An uncle may have had tubero ulosis. Pa tient denies absolutely any venereal affection; had used alcohol to excess. Had never had any reason to believe that he was the subject of a pulmonary trouble until March, 1902, when after exposure on a rainy day, he was three days later, when about to go to his work, taken with a severe pulmonary hemorrhage. He stated, a cupful of blood was raised. This bleeding was repeated one and one-half hours later. He then went to the City Hospital, and during his stay of seventeen days, he claimed to have had thirty hemorrhages.

On the 17th of the following May he entered the Mullanphy under the care of our predecessor, and from that date to the time of his becoming our patient, it was learned that he had had repeated hemorrhages, many of which were severe. He also lost greatly in weight and strength. All during this time he was thought to have pulmonary tuberculosis, and was treated accordingly, which resulted also in some improvement, as he gradually became able to leave his bed and be up and about the ward for a short while at a time, but he was still (June 25, 1903) very thin and feeble. Careful physical examination at that time showed evidence of infiltration of right lower lobe posteriorly, and some subcrepitant rales in right infra-axillary and infra-mammary regions, also scar on fraenum of penis and a perforation of nasal septum. Examination of sputum showed no tubercle bacilli.

These findings naturally aroused suspicion of pulmonary syphilis, and accordingly he was placed on specific treatment June 28, 1903, which treatment was continued, on the intermittent plan until his discharge, September 9, 1903. During this period he had no more hemorrhages. His cough disappeared, and he gained in flesh and strength, so that at the time of leaving the hospital his general condition was very good.

A thorough physical examination, made August 21, 1903, showed that all evidence of pathological changes in his lungs had cleared up entirely.

During the time patient was under observation repeated careful examinations of the sputum were made by my associate, Dr. Fahlen, with always negative results.

Here then we have had a case that certainly behaved in every way like syhpilis of the lungs, but, of course, the diagnosis was not confirmed by autopsy.

I can also recall two other cases, the first, in which a man of six feet and weighing 200 pounds has had for several years all the evidences of a cavity, the size of a hen's egg, just below the angle of right scapula-lungs otherwise normal. He has never raised any

sputum, focus apparently quiescent as regards general condition.

The second case is that of an infiltration with moist rales in left infra-scapular region, remaining portions of lung in an emphysematous condition, due to repeated attacks of bronchitis. This subject also keeps in good flesh and in fairly good health between his bronchial attacks.

Both of these men are about 45 years of age; and one of them admits a venereal bistory. In neither have tubercle bacilli been found in the sputum. The lesions in both, however, appear to be favorably influenced by the iodides, but have never completely cleared up. May not these also be obscure cases of pulmonary syphilis?

DISCUSSION.

Dr. H. W. Soper (813 N. 18th St.) stated that he could recall two cases that had developed tuberculosis while under treatment for syphilis. The first case developed the first evidences of tuberculosis about a year after the syphilitic infection. The patient seemed to be responding well to the treatment for syphilis, and had no lesions at the time. The tuberculosis was remarkably rapid and the patient succumbed in about one month's time. The second case developed it after about two years. He had kept his weight and general nutrition very good Results of the antisyphilitic treatment was not very favorable at the time. The tuberculosis ran a slow course. These cases, however, were not believed to be a fair sample of the kind that Dr. Smith wished discussed. These went to the bad very rapidly, the second being slower than the first.

He

Dr. M. W. Hoge (Linmar Building) believed that a case which he had had under treatment a few years ago would be of interest in this discussion. The patient was an emaciated, cachectic individual, who had never given any definite history of infection. had treated her once following an attack of influenza, following which there was fever, coughing and bloody sputum. She would cough up sufficient blood to almost call it pulmonary hemorrhage. The condition ran a slow course, the fever diminished and finally subsided. There was no cavity formation that could be determined. She did not want a diagnosis made, and would call upon the doctor only when there was some serious trouble. Some months after that, she developed a nasal trouble which was referred to a nose and throat specialist. recommended that an iodide be given in small doses, on account of the lung trouble, probably being tubercular. Her condition im

He

proved very rapidly, and there was no injuri ous effect shown on the lung. The result was rather favorable. Subsequently when this patient came to the doctor in a run down condition, she was usually benefitted by a specific treatment. The speaker could not tell whether the lung trouble was tubercular or syphilitic. If it was syphilitic, it showed the benefit of the treatment. If it was tubercular, the trouble was not increased.

Dr. Albert E. Taussig suggested that in obscure cases like the one reported, it was often worth while to inject some of the sputum into the groin of a young guinea-pig. If the sputum contained tubercle bacilli, even in numbers so small as hardly to admit of detection by means of the stained spread, a general tuberculosis would develop in the inoculated animal. If on the other band no such tuberculosis developed, this result would speak, so far as it went, for some other diagnosis. In the case reported, the possibility of a tuberculous condition was the confusing feature, and light might thus have been thrown upon the matter by animal experi

ment.

Dr. Fischel in closing the discussion, stated that the patient had had lesions fourteen years before and that his hair had come out. Special emphasis was laid upon the peculiar gait, and this, the doctor stated, could not be accounted for on any other ground. He could not be certain as to the absence of tubercle bacilli. All of the many tests were negative. The patient had improved wonderfully since the iodide potassium treatment commenced. The doses were increased up to 40 drops three times a day, and unly stopped then because the results were good, and there was no good reason for increasing the dose. As to the guinea-pig test, the doctor wished that it could be tried in the City Hospital, but the facilities were not at hand.

FOURTEEN Women physicians of Detroit recently organized a society whose membership is limited exclusively to women practitioners. It is designated the Women's Academy of Medicine, and is the third of its kind in the country, the others being located at New York City and Rochester, New York. Women physicians in Michigan who are members of their county society are eligible to membership in the new guild. The following officers were elected for the ensuing year: President, Dr. Lucy J. Utter; vice-presdent, Dr. Mary G. Haskins; secretary, Dr. Anna Starring; treasurer, Dr. Minta P. Kemp; councillors, Drs. Florence Huson, Louise RosenthalThompson and Isabella Holdom.

Medical Society, held May 15, 16 and 17, THE Springfield meeting of the Illinois State

The Meeting of the Illinois

State Medical
Society.

was the largest in attendance in the history of the society. Three factors contributed to making this a large and profitable meeting: first, the location, which is central and accessible, with ample hotel acommodations; second, the increased membership of the society, due to the extension of organization, every county now but one in the State being organized, and this factor is of inestimable importance alone, in the fulfilling of the aims and purposes of the sooiety; third, but not least, the growing interest of physicians in the progress which medicine as a science is making by reason of more mutual interest being shown by physicians in each others work and the work of the profession at large. fession at large. Fully seven hundred and fifty physicians were present during the Springfield meeting with a registered list of actual members present of over 500.

This number emphasizes the importance of having the society convene at central and accessible points, where hotel accommodations are sufficient to meet the demands of this growing society, and we hope that at not a far distant day it will be decided that Springfield will be chosen as the regular meeting place of this society, because of the above mentioned reasons. The program of the meeting was excellent throughout, perhaps too many papers were contributed, which fact hinders, somewhat the value of discussion and creates hurry and over-time sessions, in order to comply with the requirements of this society in having papers read, before permitting their publication in the transactions.

The sym

posium feature gave interest and value to the

presentation of timely subjects, thus giving the opportunity for a full discussion of practical and valuable phases of the varied diseases selected for discussion. The society was honored by a very thorough and scientific address by Governor Chas. S. Deneen on some features of Criminology derived from personal observations during his term of service as prosecuting attorney of Cook county. We hope to present this address in full at a later date. The president of the society Dr. H.C. Mitchell, of Carbondale, delivered a very exhaustive, earnest, helpful and suggestive address in the opening meeting, covering many of the essential features of practice, showing the relationship of the profession to the public, following along the lines which Dr. McCormick has so zealously advocated in his soul-stirring addresses throughout the country. We congratulate Dr. Mitchell on the fulness of his address, and the true spirit of serve, which he exemplifies and so earnestly presented. It is from the living examples that ideals grow and from whom young men get their inspirations and for this reason we believe such addresses as that of President Mitchell should be published in various journals that the young men in medicine, especially, may build for themselves realities in practice, which will make them earnest, serviceable and true followers of the nobler motives of our profession.

The House of Delegates in its sessions passed a number of resolutions which will show to the world that professional dignity, true reform and earnestness of purpose is markedly in evidence in the Illinois State Medical Society. Among these are one urging a law requiring the publication of the formula on the bottle of proprietary_medicines; one thanking Collier's and the Ladies Home Journal for their work in the proprietary medicine evil; one for the creation of law requiring inspection of the eye sight and bearing of the pupils in the public schools; one for State work in the care of cases of tuberculosis; one requesting members of the society not to make an examination for life in surance (old line companies) for less than five dollars. A number of other deserving measures were discussed.

The election of officers for the next year resulted as follows:

President J. F. Percy, Galesburg. First vice-president-H. A. Nickerson, Quincy.

Second vice-president-J. H. Stowell, Chicago.

Treasurer-E. J. Brown, Decatur. Secretary-E. W. Weis, Ottawa. Rockford was chosen as the place of meeting in 1907.

Dr. J. F. Percy, of Galebsurg, Ill., the newly elected president of the society, is one of the wheel-horses of the society, and has been ever since his election to membership. A man truly great in his qualities of manhood, devotion to the spirit and letter of the profession and his professional acquirements. It is certainly a high commendation of the regard with which he is held in the society by the fact, that he was elected by acclamation and with no opposing candidate in the field.

We congratulate the Illinois State Medical Society in its selection of this lovable, good and earnest man as its president, and we congratulate Dr. Percy on his selection to this high office, the gift of his fellows, and we are sure he will make this year one of deserving honor to himself and the society. F.P.N.

THE 1906 meeting of the Missouri State Medical Association made good all that had

The Meeting of the Missouri State Medical

Association.

been predicted for it, it was a delightfully profitable occasion. Jefferson City proved a most satisfactory meeting place, true there was a lack of hotel accommodation, but the citizens of the capital city opened their homes and comfortable quarters were found by all and many more might have been cared for. The division of the scientific work of the association in two sections again emphasized the fitness of the selection of the meeting place, the legislative halls of the capitol serving most conveniently, and holding the integrity of the work as could not have been with the sections in different buildings.

The programs presented at both the surgical and medical sections were of pleasing excellence. A surprising feature was the strength of the attendance at the medical section, which was at all times considerably larger than at the surgical, and is a healthful indication. The uniform excellence of the program makes it impossible to select features of exceptional interest. The discussion. of abortion, which was introduced by Dr. Lockwood, of Butler, showed the interest of the association in the present time of cleansing, it appears that the association is a unit in favor of an end to this evil.

The annual address on Medicine by Dr. W. G. Moore, of St. Louis, and that on Surgery by Dr. C. H. Wallace, of St. Joseph, were scholarly and in keeping with the day's spirit of progress.

The social functions were well arranged and not allowed to interfere with the real

purpose of the meeting.

Never have we experienced so well developed a spirit of fraternity within the association as at this meeting, the three days were a continuous meeting with good fellows and real friends, and that in itself made the going worth while. The dinner with brother Mat. Hall at the penitentiary, the reception given by Gov. Folk, and the barbecue were generally enjoyed.

The attendance at this meeting was good, St. Louis was represented by some fifty members and a few friends who should be members.

The election of officers for the ensuing year resulted as follows: President, Dr. C. H. Wallace, St. Joseph; vice-presidents, Dr. F. W. Allen, Callao, Dr. W. G. Cowan, Sedalia, Dr. C. J. Orr, St. Louis, Dr. E. H.

DR. C. H. WALLACE, President-elect Missouri State Medical Association.

Thrailkill, Kansas City, and Dr. H. L. Reid, Charleston. Dr. C. M. Nicholson was reelected secretary, and Dr. G. Franklin Welch, Salisbury, treasurer. The committee on scientific work was named to consist of Dr. C. M. Nicholson (chairman) and Dr. J. C. Morfit, both of St. Louis, with Dr. F. E. Murphy, of Kansas City; that on public health and legislation, of Dr. F. J. Lutz (chairman) and Dr. G. Homan, of St. Louis, and Dr. H. E. Pearse, of Kansas City. Councillors: 1st District, Dr. E. E. Parrish, Memphis; 3d, Dr. J. D. Brummall, Salisbury; 4th, Dr. C. R. Buren; 5th, Dr. E. H. Miller, Liberty; 6th, Dr. W. E. McKinley, Denver; 7th, Dr. W. T. Elam, St. Joseph; 8th, Dr. L. W. Dallas, Hunnewell; 9th, Dr. C. W. Reason; 14th, Dr. W. F. Kuhn, Farm

ington; 18th, Dr. G. Ettmueller, Jefferson City; 20th, Dr. C. T. Ryland, Lexington; and 22d, Dr. J. R. Buchanan. Dr. W. F. Kohn was appointed orator in Medicine, and Dr. Paul Tupper, of St. Louis, orator in Surgery, for the next annual meeting.

Delegate to the A. M. A., Dr. W. J. Frick, of Kansas City; alternate, Dr. O. B. Campbell, of St. Joseph. Jefferson City was selected as the next place of meeting. The registration was 348. It transpired later that Dr. Frick was not a member of the A. M. A., Dr. Campbell therefore went to Boston as delegate.

This deals liberally with St. Louis and gives strong men to represent us.

The association journal is to be hereafter more completely devoted to organization and unifying the association; it is not to be the organ of any county society, and will serve the best interests of each and all. Dr. E. J. Goodwin, of St. Louis, will be its managing editor, a choice which assures conservative and wise conduct for a valuable organ.

The association voted to make Jefferson City its meeting place in 1907. The profession and people who made this occasion so enjoyable for us may take the fact that we wish to repeat as an expression of our appreciation.

The Illinois
State Medical
Society

Entertained by an Authors' Clinic on the Eye, Ear, Nose and Throat.

DURING the meeting of the Illinois State Medical Society held in Springfield, May 15, 16 and 17, a unique entertainment was given to those members interested in the eye, ear, nose and throat. It was called an authors' clinic, and lasted three days, commencing Tuesday morning at the David Prince Sanitarium; Wednesday morning at the St. John's Hospital, and later at the Springfield Hospital. The idea originated with an invitation extended to Dr. Otto Freer to demonstrate his operation of window resection for deflected septum, and grew into the conception of inviting other available authors.

The clinical material was assigned to the hospitals, and the individual operator was notified of the time and place of his demonstration. When possible, operations were conducted in adjoining rooms, and on two occasions, three operations were conducted simultaneously.

On Wednesday an automobile service was established between the hospitals and the place of meeting. All the physicians of

Springfield and the adjoining towns co-operated to make the experiment a success.

About forty-five operations were performed during the meeting.

Authors of operations who were invited

were:

Dr. Otto Freer, Window Resection of Septum.

Dr. Frank Allport, Ptosis.

Dr. Casey Wood, Excision of the Tarsus for Intractable Trachoma.

Dr. B. L. Ballinger, Enucleation of Tonsil in its Capsule.

Dr. Chas. Robertson, Tonsil Excision.
Dr. F. C. Hotz, Entropion.

Dr. Wilder, Symblepharon.

Dr. Baird, Advancement of the Rectus.

Dr. E. Fletcher Ingals, Intranasal Method

for Frontal Sinusitis.

Dr. Ostrum, Septum Deflection.

various grades of arthritic trouble. This last theory, perhaps, reconciles the view held by those who believe in the specific coccus with that of those who regard the attenuated pus coccus as the casual agent. This, Frissell believes, is strongly suggested by the results of his own investigations.

DR. WILLIAM PORTER, St. Louis (Jour. A. M. A., May 26, 1906), discusses some of the

Tuberculosis Infection.:

phenomena of tuberculosis infection and makes a few therapeutic suggestions. The bacillus is the central point

in most of the experiments and investigations concerning tuberculosis, and Porter says that though almost two decades of study have been devoted to this organism, he be

Dr. A. E. Prince demonstrated his advancement operation, excision of the rectus for paralytic squint, and exercised a general management of the clinic.

DR. LEWIS FOX FRISSELL declares that the idea that the disease known as rheumatic

The Etiology of Acute Rheumatism.

fever or acute articular rheumatism is of bacterial origin is no new one. After discussing this subject in scme de

tail in the Medical Record, he concludes that as a result of a careful clinical analysis of the pathology and symptumatology of rheumatism one is forced to look beyond the common joint affection to gain a clear idea of such a protean disease attacking the joints oftenest, to be sure, but too frequently the skin, pleura and heart. Granted a point of entry, probably the tonsil, as the frequency of tonsillitus in rheumatism would suggest, the various conditions vaguely called rheumatic, as well as the outand-out attack of acute articular rheumatism, seem best explained by considering the essential condition to be a blood infection. As

suming this hematogenous origin, the localization of the symptoms he says is readily accounted for by the bacterial embolus or local toxin action. In regard to the nature of the organism at fault he presents five possibilities: An infection caused by the ordinary streptococci or staphylococci with their virulence in some way decreased. Infection by a specific bacillus. A mixed infection with bacilli and cocci. An infection caused by one of a group closely allied organisms, probably diplo- or streptococci, which cause

He

our lesson and that so far as specific antagonism is concerned we await the dawn. He describes in some detail the routes of invasion and states that at present the respiratory tract is considered by many observers the main channel, though he is convinced that many more pulmonary cases are directly infected through the lymphatic and blood channels than are recognized by the average physician. He also states that in nearly all cases of advanced pulmonary phthisis the faucial tonsils become inoculated and that in about 5 per cent of hypertrophied pharyngeal tonsils some form of primary tuberculosis will be found. discusses the danger of autoinfection, and states that constipation with intermittent diarrhea is found in most cases of pulmonary tuberculosis. He deals briefly with the early signs of infection and refers to tuberculin and the X-ray as diagnostic aids. He states that the cases most difficult to control in his experience have been those in which the physi. cal evidence was most marked in the upper dorsal region and calls attention to the fact that the extent of the local lesion is not always a criterion of the general condition of the patient. In regard to the relation of pleurisy to tuberculous pulmonary infection he says that no man has a right to speak dogmatically. He declares that he has seen

cases of pleurisy with effusions that were not tuberculous and that never became tuberculous, but admits that these may have been exceptions. The majority of tuberculosis cases have pleuritic extension and infection.

DR. D. L. HARRIS has been appointed city bacteriologist, and Dr. D. M. Shoemaker his assistant by Mayor Wells. These appointments are pleasing to the profession.