New York Medical College - Fleuroscope Yearbook (Valhalla, NY)

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cerebral trauma by dehydration and fluid limitation. He claims a mortality of only 13.8921 after the third hour of admission. Zierold on the other hand wishes to destroy the common belief that increased intra-cranial pressure is a com- mon, if not constant, accompaniment to severe head injury. Zierold questions the possibility of treatment by spinal drainage or by the use of hypertonic solutions in any case of increased intracranial pressure of a degree sufficient to endanger life. Significant advances have been made in the exposure of the cranial nerves. Peet presented fourteen cases of complete cure of glossopharyngeal neuralgia by intra-cranial section of the glossopharyngeal nerve. The symp- toms are those of sudden sharp excruciating pains which shoot down from the ear, base of tongue or posterior pharynx. Dandy finds the cause of Menieres disease to lie in the sensory root of the auditory nerve. Patients were cured by intracranial section of the nerve. A successful exposure of the facial canal was obtained by Tremble and Penfield in 1936. With the advent of ventriculography and encephalography a new and valuable aid in the diagnosis of intra-cranial lesions has been acquired. les- sen, Schoenfeld and Freeman made use of thorium dioxide as a contrast medium for ventriculograms in 1933. A recent innovation in cerebral arterio- graphy is the use of colloidal thorium for injections into the internal carotid artery to be followed soon after by a rapid series of skull films. That this method is not without danger was shown by Shih and lung who experimentally produced thrombocytopenic purpura by the intravenous injection of thorium dioxide in rabbits. Alexander, lung and Lyman again, found ependymal inflammation in certain cases, after the introduction of thorium into the ven- tricles. The miscellaneous contributions and noteworthy achievements which have been described are readily seen to have permeated all branches of surgery. That many of the stumbling blocks to health have been mowed down by the surgeon's knife must be granted but that numerous perplexing problems have been created, the solutions of which have merely been begun, cannot be denied. Although I am sadly unqualified to comment upon the training of a sur- geon, a few thoughts and observations are inescapable. Bedside instructions and the acquisition of diagnostic ability are to be highly recommended. How- ever, with the current practice of deep-seated and intricate explorations of organs and tissues a very thorough knowledge of surgical anatomy becomes indispensable. How can this be better acquired than by actual dissection upon the cadaver? It is perhaps only as a senior that the medical student realized the value of the many hours spent in the dissection room during his first year. Why should not the medical student as well as the interne have the opportunity of returning to the cadaver with the new interest and under- standing of one who is really prepared to intercept his findings? Surgical pro- cedures may be practiced upon the cadaver to very good advantage in prepar- ation for the surgery of the operating room, which to my mind, is delayed far too long. If we consider operative technic a mechanical skill to be developed just as any other act of skill it should be apparent that only thru early and persistent practice will it be acquired. Surgeons who have combined an irre- proachable surgical technic along with their diagnostic acumen and insight into pre and post operative care will always win our respect and admiration. -ill One hundred seventy-six

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temporal migriane by a combination of surgical procedures designed to diminish the angiospasm and desensitize the meningeal vessels. Instant and complete relief followed periarterial sympathectomy of the common carotid artery and removal of the superior cervical sympathetic ganglion along with six centimeters of the cervical sympathetic trunk. In 1935 Adson used a technic whereby the splanchnic nerves are sectioned and the first and second lumbar ganglia, together with a portion of the suprarenal gland, are excised. He claims that a modified high kidney incision gives excellent exposure. He believes this operation is superior to, and less formidable than a bilateral and ventral rhizotomy of the thoracic and lumbar roots from the sixth thoracic to the second lumbar segment, inclusive. Promptly following operation the systolic blood pressure is capable of dropping from 270mm. of mercury or more, to lOOmm. Improvement in clinical symptoms is more manifest than the actual drop in blood pressure. Retinal hemorrhage, spasm, and papilledema will often disappear following sympathectomy. Cardiac and renal functions also improve. Flothow and Swift reported a review of 100 cases in which sympathetic ganglionectomy was performed for various purposes. In scleroderma only some of the symptoms were ameliorated. In Raynaud's disease better results were obtained when only the lower extremities were involved. The question of operability or degree of vasospasm in thrombo-angitis obliterans was simpli- fied by the diagnostic injection of sympathetic nerves or by spinal anesthesia. Crile performed denervation of the suprarenals in over three hundred cases of various sympathetic disorders. Over 9O'k of those having neuro- cir- culatory asthenia, hyperthyroidism or peptic ulcer were cured or greatly im- proved. Selected cases of diabetes, epilepsy, and early hypertension also showing promising results, Crile's latest exploits have been localized about the celiac ganglion and aortic plexus. Whether young or old patients are concerned, Crile's treatment of essential and malignant hypertension by means of a bilateral excision of the celiac ganglion and denervation of the aortic plexus affords promise of permanent relief. Craig suggests section of the presacral nerves in cases of uncontrollable bladder pain or dysfunction, severe dysmenorrhea, or I-Iirschsprung's disease. Leriche and Fontaine advocate novocain infiltration of the lumbar sympa- thetic nerves for the treatment of post-operative femoral phlebitis. Pearl and Shapiro found that instances of abnormal sweating as to color, odor or chemi- cal composition calls for surgical intervention. Sympathetic ganglionectomy at the proper level will produce a total inhibition of sweating in the desired regions. They claim that the accompanying rise in peripheral vasoconstriction gives no uncomfortable symptoms. Levine has furnished us with evidence to show that the vagus in man is not the constrictor nerve of the bronchial mus- culature, and that impulses for bronchial constriction must therefore be con- tained in the sympathetic fibres. With this in mind he attempted to interrupt this sympathetic reflex mechanism in bronchial asthma. In 23 cases of intract- able bronchial asthma treated by injection of the communicating rami complete relief was obtained in 75W, with varying degrees of improvement in the re- mainder. The management of brain abscess is still in a state of confusion. Many surgeons are in doubt when to drain an abscess, and are uncertain as to the procedures to use. A similar disagreement exists in the treatment of head injuries. Temple Fay regularly presents data, to support the treatment of One hundred seventy five

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IT HAPPENED IN ANATOMY- . Dr. Gerlach-Describe to me the mesentery of the duodenum. Bohmer-I cant describe it but l'll draw it. Dr. Gerlach-Dat iss a goot drawink but I giff you feefty. Vat structures pierce the diaphragm? Rohmer-CI-Ie fooled me once but not againl NOTHINGI Dr. G-erlach-Excellent, I giff you zero. BACTERIOLOGY- Schwab-Give me the lid of that Petri dish, Hank. I'm ready to plant the culture. Sherwood-You don't put it on the lid, you put it on the media. Schwab-You're crazy, it belongs on the lid. Sherwood-O. K. Schwab-fAfter 15 minutesl Dr. Hotchkiss, how long does it take for the bacteria to fall from the lid on to the media? GYNECOLOGY- Dr. Silverblatt-What are the three stigmata of gonorrhea in women? Tramont-Well, I really don't think you can always blame the woman. Dr. Silverblatt-CAS the class laughsl Doctor, stigmata means signs. CHEMISTRY- Quiz Master-What are the advantages of mother's milk over cow's milk? L. Rubin-It doesn't have to be kept on ice. Sherwood-It doesn't have to be pasteurized. Reinstein-lt comes in more attractive containers. PHARMACOLOGY- Dr. Boyd-What is another name for Chorea? Kay-St. Vitus dance. Dr. Boyd-Who was St. Vitus? Kay to Sherwood-Who the hell was he? Sherwood-Buzzzzzzzzz Dr. Boyd-Well? Kay-Oh yes, he was the man who chased all the rats out of Ireland. PATHOLOGY- Miss Fisher-Dr. Speer, I've come to return my box of slides. Dr. Speer-Carl, will you please take care of Miss Fischer's box. OBSTETRICS- Dr. Yerbury-What is the first thing you ask your patient when she tells you she thinks she is pregnant? Gartner-Ask her if she had any intercourse. PHYSICAL DIAGNOSIS- Dr. Zimmerman-What are to two types of breathing? Tedesco-What? Dr. Zimmerman-What? Tedesco-What? Dr. Zimmerman to class-What did he say? Class-He says he can't hear you. Dr. Zimmerman-Oh-What are the two types of breathing? Tedesco-Oh-NORMAL AND ABNORMAL. MINOR SURGERY- Dr. I-Ierrlin-What is the first thing you do when you find a patient in shock? Burrett-You give him a whiff of chloroform. ORAL SURGERY- Dr. Mayer-What is Tic Doloreux? De Philips-Why Doctor--er it's-that is-it's a form of Neurology. H R One hundred seventy-seven