SECOND SCIENTIFIC SESSION, PITTSBURGH, PA.
DECEMBER 27-28. 1917
JOSEPH H. BYRNE
EDWARD E. CORNWALL
Published for the Congress by the Burr Printing House, New York
Nineteen Hundred and Eighteen
Glentworth R. Butler, President, Brooklyn, N. Y.
Elias H. Bartley, Vice-President, Brooklyn, N. Y.
*Heinrich Stern, Secretary-General, New York, N. Y.
Joseph 11. Byrne, Assistant Secretary-General, New York, N. Y.
Augustus Caille, Treasurer, New York, N. Y.
Charles D. Aaron, Detroit, Mich., 1921.
James M. Anders, Philadelphia, Pa., 1919.
Noble P. Barnes, Washington, D. C, 1921.
Henry Wald Bettmann, Cincinnati, Ohio, 1918.
Louis Faugeres Bishop, New York, N. Y., 1920
Harlow Brooks, New York, N. Y., 1919.
Joseph H. Byrne, New York, N. Y., 1920.
Edward E. Cornwall, Brooklyn, N. Y., 1920.
Judson Daland, Philadelphia, Pa., 1921.
Britton D. Evans, Morristown, N. J., 1921.
Henry A. Fairbairn, Brooklyn, N. Y., 1918.
Charles Lyman Greene, St. Paul, Minn., 1918.
John C. Hemmeter, Baltimore, Md., 1919.
Clement R. Jones, Pittsburgh, Pa., 1918.
John A. Lichty, Pittsburgh, Pa., 1919.
William H. Mercur, Pittsburgh, Pa., 1922.
Francis M. Pottenger Monrovia, Cal., 1921.
Thomas M. Reilly, New York, N. Y., 1920.
Charles E. de M. Sajous, Philadelphia, Pa., 1922.
Thomas E. Satterthwaite, New York, N. Y., 1922.
William H. Stewart, New York, N. Y., 1920.
Frederick Tice, Chicago, 111., 1918.
Henry Enos Tuley, Louisville, Ky., 1922.
Joshua M. Van Cott, Brooklyn, N. Y., 1919.
Reynold Webb Wilcox, New York, N. Y., 1922.
Officers, 1917-1918 3
Councillors, 1917-1918 3
Address of Welcome, by John A. Lichty 7
Response to Address of Welcome, by Thomas F. Reilly 8
Address of the Vice-President, by E. H. Bartley 9
Address of the Secretary-General, by Heinrich Stern 14
Report of the Treasurer, by Augustus Caille 15
Report of Deaths of Members, by E. E. Cornwall 16
Election of Officers 16
Roentgenology and the Internist, by C. D. Aaron 17
Roentgen Diagnosis of Diseases of the Chest, by G. C. John-
A Resume of Roentgen Findings in Abdominal Pathology, by
W. A. Evans 33
The Value and Limitations of Radiotherapy in Internal Medi-
cine, by R. H. Boggs 45
Communicable Diseases Among Soldiers, by W. H. Parks'. ... 56
Some Problems of Cardiovascular Disease, by E. E. Cornwall. . 65
The Role of Infection in the Production of "So-called Perni-
cious" Anemia, by Frank Smithies 71
Discussion of Papers of Drs. Cornwall and Smithies, by Drs.
Wilcox, Field, Tice. Barr, Barach, Caille, Ives, Stern,
Friedman, Mercur, Haythorn, Smithies 88
Obituary Notice of Heinrich Stern 101
Constitution and By-Laws 103
List of Members 107
THE AMERICAN CONGRESS ON INTERNAL MEDICINE,
SECOND SCIENTIFIC SESSION
DECEMBER 27 and 28, 1917,
HOTEL WILLIAM PEXX, PITTSBURGH, PA.
The Congress was called to order at 11 A. M., December 27, 1917,
by the President, Dr. Reynold Webb Wilcox.
The President called on Dr. John A. Lichty to welcome the mem-
Dr. Lichty : Mr. President ; Members of the American Congress
on Internal Medicine and Respected Guests: In behalf of the medi-
cal profession of the city of Pittsburgh I greet you.
We are conscious of the honor conferred upon us by the presence
of the distinguished members of the American Congress on Internal
Medicine. It would be a pleasure to me to recount the aims and
accomplishments of the congress, as well as to speak of our obliga-
tions to those of its members who have done pioneer and advanced
work in internal medicine, but I will leave that to be spoken of by
others, and shall devote my few allotted moments to introduce to
you things medical, which are characteristic of the great city to
which you have come.
Th city of Pittsburgh may well be called the industrial center of
the world. The present great world crisis has only emphasized this
the more. Its mills and manufactories are well known. It is an
inland town, but its river harbors receive, and send out vessels
whose tonnage is equal to that of London and Liverpool combined.
To us this is a well-worn, but agreeable expression, and while it may
not at present stand the statistical test, it at least, as Mark Twain
says, "sounds well." The city is centrally located. Someone, I
do not know whether he is a member of the National Geographical
Society, or only a statistician of a large insurance company, has
said that Pittsburgh was only a night's ride from all the great cities
of the United States. The railways and waterways have made its
transportation facilities unsurpassed. With such resources and
8 THE AMERICAN CONGRESS ON INTERNAL MEDICINE
facilities this city, with its surrounding community, has become a
veritable workshop for the whole world. The relation of the medi-
cal profession to such an important geographical and industrial
center has, up to the present time, been largely one of surgical
repair, and the city, as a result, can boast of an amount and quality
of surgery which can scarcely be surpassed in any other city of
the world. It would be a pleasure to recount the names of men
who have made themselves famous here in the practice of surgery
during the past fifty years. It would include such men as Walters,
known for his conservative surgery ; Sutton, known for his early
introduction of the principles set forth by Lister and Pasteur and
Lawson Tait ; the McCanns ; the Dixons ; and the brilliant, beloved
and lamented Stewart.
While internal medicine has, in a way, kept pace with surgery,
it is only recently that it has come into its own, as in preventive
medicine, as well as in other well recognized activites. Pittsburgh
formerly had the highest incidence and mortality of any city in the
United States in typhoid fever. Through the direction of the late
Eugene Matson, bacteriologist and director of the department of
public health, the city has laid unsurpassed filtering beds so that
the water of the city is now clean and typhoid has been entirely
The laboratories of the city are now directed toward the preven-
tion of diseases which are likely to occur in the industries which are
here represented. Internal medicine has given valuable assistance
in the elimination of the smoke nuisance. Diseases of the lungs in
relation to smoke and soot have been particularly studied in the
laboratories of the University of Pittsburgh School of Medicine,
and in many other ways internal medicine has set about to bring
to pass a prevention of diseases, accidents and calamities which
have heretofore prevailed in our community.
The internists of the city, as well as the profession at large,
appreciate the benefits which may accrue from the meeting of such
a body as the Congress on Internal Medicine represents, and I
again, in their behalf, welcome you.
Dr. Thomas F. Reilly, in responding to the address of welcome:
Gentlemen and Members of the Congress: We are all glad to be
here. Three or four months ago it was feared that we would not
be able to meet here, as the conditions that the war has brought
about have made it necessary for many learned societies to close
THE AMERICAN CONGRESS OX EXTERNAL MEDICINE 9
their doors, and therefore, they were not ahle to assemble here.
Our president was on service in the United States army, and mat-
ters had gone so far that we were even warned by Dr. Richards that
men had better stay at home and help to conserve matters by so
doing. We were also warned by the Pennsylvania Railroad that we
had better stay at home, and they refused to sell us return tickets.
However, in spite of all this discouragement, we felt that this meet-
ing was a necessity and that the men who are willing to go to all
the expense and trouble that is entailed by travel in these times,
are earnest in their desire to attend the meeting. We are glad to
be in Pittsburgh, to show you that our interests are not parochial;
that these meetings belong to the East and to the West. Every soci-
ety that moves out West moves toward progress. (xA.pplause.)
Every progressive movement lies toward the West, The very spirit
of terrestrial magnetism that is in evidence in this place, the fact
that we are surrounded by so much iron and steel must have a
physical effect, and therefore, indirectly, a mental effect, upon us.
Dr. Lichty has pointed out that Pittsburgh is a suburb of Philadel-
phia, so far as scientific matters are concerned. There are numer-
ous large foundations developing, in scientific matters, so that
Pittsburgh is awakening to new scientific life. The names of
Lichty, Mercur, and Johnston are evidences of this. They have
made the name of Pittsburgh in connection with science, a house-
It is said that there are three classes of millionaires — millionaires,
multi-millionaires and Pittsburgh millionaires. I feel sure from my
study of matters in this city that one may say there are three classes
of internists — internists, great internists and Pittsburgh internists.
The President : Last spring, when I was ordered on duty as an
officer in the United States Army, I feared that it would be impos-
sible for me to come to the meeting. I asked the vice-president,
Dr. Bartley, to prepare a presidential address for you. Fortunately,
I am able to be with you to-day. However, Dr. Bartley has pro-
vided for you a much better address than I could have done.
By DR. E. H. BARTLEY
Gentlemen and Members of the Congress: At the opening of this,
the second meeting of the Congress of Internal Medicine, I con-
10 THE AMERICAN CONGRESS ON INTERNAL MEDICINE
gratulate you on the evidences that we are to have an interesting
and instructive session. We miss the faces of many we had ex-
pected to have with us to-day. We cannot refrain from expressing
a feeling of sadness for the occasion which has called away thou-
sands of our hrehren to the colors in the national defense. Not
only the young and ambitious but those of reputation and years of
experience of which the Congress is largely composed have gone to
help to win this war. That this comparatively young organization
must be affected by their absence was to be expected. It was to be
expected that the attendance would be decreased, and your council
seriously considered whether it might not be advisable to omit hold-
ing the congress this year. We hope you will agree with us that it
was best to carry out the program in spite of the danger of the
diminished attendance and the loss of enthusiasm born of numbers.
One of the greatest incentives to the life of a society is new
members. The membership of this Congress is large and it should
be larger. It has increased about one hundred since the last meeting.
It should be doubled during the next year, and it can be if the
fellows will all do their part. Any qualified physician engaged in
the practice of internal medicine, or in laboratory research pertain-
ing to it, may be proposed for fellowship, which proposal should
be made in writing to the council through its secretary. It is very
their doors, and therefore, they were not able to assemble here,
desirable that the fellows should be careful, in proposing candidates,
to select physicians in their localities whose reputation and char-
acter are above reproach. We could easily double our membership
by circularizing the medical profession of the country, but this is
not desirable as many would respond who might be undesirable, or
who would be unknown to the council, and they would have no
means of intelligent selection of the proper ones. The council must
depend largely upon the good judgment of the fellows for the selec-
tion of the names of the physicians of their own locality. If this
plan is carried out the congress will be composed of selected repre-
sentative physicians from every locality ; a fellowship of which we
shall be proud, because it will include the best purely medical prac-
titioners of the country. This will make this congress distinctively
a body of physicians engaged in the practice of internal medicine, or
the investigation of internal pathological conditions. I would urge
upon every fellow to use his best endeavor to help make this con-
gress a great organization by securing as candidates for fellowship,
the best physicians of his acquaintance. We must select with even
THE AM URIC. IX CONGRESS ON INTERNAL MEDICINE 11
greater care those fellows of this congress whom we propose for
fellowship in the college. This is a distinction and an honor which
should only he bestowed for some notable contribution to the prog-
ress of internal medicine, or to the public good.
It will then mean that the holder of this certificate has done
something to warrant distinction, and we believe this will stimulate
others to do something for the advancement of scientific medi-
To a very great extent the progress of scientific medicine, except
that connected, either directly or indirectly, with military medicine
or surgery, is at a stand still, throughout the world, because of the
war. Everywhere the hospitals and the laboratories have been
hampered by the loss of members of the trained staff. Internes are
scarce and difficult to obtain, and much of their work is being done
by students not yet graduated. There are many of us who because
of age and other unavoidable circumstances could not go to the
front, and not a few who from the character of their training
should not go, must do their bit at home among the civilians ; not
less loyal, not less willing to serve their country in spheres no less
useful, in hospitals, assisting in the work of the draft boards, or in
the homes of their several communities. The aims and objects of
our organization, so ably set forth in the president's address of a
year ago, and which you have had time to read and digest, have not
changed nor will they change with the changing times. As the man-
hood of the world is being so heavily drawn upon by the war, the
attention of the medical profession should be turned to the supreme
importance of the conservation of the health and life of the people
left at home.
The lessons of the selective draft have impressed upon us the
necessity of working for the betterment of the race. The statistics
of some of the local boards who have been examining recruits for
the army and the navy, show that as high as sixty per cent., or
more, of the men who came before them were unfit for the service,
according to the standards set. This was a surprise to most of us
and should be a cause of concern for the future of American man-
hood and womanhood. When there is added to this large percen-
tage of physically unfit, the maimed and shattered remnants of these
young men we are now selecting to send over the seas, new and
serious problems must be met. To those of us who remain in civil
life these problems should appeal with great force. These lessons
of the war, or more properly, the preparation for war, must come
12 THE AMERICAN CONGRESS ON INTERNAL MEDICINE
home to us, and they should be met as part of our duty to the
There is already a great field for the medical profession in efforts
to correct the defects in those who have been found physically unfit,
so far as these defects may be remedial, and more especially per-
haps, in those who will soon become liable to call, by reason of age.
Physical defects are more easily corrected in early life than at draft
age. It should not be a matter of pride, that, owing to the laxity
of the medical profession in their efforts to correct the physical
defects of children, the boards of health and education have been
compelled to take the matter up as a function of the state, or of
public health. Much is being done in this line by the medical inspec-
tion of schools, and by the periodical examination of the employees
of large establishments and of city employees. It is a hopeful sign
that this matter is being taken up by labor organizations. It cannot
he gainsaid that the medical profession has been remiss in not
taking the initiative in this line of preventive medicine. They have
generally left it to the boards of health, or to life institutes or in-
Is it not an opportune time and the duty of such bodies as this,
and similar organizations of representative physicians, to undertake
some concerted action looking toward the physical improvement of
the masses of the people? The time is, or ought to be, that the
practice of medicine should not be confined to the diagnosis and
treatment of the diseases of the acutely ill, but should include all
measures for the betterment of the race; certainly to the careful
supervision of the health, development and defects of the young of
pre-school age, before they come under the supervision of the school
authorities. It has been stated by competent authorities that there are
in the public schools of Xew York City more than 20,000 children
suffering with serious heart lesions. It must be admitted that many
of these if properly handled before the age of six years, may be
converted from serious into at least benign conditions. As ex-
amples of other remedial conditions met with in early life, we may
mention the various focal infections; of the middle ear, tonsils,
nasal sinuses, teeth, and intestine; defective nutrition, defective
growth, deformities, defective or abnormal endocrinous glands,
tuberculous infection and lues. It is the general practitioner and
the internist, not the specialist who must primarily either deal with
these conditions or be responsible for their neglect. Every internist
has these physically defective children brought to him for consulta-
THE AMERICAN CONGRESS ON INTERNAL MEDICINE 13
tion and he cannot entirely shift the responsibility upon the pedi-
The most vulnerable age is the pre-school age. Most of the
tubercular-infections and many of the organic heart diseases begin at
this time. It is at this age that those nutritional defects begin which
are apt to continue to later years and affect the efficiency of the
future man or woman. In this connection, there is no more im-
portant held of investigation than that which is claiming the atten-
tion of some biological chemists to-day, relating to the study of the
effects of different foodstuffs on the development and growth of
animals. There is a great need of a better understanding of the
principles and practice of feeding the young, so as to promote
growth and development to the best advantage. We have not
developed the art of feeding the human animal to the extent that
the agriculturalist has that of feeding farm animals. What we have
already learned from recently conducted feeding experiments has
given us an explanation of the etiology of a number of diseases,
now known as deficiency diseases, such as scurvy, berri berri, pel-
lagra, etc. We have reason to hope that this line of inquiry will
teach us how we may overcome the handicap of a poor heredity by
proper application of the principles of feeding, with perhaps, the
discovery of an active principle promoting growth which can be
added to the ordinary diet. Some efforts have been made to find
such substance, with very limited success, in the internal glands.
Investigations made by the New York Board of Health show that
from eight to twelve per cent, of the children in the schools of that
city suffer from such a degree of malnutrition as to need supervision,
in their opinion. This represents about 125,000 school children in
that city whose nutrition needs supervision. That this is not due
entirely to the high cost of living is shown by the fact that the
figures are higher for 1916 than for 1917. Many of these children
will grow up to inefficient men and women. The hope for the
citizenship of the future of this country is not in the children of
the educated and wealthy classes, for they are not prolific in the
production of their kind. It is the children of the so-called labor-
ing classes, and the ignorant foreign-born parents who fill our public
schools ; or those who are least able to appreciate these facts and
their importance. It is these children who will make up the majority
of the future men and women of America. Whether they maintain
the traditions of the past will depend upon how well the medical
profession, the schools and churches do their patriotic duty by them.
14 THE AMERICAN CONGRESS ON INTERNAL MEDICINE
This war has made this country the dominant nation of the world.
When this crisis is past, we must be ready to meet the great indus-
trial war that is to follow. Europe will look to this country for
men and material resources to help them to reconstruct and rehabili-
tate their countries. Shall we be equal to the task? I believe we
shall, but it will depend upon the energy and efficiency of our
people, east, west, north and south. Efficiency depends on good
health. Unless this war should terminate very soon, there will be
a new and very great task imposed upon the medical profession of
this country, in the reconstruction of the men returning to us from
the trenches. These will require the neurologist and internist as
well as the orthopedist. There is a great work ahead of us, and
much of it will be unremunerative, and which we shall accept as a
national duty. We cannot afford to be regarded as slackers in this
duty. We have only words of praise for those of our profession
who have so nobly and with great personal sacrifice, enlisted in the
national service. The loyalty of those who remain at home is under
observation and on trial.
Dr. R. W. Wilcox : The problem of the organization of a soci-
ety of internists has been an important one to the medical profession.
There is one member of this society who thought of this and
planned it. and worked day and night toward its organization, for
years before this society was born. You all know him, gentlemen ;
I am sure that I need not make any further comment in regard to
the work of our secretary-general.
ADDRESS OF THE SECRETARY-GENERAL,
By DR. HEIXRICH STERN
New York City
Gentlemen: I came here to-day to show my interest in the society
as I think it is necessary to push the organization along this year.
I was told that there would not be a meeting, but I insisted upon
it, although the men who were on the committee were in some trepi-
dation. They said that the Pennsylvania Railroad would not sell
return tickets and asked me to call the arrangements off. However,
I feel that the meeting is necessary at this time ; we are only begin-
ning to be involved in the war, and next year we may be much more
deeply in, and we physicians have to be prepared to see it through.
THE AMERICAN CONGRESS ON INTERNAL MEDICINE 15
This year it might appear that we had not done much, but the
council has had ten meetings. We have added to our list 125 to 130
new members, and 1 feel that that is very encouraging for a new
organization. We muster about 450 members now. That, of itself,
shows that the congress on internal medicine was a necessity. The
work last year was largely left to individuals, and I may say that
Drs. Pottinger and Aaron did the hulk of the work in getting mem-
bers for our organization. Dr. Pottinger is a horn agitator. He
has seen a great number of people, and we have not had to advertise
as the College of Surgeons has. Dr. Aaron has made great per-
sonal efforts and has got us the best men of the profession.
During the year, the secretary has taken upon himself to publish
the transactions. Dr. Cornwall has rendered the most loyal and
effective assistance, and thanks are due to him, more than to me, for
the results. If there are any special questions that anyone wishes
to put to the secretary, in regard to either the American Congress on
Internal Medicine or the American College of Physicians, I shall
be more than glad to answer them.
Dr. R. W. Wilcox: Judging from the work of the committee on
arrangements, it is not a matter of great importance that we could
not get return tickets. We appreciate the hospitality of Pittsburgh,
and we are ready to stay here. We will now listen to the report
of the treasurer.
REPORT OF THE TREASURER
Dr. A. Caille: The treasurer would like to add a remark on
the reading of his report. During the first months of organizing a
new society, the expenses are enormous, compared with what will