumor pressure the uterus had best be removed. Surprisingly, this may often occur without any discomfort to the patient. Often a fibroid of considerable size gives rise to no symptoms except abdominal distention. No woman should be required to appear as though perpetually pregnant or to have a permanently distorted figure and I believe this constitutes a reason for surgery even without other symptoms. 1 9 54 392 BULLETIN A history of repeated miscarriages in a woman with fibroids of reason able size constitutes an indication for myomectomy, but a woman with small fibroids, pregnant or desiring to become pregnant, should not be subjected to immediate laparctomy. I am constantly impressed with the number of pregnancies which go to term in the presence of large tumors. On the other hand, fibroids that are rapidly increasing in size in women desiring children but failing to become pregnant constitute a legitimate reason for myomec tomy. In reference to the problem of pregnancy and fibroids one can only say that each case should be considered carefully and individually before deciding on the best course. When a woman is told that she has a fibroid uterus and is advised that it may be safely kept under observation the natural question is: "What about malignancy?" The chance of fibroids undergoing malignant change is very slight. Evans, in a large series of fibroids removed at the Mayo Clinic, found sarcomatous change in only 0.7 per cent. Actually the per centage of malignancy in fibroids is much less than this, for this percentage was based on the fibroids removed for proper indications. If the percentage of malignancy had been based on all existing fibroids, it would have been much smaller. Certain it is that the risk of malignant change is no greater than the risk of surgery, so the possibility of its occurrence does not con stitute a legitimate reason for removal. On the other hand, when there is reason to believe that malignant change is probable, as evidenced by rapid growth, fixation of the tumor or variation in consistency of the tumor, surgery is indicated in the absence of symptoms. Likewise, when there is a question as to whether the tumor arises from the uterus or the ovary, it had best be removed because of the possibility of malignancy in the ovarian tumor. Much has been written in recent years about carcinoma-in-situ of the cervix. I believe its presence constitutes a legitimate reason for hysterectomy, but I am sorry to say that the publicity given this disease has been responsi ble for many unnecessary hysterectomies. The usual reason for this is in adequate knowledge on the part of the pathologist. He is doubtful about the lesion and, therefore, recommends hysterectomy to the surgeon to play safe. Carcinoma-in-situ of the cervix never constitutes a surgical emergency. There is always time to get another opinion on the pathology, and if neces sary, to get further evidence by cytological smear and biopsy. Another sin which has been all too common in the field of surgery in recent years is the attempt on the part of surgeons and gynecologists to perform the radical Wertheim type of hysterectomy with lymph node dis section in Stages I and II of cervical cancer. This operation is being done by a very few expert pelvic surgeons in selected cases with results equal to the results with irradiation. Hearing or reading of this, many unqualified surgeons are attempting this difficult operation. In many instances, difficulties are encountered and the operation which actually is accomplished is far from that which is carried out by the few experts. Indications for operability in cervical cancer are also being extended by over enthusiastic surgeons. As a result, serious postoperative complication such as ureteral or vesical injury are frequent and many lives are made unbearable by complications that could have been avoided had the lesion been treated by irradiation. Such surgery is not only unjustified but is dangerous. There are two minor uterine lesions for which hysterectomies are often unnecessarily done-chronic cervicitis and functional bleeding. There is some JULY THE MAHONING COUNTY MEDICAL SOCIETY 393 evidence that chronic cervicitis may at times predispose to cancer, but this does not constitute a legitimate reason for a hysterectomy. There are lesser procedures by which the cervical infection can be eradicated. One often hears an attempted justification for this surgery as being a prophylaxis against cancer. A surgeon may observe that the lacerated cervix appears bad and he fears tha.t it may harbor malignancy or ultimately become ma lignant. The biopsy and smear are simple procedures available to every practitioner and the time to find out whether malignancy exists is before definite treatment is undertaken. If such a "suspicious" cervix actually har bors malignancy and an ordinary total hysterectomy is done, the patient has been treated inadequately. If malignancy is not present, she has had an unnecessary hysterectomy. Functional uterine bleeding is also frequently treated unnecessarily by hysterectomy when a curettage is all that would have been necessary to establish a dia-gnosis and often cure the patient. Although many cases of functional bleeding are not relieved by curettage, many are. Not infrequently the bleeding which is thought clinically to be functional, turns out to be due to an endometrial polyp which can be removed by currettage or with the polyp forceps. In young individuals functional bleeding can often be con trolled with proper hormonal therapy. However, when after curettage reason ably severe functional bleeding recurs, hysterectomy or irradiation may have to be considered. Younger individuals should always be given a trial at hormonal therapy. As the age of the patient increases the indications for hysterectomy in this group of patients with recurrent functional bleeding be· come less rigid. This is particularly true when symptomatic cystocele and rectocele are present. When I perform a hysterectomy for recurrent functional bleeding I prefer to remove the uterus vaginally, whether vaginal plastic surgery is necessary or not. ST. EI.IZABETH HOSPITAL EX-INTERN REUNION Members of the Ex-Intern Association of St. Elizabeth Hospital, members of the Staff and area medical students participated in the annual reunion of the Association on Thursday, June 17, 1954. Dr. S. W. Ondash, retiring president, was in charge of activities. Newly elected officers are Dr. J. B. Kupec, President; Dr. C. E. Pichette, Vice Presi dent; and Dr. L. Zeller, Secretary-Treasurer. Dr. Robert D. Taylor, Associate Professor of Medicine at Bunts Educational Institute, Cleveland Clinic, was the speaker at the scientific session held at the Nurses' Home in the morning. He was introduced by Dr. John LoCricchio, Director of St. Elizabeth's department of pathology and laboratory medicine. Sister M. Adelaide, superintendent of the hospital, was hostess at a luncheon at the hospital. In the golf tourney held at the Youngstown Country Club, Dr. Breesmen was winner at low gross and Dr. Mahar at low net. Blind bogey awards went to Drs. F. Morrison, J. J. Sofranec and S. W . Ondash. A banquet fol lowed the golf tourney. "No one rises so high as he who knows whither he is going." Oliver Cromwell 1 9 5 4 392 BULLETIN A history of repeated miscarriages in a woman with fibroids of reason able size constitutes an indication for myomectomy, but a woman with small fibroids, pregnant or desiring to become pregnant, should not be subjected to immediate laparctomy. I am constantly impressed with the number of pregnancies which go to term in the presence of large tumors. On the other hand, fibroids that are rapidly increasing in size in women desiring children but failing to become pregnant constitute a legitimate reason for myomec tomy. In reference to the problem of pregnancy and fibroids one can only say that each case should be considered carefully and individually before deciding on the best course. When a woman is told that she has a fibroid uterus and is advised that it may be safely kept under observation the natural question is: "What about malignancy?" The chance of fibroids undergoing malignant change is very slight. Evans, in a large series of fibroids removed at the Mayo Clinic, found sarcomatous change in only 0.7 per cent. Actually the per centage of malignancy in fibroids is much less than this, for this percentage was based on the fibroids removed for proper indications. If the percentage of malignancy had been based on all existing fibroids, it would have been much smaller. Certain it is that the risk of malignant change is no greater than the risk of surgery, so the possibility of its occurrence does not con stitute a legitimate reason for removal. On the other hand, when there is reason to believe that malignant change is probable, as evidenced by rapid growth, fixation of the tumor or variation in consistency of the tumor, surgery is indicated in the absence of symptoms. Likewise, when there is a question as to whether the tumor arises from the uterus or the ovary, it had best be removed because of the possibility of malignancy in the ovarian tumor. Much has been written in recent years about carcinoma-in-situ of the cervix. I believe its presence constitutes a legitimate reason for hysterectomy, but I am sorry to say that the publicity given this disease has been responsi ble for many unnecessary hysterectomies. The usual reason for this is in adequate knowledge on the part of the pathologist. He is doubtful about the lesion and, therefore, recommends hysterectomy to the surgeon to play safe. Carcinoma-in-situ of the cervix never constitutes a surgical emergency. There is always time to get another opinion on the pathology, and if neces sary, to get further evidence by cytological smear and biopsy. Another sin which has been all too common in the field of surgery in recent years is the attempt on the part of surgeons and gynecologists to perform the radical Wertheim type of hysterectomy with lymph node dis section in Stages I and II of cervical cancer. This operation is being done by a very few expert pelvic surgeons in selected cases with results equal to the results with irradiation. Hearing or reading of this, many unqualified surgeons are attempting this difficult operation. In many instances, difficulties are encountered and the operation which actually is accomplished is far from that which is carried out by the few experts. Indications for operability in cervical cancer are also being extended by over enthusiastic surgeons. As a result, serious postoperative complication such as ureteral or vesical injury are frequent and many lives are made unbearable by complications that could h.ave been avoided had the lesion been treated by irradiation. Such surgery is not only unjustified but is dangerous. There are two minor uterine lesions for which hysterectomies are often unnecessarily done--chronic cervicitis and functional bleeding. There is some JULY THE MAHONING COUNTY MEDICAL SOCIETY 393 evidence that chronic cervicitis may at times predispose to cancer, but this does not constitute a legitimate reason for a hysterectomy. There are lesser procedures by which the cervical infection can be eradicated. One often hears an attempted justification for this surgery as being a prophylaxis against cancer. A surgeon may observe that the lacerated cervix appears bad and he fears that it may harbor malignancy or ultimately become ma lignant. The biopsy and smear are simple procedures available to every practitioner and the time to find out whether malignancy exists is before definite treatment is undertaken. If such a "suspicious" cervix actually har bors malignancy and an ordinary total hysterectomy is done, the patient has been treated inadequately. If malignancy is not present, she has had an unnecessary hysterectomy. Functional uterine bleeding is also frequently treated unnecessarily by hysterectomy when a: curettage is all that would have been necessary to establish a diagnosis and often cure the patient. Although many cases of functional bleeding are not relieved by curettage, many are. Not infrequently the bleeding which is thought clinically to be functional, turns out to be due to an endometrial polyp which can be removed by currettage or with the polyp forceps. In young individuals functional bleeding can often be con trolled with proper hormonal therapy. However, when after curettage reason ably severe functional bleeding recurs, hysterectomy or irradiation may have to be considered. Younger individuals should always be given a trial at hormonal therapy. As the age of the patient increases the indications for hysterectomy in this group of patients with recurrent functional bleeding be· come less rigid. This is particularly true when symptomatic cystocele and rectocele are present. When I perform a hysterectomy for recurrent functional bleeding I prefer to remove the uterus vaginally, whether vaginal plastic surgery is necessary or not. ST. ELIZABETH HOSPITAL EX..:JNTERN REUNION Members of the Ex-Intern Association of St. Elizabeth Hospital, members of the Staff and area: medical students participated in the annual reunion of the Association on Thursday, June 17, 1954. Dr. S. W . Ondash, retiring president, was in charge of activities. Newly elected officers are Dr. J. B. Kupec, President; Dr. C. E. Pichette, Vice Presi dent; and Dr. L. Zeller, Secretary-Treasurer. Dr. Robert D. Taylor, Associate Professor of Medicine at Bunts Educational Institute, Cleveland Clinic, was the speaker at the scientific session held at the Nurses' Home in the morning. He was introduced by Dr. John LoCricchio, Director of St. Elizabeth's department of pathology and laboratory medicine. Sister M. Adelaide, superintendent of the hospital, was hostess at a luncheon at the hospital. In the golf tourney held a:t the Youngstown Country Club, Dr. Breesmen was winner at low gross and Dr. Mahar at low net. Blind bogey awards went to Drs. F. Morrison, J. J. Sofranec and S. W . Ondash. A banquet fol lowed the golf tourney. "No one rises so high a:s he who knows whither he is going." Oliver Cromwell 1 9 5 4 • 394 BULLETIN PATRON~ZE OUR ADVERTISERS AND MENTION THE BULLETIN For Ethical Prescription Service For Physicians Supplies We are pleased to serve you and your patients. LESTER'S Prescription Pharmacy 264 W. Federal RI. 4-4111 318 Fifth Ave. RI. 7-7141 Waiting Room Chairs Desks and Filing Equipment • OFFICE FURNITURE ~ JAMES & WEAVER "Office Outfitters" Riverside 4-4427 W . Wood St. JULY • THE MAHONING COUNTY MEDICAL SOCIETY 395 TRENDS AND EVENTS Should interns and residents carry malpractice insurance coverage? ... Best advice from various sources is: "Yes, especially if they hold license to practice." -o-- The total number of physicians - 218,522 - licensed to practice in the United States set an all-time record in 1953. Official figures from the 52nd a nnual report on medical licensure of the A.M.A.'s Council on Medical Edu cation and Hospitals indicate that 7,276 persons were added to the medical profession in 1953. During the same period, 3,421 physician deaths reported to the A.M.A. Headquarters gives a net increase of 3,855 in the physician population of the country. In 1952, an increase of 2,987 was reported. -o-- 'Shouting in the Dark' is the title of a guest editorial which John L. Bach, director of A.M.A. press relations, wrote in the May issue of the Medi cal Annals of the District of Columbia. The piece analyzes two specific cases, pointing to an overlooked fact in medical public relations today: that articles written by physicians and published in medical journals for the enlightenment and educational benefit of their colleagues can be picked up by lay writers and twisted into a more or less sensational story for lay readers. "It appears today," the editorial said, "that what a doctor writes frankly a nd objectively for the betterment of his profession and the advancement of medical science, can actually boomerang to the detriment of the profession a s a whole." 'After the Doctor Leaves' is a fine book. Marguerite Clark, who has been a good writer-friend of the medical profession for many years, has just pub lished an excellent book entitled, "After the Doctor Leaves.'' Mrs. Clark, who is medical editor of Newsweek magazine, discusses the 12 most important medical classes of disease and gives readers some fine practical help to supplement the advice of the family physician. She did a good job of telling people how to live with chronic ailments. -0-- The Eisenhower administration has forwarded to Congress, with a recom mendation that it not be ratified, the International Labor Organization's convention on minimum standards of social security . The medical care section stipulates that a country may qualify as rati fying if it agrees to provide one of the following: (a) a system of compulsory health insur=ce, (b) private, voluntary health insurance "administered by public authorities under established regulations" set by law, or (c) private, voluntary health insurance administered by insurance companies but under government "supervision.'' Half the population would have to be covered. --a-- Secretary Hobby has strongly urged the National Association of In surance Commissioners to reverse its stand and support legislation for fed eral reinsurance of health insurance programs. (The association opposed reinsurance at Congressional hearings). -o- The House Appropriations Committee, in reporting out a $1,637,615,011 budget for the Department of Health, Education, and Welfare for the next fiscal year, was highly critical of Secretary Oveta Culp Hobby's adminis tration and her budgeting for some health programs. I 9 5 4 • 394 BULLETIN PATRON1ZE OUR ADVERTISERS AND MENTION THE BULLETIN For Ethical Prescription Service For Physicians Supplies We are pleased to serve you and your patients. LESTER'S Prescription Pharmacy 264 W. Federal RI. 4-4111 318 Fifth Ave. RI. 7-7141 Waiting Room Chairs Desks and Filing Equipment • OFFICE FURNITURE ~ JAMES & WEAVER "Office Outfitters" Riverside 4-4427 W . Wood St. JULY • THE MAHONING COUNTY MEDICAL SOCIETY 395 TRENDS AND EVENTS Should interns and residents carry malpractice insurance coverage? ... Best advice from various sources is: "Yes, especially if they hold license to practice." -o--- The total number of physicians - 218,522 - licensed to practice in the United States set an all-time record in 1953. Official figures from the 52nd a nnual report on medical licensure of the A.M.A.'s Council on Medical Edu cation and Hospitals indicate that 7,276 persons were added to the medical profession in 1953. During the same period, 3.421 physician deaths reported to the A.M.A. Headquarters gives a net increase of 3,855 in the physician population of the country. In 1952, an increase of 2,987 was reported. -o--- 'Shouting in the Dark' is the title of a guest editorial which John L. Bach, director of A.M.A. press relations, wrote in the May issue of the Medi cal Annals of the District of Columbia. The piece analyzes two specific cases, pointing to an overlooked fact in medical public relations today: that articles written by physicians and published in medical journals for the enlightenment and educational benefit of their colleagues can be picked up by lay writers and twisted into a more or less sensational story for lay readers. "It appears today," the editorial said, "that what a doctor writes frankly a nd objectively for the betterment of his profession and the advancement of medical science, can actually boomerang to the detriment of the profession a s a whole." 'After the Doctor Leaves' is a fine book. Marguerite Clark, who has been a good writer-friend of the medical profession for many years, has just pub lished an excellent book entitled, "After the Doctor Leaves." Mrs. Clark, who is medical editor of Newsweek magazine, discusses the 12 most important medical classes of disease and gives readers some fine practical help to supplement the advice of the family physician. She did a good job of telling people how to live with chronic ailments. -o--- The Eisenhower administration has forwarded to Congress, with a recom mendation that it not be ratified, the International Labor Organization's convention on minimum standards of social security . The medical care section stipulates that a country may qualify as rati fying if it agrees to provide one of the following: (a) a system of compulsory health insurance, (b) private, voluntary health insurance "administered by public authorities under established regulations" set by law, or (c) private, voluntary health insurance administered by insurance companies but under government "supervision." Half the population would have to be covered. --o--- Secretary Hobby has strongly urged the National Association of In surance Commissioners to reverse its stand and support legislation for fed eral reinsurance of health insurance programs. (The association opposed reinsurance at Congressional hearings). -o- The House Appropriations Committee, in reporting out a $1.637,615,011 budget for the Department of Health, Education, and Welfare for the next fiscal year, was highly critical of Secretary Oveta Culp Hobby's adminis tration and her budgeting for some health programs. I 9 5 4 396 BULLETIN D'octo~ Draft Act Amendment. The House on June 11 passed and sent to th~ .White House the Doctor Draft amendment which permits utilization of phys1c1ans, dentists ::md specialists in enlisted grades of the .Armed Forces. --o- V et er c:ns A~inistrator Harvey Higley says the agency is planning on a 110,000 dm~y pahent load for its hospitals in fiscal 1956 (starting July 1, 1955). On th~ basis of a current staffing of 114,000 beds and a 90 % occupancy, the new figure would mean approximately 8,000 more beds would have to be added. One estimate of hospital experts is that the cost of the 8,000 additional beds would be well in excess of $120 million. -o- Kaiser urges press to support his mortgage loan bill. In an address before the National Press Club in Washington, Henry Kaiser urged newsmen to get b~hi~d his propos::d for federal guarantee of loans for constructing an~ eqmppmg group practice facilities. The industrialist, who started the KaISer Medical Foundation, said that now "millions are being forced into financial bondage" because of medical care costs, but that if the press would help to publicize his ideas, a "ground swell" of popular support would put the plan over. The "Kaiser plan" is embodied in H.R. 7700, now before the House Inter state and Foreign Commerce Committee and sponsored by the chairman, C~arl~s Wolverton. The American Medical .Association has three principal ob1ecl1~ns to the bill: 1. Facilities already are being provided for medical care without federal intervention. 2. Group practice would be favored at the expense, of t~e individual practitioner. 3. To be eligible for loan guarantees, a group s pahents would have to be predominently from prepaid health plans. (Mr. Wolverton is willing to remove the last requirement.) THE MAHONING COUNTY MEDICAL SOCIETY 397 Cooperation of private M .D.'s with clinical center cited. The director of the National Institutes of Health has informed Congress that the year-old Clinical Center at. Bethesda has had exceptionally good working relations with medical societies and private practitioners. Dr. Sebrell noted that when a physician refers a patient to the Clinic, "he knows that the patient is going to get the best that modern medicine can do for him in terms of research and advanced procedure and I think our whole future depends on this kind of relationship.'' He estimated that by July 1 NIH expects to have between 200 and 250 beds opened in the Clinic with about 80 % occupancy. -Q- A series of short postgraduate courses designed to keep medical officers in outlying installations informed of current medical advances will be con ducted by the Army starting July 1. They will be open to civilian doctors. m edical officers o.n active and inactive duty, physicians from other gov ernment agencies, and Navy and Air Force personnel. - 0- Some 900 workers labor in the Chicago A.M.A. building that contains the world's most powerful medical organization. Their duties on behalf of 140,000 doctors range from laboratory studies to legal wrangling, through lobbying, publishing journals, books and pamphlets, and investigating. The A.M.A.'s newest venture is a program to promote mental health. The asso ciation says 60 per cent of its $9,000,000 annual revenue is spent on its scientific activities. -0- It is difficult and often impossible to tell hypochondriacal neurosis from early schizoid or affective psychosis. -0- Long-term follow-up studies of women treated with X-rays for sterility a nd menstrual dysfunction reveal that X-irradiation, when used properly, is harmless to the women and to their offspring. Second and third generation offspring of these women also showed no adverse genetic effects. Kaplan, I. I.: Am. ]. Obst. & Gynec., March 1954. MISCELLANY MEDICAL WITNESS Basically, to be a good medical witness requires attention to the follow- ing list of do's and don'ts: 1. Tell the truth. 2. Come prepared. 3. Don't be afraid, but be modest and natural in actions and speech. 4. Listen to questions, and answer only what is asked. 5. Admit if you don't know. Don't hedge or become flustered. 6. Speak up, be courteous, do not lose your temper, and do not be belligerent. Always remember, that once in the courtroom the lawyers for both the defenden! and plaintiff are in command. You are on unfamiliar ground and just another person present to answer questions to the best of your medical and surgical ability and knowledge. I. Phillips Frohman, M.D. l 9 5 4 396 BULLETIN D'octo~ Draft Act Amendment. The House on June 11 passed and sent to th~ .White House the Doctor Draft amendment which permits utilization of phys1c1ans, dentists ::md specialists in enlisted grades of the .Armed Forces. --o- V eterc:ns A~inistrator Harvey Higley says the agency is planning on a 110,000 dm~y pahent load for its hospitals in fiscal 1956 (starting July 1, 1955). On th~ basis of a current staffing of 114,000 beds and a 90 % occupancy, the new figure would mean approximately 8,000 more beds would have to be added. One estimate of hospital experts is that the cost of the 8,000 additional beds would be well in excess of $120 million. -o- Kaiser urges press to support his mortgage loan bill. In an address before the National Press Club in Washington, Henry Kaiser urged newsmen to get b~hi~d his proposal for federal guarantee of loans for constructing an~ eqmppmg group practice facilities. The industrialist, who started the ~mser Medical Foundation, said that now "millions are being forced into fmancial bondage" because of medical care costs, but that if the press would help to publicize his ideas, a "ground swell" of popular support would put the plan over. The "Kaiser plan" is embodied in H.R. 7700, now before the House Inter state and Foreign Commerce Committee and sponsored by the chairman, C~arl~s Wolverton. The American Medical Associa.tion has three principal ob1ecl1~ns to the bill: 1. Facilities already are being provided for medical care without federal intervention. 2. Group practice would be favored at the expense, of t~e individual practitioner. 3. To be eligible for loan guarantees, a group s pahents would have to be predominently from prepaid health plans. (Mr. Wolverton is willing to remove the last requirement.) THE MAHONING COUNTY MEDICAL SOCIETY 397 Cooperation of private M .D.'s with clinical center cited. The director of the National Institutes of Health has informed Congress that the year-old Clinical Center at Bethesda has had exceptionally good working relations with medical societies and private practitioners. Dr. Sebrell noted that when a physician refers a patient to the Clinic, "he knows that the patient is going to get the best that modern medicine can do for him in terms of research and advanced procedure and I think our whole future depends on this kind of relationship." He estimated that by July 1 NIH expects to have between 200 and 250 beds opened in the Clinic with about 80 % occupancy. -Q- A series of short postgraduate courses dP.signed to keep medical officers in outlying installations informed of current medical advances will be con ducted by the Army starting July 1. They will be open to civilian doctors, m edical offfoers on active and inactive duty, physicians from other gov ernment agencies, and Navy and Air Force personnel. - 0- Some 900 workers labor in the Chicago A.M.A. building that contains the world's most powerful medical organization. Their duties on behalf of 140,000 doctors range from laboratory studies to legal wrangling, through lobbying, publishing journals, books and pamphlets, and investigating. The A.M.A.'s newest venture is a program to promote mental health. The asso ciation says 60 per cent of its $9,000,000 annual revenue is spent on its scientific activities. -0- It is difficult and often impossible to tell hypochondriacal neurosis from early schizoid or affective psychosis. -0- Long-term follow-up studies of women treated with X-rays for sterility a nd menstrual dysfunction reveal that X-irradiation, when used properly, is harmless to the women and to their offspring. Second and third generation offspring of these women also showed no adverse genetic effects. Kaplan, I. I.: Am. ]. Obst. & Gynec., March 1954. MISCELLANY MEDICAL WITNESS Basically, to be a good medical witness requires attention to the follow- ing list of do's and don'ts: 1. Tell the truth. 2. Come prepared. 3. Don't be afraid, but be modest and natural in actions and speech. 4. Listen to questions, and answer only what is asked. 5. Admit if you don't know. Don't hedge or become flustered. 6. Speak up, be courteous, do not lose your temper, and do not be belligerent. Always remember, that once in the courtroom the lawyers for both_ the defenden! and plaintiff are in command. You are on unfamiliar ground and just another person present to answer questions to the best of your medical and surgical ability and knowledge. 1. Phillips Frohman, M.D. 1 9 5 4 398 BULLETIN TODA Y'S THOUGHT: Success-making more money to meet obligations you wouldn't have if you didn't have so much money (anon.). -()-- Caleb Fiske Prize The Trustees of what is considered America's oldest medical essay com petition, the Caleb Fiske Prize of the Rhode Island Medical Society, announce as the subject for this year's dissertation "MODERN DEVELOPMENTS IN ANESTHESIA." The dissertation must be typewritten, double spaced, and should not exceed 10,000 words. A cash prize of $250 is offered. For complete information regarding the regulations write to the Secretary, Caleb Fiske Fund, Rhode Island Medical Society, 106 Francis Street, Provi dence 3, Rhode Island. -o-- PR Institute Set for September 1-2 That's the time for A.M.A.'s third Medical Public Relations Institute to be held at the Drake Hotel in Chicago. Designed primarily for public rela tions personnel and chairmen of state and county medical societies, this year's informal sessions are designed as an "idea exchange - a public relations seminar" - to stimulate the exchange of ideas in all areas of medical public relations. -()-- Says It's The Spokesman Does the A.M.A. really speak for America's doctors? The A.M.A. says it does. It says survey:;; show that the vast majority of doctors approve A.M.A. policies. And the A.M.A.'s governing body, or house of delegates, is organized to represent all members of county and state medical societies on a proportional basis. Dr. Walter B. Martin, president-elect of the A.M.A., recently concluded a discussion of the A.M.A.'s "constructive program" with these words: "The American Medical Association has always accepted and carried out the responsibility of leadership in safeguarding the public health, raising the standards of medicine, and making good medical care available to the people. "This nation's medical progress over the past half century has given the United States the world's highest standards of health and medical care ... "That progress has been achieved under a voluntary system which em phasizes free enterprise, individual initiative, and responsibility, and coopera tive effort . . . "Our most urgent effort should now be directed to the solution of the problem of the medically indigent and the chronically ill. We believe that this objective can be reached without major change in our existing mechanism." -0- Verdict of Unethical Adverlising Upheld By secret ballot in closed executive session the House of Delegates of the Medical Society of the State of New York has upheld the verdict of unethical conduct in the case of a Queens County physician affiliated with a medical group of the Health Insurance Plan of Greater New York (HIP). The verdict, in essence, was that a physician, Dr. Ben E. Landess, Medical Director of the Jamaica Medical Group and affiliated with HIP, was guilty of unethical conduct under that portion ot the Code of Prcfesssional Conduct dealing with unethical advertising. JULY THE MAHONING COUNTY MEDICAL SOCIETY 399 The Code of Professional Conduct is specific on this point. The group practice of medicine is not of itself unethical. BUT each such medical group shall obey all the rules of ethics as would an individual physician. Since a physician in private practice cannot advertise for patients, the same rule applies for physicians in groups. Hence Dr. Landess was found to be un ethical when his name appeared in HIP literature. -o-- Kenneth B. Babcock, M.D., will assume his duties as director of the Joint Commission on July 1, coming to Chicago from Detroit where he has been director of the Grace Hospital. As the Commission Chairman, Dr. Newell W. Philpott of Montreal, said in announcing the appointment recently: "We are delighted that Dr. Babcock has accepted the important task of. directing the Joint Commission on Ac creditation of Hospitals. There is perhaps no more vital program than this effort by doctors and by hospitals' to constantly elevate hospital care stand ards by a vigorous and voluntary method of self-discipline. Dr. Babcock's career, first as a physician and surgeon and then as a hospital administrator, guarantees the sound continuance of this program which got off to such an excellent start." -0-- Blood Pressure Study in Persons 65 and Over The evaluation of blood pressure in old age has become a major prob lem because of the growing number of older people in the United States and the paucity of data in these age groups. Millions of Americans are now 65 years of age or older. With the increasing life span, many more millions will be added within several decades. It is essential to know (1) the normal range of blood pressure as well as the lower limit of hypertension for each age group over 65 for both sexes, (2) whether the blood pressure continues to increase with age and to vary with sex in those who are more than 65 years old, and (3) whether the blood pressure is related to weight, or (4) to surface area, or (5) to height. To seek answers to these questions, Dr. Arthur M. Master, Director of the New York Heart Association and cardiologist at Mt. Sinai Hospital, New York, Mr. Herbert H. Marks, of the Metropolitan Life Insurance Company, and Dr. Harry L. Jaffe, New York, have undertaken a statistical study of the blood pressure in people who are 65 years of age and over. The investigation is sponsored by the organizations mentioned above. The American Medical Association has given aid to the project. -()-- Second World Congress of Cardiology and 27th Scientific Sessions O f American Heart Association. Set for Washington Sept. 12 - 17 Physicians and research scientists from many nations will join their United States colleagues in Washington, D.C., next September 12 through 17 for a combined meeting of the Second World Congress of Cardiology and the Twenty-seventh Scientific Sessions of the American Heart Association. This will be the first international medical gathering of its kind ever held in th e United States. Detailed information concerning the Congress is available from the Secretary-General, L. W. Gorham, M.D., Second World Congress of Cardiol ogy, c/ o American Heart Association, 44 East 23rd Street, New York 10. 19 H 398 BULLETIN TODA Y'S THOUGHT: Success-making more money to meet obligations you wouldn't have if you didn't have so much money (anon.). -0-- Caleb Fiske Prize The Trustees of what is considered America's oldest medical essay com petition, the Caleb Fiske Prize of the Rhode Island Medical Society, announce as the subject for this year's dissertation "MODERN DEVELOPMENTS IN ANESTHESIA." The dissertation must be typewritten, double spaced, and should not exceed 10,000 words. A cash prize of $250 is offered. For complete information regarding the regulations write to the Secretary, Caleb Fiske Fund, Rhode Island Medical Society, 106 Francis Street, Provi dence 3, Rhode Island. -0-- PR Institute Set for September 1-2 That's the time for A.M.A.'s third Medical Public Relations Institute to be held at the Drake Hotel in Chicago. Designed primarily for public rela tions personnel and chairmen of state and county medical societies, this year's informal sessions are designed as an "idea exchange - a public relations seminar" - to stimulate the exchange of ideas in all areas of medical public relations. -0-- Says It's The Spokesman Does the A.M.A. really speak for America's doctors? The A.M.A. says it does. It says survey:? show that the vast majority of doctors approve A.M.A. policies. And the A.M.A.'s governing body, or house of delegates, is organized to represent all members of county and state medical societies on a proportional basis. Dr. Walter B. Martin, president-elect of the A.M.A., recently concluded a discussion of the A.M.A.'s "constructive program" with these words: "The American Medical Association has always accepted and carried out the responsibility of leadership in safeguarding the public health, raising the standards of medicine, and making good medical care available to the people. "This nation's medical progress over the past half century has given the United States the world's highest standards of health and medical care ... "That progress has been achieved under a voluntary system which em phasizes free enterprise, individual initiative, and responsibility, and coopera tive effort . . . "Our most urgent effort should now be directed to the solution of the problem of the medically indigent and the chronically ill. We believe that this objective can be reached without major change in our existing mechanism." -o- Verdict of Unethical Advertising Upheld By secret ballot in closed executive session the House of Delegates of the Medical Society of the State of New York has upheld the verdict of unethical conduct in the case of a Queens County physician affiliated with a medical group of the Health Insurance Plan of Greater New York (HIP). The verdict, in essence, was that a physician, Dr. Ben E. Landess, Medical Director of the Jamaica Medical Group and affiliated with HIP, was guilty of unethical conduct under that portion ot the Code of Prcfesssional Conduct dealing with unethical advertising. JULY THE MAHONING COUNTY MEDICAL SOCIETY 399 The Code of Professional Conduct is specific on this point. The group practice of medicine is not of itself unethical. BUT each such medical group shall obey all th.e rules of ethics as would an individual physician. Since a physician in private practice cannot advertise for patients, the same rule applies for physicians in groups. Hence Dr. Landess was found to be un ethical when his name appeared in HIP literature. -o-- Kenneth B. Babcock, M.D., will assume his duties as director of the Joint Commission on July 1, coming to Chicago from Detroit where he has been director of the Grace Hospital. As the Commission Chairman, Dr. Newell W. Philpott of Montreal, said in announcing the appointment recently: "We are delighted that Dr. Babcock has accepted the important task of. directing the Joint Commission on Ac creditation of Hospitals. There is perhaps no more vital program than this effort by doctors and by hospitals' to constantly elevate hospital care stand a rds by a vigorous and voluntary method of self-discipline. Dr. Babcock's career, first as a physician and surgeon and then as a hospital administrator, guarantees the sound continuance of this program which got off to such an excellent start." -0-- Blood Pressure Siudy in Persons 65 and Over The evaluation of blood pressure in old age has become a major prob lem because of the growing number of older people in the United States and the paucity of data in these age groups. Millions of Americans are now 65 years of age or older. With the increasing life span, many more millions will be added within several decades. It is essential to know (1) the normal range of blood pressure as well as the lower limit of hypertension for each a ge group over 65 fer both sexes, (2) whether the blood pressure continues to increase with age and to vary with sex in those who are more than 65 years old, and (3 ) whether the blood pressure is related to weight, or (4) to surface area, or (5) to height. To seek answers to these questions, Dr. Arthur M. Master, Director of the New York Heart Association and cardiologist at Mt. Sinai Hospital, New York, Mr. Herbert H. Marks, of the Metropolitan Life Insurance Company, and Dr. Harry L. Jaffe, New York, have undertaken a statistical study of the blood pressure in people who are 65 years of age and over. The investigation is sponsored by the organizations mentioned above. The American Medical Association has given aid to the project. -o-- Second World Congress of Cardiology and 27th Scientific Sessions O f American Heart Association. Set for Washington Sept. 12 - 17 Physicians and research scientists from many nations will join their United States colleagues in Washington, D.C., next September 12 through 17 for a combined meeting of the Second World Congress of Cardiology and the Twenty-seventh Scientific Sessions of the American Heart Association. This will be the first international medical gathering of its kind ever held in th e United States. Detailed information concerning the Congress is available from the Secretary-General, L. W . Gorham, M.D., Second World Congress of Cardiol ogy, c/ o American Heart Association, 44 East 23rd Street, New York 10. 19 H 400 BULLETIN Why Not Encourage the Self-Employed to Build Their Own Retirement Funds? Employed persons in the United States are at least partially protected for their old age by Social Security. In addition, many of them are the beneficiaries of company pension funds. Payments into such funds by em ployers, as well as the employers' share of the Social Security tax, are deductible from taxable income. Up to now, however, there is no similar provision for a large group of self-employed people, such as physicians, lawyers or farmers. Their efforts to provide for retirement are hampered by exorbitant taxation. In the Philadelphia area recent, a physician enjoying a large and pre sumably profitable private practice retired and took a job in a Government hospital. He gave as his reason for doing so the fact that he had been unable to educate his children and at the same time save enough to provide for eventual retirement. He felt himself compelled to become an employed person in order to receive the benefits of a pension fund. A young doctor or lawyer, after a long and expensive education and apprenticeship, is likely to find adequate saving almost impossible under present conditions. Congress is now considering a measure which is designed to fill some of these gaps. The Jenkins-Keogh Bill, which was introduced last year, is an outgrowth of several efforts to solve the problem. In general. it provides that any individual who is not eligible to participate in a pension or profit sharing plan may set aside each year an amount not to exceed 10 per cent of his earned income, and in no case more than $7500, to be paid into a restricted retirement trust or insurance annuity. The amount thus set aside could be deducted from his taxable income. The proposed law places certain restrictions on the means by which these savings can be accumulated and provides that the taxpayer may not tap the fund until he is sixty-five years old, "except in the case of total disability." This would place him roughly on the same footing with employed individuals who are the beneficiaries of private pension funds. Undoubtedly the proposed measure does give the self-empioyed certain other advantages over their opposite numbers in the ranks of the employed. For example, the beneficiary of some company pension funds may not ac cept a job in another company without forfeiting his equity in a pension from his first employer. The self-employed doctor who builds up his own retire ment fund may leave his community and set up shop somewhere else and still hang on to his retirement allowance. There are undoubtedly other dis crepancies, but if an individual can do better on his own account than through a company pension fund, this might be an important step away from the welfare state. Private saving should be made at least as attractive as reliance on contributions by employers or the Government. Few reliable estimates have been made of the possible loss of revenue to the Government if such a law were passed. However, as a writer in the Harvard Law Review has observed, "even the possibility that the revenue loss would be so considerable as to necessitate higher tax rates is not a valid objection; it seems more equitable to distribute the tax burden among all taxpayers than to continue discrimination against one group." (April 24, 1954) Reprinted by Special Permission of The Saturday Evening Post - Copy right 1954 by The Curtis Publishing Company. JULY THE MAHONING COUNTY MEDICAL SOCIETY 401 FROM THE BULLETIN TWENTY YEARS AGO-JULY~ 1934 The Depression was not over yet and the doctors were struggling along trying to make ends meet. The old Wednesday night ve:iereal clinic ~t the Youngstown Hospital was closed and patients referred with welfare slips to their private physicians. Drugs were supplied free by the Health Department. The physicians in charge of the Baby Welfare Stations presented a resolution to Council urging (I) that the stations should be conducted for well babies only, (2) that no therapeutic medicine should be practiced there, (3) that attendance should be limited to families making not more than $75.00 a month and (4) that no immunizations or vaccinations be performed there. The President urged all members to join and support the new Medical- Dental Bureau. You could buy a Knox hat at Scott's for five dollars. Joseph Keogh was among the new internes at Youngstown Hospital. - The annual Medical Society picnic at Southern Hills Country Club featured golf, horseshoes, archerv, trap and crap shooting, croque t, knitting, bridge, mumblety peg and hog .calling. The committee said, "If you miss this one, you'll Hate Yourself!" TEN YEARS AGO - JULY. 1944 It was vacation time but with the war on there was little time and no gasoline for long trips. Train travel conditions were somewhat improve~ ~nd restaurant eating was better. Some of the doctors ventured out on hshmg trips in Canada and for those at home the Society held a Golf Meet for physicians and druggists at the Youngstown Country Club. Doctors in the service were too busy with the grim business to write many letters to the Bulletin. Harold Reese had received a promotion a~d was transferred to Mobile, Alabama. Sears was back from England and ill in a hospital in New Y erk. McElroy was still in Italy and getting along well. The late J. H. Collier published a scholarly article on blood transfusions in which he explained the nature and clinical significance of the Rh factor. J. L. F. A course in "Newer Developments in Cardiovascular Diseases" will be given at The Mount Sinai Hospital. New York, October 11th through l~th, 1954, under the auspices of the American College of Physicians. As the title implies, the recent advances will be stressed. Dr. Arthur M. Master and Dr . Charles K. Friedberg will direct the course and prominent cardiologists a nd cardiac surgeons will participate. "Worry, like a rocking chair, keeps you busy but gets you nowhere." Bradford Thomas 1 9 5 4 400 BULLETIN Why Not Encourage the Self-Employed to Build Their Own Retirement Funds? Employed persons in the United States are at least partially protected for their old age by Social Security. In addition, many of them are the beneficiaries of company pension funds. Payments into such funds by em ployers, as well as the employers' share of the Social Security tax, are deductible from taxable income. Up to now, however, there is no similar provision for a large group of self-employed people, such as physicians, lawyers or farmers. Their efforts to provide for retirement are hampered by exorbitant taxation. In the Philadelphia area recent, a physician enjoying a large and pre sumably profitable private practice retired and took a job in a Government hospital. He gave as his reason for doing so the fact that he had been unable to educate his children and at the same time save enough to provide for eventual retirement. He felt himself compelled to become an employed person in order to receive the benefits of a pension fund. A young doctor or lawyer, after a long and expensive education and apprenticeship, is likely to find adequate saving almost impossible under present conditions. Congress is now considering a measure which is designed to fill some of these gaps. The Jenkins-Keogh Bill, which was introduced last year, is an outgrowth of several efforts to solve the problem. In general, it provides that any individual who is not eligible to participate in a pension or profit sharing plan may set a side each year an amount not to exceed 10 per cent of his earned income, and in no case more than $7500, to be paid into a restricted retirement trust or insurance annuity. The amount thus set aside could be deducted from his taxable income. The proposed law places certain restrictions on the means by which these savings can be accumulated and provides that the taxpayer may not tap the fund until he is sixty-five years old, "except in the case of total disability." This would place him roughly on the same footing with employed individuals who are the beneficiaries of private pension funds. Undoubtedly the proposed measure does give the self-empioyed certain other advantages over their opposite numbers in the ranks of the employed. For example, the beneficiary of some company pension funds may not ac cept a job in another company without forfeiting his equity in a pension from his first employer. The self-employed doctor who builds up his own retire ment fund may leave his community and set up shop somewhere else and still hang on to his retirement allowance. There are undoubtedly other dis crepancies, but if an individual can do better on his own account than through a company pension fund, this might be an important step away from the welfare state. Private saving should be made at least as attractive as reliance on contributions by employers or the Government. Few reliable estimates have been made of the possible loss of revenue to the Government if such a law were passed. However, as a writer in the Harvard Law Review has observed, "even the possibility that the revenue loss would be so considerable as to necessitate higher tax rates is not a valid objection; it seems more equitable to distribute the tax burden among . all taxpayers than to continue discrimination against one group." (April 24, 1954) Reprinted by Special Permission of The Saturday Evening Post - Copy right 1954 by The Curtis Publishing Company. JULY THE MAHONING COUNTY MEDICAL SOCIETY 401 FROM THE BULLETIN TWENTY YEARS AGO-JULY~ 1934 The Depression was not over yet and the doctors were struggling along trying to make ends meet. The old Wednesday night ve~ereal clinic ~t the Youngstown Hospital was closed and patients referred with welfare slips to their private physicians. Drugs were supplied free by the Health Department. The physicians in charge of the Baby Welfare Stations presented a resolution to Council urging (1) that the stations should be conducted for well babies only, (2) that no therapeutic medicine should be practiced there, (3) that attendance should be limited to families making not more than $75.00 a month and (4) that no immunizations or vaccir.ations be performed there. The President urged all members to join and support the new Medical- Dental Bureau. You could buy a Knox hat at Scott's for five dollars. Joseph Keogh was among the new internes at Youngstown Hospital. ' The annual Medical Society picnic at Southern Hills Country Club featured golf, horseshoes, archery, trap and crap shooting. croque t, knitting, bridge, mumblety peg and hog calling. The committee said, "If you miss this one, you'll Hate Yourself!" TEN YEARS AGO-JULY. 1944 It was vacation time but with the war on there was little time and no gasoline for long trips. Train travel conditions were somewhat improve~ ~nd restaurant eating was better. Some of the doctors ventured out on hshmg trips in Canada and for those at home the Society held a Golf Meet for physicians and druggists at the Youngstown Country Club. Doctors in the service were too busy with the grim business to write many letters to the Bulletin. Harold Reese had received a promotion a~d was transferred to Mobile, Alabama. Sears was back from England and ill in a hospital in New York. McElroy was still in Italy and getting along well. The late J. H. Collier published a scholarly article on blood transfusions in which he explained the nature and clinical significance of the Rh factor. ]. L. F. A course in "Newer Developments in Cardiovascular Diseases" will be given at The Mount Sinai Hospital, New York, October 11th through l~th, 1954, under the auspices of the American College of Physicians. As the title implies, the recent advances will be stressed. Dr. Arthur M. Master and Dr . Charles K. Friedberg will direct the course and prominent cardiologists a nd cardiac surgeons will participate. "Worry, like a rocking chair, keeps you busy but gets you nowhere." Bradford Thomas 1 9 5 4 402 BULLETIN COUNCIL MEETING !he reg~lar monthly meeting of the Council of the Mahoning County Medical Society was held at the offices of Dr. M. W. Neidus, 318 Fifth Ave., Youngstown, Ohio, on Monday, June 14, 1954. The foll~wing doctors were present: J. D. Brown, president, presiding; V. L. Goodwm, C. A. Gustafson, S. W. Ondash, G. E. DeCicco, A. A. Detesco E. R. McNeal. A. Randell. A. K. Phillips, comprising the Council; also Dr. M : p: Mahar, Mr. Franklin Powers, Counsel, Mrs. James H. Walls from the Youngs town Area Heart Association, and Mr. Morqan, from the Blue Cross. ~n order to acquaini Council with thei; suggested instruction classes for cardiac housewives, Mrs. Walls demonstrated and explained in brief their proposed set-up. Mr. Morgan, frcm the Blue Cross, explained their proposed set-up on a group plan for professional people and their families. Council suggested that he find out just how many of our members they now have and the percentage needed for enrollment, together with a copy of the benefits and plan and present them at the next meeting of Council. Mr. Powers submitted a cautionary memo re: Accident and Health Insur ance. He stated there are three rather simple cautionary statements that can properly be made by a physician to his patients: 1. Do your best to deal only with a reputable insurance agent. 2. Be sure that you understand the actual coverage afforded by your policy. 3. See that the application for the policy sets forth accurately and honestly your actual physical condition so far as you are aware of it. Dr. M . P. Mahar reported progress of the newly appointed committee that is working on the various Health and Hospital insurance plans. Some set-ups have not been heard from but he hopes to have a full report at the next meeting of Council if not before. Dr. Brown discussed the Community Chest drive. Many professional groups are soliciting their own members rather than the Community Chest doing it. Council was of the opinion that the amount of last year's contribu tion and the expected amount to be given be omitted from the card and that the Medical Society handle the collection from their own members. Dr. Randell discussed the need in this community for a home for the aged chronically ill. Also, the Society sponsoring a summer camp for handi capped children as has been done in the past. Dr. Brown appointed the following committee to work with Dr. Randell: Dr. Randell, chairman; Dr. M. P. Mahar, Dr. J. A . Rogers and Dr. C. A. Gus tafson. The following applications were read: Active Membership Dr. George L. Altman, St. Elizabeth Hospital Dr. Cary S. Peabody, 810 Dollar Bank Bldg. Dr. Milan Balmos, 1647 Mahoning Ave. Interne Membership Dr. James R. Sofranec, St. Elizabeth Hospital Dr. Evelyn M. Bellaire, T. B. Sanitarium Unless objection is filed in writing within 15 days with the Secretary, the above become members of the Society. G. E. DeCicco, M.D. Secretary JULY THE MAHONING COUNTY MEDICAL SOCIETY 403 A NIGHTMARE The other night, in place of restful slumber, I had a dream. After count ing the usual qi.iota of sheep, sleep of a sort came, and during this restless sleep, a nightmare. Somehow, in the peculiar mixed-up ways that dreams have, I was in court. I was both an observer and a defendant, and at times even seemed to be a witness. The judge, an unreal and awe-inspiring figure, called three physicians as defendants to take the stand. The first was a physician who was specifically accused of sending a large bill to a patient in very moderate circumstances, and for a service which was not unusual in any way. This defendant admitted that he had not determined the patient's ability lo pay "because he didn't feel ii was fitting for a physician to discuss money matters." Further, he argued, there was the probabilfty that an insurance company was paying part or all of the bill, so "because an impersonal agency was responsible, he was justified in charging a large fee." In my dream I recall being very disturbed because neither the judge nor the jury, as laymen, seemed impressed by the de fendant's reasoning. The second defendant was another physician, not overly impressed with his own importance, but hurried and harried in his manner. He was accused of rendering substandard care, inadequate examinations, both clinical and laboratory, and shotgun therapy. When he explained that he was too busy to do careful work, the court again did not seem impressed. The only com ment came from the judge, who suggested that possibly more help was needed in the medical profession. The third defendant was another physician. The man's manner was arrogant and impersonal. He was specifically acc~sed of failing to discuss a nything with his patients, either medical or financial. Several witnesses declared that the physician was reluctant to tell them what was wrong, what significance their medical condition had for them, and what their finan cial obligation probably would be. His attitude was that they were fortunate to be able to retain his services without wasting his time with useless expla nation. Again, surprisingly, the court did not seem favorably impressed by the defendant's testimony. Having heard these three defendants and numerous witnesses, the judge gave his instructions to the jury. He was in the midst of telling them that they must consider fairly the evidence for and against these three medical men, and at the same time decide whether this evidence reflected favorably or unfavorably on the practice of medicine as a whole and the conduct of "organized medicine." Fortunately, at this moment a final witness asked to be heard and this unusual privilege was granted. In his testimony he pointed out that thousands of physicians were practicing honestly, intelligently, and thoughtfully, and that American medicine was a leader in the field of world medicine. He urged that the medical profession not be condemned for the thoughtless, selfish tactics of a few of its members. This testimony very obviously impressed both the judge and the jury, to the extent that further instructions were given the jury. In these instruc tions the judge pointed out that the whole medical profession shouldn't be condemned for the acts of a few. He did, however, emphasize the responsi bility of "organized medicine" to keep its house in order, to instruct and discipline its recalcitrant members, and to be a leader in providing the best I 9 5 4 402 BULLETIN COUNCIL MEETING !he reg~lar monthly meeting of the Council of the Mahoning County Medical Society was held at the offices of Dr. M. W. Neidus, 318 Fifth Ave., Youngstown, Ohio, on Monday, June 14, 1954. The foll~wing doctors were present: J. D. Brown, president. presiding; V. L. Goodwm, C. A. Gustafson, S. W. Ondash, G. E. DeCicco, A. A. Detesco E. R. McNeal, A. Randell, A. K. Phillips, comprising the Council; also Dr. M.' p: Mahar, Mr. Fra.nklin Powers, Counsel. Mrs. James H. Walls from the Youngs town Area Heart Association, and Mr. Morgan, from the Blue Cross. !n order to acquaini Council with thei; suggested instruction classes for cardiac housewives, Mrs. Walls demonstrated and explained in brief their proposed set-up. Mr. Morgan, frcm the Blue Cross, explained their proposed set-up on a group plan for professional people and their families. Council suggested that he find out just how many of our members they now have and the percentage needed for enrollment, together with a copy of the benefits and plan and present them at the next meeting of Council. Mr. Powers submitted a cautionary memo re: Accident and Health Insur ance. He stated there are three rather simple cautionary statements that can properly be made by a physician to his patients: I. Do your best to deal only with a reputable insurance agent. 2. Be sure that you understand the actual coverage afforded by your policy. 3. See that the application for the policy sets forth accurately and honestly your actual physical condition so far as you are aware of it. Dr. M . P. Mahar reported progress of the newly appointed committee that is working on the various Health and Hospital insurance plans. Some set-ups have not been heard from but he hopes to have a full report at the next meeting· of Council if not before. Dr. Brown discussed the Community Chest drive. Many professional groups are soliciting their own members rather than the Community Chest doing it. Council was of the opinion that the amount of last year's contribu tion and the expected amount to be given be omitted from the card and that the Medical Society handle the collection from their own members. Dr. Randell discussed the need in this community for a home for the aged chronically ill. Also, the Society sponsoring a summer camp for handi capped children as has been done in the past. Dr. Brown appointed the following committee to work with Dr. Randell: Dr. Randell, chairman; Dr. M. P. Mahar, Dr. J. A. Rogers and Dr. C. A. Gus tafson. The following applications were read: Active Membership Dr. George L. Altman, St. Elizabeth Hospital Dr. Cary S. Peabody, 810 Dollar Bank Bldg. Dr. Milan Balmos, 1647 Mahoning Ave. Interne Membership Dr. James R. Sofranec, St. Elizabeth Hospital Dr. Evelyn M. Bellaire, T. B. Sanitarium Unless objection is filed in writing within 15 days with the Secretary, the above become members of the Society. G. E. DeCicco, M.D. Secretary JULY THE MAHONING COUNTY MEDICAL SOCIETY 403 A NIGHTMARE The other night, in ploce of restful slumber, I had a dream. After count ing the usual qt.iota of sheep, sleep of a sort came, and during this restless sleep, a nightmare. Somehow, in the peculiar mixed-up ways that drearn.s have, I was in court. I was both an observer and a defendant, and at times even seemed to be ct witness. The judge, an unreal and awe-inspiring figure, called three physicians as defendants to take the stand. The first was a physician who was specifically accused of sending a large bill to a patient in very moderate circumstances, and for a service which was not unusual in any way. This defendant admitted that he had not determined the patient's ability to pay "because he didn't feel it was fitting for a physician to discuss money matters." Further, he argued, there was the probabihty that an insurance company was paying part or all of the bill, so "because an impersonal agency was responsible, he was justified in charging a large fee." In my dream I recall being very disturbed because neither the judge nor the jury, as laymen, seemed impressed by the de fendant's reasoning. The second defendant was another physician, not overly impressed with his own importance, but hurried and harried in his manner. He was accused of rendering substandard care, inadequate examinations, both clinical and la boratory, and shotgun therapy. When he explained that he was too busy to do careful work, the court again did not seem impressed. The only com ment came from the judge, who suggested that possibly more help was needed in the medical profession. The third defendant was another physician. The man's manner was arrogant and impersonal. He was specifically acc~sed of failing to discuss a nything with his patients, either medical or financial. Several witnesses declared that the physician was reluctant to tell them what was wrong, what significance their medical condition had for them, and what their finan cia l obligation probably would be. His attitude was that they were fortunate to be able to retain his services without wasting his time with useless expla nation. Again, surprisingly, the court did not seem favorably impressed by the defendant's testimony. Having heard these three defendants and numerous witnesses, the judge gave his instructions to the jury. He was in the midst of telling them that they must consider fairly the evidence for and against these three medical men, and at the same time decide whether this evidence reflected favorably or unfavorably on the praciice of medicine as a whole and the conduct of "organized medicine." Fortunately, at this moment a final witness asked to be heard and this unusual privilege was granted. In his testimony he pointed out that thousands of physicians were practicing honestly, intelligently, and thoughtfully, and that American medicine was a leader in the field of world medicine. He urged that the medical profession not be condemned for the thoughtless, selfish tactics of a few of its members. This testimony very obviously impressed both the judge and the jury, to the extent that further instructions were given the jury. In these instruc tions the judge pointed out that the whole medical profession shouldn't be condemned for the acts of a few. He did, however, emphasize the responsi bility of "organized medicine" to keep its house in order, to instruct and discipline its recalcitrant members, and to be a leader in providing the best 1 9 5 4 404 • BULLETIN MARK YOUR CALENDAR - ANNUAL GOLF MEET THURSDAY. AUGUST 19 YOUNGSTOWN COUNTRY CLUB PATRONIZE OUR ADVERTISERS AND MENTION THE BULLETIN OVERLOOK SANITARIUM New Wilmington. Pa. A beautifully loca ted sa nitarium, just fift een miles from Youngstown, especially equipped for the care of psy choneuro sis. Mental cases and a lcoholics not admitted. RE-EDUCATION METHODS REST CURE PSYCHOTHERAPY HYDROTHERAPY Elizabeth McLaughry, M. D. Elizabeth Veach, M. D. • JULY THE MAHONING COUNTY MEDICAL SOCIETY 405 medical care at a price the public can pay. He pointed out that the possible alternative would be Government-sponsored and -regulated medical care. At this point _I awoke in a cold sweat, thanking my stars that this was only a dream . . . . . . . or was it? F. D. Costenbader, M .D. Medical Annals of D. of C. PERIODICAL PEARLS Congenital Cysts of the Lung by Sol Katz, M.D. The subject of congenital cystic disease of the lung is confusing because of differences in nomenclature and classification. Over thirty terms have been used when referring to cysts of the lung. Cystic diseases of the lung may be acquired or congenital. Acquired cysts include emphysematous bullae and blebs as well as chronic lung ab scesses in which there has been control of infection and subsequent partial or complete epithelialization due to ingrowth into the cavity of cuboidal or columnar epithelium or due to squamous metaplasia. Congenital cysts may arise from the mediastinum or may appear within the lung substance. Only the latter will be considered here. At times it is difficult or impossible to differentiate between an acquired cyst and a congenital cyst on the basis of history, x-ray examination, and even histological study. Congenital cysts of the lung may be single or multiple and they may contain air, fluid, or both. The cyst wall is lined by bronchial mucosa con taining either columnar or cuboidal ciliated cells. Some congenital cysts are of the alveolar type in which the wall is composed of flat cells characteristic of the air sacs. The epithelium may be destroyed by infection. Symptoms may occur shortly after birth or in childhood. However, in some there are no symptoms until adult life, while in others the cysts are asymptomatic. The symptoms result from infection, with manifestations of pulmonary suppuration, and from impaired pulmonary ventilation due to overdistention and compression of surrounding lung. X-ray examination of the lungs is the most valuable method of diagnosis. A cyst may appear as an area of radiolucency surrounded by a thin wall. A horizontal fluid level is seen when air and fluid are present. When the cyst is filled with fluid, a round sharply limited density occurs. Even in the presence of infection, the adjacent lung and pleura are often not inflamed. A striking feature is the presence of linear strands traversing the cavity. Some cysts may become hyperinflated due to partial obstruction of the communi cating bronchus. These cysts cause compression of the surrounding lung and even the opposite lung and appear as a large area of radiolucency surround ed by a thin w all herniating across the mediastinum into the opposite hemi thorax. With multiple cysts there are many round areas of decreased density some of which contain fluid. "It is better to light one small candle than to curse the darkness." Confucius 1 9 5 4 404 • BULLETIN MARK YOUR CALENDAR - ANNUAL GOLF MEET THURSDAY. AUGUST 19 YOUNGSTOWN COUNTRY CLUB PATRONIZE OUR ADVERTISERS AND MENTION THE BULLETIN OVERLOOK SANITARIUM New Wilmington. Pa. A beautifully located sanitarium, just fifteen miles from Youngstown, especially equipped for the care of psychoneuro sis. Menta l cases and a lcoholics not a dmitted. RE-EDUCATION METHODS REST CURE PSYCHOTHERAPY HYDROTHERAPY Elizabeth McLaughry, M. D. Elizabeth Veach. M. D. • JULY THE MAHONING COUNTY MEDICAL SOCIETY 405 medical care at a price the public can pay. He pointed out that the possible alternative would be Government-sponsored and -regulated medical care. At this point .I awoke in a cold sweat, thanking my stars that this was only a dream . . . . . . or was it? F. D. Costenbader, M.D. Medical Annals of D. of C. PERIODICAL PEARLS Congenital Cysts of the Lung by Sol Katz, M.D. The subject of congenital cystic disease of the lung is confusing because of differences in nomenclature and classification. Over thirty terms have been used when referring to cysts of the lung. Cystic diseases of the lung may be acquired or congenital. Acquired cysts include emphysematous bullae and blebs as well as chronic lung ab scesses in which there has been control of infection and subsequent partial or complete epithelialization due to ingrowth into the cavity of cuboidal or columnar epithelium or due to squamous metaplasia. Congenital cysts may arise from the mediastinum or may appear within the lung substance. Only the latter will be considered here. At times it is difficult or impossible to differentiate between an acquired cyst and a congenital cyst on the basis of history, x-ray examination, and even histological study. Congenital cysts of the lung may be single or multiple and they may contain air, fluid, or both. The cyst wall is lined by bronchial mucosa con taining either columnar or cuboidal ciliated cells. Some congenital cysts are of the alveolar type in which the wall is composed of flat cells characteristic of the air sacs. The epithelium may be destroyed by infection. Symptoms may occur shortly after birth or in childhood. However, in some there are no symptoms until adult life, while in others the cysts are a symptomatic. The symptoms result from infection, with manifestations of pulmonary suppuration, and from impaired pulmonary ventilation due to overdistention and compression of surrounding lung. X-ray examination of the lungs is the most valuable method of diagnosis. A cyst may appear as an area of radiolucency surrounded by a thin wall. A horizontal fluid level is seen whe n a ir and fluid are present. When the cy st is filled with fluid, a round sharply limited density occurs. Even in the presence of infection, the adjacent lung and pleura are often not inflamed. A striking feature is the presence of linear strands traversing the cavity. Some cysts may become hyperinflated due to partial obstruction of the communi cating bronchus. These cysts cause compression of the surrounding lung and even the opposite lung and appear as a large area of radiolucency surround ed by a thin wall herniating across the mediastinum into the opposite h emi thorax. With multiple cysts there are many round areas of decreased density some of which contain fluid. "It is better to light one small candle than to curse the darkness." Confucius 1 954 406 BULLETIN The Benefit of Respiratory Exercises in the Emphysematous Patient by Warde B. Allen, M .D. Associate Professor of Medicine Charles Austrian Chest Clinic, Johns Hopkins Hospital, Baltimore There is no great problem in recognizing emphysema. A physician from a large chest service in this country stated "we can diagnose emphysema but we don't treat it." The major features of this condition center around the loss of alveolar elasticity. The respiratory and circulatory readjustments are an attempt to compensate for this loss. Christie has shown that in emphysema the intra pleural pressure is not always negative throughout the respiratory cycle as it is in health, but approaches that cf the atmosphere. Because of the in ability of the lungs to retract during expiration, there is an increased amount of air in the lungs which keeps them in a permanent state. of distention close to the confines of the thoracic cage, even infringing on the abdominal cavity by downward pressure on the diaphragm. The residual air which accumulates in the vesicles is at the expense of the vital capacity, and the vital capacity may closely approximate the resting tidal air, so that an individual at rest may be comfortable, but during any exertion he may have severe respiratory distress. There is nothing new in using respiratory exercises to treat emphysema. Thomas emphasized, as have Christie and others, that the important phase of respiration in the emphysematous patient is expiration. Christie and others felt that this effort would be of necessity cm unnatural effort. However, it is our opinion, indeed, our experience, that it can be developed into a natural effort, by systematic and persistent instruction in the series of exercises here presented. Method. It is of paramount importance to impress upon the patient that his breathing mechanism can be helped. It is then demonstrated to the patient that instead of struggling to make the thorax move, it is much simpler to use the abdominal muscles. Then it is demonstrated to him that the ex piratory phase of respiration is the important feature, and instead of being passive he is able to make it active, with the result that the inspiratory phase becomes passive rather than active. It has been a surprise to observe how rapidly these patients can accommodate their respirations to conform with this newer concept. In fact, this type of respiration is carried over into sleep and has been seen to be maintained under anesthesia. . The first signs of improvement are the feeling of well being, the confi dence of being able to breath, the subsidence of respiratory effort and the lessening of dyspnea. Studies of vital capacity have been done routinely but have not shown an increase commensurate with subjective improvement. There is no set of exercises which can be mimeographed and handed to patients to be done at home. The importance of individual differences and the day to day developments cannot be overemphasized nor can they be anticipated. Therefore, each patient is a different problem and the specific prescriptions are made every day according to progress made and stumbling blocks which develop. Instruction is given to the individual patient, progressing through the following list of exercises: 1. Patient in supine position with minimal elevation for comfort. JULY THE MAHONING COUNTY MEDICAL SOCIETY 407 a. Teach easy corrected breathing: air expired through nose; chest re laxed; throat relaxed; abdominal contracting to produce expiration actively; abdominal relaxing to allow inspiration passively. b. Deepen both phases by increasing expiration. c. Add retraction of lower ribs to abdominals in expiration. d. Teach these with the patient lying on his side, right and left. 2. Patient in sitting position, knees apart for stability, arms relaxed. a. Correct posture and teach exercise la. b. Add exercise lb, maintaining all corrections. c. Add exercise le, usually an easy step. 3. Patient in standing position against wall. a . Correct posture without adding tension. b . Teach exercises la, 2a, lb, 2b, le and 2c, progressing only as skill and accuracy are maintained. 4. Teach walking coordinated with easy respiration. 5. Teach lifting and replacing small objects of light weight. 6. Eliminate mouth breathing in expiration except in deep exercise. 7. Teach stair climbing: 2 to 4 steps with expiration, l or 2 with inspiration. 8. Translate all usual every-day activities into breathing pattern. 9. An optical procedure is to teach mild posture exercises in all positions within breathing pattern. IO. Encourage gradual increase in walking and stair climbing as criteria of improvement. No progression of activity must be made until each previous skill is mastered. Practice sessions between treatments are essential. Coughing and expectoration are encouraged. Results are dependent upon understanding a nd cooperation of patient. Automatic carry-over should begin at about Exercise 3. (Am. J.M. Sc., September 1952) -0- Ne·w Pamphlets for Doctors' Waiting Rooms The American Medical Association's PR Department has just completed publication of four new pamphlets describing medical scientific achievements, doctors' services to the community, and their desire to provide high quality medical care to everyone. Subjects of the four are: 1) "Quack!" - explains the dangers of going to quack healers for medical treatment; 2) "Health Today!" - tells about medicine's progress during the past 50 years; 3) "On Guard!" - outlines the steps A.M.A. has taken to evaluate drugs, and 4) "Why Wait?" - de scribes the best way to select a family doctor. "People buy what they are made to want." Anonymous l 9 5 4 406 BULLETIN The Benefit of Respiratory Exercises in the Emphysematous Patient by Warde B. Allen, M .D. Associate Professor of Medicine Charles Austrian Chest Clinic, Johns Hopkins Hospital, Baltimore There is no great problem in recognizing emphysema. A physician from a large chest service in this country stated "we can diagnose emphysema but we don't treat it." The major features of this condition center around the loss of alveolar elasticity. The respiratory and circulatory readjustments are an attempt to compensate for this loss. Christie has shown that in emphysema the intra pleural pressure is not always negative throughout the respiratory cycle as it is in health, but approaches that cf the atmosphere. Because of the in ability of the lungs to retract during expiration, there is an increased amount of air in the lungs which keeps them in a permanent state. of distention close to the confines of the thoracic cage, even infringing on the abdominal cavity by downward pressure on the diaphragm. The residual air which accumulates in the vesicles is at the expense of the vital capacity, and the vital capacity may closely approximate the resting tidal air, so that an individual at rest may be comfortable, but during any exertion he may have severe respiratory distress. There is nothing new in using respiratory exercises to treat emphysema. Thomas emphasized, as have Christie and others, that the important phase of respiration in the emphysematous patient is expiration. Christie and others felt that this effort would be of necessity an unnatural effort. However, it is our opinion, indeed, our experience, that it can be developed into a natural effort, by systematic and persistent instruction in the series of exercises here presented. Method. It is of paramount importance to impress upon the patient that his breathing mechanism can be helped. It is then demonstrated to the patient that instead of struggling to make the thorax move, it is much simpler to use the abdominal muscles. Then it is demonstrated to him that the ex piratory phase of respiration is the important feature, and instead of being passive he is able to make it active, with the result that the inspiratory phase becomes passive rather than active . It has been a surprise to observe how rapidly these patients can accommodate their respirations to conform with this newer concept. In fact, this type of respiration is carried over into sleep and has been seen to be maintained under anesthesia. . The first signs of improvement are the feeling of well being, the confi dence of being able to breath, the subsidence of respiratory effort and the lessening of dyspnea. Studies of vital capacity have been done routinely but have not shown an increase commensurate with subjective improvement. There is no set of exercises which can be mimeographed and handed to patients to be done at home. The importance of individual differences and the day to day developments cannot be overemphasized nor can they be anticipated. Therefore, each patient is a different problem and the specific prescriptions are made every day according to progress made and stumbling blocks which develop. Instruction is given to the individual patient, progressing through the following list of exercises: 1. Patient in supine position with minimal elevation for comfort. JULY THE MAHONING COUNTY MEDICAL SOCIETY 407 a . Teach easy corrected breathing: air expired through nose; chest re laxed; throat relaxed; abdominal contracting to produce expiration actively; abdominal relaxing to allow inspiration passively. b . Deepen both phases by increasing expiration. c. Add retraction of lower ribs to abdominals in expiration. d. Teach these with the patient lying on his side, right and left. 2. Patient in sitting position, knees apart for stability, arms relaxed. a. Correct posture and teach exercise la. b. Add exercise lb, maintaining all corrections. c. Add exercise le, usually an easy step. 3. Patient in standing position against wall. a . Correct posture without adding tension. b . Teach exercises la, 2a, lb, 2b, le and 2c, progressing only as skill and accuracy are maintained. 4. Teach walking coordinated with easy respiration. 5. Teach lifting and replacing small objects of light weight. 6. Eliminate mouth breathing in expiration except in deep exercise. 7. Teach stair climbing: 2 to 4 steps with expiration, 1 or 2 with inspiration. 8. Translate all usual every-day activities into breathing pattern. 9. An optical procedure is to teach mild posture exercises in all positions within breathing pattern. 10. Encourage gradual increase in walking and stair climbing as criteria of improvement. No progression of activity must be made until each previous skill is mastered. Practice sessions between treatments are essential. Coughing and expectoration are encouraged. Results are dependent upon understanding a nd cooperation of patient. Automatic carry-over should begin at about Exercise 3. (Am. J.M. Sc., September 1952) -0- New Pamphlets for Doctors' Waiting Rooms The American Medical Association's PR Department has just completed publication of four new pamphlets describing medical scientific achievements, doctors' services to the community, and their desire to provide high quality medical care to everyone. Subjects of the four are: 1) "Quack!" - explains the dangers of going to quack healers for medical treatment; 2) "Health Today!" - tells about medicine's progress during the past 50 years; 3) "On Guard!" - outlines the steps A.M.A. has taken to evaluate drugs, and 4) "Why Wait?" - de scribes the best way to select a family doctor. "People buy what they are made to want." Anonymous 19 54 wise addition to the menu when diet is restricted ... ~ INC. MllWAVKH I, WISCONSIN • 1954 of the MAHONING COUNTY MEDICAL SOCIETY