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c Colendar of Medlcal Meetfos-May 1954 MONDAYS I TUESDAYS I WEDNESDAYS THURSDAYS FRIDAYS SATURDAYS Page Page Page Page Page Page May 5 May 6 May 7 N.Y. Soc. of Physical NYAM-Stated NYAM-Surgery; N.Y. Medicine 363 Meeting 362 and B'klyn Com. *J.Y. Hospital- NYAM-Postgraduate on Trauma 362 Prac. Conf. 363 Radio Program 368 Montefiore Hospital 363 N.Y. Allergy Soc. 363 Medical Circle 363 May 10 May I I May 12 May 13 May 14 May 15 Soc. of Medical Juris- N.Y. Neurological iVYAM-Historical & The Mt. Sinai Hosp.- N.Y. Society for Columbus Hospital 366 prudence 363 Society & NYAM 362 Cultural Medicine 362 Ophthalmol. Conf. 364 Thoracic Surgery 365 Beth David Hosp. 363 The M.. Sinai Hosp.- N.Y. Hospital- U.S. Veterans Hosp. 365 American-Hungarian The Mt. Sinai Hosp.- Gzslroca:-erology 364 Prac. Conf. 363 N.Y. Cardiological Medical Assn. 366 Neurological 364 ~ The Mt. Sinai Hosp.- Society, Inc. 365 Diabetes & Nutrition 364 NYAM-Postgraduate High Point Hospital 364 Radio Program 368 Columbus Hospital 364 The N.Y. Hospital- N.Y. Surgical Society 365 Plastic Surgery 365 N.Y. Soc. for, Speech & Voice Therapy, Inc. 365 Adelphi Hospital 365 May 17 May 18 May 19 May 20 May 21 NYAM-Ophthalmol. East Side Clinical N.Y. Hospital- The Hospital for The Assoc. for the & Obstetrics 362 Society 366 Prac. Conf. 363 Spec. Surgery 367 Advancement of N.Y. Roentgen Society 362 Harlem Hospital 366 Gouverneur Hospital 367 Psychotherapy 367 Madison Ave. Hosp. 366 Medical Arts Center 366 The Harvey Society 368 NYAM-Orthopedic 368 The Clinical & Alumni NYAM-Genito- NYAM-Postgraduate Soc. of Morrisania Urinary Surgery 367 Radio Program 368 City Hospital 366 NYAM- Ofolaryngology 368 May 24 May 27 N.Y. County Society i•JYAM-Postgraduate Stated Meeting Radio Program 368 I

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Programs NEW YORK ACADEMY OF MEDICINE All meetings are open to the medical profession and to medical students. 2 East 103 Street, New York 29, New York THE NEW YORK ACADEMY OF MEDICINE STATED MEETING Thursday evening, May 6, at 8:30 o'clock The Ninth James Ewing Memorial Lecture Attacking cancer in a community. WALTER B. QUISENBERRY Director of Preventive Medicine, Territorial Health Department, Honolulu, Hawaii Combined Meeting SECTION ON SURGERY with the NEW YORK AND BROOKLYN COMMITTEE ON TRAUMA Friday evening, May 7, at 8:30 o'clock PAPER OF THE EVENING Overall care of hand injuries. ERIK MOBERG Sahlgrenska Sjukhuset Hospital, Goteborg, Sweden Discusszon: J. WILLIAM LITTLER PRESTON A. WADE Combined Meeting SECTION ON NEUROLOGY AND PSYCHIATRY with the NEW YORK NEUROLOGICAL SOCIETY RESIDENTS' PROGRAM Tuesday evening, May 11, at 8:30 o'clock PAPERS OF THE EVENING Bellevue Hospital Acute cerebral venous occlusion manifested by spontaneous subarachnoid hemorrhage STEFAN SZANCER - New York Hospital-Payne-Whitney Clinic Psychopathological indications and contra- indications for the use of subcoma insulin treatment DONALD C. GREAVES Bellevue Hospital Schizophrenic children under the age of six MANUEL FURER New York Hospital-Westchester Division A survey of general surgical procedures in a group of emotionally disturbed women patients WILLIAM A. TRIEBEL The Mount Sinai Hospital The creative drive-a case history RICHARD S. BLACHER General Discussion: S. BERNARD WORTIS OSKAR DIETHELM M. RALPH KAUFMAN BERNARD C. MEYER SECTION ON HISTORICAL AND CULTURAL MEDICINE Wednesday evening, May 12, at 8:30 o'clock PAPER OF THE EVENING "Our heritage from William Osler-1954" STANLEY E. DORST Dean, University o f Cincinnati College of Medicine; Chairman, Directing Staff, Cincinnati General Hospital Discussion : MR. HERBERT WOHL College of Physicians and Surgeons, Columbia University MR. RALPH C. WILLIAMS, JR. Cornell University Medical College MR. HENRY N. CLAMAN William Welch Society, New York Univ. College of Medicine MR. HAROLD STEINBERG New York Medical College, Flower and Fifth Avenue Hospitals MR. AARON'R. RAUSEN Medical History Club, State University of New York, College of Medicine at New York City General Discussion Combined Meeting SECTION ON OPHTHALMOLOGY with the SECTION ON OBSTETRICS AND GYNECOLOGY Monday evening, May 17, at 8:15 o'clock SYMPOSIUM: Ocular manifestations in normal and abnormal. pregnancy': Ocular diseases occurring during pregnancy. ELLEN F. REGAN Retinal findings in pregnancy. STUART S. SNYDER The value of retinal and conjunctival vascular findings in normal and toxemic pregnancies. ROBERT LANDESMAN General Discussion NEW YORK ROENTGEN SOCIETY in af}iliation with THE NEW YORK ACADEMY OF MEDICINE RESIDENTS' PROGRAM Monday evening, May 17, at 8:30 o'clock PAPERS OF THE EVENING a. Special studies on the lateral soft tissue: Roentgenogram of the neck. DORIS BATE, OSCAR RUIZ Francis Delafield Hospital (Continued on page 367) 362 NEW YORK MEDICINE

Programs LOCAL SOCIETIES AND HOSPITALS : i MEDICAL SOCIETY OF THE COUNTY OF NEW YORK There will be no meeting of the MATERNAL MORTALITY ANALYSIS GROUP of the SPECIAL COMMITTEE ON MATERNAL WELFARE in May. RALPH L. BARRETT, Chairman NEW YORK SOCIETY OF PHYSICAL MEDICINE STATED MEETING Wednesday evening, May 5, 1954, 8:30 p.m. New York Academy of Medicine Building, 2 East 103rd Street, New York, N. Y. Members of the medical profession are cordially invited. SCIENTIFIC SESSION The problems of the service for handicapped children, the Board of Health, New York City. Panel Introduction (12 minutes each) HELEN WALLACE JEROME TOBIS ROBERT SIFFERT MISS MARGARET LOSTY, R.:V'. MISS HELEN GOSSETT, Social Service Panel Discussion (30 minutes) EXECUTIVE SESSION MORTON HOBERMAN, President 175 East 79th Street, N. Y. 21, N. Y. MADGE C. L. McGUINNESS, Secretary 48 East 62nd Street, N. Y. 21, N. Y. NEW Y ORK HOSPITAL PRACTITIONERS' CONFERENCE 525 East 68th Street, New York City Wednesday, May 5, 1954 Osteoporosis. Wednesday, May 12, 1954 Thrombophlebitis and embolism. Wednesday, May 19, 1954 Vitamin B12 and folic acid: assets and liabilities. CLAUDE E. FORKNER, Chairman NEW YORK ALLERGY SOCIETY Wednesday evening, May 5, 1954, 8:30 p.m. Room 440, N. Y. Academy of Medicine 1. Asthmatic attacks in children caused by bacterial strains in carriers. (6 min.) FRANKLIN A. STEVENS _ 2. The use of injectable anti-histaminics in herpetiform lesions. (10 min. ) MAURY D. SANGER 3. Mucolytic detergent therapy in bronchial asthma and other respiratory diseases. (45 min.) JOSEPH B. MILLER (by invitation) FREDERICK R. BROWN, President LEONI N. CLAMAN, Secretary MONTEFIORE HOSPITAL, DIVISION OF NEOPLASTIC DISEASES Friday afternoon, May 7, 1954, at 3:00 p.m. Social Hall, Main Bldg, Montefiore Hospital, MAY 5, 1954 100 East Gun Hill Road, New York 67, N. Y. The internal distribution of body sodium, potassium and water; its implications on the interpretation of metabolic balance and tracer dilution data. I. S. EDELMAN Established Investigator o f the American Heart Association; Assistant Professor of Medicine, School of Medicine, Univ. of California, San Francisco, California MEDICAL CIRCLE Friday evening, May 7, 1954, at 8:30 o'clock The Academy of Medicine, 2 East 103rd Street A contribution to the sterility pro'alcm. E. FARBER Common errors in rectal diagn,)s:s. F. VOGEL PAPER OF THE EVENING Present concepts of allergy. E. HELLREICH M. GROLNIK F. VOGEL, Secietary THE SOCIETY OF MEDICAL JURISPRUDENCE Monday, May 10, 1954 70th ANNIVERSARY DINNER Honoring DR. LEON THEODORE LEWALD'S 35 years of service Hotel Statler-Penn Top Room 6:00 p.m., Reception; 6:30, Cocktails, 7:00, Dinner Speakers: HON. EDMUND H. LEWIS Chief Judge of The Court of Ap,heals of The State of New York Ho:.. ANDREW A. EGGSTON, M.D., D-PA, FCAP President of The Medical Society of The State of New York Send in your reservations to Joseph Carl Thomson, Secretary, 217 Broadway, New York 7, at $7.50 per person. HOWARD C. HUTTER, President JOSEPH C. THOMSON, ESQ., Secrerary BETH DAVID HOSPITAL CLINICAL SOCIETY CONFERENCJ Monday, May 10, 1954 at 9:00 p.m. Beth David Hospital, 161 East 90th Street, New York City 1. Synovial Sarcoma JULES D. GORDON Discussion : JOSEPH BUCHMAN THEODORE M. SANDERS 2. Case of Hyperparathyroidism ELLIOTT HOCHSTEIN Collation Members of the medical profession cordially invited. ARNOLD KOFFLER, Chairman 363

THE MOUNT SINAI HOSPITAL GASTROENTEROLOGY Tuesday evening, May 11, 1954, 8:30 p.m. Lecture Room 3-B. Entrance: North Side of 100th St., between Fifth and Madison Aves. SYMPOSIUM Reports from the gastroenterology research laboratory. FRANKLIN HOLLANDER, PH.D., Chairman An investigation into the Etiology of cardiospasm. JOSEPH BANDES in collaboration with VICTOR WILLNER The influence of steroid hormones on the healing of experimental gastric ulcers. VERNON WEINSTEIN in collaboration with HENRY D. JANOWITZ A new approach to ulcer therapy through inhibition of intracellular enzymes. HENRY D. JANOWITZ Effect of a carbonic anhydrase inhibitor on pancreatic secretion in man. DAVID DREILING in collaboration with HENRY D. JANOWITZ Effect of subtotal gastrectomy upon external pancreatic secretion in dogs. ALEXANDER RICHMAN in collaboration with LOUIS J. LESTER ASHER WINKELSTEIN, Presiding HARRY YARNIS, Secretary 1075 Park Ave., N. Y. 28, Pd. Y. LAST CONFERENCE OF THE SEASONI THE MOUNT SINAI HOSPITAL MONTHLY NEUROLOGICAL CONF. Monday evening, May 10, 1954, at 8:00 p.m. Lecture Room 3-B. Entrance: North Side of 100th Street, between Fifth and Madison Aves. 1. Neuropathology: a case of embolic occlusion of the middle cerebral artery. I. FEIGIN I. SILBERMAN 2. Two case presentations: Wilson's disease. I. SILBERMAN M. BORti STEIN 3. Metabolic studies in Wilson's disease. A. G. BEARN 4. Personality factors in patients with intractable pain: effect of electro-convulsive therapy. E. A. WEINSTEIN P. S. BERGMAN R. L. KAHN MORRIS B. BENDER, Chairman SEMINARS ON DIABETES AND NUTRITION Wednesday, May 12, 1954, 8:30 p.m. Lecture Room 3-B. Entrance: North side of 100th Street, between Fifth and Madison Avenues. 1. Case Presentation STEROID DIABETES TREATED WITH LENTE INSULIN ROBERT H. ,TOELSON The Mount Sinai Hospital 2. COMPARISON OF LENTE INSULIN, A NEW MODIFICATION, WITH OTHER INSULINS IN THE TREATMENT OF DIABETES MELLITUS W. R. KIRTLEY Physician-in-Charge, Diabetes Research Lilly Laboratory for Clinical Research, Indianapolis, Indiana . HENRY DOLGER, Chairman JOHN BOOKMAN, Secretary Next Seminar: Wednesday evening, Novem- ber 10, 1954. OPHTHALMOLOGICAL CONF. Thursday evening, May 13, 1954, 8:30 p.m. Lecture Room 3-B. Entrance: North Side of 100th St., bet. Fifth and Madison Avenues 1. Behcet's disease. DAVID SILVER 2. The use of gelfilm in filtration surgery for glaucoma. JOSEPH LAVAL ROBERT S. COLES 3. Review of service cases. HENRY MINSKY, Chairman SYLVAN BLOOMFIELD, Secretary 1010 Fifth Avenue, N. Y. 28 LAST CONFERENCE OF THE SEASON HIGH POINT HOSPITAL MONTHLY CONFERENCE Wednesday, May 12, 1954, at 8:30 p.m. New York Academy of Sciences, 2 East 63rd Street, New York Speaker: STEPHEN W. KEMPSTER Attending Psychiatrist, High Point Hos- pital, Port Chester, New York. Topic: Special Techniques in the Treatment of Schizophrenia Chairman: MERVYN SCHACHT Attending Psychiatrist High Point Hos- pital, Port Chester, New York Director: ALEXANDER GRALNICK High Point Hospital, Port Chester, New York (The profession is cordially invited) COLUMBUS HOSPITAL SCIENTIFIC CONFERENCE Wednesday, May 12, 1954, at 8:30 p.m. Amoroso Conference Hall 227 East 19th Street, New York 3, New York Carcinoma of the Breast FRANK E. ADAIR Memorial Hospital, New York City Discussion by Staff Collation 364 NEW YORK IMEDICINE

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I THE NEW YORK SURGICAL SOCIETY Wednesday evening, May 12, 1954, 8:30 p.m. The New York Academy of Medicine, 2 East 103rd Street, New York City CASE PRESENTATIONS 1. Dessimated fat necrosis one year following surgical resection of head of pancreas for acinous carcinoma. NELSON W. CORNELL 2. Cholecystectomy for cholelithiasis and inci- dental carcinoma of the gallbladder: Five year arrest. GEORGE M. SAYPOL 3. Aneurysm of the superior mesenteric artery successfully treated by restorative ancurysmorrhaphy. JOHN P. WEST 4.Intcrscapulothoracic amputation for diffuse angiomatous malformation. ELLIOTT S. HURWITT and AUSTIN JOHNSON (by invitation) 5. Avulsion of the scalp. A comparison between modern and old therapy. WILLIAM P. WHALEN 6. Radical resection and reconstruction of the chest wall for chondrosarcoma. WILLIAM I. WOLFF 7. Cholecystitis and kidney cyst stones simulating double gallbladder. D. REESE JENSEN and RUSSEL H. PATTERSON E. JEFFERSON BROWDER, President 200 Hicks Street, Bklyn. 2, N. Y. JERE W. LORD, JR., Secretary 55 East 92 Street, N. Y. 28, N. Y. NEW YORK SOCIETY FOR SPEECH AND VOICE THERAPY, INC. Wednesday, May 12, at 8:45 p.m. Hunter College, Park Ave. and 68th St., Room 1403, N. Y. C. Case Demonstration: Voice Break of Peculiar Origin HELEN BEEBE ~ Discussion Lecture: The Role of Grammar in Normal and Aphasic Speech EMIL FROESCHELS Discussion Guests welcome EMIL FROESCHELS, President HELEN BEEBE, Secretary ADELPHI HOSPITAL STAFF SOCIETY MEETING Wednesday, May 12, 1954, 9:00 p.m. 50 Greene Avenue, Brooklyn 38, N. Y. ANTIBIOTICS AND CHEMOTHERAPY THE INTELLIGENT USE OF ANTIBIOTICS IN MEDICAL CONDITIONS CARL A. BERNTSEN, JR. Research Fellow in Medicine Cornell University Medical College MAY 5, 1954 -IN SURGICAL CONDITIONS LT. COLONEL EDWIN J. PULASKI Director, Division of Surgery Army Medical Service Graduate School Walter Reed Army Medical Center Collation DAVID R. TELSON, President F. PAUL ANSBRO, Secretary THE NEW YORK HOSPITAL PLASTIC SURGERY CONFERENCE Thursday, May 13, 1954, 3:30 p.m. U. S. Veterans Hospital, 130 W. Kingsbridge Road, Bronx, N. Y., 5E Conference Room Surgery of the Hand ERIK MOBERG Guest lecturer of Goteborg, Sweden HERBERT CONWAY Consultant Plastic Surgeon THE NEW YORK CARDIOLOGICAL SOCIETY, INC. Ninety-Fifth Regular Meeting Annual Meeting for 1954, Thursday, May 13 Academy of Medicine, 2 East 103rd Street, Room 441, 8:30 p.m. Practical Problems in Rheumatic Fever in the Young LEO M. TARAN Director of the St. Francis Sanatorium for Cardiac Children. Cardio-vascular Features of the Arthritides and Related Conditions OTTO STEINBROCKER Attending Physician in Rheumatology- Hospital for Joint Diseases and Lenox Hill Hospital Members of the Medical Profession Invited. LOUIS FAUGERES BISHOP, President JOSEPH HENRY HODAS, Secretary NEW YORK SOCIETY FOR THORACIC SURGERY Friday, May 14th, at the Academy of Medicine, Room 440, at 8: 30 p.m. 1. Unusual Foreign Bodies of the Esophagus: Removal by Endoscopy and by Cervical Esophagotomy Case report by GEORGE N. J. SOMMER, JR. 2. Two Cases of Uncommon Malignant Esopha- geal Neoplasm Case report by WILLIAM G. CAHAN 3. Non-specific Granulomatous Esophagitis Case report by FRANK A. GAGAN 4.Intramural Reduplication of Esophagus Case report by HERBERT C. MAIER 365

AMERICAN-HUNGARIAN MEDICAL ASSN. STATED MEETING Friday evening, May 14, 1954, 8:30 p.m. Room 441, Academy of Medicine Building SCIENTIFIC MEETING Case Presentations: Subtotal gastric resection for peptic ulcer in an asthmatic patient. MARCEL , HAAS Cardiac arrest. Resuscitation by thoracotomy and rhythmic compression. ALEXANDER STRELINGER A desperate case of pulmonary tuberculosis. CHARLES BLAZSIK a. Disseminated lupus erythematodes. b. Suba.rachnoid hemorrhage with polycystic kidney and pregnancy. JEROME GERENDASY Extracapsular cataract extraction with Ridley's implant. WILLIAM T. BROWN Two cases, simulating psychoneurosis. EMORY I. WELLS Skin-grafts of the extremities. STEPHEN WAHL General Discussion Collation JOSEPH J. FRIED, President STEPHAN S. ROSENAK, COYr, Secy. COLUMBUS HOSPITAL CLINICAL PATHOLOGICAL CONFERENCE Saturday, May 15, 1954, at 9:00 a.m. Amoroso Conference Hall 227 East 19th Street, New York 3, New York Case Presentation: EMMET A. DOOLEY STAFF BERNARD MARRAFFINO, Chairman THE CLINICAL AND ALUMNI SOCIETY OF MORRISANIA CITY HOSPITAL ANNUAL SCIENTIFIC LECTURE Monday evening, May 17, 1954, 9:00 p.m. Morrisania City Hospital Auditorium, 168th Street and Gerard Avenue, N. Y. 52 Newer concepts of hepatitis and cirrhosis of the liver. ISIDORE SNAPPER Director of Medicine and Medical Education, Beth El Hospital CARL R. ACKERMAN, President, Alumni Soc. MADISON AVENUE HOSPITAL CLINICAL SOCIETY MEETING Monday, May 17, 1954, at 9 p.m., sharp. Madison Avenue Hospital, 30 East 76th Street, New York City-TRafalgar 9-1100 Two Tonsillectomies with unusual post-opera- tive Complications A. LASZLO Reconstruction of Paralytic Feet S. WAI3L Malignant Adenoma of the Thyroid I. BUSCH Post-operative Vesico-vaginal Fistula J. Ricci Climacteric Bleeding G. WEITZNER A Premature Infant H. E. COHEN Interesting x-rays I. WEITZNER General Discussion CoIlation GEZA WEITZNER, Secretary Members of the Medical Profession are cordially invited EAST SIDE CLINICAL SOCIETY Tuesday evening, May 18, 1954, 8:30 p.m. Manhattan General Hospital, 307 Second Avenue, New York City PAPERS OF THE EVENING 1. Surgical, diseases of the small intestine. JUSTUS KAUFMAN 2. Newer drugs in treatment of hypertension. MILTON MENDLOWITZ 3. Medical cases for diagnosis. ARTHUR C. LINDEN Collation will follow the meeting. MAXWELL L. GELFAND, President 60 Gramercy Park, N. Y. 10, N. Y. ARTHUR FEITELL, Secretary 40 Gramercy Park, N. Y. 10, N. Y. HARLEM HOSPITAL TUMOR CLINIC CONFERENCE Wednesday morning, May 19, 1954, 10:45 a.m. Women's Pavilion, Main Floor, 137th St. Ent. The role of surgery in cancer,. HENRY T. RANDALL Clinical Director and Chie f, Department of Surgery, Memorial Hospital Center D iscussion : Louzs M. RoussELOT Director o f Surgery, St, Vincent's Hospital Chairman: ISIDORE ARONS Director, Radiation Therapy and Tumor Clinic, Harlem Hospital LAST LECTURE OF THE SEASON. Lectures will resume again in October, 1954. MEDICAL ARTS CENTER HOSPITAL CLINICOPATHOLOGICAL CONFERENCE Wednesday, May 19, 1954, at 8:30 p.m. Lecture Hall, Medical Arts Center Hospital Second Floor, 57 West 57th Street Report of Medical Board NEW DEVELOPMENTS IN DRUG THERAPY 366 NEW YORK MEDICINE

4 Round Table Discussion Panel: LLOYD'F. CRAVER Prof. Clinical Medicine, Cornell University Medical College. Attending Physician, Memorial Hospital RICHARD H. LYONS Prof. Medicine, Syracuse State University, School of Medicine. HAROLD J. STEWART Assoc. Prof. Medicine, Cornell University Medical College Attending Physician, New York Hospital CHARLES F. WILKINSON, JR. Professor of Medicine, Post-Graduate Medical School, New York University Moderator: CHARLES H. WHEELER Assoc. Prof. Clinical Medicine, Cornell University Medical College Assoc. Attending Physician, New York Hospital Ass't Attend. Physician, Memorial f~ Ewing Hospitals Collation HENRY M. SELBY, Secretary THE ASSOCIATION FOR THE ADVANCEMENT OF PSYCHOTHERAPY Friday, May 21, at 8:30 p.m. N. Y. Academy of Medicine Building 2 East 103rd Street, N. Y. C. 1.New Light on an Old Cause of Reading Disability WILLIAM CALVIN BARGER 2. Discussion ROSE RIEGER, Secretary THE HOSPITAL FOR SPECIAL SURGERY CLINICAL CONFERENCE Thursday afternoon, May 20, 1954 The Hospital for Special Surgery, 321 East 42nd Street, New York, N. Y. STAFF CONFERENCE-3:15 p.m. Analysis of results. SCIENTIFIC PROGRAM-3:30 p.m. Social and emotional problems in orthopedic practice. WILLIAM COOPER HELE:Q- WORTIS Open to the profession. ALEXANDER HERSH, Secretary JEROME LAWRENCE, Chairman GOUVERNEUR HOSPITAL GENERAL STAFF CONFERENCE Thursday evening, May 20th, 1954, 8:30 p.m. 1. a. Unusual tumor of kidney. b. Classification of renal tumors. Presentation: NATHAN, BLOCK Discussion: ALVIN C. DRUMMOND 2. Selection of cases of hyperthyroidism for radioiodine therapy. Presentation: SIDNEY ROSENFELD MAY 5, 1954 3e a. Case of aspirin poisoning in an 11-month old infant. Presentatton: WILLIAM D. IRVING Discussion: JOHN D. CRAIG b. Case of measles encephalitis. Presentation: ANDREW F. TURANO Discussion: JOHN D. CRAIG 4. Bidirectional ventricular tachycardia associated with digitalis toxicity. Presentation: ARTHUR LIND Discussion: EMANUEL HELLMAN New York Academy of Medicine (Continued from page 362) b. A case of re-duplication of jejunum. STANLEY DECKOFF Beth Israel Hospital c. Gastric volvulus. VIRGINIA KANICH St. Luke's Hospital d. Pituitary irradiation for metastatic bone: Disease from carcinoma of the breast. SEYMOUR BRENNER Jewish Hospital of Brooklyn e. Unusual cause for intracardiac calcification. A\T.\ SILVF.RMAN Presbyterian Hospital f. Studies of the biliary tract by intravenous methods. LEWIS IMMERMAI Long Island College Hospital g. The arteriographic study of the anterior choroidal artery ALDO MORELLO, IRVING S. COOPER New York University SECTION ON GENITO•URINARY SURGERY RESIDENTS' MEETING FOR THE PRIZE-WINNING PAPER Wednesday evening, May 19, at 8:30 o'clock. DINNER - MEETING a. An office method of urine culture. ROBERT B. ZUFALL 2nd Division Urology- Bellevue Hospital Discussion: JOHN W. DRAPER b. Erythroplasia of queyrat with carcinoma in situ. HERMAN WECHSLER, LOUIS L. SPIVACK Bronx Veteran Administration Hospital Discussion: ARCHIE L. DEAN, SR. c. The bacteriologic diagnosis of urinary tuberculosis. ARCHIE L. DEAN, JR. Squier Urological Clinic- Columbia-Presbyterian Medical Center Discussion: GEORGE F. CAHILL JoHN K. LATTIMER d. Multiple primary malignancies of the genito-urinary tract. AURELIO C. Uso:. Squier Urological Clinic- Columbia-Presbyterian Medical Center Discussion: JOHN N. ROBINSON 367

Announcement of Award of the Oswald Swinney Lowsley Foundation, Inc., to the Resident presenting the most outstanding paper. SUBSCRIPTION DINNER Dinner at the Academy will precede the Genito- Urinary Surgery Meeting on May 19. Fellows and guests are invited. Subscription $6.00. Checks should be made payable and forwarded to Dr. George A. Fiedler, 111 East 71 Street, New York 21, N. Y. Reservations must be received by Monday, May 17. Dinner at 6:15 o'clock Dress Optional SECTION ON OTOLARYNGOLOGY RESIDENTS' MEETING Wednesday evening, May 19, at 8:30 o'clock PRESENTATION OF CASES: a. Does laminography help in the diagnosis of laryngeal conditions? by 30SEPH ALO read by A. F. FRAGOLA Veterans Administration Hospital, Kingsbridge Discussion: L. R. LAWRENCE b. Case of nose and throat malignancy, presenting two primary lesions. WILLIAM RABBETT Manhattan Eye, Ear and Throat Hosp. Discuss2on : ALEXANDER CONTE c. Local treatment with antibiotics in various forms of otitis. RICHARD FREEMAN Columbia-Presbyterian Medical Center Disc2LSSion: EDMUND P. FOWLER, JR. d. Nasal meningocele-surgical correction ADOLPH WEHRLI N. Y. University-Bellevue Med. Center Discussion: JOHN CARDONA THE HARVEY SOCIETY in affiliation with THE NEW YORK ACADEMY OF MEDICINE Thursday evening, May 20, at 8:30 o'clock The Ninth Harvey Lecture The control of heat loss and heat production in physiologic temperature regulation JAMES D. HARDY Professor of Physiology, School of Med., University of Pennsylvania, Phila., and Director of Research, Aviation Medicine Acceleration Lab., Naval Air Develop- ment Center, Johnsville, Pennsylvania SECTION ON ORTHOPEDIC SURGERY Friday evening, May 21, at 8:30 o'clock PAPERS OF THE EVENING End-result evaluation of open reduction of 60 fractures of shaft of femur. ALEXANDER GARCIA Presbyterian Hospital Discussion: PRESTON WADE Lamppost hip prosthesis (preliminary report, based upon three years of use). ROBERT K. LIPPMANN Discnssion: PHILIP D. WILSON, SR. The role of the orbicular ligament in tennis elbow. DAVID M. BOSWORTH Discussion: FRANK STINCHFIELD POSTGRADUATE RADIO PROGRAM The New York Academy of Medicine Twentieth Series Committee on Medical Information in coopera- tion with Committee on Medical Education and The New York City Cancer Committee Thursdays 9-10 p.m. Station WNYC - FM 93.9 megs. Thursday evening, May 6, 1954 Reticuloendotheliosis. PAUL KLEMPERER ' Pathologist, Mt. Sinai Hospital, N.Y.C.; Professor of Pathology, College of Physicians and Surgeons, Columbia U. Acute leukemia in childhood. A. LEONARD LuHBY Assistant Professor of Pediatrics, New York Medical College, Flower and Fifth Avenue Hospitals Thursday evening, May 13, 1954 The bearing of anthropology upon medicine. BENJAMIN D. PAUL Lecturer, Social Anthropology, School of Public Health, Harvard Univ. The diagnosis of abdominal masses in children. LAWRENCE B. SLOBODY Director and Professor, Department of Pediatrics, Flower and Fifth Ave. Hosp. Thursday evening, May 20, 1954 Methods in hematology. DANIEL STATS, Panel Moderator WILLIAM H. CROSBY MARTIN ROSENTHAL JOSEPH F. Ross MARIO STEFA:IINI Cancer of the esophagus. LINN J. BOYD Director and Professor, Department of Medicine, New York Medical College, Flower and Fif th Avenue Hospitals Thursday evening, May 27, 1954 Where law and medicine meet. DAVID W. PECK, LL.D., D.J.S. Presiding Justice of the Appellate Division of the New York Supreme Court, First Department Jaundice as a symptom of cancer. ALFONSO A. LOMBARDI Assistant Clinical Professor, New York Medical College; Assistant Attending Physician, Flower and Fifth Ave. Hosp. 368 NEW YORK MEDICINE

Tobacco (Continued from page 359) 1951, having been asymptomatic since De- cember of 1950, he came to the United States to live, and was well until September of 1951. He continued to smoke and developed gan- grene of the first toe of the left foot. This was soon followed in November by a cold and tingling sensation of his hands. He was ad- mitted to The New York Hospital in January 1952 for the first time with the physical find- ings essentially as described above, the ampu- tated toes, the gangrene of the left first toe and cold hands. He was placed on a rocking bed, given priscoline, whiskey, local heat, de- bridement of the wound and a course of ther- apy with typhoid vaccine. Smoking was discon- tinued for the first time. An incidental bladder stone was discovered and removed. He was dis- charged after three months and in May of 1953 felt so well and had been so asymptomatic that he decided to stop taking priscoline and started smoking again. He was cautious enough to begin smoking a brand of cigarettes that ad- vertises a micronite filter. In August, about 3 months later, he developed a phlebitis of the right foot which was treated by his private physician. About the same time he injured the fifth finger of his right hand striking it with a hammer, creating a lesion which never seemed to heal. On the 16th of September 1953 he was admitted to The New York Hos- pital for the second time. On physical examination his vital signs were within normal limits. The positive physical findings were restricted to the extremities. The nail beds were found to be quite cyanotic. The brachial pulse on that side was weak. His hand was cold and gangrene of the tip of the fifth finger was noted. Also the ulnar pulse on the left hand was weak. The amputations of the toes on the feet were noted. There was bilateral absence 'of the dorsalis pedis and posterior tibial pulses. The laboratory work at that time was es- sentially negative and the course of therapy was almost identical with the previous admis- sion. He was discharged after three wee'cs. CHAIRMAN FORKNER: Dr. Wright, what does this sound like to you? DR. IRVING S. WRIGHT: It sounds like a perfectly typical history of a person with thrombo-angiitis obliterans who continues to smoke either without periods of intermission or with them. This man has been followed in the Vascular Clinic and we have seen him re- peatedly. We still encounter a number of these patients who have never been told to stop smoking. They frequently submit to multiple sympathectomies which are quite futile if the patient continues to smoke. I think that per- haps now this patient learned that he can- not smoke. I hope he has. It is a very serious matter with him. If he continues he is in danger of losing his legs and his arms. CHAIRMAN FORKNER: You think that peo- ple can stop smoking when they want to, Dr. Wright? DR. WRIGHT: Patients can definitely stop smoking if they make up their minds to. On the vascular clinics and services we have stopped hundreds of patients from smoking in the last 20 years. With some there, has been great diffi- culty due to the vagaries of human nature. CHAIRMAN FORKNER: Are you smoking now? PATIENT: No. CHAIRMAN FORKNER: Are you going to smoke in the future? (Patient shrugs his shoulders. ) DR. WRIGHT: If he does we will have him back in the hospital all too soon. CHAIRMAN FORKNER: Do you think from your own experiences that these troubles you have are related to smoking? PATIENT : Y es. CHAIRMAN FORKNER: What happens when you smoke? Do you notice any trouble with your extremities? Do they change color or do you have pain in your toes or fingers? PATIENT: Not at the time I am smoking but perhaps later. DR. LAWRENCE SONKIN: N'1'Ould you tell us what happened to your hands, sir, after you started smoking cigarettes with micronite filters again? Did you notice some change in color? PATIENT: My hands were turning white. CHAIRMAN FORKNER: Micronite filters did not prevent your trouble? PATIENT: No.... Patient leaves.. . . MAY 5, 1954 369

CHAIRMAN FORKNER: Dr. Wynder, have you anything that you would like to tell us now to develop your point further? DR. WYNDER: As you undoubtedly know a relationship between cancer of the lung and tobacco is believed to exist. I should like to review briefly the extent of the evidence for this association. The subject came into being during the last two decades because cancer of the lung has become the most common can- cer in males, and in many areas of the world accounts for one-third of all cancer deaths in males. There is hardly any disagreement today on the .point that the increase that has taken place in cancer of the lung has been real. The primary reason for this has been the fact that the increase has been primarily in males. To- day the sex ratio of cancer of the lung is up to 20:1 and if you will just take epidermoid cancer of the lung, the ratio may reach up to 40: 1. If it were a question of improved diagnostic means or aging population, we should expect as much increase in women. The fact that the increase has occurred primarily in males leads to the suspicion that it might be due to a factor to which males have been exposed more and over a longer duration of time than women. It stands to reason that to- bacco was considered to be one of these factors. Such an association has been thought to exist first because the curve of increased sales of cigarettes runs closely to the increased in- cidence of cancer of the lungs. This has never impressed us very much because of things now in our environment such as gasoline fumes, nylon stockings, refrigerators, television, etc. Because of the ever increasing incidence of lung cancer Dr. Graham and I began an in- vestigation in 1948 trying to determine whether there could be any association of environmental factors in relation to cancer of the lung. In this study we investigated all possible factors. We investigated occupations. We found a few occupations which seemed to have a higher than expected frequency of lung cancer but they could not account for the great increase in lung cancer. We investigated the urban and rural distribution of lung cancer, about which I want to say a little more later. lt must be realized in this regard that cancer of the lung had also increased in farm areas. Finally we found that tobacco was positively associated with cancer of the lung as compared to our control patients. Table 1 shows the summary of our first paper. The two outstanding features of the graph are: 1) that the control patients include considerably more non-smokers than are found among lung cancer patients, whereas among the lung cancer patients there are considerably more excessive chain smokers than in the con- trol group. These patients are of similar age and economic distribution. TABLE I Percent distribution of 870 male patients with epidermoid, undifferentiated, or unclassified bronchi- ogenic carcinomas, and 780 male control patients of similar age and economic distribution, according to tobacco consumption over a 20-year period. Smoking Lung Cancer Control Classification* Patients Patients Total 870 780 Less than 1 1,6 14.6 1- 9 2,6 11.5 10-14 9.2 19.0 15-20 35.1 35.6 21-34 30.8 11,5 35 or more 20.7 7.6 *Equivalent number of cigarettes per day. One cigar has been arbitrarily treated as the equivalent of 5 cigarettes and a pipeful as 2'/•-~ cigarettes. Graph I summarizes this data by showing that the risk of developing cancer of the lung seems to increase in direct proportion with the amount smoked. This was also shown in a study by Cornfield and myself in which we analyzed the tobacco habits of physicians who died from cancer of the lung and we found what was true for the general population is true also for the physicians. The more these patients smoke the greater is the chance of developing cancer of the lung. The lower curve, taken from a study of Doll and Hill in England, which today has been extended to 1,465 cases oi cancer of the lung, demonstrates the same re- lationship which v:e found in this country. During the past three years a large number of difrerent studies have been published compris- ing more than 6,000 patients with cancer of tlie ]tm;, an3 a simiiar number of controls. All confirm this type of data; namely, that 370 NEW YORK MEDICINE

GRAPH 1 the more a patient smokes the greater is the chance to develop cancer of the lung and it is exceedingly rare for a non-smoker to develop cancer of the lung. CHAIRMAN FORKNER: How common is cancer of the lung in relationship to other cancers? DR. WYNDER: Cancer of the lung today accounts for about one-fourth of all can- cer deaths in males in England. In Aus- tria it accounts for one third of all cancer deaths in males and it is rapidly increasing. (Slide) Table 2 shows the distribution of cancer of the lung among various types of smokers. I think that the cigarettes have been a little bit unduly regarded as the only type of tobacco related to cancer of the lung. These data show that the mortality among pipe smok- ers and cigar smokers is also greater than among non-smokers. The reason why we be- lieve that pipe smoking and cigar smoking is perhaps less associated is because of the prac- tice of inhaling which is more commonly prac- ticed among cigarette smokers. TABLE II The Present Distribution of Lung Cancer and Control Groups by Type of Smoker Estimated Annual --Mortality per 100,00'0- Among Among General T)pe of Smoker Physicians Population Non-smoker 10 4 Smoker: Total 60 58 Predominately: Pipe 40 16 Cigar 24 22 Cigarette 84 70 (Slide) Table 3 shows a distribution of smoking habits in England among city people and among farm people. A few investigators believe that air pollution is an important fac- tor in cancer of the lung because cancer of the lung occurs more commonly in cities. It is well established that cancer of the lung does occur more in cities, but this does not mean that air pollution is a factor. The British have tackled the problem and showed that city people smoke more cigarettes than farm people and that there are more non-smokers in the rural areas. Differences in smoking habits must be consid- ered before one can condemn air pollution as being a factor in the ~levelopm_ent of cancer of the lung." TABLE III Smoking habits of general male population in greater London (1,393) and rural districts of England (327) (Doll and Hill) Greater London Rural Districts Non-Smokers 5.1 % 10.4C/o Heavy Cigarette Smokers 14.6c7o 7.7% Pure Cigarette Smokers 74.2% 58.4% Cigarette / Pipe Smokers 16.0% 21.5C%o Pure Pipe Smokers 4.8Cib 9.8% Recently, Doll has demonstrated that sta- tistically a non-smoker regardless whether he lives in city, suburban or rural areas has the same change of developing cancer of the lung, a chance which is very low. Therefore air pol- lution does not seem seriously to affect the development of cancer of the lung. Because of the evidence we had at hand, Dr. Graham, Miss Croninger and I proceeded to determine whether cigarette tar could induce cancer in animals. Recently you read some statements in news- papers that animal data, which I shall present, prove nothing as far as human cancer is con- cerned. I should like to state that these animal data were done because of the human evidence already at hand. Furthermore throughout the history of animal cancer re- search there was a close correlation between animal data and cancer in man. This holds true particularly for epidermoid carcinogensis in mice and men. We produced tobacco in a smoking appa- ratus which simulated human smoking habits. The tar obtained from condensed cigal•ette smoke was applied to the backs of mice. 40 mg, three times a week, dissolved in acetone. At the MAY 5, 1954 371

0 N N N N N N N N N N N N N N end of the first year the first carcinoma was noted. This was typical undifferentiated carcinoma with typical mitotic figures. Miss Croninger transplanted one of these cancers through thirteen generations which shows definitely that it was a true neoplasm. Percent Lesions 70 60 50 ALL FIRST GROSS APPEARAfVCE OF PAPILLOMAS AND CARCINOMAS CARCINOMAS PROVED HISTOLOGICALLY 0~,~, . -- -, - --i-; 0 4 8 12 i6 20 Number of Manths of Applfcutfon CAF mice(8)) Cqorefle 1arlAceWne CAF mice (30) Acetone GRAPH 2 10 40 30 20 Graph 2 shows a summary of these data. At the end of two years 44 per cent of 81 mice painted with this condensed smoke developed cancer of the skin, whereas none of the con- trol animals painted with acetone alone de- veloped any cancer. These animal data have proved that tobacco tar does indeed contain carcinogenic elements. It does not prove that it contains elements that are also carcinogenic to man but, as I stated before, these studies were done because of the evidence already at hand in man, and the great significance of these data we believe s is that they give us a working tool with which to examine these tars in order to determine which fraction in these tobacco tar samples is carcinogenic. At the present time we have no idea which fraction or fractions within tobacco smoke is carcino- genic. Experiments are now at hand both in Washington University, Memorial Hospital and New York University and other institu- tions in this country to determine these ele- ments. We believe that if these substances can be identified, and should be removable from tobacco, we would make tobacco less harmful, at least as far as its carcinogenic effect is con- cerned. We believe that any carcinogenic ma- terial is a specific substance. We do not believe that chronic irritation per se is carcinogenic. 11'e have, therefore, instituted these large re- search projects trying to identify the active 372 carcinogen in the tobacco. It would, therefore, seem to us that there is a positive association between cancer of the lung and smoking as far as human data are concerned. At a recent conference in Louvain, spon- sored by the World Health Association and Unesco, the relationship was regarded as es- .tablished. The fact, that cancer of the lun- 0 is so common, that its incidence increases from year to year, and that statisticians tell us that within the next 30 years there will be another five-fold increase of cancer of the lung, makes it one of the most alarming types of cancers we are dealing with today. It is made further alarming, as Dr. Wilson will point out to us, be- cause of the great mortality of cancer, a type of mortality which we may not be able to over- come because of the anatomical locaticn of cancer of the lung. VVe, therefore, believe that the greatest hope that we have in our fight against cancer of the lung consists of pre- ventive measures. I do think that practical preventive measures are at hand. Some day these measures may lead to a startling decrease of lung cancer. DR. GREYDON BOYD: May I ask Dr. Wynder a question? Did not Roffo in 1938, do the same work on rabbit's ears and produce a cancer such as you have in mice? DR. WYNDER: Throughout the 1930's Dr. Roffo published a series of papers based upon tobacco tar obtained from distilled tobacco. It ha,s been claimed using distilled tobacco, one uses a high degree of heat and that there- fore the actual nature of the tars used is changed. Thus his studies were never fully ac- cepted. It is also noticed that Sugiura at The Memorial Hospital and Flory in Chicago, try- ing to repeat the experiments, were unable to do so. The major criticism of his work has been the fact that he used the type of tar which was not the type of tar to which humans are exposed and this is the one factor that we tried to avoid in our own experiment, using a type of tar which simulates human smoking habits as closely as possible. CHAIRMAN FORKNER: Dr. Wilson, Dr. l1'yn- der has spoken something about the irritating effects of these tars. Have you observed them bronchoscopically? NEW YORK MEDICINE N

DR. NORMAN WILSON : I think anybody who looks hard enough at enough smokers can see irritation and observe great disability from it, too. In fact, I am almost as alarmed by the pulmonary patient I see, whose respiratory re- serve has been reduced by his smoking habits, as I am about the cancer problem. Many times a patient with a cancer has so much broncho- spasm and trapped air in the lungs, you have to treat this before you can safely operate for cancer. One can see the irritation bronchoscopically, but not in all people. In many patients, who have severe symptoms, you do not see the vis- ible evidence of irritation yet they have parox- ysmal cough and raise a great deal of sputum. I would like to confirm what Dr. Wynder said about the seriousness of cancer. In our experience cancer of the lung occurs exclusively in people who smoke heavily. The disease is very serious. Only about 8 or 10 percent of patients with carcinoma of the lung are alive five years after the beginning of symptoms. The problem of carcinoma of the lung is rapidly increasing in the experience of all physicians and yet we have not shifted gears in our teaching of students and in our publica- tions to the medical profession at large about the salvable cancer patients. The statistics in textbooks and many articles still cover all can- cers so that the physician, and oftentimes the senior medical student, thinks that 65 per- cent of cancers are visible through the bron- choscope. That is true if you take the many advanced cancers that are sent in but let us take the salvable cancer, the early cancer, the one you and I, as physicians, should be most interested in because it is the one we can pos- sibly cure. This patient is apt to have a nega- tive bronchoscopic examination. He is very apt to have a negative Papanicolaou smear, as you saw in the first case here, and almost rou- tinely lie has no physical signs. The shadow is usually the only evidence of the tumor. I have a few slides that might be helpful at this point. (Slide) In private clinics the general ex- perience in this country is that around 37 per- cent of cancers in the lung can be diagnosed by means of bronchoscopy. However, in "sur- vey cancers" we can get bronchoscopic evi- dence in only 11 percent. That includes those with symptoms. CHAIRMAN FORKNER: What do you mean by "s'urvey cancers"? DR. WILSON: Those who did not know they had trouble until x-rays were taken. If you take the symptomless survey patient the value of bronchoscopy almost fades out of practical value. Likewise the Papanicolaou test is posi- tive in a little better than 60 percent in our experience, but in our "survey carcinomas" in only 25 percent, and those without symptoms much lower than that. I think a very important point to drive home is that the patient who is salvable is a patient who usually has symptom- less cancer and one without physical findings, who will have a demonstrable lesion on x••ray and whose diagnosis can best be proved by ex- ploratory thoracotomy. I have never quite un- derstood why we as a group have a different fundamental concept about the cancer we have to look at in an x-ray and the one we can palpate with our fingers. I f nd that almost routinely my senior students are very willing to explore a breast for a palpable nodule but S" A ALjIEK. to pt #010 0 Pediforme IN~~ ~-~ F 0 0 T W E A R lit MANHATTAN 34 WEST 36th ST BROOKLYN 288 LIVINGSTON ST. FLATBUSH S43 FLATBUSH AVE Other shops in - HEMPSTEAD NEW ROCHELLE HACKENSACK E. ORANGE WRITE FOR SHOE ALTERATION FOLDER ~ 4 MAY 5, 1954 373

are very unwilling to have an exploratory thoracotomy for a symptomless tumor that they look at in an x-ray. It takes quite an effort to teach them that this is the proper procedure. (Slide) Here again you see what symptoms mean in cancer of the lung. You will notice that in this group with symptoms only one ol ten has a chance of having negative lymph nodes, whereas in the patients who do not have symptoms, seven out cf ten have negative nodes. This means that there is a great differ- ence in the final statistics in the two groups. Our five year statistics in the patients with symptomless cancer shows 40 percent to be alive. (Slide) This is the real big clinical prob- lem. Here is a small carcinoma without phys- ical signs, without symptoms and in this par- ticular instance unchanged over a period of one year as judged by its appearance in the x-ray films. It was a symptomless cancer dis- covered at a time in the evolution of the disease when the patient could be saved. When patients develop symptoms we have very little .chance to pull them out of the fire. We feel that these people should be explored, as early as possible to establish the diagnosis of the x-ray shadow. CiHAIRMAN FORIiNER: Will you point that out to us, Dr. Wilson? DR. WII,soN: These films were taken 14 months apart and you have to take my word for it that the x-rays taken every two months showed no demonstrable change. We feel that this demonstrates the clinician's and the sur- geon's problem today with these cancers. When a patient is presented to you with an unex- plained lesion in his chest, even though it is very small, we feel that you have only one of two roads to send him down. You can send him down that dark road over there without any lights on it, which means you are going to wait and see if it grows or causes symptoms and if it does, then you cannot have much chance of saving him, or you can do what you would do with any other tumor. You can ex- plore it and have a frozen section performed by your pathologist. Statistically you have jus- tification for early exploration because the risk of having cancer in unexplained peripheral lesions, which contain no calcium, is about 40 percent. The risk of exploration in a patient in good condition is definitely under 1 percent. Early exploration really represents not only the intelligent but also the conservative approach to this rapidly increasing problem. CHAIRMAN FORKNER: Dr. Wright, will you tell us about the cardio-vascular aspects of smoking? DR. WRICxT: I think we ought to consider first the normal reaction of the circulatory sys- tem to the use of tobacco. The question is often raised as to whether effects can be meas- ured from absorption from the mucous mem- branes of the mouth and perhaps the nose with- out inhalation. In other words, does the person have to inhale deeply in order to obtain a re- sponse which can be measured from the view- point of the circulation? As it was brought out before, our interest is primarily not with the tars but primarily with nicotine. If there are other agents in tobacco which have an effect on the circulation we are not aware of them and have not been able to demonstrate them. It is true that nicotine is readily absorbed from the mucous membranes of the mouth. So it is not important whether the patient smokes cigarettes, cigars or pipes, or whether he chews. He can absorb enough nicotine to get a profound effect. If you doubt this, place a drop or two of nicotine sulphate solution 1: 1000 dilution on the gum of a dog and watch him die within a half minute as a result of absorption from the gum. During smoking the average individual shows some increase in pulse rate. Many show an increase in blood pressure, the blood sugar character- istically rises temporarily. That may in a way account for the feeling of a "lift." Many people do develop cardiac premature contractions, which are not in themselves serious but may be annoying. There is a decrease in the periph- eral blood flow as evidenced in most normal persons by a drop in the surface temperature of the finger tips and tips of the toes. (Slide) There is often a profound drop of from 3-9 degrees in the temperature of the fnger following the smoking of a single ciga- rette. This curve is characteristic not only for normal standard brands but also for men- 374 NEW YORK MERIC/NE

tholated cigarettes. The results were identical when denicotinized cigarettes were smoked. In the so-called denicotinized cigarette the drop is just as precipitous. A number of filters thus far tested have also been ineffective in block- ing this effect even though they quite obviously appear to reduce the tar carried into the mouth. Measuring the circulation at the periphery by plethysmography, as determined by Lamp- son, confirms this general observation. There are a few individuals who show no response of this nature but the majority show some degree. Some patients, more commonly those with cor- onary insufficiency, have an increase in anginal pain. We do not always understand the exact mechanism. There are individuals who, when they stop smoking, have a striking diminution or cessation of this anginal pain and for them it is unwise to continue. This pain response may be due to spasm of the coronary arteries but it is difficult to prove beyond doubt. How- ANS1ER TELEPHONES... ever, in some patients, it is possible by smoking to produce definite transient changes in the electrocardiograms, such as negative T waves, which are not due to deep breathing alone. In those individuals the evidence appears more convincing. When we consider the peripheral vascular diseases, thrombo-angiitis obliterans, the dis- ease seen in the first patient, is the most clearly related to tobacco. It is a relatively rare disease, yet there are thousands of such patients in the United States. I do not think anyone knows the statistics on thrombo-angiitis obliterans be- cause most of these patients do not die from the disease but if they die they die after they have had it for many years. It would be inter- esting to know whether or how these figures compare with the number of patients who have carcinoma of the lung. There might be quite a similarity, yet in my experience I have yet to encounter a patient with carcinoma of the lung and thrombo-angiitis obliterans, which DOCTORS TELEPHONE SERVICE • 224 East 38th St., New York 16 Pictured above is our office at 205 East 78th Street, one of our 14 neighborhood Answering Offices. In this office we handle Doctor's Emergency Service sponsored by the New York County Medical Society. In our 29 years of service to the physicians and dentists of New York, we have done everything in our power to create happy and congenial working conditions for our girls. This is reflected in their work. Our reputation for courtesy, intelligence and efficiency is unsur- passed. We are honest, dependable and accurate. Telanserphone has come to be known as the "voice" of experience. Nominal rates -Monthly basis-No contract. Phone for l nformation U r r a H i l l 1-6 5 0 U Telanserphone Inc. y MAY 5, 1954 375

again makes me suspect we are dealing with different agents rather than tobacco as a whole, or similar agents. I would like to show a few slides illustrating patients who have had this disease and their problems. (Slide) Here is an individual who came to see us in 1933 with amputation of the left leg at the age of 19 for gangrene. He stcpped smoking at that time but resumed smoking and developed gangrenous ulcers of the right foot and changes in the vessels of his hands. (Slide) This is a closeup of the gangre- nous ulcers which he developed in his right foot, which had been his good foot. This was ex- tremely important to this man because he already had lost one leg. (Slide) This is the so-called Allen test, which in brief indicates, by the pallor of the right hand when the ulnar artery is open and the radial artery is occluded, that the ulnar artery is already affected. (Slide) The next slide illustrates another patient with thrombo-angiitis obliterans with multiple 'ulcers involving the fingers. (Slide) These are close-up pictures. These are extremely painful small ulcers but will con- tinue to develop into a gangrenous condition if the patient continues to smoke. (Slide) These are the hands of a physician. This individual came to us with gangrene of the fingers of both hands, a very advanced situ- ation. It looked as though he were going to lose his hands. He did lose part of the tips of the fingers of his left hand and it looked as though he were going to lose the third finger of the right hand. That finally healed. He stopped smoking and was treated with typhoid vaccine for a while. (Slide) This shows a picture of his foot which was involved. (Slide) This is a picture of another indi- vidual, a woman who had had a sympathec- tomy and was never told to stop smoking. She proceeded to develop gangrene and lost the fourth toe. (Slide) This man has lost his leg because of arteriosclerosis associated with diabetes mel- litus. There is no evidence whatsoever that arteriosclerosis obliterans is produced by smok- ing. However, once the patient has a marked diminution in circulation, it is very important that the spasm be not produced in the col- lateral vessels that are endeavoring to take over the load in lieu of the loss of the major vessels. This case is demonstrated as an ex- ample of that. (Slide) Some years ago several of us made some studies at Macy's of individuals who had followed a similar course in reference to their occupation for many years. Among other sta- tistics of interest, was the incidence of arterio- sclerosis, as we are measuring it, in tobacco users versus non-users; for the sake of general interest alcohol was also studied. As you can see there is no significant difference in the in- cidence of arteriosclerosis between the two groups. I think that this is sufficent evidence in our view to indicate that: a. patients with thrombo-angiitis obliterans should never smoke. Even a single cigarette may produce a recurrence in their gangrene as long as several years later. We see many ex- amples of this. b. if they have an impaired circulation from another serious disease they should not smoke, not because the disease is associated with to- bacco in terms of etiology, but because it may aggravate the disease by producing constric- tion of the small collateral vessels when they are needed to save the tissues. CHAIRMAN FORKNER: Thank you, Dr. N1'right! Dr. Boyd, what about the nasopharynx and perhaps the larynx? DR. Bovo : An average of one-half pack of cigarettes is smoked daily by every person over 15 years of age in the United States. It seems that the public may not be well informed about the harmful effects of tobacco because news sources carry tobacco advertisements that are deceptive. The public, however, senses some danger as shown by the 1949 Gallup Poll, in which more than 50 percent of smokers thought it harmful and had tried to quit. Another evidence of this is shown in the r.se of the slang terms such as "Coffin nails," "Gaspers," "Weeds," "Pills," "Lung Dusters," "Dope sticks" and "Poison Sausages." The use of mis- leading endorsements by ball players and actors 376 NEW YORK MEDICINE

, k I and such statements as "Leading doctors find no nose, throat or sinus irritation or harmful effects," are still being used, in spite of the Federal Trade Commission's efforts. I think as far as the prevalence of symptoms is concerned there are more in the nose and throat than from any other effect of tobacco. Of eighteen leading otolaryngologists inter- viewed prior to this meeting, 100 percent be- lieved tobacco smoking to be irritating to the nose and throat. They believed, that tobacco caused sore throats, cough, post-nasal drip, and redness of the throat. Other adverse effects were: mechanical irritation, hot smoke, foreign body effect, vasomotor symptoms, nasal ob- struction, leukoplakia, edema, dryness, staining of the teeth, nicotine hypertrophy of the palate, gagging, hoarseness, vertigo, asthmatic wheez- ing, hearing loss and Meniere's disease. There is a tremendous amount of difference in individuals as to the way they respond to irritation and I think that is also true of tumor response in the throat and mouth. In the throat the amount of smoking makes a great deal of difference. My discussion will be divided into three primary parts. One is the irritation of tobacco on the throat primarily producing a red, thickened mem- brane with increased secretion, post-nasal drip, cough, morning gagging, etc., that smokers have. Also there is a definite entity called smoker's larynx-in which a fibrous polypoid condition occurs in the larynx. On removal it is found to be an inflammatory rather than al- lergic type of hypertrophy of the vocal cords. It occurs most often in individuals who have short necks and who smoke from 20 to 120 cigarettes daily. Other results of smoking are gingivitis and leukoplakia that occur in the mouth. This is common in all types of smoking. Cigar smoking particularly causes cancer of the palate. Ciga- rettes, however apparently do not cause as much cancer in the mouth as does the smoking of a pipe or of cigars. I think there is not any great evidence that the cigarette smoking itself causes very much cancer of the mouth. To- bacco chewing has been reported to be asso- ciated with cancer. The third point I wish to mention is the effect on the nose and the question of allergy. MAY 5, 1954 The consensus of opinion is that in a fair num- ber of patients the main effect from smoking is the secondary irritation of tobacco on the nose in allergic people. It aggravates the symp- toms and results in congestion of the nose fol- lowed by poor sinus drainage and sinusitis secondarily. In the ear an occasional case of Meniere's and toxic deafness occurs from to- bacco. Those people who have the latter con- dition are generally smokers and drinkers at the same time. Anesthetists feel that anes- thesia in smokers is more prone to be associated with bronchial complications. Toxic amblyopia is one of the results of the use of tobacco. Loss of smell or diminished sense of smell may occur. What about filters and King size cigarettes as far as the nose and throat are concerned? I think the length of the cigarettes and the use of filters do the same thing, namely reduce the amount of smoke. How little smoke do you want to get at the other end? If you put enough filter in you won't get any smoke and you won't get any irritating effect from the cigarette. I think the fancy brands or special kinds of cigarettes sold today do not make a great deal of difference. DR. WILSON: May I ask a question? Maybe Dr. Wynder and Dr. Boyd might take part in answering it. I wonder if you know of any evi- dence to indicate a difference in the potential- ity of the mucosa of the nose as compared with that of the bronchus for developing metaplasia? DR. WYrrnFx: We are currently investigating this problem at Memorial Center. For the past two years we have interviewed routinely every patient on the Head and Neck service of Me- morial Hospital. In addition we have inter- viewed patients at the Radiumhemmet in Swe- den and the Tata Memorial Hospital in Bom- bay to get differences in national levels on tobacco habits. I think the data indicates that tobacco chew•ing in certain parts of the world is associated with carcinoma of the esophagus, carcinoma of the tongue, buccal mucosa and larynx. As yet I can not tell whether cigarette smoking is less or more responsible for these types of lesions of the oral cavity than cigar smoking or chewing tobacco. Bronchial epithelium seems particularly susceptible to metaplastic changes. 377

The apparent stabilized incidence rate of cancer of the larynx has frequently been men- tioned as one of the reasons for believing that smoking is not a cause of cancer. There seems to be less effect of tobacco on the larynx than on the lung. We must consider the suscepti- bility of tissue in this comparison. We must also consider that not every person who smokes develops cancer of the lung. This may be the result of individual difference in predisposi- tion. Frequently one is asked "What about Winston Churchill?". He certainly smokes heavily and is still free of cancer. If we knew the answer to this question we might have the answer to the cancer problem. If we would know why a given person is resistant against cancer, we might not be here today to discuss the cancer problem. But in view of the fact that we do not know what predisposition means, we must tackle those factors that we know today. I think that tobacco is one of the factors that is known and therefore we have to concentrate our efforts in that direc- tion. CHAIRMAN FORKNER: Dr. Wynder, it is com- monly thought by a number of people that if you smoke for twenty years, that you have al- ready conditioned yourself and you might just as well go ahead and smoke for another twenty years, that it has already been decided whether or not you are going to get cancer of the lung. Is that true? DR. WYNDER: That question is asked most often by those people who do not want to stop smoking. We have found in our first series of 650 lung cancer patients, five cases that had stopped smoking ten years prior to developing cancer of the lung. We believe the latency period of cancer takes many years to develop. I would say that a patient who has stopped smoking may still develop cancer if he is des- tined to do so. However, I would also state that if a person continues to smoke his chances, if susceptible, are greater than in the person who has stopped and I think also he may de- velop his cancer at an earlier time. DR. BOYD: I have a question which I think is quite important with regard to leukoplakia. I run across many statements that leukoplakia from smoking does not become cancerous very often. I have always felt that it was a poten- tial forerunner. I want to know what you think about it. DR. WYNDER: I think leukoplakia in the oral cavity, particularly on the tongue is pre- cancerous. Leukoplakia does not always de- velop into cancer. We know that in many of these patients, if they stop smoking, it be- comes reversible. Leukoplakia can go either way. In general I believe we must consider it a precancerous condition. CHAIRMAN FORKNER: Dr. Wynder, we heard from Dr. Wright that the filters do not filter out the nicotine. Is that correct? DR. WRIGHT: I believe that essentially is true. They may filter out some of the tar but I don't think they filter out a considerable amount of nicotine. There is one point that may be made. If you have a cigarette that has a smaller amount of nicotine than the av- erage, we will concede that perhaps if that to- bacco is moist more of the nicotine will be distilled and probably more of the tars will be distilled back through the cigarette into the mouth; whereas, if the cigarette with a higher percentage of nicotine is dry it will burn up and consume the tars and nicotine as it pro- ceeds, so that the patient is not so apt to have as marked a response. So, actually you not only have the amount of nicotine in the to- bacco but the moisture in that tobacco playing a major role. DR. COBB: I was going to ask what about the effect of filtered cigarettes on the carcinogenic tars. Quite a lot is absorbed in the filter. DR. WYNDER: The makers of filtered ciga- rettes, as you know, are the ones who pri- marily gained from the recent publicity about cancer of the lung being related to smoking. People assumed that these cigarette filters re- moved a certain amount of tar. There is no question that some filters remove some and others less and if a given filter removes 50 percent of the tar, we might state that per- haps it might remove 50 percent of the car- cinogenic material. This is by no means proved. As long as we do not know what the car- cinogenic material is we do not know whether the filter will remove any or all of this material. Now one study done recently in Germany by Dr. Druckrey which has not been pub- lished, shows that if you take cigarette smoke 378 NEW YORK MEDICINE

and do not inhale it and blow into optical free benzol and show it under the ultraviolet lamp you get a marked fluorescence. (Slide) This on the left here is the very marked fluorescence that you get from ciga- rettes which have not been inhaled. In the mid- dle is the optical free benzol without any smoke in it. On the right, No. 3, is the fluorescence of cigarette smoke that has been inhaled and No. 3 contains twice as many cigarettes as No. 1, which demonstrates that inhaling ab- sorbs up to 90 percent of some material which is fluorescent. It was also shown that filters will take out very little of this material that fluoresces. We do not know whether this ma- terial is carcinogenic. However, it indicates that some particles which are almost completely absorbed through inhaling and are not re- moved by filters remain in the tobacco. So unless we have the answer as to what is the carcinogenic element we cannot say how good filters will be. DR. WRIGHT: Isn't it true, Dr. Wynder, since filters of any degree of effectiveness what- soever are so recent that any information re- garding the ability to prevent carcinoma would be deferred, would be difficult for us to judge for some years to come? DR. WYNDER: As far as the incidence data is concerned, we could not draw any conclu- sions at all. CHAIRMAN FORKNER: I would like to ask the members of the panel whether or not it is their opinion that the advertising about cigarettes is wrong, morally wrong. Would you not advise the advertising agencies to face this problem squarely, admit that tobacco has ill effects and advise the tobacco companies to put funds into research. Studies designed to make tobacco safe rather than to make false advertising claims over the radio and in news- papers would appeal to the American public. Could we make that recommendation to the tobacco companies? DR. WRIGHT: We have been making that recommendation since 1934 but I have not been able to gain much headway. CHAIRMAN FORKNER: The impact might be a little more, a little stronger now. On behalf of all of us I wish to thank the members of the panel for this timely discussion. Summary By CLAUDE E. FORKNER, M.D. 1. Current advertising of tobacco companies has been shown by The Federal Trade Commission to be deceptive, misleading, false, and has been to the prejudice and injury of the public and has consti- tuted unfair methods of competition in commerce. 2. Cancer of the lung, during the last two dec- ades, has become the most common cancer in males and in many areas of the world accounts for one- third of all cancer deaths in males. Its incidence is increasing rapidly. 3. The risk of developing cancer of the lung increases in direct proportion to the amount smoked. It is rare for a non-smoker to develop cancer of the lung. 4. The smoking of cigars and of pipes is less likely to be associated with cancer of the lung pre- sumably due to the practice of inhaling which is more common among cigarette smokers. 5. Pollution of air in urban areas has been con- sidered as a possible cause of cancer of the lung, but recent studies show that this probably is an unimportant factor. 6. Tar, obtained from condensed cigarette smoke, when applied to the skin of mice three times weekly for from one to two years, resulted in the appearance of typical undifferentiated carcinomas at the site of application of the tar. 7. The specific fraction of the carcinogenic tar from cigarette smoke which is responsible for the cancer has not been identified. 8. Irritation of the bronchi associated with smok- ing often is visible by means of bronchoscopy. 9. The patient with carcinoma of the lung who is salvable usually is symptomless, without positive physical findings and in whom the diagnosis is sus- pected by virtue of a density in the x-ray film. The diagnosis often can be proved only by exploratory thoracotomy since less than 25 percent of such symp- tomless cases prove to be positive with the Papani- coloau test or by bronchoscopy. 10. Ninety percent of patients who exhibit symp- toms of carcinoma of the lung have metastases in the regional lymph nodes, whereas only thirty per- cent of symptomless patients have such metastases. 11. Only 8 or 10 percent of patients having car- cinoma of the lung with symptoms are alive five years later in spite of vigorous treatment, whereas 40 percent of symptomless patients treated are alive five years after the discovery of the carcinoma. 12. The presence of an otherwise unexplained density in the lung field in an individual of appro- priate age should be regarded as a carcinoma until proven otherwise. Exploratory thoracotomy is not only justifiable but is imperative to establish the diagnosis. The surgical risk is under 1 per cent. 13. Nicotine is the active agent in tobacco which affects the blood vessels. 14. Nicotine is absorbed from the mucus mem- branes and is harmful whether the individual smokes cigarettes, cigars, pipes or chews tobacco. 15. Nicotine causes a decrease of peripheral blood flow. Smoking a single cigarette may produce a pro- found drop of from three to nine degrees C. in the temperature of the fingers. Identical changes are MAY 5, 1954 379

encountered with so-called denicotinized cigarettes or with standard brands. 16. A number of filters have been tested and found to be ineffective in blocking these vascular changes. 17. In some individuals with coronary artery in- sufficiency adverse changes in the electrocardio- gram may be produced by smoking. 18. Even smoking a single cigarette may produce a recurrence of gangrene of an extremity in a pa- tient with thrombo-angiitis obliterans. 19. Individuals with an impaired circulation, brought about by disorders other than smoking, should not smoke because smoking may aggravate the disease by producing constriction of the small collateral vessels when they are needed to save the tissue. References 1. Allen, E. V., Barker, N. W., & Hines, E. A., Jr. Peripheral Vascular Diseases. New York, W. B. Saunders, 1946. 2. Breslow, L. Does cigarette smoking cause lung cancer? California's Health, 9:1-3, 1951. 3. Carroll, F. D., Ireland, P. E. Association of Toxic Deafness with Toxic Amblyopia Due to Tobacco and Alcohol. Arch. Otolaryng., 21 :459, 1935. 4. Consumers Report. Cigarettes. February, 58;75, 1953. 5. Council for the International Organizations of Medical Sciences under the auspices of The World Health Organization. Recommendations Adopted by the Symposium on the Endemiology of Cancer of the Lung. Cancer Research, 13:471- 475, 1953. 6. Cummer, C. L. Leucoplakia of Palate. J.A.M.A., 132:493-498, (Nov.) 1946. 7. Doll, Richard. Mortality from lung cancer among non-smokers. Brit. J. Cancer, 7:303-312, Sep- tember, 1953. 8. Doll, R. and Hill, A.B. A study of the aetiology of carcinoma of the lung. Brit. Med. J., 2:1271- 86, 1952. 9. Doll, R. and Hill, A. B. Smoking and carcinoma of lung; preliminary report. Brit. Med. J., 2:739-48, 1950. 10. Finnegan, et al. Quantitative method for measur- ing cigarette smoke inhalation. J. Pharmacol. & Exper. Therapy, 89:115-124, (Feb.) 1947. 11. Flory, C. M. The production of tumors by tobacco tars. Cancer Research, 1:262-276, 1941. 12. Ganz, A., Kelsey, F. E. and Geiling, E. M. K. Ex- cretion and Tissue Distribution studies on Radio Active Nicotine, Jr. of Pharm. Exp. Therapeutic, 103-209-214, Oct. 1951. 13. Gsell, O. Bronchialkarzinom und Tabak: Ur- sachen des Lungenkrebses. Schweiz. med. Wchnschr., 81:662-68, 1951. 14. Haggard, H. and Greenberg, L. Concentration of Menthol in the Smoke from Mentholated Cig- arettes. A study of Local Systemic Effects. Arch. of Otol., Rhin. & Laryng., 33-711, 1941. 15. Kini, M. G. Epitheliomas of Palate Caused by Smoking of Cigars with Lighted End in Mouth. Indian M. Gaz., 79:572-574, (Dec.) 1944. 16. Koulumies, M. Smoking and pulmonary car- einoma. Acta Radiol., 39:225-60, 1953. 17. Levin, M. L., Goldstein, H. and Gerhardt, P. R. Cancer and tobacco smoking: a preliminary re- port. J.A.M.A., 143:336-38, 1950. 18. McConnell, R. B., Gordon, K. C. T. and Jones, T. Occupational and personal factors in the aetiology of_ carcinoma of the lung. Lancet, 2:651-56, 1952. 19. Mills, C. A. and Porter, M. M. Tobacco smok- ing habits and cancer of the mouth and respira- tory system. Cancer Research, 10:539-42, 1950. 20. Myerson, Marvin C. Smokers larynx-Clinical Pathological Entity. Ann. Otol., Rhin. & Laryng. 59:541-546 (June), 1950. 21. Pinburg, J. J. Tobacco Gingivitis. Jr. Dental Research, Coliobia, 26: 3:261-264, 1947. 22. Roffo, A. H. Unidad Carrcerigena de Los Al- quitranes de Diversos Tipos de Tobacos. Bol. Inst. de Med. Exper. Paro el Estud. y Trat. d. Cancer, 15:349-406, 1938. 23. Roffo, A. H. Krebserzeugendes Einheit der ver- schiedenen Tabakteere. Deutsche med. Wchnschr. 65:963-67, 1939. 24. Roffo, A. H. Der Tabak als krebserzeugendes Agens. Deutsche med. Wchnschr. 63:1267-71, 1937. 25. Roth, Grace. Tobacco and the Cardiovascu- lar system; the effects of smoking and of nicotine on normal persons. Springfield, 111. Charles Thomas, Inc., 1951. 26. Sadowsky, D. A.; Gilliam, A. G.; Cornfield, J. The statistical association between smoking and cancer of the lung. J. Nat. Cancer Inst.,.13:1237- 58, 1953. 27. Schrek, R.; Baker, L. A.; Ballard, G.P. and Dolgoff, S. Tobacco smoking as an etiologic factor in diseases. Cancer Research, 10:49-58, 1950. 28. Scott, R. B. Some medical aspects of tobacco smoking. Brit. M. J., 1:671, 1952. 29. Sugiura, K. Observations on animals painted with tobacco tars. Am. J. Cancer, 38:41-49, 1940. 30. Waldbott, G. L. Further observations on smokers' respiratory syndrome. Annals Int. Med., 39: 1026, Nov. 1953. 31. Sollman, Torald. A Manual of Pharmacology. 6th Edition, 1942. 32. Watson, W. L. Cancer of the Lung: considera- tion of Incidence and etiology. New York Med., 6:15-18:40, 1950. 33. Wright, Irving S. Vascular Diseases in Clinical Practice-page 161. The Year Book Publishers, Inc., Chicago, Ill., 1952. 34. Wynder, E. L, and Graham, E. A. Etiologic fac- tors in bronchiogenic carcinoma with special reference to industrial exposures. Arch. Indust. Hyg. & Occup. Med., 4:221-235, 1951. 35. Wynder, E. L. and Graham, E. A. Tobacco smoking as possible etiologic factor in bronchio- genic carcinoma: a study of 684 proved cases. J.A.M.A., 143:329-336, 1950. 36. Wynder, E. L. and Cornfield, Jerome. Cancer of the lung in physicians. N.E.J.M., 248:441-444, 1953. 37. Wynder, E. L.; Graham, E. A. and Croninger, A. The experimental production of carcinoma with cigarette tar. Cancer Research, 13:855-65, 1953. 380 NEW YORK MEDICINE

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llep©rt of the Nilk Co.mmissiv.n Because many physicians are recommending the use of skimmed milk in the dietary management of various conditions, we should like to call their at- tention to the fact that Certified Skimmed Milk- Pasteurized is now available. Certified Milk is produced by: Walker-Gordon Laboratory Company Raw Pasteurized Pasteurized Homogenized Vitamin D Pasteurized Skim Tarbell Guernsey Farms Pasteurized Certified Pasteurized Cream is produced by: Walker-Gordon Laboratory Company Certified Goats Milk is produced by: Prasse Goat Dairy Tyler Goat Farm Walker-Gordon Certified Milk is distributed by: Borden's Farm Products Co., Inc., 110 Hudson Street Sheffield Farms Co., 524 W. 57th Street Janssen Dairy, 109 Grand Street, Hoboken, N. J. Stores on request. 'I'arbell Certified Milk is distributed by: Daitch Dairy Co., 231 Dyckman Street Prudential Dairy Products, Inc., 24-30 49th Street, Long Island City Tarbell Farms, 102 E. 24th Street Certified Goats Milk is distributed by: Prasse Goat Dairy, Prince's Bay, Staten Island, N. Y. Tyler Goat Farm, Flemington, N. J., through local stores. Wholesale customers using Certified Milk are: Hotels: Ambassador, Barclay, Biltmore, Commo- dore, Croyden, Gotham, Gramercy Park, Madi- son Square, Marguery, McAlpin, Paramount, Park Lane, Statler, Pierre, Plaza, Ritz-Carlton, Roosevelt, St. Regis, Seymour, Shelton, Wal- dorf-Astoria, Warwick and Weyland. Clubs: Brook, City Mid-day, City Midtown, Col- ony, Downtown Association, Luncheon, The Links, Manhattan, N. Y. Athletic, Racquet & Tennis, Stock Exchange Lunch, Union League, University, Whitehall, Yale and Recess. Restaurants: Cafe Trouville, Mayfair House, Savarin, Longchamps, Schraffts, Union News, Holland House, White Turkey, and Borden's Milk Bar (Hudson Terminal). Stores Distributing Certified Goats Milk: Honey House, All Health Foods Distributors, A-Radiant Health Food, Miss Carolina Brooks Vitamin Bar. Stores Distributing Certified Milk: Walker-Gordon Certified Milk can be obtained through local stores on request. HARRY ZUCKERMAN, Chairman ROBERT O. DuBois, Secretary PORO THE BEST PROCURABLE New ideas are frequently incorporated in Pomeroy supports. When a change to bring better and more refined service is proposed, it is carefully checked and tested. Then, if approved, it is adopted as standard. But the essential principles of construction and application remain unaltered. Thus Pomeroy appliances after eighty-seven years of such development-sticking to principles and adding refinements-are the best procurable. POMEROY COMPANY, INC. 16 EAST 42nd STREET NEW YORK 17, N.Y. Brooklyn • Newark • Boston • Springfield • Wilkes-Barre SURGICAL APPLIANCESaa. . ~ 382 NEW YORK MEDICINE

e CONVALESCENT AND NURSING HOMES STAMFORD HALL STAMFORD, CONN. Established 1891 Telephone 3-I191 FOR THE TREATMENT OF NERVOUS AND MENTAL DISORDERS GENERAL INVALIDISM Modern Equipment and Large Assisting Staff Rates Reasonable • CLIFFORD D. MOORE, M.D. WRITE FOR DESCRIPTIVE INFORMATION Riverdale Nursing Home INC. Kingsbridge 3-4220 Convalescents, Chronics, and Retired guests. Pleasant and cheerful Pavilions. Semi-private and Private rooms. Spa- cious lawns and grounds where guests may take advantage of the country within the convenience of the city. Carefully selected diets. Efficient serv- ice. Guests are under the care of their own physician. 3031 Henry Hudson P'kway., at 231st St., N. Y. E. NORBIT, R.N., Director WEST HILL OCEANSI DE GARDENS SANITARIUM Licensed by N. Y. State Dept. of Mental Hygiene Registered by A.M.A. Individual Treatment of nervous and mental disorders Electro Shock Therapy • Insulin Therapy Psychotherapy • Occupational Therapy Non-Institutional Atmosphere LUDWIG LEWIN, PH.D. KNUT HOEGH HOUCK, M.D. Superintendent Physician-in•Charge 24 Harold Street, Oceanside, Long Island Rockville Centre 6-4348 West 252nd St. and Fieldston Road - Tel.: Kingsbridge 9-8440 RIVERDALE-ON-HUDSON, NEW YORK CITY Location within the city with advantages of a country sanitarium. Mental rest, drug and alcoholic patients. Scientifically air-conditioned cottages. Ten acre private park. Occupational therapy and all modern treatment facilities. Send for Descriptive Booklet Address HENRY W. LLOYD, M.D. MAY 5, 1954 383

~/ NURSING Xn~OOu HOME, Inc. p~ "All the Comforts of Home" FOR THE CHRONIC - AGED - CONVALESCENT PINEWOOD Neuropsychiatric Hospital DR. JOSEPH EPSTEIN-DR. Louis WENDER Physicians in Charge Westchester County Katonah, N. Y. Katonah 4-0775 Emphasis is placed on a psychotherapeutic ap- proach-Group psychotherapy, individual analy- sis, narcoanalysis, and narcysynthesis. Electric shock and insulin coma where indicated. Monthly clinical conferences open to profession. N. Y. City Offices-By Appointment DR. WENDER-59 E. 79 St. (Mon., Wed., Fri.) Butterfield 8-0580 DR. EPSTE>:N-975 Park Ave. (Tues.,Thurs.,Sat.) Rhinelander 4-3700 ROYAL OAKS ONE OF NEW YORK'S FINEST • Television • Roof Garden • Elevator • Beautifully Decorated • Fireproof • Day & Night Nurses LICENSED BY DEPARTMENT OF HOSPITALS Distinguished Licensed Nursing Home for Convalescence Cardiac and Digestive Disorders Beautiful Surroundings. Diets. Dr. Herman Weiss Resident Medical Director 306 West 102nd St., New York City UNiversity 4-7617 BRIGHAM HALL HOSPITAL C A N A N D A I G U A, N E W Y O R K FOR MENTAL AND NERVOUS PATIENTS. Alcoholism addictions, and geriatric patients accepted. Modern tr.atm.nt, scientific and individual, In a home-like atmosphere. Mod- erate rates. Licensed by ihe dept. of Mental Hygiene. (See also our advertisement in the Medical Directory of N. Y., N. J. and Conn.) Address inquiries to: FRANCIS W. KELLY, M.D., Physician-in-Charge HOLBROOK MANOR NH MIEG Five Acres of Pinewooded Grounds SENILE Non-sectarian, dietary laws observed Medical Director O. L. Friedman, M.D., Q.P. HOLBROOK, L. 1. N. Y. Office: GRamercy 5-4875 Madison, New Jersey MAdison 6-0655 CERTIFIED MILK • Has maintained standards of milk production for more than 50 years. • Produced under the supervision of the Medical Profession. • Produced according to the highest standards. • The following types are available. Pasteurized - Whole Pasteurized - Skimmed Pasteurized - Homogenized Vitamin D On Doctor's prescription: Raw Certified Milk Raw Certified Goat's Milk MILK COMMISSION OF THE MEDICAL SOCIETY OF THE COUNTY OF NEW YORK LOUDEN-KNICKERBOCKER HALL, Inc. •••; : John F. Louden, Pres. A Private Sanitarium Established In 1886 (~ ; AMdTYlIILLE, Long Isiand, N. Y. SPECIALIZING in NERVOUS and • . ~ : • Tel.: Amityville 4-0053 MENTAL DISEASES • ~ (33 miles from New York City), Electric shock therapy administered. 0 : NEW YORK CITY OFFICE ... EMPIRE STATE BUILDING . . . TELEPHONE: LOngacr. 3-0799 : 384 NEW YORK MEDICINE

• assil.e Advertising Deadlines for Copy are the 1 st and 15th of the month (20 Days Preceding Publication) NEW YORK MEDICINE accepts only what Is believed to be ethical advertisement, but does not assume any responsiblltty for any statement made in these columns. Rate: $3.75 minimum for 25 words or less; additional words 15c each; box number 75c. Address all classified advertisements TYPED IN DUPLICATE WITH YOUR REMITTANCE to the office of NEW YORK MEDICINE, 2 East 103 St., N. Y. 29, N. Y. Telephone ATwater 9-7305. SERVICE Expert Watch Repairing-Your watch has a heart, too ... it beats 18,000 times an hour and, naturally, just like your own, it needs periodical check-ups. Whatever the MAKE, whatever the AGE, whether for major REPAIR or for CLEANING, your watch is SAFE in the hands of: BERNARD SAMTER Certified Swiss Watch Technician 55 West 42nd St., NYC Room 1453 LO 4-6353 ASSOCIATE WANTED ENT practice for sale-growing suburban area. Box No. 4027, New York Medicine. PRACTICE AVAILABLE Year around Mountain Retreat in Putnam County-an eight-room house with attached two car garage, beautifully situated on three picturesque acres adjoining the Carmel County Club. Automatic oil heat, artesian well, log-burning fireplace, landscaped with lawn, flowering shrubs, fruit trees, berry bushes, etc. Congenial neighbors. Just 55 miles from New York along scenic parkway. For details, call Mr. Paul Keefe (Pres., Keefe & Keefe). TRafalgar 9~1600. Two General Practices for cost price of beautiful home and office combination in Sunnyside, Queens. Husband and wife leaving to specialize. Wonderful opportunity! RAvens- wood 9-4551. Forest Bills Gardens-extremely attractive nine room house, 3 baths, center hall, finished basement, terrace, oil, $37,500, excellent condition. MUrray Hill 5-8981. Jamaica Estates $35,500. A real home in a beautiful neigh- borhood within walking distance to subway. The house must be seen to be appreciated. Every comfort and con- venience, 7 rooms, 2% baths, finished basement. By appoint- ment only. Call TEmpleton 1-4224. COURSE Histopathology of the Eye course. May 17 thru May 22nd, 1954, 2 to 6 P.M. each day. Given by Drs. Payne, Roberts and Samuels; fee $100. Address, Registrar. New York Eye and Ear Infirmary, 218 Second Avenue, New York City. OFFICES FOR RENT Good opportunity for G.P. to take over very well estab- lished practice of recently deceased physician. 200 miles from New York upstate; reasonable terms. Box No. 4047, New York Medicine. PHYSICIAN WANTED Professional Building In Franklin Square, L.I. Occupancy July 1st; afr-conditfoned. Needing medical specialists. Call HEmpstead 7-7483. Medical Arts Building-New; air-conditioned. All specialties rented except-E.N.T., Eye, Dermatology, Psychiatry, Proc- tology and Allergy. Excellent opportunity in a rapidly growing area. Call MAssapequa 6-2448. OFFICE TO SUBLEASE OR SHARE 106 East 85th St. (Near Park Ave.) Office for rent; 2-3 rooms with right to sublease or share. Share beautifully furnished waiting room. Nurse-secretary available all day. Call 9:30-6:00. Phone RH 4-0568. FOR SALE Professional Office Available at No. 1 VINCENT ROAD Bronxville N.Y. New Modern 96 Family Elevated apt. House in one of the wealthiest suburban communities. Specially planned for large medical suite; for combined offices or for living quarters-office combination. Agent Premises or BRonxville 2-9686 Professional Office (5 rooms) in exclusive cooperative pro- fessional building East 60th. St. near Park Ave. TE 8-7626. Jamaica Estates Residence. Prewar, custom built~ porches, beautiful landscaping, 4 bedrooms, Ideal locatioh, profes- sional use, at Subway Terminal, Manhattan 30 minutes. Easy shopping, schools. JAmaica 6-4949. West 87th St., 4 Story 3% modern baths. Perfect for resi- dence and office or clinic. Excellent heating system. Asking $25,000. Low cash. MU 8-3918 or BR 9-9267 A.M. For Sale due to Illness-Medical practice, fully equipped office. Modern building middle class neighborhood. X-ray, fluoroscope, Basal, Diathermy and dark room, instruments and furnishings. Immediate occupancy; to start practice at once. Equipment like new, wonderful opportunity. Phone for appointment. PE 8-2595. East 60th Street. Exclusive Professional Building. Two unfurnished rooms with privilege of reception room. 24- hour phone service. Box No. 3193, New York Medicine. 2 East 86th Street off Fifth Ave. (The Adams), second floor. Any size adjustable to doctor's requirements. Call Mr. Ad. Kramer, Executive Director. RH 4-1800. 27 West 86th St. Desirable, location, furnished, part or full time-very low cost. Call SChuyler 4-2886. Apartment now available. Street level, two entrances, lobby and street. Newly renovated; perfect location for doctor's office. 170 East 78th St. BU 8-3652. 502 Park Avenue. Partly furnished. Common waiting room. Suitable daily hours. Attractive rental considerations. OFFICE TO SHARE 245 E. 17th Street. Share large suite, air-conditioned. Beautifully furnished, fully equipped, including infra-red and diathermy. Secretary-nurse, cleaning service. Labora- tory service available. Radiologist on premises. Moderate rent. ORchard 4-0246. 35th Street, at Lexington Avenue. Modern, attractively furnished office. Hours can be arranged. Rent reasonable. Call MU 6-8152 between 12 and 1 P.M. 61st Street, 40 East. Furnished consultation room and examining room in five room suite available weekdays until 3, Saturday and later weekday time by arrangement. TEmpleton 8-6344. 52nd Street near Park Avenue, fully equipped medical office, morning hours till 1 P.M. Medical building; X-ray and complete lab in bldg. Call owner, ELdorado 5-6184, evenings up to 11:30 P.M. 61st St., II1 East (near Park Ave.). Completely equipped medical and psychiatric offices; Receptionists; 24-hour tele- phone service. Infra-red, diathermy, violet-ray, fluoroscope available. On hourly basis-paying only for time occupied. TEmpleton 8-7840, mornings. 39 East 65th Street. Radiologist will share well equipped, X-ray, diagnosis and therapy office. Morning and evening hours also available for other specialties. BUtterfleld 8-1021. 65th Street & Park Ave. Five rooms, air-conditioned: newly decorated, impressive, furnished or unfurnished. Private street entrance. Suitable any specialty. Entire suite or share. ORchard 4-0246. MAY 5, 1954 385

CLASSIFIED ADVERTISING-CONTINUED Park Avenue, corner 66th St. Attractive office, completely equipped. Exclusive use of consultation room and examin- ing room every morning from 8-12. Call REgent 4-8268. Park Avenue, 71st Street. Unusual opportunity for right man to have hours in high class office. Five rooms, fur- nished; fluoroscope, private entrance. BUtterfleld 8-5660. SECRETARIAL SERVICES CHARLES TRANSCRIPT SERVICE: Audograph, Dictaphone, Edison, SoundScriber dictation; tape recorded or dictated material accurately transcribed; written material beauti- fully typed and proofread. Heavy experience; references. Prompt mail or messenger service. 154 Nassau Street, N.Y. 38. WO 4-1486. 3 East 74th Street. Fully furnished, equipped, X-rays, Short Wave, etc., Secretarial service, cleaning service, morning, afternoon, evening hours, reasonable rates. Call RHinelander 4-4703. Park Avenue and 77th St. Fully equipped and furnished office. Suitable for specialist. RE 7-2551. Park Ave., corner 81st St. Attractive office, exclusive loca- tion. Two consulting rooms and multiple examining rooms; completely equipped. Available every afternoon and some mornings. TR 9-4100. 81st Street, near Central Park West, opposite Planetarium. Exclusive use two rooms, share large waiting room, X-ray, fluoroscope. EKG, Basal, Diathermy, Rer.eptionist-Lab as- sistant. EN 2-5065. Central Park West-84th St. Exclusive use, attractive 3 room suite, E.K.G., B.M.R. X-ray. SU 7-4550. 9 to 1. 4 East 95th St. Large, attractive new office. Fully furnished and equipped, including X-ray. Suitable hours arranged. SA 2-5334. Central Park West--g4th St.-Exclusive use of attractive three room suite in completely equipped office or afternoon hours. SU 7-4550, 9 to 12 A.M. Central Park West, 96th St., N.Y.C. Office to share; attrac- tively furnished; well equipped; fine building. Hours open. Reasonable. RIverside 9-5900. 325 West End Avenue (corner 75th St.) Exclusive use of one room in a modern, well equipped and attractively furnished office. Receptionist, secretarial and laboratory facilities. Radiologist on premises. TRafalgar 4-6362. POSITIONS WANTED Internist diplomate seeks part-time or exceptional full time position. Long experience in practice, writing, editing. Box No. 4046, New York Medicine. R.N. (1945 Grad.) Alert, experienced, seeks Dr.'s office. research or other position. Secretarial and medical abstract- ing experience. RE 7-4134. WANTED Experienced Stenographer, typist and office assistant to Otolaryngologist. 5'/2 day week. Phone ENdicott 2-2080 before noon for interview. OFFICE WANTED East Side between 60th and 88th St. bet. Fifth and Lex- ington Ave. wishes physician to rent use of waiting room and two exclusive rooms. Box No. 4046, New York Medicine. NURSE WANTED Registered nurse, preferably with experience in Public Health nursing, for girls' camp in Maine. Season-July and August. Apply Mildred Hamburger, BU 8-6554. MEDICAL PERSONNEL AGENCIES PATRICIA EDGERLY has directed the oldest and largest medical placement bureau in New York and has enjoyed an enviable reputation for over 25 years. Physicians, hos- pitals, industrial medical departments, pharmaceutical and allied fields. Don't confuse us with any others. NEW YORK MEDICAL EXCHANGE (Agency) 489 Fifth Ave. (opposite Public Library) MUrray Hill 2-0676 Receptionists, secretaries, assistants. Applicants of ability, neat appearance, good education. Larkin Employment Agency 130 West 42nd Street OXford 5-2668 NASSAU MEDICAL EXCHANGE Medical Placement Specialists Available for immediate placement- Physicians. Nurses, Technicians, Secretaries, Receptionists. 251 West 42nd Street Agency Wlseonsin 7-9781) SPECIFICALLY FOR THE MEDICAL AND ALLIED PRO- FESSIONS: Offering screened specialized personnel for staffing Hospitals, Psychiatric Organizations and Physi- cians' Offices. Prompt service for your personnel needs. N. Y. MEDICAL PLACEMENTS AGENCY Suit 3436 30 Rockefeller Plaza CI 6-0268 Russell B. MacFarlane, B.S., MEd., Director MEDICAL AND PSYCHIATRIC SECRETARY Part-time, free lance, American Board and P.A.C.S. reports, manuscripts, personal office service. Linda Dubester LUdlow 5-5716a MEDICAL SECRETARIAL SERVICE Phyllis Reisman Goldberg, Director. Expert preparation of AMERICAN BOARD, FACS, FICS cases; manuscripts; cor- respondence; research. Call OLympia 8-7723; if no answer call VIrginia 7-9524. Stenographio Reporting Service, Stenotype and Stenograph verbatim reporters for Medical Meetings, Scientific Ses- sions, Conferences. Specialists in COMPLETE PREPARA- TION of American Board, FACS, FICS Cases; Manuscripts. Notary Public. Joseph P. Kramer, COrtland 7-2912. EQUIPMENT FOR SALE 4 Allison Pediatric tables, 3 Jones & McKesson Basals rea- sonably priced, X-ray Fluoroscope Combinations, fully guar- anteed, direct writing Electrocardiographs, Microscopes, $75. and up, 10 Otoscopes, sterilizers, 2 Trial Lens Cases, 1 A. O. Lensometer, 1-Perimeter, 6-Brown Buerger Cysto- scopes. We pay top prices for X-ray, Medical and Oph- thalmic Equipment. Marburger Surgical Co., 644 Columbus Avenue (near 91st Street) TRafaigar 7-2743 Used Physicians' Equipment, Bought and Sold. Sterilizers; Scales; Wheel Chairs; Tables; Cabinets; Instruments; Lights, etc., always on hand. Harry Wells, 400 East 59th Street. New York City. PLaza 3-2023. X-ray machine for therapy, radium and other equipment at 140 East 54th St., N.Y.C. OFFICE MAINTENANCE EQUIPMENT SPRAYING Your equipment can be sprayed to look like new, at your office, your convenience. CITY SPRAYING SERVICE 620 West 172nd St. WAdsworth 3-6101 DOCTOR'S CREDIT EXCHANGE Collections by Experts-Commission Basis "We collect . . Not Just Promise" Doctors' Credit Exchange 258 Broadway, New York 7, N. Y. Telephone: COrtlandt 7-3045-6 Beth David Alumni Meet The sixth Annual Frederick W. Bancroft Lecture in Surgery, sponsored by the Beth David Hospital Alumni Association, will be delivered by Dr. John H. Mulholland, Professor of Surgery and Chairman of the Department, New York University College of Medicine, Director of Surgery, Bellevue Hospital Third Division; Surgeon, University Hospital, on Wednesday evening, May 5, 1954 at 8:30 P.M. Dr. Mulholland's subject will be "Benign Diseases of the Pancreas." The lecture will be held at Beth David Hospital, 161 East 90 Street, New York City. 386 NEW YORK M/EDICINE