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SOCIETY P90CBEDIKG8.



OPERATIONS PERFORMED.



Urethrotomy, external

Stricture, dilated

(Castration

Nephrectomy

Nephrotomy

Floating kidney, sutured

Varicocele

Hematocele, decortication

Hydrocele

Fistula ani

Hemorrhoids

Wiring fractured patella

Abscess, opened

Cold abscess

Psoas abscess

Aspiration, pleuritic

Aspiration, knee-joint

Bmpyema, operation

Skin-grafting

Secondary suture

Iodoform injection in tuberculous joints ....
Injection toxic products of erysipelas, for sarcoma
Extirpation carbuncle



Total 189 146 18 . . I4 II



IS



^ociefy procee3.ingA.

MEDICAL SOCIETY OF THE COUNTY OF ERIE.

Annual Meeting, January 9, 1894-

Reported by ELI H. LONG, M. D., Secretary.

The annual meeting of the Medical Society of the County of Erie
was called to order by the President, Dr. John Parmenter, at
10.40 A. M.

The minutes of the last semi-annual and two special meetings
were read and approved.

The Membership Committee reported favorably upon the
following-named applicants for membership, and, upon motion,
they were unanimously elected : Drs. Albert T. Lytle, Ada C,
Latham, Harry Mead, Dewitt H. Sherman, Horace Clark, Charles
S. Jewett, A. W. Bayliss, Cyrus S. Siegfried, and Francis T.



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MEDICJLL SOCIETY OF THE COUNTY OP ERIE. 421

Metcalfe. The committee further reported that Franeis A. Drake
and Charles H. Perry had failed to exhibit their diplomas, there-
fore could not be reported upon at this meeting.

Applications for membership by the following-named physi-
cians were presented and, according to rule, were laid over until
the next regular meeting : William Meisburger, Maud J. Frye,
Ilelene J. C. Kuhlmann, Ludwig Schroeter, William Q. Taylor and
William C. Fritz.

Dr. Wm. Warren Potter moved to postpone the President's
address until after completion of the executive business. Adopted.

The Secretary moved that communications be now read.
Adopted.

Communications from the National Quarantine Committee and
of the New York Academy of Medicine, relating to the bill pro-
posing to establish a Bureau of Public Health, were read, and, in
addition, the Secretary reported that, upon suggestion by the same
t^mmittee, the President and Secretary had transmitted letters to
the members of Congress from this State and likewise to the Com-
tnittee on Epidemic Diseases of the United States Senate.

Dr. Hopkins moved that the action of the officers as reported
\)e endorsed. Adopted.

A further communication from the New York Academy of
Medicine, relating to the coroner question, was received and filed.

The resignations of Drs. S. W. and Mary Wetmore from mem-
bership, on account of removal from the county, were read and,
tipon motion, the same were accepted.

A communication from Dr. J. F. Krug, in reference to illegal
))ractitioners, was read.

Dr. Walsh moved that the communication be received with
shanks to Dr. Erug.

The Secretary moved to amend by adding that the communi-
cation be referred to the new Board of Censors. The motion as
amended was adopted.

At the suggestion of the President, miscellaneous business was
taken up at this time.

Dr. £. H. Long, chairman of the committee on revision of the
by-laws, then made the final report of the committee, which was
In form of printed proofs of the by-laws as recommended by the
tK>mmittee. The report was considered section by section, and a
few amendments thereto adopted. The chief amendment was



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422 8001BTY PBOCBBDINGS.

offered by Dr. W. W. Potter, and consisted of a section providing
for the appointment of a standing committee on hygiene. After
amendment, the report was adopted as a whole and declared to
be the by-laws of the society.

It was then moved that the Secretary be authorized to have
the by-laws printed and that a copy be sent to each member.
Adopted.

The Secretary asked whether, in the revised list of members,
the names of non-residents who were formerly members of the
society should appear. It was decided that only names of resi*
dents of the connty could properly appear, and the Secretary was
instructed accordingly.

The Secretary also asked what should be done with the resign
nation of Dr. Geo. H. McMichael from membership, which had
been presented at a previous meeting. Dr. Callanan moved that
the resignation be accepted. Carried.

Dr. J. S. Porter moved that a committee of three be appointed
to draft a bill to be presented to the Legislature, which shall
require every practising physician to qualify before the State
Board of Medical Examiners. Dr. B. G. Long moved to amend
by making it the duty of the committee to petition the Regents to
use all possible means at their command to regulate the practice
of medicine. The amendment was seconded by Dr. L. Howe, and
adopted. The motion as amended was then carried.

The Chair appointed as such committee : Drs. James S. Porter^
H. R. Hopkins and W. W. Potter.

The election of officers was then taken up.

Dr. Walsh moved that a committee of five be appointed to
nominate officers for the ensuing year. Carried.

The Chair appointed as such committee : Drs. H. E. Hayd^
Henry Lapp, B. G. Long, R. L. Banta and E. L. Frost.

After a conference the committee reported the following list
of nominees : President, Dr. Wm. H. Gail ; Vice-President, Dr^
F. W. Bartlett ; Secretary, Dr. Franklin C. Gram ; Assistant
Secretary, Dr. George F. Cott ; Treasurer, Dr. Edward Clark ;
Assistant Treasurer, Dr. Eugene Smith ; Librarian, Dr. Wm. C,
Callanan ; Committee on Membership, Drs. Jno. A. Pettit, Jas.
W. Putnam and G. W. MacPherson ; Censors, Drs. J.F. Krug, Jas^
S. Porter, J. H. Potter, Henry Lapp, A. L. Benedict ; Delegate to
Medical Society of the State of New York, to fill vacancy, Drt
John H. Pryor.



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MEDICAL SOCIEXr OP THE COUNTY OP ERIE. 423

The Secretary was directed to cast the ballot of the society
for the nomineesy and they were then declared elected.

The President then appointed the committee on Hygiene to
consist of Drs. H. R. Hopkins, Edward Clark, E. C. W. O'Brien,
W. W. Potter and W. D. Greene.

The President reported the library now available in one of the
alcoves of the library of the Uuiversity of Buffalo.

The Librarian's report for the year is as follows :

To the Medical Society of the County of Erie :

Up to the time of the removal of your library from the old college,
there were no applications to me for books. In accordance with the
desire of the society that the books should be available ; and with the
authority from the resolution passed at the last annual meeting, con>
stituting the President and Librarian a committee with power of selec-
tion and location, the committee moved the books to the new col-
lege. An alcove, nicely cased and shelved, was given for books, and
therein they have been placed. The services of the librarian of the
college library were given me, and she has arranged the books.

Owing to almost continuous absence from the city, and now per-
manent removal, I have been unable to catalogue the books, nor am I
able to report the degree of their use.

I wish to acknowledge the courtesy ot the college authorities, and
especially of the secretary and the librarian, and I thank them for the
same in this report to you.

I would suggest that the society empower its librarian to make
such arrangements with the college librarian as shall render the
books most available, as often members cannot afford time to hunt up
the librarian or go to his office.

I thank you for the honor conferred upon me in the election as
your librarian in the last two years.

Respectfully submitted,

CHARLES A. RING.

Librarian,

The Treasurer's annual report, showing a balance on
hand of $148.92, was then presented and referred to an audit-
ing committee, consisting of Drs. J. W. Putnam and B. Q. Long.

The Auditing Committee reported the Treasurer's accounts
correct, and they recommended that the Treasurer be instructed
to notify all members who are three years in arrears for dues, that
unless their dues are paid, their names will be dropped from the
membership list of the society.



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424 COBBESPONDBNCE.

The report of the Auditing Committee, including their recom-
mendation, was unanimously adopted.

The President's valedictory was then presented and read.

It was moved that the address be published in The Buffalo
Medical and Surgical Journal. Carried.

Dr. W. W. Potter moved that the Secretary and Treasurer be
each paid the sum of $50.00 for services during the past year.
Carried.

Dr. Callanan moved that the Board of Censors be authorized
to employ an attorney when necessary, but that the expense shall
not exceed |1 00.00 for one year. Carried.

The society adjourned at 1.10 p. m.



(^orreAporic^erice.



Letter from Mr, Lawson Tait. — JETe comments in detail on Dr. F,
Byron Robinson's paper in the December Journal, entitled^
^^What Kills After Laparotomy — Anesthetic^ Nephritis or
Infection ? " — He begins by protesting against the use of the
word laparatomy, — How he discovered that ether arrests the
•flow of urine, — Interesting history relating thereto. — English
practitioners and coroners'* inquests. — How chloroform and
ether kill. — " Ether mixture far better and safer than chXoro-
form.''^ — Reply to Dr. RobinsorCs question concerning infec-
tion deferred until another communication.

Sir — In the number of your valuable Journal for the current
month, I have just read an interesting paper by my friend and
former pupil, Dr. F. Byron Robinson, which requires a little
notice, for I think he is hardly fair to me, or to my brethren on
this side of the Atlantic, when he says that few of us engaged in
abdominal surgery give much attention to the kidney in their
work.

His paper has a most suggestive interrogatory title, " What
Kills Patients After Laparatomy — Anesthetic, Nephritis or Infec-
tion?" Dr. Robinson hardly answers his own question, nor does
he make quite clear his intention in asking it, but it is sufficient
for my present purpose that he does ask it, and that he does so
without that full information which I thought he possessed after



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C0BBE8P0NDBNCB. 425

bis long residence with me. I, therefore, desire to supplement
some of his remarks.

I need not stop again to protest against the continued use of
the word " laparatomy," which can be used properly for opera-
tions involving incisions made in the flank, and cannot be extended
to anything like an ordinary ovariotomy, and I therefore pass
at once to the question at issue, rejecting this objectionable
phrase.*

In order to place myself historically right, let me say that it is
now about twelve years since I made the discovery that the anes-
thetic ad ministration of ether in the human subject may — certainly
does, in some instances, — completely arrest the flow of urine during
its administration. The discovery was made by accident in a case
of great rarity, a uretero-uterine urinary fistula, where I failed
time after time because I missed the fistula. This was due to the
fact that I used ether and therefore thought I had closed the
aperture, when I had only temporarily arrested the flow of urine
at the very time when I most needed the guidance of its misdi-
rected current. I then used chloroform, closed the fistula properly
and cured the patient.

In operating on several bladder cases immediately after this
incident, I had opportunities of confirming the experience, and
these facts set me thinking. At that time a great enthusiasm had set
in for the use of ether, a prejudice had steadily grown against
ohloroform, and I had, unfortunately, been carried away with the
stream. But my new fact set me thinking, and my thoughts drove
me into a careful research of a number of fatal cases of operation
where no complications of the operation could account for the
deaths, but where the fatal results were found to be due to pulmon-
ary and renal lesions, some known to have been in existence before
the operation, others not suspected or not possible as antecedents.

I appealed to my friend and colleague, Dr. Robert Saundby,
now known as one of our greatest authorities on renal pathology
and then our acting pathologist, for assistance, and that was
promptly and abundantly given. He had known for years that
degenerative changes in the kidney were very commonly associated
with all abdominal tumors. Dr. Saundby and I had discussed the
fact often before 1878. I knew perfectly well that many operators
refused to undertake cases where the coarse test of the presence of
albumin in the urine seemed to indicate serious kidney disease.
But 1 had steadily set my face against ever refusing to operate on



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426 COBRBSPOND£NCB.

any case whatever, and, therefore, disregarded this apparently omi-
nous sign. The result was that I scored a great number of brilliant
successes in cases refused by men then at the head of my depart-
ment. But I met with equally disastrous failures in cases where I
could not see that anything was wrong with the operation and
where Dr. Saundby and, subsequently, Dr. Fozwell steadily
reported " kidney degeneration and pulmonary edema."

Then two cases occurred which put a great light* on the
whole thing, a light which ought to have been admitted before,
and would have been recognized long before, but for that most
unfortunate habit we adopt of moving restlessly about in streams
of fashion, giving to no proceeding and to no plan a systematic
and logical investigation. The cases were, briefly, these: A
young Irish girl came to me with an enormous ovarian tumor,
which had been tapped over and over again, the radical cure having
been refused to her by no less than five leading surgeons in Great
Britain alone. Her legs were so enormously swollen that no kind
of joint flexion was possible, and no vaginal examination could be
made, on account of vulvar edema. She passed only about twenty
ounces of urine in each twenty-four hours, and quite half of that
was albumin. According to our notions at that time, nothing
could be more unpromising, but I undertook the operation. On
thinking over the special conditions of the case, I remembered
Simpson's great belief in chloroform as a remedy for the extreme
conditions associated with albuminuria, especially the eclampsia
of the puerperal woman and the convulsions of post scarlatinal
nephritis. I determined to give this case chloroform, and she got
well without an interruption, the albuminuria disappearing as
rapidly as her convalescence. In three months she was a strong
and perfectly healthy woman.

The other case was that of a strong young woman of thirty,
with a rapidly growing soft edematous myoma. All her visceral
functions were healthy, so far as could be determined, before the
operation. I did hysterectomy, the patient being under the influ-
ence of ether. She passed very little and highly albuminous urine
after the operation, and she never drew an easy breath after she
came out of the anesthetic. Death occurred on the fourth day, and
post-mortem examination showed that she died of acute pulmonary
edema, that the kidneys were quite healthy, and that the ureters
were quite uninjured and far away as usual from the clamp wire.
(I had feared they would not be found to be so.)



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CORBBSPONDENCE. * 427

This was a lesson which coald not be misunderstood, and I
immediately published my experience, which received many
important confirmations, to the effect that ether had secondary
results of an extremely risky kind on the kidneys and on the lungs,
but the utterance made but very little impression. My experi^
ences were summarized and published, in 1884, in a paper entitled
"A Series of One Thousand Cases of Abdominal Sections," as fol-
lows, and I thought then, as I think now, that they were the most
important sentences I have ever published in my life :

The question of the best anesthetic for use in abdominal surgery is
one to which, of course, I have given a very large amount of attention »
and it is very singular that in the class of drugs, the action of which
there can be the least doubt about, we are, as yet, certainly very
unsettled in our views. Like all pupils of Simpson, I began my profes-
sional life with a most profound belief in the advantages of chloroform
over all other anesthetics. I have never seen an accident from chloro-
form, but, partly by reason of the fear of inquests and partly by the
example and teaching of Dr. Keith, a belief grew in my mind that ether
was preferable to chloroform, and at first I had the impression that
the sickness after ether was less marked than after the use of its rivals.
I was not, however, very long in discovering that ether has special
risks for people with a tendency to bronchitis ; and later on I discov-
covered, and have already published the fact, that during the adminis-
tration of ether the secretion of urine is completely arrested. It was
subsequently very forcibly impressed on me that, for patients with
damaged kidneys, ether is a dangerous anesthetic, and although I can-
not say that I have seen any fatal results arising from this peculiarity
t>f its action, I certainly have had abundant cause to fear it. My first
alteration, therefore, in my views concerning ether, was to limit its
application to patients under forty, but even after this I found my
confidence in its safety greatly diminished by the fatal occurrence of
bronchitis in a case of hysterectomy in a woman aged thirty. In this
case the patient's breathing was embarrassed from the moment she
recovered from the anesthetic, her urine was scanty and became ulti-
mately albuminous, and she died on the fourth day from suffocative
catarrh, the post-mortem showing* that, so far as the operation was
concerned, everything was perfectly satisfactory.

These utterances attracted very little attention, and my example
was very little followed, if at all. The reasons were two : First,
that crowds of experiments on animals had just been published, in
which it was proved that, so far as animals were concerned, ether
was a safe anesthetic and chloroform was not. Even if this con-
clusion were correct, and for many reasons I doubted, and still



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428 • COBBBSPONDBKCE.

doabt it, I urged the plea that what was true aboat animals need
not be, and was not, true about human beings, and that no animal
was known which suffered from chronic renal degeneration or
which died from acute pulmonary catarrh. Nobody would listen
to me, and my arguments were put down as those of a crank who
had strong views about experimenting on animals. My views on
this subject were entirely misrepresented, as they have been again,
and quite recently, by the editor of the British MediccU Journal,
I am content to leave the quasi-moral arguments alone, and I con-
fine myself to my own department, that of surgery, and I said
fourteen years ago what I say now, that, for surgical purposes,
experiments on animals are wholly untrustworthy and have been,
in very many instances, grossly misleading. I have never said
anything more, and no amount of bullying or ridicule will
make me say anything less. So much for the first reason of the
neglect with which my utterances on anesthetics were received.
My only comfort is that, last year, I induced the Council of
the British Medical Association to exclude from their offi-
cially conducted research on anesthetics all experiments on
animals.

The second reason was a stronger one. England is emphati-
cally the land of coroner's inquests ; and, considering also it is
the land which has established the freest and yet most responsible
system of jurisprudence the world has yet seen, its people stand
an amount of nonsense from coroners and their juries which is
most astonishing.

The thing which an English practitioner hates above every-
thing is a coroner's inquest upon any incident in which the con-
duct of his own practice is concerned may be called in question.
Coroners seem always fond of making public inquiry into cases
of death under an anesthetic, as there seems to be ingrained in
the public mind, from the ridiculous misrepresentations they see
on the stage and read of in novels, that anesthetics may be used
for purposes of rape and robbery. Every such death is, therefore,
blazoned abroad until the use of chloroform has become a bite
noire of surgical practice alike for practitioner and patients.
Chloroform, when it kills, which it does very rarely, kills on the
instant, and, in England, there is an inquest. When ether kills,
which it does far more frequently, it kills some days after its
administration, and there is no inquest, not even an inquiry. In
Scotland there are no coroners and no inquests, and as it is uni-



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CORBBSPONDBNCB. 429

versally known and believed there that chloroform is far safer and
better than ether, the former is used and the latter is not.

To get over the difficulty, I began to use a mixture, and soon
found that it was a great advance over either of the two anes-
thetics used separately. I vary the proportions according to age,
increasing the proportion of chloroform from one-third to two-
thirds rapidly after forty, and in case there is any suspicion of renal
or pulmonary incompetency.

Twelve years' experience has driven entirely out of my practice
all those disasters which ether brought into it. In a number of
administrations, now amounting to a great many thousands, not a
mistake has occurred, and alarms occur only where some new and
inexperienced administrator will indulge in such fantastic tricks
as pushing back the tongue by pressing up the jaw. or violating in
some other foolish way the simple rules for administration laid
down over forty years ago by Simpson, not one of whose methods
has yet been surpassed.

I have also this advantage, that when compelled to operate with
the assistance of some practitioner in the country, whose opportuni-
ties of administering an anesthetic are few and far between, I hand
him my anesthetic, with the usual remark that it is an ether mixture;
he goes to his work with confidence devoid of fear. If I told him
that it was chloroform, his hair would stand on end, he would
think of nothing but an inquest all the time, and I should never
have the patient properly under from beginning to end of the
operation. In fact, I should have all the elements of danger, as
Simpson lays them down, arrayed against me.

Further, in discussing details of an operation with women
patients, half of them want to know if they must take chloroform,
because they are sure their hearts won't stand, and they have been
told this, that and the other. '< Ether mixture, far better and
safer than chloroform," settles the question and calms their morbid
imaginations.

Perhaps you will permit me, in another letter, to reply to the
third part of Dr. Byron Robinson's question concerning infection.
Meantime, accept my assurances of respect and believe me, yours
sincerely,

LAWSON TAIT.

The Crescent, Birmingham, Eng., December 9, 1893.



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430 EDITORIAL.

BUFFALO MEDICAL AND SURGICAL JOURNAL

A MONTHLY REVIEW OF MEDICINE AND SURGERY.

EDITORS:
THOMAS LOTHEOP, M. D. - - WM. WARREN POTTER, M. D.

All oommunioations, whether of a literary or business oharaoter, should be addressed
to the managing editor: 384 Fbankliit Strbkt, Buwwajm, K. Y.

Vol. XXXIII. FEBRUARY, 1894. No. 7.

SYMPHYSEOTOMY.

The revival within the past two years of this operation has
marked an era in the obstetrical world. The operation was
originally proposed in 1768 by Sigaalt, then a medical student in
Paris. As is well known, it consists in a division of the sym-
physis pubis, with a view of allowing the pubic bones to separate
sufficiently to admit of the passage of the child. According to
Play fair, in 1778, the operation was performed thirteen times in
Germany, France and Belgium ; but once only in England, in
1782. It then gradually fell into disfavor, and finally became
practically obsolete. In 1863, however, Morisani, of Naples,
studied the operation on a dead subject, and three years later he
operated on a living woman, saving both mother and child.

We have said that the operation has been revived within the
past two years, for it is only within that time that it has come to
be recognized in America as having a substantial basis. It is
true, however, that it had been performed between January 1,



Online LibraryJ. A. (Joel Asaph) AllenBuffalo medical journal → online text (page 43 of 78)