The Bismarck tribune. [volume] (Bismarck, N.D.) 1916-current, 1934-01-17
THE FINAL FADE OUT

OF all the services q health column
conductor is asked to render, the most
lugubrious is posthumous diagnosis.
In spite of my shocking japes about
this, every little while some distraught
widow or mother-very rarely q hus-
band or father-insists on reciting her
version of the case and having my
confidential opinion upon the dag
nosis and the treatment. That isn't
the worst OF it, tho. It IS not much
trouble to lie like gentleman about
such things. But quite likely the be-
reaved one asks me whether the out
come would not have been different
had she not done something she did
do or done something she neglected to
do. A casual lie will not meet the re-
quirement here. You have to touch
it up with circumstance-and that is
the main reason why I dislike doing
autopsies by mail Better q thousand
mistakes peacefully laid away than
one live doctor caught lying, say I.
And so to work. The body this
week appears to be that of poorly
nourished. somewhat emaciated man
of So or 60. There is history of AZ
years illness from stomach, liver dis
orders, colitis, and anemia. The man
was suddenly taken III, complained Of
much soreness in hypogastrium, that's
away down around Chill, and later
the soreness seemed to be in the chest.
Within hours from the time this dis
tress began the man was dead, from
hypostatic pneumonia or pulmonary
edema. Are these the same thing?
Aside from the distress, which Is not
essential, hypostatic pneumonia" or
pulmonary edema Is not a bad way
to go, not half bad. In either case,
the victims consciousness becomes
gradually obtunded and he drifts
peacefully into oblivion, notwithstand-
ing the labored or perhaps stertorous
breathing.
Hypostatic means settling Of the
blood in the lowest portion Of the
chest and lungs. This occurs IS .
terminal condition in many chronic.
exhausting illnesses, with failure Of
the circulation. It Is carelessly called
hypostatic pneumonia" but there Is
no inflammation, only mechanical
settling Of the blood by gravity, so
the correct term for 1t is hypostatic
congestion. The base or lower portion
Of the lung may contain little or no
air when hypostatic congestion is adj
vanced. Such splenization gives dull
note when the doctor sounds the chest,
similar to the dull note elected in
pneumonia, and hence the incorrect
term.
Hypostatic congestion Of the lungs
is an insidious development. Doctors
attending exhausted bed-ridden pa
tients have to watch for it. Nurses
have to turn such patients from one
position to another at regular inter-
walls to guard against the effect Of
gravity.
Feeble persons who wander away
and are exposed to cold and hunger
are likely to develop hypostatic con-
gestion. II they are rescued alive. This
circumstance has too often been in
terpreted as evidence that exposure
causes pneumonia.
But we should understand clearly
that hypostatic congestion Of the
lungs Is always secondary condition.
II . physician enters such . cause
Of death the health authorities i'm
mediately return the certificate for
the direct or primary cause Of death.
This IS another reason why some doc
tors call hypostatic congestion "pneu-
monia." Pneumonia Is accepted aS
diagnosis and . sufficient cause Of
death.
Well have edema Of the lungs an
other time.