CAT, NATIONAL LIBRARY OF MEDICINE Bethesda, Maryland ....TRANSACTIONS.... OF THE WYOMING State Medical Society. First and Second Regular Meetings, HELD AT Rawlins and Rock Springs, May and Nov., 1898. CONSTITUTION, BY-LAWS AND LIST OF MEMBERS. PUBLISHED FOR THE SOCIETY. Denver, Colorado: APP ENGRAVING & PRINTING CO. 1K99. U36 V..; ■M D President Wyoming State Medical Society. E. STUVER, M.D., Secretary Wyoming State Medical Society. PREFACE. On presenting this volume, containing the transactions of the First and Second Regular Meetings of the Wyoming State Medical Society, I desire to congratulate the profession of the State on the splendid start that has been made to unify and strengthen the medical profession and bring its regular members together into a strong organization for the advancement of Scientific Medicine, the alleviation of human suffering and the stamping out of diseases. Already fully 50 per cent, of the regular physicians of the State have been enrolled as members of the society; a proportion which I believe will compare favorably with any state medical society in the United States, no matter how old it may be. This, together with the interest evinced by the members, and the high order of the papers presented at our Rock Springs meeting, indicate that no effort will be spared to place the Wyoming State Medical Society in the front rank of state medical societies. Neither the Society nor the Editor assumes any resposibility for the views or opinions as enunciated in the various papers and discussions. With our vigorous young society as the rallying point for all that is best and noblest in the medical profession, let us, in the words as quoted by our own beloved Longfellow, "Look not mournfully into the Past; It comes not back again. Wisely improve the Present, it is thine. Go forth to meet the Shadowy Future, Without fear and with a manly heart." E. STUVER, Secretary and Editor. Fort Collins, Colorado, March 11, 1899. CONTENTS. Frontispiece—President and Secretary. Preface.................................................. i Proceedings of First Regular Meeting, May 13, 1898.......... 3 Minutes of Second Regular Meeting, November 1, 1898....... 11 President's Address—The Importance of Closer Scientific and Fraternal Relations, R. Harvey Reed, M.D., Rock Springs, Wyoming............................................. 17 Auto-Intoxication, E. Stuver, M.D., Fort Collins, Colorado..... 24 Suppurative Diseases of the Accessory Sinuses of the Nose, Wm. Winthrop Betts, M.D., Salt Lake City, Utah.............. 31 Cerebro-Spinal-Meningitis, John F. Leeper, M.D., Casper, Wyoming............... ........................... 40 How Does the Cause of Disease Produce Disease—A Further Study, G. M. Russell, M.D., Dixon, Wyoming............ 44 Hiccough: Report of a Case, W. A. Jolly, M.D., Rawlins, Wyoming............................................. 49 The Prophylaxis of Puerperal Infection, C. H. Solier, M.D., Evanston, Wyoming.................................. 50 Discussion on Dr. Solier's Paper, Mrs. Charlotte G Hawk, M.D., Green River, Wyoming................................. 57 Report of a Case of Foxtail Infection, R. C. Chamberlain, M.D., Rock Springs, Wyoming................................ 58 Synopsis of Discussion on Report of a Case of Foxtail Poison- ing, R. Harvey Reed, M.D., Rock Springs, Wyoming...... 61 Acute Broncho-Pneumonia in Children, Charles Pinkney Hough, M.D., Salt Lake City, Utah............................ 64 The Radical Treatment of Disease of the Hip-Joint, Charles G. Plummer, M.D., Salt Lake City, Utah.................... 67 List of Members......................................... 77 UCXJUUCJUCJtJCJCJtJ First Annual Meeting OF THE Medical Society OF THE STATE OK WYOMING. jHeld at I^au/lii)s, U/yomipg, (T\ay 13, 1898. #J* Portland, Oregon: Medical Sentinel Print, r y v y v y v y v y v y v y v y v v v y v vv v OFFICERS. President.......................___Dr. R. HARVEY REED, Rock Springs First Vice-President, .......... K,---Dr. JACOB W. HAWK, Green River Second Vice-President,.....................Dr. J. O. HAMMOND, Hanua Third Vice-President, ..............Dr. \V. C. C. FREEMAX, Rock Springs Secretary and Editor, ........:..'.'...............Dr. K. STUVER. Rawlins Treasurer.................................Dr. H. M. BENNETT, Rawlins V OFFICIAL CALL a^4i&2m*NG STATE MEDICAL SOCIETY. Rawlins, Wy., April 29, 1898. Dear Doctor: Every year more fully demonstrates the ab- solute necessity of a closer organization and firmer union of the medical profession in order to promote its material as well as its scientific interests. In view of the fact that nearly every state and territory of our Nation, except Wyoming, has an active medical society to look after the welfare of the medical profession, and believing that the present is a most auspicious time, and that it is the duty of the medical pro- fession of our state to organize a State Medical Society, so that we shall be entitled to delegate representation in the American Medical Association at its coming meeting in Den- ver, June 7th, we, the undersigned, do hereby issue a call for a meeting of the regular physicians of Wyoming to be held in Rawlins, May 13th, at 10 o'clock, a. m., for the purpose of or- ganizing a state medical society, or reorganizing the one which has lain dormant for so many years. You are urgently requested, if possible, to be present at the meeting, but if you cannot be with us, send in your applica- tion for charter membership at once. Signed: E. STUVER, M. D. THOS. G. MAGHEE, M .D. Pursuant to the above regularly issued call physicians from various parts of the state met in the parlor of the Union Pa- cific Hotel, at Rawlins, Wyoming, May 13th, for the pur- pose of organizing a state medical society. The meeting was called to order and the call read by Dr. E. Stuver, temporary secretary. The meeting then proceded — 1 — to the consideration of a constitution and by-laws, which after a free discussion was adopted subject to alterations and amendments at the next regular meeting, which will be held in Rock Springs, Nov. 1, 1898. The following officers were then elected to serve until the next annual meeting, viz.: President, Dr. R. Harvey Reed, Rock Springs; first vice president, Jacob W. Hawk, Green River; second vice presi- dent, J. C. Hammond, Hanna; third vice president, W. C. C. Freeman, Rock Springs; secretary and editor, E. Stuver, Rawlins; treasurer, H. M. Bennett, Rawlins. Drs. R. Harvey Reed, E. Stuver and J. C. Hammond were elected delegates to the American Medical Association. Alternates, Drs. W. C. C. Freeman, Jacob W. Hawk and W. W. Cook. The following committees were then elected, viz.: Executive—J. C. Hammond, ex-officio; E. E. Levers, C. II. Solier. Admission and Medical Societies—Jacob W. Hawk, James Carter, Frank Dunham. Program—President, secretary, ex-officio; treasurer. Legislature—R. Harvey Reed, C. H. Solier, W. W. Crook. Ethics—James Carter, James Lane. Necrology—Robert C- Chamberlain, G. N. Russell, Frank Dunham. No other business appearing, the society adjourned to meet in Rock Springs, November 1st, 1898. E. STUVER, Secretary. * £ * CONSTITUTION OF THE WYOMING STATE MEDICAL SOCIETY. ARTICLE I. Name. This association shall be known as the Wyoming State Medical Society. ARTICLE II. Objects. The objects of this society shall be the maintaining and upbuilding of a hign standard of the medical profession throughout the State, the preparing, reading and discussion of papers on medical, surgical and allied subjects, the report of cases and social advancement. — o ■— ARTICLE HI. Membership. Section 1. Its members shall consist of active and honorary mem- bers. Active members shall be residents of the State at the time of their election, and shall be graduates of some regular, reputable medical college, and shall sign the constitution of this society before they are eligible to franchise and shall pay an annual assessment of not less than one nor more than five dollars, at the discretion of the society, which sum shall be regulated at each annual meeting. Sec. 2. Honorary members shall consist of distinguished members of the profession who shall be elected as hereinafter provided for. Sec. Application for active membership shall be made in writing and supplemented by the written approval of at least two active mem- bers who have personal knowledge of the professional standing of the applicant. Sec. 4. Honorary members shall be recommended by at least two active members in good standing, and no honorary member shall be elected to this society who has not distinguished himself in some special manner in the advancement of the medical and surgical sciences. Sec. 5. Not more than five honorary members shall be elected in any one year, and the limit of honorary members shall not exceed fifty. Sec. G. Honorary members shall have the same privileges as active members, except the right of franchise, and shall be exempt from any clues or assessments. ARTICLE IV. Meetings. Section 1. This society shall meet annually the first Tuesday of November, unless otherwise ordered by the society at a regular meeting of the same, but special meetings may be called by the president and secretary on the written application of five members stating the ob- ject of said special meeting, at which time no business shall be trans- acted except that mentioned in the call for the same, and no special meeting shall be called without giving each active member a written notice thereof at least two weeks prior to the time of said meeting. Sec. 2. Five members shall constitute a quorum for the transac- tion of business, provided every member shall vote in the affirmative on questions of expenditure of money, disciplining a member or changing the constitution. ARTICLE V. Penalty. Section 1. Upon sufficient showing that a member of this society has been willfully guilty of gross violation of the constitution and by- laws of the same, or any form of unprofessional conduct, the executive board may recommend that his resignation be requested, or move his suspension or expulsion, a majority vote of the members present at a — (I — regular meeting being necessary to fix the penalty, after said mem- ber has had a fair and impartial trial before the committee on ethics. ARTICLE VI. Code of Ethics and Parliamentary Rules. Section 1. The code of ethics of the American Medical Association is hereby adopted by this society. Sec. 2. Robert's Rules of Practice are hereby adopted for the par- liamentary regulations of all meetings of this society when not other- wise specified in its constitution and by-laws. ARTICLE VII. Officers. Section 1. The officers of this society shall consist of a president, three vice-presidents, secretary and editor, a treasurer and executive committee of three; a committee on admissions and medical societies of three: a committee on program and printing, of three; a committee on necrology, of three; all of whom shall be elected as hereinafter provided for. Sec. 2. All officers shall be elected by ballot, except when other- wise provided for. Sec. 3. The retiring president shall be ex-officio a member of the executive committee for the following year and one member of said committee shall be elected by ballot each year to serve for two years. Sec. 4. The members shall be elected by ballot annually to serve on each standing committee, except the executive committee, which shall serve for a term of three years, except that at the meeting held at Rawlins, May 13th, 189N, one member shall be elected to serve until the first Tuesday of November, 1898; one member shall be elected to serve until the first Tuesday of November, 1890; one member shall be elected to serve until the first Tuesday of November, 1900. Sec. 5. All officers shall serve until their successors are duly elect- ed and have signified their acceptance of the same. ARTICLE VIII. Duty of Officers and Committees. Section 1. The president shall preside over all meetings in ac- cordance with this constitution and by-laws, and deliver an annual address. Sec. 2. The vice-presidents shall preside in the order of their rank in the absence of the president or at his request when present. Sec. 3. Secretary and Editor.—The secretary shall keep a correct record of all the proceedings of this society, and make a report of the same at each annual meeting, which shall be referred to the executive committee, and do such correspondence as shall be deemed necessary for the interest and progress of the society. He shall also edit and prepare all manuscripts for publication, read galley and form proofs of the same, and furnish each member who has read and discussed a paper a galley proof of the same when so request- — 7 — programs, procure the necessary stationery for the officers and keep the seal of the society, and perform such other duties as may be as- signed him and submit a written report at each annual meeting. Sec.4. Treasurer.—The treasurer shall collect all dues and make an itemized report of the same at each annual meeting, which shall be referred to the executive committee. He shall also report to the secre- tary the names of all new members, together with those who have paid their annual dues for the year; also those who are delinquents, giving the names and addresses of the same, the first of each month. He shall keep a correct record of all money received and disbursed, and shall expend no money except on the written order of the secre- tary and president. He shall also render a receipt to each member, paying his dues or assessments, and keep a stub of the same, each of which shall indicate the amount paid, and the time covered by the same, and take a receipt for all money expended, which shall be ac- companied by a written order authorizing the payment of the same. He shall give a bond of the sum requested by the society. ARTICLE IX. Section 1. Committees.—The committees of this society shall be standing and temporary. Standing committees are those whose duties shall continue from year to year, and shall consist of five separate committees, as herein- before designated. Temporary committees are those whose functions cease at the meeting at which they are appointed. They shall be appointed by the president, unless otherwise provided for, as the necessity of their existence arises. Sec. 2. Duties of the Committees.—The executive committee shall have general supervision of the affairs of the society. It alone shall have the power to move expulsion or suspension of any member of the society for alleged offense against this constitution and by-laws when the evidence for the same has been submitted to them by the com- mittee on ethics; it shall act as a committee on credentials, hold any necessary meetings in the interval between sessions, and its action shall be deemed the action of the society unless reversed by that body; it shall have general charge of all the monetary affairs of the society, audit all bills, together with the books of the treasurer, and shall rec- ommend each year the amount of annual dues or special assessments necessary for the maintenance of the society and ihe publication of its proceedings. Sec. 3. The committee on admissions and medical societies shall examine and pass upon the qualifications of delegates and applicants for permanent membership and submit their credentials for the appro- val of the executive committee, and on approval oi the same shall re- port the applicants or medical societies for election provided the cre- dentials are satisfactory. Section 4. The committee on program and printing shall consist of the president, secretary and editor, and treasurer, and shall exam- — 8 — Ine all papers presented to the society and have printed in the trans- actions such as it deems worthy of publication, order the printing of programs, notices, and such other literature as may be deemed neces- sary for the interest of the society or ordered by the same. Sec. 5. The committee on Legislature shall watch the course of the state legislature on medical subjects, and take charge of such med- ical and allied subjects and such matters as shall be referred to it by the society. All proposed medical legislation offered by any member of the society and all resolutions touching medical legislation shall be referred to this committee, which shall make a report thereon to this society as soon as possible after said material has been submitted to them for their consiueration. Sec. 0. The committee on ethics shall examine and report for the action of the society any member, charged in writing, with any viola- tion of the provisions of this constitution and by-laws. A copy of such charges shall be furnished to said member, and the accused and accuser sha~ appear before the committee at a date fixed by the so- ciety, when it shall proceed to hear the case and submit the testimony of the same to the executive committee as hereinbefore prescribed . Sec. 7. Committee on Necrology.—It shall be the duty of the com- mittee on necrology to keep itself advised regarding the death of any member of this society,and make a proper report of the same at each annual meeting. ARTICLE X. Amendments. Section 1. Every proposal for amending the constitution shall be made in writing, and if such an amendment receives a majority of four-fifths of a quorum, it shall be adopted, but otherwise the amend- ment shall lie over until the next meeting, when it may be adopted by a majority of two-thirds of the members present. BY - LAWS. I. Order of Business. 1. Call to order. 2. The minutes of each session shall be read, and if necessary corrected and approved prior to the proceedings of the next session. 3. The time for the president's address shall be fixed by the com- mittee on program. 4. The election of officers shall be held the afternoon of the last day of the meeting. 5. The selection of a place for the ensuing meeting shall be made immediately after the election of officers. 6. Business which requires early consideration. 7. Reports of Standing Committees. — 9 — 8. Report from the delegates to the American Medical Associa- tion and other societies. 9. Regular program of papers and their discussions. in. Report of cases, exhibition of patients, specimens, apparatus, etc. 11. New business. 12. Unfinished business. 13. Miscellaneous business. 14. Adjournment. II. Temporary Committees. As soon as practical after his election, the president shall appoint a committee of arrangements, consisting of not to exceed five members, and if no sufficient reason prevent, said committee shall largely be composed of members at the place where the next annual meeting is to be heid. The said committee shall provide suitable rooms and ac- commodations for the meeting of the society, arrange for such enter- tainment as they may deem in the interest of the society at all times. III. It snail be the duty of the president, not later than the second session of the meeting, to appoint a committee on nominations, con- sisting of three members, whose duty it shall be to submit a list of names proposed for the officers provided for in this constitution IV. Not to exceed twenty (20i minutes shall be allowed for the reading of any paper without specia* permission. V. No paper shall occupy over thirty (30) pages of the transactions without special permission of the society or executive committee. VI. All reports, papers and addresses presented to this society by its members shall be the property of said society, and shall be referred without motion and without recommendation to the committee on pro- gram and printing, and it shall be considered a misdemeanor for the author of any such report or paper to permit the same to be published without giving due credit to this society. VII. No one participating in the proceedings shall be al'owed to speak at two different times on the same subject without the consent of the society. VIII The time allowed each speaker shall not exceed ten minutes except by general consent. — 10 — IX. Any of these by-laws may be amended at any time by a three- fourths vote of the members present. Every proposed amendment must be offered in wricing, and if it receives a four-fifths vote of the members present, it shall be adopted; but otherwise, shall lie over until the next meeting, when it may be adopted by a majority of two- thirds of the members present. MINUTES of the SECOND REGULAR MEETING OF THE WYOMING STATE MEDICAL SOCIETY, HELD AT ROCK SPRINGS, WYCX, November J, 1898. The second regular meeting convened in Rock Springs, November 1st, 1898. Met in the city hall at 10 o'clock a. in., and was called to order by the president, Dr. R. Harvey Reed. The minutes of the last regular meeting were read and ap- proved. The mayor, Hon. YV. K. Lee, delivered a felicitous address of welcome, and extended the hospitality of the city to the society. The address of welcome was responded to by Dr. C. H. Solier, who thanked the citizens of Rock Springs for their courte- sies and made a strong plea for the organization of the medical profession and a closer union of its members. In the absence of Drs. J. C. Hammond and E. E. Levers the president appointed Drs. J. H. Maynard and J. W. Hawk to fill the vacancies on the executive committee. This committee then took up the applications for charter membership and the following were recommended for membership, and the report was unanimously approved by the society. List of charter members: E. Stuver, W. W. Crook, Char lotte G. Hawk, Jacob W. Hawk, R. Harvey Reed, YV. C. C. Free- man, Ernest E. Levers, Robert C. Chamberlain, G. M. Russell, James Lane, Frank Dunham, C. H. Solier, James Carter, M. H. Verpoorten. H. M. Bennett, J. C. Hammond, R. YV. Hale, John H. Lott, YV. L. Johnson, John F. Leeper, George G. Verbryck, L. A. Gates, F. Horton, Allen F. Miller, Win. A. Jolley. Arthur V. Stoughton, H. A. Abbott, J. B. Weaver, J. E. Osborne, H. J. Maynard. At the afternoon session the following additional applica- tions were approved, viz: George P. Johnson, E. P. Ranch. Dr. J. YV. Hawk, first vice president, was then called to the chair and the president, Dr. Reed, read his presidential address, "The Importance of Closer Scientific and Fraternal Relations." — 12 — It was moved by Dr. Solier, and duly seconded, that a vote of thanks be extended to Mayor Lee. Carried. It was moved by Dr. Maynard, and seconded by Dr. Solier, that the application of Dr. A. E. White, together with his initia- tion fee, be returned to him. Carried. Dr. Chamberlain then read his paper on ''Foxtail Infection." In order to give the society an opportunity to see the case before discussing the paper, it was moved, duly seconded and carried that the discussion be postponed and that we proceed with the transaction of important business to come before the society. A letter from Congressman John E. Osborne to the presi- dent, R. Harvey Reed, suggesting that the society adopt strong resolutions condemning the pending anti-vivisection bill (Senate Bill 1063); also favoring the reorganization of the United States Army Medical Department on an independent basis with a medi- cal officer in the President's cabinet at its head, and pledging himself to use his influence in securing such desirable ends, was read and it was moved, duly seconded and unanimously carried that the president and secretary prepare suitable resolutions on these subjects. Accordingly the following resolutions were pre- pared and adopted by the society, viz.: On the anti-vivisection question: Whereas, many of the great discoveries as to the causation, the prevention and the cure of diseases as well as the advancement of sanitary science and the greatly lowered death rate among civilized nations are largely due to experiments on living animals; and, ^Whereas, the bill now pending in the United States Senate (Senate Bill 1063), or any similar legislation, if enacted into law will greatly obstruct and hamper scientific investigators in their work and tend to prevent life-saving discoveries in the future. Be it therefore resolved, that we, the Wyoming State Medi- cal Society, in regular session assembled, do hereby condemn Senate Bill 1063 and strongly protest against its passage and urge upon our representatives in Congress and the United States Senate,as well as all friends of progress, to use every honorable means to secure its defeat, and the defeat of any similar measure that may hereafter be introduced. (Signed) R. HARVEY REED, E. STUVER, Committee. On a Department of Public Health: Whereas, the progress and happiness of a nation are largely dependent on the health and physical integrity of its people; and, — 13 — Whereas, the protection of our country against the intro- duction of infectious and contagious diseases and the advance- ment of sanitary science can only be accomplished under the di- rection and control of sanitary experts: Be it therefore resolved, that we, the Wyoming State Medi- cal Society, in regular session assembled, do hereby recommend the establishment of a public health department under the direc- tion and control of a medical expert, who shall be a member of the President's cabinet. And the following resolutions condemning the Behring pat- ent on diphtheria antitoxin were then unanimously adopted, viz.: Whereas, prevailing conditions of patent and trade-mark laws enable any one to secure proprietary rights to chemical compositions associated with or without trade-marks, thereby inflicting an injustice upon the American people; and, Whereas, under our lax laws Professor Emil Behring and his agents have secured a patent on diphtheria antitoxin: Resolved, that the State Medical Society of Wyoming ex- presses its unqualified condemnation of the course pursued by Professor Emil Behring and the Farbwerke of Hoechst-on-the- Main, German}', in securing a United States patent on diphtheria antitoxin, and that this society regards such action as a violation <»!' professional ethics, as an injustice to the medical profession, and as an imposition upon the American public. Resolved, that this society earnestly reprobates the prevail- ing laxity in our patent laws, which bestow upon foreigners spe- cial privileges, concessions and monopolies that they cannot se- cure in their native lands. Resolved, that while it is the duty of our government to encourage invention, it is eminently unjust and contrary to pub- lic policy to grant perpetual property in a trade-mark name and to accord pa i mis 01; the chemical composition of medicinal sub- stances, thus preventing their manufacture by other processes or their sale under different names. Resolved, that copies of these resolutions be transmitted to the members of the commission appointed by President McKin- ley for the revision of the United States patent and trade-mark laws, namely, Mr. Francis Forbes of New York city, Hon. Arthur P. Greeley, assistant commissioner of patents, Washington, D. C, and Hon. Peter Grosscup, Chicago, Illinois. Resolved, that we commend the action of the American manufacturers of antitoxin who have agreed to protect the pro- fession in the use of their serum, and recommend the use of the American product in preference to Behring's. AFTERNOON SESSION. The report of the delegates to the American Medical Asso- ciation meeting in Denver last June was then called for. No writ- — 14 — ten report was presented but Drs. Stuver and Reed reported that our society had been duly recognized by the American Medical Association, with which organization we are now in affiliation. They also reported that Wyoming's full delegation presented papers to and took part in the discussions before a number of the sections. The society then proceeded to the election of officers and the following were unanimously chosen, viz.: President, R. Harvey Reed, Rock Springs; First Vice Presi- dent, H. J. Maynard, Cheyenne; Second Vice President, George G. Verbryck, Cambria; Third Vice President, E. E. Levers, Almy; Secretary and Editor, E. Stuver, Rawlins. For Treasurer, Drs. C. H. Solier of Evanston and J. F. Leeper of Casper were placed in nomination, and a ballot being taken, Dr. Solier received six votes and Dr. Leeper two votes, whereupon Dr. Solier was de- clared elected Treasurer for the ensuing year. The following committees were then elected, viz.: Executive Committee—R. Harvey Reed, ex officio; C. H. Solier, 1809; George P. Johnson, 1900. Admission and Medical Societies—J. W. Hawk, James Carter, Frank Dunham. Legislature—R. Harvey Reed, C. H. Solier, George G. YTer- bryck. Ethics—James Carter, Allen F. Miller, J. F. Leeper. Necrology—F. Horton, J. C. Hammond, W. C. Freeman. The following delegates and alternates to the American Medical Association meeting to be held in Columbus, Ohio, next June were then unanimously elected, viz.: Delegates—R. Harvey Reed, E. Stuver, H. J. Maynard; and the secretary was empowered to select the fourth delegate: Alternate—W. C. C. Freeman; and the secretary was empowered to select three alternates, to fill the vacancies. It was moved by Dr. Solier, duly seconded and unanimously carried that Laramie City be .selected as the next place of meet- ing. It was moved, seconded and unanimously carried that the next meeting convene on the second Tuesday of October, 1899. It was moved, seconded and carried that the society next year hold a two days' session, beginning at 2 o'clock the first day. The society then proceeded with the reading of papers. — 15 — "Autointoxication" was read by E. Stuver and discussed by Drs. Maynard, Charlotte Hawk and Solier and the discussion closed by Stuver. Dr. Chamberlain's paper was then discussed by Drs. Solier, Reed, Maynard and Chamberlain. Dr. Solier next read his paper on "The Prophylaxis of Puer- peral Infection." The paper elicited an interesting discussion, which was participated in by Drs. Freeman, Charlotte Hawk, Stuver and Reed. As the time for adjournment was approaching, it was moved by Dr. Maynard, duly seconded and carried, that the papers of Drs. Russell, Levers. Leeper, Jolley and Betts be read by title and referred for publication. It was moved, seconded and after some discussion carried, that the fees for the ensuing year be fixed at $1. Jt was moved, seconded and carried that the Program and Printing Committee (president, secretary and treasurer) are hereby instructed to make the most favorable arrangements for the publication of the transactions of the society. It was moved, seconded and unanimously carried that a vote of thanks be extended to Dr. H. W. Coe for courtesies shown towards the society in printing the transactions of our last meet- ing. It was moved, seconded and unanimously carried that Drs. Maynard, Solier and Jacob Hawk be elected a committee to pre- pare a A*ote of thanks to the citizens of Rock Springs for their hospitality. The following resolutions were presented and unanimously adopted by the society, viz.: We, the undersigned committee on resolutions appointed at a meeting of the Wyoming State Medical Society, do hereby ex- press our thanks to the authorities and citizens of Rock Springs for the kind, generous and whole-souled reception and entertain- ment given us on the occasion of our annual meeting. (Signed) H. J. MAYNARD. C. H. SOLIER, J. W. HAWK. It was moved by Dr. Solier and seconded by Dr. Maynard that a vote of thanks be extended to the officers of the society for the efficient manner in which they have performed their duties. Unanimously carried. — 16 — No other business appearing, the society then adjourned to meet in Laramie City the second Tuesday in October, 1899. Between the sessions the members of the society were taken to the Wyoming State Hospital, where they had the pleasure of seeing many interesting cases which are being excellently cared for under the able management of Dr. Reed, with the as- sistance of Drs. Chamb'erlain and Ranch and a corps of trained nurses. From the hospital the members of the society were taken to the Commercial hotel, where they were royally entertained at lunch by Dr. W. C. C. Freeman. In the evening Dr. Reed and his amiable wife gave an ele- gant reception at their home in honor of the occasion. Here we had the pleasure of meeting a large number of the very best people of Rock Springs, and it is needless to say that the .affair was a most enjoyable one and highly appreciated by every one present. After the reception a grand ball was given in the Opera House in honor of the society. A large and brilliant company was present, care was thrown to the winds and enjoyment was the watchword of the hour. Thus ended a most successful and enjoyable meeting, one which will ever remain a red letter day of the Wyoming State Medical Society. E. STUVER, Secretary. - 17 — PRESIDENT'S ADDRESS. THE IMPORTANCE OF CLOSER SCIENTIFIC AND FRATERNAL RELATIONS. By R. HARVEY REED, M.D., Superintendent and Surgeon-in-Charge, Wyoming General Hospital; Member American Medical Association, American Academy of Railway Surgeons; Rocky Mountain Inter-State Medical Association; The Western Surgical and Gynecological Association, Etc. Rock Springs, Wyoming. For ages medicine has been lauded by fiction and song as the noblest of all professions, and yet it is a lamentable fact that its members are the object of ridicule, largely by those who know the least about them on the one hand, and on the other by those who know the most about them. Paradoxical as it may seem, we regret it is true, and while the attorney contests the right of his client to the bitter end, before the bar, the moment his case is closed he is a bosom friend of his antagonist, and clasps him with the right hand of fellowship and opens his heart to him in the hour of distress. The ministry has its dissensions on questions of orthodoxy, and while they disagree as to the beliefs and teachings of the Holy Writ, yet, as a profession at large, they stand together for one cause regardless of their friends or foes. Why is it that the physician and surgeon is made the object of ridicule, not only by the public but by the press, and the oft-repeated adage by Pope, "Who shall decide when doctors disagree?" is quoted to their discredit and disgrace. In studying the history of medicine we learn that it has come down from the days of Galen and Esculapius, and at that time books and literature of all kinds in reference to medicine was practically unknown, and the student of medicine was obliged to learn from his master, and his master in turn was obliged to learn from experience, which was confined to his own circle of obser- vation, and as a consequence it begot narrow-mindedness and lacked the broad expanse which the student of to-day has the pleasure of enjoying. Each of the great masters thought that he, and he only, was right, and the followers of each likewise lauded — 18 — the one and scorned the other. This condition of affairs is most lucidly set forth by the poet in the oft-repeated couplet: "A little1 learning is a dangerous thing, Drink deep, or taste not the Pierian spring." Gradually, however, the medical profession has steadily evolved from this chaotic condition of empiricism into a broad expansive field of scientific advancement. Instead of a two years' course of six months each, which was given the tyro who was taken from his humble field of labor, without a reasonable foun- dation of a generous education, we have now a four years' course of nine months each in all the best medical colleges of the land, and instead of the old classical seven branches of anatomy, physiology, chemistry, materia medica, obsterics, surgery and medicine, we have the number of studies more than quadrupled. The student of to-day must delve into the mystery of bacteriology, seeking the cause of the disease produced by numerous vegetable organisms that cause typhoid fever, diphtheria, yellow fever and a score of other diseases that are well known to those who are versed in the science of modern medicine. Nay, he can not stop there; he must proceed to search through the distorted cells, the result of disease, and learn from their pathological conditions how the various parts of the human economy produce certain symp- toms and their inevitable results. He must familiarize himself with embryology as well as obsterics. He must study physiologi- cal chemistry as well as the chemistry of the inorganic and or- ganic world. He must delve into the mysteries of histology and not content himself with the mere symptoms that present them- selves at the bedside. The abdominal cavity is the common field for the gynecolo- gist and the general surgeon, who, instead of allowing his patient to die from benign tumors or obstruction of the intestinal tract, have no hesitancy in opening this once sacred cavity and remov- ing the pathological conditions, and in the last few years they have not only practically reduced it to a science, but have saved thousands of lives and ameliorated the sufferings of humanity beyond human comprehension. This being the fact, it is high time that they should cast aside these petty jealousies that arise principally from ignorance, and close their eyes to these ignoble dissensions, and seek a closer scientific and fraternal relation. It lies with them to eradicate 19 — this evil and instead of being the object of ridicule, they have within themselves the power to unite and stand firm against any other profession in the civilized world. Yea, they have learned this by the incessant burning of the midnight oil, by the never- ending investigation, by the discoveries of such men as Koch, Pasteur and Esmarch of the old world, and Rush, McDowell, Gross, Morton, Agnew and Senn of the new world, who, with many others, have immortalized themselves in their ardent, self- denying, conscientious study for the advancement of scientific medicine, and who have made it possible for you and me to adopt for ourselves the lines of Adams, who said: Fifty years of strong progression! Half a century of rise! Noblest in a great profession, Highest far, by all confession, But gentle as thy name implies. In the midst of Time's swift eddy, Fraught with wrecks of human life; Thy figure stands out strong and steady, For thy duty calm and ready, Never blinded by the strife. In the language of the Pacific Medical and Surgical Journal, "At no moment in the world's history was so much mental power directed in the channel of medical study; never were there so many giant intellects laboring to advance the various depart- ments of medical science." It is an easy matter for us to find excuses for not attend- ing medical societies. It is an easy matter for us to find excuses not to meet our brothers in consultation, but it is just as easy to reverse this order, and be willing' and ready, nay, anxious for both, for he who shuts himself up in his own little circle, and ex- cludes himself from the associations of his fellow practitioners, denies himself the pleasure of the advancement obtained by the attending of medical societies, numerous as they may be, digs for himself his own grave in which he will be buried by an avalanche of his own bigotries. It is true there are exceptions to these general principles, and some of our best men are in such circumstances as to make it impossible for them to attend the scientific and social functions of our medical societies. But these are exceptions to the rule, and it is said that exceptions to the rule only prove its truth. — 20 — The science of medicine should recognize no geographical bounds. It should "Seize upon truth where'er 'tis found, Among your friends, among your foes, On Christian or on heathen ground: The flower's divine where'er it grows." We realize in the newer states of the Union and in the so- called "Wild and Woolly West," where the members of the pro- fession of necessity are widely separated from each other, that it is impossible for them to enjoy the daily intercourse which is afforded the members of the medical profession in the crowded states of the East, but this very fact has made the members of the profession in the West independent instead of dependent, as they are found in the East, notwithstanding it considers itself the Nestor of medical education, for here they are compelled to depend upon themselves and only in extreme circumstances are they able to call in counsel or mingle with the fellow members of the profession and consult over important cases, whereas in the East, where the profession is overcrowded, the student looks to his professor the moment he encounters a hard case, and de- pends upon him to bear the burden and responsibility, while he himself becomes a menial slave to dependency instead of inde- pendency. Dr. Norcom, in an address before the Medical Department of the University of Pennsylvania on March 4, 1878, said: ''Think for yourselves and cultivate self-reliance. Your pa- tients will not have confidence in you unless you show them that you have it in yourselves, which you cannot do unless you possess the knowledge their cases require. Be truth-lovers and you will be truth-seekers. In this way only can you avoid the influences to which we are all more or less exposed." The fact that circumstances have excluded to a certain ex- tent professional intercourse makes it all the more important and enjoyable when we have an opportunity to meet and consult with each other over those matters which are of common interest to our profession. It has been my observation that owing to the attenuated condition of the medical profession in many parts of the West it has kept up to the times by taking the best medical journals published, and the progressive members of the profession are all supplied with the latest publications from our best authors. Yet it is to be regretted that there are still some who fail to — 21 — realize the importance of closer scientific and fraternal relations, and, like Lucifer, live, "Never to hope again." Again there is another class of our profession who avoid so fas as possible a consultation with a brother practitioner, or when they do they feel that it is either their duty to disagree with him or live in mortal fear that he will disagree with them. This is a mistake and tends to the depreciation of the medical profession. My fellow-members of the Wyoming State Medical Society, permit me to admonish you never to refuse a consultation. It gives you strength and standing before the laity, and every con- sultation should be in the interest of the patient; every true mem- ber of the medical profession should be above anything that smacks of selfishness. Consultations should be purely scientific, investigating the facts, and then as judge of the court, arrive at a decision, based on the testimony before you, and do not fear each other, for if you are up in your profession, as a rule, you cannot but arrive at the same conclusion in the more common forms of disease, while on the other hand, in that class of cases which is deceptive to the best you cannot be criticised justly for having a different opinion from that of your fellow practitioner, and if you have it is no disgrace to you, but it should stimulate you to higher and greater efforts in the study of your noble profession. Re- member the words, "Our doubts are traitors, And make us lose the good we oft might win By fearing to attempt." Never take a different opinion to heart, but always bear in mind that the same symptoms in doubtful cases may lead you to have one opinion while your brother practitioner may be just as honest as you in having another. This, however, should never be allowed to cause enemies, for it is this very fact that depreci- ates you in the eyes of the public, which never stops to think that there is no end to the advancement of the medical and surgical sciences, and notwithstanding it has made greater progress dur- ing the last fifty years than any other science known to the world, it is still not infallible, and for this reason it is our duty to our- selves and our patrons to continue to burn the midnight oil and never give up our task until life shall cease to exist. In this way. and only this way, can the importance of closer scientific and fraternal relations be thoroughly appreciated. We must remem- ber that "The world's a room of sickness, where each heart Knows its own anguish and unrest, The truest wisdom, then, and noblest art, Is his who skills of comfort best; Whom by the softest step and gentlest tone Enfeebled spirits own, And love to raise the languid eye When, like an angel's wing, they feel him flitting by." Notwithstanding the state of Wyoming has medical laws that are in many respects better than those of some of its sister states, yet this is no reason why it should not take advantage of the best, and by so doing encourage closer scientific and fraternal relations, by amending our laws so that hereafter no one shall be admitted to practice medicine or surgery in any form in this great state without having graduated at a reputable medical college recognized by the Association of Medical Colleges of the United States or the National Confederation of State Medical Examining and Licensing Boards. Yes, further I would recom- mend the passing of a law creating a State Board of Health, which shall be vested not only with the power of examining into the qualifications of every physician or surgeon who shall knock at our door for admission to the medical profession of this state, but at the same time have under their care the sanitary and hygienic conditon of its citizens. On this question I can speak from experience, for notwithstanding my native state is one of the leading states in the Union from a commercial and political standpoint, yet it was only within the last few years that the medical profession of Ohio were granted laws which looked to the advancement of the medical and surgical sciences, and conse- quent protection of the citizens of that great commonwealth from the intrigue of charlatans and quacks. Truly are delays danger- ous in this connection, for as state after state in the Union passed laws compelling the medical profession to be proficient in their calling, the scums of these states naturally flocked to other states where there was no barrier against their quackery, where they were at perfect liberty to practice their nefarious schemes at the expense of the public. Hence I repeat it that it is important that this state should be abreast with the other states and have the best medical laws in the land that w*ill protect it and its citizens 23 from the schemes of the ignoramus, wiio only use the cloak of the medical profession as a means of gain and cares nothing for its scientific and fraternal relations, Before closing I beg your indulgence in calling attention to the importance of the medical profession of this state in standing as one solid phalanx against the passage of a bill now pending in the Senate of the United States with a view of prohibiting vivisection, for I am sure it is not necessary for me to state to you that wrere it not for legitimate vivisection the United States of America, which has recently shown itself to be one of the greatest powers of the earth, would not stand as it does to-day, the leader in medicine and surgery. We, as members of the medical profession, and our patients who patronize us and expect from us the best the world can af- ford, cannot tolerate the passage of any law that will take from us any possibility for the lessening of pain and the prolongation of life. Then, fellow-members, let us resolve ourselves into a committee of one and make it a point, regardless of political or religious relations, to make a personal appeal to our members of Congress and our United States senators against the passage of this nefarious law. In closing I wish to thank the members of this, the youngest state medical society of this great country, for the honor they have conferred upon be by electing me their first president, and trust each one of aou will remember, as we separate for our daily avocations, that "Above all price of wealth The body's jewel—not for minds profane, Or hands, to tamper with in practice vain— Like to a woman's virtue is man's health. A heavenly gift within a holy shrine! To be approached and touched with serious fear, By hands made pure, and hearts of faith severe, Ev'n as the priesthood of the One divine!" -24 — AUTO-INTOXICATION. By E. STUVER, M.Sc., M.D., Ph.D., Member American Medical Association, Fellow American Academy of Medicine, Etc., Fort Collins, Colorado. Weber defines auto-intoxication as a poisoning of the sys- tem by the products of its tissue metamorphosis; they may be normal products and do harm by excessive accumulation or may be abnormal, pathological, viz., either not at all or in minute par- ticles only present in the healthy body. (Charlotte Medical Jour- nal, Nov., 1897, p. 580.) During the early period of the germ theory of disease, the germs themselves were regarded as the maleficent agents and the active causative factors in the production of disease pro- cesses. Later on it was contended by many eminent authorities that it was not the germs themselves but the toxic materials or toxins which they generated that caused the trouble, and within still more recent 3'ears the theory that the body without the in- troduction of any external disease-producing germs or toxic ma- terials, can, by a retrograde metamorphosis of its own tissues, produce virulent poisons which may and frequently do lead to serious derangements and even cause death. It has been clearly demonstrated that intense muscular activity is followed by the formation of organic poisons. This poisoning is, other things being equal, in direct ratio to the in- tensity of the effort and the amount of muscular tissue involved. Fernand Lagrange, in his work, Physiology of Bodily Exercise, page 348, says: "In the opinion of all physicians in these days the fevers of overwork, which are observed alike in animals and in men, are due to a kind of poisoning of the body by its own elements, to an auto-intoxication of the system by the products of dissimilation which have accumulated in too great abundance in consequence of excessive work." Michael Foster, the great physiologist, in a lecture before the University of Cambridge, a few years ago spoke as follows: "When we have excessive muscular exertion, the weariness may take a form of distress, and if the effort be continued the distress may become so great as to occasion such complete exhaustion — 25 — that even death may result. In excessive work, of whatever kind it may be, in order for the work to be accomplished there is a greater demand upon the blood for oxygen. There are many things beside carbonic acid which are swept into the blood as the result of the activities of the body; in other words, the pro- duct of work in the human body is a poison which must needs be eliminated through the medium of the lungs and the other excretory organs. As physical and mental efforts are continued the eliminating capacity, unless carefully guarded, is marred, the resulting poisons are more and more heaped up in the system, poison the muscles, poison the brain, poison the heart, poison at last the blood itself, starting in the intricate machinery of the body new poisons in addition to themselves. The hunted hare run to earth dies not because his heart stands still, its store of en- ergy having given out, but because the poisoned blood poisons his brain, poisons his wiiole body." In view of these facts as to the formation of toxic materials by strong muscular activity, I have long been convinced in my own mind that many cases of mild poisoning following partu- rition in which every possible precaution has been taken to avoid external infection, are caused by the long continued uterine ac- tion, which, if intense and tonic, in all probability generates toxic materials much more rapidly than they can be eliminated, es- pecially if this action has been rendered more tonic, intense and continuous by the administration of ergot during labor. In a paper, "Should Ergot Be Used During Parturition and the Subsequent Involution Period," read before the Colorado State Medical Society in 1891, and published in the Journal of the American Medical Association September 15, 1894, I called attention to this subject, and I now desire to emphasize the po- sition then taken and to insist on the importance of keeping all the excretory functions of the pregnant and parturient woman in first-class working order. Furthermore, my experience has convinced me that a few small doses of calomel, in conjunction with acetate of potassium and sweet spirits of nitre, to each dose of which a couple minims of tincture of aconite root is added, if the latter be indicated, administered every two hours for a day or two, will arouse the excretory organs and poison-destroy- ing powers of the system and do more to relieve the threatening symptoms than all the quinine and coal tar derivatives that can be given to such cases. — 26 — In the preface to his translation of Bouchard's work, Dr. Oliver speaks as follows: "Bouchard, in his Auton-Intoxication, clearly indicates to us that man is constantly standing, as it were, on the brink of a precipice; he is continually on the threshold of disease. Every moment of his life he runs the risk of being over- powered by poisons generated within his system. Self-poisoning is only prevented by the activity of his excretory organs, chiefly the kidney, and by the watchfulness of the liver, which acts the part of a sentinel to the materials brought to it by the portal vein from the alimentary canal," and continuing, he says: " The part played by auto-intoxication in mental disease is attracting attention. In the Medical Week, August 11, 1893, there is a lengthy report upon the subject as discussed at the French Con- gress of Psychological Medicine by Drs. Regis, Chevalier-Lavaure and others. It has long been known that the various fluids of the body undergo modifications in the insane. Recent investiga- tion has shown that the urine is much less toxic than normal in cases of mania, while the lethal action of this fluid is increased in melancholia. Maniacal urine gives rise to excitement and con- vulsions, when injected into an animal, while the injection of urine from a case of melancholia is followed by a depression of spirits, restlessness and stupor—a proof that auto-intoxication is the cause and not the effect of the mental condition. I believe that every observing physician could bear witness to the fact that many cases of depression of spirits, mental hebetude and general pessimism are due, not to some incipient serious organic disease, as the patent medicine manufacturer or the blatant advertising charlatan wTould have the sufferers be- lieve, but are merely the result of the accumulated retrograde toxic products, produced by the normal activities of their bodies, but which, instead of being promptly eliminated, accumalate in the blood and poison the nervous centers, set up disorders of the digestive organs, overtax the liver and lead to almost innumer- able functional derangements. I had an excellent illustration of this sort of trouble in the case of a prominent county official that I treated a short time ago. He came to me with a severe, dull, heavy headache and a sense of weight and oppression at the base of the brain; mental hebetude, defective memory; tongue foul and quite heavily coated; bowels constipated and digestion impaired. This condition had existed for a month or two and he had been treated by another physician, who gave him several dif- — 27 — ferent prescriptions, but instead of improving he was constantly getting worse. I regarded the case as one of auto-intoxication and gave him small doses of calomel and sodium bicarbonate until the bowels acted freely; and the following prescription, viz.: R Sodii Salicylatis, 24.00 F. E. Oascarae Sagradae, 12.00 Aquae, 30.00 Syrupi Haematici Comp. (P. D. & Co.'s) q. s. ad.180, M. Sig: Teaspoonful three times a day. He almost immediately felt greatly relieved and in a few days the disagreeable symptoms had entirely disappeared. Bouchard, in his classical work on "Auto-Intoxication," has clearly demonstrated that normal urine—that is, urine taken from healthy persons—when injected into animals produces toxic symptoms, and if sufficient be used causes death. From a careful study of a large number of experiments on animals he arrives at the conclusion that the urine contains substances which pro- duce the following effects, viz.: First—A diuretic substance, which is urea. Second—A narcotic or truly toxic substance to which a name has not yet been assigned. Third—A sialogenous substance, or one which produces salivation or an increased flow of saliva. Fourth—A convulsive substance, fixed, stable, organic, in- soluble in alcohol; it might belong to the group of coloring sub- stances from the manner in wiiich it behaves; it is really an alka- loid, since it is insoluble in alcohol either in the form of a salt or a base. Name not determined. Fifth—A substance which produces contraction of the pu- pil; fixed, organic, possibly a coloring substance; probably not an alkaloid. Sixth—A heat-reducing substance which lowers the tern perature by reducing heat production. Seventh—Another convulsive substance, fixed, inorganic, in sliort, potassium, whose toxic and convulsive properties have long been known. {Auto-Intoxication, pp. 60-65.) Time will not permit me to enter into the details of this ex- tremely fascinating subject, but en passant I desire to report a case of auto-intoxication from retention of urine. On April 22, 1898, I was called to see a case sixty-five miles north of Rawlins and found the following condition: The woman 28 - had been confined with her second child about six days before; the placenta was retained. This was removed and the uterus curetted and washed out by Dr. Calloway of Lander, Wyoming, about three days after the birth of the child. I found the woman at 8 o'clock p. m. in great distress, pulse about 120, temperature 104 degrees F.; tongue coated and foul; bad taste in mouth; no appetite; bowels somewhat constipated and the whole body was covered by a dark purplish eruption very much like that of measles; face, hands and feet greatly swollen. There was no pain nor tenderness of uterus nor abdominal dis- tension ; discharge from uterus about normal in quantity and free from offensive odor. She had not passed any urine for over seventy-two hours, and I drew off seventy-two ounces of highly- colored urine, which afforded great relief. I at once began to administer diuretic and eliminant remedies and the pulse and temperature almost immediately began to fall so that on the following morning they were nearly normal. This treatment re- sulted in a prompt recovery, but the husband reported to me later on that there was an extensive exfoliation of the epidermis which came away in great scales, some several inches long. It is gradually beginning to be more clearly understood that not only are diseases directly connected with the digestive and urinary organs caused by auto-intoxication, but likewise disorders of distant and special organs are due to the same cause. In the Journal of the American Medical Association, October 1, 1898, p. 772, is published a paper by Dr. H. B. Young on "Amblyopia from Auto-Intoxication," in which, after eliminating other causa- tive factors, the author very conclusively shows that in all prob- ability they were due to this cause. This paper (read at the Den- ver meeting of the A. M. A.) elicited an expression of opinion on the part of a number of eminent medical gentlemen, who corrobo- rated the views expressed by the author. Dr. Casey Wood of Chicago spoke as follows: "I have been especially interested in Dr. Young's paper because I believe that I have obtained ample evidence of the auto-intoxication theory of amblyopia. Another matter to consider in connection with this paper is that form of atrophy of the optic nerve that Uthoff placed among the unknown causes. I have for several years held the belief that these cases were in some instances, at least, due to auto-intoxication," and Dr. Dudley S. Reynolds said: "I have every reason to believe that there are many cases of amblyopia due to auto-intoxication. That — 29 — view has been forced on me by experience. The inhibitory effect of alcohol on the eliminating organs affords at least reasonable grounds to suspect that a part of the results of amblyopia form- erly attributed to alcohol are really due to auto-intoxication, be- cause similar conditions are found in people with disturbed nu- trition who do not use alcohol." Dr. Jonathan Hutchinson (Archives of Surgery, July, 1898), writing about the infective materials generated in the act of in- flammation, speaks as follows: "Whilst there can be little doubt that the introduction at the time of the injury of some living germ matter (bacillus) developed in connection with the process of inflammation in the contributor very greatly adds to the risk and gives character to the inflammation induced, there are good reasons for doubting wThether any such material is essen- tial. It is highly probable that in some instances a chemical product of decomposition may take its place, and further that in some cases no poison of any kind has been introduced. In the latter group we have to suppose that the tissues of the person wounded are capable of generating as the result of merely me- chanical irritation a poison which shall prove infective. We have to accept the proposition—in all probability a truth—that the inflammatory process, however initiated, is always attended by the production of a virus (living or chemical, or both). Inflam- mation in its early stages always leads to multiplication of modi- fied cell organisms which may be infective; in its later stages it leads to death of cells and may favor the access to the blood of chemical elements, the result of decomposition which may prove very injurious." (Charlotte Medical Journal, September, 1898, p. 320.) While not relaxing one iota of our care and vigilance to prevent the introduction of external infective materials (indeed, I believe every possible precaution should be taken to prevent such an undesirable contingency), yet at the same time I believe the facts to which I have called attention above should give us a more comprehensive view of the causes of diseases and increase our vigilance in preventing them and enlarge our power of com- batting them when existent. While such a course should not make us less eager in our search for the specific bacilli, bacteria et id omne genus and their toxins, which cause many diseases, it should at the same time en- large our mental horizon and impress upon our minds the fact — 30 — that our whole duty is not comprised in identifying the germ and discovering a germicide to destroy it, but that the afflicted in- dividual should at the same time receive our most serious and earnest consideration. We should strive to secure the elimina- tion of the peccant materials by keeping the excretory organs in good working order and by strengthening the cells and tissues in their fight against their destroyers. As the individual is the social and economic unit of a nation, and as the strength and resisting power of a nation depends on the health and integrity of its individuals, so the cell is the in- dividual element of the organism and on its strength and unim- paired functional activity depend the health and possibly even the existence of the body. As money is the circulating medium of a nation, which enables its individuals to exchange their products, satisfy their wants and gratify their aspirations and ambitions, and as the prompt performance of these necessary functions depend on its free and unimpaired circulation among the individuals compris- ing the nation, so the blood is the great circulating medium of the body and on the proper performance of its functions depend the health, integrity and functional activity of every cell and tissue of which this body is composed. In a normal, healthy condition a never-ending interchange is going on between the component cells of the body and the blood. If this interchange is free and unimpeded the blood con- stantly conveys to every cell and tissue the nutrient material necessary for their growth, the preservation of their integrity and their proper functional activity, and receives from these cells their retrograde toxic products and conveys them to the excretory organs, which, if they are in proper working order, promptly dis- charge them from the body. When the truth is once thoroughly understood and appreci- ated that anything which interferes with the functional activity of the excretory organs and prevents the free elimination of poisons not only causes the blood to become loaded with toxic materials and thus renders it less able to take up the retrograde products of cell activity than when it contains a comparatively small amount of these materials, but that the poisoned blood less readily conveys the nutrient material which is absolutely neces- sary for the life and health of the cells, and that the accumulating poisons inhibit their activity and lessen their power to recognize — 31 — and combat maleficent agents, when I say we once fully appre- ciate the importance of these truths and realize to how great an extent the welfare of the body depends on the consentaneous activity of the cells, the blood and the excretory organs, we will be able to appreciate the importance of auto-intoxication as an active factor in the production of diseases. SUPPURATIVE DISEASES OF THE ACCESSORY SINUSES OF THE NOSE. By WM. WINTHROP BETTS, M.D., Salt Lake City, Utah. While a great deal has been written on the subject of sup- purative inflammation of accessory sinuses of late, it is a sub- ject that can hardly be said to be exhausted. It is one of great importance, and is equally interesting to the general practitioner and rhinologist. A chronic purulent discharge from the nares, associated with little or no fetor perceptible to the attendant, with a history of nasal polypi, an acute "head cold," hypertrophic nasal catarrh, or perhaps of alveolar abcess at a period more or less remote, has, comparatively speaking, only recently and with the development of the study of rhinology, been of any special significance to the surgeon. With the evolution of the specialist, howTever, and classifi- cation of diseases of special organs on a more scientific basis, was soon followed by a clearer comprehension of the nature of morbid conditons of which such a discharge is the evidence, and in many instances the only evidence at the command of the phy- sician. Treatises on general surgery, as found in our libraries, con- tain very little that is of practical value upon the subject, and even those more recent and exhaustive works upon rhinology which have appeared within the last decade, give comparatively little space to the discussion of the aetiology, pathology and treat- ment of a morbid condition, the importance, the consequences and the extreme obstinacy of which can only be estimated by -32- those who, like myself, have often seen their best efforts vainly directed, and that with perfect cognizance of the existing con- dition. That empyema of these sinuses is not an infrequent compli- cation I am assured, as well from the number I have myself seen as from the reports of others, and yet I am convinced that it is less often recognized and correctly differentiated than any other disease of the nasal tract. AETIOLOGY AND PATHOLOGY. Many are of the opinion that the most frequent cause of this disease is the extension of the inflammatory process from the nose into the cavities. While Bosworth and others dissent from this view, believing that the diseases rarely result from an ex- tension of the inflammation through the continuity of tissue, but is due rather to a catarrhal inflammation of the mucous mem brane of the sinuses, brought about by a closure of the nasal open- ing, Baerhav's researches show that in the normal condition the sinuses contain a bland, inodorous, gelatinous, colorless fluid; that this secretion keeps the walls moist, but does not accumulate in the cavities, it being partially absorbed and possibly partly evaporated by the passing air current, but should causes operate to close the orifice, the external air could not penetrate into it, nor could the air already in the cavity escape from it. In this case the vascular system would act as a medium for gradual ab- sorption of the confined air, which would necessarily be replaced in the sinus by secretion. But as this secretion could not be ab- sorbed as rapidly as exuded, the air yet remaining in the cavity of the sinus would decompose the accumulated mucus, thereby causing irritation and disease of the mucous membrane, and which eventually degenerates into one characterized by a puru- lent discharge. In this manner hypertrophic rhinitis and polypi producing stenosis of the natural opening, frequently cause a sup- purative inflammation. Zuckerkandl, in his treatise on pathological anatomy of the air passages, says: "My experience with the inflammatory dis- eases of the lining of the accessory sinuses is that then- mostly follow pathological processes of the nasal mucous membrane," while Watson of London (in his work) expresses the opinion that nasal polypi are the most frequent causes of suppuration. - 33 The cavities also become infected and undergo changes in diphtheria, measles and scarlatina. Bacteriological examinations of the accessory cavities were made by Dr. Wolff of Paris in 1896 and twenty-two cases were examined. In all there were dis- ease changes in the antrum of Highmore. In seven cases only slight changes were observed, these being mucous and muco- purulent secretions without inflammatory changes in the mucous membrane itself. In the remaining fifteen cases there were more marked changes, the mucous membrane being in a condition of inflammatory oedema with hemorrhage in places. The diphtheria bacillus was confined to the cases with marked changes, and was absent in three out of fifteen. The sphenoidal sinuses were not developed in fifteen cases. In the other seven cases there were more or less inflammatory changes. In six of these the diphtheria bacillus was present. The frontal sinus in the only case in which it was examined was the seat of severe edematous swelling and contained diphtheria bacilli. Five cases of measles and two cases of scarlet fever were also examined, various bacteria were found, and severe inflammatory changes were found like those in the case of diphtheria. Influenza is found to be a fruitful cause of suppurative dis- ease; traumatism and syphilis may also be the cause of the trouble. Text-book authorities seem to be about equally divided as to antrum trouble—on the one hand asserting that disease of the teeth is the most common source of the affection, and on the other believing the majority of cases result from diseases of the nasal cavities. I will quote from a paper read before the A. M. A. in 1896 by Dr. M. D. Fletcher, entitled, "What a Dentist Saw In Examining 500 Crania." "As to diseases of the antrum, it is claimed by the majority of authors that this disease comes more frequently from abeessed upper molars than from any other source. My series of examinations showT that out of 252 cases of abeessed upper molars, only 12 perforated the antrum. This would seem a remarkably small number and would indicate that abeessed teeth do not cause antral trouble as often as is generally maintained, and there is good ground for the belief that the teeth may often be affected by disease of the antrum." And later on he states: "It is my belief that if accurate statistics could be had they would indicate that the exciting causes of disease of the antrum is ten to one in favor of intranasal diseases." — 34 — On the other hand, we find that Dr. William Carr of New- York stated before the A. M. A. in 1889 that, "in his belief 80 per cent, of the cases of suppuration of the antrum are caused directly or indirectly by diseased teeth." In Burnett's system of diseases of the "Ear, Nose and Throat," I find an analysis of thirty-one cases. Thirty-three per cent, were due to dental caries, 10 per cent, to tumors, 22 per cent. to unknown causes, wiiile but 13 per cent, could be attributed to causes arising within the nose. The proportion here attributed to dental diseases seems to me extraordinarily large, likewise the number for which no cause could be found. That it is often im- possible to determine which of two existing lesions—dental caries or hypertrophied and degenerated turbinated tissues—is the primary cause of pus secretion in the antrum, I am well aware. However, reviewing what has been written upon aetio- logy, we find a somewhat startling difference of opinion even among contemporaries with equal opportunities for observation. It would be difficult to account for this discrepancy w7ere it not that most of the writers of ten or fifteen years ago were influenced largely by the purely surgical aspect of the disease. To illustrate, I will quote from Garrotson's System of Oral Surgeiw. He drew the conclusion that "diseases of the antrum are for the most part simple in character, easy of diagnosis, and as a rule not at all difficult of treatment." And Louis McLean Tiffany, professor of surgery, University of Maryland, says in his article written for the American System of Dentistry: "The diagnosis offers no diffi- culty and treatment is simple and rapidly effective." This con- clusion is very misleading, and I think it will be borne out only by the experience of the oral surgeon, and not by that of the rhinologist. For reasons at once patent, the former as a rule comes in contact with those cases arising from caries of the teeth alone, and that during or subsequent to the acute stage, while the latter has to deal with those arising primarily in the cavity, or from a diseased condition in the nose as well, and as a rule is consulted only after chronicity is well established, the history often indefinite, and merging into that of polypus, or hypertrophic catarrh, and without those perfectly clear aetio- logical landmarks which present in the former. Now, if this be true of the antrum, the largest and most commonly affected of all the accessory cavities, it applies with much greater force to the conditions affecting the frontal and sphenoidal sinuses and the 35 — ethmoid cells. When these cavities are affected, it is by no means an easy matter to correctly diagnosticate the case, and still less so to successfully treat it. DIAGNOSIS AND SYMPTOMS. In spite of the advances that have been made in the study of diseases of the nose and its neighboring sinuses within recent years, we still find abscesses that have existed in these cavities for a long period and have been treated for neuralgia, etc. These facts bring the symptoms and diagnosis to our attention with un- usual interest. The symptoms of empyema of the antrum vary with the in- tensity of the inflammation and the possible closure of the ostium- maxillare, varying from a mere discharge of pus into the nasal cavity to the most distressing sensations, pain and tenderness. A suppurative inflammation of the nose is an extremely rare affec- tion. It may, however, occur from infection, as, for example, from gonorrheal poison. Aside from the infection above men- tioned, there are five possibilities, after eliminating wounds and inflammation following the acute exanthemata, that may give rise to pus in the nasal chamber: First—Foreign bodies, including nasal polypi. Second—Diseases of the bone. Third—Secretion of pus from the antrum of Highmore. Fourth—From the anterior ethmoid cells. Fifth—Secretion of pus from the frontal sinus through the infundibulum. While the secretions from the posterior cells find their way into the pharynx with those from the sphenoidal sinus. If pus should continue to flow after the removal of the polypi or foreign body, we are then likely to have either an abscess of the maxillary sinus, of the frontal sinus, or of the ethmoid cells. Occasionally it is difficult to differentiate between these, for in each case pus is found in the middle meatus, extending along the inferior border of the middle turbinate body. When this body is sufficiently contracted, which can be accomplished by an appli- cation of a 10 per cent, solution of cocaine, the middle meatus will be brought into full view and pus found in the hiatus-semi- lunaris. If it is not possible to bring about the contraction of this body by cocaine, then the hypertrophied or swollen tissue should be destroyed by means of cautery or chromic acid. The opening of — 36 — the frontal sinus will be found in front of the ostium-maxillare in a funnel-shaped depression (the infundibulum). Owing to the close proximity of these twro openings, it is very difficult to dis- cover from which the pus flows. Hartmann of Berlin has sug- gested the following method to ascertain the source of the secre- tions: "After drying the parts thoroughly with absorbent cotton, he drives a blast of air through the affected nostril by means of a Politzer air bag." By this procedure he claims to be able to aspirate the pus from the sinus and thus discover its source. Another point in the differential diagnosis is that abscess of the maxillary sinus is of comparatively frequent occurrence, wThile that of the frontal sinus is comparatively rare. The most positive means of differentiating between these two affections is by making an exploratory puncture under the inferior turbinated body about its middle. There is very little pain following the operation and it is devoid of danger. The puncture should be made in all doubtful cases, and its use will, I think, tend to prove that this affection is much more common than is generally sup- posed. In continuing, I will limit my remarks as much as possible to the frontal and ethmoidal sinuses. It is very important that these cases should be recognized and treated early, for upon their early recognition depends the final issue, which in many cases has resulted in death of the patient. In well-marked cases the diagnosis of abscesses of the ethmoid cells is not a difficult mat- ter, but in many instances the symptoms are obscure, and there is frequently an implication of one or more of the neighboring cavities, so that it is almost impossible at times to tell which is the source of the pus. Then we can arrive at a diagnosis only by exclusion. Among the earlier symptoms of abscess of the ethmoid cells may be mentioned pain, neuralgic in character, referable to the bridge of the nose, increasing in intensity with the progress of the disease, and extending outwardly along the inferior orbital ridge, and occasionally along the superior orbital ridge. With a distension of the cells there is a sense of pain, pressure felt in the orbit, and a narrowing of the field of vision. On rhinoscopic ex- amination, if the abscess is of the open variety, pus will always be found in the middle meatus, and if the posterior cells are in- volved it will occasionally be found passing into the post-nasal space. The middle turbinated may or may not be enlarged. 37 — This depends on whether it communicates directly with the ethmoid cells. Occasionally an abscess may exist in the frontal sinus without giving rise to any symptoms except a slight dis- charge of pus from the nose, but in the majority of cases the symptoms are very pronounced and vary in intensity according to whether the frontonasal duct is open or closed. Pain in the frontal region at first is dull and then becomes lancinating in character as the secretions distend the cavities. This is the most common symptom. There is pain on pressure over and under the supra-orbital ridge, and there may also be some redness and swell- ing of the skin over the affected sinus, which sometimes involves the eyelid. If the frontonasal duct is open there will be a dis- charge of pus from that side of the nose, and upon rhinoscopic examination pus will be found in the middle meatus just under the anterior extremity of the middle turbinated body. This is the variety of the disease most frequently met with. If, however. the duct should be closed, then there is a dilatation of the sinus, with a tendency to bulge at its thinnest part at the inner angle of the orbit, on a level with the root of the nose. If there is no relief, the pus finds its way through the swelling into the orbit or ruptures posteriorly into the cranial cavity. Occasionally ab- scess of the frontal sinus is complicated with abscess in the ethmoidal and maxillary sinuses. As these cells are in close proximity to the frontal, in all cases of obstinate or prolonged suppuration in this cavity they are involved in the suppurative process. The method which promised much for differential*diagnosis was brought out some years ago. By many it is considered the most valuable agent of diagnosis we possess, while others con- demn it and a few- speak of it as an elegant plaything. I refer to transillumination. My personal experience with it, however, is limited and unsatisfactory, possibly due to faulty methods of ex- amination, and I hope some one here can come forwrard with a more favorable opinion. In passing I refer you to papers of Dr. Codwell (New York Medical Journal, Vol. 58, p. 528) and Frank S. Malbury (New York Medical Journal, Vol. 64, p. 519). These very excellent papers give very full notes on technique and reports of cases. After reviewing the observations of many rhinologists the results are disappointing. While transillumination has its field as a diagnostic method, it should not be depended upon to the 3H exclusion of other valuable means. Taking all the results into consideration, it may be said that transillumination is of value in some cases to corroborate an already established diagnosis, but that it cannot be regarded as a reliable method, particularly if.the other well-known symptoms are absent. I think it might be of more value in watching the progress of cases under treat- ment than as a method of diagnosis. I have dwelt thus at length upon the aetiology and diag- nosis as the importance of early recognizing the exciting causes of the disease in question cannot be overestimated by one who expects success to attend his efforts toward a cure. When but one sinus or one side is affected and in typical cases seen early, diagnosis is not difficult, but typical cases are not the rule, and it is seldom that the advice of a physician is sought before chron- icity has complicated the primary lesion with its confusing se- quelae, and then it is that diagnosis will often of necessity sink to the level of a mere conjecture. Of the treatment of these affec- tions I can say very little that is not better told, and as I have already trespassed upon the time of the society, I will refer you to the published reports of cases and the text-books for the de- tailed methods of procedure. However, in order to bring the subject of treatment before the society for any who care to dis- cuss it, and yet remain under the dominion of this paper, I will state as briefly as possible some deductions made from personal experience and quite an extensive review of the literature on the subject. First—Not all cases need surgical interference, and many acute cases get well spontaneously, others by treating the hyper- trophy of acute coryza. Second—That we must be guided in the choice of operation by the probable cause of the trouble and its chronicity. In empyema of the antrum, when due to inter-nasal obstruc- tion or inflammation, remove the obstruction and reduce the in- flammation; if the discharge is inodorous and no other symptoms, wash out through the normal opening or puncture in the inferior meatus. If there should be other grave symptoms, such as those due to pressure and death of tissues of the antrum, not due to dental caries, the choice of operation would be through the canine fossa, and I would only sacrifice a tooth when there is everyreason to believe the trouble due to dental caries. As a cause for opera- — 39 — five interference dental caries can be excluded from the other cavities. One of two methods can be chosen for operating on frontal sinuses: Inter-nasal, and by perforating just above the super- orbital ridge. The sinus may be freely opened by enlarging the infundibulum through the nose with a curette, and the sinus irri- gated and medicated by means of a soft silver catheter. The older operation of cutting through the frontal bone is necessary in all cases of extreme exfoliation or necrosis. When the ethmoid cells are affected it is advisable to break through them and curette. In order not to confuse symptoms and indications for treat- ment, I have avoided speaking of the sphenoid sinus except in a general way. The posterior ethmoidal and sphenoidal cells, how- ever, form what may be called a posterior group. Their openings are above the middle turbinated body and can be studied only in the rhinoscopic mirror. The posterior ethmoid cells are drained by several openings above and below7 the superior turbinated bone. Therefore pus found in this region or seen in the posterior examination above the middle turbinated body must have escaped from the posterior ethmoid cells. The sphenoidal opening is in the extreme upper portion of the posterior wall opposite the su- perior turbinated body, and the usual course of the secretion from it is downwards along the posterior wTall close to the septum. The subjective symptoms of empyema of the cells is similar to the other cavities except the headache is referred to the back of the head, and there are more marked ocular symptoms. I was very much interested in a discussion precipitated by Dr. Bosworth last year before the A. L. A. relative to the fre- quency of sphenoidal disease. Dr. Bosworth says: "My own records show reports of 150 cases of ethmoid disease, which as a rule yielded more or less satisfactorily to treatment, but in all my experience I have seen but two cases of sphenoidal disease and both terminated fatally." Leading specialists of the country give evidence in their discussions of similar experience. These statements would indicate it to be a rare disease, still more rare as a primary disease and more frequently observed as a compli- cation of abscess of the ethmoid cells. The operation for relief of the sphenoid trouble is exceed- ingly difficult even in the hands of experts, the choice of operating being the anterior-nasal and the posterior. The body of the — 40 — sphenoid can be reached from either angle. The treatment of dis- eases of the accessory sinuses will occasionally be found very tedious and discouraging, but if care has been taken to establish free drainage and the antiseptic applications thoroughly applied, the majority of patients will recover. CEREBROSPINAL- MENINGITIS. By JOHN F. LEEPER, M.D., Casper, Wyoming. In the year 1805 Vieussens described, under the designa- tion of a "malignant, non-contagious fever," a disease which of late years has become one of the most dreaded maladies which the physician is called upon to treat. Previous to that date we have no record of it in the writings of any authority, but since that time we find it treated of at length in the works of all writers on general medicines. Cerebrospinal meningitis might be defined as a malignant, non-contagious, inflammatory disease, probably due to microbic infection, and manifested by the occurrence of acute inflamma- tion of the meminges of the brain and spinal cord. That the dis- ease is primarily a constitutional disease, and that the meningitis is but the local manifestation of systemic infection, is abund- antly proven by clinical research. Although the disease some- times occurs as a complication of other diseases, it is usually primary and the patient is stricken down abruptly, without any premonitory symptoms, and is in a dangerous condition from the first, and in a large percentage of cases the disease ends fatally, from the intense hyperaemia of the nervous centers, or from the severity of the cerebro-spinal meningitis. It is now generally believed that the disease is of microbic origin. The microbe is of an oval shape and occurs mostly in pairs. It resembles the pneumococcus of Friedlander so closely that the best microscopists are of the opinion that they are iden- tical. Cases have been related by competent observers that seem to show that in some instances the cause of cerebro-spinal men- ingitis and pneumonia might be identical. The epidemic which 41 _ I observed occurred in just such weather as would be favorable to the development of pneumonia, but during the whole continu- ance of the epidemic there were no cases of pneumonia that came under by observance. The rapidity with which the exudation is poured out around the brain in cerebro-spinal meningitis, taken in connection with other symptoms, have led me to wonder if the disease were not a metastasis of the specific cause of pneu- monia, which, under certain favorable conditons, took up its seat of action in the meninges, instead of the lungs. This point re- quires further study, and is a favorable field for original investi- gation. That cerebro-spinal meningitis is not contagious is, I think, settled beyond question. That it is dependent upon some local anti-hygienic condition is also highly probable. In one in- stance I had three children, all there were in the family, sick at one time. They lived on the third floor of a flat, and on the floor below- were three other children, of similar ages, who came and went about the sick room as often as they wished. Two out of the three cases died, while not one of the children living on the second floor contracted the disease. The surroundings of the two families were practically identical, so far as outward appear- rances would indicate. Why one family should be attacked and the other escape is hard to understand. The lower animals are often affected with the disease. In 1890 there was an epidemic of cerebro-spinal meningitis among the horses in the vicinity of Casper, in which whole herds were exterminated. In one instance the effect of locality was very clearly illustrated. The horses had been dying at the rate of three or four a day, when the owner determined to change the range. They were moved to a new range, only a few miles away, and from that time on only two animals were lost out of the herd. In the epidemic of last spring I advised all who could to leave town, and although some of the families only moved a few miles into the country, not one case occurred among those who left. This proved to me that the incubative period is very short, and that the cause or causes of the disease are limited in area. In no instance has the disease been transported from one city or locality to another, so far as I am aware. In May and June of the present year I attended eighteen cases, six of which were fatal. Of the six fatal cases one died in thirty-six hours and all died in less than five days after being attacked. The first case was that of a little girl aged 6 years, — 42 — who was taken with vomiting about 11 o'clock at night, which, after an hour or two, subsided, and she slept well until morning. I was sent for next day about noon and found the child about the house, feeling fairly well. I did not examine her very closely, but concluded, from the history of the case, that she had had indi- gestion and that all she needed was simple treatment, and so I informed the parents. I prescribed a mixture of pepsin and bis- muth, and when I heard from her that evening she seemed as well as ever. She played in the yard after supper and went to bed at the usual hour and slept well until about midnight, when she waked up crying with the headache. She vomited, and when the parents found that the medicine that I had been giving did not relieve her I was sent for and found her in a semi-cons- cious state, with widely-dilated pupils, with the head retracted and the arms flexed strongly at the elbow. Upon trying to straighten the arms it seemed to cause suffering, and the slight- est touch about the chest or abdomen seemed to cause intense pain. After a careful examination I pronounced the case cerebro- spinal meningitis, and told the parents she would probably die. Nothing that I could do seemed to benefit her in the slightest degree, and she died next day at 2 o'clock p. m. The surface was covered with petechial spots, which, several hours before death, became purple and sometimes black. Death was apparently due to failure of respiration, the breathing becoming irregular and finally stopping altogether, while the pulse continued to beat after the breathing had entirely ceased. I relate to you this case only to call attention to the fact that the disease is characterized by remissions, when all the symptoms are improved, and the physician and family are liable to believe that the danger is past, when in a few hours, or even minutes, the symptoms return with increased severity, and, if the physician has given a favorable prognosis, he is now placed in a very unenviable position. The symptoms vary in different cases, but in all the cases treated by me in this epidemic the onset was sudden and usually attended by vomiting. Most of the cases developed in the after noon or early part of the night. I did not see a case where the sickness began in the early morning. Among the earliest symp- toms are those relating to the pupil of the eye. In most cases the pupil is found dilated and it does not react readily to light. In some of the cases observed by me there was irregular contraction. In one case one of the pupils was crescent-shaped. In some cases — 43 - there is marked strabismus, which is usually convergent. The skin presents appearances which, taken in connection with other symptoms, is highly characteristic. In even the mildest cases there will be found certain eruptions. In some of the mildest cases small, symmetrical, rose-colored spots will be found scat- tered on the surface, which are most pronounced on the soles of the feet and palms of the hands among children. In the most serious cases the eruption may be in the form of petechiae, or may be as large as a dollar. The eruption seems to be a hemorrhage into the skin. I did not observe any hemorrhages from mucous surfaces in any of my patients. In regard to the treatment, I found that in some cases cold applications to the head and spine were well borne and seemed to do good, but in a great many cases they produced too much dis- turbance and required force in some cases to keep them on at all. After trying both my preference is for heat instead of cold. My plan was to shave the head and make a poultice of flaxseed meal, made somewhat irritating with mustard, in the shape of a cap, to completely envelope the head, and another along the spine. These were changed every few minutes, applied as hot as they could be borne. This I kept up night and day until the symptoms began to abate. Internally I am opposed to the use of morphine or opium. I tried both faithfully but was disappointed in their use, and finally discarded them altogether except as an adjunct to other medicines. I used bromide of potassium for the rest- lessness and headache and gave the veratrum-viride in frequent and full doses. In using veratrum-viride I preceded the dose with a small dose of deodorized tincture of opium to prevent the nausea produced by the veratrum. Two cases treated in this way recovered when the symptoms seemed as bad as any of those that I lost on other treatment. In the declining stage of an epidemic there are a great many abortive cases in which the symptoms start in severe but cease as suddenly as they began, and recovery takes place in a short time. In still other cases the disease is prolonged for several weeks, while the symptoms are at no time severe, recovery taking place with simple treatment. I would like to go fully in detail in regard to this import- ant disease but have not got the time, and so will close, asking the society to excuse this poor effort at handling a very import ant subject and promising to do better at the next meeting, when I hope to be present myself and renew old acquaintances and make new ones. -44 HOW DOES THE CAUSE OF DISEASE PRODUCE DISEASE—A FURTHER STUDY. By G. M. RUSSELL, M.D., Dixon, Wyoming. In the Journal of the American Medical Association of July 2, 1898, appeared an article entitled, "How Does the Cause of Disease Produce Disease? A New Interpretation of Operative Principles," by Dr. W. B. Dunham of Keene, New Hampshire. The subject matter of this article appeared to me to be worthy of some study and consideration and to be of such a nature as might prove of interest, at least to some of the mem- bers of this society. Dr. Dunham holds that vital force is the only active force responsible in the manner of causing disease. He quotes from a distinguished editor of an American medical journal as follows: "There is no drug yet discovered, unless it be alcohol, which adds to the forces of the body." He then goes on to say: "But even this only source will be discredited when it is recognized that medico-biologic science is based entirely on the functions and operative principles of the vital force energies; therefore in place of teaching medico-biologic science as being based on functions and operative principles, derived from both within and without, this division of natural science will have its recognized first prin- ciples beginning with the comprehension of the nature of the vital force agency." He also quotes from Henry Maudsley. "It is easy to per- ceive how impossible it is in the present state of science to come to any positive conclusion in regard to the nature of vital force. This generation and generations to come will have passed to their everlasting rest before a discovery of the secret of vital activity is made." Commenting on this he says: "Notwithstanding such statement the vital force problem, as implied in the operative plan of its several ultimate principles, is already solved, and is no more difficult to comprehend than the Copernican plan of astro- nomical science and may be as positively demonstrated." He lays great stress upon his definitions for sensibility, in- stinct, sensation and contractility and says a proper understand- ing of them is necessary in order to comprehend his theory. — 45 — His entire theory is based on sensation and its transmission, in that pathologic processes are set up by irritation reflexly; that the conditions called health and disease are each presented or executed as involuntary acts in response to existing sensation, normal or abnormal. That medicine is useful, not because of an associated active principle, but as the means from a relation of contact for the development of special sensations—the idea that medicine acts is misleading; there is no medical power, but medi- cine causes special sensations in response to which involuntary life acts are exercised; that the cause of disease does not attack the organism; that the food or soil favorable for development of bacteria in the human system is made to exist largely from pathologic vital action, and thus in the virus produced by non- recurrent contagious diseases micro-organisms will, multiply into millions and perish when the food supply or materies morbi is no longer liberated—in such instances the presence of the microbe becomes a consequence rather than a cause of the disease; that the "special virus" is a product from pathological vital action and not a poison excreted or secreted by the microbe—the mi- crobe does not come in and attack the human organism, but simply multiplies and consumes the virus as scavengers—that it is the virus and not the microbe that becomes the cause of the disease; that the microbe is not sufficiently complex to perform the function of excretion or secretion of poison and does multiply and perish rapidly; that it is only the micro-organisms which have been developed from some virus cause of disease that cause pathological disturbances to be manifested. It would seem to me that in endeavoring to reason out the method in which the cause of disease produces disease, Dr. Dun- ham made his cause of disease to conform to his new theory, instead of modeling his theory to conform to the accepted cause. At any rate, he has lost sight of the real cause itself, and there is danger of leaving us just where we were before the microbe and its relations to disease were discovered. The only demonstrable causes of certain diseases are the micro-organisms, and as we all know, the bacterium of each disease has its own peculiar charac- teristics, and it is always found in the disease which it produces if looked for by a competent and careful observer. The same dis- ease is caused by the same microbe when introduced into a healthy organism, and yet in the face of the evidence that the ab- solute causes of these diseases are microbic in character, this -46 — new theory is advanced, refuting and branding as false the posi- tive knowiedge which the results of many years of labor and in- vestigation have made one of the pillars upon which the science of modern medicine rests; assuming that the microbe is generated de novo and adopting instead a vague, indefinite "special virus" liberated by vital force, the initial cause of which is irritation— and by what? He does not state what the irritation may be which in the first place causes an impulse to pass in through the sensorium and cause reflexly the liberation of virus, nor does he enlighten us as to the material from which the special virus is produced, nor yet again from what the microbe may result. The microbe again is but a scavenger to consume the virus. Then why would it not be better to introduce them and aid and succor their growth in order that the virus may be the more quickly devoured ? Why are the modern surgical methods so successful in dealing with diseased conditions? Can it be possible that the antiseptics in use, so destructive to the bacterium, are in every case coindi- dently destructive to the special virus? Then as to the differen- tial cause he makes no provision, whether there is a different kind of irritation necessary to produce diphtheria from that which is required for typhoid fever or measles, or whether it is necessary that the irritation should be produced upon a certain set of nerves for its differential effect. He says we should observe a distinction between primary and secondary causes. The former may occasion a disturbance which in itself later develops a great variety of secondary causes for the continuance of disease. According to this, why should we not have a cycle of all diseases, each new batch of virus serving as an irritation for a succeeding lot? Then as to the army of disease microbes, which he says is not hovering in the air await- ing an opportunity to attack exposed tissue, we are all aware that the great mass of microbes in the air are non-pathogenic. The only way in which he explains the method of causing disease is through a reflex; but that is not sufficient; it does not take us to the last step in the process. To what particular cells and what particular organ or organs does the reflex go? Of what nature is this special virus, how is it elaborated and from what? What causes the original irritation? If virus which has been introduced, what shape is it in and howr has it gained en- trance? In fact, what are the successive steps from the introduc- tion of the cause of the original irritation to the elaboration of — 47 — the virus? After elaboration of the virus what becomes of it if it is not consumed by the microbes? Vital force is like the mind, an unknown quantity. It is. as an eminent alienist has pictured the mind, "but an organist." and when the organ is out of tune or out of repair the result is a discordant jumble. And so with the organs over which vital force presides. When the cells of the organs have departed from a state of health or from a state of "harmony with their environ- ments," as one author puts it, vital force can do nothing but what the organist would do—strike the proper keys. We are no nearer the solution of the vital force problem than we were at the time Maudsley wrote the words above quoted, and I see no more reason for accusing vital force of that of which it may be innocent than I do for ascribing to "reflex" all the ills of humanity for which we can discern no other cause. Judging by analogy, however, I cannot believe that vital force changes its character any more than any of the other forces of nature, nor, by the same process of reasoning, do I see why it should be governed and controlled by irritation. The results of the actions of the other forces of nature vary with the nature, conditon and properties of the ob- jects upon wrhich they act, and why should vital force be an ex- ception in this? Every cell of our body is bathed in lymph, which is the food vehicle, and in this fluid are all the substances which are ab- sorbed and to be assimilated. In it there may be toxic elements or principles, or the elaborators the microbes themselves, or what- even may be the pathogenesis. The cells then are out of harmony with their environments, bio-chemical changes take place which alter the shape and composition of the cell and perhaps results in its death. The cell being so altered, the result of the action of vital force is likewise altered and modified or lost entirely. The solution of this problem cannot be definitely made until we can compare the bio-chemical composition of the live, healthy cell with that of the diseased cell. Just as the key of an organ may be out of tune by any number of different degrees, so may the biochemical composition of the live but diseased cell differ in a variety of forms. We can follow^ our toxic producers or their products through the digestive or respiratory tracts into the blood. We can fol- low them into the lymph and can find them in the cells them- selves, but their positive and ultimate action with respect to — 48 — the changes and alterations in the bio-chemism of the cells is yet to be discovered. It is at this point where vital force and ma- terialism meet. Here is the missing link in the mode of cause of disease. What particular modifications are necessary, and in what infinitesimal degrees these modifications must differ to produce the various phenomena we call disease, remains for further scientific investigation. Certain it is that these modifi- cations differ according to the pathogenic cause. It would ap- pear to me that the toxic substance coming in contact with the cell changes its bio-chemical composition just as a chemical rea- gent changes that of a salt; that the strength and nature of the reagent (virulence and kind of the toxine) is the measure of the amount of variation from the normal composition, and this vari- ation gives us our different forms of disease of our various organs and their degrees of severity. Medicines, then, act in the same manner in which the toxic elements do, i. e., by altering the bio-chemical composition of the diseased cell, neutralizing the action of the toxins and bringing the bio-chemical formulae back to the original normal. As the bio-chemical composition of the cell varies from the normal, so does the result of the action of vital force upon it vary from the normal. It is not within the province of this paper to argue for or against the germ theory of disease. The consensus of opinion of scientists is that microbes are the cause of most disease, which opinion is based on facts which have been proven and reproven by years of thorough investigation by competent men. Why should we abandon these facts and resort to theory and specula- tion of which we have too much already? Time would be much better spent in investigating the changes which undoubtedly take place within the cell protoplasm when brought in contact with the toxins. Practical, material research is the need of the hour. — 49 — HICCOUGH: REPORT OF A CASE. By W. A. JOLLEY, M.D., Rawlins, Wyoming. We are all so familiar with the "hie" of the drunkard that the following history of a case of hiccough may be of interest to you for a contrast: Mrs. L., age 26. Cuban, married, borne children and had miscarriages, has had pain in right chest for several years and at intervals spits blood. August 12th began to spit blood and complained of severe pain in right chest. The next morning began to hiccough six to ten times in rapid succession; stop for two minutes, then start again. The intervals of rest were never over five minutes unless the patient was completely under the influence of bromides and morphine, which the attending physician prescribed. I first saw her August 16th, 10 a. m., after she had been hiccoughing for three days. She was nearly exhausted as she had taken no food; pulse 120; was sore all over. Prescribed antipyrine 1\ grains every 3 hours; ammonium chlorid 15 grains in mist. give. comp. 3i every three hours. Ice bags were placed over pain in right chest and over stomach, but no relief was obtained. Mustard plasters were then applied but gave no relief. 10 p. m.—Condition not improved. Gave her morph. sulph. 1-16 gr., atropine sulph. 1-300 gr., strych. sulph. 1-30 gr., and in- halation of 10 grains of menthol dissolved in 2 drams of chloro- form during paroxysms. Intervals of rest lengthened and she was able to sleep from 12 p. m. to 6 a. m., when the hiccoughs started as bad as at first. Gave 2 comp. cathartic pills, inhala- tions of menthol in chloroform, and antipyrine 1\ grains every one and a half hours. Intervals gradually lengthened and at 10 p. m. wrent to sleep and slept until 5 a. m. She had an occasional paroxysm for several days. As to the cause, I am unable to determine. She has some uterine and ovarian disorder in addition to the chest trouble, but I was unable to determine the exact lesion of either. She also had a gastritis at the time. Whether it was due to the medicine I do not know. — 50 Among the remedies which I saw recommended were the following: Holding the breath as long as possible, rapid breath- ing, lavage of stomach, rhythmical traction of tongue, pressure upon phrenic nerve, using snuff and nearly every drug in the U. S. P. December 5th patient sent for me, said that she had taken cold and was afraid she would have another attack of hiccoughs. Prescribed an expectorant, but they started at 3 p. m. Antipyrine was administered after an active cathartic. Paroxyms stopped at 1 a. m. THE PROPHYLAXIS OF PUERPERAL INFECTION. By C. H. SOLIER, M.D., Superintendent of the Wyoming State Hospital for the Insane, Evanston, Wyoming. The subject I have chosen for consideration to-day would seem to be worn quite threadbare from its having been so often used as a theme for discussion. Yet the urgent necessity of a more strict adherence to the principles of aseptic and antiseptic surgery in obstetrical practice is so apparent that I trust the few moments given to its consideration will not prove profitless. Probably when mankind was in its primitive state, not yet perverted and enervated by the environments, habits, restraints and diseases of modern life, the process of parturition was largely a physiological one, and practically devoid of danger. Our civili- zation unfortunately, however, has so modified these conditions that this process may well be regarded as a complicated patho- logical one, and one demanding on the part of the obstetrician the exercise of a high degree of caution, discretion and practical knowledge. In fact it is probably true that the practice of ob- stetrics entails upon the physician a greater degree of responsi- bility than that assumed in any class of cases excepting, of course, surgical ones. Death from any cause is instinctively dreaded, but the death of a mother, either at the very threshold of active life or later, when entrusted with the care of a growing family, is indeed an awful calamity. And woe to him who by any act of ig- norance or carelessness, shall convert this occasion of hopeful rejoicing to one of disconsolate mourning and despair. — 51 — Probably in no branch of medical or surgical practice is there a more convincing demonstration of the fact that ours is a progressive art than in the remarkable reduction in recent years of the mortality attending the puerperal period. In hospi- tals and maternities where careful statistics have been kept, the results are indeed surprising. The present mortality in many of these institutions is almost nothing. This is the more remarkable when we consider the fact that their patients are largely com- posed of the homeless class, some of whom were taken in labor before admission, and many of them in a deplorable condition as the result of protracted labors or severe operative measures which had been unsuccessfully attempted elsewhere. For ex- ample: Dr. Goodell has stated that at the Preston Ketreat, in 756 cases of labor, there had been but two deaths from sepsis. Dr. Palmer of Cincinnati recently stated that twenty-five years ago the mortality in puerperal cases at the Cincinnati Hospital was 10 per cent. Now it is almost nothing, there having been no deaths in the past three years. It is unnecessary to multiply instances of the favorable results attained in numerous mater- nities, both in the United States and in Europe. Suffice it to say that the achievements of aseptic and antiseptic midwifery, as practiced in these institutions, rank with those of modern sur- gery. It is wTell known that the results in private practice are far from being so satisfactory. It is true that the murderous epi- demics of a generation ago are now happily unknown. But the mortality is still large and casts a certain degree of odium upon the general practitioner. It is really too much to expect as favor- able results in private practice, for there are many obvious dis- advantages encountered that are detrimental to the aseptic con- duct of labor. Many of these unfavorable conditions are inherent to private practice and are unavoidable. Such are unsanitary surroundings, incompetent and untrustworthy nurses and at times the extreme difficulty if not impossibility of successfully carrying out the details of asepsis and antisepsis. But in spite of all these considerations there are too many deaths in private practice from puerperal infection. What is the reason? Simply because so many men fail to appreciate the essentially surgical nature of an obstetrical case. Consequently they omit altogether the details necessary to secure surgical cleanliness or they attend to them in such a slovenly or perfunctory manner that it vitiates 52 the whole procedure. It is a well understood fact that measures to secure cleanliness are not equally and uniformly necessary as in surgery. As one writer has it, "It is perhaps possible for a physician to deliver in succession a hundred women in utter dis- regard of aseptic measures and still have no fatal results." I have sometimes thought that the successful obstetrician was a good example of the law of the survival of the fittest. It is only the man well endowed with tact, perseverance and determination who can successfully withstand the determined opposition, through ignorance or false modesty, that is so frequently en- countered in one's efforts to secure all the conditions necessary to the aseptic management of labor. When once this opposition has been yielded to, it is quite easy to acquire loose and careless methods until finally some fatal case of sepsis suddenly arouses the negligent physician to the necessity of a radical reformation of his methods. In private practice the physician is exposed to so many and to such varied sources of infection that any rational system of proyhylaxis must begin with the physician himself. In this connection Dr. William D. Porter of Cincinnati states in a recent number of the Medical Fortnightly that "The most urgent re- quirement is that the physician approach each case with clean hands, and all intelligent physicians try to do this. The difficulty of cleansing the hands would be considerably diminished if we were more careful in avoiding the sources of contamination. For instance, in opening an abscess it is not necessary to bathe the hands in pus. By the free use of absorbent cotton or gauze it is possible to avoid soiling the fingers in the least. Moreover, after such soiling the time to disinfect the hands is immediately. In this way the physician would escape the infection of his clothing, and the infectious material would not have time to get fixed in the epithelial crypts of the skin." He advises that similar pre- caution regarding hands and clothing should be observed when at- tending contagious diseases. The avoidance of contamination and prompt disinfection after exposure should become the in- stinctive practice of every physician. Indeed, the cleansing of the hands is the most important of our prophylactic preparations. A nail brush and a cake of aseptic or preferably an antiseptic or germicidal soap should be a part of every obstetrical outfit. When the hands and the nails have been thoroughly scrubbed, they should be bathed for a few moments in a one to 2,000 bichloride 53 — solution before any vaginal examination. Such a solution is more easily kept warm in a quart pitcher and should always be placed where it can be readily reached. The preparation of the patient and the bed is a matter about which the physician is rarely consulted, and one in which he is often required to exercise his authority. The patient must be impressed with the importance of cleanliness about her person, clothing and bed. The latter is often littered with unclean cloths with which the hands can scarcely escape coming in con- tact at some stage of the labor. It should therefore be a routine practice to see that not only the patient's clothing, but everything about her is clean. While a complete bath will usually be im- practicable, it is always possible, except in emergencies, to have the genitals, thighs and anal region thoroughly cleansed. The hands also of the mother should not be overlooked. Serious cases of sepsis have been traced to the manipulation of the genitals by the patient during labor. The subject of antepartum vaginal douches seems at present to be one of the most debated questions in obsterics. It is a well- proven fact that the external genitals provide favorable con- ditions for the development of pathogenic bacteria and authori- ties are practically agreed that these parts, as well as everything that comes in contact with them, should be rendered as clean as possible, but as to the existence of pathogenic germs in the vagina, there seems to be a marked difference of opinion. Dr. Williams of Baltimore, after an examination of more than 100 cases, and after considering the findings of other investigators, states that the reason that some of the investigators had re- ported pathogenic organisms in the vagina, was because they had made use of a large speculum, which had carried in with it some of these organisms from the external genitals. By taking the necessary precautions to guard against this source of contamina- tion he arrived at the following conclusions: First, as the vagina does not contain pathogenic germs, self-infection with such germs is impossible; second, if the vagina really did contain strepto- cocci, frequently a vaginal examination would be very dangerous, which it is not; third, the vagina may occasionally contain bac- teria capable of giving rise to mild sapremia; and fourth, death from puerperal sepsis is due to infection from without. On the other hand, the bacteriologists generally believe that the vagina is the habitat of certain pathogenic germs, though its - 54 - acid secretion has an inhibitory influence on these organisms. But it is also contended that during the progress of labor large quantities of alkaline secretion is poured out of the uterus which neutralizes the vaginal secretion, and thus for the time prevents this inhibitory influence on these germs. It is further claimed by the advocates of antepartum irrigations that during vaginal examinations there is danger of carrying into the uterine cavity those germs which are normal to the vagina. Certainly when there is evidence or wTell founded suspicion that the vaginal se- cretion is abnormal, as for example, gonorrhoeal, there is no ques- tion whatever but that frequent irrigations of strong antiseptic solutions should be employed. In the absence of such indica tions the opponents of antepartum douches claim that steriliza- tion of the vagina by scrubbing with soap and by the use of strong antiseptic injections is meddlesome widwifery. They in- sist that these strong injections destroy the normal lubricating fluids of the vaginal mucous membrane, which materially con- duces to the easy birth of the child. The consensus of opinion of our leading authorities seems to be that the antepartum injec- tion should be limited to those cases in which the character of the vaginal secretion clearly indicates it, and to cases where operative or instrumental interference becomes necessary. The advisability of digital examinations for the diagnosis of the presentation, or to ascertain the progress of labor, has lately become the subject of discussion. A recent contributor to the Medical Becord argues that such examinations are not only unnecessary, but dangerous; unnecessary because the presenta- tion and progress can be readily determined by abdominal palpa- tion and by careful observation of the character of the pains, the exclamations and general behavior of the patient; and dangerous because of the alleged impossibility of rendering the hand per- fectly aseptic. It does not seem probable that any respectable number of physicians will accept such apparently extreme views. They are undoubtedly a natural reaction against the old practice of making too frequent and too extensive vaginal examinations. It may be that an obstetrician of extended experience and of ex- ceptional ability might successfully pursue this proposed method, especially if he insists and has the opportunity of examining his patient before the beginning of labor. But it seems much more certain that, for obvious reasons, the physician possessed of more limited experience and ability will sooner or later regret the — 55 - adoption of this method. After a careful examination, made under aseptic and antiseptic precautions, there is no need of its repetition except at rare intervals. Nor is it necessary to insert the examining finger into the uterus unless there are clear indi- cations for such a step. As to the impossibility of sterilizing the hands, the results of aseptic surgery would seem to positively prove the contrarj-. One of the essential conditions of sepsis is trauma. Indeed, without trauma it is impossible for septic infection to occur. While there is always present a denuded endometrium, the extent of the contusions and lacerations of the cervix, vagina and peri- neum will be largely determined by our management of the sec- ond stage of labor. If this has been faulty and these wounds are extensive, there is at once presented a condition favorable to the entrance and development of septic germs. The use of chloroform to control violently expulsive pains, the support of the perineum and the cautious yet timely use of the forceps are measures familiar to you all, yet they cannot be overlooked in the consideration of the etiological factors and consequently the prophylaxis of septic infection. Within the past year I have seen in consultation two cases of septicemia, one of which proved fatal, where I am satisfied that the infection occurred primarily from extensive perineal lacerations. The prompt repair of such lacerations will tend to limit the area of lacerated tissue, and to that extent lessen the susceptibility to infection. In the postpartum treatment of every case there should be frequent cleansing of the vulva and the adjacent parts, prefer- ably with an antiseptic solution, after which there should always be applied a well-fitting antiseptic pad. The use of antiseptic postpartum irrigations after uncomplicated natural labors, is an other unsettled question that is much debated. In this practice as in surgery, our course should be governed by the indications. In the cases just mentioned there does not seem to be any neces- sity Tor such irrigations, as the frequent cleansing of the vulva and the antiseptic pads would seem to meet all the indications. But when, as frequently happens, after the third or fourth day the lochia becomes fetid, douches are clearly indicated. It is well to remember in this connection that while the patient is in the recumbent position the upper border of the cervix is below the level of the posterior commissure, thereby producing more or less vaginal retention of the lochia. Not only in the event of fetid -56 — discharges, but also where there have been much bruising and laceration of the cervix, vagina or perineum, I have never hesi- tated to make use of daily irrigations of hot antiseptic solutions. Sometimes I have used sterilized water, occasionally one to 3,000 bichloride solution, but more frequently a 1 per cent, solution of lysol. I believe there is no question whatever but that, in the hands of a nurse of average intelligence, such injections are valu- able in many ways, not the least of which is the stimulation of healthy granulations and consequent avoidance of septic absorp- tion. It is universally conceded to be a legitimate if not an im- perative practice to employ intra-uterine irrigations after every case of manual or instrumental delivery. While it is probable that if such operations have been performed under aseptic and antiseptic precautions, the irrigations might be dispensed with, yet the possibility of infection seems to be a sufficient justifica- tion for this procedure. Personally I have always felt that I was shirking a plain duty if I did not scrupulously observe this rule. In the limited time at my disposal I have but briefly men- tioned many interesting and essential phases of this most import- ant subject. I will only add, in conclusion, that no matter how well qualified by knowledge and experience we may be for this line of practice, and regardless of the patience and skill which we may have employed in any particular case, unless the puer- perium is kept under careful observation our duty has been but partially performed and all our efforts may come to naught. In localities where we are deprived of the services of competent and trained nurses and where we must be satisfied with those who are ignorant, superstitious, obstinate and negligent, daily visits can- not with any degree of safety be omitted. The storm of septic in- fection does not come all at once, but certain premonitory indi- cations warn us of its approach, so that prompt and vigorous measures will often modify it favorably. I believe that the early recognition and treatment of septic symptoms will save many lives that would otherwise perish. — 57 — DISCUSSION ON DR. SOLIER'S PAPER. By MRS. CHARLOTTE G. HAWK, M.D., Green River, Wyoming. Mr. President and Members of the Profession: This is a paper of unusual interest to me, as my work naturally, as you might suppose, falls into this line. The puerperal state is unique in its position, "being on the borderland," as Lusk puts it, "between the physiological and the pathological." Conditions which in the pregnant woman are physiological, under any other circumstances would be pathological. For in- stance, the congestion of the uterus in the early stages or the thrombi wilich form in the placental sinuses. But while these are physiological, yet it places the woman in a condition of danger, for the increased activity of the circulatory system ren- ders the parts liable to take up any septic material that may find its way into the vagina, and the physiological thrombi may be- come pathological, with all its disastrous results if infected. Statistics are alarming on these cases, and the worst of it is that it falls upon the most valuable class, mothers of families, whose loss is a national as well as a private one. I do not like the use of vaseline as a lubricant, as I think it is liable to carry infective material. I prefer a good soap, carbolized for instance. I use the douche after confinement for cleanliness as well as comfort to my patient. But if I have not a reliable nurse I see to it myself, as there is a liability of some- thing being carried in there that may infect. 58- REPORT OF A CASE OF FOXTAIL INFECTION. By R. C. CHAMBERLAIN, M.D., House Surgeon, Wyoming General Hospital, Rock Springs, Wyoming. Through the kindness of Dr. R. Harvey Beed, superintend- ent and surgeon in charge, I have the pleasure of reporting to you a very interesting and unique case of foxtail infection. Foxtail, or squirrel-tail grass, as it is sometimes termed, is probably well known to most of you and will require but little description in connection with the report of this case. Suffice it to say that it grows in rather dense tufts of eight to twenty inches in height, with short, flat leaves and compact, elongated heads, or spikes, which are made up of a number of spikelets growing from a cen- tral stalk or stem. These spikes at maturity become disarticu- lated and the seeds, with their barbed beards, set free to be scat- tered hither and thither at the mercy of the winds. In this ma- ture condition the beards become very tough and stiff, and owing to the angle at which the barbs grow from the beards, when they once enter a tissue they readily pass still deeper, carrying with them a poison, the exact nature of which has not been fully demonstrated. So great is the havoc this grass plays among the horses and cattle of this state that Professor Nelson of the experiment station at the State University has just recently written a very interesting article in which he describes its botanical character- istics and habits, and its rapid growth in an alkali soil like ours. He also demonstrates the manner of infection and the nature of the injury inflicted, and very strongly urges its early extermina- tion. The intensity of the infection and the effect on the human economy is demonstrated somewiiat clearly in the following case: Peter B., age 35, male, white, single, laborer, was received at the Wyoming General Hospital from a west-bound train, August 27, 1898, by the order of Dr. H. M. Bennett, county phy- sician, Rawlins, Wyoming. No history of the case could be elicited from the patient at this time more than that he was suf- — 59 — fering greatly and wished to be left alone. A few days later, how-ever, when questioned closely, he said that on August 13, 1898. while riding on a load of hay from the field to the stack, he passed two heads of foxtail grass into the urethra, and when he attempted to remove them he was unable to do so. He could assign no reason for such an action further than that he was in a playful mood and did not know how to amuse himself other- wise. He experienced little or no inconvenience from this for three or four days, when the penis began to swell and he had dif- ficulty in voiding his urine. He suffered in silence for a few days, during which time he deserted the "tie camp" and wandered off some twelve miles in the mountains, where he was discovered by his fellow laborers; ashamed, as he said, to approach his com- rades or a physician, but was finally compelled to consult Dr. Bennett, with the result that as soon as satisfactory arrange- ments could be made, he was sent to the hospital. On examination the extremities were found to be cold, the temperature 97 degrees F.. the pulse 112, the tongue furred and the teeth covered with sordes. The abdomen was very tympanitic and the bladder greatly distended, as was demonstrated both by palpation and inspection. The penis was swollen to fully twice its natural size, when in the erect condition, while there was a marked phimosis with a white and very fetid discharge from the urethra. The scrotum was swollen to about the size of a large cocoanut, very hard and ecchymotic. He was immediately catheterized and fully four pints of urine drawn off. A quarter of a grain of morph. sulph, with 1-150 grain of atropine was given hypodermically, followed with hot milk and whisky by mouth. A bichlorid evaporating solution* pack was applied to the penis and scrotum, which was supported by a T bandage; hot water bags were put to his feet and legs and he was covered with hot blankets. That night he was ordered morph. sulph. q. s. to secure rest and fractional doses of calomel, to be followed in the morning with salines. He rested fairly well and in the morning, after a thorough evacuation of the bowels, seemed brighter and more talkative. His temperature was 99| F., and his pulse 115. He was ordered to be catheterized every eight hours and the bichloride pack continued. Tonic doses * B -chlorid Evaporating Solution—80 parts boracic acid sol. 3 per cent.; 10 partss alcohol; 10 parts glyceriue, and 8 drops of a saturated solution of bi-chlorid of mercury to the pint. The saturated solution u.i degrees. His teeth were covered with sordes, and while he was usually a strong, robust young man', he was emaciated to a mere skeleton, but as you will see him when you visit the hospital to-day, he has now become fleshy, all evidence of the gen- eral septic infection having disappeared, and now we are simply waiting the repair of the parts. We expect to make a circum- cision, which has become necessary owing to the cicatricial con- traction induced by the inflammatory change, and after the re- covery from the circumcision we intend to make a plastic opera- tion, and if possible restore the urethra. What the result will be in this case remains to be seen. We all know that this peculiar plant has a very hazardous effect upon stock that eats it, the barbs penetrating not only the soft tissues of the mouth, as well as the bone, but producing large ulcers, followed by necrosis of the bone, and at times when pene- trating the intestines of the animal produces death from peri- tonitis, if not by septic infection when this does not occur. Whether or not this is due to the toxic effect of the plant itself or to its peculiar construction, which favors its passage through the soft and hard parts and carries germs, as has already been stated. I am unable to say, but one thing is certain, that its re- moval in the case which has just been reported by Dr. Chamber- lain has been followed by a speedy and most remarkable recovery from a decicedly typhoid conditon with the lowest and longest continued low temperature that I have ever yet seen. N. B.—Since the meeting of the Wyoming State Medical Society I beg to state that I performed the circumcision on the case, which healed by first intention, and a few days later re- stored the urethra by a plastic operation whereby we took the skin from either side of the perineal region, allowing the flaps to remain attached to the anterior portion of the pubes, bringing the two flaps together and making the line of suture along the natural position of the raphe. This required us to cut the flap from the ischial region, owing to the cicatricial tissue which we had to deal with in the region of the urethra, and after suturing the lateral edge of the flaps on either side to the cicatricial tissue, which was thoroughly denuded in the hope that we would get adhesions, we sutured the center along the line of the raphe, leaving the denuded surface to granulate. At present writing, a week after the last operation, the patient has not entirely re- coverd. but the indications are favorable to a complete recovery. (54 — ACUTE BRONCHO-PNEUMONIA IN CHILDREN. By CHARLES PINCKNEY HOUGH, M.D., President of the Rocky Mountain Inter-State Medical Association, Member American Medical Association, Member Association of Military Surgeons of the United States, Member Medical Association of Montana, Member State Medical Society of Utah, Salt Lake City, Utah. Mr. President and Gentlemen—I will not trespass upon your valuable time with tedious and laborious references to pathological anatomy, physical signs and symptomatology in this most serious and frequent disease, it being a fair presumption that all are informed on those essential points upon which our text-books are quite agreed. Broncho-pneumonia, usually designated catarrhal pneu- monia, is essentially the pneumonia of infancy. It is a bilateral disease, and when fully developed gives scattered areas of dull- ness on percussion. In this disease we should bear in mind the double circulation of the lungs, that is, the functional and the nutritive, and also remember the pulse-respiration ratio common to infants in health, and as found in pneumonia; this is often the principal diagnostic feature early in the attack that attracts the attention of the observing and wide-awake physician, which, with a high temperature always expected, and circumscribed rales, is good grounds for apprehending this often insidious dis- ease. Nearly all cases of primary pneumonia in children under two years of age are of this kind, as are nearly all secondary pneumonias during childhood. In the primary affection the mor- tality is high on account of the age, and in the secondary form on account of the complications to which it is sequela. It is very infrequent after four years of age as a primary disease. Male children seem to be more subject to it, and about 70 per- cent, of the cases occur in the winter and spring, children with poor hygenic surroundings being most frequently attacked. Ex- posure to cold and sudden atmospheric changes are still recog- ' nized as potent factors in its causation. To this fact I would especially ask your attention; you may protect some precious litth- ones if you still believe that people catch cold or catch hot, as you may choose to term it. Broncho-pneumonia as a sequela - 6o to diphtheria is usually due to the streptococcus infection. In twenty-five cases reported by -Netter, in which only one form of bacteria was present, i-: ten only the pneumococcus was found, in eight only the streptococcus, in five only the staphylococcus, and in two only the Friedlander bacillus. This observation of the different kinds of cocci by the microscope would suggest some factor of irritation preceding their activity. In primary cases the pneumococcus is nearly always pres- ent and in a large per cent, of such cases it occurs alone. The mixed infection is common in secondary cases, while those that show the stpertococcus infection are usually the most severe. The cases resembling lobar pneumonia are usually due to the pneumococcus infection. I think it would be wise if authors and teachers would dis- card all synonyms in writing and lecturing upon this disease. It would do away with much confusion in the minds of medical men. The more clear our understanding in pathology, the wiser and safer our therapeutics. The rule is for the catarrhal inflammation to extend from the bronchial tubes to the bronchioles and air vesicles, yet in some cases the disease would appear to begin in the bronchioles and air vesicles at the same time. A very large per cent, of autopsies show very general disease in both lungs; while the pathological process may be arrested at any stage, death may also occur at any stage. Resolution sometimes takes place quickly, but when it is very slow, or only partial, there is likely to be re- curring attacks, after which you may have chronic interstitial pneumonia. Pleurisy is almost invariably found over every large area of dullness after the fourth day, while autopsy in cases fatal on or before the third day show that up to that time the pleura is normal or only congested. Large serous effusions are rare in the pleural cavity, the disease is without typical course, wiiile prostration is extreme from the beginning, cyanosis is usually present in some degree and is rarely absent before the fatal issue. Cough may be slight or absent, cerebral symptoms are often quit^ prominent. Physical signs are often few and slightly marked. Death has been reported within twelve hours after the attack, diagnosis being verified by autopsy. This type of the disease passes for malignant scarlet fever or measles, with sup- pressed eruption, or possibly as cerebro-spinal meningitis. We should not overlook this serious feature and should always exam — 66 — ine the lungs in infants who are taken suddenly ill with embar- rassed respiration, cyanosis or cerebral symptoms. The severity of the symptoms in these cases is explained by compression of the air vesicles from the intense engorgement of the tissues al- most as much as from the exudates. The treatment is largely a matter of individual personal experience, influenced for or against the patient in accordance with the good judgment and attention of the mother or nurse, as well as the therapeutic ability of the physician. A close clin- ical observer once said thai in broncho-pneumonia we can do but little for the disease, but much for the patient. This being rec- ognized to be most frequently a secondary pneumonia, we should not overlook the prophylactic measures in those diseases that are chiefly productive of broncho-pneumonia. The nose, mouth and pharynx should command our attention and be kept as clean as possible. The position of the patient should often be changed, and expectoration should be aided and encouraged. Tepid bath- ing and cold douching is recommended as an efficient agent in preventing broncho-pneumonia, or if it be in the incipient stage, checking its further development. By some the cold pack is pre- ferred. The child should have a large airy room, with an even temperature of not less than seventy. The atmosphere should be kept somewhat moist with vapor. The diet should be nutri- tious and easily assimilable; the bowels should be freely moved, by preference with calomel. Alcohol or a combination of alcohol and strychnia should be given in sufficient amount to maintain a good heart action. The preparations of ammonia with expector- ants, while condemned by some, are generally accepted as being beneficial. It is my custom to irritate the chest with mustard, afterwards freely apply camphorated oil, or simply use camphor- ated oil and turpentine, covering the chest with flannel or cotton v. adding, not changing it until it becomes soiled from the excre- tions. I never use the oiled silk jacket, as I wish the full benefit of evaporation. I have much faith in diaphoresis in broncho- pneumonia. The kidneys receive my especial care. Since this is not a self-limited disease, and we cannot calculate as to its duration, I wTould urge especial attention to the diet and drink. A new fad in the diseases of infancy is to rely largely on the lat- ter, to which I give my partial endorsement, believing it to act as an eliminant. As a rule children get too little water, especially when indisposed. I have confidence in quinia as a tonic in com- — 67 — bination with ammonia and digitalis. Aconite is an efficient remedy in the acute stage. I am wholly without experience with the c-old bath and pack, but frequently resort to the hot mustard bath in threatened collapse or sinking, and have had from it prompt and happy effect. In reducing the temperature, cold to the head and sponging the face and upper extremities give good results. I have found it quite impossible to adopt in my family practice many highly praised hospital methods, and have be- lieved it good judgment not to try to force methods of external treatment wherein I could not have the full co-operation of the family and the nurse. It is possibly mortifying to confess un- familiarity with the highly commended antipyretics, the cold bath and the cold pack, but a due regard for truthfulness justi- fies the statement. When mucus accumulates and the patient cannot expectorate, an emetic of ipecac or alum is beneficial. Strychnia through central stimulation is said to aid expec- toration. The alternating of the hot and cold douche is said to be efficient. Frequent cough frees the bronchial tubes, but if it be a ery annoying, I use small doses of antipyrin or tinct. opii camph. Oxygen gas is by some used with satisfaction, and the inhalation of creosote is said to be good. For extreme nervous- ness the bromides, antipyrin and phenacetin, are used, while for failing circulation I w-ould commend the hot mustard bath, strychnia, nitro-glycerine, nitrite of amyl, or perhaps atropia of caffeine hypodermically. Good and intelligent nursing and feeding is in my opinion the great essential, and in this particular trouble I place as much confidence in wise and tender motherly care as I do in medication. THE RADICAL TREATMENT OF DISEASE OF THE HIP-JOINT. By CHARLES G. PLUMMER, B.S., M.D., Salt Lake City, Utah. During the past two or three decades we have learned much in the treatment of disease of the hip-joint. Some of our knowledge is the direct result of years of research—yet more has the freshness and newness of the teachings of men of our own age. — (iS The equipment of recent graduates in the theoretical treat- ment of this class of ailments is immense, but what they lack is the illustrated application. This we call experience. It is that something which we do not attain didactically—it only comes by personal contact. This fact holds equally good with almost any subject we might mention, but it is especially impressed on our minds with reference to surgical procedures. There was a time, and it is not so far in the past that we cannot witness living examples of the fact, when cases of hip-joint disease went unrecognized. I do not say they do not go without recognition to-day—I wish I could. But. with the advent of new ideas, new methods have taught us more of the subject, and now fewer cases are overlooked than at any rime in the history of surgery. So much valuable time is lost in many cases by the diagnosis of rheumatism or "growing pains." And I am compelled to ad- mit, in deference to those who treat the condition in its early manifestations from that standpoint, that their error seems ex- cusable. For there is quite a similarity, in a general way, in the very early stages of the seizure. But w7hen a diagnosis is made and treatment instituted and maintained, where the cardinal points which go to make up the diagnosis of hip-joint disease are in evidence, the mistake is culpable. To be sure neurotic reflexes, with symptoms referable to the region of the hip and knee, such as preputial adhesions, anal fissures, or rectal ulcerations, have misled many most excellent men. I believe it is the search for some of these little things wherein lie our most pronounced successes. With their removal, or the elimination of their possible existence, our diagnosis is so much easier. Still, when we take into consideration the fact that the great majority of these cases occur in childhood, or early youth, we may be pardoned when we say we sometimes meet cases wherein a diagnosis is not easy. Children are so apt to magnify their ailments, they are often so unmanageable and reticent that our diagnosis is almost wholly subjective. It is sometimes impossible to conclude posi- tively that we have morbus coxarius from a single inspection and examination. It will pay us to keep the suspected case under close observation, seeing it perhaps every few days, with instructions to the family to look for certain prominent symp- tom^, upon which we are to base our conclusions. 69 We may not observe in any one case all the pathognomonic signs of the disease; still when we see the marked flexion and abduction of the limb, either in the prone or upright position, the limited motion, the apparent anchylosis at the hip, night pains and pains referred to the knee, we cannot miss it much by pronouncing it coxitis. Perhaps the subject has suffered some traumatism—perhaps not—it does not matter, for what- ever the cause the treatment is identical. In coming to the cpiestion of treatment, I wish to state that I believe all the successful methods of treating hip-joint disease today may be termed radical. That there are degrees of radicalism we cannot deny. Looking upon the result s of treat- meni of these cases in the hands of some whom we might term anti-radicals, or extremists in conservatism, I am not much im- pressed with the wisdom of their medico-supportive and except- ant methods. The physician who allows a case to progress so far as to permit of the formation of abscess in or about the region of the hip-joint makes a grave error. And to one who has not seen cases of advanced disease of this joint, he will find that he is totally unable to appreciate the terrific ravages such ab- scesses will commit. Extensive suppurative sinuses will pene- trate the deeper structures of the hip and thigh, extending in some cases down the leg to the knee, forming large, bulging pockets of pus in the popliteal space, or above the patella; or they will burrow7 underneath the gluteal muscles across to the other side, or come out under Pourpart's ligament, or through the is- chio-rectal region. And just as sure as hip joint abscess develops, deformity in some degree may be expected. My experience has taught me that every deformity, by which I mean modified or absolute anchylosis with shortening resulting, is due either to abscess or neglect, and deferred treat- ment. Why is such deformity in evidence? Often because of the expectant and medicinal treatment of misguided conserva- tism. Do not misunderstand me, please, for I believe in every endeavor to prove the value of conservative measures, but there comes a time when conservatism is not a synonym for good sense, when delay is dangerous, when hesitancy loses the day. For just such cases as these radical surgical procedure is necessi- tated. 70 Radical treatment means the institution of active surgical measures, as opposed to the delay, linger and wait methods of the ultra-conservative. My interpretation of radical advances begins with the use of injections of emulsions of iodoform, iodine, or any other drug into or about the joint cavity; or with exten- sion alone; or with extension combined with hypodermatic in- jections at the site of the disease, or Vaughan's nuclein solution; or with resection of the head of the femur and thorough removal of all evidences of the disease. 1 have purposely refrained from saying anything about the etiology of hip-joint disease, for I am certain we are a unit on that subject, if not entirely so, on that of treatment. My reading, and my own experience1, convince me that morbus coxa- rius has its origin in the tubercle bacilli—hence it is merely a circumscribed tuberculosis. It does not matter whether there be a cachexia or not, or whether it result from a traumatism, I believe the cause always the same. One may not always be able to demonstrate the tubercle bacillus, he cannot find it every time he examines the sputum of a tuberculous subject; neverthe- less, the existence of foci of disease, absolutely characteristic in every particular, proves the origin to be one and the same. While the name of hip-joint disease is used to designate a tubercular inflammation of the hip-joint, it may have its origin in any one of three places: First, on the femur, called epiphy- seal; second, acetabular; and third, arthritic, or synovial. If it begins, as is usual in the majority of cases, among children especially, in the epiphysis, the treatment must be more rapidly enforced, and of a much greater degree of severity. For my own convenience, I hav divided radical measures into three classes. viz.: First, injections of drugs into or about the joint cavity; second, the employment of extension: third, resection of the head of the femur. In the first and second classes, as I have already indicated, we may use a combination of methods to suit the exigencies of the case, and to promote the best results. For instance, one would not give intraarticular injections of iodoform emulsion and allow the patient to perform his ordinary duties, because rest is one of the first considerations. So, with a judicious use of the very best means combined. it becomes our function to save the vast majority of cases from the dreaded fate of the last degree of radical surgical procedure, viz , resection of the hip-joint. — 71 — Upon the recognition of a case of hip disease, no matter what the age of the patient, the tripod of success is, first, per- fect immobilization with the Thomas splint; second, the prone position; third, extension. Without any other means whatever, I feel confident, in at least 90 per cent, of all cases, of securing the best results when the above rules are strictly adhered to, and intelligently carried out. With the intra-articular and parenchymatous injection of a 10 per cent, emulsion of iodoform in glycerine, properly steri- lized, we get better results than with a similar use of any other of the numerous solutions that have come before the profession. This treatment has been followed some years, but is, properly speaking, one of the weapons of modern surgery. Since the dis- covery that the tubercle bacilli existed in the so-called cold abscesses and joint affections, its employment has been more a matter of scientific application, with results directly proportion- ate to the thoroughness with which it is carried out. Sometimes iodoform intoxication occurs among those who are particularly susceptible, but it is infrequent and rarely of much violence. Nevertheless, in its administration one should give but from twenty to thirty grains, according to the age of the patient, at the first treatment, and watch the effect. If the patient bears it well, it may be increased to a much larger dosage. After we are satisfied of the existence of disintegrating material, boldly plunge a small, perfectly sterilized canula into the capsule, or the body of the abscess, and draw off all the contents. Leave the canula in position, and with an aseptic rubber tube attached to it, thoroughly irrigate the interior with a warm Thiersch solution, or a 2 to 1 per cent, solution of boric acid. Continue irrigating until the returning solution is per- fectly clear, then fill the cavity moderately full of the iodoform emulsion, remove the canula and place over the opening a close aseptic dressing. The parenchymatous injection is about as effective as the intra articular, and the same technique is employed. In the hands of many surgeons balsam Peru, corrosive sublimate, iodine, carbolic acid, and arsenious acid have proven of more or less value in their anti-bacterial action. The violent inflammation set up by the most of these agents is a hindrance to their more general adoption, so that iodoform in glycerine is much more popular. Different operators publish a variety of -- 72 statistics on the employment of iodoform in this manner, some going so far as to absolutely deny any anti-bacterial action what- ever, Avhile others consider it the best and most curative agent in our hands. As far as I am able to judge of its value in the few cases in which I have used it, I believe it has a definite, germicidal power, depending largely, as a cure, on the stage of the diseased process wherein it is used. True, I have not always found the tubercle bacillus in the gross discharges from such a condition-— it is sometimes quite difficult; neither can we alwrays attest the infallibility of the Widal test in typhoid fever; yet, to him who has come in contact with very many representatives of these diseases, the phases are so pertinent that a mistake in diagnosis is improbable. And we are certain, absolutely so, in spite of all the tests, that the above diseases exist, even when their bacilli cannot be demonstrated. *So much for the first method of treatment alone, which may be combined with the second, that of extension, and often to great advantage. As I have previously declared, the success of treatment by extension depends on perfect immobilization of the affected part, and rest in the prone position, during the acute stages at least. I am unwilling to admit that a patient can do as well with the joint immobilized and be allowed to go about on crut- ches. The great requisite is rest for the joint, and also for the tissues enveloping it. No one can be sure of the entire absence of muscular, and even of joint motions, when a patient is in the upright position. And it is this perfect rest, with separation of the diseased synovial membranes, upon which w-e base our assumptions for relief and cure. We know full well how little motion or disturbance can be borne by the sufferer whc a we attempt to make an examina- tion of the hip-joint without anaesthesia. It does not appear that age makes much differ* nee; from extreme childhood to old age the excruciating agon.) they endure, upon the slightest mo- tion, goes to show why perfect rest is best. One of the best means for securing immobility is the Thomas splint, perfectly fitted, applied and maintained. I do not deem it always requisite to use this splint. In adult cases it is not needed as much as among children. When immobilization can — 73 not be secured by ordinary bandaging for extension, then the Thomas splint is the best appliance known. Its use should be maintained after the acute stage has passed, and the patient is allowed to go about on crutches, with a patten under the foot of the well leg. Another most beneficial agent incorporated in the arma- mentarium of the surgeon for the treatment of this condition is Vaughan's nuclein solution, as produced by Parke, Davis & Co. I have used it in conjunction with extension in a number of cases. In one case, male, aged 14 years, it was not administered hypo- dermically. I gave him the 5 per cent, solution by the mouth in rapidly increasing doses, until he was taking sixty minims four times daily. From the very beginning an attempt w-as made to thoroughly saturate him with the nuclein, and the happy results more than repaid us. A rapid decrease in the swelling about the hip-joint took place, the tenderness wholly disappeared, his appetite improved, and there was a complete subsidence of the usual train of annoying symptoms, that rarely in previous cases had been accomplished by extension alone. During the incarceration of this patient's hip-joint he gained over twenty pounds in weight. He had previously undergone amputation of the foot, on the same leg that now suffered from hip disease, for tuberculosis of the ankle. At the time the extension apparatus was adjusted there were several small tubercular ulcers on the tibia above the stump; hence it was not without misgivings that radical treatment was instituted. And I feel compelled to admit that without such a powerful agent as Vaughan's nuclein solution, producing a vigor- ous leucocytosis, the result in this case could not have been good. The great increase in the disease-resisting power afforded the human body by such an element, its germicidal influence and antiseptic properties, recommend it very strongly to our con- sideration in these cases. Experimenters speak of it very highly also, in cases of mixed infection. Its use. either by the mouth or hypodermatically, is attended by no evil results. I presume I have given nearly 1,000 injections of it, and have had as yet no needle abscess, something one cannot say of all the various anti toxins we use nowadays. The third and most extreme measure adopted for the treat- ment of this disease, resection of the hip-joint, I have found it necessary to employ three times. It is so radical, and the de- 74 fortuity is so marked, that one hesitates to resort to it, often putting off the evil day, until he feels he is not doing the patient or himself justice. Some writers may deem it the only treat- ment employed that might be termed radical. To be sure, it is the extreme of radicalism, but is demanded in a certain class of cases. There are degrees of severity of the invasion of the hip- joint by the tubercle bacillus, just as there are of any other dis eases with which w7e come in contact. One type we can treat by a measure as radical as any other, because it singles out the cause and eradicates it; another, by means just as effective and as far-reaching, but perhaps not as brilliant; and a third by the last resort method, the sacrifice of more or less tissues, but the permanent removal of all growth interfering with local and gen- eral recovery. Surgical good sense, for which conservatism is so often used as a synonym, and improperly so, should be the bulwark of every wTell and properly equipped operator. With a case in hand, one cannot go over the ground and make an operation of selection, for you have something to do other than a mere removal of the head of the femur. The anatomical relations are so changed that one would scarcely recognize the vicinity, and the attack of the great, bulg- ing, sloughing mass cannot be made upon any hard and fast lines. The idea is to get to the seat of the trouble as rapidly as possible, and with the loss of as little tissue as is practicable, and, at the same time, be thorough. The simple resection of a practically normal case is nothing compared with what confronts one in a last stage case. The amount of pus that can burrow around the hip and pelvis, and the amount of disintegrated tissue that comes away through a free incision, is astonishing. The removal of all adjacent diseased tissue, and the scraping of all foci, is secondary to the rapid and careful resection of the head of the bone. Remove all signs of disease, but leave all the bone that it is possible to leave. In doing the section, leave the great trochanter, if possible; if it must be sacrificed, saw through it just above the lesser trochanter at an angle, thus maintaining the integrity of the muscular attachment for the great muscles of the thigh. — HI — Notwithstanding the deformity which must result from the removal of such an important factor, it is neither as great nor as maiming as that which follows the usual suppurative processes invohing the hip-joint, when allowed to heal by natural resolu- tion. Resection presents the horrors of an operation to patient and relatives. It also guarantees speedy and permanent relief from pain, but a permanent shortening. This shortening may be much or little, many times depending on the attending sur- geon in his removal of tissue, also in his after treatment and care of the case. If the case be young, we have every reason to believe that there will be a continuation of the growth of the femur, thus modifying more or less the permanent shortening. In my experience, those who have endured this operation are lame only from the shortening. While in the result of a spontaneous cure, a very aggravating anchylosis and tilting of the pelvis accompanies it, with even a greater amount of short- ening. Much more might be said on this subject, cases could be cited of the various methods of treatment, and details pursued, but it is not pertinent at this time. I am satisfied that not all is accomplished by radical measures that should be expected, Still, with the improved methods at our hands, the greater knowledge of cause and effect, we may hope to accomplish much more than has ever before rewarded our efforts. MEMBERS. Abbott, H. A., Bennett. H. M., Crook,' W. \\\, Carter, James, Chamberlain, Robt. C, Dunham, Frank, Freeman, W. C. C, Gates, L. A., Hawk, Mrs. Charlotte G., Hawk, Jacob W.. Hammond, J. C , Hale. R. W., Horton, F.. - Johnson, W. L., Jolly. W. A., Johnston, Geo. P., Levers, Ernest E., Lane, James, Lott, John H., Leeper, John F., Miller, Allen F.. Maynard, H. J., Osborne, J. E., Price, Sam T., Reed, R. Harvey, Russell, G. M., Ranch, E. P., Stuver, E., Solier, C. H., Stoughton, Arthur V. Verpoorten, M. H., Verbryck, Geo. G., Weaver, J. B., Rawlins, Wyoming. Rawlins, Wyoming. Cheyenne, Wyoming. Carbou, Wyoming. Rock Springs, Wyoming. Lander, Wyoming. Rock Springs, Wyoming. Thermopolis, Wyoming. Green River, Wyoming. Green River, Wyoming. Hanna, Wyoming. Otto, Wyoming. Newcastle, Wyoming. Rawlins, Wyoming. Rawlins, Wyoming. Cheyenne, Wyoming. Almy, Wyoming. Sweetwater, Wyoming. Buffalo, Wyoming. Casper, Wyoming. Sundance, Wyoming. Cheyenne, Wyoming. Rawlins, Wyoming. Grand Encampment, Wyoming. Rock Springs, Wyoming. - Dixon, Wyoming. Rock Springs, Wyoming. Fort Collins, Colorado. - Evanston, Wyoming. Afton, Wyoming. Laramie, Wyoming. Cambria, Wyoming. Dixon, Wyoming. PRACTICE OF MEDICINE (Chapter 18, Session Laws 1890.) Terms Vacancies Qualification Organization ol Board Oath An Act to regulate the practice of medicine, surgery and obstetrics in the State of Wyoming, and to repeal Chapter one of Title thirty-four of the Revised Statutes of Wyoming of 1887. Be it Enacted by the Legislature of the State of Wyoming: Section 1. That the Governor by and with the advice ^»«™tof and consent of the Senate shall appoint three persons, who shall be electors of this State, who shall constitute the State Board of Medical Examiners. One of the persons so ap- pointed shall hold his office for four years, and the other two for two years, and until their successors are appointed and qualified: Provided, That the first Board shall be appointed upon the passage of this Act, and shall consist of one mem- ber for four years and two members for two years, and in each succeeding legislative year there shall be appointed one member for four years and one member for two years. And provided further, That all vacancies occurring in the Board of Medical Examiners, by death, resignation or re- moval from the State or otherwise shall be filled by appoint- ment by the Governor and the person so appointed to fill any such vacancy shall hold his office until the expiration of'the term he was appointed to fill. No person shall be ap- pointed a member of the State Board of Medical Examiners who is not eligible to registry in accordance with this Act. Sec. 2. The State Board of Medical Examiners shall organize within sixty days after their appointment by tak- ing and subscribing an oath to faithfully discharge the du- ties of the office, and by the election of a President, Secre- tary and Treasurer. It shall provide itself with such blanks and certificates as are necessary to comply with the provis- ions of this Act, and with an appropriate seal, which shall be attached to all certificates and orders issued by the * Board. Said oath shall be filed with the Secretary of State. Sec. 3. It shall be the duty of the State Board of Med- ical Examiners to pass upon the qualifications and deter- mine the fitness of all persons who may desire to practice Medicine, Surgery or Obstetrics, or who may publicly pro- fess to cure or treat disease, injury or deformity in any man- ner whatever in this State. Sec. 4. Every person practicing Medicine in any of its Requirements departments shall possess the qualifications required byofpractitioners this Act. If a Graduate in Medicine, he shall present his Diploma to the State Board of Medical Examiners for veri- fication as to its genuineness. If the Diploma is found to be genuine, and issued by a Medical College of recognized merit, said College being a member of the American Asso- ciation of Medical Colleges, the Homeopathic Institutes or the National Eclectic Medical Association, or any College of similar standing in foreign countries, and if the person named therein be the person claimed and presenting the Diploma, the State Board of Medical Examiners shall issue its certificate to that effect, signed by the majority of all the members thereof, with the Seal of the Board attached, and such Diploma and certificate shall be conclusive as to the right of the lawful holder of the same to practice medicine in this State; Provided, no person holding Di- Duty Diplomas Certificate Examination plomas, certificates or other credentials from schools or in- stitutions other than those of recognized merit, as speci- fied in this Chapter, shall be permitted to practice in this State until he has passed a satisfactory examination be- fore said Board. Said examination may be in whole or in part in writing, and shall be of an elementary and practical character, and shall be upon the subjects following: Anat omy, Physiology, Chemistry, Pathology, Materia Medica and Therapeutics, Hygiene, Theory and Practice of Medi- cine, Surgery and Obstetrices, and sufficiently strict to test Fee the qualifications of the candidate as a practitioner. For the said examination a fee of twenty-five dollars shall be paid by the candidate to the Treasurer of said Board. Sec. 5. The State Board of Medical Examiners shall receive through its Secretary applications for certificates and examination. The President, or acting President, shall Power of have the authority to administer oaths, and the Board may Boardtake testimony in all matters relating to their duties; they shall issue certificates to all who furnish satisfactory proof of having received Diplomas as provided in Section four of this Act. The Board shall prepare certificates for those Meetings entitled thereto. Said Board shall hold annual meetings, and in selecting places to hold their meetings they shall, so far as it is reasonable, accommodate applicants residing in different sections of the State, and due notice shall be published of all their meetings. Examination of Sec. 6. Said State Board of Medical Examiners shall diploma. Fee examine Diplomas as to their genuineness and character, and if the Diploma shall be found genuine as represented and of a character hereinafter provided, said Board shall receive a fee of five dollars from each graduate, and no further charge shall be made to the applicants except the fee for recording the same, as hereinafter provided. In case of application made by any person holding a Diploma, as required by Section five of this Chapter, for a certificate to practice within the State, it shall be sufficient for the applicant to present such Diploma and proofs to the Sec- retary of such Board, and if such Board be not then in session, such Secretary shall inform the members of the Board of such application, by writing or otherwise as will be most practicable, of the facts upon which such appli- cation is based, and thereupon such members shall in writ- ing, advise such Secretary as to whether such application be allowed or rejected and, if allowed, the certificate shall be issued as in other cases in this Chapter provided. The dMomaCation of verification of the Diploma shall consist in the affidavit of the holder and applicant that he is the lawful possessor of the same, and that he is the person therein named. Such affidavit may be taken before any person authorized to administer oaths, and the same shall be attested under the hand and official seal of such officer. Graduates may dip'iomantatlon°fpresent their Diplomas and affidavits as provided in this Act, by letter or by proxy, and the State Board of Med- ical Examiners shall issue its certificate the same as if the owner of the Diploma was present. Certificate with- gec 7 rp^e Board shall be permitted to issued cer- out diploma "^ , , 1 • 1 n tificate to any person who has not a diploma from some recognized college as contemplated in this Act, but who has been actually engaged in the practice of medicine for a period of ten years, the last five of which shall have been in this State, upon the payment of five dollars, and mak- —3— ing application as set forth in Sections four and six of this Act, and filing proof by affidavit or otherwise, to the satisfaction of such Board, setting forth the place of res- idence, time and places wherein such applicant has prac- ticed, and showing such applicant to be a person of good moral character and sobriety. Sec. 8. Any person who shall make application to Fraudulent «h- such Board for admission to practice upon Diploma, andploma such Diploma be found to be fraudulent, or not lawfully owned by such person, such person shall be deemed guilty of a misdemeanor, and on conviction thereof, shall be fined in any sum not exceeding one hundred dollars, or be sen- Penalty fenced to imprisonment for not more than thirty days, or punished by both such fine and imprisonment, in the dis- cretion of the Court. Sec. 9. Every person holding a certificate from the State Board of Medical Examiners shall have it recorded tifiiTd of cer" in the office of the County Clerk of the County in which he resides, and the date and place of record shall be en dorsed thereon. Any person moving to another Countv to practice shall procure an endorsement to that effect on the certificate from the County Clerk, and shall record the certificate in like manner in the Countv to which he removes; and the holder of the certificate shall pay to the County Clerk the usual fees for making the record. Sec. 10. The County Clerk shall keep in a book pro- county record vided for that purpose, a complete list of all the certifi-ofcertificates cates recorded by him, with the date of the issue. If the certificate be based on a Diploma, he shall record the name - Of the Medical Institution conferring it, and the date when conferred. Sec. 11. The fees received by the State Board of Med- Medical fund ical Examiners shall be kept in a fund to be known as the Medical Fund, and subject at all times to the warrant of the State Auditor, drawn upon written request of the ExPenses President, and attested by the Secretary of the Board, with the Seal attached, for the payment of any and all expense made by said Board. Sec. 12 The State Board of Medical Examiners may Revocation 0« refuse certificates to individuals guilty of unprofessionalcerdficates or dishonorable conduct, and they may revoke certificates for like causes. In all cases of revocation, the applicant or practitioner may appeal to the District Court of the County in wich such revocation is made which shall have power, after examination into the matter, to revoke the action of the Board. Sec 13. Nothing in this Act shall be construed to prohibit students from prescribing under the immediate Emergency supervision of preceptors, or to prohibit gratuitous service in case of emergency, and this Act shall not apply to Com- ™oQed Surge0ns 0f the United States Army and Navy or Medical Examiners of relief departments of railroad com- panies, while so employed, or any lawfully qualified Physi- „. . emus residing in other States or Countries meeting regis-«SsSEfio,n tered Physicans of this State in consultation, or any Physi- cian or Surgeon residing upon the border of a neighboring State, and duly authorized under the laws thereof to prac tice medicine and surgery therein, whose practice extends into the limits of this State. as Sec. 14. Any person practicing medicine or snrwpr p *■ ■ 5vi +Uia C2+«+^ „ -4-Y. m i . & 'X1^U,VI11C "l oillgerV Practicing in this State without complying with the provisions of £te0nt cer this Act, shall be punished by a fine of not less than fifty Penalty dollars> nor more than three hundred dollars, by imprison- ment in the County jail for a period of not more than one year, or by both such fine and imprisonment for each and every offense, and each person filing or attempting to file as his own the Diploma of another, or a forged affidavit of identification, shall be guilty of felonv, and upon con- viction, shall be punished by imprisonment in the peni- tentiary for a term not to exceed (3) three years. Midwifery Sec. 15. The State Board of Medical Examiners shall examine all persons upon the theory and practice of Obstet- rics who openly profess to practice obstetrics and midwifery who do not have authority to practice medicine or surgery- and they may issue to such candidates and person or persons who shall pass a satisfactory examination, certificates which shall authorize and empower them to practice obstetrics or midwifery. No person shall practice obstetrics or midwifery unless' either a Practicing Physician author- ized to practice under the provisions of this Act, or hold- Emergency mf s"^ certificates as are prescribed by this Section; Pro- vided, that nothing in this Section shall be construed to prohibit persons from rendering services in cases of obstetrics or midwifery in cases of emergency. itinerants Pro-. v fec' 16' An^' itinerant who has not qualified as here- hibited mbefore provided, who shall sell or offer for sale anv dru«- nostrum, ointment or appliance of any kind intended for the treatment of any disease or injury, or shall by writing printing or other method, except by ordinary professional card or sign, publicly profess to cure or treat disease in- ---J"ry.°.r de_formJty by any drug, nostrum or in any mannei w liatever, shall^be femecTguilty W a misdemeanor, and Penalty J?0* J^!?*!?11 thereof' sha11 be "ned ™ any sum not less than fifty dollars nor more than one hundred dollars, and costs of prosecution, for each offense, and shall be com- mitted until such fine and costs are paid. secretary'ssai- , Sec- ^J\ The Secretary of said Board shall be paid a •y salary which shall be compensation for the actual work done in the performance of the duties of his office the amount thereof to be fixed by the Board, not to exceed the sum of fifty dollars per annum, the same to be paid out 0 of the Medical Fund by warrants drawn by the State Auditor, upon there being filed with the Auditor a cer- tificate to be signed by the President and Secretary of the Board, with the seal of the Board attached, showing that the Secretary has acted in that capacity for the time for which his bill is presented. The salary shall be paid Board's salary annually. The members of the Board shall receive the sum of five dollars per day while actually emploved in at- tending meetings of the Board, or in carrying out the provisions of this Act, and shall also receive their actual traveling and necessary expenses while engaged in the performance of their said duties to be paid out of the Medical fund upon warrants to be issued by the State Auditor, and all bills therefor shall be accompanied by a certificate signed by the President and Secretary of the Board, with the seal of the Board attached, attesting ti.e correctness of the bill. ' * r , -+wtC' 18" • ^1J Acts and Parts of Acts inconsistent RePea. Wlth the provisions of this Act are herebv repealed Sec 19 This Act shall take effect and be in force from and after its passage. Approved February 14th. A. D. 1899. ary ifft- fill J