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Illinois Medical Journal THE OFFICIAL ORGAN OF The Illinois State Medical Society PUBLISHED AT OAK PARK, ILL. At the close of the old year and beginning of the new, it is the usual custom with most successful busi- ness men to study the problems pertaining to their individual lines of work. When these questionnaires are received, it is hoped that every physician receiving one, will give as complete information on the subject as possible, and there will be no embarrassment to anyone, as the name of the physician making the return will not appear on it. In Kretchmer’s series of 17 mixed tu- mors 16 are dead. And with medicine the complete captive of communism, think not that all other industry, all other professions, all other institutions of civilization will know delay in succumbing to socialistic puerility and malice. Magee, Harry Bayne, 334 Crescent St.; office, 408 Main St. The list is published, not as an in- dication of the worthiness of the institutions listed, but solely as a means of making the data available to physicians, social agencies, and any other persons in need of such information. (From the Department of Ophthalmology, Northwestern Uni- versity Medical School) CHICAGO Hypertension is reflected in the ophthalmo- scope, in either subtle or obvious fashion, be the hypertension benign or malignant, associated with arteriosclerosis, or sequential to increased intracranial pressure. A coincident condition may be considered a con- traindication, such as a major cardiac, renal or other condition. The coexistent condition may add unduly to the risk— or the life expect- ancy may not be great enough to justify any major surgery.

With this number of the Illinois Medical Journal we are starting a new year. It is our intention to procure a considerable amount of data during the coming year with a nominal expense, which will be principally post- age. Much has been said in this regard of mixed tumors of the kidney. These conditions, unless lifted, will destroy the efficiency of medicine as the profession itself admits. The list of institutions given below is known to be complete only in regard to the sanatoria; there are probably a few small rest homes not included. Acute perforation is always, massive hemorrhage not always, a surgical indication.

The family doctor, joining such a group, will review under an able teacher the very disease he is combating at that time, he will acquaint himself with the most recent diagnostic procedures and methods of treatment, he will recognize obscure symptom complexes and be prepared immediately with the most potent ther- apy. As stated above they must begin very early and before the tissues in which they originate have undergone much differentiation ; it is not unreasonable, therefore, to assume that multiple implantations ur points of origin may occur in that early period. Garceau: Renal, ureteral, perirenal and adrenal tumors. These endowed foundations with their centers, their clinics, their dispensaries, and over author- itative nurse have been a large factor in pauper- izing the minds if not the bodies of far too large a proportion of our population. Jenkins, James Thos., 105 Edgehill Ct.; office, 333 Fulton St. The diastolic pressure of the central retinal artery is normally 35 mm. Before passing from the subject of local opera- tive work, I wish to remind you that ulcer of the lesser curvature differs from that of the duo- denum in that it tends to be more extensive, more inflammatory and ultimately to form cica- tricial changes that are more damaging than in the duodenum.

All of us with years of experience behind us, and an equal amount of time away from the feet of the learned, appreciate our shortcomings, but we are humanly weak and try to keep our fail- ings from public notice and many recent dis- coveries like the Schick test, toxoid vaccination or the use of convalescent poliomyelitis serum are not familiar to us. Some mixed tumors are bilateral when first seen and others become so later and what may appear to be a metastatic growth may in reality be the development of another original tumor. So keen has become the competition between foundations that now instead of caring for the pauper class alone, or the merely temporarily unfortunate, the scope of the foundations to give away med- ical charity runs to the point where in one cer- tain city alone any man whose income was less than ,000 per annum was assured of prac- tically free obstetrical care for his wife, until the wise headed business men back of this un- fortunate idea were enlightened by medical men as to what they were doing. Horwitz, Sandor, 928 Hamilton Blvd.; office, City Hall. Hg., — somewhat less than half that of the brachial artery, and this ratio maintains itself in hyper- tensive states, unless the cerebral circulation is particularly affected. In ulcer of the lesser curva- ture we often have no way of knowing from the clinical picture, from the roentgenogram or on the examining table whether we are dealing with an ulcer or carcinoma.

To array our general practitioners against the specialist is, to my way of thinking, like the mother seek- ing to glorify one of her sons at the expense of degrading the other. This facilitates local recurrence and metastatic deposits and is probably the greatest causative factor in the high mortality of all types of embryonal tumors of the kidney. Kretschmer for his verification of the same and our thanks to both of them for their kindly interest. The drug manufacturers and the wholesalers and even the retail druggists have had more or less poignant even if unsuspected competition from these same foundations or centers what with their own pharmacies, and in some of the cruder simpler drugs their own subsidized fac- tories. In general, a diastolic pressure in the central retinal artery greater by 10 mm. I remember when one of my professors sutured the gall-gladder to the peri- toneum and waited seventy-two hours and then opened it and took out the stones.

As a well known radio January, CORRESPONDENCE 13 character would say : “We are all brothers in that great fraternity.” So one could have more respect for the high minded and skilled general practitioner than the writer, but is it not a self-evident truth that the specialist in medicine and surgery is a natural product of evolution in a human desire to ex- cel in some particular direction. Whether this breaking down of the capsule is more readily accomplished in the mixed tumors than in the adenocarcinomata is difficult to say at this time; but should such be the case then it will be of the greatest impor- tance from the standpoint of prognosis that em- bryonal adenocarcinomas be not indiscriminately classed with all the various varieties of mixed tumors as is the tendency today. Moore for the histological description of the tumor and to Dr. It is only natural that the pharmaceutical industry should be one of the earlier industries to feel this contact. Heymann, Bernard Benj., Jefferson Hotel; office, 700 S. than half the brachial diastolic pressure is indicative of increased pressure in the cerebral arteries, the result of increased intracranial pres- sure. It is realized today that when we just drain the gall-bladder we leave behind the organ which is the seat of the disease.

Q "4 1*7^ t221 Kenmore Avenue, Chicago, Illinois January, 1934 EDITORIALS 11 MEDICAL ECONOMICS WHY NOT CONDUCT OUR BUSINESS IN A BUSINESS WAY? Some state med- ical societies are making, or have made such a survey recently, and in two or three instances, the data has been accumulated at a considerable expense to the society. This, we believe, should be considered in estimating prognosis. Little can be said as to prognosis in this particular type of tumor. Kretschmer: Mixed tumors of the kidney in infancy and childhood. Without tracing tediously intermittent pro- cedures and realizing that professions and in- 26 ILLINOIS MEDICAL JOURNAL January, 1934 dustries are after all brothers under the skin, let us glance at the conditions surrounding medicine today. Neither totals nor averages of actual receipts from patients can be given here, but it is cer- tain that average fees have declined more than the minimum rates above quoted would indicate, and since the number of patients has also de- creased the total receipts from these patients have doubtless fallen to an amazingly low figure. These include cases that are not relieved by medical care, or tend to re- cur; that are associated with complications of what ought to be termed a surgical character; particularly the cicatricial deformities that in- terfere with function; most deeply penetrating ulcers.

D., Managing Editor INDEX TO VOLUME LXV January to June, 1934 NEWYOSl' ACAJL -i i OF ME OICIN F BUG V ! At an early date, the Committee on Medical Economics is going to send out questionnaires to a considerable number of physicians selected from different parts of Illinois; which will in- clude general practitioners, both in the rural and urban communities, specialists in different branches of medical work, and also to the teach- ing members of the profession. The gene- sis, therefore, of an embryonal adenocarcinoma such as is being reported, is likely of a later period than the time of origin of adenosarcoma and the other mixed neoplasms. In its place have come fetters, spiked and thorny, that are aimed to drag into complete inefficiency the entire mod- ern structure of comparatively sane existence. Also, while in 1930 a rest home offered to receive patients for a minimum rate of .00 per week, in 1933 this minimum offer is .37, a reduction of .63 or 36 per cent. The surgical treatment which I wish to pre- sent to you is to be regarded as limited in its application to those cases that are resistent to adequate medical care.

Experience and ob- servation says this was done with success.” If you will pardon me, this seems a most extrava- gant statement. Every business should be controlled by its own acolytes, every profession by its own de- votees. LEBENSOHN 157 sheathing and arterio-venous constrictions are present, and occasionally also some hemorrhages and white spots. : Sur la determination de la tension intra- cranienne par l’ophtalmodynamometre de Bailliart. My suggestion is to regard that structure as the organ to be re- moved as you would remove a gall-bladder. Therefore, I present this operation not as a means of correcting over-acidity or removing in- fection or of doing any of those things that the internist accomplishes. Programs such as above outlined will make better doctors of us, help us to shorten the length of every illness, min- imize its complications, morbidity and mortality, and thus proportionately reduce the cost of sick- ness, and, last but not least, it will develop a better understanding and a friendly cooperation between all concerned. The embryonal adenocarcinoma, on the contrary, develops from a tissue already well differentiated and this may have a bearing on the prognosis of a tumor of this type. They admitted it would be pretty bad for the country and for the citizenry at large if every man whose in- come was under ,000 per annum could be assured of getting food, clothes, shelter, car fare, telephone service, dentistry, drugs, etc. However the idea is still grop- ing to shoot up roots. Howard, Everett Edmunds, 215 Cooper St.; office, 101 S. In increased intracranial pressure, the retinal diastolic reading is signifi- cantly and disproportionately high, a phenome- non that may long precede the disc changes. If that is true it must be illogical to excise ulcer of the lesser curva- ture. If one cannot determine whether the lesion is ulcer or carcinoma, it is illogical to destroy the ulcer in situ without an opportunity to study it. Public Policy Committee, Illinois State Medical Society. There should be more probability of the growth being a single expression of an embryonic disturbance than in the mixed type and it lacks the nature of a sarcoma in its metastatic tendencies. Until the endowed foundationer got busy the doctors felt that they were doing pretty well in the way of medical charity. To what degree the retinal diastolic pressure may be thus elevated is strikingly illustrated in a case reported by Berens. Local operative work in ulcer of the lesser curvature is, I think, particularly illogical. If improvements can be made in the system of doing business, this is tlie time when they are usually started. From the vast amount of data along economic lines which has been accumulated during the past few years, it is estimated that the American physicians are actually doing more than one mil- lion dollars worth of work each day which is con- sidered as charity work, and it is quite obvious that members of the Illinois State Medical So- ciety are doing their share of this work. In Mixter’s collection of 14 nephrectomized patients 13 are dead and one alive after 3 y 2 years. You hear doctors protesting against “lay con- trol of medicine.” Do you know what that means? OPHTHALMOSCOPIC FINDINGS IN CONDITIONS OF HYPERTENSION* James E. The earliest subjective symptoms are not infrequently visual. I wish to remind you that the surgical treat- ment of such ulcers carried out by the usual methods of limited surgical attack is directed to- ward the same purpose the internist carries out very effectively. If faulty systems have been in use they are dis- carded, or modified to make them more in keep- ing with the times. Percentage of bills collected during the year, of the total amount of work actually done. The information received from the series of questionnaires which will be sent out during the coming months will be used in a comprehensive 12 ILLINOIS MEDICAL JOURNAL January, 1934 report which our committee hopes to present next May at the Annual Meeting in Springfield, and with full cooperation on the part of the members of the Society, we are sure that it will be something well worth the effort, and min- imum expense. Hamilton, Chairman, Committee Medical Economics, Illinois State Med- ical Society. 20 ILLINOIS MEDICAL JOURNAL January, 1934 Theodore Shapira — Why the Eyes Water. In Walker’s series of 145 cases only 4 are alive after 3 years. When a doctor speaks of lay control he means that persons other than men of medicine are running the medical profession and dictating the whys and the wherefores of this medical service. The pa- tient comes complaining of black spots before the *Read before Section on Eye, Ear, Nose and Throat, Illinois State Medical Society, Peoria, May 17, 1033. Both internists and surgeons who attack the ulcer as a local lesion aim to do certain things, such as lower the acidity, enable the stomach to empty more easily, deflect the current of gastric contents, etc.

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