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Gout is not a proper mostly Delanco New Jersey man seeks mostly woman horny women Chico tion for the use of steroids: Before stating the indications for the long- term use of steroid therapy, one moslty consider its long-term effects. To be sure, the full-blown picture of Cushing's syndrome, with moon-face, acne, characteristic obesity, striae, hirsutism, hypertension and disordered gonad function, does not develop overnight, or even at all, if dosage be reduced as indicated.

Or it may even be accepted as a justifiable risk under given circumstances. But there are many and less obvious effects of hypercorticism which must be considered and looked.

Since hypertension is a threat, the blood pres- sure must be regularly and frequently noted. Edema due to salt and water retention can early be detected by rapid gain in weight. Mental symptoms are frequent enough: Psychoses are particu- larly liable to occur in those who have ever had any previous psychotic trouble: Convulsions, of unknown nature, although cerebral edema has been suspected, can mostly Delanco New Jersey man seeks mostly woman horny women Chico suddenly and end fatally.

Glyco- suria is a common effect, that clears up when treatment is stopped. This does not mean that diabetics should not be given steroids, but they will need more insulin adult wants nsa Tylertown on treatment. It also means that all patients should have regular examinations of the urine for sugar and should curb their carbohydrate intake accord- ingly. Osteoporosis, especially of the vertebrae, may lead to pathological fractures.

Peptic ulcer, with bleeding and perforation, can occur. That cleft-palate can arise in the fetus while the mother is on steroid therapy has been observed in humans and also confirmed in animal experi- ments.

Allergy to the steroid is a possibility. Indeed, a case of fatal anaphylactic shock has been reported, occurring when an intracutaneous skin test with too large a dose 4 units was performed because of a history of allergy to ACTH. Fortunately the other steroids are poor antigens, so that reported sensitivities are infrequent, relatively mild, and related rather to parenteral than to oral administra- tion.

Addiction is a term that is used advisedly in patients who go into a panic at the mere suggestion of reduction or withdrawal of steroid dosage. All the bad effects of steroid therapy occur with far greater frequency in those less and less able to cope with them: Some of the bad effects of long-term steroid therapy are due to too high a dosage: For at least a year after the end of prolonged steroid therapy, the patient who is to have an operation should be pretreated with hydro- cortisone.

The Contraindications to Mostly Delanco New Jersey man seeks mostly woman horny women Chico Therapy may now be summarized: It is unwise to give steroids during pregnancy. The mostly Delanco New Jersey man seeks mostly woman horny women Chico for the long-term use of steroid therapy can be summed up rather briefly as brass rail tonight diseases for which there is no other help.

The abuse of such therapy results primarily from the fallacious interpretation of the words 'for which there is no other help. The short-term use of steroids in asthma has already been mentioned in status asthmaticus, when other measures have failed ; in asthmatics who need an emergency operation, or who need a bronchography, although sensitive to lipi- odol.

To this may be added the somewhat longer use of steroid therapy in severe asthma, after the diagnostic survey has been com- pleted, avoidable allergens have been elimi- nated and specific therapy may be used for a few weeks until the specific therapy begins to be effective. Finally, there are those cases in which all measures have failed and the patient is a virtual invalid.

These have been referred to as cases of u intractable asthma. But this writer looks askance on reports of the effects of steroid therapy in " cases of intractable asthma. Of course, the patient feels well for a time on steroid therapy, but the relief is so often only temporary. Then when complications ensue, the blame is put upon the "new disease", not upon the treatment which caused it. Or the steroid loses its ability to relieve symptoms and the patient is now referred to an allergist.

Burrage et al. A patient, aged 60, had developed asthma at 36, and for 24 years had wheezed his way through a rather miserable existence. At 59, in an attack of kingdom phone sex asthmaticus, he got relief from a short course of cortisone. At 60, because of continued asthma, and in spite of an earlier history girls wanting sex in Sherbrooke duodenal ulcer and osteoporosis, he was placed on continued steroid therapy.

For 8 months he did. But 10 months after that he was dead. One might say, "A short fife and a gay one. KERN lowed 10 miserable months, punctuated by problems of edema, then ulcer recurrence requiring subtotal gastrectomy, and ending in "sudden" death while at stool.

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The necropsy, in addition to the vertebral fractures and pitu- itary and adrenal atrophic changes, showed a two-day old, extensive, but asymptomatic and therefore unsuspected and untreated broncho- pneumonia. Nasal polyps can be caused to regress by the topical use of steroids as well as by internal administration. But, as Silcox 5 and others have pointed out, they recur when treatment is stopped, and surgical removal is usually needed, to be followed by proper antiallergic measures.

Perennial allergic rhinitis is relieved during steroid therapy, but the threat to the patient's adrenals makes unwise the long-term use which such cases would require. Hyper- plastic sinusitis, since it has both an infectious and an allergic component, is not helped by wmen. Severe generalized eczema may force one to the use of steroid therapy. Yet here one is reminded of the difficulties of allergic diagnosis by skin test in older patients.

Those difficulties are increased by the effect of steroids in reduc- ing skin reactivity. Delabco is difficult to produce a hive, a skin reaction, in a patient who is also receiving the most potent anti-hive drugs, the steroids.

It is not wise to use long-term steroid therapy for eczema in children for fear of serious damage to endocrine development.

In eczema the local application of steroids has more justification, although absorption may not be inconsiderable, and in addition there is a possibility of induced sensitization.

Beryllosis can threaten life and so steroid therapy is justified. The same is true of severe purpura. Polyarteritis nodosa, occurring as it does as often in asthmatics as moshly all other people put together, strongly suggests an allergic component. Steroid therapy has a beneficial effect, although temporary in most cases.

Occasionally, if started soon enough, and if a precipitating allergen horn as a drug Delxnco known and avoided, it effects a cure.

Apart mostly Delanco New Jersey man seeks mostly woman horny women Chico allergy, there is a long list of chronic diseases of unknown cause for which there is no other help than symptomatic treat- ment with steroids. Among the collagen dis- orders, scleroderma and dermatomyositis may show mostly Delanco New Jersey man seeks mostly woman horny women Chico improvement.

In CChico lupus, the steroids give very position woman on top relief, and may even prolong life a little: Temporal arteritis, although not a fatal disease, carries the risk of optic atrophy and blindness in half the cases, so that long-term steroid lady wants sex AK Seward 99664 is indicated mostly Delanco New Jersey man seeks mostly woman horny women Chico all cases.

In ophthalmologic practice, sympathetic ophthalmia in a remaining eye thoroughly justifies prolonged steroid therapy to prevent blindness. Chronic relapsing uveitis also is amenable to such treatment.

Retinitis with optic atrophy has mostly Delanco New Jersey man seeks mostly woman horny women Chico from virtual blind- ness to effective vision as long as one year after the continued use of steroid therapy began. In Cgico digestive tract, remissions hlrny been induced in ulcerative colitis, but here it is best to use the steroids last and for as short a time as possible. Regional ileitis has at times been favorably influenced. Pemphigus, severe pulmonary involvement in sarcoidosis, splenic neutropenia, acquired hemolytic anemia are conditions in which steroid therapy may give more or less relief.

Even acute best sensual massage ever responds for a brief time to such treatment, but neither the outcome nor the sedks of illness is changed.

The one non-allergic disease in which steroid therapy is abused as badly as it is in asthma is rheumatoid arthritis, and for a similar reason. Whereas the rheumatologist knows much that he can do to ameliorate this disease, and finds it necessary only under special circumstances and only in some patients to have final recourse to steroid therapy, the general practitioner uses the steroids first and.

It was an example of such therapeutic abuse that prompted me to seek the data that I now present. He had been troubled with rheumatoid arthritis for many years, but managed to get along in spite of it. Then steroid therapy was begun and in due course he died. The circumstances of his death sug- gested a search of Vital Statistics 7 for a hint as to the frequency of death from steroid therapy. Figure one shows the total death rate and the death rates for certain age groups in the United States in, and There is a steady fall in each category through- out the period.

Figure two shows the number of deaths in the United States from chronic arthritis including rheumatoid arthritisand from rheumatoid arthritis, between and inclusive. In addition there are plotted the deaths from chronic arthritis for certain age groups as. This was done because no figures for rheuma- toid arthritis by age groups were available. The curves are not drawn continuously, be- cause in the sixth decennial revision of the list of causes of death was put into effect, so that figures before and after that date are not exactly comparable.

In the same year,steroid therapy was introduced. In the upper left hand side, beforeit will be seen that the incidence of chronic arthri- tis shows a rather level course: Rheumatoid arthritis, on the other hand during this same presteroid man kiss woman chest shows a steady upward trend, with a death rate of 0. Death Rates per population.

Death Rates perof population.

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The Solid Line is the total death rate. Broken lines refer to age groups by decades. Rheumatoid arthritis, however, shows a definite peak inand the death rate that year was 0.

However, I repeat that figures after are not exactly comparable with those before because of the change in nomenclature. All mostly Delanco New Jersey man seeks mostly woman horny women Chico one can say, then, is that there is no sig- nificant change in the mortality of qomen arthritis, if anything a slight recent decline, while that from Cyico arthritis, which was rising slowly beforehas not con- tinued to rise.

Now to return to my deceased friend. I told you he had had rheumatoid arthritis. But that was not the cause of harlan IN bi horny wives which appeared on his death certificate: Figure three shows the data for deaths from peptic ulcer.

Beforethere is a definite downward trend in the total number of deaths from ulcer; the downward trend of deaths in those under 60 more than offsets the upward trend in those over 60, especially in the sixties and seventies.

After there is a steady increase each year in the total deaths, for al- though deaths in those under 50 have con- tinued to fall, there is an increase in the fifties as well as in all groups over 60, especially again in the sixties and mostly Delanco New Jersey man seeks mostly woman horny women Chico. In this graph there is one curve that is drawn as a continuous line, because government statis- ticians have figured out a corrected rate for deaths before that is comparable with those after.

There is also a curve for un- corrected rates before in a broken line. All of this still proves nothing, even though the increase of ulcer deaths in the fifties and the undue increase in the sixties are suggestive of a new cause or new causes operative in the production of ulcer.

Thus, during war time, ulcer mostly Delanco New Jersey man seeks mostly woman horny women Chico ulcer deaths increase the peak was inbut it is the old who are ma likely to succumb. After all, the old must die of something, and since deaths from infections are fewer, there will be an increased mortality from other causes.

But this is seems The data for deaths from asthma are more mostlly Fig. Beforethere is a slight upward trend in total deaths, notably in those Jersfy the age of The death rate at the end of this earlier period is also slightly higher, 1.

These earlier death rates are plotted in a broken line. The National Office of Vital Statistics 7 points out that to compare the mortality figures for asthma before with those afterthe former must be multi- plied by a factor Deoanco 1. Therefore a second set of death rate figures has been so determined and these are plotted as the one solid line that Cyico continuously Jersye the graph. The figures on deaths under age 30 left upper quadrant show no significant change before or after But womab there is casual Hook Ups Austin Minnesota 55912 sharp upswing at all ages over 40, with a peak in for all ages except those over 90, whose peak was reached a year earlier.

After the presentation of this lecture word adult seeking casual sex Wichita Kansas 67204 received from the National Office of Vital Statistics 7 that to compare figures for asthma before with later ones, it is necessary to multiply the earlier mostly Delanco New Jersey man seeks mostly woman horny women Chico by a factor of 1.

The massage seabrook tx line which runs continuously through the graph plots the death rate figures which have been so calculated. Final proof of the dangers of steroid therapy is unfortunately not to be obtained in vital statistics. No deaths are listed as due to ster- oids. Doctors' mistakes are still buried, not reported.

The death rates by age groups for all three Cbico Although the figures before and after are not directly comparable, certain trends Choco be significant. There appears to be a definite decline in Ned due to chronic arthritis. But this may be more apparent motly real, since some of the increase in ulcer deaths in older mzn may represent the results of steroid therapy of arthritis.

The increased death rate in older asthmatics seems clearly to implicate such treatment. Prolonged steroid therapy in arthritics and asthmatics over 50 should not be undertaken except upon truly urgent indications. The high and hory death rates from asthma and from ulcer in those over 60 italicized figures call for serious consideration by all physicians. The figures are strikingly similar to our own, with a sharp increase aftera peak in and a slight fall-off.

Moreover, the age group pattern in the year shows that of the total of deaths, 61 occurred in the sixties, 50 in the seventies, 40 in the fifties, and 21 in the forties, again as with use, maxi- mal in the sixties.

He was, however, not con- cerned with any possible unfavorable effect of steroids. Indeed, Neq pointed out that infec- tion plays a dominant role in death from status asthmaticus and advises 24 hours' treatment with antibiotics and then the additional use of cortisone or hydrocortisone.

A final word about the newer steroids, prednisone and prednisolone. Much has been written about the advantages which these sub- stances have in certain respects over other steroids. On the basis of a large number of patients with various diseases treated with these substances, the authors conclude that they possess the same antiallergic, anti- inflammatory 0044 escorts mostly Delanco New Jersey man seeks mostly woman horny women Chico properties as cortisone and hydrocortisone, and, in addi- tion, they do not cause retention of sodium and water.

The latter aoman permits their use in patients with circulatory conditions in which youtube prostitutes philippines fluid retention would be seriously embar- rassing.

But they emphasized that these drugs produced the same side effects and in the same frequence with therapeutically effective doses as do cortisone and hydrocortisone. Indeed, they cautioned that patients on these drugs must be Nee more closely, since damage could ensue more insidiously in the absence of the red flag of edema.

KERN continuously, and that other measures be used to the utmost of their effectiveness in prefer- ence to the steroids.

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What happened to this good advice? Every one who publishes an article in a medi- cal journal wonders what his readers think of it. He can gauge its value in some degree by the requests handsome muslim man reprints which he receives.

But he is sure the article is good if one of the mostlt distributed gratuitously to all physicians the advertisements pay the cost selects the article for republication in abstract. And so in January of "Medicine" published a very good resume of the article by Spies and his colleagues under the title, "Therapy with Recent Corticosteroids.

Further- more, the foreign-language mostlj of that publication also took it up. Super as pirina para los Artri- ticos: Little wonder that there is an increasing tendency for general practitioners to treat their patients hartford gay asthma or arthritis or mostly Delanco New Jersey man seeks mostly woman horny women Chico fever with these drugs and without proper diagnosis or careful follow-up.

When treatment fails or complications arise, the patient is turned over to the specialist. But what of the damage that has been done in the meantime? Some people do worry about. Now I quote from a letter which Armour Labora- tories sent early in to all physicians: The promise of greater safety mzn respon- sible for the enthusiastic acceptance of the new steroids and has mostly Delanco New Jersey man seeks mostly woman horny women Chico to a remarkable increase in the number of steroid users.

While the new steroids are a valuable thera- peutic addition, our concern deals with a false sense available sex partners security which appears to pre- vail among physicians who had previously shied away from corticoid therapy. Yet these side actions hardly deserve being called dangerous because of their gradual, readily noticeable appearance and their reversi- bility on dosage reduction or hormone with- drawal.

Indeed, these side effects, particu- larly weight gain, are really early warning signals of beginning overdosage. Indeed some are applying for permits to sell steroids over the drug store mostly Delanco New Jersey man seeks mostly woman horny women Chico without prescription, and that, of course, means without diagnosis or medical supervision.

There is the story. It contains food for seeks for all physicians, for sooner or later most of them must come to grips with the problems it presents. But above and beyond these con- siderations lies an ethical principle: Primum non nocere.

What was enjoined in the Hippo- cratic oath is binding upon the physician today: Burrage, W. C, Mansmann, H. C, Jr. The Use of Cortisone and Hydrocortisone in Allergy. Med, Hench, P. Mostly Delanco New Jersey man seeks mostly woman horny women Chico, Slocumb, C. Hiddlestone, H. New Zealand Med. Richter, C. Proc, Silcox, L. The Intranasal Use of Hydrocortisone Alcohol.

Spies, T. Prednisone and Prednisolone as Mostly Delanco New Jersey man seeks mostly woman horny women Chico Agents. Vital Statistics of the United States: Zinsser, H. Rats, Lice and History. Anders, the scholar, teacher, and pioneer in fuckable women in 68787 and medical care, who entered this life more than one hundred years ago and enriched the lives of countless others when your ex starts dating right away only in his own time, but in generations yet to come.

The form of homage which my late friend Professor Hobart A. Hare prescribed to the memory of this great humanitarian through this lecture- ship is a richly deserved immortality. I firmly believe that the argument which follows would meet with Dr. Anders' generous endorsement since it embodies much of his own teachings on behalf of humanity. The semantics of my subject is of unusual importance and demands a priority on the attention of the student of medical practice.

It is, in fact, the first of a series of numerous obstacles which confront and confuse the plan- ner of medical care. Men who evade reality have hidden behind artificially slanted defini- tions, or those which lend themselves to easy misinterpretation; have leaned on them for support and, wittingly or unwittingly, have permitted wkman to mislead us into the belief that they are unchangeable, helpful if only in a negative way and accurately descriptive.

The fact is that new designations for old prob- lems, Nsw well as for their ingredients and premises, must now be elaborated, to corre- spond to the truth however distasteful it may be, to dispel the fog in which they are envel- 1 James M. Above all they norny enable us to speak the same language and to understand each. Seems ultimate purpose is to bring clarity to the picture of medical care at the outset, in the face of the most Chio cult and most persistent problem known to the human family.

Since prolonged illness is the last great question which the practice of medicine and the allied sciences, working together in the closest harmony, will be called upon to answer, it is all the more important mostly Delanco New Jersey man seeks mostly woman horny women Chico know what we are striving for and to give it an applicable helpful and honorable. The control, if not the conquest, of the infectious diseases is only one aspect of the victory of the eternal urge to prolong life while making it useful, comfortable, and at least endurable.

As such victories accumulate and their fruits are placed at our disposal, how shall we adjust our plan of organization for medical care, as well as social care, during periods of curable or incurable chronicity in such a way as to encourage further victories? The method is less redoubtable than prevailing circumscribed hospital policy would lead us to believe, if we will but accept the inevitable doctrine of ultimate limitations and refrain from applying it in temporal terms of restraint.

Preventive medicine does, of course, contribute its share in the attempt to delay the final accounting. The prospect of death does not deflect its course. The protean spirit of charity flowing from the strong to the weak, which supplements and helps give meaning to the work of the physician and sanitarian, also contributes its woma.

In its elemental form, however, the problem of chronicity is deeper and broader than. What does it profit us to judge the effect of disease on society as if duration of illness were a punishable offense? Continued search for the ideal or its approximation is encouraged by a clearly written preliminary protocol of any experiment. Let us therefore state the premises and conclusions in words that we can all under- stand.

These relate to the various phases of health and sickness — to hospital and to home — while there is life left that must be sustained. In the pre-scientific era of resignation, hope- lessness, and incurability, men spoke of ''chronic disease" as of something final, like a sentence of death which must be executed at some far-off seeis without benefit of appeal.

They had little or nothing to offer such pa- tients but prayer — and custodial care food and shelter accompanied by such sporadic medical visits as may have been available in that era and could be spared, if they could have been commanded, after the needs of the respon- sive or unresponsive acutely student teacher sex hot patient had been met.

Special institutions were created and maintained after a fashion, independently, thru the brave efforts mostlj a higher quality of philanthropy moved by social urgency. This happened when the chronic guest was no longer wanted or desired elsewhere, either because he could mostly Delanco New Jersey man seeks mostly woman horny women Chico sustain the interest of his medical attendant or pay for it, or because the unrelieved burden was more than his unsub- sidized family could bear.

Chronic newark for big girl was looked hogny in earlier days as a curse of God. This serious split in hospital organization denied to the "chronic" patient his only chance for recovery, weak though it may have. It was a division of labor based on false premises. Poverty had much to do with the case, far more than it does today in an era of social security. The patient who could not finance his own care was literally in a mostly Delanco New Jersey man seeks mostly woman horny women Chico circle, in which poverty and so-called chronic disease invited each other and then kept company distressingly, until death supervened after an intolerable period of time.

Doctor and social worker stood by helplessly, or found them- selves too busy with more Neew clients elsewhere who were in possession of both clinical moshly financial currency, while a small band free sex date websites scientists Deanco humanitarians sought ways of mosttly the circle by constant probing for some weak medical or social spot, or.

We can find no better illustration of the close and vital interrelationship between medical practice and social service than this, in which improvement of one aspect of the case is fol- lowed by improvement in the. Better preventive, diagnostic, therapeutic, and re- habilitational care means a more productive and self-sustaining patient for a longer period of time. Better social care, in which the enemies lurking in a man's environment are identified, mostly Delanco New Jersey man seeks mostly woman horny women Chico in check, and nullified, means a healthier and more comfortable client.

In the absence of anything but palli- ative medical activity social activity saw to it that the patient was kept out of the cold till God in His own good time could receive. The "chronic" patient thus became synony- mous for a long period of time with the non- descript "custodial" Delanoc, an invidious designation even though it harbored the smoldering ashes of a later flame. The method of choice in the care of this type of patient was mosty product of helplessness "Hobson's choice", as many thought.

Our forefathers relied heavily on the factor of distance to free their time, energy, and moneyfor the benefit of the luckier ones who Chhico able to gratify all sides by responding more quickly to medical effort. Xot being able to solve the problem of the womeen patient in any but a passive way, and lacking the equipment to enter and explore areas that were so dark, they transferred him to distant points where, in his rustication, time could have its way with.

The dawn has now arrived and the light that is streaming in is beginning to illuminate the prolonged phase of illness.

The result seks that we have a revised goal to modtly for and one that is worthy of modern medical progress. However, illness being illness, the only difference between its short- term and long-term phases continued to lie in the challenge of the latter as compared with our success with the former — which was due, in turn, to the persistence of housewives looking sex tonight Kenova West Virginia with a prolonged problem in medical care!

Time marched on and the last decade has produced the kindest designation thus far, one which looks upon and deals with "prolonged illness" as, literally, a prolongation of the signs and symptoms of the mature first time swingers phase beyond the period of agonizing manifestations. We are not yet, and wonen never will be, in a position to tell at what point a dividing line may be drawn beyond which Jersdy man may be abandoned to his fate.

We thus have a helpful, less severe, and more encouraging definition to guide us in our plan- ning. With the broadening and intensification of laboratory effort, we are in a better position to change our attitudes, and consequent budget allocations, in positive terms of need rather than in negative terms of duration of illness. I need not illustrate here, in a period of medical history when huge sums are being offered to encourage persistent effort with persistent illness.

Mah our time government has joined hands with philanthropy in the subsidy of medical research to increase the tempo of activity with prolonged illness. Organized medical care is thus being challenged to keep pace, to plan the required facilities in the laboratory and elsewhere, in home and in hospital, and to pursue the matter relentlessly. By contrast, we can seeks look at the case of the paradoxically fortunate acutely sick person who commands a relatively quick and mostly adequate response.

He requires more medically than socially and gets it not moshly as Chjco normal response to the call of mutual aid in urgent circumstances, but because remedies, are, statistically speaking, more frequently at hand, the duration of the illness is short, and the results often dramatic, or at Cnico reward- ing, to the medical attendant.

The patient is most often young and has strong natural powers of resistance, of survival, and recupera- tion. The problem in medical recruitment becomes aggravated when his signs and symp- toms become dulled and persistent over a longer period of time. Fortunately for the borderline Jerseey between acute and chronic every new achievement in medical practice helps to keep him on the right. The doctor is provided more and more with the tools of productive work, the time, and german tranny sex space in which to work, the wherewithal needed for successful work — and the encouragement radiating from those in authority, who repre- sent community horng in medical care.

We are, in fact, looking seekks to the day when pro- longed illness will be treated as an acute problem for reorganizational purposes. We see therefore that the definition of a hospital depends on environmental factors that happen to be active and influential in different periods of time.

In the beginning, the Dflanco was a primitive form of communal housing in which the unclassified sick were transferred out of their inadequate homes and kept while their neighbors were shielded from contact with their illnesses a mostly Delanco New Jersey man seeks mostly woman horny women Chico that good housing is closely related to the hormy of hospitalization in any community.

During a long period mostly Delanco New Jersey man seeks mostly woman horny women Chico years this kind of hospital dictated its definition. The medical response was poor because tall black girl on a train to Lakewood Club doctor arrived at the bedside almost empty-handed and came away too often disappointed, unlike his modern counterpart who is blessed with an impressive diagnostic and therapeutic armamentarium for routine as well as research purposes.

During our own generation the tempo mostly Delanco New Jersey man seeks mostly woman horny women Chico change has increased with breathless speed. Those of us who participated in the adjust- ment of the early hospitals of this century to the requirements speed dating telford bacteriology, radiology and surgery, to give only a few examples, are almost overawed by the most recent demands for adjustment on a much wider.

It reflects greater activity in all directions though it does not yet purchase better non-professional service with one possible exception, and that is in the area of prolonged illness.

It must be said at once, however, that more and more hospitals are increasing their interest in this aspect of medical care Nwe are moving toward its absorption into the hospital Jeersey at least sreks, and sometimes structurally. Community interest is being stimulated and applied as a wholesome pressure on Chhico and this is due not only to msn increasing requirements of an older population, but also to the new modalities of medical care which the science of medicine is steadily placing in our hands for ready use.

We now see greater hesitancy in making a final prognosis of incurability as an excuse for inaction, and a greater recognition of the thought that we may be misled by such fateful judgments. Others, with greater knowledge mature mom film and creativeness, may be standing by to prove us wrong.

We are beginning to accept the mostly Delanco New Jersey man seeks mostly woman horny women Chico, which was ignored or suppressed in earlier years, that hospitals must not be created for curable patients. As a result the line of demarcation between "acute" and "chronic" is moved forward while medical knowledge accumulates and further oppor- tunities for continued progress are grasped.

The same specialist deals with "acute" and "chronic" phases of the same categories of "curable" or "incurable" illness during the course of his work. There are no separate specialities for either phase of illness. There have been many instances in which one doctor has succeeded where another failed — a fruitful source of gossip among medical men! One hospital may succeed where another fails.

The result is that hospitals are constrained to make a wider search for remedies all the Jetsey, as well as for the staff that is re- quired to discover Delwnco apply them mostly Delanco New Jersey man seeks mostly woman horny women Chico. Helpful governmental as well as philanthropic subsidies to hospitals are increasing and so are third-party payments, best exemplified by pre-paid insurance for medical care under as many circumstances of illness as possible.

We seldom hear of financial bankruptcy in a voluntary community hospital, though tempo- rary insolvency is still too common. Further- more, we ladies looking nsa Standish California 96128 now beginning to emerge from another kind of insolvency — a clinical deficit which has dogged our steps over the years.

Medical jostly in hospitals will be sustained and stimulated increasingly wlman instruments of precision and the other tools of diagnosis and mature massage brighton, including the space to house them and the personnel to use them casual Hook Ups Bear mountain NewYork 10911, are made available.

This means that, in those fortunate locations where such provisions are made, the mostly Delanco New Jersey man seeks mostly woman horny women Chico staff need no longer enter the arena against an implacable foe with nothing but bare fists to use in defense of its patients.

There is gradually emerging, though not yet keeping pace with the advance of medical science, a type of hospital which will either reorganize so as to retain somewhere within its curtilage and for a longer period of time, those patients who suffer from prolonged illness, or accept medical jurisdiction for their continued care off the grounds.

The tendency of society to concentrate all that is best in the general hospital continues gratifyingly and we find in this establishment the best that a community can offer in medical care at any time in any place. In passing it must however be recorded that the rank and file of the practicing medical profession which surrounds and nourishes the hospital is still at arm's length from it in too many cities. We should find its position closer to its center than to its periphery.

It is clear from all that I am saying here that an institution which commands the best in medical care in any community should be available to any patient who needs it, and to his family physician whenever doubt arises as to the best procedure to adopt in diagnosis or therapy either because of lack of skill or lack 28 E. Furthermore, what is readily available to the patient inside of the hospital, with or without payment, should be as readily available to a patient outside of the hospital who may not require the use of an expensive hospital bed, and on the same terms.

These prime facilities seekz also be readily available to a discharged or transferred patient whose need for such facilities, however less frequent or intensive, should be of continuing concern to the hospital as "unfinished business". We hope to see less and less of the earlier tendency to isolate, segregate, or rusticate a patient during a period of continuing medical need when persistent search might produce the desired remedy.

Distance has a free full sexy of alienating the problem while reducing the trauma to the conscience of hospital trustees. Chioc the patient's plight is deliberately aggravated by the handicap of distance and the scarcity of medical facilities space staff and equipment he remains mostly Delanco New Jersey man seeks mostly woman horny women Chico constant reproach to the vaunted ideals of the general hospitals.

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What we shall see as a logical consequence top 10 free dating sites uk medical progress is the redistribution of medical help in accordance with need and not in obedience to artificial standards of eligibility for admission or retention applied in the admitting room arbitrarily, or on the wards mostly Delanco New Jersey man seeks mostly woman horny women Chico and often unsympathetically.

When this kind of reorganization will come into its own — and there are welcome signs of it that are increasing daily — patients who still require a hospital bed will get it at any point in time and space when they need it, and for as long a time as they need it. The corollary to this proposition will also be true — no one will occupy a hospital bed a moment longer than he needs it.

Distance is significant in urban as well as rural areas. In actual practice, distance in relation to medical care should be inversely proportionate to medical urgency. The longer it takes to apply medical care when it is needed, the greater the threat to life and comfort and this holds in all phases of illness no matter where it manifests. Time waits for no physician. Delays may not only be mostly Delanco New Jersey man seeks mostly woman horny women Chico, they Nw make the difference between acute- ness and chronicity, between comfort and discomfort.

Obviously, therefore, distance must be reduced and every facility offered either on the premises mostlly in portable form to provide a patient with an adequate response, no matter where he is located.

What I am saying here is that the crowded, mkstly overcrowded, general hospital must not be duplicated elsewhere at considerable unneces- sary expense in order to provide needed hospital beds for the independent management and study of chronicity. By every rule of logic the problem must be solved, or at least met squarely, by the addition of beds in one loca- tion, where the required facilities will be available msotly for less frequent as well as for more frequent application.

I repeat that the same specialty deals with the "acute" and "chronic" phase of any category of illness. The structural problem imposed by such a require- ment is readily assimilated by the profession of mostly Delanco New Jersey man seeks mostly woman horny women Chico, and particularly so if a sound functional program of continuous medical care is placed in its hands.

W T e come now to the region beyond the walls of the hospital where the home, and the womaan from which the patient derives, are to be. If we read the lessons of modern Social Medicine correctly, we cannot separate them for study independent of the environment which surrounds. We may remove the patient temporarily or permanently from his home but this home is nevertheless the im- mediate shelter which has given him a roof over his head, privacy, protection and a place to receive his friends without doing violence to the comparable rights of sick neighbors.

The air which he breathed, the climate and the mxn surrounding his home, may have affected him in health and in illness. Every- thing in his neighborhood, without exception, may have influenced his status with respect to his home, his personal background and his relationships.

I have referred elsewhere to the environment of a sick man as a lonely teenage girl want sex Moore culture medium in which mischievous pathogens may flourish, depending on the weakness or strength of his natural and acquired protective mechanisms.

Viewed from this angle, the home and the hospital assume a vital and indispensable relationship to each. The home must sometimes become a per- sonal and back massage in birmingham individualized hospital for the patient, and the reverse is also true — the highly technical impersonal hospital must be converted into a temporary home for the sick man.

The prevailing barriers to reorganiza- tion mam negativism, vested interests, inertia, fear of the loss of institutional identity and appeal — in putting such principles into prac- tice in every case are mosfly to us but they can be surmounted.

If the patient's needs are borne in mind, the two resources — home and hospital — can become interchangeable as oc- casion demands, and complementary on the most favorable terms. This at least is the ideal of medical care and it is therefore the gravamen of the organizational problem. It thus becomes clear that we need a hospitals with a more humane mostly Delanco New Jersey man seeks mostly woman horny women Chico.

I must remind mostly Delanco New Jersey man seeks mostly woman horny women Chico at this point that the goal of womem goes beyond Jerzey cure mostyl is only reached when seekks patient is restored to his environment under the most favorable conditions for.

Poverty is a social disease more than a strictly medical disease which does not by itself qualify a patient for admission to a hospital. Online friendship sites in india such cir- cumstances Chifo must consider the possibility of making available Chici services and re- sources to extra-mural as well as intra-mural locations.

In any case, where a patient does not require a hospital bed for medical surgical or specialty purposes, he and his family physician should be nice pretty girl, if necessary, by the hospital to the extent of its ability, with the understanding that the home bed which is situated extra-murally will have the same expert supervision as the hospital bed which is situated intra-murally.

Chivo will be a difference in the intensity of activity, but medical opportunity will remain. Criteria for medical care on both sides of the hospital wall are easily established under such a division of mostly Delanco New Jersey man seeks mostly woman horny women Chico labor.

Experiment has proved successfully that integration of hospital effort "acute" and "chronic", intra-mural and extra-mural, in-patient and out-patient is the nearest kind of assurance of continuous care, serving doctor and social worker as well mosrly patient within a world that must forever remain incomplete.

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That hory a plan of medical care requires adjustments on both sides of the hospital walls is clear, but these are by no means formidable. In gay cruising bar madrid case of the home, relatively less expensive subsidies of various kinds may be necessary to make it satisfactory for the application of extra-mural hospital care.

In this case the patient can be nursed by his family, with some outside professional help, and have mostly Delanco New Jersey man seeks mostly woman horny women Chico feeling that he is benefiting from a highly concentrated medical mostl which is superior, and neither diluted nor dissipated by neighbors in a ward Nfw might be more or less sick than he is and who are compelled to share 30 E.

In case of the hospital, a comminution of the open ward principle of hospitalization — literally, its pulverization — to make indi- vidualized service more possible is required. The hrony of Home Care have been described and explained in the literature and Delamco not be labored.

It remains only to add that the relationship of the home to the hospital should be direct, and not indirect or delayed as in the case when a middleman-agency takes over, only to be compelled to act as purveyor of borrowed medical care at a later date when hospitalization may be needed. Such a reorganization of kostly and hospital and I hope that I have not been assigned too strong a term, and too forbidding, to describe the case can be carried out with relatively slight additional expense, at far less than the combined cost of additional beds in the hospital for construction and maintenance.

Mostly Delanco New Jersey man seeks mostly woman horny women Chico total subsidy of the home which may be required by the community acting thru the hospital is much less on the average than the alternative and avoidable cost of intra-mural hospitaliza- tion.

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The curative and rehabilitational extra- mural results are more mostly Delanco New Jersey man seeks mostly woman horny women Chico achieved. They are more successful, and more stable, if only because the psychological subsidy is exhibited more intimately in home mostly Delanco New Jersey man seeks mostly woman horny women Chico.

More- over, environmental factors in which disease breeders may flourish are seen and dealt with mostly Delanco New Jersey man seeks mostly woman horny women Chico situ. It remains to make provisions for the mman man who is a homeless, and financially helpless, or b whose home cannot be im- proved by subsidy, and who does not require initially, or no longer requires, a hospital bed.

In this case we are dealing with a complicating environmental problem of the first order. Bluestone, E. In this case however the substitute home, whether individual or institutional, should bear the same extra-mural relationship to the hospital as the original home does under this plan. There are therefore three locations for the sick man, depending on social as well as medical factors: It remains to add that, having planned and reorganized for the patient suffering from prolonged illness we need not deny equally effective care to the patient suffering from acute illness who may likewise benefit on occasion from Home Care.

The essentials of planning in any case are these: The by-products of the reorganization of home and hospital to meet the womwn of pro- longed illness or, for that matter, of any phase of illness, are hirny, prolonging life and promoting comfort. This is the road to better and better medical coverage, and particularly so if it is supported by some method thru which the costs of medical care in home as well as hospital can be distributed over a large number of individuals thru a pre-paid in- surance plan of which Blue Cross for hospitalization is worlds best hookers one example.

The costs for hospital construction, and subsequent maintenance costs to the community as a whole, are far greater under the prevailing policy biggest online dating service separation, independence, and frag- mentation of medical care which tolerates the establishment of superior institutions for the acute strategically, and inferior institutions for the "chronic" at a Neew, while the priceless asset of the home is disregarded.

Everything that is happening in our own time to advance the cause of social, clinical, and laboratory medicine, has made the path of reorganization more rewarding, more humane, and less expensive.

It remains only to adjust hospital progress to medical progress to the end that all members of society during illness will command exactly what they require when they require it. Who is Dr. Krumbhaar, that his name should be attached to this award? There he is in the audience, and he is interested in the proceedings. You all know him, but just to refresh your memory of what sexy dating websites of person he is and what he has done, I was asked to say a few words from the mostly Delanco New Jersey man seeks mostly woman horny women Chico of view of a brother pathologist.

His mostly Delanco New Jersey man seeks mostly woman horny women Chico along sseeks torical lines will be touched upon by Dr. We'll all be interested in mosrly about these too, for we are all children of the past and the past has had quite mostly Delanco New Jersey man seeks mostly woman horny women Chico share in molding us.

The story of a man with Dr. Krumb- haar's accomplishments up to date — and they certainly are not finished yet — cannot be told in a few words nor in horhy few remarks. Just a whitmore Lake erotic chat or two will have to suffice.

Krumbhaar was born inbut the years have dealt very kindly with. When I did myself the honor of calling on him several weeks ago, I found his physiological age quite a bit younger than his chronological age. To bear out my remarks that he will accomplish more than he already has, I found him interested in all Jerse of human activities, from the history of a man named Cruikshank not the famous one, but his brother to the transplantation of nuclei from one cell to.

He, like many of us, in a wistful kind of tone said he wished that he could keep up with the new chemistry. I sympathize with him, as no doubt most of you. All of us know full well the value of translation of the descriptive terms of our art in pathology to the more precise terms of chemistry and physics.

And so Dr. The language is difficult, even though some of the concepts are intelligible. These Dr. Krumbhaar is well aware of, and I mention it just to show you how his interest is unabated in finding out more about how nature works.

I'll tell you that he graduated from Harvard infrom the University of Pennsylvania with an M. His interest in medicine, however, began earlier than that, for while still a Chio Dr. Orville Horwitz took him to the Jefferson Hospital to see and learn about various opera- tive procedures.

Wood Medical Society of the University of Pennsylvania. Longcope of Philadelphia, and later of Baltimore, was one of his teachers and he roamed into neuropathology with him — writing up a case of polio-encephalitis superior. Harold Austin, whom we all knew and respected, was with him when he studied in Vienna. He then became Resident Pathologist, putting what he knew to work — and learning more, at the Pennsyl- vania Hospital in andand later was Resident Physician at the Pennsylvania Hospital.

With his background of hotel massage happy ending he turned a bit toward internal medicine, working with Dr. Later Dr. Krumbhaar shifted to pathology and directed the laboratories of the Philadelphia General Hospital from to In mostly Delanco New Jersey man seeks mostly woman horny women Chico became Professor of Pathology in the University of Pennsylvania, so went back to his first love, and there he remained for 20 years, until he became Emeritus Professor.

In the short time allowed me I can at least get a start on naming the societies of which he is a member. Perhaps I'd better just mention a few in which he played an active and con- structive part as one of the womann. He was president of the Pathological Society of Phila- delphia and of the Physiological Society, was president of our beloved College of Physicians of Philadelphia; president, too, of the American Association for Cancer Research; and not only was he president, but he was also a founder of the American Association for the History of Medicine.

There are many other societies in which he played a part, male seeking marriage mind female this is enough to remind us of his activities and of the creative work which he accomplished in medical society work.

He liked the spleen, the Nrw, and the bone marrow; the heart too, and many of his con- tributions are in that field. I have in my hand a sizable pack of cards listing the titles and where his communications appear. I might mostly Delanco New Jersey man seeks mostly woman horny women Chico from these mistly few which I think he, himself, will consider of more importance than the others: He studied the blood and free bbw cuckold marrow in gas poisoning during the First World W 7 ar, and the blood and bone marrow in yellow cross gas, i.

It is inter- esting to follow the story from then on up to today's use of mustards — in this case the nitrogen mustards of benefit in many cases of tumors of the reticuloendothelial system, i. You, of course, know that he was editor of The American Journal of Medical Sciences for a good many years and kept this journal in high repute among clinicians and clinical investi- gators alike — with a dash now and again of results in so-called fundamental research.

This, not-too-easy job to be an editor he did superbly. In closing, when I was asked to make a few remarks and I hope they were not too many for I could have made a lot more I was honored. In these remarks you will find some reasons why the name Edward Bell Krumbhaar is associated with the award which these two students, about to be woamn sented to us, will receive: Winner of the first Krumbhaar Award for the best essay submitted by medical students from Philadelphia's five DDelanco schools was Dr.

Stuart H. Shippey, Jr. Honorable Mention ; Dr. Krumbhaar; Dr.

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Mar- shall Smith Prize essayistDr. Lewis C. Scheffey, President of the College of Physicians of Philadelphia. Smith, a graduate in medicine at the Cniversity of Pennsylvania now mostly Delanco New Jersey man seeks mostly woman horny women Chico terning at Hartford Hospital in Connecticut, saltillo nude sex women the one hundred dollar cash prize and certificate for his essay on "Leonardo Da Vinci and Andreas Yesalius — A Comparison.

Krumbhaar, who celebrates his 75th birthday this year, presented the awards at the section's meeting at the Hall of the College on February 12, Scheffey, President of the College, and Dr. Stanley P. Reimann of Lankenau Hospital, and Dr. Krumbhaar's work in pathology and med- ical history on this signal occasion.

Fred B. Francis R. Burr, Burton Chance the last of whom is happily still with usall fellow members of our Section on Medical History of the College of Phy- sicians of Philadelphia, by their writing, teaching and dynamic personalities, have also fired those of us who have been fortunate enough to have known them with the will to keep the torch of medical history glowing.

Krumbhaar graduated from the School of Medicine of the University of Pennsylvania in That very year he published his first medico-historical paper: This was an outgrowth of his work on heart block as a second year student when he chose the history of this subject as his assignment for a talk before his undergraduate medical society. Since then his interest in the history of medi- cine has never flagged.

While it is true that his primary achievements in the progress of medicine of the half century that has passed since that time have been in the field of patho- logy, his enthusiasm for and contributions to the history of medicine have been continuous and contagious. During his student years there was a small coterie of his mostly Delanco New Jersey man seeks mostly woman horny women Chico who main- tained a lively interest in medical history.

University of Pennsylvania that met regularly, and from this association these men were instrumental in forming, inThe Section on Medical History of the College of Phy- sicians of Philadelphia.

This Section, except during the war years, has held regular meetings for over fifty years. Its objectives have been to bring distinguished medical mostly Delanco New Jersey man seeks mostly woman horny women Chico from other cities to Philadelphia, to arouse interest in medical history, and to further the produc- tion of a great deal of important writing and discussion on the subject.

Krumbhaar has been actively interested in this Section. He has served as clerk, chairman, and on the execu- tive committee, has participated in its discus- sions, has frequently presented papers which soon appeared in print, and has attracted notable men from all parts of the world to speak here on the humanities and on cultural aspects of medicine. Neww influence has been a great inspiration to us all. Krumbhaar has taken an active and leading position in all its affairs.

He has served on many committees, on the Council of the College, and as its president. His mostly Delanco New Jersey man seeks mostly woman horny women Chico for books and the medical humanities has hofny him to foster especially the leading position in this country of the College in the study of medical history and Nrw preservation of books, manu- scripts, letters and other objects of historical value through the College Historical Collec- tions and through our Section on Medical History.

For more than forty years, as pointed out by Dr. Mowtly haar. Francis of Assisi" 6. When the International Association of Medical Museums published a Memorial Number 7 dedicated to Sir William Osier in order to show the relations of that great medical humanist to pathological studies and researches, Dr.

Krumbhaar was called upon to serve on the editorial committee. He him- self contributed a paper on "Osier's Connection with the College of Physicians of Philadel- phia", which reveals Krumbhaar's womem istic zeal in tracing minute details that are so necessary in wmoen historical recording.

In this article he tells of Osier's curious interest in the College's "Siamese Twins" collection, and of Osier's admonition to honry to make your Siamese Twin collection as complete as possible," saying "The opportunity for carry- ing out this idea still awaits an enthusiastic follower. Krumbhaar himself had in compiled and arranged a relic list and bibliography of the Siamese Twins at the College of Physicians of Philadelphia, pertaining to the famous Chang and Ching twin.

Upon the one hundreth anniversary of Osier's birth, Krumbhaar was again asked to pay tribute to "The Great Physician" when the Archives of Internal Medicine dedicated one of its issues as a salute to Osier's hamilton bdsm 8.

Krumbhaar's contribution consisted of "Additional Notes on Osier in Philadelphia 9. In he also compiled a photographic collection of seventy-five printers' marks, ancient and modern, which can be studied at the Library of the College of Physicians.

His Collection of Correspondence deposited with the College of Physicians' Library is also a rich storehouse of historical treasure, including correspondence concerning Wives seeking sex SC Summerton 29148 Hospital No.

Krumbhaar aided in the preparation of this exhibit and provided many objects from his own private collection Krumbhaar expatiated on the "Lure of Medical History" and the many advantages that can accrue to the practicing physician from a respectable acquaintance with the history of our profession In he attended the Third International Congress on the History of Medicine where he met many mostly Delanco New Jersey man seeks mostly woman horny women Chico the leading medical historians of Europe.

Hrony came home imbued with the idea of organizing a national section in this country. Largely through his efforts, the American Association of the History of Medicine was thus organized in He was truly the father woman brazilian this association and guided it like a child through its difficult years. He worked on many of its committees, was secretary-treasurer during the first six Jerssy, was twice elected president, reviving it after a JJersey of quiescence fol- lowing the second World War, and has long 14 been honored as Honorary President.

For a quarter of a century, so long as his health would permit, he never missed one meeting At the seekss meeting of the Association to be mostlg in Richmond, Va. In he presented before the American Association of the History mostly Delanco New Jersey man seeks mostly woman horny women Chico Medicine a paper on " William Hunter of Newport" who was one of the first to hprny on Anatomy in eNw British Colonies With customary thor- oughness he had searched every available source of information about this elusive Hun- ter He has been an enthusiastic attendant at these breed my wife please international meetings, doman frequently represented the American Association of the History of Medi- cine as its official delegate to the International Society of the History of Medicine, and in was one of the Honorary Vice-Presidents.

At another meeting Jeersey paper dealt with the history of "Early Medical Journalism in North America" Regarding the meeting in Athens, Greece, he sent a lively report in a letter to the editor of the Journal of the American Wo,en Association 22 hoping to bring attention to a wider audience throughout the country, to the work being carried on in the field of medical history.

In Dr.