Then I thought it was a malignant growth somewhere in the abdomen. Abdominal section, however, revealed stricture of the descending colon. DOCTOR CARSTENS: Doctor GREENSHIELDS brought out a point which I think is quite important, the compensatory hypertrophied development. There may be extensive stricture without any symptoms. Last year I had two cases in which the compensatory hypertrophy of the intestinal walls was remarkable. These patients evidently had this condition developing for a year or more. One gave a history of two years with no serious premonition until suddenly, acute symptoms developed, which were very deceiving as though they indicated an acute invagination, or a severe inflammatory condition. On examination this hypertrophied condition was found a stricture, which would not allow a pencil to pass through it. Sometimes a surgeon is called upon to operate for obstruction of the bowels and finds only a case of appendicitis. Often there is no obstruction of the bowels at all. They are simply paralyzed by large doses of opium, and the vomiting is purely of asceptic origin. Such cases are deceiving and must be borne in mind. Malignant growths occur on almost any part of the body. I once had a case in which there was a malignant growth between the stomach and the transverse colon, yet there was no obstruction. This growth had flattened out. The transverse colon caused symptoms; by removing it the symptoms afterwards disappeared, although the man died later from recurrences. I think these cases must be handled early. I had a patient a short time ago who had been in the hospital without any effort being made to relieve him, but he had been subject to the usual treatment of calomel, soda, et cetera, and was absolutely starving. He was weak and run down, and I did not think an operation would be beneficial. I made gastroenterotomy but the man died soon after. If it had been done two weeks earlier he would probably have been relieved even though the growth could not have been removed. STATED MEETING, NOVEMBER 7, 1900. THE PRESIDENT, CHARLES T. MCCLINTOCK, M. D., IN THE CHAIR. DISCUSSION OF PAPERS. DOCTOR ALONZO BRYAN read a paper entitled "The Pathology and the Antiseptic Treatment of Smallpox." (See page 19). DOCTOR CARRIER: A point of particular interest in the consideration of smallpox lies in the fact that this is a disease which has been characterized by such a great mortality and one in which the results have been manifested by such severe scarring. It is a disease from which the horror has been removed to some extent by vaccination; and yet at the present time, it is appalling that there should be so many people unvaccinated, and thus liable to attacks of the disease. A peculiarity of smallpox lies in the fact that no matter how mild the attack may be, a person taking it from the patient may experience a severe form of the malady; in this it differs from other contagious affections. As to whether the disease is caused by specific germs or not is a debatable question at the present time. There must be something about it that is specific or it would not be contagious. Anyone who has attended a severe case of smallpox knows that the whole mucous membrane is affected by these lesions just as much as is the skin, and it scarcely seems possible that infection from them could occur or that the disease could be benefitted by the application of a local remedy. Someone has said: "If the disease lasts for seven days it is due to secondary infection, but the development of the pustule is the result of the specific disease and not of the germs." DOCTOR BRYAN must suppose that pus-producing germs are present in all cases. These germs have been present in enough cases to show that they stand in the relation of cause and effect. Most authorities claim that the infection enters the system through the respiratory apparatus and not often by contact. Cases are on record in which individuals have contracted the disease by occupying rooms wherein a preceding case had occurred two years previous. Of the cases that have occurred in the city of Detroit, I think only two have died of hemorrhagic smallpox. I believe a great deal can be done toward the prevention of scarring by the removal of the crust. DOCTOR MANN: It seems to me that all we know of the source of smallpox is that it is a process originating in the upper superficial and the middle cells of the integument. DOCTOR BRYAN maintains that this disease ends in the vesicular stage, that it does not attain the suppurative stage, and that it is transmitted through the epidermis. We have evidence of numbers of cases wherein there has been no possibility of infection through the skin. I think it would be necessary for the doctor to show us a case of infection from pus-forming microbes. I cannot say that I agree entirely with DOCTOR BRYAN'S theory regarding the nature of the suppurative stage of smallpox; I think, however, he has called our attention to a very useful part of the therapeutic stage of the disease. DOCTOR DONALD: There is a close relationship between varicella and variola. Speaking from my clinical experience I protest against the idea that they are one and the same. There are two distinct types of the disease variola and varicella. Re DOCTOR TROY: I believe that smallpox is caused by a specific microorganisın. I cannot conceive how any infectious disease that requires a definite period of incubation can originate from any other source. The question of immunity, which is of so much importance in all infectious diseases, was demonstrated first and best in smallpox. When a case of smallpox is discovered, as it will and should be, the only treatment will be serum. It matters not how much smallpox is treated, an ideal treatment seems to be no nearer attained. The essayist mentioned his treatment, having especial reference to the eruption. It is, however, a well-established fact that smallpox may appear and run its course without the slightest sign of an eruption to indicate the nature of the disease. garding this, I have never seen a case myself that could be so designated, but DOCTOR GIBBES has informed me of an autopsy held in a case of this kind, the staff of the hospital having already seen the case. The patient had died after four or five days of severe illness, and not until the autopsy was the nature of the disease determined, and of the men who were present, I think eighteen contracted the disease, the majority of them dying. I have seen one case of hemorrhagic smallpox, and the patient did not have the slightest trace of an eruption such as would be expected to be seen in smallpox. DOCTOR CARRIER brought out that hemorrhage in the smallpox lesion is not hemorrhagic smallpox. Some cases of hemorrhagic smallpox have no lesions. The first thing noticed is a slight redness on portions of the body, that become deeper and darker until it is almost black-the number of these ecchymoses indicating how dark the whole body may become. The mucous membranes bleed more or less freely. In the case that I saw the young man was taken severely ill with pneumonia and vomiting, which continued a day or two, his mind then becoming affected. In cases of hemorrhagic smallpox, vaccinaton seems to be almost useless. As to the relationship of smallpox, it is a well-known fact that all infectious diseases come in waves of more or less malignancy. Regarding the treatment, I do not believe we will ever have an effective one until a serum therefor is discovered. Taking into consideration the probability that the disease is due to a microorganism, it would seem that the treatment must be along the line of serum therapy. DOCTOR SCHMALZRIEDT: While treating some cases of smallpox I saw two cases of varicella, and one which having been wrongly diagnosed varicella resulted in a brother and another sister of the patient taking smallpox. There may be a possibility of an interrelation between varicella and variola, but I doubt it. Regarding the advance rashes of which DOCTOR CARRIER asked me to speak, I would say that most of the cases were not seen until the papular or vesicular stage, but in those cases wherein I have seen the advance rashes-two being of the confluent type-the papula followed within a few hours after I saw the rash, and it did not resemble the rash of any other disease, with one exception in which I would have made a diagnosis of scarlet fever had I not known that the patient had been exposed to smallpox. Concerning the hemorrhagic type, two forms are known the hemorrhagic smallpox and the hemorrhagic pustular smallpox. The hemorrhagic is usually fatal within four or five days. I once had a case of hemorrhagic pustular smallpox in which the vesicle and. pustule had formed and hemorrhage had taken place into the pustule. This case lasted nine days. As to the external treatment of smallpox, the most important duty of the nurse is to keep the external serface clean. DOCTOR BRYAN: I wish to allude to the question of the infection of the mucous membrane. The mucous membranes in smallpox, according to my observation, and I have had extensive observation, are not seriously affected. The membrane of the eye is continually washed by a normal solution, the tears, purulent infection being prevented thereby. Even this slight optic eruption is more severe than that which occurs in the mouth and in the alimentary tract. There never are any very severe hemorrhages from the bowels in cases of smallpox, although I cannot say that there are none. To call your attention to the occurrence of the purulent infection, I would like to answer the question: "How is that evolved?" Purulent infection is evolved through the medium of germs on a denuded surface in the vesicular stage. True smallpox proceeds only so far as the vesicular stage; consequently, true smallpox, if nothing interfered with it, would be a mild disease by which few lives would be lost. EDITORIAL ARTICLES. A CENTENARY MEETING. THE end of the century was celebrated by the Detroit Medical Society by a centenary meeting held December 19, 1900. The theme of the evening was the advancement in medicine and surgery and an acknowledgement to the medical benefactors of mankind. DOCTOR N. W. WEBBER gave local coloring to the occasion in the introductory address on 'The Old Doctors of Detroit and Michigan." 66 The names of WILLIAM BEAUMONT, who made his observations upon ALEXIS SAINT Martin, at Mackinac, ZINA PITCHER, ABRAM SAGER, RICHARD INGLIS, H. O. HITCHCOCK, A. B. PALMER, WILLIAM BRODIE, FOster PRATT, GEORGE E. FROTHINGHAM, CHARLES J. LUNDY, DAVID FARRAND, and some among the living were repeated with the veneration that comes of tender memories, and their characteristic qualities recalled. FRANK T. LODGE, Esquire, discoursed upon "A Half Century in Medical Jurisprudence." He reviewed the gradually increased legal restrictions which have been thrown around the practice of medicine in nearly all the states and referred with pride to the enactment of the Chandler bill in Michigan. Next, after relating the origins of the ridiculous "boy of fourteen" and the "wild beast" theories of emotional insanity, he traced the successive steps of advancement to our present conception of this subject and its aspect before the courts. The rise, development and decline of the medical expert were historically considered and mentioned as important changes in the realm of medical jurisprudence. DOCTOR H. O. WALKER addressed upon "The Surgical Progress of the Nineteenth Century." The early history of surgery was hastily narrated and the status of the art' at the beginning of the present century defined. "To sum up briefly the surgeon of 1800 was a good anatomist and possessed great manual dexterity with indifferent technique, no knowledge of pathology or the prevention of sepsis, and with but a dream of anesthesia." The beneficent discoveries of that American trio, JACKSON, MORTON and WELLS, and of LISTER were commemorated, the memorable and heroic achievement of MCDOWELL extolled, the surgical services of MOTT, PHYSICK, DANIELLS, BUCK, VAN INGEN, FLUHRER, LITTLE, SAYRE, PHELPS, WYETH, MURPHY, SIMS, SENN, KINLOCH, BOBBS, VAN HOOK, PARKER, BIGELOW and other Americans called to mind, the discovery of ROENTGEN noted and the great contrast in medical books, journals, libraries, colleges, hospitals and training schools at the beginning and end of the century set forth. Especial attention was directed to the part that the United States had taken in the real progress of surgery. The national rivalries and jealousies which precluded the ready adoption by the nations of Europe of each other's advances offered no hindrance here. All that was good in the discoveries, inventions or theories of others was freely appropriated, as a result of which American surgery has a history of which we need not be ashamed. "The Medical Progress of the Nineteenth Century" was the topic of an address by Doctor V. C. VAUGHAN, of Ann Arbor. Starting with the demonstration by JENNER in 1796 and comparing with it the willful negligence of vaccination and the consequent pestilence in his own shire a hundred years later, he detailed the progress in the control of many of the infectious diseases. The work of PASTEUR, POLLENDER, KOCH, BEHRING and Roux was spoken of and account given of the enthusiastic reception of Roux's concurrence in BEHRING'S claims for antitoxin, at the International Congress. Again reference was made to the work of BEAUMONT and to his co-workers in the investigation of digestive diseases. He predicted the coming of the day when man would no longer pollute the water he drank, the food he ate, the air he breathed, nor the ground on which he walked. He talked of the discoveries in chemistry and biology, of the hypodermic syringe and of anesthesia and asepsis which have lifted the curse of pain and death in maternity from the daughters of Eve. "What the future will bring we do not know, but we hope for good things. Civilization has much to dc with progress in any branch of science, but sometimes civilization itself becomes diseased. Progress is not always in a straight line. It moves sometimes in curves, and the descent may be as abrupt as the ascent. Witness the burning of the Alexandrian library and the neglect of Grecian art. In our faces are osteopathy, Christian science, free dispensaries, and other problems of great significance to us. We can only hope for the best." ANNOTATIONS. THE NATURE OF SMALLPOX AND ITS TREATMENT. NOTWITHSTANDING that smallpox is supposed to have been recognized in the orient before the Christian era, and although introduced into America nearly four centuries ago, little more than its extreme contagiousness was known about it until Jenner demonstrated the effect of vaccination. During the century now ended vaccination and quarantine have kept the disease within bounds, but aside from vaccinia nothing more than empiricism has been in store for the afflicted patient. It is true antiseptics of various kinds have been recommended and used for several years, but they were designedly employed rather to prevent pitting. than to prevent sepsis. In short pustulation has usually been regarded as an essential part of the disease. About six years ago DOCTOR ALONZO BRYAN, of Detroit, pointed out and insisted that smallpox extended to and included only the vesicular stage and that the vesicles became pustular only by accidental infection. From this standpoint he reasoned that by systematic and thorough asepsis not only could pitting be avoided but also the further course of the disease be averted. In his presentation of the matter, now for the third time, in other pages of this issue his views and proofs are set forth. It is unfortunate that greater opportunities were not afforded him to test his views and develop his method of treatment. However, since his first publication others have followed out the idea of antiseptic treatment and submitted their reports, which make it more than probable that the science of this subject has been materially advanced. So far as we are informed DOCTOR BRYAN'S claim to precedence in this discovery is justified, and we take pleasure in recog nizing it. PSYCHOPHYSICAL STUDIES. THERE are perhaps not many points of actual contact between the three learned professions: not many subjects for study that may properly claim their attention to an equal degree. It is true, however, that man in his psychophysical relationship appeals to the divine, the student of law and the physician alike. Indeed art itself is deeply concerned with the manifestations of normal and abnormal qualities and similar bases for study should be patent to the educator and indirectly to all classes of student-workers. Thus far we have all been almost totally engaged with that which lies nearest. In crime we have been dealing principally with the criminal and neglected the causes which made him such. As a nation we spend fifty-nine millions annually on judiciary, police, prisons and reformatories, and in spite of this great outlay only one in four or five is |