1 THE' JIAHO:\I).1G CO • !TY MEDICAL SOCIETY PARDON ME, MAJOR BUT YOU'LL ENJOY Heberding"s Indian Creek Farm Milk after the parade is over! It's-full of llell! You will find our stoc.;k of Knox hats complete in e'Yery • detail. The Scott Company 32 "{OTlII 'Phelps Street • Youngstown Owned and Operated CR S DR S 6 EAST FEDERAL STREET In the Stambaugh Bldg. 1 WEST FEDERAL STREET Patronize Our dv rtis r In Central Tower Bldg. and 3'v1ention th CJ3ull t'n • vVE INVITE YOU TO VISIT OUR PRESCRIPTION DEPARTMENT Five Pharmacists to Serve You. Prescriptions Delivered to Your Patient. 1'.\TRONIZE OCR AUVERTISERS A:'\J) i\JE:'\TIO:'\ THE BCLI.,ETIN • • ~~®~ OO~~~= Q You will find our stock of Knox hats complete in e"ery detail. The Scott Company 32 W"orth Phelps Street Patronize Our cAdyerlzsers and 3V1ention the C13ulletin THE :'\'IAHO:\I:\!G ('OU,\TY l\lEDICAL SOC1F.TY PARDON ME~ MAjOR BUT YOU~LL ENJOY Heberding:'s Indian Creek Farm Milk after the parade is over! It's-full of pep. ,/ -.... ..~ Jrlii/ll < <'tl ~M!2 p==(-~/-.-, a.h., Youngstown Owned and Operated SS DRUGS 6 EAST FEDERAL STREET In the Stambaugh Bldg. 1 WEST FEDERAL STREET In Central Tower Bldg. • "\VE INVITE YOU TO VISIT OUR PRESCRIPTION DEPARTMENT Five Pharmacists to Serve You. Prescriptions Delivered to Your PatienL PATRONIZE ocn ADVERTISERS AND MENTIO?\ THE BCLI.ETIN B LLETI:\ TT-m :\'IAllO::'\Ii'\C COCYI'Y I\['mlC:\L SOCn:TY SYRUP (OCILLA A COMPOUN ALCOHOL 10',1, Each Fluid Ounce Represents • Ethylmorphine Hydrochloride . Il" gr Tr. Euphorbia Pil. 120 min. Syr. Wild Lettuce .120 min. Tr. Cocillana 40 min. Syrup Squill Camp. 24 min. Menthol. Cascarin q. s. Expectorant and Sedative. DOS/\GE: One or two teaspoonfuls as required. A Superior Preparation at $4.50 per Calion. LOT o. MANUFACTURING PHARMACISTS 26 Fifth Avenue Phone 40131 Youngstown, Ohio • q)OctOT c:y r wlz re Prefer Mt. ock Fleece VERC ATS And rig!-',tly so. They know they can depend on their fleecy fabric for protection during freezing middle-of-the-night calls. They know the experienced designing. cutting and tailor ing are representative of the standards they must maintain as professional men.. $45 McKELVEY'S PATRC NIZE orR ADVERTISERS A:\D ~IE:\TIOX THE IH:I.LETl~ • • Dorst and Morris, Burger and other clinicians have demonstrated the fact that toxic absorption from the in testinal tract may be decreased by the oral administra tion of Soricin. When given in adequate amounts over a reasonable period of time, Soricin (capsules or tablets) relieves the many con ditions that accompany or result from intestinal toxemia. Soricin is non-toxic and is not absorbed from the bowel. Large doses have been given over long periods of time without any ill effect. DOSAGE FORMS: Soricin Capsules-Enteric capsules of sodium ricinoleate available in five-grain and ten-grain sizes.• Soricin Tablets - Enteric coated tablets each containing five grains of sodium ricinoleate. ACTION: Detoxifies in vivo. Derensitizes • hhibils putrefaction. Prevents loxic absorption. INDICATIONS: Bacterial Hypersensitivity of the intestinaltracl • Intestinal toxemia • Intestinal allergy. Allergic diarrhea· Urti caria • Angioneurotic edema • CoUtis. Literature and Sample on Request • Karicin-Merrell A palatable ricinoleated emulsion of colloidal kaolin with mineral oil. Write for descriptive Utero.ture. THE WM. S. ME RUL COMPANY, Cincinnati, U. S. A. P.\TRONIZE OCR ADVERTISERS A1\1l ~IE:\TWN TIlE BCI.LETI~ 2 BDLLETn° SYRUP COCILLANA COMPOUND ALCOHOL 10',;" Each Fluid Ounce Represents Ethylmorphine HydrochlOride '/' gr Tr. Euphorbia Pil 120 mill. Syr. \Iv',ld Lettuce .. 120 mill. Tr. Cocillana 40 min. Syrup Squill Camp. 24 min. Menthol. Cascarin . q. s. Expectorant and Sedative. DOSAGE One Or two teaspoonfuls as reqUired. A Superior Preparation at $4.50 per Calion. LYONS PHYSICIA1, SUPPLY CO. MANUFACTURING PHARMACISTS 26 Fifth Avenue Phone 40131 Youngstown. Ohio rtJoctors cver)'nJlere Prefer Mt. Rock Fleece ERCOATS And rightly so. They know they can depend on their fleecy fabric for protection during freezing middle-of-the-night calls They know the experienced designing. cutting and tailor ing are representative of the standards they $4 must maintain as professional men. 5 • TilE :\1 <\I-IOI\I:\C CUU>iTY lI[!'J)[CAL SOCIETY ::~ • Dorst and Morris, Burger and other clinicians have demonstrated the fact that toxic absorption from the in testinal tract may be decreased by the oral administra tion of Soricin. When given in adequate amounts over a reasonable period. of time, Soricin (capsules or tablets) relieves the many con ditions that accompany or result from intestinal toxemia. Soricin is non-toxic and is not absorbed from the bowel. Large doses have been given over long periods of time without any ill effect. DOSAGE FORMS: Soricin Capsules-Enteric capsules of sodium ricinoleate available in five-grain and ten·grain sizes.• Soricin Tablets -Enteric coated tablets each containing five grains of sodium ricinoleate. ACTION: Detoxifies in vivo. DeEensitizes • hhibits putrefaction. Prevents toxic absorption. INDICATIONS: Bacterial Hypersensitivity of the intestinal tract • Intestinal toxemia • Intestinal allergy. Allergic diarrhea • Urti caria • Angioneurotic edema • Colitis. Litera/ure and Sample on Request • Karicin-Merrell A palatable ricinoleated emulsion of colloidal kaolin with mineral oil. Write for descriptive literature. McKELVEY'S THE WM. S. MERRELL COMPANY, Cincinnati, U. S. A. P.\TROl'\!ZE OCR ADVERTISERS AXil JIE~T[OX THE BLLI.RTl!'· f':\TRONIZE OUR ADVERTISERS A~D l\llliYrrO~ TIlE BlTLLETIN - 4 DULLETI~ I Tonsillitis Parkvie'''' PharJnacy Walter R. Zimme man 909 Elm Street W call fOl" and tleliv r PrescTi ion to any part of the ity, RESPONSIBLE Phone 3-9831 DRY CLEANING PLUS TEXTURIZING Prolongs th life of garm nts and re tore 11lei' beauty and Lyl, all II a d judge for F. J. I{ RRIS y tH'S If. PHARMACIST EARL . BLAIR , Phone 103 Ca"j ld, Ohio INC. We fill a's a ou write 2607 I nw d them. We will be ",lad to Phone 4-4.228 favor you at any time. CHURCII 1- ILL REST HONIE Recomm r>nded by Physicians for Convalescents and Invalid THELMA MEDLEY Phone 74~)51 Belmont Ave. Extension Dodon; are welcome to inspect our home at any time. H. H. TREUDLEY & co. Wishing You a Prosperous INC. and 123 E. COMMERCE STREET Happy New Year OFFICE SUF'PLIES ACCOUI\lT BOOKS p~ SCHMIDT STEEL & WOOD OFFICE FLORIST FURNITU ,E 31-1 1arkel t. Phon 2-4212 T ulIllg',;town, Ohio Call 4-4421 For Prompt Service PATIW:\fIZE OUR ADVERTISERS :\ND i\lE:\fTIOX THE BLLLETIX the lymphatic systenl of the entire throat is involved, as the tonsils themselves are an iIllportant unit of this systeln. 1] E stlnlulation of this capillary net-work ,,,,ith generous applications of uti"kIOflistiue ov r the entire neck, is frequently all the local treatlnent that is required to renlove the toxic products and thus relieve the disconifort and redll .~ the inflanunation alm,ost irnnledia(;ely. Generous dini£ul supply und descriptive literature on request from: THE DENVER CHEMICAL MANUF CTURING COMPANY 163 VARICK STREET NEW Y RK, N. Y. 4 DULLETJl\ Parkvie,,,r Pharrnacy Walter R. Zimmerman 909 Elm Street We call for l\nu deliver PrcsniptiQIlS to any part of the Cit~. RESPONSIBLE Phone 3-9831 \ DRY CLEANING I I, J PLUS TEXTURIZING - Prolongs the life of garments and restores their beauty and style. Call us and judge for F. A. NIORRI yourself. PHARMACIST EARL M. BLAIR II I Phone 103 Canfield. Ohio INC. We fill R-'S as you write 2607 Glenwood AV~. them. We will be glad to hone 4-4228 fa"or you at any time. CI-IURCII IfILL REST IIO~/IE Recommended by Phy;.;ician8 for COllvalesccnb and Invalids THELMA MEDLEY Phone H95l Relmont Ave. Extension Doctors are welcome to inspect our home at any time. Wishing You a and Prosperous ~1 II H. H. TREUDLEY & CO. INC. 123 E. COMMERCE STREET Happy New Year OFFICE SUPPLIES PAUL SCHMIDT ACCOUNT BOOKS FLORIST 3121 Market St. Phone 2-4212 STEEL & WOOD OFFICE FURNITURE Youn,g-stown, Ohio Call 4-4421 For Prompt Service PATRONIZE orR ADVEHTlSERS AND MENTION THE BULLETI;,\ In Tonsillitis lhe lynlphatic system of the ~ntire throat is involved, as the tonsils thenlselves are an iUlportant unit of this systenl. • THE stimulation of this capillary net-work with generous applications of J.ntipklotlistine over the entire neck, is frequently all the local treaLJl1ent that is required to rel1wve the toxic products and thus relieve the discolnfort an reduce the illjlamJnation az,nost iln11'wdiately. Generolls clinical supply and descriptive literature on request from,: THE DENVER CHEl'UCAL MANUFACTURING COJliIPANY 163 VARICK STREET . NEW YORK, N. Y. Ij B LLETlN THE MAHONING CO KTY MEDICAL SOCIETY BULLETIN It is not only when accidents occur that our ambulance is OFFIe RS OF THE ETY valuable: it is the most comfortable way to move invalids or P,IU .I. !'t;ZY, i\1. D" Pre,idem ~1. I-l. B.ICIDLI''-. \1. I)" Treasurer expectant mothers between hospital : U.\1. B.\ '>: IJlTr :'\O,>:-PE'>:ETRxrl:,\c TR.\c\1.\ OF TilE l\RDO.\JE:'\ ;'\EWS hD1S \-1 EllICAL C1.E.\:'\I:'\CS SO\IE PRORLE\IS 1:'\ H,\f';\I:\TOLOC;Y PRESII)E:-':T's P:\CE " o 12 1 1+ 15-18 1)-10-1 J 11 12 olerto Engi . eenng Company PI1AR;\J:\CY SPEAKS TO SECR1'T,\RY's RI'PORT .\IEDICJ:'\E 19-20 2 20 R.\D10 '1':\I.KS 605 Market Street Youngstown, Ohio 21 PERSO:'\:\1. hE.\IS = t PATRONIZE Ol'R ADVERTISERS ANI) MENTION TilE IH'LLETIX .. BULLETL\T THE MAliO~I;\G COC:'\TY }IF:DICAL SeCrETY ,. ]j r ~9T of the I'll retiring administration merits ~l hearty hand-shake and congratulations, for the splen did wurk that they have accomplished in the year I()3t>. The l:ommittees have all been active, and in the final analysis, committee activity is the yard stick by which s()L'iety progress is meas u red. Th rough these va rious commi ttee ac tivities, this society, in the last ten years, has assumed a place of .It{{tc prollllfll.:flcc. Hrl\v <:\'er, to maintain this enviable position we now hold, will require maintained activity and increased Cil-opera tion, not only of the various committees, but of {'(/{:!I 11/l'mber of • the society, • Il organization, such as Ilurs, that has ac complished what it has in the past, can be expected to continue its activity for better scientific med icine. Your officers v'lill strive to interpret the will of the majority, and initiate policy, where it is indicated. This is a society of the physicians of :vra honing County, Ohio. Each of us has h is duty to his patient, his family, himself, and his societ~ . " "nited we stand---divided we fall." PAUL J. FUZY, }I. D. J{/llIIorr • • MAHONING COUNTY MEDICAL SOCIETY JANUARY 9 3 7 SOME PROBLEMS IN HAEMATOLOCY By DR, W, H. BUNN Our rCCl'rH tuur of Jutl' Oil \VarJ till: best explanation to date, Adl\ lia Scn'ice Il'a.; <:specially interesting Iw ga,;trica i,; mo,;t likeh' just an associ ('au.;e of ,;C\'cral ('ase, pr(',;entinl!; ,aline ated «a,;tric Jl'sfllllction but i, ,tlm:a,trica is mo,;t lihh ju,;t an ;l:,:,o(:i ;lted ;..'a,tric d),ful1ctio!; but i,; alml),;t 100;' a dependahlc ,;ign, Our ITl'('nt I\'arel case pre',,'ntl'd t\\,O unu,;ual featur(',,: l"t-a tcnd cnc, to hl('('d, having hoth hematuria anti epi,;taxi,;; 2nd-g,,'nnalized ana sarca to a marked dq.;rc(', His lc:;s and face 'l'l'IT ;!J'lJ.;,;ly t'dClllatull' and there "',t,; a larg:(' aillfllint of a,;citic fluid. Small purpuric 'pllt;; art' not un l'OInlllllll in pcrnicioll' anelllia hut free henlllrrha~(' i,; lIuit(' unll,ual. ,\-Vc ha vc not found, in a cu r,;on' reading of the literature', a C:l';(' r('port (If pnni,'iou,; anl'mia "'ith alla,;arc;\. Fur ther ,;carch i, heill;! matk. Thi,; pa tient had no fr""I::lCL. Ilere,;pllrHl l'd pJ'lJlllptl" to intramll,cular lil'er therapy. showing a prompt reticulo cyte re,;pon,;e and left the ho,;pital with ;1 ,;ati,farton' blood count. A puint worth' ,tn:~..;ing: i, thl' di,; tinct al!l'antage of intramlN:uJar li,'rr thnap" {)ITr liver h,' 111lluth. 'rhe blood 'n·,pon,;e i,; l1lor~ rapid and bet ter su,;tained. Liver extract. reprt' ,entin!! Ion pns. of lil'er, i,; rea,;on ailll' priced and ComC',; in 1 cc. a111 .If/l/llflrl' N37 - 11 10 BCLLETIX !louie" It Cll!.'('., littk pain and will A.nemia GUlnot he diag:nosed at a oft('11 keep the hlond l:Ount lip ii g:ivel1 ~Iance \\'ith an)' de~rce of certainty, onl'<' per \\Tek or en'n at Ie" frequellt ('.'pecially in children, The hlood of ill ('n'ak infants and cltildrl'll varies cOll,;idrr :\11 ,~ml1toms of perIllCIOl!.' alH'lllla abl~ from that of adults in normal ar(' re!in~d h~ li\·~r thcra\1\· exccpt 1tl'lllog!obin content and in cellular tllll,e arising- from cord l'hall.~(", clllnpo,ition, At hirth thr infant no!' ,-\ddison'.- idiopathic allemia is ,im malh- has bet\I'(Tn +.500.000 and ulated in SOllle respl'l'h 1)\ anemia due 0..500,000 n,d cells per cubic milli tl, other caus('s, In s(T~ral of tlll'S(' Ineter of blood, Hl'nwglobin I'alul''; disorder, the hlo(JJ chal1~C' are ('SS('lI ahol'(' I00'.. { arc found (I + gill, of ti;rlh thl' sallle, hllt 1H'I-\lot thl're is a lJJoderate leukoc)'tosis. the p r('sel1 t. total \\'hite count frt.:qul'lltl~' heing .\ PUlllClOllS tl·pe of alll'lllia I;; het\\Ten 10,000 and 20,()OO celb per foulld ill ,pru~, cubic millimeter. Thl' platelets of Infl'stati'Jn 11\ tllC hroad tapl'll'orm tlte blood of new-horn infant> are g-iV\" ri,l' to a 'l'n'n' sl'rondal'\' al1(' ab,:ut nonnal as judged by adult mi;1 \I'hicll ma~ il(' confounded \I'ith standards, i. l', about JO(),()()(J per jHlll1al'\' ancluia. cubic lllillinH'ter. [n till' first fn\ A!el;kul'l t!Jl'lIlir leukemia i, a rare daIS follU\I'ing birt!r there is a rl' di'l'a,(' of thl' blo(JJ and hlood-form markahle change in the blood. H('mo ing" or~an:-:. \\"hich raXl':-i dl glohin are considered normal. associatl'J \\'ith g:a,tric carcinollla. or t!J;lt resulting: froll! acutl' or dll'lllli(' Sickle cd I anemia. fllrlJJer!l J1liII-Specilic infections, mal' prl"('11t a thoug:ht to 11(' rare and mntined 1';) blood picture res(,lllhling: that of per till' Segl'll race, is nll\I' knoll'n til he nil'ious anl'mia, It i, important to IT a hrrl'dital'l conditilln, not n:tremell call that srcundarl' anl'lllia Illal rOlll uncOllllncn' and not conlinI'd C'ntirl'l~ "Ii("tte pl'rnicious' anemia and' \itiat(' to \'egrot's, Th(, tnm "sick Ie cell.;' thl' Ill'ndicial ~ffl'ct,; of thl' thuap~lItic 11\' \\'hich this t~'pe of anemia i, ll!l'a,un:s adopted. This Il'ill Ill' fur knOll'll. is derin'd fl'lllll ob,er\'ation th('f' disCLls,t'll 1)\, Dr. :'\ oIl. that, \I'hen a fresh preparation of Thl' alll'mias' of sqJhili". malaria, b[lJod frollJ tht.:se paticnt,; is sl'ail'd in !J(Jok\\'orm disl'a,e or h~'pothlToidism, a Illoi,t chamhl'l' and aIIOl\'C'd to :;talld, ,spIt-nic allC'llJia, and the il'ukl'lnias, art: IJJany of the n'd cdls \I'iH assullJe an olten con usin,'2:, elongated, curvc·d ,;!rape resembling The former di\'ision of anemia, into the blade of a sickle, This tcndenc\ primary and s(Tolldar~' types hard!>. to "sil'kling" i, \'cry Illarked and IJJa~ sufficr', to properh- classifl' the an(: ilJl·oln' frollJ 20 to 90 pnccllt of all mias of infant5 a;1(! chillirm, Thl' red cells. The l'tiolog~' of sicklr- cell OCc'UITl'ncr' of priman- anenlia in chil anemia is unkno\l'n. Sevnal IITiters dren is llr1l'Olllmon. Pernicious anelllia bdil'\'[' that some defect in IJJctaholism IS practicalh- unkno\l'n before the is the underlying cause. Cook)' i;; of tcen age. this bclil'f and he considers sickle cdt .If/Ill/ar!' THE }[AIIOXI.\G COeXTY }[EDICAL SOCIETY 'tnelllla, l'rythroblastic anemia, and hnnlJlnic icterus to lw related etio logically. Eryrhroillasti,' anemia i,; thoug:ht to he limitl'd to children of .\1l'(li terranean pcoples, .\·ro,t of the re ported case, han> occurred in Itali:lns, Greek,;, Sicilians and Armenians. The al'Crag-e agl' of onset is two )'l'ars, The first siglls and symptoms (Jf the disease include a gradually Incn'aSIl1;l anemia, dela) ('d grml'th. IITakness, increasl'd su,ceptibility to infection, and splenil' enlargcn1l'nt. Thl' ap pearancc of children with tlri, di,t'asl' i, charactl'ristic, I t has bt.:('n relJJarhd that thc~' rcsemble each other mort~ than thn' re,;embJr. their ml'n rela tin's. All have ;I peculiar coloring: due to the comhination of severt' ane mia and mild icterus in a dark skinned per;;on, All sllll\l' a depression of the bridge of the nos(' and nearly all show ,I tendcncy to\\'ard slant e~'('s giving a mongoloid appearancc. The prog no,is in er~ throbla,;tic anemia is poor. but the disea,c runs a chronic rour;;e 'Ind thc patil'nt ma~ Ii\'(: for ,.;e\ eral ~ ear,. j ~ l'mulytic ictl'ru, or hemolytic jaundil'c I'; often ClIn;;idernl a, a di,e,lse of the spleen, l t mal' bl' propn!l- rla,;,;ified \I'ith the con~titu­ tional hemoh'tic anemias since anemia i, its 1l10;;t ilnportant manife,tation, Likt.: ."icklc cdl anemia and ervthro bl;l,tic ancmla, hemolytir i'ctnll:' ,IIlI\\" a strong familial trend. A~ a nd(' ancmia and jaundice arc not('d in infanc~' or C'arly childhood. E.'\am in:ltion ,ho\\'s icterus, anemia. pai l ahk ,p!el'n, and in more sc\'ert' (;I,e:; 'he li\ er mal' bc somcwhat ('nlarged. lJiagnu,i, depend;; on hi"tory and ph~ ,iral examination plu;; the d('lTHlll . ration of decrea;;ed resistance of the er~ thrm'l·tes to disruption when sob jeetl'd to h~'pnotic solutions. Red l'ells of a patient :;uffering: from hemolytic icterus frequently are hemolyzed hy o. 'i', :;olution of ,odium chloride and ,I I ca:;e:; ;;ho\\' complete henlOl~ sis 1 1 )]7 above 0,+'/;, 'I' rt'atlll('n t other than splenectomy is symptomatic. Finalll': Hemodohin formation is not inseiJ;lrahl~ li;lked \\'itll red cell formation for \\'1' knoi\' that a normal ]'ed cell count is not all\'a,s a('com panied b~ a normal amount of hemo globin. Ho\l'('\ cr, for practical pur pose,;, and in the ab"cncc of ~xact kl1ll\I'led"e concernin"· hemon-Iobin fornlatio;l. \I'l' can as:ullll' th,~ the 1'11'0 are do,;eh' relatr'd ilnd that h011(' Illarrm\' depre~sion will re,ult in <'Ih Illlnnal formiltion of both red rells and hemo~lohin, There \;'as a prartical point brolli-!:ht out at thl' rel'l:nt Centra' Socil't~ meeting in e.'\periml'ntal iron dC'fici enc\'. I t seems like!l- that iron ddi,'j lnc; in prl'gnan t \1.'lJlnen may H'slll t in a diminislH'd iron ('ontent of the nell' born. Apparently a normal iron resel'l'e is important for normal hl'lllo glubin formation during the first ~Tar of Ii fl'. Another point hroug:ht out at thi;; meeting: ha, to do \\'ith Irematophoesis in Illyxoc(kma. \ Vithout offering: an explanation the fact ha,,, been e,tab li;;hed that thyroid extract causl'S rl' ticullJl'Ito,;i,; in m~'xlll'dcmatous pa ticnts and that li\'l'r ntral't produce, very little chang:e, ----....'-----, NEWS ITEMS Doctors ,\·fcSamara. .\JcCann and H nalJ pre,ented a snies of papers on thl' Sympathetic \' ('I'VOU, System at the ;'\ovcmber IIll'eting of the Staff of Saint Elizabcth's Hospital. Dr. C, S, LlJ\I'endorf ha, he('IJ e!rct l'd to membership in the American Academ,l' of Orthopaedic Surg:C'ons. The following officer,; for the year of I ()37 lI'ere elected at the December l1lel'ting of the Staff of Saint Eliza heth's Hospital: Chief of Staff, Dr. F. \V, :VIc.'\amara; Vice Chief of Staff, Dr. .r. 13. Sel,on; Secretary and Trrasllrer, Dr. Saul r. Tamar kin; Chief of .\Iledicine. f.>r. A. :\11. Rosenblum; Chief of Surgen', Dr. .J . .\1. Ranz. ' 10 BeLLETI:\' • pOIJIe~. It cau~e, little pain and II·ill A.nemia cannot Ill' diagno,ed :It a often keep the blood count up if gin'n glance with an)' degTcc of certainty., Onl'l' pn l\"t'ek or nTn at le~..; fn'qlwnt ('sprciaJh in children. The blood of inten·ak infant" ;lI1d children "arie" con,ider All ~.\"I11ptom, of pnniciou~ anemia ahk from that of adult, in norm:Ll are reIin'ed hI' Ii I"('r therapI exc('pt hel;lOglohin content and in cellular tllO'e a:'i,ing f;'om cord ,·IJang(,~. composition, At birth the infant nor A.ddi,on'.; idiopathic anemia i, "im mal h ha" betw('en +,500,000 and ulated in "onl(' re"pcct, h) anemia due iJ.50(J,OOO red cells per cuhic milli to other cau,e", Jn ,everal of the"c meter of blood. HClJ]oj.dobin value,; di"oruer" till' blood chang:e" are (',,~('n­ ahOI'C 100'/!, an' founu (1-+ g:m. of tialh the ~ame, but per"i~tent achlor hemoglobin pl'r 100 cuhic centimcters 111 dl:ia and ,ubacute comhirll'U dei!e!l of hlood i, taken :b the al'(~rage) and e;'ati"n "f the "pinal coru are' not there i, a !1lodnate leukocyto,i,;, thc pre,cnt. total lI'hite l'lllJl1t frequently heing: A pcrniClOU~ t) pc of anemia IS hetweCll J0.000 and 20,000 cells per found in sprue. cuhic millimcter. The plarelet, d Jnf(,~tation b) the broad tapnl':JrI11 the hlood of new-horn infant, are g:iu:, ri"e to a sel"(.'re "econdary" ane ahout normal as iudi!cJ 111' :luult 11lia which may" be confounded with standard" i, e, al;out' 300,iJOO per .. prUlla 1') anemia, cubic millimctcr. I n the lir,t ICII' AkuknCI themic leukcmia i" a rare day, following birth rhere i, a rc di,ea,c "f the hlood and blood-form markable chang:e in the hlood. Hcmo ing orgaTl~ which taxes Jiag:no"tic in globin and n'd cell, decn'asc rapidly g:enuity. The confusion in relation to '0 that h) the end of the iir,;r II'l'l'k Addi,on'.; anemia i" due to th(· high of life hoth are at or ,Iig:llth helllll' g:rade neg:eneratil e appearance of tIll' normal for the adult. The fall in red cells, without ahnormal kuco IwnlOglohin is more rapid than that cl"te". 01 the red celk After the ;,ccond , Sev('J'e ,,('condar)' anrmia of metah wCl'k, -+.O()(),OOO to +,SO(),OO() red olic origin, that foIJ(JII'ing: hemorrhag:e cdl, and 85 to 9S per cmt hCllw a",ociated \I'ith g:;J,tric ca rcinoma, or glllhin an: con,idrred normal. that re"ulting: from acutr or chronic Sickle cell anemia. formerl) non-,pccilic infection" mal pre,ent a tlJOug:ht to he rare and coniilled to hlood picture resembling: that of per the '\egro race, i" now knOll'll to he nicioll~ anemia. It i, important to IT a hen:d'itan' condition. not extremrh· call that secondan anrmia llIal' com uncommon' and not con lined entirel~ plicatr perniciou,' anemia and' I'itiate tl1 '\('i!rfle". The rerm "sickl(' cell.;' the heneficial (:ffect, of the thnapeutit 111' lI,hich thi,; tli1l' of ancmia i..; mea,un'~ adopted. Thi, will he fur k;l;;In an'rage agc of on,et j,; two year". kno\\'led!!e conl'erni n~ I1l.'Illoglohin The iir"t ,ign, and ';yl1lptom, of thl' form:ltion, lIT can :1';';lIn1(' that the di,t';N' incluue a gradualh inerea,;ing two :In: rlo"eh n·latl'd and that hon lllt'lllla, dl,layed grOlnh, lIeakncss, marrOll' d('pre~,ion Il'ill rr,ult in ab mnea,ed su,;crptibilitl' to infenion. normal lormation of both red cells ;md ,plellic en larg('!1lcnt. The ap and Ill'Illog:luhin. prarance of childrCll Il'ith rhis dise,).;[' Thl'rC' II'a" a pranical point hrought i..; charactni,tic. It ha~ heen rl'lnarkl'd ('ut at the recent Central ~ucict)· I hat thel' resemble ('ach othcr nHln: mecting in ('xlwriml'lltal iron ddici than thn' rl'''['lJ]b\c their -• .----- properl)' rla.;silicd II·ith thr con"titu tional hemolyric anemia, since anemia NEWS ITEMS Doctor, .\Ic'\amara, :\'IcCann and Likl" ,idle cell anemia anu ernhro i" it:' n](l,t important manife,tatiun. Herald pre,ented a s('tie..; of paj]('r< hJa,tic anemia, hClllolnic icterus on the Sympathrtic :\l'rI"OUS S),;tlm ,~hOlI'" a ,trong familial trend. As at the :\ uvcmber metting of the Staff of Saint Elizabeth', Hospital. a rule anemia and jaundice are noted in infancv or earh· childhood. Exam ])r. C. S. LOII'enr!orf ha" hc('Jl elrct ination ;ho,,'~ ic;'nu". anemia, pal 1"(1 to Illcmber,hip in the American p:lhle ,;p!crn, and in more ,elTtl' cases Academy of Orthupaedic Surg:cuns. t!Jr lin'r ma~' bc "olllewhat enlarged. The folloll'ing officers for the) ('ar Dial.{no,i" depend" on history and of 1cn7 Il'ere ekcted at the Decemher ph) ,ical e,... amination plus the demun meering of the Staff of Saint Eliza ,tration of decrra,;ed resistance of rhe beth',; Ho,pital: Chid of Staff, ])r. en throcytes to di,;ruption when sub F. \\1. .\Jlc:\amara; Vice Chid of je(J"l,d to h) pJ](Jtic solutions. Red cell.; Staff, Dr. L B. !\d,on; Senl.'tan of a patil'llt sllffering from hemolytic and Treasu~Tr, Dr. Saul I, TamaJ: irtl'rus frrl]uently are hemoh-zed by kin: Chief of .VIedicine. r)r. A. .\l. O.~~; ,;olution of sodium chloride and Rusenhllllll; Chief of ~urgrn', Dr. all cases show complete hemoh'sis .r. .\1{. Ranz. .I(III liar.!" 11)37 - 11 12 BULLETIl THE :vIAHOXIl\G COC':\TY MEDICAL SOCrE:TY 1 ·, " J )octor and 1 ... J. ,till on the gick li"t. 1. Brody arC little, if :lIll', protection can be ',- pected of ~'(JIlI'ale,;cl'nt or il1lll1unl' ,;erum. Kolmer',; \\ ork \\·ith a rin OFFlCHRS COMMITTEES FOR 1937 \Ir. and Baltimore, .\lrs. Harrl Hartzell of i\Jan'land, 'anllllUnCe the l'inoleateu \·irll'; ha,; hl'l'n lIuite gl'n eralh' disLrellited. There onl~ re P.11,;I. J. FL/Y. Pre,ident eL.\Lll'!' B. :'\ORRl>, Pre,idcnt-Elect \\'~I. :\1. S"ll'l', Vice Pre,ident ROIlERT B. POJ.l:-.:r;, Secrrtan' marriagl' of the(r daughter ,\nira to I r. T. K. iolden. Doctor and .\lr,;. main, a,; a mea,u re again,t in ir. Sid;ll'l' 1\1. .\tlL" Curdy, ledllrl'r (1I: indu,;t;'ial llI:'di· cine. Dr. C:harles i Ooan become" the n'll' chairman 0 the department of llIedicine, Dr. I. B. Kramer and Vr. R, B. Polin[2; appcar on the li"t of patholo' gi:t,;, a,; cntiJicd 11\ thl' Alllcrican i\Tedical c\',;ociation. Dr. I·:. C. Bahr ,;pmt thc \ITek of Dcl'. 7th in attendancl' at the "bdio!ol!il'al Illceting at Cincinnati. He pl'('~ented a paplT on the roent, gl'llological r' 'o"nition uf Parathy roid di,;turbance. MEDICAL CLEA INCS In the ,) lIIeri({l/I J"III'IUd or 1{II' lledimi Scil'llcl's, Vol. 1 1 )2, pag~ +09, i.' an artidc ntitkcl "Recent \ 'urk o the Ti ue 'h;Lllgl''; in Vitamin 'j\' r dicicll '1" bl' f:l iz~d)('t11 Chant Rob 'rt ·Oll . .\l. D:, that i,; 1\'l'1l \\'urth till: readin~. TIl(' Odober i, 'ue of 'l'hl' .J ulln/lll ',I Ln/;om/orr IIlId Clilli"l1{ IH,.di,.illf i r Anita to rnaill-~ a~ a Inea::.:urc a~aiIl~t jnf~cti()n /1,1. II. B.ICIDI.I'(, Trea'urer I) r. '1'.' K. Golden. I);lctor and .\·lrs. \I'jth puliollllTlitis linlS, the propl1\' r;olden arc ;It home at the Burke lactic treatment of the na~al passage {.'O,lI.1IJTTFF.S j\partment,;. during the periud of endemicity. Tilis r; 1Jl/ lIciiorJ Jlldi,/f'lIl N!'h!'1 l'uhlirity is hl'st accul11plislll'd h)' daill' in~tilla­ Additions to the .Yledieal Facultl' I. B. :\elsoll E. II. YOllllg, Ch"irmall tioll of -+'/~ Tallnic acid. -+f/I, A.\IIn E. r. Reillv, Chairmall of Ohio State Unin'rsitl' School of J. J.. Fisher R. S. C"faro S. \\" Weaver .\i1edicine include VI'. Sid;le) .\1. .vlc or Alum and Tannic acit!' Consult 1.. (T. Coe P. I. :\'lalter \\'. r. Tim' the American journal of the }ll'di~al J. i.. Scarnecchia Curd), lecturer on industrial lIl~di­ H. il. Kaufmall IJrlr!Jflte, CIne. Sciellces, \'01: IQ2, pa!2:e -+36. for n. E. \.'lolltgotnerv \\'. C. Autelll'eilh \\'. 1-1. Stewart complete details. (). I. Walhr (:()llJtilul;'Jll flud I)r. Charles A. Doan hecomes the ------0·-0-.. 0---__ ,lIt~l'1Ifllr lJelrlft/lf'., nJ'-I.ll~"·J n<>II' chairman of the department of (;or,-(',\ pOlldl'll! Greetings from the President of "'all C. Smith c. B. \orris, Ch'lirmall med ieine. (;onloll (;. ~ e)",ol1 /1) j"l/rno! C. R. Clark the Ohio State Medical Ass'n. O. ]. Walker \\'. C. Redd Dr. C. B. Krallll:r and Dr. R. B. FdillJrit/1 Dr. rI, L Patrick. F. \\'. .\'Ic:\amara Polin;! app<>ar on the list of patholo II. E. Patrick, tHahoning-Connty .\Jedical Bulletin. Editor of BlIlletill gists. as certilied h)' the ,-\lIltrican .11 rdirlJ-I"'f/nl .11 rlll/;!'ultip ((//(1 Youngstoll'n, Ohio. J,awrenre S~gal, .\Jed ical Assol'iation. D. II. Srnell/er, Chairman ..lllclld(//IU Husille:-... \lanager \\'. II. Bennett Dear Doctor Patrick: ,. L. Fi,her ' S. I. Klatlllall. Chainoall Dr. E. C. Baker spent the In:ek E. W. Cliffe \\'. H. BIIIlIl Sa;lltlel Tarna rkin D . .\'1. Rothrock of Dec, 7th in attendance at thl' I slltluld like to 'end ~rel'tin~s to .\. .I. Bralldt C. :\. Parillo 1;wl Tamarkill (;ordoll ;\tl~()II. ('hainllllll genological recognition of Paratlll H. :VI. Si,ek the' constallt ~ro\l"ing !'I'idl'llcl' of Flllf'rf({;llmr1l1 roid distll rhance. proper medical' ~pirit that pl'rvades l'PJ IIr(l Tn iVlorris Ro~ellhl\lll\ \'llllr society. John :\011. Ch~irrllall .J. R. BICh,,",," \\'. II. E"all~, Chairmall \Y. D. 'VlcElro, 1\ . .I. Bralldt F. \\1. yle:\alllara MEDICAL GLEANINGS The State i\ssociation is sholl'ing C. II. \\'arelUck \\'. K. ,\II,,,p that it has fOllnd a rathn fertile spot I. \. ;'dcCallll J.f'qiJlllli'l'f' S. II. Sed\\'ilz In the .J lIIf'rirf/1I }f/llnw/ f,.f II", \Iorris Deilchrnall R. E. Odom frolTl \I'hich it can dra\l' matnial for O. I. \\'alkn, Chairmall ,l1u!im! Sri"III'i's, Vol. 1()2. page -+09, E. C. Baker Clarellce Stef",,,ki I'~. J. \\'ellaH lise in it~ nell' activities, is an article entitled" Recl'nt vVork ff'fJlIomir,l" 1'. I.. Bovle 'I'he real live, \I'orth-II,hile \\Ol'~ i\. C. MOlltalli on the Tissue Changl's in Vitamin 'A' \\'. K. Steware. Chairman for till' flltllre of medicine mllst he Spnll.'I'r.\' Rur('ffll Ddicicnn" bl F1izabeth Chant Rob ). :\1. Rallz I'uhlir IIr"ltI, done in the COllntl "JCil~tie~. The P. R. \lrCollnt'lI R. B. Pulillg. (Ttson, .\{ Ii.. that is IITII worth the E. R. Thorna', Ch"i,.,11all fllllction of the State .-\"'ociation is E. H. :\agel Secreta rv's office readin;.'. F. r. .\'!ollroe I, B. Kupec that of L1nih'in~ thl' ,nl!'k of the cOLIn ). B. Birch The C)r-tohn issue of Thl' '/ol/n/{:/ \\'. O. Mermi, tl' unit,; a,~d ;lIlll'ss the nWlllhns of '1.. S. De:lchmall f,{ Lfili"ralory f/lld Clilliml illl'dicillc l'IiMir Ntlntiolls 1111:/J[11(/ lIncl I,ihrtlry the collntl' medical "ocil:ti~'~ are ;l\\'ake W. S. Cllrtj~ is gin'n OITr to a snnposiulll on J. B. :\elsoll. Chairell"o II. E. Ilathlwrll, Chairrn;1I1 to tlwir ·lll·eeL. and initiate for\l'ard .Judi;ill!j Rheumatoid Diseasl's. The papers J. P. Han'e" C. C. Ste\\'art ~tep'. the State ,\,sociation is left "Oil 'J. I.. Fi,her P. II. Kerlllt,h' L. \\'. Weller \\'ere read hefore TIll' .'\ml'rican .Asso the lilllh"; so liT are proud to pla~e i... (;. Coe 1\. :Vlarillelli R. \\'. RUllIllre!I ciation for the Studl of Pren'ntion the .\1ahonin!! COIlI1tI .\·fedical So .\. E. Brallt .I. S. :\Iariller II. S. HallnilJga of the Rheumatoid Disl'ases held in rietl' among thosl' ,o~icti('s in tire Kansas Cit). front rank of aggressil'e and intn Borh jcufllals a re on file in thl' (',ted component units from \\'hich th l · C,\.RRON TED Lihrary at rhe South Lilit. State ;\s,;ociatiol1 deril ('s its confi I.I~E 'VATER. Polio1ll1 eliti. .; continill's to ("\'ade dence and IHllw of I!il'illg more to ib NOT A l..A.~TIVE the efforts of tile 1'(',;('arch \I orks to mcmhers a~ each) ear cOllle,; on. UNIFORM STRENGTH-PURITY provide a llletlllld of illllllunization. Sincerc'-'" I'ours, kalak , . CO. OF .....'_••11" .. Reer'nt sUllullaries al"o point out t;lat DR. E. .\1. IICSTO:\. }rI/ll/arl' 1937 BULLETI~ THE i\IAI-IO:\I:-\G COU:,\TY .\mDICAL SOCIETY lJj l NON-PENETRATINC TRAUMA OF THE ABDOMEN By FRANCIS W, McI'JAMARA, M, D, (1'1"1'",.,,1(',1 !I('f"r,. Ih,. ,I!a!if,,,;,,g (.'llIlIIly .\//'di"i! S"riply, iY"'V/'l11 !"T, 193(.) cAnnual Banquet "f the Mahoning County Medical "ociety Y • GSTOW - CLUB Tuesday Evening' .January 19th, 19~7 • Presenting' The OUSE F MAGIC ThrOllg-h It;; Int.eepreter MR. ELLIS MANNING of the f{esearch Laboratories • ot" the (;eneral Electric Com pany Schenectady, ~ew York, \1r. _\Ianning lI'ill introduce hi, :Iudieuce to such "ubjects I I as the fol!o"'ing:: I n"ing Langmuir's '\"(Irk on \Ionol11olecular film", RelTnt ,,"ork on ga,;eou,; di,;chargl''', Il'ith mention of the Sodiull1, tlte high and ultra-high pre""lm? .\;JerCllrl, The ,Hncury Iluorc~cent lall1p, Coryl Ha"kin',; "'urk on X-Ray Gl'netic", The new recording Spectrophotometer. Jalllla,..\' The rel'eipt of thi,; Hanning in ,itation from your program commit tee to pre"ent a paper hdllrc thi,; SIl cietl', ha,; given nw a lot of concern, hoth as til til(' choil'e of the "ubject matter, and a!,;o as til the amateurish po,;itio;, in Ilhich I find myself, in I iell Ilf the c\:c(,llellt national talcnt that the Societ\' has had the oppor tunity of cnioy~ng in the last sncral ~ ears, In this actil'e in(lustrial c('nter, "here man, thousamb of individual, are engaged in l110re or le~,; hazardous occupations, ;IIHI in these times ,dH'n ,eriou, automohile ca,ualtic,; are IlI; comin" ,nore numcrou" ;, discu"ion of nOI~~penetrating trauma of tIll' ab doml'I1 might ,er forth ,llm[' points of nranil'al,:alue, Peculiarl\' the major ity of patimh ,;ustaining abdol11inal trauma, are children and till' aged, Uur industrie, offer such protection tod;I\, that emplo\,ce,; are ~afer from this 'particular tq;e ot traul11a duriug "'orking hours, than durin!!, their hou rs of di"ersion, The automobile i~ the chief oftender, The discus"-ion ,,"ill be limited to in.iurie~ of the g-astro-intestinal tract. SOll1e general consideration ",ill hI.' presented at fir,;t, and later l110re detailed deseril' tion, of til(" picture pre,;ented hI' tr:nJlna of special organ" Contusion of the ahdominal "i,;cera i, cau,ed mainly hy blo""", crIl"hing for 'es, falk compre:;,;ion bet,,'cen hral\" objects, blunt object,; tral'eling through "pace "'ith ,Ol11e velocity, and recurring pres>ure from certain tool handle" The "everity of injurv (II.: pend,; on the amount of force exertnl, the angle of impaction, and the con dition of the abdol11inal IIlU,-clr", The a:'cd ,,"itll ""eak abdolllinal and vi,, ll'ral lIlu,;culature, mal' ,;ufter "evere 'i"ceral injun froI11 '"light trauma, The ten"e, expectant abdominal I11U, cle of the athlete a~~imilntl's force (1)37' with little damage, COll\ ersell-, ~ud­ den ullt'xpertuJ force applied to a lax ahdom,n, l1la~' cau"e fatal rupture of a vi"cu", :\ fall from SOl11e height \I"ith the patiellt landing upright. or a sevnl' hloll' Oil the hack mal' nlp ture the attachment" of oq!:ans, A detailed histor~ of the etiological fac tor i" mo,;t important in ddnmining: the extl'llt of damage inflicte'd, Injurr to holloll' organ" is u"ually caused hy c(;nlpl"('~"ion of the ,'i,;cera again"t "ome k~,; I"ielding ti""ue, e, g,-u"u ally" bon<:""':"'tl.Je ilillm or the "Iline, In diffuse il11pal'tion, a" \\'!wn tlw ahdomen strike,,, a broad Ilat surface, the le,ion ma, he: cau"ec! bv contu"ion, hy' blIr,;ting 'from \\'ithin,- or b" the tearing of an a ttal,llIllelll, Di reet vio knee {)\"('r a di:'t('llded coil of inte"tine may cause rupture of the inte"tine from \\ ithin, The stomach sholl's gn'ater n:,;i,tance than the inte,;tille,;, \Vhen the ~tomach is injur<:d, the I('~"er curvature ,uftn" mo~t. and the rupture i" u"ualh' of the hUr>tini! typ<:, that i,; fWIll "'ithin, Rupture ot the "Illall inte~tine oc cur" Illore often in ih Ie"" Ill(l\"able portion"-that i~ the duodenul11, fir"t portion of the jejunulll, ;lI1d the iliulll, Like"'i,;e, rupture of the large bO\\"l'l i" more fret/ul'nt ahout the right colon, Ccntu"ion ,U1(J tear" of the lIle,<:ntery ma~' produce ma",i\"(' ltelllorrhage tir"t and latn necw"i" of the inte"tinl', Th<: "olid organ" are ruptured les, often than the inte"tine, Lil'er, "pll'<:n and j1ancrea, le"" often than the kiduel"", Organ" :,oftened bl" e!i>ea,;c' lactr,;te nl(lr~ ea"ily than no;'mal vis cna, Sevtre contu,ion Illar rupture the gall bladder. The "ign" ano ';\"Illj1tOI11" of intra abdominal inj u ryo depend on ( I) The amount of hemorrhage, (2) The extent of peritoneal ir ritation, 14 BVLLETIX cAnnual Banquet of the Mahoning County Medical Society YOUNGSTOWN CLUB ~I Tuesday Enning January 19th, U):37 • Presenting The H USE OF MAGIC Through Its Interpreter R. ELLIS MANNING of the Research Lahoratories ot' the General Electric COlllpany Schenectady, .:"ew Yurko :\1r. :\Iannin~ \\'ill introduce hi,; audicnce to ,;uch ,;ubject,; a,; the followin s : Iii I rvin~ Lanjfmuir\ \\'ork Oil :\Ionomolccular Iilm,;, Reccllt "'ork Oil ga:;cou,; di~charge,;, \\'ith mention of the Souium, the high and ultra-high pre:;:; url' :\'Icrrury. The :\/Iercury Iluorc,;cl'l1t lamp. Loryl H a,kin',; \\'ork on X-Ra~, Genetir,;. The lIew recordini[ Spectrophotometer. .Iul/uary 1,) THE :'vIAHOXIXG COu~TY 1IEDICAL SOCIETY NON-PENETRATING TRAUMA OF THE ABDOMEN By FRANCIS W, McNAMARA, M, D, (I'rI'JrI/II'" fulol'!' Ih,' ,\li/iI'l1/il/!! (,"0/11//)' .111'diral .\·,lIil'ly, /Y/H'i'lfIhrr, \93(,) \\ ith little damag':. ConlTr,;ely, ,ud den une~pectcd fmrc applied to a la,\ Thl receipt of thi,; Hattning in ,itation from \"lHlr program comll1it ahdomen, ma)' Gllt:'e fatal rupture of H'" ttl pre,;ent :1 paper before thi, So a '\SCU,;, f\ fall from ,;mlle hei~'ltt ,·il'!I. ha,; ~i, en me a lot of cuncern, with the patient landing upright, or hotil ii' tt; the elwin: of the ,uhject a ,;evere blo\\' Oil the h;Kk may rup m'ttter, illld al';l' a, to thc amateuri,;h ture the attachment>' of ml!;UlS. .: po,ition in which I lind m",elf, in detailed hi,tolT of the etiolo'gieal fae", ,inl of the e~cellcllt national talent tor i, mo,t important ill detnmining that the SociN" ha, hau the oppor the extent of damage inflicted. Injury tUllity of enjOl inl; in the la,t ,e\"l'ral tll hollo\\' orgal]'; is u,ually caused hy 1(':11". c<:lllpreS'ion of the "i,cera again,;t In thi,; actin' indu,trial centn, ,onw II'';'; yielding ti,;:;ue, e, g.-usu \\'herc malll tllOu,and, of indi,'idual~ ally hone-the ilium Ill' the ,pine. ,Ill' engageli in more or Ie,;, hazardous In diffu,e impaction, as whcn the IIccupation,;, ;lllll ill the,e time,; \I'hen ahdunll'n ,trikes a hroad Ilat :,urLlt'e -nillll' automohile ca,ualtic, arc be the Ie,ion ma,' he caused h" contu,ion. (illning l110re IHI1l1(-'rnll~, a di:-,cu;,;;:,ion by hur,;ting from \I'ithin, or b)' the of ntlll-penetrating trauma of the ah tearing of an attarlmll'nt. Direct vio dmllen might ;et forth ,ome point, of lence 11\'("1' a distended coil lIf inte,tinr' practical, alue, PeculiaI'll' tlw major ma~ cau,e rupture of thl' inte,tin l ' it" uf patient, ,u,taining ahduminal from \\'ithin. The ,tomac.h ,htl\", t,:aul1Ja, are children and the agnl. greater rc,i,tance than the intestine,. ()ur indu,trie,; offer such protectiun \Vlll'n the ,tomarh is injllred, the tOl]a", that emplol'ees are ,afer from Il'"er curvatur<' ,uffer, mo,t, and the this "particular t,p"c of trauma during rupture is u,;ualh of till' bur,;tinl!: \\orking hour,;, than during their type, that i, frllm' within. ' hOllrs of diversion. The automobile is the chid offender. The di:;Clb,ion Rupture of the ,mall intestine oc \\'ill he limited to injlll'ies of the curs Illore ohen in it:' Ie", mOl'ahll: gu,tro-inte,;tinal tract. 'Some general !1ortion,;-that i, the dUtllknulll, lir,;t con,ideration \\'ill he pre,ented at portion of the jejUl1llm, and the ilium. 1ir,t, and Lncr more detailed uescrip Like\l'i,t:, rupture of the large !Jowel tions of the pictu re pre,;ented by i,; more frequent ahout the right colon, trauma of ,;pecial organ,;. C<:rltu,ion aud tear, of the !ne,;entcl'\' !na~' produce ma:;:;iH hemorrhag(' lir,;t Lontu,;ion of the abdominal vi,cera and later necro,i, of the inte,tinl'. i, cau,ed mainly h, hlOl"', crushing force,;, fal b, cumpre",ion hetween The solid organ, are ruptured 11'';: hea,'y ohjects. hlunt objects traveling often than the intestine. Liver, splt'cn throug;h ,pace with ,ome "e!ocity, and and pancreas Ie':' often than th(' recurring pre';:;lll'e from certain too] kidne,',. Orl!:an,; ,;oftl'l1ed lw dis('a'l' handles. The ,e,'Crill of injury de lacer;;te mor~ ea,ik than no;'mal ,'i, pend, on the amount lIf force c:'\erted. cera, Se\'(~re contu,;ion Jl1a~' ruptuIT the angle of impaction, and the con the gall bladder. dition of the ahdominal mu,cle,. The The ,.;ign, and ,nl1ptOIl1' of intra ageel with \l'eak abdominal anu yj,; ahdominal injun' d'epcnd on cer;t1 musculature, ma,' ,uffer severe ( I) The amount of hemorrhage. 'isceral injlll'y f~om ',light trauma, The ten:;e, expectant abduminal mu, (2) The extent of peritol1eal ir" ell' of the athlete a",imilates force ritation. 1937 17 lfj BULLETl;\, THE MA['lO:-.II~G COl::\TY }IEDICAL SOCIETY In general Sl'lllptonb and signs are ;(,; foUml's: (I) Shod -,dig:ht or st:l'(~n' ac l'()rdilw to extent of injun. There is pall'or,"'an,'il't~ at first.' L;,ter in nq?; Il'ded ca. e" pallor or clanosis, cold, damml' perspiration, apath), dulled Illenta(itl', rapid pUISl', l(j\n~n'd hlood pressure,' ~halloll" respirations. /'"ill-Thnl' is som:' gcneralized pain, hut u uall) most anlt(' at site of injury, Ir injun- to the upper ahdol11en, pain is aggr;l\ated by the ITspiratOJ') mOITl11l'nt,;, If injurl is slight, pain suhsides in a f('II' hours. \Vhere there has bcen perforation of a 111.1 lOll" I'iscus, pain increasl's de pending upon the fluid liher;lted. Lcak;l"e frol11 the stlllllach, dUlllknul11 and .i~unllm cau,;(~ the greatest de gree of pain. 7\'(111.1'('(1 (///(/ VOli/itill(/-Frequt'ntl) prescnt l'lTn in minor illjul'ies. Thc)' are constant sig:ns in injllrit' to the stomach and intl~:'tillL'S, hloou 11l'ing; pn'scnt freqllcntl) Il'hen thc stomach i, injured, \Vith ntension of peri tone;;l irritation, there i:, an Ulcn'ase in lomiting, 1.Jiurr/II'a-l prcsent Il'hcn thne is 1H'I11OJ'rhag:c into the lumen of the ImIITI. r,!"1'('" - Temperature is lOll' at tir,t. \Vhcn thl'J'e has hccn exposure or llurked hemorrhagc, temperature m;[1 drop tll 1)5 dcgrce" i\ "aluahle pn;gnostic ,ign i, thc uegnT of IT Spehi( si,r,l/s-l f on rectal exam ination, onl' finds ddinite signs of tenderness in the pelvis, it indicate, the presence of free Iluid or pnitoneal exudate, Ifeli/lltr)/"(jJ' - tn the prcsenn' o{ hemorrhage in till' abuominal cavity, there lI'ill be progTcssin' increase in Icukocl'tes. Leukocl'tCS respond rap idh- tl; irritating d~~nH:'nt,; from con ter;r,; of hoIlO\\: I'iscna, The hemo glubin alld reu cdls arc n'dured, ,X-RaJ' lJiu(jl/"sis-X-ra~ examina tlun ran usually demonstrate pneumo January Fnitoneulll. A Iluid lewl mal be "ecn Il'hen both Huid and air are' present. X-ray examination should he made as ,(jon a:' shock has "uhsiued; at onrc if suitable portable apparatus is ;I\'ail able, L'nflll'tunat~h-thl're i" no S1g:n, ';) mptlllll, or rOlllbination of tlll'Sl', suflil'i('ntly constant to indicate the sl'l'crity ur thc nan naturc of the injur). [:\ploJ';Ltor~ laparotoml' i" the safest diagnostic aid for l'ffe~til'(~ treatlllen t. TRAL:XI:\ OF STOXI,ICII-Ahdom inal trauma, UIlIeSS of thl: mlJlT severe crushing tl pe, rare'" causes more than a h<:>matonu of the stomach wall. Di n'rt blo\I" are Illore apt to cause Injury to the overlying small intes tine. Anatomicallt- thl' proj('ction of the stOlnarh on the abdominal lI'all plTsents a small area of vulnnabilitl'. l'l'lIshing injuries of thC' stomach s~,­ I'l're enough to cau,e lacnation or rupture, are most ahl';I"" associ;\tl'd \I'ith fatal iniuI'l' to aujacl'nt :lrgans the chest and its contents, the dllo Jenu11l, li\Tr, splel'n anu pancreas, E"tensil t' hcmatenll'sis IS the onI)' dear symptom, and the on h indica tion for ,;urgiral interferencc. In con tusion of the stomach thnl' rna) Ill' I'llmiting uf blood stn'akl'll mUl'OU,. L, uall)' the situation dear, up rapidly \\-ithollt interference, (;astric ukn bas becn reporteu as a :,eque! of trauma. It is extrcilleh douhtful If trauma play, anI' part i;l the etiologl of ukel'. TR.\l,;XI.\TIC PERF()R,\TI()~ OF PI.I'TIl' L;1.l'ER-lt i,; possihle that trauma llf a stomach 01 ndistendcd lI'itil ga:, or food mal' causc a bloll'out at th . site of an uk~·t'. In m) limited t:,xperience, I hall' never Sl'en a cas,' uf this kind. HOllner, \1'(' do know tbat suudC'n 1l111snilar effort ma\ cause plrforation of an uker, and st;'angl'h ('nou rh, \I'here there can be no 'prr: \ ious uker histon found. TR,\l :\1.\T1l' Ai'I'E~J)ICnls-,VIaJl\' authOrities agree todal' that there is no surh enti·t\'. Sloan' thinks it i:, a possible predisposing l'allSl' but Oil(' hard to prol'('. Kdh' cites lifty C;bl'S of so-c.alll'd tralllllati~' appcndicitis. [n fortI' of thl'se thne \I'as a prc\'ious histol'l of pathology in thc appendix. It is 1\'l'1I knenl'll that patholo~i,' changes ma) be present in an appcn dix 1\ ithout ('\ idcncilw anI' clinical symptoms. .'\cutl' appe;~uiri tis foileJ\\' ing kicks or bleJ\\''; in the ril..dlt !:ht trauma, haIT been 'ohsl:rVe(i. 'l'ilen' is IHI characteristic sit.'"n or SlmptOI1l, Thne i,; thl' usual pil'tl1l'e ;If hemfJrrhage, The plriod of slwck is usuall~, of ,Iwrt duration and rlears up betore the pniod of heillorrilage begins, In "ome cas<'" there is, after the n:(ll\'('r)' frmn silm'k, an intc[\,al of improve Illeflt Iwfore the Oflset of s~cofldar~' relap"e, 'J'III' Inlr/ll perilJd. During thi" pniod the patient has ,OIllC ahdolllinal pain and lI'ill preseflt "igns of llloder ate ahdlllTliflal injury, but nllt sniou, eflough to cause alarlll. 'I 'hen C'Ollll.', the "cundar\' belllolThag:e wilich mal 1)(' fatal. Till.' local si:.':ns re:'.l.'mblt: pniwniti" There is gmnalized llr lllcali;t,ed pain in left hypocllllnd ri um and p;lin re ferred to left "houlder Illay he pre,ent. This i,; not pathogonomic a, it i,; pre, ('nt in man\, other cllnditions, In the earl\, ,;tatcc< there is often It-ukoc~,tosi, \\'it(wnt'diminutiofl in red cells or IH'moglobin, Ddinitt: diagno,is is dif ficult to make, 'I'll J: P,I:\CRI':ilS- Is occasionaJl~ iniured bl' the applicatilln of con,icl rr:lhle fo;"((' to the ahdominal wall, lTushing the organ against the lumbar I ntcbrae, Extreme shock is the im lIlediate re,ult. .\larked ti"ue de ,truction is caused Ill' the di,charge of pancreatic juice into'either the greater or lc"er peritoneal ell it)'. There arc no dc.liniteh- charactnistic SllIlptOlllS. I f the patil:nt recovns fron; the illl lIlediate effect" a rctro-pcritoneal helllatoma or a pancreatic cy,t may fl) Ilml', (;,.\1.1. BL,IIJIJER ,I:\IJ BILE Uccr Rupture of the gall hladder alone is rare, unle,;;.; it is greath di,tended. The il. :-li"h.. ill" medical produl'ts a joint met·lin}.! w;}.:-, held l)(.. lw('{'11 th<.'!'-I I and phannacy e~-c to \\'avlIC' Countv ~-ledieal SOl·icly and the of pro\"ell t lerapeu U..·t~·oil Retail lJnl}....·<..dsb A:..;:-;ociatiun. tic \"alul', covering e\ e is indeed a plea=-- I'rumil1l'nt ~lwaken; ad(lrl~"';:o'<"d the lrH.'f't u~re and [ hO\le thi~ in~r. ~ll·(·~~in:! tht, ('Io~l' J'(·lalioll:o.hip hl~-~('\ eral decade:" 110\\ tWCCIl mnlicinp alltI phal't'rlacy. I'I"j(JJ til t' prog:rall1 \\·ill intro- :1 IL'L'luTC" h.... Ill'. Ih::l'f1anl Fantu:oi ur cOIlstitute::, part () dCll '~ 11111 tl),,"1111" (~hi,'"",o, i\-lr: 0, 1:. "i••o,.. rh"irm"(~1 "I' the c.~,P, &: "Y. \ '- the Illt(,l·profl·~~iollal Helallon.... :Olll of the more illlpor- mitto" or the K,A,R,D.. ,pol,e IH'lerly i\l1leriCall me: d i c J! of the ('OoIH.'r;ltiun n(·cC'.... :<.:ln·· hetw('t n Illl'll ,,"hOlild he rrtll,l tant fcatuITs of the th:.:- two "l-oj(':.:~ioll~_ llC' (";.t1lt~(1 aUl.'n\ion " C" S P , "I' to the pantlld lint!.~ alon'-t whi('h llolh t!ratl.'ful for the ~i~­ .'('\'- .... &. -,. '. pn.ll'L':o::--iowoI run. th(· main point or <, • "I'hr s e books :Irl' thc d"man'alion h"in" th,,1 "I' <1;a"""<;,, nal COlltributiolls III Th,' an'ompal\)'i"". o,tn\('I,' al'l, 1',,(.. til". til'ld of m:'lkine r r~ :-- t a II iz a t ion of sf:nt<;>d in t h(> h()p(' lhal nHJJ-e m ~lin~~ \. 11I't'l' JO() I of thi:; kind mav til' :LITanJ.H·d. u lh('y ,,·!liclt are bcin;.! dt'f - yea rs 0 ",(l\noL h,'lp hut ,1.)'o""th,.1\ Ih,' ti lhat I ' I cun ti nLI()U~ resea fcb bin.1 thc..;e t\\'o :,!rcal profe:.::-;ions. in iteh· enl}) l~bIZe( alld n:perilllent,. [11' 2+ s~I11posiuJl1 Beth phl'sician and pharJl1acist hall' relt'ases frOJl1 mCJl1l1crs of the rni,i')Jl n rr bee'n pionens ill progress and COlulllittee, Thel' are no\\' regular!'. pn)\e the truth of Dr. [0'0.\',.; state- appearing ill the: Americ,all, .\ledical 11Itrlt, ';Science ,;hall rep~ace g'uess A,;sociation [ournal. beginnIng Il'Ith \\'fJrk, " the issue of Septcmbn 5th, 1().lb. .\ledicine and Phanllac~ arc a~'-Gc'ntlemen, you are profoundly tuall~ dependent upon each other for edllcated, knOll' all about tht: romance a sllccessflll 'en'ice to the ,ick. It is of mcdicine; \'ou are trained in the not a case of indil'idualisul. One man tht'on' of Il'ar OIl di,;ease anJ p:)"e" or ,~roups of men in eithn field cotIld tht: {nstruments, All of tbese are nel cr accolllplish the benefits that a\'ailable, but ~'Olt do not sufficimth organized '\-'Iedicint> and PhartlJacI 1\'l'll knOll" \'I}ur allllllUllition-II'hlch ha~T devdoped to the pre,t:nt da\:. is pharmaCl': a I'ery practical art. \\"e Inust realize that liT are iust i;l- PharmacI' Ita, no quarrel I\'itlt di\'idual spokes ill a great ,,'h~el. and pharmaceutic'al manufacturer, rWI that bl' eaclt uther's help II'e support \I'ith al1\'onc doing; original rc,earclI thi" great structure, work, b;1t pharmacy does resent the Unfortunatel~', tlte curriculum of exploitatiun of prrp;lrations, at shame l1ledical ,chools gin', "tudt>nts on" ful prices. upon lI'hich little or no ]', of pharmaeolog~ (lI'hich is rwt rl'search lI'ork has hecn done, e. g" S\'flfln~-lllOUs II·ith ph a rrllaC') ), ~ et the lIlandelie al'id, the miwd benzoates resFcnsibilit~ llf tllat item of medi- and man\ other ,imple and t:lllllp!e.\ eine to the lait~ is ahout 20'';;. A proprieta~,' articles. SUCCl'';'; lI'ill, ac' I'acuum, therefore, of IW; exists and nul' and the puhlic lIla) he IJCueltt('d it is lI'ithin this I W/ that lJuacki,;r~ onl\' 1I'llm therapc:util' tests han' and other lI'ill' SI'stl'Ills of advntisin!2: pro"ved the value of animal (':>;pcri prey upon rre'duiity, exploiting medi- mentation, Thi,; must bt: done hl' cine and pharrnac~' to thl' public lI'ith cause individual phI sician, havl' nll little or no consideration for till' Ind- cndml'mcnts with 1I'lIich to carry lin bre lIf either, to such an (:":>;tent that their r('seareh. it is a disgrace to modt'rn eivilizatilln, You realiZl' as \ITII ;\S I that there One of the pill'sician's greate"t and is ,mllething l\Tong lI'ith medical ('co l1lo,t effective IITapOllS again,;t disease nomics. 1 halT only one suggestion to is a broad knowledge of therapeutics. lIlake, e, g., that since prescription, .-\, lI'ide range of information Cllncerll- HC priced upon a cost-plus ha,;i.;, in ]037 18 H"CLLETI~ picture of ,;llOck caused rn' rupture of struction is caused hI' the discharge of a hoilo,,' \'i,;cu,;, pancreatic juice into either the greater Latc ",mptom,; an' j:lundic:c. the or lesser peritolll-al cavity. There are pn',;cllcc ilf hill' pigment~ ill the uriue no detiniteh-characteri,;tic snllptOJ1l';. and ,;ometiml" ghco,uria. Thc diag If the patic'nt recovers frOJ1l the im no,i,; of hemorrhagc> follO\\"in12: trauma mediate effects. a retro-peritoneal in thc reg:ion (>t' thl' li\"l'r 'warrant,; hematoma or a pancreatic cy,;t may e:\ploratioll. foll(l\\' . SI'l.EE:': -Contll,;ion alld rupture GALl. BL\lllJER !\~11 Bll.1e ])CCT of thc ,;plcen arc g:('lwrally cau,;eJ hy Rupture of the gall hi adder alone is trauma tran,;mitted dirn:tll' to the rare. unless it is great'" distenUl'd. ,;pleCIl throu~h the thora:\ (ir ahdom The gall hladder can ,,'ithstand 100 inal "'all. lndirel"t \,iolem:e l'au,;ed h\, Ihs. air prl',;,;un' Iwfore rupturl', if trauma to ,;onH: distant point of the the gall hladder is ruptured or lacer, b()(h halT heen reportcd, a,; a fall Oil ated. its contents arc evacuated into the' ril!ht side of the ahdom('Jl. A the pcritol1l:aI ca\-ity. Thne is Jl]od splc(~n' enlarged and sotrl'ned h\, dis erate degree of shock anu sign of ea,;e is more pronc to rupture. In ,;Iight hemorrha,~l'. Only the bilc con stanccs of ruptun' \\'itllOut trauma. tained in the ~all hladder "'ill escapc. llf follo,,'ing a \'en' slig:ht trauma. In rupture of the bile duct,;, there is havc heen obscrlTd. There i" nu thl' cxtra\'asation of a considerahle characteristic sign or s~ mptom. There amount of bill', and earl)' appl'arancc is the usual picturc of hcmorrhage. of jaundice. A bilian' peritonitis oc The period uf ,hock i, usually of curs, not al,,'a} s of the stl'l'ilc t\'pe. short duration and clcar, up hdllfe I f infection l':\isrs in the gall hladder tIl<' pniod of hl'nwrrh:Jg(' !wgins. In or duct,;. sl'ptic pnitonitis resul rs. ,;onH' cas" there i,. aftn the recoverv :\/ORT:\I.ITY ](",1'1-: I~ AHUO\lI:':,.\1. from "huck. an inter\'al of impnl\'(: TR.'\ l-"\f..\-This depends of course on IIwnt before thl' on,;ct of s~Tondar\" the severit\, of till' in jun' and the relapse. ' nllmher o( organs inv;l!v~d. It in 'TIll' /({/('III pnifJr/. Ou ring this cn'a';l'S directh "'ith the l'xtent of period thl' patil'nt ha,; some ahdominal time ('lapsing 'bet\\'Cen till' onset of pain and ",ill pres('Ilt sign,; of l1HHler injun' and the institution of treat ate ahdominal injur~', hIlt not serious nll'nt: Complete traumatic ruptu re of l'nough to C;IUSI~ alarm. Then come the stomach presents the highest mor the sccondan' helllOrrha12:e ,,'hil'h ma\' tality-almost 100~/;. he fatal.' . , Rupture and lacerations of the The local signs resemble peritonitis. li\'l'I', if e:\tensive. cause death from There is gl-neralized or localized pain hemorrhage in over 75'/'. in left hypochondrium and pain re Extensive rupture of the colon ferred to left shoulder may be present. cauSl-S de;nh from peritonitis in 60~~. This is not patho~onomic as it is pres Rupture of the small intestine and ent in marl\' other conditions. In thl' rupture of the spleen ,ho,,' mol' early stage~ there is otrt'n leukoc) tosis favorahle results. Rupture of th without diminution in red cdl,; Ill" ,;pIt-en. if treated early, and if the hl'nlOglobin. Ddinitt' dia~llO,;is is dif nrgal1 is not enlarged by previous fiClJlt to make, disease. shows a nlllrtalitv not O\,cr TH E P:\:\CRE/\S -Is occasional I} 25~. ' injurl'd In' the application of consid Treatment of laceration of the erahle force to the abdominal "'all, small bowel give the best n:sult, un, crushing the or~an against the lumbar less there has been extensive separa \'ntehrae, ExtreJ1ll' ,;hock is the im tion of thl' mesenteric attachment. nlt'diate result. .\larked tissue de- The lllortality may be as lc)\\' as 15/:. THE l\IAHO:\I!\G COl::\TY ~\IEDIC.'\L SOCrETY J!i PHARMACY SPEAKS TO MEDICINE By 0, U, SISSON, Chairman of the Interprofessional Relations Committee of the N, A, R, D. On Ih'('('rJllJer ilh. in Ddr"lil. )lil'h.. To ';('f nwdicine ing m<'dical product, i.I joinL m(,(·tin~~ wa~ hl.'J.1 h('l \\"C<.'IL thp :ll1J pharmacI' ey'e to \V::IY1H,> County i\le.dic·al !-;ueiL'ty and till' of prmTn thl'l'apl'll l)l,.'t.l'oit Rl'laiJ [)ru}.!:g-i~t~ Al'~o{'iation. nl' j, indeed ;)n·;\1l~(·d" :l~ they 1,\'('1' 200 -,"fars of \\,hich an' being det l"UllIWt. 111--,,11' hut ~tl"cnglhl..·n 1h(~ tip...; that r<:ntinUDUS research hin,] t.hr"e twp great Jlrl)re:,~iun~" initl'h' l'mphasizl'l.l ;Jlld e:\prriment,. ))\ 2+ s\"lllpo-;iuni J:lt.lh ph\'sician and pharmacist h'1\ (. releases from ml'miwrs of th'(· r('l'ision 1\ n Iwen pionens in pro.12:n',;,; and committee:. Thl'\" are no\\' rel!ularh pro\'(' the truth of Dr. Fox's statl' appearing in th~ American ,\'ledic;;1 nil nt, "Science shall rl'p~ace guess A"'ociation Jouma!. beginning \\,ith \\ ork." the issue of Sl'pt(~mhn 5th. J03cl. :\ledicilH' and Pharmac\' are a,' Centleml'n, you arc profoundh tualh depl'ndellt upon each' other for edllGlted. kno\\' all about the romancC' ;[ ,;ucce,;sful ,en'ice to the sick. It is of medicine; you arc-trained in t1w not a case of indi\'idualism. One man theon' uf \\'ar on diseaq· and P:l,;sl~-;' (II' ;,:roup;; of men in either lield could the in,;trunwnt,;. All of these are n('\Tr ,lCcompli,h the beneiit,; that ;l\·ailable. but \'OU do not sufficientl\ org:anized ,\'ledil'ine and Pharm;\cy \\,ell know \ lll;r ammunitiun-\\'hicil haH deHloped to the present d;l\. i, pharmacy: a ver) practical art. \Ve must realize that \1'(' arc just i;l Pharmac\' has no ljuarrrl \\,itll di\,iclual spokl~s in a great \\'h~el, and pharmaceut'ical manu tactu rns nur that h, each otllt'r's hdp \\'l~ SUPP(lrt with an)one doing original rc's(·arc.h this great struetu re. \\'urk. but pharmacy do('s J'e;;;ent the L'nfortunateh'. the curriculum of exploitation of preparations. at shan1l' medical schools' gin's students (lIIl\, ful prices. upon \\"hidl little or IlO 2', of pharmaco!og\' (which is not research ,,'ork ha,;, heen done, e. g.. sl'llonymous \\,ith pharmaC\'). \,et the mandelic acid, the mixed bel17.oates r-l'sru'l,;ibilit,\' of that iten~ (l medi and many other ,implc and comple\ cinf to thl' lain' i,; about 2(J'j" :\ proprit'tar) article,. SlIl','C'SS \\,ill a..: \al'uum. thncfo;'e. of Il-i'/; e"ists and erue and the public ma) be benetited it is \\,ithin this lW/; that quackel\ onll when thcrapl'utic tests han' and othn will S\'stl'ms of acl\'('rtisinl!: pro'ved the \,;due of animal (':\\wri pre\' upun nf-duiin'. expluiting nwcli lllenwtio!l, This IllU,t 1)(' done hc cine and pharmac)' tu the public \\,ith causl' indi\'idual pill'si,'ian,; have no littlf or no con,idcration for the \\TI tndo\\'nlel1ts \\,ith which to CaIT\' on fare of either. to such an l':\tent that thfir rl'search. ' it is a disl!race to modern cil'ili7,ation. You reali;r.e as \\TII a,; 1 that there One of the pll\-sician's greatl'st and is something ,,'rong ",ith medical l:CO mu,;t effecti\'(~ \\TapOn, against disease nomic". I have (Jnh, (JIll: ,;ugge,tion til is :1 broad knml'!edge of therapt'utics. make, e. ~., that sincC' pl"l',criptions ,\ \\,ide range of information concern-are priced upon a cost-plu, hasis, in Wj7 J(ilIIIU".!' 21 THE }IAIlO:':I:\G COU):;TY MEDICAL SOCIETY the IN: of official prrparatiolb ~'llU are ~al'in~ I'our pati('nb from 10';" to +0'/; on ('ach pre~rription if you II'ill remember to pre~rribe d rug~ b~ tbl'i r oHil'ia[ nallle~ instead of l'oinrc! ~ub­ ,titu tr~, You realize Il'e bave nnl' "andartb Il'hich are rrally Il'tlllderful product" ;if1d it i~ tbe dutl' of medil'ine to kllOll' lllore of them and to U'l' thelll, "'Iweialk the palatahle vehicle~ a~ for example': Syrup l.irfJriCl' (IJr fJrrJlllid('s Srr///> Can"i /irr/>, (IJr (;IJfI! Tflr j-'rfJfl//rls Syr///> CillJlflll/()II jfJr IrfJII (/lid ,IIII II/fill , Cil, and man) otbl'r~ too nUllll'row, t(,1 mC'n tion, In the pa,t ,ix ) ear, I hall' Ileard Illalll doctor, ,peak Il'itb frank rriti ci,m' and practical ~u~g('~tioll', Thi" I beli('VL', come, frOIll tbeir knowl('d~e ;u1(1 ulldcr~tandin;: of your trouble" and Ill' notin;: hOll' their difficulti" parall~l tho'e' of pharmacI, a better rrlation,llip i~ king del'rloped, -Rl'l'rilJl hllm Cliira{jf} .I[('diral Su ,il'ly Bill/dill, ----dll'in Ita,; completed hi, ,tudie~ in (,IT, ear, nO,;l' and throat. Dr. Stan!el' .VIl'ler~-f()rmer re:,i dent of Y Illl;lgstOl;n Ho~pital-nml' of .\la"achu:'l,tt:' General Ho,pital, ,pent tlte Cltri~tma:' ho[iday~ Il'ith friend, Ill're in Young,tOlI'n. I)r. Joe Keoglt of }Ia"achll,ett~ C-;eneral, al,o spent X-ma:' !iolida" in Young,;wll'll. Dr, David Jame~. of \Vomen',; t lo,pital, [)etroit. -"[ich., Il'as a re lTnt II'e!t-ome I·i:,itor Il1 our fair I'it),. Dr. A. E. Brant i, ,pending the holidal~ in tlte Ea,t. ])r. .\-1. H, Bachman ha~ rt'moV(,d hi, office to the Ctntral TOIu'r from -"orth Pltdp, Street. Regula r "aff ml,('tin~ to Ill' held at the Yuung~tOll'll Ho~pital. Jan. 5th, IIn7, Dr. \V. B, Turner and staff are in char;.!e of the pnJ;.!rall1. P\I:\ 1) H istor) and Ph)~iol()~) - [) r. \\Trller, 2) l\natom~ of Sunpathetic ' er I'OU~ s."tem - Dr. c;u~taf:'on, 3) Technique of [njection of ,'\ erve~ for Control of Pain - Jh. Sedll'it;r" :\lotiofl pieture~ (If thr technique of contro! of abdominal and lumbar pam, wa~ an add('d feature. .•.-<::;--.•._-- FOI{ SALE- Solid :vrahoJ':any -",um Chait', GG" Solid Walnut Desk (_\Ta hog-any Fini~h), Infant.'s White Fair banks Scale, Mahogany Libral'y Table, G. F, All~teel Filing- Cabinet, (Ma hog-anI' Fini~h) a :~x5 File Dl'all'en" 2 4xl; File Drawers, 1 Regulation Letter File. These tan be seen fl'Om !) to 12, :101 Keith AlbC'e Bldg-. 20 BULLETl:\, the u~e of offici:11 preparation~ ~'ou arr a \\'a\, m not too great time. Di,;e:1,;e ';;1\'ing nlllr patient,; from 10';' tn progre~,;e,; "'hi Ie the "'aiting i,; going -+0'/; on each pn:,;cription if y011 will on. remember to pre,;cribe drllg> h~ their The dill:'; for the year 1937 h:1\'c official name,; in,;teacl of coined ';lIh been coming in fairh' \Iell. Too man" ,;ti tute,;, ml'mber,; h;;n: not ,;aid to date, It;,; You n>alize "'e have IW'" ,;tandard,; 1\'l'1I to lw rcmindt~d that nH'mhn,; are which arc n'ally "'onderful product,;, delinquent if due,; have not been paid and it i,; the dlltl of medicine to hI' lanllan' ht, 1937. [t i,; now I,t know nwn: of then'l ;uHI to 11';(, them, t;n~ and j1l'l)pe'r to remit .)12.00 to ('';IJecialh till' palatable vehicle, a,; for the ';l'net;II,\,. Thi,; \I·ill a,;,;II rc \'Olll' 1",ir difficllltie~ tion. parallel tllO,;e of phal'mac~, a IWller The fcll(l\\'ing application,; for re];ltion,;hip i,; Iwing dl'\'l'lopt-d, mt'mbn,;hip to .\Ialwning Count~ -Reprint froll' CI,ir{/,/" .llrdilltl So .\ ledic;r1 Societl' \\'eIT acted on f;l\ 01' ri,-Il' BI/I/rlil/, ...--0-.•.------ahl\, Ill' COli IH:;I at the la,;t meeting': L)r.' Sanlllel \,yood \Vea\'l'r SECRETARY'S REPORT ])r. Jo,;eph F . .\ IcGowan It i,; the appropriatt time to h(~,'.':in Dr. .\'hron 1-[;11'1'1 Stl'inbng ani'''' in Olll' ;lcti\,itie,;. The en';lling Dr. A,;lll'; BOler Sherk lear no dOllbt ",ill bring (lilt mal1l' Dr. Da\'id If. Ln'~ \ ariahl(',; in the man;I,l!:I'n1('nt of the Dr. Carl Arthur CII,;t;lf,;on ';'Kiety. It ,;eem,; logic;ll t'l nqwet Dr. .\oJ artin Ed\l'ard Conti, ,;oml' inn'I\'ation,; in nH:dical altair,; Should there he an)' obj ection,; to inamllleh a, the ';Ol:ial pha,;r of man ;\11~' of the,;r applicant,;, pre,;el1t :>hjer ag('mcnt con,;tanth demand,: a hear tion,; in \I riting to the ,;ecret;tr~· of i,;g. Du(' to tl1<' l;('ttermmt of finan the Societ\· \\'ithin ]5 (Ja~,;. cial condition~ in the countr~ there ROBERT B. rOLl:\C, i,; ,;onw danger of a ITne\\'al of leth -----,•.<:>--.--- arg\' on the part of practltJ(Jn('f~ Radio Talks therein' creating a fertile time for Del'. 7, ]036-Dr. ,\1. I. Bcrk,;:lIl: ,;ociali,;ts and clllti,;!,; to make l!ener-1:(3a~triti~.., CJlI~ g;lln~. Der. 1-+. ]lJ36-Dr. r=. J, Rrill)': The important que,;tion IIf carin:.!: "The Doctor',; Scotland Yard." for \'l'nereal ca,;('~ continue,; III1,;olved Dec. 21, 1936-U]", C. A, Gu,;taf In' ollr local profe,;~ion. It doe,; ~I>em son: "Holida\ Follie,;," that if thi,; i,; a hurning i",ul' there Dec. 2H, 1<)36-Dr. C. A. CII,;taf ,:llOuld be t'nollgh conviction to lind ,;on: "The Quick Lllnc!J." TilE :\IAHO:'\I)/G COU:--iTY MEDICAL SOCIETY PERSONAL ITEMS Dr. Palll r. .\IIahar announce,; to hi,; patient,; ;~nd friend,; that at the pre';l'nt time hl' i,; located in hi,; 111'\1 office at 2()()fJ Hi llman St. Phone,;: Doctor-Office 3-+-+3-+; Re,;. 2-+~ 1t). Dr. \'ernc (;ond\\'in and ,\:Ii,;,; R11th H II X !e\,-nlJl\ ~\I r. and .\-11'';. will make tileir home in :\e\l' York Have You Ever Citl' for rile next tl\'l) I'(~ar,; until Dr. Go;,d\l'in ha,; ('otnpll'tl'~1 hi,; ,;tudies in Bought A Car (')'(', car, nO,;l' and throat. Ih. Stanln' .\/Iners-former re.-j From dl'llt of YOll;lg,;tO\;'n IIo,;pital-n()\\' of .\tla,;,:aL·hll,;ett,; (;en['l'a\ IJo,pital, ,pent thc Chri,;tma,: holidal"~ "'ith friend,; hert' in YOllllgsto\l'n. Dr. roe KI'ogh of .\la,;,ach lbrtts ILL AL C-;enl'l'aL al,o ';I:)('nt :.\.-ma,: l1lJlida~ ~ at in Youngsto\l'n. !h, David Jamc,;, of \Vomcn',; STRUTHERS? • [!o,;pital, Detroit, VIirh., ,,'a, a re cent \\'C!c0l1H' vi,itor 111 our fair cit~. ])r. .-\. [':. Brant i,; ,;pcnding the holida" in thr Ea~t. Dr. .\'1. H. Bachman ha,; ITmO\ ed hi,; oflice to the Central '1'0\1'('1' hom .'\mth Phelp,; Street. Rl'gular ,;taff mceting to he hcld at PLYMOUTH the YOllllg:,;t()\\'Il 1J0,;pital, Jan, 5tll. ]l'l? I do:;; to them, you know they make a "\Vel'en'l you ahva.v~?" business of it. Thev know how "1\'0. l was a vel'Y poor col to get people to pay' without of lectol'. People knew it and im fending- them. :\ow I can con posed on me, 'I drcadl'd asking' Cl'ntratc on my practice, and be for money. \rhen I would tn' snre of a gooo:l percentagl~ of to ('oiled;' I guess I ,,'cnt at it lny lnoney." A 21-IIour Service :Hj;) Days in the Year Th lVledical-D tal Bureau~ Inc. Phones <\4;)13 1204·0.')·0(; Central Tower I'hol1e,; H,,)I:{ STANDARDS OF 1937 Our prescription equipment and suppl ies are kept abreast of the times, A. J. LAE I "The Apothecary" Home Savings and Loan Bldg. PHONE 7-3116 Free Delivery LEE J. BACHMAN Service Life Insurance 501 Stambaugh Bldg. PAT ~IZE l'R ADVERTISERS A.\'D )IE:\'TI0~ THE BrI.LETI:\' STONE'S GRILL 147 West Federal Street • Right in the heart of YoungRtown. • Fine Foods Beer and Liquor Served. Famous For REAL FOOD and DRINKS 'fh.£ inq/,),i&£ "A Good Place to Meet Your Friends" Cor. Ha%el and Commerce BEN HARRIS MANAGER Phone 4-0639 PATRONIZE O('R ADVERTISERS NATIONAL WALL PAPER STORES • \VATERFAST PAPERS TH RIFT-WAY I'AINTS Ii • 321 East Federal St. Phone 41705 D RUG S PRESCRIPTIONS • Our Prescription Department Is Waiting to Serve You. • Maxwell IPharmacy 127 Bridge Street Struthers. Ohio Phone 5-2191 AND MENTlO.\' THE MeLLETIN 2~ BULLETI1\" Doctor John Hustle Is Having His Best Year ",John, you are looking fine. How i~ ~'OUl' pl'actice"" "Excellent. Tbi, will be 1l1.\' be~t Yl'ar." 'fAn~l spe<:la] l'<,la~on '!" "Yes, t.his yeaI'I am ,g'etting' paid for mo,t of the work 1 do," H\VC'l'en't you a!\yays '?" ":'\0. I wus a very poor col lect(lI', People knew it and im posed on me. I dreaded aFking for monev. When I would Irv to colle~t: 1 I,('ues;; I went at. i't thl~ wrong way, because it made many of 1l1~' patients an!','!'y." "\Vell, what happened '?" "1 finally joined The :Vledical Dental Bureau, now 1 get a credit rating on all new patientF and turn O\'er my collection~ to them vou know thev m illJiDfCAL f)ROFE,~Sf(), A Night Call If you have a few We mauufaclure a complete bottles of Renner's line of nledicinal pl'clclucts of the all ready for that very hIghest standard which we offer direct to members pf th night call to the re I medi~a] pl'ofession. Every pro frigerator, you will duct is l'eady for immediate tlse, find real thirst satis II . "~Isily dispcnsed. \Ve guarantee hem true to lahds and of re- faction in every sip, liable potene)' -our c:itn]ogue jree OIL reqllest. THE ZEMMER co. (,'I,rmi.. t., to thr .11 ediflll Pro/cssjon :~!, 13-;;-1 ~mnctt Sl. Oakland Station Phone 44467 Pittsburgh, Pa. TWO STOMAC PREPARATION Gastric Acidity --Pulvis Sippy Im proved -Bismuthi Subcarbonas, Mag nesii Carbonas. Calcii Carbonas, Sodii Bicarbonas. Diastasum Cone, 01. Menth. Pip.-A balanced formula combining the heavy carbonates for relief with the light carbonates for sustained action. Ulcer conditions -Bismuth Subsalicylate, Compound. Bismuth Subsalicylate, Sodi Bicarbonate. Magnesium Oxide, Magnesium Carbonate Extract Belladonna. -Combines the coating action of the Bismuth with the analgesic dction at the Sal icylate ndicle Prescribe them WHITE'S DRUG STORES DEPENDABLE PRESCRIPTION DRUGGISTS PATRONIZE OUR ADVERTIST~RS AJ\D :\IENTION THE Bl'LLETfr BULLETIN TilE !\rAHO~I~G COUKTY ~I' ICAL SOCIETY \\ \l D~c~~~ 'Iary's Sealt esl las,ier •• ' prefer San' ~e iI's richer •• 'n ls k ..ep a Milk. Becauh'ng Wise pare help ,l,en' n ~ore refre s "he' (an'''Y c:o and l'urilY boule ...here d in qua"l) I r)" I'ro' Prolecle { Lnbo rll 0 • selves. 1 esl !hslen' 0 favorile slore, by ,he Sea I 'I {rom your r phone leelion. G~t try'S ...i1kman, 0 ,.our San'I" , ~__-- ':\.2161. • e a I tell t S~'8t("m tflndnrlb gllurantetd • ad'5'erti~ed In Sealtest "Cream• Top" Milk ,. ood Housekecpinlf" MEET AT RESTAURANT CO. FOR GOOD FOOD PATRONIZE Ot:R :\DVERTISERS AND ~IENTION THE BUI.LETI~ THE MERCER SA TARIUM RCER. PE SYLVA fA For I il Mental Disorders. oeat ennsylvania. thirty miles fr 111 Y ung tow. Farm of one h ndre cr with regist r d, tuberculin-tested herd. e-educ tional m sure emph ized, especiall art n rafts and a tdoor p rsuits. 0 ern aboratory f cilities, Address: \V. W. Ie ARDSO ,M. D., Me i I Dire or Formrr/I' GM" Physician, Slale florpitaf for Insane, Norristown, Pa. OUR.. "'AT'S OFF 10 YOU,! The physicians of the Ma Our sole interest is to make honing County Medical So your understanding of our ciety have helped make the SUPERB Invalid Coach Service Central Square Garage Clear to You y"/Il/!/... lfJi(·II·... ",11".,/ !'"Pl/!fll'" !'([rkillfj ([lid S('n';r(:' Garl/f/t' Clifford L. Thompson Wick (; Commerce 2151 Market Street Phone 35167 Phcne 3 -2626 1'.\TrWXIZE OCR .\DVERTrSERS AND MENTION THE Bt:LL 'TIN 26 BULLETIN C\\\lDRlt\ prefer Sanitar,"s Sealte\lt "Cream-Top" Milk. BeeaUse it's richer ••• tastier ••. nt l ,no refre"hing. Wi"e ,)are " keep " re r.a boule where the, fan,il," n help then "elves. Protected ill (l""lity and r l)Urity by the Sealtest Systen1 of Labor"to ,. pro tection. Get it fronl yo"r favorite "tore,hone your Sanitarys ",ilk,n"n. or v 3·2,16l. S e.. 1 t e8 t S~'."tf'm ~..:--:-~ ..tandarrls J;"uaranteed ." • d v f'I'ti tI ed inII Sealtest "Cream·Top" Milk i'Oood Bousek("('pinI" MEET AT CLARK'S RESTAURANT CO. THE :.\lAHO.'\ll\G NTY :.\lEDlr'AL SOCrETY ~I THE MERCER ANITARlillvI ERCER, P SYLVANIA For Nervous and Mild Mental Disorders. oeated at Mercer, Pennsylvania, thirty miles from Youngstown. Farm of one hundred eres \"lith registered, tuberculin-tested herd. e-educational measures emphasized, especiall arts and crafts and outdoor pursuits. Modern laboratory facilities. Address: CHARDSON. M. D., Medical Director Formerly Chh/ Physician, State /lospital for J1lSan~, NorristQwn. Po• A POOR. OUR... \\AT'S UNDERSTNJOING! OFF ,0 YOU.! I II III I The physicians of the Ma Our sole interest is to make honing County Medical So your understanding of our ciety have helped make the SUPERB ~II Invalid Coad. Service Central Square Garage : FOR GOOD FOOD Clear to You )'Ollllfj.'loWII·.' ",110.'1 PUpll/(/"" P(/rkill!! IIlId ,\'I'r'7'ia Gflmgl' Clifford L. Thompson Wick 6-Commerce 2151 Market Street Phcne 35167 Phcne 3-2626 PATHO~IZE orR ADVERTISERS A:ND :\lENTIOK THE Bt:LLETC' PATRONIZE OUR .-\DVERTISERS AND MENTION THE BCLLETIN ., E LLETL~ AS PERFECT AS MODERN SCIENCE PERMITS JHiraclean Clean As a Breath of Spring. The Last Word in Modern Scientific Dry Cleaning "Get Thornton Wise" Phone '1-01:>:> THORNT N LA DRY & DRY CLE 2:14 Belmont An't1ue RI TI Making a Good Impression-- (f' on I That's Our Business. Let us I 33112 demonstrate our ability to please. T E YOUNGSTOWN PRINTING CO. 787 w C K A V E N U E PATR .. TZU: UR ADYERTISERS A:"ID 'IENTION THE BULLETIN Id Way •.• DRING RICKETS in he LEFT of an A H TREE F R many cenruries,-and apparenrIy down to the rrl:Se!lt time, even in this couorry- ricketlc chil ren lu' b n passed through a cleft ash tree to cure h m uf t 1 ir rickers, and thenceforth a sympatheric r Llti) hip was supposed to exist between rhem and the trce. F . er states thar the ordinary mode of effecting Icc Ie is to split a young ash sapling Ion i lUdtn.ILly for a few feet and pass the child, nak d, 1:' h r rlm:e times or rhree times three through rhe 'to at s rise. In the \V, t of England, ir is said th ' I .1·:,lge must be ",tgainst the sun." As s n as the Lcrcmony is performed, the tree i bound tighrIy I 1 ,'f1J the 1i 'sure plasrered over wirh mud or day. t. I dlef is that just as rhe deft in the tree will be II.J! 51 the child's body will be healed, bur rhat if th ri r . in rhe tree remains open, rhe deformity in II L ti i1d 'III remain, too, and if rhe tree were t die, the death of the child would surely follow. I tis ironical chatrhe practice ofattempting J .•.. to curl" ri'kct· y holdin,.-;- the child in.h clcft of an a.)h {fLe '\\ J "i a.s~OCialcd with the ri~ing ofthe sun, {he light of which we now know is in itself one of Narure'~ spL'cifics. e Way ... rev nting and Curing Rickets with OLEUM PE COMO PHUM N OWADAYS, the physician has at his command, Mead's Oleum Percomor phum, a natural vitamin D product which actually prevents and cures ric cts, when given in proper dosage. Like other specifics for other diseases, larger dosage may be required for extreme c' e. It is safe to say that when used in the indicated dosage, Mead's <- h:um Percomorphum is a specific in almost all cases of rickets, regardless of d 'grec and duration. Mead's Ole m Percomorphum because of its high vitamins A and D content is I. () useful in deficiency conditions such as tetany, osteomalacia and xerophthalmia. Mead's Oleum Percomorphum is not advertised to the public and is now obtainable t rug stores at a new economical price in 10 C.c. and 50 c.c. bottles all lO-drop capsules. lEAD JOR SON & COMPANY, Evansville, Indiana, U. S. A. 2R Bl"LLET1N AS PERFECT AS MODERN SCIENCE PERMITS -.JtiracLean Clean As a, Breath of Spring. The Last Word in Modern Scientific Dry Cleaning "Cet Thornton Wise" Phone J·Ol ,),j THORNTON ~~r~DRY & DRY CLEAJ\ll'G 2:~~ Jklmollt A"l'1ll1C p I TI G-- (Ph.onE. 33112 Let us Making a Good Impression-- demonstrate our ability to please. That's Our Business. THE YOU GSTOWN PRINTING CO. 787 w CK AYEN UE Way ••• CURING RICKETS in the CLEFT of an ASH TREE F OR many cemuries,-and apparcarly down to tbe I'r"'S<:llt nme, even in this country-ricketic chil .r'1l h;I\'C been passed through a deft ash tree to cure lhem of their rickets, and thenceforth a sympathetic rc:LI! illll~hir \Va.~ supposed to exist between them and thl:' tTl:c:. rr,i7<:r sores that the ordinary mode of effecting Ill.. (ure-is to split a young ash sapling longi tuJIl1.diy for a few feet and pass [he child, nakeJ, tl\l.~ three times or three times three through the fi~u! L: It sunrise, In the West of England, it is said 'a~\a.gt must be "against the sun," As soon as Ihe CntnlOny is performed, the tree is bound tightly lip all,j the fissure plastered over with mud or clay. e bdlt::f is that just as the cleft in the tree will be le,j ~o the child's body will be healed, but that if in trl tbe tree remains open, the deformit)' in hlIL I "ill remain, too, and if the tree were to die, he tlt-.lth of the chil.:! would surely follow. Jti~ironical that the p...ctice ofatremplill~ \;,:T GoillWi Bo)ur;h. "01. 1, New 10t'1I:. ~tacIJIi;hm ~ ";0., 1928 ro cure ricket.s b)' holdinJl the child in th cleft of an ash trCC wa\-a~\(>ciat(:d with the rising oftb<: Sun, thehghtofwhich wt now know is in itself one of Natur~'s spc'Cifics. ewWay ••• Preventing and Curi ickets with OLEUM PERCOMO p UM N OWADAYS, the physician has at his command, Mead's Oleum Percomor phum. a natural vitamin D product which actually prevents and cures rickets, when gi,'en in proper dosage. Like other specifics for other diseases, larger dosage may be required for extreme cases. It is safe to say that when used in the indicated dosage. M~ad's Oleum Percomorphum is a specific in almost all cases of rickets, regardless of degree and duration. Mead's Oleum Percon.orphum because of its high vitamins A and D content is ho usefulin deficiency conditions such as tetany, osteomalacia "nd xerophthalmia. ~Iead's Oleum Percomorphum is not adverti~ed to the public and is now obtainable at drug stores at a new economical price in 10 c.Co and 50 C.c. bottles and lO-drop capsules. lEAD JOHNSON & COMPANY, Evansville, Indiana. U. S. A. pll-91' M,".d John.on prQdlu:t to Cl)()p"r.ta Hl pn.....nUn-lrtll.llic ro:at'hmr u"'lUthQ..-~..Jj I"-WU PATRONIZE OUR ADVERTISERS AND MENTION THE BULLETIN • 1m r ant ·_ of a LI ETIME BULLETI of the Prominen m n he .. ...--1Iiii quentlv retain a parson .. III 11 ysicilUl to help them preserve h ir ...'f' .J&.~.,.....''"''n g C u ty neal h. But the most un· poJlan time to have th pnySlCian'$ supervj~on oc e Y u duung the pte-school years, and pArhcularly during th very nut yeu or the individaaJ's lile PhysicIans agree thai brea t msllc from h. notmal mothlU 's the ideallood for the human mfant. For i fan de· p d of breas milk, il IS only logical to plescribe a food which '"1I•••III•••iiI~;..Dtesemblas breaJIt milk u closely as possible, S. •A_. when iWutec1 accordin9 to direc· Organized 1872 ons. resemb e breast milk not o~ly In percentages or carbohydrate. rolem,.fa IS d lotal 4all1l ah) content, ut also In die chemical and physIcal onstanls 01 "n ~~.~n;"'t~.an"-'>d-:-'i,'n e nd of carbohyclrat pIe onelntion of th.. constitu· eM', From Ihe beqlnmng S.M'.A. haa c nl.ined anouoh vitamin D to pr&venl r kets and spasmophilia. The lib ral p "0 QVIBI n 01 V1 amin A is untlonn and Cel • S.M. A. throughout I,he year: h ea. thill faelor is variable m milk. fxesh or aporated. co II F l r larv 1Y 7 Samples a d lileratur are healy avail· ah e to phyncians opo reqoest. '\ olum A 7 JlImb r_ 8.M.A. CORPORATION - - CLEVELAND, OHI