currettement ? Given a tube distended with
pus, is it conservative treatment to apply rem-
edies to the vaginal vault, ice, poultices or blis-
ters to the abdomen, massage of the tube, the
grand-stand play of electricity which does more
harm than good, or to promptly operate, save
the suflFering and exhaustion and sepsis by mak-
ing an outlet at a place affording the most direct
drainage ?
Those troubles due to traumatisms also cover
a very large class. Retroversions, prolapse, rec-
tocele, hypertrophies of the cervix, ulceration
of the cervix (so-called), and the vast majority
of rectro- vaginal and vesico-vaginal fistulae, come
under this head. Conservative treatment here is
to properly diagnose the lesion, then to remove
cicatricial tissue and repair.
Those diseases which are dependent upon dis-
eases elsewhere are not a large class, and there
is a question if they should be classed as gyne-
cological diseases. They follow the fortunes of
the primary disease, and usually call for no spe-
cial therapy other than that for the original
trouble.
In general, . in a purely gynaecologic case, when
the diagnosis has been correctly made of the con-
dition and of its causation, it will be found that
there is little of real curative therapeutics that
is not- surgical, and operative at that, and also
thai the most truly conservative gynaecology is
often early operation of some kind.
Discussion —
N. H. Williams — I was interested in the pa-
per, especially in the application of the term
"conservative." What may be conservative to
one person may be radical to another, depending
upon one*s temperament. It is a good question
to ask oneself: Is a case curable or non-curable?
If it is curable without operation, that should
be done. A mistake often made by surgeons is
the operating upon neurotics. They go the
round, have operation after operation with no
results, and become a reproach to the profession.
Time is a con.servative agent, and where a dis-
ease is amenable to treatment, and where patient
has means and is not compelled to work, it is
the best agent. Of course pus tubes and new
growths should be removed. Otherwise the re-
moval of uterus and ovaries should be post-
poned.
T. S. Langford — Conservative gynaecology
should be prophylactic. The young practitioner
sees many cases of gonorrhoea in the male, and
ceases to wonder at the prevalence of disease in
the female.
The Society then adjourned to the operating
room of the Jackson City Hospital, where they
witnessed two laparotomies and a curettage and
tracheolorrhaphy skillfully performed by Reuben
Peterson, of Ann Arbor.
R. Grace Hendrick,
Secretary.
MONROE COUNTY.
The quarterly meeting of the Monroe County
Medical Society was held in Newport, April 21st.
C. T, Southworth, of Monroe, read a paper on
"The Pancreas and Its Diseases, With Report
of a Case."
Abstract —
1. Physiology of pancreas.
2. Diseases of pancreas — Rupture, cysts, cal-
culi, haemorrhage, acute gangrenous and sup-
purative pancreatitis, chronic pancreatitis and
cancer of the pancreas.
3. Report of a case.
On March 14th, 1904, at 8 p. m., I was called
to see A. H. W., male, age 55, a bachelor and
lumber dealer. I found him suffering intense
pain in the epigastric region, accompanied by
some nausea and moderate tympany. The tem-
perature was normal, pulse 100 and weak, and
tongue fairly clean. The patient had made a
diagnosis of acute indigestion and I saw no rea-
son at that time for differing with him. He had
taken a dose of sodium bicarbonate in hot wa-
ter and I administered a Seidlitz powder and
left him.
Two hours later I was hurriedly called
again. I found him in the same condition as
when I left him, except that a cold perspira-
tion stood out upon his forehead. I then ques-
tioned him more closely and found that this
pain had come on him very suddenly while he
was in the barber's chair at 5 p. m. He had
been feeling perfectly well up to that time. He had
worked hard all the day, had eaten lightly and
had not been drinking as much as usual on that
day. I could get no history of injury. At this
time the distension of the abdomen was some-
what greater, eyes very dull, pulse weak but
regular, thirst intense, tongue parched but no
vomiting. I administered morphine sulphate gr.
^ ^, nitroglycerin gr. 1-100 hypodermically, and
a dose of Epsom salts internally. I remained
with the patient all night and watched him
Digitized by
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262
CX)UNTY SOCIETIES.
Jour. M. S. M. S.
^ closely, not being satisfied what the trouble was.
I was under the impression I had a bad case of
gall-stones to deal with. After the hypodermic
injection the patient rested until 2 a. m., when
he vomited. There was nothing about the
vomit that was characteristic of any disease. The
patient remained quite comfortable the remain-
der of the night and I gave no further treat-
ment. At 6 a. m. the bowels had not moved. I
gave another dose of "salts." The sweating had
almost ceased, the pulse was stronger and the
man was comfortable.
I saw the case again at 10 a. m., and
found a return of all the bad symptoms,
extreme thirst, cold perspiration, weak pulse,
abdomen much distended. There was, how-
ever, but little pain. The bowels had not
moved nor had the patient passed any gas. At
this time I told him that he was in a very criti-
cal condition. Geo. F. Heath was called in con-
sultation. After an examination he concluded
that we had an obstruction of the bowels to deal
with. So we went to work with enemas of dif-
ferent kinds, but with no effect whatever. At
noon we concluded that a laparotomy was the
last resort. T. A. McGraw, of Detroit, was
called. After a careful examination, he pro-
nounced it a case of either rupture of the gall-
bladder or the stomach. Dr. McGraw made an
incision in the abdomen in the median line. The
abdominal cavity was filled with a large amount
of almost clear fluid. This proved to be the wa-
ter that the patient had been drinking. It had
leaked through the stomach wall. The next
thing that attracted attention was a large ulcer-
ated surface the size of my hand. Upon exam-
ination of the stomacli, a small perforation was
found in the lesser curvature. The pancreas
was enlarged and hard. The intestines and
gall-bladder were normal. Owing to the weak
condition of the patient, large drainage tubes
were inserted and the wound closed. The pa-
tient rallied almost immediately from the an-
aesthetic and slept fairly well through the night.
From this time on he suffered no pain whatever.
The temperature never rose above 101°. The
pulse remained about 88 and respiration 22. There
was some distension of the abdomen but no ten-
derness. Nutritive enemas were given every two
hours after the first 18 hours and all were re-
tained. The bowels moved naturally about once a
day. Everything looked favorable until the morn-
ing of the fourth day, when the pulse began to
fail and the temperature to rise. There was some
delirium and the abdomen was more distended.
The patient died at 9 p. m. that night
We did not have a post mortem but I re-
mained with the undertaker and we opened the
wound and made a further examination. At
this time we found a large abscess of the pan-
creas.
After the operation, the urine was examined
and a slight trace of sugar was found. Other-
wise the urine was normal. The white or gray-
ish substance we took to be an ulceration proved
to be fat necrosis. From the amount of fat ne-
crosis present, it is evident that this disease had
been present in the man for some time. Upon
the very closest questioning we were able to
find but two complaints in his entire make-up,
viz., constipation and a sleepy feeling. The two
symptoms he was able to trace back for over
a year. He never suffered any pain. He al-
ways had a good appetite and a most perfect di-
gestion. In fact so far as he or anyone else ever
knew, he was a perfectly well man until he
was stricken on Monday, after being about his
work all day.
Geo. F. Heath,
Secretary.
MONTCALM COUNTY.
Montcalm County Medical Society held its reg-
ular meeting at Howard City, April 14th. Fif-
teen members were present. Drs. J. D. Whelp-
ley and N. Nelson, both of Howard City, were
elected members, making the total membership
of the Society 26. This is a gain of two over
last year.
A. W. Martin read a paper on the "Therapeu-
tics of Ergot." W. P. Gamber, who passed the
winter in Augusta, Ga., gave a very interesting
talk on Southern medicine. L. S. Griswold pre-
sented a paper on the "Surgery of the Head."
J. Black read a paper on "Diphtheria."
Abstract-
He advocated the early use of antitoxin. Al-
coholic stimulants are of the greatest value.
There is more danger in giving too little than
too much. The high fever should be combated
by sponging and baths. Antipyretic drugs should
be avoided, because of their depressing effects.
In rapid heart failure, moderately large doses
of morphine hypodermically should be used.
There should be plenty of sunlight and fresh
air in the room. Cleanliness of the parts should
be had by frequent removal of decomposing ma-
terials and disinfection of the discharges. In-
sist upon the recumbent position and avoid all
exertion on part of the patient.
Meeting adjourned.
H. L. Bower,
Digitized by
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Secretary.
JUNB, 1904.
MISCELLANEOUS.
263
WAYNE COUNTY.
General MEsnNG, April 28, 1904.
C. G. Stoclcston, of Buffalo, presented a pa-
per on "Tubercular Pericarditis." After giving
the histories and autopsy findings in three cases,
the doctor drew the following conclusions:
1. Tubercular pericarditis is not a rare affec*
tion.
2. The diagnosis is usually not made except
in cases having simultaneously active tubercular
processes in other parts.
3. The concurrence of pleurisy with blood-
stained effusion may be regarded as suggestive.
4. The pericarditis may be of a chronic obliter-
ative type or there ;nay be massive effusion, gen-
erally sanguinolent but rarely purulent.
5. It may be acute, continuing for not a few
weeks, or chronic, existing for many months.
6. It may be a part of a multiple serositis, and
the proportion of cases in which at least one or
more of the pleural cavities are involved is re-
markable.
7. The disease is to be regarded as a sec-
ondary affection, although from ia clinical point
of view, some cases may be looked upon as pri-
mary.
8. The point of origin of the infection is oft-
en found in the bronchial and mediastinal lymph
nodes, although these may be quite exempt from
the disease. The infection may be direct from
continuity of tubercular tissues or by transmis-
sion through the lymph vessels or through the
circulation.
9. The heart may be greatly enlarged or nor-
mal size or even somewhat small,
10. Some observers believe that occasionally
the process subsides and that comparative cure
results.
nDi0ceUaneou0.
NEWS ITEMS.
The Canadian Medical Association will hold
its annual meeting at Vancouver, B. C, August
23, 24, 25 and 26, 1904. The President and Exe-
cutive Committee of this Association extend a
cordial invitation to all the members of the
Michigan State Medical Society to be present at
this meeting.
The annual meeting of the American Medical
Association will be held at Atlantic City, June
7-10, 1904.
The American Academy of Medicine will hold
its twenty-ninth annual meeting at the Shelburne
Hotel, Atlantic City, June 4 and 6, 1904.
nois and Missouri will meet in St. Louis June
15-17, 1904.
The Nebraska State Medical Society held its
thirty-sixth annual meeting at Omaha, May 3-5,
1904.
The French Congress of Alienists and Neuro-
logists will hold their 14th annual meeting at
Paris, August 1-7, 1904.
The International Congress of Ophthalmology
will meet in Lucerne, September 13-17, 1904.
The Royal London Ophthalmic Hospital
(Moorefields), was founded one hundred years
ago. It was the first and has remained the largest
eye hospital in the world. It was founded and
is maintained as a pure charity, supported by
private contributions. The most celebrated Eng-
lish ophthalmologists have made its reputation,
as Wm. Bowman, Geo. Critehett, Jonathan Hut-
chinson, and others.
The fate of doctors who endeavor to correct
abuses in public institutions is illustrated by that
of Dr. Wm. D. Robinson, of Philadelphia. For
several years he had been resident physician of
the Eastern Penitentiary. Later he was appointed
a member of the Board of Inspectors, and became
especially active in investigating and exposing
abuses — result, removal by the Governor. It seems
universal that public institutions under political
control must be given over to plunder by incompe-
tent or dishonest henchmen, and that reformers
are summarily bounced.
Dr. William T. Bull has resigned his position
as Professor of Surgery in the College of Physi-
cians and Surgeons, New York City. Dr. George
E. Brewer, Professor of Clinical Surgery, has
taken his place.
The College of Physicians, of Philadelphia,
Pa., the owner of one of the largest medical
libraries in America, has decided to remove to
the corner of Ludlow and Twenty-second
streets, and erect a modem, commodious building
at a cost of a quarter of a million dollars — so
prosperous is this medical organization. It ex-
ists not to make more doctors but to develdip those
already made. Not .a little of Philadelphia's
medical prominence has been founded on the
facilities afforded by this institution.
The Tri- State Medical Society of Iowa, Illi-
New York has abolished the antiquated coro-
ner system. A Board of Medical Examiners ap-
pointed by the Mayor, takes its place. Suspicious
cases are to be examined in the presence of the
district attorney and one policeman. It is time the
same was done in Michigan, as it$ practical work-
Digitized by LjOOQIC
264
MISCELLANEOUS.
Jour. M. S. M. S.
ing has been most satisfactory in Massachusetts
and elsewhere.
It is announced that the Agricultural Depart-
ment at Washington has discovered a substance
which will destroy typhoid germs in stagnant
water. Sanitarians doubt this claim; outsiders
await the results of studies by others.
It is said that the germ of mumps has been
discovered by Dr. Samuel Darling of Baltimore
City Hospital.
The St. Louis Court of Appeals has decided
that physicians who are also druggists cannot
fill their own prescriptions if the main ingredient
be whiskey, as this would remove the check to
the sale of whiskey, established by law.
Dr. and Mrs. C. S. Cope, of Ionia, celebrated
their 25th anniversary on April 23rd.
John G. Goode, in the Charlotte Medical Jour-
nal, reports a case of a child born with its heart
outside of its body. The labor was normal and
the child weighed 5y^ pounds at birth. The
heart protruded from the chest through an open-
ing just large enough to permit the vessels to
enter the chest cavity. The opening corres-
ponded in position with the second piece of the
sterum (gladiolus). The child did well for
some days but the walls of the heart gradually
got thicker and thicker. At the end of sixteen
days the child died. From the birth of the
child the heart was kept anointed with olive oil
and protected from all clothing, etc., with a paste
board appliance, cone-shaped, placed over the
organ.
The Louisiana State Medical Society held its
2.5th annual meeting at New Orleans, May 10-12,
1904.
At the close of their college years and pre-
ceding their commencement exercises, the De-
troit College of Medicine and the Michigan Col-
lege of Medicine and Surgery entertained their
alumni by lectures, clinics at the hospitals, re-
ceptions and dinners.
CHANGE IN MEMBERSHIP.
(April 15th to May 15th.)
NEW MKMBBRS.
C. W. Armitage, Port Hope, Mich.
O. C. Bowen, Manistique, Mich.
J. D. Brook, Grandville, Mich.
W. T. Campbell, Brown City, Mich.
G. H. Chappell, Grand Rapids, Mich.
G. C. Christmas, Harbor Beach, Mich.
J. A. Clark, Cascade, Mich.
J. Corcoran, Ubly, Mich.
W. H. Fulton, Bad Axe, Mich.
W. A. Giffin, Ubly, Mich.
F. A. Kinsey, Three Rivers, Mich.
R. Leuschner, Mt. Clemens, Mich.
M. C. McDonnell, Bad Axe, Mich.
C. B. Morden, Pigeon, Mich.
J. O. Nelson, Howard Citv, Mich.
J. H. O'Dell, Three Rivers, Mich.
W. J. Saunders, Soule, Mich.
W. J. Shilliday, Lake Ann, Mich.
A. Toal, Peck, Mich.
J. W. Weed, Brown City, Mich.
J. D. Whelpley, Howard City, Mich.
CHANGE OF ADDRESS.
J. H. Braily,. Kalamo, Mich.
W. C. Conley, Ironwood, Mich.
W. D. Kean, Michigamme, Micti.
A. C. McKinnon, Mio, Mich.
J. A. Vernier, 216 24th St., Detroit, Mich.
L. Westcott, Madison, Wis.
BOOKS RECEIVED.
Von Bergmann's Surgery. — By Drs.' E. von
Bergmann, ?. von Bruns, and J. von Mikulicz.
Edited by William T. Bull, M. D. Vol. IL
Lea Brothers & Co., Philadelphia and New
York, 1904.
Musser's Medical Diagnosis. — New (5th) edi-
tion.— By John H. Musser, M. D. Lea Broth-
ers & Co., Philadelphia and New York, 1904.
Manual of Materia Medica and Pharmacy. —
By E. Stanton Muir, Ph. G,, V. M. D. F. A.
Davis Co., Philadelphia, 1904.
Proceedings of the Connecticut Medical So-
ciety, 1902.
Transactions of the American Medico-Psy-
CH01.0GICAL Association, 1903.
Corrcepon&cncc.
Mt. Clemens, April 20, 1904.
Editor of The Journal of the Michigan State
Medical Society :
Dear Doctor. — Several of the physicians com-
plain that the name of Dr. M. C. Cronin, of this
place, appears in PoIk's Medical Register (1904
edition) as a mcmhcr of The American Medical
Association and of The Michigan State Medical
Society. As you know, he was deposed two
years ago from membership in the latter body
for unprofessional conduct. I should like to
know if this cannot be corrected by the State
Journal and The Journal of the American Medi-
cal Association?
Yours very truly,
Joseph M. Croman,
Sec'y Macomb/CD^.^^^^ fecV-
Digitized by *
JXS'c^^^"^'^
JUNB, 1904.
BOOK NOTICES.
Booh l^oticee*
265
Under the charge of
RAY CONNOK.
D1SBASB8 OF THE Nose and Throat. By Charles H.
Knight, M. D. 148 illustrations. Octavo; 423 pages.
Cloth: $3.00 net. P. Blakiston's Son & Co., Philadel-
phia.
Few text-books are written with so unbiassed
and judicial a mind as the one before us. At
times one almost wishes the author had been
more of the advocate and less of the judge and
had given a little more decidedly his personal
experience in the matter under discussion. The
book is based on the author's lectures to the
Cornell students and despite the fact that he re-
fers to other text-books for the details of the
anatomy, enough has been included to satisfy
the average reader. The effort has been made
to give credit to the original sources but space
did not permit a complete bibliography.
The nose and its accessory sinuses with their
diseases receive the first attention. The chapter
on the sinuses is especially good. The methods
of diagnosis and treatment are clearly and con-
servatively given- from the antral puncture to
Luc's radical operations. Then the pharynx
and finally the larynx are considered systemati-
cally. In the removal of the tonsils the Mac-
kenzie tonsillotome receives the place of honor
for its simplicity, safety and efficiency. As re-
gards carcinoma of the larynx, he differs great-
ly from J. N. Mackenzie and concludes that con-
ditions so extreme as to require a complete lar-
yngectomy render a case inoperable.
There is no padding in the work and a sur-
prising amount of valuable information has been
crowded into what appears at first sight to be a
rather small book. The author's style is schol-
arly and concise. He displays a thorough ac-
quaintance with the extensive literature of the
subject as well as a clear estimate of the rela-
tive value of his facts. The illustrations, many
of which are of instruments, although some are
from the author's specimens, add much to the
value of the work. The letterpress and mechan-
ical features of the book are excellent.
The work can be most heartily recommended
to those who want a complete, yet comparatively
brief resume of the subject up to date.
Manual op Clinical Microscopy and Chemistry. By
Dr. Herman Lenhartz of Hamburg. Authorized trans-
lation by Henry T. Brook, M. D.. of New York.
With 148 illustrations and 9 colored plates. PaRcs
jixxii — 112, Octavo. Cloth, $8.00 net. F. A. Davis Co.,
Philadelphia, 1904.
Prof. Brooks* experience in teaching many
hundreds of graduate physicians has been of
great service to him in translating this work.
The many additions from his pen have added
greatly to the usefulness of this book to the
general practitioner. Thus, for haemoglobin es-
timation he recommends the Talquist scale as
the best method yet devised for everyday use in
practice. This is not even mentioned by the
author amongst a number of others more accu-
rate, perhaps, but taking more time and expen-
sive apparatus.
The translation is based on the fourth Ger-
man edition and includes a wide range of sub-
jects. Vegetable and animal parasites are given
the first consideration. The position of bacteria
in the vegetable kitchen is shown schematically.
The common pathogenic organisms are taken
up systematically and described. No references
are given to the literature, but the value of the
work is much enhanced by brief historical notes,
preceding the practical points. Thus, before the
description of the tubercle bacillus, the part tak-
en by Villemin, Cohnheim, Baumgarten and
Koch in the identification of the disease is con-
cisely set forth. Then follows its morpholog-
ical, cultured and staining characteristics.
The ectoparasites are passed over with a mere
word, although some, such as Phthivius Pubis are
figured. Tlie entoparasites are taken up at more
length, although trypanosomiasis is not men-
tioned. The blood in health and disease is the
next topic considered and includes an article on
the Forensic Detection of Blood Spots. The ex-
amination of the sputum and the secretions of
the alimentary tract furnishes the food for two
more sections, while the discussion of the urine
and aspirated fluids complete the work.
A fairly complete index adds much to the value
of the book. Certain minor discrepancies de-
tract somewhat from the excellence of the whole.
Thus, under the description of the tubercle bacil-
lus a reference is made to Plate VII, Fig. 5,
where anthrax bacilli are figured. Strangely
enough the determination of the molecular con-
centration of urine is given the name cryoscopy,
while the same process with the blood is denied
that title.
The work as a whole contains much of value
which is so arranged as to be easily accessible
to the busy practitioner. It should serve, as its
author intends, to disseminate the use of the
methods described to the mutual benefit of the
doctor and his Patiet^igifeed byGOOglC —
266
PROGRESS OF MEDICAL SCIENCE.
proore06 of HDeMcal Science.
Jour. M. S. M. S.
MEDICINE.
Under the charge of
HABUSON D. JSNKS.
Myelopathic Albumosuriad — Bruce, Lund and
Whitcombe report the rare case of Myelopathic
albumosuria in a woman, 51 yrs. old, who, in
bending over a fire, fractured her left femur.
One week after the fracture," while the nurse
was lifting the patient slightly, the left clavicle
was fractured. Three months later a rib on the
left side was fractured. There was marked an-
aemia, emaciation and lassitude, vomiting and
frequent diarrhoea. Vomiting and diarrhcea
came on suddenly without pain or effort or pre-
ceding nausea. A month later the left humerus
was fractured in trying to reach for something
under her. Four weeks later she died.
There was nothing in her previous history of
importance except that she had partaken of a
very spare diet. She had had considerable neu-
raligic pain in different parts of the body. There
was no enlargement of bones during the eight
months she was under observation. Examina-
tion of urine showed it straw-colored, often
syrupy, forming froth on shaking. Odor was
aromatic (the odor later was perceptible in the
breath). Sp. gr. 1019-1022, quantity 80 to 120
oz. Ileat gave a precipitate dissolving on boil-
ing. Cold nitric acid gave a precipitate which
dissolved on boiling. Hydrochloric acid gave ex-
actly the same condition as nitric.
At the necropsy about the fractured humerus
there was six ounces of pale pink blood-stained
fluid giving a gluey feeling. This fluid was