The Journal of the Philippine Medical Association Vol. XXII, No. 4 (April, 1946)

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Part of The Journal of the Philippine Medical Association

Title: The Journal of the Philippine Medical Association Vol. XXII, No. 4 (April, 1946)
Issue Date: Vol. XXII, No. 4 (April, 1946)
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extracted text: ____ c:ehc--lJO OF THE PHILIPPINE ..-..-..-ICAL ASSOCIATION =============••• .============= VoL. xx11 APRIL, 1946 No. 4 Clan tents ORIGINAL AR!IC!...ES: Page Oh~cr\'ations and Prohlcms in T ubcrculosi~ in the City of Ma nil a Before. During and after the Japanc~c occupation-by S1xto A. Francisco, M.D. and Cesar Ongpin. M.D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 Camcrum Ori~: Oh~cr\'ations on It~ I ncidcnce and Trcatrncnt-hy Alberto V. Tupas. M.D. and Artemw P. ]ongco. M.D. . . . . . . . . . . . . . . . . . . 15 3 Practical Con~idcration~ in Refraction-by Felisa Nicolas-Fernando. M.D. 159 A Modified Field Stain For Rapid Staining of Thick and Thin Blood Smcar~---hy T. f'. Pesigan. !-.1.D. and E. Y. Garcia. M.D. . . . . . . . . . . 165 (Continued on page I) Published Monthly by the Philiprine Medical Association 54 7 Herran Street, Manila Entered as second class matter at the Manila Post Office March 7. Hl46 Single Copy P0.50 Per Year P6.00 - "SANDOZ Ltd. All Pharmaceutical Specialties n1a.nufactured by "Sandoz Ltd." Basie ( S\vitzer land) are no\v again available to the Medical Profession of the Philippine Islands Allisatin Basergin Belladenal Bellaf oline Bellergal Calcibronat Calcium Gluconate Calgulquine (Quinine Calcium) Cedilanid Digilanid Felamine Glysenid Gynergen lpesandrine Lobeline l\iacalvit N€o-Gynergen Optalidon Panthesin Raphabil Sandoptal Scillaren Strophosid Sole Representatives: IN HELDER INCORPORATED Trade & Commerce Bldg.-Room 509-5th Floor Manila, P. I., 123 Juan Luna i(~- . r~ . \, RAPID I \'" \ ~ -Creamalin promptly reduces stomach acidity. Moreover, the antacid effect is sustained. • • With Creamalin there is no compensatory reaction by the gastric mucosa and no oversecretion of hydrochloric acid. Furthermore, there is no risk of producing alkalosis. • • When employed with an ulcer regimen. Creamalin often induces rapid healing of peptic ulcer. SUPPLIED IN 8 oz .. I 2 OZ. ANO I PT. BOTTLES •:,':.~ .. ~.,'4 A\\" N 0 N A l I< A l N E ANTACID TH f R l PY WI NTH A 0 PC HEM C A l COMPANY, I N C • PHARMACEUflCALS OF MERIT FOR fHE PHYSICIAN• NEW YORK 13, N. Y. •WINDSOR, ONT. !vIANILA OFFICE: 670 Dasmarinas :~rd Flool' Telephone: 2-70-06 107/.l Jour. P.M.A., Volume XXII, Number 4 CONTENTS-Continued EDITORIAL: The Medicine of Tomorrow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11ISCELLANEOUS: ABSTRACTS FROM CURRENT LITERATURF •••••••••••••••••••••••.••• 173 ' 175 Program of the 39th Annual l\1ecting of the Philippine Medical Association 17S National Health Program of the American Medical Association . . . . . . . . 187 IMPORTANT NOTICE E~ch member of the As~ociation is entitled to receive a copy of the Journal every month. Articles are accepted for publication on condition that they are contributed solely for tais Journal. Manuscripts should be typewritten, double-spaced, and the original, not the carbon copy, submitted. Advertising matter must be received not later than the 20th of the month immediately preceding the month of issue. Our readers are requested to send in items of news of interest to physicians. We shall be glad to know the name of the sender in every instance. Outside of views or statements that are the authoritative action of the Philippine Medical Association, neither the association nor the editors assume responsibility for opinions and statements published in the Journal of the Philippine Medical Association. Views set forth in the various departments in the Journal represent the views of the writers thereof. AMERICAN FIRMS: LEDERLE LABORATORIES, N. Y. BA·UER & BLACK, CHICAGO MCKESSON & ROBBINS .. N. Y. DR. D. JAYNE & SONS, PHIL. H. K. WAMPOLE & co.i PHIL. SWISS FIRI\IS: HAEMATOGEN HOMMEL, LTD., ZCH. DR. A. WANDER S. A. BERNE M. ZELLER SONS, ROMANSHORN Represented in the Philippines exclusively by: F. E .. ZUELLIG, INC. 55 Rosario St., Manila I II Jour. P. M. A. April, l ~l-16 - . . ~--- ---D 0 C TOR! Have you seen the performance of the· U.S. Army Field X-Ray Unit? Designed and built solely by Picker X-Ray, U. S. Army Field Units have g~ne triumphantly through every campaign, performing in a way to '"'·in unanimous acclaim. The same fine engineering and sound construction are reflected in civilian Picker X-Ray apparat·us. An investment in Picker equipment is an investment in consistently high performance over an exceptionally l'ong life. The ''Century" F1uoroscopic and Radiographic X-Ray Unit, one of a large variety of civilian Picker X-Ray models. Expert technical installation and maintenance service assure you of continued satisfactory operation of your Picker equipment. ShipJne11ts of civilian Picker X-Ray units are continuously arrivingarrange for a reservation of the model most suitable for your requirements. It will assure you of earlie.st possible delivery. PICKER X-RAY CORPORATION Ei:clusii-e Distributo·rs for the Phil-ip]Jines 0 C EA N IC C 0 MM ER C I A L, IN C. (Levy & Blum) 3.5 Pl3.z~ Sta. Sruz Te 1. 8-78-38 . . . . ,,. ,_ '. . . Valume XXll Number 4 Presents to the Mt.O\CA\.. pROf-t.SS\Ot..\ · · · l~fENACYL TABLETS LAKESIDE The s•lic>late ,,.;tb protection 8 ga\nst he1JloTrbaGe· Bottle ()'{ 100 Tab· .. and Th• 1 .. tcst ncVI•· aoctoT. i& tbnt ;ntcn· si•• oT (,eauent ... 1;cy\ate auminist<•" Hon prcdis?os•• youT p1>tient to b<;oT· ,nag•' l TbC ,;gbt sAuc'ILA'I ~ 15 'M~AC"iL· Encb tAENAc'IL tablet p<o•iUe& .a.33 gin. of .. pirin. o.33 11111· o! m•~"d1011•· 33.3 ,..g. of ""coTbi< nc\d. Tb\11 pb•T· maceutical con!iguTat\o11 aid• in main· to.ininll ph>•iololl\cal balance -. •••" durinll tl:• most inten•• sa\icy\at• theTaphY· \Sc"amc oil su\•cnt toT 'f'eni<i\\it,.) Qne oinll\e ;njecti011 viitb pTo\onlled III Via\ 5 cc Tb• sol.ent o{ choice for ?cnicillin and oth•T dTUll•· r;14ULG'£N mi><Cd ..,;th -penicillin t>O.,..aer gi•es adequate pTotect\on tor tnanY bouTB with ONE nct\un· £1'\ULGEN will sa•• ,..ueb ~alUabl• tim• toT tb• physician... and sa•<• pain !OT the pat\ent •. 'f'enicillin "'"' be iniected in on• bill Uo•• il it i• with 'E~f\JLG'E~· E~JEC'flO~ O~L Y. * "MANDRUG" . LIFE THEA Rooms 208-209 TRE BUILDING - 515 Q CABLE ADDRESS· UEZON BLVD. 1v· J .:>Ur. P. M. A. A11ril. 1M6 CRYSTALLINE SODIUM SALT * Requires No Refrigeration * Pain upon injection Minimized, Even in High Dosages * Well Tolerated and Effective Subcutaneously * Poten~y Clearly Stated on Label ~OTE THESE AD\T ANTAGES E ;eel usive Distributor::; LA ESTRELLA DEL NORTE LEVY HERMANOS INC. 1001 P". HIDA.LGO ~dANILA V t•lume XXII V Number 4 914 + 20 Years = Neoarsphenamine It took Erhlich 914 experiments to produce Neoarsphenamir.e. Continuous Abbott research for over 20 years has produced an in1proved trivalent arsenic compound of low toxicity and high potency. A wide n1argin of safety is guaranteed on every batch by de-rnonst•rated tolerar.ce, in test anin1als, considerably above the official requiren1ents of the United States PubUc Health Servi'.!e - 'vithout dimunition of therapeutic efficacy-the rnost outstanding feature of N eoarsphenamine, Abbott. Council Accepted Supplied in 5-ampoule boxes of .15, 0. 30, 0. 45 > 0. 60, 0. 75 and 0. 90 gJns. Litera:f:ure on request froni ABBOTT LABORATORIES EXPORT CORPORATION l\ianila Branch - 1023 R. Hidalgo VI Jour. P. M. A. April. l!M6 E. R. SQUIBB & SONS INTERNATIONAL CORPORATION CARE OF Ed. A. Keller & Co., Ltd. Vvise Building, C~Jle Juan Luna Manila, P. I. J"uly 15, 1946 Dear Doctor: Squibb Penicillin is now arriving in the Philippine Islands in fairly good and steady quantities and we wish to take this opportunity t6 thank you for the preference you have shown for it and for the forbearance you have shown when faced with the difficulties occasioned by shortage of supplies. Some of our medical friends have remarked that Penicillin is some times a cake; sometimes lumpy and sometimes a powder. This is very true for Squibb Penicillin may appear in any of these forms. Squibb Penicillin is prepared, dried and packaged under one of the most scientific of systems by which the purity and ·the keeping quality of the preparation is enhanced; however, by this process, we cannot control slight variations in color and appearance of the finished product. We have been using the· same system for a long time and innumerable tests by authorities in all parts of the virorld have proved conclusively that this variation in color and appearance has no relation to the purity, potency, moisture content or therapeutic efficacy of the product. Again thanking you for the interest you have shown in Squib.b products and hoping for the continuance of your favor, we beg to remain, Yours faithfully, E. R. SQUIBB & SONS INTERNATIONAL CORPORATION PARK E. GREEN Man~ger, Philippines Division P. S.: If vvc have improperly addressed.you kindly advise us and if you knovv any physician who remarks that he has not received this letter please ask him to send us his name and address. V CJlume XXII N 1.a111b\!r 4 STRONG LINKS For ·iron-Deficiency Anemias In hematinic and regenerative therapy, the com· bined action of Vitamin B Complex, plus Liver. plus Iron is more effective than any one or two of these. The nutritional influence of liver and vita· mins assists in the utilization of iron for hemoglobin production. Multiple prescription writing to achieve the de· sired therapeutic results is not only time coneum· ing for the physician, but inconvenient and expensive medication for the patient. Each ENDOGLOBIN TABLET contains: Liver residue ••• 3 gr., Ferrous Sulfate, Exsiccated (U.S.P.) ••. 3 gr., Thiamine HCI ... I mg.~ Riboflavin ••• 0.66 mg. and Niacin ••• 10 mg. For nutritional anemias ••• not intended for pemicious anemia. Samples and literature to physicians on requesL El\IDOGLOBll\I leg. U. S. Pat. Off. 7allet4 EXCLUSIVE DISTRIBUTORS THE MODERN PHARMACAL PRODUCTS CO. CEBU 88&-888-890 Rizal Avenue, :Manila, P. I. ILOILO VII VIII Jour. P. M. A. April. 1946 VILCO D-RUG DEPARTMENT VILCO COMMERCIAL 371 Muelle de Binondo, Manila IMPORTERS 8c WHOLESALERS * * * DRUGS * * * CHEMICALS * * * PHARMACEUTICAL PRODUCTS THE ASSOCIATED PUBLISHERS 1104 Castillejos, Quiapo, Manila (Philippine Education Plant) ReIJresenting Leading Medical Book Publishers W. B. Saunders Co. F. A. Davis Co. C. V. Mosby Co. Williams & Wilkins Co. MacMillan Co. W. F. Prior Co. Orders accepted for Medical Books of the above ·publishers AT PREWAR PRICES Volume XXlll Number 4 IX ~======================================================~ CLINITEST ONE MINUTE TABLET METHOD FOR TESTING URINE-SUGAR The Clinitest tablet method of urine-sugar testing represents the culmination of successive improvements on the basic copper reduction tests. Involves three simple steps: (1) Place 5 drops of urine in test tube; (2) Add 10 drops of water; (3) Drop in Clinitest tablet, and compare with color scale 15 seconds after boiling stops. Heat is self generated within the test tube, as the Clinitest tablet dissolves in the aqueous urine solution. Clinitest is equally adaptable for routine use in the hospital, the physician's laboratory and by the diabetic patient . • Sole Distributor in the Philippine Islands ED. A. KELLER & CO., LTD. 3rd Floor, Wise Building, Manila • AMES COMPANY, INC., ELKHART, INDIANA, U. S. A. x ''THE PAIN DOCTOR .... CAN'T YOU DO SOME· THING?'' Yee, that's the question that greets most physicians who encounter cases o( intermittent claudication, renal colic and primary or secondary dysmenorrhea... for to the pntk nt, prompt relief tron1 the excrucieting pain is the most important type of therapy. 'Depropanex' extract ia also indicated for controlling pain caused by stone, stricture or instrumentation and is effectively em.ployed to facilitate retrograde pyelography and uretcrnl dilation. 'DeprC"pnnex' dcprotcinated pancreatic extrnct providt.'9 prompt symptomatic relief from pain by rapidly relaxing smooth muscle spasm-the immediate cau~e of pain. It's action is very prompt, usually within three minutes following administration and can be administered over long periods without any untoward general effects. 'Depropancx' extract is free from insulin, histamine and acetycholine. Supplied in 10 c.c. vials. DEPROPANEX DEPROTEINATED PANCREATIC EXTRACT Sharp & Clinical and laboratory reports indicate that the whole Vitamin B-Complex i& superior tberapeatically to any single fraction. Jour. P. M. A. Apn1, 19·16 'B-G-Phos' Elixir contains all the elemente of the B-Complex plus the glycerophosphates, calcium, potassium and other essential salts. It stimulates the appetite, improves digestive functions, tends to correct Vitamin B-Complex deficiencies and thus increases the physical well-being of the patient. This vitamin-mineral tonic can be effectively administered over loug periods to improve digestive function and to prevent or correct deficiencies of Vitamin B 1, especiaJly during childhood, pregnancy, febrile illnesses, convalescence, and old age. Since it is unusually palatable, it ia aceeptable to both children and adults. Dose: One tablespoonful three times daily before meals. Supplied: In 8 oz. and 16 oz. bottlea. B-6-Phos ELIXIJl Dohme PHILADELPHIA, U.S.A. Di'Stributors in the Philippines: ELIZALDE TRADING CORP. ELIZALDE BLDG. MANILA * Note: To Physicians . . . scientific literature sent upon Tequest by our distributors. THE JOURNAL OF THE Philippine Medical Association Devoted to the Progress of Medical Science and to the interests of the Medical Profession in the Phil.ippines Manila, Philippines VOL. XXII APRIL, 1946 Ol)riginal Artirles NO. 4 OBSERVATIONS · AND PROBLEMS IN TUBERCULOSIS IN THE CITY OF MANILA BEFORE, DURING AND AFTER THE JAPANESE OCCUPATION SIXTO A. FRANCISCO, M.D. Chief, TubeTt:ulosis Coutrol Section, B·i.iteau of Health AND CESAR ONGPIN, M.D. Phithisiolo gist,Superoisor This paper is presented from a public health view point, and it consists of the observations made and problems encountered in the city of Manila before, during, and after the Japanese occupation. These problems are so complicated and extensive that the steps taken in their solution have proved inadequate and ineffective. From the epidemiologist point of view, tuberculosis as a public health problem in the city of Manila or elsewhere in cthe Philippines, is practically the same now as, if not worse than, it was many years ago. X,RAY MASS SURVEY FOR TUBERCULOSIS Before World War II, an x .. Ray mass survey for tuberculosis incidence was conducted among 24,005 Philippine government employees residing in the city of Manila. These employees were classified into 10 grou~s - technical employees teachers, nurses, midwives, clerks, policemen, detectives, sanitary inspectors, soldiers, trainees, janitors, helpers, laborers; and, under miscellaneous, were chauffeurs, me, chanics, guards, gardeners, and others, who were too few to be classified separately into individual groups. (See Table 2) Out of these 24,005 individuals who were X,Rayed, 1,492 cases or more than six per cent ( 6%) were discovered suffering from pulmonary tuberculosis. This approximates very closely our findings among 1,037,577 Filipinos examined by the Traveling X,Ray Clinic in 19 provinces in the: Philippines, which is 6.83%. (See Table 1) 146 TUBERCULOSIS-Francisco et al. Jotrr. P. M. A. April, 1946 Another extensive X,Ray mass survey was conducted before the recent war among the city of Manila public schools, comprising 6,171 teachers, 125,640 students, and 426 janitors - a total school population of 132,237. (See Table 3) Among the 125,640 students, 1,02'Z positive cases were found, giving a percentage of 0.817. There were 285 positive cases among the 6,171 teachers or a percentage rate of 4.618, and still a higher tuberculosis incidence among the janitors. Of 4 26 janitors exam ... ined, 39 were discovered suffering from pulmonary tuberculosis or a percentage of 9.154. In other words, the tuberculosis incidence among the students is less than one per cent ( 1 % ) , but the tuberculosis incidence among the teachers is five times that of the students, while among the janitors, it is practically twice as high as among the teachers. This is significant, for it will enable us to trace the source of the infection, as we11 as the potential carriers of the disease. CLINIC OR DISPENSARY CASES During the three years before ·the Japanese occupation of the city of Manilalhat is, from 1939 to 1941 inclusive-a total of 246,437 persons were examined fluoroscopically with a total of 26,487 positive cases or a percentage of 10.7 5. (See Table 4) This relatively high tuberculosis incidence needs explanation. Most of those persons X,Rayed were dispensary cases, and they came to the clinic of their own accord, because they already felt something wrong with their health. A number of them were recommended to be x .. Rayed by physicians who had discovered signs and symptoms of the disease. The X,Ray positives among this group of individuals would naturally be high as compared with our findings in an X,Ray mass survey. During the three years of Japanese occupation of the city of Manila ( 1942 ... 1944), a total of 102,006 persons were examined by X,Ray, with a total of 17,785 positive cases or a percentage of 17.44. (See Table 4b) The following year after the Japanese occupation of the city of Manila, a total of 51,550 indiviquals were examined with 11,258 positive cases or a percentage of 21.84. . (See Table 5) This glaring increase of ·the tuberculosis incidence in the city of Manila during ~he Japanese occupation may be attributed to ( 1) undernourishment or malnutrition, (2) traumatic injury resulting from physical tortures inflicted by the Japanese on a big number of people either at Fort Santiago or elsewhere, ( 3) prolonged exposure to sun and rain and starvation during "zonification ", ( 4) low bodily resistance hrought about by the war with its attendant worries, lack of medical facilities and food, fear, etc., ( 5) poor living conditions, and ( 6) presence of concurrent infections as attacks from malaria, dysentery, and intestinal parasites. After the liberation-that is, during the year 1945-the tuberculosis incidence ought to have come down because of the improved conditions of living and the availability of foodstuffs; but our findings in Table No. 7 point to the contrary.This may be explained by the fact that tuberculosis is a chronic disease, and those who had contracted it during the Japanese occupation had shown great physical resistance to the infection and only developed the disease a year later when their bodily resistance manifested a Hhreakdown ,, due to many causes, among which were overwork, excessive physical ef farts, and abuses of all kinds. TUBERCULOSIS MORTALITY According to Dr. M. C. lcasiano, Manila City Health Officer, tuBerculosis has Vt:tlume XXll Number 4 TUBERCULOSIS-F1·ancisco et al. 147 rated as the number one scourge in the city for the past several yea.rs, causing more deaths to ·the city inhabitants than any other disease. During the three years previous to the war (1938,1940), the average number of deaths from tuberculosis was 2,000 per year. During the Japanese occupation ( 1942 .. 1944), this average rose to 6,000 deaths per year. In 1945, the figure went down somehow, but later-in 1946-ia showed a tendency to go up. With these statistical data on hand on tuberculosis mortality in ·the city of Manila, any competent and impartial observer can readily realize the extent and magnitude of the tuberculosis problem in this country. It is decidedly a public health problem, because of its vast ramifica·tions with various public health problems. The different aspects of the tuberculosis problem - medical, socio,economic, educa, !ional, and moral - make it extremely difficult for any health entity other than the governmental to carry out a balanced' anti .. tuberculosis campaign on a national scale. In fact, in the United States of America, the control and prevention of tuberculosis is the primary concern of the U.S. Public Health Service; and the activities of all the other health organizations dealing with tuberculosis merely sup .. plement those of the Fe~eral Health Service. OBSERVATIONS AND PROBLEMS An analysis of our findings has revealed an exceedingly high incidence of tuber, cu1osis infection and an alarmingly large number of open cases of tuberculosi" There are convincing evidences that tuberculosis in the c:ty of Manila, is becorr.&ng a more and more serious public health menace because of the social and economic factors involved. Our observation and study of the problem according to age,group is significant especially to public health workers, because i·t points out to what particular age,group - the midd}e .. age group - all the efforts in the campaign must be directed if a headway is to be made in the prevention and control of th~ diseas~. ·The follow .. up work among tuberculous pait:ients in their homes has also brought to light certain points which may have important bearings on the practical applica, tion of health rt!les and regulations for ·those afflicted with the disease. This consists mostly of compi1ing epiden1iological data, and giving instructions on the practical methods of disinfection, prevention, and control of the disease. The greatest num, ber of the cases visited were those living in poor and insanitary environments, densely populated, and with little or no sani·tary facilities. As a general rule, all of them belonged to the lower social strata and led what might be called a hand, to .. mouth existence. Many of them could not even stay home for the required rest. they had to go o~t to earn a living. Accustomed to active 'life, they could not accept the fact that they were far from well; and enforced inactivity caused them great mental distress. Let me give a rough p~cture of a family with somebody ill of tuberculosis. In that family, the care of ithe sick is inadequate and preventive measures are not ob, served. Sputum is scattered everywhere. The cloth and the utensils of the sick are inixed with those of the rest of t~e family. Both the sick and the healthy slept in the same room and of ten under the same mosquito net. Medical advice is not heeded. Not infrequently the sick member is the main support of the family. The necessity to provide for himself and his dependents forces him to disregard and 148 TUBERCULOSIS-Francisco et al. Jov. P. M. A. April, 1946 violate all rules and regultions for an ideal treatment. The desire to provide his dependents with food, clothing, and other necessities often leads the breadwinner to sacrifice his own health and well,being---even his life. It is only when he feels sure that the livelihood of his family is secure, or when he can no longer endure his suffering, that he would give up his job. By that time, unfortunately, the disease would be too far advanced to check. The prevention and control of tuberculosis, the necessity for a more extensive and intensive health education campaign, the lack of hospital accommodations for even the open cases (there are less than 1,000 beds altogether available at present for tuberculous patients throughout the Philippines), and the inadequate measures taken in the industrial and food,handling establishments to protect the employees against cases of tuberculosis - these are among the outstanding problems that have to be met and solved if the ravages of ,tubercul6sis in this city are to be curbed. Tuber, culosis in the city of Manila - or anywhere alse in the Philippines, for that matter --cannot be eradicated or even controlled merely by expert medical diagno~ .s and modern treatment. This is not to belittle the curative phase of the campaign "gainst this dreadful disease; it is only one way of stressing that "~an ounce of prevention is worth more than a pound of cure." Preventive measures, for this reason, should be given more importance and financial support than the cure. They are less expensive and decidedly more effective. Above all it must be borne in mind that tuberculosis is a disease requiring social diagnosis and social treatments. From our point of view, uit is the soil and not so much the seed that matters. " To cope adequately with the great and extensive tuberculosis problem in this city, or elsewhere in this country, a long range national plan has ~een prepared which has for its goal the control of tuberculosis within a fixed period of ten years. A condensation of this project into a four,year tuberculosis program to conform with the requirements of the uRehabilitation Legislation'' has been recently effected, retaining it he most important and immediate activities, and doing away with those that are not urgent. The tuberculosis problem in the Philippines ad .. mi~tedly would be too big a task for any health entity other than the Government to ·tackle. And, what is needed more urgently than anything else, is money. REFERENCES 1 . First national congress of tuberculo~is, Manila, Dec. 13, 18, 1926. Proceedings. 2. Francisco, Sixto A. The epidemiological phase of the anti,tuberculosis campaign. Revista filipina oe medicine y farmacia, Nov., 1933. 24:11 3. Francisco, Sixto A. The prevalence of pulmonary tuberculosis among Philippine gov: ernment employees. Revista filipina de medicina y farmacia, Mar., 1938. 29:3 4. Francisco, Sixto A. and Ongpin, Cesar. X,ray mass exami~ation for tuberculosis diagnosis among 59,077 Filipinos. Journal of the Philippine medical association, Feb., 1935. 15:2 S. Philippines. Tuberculosis commission. Report of activities from February 16, 1931 to December 31, 19 3 2. Manila, Bur. of Print., 19 31J Volume XXII Number -& TUBERCULOSIS-Francisco et al. 14!> TABLE 1-Total Number of Fluoroscopic Exani~nation with the Total Number of Positit'e P.T.B. Discovered by X-Ray fr<>HL .1933-1942 Number Province Total Number Total of % of of Examination Positive Cases Positive 1 Al bay 49,009 2,390 4.88 2 Bataan 12,109 671 5.54 3 Batangas 10,508 1,256 11.95 4 Bulacan 8,706 359 4.12 5 Cavite I 8~569 211 2.46 6 Camarines Norte ! 16,306 960 5.89 7 Camarines Sur 43,215 2,005 4.64 8 Davao 9,628 652 6.77 9 Laguna 1.059 24 2.27 10 Manila 509,559 47,448 9.31 11 Negros Occ. 17£\.100 5,055 2.89 12 Negro3 Or. 502 8 1.59 13 Nueva Ecija 10.419 736 7.06 14 Pa1np~nga 3,29:} 69 2.09 15 Pa ng·a~inan 125,072 3,530 2.82 16 Rizal 22.267 762 3.42 17 Sorsogon 6,597 188 2 85 18 Ta ya bas 9,093 307 3.38 19 Zam bales 16,546 1,119 6.76 - Total .............. 1,037~577 67,750 6.53 Incidence of P.T.B. Discove1·ed by X-Ray Arranged Acoording to Jnttnsity of In'(fection I Batangas } 1 Manila 540,114 50,092 9.27 Davao Nueva Ecija Zam bales l Cam. Norte J 2 Bataan 137,185 7,145 5.21 Al bay Cam. Sur . Bulacan 3 Rizal Tayabas ,. . 221,763 6,671 3.01 Negros Occ. Sorsqgon Pan~asinan l 4 Cavite I 3,842 Laguna 138,495 2.77 Pampanga Negros Or. Tot a 1 . . . . . . . . . . . . . . . . . 1,037,557 67,750 6.53 I l I I I I I I ! 1501 TU B"ERCU LOSIS-F1·ancisco et al. ~our-. P .. M. A. April,. 1946 TABLE 2.-Results of 24,00.; X-Ray Ea·a.m..inations I Total No. Classification Negative Positive of Percentage Examinations - - - Technical Employees 348 26 314 6.951 Teachers (Public Schools) 6,991 405 7,396 5.~75 Nurses and Midwives 574 31 605· 5.123 Clerical Employees 9,939 706 10,645 6 632 Policemen and Detectives 1,300 86 1~386 6.204 Sanitary Inspectors 195 14 209 6.698 Soldiers and Trainees 1,447 43 1,490 2.885 Janitors and Helpers 854 76 930 8.172 Laborers (skilled & unskilled) 314 40 254 11.299 Miscellaneous 551 I 65 616 10.551 - TOTAL ........ 22,513 1,492 24,005 I 6.215 TABLE 3.-Prevalence of Tube1·culosis r11ncng Teq.c/ierR, and Students Number of Positive Cases Occupation Exami- Total Percentage nations fvl in iinal · Mod. Adv Far Adv. Students 125,G40 825 137 65 1,027 0.817 .Teachers 6,171 238 36 11 285 4.618 Janitors 426 24 13 2 39 9.154 ' TOTAL .. 132.237 I 1.087 186 78 1,351 1..021 TABLE 4.-Summary of X-Ray Examinations Conducted in the City of 1'1anila fl'Om 19.1.9-.1945 No. of POSITIVE CASES I Ye a r Exam in aMinimal /Mod. Adv. Total Percentage tions Far Adv. Before Japanese I Occupation 1939 102.111 8,789 1,784 261 10,834 10.61 1940 73,135 6,130 2,358 708 9,196 12.57 1941 71,191 3,700 2,147 610 6~457 9.07 Tot al ...... 246,t!37 18,619 6,289 1,579 26,487 10.75 During Japanese Occupation I Hl42 27 ,312 2,G93 1,719 603 4.418 16.18 1943 45,113 3,206 2,739 1.474 7,419 16.45 1944 29,581 2,610 1,960 1,378 5.948 17.44 I -Total ..... 102,006 7.912 6,418 3,455 17,785 17.44 After Japanese I Occupation 194!5 51.550 4.263 ~.918 3,077 11.258 21.84 ' r V cJJume XXll Numbel' 4 TUBERCULOSIS-F1·ancisco e·t a1. 1~1 TABLE 5.-Jncide1lce of P.1'.B. Discove1·Ed by X-Ray (Fluoroscopy) After Liberation of The Philippines fro>n the Japanese by the Anierican Forces (.1945) Su:mmar11 of X-Ray E~ramination~ by 1l1onths (Neu· Cases) Number of POSITIVE CASES I Total No. "k of l\fonth Examina- j of Posi- Positions l\ilinimal l\fod. Adv. Far Adv. tives tives January 627 62 81 69 21~ 33.81 February 495 47 76 56 179 36.lG l\1arch 5,941 345 424 462 . 1,231 20.72 April fl.294 442 45G 412 1,310 24.75 l\iay 5A46 519 502 381 1.402 2S.74 June 5.631 512 443 312 1.267 22.50 July 4,951 475 385 307 1.167 23.57 August 4,862 437 369 266 1,072 2~.05 ' September 4,266 3:)3 325 211 889 20.84 i Octobe~· 4.955 423 289 238 950 19.17 November 4,941 350 313 186 849 1718 December 4.14.t 298 255 177 730 17.63 Total ... 51.550 4.263 -, 3,918 3,077 I 11,258 21.84 Summary nf X-Ra11 Exam.inations l>?J Ane-Group Number POSITIV Age-Group of Examinations Minimal Mo~l. Adv. E Total No lit- of PosiFar Adv. of Positives tives I - -----J 0-9 1,681 ?.36 215 122 57?, 34.09 10-19 5,040 384 318 20-29 14.841 J .208 1.071 265 967 19.19 844 3,123 21.04 30-39 13,600 1~198 1,083 40-49 9.486 703 680 830 3.111 22.88 575 1,958 20.64 50-59 4,904 398 396 60-up 1,998 136 155 322 1,116 22.76 119 410 20.52 Total ... 51,550 4,263 3,918 3.077 1-11,258 21.84 X-Rny Examinations by Scxrs Se x e s Nu in be rl PO~ITIVE Total No. % of Posiof Examinations Minimal Mo~l. Adv. Far Adv. of Positives tive~ Male 28.667 2,169 2.000 1.681 5,850 20.41 Female 22,883 2,094 1,918 1.396 5,408 23.63 Total 51,550 4.263 3.918 3.077 11.258 ·I 21.84 X-Ray Examimation-s by Cit·il Status Number POSITIVE Civil Status of Exami- . Total No. % of Posinations Minimal Mod. Adv. Far Adv~jof Positives t:ves Child 2~274 :321 266 168 755 33.20 I Single 14,482 1,108 926 813 2,847 19.66 Married 27,370 2,123 2,001 1~497 5.621 20.54 Widowed 7,424 711 725 fi99 2,035 27.41 I - Total I I I - .... 51,550 4.263 I 3,918 3,077 11,258 21.84 -· CANCRUM ORIS: OBSERVATIONS ON ITS INCIDENCE AND TREATMENT ALBERTO V. TUPAS,, M.D. and ARTEMIO P. JONGCO, M.D. Department of Pediatrics, College of Medicine, University of ;the Philippine:;. Reports in 1878 .. 1882 1• 2• 3 pointed to a widespread distribution of cancrum oris, also called noma or gangrenous stomatitis, in Europe. Later reports, however, showed it became rare. Y. Durant4, Goebels5, and EcksteinG, agree that the disease 1s now very rare. Cancrum oris is not infrequent in the Philippines. Stransky and Pccache reported7 42 cases in five and one half years (1935 .. 41), an average of 7 .. 8 a year. Albert and Pecache8 collected five cases from December 8, 1941 to May 31, 1943 and twenty .. three from June 1, 1943 to October 31, 1944. The unusual and sudden rise in the frequency of the disease in the latter years of the Japanese occupation in, stantly a·ttracted attention of everyone and was attributed by the authors partly to the outbreak of an epidemic of measles. From the reopening of the Philippine General Hospital on April 4, 1945 until April 5, 1946, a period of one year, we studied and treated 15 cases. In the last seven months of our investigation, however, ·the tendency for the disease to decrease in frequency was very evident. We believe that the high incidence of the disease during the Japanese occupation, especially in its latter years, is largely due to rthe scarcity of food and partly to the poor hygienic and living conditions-factors which are accepted to play a role in the formation of noma. This latter belief seems logical because diseases like ·nutritional ane, mia and edema and chronic ulcers, which are closely related to the above named fac, tors and which were prevalent among the poor and starving classes during ·the Japanese occupation, decreased hand in hand with noma, despite the continued epidemic af measles, as a result of the more abundant food supply and better hygienic and fiving conditions brought by the coming of the Americans. AGE INCIDENCE The disease is no respecter of age. However, most cases were observed in children. The Stransky, Pecache and the Albert, Pecache reports showed the disease to be more frequent after the -first year through the fifth. The age distribution of our cases con, firms this observation (Table 1). TABLE 1-Age lncid.ence Aae Tttpas-.J ongco Stransky-Pecache A.lbert-Pecache Below 1 year 0 2 0 1-2 years 1 10 5 2-3 years 6 11 6 3-4 years 4 8 8 4-5 years 2 6 6 Over 5 years 2 3 3 Adults 0 2 0 Total 15 42 28 154 CA1VCRUIU ORJS-Tupas et al. Jour. P. M. A. April. 1946 Our youngest patient was one and one half years while the oldest was six years. SEX INCIDENCE Mohler, 9 Osler and McCrea 10 reported the disease to be more frequent in ( e1nalcs. On the other hand, Ecketein found it more frequent in males. Stransky ... Pccache and Albert .. Pecache found out that cancrum oris has a tendency to predomi ... nate in fe1nales. Of our 15 cases, 9 are females and 6 male. (Table 2). Females Males Total Eckstein 12 28 40 TABLE 2-Sex Incidence Stransky-Pecache 26 16 42 Albert- Pecache 16 12 28 SEASONAL INCIDENCE Tupas-Joncco 0 v 6 15 Eckstein ,s, Albert's, dlid Pecache 's reports showed a much h:gher incidence of the disease in the la.9t six months than the first six months of the year (Table 3). A} ... though lack of food; measles; poor oral, personal, and general hygiene; and fatiguef actors known to predispose the individual to the format!on of noma-may explain the unusually high frequency of the di~ease during the Japanese occupation, yet we can .. not see whv it should be frequent in the last six months of the year. Stransky"s and Pecache \; report as well as ours showed practically an equal distribution of the cases in the two halves of the year. TABLE 3-Seasonal Incidence Eckstein St>·ansky Albert Tu pas Month (A nka ,.a ) Pecache Pecache Jongco (Jl/ c.uiila) (Atlanila) (llf anila) January 2 3 1 2 February 2 3 0 2 March 1 4 0 0 April 1 3 1 1 May 1 4 2 1 June 2 3 1 2 Sub-Tutal 9 20 5 3 July 3 5 4 5 Auo·ust 9 2 5 0 .... 2 September 5 4 7 October 6 5 4 0 November 5 3 1 0 December 3 3 2 0 Sub-Total 31 22 23 7 Grand Total 40 42 28 15 No specific organism has been found to cause the di~ase, although many11 believe that it is caused by Vincent's fusiform bacillus and spirochetes. It is known, however, that noma is a contagious diseei~e and -that it affects those with run .. down general condition. It usually develops after other infectious diseases, most frequently measlest2 and ileocolitis. It is also frequently observed in poor individ11als Y•ith poor oral and personal hygiene. The parts affected are usually the sites of previous local diseases. Volume XXII Number 4 CAl·lCRUM ORIS-Tupas et al. 155 The diseases with which our fifteen cases are associated are sho\vn in the follow, ing table. TABLE 4-Diseases associated with N unia Etiologic Diseases Ileocolitis Measles with Bronchopneumonia Tuberculosis Ileocolitis and Malaria Males 1 3 2 1 7 SYMPTOMATOLOGY Females 5 3 0 0 8 In -the cases we studied, the constitutional symptoms of the disease were modified by the nature, location, and severity of the primary infection and by the patient's ca, pacity to react. A few showed high fever, many low or modera·td, and some none at all. Dullness, apathy, weak, rapid pulse, muscular relaxation, and often diarrhea were observed. In almost all our cases, the foul offensive odor of the breath was the first to a·ttract attention; very rarely, the dusky spot on the cheek or lip. All our patients were undernourished due to the presence of a chronic and wasting primary disease. The majority of them manifested vitamin deficiency in the form of xerophthalmia, keratomalacia, and angular stomatitis. Besides ·these manifestations, three cases showed only slight or no swelling of the part affected, with very little necrosis in the gum or cheek. In 12 cases, the gum or inner side of the cheek or lip revealed dark, greenish, black, necrotic masses, sur .. rounded by swollen, edematous tissues, so that the cheek or lips, as the case might be, was two to three times thicker than its normal s:ze. The S\velling, which always ex, tended way beyond the gangrenous part, was easily noticed outside and appeared tense and brawny. As .the disease progressed, the teeth loosened and fell out. In two of our patients, the necrosis involved the alveolar processes with perfora·tion of the cheek. Extensive sloughing and ulceration of the face ( l 1h inches in diameter) was observed in three patie1\ts, resulting in ·their horrible, unsightly appearance. Pain was seldom complained of and was not severe. Profuse hemorrhage was never observed. MORTALITY All previous reports on cancrum oris gave a very high mortality rate. In the earlier reports, the mortaHty was as high as 95 to 100 per cent. Later reports by V. Bruns and Dl!.rant gave a fa·tality of 70 to 75 per cent. R. Va!enzuela13 report, ed only six recoveries out of his thirty,six cases. Stransky and Pecache gave a dea:th rate of 88%. Albert and Pecache estimated their deaths at 83 to 85%. All these reports clearly point to the malignant nature of the disease. Out of our 15 cases, only two died, a mortality of 13. 3 3 9o. One of our deaths was a patient who was brought in a very critical state and died a few hours after admission in the hospi·tal, so that the drugs given had no time to act. The other death was in a patient who suffered from protracted ileocolitis with xerophthalmia, cachexia, and terminal bronchopneumonia; but the pa·tient died after the local lesion, noma, in the mouth had practically healed. From the standpoint of noma alone, the second case should be included with improved cases, thus bringing down our death ra·tc to 156 CA.VCRUM ORIS-Tupas et al. Jour. P. M. A. April, 1946 6.67%. With earlier treatments of noma cases, we would net be surprised if the mortality of this disease would, some day, be even lower than 6%. Why is our mortaHty rate very low? We will refrain from answering this ques, tion categorically because of the few cases we have had so far, although we are constrained to believe that the modern therapeutic agents, perhaps not entirely, con, tributed materially in bringing about the high percentage of cure. TREATMENT As in any other condition, the best ·treatment is to prevent the disease. Cancrum oris should be prevented by prompt and thorough treatment of all buccal infections and by paying particular attention to the mouth in acute infections. Irrigating the: mouth with an oxidizing agent like dilute potassium permanganate or some antiseptic solution whenever any form of stomatitis is present may help in preventing the disease. When noma is already present, earlier inves·tigators advised complete excision of the gangrenous area under local anesthesia \vithout delay. The excision should be done beyond the area of visible involvement and the margin of the apparently healthy tissue should be. cauterized wi·th concentrated nitric acid. As has been stated above, the mortality rate \vas very high despite the early surgical treatment. In 1943 R. Valenzuela 13 reported that local application of sulfathiazole gave a better ef feet than any other method he had ever used 1n the treatment of noma. With the coming of chemotherapeutic agents like the sulfa drugs and penicillin, we have surprisingly reduced the fatality rate to a little less than 7%. The result of our treatments undoubtedly indicates that the medical care of cancrum oris is not only hctter than the surgical one but is also the best treatment of the condition at present. Incidentally we may state the reason why \Ve used the sulfa drugs and penicillin 14 in the trea~ment of noma even before \Ve had read the Valenzuela report. It is because these drugs have not only proved ·to be effective in the treatment of the primary disease associated with cancrum oris, but they have also been found to be effective against the fusiform bacilli and spirochetes16. Like the other workers, we almost invariably gave antiseptic gargles, mos·t often dilute potassium permanganate solut:on, especially among those with fetid, offensive odor of the brea·th. The mouth was first cleansed with an antiseptic solution, usually dilute potassium permanganate; and the sulfanilamide, sulfathiazole, or sulfad7azine powder \vas applied locally to the lesions in almost all cases. In addition, eight pa, ·tients received either sulfathiazole or sulf adiazine by mouth at a dose of 15, 2 5 centi, grams per kilo body weight per twenty,four hours. The two deaths were with this group, although I have already stated ·that one death should properly be included with improved cases. The remaining seven ctlses were given sulfathiazole or sulfadiazine by mouth and penicillin intramuscularly. These seven patients recovered. We varied the dose of penicillin from 100,000 to 250,000 uni·ts daily depending upon the freshness of the drug obtained and the age of the patient. In general, we gave a dose much bigger than the one usually advised in the different literature. The nourishment of all the patients was carefully taken care of either through the mouth or parenterally. Stimulants and other symptomatic treatments were also given as necessity arose. All noma cases were isolated to prevent contamination of other patients. The improvements we observed during the treatment were immediate. In from Volum~ XXII Num~r 4 CANCRUM ORIS-Tupas et al. 157 24 to 72 hours, the foul, offensive breath, the swelling and edema of the affected part subsided considerably, if not entirely. The rapidly progressing gangrene was arrested and became well demarcated from the healthy tissue. In the cases with sloughing and ulceration, granulation and cicatrixat~on took place very slowly with resulting horrible disfigurement of the face. These improvements were soon follo\ved by gain in flesh and weight. CONCLUSIONS 1. Fifteen cases of cancrum oris admitted and treated in the Pediatrics Depart, ment of the Philippine General Hospital from April 4, 1945 to April 5, 1946 were presented. 2. The incidence of noma in the Philippines, before, during, and after the second world war was discussed. 3. A reduction of the mortality rate from 70%--100 7o to 6.67% with the use of sulfa drugs and penicillin was reported. 4. Other reports on the incidence, mortality, and treatment of cancrum oris were briefly reviewed and compared with our findings. REFERENCES 1. Bohn: Gerhardt'~ H~mdbook of Pediatrics, IV; part 2, Tubigen, 1880 2. Bruns, von: Handhuch der praktischan Chirurgil .. , II Abt. Vol. I, Tubigcn, 1859 3. Tourdes: Du noma ou du sphacele de la bouch~ des cnfants, Di~scrt, Strassburg, 1848. 4. Durant: Brennemann 's Practice of Pediatrics, Vol. 3, Hagerstown, Maryland, 193 7. 5. Goebels: Dagwitz and Eck~t~in ·s Lahrbuch dcr Kindelheilkunde, Leipzig, 193 3. 6. Eckstein: Noma, American Jour. Dis. of Children. 59: 219, 1940. 7. 8transky. Ci Pecache: Noma in the Philippines, Journal Phil. Med. Assoc. XII: 501,7, Oct., 1941. 8. Albert fi Pecache: Cancrum Oris, Study of the cases admitted in the Philippine General Hospital from Dec. 8, 1941 to Nov. l, 1944. (Not yet published). 9. Mohler: Osler·s Modern Medicine edited by McCrea, Philadelphia and New York, IV: 256, 1925. 10. Osler and McCrea: The Principles and Practice of Medicine~ 9th ed. New York and London, 1920, page 450. 11. Holt & McKintosh: Diseases of Infancy and Childhood, 10th ed. 1933, D. Appi~ton Century Co. page 359. 12. Mitchell & Griffith: Textbook of Pediatrics, 2nd ed. 1938, W. B. Saunders Ci Co. page 501. 13. Valenzuela, R. H.: Rev. Mexicana Pediatrica, 1943, Aug. 10, Vol. 13, No. 8, '.HQ, 16 (Published' also by J. F. Corson in the Tropical Diseases Bulletin, Dec. 1944.) 14. Herrel, \V. Nis_hoJs, D. fJ Heilman, D.: Jour. Amer. :tvfed. Assoc. 125:1003·1J, April 12, 1944. 13. Frazier, Chester fJ Frieder, E: Jour. Amer. Assoc. 130: 677, March 16, 1946. PRACTICAL CONSIDERATIONS IN REFRACTION FELISA NICOLAS,fERNANDO, M.D. Department of Eye, Ear, Nose, at!d Throat, North General H~:>spital. Burea!4 of Health. To anyone who has practised ophthalmology, the high incidence of refractive errors is well known. This is because people in all walks of life and of ·an ages strain their eyes through excessive indulgence in near work, especially in reading, ei·ther for necessi·ty or for pleasure. Pre,school tots who become engrossed in comic strips even before they learn their alphabet, children in the grades, youngsters in the high school. young men and women in colleges and universities, young professionals, clerks, bank tellers, printers-especially type,setters--all these subject their eyes to undue strain during ·their waking hours. It is not surprising, therefore, that, whereas 30 or 35 years ago only myopcs and presbyopes wore glasses and there was only one or t\vo optical stores in the city, no\\' people wear glasses for all kinds of ametropic conditions and no less ·than 30 or 40 optical stores are doing good business. Neither should it be strange that 7 5 l/C or S07o of eye cases in private practice are cases of errors of refraction. An authori·ty has aptly remarked that refraction is the mainstay of the ophthal, n1ologist. For one thing, the number of cases of errors of refraction is always large. For another, as the practitioner gets older, he finds in the surgical field less and less attraction; whereas in the field of refraction his accumulated '\vcalth of experience can be put to greater and more valuable use. The object in presenting this paper is to pass on to those who are starting in practice what observations we have found practical and helpful in our rcf raction work during the last 2 5 years of private practice and 12 years ( 1929 ... 1941) in the U niver, sity of the Philippines Infirmary. About 7 5 to 80 % of all eye cases in private practice arc cases of refraction, and in the U. P. Infirmary ithe relative frequency of these cases is even higher. Out of the average yearly enrollment of 5000 students in the Manila colleges alone, from 1929,41, 10 % were found wearing glasses for the correction of ametropia. Actually this figure is much lower; for many of those who were supposed to wear correcting lenses, especially cunong the girls did not do so because of ... looks'", \vhile others \vhose eyes had not yet been put to the test of college work, were not aware that there was something wrong with their eyes. In the University of the Philippines· before the war, it was not uncommon to have from 10 ... 15 cases of refraction a day, especially during the latter part of the semester or one or two weeks before the final exam, inations. With cases coming at this rate and especially with the ordinary n1c~hods then employed, we feared tha·t someho\v the examinations might not be accurate. In 1939, fortunately, the Infirmary acquired a Green's Refractor, which because of its mechanical efficiency the examinations could be done with speed and accuracy. Looking over our records for the la.st eleven months (all other previous records were burned) the cases of refraction that have come up for correction fall into two main 160 REFRACTION-Nicolas-Fernando Jour. P. M. A. April, 1946 groups-those found in the young (below the presbyopic age) and ·those found in presbyopes. Out of 5 54 eyes examined, there were: Group 1-In the Young 1. Hyperopia simple .............................. ~ ........... . 2. Myopia, simple ............................ . :3. Hyperopic Astiginatism ..................... : : : : : : : : : : : : : : : : 4. Compound l\ilyopic Astigmatism ............................. . 5 M . A . . . yop1c st1gmat1sm ....................................... . 6. Comp. Hyperopic Astigmatism ............................. . Group 11-In Presl>yopes 1. Presbyopia with Hyperopia, simple ..•........................ 2. Presbyopia with Myopia ..................................... . 3. Presbyopia with Hyperopic Astigmatism ...................... . 4. Presbyop.ia with Myo2ic .Astigmatism ........................ . 5. Presbyopia with Comp. Hyperopic Astigmatism ................ . 6. Presbyopia \vi th Myopic ), stigmati~m ........................ . 7. P1·esbyopia alone ........................................... . 16.3 ·% 9.3 o/o 8.1 % 6.9 % 3.6 % 2.25% 21.8% 6.7% 5.0% 4.6% 4.0 '/(i 1.6% 9.1% These figures sho\v that the great majority of the cases of ref racticn tha·t come to the ophthalmologist are not 1he simple ones. the correction of which of fer no prohlcm like simple myopia or presbyopia. They arc rather the cases that are at, tended by symptoms of strain, ocular or nervous, that make reading or any other form of near work not only uncomfortable hut also many times distinctly painful and ex' hausting. Among these are those ref erred by the internists or general practitioners oto whom the patients have gone for medical advice and treatment because of symptoms like headache, di:ziness, nausea, vomiting, ga~itiic disorders, etc., the underlying cause of which \Vere suspected to be of ocular origin. In both groups we find that hyperopia tops the lists of errors. It is clear, there, fore, that much of rthe work of the ophthalmologist consists not only in correcting the manifest errors, simple or associated with astigmatism, but ah:o and mostly in un, Lovering the latent amount if the~c cases are to be satisfactorily managed. As every, body kno\vs, this is done by fogging and by the use of cycloplegics. There are no hard and fast rules as to \vhen to u~e one or th_e other. Each has its O\vn advantages and disadvantelges. While with fogging we do away \vith the ohjectionable paralysis of accommodation, not all cases lend \vcll ito fogging and in the young with strong accommodative power we prefer to use a cycloplegic. Although some authorities claim to be able to uncover even a greater amount of latent hyperopia by this method than by the use of cycloplegics (and we have had occasion to confirm this observation in some of our cases) still we seem to feel a greater sense of reliability in our results when a good and efficient cycloplegic is used especially in individuals below 18. The long,lasting effect of a·tropin on accom, modation is with rea~on objected to by many of the patients--students, professionals, and employees-who depend on near work in their daily living. From 1939 to 1941 in our refraction \vork at the lJ P. Infirmary we used homatropin hydrobromide 5 % solution in combina·tion with paredrine hydrochloride 1 '70 ophthalmic. With this, refraction can be effected in about an hour, and the effect pas.5es off in about 48 hours at most. These distinct advantages over atropine has made this combination our cycloplegic of choice. Shortly after the outbreak of the war, however, our supply of paredrine was exhausted and we had to revert to atropin cycloplegia. The paredrine was ordered directly from the manufacturers, Smith, Kline and French laboratories of Philadelphia. Volume XXII Number .& REFRACT 10;.V-N icolas-Ferna-ndo 16] As a general rule we use both methods to relax accommodation, fogging, and cyloplegia. Among the young,. we almost always use cycloplegia; while among the older patients we depend more on fogging, except in cases where there are reasons to believe that there is spasm of accommodation so tha•t the manifest error is not the real ametropic condrtion of the eye. A patient 37 years old came to us~ after having been given a -.50 ax 180° to correct ·what appeared to be a manifest error, because of unrelieved headache an<l dizziness. She would not fog satisfactorily. Actually she accepted the correction she ~as using. Refraction under cycloplegia revealed an error correctible with +. 7 5 ax 90°, and after the use of ·the latter she no longer compla:ned of headache. Low myopic errors, spherical or cylindrical or sphero,cylindrical, attended with discomfort or headache on use of the eyes. for near, should make one suspicious; and no prescription for glasses should be given until an exam:nation has been made under a cycloplegic. Whether we use atropin or homatropin wi·th paredrine, we adhere strictly to the recommended method of instilling cyclopleg:a to in!ure maximum absorP'tion of the drug-i.e., to drop the solution on a horizontal cornea by ·tilting the head way back and instructing the patient to direct his gaze downwards so tha•t as much as possible of the limbus is bathed in the solution. The lids are held open by 1:he index finger and thumb for about 30 to 40 seconds to give time for the drug to be absorbed; other, wise, if the lids are allowed ·to close as soon as the solution is dropped, it will be squeezed out and then we will be wondering later why the accommodation has not been relaxed in spite of the drug. One point to remember when ref ract:ng under a cycloplegic is to find out whether the accomn1odation has been fully and completely paralyzed before refracting; or, ho\v much residual accommodation was still left. This is roughly tes~ed by asking the patient whether she can no longer read the J # 1 a·t. the ordinary reading dis, tance-in which case we presume that the occommodation· is already fully paralyzed and the patient ready for refraction. With this procedure, we can not be sure that the result of the refraction obtained is the true measure of the total amount of hypero, pia; for, if there has been a considerable amount of residual accommo~ation left. our deductions later in prescribing the correction to be worn will not be correct. For example, a young individual-say, about 20 years old-complains of head· ache, blurring _of the types when re.1d~ng even for a short time, etc., has vision of 20/20 and J #1. We try fogg·ng and the most that can be uncovered is .50 or .?SD. We are convinced, however, tha·t an error of this amount would hardly give rise to such symptoms as the patient complains of, especially when the indiv.dual is young and appan:_ntly in good health. Refraction is then done under a cycloplegic. But even if the vision were 20/20 and the patient could no longer read J # 1, it would not yet be quite accurate to conclude that there is no error. For ·the accommo, tion might have been incompletely relaxed; i.e.. not enough ·to see J # 1 at 3 3 1 /3 cm. but enough to see 20/20. If he can do this with + 1. or + 1.50 then we know that 2.D or 1.50 D of accommodation is still active. Another point which we have ob~erved is that low errors which would otherwise remain latent or comfortably overcome in young and healthy individuals may become manife&t or may give rise to symptoms of ocular strain under ~uch con, ditions as overwork, physical exhaustion, convalescence, or lowered bodily resistance due to foci of infection. We should have this in mind before prescribing glasse! so 162 REFRACTION-Nicolas-Fernando Jour. P. M. A. April, 1946 as to avoid burdening the patient with an unnecessary expense and subjecting him to an equally unnecessary discomfort of wearing a correction that is practically useless. Hyperopes do not usually accept their correction as readily as the myopes and they would insist that they can see better without the glasses than with them. It is our routine practice to anticipate this of the patients and explain to them that they have to wear the correcting lenses if they expect to be relieved of their headache., ocular pain, and other symptoms which are the direct results of the strain entailed by the use of the eyes in the presence of an uncorrected error of refraction. After all, in these cases of hyperopia with or without astigmatism, the glasses should be considered more as a therapeutic than as a visual measure. Not infrequently these patients, after the initial relief consequent to the use of the hyperopic correction, feel that their eyes are again normal and strong, and so gradually forget to wear the glasses and eventually discard them altogether. After a few months they come back complaining that their glasses no longer fit them. They are again bothered, (regardless as to whether or not they wear their gla~es) by headaches and by the other symptoms they used to have. Our procedure is to put them again under a cycloplegic and advise them to wear their glasses constantly. In the correction of supposedly myopic errors (simple or associated with astig .. matism) in young or older individuals, especially when the amount of error is low and symptoms of strain are present, we invariably do a cycloplegic refraction; for, at times, errors for which the patients accept minus sphere or cylinder, tum out to be hyperopic when the accommodation is relaxed. Illustrative cases: Case 1,-B.L., 14 years old, single. Complain~ of dizziness and headache. 0.D. 20/25 - 4. with - .50 ax 180° 20/20 0.S. = 20/25 - 3. with - .SO ax 180° = 20/20 Under atropin cycloplegia O.D. 20/40 with + .75 ax 90° 0.S. = 20/40 with + .75 ax 90° Post cycloplegic ref rac·tion0.D. + .5.0 ax 90° O.S. + .50 ax 90° 20/20 20/20 Case 2 .-E. V ., 3 5 years old, single. Came because of headache and dizziness. Has glasses prescribed by an optician. O.D. -.50 ax 180° = 20/20 0.S. = 20/20 Fogging unsatisfactory. Refraction under atropin: O.D. 20/.70 with + LOO ax 90° 0.S. = 20/50 with + 1.00 ax 90° Post.-cycloplegic ref rac-tion0.D. + .75 ax 90° 0.S. + .50 ax 90° 20/20 20/20 Before leaving this subject of refraction among the young, I should like to point ouit that those with moderately high myopia, especially when associated with astig, matism-those who have not been wearing their correction or who will be using their Vo:\:me XXII Number 4 REFRACT ION-Nicolas-Fernando 163 correction for the first time or who have been wearing an insufficient correction for a long time-generally cannot have their vision corrected beyond 20/30 or 20/ 40 (ametropic amblyopia); but, after the administration of a series of strychnine or thiamin injection, their visual acuity is improved and the correction could be brought down ·to 20/20 and we give the prescription for the glasses then. We have had several illustrative cases of this condition: Case 3.-A.L., 24 years old, med:cal student. Lost her glasses during the liberation. O.D. = 20/200 with - 2.50 = 20/40 0.S. = 20/200 with - 3.50 = 20/30 Thiamin chloride 25 mgms. daily for 10 days. After the administration of thiamin O.D. 20/200 with - 2.50 - .75 ax 180° O.S. = 20/200 with - 3.50 - .50 ax 180° 20/10 20/20 Case 4.-V.C ., 22 years old, Senior student Nu(se, North General Hospital. Ha9 been wearing glasses since 8 years ago. O.D. with her glasses on 3.50 20/200 O.S. with her glasses on 3.50 20/200 Refraction : O.D. 6.00 .75 ax 180° 20/25 O.S. - 6.00 - .75 ax 180° 20/25 Refraction after administration of strychnine O.D. with - 5.50 - .50 ax 180° 20/20 O.S. with - 5.50 - .50 ax 180° = 20/20 Case 5.-C.}., 18 years old student, Pagsanjan, Laguna O.D. = with glasses worn - 5.50 = 20/100) She has been wearing O.S. = with glasses \vorn - 5.50 == 20/ 70) this correction for the last 7 years. Refraction: O.D. with - 7 .00 - 2.50 ax 90° O.S. with - 6.00 = 20/ 40 20/40 Was given a series of 10 injections of strychnine sulphate and another refraction done afterwards with the following results: O.D. -- 8.00 - 1.25 ax 165° = 20/20 O.S. - 6.00 - 1 . .50 ax 45 ° = 20/20 The real work of the refractionist has to do with those who are nearing the pres, byopic age and not aware of an error of refraction which they could. have overcome previously, begin to have the most annoying symptoms, general or ocular, on doing their accustomed near,work. For example, a patient who used to be able to do any amount of near,work comfortably during his younger years, would a1 about the age of 37 or 38 begin to suffer from dizziness, headaches, and at times even nausea accompanied by cold clammy perspiration. This latter symptom is induced by a fear that· they may be suffering from some serious ailment like hypertension and that an 164 REFRACTION-Nicolas-Fernando Joor. P. M. A. April, U)46 attack of unconsciousne.ss might even be impending. This is especially true of those with a nervous or easily excitable temperament. When the hyperopia, with or without astigmat ·sm, is manifest; or when it be ... comes manifest by fogging, the patient generally accepts the glasses uncomplainingly. However, those in whom the hyperop~a remains latent so that vision registers 20/20 or even 20/ 15, but in whom the near correction varies from what should be expected according ·to the age of the patient, are bound to have trouble if the lenses prescribed are just piano for distance and uncorrespondingly high for near vision. In these cases, we take time and patience to· do fogging or refraction under cycloplegia; and not infrequently \Ve are able to uncover a considerable amount of hyperopia, alon~ or w:1h astigmatism. An illustrative case is that of a patient 49 years old who, in spite of the glasses given her by an optician, suffered from headaches every time she used the glasses for reading even for short periods. Her glasses were plane for distance but the near correction was +2.75 sp. \\:'ithout glasses this patient could see 20/20 and ~ven 20/15 but after fogging she accepted a + 1.00 and + 1.25 sp. for distance. As her accommodation was evidently strong, we just prescribed + . 7 5 and + 1.00 for distance and reduced her near correction to + 1. 7 5. Nor are the hyperopes the only ones that have trouble as they approach the presbyop~c age. Myopes, especially ·those with astigmatism, who have worn their corrections constantly, are apt to be bothered by dizziness on doing near work when they pass 40. As these patients have been able to see well with their glasses both far and near until then, they are not aware that other changes have taken place in their eyes, making it impossible for their distant correction to be worn unchanged for near work any longer. A physician 41 years old who had been wearing a minus sphero ... cylindrical combination for distance, began to be bothered by severe d.zziness. Thinking that his glasses needed a change, he had these checked; and a slight change was made in the cylinder. However, even with this, the dizziness continued. The trouble proved to be ·that, although this patient was 41 years old, no provision had been made for the presbyopic change. Just because he had been able to see J No. 1 at first glance, he had not been aware of the change. In correcting presbyopia, it is preferable to undercorrect, especially when the correction is to be worn for the first time. Too often, the tendency is to give as much as the patient would accept, and the result is overcorrection. These many pa .. tients can not ·tolerate when first they begin to use the correction. Cases of anison1etropia, especially when one eye is myopic· and the other hypero ... pie or normal, come late for their p·resbyopic correction because one eye can compen ... ~ate for the other so that vision is apparently just as good for distance as for near, although 1:hey have lost single binocular vision. ·Lastly. before we give out a prescription for glasses, we always check one exam, ination with a subsequent one; and, in case we use cycloplegia, the results of at lea.st three examinations are taken into consideration together with the near point of accom .. modation. A MODIFIED FIELD STAIN FOR RAPID STAINING OF TH]CK.AND THIN BLOOD SMEARS1 T. P. PESIGAN, M.D. and E. Y. GARCIA, M.D.2 Department of Parasitology, Institute of Hygiene, University of 1the Philippines INTRODUCTION The sudden outbreak of the war in ·the Pacific between Japan and the United States on Pecember 7, . .1941, took us by surprise. We found ourselves without a sufficient stock of materials, especially stains for malaria; and, because communica .. tions were cut off, orders from abroad could not come. Malaria smears that had to be examined in our laboratory increased tremendously even while the Bataan campaign ·was still raging, because of the great number of civilian refugees returning from evacuation centers, when Bataan surrendered and thousands of prisoners of war almost all sick with malaria were released, we were faced with an unprecedented shortage of staining materials for malarial parasites. By the middle of April, 194 2, our stock of Wright and Giemsa stain had almost completely disappeared. At the same time, all our attempts to replenish our supp!y from any possible source proved in vain. We were therefore, forced to evolve a substitute stain from whatever materials we had on hand, in order not to paralyze the work in the Department. Our efforts resuloted in the discovery of the stain, which is the subject of this report. From the very beginning, we had the following aims in mind: ( 1) to eliminate methyl alcohol. if and whenever possible, bec.ause of its scarcity at the time; (2) to shorten the staining process without sacrificing clarity of blood picture, a parti .. cularly important consideration jn handling a large number of smears at one time; ( 3) to make the technic less delicate; and ( 4) to devise a means whereby a rigid economy in the use of the stain could be attained. With all these objectives, we began making different mixtures of stains out of whatever materials we had on hand, then modifying them, trying one vehicle after another, and finally testing different mixtures in varying proportions with different timing. The literature on different blood stains already used in the past helped us a lot in solving our problem. Thus. from the monochromatic stain of Manson, we were able 1:0 pick the borax solution which we found· to be the most suitable vehicle for an aqueous stain. eliminating at the same time the methyl alcohol as we had intended. We also noted that even if the Manson stain, was diluted to 1 :10 or even to 1 :20. malarial parasites in thin smears could be stained in only 5 to 10 sec .. onds. We later discovered that this speed of staining malaria p~rasites had also been attained successfully by Field ( 1940. 1941) but only in thick smears by means of aqueous mixtures with isotonic buffer solution as vehicle. With 2.5% borax solution i Read at the 39th Annual Convention of the Philippine Medical Association, Manila, May 7,11, 1946. 2 Dr. E. Y. Garcia resigntd on October 1 S, 1944 and is ~o longer with the Institute of Hygiene. 166 MODIFIED FIELD ST AIN-Pesigan et al. Jour. P. M. A. April, 1946 as vehicle, ho\\·cver, we tried to prepare a new mixture, which may be considered as a modification of Field stain; and we found that we could stain beautifully malarial parasites not only in thick but also in thin smears. Thus, after a considerable time spent in preliminary trials, we· adopted tentatively the formula of our mixture, which we later subjected to continuous testing, varying the timing of staining evecy now and then from 5 to 15 se.conds to find out the most appropriate time that would produce the most vivid picture of the cellular elements of the blood and of the malarial parasites. After several weeks of con.stant and critical trial, we noted that the staining quality of the· stain improved gradually as the stain was ripened. As a result. we no. longer felt the shortage of Wright and Giemsa stains. About· the middle of August, 194 2 we decided to adopt the present formula; and, ithroughout the Japanese occupation, we used this stain satisfactorily in our routine diagnosis. and even in class work, for both thick and thin films. COMPOSITION AND PREPARATION OF THE STAIN There are three separate solutions in this stain when used for fresh thin films: blood I. Methyl alcohol.-Absolute or 9 5 % for fixation. (Old thin smears and thick blood films do not need fixation, so methyl alcohol can be dispensed with; but this can not be done with fresh thin smears. II. Basic stain Brilliant cresyl blue .......................... . fuure II .· .................................. . 0.35 Gm. 0.50 Gm. Borax solution 2·.s 7o .......................... , 100.00 cc. III. Acid counter.-stain Eosine.-Y (Water soluble) .................... . 0.20 Gm .. Distilled water . . . . . . . . . . . . . . . ..... . . . . . . . . . . . . . . 100.00 cc. The basic stain is best prepared by heating 100 cc. of distilled water in a flask. When near boiling. 2. 5 grams of borax powder is added. Borax powder disrolves faster in hot water. To this solution 0.35 gm. of brilliant cresyl blue, first ground in a mortar. and 0.50 gm. of Azure II are added and shaken very well. ·The flask is plugged with cotton and the mixture filtered after being allowed to. stand 24 hours. The stain is ready for use, but better results are obtained if it is . allowed to ripen for a week or more. It may not be necessary to re,filter the solution until several weeks later. It will maintain its good staining quality for many months more. The counter.-stain is more easily prepared by simply adding 0.20 gm. of eosine.-Y (water soluble) powder to 100 cc. of distilled water in a flas~, shaking the solution and filtering it. This solution is at once ready for use. It is . advisable, how.ever, to have a 1 % eosine solution kept in stock from which to prepare a 0.2 % solution by mere dilution. This stock solution can remain good for an indefinite length of time. To effect rigid economy in the use of the stain, a very important consideration during the Japanese occupation, we found it best to place the solutions in Coplin jars with cover~ using the same solutions over and over again. A very fine layer of metallic scum may form on the ·surface of the · basic stains· especially when left unused in the. Coplin jar for some time, but this ~ay easily be re~oved by scooping the surface with the edge of a slide. Although no scum forms on the surface of the Volume XXII Num'kr 4 MODIFIED FIELD STAIN-Pesig_an_ et· al. 167 counter .. stain, this solution when constantly used lasts for a shorter time. This is due to the constant admixture of small amqunts of the basic stain· carried over by the slide in the staining process. TECHNIC OF STAINING Thick and thin smears may be prepared together on one slide by the simple and ordinary conventional procedure; taking all the usual precautions as to clean, liness of the slide; sterilization of the finger and prickling needle; rapid smearing before coagulation begins; p~otection from dust; rapid drying of the film with the aid of an electric fan, a lighted bulb, or sunshine. It is ideal for the cthin smear to be as thin as possible to a void overflapping of the red blood cells, and for the thick smear to be not more than 50 micra in thickness1 spread evenly with the aid of one corner of another slide in a circular area about 5 .. 7 mm. in. diameter. Technic for staining fresh thin smears alone: 1. Dip in methyl alcohol for a second . and wash in running water. 2. Dip in the basic stain for 6 seconds or just count 15 with moderate speed and then wash in running water. 3. Dip in the counter .. stain for 4 ieconds or count 10 with the same speed and wash in running water. 4. Dry in air by placing vertically in a rack and examine under oil im, mers1on. Technic for thick smears and old thin films: The same procedure i~ foil owed as above, but fixation with methyl alcohol (or step No. 1 a~ove) after dehemoglobinization is omitted. This can be done simply with tap water. When partial dehemoglobinization of the thicker por .. tion of any thin smear is desired, it may be dipped directly into the basic stain and then washed in running water for a litrle while. But it should not be held under the tap too long; otherwise, all the hemoglobin and the stain may be washed off. Old thin films are best treated this way and then counter .. stained. When thin and thick smears are togcthe.r in one slide, the thin ~mear is first fixed in methyl alcohol and then passed into another Coplin jar full of water, immersing the whole slide ·to dehemoglobinize the thick smear while at the same time washing the thin smear. The .re.st of the procedure is the same as that described above. Under ideal conditions, if the technic above described is followed., the cellular elements of the blood and many haemoprotozoan parasites are very vividly stained and sharply dif fei;.entiated.. By this technic of dipping the smears in the stain placed in Coplin jars, we do not only economize on the stain and avoid the appearance of precipitates on the slide; we also obviate the danger of making a mistake of staining the wrong face of the slide. This happens sometimes when the ordinary method of pouring the stain over the smear is employed as in Wright or Giemsa. staining. This aqueous stain has an added advantage. Used siides are easier to clean, because the slides themselves are never stained, as when the Giemsa or the Wright stain is used. There are, of course, various difficulties to be encountered; but these may be overcome through experience in the use of the stain, especially in timing. Corrections may be made by destaining or decolorizing the stain with alcohol, wash, ing with running water, and restaining it. 168 MODIFIED FIELD STAIN-PeBigan et al. COMMENTS Jour. P. M. A. April, 1946 Like other blood stains evolved in the past and now a vallable under various names , our stain is polychromatic. It is based on the well,known principle of Romariowsky, who in 1891 first combined eosine and methylene blue to produce a mixture that exhibits great selective staining ·properties especially· for malarial parasites. Although the true chemistry of the mixture was not known recently, 'Romanowsky soon reahzed that the mixture of the two dyes he had produced did not merely stain the nucJei of the parasite red and the cytoplasm blue, but also that this selective staining quality of the mixture grew with age. After Romanowsky, other investigators tried to produce other blood stains; but they could not depart very far from the original Romanowsky stain-the eosine,methy, lene blue combination. As a matter of fact, Conn, in a review of the different biological stains ( 192 5), stated that almost all present,da y blood stains are simply modifications of the Romanowsky formula. Notable among ·these are those of Jenner (1899), Leishman (1901). Wright (1902), Giemsa (1904), and McNeal (1922, 1925). These stains, which are known in the market by the names of their originators, are aill based on the Romanowsky principle. They differ. ·only in the manner of pre, paring the eosine,methylene blue mixture or compound. Thus, for in!tance, Jenner produced, in 1899, eosine,methylene blue by mixing equal parts of 1 % untreated or unpolychrome methylene blue and 1.2 % eosine. To Jenner, it must be remembered, belongs the honor of being the first to make use of the precipitated compound stain formed from the mixture which he later dissolved in methyl alcohol. This stain, however, lacked the nuclear staining principle or the true ~·Romanowsky effecf' due to the quality of the methylene blue that he used, which was the untreated methylene blue. In 1901, Leishman improved on it by utilizing polychrome methylene blue \vhich he prepared by heating it with 1 /2 % sodium bicarbonate for 12 hours at 65 °C, letting the mixture stand for 10 days, and mixing it wi·th an equal part of 0.1 10 aqueous eosine. The Wright stain ( 1902) is almost the same as the Leishman, differing only in the manner the polychrome methylene blue is prepared__,that is, by heat.ng it only for an hour in flowing steam. In 1904, however, Giemsa departed a little further f rorri the techr1ics of his predecessors by obtaining first methylene azures in purer form and combining them with eosine. The resultin~ products are now kno\vn in the market as Azure Ii and Azure 11,eosine, the main components of the well,kno\),,'n (;iemsa stain. Later in 1922. McNeal produced a tetrachrome blood stain, almost exactly the same as that of Giemsa, but which he prepared more scientifically by mixing de, finite proport ons of methylene blue, methylene violet, methylene azure, and eosine .. The most important of these constituents of McNeal tetrachrome stain is the methylene azure now known in the market as Azure I and is a variable mixture mainly of Azure A and B. At this point, it is worth while to note that in all the above described stains, now available in the market in pure powder form, methyl alcohol is used as ·the vehicle for dissolving the powder stain, in "vhich are <;ombined both the fixing and staining qualities. Except with Giemsa, which requires p_reliminary fixing· and takes longer to stain-from 30 minutes to \ hour-the staining process takes about l5 minutes. Volume XXII · Number 4 MODIFIED FIELD STAIN-Pesigan et al. 169 Lately, however, various workers have shifted to aqueous preparations of blood stains, perhaps with the same purpose of doing away with methytl alcohol as we hoped to do at the start of this work. Among these workers, we found that the most recent was Field, who, in 1940, first reported a rapid method of staining malarial parasites in thick blood films for only a few seconds by using 1 % brilliant cresyl blue in isotonic buffer solution. In 1941, Field reported another rapid method of staining with more vivid differentiation of the malarial parasites by the use of basic mixture and a counter,stain but applying it only to thick blood films. The basric mixture of Field was composed of 0.18 % methylene blue and 0.1070 Azure I in isotonic buffer· sa:ution adjusted to pH 6.6, \\1 hile the counter,stain was a 0.20 7o eosine in the same kind of vehicle adjusted to the pH. Although this is merely a modified Romanowsky stain, it differs radically from the latter in that the two solutions are not mixed but are separately applied and allowed to interact in the film itself. Basically, our stain is like the Mason monochromatic stain, which consists of a simple 2 % solution of methylene blue in 5 7o borax. But we modified it afterwards and made it polychromatic by the use of a counter,stain. Always using 2.5 J'o borax .solution as vehicle we tried the methylene blue by Manson, Azure I used by MacNeal, Azure II used by Giemsa, the brilliant cresyl blue used by Field in all conceivable combinations and proportions. We finally arrived at the present formula of our basic mixture \\1 ith 0.2 % eosine in distilled water as our counter,stain. Very much like Field, our stain, as finally adopted and described here, consists of two aqueous mixture~ separate from each other -a basic mixture and a counter, stain. Applied separately 6 seconds and 4 seconds respectively, they produce a very high degree of clarity of the cellular elements of the blood and haemoprotozoan parasites, almost free from distortion and with vivid differentiation especially in thin smear. The red blood cells maintain their perfect contour and take up a purplish blue or greyish blue color, the nuclear chromatin of the material parasites turn red or lilac red, while the cytoplasm becomes deeper blue. The malarial pigments retain the same natural color as in other blood stains. The leucocytes are even more beauti, fully stained. Their contour is well shown in faintly purplish outlines. The internal structures of the nuclei are vividly differentiated, taking different shades of libc or purple; and the cytoplasmic granules take their characteristic colors-red for eosinophiles, purplish for neutrophiles, and bluish for basophiles. The cytoplasm of the lymphocyte9 and mononuclears stains like the neutrophiles. The blood platelets appear lilac with purplish border. The thinner the smear, the cle,\rer and the more vivid are the structures of the cellular elements of the blood and •the more distinct are the malarial parasites. In the thick smear which has been sufficiently dehemoglobinized, the same tine, torial reactions appear, although there ts slight dimming or haziness of the border of the leucocytes and of the malarial parasites. The lyzed red blood cells, however, appearing as a thin purplish blue cloudiness, furnish a good background for the malarial parasites and leucocytes and make them clearly visible. This is not only because of their greater concentration per miscroscopic field, but also and mostly because of 1he marked contrast between the stained elements and their background. It may be added here that in thick smear, the ma1arial parasites tend to appear smaller than in fixed thin smears, r.nd to be obscured, diffused, or distorted. This 170 MODIFIED FIELD STAIN-Pesi.gan et al. Jour. P. M. A. Ay,rH, 1946 renders species diagnosis more dJficult. Their numerical advantage per unit field and !he more distinctive appearance of malarial pigments, however, render it more certain to make at least a positive or negative diagnosis of malaria than is thin smears, especially in extremely light infections or in !hose that have received treatment. With this stain, young red blood cells are even recognizable, especially in par, tially dehemoglobinized smears. We a·ttributc this to the brilliant cresyl blue in the basic stain. To experienced workers in malariology and hematology, this is definitely more an advantage than a drawback; for it affords a check-up for the supposedly greater affinity of malarial parasites especially P. vivax to young red blood cells. If this affinity is true, then spotting of malarial parasites may even be made easier through these recognizable young red blood cells. More than that, a9 in Field stain, the tendency for the appearance of precipitates is practically nil. \Ve have also used our stain for splenic, bone marrow, and brain smears, and in staining micro, f ilaria and trypanosomes with satisfactory results. Above everything else, our stain is undoubtedly very economical, for the same solutions placed in Coplin jars can he used over and over again for months without impairing its staining quality and without even the necessity of pH control. Our stain. then. closely resembles Field stain but differs radically from it ch;efly in the isotonicity and pH of the solutions and in the vehicle used. Field relied very much on the isotonic buffer solution which he used as vehicle for both basic stain and the counter,stain and both ad justed to pH 6. 6. We, on the other hand, attribute our success to the 2.5 9'o borax solution which we use as vehicle for our basic mix, ture. Because of this, our stain is very much less sen!:litive to isotonicity and pH control, Vv'hether the stain be freshly prepared or old. Alon.e, 2.5 7c borax solution ha9 a pH of 9.5; with the mixture, it has a resulting pH of 9.0, which is definitely basic or alkaline. Our counter,stain, on the other hand, is a simple 0. 20 % eosine solution in dis, tilled water, not in isotonic buffer, with a resulting pH of 5.5 which is decidedly acidic-very different, for this reason, from the counter, stain of Field. Briefly stated, the 2.5 o/o borax rolution probably exerts a very good mordanting effect on the basic mixture of 0.35 % brilliant cresyl blue and 0.50% Azure II a solution very rich in methylene azures and produces an excellent differential staining with 0.20~'c eosine in record speed of only 10 seconds. We feel justified in reporting on this modified Field stain and on its applicaf on not only to thick blood films but also to thin smears. For, in this stain, '\ve have found the three most important desiderata of a good stain for blood and hemopro, tozoan parasites, namely-( 1) good clarity of blood picture allowing ~asy and accurate diagnosis of malaria, (2) rapidity of staining, and ( 3) economy in the use of the stain. It must be emphasized, further, that with it, staining can be done satisfac, · torily even on unfixed smears-that is, without the use of methyl alcohol, if none is available. The technic of staining is very simple and not at all delicate. Even students trying to learn staining for the first time can get fairly good results with it. It must be added, however, that thick and thin smears stained with this stain fade easily, especially after several examinations under oil immersion and repeated wiping with xylol, because the stain is easily removed. Althcugh this makes it easy to clean used slides, it maxes it difficult to keep slides for permanent file or for Volume XXII Number 4 A10DIFIED FIELD STAIN-Pesigan et al. 171 detailed morphological studies without further re,staining them with Wright or Giemsa. By this combined or the so,called Hpanoptic,, process, the tinctorial char, acteristic of the parasites and the cellular elements of the blood show more clearly than by Wright or Giemsa alone. CONCLUSION A modified Field stain for the rapid and accurate diagnosis of malaria in both thick and thin smears is here described. It is particularly useful in routine laboratory diagnos~s and is very economical. I ts usefulness may also be taken advantage of in studies of bone marrow, splcnic, and brain smears; in other hematological studies; <1nd in staining other hacmoprot8zoan parasites such as trypanosomes and micro, filaria. REFERENCES 1 . Conn, H. J.: Bio]ogica] Stains, Geneva, N. Y. 1st edition, 19 2 5. (Committee on Standards). 2. Fie~d. J. \V.: A Simpl~ and Rapid Method of Staining Malaria] Parasit<.>s in Thick Blood Smears. Trans. Roy. Soc. of Trop. Med. and Hyg., 34: No. 2, pp. 195,202. Aug. 16, 1940. 3. Field, J. \V.: A New Rapid 1'1ethod of Staining Malarial Parasites in\ Thick Blood I Films. Bull. from the Inst. for Med. Res. Feder. Malay States, No. 2 of 1941. 4. Field, J. W.: Further Note on a Method of Staining Malarial Parasites in Thick Blood Films. Trans. Roy. Soc. of Trop. Med. and Hyg., 35: No. 1, pp. 35,42. July 3, 1941. !>. Giemsa, G.: Eine Vereinfachung and Vervollkommnung meiner Methylcnazur,Methy1en, bbu,eosin Farbemethode zur Erzielung der Romanow~ky,Nochtschen Chromatinfarbung, Centbl. f. Bula., I Abt., 3 7: Sec. 2, pp. 308, 311. 1904. 6. Jenner, L.: A New Preparation for Rapidly Fixing and Staining Blood. Lancet, 1: pp. 3 iO, 3 71. Feb. 11, 1899. 7. Lcishmann, W. B.: A Simple an~ Rapid Method of Producing Romanowsky Stainin~ in Malarial and Other Blood Films. Brit. Med . .four., 2: pp. 757,758. Sept. 21, 1901. 8. McNeal, W. J.: Tetrachrome Blood Stain:· An Economical and Satisfactory Imitation of Lcishmann Stain. Jour. Amer. Med. Assn. 78: No. 15, p. 1122. Apr;t 15, 1922. 9. Mc Neal, W. J. and Killian" J. A.: Chemical Studies on Polychrome Methylene Blue. Jour. Amer. Chem. Soc., 48: pp. 740,747. March 5, 1926. (Method of Preparation of Azures A and B and of 11ethylene Violet form Methylene Blue). 10. Noc ht, B. and Mayer, M.: lvfalaria, Handbook of Treatment, Para!'itolc;gy,, and Pr£, vention, John Ba1e Med. London, 1937. 11. Romanowsky, D. L.: Zur Frage Der Parasitologie und Therapie dcr malaria. Deutsch \'On P. W cr11er, Petersburg, 1SQ1. (On the Question ot P:,ra~itology and Therapy of Malaria. Imp. Med. Mil. Acad. Disscrt. No. 38. St. Petersburg, 1891. Proposes \:Om' binatiqn of cosin and methylene blud for staining blood). J 2. Todd, J. C. and Sanford, A. H.: Clinical Diagnosis by Laboratory. Methods, 9th ed. 1941. (De~cription of Wright stain quoted from· A Rapid Method for the Dif, fercntial Staining of Blood Films and Malarial Parasites by James H .. Wright. Jour. }vfed. Res. 2: pp. 138,144, Jan., 1902). THE JOURNAL OF THE Philippine Medical Association Published monthly by the Philippine Medical Association under the supervision of the Council. VOL. XXII Office of Publication, 547 Herran, Manila, Philippines Devoted to the progress of Medical Science and to the interests of the Medical Profession in the Philippines. APRIL, 1946 The Council NO. 4 Officers of the Philippine Medical Association, 1941 extended to 1946 President: Dr. Victorino de Dios Vice, Presidents: The Council consists of the President, the Vice, Presidents, the Secretary, Treasurer, and the following Councillors: Dr. R. Abriol Dr. Januario Estrada Dr. W. de Leon Dr. Honoria Acosta, Sison SecTetary,T reasurer: Dr. A. Villarama Dr. Jose C. Locsin Dr. M. Canizares Dr. Antonio S. Fernando ANTONIO S. FERNANDO. M.D., Editor I. V. MALLARI, Copy EditoT PEDRO M. CHANCO. Business Manager Associate Editors (alphabetica1ly listed) V1cTORINO DE D1os. M. D. JosE GumoTE, M. D. AGER1co B. M. S1soN. M. D. RENATO MA. GUERRERO, }Ii D. WALFRIDO DE LEON. M. D. ANTONIO G. SISON, M. D. CARMELO REYES, M. D. Signed editorials expres$ the personal views of the writer thereof, and neither the Asso, ciation nor the Journal assumes any responsibility for them. 1fbitorial :rHE MEDICINE OF TOMORROW The type of medical practice follows the pattern of the social structure fron1 which it has sprung. Thus the earlier physicians vvere linked with sorcerers, barbers, and priests. In the course of social evolut~on and civilization, there appeared the figure of the family physician, who was not only the healer of all kinds of ailments afflicting the families under his care, but also a consultant on family and personal matters. This familiar figure is fast disappearing pue to the amazing developments in the fields of science and industry. The tremendous progress at174 EDITORIAL Jour. P. M. A. April, 19-16 tained during the last quarter of the century in all branches of human endeavor, specially in the science of medicine, has made it utterly impossible for one single physician to master the different branches of the art of healing. And we venture to predict the complete disappearance of the traditional family physician, the general practitioner .. The family doctor has evolved with the social struc~ure. Before the era of industrializa~ion, no one felt the need of social security. For, out of every five individuals, four were independent farmers; and only one \Vas dependent upon his employment in some sort of organization. But, \Vith the advent of modern methods and technics that led to the development of assembly lines and mass production, the situation was reversed. Now, out of every five individuals, four are dependent upon their employment in one organization or another: and only one can consider himself independent of industrial fluctuations. This has forced individuals to form groups for security. Likewise, the physician today finds himself more and more dependent upon his colleagues in performing his task. For society demands the best available medical care which highly skilled and trained men alone can give. And, in order to render the best medical service, physicians traine~ in the different branches of medicine will have to group themselves into a sort of medical center where patients may come for the relief of ·their ailments. Group practice, in short, will inevitably replace the present g·eneral practitioner. But group practice can not render the best service to the greatest number, because the cost of medical care "'rill necessarily be very high. The individual physicia:ns have spent much time and energy to become p:roficient in their respective lines, and the modern methods of diagnosis and treat1nent also requi1~e large sums of money. On the other hand the bulk of the population demands a cer~ain dE·gree of health security, so that in times of distress, they may call on .th2 best medical service available. The medical profession can answer this demand of society only by the adequate training of the individual physician along modern 1nethods, and by group practice. And, in order to make their services a·;ailable to ·~he greatest nu1nber of individuals in the low-income g·roup, some sort of cooperative enterprise in the form of pre-paid medical service 1nust be organized in the different comtnunities. This is the medicine of tomorrow.-A. B. M. S. •isrellanenus ABSTRACTS FROM CURRENT LITERATURE ABSTRACTORS lsabelo Concepcion, M. D . Walfrido de Leon, M. D. Felisa Nicolas, Fernando, M. D. Carmelo Reyes, M. D. Summary of Some Knoum Facts Concerning the Common Cold. by A. C. Hilding, M.D .• The Annals of Otology, Rhinology and Laryngology, 53:457 (September) 1944. The author made the following conclusions: These facts about the common cold seem to be fairly well established. It is a widespread, contagious, epidemic disease which occurs in all climates, especially in th~ autumn and spring months. It is spread by droplet infection and can be controlled by isolation like other communicable diseases. It is caused by a specific virus and is frequently followed immediately by complica, tions due to bacterial infection. These are purulent rhinitis, ot1t1s media, laryngitis, bronchitis. Chilling and exposure are definite etiologic factors probably because of prolonged reduced tern, perature in the nasal mucosa. Immunity foilowiRg attacks is very brief both as far as the virus and the complicating bacteria are concerned. Vaccination is unsuccessful>! apparently be, cause both the virus and bacteria have sue~ poor antigenic properties. Prevention by the giving of vitamins, or by so-c:alled "hardening processes" are also large, ly unsuccessful. The local pathology centers about injury to the epithelium, presumably by direct action of the toxins on the epithelial cells, andl consists in the dt"struction of the superficial cells. There is a marked submucosal cellular reaction. The secretion increases tremendously in volume and contains a lower percentage of mucin. There is at least some indication that the lysozyme content decreases even before the volume increases. The change in pH is small, if any, and tends toward the alkaline side. Systemic pathological changes are largely unknown . Treatment i~ not very successful and consists principally m symptomatic measures and attempts to prevent complications.-F. N. F. Prolonging the Effect of Penicillin by Chilling, by Lt. Commander Max Trumper, H ( S), U .S.N .R. and Commander Gershom J. Thompson, MC(S), U .S.N .R., J.A.M.A. 130:627 (March) 1946. The ephemeral- power of penicillin has set clinicians and scientists working on methods of prolonging its effective action, aiming to make unnecessary. the renewal of intramuscular doses every few hours. Effective and prolonged blood levels have been obtained by using a penicillin beeswax,peanut oil mixture. TECHNIC The chilling procedure may be summarized by thd following directions which were issued to hospital ward personnel: 1. Two hours prior to the injection of penicillin,. fill the ice bag 90 per cent full o~ crushed ice. 2. Before closing the bag squeeze out all excess air and repeat one hour later, so that the bag can he molded around the deltoid muscle. 176 ABSTRACTS FROM CURRENT LITERATURE Jour. P. M. A. April, 1946 3. Enclose the ice bag in the shoulder bag and place on the upper arm and shoulder, tasten it to the vest and see that it is maintained there for two hours. 4. Chill the bottle of Peniciliin ( 100,000 units in 10 cc. of saline solution) in crushed ice for at least five minutes prior to th~ injection. 5. With a 1/2 inch hypodermic needle in a cool syringe, inject the chilled penicillin• slowly into the deltoid muscle. 6. Replace the ice bag immediately and maintain it around the deltoid area for twelve. hours, renewing the ice every few hours as needed. The authors gave the following Summary and Conclusions: One hundred patients with uncomplicated gonococcic urethritis were tr\!ated with a single dose of from 50,000 to 100,000 units of penicillin dissolved in saline solution and inject~d into the deltoid muscle, which was chilled before and after the injection. Results from dosages of 50,000 and of 70,000 units gave cures of 77.3 per cent a,nd 85. 7 per cent respectively. The 100,000 unit dosage cured 91 per cent' of the patients. This percentage compares favorably with the results obtained by others using multiplQ injections as well as the single injection of 100,000 units of penicillin in mixture~ of beeswax and peanut oil. It can be concluded from the high percentage of cures that the chilling technic prolonged the effective action of penicillin, reduced to ond the number of injections required to treat uncomplicated gonorrhea and rendered that injection painless, all of which was accomplished without introducing any other foreign substance intramuscularly.-P. N. F. Oral PeniciJlin, by P. Gyorgy, Katharine W. Evans, Elizabeth K. Rose, Josephine G. Perlingiero and W. F. Elias, Pennsylvania Medical Journal, 49: 385-496 1946 p. 409. Gyorgy and his associates compared the blood levels of penicillin in children after ingestion of aqueous penicillin solution and of buffered penicillin (mixed with sodium citrate.) Less irregular, higher and more prolonged blood levels were the rule after administration of buffered penici11in by mouth. As buffers aluminum hydratel gel was considered by the writers as a possible substitute for sodium citrate. The blood levels obtained were higher after ingestion of buffered penicillin than after thet ingestion of capsules containing the penicillin-oil-beestvax mixture. Howe\•er, tri~odium citrate seemed superior to alumin•Jm hydrntc gel. The blood 1eve1s obtained after the use of 15,000 units of penicillin given intramuscularly do not differ materially from those observed foJlowing the use of 40,000 units of penicilJin buffered with trisodium citrate administered by mouth. Given in doses which were npproximately three times higher than the customary parenteral doses, penicillin by mouth proved to be therapeutically effective in pneumonia, in upper respiratory infections and their complications, in gonorrhea and in pyogenic cutaneous infections. It appears inadvisable to supplant parenteral with oral penicilJin indiscriminately. Parenteral administration in their opinion still remains the method of choice, at least during the early acute phase m very sick patients with septicemia or meningitis.-F. N. F. Cancer and Caloric Restric.tion, Editorial, J .A.M.A. 129:1169 (December 22) 1945. Tannenbaum demonstrated that underfeeding-restriction of the ad libitum intake by approximately one third-invariably caused a significant reduction in the incidence of tumors in mice. Furthermore, the tumors of the underfed groups appeared. on the average, later, than those of the full-fed groups. Tannenbaum suggested that the inhibition of tumor formation through underfeeding (all components and calCJric content being reduced proportionately) was due mainly to restriction of calories rather than to restriction of some essential components ofl the diet. In sub, sequent investi~ation only the carbohydrate content of the diet was restricted, while the. protein. minerals and vitamins were maintained constant (caloric restriction per se) and' yet the nature and extent of inhibition of tumor formation was similar to that ~bserved in the earlier in\'cstigations. Tanncnhaum concluded that any dc~rec of caloric restrict;on may exert some inhihitory effect on the formation of tumors; howe\'Cr, the lower the caloric intaf<c, the greater the inhibition. Vclume XXII Number 4 ABSTRA.CTS FROPrl CURREJ.VT Ll7'ER.4.TURE 177 Although nutrition may be of some value 1n the prevention of tumors, the evidence suggests that there is little likelihood that it is of practical help in controlling the. growth oi tumors. This dependence of the genesis of tumon in mice on the caloric value of the diet would obviously suggest inquiry into its applicability in human cancer. Tannenbaum ·s review of the available insurance statistics suggests that persons of average weight or less are not as likely to develop) cancer as are those who are overweight. Obesit}" and the consumption of more food than the body needs for its current activity appear to be contraindicated. Other nutritional factors undoubtedly have some effect on the formation of tumors" Probably avoidance of overweight besides being of value prophylactically in diabetes, hea-rtt disease and arthritis, may aid in the prevention of many types of cancer occurring in man or, at least, delay the onset. The study of relationship of nutrition t<l the origin and growth of tumors appear to be a fruitful and possibly practical field of investigation.-F. N. F. PROGRAM OF THE THIRTY-NINTH ANNUAL MEETING .. OF THE PHILIPPINE MEDICAL ASSOCIATION TO BE HELD AT STO. TOMAS UNIVERSITY GYMNASIUM MAY 7-11, 1946, MANILA SCHEDULE OF SESSIONS. VISITS AND EN.TERT AIN.MEN.TS TUESDAY,; May 7, 1946. 8 :00 a.m.-5 :00 p.m.-Registration of M.;mbcrs (Gymnasium). 2: 30 p.m.--First Meeting of the House of Ddegates (Gymnasium) 4 :00 p.m.-Tea Party offered by the President of the Manila Medical Society, Dr. Jose Y. Fores, to welcome the Guests, Delegates, and M~mbers. St. Lu~e's Hospital. Magdalena St. WEDNESDAY, May 8, 1946. 8 :00 a.m.-Registration (continued) 9 :00 a.m.-Openin~ General Session (Gymnasium) Noon -Luncheon offered by the President of the Philippine Medical Asso, ciation, Dr. Victorino de Dios, in honor of the guests and delegates. Y c Old Mansion, Gral. Solano St. 4 :00 p.m.-Visit to the Emergency (Orthopedic) Hospital, Mandaluyong THURSDAY, Mayt 9, 1946. 8 :00 a.m.-12 :00 noon-Scientific Sessions. (Section on Suq!ery; Section on Medicine and Pediatrics; ScctiOJ1 on Ophthalmology and Otolaryngology). 4 :00 p.m.-Visit to the First General Hospital, Phil. Army, Mandalu)•ong. FRIDAY, May 10, 1946. 8:00 a.m.-12:00 noon-Scientific Sessions. (Section on Hygiene and Public Health; Section on Medicine and Pediatrics; Section on Obstetrics and Gynecology). 2: 30 p.m.-Second meeting of the House of Delegates, (North General Huspital) 4 :00 p.m.-Visit to the North General Hospital, Espana. SATURDAY, MaY, 11, 1946. 8:00 a.m.-12:00 noon-Scientific Sessions. (Section on Surgery: Section on Medicine and Pediatrics. N.B.-Papers not read in previous days may be read tod~y.) 2: 30 p.m.-General Business Meeting of the Association. (Election of Of,' ficcrs and thtir Installation). Members arc requested to brin1 their membership cards. J:OOO p.m.-Closing Meeting o~ the House of Delegates. OPENING GENERAL SESSION Wedne~day, May 8, 1946, 9 :00 a.m. Sto. Tomas University Gymna!'ittm Dr. Victorino de Dios, Presiding Dr. A. S. Fernando, Secretary Vo1ume XXII Number 4 PROGRA1ll OF THE 39th ANNUAL ll1EETING 1. OVERTUREPhilippine Army Band II. INVOCATIONVery Rev. Fr. Eugenio Jordan, 0.P. Rector Magnif icus, Sto. 'f om as Vniversi·~y. lll. WELCOME ADDRESSDr. Jose Y. Fores President, Manila Medical Society. IV. PRESIDENTIAL ADDRESSDr. Victorino de Dios, President. Philippine Medical Association. 11n V. Awardfog of a Gold Medal and a Citation to the late Dr. Candido M. Africa for his outstanding contributions to Medical Science. VI. ADDRESS BY THE GUEST OF HONORHon. Elpidio Quirino, Vice-President-Elect of the Philippines VII. MARCHPhilippine Army Band SCIENTIFIC SESSIONS SECTION ON SURGERY Thursday, May 9, 1946. 8:12 a.m. Chairman Secretary ........................... ............................ Chronic lntussusception: Diagnosis And Treatment Dr. Porfirio Recio Dr. Januario Estr;-ida Dr. Luis F. Torres11 Jr. Department of Surgery, College of Medicine, V. P. Report Of A Case Of Pulmonary Embolism After A Pelvic Operation Drs .. J. Z. Sta. Cruz and M. D. Penas Deparment of Pathology, Faculty of Medicine and Surgery, University of Sto. 'Tomas. Tenoplasty And Tendon Transplantation as Treatment In Some Chronic Cases of Infantile ParCllysis Dr. Rodolfo Gonzales Department of Surgery. Faculty of 1'1edicine and Surgery, University of Sto. Tomas. Cranial Metastases Of Carcinoma Of The Thyroid Dr. Porfirio Recio Department of Surgery, College of 1'1edicine, U. P. Report Of A Case Of Mullcrian Duct Cyst In An Aduit Drs. J. Y. Fores and J. Z. Sta. Cruz Departme111t~ of Surgery and Pathology, St. Lu~e's Hospital. Surgical Management Of Carcinoma Of The Stomach Dr. J. Y. Fores Department of Surgery. S:. Lu~e's Hospital. - The Management Of Prostatic Obstructions Dr. Luis P. Torres, Jr. Depattment of Surgery. College of Medicine, U. P .. and St. Ltt1\e's Hospital. Spinal Cord Injuries Drs. Andres Zavalla and Victor A. Reyes Department of Surgery, College of Medicine, U. P. Acut6 Appendicitis: Diagnosis And Treatment Ors. C. D. Franco and P. Recio Department of Surgery, College of Medicine, V. P. ~ilateral Orchiectomy In Cancer of The Prostaf~ Drs. Luis F. Torres, Jr. and Pahlo Morale~ Depa.,,tment of Surgery, College of 1'1edicine. U. P. 180 PROGRAM OF THE 39th ANNUAL MEETING Jour. P. M. A. April, 1946 Aspiration Biopsy: Its Va1ue in Cancer Diagnosis Drs., J. Z. Sta. Cruz. and Mario Oca Department of Pathology, St. Lu~e'.s Hospital. Transurethral Resection In The Treatment Of Prostatic Median Bar Drs. Luis F. Torres, Jr. and Pablo Morales Department of Surgery, College of Medicine, V. P. Blood Bank-Its Management At St. Luke's Hosp~tal Drs. j. Z. Sta. Cruz. and J. Y. Fores Department of Pathology and Surgery, St. Lu~e's Hospital. Present Status Of Acute Appendicitis Based On A Study 0 f Cases At the North General Hospital Drs. Francisco C. Guzman and Felipe Constantino 'North General Hospital Newgrowths Of The Gastrointestinal Tract: A Statistical Study Drs. C. D. Franco and P. Recio Department of Surgery, College of Medicine, U. P. IJeo,Cecal Tuberculosis: An Evaluation Of The Progress In Iu Management Drs. C. D. Franco and P. Recio Department of Surgery, College of Medicine, U. P. SECTION ON MEDICINE AND PEDIATRICS THURSDAY, MAY 9, 1946. 8,12. A.M. Chairman • • • • • . • . • • • • • . . • . • • • . • • • . • . Dr. Victorino de Dios Secretary. . . . . . . . . . . . . . . . • • • • . • • . • . . . Dr. Mariano Alimurung Paratyphoid Fever Among Filipinos Dr. Pedro Lantin Department of Medicine, Faculty of Medicine and Surgery, University of Sto. 'Tomas. Diet In Typhoid Fever Dr. Pedro Lan tin Department of Medicine, Faculty of Medicine and Surgery, University of Sto. 'Tomas. Clinical Observations On Post,War Pneumonias Drs. Pedro Lantin, Aniceta . Barcelon,Guevara, Mariano Alimurung and Raymundo Katigbak Department of Medicine, Faculty of Medicine and Surgery, University of Sto. 'Tomas. Report Of A Case· Of Lymphogranuloma Venereum Simulating Dysentery Dr. Victorino de Dios President. Philippine Medical Association. Splenomegaly In Malaria Drs. A. G. Sison,. R. J. Navarro and N. M. Santiago Department of Medicine, College of Medicine, U. P. Mediastinal Tumor Treated By Radiation ( 5 years follow,up. Report of 2 cases) Dr. P. Chikiamco Department of X,Ray and Physical 'Therapy, Philippine General Hospital. Pneumococcic Meningitis Successful1y Treated With Combined Penicillin And Sulfadiazine Therapy Dr. Fe del Mundo Department of Pedriatrics. Faculty of Medicine and Surger)'. University of Seo. 'Tomas. Dr. Ester Sucgang North General Hospital. Allergic Peritonitis: Presentation Of A Case Drs. S. Ador Dionisio, J. A. Silva and P. C. Chavez Department of Medicine, College of Medicine, V. P. Philippine General Hospital. ' and Department of Laboratories, VrAume XXIJi Number 4. PROGRAM. OF THE 39th ANNUAL MEETING Has Infantile Beri .. Beri1 Disappeared In Manila? Drs. Moises B. Abad and Leon V. Pecache Department of Pediatrics. College of Medicine, U. P. Hypoglycemia In Children Drs. Renato Ma. Guerrero and Felix Estrada 181 Depa.11tment of Pedia.trics. Faculty of Medicine and Surgery. University of Sto. Tomu. Urotherapy In Urticaria: Furthert Studies Dr. S. Ador Dionisio Department of Medicine. CoU~ge of Medicine, U. P. Blood Bilirubin Determinations As An Aid In The Differentiation Between Peptic Ulcer And Portal Cirrhosis ln1 Gastric Hemorrhage Drs. R. J. Navarro, P. Ignacio and J. A. Silva Department of Medicine. College of Medicine. U. P. Subacute Lobar Pneumonia Drs. Renato Ma. Guerrero and William Huang Dep4rtment of Pedia.tr.ics, Faculty of Medicine a.nd Surgery, Uni\lersity of Sto. Tomas. Simplified Artificial lnfanq Feeding Drs. Peregrino H. Paulino and Jose R. Jimenez lndigenit Children·s Hospital. Bureau of Publ·ic Wdfa.re. SECTION ON OPHTHALMOLOGY AND OTOLARYNGOLOOY Thursday MorninG~ 8: 12 Chairman • • • • • . • . • . • . • • • . • . . . • Antonio S. Fernando, M. D. SecTetary Chairman's Address. . . . . . . . . . . . . . . . . . . . . . . . . . . . Dr. Antonio S. Ferna;ndo. Jose 1~. Cruz, M. D. Presiden1t, Philippine Ophthahnological and Otoiaryngologic:al Society. Ocular War lnj uries Drs. A. R. Ubaldo and C. V. Yambao, College of Medicine, V. PJ Local Instillation of Penicillin in Acute Conjunctivitis Dr. G. Farrales. St. Lu~e·s Hospita.I and Afable College of Medicine. Disturbances of Associated or ConjugateJ Ocular Movements Dr. Geminiano de Ocampo, St. Anthony's Hospita.I, Ma.nil4. Chronic lridocylitis with Occlusio e- Seclusio Pupillae Dr. H. Velarde, College of Medicine, U. P. Retropharyngeal Abscess Drs. A. R~ Ubaldo and J. N. Crui, College of Medicine, V. P. Practical Consideratit>ns in Refraction Dr. Felisa Nicolas,Fernando North General Hospital, Manila Local Instillation of Penicillin in Chronic Suppurative Maxillary Sinusitis Dr. Jesus Tamesis, North General Hospita.l, Manil'4 Foreign Bodies of the Air and Food Passages Dr. Jose N. Cruz College of Medicine, V. P. The Fogging Method of Refraction Dr. Geminiano de Ocampo, St. Anthony•s Hospital, M4nila.. 182 PROGRAM OF THE 39th ANNUAL MEETING Acute Epiglotitis Dr. C. V. Yambao College of Medicine, U. P. Jour. P. M. A. April, 19t6 N. B.-On Friday and Saturday from 8-12 in the morning there will be demonstrations in North General Hospital and Phil. General Hospital, of Slit·lamp microscopy, Ophthalmos• copy, Direct Laryngoscopy, etc. as well as an operation on nasal accessory sinuses and chronic glaucoma by specialists chosen by the Committee on Postgraduate Course of the P. 0. ES 0. S. for the benefit of the members of the Association. This committee consists of Drs. Edmundo Reyes, chairman, Jesus Eusebio and Cesar Maloles, members. SECTION ON HYGIENE AND PUBLIC HEAL TH FRIDAY, MAY 10, 1946. 8·12 A. M. Chairman . . . • . . • . . . . . . . . . . • . . Dr. Bienvenidci P. Caro Secertary . • • • . . . . . . . . . . . • . . . . Dr. Rosales The Public Hea·lth Laboratory, Manila Health Department Dr. A. P. Roda Section of Public H ea.Ith Laboratory Studies on the Treatment of Industrial Coconut Waste Dr. P. I. de Jesus Institute of Hygiene, University of the Philippines, P. E. Chavez, B.S.C.E., Bureau of Health Modified Field Stain for Rapid Staining of Thick and Thin Blood Smears Drs. T. P. Pesigan and E. Y. Garcia Department of Parasitology, Institute of Hygiene, V. P. Biological Assay of Annatto (Bixa OrcJlana) for Vitamin A Activity Drs. P. I. de Jesus and R. Lim Institute of Hygiene, U. P. Penicillin in the Treatment of Gonorrhea and Syphilis Lt. Col. Alonso F. Brand U. S. Public Health Service, Veneual Disease Control Adviser, Office of the American High Commissioner. Simple Qualitative Tests for Adulterated Fresh Milk Dr. Segundino G. Jao Section of Industrial Hygiene, Drugs and Laboratories. The Advisability of Using Chemical Preservatives in Soft Drinks Dr. A. P. Roda Section of Public Heaith LaboratoT)' Modern Trends in the Therapy of Gonorrhea and Syphilis Dr. Jaime 0. Quiazon Division of Social Hygiene, Manila Health Department. Venereal Disease Control in the Philippines After the Liberation Dr. Trinidad Yusay Venereal Disease Control Section, Bureau of Health, and Dr. Florencio Z. Cruz Division of Social Hygiene, Manila Health Department. The Carrier State Among Food Handlers and iu Relation to the Incidence of Intestinal In· fections in the City of Manila Dr. A. P. Roda Section of Public Health LaboT41toTy. The Mazzints Flocculation Test-A Comparison With the Kahn and Kolmer Tests--Preliminary Report Drs. J. Ramirez, J. Tanquintic and Miss F. Catanjal A Report of the Serological Findings of Cerebro•Spina~ Fluids Drs. J. Ramirez, J. Tanquintic and Miss P. Catanjal Volume XXIl Number 4 PROGRAM OF THE 39th ANNUAL MEETING The Bacteriological Examinations of Soft Dr mks Drs. A. P. Roda and R. Valdes Section of Public Health Laboratory. 183 Biological Assay for Thiamin of the .. Carabao.. Variety of Philippinei Mango (Mangifera In· dica L.) Drs. S. G. Jao and P. I. de Jesus Institute of Hygiene. U. P. Biological Assay for Thiamin of Three Varieties of Rice Grown 1n the Philippines Drs. P. I. de Jesus, and S. G. Jao and M: Gutierrez Institute of Hygiene. U. P. The Incidence of Intestinal Parasitism Among Food Handlers Drs. P. Calubaquib and Mr. H. Rolda Section of Public Health Laboratory. Digenia Simplex as a Substitute in the Treatment of Ascariasis Drs. H. Lara, T. M. Gan, M. Y. Matias, and A. C. Reyes Department of Epidemiology, Biostatistics a·11d Public Health Administration. Instiitute of Hygine. U. P. SECTION ON MEDICINE AND PEDIATRICS! FRIDAY, MAY 10, 1946. 8· 12 A. M. Chairman . • • • . . . • . . • . . • • . • . • . Dr. Daniel Ledesma Secretary . . . . . . . . . . . . . . • • • . . . Dr. Jose G. Cruz Report of the First Case of Intestinal Heterophydiasis Diagnosed in the Philippines Drs. P. D. Gutierrez and A. A. Lozano Department of Medicine, Philippine Gene·raJ Hospital. Evaluation of Diets Served to Woman Students of the University of the Philippines Drs. P. I. de Jesus and S. G. Jao Institute of Hygiene, U. P. Report of a Case of Polycythemia Vera Drs. Jose R. Cruz, Elpidio Gamboa and Emiliana Escosa North General Hospital. Incidence of Cardiac Arrythmias Dr. Jose M. Barcelona Department of Medicine, College of Medicine, V. P. The Treatment of Pneumonia in Children-A Study of 400 Cases Dr. Fe del Mundo North General Hospital The Bromsulphalein Test in Liver Dysfunctions Dr. Medina Cue Section of Clinical Laboratory and Dr. Mariano Alimurung Department of Medicine and Surgery, University of Sto. Tomas. Megakaryocytic Rea.c;tion Localized in 6 the Bone Marrow: Report of New Hematologic Syndrome With Observations Oill the Origin and Development of the Megakaryocytes and on the Derivation of PJatelets Dr. Victorino de la Fuente Section of Hematology, Department of Medicine, Faculty of Medici1\e and Surgery. University of Sto. er omas. Ventricular Aneurysm Drs. Isidro Pertierra, Mariano M. Alimurung and Paulino J. Garcia Section of Radiology, Department of Medicine, Faculty of Medicine and Surgery. Univ" ersity of Sto. er omas. Blood Examination for Private Cases Dr. Victorino de la Fuente 184 PROGRAM OF THE 39th ANNUAL MEETING Jour. P. M. A. April. 1946 Section of Hematology, Department of Medicine, Faculty of Medicine and Surgery, University of Sto. Tomas. The Bio,Chemical Basis for the Use of Protein Hydrolysates in Peptic Ulcer Dr. Isabelo Concepcion Department of Bio,Chemistry, Faculty of Medicine and Surgery, University of Sto. Toma.;. Observations of War,Time Pneumonias, With Special Reference to Chemotherapy Drs. Agustin Liboro, Hermogenes Santos and Emmanuel Gatchalian Department of Medicine, Faculty of Mldicine and Surgery, University of Sto. 'T omo.s. The Adequacy of Post,War Diet of Filipino Wage Earners in the City of Manila. Dr. Isabelo Concepcion Department of Bio,Chemistry, Faculty of Medicine and Surgery, University of Sto. 'Tomas. The Use of Human Ascitic Fluid in Shock, Nephrosis and Allied Conditions Drs. Ricardo D. Molina (deceased), Hermogenes Santos, and Mariano Alimurung. Department of Medicine, Faculty of Medicine and Surgery, Universioty of Sto. 'Tomas. Tetrachlorethylene Treatment in Ankylostomiasis Drs. Ricardd D. Molina (deceased) and Hermogenes Santos Department of Medicine, Faculty of Medicine and Surgery, University of Sio. 'Tomas. SECTION ON OBSTETRICS AND GYNECOLOGY FRIDAY, MAY 10, 1946. 8, 12 A.M. Chairman • • • • • • • • • • • • • . • • • • • • Dr. Honoria Acosta,Sison Secretary • • • • • • • • • • • • • • • . • • • • Dr. Jose Villanueva War Strain as a Contributory Cause of Prolapse of the Uterus Dr. P. Bayan Departmen•t of Gynecology, College of Medicine. U. P. Dystocia and Occipito, Posterior Position Dr. Jose Villanueva Department of Obstetrics, College of Medicine, U. P. Stillbirths and Neonatal Deaths in the Philippine General Hospital From April 1, 1945 To April 15, 1946. Drs. Honoria Acosta,Sison and Jose Villanueva Department of Obstetrics, College of Medicine, U. P. Caesarian Section-A CritiqueDr. Jose Gena to . Depantment of Gynecology, Faculty of Medicine and Surgefy, University of Sto. Toma&. The Managemen~ of Placenta Previa Drs. Guillermo Rustia and Gloria Tancinco,Yambao Department of Obstetrics, College of Medicine, V. P. The Importance of HBEs in the Positive Diagnosis of Uterine Chorioepithelioma Dr. Honoria Acosta,Sison Depa.,,tment of Obstetrics, College of Medicine, U. P. The Rh Factor Among Filipinos Drs. Constantino P. Manahan and Mamerta Andaya 'N.orth General Hospital. Is Hypoproteinemia The Cause of Toxemias of Pregnancy? Drs. Honoria Acosta,Sison and Angelica lnfant~do Depa11tment of Obstetrics, College of Medicine, U. P. The Early Diagnosis of Cancer of the Cervix Dr. Constantino Manahan St. Lu~e's Hospital and North General Hospital Rupture of the Uterus on Previous Cesarean Section Dr. Alfredo Baens Depo.Ttmenit of Obstetrics. CoUe,e of Medicine, U. P. Volume XXIll Number 4 PROGRAJl OF THE 39th ANNUAL MEETING The Management of Prolapse of the Uterus Drs. Constantino P. Manahan and Jovita Coronado 'N_orth Gener4l Hospital. Pyelonephritis of Pregnancy Drs. Jose Villanueva and Gregoria Maree.lo Department of Obstetrics, Philippine General Hospi•uil and. Dr. Luis F. Torres, Jr., Department of Surgery, Philippine Gener~ Hospital. Chorionepithelioma: Its Relationship to Hydatidiform Mole Drs. N. A. Espinola and C. P. Manahan North General Hospital. SECTION ON SURGERY SATURDAY, MAY 11. 1946. g,12 A.M. Chainnan Secretary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pancreatic Aneurism, Report of a Case Dr. M. C. Magboo Dr. Jose Y. Fores Dr. Luis F. Torres, Jr. Department of Surgery, St. Lu~e's Hospital. A Rare Case of Umbilical Fistula With Evisceration Drs. J. Y. Fores and C. P. Manahan Departmerut.s of Surgery and Gynecology, St. Lu~e'.s Hospital. Modern Trends in Urology Dr. Domingo Antonio, Jr. 185 Departments of Su~geey and Uroliogy, Faculty of Medicine and Surgery, University of Sto. 'Tomas. The Incidence of Cancer in General Hospitals for the Past Five Years Drs. ] . Z. Sta. Cruz and Mario Oca Department of Pathology, St. Lu~e's Hospital. Some Problems in Goiter Surgery Dr. Aurelio Dayrit Department of Medicine, Faculty of Medicine and Surgery, University of Sto. 'T om4S. Experiences W itb Surgery ofl the Autonomic Nervous System Drs. G. Santos,Cuyugan and G. Veloso Department of Surgery, College of Medicine, V. P. Cranium Bitidum With Encephalo,Meningocele: A Case Report Drs. Andres Zavalla and Victor A. Reyes Department of Surgery, Conege of Medicine, V. P . • ~rrest of Growth as a Complimentary Surgical Treatment for Old Untreated Fractures of the Lower Extremity Dr. Rodol fOI Gonzales Department of Medicine, Faculty of ~ifedicine and Surgery, University of Sto. 'Tomas. Gallbladder Disease-An Analysis of Cases in the North General Hospital Drs. FranCisco Guzman and Pablo Morales North General Hospital Surgical Aspects of Scurvy Dr. Alberto A. Galves, Lt. Col., MC, PA Camp Olivas St4tion Hospital. Benign Giant,Cell Tumor of the Right Humerus: Case Report (5 years follow up after X1 Ray treatment) Dr. P. Chikiamco Department of Physical Therapy,t Philippine General Hospital. Epidermoid Carcinoma of the Vulva: Radical Vulvectomy Dr. M. C. Magboo Department of Surgery, St. Lu~e's Hospital. 186 PROGRAM OF THE 39th ANNUAL MEETING The Radiological Aspects of Gastro· Intestinal Adhesions Drs. P. Garcia and M. C. Mag boo Departments of Surgery and Radiology, St. Lu1<,e's Hospital. Repair of Bucal Fistula By Transplantation of Skin Using Tube·Flap Method Dr. Jaime E. Laico . Department of Surgery. College of Medicine. V. P. A Case of Ureteral Leukoplakia: Resection of Ureter Drs. Luis F. Torres, Jr. and Porfirio Recid Department of Surgery, CoUege of Medicine, V. P. Modification in the Repair of Inguinal Hernia Drs. C. S. Harn, M. de Leon, Jr. and M. S. Ocampo St. Lu~e's Hospital. Report of a Case of Motile Body in the Thigh C'Pague" Bone) Dr. Jose Leviste Department of Surgery, St. Lu~e's Hospital SECTION ON MEDICINE AND PEDIATRICS SATURDAY, MAY 11, 1946. 8·12 A.M. Chairman • . . . . • . . • • . • • . . • . • . . Dr. Gonzalo Santos Secretary • • • • • • • • • • • • • • . . • . • • Dr. Jose G. Cruz A Morphological Variation of Plasmodium Vivax Dr.· T. P. Pesigan Department of Parasitology, Institute of Hygiene, U. P. Hemophilia in Pour Generations Drs. Alberto V. Tupas and Domiciana P,. Dauis Department of Pediatrics, College of Medicine, V. P. Dr. Potenciana Kabigting-Chavez Department of Laboratories, Philippine General Hospital. Primary Atypical Pneumonia (A Study of 241 Cases of .. Lobar Pneumonia") Drs. P. D. Gutierrez, P. F. Tangco and D. Ruiz Department of Medicine, College of Medicine, V. P. 1'.fultiple Serositis Caused by Tuberculosis Drs. Alberto V. Tupas and Artemio P. Jongco Department of Pediattrics, CoUege of Medicine, U. P. Amoebiasis in Children Jour. P. M. A. April. 1946 Ors. Alberto V. Tupas, Artemio P. Jongco, Jose 0. Chan and Domiciana F. Dauis Department of Pedia.trics, College of Medicine, U. P. Cancrum Ori~Recent Observation on its Incidence and Treatment Drs. Alberto V. Tupas and Artemio P. Jongca Department of Pediatrics, College of Medicine, V. P. The Efficiency of Hexylresorcinol in Ascariasis as Observed 1n 200 Children Drs. Fe del Mundo and Ester Sucgang N,orth General Hospital. Some Newer Knowledge in Parasitology: A Review Drs. T. P. Pesigan, F. A. Reyes, Jr. and M. G. Yogore, Jr. Department of Parasitology, Institute of Hygiene, U. P . .Syphilis in Children in the Phi1ippine~lts Incidence and Treatment Drs. Alberto V. Tupas and Jose 0. Chan Department of Pediatrics, College of Medicine, V. P. Transfusions in Children With Pooled Type 0 ·Blocd (Closed Method) Drs. Pe del Mundo and Remedios Cenizal North General Hospital. Vclume XXID Number 4 NATIONAL HEALTH PROGRAM Treatment of Malaria in Children as Observed in 100 Cases Drs. Pe del Mundo and Belen Bautista North General Hospital. Xerophthalmia and Keratomalacia in Children With Repord of 96 Cases Drs. Alberto V. Tupas, Leon V. Pecache and Adolfina Melo Department of Pediatrics, College of Medicine, U. P. NATIONAL HEALTH PROGRAM OF THE AMERICAN MEDICAL ASSOCIATION Adopted by the Board of Trustees and the Council on Medical Service, Feb. 14, 1946 (Published J. A. M. A., 130:641 (March) 1946.) 187 1. The American: Medical Association urges a MINIMUM STANDARD OP NUTRI, TION, HOUSING, CLOTHING A'ND RECREATION as fundamental to good health and as an objective to be achieved in any suitable health program. The respon&ibility for; ·at· tainment of this standard should be placed as far as possible on the individual, but the ap· plication of community effort, compatible with the maintenance of free enterprise.. ~hould be encouraged with governmental aid where needed. 2. The provision of PREVENTIVE MEDICAL SERVICES through professionally competend health departments with sufficient staff and equipment to meet community needs is recognized as essential in a health program. The principle of f edera.1 aid through pro vi· sion of funds or personnel is recognized with the understanding that local areas sha11 con, trol their own agencies as has · beei:i established ill: the fie1d of education. Health Depart• men ts should no~ assume the care of the side as a function, since administration df medical care under such auspices trends to deterioration in the quality of service rendered. Me .. dical care to those unable to provide. themselves is best administered by local and' privatet agencies with the aid of public funds when needed. This program for national health should include the administration of MEDICAL CARE, INCLUDING HOSPITALIZATION TO ALL THOSE NEEDING IT BUT UNABLE TO PAY, such medical care to be provided preferably by a physician of the patient's! choice with funds provided by local agencies with the assistance of federal funds when necessary. 3. The procedure established by modern medicine for advice to the prospective mo, ther and for ADEQUATE CARE IN CHILDBIRTH should be made available to all at a pricet that they can afford to pay. When local funds are lacking for the care of those: unable to pay, federal aid should be supplied with the funds administered through local Of' state agencies. 4. The child should have throughout infancy PROPER ATTENTION INCLUDING SCIENTIFIC NUTRITION, IMMUNIZATION AGAINST PREVENTABLE DISEASE AND OTHER SER VICES INCLUDED) IN INF ANT WELFARE. Such services are best supplied' by personal contact between the mother and the individual physician but may he: provided through child care and infant welfare stations administered under local auspices with support by tax funds whenever the need can be shown. 5. The, provision of HEALTH AND DIAGNOSTIC CENTERS AND HOSPITALS necessary to community needs is an essential of good medical care. Such facilities are pre· ferably supplied by local agencies, including the community,• church and trade agencies which have been responsible for the fine development of facilities for medical care in most Amer· ican communities up to this time. Whete such ·facilities are unavailable and cannot ':>e supplied through local or state agencies, the federal government may aid, preferably under a plan which requires that the need be shown and that the community prove its ability to maintain such institutions once they are established (Hill· Burton bill.) 6. A program for medical care within the American system of individual initiative and freedom of enterprise includes the establishment of VO LUNT ARY NONPROFIT PRE· 188 NATIONAL HEALTH PROGRAM Jour. P. M. A. April, 1946 PAYMENT PLANS FOR THE COST OF HOSPITALIZATION (such as the Blue Cross plan) and VOLUNTARY NONPROFIT PREPAYMENT PLANS FOR MEDICAL CARE (such as those developed by many state and county medical societies.) Th9 principles of such insurance contracts should be acceptable to the Council on Medical Service of the Amer, ican Medica~ Asssociation and to the authoritative bodies of state medical associations. The evolution of voluntary prepayment insurance against the cost of sickness admits also the utiliiation of private sickness insurance plans which comply with state regulatory statutes and meet the standards of the Council on Medical Service of the American Medical As, sociation. 7. A program for national health should include the administration of MEDICAL CARE .. INCLUDING HOSPITALIZATION, TO ALL VETERANS, such medical care to be provided preferably by a physician of the veteran's choice, with payment by the Veterans Administration through a plan mutually agreed on between the state medical association and the Veterans Administration. 8. RESEARCH FOR THE ADVANCEMENT OF MEDICAL SCIENCE is funda· mental in any national health program. The inclusion of medical research in a National. Science Foundation, such as proposed in pending federal legislation, is endorsed. 9. The services rendered by VOLUNTEER PHILANTHROPIC HEALTH AGEN, CIES such as the American Cancer Society, the .National Tuberculosis Association, the Na, tional Foundation for Infantile Paralysis, Inc., and by philanthropic agencies such as the Commonwealth Fund and the Rockefeller Foundation and similar bodies have been of vast benefit to the American people and/ are a natural outgrowth of the system of free enterprise . and democracy that prevail' in the United States. Their participation in a national health program should be encouraged, and die growth of such agencies when properly administered •hould be commended. 10. Fundamental to the promotion of the public health and alleviation of illness are WIDESPREAD EDUCATION IN THE, FIELD OF HEAL TH and the widest possible dis, semination of information regarding the prevention of disease and its treatment by authori, tative agencies. Health education should be considered a necessary function of aU depart, ments of public health, medical associations and school authorities.-F. N. F. V~ll.4m~ xxrn Numbt>r 4 Exclusive Distributors LA ESTRELLA DEL NORTE LEVY HERMANOS, INC. 1001-1007 R. Hidalgo Manila, P. I. XI XII Jour. P. M. A. Apdl, 1~46 Velum-? XXII Number 4 BARLOW=MANEY has the pleasure to introduce to THE PHILIPPINE MEDICAL PROFESSION the fine.st quality PHARMACEUTICAL PRODUCTS XIII We p1·opose to maintain the highest ethical quali,fAJ of P'harmaoeuticals. This is a point of necessity witk BARLOW-MANE"!{ products a w,1ne you can have the utrnost cont idence in. Some of our products worth waiting for: PENICILLIN PECTO-KALIN AMINOPHYLLIN BI-FER-LIN NONA-VI1\1S • PECTO-THIAZOLE CHERRO COUGH SYRUP CAL-0-NOL CREAM BARLOW-MANEY, LABORATORIES INC. Manufacturing Pharmaceutical Chemists ---------~ Philippine Representative: MANILA c·HEMICAL COMPANY (A. T. Suaco & Co., Ltd.) Manila Off ice : 1111 Tay a bas. St., Manila XIV Jour .. P. M. A. April, rn46 Commonwealth of the Philippines Department of Public Works and Communications BUREAU OF POSTS Manila (Required by Act No. 2580) The undersigned, PEDRO M. CHANCO, bu~iness manager of JOURNAL OF THE PHILIPPINE MEDICAL ASSOCIATION, published Monthly in English at Manila, 547 Her.ran St., Manila, after having been duly sworn in accordance with law, hereby submits the following statement of ownership, management, circulation, etc., which is required by Act No. 2580, as an1ended by Commo1_1wealth Act No. 201: Name Editor: Antonio S. Fernando, M.D. Bu&iness Manager: Pedro M. Chanco Owner: Philippine Medical Association Publisher: Philippine l\1:edical Association Printer: Carmelo & Bauermann, Inc. Office of Publication: Post-Office Address 547 Herran St., Manila College of l\1edicine, U. P., Manila 547 Herran St., Manila 547 Herran St., Manila 2057 Azcarraga St., Manila 547 Herran St., Manila If publication is -0wned by a corporation, stockholders owning one per cent or more of the total amount of stocks: (Not owned by a corporation) Bondholders, mortgagees, or other 8ecurity holders owning one per cent or more of total amount of security: None In case of publication other than daily, total number of copies printed and circulated of the last issue, dated January, 194 6 1. Sent to paid subscribers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 504 2. Sent to others than paid subscribers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 562 PEDRO M. CHANCO Business Manager Subscribed and sworn to before me this 27th day of March, 1946, at l\lanila, the affiant exhibiting his Residence Certificate No. A13071, issued at l\lanila, on .January 5, 1946. Doc. No. 309 Page No. 58 Book No. 18 Series of 1946. HUGO S. YONZON Notary Public until Dec. 31, 1946. Volume XXII Number 4 xv For Regeneration & Growth FI-MA CALVITA for NURSING & EXPECTANT MOTHERS and for the health of growing CHILDREN. It supplirnents in adequate amounts the essential dietary minerals and nutritive needs of a healthy diet, increasing and improving the maternal milk, building up strong and healthy Children, the bulwark of every nation, our nation, Dear Doctor! Dosage: Generally starting with % teaspoonful for babies, increasing to 1 teaspoonful ~3 times daily. Adults in tablespoonfuls 3 titnes daily or as directed by the physician. In 12 Oz. bottles at ai.l Drugstores or from FIMA-465 Leveriza, Pasay, Rizal-Tel. 5-16-36 H. E. A. FISCHER - Philippine Citizen XVI Jour; P. M. A. April, 1946 , MEDICACION POR INFILTRACION La acci6n de NUMOTIZINE esta indicada para descongesti6n y analgesia prolongadas y efectivas en condiciones inflamatorias ligeras. Por infiltraci6n a troves del emplasto y de las capos dermicas y epidermicas, el guayacol, la creosote de haya y el salicilato de metilo son lentamente absorbidos, produciendo efectos terapeuticos sistematicos locales. NUMOTIZINE eierce su efectividad en forma gradual y firme por un periodo de ocho horas o , mas. no nn on rru lf ··n JJ n c \n re LA CATAPLASMA POR EXCELENCIA UU UD Li 1 Ju lill LI LI ll:: Li U'1 J lb NUMOTIZINE es limpio y f6cil de usarse; evita el inconveniente de procedimientos antiguos, como recalentamiento, y, en consecuencia, elimina la necesidad de una atenci6n constante. Esta indicado en afecciones inflcmatorias ligeras del arbol respiratorio, torceduras, neuralgias, contusicnes, epididimitis, •• abscesos superficiales, mialglas, neuritis y condiciones similares. Se suministra en tarros de cristal de 57, 114, 228, 425 y 850 gramos. MUMOTIZINE, INC., 900 NORTH FRANKLIN ST., CHICAGO 10, ILLINOIS, E. U. de A.