of tetanus in one of which he had an autopsy and in both there were evidences of gastro-intestinal disturbances with dilated stomach.

Dr. W. H. Thomson of New York had seen such cases and had used the benzoates of sodium and ammonium with success. These cases seemed to occur in groups and he thought there were evidences of a cumulative action of the poison as in uremia.

Dr. Rachford in conclusion in answer to Dr. A. H. Smith said that he had used the permanganate of potassium as an oxidizer although he had no evidence of its action in this way. In answer to Dr. Shattuck he said that the examination took three to four weeks for completion and in answer to Dr. Graham of Toronto he said that he did not find these leucomains before the attack. He had had no opportunity of studying tetanus as he had had no suitable case, but he had it in mind. The subject has an important bearing on uremia and allied conditions.

Dr. A. C. Abbott of Philadelphia then read a paper on The Effects of the Gaseous Products of Decomposition upon the Health and Resistance to Infection of Certain Animals that are forced to

Respire them. He put rats, guinea pigs and other animals under a bell jar and compelled them to respire air from decomposing meat infusion, sewerage, urine, etc., and some of the animals were inoculated with cultures of the bacillus of typhoid fever. The general condition of these animals during the experiments, as determined by their outward appearance, appetite and daily fluctuations in weight, was as good as that of other animals kept under the ordinary conditions of the laboratory. As a result, the conclusion seems justifiable that, as ordinarily respired, the air of sewers, or that from other bodies undergoing decomposition and putrefaction, has either not the power of induc. ing pathological conditions at all, or, if it has, such conditions are not demonstrable by such laboratory methods of experimentation as we have practiced on rabbits and guinea pigs.

Dr. C. Baumgarten of St. Louis then

read a paper on Renal Affections following Influenza, in which he reported eight cases, from which it appears that damage to the kidneys is a frequent, and sometimes a serious, consequence of grippe. Besides transient albuminuria, there have been found acute degeneration of the kidney, acute inflammation, both forms of chronic diffuse nephritis, and cases of persistent albuminuria not plainly belonging to one of these groups. The injurious influence on public health exerted by an epidemic of grippe may last much longer than the epidemic itself, by reason of renal and other sequels.

Dr. A. Jacobi of New York said he had frequently seen cases of this kind and he said but for the use of the centrifuge in urinary analysis he would have failed to find casts in many cases. It is due to the toxines of these diseases, as similar condition is observed during and after attacks of diphtheria and typhoid fever, but it is not like the postscarlatinal nephritis. Many of these cases after influenza get well without

treatment.

Dr. James Tyson of Philadelphia said he had seen persons who suffered from this trouble after grippe. Also in cases of cyclic albuminuria he found that after grippe it was worse.

Dr. F. C. Shattuck of Boston referred to cases which he had seen. He thought there was a distinction between the different kinds of nephritis of these various diseases.

Dr. M. H. Fussell of Philadelphia said he had discovered several cases of this kind which convinced him of the great importance of the routine examination of the urine in all cases.

Dr. A. H. Smith of New York had found the complications more often than was usually supposed.

Dr. Baumgarten said in conclusion that we must distinguish between those nephrites that come on during and those that come on after an attack of these diseases.

Dr. George M. Sternberg, SurgeonGeneral U. S. A., then made a Report on Immunity against Vaccination Conferred upon the Monkey by the Use of the Se

rum of the Vaccinated Calf and Monkey. This work was done by himself and Dr. Walter Reed, Surgeon U. S. A. He inoculated calves and monkeys with serum of vaccinated calves and even used the fresh blood serum of persons who were recovering from smallpox and noted its effects on vaccination and on the course of the disease. Immunity was established in the monkey for thirty days, but the method was as yet impracticable, as it took too much of the serum to have an immunizing effect.

Dr. James T. Whittaker of Cincinnati then read a paper on the Etiology of Idiopathic Hypertrophy of the Heart, in which he spoke of hypertrophy independent of valve disease or obstacle to the circulation in the heart itself. The term is a misnomer. The condition is more frequent than is commonly believed. Hypertrophies are due: 1. To increased resistance in the vascular system. For example, arterio-sclerosis. 2. To diseases of the heart muscle from

infection, degeneration, etc. 3. To affections of the nervous system. The hypertrophy may be that of age, of work, of plethora, of pregnancy, of alcohol. It may come from Bright's disease, from diseases and deformities of the chest, emphysema, kyphosis, from myocarditis, syphilis, gout, diabetes, from irritation of the vagus, from abuse of tobacco, from excess in venery, etc.

Dr. J. P. Crozer Griffith of Philadelphia read a paper on The Transmission of the Mitral Diastolic Murmur, in which he called attention to the fact that these murmurs were often heard far outside of the area usually laid down in the books and even behind, and he presented charts to prove his point.

Dr. James Tyson of Philadelphia had seen one of these cases and had also observed the fact in other cases.

Dr. James T. Whittaker of Cincinnati said it was not so much the position of these murmurs as their points of greatest intensity.

Dr. Charles Cary of Buffalo spoke of the intensity of these murmurs and the condition of the valves causing them so that they must almost always be also a regurgitation and the murmur may

extend through the diastole into the systole.

Dr. John H. Musser of Philadelphia said he was familiar with the work of Dr. Griffith and related a case of hypertrophy in which he thought a resulting mitral regurgitation rather helped matters and removed the headache and other unpleasant symptoms.

Dr. Mc Phedron of Montreal thought that the murmur might depend on the tension of the pulmonary circulation.

Dr. A. H. Smith of New York thought that the want of coaptation of the mitral valves might cause a regurgitation as well as a stenosis and he thought that perhaps in health there was at times a mitral regurgitation.

Dr. Stockton asked if the murmur were diastolic or presystolic.

Dr. Griffith in closing said that what he called a presystolic was a murmur during the diastole. He made his diagnosis on the position and point of greatest intensity.

Dr. A. H. Smith of New York then read a paper on the Use of the Differential Stethoscope in the Study of Cardiac Murmurs. He thought that if the hearing were good in both ears, a differentiating stethoscope would help to distinguish synchronous and alternate sounds. The ear could easily be trained.

Dr. James T. Whittaker thought that while the position of the sound differences might be interesting the condition of the heart muscle was a much more important point.

Dr. Charles Cary of Buffalo read a paper on The Cause of the Exaggeration of Sounds over the Right Upper Chest, both in Health and Disease, in which he demonstrated some specimens to show that there was an anatomical reason for the difference between the two sides of the chest and showed the points of resemblance and difference between the two sides. This paper was discussed by Drs. Griffith and Tyson.

Dr. Charles G. Stockton of Buffalo reported two cases of Fat Necrosis.

SECOND DAY, FRIDAY, MAY 31. Dr. William H. Welch opened the Discussion on Antitoxine. The decision of this subject rests more with clinicians

than with the bacteriologists. The two most prevalent theories are the chemical and the vital. The latter has more followers. There is evidently a quantitative relation between the toxine and the antitoxine. There is no means of knowing how much toxine is in the blood and how much antitoxine should be given. The benefits of this treatment are very doubtful when the antitoxine is injected after the third day. Some are in favor of calling all sore throats diphtheria where the Klebs-Loeffler bacillus can be demonstrated. This would include cases not counted before. It is found in healthy throats and mild anginas. Now if these very mild cases which cannot be recognized clinically are to be put down as diphtheria the statistics will be influenced very materially. On the other hand there are certain cases of pesudo-membranous inflammations of the throat which are like diphtheria but which are not, because the Klebs-Loeffler bacillus is absent and these cases were called formerly diphtheria and now they are not. He believes that large hospitals and boards of health give a wrong impression of this. These examinations are made in a routine manner by young men, often inexperienced, and considering the difficulty we must say that it is often there and not discovered. The antitoxine cure is not different from the natural; in fact, it is the natural cure only hastened by the antitoxine artificially introduced. If statistics are to be believed they show that the mortality of this disease has been reduced. Some say that the past few epidemics since the use of antitoxine have been especially mild; others say that the agitation in the public press has caused people to seek treatment earlier which brings about more cures, and the discovery of the specific bacillus causes many mild cases to be treated successfully which increases the number of cures and thus affects statistics. Some cases fail to respond to the treatment for some unknown reason. Those treated before the third day stand a good chance for recovery. Then the clinical impressions of such men as

Baginsky, Widerhofer and others are to be considered. They are all inclined to think it is a benefit. Some say that the after-effects of the antitoxine, as albuminuria, skin eruptions, etc., are against the treatment. These effects are only temporary. It will take a long time and many cases before proper conclusions can be drawn.

Dr. Mason related his experience in the Boston City Hospital. The mortality had been certainly decreased. School examiners have found more cases and this affects statistics. The effects on the attendants, nurses, etc., was differThere is not so much fear. Hospital cases are generally advanced and give fairer statistics.

ent.

He

Dr. A. Jacobi of New York was much impressed with this treatment but thought the numbers from which to draw conclusions were too small. He had known of former years when the results of treatment by the mercury method were just as good as there are now and in his cases he used other things besides the antitoxine. thought albuminuria was no more frequent but the urine is now more carefully examined than formerly. He thought the clinicians were too much in the hands of the bacteriologists. Diphtheria was not always caused by the KlebsLoeffler bacilli alone but by streptococci and other organisms as was well known and many other conditions would show that the clinicians accept too blindly the statements of the bacteriologists.

Dr. John S. Billings said the statistics. were of no value unless carried over a long space of time. The hygiene of the case and its surroundings should be taken into account.

Dr. Mason said the proper way to compare was by seasons.

Dr. A. C. Abbott of Philadelphia said that clinicians look to bacteriologists for help and the etiology of disease was in a very chaotic state until the bacteriologists lent a helping hand.

Dr. George M. Sternberg said that persons were skeptical because of the failure of experiments on animals with tuberculin.

Dr. F. H. Williams of Boston had used antitoxine with good results, when it was applied in the first forty-eight hours. He showed his glass syringe packed with asbestos and with a rubber tube between syringe and needle. This could be sterilized.

Dr. William Osler related a series of cases in four of which no organisms could be found.

Dr. D. W. Prentiss of Washington, D. C., exhibited a case of Purpura Hemorrhagica Rheumatica which he had shown to the Association in 1889. The boy was almost blind, but he followed his trade of carpenter. He had treated him with phosphorus with good results.

Dr. William Osler said that Henoch had described this disease very thoroughly. First, there are recurrences; second, there are marked gastro-intestinal crises which may occur without any other manifestations; third, the symptoms may be articular; fourth, there may be hemorrhages under the skin, erythema multiforme, simple edema, hemorrhages from the mucous surfaces and with all this an acute nephritis in some cases. There is little literature on the subject in English and the best work is found in Henoch's Festschrift. This was also discussed by Drs. Stockton and Prentiss.

Dr. J. G. Adami of Montreal then reported a Case of Madura Foot Disease (Mycetoma Pedis) which was probably the first case of its kind reported on this continent, in which the microscopical picture was much like that in actinomycosis.

Dr. William P. Northrup of New York read a paper on Gonorrheal Arthritis, in which he reported several cases showing the joint affected, the swelling, exquisite sensitiveness, little fever, short course of four weeks and recovery with perfect joint and effusion usually only

serous.

Dr. William H. Welch referred to the absence of pus in the joints and spoke of the joints opened by Dr. Halsted and the hemorrhagic effusion found by him. The success with the cultivation of the

gonococcus had not been very great until lately. He related a case in which Dr. Flexner had accidentally found that an extract of the fetuses of pigs formed a good culture medium. He showed the specimen of another case in which there was a gonorrheal endocarditis and in which Dr., Flexner had during life extracted some blood from the patient and had made a culture medium with it and agar and found the gonococcus on it. Dr. F. C. Shattuck of Boston, on looking up the literature of the subject, was surprised to find so many cases of two or more joints affected, contrary to his ideas and to the general belief. The paper was further discussed by Drs. Cary, Mason, Griffith, Adami, Roosevelt, Osler and Northrup.

Dr. A. Jacobi of New York then reported a Case of Hyperthermy up to 65° C. (148° F.). The man fell on a steamer and struck his head. He afterwards came into hospital and his temperature began to ascend and broke thermometer after thermometer and finally when it reached 148°F. he ran away from hospital.

Dr. William H. Welch said that Dr. Jacobi had omitted the case of Galbraith of Omaha, which went up to 171°F. This case was further discussed by Drs. Shattuck, Dock, Fussell and Jacobi.

Dr. J. Guitéras of Philadelphia made Some Observations on the Spleen and Marrow in Leukemia.

Dr. F. H. Williams of Boston exhibited a Comfortable Way of Using Cold in Fevers.

Dr. George Dock of Ann Arbor then read a paper on Goiter in Michigan, the object of which was to call attention to the prevalence of goiter in Michigan and its vicinity, with the view of exciting a greater interest in the subject. Although the disease is often so mild that it does not require treatment, it is sometimes severe. Allied diseases, like myxedema and cretinism, do not seem to be less rare there than in other places. A relationship with water supply must exist, a point to which attention is called in reference to prophylaxis. This

was discussed by Drs. Henry M. Hurd of Baltimore and Osler.

Dr. J. E. Graham of Toronto read a paper on Displacements of the Liver, in which a brief account of the literature of the subject was given; a short description of three cases met with in practice; the etiology, symptoms, diagnosis and treatment of displaced liver; and a tabulated statement of thirty published

cases.

Dr. M. H. Fussell of Philadelphia read a paper on Carcinoma of the Liver with Cirrhosis, in which he reviewed the literature of the subject from an article by Kelschard Kierer, in Archives de Physiologie, 1876 to the present time. There was absence of any note of the conditions in the English language. He cited two cases and showed the relations of the cirrhosis to the cancerous growth, and considered the origin of the cancer cells, whether from the hepatic cells or intertubular ducts.

Dr. S. C. Busey of Washington, in collaboration with Dr. George M. Kober, read a paper on Milk as a Morbific and Infective Agent, with Tables of 134 epidemics of Typhoid Fever, 73 Scarlet Fever and 27 Diphtheria Due to Milk Infection.

Dr. W. P. Northrup of New York read a paper on Forcible Artificial Respiration, in which he exhibited the Fell-O'Dwyer Apparatus and gave an account of cases where artificial respiration was maintained four, twelve and twenty-five hours, in fracture of the skull, with operation, opium poisoning,

etc.

Dr. S. J. Meltzer of New York read a paper on the Direct Faradisation of the Mucous Membranes of the Stomach and the Intestines in Animals, Dogs, Cats and Rabbits. Against all clinical expectations, the experiment on animals revealed the surprising fact that neither the stomach nor the intestines can be brought to contraction by faradisation of their mucous membranes. Neither can the stomach be brought to contraction by application of one of the electrodes on the mucous membrane and the other direct on the muscular sheath of the stomach. The application of one

electrode on the intestines, and the introduction of the other into the rectum, does not produce any contraction of the intestines, but kills the animal sometimes.

CORRESPONDENCE.

AMERICAN MEDICAL COLLEGE
ASSOCIATION.

WOMAN'S Medical College
OF BALTIMORE.

Editor MARYLAND MEDICAL JOURNAL :

Dear Sir:-We may well congratulate ourselves on the achievements of the American Medical College Association. Who could have anticipated that the humble effort which was inaugurated against the advice of some on December 17, 1889, would lead to such results and in such a short period? The time seems to have been chosen and it needed but the spark to kindle the fire - or shall I say conflagration? for it seems to be something more than a mere fire. The work has been accomplished with a rush and doubtless some have been most unwillingly forced along; but those who are in a condition to take an impersonal view of affairs must feel highly gratified at the vast and unexpected change and the great improvement secured in our schools and methods of instruction. As soon as I can find time, if it will be acceptable to you, I will, from the materials in my hands, write up the history of the movement from its inception. I think our Baltimore schools deserve great credit for it. The importance of the subject demands that an authentic record of the events connected with the founding of the American Medical College Association should be published. Apart from its inherent interest, it will show how small beginnings will sometimes lead to very great results and thus afford encouragement to the humblest among us to "act well his part" however insignificant that part may appear to be in the world's history. Yours truly, EUGENE F. CORDELL, M. D. May 25, 1895.