Wm. H. Veenboer,
The Lapeer County Medical Society held its
regular meeting at Lake Pleasant, July 13, 1904.
Hal C. Wyman, of Detroit, was the guest of the
Society and was elected to honorary membership
in the same.
C. W. Braidwood, of Dryden. read a paper on
"PavloW^'s Study of the Digestive Glands."
The pancreas is governed by the same general
laws which govern the gastric and intestinal secre-
tions. The amount of pancreatic juice is regu-
lated by the quantity and quality of the food
ingested. Fats have, for instance, a specific action
on the duodenum, causing an increased pancreatic
flow and a decreased flow of the gastric juice and
in the duodenum within 365 minutes causes an
increase of pancreatic juice, while acid, in the
stomach with the duodenum ligated, has no effect
whatever on the pancreatic flow^.
The mind has a controlling influence on diges-
tion, both gastric and pancreatic. Stimulation of
vagus never causes a decrease in pancreatic flow,
while stimulation of the sympathetic causes an
increase. Bile is continually being secreted. An
acceleration in the portal circulation causes an
increased flow of bile. Therefore during digestion,
when there is an increased activity of the portal
circulation, there is an increased flow of bile.
Intestinal juice wa^i§^ft|^b|^<^0l0gttecon-
tain a ferment called "chymaze," whose main
function is to stimulate the activity of the fer-
ments of the pancreatic juice. Pure pancreatic
juice will not digest albumen but with. the addi-
tion of "chymaze," digestion readily takes place.
These physiological truths it behooves us to apply
at the bedside.
W. J. Wall, Elba, read a paper on "Summer
Diarrhoeas of Children."
Improper feeding is the chief etiologic factor,
and occurs almost exclusively in the infant artifi-
cially fed. Improper feeding may be due to too
much milk given at one time, or to too frequent
feedings, or to cow's milk, not properly modified.
There can be no doubt that bacteria play a large
share in producing this class of diarrhoeas. The
bacillus of Shiga was found by Duval and Bassets
in 42 cases. In 25 cases, not suffering from diar-
rhoea, it was not found.
The treatment consists in the following: Stop
the milk for 48 hours at least. Cases are cited
where it was withdrawn completely for fivt days,
when plenty of water was given, and where the
children recovered. The usual method of medi-
cinal treatment is gr. 1/10 of calomel every half
hour for 10 doses, followed by castor oil. Bis-
muth is given in ten grain doses every two hours.
Arsenite of copper gr. 1/1000, has been consid-
ered by some as almost a specific. Opium, if
used at all, should be used with care and then
only when the intestinal tract has been thor-
oughly emptied. Plenty of fresh air, light cloth-
ing, frequent baths, etc., are recommended.
J. V, Frazier, Lapeer, read a paper on "Eye
Eye strain is a frequent cause of headache. The
typical case is one where the headache, frontal or
occipital, comes on after the use of the eyes in
close work. Vertigo is also in some cases caused
"by eye strain.
Hal C. Wyman, Detroit, read a paper on
"Radical Operations for Hernia."
Hernia is divided into two classes — natural,
where the hernia is the result of rupture of the
abdominal muscles, and fascia, due to an excess
of pressure in abdomen. Under this head we
have the infantile hernia, which is caused by
excessive crying and tight clothing. Treatment
in these cases is removal of all constructing bands
and suspension by shoulders, combining with this
massage and proper dietetic management.
In the second class, the hernias of adults, we
find the inguinal predominating. In women who
have borne children often we find the umbilical
hernia as a result.
The trouble with all trusses is that they restrict
free movement of the abdomen.
The only rational treatment is the radical oper-
ation or the closing up of the ring.
In most cases you will find that the gut is
adherent to the peritoneal wall and will have to
be gently separated before sack can be fully
drawn out and tied off.
Umbilical hernia— The incision used is the
transverse one. The after treatment consist of
rest in bed, restricted diet, consisting of from
18 to 22 ounces in 24 hours for a patient weighing
Inguinal hernia — In persons between 14 and 55
years of age, the best treatment is operation and
the best operation is the simplest. Rest in bed
for at least three weeks should be carried out in
each case, no matter what operation is performed.
This gives the muscles a chance to become thor-
The larger hernias are harder to cure. In these
cases proceed as in ordinary operation, and then
take a sterilized forcep and force it up from
underneath the transveralis muscle. Through the
muscle and through the opening drag your sack.
Then proceed as in the ordinary way.
In another condition of enlarged hernia where
there is insufficient tissue, dig down and cut out
a V shaped piece so as to cover the opening.
Another method is by exposing the whole of
The operation for hernia, if carried out in a
cleanly manner and quickly, is almost devoid of
The best material for closure in my hands has
been silk. H. E. Randall,
Montcalm County Medical Society held its
regular quarterly meeting in Greenville, July 14,
Jay O. Nelson, of Howard City, read a paper
entitled "Acute Leptomeningitis (Cerebral)."
Acute leptomeningitis is frequently diagnosed
as typhoid fever. The absence of morning remis-
sions, and evening exacerbations of temperature,
iliac tympanites and gurgling help one to make
The disease is caused by the diplococcus in
tracellularis of Weichselbaum.
Treatment: ^.^.^^^^^ ^^ GOOglC
Jour. M. S. M. S.
j\fter receiving a calomel purge the patient
should have light nutritious diet. Alcohol spong-
ing is of benefit in reducing the temperature.
Opium in small repeated doses is given for rest-
lessness. Whiskey in milk acts as a heart tonic.
It may be necessary to feed the patient with ene-
mas. Tr. Veratrum Album gtts., 3, every 4
hours, is an excellent remedy.
A. P., age 14, male. Type of rapidly growing
boy exposed to heat, dust, overwork.
Sept. 3rd had to stop work and go to bed with
headache, anorexia. Temperature 104, pulse
110. Would drop off into a doze while be-
ing questioned — somewhat difficult to rouse.
Urine scanty, high color, no albumen. Coma
came on early, and lasted for 20 days — fever run-
ning high from 102° to 104". Pulse grew weaker.
Cheyne stokes respiration became quite marked
as coma continued. Tonic contraction of the mas-
seters was a peculiar feature. During spells of
yawning, though, the mouth would open widely,
but upon closure the masseter contraction was
re-established. Spinal muscles were tender and
tense throughout. No medication seemed to
have much beneficial action upon the disease itself
until we used Tr. Veratrum Album, gtt. 3, every
4 hours. The improvement in cerebral condition
showed so early after beginning^this medicine that
I certainly feel that it exerted a specific action.
Despite precautions used, a bed sore developed,
and complicating lobar pneumonia of left upper
lobe. Resolution took place upon seventh day,
and recovery was perfect though slow. There
was no resulting paralysis.
H. L. Bower,
The Tuscola County Medical Society held its
regular meeting July 11, 1904, at Millington.
Twelve were present at the meeting.
W. C. Garvin presented a case of Hodgkin's
Disease coming from the Isthmus of Tehuantepec,
F. P. Bender read a paper on "Stone in the
Bladder," reporting two cases. He presented a
specimen of stone removed from one of the cases
in which bees-wax, which had been introduced
into the urethra, had found its way to the bladder
and had become the nucleus of the stone.
W. C. Garvin read a paper on "Acute Suppura-
tive Osteomyelitis," reporting two cases in which
early operation was performed.
According to Senn, suppurative inflammation of
the marrow of the bone is an exceedingly frequent
affection in children and young adults.
Osteomyelitis is essentially a phlegmonous in-
flammation of the marrow, caused by the lodge-
ment in this tissue of pus microbes which have
found their way into the circulation through the
skin or mucous membrane of the lungs or the
digestive tract. The disease attacks preferably
the long bones near the epiphyseal lines.
Premonitory symptoms of acute suppurative
osteomyletis are sometimes noted, such as bron-
chial catarrh or a diarrhoea. Likewise a car-
buncle or other suppurations of the skin may be
looked upon as the primary lesion.
The disease proper is usually ushered in by
a chill and other well known symptoms which
indicate the commencement of an acute suppura-
The local manifestations of the disease are pain,
tenderness, swelling, redness, synovitis epiphyse-
olysis, and loss of function.
Acute suppurative osteomyelitis is often diag-
nosed and treated for other affections as rheuma-
tismtism, periostitis, typhoid fever, or phlegmon-
ous inflammations of the soft parts. It is only by
a careful consideration of every feature of the
clinical picture, that a correct diagnosis can be
In the treatment of this malady, an early and
correct diagnosis is of the greatest importance.
From the very nature of the disease, it is evident
that the treatment is essentially surgical.
Thorough cleansing of the digestive canal
by a brisk cathartic is often useful.
It is doubtful if the use of strong tincture of
iodine applied to the skin, or the interosseous
injection of antiseptics, have any influence in
arresting or even retarding the progress of the
In every case of acute suppurative osteomyelitis,
the medullary cavity should be freely exposed
. and submitted to direct and most thorough anti-
septic treatment. This should be done as soon
as a positive diagnosis can be made. An early
radical operation accomplishes the following:
(1) It removes the pain.
(2) It enables the surgeon to len-rve the local
cause of the trouble, completely or in part.
(3) It prevents extensive necrosis.
(4) It is the best prophylactic measure agaiiist
fatal septicemia and pyemia.
(5) It prevents extensive destruction of the
periosteum and contiguous soft parts.
(6) It cuts short the attack and expedites re-
cov^^y- Digitized by GOOg IC
Senn divides operations for acute suppurative
osteomyelites into three classes:
(1) The early operations: Here the medul-
lary cavity is opened for the purpose of disinfect-
ing the primary focus before the inflammation
has extended beyond the limits of the bone.
(2) The intermediate operation: This oper-
ation is performed after an extension of the sup-
puration to the soft tissues around the bone. The
object of the operation is to give free drainage by
multiple incisions through the soft parts. Small
openings are made into bone for the purpose of
exposing its interior to antiseptic irrigation.
(3) The late operation: This is done for the
removal of sequestra. It should always be post-
poned until the involucrum is strong enough to
furnish the necessary support and until the se-
questrum is completely separated.
Report of two cases:
A luncheon was served to the visitors by the
W. C. Garvin,
The Wexford County Medical Society held its
regular meeting at Cadillac, August 11, 1904.
James A. King, of Manistee, read a paper on
"Danger of Taxis in Strangulated Hernia," with
report of eight cases:
The more I see of strangulated hernia, the
more impressed I am with the dangers of severe
or- at all prolonged efforts at manipulative re-
duction. When a hernia is reduced without oper-
ation, you have at best only, prolonged the exist-
ence of an incapacitating and 'maimed condition
that is a constant menace to, life. When opera-
tive means are employed you have cured a
cripple. Like most country practitioners, I be-
lieve, I keep no case book and will refer briefly
to* a few cases illustrative as I recall them to
Case 1. — Mrs. V. S., referred to me by a very
competent physician twelve hours subsequent
to strangulation. I feel confident no unusual ef-
forts at reduction had been made. Longitudinal
muscular coat of bowel was split for at least two
inches and the inner circular coat protruded,
making a secondary strangulation which would
have soon resulted in ulceration and rupture of
intestine. Suture of the torn outer coat and of
abdominal walls was followed by recovery and
Case 2. — W. J., brought in by parent. Father
had made repeated efforts to reduce an irreducible
hydrocele of the cord, following rupture. The
sac being empty, no injury was done to the- intes-
tine. Possible injury was confined to abdominal
wall and cord. Operation was followed by re-
covery and cure.
Case 3. — S. O. — Strangulation had existed eight
days. Repeated efforts were made at reduction by
different surgeons, as patient refused operation.
When patient was referred to me, the hernia was
apparently readily reducible. Symptoms of com-
plete obstruction were marked, which I believed
to be due to the hernia. Incision over internal
ring developed the fact that the whole ring had
been literally torn loose from the abdominal
walls, ring, intestine and all being returnable into
the abdominal cavity together. Liberation of the
intestine and suture of abdominal walls were
followed by the usual symptoms of auto-infec-
tion. The patient, however, survived for eleven
days and slowly sank, apparently from the effects
of the poisons absorbed during the long strang-
Case 4. — C. — Called two weeks after a swelling
slowly appeared in scrotum, variously diagnosed
by several physicians. Diagnosis : Omental Hernia.
Sac in scrotum was filled with grumous, offen-
sive discharge and a mass of decomposed omen-
tum ; adhesions had formed over the upper end
of the sac, walling it off from the abdominal
cavity and from the secondary sac above, which
contained more omentum and a knuckle of in-
testine which was not strangulated. Before pa-
tient was able to be up, he contracted pneumonia,
from which he died. According to the attend-
ing physician, the operation was in every way
satisfactory. This case was first diagnosed as
rupture, and manipulative efforts were made to
reduce it. Operation then would have cured the
rupture and saved the patient from a probable
Case 5. — J. J. — I was called one year prior to
his operation. Case resisted all my efforts at
reduction. When, after talking over the necessity
of operation with his friends, he made a further
effort of his own, using an amount of force un-
pardonable on the part of any surgeon, and suc-
ceeded. Called to operate one year later by Dr.
J. Bowel was found intact, tissues bruised, doubt-
less the result of patient's own reckless efforts
at reduction. Operation was followed by recovery
The two following cases do not illustrate the
dangers of taxis, but do show^the futilitj^ and
Digitized by VjOOQ TC
Jour. M. S. M. S.
wa^te of time that results from postponing oper-
Case 6. — Mrs. M. — Operated on sixteen years
before for fibroid. The scar of the incision reach-
ed from the pubic bone to umbilicus. The
muscks had not united at all and had retracted
on the left side to a line drawn parallel to the
anterior iliac spine, and on the right side about
two inches less. The patient was immensely fat,
standing about 5 ft. 2 in. and weighing 200 pounds
or more. All the intestines apparently protruded
through this immense ventral hernia, and the
skin and mesentery, had gradually become so
'ejongat^ and stretched that the hernia reached
almost to her knees. The difficulties in bringing
together the misplaced and the long unused ab-
dominal muscles were almost unsurmountable,
but the operation was followed by recovery and
Case 7. — S. C.-*-Hernia had existed since boy-
hood. Irreducible. One night he was suddenly
seized with pain on rising from his chair, and in
a few moments the intestines and omentum be-
*g4m to pass through the ring into the scrotum
and neighboring skin until they had apparently
all passed into their new location. It is impossi-
ble to describe the monstrous deformity presented
by this immense tumor. Only a dimple marked
the site of the organ of copulation. Every avail-
able bit of skin had been used to keep the tumor
from bursting. A surgeon, standing by before
the operation, mistook the dimple, on the white
?hiny surface for the umbilicus. The operation
was difficult; the dissection of the primary and
secondary sacs took a long time and great care.
I was obliged to make an opening three or four
inches long above the ring to return the intes-
tines to the abdominal cavity, and then could not
get a start until I punctured the intestine and
allowed gas and fecal matter to escape. Result:
recovery and cure.
Case 8 is included here, because it shows a
possible result of taxis in aged persons with de-
generation, though the condition described was
not due to manipulation in this case.
Case 8 — Mrs. D. — Age 71. Umbilical hernia
for many years. Several times strangulated.
Arose quickly from her chair and felt intense
pain, when, with a rush, intestines began to fill
the sac. Dr. K. called me an hour afterward.
The pressure of the intestines had dissected the
skin up in all directions and dilated the sac. The
tumor was the size of a child's head and skin
blue. I feel positive this blueness was not due
to undue manipulation for the physician in charge
was a very careful man; but undue manipula-
tion might easily produce the condition about to
be described, and serves as a warning against
careless taxis. Extreme care was necessary in
opening over the rupture for there was not even
cellular tissue left between the skin and intes-
tine.. I know of no explanation of the tremend-
ous pressure sometimes exerted by these large
ruptures, but they will dissect up skin apparently
as fast as we can do it with the fingers. I found
the intestines full and blue. I punctured in sev-
eral places, and there escaped a large quantity of
partly digested blood. This blood came froni
capillary oozing in the intestinal walls. I en-
larged the opening and returned the intestines,
but the bleeding continued and the patient died
from capillary hemorrhage of the intj^stincs
about six hours after operation. This hemorrhage
was caused apparently by the violence of the
pressure within the sac. The intestines within
the abdomen were healthy. It might easily have
been caused by undue manipulative efforts.
I have not cited near all the cases of s^angu-
lated hernia that I have operated on that tcltl their
lesson against prolonged taxis, but my paper is
already too long, and I will close, giving this as
my opinion about taxis : That at best it is a very
undesirable make-shift procedure; that only very
gently effort under chloroform is ever safe; that
the patient has usually made all the manipulation
effort that is warrantable; that any force at all
is dangerous with the aged and degenerate pati-
ent and that the knife and a radical cure is infin-
itely safer than any method of taxis ever in-
B. H, McMullen gave a demonstration of the
S. C. Moore,
The Mississippi Valley Medical Association
will hold its thirtieth annual meeting at Cincin-
nati, October 11, 12, 13, 1904. Dr. Hugh T.
Patrick is President and Dr. Henry E. Tuley,
Secretary. Dr. William J. Mayo, of Rochester,
Minn., will deliver the oration in Surgery, and
Dr. C. Travis Drennen, of Hot Springs, Ark.,
the oration in Medicine.
The White League of Pennsylvania was char-
tered on June 14, 1904, for the treatment of pul-
monary tuberculosis among the poor. The
League intends to adopt the hygienic method of
Digitized by VjOOQIC
treatment. The League has a site on the east-
ern slope of the Allegheny Mountains (eleva-
tion of over 1,500 feet), near Glen Sunimit,
where a permanent camp will be built. It is pro-
posed to provide for the hopelessly ill in a health-
ful location, so as to afford them the comforts
of life as long as they live.
Owing to the large increase in the number of
pneumonic cases in New Yorl^ City, Health
Commissioner Darlington has invited the follow-
ing men to serve on an investigating commis-
sion, whose purpose is to avoid a pneumonia »epi-
dcmic in the metropolis this coming winter:
Drs. William Osier, Baltimore; William H.
Welsh, Baltimore; Edward A. Janeway, New
York City; J. Mitchell Prudden, New York
City; L. Emmett Holt, New York City; Frank
Billings, Chicago; John H. Musser, Philadelphia,
and Theobold Smith, Boston.
Hawaii wants the Government to help pro-
vide for the leper colony and for the scientific
study of the disease. In Hawaii's leper set-
tlement at Molokai there are 951 native Hawaii-
ans, 34 Chinese, 10 Portuguese, 10 English and
Germans, 5 Americans and 4 Negroes and Ma-
Some physicians have been studying the part
perspiration plays in throwing off the poisonous
products developed in the body by pathologic
conditions or by the effects of drugs. The con-
clusion reached is that in the elimination of nor-
mal and abnormal substances, the skin is com-
paratively imimportant compared with the kid-
CHANGE IN MEMBERSHIP.
(July 15th to August 1.5th.)
G. W. Beeroan, Munising, Mich.
J. B. Brasseur, Norway, Mich.
Henrietta Carr, Eaton Rapids, Mich.
J. M. GaJlery, Eaton Rapids, Mich.
L. L. Goodnow, Negaunee, Mich.
R. S. Griswold, Bay City, Mich.
C. L. Hathaway, Hanover, Mich.
F. H. Short.s, Chatham, Mich.
B. Thompson, Jackson, Mich.
C. L. Tuttle, Clinton, Mich.
F. A. Van Sickle, South Frankfort, Mich.
-A. J, Warren, Mt. Clemens, Micl^,
H. B. Williams, Marlctte, Mich.
CHANGE OF ADDRESS.
S. E. Campbell, Hancock, Mich.
H. E. McLennan, Petoskey, Mich.
G. R. B. Meyers, Colorado Springs, Colo.
C. J. Kneeland, Traverse City, Mich.
VoN Bergmann's Surgery.— By Drs. E. von
Bergmann, P. von Bruns, and J. von Mikulicz.
Edited by William T. Bull, M. D. Vol. IV.
Lea Brothers & Co., Philadelphia and New
Radiotherapy and Phototherapy, including
Radium and High Frequency Currents. —
Charles W. Allen. Lea Brothers & Co., Phila-
delphia and New York, 1904.
The Practical Application of RoNTfcEN Rays
IN Therapeutics and Diagnosis. — William
Allen Pusey, M. D., and Eugene W. Caldwell,
M. D. Second Edition. W. B. Saunders &
Co., Philadelphia, New York and London, 1904.
A Text- Book of Pathology. — By Joseph Mc-
Farland, M. D. W. B. Saunders, Philadelphia,
New York and London, 1904.
Clinical Treatises on the Pathology and
Therapy of Disorders of Metabolism and
Nutrition. — By Prof. Dr. Carl von Noorden.
Part II., Nephritis. Part III., Colitis.
Properties of Anti-Crotalus Vcnin. —
1. The local lesions caused by crotalus venom
interfere with the employment of the venom in
an unmodified form for purposes of immuniza-
2. Hitherto no practically successful produc-
tion of antitoxin for rattlesnake venom has been
accomplished because no method has been known
by which the local effects of the venom could be
removed without rendering the venom useless
for purposes of immunization.
3. The modification of venom by means of
heat reduces or abolishes the activity of the
venom at the expense of the hemorrhagin and
possibly other locally acting principles.
4. In order to produce an antitoxin for cro'
talus venom, the attempt was made to transform
the locally active principles of this venom into
5. Through the use of hydrochloric acid and
iodine trichloride, the venom is deprived of a
large part of its toxicity, while it still preserves
the power to set up anti-venin formation in the
dog and rabbit.
6. That an anti-venin of considerable activity