THE EVILS; THEIR CAUSES AND THE REMEDY THAT WILL EDIFY MEDICINE IN THE

UNITED STATES.

Dr. A. Osness, Dayton, Ohio, read a paper, in which the evils are held to be "mushroom schools," antagonistic pathies, overcrowding in the profession, lack of scientific spirit among medical teachers, undue ostentation, and unscru pulous intrigues in the profession. The causes of these are: 1, paltry remuneration for professional services; 2, the fallacy of a profitable notoriety. The author suggested as a remedy the regulation of schools and professorships, obligatory interneships of all graduated, conditioning diplomas revocable for unprofessional conduct, charity hospitals to be under the supervision of medical men, the encouragement of strictly prescription pharmacies.

Dr. Wm. F. Barclay, Pittsburg, Pa.. felt that there was an implied disparagement of the American physician. He is of the opinion that physicians in this country compare favorably with those educated abroad, and that our schools and colleges are equal to any and superior to many of the foreign schools. We have advantage over the foreign physician in thoroughly understanding our own language, but that ought not to be offered as an excuse for any disparagement of American physicians and American institutions. Much that the essayist said is worthy of appreciation, especially his reference to charity work, as it is difficult to know just where charity ends and imposition begins. The points about the dispensing pharmacists were well taken, but much has been done to lessen the demand for proprietary medicines by placing them in the general stores at the least rates. The question as to how to remedy all these evils is a very difficult one to solve.

Dr. E. M. Epstein, Chicago, remarked that all American physicians are very

well received in Europe. The only remedy for all the evils portrayed by the essayist, in his estimation, is to have representation in the cabinet of the President of the United States, by the secretary, who is to be appointed or elected irrespective of politics. Then we would have some one to speak for us and to look after our interests.

Dr. John Punton, Kansas City, Mo., believes the remedy rests with the physicians themselves, who must enter politics and be willing to go to the legislature to demand the rights which are due the medical profession, and as long as this is not done we can not expect to be recognized by the government.

Dr. C. M. Skinner, Hartland, Wis. speaking for the pharmacists, said that they had been forced to resort to counter prescribing by the doctors, who, in the majority of instances, use their own medicines and even went so far as to dispense hot water bottles, syringes, etc

Dr. C. J. Lewis, Chicago, agreed with the essayist that it is impossible for a scientific investigator to be engaged n any commercial pursuit at the same time. We certainly ought to have a supervising mind in the Cabinet at Washington, and in this way only can our many professional evils be remedied.

TWO CASES OF TYPHOID FEVER WITH UNUSUAL COMPLICATION IN VERY YOUNG CHILDREN.

Dr. E. B. Montgomery, Quincy, Ill.. presented this paper, reviewing the literature on typhoid fever occurring in infancy and childhood. He reported two cases. One, aged 9 months, presented symptoms simulating a tubercular meningitis, recovery taking place on the twenty-third day. The second case developed a suppurative parotitis about the twenty-fifth day, with aphasia. After medical treatment of this condition re

covery resulted on the forty-fourth day. A search revealed but three cases in which there was involvement of the submaxillaries. He also mentioned one unreported case which occurred in the practice of Dr. Rook of Quincy.

Dr. J. O. Malsbury, Peru, Ind., beieves that typhoid in infants under 6 inths is more common than is generally supposed, and that cases are often wrongly diagnosed, being termed "catarrhal fever.' A very important diag nostic point is to determine the proximity of typhoid in the neighborhood, or whether it has existed in the family some months prior to the present case. This has occurred in his practice several times.

Dr. Archibald Church, Chicago, be lieves that meningeal symptoms are very common in typhoid, but are taken too much as a matter of course, and little attention paid to them. It has been proven by culture experiments that the typhoid bacillus or its product enters the cerebral cavity. A certain amount of cerebral disturbance is expected in every case of typhoid, and it is the symptoms which make the diagnosis between typhoid and meningitis difficul:. In the case presented there was no doubt an invasion of the cranial contents the same as occurs in the intestines and elsewhere. That recovery takes place after a sever invasion is preved by noting the percentage of recoveries from typhoid with marked cerebral symptoms.

FURTHER OBSERVATIONS ON
THE TREATMENT OF THE
ABDOMINAL VISCERA
THROUGH THE
COLON.

Dr. Fenton B. Turck, Chicago, read a paper in which he dwelt particularly on the importance of colnic lavage in the treatment of all diseased conditions of the bowel. He explained his method. very fairly illustrating it by a series of experimental reports.

Dr. Wm. F. Barclay, Pittsburg, Pa., expressed himself as being very much opposed to the indiscriminate injection of large quantities of water into the bowels. He was pleased to learn that Dr. Turck uses only a small quantity of water, as large quantities have in his experienced proven to be injurious. He

especially condemned the use of syringes, as they destroy the muscular tone of the bowel and a constipation is set up which is almost irremediable. Cathartics, too, are unpleasant to use, but cathartic medication in conjunction with regulation of diet is to be recommended.

Dr. T. Wertz, Evansville, Ind., sees no reason why the bowel should not give out the same as any other organ. Many persons are incapacitated for business on account of constipation, and from the constant use of cathartics their stomachs have become irritable, so that they are obliged to resort to water enemas. In cases where there is a paralysis of the bowel or insufficient peristalsis, water enemas are the rem edy. Many lives have been prolonged by the use of food enemas when the stomach is non-retentive and needs a

rest.

Dr. C. J. Lewis, Chicago, thinks that there is a general agreement at the present time that the saprophytic bacteria in the intestinal tract are largely the cause of appendicitis. Colonic lavage facilitates diagnosis, as we need only to unload the bowel of its accumulated bacterial infection in order to make pos. sible more accurate palpation of the appendix and thus determine its condition of inflammation.

Dr. Thomas J. Schnell, Parnell, Iowa, for many years believed himself to be the originator of colonic lavage in the treatment of appendicitis. The usual idea is to unload the cecum, but by using water at 110 F., it will not only unload the cecum and colon, but it will at the same time excite the peristalsis of the cecum as well as the appendix. Many cases of appendicitis are due to impaction of the colon producing paralysis of the muscle fibres and the formation of a ball-valve action of the cecum, and by means of a slight shock, such as jumping, the fecal matter is forced into the appendix, bacterial decomposition sets in. inflammation, necrosis and pus formation. Colonic flushings should be given every three or four hours for the first twenty-four to thirty-six hours, and after four or five flushings beneficial results are very apparent.

Dr. Turck, in conclusion, emphasized the value of using the colon as a means

of treating the abdominal viscera. It is not the quantity of water so much as the temperature which procures the characteristic reaction. Hot water draws out the water from the intestines. and the original injected quantity is thus increased. The temperature raises the body temperature two or three degrees, and, like cold, is a vasomotor stimulant. Fecal matter is a normal stimulant to peristalsis and the same effect can be produced by artificial stimulants. This can be done by means of small quantities of water, and when it is desired to produce gymnastics of the bowel. hot air is urged, and it acts on all the abdominal viscera at the same time. as a stimulant.

CASE OF COMPLETE HERNIA OF THE PREGNANT UTERUS. IN A X-PARA.

Dr. W. V. Anderson, Toledo, Ohio, reported this case. After thirty-six hours duration of labor examination revealed separation of the recti muscles with a complete uterine hernia, the fundus reaching to the knees, the uterys freely movable and the os dilated. Contractions were good, but ineffectual, owing to the position of the uterus; expulsion was interferred with by constriction of the cervix. Under anesthesia the uterus was inverted, forceps applied, and a living baby delivered without any difficulty.

PATHOGENESIS OF FUNCTIONAL NERVE DISEASES AND ITS PROPHYLACTIC INDICATIONS.

Dr. John Punton, Kansas City, Mo., read this paper. In the pathogenesis of nervous diseases. heredity stands fore most, as the results of injurious living on the part of the parents are often transmitted to the offspring. Patho logic changes are produced in the blood. and act on the nervous system in such a manner as to cause actual disease. In certain nervous diseases the red blood. corpuscles disintegrate and the plaques are much multiplied. Good diet and tonics tending to improve the system and the condition of the blood speedily restore health. In this connection the study of sociology ought to claim earnest attention, as it is a most important

factor in the causation of nervous dis

eases.

Dr. Philip Zenner, Cincinnati, Ohio, thought that much could be done to lessen the tendency to development of diseases of the nervous system when hereditary influences existed, by taking proper care of the child from the time of birth. He believes that the essayist is too optimistic as regards the condition of the blood being an etiologic factor, although improving the system is essential and productive of good results. The mental condition of the patient must also be improved by suggestion.

Dr. Daniel R. Brower, Chicago. makes it a routine practice to ascertain the exact condition of the blood in all cases of diseases of the nervous system. With the improved methods of investigation which we now have, there is ab solutely no excuse for anyone to overlook this important factor, any more than to neglect to make a urine exami nation. A knowledge of the exact state of the blood materially aids the treatment of diseases of the nervous system.

Dr. J. A. Witherspoon, Nashville, Tenn., believes that a child born with neurotic tendencies should receive especial care at the time of teething, and a the period of puberty, when the nervous system is subjected to exceptional strain and irritation. This is especially true of girls, in whom a crisis is often precipitated by an ovrecrowding of their minds at school, during the development of their nerve force, by the taking away of blood from the genital organs. and faulty hygienic surroundings. All depressing influences and critical pericds have an important bearing in neurotic patients, as they impoverish the blood.

Dr. William Oldright, Toronto, called attention to the improper hygienic conditions existing in our schools and colleges. Improvement of these conditions will materially lessen the occurrence of blood and nervous diseases.

Dr. John Punton, in closing, regretted that every advance in medicine is met by more or less opposition, and he expected his blood theory of nervous diseases to share the same fate, only to be subsequently acknowledged, just a several other of his theories had been in recent years.

ASSOCIATION OF HYSTERIA WITH ORGANIC DISEASES OF THE NERVOUS

SYSTEM.

Dr. Philip Zenner, Cincinnati, Ohio, read this paper. Organic diseases of the nervous system often follow hysteria, but are often obscured by the hys. teric manifestations. Diagnosis is facilitated by noting the personality of the patient, relation of symptoms to organ c diseases, and the clinical picture presented. Prominent among these are hysteric temperament, stigmata of disease, anethesia, paralysis, contractures and visual changes. In hysteria specia! attention must be given to globus hystericus, concentric contraction of the visual field. In organic disease, the alteration of the deep reflexes, rigid pu pils, and the reaction of degeneration must be noted.

Dr. Albert E. Sterne, Indianapolis, discourages the practice of informing patients of their real condition, if at all serious, as it often leads to serious results. They should be told only so much as is necessary to gain their intelligent co-operation in the treatment of the disease with which they are af flicted.

TEMPERAMENT AND ITS IN

FLUENCE.

Dr. Albert E. Sterne, Indianapolis, Ind., read this paper, in which he divid ed temperament into the acid, alkaline and neutral varieties, each one of which causes diseases peculiar to itself. This study is still in its infancy, but is one of vast importance in the cause of diseases of the nervous system, and is deserving of further investigation. BACTERIOLOGIC DIAGNOSIS IN ALL DISEASES OF THE CON

JUNCTIVA AND CORNEA. Dr. J. O. Stillson, Indianapolis, Ind., read a paper in which he set forth the importance of the bacteriologic diagnosis in all diseases of the conjunctiva and cornea. Water curettage is advocated in certain ulcers of the cornea. A small stream of either sterilized water or antiseptic solution is thrown against the cornea with sufficient force to dislodge the necrosed epithelium and clean out the ulcer. This method has been found salutary in the hands of the author.

Dr. Dudley S. Reynolds, Louisville, Ky., favors the curette in the treatment of persistent ulcers of the cornea, as it is an infection and requires antiseptic treatment. The best antiseptic in his opinion is carbolc acid, applied carefully with the point of a needle so as not to puncture the posterior layer of the cor

nea.

Dr. Stillson finds that the carbolic acid has a tendency to burrow into the layers of the cornea and cause serious separation of these layers, and it is for this reason that he adopted the water curettage.

INTESTINAL

AUTO-INTOXICA

TION, ITS PREVENTION AND
TREATMENT.

Dr. W. F. Barclay, Pittsburg, Pa.. deduced the following conclusions in his paper. Daily evacuation of the bowels will prevent decomposition of matter in the intestines, and subsequent auto-intoxication. Rectal injections of water, for the purpose of producing a bowel movement, or for cleansing the bowel,are not approved of, but cathartics are recommended, especially calomel, papoid salines, saline mineral waters, cold baths, etc. Proper food at regular intervals is important. INDIGESTION IN INFANTS AND CHILDREN.

Dr. James H. Taylor, Indianapolis, Ind., followed with this paper. He discussed the causes of indigestion, such as improper food and overfeeding. Treatment consists in washing out the stomach, ridding the alimentary tract of all irritating matter, then regulating the diet and time of feeding. He insists on absolute rest. Medicinal treatment is not so essential. Tincture of nux vomica and arsenite of copper are given.

Dr. Albert E. Sterne, Indianapolis, attributes the sclerotic change in the blood-vessels of young men to intestinal auto-intoxication. As to the feeding ci infants, and even adults, milk, being. absorbed and not digested, should always be given alone, and at frequent intervals.

Dr. Henry B. Favill, Chicago, mentioned the importance of properly using the terms auto-intoxication and autoinfection, as they are not synonymous, and should not be used in that sense. Products of imperfect met