ROSTER NUMBER
ublic
» the
UNIVERSITY
\/ OF MICHIGAN
&
ka AY 26 1955
Sur- AL
» the
k on
short
The
TP NIEDICIIIE
aii PuBLISHED MONTHLY By THE MINNESOTA STaTE MEDICAL ASSOCIATION
ws Volume 38 MAY, 1955
stu-
il General Practice Symposium
Dr.
ns Printed in U.S.A. (Table of Contents—Page iii) 40c a copy—$3.00 a year
or
; of
rom
the
) to
_ wide clinical range:
epts 80 percent of all
a bacterial infections
ae and 96 percent of all
five c ) 4
‘ acute bacteria!
respiratory infections
1S” respond readily
eral
i notably safe, well tolerated
ree-
art-
INE ry SH,
2
iSNIVULS BEY 4O %L1—G DILOISILNY
‘ bd ‘
' +4 ri
SNIVULS 90S 4O 3NON—V SILOIGILNY
‘ ° ]
'
'
e
‘
SNIVHLIS 98S AO %~VE—NILADAWNOYXOTHD
ITOO IHDIWAHDSS 'SNIVULS SLE JO %oz—a@ 21.0161 LN VOSS rE
ry s
§NIVULS BLY 40 3NON—V DILOIGILNY
s
° :
SNIVH1S BS AO %~OOL—NILADAWNOYUOTHD
SNVQIYNIA SNODOVO Lda aL
SNOPODOLAIALS DILATOWA
nt
Nn
AUNV SNODGIOUSIW JIL
SNIVHLIS 9LL AO ~%YVL—NILADAWONO TH
SNFANV SADDOIQUSIN:
sensitivity of common pathogens to CHLOROMYCETIN
and three other major antibiotic agents
n
—_
a
<
O
a
a
more effective against more strains...
AEROBACTE
Chloromycetin.
for today’s problem pathogens
ceeenaces
Because of the increasing emergence of pathogenic strains
resistant to commonly used antibiotics, judicious selection of the
most effective agent is essential to successful therapy. In vitro
sensitivity studies serve as a valuable guide to the antibiotic
most likely to be most effective. Both clinical experience and
sensitivity studies indicate the greater antibacterial efficacy of
CHLOROMYCETIN (chloramphenicol, Parke-Davis) in the treat-
ment of many common infections.
OF 173 STRAINS
OF 19 STRAINS
CHLOROMYCETIN is a potent therapeutic agent and, because certain blood
dyscrasias have been associated with its administration, it should not be used
indiscriminately or for minor infections. Furthermore, as with certain other drugs,
adequate blood studies should be made when the patient requires prolonged or
intermittent therapy.
a - 4
ANTIBIOTIC A—NONE OF 506 STRAINS
, :
ANTIBIOTIC B—17% OF 488 STRAINS
CHLOROMYCETIN-—91
° '
CHLOROMYCETIN—95%
' '
Adapted from Altemeier, W. A.; Culbertson, W. R.; Sherman, R.; Cole, W.; Elstun, W.,
& Fultz, C. T.: J.A.M.A. 157:305 (Jan. 22) 1955.
DETROIT. MICHIGAN
Volume 38
GENERAL PRACTICE SYMPOSIUM
LABORATORY AIDS
Neurodermatitis Carcinoma in situ of the Uterine Cervix ener
Louis A. Brunsting, M.D., Rochester, Minnesota .... 291 David C. Dahlin, M.D., Rochester, Minnesota .......... ¥
Differential Diagnosis of Tumors of the Neck
Oliver H. Beahrs, M.D., Rochester, Minnesota ......... 293 CASE REPORTS
Fractures of the Upper Extremity in Children os 0
John C. Ivins, M.D., Rochester, Minnesota ................ 296 Hemobilia Following Blunt Trauma to the Liver sahet
Management of Recent Injuries of the Hand
Paul R. Lipscomb, M.D., Rochester, Minnesota ........ 299
Precautions in the Use of Cortisone for Treatment of
Rheumatic Diseases
L. Emmerson Ward, M.D., Rochester, Minnesota ....
H. M. Broker, M.D., and L. J. Hay, M.D., Minne- How I
PONS, TIMES O Ay 525.25. Arsensccscdsas tesco cevesecesewecuscsvessthes 1
Association of Intracranial Meningioma with Pituitary
304 Adenoma ce
J. Grafton Love, M.D., and Charles M. Blackburn,
Digestive Ailments of Older Patients M.D., Rochester, Minnesota ........:.ccesceeeseseeeesesseeeen ea
Albert M. Snell, M.D., Palo Alto, California ............ 309 ax D
ation
Management of Acute Abdominal Diseases
William H. ReMine, M.D., Rochester, Minnesota .... 315
CLINICAL-PATHOLOGICAL CONFERENCE
Hematuria Case Presentation
John L. Emmett, M.D., Rochester, Minnesota .......... 320 A. C. Aufderheide, M.D., Duluth, Minnesota ............ 3
The Technique and Interpretation of the Vaginal atroge
Examination Char
Edward A. Banner, M.D., Rochester, Minnesota ........ 323 PRESIDENT’S LETTER
The Treatment of Anemia
Charles H. Watkins, M.D., Rochester, Minnesota .... 327
In Appreciation
Arnold O: “Swenson; WMD. a. cciisiccccciccescctesicvcssssvcscscecetses j
Owner and Publisher
Published by Minnesota State Medical
Association
496 Lowry Medical Arts Building
St. Paul 2, Minnesota
Official Journal
Minnesota State Medical Association,
Southern Minnesota Medical Associa-
tion, Northern (Minnesota Medical
Association, Minnesota Academy of
Medicine, Minneapolis Surgical So-
ciety, Minnesota Obstetric and Gyne-
cologic Society, Duluth Surgical
Society, Minneapolis Academy of
Medicine, and Minnesota Society of
Clinical Pathologists.
Business Manager
R. R. Roseti
496 Lowry Medical Arts Building
St. Paul 2, Minnesota
Contents of MINNESOTA MEDICINE
copyrighted by Minnesota State
Medical Association, 1955.
Entered at the Post Office in Saint
Paul as second class matter. Accepted
for mailing at the special rate of
postage provided for in Section 1103,
Act of October 3, 1917, authorized
July 13, 1918.
ains |
vhich
conti
ptable
photog
Authors
Manuscripts should be addressed to Arthur H. Wels, M.D., Editor, 915 East Fi
Street, Duluth 5, Minnesota. Telephone RA 7-6636 or JA 5-2319. Original papers prepart
for publication solely in MINNESOTA MEDICINE will be considered by the Board of Edito
providing they fulfill the following editorial standards. Manuscripts should be typi
double spaced on white paper with at least 1-inch margins. The original (not a carb
copy) is requested. The title on the first page should be under six words if possi
or divided into two parts. The author should give his highest degree, his institutio
position or his relationship to a hospital or medical organization which he may !
addressing. Pages should be numbered consecutively and the author’s last name shoUffhe rig
appear at the top of each page after the first page. views
le Med
Biographical references should appear on a separate sheet entitled “Bibliography.” TM
should appear and be numbered consecutively in the order in which they first occur
the text (not alphabetically). Citations in the text require reference numbers if 4
author’s or authors’ names are not used or if there is more than one reference to Wy).
same author or group of authors. All references to author should appear in
Bibliography and no references should be included which are not in the text. The stiMlassifie
and exact punctuation used in the J.A.M.A. references is requested. For a journal this iMtional,
Author’s last name, initial, initial.: title-of paper. Abbreviated name of journal, volu elepho
number: page, year. Book references should give author, title, edition number, (
publisher and year. nual
B30.
Illustrations (photographs, tables and graphs) should be submitted separately and ‘ommu
combined in the text. There should be a separate sheet entitled “Illustrations” Woilfyesoy
ii
Contents. for May, 1955
JTORIALS WOMAN’S AUXILIARY
eneral Practice Symposium ...............c:cccccccccessceescceeceeeee 341 International Health Organization, Part I
Lsessssees ER BERT SESIEE EROM Cee Rer noe er neuen Te 341 Bes. ED. BP. Walthquist 1..o-.osssesesesssnsssnvscanserieecsneesinoconenes
i my Praming in: Alletgy ....2.:...:0..<..s0ss.e0sedsencsesexsceeee 342 Cilarhficld Blois HleaBibe Wey ccosecccocscccsccsccceccoceccsossossee
MEE IN EG 2 5525520255, Seen eds cc sales caee Coco Saves dachabecaseen anion 342 Ramsey Auxiliary Reports Activities
os of Hearing in Children 200.000.000.000. cccccecceseeeeeeeees 343 a ee ne ee oe ee ee
r jabetes Detection Programs. ..................:ccccceccessceeeeeeeeeees 343
Minne- [Mow Long Should One Keep Valuable Papers? ............ 343
mie , , " IN MEMORIAM
ituitary Wadia is As Vitae 2205 otek tee
ICAL ECONOMICS hubené:-Rowriseme Sheen aiie cc. ctis. ccsnceedicecsceeereen tune:
ickburn, fi Pum ~ iemanneas C lala CRAIN 52a nce ceca aines cent reece
ieee qgpMA Reviews Legislation Status..................ccccccscsscssssseree S49
ax Deferment Bills Make Slow Progress ......................+ 346
ational Board Notes Exam Requirements .................... 347. OF GENERAL INTEREST
NCE TRCUAMMIMEETINO@ WES «<< cace ccs cxcssoxescvasexrosesaceetassaiis eee eas
1 OC JOSS | oS ee ee en ROR Race ete a atone OPE eer oy sr
oe pRRENT CARDIAC CONCEPTS Minnesota Blue Shield-Blue Cross Plans ..........:::0c0-000
atrogenic Heart Disease
K REVIEW ;
sei th. Resse: Wi Sea. tly PO ice asa cra
ROSTER—MINNESOTA STATE MEDICAL
A 4@PORTS AND ANNOUNCEMENTS ........--:0::-5 349 ASSOCTATION, 1955 «......--:cc-cscsssssserscssscrsrssosesenseeses
ains the various types of illustrations listed separately and numbered in the order Editing and Publishing
; hich they appear in the text. All photographs must be in black and white, clear Committee
) East Fi contrasting, and on glossy prints. Instructions for combining photographs are E. M, Hammes, M.D.
ers prepalintable. Any number of illustrations over 4 are charged to the author. Combinations Chairman, Saint Paul
d of Edita photo h . y ‘ 3 F. M. Owens, Jr., M.D.
graphs up to one-half page (6 x 43@ inches) count as 1 illustration. Satae Daal
id be typ T. A. Peprarp, M.D.
ot a carbd Minneapolis
3 . H U ,» M.D.
if eae
institun"iters and Reviewers ’
he may | Board of Editors
Jame sho he right is reserved to reject material submitted for reading or advertising columns. he Oe ae.
views expressed in this journal do not’ necessarily represent those of the Minnesota Editor-in-Chief, Duluth
Medical Association or any of its constituents. — W. Arneicer, M.D.
hy.” Tht Minneapolis
phy. Joun F. Briccs, M.D.
rst occur Saint Paul
if ti A E. B » M.D.
ibers : "‘Rechanat ‘sii
ence 10 “Berti ; S. Francis C , M.D.
a ae tiers and Subscribers preancis Cuptzcia
3 The st lasified advertising—10 cents a word; minimum charge $2.00; key number, 25c a et
rnal this #@tional, Remittance should accompany order. Display advertising rates on request. a B. Howan, M.D.
: Jun Minneapolis
nal, volul elephone Nestor 2641. Henry G. Moenrinc, M.D.
umber, il Duluth
nual Subscription—$3.00. Single Copies—$0.40. Foreign and Canadian Subscriptions Guenn J. Mouritsen, M.D.
B50, Fergus Falls
‘ be af a. B.A.
ely and "ommunicati . + oo gs aint Pau
on unications concerning advertising and subscriptions should be addressed to Cine Sites. 60%
ions) Wl'KNEsora MepICI
NE, 2642 University Avenue, Saint Paul 14, Minnesota.
iil
Rochester
The pulmonary Ventilator is designed for the
administration of oxygen to the patient's
lungs under intermittent positive pressure. It
is excellent for the applications of aerosols
such as Alevaire, Aarolone, Isuprel, and other
broncho-dilators, as Vaponefrin or various
antibiotics. These agents under intermittent
positive pressure distribute themselves
throughout the respiratory tract. Its exception-
al utility has been demonstrated in the suc-
cessful treatment of the following:
e Bronchial Asthma
e Bronchiectasis
e Chronic Bronchitis
e Emphysema
e Pneumonitis
e Silicosis
It is recommended for these and other related
fibrosis diseases where continued administra-
tion of aerosols is indicated. The results of the
intermittent positive pressure breathing, ob-
Tn Pulmonary Ventilator
Sensitive
Safe
Highly
Effective
served in the symptomatic treatment of chron-
ic pulmonary diseases have been definite. In
patients affected with dyspnea, hard racking
cough, and tenacious sputum, improved
breathing at rest and during exercise with
lessened cough and expectoration has been
recorded. In general, improvement has been
most definite in cases with moderate admix-
ture of emphysema, fibrosis, and chronic
bronchitis. Adaptable for use with any oxv-
gen supply, the compact Pulmonary Ventilat-
or may be used quickly and efficiently in
hospitals and doctors’ offices. The extreme
ease of operation and comfortable breathing
action of the Pulmonary Ventilator are two
major advantages, and the fact that this in-
strument most nearly approaches the ideal
physiological mask pressure curve is imme-
diately discernible. In addition to its safe,
effective operation, the instrument's simplic-
ity of design facilitates cleaning and main-
tenance.
M-555
Physicians and Hospitals Supply Co.
1400 Harmon Place
Minneapolis 3, Minnesota
Ge
M:
M.
General Practice Symposium
Neurodermatitis
HE commonest disease of the skin is eczema,
and the commonest form of eczema is neuro-
dermatitis, which is merely a word to express the
relationship between the nervous system and the
skin. Various forms of neurodermatitis occur,
such as the exudative form characterized by blis-
ters on the fingers or oozing widespread plaques,
which may occur in childhood as well as in older
persons. The commonest form, however, is the
circumscribed thickened plaque called “lichen
simplex chronicus.” These plaques, single or
multiple, may occur in various places or they may
become a diffuse process to the extent of exfolia-
tive dermatitis. The patient may be entirely in-
capacitated and be miserable day and night be-
cause of the outstanding symptom of itching,
often paroxysmal in nature; many patients are
driven to distraction and almost to suicide.
Lichen simplex chronicus occurs in certain
types of persons who may have hay fever, asthma
or urticarial tendencies. Thickening of the skin
results from scratching. This thickening brings
on exudation and nonspecific cellular reaction;
the tissues are thus changed so that itching results
and a vicious cycle is established.
The most familiar site for the appearance of
lichen simplex chronicus is along the lateral sur-
face of the thighs, on the shins, about the ankles
and on the elbows or knees, where the lesions
tesemble those of psoriasis. A peculiar form
occurs in the nuchal region of women almost ex-
clusively, as well as behind and in the ears; an
extremely common form of neurodermatitis, or
Read at the meeting of the Minnesota Academy of
eneral Practice, Rochester. Minnesota, October 20, 1954.
From the Section of Dermatology, Mayo Clinic and
Mayo Foundation.
The Mayo Foundation, Rochester, Minnesota, is a part
of the Graduate School of the Universitv of Minnesota.
May, 1955
LOUIS A. BRUNSTING, M.D.
Rochester, Minnesota
lichen simplex chronicus, produces the symptoms
of pruritus vulvae or ani.
The presence of neurodermatitis around the
ankle always brings up the question of whether
or not varices are present. One must distinguish
neurodermatitis of the lower portion of the legs
from so-called stasis dermatitis. Whenever any
disturbance occurs in the lower part of the legs,
hydraulic factors come into play, and any time the
skin is injured, the circulation becomes stagnant
in that region. It is rare to relieve these patients
of their symptoms by treatment of varicose veins,
although the use of an ace bandage is helpful
for two reasons, namely swelling is prevented and
the site is covered so that scratching is not
possible.
When the disease reaches the proportions of
exfoliative neurodermatitis, it is extremely diffi-
cult to arrive at a satisfactory diagnosis. The
contiguous lymph nodes are invariably enlarged
and present an almost irresistible demand for
biopsy. Other diagnostic facilities should be
utilized first, for in such patients the site from
which the specimen has been removed for biopsy
frequently becomes infected. The microscopic
picture of the nodes is usually one of reticulum
cell hyperplasia, plus the presence of pigment and
fat. Pathologic diagnoses such as lipomelanoretic-
uloendotheliosis may be returned, although the
condition is nothing but a scavenger reaction in
the lymph nodes as the result of extensive chronic
dermatitis. Biopsy of the skin shows a rather
nonspecific picture that may be almost impossible
to distinguish from that of psoriasis. A patient
who has dermatitis of this magnitude is entirely
incapacitated. As already indicated, some patients
who have this syndrome have had asthma, eczema,
hay fever and urticaria off and on since infancy.
291
In not a few of them, opacities in the lenses will
develop that are typical of allergic cataracts.
Therefore, one test in these patients should be
routine screening by slit-lamp examination to
detect such changes in early stages. If such lesions
are found, serious restrictions are placed on the
patient’s activities.
The localized plaque of neurodermatitis may be
treated by topical measures. Protective pads,
such as an elastoplast cutout, placed over the
plaque are sometimes helpful. Tying the hands
at night is of aid in some of these conditions, as
is any artificial device to break the cycle of the
scratching reflex. Systemic measures, such as
allergic surveys and dietary restrictions to remove
supposedly allergenic foods, are practically worth-
less. A mistake is often made in prescribing oint-
ments containing a local anesthetic agent, such
as dibucaine hydrochloride (nupercaine) or ben-
zocaine, for the relief of itching. Sooner or later,
sensitivity to these agents develops and the origi-
nal condition becomes aggravated and widespread.
The same is true in the presence of slight infec-
tion, when the prescribing of sensitives, such as
nitrofurazone (furacin) is to be condemned. The
use of roentgen therapy in moderate doses is
helpful; however, excessive amounts of such
treatment produce actinodermatitis, which leads to
no end of complications.
Dietary control is prescribed for patients who
have gained weight; patients who have hyperten-
sion should have proper restrictions from the
standpoint of their general health. Sometimes in
women this condition first appears during the
menopausal years; under these conditions, some
estrogenic support is helpful. When neuroder-
matitis becomes widespread and the patient is
extremely unstable, some restrictions should be
made on the excessive activity. These people usu-
ally are hyperactive and like to improve every
shining minute. The typical woman who has
neurodermatitis never sweeps anything under the
rug. She may be on a committee; soon she is
chairwoman and soon there are no other members
on the committee but this woman—she’s the chair-
woman and the entire committee. It is useless
to attempt to find an ointment in this jar or that
to correct the symptoms which are trying to tell
us that such a patient is about to blow a fuse.
Phenobarbital is helpful but it is also sometimes
capable of provoking allergic reactions. Some
292
NEURODERMATITIS—BRUNSTING
favorable results have been attained by use of
reserpine (serpasil), even in the absence of hyper-
tension, because of the tranquilizing effect of this
agent. Chloral hydrate is a useful bedtime sed-
ative.
Topical applications in the acute stage include
use of moist compresses of boric acid (saturated
solution) or aluminum subacetate. The latter is
prescribed as an 8 per cent solution that is to be
diluted 1 fluidounce to a pint. It is not used as
a wet poultice but as a moist dressing ; it is useful
in relieving the irritation.
One of the most successful but rather messy
treatments is the use of tar. It can be prescribed
as an ointment containing 1 or 2 per cent each
of crude coal tar and salicylic acid. If tar is used
in the hair, it should be incorporated in a water-
soluble base.
Dermatitis of the ear canal is often neuroder-
matitis, and fungi are not involved. It is neces-
sary to clean out the canal frequently. A small
wick of moist dressing may be helpful. The most
characteristic reaction in this location is intense
itching, and the patient perpetuates the condition
by scratching. In the treatment of ear conditions,
nuchal eczemas and pruritus vulvae et ani, use
of an ointment containing 1 per cent hydrocorti-
sone is helpful. The effect of this steroid applied
locally wears out in time unless the underlying
disturbances are corrected, but it has been a most
significant advance in treatment. I have no brief
for those who would use cortisone or corticotropin
(ACTH) systemically for the treatment of neuro-
dermatitis, even when the condition becomes
generalized, because the patient becomes depend-
ent on it and it is difficult to discontinue treat-
ment without a rebound reaction. Occasionally,
when the condition is uncontrollable, it is useful
to give 15 to 25 mg. of ACTH intravenously as
an eight-hour drip in a 5 per cent solution of
glucose.
As already emphasized, patients who have wide-
spread neurodermatitis are incapacitated and
really need hospitalization for immediate relief.
In long-range treatment they need readjustment
of their habits of living and sometimes a change
of environment. Some of the mafiana influence of
the Southwest is helpful and the sunlight there
is also beneficial.
MINNESOTA MEDICINE
| ian Ti an nn nn? 7s a ee. |
QO. - FS
se of
yper-
f this
sed-
clude
rated
ter is
to be
ed as
iseful
nessy
ribed
each
used
vater-
‘oder-
1eces-
small
most
itense
dition
tions,
|, use
corti:
»plied
rlying
most
brief
ropin
euro-
-omes
pend-
treat-
nally,
iseful
sly as
on of
wide-
and
relief.
tment
hange
ice of
there
Differential Diagnosis of Tumors
of the Neck
: eh tumor of the neck, as is one in any other
place in the body, is potentially dangerous
and should be treated accordingly. The only way
to establish a definite diagnosis is by histologic
study, which requires biopsy or removal of the
lesion. The best time to carry out primary treat-
ment of a tumor in the neck, especially if it is
malignant, is at the time of biopsy. Therefore, it
is important to use every possible means to estab-
lish a preoperative working diagnosis so that the
physician can better explain to the patient and his
relatives what might be expected in the way of
definitive treatment.
It is for these reasons that one always should
keep in mind the differential diagnosis of tumors
in the neck when a patient is being examined.
For instance, if a lesion should prove to be a
squamous cell epithelioma metastatic from a pri-
mary tumor in the mouth, there is no better time
to do the necessary radical dissection of the neck
than when the primary lesion is removed. If one
strongly suspects that a lesion is squamous cell
epithelioma, possibly primary dissection of the
neck should be done in preference to biopsy, be-
cause biopsy in squamous cell epithelioma may
increase the chance of recurrence because of
“seeding” at the operative site or persistence of
the carcinoma because of incomplete removal of
the tumor. Thus in the course of examination of
the neck, one should always inspect the lip, the
endoral cavity and the larynx, because of the
potential danger of metastatic involvement of
lymph nodes in the neck arising from primary
carcinoma in these regions.
General Aspects of Examination
The examiner must consider a tumor of the
neck from the standpoint of the history and the
results of inspection, palpation and auscultation
——
Read at the meeting of the Minnesota Academy of
eneral Practice, Rochester, Minnesota, October 20, 1954.
From the Section of Surgery, Mayo Clinic and Mayo
oundation.
The Mayo Foundation, Rochester, Minnesota, is a part
of the Graduate School of the University of Minnesota.
May, 1955
OLIVER H. BEAHRS, M.D.
Rochester, Minnesota
of the tumor. If the tumor has been present for
many years without any evidence of recent change,
that means one thing to the examiner; if the
tumor has been present for ten or twenty years
and in the past month has shown a sudden in-
crease in size, that means something else; if the
tumor was first noted a month ago and is painful
and tender, that means yet another thing. One
should also note whether or not there has been
any difficulty in swallowing, or any recent evi-
dence of hoarseness. One factor that is sometimes
misleading is whether or not the tumor varies in
size. The patient may say that the lesion increases
and decreases in size. It is difficult to judge this
because with change of the position of the neck,
as in moving the head from side to side, the ap-
pearance of the tumor will change; it appears best
to ignore this particular symptom.
For inspection, it is helpful to have the patient
stand directly in front of the examiner, perhaps
2 or 3 feet away. This establishes whether or not
asymmetry of the neck is present; if it is, the
tumor is obvious and merely from inspection one
should get some idea of its nature. Motion of
the tumor up and down as the patient swallows
gives certain information, perhaps indicating a
nodular goiter. A tumor that is not easily appar-
ent on inspection sometimes becomes prominent
when the patient swallows. Also, movement of
the head from side to side occasionally makes the
tumor more prominent. Any dimpling or attach-
ment of the skin over the tumor should be noted.
Palpation should not be attempted until after
thorough inspection. The physician should feel
the neck rather carefully, as some people are
rather sensitive to such palpation. The tumor
preferably should be grasped between the thumb
and the fingers. Occasionally, however, one is
unable to feel the tumor between the fingers and
then it must be palpated against the deeper struc-
tures of the neck. At times, one can depress the
structures of the neck with the opposite thumb,
causing the tumor to become more prominent and
more palpable. One should note whether the
293
tumor is firm or soft, encapsulated or infiltrative,
solid or cystic, tender or nontender, fixed to sur-
rounding tissues or freely movable, in which di-
rection it moves and, if possible, from which struc-
tures of the neck it arises. When the lesion is
in the upper cervical region, especially the sub-
maxillary triangle, bimanual palpation with the
fingers in the mouth is of value. One should also
determine the degree of hardness or firmness. A
tumor that is calcified is like a rock and usually
is benign, in contrast to a firm tumor that feels
as though it is infiltrating adjacent tissue; the
latter type of tumor frequently is malignant. One
should feel for attachment to surrounding tissues.
In the course of palpation, one should notice if
there is any pulsation of the tumor. Occasionally,
an aneurysm or a vascular tumor might arise from
structures in the neck. It is extremely important
to know this before exploration of a tumor.
Auscultation of the lesion may aid in this
diagnosis.
Regardless of how expert the examiner is and
how certain he may be that a lesion is of this type
or that, the only way to prove the point is to
excise the lesion for histologic diagnosis. Then
the lesion can be forgotten or the indicated defini-
tive treatment can be carried out.
Tumors of the neck may be divided into con-
genital lesions, primary tumors, metastatic tumors,
tumors of the salivary glands and inflammatory
lesions. This presentation is primarily concerned
with the characteristics of these lesions that might
be of diagnostic value.
Congenital Lesions
Among congenital lesions occurring in the
midline of the neck are cysts of the thyroglossal
duct. This tumor occurs in the midline and lies
either over or below the hyoid bone. If it is much
below, the cystic mass may move slightly to the
right or the left of the midline. Most often this
lesion is definitely cystic; however, if it is tense
it is somewhat difficult to establish its cystic na-
ture. If one grasps the tumor and creates pres-
sure on it downward and then feels above the
tumor, between the tumor and the hyoid bone, one
frequently can feel the cordlike structure that
represents the tract from the cyst through the
hyoid bone to the base of the tongue; palpation
of such a tract renders it fairly certain that the
tumor is a cyst of the thyroglossal duct. If the
lesion has been previously incised, or if it has
294
TUMORS OF THE NECK—BEAHRS
previously drained, the character of the discharge
is important. A discharge from a cyst of the
thyroglossal duct is mucoid in type. A cyst of the
thyroglossal duct may not have been noticed in
childhood and may be initially discovered in pa-
tients sixty or seventy years of age.
Among the lesions in the lateral aspect of the
neck are branchial cleft cysts, which occur in the
submaxillary triangle, usually just anterior to the
anterior border of the sternocleidomastoid muscle.
The cystic nature of a branchial cleft cyst can
usually be determined. It is superficial, has a
smooth surface, is freely movable, unless it is
large or has been previously infected, and is not
attached to any of the underlying tissues. Sinuses
sometimes are assdéciated with branchial cleft
cysts if the cysts have been previously operated
on and not completely removed. One should
always inspect for a branchial cleft sinus or fistu-
lous opening, which occurs along the anterior
border of the sternocleidomastoid muscle usually
just above the clavicle. The characteristic dis-
charge is mucoid in type. A branchial cleft fistula
has no cystic component as a rule. When the
course of the tract is put under tension, a cord-
like structure can be felt along the edge of the
muscle.
Another lateral cystic lesion is a cystic hy-
groma, which often occurs in the lower portion
of the cervical region, especially if it is small.
If it is large, it may involve the entire neck. Such
a lesion is cystic, soft and multilocular. A ranula
is possibly a similar structure occurring in the
upper portion of the neck. A ranula frequently
can be identified by inspection of the floor of
the mouth, where it shows as a watery bleb that
disappears when punctured. Such lesions also
can be felt in the submandibular region as cystic
structures, usually bilateral.
Tumors of the Thyroid
Adenomas of the thyroid are frequently en-
countered. One should always be suspicious of a
thyroid adenoma and should palpate the lateral
aspects of the neck in all cases of nodular goiter
for possible metastatic lesions. My colleagues and
I consider that a nodular goiter is frequently
enough malignant so that all nodular goiters
should be removed. Whenever a node is found in
the neck that has the characteristics of a meta-
static lesion, the thyroid always should be care-
fully palpated. In our experience, about 4 per cent
MINNESOTA MEDICINE
-_
PO, ae ee ee eee ee ee ee a ee
arge
the
the
d in
pa-
the
| the
» the
scle.
can
aS a
it is
not
uses
cleft
‘ated
ould
istu-
erior
ually
dis-
stula
the
‘ord-
r the
hy-
rtion
mall.
Such
inula
1 the
ently
r of
that
also
-ystic
en-
of a
iteral
roiter
s and
ently
yiters.
nd in
neta-
care-
- cent
DICINE
of nodular goiters that are not producing symp-
toms will contain unsuspected carcinoma.
Occasionally confused with a cyst of the thyro-
glossal duct is an adenoma of the pyramidal lobe
of the thyroid gland. An adenoma may or may
not be firm but rarely does it feel cystic. There
is no palpable tract above an adenoma as is often
noted with a thyroglossal duct cyst. Adenomas
usually move up and down when the patient
swallows and frequently the presence of other
adenomas of the thyroid gland supports the diag-
nosis of this midline tumor as an adenoma.
Also to be confused with an adenoma of the
thyroid gland or a cyst of the thyroglossal duct
is a delphian node, which also occurs in this re-
gion. A delphian node is a metastatic lesion from
a primary carcinoma in the thyroid. When the
carcinoma is located in or near the isthmus, one
of the first areas of spread is to a lymph node
located over the thyroid cartilage; such meta-
static lesions, however, are firm, usually small,
and freely movable.
Tumors of the Salivary Glands
Tumors of the salivary glands are important in
examination of the neck. A mixed tumor of the
parotid gland will have been present for a long
period; it is hard but yet as a rule it is freely
movable unless it is in the deep portion of the
gland. If a tumor that has been present for many
years shows sudden growth, one has to be sus-
picious of malignant degeneration. The facial
nerve is rarely involved regardless of the size of
the tumor unless a malignant tumor is super-
imposed on the mixed tumor. However, a cylin-
droma, an adenocarcinoma, or another type of
malignant tumor of the parotid gland is not only
hard but is usually fixed within the tissue; such
tumors frequently cause paralysis of the facial
nerve, which is extremely important in evaluating
a tumor and advising the patient regarding the
treatment that should be carried out. Warthin’s
tumor, which is cystadenoma lymphomatosum,
occurs in the parotid gland; it is soft, usually
presents itself below or slightly behind the parotid
gland and appears to be encapsulated on palpa-
tion. One should not confuse this lesion with a
mixed tumor,
Miscellaneous Tumors
Among the primary tumors of the neck are
tumors of the carotid body. These lesions occur
in about the same area as do branchial cleft cysts
May, 1955
TUMORS OF THE NECK—BEAHRS
but are deeper in the neck and are not cystic.
Tumors of the carotid body may be elongated,
extending upward and downward; because of
their fixation to the carotid vessels, they can be
moved laterally but not up and down, which is an
important diagnostic finding. Lymphosarcoma
occurs in a similar region in the upper part of
the neck and in the lower portion of the neck in
the internal jugular lymph nodes, Usually lympho-
sarcoma in the neck involves multiple nodes,
frequently matted together. These nodes are
usually rubbery in consistency.
A parathyroid cyst has to be considered occa-
sionally, although this is a rare finding. A neuro-
fibroma might occur along the lateral aspect of the
neck under the sternocleidomastoid muscle. It is
an elongated tumor in contrast to a lymphosar-
coma, which is round or associated with a matted
group of nodes. Neurofibromas frequently are
bilateral. Lipomas are seen usually in the supra-
clavicular region and the posterior cervical tri-
angle. They are soft and multinodular.
Inflammatory Lesions
Inflammatory lesions of the neck include acute
lymphadenitis associated with respiratory and
oral infections; this condition does not create a
diagnostic problem since the enlargement of the
nodes is of recent origin and usually bilateral.
lf, however, such lymphadenopathy does not
disappear within two weeks, it should be regarded
with suspicion. The chronic lesions of tuber-
culosis, sarcoidosis or other granulomas occa-
sionally.are confusing ; biopsy is required to estab-
lish the diagnosis but one should be suspicious
of this type of lesion from the history.
Metastatic Tumors of the Neck
Metastatic tumors in the neck are usually of
recent origin and are firm and nontender. They
may be movable but, if large, may be fixed to the
surrounding tissues. Again, when one is suspi-
cious that a tumor may represent metastasis to a
node, careful search should be made for a primary
lesion on the lip, in the oral cavity, or in the
larynx, as well as on the skin of the face or scalp.
Lesions of the lip spread in an orderly fashion
to the submaxillary nodes in the neck. A node
that is the seat of metastasis may be misleading
if it has a necrotic center and feels soft. If a
(Continued on Page 303)
295
Fractures of the Upper Extremity
in Children
RACTURES in children are different than
similar ones in adults. Ordinary good treat-
ment produces better results in children than it
does in adults. The heavy periosteum that sur-
rounds the bone in children may help to prevent
displacement ; most of the time it makes for sat-
isfactory manipulation and easier closed reduc-
tion. In preadolescent children, the potential for
rapid growth will produce an excellent end result
even after mediocre reduction. This same growth
potential is responsible for the usual speedy
union and the rarity of nonunion in children.
This generally optimistic outlook must be tem-
pered by the knowledge that with improper treat-
ment the complications of fractures in childhood
can be disastrous. The general principles of treat-
ment are not complex. Alignment is the chief
requirement. While it is desirable to produce
restoration of length and anatomic apposition,
such restoration certainly is not necessary and
failure to produce such a result is no indication
for open reduction and internal fixation in chil-
dren. As a rule, completely satisfactory results
can be obtained by traction or by closed manipu-
lation and immobilization in plaster. This rule,
however, has the usual exceptions. Some frac-
tures, notably certain types about the elbow, often
require open reduction. In this discussion, I wish
to consider the commoner major fractures of the
upper extremity in children and to emphasize
those that may be attended by complications or
that require open reduction.
Fractures of the Humerus
Fractures of the humerus occur through the
condyles, through the shaft, below the tubercles
or through the upper epiphysis in about that
order of freqency. Fractures of the shaft are
Read at the meeting of the Minnesota Academy of
General Practice, Rochester, Minnesota, October 20, 1954.
From the Section of Orthopaedic Surgery, Mayo
Clinic and Mayo Foundation.
The Mayo Foundation, Rochester, Minnesotz, is a part
of the Graduate School of the University of Minnesota.
296
JOHN C. IVINS, MD.
Rochester, Minnesota
rarely accompanied by palsy of the radial nerve
and may be satisfactorily treated by application
of a hanging cast. If the general alignment and
rotation are good, one need not worry about
end-to-end apposition or overriding and shorten-
ing of up to a half inch; sound union will occur
and the proper length will be restored by sub-
sequent overgrowth.
Separation of the upper humeral epiphysis may
be treated the same way. Restoration of function
and normal bony contours is usually rapid. If
the epiphysis is completely displaced, manipula-
tion with the patient under general anesthesia will
be required, but even then one need not insist
on strict anatomic reduction, and open reduction
is rarely required,
Supracondylar fractures are common. Ac-
curate reduction is difficult to achieve and even
more difficult to maintain. Neural and vascular
complications are more common than the physi-
cian usually suspects. Because of the close prox-
imity of major nerves and arteries, in a typical
supracondylar fracture the artery or one of the
nerves may be impaled on the end of the proximal
fragment or actually may be caught between the
ends of the fractured bone. Once the diagnosis
is established by initial roentgenograms, prompt
treatment can be effective. Of prime importance
is accurate evaluation of the patient’s condition.
Simple sensory and motor testing should be done
to determine the status of the major nerves. The
presence or absence of radial pulsation should be
established ; if it is present, one should note its
quality. Closed reduction is then carried out
with the patient under general anesthesia by trac-
tion in the long axis of the arm combined with
flexion and pronation. It was formerly taught
that these fractures should be put up in supina-
tion, but I believe the rotary components can
be reduced best by putting the forearm up in
pronation. Satisfactory reduction can be main-
tained only by means of a posterior plaster splint
that holds the arm in flexion. If this causes dis-
MINNESOTA MEDICINE
ge
0s
hu
tel
an
th
co
me
all
an
aw
the
ori
ba
so!
the
ple
lat
un
Ma
M.D.
ota
erve
ition
and
bout
rten-
ccur
sub-
may
tion
If
yula-
will
nsist
ction
Ac-
even
cular
hysi-
\rOX-
pical
f the
cimal
1 the
nosis
ompt
tance
ition.
done
The
Id be
re its
out
trac-
with
vught
pina-
- can
ip in
nain-
splint
s dis-
DICINE
appearance of radial pulsation, the elbow must
be extended until pulsation reappears.
One can deal with these fractures by either
continuous traction in bed or open reduction and
fixation of the fracture by crossed Kirschner
wires. Traction in bed will produce just as good
results as will surgical intervention. The greatest
danger is Volkmann’s ischemic contracture, which
presents pain as its most significant symptom.
Never disregard the complaint of pain in the
hand associated with these fractures. If this pain
is accompanied by swelling, coldness, cyanosis
or pallor of the fingers, prompt action must be
taken regardless of the hour and regardless of
the interval of time since the fracture. If exten-
sion of the elbow and removal of all circular
dressings do not result in a prompt satisfactory
return of circulation, block of the stellate gan-
glion by means of procaine might be considered.
However, it is preferable to deal with this situa-
tion directly by opening the antecubital fossa and
exploring the artery. The artery may be contused,
transected or caught between the ends of the
bone. Segmental resection of the damaged portion
of the vessel relieves the reflex vasopasm and
usually results in adequate circulation. Vascular
grafting is not indicated in such cases.
Epiphysial Injuries at the Elbow
Epiphysial injuries at the elbow usually are
more serious than the clinical picture or the roent-
genograms would indicate. Three main centers of
ossification are present at the inferior end of the
humerus. One is for the lateral condyle, or capi-
tellum, one is for the medial condyle, or trochlea,
and one is for the internal epicondyle. At times,
there may be a fourth center for the lateral epi-
condyle. A fall on the point of the flexed elbow
may displace the entire epiphysis forward. Usu-
ally, however, the fall is on the outstretched hand
and one of these centers of ossification is pulled
away from the others by muscular traction. When
the joint is forced into the varus position, the
origin of the common extensor muscles on the
back of the forearm may avulse the lateral part
of the epiphysis, the capitellum, together with
some of the adjacent portion of the trochlea and
the end of the shaft. If the aponeurosis is incom-
pletely torn, the condyle simply may be displaced
laterally and not rotated. Such a fracture will
unite firmly, with good results.
However, if the aponeurosis is completely torn,
May, 1955
FRACTURES OF THE UPPER EXTREMITY—IVINS
the condylar fragment may be rotated completely
out of the joint and turned upside down. If the
fracture is allowed to heal in this position, there
will be an increase in the carrying angle and
sooner or later ulnar palsy will appear because of
stretching of the ulnar nerve. Open reduction is
usually required. After the condylar fragment
has been anatomically reseated in its bed, it usu-
ally can be held there firmly by suture of the sur-
rounding soft tissues of the aponeurosis. Internal
fixation of such a fracture is not required.
The epiphysis for the internal epicondyle does
not unite until about the age of eighteen; thus,
injury to this structure can occur until late in
adolescence. Until that time, the origin of the
common flexor muscles, which attaches to the
internal epicondyle, may avulse this structure
when a strain in the valgus position is applied to
the elbow. This is an opposite strain from the
one that has just been considered. At least four
grades of such a displacement may occur. The
least serious is a slight separation, with minimal
displacement. The most serious is avulsion of the
epicondyle associated with complete outward dis-
placement of the elbow. The more serious dis-
placements usually are associated with some dam-
age to the ulnar nerve. Less extensive displace-
ments may be adequately treated by closed manip-
ulation, with immobilization of the elbow in the
flexed position. However, when the avulsed epiph-
ysis has been drawn into the joint it is neces-
sary to do an open reduction, securing the frag-
ment in its bed by means of a few sutures. An
important point about the roentgenograms in
epiphysial injuries is that the films may not tell
the story at all as these structures are composed
mainly of cartilage and are not well portrayed
roentgenologically.
Children who fall on the outstretched hand may
impact the head of the radius against the capitel-
lum, causing displacement of the upper radial
epiphysis. An important consideration here is that
the head of the radius in children must never be
excised. To do so will result in radial shorten-
ing, radial deviation of the hand and disruption
of the radio-ulnar joint at the wrist. The usual
displacement of the radial epiphysis can be treated
by closed manipulation. When the displacement
is more pronounced, it may be necessary to make
a short incision and restore the parts under direct
vision. In most cases, the epiphysis is perfectly
stable after such a procedure. Occasionally, when
297
FRACTURES OF THE UPPER EXTREMITY—IVINS
it is not stable and will not stay in position, a
Kirschner wire can be introduced from the back
of the elbow through the capitellum into the shaft
of the radius to hold its position for two or three
weeks until early formation of callus occurs.
Fractures of the Forearm
Fractures of both bones of the forearm occur
at the distal third, at the middle third and at the
proximal third in about that order of frequency.
Open operation is not justified for such fractures
regardless of their level. It must be emphasized
that no trace of angulation should be present in
fractures of the proximal or middle third, for
this will not correct itself with growth. Instead,
permanent limitation of pronation and supination
will result. Greenstick fractures at these levels
frequently will be troublesome because of persist-
ing and recurring angulation. In such situations
it may be necessary to extend the greenstick frac-
ture and convert it into a complete simple fracture
in order to prevent recurring angulation. Some
overriding is permissible if good alignment is
attained.
Fractures of the upper third of the forearm
should be immobilized in full supination and
those of the middle third should be immobilized
in midposition due to contraction of the muscles.
It may be necessary to maintain alignment by
using traction on the fingers and one need not
fear doing this in children. Perfect restoration
of the contours will be obtained in a few months
and function as a rule will be normal.
Fractures about the distal third of the fore-
arm may be left unreduced if the angulation is
less than 30 degrees. The hazard of leaving such
fractures alone is far less than the hazard of
giving the patient an anesthetic agent and manip-
ulating the fracture in any way. The distal
fragments usually are displaced dorsally. In such
fractures, there is a strong tendency for angula-
tion to return even in a well-applied cast. Immo-
bilization of such a fracture should be in a long
cast with the elbow at a right angle and the fore-
arm pronated. Molding of the cast is a more
effective way of controlling the angulation than
trying to put the hand way down in pronounced
flexion. There is no justification at all for open
reduction.
Fractures of the Hand
Space allows discussion of only one fracture of
the hand. One of the common athletic injuries in
adolescence is fracture of the neck of the fifth
metacarpal. Such a fracture cannot be handled
with the finger extended, because with such exten-
sion the ligaments are relaxed and the small
distal fragment cannot be controlled. If the
fracture is allowed to heal in this position, the
end of the metacarpal will be down in the palm
just like a marble. This type of fracture can be
easily reduced, however, by flexion of the meta-
carpophalangeal joint to an angle of 90 degrees;
after its reduction, it can be held that way by
means of a plaster slab.
Conclusion
A plea is made for conservatism in treating
fractures in children. Nature will do a wonderful
job in healing these fractures and normal func-
tion will be restored, as a rule, if physicians will
simply assist nature to the extent of restoring
alignment and providing proper immobilization
for an adequate length of time. In some cases,
it is almost unbelievable to what extent nature
will afford correction of extremely severe frac-
tures in spite of minimal correction obtained at
the time of manipulation,
SKIN CANCER
Sunlight may be a major cause of skin cancer. Five
fields of evidence point to sunlight as a possible caus-
ative factor: “(1) Cancer of the skin of laboratory ani-
mals (mice and rats) can be induced by exposure to ul-
traviolet radiation; (2) cancer of the skin is more com-
mon among outdoor than indoor workers; (3) cutaneous
cancer is less prevalent in Negroes than in the white
races, presumably because the former are less susceptible
to sunlight; (4) the incidence of cancer of the skin is
greater in regions of the earth that receive high insola-
tion; (5) cancer of the skin occurs principally on parts
of the body most exposed to sunlight.”—KETTERMAN,
H. L.: Sunlight and cancer, Journal of Kansas Medical
Society, 41:12 (Jan.) 1955.
MINNESOTA MEDICINE
-ptible
kin is
nsola-
| parts
RMAN,
ledical
‘DICINE
Management of Recent Injuries
of the Hand
ANY excellent articles have been published
about the injured hand. Much of the mate-
rial included in this presentation was derived from
articles published by the great pioneer in recon-
structive surgery of the hand, Dr. Sterling Bun-
nell,»? from a series of bulletins produced by the
American Society for Surgery of the Hand* and
from a recent article by Godfrey.* The accom-
panying sketches outline a plan of procedure that
is applicable in the early management of the
majority of injuries of the hand.
Wounds of the hand comprise 36 per cent of
all industrial accidents. Although no accurate
statistics are available, it is probably safe to esti-
mate that a similar incidence is present in injuries
around the farm and the home. If an injured hand
is to regain useful function, it must be protected
from infection and from additional damage to
tissues, both of which may be instrumental in
converting the hand into a rigid club. This pro-
tection is furnished initially by avoidance of
meddlesome interference with the wound, clean-
liness of the surrounding area, application of
sterile protective dressings and immobilization in
the position of function. Probing, examination,
cleansing and treatment of the wound itself should
not be undertaken until adequate surgical facili-
ties are available.
Bunnell noted after examining thousands of
crippled hands that six main types of crippling
are encountered. These are (1) stiffening of the
hand in poor position, (2) flexion contractures,
(3) skeletal malalignment, (4) dysfunction from
injuries to tendons and nerves, (5) ischemic con-
tractures and (6) trophic or vasomotor conditions.
Although the latter two types of crippling usually
but not always are due to the initial injury, the
Read at the meeting of the Minnesota Academy otf
General Practice, Rochester, Minnesota, October 20, 1954.
From the Section of Orthopaedic Surgery, Mayo
Clinic and Mayo Foundation.
The Mayo Foundation, Rochester, Minnesota, is a part
of the Graduate School of the University of Minnesota.
May, 1955
PAUL R. LIPSCOMB, M.D.
Rochester, Minnesota
first four types are often due to sins of omission
as well as commission in the treatment of the
injured hand.
Stiffening in Poor Position
Edema, together with immobility, is the com-
monest cause of stiffness. When these two factors
are combined with a position of nonfunction after
injuries to the hand, it will stiffen in its poor posi-
tion. Edema results from many causes but espe-
cially from infection. In the presence of edema,
fibrin is precipitated about the tendons, muscles
and joints. Soon the fibrin is converted into rigid
fibrous tissue and the hand becomes a club rather
than a finely co-ordinated and delicate piece of
machinery. Edema is prevented soon after the
injury by elevation and use of compression dress-
ings. These dressings must be voluminous and
snug but not too tight. Active motion must be
started as soon as it is feasible. The part that is
fractured, burned or otherwise damaged must be
splinted, but the remainder of the hand must not
be immobilized but kept active and moving. The
position of function of the hand is that of moder-
ate dorsiflexion of the wrist, moderate flexion of
the fingers and moderate abduction and opposition
of the thumb. When injuries of the hand are
treated, this position must be borne in mind con-
stantly. If for some unpreventable reason the
hand should partially stiffen in this position, all
function is not lost, whereas if the wrist is flexed,
the fingers are straight or clawed and the thumb
is adducted, function is lost.
There is no place in the treatment of injuries
of the hand for a splint that holds or allows the
fingers to be maintained in the extended position.
Even in mallet or baseball fingers. although the
distal joint is hyperextended in treatment, the
midjoint must be flexed so as to tighten the central
slip of the extensor tendon and thus approxi-
mate the avulsed extensor tendon to the distal
phalanx. In an extended finger, its intercapsu-
299
INJURIES OF THE HAND—LIPSCOMB
lar ligaments are relaxed and soon become fibrotic
in this shortened position. In a flexed finger, the
ligaments are tight.
Fig. 1. Wounds of the hand should be covered im-
mediately by a large protective sterile dressing. The
nose and mouth of the physician or first-aid attendant
and the patient should be covered in an attempt to
prevent further contamination of the wound.
Infection as a Cause of Stiffening in Poor
Position.—Infection produces edema, pain on
motion and thus immobility and a poor position,
which is assumed for protection. Therefore, all
possible precautions should be taken to prevent
infection. A mask should be worn by all who
come in contact with an open wound of the hand
(Fig. 1). A large protective sterile dressing
should be applied to the hand immediately after
injury. The wound should not be probed or fully
examined until this large first-aid dressing is re-
moved and all arrangements have been made to
proceed with the necessary surgical care (Fig. 2).
The patient must be taken to the hospital imme-
diately, as time is an important factor in pre-
venting infection.
It is unsafe to repair deep structures in a wound
of the hand if bacteria have had an opportunity
to multiply for more than 8 to 10 hours after
injury. The wound should be gently but thor-
roughly cleansed with soap and water and then
completely excised or débrided; tendons, nerves
and bones should be carefully preserved (Fig. 3).
Fresh wounds have nonvirulent contamination
and heal well if circulation, closure, compression
300
dressings and rest are adequate. Tendons and
nerves should not be repaired primarily in crush-
ing, explosive or grinding injuries.
Fig. 2. The first-aid dressing is not removed nor
is the wound thoroughly inspected until the patient is
in the operating room and plans have been made to
proceed as necessary. Careful evaluation of the injury
is then made and recorded and a plan of reconstruction
is decided on. The hand and forearm are shaved, washed
with soap and water and the wound is thoroughly ir-
rigated with normal saline solution. A pneumatic-cuff
tourniquet is applied.
Every effort should be made to attain effective
and early closure of the wound. The rotation of
flaps of skin and grafting of the donor site,
using the skin of a filleted finger or an immediate
pedicle flap from the abdominal wall, may be
necessary (Fig. 4). Thus, months of drainage
from infection and its concomitant crippling may
be avoided. Especially is it important to cover all
vulnerable parts such as joints, bones, tendons
and nerves, which are so suspectible to infection.
On the other hand, the closure must not be under
tension. If a wound is too dirty to close, it may be
packed open for five to seven days and closed
secondarily.
Flexion Contractures
Flexion contractures are due to contracted scar
tissue resulting from a burn or an open infected
wound. Prevention, therefore, involves utilization
MINNESOTA MEDICINE
ective
on of
site,
ediate
ry be
inage
x may
rer all
ndons
ction.
under
ray be
closed
d scar
fected
zation
EDICINE
INJURIES OF THE HAND—LIPSCOMB
of all available means to close the wound. In
burns, the deep bed is usually in good condition
for grafting. Often the burn has become demar-
Fig. 3. Definitive treatment requires a well-equipped
operating room, good lighting, adequate instruments,
sufficient assistance, complete anesthesia and a bloodless
field as supplied by the pneumatic tourniquet. Strict
asepsis, with use of masks, gowns and gloves, helps
prevent contamination of the wound with more virulent
organisms. The wound is thoroughly débrided but all
usable parts are saved, especially nerves and tendons.
Fractures are reduced, the digits being placed in the
position of function so they will be opposable.
cated to such an extent that the destroyed skin can
be excised four or five days after injury and a
split-thickness skin graft can be applied at the
same time or a few days later. Granulation tissue,
if present, should be scraped off so as to apply the
skin on a good bed that will not contract later.
The borders of either a free or a pedicle graft
should be zigzag and should not cross a flexion
crease in a straight line. The hand and wrist must
be splinted in a position of function if contrac-
tures are to be avoided (Figs. 5 and 6).
Skeletal Malalignment
Skeletal malalignment must be prevented by
restoration of normal function of the bony struc-
tures at the earliest possible time. Restoration of
normal position is accomplished by manipulation,
May, 1955
skeletal traction or open reduction. Regardless
of whether a fracture or a dislocation is being
manipulated, full relaxation, preferably induced
Fig. 4. A cover of skin is supplied if at all possible,
and usually it is, by swinging a flap as illustrated and
applying a split- thickness graft to the resultant defect,
by application of a split-thickness graft directly to the
defect in selected instances or by use of a direct pedicle
graft from the abdominal wall. If a finger has to be
discarded, its skin with vessels and nerves may be
utilized for cover.
by having the patient under general anesthesia, is
desirable. Manual traction, pressure and molding
should be performed gently and deliberately to
avoid further injury to soft tissues. If reduction
is not promptly successful, operative (open) treat-
ment is in order, since less harm is done by gentle
surgical procedures performed through a correct
incision than by rough and forceful closed
manipulation.
To maintain reduction, particularly of oblique
or comminuted fractures of the phalanges or
metacarpals or fractures into joints, control by
skeletal fixation may be required. The hand and
the injured finger or fingers should be supported
in the position of function. Not much traction is
needed for fractures of the metacarpals and
phalanges. The pull must be applied with the
finger held semiflexed and never straight. Use of
banjo splints is to be condemned. Rotary malunion
of digits is avoided by checking to see that the
plane of motion of each finger passes through the
navicular tubercle and by observing the plane of
the nail. Stiffening of adjoining fingers is avoided
by splinting only the one that is injured. All
uninjured parts must be kept moving. The cast
should hold the wrist in dorsiflexion; it must be
molded to the metacarpal arch and should termi-
nate at the distal flexion crease and the thenar
301
INJURIES OF THE HAND—LIPSCOMB
crease in the palm so that the proximal finger
joints are free to flex.
lor many metacarpal fractures, temporary pin-
ning with Kirschner wires cut off beneath the skin
Fig. 5. Swelling is avoided by fluff compression dress-
ings that are applied just tightly enough, but not too
tightly, to the hand, which is in the position of func-
tion with the finger tips exposed so that circulation may
be evaluated. Straps for elevation are incorporated in
the dressing.
to avoid infection is an excellent method of fixa-
‘tion; the hand does not stiffen, as it is not in a
cast. The wiring or plating of fractures of the
bones of the hand generally is unsatisfactory.
Healing of fractures of the long bones of the
hand requires immobilization for three to five
weeks; healing of fractures of carpal bones re-
quires twelve to fourteen weeks. Fractures of the
navicular may require four months for union. If
immobilized consistently for these periods, most
of these fractures will not require surgical inter-
vention.
Injuries to Tendons and Nerves
The dysfunction from injuries to tendons and
nerves is best prevented by repairing these struc-
tures early, within a few hours, and establishing
a good cover of skin. Success depends on obtain-
ing primary healing. In wounds more than eight
to twelve hours old or in badly contaminated,
dirty or explosive wounds, primary repair of
tendons and deep structures must be omitted or
serious infection will follow. The surgical repair
must be done through proper incisions, with mini-
mal trauma. The best conditions for healing are
accomplished by avoidance of dead spaces, hema-
tomas, buried sutures, especially catgut, and tight
302
suturing. Tor the average surgeon it is best to
unite the ends of nerves with one suture of stain-
less-steel wire or silk to prevent retraction of the
ends, thus facilitating secondary resuture under
|
Fig. 6. The bandaged hand is elevated and rest is en-
forced until the acute reaction of the injury is past,
which usually takes about three days.
the best of conditions later. However, when pri-
mary suture of a nerve is performed expertly, the
regeneration is sooner and better than that ob-
tained after late repair. Nerves can and should
be successfully repaired down to the distal flexion
crease in the finger, including even the tiny motor
branches within the hand. Injury to the nerves in
the arm or brachial plexus is just as crippling as
is injury to the hand itself and repair of these
nerves should take precedence over that of bones
and joints. When this is not done, the paralyzed
muscles and distal portions of the nerves undergo
such irreversible fibrous atrophy that restoration
of function is impossible. A paralyzed hand needs
to be kept mobile and in the position of function
or it becomes a useless claw in a position of non-
function. The patient should be instructed to keep
the paralyzed hand in the position of function by
gently manipulating it with the good hand. Pain-
ful and tender neuromas are avoided by mini-
mizing formation of scar tissue. Amputation
should be done in noninfected fields and the end-
ings of nerves placed in good tissue.
Ischemic Contractures
Ischemic contractures, both of the Volkmann
type and the local type in the hand, usually are
preventable by avoidance of tight casts or dress-
ings. If the patient continues to complain of
MINNESOTA MEDICINE
ann
are
eSS-
. of
INJURIES OF THE HAND—LIPSCOMB
severe pain a few minutes after the cast or dress-
ing is loosened and if there is evidence of im-
paired circulation in the hand, emergency surgical
treatment is necessary if the severe crippling that
results from prolonged ischemia is to be avoided.
Fig. 7. Supervised active, not passive, motion not
only of the uninjured parts but also of the injured part
must be started as soon as healing will permit.
Trophic or Vasomotor Conditions
Some patients appear more inclined to experi-
ence so-called Sudeck’s atrophy and the tendency
to causalgia than do others. These persons usu-
ally have unstable sympathetic.nervous systems.
Early recognition of such patients and encourage-
ment in whatever activity may be required to make
these people use their hands during every waking
moment usually will abort the development of
this extremely painful and disabling complication
(Fig. 7).
Summary
Review of the six main types of crippling of
the hand, namely stiffening in poor position, flex-
ion contractures, skeletal malalignment, loss of
motion and sensation from injuries to tendons
and nerves, ischemic contractures and trophic or
vasomotor conditions, leads to the conclusion that
many of these complications can be ascribed to
treatment and, therefore, are preventable.
References
. Bunnell, Sterling: The injured hand—principles of
——-* Indust. Med. & Surg., 22:251-254 (June)
53.
. Bunnell, Sterling: The early treatment of hand in-
juries. J. Bone & Joint Surg., 33-A :807-811 (July)
1951.
. American Society for Surgery of the Hand: Prin-
ciples of Early Management of Hand-Injuries and
the Care of Hand Injuries. From a series of ar-
ticles published in bulletin form, prepared by the
American Society for Surgery of the Hand and
distributed by the Committee of Trauma, Ameri-
can College of Surgeons, through its Regional Com-
mittees, 1948, 1949, 1950, 1952.
. Godfrey, J. D.: Early management of the injured
hand. J.A.M.A., 155 :1484-1486 (Aug. 21) 1954.
TUMORS OF THE NECK
(Continued from Page 295)
tumor is invading surrounding structures, it may
be tender and make the examiner think of an
inflammatory lesion.
If a patient has a hard, nontender node or
nodes in the lower deep jugular region or supra-
clavicular region (Virchow’s, or sentinel, node)
on the left, one must be suspicious that these are
secondary toa primary tumor of the lung, stomach
or kidney.
Incision for Lesions of the Neck
In removal of a tumor of the neck for exami-
nation, it is extremely important always to use
a transverse rather than a vertical incision. A
transverse incision heals nicely and is not a
cosmetic problem later. Any incision that is made
May, 1955
vertically in the neck crosses the natural cutaneous
lines and results in a puckered scar. For a large
tumor in the neck or when an extensive resection
is being done, such as a radical dissection of the
neck, a vertical component to the horizontal inci-
sion is usually necessary.
Comment
Regardless of how careful the examiner may
be, his impression of a tumor of the neck is just
a guess until he proves the diagnosis by biopsy.
Since many of these tumors are malignant, cos-
metically deforming and potentially infected, all
should be surgically investigated when discovered.
The attitude, “The tumor is not bothering
you, why bother it?” should not prevail.
303
Precautions in the Use of Cortisone
for Treatment of Rheumatic Diseases
ORTISONE and related hormones, such as
hydrocortisone and corticotropin, are the most
potent antirheumatic agents known at present.*
Unfortunately, these hormones also are capable
of producing metabolic effects that often are
undesirable and, indeed, sometimes temporarily
harmful, especially if excessive doses are em-
ployed.
For optimal results, the use of these hormones
in the treatment of rheumatic diseases must be
attended by certain precautions, which can be
divided into three convenient categories: (1)
selection of the proper disease for treatment, (2)
selection of the proper patient having one of these
diseases, and (3) selection of proper dosage and
attention to other details of management during
treatment.
General Precautionary Measures
Selection of the Rheumatic Disease —Cortisone
is most commonly indicated in selected cases of
the following rheumatic diseases :
1. Rheumatoid arthritis and its variants, such
as rheumatoid spondylitis, Still’s disease, Felty’s
syndrome, Reiter’s syndrome, psoriatic arthritis
and the arthritis associated with chronic ulcera-
tive colitis.
2. Acute rheumatic fever.
3. Systemic lupus erythematosus.
4. Periarteritis nodosa.
In a second group of diseases cortisone occa-
sionally may be helpful but its systemic admin-
istration is usually not indicated, since other and
simpler measures ordinarily suffice. These diseases
include :
Read at the meeting of the Minnesota Academy of
General Practice, Rochester, Minnesota, October 20, 1954.
From the Section of Medicine, Mayo Clinic.
*Reference will be made primarily to cortisone in
this presentation, although the remarks apply generally
to hydrocortisone or corticotropin.
304
L. EMMERSON WARD, M.D.
Rochester, Minnesota
1. Arthritis of hypersensitivity states, such as
serum sickness, in which antihistaminic drugs,
epinephrine, salicylates, local application of heat,
and rest for the affected joints usually are
adequate. ;
2. Acute gouty arthritis, for which colchicine
is the drug of choice.
3. Acute nonspecific bursitis, tendinitis and the
shoulder-hand syndrome; for these conditions,
physical medicine, salicylates and, in certain cases,
roentgen therapy or local injection of hydrocor-
tisone generally are sufficient.
Cortisone should not be employed for:
1. Specific infectious (septic) arthritis.
2. Osteoarthritis.
3. Primary fibrositis.
4. Psychogenic rheumatism.
In osteoarthritis of peripheral joints, intra-
articular injection of hydrocortisone may pro-
duce temporary symptomatic relief and is often
useful, especially for acute or subacute flare-ups,
but prolonged systemic administration of corti-
sone should be avoided.
Selection of the Patient.—If it has been estab-
lished that a co-operative patient has a disease
for which cortisone may be indicated, the next
decision concerns the suitability of its use in the
particular patient. Two principal considerations
arise in this regard. The first is whether the
disease in this particular instance is of sufficient
activity and severity to warrant the use and
expense of hormonal therapy or whether the
patient would respond equally well to simpler
treatment. For example, many patients who have
mild rheumatoid arthritis can be managed satis-
factorily by a general program, such as physical
therapy, salicylates, extra rest, protection of joints
and other supportive measures. Secondly, does
the patient have some other condition that might
be aggravated by cortisone and that, therefore,
MINNESOTA MEDICINE
it
are
ine
the
ns,
eS,
or-
tra-
rO-
ten
Ips,
rti-
ase
ext
the
ons
the
lent
and
the
ler
ave
tis-
ical
ints
loes
ight
ore,
CINE
might contraindicate its use? Absolute contra-
indications to prolonged usage are psychoses,
Cushing’s syndrome, and tuberculosis and certain
other infections not readily susceptible to control
by currently available therapeutic agents, as acute
poliomyelitis. Relative contraindications include
renal and cardiovascular insufficiency, peptic
ulcer, psychoneuroses, osteoporosis, diabetes mel-
litus, convulsive disorders and certain severe in-
tercurrent infections.
The decision of whether or not to employ corti-
sone in the presence of one of these relative con-
traindications requires balancing the possible
benefits of cortisone against its possible hazards
in each particular patient. For example, one
might elect to avoid use of cortisone if a patient
has a moderate degree of rheumatoid arthritis
but a peptic ulcer that is difficult to control,
whereas one might employ cortisone for severe,
incapacitating active rheumatoid arthritis in the
presence of a peptic ulcer that could be controlled
by careful medical management. Occasionally,
the pros and cons are so evenly balanced that
only cautious trial of treatment may allow a
definite decision.
Selection of Dosage and General Management.
Studies Prior to Treatment.—Before cortisone
is used, the patient should receive a complete
medical examination, a roentgenogram of the
thorax, serologic tests for syphilis, urinalysis,
determination of hemoglobin and leukocytes in the
blood and other tests pertinent to evaluation of
the disease or complicating conditions. The physi-
cian should discuss thoroughly with the patient
the potentialities and limitations of treatment with
cortisone and should stress the necessity for fre-
quent rechecks and co-operation in following
directions carefully.
Choice of Hormone.—Doses of cortisone, hy-
drocortisone or corticotropin required to produce
equivalent antirheumatic effects differ somewhat.
On the average, the required amount of hydro-
cortisone given orally may be about 20 per cent
less than that of cortisone, although in practice
individual variations are considerable.’ It is even
more difficult to estimate comparative doses of
corticotropin owing to differences that result from
such factors as the preparation used, the route of
administration and the variable activity of the
adrenal cortices. However, increased antirheu-
May, 1955
CORTISONE IN RHEUMATIC DISEASES—WARD
matic activity of these hormones is accompanied
by increased metabolic activity, affecting electro-
lytes, water, protein, fat and carbohydrate. No
one of these three hormones has proved con-
sistently superior to the others in the avoidance
of hypercortisonism.
Examination During Treatment——During ad-
ministration of the hormones, the patient should
be examined periodically with regard to the effect
of treatment on control of the disease and to the
presence or absence of hypercortisonism. The
frequency’ of periodic rechecks depends on the
disease and the individual circumstances. The
patient who is treated for acute systemic lupus
erythematosus with large doses of cortisone needs
to be checked clinically at least daily ; laboratory
tests, such as urinalysis and measurement of
serum electrolytes, sedimentation rate and hemo-
globin, may be required frequently. On the other
hand, the rheumatoid patient treated with small
doses of cortisone may need to be seen only at
weekly intervals initially, then later at intervals
of two to four weeks, at which time the clinical
status should be evaluated carefully.and weight
and blood pressure recorded ; necessary laboratory
tests may be minimal, such as urinalysis and
measurement of hemoglobin and leukocytes every
two or three months, and roentgenograms of the
thorax every six to twelve months.
Careful clinical observation of the patient is of
more importance than are laboratory tests in the
management of the patient receiving cortisone,
especially in the detection of hypercortisonism.
Such evidence of hypercortisonism as mental
stimulation, increased appetite, gain in weight,
facial rounding, retention of fluid and appearance
of supraclavicular fat pads usually occurs long
before any laboratory signs of hypercortisonism.
Regulation of Dosage.—Regulation of dosage
is the most important phase of careful treatment.
Attitude toward dosage should be conditioned to
a great extent by the disease under treatment and
the anticipated duration of hormonal therapy.
For acute self-limited but potentially damaging
diseases, such as acute rheumatic fever, relatively
large doses are employed to accomplish quick
suppression of the inflammatory reaction; then
a gradually lowered but completely suppressive
dose is maintained for the relatively brief course
of the disease. For example, one might give to a
305
CORTISONE IN RHEUMATIC DISEASES—WARD
young adult with acute rheumatic fever 200 or
300 mg. of cortisone daily for a few days until
clinical signs of acute rheumatic fever have dis-
appeared, after which the dose might be reduced
to about 100 to 150 mg. daily for the next two or
three weeks. Then slightly lower doses, perhaps
50 to 100 mg. daily, might be employed for the
next few weeks. Thereafter the dose might be
tapered off in a period of another week or two
or longer if necessary. Recurrence of activity
may call for temporary increase in doses. Signs
of hypercortisonism in the presence of apparently
complete suppression of the disease would indi-
cate the probable desirability of some reduction
in dosage. Obviously, dosages and duration of
treatment should be adjusted to the needs of the
individual patient; the variation in severity and
duration of the disease does not permit a routine
schedule of treatment. When such large doses as
just outlined are employed, a low-salt diet and
the administration of potassium chloride (for
example, 2 gm. three times daily) are advisable.
For subacute and chronic diseases typified by
occasional acute, potentially fatal flares, as for
example in systemic lupus erythematosus, ex-
tremely large doses of 300 to 1,000 mg. or more
per day may be employed temporarily during the
acute stages; subsequently the dose is tapered off
so that during the chronic stages little or no corti-
sone is employed. If the use of cortisone is neces-
sary during the less acute stages, the dosage
should be regulated to avoid hypercortisonism in
much the same manner as will be described in the
discussion of rheumatoid arthritis.
lor chronic diseases requiring indefinitely long
treatment, as in chronic rheumatoid arthritis, the
dose should be kept low enough to avoid hyper-
cortisonism.
Dosage in Rheumatoid Arthritis
The objective in the treatment of rheumatoid
arthritis with cortisone or related hormones should
be to achieve as much antirheumatic effect as
possible without producing hypercortisonism.
Problems of Chronic Hypercortisonism.—lf
large doses of cortisone, hydrocortisone or cor-
ticotropin are administered to a rheumatoid pa-
tient, antirheumatic effects may be maintained
whether or not signs of hypercortisonism appear.
However, in some patients maintenance of
306
excessive doses producing hypercortisonism
eventually leads to serious complications, such
as osteoporosis with fractures, peptic ulcers, pro-
nounced emotional disturbances and excessive
retention of fluid. Extreme fatigability, emotional
lability and depression and diffuse aches and
pains unlike but often confused with rheumatoid
symptoms may be noted.‘ Reactions simulating
systemic lupus erythematosus or periarteritis
nodosa have occurred in several cases.° At
present, one cannot predict in which patients
significant complications will develop if hyper-
cortisonism is permitted to persist. Therefore,
doses should be regulated to avoid hypercortison-
ism in all patients.
Policy on DosageA policy of restriction of
dosage so as to avoid hypercortisonism implies
that doses will be smaller than those employed
previously by many physicians. As a conse-
quence, less than complete antirheumatic effects
may result in many cases. Necessary com-
promises in dosage may permit suppression
of only 50 to 75 per cent of symptoms. Relief of
this or greater magnitude generally can be
achieved in at least 50 per cent of cases, often
more easily in men than in women. In about 35
per cent of cases satisfactory regulation of dosage
may be more difficult, while in about 15 per cent
continuous adequate control of rheumatoid arthri-
tis with tolerable doses is difficult or tnsatis-
factory.
Initial Doses —My colleagues and I virtually
have eliminated the use of large initial priming
doses in our present treatment of rheumatoid
arthritis. Starting doses are the approximate
amount estimated as reasonable for prolonged
maintenance, governed by the activity of the in-
flammatory reaction and the patient’s expected
susceptibility to hypercortisonism. The following
daily doses of cortisone often are employed ini-
tially: for men, 40 to 60 mg.; for postmenopausal
women, 20 to 30 mg.; for other women, 25 to 40
mg. Doses of hydrocortisone are slightly less.
Sometimes the chosen initial dose may prove
insufficient, in which case a small increment
(5 to 10 mg.) may be made temporarily.
Reduction of Dose.—As soon as antirheumatic
response is definite, gradual reduction of dose is
attempted. Decrements generally are from 2.5 to
5 mg. when the dose is 50 mg. or less, or from
MINNESOTA MEDICINE
ism
ach
r0-
sive
nal
and
‘oid
ing
“itis
At
nts
yer-
f of
be
ften
t 35
sage
cent
thri-
atis-
tally
ning
itoid
mate
nged
2 in-
>cted
wing
- ini-
1usal
0 40
less.
rove
ment
matic
se is
,.5 to
from
DICINE
CORTISONE IN RHEUMATIC DISEASES—WARD
5 to 10 mg. when the daily dose is more than 50
mg. If a previous reduction has been well
tolerated, the dose may be reduced again within
a week or so. In some patients, reduction must
be made less often. If the response to the pre-
vious reduction has been less favorable, another
decrement may be delayed for several weeks or
as long as necessary for the patient to readjust
to the new dose, unless further reduction is
dictated by other circumstances, such as the pres-
ence of hypercortisonism.
Maintenance Doses.—The maintenance dose is
not a fixed dose. Ideally, it is that variable and
usually decreasing amount required to maintain
relief without producing hypercortisonism. Thus
maintenance refers to relief, not dose. The proper
dose for maintenance of relief varies from patient
to patient and from time to time in the same
patient; hence, frequent individual attention is
required. Occasional and repeated attempts at
reduction should be made even though the patient
appears to be well stabilized at a given dose,
since a smaller dose may accomplish as much. If
the reduced dose proves insufficient, the former
dose can be reinstated, perhaps for one to three
weeks or so, before reduction is again attempted.
Eventual discontinuation of medication by gradual
reduction should be the aim.
For mild or moderate flares, the dose often can
remain unchanged; extra amounts of acetylsali-
cylic acid, physical therapy and rest may suffice.
If necessary the dose may be increased by 5 mg.
for mild or moderate flares and 10 mg. for more
severe flares; a second increment may be given
later if required. The dose is reduced again as
soon as the flare begins to recede.
Experience suggests that daily doses for pro-
longed treatment generally should not exceed the
following limits: for men, 50 to 60 mg.; for post-
menopausal women, 30 to 35 mg.; for other
women, 40 mg. Hypercortisonism develops in
some patients who receive less than these doses;
others can tolerate slightly larger doses. In case
of increased stress or pronounced articular flare,
temporary use of larger doses may be required.
Division and Spacing of Daily Oral Doses —
For most patients the daily oral dose of cortisone
should be divided into four more or less equal
parts and one part should be given every six
hours; a typical schedule might be 10 mg. at
May, 1955
6 a.m., noon, 6 p.m., and midnight. The duration
of antirheumatic effect of cortisone sometimes is
sufficiently long to permit the patient to take the
last dose of the day at bedtime rather than having
to be roused from sleep to take the final dose
at a later time.
Other patients may be treated more satisfac-
torily by varying the size of individual doses dur-
ing the twenty-four-hour period so as to provide a
little more cortisone for times when symptoms are
likely to be worse. Thus, for a man whose symp-
toms are particularly severe during the morning
but much less severe in the afternoon and evening,
a program of 20 mg. at 6 a.m. and 10 mg. at noon,
6 p.m. and midnight may achieve better results
than a program of 12.5 mg. every six hours,
although the total dose would be the same in each
instance.
Flexible Program of Dosage-——Many rheuma-
toid patients experience varying degrees of symp-
toms from day to day during an average week.
For some such patients it may be better to
employ a flexible program in which the patient
takes a slightly different amount for “average”
days, “good” days and “bad” days. Thus, instead
of a daily maintenance dose of 45 mg. during the
week (total weekly dose of 315 mg.), such a
patient might more effectively take 40 mg. daily
for three average days, 35 mg. daily for two good
days and 45 mg. daily for two bad days (total
weekly dose of 280 mg.). Such a program not
only supplies more cortisone when needed but also
reduces the amount given at times when less is
required. In this way smaller total doses may be
successfully employed. This plan requires espe-
cially intelligent co-operation by the patient, as
well as careful check by the physician to insure
that supplemental doses are not employed exces-
sively or unnecessarily. The patient is not per-
mitted to regulate his own dosage but rather is
permitted a choice within a slight range of dosage
predetermined by the physician.
Supplementary Measures.—Appropriate sup-
plementary treatment, such as physical therapy,
salicylates, adequate rest, protection of involved
joints and other supportive measures, should be
continued during administration of cortisone.
Management in Case of Stress —
The pituitary-adrenocortical mechanism is in-
hibited by long-term treatment with cortisone or
307
CORTISONE IN RHEUMATIC DISEASES—WARD
corticotropin and, therefore, it cannot react nor-
mally to produce increased quantities of needed
adrenocortical hormones in case of stress. Thus,
in order to prevent the serious consequences of
adrenocortical insufficiency in severe stress, suff-
cient additional hormone must be administered.**7
For minor stress, such as a mild intercurrent
infection or a minor surgical procedure per-
formed with the patient under local anesthesia,
the maintenance dose of cortisone should be con-
tinued or rarely increased slightly, perhaps by
25 to 50 mg., for the duration of the stress;
careful clinical observation should reveal any
need for additional cortisone.
In major stress, such as a major surgical
operation, serious injury or severe intercurrent
infection, even more additional cortisone must
be given. In elective major surgical treatment,
my colleagues and I give 200 mg. of cortisone
intramuscularly forty-eight hours, twenty-four
hours and one hour before operation. On the day
after operation, 100 mg. is usually given if the
patient’s condition is satisfactory ; within the next
two to three days the dose is gradually reduced
to the preoperative maintenance level or its use
is discontinued. Oral administration is resumed
postoperatively conveniently
possible.
whenever it is
For more urgent surgical procedures or other
emergencies, 200 mg. or more of cortisone is given
intramuscularly as soon as possible; this dose is
repeated after operation and as needed thereafter.
In addition, a dose of 100 to 200 mg. of hydro-
cortisone in solution is given intravenously in
250 cc. of isotonic solution of sodium chloride
during operation or for rapid effect in other
emergencies, to be repeated as needed during or
after operation.
Other precautions also are advisable to mini-
mize the effects of major stress in these cases.
Operation should be performed early in the day
to avoid prolonged fasting and other stress inci-
dent to waiting. If intravenous administration
of fluids is required, the use of glucose alone in
distilled water should be avoided; isotonic solu-
tion of sodium chloride or such a solution con-
taining 5 per cent glucose should be used instead.
Morphine is poorly tolerated by patients who have
adrenocortical insufficiency ; the use of meperidine
308
hydrochloride (demerol hydrochloride) appears
preferable.
During and after operation or other stress, the
patient should be watched closely. Blood pressure
and pulse are checked at least hourly for twenty-
four to thirty-six hours. If signs of adrenocor-
tical insufficiency develop, such as weakness,
tachycardia, hypotension, vascular collapse or
respiratory failure, 100 to 200 mg. of hydrocor-
tisone should be promptly administered intra-
venously in 250 cc. of isotonic solution of sodium
chloride; this injection should be repeated as
often as necessary to maintain normal blood
pressure. A dose of 200 mg. of cortisone should
also be given intramuscularly for later supportive
effect. Oxygen, blood transfusions and vasopres-
sor drugs, such as norepinephrine, 4 mg. in iso-
tonic solution of sodium chloride, may be em-
ployed as indicated if shock develops.
The afore-mentioned precautions are employed
not only for patients currently under treatment
with cortisone but also for those who have re-
ceived significant amounts of the hormone
within the past three to six months, or even
within the past year if hypercortisonism has
been present. In patients treated with cortisone
less recently, prophylactic use of cortisone
often is deemed unnecessary. However, in
such cases the other precautions just described
are observed just as in the case of the patient who
receives cortisone, and a solution of hydrocorti-
sone is kept available for emergency intravenous
use.
Patients treated with cortisone or related hor-
mones should carry cards similar to those carried
by diabetic patients to inform those who might
care for them in an emergency that special care
and additional doses of hormone may be required.
Conclusion
This presentation purposely has stressed the
possible hazards and necessary precautions dur-
ing administration of cortisone in the treatment
of certain rheumatic diseases. In viewing these
hazards, one must not overlook the benefits that
result from use of cortisone in certain carefully
selected, properly managed patients who have one
or another of the rheumatic diseases for which
(Continued on Page 322)
MINNESOTA MEDICINE
eSS,
or
‘or-
tra-
um
as
ood
uld
tive
res-
iSO-
em-
Digestive Ailments of Older
Patients
N AGING population is rapidly developing
and more patients are living longer and re-
maining in better health at present than at any
time in history. Among this group, gastroin-
testinal complaints are extremely common and
varied. The literature bearing on the field of
geriatric gastroenterology is scanty and individual
experience is limited. Since degenerative cardio-
vascular renal disease and cancer loom so large
as causes of death, it is natural that the bulk of
the literature on the aging process has concerned
itself with these two problems while the gastro-
intestinal tract has been almost forgotten. Only
in recent years have gastroenterologists become
interested in this problem. Those who have writ-
ten about it have agreed in emphasizing (1) the
fact that many of the gastrointestinal complaints
are due to curable or correctable lesions, (2) the
variation in symptomatology from the usually
accepted classic clinical syndrome of the disease
in question and (3) the opportunity which the
family physician has in dealing with this group
of patients.
The Pathologic Physiology of Aging
The changes which occur in various organs of
the body as a result of the aging process have
been fairly well documented, the exception being
the gastrointestinal tract. There are minor de-
generative changes of the salivary glands with
a reduction of ptyalin secretion. Since digestion
of starch begins in the mouth, these changes may
be reflected in the development of fermentative
diarrhea, The esophagus itself is usually seen
to resist the passage of time but in some very
old persons there may be either atony or un-
co-ordinated peristalsis with resulting dysphagia.
The lowering of gastric acidity with age has been
well studied and it is probable that about 10 to
12 per cent of older persons have permanent
Read at the meeting of the Minnesota Academy of
General Practice, Rochester. Minnesota, October 20, 1954.
From the Palo Alto Clinic.
May, 1955
ALBERT M. SNELL, M.D.
Palo Alto, California
anacidity. Some atrophy of the gastric mucosa
has been reported but this finding has been con-
tradicted by recent gastroscopic biopsy studies
that show essentially normal mucosal structure in
the stomachs of many older people. Radiologists
tell me that there is little evidence of a loss of
gastric tone or motor activity in the aged. So
far as the small intestine is concerned, the little
that is known about it would indicate that no
significant changes take place in it as a result of
aging. The same statement cannot be made of
the colon, in which loss of muscle tone and pro-
pulsive activity is frequently seen. This problem
is frequently compounded in older persons by the
development of rectal lesions that interfere fur-
ther with normal intestinal function.
So far as the accessory organs of digestion are
concerned, some falling off in organ weights may
occur but little else has been observed. The liver
may show some abnormal pigmentation of its
cells and fibrosis around the portal spaces but the
cell mass as a whole appears to be normal and
such liver functional data as exist would indicate
that the physiologic capacity of the liver is not
greatly disturbed. Much the same statement can
be made with regard to the pancreas.
With regard to the abdominal vasculature, ag-
ing may be a basis for such lesions as mesenteric
thrombosis. However, existing evidence appears
to indicate that degenerative vascular disease of
the abdominal aorta and its branches lags some-
what behind the same changes in other portions
of the body.
I shall have relatively little to say about cancer
and will, in the main, deal with the benign gas-
trointestinal diseases, for many of which there
are satisfactory and acceptable forms of treat-
ment.
Case-taking in Geriatric Gastrointestinal Disease
As in pediatrics, diagnoses in old patients must
be based largely upon objective evidence and
upon a sound general knowledge of what is likely
309
DIGESTIVE AILMENTS OF OLDER PATIENTS—SNELL
to be wrong. The histories in older patients, al-
most all of whom have some digestive complaints,
may be grossly misleading. Many elderly in-
dividuals are willing to blame their complaints
on “something I ate,” upon supposed allergies and
upon other ailments that they have been known to
have for a long time. Many of them probably
minimize their symptoms because they are afraid
of what might be found. Finally, many of them
are unwilling to discuss the personal, social and
economic difficulties which may play a large part
in the production of their symptoms. For this
reason one may recommend the general practice
of first getting acquainted with the patient, then
seeing what else is wrong with him (since mul-
tiple diagnoses are the rule in the aged), and
finally considering the gastrointestinal complaints.
The well-established practice of obtaining a his-
tory of the complaints for a single typical day is
helpful; of even greater value is the presence of
a relative or friend who may often supply the
pertinent details. Finally, it is wise to make an
attempt to see any acute episodes of distress
which these oldsters may have. A visit to the old
man or woman in the patient’s own home and the
observation of an episode of the illness at first
hand may be of greater value than even the most
detailed studies in the hospital. The advantages
that the family physician has in respect to these
factors are obvious.
Common Gastrointestinal Diseases of the Aged
I shall attempt to refrain from statistics so far
as is possible. However, I have drawn freely
upon Monroe’s experiences at the Geriatric Clinic
of the Peter Bent Brigham Hospital, upon some
observations kindly made for me by Dr. Roger
Egeberg and his colleagues at Wadsworth Hos-
pital in Los Angeles and upon the personal ex-
periences of some of my own colleagues. It
seems well to begin at the entrance to the digestive
tube.
Diseases of the Esophagus.—There are prob-
ably more erroneous diagnoses made in respect to
esophageal disease than any other field of gas-
troenterology, the reason probably being that it
is not often recognized how frequently esophageal
disorders will produce symptoms referable to the
abdomen. Cardiospasm is a relatively rare condi-
tion in older persons, but carcinoma is common
enough and should be the first consideration in
310
any elderly person with a short history of dyspha-
gia. Both of the former are overshadowed in im-
portance by one common ailment, namely, hiatus
hernia, with or without peptic esophagitis. Such
hernias are common in old people; in fact, evi-
dence indicates that there may be a relative re-
laxation of the esophageal hiatus which increases
with age. The diagnosis frequently can be made
from the history alone, the most common feature
of which is nocturnal or postural pyrosis and
regurgitation of food, along with varying degrees
of transitory dysphagia and of pain in the epi-
gastrium and left upper quadrant. The diagnosis
is clinched by roentgenologic study. If one is to
get maximal help from the radiologist, however,
one must tell him what is suspected.
It is remarkable how often older patients with
hiatus hernias are admitted to the hospital with
a history of bleeding; probably at least a third
are anemic when first seen. Actual esophageal
ulcers are not infrequently seen when they are
sought for, usually in the herniated portion of the
stomach or in the distal portion of the esophagus.
Probably patients can bleed from esophagitis and
gastritis alone without gross ulceration.
Diverticula of the esophagus are not especially
rare. It is noteworthy that they infrequently
cause symptoms until the later years of life. The
important diverticula to identify are those at the
pharyngo-esophageal juncture. Such diverticula,
when filled with food, may set off a chain reaction
of aerophagia and belching ; hyperventilation may
be associated with the condition as well. Ausculta-
tion of the neck during the act of deglutition may
be of diagnostic value.
Traction diverticula of the middle third of the
gullet are of lesser importance, while those of its
distal portion are extremely rare. It is important
to exclude esophageal lesions in patients who
have supposed cardiac disease. Barium studies,
so widely used by radiologists in studying the out-
lines of the heart and aorta, have in many in-
stances served to establish an entirely different
diagnosis, namely, that of esophageal disease.
Diseases of the Stomach and Duodenum.—
Since gastric acidity decreases with advancing
age, it was the general belief about 30 years ago
that ulcers of the stomach and duodenum would,
therefore, disappear or become quiescent. The
situation is different today and it is now recog-
nized that either acute or reactivated ulcerative
MINNESOTA MEDICINE
DIGESTIVE AILMENTS OF OLDER PATIENTS—SNELL
disease of the stomach and duodenum is relatively
common in patients more than 60 years of age.
In his afore-mentioned studies, Monroe found
that 6.4 per cent of the more than 8,000 admis-
sions to the Geriatric Clinic were for peptic
ulcer; in only about half these cases was the
usual long and classic history obtained. In one
home operated by the Veterans Administration,
60 per cent of all gastrointestinal admissions from
the home to the hospital are because of ulcer
problems involving obstruction, bleeding or pene-
tration and almost universally requiring surgical
consultation and study.
Some interesting points are found with regard
to the location of peptic ulcers in older patients.
In the population as a whole there are probably
ten duodenal ulcers to every gastric ulcer. In
the aged, this ratio falls to about 3.5:1. Some
correlation may exist between gastric ulcer and
degenerative arterial disease, which may be of
clinical importance, especially in connection with
the cause of gastric ulcers and the seriousness
of bleeding from them.
The patient with a long-standing ulcer history
who experiences reactivation of his ulcer diathesis
in later years presents no particular problem.
There is a sizable group of old patients, however,
who present their first ulcer symptoms in the sev-
enth decade of life. In such -patients bizarre
symptoms appear to be the rule rather than the
exeception.
The usual sequence of pain with an empty
stomach and ease with food often does not appear,
being replaced by symptoms having little rela-
tionship to those usually described by ulcer pa-
tients. A common story is that of isolated attacks
of severe pain unrelieved by anything short of
narcotics and not infrequently associated with
vomiting and bleeding. Other patients may com-
plain of pain aggravated by the taking of food
or of periodic vomiting.
Complications, as already indicated, are al-
most the rule in the aged. Of these the most
serious is bleeding, which not infrequently comes
out of a clear sky. Duodenal ulcers apparently
bleed a little less often than do ulcers on the
gastric side. Men have more hemorrhages than
women. Both the incidence and gravity of hem-
orrhage appear to increase with age, with a cor-
responding effect upon mortality. The true in-
cidence of hemorrhage is difficult to determine,
figures of from 5 to 30 per cent appearing in the
May, 1955
literature; in Monroe’s series, the latter per-
centage obtained. It is difficult to estimate the
severity of hemorrhage in the aged, and a high
incidence of cardiac and cerebral thrombosis
follows hemorrhage, even that of moderate de-
gree.
Obstruction is noted in about 10 to 15 per
cent of old patients with ulcer, slightly more
often with gastric than with duodenal lesions.
Many of these patients have symptoms and roent-
genologic findings suggestive of cancer. Obstruc-
tion may appear suddenly and with little in the
way of antecedent history. Persons who have
acute obstruction area particular problem and may
need hospital study with repeated checks of gas-
tric retention and radiologic studies before a
final diagnosis can be made. It should be pointed
out that imbalance of electrolytes and azotemia
develop with extreme rapidity in older patients
after either hemorrhage or obstruction and that
neglect of fluid balance for as little as a day or
so may result in serious complications. Most of
these older patients with pyloric obstruction can
be handled well by simple surgical procedures,
such as gastroenterostomy with or without ex-
cision of the ulcer. Fortunately, perforation oc-
curs only about half as often as obstruction. A
pronounced sex difference is noted, perforation
being five times as common in men as in women.
What impresses gastroenterologists in dealing
with the older ulcer patient is the bizarre symp-
tomatology, the high incidence of complications
and the relatively high mortality and morbidity
rates; the persistence of the ulcer diathesis be-
yond the seventh decade of life is also impressive.
Obviously, we should make roentgenologic studies
of the stomach on more old patients even if the
history is bizarre; we must be particularly quick
to investigate a history of gastrointestinal bleed-
ing, even if the amounts of blood lost are small.
Finally, if the patient is seen for the first time
with hemorrhage or other complications which
might be attributed to ulcer, immediate investi-
gation is compulsory.
One final point is stressed by gastroenterol-
ogists who have dealt extensively with ulcer in
older patients. Treatment should never be con-
tinued for any length of time on the basis of
symptomatology alone without confirmatory
roentgenologic studies. Even after examination
has revealed a lesion that appears to explain the
complaint, and even if symptoms are benefited
311
DIGESTIVE AILMENTS OF OLDER PATIENTS—SNELL
by medical management, further roentgenologic
studies after a lapse of time are necessary. The
high incidence of neoplastic disease in the stomach
should warn us not to be misled by a solitary
roentgenogram that shows a supposedly benign
lesion.
Diseases of the Gallbladder.—Thirty years ago,
when disease of the gallbladder was suspected in
all middle-aged patients who had any sort of
dyspepsia, a good many unnecessary cholecystec-
tomies were done. Over the years the pendulum
has swung in the opposite direction and today
even cholecystography is often omitted unless the
patient has had fairly classic symptoms referable
to the biliary tract. As a result, a great many
persons are going into the later years of life
carrying gallstones which are not suspected until
a catastrophe of some sort occurs:
The increasing incidence of gallstones with
age requires only brief mention. Women ap-
parently form most of their gallstones between
their middle twenties and the menopause. In
men the process starts later and continues into
the eighth and ninth decades of life. The end
result is that the incidence of stones in the two
sexes becomes nearly equal in the very old.
Many of these stones remain completely asymp-
tomatic for life; others produce their first and
only symptoms in advanced age. It is well to
remember that gallstones are probably the com-
monest single cause of serious abdominal pain
in patients more than 65 years of age and that
neither the location nor the exact character of the
pain is of much diagnostic value.
Should the accidentally discovered calculous
gallbladder be removed in older patients? Is a
single bout of pain sufficient indication for radi-
cal treatment? These questions are practical and
the answer is not always simple. When statistical-
ly considered, the answer must be in the affirma-
tive.
If one checks present hospital mortality rates
from gallstones against the generally accepted
surgical risk, it will be found that the mortality
rate of stones in older patient is much higher
than the least optimistic figures on surgical risk.
In old patients the complications of gallstones and
associated disease are jointly responsible. In Mon-
roe’s series there were many patients with chole-
cystenteric fistulas, gallstone ileus, common-duct
stones and obstructive cirrhosis, to say nothing
312
of associated pancreatitis; in the same series, the
incidence of vascular complications was high.
About 44 per cent of the patients who had gall-
stones had associated nonvalvular heart disease
and 10 per cent had had previous cerebrovascular
accidents.
Thus, gallstones are a distinct hazard to life
which increases rapidly with age. Surgical mor-
tality rates run a parallel course, although as a
tule the old patient with gallstones stands oper-
ation well and there are few contraindications.
The mortality rate of all patients with gallstones,
according to Monroe, is materially increased
above the hospital mortality rate of all old pa-
tients by at least 10 per cent. In his series, 4.5
per cent of the “medically treated” patients with
gallstones died in the hospital solely as a conse-
quence of their biliary disease and 8.5 per cent
died from gallstones with complicating disease
elsewhere in the body.
Diseases of the Small Intestine —Regional
ileitis is rare at all ages and decidedly uncommon
among the old. The disease appears to present
no special features in the later years of life.
Whether healed ulcerative or granulomatous dis-
ease in early years leaves any residues that per-
sist into the later years of life is not known. |
recall three instances of intestinal strictures from
my own experience ; one caused obstructive symp-
toms of some severity while the others caused
difficulty of a relatively mild degree. In two the
origin was unknown; the third was associated
with polyarteritis.
Diverticula in the small intestine, not uncom-
mon in the aged, interest the radiologist but are
rarely productive of serious symptoms. Duodenal
diverticula in particular are probably of no great
clinical importance, although a few are known
to have produced mechanical difficulties chiefly
because of their large size. Meckel’s diverticula
are rarely considered in diagnosis, yet I know
of a recent case in which one produced obstruc-
tion in a 92-year-old man. This lesion was suc-
cessfully resected and the obstruction relieved.
Diseases of the Colon.—lf one arbitrarily ex-
cludes cancer from the discussion, only a few or-
ganic conditions involving the colon remain to be
considered in the older age group. Ulcerative
colitis is rare in geriatrics, yet an occasional case
is found even in the aged.
MINNESOTA MEDICINE
in tl
quen
gura
poly,
block
hemc
Sines
their
perie
comp
not 1
So
pend;
ed o1
old |
flamn
ently
cance
volvu
nom
citis
zarre
picior
diagn
Suspe
May,
mon
sent
life.
dis-
per-
vane |
rom
‘mp-
used
» the
ated
-om-
are
lenal
rreat
own
jiefly
icula
now
truc-
suc-
ved.
DICINE
DIGESTIVE AILMENTS OF OLDER PATIENTS—SNELL
One sees on histories a great many diagnoses
of diverticulitis of the colon. Diverticula them-
selves are as common after 50 years of age as
gray hair or wrinkles; they rarely produce symp-
toms until they are called to the patient’s at-
tention. In private practice a really significant
attack of diverticulitis is something of a rarity.
One sees frequently on radiologic examination
of older persons a narrowed cicatricial strip of
intestine beginning in the descending colon and
extending into the sigmoid. These lesions are prob-
ably truly the consequences of previous diverticu-
litis. They may simulate cancer, although their
length and the rather indefinite terminal margins
they present argue against such a diagnosis. In
a few patients, cicatricial obstruction of the region
may occur which can be relieved only by surgical
excision of the diseased segment of intestine. It
has been said that lesions of this type do not
bleed, yet I am sure that some must do so. One
woman, aged 83, with this radiologic picture
bled from the intestine for years in quantities
such as to require frequent transfusions. In spite
of many roentgenologic studies and two laparot-
omies, no other cause for the bleeding point was
ever found.
Much has been said and written about polyps
in the colon. The small multiple polyps so fre-
quently seen during sigmoidoscopy are easily ful-
gurated and removed. Larger single, adenomatous
polyps, which produce symptoms by mechanical
blockage of the intestine or by ulceration and
hemorrhage, are not uncommon in older patients.
Since many of them are potentially malignant,
their removal must be advised, but in my ex-
perience the expected cure of the vague abdominal
complaints so commonly associated with them does
not materialize.
Some special mention must be made of ap-
pendicitis in the aged. Dr. Egeberg has comment-
ed on the frequency of appendiceal rupture in
old patients associated with only moderate in-
lammatory reaction. These ruptures are appar-
ently caused by distal obstruction incidental to
cancer, the cicatricial residues of diverticulitis,
volvulus or perhaps even constipation. There is
no more difficult diagnosis than that of appendi-
itis in an old person. The symptoms are bi-
zarre and the peritoneal reaction minimal; sus-
picion frequently is the only possible basis for
diagnosis. All too frequently a diagnosis is not
suspected until an abscess develops.
May, 1955
The major problem referable to the colon in
No bulk formers,
lubricants or antispasmodics will get much of
a performance out of the old colon. What one
should attempt to do is persuade the patient that
the intestine need not be emptied every day and
that no physical harm will result from an overdue
stool. Such arguments leave most old people un-
moved, and it is a rare person who has not worked
out his own salvation by means of various laxa-
tives, suppositories or enemas. It takes a hardy
physician to attempt to correct some of these no-
tions and no amount of talking can divert some
oldsters from their preoccupation with their bowel
habits.
old patients is constipation.
The diarrheas of old people are troublesome.
In some instances, they are associated with achlor-
hydria and probably also with deficient intestinal
absorptive capacity. Such difficulty may be re-
lieved in part by parenteral administration of
liver extract and use of vitamin concentrates.
Orally administered antibiotics may be responsi-
ble for setting the stage in many such patients.
In others, no apparent explanation is. available
and one has little to offer except purely sympto-
matic measures. The nature of such diarrheas is
obscure; much further study of the subject is
needed.
Hepatic and Pancreatic Disease.—Cirrhosis of
the liver does not frequently present itself as a
clinical problem in the later years of life. This
is probably due to the fact that the peak incidence
of cirrhosis as a cause of death is past at age 60.
Also, many types of cirrhosis are inconsistent
with long life. Hemochromatosis and biliary cir-
rhosis (often described as xanthomatous) usually
have run their course long before the seventh
decade. Somewhat the same statement may be
made in regard to chronic hepatic atrophy, an
especially lethal ailment in postmenopausal wom-
en. What remains, therefore, is chiefly nutritional
cirrhosis and the cause is, in most instances, al-
cohol plus malnutrition. The incidence of the
disease varies with the location and dietary habits
of the community.
As might be expected, the complications of cir-
rhosis, chiefly hemorrhage from varices and epi-
sodes of hepatic necrosis, are highly fatal in old’
persons. Some fortunate patients, however, ap-
pear to achieve a balance between cellular destruc-
tion and repair, with the result that the aged pa-
313
DIGESTIVE AILMENTS OF OLDER PATIENTS—SNELL
tient may carry on successfully. I recall a num-
ber of older patients with cirrhosis who presented
every evidence of gross hepatic damage and yet
survived for years in a reasonable state of health.
One man to whom a fatal prognosis was given
at the time of his admission to the hospital lived
for 10 years, dying of arteriosclerosis. One should
not despair of the older cirrhotic; he deserves as
vigorous treatment as the younger patient and not
infrequently will reward these efforts by a long
and reasonably comfortable life.
Viral hepatitis is no respecter of age. Epi-
demiologic study appears to indicate that persons
in middle life and beyond have a fairly solid im-
munity to the naturally acquired disease but this
conveys no immunity to the serum-borne type.
Probably because of this fact and the likelihood
that hepatitis in the aged may be due to virus
SH, by far the more dangerous type, the prog-
nosis in the old patient with hepatitis should be
guarded. The state of the patient’s nutrition and
the presence or absence of associated disease else-
where in the body may be determining factors in
the outcome. It is wise to study the old person
with jaundice with great care, since the difficulty
of diagnosis between obstructive and parenchym-
atous jaundice apparently increases with age.
The patient who has a definitely obstructed biliary
tree cannot be explored too promptly, whereas
the patient with primary hepatic cellular disease
must be kept out of the operating room.
Chronic relapsing pancreatitis appears to be
relatively rare in older persons but it does occur
often enough to keep one constantly reminded of
its presence. Pancreatic edema associated with
common-duct stone is, of course, frequently seen
and is relieved when the offending calculus is re-
moved. Two patients recently seen with episodes
of hemorrhagic pancreatic necrosis were in the
seventh and eighth decades of life. Both recovered
after a long and stormy illness characterized by
imbalance of electrolytes and azotemia. It is en-
couraging to be able to tell these patients that
only about half of those who have this syndrome
will have a recurrence. Surgery in such patients
is probably better avoided, but one must make
an exception for the patient with a pancreatic
cyst. The suspicion of cancer is ever present in
this group of individuals but it appears well
established that the more violent episodes of
illness are most often associated with the benign
form of pancreatic disease.
314
Functional Complaints of the Aged.—These
are legion even in persons who have an under-
lying organic disorder. In these patients one
has to pick up the trail of an organic disorder
out of the maze of bizarre symptoms. One must
beware of the alleged functional complaint in
patients more than 45 years of age; this statement
is doubly true for patients more than 60 years
of age. One learns to be cautious in commitments
made to these patients and to advise re-examina-
tion if the character of the symptoms changes.
There are, however, innumerable older persons
who always have had digestive disturbances that
simply grow in number and magnitude with the
passing of years. Among these, certain types
stand out, such as fhe bolters of food and the
swallowers of air, who usually can be distinguished
by their ability to belch at any time and as fre-
quently as desired; another type is the confused
oldster who has himself imagined or has been
led to believe that he has food allergies or sensi-
tivities and who as a result has restricted his
diet severely. To convince these people of the
error of their ways and to get them back on a
full and proper diet require diplomatic skill of
the highest order. A third group, and perhaps
the commonest of all, are persons with so-called
mucous colitis. It is a fortunate physician who
does not have a group of these unfortunate pa-
tients under his care. To the best of my knowl-
edge there is no dietetic program nor any com-
bination of drugs which will restore peristaltic
activity to normal in the colons of these individ-
uals. With persuasion and guidance, some of
them improve, but more often they drift dis-
consolately from one physician to the next, ob-
taining little relief from any.
Finally, some comment must be made about
the organic psychoses of old age and their tend-
ency to produce digestive symptoms. Minor
cerebrovascular accidents, encephalomalacia of
arteriosclerotic origin and even simple reactive de-
pression may produce somatic digestive symp-
toms of a most bizarre type. The depressive
episode may pass and the digestive complaints
disappear, but with organic cerebral damage,
prognosis for recovery is not good. If any help
is to be obtained for these older persons with
functional digestive complaints, it is usually at
the hands of the wise family physician who knows
(Continued on Page 330)
MINNESOTA MEDICINE
Management of Acute Abdominal
Diseases
T HE diagnosis and management of acute dis-
eases of the abdomen continue to be among
the most perplexing problems that confront the
surgeon today. Regardless of the tremendous
strides in modern medicine, considerable room
for improvement exists in this field. It must
be remembered that the first successful closure
of a perforated peptic ulcer was done less than
50 years ago and that removal of a diseased ap-
pendix has been a practical surgical procedure
only for about the same time. Laparotomy for
intestinal obstruction was regarded until com-
paratively recently as a procedure of last resort.
Needless to say, the most important and also
one of the most difficult problems is that of ar-
riving at the correct diagnosis. While it is not
within the scope of this paper to discuss the
taking of a history and the performance of the
physical examination, it should be emphasized that
extreme care is needed at this crucial stage.
Among the several diseases that simulate an
acute surgical condition of the abdomen are
cardiac derangements, chronic interstitial nephrit-
is, pneumonia, porphyria, hydronephrosis, typhoid
fever, tuberculous peritonitis and tabes dorsalis.
The latter three diseases are not seen nearly so
often as formerly. For some time it has been
the policy of my surgical colleagues and me to
require as routine on all candidates for emergency
surgical treatment a certain minimum of labora-
tory studies, including a complete blood count,
urinalysis, thoracic roentgenogram, a scout (pre-
liminary survey) film of the abdomen when in-
dicated, and determination of the blood group
and Rh factor. Other studies may be done de-
pending on the particular problem at hand; these
include such things as roentgenograms of the
abdomen with the patient upright or in the lateral
—_——_.
Read at the meeting of the Minnesota Academy of
eral Practice, Rochester, Minnesota, October 20, 1954.
From the Section of Surgery, Mayo Clinic and Mayo
Foundation.
The Mayo Foundation, Rochester, Minnesota, is a part
of the Graduate School of the University of Minnesota.
May, 1955
WILLIAM H. ReMINE, M.D.
Rochester, Minnesota
decubitus position to determine the presence of
free air, and chemical determination of values for
serum amylase and lipase. Such studies are of
considerable value when used in the proper situ-
ation, but they should not be ordered indiscrimi-
nately as they are time-consuming and expensive.
Stomach and Duodenum
Acute hemorrhagic peptic ulceration, either gas-
tric or duodenal, is a most formidable problem.
Constant observation of the pulse, blood pressure
and value for hemoglobin is necessary in addition
to the usual administration of blood and other
supportive fluids. Massive bleeding must be
brought under control without delay. The patient
who has such hemorrhage presents a considerably
different problem than does the usual type of
bleeder. The mere induction of anesthesia may
prove fatal as a result of aspiration of large
quantities of regurgitated blood. During the past
two years my surgical colleagues and I have worked
in close co-operation with the anesthesiologists
and have established a routine method of man-
agement in these difficult situations. Since its
inception, the surgical mortality rate has been
greatly reduced.
Our present method of surgical management of
bleeding peptic ulcer is as follows: two 15-gauge
needles are inserted into the veins even if it is
necessary to cut down on the veins to accom-
plish this. It is thought that complete and ade-
quate control of two veins is of utmost importance
in the maintenance of an adequate circulating
blood volume. The systolic blood pressure should
be maintained at more than 80 millimeters of
mercury in order to be well above the minimal
pressure for renal filtration and thereby fore-
stall development of lower nephron nephrosis.
The abdomen is opened after local infiltration
with procaine has been accomplished. The stom-
ach will be greatly distended and filled with blood
and clots; therefore, the stomach is opened and
evacuated immediately so that the patient can-
315
ACUTE ABDOMINAL DISEASES—RE MINE
not regurgitate large quantities of blood. The
anesthesiologist then puts the patient to sleep and
inserts an intratracheal cuffed tube. Thus, with
complete control of both the circulatory system
and the airway, the surgeon can proceed with the
operation with relative ease and considerably less
risk to the patient.
The next problem is to bring the bleeding
point under control by either suture or ligature ;
once this is accomplished, the condition of the
patient will become stabilized fairly well. Of
course, blood is being replaced all the time, and
after the bleeding has been stopped the surgeon
can proceed with an adequate and satisfactory
gastric resection of whatever type is preferred.
Perforated peptic ulcers have had considerable
attention recently due to the advocacy of con-
servative methods of management by some work-
ers. For the most part, my colleagues and | con-
tinue to treat perforated ulcers surgically. At -
present no attempt is made to close a perforated
gastric ulcer, since it cannot be determined im-
mediately whether such a lesion is an ulcer or
a carcinoma. Therefore, these lesions should be
resected whenever possible.
Perforated duodenal ulcer presents a somewhat
different problem. The diagnosis of an acute
perforated duodenal ulcer is made from the cri-
teria of previous ulcer history, sudden onset of
acute abdominal distress, free air in the abdomen
and an increased value for serum amylase. The
serum amylase is increased usually to 500 or
1,000 units in perforated duodenal ulcer; this
finding is often important in differentiating this
disease from acute pancreatitis, in which the
value for serum amylase is considerably higher,
often ranging from 3,000 to 4,000 units. As
soon as the diagnosis of perforated peptic ulcer
is made, the patient should be prepared for oper-
ation unless very definite localizing signs are de-
monstrable.
Such preparation consists of immediate gastric
intubation to rid the stomach of its contents and
prevent further leakage into the abdomen. In
addition to this, the patient receives parenterally
large doses of atropine or methantheline bromide
(banthine) to further inhibit gastric secretion and
also to inhibit pancreatic secretion. The patient
should receive large doses of antibiotics, with
morphine or some similar narcotic to allay ,the
pain ; intravenous administration of fluid or blood
tranfusions are given as necessary to treat shock
316
or to restore proper hydration. The perforation
is then promptly closed,
Many times the abdominal cavity will be great-
ly soiled with contents from the stomach and
duodenum, and severe chemical peritonitis will
be present as a result of the gastric acid, bile
and pancreatic juice liberated into the peritoneal
cavity. Under such conditions, the peritoneal
cavity should be lavaged profusely with large
quantities of saline to remove such material and
reduce the extent of chemical peritonitis. A
mixture of penicillin and dihydrostreptomycin is
left in the abdomen to combat the growth of any
bacteria that might have been introduced into
the cavity. As the result of use of this method,
there have been no deaths at the Mayo Clinic
in the last two years from perforated peptic ulcer.
In addition to this regimen, more perforated
duodenal ulcers are now being resected than
before.
closure of a perforated duodenal ulcer will return
later because of reperforation, obstruction or
hemorrhage. If primary resection will spare the
patient a second major surgical procedure, the
surgeon probably is obligated to do this when-
ever possible. However, primary resection should
Many patients who have had _ simple
not be used indiscriminately, and candidates for
the procedure should be picked with great care.
A number of factors enter into the selection
of patients for primary resection of a perforated
duodenal ulcer. The age of the patient should
come into consideration, but no hard and _ fast
rule can be set; a 65-year-old patient may be in
unusually good condition for his age. The gen-
eral condition of the patient is important; the
physician must use his clinical judgment in eval-
uating the condition of each patient. The amount
of soilage in the abdomen should be considered.
If the patient is having a great amount of shock
resulting from severe chemical peritonitis, the
surgeon should not add to that shock by attempt-
ing a long procedure, such as gastric resection.
The duration of the perforation is also to be
considered. If the perforation has been present
for some time, much contamination has occurred
and the patient’s condition may not be good; un-
der such conditions, mere closure of the ulcer
should be done. The condition of the duodenum
is of prime importance. This will determine
whether or not adequate closure of the duodenal
stump can be done. If the tissues are in poor
condition, friable, or edematous, if much fore-
MINNESOTA MEDICINE
ition
reat-
and
will
bile
meal
meal
large
and
A
in is
any
into
thod,
‘linic
ilcer,
rated
than
mple
turn
1 or
» the
_ the
rhen-
ould
s for
care,
ction
rated
ould
fast
be in
gen-
- the
eval-
\ount
ered.
hock
the
mpt-
‘tion.
o be
esent
irred
> un-
ulcer
num
mine
denal
poor
fore-
DICINE
ACUTE ABDOMINAL DISEASES—RE MINE
shortening is present, or if the perforation is
extremely large and occupies a major portion
of the wall of the anterior surface of the duo-
denum, then it is not wise to attempt resection and
run the risk of a draining duodenal stump in
addition to the many other associated problems.
Gallbladder
Difference of opinion continues as to when oper-
ation should be performed in acute disease of the
gallbladder. Patients with this disease must be
carefully individualized. Emergency surgical in-
tervention does not have to be considered for
patients who are merely having minor attacks.
Patients having attacks severe enough to necessi-
tate admission to a hospital or repeated injection
of narcotics for relief of pain present a consid-
erably different problem. Such patients may be
evaluated on the basis of several factors, among
the most important of which are (1) the duration
of the present attack, (2) the severity of the
present attack, (3) the number of previous at-
tacks and (4) the association of pancreatitis.
If the duration of the present attack has been
as short as twenty-four hours or so, it is advis-
able to observe the patient for a while longer, per-
haps an additional twelve to twenty-four hours.
This allows time to show improvement, and
in the meantime proper medical-management can
be instituted. At the end of this period if the
pain and other symptoms are less and the tem-
perature is on the decline, then the program
should be continued. If, however, the condition
of the patient has not improved or has become
worse, then surgical intervention is indicated. At
the end of this period, the attack has not been of
sufficient duration for the surgical procedure to
be technically difficult because of inflammatory
reaction. On the other hand, if the attack has
lasted five or six days, the affected tissue by this
time has become so brawny and ligneous that
cholecystectomy is extremely hazardous and dif-
ficult and should not be attempted if it can pos-
sibly be avoided. Thus a duration of five or six
days is the upper margin of safety beyond which
operation is not recommended until after the at-
tack has subsided.
The number of previous attacks may play an
important’ role in determining the best form of
treatment for a particular patient. If the patient
is seen in a severe attack and has not had pre-
vious gallbladder disease, that patient should be
May, 1955
operated on immediately. It is largeiy among
this group that free perforation of the gallbladder
is found, associated with bile peritonitis. This
is due primarily to the fact that the adjacent
abdominal structures have not yet had an oppor-
tunity through repeated minor attacks and re-
sultant inflammation to wall off the area around
the gallbladder and thus prevent so-called free
perforation. Approximately 4 per cent of all
acutely inflamed gallbladders will perforate.
In the event of associated pancreatitis, which
is evidenced by pain penetrating through to the
back and by an increase of serum amylase, sur-
gical intervention should be postponed if at all
possible. This is especially true since these pa-
tients may have a stone in the common bile duct,
which would necessitate exploration of the duct.
This is technically difficult in the presence of
severe inflammation; therefore, operation should
be delayed if at all possible until after the attack
has subsided sufficiently to allow the inflammation
to subside, which usually takes two or three
weeks after onset of the disease.
Pancreas
Acute pancreatitis continues to be a most diffi-
cult and often lethal problem. A rigid abdomen,
a shocklike picture and greatly increased values
for serum amylase and lipase, in the absence of
free air in the abdomen, lead to the diagnosis of
acute pancreatitis. In the past, several procedures
have been offered for use in surgical manage-
ment of this disease. Among these are drainage
of the common bile duct, drainage of the region
around the pancreas and splitting of the capsule of
the pancreas. These methods have not proved
to be of sufficient value to recommend their rou-
tine use. Instead, a properly managed conserva-
tive regimen appears to offer considerably more
than does surgical intervention in this disease
and does not add to the already existing shock
of the patient. ;
As soon as the diagnosis of pancreatitis is
made, all efforts should be directed toward the
suppression of pancreatic function, general sup-
port of the patient and the relief of pain. The
patient should receive nothing by mouth and con-
tinuous gastric suction should be instituted. This
removes the gastric acid as a source of pancreatic
stimulation. Use of morphine and codeine should
be avoided as these drugs frequently may cause
spasm of the sphincter of Oddi, thus hindering
317
ACUTE ABDOMINAL DISEASES—RE MINE
pancreatic drainage. Other drugs for the relief
of pain should be used, however, in sufficient
doses to give adequate relief. Large doses of
atropine or banthine given parenterally should be
used to suppress gastric as well as pancreatic
function. Massive doses of broad-spectrum anti-
biotics should be given, as sterile abscesses fre-
quently form from necrosis of tissue and pan-
creatic digestion and these may be secondarily
infected by bacterial invaders. Adequate amounts
of fluid and blood should be given parenterally as
indicated. This program has proved to be satis-
factory and has greatly reduced mortality rates
in the management of this disease.
Small Intestine
Emergency problems of the small intestine may
be divided into three main groups, namely (1)
those related to Meckel’s diverticulum, (2) those
resulting from mesenteric vascular occlusion as
the result of either thrombosis or embolism and
(3) obstruction from such conditions as adhe-
sions, congenital bands, volvulus, tumors (either
benign or malignant, such as polyps, lipomas,
myomas, adenocarcinomas and carcinoids), and
foreign bodies, such as ingested articles and gall-
stones.
Meckel’s diverticulum may give symptoms from
bleeding, obstruction or perforation. The diag-
nosis usually is made by exclusion, as there are
no good pathognomonic signs to indicate the
lesion.
Mesenteric thrombosis may be acute or insidi-
ous in onset depending on the causative situation.
The existence of ventricular fibrillation often
may give a clue but this is not necessarily a
prerequisite for mesenteric vascular occlusion.
Venous thrombosis may be a more frequent cause
of mesenteric vascular occlusion than is arterial
embolism ; the former may occur on the basis of
cardiac failure with resultant decompensation and
diminished venous return. The affected tissue
must be resected; otherwise the outlook is ex-
tremely poor.
The diagnosis of intestinal obstruction may be
made on the following criteria: intermittent
crampy pain, borborygmi at the height of the
pain, nausea, vomiting, interference with bowel
movements, abdominal distention, localized ab-
dominal tenderness and roentgenologic evidence.
Certain factors contribute to a late diagnosis in
acute intestinal obstruction. These include failure
318
to recognize intestinal colic, failure to auscultate
the abdomen, frequent lack of local findings, con-
fidence in enemas, apparent effect of laxatives
and premature use of morphine.
Whenever possible it is always well initially
to try conservative methods in the management of
simple intestinal obstruction. Such methods in-
clude giving nothing by mouth, intestinal in-
tubation, parenteral administration of fluids, hot
abdominal stupes, inhalation of oxygen, blood
transfusion when necessary, warm gentle rectal
irrigation and close observation, including blood
chemical determinations and roentgenograms of
the abdomen.
Obstruction of the small intestine presents
many varied problems. Adhesions and congenital
bands are the cause in the great majority of
cases. In the case of adhesions, medical decom-
pression by means of a Miller-Abbott tube or
some other type of long intubation tube, if
possible, is preferable to surgical procedures be-
cause the latter only produce more adhesions.
Volvulus of the small intestine presents an ex-
tremely serious problem. Often an indication to
the correct diagnosis may be noted on a scout
film of the abdomen. A characteristic roentgeno-
logic picture is the so-called almond-shaped de-
formity, which is pathognomonic of a closed-
loop obstruction of the small intestine, or so-
called volvulus. Once this picture is seen, the
patient should be operated on immediately ; other-
wise gangrene of the intestinal loop will develop,
necessitating a much more extensive procedure,
with resection of a segment of the small intes-
tine.
Tumors that produce obstruction must be re-
moved surgically. It is best, however, to decom-
press the intestine as much as possible before-
hand, as this will make the operative procedure
considerably easier for both the surgeon and
patient. Resection of the small intestine may be
unusually dangerous, especially when one is
forced to attempt anastomosis in a distended
edematous friable segment. In order to put the
tube into the small intestine as far down and as
rapidly as possible, it is often necessary to push
the tube into the small intestine through the
pylorus with the aid of fluoroscopic examination.
Tubal decompression may greatly improve the
integrity of the tissues with which the surgeon
is forced to work.
Foreign bodies occasionally may cause intestinal
MINNESOTA MEDICINE
ACUTE ABDOMINAL DISEASES—RE MINE
obstruction; many of them can be noted on a
scout film of the abdomen. Ileus produced by a
gallstone, however, is an extremely difficult prob-
lem to diagnose preoperatively at times, yet to
the careful observer the diagnosis frequently may
be made from the scout film. The stone itself
seldom may be seen; however, the presence of
free air in the biliary tree is pathognomonic of
gallstone ileus. This finding means that the patient
should be operated on immediately, because it is
indicative of air that has escaped into the biliary
tree through the fistula between the gallbladder
or the common bile duct and the small intestine.
The stone usually will lodge in the distal 5 or 6
cm. of the ileum, with a marked amount of inflam-
matory reaction around it and a considerable
degree of distention above it. When the stone is
found it should be milked proximad away from
the inflamed and edematous intestine up to a nor-
mal segment, where a small incision can be made
through the wall of the intestine, the stone re-
moved and the incision closed with minimal diffi-
culty. One per cent of all obstructions of the
small intestine are due to gallstones.
Large Intestine
Acute emergencies involving the large intestine
may be generally divided into three main groups,
namely (1) those resulting from appendicitis, (2)
those resulting from diverticulitis and (3) those
resulting from obstruction from other causes.
Appendicitis will not be considered in this pres-
entation because relatively little recent change has
occurred in the management of this disease.
Diverticulitis is primarily a disease of middle
and old age. Five to 10 per cent of persons more
than forty years of age have but do not suffer
from diverticulosis. Of these persons, one in 300
experiences diverticulitis. Diverticulosis is twice
as common among males as among females but
diverticulitis has an equal sex incidence. Divertic-
ulitis is located in the sigmoid in 75 per cent
of cases. Emergency surgical procedures for this
condition are indicated only in the presence of
free perforation or obstruction. A transverse
loop colostomy to divert the fecal stream is usually
all that should be done initially, and more defini-
tive surgical treatment should be planned for a
later date. Rarely the affected region may be
exteriorized. Primary resection of the perforated
obstructed segment is difficult because of the
severe inflammatory reaction and seldom can be
accomplished. Other conditions of the colon that
necessitate emergency surgical procedures are
volvulus and closed-loop obstruction.
Carcinoma of the sigmoid and rectosigmoid ap-
pears to be the commonest cause of closed-loop
obstruction in the presence of a competent ileo-
cecal valve. A closed-loop obstruction may be
readily recognized on a scout film of the abdomen
by the severe distention of the colon, with appar-
ent absence of gas in the small intestine. These
patients should be followed with extreme care
since perforation of the cecum may be imminent.
Impending cecal perforation may be diagnosed by
the following criteria: progressive cecal enlarge-
ment as evidenced by roentgenologic studies, pain
and tenderness over the cecal region, rebound
tenderness over the cecal region and an increase in
pulse rate. Many times in the presence of closed-
loop obstruction, the first symptom may be pain
in the right lower quadrant, which will draw
attention away from a lesion in the sigmoid or
rectosigmoid and may cause it to be overlooked.
The reason for such pain with an obstructing
lesion in the sigmoid or rectosigmoid is that the
cecum is the thinnest and most easily distensible
part of the intestine, which is why it also is the
commonest point of perforation.
When the afore-mentioned findings are noted,
immediate surgical decompression is compulsory.
In our experience the procedure of choice in this
instance is transverse loop colostomy. Some sur-
geons favor use of appendicostomy or cecostomy.
It has been our experience that an appreciable
number of the stomas established by these latter
procedures do not function in a satisfactory man-
ner and failure to function at this crucial time
may prove fatal.
Thousands of people are abroad in the country with
tuberculosis which is arrested or inactive following
treatment. Antibiotics have played a large part; and we
hope these people will remain well for many years, but
how many will relapse,-we do not know. How many may
at some time produce tubercle bacilli, which may be
a danger to the community, we do not know. Will the
May, 1955
antibiotics lose their effectiveness as the number of re-
sistant cases increases in the community? Again, we do
not know. It is such uncertainties that lead the pessi-
mists to say that tuberculosis, like the poor, will be al-
ways with us.——Georce J. WuHerrett, M.D., National
Tuberculosis Association Transactions, 1954.
319
Hematuria
ODERN physicians are fully aware of the
potential seriousness of hematuria and ad-
vise patients who have such a condition to under-
go prompt and thorough examination. The trag-
edies that occur from delayed diagnosis of ma-
lignant lesions of the genitourinary tract often
can be ascribed to the patient, who either does
not seek advice immediately after hematuria ap-
pears or ignores the counsel of his physician. The
public must be educated to the seriousness of
hematuria. :
Hematuria always demands a qualifying ad-
jective, namely either gross or microscopic. Gross
hematuria always means an abnormal or patho-
logic situation. On the other hand, the finding of
microscopic hematuria’ always brings up the un-
answered question with.regard to whether or not
a few erythrocytes may be present in the urine
of normal persons. The bulk of evidence accu-
mulated over the years would .indicate that, with
ordinary techniques of urinalysis, the presence
of more than two erythrocytes per high-power
microscopic field in a centrifuged specimen is
abnormal. Of course, many variables enter into
this conclusion, such as the accuracy of the tech-
nician, the speed of the centrifuge and the spe-
cific gravity of the urine. Dilute urine contains
fewer erythrocytes than does an equal volume
of concentrated urine.
Sites of Origin of Hematuria
There are three main possible sites of origin
of hematuria, namely lesions occurring as part
of a systemic disease, lesions in organs adjacent
to the genitourinary tract and lesions in the geni-
tourinary tract itself. Among the systemic dis-
eases that may cause erythrocytes to appear in
the urine are (1) acute or chronic nephritis; (2)
diseases of the blood-forming organs, such as
_ Read at the meeting of the Minnesota Academy of
General Practice, Rochester, Minnesota, October 20, 1954.
From the Section of Urology, Mayo Clinic and Mayo
Foundation.
The Mayo Foundation, Rochester, Minnesota, is a part
of the Graduate School of the University of Minnesota.
320
JOHN L. EMMETT, M.D.
Rochester, Minnesota
thrombocytopenic purpura, leukemia, Hodgkin’s
disease, hemophilia and polycythemia vera; (3)
cardiac disease, as in congestive cardiac failure
or renal infarction resulting from rheumatic car-
ditis and auricular fibrillation; (4) acute exan-
thematous diseases and (5) deficiency diseases,
such as deficiency of ascorbic acid or vitamin K.
Drugs and chemicals, such as methenamine, car-
bolic acid, turpentine and sulfonamides, may pro-
duce hematuria, as may administration of anti-
coagulants, such as dicumarol or heparin.
Lesions in organs adjacent to the urinary tract
can be disposed of briefly by simply stating that
the possibilities are unlimited. Among such le-
sions that may produce hematuria by irritation
or invasion of the genitourinary tract are ap-
pendicitis, salpingitis, diverticulitis and carcinoma
of the colon.
The remainder of this presentation will be
devoted to a consideration of lesions of the geni-
tourinary tract itself.
Microscopic Versus Gross Hematuria
The presence of asymptomatic microscopic he-
maturia is perhaps more troublesome to the phy-
sician than is gross hematuria because it is en-
countered more frequently and is associated with
a much smaller incidence of serious disease; yet
the physician does not dare neglect such a finding.
Significant lesions will be found in approximately
5 per cent of such cases; thus the clinician would
like the urologist to furnish a rapid and simple
screening procedure that would eliminate the 95
per cent of cases in which such minimal hema-
turia is insignificant. To date such a procedure
is not available and it is necessary to subject 100
patients to such procedures as excretory urog-
raphy, cystoscopy and retrograde pyelography to
discover the five or six who have significant
lesions. In some of the cases in which no lesions
are discovered to explain the hematuria, the con-
dition simply may be normal erythrocyturia. In
some cases hematuria may originate from trauma
as a result of digital rectal or pelvic examination
MINNESOTA MEDICINE
rkin’s
(3)
ilure
- Car-
*xan-
‘ases,
n K,
car-
pro-
anti-
tract
that
h le-
ation
- ap-
10mMa
ll be
geni-
auma
ation
ICINE
HEMATURIA—EMMETT
In other cases,
before the urine was obtained.
subclinical nephritis or a small angioma of the
kidney may be present. It is apparent that asymp-
tomatic microscopic hematuria is a worrisome
problem whose solution is not always satisfactory.
Gross hematuria is a less troublesome problem,
at least to the physician, simply because it is as-
sociated with such a high incidence of significant
and serious lesions that a complete urologic ex-
amination is compulsory.
The commonest cause of gross hematuria in a
woman is inflammation, usually cystitis or pyel-
onephritis. The commonest cause of gross hema-
turia in a man is a tumor of the bladder, with
hypertrophy of the prostate in second place. An
important point to emphasize is that benign en-
largement of the prostate causes hematuria much
more frequently than does carcinoma of the
prostate.
General Clinical Aspects of Hematuria
When the physician is confronted with a pa-
tient who has gross hematuria he first considers
the age of the patient. Hematuria is rare in in-
fancy and childhood; usually it is the result of
infection in such instances. Such infections usual-
ly are produced by stasis, which usually is caused
by congenital obstruction. The latter is ordinarily
at one of three chief points, namely the ure-
teropelvic juncture, the vesical neck or, in the
male, the urethral meatus. Tumors of the geni-
tourinary tract in infancy are rare and are chiefly
Wilms’ tumors and sarcomas. Such lesions rare-
ly cause hematuria; they are diagnosed because
they present themselves as abdominal masses.
With regard to gross hematuria in adults up
to 40 years of age, the common causes include in-
fection, cystitis, pyelonephritis, tuberculosis and
calculi. Tumors are relatively uncommon in this
age group. However, in patients more than 40
years of age, the incidence of neoplasms and
prostatic lesions, both benign and malignant, be-
comes increasingly common.
The type of hematuria may give some clue as
to its origin. Initial and terminal hematuria usu-
ally is conSidered to indicate a lesion in the neck
of the bladder or the prostatic portion of the
urethra. If it is present in the same degree
throughout urination and if the blood is dark,
the lesion is thought to be in the upper part of
the urinary tract, whereas if the blood is fresh
and bright, it supposedly comes from the bladder.
May, 1955
However, it is not wise to place too much reli-
ance on this finding. Blood that emerges directly
from the urethra and soils the clothes of either
a man or a woman originates distad to the ex-
ternal sphincter. It is well to be cautious about
a story of bleeding in a woman. The physician
must take a careful history and be extremely pa-
tient with a woman in order to ascertain whether
she is talking about vaginal bleeding, about ure-
thral bleeding or about cystitis; this is because of
embarrassment and because many women do not
understand the terms used. Sometimes a com-
plete urologic and gynecologic examination is re-
quired to uncover the true situation.
The general physical examination may not be
too productive in the diagnosis of hematuria but
it should not be overlooked. Palpable renal en-
largement may indicate neoplasm, hydronephrosis
or a cyst of the kidney. Tenderness in the flank
may indicate a stone, infection or hydronephrosis.
Enlargement of a supraclavicular lymph node
may herald hypernephroma. Acute left varicocele
in a man past 40 years of age often means a
left hypernephroma with invasion of the left
renal vein, because the spermatic vein empties
into the left renal vein. Digital rectal examination,
which is so important, can aid in the diagnosis of
carcinoma of the prostate, benign hypertrophy
of the prostate or prostatic calculi. Vaginal ex-
amination may reveal infiltration at the base of
the bladder from a tumor.
Excretory Urography
Emphasis should be placed on the value of
excretory urography, including the plain roent-
genogram of the kidney-ureter-bladder region
that accompanies this procedure. This examina-
tion is of great importance in the diagnosis of
urologic lesions because it is one of the greatest
tests of renal function, indicating the compara-
tive function of the two kidneys. The other
factor of importance with regard to excretory
urography is that it focuses attention on the part
of the urinary tract that is involved, which is
of great aid in cystoscopy.
Excretory urography can be of assistance in
the localization of urinary obstruction, demon-
strating whether such obstruction may be at the
ureteropelvic junction or lower in the. urinary
tract. It can accurately localize calculi in the kid-
neys, pelves or ureters. It may demonstrate fil-
ling defects at the base of the bladder as the re-
321
sult of prostatic hypertrophy. Other filling de-
fects may indicate infiltrating tumors of the blad-
der. Pedunculated tumors of the bladder may
be outlined by the way in which the opaque me-
dium surrounds them. Hypernephromas may be
indicated by characteristic distortion of calyces.
Tumors of the renal pelvis may produce typical
filling defects.
Cystoscopy
It is usually necessary to perform cystoscopy
to complete a urologic diagnosis because it is
easier and more accurate to study lesions in the
bladder under direct vision than to rely on
urography entirely. Also, it is often necessary
to do retrograde pyelography to supplement ex-
cretory urography. It is of importance to examine
the patient urologically while bleeding is still
present. So often a patient bleeds grossly for
2 or 3 days and by the time he gets ready for
urologic examination the bleeding has stopped,
making it difficult to determine the source of the
hemorrhage.
Another element of importance in cystoscopy
HEMATURIA—EMMETT
is to examine the ureteral orifices and watch the
urine as it spurts from them. That is the only
way to determine whether or not blood is coming
from a kidney. Examination of a specimen of
ureteral urine taken from a ureteral catheter will
not necessarily indicate whether or not blood is
coming from the kidney in question because the
trauma caused by passage of a ureteral catheter
in most cases will cause either microscopic or
gross hematuria. However, the appearance of
bloody urine flowing out from a ureter that has
not been catheterized will localize the kidney that
is bleeding.
In conclusion I wish to emphasize that the
Bladder Tumor Registry indicates that 50 per
cent of tumors of the bladder are not diagnosed
within one year after the first attack of hematuria.
This is a tragic situation; it means that all phy-
sicians must be on the alert in their practice and
community to educate patients and the public to
the seriousness of hematuria and the advisability
of seeking medical advice immediately when it
occurs.
CORTISONE IN RHEUMATIC DISEASES -
(Continued from Page 308)
such treatment is indicated. Until better thera-
peutic measures are developed, cortisone and re-
lated hormones will continue to be important and
valuable agents in the management of such
patients.
Addendum
Since this paper was prepared, another potent
antirheumatic steroid, namely metacortandracin,
or 1-dehydrocortisone, has been synthesized. Al-
though this steroid has less tendency than does
cortisone to cause retention of sodium, chloride
and water, and to produce excretion of potassium,
it does cause many other cortisonelike metabolic
effects. The dose of 1-dehydrocortisone (meta-
cortandracin) necessary to produce an equivalent
antirheumatic effect appears to be only a third
or a fourth that of cortisone, perhaps even less
in some cases. The use of this steroid should
be attended by the precautions indicated during
treatment with cortisone; however, restriction of
intake of sodium and supplementation of potas-
sium usually have not been required, at least not
in rheumatoid ‘patients treated for periods up
322
to several months with doses of 5 to 20 mg. per
day.
References
1. Boland, E. W.: Hydrocortisone (Kendall’s Com-
pound F): Experiences with the free and acetated
forms in rheumatoid arthritis. J. Am. Pharm. A.
(Pract. Pharm. Ed.), 13:540-544 (Aug.) 1952.
2. Hench, P. S., and Ward, L. E.: Rheumatoid
arthritis and other rheumatic or articular diseases.
In Lukens, F. D. W.: Medical Uses of Cortisone:
Including Hydrocortisone and Corticotropin. p. 208.
New York: The Blakiston Company, Inc., 1954.
3. Salassa, R. M., Bennett, W. A., Keating, F. R.,
Jr., and Sprague, R. G.: Postoperative adrenal cor-
tical insufficiency : Occurrence in patients previously
treated with cortisone. J.A.M.A., 152:1509-1515
(Aug. 15) 1953.
4. Slocumb, C. H.: Relative cortisone deficiency simu-
lating exacerbation of arthritis. Bull. Rheumat. Dis.,
3:21-22 (Oct.) 1952.
5. Slocumb, C. H.: Rheumatic complaints during
chronic hypercortisonism and syndromes during
withdrawal of cortisone in rheumatic patients.
Proc. Staff Meet., Mayo Clin., 28:655-657 (Nov.
18) 1953.
6. Slocumb, C. H., and —_, z. S.: The use and
abuse of cortisone in ry. S. Clin. North
America, PP. 1105-1107 thers 1952.
Ward, L. Polley, H. F., Slocumb, C. H., and
Hench, ty S.: Cortisone in treatment of theu-
oe arthritis. J.A.M.A., 152:119-126 (May 9)
1953.
af
MINNESOTA MEDICINE
will
d is
- the
leter
POF
: of
has
that
the
per
ysed
Iria.
hy-
and
c to
lity
1 it
per
om-
ited
oid
ses.
ne:
‘or-
isly
515
nu-
iS.,
ing
ing
its.
Ov.
ind
rth
ind
=U-
9)
of the Vaginal Examination
M°! of us learn best by doing, and so it is
fortunate indeed that the technique of the
pelvic examination can be attained more by doing
than by reading or hearing about it. What I have
to say, therefore, is directed chiefly toward actual
performance of this examination, with some at-
tention to interpretation of what the examiner
finds.
The conditions to which the physician’s atten-
tion is called most often by women include inflam-
matory and infectious disease, new growths,
sequelae of labor and endocrine dysfunctions
which produce aberrations of menstrual function.
Often the patient will seek your counsel because
of abnormal vaginal secretions, genital bleeding or
pelvic pain. Less often, she may come to you
because of protruding masses or generalized pelvic
or abdominal discomfort. Still others may visit
your office because the persistent “cancer drives”
have made them apprehensive, and they wish to
reassure themselves by such routine measures of
investigation as you are able to provide. What-
ever the cause, it is certainly true that the number
of such patients in the office of the gynecologist
is increasing. The net result is to place greater
responsibility on the physician, for if mass edu-
cation sends more patients to him, he will be
expected more and more often to detect malig-
nant.processes in earlier stages, where treatment
can be swift and effective, and lives can be saved.
The Physical Examination
A general physical examination should follow
the history and should, whenever it is possible,
precede the pelvic examination.
What to Look For.—in the general examina-
tion of the patient much can be learned: her
Read at the meeting of the Minnesota Academy of
General Practice, Rochester, Minnesota, October 20, 1954.
From the Section of Obstetrics and Gynecology, Mayo
Clinic and Mayo Foundation.
The Mayo Foundation, Rochester, Minnesota, is a part
of the Graduate School of the University of Minnesota.
May, 1955
The Technique and Interpretation
EDWARD A. BANNER, M.D.
Rochester, Minnesota
habitus, whether masculine or feminine, robust or
frail, hirsute or balding—all may be noted with
a glance. The temperature, pulse rate and blood
pressure should be recorded. The breasts should be
examined, for they are secondary sex characters
and as such they share in many changes and
physiologic conditions within the pelvis. In the
abdominal examination the physician should note
the presence or absence of striae indicative of
rapid loss of weight, and evidence of past preg-
nancies or endocrine dysfunctions. Tender areas
should be carefully palpated, and distinction
should be made between rigidity and normal
muscular defense reaction. ‘
Much can be learned from an adequate abdom-
inal examination, and although it is neglected
by many, it may actually bring to the fore the
primary difficulty at hand, especially if the patient
is acutely ill or apprehensive. In passing, let us
remember that a full bladder at times has de-
ceived the shrewdest of examiners. For this rea-
son, some gynecologists have suggested that the
patient void immediately before examination to
forestall such a diagnostic pitfall.
The Pelvic Examination
Whatever is learned after the history and the
physical examination must be gained tactually,
and must be correlated with information gained
from those two procedures. The only way I know
of to develop the tactile sense is to do enough
pelvic examinations to acquire the faculty of
instant recognition not only of the normal ana-
tomic relationships but also the minor aberrations
which are the hallmarks of pelvic disease. One
should become familiar with the nodular tender
areas involving the uterosacral ligaments and
posterior uterine surface so characteristic of endo-
metriosis; also the thickened, tender and bulbous
swelling of the tubes portraying the aftermath of
pelvic inflammatory disease.
323
Equipment.—All the necessary equipment for
the proper performance of a pelvic examination
should be at hand before the examination is
begun. This would include drapes, hand protec-
tion, lubricants, light, material for taking smears,
and a table which will offer the examiner every
advantage.
Since the speculum is an indispensable instru-
ment to the gynecologist, a word should be said
regarding the various types available. For most
purposes, the bivalve speculum is perfectly satis-
factory. It is made in several sizes, and the
examiner selects that size which can be introduced
easily and does not cause discomfort to the
patient. In children, the most satisfactory specu-
lum is the tubular cystoscope, which is used
with the patient in the knee-chest position. The
tubular speculum likewise is available in a variety
of sizes. For some patients the flat Sims speculum
may be used to advantage. The physician should
become familiar with the various speculums and
their sizes to facilitate and insure maximal com-
fort to the patient.
Rapprochement With the Patient.—Establish-
ing the patient’s confidence is the greatest single
factor in promoting ease of examination. Uncon-
sidered remarks or chance actions which engender
fear, resentment or anxiety may result in a tense,
disturbed or apprehensive patient. Such a patient
is rigid and ill at ease, and in a state that may
make a pelvic examination impossible or seriously
unproductive. In creating confidence, gentleness
is the first essential. Relaxation may be encour-
aged by asking the patient to breathe through her
mouth. Constant reassurance is helpful. No vio-
lation of modesty should enter the pelvic examina-
tion, but exposure should be consistent with
thoroughness. The presence of a nurse or an
assistant may aid in this respect, although it is not
entirely necessary. Most of all, the physician
should maintain an attitude of kindly and imper-
sonal thoroughness. A pelvic examination is not
a pleasant experience for any woman, and the
success with which it is conducted will depend as
much on the attitude of the physician and his
assistant as upon the actual situation in the pelvic
region.
What to Look For.—Inspection of the external
genitalia is done with the patient in the lithotomy
position, with the physician standing between the
324
VAGINAL EXAMINATION—BANNER
patient’s knees. The vulva is inspected for dermal
lesions, excessive secretions and tumor masses.
Since vulvar neoplasms frequently metastasize
to the inguinal glands, these glands should be
palpated for tenderness or enlargement. Small,
shotty inguinal glands are not unusual, especially
in young women, and should cause no concern
unless they are associated with definite lesions.
After examination of the vulva, the labia should
be gently parted, and the size, shape and dermal
changes, if present, should be noted carefully.
Inspection for kraurosis vulvae, lichen sclerosus
et atrophicus and leukoplakia should be made.
If it is suspected that one such condition is
present, the counsel of a dermatologist is of
inestimable help in identification. If a discharge
is present, the examiner should determine whether
it is bloody, serosanguineous, purulent or mucoid.
Normally, Bartholin’s glands should not be pal-
pable and Skene’s glands should not be tender.
If the hymen is intact, examination of the pelvic
organs may be completed rectoabdominally. Care-
ful note should be made of the caliber of introitus.
By pressure exerted downward against the peri-
neal body, more space may be obtained with less
discomfort to the patient.
The condition of the pelvic floor is then deter-
mined. To determine the presence or absence of
rectocele is not difficult, but may be rendered
easier by pressure exerted upward on the pos-
terior vaginal wall, through the rectum. The
size, shape, consistency and position of the cervix
should then be determined by palpation. A normal
cervix is said to have the consistency of the end
of the nose, whereas a cervix invaded by a malig-
nant process generally has a hard or gritty
consistency.
At this point, examination with the speculum
is begun. It is well to recall at this point that the
axis of the vagina is directed posteriorly, while
the long axis of the introitus is anteroposterior.
It is well, then, to introduce the speculum of the
bivalve type with its long axis vertical, to conform
to the shape of the vaginal orifice. This is pre-
ceded by separating the vulva and pressure on the
perineal body. When it is well past the entrance
of the vagina, the speculum is turned so that the
blades lie transversely, with the tip of the specu-
lum pointed posteriorly toward the vaginal floor
when the blades are opened. The common practice
of using soap or lubricants is not advisable, since
soap alters the chemical reaction of the vaginal
MINNESOTA MEDICINE
tis
sh
at
bi
ep
ep
m:
H
m
m<
pa
ar
or
no
tis
M.
VAGINAL EXAMINATION—BANNER
secretions and interferes with staining and cul-
tural reactions. Lubricants also frequently make
interpretation of Papanicolaou smears for malig-
nant cells more difficult or even impossible.
Rather, it is better to wet the gloved hand and
speculum with warm water, thereby decreasing the
shock to the patient and offering adequate lubri-
cation.
With the aid of a strong light, the cervix is now
visualized directly. Size, position and length of
the cervix, as well as the nature of its secretions,
are noted. This is the moment at which an old
adage becomes most significant: “Examine the
cervix with a strong light and with a suspicious
mind.” A smear for study by the Papanicolaou
technique may be taken; secretion should be
taken from both the internal os and the vaginal
pool. Samples may be taken with the use of either
a wooden spatula or a cotton applicator. The
secretion is spread on a clean glass slide which is
dropped immediately into a solution of 95 per
cent alcohol. Because of the danger of explosion,
ether should not be added to the solution of
alcohol stored about the offices.
Next, the cervix is inspected for evidence of
cystic change, lacerations or erosions. A speci-
men of tissue can be taken for biopsy, if biopsy
is indicated. A specimen of any abnormality that
is seen should be taken for biopsy before definitive
therapy is offered. Such a specimen should be
obtained in the presence of all cervical erosions,
and care should be exercised to obtain adequate
tissue from the squamocolumnar junction. This
should always be done before cervical cautery is
attempted. The application of Lugol’s solution
will demarcate those areas most applicable for
biopsy.
You will recall that normal cervical and vaginal
epithelium contains glycogen, whereas abnormal
epithelium, such as that found in erosions or a
malignant lesion, contains little or none at all.
Hence, by applying a weak solution of iodine
(%4-strength tincture of iodine) to these areas, a
marked differentiation may be seen rapidly; nor-
mal tissue taking a deep mahogany brown, the
pathologic’a pink. It is from the pink or light
areas that specimens for biopsy should be taken.
One must be cognizant of the fact that the Schiller
or iodine test is not specific for any type of lesion,
nor does it distinguish malignant from benign
tissue. All it does is to demarcate the areas from
which specimens of tissue for biopsy should be
May, 1955
taken. There is no special time in the menstrual
“cycle when the specimen for biopsy should be
taken; the important factor is to do it when the
patient is seen. In this regard, the endocervix
should not be neglected, because the introduction
of a small sound or cotton applicator within the
cervical canal (the so-called Clark test) will many
times disclose a pathologic process which other-
wise might have been missed.
Many women present themselves with bleeding
after subtotal hysterectomy. Under such circum-
stances, a small endocervical curet may be used
to obtain tissue for examination. If small endo-
cervical polyps are the cause of the bleeding, this
curettage may be therapeutic as well as diagnostic.
It is always well to submit all such material to a
competent pathologist for careful examination and
evaluation.
It is also a wise practice to remove all polyps
which may be found extruding from the cervix.
Polyps can be removed easily by torsion; this
should be followed by fulguration of the bases of
the polyps. All polyps should be examined by a
competent pathologist. Before the speculum is
removed, the condition of the pelvic walls should
be observed, with attention to the presence or
absence of excoriations or new growths.
The bimanual examination, which would better
be known as the “vaginal-abdominal examina-
tion,” can be done with either the left hand or the
right within the vagina. From a practical stand-
point, and especially in the case of those physi-
cians who practice obstetrics, I believe it is useful
to develop ambidexterity in the performance of
this examination. With the examiner’s fingers
resting against the pelvic floor, the cervix is
palpated, while the examiner’s other hand is
placed flat on the lower part of the patient’s abdo-
men. By elevating the palm and using the tactile
sense in the balls of the fingers rather than in the
tips, the various organs are located, steadied and
evaluated. The size, shape and consistency of each
structure can be determined, and if tumors project
into the superior strait, their outlines can be noted.
After the cervix has been palpated, the presence
or absence of pelvic pain on motion is determined.
The position of the uterus is ascertained by locat-
ing the body of the uterus. When the uterine
fundus lies in its normal relationship, it is usually
in an anteflexed position. Retrocession or retro-
flexion occurs normally in a high percentage of
women. The mobility of the uterus may be then
325
VAGINAL EXAMINATION—BANNER
thoroughly tested. Immobility or excessive pain
on uterine motion may be indicative of chronic
infection, acute exacerbation of chronic infection,
adhesions or endometriosis. ‘When the median
part of the pelvis has been palpated and the condi-
tion of the uterus has been determined, the
examining fingers are now slid into one of the
fornices lateral to the uterus. The abdominal hand
is directed in a like plane, and is moved slowly
and deliberately.
Next, the examiner’s fingers in the vagina are
pushed out into the lateral fornix, while the hand
resting on the abdomen is directed in a like plane.
The ovary is then palpated between the tips of
both fingers. A normal ovary is sensitive and
mobile. Ovaries which are retrocessed within the
pelvis are best examined later by rectoabdominal
approach. The physician should become familiar
with the normal size of an ovary and should keep
in mind its tendency to enlarge after contralateral
oophorectomy and hysterectomy. The normal
ovary feels like an almond; it is about 4 cm. long
and 2 to 3 cm. wide. Normally, it will move within
a limited range. Occasionally, its mobility may
become abnormal and it may be situated imme-
diately lateral to the cervix, within the cul-de-sac,
or high on the lateral pelvic wall.
Normal fallopian tubes usually cannot be pal-
pated through the vagina; however, if they are
thickened or are the sites of chronic residual
changes from infection, they may be sensed as
masses of hornlike shape which occasionally are
fluctuant, and many times are tender, firm and
resistant.
Occasionally, it is possible to palpate the ureters,
lying as they do on the lateral pelvic wall. If
pyelonephritis is present, the ureters may be
thickened ; if tuberculosis is present, they may be
nodular. Ureteral calculi occasionally can be pal-
pated ; inflammatory conditions within the ureters
may provide their own clues by making the ureters
unusually tender.
Rectal examination should be done for all
patients who complain of difficulties referable to
the pelvis, and it is especially indicated for young
women with an intact hymen. When a pelvic
malignant process is present, the rectoabdominal
examination gives perhaps more information than
any other. The necessity for an empty bowel is
326
clear. Care should be taken not to exert too much
pressure against the anterior wall of the bowel,
for that structure may be extremely tender.
Should any abnormalities be noted, proctoscopic
examination is indicated.
Lesions within the vagina and cervix occa-
sionally may be seen best by examination with the
patient in the knee-chest position. The vagina is
easily distended with air, making the vaginal
rugae disappear, and allowing the walls of the
vagina to be seen clearly. Examination of chil-
dren and young girls is best done with the patients
in this position, and with the aid of a Kelly
cystoscope.
At times, it may be necessary to carry out
pelvic examination with the patient anesthetized.
This is indicated only after repeated pelvic exami-
nations have been entirely unsuccessful, sometimes
with several days intervening. We should be
aware not only of the usefulness of this procedure,
but also of its limitations. Naturally, examination
of the pelvis with the patient under anesthesia
has no value under conditions in which the co-
operation of the patient is needed; for example,
to locate areas of pain or minimal discomfort.
In general, the more complete and accurate the
pelvic examination is, the less frequently need
one resort to anesthesia in gynecologic diagnosis.
Laboratory Aids——A paper on the pelvic exam-
ination of course is not complete without brief
mention of some of the laboratory facilities which
aid in the diagnosis. These should include uri-
nalysis, complete blood counts, determination of
the sedimentation rate, serologic tests for syphilis,
smears and culture of specimens of urethral and
cervical secretions, and finally, the taking of
special smears for the Papanicolaou technique of
detection of malignant cells. Specimens of cervi-
cal tissue should be taken for biopsy if the exami-
ner believes this laboratory procedure is indicated.
It is well to emphasize again that all laboratory
procedures should be supplemental to clinical ob-
servation and carefully performed bimanual
examination. Preceded by a carefully taken his-
tory, the value of any laboratory test is dependent
upon the clinician’s ability to interpret the findings
and correlate them with what he has found by
direct examination of the patient.
MINNESOTA MEDICINE
1uch
wel,
der.
opic
cca-
the
a is
inal
the
‘hil-
ents
elly
out
mi-
mes
ire,
‘ion
Sia
ple,
ort.
the
[NE
The Treatment of Anemia
N ANY consideration of the treatment of
anemia, it is important to recognize that
anemia is not a disease in itself but merely a
symptom resulting from some underlying cause.
Therefore, one must establish the etiologic factor
involved in the anemia prior to therapy.
Hypochromic (Iron-Deficiency) Anemia
The great majority of anemias are of the
iron-deficiency type and usually are secondary to
chronic loss of blood, to inadequate intake or
inadequate absorption of iron, or to the so-called
physiologic deficiency of iron. Morphologic ex-
amination of the erythrocytes reveals a decrease
in hemoglobin within the cell, with resultant hy-
pochromasia. The erythrocytes are usually nor-
mal in size, although some regenerative macro-
cytes may be present ; in some instances the eryth-
rocytes may be smaller than normal. Regenera-
tive macrocytosis with increased polychroma-
tophilia may be noted, particularly if the loss of
blood has been severe. A proportionate reduction
in the number of erythrocytes usually occurs in
acute hemorrhage ; however, in this case the cells
rarely show a loss of hemoglobin unless an as-
sociated hypochromic anemia of some duration
has been present prior to the onset of the acute
hemorrhage.
It is important to ascertain, insofar as possible,
whether any loss of blood has occurred in a per-
son who has hypochromic anemia. Loss of blood
with menses frequently may produce a rather pro-
nounced hypochromic anemia. Bleeding from the
gastrointestinal tract is relatively common. Such
bleeding may originate from ulcers, carcinoma,
polyps, varices or hemorrhoids; various hemor-
rhagic diseases may be manifested initially by
bleeding ‘from the gastrointestinal tract. In a
patient who has an obscure anemia, one should
Read at the meeting of the Minnesota Academy of
General Practice, Rochester, Minnesota, October 20, 1954.
From the Section of Medicine, Mayo Clinic and Mayo
Foundation.
The Mayo Foundation, Rochester, Minnesota, is a part
of the Graduate School of the University of Minnesota.
May, 1955
CHARLES H. WATKINS, M.D.
Rochester, Minnesota
examine the stools for evidence of occult blood
and a thorough gastrointestinal investigation
should be done.
Under modern conditions, anemia associated
with an inadequate intake of iron is relatively
rare. A well-balanced diet in the northern part
of the United States contains approximately 10
mg. of iron daily. The gastrointestinal tract is
able to absorb approximately 0.5 to 1.5 mg. of
iron daily; this absorption occurs at a constant
rate even when there may be unusual demands
for iron by the body. The normal excretion of
iron is approximately 1 mg. daily. In certain in-
stances it is well to obtain a detailed description
of the patient’s diet if other etiologic factors can-
not be elicited in the investigation of hypochromic
anemia.
Anemia due to, physiologic deficiency of iron
may occur in several conditions. In infancy there
is usually an inadequate intake of iron as well as
a period of rapid growth with a rapid increase
in blood volume; consequently, the relative de-
ficiency of iron results in hypochromic anemia.
This same condition may prevail during periods of
rapid growth in later years, particularly at the
time of puberty. At such times the great increase
in blood volume may be accompanied by a rela-
tive decrease in the amount of iron available,
with development of hypochromic anemia. At the
onset of menstrual flow, blood may be lost at a
time when rapid growth is still occurring, pro-
ducing a double demand for iron; in such in-
stances, rather severe degrees of hypochromic
anemia may appear. The so-called physiologic
anemia of pregnancy is due in part to the fact
that within a relatively short period a great in-
crease in blood volume occurs with a relatively
constant intake of iron; thus, iron-deficiency
anemia may occur.
Practically all persons can absorb iron from
the gastrointestinal tract. The iron is: absorbed
in the form of ferrous salts and the chief site
of absorption is the duodenum. As already in-
dicated, an extremely small amount of the iron in-
327
gested is actually absorbed and, after hema-
tologic vaiues have been restored to normal by
administration of iron, it is well to continue the
treatment for a month or so in an attempt to
supply the body with sufficient stores of iron.
Protracted treatment after that time is usually
not advisable.
When an anemic patient takes iron, the peak
of the response of reticulated erythrocytes occurs
in about eight to twelve days, which is about the
same time at which it occurs in the treatment of
pernicious anemia with effective fractions of liver
or vitamin B,2. Since administration of iron is
the treatment of choice in iron-deficiency anemia,
the use of liver extract, vitamin B,., folic acid and
other similar substances is not indicated.
Practically all patients respond to the oral use
of iron. However, an occasional patient cannot
tolerate iron given by mouth. Also, in certain
severe hypochromic anemias it may be desirable
to obtain a rapid increase in the value of hemo-
globin. In such situations, the intravenous in
jection of iron is of value. Several formulas for
the calculation of the amount of iron needed in-
travenously to bring the hemoglobin to a normal
level can be found in the literature. The simplest
one is based on the fact that approximately 25
mg. of metallic iron is required to increase the
value for hemoglobin by 1 per cent. This pro
vides an easy method of calculating the amount
necessary. The preparation used is a solution
of saccharated iron oxide in a dose of 100 mg. in-
jected intravenously once or twice daily. Care
should be taken to determine that the material is
not unduly toxic for a given patient and a small
initial dose should be used. If an untoward reac-
tion does not occur, the patient usually will tol-
erate larger doses. Actually it is rarely necessary
to resort to intravenous therapy, as practically
all patients respond satisfactorily to iron given
orally.
Macrocytic Anemia
Among the various types of macrocytic anemia,
often termed “megaloblastic anemia,” the com-
monest is pernicious anemia. Fortunately this form
of anemia responds well to adequate therapy. The
clinical findings in pernicious anemia may vary
but in general they include anemia, glossitis with
atrophy of the mucous membrane of the tongue,
a history of pernicious anemia in the family, early
gray hair, evidence of combined system disease,
328
TREATMENT OF ANEMIA—WATKINS
absence of free hydrochloric acid in the gastric
contents, and intestinal manifestations, which may
be characterized by loose watery stools or by con-
stipation alternating with loose stools. As a rule,
patients who have pernicious anemia do not lose
weight and may have a relatively abundant amount
of subcutaneous fat. They often display a sur-
prising amount of energy for the degree of anemia
that is present; this is probably due to the fact
that, because of the gradual onset of anemia, the
body becomes accustomed to the anoxemia.
Examination of blood smears in pernicious
anemia reveals generalized macrocytosis, with
the erythrocytes usually containing normal
amounts of hemoglobin. There is usually an in-
crease in poikilocytosis or the appearance of
pear-shaped erythrocytes, which is thought to
be due to loss of elasticity of the cellular mem-
brane. The leukocyte count is usually normal but
may be decreased or even increased. Megalo-
blasts or normoblasts may be present in severe
degrees of pernicious anemia and thrombocyto-
penia occasionally may be noted. More rarely,
a leukemoid reaction may occur in severe de-
grees of pernicious anemia. An occasional pa-
tient who has pernicious anemia in crisis may
have a leukocyte count as high as 40,000 or more
cells per cubic millimeter of blood, with a great
increase in immaturity, so much so that the pres-
ence of acute leukemia may be suspected in an
occasional case. Examination of the bone marrow
reveals the presence of megaloblasts, which, to-
gether with the clinical findings, usually enables
one to establish the diagnosis of pernicious ane-
mia. The polymorphonuclear neutrophils usual-
ly exhibit thinning of the individual lobes, with
stranding between the lobes. Hyperlobulation
may occur, with as many as six to twelve lobes,
or even more, being present. This type of neu-
trophil, although not absolutely diagnostic, is the
so-called pernicious-anemia neutrophil and its ap-
pearance, with other findings in the peripheral
blood, would make one suspicious of the presence
of this disease.
After the diagnosis of pernicious anemia is
established, the treatment is relatively simple.
The most important factor is to give effective
doses of liver extract or vitamin By. Depend-
ing somewhat on the degree of anemia, I prefer
to start treatment with fairly large doses. If con-
centrated liver extract is used, an initial dose of
3 cc. (45 units) is given; if vitamin Biz is used,
MINNESOTA MEDICINE
Tic
lay
On -
ile,
OSe
ant
ir-
nia
act
the
the initial dose is 60 micrograms. This dose
is given intramuscularly once daily for three
successive days. Then 1 cc. of liver (15 units)
or a dose of 30 micrograms of vitamin Bi2 given
once a week usually restores the blood to a nor-
mal level, after which time a maintenance dose
may be worked out. In the uncomplicated case,
this dose averages about 15 units of liver extract
or 30 micrograms of vitamin B,. every two to
four weeks. Some persons require more than
others. In the presence of combined system dis-
ease, a larger dose of an effective fraction may
be necessary, such as 30 units of liver extract or
60 micrograms of vitamin B,, twice a week, which
may be continued for a number of months de-
pending on the degree of improvement in the
combined system disease.
Proper maintenance therapy consists in giv-
ing a sufficient amount of an effective fraction
to keep hematologic values at normal levels, to
avoid macrocytosis and to prevent any advance-
ment of neurologic symptoms or to improve
them, if it is at all possible. Sometimes a patient
may be receiving maintenance doses of liver ex-
tract and getting along satisfactorily; in spite of
this, the symptoms and findings of combined scler-
osis will develop. In such instances, larger doses
of the effective agent are required.
There is practically no difference between the
response obtained from vitamin By. and _ that
obtained from liver extract. One slight difference
is that liver extract exerts a slight effect on the
coagulation of blood that is not produced by
vitamin Bj. This is relatively unimportant and
is of no consequence with regard to the manage-
ment of pernicious anemia. The main factors are
to give sufficient material for control of the neu-
rologic symptoms and to keep the patient on sus-
tained and steady treatment for the rest of his
life,
Parenteral administration of liver extract or
vitamin By2 is in general the treatment of choice.
As a rule this method is cheaper, it permits the
physician to keep the patient under observation
so that he can determine whether or not the treat-
ment is adequate, it impresses on the patient the
importance of regular therapy and it assures that
the material is absorbed. Vitamin B,. has what
might be considered some advantages over liver
extract in that it is a purified crystalline substance
of constant potency, it may be used in patients
who are sensitive to liver extract and it produces
May, 1955
TREATMENT OF ANEMIA—WATKINS
a minimal local reaction. Oral therapy for per-
nicious anemia produces a satisfactory remission
and patients may be maintained satisfactorily by
such treatment. However, at present it is usually
expensive, absorption may vary greatly ‘depend-
ing on the condition of the gastrointestinal tract
at a given time and in general it is difficult to
maintain adequate control of the patient by such
therapy.
Folic acid is known to be important in the
maturation of erythrocytes. It will convert a meg-
aloblastic bone marrow to a normoblastic state
and will correct the hematologic abnormalities as-
sociated with pernicious anemia. However, glos-
sitis and the symptoms of combined sclerosis may
develop in many patients while folic acid is being
given. Consequently its use is not advisable al-
though it is not contraindicated. Essentially the
same is true for citrovorum factor, or so-called
folinic acid, another substance that has been
shown to be necessary for the conversion from
a megaloblast to a normoblast. Folic acid and
citrovorum factor are effective either orally or
parenterally but neither of them exerts any
beneficial effect on combined system disease. They
usually have no effect on the gastrointestinal
symptoms in pernicious anemia. Citrovorum
factor, however, is important in that it is of great
value in combating the toxic reactions to anti-
folic substances that have been used in the treat-
ment of certain leukemias. Combination therapy
with liver extract and iron is rarely needed be-
cause in most instances the stores of iron in per-
nicious anemia are at a high level. Administration
of hydrochloric acid as a rule is not necessary
in the management of pernicious anemia.
The treatment of other types of megaloblastic
anemia is often extremely difficult. It usually
may be summed up as a method of trial and
error, utilizing various substances that are es-
sential for hematopoiesis. Megaloblastic anemia
other than pernicious anemia may occur as the
result of gastrointestinal disease, total gastrec-
tomy, intestinal strictures and fistulas, or short-
circuiting operations; nutritional macrocytic ane-
mia is seen in the tropics and with sprue, either
tropical or nontropical. Megaloblastic anemia also
may be associated with pregnancy ; this is the so-
called pernicious anemia of pregnancy, which is
usually due to a deficiency of folic acid. Use of
liver extract or vitamin B,. may produce improve-
ment; otherwise, folic acid may be of value. The
329
TREATMENT OF ANEMIA—WATKINS
megaloblastic anemia of infancy usually can be
corrected by use of folic acid, although in some
instances liver extract or vitamin Biz. may prove
effective. The megaloblastic anemia associated
with infestation by the fish tapeworm shows a
variable response to the administration of vita-
min By, or folic acid.
The treatment of megaloblastic anemia other
than pernicious anemia is probably best begun
by use of vitamin B,. in the same dosage as
would be used in treatment of pernicious anemia.
If no response occurs after two or three weeks,
use of folic acid may be tried. If there is still
no response, folinic acid or citrovorum factor
can be used. Transfusion may be necessary in
some cases because of lack of response to any
of these substances. Occasionally, a rare macro-
cytic anemia may occur with a relatively aplastic
bone marrow that will respond to administration
of cortisone, following which the blood responds
to use of folic acid or vitamin Bis. In refrac-
tory anemias, such treatment might be tried.
Anemia in Systemic Diseases
Anemia is a frequent finding in many systemic
conditions for which treatment is of practically
no value. Examples of such anemias are those
associated with metastatic malignant lesions in-
volving the bone marrow, nephritis with azotemia
and the anemia associated with infection. In azo-
temia, if it is possible to decrease the blood urea,
the patient’s blood usually will respond auto-
matically. In true hypoplastic or aplastic anemia,
treatment is of little or no value. The same is
true of the leukemias and lymphoblastomas. The
anemia associated with rheumatoid arthritis rarely
responds to any of the usual hematinics. The
anemia associated with myxedema responds to
administration of desiccated thyroid but usually
fails to respond to any other substance.
In conclusion, it is important to establish the
diagnosis and the etiologic factor responsible for
the anemia before treatment is started. In cer-
tain instances, treatment of anemia may mask
an underlying serious disease whose early diag-
nosis would save the patient’s life.
DIGESTIVE AILMENTS OF OLDER PATIENTS
(Continued from Page 314)
the background of the patient, his habits and
his way of life, and who can, by persuasion and
advice, do much to ameliorate these symptoms.
Summary
An attempt has been made to show the fre-
. quency, distribution and severity of benign di-
gestive disorders in the aged. In many instances,
the complaints, however bizarre and atypical, are
likely to have an organic background. The diag-
nosis of the organic disease is often far from
easy, chiefly because the usual clues which lead
to diagnosis are absent or distorted. If the history
is brief, full investigation is compulsory. If it
is a continuation of one which has plagued the
patient all his life, investigation is still essential,
if only to provide the necessary reassurance and
support essential to treatment. Symptomatic
treatment without full investigation is at its best
a risky business and temporizing on such a basis
is the cause of much disability and many fatalities
in the aged. It should not be forgotten that per-
sons who reach the eighth decade of life are
of a rather special pattern and mold, and not
infrequently are made of better biologic materials
than their juniors. Their tolerance to surgery may
be amazingly good and their recovery from even
major procedures rapid. Here is a field in which
all physicians can participate in reducing mortality
and morbidity rates, and in making life more
bearable for many people who have passed their
prime.
MINNESOTA MEDICINE
Laboratory Aids
Sponsored by
The Minnesota Society
of Clinical Pathologists .
George G. Stilwell, Editor
CARCINOMA IN SITU OF THE UTERINE CERVIX
Carcinoma in situ is a lesion in which epithe-
lium in its normal anatomic location possesses the
cytologic criteria for malignancy. It has not
broken through the anatomic barrier that sepa-
rates the epithelium from the underlying connec-
tive tissue. Such preinvasive or intraepithelial
carcinoma has been observed in many sites, in-
cluding the skin, the mammary ducts and acini,
colon, stomach, bronchi, larynx and uterine cer-
Vix.
Intraepithelial carcinoma of the cervix has
been recognized for more than thirty years. How-
ever, large series of cases have accumulated only
during the past decade, as a result of develop-
ment of intensive programs for the early detec-
tion of cancer. Investigators have established
some facts concerning this phase of cervical car-
cinoma and have emphasized some other prob-
lems relating to it that as yet are unsettled.
Knowledge of the established facts is necessary
to an understanding of the controversies. Carci-
noma in situ is ordinarily invisible. Most of these
early malignant lesions are discovered when a
smear or a specimen for biopsy is procured from
a grossly normal cervix or one that has an erosion,
an eversion, leukoplakia or “cervicitis.”” Applica-
tion of Lugol’s solution may outline the neoplastic
lesion when it is otherwise invisible; normal
cervical mucosa stains dark brown owing to a
high glycogen content of the cells, whereas little
or no staining occurs in the malignant cells, which
are deficient in glycogen.
Carcinoma in situ nearly always begins at the
squamocolumnar junctional zone. This line is
usually at the external cervical os but may lie
well out on the portio vaginalis or up in the cer-
From the Section of Surgical Pathology, Mayo Clinic.
This is the twenty-seventh in a series of editorial re-
ports sponsored by the Minnesota Society of Clinical
Pathologists and designed to foster closer relationships
between clinicians and pathologists.
May, 1955
DAVID C. DAHLIN, M.D.
Rochester, . Minnesota
vical canal. Those in situ carcinomas associated
with leukoplakia may arise any place on the cer-
vix and even in the vagina. Downgrowth of this
surface carcinoma into the mucous glands of the
cervix is common and may be extensive. Such
spread does not impart a metastasizing potential
in the absence of true stromal invasion, because
the basement membrane of replaced glands acts
as a barrier to lymphatic and hematogenous dis-
semination.
In situ carcinoma may be as small as a square
millimeter and involve only a minor portion of
the circumference of the squamocolumnar junc-
tional zone. However, it may spread to involve
large regions of the portio vaginalis and even,
though rarely, the upper part of the vagina. This
surface lesion also may extend 2 or 3 cm. up to
the endocervical canal.
The accessibility of the uterine cervix to in-
spection and for procurement of specimens
adapts it well to cytologic techniques for early de-
tection of cancer, Jn situ or early infiltrating cer-
vical malignant tumors that are invisible can be
unmasked with a high degree of accuracy by
study of stained smears of scrapings from the
exocervix and endocervix. Tissue for biopsy that
includes the squamocolumnar junctional zone
taken from each quadrant of the cervix provides
a similarly great accuracy of detection.
Cervical carcinoma in situ appears to be present
in about 1 per cent of adult females. Practically
equal numbers of these lesions can be detected by
good cytologic screening, by careful biopsy tech-
niques or by a combination of the two. Sizable
variations from this usual rate of prevalence in-
dicate differences in the criteria for carcinoma
accepted by some pathologists or in the efficiency
of the detection program.
Debates concerning some of the controversial
phases of this subject can hardly add real knowl-
331
CARCINOMA OF THE UTERINE CERVIX—DAHLIN
edge, although they do bring known facts into
focus.. Scientific statistical evaluations of the type
contributed by Dunn?’ likely will supply the ulti-
mate answers. Unwillingness to submit human
béings to periods of observation of intraepithe-
lial carcinoma hampers acquisition of knowledge.
Evaluation of recorded studies is clouded by the
fact that biopsy sometimes eliminates the entire
lesion, as can local cautery.
Does uterine carcinoma in situ usually progress
to infiltrating carcinoma and is the latter ordinari-
ly preceded by the former? More than forty in-
stances of such progression have been document-
ed, and a lesser number of these preinvasive car-
cinomas reputedly have regressed.? Limited data
suggest that a preinvasive phase usually precedes
clinical carcinoma of the cervix.
How long is the latent period, the time from
which intraepithelial carcinoma is histologically
recognizable until it produces clinical carcinoma?
The average difference in age of patients at the
time of detection of each form of lesion indi-
cates an interval of about eight years. Since de-
tection of the asymptomatic and invisible carci-
noma in situ is a matter of chance, the average
lesion in a screened population is found at about
the midpoint in its evolution from histologic
recognizability to clinical invasiveness. Accord-
ingly, it is likely that the preinvasive phase lasts
about twice as long as the ages at detection would
indicate, or about fifteen years.
The likelihood that preinvasive carcinoma in-
cubates for more than a decade lends credence
to its significance. Statistically, the average prev-
alence of the im situ lesion and the recorded in-
cidence of development of clinical cervical malig-
nancy are consistent with the view that the form-
er is the precursor of the latter. Additional valid-
ity for the concept of carcinoma in situ is afford-
ed by other facts. Jewish women enjoy the same
relative immunity for this incipient lesion that
they are known to have for clinical carcinoma of
the cervix. Recognizable malignant cells appear
in smears in both stages of the disease. Typical
intraepithelial carcinoma is frequently found at
the periphery of ulcerating cervical carcinoma.
The full-blown picture of carcinoma in situ
probably is valid diagnostically during pregnancy,
although some investigators caution against over-
diagnosis of epithelial hyperplasia in the pregnant
state.
Controversial criteria have been suggested for
establishing that a given carcinoma is still in situ.
The experience of my associates and me** in-
dicates that study of a section made from each
of about twelve serial blocks of the entire squa-
mocolumnar region at right angles to the junc-
tional zone is adequate. Minimal evidence for
true invasion includes obvious vascular invasion
or stromal permeation, the latter often accompa-
nied by a scrirrhous reaction to the penetrating
cells. ;
What treatment should be given for carcinoma
in situ? Hysterectomy alone is curative except
for the rare case in which surface spread past
the line of excision in the upper part of the vagina
has occurred. Some physicians consider that coni-
zation of the junctional region or extensive
cautery is adequate. Extensive surface spread
to the: exocervix or vagina or up the cervical
canal imposes obvious limitations on either of
these procedures. The more radical procedures,
including Wertheim hysterectomy with dissection
of the pelvic lymph nodes and conventional radi-
ation therapy, are unnecessary.
References
. Dunn, J. E., Jr.: The relationship between carcino-
ma in situ and invasive cervical carcinoma: A con-
sideration of the contributions to the problem to
be made from general population data. Cancer,
6 :873-88 (Sept.) 1953.
. Jones, H. W., Jr., Galvin, G. A. and Te Linde,
R. W.: Intraepithelial carcinoma of the cervix and
its clinical implications. Internat. Abstr. Surg., 92:-
521-524 (June) 1951.
. Dahlin, D. C., Mussey, Elizabeth, and Dockerty,
M. B.: Cervical smears in the detection of pre-
clinical carcinoma. Minnesota Med., 35 :305-312
(Apr.) 1952.
4. Dahlin, D. C., Randall, L. M., Soule, E. H. and
Dockerty, M. B.: Smears in the detection of pre-
clinical carcinoma of the uterine cervix: Further
studies with emphasis on the significance of the
negative “repeats.” Surg., Gynec. & Obst., 100 :463-
468 (Apr.) 1955.
MINNESOTA MEDICINE
Case Reports
HEMOBILIA FOLLOWING BLUNT TRAUMA
TO THE LIVER
Hemobilia is a term used to designate hemorrhage
into the biliary tract as a result of trauma to the liver.
Fourteen cases are reported in the collected literature
which has been reviewed by Sandblom,? by Sparkman,‘
and by Sparkman and Fogelman.5 We wish to report
two additional cases.
&:
Fig 1. Case-1. Postoperative chest
roentgenogram taken on December 10,
1953, showing a right pleural effusion
with an air fluid collection under the
right diaphragm.
Case Reports
Case 1—D. U., a twenty-five-year-old white man was
admitted to the Minneapolis Veterans Hospital on No-
vember 22, 1953, sixteen hours after having been in an
automobile accident. The patient suffered no apparent
injury at the time of the accident and was taken home
by a passing motorist. Shortly after arriving home,
he developed abdominal pain and a physician was called.
When examined by the doctor the patient was in shock.
A transfusion of 1000 cc. of whole blood was given at
the local hospital and he was transferred to this hos-
pital for definitive treatment.
Dr. Hay, formerly Chief of the Surgical Service,
Minneapolis Veterans Hospital, Minneapolis, is now
Director of Surgical Research, Mount Sinai Hospital,
Minneapolis.
Ma x, 1955
H. M. BROKER, M.D., and L. J. HAY, M.D.
Minneapolis, Minnesota
Physical Examination.—On admission, the blood pres-
sure was 90/60 and the pulse was 120 beats per minute.
Examination of the head, neck and chest was normal.
The abdomen was moderately distended and generalized
rebound tenderness and spasm were present. There were
no abrasions of the thorax or abdomen.
Laboratory Examination—The hemoglobin was 12
Fig. 2. Case 1. Postoperative roent-
genogram of the abdomen after choledo-
chostomy. This view shows the develop-
ing area of emphysematous tissue under
the right diaphragm and a large air
bubble present in that region.
Gm./100 cc. blood. The urine was normal. The flat
and upright roentgenograms of the abdomen were not
diagnostic.
Hospital Course—Shortly after admission, the patient
vomited 2000 cc. of grossly bloodly fluid. A transfusion
of 1500 cc. of whole blood was given rapidly, after
which the hemoglobin was reported as.11.7 grams. The
blood pressure rose from 90/60 to 130/80 but. the pulse
remained at 130.
The patient was operated upon. Approximately 3000
ce. of blood was present in the peritoneal cavity. The
capsule was torn free from an area of the dome of the
right lobe of the liver. The laceration was estimated as
8x12 cm. in dimension. Liver tissue and blood clots were
scooped out to a depth of 3 or 4 cm. The wound was
333
HEMOBILIA—BROKER AND HAY
packed with gelfoam. Two large rubber tube drains to
the area were brought out in the right flank posteriorly
under the margin of the twelfth rib. Postoperatively, the
patient’s temperature remained at 100-101 degrees F.
There was a large amount of bile drainage (Fig. 1).
It was suggested that, since most of his bile was draining
Fig. 3. Case i. The large cavity is
seen On roentgenogram in Figure 2 as an
emphysematous area. The cavity is filled
with necrotic liver tissue which is shown
in Figure 4.
through the posterior drain, a decompression of the bili-
ary tract be performed. On December 18, 1953, a chole-
dochostomy was performed. This was followed by a
marked decrease in the bile drainage from the wound.
On December 24, 1953, a peculiar emphysematous
mass with a fluid level was noted under the right dia-
phragm on the roentgenogram (Fig. 2). This mass was
explored through an incision traversing the tenth rib
bed and diaphragm, and a sequestrum of necrotic liver
tissue, 10 cm. in diameter was removed. The sequestrum
was separated from the viable liver tissue by a fibrotic
layer. It was removed by finger dissection. Brisk bleeding
was controlled by a gelfoam pack. It was estimated at
the time of surgery that about 30 per cent of the right
lobe of the liver had sequestrated(Figs. 3 and 4).
Postoperatively, the patient developed a_ stenosing
esophagitis involving all the esophagus beyond the aortic
arch. This was satisfactorily controlled by dilatation.
Healing of the liver defect was slow but progressive
and was complete after four months.
This patient has been followed for one year. Liver
function tests were within normal limits on December
13, 1954. The patient is completely asymptomatic and is
working.
Case 2.—P. H., a twenty-year-old white woman was
admitted to the Minneapolis General Hospital on June
19, 1954, following an automobile accident. On admis-
sion, she was irrational and uncooperative.
Physical Examination —Blood pressure was 94/54, the
pulse was 100 and the temperature was 98 degrees F.
Findings included a large hematoma of the forehead,
tenderness over the right lower chest, and abdominal
rigidity with marked tenderness present in the right
upper quadrant. Bowel sounds were absent.
334
Laboratory findings were essentially normal with the
exception of a hemoglobin of 10 Gm./100 cc. blood.
Hospital Course.—A peritoneal tap performed on ad-
mission was negative. After the patient had received
1000 cc. of whole blood, her blood pressure stabilized
Fig. 4. Case 1. The resected specimen
of necrotic liver tissue from the right
lobe. This tissue is seen on the roent-
genogram in Figure 2, represented by
the area of emphysematous reaction,
at 130/80, and a laparotomy was performed. The peri-
toneal cavity contained approximately 2000 cc. of blood.
Examination of the liver revealed a 5x10 cm. stellate
laceration of the dome of the right lobe.
The laceration of the liver was packed with gauze and
a large Penrose drain was placed to Morison’s pouch
and to the area of laceration.
The drains and pack were removed and the patient
was asymptomatic by July 4, 1954.
On July 12, 1954, the patient became febrile and com-
plained of right upper quadrant pain. This was followed
by one episode of hematemesis, after which the hemo-
globin was 8.8 Gm. A transfusion of 1000 cc. of whole
ED was administered, and the hemoglobin was_then
2 Gm. The pain in the right upper quadrant continued
ae Me until July 20, 1954, when it became severe
and radiated to the back. On that day the hemoglobin
dropped to 8.0 Gm.
On July 21, 1954, after the patient had been given a
transfusion, a laparotomy was performed. The gall
bladder was filled with clotted blood. The subphrenic
space was explored and contained a “deep purplish”
exudate. Brisk bleeding occurred from the lacerated area
of the liver and was controlled by repacking with gauze.
A cholecystostomy was performed and the abdomen
was drained.
The pack was gradually removed over a two-week
period. The patient was asymptomatic until August 10,
1954, when mild right upper quadrant pain occurred.
Three hours later the pain had become severe and the
patient began to bleed profusely from the site of the
previously removed subphrenic drain and through the
cholecystostomy tube. In a two-and-one-half-hour period,
the patient received 7500 cc. of whole blood. The patient
died in the operating room from shock before definitive
surgery could be accomplished.
(Continued on Page 336)
MINNESOTA MEDICINE
ASSOCIATION OF INTRACRANIAL MENINGIOMA WITH
PITUITARY ADENOMA
Report of Successfully Treated Case
N SPITE of our present-day accuracy of neurologic
and ophthalmologic diagnosis, a neurologic surgeon
must be prepared for unexpected developments when
he opens a patient’s skull.
The diagnosis of a chromcphobe adenoma of the
pituitary gland usually is not difficult. The visual loss
which causes the patient with such a lesion to consult
a neurosurgeon ordinarily is rather classic, and the
roentgenologic finding of an enlarged and eroded sella
turcica is most often pathognomonic of a pituitary tu-
mor, yet occasionally the surgeon uncovers a lesion that
is entirely unexpected. The following report is illus-
trative of the unexpected situation that may be en-
countered once in a while.
Case Report
A sixty-five-year-old woman came to the Mayo Clinic
complaining chiefly of poor vision in her right eye.
The decreased vision on the right had been noticed for
about five months. A local ophthalmologist had pre-
scribed “drops”; these had been used without improve-
ment. Two weeks before coming to the clinic this pa-
tient saw another ophthalmologist, who examined her
eyes and advised roentgenologic examination of her head,
which was done. The patient said he told her she had
a “boil” in her head, and that it needed to be “dried out”
with x-ray treatments. A neurosurgeon saw her and
was said to have concurred in the diagnosis and treat-
ment. During the two weeks prior to the patient’s visit
to the clinic the husband had noted a slightly increased
prominence of her right eye.
In addition, the patient complained of mild bitem-
poral and biparietal headache. There had been no
symptoms to suggest endocrine dysfunction.
The patient was 59%4 inches tall and weighed 14814
pounds without her clothes. There were no physical
signs of pituitary insufficiency. The blood pressure was
178 systolic and 108 diastolic, measured in millimeters
of mercury. The uterus was surgically absent (hysterec-
tomy had been done in 1930). Vision was recorded as
6/20 on the left and 1/60 on the right. There was 1 mm.
of proptosis of the right eye. The palpebral fissure was
mm. wider on the right than on the left. Extra-ocular
motions were generally restricted in all directions in the
tight eye. The tension in the right eye was 27, whereas
in the left eye it was 20. The ocular fundi revealed a
moderate degree of pallor, and the arterioles of the
retina showed the changes of chronic hypertension.
Dr. Love is in the Section of Neurologic Surgery and
Dr. Blackburn is in the Section of Medicine at the Mayo
Clinic and Mayo Foundation. The Mayo Foundation in
Rochester, Minnesota, is a part of the Graduate School
of the University of Minnesota.
May, 1955
J. GRAFTON LOVE, M.D., and
CHARLES M. BLACKBURN, M.D.
Rochester, Minnesota
The fields of vision when plotted revealed bitemporal
hemianopsia, with involvement of the right optic nerve
and right side of the optic chiasm.
Neurologic examination did not disclose any additional
abnormalities. Roentgenologic examination of the
Fig. 1. Lateral roentgenogram showing enlargement
and erosion of the sella turcica, such as is seen in the
presence of a pituitary tumor.
head demonstrated erosion and enlargement of the sella
turcica, which condition was interpreted as being due
to a large intrasellar tumor (Fig. 1). Roentgenograms
of the optic canals showed them as normal. The su-
perior orbital fissure on the left was slightly larger
than that on the right. This was thought to be of no
clinical significance.
The basal metabolic rate was within normal limits
(+6), as were results of blood counts and urinalysis.
We knew we were dealing with a progressive lesion
involving the sella turcica and the visual apparatus. We
felt the lesion was neoplastic and not an aneurysm of
the carotid artery or the circle of Willis. In an attempt
to explain all the ophthalmic signs and the eroded sella
turcica we considered three different neoplasms which
might be conceived to be present, and we ‘assigned the
following percentages, in terms of likelihood, to each:
meningioma, 50 per cent; pituitary adenoma, 40 per
cent; pituitary adamantinoma, 10 per cent.
Operation for the removal of a tumor involving the
visual apparatus was advised and accepted.
335
INTRACRANIAL MENINGIOMA—LOVE AND BLACKBURN
Although there was no clinical evidence of pituitary
insufficiency, the patient was given 200 mg. of cortisone
intramuscularly forty-eight, twenty-four and two hours
prior to craniotomy. It was thought advisable to supply
the patient with such a depot of cortisone in the event
that operation resulted in acute anterior pituitary in-
sufficiency, either temporary or permanent. After the
operation the administration of cortisone was gradually
reduced over a period of several days.
Right transfrontal craniotomy was performed with
difficulty with a malleable needle. It was necessary to
convert two of the perforator openings into burr open-
ings, but we still were unable to turn the flap without
lacerating the dura. There was sharp bleeding at the
anterior temporal opening, and ultimately we realized
why. After the flap had been turned, and as we were
inspecting the lacerated dura, we noted a hard, firm,
nodular mass in the anterior temporal hole and a thick-
ened dura; this mass proved to be a typical meningioma
of the Sylvian fissure, and it was of very respectable
size. For a moment, it was thought that this process
might be a lateral extension of a meningioma of the
sphenoid ridge. However, this entire tumor mass was
removed in one piece after the nutrient artery had been
closed with silver clips and there seemed to be no deep
extension.
Yet it was obvious that this tumor was not producing
the defect in the visual fields or causing the erosion
of the sella turcica. We then stripped the adherent dura
from the roof of the right orbit and exposed the visual
apparatus. As we did so, we saw a large, thick-walled,
nonpulsating tumor projecting above the sella and ex-
tending under the right optic nerve and internal carotid
artery, both structures being displaced upward. The
tumor presenting between the optic nerves and anterior
to the chiasm was aspirated without obtaining blood.
Then it was incised and typical pituitary adenomatous
tissue was obtained. A considerable amount of tissue
was saved for microscopic examination. Most of the
tissue within the capsule was removed with a sucker.
A large adenomatous extension under the right optic
nerve and internal carotid artery was pulled within the
sella and removed. Extensive resection of the capsule
was carried out; a piece along the floor was left. The
bleeding was under control. The lacerated dura was
covered with a sheet of animal membrane. The bone was
wired in place with two pieces of wire. The wound
was closed in layers without drainage. The 30 cc. of
fluid which had been removed through the malleable
needle was replaced in the spinal canal.
The pathologist’s report identified these lesions as
(1) a meningioma of the Sylvian fissure, and (2) a
chromophobe pituitary adenoma which was intrasellar,
suprasellar and extrasellar (supratentorial) in extent.
The patient received 500 cc. of blood during these
procedures.
The patient’s postoperative convalescence was unevent-
ful and very gratifying.” For one twenty-four-hour pe-
riod (the second) after operation the intake and output
of fluids was markedly increased (4,800 cc. intake and
5,300 cc. output). However, this condition spontaneously
subsided without the employment of posterior pituitary
substance.
The patient was dismissed from the hospital on the
eighth day after operation, and from the care of the
Mayo Clinic four days later. At the time of dismissal
there had been some improvement in vision in the tem-
poral field of the right eye and ocular motions were
normal.
HEMOBILIA
(Continued from Page 334)
Autopsy revealed an area of liver necrosis measuring
5x6 cm. There was an erosion of a branch of the right
hepatic artery deep in the substance of the right lobe of
the liver.
Discussion
The sparsity of reports in the literature would suggest
that bleeding into the gastrointestinal tract as a result of
liver injury is a rare condition.1 It is more likely that
bleeding is often mild or masked by the associated
problems presented by other injuries.2}Hemobilia may
be an early or, late complication of liver injury as in the
two cases reported.
Central rupture of the liver occurs by compression
of the inelastic and fragile liver parenchyma. When a
tear occurs, arteries, veins, and bile ducts are ruptured
and the cavity fills with blood and bile. This process
produces necrosis which in turn produces secondary
hemorrhage. The only exit of drainage in central lacera-
tion is into the bile ducts or the blood vessels. Autolyzing
ferments at the site of injury, sequestration of damaged
liver tissue and infection of devitalized tissue are other
causative factors in the etiology of hemobilia.
Usually, hemobilia is an insidious process since the
central portion of the liver has no sensory nerve endings.
Only after the liver enlarges enough to distend the cap-
sule or after a tear occurs in the capsule will pain be
present. Shortly after the occurrence of bleeding into
the bile ducts, the symptoms of typical biliary colic
become manifest. This occurred in the second case
reported.
336
Sparkman gives the symptoms of hemobilia as a triad
of abdominal injury, pain, simulating biliary colic and
gastrointestinal hemorrhage. In the second case reported,
the patient experienced pain prior to the onset of hemor-
rhage and could predict the episodes.
Summary
Two cases of hemobilia are reported. In the first
patient, the hemobilia occurred at the time of the injury,
and in the second it occurred twenty-one days after
injury.
Knowledge of this entity and the possibility of seg-
mental necrosis of the liver substance should permit
earlier debridement and decrease the chances of second-
ary hemorrhage.
References
. Mikal, S., and Papen, G. W.: Morbidity and mor-
tality in ruptured liver. Surgery, 27 :520, 1950.
. Owen, H. K.: Case of lacerated liver. London M.
Gaz., 7:1048, 1848.
. Sandblom, Philip: Hemorrhage into the biliary tract
following trauma-traumatic hemobilia. Surgery,
24 :571, 19
. Sparkman, R. S.: Massive hemobilia following trau-
= rupture of the liver. Ann. Surg., 138:899,
1953.
. Sparkman, R. S., and Fogelman, M. J.: Wounds of
the liver. Ann. Surg., 139:690, 1954.
MINNESOTA MEDICINE
Clinical-Pathological
Conference
Sponsored by
The Minnesota Society
of Clinical Pathologists
Donald F. Gleason, Editor
CASE PRESENTATION
The patient, a white nun, was originally admitted to
St. Mary’s Hospital in 1945 at the age of sixty-one for
multiple contusions suffered when she fell while hanging
curtains. Except for a fracture of a metacarpal bone,
there were no other significant findings or complaints. At
that time, the hemoglobin was 12 gm. per cent, red blood
count 4,210,000/cu. mm. and white blood count 6,600/cu.
mm. Recovery was uneventful.
The second admission was in 1946, at the age of sixty-
two, for “strain of lumbar spine.” While cleaning win-
dows, she strained her back. She was admitted with
severe pain in the lower back over the lumbar and sacral
spine. There was local tenderness to deep pressure.
Except for hyperactive tendon reflexes throughout, neu-
rologic examination gave negative findings. The hemo-
globin was 12.8 gm. per cent, white blood count 8,700/
cu. mm., red blood count 4,320,000/cu. mm. Complete
urinalysis showed no abnormalities. The spinal fluid
showed 7 white cells/cu. mm., 64 mg. per cent sugar,
740 mg. per cent chlorides and 25 mg. per cent total
protein. The colloidal gold curve and serology were
normal. X-rays of the area were not remarkable except
for slight wedging of the first and fourth lumbar verte-
brae with hypertrophic changes which might represent
old compression type fractures. The spinogram was
negative for herniated intervertebral disc. The patient
was fitted with a lumbosacral support and recovered
uneventfully.
The final admission in February, 1954, occurred when
the patient was sixty-nine. While sitting in a chair,
she bent over, fell and struck the right hip, suffering
immediate, severe pain in that area. Past history included
pulmonary tuberculosis in 1907 for two months and a
few minor surgical operations. System review revealed
no abnormal findings except for blindness in the left eye
for two years. Physical examination showed an obese
white woman with severe pain in the right hip. A
mature cataract was present in the left eye. The tongue
was in the midline, and the pharynx showed no unusual
changes. The chest was examined only anteriorly but
showed no abnormalities. The blood pressure was
156/86 mm. of mercury. No other cardiac physical find-
ings were present. The abdomen showed no abnormali-
ties. There was an obvious fracture of the neck of
the right femur. X-ray examination confirmed the frac-
ture. A portable chest x-ray on the second hospital day
was unsatisfactory, suggesting possible atelectasis on the
From the files of the Department of Pathology, St.
gh Hospital, Duluth, Minnesota. Discussed on June
9, 1954,
May, 1955
A. C. AUFDERHEIDE, M.D.
Duluth, Minnesota
right and an elevated right diaphragm. An electrocardio-
gram was normal. On the third hospital day, the hemo-
globin was 16 Gm. per cent, the white blood count
14,500/cu. mm. with 73 per cent neutrophiles, 24 per
cent lymphocytes. On the fourth hospital day, the
hemoglobin was 14 Gm. per cent, platelets 135,300/cu.
mm. A preoperative physical examination on the second
hospital day showed a blood pressure of 150/80 mm. of
mercury, pulse of 96, respirations 20/minute and tem-
perature 100.2°; otherwise, there had been no change.
The urine, which showed a specific gravity of 1.026,
was otherwise normal. On the fourth hospital day, a
hip-nailing procedure was carried out without difficulty.
The patient progressed satisfactorily, and on the seven-
teenth hospital day she began to be up in a chair. On
March 19, 1954, (thirty-third hospital day), the patient
complained of a thick feeling in the tongue and difficulty
in speaking. No other changes were found on examina-
tion. On March 22, she developed slurred speech as
well as trouble in chewing and swallowing. The tongue
deviated to the left. On March 24, she had two sudden
episodes of dyspnea lasting about ten minutes each. The
lungs were dry and the heart rhythm regular. On March
25, panting respirations were noted. An electrocardio-
gram repeated on this day was again normal. Neurologi-
cal examination showed a nasal voice tone. Hypalgesia
was present in the fifth finger and less in the fourth
finger of the right hand. Deep reflexes were moderately
hyperactive. Speech was difficult. Regurgitation of
liquids occurred through the nose. No cerebellar signs
were found. On March 26, a spinal puncture showed
a pressure of 410 mm. water, and 4.5 cc. of clear color-
less spinal fluid was removed. This contained no cells,
but 45 mg. per cent sugar, 14 mgm. per cent total protein
and 755 mg. per cent chlorides were present in the fluid.
Pandy’s test was negative, as were the gold curve and
Wassermann tests. On this day the white blood count
was 7,750/cu. mm., the hemoglobin 11.8 mg. per cent.
On March 26, there was little change with no facial
weakness detectable and an active gag reflex was present.
On March 27, examination of the ear, nose and throat
gave essentially negative findings. Pharyngeal muscle
function was difficult to evaluate but all muscles moved
as did the vocal cords. On March 29, the previous symp-
toms increased. On March 30, physical signs of diaphrag-
matic paralysis bilaterally were confirmed by fluoroscopy.
The tongue became uncontrollable, and there was much
respiratory distress. A tracheotomy was performed.
‘Thoracic muscle action was poor. The patient was placed
in a Drinker respirator. On March 31, her condition
337
CLINICAL-PATHOLOGICAL CONFERENCE
was grave with obvious signs of insufficient oxygenation.
Slight nystagmus was apparent with the gaze to either
side. The left palpebral fissure was narrower than the
right. The left corneal reflex was less active than the
right, and there was slight deviation of the tongue to
the left. Her condition progressed to complete coma and
death that night. The white blood count the day of death
was 21,500/cu. mm., with 82 per cent neutrophiles. The
temperature was normal throughout her illness until the
day of death when it rose to 101 degrees.
Differential Diagnosis
Dr. L. R. Gowan: Review of the protocol as well as
the nurse’s notes indicate a rather marked fluctuation in
the severity of symptoms from hour to hour. The past
history also includes several falls with resultant frac-
tures (ribs, ankle, wrist, hip). The x-rays served
primarily to corroborate the clinical impression of
diaphragmatic paralysis and also show no bone signs of
hyperparathyroidism.
A broad view of the problem would demand considera-
tion of many entities including:
. Anterior horn disease
Bulbar palsy (arteriosclerotic)
Pseudobulbar palsy
Basilar artery thrombosis
Vascular anomaly (aneurysm of basilar artery)
Tumor (pontine)
Hyperparathyroidism
Myasthenia gravis
. Guillian-Barre’s syndrome
. Bulbar multiple sclerosis
Multiple CNS metastases
Toxic encephalitis (CO, As, etc.)
All of these conditions may produce bulbar signs. In
the process of elimination, the negative spinal fluid find-
ings rule out poliomyelitis, or encephalitis or other
anterior horn-cell disease not already ruled out by the
history. The absence of fibrillation and vacillation of the
clinical course are not characteristics of bulbar palsy.
Basilar artery thrombosis causes quadriplegia and death
in about twenty-four hours, if complete; if incomplete,
I would expect more neurological signs as a result of
brain stem and cranial nerve nuclear involvement; the
same arguments apply to aneurysms. Pontine tumors
are rare at this age; furthermore, the patient had no
headaches, dizziness or visual disturbance. Hyperpara-
thyroidism must be considered, especially with the long
history of bone aches, demineralization and leg weak-
ness; the x-rays show no cystic changes, but these are
not invariably present. Guillian-Barre’s disease is a diag-
nosis which, if made at all, should be considered only
in a patient with a fairly characteristic picture. The
patient’s age is the biggest argument against multiple
sclerosis, although this disease could begin at this age.
I would expect more neurological findings in the extremi-
ties, however; furthermore, even apoplectic onsets of
multiple sclerosis usually produce a history of previous
symptoms upon specific questioning. There is nothing to
suggest a primary tumor, and multiple metastases would
338
not have produced such a fluctuating clinical picture. No
exposure to: a toxin makes toxic encephalitis untenable
as well as lack of more widespread evidence of brain
involvement.
Myasthenia gravis and pseudobulbar palsy must be
considered seriously. There is a past history of hyper-
tension; therefore, vascular disease is possible. There
is no atrophy; pyramidal tract involvement is common
in pseudobulbar palsy, absent in this case. Past history
of a stroke is also common, again lacking here.
Myasthenia gravis may appear in older people. The
clinical vacillation in severity of symptoms is quite con-
sistent with this diagnosis. Respiratory muscle weak-
ness is common in myasthenia gravis. Clinically, myas-
thenia gravis usually falls into three groups: (a) bulbar,
(b) ocular, (c) myasthenia of the extremities. This
case was primarily bulbar in type with minimal ocular
signs. Of course, most cases are much more gradual
in their onset than was this case, but such sudden onsets
occur and may be an exacerbation of a subclinical form
of the disease. Unfortunately, we have no therapeutic
test (prostigmine) recorded in this case. I believe this
patient died of an acute form of myasthenia gravis but
cannot definitely rule out pseudobulbar palsy. The other
possibilities are improbable for the reasons mentioned
above.
Dr. I. T. Criark: The chest x-ray shows high
diaphragms and right lower lobe atalectasis. No evidence
of thymoma is seen.
Doctor Gowan’s Diagnosis
Myasthenia gravis
Possible pseudobulbar palsy
Anatomic Diagnosis
1. Benign Thymoma
2. Acute myasthenia gravis
Dr. A. C. AUFDERHEIDE: The heart weighed 380
grams. It was otherwise normal; except for lower lobe
atelectasis on both sides, the lungs were not abnormal.
The gastrointestinal tract showed no: pathologic lesion.
A small benign fibroma was present in the right ovary.
A benign cortical adenoma (3 cm. in diameter) was
found in the right adrenal gland. Osteoporosis of the
lumbar vertebrae was apparent. Four parathyroids were
grossly and microscopically normal. The parenchymal
and vascular tissue of the brain and spinal cord showed
no gross or microscopic changes. Microscopically, the
skeletal muscle of the diaphragm was not abnormal.
Situated in the superior anterior mediastium in the region
of the thymus gland was an encapsulated, lobulated,
hard tumor measuring 4x3x3.5 cm., which on cut
section was white, trabeculated with a few hemorrhagic
areas. Microscopically, the tumor consisted of larger
epithelial-appearing cells mixed with smaller cells indis-
tinguishable from lymphocytes (Fig. 1). The picture is
that of a benign thymoma.
The absence of central nervous system lesions, the
presence of a benign thymoma and the clinical history
led us to conclude that this was a case of acute
myasthenia gravis.
MINNESOTA MEDICINE
CLINICAL-PATHOLOGICAL CONFERENCE
Discussion
Dr. H. Fiskett1: Are malignant tumors of the thymus
ever associated with myasthenia gravis?
Dr. A. C. AUFDERHEIDE: Rarely, a few cases have been
reported, but with these few exceptions, thymomas
accompanying myasthenia gravis are benign.
Dr. A. C. AUFDERHEIDE: About 50 per cent of
myasthenic patients have a thymoma or hyperplasia of
the thymus on x-ray examination.
Dr. J. Cott: Johns Hopkins University has reported
up to 80 per cent at autopsy, if a careful search is made.
INTERN: What is the current status of thymectomy
in myasthenia gravis?
Fig. 1. (A) Low power photomicrograph of the thymic tumor. Note the cellularity.
(B) High power photomicrograph of the thymic tumor showing the two types of
cells.
much larger and stain less deeply.
Dr. J. K. Butter: What is the treatment of choice?
Dr. J. B. Mover: Neostigmine tablets are the most
popular; the methyl sulphate form of neostigmine is
available in ampule form for emergencies. Other prod-
ucts are also available; I haven’t had much experience
with them but I understand they are quite toxic. It is
important that enough drug be given; too many myas-
thenic patients are undertreated by their physician.
Dr. N. E. A. Leppo: What is the incidence of thy-
moma in myasthenia gravis?
The smaller, dark-staining cells resemble lymphocytes while the others are
Dr. Gowan: Debatable at present. The Lahey Clinic
staff feels that their series shows definite benefit from
thymectomy; the Mayo Clinic staff felt otherwise but
recently supported the eastern school after re-evaluating
their results. Thymectomy usually produces a severe
postoperative transient exacerbation of the disease so
that treatment must be vigorous during that phase.
I think this patient had had subclinical myasthenia
gravis which probably caused enough muscle weakness
to result in her frequent falls and that the present
episode represents an acute exacerbation of the disease.
POSTOPERATIVE WALKING
Although having surgical patients ambulate soon
alter their operation has been widely practiced since
World War II, Palumbo believes it should be followed
ven more extensively than it is today. He feels that
hesitancy on the part of many surgeons is due to fears
that certain undesirable effects such as wound disrup-
tion may occur. The author disagrees and notes that
Through disturbances in metabolism, prolonged bed
rest produces weakness and loss of tone of both smooth
and skeletal muscles, loss of calcium and nitrogen from
the body, reduced vital capacity, decreased cardiac out-
May, 1955
put, slowing of circulaticn, and a delay in wound healing.
These changes may result in an increased incidence of
complications of the gastrointestinal tract, as evidenced
by ileus, constipation, nausea, vomiting, and/or decrease
or loss of appetite.” Conversely, “Early ambulation en-
hances wound healing and reduces other complications
which may occur in the gastrointestinal tract, in the
cardiopulmonary and in the peripheral-vascular system:”
—Pa.umpo, L. T.: Early postsurgical ambulation, Jour-
- of the Iowa State Medical Society, 45:12 (Jan.)
President’s Letter
IN APPRECIATION
This issue of MINNEsoTA MEDICINE should reach you about the time of the state
meeting, and the impact of the work of your state association, plus the work of your
local arrangements committees in bringing to you this excellent annual meeting,
should be fresh in your mind.
On occasion, I have been asked by members of local units of medical societies,
“What does my county medical society do for me?” At such times, even though
I could talk indefinitely on the subject, I have often felt completely tongue-tied
and frustrated. Perhaps I have felt somewhat as you would feel if, after you had
successfully seen a patient through a critical illness, he were to say to you, “I
guess I would have done just as well if I had gone to bed and seen it through
without you, eh, Doctor?”
That the physician can ask such a question about his medical society, is evidence
that he is not even a member of the society in his own heart. If he had helped to
cook the meal, he would inevitably have tasted some of the bounties of society
membership in the process.
So many members have participated in the work of our state association that
to single out any one man or group would be an injustice. The work of the
Hennepin County Medical Society, our hosts at the state meeting; the Insurance
Liaison Committee; the Committee on Malpractice; the committee studying our
functions in civil defense ; Maternal and Child Health Committees ; and the editing,
publishing, and editorial boards of MrinNEsota MEDICINE, to name only a few,
have been so outstanding that our membership owes them a debt of gratitude
beyond their ability to repay.
It is, indeed, a source of satisfaction to your officers and Council that when
help and advice is needed, it is freely given. Time and efforts seem of little
consequence to these devoted members of our Association when they are asked
to contribute to the profession of our state.
In the light of the accomplishments of the committees, on both scientific and
non-scientific work, can any one of our members seriously ask, ““What does my
society do for me?” Rather let us ask, “How can I aid in the dedicated work of
our Association, whose object is the improvement of public health, the advance-
ment and dissemination of scientific knowledge, and the protection and advance-
ment of our profession in the accomplishment of these objectives ?”
President, Minnesota State Medical Association
MINNESOTA MEDICINE
di
DICINE
Editorial
GENERAL PRACTICE SYMPOSIUM
This number of MINNEsoTA MEDICINE con-
tains material presented on October 20, 1954, at
the Fourth Annual Refresher Course of the
Minnesota Academy of General Practice in Roch-
ester.
This meeting was representative of what I feel
to be one of the richest heritages of American
medicine. Five hundred general practitioners reg-
istered and attended the meetings wherein four-
teen specialists gave of their time and knowledge.
The meeting demonstrated a co-operation for
the good of the patient that is typical of the
medical profession. Nothing could so well belie
those vocal few who would have us believe that
the specialist and the general practitioner are
continually at each other’s throat. The attendance
and attention of the general practitioners earned
them the respect of the speakers.
Members of the Minnesota Academy of Gen-
eral Practice have seen these meetings grow and
have watched the enthusiasm mount each year.
This annual meeting, along with the regional
meetings that are held throughout the state, gives
general practitioners an opportunity to get post-
graduate instruction that will qualify them for
continued membership in the Academy. It also
provides nonmembers with an opportunity to
“refresh” themselves.
The papers included in this symposium are not
meant to be a basic contribution to the medical
literature but do review some of the basic con-
siderations in diagnosis and treatment of the con-
ditions discussed. It is considered that their in-
clusion in MINNESOTA MEDICINE might be of
value to physicians unable to attend the meeting.
H. A. Wente, M.D., Secretary-Treasurer
Minnesota Academy of General Practice
BMD
The last twenty-five years have flooded us with
alphabetic agencies, and he is indeed a dolt who
doesn’t understand UN, WHO, UNESCO, et
cetera. The Armed Forces gave us a goodly num-
ber of useful alphabetics ; e.g., SOP for Standard
Operating Procedure (quite reminiscent of the
s.0.b. that appears on clinical histories to indicate
May, 1955
Joun F. Briccs, M.D.
ArtHuR H. WE tts, M.D.
Henry G. Moenurinec, M.D.
short of breath—beware of capitalizing these let-
ters, though), and SNAFU for Situation Normal,
All Fouled Up. The tendency to reduce com-
munications to a series of letters has even carried
into domestic life. We know an efficient head-
of-a-family who used to telephone home just as
he left his office to deliver the command, “PMC,”
and the wheels would begin to turn at home in
anticipation of his arrival. This worked fine as
long as he drank only coffee, because even his
youngest child could comprehend this cryptic com-
mand, “Pour My Coffee.” As he rose in the
world, his tastes became more expansive and
expensive, and an alternate translation appeared,
“Pour My Cocktail(s).” Finally, when he went
on a reducing diet and “Peel My Carrots” was
added to the reasonable interpretations, things
became so chaotic that he had to revert to impera-
tive sentences rather than initials—like ordinary
inefficient folks. Thus ends one success story.
Now this BMD business, which insidiously
entered our lives via an innocent conversation,
has to do with success in another way. It is a
criterion of success. You remember how in order
to pick the man-most-likely-to-succeed in our
class, we first strove for a definition of success.
We settled for health, wealth and happiness, with-
out thinking that we still had not arrived at an
objective definition. In any event, many of us
were sure that we were successful when we could
go around with roseate cheeks, a smiling face,
and a new Buick for house calls. This rotund,
bourgeois concept of success was soon elbowed
out by the unsettling information that a man was
successful only when he had the prerogative of
choosing the interior decorator who would do
his office—at least junior partnership in the firm.
Now this BMD came to us as a subheading of
the interior decorative criteria of success when
a friend of ours declared he was working for his
BMD. We were unable to equate this with any
degrees we’d heard of and were wondering wheth-
er it had to do with a new telescoped type ,of
Bachelor-Doctor of Medicine when he gave us the
literal translation: Big Mahogany Desk.
H. G. M.
341
SPECIALTY TRAINING IN ALLERGY
Allergy must now be considered as a clinical
entity with its various phases integrated by known
factors or implications. It is a specialty which
must be correlated with all other specialties of
medicine. There is a growing appreciation that
allergy is wholly or partially responsible for so
many diseases or symptom-complexes that it is
expected to be met in the practice of the internist,
pediatrician, dermatologist, otorhinolaryngologist,
and general practitioner. They cannot escape from
the responsibility of at least its recognition so that
the patient may be referred to a properly trained
allergist or they must become trained in the
specialty themselves.
The primary allergic diseases, asthma and hay
fever, afflict approximately 10 per cent of the
total population, making this category of chronic
diseases third in prevalence in the United States.
We must also recognize that the mechanism of
hypersensitivity is responsible for plant derma-
titis, urticaria, eczema, allergic headache, allergic
evidence of infectious diseases, rheumatic fever,
serum sickness and drug allergies, thus making
the incidence of allergy much higher.
Allergy in industry is becoming a serious prob-
lem, and many manufactured products now cause
important allergic diseases. Allergic reactions to
our modern drugs, particularly to antibiotics, are
mounting to alarming proportions and becoming
a very serious problem. Allergy today is a social
problem, extending from birth to old age.
Certification, in itself, in internal medicine and
pediatrics does not indicate that a physician is
qualified for the diagnosis and treatment of
allergic disease. The extremely small number of
physicians subcertified in allergy attests to this.
There are only seventeen AMA-approved institu-
tions in the United States which train residents
and fellows in allergy. A well-organized Ameri-
can Foundation for Allergic Diseases is now
carrying on these functions of teaching and re-
search. The impact of allergy on medicine must
be strengthened by the education of physicians
and the public alike.
Frep W. Wirtticyu, M.D.
FARM PRICES
The medical profession should be very familiar
with the American concept of profitable produc-
tion; namely, that the units of production mul-
342
EDITORIAL
tiplied by the price per unit produced, less the
cost to produce, means the eventual profit.
Farmers, like doctors, live and progress on
profits. They do not live off just price or produc-
tion. Farm production is subject to the vagaries
of the weather, varies from year to year and from
locality to locality. Farm prices should be allowed
to flex in line with needed production, in order
to keep down price depressing surpluses on the
one hand and to stimulate needed production on
the other hand. This is the basic concept of our
free enterprise system.
Since in the late 1930’s, the government has
been trying artificially to peg prices to farmers
in order to insure a measure of farm stability.
In times of full farm production and reasonable
costs, artificially pegged high farm prices bring
high prosperity to farmers. On the other hand, if
artificially pegged high prices create surpluses
which force production cuts and higher costs, the
farmers actually receive less net income. This is
what has happened in agriculture within the last
several years.
Cotton producers and tobacco producers voted
and accepted high government prices and took
acreage cuts in return. These cut-out acres went
into wheat, corn and feed which in some cases
were also price-supported too high, and the results
were surplus produce and acreage cuts.
Today, we are witnessing the confusion of
government interference in agriculture. Some
commodities are artificially high priced above
market demand and are causing ceiling prices and
restrictions. Other commodities are supported
flexibily and are feeling the effects of the spill-
over of acreage cuts of high supported crops.
Feeders and dairymen are feeling the effects of
governmentally determined high feed costs, while
their products are allowed to drop. Butter must
drop because it is too high for its competition or
continue to loose its market. If the socializers
and communizers wanted to create confusion in
agriculture, they couldn’t have done a better job.
Or maybe the boys that wrote and policed the
bills did know what they wanted to do.
I hope physicians won’t buy such government
paternalism. Perhaps we can all work together to
get back to the real system.
J. DELBERT WELLS, Secretary
Minnesota Farm Bureau Federation
MINNESOTA MEDICINE
tic
ag
si
ce
vi
to
re
the
; on
duc-
irles
rom
wed
rder
the
1 on
our
has
ners
ility.
able
ring
d, if
uses
, the
is is
last
oted
took
went
“ases
sults
1 of
ome
bove
and
yrted
spill-
rops.
s of
vhile
must
mn Or
izers
mn in
job.
| the
ment
er to
ation
DICINE
LOSS OF HEARING IN CHILDREN
Loss of hearing in children is of two main
types: (1) middle-ear dysfunction, which is often
preventable, and (2) nerve dysfunction, for
which no prevention or cure exists at present.
The Committee on Conservation of Hearing of
the Minnesota State Medical Association con-
ducted a survey of school children in the state.
As a result, 1,028 children were reported to have
loss of hearing sufficient to be a handicap in school
and later life. Only 175 of these were under
treatment or in special schools.
The committee prepared a brochure that has
been mailed to all physicians in Minnesota. This
brochure presents a concise digest of present
opinion in the fields of treatment for loss of
hearing, training of the deaf child and selection
of a hearing aid. It should be filed in an available
location by all physicians.
The Minnesota Department of Health is co-
operating in the project by mailing letters to the
parents of children discovered by the survey.
Parents are advised to seek medical advice for
diagnosis and for therapy or rehabilitation of the
handicapped child.
This program demonstrates the close co-opera-
tion between organized medicine and public health
agencies. Further co-operation by individual phy-
sicians is required to carry the project to a suc-
cessful conclusion. With the information pro-
vided, every physician can give valuable advice
to the parents of children handicapped with
respect to hearing.
K. M. Stmonton, M.D.
DIABETES DETECTION PROGRAMS
dt is axiomatic that the earlier the diagnosis
of an ailment, the better the prognosis for great-
er comfort, for prolongation of life and for
cures. It is unfortunate that in some diseases,
such as cancer, a diagnosis is quite impossible
until the condition is fairly well advanced.
Diabetes is one disease in which a correct diag-
nosis can be made quite simply. It can be sus-
pected without the patient’s even visiting the
doctor, by having the urine examined for sugar.
If glycosuria is present, then more careful tests
can be made to establish definitely the presence
or absence of the disease. Because of this sim-
plicity for mass detection, diabetes detection
drives have been instituted all over the country.
May, 1955
EDITORIAL
Through this procedure, a possible one million
diabetic persons might be found and placed under
proper supervision and control.
The more recent introduction of the St. Louis
Dreypak strip has simplified the entire procedure.
The strips, after having been immersed in the
urine and dried, can be sent through the mail to
the laboratory with practically no inconvenience
to the patient. Every community should arrange
for the simple facilities necessary to carry out
this procedure. From this center, the results may
be transmitted to the patients. Such an arrange-
ment should prove very simple and inexpensive.
The co-operation of the medical profession in the
Diabetes Detection Week conducted by the Ameri-
can Diabetes Association will help establish excel-
lent public relations between the medical profes-
sion and the community.
In the Diabetic Detection Drive in Minneapolis
in November, 1952, 32,063 specimens were ex-
amined, of which 657 (about 2 per cent) were
found to be positive for sugar. Of these persons,
further tests proved that 40 per cent were truly
diabetic, and they were advised to consult their
doctors for management and control.
Moses Barron, M.D.
Governor, Minnesota District
American Diabetes Association
HOW LONG SHOULD ONE KEEP
VALUABLE PAPERS?
These days all of you have to contend with the
problem of deciding how long records and other
valuable documents should be retained. You are
concerned with keeping not only those records,
documents and papers necessary for the protec-
tion of your interests in the ordinary administra-
tion of living but also those which are necessary
as a result of your professional practice.
Quite apart from the maintenance of files with
respect to the treatment of patients, as to which
you may have some kind of moral obligation,
there is the possibility that at a future date you
may be called upon in a proceeding in court or
elsewhere to present your records for the purpose
of verifying and establishing what has or has not
been done. It is impossible to enumerate all of
the instances in which a physician’s records may
be required. There may be occasions where it
will be of value for you to use records merely to
refresh your recollection as to whether you were
343
EDITORIAL
in or out of the city on a particular date. It is
quite possible that at some time you will be called
upon to explain and even justify the method of
treatment employed in a particular instance. Al-
most surely, you will be called upon at some time
to explain the extent and nature of your income
and of your deductions for income tax purposes.
As a rule of thumb, it seems desirable that
account books and all other records reflecting
income and expenditures should be kept until
January first of the eighth year after the year to
which they pertain. If a creditor attempts within
that time to assert that a bill has not been paid,
you will have your records available to dispute
him. Or if the tax collector has some question
as to the proper tax liability for a given year, the
correct data will be available for his perusal and
for use in court, if necessary.
Deeds, mortgages, leases and other documents
pertaining to real estate are seldom of burden-
some volume and should be retained indefinitely.
A minimum tax file should be kept for an indef-
inite period. This should contain not only the
returns but also sufficient supporting evidence to
establish your income and your deductions. Papers
having no particular present interest may be
destroyed when their usefulness has been served.
In this class fall expired policies of insurance
where no loss has occurred (other than liability
insurance), cancelled savings account books, con-
tracts which have been fully performed, and
similar documents. As to checks and records
pertaining to items which do not have tax conse-
quences, the eight-year period seems to present
only reasonable risks, if any.
Of course, in any unusual situation, you will
want to consult your lawyer because of the obvi-
ous danger that the general rule may not cover
the particular situation.
Rovanp J. Faricy, Attorney
Saint Paul, Minnesota
TONGUE CANCER TREATMENT
Initial treatment of the primary lesion in cancer of the
tongue and floor of the mouth seems to be best accom-
plished by radiation therapy, Dr. C. L. Ash, of Toronto,
Canada, has concluded.
Dr. Ash presented his conclusions, based on a five-
year study of thirty-nine patients with cancer of the
tongue and ninety-five patients with cancer of the
mouth floor, in a recent (April, 1955) issue of the
American Journal of Roentgenology, Radium Therapy
and Nuclear Medicine.
344
The Canadian radiation specialist is associated with
the Ontario Institute of Radiotherapy and the Depart-
ment of Radiotherapy in the Toronto General Hospital.
“In general, the secondary lesions of the oral cavity
developing in the lymph nodes of the neck are most
adequately treated by radical surgery,” Dr. Ash said.
He admitted, however, there are certain exceptions to
this rule.
“The patients we treated represent all the various
forms of radiation therapy—radium in the form of
molds, needles, radon seeds, teleradium therapy, or
roentgen rays of 200 to 400 kv., as well as intraoral
roentgen rays generated at &8 to 200 kv.”
His overall results showed a 49.9 per cent “control’”—
that is, a total of five years with the lesion healed—for
cancer of the tongue and 38.7 per cent control in cancer
of the mouth floor.
However, in the early cases of tongue cancer, there
was 67.0 per cent control—as compared with 32.3 per
cent control among the late cases.
In mouth-floor cancer, there was 49 per cent control
in the early group and 26.2 per cent in the late.
“Better results appear to attend the use of radium, or
a combination of interstitial radium and roentgen rays,
than is the case when external therapy is used alone,”
Dr. Ash said. His conclusion:
Studies at present are being made as to the value
of extending the field of surgery in the so-called radia-
tion “failures’—particularly when initial treatment has
failed and the lesions remain localized.
AIR CONDITIONING
The wide differential in temperature between summer
climates and some air-conditioned interiors poses a pos-
sible health question. “The chief difficulty centers about
the ‘comings and goings’ of occupants of this artificial
climate.” In winter, the human body becomes adjusted
so that persons leaving interiors heated to about 80 de-
grees (Fahrenheit) can enter a near-zero environment
with only the addition of an overcoat and hat. In sum-
mer, however, moving from air-conditioned environments
with relatively low temperatures into exteriors of high
temperatures may result in a condition of “thermal
shock.” The ideal solution of a three to four stage tran-
sition is unfortunately impractical. “Under the circum-
stances described, much may be accomplished by cloth-
ing adjustments. In many air-conditioned spaces, par-
ticularly if there is excessive air motion, added gar-
ments are necessary, especially among women. The
divestment of these garments aids the physiological state
on re-entering the hot outer air. Humidification of the
air is less important to health than was earlier con-
tended. As to comfort, the degree of humidity may be
more important but still is not fundamental. Some in-
vestigators, with respect to air conditioning in summer,
advise merely dehumidifying the air to a low point with-
out effort to lower temperatures, but this may give
rise to an unpleasant sense of chilling owing to increased
evaporation. In any event, a humidity between 40 and
60 per cent is regarded with favor.”—QUERIES and
Minor Notes: Air conditioning, Journal of the Amer-
ican Medical Association (157:1265 (April 2) 1955.
MINNESOTA MEDICINE
d with
Depart-
Ospital,
cavity
e most
said.
ions to
various
rm of
Py, or
itraoral
trol”—
-d—for
cancer
, there
3 per
control
um, or
1 rays,
alone,”
value
radia-
nt has
immer
a pos-
about
tificial
justed
30 de-
nment
sum-
ments
high
ermal
tran-
rcum-
cloth-
par-
gar-
The
state
yf the
con-
ay be
1e in-
amer,
with-
give
eased
) and
and
lmer-
).
ICINE
Medical Economics
AMA REVIEWS LEGISLATION
STATUS
After three months of the 84th Congress, the
American Medical Association has published a
summary of the status of federal legislation of
interest to the medical profession. More than 200
medical-interest bills are being followed by the
Washington Office of the AMA, and also con-
sidered are pertinent testimony before commit-
tees, committee actions, and all available informa-
tion on future plans and objectives of the Ad-
ministration and Congress. An early April issue
of an AMA Washington Office Special Report
reviews current status of legislation under several
categories :
Reinsurance
Legislation provides an initial $25 million to
start a trust fund that would be maintained by
percentage payments from premiums of partici-
pating health insurance plans. The fund would
reimburse voluntary health insurance plans (com-
mercial and nonprofit) for abnormal losses in
extending coverage and expanding benefits. This
is on the “must list” of the Administration’s
health and medical care program. No hearings
had yet been scheduled in early April.
According to the Report:
“While endorsing the stated purposes of the bills (to
promote the best possible medical care on reasonable
terms), the American Medical Association again op-
poses the proposal on the grounds that (1) extensive
private funds are available within the insurance indus-
try for such purposes, (2) reinsurance doesn’t provide
a means for making insurable what otherwise would be
an uninsurable risk, (3) it will not fulfill its intended
Purpose and might even inhibit the satisfactory progress
made to date by voluntary plans, and (4) it is a poten-
tial subsidy.”
Mortgage Guarantee
For a fee, this legislation would guarantee up
to 95% of private mortgages for construction
of non-government health facilities, to be owned
and operated for profit or on non-profit basis.
May, 1955
Edited by the
Committee on Medical Economics,
Minnesota State Medical Association
George Earl, M.D., Chairman
The mortgage could not exceed 80 per cent of
the estimated value of the project and equip-
ment, and maturity could not exceed thirty years.
The guarantee would apply to refinancing, as
well as to new construction and modernization.
Hearings are to be scheduled.
The AMA Report states:
“The Association (AMA) is actively opposed to this
legislation on grounds that (a) private financing is meet-
ing the need, and (b) the proposal represents intrusion
by the federal government into a field where government
help is not required.”
Mental Health
The Administration wants a new five-year pro-
gram of increased grants to states on a need-
population-per-capita-income formula to help
maintain and improve mental health facilities,
to stimulate special projects, and to train more
personnel. Several bills for grants to finance a
three-year survey have been introduced, and an-
other to create a permanent federal commission
on mental health, which would study the problem,
make recommendations and attempt to co-ordinate
all work in this field, private as well as govern-
ment. These proposals have made the most
progress of all health bills, and the former, both
in the House and Senate, are expected to reach
the floor.
AMA policy on this matter is: wholehearted
support of the survey bill, also favoring the Ad-
ministration bill, but only as a temporary measure
until Congress has been able to redefine the fed-
eral and local areas of responsibility in public
health matters. The Report states: “This interest
in mental health problems dates back to the found-
ing of the AMA more than a century ago.”
Federal Aid to Medical Education
Plans for federal aid to medical education
range from “one-shot” construction grants to
outright operating aid for schools increasing en-
rollment. Most prominent in this Congress are
identical bills in the House and Senate, providing
a five-year $250 million program of construction,
345
MEDICAL ECONOMICS
expansion, modernization, and maintenance grants
to new and existing schools. Hearings should be
scheduled shortly.
According to the Special Report:
“The Association favors one-time construction, reno-
vating and equipment grants to medical schools on a
matching basis similar to the Hill-Burton formula, but
opposes federal grants for instruction or continuing
grants for operation or maintenance. It approves the
Hill-Priest bill, providing some specific changes are
made in line with the above policy. It opposes the Burn-
side bill, until he accepts changes that have been sug-
gested to him.”
Doctor Draft and Military
Medical Scholarships
The Doctor Draft extension bill would con-
tinue the present act for another two years be-
yond July 1, 1955. Under the scholarship bill,
the government would pay up to $133 a month,
plus tuition and fees. Students would be obligated
for three years’ active duty if the scholarship
was for a year or less, and four years if for more
than one year.
The Doctor Draft provision is expected to come
up this session, but hearings had not been sched-
uled in early April. The scholarship bill is an
official Administration measure, and is planned
for consideration before the Doctor Draft act.
The AMA policy on the above is described as
follows :
“When there was a proven need for it at the start
of the Korean War in 1950, the Doctor Draft was sup-
ported by the AMA. The AMA also supported one
extension of the law. Now, in the face of the Defense
Department’s request for another (and peacetime) ex-
tension, the AMA’s policy is unchanged. If it can be
demonstrated that there is a continuing need for the
act, the AMA will support the extension. Evidence
so far presented has not established the need. The De-
fense Department admits the regular draft obligation
will supply it with the young physicians it needs, but
says that the Doctor Draft is required to bring in more
experienced men with special skills and administrative
ability. Without these, the Department insists, the mili-
tary medical services cannot be maintained during the
next two years. The AMA believes the services could
do a great deal more to build up their regular Medical
Corps and to make more efficient use of the experienced
men now in uniform.”
Regarding the military scholarships, the AMA
supports the scholarship idea, provided that (1)
a student not be approached by the military until
he is fully matriculated in the medical school,
346
(2) no student so selected receive any preferen-
tial treatment, and (3) number of military
scholarships in a school not exceed 5 per cent of
any year’s class or the total enrollment.
Military Dependents
The present program of medical care for mili-
tary dependents is irregular, Legislation would
substitute a plan that would (a) apply a uniform
definition of dependents to all services, (b) make
all dependents eligible for the same amount of
treatment, and (c) offer relatively the same de-
gree of care regardless of residence of the depen-
dents. Uniformed physicians and military hospitals
would take care of all dependent patients within
limitation of resources. The Secretary of Defense
could set a token fee schedule to be charged de-
pendents in military facilities.
No hearings had been scheduled at the re-
lease of the AMA Special Report. Two identical
bills have been introduced in the House and
Senate, and it is felt that the Administration will
support some kind of change in the present law.
The AMA has no argument with the military
services on most provisions of the Defense De-
partment bill, but is unalterably opposed to one
part of it: “Whereas the Administration thinks
the military medical departments should care for
all the dependents they can handle, the AMA
feels that dependents, like other civilians, should
be treated by private physicians and in private
hospitals unless these private facilities are inade-
quate. In the latter case it would be the military's
responsibility to care for dependents.” The AMA
is working on a set of guiding principles to pro-
pose for amendment when the bill is brought
up.
TAX DEFERMENT BILLS
MAKE SLOW PROGRESS
There seems to be little evidence that Congress
will act on the Jenkins-Keogh-Ray type of bills
this session. The Treasury Department has
studied some of the proposals, but the Adminis-
tration is not supporting any.
The purpose of the Jenkins-Keogh and Ray
bills is broadly the same: “namely,” according
to a recent issue of the AMA Journal, “to en-
courage but not compel saving for retirement by
the self-employed and by employed persons whose
employers have not established pension and/or
profit-sharing plans for them . . . Both bills make
MINNESOTA MEDICINE
eferen-
rilitary
cent of
r mili-
would
niform
) make
unt of
ne de-
depen-
spitals
within
efense
ed de-
he re-
entical
e and
mn will
it law.
iilitary
se De-
to one
thinks
ire for
AMA
should
private
inade-
itary’s
AMA
O pro-
rought
ngress
f£ bills
t has
minis-
1 Ray
ording
to en-
ent by
whose
nd /or
, make
EDICINE
MEDICAL ECONOMICS
special provisions—past service credits—for those
older self-employed and pensionless employed
persons who have not had the benefit of tax de-
ferment during the early and middle parts of
their working lifetimes.”
The American Medical Association supports
all these bills, including medical expense deduc-
tion bills, but among the tax deferment proposals
it prefers the Jenkins-Keogh approach.
NATIONAL BOARD NOTES
EXAM REQUIREMENTS
The National Board of Medical Examiners has
released general information on taking national
board examinations, which should be of value to
many physicians. The National Board is a volun-
tary and unofficial examining agency, the purpose
of which is to “prepare and to administer qualify-
ing examinations of such high quality that legal
agencies governing the practice of medicine with-
in each state may at their discretion grant success-
ful candidates a license without further examina-
tion,” their publication states.
The National Board certificate is accepted as a
suitable qualification for the practice of medicine
by forty-one licensing authorities in the states,
the District of Columbia, Hawaii and Puerto
Rico, Minnesota is one of these states.
The examinations are divided into three sepa-
rate parts, I, II and III which must be taken and
completed in numerical sequence. Examinations
are held in February and June at medical schools
in the U. S. and Canada; an additional examina-
tion in Part IT is held in April and an additional
examination in Part I in September.
Who Is Eligible?
The National Board admits to its examinations
any student in or graduate of approved medical
schools in the United States and Canada. A can-
didate is eligible for Part I when he has com-
pleted the first two years of work in an approved
medical school; eligibility for Part II calls for
successful completion of a four-year medical
course in an approved medical school; a candi-
date is eligible for Part III if he has passed
Parts I and II, received a degree of doctor of
medicine, and served at least one year in an ap-
proved hospital internship.
May, 1955
Advantages Named
In its recent publication, the National Board
examination advantages are outlined as:
“Because the answer sheets are machine scorable, the
grading can be accomplished rapidly, accurately, and
impartially. With this type of examination, it becomes
possible to determine the level of difficulty of each
test and to maintain comparability of examination
scores from test to test and from year to year for any
single subject. Moreover, of even greater long-range
significance is the facility with which the total test
and individual questions can be subjected to thorough
and rapid statistical analyses, thus providing a sound
basis for comparative studies and for continuing im-
provement in the quality of the test itself.”
Further advantages result from the fact that
these examinations are set up in three parts, the
Board states, and may be taken during the course
of training in the medical school when the stu-
dent is fresh from his preparation in the various
subjects included in the medical curriculum.
Preparation of Examinations Noted
The summary of examinations by the National
Board publication states that approximately a
year goes into the preparation of each examina-
tion. Each committee member thoughtfully and
laboriously writes test questions selecting that type
best suited to a particular point. Each question is
then subjected to the critical review of the other
members of the committee; any doubtful item is
revised or discarded. It concludes: “Hence, each
examination contains only material that has been
thoroughly worked over and agreed upon as ap-
propriate, free from ambiguity and representative
not only of important aspects of a subject, but
also of high standards of medical education.”
In 1902, Charles Richet, a French physician, theorized
that an inoculation of a given protein in animals would
produce a hypersensitivity to that protein. He termed
this process “anaphylaxis,” derived from the Greek ana,
meaning “backward,” and phylaxis, meaning “protec-
tion.” The term, then, refers to the reverse of “prophy-
laxis,” or a state of increased susceptibility to a drug
protein or toxin following administration of the drug.—
Wain, H.: The story behind the word, Ohio State
Medical Journal 51:362 (April) 1955.
347
IATROGENIC HEART DISEASE
The word “iatrogenic” comes from two Greek
words meaning “physician and producing”—actu-
ally generated by the physician. It is a term ap-
plied to disorders induced in the patient by auto-
suggestion, resulting from the manner in which
the physician conducts his examination, and what
he tells the patient.
Today, when there appears to be such a great
increase in the incidence of coronary arterio-
sclerosis with coronary occlusion and myocardial
infarction, everyone is aware of this growing
menace to life and health.
Consequently, more than ever before, people
with any pain or abnormal feeling in the left chest
seek medical advice to learn how serious this
symptom may be. If the doctor, after a brief his-
tory and physical examination, finds a regular
heart of normal size and a normal blood pressure.
and tells the patient, “I find nothing wrong, but
you'd better be careful at your age,” or, “I find
nothing wrong, but you'd better take a little
digitalis and avoid doing anything strenuous,”
then he is is likely to generate “iatrogenic heart
disease.”
Actually, when a doctor gives such advice, he
is “straddling.” He is not entirely sure himself.
and so, should this patient later develop actual
organic heart disease, he wants to be able to say,
“You see I was right. I warned you.”
When any person first comes to a physician
complaining of a pain or an ache in his left chest
that physician is charged with a very grave re-
sponsibility for making the right diagnosis and
for telling the patient, at once, he has or he does
not have heart disease.
The first contact with such a patient is most
important, because how the doctor conducts him-
self may determine success or failure in handling
the case. He must sit quietly with the patient
and take plenty of time to obtain a complete
history of his chest pain or ache. When did
it begin—day or night? What was its relation
to exertion, to rest, to anxiety? Was there any
antecedent exhausting illness? Was there a recent
bereavement, or grief over the death of a loved
one? If such a death were sudden and from a
heart attack, does this patient fear that he, too,
may be so stricken?
Has there been a series of strains and anxieties
in the mother of a large family, with many ill-
nesses and many nights of broken sleep? Has
348
CHARLES N. HENSEL, M.D.
Saint Paul, Minnesota
there been a recent “bout” of upper respiratory
tract infection or a tonsillitis or a pleurisy?
Inquiry into all of these factors will point to-
ward the diagnosis of either organic heart disease
or a functional heart disturbance, such as a ner-
vous heart.
The next step is a complete physical examina-
tion with clothes removed. This should include
pupillary reactions, examination of the oral
cavity, palpation of the thyroid gland, examina-
tion of the lungs, determination of the heart
borders and auscultation of the heart, determina-
tion of blood pressure, examination of the abdo-
men, rectal examination, study of the reflexes,
a check for edema of the shins, temperature of
the body, and examination of urine and blood.
Next follows the examination of the heart after
exercise, using such a simple test as twenty hops
on one foot and twenty hops on the other foot,
noting the height of the pulse and the blood pres-
sure and the time of their return to normal.
Then, and not till then, comes the observation
of the heart and lungs under the fluoroscope,
study of the heart silhouette from a 6-foot heart
film, and reading of the electrocardiogram.
If all of these examinations and tests have pro-
duced normal responses, then and only then, can
the examining physician be justified in telling the
patient that he does not have any heart disease at
all, that the dull ache in his left chest and the
palpitation of his heart when he gets into bed at
night are “fear reactions,” because fear tends to
pour extra adrenalin into the blood stream, and
it is this extra adrenalin that makes his heart
slam and bang against his ribs.
Tell him that the symptoms of organic heart
disease are relieved by the horizontal position.
that the pain of organic heart disease is not a
dull ache, but a sharp stabbing pain, which passes
with rest or standing still.
Tell him that a dull ache in the left chest is
frequent in people with a nervous heart.
Look for other associated nervous signs, such
as light headedness, trembling, sweating and an
abnormal tendency to sigh.
Tell him that exercise is good for people with
nervous hearts and that they should walk erect
and breath deeply.
Do not ever hedge—tell him yes or no. And
if he has no organic heart disease, tell him to do
normal things and to lead a normal life. But
whatever you tell him, be definite.
MINNESOTA MEDICINE
} M.D.
inesota
ratory
nt to-
isease
1 ner-
mina-
clude
oral
mina-
heart
mina-
abdo-
lexes,
ICINE
Reports and Announcements
MEDICAL MEETINGS
State
MINNESOTA STATE MEDICAL ASSOCIA-
TION, annual meeting, Minneapolis, May 23-25, 1955.
Minnesota Academy of Occupational Medicine and
Surgery, annual meeting, Minneapolis Athletic Club,
May 2, 1955.
National
American Association of Blood Banks, eighth annual
meeting, Palmer House, Chicago, Illinois, November
19-21, 1955.
American Cancer Society, Board of Directors and
special committee meetings, Hotel Radisson, Minne-
apolis, June 2, 1955.
American Medical Association, annual meeting, At-
lantic City, New Jersey, June 6-10, 1955.
American Proctologic Society, annual meeting, Hotel
Statler, New York, New York, June 1-4, 1955.
International
International College of Surgeons, twentieth anniver-
sary congress, Palais Du Conseil General, Geneva,
Switzerland, May 23-26, 1955.
International Hospital Congress, Lucerne, Switzer-
land, May 30-June 3, 1955.
International College of Surgeons, Cape Cod regional
meeting, Chatham Bars Inn, Chatham, Massachusetts,
July 1-4, 1955.
International Symposium on Enzymes: Units of Bio-
logical Structure and Function, Henry Ford Hospital,
Detroit, Michigan, November 1-3, 1955.
AMERICAN ACADEMY OF GENERAL PRACTICE
The American Academy of General Practice is allow-
ing twenty hours of informal credit to its members who
attend the medical sessions of the annual meeting of the
National Tuberculosis Association and its medical sec-
tion, the American Trudeau Society. The sessions will
be held in Milwaukee, Wisconsin, May 22 through 27.
Further information may be obtained from the Min-
nesota Tuberculosis and Health Association, 614 Port-
land Avenue, St. Paul, Minnesota.
AMERICAN ASSOCIATION OF ANATOMISTS
At the sixty-eighth annual session of the American
Association of Anatomists, held at the Jefferson Medical
College, Philadelphia, April 6 through 8, Dr. Edward
A. Boyden, University of Minnesota professor emeritus
of anatomy, was named president-elect of the organiza-
tion. He will take office in April, 1956.
Dr. Boyden, who retired as head of the University of
May, 1955
Minnesota’s anatomy department in 1954, is currently a
visiting professor of anatomy at the University of Wash-
ington, Seattle.
MINNESOTA CHAPTER, ARTHRITIS
AND RHEUMATISM FOUNDATION
The formation of the Minnesota Chapter of the
Arthritis and Rheumatism Foundation was completed in
Minneapolis on April 13 with acceptance of a charter
from the national foundation. Elected as officers of the
organization were Dr. Charles Slocumb, Rochester, presi-
dent; Dr. Macnider Wetherby, Minneapolis, first vice
president, and Dr. Cecil J. Watson, University of Min-
nesota Medical School, second vice president.
Executive secretary of the chapter is R. V. Stevenson,
with offices at 89 South Tenth Street, Minneapolis.
Purpose of the foundation is to fight arthritis and
rheumatism by working for establishment of free clinics
for treatment and to provide for research through estab-
lishment of scholarship and laboratory grants.
ST. LOUIS COUNTY SOCIETY
The St. Louis County Medical Society held a meeting
at St. Luke’s Hospital, Duluth, on April 14. Principal
speakers at the meeting were Dr. William B. Martin
and Dr. Kenneth A. Storsteen, both of Duluth. They
discussed the diagnosis and treatment of hyperthyroid-
ism, using radioactive substances.
MINNESOTA OBSTETRICAL AND
GYNECOLOGICAL SOCIETY
Recently elected as officers of the Minnesota Ob-
stetrical and Gynecological Society were Dr. Leonard A.
Lang, Minneapolis, president; Dr. Rodney F. Sturley,
St. Paul, vice president, and Dr. Edward A. Banner,
Rochester, secretary-treasurer.
MINNESOTA SOCIETY OF NEUROLOGY
AND PSYCHIATRY
The Minnesota Society of Neurology and Psychiatry
will meet at the Mayo Clinic, Rochester, Minnesota, on
May 21.
Surgical clinics will be held at St. Mary’s Hospital
at 8:00 a.m., followed by presentation of papers at
10:00 am. Papers to be presented are as follows:
“Chloropromazine and Reserpine in the Treatment of
Chronically Ill Mental Patients,’ by Dr. M. C. Petersen
and Dr. C. W. Baars. “Hormones and Psychoses,” by
Dr. Howard P. Rome. “Investigation of Environmental
Factors in Schizophrenia,” by Dr. Peter Beckett and
Dr. Jane Watson.
Luncheon will be served at the Foundation House at
12:30 p.m. Principal speaker at the luncheon will be
Dr. J. H. Tillisch, who will discuss “The History of
the First Minnesota Regiment in the Civil War.”
349
oun a, ee
THE
Minnesota
Medical Foundation
beds Your , /
1) To promote the welfare of the medical School
of the University of Minnesota
2) To improve the undergraduate, graduate ‘and
research functions of the Medical School
To establish scholarships, lectureships,
professorships, research and student loan funds
To publish a weekly bulletin
To advance the interests of the University of
Minnesota Medical School and its alumni
The Minnesota Medical Foundation is desirous of obtaining the support of all
members of the medical profession in this area. The Weekly Bulletin is a major
project of the Foundation. It is an expensive undertaking and a fund must be
accumulated to insure continued publication. All members of the Foundation
automatically receive the Weekly Bulletin of the University of Minnesota Hos-
pitals and The Minnesota Medical Foundation.
MEMBERSHIP SEND CHECK TO
Annual. ... . . .$ 10.00 per year Minnesota Medical Foundation
Contributing . . . . . 25.00 per year 1342 Mayo Memorial Building
Sustaining. . . . . . 100.00 per year University of Minnesota
Patron. . . . . . . 1000.00 or more Minneapolis 14, Minnesota
(Membership dues and contributions are tax deductible)
MINNESOTA MEDICINE
DICINE
Woman’s Auxiliary
INTERNATIONAL HEALTH
ORGANIZATIONS—PART I
Mrs. H. F. Wahlquist
A needless cause of embarrassment to many wives of
physicians is not knowing how to explain to many people
just what World Medical Association and World Health
Organization mean. Each of us has a vague idea of
what these two organizations represent—we know they
are organized for health purposes, but we lack knowledge
df their basic principles, and their differences. Perhaps
circumstance has really never made it imperative that we
study and ferret out facts about their organizational
structure and purposes.
Constantly, I am hearing some one refer to WMA
when she means WHO and vice versa. As wives of
physicians, we must know more about these two organi-
zations. They are both related to medicine, and yet both
are basically different. Perhaps one of the most basic
differences is that WMA is made up of physicians;
WHO of technical representatives of member states.
As wives of physicians, we need to know more than this!
In these few brief paragraphs, I shall attempt to
clarify the purpose of each organization and in later
comments describe the organizational structure and
functions of each.
The World Medical Association (WMA) and World
Health Organization (WHO) are two international
organizations. The WMA is non-governmental; it is an
organization of national medical associations and its
members are solely physicians. I say “solely,” for in the
United States a WMA U. S. Committee, Inc., of which
other citizens may become a member, has been formed.
The WHO is inter-governmental; it is a branch of the
United Nations and represents the governments of the
world in the field of health. It is a specialized technical
agency of the United Nations system, but under a sepa-
rate treaty with membership independent of membership
in the United Nations and with its own governing
assembly. The WHO is supported entirely by govern-
ment funds. The WMA is supported by dues and volun-
tary contributions.
When the Constitution of WHO was written in 1946,
specific functions were assigned in three general cate-
gories :
l. Functions relating to international sanitary regula-
tions, causes of death, nomenclature of diseases, new
drugs.
2. Coordination of health activities of governments
for the eradication of epidemic and endemic diseases, the
Promotion of research in fields of public health and the
Promotion of improved standards in the medical and
telated professions.
3. Assistance to governments in strengthening national
health services, furnishing technical assistance, promo-
May, 1955
tion of improved housing, nutrition and sanitation and
the promotion of maternal and child health.
Its real objective is to aid in the long term solution
of a country’s health problems through strengthening
the national health service, rather than developing
Specific programs.
The World Medical Association aims to promote
closer ties among the national medical organizations and
thus among the physicians of the world. It seeks to serve
as a forum for discussion of mutual problems. Its aim
is to disseminate information and to raise the standards
of health, medical education and medical care throughout
the world. Through its officers, it can present the points
of view of the medical profession before other interna-
tional bodies; as WHO, UNESCO, giving physicians
a voice in international affairs when matters of medicine
and health are discussed. Perhaps the most significant
of its aims is to work toward world peace.
(Parts II and III will appear in succeeding issues.)
CLARKFIELD HOLDS HEALTH DAY
Sponsored by the Clarkfield Community Hospital
Auxiliary, a successful “Health Day” was held on Satur-
day, April 2, in the High School Auditorium in Clark-
field.
Mrs. M. I. Hauge, first chairman of the hospital auxili-
ary and state chairman of Today’s Health for the
Woman’s Auxiliary to the Minnesota State Medical
Association, served as chairman of a very active health
day committee.
The afternoon and evening programs included a talk
on “Child Accidents” by Dr. A. B. Rosenfield, Minne-
sota Department of Health, a talk on mental health by
Rev. Fred Norstad, President, Citizens’ State Mental
Health Association, and panel discussions on child health,
the aging population and the new wonder drugs. Music
and numerous information booths helped round out an
excellent program to a large crowd from Clarkfield and
the vicinity.
RAMSEY AUXILIARY REPORTS ACTIVITIES
Mrs. L. T. Simons
Mrs. W. P. Gardner, president, called a board meeting
on April 18 in the Medical Arts Library. Members made
cancer dressings during and following the meeting. An-
nual reports of all committee chairmen were presented
and plans for the May meeting were discussed.
Mrs. Duane Ausman and Mrs. E. R. Sterner, hos-
pitality chairman and co-chairman, took reservations for
the monthly luncheon meeting, held in the Commodore
Hotel on April 25. Mrs. S. M. Loken, program chair-
man, presented Dr. Clarence Rowe, assistant teaching
professor in psychiatry at the University of Minnesota
and director of the Hamm Memorial Psychiatric Clinic,
who was the main speaker on the program.
351
In Memoriam
RUDOLPH A. BEISE
Dr. Rudolph A. Beise, Brainerd physician, died April
4, 1955. He was seventy-eight years old.
Dr. Beise was born in Medo, Minnesota, in 1877. He
attended school in Mankato before going to the Univer-
sity of Minnesota and Rush Medical School. He interned
at Cook County Hospital in Chicago and started his
practice in Brainerd soon afterward.
During his active life, Dr. Beise participated in many
civic affairs. He was mayor of Brainerd from 1915 to
1919. He was a member and secretary of the Brainerd
Park Board. In 1953, Governor C. Elmer Anderson
selected him to represent Minnesota at the First Western
Hemisphere Conference of the World Medical Asso-
ciation.
Dr. Beise was a vestryman of St. Paul’s Episcopal
Church. He was a charter member of the Brainerd
Rotary Club and served as its president from 1923 to
1924. In 1951, the club held a testimonial dinner honor-
ing him for his fifty years as a practicing physician.
Dr. Beise was chief of staff at St. Joseph’s Hospital
in Brainerd. He was a member of the Upper Mississippi
Medical Society, the Minnesota State Medical Association
and the American Medical Association. He was a Life
Member of the State Association and a member of the
“Fifty Club” ‘for doctors who have been in practice for
fifty years.
He is survived by his wife, the former Minnie Keller ;
a daughter, Mrs. Ruth Louise Quanstrom, Brainerd;
and a sister, Ida Beise, of Ada.
HUBERT TOWNSEND SHERMAN
Dr. Hubert T. Sherman, long in practice in southern
Minnesota, died March 23, 1955, in Cambridge. He had
been a medical staff member at the Cambridge state
school and hospital since 1944.
Dr. Sherman was born at Wykoff, Minnesota, in 1879.
He attended high school at Minneapolis Central and
continued his education at Hamline University and the
Minneapolis College of Physicians and Surgeons, grad-
uating in 1904.
Dr. Sherman practiced in several Minnesota locations,
spending brief periods of time at Becker, Minneapolis,
Grand Meadow, Bellingham and Echo. He spent many
years in practice at Big Lake, Franklin, and Plainview.
While at Plainview, Dr. Sherman served as President
of the Wabasha County Medical Society. He was a Life
Member of the Minnesota State Medical Association
and was a member of county societies where he was
practicing.
352
He is survived by his wife, Rachel; three daugliters,
Mrs. Will McCoy, Rock Falls, Ill, Mrs. Clifford Kast,
Aitkin, Minn., and Mrs. Roy Peterson, Mahtomedi: three
sons, John and Hubert, both of Minneapolis, and Roy,
of Albuquerque, New Mexico; a sister, Mrs. H. E. Hart,
Long Prairie, Minn.; eleven grandchildren, and three
great-grandchildren.
JAMES CORY FERGUSON
Dr. James C. Ferguson died April 17, 1955, at the age
of seventy-nine. He had practiced medicine for over
fifty years. ;
Dr. Ferguson was born at Fort Totten in what was
then the Dakota territory. He attended school in Coop-
erstown, New York, the home town of his mother. He
came west to attend the University of Minnesota, grad-
uating in 1901.
He combined his internship with work as a pathologist
for St. Joseph’s Hospital in Saint Paul for several years
and became a member of its staff.
Dr. Ferguson served with the army during World
War I, both in this country and overseas. He was a
Life Member of the Ramsey County Medical Society,
the Minnesota State Medical association, and a member
of the American Medical Association. He was a charter
member of the Minnesota Pathological Society and a
member of the Association of Military Surgeons. In
1951, Dr. Ferguson became a member of the “Fifty
Club” of the Minnesota State Medical Association.
He was active in Masonic affairs and was a life
member of the Minnesota Historical Society.
He is survived by his wife, Emily K.; three sons,
James Cory of Lake Minnetonka and Robert Bruce
and William Frederick of Saint Paul, and six grand-
children.
A sample survey of some 12,000 industrial firms, in-
cluding manufacturers of chemicals and_ professional
and scientific equipment, has been started by the Na-
tional Science Foundation. Director Alan T. Waterman
said the findings should be valuable to companies in
planning and appraising their own research programs,
“besides contributing greatly to the formulation of na-
tional policies for research.” He estimated industry’s con-
tribution to the total $3.5 billion national research and
development effort at around $1 billion a year. The
federal government, in addition, spends about $1 billion
annually to support research and development in indus-
trial laboratories. Survey plans were worked out in con-
sultation with National Association of Manufacturers,
Industrial Research Institute and other industry groups.
MINNESOTA MEDICINE
ghters,
| Kast,
; three
1 Roy,
. Hart,
three
he age
rover
it Was
Coop-
‘r. He
grad-
ologist
years
World
was a
ciety,
ember
harter
and a
is. In
‘Fifty
a life
sons,
Bruce
rrand-
s, in-
sional
Na-
rman
es in
rams,
f na-
; con-
1 and
The
villion
ndus-
-con-
arers,
oups.
CINE
Of General Interest
Dr. Karl Lundeberg, Minneapolis health commis-
sioner, has announced that Minneapolis ranks lowest
in cities of 400,000 or more for reported cases of
venereal disease in 1954. Minneapolis had a rate of
18 cases of syphilis per 100,000 population. The high-
est rate in the nation, reported in Washington, D. C.,
was 517 cases per 100,000. Similarly, Minneapolis had
only 84 cases of gonorrhea per 100,000 population,
compared to 1,400 per 100,000 in Washington.
* *k *
Among the speakers at a meeting of the fifth dis-
trict of the Minnesota Society of X-Ray Technicians
at Mankato on March 13 was Dr. J. W. Burnett of
New Ulm. Dr. Burnett spoke on “Urinary Tract
Examination.”
x ok *
Dr. Henry W. Meyerding, Rochester, who retired
in November, 1949, as professor of orthopedic sur-
gery in the Mayo Foundation, has been elected an
honorary member of the Turkish Surgical Associa-
tion and an honorary fellow of the Philippine Col-
lege of Surgeons.
Dr. Meyerding recently completed an around-the-
world tour by airplane. Countries he visited included
Hawaii, the Philippines, Japan, China, India, Thai-
land, Pakistan, Lebanon, Turkey, Israel, Greece,
Italy, Iceland and France. Chapters of the Interna-
tional College of Surgeons were installed and lectures
were given at various universities and surgical meet-
ings.
x ok Ok
Dr. Henry E, Michelson, Minneapolis, has been
invited to address the 1955 annual session of the
Michigan State Medical Society in Grand Rapids,
Michigan, on the subject, ‘““Dermatological Diagnosis
and Treatment.”
* * OK
Dr. Wendell L. Downing, Le Mars, Iowa, a gradu-
ate of the University of Minnesota Medical School in
1919, has been named president-elect of the Iowa
State Medical Society. Dr. Downing has been a
member of the organization’s board of trustees and
was chairman of it last year. In February he was
elected president of the Sioux Valley Medical Society.
K * *
Principal speaker at a clinical conference at the
Community Memorial Hospital, New Prague, on
March 15 was Dr, Stuart W. Arhelger, assistant pro-
fessor in the department of surgery at the Mayo
Memorial Hospital, University of Minnesota. He dis-
cussed the diagnosis and treatment of cancer. The
clinical conference was one of a series sponsored by
the Minnesota Department of Health, Minnesota
State Medical Association, University of Minnesota,
Minnesota Heart Association and Minnesota Cancer
Society.
May, 1955
Guest consultant at a clinical conference at the
Kanabec Hospital, Mora, late in March was Dr. Paul
Winchell, staff member of the Variety Club Heart
Hospital at the University of Minnesota. He dis-
cussed diseases of the heart.
x k *
Dr. H. H. Russ, Blue Earth, was guest speaker at
a meeting of the Kiester Parent-Teacher Association
at Kiester late in March. He spoke on cerebral palsy
and showed a motion picture on the same subject.
* * *
Dr. Tray G. Rollins, formerly of Elmore and now
located at Cass Lake, has been awarded a fellowship
in dermatology at the Mayo Clinic, Rochester, effec-
tive January 1, 1956,
* * *
Dr. E. L. Penk, Springfield, has been appointed to
a three-year term as Springfield’s health officer. He
replaces Dr. W. G. Nuessle, whose term of office
has expired. Dr. Penk also heads the Springfield
board of health.
es
Fathers and expectant fathers heard Dr. Milton L.
Kaiser, New Ulm, discuss the anatomy and physiol-
ogy of reproduction and the responsibilities of
fathers at a parent education meeting in New Ulm
late in March. Two motion pictures on the subject
were also shown. The session was the last in a series
of parenthood classes sponsored by the Union Hos-
pital at New Ulm.
x * *
Dr. Dale Cameron, medical director of the Min-
nesota Department of Public Welfare, was the prin-
cipal speaker at a meeting of the Minneapolis and St.
Paul sections of the National Council of Jewish
Women in St. Paul on April 4. Dr. Cameron spoke
on mental health problems in Minnesota and the
work of volunteers in mental health programs.
* * *
Dr. S. J. Raetz, Maple Lake, attended a meeting
of the International Academy of Proctology in New
York City during the last week of March. While at
the meeting he also attended lectures and surgical
clinics at the Jersey City Medical Center.
* ok x
Childhood accidents were discussed by Dr. Thomas
Murn, Thief River Falls, at a meeting of the Oklee
Parent-Teacher Association in Oklee late in March.
* * *
Dr. E, H. Rynearson, Rochester, has been named
by the board of managers of the Gamehaven Founda-
tion as general chairman of the Camp Building Fund
Campaign, a drive to raise funds for improvement of
scout camps near Rochester and Lake City.
353
OF GENERAL INTEREST
Dr. G. W, Clifford, Alexandria, was guest speaker
at a meeting of the Woman’s Club in Alexandria on
April 4. Dr. Clifford spoke on the subject, “Under-
standing Old Folks.”
* * *
Dr. and Mrs. Robert N. Bowers, Lake City, spent
an eleven-day vacation trip in Haiti, Jamaica and
Cuba during the middle of March. They made the
journey by air. While in Cuba they were entertained
by friends, Dr. and Mrs. Carlos Menendez of Havana.
ae ee
An auxiliary of Doctors Memorial Hospital, Min-
neapolis, has been organized by Dr. Olga S. Hansen
to assist the hospital and its patients.
* * *
The engagement of Suzanne Elizabeth Scott, St.
Paul, and Dr, Thomas H. Kirschbaum, Minneapolis,
has been announced. A graduate of the University
of Minnesota Medical School, Dr. Kirschbaum in-
terned at University Hospitals. At present he is on
active duty with the Navy at San Diego.
* * *
Principal speaker at a meeting of the Kiwanis
Club at Alexandria late in March was Dr. L. F. Was-
son of Alexandria, who spoke on the topic, “Does
Cigarette Smoking Cause Cancer?” He discussed the
opinions of groups on both sides of the somewhat
controversial question.
* * *
Fifty-four members of the Chicago Surgical So-
ciety visited Rochester on March 25 and 26 for
scientific sessions, observations of operations and
tours of the Medical Sciences Building. Dr. John
M. Waugh of the Mayo Clinic was in charge of
the two-day affair. During the scientific sessions
papers were presented by fellows in the Mayo Foun-
dation and by members of the clinic staff.
* * *
Dr. A, O. Swenson, Duluth, president of the Min-
nesota State Medical Association, has been named
a member of the advisory board of the Minnesota
Poll, a public opinion survey conducted by the Min-
neapolis Tribune as a public service.
*x* * *
Dr. and Mrs. S. W. Harrington, Rochester, re-
turned home in mid-March after spending almost two
months in South America. During their tour Dr.
Harrington, a retired staff member of the Mayo
Clinic, presented lectures at several colleges and uni-
versities. He received an honorary award from the
University of Buenos Aires.
* * *
June 26 has been designated as Dr. McKaig Day
for the residents of Pine Island and surrounding
communities. On that date they will celebrate the
birthday of Dr, Carle B. McKaig and honor him for
his half-century of medical service. Committees have
354
been formed, and the citizens of Pine Island are
busily preparing for the event.
* *k *
Dr. C. E. Anderson, who became resident physi-
cian at Stillwater Prison on February 15, has resigned
from the post because of illness.
x ok *
Dr. and Mrs. O. K. Behr and their two sons have
returned to Crookston after a six months’ absence,
during which time Dr. Behr had a senior residency
in urology at the San Diego County Hospital in
California. While Dr. Behr was in California his
practice at Crookston was conducted by Dr. Norman
R. Haugan, who is now in practice at Park Rapids.
* * *
Among the speakers at the Upper Midwest Busi-
ness and Industrial Forum on Problem Drinking,
held in Minneapolis°on April 12, was Dr. Charles
W. Mayo, Rochester. Dr. Mayo spoke on “People
Who Overdrink.” The meeting was conducted by
the Upper Midwest Foundation on Problem Drink-
ing, assisted by the Minneapolis Chamber of Com-
merce and the Salvation Army.
* * *
Dr. Donald E. Dille, Litchfield, left for Fort Sam
Houston, San Antonio, Texas, on April 3 to report
for a two-year tour of duty in the Army. Dr. Dille
has been associated with the Litchfield Clinic since
1946. While he is in service his duties as Meeker
County coroner will be carried out by Dr. Harold
Wilmot, previously deputy coroner.
* * *
Two staff members of the University of Minne-
sota were the principal speakers at a one-day institute
for private duty nurses held at the Midway YMCA,
St. Paul, by the Minnesota Nurses Association on
April 21. Speaking on the cross-circulation tech-
nique for intra-cardiac surgery was Dr. Raymond
Reed, while Dr. P. H. Soucheray discussed the psy-
chosomatic aspect of illness in older persons.
* * *
A biographical sketch of Dr. Samuel G, Balkin,
Minneapolis, appeared in the Town Toppers column
in the Minneapolis Star on April 6. The article de-
scribed Dr. Balkin’s civic and professional activities.
Town Toppers features brief biographies of leading
citizens of Minneapolis each day.
* * *
The Minnesota department of the Veterans of
Foreign Wars recently presented the University of
Minnesota with a certificate announcing that the
organization had raised over $100,000 in its campaign
to get $450,000 for a cancer research institute to be
built at the University. Accepting the certificate for
the University were J. L. Morrill, president, and
Dr, Owen H. Wangensteen, chairman of the depart-
ment of surgery. The VFW group voted at its annual
meeting in 1953 to raise the money needed to build
an eleven-bed nine-laboratory center without public
MINNESOTA MEDICINE
1d are
physi-
signed
s have
sence,
dency
tal in
ia his
Orman
apids.
Busi-
nking,
harles
-eople
-d by
Yrink-
Com-
OF GENERAL INTEREST
solicitations for donations. It passed the $100,000
mark in less than eighteen months.
* * x
Dr. Kenneth H. Peterson, Hutchinson, left for
Fort Sam Houston, Texas, on April 3 to report for
a two-year tour of duty in the Army. He holds the
rank of captain in the reserve. Dr. Peterson has
practiced at Hutchinson for the past ten years.
* *k *
Dr. E. V. Allen, Rochester, was chairman of a
symposium on hypertension at a postgraduate course
conducted by the American College of Physicians in
New York City late in March.
x ok *
The prevention and treatment of ski injuries was
the topic discussed by Dr. Vernon D. E. Smith, St.
Paul, at a meeting of the American College of Sur-
geons at Sun Valley, Idaho, April 18 to 20.
* * *
Dr. R. B. J. Schoch, St. Paul health officer, was
guest on “The Doctors’ Round Table,” a television
show on WCCO-TYV, on the last Sunday in March.
Dr, Schoch discussed a case study made in St.
Paul on the spread of tuberculosis in a family.
* * *
Dr. Donald R. McFarlane, associated with the
Oliver Clinic in Graceville, reported at Fort Sam
Houston, Texas, on May 8 to put in a two-year tour
of duty in the Army.
* * *
Dr, Thaddeus J. Litzow, Rochester, has been ap-
pointed to the staff of the Mayo Clinic as a con-
sultant in plastic surgery and laryngology. Dr.
Litzow entered the Mayo Foundation in 1951 and
was an assistant to the staff from 1953 to April, 1954.
*x* * *
Among Minnesota physicians attending the seventh
annual scientific assembly of the American Academy
of General Practice at Los Angeles, California, dur-
ing the last week of March were the following:
Dr. J. A. Cosgriff, Sr., Olivia; Dr. H. L. Huffington,
Waterville; Dr, O. B. Fesenmaier, New Ulm; Dr.
C. A. Wilmot, Litchfield; Dr, William E. Johnson,
Morgan; Dr. H. E. Drill, Hopkins; Dr. B. F. Pear-
son, Shakopee; Dr. E. J. Tanquist, Alexandria, and
Dr. E. W. Lippmann, Hutchinson,
a
Winner of second place by popular ballot at the
1955 Rural Art Show in the Agricultural Library at
the University campus, St. Paul, was a painting by
Dr, Paul F. Brabec, Hastings. Dr. Brabec’s painting,
entitled “Captain Bill,” was entered in competition
among painters from towns of under 10,000 popula-
tion. Over 400 entries were received for the show,
which was attended by 2,000 visitors.
* * *
Dr. T. M. Seery, Austin, attended a series of lec-
tures on “Pathology and Pathologic Physiology in
May, 1955
Internal Medicine” at the Frank E. Bunts Educa-
tional Institute in Cleveland late in March. The lec-
tures were presented by the Cleveland Clinic Foun-
dation. neo
Dr, and Mrs, Frank E. Mork, Anoka, returned in
mid-March from a trip through the South. During
the journey Dr. Mork attended the annual meeting
of the Graduate Medical Assembly in New Orleans,
Louisiana.
* * *
Several section changes at the Mayo Clinic, Roches-
ester, became effective April 1. Dr. R. K. Ghormley
became senior consultant in orthopedic surgery, with
Dr. H. H. Young as chairman of section. Dr. F. A.
Figi became senior consultant in the section of plas-
tic surgery, with Dr. J. B, Erich as head of section.
Dr. W. McK, Craig became senior consultant in the
section of neurosurgery, with Dr, J. Grafton Love
as head of section.
* * *
Dr. R. H. Puumala attended a three-day course in
radiology at the University of Minnesota Continua-
tion Center on April 11, 12 and 13.
* * *
Dr. Douglas L. Johnson, Little Falls, began a fel-
lowship in ophthalmology at the University of Min-
nesota on March 28. On completion of the graduate
study he plans to return to Little Falls and limit his
practice to ophthalmology.
* * *
Principal speaker at a meeting of the Lions Club
in Mabel late in March was Dr, Joseph F. Schaefer,
Owatonna. The meeting was held in honor of the
local Boy Scouts.
* * *
Three Minnesota surgeons participated in a sec-
tional meeting of the American College of Surgeons
at Winnipeg, Canada, April 25 and 26. They were
Dr. Morley Cohen and Dr. W. Robert Schmidt,
Minneapolis, and Dr. John C. Ivins, Rochester.
te &
Guest consultant at a clinical conference at the
Municipal Hospital at Wells on March 28 was Dr.
Alan P, Rusterholz of the department of medicine at
the University of Minnesota. He discussed heart
disease at the conference, which was sponsored by
several Minnesota medical organizations.
* * x
Dr. and Mrs. S. T, Kucera, Northfield, returned in
late March after a three-week tour of the southern
states. While on the trip Dr. Kucera attended the
eighteenth annual meeting of the New Orleans
Graduate Assembly.
i
Dr. Thomas L. Pool, Rochester, associate professor
of urology in the Mayo Foundation, was a consult-
ant in medicine at a Career Conference at Knox Col-
355
OF GENERAL INTEREST
lege, Galesburg, Illinois, recently. Experts from
twenty-six vocational fields attended the conference
for a day of counseling and meeting with students.
er kk
A biographical sketch of Dr. Ivar Sivertsen, Min-
neapolis, in the Town Toppers column of the Min-
neapolis Star on April 14 emphasized the physician’s
early affiliation with Fairview Hospital. Dr. Sivertsen
admitted the first patient to the hospital in 1916 and
performed the first operation in the hospital’s old
operating suite.
Dr. Jack A. Guy, New London, now with the U. S.
Public Health Service, expects to return to his prac-
tice at New London about June 1. He recently com-
pleted a two-week course in fractures and traumatic
surgery at the Cook County Postgraduate School of
Medicine in Chicago.
Dr. and Mrs. C. J. Olson, Belle Plaine, returned
on April 7 from a vacation trip to California and
Texas. While in San Diego, Dr. Olson attended an
institute in heart disease at the naval hospital.
NEW LOCATIONS
Dr. R. G. Ziegler has announced that he will dis-
continue his practice at Welcome about May 22 and
will move to Brush, Colorado. Beginning July 1,
he will be affiliated there with the Brush Clinic. He
has practiced at Welcome since 1951.
* x ok
Dr. John W, Schut opened offices for the practice
of medicine in Anoka on April 1. A graduate of
Northwestern University Medical School, he was a
resident at the University of Minnesota for two years
and served as a psychiatrist at the Anoka State
Hospital for another two years. Until recently he
was doing research at the Galesburg State Research
Hospital, Galesburg, Illinois.
a a
Dr. Wallace E. Anderson has announced that he
will leave Lakeville in July to become associated in
practice with Dr. Stanley Stone, Minneapolis. Dr.
Anderson has practiced at Lakeville since July, 1952.
a ie
Dr. Norman Haugan, formerly of Crookston,
opened offices for the practice of medicine in Park
Rapids on April 1. After graduating from the Uni-
versity of Minnesota Medical School in 1953, Dr.
Haugan practiced in Watertown before moving to
Crookston where he was associated with the Crook-
ston Clinic.
356
MINNESOTA BLUE SHIELD-
BLUE CROSS PLANS
Blue Shield
At a Blue Shield professional relations meeting held
in Chicago on February 24 and 25, 1955, over 100 repre-
sentatives of Blue Shield Plans throughout the country
were present to review and evaluate methods used in
professional relations programs. Arthur J. Doherty, of
Minnesota Blue Shield, found that the whole program
was devoted to consideration of means of providing
greater service to the doctor, bringing information about
‘Blue Shield directly to the doctor, and creating a closer
relationship between the doctors and the Blue Shield
Plans.
At the conclusion of these sessions, it was the opinion
of those present that developing closer liaison between
the doctor and Blue Shield through personal visits is
the most effective feature of any such program. This
method of improving professional relations is being
used by many of the Blue Shield Plans in other states
and has proved successful in securing the necessary
close relationship and understanding between the doctor
and Blue Shield.
Minnesota’s Blue Shield program of professional re-
lations is strikingly similar to that carried on in other
states. In October, 1954, the Minnesota program became
fully active. Since then, three Blue Shield field repre-
sentatives have made over 1800 personal calls to doc-
tors’ offices. In more than 25 per cent of these calls,
the doctor has been personally visited. When the doc-
tor has not been available, various features of Blue
Shield have been discussed with the members of his
office staff. In each instance, the Blue Shield contract
and procedures are explained to the doctor and his staff
ffor clarification of Blue Shield objectives of subscriber
benefits, claims reporting, and payment of claims.
During the first two months of 1955, maternity cases
ranked first in frequency of occurrence for hospitaliza-
tion of Blue Cross subscribers, respiratory _ illnesses
ranked second and accidents third.
Blue Cross
The number of maternity cases paid during the first
two months of this year totaled 4,302, a slight increase
over the 4,277 cases paid during the same period of
1954. Maternity benefits of $463,106.08 were provided
by Blue Cross during the first two months of 1955.
Although respiratory illnesses ranked second in fre-
quency of occurrence during the first two months there
was a slight decrease in the number of cases over the
previous year. There were 3,857 respiratory cases for
the first two months of 1955 with Blue Cross respira-
tory benefits totaling $309,102.19.
Accident cases numbered 3,599 for the first two
months of 1955 and the Blue Cross accident benefits
allowance amounted to $190,888.17.
Since 1933, $113,979,811.15 has been provided by
Minnesota Blue Cross for hospital care of subscribers.
During the month of February, 1955, 4,056 contracts
representing 10,171 participant subscribers were en-
rolled in Blue Cross bringing the net enrollment as of
February 28, 1955 to 1,003,104 participant members.
MINNESOTA MEDICINE
r held
repre-
yuntry
sed in
ty, of
ogram
viding
about
closer
Shield
pinion
etween
sits is
. This
being
states
‘essary
doctor
nal re-
| other
vecame
repre-
0 doc-
> calls,
ie doc-
f Blue
of his
ontract
is staff
scriber
s.
y cases
italiza-
lInesses
he first
ncrease
riod of
rovided
955.
in fre-
is there
ver the
ses for
respira-
rst two
benefits
ded by
scribers.
contracts
ere ef-
it as of
bers.
[EDICINE
BOOK REVIEWS
Books listed here become the property of the Ramsey,
Hennepin and St. Louis County Medical Libraries when
reviewed. Members, however, are urged to write re-
views of any or every recent book which may be of
interest to physicians.
BOOKS RECEIVED FOR REVIEW
CLINICAL DISORDERS OF HYDRATION AND
ACID-BASE EQUILIBRIUM. Louis G. Welt, M.D.
Professor of Medicine, Department of Medicine, Uni-
versity of North Carolina. 262 pages. Illus. Price
$6.00, cloth. Boston: Little, Brown & Co., 1955.
DEMONSTRATIONS OF PHYSICAL SIGNS IN
CLINICAL SURGERY. 12th Edition. Hamilton Bail-
ey, F.R.C.S. (Eng.), F.A.C.S., F.R.S.E., Emeritus
Surgeon, Royal Northern Hospital, London; General
Surgeon, Metropolian Ear, Nose and Throat Hospital ;
Consulting Surgeon, Italian Hospital; Hunterian Pro-
fessor, Royal College of Surgeons; formerly External
Examiner in Surgery, University of Bristol. 456 pages.
ea Price $8.00, cloth. Baltimore: William & Wilkins,
1954.
BRUCELLOSIS. M. Ruiz Castefieda. Director del De-
partmento de Investigaciones Médicas, Hospital Gen-
eral, México, D. F. Miembro del Comité de Expertos
en Brucelosis de la Organization Mundial de la Salud.
302 pages. Illus. Mexico, D. F.: La Prensa Med-
ica Mexicana, 1954.
THE TEMPOROMANDIBULAR JOINT. Edited by
Bernard G. Sarnat, M.S., M.D., D.D.S., F.A.CS.
Professor and Head of the Department of Oral and
and Maxillofacial Surgery, College of Dentistry;
Clinical Assistant Professor, Department of Surgery
(Plastic Surgery), College of Medicine, University
of Illinois, Chicago, Ill.; Diplomate of the American
Board of Plastic Surgery. 148 Pages. Illus. Price
$4.75. Springfield, Ill.: Charles C Thomas, 1951.
This small volume by five faculty members of the
dental schools of three universities in Chicago dis-
cusses the anatomy, physiology, and pathology of the
temporomandibular joint with emphasis on the dental
aspects. The Costen syndrome, attributing numerous
auditory and vestibular symptoms to dysfunction of the
temporomandibular joints, is thoroughly evaluated with
the conclusion that it is not supported by facts and
should be abandoned. The book is strictly limited in its
objectives and makes no pretense at covering all the
clinical features of the temporomandibular joints.
ExLMer C. PAutson, M.D.
BONE TUMORS. By Louis Lichtenstein, M.D., Senior
Pathologist, General Medical and Surgical Hospital,
Veterans Administration Center, Los
pages. Illus. Price $10.50. St. Louis:
Mosby Company, 1952.
The introductory chapter stresses the importance
of biopsy in conjunction with roentgenographic exam-
ination of suspected bone tumors before treatment is
attempted. Since many new skeletal lesions, both neo-
Plastic and non-neoplastic, have recently been described,
Angeles. 315
Fhe€.. “V.
‘the necessity for open-mindedness is emphasized.
A classification of bone tumors is presented for con-
sideration as a helpful working hypcthesis, along with
Pertinent comment in support of proposed categories.
May, 1955
The chapters on bone tumors describe the clinical
features, pathology, radiograms and therapy of various
bene tumors. An appendix discusses some lesions of
bone often mistaken for tumors.
The text is adequate and readable. The illustrations
include radiograms, gross photographs, and photomicro-
graphs of good quality. There is an adequate bibliog-
raphy with each chapter. This book will prove itself
useful to pathologists, surgeons, and radiologists alike.
J. W. James, M.D.
PRIMER OF ALLERGY; A GUIDEBOOK FOR
THOSE WHO MUST FIND THEIR WAY
THROUGH THE MAZES OF THIS STRANGE
AND TANTALIZING STATE. By Warren T.
Vaughan, M.S., M.D., Richmond, Va. _ Illustrations
by John P. Tillery, 4th edition, revised by J. Harvey
Black, M.D., Dallas, Texas. 191 pages. Price $4.25.
St. Louis: C. V. Mosby Co., 1954.
This book has fulfilled its primary purpose. It is an
interesting book on allergy which will be read by the
intelligent patient and enable him to co-operate with
his dcctor. It is written in a style which stimulates the
patient to do his best in treating his allergies. Every
practicing physician will do the patient and himself a
favor by introducing the patient with an allergic disease
to this short book. The language of the doctor will
no longer be just a lot of words after the patient has
read this book.
The secondary purpose of this book, that of giving
concise information to the physician doing a minimum
of allergy work, has also been fulfilled. However, this
reading should be expanded by reading a larger book
in the field of allergy as soon as the physician’s time
permits.
Donato W. Koza, M.D.
MOTION PICTURE FILMS
A completely revised Fourth Edition of “Professional
Films” is now in compilation. (The frequency and num-
ber of future insert pages necessary to assure a compre-
hensive index that is continuously current over a period
of years will be determined by the volume of forth-
coming productions.) It will include new sections pro-
viding biographical data on authors, and information
on the audio-visual activities of medical schools, dental
schools and graduate teaching centers.
Over 28,000 copies of previous editions are in use
by medical and dental schools, program chairmen of
state and specialty societies, and others here and abroad.
Academy-International of Medicine provides this valu-
able audio-visual information to the profession-at-large,
without profit, as one of its contributions toward elevat-
ing the standards of medical and dental services by ex-
pediting the dissemination of professional knowledge.
You are urged to directly assist by (1) informing film
authors of this announcement so that they can write
for questionnaires, or (2) providing the film title and
(full name and address of any film author. Write to
the Academy-International of Medicine, 601 Louisiana
Street, Lawrence, Kansas.
357
Minnesota State Medical Association
1955
Officers
PAD BANA SIO IN NED, sa scnsasscascesen.neonssevsgossensdeeveovan eae President
F. W. BeHMteErR, M.D......
Kart E. JouHnson, M.D......
First Vice President....
Second Vice Prestdent
Bee er NNT RODD sc ss scescssescssexsestsctscssansssesesscooessoveesacel Secretary
W. H. Conoprr, M.D
R. R. RoseEti
Treasurer
CRS BP PARD, DED. vcs ssssccsscessnses sosesesenecd Speaker, House of Delegates
PASM GROW UNNEID 5. cccscsesonessscveiescsssovespovesooounscsess Vice Speaker
Executive Secretary.
Minneapolis
Hutchinson
Rochester
Saint Paul
Councilors
(Terms expire December 31 of year indicated)
First District
J. M. Stickney, M.D. (1956)
Second District
R. C. Hunt, M.D. (1956)
Third District
P. E. Hermanson, M.D. (1955)
Fourth District
H. J. Nitson, M.D. (1957)
Hendricks
North Mankato
Ninth District
CLARENCE JACOBSON,
Rochester
Fairmont
M.D. (1957)
Fifth District
L. R. Crircurietp, M.D. (1955)
Sixth District
H. B. Sweetser, M.D. (1957)
Seventh District
W. W. Witt, M.D. (1955)
Eighth District
C. L. Oprrcaarp, M.D. (1957) Chairman....Crookston
Saint Paul
Minneapolis
Bertha
Chisholm
House of Delegates, American Medical Association
Members
J. ARNOLD Barcen, M.D. (1956)
O. J. CAMPBELL, M.D. (1955)
GerorcE Earz, M.D. (1955)
F. J. Extras, M.D. (1956)
Rochester
Minneapolis
Saint Paul
Duluth
Alternates
Paut C. Leck, M.D. (1956)
W. W. Witt, M.D. (1955)
E.M. Hammes, Sr., M.D. (1955)
A. O. Swenson, M.D. (1956)
Scientific Committees
COMMITTEE ON SCIENTIFIC ASSEMBLY
A. O. Swenson, M.D., General Chairman Duluth
POSTUE OAC, NID. osscsssscsssessen<cscsvceescovsecesvesconss St. Paul
IB a OCB TER EID iin csbeseussoequsvesersssoncsecseucsesvesaes St. Paul
R. R. Rosey St. Paul
Section on Medicine
D. W. WHEELER, M.D., Chairman
R. O. Satuer, M.D., Secretary
Section on Specialties
. T. WENNER, M.D., Chairman
. B. Hunt, M.D., Secretary.
Section on Surgery
. MircHELL, M.D., Chairman
. Lannin, M.D,, Secretary
Local Arrangements
MANCEL T. MITCHELL, M.D., Chairman
358
ANESTHESIOLOGY
BR. AAAS, I osc snk cececacescaeessesesceesvescasseveass Rochester
MarGARET C. ANDERSON, M.D............c:ccceeeeee Mankato
J. We SBA, GD oo scscssciscsscncscssvcscesenseeoossits Minneapolis
J. H. CRowLEY, IRM cc vccsasissvodus sane sadaovenstsvevent Saint Paul
R. C. Gaarp, ‘M.D Ree seaa ieee ces sats covey Mencesesnoan Minneapolis
RoBerT C. KNUTSON, M.D..........::ccesceesceesteeeeees Saint Paul
K. E. LAtTTERELL, ROSIER Duluth
WD. MES SELDON: MOD 0. cscessssescscsseccesesscsssasiseccseees Rochester
BLOOD AND BLOOD BANKS
TP INN, IN svc s seca dees saavacsp sescccees cacdeonsvaners Rochester
PAUE FODWAN, DAUD io. .cicscciccsscsssecscosaccssssetesesses Minneapolis
J. W. Epwarps, IRAEM os cscs cack cocsetsedeuotvensyeomnees Saint Paul
E. V. Gotrtz, MD ayers Saint Paul
Wo. V. KNOLL, M.D......
R. WW; KoOuery, MiDiiic...cciscccsesccsoscesss ...Minneapolis
M. T. MircHett, 1.13 Se nea ree ee Minneapolis
N. C. PLIMpTON, M.Da..........ccccscccserceseceeeseesees Minneapolis
Howarp M. WikorF, Do casaaocesescosnasssascteevect Crookston
MINNESOTA MEDICINE
—
UmHzr zoey
Bsr SOmneoa
,
SOS =e
Opp
2?
SAM Som weno
<pe2™
Ss
>
COMMITTEES
CANCER
(Three-year appointment)
Davw P. ANDERSON, Jr., M.D. (1955)
Hersert Boysen, M.D. (1955)
MerRIAM Frepricxs, M.D. (1956)
G. F. HartNaGEL, M.D. (1956)
C. R. Hrrcucocx, M.D. (1956)
N. K. Jensen, M.D. (1958)
LeonarD A. Lane, M.D. (1958)
N. Locan Leven, M.D. (1956)
T. B. Macatu, M.D. (1956)
F. M. Owens, Jr., M.D. (1958)
D. E. Stewart, M.D. (1958)
CHILD HEALTH
G. B. Locan, M.D Rochester
Etpon BerGLuND, M.D Minneapolis
Pees. CHIBHOLM, MLD. ......0::i.0..csescsessesescsenecese Minneapolis
Je J. GALLIGAN, MUD.............cscccccrssscccecsscnsesseres Saint Paul
MEE TONES, NOD) i ocncsssasescoscsesssersosenscosevesnssnsoees Mankato
WUD: RICHARDS, MID). .cccscscecssceescsvsssccsszssesssessse St. Cloud
A. B. ROSENFIELD, M.D................ccccecccceeeeses Minneapolis
OY, WHRE GON: RODD v5 cc cccsccsseusssevscsssocossecsnassesseents Rochester
BAWARD ZUPANG, MED)iniccccsceccsccececsesccccscsssiecessovesened Duluth
CHRONIC ILLNESS
CARLETON W. LEVERENz, M.D Saint Paul
vk. AUNDMBGON TMU y ooscssccacsenccccocssssesscesonscacéscessese Hector
ET, (CONEMY. NIB) occccscccssscacssesteecssseseesasisconessess Mankato
Joun LEo DELMORE, JR., M.D..........ccccssscesceeseeeees Roseau
ALBERT J. GREENBERG, M.D Minneapolis
OM. FREIBERG, MiB).....0cccsecspscsccoscesessscznesese Worthington
NOHN A. EEPAR, MD) .......ccscsesssccscasceaseccssssescesss Saint Paul
E. L. Tuony, M.D............000 ...Duluth
CONSERVATION OF HEARING
K. M. Simonton, Rochester
L. R. Bores, M.D Minneapolis
JoHN H. CAMERON, M.D.u.......:ccsccsesscesseessesees Crookston
WE CON NGM NED iiivsvcsicsscccesessvscconsssscsscccecenceness Saint Paul
WER CATIVAS WOM DP occ iccencessccnsesscascuctsqedessonatiaceassse St. Cloud
ANDERSON EREDING, MiiDD......000s0-cscscocsssescsessssesesseases Duluth
ConraD J. HOLMBERG, M.D............csscescsseseeeees Minneapolis
J. DonaLp Syopinc, M.D Mankato
DIABETES
Pehee: NORAD, De occ ccssscezssncecossassssccsteucsiaciseed Saint Paul
Moses BARRON, M.D.........::ccesscssscsecesseeenseeees Minneapolis
j. J. BozHREerR, M.D Minneapolis
al ROC CARR 2 2 SER ee Pe Sn Duluth
J.J. EustermMann, M.D
D. R. Gittespre, M.D...
W. S. Nerr, M.D
R. V. SHERMAN,
RANDALL G. SPRAGUE, M.D............sccsecesseeseeseeeees Rochester
C. W. VANDERSLUIs, M.D
FIRST AID AND RED CROSS
ee AUP EERNRS NMP aig cnace ccccuecesecccsadedesadetousstcntaed Rochester
F. BricHam, Jr., M.D.... ...5t. Cloud
W. Epwarps, M.D.......
F. Fettows, M.D
Ais EBSOHE, MED c.0cccesccctsecssccascesssessesscecceed Lake City
Vs CROs NM Bi ec cs ocasas.coccseceeaacuduseccteccccecenes Saint Paul
I OE Bees | soc e hascaaccctenavoessececuuacccessss Faribault
4 INCHRESIO AN. WDD: oicesesscescecesuctessvessccnonessensceseesess Mora
C
C.
Minneapolis
Minneapolis
Minneapolis
Saint Paul
Rochester
... Saint Paul
O’PHELAN, Minneapolis
« TPEDMEPTON, MED). .cccccsscssscessccscsscsscscsiens Minneapolis
VERNON, “Does caccssicscescpenrcancsasctesavevestese Mapleton
J.
C,
J.
M.
B.
E.
J.
W.
E.
N.
J.
FRACTURES
i, i I oicruectvisbbaiesieasceiviien Minneapolis
N. H. Baker, M.D Fergus Falls
ee er Saint Paul
Rozsert B. ENcstrom, M.D Mankato
V. P. Hauser, M.D
May, 1955
Joun C. Ivins, Rochester
W. J. McDonatp, M.D Crookston
J. H. Moz, M.D Minneapolis
EUAGIEY: Bie FUMIE 5 Wee ccencse5asoccassccsussascedcscanesgs Albert Lea
17 A EAS 1) SE RRTOn SE Biante ree Minneapolis
A. B. RogzHuxe, M.D.......... Elk River
W. A. SwEepBERG, M.D u
Vi ee Aes Ye oa bccscascccsecsrasscscccescancecancetertes Brainerd
GENERAL PRACTICE
James A. Cosorirr, Sr., M.D...........cc.cccccssescsceeees Olivia
EB. ©. BAvERW MEiDyie. 52ccsscsscsccsssass
Pasa Ao Garam oi sasc oss csesccscaacaccanecseceaccecsadesece Hopkins
De i a lindas ccnensnccsccacenadsacasocsees Saint Paul
Cuas. C. Cooper, M.D
H. E. Coutter, M.D
Dona.p C. Deters, M.D
C. S. DonaLpson, M.D
R. J. Eckman,
ND SS 7 8 |) RR ieee meer eperecr errr er Monticello
WOW, Hammes ED a5 ocssenicanccsccsicas caecascestacensntece Wayzata
HEART
(Three-year appointment)
F. J. Hirscusoeck, M.D. (
J. F. Borc, M.D. (1958)
J. F. Briccs, M.D. (1956)
Henprik DeKruir, M.D. (1955)
Pau. F. Dwan, M.D. (1955)
C. N. Hensext, M.D. (1955)
M. M. Hurwrrz, M.D. (1956)
R. O. Satuer, M.D. (1958)
H. L. Smiru, M.D. (1958)
CHESTER TurEM, M.D. (1956)
D. W. WHEELER, M.D. (1958)
ASHER A. WuirteE, M.D. (1955)
HISTORICAL
Roper? ROSentTHab, MDi nn .ccicciecicccsssccccecsssséuse Saint Paul
TRIGEIAMED HARBORS, DE occ cssice ie cccsiecascacsccacevescadacsaced Duluth
WheOP. CRAARCEE, Beans viccicsicicssseistsiceactsteences Rochester
....Fergus Falls
Minneapolis
Saint Paul
Crookston
A. G. LrepLorr, M.D
Tuos. A. PEpparD, M.D
G. E. SHERWOOD, M.D......
Harotp R. TuyseE.u, M.D....
A. M. Watson, M.
W. E. Witson, M.D
HOSPITALS AND MEDICAL EDUCATION
H. S. Dixit, M.D Minneapolis
fe OT SS 0 3) Ey einen eter Saint Paul
Crookston
Northfield
A. C. Kerxuor, M.D Minneapolis
Henry A. Onna, MED... cccccssscccscsscctsccesess Pelican Rapids
ARNOED 'LARGON, MED... ccascess sccccesecesesecciaces Detroit Lakes
Joun P. MEepELMAN, M.D Saint Paul
De ah coarse cha ccenacesdecéscccsagegansenaes Faribault
H. J. WAtpER, M.D
E. E. Wo.uarecer, M.D
Bee Be WOR UGG I ooo coos cai eceasccscedececactancccaceacsad Winona
INDUSTRIAL HEALTH
| Fe Pa, 81 2 Sd. =) ) Eee ncn EDS Fe Minneapolis
‘Tracy-E.. Banewm: Vrs, Mb oinccscccecccccicscsvadiscccciarsee Austin
JOuaN DD. AMM, nace cc ccsscciccsncsscccsaconssanievaccetsts Duluth
Or Cr em WS oe sists hs ckcanscnecdsedatececssededecee Saint Paul
Be Orr Am a i hee re St. Cloud
ea SOV |) Sa ne ee tene ee: South Saint Paul
Rosert F. McGanpy, M_LD...............cccccccceees Minneapolis
O. L. McHarriz, M.D :
W. E. Parx, M.D Minneapolis
Joun ‘W. Raarrama, MLD....:.:::..:062<..c0.i00.cc00s000. Nashwauk
BEWARE SOHONG MID. o. onc csesccecectcseccdecccevasesseces Saint Paul
H. H. Younc, M.D Rochester
359
COMMITTEES
MATERNAL HEALTH
J. J. Swenpson, M. Saint Paul
tyes NS ee ee re Seen Duluth
R igh co) Ca RS 0 2 Sauk Centre
Rochester
O. B. FEsENMAIER, M.D
G. F. HartnacE., M.D............
Joun A. Haucen, M.D Minneapolis
BaP ION NCI i esc ssnsescandasbeoesbicsiedsacssocccaneeeascoe Echo
J. L. McKetvey, M.D Minneapolis
SRS ANAM: INNIS 5572. < 025<oxtstisvaesovse Genectuscoeetth Crookston
A. B. RosENFIELD, M.D Minneapolis
F. L. ScHape, M.D Worthington
MEDICAL TESTIMONY
BO AAMAS SR, NED os ccss cvsceccssieseccin ce Saint Paul
Marx B. Coventry, M.D
A. J. LEEMuHutIs, M.D
L. H. RutLepce, M.D
G. J. StREWLER, M.D
W. G. Workman, M.D
MILITARY AFFAIRS
K. E. JoHNson,
E. G. BENJAMIN, Minneapolis
FLoyp M. Burns, M.D Milan
PUA iy RARER INLD 6c gcsiessssceesvssossscepsesasonveatoel ‘Mankato
N. H. Lurxin, M.D . Minneapolis
DonaLp McCartuy, M.D Saint Paul
W. P. Ritcure, M.D Saint Paul
NOSEPEOM: TRGAN, GMD) onicscncsvessesesssudssosessosveours Saint Paul
Joun T. Smitey, M.D Minneapolis
A. K. Stratte, M.D
BERNARD STREET, M.D Northfield
J. H. Tmurscu, M.D Rochester
NERVOUS AND MENTAL DISEASES
je sg, Co ce I D en ee ere Saint Paul
OWA ROW N NUD 52522 s00.055sssucystedvendsesieastacesoveets Rochester
W. S. CHatcreN, M.D
Bis UNG BBM SIO: «525 csscsecatsdendodscxescenssyessnorices Faribault
J. E. T. Haavix, M.D
E. M. Hammes, Jr., M.D
H. B. HANNAH, M.D
Haro.tp H. Noran,
W. L. Patterson, M.D
OPHTHALMOLOGY
ae tite) 1 .\, LB Se oe New Ulm
AP ADAIR SRS IMD os o5cc50cicsessoses .. Saint Paul
ArtTHuR V. GarLock, M.D Bemidji
EE RE CN: OC 5 a ee Saint Paul
ESMWN 5 MAGNE N ONO. 525 os 5505 csonscesseacsé suse ascecceeed Minneapolis
Hosart C. Jonnson, M.D
FM MRNA FUNNIES 5 sic ces ox'oscosisss sei enecdssbsssscencenticceeme Duluth
C. W. Rucker, M.D Rochester
Minneapolis
Detroit Lakes
Saint Paul
Minneapolis
Minneapolis
Fergus Falls
Non-Scientific
EDITING AND‘ PUBLISHING
E. M. Hammes, 8r.,
FREDERICK M. Ow_ENs, Jr.,
T. A. Pepparp, M.D
H. L. Utricu, M.D
A. H. WEtts, M.D. (Ex officio)
BOARD OF EDITORS
A. H. WEtts, M.D., Editor
STUART W. ARHELGER, MiD:........60c.cceeccovecsexe Minneapolis
Joun F. Briccs, M.D Saint Paul
PRE TG AROWN DUD cn cssscccsivcctesosdessecestcvcessvers Rochester
S. F. Cerptecua, M.D Redwood Falls
Tacug C. CuisHotm, M.D Minneapolis
300
Saint Paul
Saint Paul
ANDREW SinAMaARK, M.D Hibbing
C. E. STanrorp, M.D Minneapolis
WY TD, VENER, GID ss cis con ceccacesiesoiceceacececeastenese St. Cloud
PUBLIC HEALTH NURSING
M. McC. FiscHer, M.D..............sscesccsssesssccessessees Duluth
Ree AMAT ONG oo cise scacien cach sccsenssevessdeveonsesavsvsaseseay Saint Paul
W. C. CHAMBERS, M.D Blue Earth
Ae ADAMI NI cog 50i ccevcsececssesoustesicevadioecapscostigeue Wadena
Heten L. Knupsen, M.D Minneapolis
C. E. MERKERT, M.D
THEODORE W. StrRaANSky, M.D
Minneapolis
SYPHILIS AND SOCIAL DISEASES
1g OR CPi 5 55 | 9 RP ae Minneapolis
Joun A. Butzer, M.D
W. E. Hatcu, M.D
Gerorce W. Hauser, M.D Minneapolis
BW SYNGE MED coca 5csicedesscesscssessocossnessescsenes Saint Paul
H. E. MIcHELson, Minneapolis
Ci We MOBERG, MUD. ..:..:05:0.:.ccccccsccsssssnsecssesens Detroit Lakes
e Rochester
TUBERCULOSIS
A) AR) SERIGGS SMUD) si sncisscsscscosacenszscnessssirctvescasevcveted Saint Paul
J. A. Myers, M.D., Vice Chairman Minneapolis
R. N. Barr, M.D Minneapolis
Rutu E. Boynton, Minneapolis
F. F. CALLAHAN, Saint Paul
S. S. CoHEN, M. Oak Terrace
DEAN 'S. FLEMING, M:D............00scssessssoosseessioscszes Hopkins
Rospert E. Hansen, M.D.......... ibbi
G. A. Hepserc, M.D
Corrin H. Hopcson,
L. S. Jorpan, M.D : Granite Falls
TDP OMRINGEELA, ONIGID) 505 .c02scccsecesssqennscescssooscccned Minneapolis
E. A. MEYERDING, M.D Saint Paul
W.. (OLB, UNEDSON, (MED). <ccccscccsssccecesseenesosneee Fergus Falls
W. E. Peterson, M.D
C. G. SHEPPARD, M.D
S. A. SLatTER, M.D
Lyte A. ToncEN, M.D......
W. H. Ube, M.D
Hutchinson
Worthington
Saint Paul
VACCINATION AND IMMUNIZATION
R. N. Barr, M.D Minneapolis
E. E. Barrett, M.D
LuTHER Davis,
| RS Re STO ERS) Ci 0 a Rochester
Cc. O. Kouusry, M.D
C. S. STRATHERN,
R. L. Witper, M.D
Committees
Rosert B. Howarp, M.D Minneapolis
HEnrY C. MOEHRING, M.D....0.....cccccceeseeeceeeeeneeeeeeee Duluth
GLENN J. MourITSEN, M.D..........ccccceecseesseeees Fergus Falls
Olive V. Seibert, B.A............ccccsccssssccssscseeeeeeed Saint Paul
GrorceE G. STILWELL, M.D Rochester
E. M. Hames, Sr., M.D. (Ex officio)
HOSPITALS AND PROFESSIONAL RELATIONS
C. ALLEN Goop, M.D Rochester
W. C. BERNSTEIN, Saint Paul
W. T. GREENFIELD, M.D.oo.i....eccecsescessccesessesceseseeees Cokato
IRANO CIIEDA, NID io cs socesssssscccsececscsestssacsosecctsees Saint Paul
Bi. 1G, ACOBSON, WED. ocsescenscscncccseacssvssesscotossosensannes Duluth
THomas Lowry, M.D...........cccccccccccsessseeseeeeees Minneapolis
GLENN MouritTsENn, M.D Fergus Falls
MINNESOTA MEDICINE
PROCES PE Ams
ee he eee
S FSS 3 a, oO
Pr Rm==E
Poe OM MO
-
Hibbing
neapolis
. Cloud
‘Duluth
int Paul
e Earth
Wadena
1eapolis
. Cloud
1eapolis
yatonna
lea polis
[ankato
Duluth
eapolis
nt Paul
eapolis
t Lakes
chester
Duluth
it Paul
eapolis
eapolis
papolis
t Paul
errace
opkins
ibbing
eming
hester
- Falls
apolis
t Paul
Falls
illmar
1inson
ngton
t Paul
apolis
apolis
uluth
idena
1ester
uluth
Paul
Peter
polis
COMMITTEES
INSURANCE LIAISON COMMITTEE
Corrin H. Hopeson, M.D
R. P. Buckley, M.D
Joun Dorpat, M.D
p, W. Harrison, M.D Worthington
hl MOCGANDY;, MED..........-.:..0::-:cs.cecesess00 Minneapolis
Horatio VAN CLevE, RN BW oc cicweauccciuaceaceccadeseeeesiees Austin
CLARENCE W. WALTER, ME csciacsscccscssctcetseaed Saint Paul
INTERPROFESSIONAL RELATIONS
(Chairman to be appointed)
a ANDERSON; MEBD:........::0...<cs0--cescstssssseoscssess Rochester
We ORE AND: WEDD eos ccesccecsccnedesssenssiccvssexeasvecses Willmar
R. Fawcett, M.D
I.
F.
A.
RANSON oo esccs cise caccce canta ceatestctetsiceeveanes Clarkfield
EBIDENG, “WD oi.0525:...sescecssescascesssonseneseass Fergus Falls
LMER LIPPMANN, M.D............:ccccsseeseeceeeceeeees Hutchinson
J.C. Manxey, M.D Minneapolis
R. F. SturteEy, M.D Saint Paul
R. H. WILSON, M.D Winona
MEDICAL ECONOMICS
GzorGE Eart, M.D., General Chairman
M.
H.
K.
M.
R.
E.
E
Saint Paul
Executive Committee
GzorGE EArt, M.D Saint Paul
AISI, EI coe cc sc occcr ta osivsndenssssédeecandnsctecsecenes Duluth
W. H. HENGsSTLER, M.D Saint Paul
CorrIn H. Hoposon, M.D. ..............cccceeeeeeceeees Rochester
Harry KLEIN,
. E. : Minneapolis
PM NB nc ca te sccccteoccacsacaccaiesecssowaccvacssdds Windom
Editorial Committee
PORCE TARE. MED)... 5. cscsccciesssessocecvacsnecodersecesenes Saint Paul
F, BRAASCH, M.D Rochester
L. PATTERSON, Fergus Falls
F. , Minneapolis
H. Duluth
W.
W.
H.
A.
Medical Advisory Committee
EFL. EIENGS TEER, MAID) 20006 ccscssncoscansescosssseesencs Saint Paul
Pe: BEUNING, MD i is.i.ccs0ccs.csecsseccoosescssonectoqnesece St. Cloud
Mark B. Coventry, M.D Rochester
P. G. E. Horper, M.D
D. C. MAcKINNoN,
G. C. MacRae, M.D
Harvey NELSON,
Medical Ethics
1,1) 0 BERR Pe et teil Ben ee PRE rs eye ore Duluth
Saint Paul
ene (INGRDEA, NED c...02.cc.c0cssccescssecsecsensoarse Minneapolis
GHORGE BE. PENN, MOD:.....20.:020ccsscccscessscccvecceseesses Mankato
Harry M. WeserR, M.D Rochester
Medical Service
Witu1aM Prorritt, M.D
F. S. Bass, M.D
C. M. BactEy, M.D
Tacuze C. CuisHotm, M.D
Lester N. Date, M.D Red Lake Falls
Frank J. Hecx, M.D Rochester
C. H. Houmstrom, MRM oo cs ee Seiiahasdescaxeseyceneetasechers Warren
jr") Saint Paul
R. A. Murray, M.D
James P. O’KeerE, M.D
H. F. R. Piass, M.D Minneapolis
tds SEMONSs MGDDi....csecssassecesscsnetessssescacecsnenceters Saint Paul
State Health Relations
GE, PROGHER,. ME DYcsscsc.cccsoscesscnceserensnssovserss Minneapolis
. C. Bayley, | —_—ee ONe eme e Lake City
ES, DONAEDSON, MD)%......:..:..ccsscssscecseesssceeesees St. Cloud
Joun TTR EN Saint Paul
J. J. Eusrermann, M.D
YMOND J. JACKMAN, M.D
D. L. Jounson, M.D
May, 1955
Harry Ktern,
Minneapolis
Saint Paul
Minneapolis
SAMUEL N. Litman, M.
C. N. McCown, Jr.,
Paur Heep, MEB..........:-.<......
CARL Smison,
C. E. Witson, M.D
Membership Committee
H. F. R. Prass, M.D Minneapolis
Pie Se Wem NA ess sare aces con cosas eewaccontardectnccarssoees Hallock
H. M. Carryer, M.D Rochester
Joun W. Grivtey, M.D
L. D. Hitcer, es eee Saint Paul
Cart LuNDELL, M.D Granite Falls
M. O. WALLACE, M.D Duluth
MINNESOTA STATE CERTIFICATION BOARD
ON PUBLIC HEALTH NURSING
Mario M. FiscuHer, M.D
PHYSICIANS’
W. R. Humpurey, M.D
WALTER G. BENJAMIN, M.D
James A. Biaxe, M.D
Paut G. Boman, M. Duluth
Joun Dorpat, M.D Sacred Heart
Mary C. GuHostLey, M.D
RrcHarp B. Graves, M.D
BReeoew Fic wies,, anna assassin acne cs onneaqeatose Winthrop
L. W. Jounsrup, M.D Hibbing
HERMAN M. JuErGENS, M.D Belle Plaine
E. A. Kitsriwe, M.D Worthington
W. E. Mackuin, Jr., M.D i
Wa ttace P. Ritcuir, M.D
E. R. SatHer, M.D
CS GC Sime, Re ose sscccissccsacsseacnige tenets Hutchinson
M. D. StarEKow, M.D Thief River Falls
R. H. Witson,
A. H. ZACHMAN,
PUBLIC HEALTH EDUCATION
F. J. Exias, M.D., General Chairman
Executive Committee
F. J. Extas, MLD.............ccccecscssccecsnserssceescssesceeecssees -Duluth
R. M. Burns, M.D
H. M. CARRYER, 1)
ASSISTANCE
Stillwater
Pipestone
Duluth
A. H. WELLs, MD
(And Chairmen of all Scientific Committees)
A. H. Wetits, M.D
K. W. ANDERSON,
G. W. CurFrrorp, M.D
T. J. Epwarps, M.
Gorpon M. ErskINE, M.D
H. W. Scumwt, M.D
Radio and Television
RR i Dice ce oes ci secs Saint Paul
Bepmanmrre ©), WAGE mY. Web yocccccincescasccecccscscccencasaes Duluth
James Rocers Fox, M.D.........2::csssesesesseseees Minneapolis
C. N. Harris, M.D Hibbing
O. M. Herserc, M.D Worthington
R. N. Jones, MD
Ts We peers RM oo occa sak cgvannvaadsexaxaaenagacagetaseeat Albert Lea
Ben A arena occ cosines ecqvteasacssedeenes Mankato
R. H. Witson, Winona
Minneapolis
Alexandria
Saint Paul
Grand Rapids
Rochester
Speakers’ Bureau
He. ME Cannwans MOR. 5eonccenc essen Rochester
W. C. Dopps, M.D Detroit Lakes
J. W. Duncan, M.D
BEN R. Gevrs, 1! |). Rene ters, eer ree ee Mankato
P. A. Lommen, M.D Austin
©) E. Ne Needenes BOE <i cetesccies Minneapolis
E. IRVINE PARSON,
Cuar_Les Rea, M.
W. B. WeEtts, M.D
Harotp E. Witmot, M.D
361
COMMITTEES
PUBLIC POLICY COMMITTEE
| i Oe | nee EOE cr rE Windom
Rae i OS oan Ef ee ee Brainerd
Bo PAS NSA DEN ST URNSID Sb si sccistvcsessseccessostetescvesabeece att Rochester
gamrs A. BLame, JR... MD ....00ccesssscecosessscconecesesi Hopkins
We ks PU MRMINE EID 525 ssc ncssncscvegesvsnaseovenesstatece te Dawson
Be Fo GEA RE ssssiscivccsccssesoecessssoneconsvesscscce’ Appleton
WR Bis Aas ACN EMER, IOS coincscccescostersssesoooseoecsseees St. Peter
Dee SAME WORMED, tos capicdsceesveceninaereciacosssbecs cosees St. Cloud
Bs AL EAUMOPROM, MLD......5..0ccseesscssisscccasssecssoss Virginia
BR ise RI NTE 5s sccpeseovcesccocsvessscvesasteaecncoves aack St. Paul
RUNS SRE GID ocnsconcscch cece conscnvasaccevesccenseeine Fosston
RURAL MEDICAL SERVICE
First District
Paut C. Leck, M.D., Chairman
Second District
WANG AD OMAN SO IMOID ss scsncecvcodbaceapicansevasshenseveuceseste Lakefield
Third District
DEAGNUS WES TBY,; (MID si ccicccccnisscosseaeessiccscscsacsseess Madison
Fourth District
LAWRENCE SJOSTROM, M.D...........csccssecesssssecsseees St. Peter
Fifth District —
AI RATE NEA ss sesucsescscsesssvescssesenevecsceesooeses Pine City
Sixth District
BE WN ABNER IID oo cisa vencevecsoshciistetiseseascesvanncoted Wayzata
Austin
Seventh District
DD, <L,, JOHNSON; MID i vcdicicdsciccssessseessoccccossssceacs Little Falk
Eighth District
C. W. JACOBSON, M.D............sccssscssscsecssscseed Breckenridge
Ninth District
SS ABO NED osc decveseectetsctvesstictoresseveseseveavsvaesed Cloquet
RURAL MEDICAL SCHOLARSHIP COMMITTEE
F. J. Exvtas, M.D.............0000 --Duluth
C. G. SHEPPARD, M.D...........ccccsccscsssssssoccseseees Hutchinson
E. J. Stmons, M.D................. ae Saint Paul
UNIVERSITY RELATIONS
JUSTUS. OHAGE) MD io i.ccncscccccssssecssscosssecessesosseves Saint Paul
©.- J. ‘CAMPBREL, MED) .cicescscsssseisscessessesevesseness Minneapolis
CHAS. C. Cooper, M.D.u........eeceeecsecessstereeeeeeeeees Saint Paul
BS PRMGIAB ONMUDD sc ccnosescsccscvecsacsavessseicsissesutedsutsttarscores Duluth
Ree J. RENNEDY, MED... .5csccscscocdsscscessssivesecsvensss Rochester
VETERANS AFFAIRS
Ratpw H. CreiGHToN, M.LD.......0 ee Minneapolis
ALVIN ERICKSON, M.D. ..........cccccssceeseeeseeeeee Long Prairie
J. J. SEUSTERMANN, MLD.............0:cscsceccsssoveseusseze Mankato
J. E. Murpuy, M.D ‘
E. I. Parson, M.D.................
AtvaAN SacH-Rowitz, M.D............c::ccc008 Moose Lake
P: TR GOUCHERAY, MED.....5...55sicesse..sescccesesecessserees St. Paul
TEE, OUPATEREENS EID aos cs siccis covcccnsnsecosscssasccocts Rochester
Councilor Districts
FIRST DISTRICT
FNL PRICEY, ORs NNO os ccesctscgiecavseecmensacel Rochester
Counties—Dodge, Fillmore, Goodhue, Houston, Mow-
er, Olmsted, Rice, Steele, Wabasha, Winona
SECOND DISTRICT
R. C. Hunt, Sr., M.D Fairmont
Counties—Cottonwood, Faribault, Freeborn, Jackson,
Martin, Murray, Nobles, Pipestone, Rock, Watonwan
THIRD DISTRICT
DP) Bh: ERE RORA NEON INE ss ssesccs cscs sccdsccsessccesounced Hendricks
Counties—Big Stone, Chippewa, Kandiyohi, Lac Qui
Parle, Lincoln, Lyon, Meeker, Pope, Redwood, Ren-
ville, Stevens, Swift, Traverse, Yellow Medicine
FOURTH DISTRICT
FA. 3 PURE BON SGD soo co sscssissvcssesesscetemnerce North Mankato
Counties—Blue Earth, Brown. Carver, Le Sueur, Mc-
Leod, Nicollet, Scott, Sibley, Waseca
FIFTH DISTRICT
1. R. CRITCHFIELD, MED......ss0ccccssesesssssssevasnssevses Saint Paul
Counties—Anoka, Chisago, Dakota, Isanti, Kanabec,
Mille Lacs, Pine, Ramsey, Sherburne, Washington
SIXTH DISTRICT
H. 1B. SwWEETSER, (MED ssicisccsccccscssveeseessessesseeeses Minneapolis
Counties—Hennepin, Wright
SEVENTH DISTRICT
WV STWW PUN REE: SOAP ssc ees ens stessccscdsecuseoscecavevssveczesasted Bertha
Counties—Aitkin, Beltrami, Benton, Cass, Clearwater,
Crow Wing, Hubbard, Koochiching, Morrison, Stearns,
Todd, Wadena
EIGHTH DISTRICT
GC. EL. ‘OPPRGAARD:. ‘MED... .<.5..cesecccicsnsscecssoosseaee Crookston
Counties—Becker, Clay, Douglas, Grant, Kittson, Lake
of the Woods, Mahnomen, Marshall, Norman, Otter
Tail, Pennington, Polk, Red Lake, Roseau, Wilkin
NINTH DISTRICT
CLARENCE JACOBSON, M.D.u..u00.. cece ceeeteeeeeee Chisholm
Counties—Carlton, Cook, Itasca, Lake, St. Louis
MINNESOTA MEDICINE
County Medical Advisory Committees
e Falls
STATE-WIDE ADVISORY COMMITTEE TO DEPARTMENT OF SOCIAL WELFARE
ane Rottanp H. Wixson, M.D., Chairman................ i J. Bi Wieear ae, ME once case sixcecsseccitacccsecseaes Saint Paul
HADDON CARRYER, MLD................:ccccccccsecsceseeees Rochester E. W. LarppMann, MLD................ccccsccccssecees Hutchinson
7 Oy. MM. FERMBERG, MD... .c000:<ccccersscssecsecncaceees Worthington C. W. MOoBERG, M.D. .........cccccccsscccceseeeesseees Detroit Lakes
roan Douctas L. JOHNSON, M.Du.......ccccccccceseseeeseeee Eittle- Balls, KE. Chenoa Mea oasis cccccticcocsscctssccdateaoe Graceville
TEE MARE, GG, JOUNSON, MCD.......c0cccccssccstasssssoccsssccseonsss Brubtte «=F. IE. rm reaeig WEDD. c...cccccsssscccececiaccesensca Minneapolis
' LEO G. RIGLER, M.D.....0.......:ccsscessesseeseeeeesseeee- Minneapolis
Duluth
+hinson
nt Paul AITKIN COUNTY CHISAGO COUNTY
MO teh CIE AIUIYE oi ss sic cdevscceddesassaasesdsdnesiaeneesbaceddadeesves Aitkin 1A) Seer tone RSS eR DEES REE APIO PERE Rush City
Bh Ei PE CARON 5 ova sasd5ccacacevnssssvctenawdarvaadaciscciverncessts ils Abs. Es DR osc ccicascsccocepesceeensceomiwsectenas i
—. | 2.22 ee < RE EITC
— ANOKA COUNTY
Duluth Bee IOAN 55a socchacdsduestessccsauaccdeseccwaseehsveseiasestes Anoka CLAY COUNTY
chester RIN PUNNBIN UNM oe oo, cue sc caelauldsiid uniwecwacwateeceadedsaseodécds Anoka UR eee AO ee re Hawley
PERN EEN coc cciscsc cscs ca siccbatcasustwsiaasdebsacioasecasteiataccsceh Anoka
BECKER COUNTY
eapolis MMO rs OREO acc gs skadkcostidscsatuaceseuessducsuisaastvecWancevecieets Frazee CLEARWATER COUNTY
P rare NEAR MIEN occas csccsvencsccacvsasesessccsacsecsiesss Detwow Eakes Ei Viameneiteciiccc cece cei ckeee ta eaarcicecneseniennies Bagley
— DPE SY: SLATESOON. 5 5i<ccnasss<csnncncsecccesessstacssodenss Detroit Lakes We. Ee. AMBMGO: iiscciciscecticesccccccccicstiteecnsenee! Clearbrook
arsha)
— BELTRAMI COUNTY COOK COUNTY
: e by
~ ne Bemidii WW. We Giaiiiinkinccncccticcenkisnincdid Grand Marais
chester BM ROGRNMGOM «5 giciosss0ssscciessessigsccsstnnsscsncasacecsaets Bemidji
Ard RUN ooo ois nace vans dutacsdsaaravsedveicssaccoate Blackduck COTTONWOOD COUNTY .
Ee: Ce, WABI cence cet a cevasaie ‘alge
Bec. Gi nc ciccescricnctccrstrnecnstenens ountain Lake
BIG STONE COUNTY J. Vu. CARES ON a ccsicccscs0 nid eraaidtandrecentd Westbrook
MES MOMS 25 oars asks caice dakcedavsnnccvacecsdesetaisegadesvosws Graceville
URC N RETAINS ooo yac.cap sinks ivascadsccennccassdacaseavosaeh excunsad) Clinton CROW WING COUNTY
Wie As. PRRDE MABE. . c.ccscccsccececsseeseacssesssorceseasssotaces Ortonville Vv QUANSTROM ER TR ON ey Seem PS Brainerd
Co he APR ocnses caeccdinescteieeieaneceee Brainerd
BLUE EARTH COUNTY Be INE eoisec cca cei cacexcicnegecencee Geecieee ncaa Crosby
G i MEINEM ois Sccevcavihs st cccau syste wetteeeg ee Mank
at Paul He tton Moroan.. a DAKOTA COUNTY
anabec, i CNC oS ee een n rate BamNice THORRSON £....0c.c..cccccscsceccccetecensscs
igton POUeeeErCTOCTOOCOCOOCer CeCe errr ee eer ri i) eee
OLR SIT) 1) 0 ee
cance ALBERT FRITSCHE...... fe DODGE COUNTY
i E. J. WoHLRABE...... Ce GEO a sos cese dea cetnitecsccarendacenc eee) Dodge Center
oO. B. FESENMAIER Ws PRIN dasa cducaconceesauaacddccquiauaetadeeteete Kasson
A. P. GOBLIRSCB.oocecccccecccccccccoceececceccecceececccccesees ae Be CHE IO cic catceendsscataeactataaaet mers West Concord
DOUGLAS COUNTY
Bertha a
rwater, UFO Bios edacso cc cncc acc cacceesedee ddeoewetesecesucsececd Cloquet E. E. EMERSON............ssssssesesssesesssesesntenteneenssneneessassed Osakis
Stearns, MEME, PPAR ocesec.seseecsoeceecedsccccecescesvececcecececceccd Cloquet G. W. CLIFFORD...........:.:csssesseesesseeseeseneeneentaneseens Alexandria
OD ERANSOINE oc ccroccocsseccocsncesocsocceocseccessocssssonseead Gixcltcrr Wee a SARI secs sce cocncsd cscs teeeostacseraccunsemeereen Alexandria
CARVER COUNTY
soitaaiie Ep ge epenaneleiemmemammne <A . L RR RINE:
n, Lake EB. PoGug. A cetopa - RICHARD VIRNIG....004...--s0sssssssensessssesssoserencenssrenctsennesees
Potter Ye POUR evsesseeesesseeessseeensssernsstennnnsteenenene
Ikin
Bp ics cu esSea dh (suse sacavatcresd eaten Albert Lea
ee AON Teen . E. J. NELSON Albert Lea
M. A. Burns......... . SHERMAN ...Albert Lea
L. A. Krystosex Or os 2ikicccnadésbaiccadtéciandseadsenese He -.Albert Lea
May, 1955 363
EDICINE
GOODHUE COUNTY
ie Be ET CIRO OR RHE ort fee ee oA Ee DSR eR Red Wing
RN MEIER oes cass dicsaptvnkescheconsohacosenetssacunesseih Red Wing
STi ME MMMOMDIAIIIE: 5. (555550505 cchsciecssensissecebacsoeceesees Red Wing
GRANT COUNTY
Dee RUAN 5 cas os Sa5 cscs ses Szasceswacen tea besetesenouee’ Elbow Lake
NR EME oo cog hs occ snssbesiavseaccvessercotentvcd web aanose eee Hoffman
HENNEPIN COUNTY (RURAL)
WUC UN TAN Sos sss Sib va scutes wdeepbecesa tne loaaeiiueiet Wayzata
US hc. C= eee ee crea eer,” Hopkins
Ms Uc Me AREAS EDE soos cs Sees seks ceSiohscsensc sh csassescevense ome Robbinsdale
HOUSTON COUNTY
PNG om MOIRA EES OOS Sires ta os As Soca nokconcassuibieocdeisoeee Caledonia
Bn a Ee Houston
Mis FR NTO 5506s sc Spsvsntscveessvseusevecnoseusc0s lectee Spring Grove
HUBBARD COUNTY
MPONAED TIGUBTON 5 50.55 0scisieesecesisecsceccisesvessecesseet Park Rapids
WY MONI oo Ss oo ish sssscseecesegabsvascavebovasiccvaone Park Rapids
IRA RR oo 5S 5. cas deg svatsncs sai <ovestieesciebessest-csstth Park Rapids
ISANTI COUNTY
BY = ek MASI IN 55 sv esas sccsevee Necihaesseteeest Te. Braham
Pe A MR RIRMEN eyo ssc Csi cosy sssedcaclod eserasacety J.sseeeeeeee Cambridge
Ray AAR PERRO Nc sion csiap scabies caseeseck as toeckueve Su lestetnes Cambridge
ITASCA COUNTY
Fe cA TR ND NMI ESF oo Se oad con in ccacuesceeuceeceaeeee Coleraine
ACs ae SR REINS 5065 5a casisses canseseccosstvecesivaceees Grand Rapids
INAS) RGIS ININA (on stesccccecscasssicasesesanstessteepstl Grand Rapids
JACKSON COUNTY
i OMI one core fiend OS Someone Lakefield
H. A. CHRISTENSEN Jackson
WN PRES POR ERSNIO BIN 5555s 650c ess z095seeioacs case oasceeceseasseaed Jackson
KANABEC COUNTY
CR ee Ll 5 RR Geen ere gee Mora
bese 5, FOUL, TS EA eA A ROR Mora
AANAUR 501.0 MRREIGE 3005555550554; 005<asackct ennsacouviniiuanetontcen Mora
KANDIYOHI COUNTY
ACTA POM ERNED ers 55 0.8 Oe hen leew usu elin ose Willmar
Pace NTeIRIRRIE SS 3 Cicily he hak el ee Willmar
| ae) ORE Oct. eae se et ane a eRe Willmar
KITTSON COUNTY
Pte pM SRN 20 255 e KET eS yey scucboore cence exter esau weet cee Hallock
tee Sg LC) 0) a Ry eRe. Karlstad
KOOCHICHING COUNTY
a ee EC: CC C0 Sa Littlefork
RES SUNS OR a Aa PSE International Falls
MSR MOND REIB Soc ccciccccecssconcinatvcvantovecdoce’ International Falls
LAC QUI PARLE COUNTY
i Sa bess LS 0°) S ALR one RE eR eae ae Re Dawson
MSHESTER ANDERGON: 5.065055. ¢00sssc5eccsseseesscscsssosssaacscee Madison
LAKE COUNTY
RALPH PAPERMAS TER .<.0..065055ccccccscccssesccscsscce Two Harbors
LAKE-OF-THE-WOODS
PA RS MEINE ohn wcasetle eth a, cues pean th ae Baudette
1 Cage, [Ao 0) Sd y ae neer ee Peer ie en aPEN Baudette
LINCOLN COUNTY
Be sy MMM BION oi vsscco ss asestecosseascesecee Nese eee Hendricks
DA id cP BRIM ENIOM ers os csa Pode eeck 5 Licss \ceiax seh coun eco SoS eeeee a Tyler
ARE ION a oe ics ks dots ca daicdonsa cere eesiek Lake Benton
364
COUNTY MEDICAL ADVISORY COMMITTEES
LYON COUNTY
TUES OFS cen ie Rn i dt ee Marshall
N= FUN cE ericsson ase cb ck sa avsudeedevceguececaevacseses Marshall
WH: UG, SUMORICMORING coos eee. co cops sccesesSsctessscoctscevssosssscenszuce Tracy
MAHNOMEN COUNTY
eI ORMIOD, - Piaren nai ugsceccons eeocte dec eacdbnipiadicans Mahnomen
Pe EIVET EMOU BANA, io550 Soshcdstsesosssentursiconcoscdenenteess Mahnomen
MARSHALL COUNTY
CARER TIOLMBTROM: .. 26.56.5055) -csccccas..ccassaceescsaeeccessesee Warren
PEs RN) MMII 055 68 5s isos g sas cakuicsenucicexswocivecgandnanownee Warren
MARTIN COUNTY
BRAG WEI co con chev bese tocds ead wae weeds norte danbauesessooe Fairmont
MOD NaI ors cho acscsccctuacessasecacdiccascecoxtensdstecssaced Fairmont
MS IN AE SBC ancl dv en xcdschaSecereviecnacs ave aN RUE Fairmont
BA. AL WWIETASEGON oso co oscascseedeccecnsssersdossscvensaveoe Fairmont
MCLEOD COUNTY
AS FINA OMIENGION 6 ca cicors szcussnesecesedoss iu snus accsestaxecenyeessiest Brownton
Ir, RUN MGRERRAIS. oc 5ccsscesscrisessssoncscsaooesesssenacsscsecd Hutchinson
TPOSBR ET SBEMON. 5 cccsscvssscahoreccecksctoosessterssaatsacoueeeus Norwood
MEEKER COUNTY
TUAROETy WHELIMEOIE ooo dicccseesccvesevascenescchceceecccgentsncavesed Litchfield
LENNOX DDANIELSON «60.50c0ccscccsesccissccssesessticacevsasess Litchfield
PAGINA DIGOON oe. oscci ossse0s soccsicesseseteeccass avasscoeed Litchfield
MILLE LACS COUNTY
WFR BOMB ERG 5 oie doc sche cobs cess cocsvancesnsvetcasseasncionse’ Princeton
Pin Ut MEMBER SINNER coos foc ccdes boas yes seve ce seneccsevencevessneseee Princeton
HNN, PO PMT on ss ic.css ev -scaicco cas cisco assutuabubeeccovoces Princeton
MORRISON COUNTY
D. L. JOHNSON............00066/ Bee ak Nusaaa st eacesteeont ees Little Falls
Bi SMO VAT BONG oo cnccisocclendssoevaesesentvednasioenssevaesecd Royalton
| Die CRU) (Sc 1 eR Swanville
| Rg: UA Ec! Ch Ne ae tr cre RIN ee Austin
MY RG IAIN en ache tes ccc acen vvcinsees as eekcusneseapaearerneess Austin
MURRAY COUNTY
Be oI SEEN GOIN 2a cA coc cncs cost Sec deus taca eases Ieotseeieapiuveees Fulda
R. F. Prersow.......... Slayton
H. D. PATTERSON Slayton
NICOLLET-LE SUEUR COUNTY
Bs (G OABAINGON 5 os cscs c.ccccieseceekcssvaessepensavardivesevivecs St. Peter
DS Hee, MOG BGING 502 os ccs ceciioecadsnts voce hve lestastonstcavesnteees Gaylord
BB A UMM oo cece ds casas catcccenseesoacecsksliomseasensnrveeds St. Peter
NOBLES COUNTY
Bic. ANN NG RS IAD 0s sock cacs cio sy.d cecdeosseeosiencctseteeasreeees Adrian
Be As, MISSION ass sg cc oes su eaee xa sansa vasseweeuceedseves Worthington
“ge | Spe SCS me AR Worthington
NORMAN COUNTY
WUSMIT) MRICS ON So oc2 cc cco casusccaccosesgeacceecssbessesteis meee Halstad
BBO IE TINICAIIE 6605 50cc) 6s casceasdectnasavseesesenvsecedesvascoccenesssovel Ada
WPERODORE TGORIN 3.06 ccsccccccesssescsccecssscssssvarvoncescvonssevacees Ada
OLMSTED COUNTY
15 AE, pa 200) C11) 5 a ep ca ee Rochester
(Oke RS (ol) fc EO Pine Island
OT HO BR vac os Sch ac dccnc Susser s vosecueesiKacdansserbavers Rochester
OTTERTAIL COUNTY
CREA RES IR WAS 2 oc cdessncksecdcpscescescccansasvoncessvsnsesacones Henning
RANI NAR ORIN 552055 ccnsseccscecseaseessssuceesoarsssesees Fergus Falls
ED WR IB SEED? ocsscecsicsocsccessvascesstssnonsscverdeem Pelican Rapids
MINNESOTA MEDICINE
Qs sr >
e2a0a
. aan
Pai
Jou?
Davi
Ken?
Loyp
shall
shall
racy
men
men
rren
rren
nont
nont
nont
nont
nton
nson
vood
field
field
field
eton
eton
‘eton
Falls
alton
ville
ustin
ustin
‘ulda
:yton
yyton
Peter
ylord
Peter
drian
\gton
\gton
Istad
Ada
Ada
lester
sland
vester
ining
Falls
apids
ICINE
COUNTY MEDICAL ADVISORY COMMITTEES
PENNINGTON COUNTY
Mea), STAREROW.............ccsccesseccsoacsnscnseese Thief River Falls
GorGE T. VAN ROOY...............:ccseceeeees Thief River Falls
PINE COUNTY
FRM Fe SRA E oe «ons die sa ans sascsdeatateseigeestecscarsveven Pine City
Rr PROBING 62055, <6 53. cc. <osSareastdecetisccosiieiee-npaveeeet Sandstone
MMM PARED Be sasvacc.sdvecnss.ccice wacsnsceaciticercoateecelt Sandstone
PIPESTONE COUNTY
W. oy a INURE Sos i ccacensavscassouscanesssdecsancsrsicasucoes oe
SE RIE i cnscnsssncecansensasatanetaronesntsesnaceneccal ipestone
PMO DUNG 505. cee sposecensipasecevanderevcevadeckcnsecnseh seats Edgerton
MRIS AMIENS 5 oa 22028 00052 cscckncedvodsnevecasccisbontaecesead Fosston
OY ERE oc oases calescccccunes cuyecccontaacaowreaseconcices Crookston
Ca OT CC en ei nn RRS veer McIntosh
POPE COUNTY
Det SWEDEN DERG: . 05.5.0 scseseseedievecoscccdccsausscosccccened Glenwood
I ENNIO oo 20 cFoac 2 ov hcde cso, daavecndcccinalcavssudeecn Starbuck
RAMSEY COUNTY
MI UN oo 505. 2a cles. < cas exsedccartceussatvdeenexigiaigesne St. Paul
PERE NE 5c305 21 ed Ra pcs aut aikindse Rusa eeavskiuakD UNG: St. Paul
PMI OEE 62 ovcccsceccensvtecewsecascvexevecedssverese%os: No. St. Paul
RED LAKE COUNTY
JS 5 a Red Lake Falls
OSE GTS Sg Red Lake Falls
REDWOOD COUNTY
"| ends TEST. eae ee AP Wabasso
OWN DIB SONGR....<5...:<cc0+-ceovescctesscsssessecssesien Redwood Falls
MM MPM PENLUNS CON oo 2055 055 sd50ysacseandscscectccdsleaxceosece soit Morgan
RENVILLE COUNTY
vA \@OSGRIBE. (Sie. coca ccce se viciciesdelcccscsesscsencwuaccacs Olivia
HEIN IV ORDAL <.00.55cc0ssostssesessccesdsvevsacexcsccsced Sacred Heart
PMT PANU OHIDD: «csc ccnasccessesunnccestssnncessaveaccevesccvee! Renville
RICE COUNTY
MEA, NU BAMGANG ce cccacccesdcondcscessustsldsasesccoccesss Faribault
MMEREZG We SBAURSERE 2; o2- <5 0523:5) coczesbesss,cceceteeiececstcsen: Faribault
BERNARD STREET)......<....0sccccccccorcscssnccotsstececsessoess Northfield
ROCK COUNTY
Cal SHR MEAN 2 occ.n50-.cescksecadianedctsecdesststeislleeee Luverne
PO PIU RI TEN ccs toss coc cc doahdat ees creecsccoae oes Luverne
He Wr BOREN KADER: «. <....csececececessccceecsaseccocesecedoecseese, Luverne
ROSEAU COUNTY
PEN E. DEEMORE, Jit. ..o-cschs-cecoeedeccelseaetisdedens Roseau
|. AO ai): 5 a ln Roseau
ERNEIDES! NEE SON <5 .00:c+0<escccecsicesndecesidsscicieccactacce Warroad
SO MMIII i csccviisiniviensnnicccuresncivsesarsonscarencactd Greenbush
ST. LOUIS COUNTY
RECO ETT Te ae. Duluth
I a ee as cera Duluth
EA CTE, Duluth
SCOTT COUNTY
nnn CER Oe te a eee Belle Plaine
ESS ANSARI Shakopee
SHERBURNE COUNTY
I, RN asc cvescnondaesesecsccsccs dees Elk River
= RRR eae: Elk River
May, 1955
SIBLEY COUNTY
RGR NEMOURS Sy 28 (ayia tad Rae Satan ed eee Winthrop
I Ne AE as fo Ad a ea ee Arlington
BPS GR. QRES ONG resect ahaa Ee Gaylord
STEARNS-BENTON COUNTY
Cl. Be AIS Tose cccaesa cence St. Cloud
To WING 5 a2 oss coe ee hacia cache St. Cloud
1 MON SRR O11: SRR ea ape oben em 98 Sect EO es ne St. Cloud
INS, We NIACIN bo coho cc Restrnt alms Foley
We Bil RAR UANEN oos sscacse sc scaesansctcaacacnsyeavaenl St. Cloud
STEELE COUNTY
Ble Te COE RON en cscs cachnasoepecetcaadseannscesancnaladenace Owatonna
TE Ae Wass ccs atee cassette Owatonna
STEVENS COUNTY
WOE. TRANGON 003k eee Hancock
Pi SONOS ck doscawngiecatesnndorer erates i Morris
PR TE, PONE oso ccsec cs oak eden ae Morris
SWIFT COUNTY
| A Age 71)” 7). Seana ee nen teenie Sea a ee Appleton
ys Gy, CUR Ge. ccs ceedessicse hen eh eaeee Kerkhoven
Rs CNUs ods occa cece vgstataracetimee ee Benson
TODD COUNTY
MEE, MOsBe.o.oi.ctciccsirc een aad Long Prairie
NAS Cala, screen taeda ee Staples
Oe Re Was cesses cheeses htc ade ae ee Bertha
TRAVERSE COUNTY
de i. “Baa os sons Sheena
Bien We RADAR ORIG soos ccc cwaasexestea saraateieasetetedaeeetaae
WW he MMII sodas a <coccnsaccncsnd Quacuvesasdecaneancnsseease
WABASHA COUNTY
C. GC. . COCHAGBI 5 6icg esciciniieieeee Wabasha
De Oy RM WW ose tsd cs coccwacacsccoccacsaicassneesaceseseenceated Lake City
BE GWA ochre eine Plainview
WADENA COUNTY
ia We AW 8 ico thac eek re eee Wadena
Oy. ER amen os cc oc fo dccsevacicstigs aera Wadena
WB A occ sciceie ee oe eee Sebeka
WASECA COUNTY
CS Eis i Cia oon aes Ae New Richland
Wh CARR Aa Rais esc s eden cctpccececesacactacitenantesies Waseca
WASHINGTON COUNTY
NM FOURGENS 4.3 <i tei tc emeequiae Stillwater
©. His SERRA oo ia < ccc cinece cect ee eases Bayport
TE. By CARES Ok. ok... cisecciccaccirieeec etc Stillwater
WATONWAN COUNTY
OG}: By RRGW@AN ices osc ernie Saint James
POMEROY SUING aesccadecccccdccacsascaistcacccess iorecsen ees Madelia
WILKIN COUNTY
C. We JACORSON.....65.465-hi cee Breckenridge
WINONA COUNTY
We . ‘WHESON:...24 eee eee Winona
WRIGHT COUNTY
S.. > aati. ees eee ee eee Maple Lake
BR WR SANDEE. csn chat spac nen eeveranesectcaseecccatinaspeiees Buffalo
YELLOW MEDICINE COUNTY
Cae ERR se a casecziecdecesocetatcoe ee Granite Falls
0)! GC 5°75") San ene eee aR ER oe ey Granite Falls
Wee RG. “UN a socac cs scdes scuascanssideetsactanecat Rate Echo
365
WOMAN’S AUXILIARY
to the
MINNESOTA STATE MEDICAL
Mrs. Peter S. Rupiz
Mrs.
Mrs. H. H. FEsLer
Mr.. JoHN Dorpba
Mrs. V. J. ScHwartz
Mrs. L. P. Howeiui
Mrs. Justus OHAGE
Mrs. Davip HALPERN
Mrs. CHARLES W. Froats
Mrs. G. H. Goreurs
Mrs. S. N. Litman
Mrs. A. J. BIANco
Mrs. LEo FINK
W. E. WELLMAN
. O. M. HeErserc....
. J. C. BuscHer
. C. W. Moserc
J. L. McLEop
Henry W. Quist, SR
ASSOCIATION
Officers
Minneapolis
St. Paul
Recording Secretary
Treasurer
Corresponding Secretary
Historian
Fifth District
Sixth District Minneapolis
Saint Cloud
Detroit Lakes
Eighth District
Grand Rapids
Ninth District
Chairmen of Committees
Advisory—Mnrs. HENRY W. Quist, SR Minneapolis
Allied Medical Careers—
Mrs. STANLEY PETERSON Austin
American Medical Education Foundation Fund—
Mrs. J. A. CoscrirF
Archives—Mrs. J. L. BENEPE
Bulletin—Mrs. C. E. CaRLson
Cancer—Mrs. W. G. BENJAMIN
Civilian Defense—Mrs. D. G. MAHLE
Editor (MINNESOTA MEDICINE )—
Mrs. L. RaymMonp SCHERER
Olivia
Saint Paul
Alexandria
Pipestone
Plainview
Minneapolis
Finance—Mrs. Marx RyAn Saint Paul
Health Days—
Mrs. Haroitp F. WAHLQUIST Minneapolis
In Memoriam—Mkrs. JouHN J. Ryan Saint Paul
Legislation—Mrs. Pui K. Arzt Saint Paul
366
Medical and Surgical Relief—
Mrs. W. T. GREENFIELD
News Letter—Mnrs. M. F. FeLttows
Organization—Mrs. H. H. FEsier
Press and Publicity—
Mrs. A. B. RoSENFIELD. Minneapolis
Printing—Mrs. WiLt1aM GJERDE Lake City
Program and Health Education—
Mrs. C. E. MERKERT
Public Relations—Mrs. G. A. HEDBERG
Resolutions—Mrs. P. J. PANKRATZ
Revisions—Mrs. D. V. BoaRDMAN
Roster—Mrs. R. F. Erickson
School of Instruction—
Mrs. LEONARD ARLING.
Minneapolis
Nopeming
Mountain Lake
Minneapolis
Clarkfield
MINNESOTA MEDICINE
County Society Roster
Key to Symbols: *Deceased, }Affiliate, Associate or Life Member; {In Service;
§Wife is Member of Woman’s Auxiliary.
BLUE EARTH COUNTY MEDICAL SOCIETY
Regular meetings, last Monday of each month.
Annual meeting, last Monday of December
Number of Members—57
President $ Hammar, Lawrence M............ Mankato § Morgan, Hugh O................::00+----Amboy-
EusTERMANN, JOHN J Mankato Hankerson, Robert G.....Minnesota Lake § Olive, John ; ee ..Mankato.
Secretary + Hassett, Roger G Mankato § Penn, George E.... =
McNear, Georce R., Jr Mankato § Heller, Edgar E.... .Mankato § Roth. Frederick
$ Hoeper, Philip G... -Mankato § Samuelson, L. Gordon..
§ Anderson, James Mankato § Howard, Marshall I J § Sanford, Raymond A... ),
Anderson, Margaret C.. es 7 + Schmidt, Paul A -Aurora, Ill.
#$Andrews, Roy N § Huffington, Herbert L., Jr.....Waterville § Schmitz, Anthony A.. ~Mankato
§ Baird, Raymond L.. § Jones, Orville THe ni.n...:.:...c.c00 Mankato § Sjoding, J. Donald...
§ Batdorf, B. Niles... + Juliar, Richard O...Los Angeles, Calif. § Smith, Harry J
Duluth § Butzer, John Ss § Kaufman, Walter § Smith, Paul M
: te § Butzer, John F § Kearney, Rochfort Wynn.. + Sohmer, Alphonse E..
neapolis § Chalgren, William S... § Kemp, Alphonse F § Stillwell, Walter C....
it. Paul § Conley, R § Koenigsberger, Charles.. § Thiem, Chester E..
1 Heart Dobson, M. § Langhoff, Arthur H... § Troost, Henry
: § Engstrom, Robert + Liedloff, Adolph G... § Vezina,
leapolis § Eustermann, John § Lindblom, Alton E. §
chester t§Franchere, Fredk. Lake Crystal + Luck, Hilda
t. Paul {Fugina, George R...............000 Mankato § McNear, George - ye. .M + Williams, gh O ...Lake Crystal
me u § Geurs, Benjamin R. ...Mankato § Mickelson, John : § Wohlrabe, St. Clair
rewster @hlaes, Jolius B..........2...:..cccccesscosed Mankato T§$Miller, Wistar icine Mankato
t. Paul
Cloud
D
uluth BLUE EARTH VALLEY MEDICAL SOCIETY
Duluth ; :
ani (Martin—Watonwan—Faribault Counties)
Regular meetings, third Thursday of each month.
Annual meeting in November
Number of Members—44
President § Hanson, Lewis.... ea ¢ Rollins, Troy G
Winnebago : mga Julius , : in, + A
Secretary ruza owe, illiam
Boysen, HERBERT Madelia +$Hunt, i § Russ, Homer H
chester Kraemer, George } § Smith, Don V....
ington § Armstrong, Ralph S... Winnebago § Krause, C. W § Snyder, Clifford D.
Echo Barr, James EB § Lester, } § Thayer, Ellsworth
Ke § Bergman, Oscar B § Lindahl, § Vaughan, Victor M
w Ulm § Blumberg, Henry B... Louisell, § Virnig, Mark P....
it Paul § Boysen, Herbert.... + Mctnoarty, John § Virnig, Richard
eapolis § Bratrude, + Mills, John L.. § Wandke, Otto E.
+§Chambers, Winslow C. t Moulton, K. B... § Watkins, John A
Cloud + Cooper, Maurice D... § Nickerson, John R... § Williamson, Harold A. ;
Lakes § Coulter, Harold § Nickerson, Neil D. + Wilson, Clyde “Blue Earth
Rapids § Drexler, George W... ...Blue Earth § rada, ae ied § Zemke, Erhart E... .Fairmont
§ Gamble, Elbert J ....Bricelyn § Parsons, R. fe Ziegler, Robert G ..Welcome-
§ Gardner, Victor H Fairmont Parsons, Ralphs Ee.
BROWN COUNTY MEDICAL SOCIETY
Regular meetings, quarterly. Annual meeting, in January
Number of Members—34
‘okato President § Fritsche. Albert Muesing, William _................. New Ulm
Seirert, Orro J § Fritsche, Carl J .N J Nuessle, Walter G... e
inkato Secretary $ Fritsche, Theodore R. t+ O'Leary, John B
Kaiser, MILTON New Ulm Goblirsch, Andrew P... ‘Sleepy Eye § Penk, —— Le
duluth Hedlund, Charles J. -Owatonna Peterson, Roy A
§ Black, William A... New Ulm Hovde, Winthrop Rayner, Ralph R
Paul Burnett, Joseph W.. Vew Ulm Inglis, William.... -Redwood Falls ea. George F....
§ Cairns, Robert J.... ...Redwood Falls © Mawer, Milton E..........ccc.s0 New Ulm § Saffert, Cornelius A..
; Carthey, Frank _J.... New Ul § Keithahn, Elmer E.. Sleepy Eye _ Schroeppel, John E...
apolis § Dubbe. Fredk. H.... .N Kitzberger, Peter J.. ..New Ulm » Scifert, Otto J
: § Dysterheft, Adolf F.. seat & Kruzick, S. J Sleepy Eye : Vogel, Howard A. L..
City 3 Fesenmaier, Otto B... ¢ § Kusske, es .New Ulm Wisness, Osmund A..
Flinn, James Mattson, Albert D St. James } Wohlrabe, Edwin J
apolis
ming CAMP RELEASE DISTRICT MEDICAL SOCIETY
A (Chippewa, Lac qui Parle and Yellow Medicine Counties)
Lake Regular meeting, first and third Thursday of April, May, September and October
inona Annual meeting, third Thursday in October
: Number of Members—33
:polis
President § Allen, John H § Burns,
- Barr, Montevideo Anderson, Chester A... § Burns, M. Alpheus
polis Secretary $ Barr, Ronald W i § Camp, Ray Junior
ALLEN, JoHN Montevideo Boody, George, Fallon, Virgil
May, 1955
<field
[CINE
t Flom, Robert © Columbus, Ga.
Guilbert, G. M 1
rt,
Hartfiel, aes A Montevid
Hauge, Clarkfield
' — A 0 Canby
udec wyn
ustad, Edward G
2 Johnson, Curtis M
§ Johnson, Vilhelm M
COUNTY SOCIETY ROSTER
t Jordan, Kathinwe Smith....Granite Falls
Granite Falls
H aufman, William C...
Krystosek, Lee on Clara
t Lee, Walter I N... aeealenr = itd
..Montevideo
Lima, ie.
Granite Falls
Lundell.
t Maus, Philip New Orleans, La.
Nelson aoe m,
Odland, M...
Owens, Wills A..
Pertl, "Albert _L...
§ Roust, Henry A
§ Schmidt Paul D au Jr. ‘Granite Fall
eon Montevideo
§ Westb y, M: -Madison
$ Westby, Norval M.......c:csccsssse. Madison
Granite Falk
Granite Falk
ontevideo
CLAY-BECKER COUNTY MEDICAL SOCIETY
Regular meeting, spring, fall and winter. Annual meeting, November 30
President
LAND,
Secretary
pps, Witiiam C...
§ Carlson, Vernon J...
$ Dodds, William C
Number of Members—26
3 Duncan, James W
Gacusana, Jose M
$ Geib, Marvin J...
y Hagen, Olaf J
§ Houglum, Arvid
§ Humphrey, h.. a ie W..
..Detroit Lakes
Lake Park
§ Lorentzen, Ernest S.
$ Midthune, A. S
3 Ooped Maz gt Ww -Detroit Lakes
kE et Lakes
Oliver, ”
Otto, Henry
§ Rice, Hagbart
3 Rutledge, Lloyd
axman, Gertrud
§ Simison, Carl
+ Thysell, Fred A...
$ Thysell, Vernon D
Georgetown
Barnesville
EAST CENTRAL MINNESOTA MEDICAL SOCIETY
(Anoka, Chisago, Isanti, Kanabec, Mille Lacs, Pine and Sherburne Counties)
Regular meetings, first Tuesday of every other month of the year
President
Larson,
Secreta ry
TescH, Gorpon H
Adkins, oo a
Albrecht, H. Chisago City
Baars, Co Camp Cook, Cot.
Berge, Harry L Mora
Beyer, Eugene F
Blomberg, Wm.
Bossert, Clarence Ss
Bunker, Bevan
Burseth, Edgar C
Dredge, Homer P.
Gully, ‘Raymond J
Number of Members—40
Halpin, Joseph E
He a og Paul
Cambridge
Rochester
McManus, William F
~ Magnuson, R. C
$ March, Kenneth A..
Metcalf, Norman B
Annual meeting, first Tuesday in December
4
$ Nordman, Willard F
Nygren, William T
Pasek, Edward A
Rudolph, Frank A...
*+§Sherman. Hubert :;
Spurzem, Raymond z
t Stahn, Louis
§ strate,
§ Swensen
3 Tesch,
Vik,
t Waller, st D
Woyda, William C
Pine City
Elk River
FREEBORN COUNTY MEDICAL SOCIETY
Regular meetings, third Thursday of even months
President
Ecce, S. G
Secretary
E.iertson, L. M
§ Barr, Lowell C
Burns, Catherine.
8 Butturff, Carl R...
Ha San hen y
ertson, Leonard M
President
SHERMAN, Roya. V.
Secretary °
Haw.ey, Georce M. B.
§ Akins, Willard ~
§ Allen, George S
t Bagby, George W...Ft. Len. Wood, Mo.
t Sol, . ‘hornton... ‘Portsmouth, Va.
§ Bridge, Ezra V..................Cannon ’ Falls
§ Brusegard, James F... ..Red Wing
Claydon, Howard F Red Wing
368
Annual meeting, December
Number of Members—30
§ Erdal, Ove A
§ Folken, Frank G...
{+ Freeman, John P...
+ Gullickson, Andrew
§ Hansen, Theodore
§ Holian, Darwin K.
* Kaasa, Lawrence
*tKamp, Byron A.
§ Keil, Marcus A..
+ Leopard, Brand
§ Neel, Harry B
sville, Texas
Albert Lea
Regular meeting, none
Annual meeting, December
Number of Members—29
§ DeGeest,
t Dovenmue e, Robt.
§ Falls, John L
Flom, Martin G
§ Graves, Richard B...
§ Halvorson, ames
§ Hartnage
§ Hawley,
§ Hedin,
¢t Jones, i
§ Juers, Edward H..........:::ccce Red Wing
Nelson, Clayton E
Nesheim, Martin O
: Whitson, Sidney A.
§ Wilcox, 'G. Charles
GOODHUE COUNTY MEDICAL SOCIETY
§ Kimmel, George C
: are. William W....
§ Miller, Winston R
§ Molenaar, Robert _E..
i Sen Royal me
§
§
§
“Cannon Falls
..Red Wing
Smith, Myron W....
Steffens, eon A...
Walter, William E.
Wasmund, Clarence W..
§ Williams, Marland R.........
MINNESOTA MEDICINE
or Reon COR OR 2 LR — AO om _ CR ER ROP?
i, i Sn, Oh an i, Pe Se: Se, Se, Se: Oe, i, ee ee, 6 6[ClUlC CC
wk COR COR COR COD
Ce
See, Oe FL Ae ee ee, ee ae ey a
002 08
won
c, ee ee
contorcon
—b +e —F
Onto C0802 = 008008008 Ft 08
‘ite Fall
‘ite Falk
Madison
it Lakes
it Lakes
oorhead
...Frazee
oorhead
it Lakes
rgetown
rnesville
oorhead
-Hawley
lk River
ed Wing
od Wing
ed Wing
on Falls
od Wing
ed Wing
ed Wing
ramingo
ed Wing
Hastings
on F;
DICINE
President
Aunc, CuHartes A.........
Secretary
Hotmperc, Conrap J
Executive Secretary
COUNTY SOCIETY ROSTER
HENNEPIN COUNTY MEDICAL SOCIETY
Regular meetings, first Monday of each month October through May
ee Minneapolis
(Minneapolis
Mi lis
Cook, THomas P.
Abramson, Milton
Adkins, Charles D
§ stsson, Hreidar.
Mi li
Minneapolis
Min Li
ern, Eugene E
§ Alexander, Harlan A
§ Aling, Charles A
M Yr
Minneapolis
Mi Iie
Althausen, Theo. L.,
7 Altnow, Hugo Oye
Amatuzio, Donald S
r
Orsi Gables, Fla.
Mi: a
Minneapolis
§ Andersen, Silas
a
Anderson,
‘Mi is
St. Louis Park
‘Mi lis
§ Anderson,
+ Anderson, |
Minneapolis
Mi Li
§ Anderson,
§ Anderson,
§ Anderson, J
Minneapolis
Minneapolis
Mi ae
§ Anderson,
18
Anderson,
§ Anderson,
§ Anderson,
Anderson,
§ Anderson,
Anderson,
Andreassen, Einar
§ Andreassen, Rolf _L.
§ Andresen, Karl D’A..
§ Andrews, Robert S
§ Ankner, Frank J
* Archer, Willard E
Arends, Archabald L
§ Arey, S. Lane
Minneapolis
Mi oe
1s
Arhelger, Stuart W
§ Arlander, Clarence E
§ Arling,
§ Arms,
Minneapolis
....Minneapolis
Minneapolis
Minneapolis
Arnold, Anna W
Arvidson, Carl G
#§Aune, Martin
Minneapolis
Minneapolis
+ Aurand, William H
inneapolis
in 1
§ Baggenstoss, Osmond J
Bagley, Russell W
§ Baird, Joseph W
M r
Minneapolis
....Minneapolis
Minneapolis
Mi ee
$ Baken, Melvin P.
Bak A. B
1s
Minneapolis
i lis
er,
Baker,
*+Baker,
1
Minneapolis
‘Min
L
§ Baker, M
§ Baleisis, Peter..
§ Balkin,
Pp
Minneapolis
‘Minneapolis
M; He
1s
Balogh, Charles J
Bank, Harry E
§ Barno, Alex
San Francisco, Calif.
St. Louis Park
Mi lis
§ Barr, Maxwell.
Barr, Robert N..............
Barron, Jesse J
cacevaed Minneapolis
Minneapolis
+§Barron,
Barron, S. Steven..
*§Baxter, Stephen H...
§ Beach, Northrop....
+ Becker,
§ Bedford, Edgar W.
§ Beirstein, Samuel
§ Beiswanger, Richard H.
+ Bell, E. T
§ Bellville, Titus P...
§ Belzer, Meyer S
enesh, Louis A
§ Benjamin, Edwin G...
§ Benjamin, Harold G.
Benson, Ellis
Berg, Clinton C.
Berger, Alex G...
§ Bergh, George S.
Bergh, Solveig M...
Berglund, Eldon B....
Bergquist, James R..
§ Berkwitz, Nathaniel J..
Berman, Reuben
Bernstein, Irving C
Bessesen, Alfred N., Jr
—, —— ae
ieter, Raymond N..
§ Bilka, Paul J
§ Binder, Manuel R....
Bjornson, Robert G. B
§ Blake, Allen J
§ Blake, James A
May, 1955
La ee
Esatees Minneapolis
-Minneapolis
.Minneapolis
.Minneapolis
/Minneapolis
-Minneapolis
-Minneapolis
/Minneapolis
Minneapolis
Minneapolis
Minneapolis
.Minneapolis
-Minneapolis
.Minneapolis
.Minneapolis
...Excelsior
inneapolis
.Minneapolis
.Minneapolis
..Minneapolis
..Minneapolis
/Minneapolis
..Minneapolis
..Minneapolis
..Minneapolis
..Minneapolis
./Minneapolis
./Minneapolis
..Minneapolis
..Minneapolis
opkins
Hopkins
Election in February
Annual meeting, first Monday in October
Number of Members—960
§ Blake, Hopkins
§ Bloedel, T. J. G.... seo
Blomberg, Robert D.. Minneapolis
§ Bloom, ecen B .../Minneapolis
§ Blumenthal, Jacob S Minneapolis
*+Bockman, Michael W. H.
Hot Springs Nat’l Park, Ark.
Bodelson, A. Little Rock, Ark.
Boehrer, John J ..Mi polis
Bofenkamp, Benjamin.......... Minneapolis
§Bohn, Donald G Minneapolis
Boies, Lawrence R..............-.- Minneapolis
Booth, Albert E Mi polis
+ Boreen, Clifton A................. Minneapolis
§Borgeson, Egbert J.. t. Paul
Borman, Chauncey N Minneapolis
Borowicz, Leonard A Minneapolis
Bowers, Gordon G Mi polis
Boynton, Ruth E Minneapolis
§ Bratrud, Arthur F.. ....Minneapolis
Bratrud, Theodore E. Minneapolis
t Breitenbucher, R. B.....Columbia, S. C.
$ Minneapolis
/Minneapolis
-Minneapolis
.Minneapolis
...Paynesville
-Minneapolis
-Minneapolis
-Minneapolis
-Minneapolis
.Minneapolis
am, -Minneapolis
Bushard, Wilfor .Minneapolis
Buzzelle, Leonard inneapolis
Cable, Morris L .Minneapolis
Cabot, Clyde M. /Minneapolis
ady, Laurence H. /Minneapolis
Cameron, Isabell L... .Minneapolis
Campbell, Lowell M ‘Minneapolis
§ Campbell, Orwood inneapolis
§ Caplan, Leslie.
§ Card, William H...
§ Carey, James B
§ Carlander, Lester
§ Carlson, Lawrence
Carlson, Leonard T..
Caron, Robert P...
Carr, Willi
+ Brooks, Charles N.
+ Brown, Edgar D...
Brown, Ian
Brown, William D
Minneapolis
inneapolis
/Minneapolis
Minneapolis
/Minneapolis
..Minneapolis
-Minneapolis
Challman, Samuel Alan........
§ Chavez, Demetrio A.... a
§ Chesler, Merrill D..
+ Chesley, A
§ Chisholm, Tague C
$ Christensen, Llewellyn E
Clark, Malcolm D
Clarke. Eric K
“Minneapolis
M; -
Minneapolis
Minneapolis
..Minneapolis
./Minneapolis
..Minneapolis
..Minneapolis
..Minneapolis
«Minneavolis
§ Cochrane,
Coe, John
§ Cohen, Bernard A....
Cohen, Evhraim B....
Cohen. Maynard M St. Paul
§ Cohen, Sumner Oak Terrace
Cole, James S ..Minneapolis
Colp. Edward Adams... ..Minneapolis
Condit, William H ..Minneapolis
Cooper, ...Excelsior
§ Cooper, . Minneapolis
Corniea, Albert D... ;
§ Correa, Dale H
§ Corrigan. Cyril J...
Cowan, Donald W...
Craig, M. Elizabeth...
Cranmer, Richard R.
Cranston, Robert W...
Creevy, Charles D
Creighton, Ralph H...
Culligan, Leo
Cundy, Donald T...
Cutts, George
Dady. Elmer E
Daggett, Donald R.
—+Amwrm
Rn ++ LRA
§ Danyluk, Michael...
§ David, Reuben......
§ Davis, Jay C
$ Davis, Witham: I........2.0.0.:0000..4... Mound
$
§
C—O — bmn
+ URLRIRIRAER IN ee
+
§ F
*
CRURIRIRin MR
RM
mun Mmm Aun mm
CREAR COR OR ODOR OD OR ORR = OD COR COD oO
rr tes
del Plaine, Carlos W
Devereaux, Thomas J.
DeWall, Richard
Dickman, Roy W
Diefenbach, Bu e
Diehl, Harold S
Dierker, Heinrich
Diessner, Henry D....
——,, Edward P..
lorge, ..Minneapolis
Dornbach, Robert A ane
ogg Harry B...Los Gatos, Calif.
orsey, George Minneapoli
Doxey,’ Gilbert L 1 am a
Doyle,
§Drake, Charles R....
Drill, Herman
uff, Edwi
Dummer, Donald J
Dunlap, Earl H
Dupont, Joseph A
Duryea, ilis M
Dutton, C. E
Minneapolis
ayzata
.-Minneapolis
Minneapolis
me J., Jr. Minneapolis
Minneapolis
.-Minneapolis
Minneapolis
Minneapolis
..Minneapolis
... Hopkins
Minneapolis
Minneapolis
Mi li
Excelsior
- a
1S
Minneapolis
pannenpene
-~-Minneapolis
Eder, W. P.
Mi lis
Ehrenber ;
g, ee: Mi poli
{a =
Minneapolis
inneapolis
: on
: vi
Eisenstadt, William S
Eitel, George
Ellison, David E Minneap
Ellison, Ellis. Mi
Emond, Albert
Emond, Joseph
Engel. Joseph P.
Engelhart, Peter C
Eagiuad, Elvia F Minneapolis
ngstrand, Oscar J Minneapoli
Engstrom, Denton P... ~“Sieneopelie
| ae ane —— O.............Minneapolis
rickson, urence F, ../Mi i
Erickson, Myron E Minneapolis
Erickson, Reuben F
Ericson, Reinhold M..
Esensten, Sidney
Evans, Edward T.
Evans, Robert D
Fahr, George
Fansler, Walter A
Feeney, John M
§Feigal, David W
Feinberg, Philip
Feinstein, Julius Y.
Fenger, Ejvind P.
Field, Charles W.
Fingerman, David
Fink, Leo Wm.
Fink, Walter H
Fisher, Isadore
Fitzgerald, D. F..
§Fjeldstad, Christia
leeson, William H....
*Fleming, Aloysius S
Fleming, Dean S...
Fliehr, Richard R
i per B
Omer, Leslie W.......c0cc...0<::! Minneapolis
Folsom, Louis B.. ee
Ford, William H.... ...-Minneapolis
Foster, Orley W Minneapolis
Fowler, Lucius Haynes. Minneapolis
Fox, Ponald P -Minneapolis
Fox, James Rogers. /Minneapolis
Frane, Donald B Minneapolis
Frear, R y Mi Li
Fredericks, George M
Freeman, Craig
Freeman, Donald W.
French, Lyle A
ae
LIS
apolis
Farmington
funn
pt Ree ~anmenpes
....Minneapolis
dison, N. J.
hai Hopkins
ame
Minneapolis
/Minneapolis
-Minneapolis
-Minneapolis
€ -Minneapolis
Friberg, Joseph B Minneapolis
Fried, Louis A Mi i
Friedell,
Friedell,
Friedman,
Friedman, Jack
Friend, Charles A Mi
Frost, John B Mi
Frost, Russell H
: Minneapolis
Louis Park
Minneapolis
Mi os
P
li
P
Mi li
§ Frykman, Howard M........... Minneapolis
Fuller, Alice H........ -Minneapolis
§ Funk, Victor K. Oak Terrace
Furman, Lucie Chr -Minneapolis
§ Gaard, Richard C.. .Minneapolis
§ Gallett, Lester E....... .Minneapolis
+ Galligan, Margaret M. -Minneapolis
*§Galloway, John B....... Minneapolis
§ Gammell, John H -Minneapolis
§ Garske, George L.. -Minneapolis
Garten, Josep -Minneapolis
Garvey, James T. -Minneapolis
Gaviser, David... ‘Minneapolis
Gibbs, Robert W.... ...Minneapolis
Giebenhain, John N.. Minneapolis
Giere, Joseph Rotesscsecs Minneapolis
Giere, Richard W Minneapolis
Gilbert, Maurice G.. Minneapolis
Gingold, Benjamin A.. ....Minneapolis
+ Girvin, Richard B... ....Minneapolis
§ Glaeser, John H..... Minneapolis
§ Goldberg, Isadore M Minneapolis
Goldman, Theodore I.........Minneapolis
Goldner. Meyer ...Minneapolis
Goltz, Robert W... e ‘Minneapolis
§$ Good, Hoff D........... ...Minneapolis
Goodchild, William R. ...Minneapolis
Gordon, Philip Minneapolis
. Louis Park
Gordon, Sewell S.
. Springs, Colo.
t§Grais, Melvin
Grant, Suzanne...............0000000 Minneapolis
§ Gratzek, Frank R. E. ...Minneapolis
Gray, Royal C hase ...Minneapolis
Green, Robert ea see ..St. Louis Park
§ Greenberg, Albert J...
§ Greenfield, Irving........
+ Greishiemer, Esther M..
Grimes, Marian.............
Grimm: ell, Francis J...
inneapolis
“Minneapolis
.Phila., Pa.
Minneapolis
Minneapolis
§ Gronvall, Paul R....... Minneapolis
Grotting, John K... ...Minneapolis
Gullickson, Glenn, ‘Ir asia Minneapolis
‘oe on, Frederick G.. /Minneapolis
Gushurst, Edward Guu... Minneapolis
Gustason, Harold T.. ..Minneapolis
Haberer, Helen inneapolis
Py Richfield
..Minneapolis
..Minneapolis
.(Minneapolis
..Minneapolis
Hagen, Kristofer...
Hagen, Wayne
Haggard, G. D...
Hall, Harry B...
Hall, Wendell H...
PMMA Tite LRAVA KMNUN+MM UMMA ws
-
Hallberg, Charles A Minneapolis
fannah, Hewitt ..Minneapolis
Hansen, Cyrus O... ..Minneapolis
$ Hansen, ..Minneapolis
Hansen, Minneapolis
t$Hansen, ‘alls Church, Va.
Hanson, Harlow _J..............3 Minneapolis
anson, Mi polis
Hanson, Svaxeerarcoeeen Minneapolis
Hanson, sh ./Minneapolis
Hanson, ..Minneapolis
Happe, Lawrence J............... Minneapolis
Harris, Leon D Minneapolis
Hartman, Evelyn E............... Minneapolis
$ Hass, Frederick M..... -Minneapolis
§ Hastings, DeForest R. -Minneapolis
§ Hastings. Donald W... -Minneapolis
§ Hauge, Erling T......... -Minneapolis
§ Haugen, George W.... (Minneapolis
Haugen, John A..... -Minneapolis
Hauser, Donald C... -Minneapolis
Hauser, George /Minneapolis
Havel, Robert J........ /Minneapolis
§ Haven, Walter K.... .Minneapolis
§ Hawkinson, Raymond -Minneapolis
§ Hay, Lyle J.. -Minneapolis
T Banyes, James’ M...0ssescccsoses Btiansapolis
§ Hays, Albert T Mi
§ Head, Douglas P.................0.0. Simaeapelis
§ Hebbel, Robert.........0.0..0...0.0. Minneapolis
t§Heisler, John J Mi poli
Hempel, Dean_J..............:.:0004 (Minneapolis
+ Hendrickson, John F.. -Minneapolis
§ Henrikson, Earl C.. ....Minneapolis
+ Henry, Clifford E.... ‘Kirksville, Mo.
Herbert, Willis L... Minneapolis
§ Hermann, _— W.. Minneapolis
+§Higgins, John H sVbabvecceskssueteee Minneapolis
ill, Earl Minneapolis
$ Hill, Elmer M........c00e0ciessesssess Minneapolis
T§Hillis, Samuel J.....East Bradenton, Fla.
Hinckley, Robert G............... Minneapolis
§ Hirshfield, oes R. Minneapolis
§ Hitchcock, Claude R.. Minneapolis
Hoffbauer, Frederick Minneapolis
§ Hoffert, Henry E........ ....Minneapolis
§ Hoffman, Roy A....... Minneapolis
§ Hoffman, Walter L. Minneapolis
§ Holmberg, Conrad J.. Minneapolis
§ Holzapfel, Fred C... Minneapolis
t Horns, Howard L..... ...-Minneapolis
§ Horns, ‘Richard G........0sssc.s000: Minneapolis
370
COUNTY SOCIETY ROSTER
+ Houkom, Bjarne..
§ Houle, Rollin &
Hovland, Melvin L...
Howard, Robert B.....
Howard, Solomon E...
§ Howell, Carter ws
Hudson, vee
§ Huenekens, =
§ Hultkrans, i «4 E.
~ Hurd, Annah
Hymes, Ch arles
Hynes, John E......
Ide, Arthur W., Jr..
+n
rs i East Africa
‘Minneapolis
JMinneapolis
/Minneapolis
-Minneapolis
FRIES Minneapolis
Hutchinson, Dorothy W.....Oak Terrace
Minneapolis
-Minneapolis
-Minneapolis
Johnson, Norman P.
Johnson, Youbert T.
§ Idstrom, Linneus G -Minneapolis
$ Ingalls, Edgar Gases -Minneapolis
+ Irvine, Harry G... ...-Minneapolis
§ Iverson, Rolf M.. /Minneapolis
§ Jacobson, Loren J.. ..Minneapolis
§ Jacobson, +“ eamel E........St. a Park
§ Jay. Alan R 4
Jefferies, “Minneapolis
t Jensen, ; ‘oslindale, M Mass.
§ Jensen, Harry (Minneapolis
*§ Jensen, Marius J minneapolis
§ Jensen, Nathan K... slis
Jensen, Reynold A................/ Minneapolis :
erome, Bourne
Jerome, Elizabeth ne
t Jeub, Robert P......... San Antonio, Texas
§ Johnson, PROEHNT T cvsnsesseseced Minneapolis
§ ohnson, August E... ....Minneapolis
§ Johnson, Emil W..... ....Minneapolis
Johnson, Frank E. ../Minneapolis
§ Johnson, Harry A. ...Minneapolis
*§Johnson, James A. ...Minneapolis
§ Johnson, John W. ...Minneapolis
*§Johnson, Julius. ........ ./Minneapolis
§ Johnson, Malcolm R... Minneapolis
§ Johnson, Norton T... ‘Minneapolis
§ Johnson, Reinald G. Minneapolis
§ Johnson, Reuben A. Minneapolis
§ Johnson, Robert E... ...Minneapolis
Johnson, Roger S...... ...... Wayzata
§ Kelly, John
+§Kennedy, Claude C..
+ Kennedy, Jane F......
§ Kerkhof, Arthur C.
Kiesler, Frank, Sri.
+ King, Edgar 7
King, Frances W.....
§ Kinsella, Thomas J...
.‘Minneapolis
Kistler, Alvin J....... .-Minneapolis
SB Kline, Mictiard’ B.....ssscssssoscoossscset Wayzata
§ Knapp, Miland E... -Minneapolis
§ Knight, LS Ad RE ree
Knight, Ray R..... polis
Knudsen, Helen L................. Minne eots
§ Koepcke. Gerald M... /Minneapolis
Koller, Hermann M... inneapolis
Koller, Louis R.... inneapolis
Koller, Robert L.. ‘Minneapolis
Korchik, John P.. -Minneapolis
Kosiak John, ae -Minneapolis
Kottke, Frederic ae -Minneapolis
§ Koucky, Rudolph W. -Minneapolis
§ Kovack, Freeman D... a
Kremen, Arnold J.....New York,
Krieser, Albert E..........:ccssssssssssssees te
§ Kucera, Frank J........ .... Hopkins
§ Kucera, William J., Sr... ‘Minneapolis
§ Kucera. William J., Jr.........Minneapolis
§ Kusz, Clarence ....Minneanolis
§ LaBree, Johm W....... “St. Louis Park
+§Lagaard. Sheldon M............. Minneapolis
Lajoie, John M... Min
§ Lamb, H. Douglas............... Minneapolis
§ Lang, Leonard A.... ... Minneapolis
t Lange, Robert D.....Washington, D. C.
§ Lapierre, Arthur P. Mi poli
§ Jones, Davi
t§ Jones, Herbert W., Jr...Brookline, Mass.
§ Jones, Richard H Minneapolis
§ Jones, William R..... ...Minneapolis
Josewich, Alexander ...Minneapolis
BPG. AMON Sis. cssescsssisosicscicosts Minneapolis
§ Judd, Walter H.......... Washington, D. C.
junl. John H Mi polis
§ Jurdy, Mitchell J............0..../ ‘Minneapolis
Kadesky. Harold B ..Minneapolis
§ Kalin, Oscar T.......... Minneapolis
§ Kallestad, Leonard L................... Wayzata
Kantar, Bruce L........ -Minneapolis
§ Kaplan, Harold A -Minneapolis
§ Kaplan, John J...... Minneapolis
§ Karleen, Conrad I Minneapolis
§ Karlen, Markle . Minneapolis
+ Katz, Yale : Minneapolis
Kaufman, Herse .-Minneapolis
§ Kelby, Giert Muu... Minneapolis
§ Kelly, Charles F polis
| anys. | Mines
- Minneapolis
*+Lazar, Henry Biase
t Leavitt, oe
7 Lebowske, Joseph A.
§ Leemhuis, Andrew J.
SRnrnwe
Tr
§
§
:
; Larson, Leonard M..
§
7
t
Lapierre, Jean T Minneapolis
Larsen, Frank W............0:000+: Minneapolis
Larson, Clarence M .-Minneapolis
Larson, Donald ; Minneapolis
Larson, Lawrence M -Minneapolis
Oak T Terrace
Larson, Loren _J..... .-Minneapolis
Larson, Paul N... Minneapolis
Larson, Ralph H.................c.sssesss0... Anoka
Larson, Roger C. Minneapolis
LaVake, Rae T... inneapolis
§ Laymon, Carl W.
— pe lis
finneay apolis
inne apo! is
-Minneat polis
-Minneapolis
Leiferman, Robert J.
Leland, Harold R...
Lenz, ‘Otto A........
Leonard, Lawrence J.
Leonard, Samuel...
Lerner, A. Ross...
Lewis, F. John...
Lillehei, C. Walton ‘Minneapolis
pergr: Bier 0: iséccccsvcscoxt Robbinsdale
t Lind, C. J., Jr...Ft. Sam Houston, Tex.
54 Lindberg, Arvid Crocs Minneapolis
§ Lindberg, Vernon L... -Minneapolis
§ Lindemann, Charles E...
g Lindner,
: Linner, Gunnar .......
no hd
§
§
: Lipschultz, Oscar. ... *
§
7
Sra
7)
Lindberg, Winston R.
-Minneapolis
Lindblom, ‘Maurice L...
-Minneapolis
-Minneapolis
Minneapolis
-Minneapolis
-Minneapolis
-Minneapolis
-Minneapolis
Minneapolis
-Minneapolis
Lindgren, Russell C...
Lindquist, Richard H...
§Linner, Henry P.
Lippman, Emanue Minneapolis
Minneapolis
§Litchfield, John T.. inneapolis
Litman, pAbraham DD sscsecssiesaned ‘Minneapolis
Lober, Minneapolis
So al y am | nee ee: St. Paul
§Logefeil, Rudolph C.. Minneapolis
Loomis, Earl A........ Minneapolis
Lott, Frederick H. ....Minneapolis
Lovett, Beatrice R...
Lowry, Elizabeth C...
Lowry, P T
Lowry, Thomas ....
..Minneapolis
Minneapolis
Minneapolis
§ Lueck, Wallace W... Minneapolis
§ Lufkin, Nathaniel H... Minneapolis
Lund, “George WY vies Minneapolis
Lundber; or Minneapolis
Lundblad, Roy A..... /Minneapolis
Lundblad. 7 W... (Minneapolis
Lundeberg, -Minneapolis
§ Lundquist, Minneapolis
+ Lynch, M Minneapolis
Lyons, James H Minneapolis
*§Lysne, Henry . Minneapolis
§ Lysne, Myron Minneapolis
Lysyj, Anatol ......... Minneapolis
Lyzenga, Anton G... Minneapolis
§ McCaffrey, F. John. ...Minneapolis
§ McCann, Eugene J..... ...Minneapolis
§ McCannel, Malcolm A.......Minneapolis
McCarthy, Donald...............0........ St. Paul
McCartney, James 6.............Minneapolis
$ McCormick, Donald P.........Minneapolis
+ McDaniel, Orianna .... ...Minneapolis
McFarland, Arthur H. Minneapolis
McGandy, Robert F.. Minneapolis
McGeary, George E..... inneapolis
on
mun
munum
§
8
McInerny, Maurice W...
McKelvey, John L........
McKenzie, Charles H..
McKinlay, Chauncey A...
McKinney, Frank
“Minneapos
McLaughlin, Byron H........... ne
McMurtrie, William B......... Minneapolis
McNeil, John _J.............. ./Minneapolis
McPheeters, Herman O..
McQuarrie, Irvine .......
MacDonald, Daniel A..
MacDonald, cae
MacKinnon, Donald Cc
Mach, Frank B
Minneapolis
Maeder, Edward C Li
§Maland, Clarence O............ Ainnespole
Mandel, Sheldon L Mi poli
Mankey, James C...........cesooo0s Minneapolis
Marking, George H... ..Minneapolis
Martin, George .Minneapolis
Martinson, RO Yiassccicdecsssesetseonoaes Wayzata
Martinson, Elmer AB a scseccesstcssesone Wayzata
Mattill, Peter M......... ..Oak Terrace
Mattson, Hamlin A. -Minneapolis
Maxeiner, Stanley R. inneapolis
Maxeiner, Stanley R., ‘Minneapolis
Meller, Robert Minneapolis
Merkert, Charles E............... Minneapolis
MINNESOTA MEDICINE
bor + con
mm ~
€
te
SSeS S3 23-22 222 222222222
+teoe
won
eee ne —beton em
noe
Kh hh od oh dd td od
=o
‘apolis
apolis
‘apolis
‘apolis
apolis
errace
apolis
apolis
Anoka
‘apolis
apolis
apolis
relsior
‘apolis
anolis
apolis is
apolis
apolis
apolis
apolis
apolis
apolis
nsdale
Tex.
apolis
apolis
apolis
apolis
apolis
apolis
apolis
apolis
apolis
apolis
apolis
apolis
apolis
apolis
apolis
apolis
apolis
Paul
apolis
apolis
apolis
rrace
apolis
apolis
apolis
apolis
apolis
apolis
apolis
apolis
apolis
apolis
apolis
apolis
apolis
apolis
apolis
apolis
apolis
1polis
apolis
apolis
‘aul
apolis
apolis
polis
rpolis
rpolis
polis
polis
apolis
polis
polis
polis
rpolis
polis
polis
polis
polis
polis
polis
polis
polis
polis
polis
polis
polis
polis
polis
yzata
yzata
§Merkert, George L................. Minneapolis
+ Merrick, Charlotte T... St. Paul
§ Meyer, Alvin J....... Minneapolis
#§Meyer, Ette L..... Minneapolis
Meyer, Robert J. ..Minneapolis
Michael, Joseph C. ..Minneapolis
§ Michel, Henry Bi... Minneapolis
§ Michelson, Henry E Minneapolis
+ Mickelsen, Emma F Minneapolis
§ Miller, Arden L..... Minneapolis
§ Miller, Harold E. Minneapolis
§ Miller, Hugo E....... Minneapolis
§ Miller, John Carleton... Minneapolis
§ Millett, D. _— ..Minneapolis
§ Milton, John S. ..Minneapolis
Minsky, Armen A... Minneapolis
§ Mitby, Irving ......... Minneapolis
$ Mitchell, Berton D.. Minneapolis
Mitchell, Edward C.. ..Minneapolis
§ Mitchell, Mancel T............... Minneapolis
+§Mixer, Harry W t. Hood, Texas
Moberg, Thomas D............... Minneapolis
ay
5
=}
®
cS
af
a
$ Moe, John H.......
§ Moehn, John T...
§ Moen, "Johannes oe Jr
+ Monahan, Elizabeth S..
§ Monson, Einer M......
§ Moore, Irvin _H...... Mi i
Moorhead, Marie . ./Minneapolis
§ Moos, Daniel J...... ..Minneapolis
§ Mork, PEST Woes issn cnceocesassespacccseens Anoka
§ Mork, Frank E...... teow Anoka
Morrison, Charlotte J.
§ Mosser, Donn
§ Moyer, Leonard B
§ Mulholland, William M.
Minneapolis
Minneapolis
M
Murphy, dmund P......... inneapolis
+ Murray, Elisabeth Merrill....Minneapolis
Muske, Marvin M........... inneapolis
§ Musty, a dp. inneapolis
§ Myers, Jay A....... Minneapolis
§ Myhre, James A. Minneapolis
§ Naslund, Ames W.. Minneapolis
Nauth, Bernard S.. Minneapolis
§ Neal, Joe | SAR UB EU Ors S St. Paul
§ Neary, Richard P......
Nelson, Bernette G..
Nelson, Bernice A...... inneapolis
Nelson, C. Barton..... Minneapolis
Nelson, Carleton A.. nneapolis
§ Nelson, Edward N Minneapolis
§ Nelson, Harvey... Minneapolis
§ Nelson, Lloyd S.. Minneapolis
Nelson, Maxine O.. Minneapolis
Nelson, Maynard C..... Minneapolis
Nelson, O. L. Norman........Minneapolis
Nelson, Wallace I...... Minneapolis
Minneapolis
Minneapolis
Minneapolis
Minneapolis
Minneapolis
Minneapolis
Nerenberg, Samuel
Nesbitt, Samuel .........
Nesset, Lawren B..
Nesset, William D
Neumaier, Arthur ....
Neumeister, Charles A...
Nice, Charles M.......
Noonan, William J
Noran, ‘Axel S. N..
Noran, Harold H..
Nord, Robert E......
Nordin, Gustaf T.....
Nordland, Martin, Sr.
Nordland, Martin, Jr.
Nudell, Gerald .....
3 Nydahl, Malvin J..
$ Nylander, Emil G.....
O'Donnell, James E.
§ O’Phelan, E. Harvey
* Oberg, Carl Mu...
lavs, Ol
$ Olsen, > de George
§ Olson, Alton C.........
$ Olson, Carl J......
Olson, C. Kent.
Olson; Detlof
+ Olson, Olof A........
Olson. Rolland A..
Po
K4
pen, E. Gerhard..
Oppen, Melvin G.
Opstad, Earl T... Oak Terrace
Palen, “Benjamin J -Eeeverrerrre! Minneapolis
Papermaster, Theodore C.....Minneapolis
Park, Wilford E ..Minneapolis
Pattee, James cis Minneapolis
Peluso, Charles Rov..scssssss- en
Peppard, Thomas A polis
erlman, Everett C..... eo eee os
Perlman, Herschel Minneapolis
Peteler, Jennings C. L......... Minneapolis
Petersen, Deane A Minneapolis
Petersen, Glenn I Mi
etersen, Peter C Mi lis
May, 1955
am
Cron
GEL. SL Lhe She Os
ab es
is Pollock, David K..
Fur
§
RRM AER RIA
Fun
HON
CRUR Mt LL LR VL LL + IRL Sh LP
num
mn ~s
§
+
8
§
8
COUNTY SOCIETY ROSTER
Ammummm mumrynr
n
Petersen, William E...
Peterson, Alice H..... Minneapolis
Peterson, Henry ...... i i
Peterson, Herbert W...
Peterson, Nordahl P.............Minneapolis
Peterson, Oliver H....... Minneapolis
Peterson, C3: A SSB Minneapolis
Peterson, Palmer A................ Minneapolis
Peterson, Peter E.....
Peterson, Willard C.
Petit, Julien V......
Petit, Leon | ae
Minneapolis
‘Feyton, * William T...
Phelps, Kenneth A...
Piasha, A i Anoka
‘Plass, Herbert F. R. i i
;$Platou, Erling S...
Pleissner, Karl
§ Plimpton, Nathan.
Pohl, John PB. MM...
Polzak, Jacob A.......
‘Poppe, Frederick H.
Potek, David ........
Dotter, Moher: Wesicscssicsscicsuene Hopkins
Pratt, Fred J., Sr... i i
Pratt, Fred J., Jr... Minneapolis
Preston, Paul J..... Minneapolis
Price, William E.....................Minneapolis
Priest, Robert E Minneapolis
§Prim, Joseph A..............:004 Minneapolis
Proffitt, William
Proshek, Charles E...
Quello, Robert O.....
Quiggle, Arthur B...
§Quist, Henry W., Sr...
Quist, Henry W., Jr...
Ransom, H. Robert..
Reader, Donald R...
Regnier, Edward A.
Reif, Harold A.....
Reiley, Richard E.
tm
Minneapolis
...Minneapolis
Minneapolis
Reitmann, John H............ ee Anoka
Remole, William D. Minneapolis
Resch, Joseph A. Minneapolis
Rice, Carl O....... Minneapolis
Rice, Frank B Minneapolis
Rice, Fred A............. Minneapolis
Richdorf, Lawrence F. Minneapolis
Rieke, Wellington W................... Wayzata
Rigler, Leo G............. Minneapolis
Riordan, Elsie M. ...Minneapolis
Risch, Ronald E... ...Minneapolis
Rizer, Dean K.. ...Minneapolis
Rizer, Robert I.. Minneapolis
Robb, Edwin F.....
Robbins, Owen F.
Roberts, Byron H.
Roberts, Lewis J...
Roberts, Stanley W.
+$Roberts, William B...
Robinson, Cartland
Rocknem, Robert E.... Minneapolis
Rockwell, Curtiss V. Minneapolis
Rodda, Fredk. C..... Minneapolis
Rodgers, Richard S... Minneapolis
Romness, Kenneth Boies Mound
Rosander, Phyllis ....... Minneapolis
Rosenbaum, David L............. Minneapolis
Rosendahl, Frederick G Minneapolis
Rosenfield, sg a B......... Minneapolis
Rosenow, "John H Minneapolis
Rosenwald, Reuben M.........00.00.. Anoka
Ross, Alexander | = i i
Rossen, Ralph X......
Rotenberg, Robert J..
Rothnem, Morris S......
Rucker, William H
Rud, Norman E.....
Rudell, Gustaf L...
Russeth, Arthur }
Rusten, Elmer M.
Rydburg, Wayne C..
t. Cyr, Harry M.,
St. Cyr, Kenneth J...
Sadler, Wm. P., Jr
Safirescu, Sorin R........
Saliterman, flv I
Samuelson, Samuel .....
Sandt, Karl E...........
§ Sawatzky, William A..
Sborov, Abe M
Schaaf, Frederick H. K...
Minneapolis
Minneapolis
Minneapolis
Minneapolis
Minneapolis
Minneapolis
Minneapolis
Minneapolis
Minneapolis
Minneapolis
Minneapolis
Minneapolis
Minneapolis
-Minneapolis
haar, Frances ....Minneapolis
Schaefer, Kenneth F............. ae
Schaefer, Wesley G
Scheldrup, Ni. H........c.ccssss000. Minne aie
Scherer, Leslie Raymond.....:Minneapolis
Scherling, Sidney S.... inneapolis
Schiele, Bertrum -Minneapolis
Schissel, Gregory A M poli
.
§ Schmidt, W. Robert.............. Minneapolis
t Schmitt, S. C........... Los Angeles, Calif.
Schneck, Jack I.... ..Waukesha, Wis:-
§ Schottler, Max E.... ....Minneapolis
§ Schroeder, Albert J Minneapolis
Schultz, Alvin L..............000« Minneapolis
Schultz, J. Harold.................. Minneapolis
Schultz, Peter J......
Schulze, William M
Schumacher, John W..
Schwartz, E. Robert...
-Minneapolis
Schwartz, Virgil J...
-Minneapolis
Scott, Horace G... Minneapolis
Seaberg, 1 1g, ee Minneapolis
Seham, Max Minneapolis
Seifert, Milton H Mi poli
Seljeskog, Sigsbee R.............. Minneapolis
Semsch, Robert D Minneapoli
LRULRURMR RUUD
Shandorf, James F.. Minneapolis
Shaperman, Eva -Minneapolis
§ Shapiro, Sidney K.................. Minneapolis
§ Sharp, David inneapoli
§ Shaw, Howard A............002 Minneapolis
§ Shea, Andrew W
Sheldon, Warren Ne .nccccancaed Minesbots
§ Sher, Lewis. seeses....--
§ Sherman, Lloyd F......
Shillington, Maurice A.
Shronts, John |
Sidell, Franklin D...
§ Siegmann, William C..
Silas, Ralph M........
Silver, John D...
+§Simons, Jalmar .......
-Minneapolis
-Minneapolis
-Minneapolis
..Minneapolis
‘Butte, Mont.
....Minneapolis
-Minneapolis
-Minneapolis
.Minneapolis
Simonson, Donald B.. ..Minneapolis
+ Simpson, *Ellery De. Phoenix, Ariz.
§ Sinykin, Melvin B... Minneapolis
Siperstein, David M -Minneapolis
§ Sisterman, Thomas J. Minneapolis
+ Sivertsen, Andrew .... ....Minneapolis
+§Sivertsen, Ivar. Minneapolis
§ Skjold, Arthur C....................; Minneapolis
Smiley, John T.........
§ Smisek, Frank M. E.
Smith, Adam M......
Minneapolis
-Minneapolis
-Minneapolis
§ Smith, Archie M......... -Minneapolis
§ Smith, Baxter A. * -Minneapolis
§ Smith, Graham G... -Minneapolis
7 Smith, Homer R... ....Minneapolis
+ Smith, Margaret :.. .Gardena, Calif.
§ Smith: Norvin Rs... Willmar
§ Smith, Theodore S$
Smith, William T.....
Soderlind, Ragnar T.
Solhaug, Samuel B...
Solvason, Harold M.
Spain, W. Thomas...
Spano, Joseph P......
Spencer. Bernard J
Spink, Wesley W....
Sponsel, Kenath H
-Minneapolis
-Minneapolis
-Minneapolis
/Minneapolis
....Minneapolis
Princeton, N. 3.
as Minneapolis
‘Minneapolis
mm my
Minneapolis
+ Spratt, Charles N ‘Minneapolis
ae, Hopkins
§ Stanford, Charles E... .Minneapolis
Staub, Henry | Je -Minneapolis
§ Stelter, Lloyd A.... ‘Minneapolis
§ Stennes, John L ....Minneapolis
Stenstrom, Annette E. T..... Minneapolis
§ Sterrie, Norman A............... Minneapolis
Stewart, Marvin J.
-Minneapolis
§ Stewart, Rolla J..... me
-Minneanolis
+§Stiegler, Farrell S... St. Paul
§ Stoesser, Albert V.. ‘Minneapolis
§ Stoltz, Robert €............. Minneapolis
+ Stomel, Joseph... Blackfoot, Idaho
Stone, Stanley Ri ee Minneapolis
+ Strachauer, Arthur C. .Minneapolis
§ Strickler, Jacob H..... -Minneapolis
§ Strom, Gordon W..... -Minneapolis
Stromgren, Delph T... -Minneapolis
§ Stromme, William B. ‘Minneapolis
Strunk, Clarence A...... ‘Minneapolis
§ Sturses, Robert L Minneap
*§Subby, — Walter. Mi polis
ukov, Marvin Mi lis
Sullivan, Ra —- Me... “Minneapolis
Sullivan. R is
Swain, hee vi Diccssscetsvseoedl Minne pots
Swanson, Roy E..... -Minneapolis
§ Sweetser, Horatio B.... Minneapolis
§ Sweetser, Theodore H., Sr...Minneapolis
Sweetser, Theodore H. Jr...Minneapolis
+ Sweitzer, Samuel E inneapolis
+§Swendseen, Carl G... ... Starbuck
§ Syverton, Jerome 3 { Minacapelis
Tam, Ernest C
§ Tangen, George M
LY eae
Taylor, Joseph H... ..Minneapolis
§ Tenner, Robert J... ..Minneapolis
t Thomas, George E. Minneapolis
Thomes, A. Boyd.... ..Minneapolis
Thompson, Arthur Mi poli:
371
Thompson, Willis H
Thorsen, David
Thorson, Stuart V
Thysell, Desmond M
Tichy, Fae Y
Tingdale, August C
Tinkham, R
Titrud, Leonard A
Tobin, John D...
Trach, Benedict B
Trow, James E Mi
Trow, William H Mi
Trueman, Harold Mi p
Tsai i} Oak Terrace
§ i Minneapolis
§ Tudor, Richard B.... -Minneapolis
+§Turnacliff, Dale D St. Paul
Twomey, Joh hn E Mi lis
§ Ude, Walter H
#§Ulrich, Henry L.
§ Ulvestad, Harold S
§ Undine, Clyde A
Vermund, Halvor
Vik, A. Elliott...
§ Vitols, -:
/Minneapolis
M Minneapolis
§ Wahlquist, Harold F. -Minneapolis
Waldron, Carl W... Hopkins
§ Wall, Tt. eae Minneapolis
COUNTY SOCIETY ROSTER
§ Walonick, Albert L St. Louis Park
§ Walsh, Francis Mi polis
§ Walsh, William T Mi poli
Wangensteen, Owen H
ard, Percy A
§ Watson, C. Gordon
Watson, Cecil J
+ Weaver, Myron Mc....
§ Re Edgar A
Roscoe C
; Webber, Richard J...
er, "Lowell W
Weisberg, Rapheal J...
Wendland, John P
erner, George
Wesolowski, Stanley P
West, Catherine C
Wetherby, Macnider meno
Wheeler, Robert W ee
§ White, Asher A polis
White, S. Marx Mi poli
§ White, Willard D Mi polis
§ Whitesell. Lloyd A... sMinneapolis
§ Widen, Wilford F... Minneapolis
Wilder, Kenneth W ‘Minneapolis
§ Wilder, Robert I Mi polis
St. ae Park
...Minneapolis
...Minneapolis
Minneapolis
Minneapolis
+§ Wilder, M., Jr Minneapolis
§ Wilken, Poul A ....Minne anolis
+ Willcutt, Clarence E... Phoenix, Ariz,
+ Williams, Robert New York, N. Y,
Winchell, Paul Minne: apolis
Winther, Nora M. C ...-Minneapolis
§ Wippermann, Frederic F ‘Minne apolis
+$Witham, Carl A inneapolis
§ Wittich, Frederick W.......... -Minne: apolis
Wohlrabe, Arthur =" -Minneapolis
§ Wohlrabe, Cabo -Minneapolis
Wolf, -Minneapolis
Wolter, Frederick H. -Minneapolis
§ Wright, Thomas D inneapolis
§ Wright, Wale S.... ‘Minne apolis
$ Wright, William -Minneapolis
Wyatt, Oswald S -Minneapolis
Wynne, Herbert M. N. -Minneapolis
Yivisaker, Ragnvald S... -Minneapolis
Yoerg, Otto W i
Yue, Wen
Zahrendt, O. Lewis..
Zarling, V. Richard.
Zaworski,
Zierold, Arthur A..
Zinter, Ferdinand A.
Ziskin, Thomas. ........0.0.000.... Minneapolis
mum
SRY MA Sh Sh
KANDIYOHI-SWIFT-MEEKER COUNTY MEDICAL SOCIETY
President
Jacoss, Douctas L
Secretary
OpsaHL, LAwreNCE J
Allison, David D
Anderson, Richard E
Austrian, Sol
§ Bosland, Howard
+ Chadbourne, Wayn
Chunn, Stanley S
¢ Daignault, Oscar
+ Danielson, Karl A.. Litchfield
Danielson, Lennox Litchfield
Dille, Donald E Litchfield
Douglas, Kenneth W Sandstone
Eberley, Tobe S
§ Ellinger, Willmar
Frederickson, Alice Willmar
Regular meetings, third Thursday
Annual meeting, third Thursday in November
Number of Members—51
§ Gaebe, Clara City
Giere, Silas W Benson
§ Gilman, Lloyd C
Griffin, R.
Guy, Jack A...
§ Hinz, Walter E..
§ Hodapp. Robert
§ Holm, Donald F
Houts, Joseph C
Jacobs, Douglas L....
§ Jacobs, Johannes C..
Kaufman, Edward J...
Lundblad, Robert M...
McCarthy, Austin M..
Macklin, William E., Jr.
§ ‘Michels, Roger P..
Nash, Eldore B
*§O’Connor, Daniel C Eden Valley
Olson, Gregory M Litchfield
§ Opsahl, Lawrence J.. .... Willmar
Ostling, Burton C ——
¥ Penhall, Fletcher W.. ;
§ Peterson, Willard E
Porter, Oliver M
Proeschel, Ray K.
§ Rorem, Joseph A.
Rygh, Harold N..
hnell, Frederick S...
+§$Solsem, Fredk. N. S
rum, F, T
Sutheriand, W.
Thompson, A. Henry.
Wagner, Norman W..
Wilmot, i
Wilmot, Harold E
LYON-LINCOLN COUNTY MEDICAL SOCIETY
President
BODABKS, (ALBERT: A .0.ic.c:.5.000sssscens0000- Tyler
Secretary
Purves, Georce H
Bodaski, Albert A
Eckdale, John E
Ferguson, William C..
Ford, Burton C
..Marshall
k ;
Hedenstrom, Philip C................. Marshall
Regular meetings, last Tuesday of each month
Annual meeting, last Tuesday of October
Number of Members—26
Helferty, John K Boise, Idaho
Hermanson, Peter ..Hendricks
Hoidale, Andrew D.. ... Tracy
Johnson, C. Percy.... ... Tyler
Kreuzer, Titus ...Marshall
Larson, Milo H.. Lake Benton
Lee, Norman J
Monson, Leonard J
Murphy, Joseph E
Peterson, Kenneth A..................- Marshall
McLEOD COUNTY MEDICAL SOCIETY
Purves, G. Harland
Remsberg, R. R...
Smith, Lloyd A
Thill, Leonard J..
Thompson, Carl O..
+§Vadheim, "Alfred L..
+§Valentine, Walter H..
olstan, Simon D...
Workman, Warner
Yaeger, Wilbert WG hesecccine snes Marshall
Regular meeting, third Thursday of each month
President
SmytH, Joun J
Secretary
Hvuesert, Dan W
Bretzke, Carl O..
§ Brink, Donald M
Carroll, John J....
T Clement, John B
372
Annual meeting, third Thursday in December
Number of Members—20
§ Floersch, Adrian J
§ Griebie, Grant L
§ Howell, Milton .....
§ Huebert, Dan W...
§ Jensen, Alvin M... ...Brownton
§ Klima, William W... Stewart
§ Lippmann, Elmer W.... Hutchinson
§ (Peterson, Kenneth H Hutchinson
Sahr. Walter G
+ Scholpp, Otto W...
§ Selmo, Joseph D
§ Sheppard, Charles G. -Hutchinson
§ Smith, G R Hutchinson
Lester Prairie
§ Struxness, David F.
§ Truesdale, Clark W Glencoe
MINNESOTA MEDICINE
ee
eoveccecs © cavtonecnconeos
at -1--tant--he ee ee ee | Laok
i ae:
ee es
600202 conto ©=—- Gon CONCORD
wn
concorconcon— HCO”
+4000
=
ne: 1polis
neanolis
x, Ariz,
ps oe
Nneapolis
neapolis
neapolis
neapolis
neapolis
neapolis
neapolis
neapolis
neapolis
neapolis
neapolis
neapolis
neapolis
neapolis
neapolis
neapolis
Terrace
neapolis
neapolis
neapolis
neapolis
neapolis
neapolis
Valley
tchfield
Nillmar
khoven
Villmar
Villmar
\twater
Villmar
ppleton
illmar
\twater
tchfield
Spicer
Villmar
.ondon
tchfield
Benson
tchfield
chfield
ndricks
.Tracy
/illmar
salaton
idricks
«Tyler
.Tracy
nneota
.Tracy
arshall
hinson
hinson
rwood
hinson
hinson
Prairie
lencoe
lencoe
ICINE
COUNTY SOCIETY ROSTER
MOWER COUNTY MEDICAL SOCIETY
Regular meeting, last Thursday of every month
President
Pererson, STANLEY C
Secretary
RosENTHAL, F. Harowp
§ Anderson, David P., Jr.
§ Anderson, Harold i.
§ Anderson, Wallace R
§ Barber, Tracy
§ Cronwell, Retkad J
Elliot, Harold J
§ Fisch, Herbert
§ Flanagan, Leonard G..
§ Grise, William B
Annual meeting, December
New officers elected in November
Number of Members—36
+ Havens, John G. W
+ Hegge, Olav H
+$Hegge, Rolv S
+ Hertel, Garfield E
§ Hesla, "Inman A Austin
§ Leck, Paul C. Austin
3 Lommen, Peter A ae
McKenna, Elizabeth M
§ McKenna, Jay K
+ Melzer, George R...
§ Miller, Herman................G
Morse, Morton P
§ Nesse, J. A
Osborn, Donald O
Peterson, Stanley C.
Robertson, Paul A
Rosenthal, F. Harold
Sargent, E. C., Jr
Schneider, Paul a.
Seery, Thomas M.
Sheedy, Chester L.
Stahl, George
Thomson , M.
Twiggs. Leo F
Van Cleve, © om P., Jr
Wilson, Franklin C.......Ft. Belvoir, Va.
Wright, Robert R Austi
NICOLLET-LE SUEUR COUNTY MEDICAL SOCIETY
President
Otson, DuaNe O
Secretary
Griptey, Joun W
+§Aitkens, Herbert B.
§ Canfield, Wayne W.
§ Covell, Walter W
§ Curtis, Rauen
t Ericson, Swan Le Sueur
Gridley, John W Arlington
Regular meeting, not scheduled
Annual meeting, December
Number of Members—27
§ Grimes, Burton P
Henry, Martin R...
§ Hiniker, Peter J
Johnson, Hobart C
Kabrick, Ola A
Kath, Reinhard H
§ Lenander, Mellvin E.
Limbeck, Donald A....
Maertz, William F..
§ Nilson, Helmer J
§ Olmanson, Edmund G
§ Olson, Duane O
t Orwoll, Harold S..
§ Rudie, Clifford N
Schulberg, Verne A
§ Sjostrom, Lawrence E
§ Sonnesyn, Nels N
§ Strathern, oe a S..
+§Strathern, Fred P...
Traxler, J. Felix
§ Wohl hlrabe, Clarence F..North Mankato
OLMSTED-HOUSTON-FILLMORE-DODGE COUNTY MEDICAL SOCIETY
Annual meeting, first Wednesday in November
Regular meeting, first Wednesday every second month starting with January
President
JacKMAN, Raymonp J
Secretary
WeLiMAN, WiLuiAM E
Abbott, Albert R
heer, aes W. P...
§ Aitelde, “Daniel E
Rochester
g Abts, 75 Jacob Caledonia
§ Allen, Rochester
t Amberg, Ry Rochester
§ Andersen, Howard -Rochester
§ Anderson, Mark J... -Rochester
Anderson, Markham Rochester
Anderson, Milton W. -Rochester
Ardan, Nicholas I., J -Rochester
§ Atmore, William
§ Baggenstoss, Archie
Bain, Robert C
Bair, Hugo
§ Baker, Georse S
+$B; aker,
$ Baker, Hilier L, Jr x
Baker, Russell L int avlicld
t§Balfour, Donald C Rochester
§ Balfour, William M Rochester
§ Banner, Edward Arthur Rochester
§ Bargen, J. Arnold .... Rochester
§ Barker, Nelson W ....Rochester
Barlow, Loren C.. ....Rochester
Barnes, Arlie R .... Rochester
Barry,” Maurice J., Jr... ....Rochester
Bartholomew, Lioyd G. -Rochester
§ Bastron, James A Rochester
t§Bayard, Edwin D
Scott a Force Base, Illinois
§ Beahrs, Oliver H Rochester
Beddow, Ralph M.. -Rochester
t Benedict, William L Rochester
erge, Kenneth G Rochester
+ Berkman, David M
§ Berkman, John _
§ Bernatz, ‘Philip E
Betts, Charles S...
§ Bickel, William Harold.
+ Bige low, Charles E
Black, B. M. ochester
t Bonnet, John D....Clovia, New Mexico
Bossard, “John Wesley.......-.-..- Rochester
May, 1955
-Rochester
Rochester
-Rochester
Rochester
Rochester
‘Rochester
‘Rochester
‘Rochester
Rochester
Number of Members—517
, Botham, Richard James
7 Bowers, Dorrance
Bowes, Donald Earl...
§ Boyd, David A., Jr
§ Braasch, John WwW
+§Braasch, William F
Brackett, Ralph D
§ Brandenburg, Robert O
raun, Robert A
Broadbent, James C
Broders, Ww
§ Brown,
§ Brown, :
§ Brown, Rochester
Rrown, ili a Rochester
Brown, Roland G Rochester
Brunsting, Louis A Rochester
Buie, Louis A Rochester
Bumpes Frank Thatcher Rochester
Burchell, Howard B.... ..Rochester
Burke, Edmund C
Rochester
..Rochester
..Rochester
Rochester
Rochester
Rochester
Rochester
Rochester
..Rochester
“Rochester
Rochester
Rochester
Rochester
ORR COR Oe we
Comal, "Donal i Cc
§ Carr, David T
§ Carryer, Haddon McC...
hapin,
§ Childs, Donald S., Jr..
§ Christensen, Norman
§ Clagett, Oscar T
Clark, Edward C
§ Clark, Leslie ar a
Clifton, © cg ie
Colby, M shea
Collins, Ca
§ Comfort, Mandred W Rochester
Compton Russell F Rochester
Cook, Edward N... Rochester
Rochester
..Rochester
Rochester
ochester
Rochester
Counts, Rober rt N ..Rochester
§ Coventry, Markham B Rochester
¢ Craig, Richard M Rochester
§ we Winchell McK
rumbley, J James J., Jr...
on Ormond S
§ Dahlin, David C
pring Valley
w+---Chatfield
.... Rochester
Rochester
Rochester
Rochester
Rochester
t Daly, David
§ Daugherty, Guy Wilson
avis, Austin
vis, Charles Truman Rochester
§ Davis, Rochester
avis, H. L Rochester
Davis, Rochester
Dawe, le J Rochesti
ies William H
Decker,
§ Devine, Kenneth D.
§ DeWeerd, James _H....
§ Diessner, Cm Roy.
f Dines, David E
ixon, Claude F
Doane, Joseph C
§ Dockerty. Malcolm “
Dodge, Henry W.
Doehlert, Charles a2 ".
Donin, J. Winnip: g, Man., Canada
§ Donoghue, Francis Edmund... ‘Rochester
Douglass, E
Doyle, James R
+ Drips,
Rochester
ochester
Rochester
Rochester
Rochester
Rochester
West Point,
N. Y.
+ Dyer, john’ Allen
t Dykstra, Peter Calvin
§ Eaton, Lealdes M
Rochester
Edwards, J Rochester
§ Elkins, Earl C Rochester
§ Ellis, F. Henry Rochester
Elstner, Howard L Rochester
Emmett, John L ochester
+ Ensrud, Earl Richard Rochester
§ Frich, To hn Rochester
Erickson, Doraid J Rochester
Erickson, John G... ....Rochester
.... Rochester
Rochester
Rochester
Rochester
Rochester
....Rochester
....Rochester
roy
...Rochester
+§Eusterman,
+ Evarts, Arrah B
Ewen, Ed
§ Faber, ohn E E
; Fabi, Mario Nestor.
Faucett, Robert ~
Faulconer, Albert
Feldmann, Floyd va
Fergeson, James
§ Ferris, DeWard 3
Rochester
373
COUNTY SOCIETY ROSTER
Keith, Haddow M
Keith, Norman M..
O’Leary, Paul A
O’Neil, Richard L
Kennedy, Roger L. J.. ....Rochester t§O”’ Shaughnessy, Edward J
§ Rochester
i
Rochester ; Kent, George B oenix, Ariz. amp Kilmer, N, he
§ K
t
§
Fieldman, E. Jay. Rock
-ANochester
Figi, Fredk. A
Fly, Orceneth A
Foss, Edward pie
§ Fricke, Robert E.
+$Gambill, Carl M
Gambill, Earl E
Garrett, Charles M.,
Rochester
. ochester
Rochester Kernohan, James W Rochester § Odel, Howard Mo... Roche ter
Rochester ye John R Rochester § Olsen, Arthur M.. -Roch ester
Rochester Rochester Olson, Ernest A.. a sland
Rochester ... Joliet, Illinois Olson, Gran »ncord
Rochester t Onifer, Theodore M.
iely, James Patrick
Kiely, Joseph
Kierland, Robert R
t§Gastineau, Clittord F N York,
ee |
+ Gatchell, Frank G
Rochester
a William D
Gee, Vernon Ray.
Geraci, Joseph Emil
Rochester
ochester
§ Ghormley, Ralph K
+§Giffin, ning Z
Giffin, Mary E
Rochester
Rochester
Rochester
§ Gifford, R. W., Jr
t§Ginsberg, Robert I
Silver Soring,
aryland
Rochester
7 Glew, ogg Bainbridge
Goff, Joh
Rochester
ochester
yp gee Norman P.....Bethesda, Md.
Jen...
Grattan, Robert T
Rochester
Rochester
Rochester
§ G
t sea Joseph B
§
Gray, Howard
Green, Paul A
Greene, Laurence
Rochester
..Rochester
Rochester
§ Griffin, George D. im Jr.....Rochester
Grindlay, John H
Groch, Sigmund N....
Rochester
..Rochester
Rochester
Rochester
t$Hagedorn, Albert Berner.
§ Haines, Samuel F
Rochester
Wiesbaden,
Germany
New Rh
Rochester
§ Hallberg, Olav Erik
Rochester
t§Hallenbeck, Dorr F
Hallenbeck, George A.
Hanlon, i
§ Hanson, Norbert Orrin,
Hardy, William M..
Hare, Robert Lewis.
§ Harrington, Stuart
§ Harris, Lloyd E
Hartman, Howard R..
§ Havens, Fred Z
Hayles, Alvin Beasley
Healy, John
eck, Frank
Heilman, Dorothy M. H
~~ Diego, California
Heilman, Fordyce
Heimark. John J
(Rochester
-Rochester
-Rochester
-Rochester
.Rochester
-Rochester
-Rochester
-Rochester
-Rochester
Riverside,
California
Rochester
-Rochester
-Rochester
Rochester
Rochester
*+Helland, Gustav M
+ Helland, John W
t+§Helmholz, Henry F..
+$Hempstead,
Hench, Phili
Spring Grove
Spring Grove
...Rochester
Rochester
Rochester
§ Henderson, Baraca DS apsesacecs
§ Henderson, John W..
Henderson, Lowell..
*+§Henderson, Melvin
+ Henderson, Robert Earl.
Hepper, Norman G..
+ Hewitt, Edith
+$Hewitt, Richard M..
ig pl wr ©...
, John Roger..
Hollenhorst,
Holman,
Holt, Allen Howard..
Horton, Bayard T...
Howell, Llewelyn P...
Hunt, Arthur
Hunter, James
Ivins,
Jackman, Raymond
acks, Quentin D....
Jackson, es L
§ Janes, Joseph M
RUMANIA uA
‘ ohnson, Carl
Johnson, Ralph B
Jordan, Stanley
Joyce, George L
i Judd. Edward i Laws
* Juergens, John L...
Kearns,
Huizenga, Kenneth A...
fohnson, a yg McF
Johnson, Einer W., Jr...
-Rochester
....Rochester
.... Rochester
....Rochester
....Rochester
...Rochester
....Rochester
....Rochester
....Rochester
Rochester
} Keating, Francis Raymond Jr.
374
Rochester
Kilby, Ralph A Rochester
Kirby, Thomas J., Jr Rochester
§ Kirklin, B. R
§ Kirklin, John W
Klakeg, Clayton H...
t Klass, Donald W
¢ Knight, James Harry..
Knutson, Lewis A
§ Koelsche, Giles
§ Kroboth, Frank J.
a Harry G
§
Rochester
Rochester
ochester
Krout, alii
Krusen, Frank H...
+ Kuhn, * Arthur B |
Kunkel, Melvin G ..Rochester
§ Kunkel, William M., Jr Harrisburg,
§ Kvale, Walter F
Lacy, Paul E
§ Lake, Clifford F.
Taw, William M
Lazarte, Jorge A Rochester
§ Leddy. Eugene T Rochester
_ hee, *Ph hilip R Rochester
ifton Forge, Va.
Rochester
Rochester
Rochester
§$ Lipscomb, Paul R.
§ Litin, Edward M
Lofgren, Karl A.
*§Logan, Archibald H
§ Logan, George B
t Lommel, Jerome G.
§ Love, J: Grafton...
§ L
t
‘Rochester
oche ter
Lundsten, Lloyd R.
undy, John Ss.
Lynn, Thomas E.
McBean, J. B Rochester
t McClure, Rensselaer W. Jr.,
Lawrence, “Kansas
(McConahey, —_— M. ., Rochester
McDonald, John R
McFarlane, John
McKaig, Carle B
t McKee, Robert E....
McKibben,
§ MacCarty,
t§MacCarty, William C.
+ Madalin, Herbert E
§ Madison, Mitchell S..
§ Magath, Thomas B
Manger, William M.
Mankin, Harold T -Rochester
Mankin, Haven W Rochester
Mann, Frank D Rochester
§ Martens, Theodore G Rochester
§ Martin, George M -Rochester
§ Martin, William J.. -Rochester
Masson, Duncan M.. -Rochester
+§Masson, James C.. -Rochester
Masson, James K.. -Rochester
Mathieson, Don R.. -Rochester
ayne, John G -Rochester
Mayo, Charles William -Rochester
Menges, Charles G. H.. -Rochester
Merritt, Wallace A.. -Rochester
Meyerding, Henry W Rochester
Miller, Roland D Rochester
Miller, William J
Mills, Stenhen D...
Moersch, Frederick P..
Moersch, Herman J......
Montgomery, Hamilton
Moore, Chris H Rochester
Moores, Kenneth D Rochester
Morlock, Carl G Rochester
Mortensen. J. D Rochester
Mulder, Donald W
Mussey, Mery E
Mussey, Robert D...
Myers, Cortland III..
Myers, Richard L
Myers, Thomas T...
Myre, Theodore T
Nehring, Jesse P
Neuman, Harold W...
Nichols, Donald R...
Norris, Neil T
O’Keefe,
“Bryan, Texas
.....Rochester
-Rochester
-Rochester
Rochester
Austin, Texas
Rochester
-Rochester
Mm SR rawr wm
Preston
Rochester
ochester
Rochester
Rochester
Rochester
Onsgard, L. Kenneth..
Opfell, Richard W
§ Osborn, John E
Owen, Charles A. J
t Paris, Jaime
Rochester
Miamisburg, Ohio
Rochester
..-Rochester
Rochester
‘ -Rochester
Parkhill, -Rochester
Parkin, “Themes -Rochester
t§Parsons, William B., Jr
Coronado, Calif.
Patrick, Robert T ochester
§ Paulson, John A ...Rochester
$ Paynter, Camen R
Great Falls, Montana
Peake, Charles O Rochester
Pearce, Francis M. ochester
Pease, Gertrude
Pemberton, Albert H..
t Pemberton.
$ Peters, Gustavus
Petersen, Arthur B...
Petersen, Magnus C
Peterson, Willard H
Pettersen, George R
Pettet, John
Piper, Monte C... e
Place, Virgil Alan.. ..-Rochester
Polley, Howard F... ..-Rochester
Pool, Th Rochester
Powelson, Myron H.
Great Lakes, Illinois
Powers, Fred Rochester
Prangen, Avery DeH...
Pratt, George
San Francisco, California
Pratt, Joseph Hyde, Jr Rochester
Price, Mary L
Prickman, Louis E
Priestley, James T...
Pruitt,
a. Donald E....
Randall, Lawrence M...
Randall, Raymond V
Rasmussen, Waldemar C
Rawls, Thompson T
Reifsnyder, William Henry III
Rochester
Reitemeier, Richard J Rochester
ReMine, William H., Jr Rochester
Rice, Roberta G.....Grand Island, Nebr.
Rigler, Robert Rochester
Ringer, Merritt Rochester
Ripepi,
Risser, Stewartville
Rodenbaugh, Fredrich Hase, Rochester
Rogne, William Gustav... ‘Spring Grove
Rome, Howard P... Rochester
Rooke, E. Rochester
Rothwell, Walter S Rochester
Rotnem, Orville M.....lowa City, Iowa
Rovelstad, Randolph Rochester
Rucker, Charles W ..Rochester
Ruggieri, Bartholomew A ..Rochester
Rushton, Joseph G ..Rochester
Ryan, Robert Frank... ..Rochester
§ Rynearson, Edward ..Rochester
Sabanas, Alvina O Rochester
Sabin, Frederick paepenee.. Rochester
§ Salassa, Ro M...... ochester
+§Sanford, j ed H. ..Rochester
Sauer, William G.. -Rochester
Sayre, George P Rochester
§ Scheidel, Alois McK. Rochester
Scheifley, Charles H. -Rochester
+ Schirger, Alexander Rochester
§ Schmidt, Herbert William Rochester
Schwartz, Carl A Rochester
Schwarz, Bert E -Rochester
Schweiniurth, J. D Rochester
§ Scudamore, Harold H. -Rochester
t aoa. James Elbert III -Rochester
t Selby, John B Rochester
§ Seldon, Thomas H.. Rochester
7 Seybold, Herbert M.. -Rochester
Shick, Richard M.. Rochester
Shields, -Rochester
Shocket, -Rochester
Sibley, John Adams. Rochester
Siekert, R. G Rochester
t Silver, “Arthur W Rochester
ORR KO
mun hth ee
*
we
MINNESOTA MEDICINE
wuows
ws
Ce le
fenlenloplc7is7iSziwlololelelele}-—)
ae
Ser © ©
r+ conecreceecocoseostorecs cos ++
eg nes res ey 9 ed Se) ed EI > > > > > Se
=
COUNTY SOCIETY ROSTER
ochester § Simonton, Kinsey M Rochester Svien, Hendrik J Rochester § Weed, Lyle A Rochester
ochester Skaug, Harold M Chatfield Symmonds, Richard E Rochester + Weeks, Richard E Rochester
ce + Skrdla, Willard B.. Rochester Tani, George T Rochester Wehr, B
r, N. J § Slocumb, Charles H Rochester Taub, Robert G Rochester
Ochester Smid, Arthur C Rochester Thompson, Gershom J Rochester
ye tHSmnith, a. Rochester ¢ ce —* a
> Asian arry ochester 5 illisch, Jan ochester
Concord ith, Lucian A Rochester § Uihlein, Alfred Rochester as
ochester i Meredith P. Rochester Underdahl, Laurentius O Rochester § Wente, Harold A Rochester
Houston ith, Reginald A Rochester Utne, R -Rochester § Westrup, John E
ochester i OR a Rochester ; vi 2 -Rochester + Wilder, Russell M......... re Md.
g, Ohio ‘ . ; Rochester Rochester t Wilkinson, George R., J Rochester
ochester H Rochester Van Patter, | 1 eattle, Wash. Williams, "George E Rochester
ochester ever, New Haven, Conn. § Vaughn, Louis D Rochester Williams, Henry L Rochester
ochester Spencer, Jean A Rochester Verby, John E Rochester *+Williams,
ochester Sperl, Michael P., Jr.. Rochester Virnig, Hildegard J Rochester § Wilson, Robert B Rochester
ochester Spittel, John A., ‘Ir. R § Wagener, Henry P -Rochester Wilson, Theodore W. Rochester
ochester Sprague, Randall G. J Was , James M.... .. Harmony § Wilson, V. O Rochester
: E Starr, Grier F e n Z -Rochester Winter, Malcolm D., Jr Rochester
, Calif, —_—, es H *+§$Wakim, Khalil G. -Rochester Wollaeger, Eric E Rochester
ochester + Stein, Harold § Walters, Waltman... Rochester § Woltman, Henry Wm. F Rochester
ochester ao Richard M t ba — wees — +§$Wood, Harry G Rochester
tevens, } ard, Bert ochester : ? ai
fontana $ Stickney, J. M § Ward, Louis ; t being George F... oe
ochester bettwell, George G... § Watkins, Charles : § Woolner, ochester
»chester Stillwell, George K.. : Watson, Eleanor J. “ t Wuest, ? :
chester § Stroebel, Charles F., Jr.. Watson, John R : , California
chester Struthers, A. Morgan. s Waud. Robert E.. : § Young, Henry H Rochester
chester Stuhler, Louis G § Waugh, John M.. fe ‘ Zimmer, J. Rochester
chester 5 Weber, Hany NM-.............:.5. Rochester
—
chester
chester PARK REGION DISTRICT AND COUNTY MEDICAL SOCIETY
alley
—— (Douglas, Grant, Otter Tail and Wilkin Counties)
chester °
chester Regular meeting, last Wednesday even numbered months
— Annual meeting, December
chester
Illinois Number of Members—64
Xtc President § Hanson, LeRoy W Pelican Rapids § Nelson, Roy Fergus Falls
S Esme, Roser Di Fergus Falls + Harris, Evelyn va Seattle, Wash. § Nelson, Wilburn O. B. 7 _
. . ecretary eegaard, illiam ...Alexandria § e reckenridge
— SHaver, Warp Fergus Falls § Heiberg, Emmett A.. ..Fergus Falls Ostergaard, ing... Evansville
chester ; § Helseth, Hovald K.........Pelican Rapids Palmerton, Ernest S Fergus Falls
neste Arndt, Harry W Detroit Lakes t Hom, Leong, Y. W ; Parson, Lillian B.. .Elbow Lake
acta Baker, Jeannette iL... ..Fergus Falls North Chicago, Illinois Parson, Lester R a
= sien Baker, Norman H... ..Fergus Falls § Hunt, William Fergus Falls + Patterson, William L.
haste + Blakey, Adam R.... Osakis § Jacobson, Clifford W Breckenridge + Paulson, Theodore S.
estar § Boline, Clifford A... § Kevern, Jay L Henning Rockwood, Philo H.
aia + Boysen, Peter. Kippen, 1 Be enri § Sanderson, David J ...Fergus Falls
chester { Cain, James H. § Korda, Henry A i i } Satersmoen, Theodore....Pelican Ravids
heat § Carlson, Carl E.... Leibold, Herbert H. ‘Parkers Prairie § Sather, Edgar R Alexandria
© ara Clifford, George W cas § Lewis, Henning § Schamber, Walter F..
pnester § Combacker, Cc ...Fers ; wis 3 Henning Schoeneberger, P.
t§Daehlin, . si ye, Fredk. A Carlos § Shaver, Ward
§ DeKruif. ..Fergus § ; = “Fergus Falls § Sommerness, a
§ Doms, Vernon A... ....Elbow Lake Daniel, S. P... _.-Fergus Falls § Stemsrud, Harold Alexandria
Emerson, Edwin E. Osak § Mahowald, Aloys ...Fergus Falls Sutton, Harris R .... Hoffman
§ Estrem, Ralph L.... fe ‘ Miller, William Anthony § Tanquist, Edwin J.. Alexandria
i Estrem, — og ae be m si Nes Bs = ; boy — oes re .
Geiser eter J ortensen, Nels Minneapolis § Wasson, Loren F.. .Alexandria
§ Hamlon, John S.. ..Fergus Falls § Mouritsen. Glenn J.. ..Fergus Falls + Wray, William E Campbell
ad Hanson, Everett C.........New York Mills + Naegeli, Frank Fergus Falls
‘hester
Grove
ester RAMSEY COUNTY MEDICAL SOCIETY
ester
— Regular meetings, last Monday each month except June, July, August
hester Annual meeting, last Monday in January
hester Election in November
rester
— Number of Members—485
hester President § Beech, Raymond H § Brodie, Log D Pau
hester Franacan, Harotp F . Paul § Beck, Harvey O... + Brown, John C. .Los ean Calif.
hester Secretary § Beer, John J... Buckley, J. J St. Paul
hester Gisss, . Paul § Bell, Charles C. § Bulinski, Theodore J. St. Paul
hester Executive Secretary § Bellomo, James. § Burch, Edward | yas ‘ St. Paul
hester Otson, Mrs. ELEANOR . Paul Bellomo, John 7 Burch, F .St. Paul
— $ Adair, Albert F. Jr... _ § Benepe, James L.. 3 § Burklund, Edwin D. St. Paul
— : t§Ahrens, Albert E.. . Paul + Bennion, P. H .....Isway, Montana § Burlingame, David A... St. Paul
vane Ahrens, Robert M Paul § Bentley, Norman P.. : St. Paul § Burmeister, Richard O. St. Paul
tenia t$Alden, J. F., J St. Paul Bernier, M. J North St. Paul +$Burns, Robert M St. Paul
a § Arnquist, Andrew S... St. Paul § Bernstein, William C St. Paul Burton, Carl G St. Paul
auch § Arny, Frederick P . Paul § Bicek, Joseph F $B St. Paul
ce § Art, Philip K Paul 7 Binger, Henrv E.. Phoenix, Ariz. § jn Herbert H...
— § Aurelius, J. Richards Paul Black, Earl J § Cain, Clark 2
cre § Auman, Duane R... Se) Paul +§Bock, Rolland A. St. Paul Callahan, Francis F.
ester § Babb, Frank S St. Paul + Boeckmann, Egil.. St. Paul Canine, James L...
row § Bacon, Donald K.. Se Dant § Bolender, Harold_L.. St. Paul § Carley, Walter A...
reste § Baer, Walter Se Baal Bonnello, Frank J.. St. Paul *§Carroll, William C...
— § Balcome, Milton M. St. Paul § Borg, Joseph F St. Paul Cedarleaf, Cherry B....
rester Barnett, Joseph M... ...St. Paul Bouma, Lewis R.... St. Paul § Chadbourn, Charles R
ester t Baronofsky, Ivan D St. Paul ma ge Florence , St. Paul § Chatterton, Carl
rester + Barsness, Nellie O. St. Paul § Brand, George D.... . Paul § Christiansen, Andrew...
nester Bauer, St. Paul + Bray, Elwyn R . Paul § Clark, Henry B., Jr
ester "Heals, Hugh.... LaJolla. Calif. § Briggs, John F..... St. Paul Cochrane, Byron B...
lester Beck, Charles x RN ey ‘aoe St. Paul § Broadie, Thomas E St. Paul Coddon, Walter D
CINE May, 1955 375
Cohen, Ellis N
§ Colby, Woodard L..
. Wallace H
Coleman, John B..
+ Collie, Henry G
t§Connoliy, C
St. Petersburg,
Fort Belvoir,
Connor, Charles E S
§ Cook, Carrol
§ Cooper, Charles C
§ Countryman, Roger S...
§ Craig, David M
$ Critchfield, nie R...
Crowley, James H...
§ Crado, Vincent D...
§ Crump, James W....
§ Culligan, John M
ulver, G
Davis, Edward V
Dawson, James .
Decker, Charles H...
§ Derauf, Benjamin I
§ Deters, Donald
+ Dickson, Thomas H
§ Drake, Carl B....
§ Dunn, James N
§ Earl,
§ Earl
yee
Edwards,
§ Edwards,
Eelkema,
§ Eginton, Charles
+ Ely,
Emerson, Edward C
§ E :
§ Endress,
§ Enroth, Oscar E
t+ Ernest, George C. H
St. Petersburg,
§ Ersfeld, Murray P St.
+ Eshelby, E. C
t Evert, John A., Jr
Farkas. John V....
*+§Ferguson, James C...
§ Fesler, Harold H....
Field, Anthony H
t Fifer,
Fink,
§ Fisher,
§ Flanagan, Harold
§ Flannery, Hubert F
Flom, R. P
§ Flynn, L. L.. J
+ Fogarty, Charles W..
§ Fogarty, Charles W.,
§ Fogelberg, Emi
§ Foley. Frederic E. B
Forsythe. J:
Fox, LeRoy
§ Freeman, Charles D.,
Freeman, Geral
§ Freidman, Louis L....
§ Fritz, Wallace L....
§ Froats, Charles W....
§ Fuller, Benjamin F
Galligan, John J...........
§ Garbrecht, Arthur W...
§ Gardner, Walter
Garrow, Douglas M...
§ Gehlen, Joseph N....
*§Ghent, Charles H....
Gibbs, Edward C....
§ Gillespie, Delmar R.....
t Gilsdorf, Donald A....
§ Gleason. Wallace A...
Goldsmith, Joseph Ww
+§Goltz, Edward V.
§ Grant. Hendrie W
§ Gratzek, Thomas
§ Grau, PR. :
Gray, Edward F
**#Gruenhagen, Arno
Hagen, Paul
Hakanson, Erick Y
§ Hall, Barnard
§ Hammes, Ernest M., Sr...
§ Hammes, Ernest M., Jr...
*+Hammond, James F
Hannon, Donald W....
§ Hanson, Harold B....
Harbaugh, John T
§ Harmon, Gaius E....
§ Hartfiel, William F..
Hartig, Marjorie
376
Paul
. Paul
. Paul
t. Paul
. Paul
. Paul
St. Paul
t. Paul
. Paul
. Paul
. Paul
St. Paul
St. Paul
. Paul
t. Paul
St. Paul
. Paul
. Paul
. Paul
. Paul
. Paul
t. Paul
. Paul
St. Paul
. Paul
St. Paul
St. Paul
. Paul
. Paul
. Paul
. Paul
. Paul
. Paul
Lake
St. Paul
. Paul
. Paul
. Paul
. Paul
. Paul
. Paul
. Paul
. Paul
. Paul
. Paul
. Paul
. Paul
COUNTY SOCIETY ROSTER
§ Hartley, Everett C.
§ Hauser, Victor P.
§ Hayes,
§ Heck, William W
Hedenstrom, Frank G..
Heili ig, Willi im va
Henderson 3G...
at gp’ "Wien i...
Hensel, Charles N
Herman, Samuel M
Herrmann, Edgar T
— Myron
§H al Andrew W..
Hilger,
ilger,
Hil er,
Hiniker,
Hochfilzer, John
Hodgson, Jane
Holcomb, Oo. W
Hollinshead, W.
Holmen, Robert W..
Holt, John E
§
t
H Heron, Roy C
t
§
Anm—- Mm
Hopkins, George W
Howard, Merrill A..
Howard, Willard S..
§ Howe, Newell
§ Hullsiek, Harold E..
§ Hullsiek’ Richard B..
§ Hunter, Murray H...
§ Hurwitz, Milton M..
Ide,
Ikeda,
+ Ingerson,
William C..
§ Ellery
§
;
Carolyn A..
§
§
§ Herbert _W..
S|
St. Paul
§ Kamman, Gordon R
Kaplan, David H
Karon, Irvin M
§ Kasper, Eugene M..
Katz, Louis J L
Keefe, Rolland
Kelly, James H..
My peat John V..
§ Kelse Chauncey
§ — ck, Emmett V..
§ Kenyon, Thomas
§ Kesting, Herman
St. Paul
+ King, George L
+§Klein,
§ Knutson,
Koza,
Krezowski,
§ Kugler,
§ Kuske, Albert
Kusske, Rradlev W
§ Kusske, Douglas R
Kvitrud, Gibert
§ Lannin, Bernard G..
§ Lannin, Donald
Larrabee, Walter F
Larson, Eva-Jane
Larson,
Larson, Kenneth R..
Martin L..
Morris H
+$Leahy. co ate
§ Leavenworth, R. O.,
r <e
Leavenworth, Richard O;. jr.
M St
§ Leick, Richard
Leitch, Archibald
§ Lepak, John A
+ Lerche, William....
§ Leven, N. Logan.......
§ Leverenz, Carleton W..
Levin, Bert G
Levitt, George X..
§ Lick, "Charles L
Lick, William J., Jr..
§ Lien, Richard
t Lightbourn, Edgar _L..
Lilleberg, Norbert A
§ Lindell,
§ Lynch, Francis W
§ McCabe, James S
§ McCain,
McCarthy, Joseph J
+ McClanahan, James H
White Bear
McClanahan, Thomas S
§ McCloud, Charles N
wan,
§ McGroarty, Brian J
a Eva Elaine...
§ McNeill,
F Mackoff, Sam M...
*§$Madden, John F....
Madland, hgree S.
§ Malerich, . Anthony.
§ Malerich,
olis, hilip M
Man » Roger
§ Martin, Dwight L
§ Martineau, Joseph L.
Mateo, Guillermo.
Matthews, ames H...
nag illiam F
§ Meade, John R
§ Mears, Burtis J
§ Medelman, John
Melancon, Joseph
§ Menold, —
erner,
Miller a G
t Miller, William T
Anthony. Jr..
Miller, Z. R
§ Milnar, Frank J
Mintz, Charles M.
H ‘Mishek, Charles J.
a,
Molander,
§ Monahan.
§ a
+ Moquin, A.
+ Moren, J. Adelaid
Moriarty, Berenice
Moriarty, Cecile
§ Muller, Albrecht E
Neibergs,
Neibergs,
¢ Nelson, Louis A., Sr
Nelson, Louis A., Jr....
Nimlos, Kenneth
7 Nimlos, eee O...
§ Noble,
§ Noble,
+ Nollet, Donald J.
Nuebel, Charles i:
Nye, Katherine
Nye, Lillian L
O’Brien, J. C
+ O'Connor, Loren J
O’Kane, omas
§ O’Reilley,
§ =.
§ Ogden,
Justus.
§ Olsen, Ralph L
Charles A....
§ Ostergren, Edward W
§ Ouellette, Alfred J
§ Owens, Frederick M., Jr
Paulson, Elmer
Paulson, Wallace J...
Pearson,
§ Pearson, Malcolm M
Pedersen, Arthur H....
(Peltier, Leonard F.
Peterson, David B...
§ Peterson,
§ Peterson,
Peterson,
Peterson.
—, 4
lotke, Harry
Polski, Paul G
Quattlebaum,
§ Ralph, James R
t Ramsey, Walter
Rasmussen, Ramby
§ Ravits, Harold G
§ Rea, Charles E.
Reid, James a
§ Reif, Robert W..
Richards, Albert
§ Richards, Ernest T.
Richardson, Edward J.,
§ Richardson, Robert J...
. Paul
Lake
Lake
MINNESOTA MEDICINE
PNMNRNRNPAPYRPAN
a
An nn
nn
cwww
THOSE OAAO
COUNTY SOCIETY ROSTER
Rick, Paul F. W . Paul + Skinner, Harvey O . Paul Van Bergen, Frederick H.....Minneavolis
Rinkey, Eugene St. Paul § Smisek, Elmer A ...St. Paul Varco, Richard L St. Paul
§ Ritchie, Wanace P . Paul § Smith, Vernon D. E. ..St. Paul Veirs, Dean M....... St. Paul
§ Ritt, Alb Paul § Sn der, e é St. Paul Veirs, Ruby J. St. Paul
Roach, . Paul § Sohlberg ..St. Paul § Venables, Alexander . Paul
St
= St
§ Rogers, Sydney F... St. Paul Sommerdorf, Vernon _L.. ... at. Paul t§von Amerongen, W. : at.
¢ Rogin, Norton ——t Ben ..9t. Paul § Waas, Charles =
t
St.
Rolig, David H. St. Paul St. Paul § Walker, Arthur E.
Rollie, Orris O St. Paul a ..St. Paul Wall, James O....
St. Paul $s E . Paul t§Wallinga, Jack.... Antiene, Galt
R gi .St. Paul § i" Paul § Walsh, Edward F
sRothschild, Harold J.... .St. Paul New vores 'N. ¥. § Walter, Clarence W.
_ Clarence J., . Paul L St. Paul Warren, Cecil A
Cc . Paul Sprafka, J ..St. Paul Watson, P. Theodore....
Mg George N Calif. § Steinberg, Charles L. . St. Paul § Watson, William H. A...
sarinks, Alan P. St. Paul Sterner, Donald C St. Paul § Watson, William
Ryan, John J St. Paul +§Sterner, Ernest G. .5t. Paul Watz, Clarence E
Ryan, Joseph M... .St. Paul § Sterner, E. R ..St. Paul § Webber, Fred L...
Sarnecki, M. M St. Paul § Sterner, John J... St. Paul ; Weis Benjamin A.
Satterlund, Victor L.. St. Paul Stewart, Alexander ..St. Paul § Weisberg, preoriee. es
t§Savage, Francis J St. Paul § Stolpestad, Armer H. ..St. Paul § Wenzel, Gilbert P.
§ Schmidtke, Reinhardt L St. Paul § Stolpestad, Herbert L... ..St. Paul Westover. E..
eapolis Schoch, Robert B. J St. Paul § Strand, Jack W ..St. Paul Wetzel.
t. Paul schons, St. Paul § Strate, . Paul *+Wheeler, Merritt W.
t. Paul Schroeckenstein, Hugo F St. Paul Straus, M. I Paul + Wilkinson, Stella L
t. Paul §Schuldt, Fredk. C St. Paul § Strem, Edward L . Paul + Williams, Arthur B...
t. Paul §Schulze, Albert G St. Paul § Sturley, Rodney = .. St. Paul § Williams, Clayton K...
+. Paul Schwyzer, Hanns C. .St. Paul + Swanson, John A ..St. Paul § Williams, John A
t- Paul Schwyzer, Mar: .St. Paul Swanson, Lawrence J. ..St. Paul Williams, Richard A.
ribault § Scott, Eugene .St. Paul § Swendson, James J ..St. Paul Wilson, J.
Paul Sekhon ohan_ S. . Paul Swenson, "Donald B. ..St. Paul § Wilson, James V....
+. Paul Sells, Richard Bien . St. Paul § Teisberg, John E ..St. Paul Winnick, Joseph B....
. Paul + Senkler, George E.. . Paul Thompson, Floyd A . Paul Witthaus, Melvyn E.
§ Setzer, Hobert J St. Paul Thoreson, M. C. Bernice... So. St. Paul § Wolff, Herman 1 ae
. Paul § Tifft, St. Paul Wolkoff, H. J
+ Shell Joh § Tongen, Lyle A.... ..St. Paul Word, Harlan L..
i , Calif. § Tracht, Robert R... ..St. Paul t Yamamoto, Joe
Short, St. Paul Travis, es S - Youngren, Everett R
Siegel, Clarence Paul § Tregilgas, ..So. St. Zachman, Leo L
§ Simons, Leander T . Paul Tregilgas, Richard B. St. Zagaria, James F
Singer, Benjamin J... St. Paul t Tucker, Jolyn S........ a § Zimmermann, Harry B
§ Skinner, Abbott. . Paul Ubel, Frank A
RED RIVER VALLEY MEDICAL SOCIETY
(Kittson, Mahnomen, Marshall, Norman, Pennington, Polk, Red Lake and Roseau Counties)
Regular meeting—four each year
Annual meeting, December or January
Election in January
Number of Members—61
President § Greene, Daniel E Thief River Falls *§$Norman, John F
THysELL, Haron R Crookston § Haugan, Norman R Crookston § Oppegaard, C. I
Secretary *+$Henney, William H.. ....McIntosh Parker, Philip J
SatHER, Russet, O Crookston § Hirsh, ...Crookston Pumala. Erven E
*+Adkins, C. M Thief River Falls + Hollands, illi Reff, Alan R... Crook
Anderson, Wallace E. Clearbrook § Holmstrom Carle is Roholt, Christian... McIntosh
Behr, Orlo K .Crookston Janeck ‘Baudette Rydland, Arne D... Foley, Alabama
Berge, David oO § Kinkade. Byron R. Ada Sather, Edgar E... F
Berlin, Anthony S. Hallock *+Kirk, George P ...East Grand Forks Sather, George A...
Biedermann, Jacob Klefstad, Lloyd H Greenbush Sather, Richard N.
Boyer, George pl do Kostick, William R. i Sather, Russell O
Bratrud, Edward. .Thief River Falls Loken, Theodore Schossow, George W.
Brink, Adlai A Baudette Lund, Anthony J.. Skozerboe. Rudolph...
Cameron ohn H. Crookston Lynde, Orrin G Stadem, Clifford
Clapp, Hubert D Fister § McDonald, William J Starekow, Milton.........
Covey, Kenneth W McHardy, Bryson R s Stensgaard. Kermit L... Thief River Falls
Dale, Lester N McKaig, Alan M......... Red Lake Falls Stewart,
§Delmore, John L.. Rosez Martin, George B.....Thief River Falls Thysell,
Delmore, | ee | 2 Mercil, illi —— Uhley, Charles G es
Downing, William $ Mueller. Donald R... Van Rooy. George T...Thief River Falls
Erickson, _Eskil Halstad $ Murn, Thomas Wendt, H. Paul Thief River Falls
Feigal, William M.....Thief River Falls +t Nelson, Henry E Wikoff, Howard M..
Flancher, Leon H Crookston Nelson, Kenneth L Wiltrout, Irving
t+ nm
RR IRA SA SRSA
+ LRUMRINTn
RENVILLE-REDWOOD COUNTY MEDICAL SOCIETY
Regular meeting, third Tuesday of each month
Annual meeting, November
Number of Members—24
President § Ceplecha, Stanley F Redwood Falls § Johnson, William E
Pierce, Rosert B ivi § Cosgriff, James A., S Oli § Knoche, Harvey A
Secretary _ Cosgriff, i h
IESSNER, ARDELL W § II Redwood Falls
§ Alcorn, William J § ... Sacred Heart
§ Anderson, Chester A a § A ; —
sesen, Daniel H.... ...-Olivi inn, s .
§ Billings,’ Ralph E... i Leo O + a ™ Joseph W.
Brand, William A § ey Fairfax § Strauchler, Jonas
§ Hinderaker, Harris Bird Island
May, 1955
COUNTY SOCIETY ROSTER
RICE COUNTY MEDICAL SOCIETY
Regular meeting, third Tuesday of each month
Annual meeting, third Tuesday in October
President
Mever,. Pau, F
Secretary
NIELSEN, ALVIN
Faribault
Northfield
§ Beaton, J. Northfield
§ Bruhl, pinz H... Faribault
{$Dungay, Neil S ...Northfield
§ Engberg, Edward J... .....Faribault
Francis, David W... -Morristown
§ Furlow. William L. Faribault
*§Hanson, Adolph M... Faribault
+ Huxley, Fredk. R Faribault
Number of Members—33
§ Kennedy. George L Faribault
§ Kolars, James J Faribault
¢ Kucera, Louis B...Colo. Springs, Colo.
§ Lende, Norman Faribault
t Lexa, F. |
§ Mears, Robert F...
Meyer, Fred’k C...
Meyer, Paul F....
t Meyer, Robert P.
§ Moses, Royal
§ Nelson, Ernest J...
§ Nielsen, Alvin M
§ Nuetzman, Arthur ..Faribault
§ Orr, Burton A
Peterson, D. H
§$ Roberts, Stanley
§ Robilliard. Charles M.
Rumpf, Carl W
Rysgaard, George M.
§ Stevenson, Frank W...
Street, Bernard
Studer, Donald J
§ Traeger, Carl A..
§$ Weaver, Paul H.. .
§ Wilson, Warren E.................... Jor
ae Faribault
Northfield
Fe ar’ ~~
ST. LOUIS COUNTY MEDICAL SOCIETY
(Carlton, Cook, Itasca, Lake and St. Louis Counties)
Regular meeting, second Thursday except July and August
President
Fawcett, KeitH R Duluth
Secretary .
Haavik, Joun E Duluth
Exec. Secretary
Gilbert, Mrs. Margaret B Duluth
§ Ahrens, Curtis F
Andrew, William F...
Antonow, Arthur M.
Arko,
Asta, J
§ Athens,
§ Aufderheide,
§ Backus, Reno
§ Bagley, Charles M...
Bagley, Elizabeth C.
§ Bagley, William R.
Baich. Velemir M....
§ Bakkila, Henry E
§ Bardon, Richard..
§ Barker, |
Barnes, Richard E...
+ Barney, Leon A...
§ Barrett, Earl E...
Bartzen, Peter J.
§ Becker, Fredk.
§ Benell, Otto E
Bepko, Marie K..
Berdez,
§ Bergan, R. O
§ Bianco, Anthony J.,
+§Bianco. Anthony J.,
+ Binet, Henry E
§ Rlackmore, Sidney C
§ Bloom. Joseph
¢ Bolz, J. Arnold.
Boman, Paul G
Bonner. John
Bouchelle, McLeo
Bowen, Robert L.
+ Boyer, Sam H.
§ Boyer, Sam H. Jr.
§ Braun, Ohrmundt
§ Bray. Philip N
‘Brockway, Roger
§ Brooker, Warren J.
§ Buckley, Robert Peers...
Burleigh, we cS:
§ Rutler, Tohn K
Cantwell, William F...International Falls
* Chapman, Theodore L Duluth
§ Chermak, Francis G...International Falls
§ Christensen. Clarence H
Ciriacy, Edward
§ Clark, Clarence L
Clark: Elizabeth A.
§ Clark: Ivan T.
§ Coll, James J
¢ Collins, Arthur N......
Colosey, Frederick J
t§Conley. Francis W
+ Cope, Hershel E
§ Coventry, William D
378
sue OChester
a
Annual meeting, second Thursday i in January
Election, second Thursday in December |
Number of Members—279
Cowan, George M
Detien, Edward D
§ Dickson, Franklin H., Jr...
Doxsee, George C
Doyle, George C....
§ Dwyer, John J
Emanuel,
Eppard, Raymond
Erickson, George P.......
Erickson, Vernon D
Erskine, Gordon
Evensta, John B
Farley, Frank G
§ Fawcett, Keith R...
§ Fellows, Manley F...
t Ferrell, Clarence R..
§ Feuling, |
Fifield, Malcolm
§ Fischer, Mario McC
§ Fisketti,
§ Flynn, {
§ Fredericks, Merriam G...
French, Bayard T
§ Fuller, Josiah
8 Gillesnie, Malcolm G
8 Goldish, Daniel R,
§ Goldish, Robert ,
Goodman, Charles...
§ Gowan, Lawrence R
+ Graham, Archibald W
§ Grahek, Jack P.
Granauist, Richard D
§ Grinley. Andrew
rohs. William H.
albert,
+ Halliday. #
Halper, Rernard..
+ Haney, Claude
Hansen, Robert F.
anson., Ernest O
Harrington, Verno
§ Harris, Carl N...
+§Hatch, Walter E
*+Haves. Michael F..
§ Hedberg. Gustaf A...
Heiam, William C...
§ Hildine, Anderson 1 C..
+ Hill, Fredk. E....
Hill, |
Hirschboeck, Frank J..
§ Hoff, Herbert O
Hoover, Norman W.
§ Honkom. Samuel S...
Hult. John E...
Hutchinson, Henry
t Indihar, Tohn E....
Treland. Gerald W.
Trwin, Homer R.....
J lacobson, Clarence
§ Tacobson. Ferdinand C..
Jensen, Thorvold
Jeronimus, Henrv J.
Tessico. Charles M...
Joffe, Harold H
Johnsen, Henry A., a Virginia
P Johnson, Edward A... Vena
: Johnson, Karl E
+
ohnsrud, Luverne W.
Johnston, Henry W
§$Tohnston, Rufus O....
Jolin, Francis M..
Tuntunen, Roy R..
§ Kelley, Walter.
§ Kelly, Albert C....
. Kelly. Robert T....
ry
: Klein, William A
§ Knanp, Frank N
§ Knoll, W. V...
§ Kohlbry, Carl O
Koskela, Lauri E...Shaker Heights. Ohio
§ Kotchevar, Frank R
Kozberg,
§ Krueger,
§ LaBree,
*+§Laird, Arth
§ Latterell, Kenneth E...
Law, Harrison E
¢ Leek. Joseph H
Lepak, Francis J..
Leppo, N. Erkki A.
pal Stanley W.
§ Litman, Samuel N
*tLovshin, William C
+ McCarty, Paul D....
oy, Mary
+ McDonald, hehdiaii
§ McDonald, Owen G.
§ McHaffie, Orval L
§ McKenna, Maurice J.
§ McNutt, John R..........
*§'MacFarlane,
§ MacRae, Gordon C...
§ Magney, Fredolph H.
§ Malmstrom, John A...
Marcley, Walter J
Marrone, Patrick H
§ Martin, ili
Martin, Webster C.
§ Mayne, Roy M
Mead. Charles H.
§ Merriman, Lloyd L
Miettunen, John B.
Moe. Thomaz..........
§ Moehring. Henry
‘Mollers, Theodore
Monroe, Paul B...
§ Monserud, Nels
§ Morsman. L. Willia
§ Moyer, John B...
Munson, Martin S
Murray, Robert A...
Nakamura, James Y
§ Neff, Walter S
§ Nelson, Robert L
§ Nicholson, Murdoch
§ Nisius,
Norberg, Carl E
§ Nutting, Roland E.
$ O'Neill, John C...
Olvon’ pan -
son rchiba u
: Owens, ... Hibbing
‘o Harbors
MINNESOTA MEDICINE
“-g
ene oe
SSeS Omid =
-Faribault
Northfield
Faribault
Faribault
Faribault
Northfield
‘Faribault
Northfield
Faribault
Faribault
Faribault
Northfield
. Virginia
Virginia
...Duluth
-.-Duluth
Virginia
‘Hibbing
ovey
... Duluth
.-Duluth
..-Duluth
jashwauk
..-Duluth
...Duluth
Duluth
Duluth
...Duluth
its. Ohio
..Eveleth
ose Lake
oneming
...Duluth
...Duluth
Duluth
Virginia
sta, Ga.
..Duluth
..Duluth
Hibbing
Duluth
Virginia
neapolis
Duluth
.uluth
..Duluth
oneming
.Duluth
Duluth
‘hisholm
se Lake
Duluth
Soudan
Cloquet
Cloquet
Hibbing
Duluth
Rornum
Hibbing
or River
Virginia
Duluth
Duluth
Duluth
Cloquet
Doluth
Harbors
DICINE
*;Parker, Owen W
§ Parker, Wilbert H
§ Parson, E. Irvine.................0.--Duluth
§ Pasek, Antone W Cloquet
§ Patch, Orien B... ..-Duluth
+ Pearsall, R. P .Virginia
§ Pedersen, Roy C. ..Duluth
7 Pennie, Daniel F... ...Duluth
Peterson, Edward N .Virginia
§ Peterson, John _H.... ...Duluth
§ Pierce, Virginia
Power,
Power,
Puumala, Reino
Raadquist, Charles S..
Raattama, John Keewatin
Arnold I Grand Rapids
* Paul Virginia
i Virginia
Virginia
0 Barbara, Calif.
Olin W Duluth
Rowles, Everett K ..Coleraine
§\Rudie, Peter S.... Duluth
Rudie, William A.. ...Duluth
§ Runquist,
Ryan William J
§ Sach-Rowitz,
Minneapolis
Chi hal.
Moose Lake
nun
Om = mw
ma Mua
COUNTY SOCIETY ROSTER
Salter,
Sanford,
Sarff,
Sax, Milton
Sax. Simon G...
Schirber, Martin J. .Grand Rapids
mid, Joh Duluth
Echneider, Laurence E
Schroder, C. H
Schweiger, Theodore
Seashore, R. T ee
Sher, David A Virginia
Shirai, Shohei Coleraine
Siegel, Joh Virginia
Sinamark, Andrew Hibbing
Sisler, Clifford E. ...Grand Rapids
Smith, Cyril M
Smith, Wallace R...
Snyker,
§ Snang, Anthony J...
§ Spang, |
§ Spang, William M...
Stein, William A
Storsteen, Kenneth A..
§ Strandjord, Nels M.
+§Strathern, Moses L...
§ Strauss, Eugene C
§ Strewler, Gordon J
CR NYRLRURLRTR
bun
acd
Strobel, William G
Sutherland, Harry N
Swedberg, "William A
Swenson, Arnold O
Teich, Kenneth W..
Terrell, Bernard J..
Tetlie, James
Thomas, John V..
Tingdale, Carlyle...
Tomhave, Wesley G...
§ Tosseland, Noel E..
Tuohy, Edward L....
Urberg, Sofus E
Van Ryzin, Donald J.
Walder, Harold J
Walker, A.
Wallace,
Walter, Frederick H...International Falls
Wells, Arthur H
Wheeler, Daniel W..
$Williams, Bruce F. P.. Fort Knox Ky.
Winter,
Wolff, *John M
#$Ylitalo, William H.
§$ Young, Thomas O..
Zemmers, Roberts....
Zick, Luther H.. ...
§ Zupanc, Edward............. :
SCOTT-CARVER COUNTY MEDICAL SOCIETY
Regular meeting, second Wednesday of every month
President
Ponterio, James E
Secretary
RiescHL, EvizasetH K
Bratholdt, pre W
+ Buck, Fredk. H
§ Cervenka, Charles F.
Clarke, John Ww
§ Doherty, Elmer M...
§ Hebeisen, Milton B..
Heinz, Ivy
: ... Shakopee
einz, Lawrence H
Shakopee
Annual meeting, second Wednesday in June
Number of Members—32
§ Juergens, Herman M.............. Belle Plaine
§ Kucera, Stanley ..Northfield
Larson, ¢ Waconia
Lukk, Olaf /Montgomery
*§Martin, Thomas Philip Arlington
Nagel, Hlarold D.......:00<c.s«.: Minneapolis
Navratil, Donald R..........Baltimore, Md.
Ninneman, Newton N...
Novak, Edward
Olson, Chester J..
§ Pearson, Bror F
Pearson, Roy T..
Philp, David R
§ Ponterio, James
Watertown
Pogue, Richard E
Shakopee
Rieschl, Elizabeth K.
§ Rynda, Edwin R
*+Sanford. James oe
Sawaryniuk, Iwan..
Schimelpfenig, George
Simmonds, Harry N......
§ Simons, Bernard H
Stahler, Paul A.......
+$Westerman, Alvin.
Westerman, Fred...............- "Montgomery
SOUTHWESTERN MINNESOTA MEDICAL SOCIETY
(Cottonwood, Jackson, Murray, Nobles, Pipestone and Rock Counties)
President
Harun, Rocer P.
Socehine
Herperc, Orar M
§ Arncld, Elmer W...
ader, J. I
§ Basinger, Harold P.
Basinger, Harvey R...
Basinger, Homer P.
Beckering, Gerrit...
Benjamin, Walter
Bofenkamp, Ferdinand |
Boone, Ervin
§Bouma, John H............. Topeka, Kansas
Brown, Alexander Pipestone
Buresh, Kenneth L.........Aurora, Colo.
Carlson, John V
Christiansen, Harold A..
lawson,
tDe Boer,
Dokken,
Doman, Victor W
Regular meetings, on call
Annual meeting, October
Election, October
Number of Members—62
Hallin, Roger P
Halloran, Walter H
Halpern, David J....
Harada, Thomas T...
Harrison, Percy W...
Heiberg. Olaf M....
Hoyer, Ludolf J
Karleen, Bernard N...........0.0.0.... Jackson
Keyes, ...Pipestone
Kilbride, .Worthington
Koenecke, .... Lakefield
Kotval, Russell J Pipestone
Laikola, Leslie A... .....Adrian
Lohmann, John G Pipestone
Maitland, Edwin T w. Jackson
Manson, Frank M..... ‘Worthington
Martin,
Minge, Raymond K.
Nealy. Donal
Nicholson, Richard W.........Heron Lake
Odland, Donald Mo.eccccccccssvss Luverne
Worthington
Brewster
..Lake Wilson
.Worthington
.Worthington
RNR IRIR LAIN VRVA VRLRIL IRSA UR TRS = SRR IA
§ Pankratz, Peter J........... Mountain Lake
§ Patterson, Hugh D
§ Pierson.
Piper, William A.
Plucker, Milton W..
Ritzinger, Fredk. R...
/Mountain Lake
..Worthington
§ Robinett, Robert W...
§ — ‘Christian A
Rose, John T
§ Sawtell, Robert R.
§ Schade. Fredk. L.
§ Schutz,
§ Sherman. Charles
§ Slater, Sidney A...... 2
§ Sogge, Ludwig L...
§ Stam,
Stanley, Court R..
Stevenson, Basil M.
§ Stratte, Harold C....
§ Wells,
Williams,
illiams,
§Zeller, Ni
STEARNS-BENTON COUNTY MEDICAL SOCIETY
President
EIF, Henry J
Secretary
Cosrriu, Vasite G St. Cloud
Alden, W. Charles. Kimball
BIGErS ORI, OES NM, cissaciccsecccosssssse St. Cloud
May, 1955
St. Cloud
Regular meeting, third Thursday of month
Election in December
Annual meeting, December
Number of Members-—69
Andrews, Bernice F............
§ Autrey, William A..........
§ Baumgartner, Florian H
§ Beuning, John B
+ Brigham, Charles F., Sv....
§ Brigham, Charles F., Jr.. .......St. Cloud
+ Broker, Henry M...
§ Buscher, Julius C....
t§Cesnik, Robert J
§ Clark, Harry B
Cleaves, William D.
§ Coseriu, Vasile G
379
COUNTY SOCIETY ROSTER
DeWeese, Robert C... St. Cloud Keith, Paul J (Milaca § Petersen, Robert T
§ Donaldson, Charles i Kelly, John F.......................Cold Sprin: § Phares, Otto
§ Dredge, Thomas E... ; Koenig, Robert P.... Re Y § Raetz,
DuBois, juan F F., Kohler, Delphin W Tacoma, Wash. § Reif, Henry
§
§
DuBois, Julian F EO SN Kuhlmann, Lawrence B "Melrose Richards, Willi iam B...
§ Evans, Leslie Sauk Rapids { Lewis, Claude B St. Cloud Salk. Richard |
t Fidelman, Norman E. ..Foley Libert, John N.... Sandven, Nels O....
§ Fleming, Lic N. - Loes, Louis A...... ; + Schatz, Francis J...
§ Gaida, Joseph St. d t§Luckemeyer, Carl . Ri § Schmitz, Everett ;
s t8$McDowell, John P... St. Cloud , Sherwood, George E.
Meyer, Anthony A.... on Sisk, Harvey E
Speen Aes St. § Stangl, Philip E
usachio, Nicholas F... Thuringer, Carl B...
Halenbeck, Philip 1 4c! Myre, Clifford R i Veranth, Leonard A...
t Henry, i Fi § Neils, Vernon E.... § Walfred, Karl A
Hoehn, i § Nessa, Curtis B.... § Wenner, Waldemar T..
Tohnson. i Milaca Nietfeld, Aloys. 3 § Wittrock, Louis H...
§ Jones, Richard N St. Cloud § O’Keefe, James P ; Zachman, Albert H..........0.......... Melrose
STEELE COUNTY MEDICAL SOCIETY
Regular meetings, called by the officers
Annual meeting, February
Number of Members—23
President Halvorsen, Daniel K Owatonna §$ McIntyre, John A
ARNESEN, Hartung, Elmer H ..(Claremont +§$'Melby, i Blooming Prairie
Henry. Kenneth G. ea + Morehead, D Owatonna
Dewey, Donarp H Honath, Donald H. a § Olson, Albert J
§ Anderson, Franklin C.. e Kulstad, Oscar S ea ‘ § Roberts, Oliver ses ..... Owatonna
§ Arnesen, John F e Kurtin, Henry §J........... § Schaefer, Owatonna
§ Dewey, Donald H J : Kurtin, Joseph J.........} oes + Senn, Ov
+ Ertel, Edward OQ: . § Lundquist, § Stransky, Theodore W Owatonna
§ Fischer, John R i iri § McEnaney, Clifford T § Wilkowske, Owatonna
UPPER MISSISSIPPI MEDICAL SOCIETY
(Aitkin, Beltrami, Cass, Clearwater, Crow Wing, Hubbard, Koochiching, Lake of the Woods,
Morrison, Todd and Wadena Counties )
Annual meeting, January
Number of Members—95
President Halme, William B... Menahga
Quanstrom, Vircit E Brainerd San. “Francisco, “Calif. § Mosby, M: Long Prairie
Secretary S owe, Base D International Falls § Mulligan, “Ar ws = enon
. ansen, Milo Little Falls Nelson, Nesmit Minneapolis
Baveaux, Georce I Brainerd Hartien. Jas Nelson, Robert H.....International Falls
Anderson, Werner W Brainerd Healy, Raymond T. neseotte ININGI, VAUMCS BB. cies csssececsoisenssesecosoas Crosby
§ Radeaux. George I.... ... Brainerd Heine, George W.... = Olson, Lillian A Ah-gwah-ching
*§Beise, Rudolph A.... Brainerd Hendricks, Esten J.. St. Paul Palmer, Harry A... Blackduck
Bender, James _ H...... .... Brainerd Higgs, . ids Parker, Charles W. Wadena
§ Benson, Little Falls Hildebrand, |} ....Bemidii Parker,
.... Little Falls Hoganson, 0 4) Pedersen, Robert
§ Borgerson, ne .Long Prairie House, Zachariah E i § Petraborg. Harvey
Brown, Hector M... wss..sWalker Houston, Donald M.. ...Park Rapids Pierce, Charles H
Cardle. George E.... ‘Brainerd Hubbard, Otto E Brainerd Ouanstrom, Virgil E
Closuit, Frederick C. § Hughes, Bernard J.... Brainerd § Ringle, Otto F
Cook, Ja ay M 2 § Johnson, Douglas _L.. .. Little Falls Rozvcki, Anthony T
Johnson, Einer W .... Bemidji Sanderson, Anton G..
” Craig, Clair C.... .._ International Falls Johnson, Rudolph E Mankato Schmitz,
Crow, Earl R...............South Bend, Ind. Johnstone, William W.....Ah-gwah- — Schwyzer. Arnold G.
Cushing, Robert L Brainerd § Kanne, Earl R Brainer: Simons, Edwin J.......
Davis, ..Wad Kelley, Roger E Crosby Skaife, William F
§ Davis, Luther F A Kinports, Edward B...International Falls Spurbeck, George R..
* Davis, Thomas L., Jr.. w § Knight, Edwin G Swanville § Stein, Raymond
Deweese, Wilford J.. idji Larson, LeRoy J Bagl Stoy,
§ Eiler, h ! i Lee, Hubert W a Thabes, John A., Jr....
§ Erickson, i Leinonen, Wendla E... Wade Vandersluis, Charles W..
Fitzsimons, William E... § Lenarz, Albert We sis : -Browerville § Watson, Alexander M..
§ Fortier, George M. A. Li Longfellow, Helen W B d Watson, Percy T
Garlock, Arthur V Bemid Lund, Werner J Staples Watson, Sydney W.
Garlock, DeWitt W ; Lundsten, sli Bemidji Witenes Dede bi
Ghostley, Mary C.... ‘Bemidji § McLane, William O.. ..Brainerd Will. Charles B a
+ Gilmore, Rowland *. Crookston MacDonald, Roger A.. .Littlefork ‘ Wi oe
Griffin, John W., Jr... Macheledt, Neil L ..Wadena § Will, W.
Groschupf, Theodore P.. : idii § Marshall, Clark M. Williams, M. M.... Ah-gwah-ching
§ Grose, Frederick N............:00+ ‘Clarissa Meller, Maurice Brainerd Zeigler, Charles M.............-+ Pine River
WABASHA COUNTY MEDICAL SOCIETY
Annual meeting, first Thursday after first Monday in October
Number of Members—13
President § Bouquet, Bertram J I § Gjerde. William P Lake City
Exus, Eart W i § Bowers, Robert N... . Glabe, Robert A.... Plainview
te + Collins, Jovogh a H Mahle, ee ‘ ..Plainview
. } nce
FLESCHE, siti PRS schecteets Lake City ; Eritrand, — * + Replogic, WH Los Angeles, Calif.
§ Bayley, E. Covell i § Flesche, Bernard A i Wellman, Thomas G Clinton, Iowa
“ MINNESOTA MEDICINE
COUNTY SOCIETY ROSTER
St. Cloud WASECA COUNTY MEDICAL SOCIETY
ang Regular meetings, as decided
Annual meeting, January
Number of Members—10
st. Cloud
aynesville
st. G
Davis, Raymond D
Florine, Martin C.
President ; :
[SGallagher, Bernard 3 oe George H
§ §
NorMANN, STEPHEN T.
§ Hottinger, Raymond Swenson, Donald
Secretar
McIntire, Homer M.... Swenson, Orvie J
FLORINE, Mam Cc
Watkins
Melrose WASHINGTON COUNTY MEDICAL SOCIETY
(Washington and Dakota Counties)
Regular meetings, second Tuesday in each month
Annual meeting, December
Number of Members—18
President § Holcomb, Joel T....:Marine-on-St. Croix § McCarten, Francis M Stillwater
Cartson, Russet E Stillwater Humphrey, Stillwater Mensheha, Nicholas... Forest Lake
: Secretary . § Jenson, James E + Poirier, Joseph A... Forest Lake
Pane Juercens, MANLEY F Stillwater ay Stillwater Racer, Harley J Stillwater
Watnnue Brabec, Paul F Beate Josewski, Raymond J Stillwater Ruggles, George M. Forest Lake
watonna § Carlson, Russel E... wees Stillwater § Juergens, Manley F Stillwater § Sherman, Carnot H..
watonna Fasbender, Herman T... ..... Hastings Just, Herman J Hastings § Stuhr, John W....
watonna *+$Haines, "James H Stillwater Kulzer, Norbert J....................... Hastings Van Meier, Henry.
watonna
watonna
watonna
: WEST CENTRAL MINNESOTA MEDICAL SOCIETY
(Big Stone, Pope, Stevens and Traverse Counties)
Regular meetings, one Tuesday in March, May, September and November
Annual meeting, November
Number of Members—25
President 7 §Eberlin, ee A
ag Alfred L
e
Ewe, O. A Hancock § Lide, +§Linde, rman
+ Elsey, Tames R. § Magnuson, Allen E
fenahga Secretary *+Fitzgerald, E. T § Merrill, Robert W.
Prairie Watson, ROBERT M........0....0c0cc0eee Morris § Giesen, Allan F. <i k ‘Muir, Browns Valley
rainerd Good, Roy H ae *$O’Donnell, Ortonville
neapolis § Arneson, Arthur I Hedemark, Homer H.. § Oliver, :
val Falls { Echmiler, Fred’k Wm. Hedemark, Truman A.. + Ransom, Matthias L....
Crosby t$Bergan, Otto § Rossberg, Raymond A.
h-ching t Bolsta, Charles .. a § Swedenburg, Paul A....
ickduck t§Bucher, | A) See ee N. § Watson, Robert M
Wadena
Sebeka
—
. Atkin
Nadena WINONA COUNTY MEDICAL SOCIETY
rainert
Walker Regular meeting, first Monday in January, April, July and October
e fon Annual meeting, first Monday in January
Anoka
le Falls Number of Members—32
, 2.
.-Edina President § Heise, Paul vR § Roemer, Henry a SARA Winona
le Falls Heise, Pumir vR § Heise, Philip vR. § Rogers, Charles vesceuseeee Winona
h-ching Secretar Heise, William v! § Rollins, Pat Charles
....Pierz Wuson, Louis J Hughes, Sidney O § Satterlee, Howard W ‘Lae
le Falls § Johnston, Leonard F.. ; § Schmidt, Hilmar R...
rainerd **Benoit, Frank T Keyes, Wi *§Steiner,
3emidji Boardman, Dalmon V.. § Loomis, G. L --Wi § Tweedy,
ovalton § Christensen, Eh. E...... + McLaughlin, Edmund M.. Wi Tweedy, Robert B...
rthfield § Finkelnburg, William O § Mattison, Percy A Vollmer, Fredk. J...
oyalton Haesly, Warren § Meinert, Albert E... Wilson, Louis J
semidji epeeweh, Roger F. Neumann, Conrad § Wilson. Rolland H.
Bertha Heise, Carl vR § oe Raymond L § Woltjen, Myron J..
Bertha
1-ching
» River
§ Heise. Herbert vR
§Robbins, Charles P
WRIGHT COUNTY MEDICAL SOCIETY
§ Younger, Louis I
Regular meeting, first Tuesday of every third month
Pre sident
SaNDEEN, Buffalo
TLIN, THEODORE J Buffalo
t Abullarade, Jose A Cokato
Anderson, Waldo P ..Buffalo
§ Bendix, Lester H... nnandale
May, 1955
Annual meeting, first Tuesday in October
Number of Members—17
+§Catlin, John J Buffalo
§ Catlin, Theodore J.. .... Buffalo
i ..Monticello
: Michael
§ Guilfoile, Pierre F.
§ Hall, William E.....0.0.0.0000.... Maple Lake
§$ Hart, William E Monticello
§ Sandeen, Robert M
§ Shragg, Robert I
§ Smorstek, Matthew B..
§ Thielen, Robert D
§ Thomas, William H...........
-Howard Lake
Monticello
....St. Michael
Howard Lake
381
‘anes, Almer M
Abbott, Albert R...
Abraham,
Abramson,
Alphabetic Roster
Key to Symbols:
*Deceased; }Associate, Junior Associate, Residency, Affiliate or Life Member; {In Service
-Red Wing
Rochester
Arden 18
‘Abullarade, Jose A
Achor, Richard W. P
Adair, Albert F., Jr.
Adams, Bertram S$
og
*+Adkins,
Adkins,
Affeldt,
Agustsson,
Ahern,
Ahlfs,
hola,
+ Ahrens,
hrens,
Ahrens,
¢ Aitkens,
Akins,
Albrecht,
Richard C
Charles M
Galen H....
Daniel E
Aga, John H
Kenneth E
Curtis F...
Minneapolis
«Thief River Falls
oka
Hreidar
M ——
Caledonia
Alcorn, William J..
t Alden, J.
Alden,
Alexander,
a | Re
W. Charles..
Harlan A
Aling, Charles A....
Allen, E
7 Altnow,
Amatuzio,
¢t Amberg, Samuel
Andersen,
Andersen,
Anderson,
Anderson,
Anderson,
Anderson,
Anderson,
t Anderson,
+ Anderson,
Anderson,
Anderson,
Anderson,
Anderson,
Anderson,
Anderson,
Anderson, |
Anderson,
Anderson,
Anderson,
Anderson,
Anderson,
Anderson,
Anderson,
Anderson,
Anderson,
Anderson.
Anderson,
Anderson,
Anderson,
Anderson,
Anderson,
Anderson,
tdgar V
Allen, George S..
Allen, John H....
Allison, David D
Althausen,
Cannon Falls
..(Montevideo
Litchfield
Jr....... Minneapolis
Coral Gables, Fla.
Minneapolis
Rochester
Theo. L.,
ugo
Donald §.
Howard A
Silas C
Arnold S...
Chester A
Chester A...
David M
David P., Jr...
Donald C
Edward D....
Ernest M..
Ernest R..
Frank _J....
Franklin C...
Rochester
Minneapolis
St. Louis Park
./Minneapolis
a
atonna
‘Minneapolis
-Minneapolis
....Mankato
.-Rochester
William H.
‘Minneapolis
William T. et
.Minneavolis
Andreassen, Einar C..
Andreassen, Rolf L.
Andresen,
K. D’A... Minneapolis
Andrew, William F...
Andrews, Bernice F...
Andrews,
t Andrews,
nkner,
Antonow.
-Holdingford
‘Minneanolis
ankato
Minneapolis
k J
Arthur M.
* Archer, Willard .
+ Ardan,
Arends,
y = Wl Stuart
Joseph
Arlander, Clarence
Arling, Leonard
rko,
, Harry Wm...
Arnesen, John F
Arthrr I.
Arneson,
Nicholas I
Archabald L
J
Minnea lis
Min ae
Minneavolis
Hibbing
/Minneapolis
-Minneapolis
-Minneapolis
Winnebago
Detroit Lakes
atonna
Sanna Morris
ane.
Arnold, Anna W........:...:0000.0: Minneapolis
382
Arnold, Elmer Wm
Arnquist, Andrew S
Arny, Frederick P....
Arvidson, Carl
Arzt, Philip K
Asta, Joseph J
thens, Alvin G
Atmore, William G
Ayfderheide, Arthur C
une, artin pol
Aurand, William H Minneapolis
Aurelius, J. Richards.. St. Paul
Ausman, Duane R.... ..St. Paul
Autrey, William A
Austrian,
Conrad W
Ss
OsSMOS
os
Baars,
Babb, Fran
Backus, Reno W...
Bacon, Donald K
Badeaux, George I
Bader, |
Baer, Walter St. Paul
Bagby, George W.
Ft. Leonard Wood. Mo.
Baggenstoss, Archie H Rochester
Baggenstoss, Osmon «-s.+.-..Minneapolis
Bagley, Charles M
Bagley, Elizabeth C.
Bagley, Russell
Bagley, William R...
Baich, Velemir M....
Bain, Robert
Bair, Hugo L
Baird, Joseph W...
Baird, Raymond L...
Baken, re re.
Baker,
Baker,
Baker,
t Baker,
t Baker,
aker,
*+Baker,
Baker,
Baker,
Baker,
Rakkila,
Balcome,
Baleisis, Peter ..
Balfour, Donald
Ralfour, William
Balkin, Samuel G.
Balogh.
Bank, Harry E
Ranner, Edwar
Barber, Tracy E
Bardon, Richard ...
Bargen, TI. Arnold..
Barker, John D
Barker, Nelson W.
Barlow, Loren C...
Barnes,
Rarnes, Richard E
Rarnett, Toseph M
Barney, Leon
Barno, Alex
Baronofsky, Ivan D
Barr, Tames S
Barr,
Barr, i p
Barr, Minneapolis
Barr, Ronald (Montevideo
Barrett, Earl E —
Barron, Tesse J
Barron, cal gemma:
Barron, S. Steven...
Barry, Maurice J..
Barsness, Nellie O.
Bartholomew, ‘oyd G
Bartzen, Peter J
Basinger, Harold P..
Basinger, Harvey R..
Basinger, Homer P..
Bastron, Tames A.
Batdorf. B. Niles...
Bauer, Eugene L
Baumgartner, Florian H.
Rayter, Sterhen H
Bayley,
Bayard, Edwin D
Scott Air Force Base, TI.
Beach, Northrop Minneapolis
...Minneapolis
Duluth
Coleraine
oe Si.
arry
Hillier es “Tr. .West Point, N
Teannet te ergus Falls
Russell L..
Henry E..
Milton
Beahrs, Oliver H
+ Beals,
Beaton,
Beck, Charles J
+ Becker, Arnetta M
Becker, Frederick T.
Beckering, Gerrit...
Beddow, Ralph M....
Bedford, Edgar Wm...
Beech, Raymond H.
Beek, Harvey O
Beer, John
Rochester
.-LaJolla, Calif,
Northfield
No. St. Paul
-Minneapolis
Duluth
...Edgerton
..Rochester
‘Minne: apolis
3
-Minneapolis
Brainerd
Beiswanger; Richard H. cet olis
Bell, Charles C t. Paul
WW Me Micssssscccncccs-aescscccisaovead ieee
‘4 Bellomo, J James St. Paul
Bellomo, John St. Paul
Bellville. Titus P Minneapolis
Belzer, Meyer S... -Minneapolis
Bender, James H. Brainerd
Bendix, Lester H...
+ Benedict, William L.
Benell, Otto E
Benepe, James L.
Benesh, Louis A
Benjamin, Edwin G...
Benjamin, Harold G.
Benjamin, Walter G..
+ Bennion, P. H
*tBenoit, Frank T.
Benson, Alfred H...
Beise,
‘Minneapolis
/Minneapolis
/Minneapolis
Pipestone
-Isway, Mont.
Little Falls
m: Paul
Berg, Arnold
Berg, Clinton C "Exce isior
Clinton
..Duluth
Berger, Alex G...
Bergh, George S
Bergh, Solveig M...
Berglund, Eldon B
Bergman, Oscar B.
* Bergquist, Karl E
+ Berkman, David M
Berkman, John M
Berkwitz. Nathaniel J...
Berlin, Anthony S
Berman, Reuben
Bernatz, Philiv E...
Bernier, M. J..........
Bernstein, Irving C
Bernstein, William C....
Bessesen, Alfred N., Jr.
Bessesen, Daniel ni
*+Bessesen. William A...
Retts.
Beuning,
Bianco, Anthony J.
+ Bianco, Anthony J.,
Bicek, Josevh
Bickel, William H...
t Biedermann, Jacob.
Bieter, Ravmond N...
t Bigelow.” Charles E.
Bigler, Earl E
Bieler, Ivan E..
Bilka, Paul J
Billings, Ralph E...
Binder, Manuel R.
Binet,
Binger, Henry E
Biornson, Robert G...
Black, B. Marden..
Rlack, Farl J
Black, William A....
Blackmore, Sidney C.
Blake, Allen J.......
Blake, James A.
Blake,
+ Blakey, Adam R.
Bloedel, Traugott J. G.
Blomberg, Robert D
Blomberg, William R.
Bloom, Joseph
MINNESOTA MEDICINE
‘Minneapolis
/Minneapolis
-Minneapolis
St. James
Battle Lake
.... Oronoco
Rochester
JMinneanolis
Hallock
/Minneapolis
....-Rochester
o. St. Paul
JMinneanolis
St. Paul
“Minneanolis
Thief River Falls
Minneapolis
Dodge Center
‘Minneapolis
“here Rapids
, Ariz.
a, inneapolis
Princeton
ochester
, Calif.
wr thfield
t. Paul
neapolis
-Duluth
dgerton
»chester
neapolis
it. Paul
t. Paul
t. Paul
Morris
ookston
neapolis
rainerd
neapolis
st. Paul
neapolis
st. Paul
st. Paul
neapolis
neapolis
rainerd
nandale
chester
Virginia
t. Paul
neapolis
neapolis
neapolis
pestone
Mont.
Winona
le Falls
it. Paul
Cloquet
Duluth
Hawley
xcelsior
Clinton
Duluth
-Roseau
Mora
»chester
neapolis
neapolis
neapolis
neapolis
James
le Lake
Yronoco
»chester
neanolis
Hallock
neapolis
ochester
t. Paul
neanolis
t. Paul
neanolis
...Olivia
neapolis
»chester
_ Cloud
Duluth
rchester
t. Paul
»chester
or Falls
neanolis
Center
Perham
Perham
neanolis
‘ranklin
neapolis
Rapids
x, Ariz.
reapolis
chester
t. Paul
w Ulm
Biwabik
Topkins
Topkins
Jopkins
.Osakis
...Osseo
neapolis
inceton
Duluth
DICINE
Bloom, Norman B.................Minneapolis
Blumberg, Henry B
French ae, Calif.
Blumenthal, Jacob S
Boardman, Dalmon V... _ Wien
+ Bock, Ronald A St. Paul
* Bockman, gy er W. H
Hot Springs Nat’l. Park, Ark.
Bodaski, aa A Tyler
tB
Little Rock, lek.
+ Boeckmann, Egil St. Paul
Boehrer, John ™
Bofenkamp, Benjam
Bofenkamp, F. Willia
t Bohn, Donald G...
Boies, Lawrence R..
Bolender, Harold L
Boline, Clifford A
+ Bolsta, Charles.
Bolstad,
t Bolz, J. Arnol
Boman,
Bonello, Frank -
Bonner, John L
t Bonnet, John D
Boody, George. 5, Je
Boone, Ervin S
+ Booth, Albert E
+ Boreen, Clifton A.
Borg, Joseph F
Borgerson, Arthur H..
+ Borgeson, Egbert J
Borman, Chaunce
Borowicz, Leonard A..
Bosland, "Howard G
Bossard, John
+ Bossert, Clarence S Mora
t Boswell, J Thornton....Portsmouth, Va.
+ Botham, Richned J
Bottolfson, Bottolf T..
Bouchelle, McLemore
Bouma, John H
+ Bouma, Lewis R....
Bouquet, Bertram J....
Bouthilet, Florence J
Bowen, Robert I ibbing
t Bowers, Dorrance. Rochester
Bowers, Gordon G i polis
Bowers, Robert N......................Lake City
Bowes, Donald E Rochester
Rochester
Boyd, ‘David A., Jr.
one Pa.
Minneapolis
‘Minneapolis
veer. George K
Boyer, George S
Viorer, & Samuel ae. Sr
r
aereton, Ruth EB Racacsesossicioscssd ‘Minneapolis
Boysen, Herbert. Madelia
¢ Boysen, Peter. Bemidji
Braasch, John W Rochester
t Braasch, William F... ....Rochester
Brabec, Paul F ... Hastings
Brackett. Ralph _D.. Rochester
Brand, George D....
t Brand, William A... “Redwood Falls
Brandenburg. Robert O. Rochester
Bratholdt, James W.
Bratrud, Arthur F
t Bratrud, Edward.
Bratrud, Theodore E
Bratrude. Earl J.............
Braun, Ohrmundt C..
Braun, Robert A
, ~
...Grand Rapids
....Rochester
St. Paul
..Duluth
Co eS
Brekke, Harvey J Mi lis
Bretzke,
Bridge,
Briggs, John F St. Paul
+ Brigham, Charles F., a Cloud
Brigham. Charles F., St Cloud
Brill, Alice K
Brink, (og SORE .Baudette
Brink. Donald M... -Hntchinson
Broadbent. James C Bee
Broadie, Thomas E.....
Brockway, Roger W rand Rapids
Broders, C. W... Rochester
Brodie, Walter |) aE: St. Paul
t Broker, Henry M..
Brooker, Warren ¥.
+ Brooks, Charles N..
Brown, Al Rochester
+ Brown, Al r i Pi
t Brown, Edgar 5 Paynesville
Brown, Hector M Walker
Brown, Henry A Rochester
Brown, Tan A Mi poli
Brown, Joe R Rochester
t Brown, John C Gatos, Calif.
Brown, Philip W Rochester
May, 1955
ALPHABETIC ROSTER
Brown, Roland G Rochester
Brown. William D ‘Mir
Bruhl, Hei Pactoealt
Brunsting, Louis A Rochester
Brusegard, James F
Bucher, Foster D
— Harold F...
Frederick H
Buckley. J Ly
Buckley, Robert P
Buie, Louis
Buirge, Raymond E
Bulinski, Theodore J.
Bulkley, Kenneth.... inneapolis
Bumpus, Frank T Rochester
Bunker, Bevan W..
Burch, Edward P.
Burch, Frank E..
Burchell, Howard B..
Buresh, Kenneth L....
Burke, Edmund C......
Burklund, Edwin C....
Burleigh, Edward G..
Burlingame, David A...
Burmeister, Richard O.
Burnett, Joseph Ww i
Burnham, Wesley H.. ‘inneapolis
Burns, Catherine Albert Lea
Burns, Floyd M Milan
Burns, LM! ee Milan
Burns, Robert M...
Burseth, Edgar é..
Burton, Carl G
Buscher, Julius C.
Bush, Robert
Bushard, Wilfred J.
Busher, Herbert H
Butler, John K...
Butt, Hugh R........
Butturff, Carl R.
Butzer,
Butzer, F
Buzzelle, Leonard K............. Minneapolis
Minneapolis
Shakopee
St. Paul
Cable, i Sinamepele
Cabot, Clyde M
Cady, Laurence H.
Cain, Clark
Cain, James C.
Cain, James H.
Cairns, Robert J.
¥ Calhoun, F. W....
Callahan, Francis
Cameron, Isabell L
Cameron, John H
Camp, Ray Junior.
¢ Campagna, Mario J
Campbell,
Campbell,
Canfie
Canine, ” James L So.
Cantwell, William F...International Falls
plan, Leslie Mi
Card, William H i I lis
Minncabors
Rochester
Minneapolis
/Minneapolis
Carey, James
Carlander, Lester W
Carley, Wal ary A...
Carlson, Ble cccss
Carlson,
Carlson. Lawrence
Carlson, Leonard T.
Carlson, Russel
Carlson,
Caron, Robert P
Carr, David T
Carr, William J
oll, John J
* Carroll, William C...
Carryer, Haddon McC..
Carthey, Frank J
Caspers, Carl G Minneapolis
¥ Catlin, John J Buffalo
Catlin, Theodore J
t Cavanor, Frank T
Cedarleaf, ay B
Ceder, Elmer T
Ceplecha, Stanley F
Cervenka, = F.
t Cesnik
Chadbourn, Charles R.
+ Chadbourn, Wayne A
Chalgren, William S
Challman, Samuel A
t Chambers, Winslow C
Chapin, Lemuel
* Chapman, Theodore L
Chatterton, Carl a 2
Chavez, Demetrio A Minneapolis
Chermak, Francis G.. International alls
Chesler, Merrill D inneapolis
+ Chesley, Albert J Minneapolis
Minneapolis
A. kas.
Minneapolis
Rochester
Rochester
...Minneapolis
Childs, Donald S., Jr
Chisholm, Tague C
Christensen, larence H
Chri Eli E Winona
Christensen, Llewellyn E
Christensen, Norman
Christiansen, Andrew
Christiansen, Harold A
Chunn, Stanley S
Ciriacy, Edward
Clagett, Oscar T
Clapp, Hubert D
ark,
Clark, Edward C
Clark, Elizabeth A
Clark, Harry B
Clark, Henry B., Jr.
Clark, Ivan T
Clark, Leslie Wm
ark, Malcolm D
Clarke, Eric K
Clarke, John W
Clay, Lyman B
t Clayburgh Bennie J
Claydon, Howard F..
Cleaves, William D..
5 Clement, John B
Clifford, George
Clifton, The
Closuit?
Cochrane, Byron B
Cochrane. Ray F
Coddon, Walter D
Coe, John I
hen, Bernard A poli
Cohen, Mi polis
Cohen, Ephraim B Minneapolis
Cohen; Maynard M.. St. Paul
Cohen, Sumner S..
Colby, M. ¥.. Je..
Colby, Woodard L.
Cole, James S
Cole, Wallace H
Coleman, John B
Coll, James 7
t Collie, Henry G
+ Coll ins, Arthur N
t Collins, Joseph S
Collins, Loren E
Colosey, Frederick J
Combacker, Leon C...
Comfort, Mandred ....Rochester
Compton, Russell F.... ....Rochester
Condit, William H... Minneapolis
¢ Conley, Francis W Ft. Hood, Texas
Conley, Robert H Mankato
¢t Connolly, eae cong J.....Ft. Belvoir, Va.
Connor, Charles E.. St. Paul
Cook, om “St. Paul
Cook. Rochester
Cook, Jay M Staples
Cooley, Rochester
cana
‘ooper,
Cooper, Excelsior
+ Cooper, Winnebago
Cooper, Rochester
Cooper, Robert R i Li
7 Cope,
Corbin, Kendall B
Corniea, Albert D
Correa, Dale H
Corrigan, Cyril J
Coseriu, Vasile &
Cosgriff, James A cg ees
Cosgriff, James A., Jr...
Costello, Addis Rochester
Coulter, Harold E Madelia
Counseller, Virgil S
Countryman, Roger
Counts, Robert
Covell, Walter W
Coventry, Markham B
Coventry, William D
Covey, Kenneth W
Cowan, Donald W
Cowan, George M
Craig, Clair C
Craig, - M St. Paul
Craig, M. Elizabeth ‘Minneapolis
t Craig, Richard M Rochester
Craig, Winchell McK Rochester
Cranmer, Richard R.. Minneapolis
Cranston, Robert W Minneapolis
Creevy, Charles D Mi 1
Creighton, Ralph H
Critchfield, Lyman R.
Cronwell, Bernhard J.
Lester Prairie
..... Alexandria
..Fergus faik
Crowley, James H
Crudo, Vincent D
Crumbley, James J
Crump, James W
383
Culligan, John M
Culligan, Leo C p
Culp, Ormond S Rochester
Culver, L. G ..St. Paul
Cundy, Donald T M 1
Curtis, Rauen
Cushing, Robert L
t Cutts, George
Dady, Elmer E
...St. Paul
ea
LeCenter
Brainerd
Daggett, cage R
Dahl, Elmer
t Dake ames C
Dahl, John A
Dahlin, David C f
Dahlstet, John P........San Ysidro, Calif.
Daignault, Oscar. B
Dale, Lester N Red Lake Falls
Daly, David Rochest
t Daniel, Donald H Minneapoli
T Danielson, Karl A Litchfield
Danielson, Lennox Litchfield
Danyluk, —, Minneapolis
Daugherty, Guy W... ‘Rochester
David, Reuben Minneapolis
Davis, Austin C... -Rochester
Davis,
Davis,
Davis,
Davis,
Davis,
Davis,
Davis,
Davis, R
Davis, Thomas L
Davis, William I
Dawe, Clyde J
Dawson, James R
Dawson, orin D
Dearing, William H...
*+DeBoer, Hermanus.
Decker, Charles H
Decker, David G
DeGeest, James H
DeKruif, endrik
t Delmore, a i * Roseau
Delmore, Roseau
Del Plaine a W. Minneapolis
Demo, Robert A a Lea
Derauf, — a. t
Deters, Donald C
Detjen, Edward D...
Deveraux, Thomas J.
Devine, Kenneth D Rochester
DeWali, Richard A lis
DeWeerd, ames H Rochester
DeWeese,
Deweese, Wilford J
Dewey, Donald we
Dickman, Roy W
Dickson, Franklin H., Jr.
Dickson, Thomas H
Diefenbach, ape J: i ats
Diehl, Harold ol
Dierker, Heinrich.
Diessner,
Diessner, Grant R
Diessner, aid E D
Dille, Donald
Dines, David E
Dixon, Claude F
Doane, Joeerh Cc
Dobson,
Dockert
Dodds,
Dodge, eae | ae
Doehlert, Charles A., Jr...
Doherty, Elmer M
Dokken, James H
man, Victor Wm.
Doms, Vernon A
Donaldson, Charles S..
Donatelle, Edward
t Donin, Winnipeg, Man.
Donoghue, Francis Rochester
Donovan, Daniel L Albert Lea
Dordal, "John Sacred Heart
Minneapolis
Dornbach, Robert A.. i
¢ Dornblaser, Harry B.....Los Gatos, Calif.
Dorsey, George C inneapolis
Douglas, Kenneth W.. .. Sandstone
Douglass, Bruce E Rochester
t Dovenmuehle, Robt. H...Durham, N. C.
Downing, William
t Doxey, Gilbe
Doxsee, George C
Doyle, George C...
Doyle, — R
Doyle, Lawrence O.
Drake, Carl B
+ Drake, Charles R
384
...Worthington
.....Rochester
ochester
Minneapolis
Litchfield
Rochester
Rochester
ochester
Mankato
../Minneapolis
....Chisholm
ALPHABETIC ROSTER
+ Dredge, Homer P Sandst
Dredge, Thomas E
Drexler, George W = ok
rill, Herman opkins
t Drips, Della G
ry, Thomas J
Dubbe, Frederick H
DuBois, J Sr.
~~
Edw
ter Sadi
Duncan, James
Dungay, Neil S
Dunlap, Earl H
Dunn, Jack, 6
Dunn, James N
Dupont, Joseph A
Duryea, illis M
DuShane, James W
Dutton,
Dvorak, Benjamin A
Dwan, Paul F
Dworsky, Samuel D
Dwyer, John ulut
+ Dyer, John i Rochester
kstra, Peter C est aie N.
Dysterheft, Adolf F... ...Gaylord
Rochester
Earl, George A
Earl, John
Eaton, Lealdes M
Eberley, Tobe S
t Eberlin, Edward A
Eckdale, &
Eckman, hilip F..
Eckman, Ralph J.
Edelmann, Robert
Eder, Walter P
* Edlund, seal
Edwards, — E
Edwards, oseph W..
Edwards, Lloyd G.
Edwards, Thomas J..
Eelkema, Harriso}
Esge. Sanford G...
a Chasies T..
renber aude
Ehrlich, SP
Eich actions A I
Eichhorn, Edmund P Minneapolis
Eide, O. A Hancoc
Eiler, John Park Rapids
Eisenstadt, David H Minneapolis
Eisenstadt, William S. Mi i
...Rochester
Minneapolis
Ellinger ’ Albert J
rag arold J
Earl Wm
Ell F. Henry.
Ellison, David E
Ellison, Ellis
Ellison, Frank E
t Elsey, James R
Elstner, Howard L
¢ Ely, Orriman S
Emanuel, Karl Wm...
Emerson, Edward C..
Emerson, ve
Emmett, John L
Emmons, R.
Emond, Albert |
Emond, Joseph S...
Eodress, Edward K...
ngber,
Engel, 7
Engelhart, “a Cc
Englund, Elvin
Engstrand, Oscar J
Engstrom, Denton P
Engstrom, Robert
Enroth, Oscar E
Ensrud. Earl Richard...
Eppard, Raymond M.
Erdal, Ove
Erich, ihe B
Erickson, Alvin O Long Prairie
Erickson, Clifford O Minneapolis
Erickson, Donald J Rochester
Erickson, Eskil Halstad
Erickson, George P Hibbing
Erickson, John G ..Rochester
Erickson, Laurence F. ‘Minneapolis
Erickson, Myron Minneapolis
Erickson, Reuben F............... Minneapolis
Erickson, Vernon D... ‘Grand Rapids
Ericson, Reinhold M Wayzata
+ Ericson, Swan Le Sueur
R —
So. _ aoa
uth
Rochester
+ Ernest, Geo. C. H...St ean Fla.
Ersfeld, Murray P St. Paul
Erskine, Gordon
+ Ertel, Edward Q
Esensten, F a wl
+ Eshelby,
Estes, J. ee
Estrem, Ralph L..
Estrem, Robert D..
+ Eusterman, George B.
Eustermann, John J... ed
Evans, Edward T. inneapolis
Evans, Leslie. Sauk Rapids
Evans, Robert D Mi
+ Evarts, Arrah B
Evensta, John B...
t Evert, jo n A.
Ewen, Edgar
Faber, John E
+ Fabi, Mario Nestor.
t Fahr, George E
Fallon, Virgil T
Falls John L
Fansler, Walter A
Farkas,
Farley,
Fasbender pays ae
Faucett, Robert L
Faulconer, / Albert r.
-Fawcett, Arthur M.
Fawcett, Keith R
Fee, John G
Feeney, John M
t Feigal, David W.......A. F. B., Wyoming
Feigal, William M.......Thief River Falls
Feinberg, Milton St. Paul
Feinberg, Philip Mi li
Feinstein. Julius . «
Felder, Davitt A.
Feldmann, Floyd
Felion, Arthur J.
Fellows, Manley
Fenger, E. P. K.
Fergeson, James O
* Ferguson, James C..
Ferguson, William C...
t Ferrell,
Ferris, Dewar
Rochester
Rochester
Mi li
Fay aaa
Minneapolis
S
¢ Fetzek, Albert *
Feuling, John C
t Fidelman, N. E....
Field, Anthony H
Field. Charles
Fieldman, E.
+ Fifer, William ”
Fifield, Malcolm M.
Figi, Frederick A
Fingerman, David
i SB eee
Fink, Leo M
Fink, Walter H
Finkelnburg, William O
Fisch, Herbert
Fischer, Blooming Prairie
Fischer, Marion McC Duluth
Fisher, Dan W St. Paul
Fisher, Isadore I i 1
Fisketti, Henry.
t Fitzgerald, Don F...
*+Fitzgerald, Edward iT
+ om William E...
a Christian A..
Flanagan, Harold F.
Flanagan, Leonard G
Flancher, Leon H
Flannery, Hubert F
Fleeson, William H
Fleming, Dean
Fleming, Thomas N.
Flesche, Bernard
Fliehr, Richard R
Flink, Edmund B Mi
Flinn, J Redwood, alls
+F linn, Remer
Floersch, Adrian J Glencoe
Flom, M ...Moorhead
Columbus, Ga.
Janesville
. Sheridan, Ill
ee
{Mi
Orceneth A., Jr...
Sime, Bernard
Flynn,
t Fogarty, Cc.
Fogarty, C. Wm., J
ee. Emil J
er, Leslie
Foley, Frederick E. B.
Folken, Frank
Folsom, Louis B
Ford, Eh (0a —
Ford, William H ‘Minneapolis
MINNESOTA MEDICINE
Albert Lea
— +
Les he > hes be > he > he > he > he > har he > he > har bao ha har kao lack LeeLee LeeLee L _ Le eeee
B, Fla.
t. Paul
Rapids
lendale
eapolis
t. Paul
chester
is Falls
s Falls
chester
lankato
eapolis
Rapids
eapolis
chester
Rapids
t. Paul
chester
chester
chester
eapolis
Jawson
ing
“ olis
» Paul
libbing
lastings
chester
chester
enville
Duluth
t. Paul
eapolis
yoming
r Falls
t. Paul
eapolis
eapolis
Terrace
chester
t. Paul
Grove
Texas
chester
v Ulm
. Paul
Aichael
Duluth
lan, Ill
lington
eapolis
chester
chester
eapolis
Paul
eapolis
eapolis
Ninona
Austin
Prairie
Duluth
. Paul
eapolis
ICINE
Forsythe, James R
Fortier, George M. A.
Foss, Edwar
Foster, Orley W
Fowler, Lucius Haynes
on
Minneapolis
Fox, Donald P.
Fox, James —
Fox, 0’
+ Franchere, roa. Wm..
Francis, David
Frane, Donald B
Minnea)
.....Morristown
Mi a
Mi
Frear, y
a ng George M
Frederickson, Alice
Fredricks, Merriam ~
Freeman,
‘Minneapolis
Willmar
...Duluth
‘Niinn Paul
Freeman,
F
Paul
t Freeman,
....Glenville
St. Paul
Hibbing
Minneapoli
Minneapolis
Minneapolis
Rochester
Frc
Mi lis
Friedel,
Friedel, i
Fri
oe
Fritz, Wall
Froats, Charles W
t Frost, John B
Frost, Russell H
Frykman, Howard M.
Fugina, George * ame
M
Fuller, *Alice
Fuller, Benjamin F
Fuller,
Funk, Victor K
Furlow, William L
Furman, Lucie C.
Furr, Leo O
Gaard, Richard C
Gacusana
Gaebe, Mi
Gaida, Joseph
f Gallagher,
Gallett, Lester
Galligan, John J.......
+ Galligan, mag
« Galloway,
+ Gambill,
Gambill, Earl E
Rochester
ochester
Gamble.
Gammeil,
Garbrecht,
Gardner, Victor H., Sr...
Gardner,
Garlock,
Garlock, Dewitt H
Garrett, Charles
Garrow, David
Garske, George L
._Bricelyn
ochester
St. Paul
Garten, Joseph I
Garvey, James T.
} Garchel
+ Gatchell,
Gaunt,
Gaviser,
Gee, Vernon -
Gehlen. Joseph_ N
Geib, Marvin J
Geiser, Peter M...
Geraci, Joseph E
eurs, Benjamin R...
*Ghent, Charles H....
Ghormley, Ralph K.
Ghostley. Mary C
Gibbs, Edward C...
Gibbs; Robert W
Giebenhain, John N
Rochester
..Rochester
‘Rochester
-Minneapolis
Rochester
mi Paul
Paul
in Bemidji
..St. Paul
‘Minneapolis
sarenenpets
Giere, Joseph Cc
Giere, Richard W
iere,
= Allan F...
iman, ial
ilmore, Rowland...
t Gilsdorf. Donald A
Gingold: Benjamin A.
t Ginsberg, R.
May, 1955
Crookston
...St. Paul
Minneapolis
San Antonio, Texas
ALPHABETIC ROSTER
+ Girvin, Richard B
Gjerde, William P
Glabe, Robert A......... eeiciesaccasueal Plainview
Glaeser, John H Mi 1
Gleason, Wallace A
t+ Glew, Wm. Bainbridge.
Goblirsch, Andrew P
Goehrs, Gilman H
+ Goehrs, Henry W...
Goff, h
Goldberg, Isadore M
Goldish, Daniel R
Goldish; Robert J
Goldman, Theodore I
Goldner, Meyer Z i
Goldsmith, Joseph W - Paul
Goldstein, Norman P
Goltz,
Goltz,
ood, C. Allen, Jr
Good, Hoff D
Good, Roy H
Goodchild, William R
Goodman, Charles E...
Gordon, Philip E...
Gordon, Sewell S
Gowan, Lawrence R.
Grace, Joseph
Graham, Archibald W.
aaa Jack P. ly
Grais, Melvin L.....Colo. Springs, Colo.
Granquist, Richard D Chisholm
Grant, Hendrie W St. Paul
Grant,
Grant, Suzanne
Grattan, Robert T....
Gratzek, Frank R. E...
Gratzek, Thomas
Grau, . we
Graves, Richard B
Gray, Edwar
+ Gray, Frank D
Gray, Howard K
Gray, Royal C
Green, Paul A ochester
Green, Robert A St. Louis Park
+ Green, Robert C., Jr.....LaGrosse, Va.
Greenberg, Albert’ J ...Minneapolis
Greene, Daniel E.... River Falls
Greene, Laurence
Greenfield, Irving..
Greenfield, William T.
t Greishiemer, Esther M.
Philadelphia, Pa.
Gridley, John W... . Ari
Griebie, Grant L
Griffin, George D.,
Griffin. pes W.,
Griffin,
Minneapolis
Min or
Minneapolis
Grimes,
Grimmell, Francis
Grindlay, John H...
Grinley, Andrew V... ..Grand Rapids
Grise, William B Austin
Groch, Sigmund N... ...Rochester
Grohs, William H..
Gronvall, Paul
Groschupf, Theodore
Grose, Frederick
Grosh, John Livingston
Gross. B Rochester
Grotting, John K Minneapolis
*+Gruenhagen. Arnold P. as
Grundset, le J
J..
Gullickson, Glenn, Jr
+ Gullickson, Andrew....Longmont,
Gully, Raymond | Cambridge
Gunlaugson, Frederick C.....Minneapolis
Gushurst, Edward .‘Minneapolis
Gustason, Harold T... ..Minneapolis
S Gey, Teele Ain. .nsecsicsissiccicscis New London
ee OM Fairfax
Haavik, John E...... -Duluth
Habein, Harold C., Sr Rochester
¢ Habein, H. C., Jr.....Wiesbaden, Ger.
Haberer, Helen R Mi Li
+ Haberman, Emil Osakis
Haes, Julius E Mankato
t Haesly, Warren W
t Hagedorn, Albert B...New York, N. Y.
Hagen, Kristofer Richfield
7 Hagen, Olaf J Moorhead
agen, Paul
Hagen, Wayne S Mi p
+ Haggard, G. D i
+ Haigler, Frank H., Jr
*tHaines, James iH
Haines,
Hakanson, Eck Y
Rochester
Stillwater
R L +
St. Paul
Halbert, John J
Halenbeck, Philip L
Hall, Barnard
Hall; Harry B p
Hall, Wendell H ‘Minneapolis
H William E... ...Maple e
* Hallberg, Charles A Minneapolis
Hallberg, Olav E Rochest
¢ Hallenbeck, Dorr F
Hallenbeck. George A...
+ Halliday, Philli
Hallin, Roger p
Halloran
Halme, Ww. B
Halper,
Halpern, David
Halpin, Joseph
Halvorsen, Daniel K.
Halvorson, James W.
Hamlon, Jo
Hammar, Lawrence M.............
Hammes, Ernest M3;
Hammes, Ernest
*+Hammond, James 7
+ Haney, Claude _L.......
Hankerson, Robert G
Hanlon, vid G
Hannah, Hewitt B Minneapolis
Hanover, Ralph D.....International
Hansen, Cyrus Mi
Hansen, Erlin
Hansen, Milo » Blasio
Hansen, Ol S
Hansen, Robert E Hibbing
¢ Hansen, Rollin M.....Falls Church, Va.
Hansen, —— M Albert Lea
t Hanson, Adolph M
Hanson, Ernest O...
Hanson,
Hanson,
Hanson,
Hanson, Mi
Hanson, Pelican Rapids
Hanson, Frost
Hanson, Maleela : Racnsenel Minneapolis
Hanson, Mark C. ‘Minneapolis
Rochester
i Rochester
Rush City
.. Owatonna
———
Hanson, Norbert on : ter
Hanson, William A. H Minneapolis
“Lake Wilson
St. Paul
Happe, Lawrence J
a Rae on E
arbaug' ohn
7+ Hardy, Wil Joe
Hare, Robert L
Harmon, Gaius E
Harrington, Stuart
Harrington, Vernon A.,
Harris, Carl
t Harris, Evelyn S..
arris, Leon
Harris, Lloyd E.
Harrison, Percy W
Hart, William E... ...Monticello
Hartfiel, Herbert A. Montevideo
Hartfiel, William F... ..St. Paul
Hartig, Marjorie ee
Hartjen, Jason K..
Hartley, Everett C
Hartman, Evelyn E
Hartman. Howard R
Hartnagel,
Hartung,
Hartwich, Roger F
Hass, Frederick M
+ Hassett, Roger G
Hastings, DeForest R Minneapolis
Hastings, Donald W. ‘Minneapolis
+ Hatch, Walter E Duluth
Haugan, Norman R
Hauge, Erling T.
Hauge, Malvin I
Haugen, George W
Haugen, John
Hauser, Donal
Hauser, George
Hauser, Victor P.
Havel, Pp
Haven, Minnea)
Havens, Fred Z Riversi if.
+ Havens, John G. W -Austin
Hawkinson, Raymond P.....Minneapolis
Hawley, George M. B., IL...Red Wing
Hay, Lyle J Mi lis
Hayes, Albert F
+ Hayes, oe M
*+Hayes,
Hayles,
Hoy Albert T.
Worthington
Checked
Minneapolis
-Rochester
Rochester
385
Heck, Frank J
Heck, William W
Hedberg, Gustaf A
Hedemark, Homer H.
Hedemark, Truman A.
Hedenstrom, Frank fs
Rass
Hedenstrom, Paul
Hedenstrom, —
Hedin, Raymond F
Hedlund, Charles 7;
Heegaard, William G..
Hegge, Olav H
Hegge,
Heiam, William C....
Heiberg, Emmett A.. ..Fergus Falls
Heiberg, Olaf M ...Worthington
Heilig, William R . Paul
Heilman, Dorothy M. H
San Diego, Calif.
Heilman, Fordyce R Rochester
Heimark, John J Rochester
Heimark, Julius .s..-F airmont
eine, George WwW Little, Falls
Heinz, Ivy
Heinz, elke H eee
Heise,
Heise,
Heise,
Heise, Philip vR...
Heise, William vR ;
t Heisler, John J ‘Minneapoli
Helferty, John K Idaho
*+Helland, Gustav M.
¢ Helland, John W
Heller, Edgar E
t Helmholz, . t
Helseth, Hoval Pelican Rapids
Hempel, Dean Minneapolis
+ Hempstead, B. E Rochester
Beach, Philip S. Rochest
Henderson, Arthur J. G.....No. St. Paul
Henderson, d D. Rochester
Henderson, .....Rochester
Henderson, % Rochester
*+Henderson, i Rochester
+ Henderson, Robert Earl ‘Rochester
Hendricks, Esten J ..St. Paul
+ Hendrickson, John F. ner olis
Hengstler, William H... St. Paul
*+Henney, William H
Henrikson, Earl C I
Henry, Clarence J
+ Henry, Clifford E... ..Kirksville, _
t Henry, Benton
¢ Henry, Sl
Henry,
Henry.
T Hensel,
Hepper, Norman G ] ,
Herbert, Willis... Minneapoli
Herman, Ss M St. Paul
Hermann, Haecid W..............Minneapolis
Hermanson, Peter E....:, .... Hendricks
Heron, Roy C St. Paul
Herrmann, Edgar T... “ Paul
+ Hertel, Garfield E...
Hertz, Myron
Hesla. Inman A...
+ Hewitt, -Rochester
+ Hewitt, ow BM sss sscoeccesscsste Rochester
4 Hei 1 Rochester
Minneapolis
Park Rapids
ee ae Bemidji
Hilding Anderson C
t ad Andrew W:
Hilger,
Hilger, Laurence D...
Hilker, Marcus D
Hill, Earl Mi
Hill, Minneapolis
t Hill, i . ..Riverside, Calif.
Hill, John P Virginia
Hill, John R ‘Rochester
..... Rochester
Bradenton, Fla.
Minneapolis
Rochester
inckley, Robert
Hinderaker, Harris
Hines, Edgar A., Jr
Hiniker, Louis P
Hiniker, Peter J...
Hinz, alter
Hirschboeck,
Hirsh, Stanton secaeeats
Hirshfield, Frank R.
Hitchcock, Claude R.
Hochfilzer, J
Hodapp,
Hodgson, Corrin H
Hodgson, Jane E...
Hodgson, John R..
Hoehn, i
Hoeper, Philip G
Hoff, Herbert O
386
Crookston
inneapolis
“Minneapolis
ALPHABETIC ROSTER
Hoffbauer, Frederick
Hoffert, ey, E
Hoffman, Ro
onenee, ak S I
Hoe ros tos
Holcomb, Joel T
Holcomb, Ww
Holian, Darwin K
Holland,
Hollands, William
Hollenhorst, Robert W...
Hollinshead, <a
Holm, Donald F
Holman, Colin B Rochester
Holmberg, Conrad J Minneapolis
Holmen, Robert W.. St. Paul
Holmes,
Holmstrom, Carle H...
Holt, Allen H
Holt, John E
Holzapfel, Fred C
Honath, Donald H
Hoover, Norman
Hopkins, George W i a
Horns, H._ L....-Colo. Springs, Colo.
Horns, Richard C inneapolis
Horton, Bayard T Rochester
Hottinger, Raymond C Janesville
ouglum, Arvid J Park
Houkom, Bjarne........ T. T., East Africa
Houkom, Samuel S$ Duluth
+ House, Zachariah E re, Calif.
Houston or M........../Park’ Rapids
Houts, Joseph C Dassel
Hovde, Rolf Winthrop
Hovland, i Minneapolis
Howard, Marshall ....Mankato
Howard, Merrill A..
Howard, Robert Boon Minneapolis
Howard, Solomon E M
Howard, Willard S
Howe, Newell W
Howell, Carter Wi
Howell, Llewelyn P.
Howell, Milton M...
Hoyer, Ludolf J
ruza, William J
* Hubbard, Otto E
Hubin, ‘Edwin G
Hudec, Elwyn R
Hudson, George E
Huebert, Dan W
Huenekens,
{ Huffi ngton, H.
Huffington, Herb L., Jr.
Hughes, Bernard J
Hughes, Sidney O....
Huizenga, Kenneth A...
Hullsiek, Harold 4 coed
—, 4 aelin . Snelling
Cloquet
..Minneapolis
..Moorhead
Humphrey, E. Sr
Humphrey, Wade R Stillwater
Hunt, Arthur B Rochester
+ Hunt, a. Fairmont
Hunt, Willi Fergus Falls
Rochester
Hutchinson, Dorothy W.
Hutchinson, Henry.
+ Huxley, Frederick R..
Hymes, Charles
+ Hynes, John E
¢ Ide, Arthur W.
Ide, Arthur W., =
Idstrom, Linneus G
Ikeda, Kano
Ingerson,
Inglis, William..
¢ Irvine, Harry
Irwin, Homer -
Iverson, Rolf M
Ivins, John
Jackman, Raymond J...
acks, Quentin D
Jackson, Richard L...
Jackson, William _—
Jacobs, Douglas a.
Jacobs, J
acobson,
Jacobson,
Jacobson, Ferdinand C.
Jacobson, Loren J
Jacobson, Wyman E
James, Ellery M
James, John
4
s
4
J
s
]
anecky, Baudette
anes, h M.. Rochester
anssen, Martin E m -
arvis, Bruce W
Jarvis, Marilyn A.
Jay, Alan R
Jeffries, William L.
Jensen, Adrian R
ensen, Alvin
ensen, Harry C...
Jensen, Marius J..
Jensen, Nathan K
Jensen, Reynold A
Jensen, Thorvold J.
enson, seemed E
erome, Bourne.
Jerome, Elizabeth E
Jeronimus, Henry J
Jesion,. Joseph W.... id
essico, Charles Duluth
Jeub, "Robert P.....San Antonio, Texas
Joffe, Harold H Virginia
Johanson, Waldemar G... Be
Johnsen, Henry A.,
ohnson, Adelaide
Johnson,
Johnson,
ohnson,
ohnson,
lohnson,
. Johnson; Carolyn A
Johnson, Curtis M..
ohnson, C. Percy.
Johnson, Douglas L..
Johnson, Edward a
Johnson, Einer Y
Johnson, Einer » ie nat
johnson. Emil we Minneapolis
johnson, Minneapolis
Johnson,
J johnson, St. Paul
Johnson,
ohnson,
johnson, ulius.
Johnson, Karl E
johnson, Malcolm R..
Johnson, Marvin W....
Johnson, =
Johnson, Norman P.. Minneapolis
Johnson, ...Minneapolis
x as ..-Moorhead
Paul
J Lanesboro
Johnson, Ray G Stillwater
johnson, Reinald G.. Minneapolis
johnson. Reuben Minneapolis
ohnson, Robert E Mi li
Johnson, Roger S
ohnson, Rudolph E
ohnson, Vilheim M
Johnson, William E..
Johnson, Youbert T...
ohnsrud, Luverne W...
ohnston, Henry W... "Virgins
chnston, Leonard F
‘Johnston, R. O.....Fort Lauderdale, Fla.
Johnstone, William W Ah-gwah- ‘ching
olin, Francis M
ones, Alva
ones, i.
ones, E he eg ee St. Pa
ones, W., W B ine, Mass.
ones, Orville Mankato
Jones, Richard A i
ones, Richard ‘,,
ones, William R it
Jordan, Kathleen Sait. Granite Pots
ordan, Lewis 6..... ranite Falls
ordan, Stanley. Rochester
osewich, Alexander.
Josewski, Raymond J. ... Stillwater
oyce, George I Rochester
udd, Allen S i li
udd, Edward S.,
>
h
uergens,
juergens, John
uergens, vary F.. .... Stillwater
uers, Edward Red ote
Juliar, Richard 3
juntunen, Roy R
urdy, Mitchell J
ust, Herman
~anies Peter
Mi
Kaen i ‘New Ulm
Kalin, Os oP is. ‘Minneapolis
Kallestad, Leonard L.. Minneapolis
Kamman, Gordon R St. Paul
*+Kamp, Byron A bert Lea
Kanne, Earl R Brainerd
MINNESOTA MEDICINE
Jaudette
ochester
st. Paul
st. Paul
t. Paul
neapolis
neapolis
» Mass,
‘ownton
neapolis
neapolis
illwater
eon
neapolis
‘Duluth
t. Paul
Duluth
Texas
Virginia
st. Paul
/irginia
chester
~ Paul
chester
t. Paul
Dawson
. Tyler
> Falls
irginia
3emidji
chester
leapolis
eapolis
eapolis
t. Paul
fankato
eapolis
eapolis
eapolis
—
eapolis
Milaca
t. Paul
eapolis
eapolis
orhead
_ Paul
1esboro
llwater
eapolis
eapolis
eapolis
layzata
ankato
Jawson
{organ
eapolis
libbing
irginia
Vinona
e, Fla.
-ching
-apolis
lwater
shester
-apolis
‘hester
D. C.
apolis
stings
bbe
‘APOUS
Dim
apolis
apolis
sinerd
CINE
Minneapolis
arleen, Bernard }
conan. Conrad I.
Karlen, Markle...
Karn, Jacob F..
K — ‘*“""
Kasper, tLugene ae
Kath, Reinhard H
Katz, Louis J ;
Katz, Yale
Kaufman,
Kaufman, Herschel J.
Kaufman, Walter
Kaufman, William C...
Kearney, Rochfort W
‘aul
.Minneapolis
Minneapolis
.Minneapolis
.Minneapolis
...Ortonville
ot. Paul
St. Paul
Arlington
-Long Beach, Calif.
inneapolis
Appleton
-Minneapolis
...Mankato
..Appleton
Mankato
Rochester
Kearns, Thomas P
Keating, Francis R., Jr...........Rochester
Keefe, Rolland E
Keil, Marcus A
Keith, Haddow M.
Keith, Norman M.
Keith, Paul J
Keithahn, Elmer E
Kelby, Gjert M
Kelley, Roger E...
Kelley, Walter M
Kelly, Albert C....
Kelly, Charles F.
Kelly, James H...
st. Paul
..Albert Lea
Sleepy Eye
-Minneapolis
Crosby
-Minneapolis
St. Paul
Cold Spring
Minneapolis
— F....
+ Kelsey, Carleton
Kelsey, Chauncey
Kemp, Alphonse F
Kenefick, Emmett
+ Kennedy, Claude C.
Kennedy, George L...
+ Kennedy, Jane F
Kennedy, Roger L. J
t Kent, George B
Kenyon, Thomas J...
Kerkhof, Arthur C...
Kernohan, James W
Kesting, Herman
nneapolis
...Faribault
Minneapolis
-Minneapolis
Rochester
St. Paul
Kevern, Jay L
Keyes, John D.
Keyes, Robert W
ohn
Henning
..Pipestone
Rochester
Kilby, Ralph Allen...
Kimmel, George C..
+ King, Edgar A
King, Frances W...
+ King, George L
Kinkade, Byron R
Kinports, Ed. B
Kinsella, Thomas J....
Neil
Joliet, Ill.
Rochester
/Minneapolis
Worthington
Rochester
-Minneapolis
..Oak Terrace
-Hudson, Wis.
Ada
International Falls
Minneapolis
Breckenridge
Rochester
Rochester
Kirklin. John Woescscccsccs.e
Kistler, Alvin J
Kitzberger, Peter J..
Klakeg, Clayton H....
» Donald W
Klefstad, Lloyd H
Klein, Harry.
..... Rochester
Minneapolis
New Ulm
..Rochester
..Rochester
+ Klein, Henry N
Klein, William A...
Klima, William W
Kline, Richard F..
Knapp, Frank N...
Knapp, Miland E....
Knight, Edwin _G...
+ Knight, James Harry...
Knight, Ralph T
night, Ray R
..Minneapolis
.. Swanville
..Rochester
Minneapolis
Minneapolis
Knoche, H A
Knoll, W. —"
organ
Duluth
Knudsen, Helen L
nutson, Gerhard E.
Knutson, Lewis A...
Knutson, Robert C
Koelsche, Giles A
Minneanolis
.Spring Grove
St. Paul
Rochester
..Tacoma, Wash.
Faribault
Mi
May, 1955
ALPHABETIC ROSTER
Koller, Robert L
Kooda, Jennings C.
Korchik, John P Minneapolis
Korda, Henry A.. ..Pelican Rapids
Kosms, Joka, Jc:.................. Minneapolis
Koskela, Lauri E.....Shaker Heights, O.
Kostick, William R Fertile
Kotchevar, Frank R... a
Kottke, Frederick J.
Kotval, Russell J
Koucky, Rudolph W...
Kovack, Freeman D...
Koza, Donald W
Kozberg, Oscar.
Kraemer, George N..
Kragh, Lyle O
Krause,
Kremen, Arnold J..
Kreuzer, Titus
Krezowski, Thomas K.
Krieser, Albert E
Kroboth, Frank J., Be
¢t Kroli, Harry G Rochester
Krout, Robert M Rochester
Krueger, Victor K..........:.:...0:0 Nopeming
Krusen, Fran Rochester
Kruzick, Josesscssesessssesssee.. eepy Eye
Krystosek, Lee Clara City
Kucera, Frank Hopkins
t Kucera, Louis B.....Colo. Springs, Colo.
Kucera, anley orthfield
Kucera, William J., i
Kucera, William J.,
Kugler, Alex A ,
Kuhlmann, Lawrence B... a
+ Kuhn, Arthur J ochester
Kulstad, Oscar S ..Dodge Center
Kulzer, Norbert J. Hastings
Kunkel, Melvin G Rochester
Kunkel, Wm. M., Jr.....Harrisburg, Pa.
+ Kurtin, Brey 1, ..Tuscon, Ariz.
t Kurtin, Joseph J... v
Kuske, Albert W.
t+ Kusske, Arthur L.... Yew Ulm
Kusske, Bradley, W. St. Paul
Kusske, Douglas R.
Kusz, Clarence V
Kvale, aM
Kvitrud, Gilbert...
LaBree, John W . Louis Park
LaBree, Robert H
+ LaGaard, Sheldon M...
Lacy, Paul E
Laikola, Leslie A..
+ Laird, Arthur T..
+ Lajoie, John M...
ioe Clifford F... 2 :
Lamb, H. Douglas.. Minneapolis
Lang, Leonard A... ...Minneapolis
t Lange, Robert D.....Washington, D. C.
Langhoff, Arthur Mankato
Lannin, Bernard G.
Lannin, Donald R.
Lapierre, Arthur
Lapierre, Jean T
Larrabee, Walter
Larsen, Frank Wm
Larson,
Larson,
Larson,
Larson,
Larson, Gerald E.
Larson,
Larson, Kenneth R
Larson, Leigh
Larson, Lawrence M
Larson, Leonard M....
Larson,
Larson,
Larson,
Larson,
Larson,
Larson, P.
Larson, :
+ Larson, Roger
Latterell, Kenneth E.
+ LaVake, R
Minneapolis
...Minneapolis
Waconia
Minneapolis
Oak Terrace
Minneapolis
Law, Harrison E Virginia
Law, William M Rochester
Lax, Morris H St. Paul
Laymon, Carl W M 1
*tLazar, Henry L
Lazarte, Jorge A
+ Leahy, Bartholomew.
Leavenworth, R. O., Sr...
Leavenworth, R. O., Jr
+ Leavitt, H. H
+ Lebowske, Joseph A
Leck, Paul C Austin
Rochester
Leo, bert W.... Brainerd
Lee, Gordon E Glenwood
Excelsior
Rochester
Minneapolis
Minneapolis
Lee, Norman J
Lee, Philip R..
+ Lee, Walter N
Rochester
laremont, Calif.
A + G
, Ga.
Minneapolis
Parkers Prairie
Leick, Richard M St. Paul
Leiferman, Robert J. Minneapolis
Leinonen, Wendla E..................... Wadena
Leitch, Archibald St. Paul
Leland, Harold R Minneapolis
*+Lemon, Willi Clifton Forge, Va.
Lenander, Mellvin E St. Peter
Lenarz, Albert J s
Lende, Norman
Lenz, Joseph R
Lenz, Otto A..............000+-.-Minneapolis
Leonard, Lawrence J............. Minneapolis
Leonard, Minneapolis
+ Leopard, Brand A.....Brownsville, Texas
Lepak, Francis J.
Lepak, John A....
Leppo, N. Erkki A.
+ Lerche, William
Lerner, A. Ross
Lester, Malcolm J., Jr.
Leuallen, Ed dC
Leven, N. Logan
Leverenz, Carleton W
Levin, Bert G St. Paul
Levitt, George X - Paul
Lewis, Arthur J Henning
Lewis, Rochester
Lewis, Henning
+ Lewis,
Lewis, F. J
+ Lexa, Frank J
Libert, John N
Lick, Charles L
Lick, Louis
Lick, William J., Jr...........
7 Liedloff, Adolph G...
Lien, Richar
Liffrig, William
¥ Lightbourn, Edgar L..
Lilleberg, Norbert J...
Lillehei, C. Walton.
Lillehei,
+ Lillie, §
Lillie, John C..
Lima, Ludvig
Limbeck, Donald
¢ Lind, C. J.
Lindahl,
Lindberg, Alfred
t Lindberg,
Lindberg,
Lindberg, Winston R.
Lindblom, Alton E....
Lindblom, Maurice
7 Linde, Herman
Lindell, Robert
Lindemann, Charles E
Lindgren, Russell C............
Lindner, Janus C i poli
Lindquist, Richard H.............. ‘Minneapolis
Linner, Gunnar Mi poli
¥ Linner, Henry P Mi is
Linner. John H Minneapolis
Linner, Paul W Minneapolis
Lipinski, Stanley W.. ibbi
Lippman, Hyman 6...
Lippmann, Elmer W
Lippmann, E 1 Mi polis
Lipschultz, Minneapolis
Lipscomb, Paul R. Rochester
t Litchfield, John T. -Minneapolis
Litin, Edward M Rochester
Litman, Abraham B Minneapolis
Litman, S 1 Duluth
Lober, Paul H.......0.............Minneapolis
Loes, St. Cloud
Lofgren, Karl A ..Rochester
Lofsness, Stanley V...... ..St. Paul
t+ Logan, Archibald H_................Rochester
Logan, George B ee ..Rochester
+ Logefeil, Rudolph _C............ Minneapolis
Lohmann, John G Pipestone
Loken, Selmur M........... ..........St. Paul
Loken, Theodore : Ada
+ Lommel, Jerome G.................Rochester
....Austin
....Brainerd
-Minneapolis
inona
etroit Lakes’
R ter
Rochester
St. Paul
-.Minneapolis
-Robbinsdale
-Rochester
-Rochester
ontevideo
{
Minneapolis
‘Minneapolis
Minneapolis
‘Minneapolis
Longfellow, Henry W..
t Loomis, Earl A .
Loomis,
Lorentzen,
t Lorton, William L
Lott, Frederick H
Louisell, Charles.
Love, Frederick A..
Love, J. Grafton...
Lovett, Beatrice R
Lowe, E
Lowe, Thomas A
Lowry, Elizabeth C
Lowry, Paul
Lo Thomas
t can, Hilda Mankato
t Luckemeyer, C. J.....Ft. Riley, Kansas
+ Ludwig, Clarence John Rochester
Lueck, Wallace
Lufkin, Nathaniel H
Lukk, Olaf...
t Lund, Anthony J
Lund, Carl J. T....
Lund, George W...
Lund, Werner J
Lundberg, Ruth I......
Lundblad, Robert M....
Lundblad, Roy A
Lundblad, Stanley W..
Lundeberg, Karl R
Lundell, Carl L
Lundholm, Arthur
Lundquist, Curt x
Lundquist, Virgil J.
Lundsten, Leslie C
Lundy, John S
Lynch, Francis W
+ Lynch, Matthew J
Lynde, Orrin G
¢ Lynn, Thomas E
Lyons, —_ H
Lysne, Henry.
Lysne, Myron
Lysyj, Anatol
LVe
M
Min
Los Gatos, Calif.
Rochester
(Mi 1
Mi
r
1:
Pr
1:
‘Minneapolis
Lyzenga, Anton G M polis -
McBean, J. B Rochester
McCabe, . : . Paul
McCaffrey, Fabian J
McCain, Don L ..St Paul
‘McCann, Eugene Mi poli
McCannel, Malcolm _A Minneapolis
McCarten, Frances M.. Stillwater
McCarthy, Austin M.... Be
McCarthy, Donald .....
McCarthy, Joseph J
McCartney. James S
t oer D
anahan, James H.
oe White Bear Lake
oe |
ae
McCloud, Charles N., Jr St. Paul
t McClure, Rensselaer, Jr.
awrence, Kansas
McConahey, W. M.,
McCormick, Donald ’P....
+ McCoy, Mary K
(McDaniel,
+ McDaniel,
+ McDonald
(McDonald
McDonald “
McDonald
¢t McDowell, John P...
McEnaney, Clifford
cEwan, Alexander..
McFarland, Arthur H
McFarlane,
McGandy, Rob
McGeary, George E
McGroarty, Brian J....
McGroarty, John J..
McHaffie, Orval L..
McHardy, Bryson R...
McInerny, Maurice W
McIntire, Homer M
McIntyre, John A....
McKaig, Alan M
McKaig, Carle B
McKee, Robert E...... ..Bryan, Texas
McKelvey, John L Minneapolis
McKenna, Austin
McKenna,
McKenna,
McKenzie,
McKenzie,
McKibben,
McKinlay, Chauncey A...
McKinney, Frank S
McLane. William O. ....Brainerd
McLaughlin, Byron ..Minneapolis
+ McLaughlin. Edmund ..Winona
McManus, William F.
McMurtrie, William B
‘McNear, George R c
McNeil, John nneapolis
McNeill, J. A St. Paul
McNutt, John ; !
McPheeters, Herman O.......Minneapolis
+ McOuarrie, i Minneapolis
McWhorter, Henry E Rochester
388
Minneapolis
Rochester
Minneapolis
..Minneapolis
“(Minneapolis
Minneapolis
* Madden, cn F
ALPHABETIC ROSTER
Rochester
MacCarty, Collin S
+ MacCarty, William C
MacDonald, Daniel A...
MacDonald, John W...
MacDonald, Roger A...
* MacFarlane, P. Harvie..
MacHeledt, Neil L
MacKinnon, Donald C.
MacRae, Gordon C
Mach, Frank B
Macklin, W. E., Jr
t Mackoff, Sam M
+ Madalin, Herbert E..
Madison itchell S
Madland, Robert S
Maeder, Edward C....
Maertz, William F....
Magath, Thomas B..
Magney, Fredolph H.
Magnuson, Allen E
Magnuson, Raymond C.
Mahle, Donald G
Mahowald, Aloys....
Maitland, Edwin T..
Maland, Clarence ‘) ..
Malerich, J. Anthony.
Malerich, J. Anthony, Jr..
Malmstrom, John
Mandel, Sheldon L
ae er, pong
ankey, James ‘Minneapolis
Mankin, Harold T.....Cambridge, ‘Mass,
Mankin, Haven W Rochester
Mann, Frank D Rochester
¢t Manning, Phil R.....Los Angeles, Calif.
+ Manson, Frank M.. «Worthington
March, Kenneth A. .....Cambridge
t Marcley, Walter J. ..Minneapolis
Marking, George H Mi Li
Marks, Roger W.. St. Paul
arrone, Patrick
Marshall, Clark M.
Martens, Theodore
artin, ..Luverne
om See St. Paul
artin, Thief Ri
Martin, G R isan =
Martin,
Martin,
Martin,
Martin, *
Martin, ; ee
Martineau, Joseph L.
Martinson, Carl J.....
Martinson, Elmer J.
Masson, Duncan M....
Masson, James
Masson, James
Mateo, Guillermo...
Mathieson, Don R....
‘Matthews, James H..
— wd |, Soe
Mattison, Percy A... . Wi
Mattson, Albert D St. sen
Mattson. Hamlin A. N........:.Minneapolis
t Maus, Philip New Orleans, La.
Maxeiner, Stanley R., Sr...Minneapotis
Maxeiner, Stanley R., jr...Minneapolis
Mayne, John Gregory.............Rochester
Mayne, Roy M. sessoveeaNE i
Mayo, Charles W......
Mazzitello, William F
Mead, Charles H
Meade, J
Fergus Falis
seseeeeeee Jackson
..Minneapolis
‘aul
... Virginia
in
- neapolis
Minneapolis
Oak Terrace
Medelman, John P.
ener — t...
Melancon, Joseph F St. P.
Melby, Benedik Prairie
eller, aurice. i
Meller, Robert L ee
Melzer, George R
Menges, Charles G. H.
Menold, William F....
Mensheha, Nicholas...
Mercil, William F
Merkert, Charles
Merkert, George L
Merner, Thomas B
Merrick? Robert L
Merrill, Robert W
Merriman, Lloyd L.
Merritt, Wallace A..
H
B
Forest Lake
....Crookston
‘Minneapolis
Mi li
......Duluth
-Rochester
sees Olivia
+ Mesker, George .
Princeton
Metcalf, Norman B..
Metz, Donald D............0......
Meyer, i M:
Meyer,
+ Meyer, E
Meyer,
Meyer, Paul F
Meyer, Robert J.
t Meyer, Robert P...
+ Meyerding, Edward A...
+ Meyerding, Henry Wm
Michael, Joseph C..
Michel, Henry H.
Michels, Roger P...
Michelson, Henry
Michienzi, Leonard
+ Mickelsen, E F..
Mickelson,
Midboe, Gilbert T.
Midthune, A. S...
Miettunen,
Milhaupt, E. N
Miller, Albe:
Miller,
Miller,
t Miller,
Miller,
Miller,
Miller,
+ Miller,
+ Miller,
‘Miller,
t Miller,
Miller,
Miller, Z
Millett, D.
Mills, Ste
Milnar,
Milton, J
inge, fk
Minsky, Armen A.
Mintz, Charles M.
Mishek, Charles J.
Mitby, Irving I
Mitchell, Berton D
Mitchell, Edwards C.
Mitchell, Mancel T.
Mixer, Harry W...
'Moberg, Clarence W
Moberg, Thomas D.
Moe, » Pe H
Moe, Thomas
Moehn, John T
Moehring, Henry G
(Moen, J. K., Jr.
- Moersch, Frederick P....
oersch, Herman J
Moga, John A
Molander, Herbert A..
Molenaar, Robert E..
Mollers, Theodore P...
Monahan, Elizabeth S.
Monahan, Robert H....
Monroe, Paul B
Monserud, Nels O
Monson, Einer M
Monson, Leonard J.
Montgomery, Hamil
Mooney, Robert P....
Moore, Chris H
Moore, Irvin H
Moores, Kenneth D
Moorhead, Marie.
Moos, Daniel J
Mogquin, Marie A
Morehead, Dewey E
Moren, J. Adelaide
Morgan, H Oo
Moriarty,
Moriarty, Cecile R
Mork, Arthur
Mork, Frank E
Morlock, Carl G
Morrison, Charlotte J.
‘Morse, Morton
Morsman, L.
Mortensen, J. D...
Mortensen, Nels G.
Mortenson, Howard O
Mosby, Maurice E..
Moses, Royal R
Mosser, Donn G
Moulton, K._ &........
Mouritsen, Glenn J.
Moyer, John B....
Moyer, Leonard B
Mueller, Donald R.
Muesing. William J
Muir, Walter F....
‘Mulder, Donald W.
(Mulholland, William
Muller, Albrecht E
Mulligan, Arthur M
Mundahl, Harold R
Munson, Martin S...
eel Thomas ie
urphy, mun
Murphy, Jack _T....
Murphy, Joseph E
MINNESOTA MEDICINE
Minneapolis
Hibbing
Rochester
R
Minneapolis
Mi is
R L +;
Rochester
Paynesville
Rochester
Naegeli, Frank
1 ace, Harold D >
Ni ura, James Y Deer River
Nash, Eldore B Eden Valley
Nash, Leo A ...St. Paul
Naslund, Ames Minneapolis
Nauth, Bernard S Mi 1
Navratil, Donald R
Neal, Joe
Nealy, Donald E
Neary, Richard P
Neel, Harry B rt Le
Neff, Walter S... ws Virginia
Nehring, Jesse P. Preston
Neibergs, Lidija St. Paul
Neibergs, Pauls St. Paul
Neils, Vernon E Sauk Rapids
Bernette G M lis
Bernice A..............
Carleton A
C. Barton
Fergus Falls
Minneapolis
Worthington
Mi _
Albert Lea
Minneapolis
onsdaic
Fairfax
Ct (sis
Warroad
, Kenneth L
Lloyd S. Mi
Louis A vw St. Paul
Louis A., Jr..
Maxine 0... Minneapolis
Maynard C.. ./Minneapolis
Melvin S... Granite Falls
Nesmith P ..Minneapolis
O. L. Norman Minneapolis
International Falls
uluth
..Fergus Falls
. Minneapolis
Fergus Falls
ochester
Beenenpen
. Samuel
Nesheim, Martin O
Nessa, Curtis
Nesse, J. A Austin
Nesset, Lawren B Minneapolis
Nesset, William D Mi i
Neumaier,
Neuman, Harold W..
Neumann, Conrad A....
Neumeister, Charles A
Nice, Charles
i , Donald R
icholson, Murdoch _A..
icholson, Richard W
Nickerson, 0 R
ickerson, Neil D.
Nielsen, Alvin M...
Nietfeld, Aloys B
ilson, Helmer J...
Nimlos, Kenneth O.
* Nimlos. Lenore O....
Ninneman, Newton
isius George
Nixon, James B
Noble, John F
Noble, John I
* Nollet, Donald J
Noonan, William J p
oran, Axel S. Minneapolis
Noran, Harold H. ..Minneapolis
Norberg, Carl E Cloauet
, Robert E Edina
in, Gustaf T. Mi poli
rdiand, Martin, Sr Minneapolis
Nordland, Martin, Jr.............Minneapolis
lordman, Willard F Mora
Norman, John F kst
Ormann, Stephen T., Jr.
orris, Neil T
oth,
Nudell, Gerald
Nuebel, Charles J
uessle, Walter G..
Nuetzman. Arthur W.
utting, Roland E
May, 1955
[inneapolis
[inneapolis
ALPHABETIC ROSTER
Nydahl, Malvin J
Nye, Katherine A
Nye, Lillian I
Nygren, William T
Nylander, Emil G Minneapolis
Nywall, Dean D Slayton
O’Brien, I. Cc St. Paul
O’Brien, Louis T..................Breckenridge
+ O’Connor, i Eden Valiey
t+ O’Connor, St. Paul
* O’Donnell, D. ....Ortonville
Minncopem
M
O’Donnell, James E
O’Hanlon, John A
O’Kane, Thomas W
O’Keefe, J
t O’Keefe, Rochester
t O'Leary, i polis
O’Leary, Paul A Rochester
O’Neil, Richard IL
O’Neill, John C
O’Phelan, E. Harvey.
O’Reilley, Bernard E.... St.
t O’Shaughnessy, E. J...Cp. Kilmer, N. J.
+ Oberg, Carl M Min Li
-Detroit Lakes
..Granite Falls
Oeljen, Siegfried C. G.
g den, Warner.
age, ustus.
Olaxs, Fo Mi is
Olds, George H New Richland
Olive, John T., J Mankato
Oliver, Irwin Graceville
Oliver, James
Olmanson, Edmund G
sen,
Olsen,
Olsen,
Gregory M Litchfield
Lillian A.... Ah-gwah-ching
. Olof A... ...Minneapolis
Olson, Rolland A.. Wayzata
+ Onifer, Theodore Michael..
Onsgard, L. Kenneth
Opfell, Richard
Oppegaard, C. L.
Oppen, E. Gerhar
Oppen, Melvin G...
Opshal, Lawrence
Opstad, Earl T
Orr, Burton A..
t Orwoll, Harold
Osborn, Donald O
Osborn, John E..
Ostergaard, Erling
Ostergren, Edward
Ostling. Burton C
Otto, Hen
Ouellette,
Ourada, Anthony L...
Owen, Charles A., J
Owens, Ben
Owens, Frederic
Owens, William A
Page, Raymond L St. Charles
Palen, Benjamin J M polis
Palmer, Clinton Albert Lea
Palmer, Harry ...Blackduck
Palmerton, Ernest S.. ...Fergus Falls
Pankratz, Peter J -Mountain Lake
Papermaster, Ralph Two Harbors
‘Papermaster, Theodore C.....Minneapolis
t Paris, Jaime Rochester
Park, Wilford E Minneapolis
Parker, Charles W. Wadena
Parker, Harry L ....Rochester
*+Parker, A ...Minneapolis
Waeber; (VR Jo scicccscscssssisescosoners Hallock
Parker, Robert L Rochester
Parker, Warren E Sebeka
Parker, Wilbert H.....................Chisholm
Parkhill, Edith M Rochester
Parkin, Thomas Rochester
Parson, E. i Duluth
Parson, E. Lillian B.. Elbow Lake
Parson, Lester R Elbow Lake
Parsons, R. A
Parsons, Ralph IL M ey
t Parsons, W. B., Jr.......Coronado, Calif.
Pasek, Antone Cloquet
asek, Edward A Li:
Patch, Orien B
Patrick, Robert_T
Pattee, James J
Patterson, Hugh D
7 Patterson, William L
Paulson, Elmer p
Paulson, Rochester
t+ Paulson, ..Fergus Falls
Paulson, J Minneapolis
Paynter, R...Great Falls, Mont.
Pearce, Francis M.,
+ Pearsall, R. P
Pearson,
Pearson,
Pearson,
t+ Pearson, Roy
Pease, Gertrude L
Pedersen, Arthur H
Pedersen, Robert L
Pedersen, Roy C
Peltier, Leonard F..
Pemberton, Albert H
Pemberton, John
Penhall, Fletcher W. Willmar
Penk, Engward L Springfield
Penn, George E Mankato
t Pennie, Daniel F. V.
Peppard, Thomas A
Perlman, Everett C
Perlman, Herschel L
Perry, arold
Person, John
Pertl, Albert L Canby
Peteler, Jennings C. L Minneapolis
Peters, Gustavus A Rochester
Petersen, Rochest
Petersen, D. H Northfield
Petersen, Mi li
Petersen,
*+Petersen,
Petersen,
Petersen,
Petersen,
Petersen,
Peterson,
Peterson,
Peterson,
Peterson,
Peterson,
eterson, Henry
Peterson, Herbert W.
Peterson, Joel L. E...
Peterson, John H
Peterson, Kenneth A..
Peterson, Kenneth H.
Peterson,
Peterson,
+ Peterson,
Peterson,
Peterson,
Peterson,
Peterson,
Peterson,
Peterson,
Peterson,
Peterson, Willard H.........Spring Valley
Petit, Julien V .Minneapolis
Petit, Leon J -Minneapolis
Petraborg, Harvey T Aitki
Pettersen, George R..
Pettet, John R
Pewters, John T.
Peyton, William T.
Phares,
Phelps, Kenneth
Philp, David R...
Pierce, Charles
Pierce, Jack
Pierce, Robert B
Pierson, Roy F F
¢ Piper, Monte C , Calif.
Piper, William A. .-Mountain Lake
Place, Virgil A Rochester
Plasha, Matthew K
Plass, Herbert F. R
¢ Platou, Erling S Mi
Pleissner, Karl W i
Plimpton, Nathan C., Jr.
+ Plondk d
Plotke,
Plucker, Milton
Pogue, Richard E
Rochester
* on
Fe all:
Miaka, rom
./Minneapolis
Rochester
P
Pr
Minneap
‘Minneapolis
Rochester
v
Forest Lake
.....Rochester
-Minneapolis
Polski, Paul G So. St. Paul
Polzak, Jacob A Mi li:
one, John
Cambridge -
389
Ponterio, James E Shal
Pool, Thomas L. Rochester
+ Poppe, Frederick H Minneapolis
Porter, Oliver M.... Atwater
Potek, David M pol
Potter, Robert B Hopkins
‘Pougiales, Mary L. Rochester
t Powelson, ochester
Power, John E., Sr
Power, John E., Jr
* Prangen, Avery De
+ Pratt, re
Pratt, Fred J., Jr
¢ Pratt, George F
Pratt, Josep
+ Preisinger. Joseph
Preston, Pau
Price, William 'E
Prickman, Louis E
Priest, Robert E
Priestley, James T Rochester
Prim, Josep Minneapolis
Prins, Leo R sin Lea
Proeschel, Ray K..
Proffitt, William E
Proshek, Charles E
Pruitt, Raymond D
Pugh, David G
Pumala, Erven
Purnell, Don C
Purves, George H.
Puumala, Reino H
Rochester
Minneapolis
Minneapolis
Minneapolis
Rochester
Quanstrom, Virgil E
uattlebaum, Frank
—_— ge o. B
uiggle rthur
t on enry W., Sr
Quist, Henry W., Jr
Minneapolis
Minneapolis
Raadquist, Charles S............+-0:: Hibbing
Raattama, John Keewatin
Racer, Harley J.. .. Stillwater
Raetz, Sylvester J..
j Arnold
Ralph, J
Ralston, Donald E
Ramsey, Walter R St. Paul
Randall, Lawrence M.. -Rochester
Randall, Raymond V.... R
Ransom, H. Robert
Ransom, Matthias L....
Rasmussen, Ramby
Rasmussen, Waldemar C...
Ravits, Harold G
Rawls, Thompson T
Rayner, Ralp
Rea, Charles E
Reader, Donald R «Mi lis
I 1
: Virginia
Reff, Alan R Crookst
Regnier, Edward A Mi i
Reid, James W So. St. Paul
Reif, Harold A i i
Reif, Henry
Reif, Robert
Reifsnyder, Wm. Henry, III..Rochester
Reiley, Richard E i i
Reineke, George F
Reitemeier, Richard J...
Reitmann, John H
Re Mine, William_H., Jr......
Remole, William Mi
Remsberg, R. R
Replogle, William H...Los Angeles, Cal.
Resch, Joseph M poli
Rice, Carl i poli
Rice, Mi polis
Rice, F Mi li
Rice, Moorhead
Rice, R
Richards, Albert M
Richards, Ernest T. F...
Richards, William B
Richardson, Edward J., Jr..
Richardson, Robert
Richdorf, Lawrence F...
Richter, David
Rick, Paul F.
Rieke, Wellington W..
Rieschl, Elizabeth K
Rigler, Leo G
Rigler, Robert G
¢t Ringer, Merritt G., Jr
—— Otto F
Rinkey, Eugene...
Riordan, Elsie M.
t Ripepi, James D...
Risch, Ronald Be.
Risser, Alden F
Ritchie, Wallace P.
Ritt, Albert E
+ Ritzinger, Frederick R
390
ALPHABETIC ROSTER
Rizer, Dean K
Rizer, Robert I
Roach, Donald E..............+++:
Robb, Edwin F
Robbins, Charles P
Robbins, Owen F
Roberts, Byron H
Roberts, Lewis J
Roberts, Oliver W
Roberts, Stanley E
Roberts, Stanley W
Roberts, William B
Robertson, Paul
Robilliard, Charles M.. a
Robinett, Robert .Worthington
Robinson, Cortland O Crystal
Rocknem, Robert E ‘Mi poli
Rockwell, C. V Mi i
Rockwood, Philo H Fergus Falls
+ Rodda, Frederick C Minenapolis
+ Rodenbaugh, Fredrich Hase....Rochester
Rodgers, Richard S Mi poli
Roehlke, Arthur B...........4........Elk River
Roemer, Henry : ...Winona
Rogers, Charles # ...Winona
Rogers, Sidney F..
+ Rogin, Norton...
Rogne, William G.
Roholt, Christian
Rohrer, Christian
< SE
a eg Park
pring Grove
ieee
rthington
.. Virginia
..St. Paul
St. Paul
..St. Charles
.Cass Lake
Rochester
Rome, Howard
Romness. Kenneth B
*+Rood, Dana C....Santa Barbara, Calif.
Rooke, E. D Rochester
Rorem, Joseph A
+ Rosander, Phyllis.
Rose, John
Rosenbaum, David L ‘Minneapolis
Rosendahl, Frederick G.....Minneapolis
Rosenfield, Abraham B Minneapolis
Rosenow, John ‘Mi i
Rosenthal, F.
Rosenthal,
Rosenwald, Reuben M
Ross, Alexander J i
Rossberg, Raymond A........:ss.0+
Rossen, Ralph Mi
Rotenberg, Robert J
Roth, Frederick D
Roth, George C
Rothnem, Morris
Rothschild, Harold J
Rothwell, Walter S
Rotnem, Orville M....Iowa City, Iowa
Roust, Henry A Montevideo
Rovelstad, Randolph A. :
Rovelstad, Roger.
Rowe, Clarence J., Jr
Rowe, Olin
*+Rowe, William H...
Rowles, Everett K
Roy, Phil C
Rozycki, Anthony.
Ruchie, Warren H.
Rucker, Charles W....
Rucker, William H
Rud, Norman E
+ Rudell, Gustave IL
Rudie, Clifford N
Rudie, Peter S
Rudie, William D
Rudolph, Frank A
Ruggieri, Bartholomew...
Ruggles, George M
+ Ruhberg, George M..
Rumpf, Carl
Runquist, John M
Rushton, Joseph G Rochester
Russ, Homer H Blue Earth
Russeth, Arthur N Mi poli
Rusten, Elmer Minneapolis
Rusterholz, Alan P..
Rutledge, Lloyd H
Ryan, John
Ryan, Joseph M
Ryan, Robert F
Ryan, William J
Rydburg, Wayne C
Ryding, Vincent
t Rydland, Arne
Rygh, Harold N..
Rynda, Edwin R
Rynearson, Edward H.
Rysgaard, George M
Minneapolis
IMankato
Pine River
....Willmar
St. Cyr, Harry M., Jr.......... Robbinsdale
St. Cyr, Kenneth J Robbinsdale
Sabanas, Alvina Rochester
+ Sabin, Frederick Chapman
Sach-Rowitz,
Sadler, William P., Jr..
Saffert, Cornelius A..
Safirescu, Sorim R..
Sahr, Walter G
Salassa, Robert M .... Rochester
Saliterman, Bernard I.........Mi P
Salk, Richard ] aa
Salter, Reginald A
Samuelson, Leonard G
Sandeen, ‘Robert M
Sanderson, Anton G.
Sandt, Karl E
Sandven, Nels O
+ Sanford, Arthur H
*+Sanford,
t —
anfor bs
Sarff, Ol ee
Sargent, Edward C ...Austin
a i, <a M St. Paul
atersmoen, eodore i i
Per agg Pelican Rapids
Sather,
Sather,
Sather, Richard N...
Sather, Russell O....
Satterlee, Howard W.
Satterlund, Victor L..
Sauer, William G
Savage, Francis J...
Sawaryniuk, Iwan....
Sawatzky, William A.
Sawtell, Robert R
Sax, Milton H
Sax, Simon G.
Chicago,
M
Mi tu i.
Schaar, Frances E Minna
Schade, Frederick L
Schaefer, Joseph F
Schaefer, Kenneth F.
Schaefer, Wesley G
amber, Walter F
Schatz, Francis W.
Scheidel, Alois McK..
Scheifley, Charles H
Scheldrup, N. H i li
Scherer, Leslie Raymond...... Minneapolis
Scherling, Sidney S Mi Li
Schiele, Burtrum C............... (Minneapolis
Schimelpfenig, George..
Schirber, Martin J
Schirger, Alexander...
Schissel, Gregory A
Schmid, John FE.
Schmidt,
Schmidt,
+ Schmidt, |
Schmidt,
Schmidt,
Schmidt, W. Robe
Schmidtke, Reinh
a Ss. C
mitz, Anthony A
Schmitz, Senet 3...
Schmitz, Glenn P...
Worthington
... Owatonna
-Minneapolis
(Minneapolis
Parkers Prairie
¢ Schoch, Robert B. J.
Schoeneberger, P. B
t Scholpp, Otto W.
Schons, Edward.
Schottler, Max E
Pottstown, Pa.
St. Paul
Schumacker, John W...
hutz, Elmer S
Schwartz, Carl A...
Schwartz, E. Robert
Schwartz, Virgil J
Schwarz, Bert E
Schweiger, Theodore R
Schweinfurth, J. D
t Schwyzer, Arnold. G..........+
San Juan, Puerto
Schwyzer, Hanns C St. Paul
MINNESOTA MEDICINE
.-Rochester
Noose Lake
{inneapol
..New
finneapolis
Lutchinsog
.Rochester
Rochester
nneapolis
nneapolis
ae
nneapolis
...Chaska
d Rapids
Rochester
nneapolis
...Duluth
Rochester
.-Winona
rora, Ill,
nite Falls
nneapolis
=
es if.
Mankato
t. Cloud
ttle Falls
ha, Wis.
ineapolis
:neapolis
St. Pel
ineapo!
binsdale
in Lake
ochester
neapolis
neapolis
to Rico
St. Paul
‘DICINE
hwyzer, Marguerite..................4 St. Paul
ew: George W... Erskine
Scott, Eugene
Scott, Horace G
Scudamore, Harold K
seaberg, John
seashore, R. T
Seay, James Elbert, IIT
seery, Thomas
Iby, Joh
ee, "Thomas H Rochester
Seljeskog, Ss. R Min 1
Sells, Richard S. No. St. Paul
Selmo, Joseph N od
Semsch, Robert
Senkler, George E...
+ Senn, Edward W
Setzer, Hobert J
+ Seybold, Herbert
Shandorf, James F..
Shannon, William R..
Shaperman, Eva P
Shapiro. Sidney K
Sharp, David D
oS eee
haw, Howard A
Shea, Andrew W
Sheedy, Chester L
Sheldon, Warren_N...............4 Minneapolis
f Shellman, John I
Pacific Palisades, Calif.
ye G Hutchinson
Sherman, Charles L...
Sherman, Hubert
Sherman, Lloyd F....
Sherman, Royal V...
Sherwood, George E..
Shick, Richard M
Shields, Jack W
hillington, Maurice A
Shirai, Shohei
Everett
Rochester
Minneapolis
Coleraine
Rochester
St. Paul
Howard Lake
I Minneapolis
Sibley, John A Rochester
Siegel, Clarence . Paul
Siegel, John S Virginia
Minneapolis
L Rochester
Silas, Ralph M i polis
t Silver, Arthur W Rochester
Silver, John D Minneapoli
Simison, Carl Barnesville
Simmonds, Harry N Prior Lake
Simon, Howard B... -Rochester
Simons, Bernard H. mt
Simons, Edwin J
t Simons, Jalmar H..
Simons, Leander T
Simonson, Donald
Simonton, Kinsey MacL
* Simpson, Ellery D
Sinamark, Andrew...
singer, Benjamin J.
Sinykin, Melvin B....
Siverstein, David M..
Sisk, Harvey F..........
Sisler, Clifford E
Sisterman, Thomas J..
Siekert, R
Rochester
Phoenix, Ariz.
Hibbing
+ Sivertsen, Andrew...
¥ Sivertsen. Ivar.
Sioding, J. Donald
Siostrom. Lawrence E
Staife. William F
Skaug, Harold M
Skinner, Abbott.
kinner, Harvey O
pold, Arthur Cc Mi i
Skogerboe, R. Karlstad
Skrdla, Willard B. Rochester
later, Sidney A Worthington
locumb, Charles H... Rochester
mid, Arthur C Rochester
smiley, John T.... i li
Smisek, Elmer A
Smisek, Frank M. E
Smith, Adam M
Smith, Archie M
Smith, Baxter A., Jr..
Smith, Cyril M
Smith, Don V
t Smith, Frederick L.
Smith, George R
Smith, Graham G
May, 1955
..Blue Earth
Rochester
-Hutchinson
* Steiner, Irving W
ALPHABETIC ROSTER
Smith,
Smith,
+ Smith,
* Smith,
Smith,
Smith, Rochester
Smith, Meredith P Rochester
+ Smith, Margaret I........../ Gardena, Calif
+ Smith, Myron Red Wing
Smith, Norvin R.. Willmar
Smith, Paul
Smith, Reginald A
¢ Smith, Ross H., Jr Rochester
Smith, Theodore S /Minneapolis
Smith, Vernon D. E. St. Paul
Smith, Wallace R Grand Marais
Smith, William G Rochester
Smith, William T Minneapolis
Smorstok, Matthew B... Monticello
Smyth, John J Lester Prairie
Snyder, Clifford D
Snyder, George W
Snyker, Omer E
Soderlind, Ragnar T
Sogge, Ludwi
Sohil
‘Rochester
Minneapolis
Windom
Solhaug, Samuel B
Solhaug, S 1 B., Jr
Solsem, Frederick N. S
Solvason, Harold M.........
Sommerdorf, Vernon L
S s, Ben...
Sommerness, M. Duane
Sonnesyn, Nels N
Sorem, Milton B
Sorum, F. T
Soucheray, Philip
Soule, Edward H
Souster, Benjamin B
Sowada, E
Spain, Ww.
Spang, Anthony J
Spang, James "
Spang, William M.
Spano, Joseph P.... Minneapolis
Spear, Harold C w Haven, Conn.
Spencer, Bernard J................. Minneapolis
Spencer, Jean A ochester
Sperl, Michael P., Jr Rochester
Spink, Wesley W ‘Minneapolis
Spittel, John A., Jr.. ..Rochester
Sponsel, Kenath H....
t Sprafka, Gregory A...
+ Sprafka, Joseph L
Sprafka, Joseph M.....
Sprague, Randall G..
¥ Spratt, Charles N
Spurbeck, George H.
Spurzem, Raymond J...
Stadem, Clifford J....
Stahler, Paul A
Stahl, George W
Stahn, Louis ..El Paso, Texas
Stahr, Aubrey C. opkins
Stam, Joh .Worthington
..Minneavolis
Fergus Falls
..Le Sueur
Stangl, 3
Stanley, ....Worthington
Starekow. Milton D.....Thief River Falls
Starr, Grier F Rochester
Staub, Henry P (Minneapolis
Stauffer, Maurice H Rochester
Steffens, Leon A
+ Stein, Harold A
Stein, Raymond J
Stein, William A
Steinberg. Charles L
Win
t Steiner. Leon E iPhiladelphia, Pa.
Steinhilber, Richard M
Stelter, Lloyd A .-Minneapolis
Stemsrud, Harold L.. ....Alexandria
Stennes, John L ‘Minneapolis
Stensgaard, Kermit L...Thief River Falls
Stenstrom, Annette inneanolis
Sterner, Donald
* Sterner, Ernest G
Sterner, E. R
Sterner, John J
Sterrie, Norman A
+ Stevens, Grant M
Stevenson, Basil M..
Stevenson, Frank W.
Stewart, Alexander.
+ Stewart, Allan H.... 4
Stewart, ‘Crookston
Stewart, i Minneapoli
Stewart, Minneapolis
Stickney, J. M a
¥ Stiegler,
Stilwell, George G....
Stillwell, George K
+ Sweitzer,
+ Swendseen, Carl G
Stillwell, Water C
Stoesser, Albert
Stolpestad, Armer H...
Stolpestad, Herbert
Stoltz, Robert C
Stomel, Joseph
Strand, Jack W
Strandjord, Nels M.....
Stransky, Theodore W..
Strate, Gordon
Strathern, Carleton S.
Strathern, Fred
Strathern, Moses L.
Stratte, Alf K
Stratte, Harold C
Strauchler, Jona
-Little Falls
Minneapolis
Straus, M. L
Strauss, Eugene C...
Street, Bernard
Strem, Edwar
Strewler, Gordon J
trickler, Jacob H
S
Strobel,
Stroebel, Chas. F., Jr..........
..... Rochester
Mi lis
Strom, Gordon W
Stromgren, Delph T
Stromme, William B
ae
Strunk, Clarence A
Struthers, A. Morgan
Struxness, Davi
Studer, Donald J
....Glencoe
Faribault
‘Rochester
Stuhler, Louis G
Stuhr, John W
Stillwater
Sturges, Robert L
Sturley, Rodney F
ubby, Walter
Sukov, Marvin
Sullivan, Raymond M
Sullivan, Robert E
Sutherland, Harry N..
Sutherland, W. H
Sutton, Harris R
Svien, Hendrik J..
Swain, Francis M
+ Swanson, John A
Swanson, Lawrence
Swanson, Roy E
Swedberg, William A....
Swedenburg, Paul A
Sweetser, Horatio B
Sweetser, Theo. H.,
Sweetser, Theo. H.
Minneapolis
Minneapolis
Swendson, James J.....
Swenson, Arnold
+ Swenson,
+ Swenson,
Swenson,
Swenson, Roy
Symmonds, Richard E
Syverton, Jerome
Graceville
Tam, Ernest C.
MMinncepelis
Tangen, George M
P
Rochester
Tani, George T
Tanquist, Edwin J
Alexandria
Taub, Robert G
Rochester
~ on
Taylor, Joseph H
Teich, Kenneth W.
Teisberg, John E..
Tenner, Robert J
Terrell, Bernard J
Tesch, Gordon
Tetlie, James P
Thabes, J. A., Jr
Brainerd
J
Thayer, Ellsworth A
Thielen, Robert D
Thiem, Chester E
Fairmont
St. Michael
Thill, Leonard J
Ralat.
Thomas, George E
Thomas, John V
Thomas, hig H
Thomes, A
Th
(Mi
Thompson, A. Henry.
Th Carl O
Litchfield
Hendricks
Thompson, Floyd A
Thompson, Gershom J
Th , Willis H
Paul
Rochester
Th , James
Austin
Thoreson, M. C. Bernice...So. St. Paul
Thorsen, David S
M
Thorson, Stuart V.
Thuringer, Carl B
Thysell, D d
1
Thysell, Fred A
Thysell, Harold R
Thysell, Vernon D
Tichy, Fae Y
Tifft, Cyril R
Tihen pone’ N
Tillisch, J
t Tingda “= ha
Tingdale,
Tinkham, Robert
Titrud, Leonard
Tregilgas, “Harold R
Tregilgas, Richard B..
Troost, Henry
Trow, James E
Trow, illiam H
Trueman, Harold S
Truesdale, _— hes
Tsai, Shih H
ow Nagy Fang s.
Tucker, Richard Cc
Tudor, Richard B
Tuohy, Edward L
¢ Turnacliff, Dale D.
Tweedy, job
Tweedy, Robert B.
Twiggs,
Twomey, John E
Ubel, Frank A
Ude, Walter H
Uhley, Charles G
Uihlein, Alfred
Ulrich, Henry L
Ulvestad, Harold S
Underdahl, Laurentius O
Undine, Clyde A
erg,
Utne, John R
Utz, "David C
Rochester
Rochester
t Vadheim, Alfred L
+ Valentine, Walter H
Van Bergen, Fredk. H
Van Cleve, Horatio P., aE.
Vandersluis, Charles W...
‘an Herik —~
Van Meier, Henry....
Van Patter, Ward
Van Rooy, George T...Thief River Falls
Van Ryzin, Donald J Duluth
Varco, Richard L sad
Vaughan, Victor M
Vaughn, Louis D
Veirs, Dean
Veirs. Ruby J.
Venables, Alexand
Veranth, Leonard A...
Verby, john E., Jr
Vermund, Halvor
Rochester
i p lis
Mapleton
Minneapolis
Anoka
Virnig, Hildegard J
Virnig, Mark
Virnig, Richard aes
Vitols, T. Minneapolis
Vogel, dines A. ...New Ulm
‘ollmer, Frederick ra Winona
¢ von Amerongen, W. W...Chandler, Ariz.
¢ Von Drasek, Joseph ankato
Waas, Charles W
Wagener, Henry P
Wagner, Norman W
Wagoner, James me
Wahlquist, Harold F..
Wakefield, Elmer G...
+ Wakim, Khalil G...
Walder, Harold J...
Waldron, Carl W
Walfred, Karl A..
t+ Walker,
ALPHABETIC ROSTER
Walsh, Francis M Minncapolis
Walsh, William T
Walter, Clarence Wm St. Paul
Walter, Frederick H.. International Falls
Walter, William E W: mingo
Walters, Waltma R
Wandke, Otto E
Wang, Jun-Chuan
Wangensteen, Owen
Ward, Bert B
Ward, Louis E
Ward, Percy A
arner, James
Warren, Cecil A
Wasmund, Clarence
Wasson, Loren F
Watkins, Charles H.
Watkins, Joha A
Watson, Alexander
Watson. C. Gordon
Watson, Cecil J p
Watson, Eleanor J Rochester
Watson, . R Rochester
Watson, Theodore...
Watson, Percy hag
Watson, Robert M...
Watson, Sydney Wm...
Watson, William H. A..
Watson, William J
Watz. Clarence E
Waud, Robert E
Waugh, John M
+ Weaver, Myron Mc
sana ™ bi Canada
Weaver, Paul H...... Faribault
wore Edgar A
Roscoe C
Webber, Fred L
Webber, Richard -
Weber, “Harry Mi... c.eseseeeseeeeeese ROChEster
Weber, Lowell W.. Mi poli
Lyle Au... eseeseeeeeeeeee ROCHESter
Wome, Richard E. a
ehr, B
Weiner, Alan D.
Weir, james F
Weis. Benjamin A
Weisberg, Maurice...
Weisberg, Raphael J
Weiss, arl A
Welch, John S
Wellman, Thomas ae
Wellman, William E...
"Red : Wing
.-Alexandria
Clinton, Iowa
Rochester
ester
Duluth
Jackson
...Minneapolis
Wente, Harold A...
+ Wentworth, Albert
Wenzel, Gilbert P
t Werner, George
Wesolowski, Reniey P
+ West, Catherine C
Westby, Magnus.
Westby, Norval M
+ Westerman, Alvin E
Westerman, Fred Cc
Westover, D.
Westrup, By E
Wetherby, Macnider.
Wetzel, Earl V.
3 Weyhrauch, Robert A.
Wheeler, Daniel W
*+Wheeler, Merritt W..
Wheeler, Robert W Minneapolis
White, Asher A ..Minneapolis
+ White, S. Marx... Minneapolis
White. Willard D. aaneapens
Whitesell, Lloyd A (M
Whitson,” Sidney A Albert "Lea
Whittemore, Dexter D
Widen, Wilford F i
Wikoff, Howard M kst
Abe Lea
Wilder, Minneapolis
Wilder, ob: L ‘Minneapolis
+ Wilder, : Bethesda, Md.
t Wilder, Russell M. Minneapotis
Wilken, Paul A
t Wilkinson, George R., Jr
t Wilkinson. Stella L St. Pau
Will, Charles B
Will, W. W Bertha
+ Willcutt, Clarence E.......... Phoenix, Ariz.
+ Williams, Arthur B St. Paul
re ‘Minneapolis
Minneapolis
Lanesboro
Minneapolis
¢ Williams,
Williams,
Williams,
Williams,
Williams, H
¢ Williams,
Williams,
¢ Williams,
Williams, M. M
Williams,
**Williams,
illiams,
Tt Williams, erm
Williamson, Harold
Wilmot, Cecil A
Wilmot, Harold
+ Wilson, Clyde E.
$ Wilson, Franklin
Wilson, . All
Rolland H..
Theodore
Viktor O..
Warren E.
¢t Wiltrout, Irving G
Winchell,
+ Winnick, — B.
Winter, jenn A
Winter, Malcolm D., Jr..
Winther, Nora M. G
Wittrock, Louis H.
Wohlrabe, Arthur A
Wohlrabe, A. Cabot.
Wohlrabe, Clarence F...
dwin J
Wolkoff, J
hve Magy Eric.
Wolstan, Simon
Wolter, Frederick
- Woltjen, Myron
Woltman, Henry Wm.
Wood, Harry G
Woodington, George F.....
oolner, Lewis B
Word, Harlan L
Workman, Warner
Woyda, William C
+ Wray, William E
Wright, Robert R..
Wright, Thomas D.
Wright, Wale S
Wright, William S.
t Wuest, "John H., Jr
Wyatt, Oswald §
Wynne, Herbert M. N
Yaeger, Wilbert W
t Yamamoto. Joe...
7 Ylitalo, William H
Yivisaker, regal
Yoerg,
Young, ond H
Young, Thomas O.
Younger, Lewis I...
Youngren, Everett R.
Yue, W
Zachman, pool H
Zahrendt,
Zarling, 'V. ‘Richard.
Zaworski, Leo
t Zeigler, Charles M.
Zeller, "Nicholas H
Zemke, Erhart E...
s, Roberts...
Zemt Luther H...
Ziegler, Robert Ge,
Zierold, Arthur A
Zimmer, J. F
Zimmermann, Harry B
Zinter, Ferdinand A
Ziskin, Thomas
Zupanc, Edward A
MINNESOTA MEDICINE
Live Music Archive
Librivox Free Audio
Metropolitan Museum
Cleveland Museum of Art
Internet Arcade
Console Living Room
Books to Borrow
Open Library
TV News
Understanding 9/11