Medicine: Postgraduates in Manhattan

As it does every autumn, the New York Academy of Medicine conducted a notable series of lectures and hospital demonstrations for the benefit of practicing physicians during the past fortnight. The subject this year was “Diseases of the Respiratory Tract,” and it provided a compact postgraduate course in all the ailments which attack the respiratory tract from the nostrils to the base of the lungs.

Dr. Eugene Hillhouse Pool, teacherish president of the Academy, opened the lecture course, then ducked out on 750 out-of-towners who signed up ($3 each) for the course. Manhattan manners were forgiven, however, when Dr. Pool, long-time professor of clinical surgery at Columbia University, reappeared at San Francisco to be elected 1936 president of the American College of Surgeons (see p. 42).

Of 21 lectures and 248 demonstrations, Dr. Pool might well have considered himself unlucky to have missed the following :

Tonus. Dr. Yandell Henderson of Yale was too sick at New Haven to present personally the most significant lecture of the series, an explanation of why people feel “all in” after operations, injuries, anesthesia and severe illness. Dr. Henderson sent his younger colleague, Dr. Howard Wilcox Haggard, to read the prepared lecture.

“Physiologists, especially those interested in the nervous system,” read Dr. Henderson’s proxy, “understand fully that posture, particularly the ability to stand erect, or to hold up one’s head, is dependent upon tonus. It is not, however, sufficiently emphasized, or even generally realized, that when a patient is too weak to stand or even to hold up his head, his condition is generally one of extremely low tonus.

“The full practical significance of tonus has not yet, I believe, been realized either by physiologists or clinicians.”

Unless the anesthetist and surgeon take precautions, four out of five patients who undergo abdominal operations suffer partial collapse, wrote Dr. Henderson. Their respiration is shallow, their pulse rapid. In most cases this can be prevented if the surgeon “traumatizes as little as possible” and if the patient whiffs at carbon dioxide off & on for three or four hours after the operation. The carbon dioxide stimulates the lungs to breathe deeply, thus raises the body’s general tone.

Sinus. Dr. Charles Terrell Porter, Boston ear, nose and throat surgeon, presented an alarming picture of infected sinuses. They may, said he, cause no pain. Painless or painful, the infection from such sinuses drops into the throat, slips into the lungs and stomach, is responsible for many diseases of the chest, asthma, arthritis, various skin abnormalities, dull and irritable wits. In children from 6 to 15, chronic sinusitis often develops, occasionally infects the eyes, brain, skull, lungs.

Dr. Porter’s warning: “In all cases with chronic sinusitis swimming and diving in fresh water and public bathing beaches should be prohibited. It is well to remember that any chlorine or other purifying agent in a pool strong enough to kill bacteria with any degree of speed is more than likely to temporarily paralyze or damage the delicate mucous membrane of the nose and sinuses, thereby tending to promote infection.”

Pneumonia is one of the most common acute diseases seen in hospitals for children,” asserted Dr. Charles Hendee Smith, Manhattan child specialist. Pneumonia— attacks either the bronchi (the big, first branches off the windpipe) or the lobes of the lungs. Bronchial pneumonia seems to be caused by a virus, and in New York City “it occurs mainly in young infants and is rare over three years. It is seen in feeble or debilitated babies, following a simple nasopharyngitis or bronchitis, after measles, whooping cough or other acute infectious diseases. . . .”

Lobar pneumonia is caused by a large variety of pneumonia germs. Rarely is it fatal. Children usually catch lobar pneumonia from relatives. Observed Dr. Smith: “There is frequently a family epidemic of colds and we have recovered the same type of pneumococcus from contacts, that is, persons who are in contact with the child patient, in a high percentage of cases. There is almost always a preceding respiratory infection, so that lobar pneumonia in children does not come out of a clear sky. The onset of fever is sudden, and is apt to be high.”

Although seldom fatal, lobar pneumonia may have serious after-results. Infection of the middle ear, said Dr. Smith, is “the most frequent complication of lobar pneumonia and the younger patients rarely escape it. Empyema is another complication that may develop, either during the acute stage of the disease or after the crisis.”

Tuberculosis has, during the past 15 years, dropped from first to seventh place as a cause of death in the U. S. as a result of preventive education of the public, improved hygiene in homes, more sanatoriums for victims. “Nevertheless,” said Dr. Arnold Rice Rich of Johns Hopkins, “tuberculosis is still far & away the most common cause of death in that valuable age period between 15 and 40. The disease that still kills more than twice as many individuals as any other single cause of death during the most productive and enjoyable period of the life span can hardly be jubilantly regarded as being nearly conquered.”

That sex has a positive effect on tuberculosis germs is a new hypothesis set forth by Dr. Rich. He sees the sex factor in the fact that until puberty boys and girls are equally resistant to tuberculosis. But during that span of 20 years during which ordinary men and women produce children, tuberculosis kills more women than men. After the sex life becomes quiet more men than women die of the disease.

Colds. To Dr. Alphonse Raymond Dochez of Columbia University has fallen the job of leading the battle against the 250,000,000 common colds which afflict the U. S. each & every year. Latest news of that battle, which Dr. Dochez reported last week, is that the common cold is primarily due to an invisible virus which he has at last grown in the embryonic tissues of unhatched chickens. That virus renders the body susceptible to secondary germs which actually cause the cold, which in turn renders the body susceptible to the germs which cause bronchitis, pneumonia, sinus, ear infections. Dr. Dochez announced that he expects to make a cold-preventive vaccine from that virus and those secondary invading germs.

The first 48 hours are “most important in curing a cold,” according to Dr. Dochez. If the victim has a fever, he should go straight to bed. This is “of especial importance in the case of old people and of those suffering from chronic diseases such as chronic pulmonary affections, cardiac conditions, chronic kidney disease, diabetes.”

Influenza. “Notable progress has been made in our knowledge of influenza during the last two years,” reported Dr. Henry Thorndyke Checkering of Columbia University. A large part of that progress was the proof which Dr. Thomas Francis Jr. of the Rockefeller Institute developed that influenza is due solely to a virus. Dr. Francis proved this by cultivating the virus in live ferrets. Although he too deals with a virus, Dr. Chickering is less hopeful of immediately developing an anti-influenza vaccine than his colleague Dr. Dochez is of developing an anti-cold vaccine.