b. Subacute pancreatitis.
As gall-stones are the usual cause of this form
of pancreatitis, a history of intermittent attacks
of spasms, at first without and later accompanied
by jaundice, will be elicited and before the onset
of the pancreatic trouble, the symptoms of infec-
tive cholangitis, in the shape of rigors with
deepening of jaundice and with intermittent fever,
will generally be found. The collapse in this
form is not so marked as in the acute variety,
and may be entirely absent. The onset as a rule
is more gradual and the upper abdominal region
does not become so rapidly distended as in acute
pancreatitis. The prognosis is very much better
in this form.
c. Chronic pancreatitis.
By chronic pancreatitis is understood an inter-
stitial change of an inflammatory character lead-
ing to formation of fibrous tissue. It may be
interlobular, in which case it exerts pressure on
and causes atrophy of the true glandular substance
of the pancreas and interferes with the digestive
function or interacinar, in which case the fibrous
tissue invades also the islands of ^angerhans and
leads, not only to an interference with the diges-
tion but also with the metabolic functions of the
gland and so glycosuria. Chronic interstitial pan-
creatitis may be primary, as in those cases recov-
ering from acute or subacute forms of pancreatitis
or from acute or chronic or suppurative catarrh,
or it may be secondary, as i:i syphilis, alcoholism,
and arterial degeneration and in zymotic diseases,
such as typhoid fever and influenza.
D. Treatment.
1. Treatment of catarrhal inflammation of the
pancreas and of chronic interstitial pancreatitis
will be at first by general and medicinal means
aiming at the cause, whether that be gall-stones,
pancreatic calculi, duodenal catarrh, gastric ulcer,
alcoholism or syphilis. If after a fair trial of
medical treatment, not too long continued, the
jaundice and . loss of weight continue, and the
signs of failure in pancreatic digestion and meta-
bolism are manifesting themselves, the question ol
surgical treatment should be seriously considered,
for the condition is one that if not relieved early
will certainly lead to serious degeneration of the
gland.
2. When the operation is undertaken before
the process has advanced to well-marked pan-
creatitis, or to the interacinar form, the writer's
experience has been that complete cure is effected
in a very great proportion of cases.
3. If the interstitial process has become well
marked, an arrest of the process is all that can
be looked for.
4. Surgical treatment will vary according to the
cause and the symptoms.
5. Where there is evidence of obstruction,
whether in the pancreatic or common bile-ducts,
the cause in the greater number of cases will
prove to be concretions which should, if possible,
be removed.
6. Beside the removal of the above, the bile-
ducts should be drained either by cholecystotomy
•or cholecystenterostomy, which will nearly always
afford relief by
I. Removing the infected bile and thus ridding
the system of poison which tends to deteriorate
the blood.
II. Removing the pressure of pent-up bile from
the pancreas, thus relieving tension.
7. In acute pancreatitis the surgeon should not
wait to operate until the collapse has passed off,
as that may be dependent on septic absorption,
which can only be relieved by operation. The
operation aims to relieve tension, to evacuate sep-
tic material, to secure free drainage^ndj© arrest
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MISCELLANEOUS.
Jour. M. S. M. S.
haemorrhage (if present), which leads to disin-
tegration and necrosis of" the pancreas.
8. The subacute form of pancreatitis is more
amenable to treatment than the acute form. It
has usually been attacked when an abscess has
formed and is manifestly making its way to the
surface. Yet there is no reason why in some
cases, surgical treatment should not be adopted
at an earlier stage.
9. Whether advanced chronic interstitial pan-
creatitis will be completely cured by operation, it
is difficult to say, for in some of the severer cases
a pancreatic reaction is found long after the
operation and after all other symptoms have
cleared up, but in several cases that have been
tested years after the operation, the pancreatic
reaction has entirely disappeared, thus apparently
proving that the case is cured. It is probable that
the operation arrests the process of disorganiza-
tion, even if it cannot alter changes that have
already occurred. Doubtless in some, the disease
was a catarrhal inflammation of the pancreas,
which was arrested either before interstitial in- ^
flammation had actually developed or before it
had advanced too far. Probably in none of the
cases had the interstitial change advanced so far
as to become interacinar or to present the ad-
vanced stage of atrophy or cirrhosis, as in none
of the cases was sugar present in the urine at the
time of operation, though the metabolic functions
of the pancreas were impaired, as shown by the
presence of the pancreatic reaction. The diges-
tive functions were affected, as shown by the
condition of the faeces. — (The Lancet, March 26,
1904. A. W. Mayo Robson.)
Cysts, Injuries, CalcuU and Neoplasms
of Pancreas. Cysts of Pancreasis. — The most
frequent cause of this is chronic interstitial
pancreatitis, in which compression and con-
striction of the ducts result from a new for-
mation of . connective tissue with consequent
stagnation of secretion. The pancreatic
urinary reaction is present (page 224).
The symptoms depend on the disease leading
to the cystic formation, and later to the pressure
exercised by the tumor on the neighboring viscera.
In 6,000 post-mortem examinations by W. Hale
White, at Guy's Hospital, during the years 1883-
1894, pancreatic cysts were only found in four
cases, and one of these was a hydatid cyst.
Injuries to Pancreas. — These are not neces-
sarily fatal. Indications for operation depend
on presence of either hemorrhage or inflam-
mation.
Pancreatic Calculi. — Oser reports 70 record-
ed cases. To this nfimber may be added seven
more.
The stones are usually multiple. They con-
tain lime in the form of carbonate, phosphate, or
oxalate. They are therefore opaque to X-ray and
so we have a means for diagnosing them.
The symptoms depend on the associated con-
dition whether that be a cyst, abscess, chronic
inflammation or other pathologic state. The
pancreatic urinary reaction is present (page
224).
The stones should be removed surgically.
Neoplasms of Pancreas. — Carcinoma, sar-
coma, adenoma, lymphoma and the granulomata
(tubercle and gumma) are found.
Carcinoma is the most common neoplasm of the
pancreas. The whole clinical course is run as a
rule within twelve months. The surgical treat-
ment is not very hopeful. It may be radical or
palliative.
The primary sarcoma is rare though the sec-
ondary type is less uncommon. Very little so far
has been done in a surgical way.— (TAe Lancet,
April 2, 1904. A. W. Mayo Robson).
ÂŁÂŁFect8 of X-ray Upon Lower Animal Life
and the Tube Best Suited to Their
Destruction.
1. Technique:
a. Strongest rays are those directed from the
centre of the anode plate in a line perpendicular
to its face.
b. Best results are obtained if a sheet of lead
be rolled into a cylinder and the rays directed
through this.
c. Distance between the tube and specimen is
of great importance. The closer, the tube is the
more potent are the rays. The writer has used
5 iiKhes as the standard distance between the
tube and specimen.
d Coil 18 inches was the one employed by
Dunham.
2. It is probably the X-ray and not the cathode
ray that causes destruction of epitheliomata.
a. Effect of X-ray on lower organisms:
a. Chilomonas.
b. Paramoecium aurelia.
c. Paramoecium bursaria.
d. Cryptomonas.
Killed by X-ray.
e. Rotifera.
f. Arcella.
Unaffected by X-ray.
4. Conclusions:
a. There seems to be an analogy existing be-
tween these tower organisms and new malignant
cells.
. b. The best ray to <iestroy epithelioma tons and
sarcomatous cells is the lower tube excited by a
heavy current with much resistance.
c. Thus perhaps our first step toward cure of
these malignant growths has been taken. (Johns
Hopkins Bulletin, February, 1904. Kennon Dun-
ham.) ^ . I
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May, 1904.
PROGRAM OF ANNUAL MEETING.
211
PROGRAM
OF THE
39th Annual Meeting
OF THE
Michigan State Medical
... Society ...
At the St. Cecilia Building,
Grand Rapids, Mich.
Wednesday, Thursday and Friday,
May 25, 26 and 27, 1904.
THE COUNCIL
Chairman — Lkartus Connor, Detroit.
Secretary — W. H. Haughby, Battle Creek.
Tuesday^ May 24th ^ 7 o^dock P, M. Standard, at
the Morton House.
Wednesday y May 2sth, 4 o^ clock P, M, Standard , at
the St. Cecilia Building.
Thursday, May 26th, 4 o'clock P. M. Standard, at
the St. Cecilia Building.
Friday, May 2jth, 1.30 o'clock P. M. Standard, at
the St. Cecilia Building.
Organization and Election of Officers.
HOUSE OP DELEGATES
ST. CHCILIA BUII.DING
President — ^Wm. F. Brbakby, Ann Arbor.
Secretary— A. P. Biddi^k, Detroit.
By-Laws— Chapter tv. Section i. Each Com-
ponent County Society shall be entitled to send to
the House of Delegates each year one delegate for
every 50 members, and one for each major fraction
thereof; but each County Society holding a charter
from this Society, which has made its annual report
as provided in this Constitution and By-I,aws, shall
be entitled to one delegate.
FIRST DAY, WEDNESDAY. MAY 25th
9 A. M. STANDARD
1. Call to order.
2. Roll Call.
3. Reading of Minutes of the last Annual Meeting.
4. Report of the Council
Lkartus Connor, Detroit, Chairman.
5. Report of Committee on Legislation and Public
Policy
W. H. Sawyer, Hillsdale, Chairman.
6. Report of National Legislative Council, A. M. A .
Emii« Ambbrg, Detroit, Michigan Member.
212
PROGRAM OF ANNUAL MEETING.
Jour. M. S. M. S.
Miscellaneous Business
a) Appointment of Committee on Nomina-
tions to nominate
ist, 2d, 3d and 4th Vice-Pres.
2 Representatives in House of Delegates,
A. M. A.^ for 2 years.
To fix Place of Meeting for 1905.
Adjournment to General Meeting.
SECOND DAY, THURSDAY, MAY 26th
9 A. M. STANDARD
1. Reading of Minutes of Previous Meeting
A. P. BiDDi^B, Detroit, Secretary.
2. Unfinished Business.
3. Report of Committee to petition the Legislature
for an appropriation for the establishment
of a properly equipped Sanitarium for the
Treatment of the Early Stages of Tuberculosis
B. D. Harison, Sault Ste. Marie.
4. Report of Committee on Vital Statistics
H. B. Bakbr, Lansing* Chairman.
5. Miscellaneous Business.
Adjournment to General Meeting,
THIRD DAY. FRIDAY, MAY 27th
9.30 a. m. standard
1. Reading of Minutes of Previous Meeting
A. P. BiDDi«K, Detroit, Secretary.
2. Unfinished Business.
3. Report of Committee on Nominations.
4. Miscellaneous Business.
Adjournment to General Meeting.
QfiNBRAL MEETINO
ST. CECII^IA BUII«DING
. President— Wm. F. Brsakby, Ann Arbor.
Secretary— A. P. Biddi«b, Detroit.
FIRST DAY, WEDNESDAY, MAY 25th
10.30 A. M. STANDARD
1. Call to order.
2. Prayer Rbv. J. Hkrman Randai^i*.
3. Address of Welcome
Hon. Edwin F. Swket, Mayor,
Grand Rapids.
4. Report of Committee on Arrangements
D. E. Wkwh, Chairman.
5. Report from the House of Delegates
A. P. Biddi«B, Detroit, Secretary.
6. Address of the President
Wm. F. Brkakby, Ann Arbor.
''''Obligations of the State to conserve Life
and Healthy
7. Miscellaneous Business
a) Nominations for President
Adjournment,
8 P. M. STANDARD
National Auxiliary Congressional and Legislative
Committee of the American Medical Associa-
tion of the Counties of Michigan.
1. Introductory Remarks
Emii, Ambbrg, Detroit,
Mich. Member National I^^lative
Council of the A. M. A.
2. Address ^
To be Announced.
3. The Work of the Auxiliaries in their respective
Counties
J. B. Griswoi«d, Grand Rapids.
4. The National and State Legislatures and the
Auxiliaries
H. A. Hazb, Lansing.
Disaission General.
SECOND DAY, THURSDAY, MAY 26th
10.30 A. M. STANDARD
1. Unfinished Business.
2. Report of Committee to secure data regarding
the prevalence of Venereal Diseases in
Michigan
A. E. Carrier, Detroit, Chairman.
3. Oration on Surgery
H. E. Randai^i;, Lapeer.
''Abdominal Pain.''
4. Oration on General Medicine
David Ingws,, Detroit.
''A Message frotn the Clinician to the
Laboratory Men . ' '
5. Miscellaneous Business.
Adjournment.
THIRD DAY, FRIDAY, MAY 27th
10.30 a. m. standard
1. Unfinished Business.
2. Report from the House of Delegates
A. P. BiDDi^B, Detroit, Secretary.
3. Oration on Obstetrics and Gynecology
A. N. Coi«UNS, Detroit.
''Have we yet learned how potent for cure
are the Natural ^^oasssesf]! \
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May, 1904.
PROGRAM OF ANNUAL MEETING.
213
4. Miscellaneous Business
At la o'clock standard the result of the ballot for
Presfdent will be announced
Iniroductum of the President Elect
Adjourment.
SECTION 01^ OENERAL MEDICINE
Chairman—R. H. Spknckr, Grand Rapids.
Secretary— H. B. Britton, Ypsilanti.
r
FIRST DAY, WEDNESDAY, MAY 25th
1.30 p. M. STANDARD
1. The Prevention of Drug Habits
W. J, Wilson, Jr., Detroit.
ResponsibiUty of the pharmacist and physician for
their formation. The duty of the pharmacist and
physician. The necessity of a state anti-narcotic
law. The Beal model anti-narcotic law. The duty
of the State Medical Society.
I
2. Gastroptosis; Special Methods of Treatment
I W. E. Newark, Charlotte.
I Gastroptosis is dilatation with prolapse of the
' stomach. Ktiology: Errors ot diet, half cheifing of
I food, rapid eating, drinking of large quantities of
fluids, improper methods of dress, lack of muscular
development.
! Diagnosis: Vomiting of large quantities of food
after meals, more than the amount eaten at one meal,
which is sour, a result of fermentation; large ab^
men, which shows outlines of the stomach. The use
of the gBStrodiaphane in the stomach.
Treatment: Correct errors in diet. Give test meal.
Test the contents of stomach. Give dry diet, avoid-
ing foods which are slow to digest; chew food thor-
oughly. Use lavage daily as long as stomach is
sore and the food is fermented. Use hot fomenU-
tions to remove the soreness, massage the stomach
daily to replace the organ and strengthen the
muscles': also use electricity for the same purpose.
Keep the bowels regular by enemas, drink plenty of
sterilised water when stomach is empty.
3. Diagnosis of Diseases of Children
W. A. Ferguson, Sturgis.
1. Why do we study Diseases of Children as a sepa-
rate Art and Science?
2. What are the Peculiarities of the Disgestive
Organs?
3. What are thePeculiarities of the Nervous System?
4. Is there any language in the Cry— the Pace— the
Positions?
5. The Importance of Diet and what it means to the
Child.
6. The Peculiarities of the Brain— the I^iver— and the
Generative Organs.
4. What is the General Paralysis of the Insane ?
Hiram A. Wright, Detroit.
It is generally assumed by alienists and neur-
ologists that in this condition the insanity manifest
is dependent upon the cortical lesions observed.
Several reasons are advanced in the essay to show
the impropriety of this assumption.
5. The Test Breakfast in Diseases of the Stomach,
with Report of Cases
Chari^bs D. Aaron, Detroit.
Definition of test-breakfast. Its value in obscure
cases. The difference between achlorhydria, hypo-
chlorhydria and hyperchlorhydria. A report of
several cases, each case having different symptoms
and all making a recovery by regulating the treat-
ment according to the analysis of the stomach con-
tents after a test breakfast.
6. Diagnostic Signs of Our Common Intestinal
Parasites P. A. M apices. Battle Creek.
7. Cause and Rational Treatment of Pneumonia
H. J. Chadwick, Grand Rapids.
That Pneumonia is the result of obstruction to the
circulation of blood in the capillaries of the tissues
between the air cells and bronchi. That this obstruc-
tion is caused by the contracting effects of a cold
atmosphere applied to the surface of the thorax and
breathed into the lungs at times when the mind has
been engaged in deep thought or is at rest in sleep,
after the thorax has been excessively warm. That
other portions of the body exposed in a similar way,
will be congested and inflamed in a similar manner.
That cold applied to the chest in the way to be
described is the sole cause, barring accidents, of
pneumonia, and not the pneumo-coccus. The oxygen
supply to ttae blood being largely diminished on
account of the obstructed blood vessels of the lungs,
the activity of the skin to aid in furnishing this
deficiency must be encouraged in every way possible.
That the alimentary canal must be thoroughly
cleaned and kept so. As the heat-producing oxygen
is largely diminished, the body must be kept at its
normal temperature by artificial means, with moist
warm air. That poultices and hot water applications
as usually applied ars a damage. That applications
of glycerine and clay is the wisest dressing for the
chest yet discovered.
SECOND DAY, THURSDAY, MAY 26th
1.30 P. M. STANDARD
1. General Tic, with Report of Case
C. C. Wai^wn, Grand Rapids.
(Presentation of a Case of Rickets).
2. Intertracheal Injections
Wii,ws S. Anderson, Detroit.
3. Hysteria, Certain Manifestations
Guy L. Connor, Detroit.
4. A Case of Persistent Vomiting
Coi,i*iNS H. Johnston, Grand Rapids.
5. Vascular Disease as a Factor in the Etiology
of Epilepsy
Wm. J. Herdman, Ann Arbor.
Cases showing the association of epilepsy with
valvular disease of the heart, disease of the cerebral
vessels and vaso-motor disorders. Discussion of the
relation and significance of the same in causing the
epileptic seizures.
6. A Pharmacological Study of Ethyl Salicylate
E. M. Houghton. Detroit.
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214
PROGRAM OF ANNUAL MEETING.
Jour. M. S. M. S.
Treatment of Chronic Otitis Media
J. G. HuiziNGA, Grand Rapids.
1. General coijsiderations, asepsis, antisepsis, etc.
2. Anatomy of the parts with special reference to
the relation of the middle ear to the Eustachian
tube.
3. The position and direction of this tube being such
as to tend to retain such secretions as it may con-
tain, should there exist a more or less complete
occlusion.
4. The impossibility of obtaining thorough asepsis
by the ordinary methods of syringing the ear as
the douching fluids rarely reach beyond the drum
membrane.
5. The necessity of thoroughly dilating the tube as
the first step in the treatment. Methods: catheter,
Politzerization and Valsalva's.
6. The necessity of obtaining thorough asepsis of
the entire auditory tract from the external ear to
the internal end of the Eustachian tube.
7. Technique in detail. Home treatment.
8. The necessity of obtaining as nearly normal a
condition oÂŁ.the upper air tract as may be possible.
9. Cleansing solutions used. Preference for Iodine
solutions.
10. Internal treatment according to indications.
3. Prophylaxis and Treatment of the Common
Communicable Diseases of the Skin
H. R. Varnby, Detroit.
Should children who are afflicted with communi-
cable skin affections, such as Ring-worm, Impetigo
Contsgiosa, Scabies, and Pediculosis be allowed to
attend school ? Consideration of medical inspection
of schools; disinfection of money; )>ublic library
books; street-cars; individual communion cups ma
prophylatic measures, etc.
Brief synopsis of personal management, and treat-
ment of the diseases mentioned.
4. Proctitis and Sygmoiditis
Wm. L. Dickinson, Saginaw.
1. Review of significant anatomical features of
sygmold and rectum.
2. Frequency and causes of disease.
3. Varieties—Atrophic and hypertrophic.
4. Symptoms of each variety; pathology and treat-
ment.
5. The Value of the Tuberculin Test
I. H. Nbff, Pontiac.
6. A Case of Colitis with Treatment
F. Hoi^MBS Brown, Newaygo.
7. Laryngeal Complication of Typhoid Fever
W. L. W1130N, St. Joseph.
THIRD DAY, FRIDAY, MAY 27th
1.30 p. M. STANDARD
Eledion of Chairman and Orator of Section,
1. Pneumonia in Children
LoRKN Curtis, Paw Paw.
I. The frequency of Pneumonia in children.
3. The lungs are attacked more often than any other
organ during childhood.
3. Neady all of the pneumonias of childhood have
the pneumococcus present and nearly all are
preceded by a bronchitis.
4. Both a lobar catarrhal pneumonia and a primary
acute bronchopneumonia are found in children.
5. The cause of pneumonia.
6. Signs and symptoms of pneumonia.
7. The importance of the pneumonic grunt.
8. Is it pathognomonic of pneumonia ?
9. Quotations from Seibert, Christopher, Holt, and
Henoch.
10. Masked cases of pneumonia.
11. The importance of the pneumonic grunt in these
cases.
13. Treatment
1. To make the child comfortable.
2. External applications to the chest, their use
and abuse.
3. The value of the hot mustard bath.
4. Expectorants.
5. Itfiquor Ammonii Anisati.
6. Fever.
7. Oxygen.
8. Inhalations.
2. The Necessity for Periodical Examinations in
the Apparently Healthy
Albxandrr McKenzik Campbei«i«,
Grand Rapids.
SECTION ON SURGERY, OPHTHALMOLOGY
AND OTOLOGY
Chairman— D. Emmett Wbi«sh, Grand Rapids.
Secretary— John W. Moore, Atlantic Mine.
FIRST DAY, WEDNESDAY. MAY 25th
1.30 P. M. standard
Removal of Second and Third Division of the
Fifth Pair of Nerves after Emergence from
the Skull, showing as good results as from
removal of the Casserian Ganglion. This
operation is much less difficult to perform,
not dangerous and with slight deformity of
the face
Wii^UAM Fui,i,ER, Grand Rapids.
Treatment of Intestinal Fistulas by the Elastic
I,igature
Theodore A. McGraw, Detroit..
Myelitis Complicating Cancer of the Breast. Re-
port of a case
F. B. Wai<ker, Detroit.
This subject suggested by the unusual course and
unfortunate result of surgical treatment for cancer
of breast. History of case before, during and after
operation. Myelitis from this cause rare. Usual
cauaes, course and treatment. The need for more
exact data for earlier diagnoses of malignant
«^™^'"- Digitized by Google
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PROGRAM OF ANNUAL MEETING.
215
4. The Treatment of Compound Fractures
A. I. Lawbaugh, Calumet.
In the treatment of compound fractures it must
be borne in mind that we are dealing with a lacerated
and infected wound of delicate tiasttes
Rigid asepsis and immobilisation. — Thorough
cleansing of the whole wound area, by scrubbing
with soap, and irrigation with mild antiseptic fluids.
All bleeding points must be controlled.— All divided
muscles, periosteum, tendons and nerves must be
united by suture.
Efficient drainage must be provided in the most
dependent part. The wound then closed and the parts
immobilized by some form of fixed dressing which
gives comfort to the patient.
5. Combined Use of Plaster of Paris and Elastic
Traction in Deformities of the Feet
C. B. Nancrbde, Ann Arbor.
The advantages of forcible correction and fixation
with plaster of Paris in club feet is conceded by all,
snd also that this method can be employed before
permanent apparatus is either applicable or desirable.
Elastic traction efficiently applied can overcome
deformities which cannot otherwise be so quickly,
painlessly and cheaply effected— hence an effective
combination of both plans is desirable. Mu<A less
cutting is requisite than in the* 'Phelps" operation and
osteotomy can often be avoided by this combination of
methods, the elastic traction completing the reposi-
tion while the wound is healing. This method is
always available, no skilled mechanic being neces-
sary.
6. Operations Upon the Prostate
E. B. Smith, Detroit.
7. Operation for the Removal of Triangular De-
pressed Fracture of Left Parietal Bone, Upper
Middle Border (Recovery)
W. Eari^e Chapman, Cheboygan.
History of patient. 1. Age.
a. Family history.
3. Personal history.
1. Development.'
2. Education.
3. Mental condition.
Injury, i. Treatment medicinal.
2. Operation.
3. Subsequeut treatment.
Result. I. MenUl.
a. Physical.
3. Psychic.
SECOND DAY, THURSDAY, MAY 26th
1.30 P. M. STANDARD
I. Differential Diagnosis of Conditions Simulating
Appendicitis
L. J. HiRSCHMAN, Detroit.