2009-Jul/Aug - SSV Medicine by Sierra Sacramento Valley Medical Society

Sierra Sacramento Valley

MEDICINE Serving the counties of El Dorado, Sacramento and Yolo

July/August 2009

Inside This Issue s

The slide box of Dr. Frederick Lloyd, who died in 1890, was the source the photos on page 22 and the following article. Evidently, small, hinged boxes with trays were the way slides were stored at the time. Today, slides are prepared by the thousands and pathologists can barely keep up with reading them, much less preserve them so elegantly.

The 51st Evacuation Unit from Sacramento ran this 750-bed hospital near the village of Welzheimin, Germany, late in World War II. The photo was taken by Dr. E.T. Rulison from an airplane flown by artillery spotters of the 81st Division. In 1937, while still a medical student, Dr. Rulison saw Adolph Hitler during a trip to Berchtesgaden and wrote about it in his diary, on page 15. He discusses that trip in an interview, followed by his photos taken in 1945, on pages 19 and 20. To read more about the history and view photos of the 51st Evacuation Unit, search for google 51st evacuation hospital on the Internet, or go directly to http://roguepublishing.com/51st/51st_evacuation_hospital_history. htm

Sierra Sacramento Valley

Medicine 3

PRESIDENT’S MESSAGE SSVMS’ Report Card

Charles H. McDonnell, III, MD

Are We Still Relevant?

Bill Sandberg

Voices of Yesteryear

Del Meyer, MD

Early Sacramento Medical History Quiz

Irma West, MD

Correction: In our last issue, the high school student essays were trans-located; each essay appeared as written by the other student author. We used numbers to identify the authors to keep the contest completely impartial; the numbers were somehow misallocated, thus the names as well. The on line issue of SSV Medicine, which is much more widely accessible than the hard copy, was withheld until corrections were made. Anyone can read, download, and print the on line issue. I extend to the authors my sincere apology for any inconvenience our error may have caused. — John Loofbourow, MD, editor

A Glimpse of Adolph Hitler

E. T. Rulison, MD·

Looking Back at a Visit to Berchtesgaden

Parasitic Diseases of Pork

Gordon Love, MD

A Repository of History

John Loofbourow, MD

Radionics and “Electrical Reactions of Abrams·”

Kent M. Perryman, PhD

What Medicine Advertised 100 Years Ago

F. James Rybka, MD

Board Briefs

Employment Practices Liability Insurance

New Applicants

Classified ads

We welcome articles and letters from our readers. Send them by e-mail, facsimile or mail to the Editorial Committee at the address below. Authors will be able to review any edits before publication. All articles are copyrighted for publication in this magazine and on the Society’s web site. Contact the medical society for permission to reprint.

SSV Medicine is online at www.ssvms.org/magazine.asp “Gone Fishing” is another in a series of covers by Greg Joy, MD, of Placerville, a retired orthopedic surgeon. He took the photo in about 2000, and started working on it a couple of years later. His comments: “Baja California has long been one of my favorite places to photograph. The only reason for arising early to fish is to watch the sun rise over calm water. This 35mm slide was scanned at 2800dpi into Photoshop, worked and then a small portion was cropped, blown up and used to make this piece.

Volume 60/Number 4 Official publication of the Sierra Sacramento Valley Medical Society 5380 Elvas Avenue Sacramento, CA 95819 916.452.2671 916.452.2690 fax info@ssvms.org

“When a photograph originates on film and is enlarged too much, the emulsion begins to affect the work. In this instance, I was able to work the piece and use this anomaly to add texture.” Some of Dr. Joy’s images can be seen at his website, www.alegriastudio.com.

July/August 2009

Sierra Sacramento Valley

MEDICINE Sierra Sacramento Valley Medicine, the official journal of the Sierra Sacramento Valley Medical Society, is a forum for discussion and debate of news, official policy and diverse opinions about professional practice issues and ideas, as well as information about members’ personal interests. 2009 Officers & Board of Directors Charles McDonnell, III, MD President Stephen Melcher, MD President-Elect Margaret Parsons, MD, Immediate Past President District 1 Alicia Abels, MD District 2 Michael Flaningam, MD Michael Lucien, MD Glennah Trochet, MD District 3 Katherine Gillogley, MD District 4 Ulrich Hacker, MD 2009 CMA Delegation Delegates District 1 Jon Finkler, MD District 2 Lydia Wytrzes, MD District 3 Barbara Arnold, MD District 4 Ron Foltz, MD District 5 Elisabeth Mathew, MD District 6 Marcia Gollober, MD At-Large Alicia Abels, MD Michael Burman, MD Satya Chatterjee, MD Richard Jones, MD Norman Label, MD Stephen Melcher, MD John Ostrich, MD Charles McDonnell, MD Janet O’Brien, MD Kuldip Sandhu, MD Earl Washburn, MD

District 5 John Belko, MD David Herbert, MD Robert Madrigal, MD Elisabeth Mathew, MD Anthony Russell, MD District 6 J. Dale Smith, MD

Alternate-Delegates District 1 Robert Kahle, MD District 2 Margaret Parsons, MD District 3 vacant District 4 Demetrios Simopoulos, MD District 5 Boone Seto, MD District 6 Karen Hopp, MD At-Large Richard Gray, MD Sanjay Jhawar, MD Robert Madrigal, MD Mubashar Mahmood, MD Connie Mitchell, MD Anthony Russell, MD Gerald Upcraft, MD

CMA Trustees 11th District Dean Hadley, MD Richard Pan, MD Solo/Small Group Practice Forum Lee T. Snook, MD Very Large Group Forum Paul R. Phinney, MD AMA Delegation Barbara Arnold, MD, Delegate Richard Thorp, MD, Alternate Editorial Committee John Loofbourow, MD, Editor David Gibson, MD, Vice Chair Robert LaPerriere, MD William Peniston, MD Gordon Love, MD Gerald F. Rogan, MD John McCarthy, MD F. James Rybka, MD Del Meyer, MD Gilbert Wright, MD George Meyer, MD Lydia Wytrzes, MD John Ostrich, MD Managing Editor Webmaster Graphic Design

Ted Fourkas Melissa Darling Planet Kelly

Advertising rates and information sent upon request. Acceptance of advertising in Sierra Sacramento Valley Medicine in no way constitutes approval or endorsement by the Sierra Sacramento Valley Medical Society of products or services advertised. Sierra Sacramento Valley Medicine and the Sierra Sacramento Valley Medical Society reserve the right to reject any advertising. Opinions expressed by authors are their own, and not necessarily those of Sierra Sacramento Valley Medicine or the Sierra Sacramento Valley Medical Society. Sierra Sacramento Valley Medicine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. Not responsible for unsolicited manuscripts. ©2006 Sierra Sacramento Valley Medical Society Sierra Sacramento Valley Medicine (ISSN 0886 2826) is published bi-monthly by the Sierra Sacramento Valley Medical Society, 5380 Elvas Avenue, Sacramento, CA 95819. Subscriptions are $26.00 per year. Periodicals postage paid at Sacramento, CA. Correspondence should be addressed to Sierra Sacramento Valley Medicine, 5380 Elvas Avenue, Sacramento, CA 95819-2396. Telephone (916) 452-2671. Postmaster: Send address changes to Sierra Sacramento Valley Medicine, 5380 Elvas Avenue, Sacramento, CA 95819-2396.

Sierra Sacramento Valley Medicine

President’s Message

SSVMS’ Report Card Just how well does our medical society operate?

By Charles H. McDonnell, III, MD In my years on the Sierra Sacramento Valley Medical Society (SSVMS) Board of Directors, I have been impressed with the transparency and fairness with which the organization operates. The dedication of so many physician leaders from our three counties has been even more moving. Nevertheless, the vast majority of our members have not had time to attend a California Medical Association (CMA) meeting or serve on a SSVMS committee. Therefore, it is difficult to appreciate how the SSVMS compares with the other county medical societies. With this “report card,” I hope to address many of the questions that have been posed to me by rank and file members over the last few years.

Dues. The last dues increase was $5 in 1985, and dues dropped $65 in 2000. Our dues today are $425. Dues vary widely throughout the state, mainly as a reflection of the size of county medical societies, varying levels of services and degree of participation in CMA activities. In 2007 (the latest data I could find), the range was $50 to $545 with the majority at $350 or more. The range for societies our size and larger was $350 to $450. Grade: AWhat was my justification for the A? Did I say dues have been flat for 24 years?

Financial Stewardship. SSVMS’s investments for 14 years have been managed by Patty Estopinal, CIMA, who is Senior Vice President–Wealth Management and Senior Investment Management Consultant with MorganStanley SmithBarney. The investments are reviewed by the SSVMS Executive

Committee and Board of Directors at least quarterly. While Kuldip Sandhu, MD, was SSVMS President, he developed a customized index to track our returns against. The customized index represents what returns we would likely achieve if we managed the funds ourselves using only index mutual funds. Patty Estopinal has managed to beat the customized index 7 out of the last 8 quarters. The investments are conservative as attested to by last year’s performance, when the general fund lost only 13 percent compared to more than a 38 percent loss for the S&P 500. The general fund has a reserve approximately equal 15 months of operating expenses, which is within the typical range for not-for-profit organizations. The society’s financial operations are audited annually by Lindsay Kate Lane, CPA. Many members might not know that the SSVMS owns its building at 5380 Elvas Avenue in Sacramento. It is a two-story, 13,500-square foot ADA compliant building with an elevator.

A Note on this Month’s Issue Sierra Sacramento Valley Medicine usually publishes articles unconstrained by subjects or theme. This month is different. Most of the emphasis is on history, with content varying from advertising in medical journals 100 years ago to recollections of a physician seeing Adolf Hitler at Berchtesgaden in 1938. We hope that the color and subjects of this issue meet with your approval. — Gordon Love, MD, Guest Editor

July/August 2009

It houses our Medical History Museum, board room and executive offices. There are conference facilities upstairs that can be reserved and utilized by SSVMS members; 3,000 square feet of office space is leased out and managed by our executive staff. Grade: A-

Membership. In 2008 we had 1,592 active members — more than any time in our history — plus 340 retired and 380 medical student members. The 1,592 members represent about half of practicing physicians in the area. This may seem low, but compares favorably to the rest of the state’s medical societies; membership ranges between 15 percent and 75 percent with an average in 2007 of 33%. This level of membership makes us the 5th largest society in California. Grade: A-

As I have been attending

Administration.

the various committees, I have been amazed at the high level of participation at the meetings.

Between executive director Bill Sandberg and associate director Chris Stincelli, there are 62 years of experience and institutional memory. We have a total staff of seven. This ranks toward the top for county medical society administrative capacity. In addition to supporting our own committees and activities, staff support the 11th delegation to the CMA. Bill serves on several community committees and task forces as well as being an advisor to NORCAL Mutual Insurance Company. I have personally found the extraordinary SSVMS executive staff to be a powerful resource that I believe is underutilized by members. Over the past several years, when I have asked for advice, information or other resources with the expectation of hearing back in a week, I typically get a phone call or email in an hour or two. The next time a question arises in your practice, I challenge you to call SSVMS to experience this level of service for yourself. Grade: A

Environmental Responsibility (shade of green). Any evaluation of an organization these days includes an assessment of green practices. While Richard Jones, MD, was president, there was interest in photovoltaic panels for the roof of the SSVMS building, but for many reasons it

Sierra Sacramento Valley Medicine

didn’t make sense at the time. Since then, the society has begun replacing the failing single pane windows in the SSVMS building with new, much more energy conserving double pane windows. A couple of HVAC units have also been replaced with much more efficient units. This year the SSVMS Board of Directors and staff have been implementing a green initiative each month, such as the elimination of bottled water, initiation of recycling and the installation of timed thermostats. The bottom line is that we are off to a good start, but we have a ways to go. Grade: B

Dedication of Members. The SSVMS currently has 10 active committees that meet on a regular basis (go to www. ssvms.org/about.asp for a list of committees). It is a tradition for the president of the society attempt to attend at least one meeting of each committee during the year. As I have been attending the various committees, I have been amazed at the high level of participation at the meetings. Furthermore, our monthly executive and board of directors meetings are always extremely well attended. For example, last year there was 86 percent attendance rate for the SSVMS board of directors meetings. Grade: A-

CMA Involvement. SSVMS’ involvement and participation with the CMA is excellent. The SSVMS is entitled to 17 Delegates and 17 Alternate-Delegates to the CMA House of Delegates. Our delegate seats never go unfilled, and there are always ample alternate-delegates waiting in the wings. Admittedly we are at an unfair advantage compared with other county societies, with CMA’s annual meeting occurring right here in Sacramento every other year. SSVMS members also take an active and influential role in CMA leadership. Currently Drs. Richard Pan, Paul Phinney and Lee Snook serve on the Board of Trustees. We have also had several members serve as CMA presidents. The most recent are Drs. John Whitelaw in 2002 and Gene Ogrod in 1995. In addition to our experienced executive staff being well known and connected with CMA staff, we also enjoy

superior access to CMA with its headquarters in downtown Sacramento at 12th and J Street. Grade: A-

Community Service. Community service is not necessarily a core function for county medical societies, but it is for SSVMS. Our Community Service, Education and Research Fund (CSERF) is a non-profit, 501(c)(3) organization established in 1995 by the Medical Society to involve physicians and the larger healthcare community in community services, education, and research. CSERF’s primary programs are the SPIRIT Project, the Adopt-A-School Program, the William E. Dochterman Medical Student Scholarship Fund and the Sierra Sacramento Valley Museum of Medical History. All of these programs are solely supported through contributions and grants from the community. The SPIRIT (Sacramento Physicians’ Initiative to Reach out, Innovate and Teach) Project recruits physicians to volunteer in county clinics in an effort to enhance primary care medical services available to Sacramento’s uninsured. The project also offers a specialty service network comprised of office referrals to participating SPIRIT physicians, “specialty sub” clinics located within existing county clinics and hernia repair surgeries done at no charge at local hospitals. Members have donated $6.2 million in medical services since inception and treated over 27,000 patients throughout the greater Sacramento area. Last year the SSVMS purchased a Non-Mydriatric digital fundus camera and donated it to Sacramento County to use for screening the uninsured for diabetic retinopathy. The current county financial crisis with county clinic cutbacks is presenting new challenges for our SPIRIT program. We have also initiated a relationship with The Effort Medical Clinic/Community Health Center (a noncounty funded community clinic) which just reopened the Oak Park clinic (recently closed by Sacramento County). Furthermore, our Child and Adolescent Health Services, Emergency Care and Public and

Environmental Health Committees and their dedicated members are actively engaged in the community issues. Finally, having Dr. Glennah Trochet, the Sacramento County Public Health Officer, on our Board of Directors ensures that SSVMS is sensitive to, and well informed on public health issues. Grade: A-

Advocacy. Many members, including myself, believe that the most important function of the SSVMS and CMA is to provide legal and legislative advocacy for physicians in our region. The CMA enjoys advocacy successes each and every year in California, which directly benefits physicians (e.g, maintaining MICRA, blocking Medi-Cal cuts, RICO lawsuits, etc.) I should also point out that the CMA is one of only two state medical societies that supports a lobbyist at the federal level. At the county level, advocacy is difficult to objectively measure. There are many personal and written communications each year between SSVMS and city, county, state and federal entities. Importantly, many SSVMS members and staff have developed relationships over the years with various elected officials. One somewhat objective measure is that for many years SSVMS consistently has received recognition for having the most “300 Club” members (those members contributing $300 or more to CALPAC, the CMA’s political action committee). Grade: B In summary, this may be an illustration of grade inflation. Or maybe I am just too biased for this exercise. But our final grade point average is 3.78 (probably not good enough to get into UC Davis for undergraduate work these days). Furthermore, I only gave out one solid A (there is always room for improvement). I believe this is compelling evidence that we as members of SSVMS have much to be proud of. The credit belongs to the many esteemed former leaders, dedicated members and exceptional executive staff. Thank you for all of your dedication and contributions.

Community service is not necessarily a core function for county medical societies, but it is for SSVMS.

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July/August 2009

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Are We Still Relevant? There may be a relative calm for medicine in our region — but big changes are on the way.

By Bill Sandberg I always enjoyed my history classes. But I did not understand what possible relevance history would play in my career. I know now that understanding what happened in medicine, and why, is vital to dealing with change and planning for the future. Medicine has been in constant flux and we seem to be headed for the biggest changes since Medicare and Medicaid. Recently, a retired physician recalled that when he joined SSVMS every physician was a member. He wondered about our relevancy; it seemed to him that organized medicine had lost its standing and influence. There was a time when I would have fired off a long list of all that was being done right now in the courts, the Legislature, in Congress and our communities for physicians and patients alike. While I can still do that, a history lesson is more fun. I believe we are in a cycle of relative calm, especially in the Sacramento region. Controversies and hassles are nowhere near what they were in the late 80s and early 1990s. Medical groups have matured and competition for physicians, patients and power seems to have settled down. I think it is the calm before a storm. But, let’s get back to history. Yes, in the late 50s, all physicians belonged to the society. We know that because we have checked our membership list against a phone book from the same era. Physicians were in solo practice and none could survive without membership. It was mandatory for hospital privileges. Making a living was nearly impossible if you were not a member. Joining was the first step in building a successful practice; a physician’s credibility and success depended on it. At our founding in 1850, the medical society’s first steps were to separate physicians from charlatans (not an easy task back then), estab

lish a fee schedule to bring reason and fairness to charges, create opportunities for ongoing medical education, and, of course, build a state organization and participate in AMA activities. The themes throughout our history have been the same: the business of medicine, insurance and insurance reform, professional liability, science and education, quality care, community health, community service, political involvement and public relations for the profession. Over time, these themes have waxed and waned in importance and attention. For example, the 1850 cholera epidemic consumed this society’s efforts for some time and led us to create California’s first public health department. We established our region’s first blood bank in 1948, now known as BloodSource. For many years we funded and maintained Northern California’s largest, fully staffed medical library. During the malpractice crisis in 1975, we were instrumental in creating the NORCAP Council which ultimately established NORCAL Mutual Insurance Company. In response to competition, we established the Foundation Health HMO, later lost control of it and saw it develop into the only Fortune 500 company headquartered in Sacramento. Alas, we witnessed its painful demise, too. So hold on to your hats and perhaps your wallets. We are on the edge of massive change. Whether good, bad or indifferent, it’s going to be big. There will be new roles to play, services to provide and challenges to hurdle. If history is any indication, organized medicine will play a huge role in this change, and we will be admired for our leadership, scorned for self-interest, praised for our care — and hassled to death. bsandberg@ssvms.org July/August 2009

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3/16/09 4:55:18 PM

Voices of Yesteryear What doctors were writing about a half century ago.

By Del Meyer, MD The Yesteryear column during 1997 gave brief monthly reviews of what happened years ago in our medical society. Although our society was established in 1868, the written record occurred some 82 years later. The official publication of our society began in September, 1950 as “The Bulletin.” Dr. Charles E. Grayson, MD, was the editor. His copy, donated to our library, was the source of this report. There were reporters for Sutter General, Sutter Maternity, Mercy, and the County Hospital. Each hospital had a brief written report monthly. There were reports from the medical staff meetings of each hospital as well as the Society meetings held on the third Tuesday of the month. There was a book review column and a “Sense and Nonsense” column. Dr. Grayson, in his first editorial, indicated “The Bulletin” was not intended as a newsy chit-chat to be discarded after read, but “a voice for our interest... expression of our opinions.”

Volume 1, the 1950s Here are some voices from those early years of our written record, when we were the Sacramento Society of Medical Improvement (which remains our corporate name today) and our member’s concerns were about compulsory medicine, the doctor draft, etc. Attributions are recorded if available. These are our last archive copies and cannot be removed from the locked portion of our library. Plan to spend an afternoon or two at the society office to explore these rare volumes. The President’s Message: We Dare To Do AGITATION for various types of medical legislation inimical to the health of the nation prompted the American Medical Association to embark on a large scale educational campaign. The campaign has gone far to thwart the propa-

ganda issued by various pressure groups and individuals whose objective is to inaugurate a system of compulsory health insurance. But it is not enough. County medical societies must do their part to prove to the people of the United States that American medicine, free of political interference, has done, is doing and will continue to do the best medical job in the world. The proximity of the state legislature makes it particularly important for our society to have a strong public relations program. This year such a program is being instituted. Through the cooperation of our members we intend assuring every one in this county of expert medal care, twenty-four hours a day, regardless of ability to pay. Actually this is nothing new. It’s not a dream of the future. It’s here now. The medical profession has always cared for the sick, rich and poor. The indigent have been cared for through part pay c1inics and the county hospitals and doctors have always attempted to scale their fees to fit the budgets of their full-paying patients. What is new, is the fact we are offering the guarantee to the public as society, instead of as individual physicians… — Andrew Henderson, Jr, MD, Sept. 1950 Executive Secretary’s Message: Our Public Relations Program — Blueprint for Building MANY MEMBERS of the medical profession seem to know better what they do not want than what they want. Perhaps this is the profession’s greatest weakness in public relations. Medical men have definitely and irrevocably stated they want no part of regiment medicine — now or ever. The public isn’t so sure. Warning has been repeatedly sounded from all quarters

July/August 2009

With nearly half of our citizens staying at home, every Communist and crackpot, in effect, casts two votes by ganging up and concentrating in strategic places.

that if the profession is to successfully combat socialized medicine it must come forward with an alternative and unanimously and vigorously support such an alternative. The profession can not just say “no” and oppose; it must settle its views on what it does want and convert those views from vociferous assorted negatives to tangible positives. Your society has taken a big step forward on the positive side. It has awakened to the imperative necessity of earning good relations with the public and has embarked on an extensive public relations program with that objective in mind. Members of the medical profession can be and are justly proud of the fine traditions, the accomplishments and the aims of the American system of the private practice of medicine. That system is based on free enterprise, individual initiative and service to the public. It is worth preserving. But if it is to be preserved the public must be made fully aware of the merits of the system and its superiority over all others — extant and proposed. And the public — right here in Sacramento, as elsewhere — must be enlightened to the inherent dangers not only to the medical profession but to itself, in the various proposed schemes directed toward the regimentation or compulsion of medicine… — Jane Algeo Watson, Sept. 1950 It’s Your Duty…As An American A communication from the California State Chamber of Commerce reveals that out of every 100 California citizens entitled to vote in the 1948 general election, only 60 went to the polls. With nearly half of our citizens staying at home, every Communist and crackpot, in effect, casts two votes by ganging up and concentrating in strategic places. Because of the apathy of those who stay home, these political minorities wield tremendous influence. We can’t afford to let them get away with it. Urge your friends, your employees and your patients to join the crusade to get out the vote in the November election… It’s one of your paramount duties as an American. This freedom of ours can be lost by

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indifference and supineness. Human freedom was gained by vigilance and struggle — it’s not a gift to man. Summary: Doctor-Draft Law The doctor-draft law, S-4029 — Public Law 779 — was signed by President Truman September 9. The law affects all non-reserve medical men. It is a grant of authority to the President and details of administration wait on Selective Service and military regulations, to be issued on the basis of this authority. Pending these announcements the following are known facts: Who Must Register? Physicians who have not reached the age of 50 and are not members of military reserves. Read more in Volume one, 1950. Borborygmi: “George Kicks Carl in Teeth” (This space is reserved for you — a place where you can blow off steam — talk back to the editor. Both bouquets and brickbats are welcome. We’ll print ALMOST anything to which you’ll sign your name.) George Bernard Shaw, 94-year-old dramatist, trips over some pebbles in his British back yard, breaks a thighbone and is shipped to a nearby hospital for an operation. The old rooster has been a Socialist since the Latter Bronze age or thereabout. Socialist medicine is now in full blast throughout Great Britain. All ordinary medical services are “free,” meaning paid for out of taxes, so you get the pleasant illusion that it‘s costing you nothing when you accept such aid. Does Shaw go in for Socialist medicine in this case? He does not. He’s one of the rotten rich whom he has always professionally denounced, and stingier with his dough than almost any other living wealthy person. Nevertheless, he kicks old Karl Marx, founder of Socialism in the teeth. Shaw demands a private room at $6.08 a day, for which he will have to pay out of his own fishhooked pocket, and specialist services, for which he will also have to pay. When top-drawer Socialists like Shaw, Attlee and Bevin can’t take their own brand of Socialist medicine, just how good or how desirable for

anybody is that medicine? Talk Delivered by Distinguished speaker at September Meeting: Dr. Hans Selye It is doubtful that our Society has ever heard a more brilliantly delivered talk than that of Dr. Hans Selye as he unfolded the story of the development of the adaptation syndrome which he and his colleagues have worked out over the past fifteen years. Our Society was treated at our September meeting to a scholarly presentation such as we are not like to hear again for a long time… In 1936 Dr. Selye was interested in the possibility of finding a new ovarian hormone, other than an estrogen or progesterone. In the course of the investigations it was found that the extracts used for injection into experimental animals caused certain characteristic changes: 1) gastro-intestinal ulcers, 2) thymic and lymphatic atrophy, 3) hypertrophy of the adrenal cortex. It was found that these changes were not due to any ovarian hormone and it was soon discovered that other substances could produce the same effects. It was found that the more impure the extract, the more extensive were the changes and it was felt that toxicity of the substance had something to do with the reaction…. It was subsequently discovered that anything causing stress will do the same thing — cold, pain, excitement, etc. Stress proved to be a very useful word, not much used in somatic medicine, though since Selye’s introduction of the term it has been generally accepted. The adrenal and lymphatic changes and intestinal ulcers represent somatic reactions to stress. This set of circumstances is called the alarm reaction… It is now known that the thymico-lymphatic atrophy is due to corticoid activity. The ulcers are an example of a pure damage change, a sign of the lost battle in the stress reaction. Selye felt it was worthwhile pursuing the study of the mechanism of defense against stress, and there then evolved the concept of the adaptation syndrome . . . Dr. Edmund E. Simpson’s extensive review of the address can be read in Volume one, page 13, in the library reading room.

Message from the Governor to the Connecticut State Medical Journal The health of our people is a basic national asset which is being preserved and constantly improved by a free medical profession whose standards of health and care are the highest in the world. To the 3,300 physicians of our State we in Connecticut owe in large part our own enviable health record which ranks with the best even in this singularly favored country. In behalf of our citizens, I wish to express our gratitude to body of professional men and women whose skill, integrity and compassion are unmatched… It is my unalterable conviction that the maintenance and betterment of the health of our people cannot be accomplished by compulsory measures. Both individually and as a body the members of our medical profession have clearly and consistently demonstrated their sense of public responsibility. Hence, as a matter both of justice and of common sense any plan for health betterment must first take into account the opinion and experience of the profession. Government controls of medicine would be not only contrary to every American concept of privacy and decency. It would also be a negative and detrimental answer to the problem of the health of our people. To the great credit of our Connecticut physicians, they have given a positive answer to this question by their encouragement of voluntary health plans and by their intelligent and close cooperation with such plans which now cover hundreds of thousands of our peop1e. With the continued help of the profession, we in Connecticut must broaden these plans which enable the citizen to guard against the economic hazards of sickness without heavy taxation or compulsion, and without the intrusion of government as a third party between physician and patient. — John Lodge, Governor of Connecticut.

Government controls of medicine would be not only contrary to every American concept of privacy and decency. It would also be a negative and detrimental answer to the problem of the health of our people.

Articles from 1965 In 1965, the size of the journal changed fom 8 ½ x 5 ½ inches, catalog size, to 8 ½ x 11 inches and was reduced to six pages. Medical Care Foundations,

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the HMO movement, Kaiser Permanente and National issues become the common topic for the local society.

Gentlemen, your officers and Board are above special pleading; the implication is unworthy of anyone.

Outgoing president L. Morgan Boyers, MD, in his message: Chiding, Changes and Challenges. The Chiding: Your medical society officers and committeemen are as dedicated to our members and their professional organization problems as we all are to the practice of medicine. However, during recent elections it was not unusual to hear someone express a desire for a particular man to run for office because he represented a specialty or particular field of practice…. Gentlemen, your officers and Board are above special pleading; the implication is unworthy of anyone. Since when did we departmentalize our Society and its governing body? The Changes: Our glossy Bulletin, so long a familiar friend on the local medical scene, is “bowing-out” with this issue by Board of Directors’ action. The only reminder will be the annual directory issue to be continued in its old format and in addition to the 12 Bulletin issues. Rising labor costs, the demand of time, changes in emphasis in the advertising world, and implications in proposed IRS rulings all have had their impact…. We make this change with a sense of nostalgia, but sincerely hope that the new format will gain greater interest and support. The Challenges: Our new president, Don Hause, assumes office at a time of great change, new pressures, and intense public involvement and concern. Just as last year seemed to end an era in Medicine, the new year portends the beginning of a new one. Because Medicine has always been concerned with the improvement of health care and its widest availability, your new officers and their able leadership will, I am convinced, meet these new challenges with forthrightness, dedication, and intelligence…

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Medical Societies-Labor Unions: Parallels Drawn In an address by William Scheuber, Executive Secretary of the Alameda-Contra Costa Medical Association to the East Bay Central Labor Council, he draws parallels between labor and medical societies. He recalls a number of accusations: Doctors have the toughest union in the world. Organized medicine is interested in keeping down the number of doctors so that it can maintain a “closed shop.” Doctors are afraid of competition. Doctors make too much money. Medicine defends incompetents and cheaters and is unwilling to disciplining its wrongdoers. Mr. Scheuber discusses each allegation in detail in the January 1965 issue. Foundation for state workers — 429 physicians sign up. The Medical Care Foundation of Sacramento was formally reactivated February 23 [1965] when a nine-member MCF Board of Trustees was elected by the Society Directors meeting in special session. The Directors’ action was in response to a motion passed without a dissenting vote at the February 16 general meeting. The MCF has been inactive since December, 1961, when the Trustees forwarded their resignation to the Board Directors because of inability to secure 50% of Society physicians as MCF participating members. The reactivation is in response to the State Employees’ Retirement System request for extension to the 24,000 state employees in the Sacramento area of an “individual practice prepayment plan,” represented statewide by Medical Care Foundations, and a “comprehensive group practice prepayment program, specifically referring to the Kaiser Health Plan…. The Kaiser Health Plan will also be available for the first time to Sacramento area state employees during the 30-day enrollment period. Both the MCF and Kaiser programs become effective May 1, 1965… President Donald Hause, MD: the Society needs to face the facts of life and practice. It may be the year of the Great Society in Washington but here in Sacramento the Medical

Society, too, has some facts of life and practice to be faced. It has been true for these many centuries, the physician’s chief reason-for-being is to serve society by caring for the sick and injured. We in American medicine today consider we have contributed to an outstanding job over the past hundred years. I believe there is no doubt as to the truth of this statement… We believe, indeed we know, that the best medical care for the greatest number of persons is only possible through a plan that allows patients to select — and remain with — their own doctors and hospitals. We believe, too, our patients know this but are requesting certainty of coverage be available to them through a full service benefit plan. The Foundation Plan will be made available to state employees in this area. We must unite in making it work as it has in other areas. It will work here. The time has long passed for philosophy. Times change. A patient-group has spoken and asked our

assistance. We should do our best to assist them in the plan of their choice and still provide the best personal medical care possible. John M. Mott, MD, Physician-in-Chief of the Sacramento Permanente Medical Group has the lead article in the Bulletin. The advent of the Kaiser Health Plan, a Kaiser Foundation Hospital and the Permanente Medical Group in Sacramento has been the subject of more questions in the medical community than any other event in the past year. Bulletin Editor Dr. Frank Brown invited Dr. John M. Mott to answer some of these questions and outline the plan’s health care concepts. Read the entire article in the April 1965 issue. President Donald Hause, MD, in his April Message, cautions lay health organizations. To do good is a common desire of many people and organizations. In no other endeavor have more do-good organizations been developed than in the health field. Every year many new ones are founded

Early Sacramento Medical History Quiz By Irma West, MD 1. Name the pioneer physician who descended from English royalty and came to Sacramento in 1849 with a price on his head.

8. What disease took the greatest toll on the Native Americans living along the Northern California rivers in the 1830s?

2. What disease accounted for the most deaths among gold seekers during the early Gold Rush?

9. Who was the first president of the Sacramento Society for Medical Improvement (now dba as the Sierra Sacramento Valley Medical Society, SSVMS)? He was also the first president of the Sacramento Board of Health in 1862.

3. Who was the wealthiest pioneer physician? 4. Name the first Sacramento resident to attend Harvard Medical School. 5. Which Physician served as Secretary of State and Mayor of Sacramento? 6. A Sacramento pioneer physician volunteered as surgeon for the Mexican Army which defeated the French at Puebla, May 5, 1862. He was also a dentist, chemist and gold miner. Who was he? 7. Who were the first women MDs to practice in Sacramento?

10. Name three physicians who served as State Commissioners of Lunacy. They were also founders of SSVMS. 11. In what early Sacramento disease epidemic were about 97 percent of the fatalities men? 12. Who was the first Sacramento physician elected President of the American Medical Association? (answers are on the next page)

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as one or another group of highly motivated people band together to see that some particular health problem is conquered. Many of these organizations are based on some strong emotional feeling associated with personal loss. The people involved develop tremendous drive to do something for others so affected or afflicted. All of these organizations, and they run the gamut from Red Cross, Cancer, Heart, Polio, Birth Defects, ad infinitum, started with an idea of doing good for someone in a crisis. All have zeal and high purposes. But inevitably the medical facts of life come to their attention and it is then that the medical profession needs to be present for guidance for no matter how high the ideals, sooner or later the program emphasis shifts from education to fund raising and then to case finding and fund dispensing. Strong emotional appeal is the basis of many such drives so as to obtain the greatest contributions, generally with great fanfare and publicity

to show the world the good the organizations can do. The problem, as we see it, is to be sure such funds, once raised, are not spent recklessly or on unwise projects. Many times it appears as though funds are wasted on fruitless projects or in maintaining a large executive staff. If the medical profession does not maintain close liaison, it is not unusual to see them go off on tangents which to lay members seem correct but which the physician knows are needless and are duplications of research… Read more in the April issue of 1965. There are a number of articles on the MCF, Kaiser Permanente, calls for involvement, not isolation, throughout this volume. The next volume, 1966, highlights Medicare and the new UC Davis School of Medicine. DelMeyer@MedicalTuesday.net

Answers to questions on previous page 1. Charles Duncombe, MD (1792–1875?), greatgrandson of King James 11 of England, fled Canada where he was charged with treason for his leadership in a failed insurrection against the British government. The reward for his capture was $1,800.

6. Dr. William Light (1819–1895).

2. Scurvy. About 10,000 perished on their way to the gold fields.

8. Malaria, which was introduced by French-Canadian trappers from Fort Vancouver.

3. Harvey Harkness, MD (1821–1901) left an estate of $150 million. He had been a successful gold miner and invested in Sacramento real estate. He was one of the 12 founders of SSVMS.

9. Frederick Hatch, MD (1821–1888).

4. Gustavus Simmons, MD (1832–1910), a Sacramento pharmacist, was graduated from the Medical Department of Harvard University in 1856. He was a leading founder of SSVMS, and gave it its first name, the Sacramento Society for Medical Improvement, which remains its corporate name today. 5. Henry Nichols, MD (1823–1915). He was Secretary of State, 1867–1871, and Mayor of Sacramento in 1858. He was one of the founders of SSVMS.

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7. Mary Magill, MD (1855–1891) and Elizabeth Ewing, MD (1839–1890). Both arrived in Sacramento in 1884 and had short careers. Dr. Magill died of tuberculosis and Dr. Ewing of heart disease. Dr. Magill was the first woman member of SSVMS.

10. Alexander Nixon, MD (1820–1889) served 22 years as a State Commissioner on Lunacy; Gustavus Simmons, MD (1832–1910) served 20 years; and Ira Oatman, MD (1819–1888), 5 years. The Commissioners administered the early state mental hospitals. 11. Cholera in 1850. Of the estimated 1,000 fatalities in Sacramento, 27 were women. 12. Thomas Logan, MD (1808-1876) was elected president of the AMA in 1872.

A Glimpse of Adolph Hitler By E.T. Rulison, MD This is an unedited entry from Dr. Rulison’s diary on July 10, 1937, in Salzburg, Austria. Following are an interview about his 1937 trip and photos taken in 1945. Off to the Bahnhof this morning to catch the 8:52 “Buckelbahn” (as Frau Christ called it) — a glorified street-car — to Berchtesgaden. I remembered to take along some German money, but didn’t remember my passport until I got to the station. It was then only 10 minutes until train time, but I dashed home and, with time to spare, bought Wurst and rolls and met the train at a stop nearby. Through town, across the river and off over the fields we bounced and bumped, traveling perhaps no faster than 25 miles an hour. Through Hollbrunn, a tiny little village, St. LeonhardGartenau, and Haugender-Stein, where the Austrian customs came aboard, then on to Schellenberg, where the German customs next checked us over, and finally into Berchtesgaden— about 2 hours after leaving Salzburg and a distance of 33 Kms. But, to go back to Salzburg for a moment, as we were bumping through the streets, I started on my breakfast of Wurst and rolls, only to have the conductor interrupt, calling “aussteigen”. We had come to the bridge over the Salzach, and as the train alone is considered a sufficient load for the bridge, we had to get out and walk across the bridge and then, with all the traffic stopped, the train proceeded slowly across. Berchtesgaden was alive with Saturday tourists, so I took the little train up to Königssee to look around there first. What a beautiful lake it is — winding up a steep-walled valley, the water has a bright dark green color which contrasts beautifully with the green slopes and the wooded mountain sides, the rocky snowcapped peaks and sky filled with big puffy

clouds. I walked part way around the lake and then sat down on a rock to enjoy a lunch of Wurst and the heel of a loaf of “grau Brot”. I wandered back and through the little settlement at the end of the lake, then part way around on the other side. Finally, back to Berchtesgaden with the little electric train about 1:30 p.m. where I decided to hike up to Obersalzburg — which I understood was “Der Führer’s” birthplace. The pilgrimage was being made by a great number of other people, and it was no easy one! Right up the mountain-side, a good hour’s climb brought us to Obersalzburg, where a barrier across the road blocked further progress. There was great activity going on, for besides about 500 people lined up behind the barrier, there was a busy stream of trucks and workmen working on the Alpenstrasse, which is to connect with the Reichs-autobahn. I didn’t know just what I was waiting for, but I stood around, too. Then, at 3 o’clock the barrier was lifted and we marched along the road around the mountain, finally coming to a halt in front of a house that looked something like “Der Fuhrer’s” new home, but it was only barracks for the S.S. soldiers on guard. Then on through two more gates to another halt. Here the road curved around the mountain so that I couldn’t see what was beyond, but when those ahead burst into excited whispers of, “There he is!” I stretched my neck and could see a party of men coming down a driveway from a big white and tan house ahead and above us. “He”— good grief I thought, that must be “Der Führer”! I hadn’t expected anything like this. Then the line moved on, and with soldiers on each side urging us to move faster, we passed slowly in front of that little group at the bottom of the driveway. There was only

Here the road curved around the mountain so that I couldn’t see what was beyond, but when those ahead burst into excited whispers of, “There he is!”…

continued on next page

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Looking Back at a Visit On April 29, Dr. James F. Rybka interviewed Dr. Ted Rulison at his home in Cameron Park, for background on his 1937 trip to Berchtesgaden, and his photos taken at the end of World War II. JR: I read over once more, your diary, which was, in fact, written just when you experienced it in 1937 and it has not been modified since, is that correct? TR: No, that’s the good thing about it; I did not do any editorializing of what I wrote in 1937. JR: Although I’m sure you did not realize

it, you were stepping in front of a man who shaped the destiny of so many people in years to come, in fact, we are still not finished with it. Just to recapitulate, I believe you were in medical school at Harvard at the time, and you were taking a summer vacation? TR: Yes JR: And you had read about some fellow who wrote up an article in the National Geographic magazine about how he had done a solo-navigation up the Rhine — TR: The Danube. He went down the Danube

continued from previous page one figure there that interested me — he was dressed in a double-breasted gray suit, and wore a gray fedora, beneath which a lock of black hair curved down over his forehead. All the other figures were in uniform. Standing off rather by himself, the little man in gray smiled and saluted as those passing alternately cheered and then fell into an awed silence. He shook hands with the young “Hitler Jugends” who had courage enough to run up and salute him, and accepted bouquets from little pig-tailed girls whose eyes shown wide with amazement. Then, it was all over before we hardly knew it, and we were moving on down the hill below the house, looking back we could see those in the line saluting as they passed the man in gray. Photographing had been forbidden, and though some risked taking a snap or two of the figure at the bottom of the drive I had been much too preoccupied during those few moments, and contented myself later with a “shot” of the house. Thinking back, the first thing that I can remember passing through my mind as I saw the little man in gray was, “I don’t see how he’s done it”, but that was “Der Fuhrer” whom I had seen. Down the mountain, I wandered through Berchtesgaden, a quaint little old Bavarian

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mountain town, until train time when, as I was starting for the station, a rainstorm broke forth. The train was crowded and no seats were available until we got to Schallenberg, and meanwhile the rainfall had become a driving storm. But, almost everyone got out at Schallenberg and I had a chance to dry my clothes, which had gotten rather wet in spite of a raincoat. In Salzburg, we got out again to walk over the bridge, and as this was near the little place I had had dinner last night, I walked over to have another generous meal and pay my 5 Grosshen debt. After dinner, walking up through the city in the rain, I passed the Marionetten Theater which was to play “Faust” this evening, and attracted, I went in and was able to get a seat for 1 schilling, the performance starting in just 15 minutes. The production was really quite a spectacle, with wonderful lighting and scenic effects, and voices were very distinct. The movements of the puppets, though, were really remarkable, and some of their antics left me wondering how they were possible. The play was over before 10 o’clock, but the streets were deserted, so feeling I had had rather a full day, I turned homeward and to bed. etrjrmd@comcast.net

to Berchtesgaden all the way to the Black Sea. Two years before this, in 1935, I had taken a short kayak trip down the Mosel River. So I decided that I wanted to follow this man’s — well, I won’t say “footsteps” — but his “paddle trip,” and go on down the Danube myself. And I started from Salzburg with the Salzach River, which then joins the Inn, and on down to Passau (Germany), where it enters the Danube, and then on to the Black Sea. JR: And you had an inflatable boat, did you? TR: You put it together; it was a collapsible boat — very handy, too! You could just throw it into the baggage car and when you get to the river, you just put the boat together and start paddling. JR: Did you buy the boat in Europe or did you...” TR: Yeah, I bought it in Munich. It’s called a “faltboot,”made by the Klepper company. They’re quite famous, and they still make them. JR: I remember myself how those long, 2-month summer vacations we had in medical school invited wanderlust. We looked towards our future and suddenly realized how limited our free time would be during residency, and thereafter in medical practice, so we wanted to make the most of them. Now you had been in Bavaria before you crossed into Austria at Salzburg so you saw some of the changes that the Nazis had instilled. But at that time, from my reading of it, Hitler then was not nearly considered the villain that he was subsequently. He had just staged the Olympics in Berlin in 1936. There were a significant number of intelligent people (outside Germany) who sided with Germany’s efforts to emerge. Am I correct at that, or was he already considered the enemy of the world? TR: No, anything but. In Germany, he was truly a hero because he had rescued his country from post World War I depression, inflation —

enormous inflation — and unemployment. The country had been in desperate condition after World War I and he had brought it back into full prosperity. Everybody had a job. He said that if anybody begs for money it’s phony because everybody had a job. JR: What were some of your impressions as you went through Bavaria before you met him? I imagine that you saw a great groundswell of support for his party, and you also saw the ugly anti-Semitic propaganda going on — maybe military marches? TR: No. The only two things I remember as being anti-Semitic were some signs outside some of the villages that said, “Jews are not wanted here.” And Goebbels’ anti-Semitic propaganda which had horrible cartoons of a Jewish profile — you know, a big nose with hairs growing out of it and articles that were very inflammatory. But that was Goebbels’ propaganda machinery putting this stuff out. JR: As you say in your diary, you were not allowed to take any pictures, so when did you capture these photos? TR: It was eight years later in 1945 towards the end of World War II and we were allowed to take little runs like overnight from where we were. Our hospital (the Sacramento-based, 51st Evacuation Hospital) had been deactivated at that time, and we were waiting for a new location. We had been in the little village of Welzheim, but then moved to the upper floors of the Robert Bosch Krankenhaus in Stuttgart for about a month before the whole hospital was deactivated and sent home, but I was not. I was sent across the river to the 216th General Hospital in Bad Canstadt, and I spent my last month there before I came home. During the time we were active in Welzheim, we were allowed to take these little excursions, and on one of these we went down to Berchtesgaden for an overnight trip, and we were able to see what remained of this mountain getaway that Hitler July/August 2009

During the time we were active in Welzheim, we were allowed to take these little excursions, and on one of these we went down to Berchtesgaden…

In one picture of the bombed out SS barracks, you can see homes up there on the hill — that was where the other government functionaries, like Himmler, Goebbels and Göring had homes.

had lived in for all these years that he was active in office. JR: Were you wearing a uniform as you visited? TR: Yes, I was still in the service. JR: A picture of the guard shows an American GI who is standing on a white board guarding what looks like the shell of what was Hitler’s mansion. There is a tree behind him, and that is about the only vegetation that you see on that whole campus which has been all destroyed, I guess, by bombs. TR: This path behind him is the one that Hitler came down, and in this picture [of Hitler’s home] here is the path that I walked down; so he stood here and I walked passed him. JR: Yes, you can see the meeting of the two paths, one of which serves as Hitler’s driveway, going up to his house. Several times you described Hitler as a “little man” and, I imagine, that from your perspective, that was true because you were over 6 feet tall. But I looked it up and Hitler measured 5 feet 9, which is my height, and he weighed about 175 pounds. I guess he was surrounded by military guards and other big guys so that they did not help to magnify his own height. When you saw him, he was the only one dressed as a civilian, right? TR: Yes. He was dressed in a double-breasted, grey flannel suit, and I guess maybe that the double-breasted suit made him look wider and shorter. And then he had a Fedora on which did not add to the impression of his height. JR: You said that there was a big crowd there, perhaps 500 or so, and these were mostly German citizens? TR: I assume that they all were. JR: You say it was fairly tightly controlled by guards. They wanted you to keep moving, TR: Yes JR: But he did make some gestures when meeting the children. Otherwise, he carried on no conversations. TR: Yes. JR: Did you know of others also living at the compound, like Eva Braun, or Goebbels? TR: On the hills surrounding. In one picture of the bombed out SS barracks, you can see Sierra Sacramento Valley Medicine

homes up there on the hill — that was where the other government functionaries, like Himmler, Goebbels and Göring had homes. And you can see that those have been destroyed too. JR: The interior of Hitler’s house was all burned out? TR: Yes. JR: Did you go in it? TR: Yes. I have one picture taken from what might look like the living room. It was a huge room and had an enormous window looking out over the valley. I don’t remember anything that was left of the interior. Now we went through the house itself. JR: Was there a bunker, or a cellar attached to it which he could have used for hiding? TR: I’m sure that there must have been, although we stayed only on the main floor, the one floor you see in the picture here. JR: In 1945 when you returned there, do you remember anything about the attitude of the Germans towards the Americans? TR: You must realize that we had a ”no fraternization” policy, so we had very little contact with the Germans. I did act as interpreter at times for our colonel at the little village of Welzheim near our setup, but we had very little association with the Germans. Our hospital was located in a field of hay, and during the season after the grass grew, the farmers came out from Welzheim and harvested the grass around our tents, but we really had no social contacts with them. JR: To continue with your own odyssey in 1937, you left Salzburg and reached the Danube. Then how far down the Danube did you get? TR: Budapest…. [Dr. Rulison met a group of about eight Hungarian boys also navigating on the river on their way back to Budapest, and he journeyed with them for several days, passing by Vienna and Bratislava. By the time they got to Budapest, the boys convinced him that it would be too dangerous for him to go farther because of growing political events — not only involving the Nazis, but also the nationalist Hungarians who wanted lands back that had been taken from them at Versailles. So he abandoned the rest of his trip at this point.]

s Dr. E.T. Rulison, in a photo taken in April of this year.

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A group of soldiers at the Kรถnigsee, in 1945.

Photos from Berchtesgaden in 1945: The intersecting paths where Hitler was seen eight years ealier. A GI guards Hitlerâ&#x20AC;&#x2122;s burned out home. Hitlerâ&#x20AC;&#x2122;s deck overlooking Berchtesgaden. Bombed out S.S. barracks.

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Su Casa Ferreteria â&#x20AC;&#x201D; see the article on page 25.

July/August 2009

s Encysted Trichinella larva â&#x20AC;&#x201C; which when ingested causes trichinosis - in skeletal muscle (borax-carmine, x400). s

Dr. Lloyd preserved the structure of a cysticercus on his slide from 1889, right. Microscopic examination of the area inside the box reveals a typical taeniid hooklet of Taenia solium.

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Parasitic Diseases of Pork By Gordon Love, MD Last year in the May/June issue, Sierra Sacramento Valley Medicine published the story of Dr. Frederick Lloyd, a young pathologist who died in 1890 of miliary tuberculosis. An elegant and meticulously labeled slide set remained in his family for 118 years and contained the lung section from the autopsy Dr. Lloyd suspected had exposed him to the tuberculosis that killed him. Dr. Lloyd’s set contained not only slides of tuberculosis, but also human and animal slides of numerous other diseases. For this issue, I have selected two representations of parasitic diseases of pork not commonly seen today: Trichinella spiralis (the etiologic agent of trichinosis) and Taenia solium (the etiologic agent of cysticercus). The following is a slice of the 1890s medical milieu in which Dr. Lloyd practiced.

Trichinella spiralis One of the smallest nematode worms of genus Trichinella, commonly Trichinella spiralis, causes trichinosis. The adult worm matures in the intestine of an intermediate host — usually a pig — and releases crops of larvae which bore through the intestinal wall to eventually encyst in muscle. Infection in humans results from ingestion of uncooked or undercooked meat containing encysted larvae. The larvae hatch after coming into contact with gastric digestive juices. The larvae mature and pass into the intestine to reproduce. Just one adult female can release up to 1,500 larvae which, in turn, bore through the intestinal wall and distribute throughout the body in skeletal muscle, forming cysts. Dr. Lloyd’s trichinosis slide is labeled “Feb 28 ’89, Trichinae.” Trichinosis had been discovered about 50 years earlier by an English firstyear medical student, James Paget (who later described Paget’s disease) after performing an

autopsy on a man with a “sandy” diaphragm. Under microscopic examination, tiny cysts containing larva were observed. His proctor, Sir Richard Owen of the Royal College of Surgeons, named the parasite in a report to the zoological society of London. Owen did not credit Paget. Only Paget’s later prominence, as well as an incidental letter written to a friend at the time, preserved his share of the discovery. Joseph Leidy in Philadelphia in 1846 noticed specks in a slice of pork that he was eating and recalled seeing similar specks in dissected human muscle earlier. Under the microscope, Leidy confirmed the presence of encysted Trichinella larvae that had earlier been described in Owen’s article. Making the connection between the Trichinella and consumption of undercooked pork, Leidy reported his findings in the Proceedings of the Academy of Sciences of Philadelphia in October 1846 and urged thorough cooking to kill the trichinosis parasite. Leidy’s work apparently was either ignored or not known to European scientists. Dr. Rudolph Virchow, the famous German pathologist, in the 1850s demonstrated that trichinosis was spread animal-to-animal through ingestion of infected meat. It was not until 1860 that trichinosis

July/August 2009

Sir Richard Owen, below left, almost succeeded in claiming credit for the discovery of trichinosis. It was actually described by James Paget, right, while a first-year medical student; his later prominence, as well as an incidental letter written at the time, preserved his share of the discovery.

Dr. Joseph Leidy, left, was the “Father of American Parasitology,” but his contributions to trichinosis were ignored in Europe. Most credit there for elucidating of the mechanism of the disease of trichinosis went to Rudolph Virchow, right. He famously called down his detractors by giving them raw, trichinosis-infected pork and telling them “esse, esse!”

was found to cause significant human morbidity and mortality. Another German physician, Frederich von Zenker, documented the trichinosis infection of a young servant who died after eating contaminated, raw pork sausage. In 1900, an estimated one in six Americans was infected with Trichinella spiralis. Since then, public education concerning proper cooking of pork as well as laws restricting pork contamination have been effective. According to the CDC, trichinosis cases dropped dramatically to 500 in 1948 and to 74 in the period 1997-2001. In the developing world trichinosis is more frequent. During the Thai New Year, 200–600 cases occur annually after consumption of a delicacy, “larb,” which incorporates uncooked pork. China has the highest case reports with human prevalence rates between 0.66 and 12 percent. Prevalence rates in pigs are as high as 50 percent in some provinces. Trichinosis is difficult to treat, and, once encysted in skeletal muscle, treatment is essentially symptomatic. To kill Trichinella larvae, the USDA recommends freezing pork at 5°F for 20 days or heating to a uniform internal temperature of 144°F. Smoking or salting may not kill the encysted larvae.

Taenia solium Taenia solium is the pork tapeworm, a cestode in the family Taeniidae. Taenia solium has four suckers on its scolex as well as two rows of hooks. Humans and pigs can be infected, but humans are the definitive hosts for this tape-

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worm. Systemic infection of humans is caused by eating eggs shed in the feces of a human tapeworm carrier. Once eggs are ingested, oncospheres hatch in the intestine, invade the intestinal wall, and migrate to skeletal muscle as well as brain and other organs of the body. The most serious manifestation of disease is neurocysticercosis in which fluid-filled bladders containing an invaginated scolex develop in the brain. Most cysticerci are 0.5 cm to 1.5 cm in diameter but, in brain, may be as long as 20 cm and contain 60 ml of fluid. Humans become tapeworm carriers after eating undercooked pork containing cysticerci. The ingested cysticerci develop into adult tapeworms in the small intestine. Adult tapeworms develop up to seven meters in length with up to 1000 proglottids each containing up to 50,000 eggs. These may live in the intestine for years. Tapeworms have been recognized as human pathogens since antiquity but it was not until the 1850s that the lifecycle of Taenia solium was developed. Dr. Frederich Kuchenmeister, a German gynecologist, established the link between cycticerci and adult tapeworms in a study of prisoners sentenced to death. The prisoners were fed cysticerci from infected pork. Following their executions, Kuchenmeister opened their intestines to find developing and adult tapeworms. With this experiment, he dismissed a prevailing view that cysticerci were degenerate bodies. Kuchenmeister offended ethical sensibilities and was criticized. Taenia solium is found worldwide. The precaution of cooking pork before consumption for Trichinella spiralis reduced the incidence of Taenia solium. In the United States, immigrants from Mexico, Central and South America and Southeast Asia account for most of the domestic cases of cysticercosis. It is remarkable that Dr. Lloyd’s slides can still be interpreted over 100 years after preparation. The yellow borax-carmine stain is now little used. Modern slide stains/counterstains are much easier to read but who knows what they would look like 100 years from now? gll4379@gmail.com

A Repository of History By John Loofbourow, MD High above the place where Aconcagua River becomes the Pacific Ocean, is a Ferreteria. To simply say it is a hardware store, for that is what it pretends to be, is like calling Tyrannosaurus rex a robin. To believe that Oscar Vega Vega is merely the owner of the store, or that the people who work there are employees is to trip over a living archaeological site and move on unaware; because entering Su Casa, for that is the name of the store, is to find oneself at the edge of time. Upon entering, the customer becomes a time traveler immediately surrounded by thousands of artifacts from the present and the past which comingle, to visually announce the nature of the Ferreteria Su Casa. The artifacts peer fixedly and silently from the ceilings, and every available vertical surface, wall or counter front.

They are restrained by screws or fine wires, as if to protect the unwary visitor from attack. Three or four clerks wearing worn smocks move silently, purposefully, behind a long worn counter/display case. They disappear intermittently for long periods, into dimly lighted recesses lined by floor to ceiling cubbyholes filled with partly visible artifacts. The storage tunnels stretch on back, and back, crossed by other dimly perceived cross tunnels. At the entrance, among bright colored plastic encased modern artifacts from China, are items wrapped in distressed browning cellophane or stored in ragged discolored boxes with labels wounded and bruised by thousands of fingers. To the extreme right and left of the counter, worn wooden stairs between artifact festooned walls ascend into an unseen second floor and descend into an imagined basement. To the left a cashier sits in a small cage behind a glass window. Here in the flesh is that classical Spanish fiction called magical realism; here it seems merely ordinary. The intruder, innocently leaving the present tense, is affected by the physical presence of thousands of formerly real items, in the care of men and women who are themselves tenuously real, yet offer the only clues to the purpose or functions of the artifacts they tend. Su Casa Ferreteria is in Con Con, Chile, a small fishing village and resort town that exhales history as the regionâ&#x20AC;&#x2122;s first coastal port city, founded 1543 by Spaniard Pedro de Valdivia to provide his ships with a way to supply Santiago, which had been destroyed two years before on the rather signal date of 9/11, by the Araucanos under Michimalonko. I had asked the clerk, and then the store manager, for permission to take photos of the interior of Su Casa, but was refused; photo taking something that is usually strictly forbid-

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“Computers and all that, they can’t know what is not fed into them. I don’t need computers. I have people who know the job.”

den in most South American stores. Yet I was so intrigued by the aura of the place that I could not give up easily. And finding a man I assumed to be Mr. Vega outside in front of Su Casa, I approached him. He is slightly portly, wears a newer version of the store clerk’s beige three quarter length smock, under a full head of steel gray hair, holding a simple wooden cane in his right hand. He listened alertly, and I thought somewhat skeptically, as I introduced myself and made my request. He said nothing, continuing to regard me fixedly, but without apparent disapproval. I continued to explain why I hoped he would be kind enough to permit my picture taking within the store. Still, he remained silent, so I began to ask him about the history of the store, which, as will become clear is the personal history of Oscar Vega Vega. Don Oscar had not started life easily. He began an itinerant peddler in 1934 at the age of 10; a person who traveled on foot from one coastal village to the next, carrying items for sale, pulling a cart with a modest stock of items he believed most likely to be wanting in local households: cloth, items for sewing, soap, brushes, spices, coffee, salt, clothing. Throughout the world depression he gradually built a clientele and a route. The young Oscar, like the young Ben Franklin, was astute, frugal, focused, and organized. Even so, it was not until the 50’s that he acquired a used ‘Citroneta’, a small car that looked like a sardine can, only lacking the windup key on top to open it up. It had a gear shift that projected horizontally from the dash, a 12 hp motor, and the reputation of a goat: ugly, indestructible, intrepid and tolerant of baling wire. In 1958 at the age of 24, Oscar bought the store and prophetically named it Su Casa. It became the existential expression of Oscar himself, nominally his own house or home. He married, and raised a family, but never took a vacation, with one revealing exception. In the words of an old employee: four miserable days in the Lake District far from Su Casa. During the “Chilean socio-economic miracle” of the late 70’s that once poor nation of 12 million, mired in the socio-economic and

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political swamps of South America, escaped into the developed world. The business prospered and was moved uphill a block to expand. Twice during succeeding years it attracted generous offers from buyers: During the 1982 world recession, and again in 2007. Despite his advancing years, health problems, and the thoughtful advice of family, friends, and financial advisors, Don Oscar declined to sell. “Don’t you have a problem with competition from places like Sodimac/Home Center?” I asked. “They are completely automated, electronically connected to a flat world of international commerce. Whenever they sell something, a replacement is automatically placed into production in various places the world over, ordered and produced sent. They can exert economies of scale and the power of volume buying. No one can compete with their prices.” “Never!” He broke into a broad smile for the first time. “They don’t even have many of the items we do, don’t know they exist, how to find them, what they are for, or how to use them. They know no one who does. Computers and all that, they can’t know what is not fed into them. I don’t need computers. I have people who know the job. And for me, that is what matters: the people I work with. This is an old town. Home owners often must maintain and repair things made by generations past. I have 15 employees who have worked more than 20 years with me. They, and they alone, know exactly where each of more than 10,000 items is kept. When we sell one we order one. What we don’t sell waits patiently, becoming more and more rare. Each of my people has invested many years to learn our system and stock, yet they have few other skills. It’s hard to find well paid work in a small town like this; if they didn’t work here they might have to go to the city, where they become merely one more among many others just like them. Here they are skilled. Here they have family, and their families are family. Behind every one of us are ten or more others who depend on Su Casa. I do also, because I am it, and it is me. How could I sell, how could I ‘retire’, and abandon my own life, my self, and my family!? First I will fall dead.”

Patricia Perez Martinez accompanied me for the photos. Her father had worked in Su Casa. The eldest of five children, she had been in secretarial school in Santiago when her father suddenly died, leaving the family with very limited means of support. While she was in Con Con helping to settle her father’s affairs, Don Oscar asked her to help out for a while as secretary. He felt it was about time he had one. That was 30 years ago, and Patricia is now manager. Though she was busy, she oriented me to the labyrinth of tunnels, patiently attempting to convey to me the order to the layout over at least half a hectare, more than an acre, on three levels. I was awed by the variety, and magnitude of the material. Soon Patricia’s cell phone alerted her precipitously to some task, and she left me to explore alone. No cool Pacific sea breeze penetrated the stuffy intersecting corridors, which were either dimly lighted or darkened. I was unaware where many of the light switches could be found. I began to be uncertain which turn I had last taken, which before that. I recalled Jason and the Labyrinth, thinking vaguely that I needed some string to find my way back. Years past on a tour of the Lima Cathedral catacombs I had slipped away from the group to be alone with the dead and flash photo the neat piles of skulls, femurs, and vertebrae. But by contrast the dark stuffy tunnels of Su Casa were threatening, and I began to feel an unease, bordering on dread. Individually the thousands of artifacts were innocuous, but collectively they pressed in on me. Protectively convincing myself that it availed me little to explore much further I turned back the way I seemed to have come, but recognized no familiar objects. Perhaps I should not have been so invasive or abusive of the trust placed in me as to venture alone further upstairs and downstairs. Could I not be lost forever somewhere in the past? Would I find my way back to the 21st Century? Even if I did, would I be someone other than myself back in 2009? I was never to find out. After a few more wrong turns some familiar areas appeared, and I escaped, thanked Patricia, and left.

To steal and corrupt a line from Faulkner: Time is the mausoleum of History.1 Reflecting on the cruelty of the natural process, I thought of the moribund small hardware stores the world over. Some die like Stewarts Point Store near Sea Ranch, or Newbert’s of downtown Sacramento. Some devolve into a zombie franchise, a living death like Emeigh’s at Watt and El Camino. Su Casa I expect will one day be entombed with its owner, Don Oscar Vega Vega. One more piece of the past will no longer encroach on or enrich the present. john@loofbourow.com 1 The Sound and the Fury

PUHP

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Some Real Headlines Ripped from Newspapers: “Panda Mating Fails; Veterinarian Takes Over” “Miners Refuse to Work after Death” “New Study of Obesity Looks for Larger Test Group” “Hospitals are Sued by 7 Foot Doctors” “Kids Make Nutritious Snacks” “Typhoon Rips Through Cemetery; Hundreds Dead” “Red Tape Holds Up New Bridges” “Cold Wave Linked to Temperatures”

Your care makes all the difference.

Trevor Austin Kott — Oct '06 - Apr '07. Still inspiring people to give hope to patients in need.

There are those who give blood and there are those who stand ready to give marrow should a match be found. To the medical professionals who care for every man, woman and child who receives these precious gifts, www.bloodsource.org

not-for-profit since 1948

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thank you for your support of every patient in need.

Radionics and “Electrical Reactions of Abrams” By Kent M. Perryman, PhD At the entrance to the Sierra Sacramento Valley Museum of Medical History on Elvas Avenue is an elegant piece of furniture that at first glance might be mistaken for an early 20th century radio. The function of dials and switches on this impessive device defies the imagination. The Calbro-Magnowave Radionics instrument has 26 bakelite dials with circular scales calibrated from 0-10 and housed in a mahogany upright cabinet. The front panel also contains a switch for diagnosis or treatment and various colored lights (“screening rays”) that shine through a hole on the right side (the “emanator”). What most visitors to the museum don’t suspect at first glance is the fascinating history surrounding this alleged medical device. This was the ultimate quackery device of the 1920s in its conceptualization, employment and cost. This radionics device was widely employed in the U.S. and Great Britain by many of Dr. Albert Abrams practitioners during the early 20th century. For an appreciation of this device’s popularity, one needs to examine the evolution of “radionics” theory espoused by Dr. Abrams.

This might be conceptualized as a very early method of imaging. Abrams differentiated disease tissue by the “dullness” of the tone reflected from percussing. He formulated a theory of disease states that could be differentiated based on not only their dullness tone but also on the abdominal location. Abrams mapped out the locations of numerous diseases on the abdomen into a topographical map he referred to as “spondylotherapy.” During its earlier developmental stage, Abrams confined spondylotherapy as a treatment modality confined to the spine for restoring blood circulation to disease regions of the body. Vacuum cups were applied by some practitioners to various regions of the back to improve circulation to diseased regions of the body. Spondylotherapy was occasionally

Spondylotherapy Dr. Albert Abrams (1869–1924) of San Francisco was trained in neurology at Heidelberg University under professor de Saver. While under the professor’s tutorship, Dr. Abrams was introduced to “radionics” as a form of medical dowsing or “radiesthesia”, meaning “sensitive radiance.” Early radionics was essentially a technique employing percussion (tapping the abdomen with the hand and listening to the sound reflected back).

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supplemented with the use of Epson salts as a cathartic to purge the intestinal tract.

Radionics

Dr. Albert Abrams

Dr. Abrams had been previously exposed to Professor de Saver’s theories on radionics. Living tissue was believed to emit radiation that could be detected. This was an energetic emission and not the ionizing type of radiation we associate with medical imaging devices. In the 18th century, Franz Anton Mesmer (“animal magnetism”) and Luigi Galvoni (“Galvanism”) had both advocated electricity in animals. Dr. Abrams was inspired to refine the theory of radionics with the arrival of radio in the late 19th century. He incorporated some of the theoretical concepts from physics and electrical engineering to disease processes. In 1916, Abrams published “New Concepts in Diagnosis and Treatment,“ which launched his conceptual legacy, “Electrical Reactions of Abrams” (ERA). ERA became the new foundation and framework for his radionics approach to the diagnosis and treatment of all diseases utilizing electrical devices he marketed. The basic tenet underlying Abrams’ ERA theory was that all diseases emit radiation at different vibratory rates that can be detected, measured and identified. An incredible facet of the ERA technique was the practitioner’s ability to perform a diagnosis without any subject being physically present! To appreciate this formulation of Abrams medicine, we need to examine his devices more closely. All of Dr. Abrams’ devices were essentially wooden boxes containing no more than

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a series of resistors called “reflexophones” that were connected in no logical engineering order. One box with a metal electrode plate, referred to as a “dynamizer,” was to function as a sample holder for blood, hair and handwriting! A subject, upon seeing an advertisement, would mail a bloodstained cloth along with a sum of money to an ERA practitioner for a diagnosis of their malady. The sample would then be placed on the dynamizer’s electrode plate, which was in turn wired to a healthy third party called a “reagent.” The reagent would sometimes stand on a rubber mat or on electrodes in a basin of water facing west with another electrode on his forehead. The practitioners would then percuss the reagent’s abdomen for areas of dullness. Utilizing the numerous rheostats (variable resistors with a circular scale) located on the main device, a specific diagnosis could be attained by comparing the settings of rheostats with the reagent’s abdominal locations and a numerical chart of diseases. Specific disease states were not only dependent on abdominal locations but also related to resistance scales in “ohms.” These results were mailed back to the subject requesting them to come in for a series of treatments. Abrams employed another wooden box for treatment he called a “oscillocast” device that was wired to the console of the main radionics unit. The subject would lie on a couch; two metal plate electrodes were positioned around the affected region of the body while vibratory waves of electrical energy were passed through the infected tissue. Return visits were sometime necessary to eradicate the infection. Some ERA practioneers charged as much as $200 a visit in the 1920s for these treatments! ERA devices could be leased for an initial $200 plus a $5 per month fee. The lessee had to sign an agreement that the device would never be opened. Abrams also held training courses at his San Francisco clinic for an additional $200. By 1921 ERA technology was alleged to be employed by 3,500 practitioners; with numerous complaints against them, fraudulent claims soon begin to ensue. Between 1923 and 1924 Scientific American investigated ERA devices and

concluded they had no scientific merit. JAMA published a series of articles in 1922 on reform of medical quackery that were targeted towards the ERA. There were assertions that physicians who employ ERA devices should be expelled from membership in medical associations. JAMA went so far as to mail in blood samples from two male guinea pigs to ERA practitioners that were subsequently diagnosed with a streptococcus infection of the left fallopian tube! A number of articles also appeared in the AMA journal exposing Dr. Abrams as a fraud who they never considered a serious threat to the medical profession.

Katherine Gray’s White Light Radionic Association in the United Kingdom and Switzerland has subsequently carried on radionics in a greatly modified, non-medical manner. Vibratory rates are believed to provide insight in psycho-spiritual development. kperryman@suddenlink.net Major Sources: McCoy, Bob. Tales of Medical Fraud. Santa Monica Press, 2000. Young, James H. The Medical Messiahs. Princeton University Press, 1967.

This diagram was found on the Internet, where radionics is still a popular topic.

Epilogue Dr. Abrams died in January of 1924 and left his estate, worth millions of dollars, to the Electronic Medical Foundation (EMF). EMF continued to market updated ERA devices as well as a diagnosis-by-mail service for chiropractors. Many of Dr. Abrams’ updated devices, such as the Calbro-Magnowave in our museum, were employed by chiropractors up until the 1960s. Stanley Rogers initially developed the Calbro-Magnowave device as a dousing device for locating mineral deposits. Two engineers, Caldwell and Brownson, subsequently modified it as a medical device in the early 1920s. This was the only medical radionics device that incorporated a “cleaning” circuit so that the energy from previous clients could be purged from the instrument’s circuits to prevent mistakenly measuring the combined vibratory rates of multiple individuals. Dr. Ruth Drown, who had studied under Dr. Abrams and later became a chiropractor, carried on some of the ERA practices in a modified fashion. After Dr. Abrams’ death, she developed a radionics device known as the “Homo Vibro Ray,” which also consisted of an array of rheostats to tune into the body’s vibratory rates. She operated a number of financially successful clinics in the U.S. that combined radionics, chiropractic and natural medicines. The AMA also discounted her claims; she was subsequently charged with fraud and died awaiting trial.

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What Medicine Advertised One Hundred Years Ago By F. James Rybka, MD Last summer, the California Medical Association asked our museum curator, Dr. Bob LaPerriere, if we wanted to take over its bound collection of the Western Medical Journal, dating back to 1904. His reply: an enthusiastic “yes!” What was different here, however, was that the advertising pages were included in each bound volume. This gave us a valuable source to review what medicine advertised about 100 years ago. This report is based on just 10 years — the journals from 1904–1914 — a decade of profound changes in our state’s scientific, cultural and ethical values.

Sanitoriums Private sanatoriums were big advertisers then, and several took out half-page ads for years. By far, the biggest of these was the California Sanatorium, located on 42 acres

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in Belmont on the San Francisco Peninsula. Its mission was dedicated to “the Scientific Treatment of Tuberculosis,” and ads included several pages of photographs of the facility. The cost for a patient’s confinement began at “$25 a week, including medicines and medical attendance.” Other sanatoriums were established for nervousness and psychiatric problems, and for addictions to alcohol or drugs. Together, their volume was so large that sanatorium ads alone could have been said to have underwritten the cost of the journal.

Hospitals Hospitals also advertised, and it is apparent that the definition of a “hospital” varied considerably. There were a surprisingly large number of such institutions in proportion to the population. One reason was that almost every ethnic group seemed to want a hospital of its own, so there was a German, French, Italian, and Chinese hospital in San Francisco. Some hospitals were small, 25 beds or less, and managed by a roster of nurses under the charge of a single doctor/owner. Others were up-to-date facilities with more than 100 beds and boasting a roster of prominent doctors. While some no longer exist, e.g., the. Wentworth Hospital in Sacramento, others

were the nidus of an institution that has since prospered and grown. These include: St. Francis, St. Luke’s, Polyclinic, Lane Hospital and Cooper Medical College, all in San Francisco. (These latter two eventually became part of Stanford University Medical School.) Also, there were Good Samaritan, the University of Southern California College of Medicine and Pacific Hospitals, all in Los Angeles, and Mater Misericordiae Hospital (Mercy Hospital) in Sacramento. (Mercy advertised that a post partum hospitalization for one week cost $25.)

Railroads Next in importance, at least from the size and frequency of the ads, were the railroads. Their considerable power on the economy was shown by their full-page ads. Southern Pacific boasted how one could get to Chicago in 68 hours for $72.50 while riding in luxurious electric-lighted cars. The rail trip to New York from San Francisco cost $108.50, which was the same fare on an alternate southern route, taking S.P. to New Orleans, and from there to New York on a “luxury steamer.”

up the imaginations of physician advertisers as well as those for chemists and pharmacists.1 Tuberculosis, “the white man’s plague,” was one of the most lethal infections of this time, second only to influenza/pneumonia (the two were grouped as one disease then).2 In 1882, Robert Koch discovered the mycobacterium that caused it. Sanatoriums provided the dual function of isolating the infected patient from the general population and providing rest, uncontaminated air, and fine nutrition which, in combination, was demonstrated to encourage healing. Soon after the radiation machine was invented by Wilhelm von Roentgen in 1895, X-rays of lungs allowed physicians to follow a patient’s progress. Immediately, doctors with little training bought X-ray machines and advertised for patients. Diphtheria and Typhoid Fever were two diseases for which vaccines were not yet invented. 3 However antitoxins were available. In volume 6 (1908), Parke, Davis & Co. and the Cutter Laboratory in Berkeley each took out full-page ads for anti-diphtheric serum and anti-diphtheric globulins which were used in patients (usually children) with the disease. In 1911, after the US Army was vaccinated against typhoid, this therapy was available to the public. In vol. 9 (1911), an ad by the Cutter

Diseases Infectious disease was the most frequent killer of the time. New helpful discoveries seemed to fire

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Laboratory brought attention to a baseball hero, Heine Heitmiller, who died at age 28 of typhoid. (Photo:Heine) Their point was that even healthy young men could be felled by this disease which, with their vaccine, had become preventable.

Medications During the battle against infectious diseases, a plethora of medications were advertised purporting to be curative or beneficial against them. Some peddlers kept their ingredients secret. So on every page in the advertising section, there was a statement from the AMA Principles of Ethics: “It is equally derogatory to professional character for physicians to dispense or promote the use of secret remedies.” There frequently were many ads for Cholegestin that was said to work against “biliary stasis, neurotic symptoms, intestinal flatulence, and hepato-intestinal toxemia.” It worked “by its combined cholagogue antiseptic and digestive action, increases and liquefies the natural laxative.” Some of their ads were folksy, asking if your liver is “like a lazy horse?” Other ads recommended the Fellows Syrup of Hypophosphites to obtain “immediate results in: anemia, neurasthenia, bronchitis and pulmonary tuberculosis.” It was prepared by Mr. Fellows of New York City, and “each dram had

the equivalent of 1/64 grain of pure strychnine.” In 1913, there was an ad for Digalen by the Hoffmann-LaRoche Chemical Works. It was a standard digitalis preparation useful to control the “myocarditis of Tuberculosis.”4

Meat packing and beer companies Meat packing and beer companies also promoted their by-products for medicinal uses. The Armour Co of Chicago promoted Lecithol as an “emulsion of lecithin, the most important organic phosphorin compound in the brain and nerve tissue.” It is useful to “simulate nutrition, increase hemoglobin and leukocytes...indicated in rickets, infantile atrophy, pancreatic diabetes, chlorosis, tuberculosis and as a tonic for the aged an overworked.” Armour also promoted Extracts of Pure Bone Marrow for anemia. Also Pituitary Liquid, the active principle of the posterior lobe of the pituitary body to be “useful in surgical shock, intestinal paresis, uremic poisoning and protracted labor.” In the push to control the

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impurities and errant dosages, it was helpful in 1908 when Pharmacology emerged in the US as a profession.5 The Anheuser-Busch Co of St. Louis promoted a Malt-Nutrine which they claimed was recognized as a tonic for nursing mothers and protracted convalescence. “She who nurses one must nurture two.” It was low in alcohol (2 percent) but high in food value with 14 percent extracts of hops and malts.

Horse Stables In 1904, horses were the usual means of transportation. The California Stables on California Street in San Francisco ran a small ad for rental of rubber-tired carriages by the hour, with special rates for doctors. When medical practices were sold, it was not infrequent that a horse and carriage went with the practice. A reasonable income for a doctor these years was $5,000 to $8,000 a year This was largely net, as there was no income tax (until the 16th Amendment in 1913). There were no ads from the Ford Motor Co, but in 1914, the last year of this survey, there were full-page ads for Chalmers

Motor cars. Two 1914 Chalmers models went for $1,925 and $2,325 respectively.

Telephones, typewriters, fans Other companies advertised their inventions, such as Bell Telephone which pointed out how much more effective a doctor could be if his orders were heard instantaneously. Underwood advertised its typewriters, and National Electric Co. promoted electric fans designed to make patients more comfortable. There were also ads for bill collectors and malpractice insurance companies. There was a small ad for an intern to work in a 25-bed hospital for $25. a week. It caught our eye because it would have been illegal today. It discriminated its hiring of “a male interne, a Protestant and non-drinker.” These are but a few of the snapshots that you would discover from mining these volumes for history. From these 10 years, we see that medicine 100 years ago was just emerging from

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homeopathy and home remedies into a new era of scientific discovery, with preventive medicine leading the way. Old ways were stubbornly difficult to break, and the importance of the AMA

and the young CMA in the struggle for effective remedies and against profiteering is evident. The institutions that housed patients, both sanatoriums and hospitals, were big industries then, and they were largely controlled by physician-owners. However, university medical schools and their hospitals were beginning to compete with these in the larger cities. Malpractice was alive and, although malpractice insurance was available, there was no such thing as health insurance. These ads might be said to expose medicine at its worst — providing a forum for commercialization and opportunities for the avaricious. The pharmaceutical industry that today seems to have such oversized power that it has contaminated the faculties of our medical schools, was barely at an embryonic stage 100 years ago. However, we must remember how few doctors, then or now, ever engaged in advertising. In the past, most doctors, and even more so the nurses, risked not only their own lives but those of their families, in daily contact with patients with mysterious lethal diseases, many without any cure.6 One benefit of the ads was to help pay for a journal that provided the busy practitioner with the latest answers for some of the devilish problems he had to take on. jimrybka@hotmail.com 1 In 1904, the life expectancy in the US for men was 46 and women 49 years. Ten years later, it was 52 years for men and 57 for women. 2 In 1910, the death rate from tuberculosis in the US was 154 per 100,000. It was 156 per 100,000 for influenza/pneumonia and 21per 100,000 for diphtheria. 3 In the 1890’s Emil von Behring developed a diphtheria antitoxin for which he was awarded the first Nobel Prize in Medicine. A diphtheria vaccine was not developed until 1913. In 1909, Frederick Russell, a US Army physician, developed an American vaccine against typhoid fever, and in 1911, the entire US Army was inoculated which wiped out that disease in the military. 4 Digitalis from foxglove had been known to be of benefit for patients with heart failure and dropsy since 1776, but extracts and dosages were particularly difficult to standardize, and an overdose could be fatal. It is not clear just how earlier physicians found access to it, but this is the first ad in the journal of a commercial preparation. 5 On December 28, 1908, under the leadership of Dr. John J Abel, eighteen men met in the pharmacology lecture room of the Johns Hopkins University Medical School to establish the American Society for Pharmacology and Experimental Therapeutics (ASPET). 6 Refer to “The Death of a Young Pathologist in 1890”, SSV Medicine, May-June, 2008.

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Board Briefs June 8, 2009 The Board: Approved the 2008 Audit Report presented by Lindsey Kate Lane, CPA. Approved sending a letter to the Sacramento County Board of Supervisors regarding the funding and function of the Public Health Department emphasizing that the budget cuts pose a serious threat to the health of our citizens and the ability to respond to a public health emergency. Approved the nomination of Drs. Janet Abshire and Micahel Carr to the County’s Emergency Medical Services Medical Oversight Committee.

Approved the Membership Report: For Active Membership — Margaret A. Chang, MD; Sammy A. Dizon, MD; Diana Z. L. Gascon, MD; Marty E. Reed, MD; Shih-Chin Wang, MD; Haifeng Yu, MD. For Multiple Membership — Maria J. Caparas, MD For Reinstatement to Active Membership — Arthur B. Dublin, MD For a Change in Membership Status from Resident to Active — Estella M. Geraghty, MD

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Employment Practices Liability Insurance A special Member First Time Buyers program is available for SSVMS members.

Open any newspaper or look on any news Web site and you’re bound to notice an article about another business being sued by an employee or former employee alleging discrimination or wrongful termination. These stories always make headlines. But are businesses truly being sued more often? Is your practice at risk? If it is, how much could you be forced to pay in such a situation? When an employee brings a complaint against a business, or a suit involves misadventure by a key employee, the trend is unmistakable: the business pays more. The number of resolved lawsuits alleging breach of the Fair Labor Standards Act more than doubled in 2005 (the last year that statistics are available) to almost 3,600 compared with the 1,596 cases in 2000.1 A survey found that complaints from disgruntled employees in 2007 cost businesses (involved in employee suits) an average $63,114, including judgments, settlements, fines and legal fees.2 The survey also reported that two out of three U.S. private companies experienced some type of event related to management liability within the past five years, costing an average $393,017. The number of incidents ballooned more than 25 percent from 2005. The survey results mirrored government statistics. The total number of charges filed with the U.S Equal Employment Opportunities Commission (EEOC) rose 26 percent from fiscal years 2006–2008.3 And the total amount of money awarded in those complaints during that span nearly tripled, from $44.3 million to $102.2 million.4 Even if a case goes to EEOC

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mediation, the average period it takes for it to be settled is 84 days—almost four business months.5 Workers’ compensation, general and professional liability insurance policies generally do not cover the vast majority of complaints filed against employers. For this reason, Employment Practices Liability insurance (EPLI) has grown in popularity. “Generally, purchasing EPLI insurance is a wise investment,” write lawyers Robert Hoffer and Kelly Schoening in the Business Courier of Cincinnati, “but not all plans are created equal.” When considering EPLI insurance, they recommend asking the same questions as you would about any insurance: • what is covered; • what is the deductible; • which attorneys can you engage; and • how are claims settled. The Sierra Sacramento Valley Medical Society offers its members EPLI insurance. This coverage also includes risk-management tools that can lower your risk, as well as access to a legal information hotline staffed by employment practices attorneys. And if you never had coverage before, ask about the simplified First Time Buyers program. You can contact a Marsh client service representative toll-free at 800-8423761 for more details. 1 Kris Maher, “Workers Are Filing More Lawsuits Against Employers Over Wages,” The Wall Street Journal, Monday June 5th, 2006. page A2. 2 Chubb Private Company Risk Survey, www.chubb.com/corporate/ chubb8596.html 3 www.eeoc.gov/stats/charges.html 4 www.eeoc.gov/stats/litigation.html 5 www.eeoc.gov/employers/investigations.html

Meet the Applicants The following applications have been referred to the Membership Committee for review. Information pertinent to consideration of any applicant for membership should be communicated to the committee. — Glennah Trochet, MD, Secretary Amin, Hemal G., Internal Medicine, B.J. Medical School, India 1999, The Permanente Medical Group, 1001 Riverside Ave, Roseville 95678 (916) 784-4050 Chong, Florence B., Emergency Medicine, WUHS College of Osteopathic 2004, The Permanente Medical Group, 2025 Morse Ave, Sacramento 95825 (916) 973-6600 Clark, Oanh Y., Emergency Medicine, WUHS College of Osteopathic 2004, The Permanente Medical Group, 2025 Morse Ave, Sacramento 95825 (916) 973-6600 Dycaico, Catherine E., Internal Medicine, UC Davis 1986, The Permanente Medical Group, 1955 Cowell Blvd., Davis 95616 (530) 757-7070 O’Neal, John H., Psychiatry, University of Washington 1974, The Permanente Medical Group, 2008 Morse Ave, Sacramento 95825 (916) 973-5300 Rangi, Jaiwant K., Endocrinology, Lady Hardinge Medical College, India 1996, Capitol Endocrinology, 3106 Pointe Morino Dr #C, Cameron Park 95682 (530) 677-0700 Yen, Lynn, Family Medicine/Psychiatry, University at Buffalo 2009, UCDMC, 2315 Stockton Blvd., Sacramento 95817 (916) 734-2011 (Resident Member)

The State, IOUs and Our Members There are many moments in the history of our medical society that illustrate our commitment to helping our members through difficult times. In August 1992, California was in a serious budget crisis like the one we are muddling through now. This was pre-Geographic Managed Care when all physicians were paid fee for service. The fees then were just as terrible as they are today and, like today, many physician practices were nearly all Medi-Cal. The state started issuing physicians IOUs in early August; the longer the deadlock continued the more difficult it became for many practices and several medical groups. Most banks would not accept IOUs, even from their own depositors! They felt that not purchasing

the IOUs would pressure the state into an earlier fix. With our Board’s approval, staff looked for a bank to accept IOUs. When we found one that would and wanted to help assure access for patients, SSVMS offered to purchase IOUs from its members. In less than a month SSVMS bought $192,144.48 of IOUs from our members. When the budget was settled, we traded in the IOUs for cask back and, soon after, switched banks to the one that had helped us out. Today’s IOUs are really warrants and a court case some time after the 1992 crisis found that payment could not be withheld from Medi-Cal providers. — Bill Sandberg

July/August 2009

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Doctor’s Placement Agency All medical personnel (916) 457-4014

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Positions Available PHYSICIANS FOR JUDICIAL REVIEW COMMITTEES The Institute for Medical Quality (IMQ) is seeking primary care physicians, board certified in either Family Practice or Internal Medicine, to serve on Judicial Review Committees (JRC) for the California Department of Corrections and Rehabilitation (CDCR). These review committees hear evidence regarding the quality of care provided by a CDCR physician. Interested physicians must be available to serve for 5 consecutive days, once or twice per year. Hearings will be scheduled in various geographic locations in California, most probably in Sacramento, Los Angeles, and San Diego. IMQ physicians credentialed to serve on JRC panels will be employed as Special Consultants to the State, and will be afforded civil liability protection to the same extent as any of Special Consultant. Physicians will be paid on an hourly basis for their time and reimbursed travel expenses. Please contact Leslie Anne Iacopi (liacopi@imq.org) if you may be interested.

Membership Has Its Benefits!

Free and Discounted Programs for Medical Society/CMA Members Auto/Homeowners Insurance

Mercury Insurance Group 1-888-637-2431 www.mercuryinsurance.com

Billing & Collections

Athenahealth 1-888-401-5911

Car Rental

Avis: 1-800-331-1212 (ID#A895200) Hertz: 1-800-654-2200 (ID#16618)

Clinical Reference Guides-PDA

EPocrates 1-800-230-2150 / www.epocrates.com

Conference Room Rentals

Medical Society (916) 452-2671

Credit Cards

MBNA 1-866-438-6262 / Priority Code: MPF2

Office Supplies

Corporate Express /Brandon Kavrell (916) 419-7813 / brandon.kavrell@cexp.com

Practice Management Supplies

Histacount 1-888-987-9338 Member Code:11831 www.histacount.com

Electronic Claims

Infinedi – Electronic Clearinghouse 1-800-688-8087 / www.infinedi.net

Healthcare Information KLAS / HIT Consumer Satisfaction Technology Products Reports 1-800-401-5911 Insurance Life, Disability, Health Savings Account, Workers’ Comp, more...

Marsh Affinity Group Services 1-800-842-3761 CMACounty.Insurance@marsh.com

HIPAA Compliance Toolkit

PrivaPlan 1-877-218-7707 / www.privaplan.com

Investment Services

Mercer Global Advisors 1-800-898-4642 / www.mgadvisors.com

Magazine Subscriptions

Subscription Services, Inc. 1-800-289-6247 / www.buymags.com/cma

Security Prescription Pads

Rx Security 1-800-667-9723 http://www.rxsecurity.com/cma.php

Professional Publications

UCG Decision Health 1-877-602-3835 / www.decisionhealth.com

Travel Accident Insurance/Free

All Members $100,000 Automatic Policy

Sierra Sacramento Valley Medicine

stability matters. If there is one thing to learn from the recent financial turmoil, knowing who to trust is paramount. Medical Protective, a proud member of Warren Buffett’s Berkshire Hathaway, has always believed that to provide our healthcare providers the best defense in the nation, our financial stability needs to be rock-solid, stronger than any other company. Stability even in the worst of times. Medical Protective is the only medical professional liability insurance company to protect their healthcare providers through all the business and economic cycles of the last 110 years, including the tough economic times of the Great Depression. We are also proud to have provided unmatched defense and stability during all the medmal crises. We provide the greatest stability with the highest ratings from A.M. Best and S&P and the backbone of Berkshire Hathaway.

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