dry and hot, pulse strong and full. A rapid pulse
at the beginning indicates a severe and possible
fatal case. I know of no disease that the physi-
cian is called upon to treat, where the prognosis
depends so much upon the heart's action, as p.:eu-
monia.
During the stage of invasion there is a dimin-
ished expansion on the affected side; by ausculta-
tion over the pneumonic lung dry and sometimes
moist rales are heard; also slight crepitation. As
the case progresses a few days all these are inten-
sified, accompanied with the characteristic sputum.
Patient has a more anxious expression, the nos-
trils expand with each inspiration, the tongue is
dry and heavily coated, color of lips dark, some-
times purple. This condition is not only due to
a rapidly failing heart but also to a state of tox-
emia. As the case progresses after four, five or
six days, delirium is usually present during the
night.
This disease nearly always terminates by crisis.
This occurs between the fifth and ninth day, the
temperature suddenly drops below normal and
all other symptoms are changed. This is usually
followed by a long, natural sleep, during which
the patient sweats profusely and gradually recov-
ers. In those cases where resolution does not take
place, the case goes on from bad to worse and
finally succumbs to the great strain on the heart
or to the toxemia. In some few cases the disease
terminates gradually or by lysis. The mortality
ranges from fifteen to twenty.*five per cent., the
greatest mortality is in those who are past fifty
years of age, and it is especially great among
those who had led a dissipated life where .the
mortality is over fifty per cent.
That there is a wide range of opinion in the
treatment of pneumonia in the medical profession,
no one will deny; that there are but very few
remedies known to the profession today that will
favorably modify the ravages of disease all will
admit.
Then the question arises. What is the conscien-
tious physician to do? Is he to stand by the
bedside of his patient, surrounded by anxious and
perhaps frightened friends and relatives, and by
his very actions and demeanor, cast still more
gloom upon the scene by saying, but very little
can be done? The older and more experience I
get in practice, the more I believe in giving the
patient fewer drugs and more confidence. We
should endeavor to impress upon patient and fam-
ily that all will be well.
It is to be regretted that we have not as yet an
antitoxin to inject that neutralizes and causes
these germs to become inactive like antitoxin does
in diphtheria, but until we do get such a specific,
we must eliminate the toxin as best we can, and
this can only be done by opening all the channels
of the excretory and secretory organs.
I would give my patient five or ten grains of
calomel, followed by a few doses of Rochelle
salts. This would not only eliminate some of the
toxic material from the bowels but would relieve
to some degree the pulmonary congestion as well.
This would not only cause the patient to breathe
easier, but would very decidedly relieve the over-
burdened heart. Of course, at this time, a few
doses of aconite or veratrum would not be out
of place, but I would endeavor to establish free
perspiration by a pack carefully watched; and
lastly, but by no means least, plenty of pure air
must be obtained for the patient to breathe. In
no other disease is plenty of pure air so essential
as in pneumonia. When we stop to consider tliat
one or two attendants in an average bedroom
with the patient will soon consume (he normal
amount of oxygen unless there is plenty of ven-
tilation; so, after the patient's alimentary tract
has been well cleansed, the skin acting freely, and
a plenteous amount of pure air in room, about all
has been done that can be done.
I know of no diseases in which the heart needs
more careful watching than in pneumonia. In
some cases there is a cardiac toxemia present al-
most from the start. The rate of the pulse may
not be so much increased, but the second sound
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of heart is weakened, due to pulmonary obstruc-
tion and also lack of tenacity of heart muscles.
Personally, I believe in the old adage in every
case of pneumonia, "that an ounce of prevention
is worth pounds of cure," and so I give heart
tonics early, strychnine and digitalis, beginning
with small doses and carefuljy watching effects,
withholding alcoholic stimulation until later.
Digitalis is condemned by some, but the writer
has never seen any bad results from its cautious
use when the stomach is not irritable. An irri-
table stomach, in many cases, is brought about by
injudicious feeding or over feeding. While the
patient's strength must be sustained as much as
possible, yet a little too much food is worse than
none. An indiscriminate milk diet causes much
trouble at times. I can recall such cases with dis-
tended bowels, diarrhoea, thickly coated tongue
with delirium. There are enough germs in the
patient's system without generating them in the
alimentary tract by the wholesale. Give only
small quantities of food and preferably such as
have been predigested. Should any distension of
bowels occur stop all foods for short time and
give tablespoon ful of castor oil, at same time
flush bowels with -enema of sterile water. After
the case runs four or five days and heart begins
to show signs of weakness, begin alcoholic stimu-
lation, increase strychnine, and in some cases
caffein is useful. Good reports are given by some
of adrenalin. Personally, I have had no experi-
ence with this last named drug in pneumonia, but
it certainly has a place in treating pneumonia just
previous to the crisis. Should there be pain and
restlessness, or active delirium, small doses, one-
sixteenth to one-eight of a grain of morphine,
hyperdermically administered quiets the patient
more effectively than any other remedy, and at
same time causing less disturbance to stomach
and digestion. Inhalation of oxygen is highly
recommended in later stages, but as a rule is used
as a last resort.
In conclusion, let me mention one more remedial
agent that ought to be used much more than it
is, especially in such diseases as pneumonia, which
is so early accompanied by general weakness and
prostration, and that is normal salt solution. This
acts beneficially in several ways: it supplies the
wasted tissues with fluids, stimulates the action
of kidneys and other secretory organs, and in a
small degree, neutralizes the toxemia in the sys-
tem. This fluid can be administered by rectum
in eight to sixteen ounce doses several times daily,
also subcutaneously in thick or fleshy parts, and
in extireme cases may be administered intravene-
ously. Of course, the strictest antiseptic measures
must be observed.
G. M. Livingston, Sec'y.
TUSCOLA COUNTY.
The Tuscola County Medical Sodety held its
third annual meeting at Caro, October 13, 1904.
Twenty-one physicians were present and three
new members were received. One visitor. The
committee on legislation made the following
propositions which were adopted by the society
and submitted to the Board of Supervisors for
their approval :
"We would recommend that no set charges be
fixed for medical services in general outside of
smallpox and diphtheria. That the charges be
the same for the county patient as for his neigh-
bor who pays his own bill.
"That for all diphtheria patients $1.00 be
charged extra for the injection of antitoxine, —
the county to furnish the antitoxine.
"That for smallpox patients not less than $5.00
per visit be charged in addition to the regular
mileage fee.
"That the minimum fee be charged for all sur-
gical operations.
"That a duplicate account be kept of all serv-
ices rendered, one copy to be left with the house-
holder and one kept by the doctor.
. "That when a doctor is called to attend a
patient whose financial condition is such that it
is certain that the doctor cannot collect his bill,
the following course shall be taken: After the
doctor's second visit he shall have the house-
holder (or some other suitable person) notify
the supervisor who, when he is satisfied that the
case is one requiring aid from the county, shall
issue the applicant two cards, one for the doctor^
in charge and one to be kept in the home of the
sick. At each visit the doctor shall enter the
charge on the house-holder's card and upon his
own card. After each entry on the house-hold-
er's card the doctor shall sign his initials and
after each entry on the doctor's catd the house-
holder, attendant or nurse shall sigh his or her
initials. In cases of contagious diseases the health
officer shall sign the house-holder's card when he
placards the premises. At the termination of the
case the supervisor shall take up the house-hold-
er's card which will be a bill to the county and
shall be presented to the Board of Supervisors
or the poor board for payment. When the bill is
paid, the doctor shall turn in his card as a receipt.
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COUNTY SOCIETIES-
559
'That the doctor shall be allowed payment for
the first two visits and in case the cards be issued
by the supervisor the doctor shall make an entry
of them on both cards."
A. L. Seeley,
C W. Clakk,
W. C. Gamvin,
Committee.
The Board of Supervisors of Tuscola Co. re-
jected this proposition by a vote of 22 to 2.
The election of officers for the ensuing year
resulted as follows:
President— B. D'Arcy, Caro.
Vice-President— R. L. King, Caro.
Secretary— W. C. Garvin, Millington.
Treasurer— B. C. Bradshaw, Mayville.
P. J. Livingstone exhibited two cases, one, necro-
sis of the tibia, the other, pulmonary and laryngeal
tuberculosis which had made remarkable improve-
ment under fresh air treatment plus the usual
medical and diatetic measures.
P. J. Livingstone then gave the outgoing presi-
dent's address in which he urged the country
practitioner to undertake greater things rather
than send all difficult cases to his city brothers.
W. C. Garvin, Sec'y.
WAYNE COUNTY.
The Wayne County Medical Society held its
regular general meeting October 17, 1904. Emil
Amberg showed a specimen of the temporal
bones with a crista temporalis instead of a linea
temporalis.
Willis S. Anderson read a paper on "Infection
Through the Tonsils."
Abstract:
The paper called attention to the lymphoid
character of the tonsils which like similar struc-
tures, have a protective function.
Infection through the tonsils from various or-
ganisms may occur at any age, but is more fre-
quently found in childhood. Infection by this
route may be a factor in the causation of tuber-
culosis, rheumatism, endocarditis, pleurisy, acute
nephritis, enlarged glands and other diseases.
Lymphatic leukaemia may manifest itself pri-
marily by tonsillar enlargement.
The importance of slow septic absorption
through the crypts of the tonsils was mentioned
and cases were cited. Thorough examination
with a bent probe for diseased crypts was ad-
vised, and the various forms of treatment by the
tonsil tome, gavano-cautery and snare were con-
sidered. Mention was made that the voice is
improved by the proper treatment of the tonsils.
In conclusion the author stated that the keynote
of the successful treatment of catarrhal affections
of the nose and throat is to remove the causes
which impair respiration and excite irritation.
When this is done, the danger of infection
through the naso-pharyngeal mucous membrane
is reduced to the minimum.
The Wayne County Medical Society held its
regular general meeting October 31, 1904. The
following resolution was passed:
Whekeas^ The members of the medical pro-
fession, as citizens, are entitled to the same privi<
leges which are enjoyed by other citizens, and
Whereas^ The Board of Regents of the Uni-
versity of Michigan have ruled (Michigan
Alumnus October, 1904, pp. 2 and 3) that the
medical faculty of the University of Michigan
must grant gratuitous medical and surgical treat-
ment to everybody applying therefor, whether
rich or poor, and
Whereas, Such ja condition is contrary to all
customs and rules governing the relation of one
citizen to another, and
Whereas, Such a ruling deprives the medical
citizens within the radius of the influence of the
University of Michigan of part of their rights in
an unwarranted manner, and is harmful to the
state as well as to the medical profession; it is
Resolved, By the Wajme County Medical So-
ciety, Michigan, that the Board of Regents of
the University of Michigan be asked to rescind
its ruling concerning the indiscriminate free med-
ical and surgical treatment of those who apply
for treatment at the University clinics, and
Resolved, That the Board of Regents of the
University of Michigan be asked to give a hear-
ing to representatives of the Wayne County Med-
ical Society.
W. J. Stapleton, Jr., Sec'y.
Meeting of the Surgical Section October 24, 1904.
Dr. P. M. Hickey Read a Paper on "Recent
Progress in Radiography."
The writer shows that in careful hands there is
no longer any danger to the patient of an X-Ray
.burn developing from diagnostic radiography.
There is, however, grave danger to the operator
from the accumulative effects of the ray. This
danger can be obviated by the inclosure of the
X-Ray tube in metal, or by the operator emplo>'-
ing a metal screen to protect himself.
The use of the diaphragms, particularly the
tubular variety, was pointed out, and a demon-
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COUNTY SOCIETIES.
Jour. M. S. M. S.
stration was given of the benefit of the new com-
pression diaphragm of Dr. Albers Schonberg.
This device marks a great advance in radio-
graphic technique. It secures the exclusion of the
vagrant rays, and compresses the part which at
the same time it immobilizes. The technique of
stereoscopic radiography was also demonstrated.
This procedure has been much simplified by the
introduction of the prism stereoscope of Cald-
well, which obviates the former clumsy stereo-
scope of Wheatstone.
In treatment the writer pointed out the bene-
fits to be derived from abandoning the use of
shields in the treatment of malignant diseases,
and also the better results which are to be ob-
tained in deep seated lesions by keeping the tar-
get of the tube 12 to 15 inches from the body.
The discussion was opened by H. H. Cook,
who spoke of the improvements in the construc-
tion of X-Ray coils and of the passing of the
static machines. At the recent meeting of the
American Roentgen Ray Association, held at St.
Louis, a coil was exhibited which the maker
dared not use for skiagraphic or therapeutic
work on account of the strength of the secondary
current generated. The importance of cutting off
the secondary rays is to be emphasized and this
is now partially accomplished by the use of a
sheet of lead at the back of the photographic
plate. The use of the compression diaphragm has
the one disadvantage of limiting the field but it is a
great advance, especially in the detection of renal
and ureteral calculi. In some kidney cases how-
ever, tenderness may, to a certain extent, limit
its usefulness. One great cause of trouble in the
standardization of exposure is the impossibility of
getting two tubes of equal penetration or the same
penetration at different times from the same tube.
A good tube is a luxury. Tubes vary greatly in
focus and one which is good for photographic
work may be very poor for therapeutic applica-
. tions. For the latter work, a year or so ago, the
tube distance employed was from 4 to 6 inches,
now, except in the treatment of superficial condi-
tions, a distance of from 12 to 15 inches is em-
ployed, thus avoiding the troublesome burns.
H. R. Vamey. Radiography is becoming
more and more a specialty, the rapid advances
being made prohibiting the general practitioner
from keeping in touch with the work. The great
bug-bear in therapeutic work is the regulation
of the dosage. The French have been able to
directly measure the rays themselves and so are
able to definitely fix the dosage. The coils
made in America are not equal to those
in use in England or on the continent,
where the -workers employ from 4 to 6 ampcrs
of current and obtain a radiograph of a hip in a
fraction of a minute. To do such rapid work
with the American coils, would require from 30
to 40 or more ampers. Roentgen ray treatment
of certain skin diseases has come to stay, al-
though the enthusiasm of a few years ago has
somewhat lulled. Certain of the ulcerating, de-
forming, skin conditions, such as lupus, can be
cured by the rays and by the rays alone.
W. E. Blodgett called attention to the fact
that the compression diaphragm exhibited by Dr.
Hickey is one of but three existing in the United
States.
O. W. Owen. I was formerly most en-
thusiastic in the treatment of epithelioma and car-
cinoma with the X-Rays but am now convinced
that most of it is a farce. I had one case of
carcinoma of the breast which entirely disap-
peared under the X-Ray. Seven months later the
patient died of cancer of the uterus. A man
cured of carcinoma of the jaw, died 16 weeks
later with cancer of the rectum. In fact I have
had case after case where an internal carcinoma
developed after a superficial cancer had been
cured. The results of the X-Ray treatment are
worse than those of the knife for the rays scatter
the disease. Certain syphilitic conditions and
lupus can be cured but cancer always returns.
P. M. Hickey. It may seem curious that the
vacuum in a tube which is hermetically sealed
can vary greatly from day to day but
this is due to the influence of the plat-
inum. There are a number of seH-regulating
tubes on the market, which though good at first,
soon become useless. Dr. Owen's experience
is certainly at variance with the observations of
a host of the most scientific, truthful and careful
men in this country and abroad. While the X-
Ray treatment is to a certain extent in the hands
of quacks and charlatans there are many eminent
men who are getting cures in superficial cancers.
Personally, I do not believe in the "scattering of
cancers" and I would not like to have the im-
pression go forth that such is the experience of
many workers along this line.
Benjamin R. Schenck,
Sec'y Surgical Section.
WEXFORD COUNTY.
At the annual meeting of the Wexford County
Medical Society held October 15, 1904, the follow-
ing officers were elected : President, J. F. Doudna,
Lake City; Vice-President, P. W. Pearsall, Kal-
kaska; Secretary- Treasurer, Otto Ricker, Cadil-
lac; Board of Directors, J. M. Wardell of Cadil-
lac, C. E. Miller of Cadillac, and David Ralston
of Cadillac. O. L. Ricker^ Sec'y.
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MISCELLANEOUS.
561
nDi0ceHaneou0.
NEWS ITEMS.
Dr. Hugh McColl was given by the members
of the Northeastern District and the Lapeer
County Medical Societies a beautiful silver lov-
ing cup. Dr. Mortimer Willson, of Port Huron,
who presented the cup said : I wish to show the
members a specimen. This is not an acute case
but a chronic one, that has been going on for
years. We have consulted all the physicians in
this part of the state and have agreed that it is
an affection of the heart, and they also have
agreed on a remedy, a silver loving cup to Dr.
McColl. Other speeches were itiade by Dr. Kay,
Dr. Jones, and Dr. Stewart. One face of cup
has engraved, "For the love of the man," and
another "Should auld acquaintance be forgot."
In Public Health Reports, September 30, 1904,
published by the U. S. Public Health and Marine
Hospital Service, is a full account of a scheme
for the encouragement of inoculation for the re-
striction of the plague in Bombay, India, set forth
in a letter signed by the chairman and secretary
of the Bombay Chamber of Commerce. Modified
to fit the conditions relative to vaccination for
the prevention of smallpox, it would be somewhat
as follows:. The principal is that a reward be
given to each person vaccinated who induces four
other persons to be vaccinated. For a very small
sum four coupons are issued to each person vac-
cinated; as soon as four other persons are vac-
cinated who present these four coupons, a reward
is paid to the person who originally purchased the
coupons. The reward paid is perhaps four times
as much as' was first received for the coupons.
Each of the four person* vaccinated receives a set
of four coupons, and the process thus continues
in a geometrical ratio to widen its sphere of in-
fluence.
An item has been going the rounds of the press
relative to the death of William Taylor, a child,
at Port Huron, alleging that "The parents believe
that his death was caused by vaccination." But
an official report to the Secretary of the State
Board of Health, clearly proves that the alleged
belief had no foundation in fact. The report says
that a short time after vaccination the child was
taken sick with bowel trouble and had no med-
ical attendance, the parents being "Christian
Scientists." After the death of the child, the
coroner called in a reputable physician and found
the vaccinated arm, aside from a small scar, was
exactly the same as the other, and showed no
sign of having been inflamed. The physician and
the coroner came to the conclusion that the child
had died of "entero-colitis"— inflammation of the
bowels. It appears that the parents belong to a
sect whose members do not believe in vaccina-
tion, nor in calling a physician, and undoubtedly
would have been pleased to have had the death
recorded as due to vaccination, especially as other-
wise there is a suspicion as to the effect of the
lack of proper medical attendance for the relief
of the inflammation of the bowels.
Dr. Mordecai Price died at his Philadelphia
home, October 29th, aged 60 years, of apoplexy.
He was one of the noted abdominal surgeons of
Philadelphia, and with his br9ther, Joseph, estab-
lished a hospital for the care of female surgical
diseases.
Arthur L. Holmes, of Detroit, was tendered a
dinner at the Detroit Club in honor of his return
from a European visit.
The fourth Pan-American Congress will be
held in Panama Jan. 2-6, 1905. Those desiring
to attend will do well to communicate with Dr.
Ramon Guiteras, 75 W. 65th St., New York, N.
Y. Those desiring can immediately thereafter at-
tend the meeting of the American Public Health
Association in Havana, Cuba.
On Sunday, October 23, more than a thousand
persons gathered in Powers* Theater, Chicago,
at a Memorial Service in honor of the late Dr.
N. S. Davis. The meeting was presided over by
Dr. Murphy, President of the Chicago Medical
Society. The principal speakers were Bishop
Spalding of Peoria, 111., and Bishop Merrill of
Chicago. A park has been named in his honor
at Chicago.
The death rate from typhoid fever in Chicago
is the lowest of any large city— presumably due to
the drainage canal, which kept the sewerage away
from the inlet pipes of the city water works. It
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MISCELLANEOUS.
Jour. M. S. M. S.
does not appear that St. Louis, Mo., has an in-
crease in typhoid fever. Hence the infectious
material must be destroyed en route between the
two cities.
Dr. F. H- Wiggin gives the following formula
for making a substitute for rubber gloves : Alco-
hol (96 per cent.) and ether each forty-nine and
one-half ounces; celloidinc one ounce; make a
>()lution and add castor oil one-half ounce.
The Medical Colleges of California report
largely increased classes with an unusually large
number from the east.
CHANGE IN MEMBERSHIP.
(Oct 15th to Nov. 15th.)
NEW MEMBERS.
C. D. Black, Lansing, Mich.
Wm. Blodget, Detroit, Mich.
A. brown, Grand Ledge, Mich.
G. H. Bunch, Kearsarge, Mich.
Dr. Bush, Jennings, Mich.
G. M. Duning, Lansing, Mich.
H. W. Hewitt, Detroit, Mich.
K. M. Morris, Gagetown, Mich.
G. W. Orr, Lake Linden^ Mich.
George Reid, Reese, Mich.
A. W. Truesdale, Shabtx>na, Mich.
CHANGE OF ADDRESS.
S. C. Burland, Chicago, 111.
D. G. Castell, Albion, Mich.
E. D. Gardner, Clarke, La.
C. J. Hobbs, Galesburg, Mich.
A. J. Howell, Deford, Mich.
G. V. Oill, Detroit, Mich.
F. T. Roach, Newport, Mich.
N. J. Robbins, Negaunee, Mich.
D. W. Roos, Benton Harbor, Mich.
Mary Wetmore, Lansing, Mich.
E. E. Bracey, Thompsonville, Mich.
A. Gasser, Hancock, Mich.
D. W. Wade, Holly, Mich.
BOOKS RECEIVED.