lot they must have a good lawyer, and on a Sunday they would not listen to the minister that is not trained in eloquence, if a better could be heard. But, more's the pity, if a wife or daughter lie dying of a fever, many are just as apt to employ a charlatan to attend them as a scientific physician.

THE RUSH MONUMENT FUND.

At the meeting of the American Medical Association in 1884, the following resolution was passed:

"Resolved, That this Association undertake to erect a statue to Dr. Benjamine Rush, in the city of Washington, by the members of the profession of medicine in the United States."

was

A

How futile has been the attempt can be made manifest when it is known that up to the present time only $4,000 has been raised. At the meeting at Philadelphia last year new energy thrown into this grand project. number of individuals subscribed large sums, and a number of States were pledged to give $2,000 each. Colorado, Pennsylvania, and several other States have already raised their shares pledged. Kentucky was pledged simply to do her duty, and as your President I desire that each and all of you help and advise with me in this matter. Don't let it be said that Kentucky, the State that never shirks, has failed to do her duty in this most worthy endeavor. incentive let me remind you that the homeopaths in this union of States raised, in a few years, $75,000 to erect, and have erected, a monument to Hahnemann. I shall appoint a committee in the morning to canvass this matter, and I beg not only your advice but your money.

As an

THE AMERICAN MEDICAL ASSOCIATION.

I desire to remind you of your allegiance to the "mother" Society, the American Medical Association. She stands to-day the peer of any medical organization in the world. It is indeed a proud distinction to be a member of this august and dignified body, controlled as she is by a code of ethics unsurpassed; each and every member

feels honor bound to treat his fellow in medicine with that respect which is born of a gentleman. Let me impress upon you your duty, which is as American physicians to stand by and encourage by your presence her every effort to uphold the dignity of the profession and to give to the world the very best medical literature extant. The coming meeting promises to be the banner one. Our Western brethren are making every effort within their power to make it a memorable one, and Kentucky should show her appreciation by sending a large delegation.

The Journal of the American Medical Association. Along with the interest shown for the national body, you should also help support its organ, The Journal of the American Medical Association. It can now boast of being the leading medical journal in the United States, and equal to any published in Europe. Under the able management of its present editor it has increased in circulation until it now has gone beyond ten thousand actual subscribers. If you are not a member of the National Association, you should at least keep in touch with it by becoming a reader of the columns of its official organ.

A SUGGESTION FOR REORGANIZATION.

It has been a noticeable fact for a number of years that neither the membership nor attendance at our State Society has been what it should be. Kentucky stands second to no State in the ability of her doctors; in the splendid standing of her medical schools; and especially in the medical laws governing the practice of medicine. It can not be gainsaid that as many, if not more, names of illustrious medical men adorn the pages of her history than that of any other State. It would be a shame if her State Medical Society was not kept up, commensurate with these claims. May I offer what I believe to be the reason for this apparent lethargy or loss of interest in our annual meeting? To the careful observer it will have been noticed that county, district, and other societies have been made to take the place of the State organization. They are many in number, and the meetings.

are frequent. The busy doctor feels that after having attended one or more of these that his duty, and perhaps his pleasure, has been sufficiently indulged. It may be that the physician living in the country feels that in his "home" society he is more to the "manor born," or that in the State meeting he is counted out by the city brother, the specialist, etc. These are not valid reasons surely. It must be conceded that it is the busy doctor who attends medical societies, and the wider the scope the more knowledge gained. Again, it can not be assumed that because one happens to live in a larger place that he is more learned in the science and art of medicine than his brother who lives in a smaller place. It is not the number of inhabitants that makes a good doctor, but rather the application to study and observation.

In this day of post-graduate instruction the dividing line of opportunity is broken down and the city and country doctor stand on equal footing. It is only necessary to remind you that Ephraim McDowell and Brashear lived in small country towns. Be this as it may, the interest manifested in your State Society is not what it should be. What is the remedy? I will try and suggest it. In the State of Indiana there are between 3,000 and 3,500 regular physicians. From this number 1,500 belong to and attend their State Society. You naturally ask, how do they accomplish so much? With your permission and indulgence I will explain by reading from their Constitution. and By-laws. Section I reads: "Any incorporated county medical society whose constitution embraces the objects of this constitution, and the code. of ethics of the American Medical Association, shall, upon application, become auxiliary to the State Society, and shall be entitled to one delegate for every five members, and one for every additional fraction of more than half this number.

"Section 5. Every county society shall, at least thirty days before the annual meeting of the State Society, make a full and correct catalogue of its members in good standing at the time and transmit the same at once to the

66

Secretary of the State Society and no one not a member in good standing in his county society can be a member of the State Society." A portion of Section IO reads: Regarding the appointment of delegates to the American Medical Association, the several county societies shall be required, at the time of appointing their delegates to this society, to nominate and forward to the Secretary the names of the delegates to the American Medical Association, the number of such nominations to be governed by the rules of said Association, and all the nominations shall be confirmed by the State Society."

It will be at once observed that by such organization encouragement is given to the formation of county societies; these form the basis of the State Society, as it is necessary to belong to the county society before they can belong to the State organization or the American Medical Association.

I would respectfully suggest that a remodeling of our Constitution and By-Laws be effected, so as to include this splendid arrangement, tested and found to be perfect by our neighbor State. The whole idea is to develop local societies and keep them in close touch with the State organization. Only one society should be formed in each. county as part of the State Society, and this should be known by the name of the county. All papers read at the State Society should be first read before the county society, and then be referred to the State Society by the Secretary. Nothing in my opinion would do more to harmonize the medical profession in the State than this. Nothing, also, would enable the State Board of Health to help enforce the medical law so much, because by such a procedure we would have a united profession. I trust that this body, looking to the upbuilding of this society, will give these suggestions careful thought and help the President to carry them into execution or formation during this meeting. I am aware of the fact that several years ago a resolution was offered in this society and carried, looking to a very similar arrangement, but so far it has proven to be only a dead letter. Let us begin

where we left off and complete a perfect organization, one that will be an honor not only to the profession but to the State.

A PLEA FOR HARMONY.

But while we are discussing the dissension between the people and the doctor, let us turn an eye, or an X-ray, upon ourselves. ourselves. We can never command the respect of the people as a great profession should until we respect one another. No dissensions should enter our ranks. We are working to accomplish the same end, all of us— the unification of the profession; in upbuilding a noble profession whose object is to protect the people against the ravages of disease. Your calling

may at times seem to be a thankless and unprofitable one, but this should not deter you from a firm purpose and vigorous action. Let us then pull together and not listen to envious tongues, or be detracted from our course by slanderous tales. We are brethren indeed, and as such should battle for the right as an army, undaunted by evil tales. May your meeting this year be characterized by dignity and decorum, by love for each other, as becomes Kentuckians. May your future lives be full of peace and happiness, and may we all, by the grace of God, meet together again next year without the dropping out of a single one by the final summons, is the prayer and wish of your President.

Colotomy and Colostomy. Mosetic-Moorhof (Wien. Med. Presse, 1898, No. 3) reviews the accepted methods of forming an artificial anus, and describes a modification in technique which he has found useful in certain cases. The classical inguinal operation that of Littre-he terms "colostomy;" it consists in bringing the descending colon up to the anterior abdominal wall, to which it is stitched, the opening into the lumen being made at once or after an interval, according to circumstances. The disadvantage of this simple operation is that it does not

entirely prevent the entry of feces into the distal part of the bowel, where they stagnate and tend to set up inflammatory troubles. To prevent this Madelung introduced true colotomy, in which the gut is cut completely across, the proximal portion brought out of the wound, and the distal closed by sutures and returned to the abdomen. This method is not entirely satisfactory, as the distal end tends to become distended by the accumulation of its own secretion, which may eventually lead to ulceration. König and Sonnenburg obviated this difficulty by leaving the upper extremity of this portion open and attached to the abdominal wall below the artificial anus; by this means the rectum can, if desired, be irrigated from above.

Another means of preventing feces from getting into the rectum is by the formation of a spur, first devised by Verneuil, whose original plan has been considerably improved by late surgeons. The disadvantage of both this method and colotomy is that they require a long and freely movable colon. and meso-colon; when they are inadvisable or impracticable the author recommends the method he has himself devised. devised. This consists in the ordinary operation of colostomy performed at one sitting, but preceded by partial occlusion of the distal portion of the bowel. A ligature is tied around this, occluding it to about one-half its diameter, and the bulging serous surfaces on either side are sewn together with interrupted stitches. An artificial constriction is thus produced, which prevents the accumulation of feces in the rectum. In attaching the gut to the belly wall the author first sews the serous and muscular coats of the intestine to the parietal peritoneum, and then passes the ordinary sutures through both bowel and abdominal wall. If, however, this would lead to considerable tension he prefers to attach the intestine to the fascia of the external oblique, leaving the skin free but shutting off the muscular planes from the risk of infection.-British Medical Journal, March 12, 1898.

Societies.

The Louisville Surgical Society.*

Stated Meeting, April 11, 1898, the President, John G. Cecil, M. D., in the Chair.

I. POTT'S DISEASE. 2. REMOVAL OF AXILLARY GLANDS FOR SEPTIC INFECTION. 3. OOPHORECTOMY FOR DOUBLE PYOSALPINX AND OVARIAN CYSTOMATA. 4. FIBRO-CYSTOMA OF THE BREAST.

BY AP. MORGAN VANCE, M. D.

Case 1. Pott's Disease. This specimen is from the body of H. F., aged 7, and, as you will see, is the lower dorsal and upper lumbar vertebræ. The patient was sent to me November 17, 1897, for a brace for spinal disease. The child was anemic. and much run down in a general way, having lived recently in a very malarial district. There was marked lateral

deviation of the spinal column and quite a good deal of tenderness over region. of spleen or lower pleural region of that side, with the walk of a Pott's case. Suspicion of an abscess induced me to explore with a needle, but no pus was found. However, he could stoop well, and had no pain on jumping on his heels (a test I rarely allow, but this When case was so puzzling I tried it). recumbent the lateral curvature disappeared entirely, and the spine was perfectly supple. No sign whatever of any muscular reflex rigidity. Hyperextension of the column was allowed without complaint, also of both thighs. There was slight rise of temperature at this first examination, made in the morning. The patient was admitted into the Children's Free Hospital, and remained there until his death of tubercular meningitis, March 24, 1898. Dr. Marvin saw him several times during these months, and attended him the last few days, but like myself could never make a diagnosis of the primary trouble. was kept in bed during the whole of the time, and given every attention in the way of careful nursing, with constructives. On several occasions he was cinchonized, as there were irregular febrile manifestations during the whole

He

Stenographically reported for this journal by C. C. Mapes, Louisville, Ky.

time. During the last month of his life the spinous process of the twelfth dorsal seemed to be a little more prominent than natural, but as the same suppleness of the column was present and no signs of reflex muscular irritability had appeared, I was unable to arrive at more than a suspicion of the true state of the case, as revealed by the post-mortem: Caries of the lower dorsal vertebræ, with left psoas abscess, also an abscess on the right of column, dissecting backward. The immediate cause of death was menin

gitis, the boy's general condition re

maining about what it was on admission up to a week before he died, when he became unconscious and died by exhaustion.

This is the first case of Pott's disease I have ever seen where there was active disease of the bone, where the muscles of the back were not in reflex tension.

The opinion of most of those who

examined the case was that an inflammatory process was going on about the spleen or left kidney.

Case 2. Removal of Axillary Glands for Septic Infection. This collection of suppurative glands are from the axilla and subclavicular region of a surgical friend and prominent member of this society.

Five weeks ago he noticed a swelling and redness about the inner side and base of the nail on the large finger of his right hand. There was very little tenderness or pain. Ten days later he incised this in a small way. There was

no pus, the incision bleeding freely. However, about this date he noticed the lymphatics in the axilla were slightly Two weeks ago enlarged, not tender.

a

I first saw him, when there was marked red line extending along back of forearm and arm, entering armpit posteriorly. This all disappeared in twenty-four hours, the finger remaining Fever was discovered just as before. next day, and continued right along, with elevation of pulse fifteen beats. Great physical and nervous depression from the first appearance of fever. The finger was opened thoroughly; no pus, but active bleeding. In forty-eight hours this was practically well. Cartledge saw him with me ten days ago, and was in favor of enucleating

Dr.

rect.

the glands at once, but we agreed to wait awhile; but as there was no improvement, but rather the reverse, his first conception of the case proved corSix days ago I, with Dr. Cartledge's assistance, opened up the armpit and removed all the enlarged glands except one, which was surrounded by the large vessels and did not seem to be suppurating. Three were surrounded by pus, one of these being below and beyond the middle of clavicle.

This case should be particularly interesting to a society of surgeons from the daily exposure they have to similar infection, and also as to the question of treatment. This is the first case of this kind in twenty years' experience in which I have found it necessary to remove the infected glands. Dr. Cartledge's experience differs; he has operated on several occasions. A culture made from the pus in this case shows staphylococcus pyogenes aureus. It would seem, judging from this case, the less local manifestation at point of infection the more chance of suppuration in glands above.

severe at

Case 3. Oophorectomy for Double Pyosalpinx and Ovarian Cystomata. These specimens came from Mrs. X., aged twenty-six, married four years; first child ten weeks old. Labor normal; slight perineal tear; sutured perineally; healed perfectly. Has for years, even before marriage, suffered with ovarian pains, more menstrual epoch; left side worse. Had a high temperature for one day-third day after delivery. Did well then until child was six weeks old. Treated locally for leucorrhea. Pains in lower abdomen gradually developed, with fever higher in evening. Examination April 2d revealed to Dr. Gosnell, family physician, tumor in left iliac fossa; very tender; finger detected very tender swelling back of uterus, elastic. Pelvic

abscess was suspected, as fever continued. Aspiration, preparatory to incision, per vaginam; obtained clear, thick fluid. Diagnosis: Ovarian cyst, with a probable pyosalpinx. Operation from above advised. Operation done April 7th. Pulse, 120; temperature, 103°. Both tubes and ovaries, as you will see, were extensively diseased, the left much

the more so. Abscess had ruptured on this side, and was capped by omentum; extensive adhesions of both uterus and appendages to intestine; left ovary cystic, in Douglas' pouch, in a mass of lymph. Enucleation very difficult, but finally successful without bowel injury. In one place the plastic deposit on small bowel was torn, but the intestine proper was not injured; suture of this was done to cover raw surface. Drainage by gauze, and glass tube was inserted after careful douching; the pus having been received on flat sponges. No fever since operation; pulse never over 100; tube removed at end of twenty-four hours, gauze at the end of forty-eight, sweet; abdomen flat. Case

in

very fair way to recover. Baby nursing twice a day, first time eight hours after operation. Bacteriological examination shows pus to be sterile. A remarkable part of this case is that conception should have occurred with ovaries in the condition these are. I feel sure that all of the inflammatory trouble found could not be post-puerperal.

Case 4. Fibro-Cystoma of the Breast. The next specimen is a breast removed from a young married woman aged thirty years. A few months before its removal a small nodule was discovered in the left breast, and this had recently seemed to fluctuate in size, leading her to consult a surgeon. There was no pain. The specimen is of no special interest except to illustrate how deceptive these tumors of the breast are. By a careful examination the enlargement seemed to be disconnected with the gland proper, but it turned out at the operation to be a fibrocystic condition seemingly of long-standing, involving the whole mammary gland, requiring its enucleation. Luckily I was able to preserve the nipple, so that the disfigurement of the breast will be slight.

DISCUSSION.

Dr. Vance's cases were discussed in the order reported, as follows:

Dr. J. G. Sherrill: There has been considerable discussion at different times. as to whether the bone is primarily involved in cases of tuberculosis of the spine. This seems to have been true in