Board of Health will maintain one organization only, and it will take full control of venereal diseases (in the department in which it logically belongs) and thus abolishes the Oregon Social Hygiene Society by that name and as a separate organization. LETTERS FROM DR. MATSON We take much interest and pleasure in publishing in this issue extracts from several letters written by Dr. Ralph Matson to his brother, Dr. Ray Matson. Dr. Matson is now occupying an exceptionally high position with the British hospital service at the invitation of Sir Almworth Wright. Drs. Matson are considered among the foremost investigators and authorities in the field of bacteriology and tuberculosis, and this latest honor is but another tribute to their prestige and repute and the high regard with which they are held, not only here but abroad. Dr. Matson writes an entertaining and interesting letter, and we are sure our readers will enjoy his observations and reports from the front. SECRETARY OF THE NAVY DANIELS' REPORT The Medical Sentinel is in receipt of the annual report of the Secretary of the Navy, covering the question therein of health and sanitation, and quotes therefrom as follows-showing that war service in time of peace is more healthful than the hazardous avocation of farming, et al.: REPORT OF THE SECRETARY OF THE NAVY The chief object of concern in the Navy to the Surgeon General and the Medical Corps, is the matter of health and sanitation and the clean living of the personnel, essential to efficient service. I doubt if the families or friends of the young men who enter the Navy realize how carefully guarded as to health conditions these young men are. No institution of private training is so zealous for the well-being of its charges, or so watchful for the preservation of its own good name as is the Medical Department of our naval service. A constant pride is exhibited by our medical officers in maintaining health and sanitation on the ships or stations under their care, and constant efforts are being exerted to provide further safeguards. Mortality statistics tell us that if these young men remain on the farm or in the city, eight out of every thousand will die during the year from the ordinary hazards open to all of us in the way of disease and injury during what should be the healthiest years of our lives. But last year only 4.48 per 1,000 of the naval personnel were lost by death. Could anything be presented more convincing of the efficiency and devotion of our caretakers of health? Incident to the nature of a seafaring life is of course the constant menace of drowning, and of our total deaths 51, or one-sixth, are due to this cause. Of these, however, 21 are those who went down with the F-4. It is noteworthy that the three predominant causes of death, drowning, tuberculosis, and pneumonia, all show upon analysis encouraging improvement over preceding years. Tuberculosis also, as it is handled in the Navy, is found less frequently in naval than civilian life. To quote statistics again, our civil population between the ages of 15 and 60 years owes 30 per cent of its total deaths to this disease; naval mortality during 1915 owes 11 per cent of its deaths to this cause, and this is being materially bettered each year. The activities of the medical department of the Navy during the past year have been unusually marked. Naval and military developments of this unprecedented epoch of military history are constantly being observed and proper use made thereof in the plans and activities of our own service. Our medical officers detailed for observation purposes with the warring powers are informing themselves of all facts available pertinent to the medico-military aspects of naval life. Our own military activities in the last two years have devolved upon our shoulders a large degree of medical care and treatment of the people of Haiti and Santo Domingo. In the former country affairs have resolved themselves into the formation of an orderly system of government, in which the United States is doing its utmost to lend assistance to the local medical authorities. Our medical officers, acting in amicable unison with a commission of leading Haitian physicians, have gone over the existing laws relative to public health matters, and new laws have been drafted making necessary changes. Certain of the more important of these changes are now being put into execution under the presnt regime until such time as the proposed alterations of the Haitian statutes can be secured. Undoubtedly the future will yield as much credit for notable sanitary efforts here as has been the case in the past in Panama and Porto Rico. The usefulness of a hospital ship as a necessity in modern warfare has been emphasized by the European conflict, and the naval act of this year, besides increasing the Medical Corps from 347 officers and 1,500 men to 600 officers and 3,000 men, besides facilitating advancement in the Hospital Corps from the lowest enlisted rating to that of actual commissioned officer, and besides increasing the total appropriation for he medical department from $682,000 last year to $1,186,728 for the current year, has led the navies of the world in authorizing the construction of a model hospital ship, which will be a veritable Bellevue afloat. The war across the Atlantic has demonstraed the value of the hospital ship. The British alone employed over 40 ships of this class during the Gallipoli campaign. These ships and the ships employed by other nations, however, were designed for other purposes and hastily converted to meet the emergency. The new hospial ship being constructed by the Philadelphia Navy Yard will be an oil-burner, with all that this means for comfort and cleanliness. A stabilizer will make for steadiness afloat. Not only will she provide hospital accommodations for the sick of the fleet, but experience of a number of years with the Solace has shown the necessity of making provision for an out-patient department, wherein men of the fleet may receive special treatments and examinations, returning to their ships on the same day. The Navy is also to be congratulated upon the consistently maintained standards that are giving us a personnel whch is the pick of the ambitious youth of our Navy. During the past year 106,392 sought enlistment in the During the last four Navy. Of these only 30.18 per cent were accepted. years, owing to a full or relatively full complement, the large number of applicants, and consequent ability to make more careful selection, the percentage of acceptances has decreased from an average for the previous six years of 52.67 to 30.18. The present rigidity of physical requirements not only insures a fine standard of men but helps to lighten the pension load of The urgent need of more men, as would happen the country in future years. in time of war, could be met by a modification of the sandards without entailing the acceptance of any deficient types. The provisions made for the medical department by the Sixty-fourth Congress, on the recommendation of the department, were timely and far in adPromotions and higher rank were accorded vance of any former provision. The reorganization of the Hospital Corps into the commissioned officers. sures advancement in their profession and promotion in rating to all, under methods of training and recognition of ability not before possible. This progress had its inception in the establishment in 1914 of the two finest professional training schools for hospital corpsmen in the world, one on the Atlantic at Newport and one on the Pacific at San Francisco. Hand in hand with this training there now exists a satisfactory steady flow of promotion through ratings similar to those of the seaman branch, established by a recent act of Congress in the appropriation act for 1917. Successful schools have been established in Samoa and Guam for training native women in nursing. Homes for nurses at Mare Island and Boston have been furnished, and provision has been made on the coast lines south of Norfolk and Mare Island, which are as yet unprovided with Navy hospitals, for the calling into being of mobile Red Cross hospitals of 250 beds each, with complete personnel and equipment. To prepare the Medical Reserve Corps a correspondence school has been initiated for the purpose of training these officers. The higher standards, the zeal and sacrifices of the men in this corps, and their devotion to health and sanitation, can not be too highly commended. Authority has been given by Congress 'for ample reserve stock, medical and surgical supplies, which is recognized as essential in a comprehensive plan of being ready for emergencies. EDITORIAL NOTES Mulford Company Anniversary The twenty-fifth anniversary of H. K. Mulford Company has been commemorated with a special issue of the Mulford Digest, is full of good things for any forward-looking doctor. The scientific original research work reported came largely from the laboratories of the firm itself. Dr. A. L. Garbat, of the Pasteur Institute, contributes an important section upon serobacterins, while the contribution of Dr. George H. Robinson on standardization of antimeningitis serum is just now specially acceptable. Noguchi's testicular method of preparing smallpox vaccine is presented by Dr. Elgin. Much other matter not here enumerated makes the booklet worth a good deal, and altogether a wonderful story is told of recent medicine and the growth of a great house of manufacturing chemists. Original Articles GALLSTONES A POSSIBLE ETIOLOGICAL FACTOR IN By J. Chris O'Day, M.D., Portland, Ore. That pancreatic disturbance may have the effect of producing glycosuria has been occasionally observed. In the year of 1907 the writer, in a paper before the Mississippi Valley Medical Society at Columbus, Ohio, suggested the possibility of gallstones, by way of disturbing the pancreas, being an etiological factor in diabetes. This paper was published the November of the same year in the International Journal of Surgery. It was shown that gallstones were found in approximately ten per cent of post mortems wherein their presence had not been suspected before death, and the observations that had been made by Professor Maurice H. Richardson were pointed to as evidence that the idea was not entirely without some very good and substantial reasons. My attention was first directed to those peculiar forms of pancreatitis observed occasionally in association with gallstones the April of 1903. At that time I heard Professor Richardson in an address before the Cleveland, Ohio, Academy of Medicine report the case which had impressed him with the belief that gallstone irritation was capable of precipitating a change in the structure of the pancreas, particularly its head. In a patient, twenty-one years of age, after removing 350 stones from the gallbladder, palpating the ducts he discovered an indurated mass running upward along the inferior vena cava. Owing to the patient's age he justified himself in excluding malignancy, and then he goes on to say that time and again he has found the head of the pancreas enlarged, hard, at times almost cartilaginous, associated with changes in the gallbladder, and usually with gallstones somewhere in the biliary tract. To quote further, "Whatever lesion may have been found in the cases of others, in mine there has been no opportunity to determine even what these changes in the pancreas mean, for the patients have all recovered perfectly, and thus far permanently. That this condition of the pancreas is connected with abnormal conditions of the biliary passages seems to me reasonable, espe cially in view of the extraordinary success which in some cases follows temporary drainage through the gallbladder. I have found these changes in the pancreas under no other abdominal condition, although for some years I have made routine examination of the abdomen whenever the patient's condition has justified this slight increase of exposure." At Within the four years which followed Professor Richardson's report, three cases of gallstones associated with a marked glycosuria were encountered and from the character of each I formed the notion that many of the cases of diabetes might have their origin in prolonged yet overlooked gallbladder diseases. the time I presented this paper, in the discussion which followed, little or no encouragement was given the idea. My case of gallstones associated with glycosuria were regarded as a mere coincidence, but before the death of Professor Richardson occurred, he, too, had observed a glycosuria which seemed to have had for its cause the same pancreatic change he had previously noted as a result of gallbladder irritation. Since that time other observers, particularly the Mayos, have made reference to the same condition. During a visit to the Mayo Clinic in May, 1916, in discussing the subject with Dr. Charles H. Mayo, he told me they had encountered quite a number of cases of glycosuria associated with gallbladder disease and that most of them cleared up after drainage of the gallbladder had been established. This, however, would not obtain if the change in the pancreas was a permanent one. At the time my report was made I knew but little of carbohydrate tolerance, but since this particular field was made attractive to me through certain cases of hyperthyroid goiter and carbohydrate disturbance I have come to such an understanding of the subject that I am compelled to look upon all glycosurias as a mere symptom of impaired, lost or destroyed carbohydrate tolerance. Thinking thus, the next question in order, how has the carbohydrate tolerance been overthrown? As I will deal with this subject in detail in a paper soon to appear in the New York Medical Journal entitled "Surgical Control of Carbohydrate Tolerance," we will now consider the report of the case I have in mind. The report of this case is exceedingly interesting because of the severity of the symptoms of diabetes and which cleared up so readily after the obstruction to the pancreas was removed. The first point of interest was the finding of stones in the ampul of Vater. These stones, while small, were conglomerated in a mucoid substance and the mass being too large to pass through the papilla had a ball-valve-like action, giving rise, at times, to obstruction of the pancreatic duct, but before discussing other phases of the operative findings we will turn to the full history. |