Chicago School of Medicine and Surgery - Medicos Yearbook (Chicago, IL)

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LITERATURE ilaistnrp nf the Cllbinagu Hlehin The seed that was sown in January, 1916, by the Class of 1917 had, at last, ripened into a wonderful flower. Like all other hot-house plants, it had to be carefully nursed so that it might not perish before reaching its maturity. If you will allow me the privilege of retrospection, I Will freshen your memory on a few details concerning the Chicago Medic. In December, 1915, Mr. ,R. S. Cook brought before the class a suggestion, that we publish a monthly magazine, in interest of the students, faculty and alumni of the Chicago College of Medicine and Surgery. The idea stimulated class action, with the result that the following editorial staff was appointed: H. Buxbaum, Editor-in-Chief, G. F. Johnston and R. S. Cook, Associate Editors, Harry Lieffers, Business Manager Clater trans- ferred to R. S. Cookj, Lena M. Stewart, Secretary and Treasurer, D. H. Levin- thal, Art Editor, and Jos. Finberg, Staff Photographer. - The faculty endorsed the publication not only financially but morally, offering numerous suggestions and medical articles. Four issues were published, each being better than the previous one. Although this magazine was in many ways a success, it was some wanting financially. I wish to take this opportunity to publicly thank our genial College Librarian, Mrs. A. E. Smith, for the valuable assistance and interest she displayed in our behalf. - , , In conclusion, I wish to state that a project, so nobly begun, shouldnot have been abandoned by the present Junior Class, and hope that each successive class will follow our footsteps and profit by the errors that must of necessity occur in the initial attempt. g HENRY BUXBAUM. I l Pagz 172

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,...u,c-....n,....n.... ....,. LITERATURE The unserhatiun uf life in the rnstatit ' JOHN s. NACEL, M. D. ' Dean and Professor of Genito-Urinary Diseases. To remove the prostate gland is a comparatively simple operation tohone who has some degree of surgical skill and who thoroughly understands the anatomy of the perirreum, the prostate .and the bladder. To have your patient live and have a functionating bladder is quite another proposition. I have no thought of entering into the etiology, pathology or symptomatology of thesenile hyper- trophied gland, nor do I propose to discuss the advantage of the supra-pubic over the permeal route or vice versa. I, however, wish to call your attention to some points that will help to lower our mortality rate in this class of cases. By the very nature of the condition we are not very often called upon to'treat these cases under the age of 60 years and most frequently between 65 and 75. We have an individual who is undergoing senile decay and we are called upon to give relief by major surgical interference. Infection of the bladder is the one thing above all that we want to avoid, and yet this is not always possible. I-Iowever, this should not deter us from making every effort to prevent it. The primary examination should be done under the most strict aseptic conditions. I want to emphasize this as only too frequently have I seen these cases so badly infected by the first catheterization that their doom was settled then and there. Improper instruments, faulty technique and disregard of asepsis, together with the lack of prop- phylactic remedies against infection increases the mortality percentage by leaps and bounds. I have reference particularly to those cases where the physician is called in an emergency to give relief to an over-distended bladder. There are very few of these cases that will permit of catheterization with the ordinary catheter and usually considerable traumatism is produced by forcing the catheter to glide over the obstruction atthe neck of the bladder to the point where urine will flow. By this time, frequently, the eye of the catheter is plugged by a clot of blood, more manipulation is indulged in and more trauma produced. The hemorrhage from such trauma is many times of serious moment, the bladder filling with clots causing constant straining and tenesmus and the patient is brought to an emergency operation under unfavorable conditions. Again, we may have as the result of this trauma effectual plugging of the neck of the bladder from the edema and inflammatory reaction which necessarily calls for repeated catheterization to relievethe urinary distension. Under my present method of operating, I am convinced that the mortality rate has a direct ratio to the absence or the severity of the infection in the bladder. A clean bladder, a low mortality rate, a badly ,infected bladder, a high mortality rate. Inability to empty the bladder or a large amount of residualurine calls for repeated catheterization or a self-retaining catheter. The former means sooner or later an infected bladder. The latter is tolerated by a very small percentage of patients. The catheter produces constant discomfort and irritation which soon leads to infection. Then we have the class of cases who have never been catherized or instrumentated and yet have an infected bladder due to chemical irritation ofthe bladder from the decomposition of residual urine and the ever present colon bacillus. In all of these cases two problems require our consideration. First, the relief of urinary distress, and second, the restoration of the functions of the bladder. In my mind the first condition is best met by the supra-pubic cystotomy. Constant drainage of the bladder can only be done by the cystotomy or by the self-retaining catheter. I have already stated that few patients tolerate the latter. They are no more free to go about than with the cystotomy and are quite as uncomfortable so far as caring for the urine is considered. Forty-eight hcurs after cystotomy the patient suffers little or no discomfort except the care of the urinary discharge. The bladder is at rest, the patient eats and sleeps normally, all back pressure is removed from the kidneys and the bladder can be easily irrigated and cleansed with- out distress to the patient, and quite as important, one step in the removal of the gland has been accom- plished and the route sealed from infection by the presence of granulation tissue. There is no definite time to complete the operation except to wait until the condition of your patient warrants it. Nfy plan is not to hurry the second step. In one case I found it necessary to wait two months before I felt safe to undertake the removal of the gland. ' ' Page 174 . -,.f........,'-A. , ,.,..,..va-a-.W-f,..... . ., ,.-He.,-.-w,-...- ,..,.Ww-. ..m......-....,,.,.t.,-,n.-- ...... A . .. , it ,,.,,,.. JL., . .l .,a..,,..,.,, .I M: f .,....,:..e. :xt-:r l