May, 1929 FIRST MEDICAL PUBLICATION, U. S.-RODIN 345 the indirect cases was 3.89 days. There were 648 treated with neutral ammonium tartrate 5 per cent, direct and 723 indirect cases. Eleven severe in- as advocated by Barkan of San Francisco.' The direct cases requiring from one month to a year's results that are obtained by this method are sur- treatment were not considered. The usual first-aid prising. Since using it the writer has not had one treatment in the indirect cases was not taken into case of disability, whereas prior thereto he had consideration in arriving at these conclusions. some very severe cases which when first seen gave The diagnosis and kind of treatment of these indications of considerable permanent disability. industrial cases is important. It is vital that a true With reference to burns, especially of the acid and accurate history of the injury be obtained; or alkali type, thorough washings with salt solu- and this having been obtained, the examination of tion should be made, followed by castor oil instilla- the injury itself can be taken up. To do this it is tion and pad. Any additional treatment is neces- imperative that we have a light of the proper in- sarily dependent upon the severity of the case. tensity and a suitable magnifying lens, otherwise From the standpoint of prevention, a greater small yet disturbing foreign bodies will not be dis- use of goggles is suggested. The employer covered. Likewise minute abrasions, lacerations, should also placard his shops with signs caution- and various small penetrating wounds, which if ing employees not to try to remove objects from not recognized and treated at an early stage, might the injured eyes of fellow workmen. In nearly later not only cause disability but even loss of the every instance this act, although motivated by a eye itself. In this connection, it is recommended kindly and sympathetic feeling, results in infec- that a concentrated alkaline solution of fluorescein tion, thereby greatly lengthening the treatment. (Gruebler's fluorescein 2 per cent; carbonate of In this connection I close by quoting E. C. Ellett, soda 3.5 per cent) be dropped on the cornea. That M. D., of Memphis: 2 "It is much wiser to adopt portion of the cornea deprived of its epithelium precautions although somewhat troublesome than will be colored green, likewise any portion of the to receive an accident which may impair one's epithelium that may be diseased, while the healthy sight, and cause, not only pain, suffering, loss of epithelium will remain unaffected. time and expense, but permanent disability, un- If there is any doubt of the existence of a for- happiness, and decrease of earning power." eign body within the eye, a careful x-ray exami- 1904 Franklin Street. nation is in order. The technique for removing the foreign body REFERENCES the eye must be given careful considera- 1. Barkan, 0. and H.: The Journal of the American from Medical Association, November 15, 1924, Vol. 83, pp. tion. First, the cornea is thoroughly anesthetized 1567-1569. (writer uses butyn 2 per cent, or holocain). Then 2. Ellett, E. C.: Conservation of Vision Series, Pam- the foreign body itself is completely removed as phlet xiii, p. 6. well as its stain, with a suitable small spud or curet, paying at all times proper respect to the HISTORY normal and healthy epithelium. Usually the gen- THE LURE OF MEDICAL eral man is quite proficient in removing the for- THE FIRST MEDICAL PUBLICATION IN THE eign body, but is rather remiss in removing the UNITED STATES stain itself, which is the underlying cause for the By FRANK H. RODIN, M. D. increased length of treatment referred to herein San Francisco above. It is urged that great care be given to proper sterilization of all instruments. T[ HE first printing press in America was estab- After the removal of the foreign body and of lished at Cambridge, , in 1639, any stain present, the eye is thoroughly cleansed and was under the control of Harvard College. with either saturated boric acid water or normal The first publications were the "Freeman's Oath" salt solution. Some antiseptic solution is then in- and "An Almanack," which appeared in the same stilled (the writer uses 1 per cent mercurochrome) year. In the following year the first book pub- and in the event the curettement has caused con- lished in the Colonies appeared: "The Psalms in siderable loss of epithelium, a 1 per cent holocain Metre, Faithfully translated for the Use, Edifica- and adrenalin ointment is instilled, followed with tion, and Comfort of the Saints in publick and a proper pad. The use of a good pad is consid- private, especially in ," commonly ered by the writer as the most necessary and im- called "The Bay Psalm Book." The printing of portant treatment afforded the patient after the books was regarded with suspicion by the authori- removal of the foreign body. In all forms of cor- ties, as it seemed "to open the door of heresy," neal injury, with few exceptions, it is essential and in 1662 two "Licensers of the Press" were that a pad be used. Too often the pad is not used, appointed. Strict supervision was maintained over thereby again affecting the length of time of everything that was printed. In this respect they treatment. did not differ greatly from us of a more modern Lime burns are very often neglected, and espe- age. The majority of the books published were cially so by the patient. After flushing out the expositions of Puritanical theology. Two years eye, or eyes, with water, such patients should later a law was passed prohibiting the establish- then consult a physician. Unless the doctor com- ment of any printing press in the colony of Massa- pletely removes all of the lime much damage, chusetts, except at Cambridge. In 1674, however, trouble and very lengthy treatment results. The this law was suspended and the general court, at lids should be everted and all particles carefully the session in May of that year, passed the follow- removed. After more washing the eye is then ing order: "Whereas there is now granted that 346 CALIFORNIA AND WESTERN MEDICINE Vol. XXX, No. S

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there may be a printing Presse elsewhere than to set up a printing press in , then a town at Cambridge; for the better regulation of the of about five thousand people. Presse it is ordered and Enacted that the Rev. One of Foster's early publications and the first Mr. Thomas Thacher and Rev. , contribution of a Colonial practitioner to the medi- of Boston, be added unto the former Licensers, cal literature was Rev. Dr. Thomas Thacher's and they are hereby impowered to act accord- "Brief Rule to guide the Common People of ingly," and permission was given to John Foster New-England how to order themselves and theirs May, 1929 CASE REPORTS 347 in the Small Pocks, or Measels," and was pub- CLINICAL lished in double column, on one side, as a poster, NOTES, CASE REPORTS and was fifteen and one-half by ten inches. An AND NEW INSTRUMENTS epidemic of smallpox prevailed in Boston during the years 1676-1678, and this was probably the IRRADIATION IN reason for Doctor Thacher's publication. The MYELOID LEUKEMIA, accompanying facsimile has been made from a WITH MASSIVE SPLENOMEGALY* photostat reproduction made from an autotype of the original in the possession of the Library of REPORT OF A CASE the College of Physicians of Philadelphia. A re- By W. T. CUMMINS, M. D. print of the publication, made in 1702, was a little San Francisco pamphlet of eight pages, five and one-half by three and one-half inches. B., service of Dr. Philip King Brown, a Portu- guese, male, age 43, painter. Admitted Feb- Doctor Thacher was born in England May 1, ruary 28, 1925. Family history unessential. He stated 1620. His father, the Rev. Peter Thacher, was a that five months ago he caught a cold and that two minister at Sarum (Salisbury). Thomas received months before he went to a doctor for pleurisy, which a good school education and his father planned was cured. During the five months he lost twenty- four pounds in weight. One week prior to admis- to send him to Oxford or Cambridge. For some sion he went to bed, having contracted another cold. unknown reason he refused and at the age of Physical examination revealed a moderately well- fifteen emigrated to New England. Soon after developed physique. Teeth were in very poor condi- his arrival he continued his studies under Dr. tion. Tonsils were slightly enlarged and congested. Charles Chauncy, an M. D. of Cambridge, pastor The left upper abdominal quadrant was filled with a slightly tender mass, which was diagnosed as spleen. of the church at Scituate, and probably the most Liver appeared normal. No ascites present. Tempera- learned man at that time in the Colonies. From ture, pulse. and respirations normal. Blood pressure, Chauncy he no doubt received some of his medi- 122/76. Urine, slight trace of albumin. Blood: hemo- cal training. Doctor Chauncy became the second globin, 60 per cent; erythrocytes, 2,960,000; leukocytes, 320,000; myelocytes, 13 per cent. Blood Wassermann president of Harvard in 1654. negative. Roentgenologic examination revealed an en- It was common to find, in the New England larged left kidney as well as spleen. Basal metabolic Colonies, the frequent combination of the offices rate plus 54 per cent, and after two x-ray treatments of minister and physician, or even minister, to spleen, thighs, and legs it fell to plus 28 per cent. Diagnosis, myeloid leukemia. He was discharged im- teacher and physician, in one and the same per- proved on April 10, after forty-two days in the hos- son. Many Puritan divines, before going to the pital. Over a period of fifteen days, with four x-ray Colonies, acquired as much of a medical training treatments to spleen, thighs and legs, the leukocytes as conditions would permit. Following this prac- were reduced to 5800, and the myelocytes to 3 per who was ordained a minister at cent. Hemoglobin fell to 50 per cent, but the erythro- tice, Thacher, cytes were increased by one million. The minimum Weymouth, June 2, 1644, not only preached but leukocytic count was noted three weeks after the last also practiced medicine. In 1677 he removed to treatment. He felt well for several months after leav- Boston, where he was installed as the first minis- ing hospital and gained eighteen pounds in weight. ter of the Old South Church, February 16, 1670. Then he began to lose strength and felt a dragging In this position he also devoted a great deal of sensation in left side. He returned for examination on March 3, 1926. his time to the practice of medicine, and was Leukocytes 87,000, and myelocytes 14 per cent. Over regarded by the colonists as one of the eminent a period of twenty-one days, as an out-patient, he re- physicians of Boston. He was also a scholar in ceived six x-ray treatments to spleen, thighs, legs, and Arabic and composed a Hebrew lexicon and wrote sternum. The minimum leukocytic reduction to 8100 and 3 per cent myelocytes was noted four weeks after a catechism. He was taken ill after visiting a the last treatment. A physical betterment was main- patient, and died of a fever October 15, 1678, at tained for several months, when his conditiorn again the age of fifty-eight years. began to retrogress. Commenting on Doctor Thacher's early publi- He was readmitted to hospital on December 2, 1926. cation, Doctor Handerson has said: "That the The spleen appeared larger than upon first exainina- a translation tion. Leukocytes 194,000 and myelocytes 8 per cent. leaflet is only compendious English He was feeling fairly well and, expressing a desire to of a portion of the writings of Sydenham, a trans- go home, he was discharged after two days in hospital. lation in which the original is followed so closely During the next eight months leukocytic counts ranged as to enable one to determine even what edition from 134,000 to 246,000, and myelocytes 8 to 11 per of the author the translator had before him, is no cent. In July 1927, his condition having materially retrogressed, he was again admitted to hospital (27th). reflection upon the motives of Doctor Thacher, Over a period of six weeks he received twenty-seven who not only disclaims all originality, but takes x-ray treatments to ribs, sternum, forearms, thighs, pains to inform the reader that he is 'no Physi- and legs. The minimum leukocytic count of 8700 was tian.' That he selected a good model is rather to obtained on the last day of treatment (September 15). He was discharged improved on that date. He was his credit." able again to return to work for a period of about six 490 Post Street. weeks. REFERENCES On November 6 while in bed he was seized with Thomas, I.: The History of Printing in America with dyspnea, and five days later returned to hospital. Ex- a Biography of Printers, and an Account of News- amination revealed the spleen to be enlarged almost papers, Worcester, From the Press of I. Thomas, Jr., to right iliac crest. Leukocytes, 119,000. Fifteen x-ray 1810, Vol. i, p. 275. treatments to spleen, sternum, forearms, thighs, and Handerson, H. E.: The Earliest Contribution to legs were given over a period of seven weeks. Within Medical Literature in the United States, Janus, 1899, * Read before the San Francisco County Medical Society, Vol. iv, p. 540. April 4, 1928.