Skip to main content

Full text of "Proceedings"

See other formats

This is a digital copy of a book that was preserved for generations on library shelves before it was carefully scanned by Google as part of a project 
to make the world's books discoverable online. 

It has survived long enough for the copyright to expire and the book to enter the public domain. A public domain book is one that was never subject 
to copyright or whose legal copyright term has expired. Whether a book is in the public domain may vary country to country. Public domain books 
are our gateways to the past, representing a wealth of history, culture and knowledge that's often difficult to discover. 

Marks, notations and other marginalia present in the original volume will appear in this file - a reminder of this book's long journey from the 
publisher to a library and finally to you. 

Usage guidelines 

Google is proud to partner with libraries to digitize public domain materials and make them widely accessible. Public domain books belong to the 
public and we are merely their custodians. Nevertheless, this work is expensive, so in order to keep providing this resource, we have taken steps to 
prevent abuse by commercial parties, including placing technical restrictions on automated querying. 

We also ask that you: 

+ Make non-commercial use of the files We designed Google Book Search for use by individuals, and we request that you use these files for 
personal, non-commercial purposes. 

+ Refrain from automated querying Do not send automated queries of any sort to Google's system: If you are conducting research on machine 
translation, optical character recognition or other areas where access to a large amount of text is helpful, please contact us. We encourage the 
use of public domain materials for these purposes and may be able to help. 

+ Maintain attribution The Google "watermark" you see on each file is essential for informing people about this project and helping them find 
additional materials through Google Book Search. Please do not remove it. 

+ Keep it legal Whatever your use, remember that you are responsible for ensuring that what you are doing is legal. Do not assume that just 
because we believe a book is in the public domain for users in the United States, that the work is also in the public domain for users in other 
countries. Whether a book is still in copyright varies from country to country, and we can't offer guidance on whether any specific use of 
any specific book is allowed. Please do not assume that a book's appearance in Google Book Search means it can be used in any manner 
anywhere in the world. Copyright infringement liability can be quite severe. 

About Google Book Search 

Google's mission is to organize the world's information and to make it universally accessible and useful. Google Book Search helps readers 
discover the world's books while helping authors and publishers reach new audiences. You can search through the full text of this book on the web 

at |http : //books . google . com/ 





Fortieth Annual Session 


Homeopathic Medical 


Held at Columbus, Ohio, May 10th and 11th, 1904. 


Cott^s Qttick Printingr House, Colnmbus, Ohio. 

To the Members of the 

Homeopathic Medical Society of Ohio : 

We respectfully submit the proceedings of the Fortieth 
Annual Session of your Society, held at Columbus, Ohio, 
May 10th and 11th, 1904. 

W. B. Carpenter, President. 
C. E. S11.BKRNAGK1*, Secretary. 
T. T. Church, Treasurer. 

Committee on Publication. 
December 1, 1904. 




President— W. B. CARPENTER, M. D., Columbus. 
FiFST Vice-Pres.— J. H. WILSON, M. D., Belief ontaine. 
Second Vice-Pres.— KATHERINE KURT, M. D., Akron. 
Secretary— C. E. SILBERNAGEL, M. D., Columbus. 
Treasurer — T. T. CHURCH, M. D., Salem. 
NECROT.OGIST — D. H. BECK WITH, M. D., Cleveland. 


L1NC01.N Phili^ips, M. D., Chairman^ Cincinnati. 

H. H. WiGGERS, M. D., Cincinnati. 

H. C. RuHi,, M. D., Leipsic. 

D. L. MoHN, M. D., Ashland. 

Sara E. Fi^etcher, M. D., Columbus. 

A. B. Smith, M. D., Spring^eld. 

1904— 190S. 

President — J. H. WILSON, M. D., Bellefontaine. 
First Vice-Pres. -SARA E. FLETCHER, M. D., Columbus. 
Second Vice-Pres. — J. A. MITCHELL, M. D., Newark. 
Secretary — C. E. SILBERNAGEL, M. D., Columbus. 
Treasurer — T. T. CHURCH, M. D., Salem. 
NECR01.0GIST — D. H. BECKWITH, M. D., Cleveland. 


T. M. Stewart, M. D., Chairman^ Cincinnati. 

C. A. ScHULZE, M. D., Columbus. 

G. J. Jones, M. D., Cleveland. 

H. E. Beebe, M. D., Sidney. 

J. P. Hershberger, M. D., Lancaster. 

J. W. Means, M. D., Troy. 

C. E. Wei,ch, M. D., Nelsonville. 



Abnormal Eye, The Practitioner and the 126 

Address of Welcome 9 

Address of Welcome, Response to 10 

Alumina 66 

Anatomy, Physiology and Pathology, Report of Bureau of. 183 

Argentum Metallicum 63 

Artificial Feeding of Infants 218 

Auditing Committee, Appointment of . 13 

Auditing Committee, Report of 13 

Aurum Metallicum 55 

Bacteriology of To-day, The 183 

Bureau Appointments 19 

Bureau Reports 37 

By-Laws 234 

Censors, Report of 15 

Cerevisine in Purulent Conditions 133 

Cervix, Injuries of, Calling for Surgical Interference .... 123 

Clinical Case, A 223 

Clinical Medicine, Report of Bureau of 222 

Clinical Verifications 48 

Comparison, A 222 

Constitution 232 

Credentials, Appointment of Committee on 12 

Credentials, Report of Committee on 14 

Crippled and Deformed Children 209 

Delegates, Appointment of 19 

Dysmenorrhoea 107 

Ectopic Pregnancy 115 

Education, Appointment of Committee on 20 

Education, Report of Committee on 32 

Election, Appointment of Supervisors of 12 

Election of Officers, Result of 17 

Executive Committee, Appointment of 20 

Eye Ball, Injuries of the 135 


Gall Bladder and Gall Ducts, A Symposium on Diseases 

of the 75 

Etiology and Pathology 75 

Symptoms and Diagnosis 85 

Treatment — Medical 95 

Treatment — Surg"ical 99 

Golden Mean, The 226 

Gynecology, Report of Bureau of 107 

Haemophilia Ag-ain 229 

Hallucinations 145 

Hepar Sulphur in Nose and Throat Work 142 

Interstate Committee 20 

Intestinal Disorders of Children, Some Fundamentals in 

the Manag-ement of 201 

Keimol in Suppurative Otitis Media 138 

Laryngology and Rhinology, Report of Bureau of 139 

Legislation, Appointment of Committee on 20 

Legislation, Report of Committee on 33 

Materia Medica, Report of Bureau on 48 

Materia Medica Melange 70 

Members Elected in 1904 15 

Members, List of 245 

Membership, Appointment of Committee on Increase of. 20 

Memorial Record 250 

Necrologist, Report of 22 

Neurology, Report of Bureau of 145 

Nervous Disorders of Children, The Relation of Rheuma- 
tism and Allied Conditions to the 149 

Obstetrical Problems, The Best Method of Solving Some. 175 

Obstetrics, Report of Bureau of 153 

Ofl&cers 4 

Ofl&cers, List of Since Organization 237 

Ophthalmology and Otology, Report of Bureau of 126 

Paediatrics, Report of Bureau of 198 

Platinum and Palladium 52 

Pneumonia 206 

Premature Labor, Induction of 159 



Present Physiolog-ical Standard, The 193 

President, Address of 27 

President's Address, Appointment of Committee on IS 

President's Address, Report of Committee on 18 

Publication Committee, Report of 12 

Puerperal Eclampsia 170 

Puerperal Infection 153 

Register of Attendance 21 

Registration and Examination, Report of State Board of 

Medical 34 

Renal Calculi, Some Comments on 188 

Resolutions, Standing 236 

Resume of the Work of the Year , 43 

Sanitary Science, Report of Bureau of 37 

Sanitation 37 

Scarlet Fever 199 

Secretary, Report of 12 

Surgery, Report of Bureau of 75 

Three Unfortunate Cases 167 

Throat, The Care of 139 

Treasurer, Report of 12 

Twin Labor, A Rare Case of 166 

Water Supply, Our — What it Should Be — What it Is . . 45 



Baxter, H. H. 34 

Beebe, H. E 226 

Bishop, H. D 75 

Buck, J. D 145 

Cameron, G. D 193 

Carpenter, W. B ... 27 

Cook, J. H 222 

Cooke, Clara E 198 

Copeland, R. S 126 

Dewey, W. A 52 

Fletcher, Sara E 218 

Geiser, S. R loi 

Goehegan, W. A 170 

Grant, G. D 32-167 

Haggart, G. B 43-45 

Hershberg-er, J. P 166 

Hetherington, Clark E 183 

Hoyt, Chas 175 

Humphrey, W. A 85 

Hunt, Ella G 142 

Hunt, M. P 33-115 

Jones, G. J 95 

Junkerman, C. F 48 

Keiser, R. O 188 

Kilgour, P. X 139 

Kraft, Frank 55 

Kurt, Katherinc 37 

Meade, C. C 159 

Munns, CO 138 

Peters, W. L 223 

Phillips, Lincoln 149 

Phillips, W. A 135 

Reddish, A. W 153 

Rosenberger, A. S 66 

Sawyer. C. E 107-209 

SchuUe, C. A 70 

Smith, A. B 229 

Stewart, T. M 133 

Welch, C. E 206 

Wilcox, De Witt G 99 

Wilson, J. H 63 

Wood, J. C 123 



Fortieth Annual Session 


Promptly at the hour of 1 o^clock, in the assembly hall of the 
Great Southern Hotel, Columbus, Ohio, Tuesday, May 10, 1904, 
President W. B. Carpenter, of Columbus, called the Homeopathic 
Medical Society of Ohio to order, stating that the hour had arrived 
for beginning the exercises incident to the Fortieth Annual session. 
There being present about sixty persons at the opening session. 

Eev. James Albert Patterson, of Columbus, was called upon 
to lead the society in an opening prayer, after which President 
Carpenter said: "The physicians of Columbus are very glad to 
welcome the physicians of the State to this city. A year ago we had 
the honor of meeting the Chief Executive of Columbus, Mr. Jeffrey, 
who gave us a very hearty welcome. This year this same honorable 
gentleman had expected to be with us again to tell us why Columbus 
was still glad to have the State Homeopathic Society to meet within 
her borders, but at the last moment he found it impossible to be 
present, and so has sent as his delegate Mr. Keating, of the city law 
department, who will now address us. 


You will doubtless be much disappointed in not having his 
Honor, the Mayor of Colimibus, address you to-day, but at the very 
last moment matters of large import came up which obliged him 
to forego this pleasure, and to send me as his unworthy represen- 
tative. I extend to you a most cordial welcome. Columbus is a 
great convention center and there is no class of men whom I am 
sure that it welcomes more cordially within its boundaries than it 
does its physicians; for yours is a noble work, gentlemen, — ^the alle- 
viation of suffering and the smoothing of the way for the fast dis- 
solving mortality. No doubt you are all well familiar with that old 


story of the advice given by an old physician to his younger asso- 
ciates in the graduating class : "Keep ^em alive, gentlemen, keep 
^em alive; dead men pay no bills." But you, as a brotherhood of 
professional gentlemen, are not actuated by such sordid motives. 
I find within your lines men the most kind, the most spirited, the 
most liberal, men who cheerfully sacrifice their own comfort, their 
own time, in following the plain path of duty for which you are so 
often unrecompensed. Columbus wants to become more of a medi- 
cal center than it is. That is another reason why it is glad. We 
have here two large colleges and unusually large and well-equipped 
classes of students. We have here the central point for the State 
Board of Health, which is most efficient; and you all know of the 
existence of the State Board of Medical Eegistration and Examina- 
tion centered at Columbus. And you know what good work these 
several boards and others have done in your behalf. Your papers 
and your discussion all tend to the uplifting of the individual prac- 
titioner, and through him necessarily his patrons and patients. 

Mr. Keating continued for some minutes in this vein, telling 
several stories, and again inviting the profession to partake to the 
fullest of the hospitality of Columbus, and to return again next 
year if that should be in the plans of the organization. (Applause.) 



If we had aay doubt in our minds as to our welcome to Colum- 
bus before Mr. Keating began his speech, I am sure that doubt has 
been dispelled. While an address of welcome by a representative 
of a city^s government may be looked upon as a mere formality, yet 
it marks the esteem good citizens have for governmental rule, and 
the homage they desire to pay to those who for a time assume the 
burden of guiding the statecraft. 

The Homeopathic Medical Society of Ohio has assembled in 
Columbus so many times that we feel somewhat at home ; and upon 
this, as upon other occasions of our meetings, we feel particularly 
glad that Mayor Jeffrey sends us his greetings ; because he has man- 
ifested in no uncertain way his sense of fair play, as well as faith 
in, that large body of physicians whom we represent in convention 
\ 0-day. 


We cannot give you facts and figures to show that we represent 
so much capital, or employ hundreds or thousands of workers, be- 
cause we represent a profession, distinguished from commercial pur- 
suits, in that we are laboring all the time to prevent, and to stamp 
out, the very diseases that furnish us employment. Our work is 
largely along quiet lines, and much of it is done with secondary 
thought to the financial element, the element so necessary to con- 
sider in the commercial world. 

Therefore our work as represented in our program is one of 
thought force, from which we hope to derive the ideas that will 
enable us to do better work in the coming year, as well as the in- 
spiration by which we shall achieve more brilliant results for the 
meetings of the future. 

The good that may be done will not show upon the surface, it 
may not add directly to the growth of your beautiful city, or any 
of the other cities or towns of our glorious Buckeye State. But 
indirectly it may retain, for a somewhat longer time, the lives and 
influence of those who labor in the active affairs that constitute the 
life force of our varied institutions. The work these minds and 
bodies may do, their service in private or public life, are back of all 
their achievements, and in the doing of that work the physician is 
often the wise counsellor. 'Bhis points to the fact that the diver- 
sity of interests in life is simply an illusion. The reality shows the 
unity at the center, the great binding force which makes us all 
workers in the evolution of a greater people, a greater nation, and 
a greater civilization. 

We thank Mr. Keating, and through him, the chief executive 
of this beautiful city, for his kindly words of welcome. 

The minutes of the Society being called for. Secretary Dr. 
Silbemagel stated that the same had been put into printed form 
and were now in the hands of the membership. 

On motion the minutes as printed in transaction form were 
approved and accepted as the minutes of the last session of this 

The Secretary then presented his annual report as follows : 



To the Homeopathic Medical Society of Ohio: 

At the thirty-ninth annual session of the Society, held in 
Columbus one year ago, there was reported a membership of 222. 
These with the eleven who joined at that time make the present 
membership 233 without considering those who have fallen from 
the ranks. 

The cost of the notices and programs for this meeting amount- 
ed to $20.25, and the cost of sending them to physicians, jour- 
nals and newspapers $13.00. In addition to this the expenses of 
this office for stamps, postal cards, stationery, stenographic work, 
etc., was $23.41, vouchers for which are in the hands of the Treas- 
urer. EespectfuUy submitted, 

C. E. SiLBERNAGEL^ Secretary. 

Eeport accepted and referred to Publication Committee. 

The President then appointed the following committees with 
oral instructions as to scope of their duties : 

Supervisors of Election — ^E. 0. Keiser, M. D., and C. F. Jun- 
kerman, M. D. 

Committee on Credentials — ^Lincoln Phillips, M. D., Charles 
Hoyt, M. D., and H. D. Bishop, M. D. 

The Committee on Publication had nothing to report except 
as to expense of publishing the transactions, which would appear 
in the report of the Treasurer. 

The report of the Treasurer was next in order, but was passed 
temporarily in the absence of that official. Dr. Church arriving a 
little later, presented his report, as follows : 


T. T. Church, Treasurer, in accoxmt with the Homeopathic 
Medical Society of the State of Ohio. 


To balance May 12, 1903 $ 192.28 

To cash received from fees and dues 343 . 00 

$ 535.28 



By Dr. Frank Kraft, as per bill 35.45 

By The A. K. Tatem Label Co., as per bill 10.15 

By N". L. Heaton, as per bill 6.75 

By Chas. M. Cott, as per bill 9.25 

By Dr. A. B. ISTelles, as per bill 3.15 

By Spahr & Glenn, as per bill 59 .00 

By The E. Liverpool Publishing Co., as per bill 212.25 

By Postage 8.24 

By Expressage 18.21 

By Freight and drayage .72 

By Twine .30 

Balance $ 171.81 

$ 535.28 
Our last list of members contained 230 names, of which — 
9 are honorary members; 

34 reside in other States; 

3 have a credit of three dollars; 
93 have paid in full; 
32 have paid to 1902 ; 

1 owes a balance of four dollars ; 

1 owes a balance of five dollars; 

35 have paid to 1901 ; 

2 owe a balance of seven dollars ; 

3 have died since our last meeting, and 

17 are to be dropped for the non-payment of dues. 

I have received, and herewith present for your consideration, 
the resignation of Dr. J. H. Harvey, whose dues are paid to date. 
Eespectf ully submitted, 

T. T. Church, Treasurer. 


The Auditing Committee appointed by the President consisted 
of Drs. J. A. Mitchell, George S. Hodson and C. 0. Munns, who in 
proper time and after careful auditing of the Treasurer's report, 
reported the same to be correct. 


The Committee on Credentials announced that a list had been 
prepared and each member present was requested to sign the same. 

On a call for Keports of Delegates from other Societies and 
Public Institutions, Dr. Stewart reported for Pulte College, saying 
that he could keep the Society busy for sometime listening to his 
report from that institution and reciting its good work; that they 
have been sending their graduates East to compete with those 
schools and to take some of the appointments in some of the East- 
em hospitals. He also reported for the Cincinnati Lyceum, which 
meets every month; that with that Society and the Pulte Alumni 
they had entertained the Miami Valley Medical Society. He closed 
by extending an invitation to the Homeopathic Society of Ohio to 
meet at Cincinnati as soon as it found it in its heart to break away 
from Columbus. 

Dr. Beckwith said Cincinnati had always been noted for its 
progress, and this year for its politics. He said he had spoken to 
Dr. Stewart at the dinner table, telling him that Cleveland wanted 
the next meeting of the State Society. Politically, Dr. Stewart is 
like his Boss Cox; he wants to cut Cleveland off. Dr. Beckwith 
stated that Cleveland had a college which stands the second in the 
United States with a fine corps of teachers and turning out fine 
graduates — 21 at the recent commencement — ^with a large class in 
preparation for another year. The hospital is doing fine business 
with its rooms filled and looking around for further and still better 
facilities. The Cleveland Homeopathic Medical Society was also 
doing well with large attendance. 

Dr. M. P. Hunt reported for the Legislative Committee, and 
Dr. R. B. House for Committee on Education. 

These reports were received and referred to Publication Com- 

The Board of Censors at various times during the meetings 
reported the nj^ones of applicants for membership in this Society, 
which names having gone through the usual and proper course were 
put to vote and elected. The following are the names of those so 
elected at this fortieth session of this Society : 


Buck, Charles K Cincinnati 

Pulte Medical College, 1902. 

Budde, Charles H Dayton 

Medical CoUegre of Nurtzburg-, Bavaria, 1880. 

Burnham, J. E Prairie Depot 

Cleveland Medical College, 1895. 

Gaston, James E Wilmington 

Cleveland University of Medicine and Sargery, 18%. 

Humphrey, William A Toledo 

Habneman Medical College of Chicagro, 1883. 

Lyons, Matilda J Cadiz 

University of Michigan, Homeopathic Department, 1887. 

McCleary, J. R Marietta 

Pulte Medical CoUegre, 1900. 

Patterson, A. M Westerville 

Cleveland Medical CoUeg'e 1895. 

Peters, W Lancaster 

Hahnemann Medical College of Chicago, 1885. 

On motion the reading of the Presidents address was made a 
special order of business for 4 :30 p. m. 

Dr. D. H. Beckwith, Necrologist, then presented his report, 
which was referred to Publication Committee. 

The President read a telegram of congratulations from the 
Indiana Institute, at the conclusion of which reading, on motion of 
Dr. Beckwith, the Secretary was requested to answer the telegram 
with the best wishes of our Society. 

The special hour having arrived for the reading of the Presi- 
dents Address, Dr. J. H. Wilson, Vice President, took the chaii* 
while the President, Dr. W. B. Carpenter, presented his annual 

The Chair appointed a committee on this address consisting of 
Drs. E. B. House, D. H. Beckwith and W. A. Dewey. 

Reports from the Bureaus of Materia Medica, Sanitary Science 
and Surgery were presented at this session. The papers were dis- 
cussed and referred to the Publication Committee. 

Before putting the motion to adjourn to 8 :30 a. m., the Presi- 
dent called attention to the banquet which the Columbus physicians 


had arranged for their visiting brethren in the Great Southern 
Hotel at 8 :30 p. m. 


Instead of the evening session a banquet was given by the 
ColTimbufi physicians to the attending physicians. Dr. G. J. Jones, 
of Cleveland, was toastmaster, and the following toasts were re- 
sponded to : 


Dr. Gains J. Jones, Cleveland, toastmaster. 

1. "The morning of a medical man's life. What should it 
be?'' Eoyal S. Copeland, M. D., Ann Arbor, Mich. 

2. "The medical man's mid-day. How to make the most of 
it." Maurice P. Hunt, M. D., Columbus. 

3. "The twilight of a physician's day. Should he rest or con- 
tinue to toil?" D. H. Beckwith, M. D., Cleveland. 

4. "How soon will the demand compel an increase in the sup- 
ply of graduates of Homeopathic schools ?" C. E. Walton, M. D., 

5. "Whither is the medical profession drifting?" Thomas 
M. Stewart, M. D., Cincinnati. 

6. "The physician's wife." De Witt G. Wilcox, M. D., Buf- 
falo, N. Y. 

7. "What is to be the limit of interstate medical legislation ?" 
H. E. Beebe, M. D., Sidney. 

8. "Is it profitable for a student who expects to practice 
Homeopathy to spend his first one or two years in an Allopathic 
school?" William A. Phillips, M. D., Cleveland. 

Wednesday, May llth, 1904. 

On reassembling at 8 :30 a. m.. Dr. Baxter was called upon to 
address the Society on the work of the State Board of Medical Reg- 
istration and Examination and gave a very interesting account of 
the work of this board. 

Referred to Publication Committee. 


Dr. Beckwith : You will all recall that in 1901 Dr. Walton 
offered a resolution that we meet four years in Columbus. We have 
been here now three sessions, in which the physicians of Columbus 
have taken much time and been at considerable outlay of money to 
ulake it pleasant for us. In conversation with many of the mem- 
bership of this Society they think it is time that we relieve the 
Columbus physicians from the labor — of love though it be — of en- 
tertaining us again, and to permit other cities to give us a little 
attention. We also believe that the increase in membership would 
be greater by a change. I move you, therefore, that the resolution 
offered by Dr. Walton, May 15, 1901, be rescinded. 

Dr. Walton : At the earnest request of Dr. Beckwith, I second 
the motion. I think our coming to Columbus has been a success, 
but we all feel that there should be a change. 

Being put, the motion was unanimously carried and the reso- 
lution of May 15, 1901, was declared rescinded. 

Dr. Beckwith : N"ow in behalf of the physicians of Cleveland, 
I wish to extend a cordial invitation to meet in Cleveland next year. 

The President decided that this was new business and must 
wait for that order to arrive. 

The special order of election having arrived, the ballot was de- 
clared closed and the result of the election announced as follows : 


President J. H. Wilson, M. D., Belief ontaine 

First Vice President Sara E. Fletcher, M. D., Columbus 

Second Vice President J. A. Mitchell, M. D., Newark 

Secretary C. E. Silbernagel, M. D., Columbus 

Treasurer T. T. Church, M. D., Salem 

Necrologist D. H. Beckwith, M. D., Cleveland 


C. A. Schulze, M. D., Columbus 

Gains J. Jones, M. D., Cleveland 

H. E. Beebe, M. D., Sidney 

J. P. Hershberger, M. D., Lancaster 

J. W. Means, M. D., Troy 

C. E. Welch, M. D., Nelsonville 


Dr. Silbemagel being in the chair, the Committee on Presi- 
dent's Address presented the following report : 


After a careful reading of the sch'olarly and excellent address 
of our President, we take pleasure in commending his recommen- 
dation for a more thorough organization of the homeopathic profes- 
sion throughout the State, and urge that medical clubs or societies 
be organized at all centers where suflScient numbers can be brought 
together to insure successful results. 

We also commend the suggestion to furnish hospital and dis- 
pensary facilities so far as it may be possible for all persons who 
may prefer homeopathic treatment. 

We recommend that all legislative matters as well as our inter- 
ests relating to the establishment of a medical department in the 
State University be carefully supervised by our standing Commit- 
tee on Legislation. 

After a careful consideration of the recommendations to change 
Section 2 of the By-Laws by reducing the amount of the annual 
dues of this society, we respectfully submit that no change be made 
at this time relating to the annual dues, but we recommend that the 
initiation fee of one dollar be stricken out. 

E. B. House, M. D. 
D. H. Beckwith, M. D. 
W. A. Dewey, M. D. 

Moved and seconded that this report be received and its rec- 
ommendations accepted and adopted. So ordered. 

In order, however, to complete the report and its amendment. 
Dr. R. B. House moved that Section 2 of the By-Laws be amended 
by striking out the words "initiation fee shall be one dollar and." 

Seconded and unanimously carried. 

On motion of Dr. H. F. Biggar, Jr., and duly seconded, it was 
ordered that a committee be appointed by the Chair whose duties 
it shall be to secure increased membership to the State and local 
homeopathic societies, and whenever practical to organize local soci- 

The President appointed on this committee : T. M. Stewart, 
M. D., C. E. Walton, M. D., R. B. House, M. D., T. T. Church, M. 
D., H. E. Beebe, M. D. 


Dr. Biggar requested not to be appointed as a member of this 

A telegram was received from Dr. T. G. Barnhill regretting 
his inability to be present and sending his best wishes for the suc- 
cess of the meeting. 

At this session the following bureaus reported: Gynecology, 
Ophthalmology and Otology, Laryngology and Ehinology, N'eurol- 

The papers were discussed and referred to Publication Com- 

Eecess until 1 :30 p. m. 


On reassembling, Dr. Baxter renewed the motion made earlier 
in the day by Dr. Beckwith inviting the Society to meet next year 
in Cleveland. This was seconded by Dr. G. J. Jones, and being put 
to vote was carried unanimously. 

The President-elect then appointed the following physcians 
to serve the Society the following year : 


Sanitary Science R. B. Carter, M. D. 

Materia Medica Frank Kraft, M. D. 

Dermatology G. W. Spencer, M. D. 

Surgery J. C. Wood, M. D. 

Gynecology C. E. Sawyer, M. D. 

Opthalmology and Otology T. M. Stewart, M. D. 

Laryngology and Rhinology R. G. Reed, M. D. 

Neurology J. E. Welliver, M. D. 

Obstetrics A. W. Reddish, M. D. 

Anatomy, Physiology and Pathology, Clark E. Hetherington, M. D. 

Paediatrics Lincoln Phillips, M. D. 

Clinical Medicine C. R. Coffeen, M. D. 


American Institute of Homeopathy — 

H. D. Bishop, M. D., and J. H. Wilson, M. D. 
Michigan State Society — 

F. B. Monroe, M. D., and Guert E. Wilder, M. D. 


Kentucky State Society — 

S. E. Geiser, M. D., and A. L. McCormick, M. D. 
Indiana State Society — 

C. E. Coffeen, M. D., and H. B. Fanlder, M. D. 


Drs. Harriet B. Chapman, 0. A. Palmer, C. S. Ames, Frank Web- 
ster and J. H. Whitehead. 


Drs. A. L. McCormick and H. H. Baxter — For three years. 
Drs. M. P. Hunt and G. B. Haggart — For two years. 
Drs. H. E. Beebe and W. B. Carpenter — For one year. 


Dr. M. p. Hunt — Three years to serve. 
Dr. T. A. McCann — One year to serve. 


E. E. Eggleston, M. D., Frank Kraft, M. D., George D. 
Grant, M. D. 


T. M. Stewart, M. D., C. E. Walton, M. D., E. B. House, M. D., 
T. T. Church, M. D., H. E. Beebe, M. D. 

The following bureaus reported at the last session: Obstet- 
rics, Anatomy, Physiology and Pathology, Paediatrics. The papers 
were discussed and referred for publication. 

Th6 routine work of the Society having been concluded, the 
Committee on Credentials reported that 86 persons had registered, 
20 of whom were visitors; and that 108 attended the banquet. 

On motion of Dr. Cook a vote of thanks was tendered the local 
physicians for entertaining the Society in such a delightful maimer. 

A vote of thanks was also extended to the President, Dr. Car- 
penter, and his efficient co-workers on the official staff, for their able 
administration; also to the hotel for its accommodations and cour- 
tesies; and to the press for its fair and generous notices of the 

The Homeopathic Medical Society of Ohio, in its fortieth 
annual session, then adjourned to meet in Cleveland, the second 
Tuesday and Wednesday of May, 1905. 




Akron — 
Childs, O. D. 
Kurt, Katherine. 

Ann Arbor, Mich. — 
Copeland, R. S. 
Dewey, W. A. 
Hinsdale, W. B. 

Ashland — 
Mohn, D. L. 

Wilson, J. H. 

Buffalo, N. Y.— 
Wilcox, Dewitt G. 

Cardington — 
White, P. R. Smith. 

Chagrin Falls — 
Cameron, G. D. 

Hoyt, Charles. 

Cincinnati — 
Brickley, Laura C. 
Buck, Charles R. 
Geiser, S. R. 
Hunt, Ella G. 
Phillips, Lincoln.. 
Stewart, T. M. 
Walton, C. E. 

Cleveland — 
Baxter, H. H. 
Beckwitii, D. H. 
Biggar, H. F., Jr. 
Bishop, H. D. 
Jones, G. J. 
Kraft, Frank. 
Miller, William T. 
Wood, J. C. 

College Hill— 
Kilgour, P. T. 

Coiunnbus — 
Allen, Alice G. 
Allen, O. S. 
Barbee, B. I. 

Bryant, Susannah L. 
Carpenter, W. B. 
Clemmer, J. W. 
Connell, R. D. 
Fletcher, Sara E. 
Ireland, Charles L. 
Jackson, L. A. 
Keiser, R. O. 
Leatherman, J. H. 
Nelles, A. B. 
Rether, C. H. 
Rogers, G. W. 
Schulze, C. A. 
Sherman, S. M. 
Silbernagel, C. E. 
Waite, H. C. 
Woods, G. W. 

Dayton — 
Welliver, J. E. 

Delaware — 
Hall, E. M. 
Pulford, W. H. 

Baldwin, H. D. 

Hoyt, William. 

Lancaster — 
Hershberger, J. P. 
Junkerman, C. F. 
O'Grady, G. W. 
Peters, W. 

Leipsic — 
Ruhl, H. C. 

I^A arietta — 
McCleary, J. R. 

i^Aarion — 
Cheatham, Elizabeth 
Sawyer, C. E. 

i^^t. Vernon — 
Amdt, G. D. 

Newark — 
Baldwin, William M. 
Hunt, H. B. 

McClure, S. D. 
Mitchell, J. A. 
Palmer, I. N. 

North Lewisburg — 
Garwood, J. Stokes. 

Oxford — 
Munns, C. O. 

Piqua — 
Hetherington, Clark E. 

Portsmouth — 
Cooke, Clara E. 

Prairie Depot — 
Burnham, J. E. 

Sidney — 
Beebe, H. E. 
Ferree, J. A. 
Reddish, A. W. 

Salem — 
Church, T. T. 

Springfield — 
Grant, G. D. 
Hadley, W. A. M. 
House, R. B. 
Miller, H. T. 

Humphrey, W. A. 
Zbinden, Christian. 

Troy — 
Means, J. W. 

Washington C. H.— 
Hodson, G. S. 

Gaston, J. B. 
Wood, G. W. 

C.Smith, A. B. 

Wapakoneta — 
Faulders, H. B. 

Patterson, A. M. 

Teegarden, William. 




From birth to death is measured by years. It is a short period ; 
some play their part, others fail to secure honors. 

Comparatively few pass from the world in a triumph of glory ; 
most men and women will pass quietly from this world, only to be 
remembered by their immediate friends; their names will soon be 

The beginning of man is the same to all, also the end; death 
is the great conqueror. 

No one can tell what basis of intelligence we shall reach, 
or how we shall be judged. 

We pay tribute to all our members that have gone to the great 
beyond. Each year takes some of this Society to their final resting 
place. This course will continue until the end of time — ^birth and 
death are natural consequences, therefore we are born and later 
shall die. 

The Necrologist reports only three deaths of our members the 
past year : 

Dr. H. B. Van Norman, of Cleveland. 

Dr. F. W. Morley, of Sandusky. 

Dr. James Dickson, of Canal Dover, of whom I have not been 
able to obtain any report. 

Two months ago one of our former members (Dr. David B. 
Hale), who met with us for many years, by reason of failing health 
found it impossible to meet with us and tendered his resignation. 
He was a valuable man to the Society as well as to the Homeopathic 
profession. His son has taken up the work of his father, and I 
trust he may become a member of the State Society. He was 54 
years of age. He was a graduate of the Eclectic school in Cincin- 
nati in the class of 1869. He was a soldier during the Eebellion. 
At the close of the war was discharged with honors. 

A young promising physician died a few months since from 
diphtheria, in Cleveland. Charles E. White, M. D. 

The members of the American Institute that have died during 
the past year were Egbert Guernsey, who was one of the early pio- 


neers of homeopathy, and a former contributor to medical journals. 

C. S. Owens, of Wheaton, 111., who perished at the Iroquois fire 
at Chicago. 

F. N". Payne, of Boston, a prominent oculist. 

H. M. Paine died at Atlanta where he had retired. He was 
formeriy located at Albany, N. Y. He was one of the oldest mem- 
bers of the Institute and devoted much of his time and energy in 
procuring laws elevating the medical profession. 

T. Y. Kinne, of Patterson, N". J., ex-President of the American 
Institute and one of the leading men of the profession. 

Henry M. Dearborn, of New York, author of a treatise on Der- 

• April 24, Dr. Franz H. Krebs, of Boston, who had been one of 
the leading physcians in that city for many years. 

Pheobe J. B. Wait, New York. 

Death has taken some of the early heroes the past year, but 
we have the satisfaction of knowing that there are left yoimg men 
who can more than fill the places of the dead whose memory we 
trust will long remain with us. 

Francis Wayland Morley, M. D., of Sandusky City, Ohio, was 
Vice President of the Homeopathic Medical Society of Ohio and 
officiated as the president of the session held in Sandusky, May 
1900. C. E. Sawyer, president, being absent. 

Dr. Morley was bom at Tully, New York, January 17, 1861, 
and died July 4, 1903, aged 42 years, 5 months and 17 days. He 
was a son of Rev. and Mrs. Butler Morley. 

Three weeks before his death he was attacked with infiamma- 
tory rheumatism. His death was caused by rheumatism of the 
brain, as diagnosed by his attending physicians. 

His early education was obtained in the common schools, later 
he entered the Cleveland Homoepathic Hospital College, graduating 
March 1884. After receiving his diploma he located in Huron, 
Erie County, Ohio, where he soon had a large clientage. 

His reputation as a successful practitioner influenced patients 
from other adjoining cities to consult him. He was recognized as 
one of the leading surgeons in Northern Ohio. 


He married Miss Eloise E. Durker, of Oakland, Michigan, in 
the year 1884. The widow and one son and two daughters mourn 
the loss of husband and father. 

In 1897 he was instructor in the Training School for Nurses 
at Dr. Sawyer's Sanatorium, in Marion, Ohio. The doctor took an 
active part in medical organization and often presented valuable 

In May, 1890, he joined the Ohio State Homeopathic Medical 

In June, 1890, he was elected a member of the American Insti- 
tute of Homeopathy. Also a member of the Northwestern Ohio 
Homeopathic Medical Society. Member of the local Board of Pen- 
sions. Member of the Erie Commandery, No. 23, of Knight 

On his death this society lost an active and energetic worker. 

A tribute from the physicians of Sandusky who have been inti- 
mately acquainted with Dr. Morley for the past thirteen years is 
more impressive than all the encomiums the Necrologist could 
bestow upon him. 

''the late dr. morley. 

Resolutions of respect by the City Physicians. 

Whereas, In His infinite wisdom our Heavenly Father has seen 
fit to remove from among us our friend and colleague. Doctor 
Francis Wayland Morley, be it 

Resolved, By the physicians of the city in which he resided so 
long, that in the death of Doctor Morley, we as well as his patrons 
throughout the city and county, have suffered a great loss, and that 
it is but a just tribute to the memory of the departed to express in 
this manner our deep appreciation of his many excellent qualities 
of mind and heart and our high regard for his zealous and useful 
labors in the community. 

To his loved ones in this hour of deepest sorrow we extend our 
heartfelt sympathy and the assurance of our ever kindly interest 
in their welfare. 

Resolved, That a copy of these resolutions be presented to the 
family of our deceased friend and brother. 



J. D. Parker. 
Adopted July 5, 1903.^' 


At our annual gathering in 1893 among our number was an 
attentive listener. He was present at all the sessions ; his white hair 
and dignified appearance indicated his threescore years. He took 
no active part in the discussions of the various papers that were 
read, but not a word escaped his observation. For twenty-eight 
years this attentive physician was a regular attendant at the State 
Society. He left these annual meetings with knowledge that made 
him a more skillful physician, therefore he claimed that his time 
and money was a good investment. At these meetings he met old 
and new friends that were striving after knowledge, and the best 
means to relieve the sick. Medical conventions were to him a 
source of rest and pleasure. 

Horace B. Van Norman was bom March 11, 1834, at Pine 
Hall, Middle Eoad, Ontario, Canada. At the age of 18 he left the 
farm to seek a place where he could obtain better educational advan- 
tages than he could obtain at home. He came to Ohio and enrolled 
his name at the Baldwin Institute as a student ready for all kinds 
of work in and about the college. For three years by his own labor 
he paid his tuition and other expenses. He found among the stu- 
dents Miss Jane Hoadly, who was a pupil in the class with him. 
It may be truly said of her that she made his life work a success. 
His graduation from the university did not take place until after 
a lapse of twenty years. 

In 1861 he entered the office of Prof. T. P. Wilson as a student 
of medicine and graduated from the Cleveland Homeopathic Col- 
lege in 1864. 

He soon located at Warrensville, and not finding a desirable 
location he went to Ashtabula, where by his industry and skill and 
perseverance he soon had a large clientage extending to many miles 
in the country. 

I call to mind an incident that took place in 1868. I was called 
in consultation. The train left at 4 a. m. and I had to remain the 
night. He suggested that I see a few other patients with him, which 
were chronic cases. The country was traversed in various direc- 
tions during the night, and I received the thanks of the country 
patients for my night visits. 

It was a trait of character of Dr. Van Norman to take the 
suggestions of other physicians if they aided him in his mission of 
healing the sick. 


In 1871 he came to Cleveland and located on the West Side, 
where he remained in active practice until a few days before his 
death, which took place on the morning of July 9, 1903. 

In 1872 the Trustees of the Homeopathic College appointed 
him Lecturer on Hygiene, and he continued for several years to 
lecture at the college on various medical topics. 

He has been President of the Alumni of the Medical College, 
President of the Alumni of the Baldwin University, and was a 
Trustee at the time of his death. 

One year after his graduation he joined the State Medical So- 
ciety and has often contributed valuable papers. 

A member of the American Institute of Homeopathy since 
1870, and was also a member of the Masonic, Odd Fellows and 
Eoyal Arcanum lodges. 

In honor of his early work and the steadfast support he gave 
the institutions of his boyhood, a special memorial service was held 
at the Methodist Church in Berea, July 12, 1903, the President of 
the college and others speaking tributes to the memory of the dead 

A strange coincidence: Dr. Van Norman and the late la- 
mented Professor Nathaniel Schneider were born in Canada, left 
the farm at about 18 years of age, and came to the Baldwin Insti- 
tute, educated themselves by their own work, attended lectures at 
the Cleveland Homeopathic College, and graduated the same year, 
and became members of this Society about the same date. 

A family reunion was to have been held in Canada in July 
1894 at the doctor^s home. He had prepared a song for the occa- 
sion, by which one year ago I was awakened in this city by his sing- 
ing with a voice soft and sweet for a man of his age. It so im- 
pressed me that I quote the two first verses : 

"If I am dreaming, wake me not ! 

Let the tides of memory flow. 
Bringing back each form and spot. 

Fresh as fifty years ago; 
Let me walk Toronto's streets 

Just a merry lad again. 
Though the boyhood chums I meet 

Are these honest, gray-haired men. 


"For Fm back in old Canada once more, 

Here^s where my heart is wont to turn, 
^Tis my native land, the mnch-loved shore, 

And her homelights in the harbor brightly bum, 
I am breathing airs of very sweetness. 

And in my soul is melody to-day. 
For seasons God hath rounded with completeness. 

For the fruits and flowers Vyb gathered by the way/^ 



Mr, Vice President, Ladies and Oentlemen, Members of the Home- 
opathic Medical Society of Ohio: 

I embrace this first opportunity to formally express to this 
Society my appreciation of the honor which the members were 
pleased to confer upon me a year ago. The responsibilities of the 
oflBce are always great, but they have been lessened by the loyal, un- 
failing support, the wise counsels, the cordial friendship that I have 
received constantly from all sections of the State; and in the clos- 
ing hours of my administration, relying upon this same consider- 
ation, I desire to talk over with you some matters of great interest 
in the hope that there may be a distinct advance in our knowledge 
of our profession, and in our ability to carry its good to others. 

First, then, let me say we live in a time when there is need for 
action, for doing something. Theory is all right, is necessary, but 
mere theory is but a waste of opportunity and never advanced any 
cause. Intelligent thought and fearless action bring results. We 
as a school do not have to fight as did our fathers for their very 
existence; the times have changed and other problems, at least no 
less necessary, must be niet and solved. The "exigencies of mod- 
em life, higher education and general culture unite in demanding 
such a thorough understanding of ourselves and our work that 
there may be new laws and associations^^ when new conditions and 
surroundings obtain. How often in our gatherings do we felicitate 
ourselves over our goodly heritage, the law of Similia, do we clasp 


hands and pat ourselves on the back over the claim that from 
Hahnemann we have received nature's perfect law of cure, and stop 
there. If that be so it is our business to know more of this law than 
Hahnemann did — ^we live many decades later. The law of prog- 
ress and development will not permit us to keep our treasure care- 
fully hidden away in a napkin ; both we and our treasure would be 
lost. Come to think of it, it is probable that nearly every homeo- 
pathic physician is individually trying to make the most of himself 
and his opportunities. But the individual cannot produce much 
force or stir ; we need organization and unity of effort. Some have 
been and are talking about unity of schools, but no conditions have 
arisen yet that render such a thing advisable or possible. We, our- 
selves, must organize. We need a Homeopathic Society or Club in 
every city, town, township, county or cross roads where two or three, 
or more, physicians can be assembled. Sectional societies, State 
and National bodies will follow and enlarge the work of these small 
centers. I would suggest that this Society consider the wisdom of 
the plan enacted elsewhere, by which members of these smaller bod- 
ies shall be members of the State Society upon the payment of cer- 
tain dues, or the complying with certain other requirements, to be 
determined by a conference between such organizations. 

To organization we owe what we are and have as a school; 
and to maintain what we have, and to succeed in the future in fur- 
thering and extending our interests, organized medical societies or 
clubs are even more necessary. 

Organized effort ought also to take another form, that of estab- 
lishing hospitals and dispensaries in every town of reasonable size. 
No doubt such an institution would have, in many instances, a very 
small beginning; but it would be a distinct advance and help, and 
would surely grow into a larger field of usefulness. Such institu- 
tions would not only be an evidence of the practical benevolence of 
our neighbors, and furnish a place for the more thorough, conven- 
ient and systematic care of our patients, but, what is still more im- 
portant, would furnish the opportunity for practical demonstration 
of the truth and power of the system in which we so thoroughly be- 
lieve. It is well enough to claim this and that, to tell those we meet 
of the superiority of our way of doing, to have popular meetings 
to rehearse our achievements, and show infallible statistics, to pre- 


pare tracts and proper literature for public distribution ; but in all 
our institutions of whatever kind and size we can demonstrate in a 
way that admits of no argument, the truth of our belief. 

As a corollary to this it follows that we must all be greater stu- 
dents of our Materia Medica; we must do continuous, systematic 
work in the study of Homeopathic remedies so that the symptoma- 
tology of our drugs may not only be reliable and complete, but also 
be at our fingers' end. Thus can we lend lustre to the triumphs of 
surgery, force to the revelations of Bacteriology, point to the study 
of Pathology, and obtain the degree of "Master'^ of our calling, 
whether it be viewed as a science or an art. 

Again, it should be our aim to secure as many recruits as pos- 
sible to the study of Homeopathy. The Macedonian cry is abroad 
in our land for practitioners of our school, and the laborers are too 
few. Young men should be encouraged to secure a really good foun- 
dation education, and then address themselves to the study and 
practice of Homeopathic medicine. We read of the "passing of the 
preceptor." For one I hope that the changed methods of scholastic 
training will never succeed in effecting the removal of those so 
necessary to our growth. Every office should be a recruiting station 
first, a source of inspiration, encouragement and help ever after- 

So far we have given consideration to professional co-operation, 
about which this further word is apropos. Let your professional 
associates know of your work and the results of your study through 
papers for medical societies and journals, and through discussion 
based on experience of others. It is quite the thing now to arrange 
for the outdoor treatment of pulmonary tuberculosis in properly 
constructed buildings or tents. Such arrangement is an evident 
help toward relief and recovery, and will be welcomed and advised 
by us all. But there is a form of tuberculosis, more amenable than 
the pulmonary variety, about which very little has been said. So I 
would call your attention to the fact that the "conditions of climate 
and general hygiene" that have made the sanatoriums for the con- 
sumptive so successful, would prove of even greater advantage to 
the numerous cases of surgical tuberculosis which you all know are 
mostly seen in the children's wards. Fresh air, simlight, proper 
surroundings and proper Homeopathic medication will show them- 


selves aids to recovery so effective that the best surgical care can- 
not suffice without them. Hence, the need for small neighborhood 
hospitals for this purpose also. 

Speaking of hygiene reminds us that the attention of the State 
has been directed during the last winter to the general question of 
sanitation by the prevalence of typhoid fever in the larger cities, 
notably in the Capital City. Prom these recent experiences we are 
more sure that typhoid is a preventable disease and is due to defiling 
living water. It is now proposed to maintain large filtration plants 
for the supplying of the drinking water. Such plants are only 
costly makeshifts ; they neither filter out the abomination nor attack 
the real source of infection. This whole question really is in the 
realm of political economy, and its problems cannot be solved with- 
out the united effort of the local and State hoards of health (these 
same boards not being political machines) ; and even then the com- 
plication and expense of the problems make it advisable and neces- 
sary for the general Government to take hold of them and through 
a Department of Health banish all these preventable diseases. 

As lending emphasis to what was said a moment ago in regard 
to the need for more students and practitioners of Homeopathy, I 
desire to make note of the fact that in Ohio our school is not keep- 
ing place wih the others in relative numbers of practitioners, etc. 
It is not pleasing, yet necessary, to know that there are only about 
nine hundred physicians of our school now practicing in Ohio, al- 
though about twelve hundred have been registered; this shrink- 
age being caused by deaths, removals and abandonment of profes- 
sional activity. You can easily see that our numbers are about the 
same as when the canvass was first made to determine our stand- 
ing on the State Board. To say the least, we must be up and doing 
to retain our relative standing in the profession, and hence on the 
State Board. We surely need to grow and not merely to exist. 

The report of the Legislative Committee will show you that 
very little was attempted, and nothing really accomplished in the 
way of changing the medical laws of the State during the recent 
session of the Legislature. There are continued efforts to induce 
the Trustees of the Ohio State University to establish a college of 
medicine as a part of their institution, the latest scheme being to 
take over an allopathic school as the Medical Department of the 


State University. We have no doubt that our interests and rights 
in this matter will be watched and guarded by the Legislative Com- 
mittee and other proper oflBcers. 

If you will turn to Section 1 of the By-Laws you will note that 
the initiation fee shall be one dollar, and the annual dues three dol- 
lars. I would respectfully suggest that effective steps be taken at 
this session to reduce the annual dues to a much less amount, prob- 
ably one dollar. Considering the dues to our National Society, and 
other societies similar to our own, we are placing too much burden 
on our inembers. The dues were placed at the present figure to 
meet the expenses of paying for the Society Transactions ; but if the 
Publication Committee were authorized to issue a volume of 
Transactions containing the record of business transacted, with the 
papers and reports incident thereto, and see that the Bureau papers 
were all published in our journals, that would willingly and gladly 
do so, then would every interest of our Society (expense and all) 
be more thoroughly conserved, and some burdens removed. 

I shall not detain you at this time to listen to a review of any 
sort of the progress of this year. Marked progress in every branch 
of our science and art has been made. The journals, our best work- 
ing literature, are full of evidences of this statement, and I am will- 
ing to believe that you all are familiar with these records. Permit 
me, though, to just refer to two lines along which decided progress 
has been made. A new light has been shed on the physiology of the 
ductless glands, as the result of the careful investigations of the last 
few years. These organs till recently supposed to be vestigial, or 
of little moment, now seem to be the chiefest in the physiological 
chemistry of cellular metabolism, tissue respiration and oxidation. 
The adrenals here play the chief part in all the oxidation proces^s 
of the body through the oxygen laden plasma. The anterior pitui- 
tary body is the governing center of these oxidation processes, and 
the thyroid by its iodine in organic combination is necessary for sus- 
taining normal pituitary function. The posterior pituitary body is 
made the chief functional center of the nervous system, and assist- 
ant in maintaining cellular metabolism of all organs. The proteoly- 
tic ferment from the pancreas and spleen plays the leading part in 
all immunizing processes. These few words give the merest hint of 


what may lead to a broader, deeper and larger understanding of 
the human economy. 

In the neurological studies there has been considerable prog- 
ress in the knowledge of structural organization of the nervous sys- 
tem; the better knowledge of function has led further up to the 
knowledge of intimate structure ; the neuron doctrine is much bet- 
ter understood, especially as regards its repair after injury; the 
nature and transmission of nerve force by means of the electro- 
chemical status of the ions seems to have been fully shown; the 
pathologic nature of acute myelitis is now known to follow vascular 
disease, and not precede it ; more important superficial reflexes have 
been recognized and catalogued ; and there is a growing tendency to 
combine nervous and mental diseases in study and in treatment, 
so that there may be more intelligent care of the mentally and mor- 
ally afflicted. This, again, is a very fragmentary statement of the 
yearns work in a specia line, still it will serve not only as a hint of 
what has been done, but be a stimulus to keep posted and even to be 
helpers in these rapidly progressing and changing departments of 
our professional studies. 

Again, members of the State Society, I thank you, and request 
your hearty co-operation in every way toward making this meeting 
a success in interest and profit. 



In view of the strenuous efforts on the part of our colleges to 
turn out a class of graduates that will be an object lesson to the 
public, and at the same time show the profession what they are able 
to do with students sent to them for a medical education, it is neces- 
sary that a careful selection be made by the physician first in the 
education of a student, and secondly in moral character. Xo mat- 
ter what other qualifications a student may have, he is the better 
for a good solid education, and in as far as it is possible, they should 
have a first-class college course, and so raise the standard of a class 
in ability to learn, when brought into the complex method of to- 
day's teaching in the medical college. 


Secondly, we most heartily recommend the university founda- 
tion for a college, and on such a basis as will place all our graduates 
on such a plane as will the more surely compel the recognition of a 
diploma as entitling a graduate of the university to practice medi- 
cine in any State in the Union. This is only to be accomplished by 
the doing away with rival colleges in the State, and the establish- 
ment of one great central school with teachers absolutely indepen- 
dent of friction, and who will give their whole time to the class 

This will be a step in advance, but your committee urges the 
work toward that end. 

E. K. Eggleston, M. D. 

Frank Kraft, M. D. 

George D. Grant, M. D. 



There is very little of importance to report at this meeting. 
The most important legislative enactment of the term Just closed 
concerning medical matters was that of the bill establishing a tuber- 
culosis hospital. A bill appropriating $70,000 for this purpose was 
passed by both houses — $35,000 available this year and $35,000 
next year. The Governor cut out one year's appropriation, $35,000, 
leaving the other to start the institution. The matter of establish- 
ment is left, I believe, in the hands of the Tuberculosis Commis- 

An attempt was made by the State Board of Medical Kegistra- 
tion and Examination to pass a reciprocity bill. This did not suc- 

The question of a medical department in- the Ohio State Uni- 
versity is being agitated again. Something may come of it. An 
article in one of our medical journals within the past year gives the 
erroneous impression that medicine is already taught in the State 
University. A few years ago an attempt was made by the Board 


of Trustees to establish such a department, but it "died in the born- 
in^/' and no such establishment exists. 

M. P. Hunt, M. D. 

G. B. Haggart, M. D. 

H. E. Beebe, M. D. 

W. B. Carpenter, M. D. 

A. L. McCoRMiCK, M. D. 

J. H. Wilson, M. D. 
Referred to Publication Committee. 



According to the annual report about to be issued, I find that 
during the year there were three hundred and eight registration 
certificates issued, and one hundred and four upon examination, 
making a total of four hundred and twelve licenses issued during 
the year to medicine practitioners. Three licenses were issued to 
mid-wives, and seven to osteopaths, authorizing them to practice 
osteopathy, but not to administer medicines. These were all issued 
upon examination. Three applicants for registration were rejected, 
and twelve upon examination. Three certificates were revoked for 
cause. Eleven thousand two hundred and eight (11,208) licenses 
have been issued since the organization of the Board. During the 
last year the Board has instituted thirty-five prosecutions for illegal 
practice of medicine ; of these eighteen were found guilty and fined ; 
five were dismissed; ten are now pending. Two of those against 
whom warrants were issued left the State before they could be 
served, and will probably not return. 

This represents only the routine work of the Board. Its real 
work cannot be expressed in figures. 

One of the objects of the Board is to bring about a better un- 
derstanding of its purposes, a better comprehension of the provis- 
ions and effects of the law on the part of the medical profession, 
and on the part of the people at large. I do not believe that any 
other profession is so much misunderstood, or encounters so much 


hostility, as that of medicine. The attitude assumed by members 
of other professions, and by the public officers, toward the medical 
profession and toward the medical law is, to say the least, peculiar. 
The legal profession has a law very similar to the medical law. So 
also have the pharmacists, and the engineers and others. Very little 
difficulty is experienced in enforcing these laws. It is almost an 
unheard of thing for any one to attempt to practice law without first 
passing the examination and receiving a license. Any attempt to 
do so would be punished so quickly and surely as to effectually pre- 
vent a repetition of the offense. A case in illustration occurred re- 
cently. Parties in Columbus obtained a copy of the questions pre- 
pared for an examination in law. This was discovered in time and 
the offenders were promptly arrested and heavily fined. Had this 
occurred in connection with the medical examination, a hard legal 
fight would have resulted and probably the culprits finally dis- 
charged. We find great difficulty in getting the proper officials to 
do the duty which the law specially imposes upon them. The law 
makes it the duty of the prosecuting attorney to prosecute those 
charged with its infraction. While in many instances they do this 
willingly, in many other cases they practically refuse. One or two 
instances will serve to show this. In one of the counties a case was 
made against a practitioner for the illegal practice of medicine. 
The evidence was clear and distinct. The witnesses were summoned 
to appear before the Grand Jury, and were on hand at the proper 
time. They remained about the court house for all of one day, and 
were then dismissed. They never saw the Grand Jury ; the evidence 
was never presented, and no indictment returned, all because the 
prosecuting attorney was not in sjrmpathy with the law, and would 
do nothing to enforce it. In another instance the indictment was 
obtained, but the prosecuting attorney practically refused to put 
the case on trial. He confessed that the trial would not take more 
than two hours. The case ran along for over two years. The wit- 
nesses were scattered, their addresses lost, and the case finally 
noUied. Many other instances of the same nature might be cited. 
Public sentiment is a great aid in such matters, and if such a senti- 
ment could be aroused to support the medical profession there would 
be much less difficulty in enforcing the law. The medical profes- 
sion, as a whole, can assist very materially by helping to create such 


a public sentiment, and at the same time produce a better feeling 
toward the medical profession generally. 

Again, against no similar law is there such a vicious fight for 
its overthrow or nullification as against this law. During the ses- 
sion of the last Legislature several covert attacks were made upon 
this law. The first was in the form of an amendment exempting 
the graduates of 1904 from the examination. It is noticeable that 
the declared enemies of the law itself were those who most strenu- 
ously favored this bill. The next step was an amendment cutting 
down the fee to five dollars. This was introduced and favored by 
those who were openly opposed to any medical legislation. In this 
connection it is proper to explain the financial conditions of the 
Board. It is to be borne in mind that the Board derives nothing 
from the general treasury of the State. All of its expenses are paid 
from a special fund created by the registration and examination 
fees. The Board has no other income from any other source. At 
no time since the organization of the Board has the yearly income 
been sufficient to defray its expenses. It has been obliged to draw 
upon its reserve fund each year. As a result members of the Board 
have done a large amount of work for which they have received no 
compensation whatever. For the first time in the history of the 
Board the annual income this year will probably be sufficient to 
meet its expenses. Should the examination fee be reduced as pro- 
posed, the Board could continue but a very short time. Another 
amendment introduced provided that no more than four members 
of the Board should be of one political party. This was as vicious 
in its character as any of the others. The Board is not a political 
body. Politics plays no part in its proceedings. I do not think it 
has ever occurred to any member of the Board to inquire as to the 
political affiliation of its members. If they are all of one political 
party it is more by accident than design. Such a feature of its com- 
position would make it political. Another amendment was intro- 
duced, which it is to be regretted could not have become a law. 
This was to enlarge the powers of the Board in the direction of rec- 
iprocity. The Board is at present handicapped in this direction. 
Ohio can accept the certificate of another State, only if issued after 
an examination. It was proposed to put this upon a broader and 
more liberal basis. The Board has gone as far in the matter of reci- 


procity as the law will permit. A limited reciprocal relation has 
been established with a number of other States, and this will prob- 
ably be increased during the coming year. 

A committee was appointed in January to visit the various 
medical colleges of the State, for the purpose of inspection and for 
the information of the Board. Another purpose of this committee 
was to establish better understanding and a more friendly relation- 
ship with the colleges. We believe that a more perfect understand- 
ing of each will eliminate any unfriendly feeling that may have 
heretofore existed. This committee has visited every college in the 
State, and I believe that much good will result. It is the desire of 
the Board to work with the colleges and have them work with us. 



G. B. HAGGART, M. D., Chairman - - _ Alliance 

1. **Resuine of the Work of the Year." 

2. Our Drinking Water— What it should be— What we are getting" 

KATHERINE KURT, M. D. - - . - Akron 

'* Sanitation." 



To say to you that the word sanitation means to be sound, sane, 
healthy is needless, for you already know it. It is commonly ac- 
cepted that an objectionable element, once out of sight, is beyond 
the reach of harm. 

Clean everywhere, in food, in air, in house, in water, in soil, 
in body, should be a watchword with every doctor who by virtue of 
his office is a teacher as well as healer. 


Two problems look the sanitarian in the face. These worked 
out and applied would add much to the sum of daily happiness and 

First — Teaching people to keep clean. 

Second — ^Method of disposal of waste substance. 

As to the first, it is difficult, possibly, always to be pursued and 
never wholly achieved. Long since corporate authority has enacted 
sanitary laws and enforced them to the benefit of every one. 

The chief trouble with city and village authorities lies in the 
low standard adopted and poorly enforced laws. This standard 
needs to be raised everywhere, in the country as well as in munici- 
palities. To keep clean does not require superior skill, and they 
who fail to attain to the standard should be shown how, yes, re- 
quired to get it. 

It is generally thought that if highways and thoroughfares are 
kept clear in the warm season a community has accomplished as 
much as possible in a sanitary way. 

To be clean is to purify and keep pure, street, alley and by-way, 
building and factory, basement and corner. 

How often in passing along the down town streets are your 
nostrils offended by mal odor arising from basement windows or 
open space under the sidewalk? Here sweepings and other offal 
land and are allowed to remain, because considered cleaned away, 
while above in the building sits the merchant who would resent the 
assertion that he needs to clean his premises below. Tenants should 
be held responsible for purity of such places. 

How can this higher standard be brought about? The ideal is 
not attained in anything. 

Were I the municipal authority I would proceed to educate the 
people in rules of purity. I would enact laws to enforce my rules. 

A municipality too large for management by one person I 
would divide into districts and appoint lieutenants who should be 
held responsible for the instruction and enforcement of laws. I 
would give to the people in their homes rules in simple printed lan- 
guage to be read and comprehended and kept in daily sight. They 
should pertain to food ; to ventilation ; to the use of lime as a puri- 


fier ; to the classification of waste material ; destroying by fire every- 
thing combustible as far as possible on home premises without in- 
jury to other people ; to the need of keeping the groimd clean and 
free so that light, air and water may touch it ever3rwhere. 

To these general rules others should be added as might become 

These rules, I would try to invest with the spirit of wholesome- 
ness and interest in the citizen^s welfare. My lieutenants should be 
required to see these rules enforced by inspection of premises, as 
far as necessary at regular intervals. The politician's hand should 
be beaten aside. He best qualified should be called to serve. This 
method diligently pursued would raise the standard of purity. 

As to my second proposition — ^method of disposal of waste 
material or garbage. 

Ever since my school days in college where I first studied chem- 
istry I have been convinced that the destruction, by fire, of waste 
and effete material is most nearly sanitary and therefore best. 

There I learned that vegetable organisms and animals are com- 
posed mainly of nitrogen, hydrogen, oxygen and carbon and that 
when the life is gone out this organism returns to the elements from 
which it was composed through the process of decomposition by heat 
and moisture, also that the same state is attained through dissolu- 
tion by fire, without danger to life. 

To me cremation or incineration of the deceased human body 
commends itself over the underground process. 

Cremation of garbage does not commend itself because of the 
high expense of money attached to the methods followed hereto- 

Through communication with the President of the Board of 
Health of the city of Memphis, Tennessee, I learn that city has 
solved the problem of garbage cremation, by test, satisfactory to her 
citizens. Statements are here quoted from the president. The 
city destroys her garbage "on the spot,'' that is crematories are 
located in several places within the corporation. 

In 1897 the city was visted with yellow fever; fifty severe 
cases developed. 

Eemembering the awful experience with this disease in 1878 
the health authorities resorted "to every conceivable thing which 


would improve the sanitary condition/' Finally they resorted to 
cremation of garbage, instead of dumping it in the river, and in 
1898 built four crematories so located in different parts of the city 
as to make the average haul of garbage somewhat less than three- 
fourths of a mile. 

They have the method so well planned that "the cost of gather- 
ing, hauling and destroying garbage costs the city only two- 
thirds as much as when it was hauled and dumped in the Missis- 
sippi river." 

At first thought one would conclude a garbage crematory oper- 
ated in a closely inhabited community would prove a nuisance. 

However, Dr. Heber Jones, President of the Board, declares 
he "can run a crematory in any part of the city of Xew York and if 
the neighbors did not see the garbage going into the crematory they 
would not know what was going on in the establishment." Their 
crematories are located in the most densely populated portion of the 
city and when in process of construction "people made direful pre- 
diction, threatened with injunction, made incendiary threats." 
^^ithin a month," says Dr. Jones, "after operation began all 
threats ceased, and since that time residences have been built within 
a stone^s throw of the buildings and not a word of complaint is 
heard." The Doctor says "if there is one sound argument against 
the destruction of garbage by fire, I do not know it." 

"We bum everything except ashes." 

I have no description of the structures at hand, but they are 
said to be sanitary. "There is not one particle of odor escaping 
from the smoke stack. In the bottom of the smoke stack which is 
intensely hot — ^being heated with coke — ^gases are effectually 
destroyed." ^^ith reference to odor in the crematory, I can take 
any of you into one and if you were blind-folded you would not sus- 
pect where you were, the draft from the hole being so strong that 
odor disappears immediately. It is sucked in, goes through the 
fiery furnace, up through the combustion chamber and is 

"You would be surprised at the small amount of coal it takes 
to run the crematories, constructed as they are. We have made many 
improvements on them since their original construction. We run 
the larger ones, which have a capacity from 50 to 60 tons a day on 


a ton and one-half of slack coal per day/^ "If the garbage is wet 
this figure will be increased somewhat, but it will never exceed two 

"The crematories cool down between mid-night and morning, 
so early in the day more is required with little or none late in the 
day and evening." 

"Ashes are kept separate and used for filling unpaved streets. 
Such material is useful. Our city engineer claims we save more 
than four thousand dollars a year by their use, which is more 
than it takes to run our crematories for the same period." 

"Unquestionably, the proper plans for garbage disposal is to 
destroy it by fire, and I do not care what the size of the city, whether 
it be IN'ew York with its four millions of people, or Memphis with a 
little over one hundred thousand." 

"If properly built crematories are used, and if properly man- 
aged and the cost of common slack coal does not exceed $1.50 per 
ton the garbage of any city can be cremated at a cost not to exceed 
20 cents per ton. This I can demonstrate. It is by all odds the 
cheapest method, provided properly constructed crematories are 
used and intelligently operated and so located that the cost of haul- 
ing is reduced to a minimum." 

In the summer, when the crematories run at full capacity, the 
cost per ton does not exceed 15 cents, and in the winter, when not 
run at full capacity, 20 cents. 

We find it cheaper to run more crematories, even at half capa- 
city than to haul garbage long distances. 

In the summer when running at full capacity we destroy about 
130 tons per day. 

The cost of labor is about the same in winter as in summer. 
The amount of garbage in winter is about one-half that of the sum- 
mer season, hence the proportional cost of incineration will be 
greater in winter. 

It is safe to say the average cost of cremation of garbage in 
Memphis the year round is 18 cents per ton. 

There is no reason why cremation of garbage in Ohio may not 
be done as well as in Memphis if the people will leam how to do it. 
I therefore advise that this society investigate the system fully and 
recommend its practical features to our cities and towns. 


Dr. Beckwith: I want to compliment the author upon her 
excellent paper. Sanitation is one of the greatest subjects that we 
have before us in cities, towns and villages. The subject of crema- 
tion has been taken up for the examination and study of the medi- 
cal profession for the last ten years. New York is very successful 
with crematories, although she doesn^t cremate all her garbage — she 
sells lots of it for fertilizers. That is where much of the garbage 
should go. In the city of Cleveland we have 25 sanitary policemen 
who visit every cellar and every yard in every building in the city 
once or twice a month, the back yards also are taken care of. There 
are no odors from decaying stuffs in Cleveland that I know of; 
these sanitary policemen visit all these places and it is their duty to 
arrest any one permitting a nuisance, provided they do not follow 
his instructions. 

Dr. Cameron : I imderstand that the tenants in the buildings 
should be held responsible for the garbage. It is therefore a little 
diflBcult to enforce these laws, for many times tenants are not people 
of property. It would be better to hold the owner of the property 
liable for the proper disposal of the garbage, than to try to hold the 
tenant, and the cost of that can be taxed against the property 
holder. That one point in practice wiU work out better if the cost 
is put upon the owner rather than upon the tenant. 

Dr. Hoyt : I was glancing over the morning paper this morn- 
ing when I happened to see the following : 



Teacher — Sterilized Stephen, do you bring with you a disin- 
fected certificate of birth, baptism and successful vaccination ? 

"Yes, ma'am." 

"Have you had your lower left forearm inoculated with correct 
cholera serum?'' 

"Yes, ma'am." 

"Have you had your vermiform appendix removed ?" 

"Yes, ma'am." 

"Have you a Pasteurized certificate of immunity from croup, 
ci;]d feet and cholera morbus?" 

"Yes, ma'am." 


"Do you promise for yourself, your heirs and assigns, for all 
ages, to use sterilized milk ?" 

"I do." 

"Do you solemnly covenant to soak your slate in sulphur 
fumes ?" 

"I promise." 

"Will abjure every companion that snijHes ?" 

"I abjure." 

"Do you promise to use an antiseptic slate sponge and confine 
yourself to individual chewing gum ?" 

(Sadly) "Yes, ma^am." 

"Then extract that one remaining milk tooth, tie a formalde- 
hyde bag ^round your neck and make your will. Come tomorrow 
and you will be assigned an insulated seat in this sanitary school- 

Dr. Kurt: I do not mean to say the tenant should be held 
responsible for the proper disposal of garbage. If it is cremated by 
the municipality the cost will fall upon the tax payer. 

All premises should be regularly inspected, inside and out, 
and the tenant, of any property whatever, should be required to 
keep it clean. I believe in compulsory cleanliness where not kept 
from motives spontaneous with the individual. 



It is usual I believe to open each Bureau with a short resume 
of the work of the year last past, — and as this bureau is one of the 
most important of any of the Society, I trust that the fortunately 
short remarks I shall offer will interest you and bring out a 
thorough discussion. 

Sanitary science is one of the few recognized departments 
of medicine. Every State as well as every country has some sani- 
tary laws. Every individual must needs be vitally interested in the 
practical workings of those laws. 

How unfortunate it is for us that we cannot, like the German 
government, see the need of more stringent food laws as well as 
municipal regulations to control the output of our supplies, and to 


stamp with the best evidence of sanitary condition everything 
offered for sale, be it food, water, residence or even clothing. 

During the last year our State has battled with three classes 
of diseases brought about in three different ways, viz: variola, — 
through contagion, or the lack of proper quarantine ; diphtheria, — 
through poor plumbing and close tenement living; typhoid 
fever, — ^through pollution of our water supply. 

There have been three ways by which the State has endeavored 
to control the spread of these diseases. By public sanitation, by 
fumigation, and by medication. 

In variola the sanitary precautions are the cleansing of pub- 
lic alleys and sewers and the institution of pest-houses. The f umi- 
gants have been largely formalin, sulphur and creolin. Medication 
has resolved itself into the only homeopathic specific there ever 
was, — vaccination. 

In diphtheria the sanitation has largely consisted of isolation. 
Fumigation has not met with much direct use. Medication still 
proves to be most effectual, whether by serum treatment or the indi- 
cated remedy. 

In enteric or typhoid fever, the sanitary precautions have 
been those of almost classical repute, — and isolation is rapidly forg- 
ing its way to the front. Fumigation has not been used except in a 
general way later. Medication, — that old, well-tried, battle-scarred 
defender of three thousand years, is still more than maintaining its 
place in all professional and lay minds. 

As then a general summary of the work for the year, I should 
heartily say, that medication has by all odds proven the most impor- 
tant ally we have had, and that we cannot say any more than usual 
this year, — ^that there are other things to assist us, but medicine is 
the best force we have ever safely employed. The State is working 
to good effect among the residents to get proper enlightenment and 
better prophylaxis. It has been a year marked by a campaign of 
education along the line of sanitary science. 





First Thought, 

Water ought to be the commonest thing in nature. Our bodies 
are composed of at least eighty per cent, of it, and it is nature's 
great diluent, the physicist of the universe, by bringing agents and 
elements in contact with each other. 

It would seem that as savage man could so well supply him- 
self with it, — camping and working near it, that the first thought 
of civilized man would be to secure an abundance of it, for his 
private social needs. What other great conductor to civility, in his 
economic needs would he allow himself to suffer for, from default? 
He needs room, — ^he takes it by means of war; he needs navigable 
rivers, — ^he gets them by stealthy politics; he needs gold, that 
product which has set the minds of all races on fire, — ^he pushes 
aside survey limits and obtains it; he needs even furs to keep him 
warm, and he carries on international litigations, without thought 
of expense, to get it even in meagre quantities. 

But what of his drink with which he must wash down his nutri- 
ment, slake his continual thirst, bathe away the poisonous excreta of 
his furnace fires within and reduce his metabolic waste? Does he 
get it in reasonable amount, free from the poisons of the arts, — ^the 
contamination of the dying organic bodies over which it fiows, — or 
does he even get it at any cost commensurate with its reasonable 
worth ? Does he try to get it at all ? Does he also, into whose hands 
the executive work to the end of so obtaining it stifle his willing con- 
science by the thought that while thousands of his fellow beings in 
the large cities are dying from the absence of it, — ^ihe need of 
water, — ^pure water, — ^that the time is not ripe, or the need for it 
not sufficiently patent? 

A Second Thought. 

What it should be. 

Why such a question? What should water be? Better in 
the usual way the question is treated ask, "What should be water T^ 
In some places the filter and the cauldron for boiling purposes will 


have to ere long give way to the excelsior meat chopper and the cof- 

What would the people of northern Michigan who have beauti- 
ful springs, — crystal fountains, truly, rock imbedded, call the vile 
stuff we pump into our houses ? 

What would the Swiss with their ice-cold currents, fresh from 
the mountain's side, glacier laden, call the material our muddy, 
stagnant streams supply? 

What do the bacteriologists who are quibbling, not over one 
or two thousand bacteria in a cu. cm. of our water, but over thou- 
sands of colonies of the most virulent of bacteria, instead, think of 
it? What can they help but think of it? 

It may be a serious question whether water can be too pure or 
not. The late Prof. Orton of this city, tried to convince the Society 
for the Advancement of Science, that distilled water, — absolutely 
pure and sterile, did not furnish the life giving elements. Did not 
contain the necessary salts of lime, soda, manganese, iron, the sul- 
phides, etc. No doubt he was right, and it is better for their addi- 
tion, but had we not better get them through our cereals, meats and 
fruits, than to take in so much filth as must need go along in their 
company in the usually supplied water of our large cities ? 

The idea that all types of the genus homo must in its lifetime 
"eat its peck of dirt'' may be classical, but not appropriate. 

What have we to say for ourselves ? We spend enough to keep 
our streets reasonably clean, sometimes bum or purify our city 
wastes, and even see to it that our politicians do not drink bad 
whisky, but we pay enough and more than enough for our political 
warfares, holiday celebrations, and junketing tours to annually sup- 
ply ourselves with even the poorest substitute for good, cleanly pre- 
pared water, — ^the artesian well. 

I cannot foreshadow the future, but I wonder what effect a 
good drink of wholesome sterile water taken at regular intervals, 
for a year would have on the working results of one of our average 
badly maligned councilmen ? 

Perhaps we should have, corresponding with the cleaner 
quality of the circulating blood supplied to his brain, and tissue 
cells, a cleaner character of political actions, more altruistic work, 


more intersections of our city streets decorated by statues of great 
men, better libraries, — at least a few art galleries, some better paid 
industries, as well as a better water supply to come. 

All vices are viciously fed. So much for the point of view. 

A Last Thought, 

Are we to be the victims of our own negligence ? 

Have we no power within our borders save that of individual 
effort ? Is not even that a great power when accurately and actively 
used? Look at the aqueducts of ancient Rome and tell me if you 
can think of a decadent civilization living through and in spite of 
such faults as our own, — they, too, without our present advantages, 
steam, electricity, and since discovered chemical activity. These 
ancient towns took their water supply from the hills and only by the 
power of gravitation forced it to baths and pools, and yet with all 
this disadvantage as we would now look at it, the people were better 
supplied, and with a purer quality of water than we, who boast of 
an intelligent civilization, and yet allow two of the diseases which 
thrive in the presence of dirt, — made possible by the lack of an ade- 
quate supply of water, to create amongst us, our greatest mortality. 
I refer, of course, to tuberculosis and enteric fever. 

Fortunately for us we have a most zealous State Board of 
Health. Its work is most laudable in its beneficent results. Proud 
Sihould be that mortal who has the ability to direct effectively this 
great work. The laurel wreath may well be accorded him, who as 
a member of the board of such a public trust can, and does do, such 
effective and all-pervading work. 

Let us give the State in whatever section we are of it, our 
efforts to. create an effective public sentiment in favor of pure water, 
— ^nothing except the purest is good enough. Condemn the crude 
well water supply. Eesist all systems of settling basins, crude filtra- 
tion, and other treatment of our city water, and try to protect our 
lake and river supply while we must use it. Hasten by our every 
effort the use of the artesian weU and spring supply. 

Pure water can be had. Its cleansing can be thoroughly done. 
Let our force of character attest that it can be had, and when it can 
be had pure, its cleansing will be well done. 



O. A. SCHULZE, M. D., Chairman - - - Columbus 

"Materia Medica Melange" 

C. F. JUNKERMAN, M. D., - - - - Lancaster 

" Clinical Verifica tions " 

W. A. DEWEY, M. D. - - - - Ann Arbor, Mich. 

" Platinum and Palladium " 

FRANK KRAFT, M. D. - - - - Cleveland 

** Aurum Metallicum'* 

J. H. WILSON, M. D. - - - - - BellefonUine 

*' Argentum Metallicum " 

A. S. ROSENBERGER. M. D. - - - - Covington 

" Alumina " 



Case I. June 22, 1889, Mrs. E. B. S., age 32 yrs., tall, slen- 
der, dark hair and eyes, had been a victim of epileptoid convulsions 
for fifteen years, always coming on at or near time of menstrual 
periods at which time she suffered with intense pressure and bearing 
down pains as if everything would protrude from pelvis. She 
would either have limbs crossed or sit with them close together, and 
muscles in a state of rigidity to prevent apparent protrusion; was 
very sad, and much depressed on account of the continuance of con- 
vulsions, which in her former physician's opinion would cease after 
child-birth, which occurred first, eight years, and second, five years 
prior to above date with little or no relief; in fact, the absence of 
convulsions during pregnancy was the only mitigation, as the 
attacks grew more severe after each pregnancy. Sepia 12x was 
given with almost immediate cessation which proved to be of a per- 
manent nature. 

Case II. Miss C, age 8 yrs., oldest daughter of Case I, light 
hair, blue eyes, was from birth troubled with incontinence of 
urine. The peculiar and interesting features of this case was that 
when being bathed or even placing her hands in water she would 
lose complete control of urine in spite of her most strenuous efforts 


to become master of this function. Otherwise she had perfect con- 
trol night and day. The only symptoms or history of this case other 
than above mentioned was that the mother was similarly affected 
during her pregnancy with this child, but after delivery she suffered 
no further inconvenience with her urinary functions. Sulphur 3 Ox 
was prescribed for the child and resulted in a complete cure. 

Case III. July 24, 1889, Wm. S., age 37 yrs., light hair and 
light blue eyes, had been confined to house for about three months 
with the following symptoms : sharp tearing pains in region of right 
kidney extending to the bladder, hence to spermatic cord, the con- 
tractions of which drew the right testicle up and held it firmly 
against the inguinal ring. Violent urging to urinate with sharp 
cutting pain in urethra, at times the pains and contractions would 
become so intense that his jaws would set as in tetanus, and every 
muscle in his body seemed to be in a rigid state of contraction. This 
intense suffering at such times appeared to be the most severe it 
had been my lot to witness. This patient had employed in consulta- 
tion and otherwise seven physicians, who had exhausted all their 
resources to palliate or restore the health, but without appreciable 
effect. He had been etherized, chloroformed, and given morphine 
so frequently and constantly that he declared that within the last 
twenty-four hours previous to my call he had received thirty-three 
hypodermic injections, which gave but slight, if any, temporary 
relief. He had taken no nourishment for twelve days. His family 
physician informed his wife and relatives that all earthly measures 
for his recovery had been tried and failed, hence they could prepare 
for his death within the next twenty-four liours. He was given 
berberis vulgaris 2nd, five pellets every fifteen minutes, and became 
perfectly quiet after taking the third dose, at which time he went 
to sleep and remained so for twenty-four hours, it being the first 
natural sleep he had had since the beginning of his sickness. On 
the third day after taking barberis he was unable to pass urine, 
and on introducing the catheter his bladder was found to be full of 
very fine sand, small calculi and much mucus which required sev- 
eral washings before it was entirely cleared, so to remain. This man 
made a rapid recovery and remains well and happy to date. 

Case IV. October 4, 1900, Wm. J., age 32 yrs., light hair, blue 
eyes, large plethoric subject, was taken with severe pains in region 


uf right kidney, extending to bladder. Pains were so severe that he 
was twisting and turning from one side of the bed to the other, 
bathed in profuse perspiration. He had been subject to renal colic 
for some years, each attack confining him to the house for three or 
four days, and the only relief he had been able to obtain was from 
the use of morphine. He was given berberis vulgaris 2nd, eight 
drops in half glass of water, of which he took two spoonfuls every 
fifteen minutes. Within two hours he was relieved and he returned 
to his usual occupation in four hours from the beginning of the 
attack. The next day he presented me with a calculus he passed in 
about twenty-four hours after taking the berberis. (The calculus 
I have with me and will leave with the chairman of this bureau for 
inspection by any one who may so desire.) 

Case V. Mrs. L. J., age 47 yrs., dark hair and eyes, weight 
before sickness 115 pounds, was taken January 25, 1904, with con- 
stant gnawing pains under lower inner angle of left scapula, extend- 
ing through chest to about two inches below left nipple. Of the 
location, character and direction of these pains the patient was very 
positive in her statement. The peculiar gnawing pain starting 
imder inner lower angle of left scapula and passing anterially 
through chest proved to be very difficult to cover with any of our 
well proven remedies, and as there were no other except such gen- 
eral symptoms as inability to sleep or lie down, loss of appetite, 
extreme anxiety and restlessness occasioned by the pain, my search 
for' the appropriate homoeopathic remedy was long, but finally 
rewarded by finding under chenopodium glauci, severe pains in 
region of lower inner angle of left shoulder blade running into 
chest. The pains of chenopodium glauci, for the left shoulder 
blade are similar to the pains of chelidonium for the right 
shoulder blade. Not having the remedy in stock, it was procured 
after considerable delay from an eastern firm, but during this time 
my patient lost fifteen pounds in weight. This, in spite of the 
carefully selected remedies, which according to Burnett and Eade- 
macher, have a specific action on the spleen, Bartlett^s principles of 
diagnosis, Butler's diagnostics of internal medicine, Elliott and 
Eanny on nervous diseases all claim this disturbance to be of splenic 
origin. We got no relief until chenopodium glauci 3rd was pre- 
scribed three drops every hour until improvement was manifest. 


which required but twelve hours. With the exception of a slight 
soreness she expressed herself as feeling quite well ; this vanished in 
a few days after taking the remedy. 

Dr. Stewart: This is the character of paper that ought to 
bring every homeopathic physician to his feet to bear witness of his 
own success in cases similar. I don^t think there is any one here 
but who could not give testimony along the line of this excellent pa- 
per. We can^t all engage in proving or reproving our remedies, but 
we can tell what success we have had with the old remedies. We are 
all looking for something better all the time, and I think we will 
some day get it. It is right along the line of Dr. Junkerman^s 
paper that I want to repeat a case in my. earlier practice. In this 
case I know it was the homeopathic remedy pure and simple that did 
the business. I can remember with a great deal of satisfaction 
a long while ago, Dr. Beckwith, that I was called to see a case of 
colic in an elderly gentleman, not Dr. Beckwith, and that it was a 
chamomilla case. He related much the same history that we heard 
reported by the essayist. He had been given morphine and all those 
usual things, and as I was the only physician in that vicinity I got 
the case. As I said I found it to be a chamomilla case, and inas- 
much as all other remedies like morphine and other anodynes had 
been prescribed without result there was nothing for me to do but 
to look up the homeopathic similimum and give it. I knew it could 
do no harm and that was all the other things had done for him any- 
way. It was an old army oflBcer, and he said homeopathy was all 
bosh and he didn^t believe a homeopathic physician could do any 
more for him than the others. But I gave him the chamomilla, and 
what is more it cured the case. It gave him so much relief without 
anything else after about half an hour that he wanted to know what 
it was I had given him, and he wanted to get a gallon of it. 

Dr. Junkerman : The cases I have reported were very interest- 
ing to me, not from the fact alone that most of them occurred in my 
early practice, as did Dr. Stewart, but they quite clearly demon- 
strate the positiveness and superiority of a prescription based on 
symptomatology, instead of pathology. 




PBEPARATION. The Spongy Platinum Triturated. 

General Action. — Platinum finds no place among the 
therapeutics of the allopathic school. Our knowledge of its action 
is derived from provings by Stapf and Gross, two disciples of 
Hahnemann. It is pre-eminently a woman's remedy. Its centers 
of action are on the female sexual organs, brain and spine, depress- 
ing them. Before Hahnemann nobody had ever used platinum as 
a drug. Nobody could have supposed this drug was possessed of 
medicinal properties unless guided by the laws of dynamization and 
cure. We have said that it depresses the nerve centers. There is 
a strong tendency to paralysis and anaesthesia, localized numbness 
and coldness produced by the drug. The great splanchnic nerves, 
distributed in the abdomen, and in particular the nerves of the 
uterine system given off from the hypogastric plexus are especially 
affected by platinum. A lack of energy, a lack of electric tension 
of the nerves seems to be expressed by the symptoms. It has no 
special symptoms pointing to great hyperaemia, congestion or in- 
flammation, hence no alterations in the pulse. Platinum does not 
directly affect the blood life, but it depresses and despotizes and 
weakens the nervous life. With this clue we will be able to under- 
stand its symptomatology. Here the mental symptoms are of the 
greatest importance. 

Mental. — The keynote to the mental condition is self-exal- 
tation and contempt for others. There is an arrogant proud feel- 
ing, contemptuous, pitiful looking down on others. Everything and 
everybody is beneath her. So she gets out of sorts with the whole 
world, everything seems too narrow, she gets restles's, sad, life gets 
wearisome, the most joyful things depress her. 

Now a very peculiar physical condition is apt to accompany 
this mental state. Objects actually look smaller than they are. On 
entering a room after a walk, everything looks small, the room looks 
gloomy and unpleasant. This condition may be found in hysterical 
patients, objects appear smaller than they really are with spasm of 
the eyelids. There is alternation of cheerfulness and sadness, 
laughing and weeping that is peculiar to hysteria, but platinum is 
especially appropriate in that form of hysteria in which the disposi- 


tion to weep and fear of death which is thought to be at hand 
accompany. Another frequent trouble found in hysteria is the 
so-called clavus hysterious, a peculiar tense headache confined to a 
small spot. Platinum has this very marked cramp-like squeezing 
pain, compression, constriction about forehead and right temple. 
The pain increases and decreases gradually. Prosopalgia with a 
numb feeling in the malar bones as if the parts were between 
screws. Pain at the root of the nose as though squeezed in a vise 
and followed by tingling and numbness. A peculiarity of the 
platinum pains besides, is that they become worse by sitting and 
standing and better by walking. Another characteristic feature is 
the evening aggravation and the accompanying sensation of cold 
and chilliness, thus there is a feeling of coldness, creeping and 
numbness in the whole right side of the face. 

Female Sexiial Organs, — Hypersensitiveness is the great 
guiding symptom. The parts are excessively sensitive to touch, 
cannot bear the napkins usually applied. Constant titillation or 
tingling in the sexual organs, internally and externally. This may 
excite the unfortunate victim to such a degree as to produce that 
horrible disease, nymphomania. The ovaries are very sensitive and 
are the seat of the burning pains, menses too early, too profuse and 
consist of dark clotted blood. They are accompanied by spasms 
and by painful bearing down in the uterine region with chilliness 
and sensitiveness of parts. Chamomilla has dark menses, but the 
mental symptoms will easily distinguish. Metrorrhagia or monor- 
rhagia with sensation as if the body were growing larger every day. 
Uterine hemorrhage, copious and often returning. In the treat- 
ment of uterine hemorrhage the color and consistence of the blood 
furnish the valuable characteristics of the remedy. In platinum 
it is very dark, thick and tarry, not so much coagulated, accom- 
panied by dragging and pressing downwards and with this unnat- 
ural sensibility of the genital organs. The disturbances caused by 
platinum consist chiefly in certain spasmodic aifections and pains, 
and too early appearance of the flow, but this does not result from* 
congestive overloading of the uterus with blood as with crocus and 
belladonna, but from atony of the nerves and vessels of the uterus, 
whereby a condition resembling anaemia is induced which is indi- 
cated in the symptoms of the platinum prover, namely : pale, sunken 


face, pale wretched aspect for several days, and also by the painful 
sensibility with almost constant internal chilliness and external 
objective coldness. There is weakness in the nape of the neck, pain 
in back and small of back, numbness in the coccyx. Very weary 
relaxed and prostrated. Platinum is one of our remedies for pain- 
ful coitus, others being sepia, belladonna, creosote and apis. 

Stools. — Constipation from inertia of the bowels. The stool 
is retarded, faeces scanty, hard, evacuated with difficulty, it adheres 
to the rectum and anus like soft clay or putty. A sticky stool. Con- 
stipation of emigrants and travellers, those who are constantly 
changing their food and water. Frequent unsuccessful attempts to 
pass stool. Painter^s colic, pain in umbilical region, extending 
through to back, pressing and bearing down in abdomen, extending 
into pelvis. Platinum antidotes the bad effect of lead. 


PREPAEATION.— Triturations of the Metal 
The mental symptoms of palladium are in many respects 
similar to those of platinum. There is much mental excitement, 
the patient is inclined to weep, is worse the day following an even- 
ing^s entertainment. They imagine themeslves neglected and their 
pride is easily wounded. Oversensitiveness to offense. Attaches 
great importance to the good opinion of others which is the opposite 
to platinum. 

Headache across the top of the head from ear to ear is a most 
characteristic symptom. 

Face sallow, blue rings around eyes, nausea, constipation. 
Soreness of abdomen with downward pressure. Knife-like pains in 
the uterus, tired feeling in small of back, sore bruised feeling, all 
over. Heaviness as of lead deep in the pelvis, worse from exertion 
and standing. Swelling of the right ovary, bearing down; jelly-like 
leucorrhoea. The tiredness is characteristic. Helonias has this 

Dr. House: Dr. Dewey has made a very concise and clear 
presentation of these two drugs, and I am sure this society is under 
many obligations to him for such a fine delineation of these reme- 
dies. I have never made use of palladium, but the other remedy I 
have prescribed frequently, and I can add my verifications in a great 


many cases to the symptoms Dr. Dewey has given. They have 
always proved true and the results have met the expectations every 
time when prescribed upon those conditions. I consider platina 
one of our good reliable remedies, one that we can prescribe with 
confidence in cases that have been presented, and one that is well 
worth the study and re-study of the homeopathic physician. 

Dr. Stewart: It has been suggested that platina is primarily 
a woman's remedy, because she has a million things to annoy- 
her; but, nevertheless, it may be a good remedy for men as well as 
women. It seems that we have had a demonstration of that not 
very far from this part of the room. Dr. Beckwith thinks I haven't 
had a chance to verify the remedy since the early years of my gen- 
eral practice — in those days when I used chamomilla. He evidently 
thinks I am a renegade and haven't practiced homeopathy. I want 
to say that I have had a number of cases sent to me by other phy- 
sicians that needed platina, one of these not very many months ago. 
It was a case of eye-strain. It had lasted for a long while. I tried 
in every way to relieve the headache, but I couldn't do it; glasses 
wouldn't do it, and I finally did what any homeopathic physician 
would have done, inquired into the case, and found that by pre- 
scribing for the sexual and menstrual symptoms and giving platina 
I cured the headache. 

Dr. Dewey: The remarks of the last speaker, especially the 
latter part of them, have answered any criticism I might have cared 
to make. It is too often the case that the specialist prescribes from 
a specialist standpoint almost wholly and doesn't do any good until 
he finally prescribes for the patient, then he will cure the headaches 
and the eye strains and all that sort of trouble. If Dr. Stewart had 
done that in the first place, as he should have done, he wouldn't 
have had to try glasses at all. 



Aurum metallicum, the copy set me, nilly willy, by the inde- 
fatigable and strenuous chairman of this section, is something with 
which I have only a little personal experience, either in the crude or 
attenuated form. 


I remember that our own talented Dewey discussed a paper 
on aurum in the International Homeopathic Congress in London, 
in 1896, and that his reference to the 16 to 1 fallacy at that time 
and in that audience, fell as flat and profitless as a Eussian joke 
would strike a modem Japanese space-writer. But that paper, 
"Aurum: Its Pathogenesy and Therapeutics,^' by the ever genial 
and interesting Washington Epps, of the London Homeopathic 
Hospital, was a rare production, and, I believe, the best summa- 
tion of what is to be found in our Materia Medica upon this aurif- 
erous subject ; and yet, at the conclusion of eighteen closely printed 
pages in the Transactions, the distinguished essayist says : "I must 
confess to some feeling of disappointment that the results of a 
search that has taken considerable of time are so small." 

This, too, has been my own personal experience after nearly 
twenty years of practice; and a frequent reading of the symptoms 
as recorded in our books causes me to believe that there is very lit- 
tle to appeal to the average, every-day, busy practitioner in the 
symptoms recorded to help him with his ordinary cases. 

In part proof of this opinion or statement let me quote to you, 
in a brief way, what the discussers said of this paper of Dr. Epps' 
at London; and when we are reminded that here were foregath- 
ered representative homeopaths from all parts of the world, the 
paucity of remark and suggestion will be the more appreciated: 

Dr. Dewey, of America, found that "afraid of the slightest 
noise" was a characteristic symptom, and this was based on the over- 
lying mental symptom. 

Dr. Drzewiecki found that aurum cured an eruption on the 
body and also the ectropion of a Jewess. 

Dr. Jagielski found poison symptoms in a patient who had the 
stumps of her teeth filled in and built up with gold. 

Dr. Clinton found just the contrary in a patient coming to 
him from Boston. It did her good. 

Dr. Villers remembered cases of poisoning in young medical 
men from wearing gold nose glasses. 

Dr. Kroner had a case of heart trouble in a patient of 78. 

And that was all ! 

If one studies the insane trend until presently he feels that 
he is hot on the spoor for some excellent symptoms — ^symptoms 


that may be safely stowed away against such ease falling into his 
practice, by reading carefully a little further, he finds himself up 
against a wall of disappointment in that the symptoms dematerial- 
ize completely, or take on a form to be better and more familiarly 
dealt with with other and more every-day remedies. Take the syph- 
ilitic line and mercury and the iodides -loom up high and tall ; this 
is true of the nose, throat, lungs and eye symptoms ; so that I feel 
with Dr. Epps like voicing my disappointment at the poor array 
of creditable symptoms upon which to make an intelligent pre- 

Let me here interpolate what most of my colleagues know, that 
I cannot and do not practice homeopathy upon any one or two char- 
acteristic symptoms. I am ^bleeged to have a totality before I can 
touch the bottle's cork. 

Here and there, in aurum, we find alleged characteristic S3nmp- 
toms, which, by frequent iteration, and frequent copying from an 
earlier into a later edition, and putting the symptom in black-faced 
type, have at length attached some validation to themselves. And 
upon these, some of my friends are able to prescribe and to pro- 
claim their victory. But like the case of the "quadruped^' births, or 
the two-tailed calf, these cures almost invariably happen over in the 
next county where I have never had an opportunity to investigate 
their essential truthfulness ; or, as in some recent reports made, the 
author has such a deplorable reputation for truth and veracity in 
the community in which he lives and moves and has his being, that 
I wouldn't trust him any further than I could sling a meeting house 
by the steeple. 

You see, of course, that I am astride of my usual hobby horse, 
the not-prescribing upon one or two symptoms however charac- 
teristic they may seem, but the rather adhering to the Hahneman- 
nian dictum of prescribing upon the whole case — The totality of 
the symptoms. 

The old school has at length discovered that there is some 
medicinal virtue in gold — notably in the gold cure. We find a num- 
ber of remedies hawked in the open chemical market containing 
varying proportions of gold, and from which commercial companies 
we are each month in receipt of a hatful of blotters, or penholders, 
or inexhaustible pencils. But, with these much vaunted remedies. 


as with all their other preparations^ I am unable to find use for 
them, unless I assume the allopathic symptomatology, and go it 

I have not undertaken to write a thesis on aurum just because 
I happen not to know anything about it ; but in what I have to say, 
I promise not to tire you, and possibly you may be able to glean a 
point or two which may repay you for your kindness and forebear- 
ance. I will plump myself upon the one and the only one of its 
many hundred reported symptoms that has ever served me, that of 
mentality, and leave all the others and singular for the discussers if 
they feel minded to take them up. 

I quote now from the Epps paper : 

The first effect of aurom would appear to be that of exalta- 
tion — "Serene, contented mood, he always wishes to converse with 
others;" "Considerable merriment and agreeable, comfortable feel- 
ing;" "Tremulous quivering of the nerves as with a joyous hope," 
and etc. This soon gives place to an exactly opposite condition,' that 
of abject despair, as shown by such symptoms as, ^TDispirited and 
desponding," he thinks that everything goes awkwardly with him, 
and nothing will succeed with him;" "Discouraged and at odds 
with himself;" "Crying and wailing; she thinks that she is irre- 
trievably lost;" "Anxiousness, even a noise before the door makes 
him anxious." These symptoms of depression become more and 
more intense, until they become so overpowering that he becomes 
suicidal. "Melancholy, he imagines he is not fitted for the world, 
he therefore longs for death, of which he thinks with the most in- 
tense delight." With this the great restlessness in the day and sleep- 
lessness and palpitation at night, nearly always present in persons 
with suicidal tendencies. This condition is shown in "He is driven 
to constant activity, and is sorry for his inaction, although he cannot 
do anything ; he cannot work fast enough ; he could not act so as to 
satisfy himself." Under sleep we have "Drowsiness during the 
day;" "Slumberous sleep with weakness of the head when sitting 
during the day;" "All night long, wide awake and without sleep, 
though without pains, and in the morning he still was not sleepy or 
xhausted;" "Early from four o'clock onward, he cannot sleep 
'indly any more ; he throws himself uneasily from side to side, be- 
( . ^e he cannot remain long in any one position, and the hand on 


which he lies soon gets tired ;" "When at last he falls asleep he is 
disturbed with vivid or frightful dreams, in which he sobs or 
screams aloud/^ 

This is the end of the quotation. 

I will mention now my aurum case which I remember so dis- 
tinctly, because it was in my early practice, when I had both time 
and inclination to study and philosophize on such few cases as came 
to me. A lady of 25 to 30 years of age, married, in good circum- 
stances, without children, healthy in body and mind, so far as out- 
ward appearances went, came to me complaining of headaches, 
beginning in the morning, which felt like a bruised pain when 
studying, or reflecting, or reasoning, or trying to make plans, and 
most especially when she was writing or talking. These headaches, 
however, disappeared little by little when she gave over whatever 
mental work she was engaged in, and would be wholly gone by seven 
o^clock in the evening. There was a history of sleeplessness but no 
pain. I was a far more faithful prescriber, as I believed, in those 
earlier days than I fear I am to-day. I was pretty thoroughly wed- 
ded to the medical calculus, i. e. the mathematical repertory, with 
frequent ponderings over the unthinkable hypotheses which had 
been unloaded on me by enthusiastic but chiefly theoretical teach- 
ers and voluminious space writers (as I have since learned). I was 
in that delectable condition and frame of mind, when if the sum- 
ming up of an hour's running down of half a dozen symptoms 
showed that calcarea carb. had 61 points, and clapporrhinum had 
62, I would most assuredly have given the clapporrhinum — ^and 
high — in the full expectation that the patient would now get well, 
tito tuto et jocunde. 

Well, I found after some careful studying of the headache 
symptoms that nux and sryonia — for sryonia was my bete noir even 
in those salad days — and pulsatilla ran high ; silicea also came into 
the picture over the fence from an oblique angle; but none of these, 
nor all of them, given singly, and well potentized, administered 
high and low — as low as the thousandth — ^proved of any signal 

One night about ten o'clock I was hastily summoned to see the 
lady. I found that she had thrown herself before a fast moving 
train, and had been barely rescued in time to save being ground into 


a shapeless and lifeless mass. "Now, this was a most disagreeable 
revelation to me; a shattering blow to my vanity/)f correct prescrip- 
tion. What was there about these headaches that would lead to sui- 
cide, and why had I not discovered the trend ? Was homeopathy a 
failure after all? Surely I had worked hard and conscientiously 
on this case ; yet here was this pitiful failure to reach the case. 

However, I began again with the examination and learned bit 
by bit that she had grown melancholy because of her barrenness ; she 
had lain awake many nights thinking of it; she fancied that John 
didn't like her as he used to do formerly (foolish girl — as if all 
Johns the world over were not equally lacking in front-gate and 
moonlight spooning after a twelve-month or two) ; that he was 
growing cool and that sometimes he neglected to kiss her when he 
went away in the mornings ; she knew he was getting tired of her ; 
she was no longer the young and pretty girl which had attracted 
him ; soon he would find some one else more young and more after 
his later taste ; he must be getting tired of this burden at his house, 
this woman who was merely an item of expense, who could do noth- 
ing for him — ^not even bear him a child ! and so the headaches began 
to come on apace, and with that came the brooding, each intensi- 
fying the other; after that came "the voice" condemning her as a 
pariah, an outcast from God's presence and favor, who, because of 
her many iniquities, would cause her to continue childless, and so 
ultimately lose her husband's rapidly waning respect. 

I had no aurum with me, but I got some pretty quick, for I 
now remembered the insane symptom, and I also learned something 
from the husband which gave color to my belief — this time without 
the aid of the yard-stick repertory — ^that aurum would help if it 
did not cure. And it did. This woman is now the mother of a 16 
year old boy and two girls, respectively 14 and 11. 

And yet, Amdt, in a recent number of his Pacific Coast Jour- 
nal of Homeopathy, said that the aurum suicidal tendency is a 
mere bluff ; that these people are too cowardly to take their lives. In 
this case it was an actual and cleverly planned endeavor to shufiBe 
off this mortal coil ; and nothing but a providential interposition — 
if you believe in that — or the accidental re-walking of the track by 
the track walker saved her from being ground into an unrecogniza- 
ble mass. It reminded me then, and it does to this day when I recall 


the circumstances, in all its tragic possibilities, of the crowning 
scene of the old play ^^Under the Gas Light,'^ which some of you 
other baldheads may remember. 

Are we to argue from this one swallow that it was a full-blown 
spring? Are we safe to assume that all suicidal talk points to 
aurum? By no means. This is what I conclude; that if I had 
taken the full case and studied it independently of the fool alge- 
braic repertory ; that is to say, if I had found all the symptoms of 
the case and deliberated and weighed them in their relation each to 
all the others, instead of running down a headache which had no 
relation to anything else, I might have found the remedy. I cer- 
tainly foimd the remedy easily enough after the fact; illustrating 
again the wonderful speech a fellow could have made if only the 
blamed things which occured to him on the staircase afterward had 
popped into his head at the time of speaking. 

As I study the materia medica I try to fix in my mind some 
practical, everyday factor of the remedy in hand, in order the more 
easily to hold it ready for a hasty call. My memory was never of the 
tarbucket order, and it is getting less retentive as I approach the end 
of lifers activities. Gold, to me, in medicine is indicative of gold 
in the crude. The getting of it in that crude, if legitimate, brings 
pleasure and happiness up to a certain point; after that it becomes 
a disease. The foolish chase after gold, as a something to hoard, 
results in morbidness, in disease, and possibly early destruction of 
mind as well as heart. I have not attained to that assumed elysium 
myself, but imagine, if you can, the horror of owning two hundred 
million dollars with nothing to wear but clothes ; nothing to eat but 
food; no books to read, because without ambition, object or pith; 
nowhere to go but out because you have been there a dozen times, 
and if the money was not gained by masterful and tactful applica- 
tion of the thumbscrews to the trust-ground populace, but comes 
by inheritance from some fur-dealing ancestor, or the ferry-boat 
owner, to children who have nothing to do but devise newer and 
more dangerous fashions of inciting their blase appetites — ^how long 
would it take, think you, before aurum would be indicated? We 
always think what a good time we would have if we had several 
million of dollars in our bank account; and, still, when we come to 
simmer it down the "good time^^ would be based almost wholly and 


solely upon feeding the appetites and passions of the body to dan- 
gerous excess; for we already have everything else in normal 

The one word, therefore, which to me would typify this rem- 
edy, is the French word ennui. But please do not jump at the con- 
clusion that there is nothing in aurum except this, for that 
wouldnH be true. There is much more to the remedy; it has been 
my misfortime that I am unable to apply it. Thafs all. I would 
put it in this way — ^it being eminently proper for the inhabitor of 
a parish practice, to conclude his sermonette with a glowing moral 
application: if you have a rich young person of either sex who 
has been pampered and coddled and given everything the world pos- 
sesses before he or she was 25 years old, has hit the booze-bottle not 
wisely but far too strenuously, and then comes to you with some 
genital disease, mild or grave, and a fearfully depressed mind, look 
well to your aurum. 

Dr. Wm. Baldwin : I am reminded that about 15 or 20 years 
ago of having had a case in a certain family. I was attending 
the wife and other members of the family for some other disease, 
and while so engaged in that family the domestic in the family, a 
young German girl, wanted to talk to me. She was the very pic- 
ture of robustness, blooming cheeks, and energetic and every indi- 
cation of health. As I was about to leave the house one time, she 
said to me, "I am not sick, but I want to see you because I have a 
peculiar thing ailing now, what that is, I don^t know, except that I 
want to commit suicide.^^ I looked at her and saw she was in dead 
earnest. "Now why do you want to commit suicide ?'' She answered, 
"I have no reason on earth." "How do you think of ending your 
life ?" "I think most of jumping out of the window." I said, "Well, 
just wait a minute and let me give you a dose of medicine." I 
opened my case and gave her a dose of aurum. I interrogated her 
a few days afterwards concerning that feeling and she told me that 
that feeling had entirely gone from her. She is now married and 
mother of a family. I have seen and talked with her since, and she 
has never had anything like that feeling since that one dose of 




There is no better way to understand a drug thoroughly and 
practically than to study it by comparison with other similar drugs. 
We find physicians differing in their methods of study, some 
depending on the memorizing of symptoms, especially the key- 
note symptoms, while a great many study from a purely patho* 
logical standpoint and endeavor to apply the drugs on a pathological 
basis, and others make the application by comparison of similar 
acting drugs, and I may say by exclusion as well, depending upon 
the peculiar symptom of the disease regardless of the pathology. 
While all of these methods have a certain value in making a selec- 
tion of the proper drug, and no one method can be as successfully 
used alone as in combination with the others, the method of com- 
parison has simplified the study of Materia Medica to me more than 
any other. 

Our worthy chairman asked me to write a paper for this 
Bureau and assigned to me argentum metallicum as the subject. 
I can only hope to bring before you some of the more prominent 
features of this remedy, and make a few comparisons with other 
drug symptoms which are similar. If in so doing I succeed in mak- 
ing it easier for some one to make the proper selection for his pre- 
scription at the bed side I will be amply repaid for my trouble. 

You will find this drug has a special action upon the cartilages 
all through the body, and upon tissues which have a feeble circula- 
tion, and will be found indicated in deep seated insidious com- 
plaints, which come on without warning many times, manifesting 
themselves in general weakness, with mental weakness, loss of mem- 
ory and confusion of the mind, this condition preceding some insid- 
ious, deep-seated trouble, such as tuberculosis, epilepsy, etc. 

Under head symptoms, we have vertigo, especially when look- 
ing down from a height or looking at running water, or any object 
passing rapidly, left-sided headache, which seems deep seated, con- 
fusion of mind, mental depression, tired, worn out feeling, prostra- 
tion, all aggravated by mental work, just such a condition as you 
will find in brain fag in the overworked business man or student. 
Gelsemium has many similar symptoms, weakness, prostration, 
wants to lie down and be quiet, don^t even want any one around, he 


feels too tired to be talked to, but this is owing to muscular weak- 
ness and exhaustion, while argentum is from brain exhaustion, and 
they come from entirely different causes. The argentum affects the 
intellectual mind and not the centers that control the affections 
as in aurum. 

Under eyes, we have some prominent s3rmptoms, but not so 
often indicated as argentum nitricum. The troubles are likely to 
be deep seated, chronic troubles, scrofulous in nature, chronic red- 
ness of margins of the lids, pustules on edges of lids. Abundant 
purulent discharge, lids everted, the tarsal cartilages liable to be 
affected. With this condition we are not liable to have much pain. 

In the nitricum we have many similar symptoms, but they 
are inflammatory in character and more painful. Graphites has 
many symptoms of margins of lids similar to argentum, but not 
likely to be deep seated like metal, and more liable to have chronic 
skin troubles in connection. 

In the throat we have swelling in region of the submaxillary 
glands, swallowing difficult as from internal swelling, throat feels 
raw and sore during expiration, coughing or swallowing. This con- 
dition may extend into the larynx, where we get the hoarseness, 
especially in professional singers and speakers, raw spot over bifur- 
cation of trachea, cough with expectoration looking like boiled 
starch. This symptom of boiled starch expectoration seems charac- 
teristic; you will find it wherever the mucous membranes are 
affected, in catarrh a discharge from the mucous membrane is seen 
resembling boiled starch. In this throat trouble patient will some- 
times have a continual short cough which is very annoying, and will 
wind up with one or two hard coughs, when there will be lump of 
mucus thrown from the throat looking like boiled starch. This will 
give relief for short time, when the same thing is repeated; these 
cough and throat symptoms are more likely to come with or precede 
deep seated diseases as in tubercular troubles. 

Aurum Triphyllum has swelling of submaxillary glands, with 
sore throat and hoarseness in singers and speakers, but has more 
constriction and burning. The discharge from the mucous surface 
more excoriating, and does not have the expectoration like argen- 
tum. Pliosphorus is frequently indicated in these conditions; 
hoarseness, cough aggravated from talking, and in the evening, and 


from changing warm to cold room. In catarrhal troubles of the 
metal we have not only the mucous membranes affected but may 
have the cartilages and bones involved, especially in tubercular con- 

We find under this metal, hunger a prominent symptom, exces- 
sive appetites even after a full meal ; there is also considerable flatu- 
lence, but not so much as under the nitricum, and like china, does 
not get relief from belching, carbo veg. the opposite. 

There is frequent desire to urinate, with profuse discharge 
of sweetish urine and worse at night. This will lead you to think of 
it in diabetes, apis mel. has profuse discharge of urine, but not 
sweetish, and generally comes in connection with dropsical troubles. 

Under female sexual organs the left ovary is the most affected. 
If you will notice this is more of a left-sided remedy than right. 
Argentum Nit. seems to give the preference to the right. 

In this short paper I have endeavored to bring to your notice 
some of the prominent symptoms of this valuable metal and show 
where they differ from a few other drugs, and wish to call your 
attention to the fact that it is not only the difference in symptoms 
but the character of the disease must be taken into consideration as 
well. J 

Dr. Beebe : This paper is truly a homeopathic materia medica 
paper, and is one that would easily be known from an old school 
paper on the same subject. Having been intimately associated with 
Dr. Wilson professionally for thirty years, I can say truly that he 
is a practical homeopath and knows how to make a homeopathic 
prescription. Dr. Wilson's success as a prescriber has been largely 
because of his close application to the study of the materia medica 
from a comparative standpoint. He absorbs the symptomatology of 
a homeopathic remedy totally. He learned that under the instruc- 
tion of T. F. Allen, and we all know what T. F. Allen's writings 
consist of. We know his success as a teacher, and his writings, as 
well as his teachings, were largely along the line of comparative 
materia medica. T. F. Allen's works, our own Farrington's, and, of 
course. Gross — ^who was an older writer and teacher — ^were the three 
teachers from whom Dr. Wilson imbibed his knowledge of compara- 
tive materia medica, and I feel that when he makes an assertion 


regarding a remedy he is not only adding a bit of actual personal 
professional experience but that he has made a study of the subject. 
I have much confidence in anything that Dr. Wilson furnishes on 
materia medica. 

Dr. Wilson: I will say in concluding the discussion that 
I had prepared a paper on the argentums, but I got notice of the 
meeting last Saturday and found that I had been placed on the 
Bureau for argentum metallicum, and Dr. Rosenberger for argen- 
tum nitricum. So I had to go all over my work again and bring 
the subject down to the one remedy. I hope Dr. Bosenberger is 
here to give us something on the nitricum end of argentum. 



Pure Clay. Among the leading conditions corresponding to 
this drug is dryness involving both the skin and mucous membrane. 
The patient has a premature old look. The functions of the body 
are performed in a manner resulting in a numbness of the limbs and 
really of the whole body. The gait is unsteady, or such as you will 
find in locomoter ataxia. The digestion is like all the movements 
of the body, slow and resulting in constipation. The books say no 
stool until there is a large accumulation in the rectum, and then 
though the stool may be soft it is expelled with diflBculty. 

We find it suited to diseases of old people and infants. The 
mental S3rmptoms are very prominent. The patient is timid with 
apprehensiveness and peevish fear of losing the mind or of death, 
tendency to suicide, yet she abhors the idea. The sight of blood on 
a knife seems to bring on the thought of suicide. This symptom 
was verified in a lady during her climacteric. She insisted on her 
husband getting all of the knives and his razor and locking them 
up at night, fearing that she might get them and kill herself dur- 
ing the night. 

The memory is much impaired, seems to be unable to remem- 
ber what she wants to say in a conversation, confusion of mind, 
uses the wrong word in conversation. Vertigo, inability to walk 
in the dark. Locomoter ataxia, must have eyes open. It is a very 
valuable remedy in this disease. It will relieve the tearing pains in 


the thighs, when sitting or lying down, and when they are worse at 
night. The nates go to sleep when sitting, with great heaviness of 
limbs. The patient can hardly walk ; has a staggering gait. Pain, 
cramps in the calves and soles of the feet. When this picture is 
present, attended by the peculiar mental symptoms, in short, when 
the symptoms agree, yon can expect (and you will not be disap- 
pointed), results with this remedy. 

I have a case of advanced locomoter ataxia in which I always 
relieve the distressing symptoms with this remedy. The 30th, po- 
tency acts very nicely in his case. 

This case has the mental symptoms very fully developed. The 
mind has that confused state. Seems to be unable to arrive at a 
definite decision, judgment is much impaired. One other mental 
condition is very marked, he is led to doubt the reality of things 
with which he has been very familiar, even his own identity is in 
doubt; thinks he is someone else or that he is insane. Gets in a 
great hurry, everything seems to be moving too slow; the delays 
worry him so much. The time of aggravation is in the morning 
after waking. Like lachesis, the remedy is full of paralytic condi- 
tions and symptoms which proceed from the spine. 

It may, and seems to be at first, a weakness of the parts in- 
volved, and is improved by rest, but it gradually increases until we 
have it general. There is at times great difficulty in swallowing. 
Then difficulty or slowness in action of the bladder. The patient 
will sit or stand a long time, and no amount of straining on his part 
does a particle of good. There is an imsatisfied feeling in the ure- 
thra after urinating, compelling an amount of straining in order to 
get rid of a drop or two that may be retained in the urethra. The 
rectal symptoms have been already referred to. We have this as a 
result of the paralytic condition of the remedy already referred to. 
We must differentiate in the rectal symptoms between this and many 
remedies that have difficulty in expelling stool, or as the books have 
it, inactivity of the rectum. Hepar sulphur, has inactivity of the rec- 
tum very marked, but when we look at the mental symptoms of the 
remedy we see a great contrast* An impulsive desire to suicide or to 
kill someone else. 

If the patient should be a barber, he can hardly restrain from 
cutting the man's throat, with his razor, whom he is shaving. The 


mother leaves her child with the nurse, for she is afraid she will 
kill it. Ferocious disposition, hyper sensitiveness to pain, easily 
irritated, very hasty in speech, a very chilly remedy. In nux mos. 
we have a very sleepy patient. Cannot sit down to do any- 
thing without going to sleep, exceeding dry mouth, a disposition 
to faint when standing a long time in a close, warm room. China 
is another remedy. But we soon find plenty of distinguishing symp- 
toms in them all if we study the test carefully, but this is necessary 
above everything else. 

These are the ways and means of the remedies expressing them- 
selves, and if we are familiar with our materia medica we soon leam 
to imderstand what it says to us. 

The remedy is full of catarrhal conditions, the symptoms agree- 
ing. From all mucous surfaces there is thick yellow discharges 
from eyes, nose and throat. Nose is full of crusts of dry mucus. 
The opening of nostrils is closed with crusty formations. Always 
expectorating, or constantly blowing the nose. Catarrhs of old peo- 
ple, of long standing, a great disposition to take cold. This would 
be a very apparent condition, a thin person being poorly nourished, 
circulation disturbed by the sluggish disposition of all the organs, 
and yet the patient cannot bear the cold air, nor a very warm room ; 
wants a medium temperature. 

The same catarrhal conditions extend down through the oesoph- 
agus, so that we find it sensitive and attended with difficulty owing 
to the sensitiveness of the mucous membrane, and in the second 
place from the tendency to a paralytic condition of the oesophagus. 
The patient expresses it that they feel the food all the way down 
to the stomach, which we never do in health. This catarrhal con- 
dition extends through the entire digestive track so that often we 
have the soft stool, and much mucous passing after the stool. 

In the paralytic condition it is very gradual in its appearance. 
At times it seems that by putting the will for a certain length of 
time upon certain muscles, they will be called into action, and per- 
form their functions. Everything is slowed down. The conductiv- 
ity of the nerves is impaired so that the prick of a pin upon the 
extremity is not felt for a second or so afterwards. This continues 
until his senses are impaired in this way, until it really means a 
benumbing of the consciousness and appears to be a mental slug- 


The skin symptoms of alumina are a very important part of its 
symptomatology. We have intolerable itching on getting warm in 
bed (something like sulphur) . The patient scratches until he bleeds. 
This we must consider, for the patient scratches until the skin is 
raw and we have a scaly surface, but originally we have itching 
without any eruption; but with the itching and bleeding we get 
some relief of the itching. 

We have thickening and indurations and ulcers with indura- 
tions at the base of the ulcers. This is a result of the sluggish, lazy 
condition both of the skin and mucous membrane and a very marked 
condition of the remedy. 

We have purulent ophthalmia, chronic sore eyes and nasal poly- 
pus most liable on left side. A disposition in the remedy is to pro- 
duce minute growths, indurations and infiltrations. Lupus or can- 
cer of nose, scirrhus of tongue, soreness and bleeding of gums, offen- 
sive saliva, and burning in mouth and throat. It will antidote the 
poisons or cure colic produced by working in paint. I have been 
able to entirely relieve a case of colic in a house painter with this 
remedy, the other symptoms agreeing. 

There is a tendency of this remedy to localize itself upon mu- 
cous membranes, hence catarrhs everywhere from the nose all the 
way through the alimentary tract. A very deep antiseptic remedy. 
The patient needing this remedy and receiving it will not see the 
immediate effect on the local part, but the patient will feel better, 
though the catarrh will show little or no improvement, yet 
this, too, will be improving eJl the while, and in time the local symp- 
toms will yield. In this it is similar to the weakness or paralysis 
produced by plimibum. 

From the effect of the remedy upon mucous surfaces we should 
see at once that upon the rectum and anus we would have all kinds 
of trouble with a thickened and indurated mucous membrane. We 
have fissures, it is an outgrowth of the effect of the remedy upon 
the economy, favoring the formation of fissures. We see that all the 
functions of the body are slow, sluggish, resulting in stasis of the 
blood in the capillaries. 

Nitric acid and graphites are remedies to be studied in this 
connection. See what they have done for the patient. We have the 
same condition upon the mucous membrane of the vagina, leucor- 


rhoea copious and acrid, inflaming the parts with which it comes in 
contact. The mucous membrane is patulous and thickened, all the 
pelvic organs are liable to the same catarrhal condition, with heavi- 
ness and weight in pelvis as if organs would fall out, all worse after 

It is a remedy for cough. The chest troubles will bear a very 
careful research. The cough is worse on waking in the morning; 
it is sometimes a long attack of it. Sometimes she coughs until 
she has to vomit, passes urine involuntarily. There is little if any 
cough during the day. There is a sensation as if the uvula was long, 
a sensation of tickling in the throat. A remedy to be thought of 
by singers and public speakers, when the voice gives out or becomes 
feeble and they cough with the feeling as if something was hang- 
ing in the throat. This symptom I recently verified in a lady who 
sang in the church choir. She insisted that there was a piece of 
skin hanging loose in her throat. Alumina C. C. relieved her 
promptly. You need to study rhus tox. along with these cases care- 
fully, but as in all rhus tox. cases they seem to do very well if they 
keep the parts in motion, but rest puts them out of use at once. 

Phosphorus, you will remember, has a similar hoarseness, but 
after the phosphorus patient thoroughly clears the throat of the 
mucus in the throat they can do very good work as long as they 
keep at it. The skin is dry, sweat is almost unknown, yet the pa- 
tient is tired, worn out, etc., yet does not sweat, as the calcarea carb. 
patient, who sweats profusely. Chronic dryness of skin, additional 
cover increasing the itching, resulting in fissures at orifices from its 



Silica. Very often one overiooks seemingly insignificant symp- 
toms. To an allopath they seem trivial and unimporiant. To a 
homeopath they may mean everything — a cure. We must look to 
the odd and unusual symptoms in reviewing our cases. They are 
the ones that set us on the right track. Such are found under 
silica. The patient will either voluntarily or upon questioning say 
"Doctor, I notice that when I have a passage from my bowels the 
fecal matter will come out pari; way and then slip back again.^^ By 


following up the other symptoms of the patient you will surely find 
them covered by silica. 

Baryta Carb, A remedy that takes away business from the 
surgeon, in my estimation, is a good thing for the patient, if not 
for the surgeon. When you find small, movable, fatty tumors under 
the skin you'll usually remove them by giving baryta carb. Be per- 
sistent and you will be rewarded. 

Colchicin, You may oftentimes be puzzled as to what to give 
to quiet the intense pain of rheumatism. You may be tempted to 
give one of the alkaloids of opium, or a coal tar derivative. I would 
advise you to try colchicin 2x before so doing. I think you will 
not have to resort to anything else. Put about four grains into one- 
half glass of water, give teaspoonf ul every hour until you get relief, 
or lengthen the interval of the dose whenever you get the griping 
effect in the bowels. 

Natrum Sulph, Oftentimes there will be bad results remain- 
ing after an injury to the head. You may have given arnica, 
hypericum, opium, aconite or ferrum phos., and still the bad 
effects are there. It may show some mental derangement and puz- 
zle you what to do farther. In such cases think of natrum sulph., 
and, happily for the patient, you will soon see an improvement and 

Bacilinum. In troublesome coughs which do not yield to your 
seemingly well-selected remedy, whether due to tuberculosis or not, 
do not forget bacilinum. The keynote is weakness and exhaustion. 
This remedy works better in the 100 or 200 potency. 

Psorinum, It may at the same time be your lot to be baffled 
in knowing what to do for foetid foot sweats. If after, or before, 
trying mercurius or silica you will look up and give psorinum 
high, you will be rewarded for your efforts. The keynote is foul 
smell or odor. 

Ferrum Phos. We possess a potent, powerful remedy in com- 
bating acute, active inflammatory conditions. It is ferrum phos. 
For incipient colds it is worth its weight in gold. If, on exposure, 
you will give your patient a dose every hour for four hours, your 
cold symptoms will have disappeared in a very short time. Try it 
if you have not already done so. 


Spiritus Glaudium Quercus. The alcoholic is to be pitied. 
Anything we can do to cure such an one, or take away the craving 
for spiritous liquors, is a boon. We have such a remedy. It is 
spiritus glaudium quercus. It should be administered in from ten 
to fifteen drop doses three times a day. It may be taken in water 
or milk. If dropsy and liver trouble is present it will be all the 
more sure to help your patient. The treatment must be kept up 
for three or four months. I have had the pleasure of curing a 
number of patients with this remedy. 

Ledum Palustre. The season of the year is coming on wh^n 
insect bites and stings will be common. Their bad effects can be 
obviated by the administration of ledum pal. internally and lo- 
cally. It is one of our best remedies in this trouble. 

Hypericum. Very often after injuries the patient complains 
of neuralgic pains or numbness. If the nerves have been injured, 
there is only one remedy to be thought of, and that is hypericum. 
I have seen the bad effects of such injuries, of months and years 
standing, disappear in a short time after the giving of the above 

My gale Lasiodura. In chorea where there is twitching of the 
facial muscles on one side, or irregular, convulsive movements of 
one side of the body, which cease during sleep, but return on awak- 
ening in the morning, be sure to give mygale las. You will be 
highly gratified at the results. 

Gnaphalium, You may run across a case of lumbago that you 
will find will not respond to your ordinary remedies like bryonla 
rhus and calcarea carb. If you have numbness in the lower part 
of the back, and a sensation of weight in the pelvis with ameliora- 
tion on motion, you will find gnaphalium will cure your case. 

Xanthoxyllum. You may often be in a quandary as to what 
to give in amenorrhoea. If your patient has ovarian pains which 
run along the course of the genito-crural nerve, and are very severe, 
with agonizing bearing down, you will quickly relieve your patient 
by giving xanthoxyllum. 

Lemna Minor. We may often be at fault to know what to do 
for post nasal catarrh. If you find loss of the sense of smell and 
a putrid taste in 1 lie mouth, especially on rising in the morning, 
dropping down of mucus from the post nasal region, you will be 


gratified by the remedial action of lemna minor. It is also said 
to be good for nasal polypi especially when accompanying above 

Dioscorea Villosa. If we are able to avert a felon, we may 
indeed be called blessed. If, when the pains are sharp and agoniz- 
ing, or on the beginning of pricking pains felt in the fingers or 
thumb, you will give dioscorea vil., you will almost always stop the 
further progress of the infiammation, at any rate bear this remedy 
in mind. 

Magnetis Polus Atistralis, A very painful and troublesome 
malady to handle is ingrown toenails. I have given quick relief 
to the pain by giving magnetis polus australis, a dose about every 
one or two hours. • 

Kali Sulph, You may have a case of wandering or shifting 
rheumatism. Pulsatilla may seem indicated, but by trying it you 
do not get results. Now if you will look up kali sulph. very closely 
you will likely find the symptoms covered by it. It is a first cousin 
to puis., and has many symptoms in common with it. 

Teucrium Marum Verum, A very troublesome affection is 
nasal polypus. Most physicians resort to the snare for its cure. 
It must have a suitable soil to grow on. Teuc. m. ver. changes the 
soil and deprives it of its nourishment. By giving it you will often 
be pleased by its rapid action in removing the cause and the polypus. 

Iris Versicolar. There are headaches and headaches. Amongst 
them all, the bilious headache is the most annoying. Such a head- 
ache sours one's life more than any other. I said sour. That is 
one of the keynotes for the remedy. Extremely sour stomach, vom- 
iting of very sour, burning fluid, great burning distress in epigas- 
trium. There is a dull throbbing in the right side of the forehead, 
shooting pains in temples, all associated with nausea. Give iris 
ver. 30x or higher, and you will quickly relieve your headache and 
cure your gastro-hepatic derangement. 

Dr. Means : I was not present when this bureau was opened, 
but I understand every member is present. I want to compliment 
the chairman on the success of this bureau, because materia medica 
has not had the recognition in this Society of late years that it mer- 
its. If we would study our materia medica more and talk amalga- 
mation less, the idea that is becoming prevalent, that we will some 


day in the near future, unite in one grand medical school, and that 
school be allopathic, would be forever banished from our minds. 
The old school knows but little about materia medica and the appli- 
cation of drugs in the cure of disease. Outside of surgery, chemis- 
try and bacteriology the allopathic school of medicine is a century 
behind Hahnemann's idea, and for us to go over to them would be 
like turning the wheels of progress backwards. Go on, give no 
quarter, and our benighted brethren will some day see the star of 
hope in the east, that will enlighten them and cause them to flock 
to our standard. 

Dr. Beckwith : I have not attended as many meetings of this 
Society as my good friend. Dr. Beebe, but I have been attending 
them for the last thirty years and also the American Institute, but 
I must say for this bureau that they have given us some of the finest 
papers I have ever listened to; the most homeopathy and the best 
subjects we have ever had in this Society. 

Dr. Schulze in closing his Bureau said that he had tried to get 
the very best writers with the best of topics. He was pleased at the 
compliments showered upon the bureau, and he believed that a care- 
ful study of the papers when published would show that they are 
really masterpieces. 



A Symposium on Diseases of the Gall Bladder and Gall Ducts 

H. D. BISHOP, M. D., Chairman - - - - Cleveland 

''Etiology dLnd Pathology" 

W. A. HUMPHREY, M. D. Toledo 

** Symptoms and Diagnosis" 

G. J. JONES, M. D. ----- Cleveland 

" Treatment— Medical." 

DE WITT G. WILCOX, M. D. - - - Buffalo, N. Y. 

" Treatment — Surgical." 




In planning the work of this Bureau, it seemed to me that 
benefit would result from a comprehensive presentation of a study 
of diseases of the bile passages. The liver, through its internal 
' and external secretion, is of more importance than any other gland 
of the body, and imtil recent years many of the pathologic condi- 
tions to which it is subject have been imperfectly understood. Our 
present information concerning it is by no means complete, yet it 
has rapidly increased within the last decade, and the principles of 
treatment have been accordingly changed. 

General Etiology. 

Diseases of the bile passages originate for the most part in 
some form of inflammation of the mucosa, this inflammation being 
caused either by some injurious material originating in or coming 
through the liver itself; or by injurious substances which have 
gained entrance into the bile passages from the intestine. 

The former are of clinical importance, only, in connection 
with diseases of the parenchyma of the liver; the latter form the 
chief etiologic factor in the diseases under consideration. 

The full recognition of this important etiological fact has 
had much to do with present day methods of treatment of the dis- 


eases of these tissues. Of the method of invasion, whether through 
the general blood current or by direct invasion through the ducts 
from the intestine, there is and has been much difference of opin- 
ion, but experimental and clinical evidence is overwhelmingly in 
favor of the latter contention. N"o matter what the source of the 
invading micro-organisms, all authorities agree upon the following 
propositions : That normal bile is sterile, and under normal con- 
ditions, i. e., when there is a free and unobstructed flow of healthy 
bile, infectious micro-organisms do not gain entrance into the bile 
passages, or if they do gain entrance, the resisting powers of the 
tissues prevent their growth and development. However, when the 
conditions exist which are favorable to the development of an in- 
fectious inflammation in any part of the body, then it is that we 
have the beginning of some form of disease. 

The most frequent of these conditions which are favorable to 
the development of an infectious inflammation which may exist in 
the bile passages is a partial or complete failure of the flushing of 
the biliary passages with bile, from a deficiency of bile, from a me- 
chanical obstruction to the outflow of bile or from a loss of peris- 
talsis of the vessel walls. A contributory condition which seems to 
favor infection even more than is ordinarily the case is the existence 
of a general lowering of the nutrition of the body with a conse- 
quent failure of ifs resisting power as is the case in old age and 
after exhausting diseases. 

The invading micro-organism, when it meets with these favor- 
able conditions, produces all grades of inflammation, characteristic 
of mucous surfaces, ranging from an increase of the normal secre- 
tion with proliferation of epithelial cells to suppuration and idcer- 
ation. The regularity with which these results are produced is by 
no means constant, the degree of injury depending wholly upon the 
conditions present. The infection may be of a very mild degree 
for some time, being finally overcome by the resisting powers of the 
body, or it may suddenly increase in violence, taking on all of the 
characteristics of a virulent infection. 

Taking up in detail, the principal diseases of the bile passages, 
we have to consider the following: 

1. Disturbances in the Caliber of the Bile Passages, There 
may be simply a narrowing of the caliber from a cholangitis or a 


complete occlusion from gall stones or a phlegmonous cholangitis. 
Whatever the degree of narrowing or occlusion there is a mechan- 
ical obstruction to the outward flow of bile with increased tension 
and dilatation of the passages above the constriction. When this 
condition exists, either permanently or for a long time, the bile 
ducts become dilated, whatever inflammation is present is inten- 
sified and finally, hypertrophy or atrophy of the liver itself may 

2. Cholangitis. Simple catarrh of the bile passages is un- 
doubtedly most often caused by conditions other than infection, 
such as gastro-intestinal disturbances, caused by dietary indiscre- 
tions and irritation from biliary concretions. Such a catarrhal 
condition is, however, always an invitation to the entrance of infec- 
tion and sooner or later there is added to the simple catarrhal in- 
flammation the exciting cause of an infection, which may or may 
not become actively virulent. Suppurative cholangitis is always the 
result of an infection, either primary or secondary as just described. 
The infective micro-organism is usually the bacillus coli in combi- 
nation with the staphylococcus aureus or albus. It is a frequent 
complication of the more severe infectious diseases, particularly 
typhoid fever and occasionally pneumonia. 

3. Cholecystitis. While the gall badder is subject to the same 
etiological factors as the other biliary passages, yet the fact that it 
is more often the seat of the development of gall stones, adds to 
its predisposition to inflammatory disease. What is true of the role 
played by infection in the other bile passages, is even more true in 
the gall bladder from the fact that the conditions favorable to in- 
fection are more prevalent here than in the other passages. A slight 
degree of inflammation is sufficient to close the small opening from 
the gall bladder, and when this is completely or even partly closed 
a rapid change takes place in the contents of the sac, from admix- 
ture of broken-down epithelium and products of germ growth. Be- 
ginning in the mucosa, the inflammation extends through it, involv- 
ing the connective tissue structures of the bladder walls, and finally 
to the peritoneal covering. The final result as far as the structure 
of the gall bladder is concerned is that of all chronic inflammation, 


This is the so-called fibrinous inflammation of the gall bladder, 
and is the most common course of the disease. Suppurative and 
phlegmonous inflammation may result as a consequence of a violent 
infection or mechanical injury to the walls from large calculi. 

4. Cholelithiasis. The frequency of gall stones is a matter 
of considerable variance according to the statistics of different ob- 
servers. It ranges from 6 per cent to 29 per cent in autopsies oT 
male and female subjects and averages about 15 per cent in female 
subjects alone. Cholecystitis and cholelithiasis are so closely asso- 
ciated in their etiology that a discussion of one involves the other. 
Clinical and experimental data have shown that to produce a concre- 
tion two things are necessary; a cholecystitis or cholangitis must 
exist, and with it, either caused by it or by some other cause there 
must exist a stasis in the flow of bile. The chief conditions in 
which these elements are present are the diseases of the bile pas- 
sages described, but a marked contributing cause either to the pro- 
duction of these diseases or to the condition of cholelithiasis is the 
mechanical obstruction produced by tight lacing and pregnancy. 
This explains to a large extent the greater frequency of gall stones 
in women. 

The changes which take place within the gall bladder incident 
to the formation of gall stones are probably as follows : A cholecys- 
titis exists which is produced by microbic infection. As a result of 
this inflammation of the mucous membrane of the gall bladder there 
is a degeneration of epithelial cells followed by desquamation and 
repair of the injured tissues. These desquamaled epithelial cells 
undergo fatty degeneration and within them are formed large and 
small droplets of fat, which as they leave the cell conglomerate and 
form little balls of fat. These balls of fat form the neuclei of the 
gall stones, and if stasis of bile is present or occurs, layers of choles- 
terin are rapidly deposited and the stone is formed. (Hoppe- 

The number of stones which may be formed is almost without 
limit and depends upon the capacity of the gall bladder and bile 
passages. Seven thousand eight hundred and two separate stones 
have been found in a single case. The most frequent location for 
their formation is the gall bladder, less often, the bile ducts and 
bile passages. 


The effect of the presence of the calculi within the bile pas- 
sages and particularly so within the gall bladder is ultimately that 
of atrophy of the part. Leading up to this condition there are the 
conditions of mucous membrane and connective tissues which are 
characteristic of infective inflammation and mechanical injury. 
These are ulceration, formation of sacculated areas, diverticulae, 
abscess formation and even perforation. 

The pathological changes incident to the repair of the injured 
tissues, offer the ideal condition for the development of carcinoma, 
and this fact should always be considered in the study of obscure 
cases of hver disease. 


Dr. Connell : In listening to Dr. Jones^ paper, I think I will 
have to take exceptions to some part of his recommended treat- 
ment, especially in reference to the handling of gall stones. They 
all seem to start with the hypodermic injections of morphine rein- 
forced with atropine. Now I have been in practice some thirty odd 
years, and I have handled gall stones after gall stones, and I have 
handled them without one use of morphine, and I have followed 
physicians that have injected their patients full of morphine, giv- 
ing it either hypodermically or by way of the stomach ; but in most 
cases you could find the trace of the needle all over the body. It 
is a trying place in which to place the physician. The patient is 
suffering and the relief is not always all that we are trying to get, 
and the physicians are not willing to stop and consider their materia 
medica as they would in other cases of disease and get the proper 
similimum, but they rush either to morphine or a surgical opera- 
tion. But when I handle one of these cases, and I have handled 
a good many of them, they receive nothing but medical treatment, 
and homeopathic treatment at that. If we don^t do this, are we 
any better than the old school ? Can. we expect any better results 
than the old school? If we use our homeopathic remedies, do we 
not invariably get better results than the old school? I say most 
emphatically, yes ! And if I was giving a young man advice today 
in the matter of gall stones it would be to study his case as he would 
a case of typhoid fever or any other condition to which he was 
called, and give the indicated remedy. Throw away the hypoder- 
mic, for it cures nothing, while the homeopathic remedy does cure. 


as we all know. I have cured one ease with veratrum album, an- 
other with dioscorea, another with ehelidonium, and you will find 
lots of symptoms of sulphur in these cases. Again, in these flabby 
cases you will want calcarea carb., and then there is belladonna 
given not lower than the third, and not oftener than once an hour, 
as well as nux and other remedies. As this speaker (Dr. Jones) 
is one of the professors of one of our colleges — which in many in- 
stances are aping after the old school and causing our boys to leave 
homeopathy for the old school — I think he should have given us 
thoroughly honest homeopathic treatment from a homeopathic 
standpoint. In addition to my homeopathic treatment I use lots of 
olive oil — ^have used gallons of it — and have had fine results by 
ordinary remedies in different cases. 

Dr. H. T. Miller : The last speaker has mentioned a number 
of remedies that have served him well, and as a young man I do not 
feel inclined to dispute him. But in an experience of sixteen years, 
five of which were in surgical work with gall stones — in all that time 
the best remedies have been turpentine and carduus. I was recently 
called to a case which had been given the usual remedies, the pains 
continued even after having been given a grain and a half of mor- 
phine. Operation revealed two ounces of gall stones and pus. What 
would your homeopathic remedy have done for you there? It 
wouldn't have done a bit of good. The diagnosis had been appen- 
dicitis — I really hadn't thought of gall stones — ^if I had had any 
doubt at all it would have been in the direction of an ovarian tumor. 
But operation revealed the gall stones that had been there about two 
years. Do you think olive oil plus all the other remedies could have 
cured that case? I think not. I congratulate Dr. Wilcox on his 
able paper. It will do more good for homeopathy than such wild 
remarks as we have just listened to. 

Dr. Wood: It certainly seems too bad to let this excellent 
series of papers pass into the proceedings without a thorough dis- 
cussion. I was not present to hear Dr. Bishop's paper, but I know 
Dr. Bishop well enough to know that he went thoroughly into the 
etiology and pathology of the subject under discussion. I heard 
Dr. Humphrey's paper on "the symptoms and diagnosis," and he 
certainly has given us an exceedingly clear and precise paper deal- 
ing with this phase of the subject. It likewise did me good to hear 


Dr. Jones' paper on "the medical treatment of gall stones/' He 
did not treat his audience as though he were talking to a kinder- 
garten school. He assumed that we knew something of the homeo- 
pathic treatment of gall stones, and he dealt directly and practically 
with the subject in hand. Dr. Wilcox, as usual, gave us a clear and 
classic statement of the surgical side of the subject. I do not think 
that anyone could put in so few words more information pertaining 
to gall bladder surgery. Gall bladder surgery is one of the live 
issues of today. We should deal with the subject from a practical 
standpoint. It is not one to be dealt with sentimentally or super- 
ficially. If there is a medical treatment that is better than surgical, 
let the gentlemen who have such knowledge give it to us without 
impassioned oratory. In short, we should deal with this as with 
all scientific subjects in the spirit of true scientists. 

Even a most cursory review of the literature of gall bladder 
surgery will show that we have made great strides during the last 
five years. The per cent of cures by surgical measures is infinitely 
larger than it was ten years ago. We would certainly be derelict 
in our duty to our patients did we not give them the very best 
chance to get well that modem science can afford. I think that we 
are indebted to our chairman, Dr. Bishop, for creating so excellent 
a symposium on gall bladder surgery as he has. The series of 
papers which have been presented make a valuable contribution to 
the literature of gall bladder surgery. 

Dr. Humphrey : I don't know that I have anything to say so 
far as the treatment medically is concerned, the symptoms and 
diagnosis of the disease, that upon which I directed my study has 
not been questioned by the society. As you all know it is not always 
possible to differentiate the different diseases of the gall ducts and 
gall bladder. It is the persistence of the symptoms that attracts 
our attention, and it is their persistence that causes us to infer the 
one or the other disease. I want to say this in the discussion of this 
matter, viz : that it is for us as physicians to enquire into the case, 
to inspect every part of the body, in order that we may get at the 
true cause, to study the treatment and cure and all those things 
that go to make a perfect picture of the disease. We are to discuss 
not only the medical side but the surgical side also. Dr. Wilcox 
has told us in the beginning that we should come to the surgical 


side only when we had exhausted the medical side. I am very much 
pleased with this thought. I have tried all the means recommended 
and one more. I have succeeded in relieving a certain class of these 
cases in which the Jaundice is not persistent nor prominent by 
flushing the gall tract, the gall ducts and gall bladder with heroic 
doses of podophyllum. I have also succeeded in curing some of 
my cases according to the Hughes method, which is calcarea and 
china high. In a number of cases I have had satisfactory results 
with this treatment, but I will say to you frankly that I used mor- 
phine during the attacks. I can't say that in any case the morphine 
worked to the detriment of the patient. I have succeeded in curing 
more cases with podophyllum in heroic doses — all they could stand 
two or three times a week for three or four weeks, and I have never 
seen but one of these cases have a return. In one case relieved by 
this remedy, it was followed by biliary colic and I had to follow it 
some time with other remedies. 

We should remember that we may have biliary colic without 
gall stones, and if we cut down for them we will not always get 
them. Last year in discussing this subject in the North-Western 
Society at Toledo, Dr. Biggar broached the thought of using hydras- 
tis, especially if they have a catarrhal origin. We must also remem- 
ber that even the presence of gall stones will be tolerated by a gall 
duct after a period of time just as any other tissue becomes tolerant 
of the presence of an object that is foreign. 

Dr. Jones : I have I presume lectured to as many students as 
anyone else in the room. I have signed the diplomas of probably fif- 
teen hundred. I have been as conscientious I believe in teaching 
as any one I know of, and I have taught them just what I knew to 
be absolutely right. When I started out in practice I had some 
such an idea as Dr. Connell has, and I remember one case as well 
as though it were yesterday. I had quite a little practice in a town 
some nine miles away. I was called there to see a man who was 
suffering from what I considered gall stone colic. He had intense 
pain. I looked the case over, because he was a man who had been 
using stimulants pretty freely. I prescribed nux vomica, and re- 
mained a short time to watch its effect. He was slightly relieved 
and then I started home. I do not believe I had reached my home 
before he sent for his old physician, who gave him a strong dose of 


opium — ^there were np hypodermic syringes then. Dr. Connell was 
somewhat inconsistent, for if he had succeeded in relieving every 
case by the homeopathic remedy there would be no use for surgery 
or a surgical operation, and if it is true that in some of his cases he 
did not relieve them with the homeopathic remedy then he must 
have reached out for something else. Certainly he must have pre- 
ferred morphine to a surgical operation. I believe that in this 
assemblage that if all spoke truly that very few beside Dr. Connell 
woidd allow himself to suffer many hours from gall stone coli(J 
without asking someone to give him a hypodermic injection of mor- 
phine. Certainly I woidd not. When this tube contracts forcibly 
upon a jagged stone there is danger of rupture at any time; then 
an operation must be very quickly done. Morphine is one of the 
means for saving the patient's life. There is one point that has 
not been touched upon, and which I consider of considerable im- 
portance. It has been stated that we are prone to have cases when 
no gall stones are found. I have had two or three instances where 
we had such symptoms and fouad no gall stones of any considera- 
ble size ; but we found instead biliary sand, a fine powder which was 
passed, and after that came the relief. One gentleman from Penn- 
sylvania came to me who had his case diagnosed as carcinoma. He 
had sharp attacks of pain followed by jaundice. After a most care- 
ful examination I found, or rather he found, that he had passed off 
as much as a drachm of this biliary sand, and by systematic medical 
treatment and diet he was cured and has not suffered for years from 
anything of this kind. It requires considerable diagnostic ability 
to differentiate this class of cases from the true gall stone. In one 
instance I had the product examined by several chemists and only 
one was able to decide what it was. He claimed that it was xanthin, 
a product of the liver. 

Dr. Wilcox: Only the most exaggerated cases will come to 
the surgeon, and I think this is especially true of gall stone disease. 
I know very well that the cases upon which I have operated have 
been cases which have passed through the hands of our very best 
homeopathic physicians, some of whom have practiced thirty and 
some even as high as Mty years, but they recognized that their 
treatment was of no avail and that something radical must be done, 
and the mechanical conditions disclosed would have convinced any 


man on the face of the earth that medicines, however intelligently 
applied, could not relieve the distinctly mechanical condition. I be- 
lieve it is the duty of every homeopathic physician or anyone else 
to relieve his patient, and if he finds that the homeopathic remedy 
will not do it, then he must resort to something that will. If mor- 
phine will do it, then well and good; if it is an operation, then 
surely an operation should be done. These mechanical cases can- 
not be relieved except by morphine. In a case of gall stone colic 
where the pain is excruciating, morphine is properly indicated. In 
many of these cases it requires about ten or fifteen minutes for a 
small gall stone to pass into the duct, and morphine is the remedy 
that will tide him over that agonizing passage. I have no doubt 
that the homeopathic remedy does relieve in many of these cases, 
especially such as have been spoken of by Dr. Hiunphrey and Dr. 
Jones; but in these mechanical conditions you will not reach the 
trouble with the homeopathic remedy. 

Dr. Jones : How large a gall stone do the members know as 
having passed through the gall duct? I have a stone at my oflSce 
which measured when passed five-eighths of an inch in diameter, 
and the patient recovered. She lived for ten or twelve years after- 

Dr. Connell : I treated one case after it had been morphined 
and morphined, and by washing the stones that were passed I found 
one that was an inch in diameter, and quite a number of stones 
from that size on down. 

Dr. Biggar, Jr. : Answering Dr. Jones' question, I would say 
that it would be most difficult to pass a stone five-eighths of an inch 
in diameter through the common duct. I think we have no means 
of knowing how long it takes to form a stone in the cystic duct or 
in the intestine by pathologic action. But these large stones re- 
ferred to by Dr. Connell may have been formed in the intestines 
or gall bladder and cause pains simulating gall stone colic. 

Dr. Jones: This woman was sick for three months, and her 
skin was of the color of black walnut; she had seen doctors enough 
to diagnose her case, and they all agreed that it was a gall stone 
condition. True, it might have ulcerated into the intestine, but 


there was nothing to indicate that. It is not strange that such a 
stone should pass the common duct while it was still intact, for I 
have seen this duct when it measured over an inch in diameter. 



Symptoms. — This condition is usually secondary to gastro- 
duodenal catarrh, to pressure from without or to local spreading 
infections. Again, it may be primarily infectious. These facts 
should be borne in mind in making a diagnosis, although we may 
have many of the common symptoms present. There may be pres- 
ent neither pain nor distress any more than is due to dyspepsia with 
languor. Jaundice is usually present in varying degree, and there 
may or may not be hepatic tenderness. 

Fever is not a constant symptom, yet we may have a moderate 
temperature. Stools are clay colored, and the urine contains bile 
pigment. The pulse may be normal, but the rule is that the pulse 
is slow, sinking to forty or even twenty a minute. 

The liver is slightly enlarged in some instances. In others the 
enlargement is quite marked. The duration is from four to eight 
weeks. The stools should be watched carefully, as in them we shall 
find the first evidences of subsidence of the swelling, or removal of 
the obstruction. 

Diagnosis. — The diagnosis is usually not difiicult. Jaundice 
occurring in young, healthy persons with absence of emaciation or 
evidence of cirrhosis or cancer and moderate in degree, usually 
points to catarrhal inflammation as the causation. Absence of pain 
and the negative results of physical examination, together with the 
maintenance of nutrition, help to confirm the opinion. 

Cases which continue over two or three months should excite 
suspicion that it is more than simple catarrh. Many cases are the 
results of typhoid, pneumococcus or other infection. Differentiation 
should be made from syphilis, tuberculosis, cirrhosis, cancer and 
other conditions. 


We should consider WeiFs disease very carefully when fhe 
symptoms are severe. In the latter, the symptoms are very abrupt 
in their onset, with chill and fever of remittent type, severe pains 
in the back and limbs, with headache and light jaundice only. 
There are no preceding languor or gastric symptoms. The liver and 
spleen are swollen. Albumen is usually present, and sometimes 
hematuria. All these are in quite marked contrast to the insidious 
onset of simple catarrhal jaundice. 

Suppurative Cholangitis is a secondary affection and simulates 
hepatic abscess, pyelophlebitis, syphilis of the liver, cancer or WeiFs 
disease. The diagnosis is based upon its slow development and the 
presence of infection of the ducts or gall bladder, foreign bodies as 
gall stones, or existence of general infection. Jaundice may be 
absent entirely. The fever is that of general infection, hectic in 
type. The liver is enlarged moderately and is tender. There is a 
tender area in the region of the twelfth dorsal vertebra near the 
middle line. ( Boas ) . 

The blood shows leucocytosis, and when there is intermittent 
fever the examination establishes the absence of malaria. ThesiB 
facts not only establish the diagnosis, but the differential diagnosis 
as well. 


Acute Cholecystitis usually gives rise to distension of the gall 
bladder, with either serous or purulent fluid. This accumulation 
depends upon the closure of the cystic duct, as a result of inflamma- 
tory swelling, and the pouring out of an inflammatory exudate 
more or less rich in cellular elements of the blood, and the epithe- 
lium of the gall bladder, depending upon the activity of the pro- 
cess. (Stockton). Much evidence has been accumulated to show 
that cholecystitis in the majority of instances is due to bacterial in- 
vasion, whose presence brings about the disturbance of the lining 
membrane of the gall bladder. There are also certain predisposing 
factors, such as age, sex, indolence, gluttony and constipation, which 
should be borne in mind. Stout, inactive, constipated women at or 
before middle life are more subject to this condition than younger, 
active individuals. The close association of cholecystitis and gall 
stones, both as to etiology and clinical history, is such that it is not 
always possible to differentiate them. 


Cholecystitis is almost always a secondary affection. It may or 
may not be associated with cholangitis. The affection is accompan- 
ied by local and constitutional phenomena. There are present in- 
creased tension and rigidity of the soft parts in the vicinity. 

The gall bladder may protrude below the liver and may be pal- 
pated below the margin of the right lobe of the liver. Oftentimes 
there is present angiocholitis, in which case there will be present 
more or less pericholecystitis with adhesions. 

The region is tender and painful, with more or less promi- 
nence according to the amount of tension and swelling. Pain is 
rarely absent and often very severe. It is generally continuous, with 
additional paroxysms of severe pain, like biliary colic. Fever, 
chills, rigors, etc., attended by marked remissions and sweating, 
vomiting and tympanitis, and at times jaundice. Leucocytosis is 
present, the white cell count rising 25,000 or 30,000 even when pus 
is not present. The patient is very ill, and dissolution threatens. 
Many terminate fatally, while others subside to recur repeatedly in 
the form of sub-acute or chronic cholecystitis. When the disease 
has reached this stage, the symptoms vary somewhat from those 
recited in the acute form. The severe pain and tenderness referred 
to the locality of the gall bladder are less, and the fever, gastric dis- 
turbance and symptoms in general less than in the acute form, yet 
there is present enough local disturbance to direct attention to the 
diseased condition. 

The liver sometimes returns to normal size, but is usually 
slightly enlarged, especially in the region of the gall bladder. Ad- 
hesions frequently form, and are a source of pain to the patient. 
Local enlargement of the liver occurs where the inflammation con- 
tinues. The gall bladder itself may shrink and be so small as to 
be concealed, while again it may take on the other extreme and en- 
large and the walls become alternated. 

The adhesions may give rise to symptoms which are of special 
diagnostic value. When they extend to the abdominal wall, there 
is a sense of tension or pain when the patient assumes the upright 
position. When they attach to the pyloris or duodenum, we often 
have disturbances of digestion occurring: sometime after eating. 
Again the symptoms are vague, involving any or all of the digestive 
tract, such as auto-intoxication, constipation, diarrhoea, etc. 


Diagnosis can often be made by exclusion only. An intercur- 
rent attack of biliary colic will be of material assistance in the diag- 
nosis, and will also help to establish the presence of gall stones. 

In fact, it is impossible to tell in any given case whether the 
cholecystitis exists with or without gall stones, but they are pretty 
sure to appear if the cholecystitis continues for any length of time. 

Chronic irritation of the gall bladder from mild inflammation, 
varied by exacerbation of the same, furnishes some valuable aids to 
diagnosis, viz: Subicteric condition of the skin and conjunctivae 
often transient, with sensation of weight or even pain or tenderness 
at the junction of the ninth rib with the cartilage, or at the point 
of the twelfth right intercostal nerve one inch from the spine, (Boas 
sign) . Or some patient may go along for years suffering from auto- 
intoxication with bad breath, slight rise of temperature and urinary 
disturbance, and not having any very distinctive sign, no diagnosis 
is made. 

If the patent has had typhoid fever at any time, no matter if 
a dozen years or more intervene, and we have this train of obscure 
symptoms, or even a part of them, we are justified in looking care- 
fully to the gall bladder and ducts for the seat of trouble, for it has 
been conclusively shown over and over again that typhoid is the 
great antecedent of gall bladder disease. 

Many of the cases of so-called relapse from typhoid are but 
development of cholecystitis, or it may accompany typhoid, mani- 
festing its presence by an altered range of temperature, and an in- 
crease of the other symptoms, and sometimes by the presence of 
jaundice. Musser's latest statistics show that forty per cent of the 
cases of cholecystitis were preceded by typhoid fever. 


Any or all of these conditions may exist as an accompaniment 
of one of the infective fevers, gall stones, etc., or secondary to in- 
fective conditions in other parts of the body. 

Often the condition is not recognized during life, or theie may 
be present only irregular fever with rigors. 

If, after an attack of hepatic colic, fever of an irregular type, 
chilly sensations or sharp rigors occur, and prostration ensues, inde- 


pendently of any paludal affection, we may suspect ulcerative in- 
flammation of the bile ducts. Jaundice is present, which deepens, 
hepatic pains are marked, and a fixed local pain in the right h3rpo- 
chondrium is complained of. If the gall bladder is involved, en- 
largement of that viscus is observed. As the inflammation pro- 
gresses, symptoms of perijiepatitis and local or general hepatitis 
occur. There is pain also in the epigastrium. Vomiting often 
occurs. Hemorrhage from the stomach or bowels occurs also, and 
diarrhoea frequently develops. Budd believes many recover. This 
depends upon the course in which the pus burrows. If by chance 
it burrows toward the stomach or duodenum, and by lucky chance 
finds an entrance into one of these, recovery may take place. Or if 
it come to the surface, it may be safely evacuated. Or if none of 
these fortunate results occur, the patient may develop a typhoid con- 
dition, the fever continues, gastro-intestinal digestion gives way, 
cholaemia occurs, and death results from perforation or exhaus- 

If the cholecystitis be due to a foreign body, such as gall 
stones, the lodging of one of these in the common duct is often 
accompanied by a peculiar intermittent fever, the so-called inter- 
mittent fever of Charcot. (Musser). Diagnosis of this form of 
infection is very imcertain in the latent form. Pain in the hepatic 
region with enlargement, and tenderness on pressure, irregular 
chills and fever with jaundice in one who has had an attack of gall 
stones, are strong factors in making up an opinion. Prognosis is 

Differential Diagnosis. — ^When syphilis is suspected, we may 
be able to get the antecedent history, or specific treatment may help 
to clear up the diagnosis. 

Infectious endocarditis may simulate this condition from the 
presence of hepatic congestion with septic fever, jaundice, etc., but 
endocarditis of itself is usually secondary, hence a careful analysis 
of the case will be a help in settling the question. 

From multiple hepatic abscess, we are not always able to dis- 
tinguish this condition, but in multiple abscess, the liver is large 
while in cholecystitis the gaU bladder is large. Later ascites, diar- 
rhoea and vomiting of blood may accompany the hepatic abscess. 


In abscess of the liver, the signs are rather posterior than an- 
terior. It is a very rare disease, is very slow in developing and is 
not painful. 

Subdiaphragmatic abscess has a history of slow development 
with both abdominal and thoracic symptoms. Exploratory punc- 
ture posteriorly will be of assistance. Pleurisy and pneumonia 
ought not to be confounded with this malady. 


Gall stones usually produce no symptoms. Kehr believes that 
symptoms occur in only five per cent of cases. 

The great majority of gall stones form in the gall bladder and 
remain there, producing absolutely no disturbance to their posses- 
sor. If they are of lesser diameter than the lumen of the ducts, they 
may pass harmlessly into the bowel without producing any symp- 
toms. Others are too large to enter the cystic duct, consequently 
remain harmlessly in the gall bladder. 

It is the moderate sized calculi, those that can enter the ducts 
and yet cannot pass readily, that make their presence known, and 
their consequences dreaded. When there are prodromal symptoms 
of cholelithiasis, they are identical with those produced by cholan- 
gitis and cholecystitis, viz: languor, dyspepsia, disturbance of the 
bowel, and the train of symptoms attendant upon whichever local 
condition exists. 

Gall stones continually present in the gall bladder act 
as other foreign bodies, and do eventually damage the mucous mem- 
brane and predispose that viscus to cholecystitis and its train of 
symptoms. If a patient whose gall bladder contains calculi should 
have an attack of typhoid, the chances of infection are very much 
increased, and we should be on the alert for the symptoms of chole- 
cystitis during and ever after the attack. 

The neurasthenic with his multiple symptoms pointing to any- 
thing and everything, may possess the one tell-tale symptom, viz: 
dragging pains in the side, which will lead to the causation in the 
gall bladder, the relief of which will dispel the whole syndrome. 

The symptoms produced by calculi are usually due to their 
presence in the ducts, and the muscular effort to force them onward 
to the bowel, when we have pain with shock, jaundice and fever. 


Jaundice occurs when the stone lies in the direct route from 
the liver to the bowel, i. e., either in the hepatic or the common 
ducts. After an attack of colic, jaundice usually appears within 
twenty-four hours. The stools will be marked by the absence of bile 
in them. If the stone pass the bowel, the jaundice will slowly dis- 
appear. The cholangitis set up by the traumatism of the duct may 
'cause swelling and temporary occlusion, which accounts for the 
slowness with which the jaundice disappears. 

In case of permanent impaction, the jaundice becomes intense, 
and death ensues from cholaemia. Icterus varies in a given case, 
and may be entirely absent from time to time. In such cases, the 
obstruction is partly relieved from time to time by the irregular 
form of the stone which permits of partial flow of bile, or the stone 
lies free in the diverticulum of Vater. Or the variation may be due 
to the "ball valve'^ action of the stone, or remittance of the swelling 
of the mucous membrane of the ducts. Pain is more or less con- 
stant, as is also colic. The constant pain is of the gnawing or drag- 
ging variety. Its presence is good evidence of calculi in the ducts. 
This variety is due to inflammation from the infective cholecystitis 
or cholangitis. Tenderness of the liver is a frequent accompani- 
ment of this dragging pain. 

Biliary Colic is usually sudden and severe and often attended 
with shock, which may be fatal, as in three cases reported by Mur- 
chison. The pain varies from minute to minute, owing to the per- 
istalsis. It is nearly always accompanied by vomiting, which is 
severe and may persist after the stone has escaped into the boweL 
Cold extremities, sweating and general depression are present. After 
persistent pain for an uncertain period, the pain ceases, owing to 
escape into the bowel, or the dropping back into the gall bladder. 
The termination is not always of this character. The symptoms 
sometimes become remittent, the calculus remaining in the duct 
for years. 

In the "ball valve" type of the disease, in which the stone lies 
freely in the ampulla of Vater, the pain may be periodical, slight 
or even absent, and the condition shows itself more by jaundice and 
fever than by pain. 

Fever. — Gall stones alone in the gall bladder will not produce 
pain in uncomplicated cases. When an attack of biliary colic occurs 


there is usually rise of temperature, even when the extremities are 
cold. It is claimed to be reflex, but it is probably due to infection. 
It is accompanied by rigors and sweating, and is of an irregular 
type. Charcot called attention to this type of fever, and it usually 
goes by his name. It is not always present, even when there is 
stenosis, Osier having repori:ed two when it was absent. 

Finding biliary calculi in the stool is conclusive evidence of 
their presence. 

Diagnosis. — It is not possible to make a diagnosis in most 
cases, since they present no symptoms. It is necessary to get a care- 
ful history of every obscure case, and to weigh all the facts care- 
fully, and as a last resort to make exploratory incision. The X-ray 
is not reliable owing to the fact that cholesterin concretions are per- 
meable to the ray. Local tenderness at two points may often sug- 
gest gaU stones, viz : (a) Midway between the ninth costal carti- 
lage and the umbilicus, and (b) immediately to the right of the 
eleventh and twelfth dorsal spines. (Boas point). 

When the symptoms are marked, the diagnosis is simple. Dif- 
ferential diagnosis should be established from intercostal neuralgia, 
gastralgia, ulcer of the stomach and duodenum, appendicitis, hepa- 
talgia, pancreatic calculi and tumors, renal colic, movable kidney, 
tumors of the gall bladder, and biliary passages, suppurative cho- 
langitis and malaria. 

Intercostal neuralgia may be excluded by absence of jaundice 
and fever, and by the presence of tenderness along the course of cer- 
tain nerves, although it may accompany gall stones in rare in- 

Gastralgia usually occurs in early life, while gall stones rarely 
occur before middle life. The pain is more to the left and is usu- 
ally relieved by food, and there is no jaundice. 

Gastric ulcer is aggravated by food, and the vomited matter 
contains blood. 

Hepatalgia is rare; its existence is denied by many. 

Pancreatic calculi are difficult to differentiate, although the 
pain is usually to the left of median line. Jaundice is rare. Gly- 
cosuria is apt to be present, the dejections contain fatty acids, and 
an excess of undigested muscle fibre. 


In appendicitis the pain is usually below the level of the um- 
bilicus, and there is swelling and dullness there. Leucocytosis is 
present, which will not be true in gall stones, unless associated with 
inflammatory complications. 

The pain of renal colic usually originates in the loin, is lower 
down, and radiates toward the genitals, and there are usually pres- 
ent urinary symptoms. 

Movable kidney is often very difficult to differentiate from gall 
stones; experienced clinicians mistake one for the other frequently. 
They do exist together sometimes. 

Floating kidney may drag or press upon the gall duct so as to 
produce jaundice. If we are able to replace the kidney, and the 
manipulation is followed soon afterward by profuse flow of urine, 
the diagnosis is clear, but all cases of movable kidney are not 
attended by twisting of the ureter or pressure upon it, hence we 
may not get this symptom, or we may have a very much enlarged 
and displaced gall bladder which will be exceedingly puzzling to 
the diagnostician. 

Many new growths and tumors cannot be diagnosed from chole- 
lithiasis; they often co-exist. Eapid emaciation, jaundice, slight 
variable fever, with distended gall bladder point to cancer. 

In cholelithiasis, the gall bladder usually is smaller, owing to 
the cholecystitis. 

Malaria can be differentiated by blood examination. 

The situation of the calculus is of great importance. Calculi 
in the gall badder can sometimes be palpated. The sensation is 
"like the grasping of a bag of hazelnuts," says Murchison. Care 
should be exercised, lest one should rupture the viscus or set up 
inflammation, which would aggravate the condition. 

When the hepatic ducts are invaded by small calculi, they usu- 
ally pass directly into the bowel without symptoms, but when a cal- 
culus lodges in the hepatic duct, pain, fever and jaundice will be 
present without enlargement of the gall bladder. 

A calculus in the cystic duct is attended with pain, but with 
jaundice only rarely. 

When the common duct is the seat of the lodgment, the symp- 
toms already detailed will be present, viz : the tender area on a line 
between the ninth costal cartilage and the umbilicus continues or 


occasional jaundice, according as the impaction is complete or 
incomplete, with absence of enlargement of the gall bladder, 
enlargement of the spleen, absence of ascites, jaundice, etc. 


If the cystic duct be the seat of chronic obstruction, the gall 
bladder becomes hypertrophied to a variable degree, reaching in rare 
instances to the pelvis, and has been mistaken for ovarian cyst. The 
contents are invariably of a thin mucoid nature, which is mixed 
with bile for a time, but in case of complete obstruction, the bile is 
entirely replaced by a clear fluid, neutral or akaline in reaction. 
The physical diagnosis of this condition furnishes the only reliable 
method of differentiation. 

Atrophy is usually preceded by this condition, and when 
extensive cannot be diagnosed except by exploratory incision. Many 
of the obscure effects of gall stones cannot be detected during life. 
For instance, perforation and fistulae. Obstruction of the bowels 
from gall stones presents the usual symptoms of this condition, the 
discovery of the calculi in the intestine being the only method of 
diagnosis. This cause of obstruction should be borne in mind, 
because it is by no means rare. Pitz found twenty-three eases out 
of 295 due to this source. 

Stenosis presents the symptoms common to cholangitis. The 
diagnosis depends upon recognizing the cause if possible. When it 
is due to external causes such as cancer or other tumors, we may 
be able to arrive at a correct diagnosis by careful exclusion. 

Another and most important remote effect of gall stones and 
diseases of the ducts is biliary cirrhosis of the liver. This condi- 
tion is important here, because its presence may assist us in arriving 
at a conclusion as to the condition of the gall ducts. Weber 
defines it as "any cirrhosis of the liver originating from 
disease of the biliary ducts or obstruction of the out- 
flow of bile.^* It occurs with or without gall stones, and 
sometimes without obstruction of the common duct. In a given 
case in which we find a resemblance to "hobnair^ liver, which has 
a history of any of the gall bladder diseases, we may reasonably 
attribute it to this cause, after excluding syphilis, tuberculosis and 
cirrhosis due to alcoholism. The latter has its origin in the blood 


vessels, while biliary cirrhosis has its origin in the hepatic ducts. 
The physical symptoms are much the same, except that biliary cir- 
rhosis is usually accompanied by enlargement which is fairly uni- 
form, and the surface is granular to the feel. It is not the coarse 
"hobnail" irregularity of ordinary cirrhosis. This, coupled with a 
former history of chronic jaundice and symptoms of cholecystitis 
or cholelithiasis gives us a reasonable basis for diagnosis. 

There is still another class of these cases occurring in the young, 
due in all probability to chronic ascending cholangitis, which was 
first described by Hanot, whose name the disease still bears. BoUe- 
ston has disputed this theory, claiming that the condition is a de- 
scending cholangitis originating in the radicles of the hepatic ducts. 
Both are no doubt correct. When we have the ascending variety, we 
are concerned as relating to the subject under discussion. Much the 
same symptoms prevail as are described above, with the result that 
the child becomes dwarfed if he lives long enough. This condition 
often exists in whole families abroad, but is very rare in this 



Preliminary to taking up the treatment I desire to say that in 
my opinion gall stones are much more common than is generally 
supposed, even by the profession, and I also believe that the major- 
ity of cases recover without treatment. In former years nearly all 
cases of severe pain in the abdomen not accompanied by any promi- 
nent local condition which would account for it were treated as cases 
of colic, and usually the patient would consider that the trouble was 
due to some error of diet, or over-exercise. In proof of this state- 
ment I desire to quote a few cases. 

Mrs. F., aged forty, called me to attend her on account of a 
very severe pain from which she was suffering. This pain was in 
the region of the gall bladder, extendiug through to the back and 
accompanied by nausea and vomiting. The pain was paroxysmal 
and lancinating, and I noticed that there was some appearance of 
jaundice. Both she and her husband told me that this attack was 


similar to other attacks which she had been subject to for twentj 
years, coming on every few months, and passing away, leaving her 
somewhat debilitated, but otherwise in reasonable health. The phy- 
sician whom she had employed during these years was a man of 
prominence in the city, and generally considered a careful diagnos- 
tician. He had never hinted that she might have gall stones, but 
had treated the case as one of gastralgia, the treatment consisting 
of a hypodermic injection of morphia, and some slight treatment, 
following for two or three days, with directions in regard to diet. 

I suggested to both the patient and her husband that I believed 
the case was one of gall stones, and that I desired the husband to 
make a search for them the following day, and to continue the 
search for two or three days. The second day he found two gall 
stones, measuring more than three-eights of an inch in diameter. 
This patient has been under my treatment since that time, about 
eight years, and has had possibly on an average of two attacks a 
year. Some of the attacks were mild, but a few quite severe. It 
has been now a year since the last attack. 

Another case, Mrs. P., aged at that time about sixty, called me 
about ten years ago. Her early history was similar to that of the 
case of ^Irs. F., she having had on an average two or three -attacks 
during the year for ten or fifteen years. The same symptoms were 
present — the lancinating pain in the epigastrium and right hypo- 
chondrium, extending through to the back, with nausea and vomit- 
ing, and finally sudden relief. Gall stones were found to be present 
in this case after a proper search was made. Prior to my visit she 
had been treated, as did the other physician in the case of Mrs. P., 
for gastralgia, and due, as he and they supposed, to an error of diet, 
and she had become very abstemious on account of the fear of these 
paroxysms. I have looked after her since that time, and she has 
had during the first three or four years about that many attacks, 
but in the last six years she has not suffered in that way at all. 

Mrs. G., aged thirty-five, called me five years ago during the 
absence from the city of her family physician. She presented the 
characteristic symptoms of gall stones, and had been treated in a 
manner similar to the treatment in the other two cases, and she 
had dieted herself so carefully on account of the idea which had 
been conveyed to her by her physician, that these attacks were due 


to errors of diet, that she had lost about one-third of her weight, 
and she was, in consequence, extremely reduced in strength. I had 
her husband make a search for the next two days, and he found 
three gall stones. Upon the return of her physician she told him 
that my diagnosis was that of gall stones, and he answered that that 
was impossible, as she had not the prominent indications of that 
trouble. She answered, "No matter about that — I have the gall 
stones here," and handed a small vial containing the stones to the 
doctor, who immediately said that that was suflBcient proof, and 
that he evidently had been mistaken in the case for these several 

Much can be done for these cases outside of drug tlierapeutics. 
The condition of the mind has very much to do with the treatment 
of gall stones. The old idea that the liver had much to do with the 
mental state has undoubtedly much truth in it, and anyone who is 
possessed of a violent temper, or is inclined to fits of melancholy, is 
much more liable to this disease than others; consequently in the 
treatment of such cases patients should bo directed to avoid all such 
troubles, and to control themselves and live, as far as possible, con- 
tented and happy lives. One case which I watched very carefully 
for years, never suffered from an attack of gall stones while she was 
away on her summer vacation, but would have one or two attacks 
during the winter while she remained at home. 

From the symptoms which I have noticed in all these cases I 
have come to the conclusion that duodenitis is a very common 
accompaniment — in other words, the inflammation which is excited 
]3y the traversing of the gall duct by the gall stones extends to the 
duodenum, and in consequence we get a catarrlial inflammation, 
and frequently an extension of this inflammation to the muscular 
coat, and possibly to the serous layer, and as a result of this we get 
atony of this portion of the bowel, or a loss of peristaltic power, 
with a consequent tendency to the accumulation of the product 
which should pass readily downward. Partial stenosis of the 
pylorus may be produced in this way by an extension of the inflam- 
mation upward until the various changes which precede that con- 
dition are brought about. Following that come dilatation of the 
stomach, with all its consc(iucnces, so that the treatment of a case 
of gall stones must include tlie treatment of a catarrhal infiamma- 


tion of the various bile ducts and of the duodenum as well, and pos- 
sibly of the pylorus. This should be borne in mind constantly when 
the diet for such cases is prescribed. 

The diet in such cases should be of such a character that it 
will not irritate the duodenum as it passes downward. No particles 
of indigestible matter should be allowed to enter the stomach. All 
food should be properly cooked and thoroughly softened by some 
process before it is allowed to be taken. During the time of the 
attack very little food should be taken by the mouth. If the attack 
is long continued, or if there is very severe irritation of the duode- 
num and stomach, I would advise rectal feeding until such time as 
the patient would be able to take liquid food. After the attack the 
food shoud be chiefly of a liquid character for some days, and then 
the cereals should be allowed, and as soon as the patient is able to 
take food in considerable quantities my advice is that they be quite 
well fed. They should take a liberal quantity of fluid — at least 
three pints of fluid should be taken within twenty-four hours. This 
should be distilled water, or some other fluid that is free from all 
solid particles. I advise such cases to take at least a half-pint of 
water upon rising in the morning and the same upon retiring at 

Medical Treatment — The treatment is to relieve the attack as 
soon as possible, and as the stomach is usually disturbed, I usually 
prefer hypodermic injections. It is entirely useless to give medi- 
cine by the mouth when there is cgnsiderable gastric disturbance. 
Ordinarily the hypodermic injection of a fourth-grain of morphia, 
combined with 1-150 of a grain of atropine will relieve the patient 
for perhaps three hours. I would not repeat it in less than three 
hours, and would probably lessen the dose then. Sometimes it has 
to be given for several days, until the stone is passed. You will 
understand that the pain may stop and the stone remain in the duct. 
By keeping quiet, the peristalsis may be stopped and the pain dis- 
continued. It is a difficult process to dilate the duct until large 
enough to allow these stones to pass. It has to be gradually 
enlarged imtil this occurs. The lower extremity is the most diflBcult 
point of distension ; frequently it does not allow the calculus to pass, 
and it may remain there for months or years. Inflammation may 
occur there in consequence of the presence of the stone, which will 


make its exit more difficult still. A poultice of slippery elm, bes^ 
applied over the epigastrium and right hypochondria, will give some 
relief. There will be some fever, as a rule, for which aconite will 
be the remedy. I. have considerable confidence in the use of china as 
a preventive of the formation of gall stones. I have used it con- 
siderably. Following aconite, if there is a regular intermitting 
fever, china would certainly be well indicated. In some cases with 
a tendency to perspiration without relief, mercurius would be indi- 
cated. This remedy is supposed to aid in the formation of bile, and 
the liver will return to its normal condition, but it more probably 
returns by curing the catarrhal condition. For the jaundice, which 
is frequently obstinate, I have found leptandra to be effectual. 
This resembles mercurius much in its action. 

Colocynth has proven a remedy of great value to me in these 
cases, not only during the period of attack, warding off the pain in 
some cases, but for the continous irritation of the duodenum fol- 
lowing such an attack. I frequently give this in the third attenua- 
tion four times daily for many weeks, and most of the cases under 
my charge at the present time who are subject to these attacks, have 
on hand a vial of the third of colocynth, which is given upon 
the first indication of a return of the trouble. 

Bryonia will prove valuable in many cases after the attack 
when there are sharp lancinating pains aggravated by the least 

Nux vomica, when there is constipation with urging to stools, 
is especially valuable after the person has taken many vegetable 
cathartics or for those who have been addicted to the use of alcoholic 
stimulants or tobacco. 



Lest the surgeon be arraigned on the charge of too hasty resort 
to the knife when medication and hygiene will suffice, I will preface 
my remarks by saying : In all cases of persistent or recurrent gall 
stone colic, with or without icterus, or in all cases of marked 
icterus, imaccompanied by pain, the knife should be used only after 
the failure of internal medication together with the most approved 


hygienic living. But in making such a provision I should desire 
to emphasize my belief that no physician has a right to persist in 
his medication treatment of such cases, unless he early succeeds in 
materially mitigating the severity of the attacks and lessens their 
frequency. To so persist means, in the vast majority of instances, 
to either jeopardize the life of the patient or to condemn him to the 
life of periodic suffering which dispels all the joy of living. There- 
fore, while the knife is not to be taken up too readily, neither should 
it be withheld a moment after a fair trial has been given less severe 

Much has been written in the attempt to classify the cases of 
gall stone disease suitable for operation. To my mind such classi- 
fication is of little benefit. If there is but one gall stone and it has 
found lodgment somewhere in the biliary tract and neither nature 
nor remedies will dislodge it, then the surgeon must go after it, and 
it makes little difference where it is lodged, for the surgeon has 
shown himself capable of reaching it no matter where located. 

Again, if the patient continues to have frequent and severe 
attacks of pain, to the extent that life is rendered miserable or the 
health fails, then again must the surgeon become the constable and 
arrest the offender, which thus far has avoided apprehension. Hence, 
my classification will be this : to operate all cases of disease of the 
gall bladder or ducts (where an operation is at all warrantable) 
when other treatment has failed, and when the health of the patient 
is jeopardized even slightly. 

Having thus settled the question of when to operate, we must 
next consider how to operate, and here a classification becomes help- 
ful, because all diseases of the biliary tract are not alike as to their 
pathology. A single large stone incarcerated in the common duct 
shows distinctly different symptoms from a number of small stones 
collected in the gall bladder. It is in the former that icterus is 
usually present, owing to the more or less complete obstruction to 
the outflow of the bile, and because of that fact, these cases are far 
more dangerous to life than other biliary diseases, the danger 
depending entirely upon the degree of obstruction. Hence a patient 
with biliary colic, presenting signs of icterus with cholemia, is a 
dangerously sick patient and will not allow very much time to be 
lost in experimental medication. Frequently the obstructing stone 


is so situated in the common duct, that it will float upward and 
allow the imprisoned bile to escape on either side and thus relieve 
the intensity of the cholemia; but a spasmodic contraction of the 
fibres of the common duct will soon drive the calculus into the nar- 
row canal and more cholaemia follows. It is here that the judgment 
of the family physician is put to a severe test, for he should recog- 
nize fully that patients whose systems are saturated with bile, do 
not go through the ordeal of an anaesthetic and an operation at all 
well, and if their lives are to be saved the knife must be used early. 

There are three distinct ways of treating the gall bladder 
surgically : 

First, to remove it entire ; cholecystectomy. 

Second, to incise it, drain it, and close it again ; cholecystotomy. 

Third, to incise it, drain it, and attach it to the abdominal wall, 
allowing a fistulous opening to remain for the purpose of evacuating 
the bladder for such time as may be necessary ; cholecystostomy. 

At present the weight of surgical opinion seems in favor of 
removal (cholecystectomy) ; yet my personal experience with incis- 
ion and drainage has been so satisfactory that I am rather loth to 
advocate the more radical operation. There are, however, certain 
indications, which render cholecystectomy absolutely necessary, and 
when such conditions are encountered, the surgeon has but little 
latitude of choice. 

The conditions calling for the removal of the gall bladder are, 
great hypertrophy of its walls with threatened gangrene, new 
growths or any indication of neoplasm of that organ. A very badly 
contracted gall bladder with thickened walls and damaged mucous 
membrane, is an exceedingly diflBcult organ to drain and the risk 
of imperfect drainage may be greater than the risk of removal, 
hence in such conditions removal may be best. Incision 
and drainage without attachment to the abdominal walls, are indi- 
cated in those cases of simple gall stones, without visible evidence 
of infection or chronic changes incompatible with complete restora- 
tion of functions. 

This latter condition is by far the most common in patients 
who have sought surgical relief early, before the gall bladder has 
imdergone irreparable repair and where the patient^s general health 
has not been reduced by occlusion of the common duct with the 
resulting cholaemia. 


The third manner of treating the gall bladder, incising, drain- 
ing and attaching to the abdominal wall (cholecystostomy) is 
required in those cases where the organ is too badly damaged to 
trust it in again performing its functions for fear of breaking down, 
but where the patient's general health and power of resistence is so 
much below par as to render a radical operation hazardous; in fact, 
I should limit the employment of this method of dealing with the 
gall bladder almost exclusively to that class of cases wherein the 
physical conditions of the gall bladder were such as to demand its 
removal and yet the patient's strength would not warrant the pro- 
longed operation requisite to its removal. 

Just a few words as to the method of operating; by elevating 
the patient's shoulders and placing a four-inch sand bag under the 
angles of the scapula, the operation is greatly facilitated. The best 
incision is the one known as Bevan's, which starts at a point just 
below the border of the last true rib (so as to escape entrance into 
the pleural cavity) and passes downward parallel to the outer bor- 
der of the right rectus muscle. 

This incision can be made long or short, according to the 
requirements. There is less objection in making a long incision in 
this part of the abdominal wall than elsewhere, because of the les- 
sened danger of a hernia, hence it is best to make an incision suffi- 
ciently long to allow ample opportunity for doing the work rapidly 
and well. After reaching the gall bladder it will be well to bear in 
mind a few anatomical points. The fundus of the gall bladder 
approaches the abdominal wall near the end of the ninth rib. It is 
from two to three inches long. The cystic duct is from one-half to 
two and one-half inches long, averaging a little over an inch. • The 
common duct varies between one and a half and five inches, averag- 
ing about three inches in length, and having a circumference of 
twenty millimeters, but is so narrowed by the vale of Heister that 
in only about ten per cent of cases will an ordinary silver probe 
pass. Just before the common duct enters the intestine it expands 
to form the ampulla of Vater, receiving at this point the pancre- 
atic duct. Lying above and posterior to the cystic duct is the cystic 
artery; to the left of the common duct is the hepatic artery, and 
between and behind these two is the portal vein. The gall bladder 
itself is quite loosely attached to the under surface of the liver by 
areolar tissue, and covered by a reflection of the peritoneum. 


The liver should be drawn upward by a wide retractor, whose 
blade is protected by a gauze pad, to prevent injury to that viscus. 
This retractor should be held by an assistant standing near the head 
of the patient ; with the liver well out of the way and the patient's 
shoulders so elevated that the light falls directly upon the gall blad- 
der, there is little diflBculty in reaching and examining the entire 
biliary tract. 

If the operation of cholecystotomy, simple incising, has been 
decided upon, then that organ is seized with volsellum forceps, 
drawn to the surface of the abdominal incision, protected well, 
opened, its contents entirely removed, whether they may consist of 
little or big gall stones, mucus, bile, cholesterine or diseased mem- 
brane; the ducts are then carefully explored by passing either a 
finger or sound through the cystic hepatic and common ducts. If 
no gall stones are found in the ducts, then the gall bladder is 
thoroughly washed, dried and closely stitched, after the manner of 
closing an intestinal incision. The abdominal cavity is then dried, 
not flushed, and the incision closed without drainage. 

Cholecystostomy is performed in much the same way plus the 
stitching of the edges of the aponeurosis to the abdominal incision. 
The gall bladder is then loosely packed with gauze and this is 
changed daily or oftener as required. If the resulting fistula does 
not close of itself in six weeks or two months, it is best to freshen 
the edges of the wound and sew up the opening. I have never had 
any difficulty with such fistulae, all of them closing spontaneously, 
save one, which required the second and third operation 'ere it 
closed, but it has since remained closed without causing any diffi- 
culty. The possibility of such fistulae is what makes the opera- 
tion of cholecystostomy unpopular, but even though such a fistula 
may result and refuse to heal, the patient is alive and in far better 
condition than when he had the frequent attacks of gall stone colic 
or was at death's door with toxic cholaemia. Personally I have 
known of biliary fistula which failed to heal. 

The method of removing the gall bladder is as follows : After 
walling oflE the abdominal contents with strips of gauze, the peri- 
toneum, connecting the gall bladder and liver, is incised around 
the entire base and neck of the gall bladder or wherever these two 
organs are attached. It then becomes an easy matter to separate 


one from the other by blunt dissection, preferably done by the index 
finger. The cystic duct is severed by making an incision through 
the peritoneum parallel with the duct, stripping off such peri- 
toneum for a little distance from the juncture of the duct 
with the gall bladder. The duct is then tightly ligated and sev- 
ered, the stump being touched with pure carbolic acid and then bur- 
ied by folding and stitching the redundant peritoneum over the 
stump, much as the stump of the appendix is buried. The most 
important paiii of the operation is to secure absolute closure of the 
cystic duct and complete burial of the stump, for a slight leakage 
of bile into the free abdominal cavity means a fatality. After the 
gall bladder is removed, the flaps of peritoneum remaining on the 
liver, where the gall bladder rested, should be drawn together and 
stitched, to avoid any raw surfaces being left. In all of these oper- 
ations I think drying preferable to flushing the abdominal cavity. 

We now come to the consideration of another class of cases, 
which while they are far more serious are fortunately less frequent, 
namely, those wherein there is an impacted stone in some one of the 
ducts. If the stone has lodged in the cystic duct, it can be removed 
without difficulty through the gall bladder by the method just men- 
tioned. In fact, nearly all cases of calculi in the gall bladder pre- 
sent obstruction of the cystic duct, hence these can scarce be con- 
sidered as a class by themselves. Lodgment in the hepatic duct is 
quite rare. I have never seen such a case, but a few have been re- 
corded. In such cases the calculus can be reached either through the 
gall badder or by incising the hepatic duct and removing the stone. 

Lodgment in the common duct is a much more frequent occur- 
rence. Mao Robson says that about 67 per cent of cases of ob- 
struction of the common duct occur at the duodenal extremity; 
about 18 per cent at the upper or hepatic extremity; and 15 per 
cent at the middle portion of the duct. 

Up to this point the operation for the removal of gall stones 
has been comparatively easy and safe, but the moment we attack 
the common duct, we pass over the line of safety into the region of 
danger. It is rare that the surgeon is called upon to make a more 
difficult or dangerous operation than that of choledochotomy, which 
is an incision into the common duct, the removal of a calculus and 
the successful closure of the rent through which the stone was re- 


moved. The calculus has succeeded in passing the sentinel at the 
outlet of the gall bladder and has pushed on into the cystic duct. 
Here it has made its ready escape and fled into the common duct, 
but has been arrested at the gateway of the duodenum by the small 
sphincter muscle situated there. Let us notice what effect this pas- 
sage and interruption of the stone has had upon the patient. She 
(three out of five such cases are women) has been conscious of the 
migration of the calculus since it left the gall bladder. It, being 
a large stone, has caused much distress while in the cystic duct, 
there being present vomiting, dull ache and other reflex symptoms 
just mentioned. As soon as the stone entered the common duct 
the agonizing gall stone colic began, which is caused by the contract- 
ing efforts of that duct to force the stone onward, together with the 
roughened edges of the calculus scraping alone the sides. This 
attack is long or short, according to the time required in complet- 
ing the journey through the duct. Usually the stone is forced to 
the duodenal extremity of the tube and there stops, but the great 
pain does not cease then, because the duct is still making great 
efforts to rid itself of the offending concretion and so keeps up its 
contracting spasms. In a few hours these contracting fibres tire 
and relax ; then comes a respite from suffering, but as the call comes 
for more bile in the intestines, the gall bladder is stimulated, bile 
flows into the common duct, contraction begins and the pain re- 
turns. This process is repeated at intervals of six, twenty-four and 
forty-eight hours, the pain usually coming on at certain hours with 
considerable regularity. In a few days the patient becomes jaun- 
diced, because there is interruption to the outflow of the bile. The 
surprise is that the jaundice does not come on earlier and become 
deeper, but that is explained by reason of the gall stone floating 
up and away from the duodenal outlet during the period of quies- 
cence, thus allowing quite a free escape of bile. Indeed, were this 
not the case, a fatal cholaemia would ensue very rapidly. How are 
we to distinguish these recurring attacks, just mentioned, from 
acute attacks due to the passage of separate individual stones? 
Very easily : the latter come with no regularity, are usually shorter 
in duration, and when the pain ceases the patient is perfectly well. 
There is no dull ache, nausea or vomiting following the pain as in 
the former. Moreover, in the case of impacted stone, each recur- 


ring attack is more severe until it is ushered in with marked chill, 
followed by high temperature and rapid pulse. But a distinctly 
distinguishing symptom in this condition is the gradually increas- 
ing jaundice with clay-colored stools. 

Our patient has now come to the point where she is seriously 
ill. She has days, possibly weeks, in which she has no pain. She 
even clears up of her jaundice, because of the valve-like action of 
the stone in the common duct, but it is sure to come on again, the 
jaundice grows deeper, exhaustion is more marked, vomiting fre- 
quent and stools clay colored; every new attack runs the tempera- 
ture a little higher, reaching 104 degrees. What is going to be the 
outcome? What can be the outcome when eight or ten ounces of 
so poisonous a substance as bile are forced into the general circu- 
lation every twenty-four hours? Inevitable death, and it is posi- 
tively foreshadowed by the foregoing sjrmptoms. A patient may 
last from three to eight months in the condition described, and 
every day nature will be crying out piteously for relief. 

There are two difficulties in the operation of choledochotomy : 
first, to find the stone, as the outlet of the common duct is in the 
lesser peritoneal cavity, behind the stomach and pylorus, deeply im- 
bedded in its surroundings by connective tissue, omentum, perito- 
neum and intestinal adhesions. The second difficulty is the inser- 
tion of the sutures to close the rent, through which the stone has 
been removed. This is best done by passing the sutures, after the 
Lembert method, before the stone is removed, for the moment the 
stone is delivered, the overstretched walls of the tube collapse in- 
stantly, bile pours out of the incision, presenting almost insur- 
mountable difficulties to a proper closing of the opening. By pass- 
ing the sutures first, the stone fixes the duct and keeps it distended. 
The loops of the sutures are pulled up out of the way, the incision 
is made between the sutures, the stone delivered, and then the 
tightening of the suture closes the incision at once. 

However, before closing the incision into the duct, the sur- 
geon should make sure that the duct is open, both into the intes- 
tine and back into the cystic duct. As it is almost impossible to 
avoid a slight leakage from the duct incision, it is better to pack 
around tube with gauze and then leave drainage; otherwise the 
leakage and diffusion of bile is almost sure to cause trouble. 


It is gratifying to learn how much is being accomplished along 
surgical lines for the relief of this class of sufferers. Few diseases 
of a chronic type cause more excruciating agony to the patient than 
gall stone colic, and any reasonably safe method which promises 
not only relief but a fairly sure guarantee against return is worthy 
of our most careful consideration. I am convinced that gall stone 
surgery soon will stand on the same plane of rational treatment as 
is ovariotomy and hysterectomy, and that in a short time there will 
be placed to its credit the relief of thousands of otherwise incurable 


p. B. ROPER, M. D., Chairman - - - Cleveland 

J. C. WOOD, M. D., Chairman Pro Tern. - - - Cleveland 
"Should All Injuries of the Cervix Be Cared for Surgically,** 

C. E. SAWYER, M. D. Marion 


M. P. HUNT, M. D. - - - - - Columbus 
"Ectopic Pregnancy" 



Normal menstruation is a natural physiological function, 
wholly free from any discomfort. The menses should arrive and 
depart at regularly stated periods without pain or distress, and wo- 
man should be as unconscious, except for physical manifestations, 
of the menstrual cycle as she is of the secretion of urine, the diges- 
tion of food or the automatic operation of the heart. And any de- 
parture from this natural condition, so far as dysmenorrhoea is con- 
cerned, depends upon one of two states of the human economy. 
First, some real organic change within the generative system itself, 
or second, upon some general constitutional incompetency. Either 
of these causes may operate singly or combinedly, and for this rea- 
son it becomes vastly important that we look with the greatest care 
into the causes of dysmenorrhoea when considering the matter of 


By so doing we learn that the possibilities in the treatment of 
dysmenorrhoea oftentimes go beyond the mere fact of local disor- 
der — ^it has to do with disturbed physiological function which nei- 
ther begins nor ends with the generative system, but affects as well 
the whole human economy. 

Dysmenorrhoea is in the majority of instances a disturbance 
of the general nervous system, and to be treated successfully must 
be regarded as such. Therefore the old classification, obstructive, 
congenital, neuralgic, membraneous, etc., do not signify much; 
they have to do rather with manifestations than conditions; they 
are effects, not causes; S3maptoms, not disease. 

This being true, it is necessary that the line of treatment 
adopted should be broader than this classification contemplates. On 
this assumption it is necessary to go farther and deeper than simple 
retrenchment against the occurrence of pain and suffering during 
the cycle. To ferret out the causes and really cure dysmenorrhoea, 
we must go into the family history, personal idiosyncrasies, individ- 
ual habits and surroundings, and lead up step by step to the pres- 
ent disturbance. Want of care in investigation of causes will leave 
many a case to continue but temporarily relieved, if relieved at all, 
when it should be cured and cured permanently. 

To simplify the subject, I shall in my discussion regard dys- 
menorrheoa as due either to local organic change in some of the 
organs of the generative system, or as the result of some general 
constitutional disorder. Among the former we may have sclerosis 
of the ovaries, inflammation of the tubes, displacements of the 
uterus, fibrous growths or stenosis of the cervical canal. Fortun- 
ately these are all conditions which may be readily diagnosed by 
careful physical examinations, and no doctor, no matter how good 
his guessing propensities, or however great his intuitive foresight, 
should ever fail in any case of dysmenorrhoea to make a careful 
thorough examination, and if any of the above named physical con- 
ditions do exist ordinarily, nothing but surgical interference will 
suffice, and no method short of radical surgical means will cure. 
There are remedies which may even in these cases mitigate the suf- 
fering, there are means which may relieve the trouble temporarily, 
but so far as cure is concerned, they are only makeshifts and should 
be so labeled. 


If it is a sclerosed ovary that is causing the trouble, take it 
out; it is already worse than dead, and consequently worse than use- 
less. If it is an inflamed and thickened tube which will not yield 
to carefully indicated treatment, after a reasonable time, remove it; 
it is only a menace to life and should be eradicated. If it is a 
fibroid growth, much may oftentimes be accomplished by internal 
medication, and the local applications of electric means. In this 
connection as a medicinal remedy, I would call your attention to 
iodide of lime, given in five grain doses three times a day. Within 
the past year I have treated successfully three cases of dysmenor- 
rhoea due to fibroid growths to complete recovery by the combined 
use of the violet ray applied externally and the iodide of lime given 
internally. In each of these cases the distress at each menstrual' 
period was so agonizing as to put the patients in bed for at least 
two days out of twenty-eight. 

In cases where medicinal and other means are not sufficient 
there should be no hesitancy in surgical procedure ; enucleation of 
the tumor is. usually easily accomplished, this, too, without compro- 
mising any of the organs. This is a field in which gynecological 
surgery has won many laurels because it saves rather than destroys. 
In the event of mal-position being the cause of dysmenorrhoea, the 
needs are self-evident, nothing but overcoming this will be sufficient 
to the end, and whatever operation or treatment accomplishes this 
best will be most serviceable. 

If a patient has real stenosis of the uterine canal, there is but 
one sensible thing to do ; that is to anaesthetize her and dilate the 
canal freely, fully, thoroughly, only desisting when all resistance 
has been overcome. Temporizing in this matter is worse than use- 
less. I would remind you that a small sound passed within the 
uterus is always accompanied with more or less danger, while com- 
plete dilatation is absolutely harmless. Stenosis is generally re- 
garded as a very common cause of painfid menstruation, but my own 
observation disproves this. If all things else are equal, if the consti- 
tutional forces are acting properly, the normal menstrual discharge 
requires but a small opening for its outlet and a pinhole os doe^ 
not by any means always indicate obstruction to flow and conse- 
quent pain. Such physical appearances are misleading, and it is in 
this particular class of cases that extreme care in diagnosis is neces- 


sary, and without this care the gynecologist's reputation may be 
compromized, for if he promises cure by dilatation alone, his promise 
may never be realized. 

This is one of the cases in which there is some general con- 
stitutional deficiency, and this brings us to the consideration of the 
second class of cases, viz : the one in which general constitutional 
forces are at f aidt and for which the treatment to be employed must 
be general, more persistent, less heroic and more continuous than in 
cases where surgical interference is indicated. 

To illustrate the class of cases to which I now refer I would 
remind you of the numerous cases of young women who come to 
every gynecologist for relief from this aflBiction, the history of many 
of which is imperfect and the cause vague. Local examination re- 
veals no specific cause. The uterus may be normal in position, size, 
shape and form, the cervical canal reasonably patulous, the tubes 
and ovaries practically normal, and yet the pain at the menstrual 
period is extremely distressing. This is what I denominate the 
trying case of dysmenorrhoea. Trying because of a lack of signifi- 
cant symptoms, trying because the patient is not always agreeable 
to the persistency of effort in its overcoming, trying because it is 
difficult to impress the patient and those related with the imporlr 
ance of the correction of habits of life and modes of living. In the 
majority of this class of cases we find two prevailing conditions, one 
a highly organized, over-sensitive nervous system, the other a 
marked disposition to rapid congealing of the blood and of conges- 
tion of all tissues. As a result of these shortcomings, it will be found 
that there is an imperfect condition of elimination going on within 
the body at all times. Examination of the urine will show high 
specific gravity, scanty flow with deposits of urates and phosphates 
in abundance. As a result of this there is going on within the sys- 
tem, a condition of auto-intoxication and all infection, no matter 
what its source, disturbs the nervous system pre-eminently. 

With this condition existing constantly, with the elimination 
forces loaded to their capacity, the menstrual cycle brings not only 
extra duty to the nervous mechanism but likewise extra responsibil- 
ity to the eliminative forces, and without help to carry on these 
extra demands, pain is a consequence, a consequence, too, which can 
only be overcome by constitutional forces operating in a proper 


direction. These are the eases which have to be studied from a 
general standpoint. They are the ones in which matters of diet, 
general habits of life and modes of living have to be taken into con- 
sideration. They need to be taught the importance of general phy- 
sical improvement, they must be instructed in matters of diet, they 
must be led to know that sweets, that stimulants, that highly sea^ 
soned foods and that a nitrogenous diet is hurtful and consequently 
they must be restricted in these particulars. These cases need 
plenty of outdoor exercise. They should be taught to breathe 
deeply, to be regular in their habits of bowel and bladder movement, 
to live as much as possible in the open air. These are the cases that 
should be restricted in social demands, in mental requirements and 
physical waste; unless these conditions are taken into account the 
indicated remedy will be ineffectual and the results unfavorable. 

A young woman presenting these constitutional conditions 
should be instructed explicitly in her mode of living. She should 
be told of the necessity of keeping all of the eliminative organs act- 
ive, the body should be bathed frequently and rubbed briskly with 
a flesh brush. She should drink freely of pure water and take 
plenty of outdoor exercise. In other words, anything and every- 
thing that will bring about the most perfect condition of elimina- 
tion and assimilation must be employed. 

I have purposely omitted drugs and their use because I take 
it that every physician knows when these are indicated and how to 
prescribe them, but I do know that every physician does not realize 
the importance of thoroughness in examination, care in diagnosis 
and the necessity of urging surgery when indicated, and the cor- 
rection of faulty habits of living, and it is to emphasize these par- 
ticular points that I find excuse for this paper. 


Dr. William Baldwin : It seems to me the Doctor's paper lays 
too much stress on the surgical measures in these cases. For thirty 
years I have had the best of success in treating such cases, and I 
don't think I have had to resort to more than a temporary dilatation 
with a steel dilator. I take the homeopathic indications always m 
consideration and treat my cases homeopathically for all the symp- 
toms presented. In fact I have such success that I have had a great 
many patients from other States. I wish I could say I had as much 


success in other diseases and ailments. I find it quite impossible 
to make a complete diagnosis without the steel sound. For in- 
stance, you will find in some cases that the womb has dropped 
slightly and makes a kink, or ante, or retroflection, so that neither 
the menstrual blood nor the sound can pass, so it strikes the poster- 
ior uterine wall. But with the steel sound you can manipulate it 
until you have it in place and the sound will gently find its own 
way to the fundus of the womb by its own weight, and makes about 
one-sixteenth of an inch opening. If we go to work and open it a 
quarter or a half inch we bring about an unfortunate condition that 
will give us trouble. I have been treating dysmenorrhoea in this 
way for over thirty years. Cures almost 100 per cent. 

Dr. Amdt : The tendency of specialists is to forget that the 
part of the body they are concerned with is really related to the rest 
of the body; and that its well being is still in a large degree in the 
keeping of a central nervous system, which relates it to the rest of 
the body, and which makes it bear its part in the general joy or sor- 
row. Any treatment of local disturbance that does not take into 
account this central nervous mechanism falls far short of complete- 
ness. Peripheral manifestations are of use, but are very often 
misleading unless they correspond to central conditions. They 
should serve to call our attention to the real trouble. In the great 
majority of cases of dysmenorrhoea we will find on examining the 
nerve centers that the lower portion of the cord will be sensitive — 
twelfth dorsal, second and fifth lumbar. A permanent cure is prac- 
tically out of the question unless these centers are relieved of the 
trouble existing there. The indicated remedy acts through the 
nervous system, and when we succeed in finding the real remedy 
there is nothing left to be desired. But very few are fortunate 
enough to often find that satisfaction, and mechanical and chemical 
aids are necessary to help perform the cure. I wish to recommend 
the careful examination of the spine in these cases, and the use of 
vibratory treatment for tender centers. 

Dr. Fletcher : I want to express my appreciation of the paper 
and of the hygienic treatment of dysmenorrheoa advised by the 
writer. I also want to say that in electricity I have found a great 
adjuvant. In young girls I find that by placing the negative 
pole over the sacrum and the positive over the uterua 


one can often relieve this condition of dysmenorrhoea, com- 
bining this treatment with proper exercise and food. In 
other cases where we have stenosis by using a dilator with the nega-? 
tive pole in the cervix you can often overcome that painful condir 
tion without the use of surgical measures. You can use the grad- 
uated sound in dilating and get very good results through the inteir 
ligent use of the continuous current. 

Dr. Biggar, Jr. : Dr. Sawyer impressed me with his original 
measures. I want to speak of one feature that has given great relief, 
and that is the exercise of fencing. By fencing you get a develop- 
ment of the pelvic muscles and pelvic structures that strengthens the 
ligaments to support in correct position the displaced organ. I can't 
see how stimulating the sacral nerve centers in the spine will relieve 
a mechanical retro-displacement, for the retroverted uterus is the 
cause of the nervous condition and not the effect, therefore correct 
the mechanical defect and relieve the tension on the sacral nerves 
and then tone up the nervous system. Sounds should be most care- 
fully used. They are at times dangerous. I have seen hyperaemic 
organs punctured from the use of sounds by careful operators. We 
have all of our sounds and dilators made with a shoulder two and 
three quarter inches from the tip, so as to obviate any accidents. 
There was one case of a woman not pregnant but whose womb was 
large and congested and the sound in the hands of a skillful physi- 
cian penetrated the wall, necessitating a laparotomy for peritonitis. 

Dr. Munn asked if Dr. Sawyer curetted in all cases of mem- 
braneous dysmenorrhoea. 

Dr. Sawyer: I do not. 

Dr. Beebe : Dr. Biggar spoke of the use of sounds with shoul-r 
ders to them. I believe that to be a very fine thought. He spoke of 
the danger of perforating the womb, and here J agree with hin^ 
again. I have had the accident of penetrating the wall of the uterus 
with a sound, fortunately without bad results. The first time that 
happened was when Dr. Wilson of Bellefontaine was with me. Wa 
were much alarmed, but the patient got along very well. I have 
done it a half-dozen times since, still I wouldn't recommend it as 
a safe surgical procedure. 


Dr. Amdt, answering a question as to the length of time for 
treatment with the vibrator, said that depended entirely upon what 
is wanted to be done. For stimulation, five to ten seconds ; for inhi- 
bition, from twenty to forty seconds with hard pressure. I think 
the matter of diet could be trusted to the disposition of the patient. 
If the body is normal and functions are active, especially that of 
the stomach, then I think the diet need give us no concern. 

Dr. William Baldwin : The diet has much to do in results in. 
these cases. Keep the stomach sweet and we can accomplish won- 
ders. My attention was forcibly drawn to this by a young lady 
who stated that when she wanted to go to a dance she would drink 
vinegar to first stop her sickness, if "on,^^ at that time. This im- 
pressed me very much, and acting on that suggestion in the treat- 
ment of dysmenorrhoea or amenorrhoea, I always see that by proper 
diet, i. e., using soda biscuits instead of fermented bread, and no 
butter except in cooking, avoiding all acids and acid fruits, using 
meats and vegetables, I delight myself and patients with results of 
the action of the indicated remedy. If the above suggestions are 
disregarded, I am always sure of defeat. 

Dr. Sawyer : I find that I failed in one purpose of my paper, 
in that I did not make clear that there are cases for treatment by 
mechanical means, and that there are other cases that cannot be 
helped except by operative means. I directed my attention chiefly 
to the surgical cases in order to emphasize the necessity of using 
surgical means to effect their relief, and I think by reference to the 
cases cited it will be shown that there is not one of them but that 
does require surgical procedure. When the condition of dysmenor- 
rhoea is due to a nervous cause; when mal-nutrition is the basis 
of the disturbance, then means should be applied in axicordance with 
the demands of the case. Again, each case of dysmenorrhoea is a 
law unto itself and must be so regarded, else we will continue to 
have many failures which might otherwise be recorded as cures. 
Dr. Beebe would have us think that it is a common thing for the 
up-to-date doctor in sounding the uterus to go through into the ab- 
dominal cavity, but I would advise against this course of procedure. 
Of course it may be possible among Beebe's patients to persist in 
this course of treatment without danger. I think this is entirely 
due to the fact that they come from Sidney. 




Pregnancy Outside the Uterus. Extra-Uterine Pregnancy. Tubal 
Pregnancy. Interstitial Pregnancy. 

Normal fertilization of the ovum takes place in the outer por- 
tion of the fallopian tube, the ampulla. The fertilized ovum then 
travels down the tube to the uterine cavity, where it becomes im- 
planted to await further development. In ectopic gestation this 
physiological action fails to take place. From some cause or other, 
probably a malformation of the tube or diseased condition of its 
mucosa, the movement of the fertilized ovum toward its natural 
temporary home is interfered with, and it immediately seeks an- 
other and becomes implanted somewhere along this canal, either 
within that portion of the tube which passes through the uterine 
wall (interstitial pregnancy), or in the narrow, constricted por- 
tion, the caliber of which will allow the passage of a common bris- 
tle, called the isthmus (isthmian pregnancy). Or, in that portion 
of larger caliber which will allow the passage of the uterine sound, 
called the ampulla (ampullar pregnancy). 

That variety of ectopic pregnancy called interstitial is not of 
frequent occurrence; or, if so, it is overlooked, as the ovum in most 
cases becomes, very soon, detached, and pushes its way into the 
uterine cavity, where it may go on to full term and be delivered 
normally, or, if anything untoward should occur, it is treated and 
terminates as an abortion, never having been correctly diagnosed. 

In the second variety, when the implantation is in the narrow 
portion of the tube, we have a different proposition ; the danger of 
rupture is very great, as the gestation sac is thin and the tubal wall 
is thin. This variety can only stand the pressure a few weeks at 
the farthest. Probably the most frequent variety is the third, or 
ampullar. This will stand for development much longer, as the 
caliber is larger. At the distal extremity it may include the ovary 
or the abdominal cavity in its attachment, as the fimbriated end is 
patulous and a slight hemorrhage or even contraction on the part 
of the tube between the attachment of the ovum and the uterus will 
cause an abortion of the tube — ^that is, the fimbriated extremity 
dilates and allows the mass to escape into the abdominal cavity. 


The isthmic or ampullar varieties may rupture into the abdominal 
cavity through the walls of the tube (abdominal pregnancy), of 
between the folds of the broad ligament (intra-ligamentous pregr 
nancy), and further development of the ovum may take place in 
either case if the placenta or embryo is not too seriously damaged. 
The placenta may attach itself to any part of the abdominal cavity; 
intestines, ovaries, uterus, bladder or abdomen, peritoneum, and 
circulation be immediately continued. The embryo usually dies. 
If it goes on to full term, it must be relieved artificially from its 
position. If, on early rupture or tubal abortion, the fetus is thrown 
into the abdominal cavity, it soon becomes absorbed, an.d in a few 
days nothing is found of it. Old embryos arrested in their growth 
either become mummified, macerated, or calcified. 

The uterus in ectopic pregnancy becomes hypertrophied and 
the mucous membrane is changed into a decidua, as in normal preg- 
nancy. This decidua is shed at the time of rupture, abortion, or 
when the embryo dies from any cause. The uterus, as a whole, in 
ectopic pregnancy becomes about the size of a womb in the third 
or fourth month of normal pregnancy. If the tubal pregnancy 
should go on to full term, the enlargement will not increase, but 
will remain stationary; as soon as the decidua is thrown off from 
rupture or abortion or death of the fetus, it gradually becomes 
smaller as involution goes on. 

The symptoms vary according to the stage. In the early stage 
only the ordinary sjrmptoms of pregnancy are likely to be observed; 
cessation of menses, nausea, and changes in the breasts. There is 
the enlarged uterus with softened cervix, and purplish appearance 
of the mucous membranes of the vagina and cervix; all symptoms 
of normal pregnancy. However, there can always be felt, to one 
side or the other of the uterus, a soft and movable tumor which 
should immediately arouse suspicion. When rupture takes place, 
however, the scene changes and that very rapidly. The pain comes 
on suddenly, is sharp and agonizing, and referred to one side or 
the other in the pelvis. Almost at once there is a bloody discharge 
from the uterus. The patient shows symptoms of profound shock 
from internal hemorrhage; she frequently falls to the floor, and in 
a large proportion of the cases, fatal collapse from pain and hemor- 
rhage will occur in a few hours. In some cases the symptoms will 


not be so severe; the rupture may be only partial, and the hemor- 
rhage not so great, but in a few hours, or perhaps days, the rup- 
ture will extend with another attack of greater severity. Then 
there follow general abdominal tenderness and subsequently symp- 
toms of peritonitis. In tubal abortion the symptoms are somewhat 
modified and may easily deceive the patient and physician as to the 
nature of the illness. The ovum becomes detached from its bed in 
the ampulla, or near the distal end of the tube, by hemorrhages 
which have occurred previously, and the dilatation is caused by 
clots forming from those hemorrhages. It is dropped into the ab- 
dominal cavity in a mass, clots, ovum and all, to be walled off or 
absorbed. There will be felt a tender, boggy mass and later sjrmp- 
toms of localized peritonitis. If the rupture occurs between tfie 
folds of the broad ligament, the pain is paroxysmal, likely to recur, 
and varied as to its severity. The symptoms of collapse are not 
so severe because the hemorrhage is not so great, owing to the pres- 
sure given in front and behind by the layers of the broad ligament, 
causing a rapid formation of clot and consequently checking the 

In this variety of ectopic pregnancy there is often found rare 
continued vitality and development of the fetus. If this occurs, 
then there is a secondary rupture into the peritoneal cavity with 
symptoms as outlined above. Few foetuses survive the fourth 
month; if one does, the subsequent symptoms axe those of intra- 
uterine pregnancy with the modification which would obtain under 
the altered conditions. 

Diagnosis, — In diagnosing ectopic pregnancy, the fact that 
there may be coexisting with this condition an intra-uterine preg- 
nancy should not be lost sight of. 

Ectopic pregnancy is most found in those women who have 
some pre-existing pelvic trouble. Diagnosis before rupture or tubal 
abortion is not at all easy. The main reason for this is that the 
patient is rarely ill enough to seek advice; she feels, and her phy- 
sician also, that it is the "same old thing,^^ and an examination is 
not made. However, the symptoms of pregnancy are there and the 
history of the case together with an enlargement of the uterus and 
txmior on one side or other of the uterus; this tumor may be so 
movable that it will have the appearance, or touch, of a cystic 


ovary and may be so diagnosed ; or, if in the narrow portion of the 
tube, it may have the feel of a pus tube and mislead in that way, 
but by keeping in view all the time the symptoms of pregnancy — 
cessation of menses, nausea, and changes in the breasts — ^an approx- 
imate diagnosis should be made in almost every case; excepting, 
perhaps, the interstitial variety. When primary intraperitoneal 
rupture takes place, with the pain and symptoms of internal 
hemorrhage and escape of shreds of decidual membrane from the 
uterus, there is no very good excuse when a diagnosis is not readily 
made. And it must necessarily be made from the symptoms, for 
bimanual examination will aid but little, on account of the pain and 
generally bad condition of the patient. When the rupture is between 
the folds of the broad ligament, the pain is variable and paroxys- 
mal, and the shock, or symptoms of hemorrhage, less severe because 
the volume of effused blood is limited by the resistance afforded by 
the folds of the broad ligament. If this form of rupture takes place 
very early in the stage of pregnancy, the symptoms may be so slight 
as to escape notice, the mass being absorbed without ever being dis- 
covered. But if the secondary rupture takes place, then the symp- 
toms are more marked, for it is now into the peritoneal cavity, and 
we have the same condition as above outlined : severe pain, collapse 
from hemorrhage, etc. If the ovum survives, another series of 
diagnostic indications is manifest, making its appearance after the 
fourth month. The general indications of pregnancy are present 
and remain characteristic as development of the fetus advances. 
There is absence of menstruation, changes in the breasts, vulva, and 
uterus, abdominal enlargement, movements of the fetus and placen- 
tal souffle. Palpation of the fetus is easily made on account of the 
thinness of the abdominal wall. This latter is not to be depended 
upon, however, as a diagnostic point, for occasionally the uterine 
wall is so thin and attenuated that it may give the impression of 
nothing between the fetus and abdominal wall. 

When the term of pregnancy is completed and spurious labor 
comes on, the diagnosis is easily made. The pains are well defined, 
contractile, gradually increasing in duration and severity, recurring 
at intervals and gradually subsiding; after spurious labor and the 
consequent death of the fetus, marked changes are observed, both as 
regards the fetal and maternal structures. The placental circu- 


lation continues for some time after this change takes place. The 
abdomen decreases in size, fetal movements cease, and the uterus 
undergoes involution. In some cases the sac and fetus break down 
into a gangrenous, suppurative mass, with general septic symptoms 
of a severe type. Pus may find outlets through the abdominal wall, 
rectum, vigina, or bladder, and the debris of the macerated fetus 
follow through those openings. Or the fetus may undergo mummi- 
fication, or calcification, and thus the patient escapes the septic 

Treatment — ^Before surgery made such rapid strides it was 
considered good treatment to arrest the development of the ovum 
and promote absorption. Strychnine to the toxic degree, hypoder- 
mic injections of ergot, and puncture of the cyst. More recently 
the injection of morphine into the sac, and later the application of 
electricity. These methods are now all of them obsolete. As will 
be seen by the above description of ectopic pregnancy, a certain 
number of cases will recover by the expectant treatment, and 
this under the most adverse circumstances. By far the larger num- 
ber will recover by prompt surgical treatment. It is shown that the 
mortality of those not treated surgically is over eighty-five per cent, 
and of those treated surgically, six per cent. The operation before 
rupture consists of an abdominal section, removal of the tube, and 
immediate closure of the wound. A simple operation on a patient 
in good condition, is free from shock or hemorrhage and without 
any septic or inflammatory lesions. 

When rupture has occurred into the peritoneal cavity an imme-' 
diate operation is necessary to save a life. It is an emergency to 
arrest hemorrhage and is just as justifiable as to tie an artery in 
any part of the body for the same purpose. When the peritoneum 
is incised, blood clots present themselves and must be rapidly 
turned out imtil the bleeding point is reached and clamped. The 
operator may then be more deliberate, clean out the cavity thor- 
oughly and tie off the tube. Irrigation with hot saline solution will 
be of benefit to the patient as a stimulant and will also help in mak- 
ing the toilet or closing the wound, which may be done without 
drainage. If some time has elapsed between the rupture and 
operation, the danger of sepsis being greater, and nature having 
thrown around the mass a protecting wall, it will be better to make 


the incision through Douglas' cul-de^sac, clean out the clots and 
arrange for drainage in that way, than to run the risk of infecting 
the peritoneum by an abdominal incision. Often these cases are 
overlooked imtil the mass becomes in verity a pelvic abscess, which 
may be emptied in the same way. 

The operation in advanced ectopic pregnancy will vary in 
accordance with the condition of the fetus, whether living or dead. 
When the child is alive the operation should be done without wait- 
ing for the spurious pains. When the child is extracted the sac 
should be stitched to the abdominal wall and the wound dressed^ 
open until disintegration of the placenta has taken place, relying 
on drainage and antiseptic treatment until the mass is discharged. 
After spurious pains and the death of the fetus it is better to wait 
for some weeks before operating. The circulation through the 
placenta will remain active for some time after the death of the 
fetus, and while it is so it is impossible to remove it en masse on 
account of the hemorrhage. After several weeks the placental 
thrombi become organized, then it can be enucleated without danger 
from hemorrhage. The danger to life, when ectopic pregnancy has 
gone beyond the fourth or fifth month, is very great, and this is due 
to the placenta rather than the fetus. 


Dr. DeWitt G. Wilcox : This is an exceedingly interesting sub- 
ject and I want to present one phase of it by relating a case which 
shows some of the legal aspects of tubal pregnancy. 

About a year ago one of our prominent general practitioners 
called me in consultation over a supposed case of tubal pregnancy. 
The patient was a young woman of about twenty-five years of age, 
married three years, never been pregnant. She had consulted this 
physician about a month prior, because she regarded herself preg- 
nant; he agreed with her and she employed him to care for her at 
her confinement. About a week prior to my seeing her she had 
sent for her physician suddenly, because she was flowing and having 
pain. He feared a miscarriage and enjoined rest. The hemorrhage 
continuing next day he placed her in charge of a nurse. Patient 
then began to have severe pain over right ovary; so severe J)hysiciaii 
gave her morphine. Upon the third day physician examined her 
and found a membrane protruding from the os. This he removed 


and upon a close examination of the same, he found it not a pla- 
centa but a well marked decidua. He then made a careful examin- 
ation, found the uterus too small for a three months pregnancy, the 
OS but slightly open, not at all patulous. He also found a well- 
defined lump upon the right of the uterus at the location of the 
tube. This lump was very sensitive and was the place to which she 
referred all her pain. He concluded she had a tubal pregnancy. 
That night her pain was even more severe, demanding morphine. 
I saw her the following evening, obtained history as above. Patient 
thought she was about three months pregnant. Had missed two 
menstrual periods ; found she had all the usual s3rmptoms of preg- 
nancy, save an enlarged uterus; this was but little larger than 
normal. Found the large tube readily and could feel it pulsate. 

Patient, husband and nurse were all sure there had been noth- 
ing which escaped from the uterus save the membrane mentioned; 
this the nurse had not preserved. 

It seemed to me one of the clearest histories of tubal preg- 
nancy which I had ever found. I so diagnosed it and recommended 
operation. Patient was operated next day, found blood clots in the 
right pelvis, tube unruptured, but the fimbriated extremity wide 
open and patulous, from which blood was oozing. I regarded it 
then as a tubal abortion, but could not find the fetus. This was not 
at all unusual, as in but a small percent of cases is the fetus found. 
I cleansed the abdomen, squeezed out the tube and left it undis- 
turbed. I then curetted the uterus to be sure that it was empty. 
I found it so, there being but a few shreds of membrane. The 
patient made an excellent recovery, returning home from the hos- 
pital in five weeks. 

When I presented my bill, the husband said, "Doctor, I have 
made up my mind not to pay this bill, because I have been led to 
believe that my wife did not have a tubal abortion but simply had a 
miscarriage, and that you and my family physician were mistaken 
in your diagnosis." I then consulted his physician and we agreed to 
sue him for our respective bills. We gave him another interview 
and went over the history of his wife^s case minutely, comparing it 
with the records of cases mentioned in our best text books, but he 
was obdurate, as some quack physician had made him believe that 
we had operated unnecessarily. 


We therefore placed the matter in the hands of our attorney, 
and it is on the docket for the next term of court. His attorney 
has made a number of offers to compromise the matter by a partial 
settlement, but we have refused to compromise one cent. 

The grounds upon which he seems to base his position is this : 
When the family physiciaa left the operating room immediately 
after the operation, the husband asked him as to the result. The phy- 
sician replied, "She is all right, but we did not find all that we were 
looking f or,^' he having reference entirely to the fetus ; not meaning 
that there was the least doubt as to the fact she had a tubal preg- 
nancy. The husband related that conversation to a so-called phy- 
sician, whose record with the profession is not good, and this phy- 
sician immediately set to work to make the husband believe that 
our diagnosis was at fault and the operation unnecessary. Undoubt- 
edly the point to be settled in court will be this : Is the presence 
of a fetus in extra-uterine pregnancy necessary to establish a diag- 
nosis. I find from reading and enquiring from other physicians 
that the fetus is found in but fifty per cent of cases. 

Dr. Wood : I think that in early rupture of tubal pregnancy 
there are very few instances where the fetus is discovered, par- 
ticularly if the rupture takes place into the fold of one or the other 
broad ligament, constituting the co-called extra-peritoneal hema- 
tocele. The fetus in very early pregnancy is quickly digested by 
the peritoneum if it escapes into that cavity. In a very large per- 
cent of pelvic hematocele, the cause is a ruptured ectopic preg- 
nancy cyst. However, occasionally we meet with instances of hema- 
tocele due to other causes. A striking instance of this kind recently 
passed under my observation, which I reported in the Medical 
Counselor, and which will appear in its next issue, (June). The 
patient was a woman who had an exceedingly tender mass in the 
posterior cul-de-sac which I took to be a retroverted uterus. She had 
besides the supposed retroflexion, lacerations of both the cervix and 
the peritoneum. She objected to having the uterus fixed in front. 
I therefore anaesthetized her for the purpose of repairing the lacera- 
tions. Under anaesthesia I felt something during the bimanual ex- 
amination give way, the sensation under the finger for all the world 
being like that of a retrofiexed fundus slipping from the hollow of 
the sacrum. After doing the orificial work, I was rather suspicious 


of her condition and therefore opened the abdomen. Much to my 
surprise I found the abdomen full of blood, which proceeded from 
a ruptured ovarian haematoma. My patient would quickly have 
bled to death had I not opened the abdomen and secured the bleed- 
ing point. The diseased ovary was of course removed and the bleed- 
ing point secured. The patient made an untoward recovery, but the 
case shows in a striking manner that we may have hematocele from 
causes other than ectopic pregnancy. The lesson is that in all 
instances where we suspect internal hemorrhage, the abdomen 
should be speedily opened. 

I do not believe that Dr. Wilcox will experience any trouble 
when his case comes to trial in getting almost any number of the 
most eminent surgeons in the country to testify in his behalf. 



When Dr. Emmet first advocated trachelorrhaphy as a legiti- 
mate surgical procedure in certain injuries of the cervix, he builded 
better than he knew. He recommended the procedure for those 
forms of laceration that are attended with eversion, abrasion and 
deposition of the cicatricial tissue. He recognized the part played 
by cervical rents in the production of sub-involution, monorrhagia 
and reflex symptoms. Later on, he recognized the importance of 
cervical irritation and scar tissue as causative factors in the produc- 
tion of malignancy. 

Those of you who were doing surgical work when Dr. Emmet 
first announced trachelorrhaphy as a legitimate and beneficent 
operation can well remember the furore which this announcement 
created. Many were the arguments pro and con regarding the sub- 
ject. A certain class of men, as is always the case, advocated 
trachelorrhaphy as a cure-all and innumerable operations were per- 
formed that never should have been performed. Another class of 
men, ever conservative, disapproved of the procedure in no less 
emphatic language. The latter gentlemen based their arguments 
largely upon the unsuccessful operations performed by men ill- 
fitted to assume the responsibilities of surgery, and who ignored 


entirely the eoliiiter-indieations which Dr. Emmet tried so hard 
to impress upon the profession. Such counter-indications were peri- 
uterine fixation with infiltration, inflammatory diseases of the 
uterine adnexa, etc. Many cases of sub-acute and chronic pelvic 
inflammation were re-excited by the efforis to repair the existing 

The status of trachelorrhaphy today is very different from 
what it was twenty or twenty-five years ago. In the first place, 
the technique has become so simplified that a skilled surgeon ought 
to do the operation in from five to fifteen minutes. Secondly, 
we know much more of the causation of cancer than we 
did twenty years ago. At least we know that cancer of 
the uterus first occurs, in a very large per cent, in the 
cervix; and that 95 per cent of cervical cancers follow in the train 
of childbirth. While then we may still be in doubt as regards the 
exact nature of cancer, we do know much pertaining to the cir- 
cumstances under which it arises. Finally, abdominal surgery has 
reached such a degree of perfection that the counter-indications 
which Dr. Emmet put forth, no longer prevail, inasmuch as the 
practical surgeon will not hesitate to open the abdomen and do 
whatever work may be necessary therein, after completing the 
plastic work upon the cervix and the pelvic floor. Then, too, we 
know much more of the modus operandi of the reflexes than we did 
twenty years ago. Therefore, trachelorrhaphy is performed much 
of tener than it was then, and rarely is it uselessly performed if we 
have present any of the several conditions enumerated. 

I no not mean to infer that every woman who has a cervical 
tear needs to have it repaired. Were this statement to hold good, 
almost every woman who has had a child would have to submit to 
operation. As a matter of fact, the larger per cent of tears of slight 
degree do not call for surgical interference. On the other hand, 
when there is sub-involution with monorrhagia, relaxation of the 
pelvic floor and rectal lesions, the cervical rent should be repaired 
when the other conditions enumerated are cared for. Or in the 
neurotic where there are reflex symptoms implicating the back, the 
intestines, the stomach, the mammary glands, or other parts of the 
body, the cervical rent should be repaired. The technique is so 
simple as to make the danger almost nil in reasonably favorable 


Sub-involution with menorrhagia, retro-displacement of the 
uterus with varying degrees of procidentia, relaxation of the pelvic 
floor, and lesions of the clitoris and the rectum, can safely be cared 
for at one sitting, after which the abdomen can be opened and 
whatever work may be called for done, providing of course no coun- 
ter-indications prevail. After the abdomen is opened lesions of the 
appendages can be dealt with, the uterus fixed in front, and should 
the appendix-vermiformis be inflamed, this can be removed at the 
same sitting. I think that I get more satisfactory results from all 
around surgical work of this kind than do I get from any other 
class of surgery. 

To summarize: 

1. Trachelorrhaphy in skilled hands is practically free from 

2. In all instances where the uterus is enlarged, the cervix 
everted, and there is hardness about the cervix, trachelorrhaphy 
should be performed. 

3. In all nervous diseases occurring in women, cervical work 
may be necessary to overcome symptoms remote from the cervix, 
In these cases even a slight amount of cicatricial tissue in the cervix 
should be removed and the rent closed. 

4. The laity should be instructed regarding the relationship 
existing between cervical tears and malignancy. In all instances 
where a cervical catarrh is perpetuated because of the laceration, 
trachelorrhaphy, with other necessary work, should be done. 



C. 0. MUNNS, M. D.. Chairman - - . - Oxford 

"Keimol id Suppurative Otitis Media" 

ROYAL S. COPELAND, M. D. - - - Ann Arbor, Mich. 

"The Practitioner and the Abnormal Eye." 

T. M. STEWART, M. D. Cincinnati 

*'Cerevisine in Purulent Conditions" 

W. A. PHILLIPS, M. D. Cleveland 

"Injuries of the Eye Ball" 



A common way of scolding is to abuse the offending party over 
the shoulders of a more intimate associate. In order to reach the 
practitioner, then, I propose to speak somewhat in detail of the 
failure of my own specialty in the most important feature of its 
usefulness, namely, the therapeutic treatment of the abnormal eye. 
In diagnosis, direct and differential, instrumental and by inspec- 
tion; in treatment, depending upon local medication and manual 
dexterity, there can be but words of praise. It is in the therapeutic 
field alone that criticism can be offered. 

Homeopathy in Ophthalmology. 

Theoretically, homeopathy bears the same relation to ophthal- 
mology that it does to surgery and gynaecology. In each of these 
fields it should be as conspicuous as it is in neurology, or in the 
treatment of disease attacking the heart, lung, stomach or kidney. 
Practically, in the surgical specialties, homeopathy is frequently 
overlooked entirely, or, at least, relegated to an unimportant posi- 
tion. This statement is, of course, simply a matter of opinion, but 
it is a conclusion based upon observation and, perhaps, experience. 

Disease is a something hard to describe. It meant one thing to 
the physician of yesterday; it means another thing to us; it may, 
and probably will, mean something else to the practitioner of to- 
morrow. But, whether the definition accepted be the birth of last 
year, or next year, it must be general enough to cover every tissue 
of the body and specific enough to describe abnormal conditions in 


any single organ. Therefore, disease is disease, whether it attack 
the lung or the ovary, the kidney or the eye. Homeopathy, then, 
which is a science of therapeutics, bears the same relation to the 
specialty that it does to general medicine. Hence, it follows f&at 
homeopathy must have the same importance in ophthalmology 
that it has in the cure of gastric disturbances. Indeed, if we con- 
sider the organs included in the last comparison, homeopathy 
should be a more important adjunct in the treatment of ocular dis- 
ease, because the accessibility and observableness of the eye add 
to the subjective manifestation of the lesion a wealth of objective 
signs. In compiling the totality of symptoms and selecting the 
similimum the ophthamologist, certainly, has greatly the advantage 
over the stomach specialist. 

Granted that this conclusion is true, why does the ophthalmol- 
ogist neglect the important functions of the internal remedy ? In 
my opinion there are several reasons. For the purposes of this dis- 
cussion it may not be amiss to consider a few of these. 
Errors of Refraction. 

The first is the frequency of functional and even organic dis- 
ease of the eye and the many manifestations of functional nervous 
derangement due to errors of refraction. The mental processes of 
the ophthalmologist differ from those of the general practitioner. 
I do not mean to imply that the Michigan ophthalmologist pos- 
sesses in any degree an intellectual advantage over the general prac- 
titioner of this State. One has but to read the history of the nation 
to know that any citizen of Ohio has inborn privileges and possibil- 
ities far and beyond those conferred upon all the scientific bodies 
of the world. This fact must be due to mental qualities unpos- 
sessed by the less fortunate sons of other commonwealths. But 
every calling in life has its special mental processes. So, the first 
thought which comes to the general practitioner, listening to the 
recital of his symptoms by the victim of a gastralgia, for instance, 
is *^hat remedy is indicated in this case?^^ The first thought of 
the ophthalmologist, however, if the disease be apparently func- 
tional, is, "Has this patient an error of refraction ?" His past ex- 
periences have led him to suspect defective vision in every such case 
and the relief of the symptoms by optical assistance is the first of 
the thought impulses. 


"Habit doth make slaves of us all/' so it is not surprising that 
the ophthalmologist falls into a routine of practice which leads him 
away from therapeutics into material and manual methods. I am 
not here to say the error of refraction should not be given first 
attention. If it is the cause of the symptoms I think it should, but 
my point is that in this specialty there must be constant self-exam- 
ination and reminder, or many a patient will be denied a means of 
cure. Undoubtedly, many a case of asthenopia is treated by the 
administration of spectacles when a broader view and wider study 
would result in a prescription of a remedy far more potent than 

The Limitations of Homeopathy, 

I desire not to be misunderstood. This is a homeopathic con- 
vention, and the members of this program are expected to exalt 
Homeopathy. Nevertheless, I cannot afford to pose in any false 
light and appear to be what I am not. To my mind homeopathy, 
like religion, has suffered by reason of hypocrisy in high places. 
To take part in any public function dedicated to homeopathy 
makes the participant, no matter how humble he may be at home, 
an important factor for the time being. In my judgment, many an 
actor under these circumstances, carried to heights of enthusiasm, 
has set a standard which no sane man in the monotony of actual 
practice can hope to attain. 

Fifteen years of active work in ophthalmology have convinced 
me that the internal remedy, high or low, diluted or triturated, given 
frequently or at long intervals, it matters not, will not cure every 
disease to which the eye is heir. It never has done it and never 
will, until every possible medicinal substance has been proven, imtil 
every practitioner has perfect knowledge of all such provings and 
infinite power of perception of symptoms, and not until he has in- 
finite wisdom in applying his absolute knowledge. Should that 
time ever come, the practitioner will fit the remedy to the disease, 
as the wing of the bird fits the air, but, since such wisdom and such 
knowledge are attributes impossible to finite man, that glorious day 
will never dawn. In the very nature of things, medicine can never 
be an exact science; it must ever be an art. There is no discourage- 
ment in this thought, because in this noble art, who best applies 
himself, who knows most of life and its secrets, who can best apply 


the means of diagnosis and best interpret the manifestations of dis- 
ease, who probes deepest the action of drugs and the symptoms they 
produce, who nearest approaches Hahnemann's ideal physician, he 
it is who will best succeed and whose professional fame will longest 

The Laboratory Idea, 

Let us be honest with ourselves and among ourselves. If gen- 
eral medicine, hygiene, physiological chemistry and bacteriology 
have produced ideas or methods useful to us and superior to any 
other practice at our command, it seems sensible to employ them 
xmtil others have displaced these in usefulness. His readiness to 
do this very thing is another reason why the ophthalmologist has 
too many times been led astray. He finds an eye congested in its 
palpebral conjimctiva, the patient complaining of photophobia, 
smarting, burning and the feeling of sand under the lids. The pro- 
gressive opthalmologist knows of several drugs, notably cocaine and 
adrenalin, which, locally applied, will cause the immediate relief 
of these symptoms and for the time, at least, the apparent cure of 
the disease. He prescribes them repeatedly with satisfaction, but 
at last, contrary to the natural history of such cases, a patient de- 
velops secondary iritis, or cyclitis. The drug used, adrenalin per- 
haps, is an active astringent. It contracts the superficial vessels 
of the eye, causing the subsidence of the external congestion, drives 
the blood to the deeper parts and the uveal engorgement develops an 
inflammation of some part of that tunic. Belladonna, euphrasia, or 
rhus, prescribed correctly, would have spared this complication. 

This experience, however, should not produce a wrong conclu- 
sion. It is not wise to abandon all laboratory suggestion because 
we misapplied our knowledge in one case. Next time adrenalin is 
employed it will be more sparingly used, and the effects more care- 
fidly noted. We would be the losers were we to abandon the gifts 
of the laboratory. Take, for instance, the disease commonly known 
as "pink eye." Much laboratory research seems a useless expendi- 
ture of time and material, but, in this disease, the bacteriologist 
has taught us a valuable lesson. Upon finding the bacillus of "pink 
eye," experiments developed a means of killing it without injury 
to the tissues of the eye. Chloride of zinc diluted materially, say 
one part to five hundred of water, is fatal to the germ and prevents 


its further ravages. Locally applied, this drug is almost a specific 
in "pink eye^^ and, in my experience, will more quickly relieve Ihe 
patient than any internal remedy I have ever used. 

On the other hand, in a case of catarrhal conjunctivitis, of the 
chronic type especially, with all the symptoms of "pink eye,*^ except 
the specific bacillus, I infinitely prefer the homeopathic remedy to 
any local application. But to be honest with myself and you, I hfeve 
purposely spoken both of the value and of the harm of the labora- 
tory idea. Because it is useful in one case, let us not be carried 
away from our homeopathic moorings, but because it fails in an- 
other, let us not condemn it all as an agency of the devil. T^re 
is a middle ground which, it seems to me, may be occupied with" dig- 
nity and propriety. 

Surgical Procedure. 

A third reason for the neglect by the ophthalmologist of 1;he 
use of the internal remedy is his reliance upon surgical procedure. 
Even now, after the performance of the cataract operation many 
hundred times, I confess, in every case, to a peculiar thrill of de- 
light upon the safe delivery of the lens and a renewed feeling of 
admiration for the surgeon who first dared so bold a thing. It is 
no longer great, in a surgical sense, to make* this common opera- 
tion, but, in the moral sense, to the happy patient, restored to light 
and sight, the thing will always seem little short of miraculous. The 
immediate result, the ease and simplicity of the means and the en- 
thusiasm of the patient, all these are a temptation to the humanity 
of the ophthalmologist and, I fear, would continue to be, even 
though he were advised of a certain therapeutic cure. But in this 
condition, where remedies, at best, are of but doubtful value; in dis- 
eases essentially surgical; and others occupying a common ground, 
where relief is possible by either means, surgical or medicinal; in 
all such cases the ophthalmologist is inclined to use the knife, be- 
cause of the greater trustworthiness of his surgical art. 

We cannot overlook the fact that many practitioners fail to 
appreciate the exact nature of cataract. You would smile were I 
to enumerate the different pathological conditions, intra and extra- 
ocular, which have been referred to me with this diagnosis. Any- 
thing which mars the appearance of the human eye, or interferes 
in the least with its vision, is "cataract,^^ not only to almost every 


layman, but also to the average practitioner. Many transient and 
superficial troubles have disappeared coincidently with the taking 
of this or that remedy. Commercialism has done the rest ; the trade 
journals have awakened hope in many breasts and it is doubtless 
true that most persons within the sound of my voice have been in- 
duced to think that cataract is curable by remedial means. The 
ophthalmologist does not believe this. Too many times his disgust 
at the attempts to cure cataract and the evil results of this practice 
in cases where mistaken diagnosis for cataract has caused irrepara- 
ble damage by the neglect of a more serious disease of the eye; too 
many times, I say, this disgust has led him to neglect remedial 
means and made him essentialy materialistic in practice. 

Superiority of Homeopathy. 

Without further attempt, I think we have shown sufficient rea- 
son why homeopathy is neglected in ophthalmology. Dependence of 
the specialist upon the test case, the laboratory methods, and sur- 
gical technique, has so engrossed his thoughts as to make him for- 
get the wonderful resources of the materia medica. At times he 
fails to remember that the eye is but one small part of a great whole. 
Observation and study of the patient, the local disease for the time 
being subordinated, will give him a broader and a better view of 
the condition. With this general oversight and a careful compila- 
tion of the totality of the symptoms, the ophthalmologist will know 
more of the condition in hand. Then, with more frequent and more 
critical study of the materia medica, he will find in every case a 
helpful adjunct and, in many, the only hope of cure. 

My plea, then, is that homeopathy is as essential to the oph- 
thalmologist as to the general practitioner and, to both, is more sim- 
ple, more useful, and more potent than all other measures at their 

Dr. Stewart : If no one else wants to discuss the paper, I will 
have to say the few things that occur to me. The thing that we 
know most about is generally the thing we like. If we know some- 
thing about the anatomy, physiology, and diseases of the eye we 
will do better by our patient, than if we do not know anything about 
the eye. We will go along the best way we can; if the patient 
doesn't get better, then we will send him to the specialist. How do 


I know that? I have been in general practice and I know how the 
general practitioner feels in regard to diseases that he dosen't feel 
quite sure about. Dr. Copeland has brought out pretty clearly by 
comparison the idea that you can get at the disease of the eye for 
diagnostic purposes very much easier than some other organs. I 
think he has done right to strike at the root of the matter in his 
essay in criticising the specialist first and then the general practi- 
tioner. A good deal of trouble is in the colleges in the teaching of 
this specialty, its anatomy, physiology and disease ; for many a stu- 
dent will go out without a knowledge that will tell him what is 
glaucoma, or iritis, or cataract. The fault lies somewhere in the 
teaching. But if the student knows he can tell the one from the 
other, then he is a long way better off than the ignorant one. He 
will know the first moment when it is necessary to send a patient 
to the specialist in order to save his sight. Let me cite you an 
illustration : 

Here is a case with a coated tongue, some nausea and vomit- 
ing, bowels disordered — it doesn^t matter which sex — ^the physician 
doesn^t make any diagnosis, even the oculist may not feel very sure 
of the case if it happens to come to him. They let this thing go 
along and at intervals they see it and give medicine. They use good 
homeopathic remedies upon their indications, but they don't get 
the patient cured. They declare it was a case of bilious attack, 
liver and stomach involved. There was one other symptom that one 
specially noted and that was of the eye. The right eye was inflamed. 
If the physician had known that all he would have had to do was 
to palpate that eye he could have told right then whether it was 
a glaucoma or not. But he didn^t know that. He was treating 
a primary eye disease and yet he looked upon the other symptoms 
as the primary ones and this as the secondary. The other diflBculty 
comes in the teaching that our boys are getting. I do believe that 
the men who go out from our homeopathic colleges are a little bit 
better quality when it comes to the specialists. But when they go 
out of some of our institutions they look upon this specialty busi- 
ness as something to come later in life when they have had the ex- 
perience of general practice. 

Dr. Copeland : There is just one thing I want to say in clos- 
ing, and that is there are some things every general practitioner 


should know about the human eye. If I had my way I would re- 
quire that every examining and registering board in the United 
States insist upon the applicant knowing: First, the treatment of 
ophthalmia neonatorum; second, the diagnosis of glaucoma; third, 
the recognition and treatment of iritis. It is a sad commentary 
upon the carelessness of the medical profession that many, many 
times the practitioner takes it for granted that any redness of the 
eye is simply a little passing hyperaemia which he regards as of no 
consequence, but which perhaps is an evidence of glaucoma. Only 
recently a case came to me from the hands of a general practitioner 
where the patient had a "redness of the eye." The doctor thought it 
was iritis and instilled atropine. In a few hours the patient was 
hopelessly blind. So there are certain things about the eye that 
the general practitioner ought to know. If I had my way I would 
not only arrest doctors so terribly ignorant and have them tried for 
malpractice, but also would have them boiled in oil, or give some 
other awful punishment. 



If the title of this paper had been "Brewer^s Yeast,^' as a rem- 
edy in purulent conditions, every one would at least have heard of 
its use, if indeed he had not used it in some troublesome cases. 
Cerevisine is simply dessicated yeast. 

Yeast has been a useful remedy in the old days and has a place 
in the internal treatment of boils, furuncles, abscesses and all puru- 
lent conditions. If it had not done good service in the hands of our 
elder brothers in the practice of medicine, there would have been 
no effort made to overcome the difficulties in securing fresh brew- 
er's yeast nor in presenting it in a more enticing form than in the 
days of yore. 

Workers in breweries discovered that yeast taken internally 
cured boils. Empirical use of the remedy extended its field of use 
to smallpox, tuberculosis, malignant growths, and to purulent con- 
ditions in general. Success in overcoming some of the troublesome 
symptoms of otorrhoea, diabetes, ulcerative conditions wherever 


located in or on the human body, gonorrhoeal vaginitis and gleet, 
led to deeper study of its action in bacteridian disorders. 

The bacteriologist tells ns that yeast has phagocytic proper- 
ties to a remarkable degree, as demonstrated on the gonococci, 
staphylococci, and all pathogenic organisms. 

The yeasts are classified among the hyphomycetes or web-like 
fungi, in which group the moulds are also classed. They are aero- 
bic, growing only in free air or oxygen. Their absorption of oxygen 
is accompanied by an elimination of carbon dioxide. Nucleinic acid, 
the essential constituent of the nuclei of cells, is also a constituent 
of the yeast cells. It has been demonstrated by Horbaczewski that 
the nucleins produce a leucocytosis, thus increasing the body resist- 
ance. Other observers have demonstrated that the nucleins are 
the germicidal elements in the blood. 

On account of the difficulty of getting brewer's yeast fresh, and 
in keeping it because of its liquid form, it has not been used as ex- 
tensively as its therapeutic merit deserves. 

A year or so ago we saw a report of several cases in a Spanish 
journal in which cerevisine was used with much success. Since 
which time we have learned that the remedy can be secured in this 
country through Fougera, of New York, the agents for the French 
chemists, Eigaud & Chapoteaut. 

In our hands it has acted well in several cases of furuncles of 
the auditory canal. Cases that went on to the development of suc- 
cessive crops of boils in the auditory canal, in spite of care in diet, 
local anticeptic cleansing, and the exhibition of calcarea picrata, 
hepar sulphur, f errum phosphoricum, mercurius, silicea, and other 
remedies. A few doses of cerevisine in the beginning of the 
attack now stops them short in these cases. 

Three cases of small boils in the entrance to the nostrils hiive 
made more prompt recoveries than we have heretofore been able to 
obtain by other treatment. Two cases of boils in general accom- 
panying a tonsilitis have been not only markedly relieved, but in 
addition the remedy has been used at the first sign of a second 
attack with great satisfaction to the patients. 

In puriQent conditions of the middle ear, aided by cotton cone 
drainage strips, cerevisine has been of decided advantage. 

In all pus or septic cases the remedy will aid in the cure at thai 
stage when intestinal fermentation is a factor. 


The remedy is the dessicated yeast cells prepared at a low tem- 
perature in vacuo. It can be given in water with a little sugar 
or in beer. Some patients object to its taste or foamy appearance; 
in such cases it can be given in gelatine capsules. The dose is one 
teaspoonful before each meal. In several cases the JSTo. 1 capsule 
has been the dose, and even in this small dose it has done its work. 
Locally it can be used in glycerine acidulated solution. 

We think yeast in the form of cerevisine is a remedy of suffi- 
cient value to call it to your attention, and this short paper intro- 
duces an old friend in a new dress which we hope will aid you in 
some of the numerous purulent conditions that resist the indicated 



Injuries of the eyeball for the most part come under the fol- 
lowing heads: 

1. — Blows upon the ball, producing concussion and perhaps 

2. — Penetrating wounds produced by &ymg chips of metal or 
by various agents, such as points of scissors, forks, knife 
blades and the like. 

3. — Bums and scalds. 

Concussion of the ball even by a blow over the closed lid will 
often produce serious results by rupturing the retina or choroid, or 
both, or by inducing optic neuritis, followed by more or less com- 
plete atrophy of the nerve. This may occur, too, without any ex- 
ternal visible signs that impairment or total loss of vision will 

In the event of rupture of the retina and choroid, hemorrhage 
occurs into the vitreous when of course no view of the fundus caH 
be obtained imtil absorption of the blood is brought about. If the 
iris is ruptured, the anterior chamber fills with blood and equally 
excludes a view of the interior beyond, so that it becomes uncertain 
whether there is extravasation into the vitreous body or not. After 
the anterior chamber clears, which will usually be in a day or two, 
the condition of the vitreous can be readily ascertained. 


The lens is very liable to suffer in accidents of this sort by a 
rupture of its capsule, producing surgical cataract; or what is still 
worse, it may at the same time be dislocated into the vitreous, or 
more rarely, into the anterior chamber. 

In order to save further complications, immediate extraction 
of the lens becomes necessary. 

If the foreign body comes in contact directly with the cornea, 
an abscess, or an ulcer, or interstitial inflammation is likely to add 
to whatever other disturbance is present in the case. Extensive rup- 
ture of the cornea or of the sclera is comparatively rare. If, how- 
ever, it does happen, extirpation of the ball generally becomes indi- 
cated sooner or later. 

Yet it is not impossible that a large proportion of the vitreous 
and the lens also be lost, and still a fair degree of sight be main- 
tained — ^the lost vitreous being replaced by the action of the struc- 
tures that likewise secrete the aqueous humor. 

Provided the cornea be ruptured, a complication arises — ^the 
iris being forced into the wound by the sudden gush of the aqueous 
fluid. This will displace and perhaps obliterate the pupil, and un- 
less the prolapsed part be drawn from the wound and excised within 
a few hours it will heal up in this imprisoned condition with cor- 
responding loss of sight. After all inflammatory symptoms have 
subsided, an iridectomy can be made which will give a more or less 
serviceable pupil according to the extent of the injury. 

The scar tissue formed in certain cases by its contraotion will 
sometimes make pressure on the nerve twigs caught in its meshes 
and will be accompanied by pain if not also by symptoms of sjrm- 
pathetic trouble. If the iris and ciliary body are seriously involved, 
it is commonly the case that the pathological changes in the ciliary 
region will lead to a softening of the globe, loss of sight, and even- 
tual loss of the ball by operative measures for the relief of pain and 
for safety to the other eye. 

The subsequent changes which occur in a badly injured eye, 
whether laceration has occurred or not, should be carefully watched 
lest the other eye gradually become involved to the extent of par- 
tially or completely impairing the function. 

No little discussion in the past has resulted in respect to the 
immediate removal of an eye in which a foreign particle of metal 


has been driven and which is so situated as not to be removed from 
the eye. So far as I am able to judge, if no severe inflammatory 
symptoms occur in the injured ball and no irritation of the fellow 
eye be present, it is reasonably safe to allow the suspicious member 
to remain. But it should be carefully watched, and if it become 
inflamed and painful, and certainly if any sympathetic disturbance 
appear in the other eye, the former should be extirpated at once. 

It is, however, usually the case that the foreign body does not 
become so entirely encapsuled that it does not in the long run give 
trouble and demand operative treatment. If the foreign body be 
any substance that can be influenced by the electro-magnet, the 
chances of removing it without serious damage to the eye is much 
enhanced. The use of the X-ray for localizing the particle, if it 
be imbedded, is of great service and makes it possible to operate suc- 
cessfully in certain cases in which it would otherwise be impossi- 
ble. But it cannot be too strongly impressed upon the mind of the 
physician that an eye containing a foreign particle is in much dan- 
ger and that sympathetic inflammation is exceedingly liable to affect 
the sound eye. Hence it should be closely watched if not removed 
at once. 

In burns of the eye occasioned by flying bits of hot metal or 
by acids or lime, the cornea is commonly acutely inflamed and re- 
sulting opacities may greatly impair the sight. Hot particles of 
metal or mortar often burn into the tissues and firmly adhere. 
They are best removed by first putting a few drops of oil into the 
eye and then gently scraping the pieces away with a piece of cotton 
or linen cloth over the end of a probe, or by the use of a scoop. A 
1 per cent solution of cocaine should first be instilled into the cul- 
de-sac ; and in many cases the use of chloroform will be required. 
The conjunctiva should not be lacerated more than is absolutely 
required in order to get the particles away. 

Cold applications should then be used to combat the inflamma- 
tory action that is bound to arise. Atropine sulfate, a 1 per cent 
solution, should be dropped into the outer opening of the lids to 
anticipate iritis. Antiseptic measures should of course be freely 
employed so long as there is any broken or ulcerated surface. 

I repeat that it must be recollected that the after effects of 
wounds and burns are much more serious than the severity of the 


case would at first seem to indicate. The contraction of scar tissue 
and the opacities are very important results to be reckoned with in 
the great majority of cases, together with the danger that the lid 
becomes adherent to the globe in the process of healing (sjnnbleph- 
aron). The prognosis therefore must be guarded or not given 
at all. 

Hoping this condensed view of the subject may aid the gen- 
eral practitioner somewhat, I leave it for whatever good it may do. 


Dr. Copeland : I feel like thanking Dr. Phillips for this clear 
paper — ^his papers are always clear and always helpful. I have 
risen to my feet to make one suggestion. I had a case once of an 
injury to an eye-ball where there had been no infection apparently, 
but where there was great prolapse of the vitreous, the ball shrunken 
like a collapsed football. A simple procedure restored and preserved 
the eye. With a hypodermic we injected normal salt solution, pass- 
ing the needle through the incision. The organ immediately took 
shape and recovery was uneventful and satisfactory. 



Two years ago Dr. Walton called my attention to keimol as 
an excellent antiseptic, since which time I have found this remedy 
to be a valuable addition to my surgical and obstetrical bags for 
sterilizing my hands and operative surfaces. 

It is an agreeable, bland, non-irritating germicide and anti- 
septic which is composed of pure phenyl salicylate and the active 
constituents of thymus vulgaris, gaultheria procumbens and 
mentha piperita, and is certified by reliable bacteriologists to de- 
stroy all bacteria in one minute's contact with the pure keimol, and 
a dilution of one to four parts water to destroy all bacteria in ten 
minutes' contact. 

About one year ago I had a particularly stubborn case of sup- 
purative otitis media come under my care, which was promptly 
cured by the use of keimol warmed and dropped freely into the 
ear after carefully cleaning with a solution of peroxide of hydro- 


gen three parts and alcohol two parts. Following this success with 
the remedy, I used it in acute and sub-acute suppurative inflam- 
mations with excellent results. I have never had an opportxmity 
to try its use in suppurative cases with destruction of bone tissue — 
what is usually termed operative cases — ^but believe the remedy to 
be worthy of a trial in the early stages of carefully selected cases 
of this class ; also in old chronic cases. Where it is desired to med- 
icate the deeper tissues when a hole exists in the drum, turn the 
affected ear up with the patient in the horizontal position, drop the 
medicine into the ear, and create a partial vacuum in the throat 
by closing mouth and nostrils, and instrucing the patient to inhale 
forcibly. The medicine will thus be drawn through into the throat 
in many cases. This effort can be repeated a number of times in 
succession, if necessary, to produce the desired result. Should you 
find it necessary to dilute the remedy, use alcohol as the diluting 
agent. I believe that water solutions should be avoided as much as 
possible in suppuration of the middle ear. Where it is desirable 
to avoid all water solutions, I have found a one to one and one-half 
per cent solution of picratol in alcohol to be the best. It has the 
disadvantage of causing a little pain in some cases. 

On the whole, I have never found any other remedy the equal 
of keimol in giving me such uniformly good results in suppurative 
inflammations of the middle ear. 


ELLA G. HUNT, M. D., Chairman _ _ _ Cincinnati 

*' Hepar Sulphur in Nose and Throat Work" 

P. T. KILGOUR, M. D., - - - - College Hill 

" The Care of the Throat" 



This is a broader subject than would appear at first thought — 
broader than can be properly discussed in this brief paper. Al- 
though this paper belongs, properly speaking, to the Bureau of Dis- 
eases of the JSTose and Throat, and they tacitly include only the in- 


side of those structures, this brief effort will be found to-be more 
or less of the shotgun order, taking in everything within easy 
range, including the outside as well as the inside. Then, too, its 
purpose is not so much to be technical as practical, not so much 
specific as general. 

The causes that go to make up a weak throat are legion, both 
inherited and acquired. Some there are who are not conscious that 
they have a throat any more than they are conscious of the posses- 
sion of any healthy organ, while others are scarcely ever permitted 
to forget that they are principally throat. 

As on the care of the throat depends largely the quality of the 
voice, it becomes a vital question, and one of national importance^ 
because of the national characteristics attaching to voice produc- 
tion. Each nation or people has its own peculiar quality of voice, 
due largely to peculiarities of structure of the throat, and to the 
care, or lack of care, which it receives. Who can not at once call 
to mind the soft, dulcet, persuasive tones of the Hibernian, who 
knows little or nothing of catarrh of the upper air passages ; or the 
nasal twang of the Yankee, who fights catarrh continually, and who 
talks as though he had a clothespin astride the cartilaginous por- 
tion of his nose? What more attractive possession than a well-mod- 
ulated voice, and how much this ought to be and is sought after ! 

In our national life too little thought is given to the matter 
of retention of good quality of vocal tones when they are natural, 
or of their production when not naturally possessed. It is said 
that there is a famous boys' school in London that has made for 
itself world-wide reputation for the sweetness and power of voice 
possessed by its members ; and this is largely brought about by the 
fact that all screeching, shrieking and cat-calling are strictly for- 
bidden, that the boys are compelled to talk in an easy, natural tone 
of voice, and to go bareheaded almost the entire year with little or 
no wrapping about the throat. It would be hazardous to predict 
what would happen if these boys were allowed to attend an Ameri- 
can baseball game and take a few lessons in the gentle art of "root- 
ing'* as practiced by old and young in our glorious land, not to men- 
tion an experience of the violence perpetrated by college yells, and 
other ear-splitting vocal inventions. 


With the general lack of thought given to the care of the throat, 
not to speak of its actual abuse, it is a matter of wonder that our 
national voice is as sweet and resonant as it is. We as physicians 
are, as our name indicates, teachers, and it behooves us to do all in 
our power to influence those under our care in such ways as will 
conduce to strengthen the throat and thus improve the quality and 
power of the voice. One of the commonest mistakes made is the 
habit of wrapping up the throat warmly at the first approach of cool 
weather in the fall of the year. This invariably paves the way for 
over-sensitiveness of the structures of the throat, and repeated colds, 
especially if the wrappings are for a single occasion forgotten. If, 
instead, morning spongings of the throat, neck and shoulders in 
water gradually cooled to a point from which the patient readily 
reacts were indulged in, followed by brisk friction with a coarse 
towel, the result would be more than gratifying. Much, too, can 
be done to strengthen the throat by systematic massage of the struc- 
tures of the throat, neck, shoulders and chest, and by active and pas- 
sive manipulations of the head and neck. The vocal practice of 
tiirowing the larynx forward as in an attempt to say ao, e, ft, o and & 
with the lips first open and then closed, is also excellent. 

It has been repeatedly demonstrated that public speakers, and 
those suffering from relaxed throat have been cured by a systematic 
course in vocal training at the hands of an experienced teacher when 
medicines alone had signally failed, showing the paramount value 
of so-called physical methods of cure. This is not intended to dis- 
parage the use of the properly indicated homeopathic remedy, but 
rather to aid its action; and it also pre-supposes that whatever of 
surgical measures are necessary, such as the removal of incurably 
diseased tonsils, and the opening up of stenotic conditions in the 
nasal passages, have been carefully looked after. 

Dr. Pulford : A great majority of throat troubles are not due 
to exposure of throat, but to a chill, which deteriorates the quality 
of the blood, congests the glands and often leaves them chronically 
enlarged, especially the tonsils. Hence instead of treating the 
throat locally, let the physician direct his treatment to the patient 
generally and caution against taking cold or chilling. 




It is not that I shall say any new thing, but rather only briiig 
as it were a word of commendation for a friend that has helped me 
many a time this past winter. We are not always of the same opin- 
ion as to the action of a remedy as our friends of dominant or eclec- 
tic schools, but I like to know their opinion. As to this remedy, we 
are all agreed. That to prevent the formation of pus or limit the 
quantity of its formation when inevitable, hepar is one of the best of 
friends. This is some of their testimony : 

"Calcarea Sulphide is a valuable remedy on account of its 
power over cellular and cutaneous inflammation with suppuration, 
or tendency to suppurate. It influences glandular and Ijrmphatic 
structure, proving a good remedy in suppurative adenitis.^^ 

"The best antisuppurative known when the condition is not 
due to syphilis.^^ 

"A remedy for nasal catarrh where the secretion is Abimdant 
with a tendency toward purulency and where patient readily takes 
repeated colds.^^ 

"In inflammation of areolar or connective tissue with tendency 
to suppuration and to prevent suppuration.^^ — Felton Lloyd, 

Again : "There seems to be little question that all suppurative 
processes are modified by calcarea sulphide in a most marked man- 
ner, ichorous pus being rendered laudable and abscesses hastened 
to maturation when once established or aborted if taken in time. 

"Glandular enlargements of the strumous and scrofulous are 
benefited by its use.^^ — Foster. 

This testimony is so similar to our own experience that I won- 
der if it might not be borrowed from us ; if so, we have more to lend, 
and that just as good. 

Our Allen says : "A tissue drug of wide action. It simulates 
mercury in its action on glandular system, sulphur in its action on 
mucous membranes, calcarea in affections of respiratory tract and 
all foregoing in its general action on connective tissue.^^ 

I think we may find it of great use in diseases of nose and 
throat. It is in suppurative inflammation of nose and throat that 
I first found hepar so valuable. 


Last winter one of the most distressing secondary symptoms of 
grip was the tendency to the formation of abscesses. The joints and 
alveolar processes were often attacked, so were the accessory sinuses 
of nose, and in these cases of acute sinus disease, both of frontal and 
sphenoidal sinuses I know hepar has brought relief, and so far 
apparent cures. 

Even in some chronic cases it has relieved the distressing symp- 
toms of severe pain, dizziness, loss of smell, etc., reducing the swell- 
ing of mucous membrane and affording an opportunity for better 

Such a statement of calcarea sulphide is applicable to a num- 
ber of maladies, chiefly those of a septic or pseudo-septic character. 
As grip might easily be classed as a disease of a septic or pseudo- 
septic character, we would expect calcarea sulphide to be of great 
service in its treatment. In fact, ten doses per day, one-tenth grain 
each have shown favorable action in influenza, frequently aborting 
the attack. 

Finding it to so readily relieve the symptoms where pus had 
already formed, and as this tendency to abscess formation seemed 
to be a prominent phase of grip for a while last winter, I decided1:o 
use it early in grip cases. 

I am not in general practice, but during the winter I am one 
of those unfortunates who board, and often act aJs a house physician 
to those in the house. An epidemic of grip struck the house about 
this time, expending its force on nose and throat, so I had an oppor- 
tunity of testing this remedy. 

There were in these cases extreme chilliness, cold shivers run- 
ning up and down the spine, greatly aggravated by cold air, or even 
a suspicion of a draught. Patient very sensitive to all external 
impressions, noises or touch; marked headache, more marked in 
frontal region than at base of brain, of a sticking or boring char- 
acter. Dizziness marked at beginning. General aching and back- 
ache quite pronounced. Perspired easily even when feeling chilly. 

On inspecting nares, mucous membranes were red and swollen, 
especially turbinates and mucous membrane of the septum opposite 
middle turbinate. Discharge scanty at first, became yellow or yel- 
lowish green later. Pharynx red and two cases had tonsilitis. 


Hepar sulphur IX or 2X one-fourth grain every two hours, for 
one day, every four hours if necessary second day, was treatment. 
It seemed to act quickly and well. As I believe that many cases of 
suppurative inflammation of middle ear need never involve the mas- 
toid if given hepar or silicea, so I believe that in hepar sulphur 
we have a remedy that will cure most cases of acute inflammation 
of accessory sinuses, especially if at first we rely on the remedy and 
do not use much forceful exploratory probing. 

We may not be able to give as exact a diagnosis, but think we 
may cure more acute cases and prevent more chronic ones. 

Hepar is useful also in chronic follicular pharyngitis with 
cough, muco purulent discharge, hoarseness with relaxed uvula, all 
aggravated in changeable weather, especially change from warm to 

Deep-seated, chronic inflammation of tonsils and of glands of 

For phlegmonous or suppurative pharyngitis, sometimes de- 
scribed as erysipelas of pharynx, hepar is a specific. 

For quinsy, I generally give hepar at first, not waiting for stick- 
ing pains, chilliness and rigors indicative of oncoming suppuration. 

In croup, chronic rhinitis, nose stopped up every time patient 
went into cold air, chronic catarrhal inflammation of nares and 
oro-pharynx, with much secretion of mucus, vocal defects of sing- 
ers, over-use or strain producing hoarseness or aphonia and result- 
ant laryngeal pain, soreness, congestion and inflammation. This 
remedy often restores the lost timbre of voice. 

Says J. S. Mitchell: "In chronic laryngitis, this remedy has 
done so much for me that I consider it the most effective of all rem- 
edies. Its use in cases occurring in professional singers has been 
attended with such success that I do not hesitate on taking the case 
to express the belief that not only the laryngeal inflammation will 
be relieved but that a manifest improvement will be apparent in the 
quality of the voice." 

This I have verified. 

General characteristics of hepar: Pains usually splinter like 
in character, aggravated by cold and dry winds. Hepar patient very 
sensitive to any pressure, touch or cold air. Septum nose very 
sensitive to touch. Worse on uncovering body. Worse in dry cold. 
Better in damp. 


Allen says: "There is no remedy that I know that has the 
amelioration so strongly marked in damp weather. Never give 
when there is a hot dry skin. Patient always sweaty and weak. 


Dr. Florence Smith-White wished to emphasize the value of 
the feeling of a splinter in the throat in these cases. This pain 
seems to be necessary to get the best eifect from Hepar sulphur. 

Dr. Kilgour : In regard to the use of hepar in croup, the essay- 
ist does not say that she used it, and yet it is one of our main stand- 
bys, not in the dry, barking croupy cough, but when it becomes 
loose and rattling and is still croupy. 

Dr. Zbinden: We must distinguish between the commercial 
calcium sulphide and hepar sulphuris. While the two are similar 
chemicals, they are by no means identical. By looking them up in 
the pharmacopoeia we find that they are prepared by different pro- 
cesses. Hepar is white and calcium sulphide is gray. 


R. B. HOUSE, M. D., Chairman - - - Springfield 

J. D. BUCK, M. D. - - - - - - Cincinnati 

" Hallucination " 

LINCOLN PHILLIPS, M. D. - - - - Cincinnati 

" The Relation of Rheumatism and Allied Conditions 

to the Nervous Disorders of Childhood " 



In studying the mechanism, conditions, and finally the nature 
of perception we are dealing analytically with our momentary expe- 
rience. We constantly realize that we are hot or cold, comfortable 
or imcomf ortable ; that an object is rough or smooth, hard or soft; 
that a sound is soft or harsh ; that a substance is sweet or sour, pleas- 
ant or disagreeable, and so on through all the varied sensations or 
emotions that result from our contact with the external world. The 


varying result of all this experience in consciousness we call percept 
Hon, Within, there is the perceiver; without, the external world of 
matter and motion. Connecting these two ends of the apparatus, 
is the sensory nerve mechanism. Consciousness may be conceived 
of, as a mental etherial, or psychic atmosphere, surrounding and 
including the whole apparatus. Consciousness is not an attribute 
or faculty like will or hearing, or perception. Consciousness sub- 
tends, includes and antedates all these. Consciousness is an ulti- 
mate. Consciousness in itself, does nothing, and we can do nothing 
without it. Indeed we should not know that we exist at all, without 
consciousness. Consciousness is therefore the first condition of 
existence or knowing. That without which we could not know 
anything, and that concerning which we know nothing except that 
it is, is consciousness. That is the meaning of consciousness as an 

Nine tenths of all the obscurity in psycholgy arises from the 
misapprehension of, and false ideas and relations as to what we 
call consciousness. 

It is essential, therefore, that we start right here. 

N'ow, returning to the mechanism of perception, there is first 
an objective stimulus, something in some way affecting the appar- 
atus from without ; as light to the retina ; sound waves to the t3mi- 
panum ; contact to the touch corpusceles, etc., the result to the per- 
ceiver in consciousness is a sensation. While as to perception in 
general, and a sensation in particular, a mechanism is required and 
a process is involved, the result; viz. a valid experience in con- 
sciousness, constitutes perception per se. 

Even so eminent a writer as Prof. Ladd speaks of consciousness 
as "perceiving.^^ 

Bear in mind, then, the mechanism and conditions of all per- 
ception, we find an external contact of some kind essential and ini- 
tial in the process in an average experience. If now, an external 
stimulus is applied, like a hot iron to the skin, light to the retina, or 
sound waves to the tympanum, and no sensation results, and no 
perception follows, we say there is peripheral paralysis, or loss of 
the function of sensation, or the power, so far to perceive changes. 
We are now ready to define hallucination. 


Where changes are perceived in the sensorium, and yet no exter- 
nal stimulus has been applied, the condition and the result are called 
^hallucination." This is usually designated as "false perception re- 
sulting from no objective stimulus at all." 

N'ow let us take the following statement of Prof. Ladd of Yale 
University. "What every man sees will depend upon what sort of a 
percipient he is, upon his memory, imagination, feeling or will. For 
every case of perception affords a new problem to consciousness; and 
precisely how that particular problem will be solved depends upon 
a great variety of conditions.*' 

"No man has the gift to see things as others see them." Again : 
''All perception is interpretation; and from partial or mistaken 
interpretation all degrees and hinds of illusions and hallucinations 
result," And finally, — quoting from the same authority "it is ordi- 
narily quite impossible to be sure that no peripheral stimulus is 
involved in what appear to be purest forms of hallucination," and, 
"if, further, we distinguish objective stimulus, from peripheral 
stimulus, then we must say of the former, that it has absolutely 
nothing to do with perception, whether true, illusory, or hallucina- 

My whole purpose in writing this paper is to call attention to 
this important and radical distinction between "objective stimulus ;" 
i. e. material contact, and periphereal stimulus, which may be alto- 
gether subjective; that is, beyond the ordinary tests for 'matter. We 
are thus driven back to the realm and conditions of consciousness, 
and the whole realm of nature's finer forces. In other words, to 
the ethereal rather than to the gross material conditions of human 
experience. The whole trend of modern psychology is in this direc- 

The whole problem concerns the nature and conditions of con- 
sciousness, in relation to experience, and cannot be confined as here- 
tofore to crude matter and objective contact. 

To the individual intelligence, a genuine hallucination, as the 
term is ordinarily used, — that is, where no objective material con- 
tact can be shown to exist, is nevertheless as valid to the individual 
as any other experience. As an experience it is valid to the indi- 


If this is denied by anyone, let him try to convince — say, a 
patient with mania potu that he does not see apes, or little devils ; 
or an insane person, that he does not hear voices, and he will soon 
be convinced that as an experience, these so-called, hallucinationa 
are, to him who perceives them altogether valid and real, no matter 
whether the average individual sees or hears them or not. Practi- 
cally, therefore, the whole question of perception, no less than that 
of thought, feeling, emotion, desire, ambition, etc., comes back to the 
problem of self-control. That is, the individual may, and if he 
would be sane, must control his experiences. The will may control,^ 
and the imagination choose and select the content of consciousness. 

This is the principle of mental and emotional g3rmnastics, and 
from this must arise our whole theory and method of treating the 
insane. All physical theories, except those that apply to recognized 
brain or nerve lesion, have signally failed. Occupation, recreation^^ 
music, and entertainment are to be credited with most improve-* 
ment recorded in recent times in the records of the insane. And 
what is this, but substitution of new experiences fot" the old and 
habitual ? In other words, mental gymnastics. 

Nor is this all : If sanitation is preferable to medication ; if it 
is a higher office to prevent, than to treat or even to cure disease, 
then is this principle of mental gymnastics in its application to man, 
and to modem life universal. It regards crime, no less than disease, 
for crime is. a disease, and the time will surely come when disease 
will be regarded as a crime inflicted by society upon the individual, 
as in the case of filthy streets and open sewers, or poisoned water; 
or by the individual upon himself through ignorance or disregard 
of the plainest laws of his own being. The first case that comes to 
hand will illustrate practically what is meant by mental gymnastics. 
Three days ago I sent a woman to Longview, no doubt hopelessly 
insane. A German woman with the thrift of her race, had through 
a relation's bad investment lost the whole of her estate, and herself 
and two daughters were reduced to penury. The daughters said, 
"never mind; who cares?'' and bravely went to work. But the 
mother, past middle life walked the floor, wrung her hands and 
night and day bemoaned her loss, imagining that she pitied her 
daughters, whom she claimed continually that she had ruined; she 
nevertheless multiplied their real troubles by her insane ravings. 


deprived herself and them of sleep, and finally put upon them the 
sorrow and disgrace of sending her to an asylum. If she had even 
tried to realize the uselessness of her lamentations, as the hopeless- 
ness of her loss ; if she had been willing to Ze^ go, mentally, of that 
which actually was gone beyond recovery, she might have comforted 
her daughters and secured a fair degree of happiness for herself. 
Possibly forcing her to occupation or amusement, or silencing her 
lamentations by music may result in improvement or restoration, 
though the unusual cerebral hyperaemia may result in lesion, 
before such improvement sets in. 

Mental gymnastics thoroughly understood and systematically 
applied should constitute the foundation of all education for the 
child, and self-control should in every case and at all times be sup- 
plemented by the installation of high ideals and noble aims in life. 
This is not that pouring-in process, of the contents of books, good 
or bad, but the drawing out — educo, of the latent powers and the 
realization of the highest possibilities of the individual soul. 





In this brief paper I do not expect to offer anything very new 
or to propound any original theories, but I do want to call atten- 
tion to a disorder that we have overlooked entirely too often in our 
daily work. We unfortunately base our ideas of rheumatism upon 
the well-known symptoms in the adult, viz : severe pain, great swell- 
ing, high fever, scanty urine, etc., forgetting that in the child it 
affects other tissues beside the muscles and the joints. In fact, the 
disease may affect almost any tissue, and at the same time present 
but few of the well-recognized symptoms accorded to rheumatism. 
Such being the case, we are liable to make an incorrect diagnosis 
and probably not iaware of the real trouble until brought face to face 
with a serious valvular lesion. 

The allied conditions to rheumatism of which I shall speak 
are lithaemia and gout. While recognizing the fact that acute in- 


flammatory rheumatism is perhaps an infectious disease, yet at the 
same time there often lies in that great realm of metabolism many 
faulty conditions, making themselves manifest in rheumatic^ 
lithaemic and gouty symptoms. 

Metabolism is imfortunately but little understood in its finer 
workings. If it were understood a host of troubles might be inter- 
preted, viz : rickets, marasmus, tuberculosis, etc. It affords a con- 
venient stopping place in our pursuit where as Kant says : "Season 
can repose on the pillow of obscure qualities." 

Well-marked cases of rheumatism are rare before the fifth 
year, yet I have seen cases in infants but a few months old. Well- 
marked cases of acute articular rheumatism are rather rare in chil- 
dren, but the abarticular cases are all too common, and all too often 
overlooked. Among the manifestations are growing pains, eczema, 
chorea, migraine, gastralgia, renal colic, anaemia, intestinal trouble, 
tonsilitis and heart affections. 

When we have a case of acute articular rheumatism, the swell- 
ing may be extremely slight, but little redness and pain and very 
moderate fever. The little one seems scarcely sick enough to go 
to bed — ^where it should be until all symptoms have disappeared. 

How shall we diagnose the abarticular? Given an hereditary 
predisposition — attacks of tonsilitis, growing pains, easily fatigued, 
anaemia, functional nervous disorders viz : sleeplessness, irritability, 
erythema, and your case is rheumatism. Faulty assimilation, grow- 
ing pains and tonsilitis are very reliable sign-posts ; but you may not 
have all these indications. You may have only a history of ton- 
silitis, with a miserably slow recovery. N'ow don^t fail to examine 
the heart, or before you are aware of it a dangerous endocarditis is 
in full bloom. The case may start with an endocarditis, and may 
cause you to make a faulty diagnosis. One attack predisposes, and 
these children need the very best hygienic care, for repeated attacks 
will surely produce heart lesions of greater or less severity. 

Always look upon "growing pains" and tonsilitis with suspi- 
cion. An illustration will suffice. Some time ago a mother brought 
her two daughters, aged 9 and 12, to my clinic at Pulte College. 
The history was "restlessness at night on account of growing pain 
and being so tired." Questioning elicited the fact that both had 
repeated attacks of tonsilitis, were catarrhal, nervous and poor eat- 


ers. The younger had the gas, red sand and afternoon aggravation 
of lycopodiiim. In the twelfth dilution it has given marked relief. 

The older one has endocarditis and a very marked cachectic 
appearance. Arsenicimi 3X has helped her, but prognosis not good. 

In reference to the nervous conditions : Many skin diseases are 
now considered of nervous origin — erythema, eczema, etc. Ofttimes 
these are of undoubted rheumatic origin. Night terrors and sleep- 
lessness are sometimes offshoots also. Migraine and gastralgia have 
been mentioned. There is one condition, however, upon which I 
wish to lay particular stress, and that is chorea. The majority of 
cases are but the manifestations of rheumatism. Uniformly you 
have the growing pains, tonsilitis and anaemia. The danger in 
chorea lies in the ofttimes accompanying endocarditis. By watching 
your chorea cases you will find that the attack is often preceded or 
followed by marked rheumatic symptoms. Authors differ as to the 
percentage of chorea cases that are rheumatic, but undoubtedly the 
great majority are engrafted upon that diathesis. 

The treatment is to be hygienic, avoiding as far as possible all 
conditions that have a tendency to aggravate and cause rheumatism. 
In regard to diet, the consensus of opinion is to restrict the sugars 
and starches. The remedies are to meet the individual idiosyncra- 
cies and not the term rheumatism. 

When the child has growing pains, tonsilitis, anaemia and 
functional nervous disorders, it invariably has rheumatism, and its 
heart is in danger. 


Dr. Amdt: I wish to call attention to the importance of 
watching the tonsils in these conditions. I have noticed that the 
removal of the tonsils has been followed by a complete and entire 
cessation of the symptoms. We cannot afford to trifle with a hyper- 
trophied tonsil and depend solely on the internal remedy. It affords 
too fine a culture-medium for rheumatic heart trouble. 

Dr. William Baldwin : I never remove the tonsils. The indi- 
cated remedy in the 30th or 200th is sure to bring satisfactory re- 
sults. In chronic cases baryta carb. is most often called for, doses 
six hours apart. In acute cases bell., mere, cor., and especially 
Phytolacca 200th cures my cases and brings me friends and money. 


In the past ten years I have found phytolaeca called for in 75 per 
cent of my cases, and but two cases have had recurrent attacks in 
that time. No class of cases brings more satisfaction in treatment. 

Dr. Kilgour : I would call attention to the importance of an 
early recognition of rheumatism in children. It is a fact that even 
infants as young as two months old may have it and they may take 
on acute rheumatism independent of tonsillar involvement. The 
infant does not want to be touched — a regular hepar sulphur indi- 
cation — and every time the child is moved it cries with pain, and it 
isn^t long before there is discovered a valvular involvement of the 
heart. I say, therefore, it is very important indeed to diagnose 
these cases even where the diagnosis seems very difficult to make, 
and to watch closely the condition of the heart. 

Dr. Childs asked why Dr. Phillips would diagnose these con- 
ditions as rheumatism rather than anaemia, which they seemed to 
him to be. 

Dr. Phillips : I have never known a case of anaemia to simu- 
late a case of tonsilitis, nor have I any recollection of finding any 
case of infantile rheumatism that might have been mistaken for 
anaemia. I do not think it is likely to mistake rheumatism with 
an endocarditis for anaemia, or vice versa. Your rheumatism may 
not manifest itself in any way except by an endocarditis. That may 
be the only symptom, so that I do not see how anaemia could be 
mistaken for rheumatism in young children. 

Dr. Kilgour: The text books say that the majority of 
cases where the heart is involved are of rheumatic origin, espe- 
cially in children under five years of age; that the percentage is as 
high as 80 per cent, and that it gradually decreases in regular pro- 
portion after that age until in old age it drops to five per cent. 

Dr. Childs: I don't get what I wanted. What I wanted to 
get was whether these cases were rheumatic or not; these that the 
essayist reported. If they were, I don't know what rheumatism is. 
I have never had a case of rheumatism that I couldn't trace to an 
anaemic condition of the liver instead of the reverse. There is al- 
ways some cause for both, but the anaemia precedes any other con- 
dition of rheumatism. 



CHARLES HOYT, M. D., Chairman - - - Chillicothe 

" The Best Method of Solving Some Obstetrical Problems " 

A. W. REDDISH, M. D. - .... Sidney 

" Puerperal Sepsis " 

C. C. MEADE, M. D. - - - - - Cincinnati 

" Induction of Premature Labor " 

J. P. HERSHBERGER, M. D. - - - - Lancaster 

" A Rare Case of Twin Labor " 

G. D. GRANT, M. D., - - - - - Springfield 

*• Three Unfortum.te Cases " 

W. A. GEOHEGAN, M. D. - - - - Cincinnati 

" Puerperal Eclampsia " 



Septicemia, pyemia and sapremia — ^three dreaded names, 
whose mere mention strikes horror into the heart of the obstetrician 
and brings a quiver to the pulse of the parturient woman. For- 
merly these diseases were the bane of hospitals, and to send a pa- 
tient there, quick with child, was equivalent to writing her death 
warrant. While not so fatal in private practice, still every physi- 
cian would gladly forego his nights of vigil with the woman in 
labor, if possible for him so to do. 

The coming of the germ theory has made possible a better 
understanding of these diseases, and asepsis and antisepsis have 
changed results. The hospitals show the best results now and pri- 
vate practice among the lower classes must, of necessity, lead in the 
percentage of infection and mortality. 

Septicemia is a condition in which there is an incursion of 
pathogenic germs into the blood and tissues of the body in general, 
with or without a discoverable avenue of entrance, but in which 
there are no foci of suppuration. 

Pyemia is a septicemia due to pyogenic organisms, plus one 
or more foci of suppuration. 


In puerperal septicemia the focus of infection is known to 
be a wound or abrasion in the parturient tract. In the majority of 
cases, septicemia is due to the presence of the streptococci or 
staphylococci, but it may be due to a combination or mixed infec- 
tion or to any one of a number of pus-forming micro-organisms. 

When septicemia starts from a local infective focus or foci, 
whence the micro-organisms enter the blood, as in the parturient 
woman, the invasion begins between the second and fourth days. 
The initial symptoms are those of all infectious diseases: chilli- 
ness, followed by fever, which tends to intermit gastro-intestinal 
symptoms such as loaded tongue becoming dry in severe cases, 
nausea, vomiting or diarrhoea, rapid, soft pulse, delirium, prostra- 
tion. In septicemia due to the streptococcus, the chill is harder, 
the fever higher with a tendency to recurrence. 

Pyemia is septicemia complicated by multiple abscesses aris- 
ing from an original focus of suppuration. This suppuration is 
generally caused by the staphylococcus or the streptococcus, but 
may be produced by a number of other organisms such as the pneu- 
mococcus or typhoid bacillus. The veins and arteries in the neigh- 
borhood of the abscess become inflamed, septic thrombi form which 
break loose and float along in the blood current as emboli, forming 
fresh foci of infection in various parts of the body. 

In the arteries they lodge in the capillaries of the tissues to 
which the particular artery involved is distributed. If the thrombi 
are formed in the veins when they break loose and float through fhe 
blood current as emboli, they pass from the uterine artery to the in- 
ternal iliac and iliac artery to the ascending vena cava, through the 
heart to the lungs, where they form new foci of infection. 

The symptoms of pyemia are hard chills at irregular inter- 
vals, recurring, it may be, in six hours, or it may be in forty-eight 
hours. The chill* is followed by high fever, to be in turn followed by 
exhausting sweat, and then an interval of varying duration in which 
the invalid may feel fairly comfortable, only to be abruptly ended 
by a returning rigor. The chills are hard, the pyrexia imusually 
high, and the sweat drenching and exhausting. Pyemia and septi- 
cemia are caused by the incursion of pus-forming micro-organisms 
into the blood and tissues, and differ from sapremia, which is due 
to the toxic products of germs gaining entrance into the blood. 


In sapremia the toxins are formed by the bacteria of a putre- 
fying placenta in the nterns. The symptoms are malaise, restless- 
ness, headache, chills and fever, rapid pulse and nervous agitation. 

There is a type of puerperal cases of which I have seen two. 
In twelve or twenty-four hours following the completion of the 
puerperal act, the patient has a chill which is the initial symptom 
of peritonitis proving fatal on the third day. Byron Eobinson, of 
Chicago, attributes these deaths to rupture of pus tubes during 
labor, and he demonstrates his diagnosis at the autopsies. 

There is another variety of septicemia that comes on after 
two or three weeks, accompanied by the usual classical symptoms 
plus obstinate constipation. The trouble appears to be located in 
the sigmoid and colon from whence infection takes place. The 
sigmoid and colon must be thoroughly emptied and disinfected. 
Every wound and abrasion in the puerperal woman is a menace to 
life and should be looked upon with suspicion. She is particularly 
vulnerable to infection with micro-organisms of the pus-forming 
variety. In order, therefore, to prevent infection every preventive 
measure known to modern medical science should be employed. Out- 
side of hospitals the physician is often seriously handicapped for 
the want of competent nurses or attendants, who appreciate the 
value of surgical cleanliness. 

The physician should prepare his hands, instruments and 
dressings as carefully as for a major operation. Boiled water 
should be insisted upon for purposes of ablution and for cleansing 
the paris before and following the accouchement, and when the 
third stage of labor is finished, thoroughly inspect the parturient 
tract, especially the perineum, for evidences of abrasions or lacera- 
tions. These should be carefully cauterized, preferably with car- 
bolic acid, and all tears coaptated with ligatures and dressed with 

I believe one fruitful source of infection is through the me- 
dium of the handkerchief, and another is by means of fecal dis- 
charges infecting the wounds. There is an evil practice among 
a certain class of women of using any soiled linen or piece of bed- 
ding as a pad during the parturient act. Eliminate all of these 
known causes and we still encounter infection, to our chagrin and 
mortification. Most cases of sepsis in my practice have been in 


simple cases of labor, and I attribute it to my practice of being less 
energetic in antiseptic after-treatment in these patients. 

Finally, do not be too caustic in your criticism of your unfor- 
tunate brother obstetrician, for you know not how soon his lot will 
be your lot and his chagrin will be yours. 


Dr. Meade asks in regard to treatment of such cases. 

Dr. Keddish: I purposely said nothing of treatment, for I 
am discussing a poisoned condition that requires quick action on 
the part of the accoucheur. But I use cleansing methods. I don^t 
curette as often as I used to do. Where there is any retained pla- 
centa, of course I remove it; but I have had some unfortunate ex- 
periences with curetting in opening up wounds. But as I say, I 
cleanse them all thoroughly, and of course aseptically. I have bet- 
ter results from quinine than from any other remedy. I would 
prefer quinine to all other remedies at such a time. I think it is an 
antiseptic in this case. I use large doses. I have used ten and 
fifteen grains at a dose. There are other remedies, but as I have 
said, I prefer quinine to any other. I also use large quantities of 
stimulants, alcoholic. And I had good results in two cases of 
pyemia by using the nascent phenic acid hypodermically. 

Dr. Humphrey : This subject is interesting and one in which 
we always find suflBcient difference of opinion to make the discus- 
sion profitable. We should bear in mind that all cases of puerperal 
fever are not septic by any means. It is estimated by the very l)est 
authority that only about 25 per cent of puerperal cases are septic 
in their nature. Of course if you cover everything and call it sep- 
tic you might have a long line of recoveries and some bad results 
besides with the others. Another point to be kept in the mind and 
one that is coming back to us is the fact that we should be careful 
not to criticise our brother practitioner when he gets a case of puer- 
peral fever. One of the best of authors avers that 70 per cent of 
perperal women carry about streptococci and many other of the 
colon bacilli. It has been proven in this same work that 25 per- 
cent of puerperal women carry streptococci in the uterus. This 
being true, it is not always due to the carelessness of the accoucheur 
that the infection takes place. Of course this sort of authority 


doesn't make us careless in our treatment of these cases ; it simply 
gives us the hope that we have not ourselves been the cause of the 
infection. It is probably and more frequently due to another cause 
than the uncleanlinesG of the accoucheur and his instruments. So 
far as the treatment is concerned in these cases, whatever the line 
may be, the first thing, and indeed the greatest element of success 
lies in getting every secretion of the body active. 1 find that in 
nine cases out of ten where you have a considerable degree of in- 
flammation that a very simple clearing out and douching thoroughly 
will cause the condition to subside without any mechanical inter- 

Dr. Jones : In the first place I have not been in the habit of 
giving quinine in any case of continued fever. I do not remember 
to have ever given a dose of quinine in a case of puerperal fever, 
and as far as my success is concerned, I believe it will compare 
favorably with any other of my colleagues with whom I am ac- 
quainted. I cannot quite understand how a 15-grain dose of qui- 
nine given in a case of puerperal sepsis with a temperature of 104 
could be of any benefit. The same is true as to alcoholic stimu- 
lants, which I do not use in such cases. There seems to be a dread- 
ful fear on the part of the younger members of the profession of 
sepsis, and that something desperate must be done at once. We have 
young men in Cleveland who use the curette quite frequently, and 
active cathartics and other means which they think are required. 
In reference to cathartics I take issue with the last speaker in that 
matter. We must remember that labor sometimes is very severe, 
that we have traumatic influences at work and that the intestine is 
frequently injured thereby. I have seen many cases of enteritis 
following labor, and to follow such a case of enteritis with a cathar- 
tic would be about the worst thing you could do. In former years 
it was practiced more than now, but I would have much more fear 
of the effect of the increased peristaltic action as a result of such a 
dose than I would to leave the bowel alone. We should individualize 
our cases and treat each by itself. 

Dr. Sawyer : If I understand the prescription of Dr. Eeddish, 
he makes it on an entirely physiological basis and does not concern 
himself with the symptomatology of the drug. In its use he does 


not deem it necessary to pay special regard to elevation of tempera- 
ture. He realizes, as the most of ns do, that temperature is not 
constant. In the majority of cases of this kind there is no rise 
of temperature, but its existence does not contraindicate the use 
of quinine. I believe quinine always to be indicated in this par- 
ticular class of cases. Its influence is as my own experience goes to 
increase the white blood corpuscles, and as the white blood corpus- 
cle is the policeman of the system, and as it is necessary that this 
force should be greater than the invading force, anything which im- 
proves or increases the number of white corpuscles aids in overcom- 
ing the destructive influence of the disease germ. 

Recent observation shows that alkalinity of the blood renders 
the patient more or less immune to disease germs and their toxines, 
and it is possible that it may be to this influence of quinine that 
such favorable results are traceable in conditions of blood poison- 
ing; but let that be as it may, experience confirms me in the opin- 
ion that quinine is specifically indicated in these cases, and I befieve 
that we as homeopaths should have no more hesitancy in using it 
than we would in giving any antidote for any other poison taken 
into the system. I contend that if we as homeopaths are confined 
exactly to the symptomatically indicated remedy in all cases that 
there are very few of us that are homeopaths, and in defense of 
Eeddish's prescription, I wish to stand for a homeopathy that is 
broad enough to apply any reasonable means in the cure of disease^ 
and I think we need oflfer no apology for any remedy which is pre- 
scribed on other than a symptomatic basis. That is to say, that 
homeopathy in its true sense implies the use of all rational means 
prescribed with a definite purpose. 

Dr. Jones: According to Dr. Humphrey's statistics, in 75 
per cent of the cases the alarm of fire is false. Does, then, this 
heroic dosage with quinine prove that it was the quinine which over- 
came the assumed invading forces ? If it be true that many women 
carry the streptococci in their uteri, is the quinine as clearly indi- 
cated in that variety of cases as in the other cases that may be due 
to ordinary infection from without? 

Dr. Bishop : Seventy-five per cent of these fevers are due to 
septic infection resulting from the absorption of toxins which orig- 


inate in putrefying matter within the uterus. When we have a 
case of continued fever above 101 F. our first duty is to determine 
whether or not there is putrefying matter within the uterus. If it 
is present, the indication for treatment is to remove it. As soon as 
it is removed, nature will be able to take care of herself and throw 
off the toxins. 

If the septic intoxication is not due to the absorption of toxins 
from putrefactive matter, it is due to the entrance of infectious 
micro-organisms directly into the blood current, and the condition 
is not a sapremia, but a septicemia. In such a case the less we 
have to do with the uterus the better. The indication for treatment 
is to so fortify the resisting powers of the body that it will be able 
to meet and destroy the invaders. It is in these cases that I 
believe quinine in large doses is particularly indicated. I also give 
strychnia almost up to the physiological action of the drug. Bro- 
mine is also a wonderful remedy in this form of infection. 

In every infection, whether sapremic or septicemic, I use saline 
infusion by hypodermoclysis. The best results are obtained when 
it is given continuously, no more being allowed to enter the tissues 
than will be absorbed. Sincei I have been using saline infusion as 
a routine measure in this class of cases I do not worry about the 

Dr. Reddish :. Dr. Jones says he does not use quinine in puer- 
peral fever. He is most fortunate in his results. I never get any 
bnt negative results from anything else but quinine, in this class of 
cases, and it acts splendidly. It must be understood that a septic 
fever is not a continued fever, but rather of the intermittent type. 



The cause of gestation may be arrested artificially at any time 
in the interests of either the mother or child. If it is arrested be- 
fore the child is viable, it is termed abortion; if after (twenty-eighth 
week) the child is viable, it is called induction of premature labor. 
The date of fetal viability is therefore the dividing line between the 
two operations. 


In abortion the welfare of the mother alone is considered, while 
in premature labor both the welfare of mother and child are to 
be considered ; for in the latter, the operation preserves the lives of 
both mother and child, or it results in taking a life to save a life. 
While in abortion tlie life of the child is sacrificed to save the life of 
the mother. 

I now drop the subject of abortion and treat induction of pre- 
mature labor. 

When the further continuance of gestation would seriously 
endanger the mother's life, the induction of premature labor is indi- 
cated, and any of the following causes may force such a proceeding 
upon us. Pernicious vomiting with exhaustion and progressive 
emaciation, in grave heart, lung and kidney troubles, pernicious 
anemia, severe chorea and jaundice after having resisted all reme- 
dies and methods known to medical science without relief, the in- 
duction of premature labor is indicated to prevent a fatal termina- 
tion due to the abnormal conditions in question, or when the con- 
tinuance of gestation to full term would expose the mother or child 
to serious risk which might be diminished or avoided by arrest of 
gestation, the induction of premature labor is indicated. 

It is difficult to formulate definite rules to follow, consequently 
each must be judged and managed upon its own merits; and since 
the extremely high rate of successes from symphysiotomy and 
Caesarian section, especially the latter, I consider nothing but a 
constitutional condition or an emergency justifies the induction of 
premature labor. Authoritatively speaking, the causes which jus- 
tify the operation are contracted pelvis, hemorrhage and eclampsia. 

Personally, I do not consider deformed pelvis at all as justifia- 
ble. I doubt that eclampsia is justifiable, but I certainly think 
hemorrhage is. If gestation has advanced to the period of a viable 
child, (wohiding emergency cases, the mother's condition would 
not warrant induction of })remature labor, as it would be better 
for the mother and far better for her offspring to continue gesta- 
tion uninterrupted to term. The large per cent of premature babies 
die for want of vitality and sustenance, which are derived from 
normal temperature and normal nutritional foods. 

In case of deformity of pelvis the length of diameters, espe- 
cially the conjugate, must be considered, and if less than 2.36 inches. 


the operation should not be performed at any period unless there 
is a positive diagnosis of an abnormally small child alive in the 

We know the normal length of the pelvic conjugate; we also 
know the diameters of the fetal head, of greatest importance from 
an obstetrical standpoint. 

Let us for sake of brevity consider only the most important one, 
the bi-parietal, which normal length at term is 3% in., at eight 
and one-half months 3.4 in., at eight months 3.2 in., at seven and 
one half months 2.96 in., at seven months 2.75 in. The fetal head 
may be compressed four inches. Remembering this degree of safe 
compressibility, having estimated the size of the fetus and the stage 
of gestation, the next important element in the problem is the de- 
termination of the degree of pelvic deformity present, which can 
be pretty accurately done by a thorough practice of the use of pel- 

As long as the fetal presenting part can enter the pelvic brim, 
the time for induction of premature labor may be deferred, but just 
as soon as the presenting part engages with difficulty, the time is 
ripe for interference. Therefore every week the physician in charge 
should examine carefully to ascertain this fact. 

After considering the above measurements of fetal cranium at 
different periods of gestation, the anterio-posterior diameters of pel- 
vis being Sy^ in., we see that in multiparae labor should be induced 
at eight and one-quarter to eight and one-half months. This is to 
be governed to some extent by size of fetus and difficulty in deliv- 
ery offered by former labors. In primiparae, since the child is usu- 
ally smaller, it is safe to wait a week before term. 

When conjugate is 3.35 inches, premature labor, both in multi- 
parae and primiparae, should be induced at from eight to eight and 
one-half months. If conjugate is 2.75 in., labor is to be induced 
at seven months to seven months and twenty-one days ; where con- 
jugate is 2.36 in., at seven months, seven days, and where below 
2.36 in., the indications for premature labor do not exist. To resort 
to it would necessarily entail an embryotomy, and this carries risk 
to the mother and subserves not the child. At this point then the 
indication for artificial abortion in contracted pelvis begins. 


Hemorrhage as an Indication for Induction of Premature 
Labor, — Hemorrhage occurring after the fourth month of gestation 
should always awake suspicion of abnormal implantations of the 
placenta. Obstetricians mostly agree as to the advisability of induc- 
ing premature labor on the appearance of the first hemorrhage. 

If this first hemorrhage occurs within the la^t six weeks of 
term and is violent and seems to endanger the mother^s life (it will 
of course cause the death of the child), labor should be induced im- 
mediately in behalf of the mother and also the welfare of the child. 
If it occurs at or near the fifth month, vigilance and care with the 
expectant plan is agreed upon as the proper course to pursue. Some 
authorities say to confine the patient to her bed will assist greatly 
in carrying the child to term. My experience has been, the woman 
is more likely to hemorrhage in recumbent position than erect. 

However many, opinions we regard in hemorrhage of the preg- 
nant woman, unless properly treated the mortality rate is high for 
both mother and child. With prudent and fearless action on the 
part of the physician in charge, the mortality rate in the case of 
the mother is reduced to almost a minimum and also decreased in 
the case of the child. 

Authoritatively speaking, the .question may be summed up as 
follows: The risk to the mother increases progressively to term 
after the first hemorrhage. On the occurrence of this hemorrhage 
the child is viable. Renewed hemorrhage simply risks viability. 
The interests of the child, therefore, are not subserved by expectancy. 
Those of the woman are actually imperiled. The teaching is sound 
therefore which says : "On occurrence of first hemorrhage, whether 
profuse or not, elect induction of premature labor.^^ The earlier 
the hemorrhage the greater the chance of the placenta being im- 
planted centrally. It is the central attachment which at term sub- 
jects the woman to the greatest risk and holds out but very slim 
chance for the child. Personally, I prefer to care for the emergency 
cases, (by which I mean, those sufficiently profuse and violent to 
immediately endanger the life of both the mother and child, and 
especially the former), by at once emptying the uterus: cases of a 
less severe type, I place in hospital where they can have capable 
attendants and nurses to carc\ for them if anything arises. This 
excludes all risk, and I am positive the nearer gestation approaches 


term, the better are the chances for the living child, and the woman's 
chances are not lessened. 

Eclampsia as an Indication of Premature Labor. — Absolute 
statement in regard to this indication is not wise, owing to the 
diversity of opinion among experienced obstetriciaQs. To reach 
approximately accurate conclusion, it will be necessary to differen- 
tiate the instances where eclampsia seems imminent, and where con- 
vulsions have developed. 

Albuminuria in pregnancy is frequently a forerunner of 
eclampsia, but in all cases of albuminuria we do not have eclampsia, 
nor do we have albuminuria in all cases of eclampsia. Eclampsia 
of a most fatal type is met with where neither casts nor albumen 
are found in the urine. Albuminuria may or may not depend upon 
organic renal disease, and it may not lead to organic disease. We 
have some cases of eclampsia coming from toxemia, possibly urin- 
ary in character, as the urea is diminished in amount, as is also 
the total quantity of urine secreted; the question, therefore, which 
the physician has chiefly to face, is the immediate risk to mother 
and child if pregnancy be allowed to progress to term, remembering 
that in no given case can it be predicted that emptying the uterus 
will ward off convulsions ; also the interference with gestation will 
excite convxdsions. It evidently is a most complex problem. 

I resort to recognized methods of treatment for albuminuria, 
if the woman's condition indicates labor. I assist and hasten the 
delivery, but I do not indorse the induction of premature labor un- 
qualifiedly for relief from eclampsia. I believe, if delivery will re- 
lieve, nature will indicate it by symptoms of labor in cases of threat- 
ened convulsions. I think to empty the uterus will ensure an attack 
unless nature indicates the necessity of such a procedure for relief. 

It must not be forgotten that albumin may be absent and yet a 
deep toxemia be imminent. Therefore the sound rule, test for urea. 

There are pages written pro and con as to the induction of pre- 
mature labor in eclampsia, yet I do not think it an indication for 
such a procedure unless labor is imminent; then it is proper to 
assist nature, but to force her to delivery without symptoms being 
present will likely help "out of the mud into a bottomless mire.'' 

The methods of induction of premature labor are numerous. 
I shall mention the objections to some of them most in practice, 


also give in detail the technique of the one I consider the best and 

Administration of medical agents are unreliable. Injecting 
water or air between the membranes and uterine walls would be 
effective, but is likely to rupture the membranes; thus imperiling 
the life of the child, and may prove fatal to the woman from 
entrance of air into the uterine veins. Vaginal irrigation with hot 
water is slow and doubtful of action and may cause local conges- 
tion, which is dangerous to both mother and child. Electricity has- 
tens and increases contractions when labor has begun, but, used 
alone, is problematical in effect, as well as highly uncertain. There 
are five other methods which are principally used by authorities and 
operators at the present time. 1. Puncture of the membrane. 
2. Tamponade of vagina. 3. Injection of glycerine. 4. Insertion 
of elastic bougie between membrane and uterine wall. 5. Mechani- 
cal dilatation of os uteri. 

Puncture of membranes was formerly very popular with the 
Vienna school, and it will certainly induce labor, and when asep- 
tically performed, is safe to the mother, but not to the child, because 
of premature rupture of membranes and loss of dilating amniotic 
wedge, which precedes the presenting part of the fetus with retained 
fluid preventing violent contractions of uterine walls and exhaus- 
tion to the child before it is delivered. 

Induction of premature labor by means of tamponade is 
neither safe to mother nor child, on account of the length of time 
required to dilate the uterus. It well fills the place under this sub- 
ject, if there exists a hemorrhage of a serious type. Aseptic gauze 
should be used and aseptic care should be observed. 

Injection of glycerine for premature labor has been both popu- 
lar and successful in Germany. When glycerin is injected into the 
uterus between the membranes and the uterine walls, it acts by caus- 
ing exosmosis from the amniotic sac. There is a profuse secretion 
of fluid from the uterus, and concomitantly uterine contraction set 
in. The objections are its being uncertain in action and the great 
length of time required when it does act. 

Insertion of elastic bougie between the uterine walls and mem- 
branes, for induction of premature labor, is perhaps resorted to 
more than any other method. It usually succeeds, but is sometimes 


slow. Like any of the methods which require the introduction of a 
foreign body, it is likely to rupture the membranes and exhaust the 
child, it also may cause a hemorrhage, either open or concealed, and 
endanger life of both woman and child. The elastic bougie is not 
easily asepticized, consequently sepsis may arise from the operation. 

The last and most successful method of inducing pramature 
labor is dilatation of the cervix. Cleanse the intestinal canal; at 
least relieve the lower bowel. The bladder is emptied and the field 
of operation is asepticized. Place the patient in a position most 
comfortable to her and most convenient to the operator. Dilate 
cervical canal suflBciently to introduce sterilized gauze, up to, but 
not into, internal os. Pack the canal thoroughly, leaving the 
remainder of the gauze in vagina. Wait ten to twenty-four hours 
for uterine contraction to begin. If it does not take place, with- 
draw gauze and unpack. If contractions do not occur from this it 
will soften the neck and os, so that the attendant has the case under 
control and may be able to continue and complete the dilatation 
with the fingers. 

In fact, I think the finger the best dilator in most cases, termed 
by the French accouchement force. Dilatation by use of Barnes' 
bag and McLean^s bag is practiced by some with success. 

Any aseptic method of dilatation, to my mind, is the ideal 
one for induction of premature labor. It evokes uterine contrac- 
tions and simulates more closely natural labor than any other 
method. They preserve the membranes intact until the second stage 
is well begun, thereby lessening the risk to the child. 

Prognosis depends upon cleanliness, the condition of the woman 
and child at time of operation, the cause for which labor is induced, 
the period of gestation, and the opportunity for election in the per- 
formance of the operation. In fact, the first and last named are the 
keynotes of success. Certainly the success, so far as the welfare 
of the child is concerned, depends largely on the period of gestation. 
In hospital practice it ought to be possible to save, with the use of 
incubator and forced feeding, 85 per cent of children born under 
operation for induction of premature labor, with an increase of 
mortality rate compared to the decrease in the period of gestation. 

Under modern methods and strict observance of cleanliness in 
operating, the mortality rate in women is less than one per cent, and 


this low rate should be farther reduced if the constitutional condi- 
tions were more normal in character and emergencies did not arise 
which hastily compel the attendant to elect a method of operation 
otherwise not well chosen. 



I was called to see Mrs. G., age 36 years, in her fifth labor. 
Found she had been having labor pains for about twelve hours, and 
on digital examination found os completely dilated and a large sac 
of water presenting at the superior strait, and through the mem- 
branes outlined the position. Four feet presenting. I at once real- 
ized that I had a condition of affairs requiring prompt action, and 
as I was in the country where I could not get counsel under three 
or four hours, I proceeded first to think, consuming ten or 
fifteen minutes in this proceeding, and decided on a method 
of procedure. Then I made a second examination and found no 
progress, although the pains were regular and strong. Euptured 
the membranes and brought down one foot quickly, blocking the 
second child from the pelvic inlet, after bringing the first child 
down into the pelvis. I proceeded to make traction with the pains, 
but found it impossible to advance the child by the most powerful 
traction I could make. 

I then adopted the plan of making traction during the inter- 
val between pains, and found I was able to make slow progress in 
the delivery. In about thirty minutes was able to deliver the first 
child. Asphyxiated, the cord had ceased to pulsate. I turned the 
first child over to an old lady and proceeded to give my attention 
to the mother and other child, as the pains were constant and reg- 
ular. The second child was bom immediately without any trouble. 

I think it is impossible to deliver first child in a twin labor, 
with children in this position, quick enough to save it. This posi- 
tion in twin pregnancies is very rare. Cazeaux gives a table cover- 
ing three hundred and twenty-nine twin pregnancies, in which series 
of cases it occurred eight times. I have been unable to find any 
obstetric literature on the method of procedure in this position in 
twin labors. 



Dr. Meade: The object of all twin deliveries is, of course, to 
get the first child. The second is not so difficult, for as a rule nature 
helps there most effectively. The best methods in all these cases is 
to let nature do the major part of the work. Traction in labor 
cases, especially in twin labor, almost always produces a wrong pre- 
sentation of your first baby's head; consequently your child's head 
will hang upon the pubic arch or the chin will hang upon the prom- 
ontory of the sacrum, and necessarily your child will be asphyxiated. 

Dr. Hershberger : The Doctor has not told me anything new. 
But he forgets the conditions of the case as I have tried to describe 
them. I found everything else in good order and the labor appar- 
ently going along as it should, when suddenly I discovered two pairs 
of feet where but one might reasonable be expected to be. I watched 
it awhile and found no descent was being made whatever. What 
was I to do — sit there and let that woman die ? So I made traction 
between pains in order to make one child come down normally. The 
child was wedged in solidly. You might as well have tried to deliver 
a brick house as that child with help during the pains. I have a 
private communication from the Eotunda Hospital, Dublin, in 
which is the statement that out of 305,000 cases of twin labors this 
condition of which I have spoken occurred but eight times. 



My experience for ten years up to 1901 had been a very com- 
fortable one in obstetrical cases, and I had begun to think that my 
dread of all cases was about over and that I could accept such cases 
and not be fearful of results. Yet at this time I began to have 
difficult cases, and in the next two years at least twelve were of 
the sort that leaves me dreading the time when I shall be called. 

My first case which I shall recount occurred December 1, 1901, 
Mrs. H., with her second pregnancy. The first one, four years 
before, had been a forceps delivery, owing to inability to help her- 
self, pains lacking force. I saw her early, and found complete dila- 
tation and a face presentation. The frontal prominences were 


wedged against the pelvic bone, and chin against the sacrum, and 
severe pains, holding it there firmly. I made every effort to change 
the position, but was imable, and calling assistance, my diagnosis 
was confirmed and we both tried to change the presentation, but 
were still unable to move it in the least, and that under complete 
anaesthesia. We decided to use forceps and deliver by force. My 
forceps were easily placed, and on traction slipped, and would slip 
every time I used traction. Finally I used a pair brought by Dr. 
Gotwald, and succeeded in keeping them on. I had used consid- 
erable force at different times in my life before this, but never did 
I know what was necessary for a forceps delivery. After nearly one 
hour^s fruitless traction, with three persons holding against me, 
and braced by one foot against the bed, was I able to move the head, 
and had the satisfaction of seeing the head fill out the perineum, 
upon which I removed my forceps and delivered without force, and 
saved the perineum. The child was alive, but I found every bone 
in the head movable, showing that the slipping of the forceps had 
been fatal, and it died two hours later. Mrs. H. I watched very 
carefully for twelve days. Her temperature never went above 101 
degrees, and at the end of two weeks was as well as the average 
woman after confinement. 

My next case, December 29, was a Mrs. M., in her fifth labor. 
She had two sons living, and had lost two by reason of difl&cult 
labors. There had been nothing abnormal in her pregnancy, and 
when summoned I found that dilatation was progressing rapidly, 
and at the end of the first hour was nearly complete, membranes 
intact, and I had no difficulty in finding the head, which lay with 
occiput to the right. While making the examination, and during a 
pain, the membranes were ruptured, and a foot was shoved into my 
hand, and it was not difficult to make out the left one, and with the 
rush of water both head and foot were forced down and fixed firmly. 
Convinced that nothing could be done without anaesthesia, I sum- 
moned Dr. K., who lived in the neighborhood, and who quickly veri- 
fied the position, and we decided on podalic version, pushing anaes- 
thesia; we attached broad tapes to the presenting leg, and began 
traction. It took one hour exactly to turn and deliver, and the head 
was quite as difficult as the rest. The result was, that a half hour's 
work in an endeavor to resuscitate the child was fruitless. The 
mother made a very nice recovery, perfectly uneventful. 


Aug. 14, 1902, Mrs. B., a large blonde, with her second preg- 
nancy. She was an unusually large woman, but not abnormal, of 
good figure, and a roomy pelvis, had had a very normal pregnancy, 
and we only feared a very large child would make her labor diffi- 
cult. Dilatation was rather tedious, and about seven o^clock in the 
evening the nurse summoned me, and I found it completed, and 
hard pains forcing the head against the brim of the pelvis, occiput 
against the pelvic bone. After two hours' ineflEectual labor on her 
part I found no movement of the head had taken place. I applied 
the long forceps, and had nor difficulty in doing so, and with the next 
pain I endeavored to help her by traction. About the third effort, 
while in the act of using considerable force, there was the ring of 
breaking steel and a slight slip of one blade. I immediately un- 
locked and found the female blade intact, and some resistance to 
my efforts to remove the male blade. I slipped a finger in and 
found that the upper segment had broken and sprimg open, and 
with the slip had impaled the cervix just as a needle would, and 
then closed the gap in the metal. Of course my move was to get 
loose, and I succeeded by springing it open with my fingers and 
pushing the blade back until I succeeded in getting clear of the 
tissue. I at once sent for counsel, and Dr. Bell responded, and 
under complete narcosis we were imable to deliver by forceps, and 
determined to perform podalic version. It took us nearly an hour 
to do so, and delivered a twelve-pound boy, perfect in form, and 
the head in good proportion to the body. The child never breathed, 
and undoubtedly was killed by the compression of the cord. 

The patient had a fight for life. For the next ten days "Eer 
temperature ranged from 101 degrees in the morning to 102.5 de- 
grees in the evening, and only by the painstaking care of her nurse 
was she kept as well as she was. After the second week she began 
to gain, and at the end of the fourth apparently was as well as ever. 

I have found that the internal use of arnica following labor 
has been very beneficial, and I have made a practice of so prescrib- 
ing for twenty-five years, believing it a great reliever of pain, and 
the soreness that follows a delivery. 

No doubt others of this society have had cases just as difficult, 
and as discouraging, as mine, but these three have left their im- 



Dr. Eeddish: In the Miami Valley Society some time since, 
Dr. Grant made the statement that in five years he had not been 
with a parturient woman longer than three hours. Dr. Walton cor- 
roborated the truth of this statement. I have often wondered what 
Dr. Grant^s experience had been since then, and it is evident from 
his paper that he has had some unhappy experiences. 

Dr. Beebe remembered that Dr. House had once said that he 
in his earlier practice, had been treating diphtheria for years with- 
out losing a case, but he finally reached the time when he also had 
tro.uble like the rest of us, with an epidemic of malignant diphtheria. 

Dr. House: That experience happened in Michigan before 
ever I came to Ohio. 

Dr. Meade: In the second case the patient undoubtedly had 
a contracted pelvis, and it was for that reason the trouble occurred. 
The first case was a face presentation which would never have been 
allowed had the doctor been present previous to engagement. 



How many physicians carefully examine the urine of every 
woman whom they are engaged to attend in confinement? Of these, 
how many are content when no trace of albumin is found? How 
many realize that albuminuria may exist with little danger of 
eclampsia, and that convulsive seizures may occur without pre- 
existing signs of nephritis? How many experienced obstetricians 
have never encountered an unexpected case of puerperal eclampsia? 
An honest answer to these questions would be startling and humil- 

Not over six to eight per cent of the albuminurias of pregnancy 
terminate in convulsions. Albumin may appear in the urine of 
pregnant women in several conditions: 

First — In chronic or passive congestion of the kidneys due to 
organic lesions of the heart. The renal affection makes no progress 
independent of the primary disease, and there is no inherent ten- 


dency to uremia. Pregnancy is always a serious matter, but the 
danger is from cardiac weakness and not from renal insuflBciency. 
An abundance of nitrogenous food is needed to sustain the strength 
of the patient and prepare her for the ordeal of childbirth. The 
induction of premature labor is rarely indicated. When labor does 
occur, instrumental aid should be rendered as early as practicable. 
In such cases the weakness of the heart muscle, fatty degeneration 
and dilatation contra indicate veratrum. 

Second — Chronic parenchymatous nephritis may first manifest 
itself during pregnancy and follow its usual course, or suddenly 
undergo an acute exacerbation. Oedema usually appears before the 
seventh month ; the urine contains large quantities of albumin, gran- 
ular and fatty tube casts and epithelial debris. Premature labor 
may occur, but the proportionate number of cases is small. Eclamp- 
sia is rare. 

Third — Interstitial nephritis is occasionally but rarely found 
in pregnant women. It is always comparatively infrequent in fe- 
males, and especially during the child-bearing period. It is easily 
diagnosed by the large quantity of urine of low specific gravity, by 
the scarcity of tube casts and slight albuminuria, and above all by 
the high arterial tension with arterio-sclerotic changes. During the 
acute exacerbations which sometimes occur, a positive pathological 
diagnosis may be impossible. The induction of premature labor or 
the use of veratrum viride are rarely indicated. It is in this class 
of cases that Tyson warns against the use of morphine. 

Fourth — The most frequent form is the so-called acute 
nephritis of pregnancy, always associated with and probably due 
to toxemia. The structural changes are often degenerative rather 
than inflammatory and not always proportionate to the apparent 
degree of toxemial Diminished excretion is the characteristic of 
this variety, and is the criterion by which its severity and danger 
must be judged. Albumin and tube casts are always present in 
the urine. Premature labor, with or without death of the foetus, 
often occurs. There is a marked tendency to uremia, the convul- 
sions occurring before, during or after labor. 

In contradistinction to the albuminurias of pregnancy with 
eclamptic seizures there are cases of puerperal convulsions, about 
five per cent of the total number, in which neither albumin nor tube 


casts can be detected in the urine up to the moment of the spasm, 
though they may appear immediately thereafter. These cas^s usu- 
ally terminate fatally. 

From this classification it is evident that the presence of albu- 
min in the urine of a pregnant woman does not necessarily indicate 
danger of eclampsia nor does its absence offer any guarantee of 
immunity. Far more valuable as a criterion is marked deficiency 
in the solids excreted with the urine. 

The toxemia seems to be due to the retention of substances 
normally eliminated by the kidneys: First, the end products of 
the normal nitrogenous metabolism of both the maternal and foetal 
organisms. Second, non-utilized proteids absorbed from the alimen- 
tary tract in excess of the needs of the body. Third, alkaloids pro- 
duced by intestinal fermentation which may be excessive during 
pregnancy, owing to disturbed portal circulation, deficient hepatic 
secretions, and the consequent impairment of their inhibitory action 
upon the fermentative processes in the alimentary tract. 

The toxicity of the blood of all pregnant women, as demon- 
strated by experiments upon lower animals, is greater than normal ; 
in eclamptics it is three times as poisonous. The urine, on the con- 
trary, has much less than its normal toxicity. 

An examination of the toxicity of the blood is not practicable 
from a clinical standpoint. The diminution of solids in the urine 
has proven a fair index of those retained in the circulation. An 
estimaton of the urinary solids may be made from the quantity of 
urine and its specific gravity by the formula of Haesen. While the 
results are not absolutely accurate, they are sufficiently so for prac- 
tical purposes. 

While urea is not the only etiological factor in the production 
of so-called uraemia, the quantity eliminated daily ought to be deter- 
mined in all doubtful cases, and it may be accepted as a fair index 
of the elimination of other toxic substances. 

When marked renal insufficiency exists as shown by diminished 
excretion of urea and other solids, there are usually manifested gen- 
eral symptoms including frontal headaches, mental depression, mel- 
ancholia, stupor, impaired appetite, vomiting and retinitis. The 
coexistence of faulty elimination and these general manifestations 
of toxemia is always indicative of danger and demands active meas- 
ures to avoid eclampsia. 


Absolute rest in bed is necessary, for all muscular eflEort in- 
volves retrograde metamorphosis of proteid tissues and the pres- 
ence of additional waste products in the blood. 

Several times a day the Sims or a modified Trendelenberg posi- 
tion should be maintained for fifteen minutes to relieve the possible 
accumulation of urine in the pelvis of the kidney due to pressure 
upon the ureters and obstruction resulting therefrom. 

Mental rest is important, as excitement or violent emotions 
may precipitate convulsions. The mental strain, and perhaps the 
tight lacing for purpose of concealment explain the greater fre- 
quency of eclampsia in illegitimate pregnancies. 

Eegulation of the diet is the principal prophylactic measure. 
The amount of proteids must be reduced to the minimum. Milk, 
bread and butter, green vegetables and fruits may be taken freely. 
In extreme cases, however, milk supplies too much nitrogen. Milk 
sugar added to milk increases its nutritive value and promotes 

Water should be given freely in the majority of cases, but not 
in all. Sometimes the kidneys fail to excrete it and the large amount 
of fluids leads to hyperemia and dropsy. Von Noorden claims that 
ill such cases it may overload the right side of the heart and embar- 
rass its action. Therefore when large quantities of water are given 
its elimination must be watched with care. Diaphoresis and cathar- 
sis may be employed to remove the excess. 

In this connection is to be considered the use of salt solutions 
either by enemata or by hypodermic or intra-venous injections. In 
the majority of cases they are of great value. Enemata as a rule 
fulfill the indications and the older methods are rarely necessary. 
They are useful when they cause diuresis or even when added fluid 
can be withdrawn by diaphoresis or catharsis. When, however, 
dropsy rapidly increases they should be discontinued. Their diu- 
retic effects during the convulsions can be determined by withdraw- 
ing the urine every four hours and estimating the solids contained. 
The recent experiments of Courmant, Widal and Javal upon the 
influences of sodium chloride in the production of oedema, and 
Koryani^s apparently well-founded theory regarding the molecular 
interchange in the tubules of salt, from the glomerular secretion, 
far urea from the blood, warn us that even saline solutions may 


occasionally be harmful by disturbing the osmotic tension of the 
body fluids. 

Diuretics as a rule are harmful, especially so during the eclamp- 
tic period, for at all such times the kidneys are secreting little or 
not at all. 

Diaphoresis is of value especially if there is a scanty excretion 
of urine and much oedema. The amount of urea excreted with the 
perspiration is not large, but even a little aid is not to be despised. 
If there is slight or no dropsy or other evidences of excess of fluids 
in the body, profuse sweating may be injurious by concentrating 
the blood and increasing the relative proportion of toxins. In such 
cases the amount of liquids withdrawn by the sweating must be 
replaced in some other way. 

Chloral has been extensively used and abused as a means of 
controlling the convulsions. Administration by the mouth is often 
impossible. Given in enemata its absorption is uncertain, and in 
some cases the system is suddenly overwhelmed by the drug and the 
physician is almost powerless to counteract it. It has few if any 
advantages over chloroform, and the latter can be perfectly con- 

N'otwithstanding the many recommendations of morphine, I 
believe its use to be unqualifiedly condemned. Its action in check- 
ing all secretions counterbalances any good residts to be obtained. 
Veratrum viride has many warm advocates who employ it in 
massive doses (10 to 20 drops of the tincture), until the pulse is 
reduced to 60, and insist that eclampsia cannot occur under such 
circumstances. Others, however, claim that such favorable results 
are by no means uniformly obtained, and that convulsions may 
occur when the pulse is under 60 and dangerously weak. In my 
own cases such heroic treatment has not been required. In some 
cases seen in consultation, patients have died in spite of large doses 
of veratrum. 

As a prophylactic measure, the induction of premature labor is 
rarely warranted. If, however, the toxemia and general symptoms 
increase in spite of enforced rest and rigid restriction of diet, preg- 
nancy should be interrupted in the interest of both mother and 
child. When convulsions occur, delay is no longer permissible. 

The after treatment of eclamptic patients is of the utmost 


importance. The proportion of cases ultimately developing chronic 
nephritis has been underestimated, but it can be reduced by pro- 
longed observation and care of the physician. 




The problems are numerous and varied in the practice of mid- 
wifery, and the best method of solving them becomes of vital inter- 
est to every practitioner of medicine who responds to obstetrical 

There are many different ways of solving some of these obstet- 
rical problems, but the one best way is the method we are all look- 
ing for when we come in contact with a troublesome case. 

When called to a case of confinement we should go properly 
equipped with the necessary instruments and appliances to solve 
any problem that may happen to come our way, and therefore our 
obstetrical bag should contain at least one pair each of long and 
short forceps, catheters, foimtain or bulb syringe, dilators, placenta 
forceps, uterine dilator, chloroform, ergot, apparatus for using nor- 
mal salt solution, some reliable disinfectant such as corrosive sub- 
limate, creolin, lysol or carbolic acid, also some good liquid soap 
such as synol soap, plenty of sutures, needles, forceps, scissors, cot- 
ton, needle holders, etc., etc., and last but not least, the Galloway 
obstetrical pan and outfit, the technique for the use of which I woidd 
refer you to my paper of last year written for this bureau. 

In all obstetrical work and operations, cleanliness is the first 
consideration. The field of operation and everything coming in 
contact therewith, such as the hands and instruments of every kind 
and description, shoidd be thoroughly aseptic. The external geni- 
tals should be thoroughly scrubbed with soap and hot water, and the 
vagina and the internal parts will be rendered aseptic by the Gal- 
loway method of using hot water. Any hair upon the external gen- 
itals likely to interfere with thorough cleanliness should be shaved 
or cut close with the scissors. Natural labor has been defined as 
being one where the mother is in good health with a pelvis not less 


than normal size, the child living and of not more than normal 
size; the vertex presenting and the child's back to the front; the 
membranes remaining unruptured until the os is at least three- 
fourths dilated, and when uterine contraction and retraction go on 
at regular intervals, and at such a rate that the child is born within 
twenty-four hours from the beginning of labor pains; the soft 
parts of the mother being uninjured by the process of labor. In 
cases of difficult labor the variations from the above description 
are numerous and varied. I shall attempt to discuss only the 
most common and every-day troubles that are liable to confront the 
general practitioner in his contact with mid-wifery cases. The im- 
portance of early diagnosis in all confinement cases cannot be over- 
estimated, this being especially true and important when there are 
problems to solve, or difficulties to be overcome, for by knowing the 
e.\act difficulty at an early stage of the labor in most cases the trou- 
ble can be overcome, and the mother safely delivered. The most 
frequent cause of difficult labor is a faulty presentation on the part 
of the cnild, the mother's pelvis and parts being normal. Occipito- 
posterior positions may be very difficult, and in some cases the final 
^'rmination of labor is natural. For instance, the vertex presents, 
me he^d is flexed and the child's belly is turned forward instead of 
backward. As the head comes down, the occiput meets with resist- 
ance on the pelvic floor, and is pushed forward and the head and 
Body turns so the occiput comes under the pubic arch and delivery 
terminates naturally, and as though naturally begun. But when 
-extension instead of flexion takes place in the above described pre- 
sentation unless it can be corrected early before the head becomes 
tlioroughly engaged, it cannot be corrected at all, and the labor ends 
as it began, and constitutes a very difficult labor and one usually 
requiring the use of forceps, as the result is in cases of extension of 
the head, that you have a frontal, or if complete extension occurs, a 
face presentation. The diagnosis of such a case should be made 
early before the membranes rupture, when the child can usually be 
fumed so the back will be to the mother's belly, when the head will 
engage properly and labor go on naturally. Face presentations should 
be corrected whenever possible by introducing the fingers of one 
Hand into the vagina and pushing the hips up with the other hand 
on the outside of the mother's abdomen. If this cannot be done and 


reasonable progress is being made, the pelvis roomy, and the head 
not too large, leave the case to nature, and if necessary later on 
apply forceps and deliver. When there is no progress and the pre- 
sentation cannot be corrected, perform podalic version by introduc- 
ing the hand into the vagina and uterus, getting hold of the feet and 
bringing them down. Pelvic presentations are full of problems and 
are of frequent occurrence especially where the children are dead or 
premature, also in the case of twins. Any part of the child^s body 
may present such as the foot, knee, breach, elbow, hand or shoul- 
der. In all essential points the management of delivery is the 
same. The danger to the mother is no greater in breech presenta- 
tions than in head presentations, nor is the labor especially pro- 
longed on account of it, but the danger to the child is very greatly 
increased owing to the pressure upon the cord. It is also claimed 
that the cold air coming in contact with the child^s legs and hips 
provokes premature inspiration, causing the child to suck in mucus 
instead of air into the lungs, thereby clogging up the air passages 
and causing asphyxia. In breech presentations the membranes 
should be kept unruptured as long as possible, as it is necessary to 
get as complete dilatation of the os and vagina as possible before 
the membranes rupture, as the body being smaller than the head, it 
can pass down and out before dilatation is sufficient to make it pos- 
sible to deliver the head. Watch the progress of the case carefully 
and if the breech does not come down properly after complete dila- 
tation of the OS, it is because the pelvis is contracted or the child 
very large, or the pains very feeble. In event of such a condition it 
is best if possible to bring down a leg and hasten delivery by trac- 
tion. The same condition prevails in cases of breech presentation 
when the cord becomes prolapsed. Breech presentations, where con- 
ditions are favorable, should be left to nature with child^s legs flexed 
upon its body, because in this position the cord is protected. Assist- 
ance can be rendered in these cases of breech presentation by pass- 
ing the fingers over the anterior groin of the child and making trac- 
tion, or by the use of the fillet passed around the thigh at the groin, 
or by using the blunt hook. Great care should be exercised in using 
the blunt hook, or the groin and thigh of the child may be seriously 


Forceps are reeomemnded by some authorities in breech cases, 
but they are very unsatisfactory in such cases, and their use is to be 
discouraged. In all cases where any part of the body presents first 
or where podalic version has been made necessary for any reason, 
the delivery of the after-coming head becomes one of the chief prob- 
lems. This must be done quickly in order to save the life of the 
child. In normal cases where the pelvis is of normal size and the 
foetal head not abnormal in size, there is no obstruction to the deliv- 
ery of the head excepting the soft parts of the mother. When the 
pelvis is too small or the head too large, the delivery of the head 
becomes diflBcult, and there are three ways of overcoming this diffi- 
culty. First: By pressing from above with both hands on the 
mother's abdomen over the uterus, this can be done by the nurse 
or assistant, but the best method to deliver the after-coming head 
may be used alone or in conjunction with the pressure from above 
as just indicated. I refer to jaw traction. By introducing a finger 
into the child^s mouth and making traction upon the jaw, complete 
flexion of the head is produced and great force can be exerted with- 
out injury to the child. The body of the child should gradually 
be carried up toward the abdomen of the mother so as to carry out 
the proper mechanism of labor. Some recommend pressure with 
the fingers of one hand against base of occiput while making traction 
with the finger of the other hand in the child^s mouth. When this 
method fails or is not feasible in the delivery of the head in any 
given case, resort must be had to the forceps, which should always 
be at hand and ready for use should occasion require. 

Prolapse of the cord is another accident that occasionally com- 
plicates labor and is at all times a troublesome problem. It is 
caused by some form of mal-presentation of the child preventing 
the head from properly engaging in the pelvis. This accident fre- 
quently complicates the birth of twins. A contracted pelvis pre- 
venting the head from engaging properly may be productive of this 
complication. This accident does not in any way endanger the 
mother, but more than one-half the children whose cords come down 
are still born. The proper way to treat this accident before the bag 
of water ruptures is to place the mother in the knee chest position 
during several pains and see if the cord will not by gravity be car- 
ried above the presenting part. If this fails and the bag of water 


ruptures, introduce the hand into the vagina and, taking the cord 
between the tips of the first and middle fingers, pass it up clear 
above the presenting part and away from danger. Various instru- 
ments have been devised for this purpose, but none equal the hand 
and fingers in usefulness. If the cord again prolapses and cannot 
be kept out of danger, the forceps should be applied whenever pos- 
sible and the delivery hastened unless it is a sure fact that the child 
is dead. I shall not attempt to enter into the various complications 
that may arise from malformation of the child, such as double mon- 
sters or some peculiar complication that may arise in the birth of 
twins, or serious pelvic deformities of the mother, as these cases 
become largely as a rule surgical, and the detail of their proper 
handling would far exceed the limits of this paper. 

Another not very uncommon problem that comes to the general 
practitioner for solution are cases of placenta previa. These cases 
vary in degree all the way from those where the placenta is im- 
planted upon the lower uterine segment to those where the placenta 
is implanted centrally over the os uteri, and upon examination the 
finger comes in contact with the placental tissue all around. For- 
tunately this accident occurs most frequently in multipara and in 
the later years of the child-bearing period, thus affording the attend- 
ing physician a better opportunity to carry out the rapid dilatation 
and manipulations necessary in the proper handling of these 
cases, as on account of frequent labors the vagina is roomy and the 
OS uteri readily dilatable. In cases of placenta previa where cen- 
trally implanted or nearly so, the placenta is usually larger and 
somewhat thinner than the normal placenta. Hemorrhage is the 
great symptom and danger in these cases and is due to the separa- 
tion of the placenta from its attachment owing to the gradual en- 
largement of the womb in the latter months of pregnancy. Hemor- 
rhage usually comes on without pain or warning and is quite as 
likely to occur at night while lying in bed as at any other time. It 
may be so profuse as to cause death immediately or at least render 
the woman very anemic. This accident usually occurs from the 
twenty-eighth to thirty-sixth week of pregnancy, depending upon 
the location of the placenta; the more central the implantion the 
earlier the hemorrhage occurs. In placenta previa the life of the 
mother and that of the child are often to be weighed in the balance. 


as often what would be best for the child would endanger the life of 
the mother, and vice versa. The mother's welfare should at all times 
be paramount, and if either life must be sacrificed, let it be the 
child's. The earlier labor comes on the less danger. For this rea- 
son as soon as placenta previa is diagnosed labor should be induced 
so as to lessen the dangers. Induce labor by dilating the os uteri 
either with the fingers, tents, Barnes' bags, Hegar's dilators or 
Champetier's bag; the latter is xmdoubtedly the safest and best 
dilator. As soon as the os is dilated sufficiently to admit two fin- 
gers, loosen the placenta all around so as to get past it on one side 
if not centrally implanted, and through it if central, turn the child 
by external and internal manipulations, if possible, then rupture 
the membranes and bring down a foot and leg, plugging the os and 
stopping the hemorrhage. Then the case should not be hurried, 
but leave the case to nature, as it would not be any advantage to the 
child to do so, and a decided disadvantage to the mother. 

In these cases the patient is not out of danger when she is 
delivered, as the sudden emptying of the tired uterus may cause 
it to relax and a post-partum hemorrhage come on, rapidly sapping 
the little remaining vitality and a fatal collapse occur. From rapid 
dilatation of the os uteri the maternal parts may be and usually are 
more or less injured, and this together with the lowered vitality of 
the mother increases the danger of infection and puerperal fever; 
therefore all antiseptic precautions should be carefully looked after 
and everything possible done to build up the patient's strength. 

The next problem to be considered is post-partum hemorrhage 
and in otherwise normal labors, it is fortunately rare when proper 
care has been used in the management of the case. Undue haste 
in delivery in the absence of pain, for instance in cases of instru- 
mental delivery or undue traction in cases of breech presentations 
without waiting for regular labor pains will often be found to be 
the cause of a post-partum hemorrhage. "The principle not to 
deliver in the absence of uterine contraction is the first point in the 
prevention of post-partum hemorrhage." The causes of post-par- 
tum hemorrhage may be divided into three groups. First, those 
cases due to imperfect contraction of the uterus. Second, some 
serious tear or injury to the uterus. Third, disease of the blood or 
blood vessels. The first thing to be done in all cases of post-partum 


hemorrhage is to empty the uterus of clots, or any portion of pla- 
centa that may have been left within the body of the uterus from 
any cause and then make the uterus contract firmly by kneading it 
through the. abdominal wall, with the other hand inside the uterus 
providing it has been necessary to introduce the hand to remove the 
clots or any placental mass. The injection of hot water is an excel- 
lent method of stimulating contractions and washing out any debris 
that may be left within the uterus. Instead of hot water ice or ice 
water are somtimes used. The use of ergot in material doses, also 
bell., ipecac, hamamelis, geranium, etc., etc., are to be used as indi- 
cated. Where the hemorrhage is due to an extensive laceration of 
the cervix the only rational treatment is to expose the bleeding part 
and with needle and suture properly repair the laceration. The 
last problem I shall consider in this paper refers to the management 
of the second stage of labor in preventing injuries to the pelvic floor, 
and when these injuries do occur in spite of our most intelligent 
efforts to prevent them, their proper repair. The frequency of pel- 
vic floor lacerations in general practice has been estimated to be 
thirty-five per cent in first and ten per cent in subsequent labors. 
In at least a part of these cases this accident is certainly unavoid- 
able. Numerous procedures have been proposed for the prevention 
of perineal injuries during delivery. Most of them have been dis- 
carded as useless if not even harmful. Any measure to be of value 
must act to promote relaxation of the outlet and pelvic floor and les- 
sen the tension to which the parts are subjected. This is best accom- 
plished by the slow and gradual delivery of the head giving the tis- 
sues time to stretch, and by regulating the expulsion of the head so 
as to keep the smallest circumference in the grasp of the resisting 
girdle, and the propelling power directed in the axis of the outlet. 
Chloroform or ether should be given for its relaxing effect and to 
lessen the torture incident to this stage of labor. The head must be 
held back and kept from advancing up against the pubic arch. These 
manipulations can best be carried out with the patient lying upon 
her left side with the buttocks near the edge of the bed and the phy- 
sician seated on the edge of the bed facing toward the foot. Then 
by passing left hand over patients body and between the legs and the 
right pressing against the head from behind he becomes master of 
the situation and can control exactly the expulsion of the head dur- 


ing this critical part of the delivery. There is no objection to the 
use of gentle pressure applied to the head through the lateral aspect 
of the pelvic floor, but pressure must be avoided against the thinned 
out medium portion, as this would tend to increase rather than de- 
crease the danger of rupture. Episiotomy when rightly timed and 
properly executed is very successful in preventing lacerations in 
cases where without it laceration would be unavoidable. The struc- 
tures involved in the incision are unimportant. The length of the 
incision should be about one inch, its depth a quarter inch and. about 
one-third way from the posterior to the anterior commisure when 
the parts are on the stretch. After labor these cuts should be imme- 
diately repaired. After the head is delivered it should be supported 
in the hand and great care used in delivering the shoulders, as with- 
out this care they are quite as apt to damage the perineum as in the 
delivery of the head. Only in very rare cases when the condition of 
the patient is such that it would imperil her chances of recovery, all 
lacerations of the pelvic floor should be immediately repaired as 
soon as the delivery is completed, although the work could be post- 
poned a few hours if necessary for any reason without endanger- 
ing the chances of success. An anaesthetic is usually necessary for 
this work to prevent too great suffering, especially if the laceration 
is pretty extensive. Various kinds of sutures are used according 
to the fancy of the operator, and the operation is performed in the 
usual manner, after which the patient^s toilet is made by carefully 
cleansing all soiled portions of the body, her linen changed if neces- 
sary and all soiled linen and blood-stained articles removed from 
the bed and the wrinkles smoothed out of the sheets and everything 
possible done to give comfort and ease to another tired soul who 
probably at this particular moment wishes she had never left her 
happy home. 

I am greatly indebted to the works of G. Earnest Herman on 
^^Difficult Labors" and the "American Book of Obstetrics'^ in the 
preparation of this paper. 


Dr. Bishop: There is one point in reference to obstetrical 
technique that is very important. While it is true that all extensive 
lacerations of the perineum are immediately repaired, yet I be- 
lieve that it is equally important that every injury of the birth canal 


should be repaired during the lying-in. The cervix should be exam- 
ined forty-eight hours after labor, and if lacerated, it should be 
repaired. If it is found that there is any old injury resulting from 
a previous labor, this also should receive attention. There is no 
more danger in doing this work during the lying-in, if the aseptic 
technique is correct, than at any other time. 


G. D. CAMERON, M. D., Chairman - - Chagrin Falls 

" The Health Standard for 1904 " 

CLARK E. HETHERINGTON, M. D., - - - Piqua 

"The Bacteriology of To-day" 

R. 0. KEISER, M. D. - - - - - Columbus 

" Some Comments on Renal Calculi" 



There is an element in all schools of practice, and perhaps es- 
pecially in the homeopathic school a contingent which is inclined 
to look with suspicion and doubt, if not with ridicule, upon any 
claims which the bacteriologist makes in determining the causative 
factors of disease. 

The physiologist may elaborate his theses, the pathologist spin 
his web of theories in his special department and his explanations 
of phenomena, be they physical or mechanical, meet with no skepti- 
cism; but the bacteriologist, he that deals with the germ, labors 
under suspicion. Perhaps this suspicion is to a degree justifiable, 
in that he has as yet given us a very narrow strait connecting the 
great seas of disease and cure. 

It is in harmony with the spirit of the age, an age of science, 
that the cause of disease, not one factor, but all should be sought. 

No intelligent physician will ignore the cause of disease if it is 
to be discovered, any more than he will ignore its phenomena. Bac- 
teriology has given us the first facts regarding the causation of 


disease which are tenable. This of course is within the scope of 
those pathological conditions whose presence cannot be otherwise 

However, the suspicion of the present rests chiefly upon those, 
who in their ardor have seen in bacteria, the only cause worth con- 
sidering, and in their destruction, the cure and prevention of a 
large number of human ills. 

The first few days of the germ theory saw the exploitation of 
antiseptic surgery with all of its excesses. Sober judgment and 
experience have at the present day come to the rescue with a surgery 
that may more rightly be termed aseptic. 

In therapeutics the day of the internal or intestinal antiseptic 
and all that sort, is rapidly giving place to more rational methods. 

Bactieriological science is today seeking to imitate nature's cures 
and is studying the phenomena of immunity, natural, acquired and 
artificial. There is going on the work of finding out what suscep- 
tibility means in terms of the body-chemistry. This turn from 
therapeutics began again upon the demonstration of the efficacy of 
the antitoxin of diphtheria. The serum therapy is by no means a 

Immunization and cure are the two uses to which the various 
sera have been put. Vaccine virus is the one serum longest in use, 
and its efficacy is undoubted, although there is much doubt as to 
the entire wisdom of its present maimer of administration. Coley^s 
mixture in malignant growths, Pasteur^s work in the prophylaxis 
of hydrophobia, the "streptolytic" sera of today and the antitoxin 
of diphtheria, have sufficiently demonstrated their wide range of 
usefulness. And if any method of treatment or any remedy demon- 
strates its efficacy in a large percentage of cases it is worthy of 
acceptance as a remedy, just as much as iron, arsenic and mercury. 

Immunity has found one explanation in the phagocytic theory 
of Metchnikoff. After the discovery of Behring of the antitoxin of 
diphtheria, Ehrlich after a series of experiments, advanced the fol- 
lowing conception : "Toxins which in the living body lead to the 
production of antitoxins, have this capacity only through the pos- 
session of specific affinities called haptophore groups, for correspond- 
ing haptophore groups belonging to side chains or receptors of cer- 
tain celMar constituents of the body, and that in consequence of 


this appropriation of receptors, others of like nature are produced 
in excess of the needs of the cells, and these being shed in to the 
blood, there constitute the antitoxins. 

The essence of Ehrlich^s theory is thus tersely put by Behring : 
"The same substance which in the cells of the living body is the pre- 
requisite and condition for an intoxication becomes the means of 
cure when it exists in the circulating blood." Taking other poisons 
in their toxic action upon the living cells, Flexner and Noguchi have 
shown that "the toxic action of the snake venoms, depends upon the 
presence of intermediary bodies with aflfinities for different cells, the 
complements being contained not in the venom, but in the cells and 
fluids of the animal acted upon." 

Keyes has shown that in the case of the cobra poison, "the 
necessary complement in hemolysis may be found within the red 
cells of certain animals, (endo complement) and further that lece- 
thin may act as a complement and complete the hemoljrtic potency 
of the venom." These experiments show that our serum and cells 
contain substances that may be turned against our own cells by 
the intervention of a foreign intermediary body. 

Further study has led Professor Welch to advance the hypoth- 
esis that since the mere disintegration of dead bacteria does not 
suflBciently explain the production of toxins, there are cell poisons 
of bacterial origin produced by special stimuli from the cells of the 

This transfers the application of the former hypothesis from 
host to the bacteria. The facts in the case of the serpent poisons 
mentioned above strengthens this view. The following is borrowed 
from a resume of the lecture by Professor Welch. 

By the same sort of mechanism, both organisms, the host and 
the bacteria, under the mutual stimuli of their cells, produce sub- 
stances that under the complicated conditions present, become an- 
tagonistic in so far as they tend to destroy or injure the cells from 
which the stimuli in the form of atom complexes are derived. It is 
recalled that familiar haemolysins and bacteriolysins are in reality 
made up of two substances: the intermediate body which is the 
specific element produced by the injection of foreign cells into an 
animal, and the pre-existing complement which is the actually toxic 
element. The intermediate body joins the complement with the 


foreign cell, which started the reaction, thus completing the destruc- 

If reactions like this are produced in the host cell, why not 
also in the 'case of the bacteria and other parasites exposed to 
analagous conditions. Expressed in the terms of Ehrlich^s side 
chain theory, certain substances of the host of cellular origin assimi- 
lable by the parasites through the possession of haptophore groups, 
with proper affinities become anchored to the receptors of the para- 
sitic cell, which if not too much damaged, is thereby stimulated to 
the over-production of like receptors. These excessive receptors of 
the parasite if cast off into the fluids and cells of the host then con- 
stitute intermediate bodies, or amboceptors with special affini- 
ties for those cellular constituents or derivatives of the host, which 
led to their production, and for others which possess in whole or in 
part identical receptors. Provided the host is supplied also with 
appropriate complements, there result cytotoxins with special affini- 
ties for certain definite cells or substances of cellular origin in the 
host. Either the parasite or the host may provide the complement. 

It will be seen by this conception how it is possible for the 
infecting bacteria to produce many special toxins for various cells 
in the body ; toxins that might be absent in the cultures because of 
the absence of special stimuli. 

Some of the things which this study promises to explain are: 
Eirst, by the demonstration of special toxins of bacterial origin, we 
are to explain many of the anaemias secondary to infectious dis- 
eases. Second, the discovery of bacterial cell poisons with affinities 
for certain cells other than the blood cells, which will explain the 
occurrence of such lesions as those of typhoid fever, etc. 

Herein lies the explanation of the difference in the extent of 
involvement of other organs in such diseases as typhoid. At the risk 
of a digression of unpardonable degree, I ask your indulgence if I 
suggest a few reasons why this study of immunity is, or ought to be, 
of special interest to the homeopath. 

Because the serum therapy is so manifestly a system which has 
its real basis in the law of similars. It has simply been approached 
from a different direction. 

To the prescribers of the "nosodes" it is of unusual interest, 
because of the analogy if not identity. 


The sera used in this therapy are dilutions not in any degree 
"low/' even in the homeopathic conception of it. 

Hahnemann himself saw the value of vaccine virus, claimed it 
to be a demonstration of his law. 

It is demonstrable from his writings that Samuel Hahnemann 
had a very vivid conception of the facts of immunity and suscepti- 
bility ; natural, artificial and acquired. He insisted that disease was 
not an entity, but that "symptoms^^ whether of drug or natural 
disease, were the product of stimulated tissue energy, and further, 
that the drug, the homeopathic prescription, ought to be such 
as to call forth a sufficient reaction only, and that there was no 
"humor" or disease entity of which to rid the body. 

Who shall deny until further experiments are made that the 
poisons of the plant of high order or certain chemical substances 
are not nature's antitoxins ? Or, why will not the investigations of 
the future show that the same theories which apply to the serpent 
venoms and bacterial poisons, are applicable to poisons of any other 
class. Herein lies the work which is to relieve homeopathy from the 
long borne burden of ridicule arising from the fact that we have 
no scientific demonstration of our law. 

It is in the light of the investigations that homeopathic drugs 
need study, especially those whose service in the acute infectious 
and contagious diseases has been established. We need to know by 
experiments on animals the immunizing power of various remedies 
and potencies. We need to discover and prove in scientific terms the 
claims of the empirically proven superiority of the potenized drugs. 
We may discover that potentization is identical in its results 
chemically with antitoxin production. 

When Professor Welch says in speaking of his added view of 
the action, "It will be seen by this conception how it is 
possible for infecting bacteria to produce many special toxins for 
various cells in the body, toxins that might be absent in cultures 
because of the absence of special stimuli," we may take the cue and 
from his standpoint investigate the reasons for the superiority of 
one drug over another in the individual cases of the same diseases. 

For example : By reason of special stimuli from the cells of 
some special organ we get a peculiar involvement of that organ, say 
the kidneys in scarlatina, herein we find explanation and justifica- 


tion for the choice of a remedy which by its "symptoms" shows it to 
be peculiarly fitted to complete the reaction in the presence of this 
special toxin. 

We ought to have, to further justify our claims, provings of 
the new sera. There is a frequent cry raised for the reproving of 
our remedies, but most are too well tried to demand the great task, 
but we do need additional knowledge concerning their manner of 
exhibition, their strength and range of application in view of our 
knowledge of disease. 

The homeopath surely has no quarrel with those who are 
investigating the causation of disease. Hahnemann himself recom- 
mended that we discover all ihsi is to be known concerning any 
disease, and if a disease is demonstrated to be bacterial in origin, it 
does not follow that the specific serum is the only remedy, but one 
of them most to be trusted. 

The discovery of the cause of disease ought to be simply a fac- 
tor to be considered in its proper place, as an indication for a certain 

The serum therapy is to give us no real short cut or abbre- 
viated system of treatment. There is not now, nor wiU be any royal 
road in medicine; achievement is ever the result of labor, the laws 
of the world, psychic and physical, forbid great results without cor- 
responding expenditures of energy. 



In this paper the word calculus is used in the general sense, and 
is taken to mean, any concretion of any size which is formed in the 
kidney. The calculus may be (1) Primary: — developing from 
urine which has imdergone no decompositional change, and is the 
result of some defect of, or addition to the composition of the urine. 
(2) Secondary: — due to decomposition of the urine resulting in 
precipitation of its elements. Concretions may consist of one or 
several ingredients, may be of any size or shape, may be of regular 
layer formation, or consist of irregular deposits. 

The conditions favoring the origin of calculi have, to a certain 
extent, been explained through the researches of Carter, who 


found ^^that the actual nucleus nearly always consists of globular 
forms of urates and calcium oxalate, rather than crystals of these 
substances; and that a colloid matrix was always an essential ele- 
ment of nuclear formation. The precipitation always takes place 
on an organic base; this may be mucus, epithelial cells, blood clot 
or colloid material. All concretions, whether they are the size of 
a grain of sand or a goose egg, have a distinct albuminoid frame- 
work, upon which the constituents of the urine are deposited.^' 

Calculi may originate in the secreting structure of the kidney — 
usually in the tubules, or in the renal calyx; but their development 
is most common in the renal pelvis. They are usually unilateral, but 
may be bilateral. They occur at all stages, including the intra-uterine 
life ; are most common before the age of fifteen, and after fifty. In 
young people, calculi are most common among the poor, while in 
advanced life calculi are more common in people of comfortable cir- 
cumstances, and of luxurious habits. As a rule, the calculus of 
infancy is of the ammonium urate variety, in young adults of the 
uric acid variety, and after forty, calcium oxalate. 

The chief symptoms of renal calculi are pain, hematuria, fre- 
quent urination, fragments of the calculi appearing in the urine, 
pyuria, oliguria, or suppression, gastro intestinal irritation. 

The symptoms caused by kidney stone are due to obstruction 
rather than the presence of a foreign body. Hence, the position of 
the stone is of more importance than its size. 
9if|. JO noiSai xeqran^ aq:^ or\. poiiojai iC^noramoo si nred aqj^ 
affected side. It is increased by motion, by jarring, and by pressure 
over the kidney. It begins as a weight and tenderness, not as an 
actual pain. It is subject to sudden exacerbations, often occuring 
at night when the patient is at rest. The pain may be referred to 
the healthy kidney, or to the bladder. It usually radiates along the 
course of the ureter into the testicle, and may cause contraction of 
the cremaster muscle with retraction of the testicle. It may be 
referred to the thigh or the calf of the leg. Attacks of rectal and 
vesical tenesmus, and reflex troubles in the form of vomiting and 
intestinal colic, are also quite common. Attacks of renal colic are 
particularly characteristic of renal calculi. Perfectly characteristic 
paroxysms may occur without the presence of stones. 


Hematuria is usually slight and transitory, and, except after 
attacks of kidney colic, can be detected only by microscopical exam- 
ination. There is found in the urine at times uriniferous tubules, 
made up of blood cells. These are absolutely characteristic of 
hemorrhage of renal origin. 

Gastro-intestinal disturbances are either reflex or due to imper- 
fect elimination on the part of the crippled kidneys. Tympany, 
vomiting, and exquisite tenderness at times complicate and greatly 
obscure renal colic. Chronic epigastric tenderness, feeble digestion, 
and constant pain may direct the attention entirely away from the 

The Urine, — Blood appears in the vast majority of cases and 
presents the following features : Hemorrhage, not profuse, but with 
or after each paroxysm, or without apparent cause. The blood is 
intimately mixed with the urine ; is not bright in color, but smoky, 
brownish, or porter colored. The urine is sharply acid, and high 
colored. After pyelitis is established, the urine and urinary symp- 
toms are as follows : Pus and mucus appear in the urine in greater 
or less quantities. More or less frequency of micturition is pres- 
ent, and the act is accomplished by uneasiness, sometimes amount^ 
ing to pain. The latter may be so pronounced as to lead to the im- 
pression that cystitis exists. 

The deposits in the urine are significant, but care should be 
exercised to secure only primary deposits, not those due to decompo- 
sitional changes. Urates and oxalates are often observed in the 
sediment, the former frequently in quantity. With the advent of 
pyelitis, more or less phosphatic deposit is found. Epithelium is 
also present. Lastly, the presence of small sized concretions in the 
urine furnish diagnostic data of the highest value. 

The diagnasis of kidney stone is based on lumbar pain, with 
intercurrent attacks of kidney colic, hematuria, the passage of 
gravel, or the fragments of calculi, tenderness and the detection of 
a tumor. These symptoms are rarely all present. Pain and hema- 
turia are the most constant, and with the exception of the passage 
of calculi, are the most characteristic. Unfortunately, they are also 
symptomatic of a number of other conditions. Thus, movable kid- 
ney often causes constant pain, with sudden acute exacerbations, 
exactly like those which arise from stone ; sometimes blood is mixed 
with the urine, but only after an acute attack of pain. 


Nephralgia may simulate renal calculus in all respects, except 
in the condition of the urine. In women, the paroxyms of pain are 
especially marked at the menstrual period ; the pain may radiate in 
the same direction as in stone. The urine, is, however, passed in 
large quantities; is of low specific gravity; is limpid and colorless, 
and contains neither pus nor blood, nor is there any history of the 
passage of calculous material. 

Tuberculosis of the kidnej, in its early stage, may simu- 
late renal stone so closely that an exploratory incision will be 
required before a differential diagnosis can be established. 

Malignant growths are characterized by a much more pro- 
nounced hematuria than that due to calculus ; clots appearing in the 
urine in the form of urethral molds ; the growth rapidly and steadily 
increasing in size. Fragments of the growth are sometimes passed 
in the urine, and these may be the only reliable means of forming 
a diagnosis. 

Ordinary pyelitis cannot be differentiated from calculus with 
infection, except by the history of the case. The distinction between 
kidney stone and gall stone may be quite impossible during an acute 
attack of pain, especially if the right side is the one affected. Dur- 
ing the intervals of attack, repeated examinations of the urine 
should throw light on the question. 

The most characteristic diagnostic symptoms, placed in order 
of their importance, are : passage of gravel or fragments of stone ; 
attacks of typical renal colic, hematuria, and ultimately pyelitis. 
It is clear that prolonged study of the urine is necessary before 
forming a diagnosis, the results of the study often sufficing to 
exclude affections, the symptoms of which in every way simulate 
those of renal calculi. 

Treatment — During the attack of renal colic, relief is usually 
experienced from a hot bath, and this is often sufficient to relax the 
spasm. Local applications are often grateful — hot poultices, or 
cloths wrung out of hot water. The patient may drink freely of 
hot water, hot lemonade, weak soda water, or barley water. Occa- 
sionally, change of position will give great relief, and inversion of 
the patient is said to at times be followed by immediate cessation 
of pain. 


During the interval of attack, the patient should, as far as pos- 
sible, live a quiet life, avoiding sudden exertion of all kinds. The 
urine should be kept abundant, and in the majority of eases alka- 
line. The patient should drink daily, a large quantity of water. 
Pure distilled water is just as good as any of the mineral waters, 
and the only advantage that any of them have in this condition is, 
that the patient can be induced to drink more freely of them than 
of the ordinary distilled water. The bowels should have due atten- 
tion, and one or two good passages a day are absolutely essential. 

The diet should be carefully regulated. The patient should eat 
at regular intervals — eat slowly, and not too much. Meat is allow- 
able, but should not be taken more than once a day. The quantity 
of starches and sugar should also be limited. Fresh vegetables and 
fruits may be taken freely, but strawberries and bananas should be 
avoided. Fats, especially in the form of good butter, may be taken 

As for the remedies, any remedy may be indicated, and what- 
ever remedy is indicated, and indicated cleariy, should be given. 

Those most likely to be indicated are : 

Sarsaparilla for children; nux vomica; arnica; arsenicum; 
berberis, calcare renalis praeperata; calc. carb. 


Dr. Biggar, Jr. : Last December Mr. J. H. C, from Duluth, 
Minn., presented himself with severe pelvic pain and symptoms indi- 
cating ureteral calculus. We were fortunate in obtaining a very 
excellent radiograph which distinctly showed a calculus of the left 
ureter located about three inches from the vesicle extremity. He 
was given tincture belladonna carried to the physiological point of 
atropism, with belladonna ointment externally, and instructions 
to drink large quantities of Cambridge Springs water. On the third 
day he passed a ragged, irregular stone the size of a small pea, and 
has since become perfectly well. 

I think it is Murphy who reports in this month's "Annals of 
Surgery,^' a case of calculus of the prostate, and in this connection 
I would like to show a prostatic instrument that Dr. Hugh Young 
of Baltimore, has devised for the purpose of assisting in pros- 
tatectomy. I have recently had occasion to use this instrument in 


a case of perineal prostatectomy and find it of inestimable service. 
Its advantages are that the entire prostate is drawn far down 
into the perineal wound, and the seminal vesicles and the ejacu- 
latory ducts remain intact. I was fortunate in seeing Young do this 
operation at Johns Hopkins and telegraphed for his instrument for 
this operation. My patient will leave the hospital this week with 
full control of the bladder. , 

Dr. Biggar, Jr., then proceeded to describe the use of the instru- 
ment and passed it among the assembled physicians. 



The fact that in this paper there is nothing new does not make 
me wish to apologize for it. Old thought still so much outruns 
present practice that it will bear repeating, and additional duties 
would be excess. Viewed from year to year through the ever-shift- 
ing kaleidoscope of progressive thought, that which we might call 
the normal public health changes. Xormal man takes on a shade in 
color, drops a pound in weight, or an inch in stature; now an organ 
assumes greater proportion and another assumes less, and still an- 
other becomes obsolete. His days are numbered differently. His 
walk is not the same. His mind wanders. His life, as an indi- 
vidual and as a nation, is but a succession of changes. Any effort 
which attempts to locate man as a physiological being is of first 
importance since it takes into account the line which separates 
him from his destroyers, and by this knowledge best of all may his 
way of escape be pointed out. This paper must be brief. 

Let us apply some of the general laws of organic life to man^s 
existing conditions and attempt to draw conclusions therefrom. 

The first great law is heredity. Men have known from away 
back that we do not "gather grapes from thorns" nor "figs from 
thistles." This state sends out pamphlets on garden seeds, hogs, 
mules, mushrooms, black-knot and what not, endeavoring to make 
out its case that man can, by his knowledge of heredity, breed 
organic forms better suited to his purpose and comfort than does 
nature unaided by his intellect. No one doubts that the San Jose 
scale receives the majority of its dangerous and mental and physi- 


cal proclivities from its ancestors. N'o one doubts the law of 
heredity in any and all scales except when applied to man. Here, 
by some strange fetish, the majority seem to look on him as outside 
of and above this inviolate law. This touches man today as a mem- 
ber of society as to his physiological condition at many points, and 
when its proper recognition obtains, besides in a measure revolu- 
tionizing our methods of dealing with the "submerged one-tenth,^' 
it will tend to do away more and more with the chance and fanci- 
ful miscegenation which at present keeps the country courts working 
overtime. A proper appreciation of this law would change punitive 
to reformative measures, and at least modify a system of school 
work which to its discredit puts the same task before the slow and 
the swift, the toiler, the feeble minded, the astute, the sick, the well, 
imbecile and genius, each and all forced through the same gimlet 
hole, fed on the same spoonful of treacle and porridge. As a result 
of this apathy natural selection is at present, as it ever has been, the 
main factor in determining what types posterity is to present. This 
is hardly in harmony with the keen interest which man takes in the 
law of heredity in breeding a candidate for the futurity. 

So much for the law of heredity which man, when applied to 
himself, ignores with almost as much regularity as he does the ten 
commandments. Again, every organ has a function which is its 
life work. The integrity of that organ depends upon a certain 
amoimt of activity. As long ago stated by some physiologist and 
often since repeated, ''use is the price of possession." We have been 
told that it is not always necessary to go back to barbarism to escape 
the evils of civilized life. Nature has, however, warned us on divers 
occasions in the history of the past that a civilization which forgets 
her laws is doomed to destruction. This law of use and disuse 
holds. It did not receive the governor's veto. 

The people of Ohio died in appalling numbers last year, as in 
previous years, from respiratory diseases. There was no week in 
the so-called epidemic of typhoid fever in Cleveland in which pneu- 
monia and tuberculosis did not each lead it in numbers in the death 
list, with bronchitis sometimes crowding it for third place, yet the 
people took it as a matter of little import and as something to be 
expected. As we look at these alarming respiratory figures and 
search for cause we find respiration habits now counted normal. 



which two or three generations back were exceptional and extreme. 
Air is the great necessity of human life. Good limg power, good 
air supply, good breathing habits, are all important to any race 
which is to preserve the physical legends of a people whose lung 
power has been developed in the open air. In our climate the first 
two or three years of civilized infancy are spent in artificially- 
heated air space, which, as a rule, means poor air. Later come the 
school years, with bad air four months of the year in the daytime 
and a bedroom no better at night. From public school a consider- 
able per cent passes to college life, clerkship, mill work, and various 
modes of indoor life, entailing cramped positions and an excess of 
carbon dioxide, often breathing the air that has been twice or thrice 
exhaled from his own or other lungs ; not for an hour, not for a day, 
but day after day, and year after year. What of it? This pale 
specimen is a normal man. This expresses the relationship from 
one standpoint. We must not forget, in connection with it, the 
increasing nervous strain under our competitive system. This 
dearth of oxygen is coupled with high and higher nervous tension. 
The doubling of the per cent of nervous diseases in the last few 
years shows that man's engines, under these conditions, are hardly 
able to follow the clip and dispose of the ashes. What one thing 
so fraught with good, so cheap in the best sense of the word, so 
practical, so possible as for the physician to cultivate and develop 
the oxygen habit in his community? "Use is the price of posses- 
sion.^' Under this head again comes the condition of present day 
care of the reproductive organs. There may be a realm or realms 
that interpenetrate our own; the spirit may be a higher mode of 
vibration than the senses can recognize. Dives may or may not be 
still lifting up his eyes in torment; society spends much time dis- 
cussing these and kindred questions, and they are, no doubt, full 
of interest to the community at large, hut what question is of more 
burning importance ? And what question ought more to engage the 
attention of the physiologist and social reformer than the present 
conflict between physiological law and social economic progress as 
applied to the sexual organs? Under the present distribution of 
light, heat, electricity, magnetism, etc., the sexual organs are devel- 
oped along in the early teens. Under our present educational, pro- 
fessional, and social progress conditions the marriageable age is 


somewhere from twenty-five to thirty. That society has gradually 
come to ask for a total disuse of sexual organs during this lengthen- 
ing period of years in the face of natural laws seems to me 
strange. The statement of one authority that from eighiy to 
ninety per cent of the up-to-date young men in large cities have 
gonorrhoea before they are twenty-one seems to show that natural 
law has a little the better of the argument. The disappointment 
of society in her bad young people with this high per cent becomes 
a matter of conscience. It makes it almost appear that under the 
name of chastity society had purchased a gold brick. If not gonor- 
rhoea then some other "oea" may be there present, and if the figures 
are correct, the question at once comes up as to what the physio- 
logical status of this interval is. This proposition is more difficult 
of solution than is the one about "good air and lots of it." It brings 
us again to the realization of the fact that economic conditions are 
of great importance in the creation and maintenance of any par- 
ticular physiological type or condition. If this interval could be 
shortened, on one end or the other, society would not be compelled 
to face so much disappointment, and the gonococcus and the influ- 
ences he leaves behind would be' more likely to take the other fork 
in the road. "Use is the price of possession." 

Again, under "over-use and disuse alike bad," did time permit 
we might again allude to our competitive system in its effect on the 
nerves as shown by increased heart action. Men work and worry 
too many hours without rest in the recumbent position. We might 
allude to its effect on rapid eating and decay of teeth, to its nerve 
strain, making the proper predisposing conditions for the use of 
alcohol and narcotics. Any class of men in Ohio today who are not 
invaded by some of these conditions would be a small class. It is the 
duty of the physician to stand for a physiological type and against 
all conditions which weaken physical man. He should not only 
talk but live them. Great cures may be wrought with medicine, 
surgery may astonish us with the brilliancy of its achievements, 
comfort may be given in the hour of extreme need to the distressed 
and panic stricken by trust in the strength and resource of the phy- 
sician ; yet all these are not so great and not so much in accord with 
the light that we have, as to increase by laborious and persistent 


effort the size of a class which may be termed physiology in the 
highest that the term implies to us. 

Summing up what we may do in a word, we may attempt to: 

1. Put practical work into schools. 

2. Have people breathe atmospheric air in winter months. 

3. Encourage better daily respiratory habits. 

4. Favor educational systems that will start persons in busi- 
ness when young. 

5. Advise early marriage and simple living. 

6. Look up the ancestry and training of our criminals and 
weak minded as much as we do that of our road horse or pointer 
dog, to the end that their treatment may be scientific. 

7. Point out the safety and saneness of quiet and rest amid 
the great worry and strife of the years to come. 

8. Teach that he who puts alcohol and narcotics into his sys- 
tem is "monkeying with very delicate machinery.'^ 

9. Encourage athletics and work to keep boys and girls busy. 
10. Believe that whatever victories you win will all, some- 
where, in some way, be placed to your credit. 



SARA E. FLETCHER. M. D., Chairman - - Columbus 

" Artificial Feeding of Infants " 

CLARA E. COOKE, M. D., - - - - Portsmouth 

"Scarlet Fever'* 

S. R. GEISER, M. D., - - - - - Cincinnati 

"Some Fundamentals in the Management of 

Intestinal Diseases of Children " 

C. E. WELCH, M. D., Nelsonville 

" Pneumonia'' 

C. E. SAWYER, M. D., - - - - - Marion 

" Crippled and Deformed Children " 



During the past winter, scarlet fever was quite generally prev- 
alent throughout this section of the United States. In fact, in some 
localities it was considered epidemic. It is manifested by its sud- 
den onset, with a decided chill or chilly sensations, usually vomit- 
ing at night, rapid pulse, pain in the throat, then follows a high de- 
gree of temperature, soon reaching 105°. The pulse ranges from 
110 to 140. The next day, a diffused Gcarlet eruption, generally 
smooth, with no intervening healthy skin, announces itself with a 
stinging, burning sensation, and our patient knows what a true 
dermatitis feels like. A heavy coated tongue, the coat covering the 
middle and back part of the tongue, allowing the swollen papillae 
to project through, leaving the edges clear, and the tip bright red. 

With this peculiar appearance we at once recognize the "straw- 
berry tongue" of scarlet fever. There is some headache. 

When we pronounce a case scarlet fever, almost the first 
thought of the family will be concerning its contagious nature. 
For it is one of the most acutely contagious of the exanthematous 
diseases. Isolation of the patient is desirable, and is right if possi- 
ble, but among the very poor people, it is almost impossible, as we 
often find a large family occupying limited quarters, it may be only 
two or three rooms. However, municipal laws come to our aid, and 


quarantine is made possible. The contagiousness is most active 
during the period of desquamation. The average time for incuba- 
tion is from one to seven days, but may be as late as twenty-one 
days. The eruption fades gradually, beginning to fade about the 
fourth or fifth day. 

The fever declines by lysis, and is followed by desquamation, 
and recovery. This in uncomplicated cases. But with a serious 
case before us, matters are different, and we feel a great responsi- 
bility rests upon us, and we are on the alert to meet the complica- 
tions that may arise. For it is the complications or sequellae that 
cause the greater troubles and anxieties in this disease. Patholog- 
ical anatomy shows granular changes in all glandular structures, 
noticeably in the Peyerian glands, although showing in the stomach 
and kidneys. There is an acute inflammation of the skin. All 
areas of suppuration have an abundant supply of streptococci. The 
bacillus of scarlet fever still remains undiscovered. But because 
of the vitality of the especial poison peculiar to the disease, it is 
probable the investigators will be successful in their search for this 
particular bacillus. There are many who believe Klebs^ micrococ- 
cus, the "monas scarlatinosum" may prove to be the poison. 

Because of the dangers attending the disease, we carefully reg- 
ulate our treatment. Several organs or structures of the body may 
be attacked at the same time, and we must be ready to combat these 
attacks. For instance, diphtheria may show itself, or nephritis, or 
otitis, conjunctivitis, otorrhoea, suppurating glands, peri, or endo- 
carditis, chorea, diarrhoea, rheumatism, arthritis. Water is one 
of the most potent factors in the cure of this disease. Kellogg, in 
his book, "Rational Hydrotherapy,'^ recommends the use of cold 
affusions. But hot water is more generally used, and is safer in the 
hands of the laity.. Usually a hot sponge bath given the patient 
in bed, only uncovering a small portion of the body at a time, rub- 
bing with moderate vigor, then covering with a blanket, will be 
sufficient. The bath ought not to occupy more than ten minutes. 
But where a bath tub is accessible, immersing the patient in water, 
the temperature of which can be comfortably borne by the patient, 
will be really more effective. 

When the fever is high sponge baths can be given frequently, 
from two to eight in the twenty-four hours. Cold bathing may be 


useful and of great benefit under some conditions, but in general 
practice we meet with few people who are competent to give a cold 
bath properly, and experience has taught there is danger attending 
if the reaction does not follow such a bath. If the patient is a 
strong, healthy child, with a good heart action, and the fever is 
high, cold sponging may relieve him for awhile, but the results 
from a tepid bath will be as good, and probably longer lasting. 

After the bath the skin may be anointed with olive oil, or vase* 
line, to soothe the itching and burning which is so annoying. Later, 
when desquamation sets in, the use of oil may prevent the spread 
of the disease to some extent by preventing the desquamated epi- 
dermis from floating in the air. 

The bed should be so placed that the bright daylight will be 
screened from the eyes. Alarming conditions of the eye may follow 
as a sequela, such as conjunctivitis, abscess about the eye, phlycten- 
ular keratitis, albuminuric retinitis, and other conditions. 

The throat always requires attention. There is always an 
angina present. A tonsilitis or a pharyngitis will be present, and 
local treatment will be necessary. A true diphtheria may develop, 
which will require careful treatment. There will be more or less 
disturbance of the alimentary tract. While there is fever the diet 
should be liquid. The bowels must receive necessary attention. 
See that the urine is voided. The skin is so much inflamed that 
unless the kidneys act very well, a nephritis may result. 

In choosing remedies, aconite, belladonna, bryonia, gelsemium, 
or veratrum viride, will probably be the remedies first thought of. 
If the condition is serious, we may have to alternate two of these, 
or we may have to think of hyoscyamus, or rhus tox. During the 
past winter rhus has served me well in several instances. The 
throat may give so much trouble that we may prefer to use hepar 
sulphur, mere, protoiod., or the biniod., or lachesis, or kali bi., in- 
stead of the first mentioned remedies. 

Violent pain in the ear is very common, and can be relieved 
with warm water. The ear troubles are also of the sequelae, 
and are of a serious nature. Hepar sulph., pulsatilla, belladonna 
may have to be called into use. 

The cardiac disturbance must be recognized. There may be 
valvular lesions, or the heart muscle itself or the structures but- 


rounding may cause permanent disability. The nervous disturb- 
ance may also be very great. 

A very trying, but an interesting case, I had recently was that 
of an eleven year old girl. She was found one morning, after she 
had dressed for breakfast, lying across the bed in an unconscious 
condition. When I arrived at the house a few minutes later, she 
had regained consciousness, but presented well-developed sjrmptoms 
of scarlet fever. She had a high degree of fever for several days, 
first one ear, then the other gave a great deal of trouble, and both 
were discharging pus. Every new manifestation of the disease 
was heralded by an attack of unconsciousness, and a very weak 
action of the heart. Her mother would notice a cyanotic appearance 
of the face and finger nails, followed by a state of unconsciousness 
lasting sometimes for five minutes or more. After recovering from 
such an attack there would be a weak and rapid pulse for several 

Eemedies in this case were rhus, belladonna, bryonia, cactus 
grand and hepar sulph. as they were required. Eecovery came 
slowly, but today she is as strong as ever. 


Dr. Hoyt: Scarlet fever is one of the diseases with which 
I have had much to do in my work. I have seen a great many cases 
and thus far have been especially fortunate. I attribute my suc- 
cess to my exaggerated care to keep the patients from taking cold* 
I do not permit them to sit up or leave the bed until the desquama^- 
tion is complete. I permit my patients to use a bacon rind to allay 
the itching consequent upon the pealing off process. 



The reason bowel disorders are more fatal to children than to 
adults is because they possess much less vital resistance than do 
adults. The therapeutic principle which applies to one applies to 
the other. While there may be some remedies that act peculiarly 
upon children, there is really very little difference as far as con- 
cerns homeopathy, whether it be an infant, a child, or an adult. 


A long continued elevated air temperature seems to be one of 
the main remote or predisposing causes of summer intestinal disor- 
ders, both in the child and in the adult. Add to this some error in 
diet, and there results usually undue bowel action. In other words, 
the immediate cause of morbid frequency is improper food. Diet, 
then, is one of the fundamentals is the management of the disorders 
under consideration. 

Constitutional debility, either acquired or congenital, unfavor- 
able surroundings and previous attacks of the acute disease are 
remote causes of the chronic variety. 

Granted that every physician is familiar with the character 
of the fecal discharges in the healthy state of the infant or child, 
viz : yellow, smooth and of the consistency of rather thin mush or 
paste, the odor being simply fecal, a variance from this being abnor- 
mal. The green stool indicates fermentation. We should remem- 
ber, however, that all stools are inclined to take on a greenish hue 
after exposure to air for some time, therefore fresh samples should 
be inquired for and examined. 

Curds in the evacuations usually depend upon the indigestion 
of the casein of the milk. Undigested fats also take the form of 
curds; these curds are smoother than the former. The passage of 
the curds through the intestinal tract sometimes cause much un- 
easiness and consequently crying and fretting. Crying and fretting 
is not always due to intestinal disorders. Lithaemic poisoning is 
oftentimes the cause of much of the uneasiness of infants. It is 
in reality an auto-intoxication, due to an excess of uric acid, 
xanthin, etc. 

We are apt to forget that even new-born infants eliminate 
much uric acid, and it may cause infarcts in the kidney and small 
calculi in the ureter. A reddish deposit in the napkin is an indi- 
cation of this disorder. . Hot baths and lycopodium relieve this 

Slimy stools result from a catarrhal condition of the lining of 
the bowels. When this mucoid material is well mixed with the feces 
we know that the irritation is quite remote from the outlet. Other- 
wise it is in the large intestine, very likely in the rectum. Very 
thin yellow stools occur in hot weather, when the child is relaxed 
and in a general way "below par.'^ This state unless checked will 


result in cholera infantum, now fortunately an infrequent disor- 
der. Excessively foul stools result from decomposition of the 
albumen of the food. 

Cholera infantum or gastroenteric infection is very different 
in its stool peculiarity from all the preceding. In this disease the 
stools are watery and profuse, there being only flakes of fecal mat- 
ter. The nursing child, when not overfed, and who has a healthy 
and unwomed mother, rarely has bowel trouble. It is the artifi- 
cially fed and the one subjected to overcrowding and unhygienic 
conditions of large cities that are likely to be affected by bowel dis- 

In cholera infantum prompt and energetic means are required. 
By energetic, I would not think of antipyretics, as there is usually 
high fever accompanying this variety. Fever in this as in other 
diseases is simply one symptom. The use of an antipyretic, which 
would not be removing in the least the cause, would be harmful 
and unphilofiophic. 

Every internal medicine used for direct reduction of tempera- 
ture is a heart depressant. We all know that every drug given in 
doses sufficient to depress the heart will bring about a decided reac- 
tion, and hence is harmful to the patient. The high temperature 
should be modified, the chief aim of temperature reduction being 
the comfort of the sick one. Hyperpyrexia may be combatted by 
tepid water spongings and aconite and belladonna, according to 
the indications. 

It should be remembered that during the early stage of acute 
cases, digestion is practically arrested, hence it does not at this 
moment become a question what to feed, which in the chronic and 
subacute cases is important, but to know the importance of not 
giving food at all. Stop all food at once, especially milk. Thirst 
must be relieved by bland fiuids given frequently in small quanti- 
ties, and cold. 

The treatment for all other varieties will be mainly dietetic. 
Eid the intestines of fermenting and irritating material. 

Professor Alexander Hamilton, M. D., Edinburg, in the year 
1804, says: "Nature has very fortunately rendered the stomach 
of infants so irritable that when it is overfilled, or loaded with in- 
digestible substances, vomiting is usually induced, but an habitual 


vomiting gradually impairs the vigor of the stomach, and any pre- 
caution which can be suggested should be employed to guard against 
the causes of this complaint/^ Again he says : "Often as the stom- 
ach is in this manner emptied, the contents of the bowels should be 
evacuated by proper doses of a gentle laxative/^ 

He suggested calomel, cream of tartar and castor oil. This old 
doctor and others before him knew the importance of sweeping 
out the prima viae. Castor oil should certainly be preferred ; while 
this is an old and abused remedy, is nevertheless a good one today. 
This sometimes relieves a relaxed condition of the bowels by remov- 
ing the cause. 

Then again it should be remembered that a child is sometimes 
starved to death by overfeeding. "Feed! feed!" is the cry. The 
mother should know that the child's nutrition depends upon what 
it assimilates, not upon the amount it eats. When milk can be 
given with propriety and can be retained, too, after its suspension 
for a while, this should be done; the effects should be carefully 
watched, and as long as undigested material appears in the evacuar 
tions, such as curds, the milk should be somewhat diluted. When 
the point is reached at which these disappear, then dilute less. 

Therapeutics. — ^While proper diet and hygienic surroundings 
are fundamental and alimento therapy of much less importance, the 
well-selected remedy aids greatly in bringing about a favorable ter- 

Bell. — ^When a hot atmosphere, or exposure of the child to the 
sun has brought about fever and irritable stomach with predom- 
inant head symtoms, congestion, heat, redness, fullness of blood 
vessels, cold hands and cold feet with drowsiness, half sleeping and 
half waking with moaning, bell, should be thought of rather than 
remedies acting more directly upon the gastro-intestinal canal. 
Later, for this watery diarrhoea, especially for teething children, 
in continuous and exhaustive diarrhoea, with indications of cere- 
bral effusion, gauco will come to our aid. 

Croton tiglium in toxic doses produces irritation of the entire 
gastro intestinal tract. In other words, it is a powerful drastic 
purge. To our old school friends it appears ridiculous even to sug- 
gest this drug for a relaxed condition of the bowels, yet from clin- 
ical observation and from experiments based on pathogenic effects. 


it has been proved a very valuable remedy in many forms of diar- 
rhoea. With the general character of sudden expulsion and great 
aggravation from taking anything into the stomach, stool occurring 
immediately after eating or drinking, generally very watery and 
yellow, sometimes associated with nausea and vomiting, at other 
times with pain following the colon down to the rectum, croton tig. 
will meet the case very happily. Should the diarrhoea only be con- 
trolled by this remedy and vomiting continue, kreosotum will be the 
curative drug, especially if dentition is seemingly painful and the 
child is sleepless, and its teeth decay rapidly and are dark and 
crumbly, with spongy, bleeding gums. The vomiting of food comes 
on several hours after eating, while in croton it comes on shortly 
after. The multiplicity of remedies and their numerous indi- 
cations transferred from text-book to text-book, from aconite to 
zincum, are certainly confusing to the student, even to the phy- 
sicians. How shall he make the selections ? He will think of ars.j 
ver., nux, mer., ipecac., etc. Arsenicum ver., frequently indi- 
cated, even alternated, without discrimination, can well be differ- 
entiated. Yer. will be called for when profuse watery, painful 
stools prevail. Painless stools never indicate ver.; then there is 
likely to be simultaneous purging and vomiting, while in ipecac 
there is vomiting and purging, independent of each other, the for- 
mer predominating. With ars., scantiness of secretions is charac- 
teristic. Small, dark, offensive stools with great prostration fol- 
lowing, preceded by restlessness, anguish and pain in the abdomen 
and burning in the rectum. Mercurius and nux have some symp- 
toms in common. Nux is often called for when babies are getting 
used to change of food and nurse. The nux child is an uneasy and 
fretful individual The stools are small, frequent, possibly mixed 
with mucus, straining even when nothing is passed. Merc, calls for 
frequent, green mucus or bloody mucus stools, with violent tenesmus 
and nightly aggravations. 




In a short paper we can hardly go into detail and consider 
the nomenclature, so diversified, in our text-books, the pathological 
conditions, morbid anatomy, etc. ; neither is it necessary to consider, 
separately, the three stages of the disease. What we are most in- 
terested in is a general discussion of the disease from the stand- 
point of the family physician. 

Pneumonia is one of the most dreaded and fatal of the dis- 
eases we are called upon to treat, in fact the death rate is so high 
and the physicians of the "old school'^ are so helpless that a recent 
newspaper, Chicago Saturday Evening Post, published an editorial 
based upon the opinion expressed by a "regular^^ practitioner that 
"pneumonia is not influenced by medical treatment." It is un- 
necessary in this meeting of homeopathic physicians to say that we 
can produce statistics and cite innumerable cases to refute the 
above as applying to the disease under scientific treatment. The 
fatalities, however, are largest among the very young — ^having a 
more favorable prognosis when coming, as a primary condition, 
between the ages of three to six years. The most important fear 
tures for us to consider are the diagnosis and treatment. 

In the diagnosis we must necessarily take into consideration 
some of the etiological factors. Primarily, especially in children, 
it comes more often from exposure, which may be very slight, espe- 
cially in the winter months and in this State where the climate is 
so changeable. The little fellow contracting the cold or first stage, 
when the mother thinks she is the most careful, not allowing the 
baby outdoors. The cool air, circulating near the floor, coming 
from beneath the doors, in a nice warm room, doing its deadly work 
while the child is innocently playing; or, getting warmed up and 
perspiring from playful exertion, he drops to the floor to rest. The 
cool air suddenly checks the perspiration, and this is soon followed 
by the usual symptoms. 

We need not discuss the diplococcus pneumoniae, as the major- 
ity of us have not the means nor the time to hunt for it, and there- 
fore can only absorb from our literature and believe according as 
we interpret the importance of the investigations of the bacteriolo- 


Secondly, we find pneumonia following closely upon or com- 
plicating many diseases. Probably first in the list which predis- 
poses to it is measles; then scarlet fever, meningitis, diphtheria, 
typhoid, whooping cough, etc. 

Our diagnosis made as to the disease, we find difficulty in de- 
termining the extent of tissue involved and the probable compli- 
cations, which are most often pleuritic and an involvement of the 
pericardium or the endocardium, when the left lung is affected. 
The fact, however, that its ravages are usually confined to one lobe 
or one lung helps the patient to a recovery. 

When first called to see our patient we usually get a history 
of a sudden onset — a chill, more or less pronounced, followed by 
general depression, which is followed by a high fever. We find 
dyspnoea, pain over the chest, and a dry, hoarse cough, rapid breath- 
ing, and alternating flushed face with dry skin and pale features 
with perspiration. The respirations, pulse and temperature rap- 
idly increases, but the respiration out of proportion to the temper- 
ature and pulse rate. In no disease do we find such a vast degree 
of difference in the pulse-respiration ratio. 

Dr. Orrin Smith reported a case to the Clinical Society of 
Hahnemann College, Chicago, in 1896, in which the pulse-respira- 
tion ratio was most interesting. A boy nine months old, from the 
fourth to the ninth day, inclusive, had an average pulse of 148 — 
the lowest being 125 and the highest 160 — and an average respira- 
tion of 93 — Slowest being 65 and highest 120. The symptoms be- 
gan to subside during the morning of the tenth day and the boy 
made a satisfactory recovery. 

Average cases are not so pronounced, however, and we usually 
watch the pulse and temperature range, and probably allow this 
to determine our prognosis more than we should, losing sight of 
the importance of the respirations. 

The cough, which is first dry, soon loosens up and the sputum 
is often streaked with blood, giving it a rusty color, being tenacious, 
however, and hard to raise, although the rattling in the chest at 
this stage indicates an abundance, and it seems as though it ought 
to come up easily. The pain is often acute and causes extreme rest- 
lessness and a slight catch in the breathing. The eyes are bright 
and staring and the whole expression one of anguish or anxiety. 


Our first duty is to prescribe the indicated remedy and direct 
the nurse, usually the mother, as to the care and diet of the patient. 
Locate the child in a room where the bed will be free from direct 
draught, but room freely ventilated, better indirectly through an 
open window in an adjoining room, and maintain a steady temper- 
ature of about 65°. Have the patient isolated, if possible, and es- 
pecially free from visitors and noise. If we see the patient early 
enough, aconite 3x is the remedy; but we are usually too late for 
this, when bryonia or ferrum phos. must be considered, then a lit- 
tle later we will often get the indications for chelidonium pro- 
nounced. Its action on the liver, and relief, in this way, from 
accumulated poison makes it the remedy par excellence. We have 
to choose from, however, phosphorus, kali mur., gelsemium, etc. The 
average case can generally be handled with bryonia, chelidonium 
and sulphur. We have our materia medica for indications for 
these remedies, so we need not expand upon them here. 

The question of stimulants must be left, somewhat, to the judg- 
ment of the physician and the exigencies of the individual case. 
Their general use throughout the case is to be strongly condemned. 
I think many cases are lost by the injudicious and persistent use 
of stimulants, especially strychnia and alcohol. In cases of extreme 
exhaustion and where stimulation is necessary in the later stages, 
I use almost exclusively hypodermics of whisky with good results. 

The old method of quinine and strong stimulants with wet 
poultices, throughout the course of the disease, is, no doubt, respon- 
sible for the newspaper article referred to; but we must confront 
the poultice question to satisfy the laity, and if possible benefit the 
patient. I think the wet poultices commonly used and frequently 
changed should be condemned, as the frequent changing, without 
proper protection, exposes the child and does much damage. 

Strips of fat meat may be stitched to a flannel cloth and ap- 
plied during the first stage, or antiphlogistine changed once in 
twenty-four hours, or what I get the best results from, slices of raw 
union placed between cloths, pounded a little and warmed and ap- 
plied, leaving explicit directions not to remove it until I order it 
taken off. When the loose, rattling condition develops, remove and 
apply a closely fitting flannel jacket. 


Cotton on oiled silk can be used throughout the course of the 
disease, in some cases with benefit, replacing with dry cotton as 
often as it becomes moist from the perspiration. 

The friction treatment, with the naked hand, applied to the 
chest, twice a day, is giving good results. 

The prophylactic treatment would mostly apply after the first 
attack, for while pneumonia is a frequent complication and 
sequela, it is also a strong predisposing factor or stepping stone 
to our most dreaded disease, pulmonary tuberculosis. One attack 
predisposes to another, and another soon follows, and this process 
weakens the lung tissue and impairs the general health of the pa- 
tient until phthisis pulmonalis gets its start, hence the care in the 
after treatment. This should consist mainly of a toughening pro- 
cess, out of door life as much as possible, less bundling up and 
more cool bathing, the object being to make the child less suscepti- 
ble to mild changes in the asmosphere. This toughening process 
should properly began at birth. 

The diet during a case of pneumonia should be liquid and 
nutritious. In young infants this is usually fixed, being mother^^ 
milk, or some ari;ificial diet as Horiick^s, Mellin's, etc. In older 
children the liquid diet, usually prescribed in most cases is allowed, 
as beef broth, cow's milk, etc. 

The greatest care should be exercised during the convalescing 
period, as the tissues are tender, and too eariy liberation from the 
sick room may cause a fatal relapse. 



For the past year and a half there has been a special effort 
made to obtain state aid for the crippled and deformed children of 
Ohio. That you may be more familiar with the progress of the 
work, I take the liberty of reading the findings and recommenda- 
tions of the Commission appointed by Gov. Nash to report on the 
necessity, feasibility and desirability of the State taking up the 
charitable work of providing an institution for the care, treatment 
and education of crippled and deformed children. 


This report is self-explanatory and shows the difBculties en- 
countered, and the results obtained, regardless of all difficulties the 
investigation proved beyond question to the Commission that Ohio 
had many cases of this kind which were deserving care and atten- 
tion they were not getting, and as the recommendation of the Com- 
mission shows, they are unanimously in favor of a complete modem 
and thoroughly equipped institution for the care, treatment and 
education of the indigent crippled and deformed. 

As the report is brief and to the point, I take the liberty of 
presenting it in full. 


To the Honorable George K. Nash, Governor of Ohio: 

Dear Sir — The Commission appointed by you in January, 
1903, in compliance with the provisions of an Act passed by the 
General assembly in special session in October, 1902, ^^to report 
upon the necessity, feasibility and desirability of the State caring 
for, treating, and educating crippled and deformed children," re- 
spectfully presents the following : 

Organization. — Having duly qualified according to law, all the 
members of the Commission met in the Governor's office at the 
State House on the 16th day of January, 1903, and organized by 
electing the Eev. John Hewitt, President, and Dr. E. C. Brush, 

After brief discussion an agreement was easily reached as to 
the purpose of the Act of the General Assembly and the duties de- 
volving upon the Commission in carrying out the same. 

The President and Secretary were then appointed a committee 
to secure information as to (a) the number of crippled and de- 
formed children in the State under the age of eighteen years; (b) 
how many of such children are able and how many are not able to 
attend school; and (c) what has been the experience of other States 
in the establishment of institutions for crippled and deformed chil- 

Methods, — The following methods were adopted for securing 
this desired information: 

1. Through the office of the Commissioner of Public Schools, 
two blank forms for returns were issued to the county Auditors 


throughout the State — one for each Auditor and one for each school 

2. A circular letter was addressed to about eight thousand 
five hundred (8,500) physicians and surgeons; also to three thou- 
sand (3,000) clergymen, and one thousand three hundred (1,300) 

3. Correspondence was opened with county and state elee- 
mosynary institutions, asking for the names of crippled and de- 
formed children cared for by them, as well as for an expression of 
opinion as to the necessity of establishing an institution for their 

4. Correspondence was also opened with existing institutions 
for the care of crippled and deformed children in other states — 
namely, Massachusetts, Minnesota and New York. 

5. Finally, the President of the Commission met and con- 
ferred with the Superintendent of the Minnesota institution, and 
afterwards visited in person the Massachusetts State institution, at 
Baldwinville, Massachusetts; the Boston city institution; the New 
York State Hospital at Tarrytown, and a private institution in New 
York City. 

Results of our Investigations, — It has been apparent from the 
first, that it would be quite impossible to secure a full registration 
and description of the crippled and deformed children in the State. 
The Census Department at Washington has not been able to suc- 
cessfully collect such statistics, and similar efforts in other states 
have been unsatisfactory to a degree. To whatever cause or causes 
this may be attributed, whether to the very general tendency of par- 
ents and physicians to withhold information, or the indifference of 
enumerators, the fact remains that we have been able to locate less 
than half of these children. This assertion is based mainly on the 
apparently full returns received from Cuyahoga County, which we 
have used as a basis for estimate. 

As a result of the various efforts of the Commission to collect 
statistics, we find ourselves in possession of the names and addresses 
of one thousand and seven (1,007) children, reported from seventy- 
nine (79) counties. No returns whatever were received from Ash- 
land, Athens, Carroll, Mercer, Morrow, Noble, Union, Wayne and 
Wyandot Counties. 


How complete the returns were is seen by a comparison of 
counties of the same approximate population. In Cuyahoga County, 
the county that seems to have made the fullest, yet we feel satisfied 
far from complete report, we have the names of three hundred and 
thirty-six (336) children; while from Hamilton County we have 
received but thirty (30). Not a single child was reported from 
Ashland, Mercer, Union and Wyandot Counties, while from Clin- 
ton and Warren Counties, with the same approximate population, 
there were reported eighteen (18) and ten (10) respectively. 

The members of the Commission are agreed, from all informa- 
tion and evidence at hand, that in every instance the cases reported 
are far below the actual number in the State. 

It is a matter worthy of note that although physicians, min- 
isters, school superintendents, institution oflBcials and citizens gen- 
erally were requested personally, and through the press, to send to 
the Commission names of all crippled and deformed children known 
to them, that out of one thousand and seven (1,007) names so re- 
ported from these divers sources, only fifty-one (51) were dupli- 
cates; that is to say that only fifty-one (51) children were reported 
by two persons. This, in the mind of the Commission, confirms 
the estimate we make, based on the returns from Cuyahoga County; 
that there are in Ohio, not less than three thousand one hundred 
and sixty (3,160) crippled and deformed children. 

While our inability to secure more definite returns is cause for 
regret, it was to be expected in view of the remarkable indifference 
shown so generally by physicians, ministers and county officials. 
Out of the eight thousand five hundred (8,500) blanks sent to phy- 
sicians and surgeons, the number returned was but two hundred 
and twenty-nine (229) ; out of the three thousand (3,000) sent to 
ministers of all demoninations, only forty-six (46) were returned. 
Only twenty-eight (28) replies were received from school superin- 
tendents and principals. Only nine (9) out of eighty-eight (88) 
infirmaries reported, and only twenty-five (25) children's homes out 
of fifty (50). Miscellaneous replies, made largely through the pub- 
licity given the work of the Commission by the press, were received 
from one hundred and thirty-eight (138) individuals. 

The returns made by the County Auditors through the State 
School Commissioner, though in some respects less satisfactory than 


others received, furnish valuable data and, so far as they go, reliable 
statistics upon which we believe definite conclusions may be safely 
reached. Partial reports were received from only thirty-six (36) 
auditors. They show a total of five hundred and ninety-one (591) 
children, two hundred and fifty (250) of whom are unable to attend 
school on account of their physical condition. These and other re- 
turns have been tabulated, and appear as part of our report. 

We believe our first estimate of three thousand one hundred 
and sixty (3,160) crippled and deformed children in Ohio, based 
on returns from Cuyahoga County, is conservative and well below 
the actual figures. But it may be claimed that conditions in 
Cuyahoga County are abnormal; that the very large proportion of 
the foreign population in the city of Cleveland, ignorant and in- 
diflferent alike to rules of health and sanitary regulations, con- 
tributes a disproportionate number of these children; and that it 
is not safe to base an estimate for the State on this one coimty. 
That this is true to an extent worthy of notice, we do not accept. 
In order, however, that we may not appear to magnify to the 
people of Ohio the importance and extent of the conditions given 
us for investigation, we have made a second estimate, based on the 
reports made by the thirty-six (36) County Auditors, Cuyahoga 
County not being of the number. The counties are Ashtabula, 
Athens, Belmont, Butler, Carroll, Clark, Clinton, Defiance, Erie, 
Fairfield, Franklin, Fulton, Gallia, Hamilton, Hocking, Lake, 
Lucas, Madison, Medina, Mercer, Miami, Monroe, Morrow, Noble, 
Ottawa, Pike, Putnam, Eichland, Eoss, Seneca, Trumbull, Van 
Wert, Vinton, Warren and Williams. 

The population of the foregoing counties was, in 1900, one 
million eight hundred and nineteen thousand two hundred and 
sixty (1,819,260). We feel safe in assuming that the class of chil- 
dren whose care we are considering, are evenly distributed in our 
general population, and that the whole number in the State bears 
the same relation to the whole population as does the number re- 
ported by these thirty-six (36) counties to the population of the 
same counties. This being true, we have in the State based on these 
partial reports, one thousand three hundred and fifty-one (1,351) 
children. under eighteen (18) years of age, of whom five hundred 
and seventy-one. (571) are not able to attend school. This is one 


of the most significant facts developed by our investigations — ^that 
a large number of children, mentally sound, are, on account of 
physical defects, deprived of school advantages. How large the num^ 
ber really is no one can say. Of one thing we are confident, that 
the five hundred and seventy-one (571) above noted do not repre- 
sent one-half the children thus excluded from our public schools. 
Even though we claim that the number of this class of children in 
Ohio is less than in the States of Massachusetts and New York, 
still a comparison of our statistics with those of the last named 
States will prove that we are justified in making this statement. 

In many instances the physical condition, cause of deformity, 
etc., of the children whose names have been furnished us, has not 
been clearly stated, except under the general terms of "crippled,*' 
"deformed,'^ "can't walk," "weak back,'' etc. However, among 
the one thousand and seven (1,007) children whose names we have, 
we find 

103 cases of hip joint disease. 

99 cases of paralysis. 
139 cases of spinal disease. 

43 cases of infantile paralysis. 

63 cases of club feet. 

27 cases of rickets. 

26 cases of dislocation of the hip. 

17 cases of tuberculosis of knee or ankle joint — a total of 517. 
A great majority of these and other cases of deformity could 
be cured if taken in time and kept imder treatment until cures were 
effected. In probably over ninety per cent of all cases cures, or 
greatly modified conditions, would result from early care and treat- 
ment. The presence of so many deformed children in our State, 
who have advanced to an age where little or nothing can be done 
to relieve their condition, goes far to disprove the claim advanced in 
some quarters, that there is already ample provision made for them 
in general and special hospitals. Another unwelcome truth is that 
so many of these children, probably forty per cent., are being kept 
from school, reaching maturity in ignorance, idleness and misery. 
Conclusions. — Our investigations up to this point lead inevi- 
tably to the conclusion that these children are equally entitled to 
the privileges and benefits of mental and manual training with the 


blind, the deaf and dumb, and therefore that a State institution 
for their care, treatment and education is equally desirable and 

In considering the feasibility of State provision, the Commis- 
sion has naturally turned to the experience of other States, where 
such institutions have been established. We find but three : Minne- 
sota, New York and Massachusetts. Dr. Arthur J. Gillette, of St. 
Paul, surgeon-in-chief of the hospital, states that the success attend- 
ing the work in Minnesota has placed the hospital high in the esti- 
mation of the people of the State, and that it has become one of its 
most cherished philanthropies. The work accomplished in Minne- 
sota, where a beginning was under adverse influence of an untried 
venture, has taken the proposition of a State institution for the 
care and treatment of these children out of the domain of experi- 
ment. There seems to be no doubt of the important place such an 
institution must fill in the field of public charities. And more: 
The contention heretofore made by those in Ohio who have given 
thought and interest in this work, that in addition to care and 
treatment such an institution must provide educational facilities, 
with trades instruction, is made good by the experience of Minne- 
sota. Dr. Gillette holds that the institution to meet its full meas- 
ure of usefulness, must be equipped with an educational depart- 
ment including, as of paramount importance, trades instruction. 

The State of Ohio in its beneficence has unhesitatingly and 
uncomplainingly charged itself with the care of the vicious and 
criminal, the insane and epileptic, the feeble-minded, the deaf and 
blind, wayward youth, the soldier^s orphan and the old soldier, and 
has provided for the county care of the poor, and the dependent 
child of sound mind and body, and for all these a period of care is 
provided that is in most instances limited only by the life of the 
individual. But up to the present, absolutely nothing has been 
accomplished in the care, treatment and education of a class of chil- 
dren whose neglect yields to the State no inconsiderable number of 
life-long dependents, and brings upon it the shame of permitting 
the unspeakably sad afiiictions of these children to develop and 
mature, when early care under modern treatment will wholly re- 
move the defects in fully half, and materially modify and miti- 
gate them in nearly all of the others. 


If the State, in discharging its obligations toward the blind, 
has deemed it necessary to provide for them a separate institution 
where they may be educated, given trade instruction and medical 
treatment, the average number being about three hundred (300), 
and similarly with the deaf and dumb to the number of five hun- 
dred (500), continuing the care of these deaf and blind children 
for a period of twelve or more years, what shall be said of its duty 
to these crippled and deformed children whose bodily infirmities 
debar them from enjoying the pleasures of childhood, deny to 
them the benefits of education, the ability of self-support, and 
opportunities of future usefulness ?* 

Your Commission is of the unanimous belief that the State of 
Ohio should without delay provide an institution for the care, 
treatment and education of crippled and deformed children. We 
believe that such an institution is "necessary, desirable and feas- 

We are convinced the results to be attained would amply 
justify its establishment and reflect credit upon our State, and that 
in a short time this class of children and young people would be 
taken from the lists of those dependent upon public charity. 

Recommendations. — ^The institution should be founded on 
broad lines. 

It shoidd provide the best surgical and medical skill, with hos- 
pital facilities and mental and manual instruction adapted to the 
requirements of these children. 

It should be located near a large industrial center with facil- 
ities for expert medical service and mechanical works. 

It should have not less than fifty (50) acres of land. 

To accomplish this, we would recommend an appropriation of 
two hundred thousand dollars ($200,000.00). 

Trusting that the facts herein stated and the conclusions 
reached will be regarded as satisfactory proofs of a faithful en- 
deavor on our part to discharge the duty imposed upon us, we are 
most respectfully, 

John Hewitt, President. 
E. C. Brush, Secretary. 
a. b. voorheis. 
Adelbert L. Spitzer. 
C. E. Sawyer. 


After this report had been formulated and presented to the 
outgoing Governor, it was the consensus of opinion of those most 
interested that owing to the present numerous demands on the 
finances of the State it would be next to impossible to carry out the 
plan without making unfavorable concessions, and fearing that com- 
promises might arise which would defeat the full purpose and 
objects of the plan contemplated, it was decided to hold the matter 
in abeyance until the reconvening of the Legislature. This will 
give those interested a better opportunity of acquiring more explicit 
information as to the number and class of cases to be treated and 
the particular needs and requirements of such. 

In order that intervening time may not be lost I am especially 
anxious that the Ohio State Society should keep on its list of com- 
mittees one whose duty it would be to take up this subject definitely 
and in detail when needful to the carrying out of the project, and I 
would urge that each aad all of you aid in every way in creating a 
public sentiment favorable to the carrying out of the report of the 

As Chairman of the Committee of the Associated Charities of 
Ohio, on "Crippled and Deformed Children and General Hos- 
pitals,*^ I propose to organize in each county of the State a sub-com- 
mittee to aid in getting definite statistics, in the accumulation of 
such information as may be desirable to demonstrate the needs of 
such an institution and to help acquire the influence of such persons . 
as will be helpful in the passage of the bill when it is finally ready 
for presentation. 

During the interim we expect to work out all of the details and 
when the matter is presented to the next Legislature we hope to be 
in position to obtain an appropriation which will justify the end 
sought. I feel assured that it is only a matter of a short time until 
Ohio will have one of the best state institutions for the care, 
treatment and education of the indigent crippled and deformed and 
I trust that your assistance may always be available. 




In presenting this subject for your consideration, I am not 
vain enough to think I shall tell you anything new. Our worthy 
President remarked, when I gave him the title of my paper, "That 
is a problem which we have always with us.^^ Such being the case, 
it calls for frequent study and refreshing of the memory. 

The specialist in diseases of children may not consider the 
undertaking a difficult one, but when the general practitioner is 
called upon to pilot a baby just beginning the voyage of life, 
through the shoals and quicksands of artificial feeding, he feels the 
burden of responsibility weigh heavy on his shoulders, and he wel- 
comes any light which will guide him and his charge into a safe 

To an infant deprived of its natural food, cow^s milk, as a rule, 
offers the best substitute. In order to prescribe it intelligently one 
must have a well-defined idea of its composition. Such knowledge 
is best gained by comparing it with human milk. 

The following tables taken from Holt are sufficient for all 
practical purposes, although finer analyses are made and there are 
frequent variations of the standards given : 


Fat 4.00 per cent. 

Sugar 7.00 per cent. 

Proteids 1.50 per cent. 

Salts 0.20 per cent. 

Water 87.30 per cent. 

Eeaction alkaline. 


Fat 3.50 per cent. 

Sugar 4.30 per cent. 

Proteids 4.00 per cent. 

Salts 0.70 per cent. 

Water 87.50 per cent. 

Eeaction neutral or slightly acid. 
Thus you see that in cow^s milk the fat is slightly deficient, 
the sugar considerably so, while the proteids are greatly in excess. 


Now just a glance at some of the uses of these various constit- 
uents in building up animal tissue in order that we may better ap- 
preciate their value in the baby's food. 

Physiologists tell us that the most important part of living 
matter is the proteid part of its molecule. In proper combination 
with fat and carbo hydrates, it furnishes the greater part of the 
energy which carries on the processes of growth, repair and nutri- 
tion. It is the only kind of food which supplies nitrogenous waste. 
The proteids are industrious little bodies, and were it not for the 
fats and carbo hydrates, would use themselves up in the produc- 
tion of heat, as well as growth and repair. These latter, conserva- 
tors of energy, furnish the heat, add to the weight of the body, and 
fulfill many other duties in the activities of life. 

The salts help largely in absorption and building up the bony 

Two-thirds of the weight of the body is due to the water, which 
is taken in through food and drink. Through its presence circula- 
tion and elimination are made possible. 

Having all these substances, and knowing their uses, the prob- 
lem is to combine them in such proportions as shall best suit the 
digestive power of the baby^s stomach. 

The proteids in cow's milk are chiefly casein and lactalbumen. 
It is the casein which causes most of the trouble. Aside from the 
fact that it is greatly in excess, it coagulates in coarser, harder curds 
than the casein of human milk. The most reliable indication that 
it is in excess in the food is the presence of curds in the stool and 
colic in the baby. In order to reduce it to the proper proportion, 
water is added as a diluent. This, of course, still further reduces 
the amount of fat and carbo hydrates, which must later be added 
in the form of cream and milk sugar. 

Should it be necessary to further aid digestion, a gruel made 
of barley or oatmeal may be used instead of plain boiled water. In 
young infants this should not be continued for a great length of 
time on account of the starches contained. In an attack of acute 
indigestion these gruels may often be the only food for a few days. 

An excess of fat will most likely show itself in loose stools and 
a regurgitation of food several hours after feeding, while constipa- 
tion which results from a lack of fat may be overcome by the addi- 


tion of cream to the food. I have sometimes found, where the 
baby's stomach will not permit the addition of cream, that a few- 
drops of pure olive oil, given daily, will produce a normal action 
of the bowels and will not disturb digestion. 

The form in which the carbo hydrates are furnished in milk 
is that of milk sugar. Of all the constituents of milk, it is the one 
most easily digested, although even an excess of this will cause 
colic aad green, watery stools. There may also be a rapid increase 
in weight, due to the large amount of sugar in the food,*but there 
is not a correspondilig increase in strength. This deceives many 
mothers, who think that because the baby is white and plump and 
full of dimples, that the food is all that could be desired. They do 
not know or do not appreciate the fact that the lusty youngster who 
lacks the dimples, but whose kicks and struggles give evidence of 
muscular development, has much greater power of resistance to dis- 
ease. A gradual increase in weight, even if it be not more than 
three or four ounces a week, is the best proof that the baby^s food 
a^ees with it. 

In these days of rapid transportation it is much easier to obtain 
fresh milk than formerly. When it can be procured, the fresh, 
•raw milk, warmed to the temperature of the body, is to be preferred. 
Sterilization, which consists in heating to 212 F. for an hour or 
more, alters the taste and causes certain changes which lessen its 
digestibility and tend to constipation, but hot weather, lack of ice 
in crowded cities among the poor, make this a necessary precau- 
tion. Pasteurization which maintains the temperature at 167 P. 
for twenty minutes, then cooling rapidly, is sufficient for ordinary 
occasions, and is said not to change the character of the milk. 
These processes are merely preservative, and milk treated in this 
manner must be modified in the same way as plain milk. 

The amount and intervals of feeding are largely governed by 
the health of the infant. Those of feeble digestion requiring more 
frequent feeding and a smaller amount than more robust children. 
The average capacity of an infant's stomach at birth is but little 
more than one ounce, at three months four ounces, at six months 
six OTmces. Eegurgitation should be the signal to reduce the quan- 
tity of the food. Should it continue, then look to the quality. 


The intervals of feeding may range from two to two and a 
half hours during the day and twice at night, up to three months 
of age, when the time may be gradually increased to three hours 
during the day, and once or not at all during the night. Experi- 
ence shows that there can be no arbitrary rule laid down which will 
govern every case. A careful and frequent observation of the child 
is necessary in order to prescribe intelligently. 

A formula used by Dr. Joseph P. Cobb, of Chicago, makes a 
very good basis for the home modification of milk. It is as follows : 

1 oz. milk; 

2 oz. cream; 
3J4 oz. water; 

1% dr. milk sugar. 

Table spoonful lime water, if needed. 

This makes a mixture in which the proportion of proteids is 
considerably reduced. Of course there are children who need less 
fat or who need less of all the other solids, but as a normal standard 
it furnishes the proper proportion. 

Often one or two pellets of cale phos. added to each feeding 
does away with the necessity for the use of lime water. 

In Boston, New York, Philadelphia and a few other cities, 
the Walker-Grordon milk laboratories have been established, where 
the cows supplying the milk receive every care, and every effort 
is made to keep the milk as pure as possible. The cream is sepa- 
rated from the milk, and cereal jellies, lime water, boiled water and 
sugar solutions are kept in readiness and in exact percentages. The 
physician writes a prescription for each case, giving the proportion 
of proteid, fat, sugar, etc., with the same care that he would 
write a drug prescription. The milk modified as directed is deliv- 
ered at its destination until the physician sees fit to change it. 

This laboratory or "percentage feeding,^' as it is called, would 
seem to be the ideal way, but unf ortiinately it also has its limita- 
tions. Dr. Louis Fischer is quoted as sa3ring: "The percentage 
method of feeding has always seemed to me plausible in theory, but 
it cannot be applied in practice. It is a fact well known by chem- 
ists, that once an emulsion of milk is broken up by centrifuging 
or other mechanical process, as in separating the top milk from 
the skim milk, we cannot have again as homogeneous an emulsion 



as prior to the breaking up of the same." We have yet to learn the 
secret process by which that great chemist, Mother Nature, furnishes 
the food best adapted to her children. 

Of the many commercial baby foods on the market, I have per- 
sonal knowledge of but a few. They served me well in the emer- 
gency which called for their use. The principal objection to most 
of them is that they contain too little fat and too much starch and 
sugar. It has been urged that their prolonged use induces rachitis. 
Should they cause fermentation and chronic indigestion with the 
resulting formation of acids and poisonous compounds in the sys- 
tem, one can easily see how such a condition follows, (the same 
would be true of any food,) but used with discrimination and a 
knowledge of their composition they often render valuable aid in 
that difficult problem of infant feeding. 



A. B. SMITH, M. D., Chairman . _ - Springfield 
'* Haemophilia Again" 

J. H. COOK, M. D.. 

New Carlile 
•M Comparison'* 

H. E. BEEBE, M. D., 

"The Golden Mean" 

W. L. PETERS, M. D., 

- - - - Circleville 
"A Clinical Case" 



In these days when the glorious results of surgery are contin- 
ually sung and when therapeutic nihilism is the order of the day, 
particularly in the dominant school, one case which came under my 
observation seems to me worth recording. For a year prior to June 
last Mr. 0. had noticed an enlargement between the seventh and 
eighth ribs on the right side, but as it did not trouble him much 
until in June, no attention was paid to it. During my absence at 
the American Institute he detected fluctuation and consulted Dr. 
D., who had him poultice it until it opened, discharging consider- 
able pus. Not liking Dr. D., he consulted Dr. S., who by the way 


is an ex-house physician to the Columbus Protestant Hospital, and 
whose student days were spent in the office of one of the most prom- 
inent surgeons of Columbus in the regular ranks. Dr. S. treated 
the case from June until November 12 by means of probing, drain- 
age, moist and dry antiseptic dressings, etc., but gave no constitu- 
tional treatment. 

At the end of this time patient was no better, and Dr. S. ad- 
mitted he could do no more unless he would go to the hospital and 
have the side opened, sinus curetted and rib resected. Then the 
came to me. I found I could introduce readily a probe four inches 
into the fistulous tract and feel the roughened surface of the eighth 
rib very plainly. The mouth of the sinus was pouting, red and 
angry and a continual discharge of thin watery pus exuded. I said, 
"I can cure you, but it will take three months.^^ "All right,^^ said 
he; "only do not cut.^^ 

I gave him silicea 3x trit., a powder four times a day. No local 
treatment of any kind except a pad of absorbent cotton to catch the 
discharge and keep from soiling the clothes as usual. Silicea was 
continued all the time, and an occasional dose of phosphorus was 

Just two days under the three months the discharge had en- 
tirely ceased, the wound was closed up solid, and nothing remained 
to show there had ever been any trouble except the cicatrix. At 
my request he showed the results to Dr. S., whose only comment 
was, "Be careful it don^t break out somewhere else.^' Of this I am 
not afraid, as the case was cured by internal treatment alone and 
not suppressed. Could surgery have offered anything better, safer 
or surer? 



Mrs. H., age 65 years, was born and lived on the farm until 35 
years old. Although not a child or woman of robust health, she was 
subjected to the usual sorts of labor and exposure that fell to the lot 
of women on the farm in those years. She was the subject of fre- 
quent asthmatic attacks until 14 years of age, and at 17 had a mild 
attack of typhoid fever, after which her general health and strength 


were improved. She was married at 20, and in the following 
eighteen years as a result of ten pregnancies had two miscarriages, 
six still-born and two living and fairly healthy children, each living 
about sixteen months, one dying of summer complaint and the 
other of whooping cough. Her labors were rather difficult and she 
was usually several months in recuperating from their effects. 

She passed the climacteric at 50 without any special difficulty. 
Just following this epoch she suffered very much from hemor- 
rhoids, which were treated by the injection method until a treat- 
ment produced an almost fatal collapse. From the time of this 
affliction — now nearly fifteen years — she has not missed a single 
day in using one or more rectal enemas and never has a movement 
of the bowels without this method. For almost a year following the 
hemorrhoidal trouble she was very much of an invalid, the last 
three or four months of which she spent in driving over the county 
soliciting funds for the establishment of a hospital in connection 
with an Ohio Ladies^ Home in which she was an interested worker. 
This out-door recreation and work did wonders in restoring her to 
a reasonable degree of health and strength. Five years ago she had 
a second attack of typhoid fever, lasting ten weeks. 

Having no family and being in comfortable circumstances, 
after recovering from this siege of fever she devoted her time and 
energies very largely to the work and management of the Home 
and Hospital. In her zeal for the success of the institution, she 
frequently engaged in some of the most arduous and disagreeable 
parts of the work, and taxed her strength and powers of endurance 
far beyond a reasonable degree for one of her physical condition. 

After some months of this kind of care and work she began 
liaving occasional attacks of sudden blindness, becoming very weak 
and faint, but by the use of a little stimulant — usually whisky — 
and a few minutes^ rest she would recover and go on with whatever 
she was previously engaged. 

Similar attacks have occurred at irregular intervals ever since. 
About this time her limbs began to fail in strength and her knees 
and ankles would sometimes give out, and during the summer of 
1902 she became unable to walk a distance of two squares, and her 
feet gave her more or less pain after a little walking. Soon the left 
foot around the edge of the heel and along the outer edge of the 


sole and at the base and ends of the great and little toes became 
quite painful from very little use, so that in the fall she was obliged 
' to use crutches to keep her weight off that foot. The painfulness 
of this foot increased in severity until by the last of December she 
was never free from pain and was suffering with frequent parox- 
ysms of severe, cutting, burning and boring pains in this foot, but 
worse aroimd the edge of the sole and in the great and little toes, 
which felt during these paroxysms as if the nails were being gouged 
out with a knife. At this time heat aggravated and cold tempor- 
arily relieved the pains. 

During the month of January, 1903, she took osteopathic 
treatment, and February and March were spent in Florida, and 
during the summer and fall she was under the treatment of three 
different old school specialists in nervous diseases and had about 
five weeks of homeopathic treatment. Through September, October 
and November she used hot air treatments to the foot and limb 
quite frequently, and these were more efficient in giving tempor- 
ary relief from pain than any other means used. At times the 
Faradic current semed to give some relief. 

During the fall the limb became flexed at the knee and the 
knee quite painful at times, and late in December there appeared 
several rows of bead or shot-like lumps along the front part of the 
limb from the ankle to knee, and above the knee two clusters of 
larger and more flattened lumps, the latter being quite sensitive, 
and all freely movable under the skin. About two months later, 
or in February of this year, there appeared on the front and outer 
side of the right thigh rows of lumps the size of a small bean. 
These were quite sensitive at first, but like the others became less 
so after a time. At this time the skin and flesh — of which there 
was very little — of the whole body and limbs was so tender that 
she could scarcely be handled at all without adding much to her 

For thirteen months now she has been confined to the house, 
and most of the time since last August to her bed. While she has 
suffered much from various other afflictions of short duration, the 
left foot has been a source of almost constant suffering for the past 
seventeen months, and recently the thighs have added much to that 
of the foot. 


One thing quite constant and characteristic in her case has 
been the agrgavations during stormy weather and at every change, 
whether to foul or fair. A great many local applications have been 
used, but no one thing has been as efficient as dry heat. She is 
conscientiously opposed to the use of opiates and will not know- 
ingly take them, but has used anodynes, principally the coal-tar 
products. Eecently she has had some codeine, but in all her suffer- 
ing, which at times has been very severe, she has been extremely 
cautious in the use of such drugs, seldom using them except at 

No treatment that has been used in her case has produced any 
permanent improvement. The homeopathic remedies she has had 
are arnica, asenicum, cimicifuga, hypericum, ferrum phos., mag- 
nesia phos., nux vomica, rhus tox., secale comutum and sulphur. 
What can we promise her in the way of treatment or results in the 
future ? 



Is clinical experience a reliable guide in practice? I think I 
hear some one say, "Yes, of course it is, why ask so foolish a ques- 
tion?^' But how much clinical experience is wanted before it is 
a true guide? That depends largely upon the judgment of the 
clinician. If he or she be an enthusiast, which is a valuable quality, 
it may demand more experience than if the worker belong to the 
slow, plodding class in general practice, not the back numbers in 
this branch of the profession. 

Now, don^t think we are making a thrust at the learned special- 
ist, for no one has a higher regard for the thoroughly trained 
worker along special lines than the writer, but it must be remem- 
bered the student taught along one idea, valuable as his knowledge 
is, he is at the same time too often biased, and therefore not always 
to be depended upon for positive final deductions. 

In practice, before reliable conclusions are deduced, sufficient 
time should elapse and a good array of cases recorded to judge 
fairly. Furthermore, in time the general profession renders an 
unbiased opinion, which is usually about correct. With this prelude 


permit the quoting of the following, though the topic be rather worn 
out, this is today the expressed view of many in our ranks : 

''Appendicitis. — J. J. Brownson (American Medicine, Janu- 
ary 16, 1904), believes that there are three periods in which the 
operation for appendicitis can be safely performed: (1) At the 
inception of the disease before fever. (2) After the fever and dis- 
tention have subsided and suppuration has taken place. (3) In the 
interval after all signs of inflammation have disappeared. He says 
that there have been more deaths from appendicitis since the opera- 
tive method has been in vogue than during the expectant plan. He 
believes that this is due to interference being practiced at the wrong 
time. He concludes that the operation for appendicitis ought to be 
done in the primary or before-fever period. The appendix should 
be removed, to guard against fulminating cases and those in which 
rupture occurs into the abdominal cavity. In the secondary period, 
after suppuration, drainage should be instituted, and nature left to 
take care of the appendix. In the interval, after all symptoms of 
inflammation have subsided, the appendix should be removed. The 
operation ought not to be done in the intermediary period when 
there is fever and distention of the abdomen, because the danger 
from operation at this time is greater than the risk of the case be- 
coming fulminating, or the abscess bursting into the abdominal 

Now, are these conclusions valid, and has clinical experience 
proven them to be true? Our brother surgeon specialist says: 
"Why, this is only one man^s opinion, and his utterances are mere 
assertions; we simply assert to the contrary, and our opinion is 
formed from practical work." 

Possibly this is so, but does not the prevailing sentiment of 
today confirm these assertions, and ask for more conservative meas- 
ures ? It certainly does, and besides, is not the golden mean being 
now established according to Dr. Brownson^s opinion ? We believe 
it is. 

Appendectomy is quite often a most important, and neces- 
sarily skillful operation, but to know when to do it is as impor- 
tant a question as to know how it ought to be done. Don't think 
all cases of appendicitis require a surgical operation. 


The surgeon is usually called to operate and nothing more, for 
as to the need of an operation that matter has been settled before 
he is called into the case. I, myself, have had this experience, hav- 
ing operated where I felt it was not really required, but the family 
physician said : "I called you to operate and if you don't do so I 
shall get some one who will operate, for we have decided that is a 
necessity." Well, I didn't let them call some one else. Fortimately 
the patient recovered. 

Again, I have operated where the attendant thought it unneces- 
sary, and I knew it must be done. But I don't cut into these cases 
as frequently as I formerly did, depending upon more conservative 
attention. Dr. Terry's oil treatment is my favorite measure. He 
says that out of fifty cases, under his personal supervision, forty- 
four were successfully treated without operation. 

Oophorectomy is a very beneficial measure when needed, and 
when well done, but today this surgical operation is not resorted to 
once to where it was performed a dozen times ten years ago. Again 
the golden mean has been established. 

Gall bladder surgery is another great necessity, but we are hav- 
ing too many bad results, not always fatalities, but biliary fis- 
tulae, which may be more annoying than the primary liver trouble. 
The risk is too great to do this operation promiscuously, and, too, 
by amateur surgeons. Gall stones do not always cause trouble, for 
they are found imexpectedly in many post-mortems. The decision is 
coming as to when to operate, not so much how, the same as in 

One of the latest, and a most important surgical operation 
today, one that gives satisfactory results as a rule, is prostatectomy, 
but enthusiasts are, we fear, overdoing it. Honest of course, but 
doubtless removing this gland where not necessary and sometimes 
bringing the work into disrepute. 

Xo single operator has yet had sufficient experience to enable 
him to speak authoritatively upon the subject, and such extremes 
of experience have been reported that it is difficult to estimate the 
real danger and difficulties of prostatectomy. It it too grave an 
operation to be resorted to as a routine treatment for enlarged pros- 
tate, and is only applicable to properly selected cases. The greatest 
danger after the operation is uremia, and the kidney should be 


carefully examined before operating. The next danger is sepsis, 
particularly in the presence of an infected bladder. Watch closely, 
and in due time this operation, like the others referred to, will 
reach its climax and seek its level. 

Certainly clinical experience is a most vaulable aid in de- 
termining the reliability of much in the practice of medicine and 

Dr. Brownson^s opinion on operating for appendicitis is but 
one example, while many others can be furnished. That clinical 
experience will find the "golden mean" in due time is, we believe, 
an established fact. 



At the meeting of this society last year I read a paper entitled 
"A Case of Haemophilia," which case was a typical one in every 
detail. As this present paper will treat of this same case, it may 
not be amiss to give a brief outline of it, so that in following out 
the course of the disease, if such it may be called, we may get a 
more complete picture of it. 

The patient, aged 44, male, was the only child. The father 
was a haemophiliac and died from a hemorrhage resulting from 
an injury when in middle life. When the patient was about 12 
years of age he had a severe attack of articular rheumatism, from 
which he has not been entirely free. It was at this time that the 
tendency to excessive hemorrhage from even the slightest injuries 
manifested itself, and several times the bleeding proved almost 
fatal, usually requiring several days to stop entirely. Some years 
ago the patient married, but had no children. At the time of the 
attack in regard to which my former paper was written, viz., August 
19, 1901, the injury was caused by an iron ring striking the man on 
the head, causing hardly more than a bruise which bled profusely, 
not from arteries, but more of a capillary oozing. This was con- 
trolled to a great extent, I am convinced, by phos. 6x, together with 
pressure over and around the bleeding surface. At all events, I 
was told that the hemorrhage was stopped more promptly than 
was usually the case, and the patient made a good recovery. There 


were no more injuries or hemorrhages until shortly after the meet- 
ing of this society last year. 

On May 27, 1903, he was brought to my office bleeding copi- 
ously, and covered with blood from the waist up, from a cut about 
two and one-half inches long on the forehead, where he was struck 
by the handle of a street scraper which broke while he was oper- 
ating it. The cut was rough, jagged and bruised, tearing the perios- 
teum from the bone, which was exposed, and fracturing the outer 
table of the skull. The man was perfectly conscious and aware of 
the gravity of his condition, as he wept continually and was sure 
he was about to die at once. 

It was useless to think of suturing the wound, for the pimc- 
tures of the needle would merely increase the flow of blood, and 
something evidently had to be done promptly. I saturated a strip 
of gauze with adrenalin chloride 1/1000 and packed the wound as 
tightly as possible with it. This allayed the hemorrhage some- 
what, but not entirely, though reinforced by several repeated pack- 
ings at short intervals, together with pressure on the surrounding 
tissues, and adrenalin, in 20-drop doses, at half-hour intervals, 
internally. Finally the bleeding subsided sufficiently for the patient 
to be moved, and I strongly urged him to let me call the ambulance 
and have him taken to the hospital, where he could be attended more 
promptly should the bleeding recur, but his confidence increased as 
the hemorrhage diminished, and he insisted upon going home, 
at least for a while. 

In the afternoon when I returned to my office I found him 
waiting for me, and bleeding about as before. I used the same 
treatment as in the morning, and, when the hemorrhage was some- 
what under control, sent him at once to the hospital. Here he re- 
mained for a few days, the wound still bleeding some, but not so 
much as at first, and gradually lessening as the edges of the cut 
united, until there was left only a small opening at the extreme 
lower edge of the wound about a sixteenth of an inch in diameter, 
through which there was a constant oozing. It was impossible to 
force into this opening any haemostatic which would entirely affect 
the raw surface inside, though this was attempted repeatedly. Vari- 
ous remedies and methods were also tried with only indifferent suc- 
cess. Finally the bleeding from this opening was controlled by 


pressure brought about by placing a small pad of closely folded 
gauze, cut exactly to fit the bleeding surface inside and bandaging 
this as tightly as possible. 

After forty-eight hours of this, the patient, thinking further 
dressings unnecessary, removed the pad and the bleeding again 
began, though not nearly to such an extent as before. The patient 
had already violated several rules of the hospital, being very obsti- 
nate and insolent; therefore, and because of the influence this had 
upon other patients, he was discharged from the institution. A 
few days later I met him on the street, still wearing a bandage. He 
said there was still some slight bleeding and that he was being 
treated by another physician. 

After that I lost sight of the case and heard no more of him 
until, on my return from my vacation, I was told the man was dead 
from another hemorrhage. I looked up a step-son of the deceased, 
from whom I got the following history : Some time in July, while 
unloading gravel from a wagon, he was struck on the side of the 
neck by the sideboard of the wagon. A swelling immediately ap- 
peared, and the man was taken at once to the office of the physician 
who had him in charge formerly. This physician diagnosed the 
case as a traumatic hemorrhage into the thyroid gland, causing 
the swelling mentioned, and advised the man to go home at once 
and keep perfectly quiet. No internal treatment was given. The 
patient returned home, but became very restless and uneasy, and 
in spite of the directions given him, got up and went out of doors, 
walking about for some time, crying and bemoaning his condition 
and complaining that he could not get his breath, until he was 
almost hysterical. The family tried to quiet him until the physi- 
cian, for whom they had sent, could arrive. Suddenly the man 
fell to the ground, gasped and fought for breath as though choking, 
and in a very short time was dead. During this paroxysm there 
was a very little bright red, frothy blood expectorated, probably due 
to the rupture of some small blood vessels in the throat due to 
straining. The doctor gave it as his opinion that death was caused 
by the hemorrhage into the thyroid gland, causing it to swell until 
it shut off the patients supply of air. While this may have been 
the case, there was no way of verifying it as an autopsy was not 




This Society shall be known as the Homeopathic Medical 
Society of the State of Ohio ; and its objects shall be the advance- 
ment of the medical science. 


Any physician of good moral character, who is a graduate of 
any legally constituted and reputable medical college, and who 
subscribes to the doctrine Similia Similihus Curentur, may be 
elected a member of this Society, upon recommendation of the 
Board of Censors, by a vote of two-thirds of the members present 
at any annual meeting. 


Every member shall, upon admission, sign the Constitution 
and By-Laws and pay the initiation fee. 

Any non-resident physician, or such other person, resident or 
non-resident, as may be judged worthy from his superior attain- 
ments in medicine or collateral branches, may be elected an honor- 
ary member by a vote of two-thirds of the members present at any 
annual meeting, and may participate in the proceedings of the 
Society, but shall not vote and shall not be eligible to office. 


The officers of the Society shall consist of a President, two 
Vice Presidents, a Secretary, Treasurer, and seven Censors, who 
shall l^e elected by baUot by a majority of the members present at 
any annual meeting; and who shall hold office until the adjourn- 
ment of the annual meeting next after that at which they were 
elected, and until their successors are chosen and qualified. 


It shall be the duty of the President to preside at all meet- 
ings of the Society, to preserve order, to put questions, announce 
decisions, and to name members of committees not otherwise ap- 



It shall be the duty of the Vice Presidents in the order of their 
appointment, to discharge the duties of the President in his absence. 


It shall be the duty of the Secretary to give notice of the an- 
nual and other meetings of the Society, keep a record of the pro- 
ceedings, conduct its correspondence and have charge of its archives. 


It shall be the duty of the Treasurer to receive all moneys, 
make all necessary disbursements and report the same at the 
annual meeting. 


It shall be the duty of the Censors to receive all applications 
for membership, and to receive and report to the Society upon the 
possession by the candidates of the qualifications required by the 
Constitution. Three members of the Board of Censors shall con- 
stitute a quorum. 


The annual meeting of the Society, at which time its officers 
shall be elected, shall be held at such place as shall be designated 
in the By-Laws, on the second Tuesday in May of each year, and 
such other meetings shall be held as shall be ordered by the By- 


Nine members of the Society shall constitute a quorum. 

Any article in this Constitution may be altered or amended 
by a vote of two-thirds of the members present at the annual meet- 
ing, provided that notice of each intended alteration or amend- 
ment shall have been given to the Society when in session at the 
annual meeting next preceding. 


B r- LA WS. 

Section 1. The annual meeting of the Society shall be held 
at such place as may be determined by a majority of the members 
at each regular meeting. 

Sec. 2. The annual dues shall be three dollars, invariably in 

Sec. 3. At each annual meeting committees shall be appointed 
to report upon such subjects as the Society may designate. 

Sec. 4. All communications read before the Society shall be- 
come its property; but no paper shall be published as a part of the 
transactions of the Society without its sanction. 

Sec. 5. The regular order of business of each meeting shall 
be arranged by the President and Secretary. 

Sec. 6. All papers presented to the Society may be read by 
• synopsis or in full, not to exceed ten minutes, except the Chair- 
maa^s, which may be fifteen. Discussions shall be limited to five 
minutes to each speaker, and no person shall speak more than twice 
on the same paper. Each paper shall be oflEered for discussion 
immediately after its reading. 

Sec. 7. The Committee on Legislation shall consist of seven 
(7) members, of which the President shall be an ex-officio member. 
The President shall appoint two (2) members annually to serve 
a term of three (3) years. 

Sec. 8. The President shall appoint the Ohio members of the 
Inter-state Committee of the American Institute of Homeopathy. 
One member appointed on this Committee shall be a member of 
our Committee on Legislation. 

Sec. 9. It shall be the duty of the President, at the opening 
of the annual session of the Society, to appoint two (2) Supervis- 
ors of Election. All names of candidates for election as officers 
of the Society shall be endorsed by at least seven (7) members of 
the Society and placed in the hands of the Supervisors of Election; 


and it shall be their duty to publicly post the names of all the 
candidates in the room where the meetings of the Society are hdd 
by five o^clock in the afternoon of the first day of the Socieiy^s 

The Supervisors of Election shall furnish printed ballots con- 
tainiiig all the names of candidates for oflBce, designating the office 
for which they are placed in nomination. 

The ballot shall be the Australian system of placing an X 
before the names of the several candidates voted for. 

The Supervisors shall hold the election from the hours of eight 
to ten o^clock a. m., on the second day of the meeting, and at the 
hour of ten o'clock a. na., they shall proceed to canvass the result 
of the election, and certify the same to the President, who shaJl 
announce the result to the Society. 

The candidate recieiving the highest number of votes shall be 
declared elected. 

Sec. 10. The Publication Committee shall consist of the Sec- 
retary, Treasurer and President for the year of which the proceed- 
ings are recorded. It shall be the duty of the Secretary to edit the 
transactions, and all the proof shall be submitted to the President 
and Treasurer for their approval. 

Sec. 11. The President-elect shall appoint a Committee of 
five members, whose duty it shall be to arrange all the minor detail 
business of the meetings of the Society over which he presides, and 
present it in such order as to interfere the least with the regular 
bureau work. 

Sec. 12. These By-Laws may be altered or amended at any 
regular meeting, by a vote of a majority of the members present- 



Resolved, That we do not deem it best to issue certificates of 
qualifications to any person or persons except they be already mem- 
bers of this Society, but would refer all such cases to local, county 
or congressional district Societies. 

Adopted June 9, 1868. 

Resolved, That hereafter no paper shall be published with the 
proceedings of this Society, the substance of which, at least, has 
not been addressed to the Society. 

Adopted May 11, 1870. 

Resolved, That all members of the Society who shall remove 
from the state shall remain members of Society only on payment 
of dues up to the time of removal, after suitable notice. 

Resolved, That all members of the Society, non-residents of 
the state, shall be exempt from all financial obligations to the 

Adopted May 14, 1873. 

Resolved, That hereafter when any member becomes in arrears 
for three years his name shall be stricken from the list of members^ 
after due notice. No member in arrears shall receive a copy of the 

• Resolved, That such members may be restored to the list upon 
payment of arrearage to date of restoration. 
Adopted May 12, 1875. 

Resolved, That the Secretary and Treasurer of this Society 
shall not, during incumbency, be required to pay annual dues. 
Adopted May 14, 1890. 

Resolved, That whenever any assessment is made which any 
member of this Society believes to be prejudicial to the Society's 
best interests, such assssment be considered to that individual null 
and void without any oflBcial action of the Society. 

Adopted May 11, 1898. 





President — ^A. 0. Blair, M. D., Cleveland. 

First Vice President — E. C. Witherill, M. D., Cincinnati. 

Second Vice President — ^W. Webster, M. D., Dayton. 

Third Vice President — A. C. Barlow, M. D., Lancaster. 

Secretary — C. Cooper, M. D., Cincinnati. 

Treasurer — G. H. Blair, M. D., Columbus. 


President — Lewis Barnes, M. D., Delaware. 
First Vice President — J. Bosler, M. D., Dayton. 
Second Vice President — A. Shepherd, M. D., Glendale. 
Secretary — E. P. Penfield, M. D., Bucyrus. 
Treasurer — C. C. White, M. D., Columbus. 


President — D. H. Beckwith, M. D., Cleveland. 

First Vice President — Geo. H. Blair, M. D., Columbus. 

Second Vice President — H. S. Barbour, M. D., Gallon. 

Secretary — ^W. Webster, M. D., Dayton. 

Treasurer — C. C. White, M. D., Columbus. 


President — J. Bosler, M, D., Dayton. 

First Vice President — G. H. Blair, M. D., Columbus. 

Second Vice President — E. C. Beckwith, M. D., Zanesville. 

Secretary — A. Shepherd, M. D., Glendale. 

Treasurer — C. C. White, M. D., Columbus. 


President — ^W. Webster, M. D., Dayton. 
First Vice President — E. L. Flowers, M. D., New Lexington. 
Second Vice President — ^A. Shepherd, M. D., Glendale. 
Secretary— T. P. Wilson, M. D., Cleveland. 
Treasurer— C. C. White, M. D., Columbus. 



President — ^E. B. Thomas, M. D., Cincinnati. 
First Vice President — S. S. Lnngren, M. D., Toledo. 
Secretary— T. P. Wilson, M. D., Cleveland. 
Treasurer — C. C. White, M. D., Columbus. 


President — E. C. Beckwith, M. D., Zanesville. 
First Vice President— W. Webster, M. D., Dayton. 
Second Vice President — Lewis Barnes, M. D., Delaware. 
Secretary — H. H. Baxter, M. D., Cleveland. 
Treasurer — J. C. Sanders, M. D., Cleveland. 


Presidenl^T. P. Wilson, M. D., Cleveland. 
First Vice President — ^M. H. Slosson, M. D., Dayton. 
Second Vice President — J. M. Parks, M. D., Cleveland. 
Secretary — H. H. Baxter, M. D., Cleveland. 
Treasurer — J. C. Sanders, M. D., Cleveland. 


President — S. S. Lungren, M. D., Toledo. 
First Vice President — J. D. Buck, M. D., Cincinnati. 
Secretary — H. H. Baxter, M. D., Cleveland. 
Treasurer — J. C. Sanders, M. D., Cleveland. 


President — J. D. Buck, M. D., Cincinnati. 
First Vice President — J. H. Coulter, M. D., Columbus. 
Seccmd Vice President — G. J. Jones, M. D., Grafton* 
Secretary — H. H. Baxter, M. D., Cleveland. 
Treasurer — J. C. Sanders, M. D., Cleveland. 


President — J. E. Flowers, M. D., Columbus. 
First Vice President— C. C. White, M. D., Columbus. 
Second Vice President — ^W. M. Detweiler, M. D., Findlay. 
Secretary — ^W. A. Phillips, M. D., Cleveland. 
Treasurer — ^J. C. Sanders, M. D., Cleveland. 



The following year, 1876, being the Centennial, and the pro- 
fession being largely occupied with the World's Convention, which 
met in Philadelphia, no session of the Society was held. 


President — ^W. M. Detweiler, M. D., Findlay. 
First Vice President— E. B. Eush, M. D., Salem. 
Second Vice President — ^William Owens, M. D., Cincinnati. 
Secretary — ^W. A. Phillips, M. D., Cleveland. 
Treasurer — J. C. Sanders, M. D., Cleveland. 


President — J. B. Hunt, M. D., Delaware. 
First Vice President— H. H. Baxter, M. D., Cleveland. 
Second Vice President — E. P. Gaylord, M. D., Cleveland. 
Secretary — ^A. N. Ballard, M. D., (pro tem,), Shelby. 
Treasurer — J. C. Sanders, M. D., Cleveland. 


President — H. H. Baxter, M. D., Cleveland. 

First Vice President— E. P. Gaylord, M. D., Toledo. 

Second Vice President — ^William Owens, M. D., Cincinnati. 

Secretary — H. M. Logee, M. D., Oxford. 

Treasurer — J. C. Sanders, M. D., Cleveland. 


President— E. P. Gaylord, M. D., Toledo. 

First Vice President — ^W^illiam Owens, M. D., Cincinnati. 

Second Vice President — E. Gillard, M. D., Sandusky. 

Secretary — J. A. Gann, M. D., Wooster. 

Treasurer — J. C. Sanders, M. D., Cleveland. 


President — H. M. Logee, M. D., Oxford. 

First Vice President — M. H. Parmelee, M. D., Toledo. 

Second Vice President — G. W. Moore, M. D., Springfield. 

Secretary — H. E. Beebe, M. D., Sidney. 

Treasurer — J. C. Sanders, M. D., Cleveland. 



President — ^William Owens, M. D., Cincinnati. 

First Vice President — E. Van Norman, M. D., Springfield. 

Second Vice President — C. C. White, M. D., Columbus. 

Secretary — H. E. Beebe, M. D., Sidney. 

Treasurer — J. C. Sanders, M. D., Cleveland. 


President— C. C. White, M. D., Columbus. 

First Vice President— C. E. Walton, M. D., Hamilton. 

Second Vice President — ^W. A. Phillips, M. D., Cleveland. 

Secretary — H. E. Beebe, M. D., Sidney. 

Treasurer — J. C. Sanders, M. D., Cleveland. 


President — J. C. Sanders, M. D., Cleveland. 

First Vice President — J. P. Geppert, M. D., Cincinnati. 

Second Vice President — M. P. Hunt, M. D., Delaware. 

Secretary — H. E. Beebe, M. D., Sidney. 

Treasurer — ^William, T. Miller, M. D., Cleveland. 


President — B,, B. Rush, M. D., Salem. , 

First Vice President — G. C. McDermott, M. D., Cincinnati. 

Second Vice President — E. E. Eggleston, M. D., Mt. Vernon. 

Secretary — H. E. Beebe, M. D., Sidney. 

Assistant Secretary — S. R. Geiser, M. D., Cincinnati. 

Treasurer — ^William T. Miller, M. D., Cleveland. 


President — H. E. Beebe, M. D., Sidney. 
First Vice President — A. Claypool, M. D., Toledo. 
Second Vice President — 0. D. Childs, M. D., Akron. 
Secretary — C. E. Walton, M. D., Hamilton. 
Assistant Secretary — H. A. Chase, M. D., Toledo. 
Treasurer — ^William T. Miller, M. D., Cleveland. 


President — A. Claypool, M. D., Toledo. 

First Vice President — J. W. Clemmer, M. D., Columbus. 


Second Vice President — E. N". Warren, M. D., Wooster. 
Secretary— C. E. Walton, M. D., Hamilton. 
Assistant Secretary — C. L. Cleveland, M. D., Cleveland. 
Treasurer — H. Pomeroy, M. D., Cleveland. 


President — N". Schneider, M. D., Cleveland. 

First Vice President — E. E. Eggleston, M. D., Mt. Vernon. 

Second Vice President — J. A. Gann, M. D., Wooster. 

Secretary — C. E. Walton, M. D., Hamilton. 

Assistant Secretary — M. P. Hunt, M. D., Cleveland. 

Treasurer — H. Pomeroy, M. D., Cleveland. 


President— C. E. Walton, M. D., Hamilton. 

First Vice President — C. L. Cleveland, M. D., Cleveland. 

Second Vice President — Frances G. Derby, M. D., Columbus. 

Secretary — Frank Kraft, M. D., Sylvania. 

Assistant Secretary — C. D. Crank, M. D., Cincinnati. 

Treasurer — H. Pomeroy, M. D., Cleveland. 

Necrologist — D. H. Beckwith, M. D., Cleveland. 


President — John A. Gann, M. D., Wooster. 

First Vice Pres.— Orpha D. Baldwin, M. D., E. Portland, Ore. 

Second Vice President — C. A. Pauly, M. D., Cincinnati. 

Secretary — Frank Kraft, M. D., Sylvania. 

Assistant Secretary — C. C. True, M. D., Cleveland. 

Treasurer — H. Pomeroy, M. D., Cleveland. 

Necrologist — D. H. Beckwith, M. D., Cleveland. 


President — ^E. E. Eggleston, M. D., Cleveland. 
First Vice President — 0. A. Palmer, M. D., Warren. 
Second Vice President — 0. D. Childs, M. D., Akron. 
Secretary — ^E. B. House, M. D., Springfield. 
Assistant Secretary — T. G. Barnhill, M. D., Findlay. 
Treasurer— C. D. Ellis, M. D., Cleveland. 
Necrologist — D. H. Beckwith, M. D., Cleveland. 



President — C. D. Crank, M. D., Cincinnati. 
First Vice President — M. H. Parmelee, M. D., Toledo. 
Second Vice President— T. G. Bamhill, M. D., Pindlay. 
Secretary — ^Thos. M. Stewart, M. D., Cincinnati. 
Assistant Secretary — S, E. Geiser, M. D., Cincinnati. 
Treasurer— C. D. Ellis, M. D., Cleveland. 
Necrologist — D. H. Beckwith, M. D., Cleveland. 


On account of the World's Pair at Chicago, 111., in 1893, no 
meeting of the society was held in Ohio. The officers elected j 

the previous year were therefore retained, and the Homeopathic ! 

Medical Society of Ohio attended the sessions of the World's Con- 
gress of Homeopathic Physicians and Surgeons, held in Chicago, 
May 24 to June 3, 1893. 


President — M. H. Parmelee, M. D., Toledo. 

First Vice President — H. B. Van Norman, M. D., Cleveland. 

Second Vice President — S. R. Geiser, M. D., Cincinnati. 

Secretary — Thos. M. Stewart, M. D., Cincinnati. 

Assistant Secretary — A. C. Roll, M. D., Toledo. 

Treasurer — ^R. B. House, M. D., Springfield. 

Necrologist — D. H. Beckwith, M. D., Cleveland. 


President — ^R. B. House, iJi. D., Springfield. 

First Vice President— William Watts, M. D., Toledo. 

Second Vice President — ^W. C. Hastings, M. D., Van Wert. 

Secretary — Thomas M. Stewart, M. D., Cincinnati. 

Assistant Secretary — Frank Kraft, M. D., Cleveland. 

Treasurer— T. T. Church, M. D., Salem. 

Necrologist — D. H. Beckwith, M. D., Cleveland. 


Presideni^W. A. Phillips, M. D., Cleveland. 

First Vice President — Thomas M. Stewart, M. D., Cincinnati. 

Second Vice President — Emma L. Boice, M. D., Toledo. 


Secretary— A. C. EoU, M. D., Toledo. 
Assistant Secretary — J. C. Fahnestock, M. D., Piqua. 
Treasurer— T. T. Church, M. D., Salem. 
Necrologist — D. H. Beckwith, M. D., Cleveland. 


President — ^M. P. Hunt, M. D., Columbus. 

First Vice President — ^W. A. Geohegan, M. D., Cincinnati. 

Second Vice President— J. T. Ellis, M. D., Waynesville. 

Secretary— A. C. EoU, M. D., Toledo. 

Assistant Secretary — B.. B. Carter, M. D., Akron. 

Treasurer- T. T. Church, M. D., Salem. 

Necrologist — D. H. Beckwith, M. D., Cleveland. 


President — ^W. A. Geohegan, M. D., Cincinnati. 
First Vice President — ^B. B. Johnson, M. D., Ravenna. 
Second Vice President— F. 0. Hart, M. D., West Unity. 
Secretary — ^R. B. Carter, M. D., Akron. 
Assistant Secretary — M. P. Hunt, M. D., Columbus. 
Treasurer— T. T. Church, M. D., Salem. 
Necrologist — D. H. Beckwith, M. D., Cleveland. 


President — E. B. Carter, M. D., Akron. 

First Vice President— A. W. Eeddish, M. D., Sidney. 

Second Vice President — ^Martha Canfield, M. D., Cleveland. 

Secretary — ^A. B. Nelles, M. D., Columbus. 

Assistant Secretary — G. D. Grant, M. D., Springfield. 

Treasurer— T. T. Church, M. D., Salem. 

Necrologist — D. H. Beckwith, M. D., Cleveland. 


President — C. E. Sawyer, H. D., Marion. 

First Vice Presidentr— F. W. Morley, M. D., Sandusky. 

Second Vice President — Laura C. Brickley, M. D., Cincinnati. 

Secretary — A. B. Nelles, M. D., Columbus. 

Assistant Secretary — G. E. Wilder, M. D., Sandusky. 

Treasurer— T. T. Church, M. D., Salem. 

Necrologist, D. H. Beckwith, M. D., Cleveland. 



President — J. W. Means, M. D., Troy. 
First Vice President — C. A. Pauly, M. D., Cincinati. 
Second Vice President — L. K. Maxwell, M. D., Toledo. 
Secretary — ^A. B. Nelles, M. D., Columbus. 
Assistant Secretary — C. E. Silbemagel, M. D., Columbus. 
Treasurer— T. T. Church, M. D., Salem. 

Necrologist — D. H. Beckwith, M. D., Cleveland. I 


On account of the meeting in Cleveland of the American In- 
stitute of Homeopathy, no meeting of the State Society was held 
in 1902. The officers elected the previous year were retained and 
the members attended the sessions of the Institute in June. 


President — Thos. M. Stewart, M. D., Cincinnati. 

First Vice President— G. D. Grant, M. D., Springfield. ' 

Second Vice President — J. P. Hershberger, M. D., Lancaster. 

Secretary — A. B. Nelles, M. D., Columbus. 

Assistant Secretary — C. E. Silbemagel, M. D., Columbus. 

Treasurer— T. T. Church, M. D., Salem. 

Necrologist — D. H. Beckwith, M. D., Cleveland. 


President — ^W. B. Carpenter, M. D., Columbus. 

First Vice President — J. H. Wilson, M. D., Bellefontaine. 

Second Vice President — Catherine Kurt, M. D., Akron. 

Secretary — C. E. Silbemagel, M. D., Columbus. 

Assistant Secretary — ^M. P. Hunt, M. D., Columbus, 

Treasurer— T. T. Church, M. D., Salem. 

Necrologist — D. H. Beckwith, M. D., Cleveland. 


President — J. H. Wilson, M. D., Bellefontaine. 

First Vice President— Sara E. Fletcher, M. D., Columbus. 

Second Vice President — J. A. Mitchell, M. D., Newark. 

Secretary — C. E. Silbemagel, M. D., Columbus. 

Treasurer— T. T. Church, M. D., Salem. 

Necrologist — D. H. Beckwith, M. D., Cleveland. 




Allen, Alice Gillespie, 
Allen, H. C. (Honorary), 
Ames, C. S., 
Amdt, O. D., 


Columbus, 203 West Goodale Street, 1888 

Chicago, 111., 5142 Washington Avenue, 1888 

Ada, 1894 

Mt Vernon, 1896 

Baldwin, H. D., 
Baldwin, Wm. M., 
Baldwin-Bruce, Orpha D., 
Ballard, A. N., 
Banning, Carina, B. C, B. S., 
Banning, Edward P., 
Bamhill, J. W.. 
Bamhill, T. G., 
Bashore, J. I., 
Baxter, H. H., 
Beckwith, D. H., 
Beckwith, S. R., 
Beebe, H. B., 

Benson-Silber, Martha B., 
Biggar, H. F., 
Biggar, H. F., Jr., 
Bishop, H. D., 
Blackburn, W. J., 
Brenizer, N. O., 
Brickley, Laura C, 
Bryant, Susannah L., 
Buck, Charles R., 
Buck, J. D., 
Budde, Charles H., 
Bumham, J. E., 

Cameron, G. D., 

Canfleld, Martha A., 

Carpenter, W. B., 

Carter, R. B., 

Chapman, B. K., 

Chapman, Harriet B., 

Cheatham, Elizabeth C, 

Childs. O. D., 

Church, T. T., 

Clark, G. B., 

Claypool, Albert (Honorary), 

Clemmer, J. W., 

Coffeen, C. R., 

Cook, J. H.. 

Cooke, Clara B., 

Cory, Kate Whipple, 

Crank, C. D., 

Blyria, 1900 

Newark, 1908 

Tampa, Fla., 1032 Florida Avenue, 1887 

Birmingham, Ala., 1877 

Fort Wayne, Ind., 181 Clinton Street, 1896 

Fort Wayne, Ind., Box 364, 1895 

Napoleon, 1898 

Findlay. . 1876 

Tippecanoe City, 1899 

Cleveland, 275 Prospect Street, 1868 

Cleveland, 94 Dorchester Avenue, 1864 

New York, N. Y., 170 Fifth Avenue, 1864 

Sidney, 1873 

Akron, 326 South Main Street, 1898 

Cleveland, 260 Euclid Avenue, 1867 

Cleveland, 260 Euclid Avenue, 1908 

Cleveland, 89 Euclid Avenue, 1894 

Salem, 1896 

Austin, Texas, 1888 
Cincinnati, Cor. Chase and Hamilton Aves., 1888 

Columbus, 859 Oak Street, 1903 

Cincinnati, 1904 

Cincinnati, 605 Traction Building, 1869 

Dasrton, 1904 

Prairie Depot, 1904 


Chagrin Falls, 1899 

Cleveland, The Rose Building, 1877 

Columbus, 657 North High Street, 1883 

Akron, 1887 

Defiance, 1894 

Cleveland, 810 Rose Building, 1898 

Marion, 1908 

Akron, 1899 

Salem, 1886 

Stillwater, Minn., 1883 

Toledo, 711 Madison Street, 1877 
Columbus, Parsons and Franklin Avenues, 1884 

Piqua, 1882 

New Carlisle, 1892 

Portsmouth, 1908 

Barberton, 1897 

Cincinnati, 231 Auburn Avenue, 1877 




Crismore, James M., 



Cummer, R. J., 

Cleveland, 531 Permanent Building, 


Curtis, H. M., 




Darby. B. A., 


Dewey, W. A. (Honorary), 

Ann Arbor, Mich., 


Dudley, Mrs. Haurtoe, 

Mt Vernon, 

Eggleston, E. R., 


Ehrmann. George B., 

Cincinnati. 28 Bast Seventh Street, 


Elliott, A. B., 



Ellis, J. T., 




Paulder, H. B., 


Fawcett, J. M., 

Wheeling. W. Va.. Ck>r. Market and 7th Sts., 


Ferris, Charles, 

College Hill. 


Ferris, Jacob, 

College Hill. 


Pinke, P. W. D., 

■ Cleveland. 610 Rose Building, 


Fletcher, Sara B., 

Columbus. 338 Bast SUte Street, 


Forward, C. B., 

Cleveland. Williamson Building, 


Fowler, B., 

Cleveland. 1439 Broadway, 


Frost, W. A., 

Tecumseh. Mich., 




Oaston, James B., 


Oelser, S. R., 

Cincinnati, Cor. Seventh and Race Streets, 


Geobegan, William A., 

Cincinnati. 918 Hawthorne Ave., Price Hill, 


Georgi, Sophia B., 

Cincinnati, 1634 Pullan Avenue, 


Gillard, Edwin, 

Sandusky, 423 Columbus Avenue, 


GUlard, B. E., 

Rock Creek. Ashtabula County, 


Ginn, Curtiss, 



Grant, George D., 



Graybill, J. D. (Honorary), 


Griggs, 0. P., 

AshUbula. 207 Main Street, 




Hadley. W. A. M.. 


Haggart, G. B., 



Hall, Edward M., 

Delaware. 18 West Winter Street, 


Hastings, W. C, 

Seattle, Wash., Suite 28, Downs Block, 


Hatch, H. S., 

Madison. Ind., 


Hershberger, J. P., 



Hetherington, Clark B.. 



Hills. H. B.. 

Youngstown. 81 West Wood Street, 


Hinsdale, W. B., 

Ann Arbor. Mich.. 


Hodson, George S., 

Washington Court House. 


Horner, J. Richey, 

Cleveland. 275 Prospect Street, 


House, R. B., 

Springfield. 108 Bast High Street, 


Howard, Blmira Y., 

Palmyra, Mo., 


HOyt. C. 

Chillicothe. 39 South Paint Street, ' 


Hoyt, William. 



Hughes, C. W.. 


Humphrey. W. A.. 



Hunt. Ella Grace, 

Cincinnati. 608 West Eighth Street, 







Hunt. H. B., 



Hunt, J. S., 

Santa Monica. Cal.. 


Hunt. M. P., 

Columbus. 208 Bast State Street, 


Hurlburt. J. 




Ireland. Charles L., 

Columbus. 942 North High Street, 


Jewitt, B. H., 

Cleveland. 484 The Arcade, 


Johnson, R. B., 

Riverside, Cal.. 


Jones. G. J., 

Cleveland. 5 Rockwell Street, 


Junkerman, C. P., 


Columbus, 54 North Washington Avenue, 


Keiser, Romeo 0., 


Kllgour, P. T., 

College Hill, 


King, John C, 

Banning, Cal., 


King, Julius, 

New York, N. Y., 


Kirk. Bllen M., 

Cincinnati. 169 West Seventh Street, 


Kraft. Frank, 

Cleveland, 57 Bell Avenue. 


Kurt, Katherine, 

Akron. 118 South Broadway, 

Cleveland.. 197 Superior Street, 


Laronge, L., 


Lee, Frank C, 



Ijehman, F. P., 



Logee. H. M., 


Loomis, F. R., 



Loy, B. N., 



Lunger, J. S., 



Lyons, Matilda J., 




McCann, T. A., 



McClure. S. D., 



McClure, W. B., 

Martin's Ferry, 


Mccormick, A. L., 

Cincinnati, 3110 Woodbum Ave., Waln't Hills, 

, 1886 

McCleary J. R., 



Maxwell, L. K., 

Toledo, 1615 Twenty-second Street, 


Mead, J. S., 



Meade. C. C, 

Cincinnati, 4226 Hamilton Avenue, 


Meade, S. J. D., 

Cincinnati, 417 Bverett Street. 


Meader, Lee Douglass, 

265 Gilbert Avenue, 


Means, J. W., 



Miller, H. T., 

Springfield, 113 Bast High Street, 


Miller, John M., 

Springfield, 113 Bast High Street. 


Miller, W. T., 

Cleveland, 260 Buclid Avenue^ 


Mitchell, J. A., 



Mohn, D. L., 



Monroe, A. L. (Honorary), 

Louisville, Ky., 


Munns, C. 0., 



Murphy, Frank W., 



Columbus, 198 Bast State Street. 


Nelles, A. B., 


Norrls, J. C,