York Medical Journal Research Articles

Telemedicine in Ophthalmology: Promise and Pitfalls

An ophthalmologist in Iowa receives a phone call from a physician in Illinois about a case and provides treatment suggestions. Is the Iowa physician practicingmedicine in Illinois? Was his contact sufficient to establish a physicianepatient relationship with the Illinois patient? Does it matter if he receives an electronic copy of the patient’s record or if the physician seeking the consult is an internist? What if the Illinois patient joins in the phone call to answer some questions? These issues arise frequently and have existed since the advent of the telephone and the origins of medical licensure. Telemedicine uses electronic communications between a physician in “one location and a patient in another with or without an intervening health care provider” to provide expert opinion and care in a confidential patient-specific electronic exchange. Cybermedicine and e-medicine are more inclusive terms that address all aspects of physicians’ electronic communications; however, most laws and regulations apply only to telecommunications that are patient-specific, that is, telemedicine. Ohio’s statutory definition is typical: Telemedicine is “the practice ofmedicine. by a physician located outside. (the) state.” The linchpin for state regulation is the definition ofmedical practice; the laws of the state inwhich the physician is located and the laws of the state in which the patient is located are both relevant. The Federation of State Medical Boards maintains a listing of licensure requirements for telemedicine in each state. In addition, as of September 9, 2013, there were 146 bills pending in state legislatures addressing telemedicine and telehealth, clear recognition of their emergence as essential for medical care. The rush to regulate and the plethora of regulations create a morass for physicians practicing across state boundaries and impede widespread access to healthcare via telemedicine. Ophthalmology relies heavily on visual images for screening, diagnosis, treatment, and monitoring of disease, which frequently can be accomplished through digital imaging and telemedicine. It is not surprising that ophthalmologists have adapted quickly to the changing cyberlandscape and employ telemedicine to expand patient access to advanced care. Telemedicine has been particularly effective in the diagnosis and monitoring of retinopathy of prematurity (ROP) and diabetic retinopathy.

Single incision technique using an interference screw for the repair of distal biceps tendon ruptures

Various techniques throughout the years have been published on surgical repair of the distal biceps tendon foracute ruptures or for recalcitrant biceps tendinosis. The first report of a single incision technique to repair this tendon was in 1897 by S. Johnson in the New York Medical Journal. Since that time many different approaches and techniques have been developed. Interference screw fixation has been a reliable and well-tested method of tendon/ligament to bone attachment. There is a large body of literature concerning the various aspects of interference fit in the anterior cruciate ligament and proximal biceps tendon literature. Anatomic measurements, osteological analysis, and radiographic examination have provided information for the design of an interference screw that can be safely used in the proximal radius. We describe a technique using an interference screw through a single incision. We present two techniques for open tenodesis of the long head of the biceps.

The Early History of Epidural Anesthesia

Leonard Corning first conceived the concept of injecting an anesthetic solution into the epidural space in the mid-1880s. In his classic paper, Spinal Anesthesia and Local Medication of the Cord, published in 188 5 in the New York Medical Journal, he described a new and way to pro ­ duce an artificial, temporary, and local­ ized anesthesia of the lower limbs.l He theorized that the mode of action was ab­ sorption of an anesthetic drug (cocaine) into the venous system of the epidural space and then into the spinal cord where it would have its action. Corning's initial experiments favored deposition of an an­ esthetic agent into the epidural space, rather than into the subarachnoid space, because of previous problems with the sys­ temic toxicity of strychnine when it was placed into the subarachnoid space. He reasoned that direct deposition of a local anesthetic into the subarachnoid space would result in similar systemic toxicity. He also recognized the possibility of physi­ cally damaging the spinal cord if he at­ tempted to inject a medication into the subarachnoid space, with a needle, with­ out direct visualization. After injection of cocaine between the dorsal spinous processes in two subjects, first a dog and then a man, he tested for anesthesia with use of an electric current on the lower extremities. He described the lack of sensibility, which developed over 5-16 minutes, and the subsequent regres­ sion of this anesthesia over a period oHour to eight hours. Corning performed these injections without knowing the exact ana­ tomic position of his needle. Because he didn't mention cerebrospinal fluid aspira­ tion, and because the time course of the block was consistent with an epidural an­ esthetic, people have speculated that he performed an epidural rather than a spi­ nal anesthetic. Corning's work was successful at produc­ ing a novel means of regional anesthesia. He hypothesized that it would be useful in sur­ gery of the abdomen and pelvis. Interestingly, after his momentous initial start in epidural anesthesia, Corning abandoned further stud­ ies.

Jack London's New Woman: A Little Lady With a Big Stick

Jack London's New Woman:A Little Lady With a Big Stick Andrew J. Furer Andrew J. Furer University of California-Berkeley Notes . My thanks to Donald McQuade and Arthur Riss for their insightful and generous comments on previous versions of this essay, and to Leonard Cassuto for the opportunity to present an initial version on his panel at the 1993 ALA. I am also indebted to Earle Labor and Jeanne C. Reesman for many enlightening conversations about London and gender, and to Sara S. Hodson of the Huntington Library and the late Russ Kingman of the Jack London Research Center for their help with archival materials. 1. Anonymous, "An Elemental Maid," The Literary Digest, 26 (1903), 60. 2. See, for example, Clarke, Sex in Education (1873), and Beard, American Nervousness (1881). See also James C. Whorton, Crusaders for Fitness: The History of American Health Reformers (Princeton: Princeton Univ. Press, 1982), pp. 150-53. 3. Martha Banta, Imaging American Women: Idea and Ideals in Cultural History (New York: Columbia Univ. Press, 1987), p. 88. See also Patricia Marks, Bicycles, Bangs and Bloomers: The New Woman in the Popular Press (Lexington: Univ. Press of Kentucky, 1990), and Banta, p. 90. Marks notes that while American popular opinion became more tolerant of the New Woman as time passed, anxieties about her mannish tendencies persisted as she continued to push for "all the advantages of her brothers . . . [including] education and careers" (Marks, p. 2). Depictions of the athletic New Woman also appear in such imperialist novels as Richard Harding Davis's Soldiers of Fortune (1897), whose heroine, Hope Langham, is an able horsewoman possessed of ample physical courage. For a discussion of New Woman athleticism in popular 1890s novels set in a romantic past or romanticized present, see Amy Kaplan, "Romancing the Empire: The Embodiment of American Masculinity in the Popular Historical Novel of the 1890s," ALH, 2 (1990), 671-75. Kaplan notes that such novels "elicit the desire for liberation from domestic constraints through adventure and physical activity" (p. 675). 4. See Whorton, p. 153, and Kaplan, p. 674. Donald Mrozek has noted that "the absence of self control which led to sexual depravity was too easily confused with that sensual expressiveness which had its outlet in sport ... the manner of [women's] sport and athletic practice ... assumed a moral intonation." Mrozek, "The 'Amazon' and the American 'Lady': Sexual Fears of Women as Athletes," in J. A. Mangan and Roberta J. Park, eds., From "Fair Sex" to Feminism: Sport and the Socialization of Women in the Industrial and Post-Industrial Era (London: Frank Cass, 1987), p. 286. 5. According to Carroll Smith-Rosenberg, "a new social and political drama" had opened, centered on the highly educated, single and economically independent New Woman, who constituted a "revolutionary demographic and political phenomenon." Disorderly Conduct: Visions of Gender in Victorian America (1985; repr. New York: Oxford Univ. Press, 1986), pp. 266, 245. The second generation of New Women, educated in the 1890s, combined a subversion of gender conventions with a rejection of "bourgeois sexual norms," and desired to be "as successful, as political, as sexual as men" (p. 177). 6. Richard von Krafft-Ebing, Psychopathia Sexualis with Especial Reference to the Antipathic Sexual Instinct, trans. F. J. Rebman (1st German ed., 1886; Brooklyn: Physicians & Surgeons Book Co., 1908), pp. 334-35. 7. Stockham (1833-1912) was a Chicago physician and author of numerous books on women's health. See Stockham, Tokology: A Book for Every Woman (1886; rev. ed., Chicago: Sanitary Publishing Co., 1887), and Karezza: Ethics of Marriage (1896; rev. ed., New York: R. F. Fenno, 1903). See also Mrozek, p. 285. 8. Ellis, "Sexual Inversion in Women," Alienist and Neurologist, 16 (1895), 153. See also William Lee Howard, "Effeminate Men and Masculine Women," New York Medical Journal, 71 (1900), 687, and Whorton, p. 153. Howard classes as "degenerates" the "female sexual pervert" and the "female possessed of masculine ideas of independence." 9. Sam S. Baskett, "Sea Change in The Sea-Wolf," ALR, 24 (1992), 5-6. See also Charles N. Watson, The Novels of Jack London: A Critical Reappraisal (Madison: Univ. of Wisconsin Press, 1983), who discusses London's attempts to represent a...

The tragedy of the ARRS founders.

Undoubtedly we will hear over and oven again as the centennial approaches how Dr. John Rudis-Jicinsky of Cedar Rapids, Iowa, wrote in 1 899 to Dr. Heban Robarts in St. Louis to suggest the formation of a society of physicians and others interested in the medical development of the newly discovered roentgen nay [1]. Dr. Hebar Robarts was a physician in St. Louis who early on became interested in the new nays and was enterprising enough to publish the first American journal devoted entirely to the X-ray and its allied sciences, The American X-Ray Journal (1897). Two years after Robarts founded his journal, his subscription list became the mailing list for the call to organize the Roentgen Society of the United States, later named the American Roentgen Ray Society (ARRS). As president of the organizing meeting and of the first regular meeting, and as editor of his journal, which the new society chose as its official organ, Robarts struggled to keep both the society and the journal free of the taint of electnologists,phototherapists, and similar practitioners who had flocked to the new organization [2]. However, because the Roentgen Society of the United States made no distinction between the quality or goals of its new members and those of the original subscribers, the electrologists and manufacturers were able to take an aggressive stance in dissuading some of the traditional physicians, who were more cautious in both outlook and practice, from finding an appropriate place for the new technology. Dr. Robarts became discouraged and eventually gave up his journal to these marginal practitioners. Indeed, the journal eventually became the electrologists’ organ and lost its identity as a reputable scientific publication. By 1905, Robarts’ name was no longer on the society roster. In 1898, Robarts turned his attention to radium, and he spent the rest of his life working in the field of radium therapy with the same energy and productivity he had earlier devoted to the promotion of the X-ray. In discussing the mantyns to the X-ray, Percy Brown gives a moving description of Robarts’ death from radium-related malignant disease [3]. Although Dr. Robarts deserved a better fate during his life, the fate of Dr. John Rudis-Jicinsky, who first suggested the organization of a society, was considerably more tragic. Dr. Rudis-Jicinsky started experimenting with X-rays as early as 1896 in Cedar Rapids, Iowa, and became captivated by the new technology, Itwas he who had hand-written the 40 invitationsto prospective members for the firstmeeting in Dr. Robarts’ officeand wrote 2000 letters for the second meeting. He and Dr. Robarts designed the society’s original constitution. He served for 3 years as the society’s first secretary-treasurer while contributing papers on X-ray therapy for tuberculosis as well as malignant disease. In 1902, atthe third meeting of the ARRS, one of the papers presented was devoid of scientific data and served as a commercial for the speaker. The meeting broke up amid catcalls from the audience, and on the following day Rudis-Jicinsky was removed as secretary, since he had arranged the program and was held responsible for inviting this quasicharlatan [4]. Despite this ignominy, Rudis-Jicinsky continued as an active member, contributing, among others, a paper on the potential use of Xnays in courts of law. Nevertheless, in 1911 Rudis-Jicinsky was expelled from the society he had co-founded on the necommendation of the board of censors. This group reported that “incontrovertible evidence has been submitted that Dr. J. Rudis-Jicinsky has been found guilty of gross intentional fraud, practiced on a patient, the same consisting of radiograms of dry bones and anatomical specimens instead of the real radiograms. The prints submitted as evidence and given to the patient as true roentgen pictures of himself are those of portions of the skeleton the bones of which had been fractuned artificially and the skeleton that of a person of entirely different size and stature and sex. The prints do not represent what they are stated to be” [5]. There is no further information or discussion and no further mention ever again of Dr. RudisJicinsky in the society’s official papers. Six years later, writing in the New York Medical Journal, Rudis-Jicinsky relates his experiences as a radiologist in Senbia in World War I [6]. He discusses fractures, foreign bodies, bullet source identification, and even the use of X-rays for sterilizing infected wounds. Dr. Rudis-Jicinsky died in 1921 in Chicago, preceding Dr. Robarts in death by 1 year.

Medical professional needs for geriatric care

Medical professional needs for geriatric care

"GERIATRICS"

<h3>To the Editor:—</h3> Permit me to correct an error in Dr. Tuohy's article on geriatrics in your issue of January 20. He said "Masters introduced it (the word 'geriatrics') in a thesis in 1914." I coined the word "geriatrics" and suggested it to cover a special branch of medicine dealing with old age, in a paper which appeared in the<i>New York Medical Journal</i>Aug. 21, 1909, lectured on Geriatrics in Medical Schools in Chicago, New York and Boston from 1909 to 1916, organized the New York Geriatric Society in 1912, and Blakiston published the first edition of my textbook "Geriatrics, Diseases of Old Age and Their Treatment" in 1914. Official duties prevented the continuance of my work in geriatrics. Now, retired and well along in years (76), I still take an active interest in the subject and hope to see it become a major branch of medicine.

Heart disease in relation to marriage and pregnancy: Herrick: New York Medical Journal, 1923, cxvii, 546

Heart disease in relation to marriage and pregnancy: Herrick: New York Medical Journal, 1923, cxvii, 546

Drainage in pelvic abdominal surgery: Kelly: New York Medical Journal, 1921, exiv, 390

Drainage in pelvic abdominal surgery: Kelly: New York Medical Journal, 1921, exiv, 390

Hemorrhagic disease of the newborn: Kaiser: New York Medical Journal, 1922, cxvi, 156

Hemorrhagic disease of the newborn: Kaiser: New York Medical Journal, 1922, cxvi, 156

The management of breech presentation: Pfeiffer: New York Medical Journal, 1921, cxiii, 178

The management of breech presentation: Pfeiffer: New York Medical Journal, 1921, cxiii, 178

Unilateral twin tubal pregnancy: Thorek: New York Medical Journal, 1921, cxiv, 403

Unilateral twin tubal pregnancy: Thorek: New York Medical Journal, 1921, cxiv, 403

A study of the death of the full term extrauterine fetus in situ: Oliver, James: New York Medical Journal, 1923, cxviii, 81

A study of the death of the full term extrauterine fetus in situ: Oliver, James: New York Medical Journal, 1923, cxviii, 81

CIRCULATION IN VARICOSE ULCER

To the Editor: —I was much interested in the short notice of Dr. Morris Kahn on A Method of Improving Circulation in Varicose Ulcers (The Journal, May 3, 1924, p. 1442). I must point out, however, that the process described is merely a crude form of the manual treatment of ulcers and war wounds, the technic for which was described by me in the New York Medical Journal 93 :978, 1911; Medical Press and Circular 99 :291, 1915, and the Practitioner 100 :491, 1918, all recently reprinted in my Collected Papers on Mechano-Therapeutics, 1924. Even massage pure and simple has been described in medical literature as a treatment for ulcers, at intervals during the last thirty years.

HATPIN IN MALE URETHRA

In the literature there are many case reports of hatpins introduced into the male urethra. In fact, these occurred with such frequency at one time that theNew York Medical Journal(1910) had an editorial on the subject. This type of foreign body has been employed to start the urinary flow in stricture of the urethra and in obstruction caused by prostatic hypertrophy; it has also been used as a form of masturbation. J. P., aged 64, had had intermittent attacks of hesitancy in starting the urinary flow. On these occasions, he would pass the ball end of a hatpin into the urethra for a distance of 3 or 4 inches. On withdrawal, the urine could be made to pass. The day the patient was brought to my office, he had introduced the beaded end of a hatpin into the urethra, when it suddenly slipped from his fingers and passed

The effect of the placenta on menstruation: Jacoby: New York Medical Journal, 1923, cxviii, 619

The effect of the placenta on menstruation: Jacoby: New York Medical Journal, 1923, cxviii, 619

The ovum as an internal secretory organ: McIlroy: New York Medical Journal, 1922, cxv, 404

The ovum as an internal secretory organ: McIlroy: New York Medical Journal, 1922, cxv, 404

"IMMUNOLOGIC OBSERVATIONS IN AUTUMNAL HAY-FEVER"

<h3>To the Editor:</h3> —In his paper on immunologic observations in autumnal hay-fever (The Journal, May 3), Dr. Harry S. Bernton discusses the Scheppegrell four-group classification of hay-fever pollens as published in the<i>Boston Medical and Surgical Journal</i>, July 12, 1917. This, however, has since been revised, the new classification of three major and five minor groups having been published in the<i>New York Medical Journal and Record</i>, June 20, 1923. In this report, the following statement is made: "While the grouping of hay-fever pollens from a biologic"—and botanic; the ragweeds and artemisias, for instance, both belong to the<i>Compositae</i>family, but are divided into separate groups— "viewpoint has proved of great advantage in simplifying the diagnostic tests and treatment of hay-fever, our experience has demonstrated that the most common member in the patient's vicinity, of the group to which he reacts, should be selected for his immunization." Regarding the ragweed

Spondylitis—A Submerged Entity in the Diagnosis of Obscure Conditions in the Abdomen

IN looking over recent textbooks and other current medical literature, one is struck with the paucity of material bearing on spondylitis. It is only when the Index Medicus is consulted that one sees the amount of thought and effort that has been expended on the subject. My specific attention to spondylitis was caused by finding a case of the “Marie-Struempell” type in a patient where all the trouble was referred to the right kidney. This man, a lean individual of thirty-five, had been down to the cystoscopy room and had been catheterized three different times, radiographs being taken each time. The kidneys were visualized and were found to be normal, as was the urine. (I had paid no attention to the spine, for we were looking for a pathological condition of the kidney. ) Talking over the case with the cystos-copist, he remarked: “The man must have some pathology somewhere; if not in the kidney, where?” It was then that I looked for something else, and at once noted the spine, which showed a marked spondylitis. Following this case I was more careful in looking over plates taken because of gastric and kidney conditions, and was surprised at the number that showed spurs and other conditions of the lumbar spine. There is no doubt in my mind that in many of the cases it was these pathological conditions in the spine that led these patients to consult their physicians, who had been misled by the referred pain to some abdominal organ or viscus. The mistake is often made of inferring that spondylitis is always accompanied by rigidity or stiffness of the spine. A number of cases that I have looked over have had no perceptible stiffness, or at least not more than one would expect for the given age. Just what is the cause of spondylitis is still a mooted question. Some consider that it is just a part of a general rheumatoid condition that for some unknown reason has affected the spine rather than some other joint. If this be true, why does it nearly always select the lumbar vertebrae? The orthopedist, McCarthy, of Philadelphia, writing in the New York Medical Journal in 1905, considered it a distinct disease entity and pointed out what I also have noted—that the pain in these cases is usually referred to some distant point and seldom to the seat of the pathology. The studies and writings of Marie, Baumler and Struempell cite a number of possible causes for the condition, but unite on no one thing. In the last American edition of Struempeli's “Practice of Medicine,” he devotes only a few lines to the condition, and that to the terminal pathology, indicating that probably he was weary of the war of words and wanted peace. Bechterew approaches the subject from the rheumatic point of view entirely, and, I think, rightly attributes the pain to the pinching of the nerve roots by the new deposits.

Ingestion glycosuria, an aid to early diagnosis of pregnancy: Long and Hirst: New York Medical Journal, 1923, cxvii, 543

Ingestion glycosuria, an aid to early diagnosis of pregnancy: Long and Hirst: New York Medical Journal, 1923, cxvii, 543