VOL. XXI.

No. 10.

cations.

CONCERNING MEDICAL SOCIETIES AND

PAPERS.

BY ROBERT HESSLER, A. M., M. D. Presidential Address before the Cass County Medical Society.

A medical society is of necessity composed of different minds, just as we see it exemplified in any other aggregation of men, and this manifests itself chiefly in the disposition, or rather indisposition, to attend the regular meetings and take part therein. Some members are very regular; they attend all the meetings and usually take part in the proceedings; others attend only rarely and some scarcely at all. Then again some of the attending members are always ready to respond with a paper or the discussion of a paper when called upon -others are never ready.

How often have we noticed on the printed program and in the announcement of the daily press that Doctor So and So will read a paper at the meeting of the X medical society when we are reasonably certain that he will not do so at all but that that individual is simply getting his name before the public. I am opposed to a society printing the names of the men who are "going to read" papers, although I have none to seeing mentioned who did read a paper.

As a general rule, I do not think it wise to come to a meeting with the intention of giving a "talk" on any particular subject without a previous preparation, especially if the speaker prefaces his remarks by saying: "I have several subjects to talk about and I think I shall talk on such and such a topic." If you have anything to give,

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papers read during the meeting will give enough opportunity for off hand talks. In writing a paper we instinctively hesitate before putting a word down-to see if the word really expresses what we wish to say, whereas if the word is used in spoken discourse it may be uttered before we are fully aware of it. A man often does himself an injustice by saying things he did. not mean or saying things in a manner he did not intend.

I believe that as a general rule it may be said that we expect the young men to be better prepared than the older, from the fact that they have more time-having less patients that demand their attention, and therefore more time to devote to the preparation of their papers or looking up the subject for a discussion.

We come to the meetings for a purpose, to learn something, and when a member arises to speak he is supposed to have something to say, something worth listening to. If this is not the case then the busy practitioner, who must sacrifice his time to come, simply stays away. Some men seem to think that a medical society is simply a social club and they come with that spirit.

Some men are too diffuse and generalize too much. We can excuse generalizations in the older members but we are apt to grow impatient with the young man with a limited experience when he attempts to generalize and especially when he wanders. away from the subject under discussion and dwells on matters that have no relation to it.

paper will be timely if it treats of the preIn a general way it may be said that a vailing disease or diseases and will likely prove of interest to all. During the prevalence of smallpox a paper and discussions on this disease are eminently proper;

during a diphtheria epidemic this disease should come in for a share of attention. The latest results of the antitoxin treatment will of itself form an interesting paper. The writer of a paper will naturally become interested in the subject as it develops and inform himself fully as to the latest advances and if he has any cases to report he can give something about their history, the treatment employed and the progress of the patients.

Case reports of accidents or of unusual cases are always of interest, likewise reports of any special investigations.

A writer ought not to conclude that because his paper is not discussed, it is a fail

ure.

Far from it. Some of the best papers I have heard were passed without a word of discussion, in some cases merely a few words of commendation were said. The chief reason why some good papers are not discussed is because no one in the audience feels himself competent. We may appreciate the paper fully yet may have nothing to say except perhaps to ask some questions or to commend the writer for his efforts.

Having selected your subject study the matter in all its bearings, jot down your notes, add to them from time to time as new thoughts and ideas come to you, arrange your notes in a logical order or sequence and finally eliminate all that is unnecessary. When before the society, begin at once. State your subject. Avoid prolix introductions.

After a paper has been read many present may desire to discuss it and to add their share to a proper elucidation of the subject. There are always some men who must be given a little time to formulate what they have to say and unless they have such an opportunity they are apt to remain silent. Fortunately some member is generally present who is conversant with the subject and who is ready at once to lead off in the discussion and this will give an opportunity for the other members to think over what they want to say.

A little urging may of course be necessary for the timid member who dislikes to enter into a discussion. It is to be hoped that no member will essay to speak twice on the same topic before all the other members have had an opportunity to be heard. Such a second discussion should

be brief and impersonal and should be in the nature of verification rather than new assertions. A separate paper is the proper means to employ to fully explain one's views if they differ markedly from those expressed in the paper just read.

In the matter of discussing a medical paper I am not much of a believer in the inspiration of the moment, particularly if one has had little experience or if his experience is limited to one case—and that one only imperfectly studied. "Beware of the man who has read or studied only one book" might be paralleled by saying: Beware of the physician who has had only one case of the disease under discussion. One case thoroughly studied may of course. have much value, perhaps more than half a dozen imperfectly studied, but it is best not to draw too many conclusions from it.

It will readily be seen that my remarks are really a plea for good work in our medical society. Let each one of us select some subject or tcpic, study it thoroughly, dig away at it, as the saying is, and I have no doubt but that a good crop of papers will be the result. I always like to assume that the author of a paper which has just been read is the best informed man on that subject in the house; I like to assume that he has looked up the matter in all its bearings.

The plea often made of being "too busy" will never hold. The busiest man always has lots of time which he usually devotes to trivial matters; it is really spare time that ought to be devoted to a better purpose. You can find the time if you decide to do so. Some men need an occasional shaking up.

In conclusion. To the young men I would say: Give us the results of your studies and special research. To the older men I would say: Give us the benefit of your experience. To all I would say: Stick to the point and avoid mere assertions and glittering generalities. We have sufficient material, able men, in this city to make a good local society and have good meetings, if we will only take hold properly. Here as elsewhere the motto or saying will hold "No excellence without labor."

Let there be no drones among us but let us all work together and have good meetings.

PREVENTIVE MEDICINE IN REGARD TO HEREDITY.

BY E. J. KEMPF, M. D., JASPER, IND.

Heredity is a study in itself, and includes such topics as Anthropology, Embryology, Palæontology, etc., and the subject of Heredity, as far as it concerns Preventive Medicine, must be restricted to the endeavor to prevent the transmission of disease from either of the parents to the offspring, whether it be a son or a daughter. Hereditary influences are such as act from within the body, and are, therefore, nonpreventable, after the conjugation of the two sexes has given life to the germ. The influences of heredity are shown in the greater prevalence of certain diseases in one family than in another. This difference is brought about by certain constitutional conditions which are transmitted from generation to generation, and consists in a lessened capability of resisting unfavorable influences on the system.

The following rules are well recognized in regard to hereditary influences as to the transmission of a predisposition to dis

eases:

1. Hereditary influences are intensified by the intermarriage of near relations, because these influences may be present in both parents.

2. The influence exerted by parents on the qualities of their offspring is universally admitted, but the relative amount of influence which each parent exerts is still to some extent undecided.

3. Longevity or the reverse, a tendency to great fruitfulness or to sterility, pecularities in the degree of delicacy in the external senses, and a special tendency to certain diseases-as gout, consumption, cancer, etc., are transmitted by one or other parent to the offspring.

4. The predisposition to any special disease may be transmitted by either parent; but where both parents have been affected, the offspring are especially liable to suffer from it.

5. Deformities and diseases engendered by circumstances to which exposure is lifelong, or affecting successive generations, are more certainly and conspicuously hereditary.

6. Physical degeneration and mental alienation are propagated in families.

The suicidal impulse appears in one, and the uncontrollable and insatiable desire for stimulants in another.

7. Epilepsy, mania, eccentricity, or delusive insanity are often manifested by different members of the same family in whom has been transmitted a predisposition to disease of the nervous matter.

8. Gonorrhea is a disease, which, whilst it cannot be transmitted by one of the parents to the offspring, is very frequently given by the male to the female in wedlock with very disastrous results to the offspring. Blindness may be the heritage of the child born to such a couple.

9. Syphilis is a disease which is given by one of the sexes to the other, and may be transmitted to the offspring with dire results.

10. The predisposition to rheumatism, gout, cancer, scrofula, tuberculosis and various diseases appears in certain families. to such a certainty that life insurance companies frequently reject applicants on account of the family history in regard to those diseases.

11. Persons suffering from tuberculosis, as well as from syphilis, gonorrhea, cancer, should not be allowed to acquire a license to marry. The sanction of the State should not be given to such marriages.

12. Restriction of marriage by the State is apt to increase the number of illegitimate births, and cause the mothers of illegitimate children to eventually swell the number of prostitutes. Therefore, only people afflicted with contagious or lethal diseases should be forbidden to contract marriage with each other or with healthy persons.

If the Government has a right to grant licenses to the male and female to marry, it certainly has also a right to make certain requirements and conditions before granting licenses to marry. The law may regulate the right to marry between certain individuals for the benefit of the people's welfare. The requirements and conditions regulating marriages should regard the ages of the respective parties, and the personal as well as the family history.

Marriages should not be lightly entered into, for it is a sacred contract upon which the future welfare of nations depends, and it should be considered the foundation

stone of human civilized society. Though divorces will have to be granted for sufficient reasons, second marraiges of divorced parties should be absolutely forbidden by the Government during the lifetime of any one of the two contracting parties. This has been the law of the Roman Church for nineteen centuries, and experience teaches us that it has been a good law.

Whether persons should bring a medical certificate of sound health and or good personal and family history, from a licensed physician, before a marriage license is issued to them by the Clerk of the County Court, is a frequently argued but as yet unsettled question. The most difficult point to decide would be, who should act as judge, the doctor or the clerk?

HERPES GANGRENOSUS; SYMMETRICAL GANGRENE; REPORT OF A CASE.

BY W. F. HUGHES, M. D., Resident Physician Indianapolis City Hospital. COMMENTS ON HERPES GANGRENOSUS, BY A. W. BRAYTON, M. D., INDIANAPOLIS, IND.* The patient, Miss A. B., age 17, entered the City Hospital September 22d, with the following history. Her father and one sister are alive and healthy. Her mother died of pulmonary tuberculosis.

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The patient has had the diseases of childhood and suffered from an attack of herpes zoster when 8 years of age. ing the latter part of the year 1900, she suffered from a severe typhoid infection with a pneumonic complication; but finally made a complete recovery. Severe pains in the back of the head began to trouble the patient in April, 1902. In the latter part of the same month necrotic areas began to appear on the arms, which condition caused her to enter the Deaconess Hospital. In July within twelve hours, two symmetrical ulcers appeared on her limbs. She was discharged from that hospital, September 6th, apparently well.

About September 15th, two patches appeared in the hypogastric region. Upon admission to this hospital, the examination showed that the ulcers were each about one

*This remarkable case was studied by Dr. Hughes at the City Hospital, and was presented to the Indianapolis Medical Society on case night, November, 1902. Dr. Hughes made additional notes on the case the present month.

by one-half inch in area with ragged undermined edges. They were covered by a very tenacious scab, which was of a dark slate color and showed quite a resemblance to that following a cauterization with sulphuric acid. A number of keloidal scars were noticed which represented the former ulcers. The patient was well nourished and showed no evidence whatever of anæmia. She was of a very nervous temperament and some symptoms of hysteria were present.

On October 2d, two patches about one inch square occurred inside of two hours over an area extending from the eighth to the tenth rib on each side of the spine. On the following day, within thirty minutes, two patches arose symmetrically on each limb just above the knee. The latter will be described briefly in the order of appearance. The eruption began as an erythema which was followed in three minutes by bullæ varying in size from a mustard seed to that of a split pea. These soon became umbilicated and a slight transudation of serum occurred. A discoloration in a limited area began to appear. At the end of sixteen minutes this area had assumed a slate colored hue and showed a marked necrosis of the cutis vera.

The following prodromal symptoms are usually present. Hot flashes, nausea, vomiting, severe headache, elevation of temperature, and an increase of pulse rate precede the eruption from one-half to four hours. Locally there is an intense, burning, tearing, paroxysmal pain. Hyperæsthesia was never a sympton in this case. The numerous patches have all presented the same general characters. However, in a few instances the bullæ have been preceded by wheals. The largest necrotic area was on the flexor side of the forearm. This one passed through the various stages very rapidly and showed a distinct irregular area of necrosis about one and one-half by two inches in extent.

A careful study of the order of the eruption showed that it was centripetal in its progress, rather than centrifugal as herpes zoster. The peripheral nerve areas in the extremities were first attacked and the subsequent eruptions showed a slow advance of the condition towards the body. After a variable length of time, the skin at the distal ends of the intercostal nerves