THIRD DAY-FEBRUARY 2D.

MORNING SESSION.

The Committee on Nominations announced the following committees for the ensuing year:

Committee on Arrangements: Samuel B. Ward of Albany, William B. Nellis of Albany, and Reynold W. Wilcox of New York.

Committee on By-Laws: H. D. Wey of Elmira, Nathan Jacobson of Syracuse, and F. C. Curtis of Albany.

Committee on Prize Essays: J. M. Van Cott of Brooklyn, Abraham Jacobi of New York, William E. Krous of Buffalo.

Committee on Hygiene: Henry R. Hopkins of Buffalo, George R. Fowler of New York, Ezra H. Wilson of Brooklyn, J. M. Mosher of Albany, George Seymour of Utica, Henry Elsner of Syracuse, M. A. Veeder of Lyons.

Committee on Legislation: Frank Van Fleet of New York, Arthur G. Root of Albany, Ernest Wende of Buffalo.

Committee on Ethics: George McNaughton of Brookyn, Charles Mason of Peekskill, Louis A. Weigel of Rochester.

Committee on Publication: F. C. Curtis of Albany, W. W. Potter of Buffalo, Charles H. Porter of Albany, Daniel Lewis of New York.

State Board of Medical Examiners: A. Walter Suiter of Herkimer, George Fowler of New York, H. D. Wey of Elmira, Daniel Lewis of New York.

Recommendation for Honorary Membership: W. W. Keen of Philadelphia, Morris H. Richardson of Boston. Eligible for Honorary Membership: John B. Deaver of Philadelphia, Joseph Eastman of Indianapolis, William Osler of Baltimore.

Delegates were appointed to the following: Ontario Medical Association, Canadian Medical Association, American Electro-Therapeutic Association, Massachusetts Society, Connecticut Society, Vermont Society, New Hampshire Society, Medical Society of New Jersey, Mississippi Valley Association, Medical Society of Virginia, British Medical Association, Florida Medical Association.

Dr. A. Walter Suiter of Herkimer: Your Committee recommends earnestly that the Committee on Legislation of this Society prepare a bill making it a penal offense for any person to obtain from a charitable medical institution gratuitous services by persons financially able to compensate for the same in the same manner that under existing laws it is made a penal offense to obtain money under false pretenses. Your Committee would recommend that the Committee on Legislation be specially instructed to make every effort possible to effect the restoration of the original appropriations of $5000 for the care and maintenance of the State Medical Library and that the cooperation, in this respect, of the Legislative Committee of the Homeopathic and Eclectic Societies be requested. DR. R. J. WILDING of Malone presented a paper upon

A FORM OF SUTURE SUITABLE FOR ABDOMINAL SURGERY.

on

DR. GEORGE M. MCCOMB of Frankfort read a paper

THE LIMITATIONS OF SURGICAL WORK IN COUNTRY PRACTICE.

DR. LOUIS F. BISHOP or New York presented a paper on THE DIFFERENTIATION OF THE DIFFERENT FORMS OF RHEUMATISM.

Diagnosis of neuritis depends upon the recollection of simple facts of anatomy and physiology. When a nerve is inflamed it is tender on pressure along its trunk. The reflexes are impaired. There are disturbances of sensation over the areas of distribution of the terminal fibers. Theoretically, the differentiation should be easy, but practically it is only made after careful study. The next differentiation of importance is from the vari ous forms of arthritis in which the rheumatic poisoning is not an active cause. Arthritis deformans is a condition of some rarity. It involves the ends of bone in proliferation, and the joint is finally lost. It must be dif ferentiated from chronic rheumatism. Rheumatoid arthritis is characterized by nutritional disorders, well seen in the marked atrophy of muscles, changes in the joints, etc. It occurs more frequently among women.

From chronic gout the differentiation is easily made by the presence or absence of gouty deposits.

A very troublesome type is the arthritis following infection with the gonococcus; this seems to arise from accidental contact at the time a patient is suffering from a mild attack of rheumatism.

Acute articular rheumatism is a systemic disease with usual manifestations in the joints, but it is abundantly proven that rheumatism may manifest itself more injuriously in other directions.

DR. S. A. RUSSELL of Poughkeepsie presented a paper on

THE SCIENTIFIC ASPECT OF THE MIND CURE,

after which the Society adjourned.

REVIEWS.

DISEASES OF WOMEN. A Treatise on the Principles and Practice of Gynecology. For Students and Prac titioners. By E. C. DUDLEY, A. M., M.D., Professor of Gynecology, Northwestern University Medical School; Gynecologist to St. Luke's Hospital, etc., Chicago. With 402 illustrations, of which 47 are in colors, and 2 colored plates. Philadelphia and New York: Lea Brothers & Co., 1898.

THE arrangement of this work is upon the basis of pathology. This is a departure from the old plan by which the subject was classified according to regions of the body. To the reader the arrangement is novel and strange, but to the student and one who considers the volume carefully it has great advantages. The book is divided into five sections. In the first, General Principles are considered, including the physiology of the subject, a clear review of bacteriology and a full de

scription of methods for securing asepsis and antisepsis. In the matter of diagnosis, the book is thoroughly up to date. The recent work upon the bladder and ureters, which has so greatly enlarged the field of diagnosis, receives adequate attention. The matter of local treatment is also considered, The writer goes fully into the question of the value of topical applications, but has found little evidence of their utility. He describes minor operations in detail, and then proceeds to a full discussion of major operations. Upon the subject of drainage, he believes that when the surgeon is in doubt he should not drain. The author considers the subject of the relation of dress to diseases of women of sufficient import ance to merit a separate chapter. This includes the most recent investigations upon the subject, and is of decided value.

In Part II. inflammation is taken up and the distinction between infection and inflammation very clearly brought out. This portion of the book should be of especial value to the student as furnishing a foundation for future studies in diagnosis. Inflammation of the uterus comes in natural order, and the writer treats fully of this most important subject. In the treatment of chronic endometritis, he states that he has used patiently and diligently all methods of topical application which are warranted. He has been disappointed in the results and in some cases has seen positive harm done. In considering pelvic inflammation, he believes that pelvic cellulitis exists, and considers fully the operative treatment by both the abdominal and vaginal routes of this procedure. This part of the book concludes with the discussion of inflammations and disorders of the urinary

tract.

Tumors, tubal pregnancy and malformations are considered in Part III. The writer has faithfully tried the electrical treatment of myomata without essential success. He has little confidence in ligation of the uterine arteries and broad ligaments. He believes that vaginal removal of myomata should be given a larger place, and that the uterus should be preserved, if possible, in these cases. An original method of operating for this purpose is fully described. He believes that a very low death-rate for both abdominal and vaginal section in these cases is to be expected. In the treatment of carcinoma of the uterus, hysterectomy is indicated, if the womb is mobile and the surrounding tissues not involved. A very good description of deciduoma malignum is given in this portion of the book. An excellent description of ovarian tumors and their treatment comes next in order.

In ec

topic pregnancy, the author believes that all cases are first tubal and secondarily found in other portions of the genital tract.

In Part IV. the writer treats of lacerations of the perineum, vagina and cervix. We find here a full reiteration of the teachings of Emmet, with the added material obtained from the writer's experience. He combines with closure of the cervix, curetting. This section is exceedingly well written and thoroughly illustrated by some very good original drawings. In the treatment of displacements of the uterus, the author describes an original

operation for anteflexion, which in about fifty cases has given one hundred per cent. of anatomical cures and seventy-five per cent. of symptomatic cures. A full chapter upon massage closes the volume.

Among thinking readers who desire a thoroughly modern book, this should be a valuable and popular work. Those who cannot appreciate efforts at progress may not be pleased with the arrangement of subjects and some of the treatment proposed. We have read the volume with great pleasure, and consider it a thoroughly modern textbook of decided value and a distinct acquisition to the literature upon the subject.

CONSERVATIVE GYNECOLOGY AND ELECTRO-THERAPEUTICS. A Practical Treatise on the Diseases of Women and Their Treatment by Electricity. By G. BETTON MASSEY, M.D., Physician to the Gynecologic Department of Howard Hospital and Late Electrotherapeutist to the Infirmary for Nervous Diseases, etc., Philadelphia. Third edition, revised, and greatly enlarged. Philadelphia: The F. A. Davis Company, 1898.

THAT the number of specialists in diseases of women who are interested in the use of electricity in pathologic conditions of the pelvic viscera is a large one would appear evident from the fact that a third edition of Dr. Massey's book has been called for. Ten or more years ago, when really remarkable results were claimed by well-known and competent experimenters in this department of gynecologic practice, many of the assertions made by the present author would have been received with a just appreciation of his wide experience and a higher value would have been placed upon them than is possible by the clinician of to-day.

During the past three years many learned medical societies have given much time to thorough discussion of the value of electricity in gynecology, and almost without exception, the consensus of opinion has been that its sphere of usefulness is confined to extremely narrow limits. Notably was the discussion by the members of the American Gynecological Society at Boston, in May, 1898, to this effect. For this reason, and because others have signally failed to achieve like results, we find it difficult to accept unreservedly many of the statements made by Dr. Massey in the book before us, for instance (page 106), that a neglected catarrhal metrosalpingitis, particularly of gonorrheal origin, is "as surely curable under positive vaginal applications, assisted by the faradic current and by subsequent intra-uterine treatment, as any similar catarrhal affection elsewhere in the body, the intra-uterine treatment being, of course, carefully employed with a view of increasing the drainage.” Likewise, one is apt to evince surprise at the perfect results obtained in the case of a young woman who presented herself for treatment of hypertrophy and prolapse of the infravaginal portion of the cervix (page 188). "The cervix protruded about two inches beyond the vulva. On passing the sound into the cavity of the uterus it entered seven inches. Bimanual examination showed that the fundus was well up in the superior strait. The

condition had lasted two months. The protruding cervix The protruding cervix was pushed within the vulva and an intra-uterine application of mercuro-cupric cataphoresis made with 80 milliamperes, followed by primary faradic current." On five subsequent occasions the treatment was repeated, with a current of 40 milliamperes, and two and one-half months from the time the patient was first treated the uterus was normal in size and position.

The Apostoli method of treatment of uterine fibroids is lauded, and instances of remarkable diminution in size, and even of complete cure, are related, so that one finally is forced to wonder why it is that myomectomy or hysterectomy is ever resorted to in these cases, and why, if such results are obtained at the hands of one or a few operators by means of the electrical current, other experienced gynecologists have long since given it up.

There is no gainsaying that the book bears the stamp of sincerity from cover to cover, and that it is the work of a man who believes thoroughly in the soundness of the principles laid down. Though he strives honestly to turn professional opinion back to a worship of its former gods it is a task, we opine, most difficult of accomplishment.

The book contains twelve original full-page chromolithographic plates, and twelve full-page half-tone plates of photographs taken from nature, as well as numerous engravings in the text. The publisher's work has been well done in every respect.

A TREATISE ON DISEASES OF THE EAR. By ALBERT H. BUCK, M.D., Clinical Professor of Diseases of the Ear, Medical Department, Columbia University. Third Revised Edition. New York: William Wood & Co., 1898.

PROFESSOR BUCK'S new edition of his text-book of ear diseases amply meets the demands of those advances in otology and aural surgery which have called the publication into requisition. The book is greatly improved by the use of larger type, more prominent headlines, and wider spacing. In addition the number of special case histories which interfered greatly with the continuity of the text in the previous editions, has been greatly reduced in the new one.

The chapter on the changes in the appearance of the membrana tympani has been much enlarged and given a more prominent position. A special chapter has been devoted to the study of those nasal and pharyngeal conditions which so often play an important rôle in the etiology of ear diseases. The chapters on mastoid disease, its complications, and treatment have been revised and enlarged.

CLEFT PALATE; TREATMENT OF SIMPLE FRACTURES BY OPERATION; DISEASES OF JOINTS; ANTRECTOMY; HERNIA, etc. By W. ARBUTHNOt Lane, M.S. London: The Medical Publishing Co., Ltd., 1898.

THIS is a collection of very practical clinical lectures on varied orthopedic topics, presenting some unique and original ideas. Particularly worthy of note is the theory of the mechanical production of arthritis deformans and the author's advocacy of operative interference in fractures,

VOL. LXXIV.

ORIGINAL ARTICLES.

PULMONARY AND LARYNGEAL TUBERCULO-
SIS TREATED WITH ANTIPHTHISIC
SERUM T. R., WITH REMARKS ON
THE ETIOLOGY OF TUBERCU-

LOSIS.

BY W. FREUDENTHAL, M.D.,

OF NEW YORK.

In a former paper I have said, with reference to the influence of post-nasal catarrh on the production of pulmonary tuberculosis: "According to our present experience, there is no doubt that infection with tuberculosis most frequently takes place through the respiratory organs. But I agree with Ponfick, with whom, by the way, Ziem also coincides, when he declares that the lungs can no longer be looked upon as the principal organs for the entrance of the tuberculous poison. To me it was always incomprehensible how the tubercle bacillus, during respiration, should penetrate the many tortuous respiratory passages, to finally build its nest at the apices of the lungs, which are so difficult to reach. Why do not other microscopic particles, inhaled in the air, do the same? Why does not soot, for example, not only enter the nose but also all parts of the lungs? If we suppose that tubercle bacilli are drawn away mechanically by the air current, I will not admit that, when inhaled in moderate quantities, they reach the apices of the lungs without their progress being previously checked. Imagine, for the sake of simplicity, the air current passing in a straight direction toward the retropharyngeal cavity. it turns at an acute angle, and it would be more than peculiar if the bacteria would not be held there by the moist mucosa. In addition, deeper down the

Here

air current is deviated at the entrance into the larynx by the various prominences, such as the epiglottis, arytenoids, etc., and again, and more especially, at the bifurcation of the trachea."

There is still another factor that makes the retropharynx the locus minimæ resistentiæ. The different kinds of bacteria, especially the cocci, according to the experiments of Babes, are prone to prepare the soil for the tubercle bacilli. Thus this factor also facilitates the entrance of the tubercle bacillus into the mucosa of these parts. Once having penetrated the lymph-tissue it wanders with the lymph-stream until it gets into the larger lymph-vessels, and finally into

No. 7.

the thoracic duct. On its way thither the bacillus is quite frequently hindered or detained by stoppage of the vasa afferentia, etc., and the latent tuberculosis, so commonly met with, originates. On the other hand, the thoracic duct becomes the main source for the further spreading of the germs. From here the infection of the apices of the lungs, the loci minoris resistentiæ, proceeds.' It is evident that the organism frequently reacts against the invasion of the tubercle bacillus, and the glandular swellings, so common in children, appear. These lymphomata, often nothing else than a consequence of an existing retropharyngeal affection, bear the same relation to this condition as the inguinal bubo does to the primary affection in the genitals.

After bringing many more proofs in confirmation of my theory I came to the conclusion that the hypertrophy of the lymphoid tissue at the vault of the pharynx is nothing more than the expression of this reactionary inflammation. At that time I had overlooked an article by Professor Trautmann of Berlin, in which he says: "Although by careful examination of the hyperplastic tissue at the vault of the pharynx, of the follicles, and of the secretion, neither giant cells nor tubercle bacilli were found, I nevertheless consider tuberculosis the cause of the hyperplasia.

. A communication made to me verbally by Robert Koch also speaks in favor of tuberculosis being the cause of the hypertrophy. After injec

tion of tuberculin he found at first a rise of temperature, then more swelling and hyperplasia of the lymphoid tissue, and after further injections both disappeared and the hyperplasia was cured, but not until treatment extended over several months."

I cannot mention here all the facts that have been elicited in favor of my theory; I will only say that Pluder and Fischer,' in an article that appeared almost on the same day as mine, came to very similar conclusions. They believe that the five cases which they mention must be considered as latent and primary tuberculosis. They explain their ideas about the propagation of the tuberculous virus in the system in a very interesting manner, for details of which I would refer the reader to the original paper. I have examined numerous patients and have found 1 W. Freudenthal: "Kleinere Beitrage zur Aetiologie der Lungen-tuberkulose," Arch. fur Laryngol., Bd. 5, 1896, and Annals of Otology, February, 1897.

F. Pluder und W. Fischer "Ueber primäre latente Tuberkulose," etc., Archiv für Laryngologie, Bd. iv, page 372.

that a great many have affections of the retropharynx, and that of these a certain percentage show tuberculous lesions in the lungs. I did not draw any definite conclusions in regard to the percentage of cases of phthisis among those affected with nasal and postnasal disease but attempted to show that a direct connection exists between affections of the retropharynx or nose and general tuberculosis; in other words, that the disease commonly called "catarrh " frequently leads to tuberculosis.

Dr. E. Fletcher Ingals of Chicago has asserted that "catarrh" has a tendency to prevent tuberculosis.1 He says that 38 per cent. of the human family at one time or another suffer from pulmonary tuberculosis, as against about 75 per cent. with diseases of the upper air passages, or nasal catarrh." This is as much as, or even more, than I expected, but he says further, that of these 38 per cent. with tuberculosis comparatively few suffer from nasal disease. Thus, for example, of his 830 cases of pulmonary tuberculosis, only 237, or about 28 per cent., showed some nasal trouble. "Of the 237 cases which make up this 28 per cent. I find that 168 consisted of exostosis and deflection of the septum, which . is present in 50 per cent. of all persons of the European race; therefore many of these would have had no possible influence in causing the pulmonary tuberculosis." I fail to see the logic of Dr. Ingals' conclusions. Because 50 per cent. of all Europeans have deflections of the septum, must we exclude them from our statistics? Are deflections of the nasal septum to be considered normal because so many civilized people have acquired them? We might as well say that gonorrhea in man is a normal condition because so many cases exist. Deflection of the nasal septum is a pathologic condition which also tends to produce postnasal catarrh and I consider it a very important etiologic factor in favor of our theory. But Dr. Ingals goes on to exclude other possibilities by saying: "Further, my records show that of all the cases of pulmonary tuberculosis, 1272 in number, only 27 of the patients, or about 2 per cent., complained of having had any previous nasal disease, which is 4 per cent. less than the normal average." His position must be very weak if he is forced to fall back on such arguments. Were we to be guided by the complaints of the patient, we would, for instance, still have to treat many cases of persistent headache as malaria and fill the patient with quinin and similar drugs, as we formerly did. We would never be justified in removing polypi, etc., in cases of asthma because the patient does not complain of his nose.

Annals of Otology, Rhinology and Laryngology, p. 173, February, 1898

About thirteen years ago, while pursuing other investigations, I examined the nasal passages of every patient, 500 altogether, that came to the Hospital for the Ruptured and Crippled, this city, and was surprised to notice how seldom the patients complained of their noses. I remember several instances in which grown persons could not breathe through their noses at all, since they were almost hermetically stopped up by numerous polypi, etc., and nevertheless they had no complaints to make. In regard to tuberculous patients, I examined 75 of the consumptives at the Montefiore Home. Of these 37 did not complain at all about the throat or nose, and 38 did, i.e., about half on each side. Of the 37 patients who did not complain, not less than 23 showed marked abnormalties in their nasal passages and in only 14 were there no marked changes at all. Although these statistics are not extensive, I am sure that they will convincingly prove that consumptives suffer from nose and throat troubles, not only as much so, but more than other people. Two-thirds of those who did not complain had some kind of affection of the throat or nose, and naturally the others, who did complain, showed lesions of the parts also.

The question of the treatment of tuberculosis with the new tuberculin T. R. has been a burning one since Koch published the result of his experiments with the agent nearly three years ago. It was during the course of certain experiments which I was making with tuberculin T. R. that I came across three publications from Professor v. Leyden's clinic, which almost made me give up my investigations. On looking over these papers, however, they did not seem to me to be altogether exempt from criticism. The first paper was that by Dr. Huber, assistant to v. Leyden, who made experiments with the new tuberculin T. R. on animals, and arrived at the conclusion that it had no therapeutic value. His deductions were contradicted by Professor Brieger, Dr. Petruschky, and others. Still, we must admit that his conclusions were correct in one point, viz., that in one or two of his experiments virulent tubercle bacilli were present in the new tuberculin. But since September, 1897, this defect has been remedied. Nor were his practical experiments on patients more successful. In five advanced cases there was no influence visible. In two cases that were doubtful the status of the patients remained unchanged. In three cases, which were suitable for this treatment, in which, however, the injections were interrupted prematurely, one patient was somewhat improved, while the others remained unchanged. In four cases in which the treatment was specially indicated, the