« ForrigeFortsæt »
it would lead to the establishing of a medical advisory board to the Dominion Government, of which there was at present great need.
For Dominion registration a five-year course would be demanded, and a high standard would be maintained. The examination would be held in the various large cities in turn. The Quebec delegates had stipulated that French delegates might take the examination in their own language.
It was proposed to extend the benefits of the regulation to present practitioners of ten year's standing. The great objects were to raise the standard of medical education and to remove the imaginary barriers or lines between the provinces.
It had been thought that the chief difficulty in committee would arise from a demand for representation on the Dominion Council in proportion to population, which would give Ontario a majority. The Ontario representatives had, however, consented to equal representation from each province. The plan then was to constitute a council of twenty-four members, three from each of the provinces, and three from the Territories. One member from each province would be appointed by the Governor-General-in-Council, one by each of the provincial councils, and the third would be the president of each provincial council, ex-officio.
It is a fact that there is in Canada no neutral territory of ten or fifteen miles between the provinces, as pertains to European countries even when the governments and languages are entirely different. So a physician living on the line of his province cannot collect a fee for services rendered in another without being subject to a fine, however urgent the case may be and however short the distance. This works not only a hardship upon both patient and physician living near the border line, but to a surgeon whose reputation entitles him to calls beyond his own province is it especially odious.
The necessity for the following preamble and resolutions which were introduced by Dr. Williams, of Ingersoll, is apparent:
Whereas, The standards of education for the profession of medicine and surgery and the qualifications for the practice of the profession vary in each of the provinces of Canada, and the assimilation of these standards, and, if prac
ticable, the establishment of uniform standards throughout the Dominion, are desirable;
And Whereas, In consequence of the provisions of the Acts of the United Kingdom of Great Britain and Ireland, known as the "Medical Acts," medical and surgical practitioners, who are by the law of a province of Canada entitled to practice the profession in such province, cannot obtain the benefits of regis tration under the said acts, inasmuch as by the said provisions the qualifications required for such registration must be regulated by the Parliament of Canada;
And Whereas, A medical and surgical practitioner duly registered according to the law of one province of Canada cannot legally practice in another province without being duly registered in such other province;
And Whereas, Serious practical inconveniences, both to the public and to medical and surgical practitioners, have arisen from the above cause:
And Whereas, It is desirable to assimilate and, if possible, to unify the various standards of qualification established by the several provinces of Canada as conditions of admission to the study of the profession, and to the practice thereof, such assimilation and unification being best attained by the establishment of some central authority with power to hold examinations of, and to establish and maintain a system of medical legislation of, such persons as desire to practice the profession in more than one province of Canada;
And Whereas, It is not within the legislative jurisdiction of the provinces to establish such central authority, the jurisdiction of each province being restricted to the limits of the province and to provincial objects only;
And Whereas, It is expedient to constitute a corporation in which the Legislatures of the various provinces may, if they see fit to do so, vest such powers as are necessary to effect the above purposes, and the other purposes mentioned in this act;
And Whereas, The appointment of such an authority is for the general benefit of Canada, and would promote the advancement of medicine and surgery throughout the Dominion of Canada,
Resolved, Therefore, That the Association heartily approve of the proposed scheme which the committee has formulated and presented at this meeting.
Further Resolved, That Dr. Roddick be empowered and requested to continue his efforts to have the scheme completed and carried into effect by such legislation as may be found necessary.
Dr. McNeil, P.E.I., seconded the motion in a very forcible. speech.
Sir James Grant supported the resolution.
The resolution carried unanimously.
In the van of progress is refinement in the treatment of disease. So Dr. Thorburn, of Toronto, presented the report of the special committee on the treatment of pauper inebriThe committee recommended the appointment by the
Provincial Government of an inspector of inebriate institutions, who should organize in the city of Toronto a hospital for the medical treatment of pauper inebriates of the more hopeful class, and in other cities of the province an inebriate department in the existing hospitals. The report was received and carried.
Dr. Bryce introduced a resolution urging the Dominion Parliament and the local legislatures to take some action to prevent the spread of bovine tuberculosis, which was carried.
Dr. R. A. Reeve, of Toronto, read a paper on the results attained by recent medical conferences.
Dr. A. T. Hobbes, of London, contributed his address on Surgery Among the Insane, and Dr. W. J. Wilson, of Toronto, read his paper on Craniectomy for Microcephalus.
I have dwelt upon legislation because it presents some of the difficulties that we in the States have encountered, and shows to those who may be tinctured with Anglo-mania that the strong government cannot cure evils without giving others in return.
There were many papers that were only read by title, and some subjects not introduced that were expected to be discussed and acted upon.
Under the head of unfinished business a resolution was offered that a committee be appointed to consider and report at the annual meeting for 1900 the best means of dealing with the consumptive poor.
The convention reached an agreement at a late hour.
Toronto, Canada, Sept. 2, 1899.
T. J. CROFFORD, M.D.
And others' follies teach us not,
Nor much their wisdom teaches;
And most of sterling worth is what
Our own experience preaches.-Tennyson.
PROGRESS OF MEDICINE.
UNDER CHARGE OF B. F. TURNER, M.D.
Visiting Physician to St. Joseph's Hospital, Memphis.
The Treatment of Chronic Kidney Disease.
Before a recent meeting of the Königsberg Society for Internal Medicine von Noorden said (Med. Press & Cir., vol. 68, no. 3140) that in chronic contracted kidney not nearly so much importance was placed on absolute limitation of albumin as in the other forms of nephritis. When one reckoned up what was permitted of milk, eggs, meat and vegetables, the quantity of albumin was found to be above rather than under 100 grams. Others laid stress on the selection of the meat, and allowed contracted kidney cases only the white flesh of fish, birds, veal, etc., while the brown flesh of slaughtered animals, game and fowls was strictly forbidden. Many patients gradually acquired such an objection to white meat that its consumption was reduced to a minimum, appetite fell away, and disturbances of nutrition came on. The chief difference between brown and white meat lay in the coloring matter, and this we had no ground for holding injurious. From his own observations he was opposed to the view of the harmfulness of brown flesh. Patients fed on white flesh excreted rather more urea than those fed on brown flesh containing equal quantities of nitrogenous material.
As regarded liquids, either nothing was said or large quantities were recommended for flushing out the kidneys. Ziemssen, in his handbook, had recommended limitation of the liquids, even when arterio-sclerosis of the kidneys was present. By observations during six years the speaker was convinced that cases of contracted kidney were extraordinarily benefited by limitation of liquids to 54 or 312 liters per diem. Patients in whom the heart had begun to fail did not often last over a month. In these cases limitation of the liquids was of the highest value. In nearly thirty cases the results were good, the cardiac asthmatic attacks ceased, sleep returned, ordinary diuresis returned, and the cardiac dilatation undoubtedly improved. This favorable condition in many patients kept up for several months and even years. Even in desperate cases, where no treatment could be any longer of use, limitation of liquids was advantageous. The best that could be done was to keep the patient in the statu quo. Hr. Ewald, of Berlin, had long been in favor of limiting the quantity of liquids in chronic renal cases, his view being based on the idea that a damaged organ should not be overburdened with work. He determined the quantity of urine passed by Oertel's method, and regulated the quantity of liquids by that, if possible remaining below the quantity excreted. He had always acted upon this principle, both in contracted kidney and in parenchymatous nephritis. By regularly estimating the quantity of albumin, he had convinced himself of the fact that the kind of albumin used, whether of egg, brown or white flesh, was of no consequence as far as the excretion of albumin was concerned.
Pneumonia Treated with Antipneumonic Serum.
Fanoni (N. Y. Med. Jour., vol. 70, no. 9) has studied the effects of Professor Pane's antipneumonic serum in six cases of pneumonia. The quantity of serum used in these cases was from a minimum of 20 cubic centimeters to a maximum of 120 cubic centimeters. In some of them only the serum No. 1 was used, in others only the No. 2, while in still others both strengths were used. The resolution in these cases was as follows:
First case, eighth day, by lysis; second case, sixth day, by lysis; third case, tenth day, by lysis; fourth case, seventh day, by crisis; fifth case, seventh day, by lysis; sixth case, sixth day, by lysis.
From his own experience, and that of his confrères in Italy, the author draws the following conclusions:
1. That Pane's antipneumonic serum is the rational remedy in pneumonia, as it constitutes the specific treatment, the same as Behring's antitoxin does in diphtheria.
2. That injections with this serum are not painful, are simple to administer, and do not produce any general or local reaction.
3. That serum over five months old is no longer active and produces no results, although it does no harm; and after it is four months old it begins to lose strength, and the amount given after this time should be increased in proportion as the date of the preparation of the remedy is removed from the date of administering up to the fifth month.
4. That the serum will not do harm, even if given in doses of 100 to 150 cubic centimeters in twenty-four hours.
5. That the serum in all these cases under my observation has shown wonderful efficacy, not only in producing rapid improvement of the general condition, but in hastening resolution in case it is given early in the disease.
6. That in any lobar pneumonia, especially if the prognosis is grave, it is the duty of the physician to use this serum, and if he fails to do so there is no excuse for such an act, except ignorance of the work that has been done in the field of the serum therapy of pneumonia.
The So-Called Typhoid-Pneumonia.
Smith (Maryland Med. Jour., vol. 42, no. 40) concludes an interesting article in the following pointed manner :
In view of the fact (1) that the majority of pneumonias occurring in the course of typhoid fever are not caused by Eberth's bacillus, but by the pneumococcus, and (2) that asthenic pneumonias, with so-called typhoidal symptoms, have nothing in common, so far as etiology is concerned, with typhoid fever, it would seem advisable, with our present knowledge, to discard the term typhoid-pneumonia as savoring too much of inaccuracy, especially as we are reminded by it of the wholly indefensive term typho-malaria. For those rare cases in which it can be proved beyond doubt that the pneumonic process, as well as the general typhoid infection, are both due to the bacillus of Eberth, we still have the term pneumo-typhoid, the use of which, however, should be subject to these strict limitations. Accuracy in terminology is the first step toward a reasonable therapy, and the ill results of calling conditions by wrong names must inevitably lead to a less clear-sighted management of them.