Society Reports. ACADEMY OF MEDICINE OF CINCINNATI. OFFICIAL REPORT. Meeting of March 22, 1897. The President, W. E. KIELY, M.D., in the Chair. W. EDWARDS SCHENCK, M.D., Secretary. [The attention of members is called to the Nurses' Central Directory, Telephone 2121, No. 210 W. Twelfth St., which is under the supervision of the Academy of Medicine, and is deserving of the members' patronage.] DR. P. M. ASHBURN read a paper entitled Primary Vaginal Sarcoma DISCUSSION. DR. C. A. L. REED: Dr. Ashburn's paper is of more than passing interest. If there was doubt before, the history as recorded shows it to be a case of primary sarcoma of the recto-vaginal septum. As has been stated, the patient came under my observation, and there occurred a most unique experience, and one that I shall never forget. While I was making a preliminary digital examination there was a sudden burst of hemorrhage, that struck the wall after I had removed myself from its course. I tried pressure, a drainage-tube as a tourniquet to stop the flow, but without success, and had to operate, which I did in twenty minutes. My next endeavor was to get her upstairs, but the stairs were too narrow and the woman too broad, so that I had to abandon my office to her for two weeks, which was easier than to remove the patient. The growth was ulcerated and was a little difficult to enucleate, which I did with some misgiving of malignancy, though microscopically it appeared not; but, considering the previous history, I took the precaution to remove the capsule, though I feared a return. She disappeared, and I knew nothing of her until my attention was called to her by Dr. Ashburn. The growth on the thigh was removed upon the solicitation of the patient, and not because it was malignant or very large, but, as she was fleshy and it was upon the inner side of the thigh and caused some annoyance, with the fear that there might be some erosion, it was removed. It was a lipoma. I have not had time to consult the literature upon the subject, but Dr. Ashburn has, most exhaustively. Never, in my observation or others that I know of, have I seen this peculiar growth in the locality of this case. We are under obligations to Dr. Ashburn for the clear and exhaustive report of the case. DR. S. P. KRAMER: Was the patient put upon anti-syphilitic treatment? DR. REED: Yes; I had her on that treatment when under my care. DR. D. I. WOLFSTEIN: In presenting a case of such extreme rarity and interest the essayist has rendered us a great service, and the paper should not go without discussion. It will have been noted from the paper that the essayist, in endeavoring to account for the occurrence of primary vaginal sarcoma so late in life, was himself dissatisfied with the "theory of embryonal cell misplacement." Like many others, too, he was disposed to the view that lacerations, frequent child-births, or, in a word, trauma, may have been a predisposing cause. We have therefore once more a condition where there is an evident desire to establish a relationship between trauma and tumor, and, in my opinion, we can very well explain this connection on the basis of Ribbert's hypothesis. The trauma causes a loosening up of cell contact, both connective tissue as well as epithelial cells, thus granting to each individual cell thus forced from the restraint of its contiguous cells its full embryonal proliferative activity. It is, of course, only a hypothesis, but so are all of the so-called tumor theoriesCohnheim's as well as all the others. DR. ASHBURN: I have nothing of importance to add. I would not try in this or any other case to account for the development of a new growth, but I think that the fact that fourteen out of sixteen adults suffering from this affec tion had borne children is too striking | posteriorly; the anterior portion of the to be disregarded. It seems to me to indicate that trauma may be a factor. Post-Syphilitic Leucoma of Tongue. DR. JOSEPH EICHBERG: This patient was operated upon at the City Hospital by Dr. Conner some years ago for a tumor of the tongue. There has been a recurrence. He did not return to the institution for this reason, but for alcoholic indiscretion. It seems to me to be a post-syphilitic leucoma. He had syphilis about twenty years ago. Specimens. DR. J. C. OLIVER presented a specimen of marked atheromatous degeneration of the arteries of the leg. The specimen exhibited was a complete dissection of the popliteal, anterior and posterior tibial and peroneal arteries; these all showed very advanced calcareous degeneration, even the small branches being typical "pipe-stem" arteries. "The specimen is from a man fiftyfive years of age, barkeeper by occupation. There was a history of alcoholic indulgence, but none of syphilis. The examination of the urine disclosed sugar in abundance. The history given was that of acute, rapidly spreading gangrene and amputation was the only resource available. Because of the fact that the skin below the knee seemed healthy, I attempted a knee joint amputation, but my first incision went into structures which were involved in the process, so I was compelled to amputate in the lower third of the thigh. The femoral vessel was thickened and exhibited the characteristics of a 'pipestem' vessel. The artery and vein were ligated with formalin cat-gut and then a silk ligature was thrown around these vessels and a quantity of muscle included. After the tourniquet was removed the face of the stump was very dry, hardly ten drops of blood oozing from the muscular surfaces." A second specimen was the upper maxilla of an infant six weeks of age. The specimen showed a marked cleft palate (complete on the right side); the left side showed an incomplete cleft cleft was closed by a deflection of the septum to that side, and thus the anterior part was closed in. The patient also had a hare-lip on the right side; this was closed, but the baby died of exhaustion about one week after the operation. Special attention was directed to the manner in which the deflected septum closed in the cleft upon the left side. Specimen. DR. C. L. BONIFIELD: This specimen is a fibroid of the uterus removed last Friday. In May, 1892, the ovaries in this case were removed to prevent an increase of the growth, since which time it has not perceptibly enlarged, but to prevent further palliative measures she requested it removed. The specimen has been kept in salt solution, so that it shows the hypertrophic condition of the endometrium quite well, which, in parts, is undergoing a cystic degeneration. Specimen. DR. GILES S. MITCHELL: This specimen, a fibroid tumor of the uterus, was removed in the presence of the class at the Presbyterian Hospital, on last Wednesday. Was assisted in the operation by Drs. Withrow and Wenning. Patient, Mrs. W., colored, aged fortyfive, married, mother of three children, youngest twenty-one years. Had enjoyed uniformly good health until one year ago. Five years ago she noticed an enlargement in lower part of abdomen, which continued to increase in size. Since about a year she has had almost constant and severe backache and frequent attacks of nausea and vomiting. Menstruation was normal as to time and quantity. The immediate steps in the operation were those of abdominal hysterectomy for uterine fibroid. Owing to the size and density of the tumor it was necessary to extend the incision two inches above the umbilicus. The only difficulty in the operation was in enucleating from between the folds of the broad ligament on the right side a fibroid mass as large as an orange. The uterus was excised at the os in terum. The cervix was closed over by THE continuous suture of fine silk and then Cincinnati Lancet-Clinic: A WEEKLY JOURNAL OF MEDICINE AND SURGERY. ISSUED EVERY SATURDAY. were freely J. C. CULBERTSON, M.D., Editor and Publisher. the anterior and posterior peritoneal flaps were united by a continuous Lembert silk suture. Abdominal walls were united by silkworm-gut sutures and no drainage used. Patient reacted promptly, and bowels moved thirty-six hours after operation. Highest temperature since operation 100.2°, pulse 90. Temperature at five o'clock this afternoon 99°, pulse 88. Regard the patient's recovery as assured. A very interesting feature of the case was the absence of disturbance in the menstrual function, menstruation remaining normal as to time and quantity. any Operative Treatment of Rectal Dr. A. B. Cooke (Medical News, November 21, 1886) gives the following important points which should be observed: 1. A careful physical examination of the lungs as well as of the entire rectum to be made in every case. 2. Pulmonary tuberculosis is not necessarily a contra-indication. 3. Do not put down the knife until certain that every sinus has been divided. 4. Remove all diseased tissue. Large wounds are not to be feared. 5. Caution: The sphincter is not to be divided only once and at right angles. 6. Special attention is to be given to the mucous opening. 7. Invasion of the perineum must be avoided, especially in females. 8. Systematic antisepsis is necessary if good results are desired. 9. Care and patience are required in the after-treatment. Dressings are not to be left to the family nurse. IO. In the after-treatment two warn ings are to be heeded: Complaints of unusual pain by the patient and increase of the discharge. Either of these may mean the formation of another abscess. 11. Hemorrhage and incontinence of feces are the chief danger. Both are amenable to treatment and should not deter from the operation. From city and country alike comes the complaint of lack of professional business for physicians, for which there must be and are good reasons: The ratio of physicians to population in the United States has varied but little for more than half a century. During that period preventive medicine and sanitary science together have reduced sickness and mortality rates more than 50 per cent. The people live under more healthful conditions, and physicians know better how to treat diseases. Hundreds and thousands of lives are every year saved and prolonged through the application of improvements which have recently been made in the arts of medicine and surgery. The people have not only been placed in better sanitary conditions, but they have been taught by physicians how to care for themselves when suffering from minor ailments, and surgery has absolutely removed many causes of con tinuous ailments, so that altogether | work themselves through college and there is not a demand for one-half the into an immediate living business. It amount of professional work that existed half a century ago. Physicians themselves have wrought this change. In large cities college clinics, dispensaries and hospitals gather in and care for thousands who formerly called in the local physician and paid him a small fee. These changed conditions in medical professional life must be recognized, accepted and lived up to. It is somewhat hard upon physicians, and necessitates a lessening of numbers in ratio with the population. Any one who desires to do so, and has a sufficient preliminary education, has a perfect right to begin a study of medicine, but the requirements for graduation must be made more and more difficult until there will be only one physician to twelve hundred people. Whenever such relations are established -and they can be brought about-physicians as a class will be assured of a reasonable livelihood derived from a practice of their profession. Physicians themselves should be very slow about offering words of encouragement to young men and young women to enter upon a study of medicine, showing them the required four long years of arduous study, and then of not less than four years of time before it will be possible to gain a living from practice, during which period they must live as though possessed of a small gold mine or an oil well. Eight years or more to a living should deter many strong hearts from beginning a course that involves labor, sacrifice and a large outlay of immediate cash. The time has passed by and is away out of sight when it is possible for men and women to start with nothing but their hands and wits and therewith to is not the fault of the willing hands and ambitious brains, but it is because conditions and possibilities have all changed. Furthermore, those who have married and then concluded to enter upon the study of medicine should be broadly and emphatically discouraged from making an attempt to enter the medical profession. Four years of study and four years of waiting while burdened with family cares are altogether too much for any man or woman to undertake; besides, it is entirely too large a fraction of the years in which it is appointed for men to live to abstract for this one purpose, in which future success is not only likely to be very moderate, but extremely problematical. The prizes in medicine are extremely limited in size and few in number. Some are gilded, glittering baubles, and represent untold debts, hard work, sleepless nights and endless anxiety, while a very small number indeed stand for that which is real and enduring. To the people the labors of the medical profession are invaluable. Length of life has been doubled and trebled, comfort of living correspondingly increased, and prosperity made possible. Yet in affairs of State charlatans and quacks continue to exert a potent power. These are the reasons, or at least some of the reasons, why members of the medical profession are not more prosperous than they are. The loaf and ham have been severed in twain. A remedy for existing conditions has been indicated. It is the only reasonable one that suggests itself to the writer; there may be a better one, and one that will manifest itself in time. In conclusion, physicians should consider very well indeed, and think | doctor to diagnose the case. three or four times, before advising a young man or woman to enter upon a study of medicine. The large financial outlay involved, the term of study, period of waiting, and division of the loaf, already subdivided, that is in the hands of the medical profession. These are the why. DRUGGISTS UNDER THE NEW MEDICAL EXAMINATION LAW. Reese handed him a bottle of some kind of medicine and stated that it was good for that particular comIt was a medicine of his own complaint. pounding, and he remarked further that the men from the oil fields came in droves to con sult him and secure that medicine. Here a delicate legal question arose as to or not. Mr. Gugle took the advanced stand that the act of telling the patient that this medicine was good for that kind of disease was in fact prescribing for the disease, and hence the practicing of medicine without a license. At this juncture the police prosecutor, who had been assisting in the prosecution, withdrew from the case, contending that the position taken by the Medical Board's attorney was untenable. This worthy young man, by name T. O'Harra, argued against the stand taken by the Medical Board's adviser and spent some several hours in trying to impress the court with the fallacy of the theory advanced by him. Judge Webster, of Toledo, has laid down some law governing the prosecution of cases brought under the recent law creating the State Medical Board of Registration and Exami-W. nation and providing for the licensing of physicians to practice, which is far reaching and sweeping in its effect, and will cause uneasiness among the thousand druggists throughout Ohio, who the judge declares are daily violating the provisions of the act. Judge Webster, before he was elevated to the bench, was known as one of the brightest and most advanced thinkers at the Lucas County bar. He was regarded as a safe counsellor and a learned man in all the branches of the law. He is the author of an able and invaluable work on medical jurisprudence and is the professor of this subject in the Medical College of Toledo. As an authority on medical jurisprudence he takes high rank. His opinion, which has been attracting great attention among the lawyers and druggists who are familiar with its holdings, has not found its way into print except in The Press through a private telegram received in this city Saturday, and then only briefly. Harrison Reese, a physician of Toledo, claims to be able to cure about any disease that ever fell to the ill lot of any mortal, and it was this professed ability to cure anything and everything that attracted the attention of the public to his case and then the State Medical Board and its wideawake and bright young counsel, Mr. George L. Gugle. The Board started an investigation on foot in the case of Dr. Reese and had him arrested on the charge of practicing medicine without a license. He was brought before Judge Webster and testimony for the State and defense was offered. Despite the fact that several of his witnesses went back on him and the police prosecutor took an entirely different view of the law bearing upon the case, Mr. Gugle was successful in maintaining his point and secured the conviction of Dr. Reese, who was fined $50 and the costs of the prosecution by the court. The testimony in the case showed that the complaining witness had called upon the de fendant and stated the nature of his disease. He did not state the symptoms and allow the Judge Webster, in a learned and exhaustive opinion, sustained Mr. Gugle on every point in question. He held that no doubt this action of Dr. Reese's in selling and recommending the medicine would and did constitute the practice of medicine under the new law. All the druggists of the State, he continued, were violating the law in selling medicines in this way, and were amenable under the law. The mere fact that the druggists in the State were not regarding the law was no reason for letting this case go by unpunished. The court remarked that he had no patience with quacks and quackery, and that half the doctors in Ohio who are licensed ought to be driven out of the practice on general principles. marked that he considered it to be one of the In regard to the law Judge Webster rebest laws of recent years. It was the best law ever enacted for the protectson of the public. health. In conclusion he gave "Doctor" Harrison Reese $50 and costs. The above is taken from a Columbus paper, and indicates what is being done in one direction alone by the State Board of Registration and Examination. The question is frequently asked as to what the Board is doing, and for an exhibition of results of their work, which is all right and proper, and there should be a presentable showing for an expenditure of more than sixteen thousand dollars in one year. One of the things apparent is the actual registration of the reputable practitioners within the State. This |