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MINUTES OF THE SECTION

ON

PRACTICAL MEDICINE, MATERIA MEDICA, AND

PHYSIOLOGY.

TUESDAY, 3 P. M., May 4. SECTION called to order at 3 P. M., by its President, Dr. AUSTIN Flint, of New York.

Dr. N. S. Davis, Chairman of a special committee, presented and read a report upon The Necessity for Coincident Clinical and Meteorological Observations and Records, in the Study of Etiology, and on the Influence of Atmospheric Conditions in the Development of the Bowel Affections of Children.

Dr. H. C. W001, of Pennsylvania, remarked that he supposed the action of excessive heat in the production of serous fluxes, especially from the abdominal organs, is with physicians generally a familiar fact. He had, however, been led to the conclusion that these serous fluxes are the results of impressions made upon the nervous system, that they are of nervous origin, and are de. pendent upon paralytic affections of the vessels, giving rise to various changes, and probably also to an influence upon the trophic nerves of the parts. He referred to the fact that Dr. Weir Mitchell, of Philadelphia, had had an exceedingly rare opportunity to study the effects of atmospheric changes in the production of neuralgia, and that the results of his observations had been substantially negative. It is probable that many gentlemen have seen cases of neuralgia in which there has been apparently a close connection between the state of the weather and the presence of the neuralgic pain. A late professor at West Point received a gun. shot wound in the late war, from which he suffered severe neuralgic pains, and there was a seeming relation between the pain and certain atmospheric conditions, and upon this point he has made accurate observations and furnished interesting charts upon which

VOL. XXVI.—7

are marked pain curves, together with meteorological observations, such as relate to the medium, maximum, and minimum amount of ozone in the air, the variations of the compass, the degree of humidity of the atmosphere, the direction and force of the wind, etc.; and, to the great astonishment of the observer, when all these items were gathered, there was found to be no relation between the pain waves and the meteorological changes noted, in other words, the result of the work was comparatively negative. We all know, however, that heat is a direct provocative of disease. It acts directly upon the nervous system, and in that way produces its effects, but there is no evidence for the speculations with regard to the production of the various diseases by an excessive or too small amount of ozone in the air, or by a meteorological condition of the atmosphere. Of course it is an excellent field of inquiry, and can only be properly pursued by those who are skilled in the use of proper instruments for making meteorological observations.

Dr. Davis remarked that we have a great deal of speculation concerning the causes of diseases, and that it is very much as it is with the action of many of our articles of the materia medica. We have thousands of articles in the materia medica about which almost all we know is that they are authorized to be used for such and such purposes, but when asked to explain their action, it is a difficult thing to get at. So it is with much of our knowledge with reference to the causation of disease. Now with reference to the item which has been mentioned, attacks of bowel complaint in cbildren. One idea is that excessive heat produces them; another is that they are dependent upon teething, and there are probably thousands of children who perish every season because of this opinion. Nothing is to be done, it is reasoned, while the teeth are growing, etc., but then comes the fact that in the first consecutive steady warm weather these affections begin to develop rapidly, teeth or no teeth, and the question is, why should the teeth have any more effect at that time, if they happen to be coming, than in general ? Then again, if it is simply high temperature, heat alone that gives rise to the disease, it is a question whether it does so by acting upon the nervous system, or whether it is heat acting upon the actual affinity which one atom has for another, disturbing the relation of one atom with another; for we know that in proportion as we have heat added to organized or dead matter there is a separation of the atoms one from another. He was not sure that beat operates solely through the nervous system, but was of the opinion that it will be found to operate upon each and every atom which goes to make up the nerve molecule, but it undoubtedly affects nerve action because these atoms are a part of the organization. If the effects, however, are dependent upon the degree of heat, then when the thermometer indicates a bigh degree of temperature we should expect to have the effect, but his studies had led him to the conclusion that such is not the fact. In no instance within the last fifteen years has be known a consecutive high temperature night and day without having an aggravation of this class of diseases. When one or two days only are expired it will seldom be seen, but five or six consecutive days characterized by high temperature will as inevitably be attended by certain results as any other well-established law of nature.

What we wish to get at now is a basis upon which to form some conclusions. He would not now attempt to speculate with regard to the cause, or how it operates, whether it is heat directly, or whether it is conditions of heat modified by certain other elements, because he had not the data upon which to form a judg. ment. But it seemed to him that the time had come inasmucb as the

government has got, and is getting more and more of trained men to make 'scientific observations which are specific, that we may in this Association make the necessary clinical means, so as to obtain finally observations which will clear away much of the rubbish with which we are now surrounded, and substitute considerable of scientific and specific deductions.

Dr. WOODWORTH, of Indiana, remarked that it is well known, as Dr. Wood has just said, that serous fluxes are more prevalent during the hot seasons of the year, and it is especially true of cholera infantum, but a reason for not regarding heat, per se, as a cause of it, is that it is a disease that does not prevail except in large towns to any great extent, and so far as he was acquainted, the disease does not prevail to any great extent, except in the United States. The prevalence of cholera infantum in the country is comparatively rare, and is almost exclusively confined to large towns and cities. There is no doubt but that children are subject to diarrhoea, during hot weather, in the country, as well as in the cities, but not proper cholera infantum. May it not be that there is something else besides heat, per se, that produces it? May there not be some vitiated state of the atmosphere, which is a greater

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cause of disease than heat? He had no belief in the idea that heat, per se, is injurious or is the cause of disease generally. A far more common cause of disease is cold, and we know that that is an exciting cause of inflammatory diseases; and a very sudden change from hot to colder weather is a fruitful cause of disease. In 1849.

, when the cholera prevailed in the towns in which he visited, there was always an outbreak when there was a lowering of temperature accompanied with an east or northeasterly wind. So in 1852 and '54 the same thing was observed. It is a common expression that a changeable climate is conducive to disease. It is often said that the climate of certain localities is so changeable that it is bad, etc. He had read in one of Dr. Johnson's works written many years ago, that, instead of this being a cause of disease, it was the real reason why the climate of England was so much more healthy than that of Italy. He was of the opinion, however, that there must be some other cause for this disease especially, besides that of heat.

Dr. ROBERTS BARTHOLOW, of Ohio, commended the spirit of the resolutions, and was of the opinion that if the plan proposed can be faithfully carried out, there will be accumulated an immense body of facts, which will be of great service not only scientifically but clinically. He then referred to the Pennsylvania Hospital Reports, in which may be found a paper upon barometric pressure in relation to mortality after surgical operations.' It was shown in that paper that when the barometer is falling it is unsafe to undertake an operation. About the same time Dr. Richardson, of England, undertook a series of investigations in the same direction, and arrived at identically the same conclusions, and that the baro. metric registrations were to be consulted when an important surgical operation was to be performed, and the operation was to be avoided when the barometer is falling. Mr. Spencer Wells was about to perform the operation of ovariotomy, and, as the barometer was descending rapidly, Dr. Richardson addressed a note to Mr. Wells stating that the operation if performed at that time would probably prove fatal. Mr. Wells, however, regarded it as a whim of a scientific investigator, and went on and performed this operation, and the result was unsuccessful as predicted. He then addressed a note to Dr. Richardson for the purpose of ascertaining how he had arrived at the conclusion he had given, and he replied that the conclusion was based upon the rapid descent of the mercury in the barometer.

Dr. W. S. EDGAR, of Missouri, remarked that, as confirmation

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