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in the early r of the uterus en the ages of hough it is seen m. I have seen ung as twentyenty-five of the ence helped her --three to within er death. I am ted to an operawould be living type of mucous the cervix, its

are different, it

The squamous

of the vaginal

the racemose or

e cervical canal,

of the mucous

y of the fundus, by the cancer evelop from all

such a macroscopical picture must be
carefully studied, and, if possible, a
small section of the diseased cervix re-
moved, dropped into a ten per cent
solution of formalin, and submitted to
some competent pathologist for care-
ful study and diagnosis.

If

a

fetid and watery discharge
exists and the cervix presents no signs
of abnormality, the disease is probably
in the cervical canal or in the cavity
of the uterus. If upon bimanual pal-
pitation irregular nodules are found, it
is probable that myomata are present.
In the great majority of cases if the
myoma is of the submucous variety
there is profuse menstrual discharge,
but, unless there is sloughing of a
fibrous nodule, there is no bloody dis-
charge between the monthly periods.
If there is a sloughing submucous
nodule, the discharge may be fetid and
bloody. In this case, many times it
can be
in the cervical canal.
When this is true, it can be easily re-
moved, and submitted to the pathologist
for study.

is an outgrowth e mucosa as well he deeper strucch in blood vesturbance of the Leed. In fact, I y of these cases nstantly because Progression of Lecrosis, and the d friable, which, king down, and ischarge occurs. e comes early in es absent if the scular.

slightly blood or ld cause one to -igin. In these often be found bleeding. It is r its surface are growths, which ith the finger or

seen

As a rule a diagnosis can be made
without the aid of the microscope. A
fibrous nodule is generally tough and
not friable, and if the finger can be
introduced into the cervical canal or
cavity of the uterus, they will be
found to be clearly defined masses,
around which one can sweep the finger.
A cancerous mass, on the other hand, is
soft, easily broken down, and bleeds
violently. Pelvic inflammation occa-
sionally gives rise to a bloody dis-
charge. A history carefully taken will
reveal old pelvic lesions,
vaginal infection, or an incomplete
abortion. The presence in these cases
of elevated temperature often clears
up the diagnosis.

a

recent

Intro-uterine pregnancy may cause a discharge similar in character, but not identical to the cancer discharge. It is intermenstrual, rarely offensive, and

period. Bimanual examinati
generally reveal the soft,
boggy mass on one side of the

In all cases where the physic
ination is unsatisfactory as fa
vealing the exact nature of th
is concerned, the uterus should
ted. In order to do this li
cedure so as to secure a
amount of curetted mater
mucosa should be removed f
anterior, posterior, and later
of the cavity as well as f
cervical canal. It is very pro
much tissue is secured, tha
nancy is present. All the t
moved by the curette, inclu
blood, should immediately be
into a ten per cent solution of
without washing.

Occasionally the pathologist
culty in determining as to wh
specimen is malignant or not,
rule the differentiation is prom
correctly made between

normal tissue.

ca

our

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With the present knowl
Possess one is absolutely unju
allowing a case under
which there is the least groun
picion of cancer to go on an
the disease until it is
macroscopically. From no o
of the body can we so easi
material for diagnostic st
there is no excuse for failure
an early diagnosis of cance
suspicion exists in our mind
tient and family should be
told of the situation and the
of rapidly arriving at the
which means saving the li
afflicted individual.

Early curettage in suspec
can do no harm and clears
certainty, which, if allowed
may result disastrously. It i
as teachers and specialists a
lines to keep constantly b

eal the soft, yielding, ■ one side of the uterus. where the physical examatisfactory as far as react nature of the lesion ne uterus should be curetto do this little proto secure a sufficient curetted material, the - be removed from the erior, and lateral walls - as well as from the

It is very probable, if is secured, that maligent. All the tissue re- curette, including the immediately be dropped cent solution of formalin ng.

the pathologist has diffimining as to whether the alignant or not, but as a entiation is promptly and e between

cancer

procrastination is the thief of time, how surely is it the greatest criminal of all in its theft of life of every individual who is afflicted with cancer.

There is no censure too great for the doctor, whether he be young or old, who, for the sake of practice, holds on to a case until it has passed the border line of safety and enters the realm of uncertainty. There can be no excuse. Ignorance in these days of enlightenment is not good ground in the profession for delay in early diagnosis. "Safety first" is a maxim in these cases that applies both to the welfare of the patient and redounds to the everlasting credit of the doctor.

Along with early diagnosis goes early operation, and with early operation is lifted the veil of uncertainty and death, which goes with watchful waiting,-tampons, iodin applications, and douches.

cases

Of the treatment of these and surgically I will say nothing, because it is a large subject and one requiring a whole evening for its discussion.

present knowledge we absolutely unjustified in ase under our care in the least ground for suser to go on and develop until it is recognized 7. From no other part can we so easily obtain diagnostic study, and cuse for failure to make nosis of cancer. Where sin our mind, the panily should be frankly uation and the necessity iving at the conclusion, saving the life of the idual.

cage in suspected cases 'm and clears up an unch, if allowed to go on, astrously. It is our duty d specialists along these constantly before the

GOLDEN JUBILEE-VICTORY CEL

EBRATION MEETING.

The Fiftieth Annual Meeting of the American Medical Editors' Association will be held at the Marlborough-Blenheim Hotel, Atlantic City, on Monday and Tuesday, June 9th and 10th, and will take the form of a semi-centennial celebration and a Victory Meeting, emphasizing the part which this Association and its members have taken in the world's war.

The enthusiasm manifested upon the part of the President, Ex-Presidents and Officers of this Association is an assurance of its successful outcome.

A most attractive program is now being prepared and every physician, even remotely interested in medical journalism, will find it to his advantage to attend.

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PRACTITIONER

A MEDICAL, CLIMATOLOGICAL AND SOCIOLOGICAL MONTHLY MAGAZINE. This journal endeavors to mirror the progress of the profession of California and Arizona.

Established in 1886 by Walter Lindley, M.D., LL.D.
DR. GEORGE E. MALSBARY, Editor and Publisher.

Associate Editors,

Dr. Walter Lindley, Dr. W. W. Watkins, Dr. Ross Moore, Dr. George L. Cole,
Dr. Cecil E. Reynolds, Dr. William A. Edwards, Dr. Andrew W. Morton,
Dr. H. D'Arcy Power, Dr. B. J. O'Neill, Dr. C. G. Stivers,
Dr. Olga McNeile, Dr. W. H. Dudley, Dr. J. M. Mathews.

Address all communications and manuscripts to

EDITOR SOUTHERN CALIFORNIA PRACTITIONER, Suubscription Price, per annum, $1.00.

1414 South Hope Street, Los Angeles, Cal.

EDITORIAL

HOSPITAL STANDARDIZATION.

have him as we have had him will be benefited by his presence.

Bishop Joseph H. Johnson made an interesting talk on the problems that face the hospitals of today. Dr. John Willis Baer of Pasadena spoke in a humorous, graphic manner in regard to the citizens' part in hospitals.

The meetings held in Los Angeles at the Hotel Alexandria on the afternoon and evening of April 2nd, for the betterment of hospitals, were of decided benefit to Southern California. Dr. John G. Bowman, Director of the American College of Surgery, had the meeting called and it was held under the auspices of that organization. Dr. Henry H. Sherk of Pasadena presided. There was at each meeting a large attendance. Dr. Bowman at both meetings spoke eloquently and forcibly on Hospital Standardization, devoting himself to the importance of laboratories, DR. S. ADOLPHUS KNOPF IN LOS case records, and staff organization.

Drs. Granville MacGowan, F. C. E. Mattison, Stanley P. Black and Andrew Stewart Lobingier all gave interesting talks along the same lines. Rev. Chas. B. Boulinier, President of the Catholic Hospital Association, also spoke at both sessions.

Dr. Bowman was the vital spark of the occasion. He spoke like one inspired and every community that can

Hospitals must never be standardized to the extent of doing away with individuality, but by such meetings as these each hospital can be aroused to a sense of its responsibilities and possibilities.

ANGELES.

It was a dark, rainy night when Dr. Knopf of New York City addressed the Los Angeles County Medical Society, Thursday, March 20th, at its regular monthly meeting. Despite the weather there was a full attendance and the speaker of the evening was filled with enthusiasm by the presence of many old friends. Dr. Knopf is still serving the Government, his special mission

se has been arrested.
s in Los Angeles he de-
to the benefits of mas-
physical training. He
is methods very graph-
tient and the five hun-
physicians present real-
enjoyed a rare privilege
ity the evening had af-
President W. T. Мс-
rs. Pottinger, Browning
lowed the address with
eciation, while Dr. Geo.
a vote of thanks to the
carried unani-

of membership in the county unit.
Since this Society has always main-
tained a pronounced attitude upholding
all that the County Society stands for,
we have not lost anything, but have
gained in having affiliated ourselves
with the organization that has always
stood for the very best in scientific
medicine.

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was

on of Southern CaliforKnopf as one of themegan his medical studies ity of Southern Califorhe first interne medical Los Angeles County Hos

on of the latter fact, at of the address the SoInternes of the Los AnHospital presented Dr. he jeweled insignia of ion. Dr. Knopf graced. On adjournment the e a reception and a re

OF THE LOS ANGELES
MEDICAL ASSO-
CIATION.

lar meeting of the Los
rical Society, March 11,
ety voted to become a
e Los Angeles County
iation, provided that by
tion the Obstetrical So-
ot lose its identity. On
he Los Angeles County
ation, through its Coun-
ly granted the applica-
Angeles Obstetrical So-

VERDICT SET ASIDE.

We recently noted the judgment obtained against Dr. W. R. Livingston, of Oxnard, in the damage suit of Davison vs. Livingston. We are glad to note that Judge Rogers set aside the verdict of the jury and granted a new trial, on the ground that the evidence did not show any negligence on the part of the Doctor, such as was claimed by the plaintiff. We congratulate the Doctor, but deem it unfortunate that he should have been put to the inconvenience of court procedure. There would be very few malpractice suits if the cases could be examined by some sort of investigating body such as a grand jury before being placed on the docket for trial.

STATE SOCIETY OFFICERS.

The California State Medical Society announces the election of the following officers for the ensuing year:

Dr. A. L. Ryfkogel of San Francisco, president; Dr. H. G. Brainerd of Los Angeles, first vice-president; Dr. Dudley Smith of Oakland, second vice-president; Dr. W. H. Kiger of Los Angeles, Dr. James A. Parkingson of Sacramento and Dr. O. D. Smith of Oakland, councillors; Dr. A. B. Spalding of San Francisco, delegate to the American Medical Association; Dr. Saxton Pope of San Francisco, secretary, re-elected.

The convention next year will be held at Del Monte.

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HERN CALIFORNIA
RACTITIONER

OLOGICAL AND SOCIOLOGICAL MONTHLY MAGAZINE.
ors to mirror the progress of the profession of California

hed in 1886 by Walter Lindley, M.D., LL.D.

RGE E. MALSBARY, Editor and Publisher.

Associate Editors,

. W. W. Watkins, Dr. Ross Moore, Dr. George L. Cole, Ids, Dr. William A. Edwards, Dr. Andrew W. Morton,

y Power, Dr. B. J. O'Neill, Dr. C. G. Stivers,

McNeile, Dr. W. H. Dudley, Dr. J. M. Mathews.

cations and manuscripts to

SOUTHERN CALIFORNIA PRACTITIONER, um, $1.00.

1414 South Hope Street, Los Angeles, Cal.

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tuberculosis in soldiers and sail
whom the disease has been arrest
In his address in Los Angeles
voted his time to the benefits o
sage and mild physical trainiı.
demonstrated his methods very
ically on a patient and the fiv
dred or more physicians presen
ized they had enjoyed a rare p
in the opportunity the evening
forded them. President W.
Arthur and Drs. Pottinger, Br
and others followed the addres
words of appreciation, while I
L. Cole moved a vote of thank
speaker, which was carried
mously.

The profession of Southern
nia elaims Dr. Knopf as one o
selves as he began his medical
in the University of Southern
nia and was the first interne
student in the Los Angeles Coun
pital.

In recognition of the latter
the conclusion of the address
ciety of Past Internes of the
geles County Hospital presen
Knopf with the jeweled ins
that organization. Dr. Knop
fully responded. On adjournm
meeting became a reception a
union.

A SECTION OF THE LOS A
COUNTY MEDICAL AS
CIATION.

At the regular meeting of
Angeles Obstetrical Society,
1919, the Society voted to
Section of the Los Angele
Medical Association, provided
such an affiliation the Obste
ciety would not lose its iden
March 13th, the Los Angele
Medical Association, through
cillors, formally granted the
tion. The Los Angeles Obste

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