Medicine: Stone & Salute

Johns Hopkins Hospital in Baltimore last week harbored the jolliest of patients. He was Senor Manuel Luis Quezon of the Philippines. The President of the Philippine Senate and No. 1 politico of the Islands kept the entire staff in stitches, rumpled all kinds of hospital rules. Senor Quezon, 56, had plenty to keep his spirits up: his longtime dream of Philippine independence from the U. S. was well on the way toward reality; he confidently expects to be the Islands’ first President; he had kept Senora Quezon in Manila from worrying by entering the hospital under the name of Pedro Lopez; he had tormented the billion-dollar American Telephone & Telegraph Co. by attempting to charge to unaccredited “Pedro Lopez” $300 telephone calls to Senora Quezon. And above all, Urologist Hugh Hampton Young had just removed from the left Quezon ureter a good-sized stone shaped like Senor Quezon’s middle initial.*

The Baltimore Sun recorded the operation as for gallstones. But the would-be President of the Philippine Islands would have no truck with euphemisms. Well did he know that if the Filipinos, no prudes, ever caught him in a lie, they would certainly suspect him of suffering from a disability worse than gallstones. Therefore shrewd Politico Quezon ordered Dr. Januario R. Estrada, his personal physician and traveling companion, to telegraph a full and simple description of Dr. Young’s operation to the Philippine Press. United Press helped Dr. Estrada by cabling to Manila at reduced press rates the following astonishingly frank report:

“Hon. Manuel Quezon operated by H. H. Young Oct. 26. Patient en route operating room was very good spirits joking with intimate friends. Spinal anesthesia with novocaine was used also oxygen inhalation by mask. Although fully conscious throughout operation, Quezon stood same excellently, talking at times with surgeon, physicians regarding progress operation. Half hour before a good dose morphine was injected yet he seemed unaffected stating he fully conscious. Quezon had insistently requested be placed under general anesthesia order be fully unconscious. This, however, not granted for his own good as it was pre-arranged use only local anesthetic order avoid least possibility risking any lesion to lung. An incision about four to five inches long on left lower abdomen was made through which an L-shaped stone was removed from lower part left ureter in about 12 minutes. Thorough exploration of entire ureter upwards to kidney, downwards to urinary bladder and careful repair wound required altogether about 50 minutes.* One extraordinary thing about operation is that peritoneum not opened or in other words the abdominal cavity was not laid open. There practically no loss blood except what was expected on making superficial incision and consequently no risk for any post-operative hemorrhage. Incision was closed completely leaving small rubber tubing as drain. The tube was inserted by stab near the incision leading to neighborhood of opening made in ureter. Technical name for this trouble is calculus or stone in ureter or ureterolithiasis. Operation for removal stone on left ureter is ureterolithotomy. —Januario R. Estrada.”

Patient Quezon quickly recuperated. To his bedside he summoned newshawks to say: “I’m going to beat the record here. I thought I was an old man. But I’m not. In 15 days I’ll be dancing the tango. Dr. Young did a fine job opening me up.”

Baltimore reporters who rarely get a chance to interview Great Men on their Johns Hopkins sickbeds greedily scribbled their notes. Senor Quezon went on to discuss his experiences with urologists: “When I left Manila, the doctors told me I could drink nothing intoxicating. When I reached Java I saw a doctor, and he said ‘a glass of beer would not hurt.’ So I drank beer from Java to Paris. In Paris another doctor said: ‘You should not drink beer; wine is the only thing.’ So I changed gratefully to white wine. Then a French specialist told me: ‘You should drink only champagne, it is the only thing for you.’ So I drank champagne for a time.

“Then I reached the United States, and here my physicians tell me: ‘Don’t drink any wines and beers at all. Whiskey is the only proper drink.’ So now, if I want a drink, all I have to do is to decide which physician I will obey.”

Laughing gaily, the wily convalescent called to his secretary, Manuel Nieto: “Get some glasses.” In a few minutes merry nurses put glasses in all hands. Secretary Nieto poured the whiskey. One and all, including the distinguished patient, emptied their glasses to this Quezon toast: “We will drink the health of the American doctor in his own medicine.”

*Kidney and gallstones are the commonest accretions in the body. Kidney stones, caused by defective kidneys permitting salts to precipitate from the urine, are chiefly mineral (calcium oxalate, calcium phosphate, sodium urate). Gallstones are masses of organic cholesterin gathered from the bile by a lazy or infected gall bladder.

**For inventing, 30 years ago, the cystoscope which allowed Surgeon Young to explore the Quezon bladder before the operation, the South-western branch of the American Urological Association last week gave Dr. Bransford Lewis, 72, a gold plaque in St. Louis. Simultaneously St. Louis University, where he is professor-emeritus of urology, gave Dr. Lewis a commemorative gold medal.