Medical Society of the State of North Carolina. An.

Transactions of the Medical Society of the State of North Carolina [serial] (Volume 62 (1915)) online

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county medical society, only perhaps in name. In these good days of
ours all kinds and classes of people have their organizations; the cap-
tains of industry and their laborers, the merchants and their clerks, the
laundrymen, the farmers, the manufacturers, the contractors, the car-
penters, the painters, brickmasons, and hod-carriers, the railroad mag-
nates, their conductors, engineers, firemen, flagmen, section foremen, and
laborers, and on and on through every activity of life from the top to
the bottom. These people profit by their organizations. Then why
should not we ? But the time is long since when argument were needed
to show the importance, the need, the value of the county medical society
in North Carolina. If it were, I would refer you to that comprehensive,
logical, learned, ornate, eloquent discussion of this subject by Dr. E. C.
Register in his president's address before the Tri-State Medical Asso-
ciation this year, and to the address of my immediate predecessor. Dr.
J. M. Parrott, than Avhieli there is none more able and none more con-
structive. But the deplorable fact remains that a large percentage of
the counties of this State have a medical society in name only and not
in fact. There are notable exceptions, however. Perhaps there is no
better medical society in this or any other State than the Buncombe
County Medical Society. It excels in everything that a county medical
society should be in North Carolina. Mecklenburg County Medical
Society is doing splendid work. In addition to their regular society



24 NORTH CAROLINA MEDICAL SOCIETY.

work, they arranged a meeting this year at which Dr. Lewellyn F. Barker
of Baltimore was their guest, and, true to the Mecklenburg spirit, they
allowed any physician who would, in this and adjoining States, to share
their pleasure with them. This society, too, is magnifying the district
meetings by arranging once a year a clinical session for their district
medical society. As an example of what a small county medical society
can do, I would present to you the work now being done by the Hender-
son-Polk Medical Society. At this time they are meeting weekly, per-
haps the only county medical society in the State that is holding weekly
meetings. The Buncombe County Medical Society, when your president
had the honor to serve as its president, changed from monthly to weekly
meetings, which was later changed to semimonthly meetings and which
so continues. And the Henderson-Polk Society at these weekly meetings
has for the principal feature "A Case Study." The complete history of
four cases is sent to them each week by Dr. Cabot of Boston. They take
up the family history, personal history, physical examination, symptoms,
laboratory findings, in order. From these each member makes a diag-
nosis, which latter is compared with the diagnosis of the hospital, of
Dr. Cabot, and lastly with the post-mortem findings. A discussion and
criticism of the treatment would close the case. There is no county
medical society in this State too small to carry out such a splendid
scheme of work as this.

Our district medical societies can be made of great value if the mem-
bership in each district so wills. I have already referred to the splendid
clinical meetings of the Seventh District at Charlotte. As an example
of what a district medical society ought to be, the Fourth District Medi-
cal Society is a conspicuous example. You all know the executive ability
and leadership of the one man who more than any other has made this
splendid district medical society possible. The Fifth District is well
organized, has two interesting meetings each year, one of these being held
at the Sanatorium as guests of the institution, where a clinic in some
special feature of tuberculosis work is given. At its winter meeting this
year this society had as its guest Dr. W. L. Rodman, president of the
American Medical Association. What these societies are doing others
can do. Some of the other societies are doing good work; others are
doing little, and a few making no attempt to hold meetings.

The greatest opportunity the medical profession of North Carolina
has ever had is now within its grasp. With the splendid foundations,
deep and wide and lasting, for public health work laid by the lamented
Wood and O'Hagan, broadened and deepened and strengthened by our
own Thomas and Lewis, and now builded upon yet by Lewis and by



OPENING EXERCISES. 25

Way and Laughinghouse, Wood the younger, and the others ; Avith Ran-
kin for the architect and contractor, who shall say that N'orth Carolina
shall not sit at the head of the table in her public health work — that she
will not soon be the vanguard in the fight against unnecessaiy disease
and needless death ? In fact, she now is.

With this splendid beginning — for it is only a beginning — fostered by
the intelligent, conscientious statesmen who form our general assemblies,
and given the whole-hearted support of this Medical Society individually
and collectively, and the cooperation of the people of our State, the
kernel, the acorn planted years ago will rear its stately head high to-
Avard the heavens, a majestic oak, and its strong branches will extend
from east to west and from north to south and give shelter and protection
from communicable diseases to eA^ery citizen, every man, Avoman, and
child AA'lio has the honor to live AA'ithin the borders of our grand old
State, and likewise to the stranger that is within our gates.

The killing of 1,500 people in JSTorth Carolina every year by typhoid
fever or in three months by tuberculosis is not so spectacular as the sink-
ing of the Titanic by an iceberg or the Lusitania by a German sub-
marine ; but they are just as dead when they die in North Carolina from
preventable disease as are those who went down to a Avatery grave in
mid-ocean on these ill-fated vessels, e'en though death comes like a thief
in the night, without beating of drums or waving of flags.

Saving a human life by the prevention of disease is not so spectacular
as opening the abdomen and relieving a volvulus or removing a gan-
grenous appendix or doing a Csesarean section, but the life saved is just
as precious. And the opportunity for saving human lives by the pre-
vention of disease is many thousand times greater than by the surgeon's
knife.

What is a miracle? In ancient times, in the times of the Bible, it
was healing the leper, making the lame to Avalk, restoring sight to the
blind, raising the dead. In modern times, in the times of Jenner and
Koch and Behring and Flexner and Lazear and Gorgas and Rankin and
the others, it is curing and preventing tuberculosis, including tuberculous
disease of the bones and joints, which is the leprosy of our day; it is
curing and preventing poliomyelitis and cerebrospinal meningitis; it is
preventing blindness in infants caused by the gonococcus ; it is prevent-
ing the death of thousands of helpless, innocent children from diph-
theria ; it is the prevention of thousands of deaths from typhoid; it is the
prevention of hundreds of thousands of deaths from tuberculosis.

It is said that in the career of John Kepler, the great astronomer,
when he discovered the laAvs of planetary motion, he Avas found in his



26 NORTH CAROLINA MEDICAL SOCIETY.

study, exulting in his triumph, and with tears of joy streaming down
his face, he was heard to exclaim: ''I think Thy thoughts after Thee,
O God !" And -when I think of these modern miracles that we are able
to perform, I feel like paraphrasing the immortal words of John Kepler
and crying : "I do Thy works after Thee, God !"

Dr. C. O'H. Laughinghouse : I move that this splendid message of
our president he referred to a special committee for consideration.

Dr. J. M. Parrott : I second Dr. Laughinghouse's motion with great
pleasure, and take the liberty of suggesting that it be amended by naming
Dr. Laughinghouse, Dr. J. Howell Way, and Dr. K. P. B. Bonner as the
committee.

This motion was carried as amended.

COKKESPONDENCE RELATIVE TO PILE OF
TRANSACTIONS.

Washington, D. C, June 11, 1915.
Dr. L. B. McBeayer, President,

The Medical Society of the State of North Carolina,
Sanatorium,, N. C.

Dear Dr. McBeayer : — The records of your society have been sent to Greens-
boro for presentation next week. Credit is due Dr. Ferrell.

It would give me distinct pleasure to be present. I recall a meeting of the
society in that beautiful city. I was a guest of your former president, Dr.
James K. Hall ; met a beautiful daughter of Judge R. P. Dick ; and young at
the time, was designated among the delegates to represent you in the Ameri-
can Medical Association.

I would have been glad, also, to have some of the Washington physicians
visit with me, to observe the character of the very superior work which your
recent transactions show is being done by North Carolina doctors.

You meet in Greensboro to elevate medical science; infuse medical enthu-
siasm ; build up medical literature ; awaken interest in better sanitation ; form
new and i-enew old friendships ; and, above all, for the prevention of preventa-
ble diseases. And with these laudable objects in view, well may your mission
and your presence pave your cordial welcome to the homes and hearts of the
best citizenship in Greensboro, who feel an interest in the medical welfare of
the State or whose bosoms swell with the generous emotions of social enjoy-
ment and State pride.

I recall Drs. Satchwell and Summerell, Thomas and Tayloe, Winborne and
Wood, Pittman and Patterson, Bellamy and Battle, O'Hagan and Hines. Payne
and Pierce, Ashe and Alexander, Johnson and Jones, Whitehead and Faison,
the Haywoods and Hills, McKees and Duffys, Dr. James K. Hall and others
of the State's foremost physicians, patriots, philanthropists, and philosophers
who "have passed to silence and pathetic dust."



OPENING EXERCISES. 27

The labor of love in a simple recitatiou of the achievements of the medical
meu of the Old North State would be a pleasing task. But should dramatic
art, rhetorical pyrotechnics, or literary feast be anticipated, to my own em-
barrassment would be added your disappointment.

Your society received my sincere devotion while in the State ; and since my
exile I have watched its progress with the solicitude of real friendship, rejoic-
ing in its success and lamenting its embarrassments as I would the triumphs
and vexations of my own household.

In closing, I cherish the hope that I may have occasion to renew old friend-
ships that will awaken old associations and bring back to memory the halcyon
days in the years of long ago. And may these words be accepted as proof
that their author does, and will forever, entertain for the officers and each
Individual member of the Medical Society of the State of North Carolina feel-
ings of the deepest interest and affection.

Respectfully, Walter C. Murphy.

Sanatorium, N. C, June 12, 1915.
Dr. Walter C. ]Murphy,

507 Fourth Street, N. W.,

Washington, D. C.

My dear Doctor : — On behalf of the Medical Society of the State of North
Carolina allow me to express to you my appreciation of your letter of June
11th and to express the hope that, while you are unable to attend this meeting,
as I would like to have had you do, you may in the near future be able to attend
some of our sessions and deliver before our society the address which I hap-
pen to know you are preparing on the "History of Medicine in North Caro-
lina."

It seems to me at this moment that nothing could be more interesting to the
medical profession in North Carolina than an address on this subject, espe-
cially when we take into consideration that the address will be prepared and
delivered by a son of North Carolina, one who has always been interested in
the attainments of our profession ; one who has set up our ideals for us and
then helped us to attain them.

May I also again be permitted to express my appreciation of your liberality
and generosity in the donation of the set of Transactions of the State Medical
Society up to 1890.

With assurances of sincerest regards and high personal esteem, I beg to
remain, my dear doctor, Fraternally yours,

L. B. McBrayer,

President.

REPORT OF COMMITTEE ON ARRANGEMENTS AND
RECEPTION COMMITTEE.

Dr. J. T. J. Battle, chairman : The Committee on Arrangements and
the Reception Committee beg leave to make the following report :

The Lodge of Elks, No. 602, cordially invites you to use their lodge at
any time.



28 NORTH CAROLINA MEDICAL SOCIETY.

We have an invitation to call at the Merchants' and Manufacturers'
Club, in the Dixie Building, where "the latch-string hangs on the out-
side." There is also an invitation from the Country Club, where the
golf links will be open to members of the society, and the house and cafe
are at your disposal.

The manager of the Masonic Home will be glad to have you come at
any time and go over the institution.

The button to which every doctor is entitled will give you all the drinks
you desire, at any drug store in the city, provided your wants are not too
varied.

This (Tuesday) afternoon, from 5 to 6, all are invited to the South-
ern Life and Trust Company's offices, to attend an informal reception
given by the Southern Life and Trust Company, complimentary to the
society.

This evening, after the evening session is adjourned, we are invited to
a floating reception at the home of Dr. J. W. Long. Dr. and Mrs. Long
will be glad to see all the members from 10 to 12 o'clock.

At 4 :30 tomorrow afternoon w^e are expected to leave this building and
go to the State Normal College in cars which will be provided for
the purpose. After an inspection of the grounds and a visit to the dairy,
the infirmary, the kitchen, and other points of interest, we will have
luncheon there, and after that a rare treat in the form of an entertain-
ment. After this entertainment, we will have our regular evening ses-
sion in the auditorium, where the annual oration and essay will be
given.

If any members of the society wish to see the largest cotton mill in the
world making one line of goods, we shall be glad to take them through
the great White Oak Mills, just outside the city.

We have also secured films along health lines which the moving picture
theaters have kindly consented to use during the convention, and are now
running.

The State Board of Health thought very wisely that this week would
be a very suitable time to have their exhibit here; so the North Caro-
lina exhibit, together with the South Carolina, Georgia, and Jackson-
ville exhibits, are on display in the rooms of the Chamber of Commerce,
a most creditable display. All are invited to visit it.

Eespectfully submitted, by the Committee on Arrangements.

It gives me pleasure at this time to hand over the gavel to our presi-
dent. Dr. L. B. McBrayer.



OPENING EXERCISES. 29

Tlie following resolution was submitted by Dr. J. M. Parrott, and,
upon motion of Dr. Cyrus Thompson, was adopted by tlie society :

Whereas the Medical Society of the State of Nortli Carolina has learned
that the Daughters of the Confederacy are making an effort to raise funds for
the erection of a monument to the late Samuel Preston Moore, Surgeon-
General of the Confederate States Army ; and whereas, this society heartily
indorses this movement : Therefore, be it

Resolved, That the attention of the medical profession of North Carolina be
called to the worthiness of this object ; and

Resolved, second, That the physicians throughout the State be urged to con-
tribute as liberally as possible to the consummation of the same ; and

Resolved, third, That this resolution be given the press of the State for the
information of physicians, and that all contributions be sent our secretary,
who is hereby instructed to receive and forward the same to the proi)er au-
thority.

Upon motion of Dr. J. M. Parrott, amended by the president, it was
voted that the courtesies of the floor be extended to Dr. R. L. Payne of
Norfolk, Va., Mr. John E. Ray of Raleigh, Dr. J. M. Wainwright of
Scranton, Pa., and Dr. Frederic E. Sondern of New York City.



SCIENTIFIC PAPERS.



SECTION ON PHYSIOLOGY AND CHEMISTRY.

SECTION ON MEDICAL JURISPRUDENCE AND
STATE MEDICINE.

SYMPOSIUM ON NARCOTICS.

SECTION ON MATERIA MEDICA AND THERA-
PEUTICS.

SECTION ON SURGERY.

SYMPOSIUM ON CANCER.

SECTION ON ANATOMY.

SECTION ON PATHOLOGY AND BACTERIOLOGY.

SECTION ON OBSTETRICS.

SECTION ON GYNECOLOGY.

SECTION ON PEDIATRICS.

SECTION ON PRACTICE OF MEDICINE.

SECTION ON CONSERVATION OF VISION.

SECTION ON HYGIENE, SANITATION, AND PRE-
VENTIVE MEDICINE.



PHYSIOLOGY AND CHEMISTRY.



SOME PHYSIOLOGIC AND BIO-CHEMIC OBSERVATIONS

ON MILK.



William Tur>'er Carstarphen, A.B., M.D., Professor of Physiology,
Wake Forest School of Medicine.



The man of business knows full well — at times too Avell — the impor-
tance of stock-taking: of ascertaining exactly how he stands. To neglect
this precaution often means disaster.

As in business, so in science, it is Avell to have a periodic stock-taking.
Scientific facts accumulate rapidly. They give rise with equal rapidity
to the formation of many theories. While they may be wonderfully en-
ticing, yet we are apt to pass from theory to theory without assuring
ourselves that the foundation on which Ave are building is secure.

Bearing this statement in mind, I beg to present some facts as Avell
as theories about an already much discussed subject. Some of these
facts and theories, though ancient, have retained their interest until now ;
and some of them, I trust, Avill at least appear in a new garb.

Milk, while considered the most satisfactory individual food material
furnished us by nature, may become a veritable Dr. Jekyll and Mr.
Hyde in the Avorld of the nutrients — that is, if we do not keep pace
with the physiologic and bio-chemic advance in the study and investiga-
tion of this specific secretory product of the mammary glands.

Milk is a natural emulsion, consisting of a plasma in which are sus-
pended the fat globules. It contains the three nutrients, protein, fat, and
carbohydrates, and inorganic salts in such proportion as to render it an
acceptable food. The globules of fat are composed of olein, palmatin,
stearin, and butyrin. The protein constituents are in colloid solution,
caseinogen being an unstable colloid, while lact-albumen is a stable one.
The carbohydrates are in crystalloid solution as well as the inorganic
salts. ^ Recently Jones- has reported that not only the carbohydrate
lactose is normally present, but that there is a hexose sugar in sterile
milk. He presents both bacteriological and chemical evidence to show
that milk normally contains a substance reacting like dextrose. Besides
these constituents, there are traces of lecithin, cholestrol, urea, creatin,
creatinine, and the tri-glycerides of caproic, lauric, and myristic acids.^
Citric acid is also present in minute traces in fresh milk, though it is apt
to separate out in an insoluble form from condensed milk.
3



34 NORTH CAROLINA MEDICAL SOCIETY.

In this connection Langdon Brown^ noted tlie frequency of thrombosis
in typhoid cases in the South African War. Condensed milk had been
used ahnost exclusively in feeding these cases. About 6 per cent of all
cases were affected with thrombosis — a rather high percentage; in fact,
about double the normal number. He is of the opinion that this in-
crease in thrombosis was largely due to the general use of condensed
milk with its absence of citric acid, or rather its separation into an in-
soluble form. He thinks that as fresh milk contains some citric acid, it
acts as an antidote to the large amount of soluble calcium salts in cow's
milk.

Lyle^ also maintains the possibility of a milk diet predisposing to
thrombosis by virtue of the large amount of soluble calcium salts which
it contains. If this be true, in such diseases as typhoid and hsematemesis,
thrombosis could be diminished by allowing a more liberal diet and not
adhering to an exclusive milk diet.

It must be remembered that citric acid is present in fresh milk only
in minute traces, so that if an exclusive milk diet is insisted upon this
difficulty may be avoided by the addition of citrate of soda to the milk.
According to Martin,'^ citrate of soda acts by forming a double salt with
calcium, which is available neither for the curdling of milk nor for the
clotting of blood.

The possible inimical role of calcium in the production of harmful
sequels in typhoid leads me naturally to a discussion of the inorganic
constituents of milks. It will not be necessary in this paper to enter
into any lengthy discussion of all the inorganic salts entering into the
composition of milk. Milk, however, as a standard for determining all
the requirements of the inorganic foods in man is an ideal one; for we
are quite sure that milk contains in just the proper proportions all the
inorganic salts necessary for the development of the growing individual.

Special interest has recently been taken in the role of calcium in the
body generally. So I shall select this one of the inorganic salts of milk
because of its general interest as well as for its particular action in the
mechanism of milk curdling, the clotting of blood and its action on the
heart. Certainly it is no inert substance, but is essential to the animal
organism, all of its activities pointing to an active function in meta-
bolism. According to Voit it is excreted in the urine and lost in small
amounts by the bowel. He estimates about 0.15 to 0.16 gram lost in
this way per day. Hence we see at once the necessity of replacing this
important substance.

A rough estimate may be gained of the relation between the com-
position of the inorganic salts of milk and that of the suckling by making



PHYSIOLOGY AXD CHEMISTRY.



35



ail analysis of the asli of both. In the case of calcium as an important
and representative one of the group, it is found that 100 parts by weight
of ash contain, in grams —



Calcium

Calcium

Calcium... ... _


Rabbit 14 days old,

35.02
Dog few hours old,

29.5
Guinea-pig, new-born,

32.21
Infant,

.36.1
Human foetus,

40.48


Rabbit's milk,

35.65
Dog's milk,

27.2
Guinea-pig's milk,

31.1
Milk,

16.4
Human milk,

14.76


Rabbit's blood,

0.81
Dog's blood,

0.9


Rabbit's serum,

1.42
Dog's serum,

2.1


Calcium







Calcium.- . ... _













It will be noted from the foregoing data that there is a striking
similarity in the amount of calcium in the young animal and that of
the milk, except in the case of human beings. It appears that the more
rapid the growth of the animal the more nearly similar will be the result
of the two analyses.

It is also of interest here to note, with reference to calcium, the wide
diiference in composition of the milk and the substances from which
they are formed, that is, blood and plasma. This leaves us to infer that
the mammary gland, in its secretive mechanism, has the power of
selection.

A question of much interest to us iioav is. Does the infant, after it is
weaned, receive an adequate supply of the inorganic foods? Taking
calcium as an example, it is found present in most of our ordinary foods
in the following amounts.

The table''' below gives the amount of lime present. The values refer
to 100 grams of substance dried at 120 degrees C, Avith the lime content
in milligrams.



SiLsrar.



Dates .



Honey 7

Beef 29

White bread 46

Rye 62

Apples 66

Graham bread 77

Pears • 95

Potatoes 100

Rice 103



108

White egg 1.30

Peas 1.37

Plums 166

Huckleberries 196

Human milk 243

Orange 575

Cabbage 717

Strawberries 873

Cow's milk 1510



This table shows that it is necessary to understand the lime require-
ments of an infant. It can be seen that most of our foods are deficient



36 NORTH CAROLINA MEDICAL SOCIETY.

in lime as compared with milk. A cliild six months old requires about
1 liter of milk daily; this contains about .5 gram of lime.'^

The lack of lime salts has often been assigned as a cause of rickets,
and it has been recognized that the disease is more frequent when
mother's milk is replaced by some other form of nourishment. Also
deficiency of lime in the food affects the infant more than the adult.
This is natural, since the former requires more lime for the growth of
bone. Some very interesting studies by Weiser on deficient calcium diet
in animals have recently been published. He points out that a ration
poor in calcium shows decided changes in growth, Avith undersize, under-



Online LibraryMedical Society of the State of North Carolina. AnTransactions of the Medical Society of the State of North Carolina [serial] (Volume 62 (1915)) → online text (page 5 of 58)