SOUTHERN CALIFORNIA A MEDICAL, CLIMATOLOGICAL AND SOCIOLOGICAL MONTHLY MAGAZINE. This journal endeavors to mirror the progress of the profession of California and Arizona. Established in 1886 by Walter Lindley, M.D., LL.D. DR. GEORGE E. MALSBARY, Editor and Publisher. Dr. Walter Lindley, Dr. W. W. Watkins, Dr. Elbert Wing, Dr. Ross Moore, Dr. George T. Dillon, Dr. C. G. Stivers, Dr. Boardman Reed. Address all communications and manuscripts to EDITOR SOUTHERN CALIFORNIA PRACTITIONER, Subscription Price, per annum, $2.00. SALVARSAN DEATHS. 500 Auditorium Building, Los Angeles, Cal. EDITORIAL Superintendent Whitman's Report. I herewith submit to your body a report covering, as near as is possible for me to do, all of the circumstances and particulars appertaining to the fatalities which occurred at the County Hospital following the administration of salvarsanized serum to eight patients, all of whom were suffering from the effects of syphilis in advanced stages of the disease. In some, there was disease of the bones; others were in advanced stages of locomotor ataxia, in which portions of the spinal cord were degenerated. The Wassermann test, which is considered reliable, was made in each and every case; in addition a cell count of the cerebro-spinal fluid and the butyric acid test were made, all corroborating the clinical diagnosis of syphilis. Hence there can be no question as to the nature of the disease from which these patients suffered. The diagnosis having been confirmed, the question of treatment was a matter of selection. Well knowing that the older forms of treatment had proven ineffective in syphilitic cases, where the spinal cord was involved, and neosalvarsan, which has been regarded as a specific in the earlier stages, had proven ineffective when administered by the blood or into muscular tissue, another recognized mode of procedure was adopted, viz., the intra-spinal administration of salvarsanized serum, the technique of which is somewhat complicated, but it is exact, i. e., the quantity given to each person is definitely known, and according to reports from medical authorities, is more effective than when given in any other way. In this connection I desire to state to your honorable body that the Los Angeles County Hospital, instead of being an experimental station, as might be inferred from some published ac counts concerning this unfortunate affair, is in fact, although progressive, one of the most conservative of its kind, as is evidenced by the fact that the intra-spinal method of using salvarsanized serum had been in use for at least a year in many medical centers throughout the country before being used in this institution, and medical reports seem to indicate that this method is becoming the method of choice by many physicians in the treatment of spinal syphilis. It follows therefore that the treatment here used was no experiment, and I desire at this time to emphasize the fact that no experimental treatment upon human beings has been conducted in this institution since my incumbency, nor will any be tolerated. On the seventh of the present month, after consultation with several physicians, all members of the attending staff, Dr. A. T. Charlton directed the administration of salvarsanized serum to eight patients in the County Hospital, the serum having been prepared by himself according to authority. As all accounts so far published in the local press concerning the preparation and administration of this remedy to these patients are more or less inaccurate, I submit herewith attached in detail, Dr. Charlton's statement concerning the technique followed by him throughout the whole procedure. Statement of Dr. Charlton. "On Friday, the sixth instant, between nine and eleven A.M., I withdrew about 15 c. c. of blood from the veins of the arms of eight patients, and from two others about 6 c. c. of blood only was obtained. The amount of blood received from the two latter patients furnishing an insufficient quantity of serum for the spinal treatment, I decided to make a dilution which would include eight spinals and two intravenous treatments, and this was done. Two ampules were used for this dilution. On account of the lapse of time the intravenous was not used. "The blood was taken through sterile pipette placed in sterile centrafuge tubes and the serum separated from the fibrin and red cells. The serum which was perfectly clear, was pipetted off to the amount of 5 c. c. and this was placed in a sterile glass stopper bottle; to this was added one, two or three milligrams of freshly dissolved neosalvarsan in sterile normal salt solution. Following this there was added to the preparation 8 c. c. of sterile normal salt solution, using a sterile graduated all glass syringe. This procedure was carried out absolutely with the serums from each of the eight patients separately. The preparations were then all placed in a water bath at a temperature of 54C for one-half hour. were then placed in a refrigerator for twenty hours, each bottle labeled with patient's name and dosage for each. Technique of Administration. They "Under the usual aseptic conditions from three to seven c. c. of spinal fluid was drawn from each patient. Then from each individual bottle there was taken the diluted salvarsanized serum, using a sterile graduated glass syringe, and with this syringe the contents was introduced through the same needle by which the spinal fluid was withdrawn." I desire to state further that from the time my attention was called to these cases until the present, I have left nothing undone that would shed light upon the cause of this tragedy. I personally drove to Pasadena and got the Coroner, and at his request, went for the County Autopsy Surgeon. I also called in consultation a half a dozen or more prominent members of the profession, whose knowledge and advice I thought might be of service to us in this emergency. I personally phoned to all of the morning newspapers, giving them the first information they had of the affair. and I have practically placed myself and the records of the Hospital at the disposal of the public through the press and county officials ever since. As to the embalming of these bodies prior to autopsy, I will state that this was not done at the County Hospital, nor by anyone connected with the Hospital, but was done without our knowledge after the Coroner had removed the bodies from the Hospital. It is only fair to the Coroner to state that to my personal knowledge he was advised by six or more physicians that an autopsy would not reveal any characteristic lesions that would account for the deaths, and this opinion was substantiated by the autopsy. However, the autopsy was justified, since it revealed syphilitic lesions in the lung, liver and spinal cord in a patient who had denied having syphilis, thus corroborating the clinical and laboratory diagnosis and justifying the antisyphilitic treatment. The most plausible explanation of the cause of death in these cases is that oxidation had taken place in the neosalvarsan. This could have occurred through some defect in the glass container that was not apparent at the time the preparation was used. In conclusion I desire to express our appreciation of the treatment accorded our County Hospital by the great mass of the public and the press in this unfortunate affair, and I can only repeat that there is nowhere more sorrow concerning this unfortunate outcome of what was intended to be for the best health interests of the deceased patients than there is among the house and attending staffs of the Los Angeles County Hospital. Very truly yours, C. H. WHITMAN, Supt. APPROACHING MEETINGS. The State Society meets at the Hotel Potter, Santa Barbara, April 14-15-16, this year. Do your part to make it the biggest and best meeting of our State. Society. Make it a point to attend and take some part in the meeting. You will then feel a just sense of pride in what promises to be the busiest and most important meeting of our state organization. The President, Dr. F. C. E. Mattison, is bending every energy to make this meeting a milestone in the memory of the present generation. Let's help him. The Southern California Medical Society meets at Riverside, May 6-7, in the Mission Inn. Dr. William W. Roblee of Riverside is President, and Dr. Walter Brem, Brockman Building, Los Angeles, is Secretary. Such a team of executive officers, with such a delightful meeting place, bespeak a good meeting. This Society has developed to a size comparable with most state medical societies, and at its sessions creditable scientific work is presented. Every physician in this region ought to feel in loyalty bound to attend the sessions of this Society and take some part in its proceedings. Make your reservations at once for these two important meetings. These professional gatherings afford opportunities to meet our fellows scientifically and socially, in debate and association, to the betterment of ourselves and our calling. STATE JOURNAL INCONSISTEN CIES. No, we will not take time to mention all of them. But we note in the February issue of the State Journal, page 85, Atophan is classed among the "Interesting Frauds." Upon turning the page, the same drug is placed first among the advertisements. By the way, where is the Coca-Cola advertisement that formerly appeared in the Jones Journal? Possibly they only ad vertise in "our" Journal in the summer - time. Seriously, don't you think it would be more becoming the diguity of our profession if we were to insist upon the elimination of erratic, caustic criticism in the State Journal? The criticisms of the Carnrick preparations, on the page referred to above, are far from scientific in spirit. The entire space, for which the medical men pay, is devoted to clippings from the "Jour. A. M. A.,' a publication that readers of the State Journal are supposed to receive. If such clippings were carefully selected, they might be of scientific interest. But a criticism is only as strong as it is reliable, and to include among "interesting frauds" a number of reliable preparations of wellknown value in therapeutics, is to weaken the attack upon those nostrums that rightly deserve censure. Moreover, it's wrong. ILEAL STASIS. Dr. Rea Smith's somewhat optimistic paper on the surgical treatment of chronic intestinal stasis that appeared in the Southern California Practitioner for January, 914, along the lines developed by Sir Arbuthnot Lane of London has been followed in the Boston Medical and Surgical Journal, February 12, 14, by an extensive editorial and a leading article by Drs. Harold W. Baker and Donald . Baker of Boston. The editorial is very illuminating and closes with the statement that the work of Lane and his collaborators "has now opened the door of hope for many a one who would otherwise have been doomed to chronic invalidism." Drs. Baker quote Metchnikoff, who first pointed out that the large intestine is the cesspool of the human body. They name four causes of ileal stasis: Chronic appendicitis, an ileal kink, a congenital membrane or an incompetent ileo-coecal valve. They then enter fully into a description of the functions The of the ileo-coecal valve, but state their belief that the most common cause of stasis is chronic appendicitis. They close their paper by saying: "Any patient with symptoms of chronic constipation, autointoxication, suspected kinks or membranes, should have an X-Ray examination. When pathological conditions are found they should be treated medically or surgically. The surgical treatment is indicated where the medical has failed and always where a true lesion is known to exist." SEX EDUCATION. Dunno. Some of the so-called popular variety is decidedly more educational than edifying. If by "sex education" is meant the inculcation of a familiarity with social rottenness, it may be well to recall that vice is a monster of such frightful mien that to be hated needs but to be seen, but seen too oft, familiar with her face, we first endure, then pity, then embrace. Something like that. Sort o' dangerous. TUBERCULOSIS NURSES. A proposition is before the Council to provide the city of Los Angeles with a force of tuberculosis nurses. Action by that body has been postponed until more than half the year has passed, with the promise that little or nothing will be done. In the meantime we are told by the Health Office that tuberculosis has increased fifty per cent during the past year and is still showing no signs of abatement. Gentlemen of the Council, what are you going to do about it? Do you believe that the people of Los Angeles will be satisfied with your inactive policy, that bids fair to give us an unenviable reputation as a hot-bed of tuberculosis? Booker Washington urges that the negro be kept in the country, and that whisky and patent medicines be kept away from him. "These three things will help my race." EDITORIAL NOTES Dr. Harry G. Watson has taken offices in the Brockman Building. Automobiles killed 302 persons in the streets of New York City during .913. Dr. Milbank Johnson has resumed practice with offices in the MarshStrong Building. Dr. L. Goldschmiedt now has offices at the Hotel Northern, 420 West 2nd street. Los Angeles. Drs. Charles L. Bennett and W. H. Kiger have established their offices in the Consolidated Realty Building. Dr. James H. McKellar, a well known Pasadena specialist, has removed his offices to the Fay Building, Los Angeles. Harry G. Watson, M.D., formerly associated with Max Einhorn, New York, is located in the Brockman Building, Los Angeles. Dr. Harley Edgar MacDonald has taken offices in the Hollingsworth Building, corner 6th and Hill streets, Los Angeles. Dr. Norman Bridge, with his usual public spirit, has accepted a position on the directory of the Los Angeles Chamber of Commerce. Mr. and Mrs. Julian Kutnow of New York City are spending a few weeks in Los Angeles. While they travel the world over, yet we claim them as residents of Southern California. Philip Mitchell of Edinburgh, in the British Medical Journal, says that researches carried on by him show that 9, per cent of young children with tuberculous neck glands were infected with bovine bacillus. He urges wholesale sterilization of milk. Dr. Arthur Stanley Granger and Miss Sara Nelson were married at the residence of the bride's parents, Los Angeles, Tuesday, February 24th. Dr. and Mrs. Granger will be at home to their friends at Chamouny Apartments, 11th and Grand View, after April first. Dr. J. W. Cline, recently of Tacoma, Wash., is constructing a fine office, at the corner of Heliotrope Drive and Melrose avenue, where he expects to make his future location. Dr. Cline has been practicing in Tacoma for the past seven years, where he has given his attention very largely to surgery; but was obliged to move to Southern California for climatic reasons, for his family. AN A-1 LOCATION FOR DENTIST. In one of best suburban districts of Los Angeles, where I am just constructing a first-class office building, ou corner, consisting of seven rooms: Four reserved for my own use, and three arranged for dentist; waiting room in common. Rent will be $37.50 per month, including services of office girl; telephones, gas, electricity, water, etc. Twenty-five minutes' car ride from center of city. A fine opportunity for new location. Address Dr. J. W. Cline, 4354 Melrose Ave., Los Angeles. (References required.) Dr. Philip King Brown has founded a self-supporting tuberculosis sanatorium for the poor at Arequipa, California, for the tuberculous poor. Dr. Brown has imported from England an expert potter and with his aid has established a pottery in which each patient must do enough work to pay his share of the expense. The following were on February 27th elected members of the Los Angeles County Medical Association: Dr. Carleton Dederer, Box 123, L. A.; P. |