california medicine - ncbi

2

California MedicineOwned and Published by the

CALIFORNIA MEDICAL ASSOCIATION450 Sutter, San Francisco 8

Phone DOugla-s 2-0062

Address editorial communications to Dwight L. Wilbur, M.D.,and business and advertising communications to John Hunton at

the above address.

EDITOR . . . . . . . . . DWIGHT L. WILBUR, M.D.

Executive Committee-Editorial Board

LAMBERT B. COBLENTZ . . . . . . . . . San Francisco

ALBERT J. SCHOLL . . . . . . . . . . . Los Angeles

H. J. TEMPLETON . . . . . . . . . . . . Oakland

GEORGE H. KRESS, M.D., Editor Emeritus

Assistant to the Editor, ROBERT F. EDWARDS

Advertisements.-The Journal is published on the seventh of themonth. Advertising copy must be received not later than the tenthof the month preceding issue. Advertising rates will be sent on request.

BUSINESS MANAGER . . . . . . . . JOHN HUNTON

Copyright, 1947, by the California Medical Association

Subscription prices, $5 ($6 for foreign countries); single copies,50 cents.

Volumes begin with the first of January and the first of July. Sub-scriptions may commence at any time.

Change of Address.-Requests for change of address should giveboth the old and new address, and should be made by county secretariesor by the member concerned.

Contributions of Scientific and Original Articles:

Responsibility for Statements and Conclusions in Original Articles.-Authors are responsible for all statements, conclusions and methodsof presenting their subjects. These may or may not be in harmonywith the views of the editorial staff. It is aimed to permit authors tohave as wide latitude as the general policy of the Journal and the de-mands on its space may permit. The right to reduce or reject anyarticle is always reserved.

Exclusive Publication.-Articles are accepted for publication on con-dition that they are contributed solely to this Journal. Ordinarilycontributors will be notified within 30 days if a manuscript is ac-cepted for publication. Every effort will be made to return unusedmanuscripts.

Length of Articles.-Ordinarily articles should not exceed 3,000words (approximately 3 printed pages) . Under exceptional circum-stances only will articles of over 4,000 words be published.

Manuscripts.-Manuscripts should be typewritten, double-spaced,and the original and if possible a carbon copy submitted.

Illustrations.-Ordinarily publication of 6 illustrations accompany-ing an artide will be paid for by CALIFORNIA MEDICINE. Any num-ber beyond this will have to be paid for by the author.

References.-Should conform to the following order: name ofauthor, tide of article, name of periodical, with volume, page, month,day of the month, if weekly, and year-i.e., Lee, G. S.: The heartrhythm following therapy with digitalis, Arch. Int. Med., 44:554(Dec.), 1942.

Reprints.-Reprints must be paid for by the author at establishedstandard rates which will accompany the author's proof of the article.

"Entered as second-class matter at the post office at San Francisco,under the Act of March 3. 1879." Acceptance for mailing at specialrate of postage provided for in Section 1103, Act of October 3, 1917,authorized August 10, 1918.

EDITORIAL BOARDChairman of the Board:

Dwight L. Wilbur, San Francisco

Executive Committee:Lambert B. Coblentz, San FranciscoAlbert J. Scholl, Los AngelesH. J. Templeton, OaklandDwight L. Wilbur, San Francisco

Antesthesiology:William B. Neff, San FranciscoCharles McCusky, Los Angeles

Dermatology and Syphilology:Paul Foster, Los AngelesH. J. Templeton, Oakland

Eye, Ear, Nose and Throat:Frederick C. Cordes, San FranciscoLawrence K Gundrum, Los AngelesA. R. Robbins, Los AngelesLewis Morrison, San Francisco

Genteral Medicine:Mayo H. Soley, San Francisco0. C. Railsbach, WoodlandLambert B. Coblentz, San FranciscoJohn Martin Askey, Los AngelesW. E. Macpherson, Los Angeles

General Surgery:Frederick L. Reichert, San FranciscoC. J. Baumgartner, Beverly Hills

Orthopedic Surgery:Frederic C. Bost, San FranciscoHugh Jones, Los Angeles

Thoracic Surgery:John C. Jones, Los AngelesH. Brodie Stephens, San Francisco

Industrial Medicine and Surgery:Rutherford T. Johnstone, Los AngelesJohn E. Kirkpatrick, San Francisco

Plastic Surgery:George W. Pierce, San FranciscoWilliam S. Kiskadden, Los Angeles

Neuropsychiatry:Karl N. Bowman, San FranciscoJohn B. Doyle, Los Angeles

Obstetrics and Gynecology:Daniel G. Morton, San FranciscoDonald G. Tollefson, Los Angeles

Pediatrics:E. Earl Moody, Los AngelesWilliam G. Deamer, San Francisco

Pathology and Bacteriology:Alvin G. Foord, PasadenaAlvin J. Cox, San F-rancisco

Radiology:R. R. Newell, San FranciscoJohn W. Crossan, Los Angeles

Urology:Clark Johnson, San FranciscoAlbert J. Scholl, Los Angeles

Pharmacology:Windsor C. Cutting, Menlo ParkClinton H. Thienes, Los Angeles

Psiblic Health:George Uhl, Los AngelesCharles E. Smith, San Francisco

Contributions of "Letters to the Editor," News and Notes,and Antispasmodics:

The Editorial Board will be glad to receive and consider for pub-lication letters containing information of general interest to physiciansthroughout the State or presenting construaive criticisms on con-troversial issues of the day. Also News and Notes items regarding theaffairs and activities of hospitals, individuals, communities and localmedical societies and groups throughout the State, as well as materialin the lighter vein.

Leaflet Regarding Preparation of Manuscripts for

CALIFORNIA MEDICINE

This leaflet will be sent to any member of the California MedicalAssociation desiring it.

CALIFORNIA MEDICINE-ADVERTISING 3

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153 Kearny Street, San Francisco 8 Heartwell Bldg., Long BeachGArfield 1-0460 Phone 632-29

California Physicians' ServiceHeadquarters office of the California Physicians' Service is located at

153 Kearny St., San Francisco 8, Telephone SUtter 1-4633. Los An-geles office located at 743 South Grand View St., Los Angeles 5,Telephone DRexel 5261.

Board of Trustees

Lowell S. Goin, M.D..................... ....PresidentA. E. Moore, M.D..... Vice-PresidentH. Randall Madeley, M.D.................... Vice-PresidentChester L. Cooley, M.D.................... SecretaryRobertson Ward.................... TreasurerRansom M. Cook.................... Assistant Secretary-TreasurerDonald Cass, M.D. A. M. Meads, M.D.C. Glenn Curtis, M.D. Mr. C. Ray MillerJ. Frank Doughty, M.D. Rt. Rev. Msgr. Thomas J. O'DwyerHenry L. Gardner, M.D.W. M. Bowman.................... Executive DirectorA. E. Larsen, M.D.................... Medical Director

Administrative Members At Large

Administrative Members of California Physicians' Service are the dulyelected Delegates and Alternates to the California Medical AssociationHouse of Delegates, together with the Elected Officers and Councilorsof the California Medical Association and elected Administrative Mem-bers-at-large. The last-named are listed below:

Mr. Lawrence Arnstein Mr. Forrest MurdockJ. Frank Doughty, M.D. Glenn Myers, M.D.Mr. Jonathan Garst Rt. Rev. Msgr. Thos. J. O'DwyerLowell S. Coin, M.D. Ernest Sloman, D.D.S.Alson R. Kilgore, M.D. Mr. Thomas TaylorDr. Tully C. Knoles Dr. Ray Lyman Wilbur

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4

Officers of the Ca ifornia Medlical AssociationGeneral Officers

President-John W. Cline, 490 Post Street. Vice-Speaker of House of Delegates Donald Editor-Dwight L. Wilbur, 490 Post Street,San Francisco 2. Garfield 1-1021. A. Charnock, 727 West Seventh Street, Los San Francisco 8.

Angeles 14.ExctvSertr--onHno,40utrPresident-Elect-E. Vincent Askey, 2210 West Chairman of the Council-Edwin L. Bruck, Executive Secretary John Hunton, 450 SutterThird Street, Los Angeles 5. Drexel 1254. 384 Post St., San Francisco 8. Sutter 1-7218. Street Room 2009, San Francisco 8. Douglas

Vice-Chairman-Sidney J. Shipman, 490 Post 2-0062.Speaker of House of Delegates-L. A. Alesen, St., San Francisco 2. Garfield 1-7164. General Counsel-Peart, Baraty and Hassard,

1401 South Hope Street, Los Angeles 15. Secretary-L. Henry Garland, 450 Sutter Street, Room 1800, 111 Sutter Street, San Fran-Prospect 6361. San Francisco 8. Sutter 1-7164. cisco 4. Sutter 1-0861.

Councilors

In addition to the elected district and at-large Councilors, the Council has as ex-officio members the following general officersPresident; President-Elect; Speaker; Vice-Speaker; and the Association Secretary.Council Officers: Edwin L. Bruck, Chairman; L. Henry Garland, Secretary.

District CouncilorsFIRST DISTRICT-John D. Ball (1950), 414

Spurgeon Building, Santa Ana. Imperial,Orange, Riverside, San Bernardino and SanDiego Counties.

SECOND DISTRICT-Jay J. Crane (1948),1921 Wilshire Boulevard, Los Angeles 5.Los Angeles County.

THIRD DISTRICT-Harry E. Henderson (1949),1214 State Street, Santa Barbara. Inyo, Kern,Mono, San Luis Obispo, Santa Barbara andVentura Counties.

FOURTH DISTRICT-Axcel E. Anderson (1950),Medical Group Building, 1759 Fulton Street,Fresno. Calaveras, Fresno, Kings, Madera,Mariposa, Merced, San Joaquin, Stanislaus,Tulare and Tuolumne Counties.

FIFTH DISTRICT-R. Stanley Kneeshaw( 1 948),404 Medico-Dental Building, 241 East SantaClara Street, San Jose. Monterey, San Benito,San Mateo, Santa Clara and Santa CruzCounties.

SIXTH DISTRICT-Edwin L. Bruck (1949),384 Post Street, San Francisco 2. San Fran-cisco County.

SEVENTH DISTRIcT-Donald D. Lum ( 1950),2225 Central Avenue, Alameda. Alamedaand Contra Costa Counties.

EIGHTH DISTRICT Frank A. MacDonald(1948), 822 Medico-Dental Building, 1127Eleventh Street, Sacramento 14. Alpine,Amador, Butte, Colusa, Eldorado, GIenn,Lassen, Modoc, Nevada, Placer, Plumas,Sacramento, Shasta, Sierra, Sutter, Tehama,Yolo and Yuba Counties.

NINTH DISTRICT-John W. Green (1949),Box 539, Vallejo. Del Norte, Humboldt,Lake, Marin, Mendocino, Napa, Siskiyou,Solano, Sonoma and Trinity Counties.

Councilors-at-LargeWalter S. Cherry (1948), 109 N. Riverside

Ave., Rialto, San Bernardino County.H. Gordon MacLean (1948), 230 Grand Ave-

nue, Oakland.Eugene F. Hoffman (1948), 2212 West Third

Street, Los Angeles 5.Sidney J. Shipman (1950), 490 Post Street,

San Francisco 2.Wilbur Bailey (1950), 2009 Wilshire Boule-

vard, Los Angeles 5.C. V. Thompson (1949), 125 South Crescent

Street, Lodi.

Standing Committees

Executive Committee*

The President, the President-Elect, the Speaker of the Hoidelegates, the Chairman of the Council, the Chairman of the A.Committee, the Secretary-Treasurer (ex officio), and the Editcofficio )

Auditing Committee*Sidney J. Shipman (Chairman) ........................... San FranciscoH.Gordon MacLean..............-........... Oakland

Donald D. Lum ----------- Alameda

Committee on Associated Societies and Technical Grou

Edward F. Nippert.............................................. Los AngelesPeter Blong (Chairman) ..................-..... AlhambraRobert A. Scarborough- ................. San Francisco

Committee on Health and Public InstructionsC. M. Burchfiel................................................... San JoseGeorge M. Uhl (Chairman)-------------------------------.Los AngelesOrrin Cook ..........-........-... Sacramento

Committee on History and ObituariesRobert A. Peers .......... ColfaxE. T. Remmen----------------------------------------------------- GlendaleMorton Gibbons, Sr. (Chairman) ...................... San FranciscoGeorge H. Kress (Honorary Historian) .............. ex officio

Committee on Hospitals, Dispensaries and Clinics

Clarence E. Rees .-...............-...................--.......... San DiegoAnthony J. J. Rourke ............... San FranciscoCarroll B. Andrews (Chairman) ................... Sonoma

Committee on Industrial PracticeDonald Cass (Chairman) . ...................... Los AngelesJ. B. Josephson..-------------------------------------..............San JoseWayne Pollock . .......... Sacramento

Committee on Medical DefenseEdward G. Ewer........... OaklandLouis J. Regan................................................ Los AngelesNelson Howard (Chairman) ...................... San Francisco

Committee on Medical EconomicsH. Gordon MacLean (Chairman) ........................OaklandHoward W. Bosworth . ........................ Los AngelesDell T. Lundquist......................... Palo Alto

Committee on Medical Education and Medical Institutio

L R. Chandler......................... San FranciscoFrancis Scott Smyth... ...................... San FranciscoB. 0. Raulston (Chairman) ......................... Los Angeles

Committee on Organization and MembershipHarold G. Trimble......................... OaklandH1ar A. Randel.........................F resnoCarlL.Mulfinge r (Chairman).L.. .... Los Angeles

Members appointed each year by the Chairman of the Cou

Committee on Postgraduate ActivitiesJohn C. Ruddock (Chairman) ........................ Los AngelesSalvatore P. Lucia San FranciscoEdward Blair ........-................. Paso RoblesL. Henry Garland ......................-.. ex officio

Committee on PublicationsR. H. Sundberg --------- San DiegoGeorge W. Walker (Chairman) ..........................FresnoGeorge Dawson ----------- Napa

Committee on Public Policy and LegislationLloyd E. Kindall .OaklandE. T. Remmen ------------------------------------------------GlendaleDwight H. Murray (Chairman)----------------------- Napa

Advisory CommitteeJunius B. Harris SacramentoH. Randell Madeley ...... VallejoWilson Stegeman Santa Rosa

Committee on Scientific WorkL. Henry Garland (Chairman) .. -.... ex officio

194819491959

194819491950

194819491950

Howard F. West .................................................. Los Angeles 1948Clayton Mote ....................................................... San Francisco 1949William 0. Russell .............-....-..... .......-.. Santa Barbara 1950George B. Robson (ex officio, Secretary, Section on Medicine)A. Morse Bowles............... (ex officio, Secretary, Section on Surgery)

Committee on Public RelationsThe Committee on Public Relations consists of the chairmen of the

following standing committees and of certain general officers of theAssociation, all serving ex officio.George M. Uhl..........Chairman, Com. on Health and Public InstructionCarroll B. Andrews..Chairman, Com. on Hospitals, Dispensaries, ClinicsDonald Cass ............... Chairman, Committee on Industrial PracticeNelson Howard............... Chairman, Committee on Medical DefenseCarl L. Mulfinger....Chairman, Committee on Organization, MembershipH. Gordon MacLean........Chairman, Committee on Medical EconomicsDwight H. Murray....Chairman, Committee on Public Policy, LegislationJohn C. Ruddock .........Chairman, Committee on Postgraduate ActivitiesJohn W. Cline............... President of California Medical AssociationE. Vincent Askey............... President-ElectL. Henry Garland............... Secretary-Treasurer

Communications for the Public Relations Department should beaddressed to the Director, Mr. John Hunton, Room 2009, 450 SutterStreet, San Francisco 8.

Cancer Commission1950 Henry J. Ullman............... Santa Barbara

David A. Wood (Sec'y, No. California). San Franciscons James F. Rinehart............... San Francisco1948 Lyell C. Kinney (Chairman) .-------------- San Diego1949 L. Henry Garland............... San Francisco1950 Orville N. Meland, (Sec'y, So. California) Los Angeles

Homer Woolsey (Vice-Chairman).WoodlandEric Larson .Los Angeles

1948 Harry E. Peters, Jr.-------------- Oakland1949 Physicians' Benevolence Committee1950 Axcel E. Anderson (Chairman)......................... resno

Elizabeth Mason Hohl Los Angelesncil. Robert A. Peers........................ Colfax

194819481948194919491949195019501950

6

ROSTER OF COUNTY MEDICAL SOCIETIES, CALIFORNIA MEDICAL ASSOCIATION(County society secretaries are requested to notify CALIFORNIA MEDICINE promptly when changes are indicated

in their roster information.)

SOCIETY PRESIDENT SECRETARY

ALAMEDA County Medical Association......Theodore C. Lawson, 3135 Webster Dorothy M. Allen, 2923 Webster364 14th St., Oakland 12. St., Oakland 9. St., Oakland 9.

BUTTE-GLENN County Medical Society......J. G. Hepplewhite, Chico. J. 0. Chiapella, 131 Broadway,Chico.

CONTRA COSTA County Medical Society....H. W. McNerney, 2600 MacDon- George D. Husser, 322 Twenty-ald Ave., Richmond. third St., Richmond.

FRESNO County Medical Society .---------------E. A. Patterson, P. 0. Box 1908, William N. Knudsen, 701 T. W.Fresno. Patterson Bldg., Fresno.

HUMBOLDT County Medical Society .......... Walter Dolfini, 539 G St., Eureka. Wayne P. McKee, Ferndale.IMPERIAL County Medical Society............. Charles Cutshaw, Brawley. George Cole, Brawley.

INYO-MONO County Medical Society..........Walter L. Wilson, 108 N. Main, Lloyd S. Bambauer, Bishop.Bishop.

KERN County Medical Society....................William H. Macdonald, 2103 18th Frederick 0. Wynia, 354 Haber-St., Bakersfield. felde Bldg., Bakersfield.

KINGS County Medical Society..................Allen Stamler, Corcoran. William F. Chamlee, Van SicklenBldg., Hanford.

LASSEN-PLUMAS-MODOC Co. Med. Soc.Wilbur C. Batson, Greenville. John Paul McKenney, Alturas.Los ANGELES County Medical Assn. E. T. Remmen, 429 North Orange, Carl L. Mulfinger, 1052 West

1925 Wilshire Blvd., Los Angeles 5. Glendale 3. Sixth St., Los Angeles 14.MARIN County Medical Society..................Ernest W. Denicke, 1010 B St., Carl W. Clark, 1010 B St., San

San Rafael. Rafael.MENDOCINO-LAKE Co. Medical Society....Clemens M. Beil, Upper Lake. E. C. Bennett, Ukiah.MERCED County Medical Society................E. R. Fountain, Merced. James A. Parker, Bank of America

Bldg., Merced.MONTEREY County Medical Society............A. L. Wessels, 11 Maple St., F. H. Smith, Salinas National

Salinas. Bank Bldg., Salinas.NAPA County Medical Society....................Charles H. Bulson, 1203 Seminary M. M. Booth, Bruck Bldg., St.

St., Napa. Helena.ORANGE County Medical Association........John Montanus, Rt. 1, Box 587A, Llewellyn E. Wilson, 502 Bank

Santa Ana. of America Bldg., Anaheim.PLACER-NEVADA-SIERRA Co. Med. Soc.....Paul Barnes, Loomis. Vernon W. Padgett, Grass Valley.RIVERSIDE County Medical Association......Franklyn D. Hankins, 3014 Pine Cecil Lord, 3616 Main St., River-

St., Riverside. side.

SACRAMENTO Soc. for Med. Improvement..Dudley Saeltzer, Medico-Dental Edmund E. Simpson, 1127 11thBldg., Sacramento. St., Sacramento 14.

SAN BENITO County Medical Society........J. M. O'Donnell, Hollister. J. J. Haruff, Hollister.SAN BERNARDINO Co. Medical Society..... Marcus D. White, 201 Fallas Bldg., Thomas F. Dempsey, 1272 E. St.,

Ontario. San Bernardino.SAN DIEGO County Medical Society.---------F. E. Jacobs, 4228 El Cajon Blvd., W. H. Geistweit, Jr., 810 Med.

1410 Medico-Dental Bldg., San Diego 1. San Diego 5. Bldg., 233 A St., San Diego 1.SAN FRANcIsco County Medical Society....Anthony B. Diepenbrock, 2180 Robertson Ward, 2180'Washing-

2180 Washington St., San Francisco 9. Washington St., San Francisco 9. ton St., San Francisco 9.SAN JOAQUIN County Medical Society......Dora Ames Lee, 110 North San H. D. Chope, Box 111, Stockton.

Joaquin St., Stockton 6.SAN LuIs OBISPO County Medical Society..H. N. Cookson, 154 Traffic Way, G. D. Kelker, Cayucos.

Arroyo Grande.SAN MATEO County Medical Society..........Stuart Lindsay, 440 Portola, San Albert G. Miller, Medical Arts

Mateo. Bldg., San Mateo.SANTA BARBARA County Medical Society-.D. H. McNamara, Cottage Hospital, Douglas F. McDowell, 317 W.

Santa Barbara. Pueblo St., Santa Barbara.SANTA CLARA County Medical Society........Joseph B. Josephson, 1541 The Leslie B. Magoon, 630 E. Santa

1101 Medico-Dental Bldg., San Jose 20. Alameda, San Jose 11. Clara, San Jose 12.SANTA CRUZ County Medical Society........Luther Newhall, Jr., Ocean and Samuel B. Randall, 230 Walnut

Broadway, Santa Cruz. Ave., Santa Cruz.SHASTA-TRINITY County Medical SocietyL. C. Mosher, Bieber. Julius M. Kehoe, Redding.SISKIYOU County Medical Society..............Richard W. Jones, 106 South F. W. Martin, Mt. Shasta.

Broadway, Yreka.SOLANO County Medical Society.---------------H. Randall Madeley, 727 Sonoma Charles H. Widenmann, 405

St., Vallejo. Georgia St., Vallejo.SONOMA County Medical Society.---------------Wilson Stegeman, 534 B St., Raimond F. Clary, 1616 Fourth

Santa Rosa. St., Santa Rosa.STANISLAUS County Medical Society......... Andrew Van De Pol, P. 0. Box J. Lyle Spellman, 138 McHenry

944, Modesto. Ave., Modesto.TEHAMA County Medical Society .......James L. Faulkner, Red Bluff. Arthur H. Meusser, Corning.TULARE County Medical Society............... Frank R. Guido, Box 1094, Visalia. Debora Pineles, Box 349, Visalia.VENTURA County Medical Society..............D. M. Clark, Foster Memorial Hos- A. A. Morrison, 34 North Ash,

pital, Ventura. Ventura.YOLO County Medical Society....................Max Waters, Porter Bldg., Wood- Emery Leivers, Woodland Clinic,

land. Woodland.YUBA-SUTTER-COLUSA Co. Medical Soc....John W. Scott, Colusa. Leon M. Swift, Box 244, Marys-

ville.

(For roster of C.M.A. committees and other organizations, see last month's issue)

MEETING

Third Monday, 8:15 p.m.,Hunter Hall, Oakland.

Second Thursday.

Second Tuesday, 8:00 p.m.

First Tuesday, University-Sequ6ia Club, Fresno.

First Thursday.Third Tues., 7 p.m., Barbara

Worth Hotel, El Centro.Fourth Wednesday, except De-

cember, January, February.3rdTues., 7:30 p.m., StockdaleCountry Club ex. Jun. Jul. Aug.Second Monday, 8:00 p.m.,

Legion Hall, Hanford.On Call.

1st and 3rd Thursday, 1925Wilshire Blvd., Los Angeles

Fourth Thursday, 7:00 p.m.,Travelers Inn, San Rafael.

Third Thursday, Hotel Tioga,Merced.

First Thursday.

First Wednesday.

First Tuesday, 7:00 p.m.,Windsor Cafe, Santa Ana.

At Call of President.2nd Mon., 8:00 p.m., Library,

Riverside Community Hosp.Third Tuesday, 8:30 p.m.,

Auditorium, Sacramento.At Call of President.1st Tues., 8:00 p.m., San Ber-

nardino Co. Charity Hosp.Second Tuesday, San Diego

Club.2nd Tues., 8:15 p.m., 2180

Washington St., S. F. 9.1stThurs., 8:15 p.m.,Medico-Dental Club Rms., Stockton.

3rd Sat., 7:00 p.m., GoldenDragon Cafe, San Luis Obispo

Third Tuesday of each month.

Second Monday, CottageHospital.

Every 2nd month, 2nd Tues.Time, place to be announced.

Second Monday.Sunday on Call.

2nd Thurs., 8:00 p.m., Casade Vallejo, Hotel Vallejo.

Second Thursday..

Second Friday, 7:30 p.m.,Hotel Hughson.

At Call of President.

First Wednesday.

Second Wednesday.

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It is estimated that between 10 and 15 per cent of adultmarriages are barren. In these the male is either a con-tributory or sole cause in 30 to 50 per cent of the cases,according to two San Francisco doctors writing in theJuly 12 issue of The Journal of the American MedicalAssociation.

Lewis Michelson, M.D., Assistant Clinical Professor ofObstetrics and Gynecology at the Stanford UniversitySchool of Medicine and Robin Michelson, M.D., studieda group of 855 barren marriages of which 519 husbandswere found to have impaired fertility.

In 287 of the couples the physicians collected adequatedata to analyze the relative fertility of husband and wife.They state that "this study offers a challenge to physicians,in that of these 287 couples there were 99, or approximately34 per cent, in which both husband and wife were appar-ently fertile, as far as could be determined (in the presentstate of medical knowledge), and still no pregnancyoccurred."The physicians point out "that either husband or wife

may be the sole cause `or both may have minor defects thecombination of which is sufficient to prevent conception.Consequently, one must not be satisfied with the findingof defects in one partner, but both husband and wifeshould be completely examined before an opinion is ex-pressed as to the factors causing the infertility and thepossibility of altering them."

CLASSIFIED ADVERTISEMENTS(Continued from Page 8)

FOR SALE: Complete x-ray equipment. 500 ma generator, rectifierand control; motor driven tilting Bucky table with fluoroscope and

rail-mounted tube stand, impulse timer accurate to 1/120 second;pendulum cassette changer. Xll Keleket. Price $1500. Cost $6500.Box 11,060, California Medicine.

FOR SALE: X-ray, 15 M. A.-General Electric, Model D. R. F.Shock proof, excellent condition, 110 volt, Radiographic and

fluoroscopic unit for office work, bucky diaphragm and table-S1,400.E. C. Oberson, M.D., 748 Marsh St., San Luis Obispo, California.

OPHTHALMOLOGIST desires California location, clinic or groupassociation. Medical, and 3 year postgraduate training ophthalmology

finest midwestern Universities. Present position, First Assistant toUniversity Chief of Dept. Previous private practice. Eligible forBoards. Well qualified to assume responsible position. Best referencesfurnished. Box 11,080, California Medicine.

FOR SALE-G. U. table used very little; Brown-Buerger Cystoscopeand all G. U. accessories. Inspect equipment 105 East Garvey,

Monterey Park. Make offer. No reasonable offer rejected.

BEVERLY HILLS, California Physicians office. Built in files andinstrument cabinets. Beautifully furnished extra large reception

room with receptionist. Beverly Hills Professional Building. Un-usually good transportation. Approximately 1,000 square feet parti-tioned, and will nicely accommodate two physicians. Complete X-Rayand Laboratory in building. Write W. E. Schwartz, D.D.S., 105 N.San Vicente Blvd., Beverly Hills.

RESIDENT PHYSICIAN for private sanitarium and clinic nearLos Angeles. Internal medicine and some experience in N. P. work

desirable. Excellent opportunity for qualified, energenc, ambitiousgentile. Salary open. Furnished residence on grounds. State full par-ticulars regarding experience, training, religion and salary expected.Also furnish recent photograph. Box 12,000, California Medicine.

PHYSICIANS WANTED-ORTHOPEDIST eligible or certifiedby board to join northern California group. Well established practice

this specialty. RADIOLOGIST for assistant with Diplomate in diag-nostic radiology. Excellent financial arrangements. Northern California.GENERAL PRACTITIONER-to begin unopposed practice in smallnorthern California community. Small guarantee frcan industrial work,equipment furnished. Housing available. OTOLARYNGOLOGISTand PEDIATRICIAN to associate with small group other specialists inPacific Northwest. Already well established. Percentage basis. IN-TERNIST-to share space with surgeon and EENT specialists. Im-mediate referrals. EENT specialist, certified or eligible to associateother physicians. Guarantee $1,000.00 month to begin. Foreign.Family housing available. Automobile furnished. Write, HedwigFalkell, Director, Pacific Coast Medical Bureau Agency, Inc., 1406Central Tower. San Francisco 3. Telephone, SUtter 1-5658.



Ready Now!

HYPNOTISM TODAYby

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REPORT TREND TOWARD RURAL PRACTICEBY RETURNED DOCTORS

The Bureau of Information of the American Medical As-sociation, which provides the medical officer with informa-tion regarding areas needing physicians, "is sensing thetrend of returned medical officers to move away from theirrecent venture in city practice to accept the opportunitiesof more active practice in smaller communities," accordingto Virginia Shuler, Director.

Writing in The Journal of the American Medical Asso-ciation, (May 17) the author points out:

"Demobilization is not completely over. Many young phy-sicians are still in the armed forces, and a large proportionof the resident physicians doing postgraduate work in hos-pitals are men who served in World War II. According tothe Directory Department of the American Medical Asso-ciation, approximately five thousand physicians have not yetdecided on a permanent location.

"Already the Bureau of Information is sensing the trendof returned medical officers to move away from their recentventure in city practice to accept the opportunities of moreactive practice in smaller communities. From studies of phy-sician distribution the general picture for location of phy-sicians during the year following V-J day shows an adequatesupply of physicians in most of the states but reflects aneed for a more coordinated system of medical service inmany of the rural areas.

"Leaders of the medical profession interested in betterrural medical service are working with the farm organiza-tions to outline a program of activity to develop in ruralareas an appreciation of modern medical service and theresponsibility of the community in planning a health pro-gram that will make the country physician a working partnertoward decentralization of medical care from urban to largetrade centers to the more rural sections of the population.The medical profession and the farm groups want to makerural medical service more adequate not only to the farmerbut also to those who extend this service to the farmer.

"Dr. F. S. Crockett, chairman of the Committee on RuralMedical Service of the American Medical Association, hasrecently announced that the Farm Bureau, the FarmersUnion, the Cooperative Milk Producers' Federation and theGrange have each appointed two of their members to actin an advisory capacity to the Committee on Rural MedicalService of the American Medical Association. This com-mittee will hold a meeting soon to outline and develop anactive program for regional and local rural' representatives.Thomas A. Hendricks, secretary of the Council on MedicalService, is working out a plan with the Committee on RuralMedical Service to coordinate the council's and the commit-tee's regional meeting in order to develop through work-shop conferences the most adequate extension of medicalservice to all areas.

"In December 1946 the Bureau of Information began asurvey through the local medical societies to determine theconditions and distribution of medical care in the ruralareas of the country. Through the cooperation of the secre-taries of the state and county medical societies, listings ofareas which have requested physicians are available to helpthe doctor in selecting an area in which to establish hismedical practice."

Accompanying The Journal article are reproductions ofseveral state maps showing the trend in locations of physi-cians from April 1946 to January 1947-the peak period ofdemobilization of doctors from the armed services. Thearticle also carries comments by several state medical secre-taries of conditions and distribution of physicians as relatedin medical care in their counties.



CANCER OF FACE, MOUTH, NECK TREATEDWITH X-RAYS, RADIUM

Two Dallas, Texas, doctors describe treatment with x-raysand radium of patients with cancer of the face, mouth andneck, in the July 5 issue of The Journal of the AmericanMedical Association.The physicians-Charles L. Martin,,,Professor of Clinical

Radiology at Southwestern Medical College, SouthwesternMedical Foundation, and Carleton Wright, radiologist-state that "cancer of the exposed surfaces of the skin andcancer of the mouth are of unusual interest to physiciansin the Southern states because of their high incidence inthis area."

Other investigators have observed that the increase inthe number of mouth lesions over that found in other re-gions was confined almost entirely to women. Drs. Martin

and Wright believe that the explanation for this is theprevalent habit of snuff-dipping among the women of thepoorer classes in the South. "About 90 per cent of thewomen admitted to our clinic with cancer of the lining ofthe cheek and palate have dipped snuff for long periods oftime," they state.The authors point out that a United States Public Health

survey made for the Dallas-Fort Worth area in Texas in1939 shows that 33.8 per cent of 3,683 cancers found amongfarmers and ranchers in the Southwestern states were skinlesions. The next highest figure was 30.3 per cent recordedin Birmingham, Ala. Most skin specialists believe that thishigh incidence results from constant exposure to sunshineand hot winds, which produce many precancerous lesionsin the blond type of skin found so predominantly in thewhite population of the Southwestern states. Cancerouslesions of the skin are so common in Texas that the average

(Continued on Page 17)

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CANCER OF FACE, MOUTH, NECK TREATEDWITH X-RAYS, RADIUM(Continued from Page 16)

outdoor worker is prone to disregard them until they becomelarge enough to cause pain or inconvenience.The technic of treatment as described by the Dallas physi-

cians is to remove the elevated tumor with an electric cur-rent and then to apply x-rays or radium to the area. Thus,the authors claim, extremely large doses of rays are notnecessary. Each treatment requires only a few minutes forits administration, and the patient loses little time from hisoccupation. However, a rather severe reaction appears aboutseven days after the treatment is completed, and the treatedarea is often denuded of skin. All evidence of the tumor

disappears during this period, and healing occurs in sixto eight weeks. "The resultant scarring is slight," accordingto the physicians, "and the cosmetic results, particularly onthe lip, are excellent."The authors caution that "the radiologist charged with

'the care of a cancer patient should make an all-out effortto produce a cure with his first series of treatments becausethe second attempt is never very effective and may actuallyproduce harmful results."The physicians state that this treatment will cure 25

patients out of every 100 with advanced cancer of the face,lip, mouth and lymph nodes of the neck for at least threeyears. A little more than 40 per cent of the patients maylive but have a recurrence of lesions during this three-yearperiod.

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JOURNAL SAYS PHYSICAL EXAMS FORPILOTS HAVE DEPRECIATED

The tendency of the Civilian Aeronautics Administrationto depreciate the quality of physical examinations for pilotshas been assailed by both The Journal of the AmericanMedical Association and the Journal of Aviation Medicine.The May 10 issue of The Journal of the A.M.A. says:The Journal has commented previously oi. the failure of

the Civilian Aeronautics Administration to'have its physicalexaminations conducted by competent physicians. TheJournal of Aviation Medicine points out that the depart-ment ruled that osteopaths could make these examinationsa few years ago and now examinations are being accepted

even from chiropractors. How many of the persons whoobserve air transport realize that this is the type of pro-tection afforded by the government agency? When one con-trasts the kind of education given to low grade nonmedicalhealers with the type of examination made by specialistswho are really competent in examining the eyes, the earsand the other special senses on which safe flying so greatlydepends, the folly of accepting examinations by the incom-petent becomes clearly apparent. The Journal of -AviationMedicine points out that the bars have not thus far beenlowered in the case of commercial and airline pilots, butthe tendency to depreciate the quality of the examinationmakes hazard of such lowering imminent. Surely, here is aresponsibility that the administrator cannot dodge.

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24 CALIFORNIA MEDICINE ADVERTISING

CUT IN V. A. BUDGET THREAT TO QUALITYOF MEDICAL CARE

Recent reduction by the Bureau of the Budget of theamount requested by the Veterans Administration to meetits needs "seems to threaten alarmingly" the quality of medi-cal care for the veteran, according to an editorial in theMay 24 issue of The Journal of the American MedicalAssociation.The editorial states in full:"The tremendous advances made in the quality of medical

services of the Veterans Administration in the past two yearsreflect the devotion of the new leaders to their ideals andthe cooperation of the medical profession. When the warended many physicians who could have returned to lucrativepractice with full satisfaction for a duty well done electedto continue beyond the ordinary call of duty through service

in the Veterans Administration. The enlistment of medicalleaders meant more than appears on the surface, for it aidedin causing many younger physicians to join the staff of theVeterans Administration. Thus the veteran himself benefitedby the improved quality of medical personnel; less than6,000 hospital beds have been closed for lack of staff. Eventhe closing of these beds was serious, but not nearly asserious as would have been the case had this program notadvanced so well. Though the program was expanding inquality as well as in the number of patients to be served,the pace was maintained. An extensive outpatient programand a series of clinics were added, 25 per cent of whosepatients would have otherwise had to seek hospitalization,even though outpatient treatment was more appropriate. Therecent reduction by the Bureau of the Budget of the amountrequested by the Veterans Administration to meet its needs


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CUT IN V.A. BUDGET THREAT TO QUALITYOF MEDICAL CARE(Continued from Page 24)

seems to threaten alarmingly this whole achievement. Al-ready the morale of staff is disturbed. The quality of servicerendered by the Veterans Administration is today a leavenfor the whole country. The budgetary needs to maintain thatquality should be met to the full if far reaching disastrouseffects are to be avoided."

THREE DISEASES CAUSE 80-90 PER CENT OFALL CASES OF HYPOGLYCEMIA

Eighty to 90 per cent of all cases of hypoglycemia, anabnormally low level of sugar in the blood, result fromthree diseases which Jerome W. Conn, M.D., of Ann Arbor,Mich., defines so that treatment may be more successful.

Writing in the May 10 issue of The Journal of the Ameri-can Medical Association, Dr. Conn differentiates the threetypes as follows:

Functional hyperinsulinism is caused by over-secretion ofinsulin in the pancreas. Insulin transforms carbohydratesfor body use but its overproduction deprives the blood ofnecessary sugar. Symptoms are weakness, irritability, fatigue,sweating and dizziness. This type is not progressive in sev-erity. It occurs more frequently under emotional or physicaltension which acts as a stimulus. Hypoglycemic attacksoccur two to four hours after meals. Dr. Conn found thata high protein, low carbohydrate diet is successful in themanagement of this type of hypoglycemia.

Organic hyperinsulinism is caused by the growth of atumor or tumors in the pancreas which stimulate the produc-tion of insulin. This type is progressive in frequency and


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THREE DISEASES CAUSE 80-90 PER CENT OFALL CASES OF HYPOGLYCEMIA

(Continued from Page 26)

severity of attacks which occur before breakfast from twoto eight a.m. and two to four hours after meals. The attacksare precipitated by skipped or late meals or exercise. Re-moval of these tumors results in complete alleviation of theentire disturbance without recurrence in the vast majorityof cases.The third type, hepatogenic hypoglycemia, is traceable to

changes in the liver. This organ is responsible for the stor-age of glycogen, which is converted into sugar as the needsof the system require. However, if this storage does not takeplace because of some condition such as a diseased gall-bladder, then the body is deprived of its needs. This typeof hypoglycemia is also progressive in frequency and severitywith attacks occurring before breakfast. These patientsshould be put on a diet both high in carbohydrate and highin protein.

ANNUAL LOSS IN MILK PRODUCTS, MEATFROM BRUCELLOSIS STAGGERING

The annual food loss in milk, butter, beef, veal and porkfrom brucellosis reaches a staggering total in calories of thekind most needed by an underfed world, according to aneditorial in the July 5 issue of The Journal ol the AmericanMedical Association.

Brucellosis, commonly known as undulant fever or Maltafever, is one of the most prevalent today and a source ofpotential danger to the national health. Goats, cows andhogs harbor the infection and man contracts it by drinkingraw milk or handling infectious material.The editorial estimates that "the total number of cases

reported in the United States has averaged about 4,000yearly for the past several years. Only the relatively severeacute illnesses are diagnosed and reported. Chronic infec-tions outnumber the acute illness by a ratio of at least 10to one but these chronic infections are rarely diagnosed.

(Continued in Back Advertising Section, Page 36)

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OFFICIAL JOURNAL OF THE CALIFORNIA MEDICAL ASSOCIATION© 1947, by the California Medical Association

VOL. 67 SEPTEMBER, 1947 NO. 3

Proctology for the General Practitioner*ROBJRT A. SCARBOROUGH,t M.D., San Francisco

][T is not the purpose of this presentation to offerAL anything new in the field of proctology, but,rather, to review certain common ano-rectal symp-toms and their correlation with the evidence of ex-amination in the establishment of correct diagnosis-a requisite for proper treatment.The average patient is reticent to volunteer to his

doctor the intimate details of his bowel habits andhis ano-rectal sensations. In most instances he willlimit description of his complaints to the simple state-ment that he has "piles." To accept this diagnosiswithout further interrogation and proper examina-tion is inexcusable neglect of the responsibilities ofthe physician to his patient.

There is no single symptom which is pathogno-monic of any specific abnormality or disease of theanal canal, rectum, or colon. Certain combinationsof symptoms may be sufficiently characteristic tostrongly suggest a specific disease, but diagnosis isnever certain until it has been established by properexamination.

Discussion will be limited to six common symp-toms: external elevations about the anus, protrusionsthrough the anus, anal pain, anal itching, bleeding,and change in bowel habits.

ANAL ELEVATIONS

The differentiation of external elevations aboutthe anus should be relatively simple, since they arereadily accessible to direct inspection and palpation.Yet incorrect diagnosis is not uncommon, with re-sultant inappropriate treatment. External hemor-rhoids should be readily recognized as subcutaneousvaricosities which distend when the patient strains

* Read before the Section on General Practice at the 76thAnnual Session of the California Medical Association, April30-May 3, 1947, Los Angeles.

t From the Department of Surgery, Stanford UniversitySchool of Medicine, San Francisco.

down. It is important to remember that externalhemorrhoids, unless acutely thrombosed, cause noappreciable symptoms. Acute thrombosis produces apainful, tender lump which must be differentiatedfrom a perianal abscess and a sentinel tag. Thesethree common types of painful elevations are not in-frequently confused and must be properly recognizedin order to initiate appropriate treatment. Acutethrombosis of an external hemorrhoid begins withsudden pain and simultaneous development of atender lump at the anus. The patient can tell, usually,not only the day but the hour when this occurred.Symptoms reach a maximum intensity quickly, andbegin to regress within a few days. In the case of aperianal abscess, pain precedes any evidence of ex-ternal swelling by hours or days. Symptoms areprogressive unless spontaneous rupture of the ab-scess occurs. A sentinel tag, often incorrectly calleda "sentinel pile," is an acute inflammatory elevationof skin distal to a fissure-in-ano. Pain with bowelmovements has usually been present for days orweeks before the development of a tender elevationat the anus.

Differentiation between these three conditionsshould never be difficult on physical examination.Acute thrombosis of an external hemorrhoid pro-duces a sharply localized, firm, rounded elevation,usually with a bluish discoloration, although at timesthis discoloration may be hidden by edema betweenthe thrombosis and the overlying skin. The usualsites for occurrence of thrombosis are in the twoposterior and the right anterior quadrants. The eleva-tion of a perianal abscess is less sharply demarcated,and palpable induration has a less distinct edge.Fluctuation may be present, but is not usually evi-dent until the abscess has reached maturity and isabout to rupture through the skin. The overlyingskin may or may not show an inflammatory red-

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The Dodo Flies Again

With the adjournment of the 1947 California StateLegislature, and more recently with the adjournmentof the first session of the Eightieth Congress, wordhas been passed around in some medical circles thatthe issue of compulsory health insurance is as deadas a dodo. While such word is reassuring, we arebeginning to wonder whether we should accept it asgospel.A few recent incidents might serve to refresh our

memories and to give us pause to consider whetheror not compulsory health insurance has actuallydied. Possibly it has only gone to sleep, to awakenat a more propitious moment.

Consider, for instance, the action of the CaliforniaState Federation of Labor (A. F. of L.) in circulat-ing a statement before the Senate Subcommittee ofthe Committee on Labor and Welfare, a statementwhich branded the California Medical Associationwith asserted unconsciousness to public needs anddisregard for sound social betterment.

Consider, again, the State Federation of Labor inwriting to every member of the California StateLegislature, to blast the C.M.A. for introducing alegislative bill which would ease the burden of sellingvoluntary health insurance by simplifying the sellingprocess without depriving any individual of the rightof self-determination. The State Federation of Laborcalls this "compulsory health insurance" which itclaims is a medical scheme to channel all voluntaryhealth insurance into the hands of the doctors.

These items are in the record now and, after aone-day spell, out of the headlines. However, theyare still in the minds of some legislators. Likewise

in the, legislative minds are memories of a recentlabor blast against Senator Robert A. Taft of Ohio,who was accused in a labor convention of beinganti-labor because he had opposed a health insuranceprogram which the convention labeled as PresidentTruman's but which we refer to as the Wagner-Mur-ray-Dingell Bill. Senator Taft may be vulnerable tolabor's attack on other grounds but this one is some-thing new.The final consideration is in the program of the

California State Democratic Party, which hasadopted health insurance as one of its goals. Thishas just happened and it means that every Demo-cratic candidate in this state may be called upon byhis party to espouse this brand of social soothingsyrup.The labor actions mentioned here might be ex-

pected as a part of labor's program of demanding itsown way. But when these moves impinge upon thecollective mind of the law-making bodies of thecountry, they represent political action. When theyenter that stage, they represent a problem whichorganized medicine must meet if socialization ofmedical practice is to be avoided. Medicine has theweapons available to it to wage the fight needed; allit needs is the will to use these weapons. And if themedical soothsayers have their way, trganized medi-cine would stack its weapons behind the door, tocollect dust.

If the threat of socialized medicine is properlydescribed in simile with the dodo, we strongly sus-pect that the ornithologists are misinformed as tothe death of this bird.

198 Vol. 67, No.3

JOHNW.CLINE, M.D.......................................................President EDWIN L. BRUCK, M.D............................... Council ChairmanE.VINCENTASKEY, M.D.........................................President-Elect L. HENRY GARLAND,M.D......................... Secretary-Treasurer

LEWIS A. ALESEN, M.D........... Speaker SIDNEY J. SHIPMAN, M.D.............Chairman, Executive CommitteeDONALD A. CHARNOCK, M.D........... Vice-Speaker DWIGHT L. WILBUR. M.D........................ Editor

JOHN HUNTON............. Executive Secretary

NOTICES AND REPORTS

The A.M.A. Centennial

Report of the Chairman of the C.M.A. Delegation

JOHN W. CLINE, M.D., San Francisco

The Centennial of the American Medical Associa-tion held in Atlantic City in June was notable for thelarge attendance, the number of foreign guests andthe quality and diversity of the scientific programs.Practically every country was represented and theattendance was said to total over 15,000.The House of Delegates was in practically con-

tinuous session throughout the four days and itsdeliberations covered a wide range of subjects. Themajor portion of the time was devoted to the prob-lems of the general practitioner, certain of the eco-nomic phases of medicine and the public relationsprogram of the A.M.A.

Concern was expressed over the current tendencyof young doctors to seek specialist training andrecognition and to shun general practice. Effortswere made to induce hospitals to be less restrictivein granting staff memberships and the Council onMedical Education and Hospitals was instructed torevise the rules for approval of hospitals for residenttraining so that requirements of experience and pro-ficiency would replace board certification and mem-bership in special societies for staff membership.

At the December, 1945, meeting, interim sessionsof the House of Delegates were established. It wasdecided at this meeting to hold these meetings indifferent parts of the country each year and to holdtwo-day scientific meetings devoted to the needs ofthe general practitioner in conjunction with them.A committee was established to survey current

medical education, to ascertain methods of utiliza-tion of hospitals to train general practitioners, andto investigate the adequacy of numbers and distribu-tion of physicians. This action was designed toascertain facts in an effort to improve the situationof general practice.

The stand of the American Medical Association inopposition to socialization of medicine was reiteratedand voluntary plans were encouraged. The Associa-tion of Medical Care Plans is to be given greaterassistance. The Bureau of Medical Economics is tobe expanded.

There were many other items of medico-economicimportance considered, including study and formula-tion of a code covering group practice, the nursingshortage, fees paid by government agencies, and payfor physicians in service.The public relations program of the A.M.A.

started in San Francisco last year came to a stand-still at this meeting due to an impasse reached by theBoard of Trustees and the Public Relations Advisorand the Executive Assistant in charge of Public Rela-tions. There were a, number of factors in the devel-opment of this situation which culminated in theresignation of the Advisor and the Executive Assis-tant. This temporarily leaves the A.M.A. withoutprofessional public relations aid. The House of Dele-gates decided that the office of Executive Assistantis to be filled as promptly as possible, and in theinterim public relations will be under the directionof the Executive Committee of the Board of Trustees.The Board has expressed a determination to see thatthe public relations of the A.M.A. are adequatelyhandled but has not yet had time to make the neces-sary appointment.The California resolution regarding public rela-

tions was passed with little change. The Californiadelegation was well represented on reference com-mittees and was active in the deliberations of theHouse.

Dr. Dwight Murray of Napa was reelected to theBoard of Trustees by an overwhelming majority.


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330, IRONTSTREET * SAN it-00R I II

BOARD OF MEDICAL EXAMINERS OF THESTATE OF CALIFORNIA

By FREDERICK N. SCATENA, M.D.

Secretary-Treasurer

Board Proceedings

While the number of applications being filed for physi-cian's and surgeon's certificates is less than the numberfor the corresponding period last year, the Sacramento officeis still receiving many inquiries from out-of-state doctorsregarding licensure in California.The following table gives the number of applications filed

for the first six months in 1946 as compared with the corres-ponding period in 1947.

APPLICATIONS FILED

Class Six months ended June 301947 1946

Written Examinations.349 380Reciprocity (other states) 617 905Government Credentials.49 61National Board Credentials 132 140

Total . . 1,147 1,486

The Board has set November 9, 1947, as the date for thethird oral and clinical examination for graduates of foreignmedical schools.

Oral examinations were held July 19 and 20 at the Boardoffice in San Francisco. One hundred and fourteen applicantswere examined with 54 successfully passing. Commissionerson examination were appointed due to the large number ofapplicants appearing.The Board appreciates the help given by the commis-

sioners and feels the doctors who are commissioners havean opportunity to learn the method used for the oral ex-aminations and also learn the reasons why over 50 per centfail in the oral examination.

ANTI SPASM ODICSTim Holt was thrown from his horse and broke his cossyx.

In case you don't know, that's the little group of bones atthe end of the spine.-From Harrison Carroll's Hollywoodcolumn in the San Francisco Call-Bulletin.We didn't know, anyway.

A man who in other respects appears to be quite rationalhas written in to suggest that if we have among our acquaint-ances a masseur who wishes to brighten up his advertising,we might offer him the slogan, "The Paws that Refreshes."

Honest good humor is the oil and wine of a merry meet-ing, and there is no jovial companionship equal to thatwhere the jokes are rather small, and the laughter abundant.-Washington Irvning.



ANNUAL LOSS IN MILK PRODUCTS, MEATFROM BRUCELLOSIS STAGGERING

(Continued from Front Advertising Section, Page 30)

If 4,000 cases are reported yearly it is probable that from40,000 to 100,000 infections occur yearly."

Citing investigations made for the state of Michigan, theeditorial points out that the average infected cow was foundto produce 2,065 pounds less milk per lactation period thanthe noninfected cow. Estimating that 10 per cent of 1,080,000cows in the state of Michigan were infected, the 108,000infected cows resulted in a total milk loss of 222,904,000pounds of market milk yearly-enough to supply about557,000 persons for one year.The editorial concludes that "development of still better

methods in diagnosis, treatment and prevention, in animalsand man, depends upon an increasing 'brucellosis-minded-

ness' and continued investigation. The disease continues tobe a major public health problem. Pasteurization of all dairyproducts must remain the greatest bulwark against humaninfection until methods of control can be perfected."

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SURGERY, X-RAYS AID IN CANCER TREAT-MENT OF LUNG AND LARYNX

Two physicians discuss the benefits of surgery and x-rayin the treatment of cancer of the lung and of the larynx,the voice organ, in the May 10 issue of The Journal of theAmerican Medical Association.John C. Jones, M.D., Assistant Professor of Surgery, Col-

lege of Medical Evangelists, Los Angeles, states that post-mortem examinations show that cancer of the lung con-tributes 10 per cent of all adult male cancers and is secondonly to cancer of the stomach; therefore it is necessary todiagnose the disease earlier if a successful surgical cure isto be secured.Between 80 to 90 per cent of patients complain of cough

as the earliest symptom. Dr. Jones lists pain as the second

most common symptom, then spitting of blood, loss ofweight, wheezing, labored breathing, clubbing of the fingersand toes and hoarseness.

X-ray, sta.es the author, "is the greatest single diagnosticaid at our disposal. . . . Bronchoscopy [inspection of theinterior of the bronchi] is the next most important diagnosticaid and is the easiest and most accurate method of earlydiagnosis."

Treatment requires removal of one entire lung. Dr. Jonessays x-ray treatment at best offers only relief for thosepatients who are inoperable.

In the past four years, Dr. Jones points out, 209 casesof cancer of the lung have been seen and diagnosed. Ofthese patients, 52 underwent surgery, being in the operablestage. Two patients died in the hospital and 11 died later.


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SURGERY, X-RAYS AID IN CANCER TREAT-MENT OF LUNG AND LARYNX


Thirty-nine patients remain alive, and a number of thesewill probably die of recurrence or spread of the disease.Maurice Lenz, M.D., Professor of Clinical Radiology,

Columbia University College of Physicians and Surgeons,New York, states that of 110 patients who received x-raytreatment for cancer of the larynx at the Presbyterian Hos-pital between 1931 and 1941, 30 were free from clinicalevidence of cancer between five and 14 years. Of these,23 patients are still alive.

Dr. Lenz points out that x-ray treatment is the methodof choice for early cancer of the vocal cords but when thecancer spreads then laryngectomy is necessary. This opera-tion requires the removal of the larynx.

URGE WIDER USE OF RADIUM FOR ASTHMATREATMENT IN CHILDREN

Treatment of 34 asthmatic children with radium provedto be so encouraging that three Baltimore physicians urgemore extensive use of this new type of therapy in the April12 issue of The Journal of the American Medical Association.

The, physicians-Arthur T. Ward, Jr., Samuel Livingstonand Dean A. Moffat, from the Departments of Otolaryngology,Pediatrics and Allergy, division of the Medical Clinic, of theJohns Hopkins University School of Medicine and JohnsHopkins Hospital-state that 15 -patients were completelyrelieved of asthmatic attacks; five children were relieved tosuch a degree that they have only an occasional mild attack;three children showed moderate improvement and 11 haveobtained no relief.


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G. F. FAIRBAIRN, M.D.THOMAS B. WIPER, M.D. W. N. TORRE, M.D.Director and Consultant in Thoracic Surgery Resident Clinicians

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Results ofHepatic FunctionalTests in Jaundice

TYPE OF JAUNDICETest Ohstructive Hepatocellular

Plasma Cholesterol . . Elevated Normal or LowAlkaline Phosphatase . Increased NormalSerum Protein ... . Normal Reduced; Reversed

Albumin-GlobulinRatio

Thymol Turbidity .. . .Negative PositiveCephalin-Cholesterol

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DOCTOR CITES WAY TO COMBAT RISINGDIPHTHERIA FIGURES

Diphtheria has made an alarming comeback, accordingto a Chicago doctor, who cites 18,541 reported cases in theUnited States in 1945 as against 14,126 cases in 1944 andpoints to an even higher trend for the first five months of1946-7,491 reported cases as compared with 5,937 dur-ing the same period in 1945.

Paul S. Rhoads, M.D., Associate Professor of Medicine,Northwestern University Medical School, writing in thecurrent issue of Hygeia, health magazine of the AmericanMedical Association, states that "according to the yearly re-ports of the United States Public Health Service about oneof each 13 diphtheria patients in this country dies of thedisease-in spite of a potent antitoxin supplied free fortreatment by most state health departments."

Diphtheria during the war years was and still is themajor epidemic disease in Europe, states the author. "In1943-44 it is estimated that more than 2,000,000 cases,"9writes Dr. Rhoads, "of which 100,000 were fatal, occurredin Europe exclusive of Russia. The epidemic is still raging.Several localized outbreaks in this country have been traceddirectly to military personnel returned from the wartheaters."The author cites other investigators who indicated that

German prisoners captured in Africa and interned in thiscountry frequently had diphtheria of the throat or skin andwere the reservoir from which many cases of the diseasespread to American soldiers and civilians.

Dr. Rhoads suggests that "if diphtheria is to be pre-vented from reaching epidemic proportions in the UnitedStates, public health 6fficials, physicians and parents mustrecheck the immunity status of all children and young adults,and properly immunize the susceptible."The Schick test, named for its originator, indicates sus-

ceptibility to the disease. But because there is no way ofknowing in advance just how long artificial active im-munity against diphtheria will last, the physician suggeststhat in order to be on the safe side the Schick test shouldbe repeated about every two years during the ages ofgreatest exposure-that is, from three to 18.The most effective and preferable preparation for im-

munization is diphtheria toxoid. "Ramon in 1923 discoveredthat diphtheria toxin could be rendered relatively nontoxicby adding formalin to it, without greatly reducing its abilityto stimulate antitoxin formation in the tissues of the per-sons receiving it," states the author, adding: "If a fullcourse of three-or better, five-injections of increasingdosage is employed, the method is more effective than toxin-antitoxin [prepared from the serum of immunized goats]and avoids sensitization of the recipient to any serum. Thusit is the preferable method. Usually it is administered atintervals of three to four weeks, but the doses may be givenat weekly intervals with safety.

"If sufficient dosage is given, 90 to 95 per cent of suscep-tible persons are immunized."

Dr. Rhoads says that every one directly exposed todiphtheria but showing no evidence of illness should havegerm cultures made from swabbings of the throat in addi-tion to a Schick test. Within 12 hours the cultures may beexamined. If diphtheria bacilli are found, the persons har-boring them may be injected with diphtheria antitoxin, apreparation made of the serum of immunized animals,usually horses.

"Thus," Dr. Rhoads states, "a good supply of ready-madeantitoxin is put into the subject's circulation and he ispassively protected for that exposure. However, such passiveprotection lasts only two or three weeks, so that a week afterreceiving the antitoxin he should begin a series of toxoidinjections so that he may become more or less permanentlyimmunized."



URGE WIDER USE OF RADIUM FOR ASTHMATREATMENT IN CHILDREN


The 34 patients were all under 14 years of age. They werechosen for this study because they had recurrent attacksof asthma and masses of adenoid tissue in the nasopharynx(the back of the nose). Twenty-four children had a familyhistory of allergic disease and 18 children had allergic mani-festations besides their asthmatic symptoms.

All of the children received complete physical examina-tions. The first attack of asthma in 22 of the 34 children wasprecipitated by a respiratory infection; for example, a *com-mon head cold, tonsillitis, pneumonia or the respiratory in-fections which are so often a part of the contagious diseasesof childhood.

In 16 patients attacks developed after exposure to the

common inhalants-house dust and animal danders or orrisroot and the common pollens.Treatment of each child consisted of applications of radium

to each side of the nasopharynx once each month for anaverage of four treatments. The immediate effect of theradium on the respiratory tract differed in these children.Many complained of sneezing and nasal discharge for 12to 48 hours after the exposures. In a number of childrenasthmatic symptoms developed several days after the first orsecond radium treatment, and the attacks were occasionallysevere.

In conclusion, the authors state that the "object of thisreport is to arouse interest in this new form of therapy, sothat its larger use may prove and extend the true value thatwe consider evident from the results of this detailed studyand from experience with hundreds of cases not includedherein."

SAN JOSE, CALIFORNIATelephone Mayfair 321

P A Non-Profit Sanatorium for the treatment of tuberculosis and other diseases_ - of the chest, located in the eastern foothills, overlooking the Santa Clara Valley.

MEDICAL DIRECTOR CONSULTANTS:Buford H. Wardrip, M.D. Harold Guyon Trimble, M.D., Oakland Glenroy N. Pierce, M.D., San Francisco

ASSOC. MEDICAL DIRECTOR Cabot Brown, M.D., San Francisco Gerald L. Crenshaw, M.D., OaklandC. Gerald Scarborough, M.D. J. Lloyd Eaton, M.D., Oakland Ina Gourley, M.D., Oakland

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WARN HOSPITAL BLOOD BANKS MAYTRANSMIT JAUNDICE TO PATIENTS

Emphasizing the danger of transmitting serum jaundicethrough hospital blood banks, three Boston physicians sug-gest preventive measures in the July 5 issue of The Journalof the American Medical Association.The physicians-Herbert Scheinberg, Thomas D. Kinney

and Charles A. Janeway from the Departments of Medi-cine and Pathology of the Peter Bent Brigham Hospitaland the Harvard Medical School, and the Departments ofPediatrics of the Children's Hospital and the HarvardMedical School-observed 11 cases of hepatitis (inflamma-tion of the liver) in the course of a year in which 2,443transfusions of blood and plasma were given.

Jaundice occurs when a bile-pigment or coloring mattercalled bilirubin, manufactured in the liver, gets into theblood and causes a yellowish discoloration of the skin,tissue linings and fluids of the body.

Serutn jaundice is a form of acute liver inflammationoccurring after an interval of 40 to 180 days followingtransfusion of whole blood, serum or plasma. Three blooddonors, subsequently investigated in this series, were foundto have had jaundice at some previous period or to havebeen exposed to someone who had.The authors explain the operation of a blood bank and

its dangers. First, a brief history is taken from each donor,which is designed to exclude those with malaria, syphilisor an acute illness. Approximately 500 cc. of blood are


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WARN HOSPITAL BLOOD BANKS MAYTRANSMIT JAUNDICE TO PATIENTS

(Continued from Page 50)then drawn and used as whole blood, if needed, at anytime during the ensuing five to seven days. At the con-clusion of this period the red cells are discarded and theplasma (the fluid portion of the blood) from 10 to 15bottles is combined to make a pool. Each pool is numberedand a record made of the donors whose plasma it con-tains. The pool is then frozen and stored in the frozenstate until needed.Of the 11 patients who developed jaundice after trans-

fusion from this pool, four died, a mortality of 36 per cent."The basis for condemning the practice of pooling plasma

is the fact that the amount of infective serum necessary toproduce the disease is incredibly small," state the phy-sicians.

They suggest that the following preventive measures beput into effect immediately: greater efforts should be madeto detect the infectious donors; the practice of poolingplasma should be curtailed, and lots of plasma should be.given to as few recipients as possible.

Blood, in their opinion, should not be taken from any per-son who has ever had jaundice or hepatitis; (2) had con-tact with a person with jaundice in the past year; (3)received human blood or its derivatives or (4) been a hos-pital patient in the past year.

In the future, the doctors suggest the use of whole bloodand plasma fractionation products in preference to pooledplasma. Plasma fractionation is more potent than plasmabecause it is derived by separating plasma proteins intocomponents responsible for a particular function. Thus theconcentrate can be used appropriately in the treatment ofspecific conditions.

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CIRRHOSIS OF LIVER NOT SYNONYMOUSWITH ALCOHOLISM, DOCTORS SAY

A serious disorder of the liver, known as cirrhosis, hasbeen persistently identified as alcoholic in origin. ThreePhiladelphia doctors suggest in the interest of scientificaccuracy "that all reference to any type of cirrhosis as'alcoholic cirrhosis' be abandoned."

Despite the progress of medical science in recent yearsin the study of the origin of cirrhosis of the liver, "its causeand mode of development continue to remain part of themysteries of medicine," according to Drs. Russell S. Boles,Robert S. Crew and William Dunbar, from the Medical andPathological Departments of the Philadelphia General Hos-pital, writing in the June 21 issue of The Journal of theAmerican Medical Association.

Portal cirrhosis, the type most frequently found in thiscountry, is generally accepted as being synonymous with

alcoholic cirrhosis, state the authors. In the portal area isa branch of the portal vein which drains the blood from theintestinal tract. When the portal vein becomes obstructed bydegenerate cells which are replaced by scar tissue, increasedpressure is necessary for forcing blood through the liver.This leads to disastrous conditions such as profuse bleeding,jaundice and swelling of the abdomen and later the legs.The authors present an analysis of 3,637 postmortem ex-

aminations made between 1942 and 1946. In this group, 142cases of portal cirrhosis were found. It was possible to obtainan accurate history concerning the use of alcohol in 64 ofthe 142 cases. Fifty were alcoholics and 14 claimed totalabstinence. In the remaining 78 cases there was either norecord of indulgence in alcohol, or the history concerning itsuse was questionable.

"It is significant that in younger persons with cirrhosis,(Continued on Page 60)

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CIRRHOSIS OF LIVER NOT SYNONYMOUSWITH ALCOHOLISM, DOCTOR SAYS

(Continued from Page 55)namely those under 40 years of age, nine of 13 admittedheavy drinking," the authors point out.Alcoholism is thought to contribute to the production of

cirrhosis of the liver because it is believed that the alcoholicnever eats enough and therefore does not get the essentialsubstances, or if he does take food he does not digest andabsorb the needed factors.On the other hand, the authors cite the theories of other

investigators who believe that cirrhosis of the liver may becaused by: intestinal bacteria following intestinal irritationfrom alcohol, acid fermentation or some other agent; allergicreaction resulting in shock, the result of repeated injectionof egg white or other protein and bacterial infections com-bined with poisons that are toxic to the liver.

ALLERGY TO PENICILLIN, ANTITOXINCONTROLLED BY BENADRYL

Two groups of investigators report the beneficial actionof Benadryl in patients who developed allergic reactions topenicillin or antitoxin serum treatment, in the April 26 issueof The Journal of the American Medical Association.

Benadryl inhibits the action of histamine, a poison releasedby the tissues in allergic reactions.

Fifteen of 824 patients who reacted with hives to penicillinwere treated with the antihistamine drug by Donald M.Pillsbury, M.D., Director of the Department of Dermatologyand Syphilology, Institute for the Study of Venereal Diseaseof the University of Pennsylvania, Howard P. Steiger, M.D.,P. A. Surgeon (R), U. S. Public Health Service, and ThomasE. Gibson, M.D., all of Philadelphia.


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ALLERGY TO PENICILLIN, ANTITOXINCONTROLLED BY BENADRYL


The doctors point out that hives and other allergic reac-tions to penicillin may constitute a serious bar to treatmentwith this drug. However, with the addition of a drug suchas Benadryl and more recently Pyribenzamine, administeredsimultaneously with penicillin, it may be possible to con-tinue treatment in these patients.

In conclusion they state: "Our experience indicates that(1) penicillin reactions are more frequently encountered inpatients who have had repeated courses of this drug; (2)some patients who have had an urticarial [in the nature ofhives] reaction to penicillin may tolerate further penicillintreatment, while others may not; (3) skin tests with peni-

cillin are unreliable as a means of prelicting the occurrenceof reactions to penicillin or further administration of thecompound; (4) antihistamine compounds, particularly Ben-adryl, are useful in controlling penicillin urticaria, and (5)urticarial reactions may at times be persistent and severe."

Another group of investigators-J. Cyril Peterson, M.D.,and Lindsay K. Bishop, M.D., from the Department ofPediatrics, Vanderbilt University School of Medicine, Nash-ville, Tenn.-treated 10 patients with Benadryl who devel-oped serum sickness following the administration of anti-toxin for such conditions as meningitis, diphtheria andinfluenza.The serum reaction consisted of a rash, vomiting or fever.

The doctors state that "in every instance 100 milligrams ofthe drug [Benadryll completely abolished all manifestationsof the serum sickness within a period of two to three hours."

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A Request forChange of Address

Must reach us at least three weeksbefore the date of issue with whichit is to take effect. Duplicate copiescannot be sent to replace those un-delivered through failure to sendsuch advance notice. With yournew address be sure to send us theold one, enclosing, if possible, youraddress label. from a recent copy.

California Medicine450 Sutter Street Room 2009

SAN FRANCISCO 8, CALIFORNIA



INDIVIDUALIZED TREATMENT NEEDED FORTHYROID PATIENTS TO AVERT CRISIS

Patients with a serious and sometimes fatal condition re-sulting from overactivity of the thyroid gland, called "thyroidstorm" by four Boston doctors, should receive individualizedtreatment directed toward the correction of all recognizableabnormalities.

Writing in the July 5 issue of The Journal of the Ameri-can Medical Association, Drs. Janet W. McArthur, RulonW. Rawson, J. H. Means and Oliver Cope, from the ThyroidClinic, Massachusetts General Hospital, state that of a total2,033 patients with a poisonous thyroid admitted to thewards of the Massachusetts General Hospital in the past25 years, 36 had experienced a "thyroid storm."

"Our conception of storm," the doctors say, "is essentiallythat it represents the inability of the patient any longer toadjust to the strain imposed by the hyperthyroidism [over-activity of the thyroid gland]."

Sixteen of 25 patients who experienced a thyroid stormfollowing surgery died and eight of 11 patients havingthyroid storm following medical treatment died.The most common complication in these 36 patients was

heart disease which was noted in 23 patients. "That thesecomplications exerted a significant, often decisive, influenceon the survival of the patients is clear," state the authors,for of the 12 survivors, whose average age was 43, five hadcomplicating diseases, whereas among the 24 deaths, averageage 49, 19 had complicating diseases.


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INDIVIDUALIZED TREATMENT NEEDED FORTHYROID PATIENTS TO AVERT CRISIS


In the majority of patients the physicians were able todetermine a precipitating factor which provoked the crisis;in the medical storms the commonest cause was the with-drawal of iodine and in the surgical storms, the crisis usuallyfollowed the removal of the thyroid.

In conclusion the authors point out that since thyroidcrisis occurs in patients with severe, poisonous thyroids whoare undernourished and suffer from serious complicatingdiseases and in whom medical treatment has been unsatis-factory, the occurrence of crisis can be reduced by notoperating on such patients until normal thyroid functionhas been restored in the patient with antithyroid drugs suchas thiouracil.

DR. ANDERSON ASSUMES DUTIES AS HEADOF MEDICAL EDUCATION COUNCIL

Donald G. Anderson, M.D., former dean of the BostonUniversity 'School of Medicine, has taken up his new dutiesas Secretary of the Council on Medical Education andHospitals of the American Medical Association. He suc-ceeds Victor Johnson, M.D., who recently was appointeddirector of the Mayo Foundation for Medical Education, atRochester, Minn.

Dr. Anderson is a graduate of Harvard College and re-ceived his M.D. degree from Columbia. He has had hos-pital and academic appointments at Boston City Hospital,Presbyterian Hospital in New York, Evans Memorial andMassachusetts Memorial Hospitals in Boston, and Colum-bia. During the war he was associated with Dr. ChesterKeefer in penicillin research for the Office of ScientificResearch and Development.

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Executive CommitteeEDWIN L. BRUCK, M.D., Chairman

G. D. DELPRAT, M.D.ALBERT M. VOLLMER, M.D.

L. E. HARDGRAVE, M.D.V. W. OLNEY, Secretary

A limited General Hospital of 200 beds admittingall class of patients except those suffering fromcommunicable or mental diseases. Organized in1871, and operated by a Board of Directors, underthe direction and supervision of the ExecutiveCommittee of the Medical Staff.

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