REPORT OF THE MEDICAL DEPARTMENT OF THE UNIVERSAL EXPOSITION, ST. LOUIS, 1904

LEONIDAS H. LAIDLEY
1905 Journal of the American Medical Association (JAMA)  
should always be explored if there is reason to believe in the existence of hemorrhage ; not only may the imme¬ diate danger to life from the loss of blood be great, but if the patient survives the hemorrhage the probability of fatal peritonitis is great. As Richardson5 well says, the use of intravenous infusion of saline solution may render such an operation possible even if the patient when first seen is in collapse and almost pulseless. In such cases as these-either intestinal perforation or
more » ... in¬ testinal hemorrhage-death without operation is so cer¬ tain and so immediate, while a fatal termination in a laparotomy negative in its findings-the laparotomie blanche of the French-is so nearly unheard of, that the proper course to pursue, it seems to me, is no longer a subject for discussion. Of the various classes of operation demanded for the relief of abdominal pain I have not left myself time to speak. Those for removing the cause of the disease, such as appendicectomy, cholelithotomy, prostatectomy, suprapubic lithotomy, oöphorectomy, hysterectomy, etc. ; those for repairing lesions in the continuity of the in¬ testinal tract, such as typhoid perforations, or perfora¬ tions of gastric or duodenal ulcers, etc. ; those for shortcircuiting the ingested food on account of intestinal stenoses-all these operations, with the indications and results of each, might well be discussed in connection with the subject of abdominal pain. But if I have suc¬ ceeded in drawing your attention to the salient points in the diagnosis and to the main principles of treat¬ ment of abdominal pain, I will feel that my remarks have not been entirely devoid of interest. ' with instructions to report to the Committee on Sanitation. At a meeting held to formulate plans for the organization of this department, the following general arrangement was made and approved: The title of the Chief Medical Officer should be "Medical Director," the appointment having already been accepted. The Medical Di¬ rector shall have authority to appoint, subject to the ap¬ proval of the Committee on Sanitation, such assistants as he may deem necessary for efficiency in organization and for the prosecution of the work. The duties of the Medical Director were thus formulated: To organize a Medical Department having jurisdiction over all cases of personal injury in the line of duty; to assume the care of the resident population 5. Richardson: Boston Med. and Surg. Jour., 1902, vol. cxlvi, p. 224. and visitors, and of such other cases as the Exposition Com¬ pany might be responsible for, or which in their judgment should be cared for; to exercise a supervision over all sanitary and hygienic matters connected with the grounds and build¬ ings and over all matters pertaining to the health and physi¬ cal well-being of the employes engaged in the conduct of the Exposition. A temporary hospital was opened in the Athletic Club House, which had been fitted up for the care of patients, two wings, offices, and examination and operating rooms were constructed, thus making reasonable provision for the care of the sick and injured. The Medical Director, after the prelimin¬ ary work in organization had been effected, was instructed to report to the president all matters pertaining to this depart¬ ment. At the end of the month, a full report was rendered both to the president and to the chairman of the Sanitary Committee. Blank vouchers, payrolls and other stationery were furnished for future use. All orders for supplies were sent to the president, and were forwarded by him to the com¬ mittee on supplies to be furnished. In the selection of my staff, I gave preference to those who had hospital experience for one or more years, and likewise selected those who did clerical work from those who had army experience, and found them well trained and willing help. The large resident population, many of whom lived in tents, with a large force of workmen, called for resident surgeons, who spent their time in the hospital, and one visiting physician, who cared for the sick in the camps and temporary build¬ ings. No one was employed in any department who would not give all his time and attention to the care of the sick and injured. The hospital service was placed under the care of the senior surgeon, to whom all should answer in the absence of the Medical Director. A full report was kept of each case brought to the hospital, both as to its medical character and the circumstances attend¬ ing the injury which might have any bearing on liability as it affected the corporation. Early in the construction period, an inspector was sent to our aid from the Engineers' Depart¬ ment, and he reported daily any insanitary condition within the grounds. BUILDINGS. The temporary hospital contained one ward, with six cots and eight wicker lounges, a drug room, an operating and ex¬ amination room, diet kitchen and sterilizing room and office of the Medical Director. The active force on duty day and night began their work July 1, 1902, Dr. Josiah G. Moore being placed in charge of the hospital. Additional members of th"· staff were appointed as the necessity arose. On January 7, 1904, the permanent Emergency Hospital was delivered to the Medical Director; it was situated at the east end of the grounds, making one of the group on the Model Street, accessible to the cars and surrounded by the park, one of the most desirable locations for the accommodation of all. In arrangement, it was well adapted for its purpose ; it was built of wood, and was two stories high ; the lower floor was covered with granitoid. On this floor there were two wards, each containing twelve beds and six wicker couches; one ward was set apart for men and one for women. Two other rooms were constructed, one for isolation and the other for sun¬ strokes. The latter room was especially fitted up for emergency in case of a hot season, but was found to be useless as there was not one case of insolation to care for. In the rear of the building were located the general operating room, the dressing room and the sterilizing room, all of which were fitted out with a complete hospital supply of the very latest and improved instruments used. I wish, in connection with this, to note that these were contributed without charge to the Exposition by the firm of Blees-Moore & Co., of this city; also all dressings and every need was furnished by them promptly and freely. At the entrance, were located the of¬ fices of the Medical Director, the staff, an ¡r-ray room, the superintendent of nurses, chief of sanitary department, store¬ room, drug room, and diet kitchen; on the second floor were the dormitories for the staff, nurses and attendants. The kitchen was used to prepare meals for the attendants; and Downloaded From: http://jama.jamanetwork.com/ by a Monash University Library User on 06/03/2015
doi:10.1001/jama.1905.92500460033002f fatcat:zhqdask4uzflro6almcfnqwxoa