nec 20 2

Illinois edical Journal

OWNED AND PUBLISHED BY THE MEDICAL PROFESSION OF ILLINOIS Office of Publication 155 N. Ridgeland Ave., Oak Park, Illinois

L, No. 6 OAK PARK, ILL., DECEMBER 1926 $3.00 a Year

CONTENTS Alleged Back Injuries. L.G. Harney, M. D., East St. a

Louis,

(For Titles See Extended Table of Contents). . 437 |

ORIGINAL ARTICLES Ectopic Pregnancy. Carey Culbertson, M. D., Chicago. . .

litis of Unknown Etiology Simulating Tapelt

ne. 5S. C. Woldenberg, M. D., Chicago. . 463 The Diagnosis and Treatment of Pyelitis. Daniel N.

Weekly Clinical Conference. G. Henry Mundt, M. Eisendrath, M. D., Chicago 488

Chicago 4 The Ambulatory Treatment of Tuberculosis. Ernst Loe- wenstein, M. D., Vienna, Austria

g the Society to the Membership and to Prospects. M. Camp, M. D., Monmouth, Iil 469 Advantages of the Closed Method of Treating Empyema. R. B. Betiman, M. D., Chicago 50

adocrine Family. James H. Hutton, M. D., Chicago 473 Etiology, Prevention and Treatment of Postopera- The Management of Resistant Syphilis. Ferdinand Herb, e Wound Infections. Max Thorek, M. D., Chicago.. 477 M. D., Chicago

Continued on Page 14 ENTY-SEVENTH ANNUAL MEETING AT MOLINE, MAY 31, JUNE 1 and 2, 1927

Entered as Second-Class Matter July 21, 1919, at the Fost Office, Oak Park, Illinois, under the Act of March 8, 1879. ptance for mailing at special rate of postage provided for in Section 1102, Act of October 8, 1917, authorized July 15, 1918.

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| ILLINOIS MeEpiIcAaL JOURNAL

THE OFFICIAL ORGAN OF

THE ILLINOIS STATE MEDICAL SOCIETY

Council.

GENERAL OFFICERS, 1926-1927

MARSIDIENT 61:5. /6/0/2isi0s010-s MATHER PFEIFFENBERGER, Alton PRESIDENT-ELECT..........G. Henry Muwnot, Chicago First VICE-PRESIDENT......EarL D. Wisz, Champaign SeconD VIcE-PresipENT.....C. S. Netson, Springfield

WERASURER. «0:55. 0000 .ee---A. J. MarRK ey, Belvidere SECRETARY....... ......-Harotp M. Camp, Monmouth THE COUNCIL D.B. Penniman, 1st District, Rockford ......... 1929 ation of E.E. Perisho, 2nd District, Streator .......... 1929 col and S. r McNeill, 3rd District, Chicago .......... 1929 ¢ freely : . Nagel, 3rd District, Chicago ....... .. 1928 patient, R. Ferguson, 3rd District, Chicago .......... 1927 ‘distur. Wm.D.Chapman, 4th District, Silvis .......... 1928 Wotics, S. E. Munson, 5th District, Springfield ..... 1928 sini H. P. Beirne, 6th District, Quincy ........... 1927 “ye I, H. Neece, 7th District, Decatur .......... 1928 uired, Cleaves Bennett, 8th District, Champaign ..... . 1929 Andy Hall, 9th District, Mt. Vernon....... 1927 J. S. Templeton, 10th District, Pinckneyville...... 1927 EDITOR

CHARLES J. WHALEN....++--.. 25 E. Washington St., Chicago

GENERAL COUNSEL

Ropert J. FoLoNiE ..--..eeeesees 39 S. La Salle St., Chicago

PUBLICATION COMMITTEE

J. W. Van DERSLICE, Secretary. ...cccccccscscccccssccees

seit ore Cais enlaces ein ocala a aE SaaS 155 N. Ridgeland Ave.,, Oak Park wi MEDICO-LEGAL COMMITTEE

C..B.. Kine, CROWN s<o:06:06:00% 4100 W. Madison St., Chicago

GroncGe WESER, SéCHClOhY. <.<.00.0ccnsscsscccccsscosceves Peoria LAY EDUCATION COMMITTEE

B. C. Ketxer, Director ...... 58 E. Washington St., Chicago

SCIENTIFIC SERVICE COMMITTEE James H. Hutton, Chairman, 6056 Cottage Grove Ave., Chicago Harotp M. Camp, Secretary......ccsccccccccccece Monmouth

State Society will pay no bills for legal services except those contracted by the Committee. Notify the Chairman at once. Do not employ attorneys.

Send original articles and all communications relating to advertisements to Dr. Charles J. Whalen, Editor, 6221 Ken- more Avenue, Chicago.

Membership correspondence to Dr. Harold M. Camp, Mon- mouth, I1?,

Society proceedings and news items and changes in the mailing list to Dr. Henry G. Ohls, Managing Editor, 1618 Juneway Terrace, Chicago.

Contributors will submit all copy for publication typewritten on standard size paper and double spaced. Copy not com- plying with this rule will be returned, if convenient.

Subscription price of this Journal to persons not members of the Illinois State Medical Society is $8.00 per year, in advance, postage prepaid, for the United States, Cuba, Porto Rico, Fhilippine Islands, Hawaiian Islands and Mexico. $8.50 per year for all foreign countries included in the postal union.

a, $3.25. Single current copies, 85 cents. Back numbers, after three months from date of publication, 50 cents,

Vor. L Oak Park, Itt., DECEMBER, 1926 No. 6

ILLINOIS MEDICAL JOURNAL Editorial

Published monthly by the Illinois State, Medical Society eee,

under the direction of the Publication Committee of the THE PRACTICE OF MEDICINE BY CONGRESS

Soon Coneress Witt TreLtt Tur Docrors How To PRESCRIBE CATHARTICS

One of the most devastating decisions of the Supreme Court of the United States is that handed down recently, permitting Congress literally to take the practice of medicine out of the hands of the country’s medical profession.

This blow at public welfare and medical efficiency is struck through the Supreme Court’s interpretation of the Volstead act. In the de- cision under consideration it is held that a phy- sician may not prescribe more than a pint of whiskey for a patient during a period of ten days. The condition of the patient, the reasons for the prescribing of the whiskey, the possibil- ity for saving life and the scientific judgment of the physician count for nothing at all in the face of the letter of the law. Truly an instance of the exactitudes of the proverbial “Pound of flesh.” If in the doctor’s judgment more than a pint of whiskey should be required to save the life, or to alleviate the suffering of his patient during the ten day period, then the physician faces no alternative. He must become a law- breaker whether he will or not. If the patient dies because more than a pint of whiskey, ad- ministered during the set time, might have saved him,—then the doctor is beyond all rea- son a murderer. Tf on the other hand, the phy- sician does prescribe a necessary amount of the forbidden medicament, he is a law-breaker and apt to lose his license to practice medicine, to pay a fine or perhaps to be imprisoned.

It is understood that the Supreme Court itself was divided as to the propriety and justice of this decision. Also, that the findings were based upon the contention that physicians differed upon the advisability or necessity for adminis-

tering whiskey in any case.

There are few drugs in the pharmacopeia about

438 ILLINOIS MEDICAL JOURNAL

which there is not a varying opinion held by doctors. What applies to whiskey, applies as well to opium, castor oil, salts or other purga- tives, digestants, mercury, and quinine. Yet Congress would be laughed out of countenance over the attempt of the Supreme Court to sit in judgement over the right of a doctor to pre- scribe for a patient a certain number of cathartic pills.

The Supreme Court justified its decision by claiming that, as doctors divide in their opinion as to the use of whiskey, Congress, acting through the Volstead law and the prohibition director, had the right to serve as arbiter, and to tell the medical profession what it should do.

Now, in present day practice doctors disagree even more about the use of cathartics than they do about the use of whiskey. Under this as- sumed jurisdiction of the Supreme Court given to Congress, the nation’s lawmakers have as much right to inform a doctor that he shall not give more than three cathartic pills in a month, or more than one bottle of citrate of magnesia in a year,

There is a great diversity of opinion among doctors, upon the value of surgical operations. Tenets of one school of medicine are built upon the theory that the knife is never justified. Even i layman can see without a diagram the folly of Congress trying to regulate the desirability or the time for a Cesarean section or an appendec- tomy, yet there is no fundamental difference be- tween legislative interference with surgery or with medico-therapy.

On the surface of affairs, the Supreme Court would seem to be hoist by its own petard. This august body excuses itself for interference with the modus operandi of another science and pro- fession on the ground that members and prac- titioners of that science and profession are a house divided against itself. The Supreme Court would seem to be guilty of the same sin. There was controversy in that body as to the handing down of this decision. As only too often happens, and as the legal profession only too often pleads, here is another instance where the bulk of logic, reasoning and sound judg- ment lies with the minority report.

Congress is telling physicians how to practice medicine. Now the practice of medicine is something about which no layman, whether a congressman or not, knows anything. In view

December, 1996

of the vast number of crucial economic prob. lems now confronting the nation Congress should attend first to those duties for which jt was sent to Washington. This would be in far better taste as well as far better for the nation than the present crude attempt to make of g great science the prostituted handmaid of in- tellects unversed in medicine.

LAY PRESS CONDEMNS SUPREME COURT DECISION AS TO PHYSICIANS PRESCRIBING UNDER THE VOLSTEAD LAW

One of the most intelligent comments upon the recent Supreme Court decision dealing with the medical features of the Volstead Act is here reprinted from the editorial page of the Chicago Tribune for December 2.

MEDICINE AND PROHIBITION

Will the Supreme Court’s decision on medi- cinal alcohol prove to be the Dred Scott case of prohibition?

It might well be. Certainly no conscientious physician in charge of a serious case will waive his judgment of the need of his patient because of the dictate of a legislature or the opinion of a bench of judges. The prescribing for the needs of the sick is not a proper function either of a legislature or a court, and the law which at- tempts to put limits on the judgment of the physician is of a piece with the fanaticism which would determine any other scientific judgment by act of law. If a legislature directs that no public school shall teach that the earth is a sphere, if it directs that it shall teach that the earth is the center of the universe and that the sun moves above it from east to west, it would be no more out of its legitimate field than it is when it forbids a physician to prescribe more than an amount of alcohol which it fixes in its own wisdom.

The 18th amendment was in plain language directed at and limited to prohibiting the use of alcoholic intoxicants as beverages. The decision of a bare majority of the Supreme Court now extends the prohibition to their use for medical purposes.

That is the rock bottom fact of this decision. The reasoning of the majority cannot evade or cbscure it. Under this decision a physician charged with care of a patient and honestly con- vinced that the patient requires an amount of

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December, 1926

alcohol beyond the limit fixed by a prohibitory statute must disobey his conscience and his scientific judgment or disobey the law. The theory of the decision seems to be that in order to prevent an abuse of medical authority the free judgment of responsible medical men may be properly circumscribed under a constitutional provision prohibiting alcoholic beverages. By such interpretation a constitutional provision can be expanded indefinitely under the device of administrative measures and the politician, the professional reformer, and the judge elbow the physician from the bedside of his patient.

We think this is an intolerable distortion of ihe functions of law and government, of legis- lator and judge. We think it is an intolerable distortion of the plain intent of the 18th amend- ment. We think it is bringing teetotalist fana- ticism to the point of murderous tyranny.

The Volstead act, with its ramifications, is like the squid. It must be destroyed. Juries, at any rate, Save When dominated by ignorance and big- otry, will not punish defiance of laws which penalize reason and run beyond the proper domain of government. If the courts support the excesses of teetotalist tryanny, they invite the hatred which the alien and sedition laws brought upon them and prepare consequences no less serious and demoralizing than the weakening of the respect for law and judicial authority which followed those devices of blind partisan- ship and which is responsible to a great extent for the inefficiency of American criminal pro- cedure to our day.

PAPERS FOR THE 1927 ANNUAL MEETING

The officers of the five sections of the Illinois State Medical Society are anxious to arrange their respective programs as early as possible. The programs next year will be conducted some- what differently from those of former years, and should make the meeting more attractive than ever before.

All members of the Society who are interested in presenting papers before any of the sections at Moline May 31st, June Ist, 2nd, 1927, are re- quested to write to either the chairman or the secretary of the section in which he is interested, giving the title of the paper and the full address of the author.

It is customary to divide the papers in each

EDITORIAL 439

section equally between members of the Chicago Medical Society, and the Downstate Societies.

The Committee on Arrangements at Moline has just reported that all sections will meet in the same building, the same that will house the exhibits, registration and information headquar- ters.

This arrangement will add materially to the interest of the meeting and all efforts are being made to have an unusually large attendance for the 7%th annual meeting.

SECTION OFFICERS Section on Medicine: Leroy H. Sloan, chairman, 1180 East 63rd Street, Chicago.

J. L. Sherrick, Secretary, Monmouth. Section on Surgery:

E. P. Coleman, chairman, Canton.

J. R. Harger, secretary, 25 East Washington

St., Chicago. Section on Eye, Ear, Nose and Throat: Louis Ostrom, chairman, Rock Island. C. F. Yerger, secretary, 4100 West Madison St., Chicago. Section on Public Health and Hygiene: H. V. Gould, chairman, 1214 Berwyn Ave., Chicago. A. A. Crooks, secretary, Peoria. Section on Roentgenology : FE. S. Blaine, chairman, 5 South Wabash Ave., Chicago.

Harold Swanberg, secretary, Quincy.

It is requested that the Chicago Medical So- ciety members write to the Chicago officers, and the Downstate men get in touch with the other members so that there will be no confusion, and the programs can be arranged in such a manner that the 1927 annual meeting will be one long remembered.

JUSTICE THOMPSON, MEMBER OF THE ILLINOIS SUPREME COURT, REBUKES BUREAUCRACY. BUREAUCRACY WHEREVER TRIED IS A CURSE; WHEN APPLIED TO MEDICINE IT IS FATAL

DANGERS OF BUREAUCRACY IN GOVERNMENT

Justice Floyd E. Thompson of Rockford, a member of the Illinois Supreme Court at the closing banquet of the Illinois Lions recently issued a challenge to American Citizens to take

440

stock of themselves and to prevent the growing tendency towards a bureaucratic government.

State and national legislatures and general assemblies will soon be in session.

There is every indication that more than the usual amount of nefarious, malicious legislation will be presented before the lawmakers.

Now is the time to interview representatives and congressmen and to discover how and why and where they stand upon the socialistic doc- trines promulgated by a group of theorists and calculated to mislead and to deceive a public already stuffed to the bursting point with freak legislation.

A good thing cannot be repeated too often. It is perhaps not amiss to cite from a recent speech of Justice Floyd E. Thompson. It will be re- membered that Justice Thompson is the sterling patriot who delivered to chiropractors and drug- less healers, the most scathing rebuke in the last decision upholding the medical practice act.

Inveighing against the approach of a bureau- cracy, Justice Thompson, who took for his sub- ject “The State in the American System of Government, said in part:

“Men of both great political parties are warn- ing that there is now under way a persistent and determined movement to change our form of government from a representative republic to a bureaucratic one. The problem transcends all differences between the historic parties. To ac- complish such a change, there must be a revolu- tion in our political beliefs. We must cast aside our experiences of a century and a half, as well as the lessons of five centuries before this re- public was born.

“This challenge to the American system of government makes it imperative that we take stock of our foundation stones. To better fit our- selves to grapple with the big problem of gov- ernment we ought to recur frequently to the fundamental principles upon which this govern- ment rests.

“Our constitution recognizes that the Ameri- can state, as a political entity, is a natural growth developed along natural lines as the needs of the people grow. All students recognize that the federal government is the people’s creature. The term ‘state’ has two well defined meanings

—it may be the corporate entity organized for the purpose of performing the proprietary func- tions of government, or it may be the citizens

ILLINOIS MEDICAL JOURNAL

December, 1996

living within the defined limits, acting together for the purpose of exercising their natural gov- ernmental functions. The state, as a corporate entity, has no sovereignty: the state, as a politi- ‘al entity, has all the sovereign rights and powers of the citizens composing it.

“Probably the greatest single menace to the continuance of our form of government is the tendency to abolish the autonomy of the state and establish in its stead an unrestrained central- ized national government.

“Wise and patriotic men of all political parties are viewing with alarm this tendency and are virtually conscious of the fact that its accom- plishment means the destruction of the liberty of the citizen and the life of the Republic.

“The sovereign that stands behind the law of this country is the people of the several states, To them, acting as separate political units, the national government owes its creation and its continuance. The federal constitution enumer- ates the powers delegated to the federal govern- ment and declares all powers not so delegated reserved to the people of the several states. If this republic is to live, we must guard carefully this right of local self-government.

“In the growing tendency on the part of the states to seek federal aid, five principal subjects now come under a ‘fifty-fifty’ system whereby the federal government makes an appropriation, matched by the state, for the promotion of various agencies, the direction of which is vested in bureaus at Washington. These subjects are highway construction, agricultural extension work, vocational rehabilitation, and maternity and infancy hygiene.

“Every one of these causes is worthy but every one of them is purely local, and yet are taken over by the federal government in direct viola- tion of the spirit of the constitution.

“Ten years ago these federal subsidies to the state amounted to less than $6,500,000 a year; in 1925 they aggregated more than $110,000,000. Vicious as the system is for the extravagance it breeds, its worst feature is the invasion of the federal government into matters purely local. Under the ‘fifty-fifty’ system, each state must match the federal appropriation allotted with an equal amount from the state treasury, and must agree to submit to supervision of the expendi- ture. This supervision comes from the federal government.”

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CHICAGO DAILY NEWS OPPOSES SHEP-

PARD-TOWNER LAW; ALSO A FED- ERAL DEPARTMENT OF EDUCATION

Recently the Chicago Daily News under the caption “Invading State Rights” said:

“The effort being made in Washington to estab- lish a federal department of education is only another manifestation of the objectionable tendency to extend the obnoxious system of bureaucracy.

“Members of congress should strenuously op- pose this movement. As the Chicago Daily News suggests, the senate committee on education and labor and the senate as a whole will be subjected soon to a severe test of sincerity and courage in connection with the vital problem in question. A bill is pending in the senate committee that would extend for two years the Sheppard-Towner maternity and infancy law. Numerous women’s organizations have approved it. The house has passed it by a decisive majority, despite power- ful arguments in opposition.

“This bill should be adversely reported by the committee and defeated on the floor of the senate. Five states including Illinois have refused to accept money authorized by the act, and there is no evidence that other states have derived substantial benefits from it. Even if, as some claim, the act has stimulated state in- terest in proper protection of maternity and infancy, there is no good reason for further fed- eral appropriations. The educational work has been done and no American state is too poor to provide for its own needs.

“The News correctly sums up the situation when it says that “senators who condemn the extension or perpetuation of federal aid where no necessity for it exists cannot with any show of logic or good faith vote for the extension of the Sheppard-Towner law.”

SCIENTIFIC SERVICE COMMITTEE BEGINS WORK

At the September 1, 1926, meeting of the Council for the Illinois State Medical Society a Committee was appointed on Scientific Service for the component societies. Jas. H. Hutton of Chicago was relieved of his chairmanship of the Lay Education Committee, his place being filled by R. R. Ferguson of Chicago, and was ap- pointed to the general chairmanship of Scientific

EDITORIAL 441

Service. Ex-officio members of the Scientific Service Committee are: Mather Pfeiffenberger, Alton, president; G. Henry Mundt, Chicago, president-elect ;; H. M. Camp, Monmouth, sec- retary.

Co-operating with Dr. Hutton for the depart- ments of medicine on which material and speak- ers are to be provided for county and district societies desiring to use this service have been: Internal medicine—W. H. Holmes; Orthopedics -—Philip H. Kreuscher; Tuberculosis—Robert H. Hayes. Valuable contributions to the work have been received from Philip Lewin, Sidney H. Easton, Ralph H. Peairs, C. C. Chapin, Ros- well T. Pettit, Frank Deneen, Clarence L. Whea- ton, W. H. Watterson, G. B. Dudley, Cecil Jack, Maurice Blatt, C. H. Boswell, EK. A. Schlageter, A. Merrill Miller, S. C. Woldenberg, C. H. Tear- nan, J. T. Gregory, F. F. Maple, E. P. Sloan.

Twenty-seven counties have been served to date and there has been a full consideration of the subject at a Councilor District meeting in Pinckneyville, with J. S. Templeton for the Tenth District; in Macomb, with W. D. Chap- man for the Fourth District; in LaSalle, with E. E. Perisho for the Second District ; in Shelby- ville, with I. H. Neece for the Seventh District ; and in Springfield, with 8S. E. Munson for the Fifth District.

Following is a list of subjects. The Scientific Service Committee will be glad to schedule com- petent physicians to present one or several of these subjects upon request filed in the office of the society, 58 Kast Washington Street, Chicago, not less than one month preceding the date of the meeting for which service is desired.

A. MEDICINE

1. Tuberculosis (a) diagnosis (b) treatment 2. Peptic Ulcer Gastric Duodenal Diagnosis Treatment (a) medical (b) surgical 3. Gall Tract Disease (a) diagnosis (b) prognosis (c) treatment—medical 4. Diabetes (a) diagnosis (b) management 5. Respiratory Infections “Flu” treatment The pneumonias

6.

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8.

9. 10.

12,

12,

13.

16.

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ILLINOIS MEDICAL JOURNAL

Cardio-vascular Disease (a) diagnosis of early heart failure treatment of early heart failure (b) diagnosis of advanced heart failure treatment of advanced heart failure Kidney Diseases Simplification of nomenclature and classification Diagnosis (Clarify nephritis and nephrosis) Treatment Goiter Simple classification Treatment of various types (medical, iodine, sur- gical) Diagnosis of various types, very briefly The Business Side of Medicine Preventive Medicine (a) Community sanitation from the doctors’ view- point (b) Periodical health examinations How profitable to doctor and patient (c) Immunizations Empyema General consideration—recognition Treatment Medical Surgical The Endocrines in Everyday Practice Endocrines factors in common complaints such as common colds “chronic rheumatism” or “rheumatoid arthritis” backache, dysmenorrhea, headache, cardiac disturbances, obesity, nephritis, etc. Recognition and treatment Medical Aspects of the Menopause Focal Infection Medical aspect Dental aspect Relation to general medicine Eye, Ear, Nose and Throat Trouble as Related to General Medicine First aid in eye injuries Arthritis—from a medical standpoint Acute—treatment Chronic—diagnosis and treatment Pyelitis or Pyelonephritis Symptoms Diagnosis Treatment

Rational Physio-Therapy

B. OBSTETRICS AND GYNECOLOGY

1.

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4.

Prenatal care Examination—pelvic and general Management of early pregnancy Toxemia Incidental diseases—tuberculosis, syphilis, heart disease Management of late pregnancy Diagnosis of type of pelvis Diagnosis of labor Labor Diagnosis of the position, presentation and shape Mechanism, management, prognosis Abnormal Labor Management of the first, second and third stages Deviation from the normal (a) slow dilitation (b) abnormal mechanism; disproportion _ be- tween passage and passenger (c) delay in delivery of placenta (d) breech presentation (e) hemorrhage Eclampsia and other toxemias

5.

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December, 1996

Final examination and treatment of conditions found Mal-positions

Lacerations

Pelvic exudate

Acute Salpingitis

Diagnosis

Treatment

Uterine Fibroids

Management

Treatment

C. SURGERY

1.

Disease of the gall bladder, including a discussion of their influence on other functions of the body and the present-day surgical treatment

The diagnosis and treatment of acute appendi- citis

Efficient first aid treatment

Surgery on thyroid, including a discussion of the type of cases, preparation before operation and the best post-operative treatment when necessary

Treatment of shock following an injury

The acute abdomen. Findings which may lead to a possible diagnosis

Treatment of fractures

Surgical management of chest diseases and injuries

Head injuries

D. ORTHOPEDICS

1.

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Fractures (special) (a) Malunited and ununited (b) Near and into the joint (c) Spinal column Internal derangement of the knee joint Injuries and inflammation in and around the shoulder joint Peripheral nerve injuries Backache (a) Causes (b) Treatment Arthritis (a) Varieties (clinical) (b) Causes (c) Management Congenital deformities of the bones and joints Infantile paralysis Tuberculosis of the bones and joints Bone and joint diseases of infancy and childhood (a) Rickets (b) Scurvy (c) Lues Et cetera Bone and joint tumors (Primary and metastatic) Foot deformities (Etiology prevention, and treatment) Posture Scolosis (Lateral curvature of the spine) Osteomyelitis

E. PEDIATRICS

Principles and technic of infant feeding

Nose and throat infections in childhood

Essentials in the care and feeding of the newborn

The prevention and treatment of heart disease in children

F. MENTAL HYGIENE

1.

Nervous and mental hygiene of childhood Its importance. Child study In the nursery, up to 2 years The preschool period, from 2 to 6 years Nursery schools The nervous child—at home, in school, in sickness Insufficient guidance, excessive love

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Timidity and fears. Bad temper, disobedience, negativism and delinquency Want of sleep and appetite, indigestion Breath-holding, habit spasms, stammering, thumb- sucking, air-swallowing, migraine, enuresis Need of parental training Mental hygiene during adolescence Physiological changes at puberty and adolescence New problems and adjustments—sex, financial, social, occupational, career, religious, etc. The war of the generations (Children vs. Parents) The great transition stage from dependent child- hood to independent adulthood The need of guidance and confidential relations The special problems of the boy and girl The need of understanding and sympathy 3. The Psychoneuroses (functional nervous disorders) Their nature. The emotions. Mental conflicts and their causes Influence of mind on body. Anxiety and fear Types of nervous breakdown: Neurasthenia, hys- teria, obsessional neurosis, hypochondria, simple depression and excitement Proper treatment 4. Prevention of nervous and mental disorders Birth injuries. Acute infectious diseases Syphilis. Alcohol. Fatigue. Cardio-vascular- renal diseases Maladjustments: Mental hygiene of childhood and adolescence, the need of normal satisfaction of the basic human desires and of a wholesome philosophy of life Emotional control 5. Psychological healing Importance and types of same Miraculous healings; philosophic methods of treat- ment; medical moralization; suggestion and hypnotism; treatment by rest and _ isolation; psychological analysis (personality study); re- education; stimulation; pharmacotherapy; moral guidance.

G. EYE, EAR, NOSE AND THROAT

Nose and throat infections Management of ear infections Nasal sinus disease

Acute eye inflammations First aid in eye injuries

SUGGESTIONS FOR MEMBERS OF SCIENTIFIC SPEAKERS’ BUREAU

The Scientific Service Committee plans to institute a service for members of county medical societies which shall be conducted from the point of view of the consultant rather than of the teacher. The whole point and purpose is to bring to the general practi- tioner specific helps for his daily practice. For the attainment of this purpose the following suggestions should be borne in mind:

1, The paper should be non-academic. practical and specific in your remarks.

2. The history and bibliography of a given subject should occupy a relatively small proportion of the paper.

3. Talk to your audience as man to man. Many an excellent paper delivered in a patronizing manner has antagonized the audience and wasted the time of the essayist.

4. Remember that attention can be concentrated upon you and your subject in inverse proportion to the size of the audience. Every effort will be made by the

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EDITORIAL 443

committee to obtain appointments for speakers in larger towns where accommodations are better and audiences substantial, as well as in the smaller communities in which there is, perhaps, the greatest demand for this service. But from the point of view of personal appre- ciation, the essayist will do well to bring his best to the small audience.

5. Talk clearly and directly. The effective speaker before a lay audience is also the effective speaker be- fore the scientific audience. Doctors are made of the same clay as other folks—subject to the same likes and dislikes. Of two papers equally valuable, they will prefer the one whose speaker they can hear distinctly, who is familiar enough with his subject to get away from his paper frequently, who seem equally as inter- ested in their comments on his ideas as he is in getting his own ideas across.

6. The test, then, of the best paper for the purpose of this committee is that it is practical, that it is pre- sented clearly and simply, that it stimulates and in- vites discussion. It is better to start folks thinking for themselves along a given line than to give them ready-made thoughts and arbitrary judgments.

IS MEDICINE DRIFTING INTO LAY CONTROL? Rexwald Brown, in California and Western Medicine October, 1926, comments on this im- portant subject as follows:

“A doctor of medicine in active practice in a

‘well-known city takes a rather energetic interest

in the progressive development of his munici- pality. Anent his efforts the editorial columns of a prominent local newspaper assailed him in this wise: ‘When Doctor Blank received the degree of M. D. these cabalistic initials meant that he was learned in medicine and not that he was learned in municipalities. The diploma when issued meant that he was fitted to practice medicine and not that he was fitted for the man- agement of municipalities.’

“This editorial point of view is expressive of the general concept of the lay mind toward the participation of the medical profession in affairs other than those of the healing art. All too fre- quently are heard the statements that physicians do not possess the requisite knowledge in extra medical matters either to have an opinion on or take part in the general movements of concern to society at large. A corollary to this largely ac- cepted conviction is the belief that a physican who concerns himself in any direct way with activities outside his professional fold cannot be

444 ILLINOIS MEDICAL JOURNAL.

a good physician in whose judgment and skill faith can be held.

“This lay attitude indicative of some people’s contempt of or indifference to medicine’s deep relationship to all the structure of civilization should concern our profession to a degree ap- parently not fully appreciated. It is harrowing to read a paragraph in the report of a senior student to his department head, William J. Kerr, Professor of Medicine at the University of Cali- fornia. (California and Western Medicine.) Kerr is trying the experiment in medical educa- tion of apprenticing senior students to well- known practitioners in the state for a period of a month—a return to the preceptor influence. The student reported, among many impressions, the following: “An old druggist in the town said that after years of experience in this coun- try and in Europe with doctors that they have the narrowest minds . . of any profession. IIe is probably correct.”

“It would be easy to laugh off these incidents as purely Jocal in character. ‘They deserve at- tention, however, because they are straws being blown by the wind. Is the place of scientific medicine in the body politic as secure as we have thought? Have we assumed to the full our great responsibilities or are we becoming slack in thought and careless of our position as guides in civilization? Are the aims and ideals of our profession being smothered by the com- mercialism of the age?

EVIDENCE OF LAY CONTROL

“Into the fabric of society are being woven new patterns of profound import. The world seethes with startling-thoughts, impulses and re- constructive purposes in the spheres of religion, politics, economics, morals, education, and sc- Wider knowledge, to which scientific medicine has made contribution, is the dynamic

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force in social reconstruction.

“As we survey the movements in progress, a disquieting feature becomes more and more evi- dent which should concern the medical profes- sion as to its gravity. William E. Musgrave in an article of compelling interest in the issue of May 22 of the Journal of the A. M. A., ‘Is Uni- versal Life Insurance Coming?’ senses strongly the danger which insidiously begins to menace the ranks of organized scientific medicine. This menace is the Jay control of medical activities.

December, 1926

“There is a