e Still National Osteopathic Museum, Kirksville, MO

• • • • • • • •

oSTEoPATHY

Lay Members

We are proud to announce the elec­tion to our Board of the following layinclividuals:

Mr. George Powell,Cashier Baltimore Bank,

Kansas City. Mo.

i\Ir. Edgar L. Evans,E. L. Evans Printing Co.•

Kansas City, Kans

Mr. Charles J. McKinley,Vice-President, Willis & Weber

, Paper Co.,Kansas City, Mo.

Weare glad to have these prominentbusiness men, all keenly interested inOsteopathy, as associates in defining thedestines of the Kansas City College ofOsteopathy and Surgery-The Aggres~

sive College.

oSTEoPATHY

IU UI • 11. • • • • • •

"

Published Bimonthly by the

Kansas City College of Osteopathy and Surgery2105 Independence Boulevard

• KANSAS CITY, MISSOURI

Vol. 23, No.1 February, 1939

Entered as Second Cia",. Matter, April 23, 1917,at the Postoffice at KanSQs Cit)" :&-IiS80uri.under the Act of August 24,1912, as a bi-month!)·. Accepted for mQiling at special rateof postq-e provided for if. section 1103, Act of Oct. 3, 1917. Authorized Auguat, 1918.

o Still National Osteopathic Museum, Kirksville, MO

KANSAS CITY CoLLEGE OF OSTEOPATHY AND SURGERY==

OUR HOBBY-ContinuedA short while back one of our graduates spoke to the writer con­

cerning some building and loan stock that he cashed in' and asked ouradvice as to its further investment. We suggested he reinvest it in thebuilding and loan company. He said he had already tried to do so butthe company refused to accept it-lias they had more money now thanthey cared to invest."

This part of the conversation reminded us of a bit of experience wehad when the fall session opened. We desired to place $5,000.00 in asavings account at Our bank. We were informed the bank would beglad to take care of our money but would pay us no interest--they werealready paying out more money on savings accounts, at the rate of2lh% than they cared to think about. We told him of this experience.

He then asked about the Trustee's Certificates we were attempting tofloat at six per cent. We had to inform him that none had been issueddue to lack of demand but if he wished to place his investment with uswe would issue our demand note at six pel' cent to be exchanged forTrustee's Certificates "when, as, and if" issued.

A few weeks later came a check fOl' $500.00 with the promise ofmore to follow. This young man has made a gilt edged investment­not in a concern set up with profits as its primary motive, but with thepurpose of helping, without profit, in the upbuilding of the osteopathicprofession. He is taking absolutely no risk, he will receive his six percent per annum interest and his principal on demand.

He has done much, he has invested $500.00. We have done more.We have invested our very lives, our every endeavor in the strengtheningof Our Hobby, He will at his will, receive his money. We cannot recallour lives nor would we. We can wish we had a dozen' lives to give tothis-Our Hobby.

Possibly, publication of these facts may induce others to do likewise.Our personal experience in trying to build up a fortune informed us thatcommercial investments are precarious at best. We have seen our realestate drop enormously in value and finally taken into the hands of themortgage holder. We had our bonds-without exception-go intoreceivership and depreciate fifty to seventy-five per cent. We've hadour building and loan stocks pay us back sixty to seventy per cent of ourhard earned investment. How we regret now that every penny wasnot loaned 01' invested or even given to Our Hobby. It would not thenhave been lost. It would not have depreciated. It would have been assecure as Osteopathy itself.

We've learned our lesson when it is too late. But there can now beno investment offered us so alluring as to attract a dime from our pocketsagain. If we, perchance, do acquire again any of this world's goods, itis going immediately into the h'easury of Our Hobby, whe'\:e it may earnhonest interest, serve a noble purpose other than adoration of the GodMammon, where it will help to make Our Hobby greater than ever before.

That is the thought for this month.A. A. Kaiser, Secretary

Page Two

KANSAS CITY CoLLEGE OF OSTEOPATHY AND SURGERY

DR. CONLEY RESUMES HIS COLLEGEACTIVITIES

It is with pleasure that we are able to make the above announcement. Dr.Conley was taken ill May 2 last, which prevented him from finishing his school­work last session. It also made it impossible for him to ~ttend the graduatingexercises immediately following; the first occurrence of the kind since theorganization of the College in 1916.

Dr. Conley was confined to his bed, without privilege of company, for 43days and was not permitted to take on any of his professional duties for 90days. Since then he has resumed his professional activities gradually, but wasunable to fill his college assignments with the beginning of the first semesterof the present session.

'His general health has improved rapidly with the onset of the coolerweather so that now he is competent and able to take over all of his collegeand professional assignments. Beginning the second semester of the presentsession he will resume his clinics at the college, both general and surgical, asin the past and will have the Seniors and Juniors in Osteopathic Practice.

The burden of the responsibility for the operation and maintenance of theLakeside Hospital having been assumed by the lay Board of Trustees withthe cooperation of the newly formed professional staff, will allow Dr. Conleymore freedom for the pUrsuance of his college activities. Not only in a teachingcapacity in which his long years of clinical experience will prove valuable tothe students who take his practical courses, but along administrative linesas well.

He has held the office of the President of the Board of Control since theorganization of the College in 1916. He has held, and continues to hold, theChair of Surgery in the College since its inception. His duties as Presid.ent ofthe Board assume greater responsibility as plans are being formulated andmeasures perfected fOI' the endowment of the College and the expansion ofits present facilities.

The reorganization of the Lakeside Hospital permits him to give hisentire time in the furtherance of his professional activities, surgical practiceand consultations, both general osteopathic and surgical. He still maintainshis professional interest in the Lakeside Hospital, takes his hospital cases thereand affiliates with it as a member of the general and executive !taff.

He has established himself in his permanent office in Suite 212 TowerBuilding, The Country Club Plaza where, in association with R. A. Murren,D. D., he will continue the conduct of his private practice.

It is assumed that the many friends of Dr. Conley will be pleased to learnof his restoration to health and that his services are once more available, notonly in a professional capacity, but in organization work as well.

Dr. A. A. Kaiser, Secretary-----

Recently I met Dr. Conley in the hall of the College early in the morning.He was in excellent spirits and told me his program for the previous day. Hehad done two major surgical operations at the Lakeside Hospital in themorning, had attended a noon-day Chamber of Commerce luncheon hadtreated several patients osteopathically in his office, and then had retur~ed tothe Conley Clinical Hospital and performed another major surgical operation.He termed it a "bully day" and certainly looked none the worse for the busyday. Dr. R. A. Murren

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e Still National Osteopathic Museum, Kirksville, MO

KANSAS CITY COLLEGE OF OSTEOPATHY AND SURGERY KANSAS CITY CoLLEGE OF OSTEOPATHY AND SURGERY

THE OSTEOPATHIC MANAGEMENT OFHEART DISEASE

J. L. Jones, D.O., of the College Staff

That mechanical and manipulative measures influence the heart is a wellknown fact to the medical profession as shown by the following references:

Dr. Beckman in "Treatment in General Practice," p. 521, says regardingtreatment of paroxysmal tachycardia. llPressure of the vagi in the neck es­pecially the right vagus often terminates an attack by stim·ulation of theinhibitory function of this nerve" and he further states that uPressure upon theorbit is sometimes effective also!·

In "Diseases of the Chest." by Norris and Landis. p. 201, we find thesestatements. "The vagus nerve may be stimulated directly by firm fingerlJr~ssure on the carotid artery just below the angle of the jaw, or indirectlyvia the fifth nerve and the vagus center; by compression of the eye ball!· * * *"These procedures often perceptibly slow the heart rate and increase pulsevolume." "If care is not exercised in compressing the carotid immediately be­low the angle of the jaw, an increase in pulse rate may occur from irritation ofthe superior cervical sympathetic ganglion. The pulse rate may be acceleratedalso from psychi~ effects.'·

Cardiac hypertrophy may be the result of spinal deformity we are told byDr. Finley in the Can. Moo. Assn. J. of Oct. 11, 1921. And Dr. Goldthwait inBody Mechanics. p. 129, tells of curing decompensating and enlarged heartswithout the use of any drug. Dr. Goldthwait on p. 133 quotes Drs. Gunther,Garnett and others as having "Recognized a pseudo-angina from involvement ofthe vertebra nerve roots from arthritis ot' postut'al deformity."

The Osteopathic Physician is con- ed, or disease will be the result" orversant with these facts, and we are in Research and Practice, p. 183,not attempting to deny in any way (Published in 1910) by Dr. Still wethese good doctors, but let me call find this, "If the heart is weak ot'to your attention that is only a short over-active the cause will be foundstep which they need to take from to be in the nerve supply."heart disease to disease in general. Yale Castlio, D.O. in "Principles ofWe would like to ask these good doc- Osteopathy," p. 74, says in speakingtors why they do not give credit of lesions of the 4-5-6 Cervical verte­where credit is due for Dr. A. T. Still bra HCardiac arythmia is not uncom­was teaching this sixty years ago, mon," and again on p. 84 he says,and by right of discovery would be "Second thoracic lesions induce as­given credit for his work. thenia and increases excitability of the

In the book, "The Failing Heart of cardiac muscle." On p. 117 he says,Middle Life," p. 13, by Hyman and "Upper thoracic lesions are likely toParsonett we find this statement, make normal function impossible and"It is a well recognized fact that the progressively weaken the myocar­functional integrity of any organ dium.JJ

depends upon the maintenance of a The Osteopathic Profession notnormal and sufficient blood supply. only recognizes the pathology of theThis is particularly true of the lesion but also has a definite theoryheart/' This also sounds like these as to the cause of disease and aauthors had been reading some· of logical therapy for the cure. In boththe works of Dr. Still, who said in of these we are far ahead of the old1874, uThe rule of the artery must school of medicine which only in abe absolute, universal and unobstruct- minor way recognizes the lesion as

Pa~e Fou,.

the cause of disease, and is ·afraid toadmit that the con-ection of thelesions will cure disease. For it goeswithout saying that if old schoolpractitioners admit this it wouldautomatically destroy all their oldbeliefs and give credit to the Osteo­pathic profession for something whichthey have tried to destroy by fairmeans and foul politics, slander andridicule.

It seems necessary from the Osteo­pathic and Medical evidence to acceptthe fact that lesions in the spine willcause heart disease: it further seemsnecessary. upon the same eVldence,to assume that the correction of thelesion by whatever name you call it(lesion. body mechanics, spinal de­formity or arthritis) will affect theheart for good. That it then becomesnecessary i.n caring for heart diseasepatients to go back to original Osteo­pathic principles and correct tht..lesions.

Rest is the one great therapeutJ("measure at our command. It takes5% more energy to sit up in bet!than it requires to lie down, and thepulse rate of the patient in bed isabout 5 beats slower than if in thp.upright position. This seems smallbut will total up to about 7,000 beatseach 24 hI'S. and it is a well recog­nized fact that all extra beats of theheart take place at the expense ofthe rest periods of the heart, whichnormally total about 13 hrl). a day.

The modern physician also musttake cognizance of the effect ofscientific diet upon his patient. Wecannot .say. "Stuff a cold and starvea fever;· for we know a cold shouldnot be sttiffed for it is a fever diseaseand a fever should not be starved.It is possible that one of the reasonsfor such a large percentage of thepopulation of today are found to beheart cases is due to the fact of themtsconception in the past on the partof the physician and the laity inregard to the diet. T·he patient witha fever has a higher metabolic rate

than in health. so will require agreater caloric intake in sicknessthan in health. In fever diseases itis co~mo~ for the patient to developan aCIdOSIS and the heart will notstand a change in the pH as well asthe skeletal muscle so will suffer firstand most.

Best and Taylor in their book"Physiological Basis of Medical Prac~tice," p. 246. have shown that theheart muscle is seriously damaged bya 0.07 concentration of lactic acidwhile the skeletal muscle will con­tinue to respond even with a concen­tration of 0.2. Dr. Osborne. M.D.,of Yale says. "Carbohydrate starva­tion is inexcusable with our presentunderstanding of the danget' fromacidemia." Protein foods should beconsumed in quantities from 40-100grams to meet the daily requirementand if your food does not contain

. sufficient protein the body muscula­ture including the heart muscle willbe called upon to furnish it. It istrue that muscle and the solid partsof. the body requires very little pl'O­tem to replace their daily wear andte~r but the blood corpuscles arebemg destroyed in great number andmust be replaced by new, young,healthy cells chiefly composed ofprotein.

Other essential food elements to beconsidered are the vitamins and min­erals. The principle minerals to beconsidered in heart facts are thesodium. calcium. and potassium whichmust be present in the blood for theheart to function. And the vitaminsto be considered are A.B.C. A. is thea~ti-infectious vitamin and deficiencyWill lower body resistance to infec­tion; lack of B. indues cardiac dis­function and causes muscular weak­ness of the heart and a deficiency ofVitamin C will cause shortness ofbreath, rapid heart action, and rapidbreathing.

The proper diet for the sick patientshould be largely composed of milkfruit juices, fruit, honey, sugars of

P.ge Five

til Still National Osteopathic Museum, Kirksville, MO

KANSAS CITY COLLEGE OF OSTEOPATHY AND SURGERY KANSAS CITY COLLEGE OF OSTEOPATHY AND SURGERY

various kinds, cereals, eggs, brothsand soups. The feedings should besufficiently frequent to give thepatient the necessary caloric require­ment of both carbohydrate and pro­tein foods.

Drugs are of no great value inheart cases. There is no known drugyet devised which will improve thecondition of scarred 'heart valves andwe find in Tice's Practice Vol. 5 p. 88under treatment of sub-acute bactct'ialendocarditis this statement, "There isno specific or even recognized treat­ment of acute endocarditis." •••"As far as can be determined alltherapeutic efforts and attempts ofvarious kinds are simply useless orfutile."

Digitalis is not a cure for heartdisease of any kind but may act forgood in some types of heart diseaseby slowing the rate and thereby giv­ing the muscle more rest.

Other digitalis-like drugs we aretold by Dr. White of Harvard Med.School in, 'IHeart Disease," p. 526-8are, uinferior to digitalis in effective­ness and reliability-and all other so­called stimulants, if active at all, pro­duce an effect not directly on theheart but on the nervouS system, bloodvessels or other tissues; none of themcan in any way take the nlace ofdigitalis. These drugs include strych­nine, camphor, caffine, theobromine,spartine, physostigmine, crataegus,cardiazol, coramine, aconitine andcactus."

When the heart muscle begins tofail treatment must be directed to­ward restoring cardiac function re­gardless of the type of lesion respon­sible for decompensation. After com­pensation is re-established it is thentime to consider the original cause,i.e., infected tonsils, rheumatism,syphilis, hypertention, etc.

The most important single factorin restoring cardiac function is REST(both mental and physical). Impressupon the patient that his chief busi­ness now is to get well. He must

Page Six

obey orders or die, there is no halfway treatment in decompensation ofthe heart. Explain to the patient thatrest in bed (sitting up if necessary)will save the heart on the average ofabout 25,000 beats a day. No bathroom privileges are extended andmeals are to be taken in bed-thepatient is not to get out of bed for

•any cause.Sometimes it is advisable to post~

pone the beginning of the treatmentfor a day or two to give the patientan opportunity to prepare his busi­ness affairs so that they will not bea source of worry any more thannecessary. The rigidness of the rest,the length of time it must be enduredand the period of l'elaxation of suchrest will depend entirely upon eachpatient, so no set rule can beestablished.

The nurse should be agreeable aswell as efficient, visitors should berestricted to a minimum or eliminat­ed. All food, medicine, treatmentand visitors should be during the daytime, the nights being devoted torest and sleep.

The old style practice of vigorouscathartics to remove edema is outgrown. It is permissable to give1.1:2.0Z. of saturated epsom salts solu­tion in the morning before any foodis taken; this is enough to be mildlycathartic and will remove some fluid,but is not drastic enough to distw'bthe patient by excessive elimination.In fact, it is of little importance evenif the bowels move only every otherday. At any rate purging is toodrastic and alters the edematous con­dition too little to wal'1'ant its use.Diuretics are generally valueless-incongestive heart failures and if digi­talis is used it will serve the purpose.Hydrotherapy is of value in cleans­ing the skin, and improving the ~ir­

culation, warm baths are good forimproving the peripheral circulation.

Massage is appreciated by the pa­tient as is the Osteopathic treatment;both will improve the venous return

circulation and promote lymphaticdrainage.

The mildest sedative that is ef­fective is the best for the particularpatient and in the beginning it issometimes advisable to begin with asmall dose of morphine. This shouldbe diminished so that within threedays a sedative by mouth will sufficesuch as lO-lv-gr. sodium bromide, Ilf2­gr. of phenobarbital, El. Alurate Oz.1 to 3; or I5-gr. chloral hydl'ate bymouth or rectum.

When all is considered we can sumUP the treatment of the heart in afew words:

Medicine outside of digitalis is oflittle or no value. Digitalis is usefulto help slow and strengthen the heartbeat in such cases as auricular fibril­lation and decompensation.

It is agreed by M.D.'s and D,O.'sthat faulty mechanics will cause heartdisfunction and the Osteopathy Phy­sician has something to do about it.Rest is the most important factor intreating heart disease, The patientshould receive a nutritious easilydigested diet containing all the foodelements; proteins, carbohydrates,fats, vitamins and minerals.

That cathartics are not advisablein cardiac disease.

,Dr. Still was the first to discoverthat mechanical malpositions of thebody would cause disease and thatthe correction of the lesions will curemany of them.

(The above paper was deliveredbefore the Missouri State Conventionon October 12th hy Dr. J. L. Jones.)

W. McKim Man-iott, M. D. says,(Recent Advances in Chemistry inRelation to Medical Practice) "Inplanning a diet a reasonable amountof milk, butter, green vegetables andcereals should be included, and whenthis is done, we need have no fears ofvitamin deficiency. Vitamines shouldbe bought at the grocery store andnot at the drug store."

ADVANCEDPOST-GRADUATE

INSTRUCTIONDr. A. B. Crites and assist­

ants of the College staff areagain offering an intensivecourse in operative surgery onthe eye, ear, nose, and throatthe last week of February, 1939.Each student will perform thevarious operations upon the ca­da Vel' under supervision. Theentire gamut of nasal and sinusSUl'gery wiII be run, 3tl'cssingreconstruction of the turbinates,submucous resection, the in­tranasal technique for frontals,ethmoids, sphenoids, and antradone under flaps and withoutmucous membrane or turbinatedestruction. The operation andelementary nasal plastic proce­dures will be demonstrated.

Dissection from a practicalsurgical standpoint of the neckand entire head will clarify andcrystallize the knowledge of theanatomy of the parts. Mastoid,radical, complications, Hinsberglabyrinth and Neumann apexoperations together with eyesurgery will be done.

To satisfy repeated requestsfor such work, this course is of­fered to those who have beendoing specialty work and wishto acquire the newer things intechnique. The college dissec­tion room will be used, thefacilities of the clinical hospitalwill be available and the classwill be strictly limited. Furtherinformation will gladly be fur­nished on request.

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C Still National Osteopathic Museum, Kirksville, MO

KANSAS CITY CoLLEGE OF OSTEOPATHY AND SURGERY KANSAS CITY CoLLEGE OF OSTEOPATHY AND SURGERY

George J. Conley, D.O.. of the College Staff

Clinical Observations of the Effect of Lesions ofTHE LUMBO-SACROILIAC AREA AS ETIOLOGI­

CAL FACTORS IN PELVIC PATHOLOGIES

It is the purpose of this article tocaIl attention in a specific way tocertain effects produced by lesions ofthe lumbo-sacro-iliac area for whichthe average gynecologist or genito­urinary specialist can find no ap­preciable explanation and which mayvaguely be ascribed by them toendocrine dysfunction, psychical man­ifestations, constitutional disturb­ances, leucorrheal diathesis and num­erous others.

It is in such cases that the special­ist or the general practitioner search­es vainly with the Hinstruments ofprecision" at his command for evi­dences of a pathology, visual or other­wise, that will account for thetroublesome and oftentimes alarmingsymptoms for which the complainingpatient consults him for relief.Among the cases that I have in mind,which are frequently encountered bythe general practitioner, are persistentleucon-hea or a spontaneous type ofinexplicable origin, vaginismus,vaginitis, essential hemorrhage ofthe womb, cystitis, hematuria, renalor ureteral spasm or colic and proc­titis. There are others but these aresufficient for the purpose in mind.

In all these cases no definite patho­logical findings are forth coming fromthe use of the various diagnosticgadgets which are usually the firstthought in the minds of the thorough­ly up-to-the-minute specialists orwouldbe aspirants thereto. As a re~

suIt, after much of examination ef­fort, the patient is subjected to around of experimental treatmentswhich run the gamut from local ap­plications and douches, the variousmodalities of heat, light, electricity,vitamin deficiency, endocrine im­balance and surgery, the end resultbeing, at best, temporary improve-

Pa~Elght

ment or failure. Understand, now, Iam speaking of cases inexplicable tothe medical specialist and far toooften concurred in by the osteopathicspecialist. Let me say here and nowthere is a grave tendency on the partof specialists of the osteopathicschool of practice to accept the dictumof medical specialists as absolute andfollow their recommendations andtreatments ad seriatim. Far toooften the osteopathic concept as anaetiological factor is overlooked orignored to the detriment of thepatient and the confusion of thedoctor.

Naturally in the examination of thepatient a sequential case history isthe first and oftentimes the most im­portant factor and this, supplementedwith a careful physical examinationby one trained to reason from causeto effect in terms of applied anatomyand physiology, will suffice to givethe clue to the offending pathology.If at this time amplification of thefindings of the case history and physi­cal examination is indicated, then re­course can be had to the X-ray, thetest tube, the microscope and other"instruments of precision." Primaryreliance, as a rule, however, must bevested in the case history and thephysical examination. Osteopathicphysicians and surgeons should al­ways adhere to this method of pro­cedure, regardless of medical dictumas to aetiology.

Briefly let us consider the nervesupply to the plevis, to the end thatthe influence of the lesions of thelumbo-sacro-i1iac area upon the pelvicviscera, may be evaluated. Thesacral plexus of nerves (the largestnerve plexus in the body) is made uplargely of the 5th lumbar and .the1st and 2nd sacral nerves. It is

closely connected with the hypo­gastric plexus of the sympatheticwhich lies immediately in front ofthe 5th lumbar and the sacral promi­tory. Both these plexuses have strongconnections with the pudendal plexus,one of whose branches, the pudendalnerve, reaches the rectum, the base ofthe bladder and the vagina. uThepelvic portion of the hypogastricplexus lies close beside the rectumupon the pelvic surface of the levatorani, close to the vagina in the femaleand on the fundus of the bladder inthe male. Together with the pudendalplexus it forms a number of smanerplexuses: the middle hemorrhoidalplexus on the rectum, the prostaticplexus on the prostate, the large uterovaginal plexus especially well de­veloped on the lateral border of thecervix uteri, the vesicle plexus on thebladder and the cavernous plexus."(Sabotta and McMurich.)

Leucorrhea may be precipitated bylesions in this area. Any irritationto the sacral plexus of nerves react­ing through its connections with thehypogastric and pudendal plexusescan influence the vagina or the en­tire womb, particularly the cervicalportion: giving rise to congestions,either acute or chronic, which mani­fest as leucorrhea. True this factoris not mentioned in medical works ongynecology, but the fact remains thatcorrection of such lesions is followedby surprising results in so-called "es­sential" conditions. By "essential" Imean inexplicable on any knownpathological findings of medicalorigin. In my own experience I haverelieved many cases by the simpleexpedient of relieving a lumbo-sacrallesion or a twisted innominate on thesacrum.

An old patient of mine from anearby village came to me one daycomplaining of a severe purulentleukorrhea of nearly two years stand­ing. She told me she had gone toanother osteopathic physician fortreatment Hbecause my prices were

too high!' She had had doucheslocal applications of various sorts~lights and various modifications ofheat treatments (administered by theoffice assistant). My examinationrevealed no causative pathology local­ly. There was deep congestion of thevaginal mucosa but no apparentreason. The history revealed a fallsome two years previously whereinshe hurt her back in an area corres­ponding to the lumbo-sacral articula­tion. Examination revealed a pelvistwisted on the spine, accompaniedwith heavy muscular contractions andsevere pain. The lesion was reduced.She was asked to return in three daysfor a check-up examination. Noother treatment of any kind was ad­vised as the effect of the reductionof the lesions was to be noted.Imagine my surprise as well as herpleasure when she reported the ces­sation of the persistent vaginal dis­charge together with disappearanceof the lumbo-sacral pain. I saw heragain within a week with completesubsidence of symptons. An intervalof three years elapsed before con­tacting her again. She came on adifferent mission, but questioning re­vealed freedom from the troublesomesymptons. Examination at that laterdate confirmed and showed normalrelationship in the' lumbo-sacralarticulation. This case is but one ofmany which yielded to the reductionof lesions of the nature referred to.I am simply calling attention to acommon condition which may act asa stumbling block to unsuspectingosteopathic physicians when confront­ed with such cases.

Again, a case of so-called essentialhemorrhage from the womb in as­sociation with a lumbo-sacral lesionand with absence of any detectableuterine pathology. Reduction of thelesion followed with adequate subse­quent observation, demonstrated thecessation of the troublesome condi­tion permanently. Under old schoolmethods the X-ray would be used and

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e Still National Osteopathic Museum, Kirksville, MO

KANSAS CITY COLLEGE OF OSTEOPATHY AND SURGERY KANSAS CITY CoLLEGE OF OSTEOPATHY AND SURC:E:llY

Remember the time-April 19 to 22, incIusjve.

ANNUAL CHILD HEALTH CONFERENCE

The place, Hotel Kansas Citian,

We will be seeing you ther'C.

The Annual Child Health Conference, which is sponsored by the

Kansas City Society of Osteopathic Physicians and Surgeons, will be held

April 19 to 22, inclusive. This is ten days after Easter which is an ideal

time.

Two-thirds to three-fourths of thesimple gastric ulcers can be curedor glreatly benefitted by proper pallia­tive treatment. All early and un­complicated cases should be given theadvantage of such treatment.

The presence of aJ;eas of pain as­sociated with muscular contractionsabout one inch to the left of the 9th,10th, 11th and 12th dorsal spines issignificant of the presence of gastric01' duodenal ulcers. Com'ection ofvertebral lesions in this area shouldalways be the major factor in thepalliative treatment of such ulcers.Even after surgical interference suchcon-ection is not only indicated but isimperative.

patient. Far too often is the phy­sician inclined to assume a complacentattitude in the fact that the successfulcorrection of pathology by surgicalmeans is all sufficient and that thereis nothing left for him to do.

of the cervix uteri and the perineum,the reduction of the les"ion, if present,palliates as a rule. The lesion tendsto recur. Particularly is this trueif the secondary effects of the lesionbecome so deeply entrenched thatnature is unable to repair the damage-in which event primary recourse tosurgery must be resorted to beforesuccessful reduction of the lesionscan be accomplished.

As a corollary-when surgery forsuch secondary conditions is complet­ed, then of necessity the primarylesions must be corrected before youcan assure the patient permanent re­lief from all the disagreeable symp­toms. If a pain persists in the pelvisfollowing a hysterectomy for uterinefibrosis or a huge fibroid with lesionsof the pelvic girdle present, don'tfollow the trend of the surgeons ofthe medical school and say, "adhes­ions" and advise further surgery.Remember your osteopathy, correctthe lesion and send home a grateful

Dr. Leo Wagner of Philadelphia will be our guest speaker on the

regular program. We are indeed fortunate to be able to announce that

Dr. Arthur Allen has promised to be with us as speaker at the Grand

Banquet on Friday evening, April 20. We hope to have 500 people atthis banquet.

Due to the fact that the Baltimore Hotel is closed for alterations,

we will hold the Child Health Conference this year on the Roof Garden

of the Continental Hotel (Continental Hotel was formerly the Hotel

Kansas Citian).

across the tongue of his wagon in arunaway. The team was running ina large circle with the result that thehorse on the inner side struck hiships every leap. He noticed pain inthe lower reaches of his back and inthe right inguinal area. A littlelater an intractable cystitis developed.He was cystoscoped by an outstand­ing urologist of our city with nega­tive findings. Later on an enterpris­ing surgeon concluded his symptomswere due to a chl'onic appendicitis.An appendectomy was done with norelief. In his search for l'elief heencountel'ed another surgeon whopostulated a hidden hernia on theright side and an operation to relievewas done. The symptoms still per­sisted. Then he journeyed to a notedclinic and after a most painstakingexamination by competent specialistswas told there was nothing the mat­ter, that he had a "nervous" bladderand to go home and forget it. As alast resort he came to the LakesideHospital where physical examinationrevealed a badly t,\'isted lumbo-sacralarticulation with much pain and heavymuscular contractions. The lesionwas reduced, the symptons disap­peared and, altho under observationfor several weeks, there was no l'e­currence.

Those tenesmic pains in the rectumwithout adequate pathological founda­tion, but accompanied with deep con­gestion of the rectal mucosa, in as­sociation with lesions of the pelvicgirdle particularly the lumbo-sacral,are usually relieved permanently byreduction of the lesion.

M.ore could be written in the way ofciting experiences corroborative ofthe influence of these lesions, hutenough has been mentioned to callthe attention to their' fa)' reachingand oftentimes cataclysmic effects.

One thing more must be mentioned:in the presence of demonstrable path­ology of organic nature-such as hem­orrhoids, pus tubes, uterine displace­ments, chronic gonorrhea, lacerations

if it failed then hysterectomy wouldbe resorted to. The same line ofreasoning is applicable to the disturb­ances of the menstrual flow in theabsence of detectable pathology.

Severe cases of vaginismus havebeen relieved permanently by givingattention to the lesions of the plevicgirdle and seeing to it that they werecorrected.

A lady was packing up prepara­tory to a change of residence. It fellher lot to pack several barrels withdishes, etc. After a long hard day ofpacking and unpacking barrels andboxes she finally had to give up andtake to her bed on account of severelumbo-sacral pain. Some time latershe went to the toilet to evacuate thebladder and was greatly alarmed tofind that she had suffered a copioushemorrhage from the bladder ac­companied with a very definite urgeto urinate at frequent intervalsthereafter, always passing blood. Inthose days the use of the cystoscopewas limited as only specialists ofknown repute made use of such aninstrument and the price was out ofthe reach of one in modest circum­stances. The pain being the im­mediately annoying factor, I founda lumbo-sacral lesion which was cor­rected. Then I decided to await de­velopments before proceeding further.The bladder pain and the urge tourinate subsided and with it thehematuria disappeared. I made amental note of it. Later on I foundanother case giving me a similarh1story, but with more fortunatefinancial conditions. A cystoscopicexamination was made but no definitepathological findin~s were noted ex­cept extreme congestion, most markedabout the base of the bladder. Insuch an event the expectant plan oftreatment was adopted. The lumbo­sacral lesion was reduced with noother treatment l'ecommended. Theimmediate result was cessation of alluntoward symptoms.

Another case, a farmer was thrown

Pallt" Eleven

C Still National Osteopathic Museum, Kirksville, MO

KANSAS CITY ('-aLLEGE OF OSTEOPATHY AND SURGERYKANSAS CITY CoLLEGE OF OSTEOPATHY AND SURGERY

L. J. Graham, D. O. and C. A. Povlovich, O. 0., of the College StaffCASE REPORT: RENAL ADENOCARCINOMA

Present History: Patient, A. H.male 56 years, on admission to thehospital' complained of weakness anda loss of 26 pounds in weight in thepast six months, persistent presenceof blood in the urine, the patientstated that the first hematuria datedto about 4 ,months previous entranceto the hospital, intermittent in char­acter, but occasional attacks werehemorrhagic in severity. At timeswould pass several clots, the lastsevere hematuria occurred fourteendays before admission. Since thattime the urine cleared up, until thepresent attack, which was more severethan any previous attacks, the patientbecame alarmed and came to the hos­pital. At no time was there ever anypain accompanying these attacks ofhematuria. In the past five or sixmonths, the patient had noticed thathe had been losing weight, and tiredeasily on the slightest exertion.

Physical Examination and PastHistory: The patient stated that hehad had mumps, measles, whooping­cough, in the influenza epidemic dur­ing the World war had influenza, fol­lowed by an attack of pleurisy, whichlasted for about four months, therewas no diagnosis that this pleurisywas tuberculosis as there were noother symptoms suggesting it. His­tory of any Gastro-intestinal distur­bances was negative, Genito-Urinary,negative up to the present onset ofhis illness. Vehel'eal diseases denied.

The patient on physical examina­tion showed a well-nourished and mus­cular individual, but who showed someevidence of recent loss of weight. Theeye, ear, nose and throat were nega­tive, orally the patient was wearingartificial dentures. The chest wasnormal. the heart negative, bloodpressure, Systolic, 155, diastolic 100,the abdomen was moderately tenderto oalpation over its entire area, inthe left upper quadrant was a pal-Pa~e '1'v..el.:e

pable rounded mass, which was mov­able on deep palpation. Prostate ap­peared negative, as did the externalgenitalia. Laboratory report: KahnReaction, negative. Erythrocytes,4,100,000 with 10 grams hemoglobin.Leukocytes, 14,200 with 78 % neu­trophilic leukocytes. Urinalysis, nocasts, large amount of blood cells.Phenolsulphonphthalein out-put intwo hours, 50%. Roentgen-ray find­ings showed a normal right kidney,the left kidney showed a filling de­fect, which was thought to be due toa kidney tumor.

\Vith the above present history,laboratory and roentgenologist find­ings a tentative diagnosis of left kid­ney tumor, in all probability carcino­matous type.

The patient was prepared for opera­tion with a liberal supply of glucoseper orum, in the following formula,which was first advocated by one ofthe authors, (CAP), glucose or karosyrup 15 teaspoonfuls, juice of 2 largeoranges, % teaspoonful sodium chlor.ide, qsad; tap water 1 quart, thissupplies the necessary carbohydrates,water and sodium chloride to combatthe dehydration post-operatively.

The immediate pre-operative ordersare as follows.

Prepare patient for left lumbar in­cision. Saline enema at bedtime, re­peat enema following A. 'M. Nem.butal 1% grains at bedtime, repeatNembutal at 5:30 next A. M. Mor­phine Sulphate %. grain, AtropineSulphate 1-150 grain at 6:20 A. M. tosurgery at 7:30 A. M.

The von Bergmann oblique lumbarincision is made by one of the authors(LJG), it begins at the lateral borderof the sacrospinalis muscle at thecostovertebral angle, a little abovethe twelfth rib. The incision is car­ried downward and forward (mesial~

ly), midway between the last rib andthe crest of the ilium, the fascia cov-

ering the sacrospinalis is now dividedfrom without inward, next comes thelatissimus dorsi, then the external andinternal oblique muscles down to theaponeurosis of the transversalis mus­cle, now dividing the aponeurosis theperirenal fat protrudes into the in­cision, the lower pole of the kidney isnow palpated. Difficulties are en­countered by firm adhesions to thecolon, w-hich had to be separated fromthe kidney, the kidney was large witha short pedicle. The tumor massappeared to occupy the upper pole ex­tending almost down to the lowerpole. In order to gain additional ex­posure at this stage of the operation,the twelfth rib was freed in its pos­terior portion upward and backwardnearly to the articulation of the ribwith the transverse process of thetwelfth dorsal vertebra. This alloweda better exposure of the kidney, sinceit was difficult to bring it up intothe incision because of the short pedi­cle, the pedicle was grasped with alarge curved nephrectomy clamp,another is now placed into position,and the pedicle is divided close tothe kidney, the kidney is now out ofthe way allowing better access to thepedicle. One ligature is applied to thepedicle on the proximal (aortic) sideof the more deeply applied forceps andthen the forceps is slowly removed.This leaves one forceps attached tothe pedicle. A second ligature is nowapplied, by transfixion, then the secondforceps is now removed. No bleed­ing in the field of operation, the in­cision is ready to close. Two cigarettedrains are placed near the pedicle andare allowed to project from the pos­terior part of the incision, the trans­versalis fascia is now closed withcontinuous suture using No.2, plaincatgut suture, the muscles are nowbrought together with interruptedmattress sutur.es. The deep fascia isnow closed with continuous No.2 plaincatgut suture. Skin clips were usedto approximate the skin edges, whichwill be removed on the sixth day. At

this time the anesthetist reports thepatient's condition excellent, theanesthesia used was induction withethyl chloride, then changing over toether inhalation.

The immediate post-operative ordel'swere as follows: Physiologic saline1000cc by hypodermoclysis, statim,Glucose 20% 500cc by Venoclysis at6:00 P. M. then repeat Glucose andSaline P.R.N.

Gross pathological report: A largekidney measuring 15x12x5 em. thetumor mass appeared partially en­capsulated and sharply demarcatedfrom the surrounding kidney structureof the cortex, it showed invasion intothe pelvis of the kidney, with somecompression of the calyces. On sectionthrough the kidney it showed a yel­lowish-white mass with some areasof hemorrhagic necrosis. No appar­ent invasion of the blood vessels wasfound. The gross picture was one ofa variegated appearance, which istypical of so called hypernephroma orrenal adenocarcinoma.

Histopathological m i c r 0 s cop icdescription of a section through thekidney tumor.

This showed a neo-plastic tissuewith an attempt at the formation ofglandular tissue, the cells were va­cuolated, rather large and rounded.The stroma is scanty and delicate, thetissue was highly vascularized, thisprobably accounts for the tendencyto frequent homorrhage into the tu­mor, and hematuria. This is a typicalexample of the so-called "clear-cell"type of adenocarcinoma (hyperneph­roma), there was no line of demarca­tion between the tumor and sun.·oud­ing kidney tissue.

The patient made an uneventful re­covery and was discharged greatlyimproved. Unable to follow up thiscase as the patient moved out of thecity, the prognosis in this type of tu­mor is very poor owing to the tend­ency of metastases through the blood,yet there are cases on record of no re­currence following early removal.

Page Thirteen

© Still National Osteopathic Museum, Kirksville. MO

KANSAS CITY COLLEGE OF OSTEOPATHY AND SURGERYKANSAS CITY COLLEGE OF OSTEOPATHY AND SURGERY

BENIGN CYSTADENOMA RIGHT OVARYCLINIC AT CONLEY CLINICAL HOSPITALHOME-COMING WEEK. NOVEMBER. 1938

George J Conley, D.O., of the College Staff

The patient, a married lady aged66 years, came to the clinic complain­ing of an enlargement in h~r abdo­men which she first noticed severalyears ago. It was painless, causedno discomfort in the early years ofits presence, and which increased insize slowly. At first the enlargementwas near the median line and justabove the symphysis pubis. Some fivemonths ago, as a result of the gradualenlargement, she experienced a feel­ing of weight and discomfort, asthough her abdominal organs were be­ing crowded. She feels as thoughshe were pregnant and experiencesdiscomfort when she walks. She alsocomplains of heart burn although onquestioning this symptom has beenannoying since her first pregnancysome 15 years ago. She complains ofpressure on the bladder.

Her familial history is negativ~while the early childhood history isuneventful. Her menstrual epoch isnormal. She was married at 21 yeal·s.Has had two pregnancies with onenormal delivery, the first stillborn andthe other a hard instrumental delivery.

In the laboratory the urinalysis wasnegative, the blood showed 84 % hemo­globin, 2,600,000 erythrocytes and5,650 leukocytes. The systolic pres­sure was 150, diastolic 75.

The physical examination revealsnothing of importance, except theenlargement in the abdomen whichextends upward ',;0 the level oi thenavel, occupies all the right abdo­men and intrudes upon the left sideahout two inches. It is smooth inoutline, tense and is fl'eely movable.On percussion the impulse is trans­mitted distinctly to the finger on theopposite side indicating fluid contents.The marked cil'cumscription of the en­largement is indicative of a cyst. The

Page Fourteen

bimanual vaginal examination revealsa tense, definitely outlined mass oc­cupying the entire right broad liga­ment area filling the culdesac and ex­tending to the left across the medianline. It crowds down from above ina manner which makes prohibitive anyattempt to outline the uterus. To theexamining finger the mass is fl~id incharacter. Rectal examination con~

firms the vaginal. I must make anunequivocal diagnosis of a right ovar~

ian cyst.Were this patient twenty years

younger T would go farther with myexamination by insisting upon x~ray

exposure and the rabbit test to ex­clude the possibility of a pregnancy.In this instance the presence of agrowth recognized by the patient cov­ering a period of years might bejudged as sufficient evidence to eli­minate a possible pregnancy.

Again the absence of the classicalsymptoms significant of pregnancyshould be additional grounds againstsuch a possibility. This may all betrue and y'et the fact that the en­largement was marked in the lastfive months might stilI be viewed withsuspicion as a possible pregnancy incomplication with a known ovariancyst. Also one must ever hear in mindthe fact that women in the childbear­ing period have been known to per­vert the facts which may get the diag­nostician in a jam. Although thepatient is 66 years of age it must beremembered, as cited in the "Book ofTruth/' that Sarah in her ninetiethyear conceived and presented Isaac(in his one hundredth year) a son andheir. We may have approached themiIlenium sufficiently, that occasion­ally men will be men and women bewomen, as in the good old days.

Our anaesthetic, which is the

"HMG--Chloroform Sequence," iscomplete under the watchful care ofDr. GIlhof!, one of our interns, andwe are ready to cut down on ourdiagnosis. At this time I am re­minded of a funny incident which oc­curred years ago before the x-raylaboratory test for pregnancy. Ayoung married lady who had had amenstrual history remarkable for itslong intervals between periods (from6 months to 18 months) was takenwith a painless persistent vomiting.She consulted an outstanding stomachspecialist who, after getting the casehistory, made a diagnosig of nervousvomiting and gave treatment calcu~

lated to correct. He failed. Shehunted up another specialist who madea similar diagnosi·s with failure toalleviate. A third was consulted withthe inevitahle failure. Then she con­sulted an osteopathic physician who,taking into consideration the standingof the specialists already consulted,accepted their diagnosis, treated, her,and after ex:hausting all his resources,in desperation called me in consulta­tion, Examination, bimanually, reveal­ed a womb symmetricaIly enlargedwith its cervix soft to the touch ofthe examining fin-gel'. She had vo­mited so long that her condition wasgrave. A diagnosis of Hpe1'lliciousvomiting- in pregnancy" was made anda therapeutic abortion recommended.This was laughed at and the aforesaidspecialists again were called in.Naturally they used every argumentat their command to prove that I, anosteopathic physician, was wrong.They continued their palIiativQo mea­sures without successful relief. Whenthe patient was suffering six to eightfainting spells a day I was calledagain by phone to see the patient."Send her to-hospital so that shemay be prepared for the operation, orcall someone else." T said. Theysaid they would call the ambulance atonce, When she was in the operatingroom under the anaesthetic and every­thing ready to begin the operation,

the referring osteopathic physician,who was present, tapped me on theshoulder and motioned me over to themost remote corner of the operat.ingroom. He had experienced for thefirst time the responsihility of "cut_ting down on a diagnosis." He saidto me in a suppressed whisper, "Doc­tor, what in the world wiII we do ifit isn't that?" So this morning I amcutting down on this diagnosis with­out any such fears,

You will note the perfect conditionof the patient as a result of Dr. Oll~

hoff's efforts with the anaesthetic.We will make the incision a trifle tothe right of the midline so that wecan avoid the navel. The incision ex­tends from the symphysis pubis to aninch above the navel. As I enter theperitoneal cavity free fluid was in evi­dence. It was a light amber colorwith no evidence of blood. Just whatsignificance can be drawn from thisfact? It is one of Nature's methodsof telling us that this growth is notmalignant. The rule is that malig­nancy in the abdominal cavity, if ac­comp'anied with ascites in any quan­tity, wiII be bloody or blood tinged.

The growth presents itself. It isa cyst of the right ovary. Here weI!over on the outer aspect of the cystis the remains of the ovarian struc­ture. It is thickened, hard and some­what irregular in development, sug­gestive of a malignant growth. Aswe raise the cyst out of the abdominalcavity a thin portion of its wall rup­tured and chocolate-colored, fluid con­tent escaped. Now we can see ·theuterus below. There aloe several fi­broids presenting so we have a condi­tion of multiple fihroids, in addition,with which to contend. A subtotalhysterectomy will be necessary. Asboth the tube and the ovary on theright side have been distorted and theovary destroyed we must be sure, be­fore clamping off the broad ligamenton that side, that the womb has notbeen rotated to the right, drawing thebladder around with it. It is very easy

Page Fifteen

e Still National Osteopathic Museum, Kirksville, MO

KANSAS CITY COLLEGE OF OSTEOPATHY AND SURGERY KANSAS'CITY CoLLEGE OF OSTEOPATHY AND SURGERY

Mabel Andersen. D.O., of the College Staff

MELANOSIS PROCTOCOLIto make such an error. It is morethan easy to cut the whole back out ofthe bladder. If this should be ligatedas tho' it were the broad ligamentpedicle, a disastrous result would en­sue. If it should be cut and then rec­ognized, a difficult and troublesomecomplication would be added to an al­ready big job. I will remove thecyst first, which will render visualiza­tion of the structures of the uterusand its adnexa, together with con­tiguous structures, more thorough.

The orientation of the uterus andthe positive location of the bladder isassured by the normal relationship ofthe tubes and round ligaments to theuterus. There is no difficulty in theidentification of the various structuresand no technical hazards in the re­section of the uterus. The cervix willnot be disturbed. All raw surfacesare peritonealized and the belly isclosed without damage. Dl'. Ollhoffreports the pulse and respiratory rateof the patient as normal with theskin dry and pink, surely an idealcondition for the patient after anoperation of this magnitude.

Now we will examine the cyst. Hereis the base of the original ovary. Itfeels thick, hard and irregular, so wewill open the cyst and examine itscontents and its wall. An area ofabout four inches in diameter aroundthe ovarian base is covered complete­ly with a cauliflower-like growth fromone-half of one to one inch in thick­ness. There are other smaller areason the cyst wall producing a similaroutgrowth. While it gives a suspiciousappearance to the eye suggestingmalignancy the contained fluid, aswell as the ascitic fluid free in theabdomen, is not blood tinged, whichargues against malignancy. We willhave this growth sectioned, a biopsy.No matter what the findings of themicroscope prove to be I have doneall that can be done from the surgicalviewpoint to protect this patient's fu­ture, Should the microscope visualizemalignant cells then thorough satura-Page Sixteen

tion with x-ray would be supplementedwith this treatment. Inasmuch as thegrowth is well encapsulated in thecyst ther~ is much less chance formetastasis, so I am very sure thispatient, regardless of the biopsy, hasa very good chance for a cure.

(Later-Patient made an uneventfulrecovery. Biopsy-Benign cystadenomaovary, Ed.)

------,---,-----,,---Fats burn only in the fire of c8lrbo­

hydrates.

The causes of peptic ulcer remainsa mooted question. Surgery does not,as a rule, corr,ect the primary factor,but deals with its effect. Hence itfollows that the cause active in pro­ducing the nrst ulcer working unop­posed will tend to bring about a re­currence.

A suitable formula £01' infants dur­ing the first year of life is preparedby adding three ounces of volume ofcorn syrup to one quart of cow's milk.This provides the proper proportionsbetween sugar and milk. Such amixture has a fuel value of 30 caloriesper ounce. For infants in the firstmonth of life, this mixture should bediluted with an equal volume ofwater in order that the infants willnot receive more cow's milk than theyare able to digest. If all goes well theproportion of water may be decreasedgradually until, at the end of the thirdmonth, the infant will be r€ceivingtwo parts milk mixture to one ofwater. By the age of five or sixmonths the infant's capacity fOT di­gestion will usually have increased tosuch an extent that the milk and sugarmixture may be given undiluted.

The mixture should be hoiled in allinstances. Ordinarily the bottle shouldnot be offered more than every fourhours and the infant should be allowedto take as much as desired. Fivefeedings a day are usually sufficientand after the fourth month many in­fants fed in the method described willnot need more than four bottles aday. (Ma~riott)

1 recall in my early proctologic ex­perience the case of a woman aboutfifty-five years of age who came tome for examination, giving her symp­toms as hemorrhoids and constipationof some years standing. On examina­tion ,I found internal venous hemor­rhoids and a moderate degree of rectalprolapse. In addition to this I foundthe entire mucosa of the rectum, ashigh as I could see with the procto­scop,e, to have a deep reddish-brownor mahogany like color. I used thesigmoidscope and as high as I couldsee in the rectum and sigmoid, Ifound the same color to the mucousmembrane.

I had examined a number of rectalcases, had read most of the late textson proctology, but had never read,heard of or observed this conditionbefore. I questioned the patient care­fully as to other symptoms, habits,medications used, etc., and finaUyguessed that the condition was due tothe use of rectal ointments and sup­positories,

I cleared up the hemorrhoid condi­tion, which relieved the congestionin the lower rectum, and soon stoppedthe use of the rectal ointments. Bycorrection of habits and diet, the pa·tient was soon able to get along with­out cathartics. I said nothing to thepatient about the pigmentation of therectal mucosa but had ,her returnevery few months during the nextseveral years for examination. Tomy surprise, the color of the mucousmembrane was greatly improved dur·ing that time.

I later came across several morecases with this same mucosal dis­coloration, and found the history,symptoms and condition to be similar.I found other proctologists askingabout this condition, but found thatno one seemed to have anything verydefinite to offer. Practically nothinghas appeared on this condition in the

standard proctology text books untilthe past year or so. Now we find aseparate chapter devoted to this con~

dition, which has been termed Melano­sis Coli or Melanosis Proctocoli.

Melanbsis Coli was first describedabout a century ago by Crueilhier.Shortly afterward, about 1847, Vir­chow described it. All studies of thiscondition up to about 1933 were basedon post mortem investigation. About1933 a report was published by Bockus,Willard and Bank based on their clini­cal investigation of the condition.

The condition is definitely a pig­mentation of the mucous membrane.There are various ideas as to thesource of the pigment and the methodof entry into the mucous membrane.Some believe the pigment is derivedfrom metals as mercury and lead.It is generally conceded that chronicconstipation is a contributing factor.Many have observed the frequent oc­currence of chronic constipation andthe ingestion of anthracene cathar­tics, as cascara, aloes, etc.

Quoting from ,Bacon on Anus, Rec­tum and Sigmoid Colon, 1938, we findthe following: "Pick was of theopinion that it was due to the prod­ucts of protein disintegration whichwere acted on by tyrosinase and con­verted into melanin. Hueck broughtforth the theory that the pigment doesnot belong to the melanin group butis a lipofuchsin; further, that thesplitting of certain products of di­gestion gives rise to a "propigment"of a lipoid nature, and this is affectedby ferments giving rise to the pig­ment. Synnott attributed the condi­tion to the metabolic pigment melanin,which is an autochthonous substanceoriginating in situ by transformationof pre-existing material. Obendor­fer explains the pigmentation on thebasis that disturbances in proteinmetabolism may result in excess pro·clucHon of waste products. At an early

Page Seventeen

C Still National Osteopathic Museum, Kirksville, MO

KANSAS CITY CoLLEGE OF OSTEOPATHY AND SURGERYKANSAS CITY CoLLEGE OF OSTEOPATHY AND SURGERY

Annie G. Hedges, D.O., of the College Staff

GENERAL RULES GOVERNING THE FEEDINGOF THE WELL BABY

date the ingestion of heavy metals,especially mercury and lead, wasthought to be the cause. Lignac be­lieved the condition to be due tohemorrhage with subsequent bacterialactivity, while McFarland adhered tothe theory that the pigment wasformed by an enzyme which acts onthe intracellular substance of thestroma of the intestinal mucosa.Lynch considers it to be due to a dis­turbance in the chromogenic functionof the liver. lJ

Symptoms: As far as the pigmen­tation of the mucosa is concerned, nosymptoms will be given, but the pa­tient will invariably mention chronicconstipation and the use of variouslaxatives belonging to the anthracenegroup.

Gross and microscopic appearance:The color of the mucous membranevaries in different cases from a lightbrown, dark brown, reddish-brown,mahogany to an almost black. Insome cases there appears to be yellow­ish striations here and there thru­out the mucous membrane. There isseldom an inflammatory or ulcerouscondition of the mucous membrane.Buie states: "Grossly, it appears thatthe deposit is in the surface of themucous membrane but on microscopicexamination it will be found that thereis no pigment in the epithelial cells.In'Stead, the entire deposit of pigmentaccumulates in the tunica propria ofthe mucous membrane where it lieschiefly within the large mononuclearcells. Rarely it extends to the muscu­laris and lymphatic involvement hasbeen reported."

Treatment consists of correctingother rectal pathology found, the with­drawal of anthracene cathartics, re­lief from constipation and restoringas nearly as possible normal circula­tion to the parts. It may take manymonths to restore the normal color tothe mucous membrane in these cases,but the condition is not serious andthere need be no great anxiety on thepart of the patient or physician for

Page Ellrhteen

a speedy return to normal. This is acondition where osteopathic t1'eatmentis very beneficial. I have found osteo­pathic treatment to be one of the mostimportant factors in correcting con­stipation, and with the correction ofconstipation the patient discontinuesthe taking of cathartics and there isusually an improvement in the localcondition.

Forcible vomiting in the new born,loss in weight, diminution in fecal ~din urinary output plus the typicall'iotus peristaltic waves seen and feltover the epigastric area means pyloricstenosis, whether functional or or­ganic.

Gastric hemorrhage may be pre­cipitated by cirrhosis of the liver, ap­pendiceal pathology, cm'cinoma of thestomach and certain diseases of thespleen. Peptic ulcer is, however, themost common cause. 90% of suchhemorrhages cease spontaneously.

Kansas City College

of Osteopathy

and Surgery

•The

"Aggressive

College"

2105 Independence Ave.

Kansas City- Missouri

•

In the making of a formula for ababy no rule can be followed expli­citly in every case. We know ap·proximately the requirements of thehuman organism in the way of calor­ies and other tissue needs but theresponse is varied in different indivi­duals so we must adapt the formulato the baby.

The average infant needs from 30to 35 calories per pound of bodyweight each day for the first two orthree weeks of life, then 45 caloriesuntil about eight months of age, whenit should be reduced to 40. Of this,the correct proportions are: 50%carbohydrate, 35% fat and 15 % pro­tein. There are times when we haveto modify these proportions and cer­tain cases which need more or lesscalories.

General Rules Used As a Basis:1. Total fluid volume per day-weight

in pounds times-3 for the firstquarter of the year, 2"12 for thesecond and third quarters. 2 forlast quarter.

2. Milk in the formula, weight inpounds times-1.75 for the first 3to 4 months-then 1.5 for severalmonths (depending on conditionand other foods given).

3. Water in the formula is the dif­ference between the total amountwhich can be given the baby andthe milk.

-1. Capacity of a baby's stomach isusually about .4 oz. for each poundof its weight (Balance of watermust be given between feedings),

5. Sugar in the formula, 10 caloriesfor each pound each day. (Amountwill naturally vary with kind ofsugar given).

6. No. of feeding per day 7 for thefirst 2 months, 6 for a few monthsuntil capacity of stomach is such

that by 7 to 10 months only 5 arenecessary.

7. Feeding intervals-4 hours frombirth for about 3 days, then 3hours until the stomach capacityhas reached a point at which the2:00 A. M. feeding can be discon­tinued, usually from 2 to 3 monthsthen 4 hours.Cod liver oil and orange juice may

be given by the end of the first monthand cereals and vegetables added bythe end of the second month, withcareful attention to caloric values andage of the child. The sugars used ininfant feeding are dextrose with acaloric value of 60 per tablespoon;milk sugar, 40 cal. per tablespoon;and honey, 99 to 100 per tablespoon.

The addition of lemon juice to theformula is valuable when gastric di­gestion is imperfect. Both lemon juiceand gelatine assist in breaking up thecurds which ordinarily form in thestomach of a baby artificially fed oncow's milk. The Beta-lactose-lemonjuice-gelatine formula is useful dur­ing mild illnesses when desirous oflimiting milk for a time. The formulaoften used in our College Clinic is:

Water 1 pintBeta-lactose 3 level ths.Knox plain gelatine 2 tsp.Lemon juice 1 tbs.Naturally these amounts may be

varied greatly to fit the individualcase. A formula similar to this ex­cept having no gelatine and only1 tsp. of lemon juice is useful for thefirst three days of feeding beforebreast feedinJ;t is fully establishedand is greatly preferable to anyform of a milk feeding at that time.It can beneficially be used once ormore a day between feedings for thefirst month.

Certain things must be consideredbefore making changes in the formula.

Pa~Nineteen

C Still National Osteopathic Museum, Kirksville, MO

KANSAS CITY CoLLEGE OF OSTEOPATHY AND SURGERY!CANSAS C,TY CoLLEGE OF OSTEOPATHY AND SURGERY

Page Twenty

-----e-----

'"E are listing herewith the Accredited Colleges

\J.J of Osteopathy. These colleges are approved

by the American Osteopathic Association, are in good

standing with the various State Examining Boards and

are members of the Associated Colleges of Osteopathy.

Chicago College of OsteopathyCollege of Osteopathic Physicians and Surgeons

(Los Angeles. Calif.)

Des Moines Still College d Osteopathy

KANSAS CITY COLLEGE OF OSTEOPATHY AND SURGERY

KIrksville College of Osteopathy and Surgery

PhUadelphla College of Osteopathy

It has been our policy to use Schil­ler's Test on many of these Erosions.\Ve are amazed at the number of posi~

tive reactions we have to this test.We are fully cognizant of the fact

that this test is not infallable. Weknow that when the cervical tissuesare deprived of glycogen we get apositive reaction to Lugol's solution.We know, too, that glycogen is absentin cancer, and we feel that if we canhun'y our patient to decide to havesurgery done early, when we find acervix that does not take the stain,we have done a good deed and prob~

ably saved our patient some veryserious trouble later on.

W. Schiller (Lancet 1; 1228)(5/30/36) warns that the aqueous io­dine test is not specific for carcinomabut marks off only the area that doesnot cop.tain glycogen. He states alsothat glycogen is absent in carcinomat­ous transformations of epithelium,hyperkeratosis of the squamous epi­thelium of the cervix, keratinizationdeveloping in prolapse, which mayalso cause the glycogen to disappear,and when the superficial layers ofglycogen containing epithelium havebeen rubbed off by inflammation,maceration or rough handling byfingers or speculum there are dif­ferent possibilities of the surface re.maining white.

Schiller also states "that paintingthe cervix with Lugol's is very easy tocarry out in an out-patient clinic." He

Pace Twenty-one

H. S. Crossen says: "An Erosion ofthe Cervix is an area on the vaginalsurface of the cervix which is foundcovered with columnar epithelium, andconsequently presents a reddened in­flamed appearance."

In our clinical work we do not gointo the histo-pathology of our cases,but we find this reddened inflamedappearance in many of our cases.Naturally, there are all grades of in­flammation, some bleeding, whileothers are slightly inflamed, withevery degree of inflammation and red­ness between these two extremes.

Our findings have been that theerosion is associated with lacerationsin a vast majority of cases. Theselacerations are often very slight, butdue to the heavy musculature of thecervix, a slight nick is sufficient tostimulate the cervical nerves andcreate the disturbance necessary tocause the tissues to erode.

It is not my intention to convey theidea that none but WOmen who haveborne children suffer from erosionsof the cervix. We have examinedyoung girls and maiden women whohav.e had very decided and extensiveerosions and we have every reason tobelieve these girls and women to bevirgins. We have also examinedwomen long past the menopause, whohave never had a pregnancy, andthey, too, like the virgin girls andmaiden women mentioned above, have"ery extensive erosions.

A Resume of the

RECORD OF THE GYNECOLOGICAL CLINICat the Kansas City Colleqe of Osteopathy and Surgery

\Vritten by Myrtle T. Moore, D. O.

It has been the privilege of the writer to be assistant to Dr. MamieJohnston in the Gynecological Clinic at the Kansas City College of Osteopathyand Surgery during the year 1938, pursuing the fifth year post graduatecourse.

During the year we have made gynecological examinations upon approxi­mately 800 women and girls. Vve have found diseases of the Cervix Uteri tobe the most common complaint of women. By actual count, there beingapproximately 44% of Our patients suffering from some involvement of thecervix and of this number more than one-half suffered erosions.

The reaction of the stool is normallyacid. Excessive proteins or indiges­tion may cause an alkaline stool.

Summing Up:In indigestion due to carbohy­

drates, the stools are loose, scalding,green, acid in odor and reaction.

In indigestion due to protein, ~he

stools are loose or constipated, darkin color, foul and alkaline, with Gram­negative bacterial flora.

(In cases of Gluteal Erythema,treatment should not be given untildetermining the reaction of the stool.)

In indigestion due to fats, the stoolsare loose at first. Later, constipa­tion often occurs. The presence ofexcess oil in the stool can usually bedetected.

Either overfeeding or underfeedingwill cause abnormality of the stooland sometimes our skill is taxed tothe utmost to determine the realcause of the trouble.

Bibliography:Holt's Dis. Inf. & C. Hlth Ed.Infant & Child Feeding-WilcoxPediatrics-Chapin & Royster

The appetite of the baby; rate of gainin weight; mental state (if satisfiedor fretful and cross) and condition ofthe stool.

Interpretation of the StoolNormally, after milk feeding is es­

tablished, the stool is smooth and soft-(semi-solid) and has a slightly sour,aromatic odor due to the lactic andfatty acids contained in it.

If curds occur, either the quantitygiven is excessive or indigestion isimperfect.

The stool accompanying starvationor insufficient food is small, darkgreen, loose or pasty and has a stalemusty odor.

Fat causes the stool to be sour orrancid, sugar sharply acid as ofvinegar, and protein more or less fouland putrid.

The color varies with the dominanceof its contents. It is pale yellow withexcessive fats, gray with starch andbrown with protein. A greenish tingeafter exposure to the air is usuallycaused by oxidation and of little orno significance.

e Still National Osteopathic Museum. Kirksville, MO

KANSAS CITY COLLEGE OF OSTEOPATHY AND SURGERY KANSAS CITY CoLLEGE OF OSTEOPATHY AND SURGERY

says "that 20 out of everyone hun­dred women show suspicious areas ofwhich only one or two proved to becancer. But even if only 1 % of thewomen examined gave a positivediagnosis the results are still verysatisfactory, for carcinoma. when de­tected and treated at that early stagegives nearly 100% security for de·finite and permanent healing."

Another very common condition thatwe find is the hypertrophied cervix.At the present time the professionas a whole is using Theelin in whole­sale quantities. The writer is of theopinion that this endocrine product islargely responsible for the great num­bers of hypertrophy of the cervixwhich we find.

John S. Lingenfelter-Cyclopediaof Medicine, Vol. 9, Pages 412-422 hasthis to say: "Doisy obtained anestrus-producing hormone in a purecrystalline state and named it Thee­lin. This Estrin is found in thesmall lake of fluid found in the corpusluteum of cows and frequently in thehuman. When Theelin is injectedinto spayed test animals it will pro­duce all of the extra ovarian histologi­cal evidences of Estrus. The uterusand vagina increase markedly in thethickness of their walls, as well as inthe diameter of their lumen. Thecells in the vaginal smears of spayedrats, mice and guinea pigs changefrom polymorphonuclear leukocytes tonucleated epithelial cells which aresoon replaced by keratinized non-llU­cleated epithelium of Estrus. WhenEstrin (Theelin) is injected into thepregnant animals in sufficient quan­tities abortion will take place. Thisoccurs in spite of the fact that Estrinis found normally in the blood andurine as well as in the placenta andamniotic fluid of the pregnantanimal."

If Theelin has the effect of thicken­ing the walls and increasing the dia­meter of the lumen of the uterus andvagina in spayed test animals, thenwe may presume that it will have

Page Twenty-two

a like effect upon a woman who hashad a surgical removal of ovaries andtubes. This is exactly the conditionwe find when these women presentthemselves for examination and treat­ment in our clinic.

The Cystic Cervix or the enlarge­ment of the follicles of Naboth isclosely associated with prolapsus, re­troflexion and retroversion. The mal­posed uterus being responsible for theinadequate circulation of blood toand from the cervix thus bringingabout the enlargement of the Naboth­ian follicles and they appear as smallcysts on the surface of the cervix.Our treatment of these cystic cerviceshas been grossly disappointing, inthat they do not respond to ordinarytreatment. Weare not equipped to dothe electrical cautery treatment onthese cases therefore we must referthem to surgery. In passing, I mightadd that invariably these cystic cer~

vices give a positive reaction toSchiller's test.

The lacerated cervix is another con­dition that we meet in our clinic alltoo frequen~ly. In years gone bywhen the Profession was using pi­tuitrin in obstetrics, pl'omiscuously,gross lacerations were the very com­mon result. Today, fortunately, wehave a milder uterine stimulant in thePituitary-Thymus preparations, andthe grossly lacerated cel'vix is notso common.

Naturally, we offer no treatment forthe lacerated cervix, except surgery,since we have proven to our own sat­isfaction that nothing but surgical re­pair or surgical amputation above thelaceration is going to put the cervixin a healthful condition.

Frequently. associated with lacera­tions of the cervix, we find polypoidgrowths. These polyps vary in sizefrom the size of a pinhead to the sizeof a hazelnut. In a number of thesecases the menopause was not estab­lished until the patient was well pastfifty years of age and then after thatage, there would be a slight "spotting"

occasionally. In one of our cases ofcomplete procidentia the patient suf­fered a bilateral laceration and ga'OW­

ing out of the right laceration wasa polyp the size of a large hazelnut.This patient did not establish hermenopause until after the age of fifty­five.

We hear so much about cancer, thesedays, that one would think in eighthundred women we should find a greatmany cases suffering with this dreaddisease. I am most happy to reportthat we have had just two cases of cer­vical carcinoma. One of these caseswas too far advanced for surgeryand was }'eferred to Radium treat­ment. The other failed to returnafter she was advised of her condi­tion, so we were unable to follow thesecases further. In each of these casesof carcinoma of the cervix there wasinvolvement of the uterus. In one,the case ref.erred to Radium treat­ment, the uterus was low in the pel­vis and was a hard nodular masswith nothing about it that could berecognized as a uteru's. In the othercase, the uterus was enlarged, solid tothe touch but not nodular.

There are suprisingly few cases ofdisease of the external genitalia. 'Vehave had some few Qases of PruritisVulvae but this condition is broughtabout, largely, from drainage fromthe vagina. Treatment of the vaginalcondition usually brings about a cureof the Vulvar Pruritis. Therefore,we direct our efforts toward curingthe vaginal condition.

The writer has assisted in theMinor Surgery Clinic where severalcases of early surgical menopausalpruritis vulvae have been treated bythe injection of a local anesthetic inoil into the sub-membranous tissuesof the vulva and the results have beenvery gratifying, the patients reportcomplete relief after the injectiontreatment.

One case of Pruritis Vulvae whichcame to our clinic is worthy of men4tioning. A woman, fifty years of age

gave a history of extreme itching ofthe vulva over a period of twentyyears. The vulvar membrane waswhite and glistening and very thick,giving the impression of leather.Either from a congenital anomaly orbecause of abrasions of the membrane,there was a complete adherence of thelabia minora to the labia majora. Thewriter is of the opinion that this wasa congenital condition since both sideswere just alike. there being no break,whatsoever, in the line of adhesion.The membrane that is usuallya loose fold over the clitoris wasclosely adherent. The clitoris wasnot papable under this adherent mem4brane, and was probably atrophied orabsent altogether. This woman wasnormal in other respects. She hadborne children and suffered from aretroflexed uterus and a badly erodedcervix. The secretions from the va­gina and the cervical erosion were, nodoubt, the cause of the extreme pruri­tis.

Such conditions as Hooded Clitoris,Enlarge<l Labia Minora, UrethralCaruncle, abscesses of Bartholin's orSkeen's glands are immediately re­ferred to the surgical department. Wemake no attempt to treat any of theabove mentioned conditions in ourgynecological clinic. The laceratedPerineum is a very common conditionand we offer no treatment exceptsurgery in these cases.

Following in the wake of the Per­ineal laceration is the Rectocele andCystocele. 'We have patients withprotrusion of the vaginal walls inevery degree of severity. I can imag­ine no condition more annoying thanrectocele or cystocele and still we havewomen who have endured this incon­venience for years. \Ve offer surgeryin these cases and surgery, alone, canbring about a cure.

It is surprising how few cases ofspecific infection we get in our clinic.During the year we have had onlytwo cases of active Gonorrhea, threecases of Trichomonas Vaginitis and

Page Twenty_three

C Still National Osteopathic Museum, Kirksville, MO

KANSAS CITY CoLLEGE OF OSTEOPATHY AND SURGERY KANSAS CITY CoLLEGE OF OSTEOPATHY AND SURGERY

one case of Colon Bacillus Vaginitis.We used the prescribed treatment inthe cases of acute gonorrheal infectionand have cleared our two cases of dis·charge. We realize that we have noteffected a cure of this disease ineither case. In the cases of Tricho­monas Vaginalis Vaginitis, we used theJohn Wyeth's Silver Picrate insuffla­tion treatment preceed.ed by athorough cleansing of the vaginal andcervical tissues with Peroxide of Hy·drogen, as suggested by the Uni­versity of Minnesota, and followed bythe John Wyeth Silver Picrate sup­positories. In all of our cases we hadabsolute cures, proven by laboratorytests.

One of our cases returned in twoweeks for a check-up. Although thelaboratory test was negativ;e, we werenot satisfied with the patient's condi­tion therefore we used two insuffla­tions, one week apart, of Beta Lac­tose. After these two treatments thepatient was in splendid condition.

In our one case of B. Coli Vaginitiswe used iodine douches and effecteda complete cur~. We used in thesedouches 10 drops of Tincture of io­dine, 1 teaspoonful of glycerine and4 oz. of water.

We have had three cases of senileatresia of the vagina, one case beingvery severe, the canal being con­stricted to such an extent that theindex finger, only, could be insertedand it was impossible to use the small.est speculum. This dear lady was inher late seventies and, of course, wecould offer her no relief. Our othercases were less severe but were verypronounced. We offered no treat­ment in either of these cases.

We found a very peculiar conditionin three patients; that of an adhesionbetween the cervix and the vaginalmucosa. One case was a congenitalanomaly while the other two werebrought about by cervical lacerationsat childbirth. No doubt, a badly con·tused vaginal mucosa courted the ad­hesion at the line of laceration.

Page Twenty_fouT

We have not had a single case ofsynhiIitic chancre of the vagina, cer­vix or vulva, nor have we found scarswhere a chancre had been at one time.We know we have many cases ofLues among our clinic patients but ifthey have -acquired syphilis they havehad their initial chancre elsewhereupon the body.

So many obese women come to uswith heaviness in the pelvis-a heavyache that does not ease. The historyin these cases invariably shows thatthe patient has been taking "shots"to reduce her weight and upon in­quiry we find the patient has beengiven Antuitrin S. Oliver Kamm,Detroit, Mich., Cyclopedia of Medi­cine Vol. 1 Pages 574-686 gives norecommendation for the use of Antui~

trin S. in treatment of obesity or hy­pofunction of the sex organs.

This author states that there aretwo types of abnormal functioning ofthe anterior lobe of the Pituitarygland, viz., those associated with over­activity and those attributable to de­ficient activity. Quote: "The dis­eases known to be associated with ex­cessive secretion are gigantism andacromegaly. Administration of gland­ular therapy is contraindicated incases of hyperactivity of the anteriorlobe. A pathological condition as­sociated with hypofunction of the an­terior lobe of the pituitary gland isDistrophia Adiposogenitalis. This con­dition has one striking characteristic,namely, marked obesity associatedwith sexual infantilism. The sexualdevelopment of an adult being nogreater than that of a young child.This disease is usually due to tumorswhich destroy the pituitary gland.This condition is greatly benefittedby the administration of anterior lobepr.eparations. It

According to Tucker menstrual dis­orders -are benefitted by the carefuladministration of the posterior lobeor whole gland preparations if thereis also skeletal or genital underdevel­opment. Antuitrin S. is the sex hor-

•

mone obtained from the anterior lobeof the pituitary gland. The writer be­iieves that a member of the Profes­sion is guilty of malpractice when heprescribes Antuitrin S. for a patient\\rho is suffering from obesity. Thedisease Distrophia Adiposogenitalis.is very rare. Obesity from ov.ereatingis a very common condition.

Perhaps a connection between theabove dissertation and diseases ofwomen is seemingly far fetched butin clinical practice it is not so. Wehave these obese women, who havebeen having their Antuitrin S. "shots"regularly, come to us with an ache lowin the pelvis. Invariably we find anenlarged uterus and an hypertrophiedcervix and upon questioning our pa­tient we elicit the information thatthis ache in the pelvis is new to them.

Our own Dr. Quintos Wilson taboosthe use of Antuitrin S. He says thatafter using this sex: hormone for atime the endometrium is built up tosuch an extent that a curettementmust be done before I'elief can be had.

The following case history maybring my argument to a point. Mrs.L. aged 32 entered the general clinic;weight upon entering was 213 P9unds.A diagnosis of obesity was made andbesides a limited diet she was to haveAntuitrin S, intramuscularly twiceweekly. This patient was very faith~

ful in coming for her treatments.After eight "shots" of Antuitrin S.she was brought to our gynecologicalclinic complaining with Utrouble~ inthe tubes."

Upon examination it was found thatshe was suffering f,rom an hyper­trophied cervix which was badlyeroded. It was impossible, because ofthe thick abdominal wall, to get theexact position of the uterus, but judg­ing from the position of the cervix,we could presume that the uterus wasin a normal position. We could alsopresume that the uterus had enlargedin exact ratio with the enlargementof the cervix. There is no doubt inthe writer's mind but that this pa-

tient \vill be brought to operation andthat a pan-hysterectomy will be nec­essary to relieve her of the distressshe is suffering in the pelvis.

Malpositions of the uterus, ofcourse, are very common. Retroflex­ion and Iretrov.ersion being more com­mon than lateral and anteflexions.We can bring about cures in many ofthese cases of retro-displacementswhen we can get the patient to co­operate with us and if the perineum isintact. We use the bimanual methodof replacement and have many curesto our credit. We can not say somuch, however, for the extreme ante­flexion and lateral displacements.

In the cases of ventral fixation thathave come to us, in our clinic, invari.ably the patient suffers a pull uponthe belly wall. Many of these WOmenare conscious of a weight suspendedfrom the particular point of attach­ment to the wall, and we can. in mostcases, place a finger upon the pointwhere the fixation is made. Unfor­tunately. we can do nothing to relievethese patients, there being no relieffor them except through sUirgery.With the badly malposed uterus, ifthere are symptoms of nervousnessand visceroptosis. the only thing wecan do is to send the patient to surg­ery.

We have had several cases of pro­lapsus and three cases of completeprocidentia. These cases are asso­ciated with perineal lacerations andretro-displacements of the uterus. Itis gross folly to render treatment inthese cases. T,here is nothing thatwill keep the uterus up in the pelviswhen the perineum is torn away,therefore, we send these cases to thesurgeon at once.

\Ve have had several cases of in­fantile uteri. These, of course, if thepatient is not too old, might devel­op and become normal in size andfunction. The cases we have had wereassociated with gross spinal lesionswhich would, of necessity, have to becorrected before one could hope forany development of the uterus.

Paae Twenty-five

e Still National Osteopathic Museum, Kirksville. MO

KANSAS CITY CoLLEGE OF OSTEOPATHY AND SURGERY KANSAS CITY CoLLEGE OF OSTEOPATHY AND SURGERY

We had one case of congenitalanomaly which might be of interest.This girl, eighteen years of a,g-e, hadwhat would seem to be a double vaginawith one section below or posterior tothe other. Upon examination it wasfound that the lower opening was amalplaced rectum. This rectum withan opening in the lower part of thevulva and anterior to the fourchettewas supplied with no sphincter andstill there seemed to be no lack ofcontrol of the bowel. This girl wasnormal in every other way. Thepelvis was well formed, the vaginawas normal and she was regular inher menstrual cycle. The normal sitefor the rectum was visible a.nd thenormal sphincter and anus could bepalpated but the canal was complete­ly closed. It was decided that so longas the patient was so nearly normaland had complete control of the bowelit would be unwise to disturb thefunctions and operate to open -thenormal anus.

Varicosities of the Broad Lig,amentsare very common. These are usuallyassociated with malpositions of theutel'us. Usually these varicositiesare palpable and, naturally, are quitepainful.

Acute pelvic inflammation coupledwith diseased ovaries and Fallopiantubes is not so common as one wouldthink when we know of the prevalenceof gonorrheal infection. We havefound that these patients gain a vastamount of l1'elief when they }'eceivethe Elliott treatment.

Chronic pelvic inflammation withchronic oophoritis and chronic salpingi­tis is relatively common. These casesmust be sent to surgery since pallia­tive treatment only prolongs the pa­tient's suffering.

Going hand in hand with chronicpelvic inflammation is chronic endo­metritis and chronic endocervicitis.These patients are extremely tenderand sore over the uterus and complainat the slightest pressure. We havebad no acute cases of metritis orparametritis, in our clinic.

Page'I'wenQ--sbc

Adhesions, either arlsmg from aninflammatory process or followingsurgery, are all too prevalent, and isthe cause of much pelvic distress.Many laterally displaced uteri arecaused by adhesions pulling the orgariinto an abnormal position and fixingit there.

Fibrotic conditions and multiple fi­broids of the fundus of the uterus areVli!ry, very common. Why this is trueI can not say but in women past fcrtyyears of age this is too often the con­dition. We find these women, ~ven

at that age are beginning to sufferirregularities in the menstrual cycle,with long flowing periods and shortperiods between the flow. In too manycases surgery must be the treatmentin order that the patient be savedfrom too great a loss of blood.

Subinvolution is not so commonand yet, we have had a number ofthese cases. These are usually asso­ciated with spinal or sacroiliac le­sions. 'Ve find that a correction ofthe lesion will bring about a cure ofthe uterine condition. We treat thesecases osteopathically, using good stim­ulation to the spinal nerv€s fromthe 9th dorsal down to the end ofthe spine with special attention tothe lumbar segments. We have hadmarked results in these cases in avery short time and we believe thatthis treatment is the very best inthese cases.

I have touched upon the importantcases and conditions that have comeinto our clinic. This work has beenextremely interesting and I might addthat I have been most happy in mywork in the gynecological clinic andin my association with Dr. MamieJohnston, who has, at all times, givenme every opportunity to make ex­aminations and also to express myopinion on all of the cases. I wishthat other doctors in our Professioncould avail themselves of the op­portunity that has been mine. duringthe year 1938, in this clinic.

Intravenious injections of drugstook form in 1656.

INTRACAPSULAR CATARACT EXTRACTIONA. B. Crites, D. O. and D. 1\1. RusselI, D.O., of the College Staff

This case because it is typical and Sinuses-Frontal, negativesince it was operated before the group Antrum-Right, 2 plus, Left, nega-of visiting physicians at the fall tivehomecoming is here reported. Ethmoid-Right, 3 plus, Left, 3 plus

Mr. C. S. H., age 72, came to the Vision-O. D., Counts fingers at 12College clinic on September 22, 1938, inches, light projection good.complaining of. blindness in the right O. S. 12/200.eye which had been failing for several Ophthalmoscopic examination re-years. About two years previously vealed an amber colored grey pupilthe vision of the left eye became with an absence of the fundus re­noticeably affected, glasses were flex and no iris shadow,changed several times with no im- Diagnosis.Right Senile cataractprovement, in fact the condition pro- mature, left immature cataract.gressed so that for nearly a year he Patient was advised to have in­has been unable to read the news- fected teeth removed and treatmentpaper. Mr. H., highly intelligent is fOl' sinus infection, and then to under­a very interesting conversationalist go an operation for the extraction ofand relates the facts that he came to the ·cataract. This suggestion wasKansas City in 1881, 57 years ago, readily accepted and he proceded to

. when there was one mule car line have the focal infection cleared up.and his first place of residence was On November 16, 1938, the patienta three }'oom house located in what is reported for a re-examination andnow the center of the Jones Store. was found to be in good physicalPhysical Examination: condition, so was operated on the

Temperature . 98.4 following day for extraction of thePulse . - 70 cataract.Blood Pressure -.- 1601/88 The operation was done with a localWeight . . 134 anesthetic, a solution of 4% cocainChest Cardio-vascular negative hydrochloride applied to the cornea.Abdomen negative Also a few drops were injected underReflexes normal the conjunctiva below and above theNeuro-Muscular system norma1 limbus. During the operation an oc.

Laboratory Examination: easional drop of cocain and adrenalinUrinalysis. were instilled in the eye. A corneal

Color . yellow section was made, which comprisedReaction acid about two-fifths of the circumfer-Spec. gr. ..--- - 1.016 ence of the cornea, and was terminatedAlbumin neg.t O h....... Ive at t e upper margin with a conjuctivalSug3lr .._....negative flap. A pe~·ipheral iridectomy wasEpith. cells ...2 plus then performed, after which the lens

BIHoobdo

was expelled by gentle pressure upon......................-- ..- 85 % the lower part of the cornea. The

R. B. C. .. 4,100,000 cataract was delivered with the cap-W. B. C --.-- -- 9,100 sule intact, the sutures which hadKahn negative previously been inserted after making

Eye, Ear, Nose and Throat Examina- the corneal section were tied, the eyetion. cleansed with a saturated solution

Nose-anterior septal perforation of boric acid and eserine ointment wasThroat-negative. Several infected applied to the conjunctiva. Both eyesteeth. were bandaged and the patient was

Page Twenty...e"en

C Still National Osteopathic Museum, Kirksville, MQ

KANSAS CITY CoLLEGE OF OSTEOPATHY AND SURGERYKANSAS CITY CoLLEGE OF OSTEOPATHY AND SURGERY

c. A. King, D.O.,Resident Physician

Statistical Report

CONLEY CLINICALHOSPITAL

loss to determine that seat of hisailment. Months elapsed and he wasstill on compensation. In relating tome the case history he spoke of thefact that he could not live on $12.00per week. He had a little patch ofground and his residence in a subur­ban community. He told me how hehad to eat his chickens because hecouldn't afford to feed them; he hadto sen his hog and finally he had tolet his cow go. "Literally taking themilk out of my babies throats," hesaid. By that time I was almostready to cry and to make sacrificesto help him when he finished hispanegyric with "and now by God, theyare going to take my automobile!"

It takes gas, oil and tires to makethe wheels of an auto turn. Thesethings are all on a "cash and carry"plan. They take all the availablemoney (encrouching on the monthlypayments' on the car even) the ownerhas at his disposal hence the butcher,the baker, the grocer, et aI, are notpaid, and being not paid, they cannotmeet their obligations and we haveall the makings of an economic de­pression.

The same holds true with the restof the household luxuries, convertedinto necessities by over zealous sales­men and transformed into unsur­mountable liabilities by a too laxcr~dit system on the part of far toomany business houses.

It is not intended here to decry theuse of labor saving devices in thehome. They are fine and should beencouraged but only in so far as thebudget of the family will permit.Everybody should balance his ownbudget and, his own being in a stateof stability, the family, the communi­ty, the county and the state will auto­matically come into adjustment. Withthese in a condition of equilibrium itcan be seen that the nation will like­wise fall in line. This simply para­phrases the philosophy of life as out­lined by Confucious some six hundredyears before Christ.

THE LOWER BRACKET INCOMEPROBLEM

Forty million people in the UnitedStates have incomes of less than$800.00 per year, according to Thur­man Arnold, Assistant United StatesAttorney General, that cannot pay formedical care.

n would be interesting as well asilluminating to have information fromthis group as to the number that aremaintaining automobiles, who haveexpensive radio outfits, up-to-dateelectric refrigeration and that arepossessed of the various electric driv­en gadgets designed to make house­work easier. But to narrow the in­quiry let it be limited to the auto, theradio and electric refrigeration. Allof these may be classed properlyamong the luxuries. And yet no oneseems to be too poor that he feels hecaj.mot afford an auto. He rides towork in his auto to save street carfare and to save time, disregarding orignoring the fact that no car can makea mileage average under five centswhen all expenses are calculated. Tothe average member of this low in­come bracket group, the time savedin transportation is dissipated in non­productive effort or in diversions de­manding a modicum at least of ex­penses. No one drawing $200.00 perJ.1lonth or less can afford an auto urless he can increase his efficiency tojustify the expense of maintenance.And yet there are day laborers, wash­er women and the like who mustneeds maintain an auto to furnishtransportation to and from work.Take any W.P .A. project and theautos parked in the vicinity almostcompel the presence of a traffic copto get them started home properly.

A man came my way who had beenhurt by a fall while at work in alarge industrial plant. He went oncompensation automatically until hecould return to work. The sum was$12.00 per week. His case was stub­born. His medical advisors were at

January.FebruaryMarchApril ....May ..June .July .AugustSeptemberOctober .... _

Average DailyRegistration __ 11* 17 'h

Percentage increase 54.5 %Average length of time in Hospital

7 days.

(end of second year)

Number of patients registered todate . 1325Registration Nov. 15, 1936 to

Nov. 15, 1937. 572Registration Nov. 1·5, 1937 to

Nov. 15, 1938...... 753

Cases in major surgical depart-ment 34~

Eye, ear, nose and throat 568Obstetrical.. 102Proctological and minor surgical. 78

Observation and Palliation 238Fatalities 38

Comparative Monthly Registration:1937 1938

January.. ....38 51February ..31 49March ... .....38 62April.. .31 49May 55 59June .48 77July... ..50 73August ..... . 71 107September _54 66October 53 75

Average MonthlyRegistration .47 67

Percentage increase .42.5%

Comparative Daily Registration:1937 1938

8 177'h 178 19

...11 16'h....14 17...12'h 17

....13'h 14..13 19'h

.....13 17 'h..14'h 20'h

sent to his room. In two days timethe dressing was l'emov,ed and the pa­tient was able to count fingers at adistance of twelve inches. The eyewas then dressed every day for thenext ten days, at which time the pa­tient was discharged from the hospi­tal, with orders to appear in twoweeks time for a refraction.

Refraction was twice r.epeated atintervals of two days, the final cor­rection being a plus 9.25 combinedwith plus 1.75'cylinder at axis 170which gave vision of 20/20 plus 1.A plus 3.00 added in the bifocal sig­ment enabled him to read the 6 pointtype in the inside of the newspaper.

Mr. H. appeared before the seniorclass on December 2nd, just threeweeks after his operation, with anentirely quiet eye, having a roundpupil, happy in the complete restora­tion of his vision.

Very few hydrogen ions exist inpur.e water, the amount of dissociatedhydrogen ions being 1/10,000,000 gramper litre. So small are hydrogen ionsthat there are approximately 60,000,­000,000,000,000 hydrogen ions in 1/10,­000,000 gram.

----

In the new born and in very youngchildren cyanosis, sudden attacks ofpallor, breath holding, convulsions orslight difficulty in breathing, shouldsuggest the possibility of the presenceof an enlarged thymus gland.

Pap Twent7-elabt

"There are some things in this worldthat are inevitable. And it is goodto think that where the inevitableis God has something in mind whichH~ wishes to accomplish.

That we do not understa~d it is amatter of minor importance." (AbbePierre)

Acids stronger than carbonic acidin the blood stream cannot exist assuch in the presence of bic&rbonate,reacting with the latter to form neu­tral salts and carbonic acid.

e Still National Osteopathic Museum, Kirksville, MO

KANSAS CITY COLLEGE OF OSTEOPATHY AND SURGERY KANSAS CITY COLLEGE OF OSTEOPATHY AND SURGERY

And it is all hinges upon that timewithin one's means."

The government is greatly distres­sed about the medical care receivedby these 40,000-,000 low income people.To be sure they should have adequatemedical attention as an economicprerequisite. Sickness is v e r yfrequently preventable. Given anourising diet, a warm, dry place tolive and sufficient clothing to keepone warm, the natural adoptive func­tions of the body will furnish suf­ficient protection to the individual tokeep him in. an average state ofhealth, one that will need the atten­tion of a physician only at rareintervals. Although this is true theypick on the doctors as the experi­mental guinea pigs in the socialsecurity plans. Why not get back tothe fundamentals and make such pro­visions as will insure the .conditionsthat will make for health automatical­ly? Why not see to it that food,clothing, warmth and housing withsuch labor saving devices as are legiti­mate, are insured to an individual atcost plus a reasonable profit. Mini­mize the number of commissions be­tween producer and consumer so thatthe product is easily purchasable.Then if the health condition is beyondthe reach of the average run of peo­ple, take some steps to make the pro­duct of medical schools Le. its grad­uates distributable by eliminating thedead wood in the curriculum of itsschools and concentrate upon the es­sentials of bedside practice so thatthe graduates will minimize timespent in school and curtail the expensethereof to a point where a reasonablefee can be charged, one that a patientin the lower income bracket can af­ford to pay when occasion demands.This problem constitutes more thanthe actual regimentation of thephysicians of the country willy-nillyto care for their physical ailments.It is one of the many results accruingfrom departure from the path of eco­nomic rectitude; from the junking

Pase Thirty

of the fundamental virtues so vitalto the success of our fore fathers;from the deliberate attempt to shirkindividual responsibility of self pres­ervation; from the nihilistic philsophythat as they were not consulted asto their entrance into the world saidworld owes them a living; from glori­fying acquisition and greed with thebelittlement of the small returns ac­cruing from legitimate vocations in­volving physical labor and self sacri­fice.

It all resolves itself within thehomely propositions of living withinones means which constitutes abalanced budget.

Blood as acid as distilled water oras alkaline as tap water is incompa­table with life.

Kansas City College of

Osteopathy & Surgery

2105 Independence Avenue

Kansas City. Missouri

The

"Aggressive

College"

•

RESERVE APRIL 19, 20, 21 AND 22, 1939

FOR THE SEVENTH ANNUAL CHILD'SHEALTH CONFERENCE

Each year, since its origin, the Child's Health Conference, which is

sponsored by the Kansas City Society of Osteopathic Physicians and

Surgeons, has grown in numbers. Each year more doctors come to this

splendid post-graduate clinic. The Clinic sponsors have the full co­

operation of the Kansas City College of Osteopathy and Surgery, the

Lakeside Hospital, the Northeast 'Hospital, the Conley Clinical Hf'.spital

and the Women's Auxiliary.

We are pleased to announce that Dr. Leo Wagnar of Philadelphia,

Pennsylvania, is to be our guest speaker and chief examiner this year.

He is a most capable pediatrician, a popular convention speaker and his

presence among us assures us a splendid meeting.

The purpose of this Conference is to give young children the benefit

of a thorough physical examination by well organized groups of special­

ists; to give practicing physicians of Missouri, Kansas and surrounding

territory four days of intensive study of the problems of childhood; and

to provide parents the opportunity of acquiring much valuable informa­

tion concerning the care of their children.

Kansas Citian Hotel's delightful roof garden will be our meeting

place. (The Baltimore Hotel, to whose management we are greatly

indebted for a fine hospitality in former years, is closed for reconstruc­

tion.)

Nothing will be omitted which will serve to make this meeting worth

while for 001' visitors. It is already endorsed as affording adequate

training to satisfy Missouri and other State Boards of Registration and

Examination. Get in touch with your own State Secretary to determine

if it is endorsed by your own state.

Watch the College Journal, Forum and A.O.A. Journal for further

announcements. We are looking forward to greeting a record attendance.

MARGARET JONES, D.O., General. Chairman.

Page Thirty-one

C Still National Osteopathic Museum, Kirksville. MO

KANSAS CITY CoLLEGE OF OSTEOPATHY AND SURGERY

THE A. O. A. MEMBERSHIP CAMPAIGN1938-1939

Arthur E. Allen, D. O. is facing the most important era in hisincumbency as President of the American Osteopathic Association. FrankE. MacCracken, D. O. is up against the most gruelling portion of his jobas Chairman of the Special Membership Committee.

The 76th Congress convened January 4th at 12 noon. During thesession legislation of vital importance to the osteopathic profession willbe enacted. The question of therapeutic parity in socialized medicine willbe decided. It directly concerns every osteopathic physician and surgeonin the United States. We must participate, and on a parity too, withthe physician of the medical school of practice in every phase of thesocialized medicine legislation.

President Allen's job is to steer or at least, to be captain of, the shipduring these strenuous and stormy days of change in the relationshipbetween patient and doctor. Not only must the general fundamentalsof parity in practice be written into these new laws, but the wording mustbe scrutinized as to possible or probable future interpretations. All inall, Dr. Allen is in command of the osteopathic ship in the most trouble­some voyage in its entire tempestuous career. This takes time, energyand money and this is where Frank MacCracken gets on the spot.

The 1938-39 directory will go to press short approximately 850names as compared to last year's issue, a decrease of about 8%. Thesenames were dropped for non-payment of dues. Each name representsan asset of $20. Figuj'e it out for yourself! The Central Office needsmoney, needs every cent the old directory figures would have yielded.It is by rehabilitating these delinquents that the needed funds can be real­ized. Dr. MacCracken's committee is charged with this responsibility.That is why Frank MacCl'acken is sitting on a hot spot. But why shouldhe be?

Every osteopathic physician will be affected alike by the prospec.tive legislation, be it favorable to our interests or adverse. Everyosteopathic physician should be alert in safeguarding his own individualinterests. Only by backing up whole heal-tedly President Allen and theCentral Office can our best interests be preserved. Therefore, it is yourjob, my job, equally, as it is Frank MacCl'acken's job, to get into theNational Association, not only ourselves if we are out, but every othernon-member of our acquaintance. Self-interest demands it. Self-preser.vation compels it.

A condition of insecurity confronts us all. The safe way out fOlT allof us is to hang together and depend upon team-work and fight to secureour professional safety.

Everybody must be a member of the National NOW!G. J. C.

•

,.,