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SEPTEMBER 5, 6, 7, AND 8, A. D. 1893. 


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Cincinnati, Ohio, N'ovemher 25, 1893. 

Dear Sir : I have the honor to transmit herewith the Transactions 
of the First Pan-American Medical Congress, hekl in the city of Wash- 
ington, D. C, September 5, 6, 7, and 8, A. D. 1893, pursuant to the invi- 
tation issued by the President of the United States to the various 
American countries in accordance with the joint resohition of Congress 
approved July 18, A. D. 1892. 

I have the honor to be, sir, very sincerely, yours, 

Charles A. L. Eeed, 

Secretary- General. 
Hon. Walter Q. Gresham, 

Secretary of State, Washington, D. G. 

Approved : 

William Pepper, 





Deparoient of State, 

Washington, October, 1892. 

Sir : The American Medical Associatiou, wliicli is the great national 
organization of the medical profession of the United States, has 
authorized an invitation to the medical profession of all countries of 
the western hemisphere to a Pan-American medical congress, to be 
held in the city of Washington, September 5, 6, 7, 8, 1893, and a joint 
resolution of Congress, approved July 18, 1892, authorized and 
requested the President to invite the several governments concerned 
to send official delegates to that congress. 

The purposes of this congress are to promote the closer relations 
between the medical profession of the various participating countries, 
and it is confidently believed that such a congress can not fail to 
result in important intellectual and material benefits. 

The sections for consideration are as follows : 

1. General medicine. 

2. General surgery. 

3. Military medicine and surgery. 
4\ Obstetrics. 

5. Gynecology and abdominal surgery. 

6. Therapeutics. 

7. Anatomy. 

8. Physiology. 

9. Diseases of children. 

10. Pathology. 

11. Ophthalmology. 

12. Laryngology and rhinology. 

13. Otology. 

14. Dermatology and syphilography. 

15. Orthopaedics. 

16. Hygiene, climatology, and demog- 


17. Marine hygiene and quarantine. 

18. Diseases of the mind and nervous 


19. Oral and dental surgery. 

20. Medical jjedagogics. 

21. Medical jurisprudence. 

22. Railway surgery. 

Indeed, from the foregoing, it may be positively stated that the scope 
of the deliberations of the body will be more extensive than in any 
previous similar congress, while the subjects that will come before sev- 
eral of these sections, such, for example, as that embraced in No. 17 — 
marine hygiene and quarantine — will lead to results of special impor- 
tance in their bearing upon the reciprocal relations between the coun- 
tries participating. 

The official languages of the congress will be English, Spanish, Por- 
tuguese, and French. 

In order to secure the complete success of the congress, it is under- 



stood that a systematic oigaiiizatiou has been effected of the medical 
profession in all of the countries interested, but it is of the utmost 
imi^ortance that there shall be present at the congress from each country 
a certain number of official delegates. 

It is the wish of the President that you promptly bring this invita- 
tion to the knowledge of the government to which you are accredited 
and urge upon it the]>leasure it would afford him to learn of its accept- 
ance and of the appointment of oflicial delegates, not exceeding 6 in 

It is the intention of the Government of the United States to be rep- 
resented in the proposed congress by G delegates. Of course, liberty 
of action as to the number each State may decide to appoint is freely 
accorded, but it is hoped the maximum number will not be exceeded. 
I am, sir, your obeilient servant, 

James G. Blaine, 

Secretary of /State. 
Thomas Eyan, Esq., 

U. aS'. Minister, City of Mexico, 



111 vital iou Issued by the Presiileut of the United ijtate.s V 

Preliminary Organization of the Congress 2 

Invitation by the Congress of the United States 4 

General Regulations 6 

Reglaniento General ' 

Siiecial Eegulations of the First Pan- American Medical Congress 10 

Eeglamento Especial para el Primer Congreso 11 

General Officers of the Congress -- 1-t 

International Executive Committee 15 

Committee of Arrangements - 1*^ 

Auxiliary Committee - 1' 

Medical Journals to which the Official Bulletins of the Congress were Regularly Furnished . . 29 

Report of the Committee on Permanent Organization 32 

Registered Delegates 3o 

Regi^^tered ilembers - ■^^ 

Proceedings of the General Sessions 57 

Address by F. A. Risquez, M. D., of Venezuela 69 

Address by the President of the Congress ^6 

Disourso Inaugural por el Presidente del Congreso 108 

Report of the International Executive Committee 138 

Proceedings of the Sections of the Congress 1'19 

Section I.— General Medicine 150 

II.— Pathology - 331 

« III. — Therapeutics 384 

IV.— General and Ortliopa-dic Surgery -180 

v.— Military Medicine and Surgery . 676 

VI. — Railway Surgery 837 

V [I.— Obstetrics 873 

VIII. — Gynecology and Abdominal Surgery 987 

IX.— Anatomy 1116 

X.— Physiology 1182 

XI.— Diseases of Children 1301 

XII.— Ophthalmology 1384 

XIII. — Laryngology and Rhinology 1196 

XI v.— Otoiogy. - . .'. 1592 

XV.— Dermatology and Syphilography 16' 5 

XVI. — Diseases of the Mind and Kervous System I'SS 

XVII —Oral and Dental Surgery 1853 

XVIII.— Hygiene. Climatology, Demography, and Marine Hygiene and Quarantine 1906 

XIX.— Pharmacology 2102 

-XX. — Medical Jurisprudence 21^8 

XXI.— Medical Pedagogics 2174 



P>^RT I. 





S. Ex. 36- 


Office of the Permats^ent Secretary 

OF the American Medical Association, 

Philadelphia, June 4, 1801. 

To the Medical Profession of the Western Hemisphere : 

At the meeting of the American Medical Association, lield at Wiisli- 
ingtou May 5, 1891, Dr. Charles A. L. Reed, of Cincinnati, introduced 
the following: 

Resolved, That the American Medical Association hereby extends a cordial invita- 
tion to the Medical Profession of the Western Hejiiispliere to assemble in the United 
States in an Inter-Contmental Ann-rican Medical Congress. 

Hesolved, That the Committee on Nominations be, and is hereby, instructed to nom- 
inate one member for each State and Territory, and one each from the Army, Xavy, 
and Marine-Hosjiital Service, who sliall constitute a conunittee, which is hereby 
instructed to effect a permanent organization of the proposed Inter-Continental 
American Medical Congress and to determine the time and ]dace at which the same 
shall bo held. 

Tiie resolutions were seconded by Dr. Wni. II. i'ancoast and others 
and unaniuiously adopted. 

Pursuant to the foregoing, 
and elected: 

the following committee was nominated 

Alabama— yX. H. Sanders, M. D. 
Jrizona — Henry A. Hughes, M. D. 
Arkansas — Ed. Bentley, M. D. 
California— W. R. Cluness, M. D. 
Colorado — Wm. A. Campbell, M. D. 
Connecticut — C. A. Lindsley, M. D. 
iJelaware — C. H. Richards, M. D. 
District of Columbia— B.W. Prentiss, M. Dr 
Florida— C. R. Oglesby, M. D. 
Georgia — J. McFadden Gaston, M. D. 
J</«/(0— Geo. P. Haley, M. D. 
iHiHOis— N. S. Davis, M. D. 
Indiana — A. M. Owen, M. D. 
loiva—B. H. Criley, M. D. 
jLansas — J. E. Minney, M. D. 
Kentucky — J. N. McCormack, M. D. 
Louisiana — Stanford E. Chaille, M. D. 

^/fline— Hampton E. Hill, M. D. 
Maryland — Geo. H. Rohc, M. D.. 
Massachusetts — Augustus P. Clarke, M. D. 
Michigan — C. Henri Leonard, M. D. 
Minnesota— Y. H. Millard, M. D. 
Mississippi — W. T. Kendall, M. D. 
Missouri — I. N. Love, M. D. 
Montana — Thos. J. Murray, M. U. 
yehraska — R. C. Moore, M. D. 
Nevada— F. .J. Aiken, M.U. 
New Hampshire — Irving A. Watson. M. D. 
Neiv Jersey — E. J. Marsh, M. D. 
New Mexico — C. E. Winslow, M. D. 
Neiv York — John Cronyn, M. 1). 
North Carolina — H. Longstreet Taylor. 

M. D. 
North Dakota— H:. M. Darrow, M. D. 


Oficina del Seceetario Permanexte 


Filadeljia, junio 4 de 1891. 
A los Senorcs profesores de medicina del HemisfeHo Occidental: 

Eu junta de la Asociaciou Medica Americana, celebvada en Wasli- 
ington el 5 de mayo de 1891, el Dr. D. Carlos A. L Eeed, de Cinci- 
nati, hizo las propuestas sigiiieutes: 

Primera: Que la Asociacion Medica Americana dirige cordial invitacion a los 
Senores profesores de mediciua del Heinisferio Occidental para reunirse en los 
Estados Unidos, forinando uu Oongreso Medico Americano Intercontinental. 

Setjiiitda: Que la Comision de Designaciones quede notificada para que nombre un 
vocal para cada Estado y Territorio, y para cada uno de los cuerpos del Ej6rcito, 
Marina y Servicio de Hospi tales Maritimos, los cnales constituiran una comision 
que lleve a debido efecto la organizaciun permanente del propuesto Congreso Medico 
Americano Intercontinental, fijando la dpoca y el lugar en que haya de reunirse. 

^Habieudo sido apoyadas estas propuestas por el Dr. Wm. H. Pan- 
coast y otros Senores, lue unanimemente adoptada. 

De conformidad con lo expuesto, fueron design ados los Seiiores 
siguientes, doetores en medicina: 

Alahama — W. H. Sanders. 
Arhona — Henry A. Hughes. 
Arkansas — Ed. Bentley. 
California— W. R. Cluness. 
Colorado — Wm. A. Campbell. 
Connecticut — C. A. Lindsley. 
Delaware — C. H. Richards. 
Distrito de Cohmhia—T>AY. Prentiss. 
Florida— C. R. Oglesby. 
Georgia — J. McFadden Gaston. 
Idaho — Geo. P. Haley. 
//?i«o(8— N. S. Davis. 
Indiana — A. M. Owen. 
loim—B. H. Criley. 
Kansas — J. E. Minney. 
Kenluclij — J. X. ^IcCr)rmack. 
Luisiuna — Stanford E. Chaill6, 

Maine — Hampton E. Hill. 
Maryland — Geo. H. Rohe. 
Massachusets — Augusto P. Clarke. 
Michigan— C Henri Leonard. 
Minnesota— F. H. Millnrd. 
Misisipi — W. V. Kendall. 
3Iisnri — I. N. Love. 
Montana — Tom. J. Murray. 
Nehraslca — R. C. Moore. 
Nevada — P. J. Aiken. 
Nueva Hampshire — Irving A. Watson. 
Nriera Jersey — E. J. Marsh. 
Nueva Me'jico — C. E. Winslow. 
Nueva York — Juan Cronyn. 
Carolina del Norte — H. Longstreet Tay- 
Dakota del Norte — E. M. Darrow. 



O/tio— Charles A. L. Eeed, M. D. \"n(jinia—J . S. Wellfurd, il. D. 

Oregon — Win. Boys, M. D. Washington — J. M. Morgan, M. D. 

Pennsylvania — Wm. Pepper, M. D. IVemt Virginia — J. H. Browulield, M. D. 

Bhode Island — Geo. L. Collius, M. D. Wisconsin — J. T. Reeve, M. D. 

South Carolina — R. A. Kinlocli, M. U. Wyoming — J. H. Fiiifrock, M. D. 

South Dakota — J. W. Freeman, M. D. U. S. Army . 

Tennessee — J. R. Biiist, M. D. U. S. Xary . 

Texas— J. W. Carbart, M. D. 
Utah—Y. S. B.-iscoin, M. D. 
Vermont— B.. D, Holtou, M. D 

Texas— J. W. Carbart, M. D. U. S. Marine-Hospital Service — J. B. Ilam- 

Utah—F. S. B.-iscoin, M. D. ilton, M. D. 

Wm. T. Briggs, M. D., • 

William B. Atkinson, M. D., 

I'erma iient Seer eta ry. 

By the Congress of the United States. 

JOINT RESOLUTION to authorize tlio President to invite certain governments to 
send delegates to the Pan-American Medical Congress. 

A joiiil it'soliitioii was uiiauiiaously adopted by the Senate June 3, 
1892, concuried in by tlie House of Rcpieseiitatives July 14, LS[)2, and 
approved July IS, 1892, by which the President was authorized and 
requested to invite the several governments of the Western Heniis])here 
to send oftieial delegates to the meeting of the Pan-American Medical 
Congress to be held iu the city of Washington September 5, G, 7, and 
8, A. D. 1893. 


Dear Doctor: On behalf of the committee appointed by the American Medical 
Association May 5, 1891, "to effect a permanent organization of an Inter-Conti- 
nental American Medical Congress," I beg leave to report that the work has been 
prosecuted as diligently as possible. A series of regulations, hereby submitted, has 
been adopted and an organization in accordance therewith h:i8 been effected, in some 
degree, in all of the constituent countries except Paraguay. In several countries 
the organization has been completed in accordance with the regulations, while in 
some instances full lists of secretaries have been secured; in others honorary chair- 
men only have been furnished, while in still others the organization has not 
advanced beyond the appointment of a member of the international executive com- 
mittee. The lists of officers are, however, sutficiently complete to furnish channels 
through which the necessary preliminary correspondence of the sections may bo 
inaugurated. In view of this, and the additional fact that a considerable time is 
necessary for the interchange of letters with some of the remoter countries, the 
committee deems it expedient to submit for promulgation this preliminary announce- 
ment of the congress. 


07i/o— Carlos A. L. Reed. Tmjinia—J. S. W«^ilford. 

Oregon — Win. Boys. WashitKjton—J. M. ]SIorgan. 

Pensilvania—Wm. Pepper. -■ Virginia del Oeste. — J. H. Br6wnfield. 

Rhode Island — Geo. L. Collius. Whconsin — T. Reeve. 

Carolina del Stir — R. A. Kiulocli. Wyoming — J. H. Fiufroclc. 

Dakota del Sur—J. W. Freemau. U. S. Army. , 

Tenesir—J. R. Buist. U. S. Navy.— . 

Tejas — J, W. Ciirliart. U. S. Marine- Hospital Service — .J. B. 
Utah—F. S. Ikiscom. Hamilton. 

Vermont — H. D. Holton. 

"Wm. F. Briggs, 

Doctor en Medicina, Presidcnte. 
GuiLLERMO A. Atkinson, 
Doctor en Medicina, Secretario Permanente. 


ACUERDO UNIDO autorizando al Presidente de los Estados Unidos para invitar 6. 
ciertos gobiernos {i enviar deleg.idos al Congreso Medico Pan-Americano. 

Se aciierda en acta por el Seiiado y Cihiiara de Kepreseiitantes delos 
Estados Uiiidos de America, reuuidos eu Congreso, que el Presidente 
de los Estados Unidos, sea, y esta por esta, autorizado y suplicado, 
para que invite a los diferentes gobiernos del Hemisferio Occidental, 
para que envien delegados oticiales a la junta del Congreso Medico 
Pan- Americano, que La de celebrarse en la ciudad de Washington en los 
dias cinco, seis, siete y oclio de setiembre del aiio del Senor mil ocho- 
cientos noventa y tres. 



MUY SoR. MID : En nombre de la Comisi6n desiguada per la Asociaci6n MMica 
Americana en mayo 5 de 1891, "para llevar ^ efecto la organizaci6n permanente del 
Congreso M6dico Americano Intercontinental," tengo el honor de poner en su cono- 
cimiento qne los trabajos ban adelantado con toda la diligencia posible. Una serie 
de articulos reglamentarios, que se acompanan, ba sido aprobada, efectuilndose de 
conformidad, basta cierto punto, la debida organizacion en todos los paises consti- 
tuyentes, con excepciun del Paraguay. En varios paises la organizacion se ha com- 
pletado sobre las bases de los Reglamentos, en algunos otros se ha obteuido llenar 
las nominas de los Secretaries, al paso que de otros sdlo se han conseguido los Presi- 
dentes Honorarios, sin que falten algunos, cuya organizacion no va miis alliC de la 
designaci6n de un vocal de la Comisicjn Ejecutiva Internacional. Las ndminas de 
Presidentes y Secretaries son, sin embargo, suficientes a abrir sendas por las cuales 
se inaugure la debida correspondoncia preliminar de las secciones. En vista de 
esto, y siendo, adeniils, considerable el tiempo que se requiere para la comunica- 
cion postal con algunos de los paises m!is distantes, juzga la Comisi6n conveniente 
proponer la publicacion de este anuucio preliminar del Congreso. 


The comiuittoe entertains the hope that the organization may be completed in 
each of the ecmstitueut countries, in accordance with the reguhitious, bel'ore the 
meeting of the congress. 

Respectively submitted on behalf the committee. 

Charlks a. L. Rkkd, 
Chairman of the Committee on I'ennauent Organization 

and Seoretary-General of the Congress. 
Dr. Hunter McGuire, 

President of the American Medical Association, Ilichmond, Va. 
Cincinnati, September 5, 18D2. 

Richmond, Va., October S, 1SD2. 
Dear Doctor: I am in receipt of the report of the committee on organization 
of the Pan-Araericin Medical Congress, transmitting the Preliminary Announce- 
mcjit of the Organization. Permit me to state that I am gratified to note the com- 
pleteness of the work which has already been accomplished by your committee, and 
that, for, the reasons stated in your letter, I deem the immediate publication of the 
preliniinary announcement imi)erative to the success of the congress. 

With the assurance that the American Medical Association will do all in its power 
to promote the interests of the meeting at Washington in September of next year, 
Very sincerely, yours, 

ITl'XTER McOt'ire, 
rresidriit of the American Medical Association. 
Dr. Charles A. L. Reed, 

Chairman of the Commillee on rermunmt Organization 

of the I'tin-Amcriean Medical Congress. 


1. This organization shall be known as Tiie Pan-American Medical Congress, and 
shall meet once in - — - years. 


2. Members of the congress shall consist of such members of the medical profes- 
sion of the Western Hemisphere, including the West Indies and Hawaii, as shall 
comply with the special regulations regarding registration, or who shall render serv- 
ice to the congress in the capacity of foreign officers. 


3. The executive officers of the congress shall be residents of the country in which 
the congress shall be held. an<l shall consist of one president, such vice-presidents 
as may be determined by special regulations, one treasurer, one secretary -general, 
and one presiding officer and necessary secretaries for each section, all of whom 
shall be elected by the committee on organization, and there shall be such foreign 
vice-presidents, secretaries, and auxiliary committees as are hereinafter designated. 


4. The committee on organization shall be appointed by the representative medi- 
cal association of the country in which the congress shall meet. This committee 


La Comisitjn concibe la esperanza de que se hallara la orgauizaciou completa en 
cada iiuo de los paises cmstitiiyeutes, de conformidad con los Reglamentos, antes 
de la apertura del Cougieso. 
Con todo respcto se somete este informe en nombre de la Coniisiuu. 

Carlos A. L. Rkkd, 
Presidente de la Co^nision de Orrjanhacion Pirmauente 

y Secretario General del Congreso. 
Al Du. Hunter McGuire, 

Presidenic de la Associneion M4dica Americana, Bichmond, Va. 
CixciNATi, scUembred de 1S92. 

RicrniOND, Ya., ocfuhre G de 1S92. 
MuY Sr. Mio: He recibido el informe de la Coniisiim de Organizacion del Con- 
greso Medico Pan- Americano, transmitiendo el Anuncio Preliniinar de la Organlza- 
cion. Tengo el gnsto de manifestar a Ustcd mi satisfacciou por lo completo del 
trabajo llevado a cabo por la Comision, siendo del parecer de Usted sobre (jiie la 
jironta publicaciou del Anuncio Preliniinar es de absoluta necesidad para el buen 
6xitodel Congreso. 

Con la seguiidad de que la Asociacion Medica Americana hara todo loposible para 
proniovcr los interescs de la junta que ba de celebrarse en Washington en setiembre 
del ano proximo, 

Soy de Usted S. S., 

HuxTKR McGriRK, 
Pixsidcnle de la Asociacion Medica Americana. 
Dr. Carlos A. L. Reed, 

Presidente de la Comision de Organisacion Permanente del 
Congreso Medico Pan-Americana. 



1. Esta organizaci(')n serii conocida con el nombre de El Congreso Mf^dico Pan- 
Americano, y se reuuira una vez cada anos. 


2. Serein considerados miembros del Congreso todos los Senores profesores de 
medicina del Hemisferio Occidental, incluycndo las Antillas y Hawaii, que acepten 
los reglamentos especiales de asiento, 6 presten al Congreso servicios como Emplea- 
dos Extranjeros. 


3. La Junta Dircctiva del Congreso se compondrii de residentes del pais en que se 
instale el Congreso, y consistira en un Presidente, el nilinero de Vice-Presidentes que 
se designe por articulo especial, un Tesorero, un Secretario General, con im Presi- 
dente y los Secretarios necesarios para cada seccion, todos los euales seriin elegidoa 
por la Comision de Organizacion; y liabr^, ademas, el numero de Yice-Presidentes, 
Secretarios y Comisiones Auxiliares que en lo adelante se desiguariin. 


4. La Comision de Organizacion sera nombrada por la asociacion modica rcpre* 
seutativa del pais en que se reuuir^ el Congreso. Esta Comision elegira la Mesa del 


shall select all domestic officers of the congress, and shall, at its discretion, confirm 
all nominations by members of flie international executive committee, and, in tho 
event that any member of the international executive committee shall fail to nomi- 
nate by the time specified by special regulation, the committee on organisation shall 
elect ofiicers for the country thus delinquent. It may appoint vice-presidents and 
auxiliary committeemen in foreign countries, independently of nominations by the 
members of the international executive committee. It shall appoint auxiliary com- 
mittees, arrange for the meeting, and frame special regulations for the session of 
congress for which it was appointed. It shall maltJ a report of its transactions to 
the opening session of the congress. 


5. There shall be an international executive committee, which shall be appointed 
by the first committee on organization and which shall consist of one member for 
each constituent country. This committee shall hold permanent tenure of ofiSce, 
except that when a member shall fail to bo present at a meeting of the congress 
nis office sliall lie declared vacant and the vacancy be filled by election held by the 
registered members from the country from which he was accredited. In the event 
of no representation whatever from the country in question, the members of thu 
international executive committee present shall determine what disposition shall 
bo made of the office. 

It shall be the duty of each member of the international executive committee to 
nominate, from the medical profession of his country, one vice-president for the 
congress and one secretary for each section of the congress, and to forward the 
same to the chairman of the committee on organization ; except that in any country 
in which the congress shall meet, it shall be the duty of the member of the inter- 
national executive connnittee for that country to request his representative natibuul 
medical association to appoint a committt^e ou organization, which connnittee on 
organization shall discharge the duties designated in Regulation IV. Members of 
the international executive committee shall a/.so nominate such auxiliary com- 
mittees, and shall furnish such information as the committee on organization may 


6. The committee on organization may, at its discretion, cause the congress to be 
incorporated, which incorporation shall hold only until the final disbursement of 
funds for the session held in that particular country. In the event of snch incorpora- 
tion, sncli additional officers shall be elected and in such manner as may be required 
by law. 


7. The following shall be considered as the constituent countries of the Pan- 
American ^ledical Congress: 

Argentine Republic, Bolivia, Brazil, British North America, British West Indies 
(including British Honduras), Chile, Dominican Republic, Honduras (Spanish), Mex- 
ico, Nicaragua, Paraguay, Peru, Salvador, Republic of Colombia, Republic of Costa 
Rica, Ecuador, Gautemala, Haiti, Kingdom of Hawaii, Spanish West Indies, United 
States, Uruguay, Venezuela, Danish, Dutch, and French West Indies. 


8. The sections of the congress shall be as follows: 

(1) General Medicine, (2) Surgery, (3) Military Medicine and Surgery, (4) 
Obstetrics, (5) Gyutccology and Ab<luminal Surgery, (6) Therapeutics, (7) Anatomy, 
(8) Physiology, (9) Diseases of Children, (10) Pathology, (11) Ophthalmology, (12) 
Laryngology and Rhinology, (13) Otology, (14) Dermatology and Syphilography, 


Congrcso interior, y qiaedara si su discrecion confirmur todo nombramiento hecho por 
los luiembros de la Comisit'm Ejecntiva Interuacional, y en el caso de qile algun 
miembro de la Comisiuu Ejecutiva Internacional dejare de hacer las desiguaciones 
dentro del tiempo sefialado por los reglamentos, la Coinision de Organizacion hara 
la eleccionpara elpais reuiiso. Estaen sus atribuciones desiguar Vice-Presidentes y 
Voeales de Comisiones Aiixiliares en pafses cxtranjeros con independencia de nom- 
bramientos becbos por miembros de la Couiision Ejecutiva Internacional. Fonuara 
Comisiones Auxiliares, preparar^ la junta, y dispondrfi reglamento especial para la 
sesion del Cougreso para que fue designada. En la sesion de apertura del Congreso 
presentard informe sobre sus actos. 

comisi6n ejecutiva ixterxacional. 

5. Se formara una Coraision Ejecntiva Internacional, que serd constituida por la 
primera Comision de Organizacion, y que consistira de uu vocal para cada pais con- 
stituyente. Esta Comision ser;i peruianeute en sus fuuciones; pero si alguno de los 
voeales dejase de asistir a una junta del Congreso, su euipleo sera declarado vacante, 
y ocupara su plaza el designado por eleccion de los miembros del pais correspondiente. 
En el caso en que el pais en cuestiun no cstuviese en ningun modo representado, los 
voeales de la Comision Ejecutiva Interuacional determinaran lo que baya lugar para 
disponer de la vacante. 

Sera de obligaci6n de cada uno de los voeales de la Comi.sion Ejecutiva Interna- 
cional designar de entre los profesores de medicina de su pais, uu Vice-Presidente 
para el Congreso y un Secretario para cada una de sus secciones, dando cuenta al 
Presideute de la Comision de Organizaci6n. Pero en cualquier pais en que se cele- 
brare el Congreso, sera de obligacion del vocal de la Comision Ejecutiva Interua- 
cional por cada pais suplicar d su asociacion raedica nacioual representante que 
seuale una Comision de Organizacion, la cual se bara cargo de las incumbencias j)re- 
scriptas en el Articiilo IV. Los voeales de la Comision Ejecutiva Interuacional 
designarau asimisiuo semej antes Comisiones Auxiliares, y daran los informes que 
pida la Comision de Organizacion. 


6. La Comision de Organizacion estii autorizada, si lo creyere conveniente, dbacer 
que el Congreso posea existeucia legislativa que tendra efecto solameute basta el 
desembolso tinal de foudos para la sesion celebrada en el pais corrcsiioiidiente. En 
el caso de que se efectile la incorporacion, se baran los nombramientos adicionales 
de conformidad con los requisitos legales. 

paises coxstituyextes. 

7. Los que d continnaci('>n se expresan, seran considerados como paises constitu- 
yentes del Congreso Medico Pan-Americano: 

Eepublica Argentina, Bolivia, Brasil, America Inglesa del Xorte, Cliile, Repiiblica 
Domiuicana, Honduras, Mejico, Nicaragua, Paraguay, Peru, Salvador, Colombia, 
Costa Rica, Ecuador. Guatemala, Haiti, Reino de Hawaii, Estados Unidos, Uruguay, 
Venezuela, Antillas Espanolas, luglesas, Frances, Dauesas y Hollandesas. 


8. Las secciones del Congreso serdn las siguientes : 

(1) Medicina, (2) Cirugia en general, (3) Medicina y Cirugfa militares, (4) 
Obstetricia, (5) Ginecologia y Cirugia abdominal, (6) Terapeutica, (7) Auatomia, 
(8) Fisiologia, (9) Enfermedades de la Infancia, (10) Patologi'a, (11) Oftalmologia, 
(12) Laringologia y Rinologia, (13) Otologia, (14) Dermatologia y Sililografia, (15) 


(15) General Hygiene ami Demography, (16) Mariiic Hygiene and Quarantine, (17) 
Orthopanlic Surgery, (18; Diseases of tlio Mind and Nervous System, (1!)) Oral and 
Dental Surgery, (20) Medical Pedagogics, (21) Medical Jurisprudence, (22) Railway 


9. The languages of tlie congress shall be Spanish, French, Portuguese, and 


10. Tlio auxiliary committee shall consist of one memltcr for each medical society 
or one for eacli considerable centerof pojiuiation in each of the constituent countries 
of the congress. Nominations for the foreign auxiliary committee shall he made to 
the chairman of the committee on organization by the members of the international 
executive connnittee, each for his own country, excejtt that in the country in wliich 
the congress is to be held nominations shall be made by the connnittee on orgaui/.a- 
tion. Aiipointments on the auxiliary committee shall hold only for the meeting for 
whicli they wen^ made. 

Members of the auxiliary i-ommittec sliall be tlie ofticial representatives of the 
congress in their respective localities. It shall be their duty — 

(1) To transmit to the ])rofession of their respective districts all information rela- 
tive to the congress forwarded to them for that pnrjiose by the general officers 

(2) To co-operate with the ofticers of sections in securing desirable contributions to 
the proceedings of the congress. 

(3) To furnish to the general officers such information as they may request for tlio 
purpose of promoting the interests of the congress. 

(4) To cause such publicity to be given to the development of the organization as 
will elicit the interest of the profession and secure attendance upon the meeting; 
and they shall discharge such other duties as will promote the welfare of the con- 


11. Amendments to these regulations can be made only by the international 
executive committee, on ;i majority vote, ten members constituting a quorum, at 
any meeting of the congress. 



1. The first Pan-American Medical Congress shall be held in the city of Washing- 
ton, D. C, September 5, 6, 7, 8, A. D. 1893. 


2. The registration fee shall be $10 for each member residing in the United States, 
but no fee shall be charged to foreign members. Each registered member shall 
receive a card of membership and be furnished a set of the transactions. 


3. Contributors are required to forward ahstracts of their papers, not to exceed 
600 words each, to be in the hands of the secretary-general not later than the 10th 
of July, 1893. These abstracts shall be translated into English. French, 8]>anish, 
and Portuguese, and shall be published in advance of the meeting for the conveni«'nce 
of the cougress, and no paper shall be placed upon the programme which has not 
been thus presented by abstract. Abstracts will be translated by the literary 


Higiene en general y Deuiografia, (16) Higiene inaritima y Cuareutena, (17) Cirugia 

ortopodica, (18) Enfermedadcs meiitales y del sistenia ncrvioso, (19) C'inigfa oral 
y dental, (20) Pedagogia medica, (21) Jurisprudencia m6dica, (22) Cirugia de 


9. Los idiomas del Congveso ser^n el espanol, el francos, el portngii^s y el ingles. 


10. Las Comisiones Anxiliares se compondrjjn de nn vocal pov cada sociedad medica 
6 por cada centro considerable de poblarion en cada nno dclos paises constituycntes 
del Congreso. Los nombramientos para la Coniisum Anxiliar Extranjera seran pre- 
sentados al jiresidente de la Comision de Orgaiiizacioii i)or la Coniision Ejecntiva 
Internacional, cada nno para su propio pafs; pero en cl ]>ais on que se reuna el Con- 
greso, los nombramientos estarifn a cargo dc la Coniisii'm de < )rganizaci(jn. Los nom- 
bramientos para la Comision Anxiliar servir^n solaniente para la junta para la cnal 
ban sido hechos. 

Los miembros de la Comisi6n Anxiliar seran representantes oficiales del Congreso 
en sus localidades respcctivas. Sera de su iucumbencia: 

(1) Trasmitir ti los facultativos de sus distritos toda uoticia relativa al Congreso 
que con este objeto le haya sido comunicada por la Direccic'm General. 

(2) Cooperar con la mesa de las seccioues a sumiuistrar los tral)aJos que se desean 
pai'a preseutar al Congreso.- 

(3) Tener ii la Direcci6u General al corriente de todo lo qne se les pida con el objeto 
de llevar Ci cabo las intenciones del Ccnigreso. 

(4) Dar la debida publicidad al desarrollo de la organizacitin para despertar el in- 
teres de la facnltad, promoviendo la asisteucia a lassesiones, y atender ii todo lo que 
asegure el bneu oxito del Congreso. 


11. No se podriin hacer reformas en este realamento sino per la Comisidn Ejecutiva 
luternacional y por mayoria de votos, entendiendose qne diez miembros constituyen 
junta para cualqnier sesion del Congreso. 



1. El primer Congreso M6dico Pan-Americano se efectnara en la ciudad de "Wash- 
ington, capital do los Estados Unidos, en los dias 5, 6, 7 y 8 de setiembre de 1893. 


2. Al asentar sus nombres los asociados residentes en los Estados Unidos pagar{in 
10 i)esos ; pero a los extranjeros no se cobrartt ninguna cuota. Cada miciiibro, despiKjs 
del asiento, recibira.nna tarjeta qne le acredite, y la colecci6n de actas. 


3. Los Senores qne presenten trabajos, babriln de dar nn extracto de sns escritos, 
que no exceda de seiscientas palabras para cada vino, poniendolo en nianos del 
Secretario General antes del 10 de jnlio de 1893. Estos extracto.s seriin tradncidos en 
ingles, francos, espauol y porhignes, y se publicaran antes de la junta para conve- 
niencia del Congreso; enteudit5ndose qne ningnn escrito tcndra lugar en el programa 
quo no haya sido antes presentado en extracto. Los extractos seran tradncidos per 


bureau of the congress at the request of coutributors. Papers to be presented to sec- 
tions must not consume more than twenty minutes each in reading and when of 
greater length must be read by abstract. Papers read by abstract may be jirinted 
in full in tlie transactions, subject to approval by the editorial committee. Abstratjfs 
should be forwarded through the secretaries of sections. Papers and discussions 
will be printed in the language in which they may be presented. All papers read 
in the sections shall be surrendered to the secretaries of the sections; all addresses 
read in tlie general session shall be surrendered to the secretary-general as soon as 
read; and all discussions shall be at once reduced to writing by the jiarticipauts. 


4. The chairman of the committee on organization shall cause the congress to be 
incorporated under the laAVS of Ohio, and fifteen trustees shall be elected in accord- 
ance therewith, who, by 1)y-laws and through the executive committee, shall sujicr- 
vise all receipts and disbursements by the treasurer, in accordance with the laws of 
Ohio. The president, secretary-general, treasurer, the member of the international 
executive connnitteo for the United States, and executive presidents of sections 
shall be ex officio members of the board of trustees. 


5. All nominations by the international executive committee must be in the 
hands of tlie chairnuin of the committee on organization by .lune 1, 1892, and in 
default thereof the couuiiittee on organization shall elect officers for countries thus 


6. The officers of each section shall consist of honorary presidents, who shall 

be residents of the constituent countries of the congress; one executive pn-sideut, 
who shall organize the work of the section, direct its deliberations, and deliver an 
inaugural address at its opening session; one English-speaking secretary and one 
Spanish-speaking secretary, residents of the United States, who shall coo]»erate 
with the executive president in conducting the correspondence of the section; and 
there shall bo one secretary for each section, resident in each additional constituent 
country of the congress. 


7. The auxiliary committee for the United States shall be elected by the com- 
mittee on organization and shall consist of one member for each local medical 
society, or, in tlu^ absence of medical organization, then one in each considerable 
center of population, which auxiliary committee shall cooperate with the com- 
mittee on organization and with the general officers in promoting the welfare of 
the congress. Nominations for the auxiliary committee shall be made by members 
of the comniittee on organization, each for his own State, except that in the failure 
of any member to make such nomination by January 1, 1892, or in the inadeciuacy 
of the same, the chairman of the committee on organization shall supply the 


8. The board of trustees shall designate seven members, including the president, 
treasurer, secretary-general, and member of the international executive com- 
mittee for the United States, who shall comprise an executive committee, which 
shall transact all business of the congress, ad interim, in accordance Avif h by-laws 
adopted by the board of trustees. 


el Departamento Literario del Congreso & petici6u de sus autores. Los escritos que 
se preseuten a las seccioiies uo hau de tomar, en su lectiira, mas de 20 luiuixtos cada 
uno; y si no lueren de esta exteusiou, habran de leerse en extracto. Los escritos 
leldos en extracto apareceran impresos integramente en las actas, uiediante la apro- 
bacion de la Mesa Editorial. Los extractos se dirigirJtn fi los Secretaries de Secciones. 
Los escritos j las disciisiones se imprimirau en el idioma correspoudiente. Todo 
escrito leido en las secciones serii eutregado {i los Secretarios de Seccion : y todo dis- 
curso leido en Sesi6n General lo sera al Secretario General inmediatamente despuds 
de la lectnra. Toda discusi6n se pondrii desde luego por escrito por los que hayau 
tornado parte en ella. 


4. El Presidente de la Comisi6u de Organizacion cuidar.l de que el Congreso reciba 
existencia legal seg-in las leyes del Estado de Ohio, y de conformidad con ellas, se 
elegintn quince curadores, los cnales, por un reglamento especial y con la iuterven- 
cion de la Comi8i6n Ejecutiva, inspeccionar^ todas las entradas y salidas de fondos 
heclias por el Tesorero, de acuerdo con las leyes del Estado de Oliio. El Presidente, 
el Secretario General, el Tesorero, el Representaute de los Estados Unidos en la 
Coniisi6n Ejecutiva Internacional y los Presidentes Ejecutivos de las Secciones, seran 
vocalea de oficio del Cuerpo de Curadores. 


5. Todo nombramiento i>ara la Comisiou Ejecutiva Internacional deber^ estar en 
poller del Presidente de la, Comi8i6n de Organizacion antes del jtrimero de junio de 
1892; y si faltare algiino, la Comision de Organizacion procedera a elegir la mesa 
corresijondiente . 


6. La mesa de cada seccion se compondni de presidentes honorarius, los cuales ban 
de ser residentes de los paises constituyentes del Congreso; de un Presidente Ejecu- 
tivo que organizarii los trabajos de la seccion, dirigird sus deliberaciones y prontin- 
ciar^ un discurso inaugural en la apertura de la sesi6n; de un Secretario que bable 
^1 ingles y otro que bable en espanol, residentes ambos en los Estados Unidos, los 
cuales auxiliar^n al Presidente Ejecutivo en el despacho de la correspondencia de 
la seccion ; y babr^ un Secretario para cada seccion, residente en cada pals consti- 
tuyente adicional del Congreso. 


7. La Comisidn Auxiliar de los Estados Unidos seri elegida por la Coraisidn de 
Organizacion, y se compondra de un vocal por cada sociedad medica local, 6, a falta 
de organizacion medica, de un facultativo por cada centro considerable de poblacion ; 
la cual Comision anxiliar cooperar^ con la Comision de Organizacion y con la Direc- 
cion General d promover el buen exito del Congreso. Las designacioues para la 
Comision Auxiliar seran becbas por vocales de la Comisii'ni de Organizacion, cada uno 
por su propio Estado ; pero en el caso de que diobos vocales no bicieien la designacion 
antes del primero de enero de 1892, 6 que ^sta fuere inadecuada, llenara el vacio el 
Presidente de la Comision Organizadora. 

comisi6n ejecutiva 

8. El Cuerpo de Curadores designar^ siete miembros incluyendo el Presidente, el 
Tesorero, el Secretario General y el Vocal Representaute de los Estados Unidos en la 
Comisi(3n Ejecutiva Internacional, los cuales constituinin una Comision Ejecutiva 
que interinameute y de acuerdo con los Regbimentos que adopte dicho cuerpo enten- 
der^ en todo lo relative a los asuntos del Congreso. 





WILLIAM PEPPER, M. D., LL. D., Pbiladelphia, Pa. 


Dr. Samuki. Gacue, Buenos Aires, Argen- 
tine Republic. 

Dr. Jkhome Cochkax, Montgomery, Ala. 

Dr. Hexjiy a. Hughe.s, PLa'nix, Ariz. 

Dr. P. O. Hooi'KK, Little Rock, Ark. 

Dr. Napoleon Rana, La Paz, Bolivia. 

Dr. Baptista De Lackuda, Rio tie Ja- 
neiro, Brazil. 

Dr. O. O. BuKGESS, iSan Francisco, Cal. 

Dr. J. E. Graham, Toronto, Canada. 

Dr. Manuel BakrosBorgono, Santiago, 

Dr. Pro Rengifo, New York, (for) Colom- 

Dr. Charles Denison, Denver, Colo. 

Dr. W. A. M. Wainwright, Bartford, 

Dr. Juan J. Ulloa, San Jost^, Costa Rica. 

Dr. James H. Cha.ndlek, Centerville, 

Dr. S. C. BrsEY, Washington, D. C. 

Dr. J. R. Daniels, Jacksonville, Fla. 

Dr. R. J. NuNN, Savannah, Ga. 

Dr. Josi: Llerena, Guatemala, Guate 

Dr. C. R. BOYER, Port an Prince, Haiti. 

Dr. Ji;s(^'s Bendana, Comayagua, Hon- 

Dr. John S. McGrew, Honolulu, Hawaii. 

Dr. John W. Givens, Black foot, Idaho. 

Dr. Edmund Andrews, Chicago, 111. 

Dr. Donald McRae, Council Bluft's, Iowa. 

Dr. W'm. B. Dewees, Salina, Kans. 

Dr. W. H. Wathen, Louisville, Ky. 

Dr. John B. Elliott, New Orleans, La. 

Dr. Thomas A. Foster, Portland, Me. 

Dr. Manuel Carmona y Valle, City of 
Mexico, Mexico. 

Dr. W. H. Welch, Baltimore, Md. 

Dr. Reginaldi^) H. Fitz, Boston, Mass. 

Dr. H. O. Walker, Detroit, Mich. 

Dr. Alexander J. Stone, St. Paul, Minn. 

Dr. B. A. Duncan, West Point, Miss. 

Dr. Young H. Bond, St. Louis, Mo. 

Dr. W. M. Schultz, Butte City, Mont, 

Dr. John E. Summers, Omaha, Nebr. 

Dr. S. Bishop, Reno, Nev. 

Dr. Granville P. Conn, Concord, N. H. 

Dr. Edward J. Ill, Newark, N. J. 

Dr. Francis H. Atkins, Las Vegas, N. 

Dr. Seneca D. Powell, New York, N. Y. 

Dr. Francisco Mates Lacayo, Leon, 

Dr. Wm. T. Cheatham, Henderson, N. C. 

Dr. Louis C. Petit, Bismarck, N. Dak. 

Dr. S. S. Thorn, Toledo, Ohio. 

Dr. E. P. Frazer, Portland, Oreg. 

Dr. S. Weir Mitchell, Philadelphia, Pa. 

Dr. Leonardo A^iular, Lima, Peru. 

Dr. Elisha p. Clark, Hope Valley, R. I. 

Dr. Francisco Nunez, St. Tec la, Salva- 

Dr. J. R. Bratton, Yoikville, S. C. 

Dr. M. Ware, Salem, S. Dak. 

Dr. Richard B. Maury, Memphis, Tenn. 

Dr. J. r. Bell, Tyler, Tex. 

Dr. Pedro Vlsca, Montevideo, Uruguay. 

Dr. F. S. Bascom, Salt Lake City, Utah. 

Dr. L. M. Bingha.m, Burlington, Vt. 

Dr. Josii Manuel de los Rios, Caracas, 

Dr. Hunter McGuire, Richnumd, Va. 

Dr. 11. C. WiLso.v, PortTownsend, Wash. 

Dr. Francisco Zayas, Habana (Cuba), 
West Indies. 

Dr. J. J. Senior, Curac^ao, West Indies. 

Dr. S. L. Crane, Surg. Geu., Trinidad, 
West Indies. 

Dr. Thos. BoweN, Bridgetown (Barba- 
dos), West Indies. 

Dr. The Hon. J. C. PiiiLLirro, Kingston 
(Jamaica), West Indies. 

Dr. J. J. CoRXiLiJAC, St. Pierre, Mar- 
tiuiijue, French West Indies. 

Dr. C. Shriver, Bethany, W. Va. 

Dr. Solon Parks, Milwaukee, AVis. 

Dr. John H. Finerock, Laramie City, 

Dr. B. J. D. Irwin, Assistant Surgeon- 
General, Washington, D. C, U. S. 

Dr. J. Mills Browne, Surgeon-General, 
Wasbiiigton, D. C, U. S. Navy. 

Surg. Chas.S.D. Fessenden, Louisville, 
K^'., U. S. Marine-Hospital Service. 



Charles A. L. Eeed, m. d., 311 Elm street, Cincinuati, Ohio. 

Asmatanl Secretaries-General. 

1. Dr. J. McFadden Gastin, 1^ Edgewood avenue, Atlanta, Ga. 

2. Dr. John Guiteras, 3914 Sansom street, Pliiladelpliia, Pa. 

3. Dr. Wm. F. HuTCHixsox, 159 High street, Providence, E. I. 

4. Dr. W. H. Heath, 415 Pearl street, Buffalo, N. Y. 

5. Dr. Irving A. Watson, 10 Centre street, Concord, N. H. 

6. Dr. J. W. Carhart, Lampasas, Tex. 

7. Dr. Ferd. C. Valentine, 236 W, Fifty-iirst street, New York, N. Y. 

8. Dr, A. "Walter Suiter, Herkimer, N. Y. 

9. Dr. Isaac N. Love, Grand Ave., St. Louis, Mo. 
10. Dr. A. ]\I. Fernandez y Ibarra, New York, N. Y. 


Abraham M. Owen, m. d., 507 Upper First street, EvansviUe, Ind. 


Dr. Isaac N. Love, St. Louis, Mo. Dr. T.V. Fitzpatrick, Ciuciniiati,Ohio. 

Dr. L. S. McJIurtry, Louisville, Ky. Dr. A. B. Kichardson, Columbus, Ohio. 

Dr. RuFUS B. Hall, Ciuciuuati, Ohio. Dr.CiiARLES A.L. REED,Cincinnati,Ohio. 


Dr. Henry D. Holton, chairmau. Brat- Dr. J. F. Kennedy, Des Moines, Iowa. 

tleboro, Vt. Dr. L. S. McMvrtry, Louisville, Ky. 

Dr. A.Walter Suiter, secretary, Herki- Dr. N. S. Davis, Chicago, 111. 

raer, N. Y. Dr. Levi Cooper Lane, San Francisco, 
Dr. William T. Briggs, Nashville, Teiin. Cal. 

Dr. George F. Shrady, New York, N. Y. Dr. I. N. Love, Sit. Louis, Mo. 

Dr. P. O. Hooper, Little Rock, Ark. Dr. Hunter McGuire, Richmond, Va. 

Pr. S. S. Adams, Washington, D. C. Dr. Claudius H. Mastin, Mobile, Ala. 

Dr. H. O. Marcy, Boston, Mass. Dr. J. C. Culbertson, Chicago, 111. 

The president, secretary-general, treasurer, members of the inteiuatioual execu- 
tive committee for the United States, and executive presidents of sections are ex 
officio members of the board of trustees. 

Executive comviittee. 

Dr. Henry D. Holton, chairman, Brattleboro, Vt. 

Dr. L. S. McMurtry, 231 W. Chestnut street, LouisviUe, Ky. 

Dr. Wm. Warren Potter, 284 Franklin street, Buffalo, N. Y. 

Dr. William Pepper, (ex officio), 1811 Spruce street, Philadelpliia, Pa. 

Dr. A. M. Owen, (ex officio), 507 Upper First street, EvansviUe, Ind. 

Dr. A. Vaxder Veer, (ex officio), 28 Eagle street, Albany, N. Y. 

Dr. Charles A. L. Rised, (ex officio), 311 Elm ^.treet, Cincinnati, Ohio. 

International executive committee. 

Argentine I\C2)ul)Uc. — Dr. Pedro Lagleyze, Calle Artes 46, Buenos Ayres. 

Bolivin.—l)v. Emilio di Tomassi, Calle Ayacucho 26, La Paz. 

British West Indies. — Dr. James A. DE Wole, Port of Spain. 

British North America. — Dr. James F. W. Ross, 481 Sherborne street, Toronto. 

Chile. — Dr. Moises Amaral, Facultad de Mediciua, Santiago. 


CoHta rira.—'Dr. Danikl NuSez, Sau Jose. 

DomiiiicuH lUpubUc— Dr. Julio Leon, Saiito Domingo. 

Ecuador.— Dv. Ricardo Cucalon, Gnayaciuil. 

French West Indies.— Dr. J. J. Coknilliac, St. Pierre, Martinique. 

Gvatemala. — Dr. Jose Montekos, Avenida Sur No. 8, Guatemala, City. 

Eaiti. — Dr. T. Lamotiie, Rue du Centre, Port au Prince. 

Hawaii.— Dr. .Juiix S. McGilKW, Honolulu. 

Honduras (S])anifsli.— Dr. Geo. Bernhardt, Tegucigalpa. 

Mexico.-Dv. Tomas Noriega, IIosi)ital de Jesus, Mexico. 

Nicaraffna.— DT. J. I. Ukteciio, Calle Real, Granada. 

Paraguay. — No nomination received. 

Peru. — Dr. Mantei, C. 1?arrk)s, Facnltad dc Mcdicina, Lima. 

Republic of Colombia.— Dr. P. M. InA.vEZ, Calie 5a Nuniero 91), Bogota. 

Sulvadqr. — Dr. David J. Guzman, San Salvador. 

Spanish JVest Indies.— Dr. Juan Santos Ferxandez, Calle Rcina No. 92, Havana. 

United Stales of .imenca.—Dr. A. Vaxder Veer, 28 Eagle street, Albany, N. Y. 

United Slates of Brazil. — Dr. Caulos Costa, Rua Largo da Misericordia 7, Rio dc 

Urufjuay. — Dr. .Tacinto de Leon, Calle de Florida No. 64, Montevideo. 
Venezuela. — JJr. Elias Rodriguez, Caracas. 

Committee of Arrangements. 

Samuel S. Adams, M. D., chairman. 
.). K. Wi.i.i.iNtJKix, M. D., secretary. 
G. L. Magruder, M. D., treasurer. 

Executive committee. 

Dr. Samuel S. Adams, eliairuian; Snrgeon-General George M. Sternberg, U. S. A ; 
Surgeon-General .1. Kutiis Tryou. U. S. N. ; Supervising Surgeon-General Walter 
Wyman, U. S. M. H. S.; Drs. S. C. Buscy, G. Wythe Cook, C. H. A. Kleiuschmidt, 
H. L. E. Johnson,, Llewellyn Eliot, H. H. Darker, C. W. Richardson, \V. Sinclair 
Bowen, Geo C. Ober, .lames D. Morgan, G. L. Magruder, J. R. Wellington, and J. 
Roland Walton, D. D. s. 


Eeccplion. — Dr. S. C. Buscy, cliainiian; Surgeon-General George M. Sternberg, 
II. S. A.; Surgeon-General J. Rufus Tryon, U. S. N. ; Supervising Surgeon-General 
Walter Wyman, U. S. M. H. S.; Drs. J. Ford Thompson, Charles E. Hagner, Louis 
Mackall, J. Taber Johnson, T. Morris Murray, G. Byrd Harrison, and Joseph H. 

Entertainments. — Dr. G. Wythe Cook, chairman ; Drs. G. N. Acker and Thomas E. 

lieyislration. — Dr. C. H. A. Kleinschmidt, chairnuin ; Drs. John S. McLainand John- 
son Elliott. 

Railroads. — Dr. H. L. E. Johnson, chairman; Drs. E. L. Tompkins and J. Foster 

Printing. — Dr. Llewellyn Eliot, chairman; Drs. Thomas N. Vincent and F. B. 

Halls and Exhibits.— Dr. H. H. Barker, chairman; Dr. J. T. Winter and C. M. 

Ways and Means. — Dr. C. W. Richardson, chairman; Drs. John Van Rensselaer, 
William Dillenback, Henry B. Deale, and William Compton. 


Tnformatioii. — Dr. W. Siucliiir Boweu, cliairniau; Drs. E. Oliver Belt and F. S. 

Hotels. — Dr. George C. Ober, cliairman; Drs. William E. Haiuly and D. O. Leach. 

C)xdcutials. — Dr. James D. Morgan, chairman; Drs. C. W. Frauzoui, Elmer Soth- 
oron, C. M. Hammett, jr., R. S. Hill, Louis Mackall, jr., and S. J. Radclitte. 

Dental Siin/enj. — J. Roland Walton, D. D. s., chairman; J. B. Hodgkin, D. D. s., 
and H. B. Noble, d. d. s. 

Auxiliary Comniittee. 

Alabama. — Dr. W. H. Sanders, Mobile, member of the National Committee on Or- 
ganization; Dr. S. S. Smith, Autaugo County Medical Society; Dr. Albert Good- 
^vin, Barbour County Medical Society; Dr. W. C. Cross, Bibb County Medical So- 
ciety; Dr. C. H. Franklin, Bullock County Medical Society; Dr. ,T. C. LeGrand, Cal- 
houn County Medical Society; Dr. B. F. Eea, sr., Chambers County Medical So- 
ciety; Dr. J. D. Donald, Butler County Medical Society; Dr. A. A. Wall, Colbert 
County Medical Society; Dr. J. E. Purdou, Cullman County Medical Society; Dr. 
Goldsby King, Dallas County Medical Society; Dr. Phillip Fitzpatrick, Elmore 
County Medical Society: Dr. J. A. Wilkinson, Escambia County Medical Society; 
Dr. M. R. Wright, Etowah Coauty Medical Society; Dr. R. T. Byrd, Gri;eue 
County Medical Society; Dr. F. M. Peterson, Hale County Medical Society; Dr. E. 
H. Sholl, Jefferson County Medical Society; Dr. W. M. Price, Lauderdale County 
Medical Society-; Dr. Edgar Rand, Lawrence County Medical Societj^; Dr. A. G. 
Emory, Lee County Medical Society; Dr. J. R. Hoffman, Limestone County Medi- 
cal Society; Dr. J. A. Pritchett, Lowndes County Medical Society; Dr. W. J. 
Gautier, Macon County Medical Society; Dr. M. C. Baldridge, Madison County 
Medical Society; Dr. J. H. George, Marengo County Medical Society; Dr. J. G. 
Thomas, Mobile County Medical Society; Dr. J. B. Gaston, Montgomery County 
Medical Society; Dr. B. F. Cross, Morgan County Medical Society; Dr. J. M. Sad- 
ler, Perry County Medical Society; Dr. P. H. Brown, Pike County Medical Society; 
Dr. W. S. DuBose, Shelby County Medical Society; Dr. J. M. McLaughlin, St. 
Clair County Medical Society; Dr. D. S. Brockway, Sumter County Medical So- 
ciety; Dr. J. J, Harlan, Tallapoosa County Medical Society; Dr. Peter Bryce, Tus- 
caloosa County Medical Society ; Dr. A. Mc. A. Stovall, Walker County Medical So- 
ciety ; Dr. J. P. Jones, Wilcox Countj^ Medical Society. 

Alaslca. — Dr. Clarence Thwiug, Sitka. 

Argentine Eepuhlic. — Dr. Pedro Lagleyze, Buenos Aires, member International 
Executive Committee; Dr. Samuel Gache, Lavalle 725, Buenos Aires, Circulo Medico 
Argentino; Dr. Francisco Lavalle, Victoria 1104, Buenos Aires, Sociedad Nacional 
de Farmacia; Dr. Emilio R. Coui, Tacuari 252, Buenos Aires, Sociedad Medica 
Argentina; Dr. Ignacio Bas Ossa, La Plata, Ceuti'o Medico de la Plata; Dr. Arturo 
Ferrand, Cordoba, Ceutro Medico de Cordoba. 

For local profession: Dr. J. Martin, Bnenos Aires; Dr. Vidal Pena, Cordoba; Dr. 
Format. Rosario; Dr. Arce Penalvo, La Plata; Dr. Cossio, Tucuman ; Dr. Alverez, 
Mendoza; Dr. Arias, Salta; Dr. Tezanos Pinto, Parana; Dr. Graciano, Corrientes; 
Dr. E. Videla, Santa F6; Dr. Matorras, Gualeguaychu; Dr. R. Sarmiento, San Juan; 
Dr. Corvalan, Santiago del Estero; Dr. Moras, Chivilcoy; Dr. Delgado, San Luis; 
Dr. Herrera, Catamarca; Dr. Luna, Rioga; Dr. Carillo, Jujuy; Dr. Amoretti, 
Territories Nacionales. 

Arizona. — Dr. Henry A. Hughes, Phoenix, member of National Committee on Or- 

For local profession : Dr. R. L. Rosson, Dr. Roberts, Dr. T. Adler, Dr. Wm. Hunt, 
Dr. J. Goodfellow, Dr. J. T. Holcomb, Dr. M. M. Gilbert. 

Bolivia. — Dr. Emilio di Tomassi, La Paz, member of the International Executive 

For the local profession : Dr. Manuel Cuellar (hijo) Sucre; Dr. Ricardo Guzman, 

"S. Ex. 3(3 2 


La Paz; Dr. Cleomedeo Blanco, Cochabamba; Dr. Giegorio Cava, Potosi; Dr. Mer- 
cado, Santa Cruz, Dr. Jose Viscana Caldcron, Oraro. 

llriUsh North America. — Dr. James F. W. Koss, Toronto, member of the Interna- 
tional Executive Committee. 

Province of Ontario: Dr. John L. Bray, Chatham, Canadian Medical Association; 
Dr. James E. Graham, Toronto, Toronto Medical Association; Dr. H. P. Wrijjlit, 
Ottawa, Ontario Medical Association ; Dr. Herbert .S. Grithn, Hamilton, Hamilton 
Medical and Surgical Society; Dr. Vincent H Moore, Pockville, St. Lawrence and 
Eastern Medicnl Association; Dr. Cliarles E. Biinihart, County of Grey Medical As- 
sociation; Dr. Walter H. Moorebouse, London, The London Medical Association; 
Dr. J. L. G. McCarthy, Bai-rie, Simcoe District Medical Society; Dr. John Bostwick 
Lundy, Preston, South Waterloo Medical Association. Eor the local profession : Dr. 
Howitt, Gu(l))h; Dr. Henwood, Brantford; Dr. Boucher, Peterboro; Dr. Wm. H. 
Henderson, Kingston; Dr. Herberts, (iriflin, Hamilton; Dr. Tayler, Goderich; Dr. 
Eakius, Belleville; Dr. D. S. Bowlby, Berlin; Dr. D. H. Moore, Brockville; Dr. 
Robt. Astlcy Corbctt, Port Hope; Dr. J. G. Scott, Seaforth ; Dr. Albert B. Welford, 

Province of Quebec: Dr. Francis E. Shepherd, Montreal, Montreal Medico Cliirur- 
gical Society; Dr. F. J. Au.stin, Sherbrooke, St. Francis District Medical Associa- 
tion; Dr. Eusebe Niqtolenn Ctievalier, Iberville, Societe Chirur. Med. For the local 
profession: Dr. E. P. Lachai)elle, Montreal; Dr. M. J. Ahren, Quebec; Dr. li. A. D. 
King, Compton; Dr. J. A. llamel, Riviere; Dr. E. Gervais, Three Rivers. 

NovaScotia: Dr. W. S. Muir, Truro, Nova ScotiaMedical Association ; Dr. A. D. Mac- 
Gillvary, Soutli Sidney, Cape Breton Medicnl Society. For the lociil profession: Dr. 
John C. McDougall, Amherst; Dr. VV. H. McDonald, Antigonish; Dr. John Stewart, 
Picton; Dr. H. B. McPherson, North Sydney; Dr. Willis B. Moore, Kentville; Dr. 
C. J. Gossip, Windsor; Dr. D. A. Campbell. Hnlifax ; Dr. Augustus Robinson, Annap- 
olis; Dr. Miller, New Glasgow; Dr. Farrish, Liverpool. 

Manitoba: Dr. Chown, Wiunepeg; Dr. J. A. Macdouald, Brandon; Dr. Robert 
W^ilsou, Morden. 

New Brunswick: Dr. .1. Z. Currie, Fredericton. New Brunswick Medical Associa- 
tion. For the local profession: Dr. Murray McLaren, St. John; Dr. .John S. Ben- 
son, Chatham; Dr. II. B. Chandler, Monctou; Dr. Ferdinand L. Pedoliu, New 

New Foundland: Dr. Alfred Harvey, St. John, New Foundland Medical Associa- 

Northwest Territory : Dr. J. H. C. Willoughby, Regina. 

British West Indies. — Dr. James A. DeWolf, Port of Spain, member International 
Executive Committee. For the local profession: Dr. W. J. Branch, St. Kitts; Dr. 
A. G. McHattie, Antigua, Leeward Islands; Dr. Arnaud, Martinique; Dr. F. G. C. 
Damiau, Port of Spain, Trinidad; Dr. Thomas Law Gaskin, Bridgetown, Barbadoes; 
Dr. Thomas Grieve, Georgetown, British Guiana; Dr. Da Costa, Kingstown, 
Jamaica; Dr. G. W. Eyles, Belize, British Honduras. 

California. — Dr. W. R. Cluness, Sacramento, member of National Committee on 
Organization; Dr. William Watt Kerr, San Francisco County Medical Society; Dr. 
Henry Gibbons, jr., San Francisco Obstetrical Society; Dr. George H. Powers, San 
Francisco Medical Benevolent Society; Dr. Joseph Bayer, Society of German Phy- 
sicians of San Francisco; Dr. D. W. A^au Slyck, Passadena Medical Association; 
Dr. J. H. Parkinson, Sacramento Society for Medical Improvement; Dr. M. F. 
Price, San Bernardino County Medical Society; Dr. E. A. Cripin, Sau Benito 
County Medical Society; Dr. F. C. Stockton, San Diego County Medical Society; 
Dr. Robert Caldwell, Santa Clara County Medical Society; Dr. A. W. Hoisholt, Sau 
Joaquin County Medical Society; Dr. J. F. Boyce, Sonouio County Medical Society; 
Dr. L. S. Burcliard, Alemeda County Medical Society; Dr. W. S. George, Contra 
Costa County Medical Society ; Dr. A. J. Pedlar, Frosuo County Medical Society ; 


Dr. Reuben Gross, Humholdt County Medical Society; Dr. S. Bert Ellis, Los 
Angeles County Medical Society; Dr. W. J. G. Dawson, Napa County Medical 
Society; Dr. J. M. West, Northern District Medical Society of Shasta and Tehama 
Counties; Dr. W. LeMoyne Wills, Southern California Medical Society; Dr. C. L. 
Bard, Ventura County Medical Society; Dr. Thomas Ross, Yolo County Medical 
Society; Dr. David Powell, Medical Society of Yuba and Sutter Counties; Dr. 
James Stimsou, Santa Cruz County Medical Society; Dr. S. A. Deuel, Placer County 
Medical Society; Dr. George F. Shiels, San Francisco County Medical Society. 

Colorado. — Dr. W. A. Campbell, Colorado Springs, member National Committee on 
Organization; Dr. Jesse Hawes, Weld County; Dr. John Chase, Arapahoe County; 
Dr. Frank Finney, Bent County; Dr. Wm. A. Olmsted, Las Animas County; Dr. F. 

B. Crocker, Huerfano County; Dr. P. "R. Thombs, Pueblo County; Dr. J. R. Robin- 
son, El Paso County; Dr. J. W. Dawson, Fremont County; Dr. E. H. Keables, Park 
County; Dr. T. B. Moore, Douglass County; Dr. J. P. Kelly, Jefferson County; Dr. 
W. A. Jayne, Clear Creek County; Dr. H. H. Stebbius, Gilpin Ccmnty; Dr. W. R. 
Earheart, Boulder County; Dr. E. A. Lee, Larimer County; Dr. J. L. Green, Eagle 
County; Dr. A. B. Arbogast, Summit County; Dr. F. T. D'Avignon, Lake County; 
Dr. J. A. Robinson, Pilkin County; Dr. A. J. Lanterman, Chaffee County; Dr. N. 
Mackintosh, Gmwiison County; Dr. L. F. Ingersoll, Mesa County; Dr. George M. 
Dorsey, Delta County; Dr. J. H. Miller, Montrose County; Dr. W. W. Rowan, Curay 
County; Dr. D. S. Hoffman, Hinsdale County; Dr. J. W. Rambo, Laguache County; 
Dr. John A. Gale, Conejos County; Dr. Louie Weiss, Rio Grande County; Dr. W. 
H. Rader, La Plata County; Dr. Milton McNeilau, Elbert County; Dr. David Back, 
Grand County; Dr. William Kernegham, Routt County; Dr. L. G. Clark, Garfield 
County; Dr. H. E. Pratt, Costilla County; Dr. J. P. Landon, Dolores County; Dr. 
J. N. Pascoe, San Juan CountJ^ 

Connecticut. — Dr. C. A. Lindsley, New Haven, member National Committee on Or- 
ganization; Dr. George R. Shepherd, Hartford County Medical Society; Dr. William 
H. Carmalt, New Haven County Medical Society; Dr. J. D. Stanton, New London 
County, Medical Society; Dr. N. E. Wordin, Fairfield County Medical Society; Dr. 

C. J. Fox, Windham County Medical Society; Dr. F. H. Wiggin, Litchfield County 
Medical Society; Dr. F. B. Look, Middlesex County Medical Society; Dr. A. E. 
Goodrich, Tolland County Medical Society. 

Costa lUca. — Dr. Juan J. lUloa, San Jos6 de Costa Rica; -Dr. Tom^s M. Calneck, 
Cartago; Dr. Juan J. Flores, Heredia; Dr. Mariano Padilla, Alaguela; Dr. Jose M. 
Castro, Lim6n. 

Delaware. — Dr. C. H. Richards, Georgetown, member National Committee on Organ- 
ization. For local profession: Dr. W. C. Pierce, Wilmington; Dr. W. H. Burr, Wil- 
mington; Dr. E. C. Baird, Wilmington; Dr. Joseph H. Chandler, Centreville; Dr. 
George W. Marshall, Millford; Dr. E. W. Cooper, Camden; Dr. James A. Wilson, 
Dover; Dr. F. E. Stewart, Wilmington; Dr. J. J. Black, New Castle; Dr. J. A. 
Ellegood, Laurel; Dr. R. B. Hopkins, Milton; Dr. H. R. Burton, Lewes. 

District of Columbia. — Dr. D. W. Prentiss, Washington, member National Com- 
mittee on Organization; Dr. S. S. Adams, Medical Society, District of Columbia; 
W. W. Johnston, Medical Association, District of Columbia; Dr. H. L. E. Johnson, 
Gynajological Society, District of Columbia. 

Florida. — Dr. C. R. Oglesby, Pensacola, member of National Committee on Organ- 
ization; Dr. Joseph Y. Porter, Monroe County Medical Society; Dr. J. D. Fernandez, 
Duval County Medical Society; Dr. J. F. M. Kinstry, Alachua County Medical 
Society; Dr. M. Kennedy, Polk County Medical Society; Dr. James S. Herron, Pen- 
sacola Medical Society ; Dr. G. A. Dwelly, Marion County Medical Society. 

Georgia. — Dr. J. McFadden Gaston, Atlanta, member of National Committee on 
Organization; Dr. Eugene Foster, Augusta Academy of Medicine, Augusta; Dr. Floyd 
W. McKrae, Atlanta Society of Medicine, Atlanta; Dr. Julius C, Le Hardy, Georgia 
Medical Society, Savannah; Dr. K. P. Moore, Medical Society of Macon, Macon. 


For the local profession: Dr. W. C. Hnnipbries, Acworth; Dr. P. L. imsinan, Albanj' ; 
Dr. .James B. Hinkle, Americus; Dr. John Geidiiie, Athens; Dr. Hiram Pirdue. Barncs- 
ville ; Dr. Jiulson A. Butt, Brunswick ; Dr. W. W. Fitt, Carrollton ; Dr. Lindsay John- 
son, Cartersville ; Dr. W.L. Bullard, Columbus; Dr. Charles P. Gordon, Dalton; Dr. 
W. B. Cheatham, Dawson ; Dr. J. W. Bailey, Gainesville ; Dr. J. Milton Daniel, Griffin ; 
Dr.F.M. Kidley, La Grange; Dr. C. B. Knight, Madison; Dr. P. K. Corlelyon, Mari- 
etta; Dr. \V. 11. Hall, Milledgeville; Dr. John T. Kcese, Newman ; Dr. Kohert Battey, 
Rome; Dr. T. M. Mcintosh, Thomasville; Dr. G. W. Mulligan, Washington; Dr. A.G. 
Whitehead, Waynesboro. 

IIondnruH. — Dr. George Bernhardt, Tegucigalpa, member International Executive 
Committee; Dr. Julius Mundt, Comayagua; Dr. Rafael Fiallos, Tegucigalpa; Dr. 
Manuel Gamero, Danli; Dr. .Julian Bairas, Amapala; Dr. Francisco l^ogran,. Santa 
Barl)ara; Dr. R. Contreras, Choluteca; Dr. R. Snarcz, Jnticalpa; Dr. Salvador Cor- 
dova, Yuscariin; Dr. G. B. Mitchell, San Pedro Sula. 

Illinois. — Dr. N. S. Davis, Chicago, member of the National Connuittee on Organi- 
zation; Dr. E. B. Montgomery, Adams County Medical Society; Dr. .J. A. Frccma.i, 
Aurora County Medical Society ; Dr. L. L. Leeds, Braiuard District Medical Society ; 
Dr. Charles W. Earle, Chicago Medical Society; Dr. I. N. Dan forth, Chicago Patho- 
logical Society; Dr. George N. Kreidea, Champaign County Medical Society ; Dr. J. E. 
Bumsteatl, Fox River Valley Medical Society; Dr. S. C. Plummer, Iowa and Central 
Illinois Medical Society ; Dr. .1. M. G. Carter, Lake County Medical Society ; Dr. T. J. 
Pitner, Morgan County Medical Society; Dr. .T. L. ^\ hite, McLean County Medical 
Society; Dr. . I. H.Wallace, Military Tract Medical Association, Warren County ; Dr. 
J. P. Matthews, Macoupin County Medical Society; Dr. E. P. Cook, North Central 
Medical Association ; Dr. James L. Brown, Peoria City Medical Society; Dr. J. L. Hal- 
lam. Southern Illinois Medical Association ; Dr. N. J. Benso, Southern Illinois District 
Medical Society; Dr. William Doug.all. Will County Medical Society; Dr. E. U. .'"Sim- 
mons, Whiteside County Medical Society ; Dr. F. R. I'ituer, Centennial Medical Soci- 
ety; Dr. C. BarloWjCrawford County Medical Society; Dr. John Wright, DeVVitt 
County Medical Society ; Dr. J. II. Miller, District Medical Society of Central Illinois ; 
Dr. R. L. Cashburn, Carthage, Illinois; Dr. A. K."\'an Home. Jersey County Medical 
Society; Dr. A. E. Palmer, La Salle County Medical Society; Dr. A. M. Powell, Mad- 
ison County Medical Society; Dr. H. W. Chapman, Medical and Surgical Society of 
Western Illinois ; Dr. Lojiis Stoskoff, Stephenson County Medical Society ; Dr. C. W. 
Sibley, Wayne County Medical Society: Dr. J.Q. Renisburg, Northeastern District 
Medical Society ; Dr. G. W. Nesbitt, Dekalb County Medical Society ; Dr. A. F. Buck- 
nam, Jo Daviess County Medical Society ; Dr. L. A. Ferry, Woodford County Medical 
Society ; Dr. Daniel Lichtz, Winnebago County Medical Society ; Dr. W. J. Eddy, 
Shelby County Medical Societj^ 

Indiana. — Dr. A. M. Owen, Evansville, member of the National Committee on 
Organization; Dr. Edwin Walker, Vanderburg County Medical Society; Dr. 
Frank Blair, Gibson County Medical Society; Dr. A. P. Buchman, Allen County 
Medical Society; Dr. E. G. Regenas, Bartholomew County Medical Society; Dr. 
Jonathan Kolb, Benton County Medical Society; Dr. N. D. Clonser, Blackford 
County Medical Society; Dr. D. H. Van Nuys, Boone County Medical Society; Dr. 
Charles Augell, Carroll County Medical Society; Dr. W. H. Bell, Cass County Medi- 
cal Society; Dr. E.W^. Bogau, Clinton County Medical Society; Dr. J. A. Scudder, 
Davies County Medical Society ; Dr. John House, Dearborn County Medical Society ; 
Dr. J. H. Alexander, Decatur County Medical Society; Dr. F. Broughton. DeKalb 
County Medical Society; Dr. W. E. Driscoll, Delaware County Medical Society; Dr. 
W. R. McMahon, Dubois County Medical Society; Dr. Charles S. Pixley, Elkhart 
County Medical Society ; Dr. Solonuju D. Shepherd, Fayette County Medical Society; 
Dr. Charles P. Cook, Floyd County Medical Society; Dr. George Roland, P'ountain 
County Medical Society; Dr. S. A. Gitlord, Franklin County Medical Society; Dr. 
A. H. Robins, Fulton County Medical Society; Dr. C. V. Moore, Grant County Med- 


ical Society; Dr. P. P. Whitesell, Hamilton County Medical Society; Dr. S. W, 
Heivy,. Hancock County Medical Society ; Dr. T. J. Adams, Hendricks County Medical 
Society; Dr. John Rea, Henry County Medical Society; Dr. William Scott, Howard 
County Me:lical Society; Dr. Cliarles W. Fry, Huntington County Medical Society; 
Dr. W. E. Whitehead, Jackson Couaty Medical Society ; Dr. Philip Dixes, Jay County 
Medical Society; Dr. William A. McCoy, Jefferson County Medical Society; Dr. D. J. 
Shackelford, Kosciusko County Medical Society; Dr. W. H. Davenport, Knox County 
Medical Society; Dr. T. W. Dryer, La Grange County Medical Society; Dr. George W. 
Burton, Mitchell District Medical Society; Dr. N. L. Wichershaw, Madison County 
Medical Society ; Dr. W. N. Wishard, Marion County Medical Society ; Dr. A. B. Young- 
man, Marshal County Medical Society; Dr. Charles P. Higgins, Miami County Medi- 
cal Society; Dr. George W.Bryan, Monroe Countj' Medical Society; Dr. O. H. Jones, 
Montgomery County Medical Society ; Dr. H. W. Cure, Morgan County Medical So- 
ciety; Dr. F. C. Maloney, Noble County Medical Society; Dr. J. M.Jones, Owen 
County Medical Society; Dr. R. R. Kime, Pike County Medical Society; Dr. A. P. 
Letherman, Porter County Medical Society; Dr. C. Hicks, Posey County Medical 
Society; Dr. E. Hawkins, Putnam County iledical Society; Dr. G. M. Kelly, Ran- 
dolph County Medical Society; Dr. E. D. Freeman, Ripley County Medical Society; 
Dr. J. W. Sparks, Rush Couutj- Medical Society; Dr. J. W. Green, Shelby County 
Medical Society; Dr. M. V. Ransburg,. Steuben County Medical Society; Dr. W. A. 
R. Wickham, St. Joseph County Medical Society; Dr. B. H. Boyd, Tippecanoe 
County Medical Sociery; Dr. Samuel G. Downing, Tipton Count}' Medical Society; 
Dr. L. J. Willien, Vigo County Medical Society; Dr. L. G. Thompson, Wabash 
County Medical Society ; Dr. C.J. Keegan, W^arwick County Medical Society ; Dr. 

F. W^ Garrett, Wells County Medical Society; Dr. F. M. Majors, Whitley County 
Medical Society; Dr. J. C. Lexton, Rush County Medical Society; Dr. Joth. Chit- 
wood, Fayette County Medical Society; Dr. J. E. Morris, Union County Medical 
Society; Dr. J. H. Ford, Wabash County Medical Society. 

Iowa. — Dr. H. B. Criiey, Dallas Center, member of the National Committee on 
Organization; Dr. D. W. Crouse, Cedar Valley Medical Association; Dr. A. A. D. 
Deering, Central District Medical Association; Dr. S. A. Spilman, Des Moines Val- 
ley Medical Association; Dr. E. F. Clapp, Eastern District Medical Association; 
Dr. iF. M. Ward, Iowa Central Medical Association; Dr. W. D. Middleton, Iowa 
and Illinois Central District Medical Association; Dr. J. B. Charlton, Medical 
Association of Northern Iowa; Dr. S. E. Robinson, North Iowa Medical Association; 
Dr. G. Baldwin, Medical Association of Northwestern Iowa; Dr. D. S. Fairchild, 
Northwestern District Medical Association; Dr. C. M. Drumeler, Stuart District 
Medical Association; Dr. S. B. Chase, Upper Cedar Valley Medical Association; Dr. 
R. Stephenson, Appanoose County Medical Society; Dr. Wm. J. Moody, Bremer 
County Medical Society; Dr. G. H. Hill, Buchanan County Medical Society; Dr. 
A. O. Strout, Butler County Medical Society; Dr. J. M. Ristine, Cedar Rapids 
County Medical Society; Dr. Thomas D. Gamble, Clinton County Medical Society; 
Dr. Donald Macrae, Council Bluffs County Medical Society ; Dr. I. F. Hildrcth, Decatur 
County Medical Society; Dr. W. J. Williams, Dallas Couuty Medical Society; Dr. 

G. H. Fuller, Delaware County Medical Society; Dr. H. B. Young, Des Moines 
County Medical Society ; Dr. George Minges. Dubuque City Medical and Surgical 
Society; Dr. G. H. Darnall, Fayette County Medical Society ; Dr. J. B. Galer, Frank- 
lin County Medical Society; Dr. I. C. Wood, Harrison County Medical Society; Dr. 
J. C. Shrader, Iowa City Medical Society; Dr. A. B. Boweu, Jackson County Med- 
ical Society; Dr. A. G. Ward, Jefferson County Medical Society; Dr. W. S. Parks, 
Keokuk Medical Society; Dr. W. S. Grimes, Louisa County Medical Society; Dr. C. 
AV. Cornell, Marion Comity Medical Society; Dr. D. S. Brainard, Mitchell County 
Medical Society; Dr. H. M. Dean, Muscatine County Medical Society; Dr. Woods 
Hutchison, Polk County Medical Society ; Dr. J. A. Scroggs, Keokitk Medical Society; 
Dr. J. M. Kuott, Sioux City Medical Society; Dr. F. S. Smith, Story Couuty Medical 


Society; Dr. J. Williamson, Wapello County Medical Society; Dr. IT. C. McClearj^, 
Warren County Medical Society; Dr. J. H. Hull, Wasbinj^ton County Medical So- 
ciety; Dr. A. L. Wright, Carroll. 

Kansas. — Dr. J. E. Minney, Topeka, member of the National Committeo on Organ 
ization; Dr. F. F. Dickman, Bourbon County Medical Society; Dr. Levi Chase, Cen- 
tral Branch Medical Society; Dr. H. Z. lli.ssein, Central Kansas Medical Society; 
Dr. M. B. Ward, Eastern Kansas Medical Society; Dr. Wni. B. Dewees, Golden Belt 
Medical Society; Dr. C. R. Carpenter, Leavenworth City Medical Society; Dr. 
Charles Gardner, Lyon County Medical Society; Dr. John T. Scott, North Kansas 
Medical Society; Dr. L. Reynolds, Northeastern Kansas Medical Society; Dr. W. V. 
Richardson, Pottawatomie County Medical Society; I »r. W. F. Sawliill, Republican 
Valley Medical Society; Dr. L. A. Buck, South Medical Society; Dr. F. M. 
Daily, Sixth District Medical Society ; Dr. C. A. McCiuire, Topeka Academy of Medi- 
cine and Surgery; Dr. G. C. Morgridge, Topeka Pathological Society; Dr. F. S. 
Foote, Wichita Pathological Society; Dr. A. C. Flack, Wilson County Medical 
Society; Dr. George M. Gray, Wyandotte County Medical Society. 

KentucJcjf. — Dr. J. N. McCornuick, Bowling Greeu, meuiber of the National Com- 
mittee on Organization. For local profession: Dr. T. D. Williams, Bardstown; Dr. 
Fayette Dunlap, Danville; Dr. B. F. Eager, Ilopkinsville; Dr. I. H. McKinley, Win- 
chester; Dr. C. IT. Thomas, Covington; Dr. T. B. Greenly, West Point; Dr. .1. H. 
Letclier, Henderson; Dr. Steele Bailey, Stanford; Dr. I. N. Bloom, Louisville; Dr. 
Ewing Marshall, Louisville; Dr. S. G. Dabney, Louisville; Dr. E. R. Palmer, Louis- 
ville; Dr. H. 11. Grant. Louisville; 1>. Arcii. Dixon, Henderson; Dr. R. C. McCbord, 
Lebanon; Dr. M. P. Creel, Central City; Dr. E. B. Pendlettm, Hartford; Dr. John 
R. Claypool. Bowling Green; Dr. John M. Wilson, Williamstown ; Dr. David Bar- 
row, Lexington; Dr. N. V. Williams, Frankfort; Dr. T.J. Shoemaker, Morganlield; 
Dr. D. W. Stone, Ilopkinsville; Dr. George Beeler, Clinton; Dr. J. M. Poyntz, Rich- 
mond; Dr. W. E. Rodman, Hodgeville; Dr. H. K. Adamson, Maysville; Dr. Jno. 
Bowen, Paris; Dr. Harvey McDowell, Cyntbiana; Dr. J. D. Kincaid, Catlettsburg; 
Dr. J. D. Kinnaird, Lancaster; Dr. C. K. Haggard, Middlesborough; Dr. F. A. 
Davis, Newport. 

Loulsiaua. — Dr. Staudford E. Chaille, New Orleans, member of the National Com- 
mittee on Organization; Prof. Jno. B. Elliott, president Lonisana State Medical 
Society. For local profession: Dr. R. Matas, New Orleans; Dr. C. J. Bicknian, New 
Orleans; Dr. F. S. Mudd, Lafayette; Dr. A. A. Lyon, Sbreveport; Dr. I. J. Newton, 
Bastrop; Dr. C. D. Owens, Eola; Dr. J. I). Hanson, Donaldsouville; Dr. T. J. Allen, 
Sbreveport; Dr. A. A. Forsythe, Jena; Dr. F. M. Brooks, Baton Ronge; Dr. R. H. 
Day, Baton Rouge; D r.J. B. Shelmire, Port Hudson; Dr. F. R. Bernard, Lake 
Providence; Dr. S. J. Perkins, Norwood; Dr. L. G. Blancbett, New Iberia; Dr. L. 
T. Postell, Plaqueminc; Dr. F. M. McCormick, Vernon; Dr. G. C. Mouton, Lafayette; 
Dr. A. J. Meyer, Thibodeaux; Dr. T. G. Aby, Monroe; Dr. A. A. Batchelor, Red River 
Landing; Dr. R. L. Luckett, Alexandria; Dr. S. F. Meeker, Lecompty; Dr. B. A. 
Littell, Oi^elousas; Dr. L. H. Jastremski, Honma; Dr. W. G. Ribbe, Abbeville; Dr. 
Jas. Leake, Bayon Sara; Dr. G. C. Chandler, St. Maurice. 

Maine. — Dr. Hampton E. Hill, Saco, member of the National Committee on Organ- 
izatiiu. For the local profession: Dr. S. C. Gordon, Portland; Dr. F. C. Thayer, 
W'aterville; Dr. F. E. Hitchcock, Rockland; Dr. R. D. Biller, Bath; Dr. D. A. Rob- 
inson, Bangor; Dr. S. J. Bassford, Biddeford: Dr. E. H. Hill, Lewiston. 

Maryland. — Dr. Geo. H. Robe, Catousville, member of National Committee on Organ- 
ization; Dr. J. H. Jamar, Cecil County Medical Society; Dr. W. W. Virdiu, Harford 
Connty Medical Societj-; Dr. J. McP. Scott; Washington County Medical Society; 
Dr. Arthur Williams, Medical Association of Howard County; Dr. T. A.Asbby, Med- 
ical and Chirurgical Faculty of Maryland; Dr. E. F. Cordell, Clinical Society of 
Maryland; Dr. J. D. Blake, Baltimore Medical Association; Dr. L. F. Aukrim, Med- 
ical and Surgical Society of Baltimore. For the local profession: Dr. M. C. Claude, 


Annapolis; Dr. C. G. W. McGill, Catonsville; Dr. James Bordley, Centerville ; Dr. 
W. Frank Hincs. Chestertowu; Dr. .J. J. Jones. Frostburg; Dr. Monnioriier Rowe, 
Deal's Island; Dr. J. M. H. Bateiuan, Easton; Dr. T. B. Saulsburg, Dr. L. A. 
Griffith, Upper Marlboro; Dr. D. I. Leatberman, Meclianicstovra ; Dr. J. Lee 
McCoiuas, Oakland; Dr. C. Biruey, Taneytowu; Dr. F. M. Lancaster, Wayside. 

Masnachuiieits. — Dr. Angustus P. Clarke, Cambridge, member National Committee 
on Oi'gauization. For the local profession: Dr. J. F. A. Adams, Pittsfieb! ; Dr. H. 
O. Marcy, Boston; Dr. G. F. Jelly, Boston; Dr. Asa F. Pattie, Boston; Dr. E.W. 
Cnshing, Boston; Dr. A. H. Nichols. Boston; Dr. F. L. Bmt, Boston, Dr. C. B. Belt- 
Boston; Dr. J. N. Nelson, Revere; Dr. H. C. White, E. Sumnierville; Dr. vS. D. Pres- 
brey, Fannton; Dr. W. H. Taylor, New Bedford; Dr. A. H. Tnttle, Cambridge; Dr. 
H. P. Walcott, Cambridge; Dr. E. P. Hurd, Newbnryport; Dr. Albert Wood, Worces, 
ter; Dr. Jno. C. Irish, Lowell; Dr. V\'m. G. Breck, Springfield. 

Mexico. — Dr. Tomas Noriega, Hospital de Jesiis, City of Mexico, member of the 
International Executive Committee ; Dr. Luis E. Rniz, San Pedro y San Pablo 13, 
Academia Nacional de Medicina; Dr. Francisco Chacon, 2a del Factor 1, Sociedad 
deGiuecologia; Juan Jose B. De AA'ellano, Consejo S. de Salubridad, Sociedad "Pedro 
Escobedo;" Dr. Eoque Macouret, Escuela de Medicina, Sociedad Filoiatrica; Dr. 

Ednardo Vargas, Escalerillas m'mi. 4, Sociedad . For the local profession: 

Dr. Francisco de P. Chacon, Mexico; Dr. Roscndo Gutierrez, Leon; Dr. Fausto 
Uribe, Guadalajara; Dr. Francisco Morfu, Puebla; Dr. Jesiis Chico, Guanajuato; 
[To be appointed], Merida; Dr. Ignacio Alvarado, San Luis Potosi ; Dr. Juan Berha, 
Zacatecas; Dr. Manuel Septien, Qiieretaro; Dr. Fernando Solozuren, Oaxaca; [To 
be appointed], Colima; Dr. Ishael Salas, Saltillo; Dr. Daniel Ruiz, Vera Cruz; Dr. 
Francisco Iturbide, Morelia; [To be appointed], Aguascalientes; Dr. Trinidad Ortega, 
Celaya; Dr. Gregorio Meudizabal, Orizaba; [To be appointed], Zapotlan; Dr. Pedro 
Noriega, Monterey; Dr. Patricio Trueba, Campeche: Dr. Felipe Martinez, Mazatlan; 
Dr. Alfonso Ortiz, Hermosillo; Dr. Pascha. Chihuahua; Dr. Mariano Herrera, 
Durango; Dr. Eduardo Navarro, Toluca; Dr. Miguel Barragan, Matamoras. 

Xew ffamp shire. — Dr. Irving A. Watson, Concord, member national committee on 
organization. Dr. Ezra Mitchell, White Mountain Medical Society; Dr. George 
Cook, Center district Medical Society; Dr. C. A. Fairbanks, Rockingham County 
Medical Society; Dr. M. A. Harmon, Carroll County Medical Society. 

'Xew Mexico. — Dr. C. E. Wiuslow, Albuquerque, member national committee on 
organization. Dr. Geo. W. Harrison, New Mexico Medical Society. 

Neio Jersey. — Dr. E. J. Marsh, Paterson, member of the national committee on or- 
ganization. Dr. Boardman Reed, Atlantic County Medical Society ; Dr. Daniel A. Cur- 
rie, Bergen County Medical Society; Dr. F. Gaunt, Burlington County Medical So- 
ciety; Dr. E. L. B. Godfrey, Camden County Medical Society; Dr. J. C. Marshall, 
Cape May County Medical Society; Dr. H. W. Elmer, Cumberland County Medical 
Society; Dr. Edward .T. Ill, Essex County Medical Society; Dr. Howard Wilson, 
Gloucester County Medical Society; Dr. O. H. Sproul, Hunterdon; Dr. B. W. 
McGallard, Mercer Coimty Medical Society; Dr. D. C. English, Middlesex County 
Medical Society; Dr. S. Pierson, Morris County Medical Society; Dr. P. A. Harris, 
Passaic County Medical Society; Dr. B. A. Waddington, Salem County Medical 
Society; Dr. H. G. Wagoner, Somerset County Medical Society; Dr. L. W. Miller, 
Sussex County Medical Society; Dr. A. Pettit, l7nion County Medical Society; 
Dr. J. C. Johnson, Warren County Medical Society; Dr. H. P. Houghton, Mon- 
mouth County Medical Society. 

New York. — Dr. John Cronyn, Buffalo, member of the national committee on 
organization. Dr. Douglas Ayres, district branch of the New York State Medi- 
cal Association ; JL»r. E. D. Ferguson, second district branch of the New York State 
Medical Association; Dr. J. D. Tripp, third district branch of the New York State 
Medical Association; Dr. S. T. Clark, fourth district branch of the New York State 
Medical Association; Dr. E. H. Squibb, fifth district branch of the New York 


State Medical Association; Dr. A. Walter Suiter, Medical Society of theState of New- 
York ; Dr. Albert Vauder Veer, Albany County Medical Society ; Dr. W. W. Craudall, 
Allegany County Medical Society; Dr. J. C. Comstock, Broome County Medical 
Society; Dr. I. Z. Fisher, Cattaraugus County Medical Society; Dr. C. P. Crivdiug, 
Cayuga County Medical Society; Dr. Edward Ames, Chautauqua County Medical 
Society; Dr. Henry Flood, Chemung County Medical Society; Dr. H. C. Lyman, 
Chenango County Medical Society; Dr. D. S. Kellogg, Clinton County Medical 
Society; Dr. E. C. Fritts, Columbia County Medical Society; Dr, F. W. lliggins, 
Cortland County Meilical Society; Dr. S. S. Cartwright, Delaware County Medical 
Society ; Dr. R. K. Lotliill, Dutchess County Medical Society ; Dr. W. W. Potter, Erie 
County Medical Society; Dr. Edward T. Strong, Essex County Medical Society; Dr. 
James Maclie, Frankliu County Medical Society; Dr. Eugene Beach, Fulton County 
Medical Society; Dr. Charles E. Willar, Greene County Medical Society; Dr. C. W. 
Hamlin, Herkimer County Medical Society; Dr. James D. Spencer, Jefferson County 
Medical Society; Dr. Lewis S. Pilcher, Kings County Medical Society; Dr. W. H. 
Johnston, Lewis County Medical Society; Dr. F. M. Perrine, Livingston County 
Medical Society ; Dr. H. W. Carpenter, Madison County Medical Society; Dr. .lolm 
O. Roe, Monroe County Medical Society; Dr. Chas. Stover, Montgomery County 
Medical Society; Dr. Frederick R. Sturgis, New York County Medical Society; Dr. 
Alfred L. Loomis, Academy of Medicine; Dr. M. S. Kittinger, Niagara County Med- 
ical Society; Dr. James H. Glass, Oneida County Medical Society; Dr. J. L. Hctfrun, 
Onondaga County Medical Society; Dr. Burk Pillsbnry, Orange County Medical 
Society; Dr. Wm. C. Bailey, Orleans County Medical Society; Dr. F. S. Low, Oswego 
County Medical Society; Dr. O. W. Peck, Otsego County Medical Society; Dr. 
George W. Murdock, Putnirtn County Medical Society: Dr. C. G. J. Finn, Queens 
County Medical Society; Dr. W. W. Seymour, Rensselaer County Medical Society; 
Dr. 1'. E. Martindale, Richmond County Medical Society; Dr. E. H. Maynard, Rock- 
land County Medical Society; Dr. B. F. Sherman, St. Lawrence County Medical 
Society ; Dr. Wni. L. Pearson, Schenectady County Medical Society ; Dr. Lemuel, Cross 
Schoharie County Medical Society; Dr. S. B. Allen, Schuyler County Medical Society; 
Dr. H. R. Ainsworth, Steuben County Medical Society; Dr. B. D. Skinner, Suffolk 
County Medical Society; Dr. W. W. Appley, Sullivan County Medical Society; 
Dr. C. L. Stiles, Tioga County Medical Society; Dr. S. II. Peck, Tompkins County 
Medical Society ; Dr. Thomas S. Dawes, Ulster County Medical Society ; Dr. B. G. 
Streeter, Warren County Medical Society ; Dr. Henry Root, Washington County 
Medical Society; Dr. J. N. Arnold, Wayne County Medical Society; Dr. E. F. Brush, 
West Chester County Medical Society; Dr. Bonj. L. Holt, Yates County Medical 
Society; Dr. R. J. Wilding, Medical Association of Northern New York; Dr. .J. W. 
Whitbeck, Rochester Pathological Society; Dr. W. M. Gobson, Utica Medical Library 

Xicaragita. — Dr. Juan Ignacio Urtecho, Calls Real, city of Granada, member of the 
international executive committee. Dr. Fran'co M. Lacayo, Le6n, Protomedicato 
de la Repnblica. For the local profession: Dr. Basilio Marin, Leon; Dr. Carmen 
Bengochea, Managua; Dr. Alejandro Bolafios, Masaya; Dr. E. Flint, Rivas. 

North Carolina. — Dr. H. Lougstreet Taylor, Asheville, member national com- 
mittee on organization. Dr. Karl von Ruck, Buncombe County Medical Society : 
Dr. J. W. Long, Randolph County Medical Society; Dr. J. M. Hays, Granville 
County Medical Society. For local profession : Dr. J. B. Watts, Taylorsville ; Dr. N. 
Robinson, Elizabethtown; Dr. R. S. Young, Concord; Dr. A. A. Kent, Lenoir; Dr. 
M. F. Arcndcll, Dr. R. H. Williamson, Yanceyville; Dr. J. M. McCorkle, Newton; 
Dr. H. T. Chapin, Pittsboro; Dr. J. F. Abernathj^ Murphy; Dr. R. H. Winborne, 
Baruitz; Dr. O. P. Gardner, Shelby; Dr. J. A. Hodges, Fayetteville; Dr. R. L. 
Paj'ne, jr., Lexington ; Dr. J. W. Blount, Kenansville; Dr. N. M. Johnson, Durham; 
Dr. E. S. Foster, Louisburg; Dr. E. B. Holland, Dallas; Dr. E. H. Sugg. Snow Hill; 
Dr. E. R. Michaux, Greensboro; Dr. A. B.l'ierce, Weldon; Dr. R. L. Allen, Waynes- 


ville; Dr, W. B. Reese, Heudersbnville ; Dr. M. W. Hill, Statesville; Dr. J. M. 
Chandler, Dillsboio; Dr. W. L. Croiise, Liiicolntou; Dr. J. M. Lylo, Franklin; Dr. 
J. H. Gilkey, Marion; Dr. F. W. Potter, AYilmingtou; Dr. Jno. Whitehead, Salis- 
hury ; Dr. James McKee, Raleigh; Dr. W. H. H. Cobb, Goldsboro; Dr. Joseph 
Gracham, Charlotte; Dr. Albert Anderson, Wilson; Dr. Charles McDnfiQe, Newberu; 
Dr. P. H. Mnii)hy, Morgauton. 

Ohio. — Dr. Chas. A. L. Reed, Cincinnati, member national committee on organi- 
zation. Dr. T. V. Fitzpatrick, Cincinnati Academy of Medicine; Dr. L. S. Colter, 
Cincinnati Medical Society; Dr. S. B. Hiner, Allen County Medical Society; Dr. 
Jno. A. Dickson, Ashtabula County Medical Society; Dr. A. J. Gawne, Bay City 
Medical Society; Dr. J. S. McClellau, Belmont County Medical Society; Dr. W.W. 
Ellsbnry, Brown County Medical Society; Dr. J. F. Baldwin, Central Ohio Medi- 
cal Society; Dr. C. E. Imhoff, Champaign; Dr. Seys, Clark County Medical Society; 
Dr. A. W. Ashbnrn, Clermont County Medical Society; Dr. W. H. Humiston, Cuya- 
hoga County Medical Society; Dr. G. W. Hoglau, Columbus Medical Club; Dr. L. 
G. Thacker, Defiance County Medical Society; Dr. J. B. Ford, Delamater Medical 
Association; Dr. O. Pomeroy, Geauga County Medical Society; Dr. Alta F. Cook, 
Erie County Medical Society; Dr. F. D. Bain, Hardin County Medical Society; Dr. 

D. J. Snider, Harrison County Medical Society; Dr. D. B. Cotton, Hempstead Memo- 
rial Academy of Medicine; Dr. A. M. Brown, Highland County Medical Society; 
Dr. J. G. Bigham, Holmes County Medical Society; Dr. A. A. Elliott, Jeiierson 
County Medical Society; Dr. Chas. F. House, Lake County Medical Society; Dr. S. 
S. Scoville, Lebanon Medical Society; Dr. Jos. Larimore, Licking County Medical 
Society; Dr. J. McCurdy, Mahoning County Medical Society; Dr. F. W. Thomas, 
Marion County Medical Society; Dr. J. H. Hysell, Meigs County Medical Society; 
Dr. T. M. Wright, Miami County Medical Society; Dr. J. W. Grimes, Monroe 
County Medical Society; Dr. F. H. Darby, Miami Valley Medical Society; Dr. Geo. 
Goodhue, Montgomery County Medical Society; Dr. H. S. Green, Morrow County 
Medical Society; Dr. R. Harvey Reed, North Central Ohio Medical Association; Dr. 

E. C. Brush, Hildreth District Medical Association ; Dr. W. C. Jacobs, Northeast Ohio 
Medical Association ; Dr. D. W. Steiuer, Northwest Ohio Medical Association ; Dr. 
T. B. Wright, Pickaway County Medical Society; Dr. J. E. Shellenberger, Piqua 
Society of Clinical Medicine; Dr. J. B. Welsh, Preble County Medical Society; Dr. 
E. 3. Galbraith, Ross County Medical Society; Dr. D. P. Campbell, Sandusky 
County Medical Society; Dr. T. J. West, Seneca County Medical Society; Dr. D. 
R. Silver, Shelby County Medical Society; Dr. David P. Maxwell, Stark County 
Medical Society; Dr. R. J. Pumphrey, Stillwater Medical Society; Dr. L. S. 
Ebright, Summitt County Medical Society; Dr. S. S. Thorn, Toledo Medical Associ- 
ation; Dr. C. S. Ward, Trumbull County Medical Society; Dr. A. L. King, Union 
Medical Society; Dr. Samuel Hart, Washintrton County Medical Society; Dr. J. E. 
Barrett, Wayne County Medical Society; Dr. W. M. Fuller, Wood Connty Medical 
Society; Dr. H. T. Sutton, Zauesville Medical Society: Dr. Dan Millikin, Butler 
County Medical Society; Dr. J. G. Reed, Union District Medical Society; Dr. Wm. E. 
Rice, Darke County Medical Society; Dr. R. B. Hall, Southwestern Ohio Medical 

Ori'iion. — Dr. William Boys, Portland, nu'iuber of the National Committee on Organ- 
ization. For local profession: Dr. H. F. McCormick, Eugene; Dr. J. M. Pruett, Pen- 
dleton; Dr.W. E. Riuehart, The Dalles; Dr. F. M. Robinson, Beiiverton; Dr.H. B.Stan- 
ley, Dallas ; Dr. O. J. West, W^asco ; Dr. O. M. Dodson, Baker City ; Dr. G. R. Farra, 
Corvallis; Dr. J. A. Fulton, Astorio; Dr. C. S. Hall, Salem; Dr. J. L. Hill, Albany ; Dr. 
M. F. Honan, LaGrande; Dr. J. M.V.Chalmers, Hillsboro; Dr. H.A.Wright, Linkville. 

Pennsylvania. — Dr. William Pepper, Philadelphia, member N.^tional Committee on 
Organization; Dr. A. W. Thomas, Adams County Medical Society; Dr. W. H. Mer- 
cur, Alleghany County Medical Society; Dr. T- M. Allison, Armstrong County Med- 
ical Society; Dr. W. H. Grim, Beaver County Medical Society; Dr. John A. Clark, 


Bedford County Medical Society: Dr. W. M. ^VcidInan, Berks County ^lodical 
Society; Dr. William M. Fiiidlay, Hl:iir("oiiiity Medical Society ; Dr. C. K. La<ld, Brad- 
ford County Medical Society; Dr, R. B. Kuigbt, Bucks County Medical Society; Dr. 
Samuel Graham, Butler County Medical Society; Dr. L. If. Mayer, Cambria County 
Medical Society; Dr. Jose])!! A. llonui, Carbon County Medical Society; Dr. C. S. 
Musser, Center County Medical Society; Dr. Jacob Price, Chester County Medical 
Society; Dr. J. F. Ross, Clarion County Medical Society; Dr. J. E. Vaughn, Clear- 
field County Medical Society; Dr. J. R. ^lontiionnry. Cohimbia Connty Mediral 
Society; Dr. George W. Barr, Crawlbrd County .Me<lical Sotietv; Dr. R. I^. SiWbctt, 
Cumberland County Medical Society; Dr. llugii Hamilton, Dauphin County Medical 
Society; Dr. J. L. Forwood, Delaware County Medical Society; Dr. C. G. Wilson, 
St. Marys, Elk County Medical Society; Dr. L. S. Gaddis, Fayette County Medical 
Society; Dr. G. S. Hull, Franklin County Medical Society; Dr. I. II. Sliarpnack, 
Greene County Medical Society; Dr. A. B. Brumbaugh, Huntington County Medical 
Society; Dr. William Anderson, Indiana County Medical Society; Dr. W. K. Dolau, 
Lackawanna County Medical Society; Dr. G. R. Rohrcr, Lancaster County Meilical 
Society; Dr. A. B. Gloninger, Lebanon County Medical Society; Dr. W. S. Berlin, 
Lehigh County Medical Society; Dr. L. H. Taylor, Luzerne County Medical Society ; 
Dr. C. W. Yonngman. Lycoming County Medical Society; Dr. E. O. Kane, McLean 
County Medical Society; Dr. J. W. Hillier, Mercer County Medical Society; Dr. S. 
H. Rothrack, Miitiu County Medical Society; Dr. .lose])!! Anderson. Montgomery 
County Medical Society; Dr. P. C. Xewb.iker, Montour County Medical Society; 
Dr. Isaac Ott, Northampton County Medical Society ; Dr. W. G. Marsh, Northum- 
berland County Medical Society; Dr. H. O. Orris, Perry County Medical Society; 
Dr. J. S. Carpenter, Schuylkill County Medical Society; Dr. P. A. Boyer, Snyder 
County Medical Society; Dr. W. L. Richardson, Sus(iuehanna County Mediial 
Society; Dr. J. A. Ritchey, Venango County Medical Society; Dr. W. M. Baker, 
Warren County Medical Society; Dr. .1. A. McKeau, Washington County Medical 
Society; Dr. R. B. Hammer, Westmoreland County Medical Society ; Dr. I. C. Gable, 
York County Medical Society. 

lU'pitblic of Columhia. — Dr. Pedro M. Ibanez, Calle 5, niimero 99, Bogota, member 
of the International Executive Committee; Dr. Josd M. Buendia, calle 10, Bogota, 
Academia uacional de Medicina; Dr. Manuel Urilie Angel, Medellin, Academia de 
Mediciua de Medellin; Dr. Evaristo Garcia, Call, Sociedad de Medicina del Cauca. 
For the local profession: Dr. Nicolas Osorio, calle 13, Bogota; Dr. Audrds Posada 
Arango, Medellin (Departamento de Antioquia^; Dr. Jorge E. Delgado, Panama 
(Departamento de Panam.i); Dr. Eugenio de la Hoz, Barranquilla (Departamento 
de Bolivar); Dr. Domingo Cagiao, Popayan (Departamento del Cauca); Dr. Jos6 
Manuel Rodriquez, Socorro (Departamento de Santander); Dr. Paulo Emilio Villar, 
Bucaramanga (Departamento de Santander); Dr. Felix M. Hernandez, Ciicuta (De- 
partamentti de Santander) ; Dr. Rafael Calvo, Cartagena (Departamento de Bolivar) ; 
Dr. N. Ribon; Mompox (Departamento do Bolivar); Dr. Miciades Castro Ibiigu«5 
(Departamento del Tolima); Dr. Cayetano Lombana, Ambalema (Departamento del 
Tolima); Dr. Jose M. Martinez, Antioiiuia (Departamento de Antioquia); Dr. Isaias 
Saavedra, Velez (Departamento de Santander); Dr. Severs Forres, Funja (Departa- 
mento de Boyac^i) ; Dr. N. Villa, Remedies (Departamento de Antioquia) ; Dr. Miguel 
Caicedo, Pa.sto (Departamento de Cauca); Dr. Emilio Villamazar, Pamplona (De- 
partamento de Santander.) 

Ilepnhlic of Guatemala. — Dr. Jose Monteros, Calle Aveuida Sur No. 8, City of 
Guatemala, member of the International Executive Committee; Dr. Samuel Gon- 
zales, City of Guatemala, Facultad de Medicina y Farniacia del Centre; Dr. Leon 
Saenz, Quezalteuango, Facultad de Mediciua y Farniacia de Occidente; Dr. Manuel 
Apariclo, Quezaltenango, Sociedad Mddica, Farmacdutico de Occidente. For the 
local profession: Dr. Enecon Mora, Quezaltenango. 

Jihoih Inland. — Di\ George L. Collins, Providence, member National Committee on 


Organization; Dr. Joliu W. Mitchell, Providence Medical Association; Dr. F. H 
Rankin, Newport Medical Society; Dr. Henry K. Gardiner, Washington Medical 
Society; Dr. W. F. Hutchinson, Providence. 

South Carolina. — Dr. R. A. Kinloch, Charleston, meuiher National Committee on 
Organization; Dr. L. T. Hill, Abbeville; Dr. T. G. Croft, Ailcen; Dr. S. M. Orr, 
Anderson; Dr. W. F. Holmes, Barnwell; Dr. A. P. Priolean, Beaufort; Dr. J. P. 
Cain, Monk's Corner; Dr. S. M. Davage, Chester; Dr. C. Kollock, Cheraw; Dr. W. 
S. Pack, Manning; Dr. Charles Witsell, Waltcrboro; Dr. .J. C. Wilcox, Darlington; 
Dr. Thomas J. McKie, Woodlawn; Dr. J. C. Buchanan, Winnsboro; Dr. James Evans, 
Florence; Dr. Tliomas P. Bailey, Georgetown; Dr. ,J. M.Wilkinson, Greenville; Dr. 
S. Smith, Brighton; Dr. W. E. Sparkman, Bucksville; Dr. A. A. Moore, Camden; 
Dr. W. O. Nesbit, Lancaster; Dr. J. T. Poole, Laurens; Dr. M. Q. Heudrix, Lexing- 
ton; Dr. J. C. MuUins, Marion; Dr. J. L. Napier, Blenheim; Dr. O. B. Mayer, jr., 
Newberry; Dr. J. James, Westniiuster; Dr. C. R. Tabor, Fort Mott; Dr. J. W. 
Quillian, Easley; Dr. B.W.Taylor, Columbia; Dr. T. S. Means, Spartanburg; Dr. 
A. J. China, Sumter; Dr. M. W. Culp, Union; Dr. S. D. M. Byrd, Scranton ; Dr. R. 
A. Bratton, Yorkville. 

.S'^*fl?n'.s/( West Indies. — -Dr. Juan Santos Fernandez, Reina No. 92, Havana, Cuba, 
member of the International Executive Committee; Dr. Federico Hortsman, Ha- 
A'ana Real Academia de Cicucias Mcdicas; Dr. Diego Tamayo, Havana, Sociedad de 

Estudios, Clinicos; Dr. Aristides Mestre, Havana, Sociedad Antropolngica; , 

Sociedad de Hygiene. For the local j)rofession: Cuba — Dr. Joaquin Diago, Havana; 
Dr. Jose H. Perez, Baracoa; Dr. Fernandez Mendez Capote, Cardenas; Dr. Gabriel 
M. Landa, Cienfuegos; Dr. Angel Cantero, Trinidad; Dr. Sebastian Cuerro y Ser- 
rano Zaza; Dr. Vicente Tomas, Matanzas; Dr. Francisco Martinez Mesa, Sagua la 
Grande; Dr. Amado del Valle, Gibara; Dr. Manuel G. Gonzalez, Nnevitas; Dr. 
Domingo Lagomasino, San Juan de los Remedios; Dr. Urbano Guimera, Santiago 
de Cuba; Dr. Fernando Pons, Guantiinamo; Dr. Francisco Codina, Manzanillo; Dr. 
Luis D. Pimieuta, Santa Cruz de los Pinos; Dr. Francisco Solano Ramos, Pinar del 
Rio; Dr. Juan Guzman, Puerto Principe; Dr. Rudesindo G. Rizo, Sancti Spiritus; 
Dr. Toribio del Villar, Gliines; Dr. Rafael Trista, Villa Clara: Dr. Leonardo Esperon, 
Colon; Dr. Francisco Portela, Guanajay; Dr. Enrique V. Valenzuela, Guanabacoa; 
Dr. Enrique Ranz, Sante F6 de Isla de Pinos. Puerto Rico: Dr. Salvador Carbonell, 
Mayagiiez; Dr. Juan Fernandez, San Juan; Dr. J. Ruiz, Aguadilla; Dr. Rafael Valle, 
Arecibo; Dr. J. Lopez, Fajardo; Dr. Blondet, Guayama; Dr. C. Camo, Naguabo; Dr. 
Vasquez, Viequez; Dr. Eduardo Lacot, Ponce. 

United States of Brazil. — Dr. Carlos Costa, Calle Largo de Misericordia 7, Rio de 
Janeiro; Dr. Visconde de Saboia, Rio de Janeiro, Academia Nacional de Medicina; 
Dr. Oscar Bulhoes, Rio de Janeiro, Sociedade de Medicina e Cirurgia do Rio de 
Janeiro; Dr. Carlos Hastings, Rio de Janeiro, Instituto dos Cirurgines Deutistas 
Brasilieros; Dr. Moura Brazil, Rio de Janeiro, Polyclinica Geral; Dr. Silva Lima, 
Bahia, Sociedade Medica de Bahia; Dr. Joiio Penido, Jiiiz de Fora, Sociedade de 
Medicina e Cirurgia de Juiz de Fora; Dr. Luiz Pedro de Barbosa, Rio de Janeiro, 
Gremio dos iuternas dos Hospitaes do Rio de Janeiro. For the local profession : Dr. 
A. Ferreira da Silva and Dr. Paulo Cezar, Rio de Janeiro; Dr. Nina Rodriques and 
Dr. Pacitico Pereira, Bahia; Dr. Mabtquias Goncalves and Dr. Alcebiades Vellozo, 
Pernambuco; Dr. Miranda Azevedo and Dr. Mello e Oliviera, Sao Panlo; Dr. O. de 
Almeida and Dr. Joao Godiuho — Balfort R6xo, Para ; Dr. Eduardo Guimaraes, Cam- 
pinas; Dr. Almir Nino, Maranhao; Dr. Victor de Britto, Porto Alegre; Dr. Luna 
Friere and Dr. Matos de Alencar, Ceara; Dr. Eduardo de Menezes and Dr. Sim6e3 
Correa, Juiz de Fora; Dr. Goulart, Esperito Santo; Dr. Duarte Schutel, Santa 
Catharina; Dr. Ismael de Rocha, Curitiba. 

Uruguay. — Dr. Jacinto de Leon, calle de Florida num. 61, Montevideo, member of 
the international executive committee; Dr. Juan L. Heguy, 18 de Julio 54, Monte- 
video, Honorable Consejo de Higiene; Dr. Jose Romeu, Plaza de Cagancha41, Monte- 


video, Circnlo M*^(lico llruguayo. For the local profession: Dr. Atilio Chiassaro, 
Salto; Dr. .Julio Jnrkoski, Artijfas; Dr. N. Pariotti, Paysaiulu; Dr. Ta-scual Cioni, 
Fray Beutos; Dr. Jerouimo Rodriguez Gallego, Mercedes; Dr. Guillermo Dall' Orto, 
Colonia; Dr. Alejandro Chiolini, San Jose; Dr. N. Laborde, Flores; Dr. Jose Sco- 
zeria, Montevideo; Dr. N. Caleza, San Carlos; Dr. Alfonso Cifani, Roclia; Dr. N. 
Murguia, Melo; Dr. Juan Resso Ilcrrora, Montevideo (por Treinta y Tres); Dr. Her- 
menegilda Gagliardi, Minas; Dr. Antonio Bonasso, San Fructnoso; Dr. Eduardo 
Lamas, Salto; Dr. Ram6u Irigoyeu, Florida; Dr. .Julian B. Blanco, Dnrazuo; Dr. 
Pedro de Froitas, Canelores. 

Utah. — Dr. F. S. Bascom. Salt Lake City, member national committee on organi- 
<!ation; Dr. A. C. Standart, Salt Lake Medical Society; Dr. J. P. Carnabau, Ogdeu 
Medical Society. 

Vvnezuela. — Dr. Jos6 Maria Rodriguez Garmendia, Tocuyo; Dr. Francisco A. Ris- 
quez, Caracas; Dr. Freites Pineda, Ciudad Bolivar; Dr. Domingo Belle Hernandez, 
Merida; Dr. Gabriel Briceno Ric6n, Trujillo; Dr. Luis Betauconrt, La Guayra; Dr. 
Francisco E. Bnstamente, Maracaibo; Dr. Paulino Balbuena, Puerto Cabello; Dr. 
Roiuuio D'Anbeterre, Cumaua; Dr. Pedro Luis Briceno Martin, Maturiu; Dr. Cesar 
Espino, Barcelona; Dr. Manuel A. Fonseca, Valencia; Dr. Arnaldo Morales, Ciudad 
de Cura; Dr. Antonio Maria Pineda, Barrpiisimcto. 

Vermont. — Dr. H. D. Holton, Brattleboro, member of national committee on 
organization; Dr. M. R. Grain, Rutland County Medical Society; Dr. E. B. Camp- 
bell, Windham County Medical Society; Dr. D. C. Hawley, Chittenden County 
Medical Society; Dr. Ralph Sherwood, Franklin County Medical Society; Dr. W. 
D. Huntington, Windsor County Medical Society; Dr. C. L. Erwin, Orleans County 
Medical Society; Dr. D. G. Kemp, Washington County Medical Society; Dr. J. D. 
Folsom, Caledonia County Medical Society. 

Virginia. — Dr. .1. S. Wellford, Richmond, member national committee on organ- 
ization. For the local profession: Dr. W. C. Dal)ney, Charlottesville; Dr. L. B. 
Anderson, Norfolk; Dr. S. W. Carmichael, Fredericksburg; Dr. R. F. Hicks, War- 
reuton; Dr. J. A. Gayle, Roanoke; Dr. W. F. Barr, Abingdon; Dr. L. B. Edwards, 
Eichmond; Dr. S. W. Budd, Petersburg; Dr. H. M. Patterson, Staunton. 

West Virginia. — Dr. J. H. Brownfield, Fairmount, member national committee on 
organization. For the local profession: Dr. L. D. Wilson, Wheeling; Dr. T. A. 
Harris, Parkersburg; Dr. W. P. Hogue, Charleston. 

Wisconsin. — Dr. J. T. Reeve, Appleton, member of the national committee on 
organization. Dr. A. J. Hosmer, Ashland Medical Society; Dr. C. S. Sheldon, Cen- 
tral Wisconsin Medical Society ; f)r. P. H. Letourneau, Chippewa County Medical 
Society; Dr. F. D. Bentley, Columbia County Medical Society; Dr. T. T. Bever- 
edge, Fox River Valley Medical Society; Dr. F. Robert Zeit, German Northwestern 
Medical Society ; Dr. F. M. Eply, Inter-Co, Medical Society; Dr. F. S. Luhraanu, 
Manitowoc Countj"^ Medical Society; Dr. J. Simonsin, Northwestern Wisconsin Med- 
ical Society; Dr. C, M. Gould, Pierce County Medical Society; Dr. W. Hausmann, 
Brainard Medical Society; Dr. Edward Kovats, Society of German Physicians; Dr. 
C. D. Conkey, Douglass County Medical Society; Dr. N. O. B. Wingate, health 
department of Milwaukee; Dr. W. A. Batchelor, Milwaukee Medical Society. 

Wyoming. — Dr. J. H. Fiufrock, Laramie City, member national committee on 
organization. For local profession: Dr. .J. .T. Marston, Cheyenne; Dr. M. C. Bark- 
Avell, Cheyenne; Dr. T. G. Ricketts, Carlion; Dr. E. S. Murray, Rock Springs: Dr. 
T. G. Maghce, Rawlins; Dr. W. A. Hockeu, Evanston; Dr. J. C. Watkins, JiutValo; 
Dr. J. M. Wilson, Douglas j Dr. H. L. Stjuire, Sundance; Dr. H. M. Bennett, 



AJdbama. — The Alabama Medical and Surgical Age, Jno. C. LeGrand, 1014 Noble 
street, Anniston. 

Argentine BipubUc. — Anales del Cfrculo Mddico Argentino, Dr. Samuel Gache, 
editor, Lavalie 725, Buenos Aires; Anales de la Asistencia Piiblica, Dr. Jose Peuna, 
editor, Rivadaviall67, Buenos Aires; Anales del Departamento Nacioual de Higiene, 
Drs. Pedro N. Arata and Emilio R. Coni, editors, 25 de Mayo 273, Bueuos Aires; Bo- 
letin de Sanidad Militar, Drs. Alberta Costa and Jose M. Cabezin, editors, Hospital 
Militar, Bueuos Aires; La Salud, Dr. J. M. Frauceschi, editor, Cliivilcoy; Eevista 
de la Sociedad Nacioual de Farmacia (anonymous), Esmeralda 591, Buenos Aires; 
Eevista M<5dica de la Plata, Drs. Bas, Arce, Peualva, Alexander, Gallastegui, and 
Ferrand, editors. La Plata. 

Brazil. — Aunaes da A.caderaia de Medicina do Rio de Janeiro, Drs. A. J. Sonza Lima 
and Alfredo Piragibe, editors, Rio de Jaueiro; Boletins da Academia de Medicina, 
Drs. A. ,T. Souza Lima and Alfredo Piragibe, editors, Rio de Janeiro; Brazil Medico 
[weekly], Dr. Azavedo Sodre, editor, Rio de Janeiro; Uniao Medica, Dr. .Joao Drum- 
mond, editor, Rio de Jaueiro; Auuuario Medico Brasileiro, Dr. Carlos Costa, editor, 
Rio de Jaueiro; Revista dos Cursos Praticos e Theoricos da Faculdade de Medicina 
e Cirurgia de Rio de Janeiro, Drs. Beuicio de Abreu, Rocba F. Joao M. Teixeira, 
Oscar Bulboes, Jose Paulo, editors; Gazeta Medica da Baliia, Dr. Pacifico Pereira, 
Baliia; Bok-tins da Sociedade de Medicina e Cirurgia de Rio de Janeiro, Dr. Jorge 
Franco, editor, Rio de Janeiro ; Boletins da Sociedade de Medicina e Cirurgia de Jniz 
de Fora, Drs. Eduardo de Menzes and Goucalves Peuna Filho, editors, Juiz de Fora; 
Revista do Greuiio dos Internos dos Hospitaes do Rio de Janeiro, Drs. Carlos Seidl, 
Modesto Guimaraes and Adolpho Possolo, editors, Rio de Jaueiro. 

Calif ornia .-r-SontheTn California Practitioner, Dr. H. Bert Ellis, Los Angeles; 
Pacific Healih Journal, Dr. J. N. Loughborough, 1059 Castro, Oakland; Occidental 
Medical Times, James H. Parkinson, 429| I, Sacramento; Pacific Medical Journal, 
Dr. D. A. Hodghead, 522 California, San Francisco. 

Canada. — The Canadian Practitioner, Dr. Adam H. Wright, editor, Toronto, Onta- 
rio', The Canada Lancet, Drs. J. L. Sevison and C. Sheard, Toronto, Ontario; The Mon- 
treal Medical Journal, Drs. George Ross, Thomas G. Roddick, and James Stewart, 
Montreal, Quebec; The Canada Medical Record, Drs. A. Lapthorn Smith, F. Wayland 
Campbell, and Rollo Campbell, Montreal, Quebec; La Gazette Mc^dicale, Montreal, 
Quebec; The Maritime Medical News, Halifax, Nova Scotia; L'Uniou Medicale 
du Canada, Drs. J. B. A. Lamarche, H. E. Desvosiers, and M. T. Brennan, Montreal, 

Cldle. — Revista M(?dica, Dr. Sancristobal, editor, Santiago de Chile; Boletin de 
Medicina, Dr. Ootavio Maira, editor, Santiago de Chile; Anales de Farmacia, Angel 
Vasquez, editor, Santiago de Chile; Revista Farmaceutica Chilena, Adolfo Larenas, 
editor, Santiago de Chile. 

Eejyuhlic of Colombia. — Revista Medica, Drs. Abraham Ajiaricio and Carlos Michel- 
sen, editors, Bogota; Revista de Higiene, Dr. Gabriel Duran Borda, editor, Bogota; 
Boletiu de Medicina del Cauca, Dr. Daniel Quijana Wallis, editor, Call; Anales de 
la Academia de Medicina de Medellin (anonymous), Medellin. 

Colorado. — Denver Medical Times, Dr. Thomas H. Hawkins, 1657 Arapahoe, Den- 

Connecticut. — New England IMedical Monthly, Dr. Wm. C. Wile, 7 Delay, Danbury; 
The Quartely Journal of Inebriety, Dr. T. D. Crothers, Fairfield avenue, Hartford. 

Costa Rica. — La Gaceta, San Jos6; El Maestro, San .lose. 

Cuba. — Anales de la Academia de Ciencias, Havana; Cr^nica M^dico-Quirurgica, 
Dr. Juan Santos Fernandez, editor, Havana; Revista de Cieucias Modicas, Dr. 
Joaq^uin Jacobson, editor, Havana; Progreso M<5dico, Dr. Gabriel Casuso, editor, 


Havana; La nigione, Dr. Manuel Dclfin, editor, Havana; El Repertorio M(5clico, 
l)r. Antonio Gonzalez Curgnozo, editor, Havana. 

Georgia. — Atlanta Medical and Snrgical Jonrnal, Dr. M. B. Hntcbins, P. O. Ijox 
431, Atlanta; Southern Medical Record, A. W. Griggs, 29 N. Forsyth, Atlanta; The 
Dixie Doctor, Dr. T. II. Huzza, 2^ Marietta, .\tlanta. 

Guatemala. — Menioria de la Facultad de Medicina y Farmacia del Centro, Dr, 
Samuel Gonzalez, editor, Guatemala City; Menioria <le la Facultad de Medicina y 
FarnuH'ia de Oecidente, Dr. Encou Mora, editor, Quezaltenango; Gaccta Medica 
Qiiezalteca, Dr. Encon Mora, editor, Qnezaltenango. 

JUinois. — Journal of the Ajuerican Medical As.sociation, Dr. J. C. Culbertons, 
68 Wabash aveuue, Chicago; Medical Standard, Dr. James G. Kiernan, 834 Opera 
House Block, Chicago; North American Practitioner. Dr. Bayard Holmes, 75 Wabash 
avenue, Chicago; Sanitarj- News, A. H. llarrynian, 90 La Salle, Chicago; Western 
Medical Reporter, Dr. John E. Harper, 163 State, Chicago; Peoria Medical Monthly, 
Dr. Thomas M. Mcllvaine, Peoria. 

Indiana. — Fort Wa> nc Journal of the Medical Sciences, Drs. C. B. and George 
Steemen, 1)5 Calhoun, Fort Wayne; .lournal of the National Association of Railway 
Surgeons, Christian B. Steemen, Fort Wayne; Indiana Medical Journal, Dr. Frank 
C. Ferguson, 19 W. Ohio, Indianajiolis. 

Iowa. — Iowa State Medical h'eporter, Dr. F. E. Crittenden, Dcs Moines. 

A'ansas. — Kansas Medical .Journal, Dr. John E. Miuney, 723 Kansas avenue, Toiieka. 

Ktntuchy. — Medical Progress, Dr. Robert C. Keuner, 315 Connuerce Building, Louis- 
Tille; Anuricau Practitioner and News, Dr. D. W. Yandell, 440 W. Main, Louisville; 
Medical Herald, Dr. Edward Miller, 327 Third avenue, Louisville. 

Louisiana. — New Orleans Medical and Surgical Journal, Dr. G. B. Lawrason, 158 
Canal, New Orleans. 

Marjihind. — Maryland Medical Journal, A. K. Bond, 209 Park avenue, Baltimore. 

3Iassachusetis. — Annals of Gyna-ccdogy, Dr. E. W. Cushing, 168 Newbury, Boston; 
Boston Medical and Surgical Journal, Dr. George B. Shattuck, 283 Washington, Bos- 

Mexico. — La Gazeta M(^dica. Dr. Manuel S. Soriana, editor. City of Mexico; La 
Revista Mt^dica de M«5xico, Ferrer, editor. City of Mexico; La Escuela do 
Medicina, Dr. Adrian de Garay, editor, City of Mexico; La Revista M(5dica de 
Puebla, Dr. Miguel Solas, editor, city of Puebla; Boletin del Hospital General de 
Puebla, Dr. Francisco Morin, editor, city of Puebla; El Estudio, Dr. Secundino E. 
Sosa, editor, City of Mexico. 

Mielii<jan. — The Physician and Surgeon, Dr. .1. W. Keating, Ann Arbor; Pharma- 
ceutical Era, Charles W. Parsons, 99 Woodward avenue, Detroit; Bulletin of 
macy, Dr. B. W. Palmer, Detroit; American Lancet, Dr. Leartus Connor, 103 Car, 
Detroit; Leonard's Illustrated Medical Journal, Dr. C. Henri Leonard, 18 John R. 
Detroit; Medical Age, Dr. B. W. Palmer, P. O. box 470, Detroit. 

Minnesota. — Northwestern Lancet, Dr. A. J. Stone, Union Block, St. Paul. 

Missouri. — St. Joseph Medical Herald, Dr. Hiram Christopher, St. Joseph; Alienist 
and Neurologist, Dr. C. H. Hughes, .500 N. Jeflerson, St. Louis; American Journal of 
Ophthalmology, Dr. Adolph Alt, 914 Locust, St. Louis; Annals of Surgery, Dr. L. S. 
Pilcher, 914 Locust, St. Louis; Medical Brief, Dr. J. J. Lawrence, Ninth and Olive, 
St. Louis; Medical Mirror, Dr. I. N. Love, Grand avenue, St. Louis; The Medical 
Fortnightly, Dr. Brandsford Lewis, 1006 Olive, St. Louis; St. Louis Medical and 
Surgical Journal, Dr. F. L. James, St. Louis; Weekly Medical Review, Dr. Frank L. 
James and Dr. A. H. Ohmaun-Dumesnil, 615 Locust, St. Louis. 

Nebraska. — Omaha Clinic, Dr. George Wilkinson, Karhack Block, Omaha. 

Xew York. — Albany Medical Annals, Albany; Brooklyn Medical, Dr. 
Joseph H. Raymond, 356 Bridge, Brooklyn; The Sanitarian, Dr. A.N. Bill, 291 Union 
street, Brooklyn; Buflalo Medical and Surgical Journal, Dr. W. W. Potter, 284 
Franklin, Buflfalo; American Druggist, 56 Lafayette Place, New York; La Revista 


M^flico — Qninirgica, Dr. Samuel E. Millikin and Dr. Pedro J. Salicrup, 126 'Liberty 
Btreet, New York; Aniericau Jourual of Obstetrics, Dr. Brooks H. Wells, 56 Lafay- 
ette Place, Xew York; Domestic Gazette, W. F. Waugh, 447 Greenwich, Xew York; 
Gaillard's Medical .Tonrnal, Dr. G. T. Harrison, P. 0. box 1124, New York; La Gaceta 
Mt^dico Farmacdutica, Johnson & Johnson, 92 William, New York; Hall's Jonrnal 
of Health, Nelson, 340 W. Fifty-ninth, New York ; Herald of Health, Dr. George 
Henry Bassett, P.O. bos 2141, New York; International Jonrnal of Surgery, Dr. 
Ferdinand King, 95 William, New- York; Doctor's Weekly, Dr. Ferdinand King, 315 
W. Sixty-third, New York; Journal of Balneology, Dr. A. L. A. Tabolett, P. O. hox 
1670, New York; Journal of Cutaneous anil Geuito-Urinary Diseases, Dr. P. A. Mor- 
row, 3 Bond, New York ; Jouru.Tl of Nervous and Mental Diseases, Dr. Charles Henry 
Brown, 25 W. Forty-fifth, New York; Journal of Syphiology and Dermitology, Dr. 
Morris H. Henry, 531 Fifth aveniie, New York ; New York Medical Journal, Dr. Frank 
P. Foster, 3 Bond, New York; New York Medical Record, Dr. George F. Shrady, 56 
Lafayette Place, New York; Medical Missionary Record, George D. Dowkontt, 118 
Forty-fifth, New York ; American Journal of Insanity, Dr. George Adler Bloomer, 
Utica; New York Journal of Gynaecology Obstetrics, Dr. J. Duncan Emmet, 91 
Madison avenne. New York. 

Korth Carolina. — North Carolina Medical Journal, Dr. Thomas F. Wood, 201 
Chestnut, Wilmington. 

Ohio. — Cincinnati Medical .lournal, Dr. Gilbert I. Cullen, 478 West Sixth, Cincin- 
nati; Lancet and Clinic, Dr. ,J. C. Culbertsou, 199 West Seventh, Cincinnati; Cleve- 
land Medical Gazette, Dr. A. R. Baker, 143 Euclid avenue, Cleveland; Columhus 
Medical Journal, Dr. J. F. Baldwin, 112 West Fourtli, Columbus; Medical Com- 
pend, Dr. H. G. BLaine, 902 Adams, Toledo. 

Pennsylvania. — American Journal of the Medical Sciences, Dr. E. P. Davis, Phil- 
adelphia; Annals of Hygiene, Dr. Joseph F. Edwards, Philadelphia; Archives of 
Pa-iliatrics, Dr. William Perry Watson, 715 Market, Philadelphia; College and 
Clinical Record, Dr. Richard J. Dnnglison, Philadelphia; Medical News, Dr. G. M. 
Gould, 706 Sansom, Philadelphia; Medical World, Dr. C. F. Taylor, 1520 Chestnut, 
Philadelphia; Medical and Surgical Reporter, Dr. E. T. Reichert, northeast corner 
Tbirteeuth and Walnut, Philadelphia; Times and Register, Dr. William F. W^augh, 
17?5 Arch, Philadelphia; Pittsburg Medical Review, Dr. X. O. Werder, 924 Pennsyl- 
vania avenue, Pittsburg; Therapeutic Gazette, Dr. H. A. Hare, 22 South Fifteenth, 

Peru. — La Cronica M6dica, Lima; El Monitor Medico, Lima. 

San Salvador. — La Fniversidad, San Salvador; Repertorio Salvadoreuo, San Sal- 

Tennessee. — Memphis Medical Monthly, Dr. F. L. Sim, 126 Hernando, Memphis; 
Journal of Medicine and Surgery, Dr. C. S. Briggs, 313 Church; Nashville; Southern 
Practitioner, Dr. Deering J. Roberts, 218 Russell, Nashville. 

Texas. — Daniel's Texas Medical Journal, Dr. F. E. Daniel, 510 Rio Grande, Austin; 
Texas Health Journal, J. R. Briggs, 903 Elm, Dallas. 

Venezuela. — La Union Mddica, Caracas; Revista Cientifica de la Universidad 
Central, Caracas. 

Virginia. — The Virginia Medical Monthly, Landon B. Edwards, Richmond, Va. 

Dental journals. 

Dental Cosmos, Philadelphia; Dental Review, Chicago; Dental Register, Dr. J. 
Taft, Cincinnati; Dental Head-Light, Dr. W. C. Barrett, Buffalo, N. Y. ; Interna- 
tional Dental Journal, Philadelphia; AYestern Dental Journal, Kansas City, Mo. ; 
American Journal of Dental Science, Baltimore; Ohio State Dental Journal, Toledo, 
Ohio; Dominion Dental Jourual, Dr. W. G. Beers, Montreal, Canada; Southern 
Dental Journal, Atlanta, Ga. 


Milwaukee, Wis., J\inc 6, 1893. 
To ihc American Medical Association: 

Your committee, appointed at Washington to effect a ])ermanent 
organization of an intercontinental American medical congress, begs 
leave to submit its final report as follows: 

An organization lias been effected under the style and title of tlio 
Pan American Medical Congress, to be held at the City of Washington, 
]). C, Sept(Mnber 5, 6, 7, and 8, A. D. 181)3, under the presidency of 
Prof. William Pepper, M. D., ll. d., of Philadelpliia. The details of 
the organization are set forth in the pnblished preliminary announce- 
ment of the Congress, copies of which are respectfully submitted 
herewitli, in both English and Spanish, as a part of this report. 

Since the publication of this preliminary announcement an organi- 
zation has been effected in Paraguay. Your committee is tlierefore 
jdeased to state that an organization of the Pan Anierican Medical 
Congress exists in every State and Territory of the United States and 
in every remaining country and colony of the Americas, including 
the West Indies and Hawaii. 

A provision has been adopted since the foregoing publication where- 
by every medical society, national, colonial, and local, has been made a 
constituent organization of the Congress. 

Tlie committee begs leave to report further that the organization 
wliich has been effected as above, by the authority you have conferred 
upon it, has been and is already very actively engaged in carrying out 
the practical ends of the Congress. 

The Senate and House of Eepresentatives at the first session of the 
last Congress adopted a joint resolution authorizing the President to 
extend an invitation to the governments of the Western Hemisphere to 
send official delegates to the meeting, and to a])point similar delegates 
on behalf of our own Government. This ofiQcial invitation has been 
issued through the Department of State, and all replies so far received 
have been in the nature of acceptances. The President has indicated 
that the Government of the United States will be represented at the 
Congress by 6 delegates. At the last meeting of the executive com- 
mittee of the congress a resolution was adopted directing that in view 



of the Columbian exercises in progress in America tliis year, and iu 
view of the relations which have become intimate between the United 
States and Spain, that the Government of the latter country be 
requested to seuri delegates to the congress. It was thought that the 
exceptional relations of amity existing between the two countries 
would warrant a course which has been avoided with regard to all other 
European countries out of deference to the interests of the interna- 
tional congress which is to meet inEome. 

The National Congress at its last session appropriated fifteen thou- 
sand dollars ($15,000) for the ])urposes of entertainment of the meeting. 

The President of the United States has consented to open the con- 
gress in person and to extend the courtesy of a reception at the White 
House to delegates and their fa?iiilies. 

A special feature of the congress will be the proceedings of the sec- 
tions on hygiene, climatology, and demography, and on marine and 
hygiene and quarantine. The proceedings of these sections will be 
largely of the nature of a sanitary conference with particular reference 
to practical questions of public health and of imminent importance. 

With this object in view, every municipality of the three Americas, 
including the West Indies and Hawaii, has been invited to send an 
official delegate, and a very large number of acceptances have already 
been received. 

The titles of several hundred papers, accompanied in many instances 
with abstracts, have already been received from representative medical 
writers in the English, Latin, French, and Portugese countries. This 
of itself assures the scientific success of the congress. 

Invitations have been extended to representative European scientists 
to be the guests of the congress, and a number of acceptances have 
been received. 

In conclusion, your committee begs leave to express its appreciation 
of the spontaneous response to its appeal for funds in the form of 
advance registration fees from the public-spirited representatives of our 
profession in America. Let it be remembered, no registration fees will 
be accepted from members of the congress residing outside the United 
States. Although money has been realized from advance registrations 
in amount sufficient to pay some of the preliminary exi^ense of organi- 
zation, a still larger sum is needed with which to meet accumulated 

It should be held in mind that the Congressional appropriation, 
meager as it is, will be available only for purposes of entertainment at 
the time of the meeting, and that the expense involved in publication, 
correspondence, and clerical work is necessarily very heavy and must 
be met at once. The members of the profession are therefore again 
urgently requested to register at once by paying the fee ($10) to the 
treasurer. Dr. A. M. Owen, Evansville, Ind. Those who thus become 
members of the congress, but who may be prevented from attending 
S. Ex. 36 3 


the meeting, will receive a set of the transactions, which of themselves 
promise to be Avorth more than the amount of the registration fee. 

In submitting this, its final report, your conimittee begs leave to 
thank the association and its executive ofificers for cordial support and 
the medical press for its energetic and efficient aid in promoting this 
earnest movement for the unification of the medi(;al i)rofession of all 
the Americas. 

liesijectfully submitted on behalf of the committee. 

CnAKLES A. L, Reed, 








Delegate from — 

Isaac E. Atkinson 

Baltimore, Md 

University of Maryland. 

United States Marine-Hospital 

H. W.Austin 

U. S. Marine-Hospital 



George N. Acker 

Washington, D. C 

Medical Society, District of Co- 

Samuel S. Adams 

Washington, D. C 

Medical Society, District of Co- 

Zabdiel Boylston Adams 

Framingham, Mass 

The State of Massachusetts, by 
appointment by the governor. 

J . Dennis Arnold 

San Francisco, Cal 

San Francisco County Medical 


Florestau Aguilar 

Cadiz, Spain 

" La Odontologia." 

Gueterrez y Arango 

Santander, Colombia . . 

The Government of the Republic 
of Colombia; the Government 
of the Department of Cauca; 
Sociedad de Medicina del 

Leonard Ballou Almy . . . 

Norwich, Conn 

The State of Connecticut, by ap- 
pointment by the governor. 

Albert Anderson 

Wilson, N. C 

North Carolina State Medical 


Joseph W. Anderson 

Ardmore, Pa 

Montgomery County (Pa.) Medi- 
cal Society. 

Howard Emerson Ames. 

Washington, D. C 

United States Navy. 

James M. Andres 

Philadelphia, Pa 

Medico-Chirurgical College. 

Joliu S. Anvim 

Columbus. Ind 

The State of Indiaua, by api)oint- 
ment by the governor. 

Lawrence Ashton 

Dallas, Texas 

Texas State Medical Association. 

John B. Baggett 

Washington, D. C 

Medical Association, District of 

Henry B. Baker 

Lansing, Mich 

State of ^lichigan, by appoint- 
ment by the governor. 

A. R. Baker 

Cleveland. Ohio 

Cuyahoga County (Ohio) Medical 

H. H. Barker 

Washington, D. C . 


Amy S. Barton 

Philadelphia, Pa 

AVoTii;m\ Mpdipnl dollpore, of T*ftTiTi- 


John N, Baskett 

Hannibal, Mo 

State of Missouri, by appointment 
by the governor. 

Joseph D. Bryant 

New York 

Bellevue Hospital Medical Col- 

Edwin Bentley 

Little Rock Ark 

Arkansas Industrial University, 
Medical Department. 

Darbv Bera in 

Cornwall, Ontario 

A. C. Bernavs 

St. Louis, Mo 

iVIiii'ioii Sims Af*^fliml OoIIbcs 

Henry G. Bever 

Annapolis, Md 

United States Navy. 
Uuited States Army. 

John S. Billings 

Washington, D. C 

Seth Scott Bishop 

Chicago, 111 

Illinois Charity Eye and Ear In- 


Alexander B. Blackader. 

Montreal, Canada 

McGill University. 

J. Mount Bleyer 

New York 

New York County Medical So- 

Eugene Boise 

Grand Rapids, Mich . . . 

City of Grand Rapids, appointed 
by the mayor. 

Henry F. Borden 

Brockton, Mass 

Massachusetts Medical Society. 

James P. Boyd 

Albany, N. Y 

Ashaway, R. I 

Albany Medical College. 

Rhode Island State Board of 

Alexander B. Briggs 


Charles W. P. Brock.... 

Richmond, Va 

National Association of Railway 





Delegate from — 

Daniel R. Brovrer ....... 

Chicago, 111 

The State of Illinois, by appoint- 
ment by the governor. 

Hawkins Brown 

Huston vi lie, Ky 

The State of Kentucky, by ap- 
pointment bv the governor. 

Sonera B. Brown 

Fort Wavne, Ind 

Indiana Dental College. 

Valentine Brown 

Vonkers. \. Y 

The city of Youkers, N. Y., ap- 
pointed by the mayor. 

Albert P. Brubaker 

riiiladelpliia, Pa 

Jefl'erson Medical College. 

Samnel W. Bogan 

Wasliiii-iton, D. C 

Columbian University. 

Peter H. Brvee 

Toronto. Canada 

Provincial Uoard of Health. 

Daniel S. I>urr 

Bingliaiiitou. \. Y 

City of Binghamtcm, appointed 
bv the mayor. 

John J. Burroughs 

Houston, Tex 

Texas State Medical Association. 

Samuel C. Busey 

Washington, D. C 

Medical Association, District of 

J.Wellington Byers 

Charlotte, N. C 

Charlotte .\cademy of Medicine. 

James Campbell 

Hartford. Conn 

The State of Connecticut, by ap- 
pointment by the governor; 
and the city of Hartford, by ap- 
pointmtnt bv the mayor. 

Henry W. Cattell 

Philadelphia, Pa 

Institution for Feeble-Mindcd 
Chihlren, at Elwyn. 

Charles G. Cannadav . . . 

Roanoke, Va 

The State of Virginia by appoint- 
ment bv the governor. 

Roland G. Curtin 

Philadelphia, Pa 

American Climatological Asso- 

Manuel Carmona y Viille 

Citv of Mexico 

The State of Tamaulipas. 

Jose Clairac 


The Spanish Government. 

Auguste Comean 

I'ort an Prince, Haiti.. 

The Haitien Government. 

J. Henry Carstens 


Detroit Gynecological Society. 
The University of Pennsylvania. 

William S.Carter 

Philadelphia, Pa 


U. S. Marine-Hospital 

The United States Marine-Hos- 


]iital Service. 

Silas J. Cartwright 

Roxbury, N. Y' 

Delaware County (N. Y.) Medical 

John J. Castellanos 

New Orleans, La 

Orleans Parish (La.) Medical So- 

David Cerna 

Galveston. Tex 

Texas State Medical Association. 

James Collins 

Philadelphia, Pa 

I'hiladelpliia County Medical So- 

Samuel Powers Carbee . 

Haverhill, N. H 

State of New Hampshire, by ap- 
pointment by the governor. 

Julian J. Chisolm 

Baltimore, Md 

The University of Maryland. 

Russell H. Chittenden .. 

New Haven. Conn 

Yale University. 

John Herbert Claiborne 

Petersburg, Va 

The Commonwealth of Virginia, 
by appointment by the gov- 

Augustus P. Clarke 

Boston, Mass 

The State of Massachusetts, by 
ai)pointment by the governor. 

N. D. Clouser 

Hartford City, Ind 

Blackford County (Ind.) Medical 

Wm. H.H.Cobb 

Goldsboro, N. C 

State of North Carolina, by ap- 
pointment by the governor. 

Anton Coe 

Washington, D. C 

Meilical College of Columbia Uni- 


Henry L. Coit 

Newark, N. J 

Essex District Medical Society. 

P. C. Coleman 

Colorado, Texas 

Cincinnati, Ohio 

Texas State Medical Association. 

Cornelius G. Comegys .. 

Cincinnati Hospital and Academy 

of Medicine. 

Granville P. Conn 

Concord, N. H 

Appointed by the governor of 
New Hampshire to re]>re8ent 

the State Board of Health, Dart- 

mouth Medical College. 





Delegate from — 

Phineas S. Coimer 

An^el Contreras 

Albert C. Corr 

Cincinnati, Ohio 

Pnebla, Mexico 

Carlinville, 111 

Dallas Center, lovra . . . 

Buffalo, N. Y 

The Medical College of Ohio; 
Darlniouth Medical College. 

The State of Yucatan. 

The State of Illinois, by appoint- 
ment by the governor. 

The State of Iowa, by appoint- 
ment by the governor. 

Medical Department of Niagara 

Walnut Lodge Hospital. 

Woman's Medical College of Phil- 

Albany Medical College. 

Massachusetts Medical Society. 

The city of Chelsea, appointed 
by the mayor. 

The State of Zacatecas. 

University of Virginia. 

Appointed by the Governor of 
Pennsylvania to represent the 
State board of health. 

The State of Georgia by appoint- 
ment by the governor. 

Napa County (Cal.), Medical So- 

The State of Louisiana by ap- 
poiutment by the governor. 
Orleans Paiish Medical Society. 

Will County (111.) Medical So- 

The State of North Carolina by 

Berton H. Criley 

.Tohn Cronvn 

Thomas D. Crotliers 

Hannah L. Croasdale. .. 

Frederic Colton Curtis. . 

Ernst W. Cnshing 

Wm C. Cutler 

Hartford, Conn 

Philadelphia, Pa 

Albany, N.Y 

Boston, Mass 

Chelsea, Mass 

Juan Martinez del Cam- 

Wm. C. Dabney 

Sftm'l S. Davis 

City of Mexico 

University of Virginia. 
Lancaster, Pa 

John Isaac Darby 

Wm. J. G. Dawson 

A. W. deRoaldes 

William Doii'Tall 

Americus. Ga 

St. Helena, Cal 

New Orleans, La 

Joliet, 111 

Charles Duffy 

Newbern, N. C 

Oxford, N. Y 

Georore Douglas 

appointment by the governor. 
The New York State Medical As- 

Columbus Drew 

E. A. de Schweiuitz 

Winiam Edornr DHrcoII 

Jaclisonville, Fla 

Washington, D. C 

Miirio,ift Tncl 


Florida State Medical Association 
and the city of Jacksonville. 

The Medical College of Colum- 
bian University. 

The State of Indiana by appoint- 
ment by the governor. 

.Jeffersou Medical College. 

Wichita Medical Society. • 

Lackawanna County (Pa.) Medi- 
cal Society. 

American Larvngological Asso- 

Francis X. Dercum 

Mary Gage Day 

G. Edarar Dean 

Philadelphia, Pa 

W^ichita. Kaus . 

Scrauton, Pa 

D. Bryson Delavan 

P. Gourdin De Saussure. 
Wm. B. Dewees 

New York ... 

Charleston, S. C 

Salina, Kans 

ciation (president). 

Medical College of the State of 
South Carolina. 

The State of Kansas by appoint- 
ment by the governor. 

The Maternitv Hospital. 

Yates County (N. Y.) Medical 

The city of New York, appointed 
by the mayor. 

Cumberland County (N.J.) Medi- 
cal Society. 

Medico-C'hirurgical College. 

Shelby County (111.) Medical 

The State of Virginia by ap- 

Jose M. de Ita 

Pnebla, Mexico 

Penu Yan, N.Y 

New York 

Charles E. Doubleday. . . 
Cyrus Edson 

Henry W. Elmer 

Thomas B. Earley 

W.J. Eddy 

Bridgetou, N.J 

Philadelphia, Pa 

Shelby ville, 111 

Richmond, Va 

Landon B. Edwards 

pointment by the go reruor. 






Delegate from — 

William H Elliott 

Savannah. Ga 

The State of Georgia by appoint- 
ment by the governor. 

Harvard University Medical 

Baltimore College of Dental Sur- 

The Government of British Hon- 

Medical Association of the Dis- 
trict of Columbia, 

Niagara Medical College. 

Harold C Ernst 

Boston. Mass ... 

Georffe Evans 

New York 

Charles Henry Eyles ... 

Robert Farnham 

George E. Falls 

Joseph Benson I'enwick. 

C. G. .1. Finn 

Belize, British Hondu- 
Washington, D. C 

Bnftalo, N. Y 

Chelsea, Mass 

City of Chelsea, appointed by 

Queen County Medical Society. 
Atchison, Topeka and Santa Fe 

Railway Hospital Association, 
Medical Department University 

of Denver, 
Cincinnati College of Medicine 

and Surgery, 
New Hampshire State Medical 

Medical Department University 

of Georgia. 
State board of health. 
City of St. Louis, appointed by 

Univorsitv of Pennsvlvania. 

New York, N. Y 

La Junta, Colo 

Denver. Colo.. . 

Frank Finnev 

Samuel A. Fisk 

T, V. Fitzpatrick 

Chas. F. Flanders 

De Sanssure Ford 

Cincinnati, Ohio 

Manchester, N. H 

Augusta, Ga 

Felix Fornicnto 

Otto E. Farster 

New Orleans, La 

St. Louis, Mo 

Chester Pa 

.T. Ti. I'orwood 

W. H. Forwuod 

Romulus Adams Foster . 

Washington, D. C 


U, 8, Army. 
Columbian Uuiversitv, 

F. W. Frankli.'iuser 

Read inf. Pa 

City of Reading, appointed by 

^Medical Society of Virginia. 
Starling Medical College. 
U. S, Navy. 

Medical News, 

Illinois State Medical Society. 

National Association Railway 

Massachusetts College of Phar- 

The R, Gundry Home for Mental 
anil Nervous Diseases, 

The State of Oajaca, Mexico. 

The Medical Service of the Khe- 

Wm. Alexander Fra/ier . 

Erskine B. Fnllertou 

Albert Leary Gihou 

George M. Gould 

Davicl Wilson (Jraham .. 

Stnnnton, Va 

Columbus, Ohio 

Hr)te] Kichmond, Wash- 
ington. 1 ). C. 

Pbiladel])hia, Pa 

Chicago, 111 

Amus Graves 

San Antonia, Tex 

Boston, Mass 

Catonsville, Md 

Mexico City, Mexico . .. 
Cairo, Etrviit 

Robert Willard Green- 
Richard F. Gundry 

Manuel Gutiewiz 

Grant Bey 

Daniel M. Glniteras 

Isaac C. Gable 

Washington, D. C 

York, Pa 

dive of Egypt. 

U. S, Navy. 

York County (Pa.) Medical So- 

U. S. Navy, Medical Department. 

City of Bridgeport, Coun, 

President-secretarv of Medical 

A. C. George 

Washington, D. C 

Bridgeport, Conn 

Lewiston, Me 


Alouzo Garcelon 

Edward R Garcia 

Louis A. La Garde 

Joseph Gardner 

13 San Jos6 de Gracia, 
Mexico City, Mexico, 

Chicago, Jackson Park, 

Bedford, lud 

The State of Tabasco, Mexico. 

U. S. Army. 

American Red Cross Association. 

Wm. Gardner 

Angel Gavino 

M. W. Gillmer 

Alfred (larees 

]\Iontreal, Canada 

Mexico City 

Bahia, Brazil 

Colombia Re])nblica . .. 
Port au Prince, Haiti .. 

McGill University. 
The State of Morelas, Mexico. 
The city of Bahia, Brazil. 
Sociedad de Meiliciua. 

V. L. Gilles 

Government of Haiti. 




John L. Heffron . 

C. R. Holmes 

Lewis E. Havrie. 

Joseph H. Hunt ... 
John B. Hamilt<)n 

Hugh Hamilton 

Charles W. Hauilin. 

Philander A. Hnrris 

Geo. Byrd Harrison 

D. H. Hazen 

Ernst Hart 

Mrs. Ernst Hart. 

Edmund Burke Hay- 
Ferdinand Herff 

Juan Hernandez 

James F. Hibberd, presi- 
dent-elect of the Amer- 
ican Medical Associa- 

W. Frank Halhnlen.... 

Clifton F. Hodge 

John VanR. Hotf (major) 

Wm. P. Hogue . 
Bayard Holmes. 

J. B. S. Holmes 

W. E.Hughes 

George Homau 

Thos. C. Hoover . . , 

James G. Hopkins 
Alvin A. Hubbell. 

Charles H. Hiighes. 

D. L. Huntington . . 

E. Fletcher lugals 

B. J. D. Irwin 

H. L. E. Johnson.. 

W. T.Jenkins. 

Antonio Jover 

Walter B. Johnson 

Dean G. Kemp 

Fred B. Kilmer 


Elijah S. Kelley . 
George M. Kelly. 


Syracuse, N. Y . . 
Cincinnati, Ohio 
Danville, Va 

Brooklyn, N.Y. 
Chicago, 111 . .. 

Harrisburg, Pa . . . 
Middleville. N. Y . 

Paterson, N. J 

Washington, D. C 

Delegate from — 

London, England. 

Raleigh, N.C 

San Antonio, Tex. 

San Juan, Porto Rico.. 
Richmond, Ind 

Philadelphia, Pa 

Worcester, Mass 

Governors Island, New 
York Harbor. 

Charleston, W. Va 

Chicago, 111 

Rome, Ga. 

Philadelphia, Pa. 

St. Louis, AIo 

Columbus, Ohio . . 

Thomasville, Ga 
Buffalo, N.Y 

St. Louis, Mo 

U. S. Army 

Chicago, 111 


Washington, D. C . 

Quarantine Station, 
N. Y. 

Havana, Cuba 

Paterson, N. J 

Montpelier, Vt 

New Brunswick, N. J .. 

Minneapolis, Minn . 
Washington, Pa . . . 

iledical Department Syracuse 

Academy of Medicine of Cincin- 

The State of Virginia by appoint- 
ment by the governor. 

Brooklyn College of Pharmacy. 

The State of Illinois by api>oint- 
ment by the governor. 

Dauphin County Medical Society. 

Herkimer County (N. Y.) Medi- 
cal Society. 

Medical Society of New Jersey. 

Columbian University. 

Medical Society of the District 
of Columbia. 

British Medical Association. 

Bchelien ^s-Sciences es lettres of 
the Faculty of Medicine of 

The State of North Carolina by 
appointment by the governor. 

State of Texas by aijpointment 
by the governor. 

Cindad de Jan Juan. 

American Medical Association 
(guest of honor). 

Medico-Chirurgical College. 
Clark University. 
U. S. Army. 

Medical Society of West Virginia. 

College of Physicians and Sur- 

Georgia State Medical Associa- 

University of Pennsylvania. 

The city of St. Louis. 

Appointed by the governor of 
Ohio to represent the Ohio 
State board of health. Starling 
Medical College. 

The State of Georgia by appoint- 
ment by the governor. 

Medical Department of Niagara 

Barnes Medical College. 

U. S. Army. 

Illinois State Medical Society. 

U. S. Army. 

Washington Gynecological So- 

Health officer of port. New York. 

University of Havana. 

American Medical Association. 

State of Vermont. 

City of New Brunswick and New 
Jersey Pharmaceutical Society. 

Health commissioner, Minneapo- 

Washington Medical Society. 





Delegate from — 

George T. Komp 

Johns TIo])kins TTni- 
vcrsitv, UaltiuKirc, 

Hoagland Laboratory. 

Peter D. Keyser 


Citv of Philadel))hia and board of 
health, City of Phila.lelphia. 

Charles W. Kollock 

Charleston, S. C 

Charleston Medical School. 

George A. Ketcbani 

Mobile. Ala 

Medical College of Alabama. 

<T allies K, King 


Washington, D.C 

County Medical i^ociety. 

A. F. A. King' 

Medical department, University 
of Vermont. 

J. Ferd. Klinedinst 

York. York County, Pa. 

Medico-Pathological Society. 

J. Rolio Kiia])]) 

New ( )rloans, La 

Louisiana State Dental Society. 

William F. Knox 

McKeesport, Pa 

Allegheny County (Pa.) Medical 

Pedro Lagloyzo 

Pnenos Ayres, Arg. Pej) 

The Argentine Re])ublic. 

Enrique Lopez 

Danniso Lai no 

1 la vana. (^uba 

.Sociedad do l''studios Clinicos. 

Medi;., Pa 

Delaware County (Pa.) Medical 


Daniel S. Jyamb 

Wasliin!j:t<m, D.C 

U. S. Army Medical Mnseum. 

Ernest La])lare 

Philadeli.hia, Pa 

Medico ciiirurgical College. 

John A. Larrabee 

Tjouisville, Ky 

Hospital College of ^ledicine. 
( Cnlral Missouri M<'dical Society. 

Henry W. Latham 

Latham. Mo .' 

Thomas S.Latimer 

Paltiniore. Md 

College of Physicians and Sur- 

Rafael Lavista 

Citv of Mexico 

(lovernment of Mexico. 

Richard Ilcnrv Lewis .. 

Raleigh. N.C 

North Carolina I'.oard of Health. 

William Patrick Lawlcr 

Lowell. Mass 

Lowell Board of Health. 

Reiiiamin Lee 


Ap])ointed by the governor of the 
State of Penn,syivania to repre- 

M ' V^A ■ 1 ** ■* » ■ &4 ^L—M ^^ y^ ■»***> aa*a 

sent the State Ib)ard of Health. 

Charles Lehlbach, jr 

Newark. N.J 

Newarlv board of health. 

Francis E. Loring 

Washington, D. C 

Jledical Department Howard PTui- 

Eugene R. Lewis 

Kansas (Mty, Mo 

National Association Railway Sur- 

E. Liceaga 

City of Mi'xico 

St.ite of Guanajuato, Mexico. 

George N. Lowe 

Randall. Kans 

Rej)ul)lican Valley Medical So- 
Medical department, Western Re- 

John 11. Lowman 

Cleveland, Ohio 

serve Fniversity. 

Charles H. Lindsley 

New Haven, Conn 

A])poiuted by the governor of 
Conneiticut for the State Board 
of Health of Connecticut. 

David Lobo 

Caracas, Venezuela 

University of Caracas. 

James E. Logan 

Kansas City. Mo 

Academy of Medicine. 

I. N. Love 

St. Louis, Mo 

Cleveland, ( )hio 

Mississippi Valley Medical Asso- 
Cnyidioga County Medical So- 



John Nolan Mackenzie.. 

Baltimore, Md 

Johns Hopkins University. 

Philip Marvel 

Atlantic City, N. J 

Atlantic County (N.J.) Medical 


A. B.. Macallum 

Toronto. Canada 

New York City 

Toronto University. 

Henry Macdonald 

National Association of Railroad 



Albany, N. Y 

Albany County Medical Society. 

Roque Maconzel 

City of Mexico 

State of Michoaean, Mexico. 

Stephen A. ]\Iahoney 

Holyoke, Mass 

Massachusetts Medical Society. 

Thomas H. Manley 

Tomas Casas y Marti 

New York .... 

Harlem Hospital. 

The Spanish Government. 

Havana, Cuba 

Henry 0. Marcv 


Massacliu.setts Medical Society. 

W\y. Marmioii 

Washington, I). C 

Medical .\ssociation, District of 

Francisco Mariu 

Piiobla, Mexico 

The State of Chiapas, Mexico. 




Rudolph .. 

Thomas J. Mays . . . 

G. Meudozahal 

Samuel K. Merrick. 
James H. Mitchell. 

Adolph W. Miller . 


New Orleans, La 


Vera Cruz, Mexico 

Baltimore, Md 

Cohoes, N. Y 

Delegate from- 

Samuel Edwin Miliikeu.i 
Charles K. Mills | 

Philade]]ihia, Pa 

New York 


Giles S. Mitchell. 
J. E. MoHJaras... 

E. E. Montgomery 

Frederick Moutezambert 

Luis G. Muuoz 

Manuel A. Mnnez 

James Bassett Mnrdock. 

Alexander J. Mullen, jr. 

Edward B. Montgomery. 

Jennie McCoweu 

Joseph D. McCann 

Edward Davis McDaniel. 

Joseph McFarland. 
John I. McLain . . . . 

C. Agress McMahan. 
Floyd W. McEae... 

Hugh T. Nelson 

Charles Bliss Nohle. 
Albert Lane Norria . . 

JohnT. Nagle 

Frederick G. Navy. . 

Dr. Rafael Alvarez Ortez 

John Oenslager, ir 

William O'Damel 

Domiugo Orvananos 

Thomas Oi)ie 


San Luis Potosi, Mexico 

Pliiladelphia, Pa 


Chihiiahua, Mexico . . 

Lima, Peru 

Pittsburg, Pa 

Michigan City 

Quincy, 111 

Davenport, Iowa 
Monticello, Ind . . . 
Mobile, Ala 

Philadelphia, Pa . 
Washington, D. C. 

Evansville, Ind . 

Atlanta, Ga , 

Charlottesville, Ya 
Washington, D. C. 
Cambridge, Mnss.. 
New York, N. Y.... 
Ann Arbor, Mich . . . 

Thaddeus O.Outerbridge 

Abraham M. Owen 
Thomas B. Owings 

Gnillermo Vargas Pare- 

Richard Henry Plummer 

Havana, Cuba.. 
Harrisburg, Pa . 

Atlanta, Ga 

Mexico, Mexico. 
Baltimore, Md. . 

Bermuda, West Indies. , 

Evansville, Ind 

Ellicott City, Md 

Bogota, South America. 
San Francisco, Cal 

State of Louisiana, by appoint- 
ment by the governor. New 
Orleans Polyclinic. 

Phihulclphia Polyclinic. 

The State of Vera Cruz. 

Baltimore Medical College. 

The city of Cohoes, appointed by 
the mayor. 

Philadelphia College of Phar- 

New York Medical Association. 

Philadelphia Neurological Soci- 

Cincinnati College of Medicine 
and Surgery. 

The State of San Luis Potosi, 

Jeii'erson Medical College. 

Dominion of Canada. 

The State of Chihuahua. 

The Peruvian Government. 

Western Pennsylvania Medical 

The State of Indiana, by appoint- 
ment by the governor. 

Illinois Soldiers and Sailors' 

The State of Iowa, by appoint- 
ment by the governor. 

The State of Indiana, by appoint- 
ment by the governor. 

Wilcox County (Ala.) Medical 

University of Pennsylvania. 

Medical Association, District of 

Vaudeberg County Medical So- 

Board of health of the city of 

State of Virginia by appointment 
by the governor. 

Washington City Dental Society. 

Harvard Medical School. 

Massachusetts State Medical So- 

Health department of the city of 
New York. 

Medical dejiartment of the Uni- 
versity of Michigan. 

Sociedad de Higieue of Havana. 

Dauphiu County Medical Society. 

City of Atlanta. 

National Medical Institute. 

College of Physicians and Sur- 

Government of Bermuda, West 

American Medical Association. 

State of Maryland, by appoint- 
ment by the governor. 

Republic of Colombia, South 

Cooper Medical College. 




.John Asborn Polak. 

Adam I'olitzer 

James G. Porteaus.. 

D. Webster Prentiss 


Charles O.Probst 


Brooklyn, N.Y .... 

Vienna, Austria 

Poughkeepsie, N. Y 

Washington, D. C . 

8t. Louis, Mo 

Columbus, Ohio ... 

Dr. Juan Padilla Guatemala City.. 

Chiulcs Page (Joxcrnnr's Island 

Wni. N. Pcncoast I Philadelpliia, Pa. 

Geo. Farrar Patton New Orleans, La. 

William Peppin 

James Cecil Phillipps .. 

Lorenzo N. Phinney 

Ambrosio Grillo y Part- 

William Peirson 

Isaac X. Quimby 

.Joseph P. Kemington. 


L. F. Reyuaud. 


Alonzo B. Richardson . . 
Maurice Howe Kichard- 

Jolm li. Roberts 

Heni-y H. Rusby 

Thos. George Roddick, 
.lolm O. Roe 

George H. Roh(5 

M. Rowe 

Eliza H. Root 

Edward K. Root 

Cliarles A. Ruggles 

Luis Hernandez Rubin . . 

Francisco A. Risquez... 

Luis E. Ruiz 

Frank Gibbs Ryan 

Beaven Rake. ... 
Edward Randall 

Augustus Ravogli 
Paul S. Redtield .. 

Henry Redmond. 
John G. Reed ... 

Philadeliihia, Pa 

) Kingston, West Indies 
(Jamaica, West In<lic8. 

Norwalk, Conn 

Santiago, Cuba 

Orange, N. J 

Jersey City, N. J .... 
Philadelphia, Pa.. .. 

Caracas, Venezuela. 
New Orleans, La 

Columbus, Ohio. 
Boston, Mass 

Philadelphia, Pa. 
New York 

Montreal, Canada., 
Rochester, N. V 

Catonsville, Md. 

Deals Island, Md. 

Chicago, 111 

Hartford, Conn.. . 

Stockton, Cal 

Havana, Cuba. ... 

Caracas, Venezuela. 

City of Mexico 

Philadelphia, Pa . . . 

Trinidad, West Indies 
Galveston, Tex 

Cuicinnati, Ohio. 
Proyidencc, R. I. 

Philadelphia, Pa 

Elmwood Place, Ciu- 
ciuuati, Ohio. 

Delegate from — 

Long Island College Hospital. 

University of Vienna. 

New York State Medical Associ- 

Medical department, Georgetown 

State of Mi-ssouri, appointed by 
the governor. 

Appointed by the governor t o 
represent the r)hio State Board 
of Health. 

Guatemala Medical Faculty. 

U. S. Army. 

Medico-Chirurgical College. 

Louisiana State Board of Health. 

University of Pennsylvania. 

Medical Council of Kingston. 

Geneva Medical College. 
Laboratorio Bacteriologico de 

Santiago de Cuba. 
Medical Society, State of New 

New Jersey City Hospital. 
Philadelphia College of J'har- 

Central University. 

The State of Louisiana, by ap- 
pointment by the governor. 
Cfdumhus Asylum for the Insane. 
Harvard University. 

Philadelphia Polyclinic. 

College of Pharmacy of the city 
of New York. 

McGill University. 

Medical Society of the State of 
New York. 

The State of Maryland, by ap- 
pointment by tlie governor. 

The State of .Maryland, by ap- 
pointment by the governor. 

Northwestern University Wo- 
man's Medical School. 

Connecticut Mutual Life Insur- 
ance Companj-. 

The StaiC of California, by ap- 
pointment by the goverm>r. 

Medical Society, Academy of Ha- 

The Government of Venezuela. 

The State of Hidalgo. 

American Pharmaceutical .\s80- 

The (lovernment of Trinidad. 

Medical Dej)artmcnt, University 
of Texas. 

The American Medical Associa- 

Rhode Island State Board of 

The University of Pennsylvania. 

The Union District Medical So 





Delegate from — 

Charles A. L. Reed. 

Cincinnati, Ohio 

The Cincinnati College of Medi- 
cine and Surgery. 

Elgar Reed 

El Monte, Cal 

The Alumni Association of Cin- 

cinnati, College of Medicine 
and Surgery. 

Howard S. Reeser 

Readino". Pa .... 

Berks County (Pa.) Medical So- 

James Edmund Reeves. . 

Chattanooga, Tenn 

The State of Tennessee, by ap- 
pointment by the governor. 

John H. Rauch 

Chioago, 111 

Journal of the American Medical 


William Scott Renner .. 

Buffalo, N. Y 

Niagara University. 

William A. B. Sellman . . 

Baltimore, Md 

Baltimore University, School of 

Reginald H. Savre 

New York. N. Y 

New York State Medical Associa- 


Thomas Sidney Scales .. 

Mobile, Ala 

City of Mobile, appointed by the 

John C. Schapps 

Brooklyn, N. Y 

St. Mary's Hospital. Brooklyn. 

George W. Stoner 

U. S. Marine Hospital, 

U. S. Marine-Hospital Service. 

Robert Lowry Sibbet. .. 

Carlisle, Pa- 

Cumberland County Medical So- 

Charles A. Siegfried 

U. S. Naval Training 
Station, Newport, 

Greenport, N. Y 

U. S. Navy. 

Barton D. Skinner 

Suffolk Couutv, N. Y. 

John Philip Slaughter.. 

The Plains, Va 

Medical Society of Virginia. 

Christian B. Stemen 

Fort Wayne, Ind 

The State of Indiana, by appoint- 
ment by the governor; tile Wa- 
bash Railway Surgical Associa- 

Robert T. Sloan 

Kansas City, Mo 

Kansas City District Medical So- 

Charles Smart 

U. S. Armv 

Medical Department, U. S. Army. 

Andrew R. G. Smith 

North Whitefield, Me.. 

Maine State Board of Health. 

Arthur Laptliorn Smith. 

Montreal, Canada 

Medico-Cbirurgical Society of 

Allen J. Smith 

Galveston, Tex 

Bridgeton, N. .J 

Seaforth, Ontario 

Texas Medical Association. 

Thos. J. Smith 

]\Iedical Society of New .Tersev. 
Royal College of I'liysicians and 

Robt. Wm. Bruce Smith . 


J. Gardner Smith 

New York, N.Y 

Harlem Medical Association. 

•F. Lewis Smith 


Panliatric Society. 
Medical Society of the District of 

Thos. C. Smith 

Washington, D. C 

John P. Savage 

Cleveland, Ohio 

Medical Department of Western 
Reserve Universitv. 

Samuel Edwin Sollj' 

Colorado Springs, Colo. 

Colorado State Medical Society. 

A. Walter Suiter 

Herkimer, N. Y 

Medical Society of the State of 
New York. 

Charles Sutherland 

Washington. D. C 

U. S. Army. 

Gottfried Stamm 

St. Paul, Minn 

City of St. Paul, appointed by the 

Byron Stanton 

Cincinnati, Ohio 

Appointed by the governor of 
Ohio to represent the Ohio State 

Board of Health; the Miami 

Medical College, Cincinnati. 

George I. Stevens 

New York, N.Y 

American Medical Association. 

James A. Stewart ... 

Baltimore. Md 

Maryland State Board of Health. 

Sarah Hackett Steven- 

Chicago, 111 

The" Woman's Medical College, 



Charles W. Stiles 

Washington, D. C 

Bureau of Animal Industry, U. S. 
Government; Georgetown Med- 
ical College. 




David St. John 

Charles Stover 

.John C. Siiiull)erjf 

Jonathan Talt 

T. Oliver Tait 

KolxTt W.'l'alhott 

A. J. Thomas 

F. IJ.Tidany 


J no. W. Trader.... 

J. Rnfns 'Iryon 

Lawrenee Tnrnbull. 


Robert Stralcer Tnrtou . 

James Tvson . 
Jiian J. riloa 

J.N. Upshur.. 

B. A. Yau'rhan . 

.Toslma M. Van Cott, jr 

William K. Vanee 

AlluTt Vander Veer. ... 
Geo. Tnlly Vaniihan ... 
Victor C. Vangiian 

Thomas Norris Vincent 

J . Roland Walton 

Arthur Williams 

Jerterson II. Wilson . 
John C(dlins Warren 

Ilackensack, N. ,T 

Amsterdam, N. Y 

Bajj;dad, Persia 

Cincinnati, Ohio 

Rochester, N. Y 

Washiiiiiton, D. C 

Kvansville. Ind 

Kansas City, Mo 

La Crosse, Wis 

Sedalia, Mo 

^Va^hington, D. C 

Philadelphia, Pa .... 

Jamaica. West Indies 
Austin, Tex 

I'hiladelphia. Pa 

San Jose, Costa Rica. 

liichmond, \a 

Columbus, Miss 

Brooklyn, X. Y 

Bristol, Teun 

.Mbany, N. Y 

Washiuiiton, D. C ... 
Ann Arbor, Mich 

Washington, D.C. 
Washington, D. C . 
Elk Ridge, Md.... 

Delegate from — 

Irving A. AVatson . 

Beaver, Pa ... 
Boston, Mass . 

Concord, N. H 

Louis A. ■\Aeigol 

Ernst Wende 

Alexander C. Wenz 

George William W^est. . . Washington, D. C . 

Rochester, N. Y ... 

Bufl'alo, N. Y 

Hanover, Pa 

Edward Graeff West . . . . 
Ha mil ton Atchison West. 
J. T. WMlsou 

Jacob L. Williams. 
Robert J. Wilding. 

James C. Wilcox . . . . 
William J. Williams 

Boston, . . 
Galveston, Tex 
Sherman, Tex.. 

Boston, Mass 


Darlington, S. C . . 
Adel, Iowa 

New Jersey State Medical Society. 

Medical Society of the State of 
New York. 

Tlu! IT. S. consulate at Bagdad. 

Dental College, University of 

Monroe County Medical Society. 

Washington Dental Society. 

Southern Hos])ital for Insane. 

rniver.sity Medical College of 
Kansas City. 

State of Wisconsin, appointed by 
the governor. 

State of Missouri, appointed by 
the governor. 

U. S. Navy ( 

.lefferson Medical College Hos- 

lioard of Physicians of .Tamaica. 

State of Texas, by apjjoinmcnt by 
the governor. 

University of Pennsylvania. 

'i'lie (Government of Costa Rica 
Costa liica Medical Society. 

The Commonwealth (tf Virginia, 
by appointment by the gover- 

Mississippi State Medical Associa- 

Long Island College Hospital. 

Bristol Medical Society. 

Albany Medical College. 

U. S. Marine-Hospital Service. 

University of Michigan, State of 
Michigan, by appointment by 
the governor. 

Medical Association of District 
of Columbia. 

Dental Department National Uni- 

Medical Association of Howard 
County, Md. 

Beaver County Medical Society. 

Medical School of Harvard Uni- 

The American Public Health As- 

Orthopedic Association. 

Health Department of Buffalo. 

York County (Pa.) Medical Soci- 

Medical Association of the Dis- 
trict of Columbia. 

Massachusetts Medical Society. 

Texas Medical State Association. 

State of Texas, by appointment by 
the governor. 

Massachusetts Medical Society. 

Northern New York Medical Asso- 

South Carolina State Medical As- 

Dallas County (Iowa) Medical As- 




John L. Wolf. 

.John R.Wolfe 

Galen Murray Woodcock 

Charles E. Woodruff. . . . 

J. Ramon Icaza 

A. G. Young 

Juan Zavala 

E. Gustav Zuike 

Bernard Zwei<ihoft 


Delegate from — 

Washington, D. C. 

Glasgow. Scotland.... 
Bangor, Me 


City of Mexico 

Augusta. Me 

Guadalajara, Mexico. .. 

Cincinnati. Ohio 

Philadelphia, Pa 

Medical Departmeut Georgetown 

St. Mungo's College, Glasgow. 
State of Maine, by anpoiutmeut 

by the governor. 
U. S. Army. 
State of Sinaloa. 
State Board of Ilealtli of Maine. 
The State of Jalisco. 
]\Ietlical College of Ohio. 
Universitv of I'ennsvlvania. 





Aguilar, F 

Acker, Georjje N 

Adams,, Samuel S 

Adams, William A 

Adams, Zabdiel JJoylston . 

Arnold, .J. Dennis 

Alden, Charlos H., A.S.G. 
Allen, Dudley P 


Allen, Rufus L 

Almy, Leonard Ballow. 

Als, Adolph 

Anderson, L, B 

Anderson, Frank 

Anderson, Albert 

Anderson, .Joseph W... 

Ames, H, E 

Anders, ,T, M 

Arwin, .loliii S 

Asli, William M 

Ashton, Lawrence 

Atkinscm, W. B 

Atkinson, I. E 

Austin, H. W 

Ayers, Kdw, A 

Aranno, G. Y 

Bennett, T. .J 

Boldt, Hermann 

Bond, Erwin I) 

Borden, Henry F 

Bowcn, W. Sinclair ... 

Boyd, .lames P 

Bovd. .lolm C 

Boyle. ('. B 

Braunwartli, A, M 

Briggs, A. B 

Briscoe, W. C 

Brock, C, W. P 

Bromwell, .J. R 

Brose. L, D 

Brothers, A 

Brower, Daniel R 

Brown, Bedt'oid 

Brown, Hawkins 

Brown, Price 

Brown, S. B 

Browne, Valentine 

Bruhaker, A. P 

Brush, E, F 

Brumbaugh, G, Marcus. 

Bogan, Samuel W.. 

Bryan, J. H 


Buchanan, C. M 

Baggett, John B 


Baker, Wf 11 iam H . 

Ball, O.D 

Baker, Frank 

Baker, Henry B . . . 

Baker, A, R '. 

Barker, H.H 

San Jos^, 2, Cadiz, Spain. 

913 Sixteenth street NW., Washington, D. C. 

1632 K street NW., Washington, D. C. 

Fort Worth, Tex. 

Framiughani, Mass. 

54 Chronicle Building, San Francisco, Cal. 

Surgeon-General's Office, AVashington, D. C. 

278 Prospect street, Cleveland, Ohio. 

W^aynesville, N. C. 

Norwich, Conn. 

3S19 Pine street, St. Louis, Mo. 

Norfolk, Va. 

1628 Nineteenth street NW., Washington, D. 0. 

1311 H street NW., Washington, D. C. 

Ardmore, Pa. 

3026 P street NW., Washington, I). C. 

Philadelphia, Pa. (Medico-Chirurgical College). 

Columbus, Ind. 

473 Florida avenue NW., Washington, D. C 

Dallas, Tex. 

1100 Pine street, Philadelphia. 

60.') Cathedral street, Baltimore, Md. 

Marine-Hospital Service, Washington, D. C. 

lal East '1 hirty-fonrth street, New York City. 

Santander, Colombia, 

Austin, Tex. 

51 West Filtv-second street, New York City, N. Y. 

Parkersburg" W. Va. 

Brockton, Mass. 

1,531 I street NW., Washington, D. C. 

Albany, N. Y. 

1313 P street NW., Washington, D. C. 

1615 S street NW., Washington, I). C. 

PostGraduate School Hospital, Chicago, lU. 

Ashawav, R. I. 

317 C street NW., Washington, D. C. 

Richmond, Va. 

1147 Connecticut avenue, Washington, D, C. 

Evansville. Ind. 

162 Madison street. New York City, N. Y. 

Chicago, 111. 

Alexandria, Va. 

Hustonville, Ky. 

Toronto, Ontario, Canada. 

Fort Wayne, Ind. 

Yonkers, \. Y. 

.Jeft'erson Medical College, Philadelphia, Pa. 

Mount Vernon, N. Y. 

904 Massachusetts avenue, Washington, D. C. 

421 G street NW., Washington, D, C. 

818 Seventeenth street NW., Washington, D. C. 

Toronto, Ontario,. Canada. 

1212 Twelfth street NW., Wasliington, D. C. 

1920 Sixteenth street NW., Washington, D. C, 

1722 Chestnut street, Philadeli)liia, Pa 

22 Mount Vernon street, Boston, Mass, 

Albany, N. Y. 

1315 Corcoran street, Washington, D. C. 

726 Ottowa street, Lansing, Mich. 

122 Euclid avenue, Cleveland, Ohio. 

1116 H street NW., Washington, D. C. 






Barton, S.S 

Baruch, Simou . . 
Bask 3tt, John N. 

Bates, N. L 

Beck, Carl 

Bell, A. Nelson . . . 


Bentley, E 

Bergin, Darby — 

Bemays, A. C 

Bey, Grant 

Beyer, Henry G. . 
Bill, T.J ........ 

Billings, John S. 

Bishop, S.S 


Bleyer, J. M 

Boarman, C. W . . 

Bodkin, D.G 

Boise, Engene 

Bryant, Jos. D 

Bnrch, J. D , 

Burnett, Swan M 
Bierd, Daniel S . 

Burroughs, John I. 
Burroughs, Silas M 
Bnsey, Samuel C 

Byers, J. W 

Cauipbell, J 

Cattell, H. W 

Collins, Orville W..... 
CaQuaday, Charles G. 

Cahart, .lohn W 

Carniona v Valle 

Caryello, H. D. W 

Carr, Wi lliam 

Clairac, Dr. Jose 

Corueau, Auguste 

Carstens, J. Henry 

Carter, William S 

Carter, H.R 

Cartwright, Silas S 

Castellanos, John J 

Cerna, David 

Chamberlin, Frank T ... 

Collins, James 

Chestnut, J. H. W 

Chittenden, Russell H... 
Claiborne, .John Herbert 

Clarke, A.P 

Clauser, N. D 

Cobb, Frederic 

Cobb, William H. H 

Coe, Anton 

Cohen, S. S 

Cohen, Felix 

Coit, Henry L 

Cole, G. R.'^Lee 

Coleman , P. C 

Col lings, Samuel P 

Collins, Charles Read .. . 
Comegys, Cornelius G... 
Compton, W^illiam Peun . 
Conn, G. P , 

1523 Spruce street, Philadelphia, Pa. 

51 West Seventieth street, New York City, N. Y. 

Hannibal, Mo. 

U. S. Navy. 

37 East Thirty-first street, New York City, N. Y. 
Brooklyn, N. Y, 

1701 H street NW., Washington, D. C. 

Little Rock, Ark. 

Surgeon-General of Canada, Ontario, Canada. 

St. Louis, Mo. 

Palais Matatin, Cairo, Egypt. 

Annapolis, Md. 

Tyler, Tex. 

Army Medical Museum, Washington, D. C. 

Chicago, 111. 

236 Mountain street, Montreal, Canada. 

118 East Sixteenth street, New York City, N. Y. 

1104 Maryland avenue SW., Washington, D. C. 

290 Clinton avenue, Brooklyn, N. Y. 

Grand Rapids, Kent County, Mich. 

51 West Thirty-first street,'New York City, N. Y. 

Aurora, Tex. 

1770 Massachusetts avenue NW., Washington, D. C. 

Binghampton, N. Y. 

Houston, Tex. 

82 Fulton street. New York City, N. Y. 

901 Sixteenth street NW., Washington, D. C. 

Charlotte, N. C. 

34 Congress street, Hartford, Conn. 

3455 Woodland aveuue, Philadelphia, Pa. 

South Framingham, Mass. 

Roanoke City, Va. 

Lamj^asas, Tex. 

Eucarnaceon, 8, Mexico City, Mexico. 

Manchester, N. H. 

35 West Forty-sixth street, New York City, N. Y. 
O'Reilly, 25, Habana, Cuba. 

Port au Prince, Hayti. 

Detroit, Mich. 

807 North Forty -first street, Philadelphia, Pa. 

U. S. Marine-Hospital Ser\'ice, Washington, D. C. 

Roxbury, Delaware County, N. Y. 

72 Orleans street. New Orleans. 

Galveston, Tex. 

22(> New Jersey avenue SE., Washington, D. C. 

704 Franklin street, Philadelphia, Pa. 

1757 Frankford avenue, Philadeliihia, Pa. 

New Haven, Conn. 

Petersburg, Va. 

Cambridge, Mass. 

Hartford City, Ind. 

102 Charles street, Boston, Mass. 

479, Goldboro, N. C. 

Washington, D. C. 

219 South Seventeenth street, Philadelphia, Pa, 

38 East Sixtieth street, New York City, N.Y. 
Newark, N. J. 

424 Seventh street, Washington, D. C. 

Colorado, Tex. 

Hot Springs, Ark. 

1125 Fourteenth street, Washington, D. C. 

Cincinnati. Ohio. 

1732 K street, Washington, D. C. 

Concord, N. H. 





Conner, Pbineas S 

Contreras, Angel 

Cook, G. VV 

Corr,A. C 

Corson, .Jos. K 

Criliy, Benton II 

Cronyn, .John 

Crotbers, Thomas D 

Croasdalo, H. T 

Cnlbertson, .J. C 

Cunningham, Thf)inas E .. 

Curtis, H. Holhrook 

Curtis, Frederic Colton .. 

Cnrtin, Roland G 

Cnrrier, Andrew F 

Gushing, Ernest W 

Cnthbert. W. F 

Cutler, William E 

Campo, Juan Martinez del 

Connell, A. J 

Carbee, Sanniel Powers .. 

Cbisolm, .Tulian .T 

Dabney, William C 

JJaland, Judsou 

Davis, James C 

Davis. Samuel T. D 

Darby, J. I 

Daly,' John S 

Dawson, Win. .1. G 

Dav, -Marv C. (i 

de Roaldes, A. W 

DoTigall, William 

Douglas. George 

Donnally, William 

Donobue, Florence 

1 )r«'w, C 

Driscoll, W. E 

Ducum, Francis X 

Dufour, Clarence R 

Dnhring, Louis A 

Dve, Hol>art S 

Dean. G. E 

Delavan, Prof. D. B 

Desaussure, R. G 

de Schweiuitz, 1^^. A 

Dcwees, William B , 

de Yta, Jose M 

Dnenas, Joaquin 

Dixon, H. T 

Doubleday, Cbas. E 

Dumcswil, A. 11. O 

Davis, Jose]ihine Grittitb . 

Dulfy, Charles 

Dolan, Wm. K 

Earley, Charles R 

Edson, Cvrus 

Early, Thomas B 

Edebobls, George M 

Eddy, W. J 

Edwards, Landon B 

Eliot, Llewellyn 

Eliot, Johnson 

Elliott. William II 

Ernst, Harold C , 

1.59 Ninth street, Cincinnati, Ohio. 

Calle de J. C. Bonilla, No. 4, Puebla, Mexico. 

3 Thomas Circle, Washington, D. C. 

Garlinville, Macoupin County, 111. 

Washington barracks, D. C. 

Dallas Center, Iowa. 

Buttalo, N. Y. 

HartCord, Conn. 

l.")l'5 Walnut street, Philadelphia, Pa. 

Cincinnati, Ohio. 

"07 Main, cor. Clinton street, Cambridge, Mass. 

^•ew York City, N. Y. 

17 Washinitton avenue, Albany, N. Y. 

IMiiladeli.liia. Pa. 

\y.} East Thirty-seventh street, New York City, N. Y. 

1(58 Newbury street, Boston, Mass. 

1462 Rhode Island avenue, Washington, D. C. 

Chelsea, Mass. 

Alcaicerea 1.5, City of Mexico. 

4IW Lackawanna avenue, Scranton, Pa. 

Haverhill. N. H. 

114 West Franklin street, Baltimore. Md. 

University Station, Va. 

319 South Eighteenth street, Philadelphia, Pa. 

Rochester, N. Y. 

Lancaster, Pa. 

Americus, Ga. 

.520 Thirteenth street NW\, Washington, D. C. 

St. Helena, Napa County, Cal. 

25 .1 block, Wichita. Kans. 

136 Grovier street. New Orleans, La. 

.507 Union street, Joliet, 111. 

Oxford, Chenany & Co., New York, N. Y. 

1022 Fourteenth street, Wasliington, D. C. 

1134 Eighth street NW., Washington, D. C. 

Jacksonville, Fla. 

525 East Main street, Muncie, Ind. 

810 Broad street, Philadelphia, Pa, 

1009 H street, Washington, D. C. 

Philadelphia, Pa. 

1403 L street NW., Washington, D. C. 

Scranton. Pa. 

1 East Thirtv-third street. New York City, N. Y. 

62 Hasell street, Charleston, S. C. 

Cosmos Club, Washington, I). C. 

Salina, Saline County, Kans. 

Pueblo, Mexico. 

San Miguel 75, Habana, Cuba. 

704 Fulton avenue, Evansville, Ind. 

Penn Yan, Yates County, N. Y. 

1 North Broadwav, St. Louis, Mo. 

132 West Twelfth street, New York City. 

Newbern, N. C. 

Scranton, Pa. 

Ridgway Pa. 

9 W. Forty-ninth street. New York, N. Y. 

1228 Fairmount avenne, Philadelphia, Pa. 

198 Second avenue. New York, N. Y. 

Shelbyville, 111. 

Richmond, Va. 

1106 P street, Washington, D. C. 

1417 N street, Washington, D. C. 

Savannah. Ga. 

Boston, ^lass. 




Evans, George 

Evaus, Warwick 

Eyler, Charles H 

Elmer, Heury W 

Eiigloman, George J.. 

Fainliam, Robt 

Fell, Geo. E 

FeuAvick, Jos. B 

Fiiilev, M. F 


Finn, C. G 

Finney, Frank 

Fiske, Sam'l A 

Fitz. Reginald H 

Fitzpatviek, T. V 

Flanders, Cbas. F 

Flicb, Lawrence F 

Fletcher, M. H 

Ford, De Saiissure 

Formcnto, Felix: 

Forster, Otto E 

Forward. J . L 

Forward, Win. II 

Foster, R. A 

Frank, Jacob 

Frankbaiiser. F. W 

Franzoni, Clias. ^Y 

Frazier, \\m. A 

Fry, Win. H 

Fuller, Wni 

Frey , C . L 

Fnlierton, Erskine 15 

Foster, W. S 

Greeuley, Tlionias 13 

Grinder, Geo. W 

Gniteras. Daniel M 

Gable, I. C 

Gad, Prof. J 

Greene, C. T 

Gorgas, A. C 

Gnrlicb, S. M 

Gniteras, Ramon 

Garcelon, Alouzo 

Garcia, Ednardo R 

Garde, La Louis A 

Gardner, Joseph 

Garrigues, Henry J 

Gardner, William 

Gavifio, Angel 

Garciadiego, S 

Garces, A 

Gilles, Y. L 

Gibbons, Richard H . 

Gihon, A. L 

Goss, Ossian W 

Goss, I. H 

Gotthiel, William S . 

Gould, George ^1 

Graham, D. W 

Graves, Amos 

Gre<ne, T. C 

(ireenleaf, R. Vv' 

Gundry. R. F 

Gunneil, R. H 

S. Ex. 3G- 

133 W. Thirty-fourth street, New York, N. T. 

1105 Ninth street, Washington, D, C. 

Belize, British Honduras. 

Bridgeton, N. J. 

St. Louis, Mo. 

1103 M street, Washington, D. C. 

72 Niagara street, Buflalo, N. Y. 

181 Chestnut street, Chelsea, Mass. 

1928 I street, Washington, D. C. 

Henijjstead, N. Y. 

La J unta, Colo. 

37 Eighteenth avenue, Denver, Colo. 

18 Arlington street, Boston, Mass. 

136 W. Eighth street, Cincinnati. Ohio. 

Manchester, N. H. 

736 Pine street, Philadelphia, Pa. 

65 \Y. Seventh street, Cincinnati, Ohio. 

Augusta, Ga. 

New Orleans, La. 

1515 Washington avenue, St. Louis, Mo. 

Chester, Pa. 

U. S. Soldiers' Home, Washington, D. C. 

2029 Q street, Washington, D. C, 

17 Lincoln avenue, Chicago, 111, 

Reading, Pa. 

605 I street, \Yashington, D. C. 

Staunton, Va. 

1826 Jetierson Place, Washington, D. C. 

Grand Rapids, Mich. 

Scrantou, Pa. 

Columbus, Ohio. 

133 Wylie avenue, Pittsburg, Pa. 

Meadow Lawn, Jefleasou Couutv, Ky. 

923 Ninth street, N\Y., \Vashington,'D. C. 

Hotel Richmond, Washington, D. C. 

York, Pa. 

Berlin S. W., Grossbeereustr 67. 

Castile, Wyoming County, N. Y. 

Museum of Hygiene, Washington, D. C. 

316 State street, Fairfield Countv, Conn. 

79 West Fifty-fourth street. New York City, N. Y. 

Lewiston, Me. 

13 San Jose de Garcia, Mexico City. 

U. S. A. Hospital, Jackson Park, Chicago, 111. 

Bedford, Ind. 

155 Lexington avenue. New York City, N. Y. 

109 Union avenue, Montreal, Canada. 

Corbatana, 6, Mexico City, Mexico. 

Guadalajara, Sautuario 8, Mexico. 

Popayan, Rep. of Colombia, del Cauca Colombia 

Port au Prince, Haiti. 
435 Wyoming avenue, Scranton, Pa. 
U. S. Navy. 
Laconia, N. H. 
Athens, Clarke ConntA', Ga. 
25 W. Fifty-third street, New York City, N. Y. 
Philadelphia, Pa. 

672 W. Monroe street, Chicago, 111. 
San Antonio, Tex. 
Chicago, 111. 

561 Boylston street, Boston, Mass. 
Catonsville, Baltimore County. Md. 
1727 Q street, Washington, D. C. 




Gutierrez, Manuel.. 
Gillmer, Maurice W 
Heiberger, Ida J . .. 

Henderson, G 

Herbert, J Fredk . . 
Herir, F 


Hernandez, Juan 

Hibberd, J. F 

Hill, E. A 

Hobbs, A. G 

Hobby, CM 

Hodge, C. F 

Holt", J. Van R., U. S. A ... 

Hollnian, R. C 

Hogue, W. P 

Holdon, R. .1 

Holmes, B 

Holmes, J. li. S 

Flolton, H. D 

Houian, G 

Hoover, T. C 

Hopkins, .1. G 

Howitt, H 


Hughes, C. H 

Huinmel, A. L 

Huutiuoton, D. L., U. S. .\ 

IIiit(liins(m, W. F 

Hyatt, F 

Heftron, Jno. L 

Holmes, Christian R 

Harvie, Lewis Y. 

Hausell, Howard F 

Hunt. .Josejih H 

Hamilton, Jno. B 

Hamilton, Hugh 

Hamlin, Chas. W 

Hammer, Robt. B 

Hammond, W. A 

Handv, W. E 

Hare. H. A 

Harris, riiilauder A 

Harrison, (ieo. Byrd 

Hart, Ernest 

Hart, Mrs. Ernest 

Hatch, Jas. H 

Hayes, Henry L 

Haynes, Irving P 

Haywood, Edmund B 

Hazan, I). H 

Haehnien, W. Frank 

Hughes, W. E 

Hiiunuond, Gr^eme Monroe... 

llulohizer, Allen H 

Ill, Edward J 

lugalls, E. Fletcher 

Inglis, David 

Irwin, R. .1. D 

Jackson, Edward 

Jackson, Jabez X 

•Johnson. II. I^. E 

Jenkins, ^Villiam T 

Johnson, Robert W 

Jovcr, Antonio 

Mexico City, 2" Aduana Vieja 12, Mexico. 

1618 S. Broad street, Philadelphia, Pa. 

722 Eighteenth street, Washington, D. C. 

817 T street, Washington, 1). C. 

1313 Arch street, Philadelphia, Pa. 

San Antonio, Tex. 

San Juan, Porto Rico. 


East Killinglv, Conn. 

Atlanta, Ga. ' 

Iowa City, Iowa. 

Worcester, Mass. 

Governors Island, X. Y. 

Oskaloosa, Iowa. 

Charleston, W. Va. 

802 Sixth street, Washington, T>. C. 

104 East Fortieth street, Chicago, 111. 

Rome, Ga. 

Brattleboro, Vt. 

St. Louis. >lo. 

Columbus, Ohio. 

Thomasville, Ga. 

Guel})h, Ontario, Canada. 

BufTalo, N. Y. 

St. Louis, Mo. 

Philadcl]diia, Pa. 

Surgeon-General's Otlice, Washingtcm. D. C. 

Providence. R. I. 

1228 Seventeenth street, Wa.shiugton, D. C. 

Syracuse, N. Y. 

Cincinnati, Ohio. 

Danville, Va. 

254 S. Sixteenth street. Philadelphia, Pa. 

1085 Bedford avenue. ISrooklyn, X. Y. 

Room 20, Post-ortiee building, Chicago, 111. 

212 Second street, Harrisburg, Pa. 

Middleville, Herkimer County, N. Y. 

(ireensburg. Pa. 

Thirteenth and Princeton street, Washington, D. C. 

300 A street SE., Washington, D. C. 

222 S. Fifteenth street, Philadelphia, Pa. 

Patersou, X'. J. 

605 Fourteenth street XW., Washington, P. C. 

Donegal Castle, London, England. 

1011 Pine street, San Francisco, Cal. 
Cor. First and B streets XE., Washington, D. C. 
316 E. Eightv-sixth street. New York, .\. Y. 
Raleigh, X. C. 

407 Sixth street SW., Washingtim, D. C. 
1421 X. Broad street, Philadelphia, Pa. 
3726 Baring street, Philadelphia, Pa. 
.58 W. Forty-fifth street, Xew York, X. V. 
Xewark, X'. J. 

36 Washington street, Chicago, 111. 
Detroit, Mich. 
U. S. Armv, Chicago, 111. 
215 S. Seventeenth street, Philadelphia, Pa. 
Kansas Citv, Mo. 

1400 L street XW., Washington, D. C. 
Health Office. Xew York, X. Y. 
101 W. Franklin street, Baltimore, Md. 
University of Havana, Havana, Cuba. 






Johnson, Walter B 

Johnson, Joseph Tahor . 

Jacobs, W. C 

Jacobi, A 

Kemp, Dean G 

Kelly, Elijah S 

Kelly, George M 

Kemp, George T 

Keyser, Peter D 

Kingsbury, Albert D . .. 

Kollock, Charles W 

Kent, Richard W 

Ketcimm, George A 

King, James K 

King, A. F.A 

Kirwan, George H 

Klienschmidt, 0. H. A .. 

Klinediust, J. Ferd 

Knapp, J. Rollo 

Knox, William F 

Koser, Simon S 

Lagleyze, Pedro 

Lopez, Enrique 

Laine, Damaso 

Lamb, Daniel S 

Lancaster, F. M 

Laplace, Ernest 

Larrabee, Jno. A 

Latham, Henry W 

Lautenbach, Louis J 

Latimer, Thos. S 

Lavista, Ral'ael 

Lawler, William P 

Lee, Ben j 

Leech, D. Oliu 

Leech, Frank 

Lehlbach, Chas. , jr 

Leighton, Nathaniel W. 

Lewis, Eugene K 

Liceaga, E 

Lincoln, Nathan S 

Love, J. W. C 

Lowe, Geo. N _ . 

Lowman, John H 

Lindsley, Chas. A 

Loboi, David 


Logan, Jas. E 

Love, Louis F 

Love, I. N 

Lucas, V. C 

Lewis, R. H 

Lovell, Chas. E 

Loriug, Francis B 

Mackenzie, Jno. N... 

Marvel, Philip 

Macallum, A. B 

Macdonald, Henry . . . 
Macdonald, Willis G. 
Mackall, Louis, jr . . . 
MacKinnon, Angus .. 

Maclean, Donald 

Macouzet, Rogue . . . . 
Magruder, G. L 

1728 K street NW., Washiugtou, D. C. 

Akron, Oliio. 

New York. 

Montpelier, Vt. 

Minneapolis, Minn. 

Washington, Pa. 

Johns Hopkins T'niversity, Baltimore, Md. 

Philadelphia, Pa. 

Needham, Mass. 

Charleston, S. C. 

Eureka Mills, Cal. 

7 N. Conception, Mobile, Ala. 

Watkins, N. Y. 

131.5 Massachusetts avenue, Washington, D. C. 

Wilkes Barre, Pa. 

304.5 N street, Washington, D. C. 

York, Pa. 

New Orleans, La. 

McKeesport, Pa. 

Williamsport, Pa. 

Buenos Ayres, Argentine Republic. 

Apartado, 273, Havana, Cuba. 

Media, Pa. 

Army Medical Museum, Washington, D. C. 

Wayside, Md. 

Philadelphia, Pa. 

Louisville, Ky. 

Latham, Mo. 

1723 Wayland street, Philadelphia, Pa. 

103 W. Monument street. J5aItimore, Md. 

1" de Independencia, Mexico City, ilex. 

60 Andover street, Lowell, Mass. 

Care Executive Mansion, Harrisburg, Pa. 

631 Maryland avenue NE., Washington, D. C. 

Children's Hospital, Washington, D. C. 

Newaik, N. J. 

143 Taylor street, Brooklyn, N. Y. 

Kansas City, Mo. 

San Andres 4, iloxico City. Mexico. 

1514 H street N. W., Washington, D. C. 

Mexico City, Mexico. 

Randall, Kans. 

441 Prospect street, Cleveland, Ohio. 

New Haven, Conn. 

Professor of ]>hysiology, University of Caracas, 

Caracas, Venezuela. 
Kansas City, Mo. 
Philadelphia, Pa. 
St. Louis, Mo. 

1101 Pearl street, Cleveland, Ohio. 
Raleigh, N. C. 
Whitman, Mass. 

1420 K street, Washington, D. C. 
.Johns Hopkins University, Baltimore, Md, 
Atlantic City, N. J. 
Toronto University, Toronto, Canada. 
Woodhaven Junction, Long Island, N. Y. 
Albany, N. Y. 

U. S. Army, Washington, D. C. 
Professor of oratario, Guelph, Canada. 
Detroit, Mich. 
Mexico City, Mexico. 
815 Vermont avenue NW., Washington, D. C. 





Mahoney, Stephen A.. 

Mauley, Thos. W 

Miranda, Ilainon I> — 
^ "Marti, ToniasCasas. 

>Marcy, Henry 

Mai niion, W. V 

Marin, Fraueisco 

Martin, Hugh 

Mayer, Oscar J 

Massoj', G. Betton 

.Matas, Rudolph 

Mathiot, Edward B 

Mattison. .J. B 

Maury, Ritliard B 

Maxcy, F. E 

Maxson, Willis H 

Mays, Thomas .J 

Jlendi/abal, Ci 

Meirick, Samuel K 

Mi trhell, James 11 

Miller, Adolph W 

Miller, Ahner M 

Miller, David P 

Milliken, Samuel i: 

Miles, Franklin 

Mills, Chas. K 

Mitchell, Giles S 

Monjaros, .1. E 

Moutjjomery, E. 1> 

Montizambert, Frederiek 

Moran, Jno. F 

Morgan, Jas. Dudley 

Munoz, Louis G 

MuTiiz, Maniuel A 

^lurdoeh, Jas. Bissett 

Mosher, Eliza M 

Mullen, Alex .1 

Mullinuix. L. P 

Muucaster, S. B 

Murray, T. Morris 

Musser, .J. H 

IMoutgomery, Edmund B . 

Morse, Fred. Harris 

Morris, Robert T 

Murray, Robert A 

Muneaster, Magruder . ... 

Mundell, John^H 

]\Iurphy, J. B 

MeArdle, Thomas E 

McCall, Hugh 

!MeCowen, .Jennie 

McCann, Joseph D 

]\IeCosh, Andrew .1 

MtDaniel, Edward D 

MeFarland, Joseph 

McFarland, Solomon F... 

McKie, T. Jetferson 

McLain, John S 

McLaughlin, James W... 
McLaughlin, Thomas N.. 

JVIeMahon, C. Agness 

MeMurtrv, Lewis S 

McRae, Floyd W 

Holvoke, Mass. 

302 W. Fiftv-third street. New York, N. Y. 

3-19 W. Forty-sixth street. New York, N. Y. 

Havana, Cuba. 

180 Commonwealth street, Boston, Mass. 

Washington, D. C. 

Infantes 11, Puebla, Mexico. 

Prince Edward Island, Canada. 

SW. corner Gary and Octavia Streets, San I'ran- 

cisco, Cal. 
212 S. Fifteenth street, Philadelphia, Pa. 
72 S. Rampart street. New Orleans, La. 
Westinghouse Building, Pittsburg, Pa. 
Brooklyn, N. Y. 

273 Beale Street, Memphis, Tenn. 
18 Iowa Circle, Washington, 1). C. 
St. Helena, California. 
1829 Spruce Street. Phila<Ie]i>Iiia. Pa. 
Orizaba, San Miguel NE., \'era Cruz, Mexico. 
843 Eutaw street, Baltimore, Md. 
Cohoes, N. Y. 

400 N, Third street, Philadelphia, J^a. 
Lancaster County, Bird-In-Hand, Pa. 
Huntingdon, Pa. 

3(i W. Fifty-ninth street. New York, N. Y. 
131.5 Masonic Temi)le, Chicago, 111. 
1909 Chestnut street, Philadelphia, Pa. 
Cincinnati, Ohio. 

Cinco de Mayo 2, San Luis Potosi, Mexico. 
1715 Walnut street, Philadelphia, Pa. 
Quebec, Canada. 

2)20 Pennsvlvania avenue, Washington, D. C. 
919 Fifteenth street NW., Washington, D. C. 
Libertad No. 7, Chihuahua, Mexico. 
Lima, Peru. 
Pittsburg, Pa. 

196 Jovalemau street, Brooklyn, X. Y. 
Jlichigan City, lud. 
Astoria, Oreg. 

1510 H street NW., W^nshington, D. C. 
730 Seventeenth street NW., Wa-shington, D. C. 
406 Locust .street, Philadelphia, Pa. 
Quiucy, Ills. 
Melrose. Mass. 

1.33 W. thirty-fourth st.. New York. N. Y. 
235 W\ Twentv third street. New York. N. Y. 
1510 H street NW., Washington, D. C. 
1022 Eighteenth street, NW., Washingtoji, D. C. 
911 Venetian Building, Chicago, 111. 
821 Sixteenth street NW., Washington, D. C. 
Lapeer, Mich. 
Davenport, Iowa. 
Monticello, Ind. 

600 Madison avenue. New York. N. Y. 
Mobile, Ala. 

1314 Franklin street, Philadelphia, Pa. 
Binghamton, N. Y. 
Woodlawn, S. C. 
1924 N street NW 
Austin, Tex. 
1226 N street NW 
Evansville, Ind. 

231 Chestnut street, Philadelphia, Pa, 
63i Whitehall sti'eet, Atlanta, Ga. 

, Washington, I). C. 
, Washington, D. C. 




McShane, James F... 
McCoiiias, .Josiali Lee 

Noble, Chas. P 

Nash, Francis S 

Nert', John 

Nelson, WoHred D. E 
Noble, Henry Bliss . . 

Noriega, Tom as 

Norris, Albert Lane.. 

Norris, Milton D 

Nagle, John T 

Northrop, Geo. .i .... 
Novy, Frederick G . . . 
Nelson, Hugh T 


City Hall, Baltimore, Md. 

Oakland, Md. 

Philadelphia, Pa. 

909 Sixteenth street NW., Washington. D. C. 

701 Carrollton avenue, Baltimore, Md. 

Astor House, New York, N. Y. 

1324 New York avenue, Washington, D. C. 

Hospital de Jesus, Mexico City, Mexico. 

Cambridge, Mass. 

Catonsville, Md. 

Health department, New York City, N, Y. 

^ilarquette, Mich. 

University of Michigan, Ann Arbor, Mich. 

Charlottesville, Va. 

Ober, Geo. C 210 B street SE., Washington, D. C. 

Ortiz, Rafael San Miguel No. 236, Havana, Cuba. 

Osio. M. T Fuen Corrall 57, Madrid, Spain. 

Oeuslager, John, ]v Harrisburg, Pa. 

O'Daniel, William Atlanta, Ga. 

Orvauos, Domingo Chavarria 25, Mexico City, Mexico. 

Otl, Isaac I]aston, Pa. 

( )pie, Thomas 219 W. Monument street, Baltimore, Md. 

Osier, William Johns Hopkius University, Baltimore, Md. 

Owen, Abraham M Evansville, Ind. 

Owings, Thomas B Ellicott City, Md. 

Outerbridge, Thaddeus A Bermuda. 

Portuoudo, A. J Santiago de Cuba, Cuba. 

Padilla, Juan [ Guatemala City, Guatemala. 

Page, Chas i U. S. Army, Governors Island, N. Y. 

Pancoast, \Vm. N Philadelphia, Pa. 

Park, J. Walter Harrisburg, Pa. 

Parker, Chas. B 564 Euclid avenue, Cleveland, Ohio. 

Parsons, Mary Washington, D. C. 

Patton, Geo. F 312 Camp street, New Orleans, La. 

Pepper, William 1811 Spruce street, Philadelphia, Pa. 

Perry, Geo. N 1524 Fourteenth street NW., Washington, D. C. 

Philiippo, James Cecil Kingston, Jamaica. 

Page, Isham R 1206 Linden avenue, Baltimore, Md. 

Phinney, Lorenzo N 26 West avenue, Norwalk, Conn. 

Postle, James ]\lartin ] Hinckley, HI. 

Pierson, William ] 13 Hillyer street. Orange, N. J. 

Pilcher, L. S ' 145 Gates avenue, Brooklyn, N. Y. 

Pitner, F. R Fairfield, 111. 

Palmer, Lewis M I South Framingham, Mass. 

Pile, Mayne M I 1230 Fourteenth street NW., Washington, D. C. 

Parendes, Guillermo Vargas. 
Plummer, Richard Henry. 

PoUitzen, Sigmnnd 

Polok, John Osborn 

Politzer, Adam 

Porteaus, James G 

Powell, Thomas E 

Prentiss, D. Webster 

Prewitt, T. F. 

Bogota, Cawera 7, 638, Colombia, South America. 

652 Mission street, San Francisco, Cal. 

21 W. Fifty-second street, New York, N. Y. 

25 Seventh avenue, Brooklyn, N. Y, 

Vienna, Austria. 

Poughkeepsie, N. Y. 

Evansville, Ind. 

1101 Fourteenth street NW., Washington, D. 0. 

3101 Pine street, St. Louis, Mo. 

Probst, Chas. O Columbus, Ohio. 

C^iuimby, Isaac N | City Hospital, Jersey City, N. J. 

Rake, Beaver. 

Randall, Edw 

Ravogh, Augustus. 
Redfield, Paul I . . . 
Redmond, Henry . . 

Reed, John G 

Reed, etas. A. L . . 
Reeser, Howard I. . 

Trinidad, British West Indies. 
Galveston, Tex. 
88 W. Seventh street, Cincinnati, Ohio. 
161 Benefit street, Providence, R. I. 
1224 Walnut street, Philadelphia, Pa. 
Elmwood Place, Cincinnati, Ohio. 
311 Elm street, Cincinnati, Ohio. 
Reading, Pa. 




Regensburger, Alfred E. 

Reicliert, Kdw. T 

Rauch, John H 

Reuuer, Wm. S 

Renshaw, Frank G 

Reyburn, Robt 

Remington, .los. I' 

Rivero-Saldivia. II 

Reyaud, L. F 

Ri chardson , C . W 

Risley, S. D 

Richardson, A. 15 

Richardson. M. H 

Roberts, J. B 

Rusbv, H. 11 

Rockwell, A. D 

Roddick, Th OS. (I 

Roe, John O 

Roh^, Geo. H 

Roher, Geo. R 

Rost, Eliza H 

Rost, Edw. K 

Rotch, J.N 

Rudgles, Clins. A 

Rubin, Luis H 

Rosquez, Francisco A.... 

Ruiz, Luis E 

Rutherford, Jacob C . 

1^ van, Frank G 

Rowe, M 

Salicru]), Pedro J 

Sellman, \Vm. A. 15 

Saumer, A. J . C 

Satterlee, Richanl i I 

Savage, Gile C 

Sayre, Reginald H 

Scliapps, J ohn C 

Schavoer, F 

Scott, Jos. F 

Scudder, Clias. L 

Septein, Manuel 

Shakepeare. Edw. O . . . . 

Sharer, John P 

Shotwell, Alfred \ 

Si bbet. Robert L 

Sayfried, Chas. A 

Skinner, Barton 1) 

Slaughter, John Phillip. 

Stemau, Christian B 

Sloane, Robert T , 

Small, J. Frank 

Smart, Chas , 

Smith, A. R.G 

Smith, Arthur L 

Smith, Allen J 

Smith, Thos. J 

Smith, Robert W. B 

Simon, Geo. E 

Smith, S. McCuen 

Smith, S. Lewis 

Smith, Thos. C 

Sawyer, Jno. P 

Snellen, Herman, jr 

Snyder, Dan'l 


San Francisco, Cal. 

Pliiladelpliia, Pa. 

Chicago, 111. 

3G1 Pearl street, BufTalo, N. Y. 

I'ensacola, Fla. 

Washington, D. C. 

Philadeli)hia, Pa. 

Caracas, Venezuela. 

24 Barome street. New Orleans, La. 

1102 L street, Washiuiiton, D. C. 

1722 Walnut street, Philadelphia, Pa. 

Columbus, Ohio. 

224 Beacon street, Boston, Mass. 

1627 Walnut street, Philadelphia, Pa. 

209 E. Twenty-third street, New York, N. Y. 

113 W. Thirty-tirst street, New York City, N. Y. 

80 Union avenue, Montreal, Canada. 

Rochester, N. Y. 

Catonsvillc, Mtl. 

Lancaster. Pa. 

•26 Central Music Hull. Clii<ago, lU. 

Hartford. Conn. 

Boston, Mass. 

Stockton, Cal. 

1 Tacon street, Havana. 

Caracas, Venezuela. 

Callo Norte, 11 N.,316, Mexico City. 

14 Franklin street, Providence, R. I. 

3739 Brown street, Philadelphia, Pa. 

Laurel, Md. 

129 E. Seventeenth street, New York, N. Y. 

Baltimore, Md. 

103 State street, Chicago, 111. 

Faston, Md. 

Nashville, Tenn. 

28.5 Fifth avenue. New York, N. Y. 

498 Bedford avenue, Brooklyn, N. Y. 

8 AtlaTitic street, Stamfonl, Conn. 

1311 Connecticut avenue, Washington, D. C. 

1 ilarlboro street, Boston, Mass. 

Queretaro, Mexico. 

Rosemont station, near Philadelphia, Pa. 

634 John street. Little Falls, N. Y. 

Mount Clemens, Mich. 

Carlisle, Pa. 

Newport, R. I. 

Greenport, N. Y. 

The Plain, Va. 

Fort Wayne, lud. 

1235 Grant avenue, Kansas City, Mo. 

135 E. Market street, York, Pa. 

U. S. Armv, Surgeon-General's Office. 

North Whitefield, Me. 

250 Bishop street, Montreal, Canada. 

Galveston, Tex. 

Bridgeton, N. J. 

Seaford, Ontario. 


1502 Walnut street, Philadelphia, Pa. 

64 W. Fiftv-sixth street, New York. N.Y. 

1133 Twelfth street, Washington, D. C. 

122 Euclid avenue, Cleveland, Ohio. 

The Netherlands. 

Scio, Ohio. 







Solly, Saml E... 

Sniiimers, Juo. E 

Sotlioion, Elmer 

Sothorou, Jas. T 

Spackman, Mary D 

Sprigg, Wm . M 

Suddarth, .los. L 

Suter, A. Walter 

Summers, Geo. H 

SuTherlaiid, Cbas 

Stamm, G 

Stanton, Bryon . 

Stearns, H. P 

Sternberg, Geo. M 

Stewart, Jas. A 

Stevenson, Sarah H 

Stewart, David D 

Stiles, Cbas. W 

St. John, David 

Stone, I. S 

Stover, Chas 

Stowell, Chas 

Stoner, Geo. \V 

Street, Dan'l B 

Strout, A. O 

Smith, J. Gardner 

Stevens, Geo. T 

Taft, Jonathan 

Tait, T. Oliver 

Talbot, Eugene S 

Talbot, Robt. W 

Taylor, Henrj- S 

Teschner, Jacob 

Thomas, A. J , 

Thompson, J. Ford 

Thompson, Jas. F 

Thorner, Max 

Thorudike, August 

Tiffanv, FJavel B 

Tillman, Wm 

Tompkins, Edmund Lee . . . . 

Tracy, Edw. A » . 

Trader, John W 

Travis, Wm. A 

Try on, J. R 

Tiirnbull, Lawrence 

Turton, Robt. S 

Tuttle, Albert Henry 

Tyner, T. J 

Tyson, James 

Upshaw, J.N 

Ulloa, Juan 

Valentine, Ferd . C , 

Valk, Francis 

Van Cott, Joshua M 

Vance, Wm. K 

Vander Veer, Albert 

Van Rensselaer, John 

Vaughan, B. A 

Vaugban, Geo. TuUy , 

Vaughan, Victor, C 

Verdin, Wm.W 

Vincent, T.N 

Wade, J. Percy 

2 N. Cascade avenue, Colorado. 

344 North avenue, Cambridge, Mass. 

1921 I street, Washington, D. C. 

1917 I street. Washington, D. C. 

1634 Sixteenth street. Washington, D. C. 

911 H street, Washington. D. C. 

821 N. Capitol street, Washington, D. C. 

Herkimer, N. Y. 

3321 N. Broad street, Philadelphia, Pa. 

1517 Rhode Island avenue, U. 8. Army. 

St. Paul. Minn. 

157 Dayton street, Cincinnati, Ohio. 

Hartford, Conn. 

War Department, Washington. D. C. 

1611 John street, Baltimore, Md. 

322 N. State street, Chicago, 111. 

2620 N. Fifth street, Philadelphia, Pa. 

U. S. Agricultural Departmeur, Washington, D. C. 

Hackeusack, N.J. 

Washington, D. C. 

Amsterdam, N. J. 

1326 New York avenue, Washington, D. C. 

U. S. Marine-Hospital Service. 

1102 Ninth street, Washington, D. C. 

Parkersburg, Iowa. 

307 Lenox avenue. New York City, N. Y. 

33 W. Thirty-third street. New York City. 

Cincinnati, Ohio. 

18 Marietta street, Rochester, N. Y. 

125 State street, Chicago, 111. 

1111 F street, Washington, D. C. 

201 West Fifty-fourth street. New York, N. Y. 

134 East Sixty-tirst street. New York. N. Y. 

Evansville, Ind. 

804 Seventeenth street, Washington, D. C. 

Fredericksburg, Va. 

141 Garfield Place, Cincinnati, Ohio. 

Bostou, Mass. 

College of Kansas City, Mo. 

La Crosse, Wis. 

Washington, D. C. 

Boston, Mass. 

Sedalia, Mo. 

Covington, Ga. 

Surgetm-Gencral, I'. S. Navy. 

1719 Chtstnut street, Philadelpliia. Pa. 

Browntown P. O., Jainaica, AWst Indies. 

735 Main street, Cambridge, Mass. 

Austin, Tex. 

1506 Spruce street, Philadelphia, Pa. 

206 East Grace street, Richmond, Va. 

San Jose, Costa Rica. 

1244 Broadway, New York, N. Y. 

163 East Thirty-seventh street. New York, N. Y. 

122 Joralemon street, Brooklyn, N. Y. 

Bristol, Tenn. 

Alljany, N. Y. 

1023 Connecticut avenue, Washington, D. C. 


U. S. Marine-Hospital Service, District of Columbia. 

University of ^Michigan, Ann Arbor, Mich. 

Lapidum. Md. 

1221 N street, Washington, D. C. 

Catonsville, Md. 





Wallace. Jaiiios 121 North Sixfooiitli street. Pliiladclpliia, Pa. 

Walton, J. Rolaiul 700 Tenth street, Wasbniyton, D. C. 

Williams, Aurthnr i Elk K'idj^e, Md. 

Wilson, JefVerson 11 ' Beaver, Pa. 

W^eld, Geo. W New York, N. Y. 

Warren, .Fohii C 1 i''>^ Beacon street, Boston, Mass. 

Watson, IrviiijiA Concord, N. H. 

Weidnian, W. Murray I Ritadin^, Pa. 

Weiiiel, Louis A j Rochester, N. Y. 

Welch, Wni. 11 1 Baltimore. Md. 

Welch, Wm. M i «l'l Nortli Broad street. Philadelphia, Pa. 

WelliuLjIon, .1 R I 1 1">5' Fourteenth street, Washington, L. C. 

Wells, Ijrooks II 71 West Forty-fitth street. New York, N. Y'. 

Wende, Ernest 171 Delaware avenue, Bufi'alo, N. Y'. 

Went/, AlcxinulerC Hanover, Pa. 

West, Geo. Wm 11<»2 Fourteenth street, Washington, D. C. 

West, Edw. GraelV (ioO Warnu street, Boston, Mass. 

West, Hamilton A Galveston, Tex. 

Milson, J. T Sherman. Tex. 

Williams. .lacoh Lafayette 1 Mount Vernon street, Boston', Mass. 

Wihliuu', K'ol.t. .1 Maloue, N. Y. 

Wilcox, .las. (' Darliugton ('. II., S. C. 

\\ illiams. William . I Adcl. Iowa. 

Wolfe, .fohn E ISKi New York .iveuuc, Washington, D. C. 

Wolfe, .John R Glaseow, Scotland. 

^^'ood, Albert (>7 Pleasant street, W^oreester, Mass. 

Wood. Casey Albert \ 103 East Adam street, Chicago, 111. 

Woodcock, (ialen Murray 

WoodrutV. Ch.-is. E 

Woodward. Wm.C 

5 Adam street, B.ingor, Me. 

Assistant Surgeon. U. S. Aruiy. 

12.") New York avenue, Washington, D. C. 

Worrell, .1. W Brownsville, Pa. 

Wilson, .las. C 1137 Walnut street, Philadelpbi.v. Pa. 

Woods. Hiram 816 Park avenue, Baltiiuore, Md. 

Wils(m. W. K'evnolds 1633 Locust street. Philadelphia, Pa. 

^Vatkins Robt. 1 320 West One hundred and forty-fifth street, New 

York, N. Y. 

Y'barra, A. M. F 194 West Tenth street. New Y'ork, N. Y. 

Yeaza, .1. Ramon City of Mexico. 

Y'oung, A.G Augusta, Me. 

Y'onnjr. Henry Byrd Burlington, N. Y. 

Zavola, .1 iiau' . . /. Guadalajara, Mexico. 

Ziuke, E. (iustav 8.5 Gari3eld I'lace, Cincinnftti. Ohio. 

Zweighaft. Bernard Philadelphia, Pa. 

Ziegler, S. Lewis 1504 Walnut street, Philadelphia, Pa. 






Resolved, That the International Executive Coniniitfefi. on the behalf of the Pan- 
Anieriran Medical Congress, (lis<l:iiins r&sponsibility for the views expressed by any 
individual contrilmtor to its proi'eodiii<T,s. Proceedings of tlie International Executive 
Cuminittte, Wanliiiujton, D. C, September 7, 1S9S. 



SEPTEisrBEii 5, 1803. 

Dr. William Peppek : Tlie Eiglit Eev. William Paret, d. d.. Bishop 
of Maryland, will invoke the blessing of Almighty God ujion the pro- 
ceedings of this Congress. 

The Eight Eev. William Paret, d. d. Let us pray. 

Our Father who art in heaven, hallowed be Thy name. Thy kingdom 
come on earth as it is in heaven. Give us this day our daily bread, and 
forgive us our trespasses as we forgive those who trespass against us; 
and lead us not into temptation, but deliver us from evil: For Thine is 
the kingdom, the power, aud the glory, forever and ever. Amen. 

Almighty Father, by whose will and wisdom it is that medicines 
have power to heal and men have the will aud skill to use them, who 
madest the bodies of men aud gave to their minds the wonderful power 
to know aud teach, bless, we beseech Thee, the medical learning and 
usefnlness, aud guide the consultations of those who are assembled to 
the glory of Thy name and the highest blessing of mankind. Lead 
them, we pray Thee, aud make their lives and labors rich with fruit- 
fulness aud blessing. We ask for Jesus Christ's sake. 

Direct us, O Lord, in all our dealings with Thy most gracious favor, 
and in all work begun and continued in Thee we may glorify Thy name 
and finally attaiu everlasting life through the grace of our Lord. 

The grace of our Lord and the fellowship of the Holy Ghost be with 
us for ever more. Amen. 

Dr. Pepper. It is in accordance with the deep interest taken by the 
Government of theL^nited States in the organization aud success of this 
Congress that the honored President of the Uu:ted States has kindly 
come this morning to exercise his function to open formally the First 
Pan-American Medical Congress. I have the great honor . 

President Cleveland. The part assigned me ou this occasion admits 
of but few words. It, however, affords me the opportunity to say how 
pleased I am to be in any way related to such an assembly as this, 
altogether in furtherance of the highest and noblest purposes aud 
designs. I hope I may also be permitted to add that the protection of 
the public health and the prevention of contagious diseases is properly 
discussed at the capital of a nation which appreciates as fully as ours 
the importance of aU and everything which adds to make intercourse 



between civilized countries andcommerce between them safe and easy. 
It is also fitting- that those gentlemen, devoting themselves to saving 
human life and the alleviation of human suffering, should consider the 
means of reaching these beneficent ends at the seat of a Government 
Avhose greatest regard is the welfare and happiness of the individual 

It only renmins for mc to declare this Congress of the Pan-American 
Medical Society open for the transaction of the business which has 
called it together. 

Dr. Adams. Ladies and gentlemen : It is but fitting to state that on 
behalf of the citizens of Washington and the committee of arrange- 
ments of the Pan-American Congress we should select one of the most 
distinguished of i ur citizens to deliver the address of welcome. There- 
fore, it affords mc much ]ilcasure to introduce to you the Hon. John W. 
Koss, LL. D., president of the Board of Commissioners of the District 
of Columbia. 

Hon. John W. Ross. The District of Columbia has entertained many 
distinguished gatherings, bnt it has never known such a one as I now 
have the honor, in the name of the local municipality, to welcome to the 
national capital. For the first time in the history of the New World 
there are assembled at <tne of its capitals the rei)resentatives of one of 
the largest and most honored of the learned professions of all the 
Americas. It is fitting that in the District of Ccdumbia, which 
derived its name from that great discoverer, and that in the year set 
apart as the one in which the nations of the earth may do honor to his 
memory, that the Cxovernments whose existence was made possible by his 
genius and daring could send their representatives to the Pan-Ameri- 
can convention. Tt is in keeping also with the s])irit of the age, which 
has prom[)ted this gathering of representative men, that the delegates 
so convened should meet, not for individual or for national aggrandize- 
ment, but for the loftier purpose of extending the range of medical 
knowledge and for the alleviation of human suffering throughout the 
world. To a profession as progressive as that of medicine and surgery 
the results of such a conference can not be overestimated. 

When we consider the vast area of surfiice of the glol)e here lepro- 
sented, its infinite variety of racial characteristics, of climatic condi- 
tions, and of all environments affecting health and disease, we can 
understand that such interchange of experience and observation was 
never before made possible. What may not be accomplished by the 
forceful men from all the Governments here represented, their plans for 
the enforcement of national quarantine relations, for international 
cooperation against the spread of infectious and contagious diseases? 
The municipal authorities of many of the cities of the United States 
are to-day vainly endeavoring to locate hospitals for the treatment of 
contagions diseases near enough to the centers of population to avoid 
the dangers incident to a long transportation of persons suffering from 


such diseases, and uear enongli to be witliiu range of the sewer system 
and of an adequate water supply. It has been the common experi- 
ence of all who are charged with such responsibility that the dread 
occasioned to those who reside in the vicinity of such proposed loca- 
tions has assumed almost the i)roportions of a panic. If the positions 
maintained by many of our most eminent physicians be correct, that 
such hospitals when properly built and properly conducted are not 
likely to conununicate disease to those residing near them, then the 
public mind should be relieved of this needless apprehension, and I 
venture to suggest that if this great body of experts should deem that 
subject worthy of its consideration there can be no doubt that the 
authority of the expression of its voice can do more than can be 
expected from any other source to educate the public mind upon this 

May there be, as a result of your deliberations upon all the important 
topics submitted to you for consideration, not only the formation and 
renewal of personal friendship, but a wider knowledge and a higher 
appreciation and a just conception of the demands of the age upon your 
profession. And I can not but believe that this extraordinary spectacle, 
this assembly of eminent physicians from all the great powers of the 
Western Hemisphere has a deeper significance than even the laudable 
one of the extension of medical knowledge among its students. Does 
it not indicate that benevolence and philanthropy are no longer limited 
by national boundaries, but that they are becoming as broad and uni- 
versal as humanity itself! There will never be a time when there will 
be no clash of interests among the nations ; but when the poor of Ireland 
were suffering for bread, when Chicago was desolated by lire, when 
Charleston and Johnstown were helpless, when the i^easantrj^ of Eussia 
were starving, the West came in the form of material aid, ignored the 
terror of the seas and the boundaries of States, remembering that 
the stricken and suffering belong to the same great human family. 
New, swift means of communication are bringing the nations into 
closer relationship. May we not be encouraged to hope that this 
Pan-American Medical Convention is a forerunner of successive courses 
of all civilized states, whereby all the common interests of the states 
may be fostered and maintained. Mr. President and gentlemen, when 
you have as your immediate hosts all the immediate members of our 
profession who are our most honored and respected citizens, I beg 
you to be assured that the i)eople of Columbia deem themselves hon- 
ored by your having selected this as your place of meeting, and we 
hope to make your welcome to the capital so cordial that you may carry 
away with you to your distant homes, only pleasant and agreeable 
remembrances of the congress at Washington. I thank you for your 
courteous attention. 

Dr. Pepper. Members of the first Pan-American Medical Congress, 
ladies and gentlemen : In assuming duties devolved upon me by the 


choice of tlie executive committee, it will be my duty to address to 
you tomorrow evening some remarks concerning the .scope of this 
congress, as those of us wlio liave been working in it have comju'e- 
hended it. It would, therefore, be improper for me this morning to 
occupy your time or detain you from the i)rogramme which has been 

You know the joint resolution authorizing the invitation i)resented 
by the President of the United States has been cordially accepted by 
every one of the countries addressed: and, following this acceptance, 
there have been appointed olhcial delegates from those countries to 
join us here in this congress. It is, therefore, eminently fitting that the 
rei^resentatives of these countries should be called to speak for the their 
constituency and for their respective governments. We have heard 
from the president and our distinguished host of Washington, D. C, 
how large is the work before this congress, how earnest is the hope 
that this congress is but the first of similar meetings to be held at 
different points throughout this great territory for the purpose of 
bringing together experts most comi)etent to discuss and pass upon 
questionsof enormous municipal, national, and international im])ortance. 
We have called tliis congress a Pan-American congress. This is in 
accordance with race usage. Why not simply American? Are we not 
to-day upon the brink of that larger conception of what this great con- 
tinent really is? That it is all really, truly American; that all Tesi- 
dents upon it, from Pnget St>und to the Straits of Magellan, are alike 
Americans, with a destiny, with international relations which necessi- 
tate national occasions, with political aspirations, which render coop- 
eration attractive and easy. I would myself hope to see, if not at this 
single meeting at least at several meetings held at various ])arts of 
tliis continent, the American Medical Association merged into the 
Pan-American Congress, and see it meet in ^[exico and Montreal, as 
well as in Washington. But these are features for the future; quite 
enough for the present the questions of importance to be presented in 
the different sections. 

And now, in accordance with the programme, 1 shall have the honor 
of calling upon the several countries, and if there should be a represen- 
tative here from any of them, we would be glad to hear from him what 
words of courteous cheer he can give us. We shall now have the pleas- 
ure of hearing from Prof. Pedro Lagleyze, of Buenos Ayres, on behalf 
of the Argentine Bepublic: 

Senor Presidente del Congreso Medico Pan-Americano — Senores: 
Anhelosa siempre la Republica Argentina, de seguir el movimiento 
cieutifico determinado por los grandes centros, no ha podido vacilar un 
instante en corresponder a la invitacion que le fu6 dirigida para con- 
currir a este acto. Si he de interpretar los sentimientos de su Gobierno, 
cuya representacion invisto en este momento, mi primera ]>alabra 
debiera ser de gratitud, una vez que se le ofrece la oportunidad de 
realizar sus nobles y grandes prop6sitos. 


Las ciencias medicas, sefiores, como sabeis, atraviesan actualmente 
uu periodo de evoluciou estbrzandose sus cultores en enriquecerla 
dia A dia cou nnevas y valiosas revelaciones, y el continente Americano 
no queriendo permanecer, indiferente al gran impulsodado a aquellapor 
la Earoj)a, lia creido llegado el monieuto de incorporarse ostensible- 
nicnte al movimiento, uiostrando al miiudo, no solamente el progreso 
material de sus hijos iudustriosos y comerciales, sino su progreso 
intelectual en las ciencias y en las artes. 

El Congreso Medico Pan-Americano es el primer esfuerzo, que, unidos 
l>or el vinculo fraternal del continente que habitamos, liacemos en el 
tortuoso sendero de la medicina persiguiendo juntos los ocultos secretos 
de esta cieucia misteriosa. 

El espiritu investigador de los genios del viejo continente ha iluminado 
un rincon del sendero y nos lia euseiiado a marcliar con la briijula de la 
j)aciente investigaciou experimental. 

Aprovechemos el trabajo de los viejos, juntemos nuestras observa- 
ciones, comparemos nuestros resultados, apliquemos con abnegacion 
nuestras jovenes facultades persiguiendo la verdad en el estudio de la 
dificil ciencia, y, llevemos, sobre las tibias aguas del Gulf Stream que 
vivifica una gran parte del viejo mundo, el cal©r de nuestra inteligeucia, 
contribuyendo al eterno fuego del espiritu de la familia luimana. 

Con estos votos, Senores, permitidme que yo, liumilde mienibro de 
este Congreso os ofrezca todomi modesto concurso en mi triple caiVictcr 
de Representante del Gobierno Argentino, de delegado por la Facultad 
de Ciencias Medicas de Buenos Aires y del Circulo Medico Argentino. 

Dr. Pepper. We sliall next have the gratification of listening to 
tlie official representative of tlie Government of Jamaica, Dr. Phil- 
lippo, of Kingston. 

Mr. Philltppo. Mr. President, ladies, and gentlemen: I come before 
you now as a representative of a very small island lying not far oft' ot 
your coast. I come from the island of Jamaica. I claim it is tlie earli- 
est portion of the Western Hemisphere discovered by Christopher Co- 
lumbus. Xext year will make 400 years since Christopher Columbus 
landed upon the coast of Jamaica. He loved the island so much that 
he returned to it. Indeed, it is said that when a person once touches 
the coast of Jamaica, he is bound to go there again. Christopher Co- 
lumbus there met with various misfortunes, being deserted by his fol- 
lowers, imprisoned, and sent home in chains. 

Jamaica has now passed a stormy youth. She has been the refuge 
of buccaneers and pirates, and has suftered from earthquakes, and 
hurricanes. But she became wealthy after all, and has become what 
is known as the key of the Gulf of Mexico. Great Britain holds 
Jamaica as the key, because from that position she can command 
nearly all of the islands, as well as the Gulf itself. For the same 
reason of her geographical position the islands should be looked upon 
as one of the outposts of the United States. If your meteorological 


department had recognized the ini])ortance of this position we could 
have forewarned you of the advance of the recent hurricanes. A.s one 
of the outposts of America, we have also something to do Avith the 
epidemics which come to you. However, we scorn such tilings as "epi- 
demics." We do not believe in them, because we have i)ut our house 
in order and have drained our sewers — or are about to drain them. 

We are like the Phoenix rising from its ashes. We send you not only 
sugar and rum, but now we are sending you that fruit which I tiiul in 
your streets, the Jamaica banana, which you seem to relish very much. 
A large and growing capital is invested in this trade We have been 
visited by your medical men, and all give glowing descriptions ot 
Jamaica. I hope to see you coming down there. (Jentlemen of the 
Pan-American Medical Congress, I rejoice to be with you; 1 have much 
to learn sitting here at the feet of your professors, learning from them 
what I lio})e will be of use to me hereafter. 

Dr. Pepper. There has been a slight change of the order of busi- 
ness. We have with us this morning one to whom more than to all 
others — I can not say to whom exclusively — is due the success of this 
])rqject. It gives me the greatest pleasure to have the honor to call 
upon Hon. J. B. McCreary, of Kentucky, to answer briefly for the Con- 
gress of the United States. 

Hon. J. B. McCreary. Ladies and gentlemen of the Pan-American 
Medical Congress: I came this morning only to pay my rcs[)ects to 
this great body, and my presence was discovered only a few moments 
ago: I did not expect to be introduced to this great assembly, but I 
desire to say that it gives me much gratification and great pleasure to 
be with you on this occasion. The Congress of the United States 
passed the bill under which you are holding your meeting without hesi- 
tation, and unanimously. When the physicians of the United States 
seemed to desire that the i)hysicians of the Western Hemisphere should 
assemble in the capital of our country, the members of the House of 
Ivepreseiitatives said, with but one voice, " We will be glad to have 
them with us, and we will welcome them to Washington.'' The Con- 
gress of the United States has in past years, through another Pan- 
American Congress, tried to cultivate commercial and social relations 
with all the republics of the Western Hemisphere. This convention 
follows properly that congress, and, I hope, ^Ir. President and gentle- 
men of the Pan-American Medical Congress, that this is but the begin- 
ning, and that there will be many other Pan-American medical con- 
gresses to raise the standard of health of the people, to promote as far 
as can be done the prosperity of the country. I hope your session in 
our capital will be successful. We all give you a hearty welcome, 
and if you should again desire any legislation from the Government of 
the United States, I should be very glad to be the humble instrument 
in trying to get it for you. 

Dr. Pepper. Now I have the honor to call on a gentleman from 
British America, who has charge of the immensely important duty of 


jjuai'fling the sauitary condition of tlie St. Lawrence Eiver, Dr. Monti- 

Dr. ^roNTizA:\iBEET. 3Ir. President, ladies, and gentlemen : Like the 
previons spealcer, when I entered the building I had not the remotest 
idea of being called upon to address yon. I regret that for one reason, 
but you may be assured that whenever there is an occasion of inter- 
change of cordial expressions, or a desire of international courtesy, 
international cooperation, international work, British America will 
never need to look far for a speaker when I am i^resent. I regret that 
I have not been able to devote more attention to this subject than I 
have, that I might take a Avider view of it than I am able to this 

My own work is not a little severe, and you I trust will bear with me 
if, under the circumstances, I am obliged to confine the remarks I am 
to make to-day to the branch with which I am most familiar, that of 
hygiene and quarantine. 

It was in the autumn of 1884, as far as I am aware, that the first step 
was made towards the international work between your Republic and 
the little neighbor to the north. The Government of Washington, in 
view of the threatening of cholera at that time, invited delegates to an 
iuteriuitional congress to be held in this city in December, 1884. I 
had the honor of represeuting my Govetnment as a delegate on that 
occasion. Since then I have continued yearly to exchange information 
concerning the public health, and a vast amount of good has resulted 
from it. It is reasonable to believe that some good results will arise 
from this movement. I umy mention as a small instance of the prac- 
tical work of this national exchange the protection of our own country 
from the entrance of certain diseases from abroad. We have inaugu- 
rated certain means for meeting the emergency. The Government at 
Washington communicated with the Government of Canada with a 
view to sending officers to inform the i)eople of the work carried on. 
This was met by our Government cheerfully, and now there are officers 
representing the Marine-Hospital Service of the United States who are 
])resent and are in a position to assure their Government, and through 
their Government the people, that the means of prevention are efficient. 
We work together with the utmost unanimity and cordiality. You will 
excuse me for giving this illustration, but it brings it down to practice, 
and it is practice wliich arises in the interchange of views that gives 
rhem their practical value. I thank you most cordially, Mr. President 
and gentlemen, and I can only say to you that British Xorth America 
most cordially joins in the sentiment before expressed, hoping for the 
unqualified success of this great convention. 

Dr. TJlloa, Costa Eica. Mr. President, ladies and gentlemen : I feel 

bound by courtesy to address you in your own language, though my 

speech, following upon the gentleman who has just spoken, may appear 

like the bringing in of a candle when the electric light is taken out, 

S. Ex. 36 5 


As the representative of one of tlie smallest Republics of the continent 
I salute these great Republics, expressing my earnest Avishes for the 
continuous prosperity of this congress. I come from Costa Rica, the 
country from which we send you coffee and bananas in exchange for 
your various and valuable products. Tour kindness has been so great 
toward all of us that we have no words to express our thanks. I wish, 
however, to express my best wishes for the success of the congress and 
the prosperity of your hospitable people. 

Dr. Pepper. In the absence of representatives at this moment from 
the Dominican Republic and ICcuador, I know you will join me in a 
cordial greeting to a representative of that body, to whose initiative 
and influence this congress owes its existence. I will call upon Dr. 
J. F. Hibberd, president-elect of the American ^Medical Association. 

J^r. lIincERD. Mr. President, ladies and gentlemen: This, some- 
how or other, seems to be a morning of suri)rises. Several of the gen- 
tlemen who have spoken before me stated they were not aware of 
the privilege and happiness they would have of addressing you 
until after they came in the room. It struck me with perfect astonish- 
ment that I should be called upon to make any remarks in the presence 
of other gentlemen, representing other countries, whom I supposed 
would be called upon to speak. However, as American citizens, all of 
us must be prepared for the emergencies of life, and. when great things 
hai>pen to us individually, we must expect other dilliculties to be made 
oi>i)osite the line of current events, and so is it tliis morning. But it 
gives me great pleasure to come here and greet you as an organization 
which had its initiative in the American Medical Association. It is 
very true that that association has in the past regarded itself as the 
parent of most of the other organizations in this country, and we, as 
a parent organization, love them and encourage them, and love to have 
tliem grow up in their proper spirit of good science and good morals. 
But I have not until this moment thought of the prospect of the com- 
ing of something which may be more extensive and perhaps wider 
than the American Medical Association. That is the Pan American 
Medical Associatioji. 

Now, we are a large country, but we acknowledge the whole conti- 
nent is larger than the United States. If it turn out in the future that 
what has been initiated here this morning will grow and expand, as we 
have reason to believe it will, the American IMedical Association will, 
perhaps, after a while have to consider itself only a i)art of Avhat 
spreads over the whole America. I can assure you from my own feel- 
ings, as I can appreciate the feelings of the whole American Republic, 
if this greater organization regard us as a part, we stand ready to bow 
to that greater organization. AYe will, therefore, expect to see the con- 
gress that is inaugurated here this morning grow and extend the 
sjihere of its scientific influence, and give renewed encouragement to 


the social relations existing between the nations of this continent. 
And we will always be glad to have yon here in the United States. 
However, we will consider ourselves, the American Medical Association, 
to be the largest and best association in the world, and I heartily 
invite yon all to meet us in San Francisco next year. 

Dr. Pepper. I will now call iipon the secretary-general for his report. 
At some other time there must be made to the secretary a suitable 
expression of the gratitude due him for his foresight in formulating the 
suggestion and for his devotion, and ability, and tact, and patience, 
and faith, which have brought about this great and fully realized suc- 
cessful day. 

Dr. C. A. L. Eeed. The congress as it stands to-day must constitute 
my report. The work of organization, which has devolved largely on 
the secretary-general of this congress, has been exacting in many 
particulars, but it has withal been an extremely pleasant task. The 
movementwas inaugurated by drafting into theservice the distinguished 
gentleman who presides over our deliberations to-day. The move- 
ment was next seconded by the Congress of the United States, 
largely through the instigation of the distinguished ex-governor of the 
State of Kentucky, who has addressed you this morning. It was sec- 
onded in the Senate of the United States by that grand peer of states- 
men. Senator John Sherman, of Ohio. The movement was ratified in 
the executive circle by the President of the United States. At a later 
stage, when an ai^propriation was found necessary, the committee 
received the zealous and efficient support and management of that 
friend of progress, Senator Gorman, of Maryland. In that particular 
way this' congress is a governmental protege. Not only were these 
movements heartily seconded and heartily pushed forward in the 
United States, but the medical profession all over this country and all 
over the neighboring countries and colonies responded with an una- 
nimity and enthusiasm, which made the work both easy and pleasant. 
The governments of the neighboring republics and the neighboring 
colonies responded and, although some of the delegates have failed to 
arrive to this date, in nearly all of those countries the delegates have 
been appointed by the government. 

The work has touched and embraced every medical society from Ber- 
ing Sea to the Straits of Magellan. To-day on the official manifesto of 
this congress you will find the names of those who have accepted offices 
on behalf of practically every local medical society of the Western 
Hemisphere, embracing a profession numbering over 150,000. The 
membership of this congress has been opened wide unto the medical 
profession, and the invitation issued has been responded to with the 
characteristic enthusiasm of all the American peoples. As I stated 
before, the formal report of the secretary-general must be found in the 
hand-book of the congress, which I will not endeavor to read in your 
presence. Thanking you all for your cooperation, I wish you Godspeed 
in the work before you. 


Dr. Pepper. I do not wonder that the lionorable Mr. Eice referred to 
the medical profession of AVashin<;ton. Tliey have been taxed and 
taxed again, but they never fail to respond, and never has the profes- 
sion of Washington come forward with nu)re interest and zeal than in 
providing- foi' the details of the actual work of this congress. I have 
therefore i)articular pleasure in calling upon the courteous chairman of 
the committee, Dr. Samuel S. Adams, of this city. 


Mr. President, Ladies and Gentlemen: Before making a very 
short speech, 1 thiuk it is but proper to state that in the foniiatinn of 
this congress it was necessary, for the recognition of the congress by 
the Government of the United States, the invitatiou having been 
extended to foreign countries to send representatives to this country, 
that an ai)i)ro]»riation should come from the Congress of the United 
States in support of the necessary expenses that would be entailed by 
such an undertaking. All of us, but nun^e particularly those of this 
territory, know with what difliculty appropriations are engineered 
through the various committees. After the recognition of this ap])ro- 
priation in one House, owing toother inrvortant matters, it was passed 
over, was ignored. It was taken up in the Senate, and those gentle- 
men passed it, but the linal act was in the joint committee of the 
House and Senate, when the Hon. Arthur tJorman, of Maryland, said 
"we will have it," and ire have it. 

It is through the energy of 'Sir. (iorinan that I am able to give you 
entertainment which will retlect credit upan the Congress wdiich donated 
this money. When selected for this important position, I with some 
dinidence accepted the invitation of these honorable gentlemen, think- 
ing I was not e(|ual to the task, thinking the duties should fall u]ion 
th.ose nuich older in years and ex])erience; l)Ut they said the> Avanted 
young blood. The gentlemen selected one of tlu; younger members of 
the profession for this duty. It has been the endeavor of my associ- 
ates, I assure you, to present a programme satisfactory to every indi- 
vidual here present. While many of our seniors have been basking 
in the sun and playing on the sands of the seashore, we have been 
laboring, during the heated periods of June and July, in an attempt to 
complete the arrangements, in order to have the congress to move 
smoothly. |Thc doctor then made the announcements of the committee 
of arrangements.] 

Dr. Pepper. I would simply emphasize one jioint, that is sharp 
punctuality. The number of sections is unprecedentedly great. Tlie 
one to Avhich I Avould call ])articular attention is that of pedagogics, 
because the questions of education that will there be brought up will 
be of extreme importance. 


As soon as tlie general session is over, the members should make up 
their minds as to the section they will attend, tliat the sections may 
meet with equal promptitude. Thus only will it be possible to cover 
the ground fully. The next item on the jn'ogramme is an address by 
Prof. Francisco A. Risquez, m. d., Caracas, Venezuela. There will be a 
general address of this character each day. 


Ann conmueve mi espiritu la inipresiou producida por la noticia 
oticial de haberseme elegido para el discurso de orden, en esta asam- 
blea general del primer Congreso Medico Pan-Americano. Tan alto 
puesto, que, discernido a una autoridad cientifica, le habrui dado 
motivo de justo orgullo, asignado n quien no tiene nnis titulos que un 
entusiasmo inagotable por los estudios medicos, constituye una dis- 
tincion tan abrumadora, que no encuentro como piuliera traducir mi 
jjalabra la inmensa gratitud de que me siento poseido. 

Yo me reconozco, en verdad, tan pequeBo para ocupar tan distin- 
guido puesto, que no me habria resuelto a aceptarlo si no hubiese 
encontrado como explicarmelo, y traido en mi auxilio una personalidad 
bastaute digna para merecerlo, bastaute grande para correspondeilo. 
Si, SeSores; yo recojo ese honor en nombre de Venezuela, la hermana 
cordialisima de la republica de Washington; es ella quien por mis 
labios expresa su recouocimiento a la Comision orgauizadora de este 
Congreso, por tal distincion, que ella recibe como el obsequio carinoso 
que la noble patria del Libertador del Norte America tributa a la 
tierra gloriosa del Libertador de la America del Sur. Venezuela no 
olvidara jamas, que los organizadores de este Areopago de sabios, le 
han cedido el derecho de enarbolar un dia el estandarte de la medicina 
en las alturas de este monumento, levantado por la primogenita de la 
libertad americana al adelanto cientiflco del mundo de Colon. 

Y un momento mas antes de comeuzar. Hijo de raza hispana y casi 
extrauo a la hermosa lengua de los desceudientes de Albion, yo debiera, 
ya que me es forzoso dirigiros la palabra, hablaros en mi nativoidioma; 
pero yo me tildaria de descortes, si, por aprovecharme de la ventaja 
que me brinda la circunstancia de ser el espafiol una de las lenguas 
oticiales de este Congreso, no me conformase con sujetaros a la necesi- 
dad de oirme, sino que os condenara, ademas, a la tortura de un dis- 
curso cientiflco en un idioina desconocido para la mayor parte de voso- 
tros. No; yo tengo que agotar mis facultades por corresponder 4 la 
esquisita galanteria del Comite Ejecutivo, y flandome por complete a. 
vuestra benevolencia, que escusara mm defectos de lenguaje, agregare 
a mis esfuerzos por agradaros, uuo mas : el de expresarme en ingles. 


Algo habro, sin embargo, de ganar eu el cainbio: naceriln mis ideas 
pobres de todo valor iiitrinseco, pero las presentare engalanadas con 
las bellezas <pie presta a la palabra vuestro dulcisimo idioma, enrique- 
cidas con el nierito de esta lengua del Xorte, que, merced al estupendo 
inogieso que liora tras bora vienerealizando esta poderosa nacion, lleva 
cauiiuo de convertirse, en un i)orvenir no muy lejano, en el idioma uni- 
versal del muudo culto. 

Y abora, si be de ser yo quien venga & atar con las d^ biles amarras 
de mi palabra la ateiicion de esta asamblea; jdonde encontrar el tema 
cuyo desarrollo pueda interesarle? ^Qu6 frutos podra producir mi in- 
teligcncia, queen lavuestrano sehayan sazoiiado ya? iQu6 nocioues 
l)udiera yo traer a vuestro examen, que no fueran asuutos fiimiliares 
(i vuestro saber ? 

Pero al fijarme en que es la ^poca conmeraorativa del suceso m/is 
grande que registran los anales de la bumanidad, dilato mis miradas 
por el Gontinente Colombino, y deteniendome ante la exbuberante vege- 
tacion de su privilegiado suelo, encuentro en ella el deseado tema, que 
me lleva it someteros un asunto digno de la consideracioii de los pro- 
fesoros americanos aqui reunidos, como que somos todos los bijos de 
este .Mundo ]N'uevo en cuyo seno germiua el porvenir, y en cuyo cielo 
resplandece ya el astro que ha de alumbrar los camiuos del progreso a 
las generacioues venideras. 

Voy ii bablaros de la Flora Americana en sus relaciones con la medi- 
cina. Pretendo bacer desfilar ante vuestra memoria los tesoros que ella 
ba regalado a la bumanidad doliente; quiero recordaros las riquezas 
([ue ella esta ofreciendo al arte de curar, sin darle mas trabajo que 
el de estender la mano para tomarlas; aspiro, en fin, 4 seiialaros los 
veneros que la vegetacion americana guarda para el investigador, como 
si fuera la flora de la America el galardon reservado por el Supremo 
Hacedor a los esfuerzos de la ciencia, en su lucba secular contra las 
enfermedades y la muerte. 

Senores! La terapt^utica, bija del empirismo, esclava en sus primeras 
edades de los capricbos del acaso y aguijoneada por las necesidades del 
arte, tuvo que a])rovecbarse de cuantos recursos le brindaba la natu- 
raleza en sus un'iltiples fuentes. 

Los tres reinos le abrian de par en par sus j^uertas, y el mineral, como 
el vegetal y el animal, llenaron de drogas los arsenales de la farmaco- 
logia. Pero a medida que los progresos de la ciencia van baciendo luz 
en la materia, el reino inorg^nico va cediendo su ijrimitiva importancia 
al reino organizado : k los metales nobles de entonces suceden los pro- 
ductos vegetales de abora; 4 los compuestos minerales del pasado 
reeinplazan los alcaloides organicos del i)resente y A las preparaoiones 
inasimilables preconizadas ayer, se sustituyen boy los principios orga- 
nizados que van 4 unirse con nuestras c61ulas en combinaciones 

Y en efecto, la terapc^utica moderna no es la aplicacion de agentes 


cuyo contacto paiece despertar, de un modo purameute uiecanico, los 
actos celulares, perturb^ndolos en sii proceso; la terap^utica de lioy no 
basa su confianza en el cobre 6 el antimonio, el oro 6 el ars^nico, la ])latsi, 
el zinc 6 el plomo, que no tienen representacion en nuestro orgauismo, 
y que no pueden, por tanto, incorporarse al moviniieuto vital de que 
depend en las reacciones salutiferas. 

No; los elenientos histologicos de nuestra organizaciou requieren 
principios semejaiites que, asimilandoseles, puedan niodificar la com- 
posicion y propiedades del elemento vivo; la terax)eutica de fines del 
siglo XIX eontesta con el similis similis al similia similihiis de las pos- 
trimerias del siglo XVIII, esfuerzo reaccionario provocado por el con- 
traria contrariis de las ^pocas liipocraticas, y es, en sunia, el reiuo or- 
ganizado el que hoy levanta en alto el estandarte de la farmacologia. 

Si; de los principios inorganicos que repletan los anaqueles de los 
droguistas, no pueden quedar ya sino aquellos que forman parte inte- 
grante de nuestro sistema; los deiiias tienen que desai)arecer como ele- 
nientos extrauos, 6 quedar reducidos 4 sus efectos topicos sobre las 
superficies con que se ponen en cou-tacto; todo cuanto no sea principio 
coustitutivo de nuestro organismo, esta fuera de aplicacion al cuerpo 
vivo, cuyos actos todos derivau del movimiento base de la vida : el pro- 
ceso nutritivo, esto es, la asimilacion, la transforniacion y la eliniina- 

Partiendo de este puuto, vemos ya la terapeutica encauzarse por una 
via racioual y cientifica, y en tres corrientes repartirse la teudencia de 
los modernos terapeutistas. 

En Europa, donde el constante esfuerzo de las inteligencias x>arece 
ser el unico aliento fecundador de aquella naturaleza relativamente 
esteril, agitanse los sabios en el anlielo de arrancar a las combinaciones 
de la quimica organica los ageutes niedicamentosos ; y encerrados en el 
laboratorio, uniendo y desuniendo atomos, reemj)lazando con el batallar 
del artificio, el espontaneo obse(][uio de la naturaleza, avara ya, si algiiu 
dia fu6 generosa, con los hijos del Viejo Muudo ; y unas veces, empeiia- 
dos en buscar el alivio de los sufrimientos por la supresion del dolor, 6 
la provocacion del sueijo, mientras otras, guiados por el espiritu de la 
(§poca, que hace dominar el x3anspermismo en biologia, mostrando en 
todas partes microorganismos como causas, y exigiendo sin tregua 
microbicidas como arnias de combate, van- daudo a luz, dia tras dia, 
hipnoticos y analgesicos, antiparasitarios y antitermicos, de los cuales 
gran numero viven efimera esistencia, se usan mientras curan, para 
relegarse luego a la fosa comun de lo innecesario, sin dejar otro recuerdo, 
acaso, que la penosa gestacion que precedio y las augustias e inquietudes 
que acompanaron su advenimiento al mundo de la terapeutica. 

De este modo es como ban venido 4 tomar xjuesto en los estrados del 
arte, atrayendo con irresistible fuerza la atenciou de sabios y de vulgo, 
de profesores y de clientes, los fenoles y los naftoles,los salicilicos y la 
autipiriua, el paraldehido y el sulfoual, el meutol y la agatina, el aristol 


y el .4j;uaiacol, la piiidiiia y las fenacetinas, los etilos y inetilos, la pioc- 
taiiiiia, el soiniial, y taiitishnos otros que se ajiloineraii y leeiiiplazaii, 
aparecen y se extiugnen, 6 iiacen y perduraii, lU-naiulo de iuai;otal»lf'S 
capitulos las pagiiias de la farnuieologia. 

La Ami'^rica, por su parte, orgiillosa de su fecundo siieloy enamorada 
de la iiaturaleza, liija de la Saprema Inteligencia Creadora^mas que del 
arte, engendro del iiigenio iuiitador del liombre, se dedica a estiidiar las 
l)r()i>iedades de sws plantas, las analiza y eiisaya, las eiitrega luego al 
fariuaci'utico ])nra (pie les de forma, enriqnoee la teraprutica eon sns- 
taiicias de gran nterito e iiiuiula los mercados del orbe con las prodiic- 
ciones de sus tierras. 

Del exaniende los vegetales naoela extraccion de losprincii)ios acti- 
vos y la rednccion de las drogas a la qiiitesencia de su actividad; los 
alealoides, los glucosidos y los aceites escnciales surgen a la arena de 
la terapeutica conibatiente, llenan el presente, sefialan el porv'enir y 
lialagan de tal niodo los anlielosdel arte, que el genio de Burggrave se 
apodcra de ellos y liinda la lOscuela Dosimi'trica, a la vcz (pic sobresus 
niisuios ciniicntos, al/a sus rea'les- la uicdicina liii)odcrniica, la ultiuia 
expresion, la idea mas praetica y el m(idico niAs seguro del arte de 
administrar medicamentos. 

Y linalmente, en el Viejo como en el Xuevo Mundo, elconccpto pato- 
gcnico de las enfermedades int'cctivas y contagiosas, y la nueva concep- 
cion de la naturaleza de las enfermedades, por desgaste de los principios 
coustitutivos de los clcmcntos anatomicos, abre magnificos liori/ontesa 
la terapeutica i)rotiliictica y curativa: las inoculaciones iniciadas i)or 
I'asteur en Francia, he(;has ya nniversales, las inyecciones de jugos 
ani males, ideades por IJrown-Scquard, en Europa, y modificadas por 
Hammond en los Estados Unidos, y las transfusiones de siieros, aliora 
en cstudio, representan lioy el ultimo adelanto del arte de curar, y van 
caminodelo futuro, generali/>audo los princii)ios, exteiuliendo el mi'todo 
simjdificando los procederes, liasta ver de liallar el modo de contrar- 
rcstar latrenu^nda fatalidad que pesa sobre el linnje liumano. condeiiado 
desde su cuna a sut'rir y a morir. 

He alii eompendiados el pasado, el presente y el porveuir de la tera- 
peutica: ayer, el reinado dc los medicamentos de origeu mineral, con 
sus lucbas, sus conquistas, sus glorias y sus desastres; hoy, el reinado 
de los principios organicos, cou sus productosartiticialesdelaboratorio 
y los productos uaturales de la flora de ambos mundos; mafiana, el 
reinado puramente animal, reprcsentado por el tratamiento de las enfer- 
medades del animal por sus mismos productos. 

No hay duda alguna: la terapeutica vuela con las alas que le presta 
el siglo del vapor y la electricidad, abandonando ii la industria los me- 
tales que un tiempo le sirvieron a sus uecesidades, y tendiendo a uu 
mafiana en que el animal lui de suministrarle sus principales 
combate. Ella avanza desdenando los esfuerzos por arrancar A los 
miuerales, 6 sacar de las retortas, en ese microcosmos de las combina- 


cioiies del carbouo, los eleuientos de la terapeutica y saludando 4 su 
fieiite ese esplendido porveuir, que el empleo de los productos bacte- 
riaiios y los jiig'os y humores aiiiinales anuncian a la medicina. 

Pero, si de ese ayer no debeiuos ocuparnos ya y ese mafiana no nos 
perteuece todavfa, peusemos en aprovecliar los recursos de hoy, ya que 
nuestras uecesidades apremiautes reclaman la diaria intervencion ; si 
la Providencia, que dio al oso del polo sn vellon aislador y planto 
laspalmerasen las abrasadoras soledades, ha colocado sieiupre los recur- 
sos al lado de las uecesidades, consagremonos a iuterpretar, a la luz de 
los modernos adelantos, las adverteucias que ofrece para el alivio de 
nuestros males esta '-naturaleza colosal, que parece," ha dicho un escri- 
tor venezolano, "elegida por el Autor de lo Oreado para levautar su 
troiio de regalo y pasatiempo."* 

La flora aniericana tieue en medicina una historia gloriosa, como no la 
ha tenido flora alguna. El valioso coutingeute ofrecido por ella a la 
terapeutica, no reconoce rival. Ella revelo a los indigenas del Perii 
ese ageute poderoso que vieue arraucando victim a si'v la iusalubridad 
de nuestras zonas, desde los remotos dias de la Condesa de Cinchon: 
ya comprendeis quo me refiero a la quina. Ella hizo brotar en el suelo 
brasilero la inimitable ipecacuana, con todos los meritos de un especiflco 
sin sustituto, en el trataihiento de la disenteria que dieziiia las comarcas 
tropicales, Ella ha ido mas alhi todavfa de esa obra tenida por diviua 
eutie los antiguos, de calmar el dolor, ha suprimido la sensibilidad al 
darnos la coca^ antes limitada a sostener las fuerzas del trabajador 
peruano, 6 embotar el hambre del iudio acemila, y hoy I'uente preciosa de 
ese alcaloide, la cocaina, que va invadiendo en el campo de la anestesia 
los dominios del eter y del cloroformo, un dia surgidos a la voz de Jack- 
son (de Boston) y Simpson (de Edimburgo), como el mas trascendeutal 
descubrimiento en terapeutica quirnrgica, base de los prodigios que la 
mano audaz del arte ejecuta en el hombre vivo trocado en masa inerte. 

Yo no podrfa en el rapido bosquejo que voy a disehar, ni ello coiulu- 
ciria a mi objeto, hacer una euumeraciou completa de los tesoros de la 
flora medica aniericana. Para obra de tanto vuelo e importancia, yo 
habria necesitado un tiempo y unas facnltades de que no he podido 
disponer. Solo preteudo citar, a manera de muestras, y como estimulo 
a la obra de mis aulielos, sus principales plautas mediciuales conocidas, 
para llegar a mi objeto principal, cual es invitaros a explorar la floia 
aniericana, desentranar las riquezas ignoradas en que ella abunda, para 
gloria y provecho de la America y beueficio y satisfaccion de la hu- 

En las naciones del sur, Chile nos da, entre otras, la Quillaya sapo- 
naria, tan util en las afecciones bronco pulmouares, como neCesaria, 
merced a sus especiales propiedades emulsiouantes; y el holdo, Boldea 
//Yfr/rrt».s\ de Ju.ssieu, Fccunnus Z>o^r/o, de Molina, con sus principios exci- 
tantes auu no del todo estudiados y su accion beiicflca, ya general- 

* Cecilio Acosta. 


mente renonocida, en las afecciones del higado y de las vi'as grnito uri- 

El Paraguay y Uruguay nos dim la contrai/erba, que quiere decir 
antkJoto, plauta del geuero Dorstenia, que a sus efectos touicos y esti- 
mulantes une los muy notables antisepticos; y el mate, Ilex paragua- 
yensis, sustituto americano del te cliino, igual 6 dste por sus ijropieda- 
des excitantes y su aroma, el compafiero inseparable del peaton viajero 
y el tonico cardiaco que compite con la cafeina y la teina. En tanto, 
la Republica Argentina nos sumiuistra, como espeeialidad digua de 
mencion, el quebracho, Aspiflospcnna quebracho, la digital del pulinon, 
como se ha llamado por sus propiedades eupneicas, y todavia no eiito- 
rameute en say ado, 

Mas al norte, Bolivia y el Peru dan (x mAs de la quina y la coca, quo 
por si solas son dos mouumentos de la terapeutica, la ratania, del ge- 
nero Krameria, el precioso tonico astringeute descubierto \>ov Ruiz en 
las tierras arenosas de las cordilleras perii-boliviauas; el matico, Piper 
anfiusti/oUum, de Ruiz y Pavou, cuyas propiedades heuiostatieas y 
antiblenorriigicas le ban asignado puesto de alto valor en terap('niti<'a; 
y el coto, con sus derivados alcaloidicos, que en las afecciones gastro- 
intestinales suple con ventajas al opio, al tauino y a los demas astrin- 
gentes vegetales reunidos. 

Y el Brasil, la tierra de la ipeoacuaua, sumiuistra tanibien el jabo- 
randi, PUocarpus pennatus, linico en su accion conibinada de eliinina- 
ciones por las vn'as salivares, cutanea y urinaria; la PaulUiiia sorbilis, 
(pie reune en alto grado las propiedades dc la cafeina yeltanino; la 
pareira brava, de propiedades al niismo tiempo diureticas, emenagogas 
y febrifugas y los berros del Para, Spila7ithes oleracea, excitaute y anti- 

De los paises de la Antigua Colombia, el Ecuador sumiuistra la .4w- 
brosia artemiswfoUa, cuya multiple accion estimulante, emenagoga, 
antihelmintica y antiiiisterica, es explotada (i diario en el pais de su 
origen; el paico, 6 te de Espana, Chenopodium ambrosioidcs, que reem- 
plaza al verdadero t6 y se utiliza en medicina por sus virtudes como 
sudorifico y diuretico, tonico estimulante, carminativo y antihelmintico 
seguro; en fin, la guayusa, tan reconocidapor el vulgo como eficaz en 
las perturbacioues dolorosas del aparato digestivo, que alii es fre- 
cuente decir: "Nadie so muere aqui de colico porque tenenxoii guayusa.^^ 

Y la Republica de Colombia, el fiimoso condurango, Gonolobus cuudu- 
rango, que un tiempo desdeiiado por motivos de errores en la eleccion 
de la plauta, aliora i)arece renacer con major credito para combatir las 
lesiones sifiliticas y cancerosas; el ccdr6n,simaba,6 Quassia cedron, tan 
celebrado como especifico contra las mordeduras de las culebras veue- 
nosas y contra la rabia, y que aiin conserva su reputacion como febri- 
fugo y estomaquico; y el palo matias, Croton malambo, cuyas virtiules 
medicinales de alto renombre entre los nacioenals, merecen estudio 
especial y el puesto d que lo hacen acreedor en terapeutica. 


Mejico y las iiaeiones de Centro Aoierica son taiiibieii ricas en plantas 
niedicinales. En estas abundau las mejores especies de Smilax, zarza- 
pariilla, liarto conocida, y cuya fa«ia raya en las alturas de uu especi- 
fico vegetal; ellas comparten con la Republlca de Colombia la principal 
produccion de los balsanios llamados del Peru y del Toln, Myroxilon 
toluifera j pereirw, que estan a la cabesa de las drogas balsamicas 
empleadas en medicina, y de ellas sale la famosa madera de campeche, 
Hematoxilon campechianuni, tan usada en la farmacia como en la 
industria, por sns propiedades tanicas y colorantes. 

Una de las ciudades de Mejico le da nombre a una planta de frecnente 
uso, la jalapa, JExogomum pnrga; en su suelo se cultiva el obligado 
corapaiiero de la zarzaparrilla, alii tambien comiin, el Sasafras offici- 
nalis, si decaido ya como antisifilitico, ensaj^ado recientemente por las 
propiedades estimnlantes de su aceite eseucial, antiseptico respira- 
torio al mismo tiempo; la cebadilla, Veratrum officinale, fuente de la 
poderosa veratrina, antitermico y analgesico y usada por el vulgo como 
inmejorable insecticida en todas las enfermedades originadas por los 
parasitos, tan abuudautes en nuestras comarcas; y el tlanepaqnelite, 6 
yerba santa, Piper sanctuum, recientemente estudiado por Don Jose 
T. Barriga, y en cuyo aceite esencial ha encontrado un anestesico 
local, y un antiblenorr^gico, usado en forma de agua destilada. 

Por su parte, el arcliipielago antillauo noescasea suconcurso: ahi se 
produce el lecolizo, Garica papaya, de donde se extrae la papaina, tan 
iustamente celebrada, que disputa su antiguo predominio a la pepsin a 
animal; las diversas variedades de quassia, y de simaruba, la Quassia 
amara, la Quassia simaruha, la Picrena excelsa y la Bittera febrifuga, 
cuyas virtudes las liacen recorrer con brillo la escala de los amargos, 
recomendilndose como febrif'ugas, antidispepticas, neuromusculares, 
parasiticidas e insectifugas ; la Piscidia erithrina, que aun no ha sido 
bien estudiada, como sedante, liipnotica y analgesica, y la cascarilla, 
Groton elutheria, excitante, diaforetica y antiemetica; la Asclepias 
curassavica, catartico, emetico, bemostatico y autihelmintico ; la 
Marantha arundinacea, 6 arroicroot, analeptica; el Gapsicum annuum y 
el fastigiatum y mucbisimas otras que, utilizadas empiricamente por 
el vulgo, estdn esperando la mano de la ciencia, que las saque ^ lucir 
sus calidades ai'm ocultas. 

T regadas en toda esa extension de la America tropical, de quien 
dijo nuestro gran poeta A. Bello, 

fecuuda zona, 

Que al sol enamorado circuuscribea 
El vago curso, y ciiauto ser se anima 
En cada vario clima, 
Acariciada de en luz, concibes ; 

entre los linderos de esa esplendida zona, desde los Estados Meridio- 
nales de la gran Republica ISTorte- Americana, hasta el corazon de Sur- 
America, la rica naturaleza ecuatorial derrama sus tesoros para la 


iiicdiciua, eiitre los cuales sobresaleu, a inds de los ya iiorabrados, el 
(joffea arahi(j((. oiiginario de otro suelo, pero acliniatado veiitajosaineiite 
en el nuestro, liasta el jmuto de considerarlo como propio; el cafi^, no 
nienos litil por eimtener el alualoide del coraz6n,mas yuias usado cada 
dia en terapeiitica, que por ser la base de ese " liquido predileeto del 
poeta, del (pie careL-io Virgilio y adoraba Voltaire," como ha dicho 
Delille; el Thcobroma cacao, nUmento de los dioses, regalo de losLuculos 
y portador de ese preoioso aceite infernientescible y de ese otro alca- 
loide conoenere de la cafcina; el Manihot uiUusima., que da una sus- 
lancia alimentieia, nn eondiniento apreciado, por ferinentacion, y un 
priiu'ipio toxico, el acido cianhidrico, por niaceracion, y cuya fecula es 
la empleada en las farniacias de mi pais como sustituto ventajoso de la 
liarina de trigo; las variedades de agave, que alimenta d los indios, da 
e\ pulque al mejicano, el cucuif d los liijos de Venezuela y es diuretico y 
emena<;ogo ;'i la vez; el tahaco, Nicotiana tahacum, tan alabado, eomo 
tan deprimido, pero sienq^re sostenido en su empleo como calmante. 
liaracitic'ida, anticonvulsive), sialalogo, estornutatorio, de iiropiedados, 
en suma, tan diversas, (|ue aun se liace nccesario precisarlas y 
asignarles su legitiino valor; y el Ziiif/iher olUcinaJifi, el cnpai/eni, las 
diversas especies de malvas, y niucliisimos otros que no seria ixisible 
enumerar en este rai)ido bosquejo. 

^ Y que diremos de este dilatado territorio del norte, donde, si bien la 
naturaleza es prodiga en ofrecer, el arte es avisado para elegir y la 
ciencia avanzada para analizar y clasiflcar? 

De aqui ban salido, jiatrocinadns jior la alta autoridad de la Farma- 
copea de los Estados Unidos, multitud de plantas que sim boy tesoro, 
de la terapeutica universal y gloria de la flora americana. 

De niuy antiguo figuran eu los fornuilarios la serpentaria j In poU- 
fl<(h(,'y nnis tarde ban venido preseatandose el Podophyllum peltatum y 
el Evonimus atropurpureus, que comparten el primer puesto entre los 
colagogos vegetales de acciou utilisima eu los estados febriles de la 
zona tropical, complicadas casi siempre con congestiones bepaticas; la 
(lauUheria procumbcns, cuya esencia, si como ligero astriugeute, buon 
aromatico y poderoso antisi'qitico, presenta extensas aplicaciones, como 
la fuente del acido salicUico y sus derivados, verdaderos especificos del 
reumatismo, es un valioso recurso terapeutico; el Gelsemium semper- 
virens, preconizado en las fiebres pab'idicas rebeldes, pero no menos 
util eu las neuralgias y eficacisimo en la dismenorrea dolorosa; la Cas- 
cara sagrada, Ehummu^ pnrshianu,(\(i alta recomendacion como laxante 
y vigorizador do las iibras intestinales, el rcmedio, en (in, de la consti- 
pacion habitual; el Geranium maculatum, cuyas virtudes tonicas y 
astriugentes utilizamos a diario eu el tratamiento de las diarreas 
hemorragias; la Cimicifuga raccmosa, el suave sedante del sistema 
nervioso, alivio de los reumaticos y esperanza de los atacados de 
consuncion; el Viburnum, prunifolium, de grande utilidad en toco- 
logia; el Hidrastis canadensis, de multiple acciou sobre el liigado, 


los inrescinos y las membranas mucosas: la Lobelia iiijhtta, de tauta, 
utilidad en las alecciones espasmodieas de los broiiquios, y la Grindelia 
rohnsta, que disputa al ioduro de potasio su virtud antiasmatica; el 
Hamamelis virginica, elevado hasta el raugo de especiflco en las hemo- 
rroides y bemoiTagias; el Cactus grandiflora,Tecien introducido en tera- 
peutica y ya de grande fama en el tratamiento de las enfermedades del 
eorazon, y lasdiversas especies de Asdejriasj que pasan por diaforeticas 
y espectorantes, como el remedio de la pleuresia (pleurisy root); catar- 
ticas y auodiuas, en el reniuatismo y eu el asma; alterautes y anti- 
helinintieas; en la sifilis, la escrofula y los vermes; astringentes y 
hemostaticas, en las bemorragias y en la blenorrea, y finalmente, para 
no bacer intermiuable esta ennmeraciou, el Abies canadensis, la Sarra- 
cenia purimrea, el Arctostaphylos uraursi,el Xanthoxylum carolinianwn, 
la Leptandra virginicaj el IJrigeron phUadclphiciis y mucbisimas otras. 

Y si para cerrar ya esta rapida exposicion, pasanios a menciouar las 
plantas medicinales de Venezuela, encontraremos nn grau numero de 
vegetales ricos en propiedades curativas, que los naeionales emplean 
empirieamente con tan notables resultados, que se ban abierto cam^io 
en la profesion medica, mas sin tener aim el pase de la investigacion 
cientifica y de la esperimentacion clinica. 

Alii se da, por ejemplo, la algalia, AbeJmosclius moschatiis, almizcle 
vegetal, digno de coinpetir con el product© de la cabra abnizclera, y tan 
util en perfumeria como precioso en la medicacion estinudante y anti- 
espasmodica; la cruceta real, planta no bien clasilicada, cnya corteza, de 
un pronuuciado sabor amargo, goza de gran reputacion como estoma- 
(piico y febrifugo, sobre todo en las fiebres intermitentes inveteradas ; 
la esponjilla, Luffa purgans, energico drastico sustitute de todos sus 
congeueres y, quiza por esas mismas propiedades, empleado como 
eontraveneuo general; la escorzonera, Cranolaria annua, que nunca falta 
en las casas de unestras puerperas, auxiliar importaute en el trata- 
miento de las enfermedades de las mnjeres por medio de las i^ildoras 
to.cologicas del medico veuezolano, Doctor Xicanor Bolet, de tan to 
credito en toda la America; el guaco, Mikania gonoclada, ilf. radicans y 
M. scandcns, usado por nuestros camjiesinos para la operacion llamada 
15or ellos, ccrrarse, es decir, bacerse refractario al veneno de las culebras, 
j)or inoculaciones rep«^tidas y a dosis crecientes del jngo de la planta, 
y que aparte esa virtud no comprobada aim cientiticainente, es un pre- 
cioso tonico preferido a sns sirailares por todos los medicos venezolanos, 
en losestados supurantes; la raiz de mato, de fabulosa bistoria, Aristo- 
locliia barbata,(i\\e unea sus propiedades estimulantes las bemostaticas, 
basta ser un raediamento obligado en todas nuestras ftebres graves de 
tendencia bemorragica; el totumo, Crescentia cjye^e, cuyo frnto parece 
deber sus pro])iedades Ji un principio oleoso, nsado \\ov vulgo y profe- 
sores en los estados cronicos intlamatorios de las vias aereas; el merei, 
Anacardium occidentale, cuyo uombre va ligado en la memoria de todo 
veuezolano al del celebre uaturalista y medico de origen franceSj Doctor 


Bcaupeitliny, victima gloriosa de sus estudios sobre la elefantiasis, en 
la cual aplicaba, como cdiistico destrnctor de los tubt^rculos, el aceite 
esencial conteiiido en el mesocarpio del fruto; el yagrunio, Cecropia pel- 
tata, recomendado por el medico venezolano Doctor G. Miclielena, como 
succeditneo de la digital, y empleado geiieralinente en el asma, con un 
6xito de que puedo yo mismo dar testimonio; el hejuco de caclena, Schnella 
splendens^ y la calar/uaJa, Folypodmm crassifolinm, que no ftdtau en 
ninguno de los Jarabes llamados depurativos, con los cuales se tratnii 
y cuian en nuestros campos y ciudades la sililis y la escrufiila, sin v\ 
socoiTO de los especificos de origen inorganico; el guachamaca, Y}]tiutn 
que ha sido mny estudiada entre nosotros, sin haberse obtenido re- 
sultados contestes, pues mientras para unos es un veneno Niolentisimo, 
para otros es un remedio manejable; y la hriisc((. Cassia occidentalism la 
conf/rina,Arlstolochia ringens/A guacimo, Gna.:uma ulniifolia, el llajitcn, 
Tlaniago majoi', y la rerdoJaguilla, el torco, la alhahaca, el chiquichUine, 
hifregosa y centenaros do otras, que fuerou exliibidas en la Exposicion 
del Centenario de Uolivar, liace diez anos, en Carficas, en m'nnero de 
482 especies, entre las cuales fuerou escqjidas, estudiadasy clasilicadas 
l)or nuestro laborioso naturalista, Doctor A. Ernst, 27!> y que en gran 
niimero encontrar<Sis expuestas en un trabajo del Doctor V]. Meier Fle- 
gel, de Carj'jcas, que lie enviado a la Seccion de Materia Mcdica y 
Farmacologia de este Congreso. 

Pero no es eso todo. Al ignal do osas plantas, cuyos noml^res y 
])ro])iedades son nuis 6 menos coiiocidas, aun cuaudo no bien estndiadas. 
bay mucliisimas otras que constituyen secretos de los indigenas, tan 
maravillosos algunos de olios, que al no verlos y comprobarlos, se 
creoria superstioion de la iguorancia, engano de la especulaciun, 6 
ilusiones de la sugestion. 

Por ejemplo, ^no babois ofdo alguna vez bablar de ciertas bojas que, 
al aplicarse a la nariz, bacon brotar por ella sangre en abundancia, 
coercible instantanoamente {\ la aplicaoion de otra clase de liojasi 

Ilace ya varios ufios que un hombre inculto, muerto despuos violenta- 
mente llevando su secreto {i la tuniba, desperto una sensacion pro- 
funda cu las poblaciones del Oecidente de V^enezuela y de Colombia, 
baciendo operaciones con el cucbillo en diversas regiones, sin derramar 
sangre, mediante la previa impregnacion de la boja cortante con una 
sustanoia de origen vegetal, apollidada entonoes, i)or el nombre del 
indooto, pero curioso cirujano. licmostatico de Pcrdomo Neira. 

Yo tengo roforoncias lidedignas do un liipnotico 6 anost«'\sico usado 
por una tribu india de Puerto Kico, qne administrado internameuto on 
oualquior liquido, produce un suefio que va, segiin la dosis, hasta un 
letargo profundo, durante el cual i)ueden ])racticarse cortes y opera- 
ciones dolorosas, sin que el sujeto experimente dolor alguno, saliendo 
luego de aquol sueno, con facilidad y sin ]ieligro. mediante una ai)li- 
caciou distinta. ^^o os parooo todo eso digno de la atoncion do la 


Y aqui mismo he traido, para presentarlo 4 vuestro exainen, uu 
reiuedio que hasta hace poco lia permanecido secreto sin ser, no 
obstante, fuente de especulacion, y de cnyo maravilloso poder he sido 
yo mismo testigo repetidas veces. Yo no pretendo que querais creerme 
por mi sola aseveracion; aqui teueis la sustaucia; os ruego la espe- 
riment^is, en beneficio de la cieucia y en provecho de la humanidad, si 
vuestras observaciones (;oufirman los hechos que yo he presenciado y 
son de piiblica uotoriedad en mi pais. 

Tomad un animal cualquiera y hacedlo morder por unaculebra vene- 
nosa, 6 aguardad se os presente el caso, aiin en un ser humano; al apa- 
recer la inflamacion y la desintegracion globular, reveladas por la 
enorme hinchazon y la hemorragia por diversas vias, admininistrad 
una dosis de este agente, de cualquier modo, en agua, en cualquier 
liquido, bastaran cuatro 6 cinco granos (0.25 gr.) aunquepuede adminis- 
trarse en mayor cantidad, pues no parece ser toxico: vereis inmediata- 
mente bajar de un modo notable la hinchazon, fluyendo j)or la herida, 
sobre todo si la habeis desbridado, un liquido amarillento; cesar las 
hemorragias, restablecerse las fuerzas y a las ijocas horas cesar aquel 
espantoso tren de sintomas, dejando al enfermo en aptitud de recobrar 
todas sus actividades. 

Sabeis que en Venezuela abundan las culebras venenosas, como las 
varias especies de cn^cabel {Crotahis liorridus j otvas) la tigra {Gras- 
indocepliahis atrox), la mapanare {Lachcsis mutuus), la coral [Helax 
coraJinns) y algunas mas de dificil estudioj pues bien, yo puedo testi- 
ficaros una multitud de casos, de hombres y animales domesticos mor- 
didos por estos ofldios, que han recobrado la salud en i)oquisimas horas, 
merced al beneficio de este medicamento prodigioso. 

Os dire mas : no hay en Mariches y Petare, sitios inmediatos a 
Caracas, camiiesiuo, cazador, 6 hacendado, que no conozca 6 lleve 
siemx^re consigo, en sus escursiones, esa sustancia, que en honor del 
agricultor que la descubrio, es llamada geueralmente el remedio de 

Este remedio parece ser el bulbo desecado de una planta anual, de 
la famalia de las Aroideas, probablemente una alocacia, 6 quiza la 
Acontias IteUehorifolius, que se marca durante el periodo de su vida en 
que brotan las hojas, para ser arrancadas en el perfodo de su seque- 
dad, cuando toda las savia se ha reconcentrado en el rizoma, couser 
Vi'indose como producto seco y faciluiente reductible a polvo. Esa in- 
vestigacion, sinembargo, esta aiin por hacerse. 

Si, pues, tantas y de merito tan notable son las plantas medicinales 
americanas; si solo falta, a fin de asignarles su valor real, analizarlas 
para separar lo iitil de lo superfluo, eusayarlas para precisar sus pro- 
piedades y entregarlas al arte para que les de forma, aprovechemos la 
favorable oportunidad que nos ofrece esta congregacion de medicos, 
para emx^render esa tarea, que reflejaria luz de gloria sobre el j)rogreso 


cieiitifico del Niievo Muiido y ariojaria torrentes de consuelo sobie la 
ti'iste liniiiaiiidad. 

Yo qiiisiera vcr sui\i;ii' <le e.ste CoiigTeso una asoriacion ameiicana 
de materia mediea y terapeutica, cou iiii (ciitro aqui, por ejeiiiplo, y 
rauiiOeaciones en todas las demas iiaciones del contiiieute, dedicada a 
explorar la flora de la America, esiudiar esas plautas medieiiiales con- 
sagiadas por la experiencia desde los miis remotes tiempos, y darle 
brillo de cieiicia y forma de arte a cuaiito hoy luce, a pesar de sii rudeza 
en manos de los incnltos liijos de nuestras comarcas retiradas. 

Y voy A terminar. Yo me diria t'eliz si al abandonar este sitio a 
que me lia traido la obseqniosidad de la Comision ()rf>"anizadora del 
Congreso, y donde la benevolencia de este resi)etable concurs© me ha 
dado alientos i)ara sostenerme, llevase la satisfaccion de no haber 
heelio propaganda inntil, y (pie mis pobres ideas y mis entnsiastas 
anhelos ban tenido eco en vuestra inteligencia y seguiran repercutien- 
dose eu vuestro espiritu. 

Que este (Jongr^^'so sea el lazo que estreche, en nombre de la ciencia, 
la gran faniilia mi'dica americaim. y ([ue esta epoca marque el })rincii)io 
de una era de progreso para la medicina en esta nueva Athuitida, con 
el auxilio poderoso de esta gran naciou, cuna y altar del primero en la 
guerra, el primero en la paz y el primero en el corazon de sus couciuda- 


September G, 1893. 

Prayer by the Very Tvev. P. J. Garrigoii, d. d., vice-rector of tlie 
Catholic University of America. 

lu the name of the Father and of the Son and of the Uolj^ Ghost. 
Amen. O almighty and eternal God, the father of light, the fountain 
of all knowledge, and the author of every good and perfect gift, we 
otter to Thee to-day the homage of our adoration, we consecrate to 
Thy glory all the faculty of our being, and we beg Thy blessing upon 
all our labors, that they may indeed tend to the welfare of our fellow 
beings and to the accomplishment of Thy holy will which is all bene- 
ficence and love. Deign. O Lord, to direct the deliberations of this 
assembly; send forth into their minds the fullness of Thy light and 
into their hearts the outpouring of Thy love, that its members may 
learn, more and more, the knowledge of those things which it is Thy 
will their noble vocation should deal with, and that all their aims and 
purposes, in the discharge of their responsible duties may ever be well 
pleasing in Thy sight, and honorable and meritorious to themselves. 
O Savior of the world Who didst look with compassion, not only on 
the spiritual ills of thy poor suft'ering creatures, but hadst also regard 
for their bodily ailments; Who didst heal the sick and pour consolation 
in the hearts of the sorrowing, deign, we pray Thee, to bless this con- 
gress of noble men animated with the same spirit of charity towards 
suftering humanity. Fill them with Thy own Holy Spirit: tit them to 
be worthy agents and instruments of Thy merciful providence, and 
guide their deliberations this day towards wise and useful results. 
All this we ask in the name of the Father and of the Son and of the 
Holy Ghost, in those sweet, simi)le words of prayer which Thou, 
Thyself hast first taught us: Our Father, Who art in Heaven, hallowed 
be Thy name; Thy kingdom come; Thy Avill be done in earth as it is 
in Heaven. Give us this day our daily bread and forgive us our tres- 
passes as we forgive them that trespass against us; and lead us not 
into temptation, but deliver us from evil. Amen. In the name of the 
Father and of the Son and of the Holy Ghost. Amen. 

Dr. Pepper. In calling upon the representatives of the various con- 
stituent countries this morning, I take pleasure in first introducing the 
official representative from that euergelic Kepublic to the south of us, 
Guatemala, Dr. Juan Padillu. 

S. Ex. 3G 6 ^^ 


Dr. Padilla. Mr. rrcsident, ladies and ffeutleineii: Since Secre- 
tary-Gciieial J)r. Eecd notified me that 1 had to speak before you, I 
liave been in doubt whether I ou<>ht to do it in my mother tongue or in 
English. I fiimlly made up my mind to address you in the latter, 
hoping to obtain your kind indulgence. 

So much has been si)oken, and so ably, about the importance, tlie 
beneficial results of the Pan-American Medical Congress and of the 
well-deserved praise due to the initiators of the great idea, that it 
would be too daring on my part to pretend to add anything on the 

I come from Guatemala as a delegate of its Government, and in its 
name and in my own I give my heartfelt thanks to the American peo- 
ple and their worthy President for their kind invitation so cordially 
extended to their little sister Kepublic. 

In Latin America, and I speak more especially of my own native 
Guatemala, Paris, looked u[ton as the iMecca of our i)rofession 
by all our medical aspirants; but, without wishing to detract from the 
importance of Paris, 1 must say that the time has come when the young 
student of medicine from the Latin-American liepublics should seek 
the light of the new Mecca of tlu' Western hemisphere. 
• The actual President of my country feels proud whenever he has the 
occasion to state that he received his military education in the United 
States. Besides that, his wife is a beautiful and estimable daughter of 
this privileged land. 

These two motives will serve, I hope, to strengthen the sympathy 
and good friendship now existing between both republics. 

Before concluding allow nie to express my regret that I bring no 
contribution for your transactions. I anticipate, however, that 1 shall 
not return to my liome empty handed, but laden with the offerings of 
science and hospitality from the great Pepublic and her citizens. 

Dr. Mendi/.abal, of Vera Cruz, responded on behalf of Mexico. In 
tlie course of his remarks he spoke of the great enthusiasm with which 
the medical profession of Mexico had met the suggestion of a Pan- 
American jNIedical Congress; how cordially it had responded to the 
invitation to send delegates to this meeting. There were many interests 
in common between Mexico and the United States, and these interests — 
mercantile, commercial, educational, and sanitary — will be largely pro- 
moted by the deliberations of this Congress; but over and above all 
will be prized by the Mexican delegates the warm friendships which 
this meeting has already engendered. He referred to the leading 
position the United States always took in advancing the dilierent sci- 
ences. The progress of this country in medicine he noted at length. 

The United States is the elder sister of Mexico in medical learning. 
While Europe is spending millions on discovering the best engines of 
war, the United States is siiending its coin in furthering the diflferent 


He expressed the hope that a great deal of benefit would accrue 
from the meeting. 

Dr. Pepper. I have pleasure in introducing; Dr. Luis Gilles, of 
Port an Prince, who comes to us as the representative of Haiti : 

Dr. GiLLES. Mesdames, Messieurs, M. le President et honores con- 
freres: Le Gouvernement de son Excellence le President Hyiipolite et 
le corps medical d'Haiti auxquels vous avez fait I'honneur d'inviter a 
prendre part an meeting du Pan-Americain Congres, nous deputent 
aupres de vous pour vous exprimer en cette circonstance leur x)lus 
grande et leur plus sincere felicitation. L'idee que vous avez concue 
de vous reunir en congres medical est noble, et elle est largement 
partagee chez nous. 

Nous avons le ferme espoir que votre obuvtc grandira et se retentira 
dans le monde entier. 

Aussi, n'avons nous pas besoin d'ajouter, M. le President et honores 
confreres, que nous nous tenons li la disposition du congres jjour tons 
les renseiguements dout vous pouvez avoir besoin sur la medecine et la 
chirurgie d'Haiti. 

Dr. Pepper. The next gentleman to bring us greetings is the oflicial 
representative from the ancient Republic of Peru. You will now hear 
from Dr. Manuel A, ]MuSiz, surgeon- general of the Peruvian army. 

Dr. Mu!^iz. Ladies and gentlemen: The Government of Peru, in ac- 
cepting the gracious invitation of the United States Government, has 
appointed me its official representative in this first Pan-American Medi- 
cal Congress, and I have great pleasure in giving public expression in 
its name, and in the name of the Peruvian Medical Corporation, to the 
feelings of friendship and good will entertained by the Peruvian people 
toward their great sister Republic, whose advancement and welfare they 
so fervently desire. 

I believe, furtlier, that this first Pan-American Medical Congress will 
aid the scientific fraternity of both Americas to accomplish fruitful 
results, on all the fields opened to our noble profession, for the benefit 
of mankind. 

Then followed a general address by Prof. Rafael Lavista, M. d., city 
of Mexico, Mexico. 

(Copy of the address of Prof. Lavista, of Mexico, has not been fur- 
nished for publication.) 

Dr. Pepper. One of the distinguishing features of this meeting has 
been the earnest efltbrt our friends have shown to display their interest 
and participate in our work by acquiring such a gratifying knowledge 
of our language. It is not a small matter, for there is likely to grow 
out of these meetings a more rapid spread of the use of English as the 
means of international communication. I feel, however, we trespass 
somewhat on the intelligences of these gentlemen by limiting the 
announcements to English. You will therefore bear with me for 
repeating the announcements in French. 


I am instrufted to ofter the following resolution : 

liesolved, That in view of the iini)ortanee of takin;^- the necessary steps 
to insure the continuance and transaction of the great continental work 
of this congress, the international executive committee is hereby 
emjwwered and requested to appoint suitable iuternational committees 
on the subject of the proper governmental recognition of State pre. 
ventive medicine, ui)on a uniformitj^ in American pharmacology, upon 
the subject of medical education, and upon such other subjects as may 
be in harmony with the general purposes of the congress. (Kepeated 
in French.) 

This subject is before the congress for action, for its discussion, or, 
if it meets the approval of the body, it will be put immediately to a vote. 
The idea is that this great meeting, which has been called together at 
such great effort and cost, shall not fail of definite results. The execu- 
tive committee will no doubt report before we adjourn some recom- 
mendation for a sec^ond meeting, where aiul when, but in the interval 
between that time and this a feeling exists that there slionld be some 
mechanism started to insure continuous results. Of course this carries 
with it no appropriation of fuuds, and therefore does not compromise 
this meeting or the successive meetings. If the gentlemen find it nec- 
essary to spend money, they must get tlie money to spend. A motion 
to adopt the resolution was then put and carried. 

Then followed the announcement of the committee of arrangements, 
by Samuel S, Adams, m. u., chairman. 

Kesolutions which had been adopted by the section on hygiene, 
climatology, and demography were then brought before the general 
session, and referred to the international executive committee. (See 
report of the international executive committee for copy of resolutions.) 

An invitation was then extended to the members to visit the Museum 
of ITygiene. (Kepeated in French.) 

The chairman of the committee of arrangements then stated that 
the hos[)itals, both special and general, were open to the members. 

The following resolution Avas reported from the section on hygiene, 
climatolog}^, and demography, indorsed by the section on railwjtiy 
surgery for the action of the whole congress : ^ 

Resolved, That in the opinion of the section on hygiene, climatology and deuiog- | 

raphy of the Pan-American Medical Congress the interests of the pnblic health in 4 

every country should be and must be intrusted to a department of the government ■ 

especially charged with their administration; and that, while the precise form of 
administration may be left to legislation, the indispensable requisites are that it ^ 

shall be natiouul, that it shall have parity of voice and influence in the national 
councils, that it shall have independent executive authority under the limitations 
common to other departments, and that it shall be intrusted to educated and exper- 
ienced medical men, who alone are competent to assume its responsibilities. 

The resolution was referred to the international executive conunittee, 


The following resolution was tlieu iutroduced by John A. Larrabee, 
M. D., of Kentucky: 

Itcsolvt'd, That the Pan-Americ;in Medical Congress has learned with extreme regret 
of the painful accident which befell the Hon. John W. Ross last night, and enter- 
tains the hope that he will be speedily restored to health. 

Dr. John A. Larrabee, of Kentucky. Mr. President and members 
of the Pan-American Medical Congress: It has been, but twenty-four 
hours since we listened to the eloquent and earnest welcome delivered 
to us by Commissioner John W. Koss, on the behalf of the District of 
Columbia. Before his words of greeting" "could be read by the thou- 
sands, the honorable Commissioner was stricken down by the most 
appalling accident, and now lies upon a bed of suffering in jeopardy 
of his liie. '' Thus in the midst of life we are in death." I therefore 
move that we, the members of this congress, do hereby express our 
profound sympathy with his sufferings and our earnest hope for his 
recovery by the adoption of the resolution which I have presented. 

Unanimously adopted. 





Metzerott Hall, Srpfnnhrr G. 1^0o. 

address by the president of the congress, prof. william 
pepper, m. d., ll. d., philadelphia, pa. 

Gentlemen of the first Pan-American Medical Congress: 
Tin's occasion is an nniqne one, and tlio tlionjilits wliicli force tlieniselves 
on the miiidsof all ol lis are, I am convinced, so similar that the briefest 
greetin<i' might well seem the most titting address, JJnt when 1 retlect that 
I stand here to represent the original committee appointed in pursuance 
of the resolution which was adoi)ted unanimously on May 5, 1891, at 
the meeting" of the American Medical Association, and that this reso- 
lution extended a cordial iuvitati(m to the medical jnofession of the 
Western TTemisphere to assemble herein a congress, I realize the unusual 
dignity of the duty I must discharge. If anything could add to the 
dignity of this assemblage, which for the first time asserts formally the 
organic union of the pliysicians of all America, it is the fact that the 
Congress of the United States, impressed with the importance of our 
proposed meeting, passed a joint resolution (July 18, 1892) requesting 
the President to extend those invitations in response to which we wel- 
come the presence here of official delegates from all the Governments 
of the Western Hemisphere. In like manner are the several States of 
our own Fnion, the principal municipalities, and many of th*; leading 
educational institutions, both of North and South America, represented 
otticially. You will not, then, think it strange that, called upon to 
address such an assenddage in this Columbian year, it should seem less 
fitting to dwell upon any technical topic than to turn our thoughts to 
the state of this continent and of its aboriginal inhabitants at the time 
of its discovery by Columbus, and to the obstacles which opposed him 
and the great men who comi)lete<l his Avork. For these have had a 
bearing on the racial developments which have since occurred here, 
and sliould be held in mind in any estimate of the i^rogress we have 
made during the subsequent four centuries. The state of medical sci- 
ence in Euroj^e at the time of the discovery, a,nd the spirit which has 
controlled its subsequent course, are fitly to be studied in connection 
with what avc have accomplished during the same period and with the 
opportunities which present themselves to us at this time. 

The recognition of the appropriateness and importance of this great \ 

meeting has been immediate and universal. International although it 
is, the basis of its organization and the special features which mark it 
remove all possible suspicion of an imitation of, or of interference with, 
the great International Congress whose successive meetings form a 


crescendo scale of scientific and administrative trinmplis which the 
medical profession of tlie worhl regards with justifiable pride. 

Onr execntive committee and our efticient geneial secretary, to 
whose unselfish energy and masterly powers of organization we owe a 
great debt of gratitude, studiously avoided the possibility of any such 
interference by delaying the selection of a date for our meeting until 
that of the Congress at Eome was announced, and by then adopting a 
date which not only permitted but encouraged the presence later at 
Eome of those who should gather here. I can only add my deep 
regrets that the unhappy reappearance of cholera in southern Europe — 
striking example as. it is of the urgent importance of the very work 
which calls us together — has necessitated a. postponement until next 
spring, a postponement which, however, there is no reason to fear will 
lessen the complete success of the meeting on its newly announced date. 
The International ^Medical Congress is, indeed, a splendid demonstration 
of the solidarity of the profession and of the world-wide scope of the 
objects we pursue. 

This congress reiirescnts much more, however, than our common 
interest in medical science and the common feeling of brotherhood 
which animates the entire profession. It is, indeed, it always has 
been, and forever may it so continue, the glory of the medical i)rofes- 
siou that their allegiance is one and undivided, for tlieir service is 
solely in the cause of truth and humanity. Dynasties have risen and 
crumbled; the map of the world has been changed times almost with- 
out number, but the nmrch of medical science through the ages has 
been ever onward and upward towards those lofty goals — the pre- 
vention of disease, the relief of auflering, the imi^rovemeut of the 

For us who jneet here there is all of this glorious recollection and 
animating purpose, and there is much more to unite and to inspiie us. 
We meet under the shadow of giant conceptions, as old as Aristotle, 
which agitated the minds of the great thinkers of antiquity, and were 
but slowly approaching a definite form when the. sublime faith and 
genius of Columbus solved the problem of the globe. 

It is true that this vast American continent, with its in,.")00,000 
square miles of territory, already numbers 110,000,000 inhabitants, 
embracing all types of human life and many varieties of x»olitical 
organization. But all that has yet been accomplished is but the feeble 
beginning of the development which awaits us. When Canning 
secured the recognition of the re])ublics of South America he boasted 
that he had called the New World into existence to redress the balance 
of the Old, and yet the luminous suggestions of Franklin, of Bolivar, 
and of Blaine as to the political and commercial relations of the coun- 
tries of the Western Hemisphere are still only x)rophesies which mu^t 
long await their fulfillment. 

The destinies of nations are slowly evolved, and occurrences which 


fill the horizon of a generation appear to the broad gaze of history as 
mere features in the great jtanorama of the ages. 

Even a i)eriod of four hundred years is but a fraction of the history 
of Spain, of France, of England. Yet four hundred years ago this 
entiie continent was not only undiscovered and unknown, but its very 
existence was unsuspected save in the ingenious speculation of ]»lii- 
losophers. \Vc recall the familiar but ever interesting Hues of Seneca — 

Vciiient anuis SiPcnla seris 
Qiiibns Ocpaiius vincula rcrnm 
Laxct, ct iiigcns i)ati'at tolhi.s, 
Tijiliys que uovos tlctcgat orbcs 
Ni'c sit ti'iris nltinia TIiiilo — 

and do not marvel that their strain of glowing conviction should have 
led Cohnubus to write them out twice over in his "Profecias." But 
all the same, this New World lay shrouded in the obscurity' of tlie 
great Sea of Darkness, cut ott", as we have since learned, from the 
known inhabited world, by changes wrought in remote geologic eras, 
:ind waiting the fullness of time whi(di should lead the inspired genius 
of Christopher Columbus to seek the east by sailing west. \\'e now 
know that in his quest of a western i)assage to Asia he reached the 
eastern shore of this continent on October 12, 1492, but even to the 
time of his death, on January 20, 150(1, neither did Columbus nor any 
voyager or writer have any conce])tion of the vastness and real sig- 
nificance of his discovery. All tliat the geogra]thi<'al knowledge of 
the day enabled them to grasp Avas the belief that Columbus had 
found a new route to the Indies by sailing- west. Within a few years, 
liowever, the daring sailors of Spain and Portugal, of Italy, and of 
ICngland i)ushed their voyages along the coasts. 

The astonishing discoveries of Americus A'espucius on his cele- 
brated third voyage in ir)01-'02, when between Lisbon and the island 
of South (-leorgia he traversed an arc of 93°, led him to apply for the 
first time to this continent (it really was South .Vmerica of which ho 
spoke) the title of New V/orld {Muudus Xovus). It concerns us not 
to consider further how, by no intent or design of Vespucius, por- 
tions of South America at first, and later the entire continent, came 
after his death to be named after him. Yet when a few days ago 
1 held in my hands the little quarto published in ir>07, in which 
Prof. Martin Waldseemiiller. of the College of St. Die in Lorraine, 
first suggests the name America, in utter ignorance that the coast 
explored by Vespucius was continuous with or even related to the *, 

land discovered by Columbus, I could not help smiling sadly at the ■ 

frantic and fruitless efforts we make to secure immortality by our 
petty observations, while here Fame, in strange whimsey, threw her 
laurels for the greatest discovery ever made around the head of one 
who neither had nor preferred a claim to it. 

Geology and paleontol(>gy have taught us that this so-called New 



World is, ill reality, in a scieutiflc sense, better entitled to the name of 
tlie Old World. The oldest known strata have their widest develop- 
ment on its snrfuce, and animals, such as the horse, which are said to 
have been introduced after 1492, are shown to have had their original 
habitat here and to have migrated hence to Europe, so that Cortes and 
Pizarro only reintroduced them to their lV)rmer home. It is more impor- 
tant to recall the fact that the entire stretch of North and South America 
was, at that date, 1492, peopled more or less thickly with the descend- 
ants of tribes who had resided here from very remote antiquity. 

A high authority assures us that the number of these aborigines w^as 
probably from twelve to fifteen millions, and in sjnte of considerable 
differences in physical appearance, as between the Iroquois of New York 
and the Aztecs of Mexico or the Incas of Peru in dialect and liabits, it 
is generally conceded that this vast aboriginal population, of North 
America and South America alike, with the exception of the Eskimos, 
belonged to one great race of red men.* 

In regard to the Eskimos, the iiolysynthetic or incorporati ve character 
of their system of word-building, in which they resemble the other 
aborigines of this continent, does not seem sufficient to counterbalance 
the marked dissimilarity in physical characteristics, and, still more, the 
strong chain of evidence which goes to identify tbem with the extinct 
CaveMen of Western Europe. Prof. Dawkins(" Early Man in Britain''), 
has es]>ecially developed this important argument. So striking is the 
resemblance of recent Eskimo remains to those in the Pleistocene caves 
of France and England, that they are pronounced by competent authori- 
ties to be indistinguishable. The extraordinary talent of the Eskimos 
for the artistic sketching of men and beasts is unique among savage 
peoples, with the single exception that among the remains of theEuropean 
Cave Men many sketches, showing a similar talent, have been found. 
The musk-sheep, which were the inseparable attendants of the Cave 
Men, no longer exist save in subarctic America among the Eskimos, but 
the fossilized bones of these animals "lie in a regular trail across the 
Eastern Hemisphere, from the Pyrenees through Germany and Eunsia 
and all the vast length of Siberia." 

Eskimos and Ked Men alike seem to have migrated to our continent 
at one time, or more probably in successive waves, in the remote i)ast, 
either when the northwest corner of America was joined to Siberia by 
the elevation of the area now known as Bering Sea, or when the lofty 
submarine ridge which now passes from France to Greenland was 

* It is evident that tlie word race is used here in its broad ethnical sense. The 
English, the French, aud the Greeks arc drtferent branches of one race from this point 
of view. No doubt, as John Fiske observes, "the Mexicans encountered by Cortes 
differed from the Iroquois encountered by Cham plain as much as an Englishman 
differs from an Albanian or a Montenegrin," but wheu we are contrasting aboriginal 
Americans with white men or yellow men, it is right to say that Mexicans and Iroquois 
belong to the same groat red race. 


elevated so tliat it would he possible to travel on foot from "Kmope to 
America. If the attemj)t be made to decide at what x)eriod of geolo<4:i<; 
time such immigration occurred, and whether in one great migration, 
or, as seems most probable, in successive waves, problems of extreme 
if not insurmountable difficulty present themselves. 

The aborigines who were living on this continent at the time of its 
discovery by Columbus presented, it is true, considerable differences in 
the stage of development they had reached, as well as in their language 
aiul even in their appearance. There are long inteivals of social develop- 
ment evident between the squalid sty of the ("alirornia savage, the long- 
house of the Iroquois, and the great structures of Zufii, of Tlascala, or 
of Uxmal. Yet in them all can be demonstrated an underlying principle 
of adaptation to a certain mode of communal life such as all American 
aborigines are believed to have practiced. 

All atteni])ts to distinguish the existence of special races, as of the 
mound-))uil(lers, ha\ e broken down in the light of critical stinly, and 
the i)owerful arguments of philology confirm the results of zoological 
study as to the essential unity of the American red race. The tribes 
in different parts of this vast territory certainly ])resented marked dif- 
ferences in physical ap])earance, and our ethnological collections 
show that as regards size and weight of frame and shape of skull con- 
siderable variety existed among them. But all ])ossesse(l the cinnamon- 
colored or copi)er-colored co)nple.\i()n, the high cheek bones ami snmll, 
deep-set eyes, the straight black hair, with scanty or absent beard ; and 
the conclusion of the most comjietent authorities is that no sufficient 
differences, physical, linguistic, or social, existed to invalidate the evi- 
dence in favor of the unity of the race. 

Importunately we are not called on to attempt to read the geological 
record. For our purpose it is indifferent whether all the relics of the 
ancient Americans are of the neolithic tyjie, or whether the apparently 
plausible claim be ultimately established that i)aleolithic remains are 
also IouihI ill various places. This, at least, we know, that the soil and 
climate had shown themselves favorable to the development of a popu- 
lation already numerous, vigorous, hardy, and enduring, and brave and 
warlike, though often cruel, and evidently advancing in social develop- 
ment, though at very different rates at different localities. Ignorant 
as we are of their ])rimitive origin, it is doubtful if the most earnest 
advocate of the monogenist* view that all mankind was originally 
descended from one pair, will urge that our aborigines were descended 
from a single couple, or eveu from a few boatloads of Asiatics acci- 
dentally carried to our Pacific coast, or that we shall hear again the 

* As is well known, the tendencies of natural science are strongly towards this 
view. Philologists seem disposed to agree that on account of the mutability of 
language, especially when unwritten and while in its earlier stages, no conclusion 
adverse to the monogenist doctrine can he drawn from the diversities of siiccch now 
existing, or that are known to liavc existed at any past time. 


arg:umeut.s drawn from the many striking resemblances between the 
myths, languages, customs, or haud-wrought objects of the aboriginal 
Americans and of various Oriental nations. The surprise which, I am 
sure, all of ns have experienced at these resemblances must be checked 
by these two thoughts, so well expressed by Fiske and by Lubbock, 
respectively, that one of the most important lessons impressed on us 
by a loug study of comparative mythology is that human miuds in 
different parts of the Avorld. but under the intluence of similar circum- 
stances, develop similar ideas, and clothe them in similar forms of 
expression; and again, that different races in similar stages of devel- 
opment often present more features of resemblance to one another than 
the same race does to itself in different stages of its history. 

An immense amount of sympathy has been expended upon the cruel 
treatment of the American aborigines by the European invaders. Of 
course it was the sad old story, so ol'ten repeated, whenever a better 
armed and more highly civilized power has come into contiict with a 
primitive, ignorant, and ill armed people. 

Over the ghastly j)icture of Indian slavery one would indeed wish to 
draw a veil, though its darkest shadows are relieved by the splendor 
of the character and labors of the illustrious Las Casas, and by the 
enlightened action of those great men, Emi^eror Charles V, Pope Paul 
III, and Cardinal Ximenes. P>ut it is a romantic extravagance to 
deplore the destruction of any system of government or society which 
existed in 1492 in any part of the continent.* 

* It may not be amiss to give here a brief abstract of the ingenious method sug- 
gested by the bite Lewis Morgan, of Rochester, N. Y., for gauging the real status 
of primitive peoples in an ethnical scale. It is obvious that any such scheme will 
be open to criticism, and it is not surprising that archajologists are divided as to 
the merits of this particular plan. 

The ethnic stages, according to Morgan, are savagery, barbarism, and civilization, 
and in each of the lower two stages there are three subordinate periods. 

The distinction between sa\agery and barbarism is marked by the point where 
the manufacture of pottery is begun. In the lower status of savagery men lived in 
their original restricted habitat and subsisted on fruits and nuts. Articulate speech 
may be supposed to have begun in this status. All existing races of men had passed 
beyond it at an unknoAvn antiquity. 

In the middle status of savagery men had learned how to catch fish and to use 
fire. My friend Dr. Lumholtz lived many mouths among the cannibal tribes of 
Australia, who are in this status. 'J he invention of the bow and arrow marks its 

The upper status of savagery, in which some of the lowest American tribes still 
continue, such as the Athabaskans, of Hudson's Bay, and the Fucgians, ends, as 
above stated, with the invention of pottery. Such tribes as the above know nothing 
of horticulture, make no pottery, and depend for subsistence entirely on bread- 
roots, fish, and game. They have little or no village life. 

The lower status of barbarism exhibits the domestication of animals other than 
the dog. In 1492, except in Peru, the dog was the only animal domesticated by any 
of the aborigines. Indeed, the absence of domesticable animals is pointed out by 
Fiske as important among the causes which retarded the development of the Ameri- 
can Indians. The horse, which is shown by fossil romains to have existed in six or 


If tlic i^roseiit state of the native Indian pojjulation in Xortli and 
Sontli America is I'ar from satisfactory and fails to fnltill tlie promise 
shown, especially in South America during' the first century after the 
conquest, may this not fairly be attributed to unwise lejiislation by the 
ruling- nations, to the absence of continued, effe('tive religious instruc- 
tion, and to the base cupidity which has led us to promote the fatal 
passion for stiiuuhints, so common among barbarous people? There 
seems no sulHcient evidence to make us lose hoi>e that the remains of 
the aboriginal Anunicaus may, nmUn- more wise and equitable treat- 
ment, gradually develoj) into useful citizens of our republics and be 
capable of wholesome assimilation with the body of the ])opulati<m. 

It is easy to assert and Imrd to disi)rove that the develoi)ment ot 
the red race ou this continent was progressing slowing jirior to ]4!>L'. 
As a matter of ftxct, we do not possess the data, either about their 
early history or about the primitive coiulition and rate of development 
of any of th(^ more civilized races, to j)ennit us to institute a comi)ari- 
son. Our eailiest knowledge of the ancient J'.gyptians, for instance, 
reveals them living in a state of civilization already advanced at least 
a full ethnical period beyond that even of the Aztecs. How many 
centuries had elapsed while the successive stages of savagery and 
barbarism were passing in lOgypt can never be even surnnsed. Tiiere 
seems no reason to doubt that, had America not yet been discovered. 

seven species, had liccoint' extinct, :m<l was reintroduced liy tlie invadors. The 
ro{;ii]ar omployincnt of tillage with irrigation, and the use of ailohe brick and stoue 
in architect ore, marked the end of the lower status of harliarisni in America.. 

The middle status ot" barbarism was marlied in the Eastern Hemisphere by the 
domestication of other animals than the dog, and tlierc. as well as in the Western 
ITcmisphcre, by the ih'velopmcnt of irrigation in cultivation, and the us«* of brick 
and stone in building, by great imiirovemcnt in the manulViclure of st(me imi)le- 
ments, and, ultimately, by the introduction of implements of copper or of bronze. 

Tlie middle status may be regardeil as ending with the discovery of the process of 
snudting iron ore; and this process becomes more and more important through the 
upper status of barbarism, and is linally associated with the production of written 
records by means of a phonetic alphabet or of advanced hieroglyphics. 

It is held by those who favor this classitication that it renders the scientilic com- 
parative study of primitive peoples vastly easier than previously. It assigns defi- 
nite meanings and boundaries for the terms savagery and barbarism, and should 
dispel entirely the repugnance with which the latter term has often been senti- 
mentally regarded. It is numifestly impossible to determine in most cases the dura- 
tion of the several periods above enumerated. It appears clear that certain races 
have passed tlirongh some of the periods more rapidly than others, and that, again, 
certain races have been more advanced in si)ecial jioints than would acccu'd with 
the general level of their attainments by which their position in the ethnic scale 
must be determined. Among the influences which have affected the more or less 
rapid development of races the following suggest themselves: The conditions of 
soil and climate as favoring or not the accjuisition of ample and varied means of 
sustenance; the exist(^nce or not of various animals suited lor doiiiestieation, nota- 
bly the borse, the sheep, and cattle; the opportunities for contact, by migration, 
commerce, or war, with races occupying a higher ethnic scale; inherent ethnologi- 
cal defects or advantages in special races. 


there would have been goino- on here for the hist four hundred years 
a shiw and irreguhir a])proach to a liij^her social couditiou. There 
certainly is no doubt that during and since the conquest many sad 
mistakes, and not a few atrocious crimes, have been perpetrated in 
the name of civilization and of liberty. But, on the whole, the student 
of history is forced to admit the enormous advantages which have 
resulted from the concpiest by Europeans of the fifteenth and sixteenth 
centuries of tribes the most advanced of which were still in a very 
primitive state of civilization. 

I have ventured upon this rapid sketch of a familiar subject because 
it is well that we should be clear in our comprehension of the conditions 
which existed in America four hundred years ago, when the start was 
made to introduce the European races and civilizations. We meet here 
to-day to represent what these have accomplished in their new environ- 
ment during these four centuries in regard to certain highly important 
subjects. We can not fail to be interested in considering what scientific 
acquisitions in these branches were actually brought here, what dis- 
advantages were to be contended with, how far our progress may be 
regarded as satisfactory, what great questions there are which concern 
us all deeply, and in what lines of research and work we may unite for 
the common good and for the greater advancement of science. 

The words graven on the tomb of Ferdinand Columbus in the 
cathedral at Seville:* "To.Castille and Leon, Columbus gave a New 
World," are indeed true, but they do not express the whole truth. 
John Fiske well says: "The discovery of America may be regarded in 
one sense as a unique event, but it must likewise be regarded as a long 
and multifarious process. The unique event was the crossing of the 
Sea of Darkness in 1492, and no ingenuity of argument can take from 
Columbus and from Spain the glory of an achievement which has, and 
can have, no parallel in the whole career of mankind. It established a 
true and permanent contact between the eastern and western halves 
of our planet, and brought together the two streams of human life that 
had flowed in separate channels ever since the glacial period." But to 
demonstrate the magnitude of this discovery, to determine the physical 
features of this Western Hemisphere, to plant firmly the seeds of 
European civilization, demanded the heroic exertions of two full 
centuries. IsTot Spain alone, but Portugal, Italy, France, England, 
Holland, Denmark, Eussia, played their part, and the names of Cabral 
and Piuzon and Magellan, of Cortes, Balboa, and Pizarro, of Ponce de 
Leon and Soto, of Champlain and La Salle, of Drake, Hudson, Baffin, 
Davis, and Bering, must remain associated forever with this stupendous 
and progressive work of discovery. Not until 1806 was the last step 
taken by Lewis and Clarke, who then succeeded in crossingthe con- 
tinent of North America from east to west, and thus completed the task 
undertaken by Champlain iu 1608, And if the mere study of the 

*A Castilla y ^ Leon Nuevo mundo dio Colon. 


outlines and dimeiisions of America occupiexl two centuries, what are 
Avc to say of the far <j;reater obstacles opposed to the colonization of the 
vast territory, and to the determination and establishment of suitable 
forms of government, andof harmonious relations between the numerous 
States and conntries into which America soon came to be divided? 

The older ijolitical systems of Europe seem to riMpiire still the assist- 
ance of considerable artificial sui)port, and their occasional disturbances 
are of a decidedly unpleasant character, is it stranije that some of us 
still luiA'c our little unideasantnesses at home or with our neighbors, 
which indicate that the education of our people is as yet Avoefully 
imperfect in those things that most nearly concern their welfare? Of 
this, at least, we may be sure, that all that pronmtes free intercourse 
among" us heli>s on mightily t'.ie solution of these hard problems. It is 
a true saying that to know is to excuse, ami, more than this, in regard 
to nations if not strictly in regard to individuals, it may be added that 
to know is to love. We turn with (luickened interest to the sage advice 
of the illustrious Franklin, who, in 174t>, end)odied in his jdan fov the 
organization of the Uni\ersity of Pennsylvania an earnest advocacy of 
the thorough teaching of the Spanish and Portuguese tongues as likely 
to hasten the develo})ment of those close reciprocal relations which j 

he foresaw wouhl inevitably arise between the countries of the two 
Americas. The si)irit of the age as it embodies itself in our educational 
systems and in our literature, the giant forces of steam and electricity, 
as they link together the most distant points of our territory, are 
working inevitably together for the enlightenment, the elevation, the 
better mutual uiHlerstanding, and the more cordial relations of all of us. 

The year whose fourhuiulredth anniversary we now celebrate found 
the world stirred as never before. A work of tremendous importance 
for the future of the human race had been going on amid the gloom of 
what are often called the Dark Ages. The more closely this period of 
absorbing interest is studied the more do we api:)reciate the magnitude 
and the necessity of the ciianges effected during those centuries in ])re- 
paration for the splendid activities of the Kenaissance. The mission of 
the Middle Ages had been really, though not obviously, a cosmopolitan 
one, and it was fitting that the noblest achievement of the Renaissance 
should be the discovery of America. The barriers between nations 
had been lowered, and there had been going on the process of blending 
and interpenetration which was soon to be extended to this Western 
Hemisphere with such large results. The protest against mere dogma 
in religion and in philosoi)hy; the revolt against usurped and abused 
absolutism; the demand for light and knowledge and the common 
1 i gilts of humanity, these awakened then to be stifled no more, but to 
swell forever in larger utterance nntil they shall, in some yet distant 
golden time, announce universal liberty under equitable laws and uni- 
versal peace through arbitration. It is not for us to taunt the glowing 
expectations of the men of li'Jl' with their long postponed fultillmeut. 


It ill becomes us ul' to-day to speak iu other than tones of liimiility 
"Nvlien across tLe brightest sjjots of the vaunted civilization of the close 
of the nineteenth century after Christ there still fall so many dark 
shadows lingering- from the deep mediieval night. 

llo\v each generation turns aside with the restless imi)atience of 
children from the lessons of the past, and shuts its eyes to the truth 
which inexorable history calmly shows, that long periods of time are 
recpured for the accomplishment of each great advance in religious, or 
l^olitical, or social, or scientific truth. 

Yet, though we smile somewhat sadly as we read the biu'sts of enthu- 
siasm so ijleutiful at that time, we dare not challenge the fitness of 
that grand name, the Eenaissance, to the age which, through its mighty 
discoveries and the master minds who used them, difi'used among the 
nations the new conceptions of the earth and the skies, of the church 
and the state. Only the pity of it that such long centuries of travail 
must ensue between this implanting of the seed of religious and politi- 
cal liberty and the mature growth for which we still wait. 

In no respect may the discovery of America be regarded as the divid- 
ing line between the Middle Ages and the Modern Era more truly than 
in regard to medical science. In spite of the prodigious learning of the 
most distinguished Arabian and Jewish phj^sicians, such as Avicenna, 
the prince of physicians, of Albucasis, of Avenzoar, the wise and 
illustrious, of Maimonides, their medical science \vas far too largely 
speculative and philosophic. Great universities were established, some 
of which, as those of Bagdad and of Cordova, jiossessed regal revenues 
and magnificent libraries. Numerous hospitals were founded, of which 
the large and wealthy one established at Cairo in 1283 merits sj)ecial 
mention.* But the outcome of this long dominion of the Arabs and the 
Moors, so far as concerns medical science, was merely a marked advance 
in chemistry and pharmacy, the introduction of many new remedies, 
and the advocacy of the union of the natural sciences with medicine. 
Their chemistry was tinctured strongly with alchemy, their clinical 
teaching was elementary, their diagnovsis and treatment lacked the true 
Hippocratic force and directness. 

The endless speculations and metaphysical discussions of the schools 
had shown that it was not that May true progress lay. Unaided obser- 
vation had scarcely gone further iu eighteen hundred years than the 
I)oint to which the immortal Hippocrates had carried it. 

True medical science, which could not progress without precise 
methods and instruments of precision, was forced to wait until from 
very different quarters came the develojmient of the natural sciences 
and the era of exact experimentation, which alone rendered them pos- 
sible. Harvey's immortal discovery of the circulation of the blood was 

*Tlie first hospitals, in onr sense of the term, were prohahly foiiutlecl ahout 335 A. 
D. by Helena, the mother of Constantiue, at Constantinople and Jerusalem. That 
at Antioch was founded in 360, and the famous Basilides Hospital at Ciesarea iu 373. 


not announced until IGIO, and liis almost cMiually inip!»rtant and ei)Och- 
luaking discovery of the origin of the liigiier animals from the ej;g' was 
publislied in lOol; yet it nuiy be safely asserted that the work of this 
modest and truly scientific Englislnnan did more to advance medicine 
than all the labors of all the schools from the days of llii)i)0crates. Not 
oidy were tlie facts demonstrated of infinite importance, but his method 
of patient, exact observation and ('Xi)erimentati()n until the truth was 
developed by cautious induction marks the introduction of a new era, 
and stam[»s ilarvey as the father of modern medicine. 

Galileo first indicated the use of the thermometer in medicine about 
1595. Sagredo, of Venice, improved it in 1013, and Saiu-torius, in 1025, 
urged its importance iu the study of disease forcibly, but as yet inef- 
fectually, and the last half of the ])resent century is reached before the 
classic wojk of Wunderlich placed medical thermometry on an enduring" 
basis of practical value. Just as the astrononu'r, (ialileo, gave us the 
lirst rude thermometer, Kepler, another illustrious astronomer, gave, 
in 1004, the first record of an accurate count of the human pulse. But 
so shnvly did the importance of this datum in the study of disease 
imi)ress the medical profession that the acute Sydenham, who lived 
until IfiSO, nowhere mentions a single pulse count. It is liard to find 
anything which illustrates better the radical difference between the 
spirit of mediaeval and of modern medicine than the vast mass of obso- 
lete literature ujion the i^ulse, loaded with fanciful s])eculation and 
super refined subtleties of description, and yet wholly deficient in the 
only features which would give practical value to the study. What 
progress in exact medicine could be made without cliemistry? Yet 
scarcely any development in this branch occurred between the eighth 
and seventeenth centuries. And it was Boyle, the father of modern 
chemistry (not born until 1G27; died KiOl), who first succeeded in free- 
ing from the trammels of alchemy this noble science. Not until the end 
of the seventeenth century did the value of quantitative analysis begin 
to be api)reciated. Lastly, it was not until 15U0 that we hear of the 
first compound microscope in the hands of Jansen. 

Meanwhile the gross sujjerstitions, combined with a blind dependence 
on the great authorities of antiquity, and esj)ecially on Aristotle and 
CJalen, wliich had so long dominated medical science, yielded slowly to 
the growing light of positive knowledge. Fine-spun subtleties, drawn 
from metai)hysical speculation; the fantastic notions of alchemy and 
astrology; the rank growth of imi)osturcs which tiourished in the soil 
of ignorance, and the bigotry which placed every organ under the 
charge of a special saint and conjoined with every remedy a special 
form of supplication, still marked medical teaching and medical practice. 

But the bold, fearless, investigating spirit of the sixteenth century 
did its work for medicine as it did for other great matters, Vesalius 
(1514-156-4) and his contemporaries created accurate anatomy. Pare 
(1509-1590) stamped imperishably on surgery the influence of his genius 


and lofty character. Paracelsus (1493-1541) hurled the shafts of ridi- 
cule and invective against the groveling- subserviency to ancient 
authority, and did a rough but important stroke of work toward the 
emancipation of the medical mind. The grand old Hippocratic method 
of careful observation and cautions reasoning was reasserted, the unpro- 
ductive philosophy of Galen and his Arabian Avorshipers was discarded, 
and at last there begins to emerge from the darkness of so many cen- 
turies modern medicine, the medicine of loyalty to Mature and revolt 
against mere huinan authority; of reverent skepticism and reasonable 
faith; the medicine of scientittc expeiimentation and of humane vivisec- 
tion, that insists upon knowing the causes of disease and that looks to 
hygiene as its noblest expression. 

The history of European medicine for more than three hundred years 
is a record of which we may well be proud, Avhen the enormous obstacles 
to progress are held in view. It is not necessary to remind tiiis andi- 
eiu;e of a single one of its great triumphs. Vesalius and Pare, Harvey 
and Sydenham, connect tliemselves with Bichat and Laennec, and 
Hunter and Jenner, and Pasteur and Lister, and Virchow and Koch, 
and the torch of genius is passed down the line of these immortals and 
lights up the ages with the splendor of their achievements. But it is 
sad to reflect upon what has been done as contrasted with what might 
have been. The dense ignorance of rulers and masses on scientific 
questions, the slow progress of sound, useful education among the peo- 
ple, the huge claiais of imperialism and of militarism, the wanton waste 
of luxury, have retarded research, have left but paltry sums available 
for the diffusion of knowledge, have hindered the emb(jdinient in legis- 
lation and in actuality of much th;it wt>uld help the healing of the 
nations. It is an odd commentary on the vaunted civilization of to-day 
to contrast the sums doled out by the most enlightened g-overnments 
of Europe for the promotion of higher education and orginal research 
or for the suppression of preventable diseases with those lavished oji 
the vast hosts of armed nn-n and the huge fleets of unwieldy armored 
ships deemed necessary for the maintenance of jjeace and order. 

Within oiu- own day we have seen the announcement of the grandest 
generalization reached by the human mind, in this century at least, 
and advanced in the most philosophic and inott'ensive manner, received 
with a burst of intellectual skepticism and of religious intolerance 
which showed that the old forces against which the Kenaissance pro- 
tCfited, and still protests, are yet alive, though ha])i)ily shorn of most 
of their power. The marvelously rapid spread of the illununating doc- 
trines of Darwin, and their incorporation in the thought and speech of 
the world and in the teachings of the churches, may indeed be pointed 
to as the crowning intellectual achievement of the nineteenth century.* 

*The grave of Harvey, in Hempstead Church, bears a plate whicli gives his birth 
April 1, 1578; his death June 3, 1(357. His iuuuortal work, ICxercitatio Anatomica 
de Motu Cordis et 8;in,'j,uinis, was unable to pass the censorship of the press iu 

S. Ex. 30 7 


If the actual progress of medical science was slow in Europe duriiifr 
the years wliich followed that annus mirnhilis, 1492, surely no word of 
reproach may be uttered against the early settlers in Xorth and !South 
America because, amidst tlieir heroic efforts to conquer this vast con- 
tinent, it was long before they found time or energy to devote to the 
cultivation of that practical and essential subject of medical science.* 
It is true that in 1551 Charles V founded the University of Lin)a, in 
Peru, and in 1553 the University of Mexico. Yet it does not appear 
that medicine was taught at these universities until a little prior to 

In North America, although Harvard College was founded in 103G, 
the title of university seems to have first been ai)plied to the University 
of Pennsylvania, which in 1765 established the first school of medicine 
in the United States. The scattered liaiulfuls of early settlers on our 
shores had, indeed, ])roblems facing them more urgent than the promo- 
tion of science. They differed as widely in their motives for under- 
taking the appalling task of conquering and colonizing America, and 
in their fitness for the work, as they did in their nati<malities. Sepa- 
rated widely from the m(>ther countries, hampered very often by unwise 
and vexatious interference from the home governments, they waged war 
against the ]>owerful tribes of aborigines who swarmed over the 
country and against the no less serious obstacles of untried climatic 
and political conditions. Bloody warfare raged promiscuously, and 
disease was rife. We have seen that the work of mere jtreliminary 
exploration occupied two centuries. The close of the third century 
found the early struggles ai)proaching a successful ending, only to bo 
followed by violent ])olitical changes, not accomplished save by long 
and costly wars. The English conquest of Canada, in 1751)-'(j(), the 
achievement of independence by the United States in 1783, the estab- 
lishment of the independence of the South American rei)ublics in LSIO 
and the ensuing twenty years — these are the events from which the 
future historian will date the renaissance or the decadence in America, 
and to Avhich reference will always be. made in estimating our capacity 
for progress in i)olitics, in literature, in art, and in science. 

For a long time it seemed even to friendly critics that the new races 

En^lniifl, and appeared (in his aOtli year), in 1628, at Frankf()it-()n-tlie-Main. 
Altbuiigli sns(('j)til>le of easy demonstraticjn, this epoch-iuaking disL()\ery failed for 
years to influence medical thought or ]iiactice. Uarwin rests in Westminster 
Abbey, with the sovereigns, the statesmen, and the warriors of a proud people. The 
inscViption, ''Born February 12, 1809; died k\)v\\ 19, 1882," is t(» be taken in con- 
nection with the lact that his chief work, "On the Origin of Species," published in 
1859, in his 50th year, was, during his lifetime, translated into all modern languges, 
and reached in England itself six editions and 72,000 copies. 

*Tho first printing press in North America is said to have been set up in 1039, in 
the house of President Dnuster, of Harvard College. 

tDr. Billings tells me there is on record a ciHujdaint of the Avant of a cadaver at 
the University of Mexico to read the lessons of anatomy over. 


wliicli strove for a footliold ou American soil were unlikely to thrive as 
AHgoroiisly as in their accnstonied habitats, and the impossibility of de- 
veloijing a genuine and lasting' American type was freely asserted. To 
those of us who have considered this point with anxious care the last 
two decades have brought results that put to rest all apprehension. 
Whatever may be the future changes in the political organization or 
relations of the countries composing America, it is a demonstrated 
fact that the European race in America, which already numbers over 
100,000,000, will show no decline in vigor or in energy, in physical or 
ia mental strength. It is not on account of mere bigness in material 
achievement that we point to the millions who fought in the great civil 
war; or to the 170,000 miles of railroad in the United States — almost 
as much as in all the world besides, and the $10,000,000,000 of capital 
invested, and the army of 900,000 employes ; or to that tremendous struc- 
ture, the Canadian Pacific Railroad: or to the plans now under consid- 
eration for developing a continous railway system for the entire conti- 
nent, from Montreal or Puget's Sound to Bueno Ayres. It is, even 
more, as evidences of large imagination, of couragetms resolution and 
dauntless tenacity of purpose, and of enormous power of physical 
endurance that we value the enterprises which have subjugated this 
continent so swiftly and are hastening its commercial consolidation. 
We may be assured that countries which have shown such sturdy love 
of independence and resistance to outside interference, which have dis- 
played so much sagacity in adapting their political constitutions to 
their peculiar conditions, which liberate and enfranchise all who dwell 
within their limits and afford to all an equal chance of advancement, 
will work out their destinies to far larger aud wiser plans of friendly 
cooperation than we can now foresee. 

Turgot, in his memorable address in the Sorbonne, well declared, 
"Tons les ages sont enchaines par une suite de causes et d'effets qui 
lient I'etat du monde a tons ceux que Font i>recede." The discovery of 
America depended on the operation of causes which can be traced back 
many centuries. The present condition of our continent, four hundred 
years later, is the result of the action and reaction of mighty move- 
ments which involve every country of the world. Here is the new and 
probably the last great place of gathering and intermixture of all 
nations. Here as nowhere else are to be studied with all the aids of 
exact science the j)roblems of ethnology and sociology.* Here are to 

* It was on tliis acconut tbat I was so anxious for the organization of tiie American 
Autliropometric Society, wbicli was happily established in 1891. The interaction be- 
tween functional activity and cerebral development is attested by so many facts, 
and the methods of examining and recording the exact arrangement and minute 
structure of the nervous centers are so securely established, that the time seems to 
haA-e come to begin, upon a broad and systematic basis, the study of the progressive 
anatomical changes effected in successive generations of individuals subjected to 
the stimulating and rapidly changing environment presented by our modern life. 
The full members of this society engage to direct that a post-mortem examination 


be worked out to the best advautajic the problems coiiceriiiiig the rela- 
tions of man to his physical environment; and the demonstration that 
in spite of tlie api)aront majjnitude of the ])o\vers of nature, and in 
spite of the admittcil inllucnce of climate and i)liysical condition upon 
the progress of civilization, the powers of nnin for intellectual and 
social advancement are incalculably sui>erior. 

In all of this work a large share must devolve u[)()ii mt'dical men, 
and fortunately our position in America is one which will enable ns 
to work togcthc)' with good effect. The higli average intelligence of 
ourpe(»i)le will nnike them prcnnpt to appreciate results of solid utility 
or scientitic value. The enornu)Us wcaltli, present and prosi)ective, of 
this continent should readily be diverted more and more bountifully 
to the promotion of learning and research — if, as may be trusted, we 
shall strive uu)re and more after peace among ourselves and abroad. 

We shall never cease to be [)roud of our lineage, or to acknowledge 
the immense debt we owe to Europe. Its languages are ours; its 
glorious past is part of our heritage; its mighty names in art and 
l)hilosophy and science are household words with us. Its rapidly 
advancing civilization incites us to loftier efforts. But the balance 
between the Old aud the New Worlds is being redressed. 

All know how the examples of our young and vigorous communities 
have supplied aud fetl the infectious principles of political liberty and 
social equality.* In every struggle for the rights of man, from the 
terrible but beneficcmt drama of the French Revolution down to the 
present hour, our example and our assistance have been invoked. 

I can not detain you by an enumeration of the services already ren- 
dered by xVmerica to medical science. Almost immediately after the 
discovery important contributions to pharmacology were announced, 

of the braiu sliiill be ])erinitt(Ml. The othor mcmhers innlvc no siieh pknlge, hixt all 
arc concerned in the promotion of anthio]>onietiic and ethnoh)gical research. The 
scope of the work undertalcen by the society is very broad aud profouudly imixir- 
tant. It is believed that nowhere else can its investip^ations be so profitably prose- 
cnted as in America. The ornanization is, however, essentially international iii 
character. It is diHicult to overestimate tiie value of a large series of exact por- 
traits of the brain, in its macroscopic and microscopic featni'cs, obtained in succes- 
sive generations during even so short a period as a thousand years. These records 
will be obtained from members of different races living under similar and under 
widely dittereut i)liysical conditions; aud it is hoj)ed to secure such records from 
many successive generations of a number of individual families intelligent 
interest in such collective investigations may be sulticiently maiutaineil. The good 
work of this society is already actively progressing. The records will be jtreserved 
in the strictly lireproof buildings of the library aud of the Wistar Institute of 
Anatomy aud Biology connected with the University of Pennsylvania. Doubtless 
the medical jVrofession of all America will be prompt to helj), from their technical 
8taudi)()int, the great work in ethnology aud archa-ology U])on which all American- 
ists are now so vigorously entering. 

*This is the only infectious principle we have coinmiuiicated. The fable which 
assigned an American origin for European siphilis has been refuted by conclusive 
evidence from many sources. 


chiefly from Soutli America, and from, the iutrodnctioii of guaiacTim, 
in 1508, until now these contributions have become more and more fre- 
quent. The entire medical world was agitated dnriiig the latter half 
of the seventeenth century by the struggle over the merits of cinchonii 
bark,* introduced into Europe, in 1(540, by Juan del Vego, and no 
more convincing tribute can be adduced as to the value of medical and 
sanitary science than the prominent ])lace occupied by malnrial diseases 
in the general and medical literature of the seventeentli nnd eighteenth 
centuries as contrasted with the feeling of inipunity with which they 
are uow regarded. Among the results which may be anticipated from 
this meeting is, I trust, the adoption of some well-considered plan for 
systematic conjoint study of our American remedies and their phar- 
maceutical preparations, looking to their scientific classification, to 
greater uniformity ?u their preparation, and ultimately to a single 
pharmacopoeia for the entire continent. 

The introduction of nitrous oxide (1S44) and of ether (1840) into 
medical practice, with Avhich the names of Wells and of Morton are so 
honorably connected ; the establishment of the operation of ovariotomy 
by McDowell, of Kentucky, ui)on a secure scientific basis — these and 
hundreds of other achievements of lesser brillianci' are too familiar to 
need mention. Every one knows now how superfluous it is to say a 
word in defense of American literature, and certainly we who know 
how x)0werfully the opinions and practice of medical men in Europe 
and throughout the world are influenced by American writings may 
view our ])ositiou with some complacency. Yet a survey of what 
America is actually contributing to medical literature shows clearly 
how far we are behind the nations which lead in medical thought. In 
the year 1879 llupprecht's Bibliotheca t gave as the total number of 
new medical books, excluding pamphlets, periodicals, and transactions, 
419, divided as follows, viz: France, 187; Germany, 110; England, 43; 
Italy, 32; United States, 21; all others, 26; and for 1891 I find the 
same Bibliotheca gives the total number as 1,063, divided as follows, 
viz: Germany, 360; France, 243; Great Britain, 141; United States, 
80; Italy, 78; Austrollungary, 70; Spain, 24; other countries (chiefly 
Switzerland and Denmark), 67. 

On the other hand, in the more ephemeral forms of medical litera- 
ture the figures are very different. I have had a careful count made 
of the volumes of medical journals and transactions filed in the library 

*Tlie motives iuflnenciiig its opponents were borrowed in part from the doctrine 
of qualities of the ancients, in part from the hatred of the Jesuits, who were 
especially active in extending the use of the drug, and in jiart, as malicious tradi- 
tion asserts, from the fear that it would cure so speedily as to render the earnings 
of physicians precarious. One is reminded of the old Indian proverl): "Various 
are the desires of men; the wagoner longs for wood, the doctor for diseases." 

tJ. S. Billings, m. d., ''Our Medical Literature." Address before the Interna- 
tional IMedical Congress, 1881. He adds that these iigures are too small, and espec- 
ially so as regards Great Britain and the United States. 



of tlie Army Medical Museum at Wasliin^i;t<>ii, witli their respective 
places of publication,* and from this it is clear that of these classes of 
medical literature there were, in 1890 and in 1801, published in America 
(including Canada, the United States, and Latin-America) about twice 
as many volumes as in Germany or France, and fully three times as 
many as in Great Britain. 

Kunibfr of volumes of Joiinials 

Number of vohmies of transactions. . 








Slates, and 






1890. 1891 











Britain and 
cies, not in- 

1890. 1891 







Otlier conn- 



1K01. 1 1800. 








Nniiilier of voliimcs of journals 

Kumbcr of voluiues of transactions. . . 













Of coui'se we must not forget the fact tlmt in tlic Iiuirv of our life of 
to-day many observations and investigations of great value are pub- 
lished in journals, instead of being reserved to become ])ait of more 
serious and complete volumes. i>ut it will not be doubted, I think, 
that the great excess of meilical journals in America, as contrasted with 
the comparatively small number of new medical works, is entirely con- 
sistent with the admitted leadership of Germany, France, and Great 
Britain in medical science. The fact that during the past twelve years 
Germany has risen from a i)lace in this list second to France, 110 as 
against 187 in 1879, to the first place at present, with 350 new medical 
works in 1891 as against L'l.J ])ublished in France, speaks eloquently of 
the strenuous effort with w hicli newly united Germany is straining for- 
ward ill science as in other fields. Tlie truth is that the apparently 
extraordinary number of medical journals in America is due chiefly to 
a substantial reason, and one which influences ecpially the existence of 
very numerous medical schools and medical societies. The vast extent 
of territory and the relatively sparse population render it impossible 
to serve the country with as low an average of medical men, schools, 
societies, or journals as is possible in more densely populated countries. 

As to other and less satisfactory reasons which have operated, espe- 
cially in the United States, to produce a great growth of ill-equipped 

*It gives me ple.'isnre to adcnowlcdije the .nssistance rendered in the preparation 
of these interesting statistics by the National Bureau of Medical Bibliography. This 
admirable enterprise, established at Washington so as to have immediate access to 
the great library of the Surgeon-General's Office, merits flic apprc<'iative support of 
the iirofession. 


medical schools and of poorly-supported medical journals it is not nec- 
essary to speak here. Indt^ed, the rapid rise in the standard of scien- 
tific requirements, both of medical men and medical literature, and the 
increasing" appreciation on all sides of the fact that the higiier medical 
education is the true interest both of the profession and of the public 
is accomplisMng the much-needed work of cliecking the ill-considered 
establishment of new medical enterprises, and of stimulating those iu 
existence to more earnest life and more lofty aims. So true is this iu 
regard to our medical journals iu particular that no one who has occa- 
sion to consult regularly the liles of any number of them can fail to 
have been struck forcibly with the steady and decided improvement in 
the tone of their management and in the scieutitic qualityof their con- 

This Congress meets at a period of peculiar and critical interest in 
medical education, and I am glad to say that for the first time in the 
medical history of the United States we may feel proud to Lave such a 
meeting convened here, and to invite a close examination of our edu- 
cational standards and facilities. I should fail in courtesy and iu can- 
dor alike were I not to acknowledge the great value of the example 
which has beeu so consistently set by Latin America and by Canada in 
the maintenance of a high standard of qualifications for medical prac- 

Fifteen years ago the medical profession of the United States 
arraigned severely the management of their overnumerous medical 
schools.* While Canada then exacted a reasonably strict entrance 
examination and a course of medical study extending over four years, 
with one session of six montlis in each year, and while every country 
in Latin- America exacted a collegiate degree or a rigid entrance exam- 
iuation and a course of medical study extending over six years, it was 
the general custom with the medical schools of the United States to 
grant a diploma conveying the full right to practice medicine to appli- 
cants who had been admitted without preliminary examination and had 
attended without term examinations two courses of lectures covering 
about five months and had passed a single and final examination con- 
ducted by their own teachers, whose emoluments were derived solely 
from the fees of such students. This discreditable prostitution of a 
great educational trust had been gradually brought about by large 
causes upon which I may not now comment. But it is with justifiable 
pride that we may point to the admirable and sweeping reforms that 
have since been instituted. It remains true that the laws of many of 
the States allow charters for medical schools to be secured without any 
guarantee of the .standard of education that shall benmintained. But 
the awakened sentiment of the profession and of the community has in 
a rapidly increasing number of the States insisted that medical grad- 
uates before being admitted to practice shall pass a State examination 

*Rej5ular schools, 65; homeopatbic, 11; eclectic, 4; total, 80, in 1877. 


coiuliictefl by an iini)aT(i{il board of examiners appointed by the gov- 
ernor. The medical schools, to their honor be it proclaimed, have, with 
lew exceptions, been foremost in the strn.u<ile to secure this wise and 
beneficent legislation. Tliey have done much more. In advance of 
these laws wdiich will insure a far higher standard of medical qualifi- 
cations in the States fortunate enough to be so protected, th(^ faculties 
of a number of the leading schools have forced their standard up at 
first to three ye.ars of obligatory study, and now to four years of eight 
months' study each, with a carefully graded curriculum and with strict 
examinations before entrance, at the close of each term, and finally 
before graduation. 

When we.recall that this has been done without the slightest govern- 
mental aid, and, further, that owing to the prevalent view that medical 
schools have been sources of large profit to their faculties the streams 
of private benefaction iiad not yet been directed in their favor, you will 
appreciate the high sense of duty and the devotion to science which 
have led these faculties to assume greatly increased labors with an 
exi)ectation of considerably diminished remuneration owing to reduced 
attendance of students and to augiiuMited ex]»euditures. 

The committee of arrangements of this congress has wivsely provided 
for a tour of inspection of some of these institutions. It is trusted that 
all of our foreign delegates, and as many as possible of the members of 
this congress, will avail themselves of this opportunity to examine the 
equi]i)ment of some of our leading medical schools. They will be grati- 
fied to fnul, in hos])itals, in laboratories, and in libraries and museums 
alike, facilities Avhii'h bear comparison with those of Euro[>e. They 
"will find an arrangement of studies, and, above all, an organization for 
the conduct of daily thorough bedside instruction in all branches of 
medicine, which leave little to be desired. It is easy to foresee, as 
another of the desirable results of such meetings as this held succes- 
sively in various parts of AnuuMca, such increased acquaintance with 
and confidence in our respective methods of medical education and 
medical treatment as will retain on our continent many of our students 
and many of our invalids who have been in the habit of going farther 
to fare no better. 

A broad field ojieus before us for the study, with the aid of collective 
investigation, of the distribution aiul course of phthisis and rheumatism 
and other important diseases as influenced by race and locality. The 
endemicfevers, otherthan malarial and typhoid and yellow fever, which 
are said to prevail in various ])arts of North and South America, have 
long demanded systematic investigation to ci>mi)lete the study which 
the illustrious Drake began. We shall now have the opportunity of 
studying, equally by means of collective investigation, the relative 
efl'ects of various climates oa the numerous races now represented in 
America, and of determining more accurately the scientific and practical 


questions cormocted with onr extensive series of health resorts which 
embrace the hnest examples of every type. 

There are, indeed, none of the sections provided for in this congress 
from whose work more valuable results should follow than from those 
on medical pedai;ogies, on hygiene and climatology, and on quarantine. 
It was a sense of the urgent importance of these latter subjects, especially 
at the present time, and of the valuable results sure to follow their con- 
sideration by such a body as this, which led the Government of the 
United States to extend the cordial iuvitaticm which has been uniformly 
accepted on the part of the Pan-American Governments. I feel that 
by this action there has been secured for the subject of hygiene and 
State preventive medicine a formal recognition never before accorded 
on this continent, and one which must surely be followed by the willing- 
ness of the respective governments to use their influence to secure the 
enactment and efficient administration of proper legislation in accord- 
ance with the recommendations of this body of emiiient experts. 

When the International Medical Congress met in Philadelphia in 1876, 
the address on Hygiene and Preventive Medicine, delivered by the 
distinguished Bowditch, himself a pioneer in sanitary science, was one 
of the most impressive utterances on that important occasion. The 
review there given of the work of the previous century in this country 
in sanitary science was not flattering, but with the tine enthusiasm 
which marked that gifted man he predicted the immediate opening ot 
the grandest epoch yet seen in the history of medicine. His closing- 
appeal must be quoted. " Our present duty is organization, national. 
State, municipal, and village. From the highest place in the national 
couucil down to the smallest village board of health we need organiza- 
tion. With these organizations we can study and often prevent dis- 
ease." These stirring words were in accord with the spirit of the times 
and with the developments of science. 

When the brilliant discoveries of Koch brought to light the specific 
bacillus of tuberculosis and of cholera, and pointed out the scientific 
method to be pursued in similar investigations in the future, an unan- 
swerable argument was provided against skepticism or indifierentism 
or official penuriousness. It required courage and showed rare breadth 
of view in Lord Palmerston to issue his celebrated reply to the Pres- 
bytery of Edinburgh on tlie occasion of the threatened outbreak of 
cholera in 1853, in Avhich he urged that the weal or woe of mankind so 
far depends upon the observance or neglect of the natural laws by 
which the affairs of the world are regulated, that if the local causes of 
disease were not removed before the return of the hot weather, the 
])estilence would be .sure to return in spite of all the prayers and fast- 
ings of a united but inactive nation. 

Much was accomplished, it is true, in preventive medicine between 
1853 and 187G, when Bowditch spoke; but it is scarcely an exaggera- 
tion to say that the progress in the past twenty years has been greater 


tliaii ill the preceding tAventy centuries. We have not, indeed, yet 
detected the specific; poison of every inlcctious dise:ise; even in regard 
to the familiar and ;nuch studied yelh)w fever tlie hitest i)nl)lication 
of the distinguished Surgeon-General of the U. S. Army shows that 
this point is still unsettled. But the position of the whole matter is 
changed radically. Hypotheses have given way to facts. Everyone 
now knows, or ought to know, that the most dreadful diseases are 
inseperably connected with definite organisms, that these organisms 
liave special laws of development and distribution, that to destroy or 
exclude them is to avoid the disease, and that to tolerate conditions 
which favor their devel()[)ment is to encourage and invite the attack of 
the disease. AVlien these simple, demonstrable propositions are con- 
sidered ill coiiiiection witli such scourges as cholera and yellow fever, and 
ty])hiis and tyi)h<>id fe\er, and scarlatina and diphtheria, and epidemic 
meningitis, it needs no liirther ariiiuiiciit to jtrove the value and the 
necessity of quarantine, and of ethcient medical inspection and pro- 
tection. Nor does it need further argument to show the wisdom of 
establisliiiig laboiatoiies of hygiene at many [)oihts over the country, of 
(Miuipping them amply ^^ ith the ablest men and the finest api)aratus, 
and of endowing th(>m liberally, so that the search after the yet unknown 
causes of disease, and alter the best methods to i)revent the develo])- 
ment of such causes as are known, may be prosecuted with cea.seless 

It is easy now to get a hearing for these views, when public com- 
fort is disturbed, the ])ublic, purse threatened, and the i»ublic con- 
science awake and sensitive. At this moment our great commercial 
communities are reposing in confidence upon the sanitary measures 
adopted by our governments, in accordance with medical advice, for 
the restriction and exclusion of two dreaded pestilences, cholera and 
yellow fever. Recall with me the popular ti'rror of last summer, 
llecall the hideous loss of life and the disastrous effects on commerce 
caused by former invasions of these diseases when the communities 
altlicted were smaller and less wealthy than are ours at ])reseiit. We 
do not have to seek back to the Middle Ages for pictures of desolation 
wrought by infectious disease. Recall that tragic story of the great 
yellow fever ei)idemic in Philadelphia Just one hundred years ago, as 
told by Rush. Try to estimate the result if cholera had effected a 
lodgment in New York City in July, 1892, and having found favoring 
local and climatic conditions, had. as on former occasions, spread its 
deadly germs to the North and South and West. The fair White City 
tliat was rising by that distant lake, under the magic wands of Art and 
Industry, would have been stricken with a fatal blow. No computa- 
tion can well exceed the loss that would have fallen on this country. 
The entire people gazed with bated breath at the struggle waging in 
New York Harbor, and universal thanksgiving arose when the dread 
invader was finally repulsed by the vigorous and sustained efforts of the 


sanitary autliorities. Tbat we in America are not today witnessing the 
aggravated recurrence of the ejtideniic, in accordance with unvarying 
precedent, can be due only to the continuance of these same efforts, 
reinforced witli large authority, and aided by more efficient local 
sanitation. When this gratifying resnlt is associated with the suc- 
cess which for some years has attended our eft'orts for the exclusion of 
yellow fever, no further argument can be needed to urge the adoption 
of such uniform measures as will for the future afford most sure pro- 
tection against these diseases. These instances exhibit in the most 
striking manner the need and the value of the international sanitary 
agreements this Congn'ss may do much to promote. 

But there will occur to all of us many other important questions to 
be solved only by earnest and u uited Avork. ITor can this work be accom- 
plished until Bowditch's cry for organization is far more fully answered 
than it yet has been. Nothing but organization and cooperation, and, 
yet more, the establishment in the government of every civilized nation 
of a department of public health, will secure tlie continuous and forcible 
attention which the magnitude of this enterprise dejuands. There 
should be, and the day can not be far distant when there shall be, in 
the cabinet of every government here represented a secretary of public 
health, of rank, influence, and i)rerogative equal to that of any other 
cabinet officer. 

Here, then, is the last and greatest service to be rendered to science 
and to the nation by our Congress. Our combined influence will be 
irresistible when used in advo<%icy of higher education ; in carrying out 
large plans for the scientific study of our national life, as affected by 
social and climatic influences; in the adoption of remedies and remedial 
measures of demonstrated merit, and in the insistence upon a fuller 
recognition of the lofty function of preventive medicine. " Salas Sani- 
tasque Eei)ublicie, suprema lex." Let us acquire here a closer touch 
Avith each other, a deeper faith in our profession and its noble destiny, 
and a stronger determination to labor in brotherly cooperation for the 
loftiest ideals of service to science and the race.* 

* It woulfl be improper to omit au ackuowleilgment of tlie free use that has been made 
in the preparation of this address uf various authnrities. Especially must be men- 
tioned Fislce's Discovery of America; Baas's History of Medicine (translated by Han- 
derson, 1889) ; Tlie Discovery of North America, by Henry Harrisse (Paris and London, 
1892) ; The History of the New World called America, by E. T. Payne (Vol. I, Oxford, 
1892); BiTckle's History of Civilization in England; Draper's History of the Intel- 
lectnal Development of Europe; Fishers Outlines of Universal History; Thie Early 
History of Instrumental Precision in Medicine, by S. Weir Mitchell, M. D.; Historia 
Bibliographica de la Mediciue, Espanola, by A. H. Morejon ; Publications and Unpub- 
lished Letters of Dr. Daniel G. Brinton; Report ou the Etiology and Prevention of 
Yellow Fever, by George M. Sternberg, 1890 (now Surgeon-General U. S. A.); Lub- 
bock's Origiu of Civilization, and also Prehistoric Times; Tylor's Anthropology, and 
also. Researches into the Early History of Mankind; Lewis Morgan, Ancient Society? 
New York, 1877. 

It gives me much pleasure to acknowledge also the assistance received from Dr. R. 
P. Robins, esi>ecially in the examination of the History of Early Spanish Mediciue. 



Setiembre G DE 1894. 


Senores DEL Primer Congreso iNfEDico I^an- Americano : Esta 
ocasioi) es sill iiiUiil: i)or lo tanto estoy coiiveucido que las ideas que 
se agolpaii en la niente de todos sou tan idrMiticas, que la alociu-ion mas 
eorta sen'a el discurso m^is adeciiado; pcro ciiando reflexioiio que me 
eiicuentro aqiii para repiesentar la resolncion nnaiiime adoptada el dia 
5 de mayo de 1891 pnr la Junta de la Asociacicui M^'dica Americana, y 
quo esta resolncion iuc (pie se hiciese invitacion cordial ;i la profesion 
iiK'dica del llemisferio Occidental i)ara «pie se reuniese atpii en Conjii-eso 
Medico, entonces comprendo el alto deber (pu' tenjio el honor de cumjilir. 
Si algo pndiera anadirse a la distin('i«M» de esta asamLlea, qiu* i»or i)ri- 
mera vez alirma fornuilmente la uni('>n org^anica de los nuMlicos de todas 
las Americas, es el liecbo de (juc el Congreso de los Estados Unidos, 
movido de la importaucia de uuestra proyectada reunion, tomo la reso- 
lncion unAuime, el dia 18 de Julio de 1S9J. de suj)licar al Presidente 
de la Xacion que llevase 4 efecto esas invitaciones; por cuyo motivo 
teuemos el honor de dar la bienvenida aqui a todos los dele.uados oti- 
ciales del lleniislerio del Occidente. Ijiuabnente cstan representados 
aqui varios de los Estados de nuestra Union, los municii>ios miis 
im[)ortantes y mucbas de las iustitnciones docentes de la America del 
Norte y del Sur. Es])ero, pues, que no os parecera extrano que, 
llamado a dirigiros la palabra en este ailo Colombino, elija como tema 
tccuico llevar nuestros pensamieutos al estado de este contineute y 
desus habitantes ])rimitiv'oseu la (5poca del descubrimiento, por Colon; 
a los obstaculos que se le opusieron, y a los jiraudcs homl>res que 
complctaron su ol)ra: i)uesto que estos ultimos haii tenido una inHu- 
eucia sobre el desarrollo de las razas que des]>ues se hau fornuido aquf, 
y que debeu tomarse en consideracion cuaudo estimamos el progreso 
que liemos Iieclio durante cuatro si.£»los consecutivos. El estado de la 
ciencia medica en Europa en la epoca del descubrimiento, y el espiritu 
que lia intluido en su curso snbsecuente, debeu ser tambien estudiados 
en conexion con lo que hemos nosotros hecbo durante el mismo periodo, 
contando con las oportunidades que se nos ofre.-en en los tiempos que 

El reconocimiento de la importancia de esta reunion ba sido cosa 
inmediata y universal ; y si bien internacional, sus bases de oriranizacion 
y sus caracteres especiales hacen desaparecer toda sospecba de una 
imitacion 6 de una interveucion con el gmu (Jougreso Internacional 
cuyas reuniones sucesivas forman una escala creciente de triunfos 


cieiitfticos y adniinistrativos que la profesiou uiedica del universo 
adinira con uu oigullo Justifieado. 

Xuestia Junta de Gobieiuo y iiuestro Secretario General, con quienes, 
por su energia y dotes especiales de organizacion, liemos contraido una 
deuda de gratitud, no queriendo pioducir el mas leve obstaculo al bueu 
exito del Cougreso de Koina, no decidio fecha algnna hasta no saber 
cuando se efectnaria este, y entouces escog'io una que, no tan solamente 
permitirfa, sino que facilitaria mas tarde la presencia en Roma de los 
que asistiesen al nuestro. I Jeploro que la triste reaparicion del colera 
en la parte sur de Europa — sorprendente ejemplo de la importancia del 
fin que uos llama arjui a reunirnos — ba necesitado diferir la fecha del 
Congreso hasta la primavera entrante, cuya demora es de esperarse 
que no afectara la importancia ni el buen exito de la reunion. El 
Congreso Internacional de Medicos es, en realidad, una demostraciou 
brillante de la solidaridad de la profesiou, y del tin universal a que 

Este Congreso, sin embargo, representa mucho mas que el interes 
comun en las cienciasmedicas y el afecto fraternal que anima a nuestra 
profesiou en general. La gloria de la profesiou medica ha sido, y sera 
siempre, su union estrecha e indivisible, puesto que su servicio tiene 
por objeto la causa de la verdad y de la humanidad. Han subido y 
han caido desmoronadas las dinastms; el mai^a del muiido ha sido 
cambiado una infinidad de veces ; pero la marcha de las ciencias medicas 
durante todas las epocas ha sido una ascensi(3n constante A las altas 
asi)iraciones de prevenir las enfermedades, aliviar a los que sufren y 
mejorar las razas. 

Nosotros los que nos reunirnos aqui tenemos para animarnos todos 
esos gioriosos recuerdos y hay mas aiin para unirnos e iuspirarnos. Nos 
reuniinos debajo de la sonibra de una concepciou gigantesca, tan antigua 
como Aristoteles, que agito la mente de los grandes hombres de la 
antigiiedad, y que leutamente se acercaba anna forma defiiiida cuando 
la fe sublime y el genio de Colon resolvieron elprobleina del globo. 

Verdad es que este vasto contiuente americano, que tiene seis millo- 
nes (piinientas millas cuadradas de territorio, ya contiene ciento diez 
millones de habitantes; que abraza todos los tipos de la vida humana 
y muchas variedades delas organ izaciones politicas. Pero todo lo que 
hasta ahora ha sido hecho no es mas que nn tenue principio de lo que 
nos espera, Cuando Canning optuvo el reconocimiento de las Eepii- 
blicas de la America del Sur, se jactaba de que habia llevado el Xuevo 
Muudo a una existenciaen que pudiese corregir las faltas del Antiguo; 
y sin embargo las lurainosas proposicioues de Franklin, de Bolivar y 
de Blaine en cuanto a las relaciones comerciales de los paises del 
Hemisferio Occidental son aun solamente profecias que tardaran mucho 
para verse realizadas. 

Los destinos de las naciones se desenvuelven leutamente; sucesos 
que ocui)au todo el horizonte de una gcneraciou resnlaudecen a la 


laz (le hi histoiia coiuo peqiienas pinceladas en el gran paiioianui de 
los siglos. 

El curso de cuatrocientos afios no es sino una fiaccion de la liistoiia 
de Espaua, Francia 6 Inglaterra; y sin embargo, liace cuatrocientos 
auos que este contineute entero no solatncnte no se habia descnbierto 
y era desconocido, sino que ni siquiera se sospechaba su existencia, 4 
no ser en las ingeniosas especulaciones de los filosofos. llecuerdo los 
nuij^ coiiocidos versos de Seneca: 

Veiiient aimis SiBCula scris 
Qiiibus Ocejimis vin(-ul:i reidin 
Laxet, et ingens pateat tellus, 
Tipliysqiio uovos dete<jjiit (irbos, 
Noc sit terris ultima Tliule — 

y no me sorprende que sus convicciones vehementes indujerau 4 Colon 
a transcribirlos dos veces en sus jtrofecias; pero sin embargo, este 
Xnevo Mundo estaba aun envuclto en el manto oscuro de li; descono- 
cido, desgarrado, como liemos jjodido saber despui's, del mundo cono- 
cido, por cambios producidos en remotas eras geologicas, esperando el 
plazo en que la inspiracion y el genio de Cristobal Colon le indnjeran 
a bnscar el Oriente uavegando hacia Occidente. Abora sabemos qne 
bnscando un derrotero al oeste hacia el Asia, llegoa las playas de este 
continente el dia 12 de octuljre de 1402; pero aun en la hora de su 
nuu'rto, el dia 2() de enero de l.">0(), ni Cohni ni ningun otro navegante 
6 escritor tenia una idea de la nmgnitud de su descubrimiento. Todo 
lo que los conocimientos geogralicos de aquella epoca les permitian 
comprender era qne Colon habia encontrado nn caniino nuevo para las 
Indias tomaudo un derrotero al oeste. Pocos afios despues atrevidos 
navegantes espaiioles, Portugueses, italianos e ingleses exploraron las 
costas del unevo continente. 

Americo Vespucio en su celebre tercer viaje, de 1501 a 1502, habiendo 
navegado describiendo un arco de noventa grados entre Lisboa y las 
islas de las Georgias del Sur, llego a comprender que era un nuevo 
mundo (Mnndus Novus), pues era en realidad la Auierica del Snr. No 
es nuestro intento ahora discutir porque des])ui'S de la mnerte de Ves- 
pucio j)arte de la America del Sur, y mas tarde todo el continente 
nuevo fue llamado por su uombre; sin embargo, cuaiulohace pocos dias 
tnve en mis manos el pequeao folletto pnblicado en 1507 por el Profes- 
sor Martin Waldseemiiller, del Ccdegio de Saint-Die, en Lorena, en el 
ciial propone se le de el UDmbre de AnRuica a toda la costa explorada 
l)or Vespucio, ignorando que todo formaba parte del vasto c(mtinente 
descnbierto por Colon, no pude menos de sonreirme amargamente de 
los esfiierzos titanicos e infructnosos que nosotros hacemos para con- 
seguir con uuestras observaciones la inmortalidad, mientras qne en 
este caso la Fania caprichosamente ha cenido con los lanreles del des- 
cubriiniento mas grandioso una cabeza <pie ni los reclamo ni tiene 
derecho 4 ellos. 


La g-eologfa y la paleontologia 110.-5 liaii demostrado que este llamado 
Xuovo Miindo era desde el j>uuto de vista cientifieo acreedor al uombre 
de Viejo Miiiulo. Las estratificacioiies mas aiitigaas tieiieii su desa- 
rrollo maxiiuo en su superficie, y aniinales como el caballo, que se dice 
fueroii iutrodueidos despues de 1492, se ha demostrado que babitabau 
antes este contiuente, y que despues emigraron a Europa; de modo 
que Cortes y Pizarro no liicieron mas que volverlos a iutroducir a sus 
antiguas praderas. Es de muelia importancia recordar el heclio que toda 
la America dt 1 Xorte y del Sur estaba en la fecha de 1492 liabitada mas 6 
menos i)opulosameiitc por los deseeiidieutes de tribus que liabian 
habitado aqui desde epoeas remotisiraas. Un autor coiupeteute nos 
asegura que el iiumero de estos aborigenes era probablemente de doce a 
quince inillones; y que no obstante las diteren(;ias fisicas que existian 
entre algiinas razas, como entre los Irorpieses de Xueva York y los 
Aztecas de Mejico 6 los Incas del Peril, en cuanto a sus dialectos y 
costiimbres, es geueralmente admitido que esta gran poblacion indigena 
de la America del Xorte y del Sur, con la excepcion de los Esquimales, 
perteuecia toda a la gran raza de los pieles rojas.* 

En cuanto a los Esquimales, sus caracteres polisiutt^ticos, 6 su sis- 
tema de construccion de palabras, en los cuales se asemejan a los otros 
aborigenes, no parecen snficientes para coutrarrestar la desemejanza 
fisica, y ami mas los indicios veliemeutes que existen i)ara iiiducirnos a 
creerlos deseeiidieutes de la raza extinta del Oeste de Europa, los lia- 
bitantes de cuevas. El Professor Dawkins eii su obra "Early Man in 
Britain" lia desarrollado iiiuy especialinente esteargumento. Las osa- 
mentas de Esquimales recientes son tan identicas a las de las cuevas 
jileistocenicas de Fraucia e Inglaterra, que, segi'm autores competeutes, 
son las mismas. El talento extraordinario de los Esquimales en cuanto 
al dibujo exacto de flgiiras kumanas y aiiimales es nnico entre las razas 
salvajes, con la iinica excepcion de los habiladores de cuevas de Europa, 
en las cuales se encontraron ideuticos dibujos. El Ovibos moscJiatus, 
que era el companero inseparable de los liabitantes de cuevas, ya no 
existe, a no ser en la America subtirtica, entre los Esquimales; pero los 
fosiles de estos aniinales se encuentran en rumbo marcado en el He- 
misferio Oriental, desde los Pirineos, a traves de la Alemania y Eusia 
y toda la gran extension de la Siberia. 

Los Esquimales, asi como los pieles rojas, parecen baber emigrado a 
este contiuente en la misma epoca, 6 quizas, mas probablemente, eu 
epoeas sucesivas de los mas remotos tiempos, cuando la extremidad 

* La palabra "raza" es evidente que se toma aqui en su seutitlo etnico mas lato. 
Pestle este punto de vista los lugleses, Fx'anceses y Griegos sou difereutes ramitica- 
ciones de una misuia raza. ludiscutibleinente, segiin obscrva Joliu Fiske, "los Meji- 
canos eucontra<los por Cort<*s se diferenciaban de los Iroqneses que encontru Cbain- 
plaiu tinito como uu Ingles se diferencia de uu Albanes 6 un Montenegriuo; -pevo 
cuando comparamos los aborigenes americanos con la raza blanca 6 la amarilla, ea 
correcto decir que Jos Mejlcanos y los Iroqueses perteneciau a la misma raza." 


iioroeste de Anu'rica astaba iinidaa la 8il)L'iia itor la elevacioii del area 
abora coiiocida por el ^lar de Bt'ring, (') ciiaudo laalta crestasiibniarina 
que ahora se extiende desde la Fraiicia liasta la Grfeiilandia era tan 
clevada que se podi;i pasar a i)ii' de la Kiuopa ;i la America. Si se 
trata de saber fijameiite en qucepoca geologica ixiirrio esta eniigraeion 
si fu6 de un goli»e, o mas probableiiiente en oleadas sucesivas, eucou- 
trareuios probleuias de insuperable resolueion. 

Los aborigeues que vi\ ian aqui en la (''p()(;a del descubi imieuto de 
Colon preseiitaban, es verdad, grandes dilereneias en el estado de eivi- 
lizaciou que habian alcanzado, asi coino en sus idionuis y liasta en su 
apariencia. Hay grandes intervalos de desarrollo social entre la 
zahnrda miserable del salvaje de California, la larga clioza del Iroques 
y las grandes estructuras de ZuPii, Tlascala 6 L'xmal. Sincmbargo, se 
puede demostrar ([ue en todos ellos liabia uu principio oculto (pie 
obedecia a la adaptacic'ui ii la vida comunal (pie se cree obscrvaban 
todos los aborigenes de las Anu^'ricas. Todas las tcntativas para liacer 
una distincioii entre los(jue liabitaban cliozas de barroy los dcinas ban 
sido int'ructuosas ante el estudiocriticojy los arguiiientos de la tilologia 
conlirnianlosresultadosde los estudios zool(')gicos de la unidad esencial 
de la raza cobriza aniericana. Las tribus en las distintas partes de 
este vasto tevritorio presentaban ciertainente niarcadas diferencias 
en la apariencia fisica, y nuestras colecciones etnol('>gicas nos deniue- 
strau quo en cuauto al taniafio y peso del esquolcto y la forma (Id 
cr;ineo liabia grandes diferencias entre cllos; pero todos tciiian el 
mismo color cobrizo, los carrillos muy prominentes, ojos pe(juerios y 
liundidos, el pelo negro y lacio y la escas(3z 6 falta de barba; por cuyo 
motivo los au tores masconipetentesno liaii [)odido encoutrar sulicientes 
diferencias tisicas, linguisticas 6 sociales contra la evideucia de la uni- 
dad de la raza. 

Afortuiiadaincnte no estamos llainados d referir laliistoria geologica 
americana. Para nuestro tin es indiferente que todas las reliipiias de 
la AiiK^rica antigua scan de un tipo neolitico 6 que al tin se pruebe 
que existen tambien restos paleoliticos; pero lo que si sabeinos es que 
el cliina y la tierra eran propicios al desarroUo de una poblacion ya 
numerosa. vigorosa, fuerte y resistente, asi como de liombres valientes 
y belicosos, aumpie a menudo crueles, y que evidentemente avanzaban 
a un estado de civilizacion, si bien a pasos diferentes. segiin la loca- 
lidad. Desconocedores como somos del origen primitivo de esta raza, 
es dudoso (pre los mas ardieutes sostenedores dela idea moaogenistas* 
de que todo el genero liumano desciende originalmente de una sola, 
pareja, quieran afirmar que nuestros aborigines descendieron asimismo 

* Es bieu sabido que las teutleucias «le las ciencins naturales estan a favor de estas 
ideas. Los filologos pareceu estar dispucstos a adiiiitir (lue, a causa de la mntabili- 
dad delaslenguas, especialmeute eu su estado primit ivo y ciiaudo no ban sido escritas. 
no se puedf llegar a couclnsionus a [versus a la doctrina inonoireui'stica, liasadas t'U 
la divt'isidad de los idioiuas ho^' e\isteutcs, 6 <|iie baa e^iistido eu epocas auteritu'es. 


de una sola, 6 ami de algunos botes cargados de asiatieos accidental- 
mente arrojado a imestra costa del Pacifico; 6 que volvamos a oir esos 
arguineutos apoyados eu la semejauza entre las tradiciones, idiomas, 
costnmbres y objetos heclios a inauo de los aborfgeues americauos y los 
de varias iiacioues orientales. La sorpresa que, estoy seguro, uos bau 
causado a todas esas seinejanzas, debe cesar ante estos dos peusaraientos 
tan bieu espresados, por Fiske y por Lubbock respectivaineute, a saber : 
que uua de las mas iniportantes leceioiies grabadas eu uuestro entendi- 
miento por uu largo estudio de la mitologia comparada, es que la mente 
del liouibre, eu distiutas partes del luuiido, pero bajo la influenoia de 
las mlsmas circunstancias, origiua y desarrolla identicas ideas, y las 
reviste con las mi&mas formas de expresion; y tambieu que difereutes 
razas en el mismo estado de desarrollo a meuudo preseutan mayores 
semejauzas uuas con otras que una raza consigo misuia en difereutes 
perfodos de su historia. 

Muebo se ha ceusurado el cruel tratamieuto que recibierou los 
aborigeues auiericanos a manos de los Europeos; pero no ha sido otra 
cosa que la niisuia triste historia repetida tantas veces, siemi^re que 
uua raza priiuitiva, igiioraute y mal armada ha eutrado en conflicto 
con otra uias civilizada y bieu armada. Sobre el cuadro triste de la 
esclavitud de los Indios mas vale correr uu velo, auuque sus sombras 
mas oscuras fueron ateuuadas por el esplendor del caracter y de las 
gestioues del i lustre Las Casas y por las sabias iniciativas de hombres 
tan emiueutes como el Emperador Carlos V, el Papa Pablo III y el 
Cardeual Jimenez; pero es una extravagancia romaucesca el deplorar 
la destruccion de cualquiera forma de gobierno 6 sociedad existente en 
este continente en 14:92.* 

*Creo convenieute dar aqui un breve extiacto del luetodo iugenioso propuesto 
por Lewis Morgan, de Rochester, Niieva York, para medir el verdadero estado pri- 
mitivo de las razas eu una escala etuica. Es evidente que todo plan semejante se 
presta ;i la critica, y no es extrauo, pues, que los arqueologos esteu divididos sobre los 
luoritos de este plan en particular. 

Los perfodos etnicos, segiiu Morgan, son: el del salvajismo, el de la barbaric y el 
de la civilizaeion, y en cada uuo de los dos priineros periodos hay tres estados secun- 

La distiiiciun entre el salvajismo y la barbaric est^ marcada por la aparicion de la 
fabricaciun de articulos de alfareri'a. Eu el estado priniitivo del salvajismo vivfa el 
hombre en su reducida guarida y se alimeutaba de Irutas y nueces. El lenguaje 
articulado pucde suftouerse que principio eu este estado. Todas las razas hnmauas 
pasaron de este estado en periodos de tiempo desfouocidos. 

Eu el estado medio del salvajismo apreudio el hombre el modo de pescar y el uso 
del fuego. Mi amigo, el Dr. Lumholtz, vivio muehos meses entre los cauibales de la 
Australia, que se hallan en este estado. El invento de la llecha marca el fin de este 

El estado nuis avanzado del salvajismo, en el cual aiin coutiuuau algunas de las 
razas de los Indios americauos, como los Atabaslians de la Bahi'a de Hudson y los 
indigenas de la Tierra del Fuego, termina, como henios dicho, con la inveneiou de la 
alfareri'a; estas tnbus deseonoceu la hi)rticultiira, uo fabrican articulos de alfareria, 

S. Ex. 36 8 


Si el presente cstiido do los iudi<;eiias de la Anieiica del Norte y del 
Sur esta lejos de ser satij>I'actoiio en cuaiito al desaiiollo que prouie- 
tiaii algaiias de las tiibiis, especialiueiite de la America del Sur, 
durante el primer siglo despues de la conriuista, (piizas i)odamos atri- 
buirlo d la mala legislacion de los coucpiistadores, 4 la ausencia de 
instruccion reli<;iosa continua, y a la vil codicia que indujo a fomentar 
la fatal pasi6n por las bebidas embriagantes, tan comiin eutre los pue- 
blos bslrbaros. Creo que no existe sufieiente causa para dudar que con 
un trataiiiiento mas equitativo y mas inteliiicnte. los que (juedan de los 
aborigenes aniericanos puedeu llej^ar <;radualmeiite a ser ciudadauos 
utiles de uuestras republicas, y asimilarse a la masa de nuestra pobla- 

Es facil de aseverar y diticil de confutar que el desarrollo de la raza 
de los pieles rojas de este continente progresaba lentamente antes de 
14t>2, Ivs un lieclio que carecemos de datos tanto de su mas remota 
liistoria como del estado primitivo y de la marclia en el desarrollo de 
ningima de las razas mas civilizadas, para poder liacer una compara- 
cion. Los conocimientos mas remotos <iue tenemos de los autiguos 

y tlependen para su a]iniontaci6u de las raices farinaceas, el pascado y la caza, y 
apciias viveii en poblaeioues. 

El primer estadi) del baibaiisino esta indicado por la domesticacidn de otros ani- 
mak'S, no coutaudo el perm. En 1492, li no ser en el Peril, el I'lnico animal domesti- 
cado era ol perro, y Fiske llama la atemion sobn- que la falta de anlmales donirsticos 
era la causa de la retardaciou del desarrollo de los Indios aiuericanos. El laliallo, 
de cuya familia existieron seis 6 siete especies, segiin lo demuestrau los restos fosiles 
encontrados, desapareci6 y fu.6 rciutroducido despues por los invasores. El cultivo 
de las tierras y la irri<;aci6n, asi como el uso del adobe y la ]iitdra en coustruccioues 
art|uitect6nicas, marrau el liu del primer estado del barbarismo. 

El segundo 6 estado medio est;i niarcado cu el Ilemisferio del Este por la domesti- 
cacion de otros animales ademas del i)erro, y alia, tanto como a(iui. por el desarrollo 
de la irrigacion en la agricultura, el uso del ladrillo y la piedra en la arquitectura, 
por el grau mejoramiento en la fabricacion de articulos de alfareria, y por ultimo, 
por la introducciou de utensilios de cobre y de brouce. 

Puede decirse que este periodo termina cou el descubrimieuto del procediniiento 
de t'wndir el mineral de liierro, el cual se hace m;is y nuis importaute en el tercer estado 
del barbarismo y esta tiualmente asociado cou la produccion de documentos escritos 
por medio de alfabetos foucticos 6 geroglificos perl'eccionados. 

Los que estiiu en favor de esta clasilicaciun aseguran (jue t'acilita niucho el estudio 
comparativo de las razas primitivas, ])ues uos proporciona una signiiicaci6u y li'mites 
defiuidos eutre el estado salvaje y el de barbarisnu>, y debiera disiparla repnguancia 
sentimental cou ([uc se ha uiirado sionipre esta ultima palabra. Es mauitiestameute 
imposible determinar en la mayor parte de los casus la duracion de los varios periodos 
euumerados, pues parece evideute que ciertas razas ban pasado por algunos de ellos 
miis riipidamente que otras. Eutre las causas que ban influido en el desarrollo de la 
civilizacion de las razas, se nos sugieren las signientes : Las condicioues mas 6 meuos 
favorables de la tierra y del clima para iiroporciouar abundautes medioa de subsis- 
tencia; la existeucia 6 carencia de varios animales facilmente domesticados, especial- 
meute el caballo, la oveja, y el ganado vacuno ; las oportunidades para el contacto por 
medio de la emigraciou, el comercio 6 la guerra, cou las razas que ocupau un grado 
mas alto eu la escala ^tuica; y las veutajas 6 defectos dtuicos iuhereutes eu razas 


Egipcios nos revelaii que viviaii ya en nu estado de civilizacion uu 
eutero periodo etnico mas avaiizado que el de los Aztecas. Cuaiitos 
sig"los pasarou entre los periodos del salvajismo y la baibarie de los 
Egipcios uunca se sabra. Noliay razoii i)ara dudar que si la America 
no liubiese sido descubieita todavia, se estariau daiido aqui en estos 
ultimos cuatrocieutos afios esos pasos ms'is 6 meuos lentos en la marclia 
liacia un estado social mas civilizado. Los Europeos han cometido 
errores y atrocidades aqui en uombre dela civilizacion y de lalibertad; 
pero tenemos que admitir que grandes ventajas se ban obtenido con la 
conquista heclia por los Europeos de los siglos quince y diez y seis de 
tribus, la mas adelantada de las cuales, se hallaba todavia en un estado 
muy primitivo de civilizacion. 

Me be aventniado a bacer este rapido bosquejo de un asunto bien 
conocido, poique es conveniente que tengamos claramente presente el 
estado de desarrollo que exist iai en America bace euatrocientos anos, 
cuando se dio comienzo 4 laintroducci6n delas razas eruropeas y dela 

Aqui nos reunimos boy para representar lo que ellas ban conseguido 
en sus nuevas posesiones durante estos euatrocientos anos. Ko pueden 
dejar de interesarnos los conocimientos cientiticos que en estos ramos 
fueron traidos aqui; cnales fueronlos obstaculos que bubo que veneer; 
basta que grado puede considerarse satisfaotorio nuestro estado de 
civilizacion ; cuales son los temas que nos interesan a todos, y en que 
camino de investigacioues podemos unirnos para el bien de todos, y el 
progreso de la ciencia. 

Las palabras grabadas en la tninba de Fernando Col(3n en Sevilla: 

A Castilla y ;i Leuu 
Nnevo muudo dio Colon, 

encierran una verdadincuestionable; perono expresan todalarealidad. 
John Fiske dice bien: "El descubrimieute de America i>uede conside- 
rarse como uu suceso sin igual; pero tiene tambieu que ser considerado 
como un procedimiento proloiigado y multiforme. El suceso sin igual 
lue la travesia del Mar de Tinieblas en 1492, y no bay argumentos, por 
mas iiigeniosos que sean, que puedan quitarles a Colon y a Esi)ana la 
gloria de un becbo que no tiene igual en la bistoriadel generobumano. 
Eue uu suceso que establecio un contacto verdaderoypermanente entre 
la mitad oriental y la occidental de nuestro i>laneta, y unio las dos corri- 
entes de la vida bumana que babian corrido separadas en distintos 
cauces desde el periodo glacial." Pero para demostrar la magnitnd de 
este descnbrimiento; para determinar los caracteres fisicos de este 
continente occidental; para arraigar las semillas de la civilizacion 
europoa se requirieron los est'uerzos beroicos de dos siglos enteros. ISTo 
solamente Espana, sino Portugal, Italia, Francia, Inglaterra, Holanda, 
Dinamarca y Rusia tomarou su parte en la gran empresa, ylos nombres 
deCabral, Pinztui y Magallanes, de Cortes, Balboa y Pizarro, de Ponce 
de Leon y Soto, de Cbamplain, La Salle, Drake, Hudson, Baffin, Davis 


y Beiin.i? debeu quedar para sienipre asociados eii la obia estupen'da y 
progresiva del descubriiuiento. Hasta 180G no vino a darse el ultimo 
paso por Lewis y Clark, quienes cruzarou el contiiieiite de Norte 
America de este a oeste, y terininarou asi la eini)resa conieuzada por 
Cliaiiii)laiii en 1008. Si solo el estudio de la extension de la tierra ya 
deseubierta exigio dossiglos; ^que diremos de los obstaculos niayores 
que se oi)Usieron a la colonizacion del vasto territorio y a la forniaeion 
y establecimieuto de gobiernos adecuados y de relaeiones arniouiosas 
entre los uuuierosos estados y paises en que la America i)ronto se sub- 

Los nn'is antiguos gobiernos de iMiropa parece que necesitan ann 
apoyos artiliciales, y sus disturbios no son a la verdad nada agradables. 
I Es acaso de extranarse que uosotros en este hem islerio tengamos tambien 
nuestras pcquefias disensiones asi intestinas conio con nuestros vecinos, 
en prueba de que la educacion de estos paises es aun lastiinosamente im- 
perfecta en lo que atane al bienestar comiin ? De unacosa podemos estar 
seguros por lo menos, y es de que cuanto tiende a fomentar las francas 
relaeiones entre nuestros paises es una ayuda poderosa para la reso- 
hu'ion del arduo problema de nuestro bienestar. VA diclio eorriente de 
que excusamos a aquellos que conocemos contiene una verdad; pero 
podria anadirse, con respecto a las naciones mas estrictamente que ecu 
resi)ecto a losindividuos, que el couociuiiento nu'ituo engendrael atecto. 
Kecordamos con un vivo iuteres el sabio consejo del ilustre Franklin, 
quien, en 1740, incorporo eu su plan para la organ izaciou de laUniver- 
sidad de I'ensilvania una clausula abogando decididamente por la com- 
pleta enseuanza de los idiomas espaHol y portngiies, como medios de 
apresurar el desarrollo de esas intimas y recii)rocas relaeiones que 
previo se estableceriau iuevitablemente entre los paises de las dos 
Americas. El espiritu de la epoca infundido en nuestros sistemas de 
educacion y en nuestra literatura; y las gigantescas fuerzas del vapor y 
la electrici<lad que unen los mas distautes pantos de nuestro territorio, 
trabajan de comun acuerdo por la ilustracion, la elevaciou, el mejor 
conociniiento mutuo y las mas cordiales relaeiones entre todos nosotros. 

VA ano c'uyo cnarto centenario actualniente cstamos celebraiido vio el 
mundo tan agitado coino jamas loestuvo. Una obra de gran inqtortancia 
para el genero humano liacia tiempo se venia efectuando en la sombra 
de la que a raenudo se La llamado la Edad Tenebrosa. Cuanto mils estu- 
diamos ese periodo de gran interes, mas apreciamos la magnitud y la 
necesidad de los cambios realizados durante esos siglos de preparaciou 
para las esplendidas actividades delllenacimiento. I'node decirseque 
la mision de la Edad Media fue cosmopolita, y (pie una de las liazanas 
mas nobles del lienacimiento fue el descubrimiento de America. Hacia 
tiempo queestaban desapareciendo las barreras entre las naciones, y que 
la mezcla de unos pueblos con otros que tan vastos resultados ha dado 
en el Ilemisferio del Oeste, se estaba llevando a cabo. Las protestas 
coiiti'a el mero dogma en religion y tilosofia, las revolucioues contra el 


absolutismo, el ausiii natural de luz y de ciencia, y los dereclios iiatii- 
rales de la hiinianidad, se despertaroii entoiices para iiuiica mas reu- 
dirse al suefio, liasta que en feclia aurea, pero aim uuiy distaute, se 
anuneiarA la libertad universal y la pacificacion completa por medio 
del arbitraje. Nt) debemos de burlarnos de los suenos dorados de los 
hombres de 1492 que tardaron tanto tiempo en realizarse; y es triste 
el ver que a fines de este siglo diez y nueve despues de Cristo se noten 
en la aurora de la civilizacion sombras oscuras, como restos de la noclie 
de la Edad ]\redia. 

Es de extranar el modo con que cada generacion desatiende con la 
imi^aciencia de ninos las lecciones de lo pasado y cierra sus ojos si las 
verdades que tranquilamente nos enseiia la liistoria inexorable, a 
saber: que se requieren largos iieriodos de tiempo para realizar todo 
gran progreso en el verdadero camino de la religion, la politiea, la 
sociologi'a 6 la ciencia. 

En nada tanto como en las cienciasmedicas debeconsiderarse el des- 
cubrimiento de America como la linea divisoria entre la Edad Media y 
la Edad Moderna. Is o obstante los vastos conocimientos de los grandes 
medicos arabes y judios, como Avicena, el prfncipe de los medicos, 
Albucasis, Avenzoar, el sabio e ilustre, y Maimonides, sus conocimien- 
tos eran mas filosolicos y especulativos que x)OsitiYOS. Grandes uni- 
versidades se formaron. algunas de las cuales, como la de Bagdad y Cor- 
dova, poseyeron grandes rentas y magnificas bibliotecas. I^umerosos 
bospitales tambien se erigieron, entre los cuales merece meucion 
especial el del Cairo en 1283.* Pero el prolongado predominio de los 
moros y arabes en cuanto se relaciona con las ciencias mcdicas no fue 
marcado mas que por el adelanto de la quimica y de la farmacia, la 
introduccion de muclios remedios nuevos y la promocion de la union de 
las ciencias naturales con la medicina. Su quimica estaba fuertemente 
adulterada con la alqaimia; su ensenanza clinica era elemental, y 
sus diagnosticos y tratamientos carecian de la verdadera fuerza y rec- 
titud de un Hipocrates. 

Las innumerables discusiones y especulaciones nietafisicas pronto 
probaron que no era aquel el modo de poder conseguir el verdadero 

Las observaciones aisladas liabian progresado ax^enas en mil oclio- 
cientos aiios mas alia de donde las liabia dejado Hipocrates. La verda- 
dera ciencia niedica, que no podia adelantar sin raetodos fijos, e instru- 
meiitos de precision, se vio obligada a esperar que por otros rumbos 
viniese la era de la verdad, ayudada j)or el estudio experimental. El 
inmortal descubrimiento de Harvev de la circulacion de la sangre no 
fue anunciado liasta 1G16, y su casi tan grande descubrimiento de que 
todos los animales superiores procedian de un huevo no se publico 

*Los primeros hospitales, estrictamente hablando, se fundaron eu el ano de 335 de 
la Era Cristiana por Elena, la madre de Constantino, en Constautinopla y Jernsa- 
16n. El de Antioqui'a se fundo en 360, y el famoso hospital Basilides en Cesarea en 375. 


liasta 1051; y sin enibargo, puedo deeirsc que los trabajos de aijuel 
modesto ingU's y veidadero lionibre cientifico bicieroii nvAs por el 
adelanto de los coiiocimieiitos medicos que todos los trabajos de todas 
las escuelas anteriores desde la epoca de Hipocrates. No solamente 
fueron de j?raii iniportaiicia las verdades que deuiostro, siiio que su 
metodo de iuvestigacion experimental concienzuda marco un nuevo 
periodo en la marclia de las cieiicias miklicas y le hace el padre de la 
mediciiui moderna. 

(Galileo iue el que priniero indico el uso del termometro en la medi- 
cina, en 1595. Sagredo, de Venecia, lo mejoro en 1013, y Sauctorio, en 
1025, insistio urgentemente sobre su ulilidad; pero nofiie sino ;i media- 
dos de este siglo cuaud(t ^\'under]ieh coloco la termometria m<''dica 
sobre bases tan solidas que se liizo indiscutible su utilidad. Asi como 
el astroiiomo (Jalileo nos dio las prinieras leyes del termometro. asi 
tambien otro astronomo. Kejdero, dio, en 1004. la primera descri])cinn 
exacta del pulso liuiiiaiio. i'ero este dato tan importante en el estndio 
de las enfermedades liizo tan ])oca imi)resion en la profesion mc^'dica, 
que el perspieaz Sydenliam. que vivi(') liasta 1089, en ningnna de sus 
obras menciona nada sobre el pulso, y en casi ninguna de las obras de 
aquella epoca que mencictuan cI pulso se dice uada sobre su importaucia 
en la patologia. ji,Q>ue progreso podia liacerse en la mediciua exacta sin 
la quimica? Y siu embargo, poco se liizo por el adelanto de ese ramo 
desde el siglo octavo liasta el decimosetimo. Eoyle fue el padre de la 
<|uimica moderna (nacio en 1027 y umrio en 1091), y fue quien logro 
librar de las trabas de la abjuimia ji esa noble ciencia. liasta fines del 
siglo diez y siete no se estimo el valor del analisis cuantitativo, y fmal- 
meute hasta 1590 no tenemos noticia del primer microscopio eu manos 
de Jan sen. 

Mieutras tanto la sui^ersticion coinbiiiada cou la fe ciega en los maes- 
tros antiguos, y esjiecialinente en Aristoteles y (Taleuo, cuyas teorfas 
liabian predominado por tauto tiempo eu la medicina, cedian gradual- 
mente a la luz de los conocimientos positives. Las fant<4sticas nocioues 
de la alquimia y de la astrologia, la ignorancia y el fanatismo que poniau 
cada organo del cuerpo humauo bajo la proteccion especial de un santo, 
nnian cada remedio d una forma especial de rogativa, marcaban toda 
via la ensenanza y practica de la medicina. Pero el atrevido espiritu 
de investigacion del siglo diez y seis trabajo ])or la mediciua, como lo 
liizo por otras graudes cosas. Vesalio (1514 -A 1504) y sus contemiw- 
raueos crearon la anatouu'a exacta. Pare (1509 4 1590) estampo para 
siempre la marca de su genio y de su caracter en la cirugia. Paracelso 
(1495 j'l 1541 ) ridiculizo las teorias antiguas 6 liizo un importante esfuerzo 
por emancipar el pensamiento medico. El gran metodo de Hipocrates 
de investigacion detenida y concienzuda echo de nuevo raices; y aban- 
donada la infructuosa filosofia de (laleno y sus adoradores ;1rabes, al 
fin principia a brillar, saliendo de la oscuridad de tantos siglos, la medi- 
cina moderna, la mediciua de la fidelidad d la naturaleza y la rebeliou 


contra lamova nutoridad liuinaiia; del esccpticisnio reverente y do la 
fe razonable; la iiiediciua do los experiinentos cientilicos y de la vivi- 
secciou sin causar sufrimientos; la inediciiia que iusiste eu couocer las 
causas de las enferniedades y considera la liigiene como su mas uoble 

La historia de la medicina eiiropea de mas de trescientos aiios a esta 
parte es una nanacion de la cual podemos estar orgiillosoSj si tenemos 
eu cuenta los obstaculos que se liau oi)uesto a su progreso. Vesalio y 
Pare, Harvey y Sydenliam estan relacionados con Bicliat y Laennec, 
Hunter y Jenner, Pasteur y Lister, Vircliow y KocIj, formaudo la gran 
cadena de nombrcs inmortales que nos lian dado la luz con sus descu- 
briniientos cientiftcos. Pero es triste refiexionar sobre lo que se La 
lieclio y lo que pudo liaberse realizado. La ignorancia de los domina- 
dores en cuestiones cientiflcas, lalentitud del progreso delos conocimieu- 
tos praoticos en las masas, y el predoniinio del imperialismo y del 
militarismo ban impedido Ja proniulgacion de leyes que liubieran 
ayudado mas al progreso de las ciencias medicas. Ann en la actualidad 
bay un contraste marcado entre lo (|ue gastan los gobiernos mas 
adelantados de Europa en propagar la educacion y las investigaciones 
cientificas, y lo que se desembolsa para el sostenimiento de esos grandes 
ejercitos y esas armadas que se dice sou necesarios para el manteni- 
miento de la paz y del orden. 

En nuestra misma opoca bemos visto el anuncio de la generalizacion 
,nas graudiosa que ba formado el entendimiento liumano, eu este siglo 
]>or lo menos, anuncio becbo del modo mas filosofico e inofeusivo, 
recibido con un desbordamiento de escepticismo intelectual y de 
intolerancia relrgiosa que demuestra que las antiguas fuerzas contra 
las cuales i^rotesto el Renacimiento existen todavia, annque, afortunada- 
mente, privadas de su auteri(n' poderio. La maravillosa rapidez con 
que se ban propagado las teorias de Darwin, y su incorporaci(3n en los 
pensamientos y las conversacioues del nuindo, asi conio en la eusenanza 
de las iglesias, puede decirse que constituyen el triunfo intelectual 
mas culminante del siglo diez y nueve.* 

Si el j)rogreso real de la medicina fue lento eu Europa durante los 
aiios que se siguieron al annus mirahilis — 1492 — seguramente que no 

*La tiimba de Harvey en la iglesia de Hempstead, tieiie nn epitafio que nos dice 
naci6 el 1° de abril de 1578 y murio el 3 de jnnio de 1(357. Su obra inmortal, 
"Exercitatio Anatoniica de Motu Cordis et Saii,<;uinis," no ol)tu\'o la aprobacion dela 
censnra de la prensa eu luglaterra, y no se publico liasta 1628 eu Fraukfort. Annque 
siisceptible de facil demostracion, aquel descubrimiento que forma 6poca en la 
ciencia tnvo iin Influjo negativo en la teorla y la prfictica m(5dica de eutonces. 
Darwin reposn eu laabadia de Westminster, con los soberanos, losliombres de estado 
y los guerreros de una uaci6n altiva. Su epitafio dice que naci6 el 12 de octubre de 
1809 y falleci6 el 19 de abril de 1882, y su obra princijtal, " On the Origin of Species," 
se puldicrt eu 1S59, ;t los cincueuta auos de su edad, y fu<; durante su vida tradiicida 
^ todos los idionias moderuos, alcanzando seis edicioues y sententa y dos mil 
ejemplares en Inglaterra. 


podfMiios tener quqja al;xuiia contra los prinieros colon iziulorcs de las 
Aiurricas del Norte y del Sur; poi'(|ue les fiie imposiblo, on medio de 
sus lieroicos esfuerzos para conquistar este vasto territorio, ocuparse 
en el cultivo de las ciencias esenciales para el estudio de la medicina.* 
En 1551 fundo Carlos V la Universidad de Lima en el Tern, y en 1553 
la Universidad de Mejico, y sin embargo no se ensePio la medicina en 
aquellas universidades liasta ITOO.t 

En la America del Norte, annqne el Colcp;io de ITnrvard fne fnndndo 
en 1G36, se di(') i)riiuero cl titulo de Universidad a la de l*ensilvaiiia. 
que en 1705 establecio la piimera escnela de medicina en los Estados 
Unidos. Las prinieras y poco nnmerosas colonias diseminadas en este 
vasto pais tenian a la verdad qnelidiar con problemas mas importantes 
que el del fomento de la medicina, y separadas como estaban dc la 
raadre patria, viendose a menudo tiranicamente dominadas por cl 
Gobierno de la T>Ietr6poli y en liucrra continna con los aborijicnes, sin 
contar con las desconocidas condiciones politicas y climatolojiicas del 
pais, liarto tenian en que ocnpar su atencion. Ya lienios visto que 
solo el trabajo preliminar de exploracion ocnpo dossiglos. El final <lcl 
tercer siglo hallo aquellas liulias proximas a terminarse triunfalmente, 
solo para ser segnidas de violentos cambios politicos qne no sellevaron 
a cabo siuo a costa de dis])cndiosas guerras. 

La conquista del Canada por los. Ingleses, de 1750 a 1700, la inde- 
pend(Micia de los Estados Unidos on 17S3, la iii(lei)end<Micia de las 
llei)riblicas Sud-Americanas en ISlo, y los veinte afios subsccnentes; 
tales son los sncesos que el futuro historiador escogera para marcar el 
periodo del Kenacimiento 6 Decadencia en America, y a los cuales 
liabrA que reCerirse sienii)re para determinar nuestra cai)acidad i)ara el 
progreso en politica, en literatura, en artes y eu ciencias. 

Por mucho tiempo asegnral>an ann los criticos mas beu^volos que las 
nuevas razas qne Incliaban por arraigarse en el snelo amoricano vo 
podrian prosjierar como en sus paises natales. y que seria imposi])le 
formar un tipo de raza c iracteristico aniericano. I'ara aqncllos de 
nosotros que liemos estndiado con ansiedad este punto, las liltimas dos 
decadas ban disipado todos nuestros temores. Sean cnales fueren los 
cambios futuros en la organizacion ])olitica 6 las relaciones de los paises 
que componen la America, esta ya demostrado que las razas europeas 
que la ban poblado y que ya suman mas de cieii niilloncs de almas, no 
mostraran decadencia en su vigor 6 en su energia, ni en sus fnerzas 
fisicas y mentales. No meramente por lo grande de nuestros triuntos 
materiales senalamos los millones que pelearon en nuestra grau guerra 
civil, ni las ciento setenta mil millas de ferrocarril que cubren los Esta- 
dos Unidos — casi tantas como hay en todo el resto del mundo — y los 

*La primera prcnsa de iniprimir de Norte America, segnn se dice, fn6 cstablecida 
en 1639 en la casa del Presideute Diinster, del Colegio de Hivrvard. 

tEl Dr. Billings nos dieo que hay una qneja arohivada de lacarenniade cadavcrcs 
en la Universidad de Mejico para las demostracionos de la claae do anatomia. 



$10,000,000,000 de capital iuvertidos en esas liiieas; 6 sn ej^rcito de 
novecientos mil empleados; 6 aquella estiipeuda obra — el ferrocarril 
del Canada al Pacitica ; 6 los planes qiie hoy se estudian para con- 
strnir un sistenia continuo de ferrocarriles en todo el continente, desde 
Montreal 6 la Bah fa de Paget hasta Buenos Aires; por la evidencia 
que presentan de una vasta iinag'inaciou, aiiimosa resolucion, intrepida 
tenacidad de proposito y enorme capacidad fisica para las fatigas, 
damos valor a las enipresas que han subyugado tan rapidaniente este 
continente, y estan apresurando su consolidaciou comer(;ial. Pode- 
mo.s estar seguros de que unos pafses que hau demostrado uu amor tan 
tenaz a la iudepeudencia, resistiendo toda intervencion extraiia; que 
han sido tan sagaces en adaptar sus coustituciones politicas a sus con- 
diciones peouliares; que ofrecen la libertad y las franquicias e iguales 
oportunidades para su mejoramiento a todos cuantos viven dentro de 
los liraites de sus territorios, lograran labrar su destino bajo planes 
mas vastos y mas sabios de amigable cooperacion de lo que podemos 

Turgot, en su memorable discurso pronunciado en la Sorbona, dijo 
acertadamente : '-Tons les ages sont enchaines par une suite de causes 
et d'effets qui lient I'etat du monde a tous ceus qui Pont precMes." El 
descubrimiento de America dependio de causas que se pneden hacer 
remontar a siglos muy remotos. El presente estado de nuestro conti- 
nente, cuatroeieutos auos despues, es el resultado de la accion y la 
reaccion de poderosos movimientos en que se vieron envueltos todos los 
paises del mundo. Este pais es el primer lugar, y probablemente sera 
el ultimo, en que se han reunido y entremezclado todas las nacionalida- 
des del mundo. Aqui corao en ningun otro lugar, pueden estudiarse 
con la ayuda de las ciencias exactas los problemas de la etnologia y la 
sociologia.* Aqui es don de con mejores resultados i)ueden resol verse 

* Fuft poresto que me rar)str6 tau deseoso fie que se organizara la Sociedad Antropo- 
logica Americana, que felizmente se estableci(5 en 1891. La acciijn recfproca entre la 
actividad fuucional y el dnsarrollo cerebral esta demostrada por tautos liechos, y los 
mi^todos de examinar y anotar la disposicion exacta y la diiniuiita estrnctnra de los 
centres aerviososestrin tan firmemente establecidos, que parece liaber llegado la liora 
de empezar a estiidiar sobre una aueba y sistcmatica base los cambios anatomicos 
progresivaraente efectuados en sucesivas generaciones de iudividuos sujetos a las 
condiciones ambientes estimnlantes, que con tanta rapidez cambian en nuestra vida 
modema. Los miembros fundadores de esta sociedad convienen en que se permita 
liacer la autopsia y examen post-mortem del cerebro. Los dem;ts miembros no han 
contraido seraejaute compromiso ; pero todos estau interesados en las investigaciones 
autropometricas y etnologicas. El designio de la obra emprendida por esta sociedad 
esde vasta y profunda iiuportaucia. Se cree que en uiuguna parte como en Am'rica 
se pueden proseguir cou tanto provecbo estas investigaciones. La orgauiz;ici6n 
tieue, sin embargo, un caracter esencialmente iuternacional. Dificil es exagerar el 
valor de una serie de fotografias exactas de la estructura macrosc6pica y microscd- 
pica del cerebro obtenidas en generaciones sucesivas auu durante un peri'odo que no 
pase de mil aiios. Estos comprobautes se obteudran de los iudividuos de las dife- 
reutes razas que viven bajo las mismas 6 enteramente distintas condiciones fisicas; y 


los probloinas coiicornientcs ii las rolacioncs del liombrc con su medio 
anibieiite fisico, y llegar A. la dcmostracion de que, n pesar de la apa- 
rente niagnitiid de las fiierzas de la iiaturaleza, y no obstante el adiiii- 
tido intliijo del cliina y de las condiciones fisicas sobre el progreso de la 
civilizacion, el poder del liouibrepara el adelante intelectual y social es 
incalculablemente sn]>eiior. 

En toda esta obra le toca una gran parte Ji la profesion m(?dica, y 
afortiinadatnciitc nuestra posicion en AiiTTica nos facilitara el poder 
trabajar unidos y con bnenos resultados. El alto grado de la inteli- 
gencia comun de nuestro i)ueblo le liara apreciar desde luego unos 
resultados de tan solida utilidinl y de tanto valor cientifico. Las 
iiunensas riquezas presentes y en perspectiv'a de este continente debe- 
rian ai^licarsc cada dia con mayor munilicencia al fomento de la educa- 
ci<')n y las investigaciones — si, como es di', espernrso confiadamente, nos 
esforzamos caila vcz m;'is por asegiirar la paz entre nosotros y coii todo 
el miiiido. 

]^unca cesaremos do enorgulleKernos de nuestros antepasados, ni de 
reconocer lo muclio (|ii(' le debemos a p]rtropa: sus idiomas son los 
nuestros; sn glorioso jtasado es una i)arte de nuestra herencia; los 
ilustres nombres de sus grandes hombres en las artes, la filosofia y la 
cieiicia, son i)alal)ras de uso corrienteeii nuestros liogares; sus r;i])idos 
adelantos en civiliz;i(;i6n nos estimulan a mayores esfnerzos: ]>ero se 
esta pasando de nuevo el balance entre el Viejo y el Xuevo Mundo, 

Todos sabemos como los eiemi)los de nuestras nuevas y vigorosas 
comunidades lian suministrado y alimentado los principios contagiosos 
de la libertad politica y de la igualdad social.* En todas las luclias por 
los derechos del liombre, desde el terrible pero beneficioso drama de la 
Eevolncion francesa hasta nuestros dias, se lia invocado nuestro ejem- 
plo y nucstr<^ ai)oyo. 

Iso i)uedo dctencros ahora con una enunioracion do los servicios que lia 
liecUo la America a las ciencias mi'dicas. Casi inmediatamente despues 
del descubrimiento se anunciaron importantes adiciones a lafjirmacolo- 
gia, especialmentc de la America del Sur, y desde la introduccion del 
guayaco Lasta la fecha ban scgnido aumentandose sin cesar. Todo el 
mundo medico estuvo agitado durante la ultima mitad del siglo diez y 

es de esperar que se puedau obtener semejantes coiuprobantes de un mlmero de fami- 

lias individiiales en muchas generaciones sucesivas, cuyo iiiteligeute interns en senie- 

jantea investigaciones colectivas pneila mantpnerse snficientemente vivo. La bnena ( 

obra de esta sociedad progresa ya con actividad. Sns arcliivos se conservar.iii en los j 

edificios H prueba de fuego del Instituto de Anatomfa y Biologia " Wistar," quo for- i 

man parte de la Universidad de rcnsilvania. Sin duda alguna la profesion nipdica 

de toda la America ostara dispuesta a cooperar, desde su pun to de vista t^cnico, en 

la gran obra etnologica y arqiieologica que tan vigorosamente ban emprendido los 


* Este es el ilnico priiicipio contagioso quo benios trasmitido. La f;ibnla que 
atribuye a la Am Mica la proccdencia de la sflilis europea ha sido victoriosainente 
confiitada con pruebas concluyentes. 


siete sobre los nitTitos de la criscara de la quiiia,* iiitroducida en Eiiropa 
en 1040 por Jnan del Vego; y no se puede aducir arguniento mas convin- 
ceute sobre el valor de la cieucia medica y de la liigiene que lo muclio que 
se ocuparon las obras y escritos medicos de los sigios diez y siete y diez 
y oclio de las enfermedades paludicas, en comparacion y contraste con 
el sentimiento de impunidad con que boy se tratan esas afecciones. 
Entre los resnltados de esta reunion quo puedeu pronosticarse, espero 
que sea uno la adopcion de un plan bien preparado para el estudio sis- 
tematico y asociado de los romedios americanos y sus preparaciones 
farmaceuticas; a fin de obtener una clasificacion cientifica y mayor 
uniformidad en su i)reparaci6n, y finalmente una sola farmacopea para 
todo este continente. 

La introduccion del protoxido de nitrogeno (en 1844) y del eter 
(en 1846) en la practica de la medieina, con cuya introduccion estan 
tan lionrosamente asociados los nombres de Wells y de Morton; la 
operacion de la ovariotomfa, fundada sobre una base cientifica segura, 
por McDowell, de Kentucky — estos y centenares de otros triunfos 
medicos de inenor brillantez son demasiado conocidos para que se 
requiera mencionarlos. Todos saben cuan superfluo es decir una palabra 
^n defensa de la literatura americana, y ciertamente los que sabemos 
cuan poderosamente ban influido las obras medicas americanas en las 
opiniones y la practica de los facultativos de Europa y el mundoentero, 
podemos contemplar con alguna complacencia nuestra posicion. Y sin 
embargo, un examen de lo que America ba aiiadido realmente a la litera- 
tura medica demuestra claramente cuanto nos falta para estar a la altura 
de las naciones que van a la vanguardia del progreso en los conocimi- 
entos medicos. En 1879 di<') la Bililiotbeca de Rupprecbt* el niimero 
total de nuevos libros medicos, publicados en el muudo, excluyendolos 
folletos, periixlicos j actas, fijandolo en 419, divididos como sigue: Publi- 
cados en Francia, 187; en Alemania, 110; en Inglaterra, 43; en Italia, 
32; en los Estados Unidos, 21; en las demas naciones, 2(); y para el 
ano de 1891 ballo que la misnniBibliotbeca presenta el numero total de 
1,063, divididos asi: en Alemania, 360; en Francia, 243; en la Gran 
Bretana, 141; en los E.stados Unidos, 80; en Italia, 78; en Austria- 
Hungria, 70; en Espana, 24; en otros paises (lirincipalmente en Suiza 
y Dinamarca), 67. 

Por otra parte, en las formas nu'is efimeras de publicaciones medicas 

* Los motives que infinyeroii en sus aiitngoiustas fueron la doctrina de las cali- 
dades de Ins antignos en parte, en parte el odio a los Jesnitas, que fueron los mils 
activos en propagar el nso de esa droga, y asimismo, segun afirma una tradiciou 
maliciosa, el niiedo de que curan'a tan eticazniente, que perjudicarfa a los medicos. 
Aqui viene a la memorio el proverbio indio que dice: "Yarias son las uecesidadea 
del liomhre; lefia pide el cargador, y enfermedades el Doctor. 

*E1 Dr. .). S.- Billings, en "Our Medical Literature." Discurso pronunciado en 
1881 ante el Congreso Medico Internacional. Esos niinieros, anade el autor, son 
demasiado redueidos, especialuieute en lo que atane il la Gran Bretana y los Estadoa 



1^11 iiuiy (lifereutes los guarismos. He lieclio coiitar cuidadosamente 
los voliimenes de periodicos 6 revistas y actas raedicas arcliivados en 
el Museo Medico del Ejercito en Wasliingtoii, indicando los paises en 
que respectivamente se publican, t y el resultado demuestra que de esa 
clase de obras se publicaron en 1890 y 1891 en la America (incluyendo 
el Canada, los Estados Unidos y la America Latina) casi doble el niimero 
de voliimenes de los publicados en Eraiicia 6 en Alemania, y tres veces 
tantos como en la Gran BretaPia. 




(-1 (J;iii:i<la, 

lo.s ICslados 
Ujiiilo.s y 

la America 



> .siis (le- 

Tiicno.s cl 













INtimero <le voirunmos (\o rovisitas 































Kuniorn rtc volrmicnes do rovi.staa 

Niiinero de vol unit' lies de acta.s 









No debemos olvidar, por. snpuesto, que en la prisa con que viviinos 
lioy muclias observaciones e investigaciones de gran valor se publican 
en la prensa periodica general, en vez de insertarse en las revistas pro- 
fcsionales do (pie se Ibrnian voliimenes de mayor consideracion; pero creo 
que no i)uede dudarse (\i\e el gran niimero de periodicos medicos dados (i 
luz en Am(:^riea, en contraste con el niimero comparativamente pequeno 
de nuevas obras medicas, jnstifica completamente la reconocida supe- 
rioridad de Aleniania, Francia, y la Gran Bretana en las ciencias medi- 
cas. El lieclio de que Alemania lia snbido del segundo lugar que ocu- 
paba en esa lista, con 110 voliimenes contra los 187 de Francia, en 1879, 
al i»rimer Iiigar que lioj' tiene, con .'>(>0 o])ras nuevas en 1891 contra las 
243 publicadas en Francia el mismo ano, es un elocuente testimonio de 
los energicos esfuerzos con que lanuevamente uniticada Alemania estA 
rapidamente adelantando en ciencia, como en otros terrenos. La ver- 
dad es que el niimero aparentemente extraordiiiario de publicaciones 
periodicas medicas en America obedece A una causa poderosa, causa 
que influye tambic'n en la formacion de numerosisimas escuclas y socie- 
dades medicas : tal es la vasta extension de territorio v lo relativamente 
esparcido de la poblacion, que Lacen imposible poder servir al pais con 

tTengo gnsto en expresar rai roronocimionto por ]a nynda qne me dispensn en la 
prepuraciou de estos intcresaiites datos estadistioos cl National Bureau of ^Medical 
Bibliograpby. Esa admirable empresa, establecida en Washington para tener ii niano 
las obras de la gran biblioteca del Surgeon-General's Office, merece el aprecio y apoj'o 
de lai)rofesi6ii. 


un promedio tau bajo de facultativos, escuelas, sociedades y revistas 
como es posible en paises iiiAs densamente poblados. En cuaiito a 
otras causas nieiios satistactoiias (^ue lian iuiluido, particularmente en 
los Estados Unidos, para jtrodueir el gran nuiiieio de escuelas medicas 
nial iJiovistas y de periodicos medicos escasamente sostenidos, no es 
necesaiio mencionaiias aqui. A la verdad, el grade cada vez mas alto de 
couocimieutos cientilicos que se requiere hoy, tanto en los facultativos 
como en la literatura medica,y el aprecio creciente por todas partes con 
que se considera el lieclio de que una educacion mi'dica superior iuteresa 
no solameute a la profesion sino tambien al publico en general, estiin 
llevando a cabo la obi a de jjoncr coto al mal aconsejado establecimiento 
de nuevas empresas medicas, y de estimular las existentes a seguir un 
curso mas formal y encamiuado :i fines mas elevados. Tan cierto es esto 
respecto a nuestras revistas medicas, en particular, que ninguno que liaya 
tenido ocasion de cousultar con regularidad las colecciones de cualquier 
niimero de ellas, ha podido dejar de impresionarse profuudaniente con el 
mojoramiento decidido y consstante de su redacciou y el merito cieutiflco 
de los trabajos en ellas publicados. 

Este Congreso se reune en un periodo de iuteres crftico y esjiecial 
para la educacion medica, y me place manifestar que por primera vez 
en la historia medica de los Estados Unidos podemos enorguUeceruos 
de que se celebre aqui una reunion semejante, e iuvitamos a todos a 
que hagan un examen detenido de nuestros modelos docentes y de sus 
facilidades para la ensefiauza. Faltaria a las reglas de la urbanidad, 
asi como a la verdad, si uo reconociese lo mucho que vale el ejcuiplo 
que tan cousecnentemente han dado la America Latiua y el Canada al 
manteuer un alto grado de educacion y de conocimientos en la profesion 
medica. * 

Hace quince aiios la profesion medica de los Estados Unidos denuii- 
cio severamente el manejo de sus numerosisimos colegios medicos.* 
Mientras que el Canada exigia un examen razonablemente estricto para 
ser admitido si un curso de estudios nu'dicos que ocupaba cuatro aiios, con 
una sesion de seis meses en cado aiio, y mientras que en todos los paises 
de la America Latina se requeria un bachillerato o un rigido examen 
para la admision a un curso de estudios medicos de m;is de seis anos, era 
costumbre general en los colegios medicos de los Estados Unidos conce- 
der un diploma, confiriendo pleuos derechos j)ara practicar la medicina 
a todo estudiante que lo solicitaba despues de haber seguido, sin examen 
preliminar de admision, y sin exameues de i^rueba, dos cursos de confe- 
rencias de unos cinco meses cada uno, y haber pasado por un solo 
examen final, dirigido por sus misinos maestros 6 profesores, cuyos 
honorarios dependian del estipendio pngado por esos estudiantes. Esta 
poco honrosa prostitucion de la enseilanza fue el efecto de cansas que 
no quiero comentar ahora. Empero con justificable satis^faccion pode- 
mos seualar hoy las radicales y admirables reformas que se han hecho 

"Escuelas alopiiticas, Go; liomeopiiticas, 11; eclecticaS; 4; total 80, eu 1877. 


despues. Es verclacl que todavia permiteti las leyes de iiiuchos de los 
Estados la incorporaciou de escuelas iiiedicas sin Tiiiicuiia garaiitia 
sobre el caracter de la eusefiaiiza en ellas mantenida. I'eio el espiiitu 
que se ha despeitado en la piofesion y en la eoniuuidad lia iusistido, 
en un uiunero cada dia mayor de los Estados, en que uo se pennita 
ejercer la profesion de medico a los que se han recibido, antes de some- 
terse a uu examen diriyido por una junta de facultativos imparciales 
nombrada por el gobernador. Las escuelas medicas, sea diclio en Lonor 
de ellas, ban sido, con pocas excei>cioues, las primeras que se ban 
esforzado per consegiiir esta sabia y provecliosa legislacion. Han 
lieclio mas aun, pues adelantandose a esas leyes, las facultudes de 
cierto numero de los colegios principales exi-^ieron primero cursos obli- 
gatorios de tres aiios, y abora de cuatro aiios, con ocbo meses de estu- 
dios eu cada uuo, y un plan de estudios acertadamente graduado, y 
rigidos examenes antes de ser los estudiantes admitidos al colegio, al 
termiiiar cada curso y liimlmente antes de recibirse. 

A\ recordar que esto se ha hecho sin la nit'is ligera ayuda del (io- 
bieriio, y mas aun, cnando se coiisidera ([ue, a causa de la reinante 
creencia quo los colegios medicos ban producido piugiies gaiiancias a 
sus facultades, no se ban encauzado todavia haeia eUos las corrientes 
de los donativos particulares, i>odreis apreciar cuan grande es la cou- 
ciencia del deber y la devocion ;i hi cieneia (pie han impulsado a esas 
facultades a tomarse mucho mayores trabajos con la perspectiva de una 
remuneracion mny disminnida por la mas reducida asisteucia de estu- 
diantes y el aumento de los desembolsos. 

La Comision de Orden de este Congreso ha decidido acertailaiiieute 
que se baga una excursion para insi)eccionar algunas de esas institu- 
ciones, y se confia en* que todos los delegados extranjeros, y tantos 
como sea posible de los demas miembros del Congreso, ai>rovecben esta 
oport'inidad para examinar los recursos de algunas de uuestras princi- 
pales escuelas m^dicas. Creo que les sera grato encontrar en nuestros 
hospitales y laboratorios, lo mismo <[ue en nuestras bibliotecas y 
miiseos, ventajas (]ue pueden compararse con las de Europa. Encon- 
tranin un plan de estudios, y sobre todo una organizacion para la 
instruccion cliuica diaria que deja poco que desear. Facil es de prever 
que otro de los resultados apetecibles de reuniones como la presente, 
celebradas sucesivamente eu diferentes partes de America, sera aumeu- 
tar de tal modo el couocimiento y la confianza en nuestros respectivos 
metodos de ensenanza y tratamieuto medicos, <pie esto reteiidra en 
nuestro continente a muchos de nuestros estudiantes y de nuestros 
invalidos que ban acostumbrado ir mas lejos siu obtener mayor pro- 

Uu vasto cami)o se abre ante nosotros para estudiar, con la cooi)era- 
cion colectiva en las iuvestigaciones, el curso y distribuciou de la tisis, 
reumatismo y de otras enfermedades principales, desde el punto de vista 
de las indueucias de raza y localidad. Las tiebres eiidemicas, no iiu-lii- 



yeiido las pahulicas, la tifoidea y la amarilla, que se dice reiiiau en vaiias 
partes de las Americas del Xorte y del Sur, liace tiempo que exigeu 
iuvestipicioues sisteniaticas para conipletar el estudio que de ellas iuicio 
el ilustre Drake. Aliora teiidrenios la oportuuidad de estudiar, igual- 
inente pdr medio de la investigacion colectiva, los etectos relativos de 
los diferentes climas sobie las numerosas razas represeutadas boy eu 
America, y de detenu inar con mayor exactitud las cuestiones cientificas 
y practicas relativas ;i iiuestros iuumerables sitios baluearios y saiiita- 
rios, que al)razan lo mejor de cada clase. Fue el couocimiento de la 
urgeute importaucia de este ultimo asunto, especiahueute eu uuestros 
dias, lo que iudujo al Gobieruo de los Estados Uuidos a extender la 
cordial iuvitaciou que lia sido unitbrmemeute aceptada de parte de los 
otros gobiernos Pan-Americanos. Estoy persuadido que este acto ha 
asegurado para la liigiene, y para la medicina preventiva del Estado 
una aceptacion fornuil que Jamas se les babia dispensado antes en este 
continente, y que debe ser iiidudablemente continuada por la disposi- 
cion de los respectivos gobiernos a valerse de su intlujo para obtener la 
pronuilgacion y estricto cumplimieuto de leyes que esten de acuerdo 
con las recomendaciones de este cuerpo de emiuentes peritos, 

Cuando se reunio en Filadeltia, en 187G, el Congreso Medico Inter- 
nacional, el discurso sobre la bigiene y la medicina preventiva, pro- 
uunciado por el distiuguido Bowditcb, uuo de los i)rimeros campeoues 
de la ciencia sanitaria, fue uno de los mas persuasivos pronunciados 
en aquella importante ocasion. La revista becba en el de los trabajos 
de este pais en la ciencia sanitaria el siglo pasado no es muy lisonjera; 
liero con el ardiente entusiasmo que caracterizaba a uu bombre de 
tanto talento, predijo que iba a inaugurarse iumediatamente la ejioca 
mas graudiosa en la bistoria de la medicina. Son de citarse las pala- 
bras con que termiuo su discurso: "Nuestro deber abora es el de 
organizacion nacional, del Estado, municipal y de aldea. Desde el 
lugar mils alto en el concejo nacional basta la ultima Junta de sanidad 
de aldea necesitamos organizacion. Con esas organizaciones podremos 
estudiar, y a menudo precavernos contra las enfermedades." Estas 
estimuladoras palabras estaban eu armouia con el espiritu de nuestro 
tiempo y el desarrollo de la ciencia. Cuando los brillantes descubri- 
mieutos de Kocb dieron a luz el bacilo especifico de la tuberculosis y 
del colera e indicaron el metodo cieutiUco que debfa seguirse en lo 
venidero para semejantes investigaciones, se obtuvo un argumento irre- 
futable coutia el escepticismo, el indifereuLismo 6 la penuria guber- 
namentales. Necesito valor y demostro una rara latitud de Ideas 
progresistas Lord Palmerston al expedir su celebre coutestacion al Pres- 
biterio de Edimburgo, con motivo de la amenazadora invasion del colera 
en 1853, en la cual iusistio con urgencia en que el bien 6 el mal del 
genero bumauo dependia de la observancia 6 descuido de las leyes 
imturales que regulaban los asuiitos del mundo; y que si no se des- 
truiau las causas locales de la enfermedad antes de volver los calores, 


renpaiecM'a irremediableineute la epideinia, ii pesar de las rogativas y 
ayuiios de una uacioii iiiiida pero iiiactiva. 

Muclio se hizo, es verdud, en mediciiia i)ieveutiva, eiitre 1853 y 1870, 
cuaudo liablo Bowditcli; pero es apenas exageracioii decir que el pro- 
greso de los ultimos veinte anos lia sido mayor (pie el de los veinte 
siglos precedeutes, Es eierto (pie todavia uo hemos descubierto el 
veneno especiflco de todas las enfermedades coutagiosas; aiin con 
respecto a la niuy conocida y ostudiada fiebre aniarilla, las ultimas 
publicaciones del distinguido URHlieo mayor del ejcieito de los Estados 
Uiiidos-indieau (pie auii no se ha resuelto delinitivaniente este puuto. 
Ila liabido, sin end)argo, un cainbio radieal en toda esta materia, 
liabiendo cedido las hipotesis su Ingar a los liechos; pues todo el mundo 
sabe hoy, 6 debiera saber, que las miis temibles enfermedades estan 
inseiiarablemente relacionadas eon bii^'ii definidos organismos, y que 
esos organismos 6 grrmenes se desarroUan y distribuyen bajo leyes 
es])eciales; (jue destruyt'ndolos o elimiiuindolos se evitan esas enfer- 
medades, y que al tolerar las oondieiones (pie lavorecen su desarrollo 
se da pabiilo y se iuvita al ataque de la enlermedad. Cuando se con- 
sideran estas simples y demostrables proposiciones en eonexion con 
azotes tales como el eolera, la fiebre aniarilla, el tifo, la liebre tifoidea, 
la escarlatina, la difteria y la nuiiiiigitis epid(ijnica, no se necesita otro 
argumento para probar el valor y la neeesidad de las cuarentenas y la 
efieacia de la inspe(x*i6u y protee('i(')n nu'dieas. Ni se reipiiere iriejor 
aigumento para demostrar lo acertado (pie es establecer laboratorios 
de higiene en miichos piintos en todo el pais, habilitandolos liberal- 
mente C(m el personal mas eompetente y eon los mas delieados ajiaratos, 
y detandolas generosamente, de modo ([iie se pueda eoutinuar eou 
vigor incesante la investigaciou de las causas desconocidas aun de las 
enfermedades, y deseiibrir los mejores mtitodos para impedir el desa- 
rrollo de semejantes causas. 

Faeil es lograr hoy se preste atenci(in a estas observaciones; ahora 
que se liallan trastornadas las comodidades publicas, amenazada la 
rifpieza publica y (k's})ierta y susceptible la eoneiencia publica. En 
estos momentos descansau iiuestros eentros eomerciales confiados en las 
medidas sanitarias adoptadas por nuestros gobiernos, de aeuerdo con 
los coiisejos nnjdicos, para restringir y excluir esas dos temibles epi- 
demias — el c(')lera y la fiebre aniarilla. Kecut^rdese el terror popular 
del verano pasado; reeu(^rdense las espantosas pi'rdidas de vidas y los 
efectos desastrosos sobre el comercio cansados por las invasiones 
anteriores de esas enfermedades, cuando las i)oblaciones azotadas erau 
mas pequeiias y menos ricas de lo que son actualmente las nuestras. 
No tenemos que remontarnos a la Edad Media a biiscar los cuadros de 
desolaciou, efecto de las enfermedades epidt'micas: recuerdese la tra- 
gica historia de la gran jilaga de tiebre aniarilla (pie azoto a Filadeltia 
hace justamente cien aiios, segiin la describe Itushj calciilese el resul- 



tado, si liubiera iiivadido el colera la ciudad de Xiieva York en 1892, y 
liallaiido favorables las condicioiies del elima y la localidad, liubiese 
propagado sns gerinenes mortiferos por el Xorte, el Sur y el Oeste: la 
bella Ciudad Blauca que a la sazou se estaba levantaudo eu las riberas 
de aquel distante lago, como tocada por la vara magica del arte y de 
la industria, liabria en tal caso recibido un golpe de muerte, y habrian 
sido incalculables las perdidas que hubieran agobiado ^ este pais. 

El pueblo entero conteniplaba lleno de ansiedad la lucLa que se 
libraba eu la baliia de Xueva York, y un bimuo universal en accion de 
gracias se elevo al cielo cuaudo el terrible invasor fue finalmente 
rechazado por los energicos y sostenidos esfuerzos de las autoridades 
sanitarias. El no presenciar nosotros lioy en America la agravada 
repetic'iou de la epidemia, de conforniidad con los in variables antece- 
dentes, solo se debe li la coutinnacion de los mismos esfuerzos, apoyados 
por una autorizacion mas lata, y ayudados con una sanitacion local 
mas eficaz. Cuando tan grato resultado se asocia con el exito que de 
algunos aiios aca ban obtenido nuestros esfuerzos ])ov impedir la entrada 
a la fiebre amarilla, no es necesario aducir mas poderoso argumento 
j)ara exigir la adopcion de aquellas medidas uniformes que en lo venidero 
nos protejan contra la invasion de esos males. Estos ejemplos demues- 
tran del modo mas convincente la necesidad y el valor de los convenios 
sanitarios internacionales que puede bacer muclio este Congreso para 
recabar. Pero otras muclias cuestiones importantes se nos ocurriran a 
todos nosotros que solo un trabajo asiduo y colectivo j)odra resolver; 
ni i)odra llevarse a buen termino semejante trabajo hasta que no se 
corresponda mas completamente que hasta aqui al clamor por organi- 
zacion lanzado por Bowditcb: solo la organizacion y la cooperacion, y 
mas aun, el establecimiento como parte del gobierno de cada naciou 
civilizadade un departamento de sanidad publica, podran proi)orcionar 
la continuada y eficaz atencion que requiere una empresa de tal magnitud. 
Deberia baber, y no esta muy distante el dia en que baya en el gabi- 
nete de todos los gobieruos aqui representados un secretario (minis- 
tro) de la salud i)ublica, revestido con el mismo rango, influjo y pre- 
rogativas que los demas miembros del gabinete. 

Este es pues, el nltimo y el mayor servicio que puede hacer nuestro 
Congreso a la ciencia y al Estado. Xuestro influjo combinado serii 
irresistible cuando lo usemos para abogar en pro de una educacion 
superior; para llevar a cabo vastos planes j)ara el estudio cientitico de 
uuestra vida nacional, hasta doude la afectau el medio ambiente social 
y el clima; i^ara adoptar los remedios 6 tratamientos de merito denios- 
trado, y para que se reconozcau mas completamente las altas funciones 
de la medicina preveutiva. " Salus sanifasque reipuhUcce, suprema 
Zej7." Seanos permitido unirnos aqui mas intimamente unos con otros; 
tener una fe mas profunda en uuestra profesion y sus nobles fines, y 
hacer el flrme proposito de trabajar en fraternal cooperacion ])or reali- 
S. Ex. 36 9 



zar el subliiiif; ideal que cousiste en servir 4 la cieiicia y (i la raza 

* No serial jnsto dojar do liacer iiionoidn aqui de las ohras de varios autores que 
lieraos consnltado para prepavar este discurso, cspecialmcntc El Descubrimiento de 
America, por Fiske; Historia de la Medicina, iior Baas (traducida por Haudorson, 
1892); El Descubrimiento de Norte America, por Henry Harrise (Paris y Londres, 
ISriL'); IjH Ilistoria del Nuevo Miiudo, llamado America, por E. T. Payne (Vol. i, 
Oxford, 181)2); Histoiia do la Civilizaeioii «;u Inj^latcrra, jior P.ufklc; Historia del 
Desarrollo do Enropa, por Draper; La Historia I'rimitiv.i de la Precision 
Instrmnontal en Mediciua, por el Dr. S. Weir Mitcliell; Historia de la Bibliografia 
de la INIediciua Espanola, por A. II. Morojon; Publicaciones y Cartas Incrlitas del 
Dr. Daniel G. Brintou; Infonne sobro la Etiologia y Prevencion de la Fiebre Ama- 
rilla, por George M. Sternberg, 18tK) (lu)y Medico Mayor del Ejdrcito de los Estados 
Uiiidos) ; Oiigcii de la Civilizacion, por I^ubbock, y tambirn sns Tiempos Preliis- 
ttiricos; Antropologia, y tanibion Indagacionos sobre la Historia Primitiva del 
Genero Huniano, por Tylor; La Sociedad Antigua, por Lewis Morgan, Nueva York, 

Tengo tambirn muclio gusto on expvesar mi rcconocimonto al Dr. K. P. Robins 
por la ayuda (|ue me presto, espccialmente en el examen de la Medicina Espafiola 


September 7, 1S93. 

Prayer by the Rev. George Elliott, d. d. 

Almighty God, Thou art the maker of our bodies and the Father of 
our spirits. Help us that this day we may glorify Thee in our bodies 
and in our spirits which are Thine. We give Thee thanks tor all the 
revelations Thou hast made in the world fashioned by Thy wisdom and 
displaying Thy power. We thank Thee that Thou hast given good 
gifts unto men, that Thou hast placed in the hands of men the skill of 
healing. The children of the Great l^hysiciau are called here to con- 
sider the sanitary needs of this great country, and we pray Thee, Our 
Father, that Thou hast held in the fastness of Thy purpose this new 
world for the solving of groat problems and the leading up of races of 
men to new and huger achievements. Grant that by sinnlar meetings 
the nations may be brought to a closer union. Grant that we all may 
be led out through the larger realms of spirit and through the deep 
mercy of Christ Jesus our Lord, with those of our families from whom 
we are absent, separated by all the miles and distances, and may we 
feel near to each other because we are near to Thee, the center of all 
love and of all hearts. Receive us into Thy hands ; live this day by Thy 
wisdom in this people; keep even step beside us through all the jour- 
neyings of our days. Hear us as we continue to pray in the words Thy 
Son taught us : 

Our Father which art in Heaven, hallowed be thy name; Thy king- 
dom come; Thy will be done in earth as it is in Heaven. Gh^e us this 
day our daily bread; and forgive us our trespasses as we forgive those 
who trespass against us. And lead us not into temptation, but deliver 
us from evil: For thine is the kingdom, and the power, and the glory 
forever. Amen. 

Dr. PEPrER. I have the jdeasure of introducing the distinguished 
representative from Venezuela. 

Dr. RiVEAEO Saldiva. It is with profound pleasure that I arise to 
express my great gratification in being privileged to attend this congress 
as a representative of Venezuela, with so many notable members of the 
medical profession gathered together for the exchange of thought on so 
many great and absorbing questions concerning the state of medicine in 
America and the world generally. After the close of these proceedings 
we will return to our respective spheres of usefulness imbued with 



fresli ideas as to the treatincut of disease which suflfering humanity is 
called upon to endure. I take this opportunity of extending, on behalf 
of my Government and my country, our sincere thanks for the cordial 
invitation extended to us to participate in these proceedings, and offer 
our heartfelt congratulations on the success which has attended this 

Dr. I'EPrER. I have now great pleasure in introducing Mr. Ernest 
Hart, of London, who has been invited by the committee of arrange- 
ments to speak briefly upon some of the general interests of the med- 
ical profession in l-^ngland and in this country. 

Mr. Hart. Mr. President, ladies and gentlemen: We are told tra- 
ditionally that Ciest D. Cooper, one of the great surgeons of this cen- 
tury who divided the honor of modern surgery with Von Ruren and 
others, and who remains with us not oidy as a model of a brilliant sur- 
geon, but an accomplislied gentleman, was in the habit of addressing 
every candidate for a degree from the college with which he was con- 
nected, something after the following manner: Gentlemen, you are 
about to enter upon a noble and difficult i)rofession, and your success 
Avill de])end principally upon three things: First, upon your knowledge; 
second, upon your continuous industry; and third, upon your moral 
character. Without the lirst, no one could wish you to succeed; with- 
out the second, industrj', you Avill never be able to succeed; and with- 
out the third, strength of moral character, even if you do succeed, suc- 
cess can bring you no happiness. Now, those words might form a very 
adequate summary, a short text-book of the conduct, private dignity, 
and conduct in relation to public affairs of all medical men; and, one 
might very well ask, whether anything more than that is at all neces- 
sary, whether there is any necessity for a detailed and elaborate code 
when the whole i)hilosopliy can be summed up in so few words. And 
some do ask that question; and just now in our country, and 1 think to 
some extent in this, it has become a question as to just how far it is 
necessary to add to the simi)le rules of ethics, which govern the conduct 
of gentlemen, Christian gentlemen and honorable gentlemen in all pro- 
fessions. Is it necessary to add to this a detailed code of medical ethics ? 
That question is one which has been solved. It was held in no doubt 
until these recent times. But, nevertheless, I think it is clear that never 
at anytime, if there were a necessity for such a code, could that neces- 
sity be nearer and more apparent than at the present moment, for under 
the stress of a complex civilization with the keenest competition, and 
with the temptations and ditiiculties induced by the enormous facilities 
for advertisement, and with all the arts of those who make advertising 
a business, and the protit to tempt the medical man from the ancient 
bond of modesty and diffidence, there is now the strongC'st reason for 
fortifying every professional man by a code so precise, by deductions so 
exact, so comprehensive, and so far reaching that he shall never be over- 
come by such temptations, but shall be able to know at once, and under 


all circumstances, Avliat is Lis duty, what is the rule of his profession in 
any one particular case in which he may be tern j) ted. By jjossible ex- 
cuses, which his vanity, his interests, his natural love of prominence 
suggests to him, he may be tempted to decide a doubtful case in his own 
favor and against the general good and welfare of the profession as a 

]S^ow, I want to say that such a code as this does exist, and exists 
upon a logical and strong basis, exists for the benefit of the public, at 
least as much if not more than for the benefit of the profession ; that 
it is not a trade's union business, it is not an elimiuatioji of public lib- 
erties and rights for the benefits of a private interest, but that it is, on 
the contrary, a movement which is made far more for the interests of 
the pubhc iu general than for the interests of the profession, and that 
applies not least but even more to those regulations of the medical 
code, which have from time to time been stigaiatized b}^ the public 
press as narrow and oppressive, and stigmatized as useless by those 
who call themselves the bolder aud younger spirits among us. But not 
even the youngest among us, as you know, are infallible, and I think it 
is precisely the youngest and boldest which iu this case are likely to go 
wrong. Now, first of all, let me remind you that the medical profes- 
sion is only one of many x)rofessions. We have standing alongside of 
us the profession of law and the profession of the church. It is inter- 
esting, from a universal standpoint, to consider what is the code of the 
legal profession, why is that justified and how does it compare with the 
medical code! Just before I came to attend this congress I wrote some 
legal men concerning some details of the legal profession. One of them 
said : "After all the general spirit of a code may be summed up in a few 
words : That every i^racticing lawyer ought to be a gentleman and 
do only what is honest and honorable and fair to others, and, if he does 
not act like a gentleman and is not honest and honorable and true to 
his profession, honorable men ought to have nothing to do with him." 

i^ow, you notice the deduction, that if he does not, honorable men of 
the profession ought to have nothing to do with him. That is pre- 
cisely our position to-day. Questions in the bar and with the legal pro- 
fession are strengtheued by this, that the discipline of the bar is abso- 
lutely in the hands of the Attorney-General of England, and is decided 
without appeal by judges, so that any solicitor who is guilty, not only 
of any technical offense against his duty as a lawyer, but any solicitor 
who is guilty of anything which brings dishonor upon him as a gen- 
tleman is frequently not only temporarily suspended but subjected to 
depriv^ation of the I'ight to plead or the right to practice his profession. 
My friend sent me a case which occurred last June, in which it was 
decided that a solicitor in a jjrovincial town who had, in virtue of cer- 
tain house property which he held, been a party to immorality, and 
used the house for immorality, and had left a stain upon his character 
as a gentleman, should be excluded from legal practice for a number of 



years, subject to reiustateiueiit upon jiroof of good conduct. So, tlie legal 
profession have a code far stricter than ours, but a code which everyone 
admits is for the benefit at least as much of the public as of the profes- 
sion. Now, let us take one or two other examples of legal etiquette. 
There are several things a lawyer must not do. One of these I was 
instructed in by an eminent lawyer with whom I spent a few days not 
long since. He may not conduct a speculative suit. That is to say, he 
may not conduct a suit in which his pay depends on the issue of the 
suit. Well, that looks like a restriction ui)on liberty. O, how that 
word liberty is licensed ! Liberty is a blessed word, but compulsion is 
sometimes a more blessed word. 

That looks like a restriction upon liberty, but if a lawyer is person- 
ally and financially interested in the result, and the case goes against 
him, he is angry with the judge and is apt to not do his duty, because 
it is his duty to see that justice is secured. So, although it looks like a 
restriction on the lawyer, it is only right he should have no financial 
interest in tlie cause he conducts. So witli many other elements in the 
legal code of ethics, wiiicli I will not dwell upon. 1 will pass at once 
to the code of medical ethics, and I will ask you to consider Avhether 
you are of the opinion that you can safely cast aside all the precedents 
of ])ast experiences, all that you may call the case law. Shall we re- 
ject the deductions wliich have been carefully and deliberately arrived 
at in resi)ect to the applications to the medical life of the general prin- 
cii)les of ethics? 

For example, a medical man is prohibited from consultation with 
quacks. Xow, in order to determine the meaning of the word quack, 
I have looked up Dr. Johnson's definition. "Quaek — a boasting pre- 
tender to arts which he does not understand; a boasting pretender in 
physic; one who proclaims his own medical abilities in public places; 
an artful, tricking practitioner in j»hysic." Thus you see there is no 
distinction between the quacks who have medical degrees and the 
quacks who have not. Another thing, no respectable physician should 
advertise. That is an essential of the quack. He is a person who 
seeks advertisement. This advertisement may be in the way of an 
interview by a representative of the secular press, or it may be by a 
published letter, by the description or criticism of some new alleged 
sj'stem of treatment, or it niay be by divulging the secrets of the sick 
room and reporting without authority or i)ermission the incidents and 
course of the illness of the distinguished or notorious somebody whom 
Dr. is treating. Such arts are in direct contravention of med- 
ical ethics, and deserve the scorn and reprobation of every honorable 
person, as well as every honorable medical man. 

It is in the interest of the public in general that the medical i^ro- 
fession and every member of it shall be worthy of the confidence of the 
community, and that the physician shall earn his reputation, not bj^ 
dishonest means, not by advertisement of himself or his books, not by 


the promineuce accorded to him by the journalists, but by the judg- 
meut of his colleagues as to his approved knowledge and iu view of 
his conscientious and modest ai^plication of that knowledge. As to 
the rule which j)rohibits the medical man possessing or i^rofiting by 
any secret remedy, not only is this an offense against professional 
morality but it is a source of great public danger as well. The physi- 
cian owes his knowledge as well as his capacity for practicing medi- 
cine to the open communications of bygone practitioners, and daily he 
continuously receives such aid from his colleagues. Indeed it is to 
their published knowledge and experience that he owes the greater 
part of his means and ability of practicing his art. A new treatment, 
drug, or medical dogma is like a doctrine, dogma, or deduction in 
theology. The one is for the purpose of aiding the body for physical 
salvation, while the other is an aid to spiritual salvation. 

From traditional law, and in viltue of the mission of the i)hysician 
or priest, both are alike the common birthright of humanity, a*id any 
man who for profit keeps as a secret a new treatment or a new doc- 
trine is a traitor not only to his profession but to all humanity. The 
I)hysician who trades iu or palters with secret remedies is untrue to 
his obligations, unfaithful to the world, a shame to himself, and a dis- 
honor to his calling. It is only right that he should be treated accord- 
ingly under the i)rofessional code, and that he should not have a stand- 
ing equal to the man who is true to his profession, true to humanity, 
and true to himself. 

Nor can the alleged value of any so-called secret remedy be held to 
condone such an offense, for never in the whole history of mankind has 
there been one of these so-called secret remedies which when divulged 
or discovered by examination has proven of the least value. 

Again, a medical man can not take charge of the patient of another 
without previous consultation and approval of the physician who pre- 
viously had the case in hand, or rather under whose care the patient 
was at the time. A physician is prohibited criticising or advising a 
patient on any matter relating to another man's work, except under 
certain stated circumstances and conditions. The consultant is for- 
bidden under any circumstances to take the place of the practitioner 
who called him in. All of this is as much, at least, and perhaps more 
for the public good than for the good of the profession and of the 

A resolution was then offered by Dr. Eeed, concerning certain 
officials becoming ex-of&cio members of the international committee, 
which was passed. 

The section on hygiene offered two resolutions, one concerning 
cholera and the other having to do with the Congress of the Ignited 
States. They were read and referred to the international executive 



September S, 1893. 

Prayer by Ivov. Byron SiiiKloilaiid. I). 1).: 

O Tliou Alini.i;lity and Eternal Jeliovnli. Fatlier of anjiels and men, 
we know that Thou art a rewarder of all them that dili<;ently seek 
Thee, for Thou has confirmed Thy faitli in this by all Tiiy wonderful 
work in the world. Amonp; us there has been all manner of disease 
and death, and Thou has raised up this new order and fraternity of 
men, and endowed them with the genius of sanitary power. Great are 
the labors of these servants, to whom Thou hast <iiven so largely to 
apprehend the laws of life and health among mankind. AVe thank 
Thee, O Thou Father Almighty, for the gracious gifts to this great 
medical and surgical profession in all its departments, which has made 
its members so valiant against the mighty host of evil that has so 
long desolated our homes and caused so much suffering. Vast is the 
needful courage to cope with so many invisible, formidable, and deadly 
forces, and yet we pray Thee that thou may ever fill us with impulses 
which lead to new discoveries for the mitigation of human sufleriiigs, 
and may they ever bear before tlieir eyes that wonderful prediction, 
the last enemy that shall be destroyed is death. We thank Thee, O, 
Thou divine ruler and director of all things, that Thou hast made it 
possible to assemble here this Continental Congress in this great year 
of expositions. And now we invoke Thy special benediction upon all 
the officers and members of this great association, ui)on their families, 
their countries, their nations, and whatsoever they represent, both at 
home and abroad. Be ever gracious unto them, and do Thou abun- 
dantly abet their endeavor, that they may be able more and more to 
open the volume wherein are enfolded the sources of vigor and strength 
for the coming generation, and when they shall have seen the monu- 
ments of this land, and shared its hospitality, wilt Thou guide them, 
each and all, to their nations, that they may lead upon ncAv researches, 
and that they may follow the lines of nobler trinm])h in the chosen 
work of their lives, and may the favor of the Almighty and Eternal 
God rest and abide upon each and all Of them, now, and evermore, 
which we ask through Jesus Christ our Lord. Amen. 

Dr. Pepper. 1 have pleasure in introducing the distinguished rep- 
resentative uf Honduras, Dr. V. C. Valentine, ex-surgeon-general of 
the army of Honduras. 


Dr. Valentine. Mr. President, ladies aud gentlemen : The presi- 
dent of the congress lias kindly excused me from addressing you in the 
language of Honduras. He does that, I presume, under the impression 
that you know a little more English than you do Spanish. 

In the name of the Eepublic of Honduras, I beg to thank you. I 
thank you because you remember that it exists; that it has a scientific 
being worthy of mention in a conclave like this; that it is not solely a 
land of gold, silver. i)recious stones, hides, mahogany, and rubber, 
commingled with volcanic upheavals and political revolutions. I say 
this not in deprecation of the writers, "who must make their letters 
readable, because I am somewhat of a journalist myself — at least I am 
so called by newsjiaper men and women when they would flatter me. 

But, to speak of Honduras itself. It is a small country with a large 
debt. For its acreage, the largest debt in the world. But the debt 
Avas not of its own making. People in the " mother country,'' from 
whence most of you sprang, pledged the building of a railroad to 
unite the Atlantic and Pacific oceans, and pocketed the money. Had 
Xorth Araericnn enterprise undertaken the work, the road would have 
bL^en built thirty years ago and the country enriched by develoi)ment 
of vast natural resources. 

You know, of course, that the finest sarsaparilla in the world grows 
in Honduras. And it was in Honduras that the carica papaya was first 
used as a digestive ferment. It may be transgressing the limits of 
modesty to tell you that a medical official of the array of Honduras was 
the first to prescribe the plant, whose juice, by dissolving the pseudo- 
membrane of diphtheria, enables us to save many little ones from a 
horrible death. 

From the paucity of literature on Honduras, it may not be knowji to 
you that it is anything but a hot, unhealthy country'. TVithin three 
hours" ride from either coast is a land of eternal spring, with an average 
temperature of 72°, and a diurnal variation of but five degrees between 
midnight and noon. There the strawberry and the orange ripen in 
June as they do in December; there one drinks water sterilized in the 
great Avorkshop of nature, charged with carbonic acid gas so that it 
purls like the best champagne, vying in purity with the waters of the 
most noted spas in Eurox)e. 

There consumptives live without a hemorrhage or even a cough, and 
there Koch's bacillus need not be sought or feared. There asei)sis 
need hardly be employed in surgery, for there the air is so iiure that 
meat exposed to it remains unchanged interminably. 

Honduras is proud that it was the first Latin-American country to 
adopt the Xorth American sj'stem of education. Honduras was the 
first tropical country to institute absolute liberty of the press, life's post- 
graduate school. In consequence, it expects to emulate the United 
States in everything, save in the minor details of size. You read much 
of political disturbances and seismic convulsions in Honduras. During 


the past thirty five years there have been but four clianges of govern- 
iiieut; one ex-President is now liviufj- abroad and another, after two 
consecutive terms of office, is farining- in Honduras. This shows that 
the Presidential term in Honduras does not expire by bullets, but by 
ballots. And as to earthquakes and volcanic eruptions, not one has 
occurred for half a century. Yet Honduras is not recognized as fully 
as it merits. It will be as soon as this j^ractieally undeveloped land is 
l^laced within six days' travel of the port of New York, and that will be 
within less than twelve montlis. Tlieii the glorious star si>aiigled ban- 
ner will greet the modest white and blue of Honduras in brotherly 
salutation; then the greatest people in the history of mankind will 
know, and consequently reciprocate, the esteem in which it is held by 
its little sister; then science will accomplish aiiotln^r of its triumphs, 
the way being opened it by the first Pan-American Medical Congress. 


The secretary-general read the report of the International Execu- 
tive Committee as follows: 

The luternational Executive Committee assembled, imrsiiaiit to call, at the 
Arlington, at 3 p. m., September 7. On invitation of the committee, Ur. Pepper, 
president of the congiess, assumed the chair. 

The following conntrics re.s])onded to the roll call by the presence of original 
members of the committee, viz., Argentine Kopublic, Dr. I'edro Lagleyze; Mexico, 
Dr. Tomas Noriega; United States of America, Dr. A. Vander Veer; Venezuela, 
Francesco A. Kiscincz. 

The following countries responded by rei>ort of election to fill vacancies held by 
their respective represcutatives as follows, viz: British West Indies, Dr. John C. 
riiillipo; British North America, Dr. F. Montizambort; Costa Rica, Dr. Juan J. 
Ulloa; Guatemala. Dr. Juan Padilla; Haiti, Dr. V. L. Gilles; Peru, Dr. Manuel A. 
Miiniz; K'epublie of Colombia, Dr. Alfredo Garcds. 

Proxies for the meeting were recognized as follows: United States of Brazil, Dr. 
Mauricio W. Gilmer; Honduras, Dr. Fred. C.Valentine; Spanish West Indies, . 

The secretary-general presented the following resolution, adopted by the general 
session of the congress : 

" Itcsoltcd, That the International Executive Committee be, and is hereby, requested 
to amend regulation ,5 by adding the following provisions, viz: 

"1. The general olficers of the congress shall be ex officio members of the Inter- 
national Executive Committee until the next succeeding meeting of the congress. 
The president of the congress shall be ex officio president, the secretary-general shall 
be ex officio secretary, ami the treasurer shall be ex officio treasurer of the Interna- 
tional Executive Committee. 

"2. The International Executive Committee shall have power to appoint st.inding 
committees to carry out the purposes of the congress, with the power to report rt^ 
interim. Such standing committees shall consist of an et^ual uumlicr of members 
for each constituent country or colony, or for so many of them as may be required 
for the object in view; shall be appointed by members of the International Execu- 
tive Committee, each member mating the required appointments lor his respective 
country. Such committees may be appointed ad interim by members of the luter- 
natioual Executive Committee, at the request of the ex o^cio president of that com- 
mittee. Members of the International Executive Committee, upon the recommen- 
dation of the president of the committee, shall endeavor to have api)ointments made 
in accordance with this provision confirmed by their respective governments." 


Dr. Moutizambert (British North America) moved the adoption of the amend- 
ments. Seconded by Dr. Ulloa (Costa Rica). Carried unanimously. 

The secretary-general reported the following as the present organization of the 
International Executive Committee for the Second Pan-American Medical Congress: 
Argentine EepitMic.—Dr. Pedro Lagleyze, Calle Artes 46, Buenos Ayres. 
Bolivia. — Dr. Einiliodi Tomassi, Calle Ayacucho 26, La Paz. 
British West Indies.— Dr. John C. Phillipo, Kingston, Jamaica. 
British Xorth America.— Br. F. Moutizambert, Quebec. 
Chile. — Dr. Moises Amaral, Facultad de Mediciua, Santiago. 
Costa Rica. — Dr. Juan J. Ulloa, San Jos^.. 
Dominican UepuhJic. — Dr. Julio Leon, Santo Domingo. 
Ecuador. — Dr. Ricardo Cucalon, Guayaquil. 
Guatemala. — Dr. Juan Padilla, Guatemala City. 
Haiti.— Bt. V. D. Gilles, Port au Prince. 
iJrt(tY(((.— Dr. John A. McGrew. Honolulu. 
Honduras {S2)anish).— Dr. George Bernhardt, Tegucigalpa. 
Mexico. — Dr. Tomiis Noriega. Hospital de Jesus, Mexico. 
Nicaraf/ua. — Dr. J. I. Urtecho, Calle Real, Granada. 

Paraauay. — Dr. . 

Peru. — Dr. Manuel A. Muuiz, Lima. 

RepuUic of Colomhia.—Dv. Alfredo Garces, Popayan del Cauca. 
SaJrador.-'Dv. David J. Guzman, San Salvador. 

Spanish JFcst Indies. — Dr. Juan Santos Fernandez, Calle Roiua No. 92, Havana. 
United States of America.— Dr. A. Vander Veer, 28 Eagle Street, Albany, N. Y. ; Dr. 
Wm. Pepper, ex officio president, 1811 Spruce street, Philadelphia; Dr. Charles A. L. 
Reed, ex officio secretin-y, 311 Elm street, Cincinnati ; Dr. A. M. Owen, ex officio treasurer, 
501 Upper First street, Evansville. 

United States of Brazil.—Di\ Carlos Costa, Rua Largo de Misericordia 7, Rio de 

Uruguay. — Dr. Jacinto de Leon, Calle de Florida No. 64, Montevideo. 

Venezuela. — Dr. . 

Dr. Phillipo (British ^Yest Indies) moved the adoption of the foregoing as the 
organization of the international executive committee for the Second Pan-American 
Medical Congress. Secouded by Dr. Vander Veer (United States). Carried unani- 

Dr. Vander Veer (United States) moved that the next Pan-American Medical Con- 
gress be held in 1896. 

Seconded by Dr. Montizambert (British North America). Carried. 
Dr. Reed (United States) moved that general regulation 8 be amended to read as 
follows : 

"Sec. 8. The sections of the congress shall be as follows: (1) General medi- 
cine, including pathology and therapeutics. (2) General surgery, including ortho- 
piedic surgery. (3) Military and naval surgery and surgery of transportation. (4) 
Obstetrics, including gynecology and abdominal surgery. (5). Anatomy, includ- 
ing physiology. (6) Diseases of children. (7) Ophthalmology. (8) Laryngology 
and rhiuology, including otology. (9) Dermtology and syphilography. (10) Gen- 
eral hygiene and demography, including marine hygiene and quarantine. (11) Dis- 
eases of the mind and nervous system, and medical jurisprudence. (12) Dentistry. 
(13) Medical pedagogics." 

Seconded by Dr. Mufiiz (Peru). Carried. 

Dr. Noriega (Mexico), on behalf of his colleagues of the delegation from that 

country, and on behalf of the general profession aud the Government of Mexico, 

extended a cordial invitation to the committee to appoint the meeting of the Second 

Pan-American Medical Congress, to be held in the City of Mexico. 

Dr. Montizambert (British North America) extended an equally cordial invitation 


for the next Congress to be held in the city of (Quebec, but stated that in view of the 
fact tliat the impression prevailed that the next meeting onght to be held in a Span- 
ish-speaking country, he would not urge the invitation as warmly as he might under 
other circumstances. 

On motion, duly seconded, the City of Mexico was unanimously selected as the 
place of meeting for the Second Pan-American Medical Congress. 

The secretary-general here read the following resolutions, which had been adopted 
by the section on hygiene, climatology, and demography, and referred l)y the gen- 
eral session to the International Executive Committee for final action: 

"No 1. liesolccd, That in the opinion of the section on hygiene, climatology, and 
demography of the I'an-American Medical Congress the interest of the public health, 
in every country, should lie and must be intrusted to a department <jf the govern- 
ment especially cliarged with their administration, and that, while the precise form 
of administration be left to legislation, the indispensable requisites are that it shall 
be national ; that it shall have parity of voice and influence in the national councils; 
that it shall have independent executive auth(trity under the limitations common to 
other departments, and that it shall be intrusted to educated and experienced medi- 
cal men, who alone are competent to assume us responsibilities. 

"No. 2. Resolved, That it is the sense of this section that in view of the preva- 
lence of Asiatic cholera in Europe at the present time, and the constantly increasing 
number of foci of infection, immigration from European countries in which cholera 
exists should be tein|>i)rarily SMsi)en(lod, as this action affords, in our o]»inion, the 
only certain means of averting a thr'ateuded invasion by the diseaseof the countries 
of the American continents. And be it further 

" Besolved, That this resolution be reported to the general session of the Pan- 
American Medical Congress, with a roiiuest for its adoption and speedy transmittal 
to the executives of the several countries othcially represented therein. 

"No. S. Whereas, in the language of a British journalist, 'greater energy and more 
systematic administration are nnich needed in regard to the sanitation of India, and 
England's imperial responsibilities in this matterare very heavy;' 

" Whereas the question has been asked in Austria, Russia and France, ' You English 
have by your sanitary improvements prevented cholera from gaining a foothold in 
England, why do you not attack it in its birthplace and prevent it from spreading 
into life in India?' 

"Whereas this question has been asked in America, 'Why should the whole 
civilized world be allowed to suffer through the constant dread of invasion or 
invasion itself of cholera on account of the religious fanaticism of the East? ' There- 
fore, be it 

" Bcsolved, That wo respectfully submit to Her Imperial Majesty's secretary for 
India these recommendations: 

"1. An imperial sanitary department attached to the Government of India. 

"2. A provincial sanitary department attached to each of the provincial Govern- 

"3. A local sanitary department. 

"Ecsolvcd, That the secretary -general of this Government be directed to furnish a 
copy of this to Her Imperial Majesty's ambassador at Washington to be forwarded 
to Lord Kimberly, Her Majesty's secretary for India." 

Dr. Vanderveer (United States) moved that the International Executive Com- 
mittee considers it undesirable to take action upon the foregoing resolutions at the 
present time. Seconded. Carried. 

The secretary-general read the following resolution from the section on hygiene, 
climatology and demography: 

"Resolved bji the section on hi/fficne, dhnatolofli/ and demography, That the Con- 
gress of the United States of America be most earnestly requested to cause a large 
edition of the very valuable report of Dr. Edward O. Shakespeare, of Philadelphia^ 



of his researclies on cholera, to be printed for distribution among the several 
countries representeil in the Pan-American Medical Congress." 

Dr. Vanderveer (United States) moved the adoptiou of the resolution. Seconded 

Dr. Owen (United States) moved that the secretary-general be requested to print 
OH a prominent page in the transactions the following: 

" Bcsolved, That the International Executive Committee, on behalf of the Pan- 
American Medical Congress, disclaims responsibilit\- for the views expressed by any 
individual contributor to its proceedings." 

The secretary-general read a resolution "which had been adopted by the section 
on hygiene, climatology, and demography, upon motion by Dr. UUoa (Costa Rica), 
urging that the congress take active steps to secure the adoption of a uniform set 
of quarantine regulations for all of the countries and colonie^s of the Western Hem- 

Dr. Unioa (Costa Rica) urged the adoption of the resolution. 

Dr. Reed (Uuited States) stated that in view of the fact that the committee had 
already established the precedent of declining to take action on matters calculated 
to interfere with the administrative policy of the constitutent countries, and for the 
purpose of carryiug out at ouce the meaning of the second amendment to regula- 
tion 5, as well as conforming to suggestions made by President Pepper, he offered the 
followiug, which would, in a measure, meet the purposes not only of the resolutions 
which had been sent in from the section on liygiene, climatology, and demography, 
but would supplement actions which were known to have been taken in other sec- 
tions. He therefore presented and moved the adoption of the followiug: 

'• Resolveci, That in conformity to general regulation. 5, as amended at this meeting, 
the International Executive Committee hereby authorizes the appointment of the 
following International American committees, viz : 

"(1) A committee, consisting of one for each constituent country and colony, whose 
duty it shall be to formulate a series of quarantine regulations which shall at once 
furnish the maximum of protection to public health with a minimum of interference 
to commerce, and shall be acceptable to each of the American countries and colonies. 
It shall be the further duty of each meml)er of such committee, when such quaran- 
tine regulations shall have been formulated, to secure, as far as may be i^racticable, 
the appointment, by his respective government, of at least one delegate to an inter- 
national American quarantine conference, vested with treaty-making powers, to which 
conference the regulations previously agreed upon shall be sul)mitted for formal 
ailoption. Each member of this committee may, at his discretion, appoint such coad- 
jutors resident in his respective country or colony as may be required to carry out the 
purposes of the committee. 

"(2) A committee, consisting of one person for each constituent country or colony, 
whose duty it shall be to investigate the expediency of formulating a Pan-American 
Pharmacopcea, and, if found expedient, to i)roceed with the work. Each member 
of this committee may, at his discretion, appoint three coadjutors resident in his 
respective country or colony. 

"(3) A committee, consisting of onemember for each constituent country or colony, 
whose duty it shall 1)0 to investigate ami report upon the medicinal qualities of the 
flora of the various American countries. Each member of this committee may, at 
his discretion, appoint three coadjutors resident in his respective country or colony. 

" (4) A committee, consisting of one member for each constituent country or colony, 
whose duty it shall be to cooperate with the object of placing the care of the public 
health in charge of experienced and educated medical men and to secure the estab- 
lishment in each of the several governments of a department of public health with 
parity of voice and influence in national and colonial councils and with independent 
executive authority under limitations common to other departments in the same 
government. Each member of this committee maj', at his discretion, appoint such 


coacljiiti)rs resident in his respective country or colony as may be required to carry 
out the purpose of this committee. 

"(5) A committee, consisting of one member for each constituent country and 
colony, whose duty it shall be to investigate and report upon a plan to secure the 
adoption of a uniforni or equivalent course of instruction in nii'diciiie in each of the 
several American countries, and to secure the reciprocal recognition in law of grad- 
uates in medicine from each of the American countries who shall have graduated 
from institutions exacting the rcfpiireraents of such uniform or equivalent course 
of instructions. Each member of this committee may, at liisdiscreti(»n, ajjpoint two 
coadjutors resident in his respective country. 

" Hefolred, That the ex officio president of the IntcniafionaT Executive Committee 
shall appoint tlie president of each of the foregoing committees from among those 
appointed as members of the same, and that the president of each committee shall 
appoint the secretary of his respective committee from among either the members 
or the coadjutors of the same. 

" Iicsolved, That the foregoing committees shall be governed by the following 
general rules, viz : 

"(1) Each committee shall have power to prosecute to a conclusion the work 
assigned to it. 

"(2) Any member of either of the committees may report progress at anj' time 
through the medical press, providing that in making such report he shall sign the 

same officially as "Member of the committee on of the Pan-American Medical 

Congress, for ." 

"(3) Copies of any or all reports thus published, or of records of work accom- 
plished, shall be forwarded at once by the member making the same as follows: One 
co])y to the president of the res|)ective special connnittee and one copy to the ex officio 
secretary of the International Executive Committee. 

"(4) The president of each committee may at his discretion prepare and publish, 
ofticially, a summary of the reports of progress of his respective comnvittee in the 
several countries and colf)nies. 

"(5) The president of each committee shall prepare a final report of the detailed 
work of his respective committee, and submit the same to the Second Pan-American 
Medical Congress. 

"((») The ex officio secretary of the International Executive Committee shall pre- 
serve the original copies of all reports transmitted to him officially by members of 
the foregoing si)ecial committees and shall file the same with the archives of the 
First Pun- American Medical Congress in tlie lilirary of the Surgeou-Gencrars Office 
at Wasliington. lie shall prepare a brief summary of the work of all the foregoing 
special committees, and of such additional committees as may hereafter be appointed, 
and shall submit the same, in connection with the report of the ad interim work of 
the luternatioual Executive Committee, to the Second I'au- American Medical Con- 

The adoption of the resolutions was seconded by Dr. Montizambert (British North 
America). Carried by unanimous vote. 

Dr. Muniz (Peru) moved that the appointment of members of these committees 
be deferred until the members could return to their respective countries to take coun- 
sel regarding the a[)i>ointmeiits which should bo transmitted as soon as made to the 
secretary -general wlio should promulgate the lists as soon as completed. Seconded 
by Dr. Gilles (Haiti). Carried. 

Dr. Vander Veer (United States) moved that the address of President Pepper be 
published in pamphlet form under the auspices of the International Executive Com- 
mittee in advance of the publication of the transactions, and that it be published 
in the transactions in the English, Spanish, and French languages. 

Dr. Ulloa (Costa Rica) moved that the following resolution be reported for formal 
adoption by the general session, viz; 


"Resolved, That the thanks of the Pan-American Congress be, and are hereb}", ten- 
dered to the President of the United States for his cordial cooperation in promoting 
the interests of this congress; to the Congress of the United States in adopting a joint 
resolntion and in appropriating funds by which the present successful meeting was 
lield under the auspices of the A'ational Government; to the Surgeon-Generals of 
the Army, Navy, and Marine Hospital Service respectively, for courtesies extended 
in their official capacities; to the general officers of the Congress and to the officers 
of sections for their devotion to the success of the Congress; to the committee of 
arrangement and their respective subcommittees for the delightful entertainment of 
the members, and to the press, medical and lay, for its cordial support of the con- 
gress from its inception, and for its careful reports of the meetings now drawing to 
a close." 

Dr. Montizambert (British North America) seconded the adoption of the motion. 
Carried by unanimous vote. 

Adjourned sine die. 

WiixiAM Pepper, 
Ex officio President. 

Charles A. L. Reed, 

Ex officio Secretary. 

Dr. L. I. McMurtry (Fnited States) moved that the report of the 
International Elxecutive Committee be adopted. Seconded by Dr. Fran- 
cisco A. Eisquez (Yenezuehi). Carried unanimously. 

Dr. J. C. Pbillippo, Kingston, Jamaica, then spoke on behalf of the 
foreign members as follows : 

Mr. President, ladies and gentlemen: It is with considerable 
diffidence that I rise before you on this occasion to return the thanks 
which are due to you for the kindness with which you have received 
the members of the foreign delegation in this, your magnificent city. 
I have talked with several of them from tlie isles of Cuba and Hayti, 
and Mexico, and tind they cordially unite with me in returning to you 
their thanks for your kindness and hospitality, which to them has 
flavored almost of perhaps too much kindness in some instances, but 
always an invariable amount of fellowsliip and good feeling. 

Gentlemen, I do not want to make a long speech on this occasion, 
but I can not leave you without recalling to mind that in this year you 
are celebrating the discovery of America by the great Christopher 
Columbus. I have heard some people say they are tired of Christopher 
Columbus. But I am sure that those who think i^roperly and quietly 
over the matter will always remember the life of that great man with 
feelings of veneration and esteem. Columbus discovered this conti- 
nent and gave to Castile and Leon a new workl. I do not think that 
he ever dreamed that in discovering this New World he would give to 
the world a miglity nation. This mighty nation has arisen, springing 
from the first inen who came here, good, wise, faithful, conscientious 
men, men who were persecuted in their own countries and who found in 
the barren rocks of Plymouth homes where they planted their standard, 
and did more than Christopher Columbus to create this mighty nation. 
And this mighty nation, thus established, has folded in its arms the 


struggling? and oppressed masses of Europe. You have liere amongst 
you people liom every nation, people who claim and look to the United 
States of America as their mother and their friend. 

But gentlemen, if Christopher Columbus gave to Castile and Leon a 
new world, the United States has given the world a mighty name, a 
man who, greater than any other man, stands unrivaled in the history 
of the world. In talking of Christopher Columbus, I have heard but 
little ot that man, who from my earlier years I have almost worshiped. 
I refer to that man who was said to be first in war, first in i^eace, and 
first iu the hearts of his countrymen. You all know to whom I refer, to 
George Washington, whose name has been given to this city of great and 
magnificent distances. It stands as a monument to him who helped to 
found this great liepublic; and, when I think of \yashington, I remem- 
ber how he, like Christopher Columbus, suffered during his lifetime 
through the jealousy of his friends. But, his name is now imperishable ; 
no other name stands in the history of tlie world to compare to that of 
George Wasliington, and tliere are few cities in this world tliat cai) 
compare in beauty and nuignificence with this city, in which we are 
now meeting. 

As I look upon the emblems of peace that surround us, I can not 
refrain from calling to mind the condition of Europe, where the roll of 
the drum and the clank and the tramp of warlike men is heard, Mhile 
pestilence and famine are ravaging the peojile, and thousands and hun- 
dreds of thousands are dying, and I thank God this Pan-American 
Congress has met in this place. When I think of these things, I 
remember that though all these nations are ready to go to war, and 
there are men ready to be let loose like the sleutlihounds, and they are 
devising all the ingenious schemes for the destruction of their fellow- 
men, war comes but rarely. Pestilence and famine we hear of, and 
they carry away hundreds of thousands, but their visitations are 
infrequent. But, there is a greater foe than these; there is a foe that 
lives and dwells in every civilized country; there is a foe that lives 
almost in every home. I mean ignorance, and superstition, and immo- 
rality. Ignorance of hygiene causes the death of one third of the 
human race in earlier infancy. And, now, it is for this great associa- 
tion, in this country, where there is no need of standing armies, to 
devote all energies to the alleviation and to the prevention of dis- 
ease and to the rescue of those infants who are thus annually slaugh- 

I hope and that this Pan-American Association will live and 
thrive for years, and that the association will soon see the time when 
human life will be held more sacred than it is. I tliink I can almost 
hear the ancient seer crying out, "Watchman, what of the night? 
Watchman, what of the night?" The night is far spent and the day is 
at hand, the morning star arises in the East, the nations shall no more 


war against nations: kings shall be nursing fathers and queens nursing 
mothers; governments, instead of warring and fighting, instead of 
seeking to increase the number of their fighting men, shall seek for the 
perpetuation of human life, for how much better it is to save life than 
to destroy it! Those are the words of our veteran poet and i)hysician, 
the autocrat at the breakfast table. His word is our law, and I hope 
the autocrat will once more tune his h^irp and give us an ode to the 
Pan-American Association. 

And now I must conclude. I fear I have taken up too much of your 
time. And if we shall meet again in three or four years I presume it 
will be in the halls of Montezuma, which, for so many thousands of 
years, have been a monument of the early power and talent of men. 
But in taking farewell of you on this occasion, my friends of the Pan- 
American Association, I can only say that I and all the foi-eign dele- 
gates are delighted to have met yon. You have been only too kind to 
us; you have made us think more of ourselves than we ought, and if 
we remained much longer we would think so much of ourselves we 
would not care to go away. And now I bid you farewell. Farewell. 

Dr. Pepper. We have enjoyed very much the coming of several 
European gentlemen of distinction, and it giv^es me great pleasure to 
present to you Mr. Ernest Hart, of London, who will respond on behalf 
of the European guests. 

Mr. Ernest Hart, Mr. President and gentlemen: No task could 
be happier or more welcome than that of expressing to you, on behalf 
of those whom I represent, especially on behalf of the British guests 
of this congress, our sense of deep admiration of the great thought 
which inspired it, and of the remarkable success with which a most 
diiiicult task has been carried out. With the thought which stimulated 
those who convened this congress, British physicians must esi)ecially 
be in sympathy. First, because the principle of scientific association 
passing beyond the barriers of nationality has always been a leading- 
thought and a constant method of action in Great Britain, and nothing- 
has ever given us greater pleasure than to welcome, for the last centur}^, 
visitors from this great continent to our annual scientific conventions. 

One great imperial object dear to the heart of every resident in Great 
Britain and of all the British colonies and dominions, is the desire for 
the confederation of all useful and benevolent public purposes of the 
English-speaking race. We are doing everything in our power to pro- 
mote it in our sphere by advancing what is known with us as imperial 
confederation. That is to bring together for common purposes of good 
all the dominions, colonies, and empires in which the English language 
is spoken within the range of British Government. This Pan-American 
confederation is, I hope, a step, and by no means the first step, and 
not, I hope, the last step, for the confederation of all the British-speaking 
and foreign-speaking races upon this great American Continent. And 
we may claim to have this much of a share in it, to show how close is 
S. Ex. 36 10 


the relation of the American with the British race, that even in this 
Pan-American Congress you necessarily inchule British America, Brit- 
ish West India, and a hirge number of British subjects, whom you 
chiim justly as Pan-Americans. So, here, we can claim that British 
and Americans stand shoulder to shoulder in the successful promotion 
of science. 1 thank you most heartily and most sincerely for the kind- 
ness with whi(;h you have entertained jour foreign guests. 

Dv. Pepper. We have accepted the cordial invitation of the Kepub- 
lic of Mexico as the place of the next meeting of this congress, and I 
have the honor to present Dr. Lavista to respond for that country. 
(Spoke in Spanish; remarks not furnished.) 


Finally, members of the Pan-American Medical Congress, it remains 
only for the society to adjourn; it is not .sine die, but to a date. This 
date is left in the hands of the International Executive Committee, and 
the reason it is not definitely fixed in 180G or 1897 — for no one sug- 
gested an earlier date than three years — was because the date of the 
next European congress can not be settled until after the meeting in 
Kome in April. If that congress shall then decide to adopt the new 
schedule, meeting in 1894, 1897, etc., it would be better for us to meet 
in 189(1, but if it meets in 1896, pDSsibly it would be to the interests of 
this congress to have the meeting in 1897. So, too, doubtless the season 
chosen will be one which will render the visit to that country most satis- 
factory. This congress completes, apparently, the needful organization 
of these continents, and of the profession of this entire hemisi)here. We 
are all determined to stand by it and develop it with all our power. This 
congress constitutes the great American democratic confederation of 
our i)rof('Ssi()n, and. with the sijstcr society, the association of England, 
it is to go hand in hand. 

We have evident]}' developed the need of a number of special socie- 
ties, and these have come to meet once in three years, a body of special- 
ists limited in their work. Now, it seems there is need for this larger 
body, supplementing, complementing, and I think we may hope com- 
pleting, the organization; so we now have a body which apparently has 
a very different function from any of the others, because it has become 
the organic liuk between all the governments of this continent and the 
profession, and for the first time there is this organic; relation created. 
The remaikable courtesy of the governments where the International 
Congress has met, and the presence of royalty have given grace to the 
occasion, but it has never met under the auspices of a joint resolution 
of Congress and the official invitation of the President, as has the first 
Pan-American Congress. This has been from the start the central con- 
ception, and I think the main impulse, fn this whole movement, that we 
were creating a new mechanism, which if allowed to grow by its own 


inherent merit would demand the respect of nations, and would come to 
have a most important organic official relation with these governments. 
Thus it would seem this Pan-American Congress hascompleted the union 
of the profession of this continent by its immediate success, and by the 
warm sympathy which we have all felt toward it. Think, this year, 
with the very successful meeting of the American Medical Association, 
with the attractions at Chicago, with the uncertainty of the congress at 
Rome, and the financial stringency, and yet we have had countless 
expressions of sympathy, for we have had the strongest and most cor- 
dial testimony of those who have spoken, as well as of many others, 
stamping with approval this Pan-American Association. 

So, my brethren of this first Pan-American Congress, in adjourning 
it I feel we have consummated an important step in the progress of 
American science. For the unfailing courtesy extended to me, and for 
the charming cordial relations which have in all instances existed 
between the officers of the congress, I can not express sufficient thanks. 
All sorts of blunders have been made, but we have all overlooked 
them. Everybody has apparently been standing by his brotherj there 
has not been for a moment the slightest feeling- or divergence of 
opinion, but only work for the advancement of our profession. Dr. 
Keed was initiative, and it is only right 1 should speak of the incessant 
work, and of the cooperation of all those connected with the organiza- 
tion. I have, then, only to say farewell, thanking you for the courtesy 
extended to us, and asking you to join with the International Executive 
Committee with the determination that we do not intend to allow it to 
go down, and with a determination to secure the continuous influence 
and the growth and the strength of the Pan-American Medical Con- 
gress in all future years. 






Honorary jjrcsidciifs. 

Dr. Manuel Carmoxa y Fallk. City of 

Dr. Francis Delafield, New York, N.Y. 
Dr. Israel F. Dunn, Portland, Me. 
Dr. Keginald H. Fitz, Boston, Mass. 
Dr. J. O. Hirschfeldek, San Francisco, 

Dr. Henry M. Lyman, Chicago, 111. 
Dr. Alfred L. Loomis, New York, N. Y. 
Dr. Emilio Martinez, Havana, Cnba. 
Dr. William Osler, Baltimore, Md. 
Dr. John A. Ouciiterlony, Louisville, 


Dr. William Pepper, Philadelpliia, Pa. 

Dr. F. Peyre Porcher, Charleston, S. C. 

Dr. G. Isaac Ugarte. Santiago, Chile. 

Dr. Armando Velez, Lima, Peru. 

Dr. H. A. West, Galveston, Tex. 

Dr. .Tames C. Wilson, Philadelphia, Pa. 

Dr. Carlos E. Berniiakd, Tegucigalpa, 

Dr. J. J. CoRxiLLiAC, St. Pierre, Martin- 

Dr. Henry Hun, Albany, N. Y. 

Dr. Guzman, Nicaragua. 

Executive president. 
Dr. YiCTOR C. Vaugiian, 15 S. State street, Ann Arbor, Mich. 


Dr. Judson Daland (English-Speaking), 

317 S. Eighteenth street, Philadelphia, 

Dr. GuEMES (Lavalle 869), Buenos Aires, 

Argentine Republic. 
Dr. A. A. DE AzEVEDO SoDRE, Rio de 

Janeiro, United States of Brazil. 
Dr. MOOREHOUSE, London, Ontario. 
Dr. A. J. Williams, Georgetown, British 

Dr. JOMN Fullock, Tobago, Trinidad, 

West Indies. 
Dr. iGNACio Gutierrez Ponce (2 Rue 

Pierre Charrou 2), Paris, France (for 

Republic of Colombia). 
Dr. Martin Bonnefille, San Jose, Costa 

Dr. .T. Carreau, Point a Pitre, Guade- 
loupe, French West Indies. 

Dr. Ramon L. Miranda (Spxanish-Speak- 
ing), 439 W. Forty-sixth street, New 
York, N. Y. 

Dr. Samuel Gonzalez, city of Guate- 
mala, Guatemala. 

Dr. Arch. Desert, Port an Prince, Haiti. 

Dr. G. P. Andrews, Honolulu, Hawaii. 

Dr. RoMULO COLIXDRES, Comayagua, 

Dr. Basilio Marin, Leon, Nicaragua. 

Dr. ViNCENTE B. Valdes (Teniente Rey 
104), Havana, Cuba. 

Dr. Enrique Figari (Uruguay 190), 
Montevideo, Uruguay. 

Dr, Francisco A. Risquez, Caraca.s, 

Dr. Demetrio Me.tia (San Andres 12), 
City of Mexico, Mexico. 

Dr. G. E. PiERREZ, Antigua, British West 





Profesior of Hygiene and Dean of the Department of Sfedidne and Surgery, 
Univenity of Michigan, Ann Arbor, Mich. 

the principles of immixity and cure in tiik infectious diseases. 

Gentlemen of the Section on General Medicine of the First Pan-Amer- 
ican Medical Congress: I wish to extend to yon a hearty greeting, and to tliank 
you for your presence aud for the interesting and valnalde papers which many of 
you have prepared, aud which will luake the work of this section worthy of the 
profession of the New World. 

In opening the labors of this section. I have decided to bring before you for yonr 
consideration a theory eonceruing the principles of ininiunity aud cure in the infec- 
tious diseases. I shall at first discuss the question of immunity and shall llien 
endeavor to ascertain the differences, if there be any, between the fundamental 
priuci])les upon which inniiunity is secured aud those by which cure may be brought 

Upou the subject of immunity many valuable contributions have been made, and 
theory after theory has been ]troposed. Roth the researches and the theories have 
their value, that of the former being permanent and that of the latter consisting 
piincipally in suggestions that stimulate aud systematize investigation. The value 
of a theory does not wholly depend upou its truth, but is rather to be measured by 
the fruit fulness of the lines of investigation that it opens. Indeed, a theory may 
be wholly erroneous and yet it may lead to most im])ortant discoveries. 

It is not my purpose to assail or even to discuss the theories concerning immunity 
that have heretofore been brought forward, but to suggest one that, in my opinion, 
will harmonize the results already attained bj' scientific workers, and which, I hope, 
will lead to other investigations. 

Immunity may be natural or acquired. Natural immunity may be peculiar to the 
species or race, or to the individual. An example of natural immunity is that of 
the domestic fowl to anthrax. As has been shown by Lazarus and Weyl, the chick, 
even at the time of coming from the shell, is immune to the most virulent culture of 
the bacillus anthracis. It is true that this animal may be made susceptible to 
anthrax, but this is an artificially-induced susceptibility. The immunity is natural 
to this bird at every period of its life. Another example of racial immunity is that 
of the frog to anthrax. This animal can also be rendered susceptible, but again it 
is true that the susceptibility is artificial and the immunity is natural. Racial 
immuuity must be inherent in the parent cell. 

The natural immunity, which is pecnliar to the individual, usually comes with 
adult life. The young are susceptible to a given disease, but adults of the same 
species lose this susceptibility aud become immune. The young rat is susceptible 
to authrax, while the adult is naturally immune, but can be rendered susceptible by 
exhaustive exercise. The child is highly susceptible to scarlet fever and diphtheria, 
while the adult, though not wholly immune to these diseases, loses very much in sus- 
ceptibility aud is likely to become infected only when greatly reduced in vitality or 
after prolonged and aggravated exposure to the poison. The only reasonable expla- 
nation of this immuuit}' is that it is inherent in the parent cell Jind comes on as 
naturally as do the cliauges in form aud voice at puberty or the growth of the beard 
in early manhood. The evolution of the condition of immuuity in these cases is due 
to the natural deA'elopment of the fnnctional activity of certain cells of the body. 
The cause of the diflPerence in the effect of the authrax bacillus on the young rat 
and that of the same germ on the adult rat exists in the rat aud not in the bacillus. 
A child and an adult are exposed to the Luttier bacillus from the same source; the 
former becomes infected, the latter does not. The germ is the same, but in the 
development that converts the child into the adult, the resistance with which the 


germ must contend lias been strengthened. The immunity that comes with adult 
life must be due to altered cell activity. 

Ehrlich has shown that immunity from poisoning with the vegetable proteids, 
abriu, ricin, and robin, is transmitted from the mother to the fetus and retained by the 
latter for more tliaii a month after birth, when it is quiclcly lost, and that the second 
generation fails to show any immunity. He conchides that there are two kinds of 
immunity: One he designates as active, the other as passive. The immunity that 
he found to be transmitted, as already stated, from mother to child .'le classifies as 
passive, and thinks that it is duo to the transmission of ready-formed antitoxins 
from the mother to the child and that these antitoxins being soon eliminated the 
immunitj'^ is lost. In active immunity he supposes that the body has ac(xuired the 
jiroperty of manufacturing tlio antitoxins, but upon this point he is not clear. He 
also demonstrates that immunity may be transmitted from the nurse to the child, 
even when the latter is not the offspring of the former and has come from a highly 
susceptible mother. 

This division of immunity into an active and a passive form is convenient and 
plausible, but Ehrlich's active immunity must be cellular in origin. Can any chem- 
ical products be elaborated in the animal body except by the activity, either direct 
or indirect, of cells? The most earnest opponent of vital energy — which now means 
cellular activity — admits that the active principles of the digestive juices are the 
products of specialized glands, and even the absorption of the products of diges- 
tion, which we once believed to be effected in accordance with the comparatively 
simple laws of osmosis, is now known to be dependent upon cellular activity. But 
can it be said that the temporary immunity that is transmitted from mother to 
child or from nurse to nursling is of cellular origin? The mother and the fetus are 
physiologically one, and the same is true of the nurse and the nursling. The blood 
of the mother flows through the fetus, and the products of the cells of the nurse 
feed the nursling. 

Ehrlich made six experiments, in which it was found that the offspring of an 
immune father and a susceptible mother did not possess even a temporary immunity, 
and this forms another reason for his belief that immunity is humoral; but Tlzzoni 
and Cattani have shown that an immunity to tetanus artificially induced in the sire 
is transmitted, though lessened in degree, to his offspring, although the mother 
remains susceptible; and Tizzoni and Ceutanni, that a like immunity to rabies may 
be transmitted from father to offspring. If these statements be true the humoral 
theory of immunity must be modified so that the noncellular elements can be con- 
sidered as inducing immunity only by their effects upon the cellular elements. As 
is claimed by Ehrlich immunity transmitted from the mother to the offspring may 
be explained by supjiosing the introduction into the latter from the former, through 
the fetal circulation or through the milk, of immunity-conferring substances in sol- 
uble form; but in the transmission from father to children we can conceive only of 
the idea that the immuuitj- must reside in the cellular elements of the spermatic 
fluid, because our knowledge of fecundation teaches us that the head of the sperma- 
tozoon fuses with the ovum and produces tlie child. 

Artificial immunity may be induced by either of the following methods: 

1. By an attack of the disease, ending in recovery. Until the discovery of Jenner 
this was the onlj* known cause of immunity, and even at present it is supposed to 
be, as far as man is concerned, the most potent cause. However, we now know that 
the period of time through which immunity thus obtained holds good has been over- 
estimated. A man may have smallpox the second time, provided several years have 
elapsed since the first attack, and provided the second exposure brings him in con- 
tact with a highly virulent form of the infection or the exposure continues through 
an unusually long period or happens at a time when the health is much reduced from 
any cause. Moreover, the period of immunitj- conferred by an attack of some of the 
infectious diseases is so short that numy have reasonabh* questioned its existence. 


It is true, I believe, tliat the more grave aud virulent the disease may be, the 
greater and more persistent is the immunity that follows. I mention this in order 
to call attention to the fact that there is a quantitative relation between cause and 
effect in the production of immunity. Please bear in mind that in this method ol 
inducing immunity the substance of the germ itself is introduced into the body. 
This metliod found a practical application in inoculation for the prevention of small- 

2. By vaccination with a modified and less virulent form of the infection or by the 
introduction of at first a very small number of the virulent germs and successivo 
inoculations with larger nuiuhers. 

The successful inoculations against chicken cholera and anthrax made by Pasteur 
consist in vaccination Avith a modified germ, and the valuable investigations of 
Emmerich and his students in immunizing certain animals to swine erysipelas have 
demonstrated the results that may be obtained by employing the virulent germ first 
in small numbers and then gradually increasing the dose. Again, it may be observed 
that the germs themselves are iutroiluced into the body, and again it is also true 
that the more potent the cause the greater and more persistent the efi'ect. The 
immunity that follows inoculation with a germ of full virulence is more marked and 
extends through a longer period than that wliich is induced by a vaccine. 

3. L5y one or more treatments with sterilized cultures of the germs. 
Immunity against the germs of typhoid fever, cholera, diplithera, tetanus, hog 

cholera, and several other diseases, has been secured by one or more treatments 
with sterilized cultures of these germs. An interesting f|uestion arises in this con- 
nection: What constituent of the sterilized culture is it that confers immunity? 
All will agree that it is not due to the ptomaines that are present in some of the 
cultures. Another important class of substances present in these sterilized cultures 
contains the so-called toxalbumins. aud to these we maj' possibly look for tlie cause 
of the immunity. 

The teaching of some of the German investigators is that each pathogenic germ 
produces both toxins and a special immunizing substance. This is a very con- 
venient theory. It supposes that each germ, while elaborating its harmful products, 
also produces a substance that will prevent its growth. Please bear in mind tliat 
this theory is wholly dift'erent from tliat wliich teaches that the germ may be finally 
killed by ifs own products. We know that liiany living things, both vegetable and 
animal, are killed by their own excretions, when the latter are allowed to accumu- 
late about the former, but the theory of the production of a special immunizing 
substance by each specific germ is -wholly different from this. The theory teaches 
that the germ produces a substance that confers immunity against itself and that 
the object in the production of this body is to confer tlie immunity. If we should 
find in nux vomica a substance that would render animals insusceptible to the 
action of strychnine, this fact would be analogous to the fheory of the formation by 
each germ of a specific iniuinnizing agent. This theory certainly jiresupposes a 
foresight and kindness on the part of the deadly germs of diphtheria and other 
infectious diseases which we hardly expected to find. 

Fracnkel states that the toxic and the immunizing substances produced by the 
diphtheria germs are two distinct bodies, the former being destroyed by a tempera- 
ture of from 55° to 60° C, while the latter will bear a temperature of 70° 0. or 
higher. Ho reconnnends that the cultures, sterilized by filtration through porce- 
lain, be heated to from 6G ' to 70^ C. aud then be used in the production of immunity. 
However, he admits the possibility that the toxic substance may be converted into 
the immunizing body by the effect of the heat in lessening the virulence of the 
former, and there are many reasons for believing that this is the true explanation. 

Brieger and Wassermann produced in guinea pigs a certain degree of iniTnuuity 
from cholera by previous treatment with bouillon cultures of the germ heated to 
from 65° to 80° C. Shall we conclude from this that the cholera germ elaborates a 




special iramuuizing substance? Wassermaun lias shown that the immunizing sub- 
stance in sterilized cultures of the comma bacillus is contained in the germs them- 
selves and is identical with the specific proteid poison of this germ. In other 
words, the substance that in larger doses kills, in smaller doses gives to the animal 
immunity from the living germ. 

I think that we can answer the question as to which constituent of sterilized 
cultures gives immunity with considerable confidence if we recoguize the following- 
facts : 

(1) Marked artificial immunity to an infectifms disease has not been obtained 
except by the introduction into the auiuuil of the germ substance, either inclosed 
in the cell wall or in solution. 

(2) Sterilized cultures contain the germ substance in one or both of these forms. 

(3) The same immunizing substance exists in the bodies of bacteria grown on 
solid media and killed by the action of chloroform. 

(4) The same immunizing effects, varying, however, in degree, are obtained with 
the bodies of dead bacteria morphologically intact or in solutiou, with living bac- 
teria modified and reduced in virulence, and with very small numbers of the viru- 
lent germ. 

With these demonstrated facts before us, I am ready to believe that tlu^ immuniz- 
ing substance is a constitneut of the bacterial cell itself; and as each kind of germ 
has its own peculiar poison (which in small doses confers immunity), this poison 
can not come from the cell wall; nor is it really a split product of the germ's action, 
but it is the essential characteristic part of the cell — that part which gives to the 
germ its distinctive properties. I believe that it is the nuclein. 

The three methods of iuduciug immunity which we have mentioned reduce 
themselves to one and the same principle, i.e., the introduction of germ-nuclein into 
the body. 

The immunity that results from an attack of the disease is caused by the intro- 
duction of germs, living and more or less virulent; that which comes from vaccina- 
tion is due to the introduction of germs, living but modified and reduced in virulence 
or administered in small quantity; that which is secured by one or more treatments 
with sterilized cultures is secured by the introduction of germ nuclein so modified 
that it is no longer capable of reproducing itself. 

Understood in this way, the production of immunity from disease becomes analo- 
gous to that which Sewall obtained with the venom of the rattlesnake, and Ehrlich 
with ricin and abrin.* Indeed, the venom of snakes, the poisonous vegetable pro- 
teids, abriu, ricin, and robin, and the cellular proteids of the pathogenic germs, 
have many characteristics in common. All are proteids, intensely poisonous; they 
lose their poisonous properties on being boiled in aqueous solutiou; dift'erent species 
of animals vary in their susceptibility to these poisons; they are much less poison- 
ous when given by the stomach than when injected hypodermatieally (the differ- 
ence in the amounts necessary to produce fatal eftects when administered by these 
difl'erent avenues being much greater than with either the vegetable or the putre- 
factive alkaloids). The immunity which is secured by all of these substances is 
gradually lost. A further resemblance between the vegetable and the bacterial 
poisonous proteids is to be found in the fact that immunity to oue of these sub- 
stances obtained from a given source does not confer immunity to another from a 
different source. An animal rendered immune to ricin is still susceptible to abrin, 
and one rendered immune to tetanus remains susceptible to diptlieria. Whether or 
not an animal made immune to the venom of one species of poisonous snake would 
still be susceptible to the venom of another species is not, so far as I have any 
knowledge, known. 

The immunity obtained by Brieger, Kitasato, and W^assermann by inoculating 

* Ehrlich tells us that one gram of ricin would be suflicient to kill one and oue-half million guinea 
pigs. The poison of tetanus can scarcely be more virulent. 


with cultures grown in thymus-bouillou is due to the same principle that governs 
in the methods already discussed. Immuuity was secured by the introduction of a 
modified bacterial j)roteid, the lessened virulence of the i)oison beini; due to a certain 
constituent of the thymus extract. The nature of this constituent of the thymus 
gland will be discussed later. That the tetanus germ is physiologically modified 
by its growth in the thymus-bouillon was demonstratcid by the fact that it failed to 
produce spores in tliis medium, as well as by its diminished virulence. 

Behring rendered about 40 per cent of tlie animals experimented upon immune to 
tetanus and diphtheria by previous treatments with small amounts of cultures to 
which iodin trichlorid had been ailded. This is .also most probably due to the fact 
that the chemical compound moilified the bacterial proteid. Bidiring himself gives 
this explanation. He also states that it is a matter of indifference whether he em- 
]>loyed cultures containing bacteria or those that are germ free. By the latter he 
means culturcss in which the germs have been deprived of flieir vitality or from 
which they have been removed by filtration. In either case the cell proteid of the 
germ is present either in the f»)rm of cells or in solution, and this cellular proteid 
is the agent that induces immunity. 

(.5) By treating a susceptible animal with the blood serum of an imnnine animal. 

Strange as it may seem, the principle upon which immunity is secured when 
the blood serum of an immunizi'd animal is injected into a susceptilde one is essen- 
tially the s;ime as that which holds good in the methods already discussed. A 
is rendered immune to tetanus by previous treatment with the modified bacterial 
proteid of that disease. As a result of these treatments a tetanus antitoxin is gen- 
erated in some organ or organs of the horse and circulates in its blood. When the 
blood clots this antitoxin is found in the serum, and if the serum be injected into a 
mouse in sufUcient quantity this animal becomes for the time being immune to the 
tetanus ixtison, provided that the poison is not introduced in quantities so large 
that it will not be destroyed by the antitoxin that has been brought over from the 

The immunity actually does not belong to the mouse. It still belongs to the horse. 
It is stolen property, and will soon be lost. The cells of the horse, not those of the 
mouse, make the antitoxin. The mouse for the time being becomes physiologically 
a ])art of the horse, and it is by virtue of this relationship that the former is for the 
time being innnune to tetanus. 

The quantity of blood serum that must in this sujiposed case be transferred from 
the horse to the mouse in order to give immunity to the latter will depeud upon the 
relative weight of the animals and upon the degree of immunity possessed by the 
horse; and the degree of immunity induced in the mouse will be governed by these 
same factors. 

Subsequent inoculation of the mouse with the tetanus nuclein, in order to prove 
its inununity, may awaken the cell activity of this animal, and then the immuuity 
belongs to the mouse; but this is not true before the introduction of the germ. 
Behring has understood this point and has given this explanation. 

We have seen that in all cases the cause that brings into existence the condition 
of immunity is a bacterial proteid. Now, in order that this inciting cause may induce 
the condition of immunity, it must act upon something. We say that it acts upon 
the animal, but with this general statement we can not be satisfied. Upon what 
organs of the body does it act? This question can be answered only tentatively at 
present, and the answer is founded upon the fact that we suspect that certain organs, 
are acted upon, because certain results follow. Certainly, the cell activity of the 
invaded host must be altered. The cells upon whose altered activity immunity 
de])onds are probably those of the spleen, the bone marrow, the thyroid and thymus 
glands, and possibly other glandular organs. As already stated, this answer, which it 
may be noticed isgiven with reserve, is founded upon inference rather than upon direct 
demonstration. However, experimental evidence on this point is not wholly wanting. 


The disastrous effects that follow tlie removal or atrophy of the thyroid gland, and 
the wonderful alleviation following the treatment of myxedema with extracts of this 
gland, are now well known to every member of the profession. These facts show that 
this "-land must furnish an antitoxin, which is essential to the preservation of health 
and life. Lindemann has shown that the normal dog will bear doses of caffeiu 
which can not be borne by the same animal after extirpation of the thyroid. Tizzoni 
and Cattani have found that rabbits from which the spleen has been removed can 
not be immunized to tetanus. 

These facts, together with others to be mentioned further on, render it altogether 
possible that the organs mentioned are concerned in the production of immunity. 

Here an interesting question arises: In what way are these organs concerned in the 
production of immunity? Do they elaborate antitoxins, and if so, what can be said 
about tiie nature of these antitoxins? These are questions in which I have been 
deeply interested for some time, and which I have attempted to solve. In this attempt 
I have borne in mind the fact that these organs are the sources of the nucleated white 
blood corpuscles. Do these corpuscles contain a germicidal or antitoxic substance; 
and, if so, what is its nature ? They difter from the red corpuscles in being nucleated, 
and, from all other tissues in containing proportionally larger and more numerous 
nuclei. The chief chemical constituent of nuclei is a substance called nuclein, some 
of the general properties of which are known to physiologic chemists. Can it be that 
nuclein is the germicidal or antioxic substance? Have the nucleins in general or as 
a class any germicidal action? As methods of isolating the nucleins are known, this 
question can be answered by experimentation. But before we begin with our experi- 
ments we will ascertain whether or not we can find that any such properties have 
ever been observed in the nucleins. I find that others have thought of the possi- 
bility that the nucleins may play a role in the production of immunity. In their very 
valuable paper, Ueber Immunitat und Giftfestigung, Brieger, Kitasato, and Wasser- 
mann have the following to say : 

^Yith the idea that the highly vitalized leukocytes or lymphocytes are concerned 
in the destruction of bacteria within the body, and that antitoxin substances are 
formed by the breaking down of these cells, we began our experiments with the best 
known and relatively most thoroughly studied decomposition-products of the white 
blood-corpuscles, the nucleins and the nucleinic acids, which we had prepared 
directly from pus. Later, Prof. Kossel had the goodness to make like prei)arations 
for us from pus and yeast, for which we again give him our best thanks. Cholera- 
cultures served us for the most part in these investigations. However, we found 
neither a decrease in the toxicity of these cultures on beingtreated with thenucleiu 
bodies, nor could we render animals proof against the poison by jjrevious treatment 
with cholera-cultures to which nuclein had been added. 

A priori, these negative results were probable because the preparation of the 
nucleins and nucleinic acids requires such powerful chemical manipulations that the 
resulting substances could only be such as would be devoid of all active energy. 
Moreover, we knew from previous researches with the bacterial poisons how sus- 
ceptible similar compounds are to apparently indifferent chemicals, like alcohol, 
ether, etc. * * * Therefore, we concluded to prosecute our studies with simple, 
aqueous, feebly alkaline extracts from organs rich in cells. 

Having reached these conclusions, Brieger and his coworkers proceed to make 
their investigations with a feebly alkaline extract of the thymus gland. 

This is the only instance, so far as I know, in bacteriologic literature, up to the 
time of the first publication of my results, in which anyone has even suggested that 
the nucleins might be germicidal or in any way concerned in the protection of the 
body against bacterial invasion, either in the production of immunity orineftccting 
a cure; and it must be admitted that this reference did not aftbrd much encourage- 
ment to my theory. However, I was not altogether discouraged, because certainly 
no one should expect to find a highly active nuclein in j)us-cells, the nuclein of which 
in the very formation of pus has been altered, probably more deeply and destruc- 
tively than would result from ''the apparently indifferent chemical reagents, alcohol 
and ether." As these German investigators failed to tell how the yeast nucleinic acids 


with wMch they experimented had been prepared, the hope was left to me that in 
tills might rest the explanation of their failure. This hope found 8ni)port in the fact 
that in the jireparation of their thymuH extract they heated it to 100^ C, and certainly 
this temperature must have had quite as much effect in depriving the living nncleiu 
of its energy as indifferent chemical reagents conld have had. The fact tliat they 
obtained the results which they did with this extract after it had been heated to 100'^ 
is an evidence of the power originally possessed by the nucleiu of this gland, for I 
think that it must be admitted, from the results which I have obtained, that the 
active agent in the thymus extract with which Brieger and his coworkers experi- 
mented is a uuclein. 

At first I tried to prepare an active nuclein from compressed yeast, but the results 
Avere not satisfactory. Compressed yeast contains a large amount of water and 
starch. The large proportion of the first-men I ioned constituent caused a very small 
yield of nucleiu, and there were many difiiculties in this complete separation of the 
starch. There were, however, two other and more serious objections to the use of 
comi)ressed yeast. The first of these is due to the fact that such yeast contains 
bacteria to begin with, and the task of preparing an active nuclein from it is simi- 
lar to that of obtaining the same substance from pus. The second diillculty lies in 
the fact that compressed yeast contains many dead cells, and an active nuclein can 
be ol>taiued only from living, healthy cells. 

Next, I attempted to jirepare an active nucleiu from the ordinary brewer's yeast. 
But I found this also contaminated with bacteria. 

At last, I was supi)lied, through the kindness of the Ann Arbor Browing Company 
and through Dr. Laasche, of Chicago, with unlimited quantities of p\ire cultures of 
yeast, without cost, and my thanks are due to the manager of the company named 
and to Dr. Laasche for this material. 

With the aid of Drs. McClintock and Novy I have succeeded in preparing active 
nuck'ius not only from yeast, but from several organs of the body as well, and as 
the further elaboration of the principles of immunity and cure in the infectious dis- 
eases depends so closely upon the action of these nncleins, I must be permitted to 
go somewhat into detail concerning their preparation, their chemical reaction, ger- 
micidal properties, and physiologic effects: 

Yeast nuclein. — The cells from i>ure cultures of yeast are washed with sterilized 
water, then treated with a 5 per cent solution of potassium hydrate, and filtered 
through paper (th<^ Falten lilter paper of Schleicher and Schull being used for this 
j)urpose). Sterilization of the filter paj^er is not necessary. The filtrate is feebly 
acidified with hydrochloric acid, and the proteid precipitated with 96 per cent alco- 
hol. The precipitate is washed with alcohol by decantatiou until the supernatant 
fluid remains colorless. The precipitate is then collected upon a filter, ami, after 
all the alcohol has passed through, it is dissolved in very dilute potassium hydrate 
(0*25 to 0-50 per cent). That this solution contains other proteid bodies besides the 
nuclein is shown by the fact that it promptly responds to the biuret, xanthoprotein 
and Millon reactions, but notwithstanding these impurities, solutions of nuclein 
prepared in this manner have markedly germicidal effects.* 

A purer form of yeast-nuclein may be obtained by digesting out the other jtrofeids 
from the alcoholic precipitate with hydrochloric acid and pepsin, in the manner 
which will be described in the preparation of animal nncleins. 

The following experiments, in which the impure nuclein-solution was used, will 
illustrate its germicidal effects. In all cases the nuclein-solution was diluted with 
sterilized normal salt-solution, then placed in quantities of 5 c. c. in sterilized test- 
tubes, inoculated with the germs mentioned in each experiment; and plates made 
after varying intervals of the time show the germicidal effects. In making the 
plates, a platinum loop of constant size (with a diameter of 2 millimeters) was 

*In fact, this is a nucleo-albumin rather than a nuclein. 


In the first four experiments, 2 c. c. of a 0'25 per cent alkaline solution of nuclein, 
containing 0'9 milligram of impure nuclein per cubic centimeter were diluted with 
3 c. c. of normal salt solution, inoculated with the germ, and plates made as follows: 


Staphylococctis pyogenes aureus. 

Time 5 minutes. 1 hour. 2 hours. 14 hours. 23 hours. 

Number of colonies 1,110 

Experiment II. 

Sta2)hi/locuccus pyogenes aureus. 

Time 5 minutes. 1 hour. 2 hours. 14 hours. 23 hours. 

Number of colonies 1,490 20 

The strength of alkali in this dilute nuclein-solution, not taking into considera- 
tion the fact that some of the alkali is absorbed by the nuclein, is U'l per cent. The 
culture of the aureus used in these experiments grows abundantly in a 0"5 per cent 
aqueous solution of potassium hydrate. 

Experiment III. 

The same solution nuclein as the preceding inoculated with the staphylococcus 
jiyogenes albus. 

Time Immediate. 20miuutes. Ihour. 2hours. 17 hours. 24 hours. 

Number of colonies. 6b0 

Experiment IV. 

The same solution of nuclein, inoculated with the bacillus anthracis without 

Time Immediate. 20 minutes. Ihour. 2 hours. 17 hours. 24 hours. 

Number of colonies. 4.5 

The total amount of impure nuclein in the 5 c. c. of dilute solution employed in 
these experiments was 1-8 milligram, or the strength of the solution was 1 part of 
impure nuclein to 2,777 parts of water. 

Experiment V. 

The 5 c. c. used in this experiment contained 10 milligrams of impure nuclein 
dissolved in O'l per cent of potassituu hydrate. The germ was the aureus. 

Time Immediate. 30 minutes. Ihour. 3 hours. 5 hours. 24 hours. 

Number of colonies. Countless. 5,000 .550 490 400 

Many other experiments similar to this were made, but as the results were uni- 
formly the same, repetition is unnecessary. 

Experiment YI. 

A loop of tuberculous sputum, showing from forty to sixty bacilli in each field 
when stained, was stirred up in beef tea, allowed to stand for twenty-four hours, 
and injected into the abdominal cavity of guinea pig No. 1. Another loojJ of the 
same sputum was added to a solution of 30 milligrams of impure yeast unclein 
in 0-08 per cent of potassium hydrate, and this was also allowed to stand in the 
incu])ator at 38^ for twenty-four hours, and then injected into the abdominal cavity 
of guinea pig No. 2. 

At the exjiiration of fourteen days both of these animals were killed. The omen- 
tum of No. 1 was a tuberculous mass throughout, while No. 2 showed not the slight- 
est evidence of the disease. 

The solutions of impure nuclein in dilute alkali may be kept at ordinary tempera- 
ture in glass-stoppered bottles for mouths, without undergoing iiutrefactive changes. 
I have now one bottle of such solution, which was prepared on the 20th of Decem- 
ber, 1892. One hundred and fifty milligrams — possibly a much larger quantity — of 


this nnclein may be injected, when properly diluted, under the skin, without any '. 

inconvenience, save slight pain at the time of injection and some soreness in the \ 

part, ^Yhich disappears after a few hours. The last statement is true whon tlie initial 
(l(),s(! is siiiall and the quantity is gradually increased. In one case, in which I gave 
an initial injection of 25 milligrams, an erysipelatous redness, as large as a saucer, 
api>carc(l in a few hours. The temperature went up 3° and the patient felt some 
nausea. The redness, however, rapidly disappeared, the temi)erature fell, and two 
days later I repeated the same dose without any ill effects. In some other 
instances I have noticed an elevation of temi)eratur6 within an hour or two after 
thi' injection. This has happeni'd only in thost; patients in which the size of the 
(lose has been rapidly increased. Yeast nnclein apjtcars at times to have a cumu- 
lative action. When employed in large doses for several consecutive daj's the tem- 
perature may be markedly elevated. 

Testicular nnclein. — I have prepared this from the testicles of the bull, dog, guinea 
pig, and rat. The testicles are strii)ped of their investing membranes as soon as 
removed, rubbed up and extracted repeatedly with a mixture of equal volumes of 
absolute alcohol and ether. Tlnm the testicular substance is digested for some days 
(until the suiiernatant lluid fails to respond to the biuret test for peptones) at 40"^ C. 
with pe])8in and 0'2 per cent hydrochloric acid. The undigested portion, which 
contains the nnclein, is collected on a filter psiper and washed first with 0'2 per cent 
hydrochloric acid, then witli alcohol. Finally it is dissolved in a 0.5 per cent solu- 
tion of potassium hydrate and iiltered through a Chamberland (ilter, without pres- 

This solution is clear, more or less yellow, and feebly alkaline. On the addition 
of nitric acid a white precipitate forms and di.ssolves colorless in the cold on the 
further addition of nitric acid. This nnclein does not give the biuret reaction, but 
does respond to the Millon test. Tiie nitric acid solution of the precipitate becomes 
yellow on the addition of ammonia. 

'ibis nnclein also has germicidal properties, as is demonstrated by the following 


A solution of nnclein of unknown strength, obtained from the testicles of a bull, 
was diluted with 1 volumes of i)hysiologie salt-solution, inoculated with the bacillus 
anthracis, and plates made, with the following results: 

Time Immediate. 30 min. 1 hr. 2 hrs. 3 lirs. 

Number of colonies ' 730 6 


The same solution inoculated with the aureus. 

Time Immediate. 30 min. 1 hr. 2 Ins. 3 lirs. 

Number of colonies Countless. 2,^s50 

Experiment III. 

A solution of nnclein from the testes of a dog diluted with 4 volumes of salt 
solution and inoculated with the staphylococcus pyogenes aurois. 

Time Innnediate. 20 min. 1 hr. 2 hrs. 17 hrs. 24 hrs. 

Number of colonies 680 

Experiment IV. 

Another solution from the same source diluted in the same manner and inoculated 
with the aureus. 

Time 5 min. 1 hr. 2 hrs. 14 hrs. 

Number of colonies 250 

Experiment Y. 

As several authors have reported tlu< tinding of a gernicidal substance iu the 
glycerin extract of certain organs, the following experiment was made: The testicles 


of a wbitt' rat were strij>ped oi" tlieir tiiuios aud extracted witli <ilycerin. Tliis 
extract, diluteil with 4 volumes of salt solution and iuociilated with the aureus, 
gave the following results: 

Time 5 niin. 1 hr. 

Number of colonies 1, 1'40 75 

I have used this solution of nuclein in doses of from 5 to 20 drops, diluted witli 
saline solution, hypodermatically in one case of nervous exhaustion, and from the 
markedly stiuiulaut etfects observed I conclude that it is to tiie testicular nuclein 
that the Browu-Se(iuard liuid owes its actiim. These eflects, as I have observed 
them, with the \-ery small doses given, soon pass away, but they are extraordinary. 

Tliyroid nuclein. — The fresh gland is cut into fine pieces, extracted with alcohol 
and ether, and then digested with pepsin and 0*2 per cent hydrochloric acid at 40^ 
for two or three days, the digestive fluid being renewed several times and the diges- 
tion being continued until the supernatant fluid fails to respond to the biuret test. 
The undigested residue is collected upon a filter, washed with 0*2 per cent hydro- 
chloric acid, then with alcohol and ether, and finally dissolved in 0-25 or 0*5 percent 
solution of potassium hydrate. 

This solution of nuclein gives a faint opalescence on the addition of nitric acid. 
It does not color on iieating with nitric acid, but becomes markedly yellow on the 
further addition of anmionia. 

A 0'25 per cent alkaline solution of this nuclein dissolved with an equal volume of 
physiologic salt-solution and inoculated with the aureus showed a germicidal action 
as indicated in the following figures: 

Time Immediate. 10 uiin. 1 hr. 20 hrs. 

Number of colonies 805 830 256 

I have not tested the eft'ects of this nuclein on man. 

Egg nuclein. — The yolk (2 dozen eggs furnish a convenient amount of material to 
work with in the laboratory) is extracted with absolute alcohol repeatedly and 
until all the coloring matter is removed. The substance is then digested for some 
days with pepsin and 0"2 per cent hydrochloric acid. (In one instance I continued 
tliis digestion for four weeks, hoping to obtain a residue which would not respond 
to the Iduret test, but this desire was not attained.) The undigested portion is col- 
lected on a filter, washed with dilute hydrochloric acid and subsequently with 
alcohol, and then disolved in 0*25 or 0-50 per cent of potassium hydrate and filtered 
through porcelain. 

This solution of egg nuclein is colorless or slightly yellow. Nitric acid produces 
a slight, white preciiiitate, which dissolves in excess; this does not turn yellow on 
heating, but does so beautifully on the subsequent addition of ammonia. 

Experiment I. 

A solution of this nuclein in 0"25 ]ier cent potassium hydrate was diluted with 
4 volumes of saline solution, inoculated with anthrax, and the following figures 
show the germicidal results : 

Time Immediate. 30 min. 1 hr. 2 hrs. 3 hrs. 

Number of colonies 2,4i)0 350 30 

Experiment II. 

Another portion of the same dilution, inoculated with the aureus, gave the fol- 
lowing results : 

Time Immediate. 30 min. 1 hr. 2 hrs. 3 hrs. 

Number of colonies Countless. 2,000 137 

Besides the foregoing sources, I have obtained nucleins from the brain and the 
spleen, and these also are germicidal in tlieir action. I have not tested the physi- 
ologic eft'ects of the nucleins from the egg, brain, or spleen on man. I have employed 
the egg nuclein on guinea pigs without any apparent deleterious effects. 

I have introduced this sketch of some experimental work, illustrating a few of 
the many experiments that I have made bearing on this i)oiut, for the purpose of 

^. Ex. 3G 11 


j;iviii.u; some correct idea of tUe ground upon which I make the assertion that 
uucleius are powerful germicides. 

I thiuk that all will now agree with me tliat the nucleiu-forming organs of the 
body most likely have some concern in the production of inmiuuity. 

Till' nucleins lornud by these colls or in these organs pass into the blood partly in 
solution and partly in the foriu of the mnltiuuclear white corpuscles — the so-called 

The germi(i<lal properties of blood serum are due tosiduble nucleins. This state- 
ment rests upon work done by Mct'lintock and myself, and the evidence upou which 
it is founded will be set forth in a paper to be read before this section. 

There are throe reasons (ouly one of which has heretofore been recognized) why 
the germicidal properties of blood scrum are greater than those of blood plasma. 
These are : (1) The lesseucd amount in the scrum of those substances that favor 
bacterial growth ; (2) the concentration in the snlulilc nucleins that occurs as a 
result of clotting of the blood; and (3) the passage of the substance of the multi- 
nuclear cells into solution. 

When 1 speak of the solution of the substance of the multiuuclear cells I do not 
wish to commit myself to the theory that the entire cells break down. I refer simply 
to the fact — and I believe it to be a fact, !'s I have found nuchin in solution in blood- 
serum — that the nuclein passes from the cell into solution. Whether this i)roce8S is 
due to the breaking down of the cell or to au active secretion on the part of the 
cell, I am as yet unable to determine. 

As is claimed by Metschnikoff, there are obA'ious advantages to the animal in hav- 
ing the ge'iuicidal constituents of its blood ([>artly) in the form of ameboid bodies. 
Concentration at a desired place can be more easily accomplished and the walls of 
the arteries and other tissues may be traversed without injury. Uut these cells do 
not eat and digest the invading bacteria. There are reasons for believing that tliey 
have no jiowerto retard the progress of the invading bacteria until the constituents 
of the cells pass into solutiou. Germs often grow and multiidy in these cells. 

The fact mentii)nedby MetschnikotT, as a proof of his theory, that in the apyretic 
stage of relapsing fever all of the spirilla are found in the splenic cells, while in the 
pyretic stage they are free in the blood, is capable of a wholly ditlerent explanation 
from that which he attributes to it. It .seems to me more likely that the s])irilla 
seek the interior of these cells as a place of rest, -where they reproduce themselves, 
and from which they go forth with renewed energy. In the monkey the splenic cells 
fail to afford this protection, and the pyretic stage does not return. Metschnikoff 
himself states that the m.ilarial hematozoiiu, during the ameboid st:ige of its exist- 
ence, liuds its way into the corpuscle, and from the substance of this the parasite 
takes its nourishment. 

The action of the soluble or alkaline nucleins on germs may be either inhibiting 
or directly toxic, or both. It is not necessary that the invading germ be killed in 
order to prevent it producing disease. If its growth and multiplication l)e inhibited 
the disease will not follow. ^letschuikoff has shown that some of the germs taken 
even after many days from the local abscess formed in au immune animal inoculated 
with a pathogenic germ, and injected into a susceptible aniuuil, may cause the dis- 
ease. These nucleins are not only germicidal; they are also toxicidal. They render 
inert the bacterial nuclein, whether this be present in living or dead cells, whether 
it be in suspension or in solution. 

In order to state my views upon immunity in a condensed form, and to bring this 
address within the limits of the time allowed, I will summarize as follows: 

There must be three factors in the production of immunity in an animal naturally 
susceptible. First there must be an inciting or immunizing substance introduced 
into the body. We are acquainted in a rough manner with the nature of some of 
these substances, such as the venom of the snake, the vegetable proteids, abrin, 
riciu and robi]i, aud certain bacterial proteids. I coll these i^roteids, and I wish 


it to be understood tli;it I do so tentatively, and that I recognize the fact that the 
exact chemical nature of none if them is known; but for the present vte may- 
call them proteids. For reasons already given, I believe that these proteids, which 
induce immunity, belong to the class of nucleins. I am aware of the fact that physi- 
ologic chemists do not always classify the uucleins among the proteids, but among 
the albuminoid bodies. These substances, be they nucleins, proteids, or albumin- 
oids, have the property, Avlieu introduced into the bodies of certain animals, in cer- 
tain amounts and under certain conditions, of so stimulating the activity of certain 
organs in the animal that these organs produce and supply to the blood an antidote 
to the substance introduced. 

Secondly, the organs whose activitj' is stimulated by these immunizing agents are 
those, such as the spleen, thyroid gland, and bone marrow, which manufacture 

Thirdly, the antidotal substance is a nuclein. The kind and amount of uuclein 
formed will depend upon the nature of the inciting agent and the condition of the 
organ or organs acted u])on. 

I use the word "nuclein" in a broad sense, including the true nucleins, nucleinic 
acids, and nucleo-albuniins. By the term "nuclein" I mean that part of the cell 
which under normal conditions is endowed with the capability of growth and 
reproduction, which assimilates other proteids and endows these assimilated sub- 
stances w^ith its own properties. It is that part of the cell which gives it its indi- 
viduality. Wliether these uucleins, while in solution and devoid of morphologic 
unity, are still capable of assimilating allied bodies or not, can not at present be 
positively determined. There, is uo a priori reason, so far as I know, for denying 
tills. These ditierent nucleins, that of the bacterial cell, and that of the blood, 
may be isomeric bodies, one of which may be designated as the a compound, and 
the other as the /:( compound, and one of these, by simply causing a rearrangement 
in the atoms within the molecule of the other, may assimilate the second. There are 
some good reasons for believing that certain jiroteid bodies contain a cyanogen group, 
and Kossel has shown that nuclein contains a basis substance, adeniu, which has 
the formula C5H.:;N-, and is a polymer of hydrocyanic acid, and Gautier has synthe- 
sized another constituent of nuclein, xauthin, by simply heating hydrocyanic acid 
in a sealed tube in contact with water and a little acetic acid. Indeed, the readiness 
with which cyanogen bodies polymerize is well knowu to chemists. Thus, li([uid 
chlorid of cyanogen CNCl converts itself spontaneously, under certain conditions, 
into solid chlorid of cyanogen, C3N3CI3 ; cyanic acid into eyilid; methyl cyanic 
ether. CON^CH^) into methyl cyaiuin ether, C30:5N3(CHa)3, and cyanogen iuto 

I do not mean to say that the process by which a uuclein assimilates another 
proteid is as simple as would be indicated by these examples, but they may suggest 
something of the nature of the cheuiistvy of assimilation. "We may suppose that 
when an alpha nuclein and a beta nuclein are brought together, one will assimilate 
the other; and which one will absorb the other Avill depeud uijon the relative 
strength or vitality ijossessed by them, and in measuring this strength several things 
must be taken into consideration. A vaccine has less of this power of assimilation 
than a germ of full virulence, and a nuclein in a sterilized culture less than either 
of the others. 

An organ that has once been stimulated by a given excitant responds more quickly 
the second time to the same excitant, provided that the interval of time is not too 
great. This explains the gradual loss of acquired immunity. 

Again, an organ that is stimulated by oue excitant may not be responsive to 
another, and this accounts for the fact that an animal rendered immune to oue dis- 
ease remains susceptible to another. 

The poison that is introduced is destroyed by the activity of certain cells. In 
order, however, to acconi]ilish this destruction, it is prol)ably not necessary that the 
poison should come in contact with the cells. For instance, the activity of th^ 


spleen been found ueces-sary, .as the experiments of Tizzoni and Cattani have 
shown, to tlie xnodnction of immunity to tetanus. We can suppose that the proc- 
ess of itnmunizing an animal proceeds in somethiii<^ like the followinjij manner: 
The modified virus of tetanus is introdsced into some distant part; in some 
unkuow)! way, the spleen is stimulated to action, and secretes a nuclein which is car- 
ried partly in solution, partly in the I'orm of niultinuclear cells, to the invaded part 
of the body, and the tetanus poison is converted into the nuclein coming in contact 
with it, or is otherwise rendered inert. Later a larger quantity of the tetanus 
l)oison is introduced, and now the S[)leen acts more promptly and energetically than 
before. This jjrouijftuess and energy of action are increased by exercise, and finally 
an amount of tetanus-culture, of full virulence sufficient to kill an animal whose 
S]tleen has not l)een subjected to this traiuiug, may ho introduced without ill ett'ect. 
On this theory the production of immunity consists in a si»ecial education of cer- 
tain cells, and artilicial immunity becomes essentially cellular. 

The ditferenco between immunity and tolerance I conceive to be this: In the 
foriuer the cells of certain organs become aggressive; a special function is devel- 
ojicd; the poison introduced is destroyed. In tolerauce, there is no aggressive 
action on the part of any organ; there is no develo])ment of special functions; the 
poison introduced is not destroyed; it only fails to kill. 

Now, what can be said about the relation between the ]»riuciples of iuimunity 
and those of cure? Are they the same? 1 think that there are essential diflereuces. 
In the llrst place, the substances with which immunity is induced are not api)lica- 
ble in the production of a cure. They are already in the body, and have failed to 
stimulate the uucleiTi-formiug cells in such a manner as to cause their own destruc- 
tion. To introduce more of the bacterial poison after the invading virus has estab- 
lished itself in the system will only strengthen the invader. No disease, after being 
well developed, has been cured by the administration of the bacterial ]>oison. I 
believe that vaccination, first performed after exposure to smallpox, may alto- 
gether prevent the development of the disease, or may modify it, but this is not 
cure. Of what service would vaccination be when the body is already covered with 
8malli)0x jjustules. 

Some experimenters have found that if a certain substance be introduced into the 
animal simultaneously with, or a few minutes, or at most a few hours, after the 
introduction of the virulent germ, the disease either does not appear, or it appears 
later than it does in control animals, and they have claimed that these are instances 
of cure. Thus, ]5ehring speaks of c«ri»(7 diphtheria in guinea-pigs with iodin tri- 
chlorid. He injected this " curative agent " immediately after inoculation, and at the 
place of inoculation, and found that, of the animals thus treated, some, although 
they sickened, did not die. He may have induced immunity in this way by the 
action of the chemical agent on the bacterial proteid, though this has been exjieri- 
mcntally denied by Tizzoni and Cattaui, but certainly such results do not deserve 
to bo designated as cures. 

Koch attempted to cure tuberculosis by introducing the proteid of the specific 
bacillus into ])atients. Theoretically this was a mistake, because this proteid in 
living, virulent form is already present in the patient, and, indeed, is the cause of 
the disease. Immunity to tuberculosis has been tested by nature in each tubercu- 
lous person and has been found wanting. Some step in the process has failed. 
Either the poison was first introduced into the body in a form too virulent to be 
resisted, or the cells of the body have been unable to act with normal euergj-. 

If I am right concerning this difference between the agents of immunity and cure, 
to what source shall we look for curative substances in the infectious diseases? 
Either we must introduce into the body some germicide formed by other cells, or we 
must employ other agencies for the purpose of stimulating the uuclein-forming cells. 
IJlood-serum therapy offers the first of these alternatives, and now that we know 
that tlio germicidtVl coustitueut of the blood is a nuclein, blood-serum therapy will 



give place to rmclein therapy, and with tlie latter there is more hope of accomplish- 
ing good results, because it reduces the size of the dose. 

I say that the germicides from which we now hope for good results in treatment 
must he of cellular origin. The experience of the medical iirofession for the past 
twenty years has demonstrated that there is no known chemical substance which 
can be introduced into the animal body in sufficient quantity to effect a cure by its 
germicidal action without harm. Time after time the discovery of a uonpoisonous, 
powerful germicide has been announced, but experience has in\ariably shown either 
that the substance is poisonous or that it is not germicidal. This universal expe- 
rience of the profession has been scientifically demoustrated to be a fact by the 
researches of Behring, who after a large number of experiments came to the conclu- 
sion that, computed ou the body weight of the animal, antiseptic substances reach 
a fatal dose when injected in absorbable form under the skin in one-sixth the amount 
which is necessary to prevent the development of the anthrax bacillus in the blood 

Now that we have learned that the animal body itself generates a germicide more 
powerful in its action than corrosive sublimate, and since Ave know how to increase 
the amount of this substance in the blood, and can isolate it, and inject it into other 
animals, renewed hojje comes to us. 

I have stated that one advantage which nucleiu therapy will have over blood-sernm 
therapy is to be found in the fact that it may enable us to employ the active sub- 
stance in larger doses. We have seen all along that quantity as Avell as quality 
must be taken into cousideration in the production of both immunity and cure, and 
that the effects are in proportion to the quantity. Even the ultra-bacteriologist 
does not now claim that a single bacillus of the most virulent kind introduced into 
the most susceptible auimal will cause disease. The animal body is no longer to be 
regarded as a mere culture flask, in which germs grow without meeting with the 
slightest resistance ; and after the germs of tuberculosis have gained the ascendancy, 
and are multiplying by the millions daily, possibly hourly, we need not hope to find 
a tuberculin which in doses of the fraction of a milligram will, within a few days, 
or within any period of time, destroy this great mass of living, growing poison. 
The miraculous effects of small doses need not be looked for. These will have no 
place in the therapy of the infectious diseases. 

If it be possible to kill the germs or destroy the bacterial poison after the develop- 
ment of an infectious disease by the introduction of a germicide or a toxicide formed 
by other cells than those of the infected person, then we may expect that cures for 
diseases of this kiud will be found in the near future. Experimentation offers the 
only means of ascertaining whether or not this be possible. The recently reported 
cases of tetanus successfully treated with the antitoxin of Tizzoni and Cattani, 
obtained from the blood of animals which have been rendered immune to this disease, 
are in accord with this principle. 

If nuclein therapy fails us, we must strive to find agents that will stimulate the 
nuclein-forming glands. This probably is the chief factor in the climatic treatment 
of tuberculosis, but so far as our knowledge of medicinal substances that will 
accomplish this result goes we are practically and wholly ignorant. The field of 
special cellular therapeutics lies before us a terra incognita. Important discoveries 
in this direction are not likely to be made soon. 

I have used the word "cure," limiting its meaning to the destruction of the germs 
or other poison. If we could destroy all of the bacilli in the body of a tuberculous 
patient would a cure be effected? If we ever reach this desideratum nature will 
probably do the rest. 

I have thus imperfectly placed before you certain ideas that have for some years 
been slowly formulating in my mind. They have enabled me to demonstrate, first, 
that the nucleius are po verful germicides, and, secondly, that the germicidal con- 
stituent of blood serum is a nucleiu. Whether or not they will lead to further eluci- 
dation of the perplexing jiroblems of immunity and cure 1 can not predict. 





Profesnor of Clinical Medicine, University of I'ennsylvania. 

Tliat tliore can be no rational treatment of gont without a correct umloratanding 
of its ])ntliolo<Ty is cvidont. It can not, on tlio otlior liand, ho claimed that the jiath- 
olojjjy ot gout is thoroughly understood, altliougli all admit that many facts bearing 
on it are well determined. One of these is that uric acid is in some way causative. 
Wh(!th(r, however, tlie uric acid thus resi)onsil)lo is the result of increased formation 
or diminished excretion, or both, is not so generally acknowledged. Thus, Garrod, 
whose work hrst published in 1859, is today regarded as one of the classics in med- 
icine, held that there is no increased formation of nrie acid in the gouty, but a 
diminished excretion which results in an acenmulatinn in the l)lood and other fluids 
of the body, and that this is true of almost every phase of gout. This Garrod showed 
by his well-known thread test. 

Although the methods of analysis employed by him were not those acknowledged 
at the i)rcsent day to be the most reliable, the more recent work of rfeiH'cr, con- 
ducted in accordance with modern methods, essentially confirms the original state- 
ments of Garrod. 

Thus PfeilTer,'' using Salki>\vski's niethorl. d(>termined the uric acid in the urine 
of certain cases of gout, of which he made two classes. Of these the cases of the- first 
category had not passed over into the chronic stage — that is, had not acquired changes, 
such as stifi' of the joints, gouty tophi, atheromatous blood vessels, and the like — 
but had sulfercd acute attacks with intervals of comp]ct<> freedom from symptoms. 
The second category included cases which had undergone the changes referred to. 
His results he contrasted with those of the urine of healthy men at corresponding 
periods of life, as fcdlows: 

In Class I, in which the urine of the exempt period was examined, the quantity of 
uric acid in the twenty-four hours per 100 kilos of body weight was — 


In gouty 

In lu'.nltliy 

30 to 40 




40 to 5 ) 


50 to 60 

60 to 70 


It will be seen that it was less in the goutj' subject th;in in the healthy man in 
Class I. 

The same was true of the urea, which amounted to only 28-8 grams in gouty sub- 
jects for each 100 kilos of body weight instead of an average of 33*1 grams for each 
100 kilos in the healthy man, observations being made on men from from 33 to &rt 
years old. 

Thus it will be seen that in the urine of such cases in the interv.ils between at- 
tacks there is a very decided diminution in the quantity of uric acid eliminated, as 
compared with persons in health. 

* Pfeifler, -ueber Ilarnsaure und Gicht, Berliner klin. Wochenscbrirt, No. 17, Apr. 25, 1892, 5, 415. 


Class IT. — In those in whom oluonic gouty changes had established themselves 
Pfeiffev noted a somewhat different result. Tiius while the average elimination of 
uric acid in a healthy man from 33 to 45 years old was -860 gram, that of the gouty 
subject between 33 and 65 years amounted to -973 and even more, while the ratio of 
the urea to uric acid, which was 33-7 for the healthy person, amounted forthe gouty 
to 35. Tims in this class of cases, the gouty with chronic change" there is an 
increased excretion of uric acid as compared with health. This is a reversal of the 
original results of Garrod who found in the urine of this class of gouty subjects no 
uric acid at all, or only traces. This is ascril)able to defect in the older method of 
analysis, that of Heintz by hydrochloric acid. It is now known that this fails to get 
out the whole of the \iric acid.*^^ 

It w411 be seen, however, that the difference in favor of increased excretion is very 
slio-ht, while the average excretions in the two classes of cases betweeu35 and 73 years 
old is still a trifle less than in the uon gouty, being -855, as compared with -860, while 
the urea is also somewhat less, being 31-3 instead of 33, the ratio of urea to uric acid 
being 36 to 1 as contrasted with 38 5. 

Now if we turn to another modern observer, Alexander Haig,t who used also 
Salkowski's method for the determination of uric acid, and whose work seems to 
have been done with unusual care, we find his studies entirely confirm the original 
results of Garrod. Haig claiins that there is " almost never" an excessive formation 
of uric acid at any time, and that its accumulation in the blood and body at any 
time is ocnerally due to retention or failure of excretion; that uric acid is on the 
whole continuously formed in the itroportiou of 1 to 33 of urea. In certain states of 
the blood constituted essentially by increased alkalinity uric acid is held in solution 
in laro-er quantity constituting uric acida-mia. At such times, too, it is eliminated 
in increased quantity hy the urine by which it is also readily held in solution because 
of the alkalinity of this secretion. 

In opposite states of the blood the uric acid is driven out of this fluid and deposited 
in the tissues of the joints. Haig holds also that these opposite conditions, which are 
fluctuations in secretion only, can be artificially produced by drugs, food, temiterature 
and other conditions influencing the reaction of the blood. Thus alkaline foods and 
warm weather favor the former, while acids and cold weather fjivor the latter and 
it is under influences like these that uric acid in the shape of ur.ites is stored up in 
the body. He further sayst that the blood never becomes loaded with uric acid except 
as the result of previous imperfect excretion, and such imperfect excretion or reten- 
tion is sufficient to account for the largest quantities he has ever seen in the human 
body, and that there is no need of excessive formation as a» explanation. Further, 
that he does not assert that excessive formation never occurs, only that he has never 
met any conclusive proof of its occurrence, while all the other phenomena of disease 
can be explained without pr stulating the excessive formation of a single grain. § 

The result is, however, the same. Whether there be diminished excretion or 
increased formation, or both, there is an accumulation of uric acid in the blood 
which is responsible first for certain premonitory symptoms of gout,. and second for 

* rfeifter says that this initispnsition of uric acid to be thrown down on the addition of hydror-hlorio 
acid, formerly regarded as cliaracteristic of ^m\t, becomes more niarlied as age advances, .and may bo 
said to be almost the rnle with persons over GO. "Possibly," says P., it may present itself earlier in 
gouty subjects than in the norm.iUy constituted." 

f Uric Acid as a Factor in the Causation of Disease. By Alexander Haig. London. 1S92. 

I Op. cit., p. 7. 

§ Kotwitbstanding these observations it is not unnsual to find even medical men under the impres- 
sion that gouty subjects excrete mubh more uric acid than the healthy, an error probably due to the 
fact that the urine of gouty subjects is .apt to contain large sediments of uric acid especially during 
acute attacks whence is erroneonsly inferred increased excretion. 

It shoiild be mentioned th.-i-t in a communication to the Tenth Congress of Physicians so re- 
cent as 1892, Mordhorst, of Wiesbaden, also as.serted that the .average of the entire uric acid excretion 
of the gouty is considerably greater than in the rheumatic and healthy. These results are ascribed 
by Pfeiffer to the careless selection of material for the observation and defective method of analysis. 


certain syiiiptoms. The latter are of an inflaniniatory nature and consist 
essentially in pain, swellinj^, ami redness of tlie joints, preferably of the smaller ones, 
and esj)ecially of the inetatarso phalangeal articulation of the great toe, more fre- 
quently, perhaps, of the left great toe. 

It may be worth while to dwell a moment on the relation of the uric acid com- 
pounds to the local inflainmitions. Ifc is scarcely necessary to siy that uric acid 
does not exist as such iu the blood, even in pathological conditions. The normal 
urates originally shown by lience .Jones, an<l recently confirmed by Sir William 
Roberts, are qtiadri-urates. In the pathological state these are converted into the 
less soluble bi-urates, which make up the blood deposits. It has all along been 
considered that these deposits are the direct cause of the gouty inllammation. 
Haig, as the result of his recent researches, reasserts this view in the following 
graphic language. " 

Then I also noticed that in iiiring a headache by giving an acid to diminish the 
excretion of uric acid, I always iirixiiice'l a certain aiiuiunt of ])ri(king and shooting 
jiain in my joints (generally in those which had been most userl on the day iu 
<|nestion) and it nalurally occurred tome that the uric acid was held back in 
these joints and ])rodnced the ])ains. The uric acid which had failed to appear in 
thi; uriiK^ must h:ive gone soiiiewhero. AVhat more natural tlian to suppose that it 
had been retained in the joints (where in gout it is found) and that the pricking 
jiains were the evidence of its jiresence? 

Then, on turning to Sir A. (Jarrol. I find that he had describeil precisely similar 
joint pains as occuiring in gouty subjects immediately after the ingestion of beer or 
wine, and a very little investigation 8ut!iced to prove that all wines and beers are 
strongly acid, so tliat a very simple explanation could be given of tiie facts. 

In striking contrast to these heretofore-acknowledged views are those recently an- 
nounced by Pfeiffer based on experiment and confirmed. he believes, by clinical facts. 
He intro<luced under the skin chemically pure crystallized uric acid suspended iu 
water, with altsolntcly no immediate result. In the course of twelve to eighteen hours, 
as the urieaeidliogan tol>edissolvcd,irritation anil skin inllammation presented thein- 
selves. These symptoms were further totally prevented if large doses of mineral 
acids were introduced into the body, V)y which solution of the uric acid was pre- 
vented, while the use of .alkalies caused them to set in earlier and with greater 
intensity. So, also, the phenomena of irritation presented themselves earlier if the 
injection of uric acid was immediately followed by the introduction of alkaline 
solutions in the same locality, pain and inflauimatiou present themselves ])romptly 
if solutions of uric acid are injected. The results of these experiments are also 
iu accord, says Pfeifier, with the clinical fact that the tophi of gouty patients are 
usually ]>ainless; often, indeed, they form without the knowlelge of the patient. 
Not the ])rccipitated uric acid, therefore, but the dissolved uric acid according to 
this view must be regarded as tlie irritating agent. According to it an acute .attack 
is the result of a rcsolutiou by the blood of previously deposited uric acid, the im- 
pulse to this resolution being an increased alk.alescence of the blood and body juices, 
the deposit being tlie result of diminished alkalescence. 

Pfeiifer. iu further support of this view, calls attention to the fact that the most 
recent chemical analyses by Lecorche, Ebstein, and hims(df show that the excretion 
of uric acid during an attack of gout is increased, and not diminished as taught by 
(Jarrod. I can, of course, have nothing to say of Pfcifier's experiments, but so fa; 
as the clinical facts which he adduces to prove his position are concerned, my owjl 
experience is not iu accord with his. The most recent stuflics on this subject, thoM> 
of Sir William Roberts, embodied in the Crooniau lectures and just republishe i 
in a small brochure entitled, "Uric Acid Gravel and Gout" support the oldt .'• 
view that the "mechanical theory ofl^"ers a natural and complete explanation." The 
crystalline urates ])rceipitated in the cartilaginous and fibrous structures of the 
joints necessarily act as foreign bodies: they excite irritation, clog the lymph chan- 
nels, exercise pressure on the tissue. 

*Ov.eit.. p. 2. 


We are now ready fm- a rational treatment of gont. Whether it be an irritant in 
solution or au irritating preci[iitate, uric acid is its cause. Hence, whatever dimin- 
ishes the amount of uric acid in the economy must tend to relieve gout. It is plain 
also that we may diminish uric acid in two ways, first by confining the gouty person 
to such food as produces a minimum of uric acid; second by aduiinistering such 
medicines as will promote its solution and elimination. The first of these consti- 
tutes in the main the dietetic treatment, the second the. medicinal. 

/. The dietetic treat men t. — I have said the elimination of urea and uric-acid pro- 
ducing substances from the dietary constitutes the dietetic treatment, which is by far 
the most efficient of the treatments of gout, without which all else is only palliation. 

This consists essentially in the elimination from the food of all nitrogenous or 
albuminous principles, whose complete combustion results in urea and incomplete 
combustion in uric acid. As to these there should be no half course. They ought 
to be excluded as far as possible from the dietarJ^ I siiy as far as possible, for it is 
practically impossible to eliminate them altogether. Tlie foods which are the typo 
of this class should, however, be altogether omitted. Such are the meats of the 
butcher shops, the albumen of eggs, and the cheeses. The first include beef, veal, 
mutton, lamb, and pork, whether salt or fresh, and for the most part fish. As to 
cheeses, as one-half pound of cheese contains almost as much nitrogenous matter 
as a pound of meat, 27 per cent when made of the whole milk, and 28 per cent when 
made of skim milk, it is evident that they are contraindicated. If we consider 
only the edible parts of beef, i. e., meat deprived of the refuse represented by 
bones, skin, and shells, it contains, according to its source, 17 to 23 per cent of 
pi'oteids; mutton from 1.5 to 18 per cent. Of fish, flounder contains 13'8 per cent, 
mackerel 18, halibut 15, and salmon 21 per cent, or quite as much as beef and more 
than mutton ; salt codfish contains 1.5 per cent, smoked herriug 20, and canned sar- 
dines 24. Poultry contains 14 to 15 per cent of albuminates and game 22 per cent. 
The hen's egg, including albumen and fat, contains 137 per cent protein, whence 
it is plain that the yellow of eggs contains a very small quantity and becomes a 
suitable food. 

On the other hand milk contains but 3 to 4 per cent protein, butter 1 per cent, 
and oleomargarine 0-6 per cent. The fat oyster contains 8 per cent and the lean 
4'2 per cent and the lobster 5*5 per cent. Other fish than the above mentioned 5 to 
10 per cent. 

Of vegetable foods wheat bread contains 8-9 per cent protein, wheat flour 11, and 
graham flour 11-7; rye bread 6*7, buckwheat flour the same, corn (maize) 9, rice 7"4, 
sugar 0'3, potatoes 2, sweet potatoes 1*5, turnips and carrots 1, cabbage 1"9, melons 
1, apples and pears 0-4 and bananas 2 per cent. Again, beans contain 23-2 per cent 
and oat meal 12 to 15 per cent, large proportions of proteins. 

Thus the typical foods permissible from the standpoint of composition are milk, 
butter, the succulent vegetables, excejit beans and oatmeal, and fruits. To these 
oysters and lobster may be added moderately, fish except those named as containing 
a large amount of protein, and where extreme rigidity is not required poultry in 
m'lderate amount; but all butcher's meat should be strictly forbidden. 

It is usual also to interdict the use of carbohydrates, i. e., starches and sugars, as 
well as the hydrocarbons or fats, but I have never been able to see any reason for this. 
There is absolutely none fi-om the standpoint of chemical composition, since they 
are totally without nitrogen, and, so far as my own experience goes, none from the 
clinical standpoint. Only in the event they produce indigestion and fermentation, 
with the generation of acids, can they become a cause of gout, and then only, I 
should say, exciting cause. I am in the habit, therefore, of permitting the use of rice, 
potatoes, and other farinacea, and, to a reasonable extent, sugar. 

I am glad to be able to say that I am sustained in this view by Sir William Rob- 
erts, who, in the I)rochnre just quoted, says also — 

The most trustworthy experiments indicate that fat, starch, and sugar have not 


the least direct infliipiue <»n tlio jiroilnctioii of iirio acid ; l»iit as the freo consumption 
of these articles uaturally optirales to restrict the iutake of nitroj^cnons food, their 
use has, indirectly, the effect of diininishiug the average production of uric acid. 

leasing his conclusions upon experiments with solutions of blood serum impregnated 
with common salt (O'l ])er cent) in which he found the precipitation of crystalline 
biurate always apitreciabl}' hastened, Sir William Koberts for some years past has 
directed gouty patients to restrict as far as i)ossible the use of common salt with 

There is, however, another sort of iugesta, also entirely or almost free from nitro- 
gen acknowledged to be both a predisposing and exciting cause of gout, and that is 
malt liquors and wines. Tliese are composed of water, alcohol an<l other carbohy- 
drates, and a trace of mineral matters, but no nitrogen, ft is not easy at first 
tliought to understand why these substances should be harmful. Experience, 
however, shows that the strongest wines, such as jtort, Madeira, and sherry, by 
their continued use, are very likely to produce gout; while the lighter wines, tlio 
clarets, hocks, and Moselle wines, if taken in luoileration, rarely produce it. After 
these, stout, porter, and the strong ales induce gout. Even lager beer, which 
contains but 3 per cent of alcohol, is capable of acting similarly; and I know many 
men who have l)een forced to give up this beverage because of this etVect. Cider 
and perry, also, predispose to gout to a less degree. Ou the other liand tlistiih-d 
spirits, especially whisky, are almost entirely without effect in producing gont. 
Why is this? Plainly, the amount of alcohol is not the measure of tlie effect, for 
whisky, gin. brandy, and rum all contain more alcohol than any of the wines alluded 
to. If reference is made to the wines most apt to produce gout it will be found tliat 
they are those which contain a considerable quantity of both sugai' and alcoliol. 
Such as port, sherry, and Madeira, all of which contain more than 1.5 percent of 
ah-ohol and much sugar; also sweet champagnes, containing II i)er cent alcohol. On 
the other hand some very sweet wines, as Tokay, Malaga, and the higher sauternes, 
whi(;h contain much sugar, produce gout less rapidly. It would seem that those 
liquors whicli contain alcoliol in combination with other substaucea. especially sugar, 
are potent gout producers, especially where they excite indigestion. 

Tliat the acidity of alcoholic drinks Acts as an exciting cause can not be doubted. 
Whatever be the explan.ition few facts in the clinical history of gout are better 
establishc<l than that the ingestion of acid is an exciting cause. 

In the same way act acid fruits, such as strawberries, acid oranges, and lemons. 
On the other hand, to such influence I have known the most divergent response. 
Thus, a gouty patient of my own could bring on an attack by drinking a single glass 
of lemonade, w hile a gouty friend would drink a pitcher of lemonade at dinner 
without any effect whatever. It is to be remembered that the otherwise harmful 
effects of the strong distilled spirits, such as are well born in gout, are no less serious 
in gouty subjects than in others, and are often induced by the careless prescription 
of whisky as less harmful than wines in gout. 

//. The medicinal treatment of gout. — From the earliest history of the disease prac- 
tice recognized two classes of remedies in the treatment of gout, alkalies and 
purgatives, the object of both being to eliminate the offender, the first by producing 
soluble combinations which pass off by the kidneys, the second by the bowels. It is 
plain that a combination of the two principles might be expected to be more efficient 
than either one alone. 

First, as to alkalis and alkaline combinations. My experience places the salicylate 
of sodium easily at the top, and while it is not so rapid in its effect in relieving the 
pain of an acute attack of gout as it is in rheumatism, it is nevertheless an invalu- 
able remedy, excelling all others. During an attack it should be given in doses as 
large as can be borne. As a rule adult men easily bear 15 grains four times a day, 
or 10 grains may be administered every two hours. Even larger doses may be given 


with advantage if borne by the stomach.* With relief to the acnte symptoms the 
dose shouUl he reduced, hut, as in rheumatism, the remedy should not be discon- 
tinued, and between attacks smaller doses should be kept u]^ for some time. These, 
however, maybe siibstituted by the natural mineral waters to lie presently alluded to. 

After the salicylates the alkaline carbonates have always held a high position in 
the treatment of goat. Half an ounce a day should be the initial dose reduced when 
the acute symptoms are relieved, but continued in smaller doses. It may be combined 
with a little lemon juice to iniprov^e the flavor, or the citrate of potassium may be 
given in the same doses. 

The lithium compounds, the carbonate and citrate, have not jiroven so useful as to 
cause me to prefer them to salicylic acid. Indeed the early result of Garrod with 
them can not be said to have been realized in modern therapeutics. Sir Dyce Duck- 
worth says of lithia that it is a remedy better adapted to the chronic than the acute 
phases of gout. Five grains foiir times a day, freely diluted, is the dose usually 
administered, and with this the potash salts are sometimes combined. 

A most valuable adjuvant to the medicinal treatment are mineral waters. The 
waters which have heretofore received almost universal approval are the alkaline 
waters, although those possessing purgative properties also possess much reputa- 
tion. In America, however, so few of these waters are native, while those which 
are, are so far inferior to the foreign waters that it is practically impossible to fulfill 
these requirements by them alone; while the costliness of the foreign waters 
imported to this country is a very serious obstacle to their use. 

The native waters commonly employed and which are highly vaunted by their 
owners on ajiparently insufficient grounds, are of the kind known as negative waters; 
that is, they have no mineral ingredient in a quantity to justify their classification 
in any of the four principal varieties of mineral waters, viz, the alkaline, the saline, 
the purgative, or sulphurous. Anj- therapeutic power they possess must be ascrebed 
to their diluent effect. At the same time it has been noted that these waters are not 
without efi^"ect in relieving gouty symptoms. Reasoning from these facts I have long 
been in the habit of prescriljing native drinking waters, such as are accessible to 
the patient, or distilled water may be used with this end in view, the simple diluent 
and solvent efi:ect which comes from an increased proportion of water in the blood. 
The further propriety of such a course is found in the fact that gouty and litlnemic 
patients are often small drinkers, never drinking water between meals and very little 
at meals. To such, 8 ounces of water ordered on rising, between meals, and at bed 
time will often clear up a dark-hued urine of high specific gravity and substitute a 
light-hued, clear urine without any sediment. 

The positive mineral waters that have acquired the greatest reputation in the treat- 
men t of gout are those of which sodium bicarbonate is the chief ingredient, to 
which the calcium l>icarbonate is a valuable adjiivant. Such are the alkaline waters 
of Vichy, Evian-les-Bains in Switzerland, Neuenahr, and Fachinglen in Prussia, 
Contres^ville, and Vittel in the Vosges, and Dax in France. 

Other waters possessed of reputation in the treatment of gout, in which the quan- 
tity of alkaline bicarbonate is smaller, owe this reputation to their combined alkaline 
and aperient proi>erties, chiefly due to sodium sulphate and magnesium sulphate, 
and belong to the second category of remedies for gout. Such are the alkaline 
waters of Carlsbad and Marienbad in Bohemia, Kronthal in Nassau, and Brides- 

*In this conDection I de.sire to call attention to a method of aflmini.stration of sodium salicylate by 
the rectum, the source of which I can not now recall : (1) The rectum is cleaned out of fnecal masses, 
preferably by warm water, and some time allowed to elapse after this before the drug is injected. 
(2) From 90 to 120 grains of Siilicylate of sodium are dissolved in 3 fluid ounces of warm water, to 
which 25 minima of tincture of opium have been added. (3) A 3-ounce syringe, with a long, soft gum 
tube attached to the nozzle, is filled with the solution, the gum tube introduced about 8 inches into 
the bowel, and the injection made once daily. (4) Afler the injection the syringe is withdrawn from 
the gum tube, which is allowed to remain in the bowel, the syringe filled with air, and this forced 
into the tube in order to retain the enema. The precaution must be taken of informing less intelligent 
persons that the injection is to be retained. 


]es Paliiis in Savoy. Then tlioro nif the saline waters represcDted l»y Piaflon-P.aden, 
Ems, Ilaiiihiirjjf, Kissiiiiion, and Inclil, ^Vicsl)aden, and (lur owu Saratoga waters, 
and those of Bedford, Pa. 

Finally, there are the bitter acidnlated and purjrative waters Hnnyadi Janos and 
Friedrichshallo in IFungary, Piilna in Pohcniia, and Ruhiuat in Spain, rarely resorted 
to for gont, bnt nseinl as eliminating agents. 

The nse of these mineral waters is especially indicated in a continnons manner 
between attacks with a view to averting them. Especially nsefnl arc the thermal 
waters in the chronic arthritic complications in which their internal use is combined 
witli bathinjr. In this connection may be mentioned Carlsbad and Marienbad, 
■where also tRe mnd baths are employed, Baden-Baden, Ems, "Wiesbaden, Ilammon 
R'Irlia in Algeria, available in winter, Plombieres in the Vosges, and Dax in Prance. 
Ilonibnrg, Kissingen, ami Ischl are also resorted to for their baths, althongh the 
waters are cold. 

Snlphnrons waters also have some rc])ntation in gont. Especially is this the case 
with the waters of Aix-la-Chapelle in RhenLsh Prussia, and Aix-les-Bains in Savoy, 
llarrowgate in England, and Richfield Springs, Sharon, and St. Catherine's in 
America. In all these places the bath treatment is an important adjuvant. 

The .second category of remedies, the aperients, are decidedly useful in gout, both 
as eliminators and to prei)are the way for the absori)tion and prom]>t action of tlie 
all<aline bicarbonatcs. They are not, however, used at the present day as freely as 
a century ago and they are commonly reserved for the acute attack. 

Among th(^ eliminating remedies is the time-honored colchiciim, a remedy which 
is of undoubted value in gout, but which in my experience in most cases must yield 
the palm to salicylic acid. For a long time its action was inexplicable, and it came 
to be spoken of as a s])ecific in gout, as (luinine in chills, and mercury in sy]»hilis. 
Modern studies have, however, solved this problem. Prof. Rutherford has shown that 
it is one of the most powerful cholagognes known. This, taken in connection with 
what we now know of the office of the liver in ui-ea formation, simplifies very much 
the s(dutionof the ])roblem. This explains, too, why colcilicum produces its sedative 
and auiesthetic efVect without necessarily producing purgation. Indeed, some (as Sir 
A. B. Garrod) consider that its eflfects are best attained without purgation, and Garrod 
says that if cathartic action is required it is better to combine some aperient with 
the colchicum, as when much purging and vomiting result from colchicum, nervous 
and vascular dei)ression follow. I confess I like to secure a little action on the 
bowels by increasing the dose gradually, and it is not necessary to produce either 
violent purging or vomiting. The preparation commonly used is the wine. In this 
country the wine of the seeds is no longer officinal, so that if the wine is ordered 
that of the root is dispensed. This is more powerful than the wine of the seeds. 
The dose of the latter is from half a drachm to a drachm or a drachm and a half 
during the attack, bnt of the root 15 to 30 minims, reducing the qnantity when 
nausea or purgation ensues. 

The acetic extract of colchicum was a favorite preparation of the older physicians, 
especially Scudatuore, who introduced it and who considered its action milder than 
any other form. It is still sometimes used and has the advantage that it may be 
put into pill form. Its dose is 1 to 2 grains. 

I am not in the habit of using colchicum in the interval between attacks of gont. 
and indeed use it less in the acute attacks since the salicylates have come into nse, 
but still value it highly. Colchicum has also been regarded as a diuretic, but later 
ob.servations go to show that it does not increase the elimination of uric acid or 
urea. It should not be omitted that some of the physicians of the third quarter of 
this century who had large experience Avith colchicum thought it caused gouty 
attacks, bnt Garrod and Sir Thomas Watson, whose combined experience is probably 
greater than that of any other two men, both deny it. It may be worth while to 
add here what the latter says of its efficiency : "This drug has certainly the property 
of easing in an almost magical manner the pain of gout," "How it operates,'' be 


says, "is not so clear." We have seen that at the present day, however, a rational 
explanation is not wanting.* 

The aperients commonly used in gout are the salines, of which the magnesinni 
sulphate is the favorite. Sodium sulphate is also used, and it is the constituent of 
the most actively purgative mineral waters, the Hunyadi, Jauos, and Friedrichshalle, 
already mentioned, which are now largely used instead. A favorite combination of the 
tilderphysicianswasmagcsiumsnlphate two drachms, magnesium carbonate a scruple, 
suspended in an ounce of cinnamon water, two or three times a day until active 
purgation results. These two substances may be combined with colchicum, and 
with it form a popular gout medicine. 

Colocynth is also employed as an aperient in gout, and advantage has been taken 
of this fact in the preparation of the secret remedy known as Lavelle's tincture, 
which is very largely used by the laity and which undoubtedly has a very prompt 
eftect in many cases of acute gout. 

The following has been publishedt as the composition of Lavelle's remedy, the 
result of analysis: Quinine, 5 parts; cinchona, 5 parts; colocynthiu, 2-5 parts; lime 
salts, 5 parts; water, 85 parts; alcohol, 100 parts; port wine, 800 parts. 

Doubtless it will be expected of me to make some allusion to a remedy which has 
recently been introduced as efficient in the treatment of gout. I allude to pipera- 
zin. I regret to say that I have been disappointed in it. In my early trials I thought 
it useful, but soon learned that it was less efficient than the salicylates and colchicum. 
An acknowledged solvent for uric acid when dissolved in water, its failure as a uric 
acid solvent in the system is well explained by some recent experiments by Dr. 
Martin Mendelsohn, who placed small uric acid gravel in a 1 per cent aqueous solu- 
tion of piperazin, in urine containing 1 per cent of piperazin, and in urine derived 
from a person during the administration of piperazin. The first solution produced 
a decided effect upon the stone, reducing its bulk one-half and liberating parts of 
the organic framework, but the stone in the second and third solutions remained 
uninfluenced. Mendelsohn further placed on a filter a known <iuantity of uric acid 
and passed over it the urine of a jierson who had taken two grams of piperazin in 
the course of a day, and found that at the end of this time the uric acid weighed 
more than it did before the urine passed over it, so that instead of the uric acid being 
dissolved away something more Avas added to it. 

It will be remembered, too, that Pfeift'er has shown that it is one of the peculiari- 
ties of the gouty diathesis that the urine possesses a marked ''precipitability'' for 
uric acid; that is, it parts with its uric acid with great readiness, and it possesses, 
further, a disposition to give off uric acid to the uric acid filter above described in 
an especially high degree, and that under the use of certain mineral waters as those 
of Vals or Fachingen the urine loses this property. Now, if piperazin is an efficient 
agent to the end claimed it ought to produce the same effect on the urine as the 
mineral waters referred to did. In very carefully conducted experiments, however, 
Mendelsohn showed that this was not the case; so that it is true of piperazin, as of 
other substances, that while in aqueous solution it dissolves uric acid there is some- 
thing in urine which interferes with this solvent power. For the relief ot the acute 
attack of gout, leeches, blisters, and cold have all been discontiuued of late years, not 
only because they are useless, but also because their use has been followed by fatal 
attacks of the so-called internal gout. 

AVarmth and moisture do, however, have a mollifying effect, which is increased if 
the liquid preparations of opium be associated with such applications. Cocaine, 
which might be expected to be useful, operates only through open surfaces. 

All pressure by boots on joints disposed to gout should be carefully avoided as 
well as injuries, as such influences undoubtedly act as predisposing causes. 

* Colchicine, the active principle of colchicum, is also employed. Its dose is the one-fiftieth grain. 
The same dose maybe employed hypodeimically. The fluid extract may be administered in doses of 
2 to 6 minims. 

t Druggist's Circular, October, 1889. 


IJ.y P. PEYRE POllCHEK, M. D., I.L. 1)., Charlestou, S. C. 

I wisli, in til is j)aper based on the study of several epidemics of j'ellow fever in 
Chailfston, to make three points whicli art; of the lirst iinportanco; also to ;;ive 
some of the results of my ex])erieuce as regards treatment ami pathology, which 1 
do not think liuve attracted the attention they deserve: 

First. That this fever in Charleston has always been accompanied by what is 
known as '"breakbone fever;'' this, though extremely mild, is not distinguishal)!e, 
but being counted iu with cases of true yellow fever jjrevents all accuracy in the 
mortality rtfports. 

Second. That yellow fever is fully susceptible <)f successful management in fair 
cases, seen early. 

Third. That life is compromised in the first six to ten hours of the disease; so that 
it is essential that treatment should bo begun early. 

Coexixtence of yvlhw and hrcakbonc fever. — Invariably two forms of fever existed 
togelher, namely, yellow fever, and a milder and more ephemeral, intercurrent spe- 
cies kno\\ u and designated as '"breakbone." Yet this was not by any means always 
ephemeral, for it often had a duration of several days. Whether they constituted two 
distinct species, or were only varieties of one and the same malady, has, strange to 
say, never been decided — no distinct lines of demarcation between the two have 
ever been satisfactorily established — no physician, however acute, having clearly 
l)ointed out any ])reeise diagnostic difterence. Though many cried "eureka," upon 
more rigid scrutiny the hopes they otlered of a solution of the dilliculty proved 

Among the observers ther(; were to be found the lax and the strict constructionists, 
so that the usual confusion prevailed: quot homiiwa tot sciilvittia: — there were as 
many opinions as there were persons to utter them. The question was, it must 
be confessed, surrounded by many ditliculties, for whilst some forms of fever 
were very mild, and some characterized by black vomit an<l suppression of urine 
were very I'atal, others presented every intervening shade of dill'erence between the 
two; and tliough the access of what proved to be the simplest cases was sometimes 
severe and vicdent, the intensity of the disease was dependent for the most part, I 
think, upon the amount of climatization enjoyed by the party suffering; and its 
gravity and its termination, whether favorable or unfavorable, would be modified, 
it seemed to me, by neglect, by delay, or methods of management injurious or bene- 
ficial in their etVects. 

Individually, 1 am of the opinion that many who, by careful and assiduous atten- 
tion on the part of the attendants were rescued from falling into a dangerous con- 
dition, and who recovered — the result would have been quite the opposite had they 
been managed otherwise. So that it was the early treatment and the apjdiances, 
and the eternal vigilance which sufficed to change the issue, and Avhich did change 
it; and I hold that such cases, so metamorphosed by the simple, but important difter- 
ence of management, would have had a very ditTereut termination; and would then, 
even by the most skeptical, have been phiced in the category of true yellow fever, 
which was denied them" if they did not get almost or quite into the third stage. The 
mild cases (breakbone, so called) may get well with little or no interference. The 
difficulty was that they could not be surely distinguished at their early ineejition; 
and the stranger, in my experience, sometimes had attacks, which, when a igoronsly 
managed at the beginning, were fully as innocent as those from which natives suf- 
fered, and which in these received the designation of breakbone. But iu a fever 
like this, which does its work so rapidly, it was at least plausible to believe and to 
argue that neglect, delay, the avoidance of the proper means and appliances for 
reducing temperature, etc., would have very much to do with modifying the nature, 


history, and endiug of each case. This need not excite surprise, for did we treat 
scarlet fever or even measles with agents as active as those we were in the habit of 
administering in yellow fever, they would inevitably be made quite as fatal. 

Pathology. — The peculiar poison when first introduced in the system produces 
(tbrough nervous paralysis of the capillary arteries, perhaps) intense fe\er and 
great excitement of the circulation, with torpor of the glandular and secretory 
apparatus. It shuts up all the secretions and excretions, and with a high fever 
which it creates, rajiid destructive metamophosis of the tissue occur, caused by the 
intense combustion going on; so that spoliative treatment, in the shape of mercurial, 
sal'ne, or other purgatives, is imperatively demanded at this inceptive stage. 
These are to be accompanied by revulsives, hot foot baths, and the application of 
cold to the upper extremities, in order, severally, to empty the intestinal canal and 
the torpid glandular organs, to diminish tem])erature, and to contract cajiillaries. 
All these means, also, serve incidentally, but powerfully, to lessen the tendency to 
nausea, and to irritability of the stomach. The latter does not decidedly lead to, or 
induce black vomit, as is commonly supposed, though the one often accompanies or 
l)recedes the other. Both result from the same efficient cause, namely, tlie altered 
condition of the blood, induced by the fever. The peculiar vomit is probably owing 
to what Warren calls ''mortified blood," blood thinned by the decomposing action 
of excessive fever (a quality peculiar to the yellow fever poison alone) transuding 
into the stomach and blackened by its acids. I could discover by the microscojie," 
freiiuently used, no distinct dilierence between this and other bloodj^ matters 
vomited, Avhich have been acted ujiou by the gastric juice, as where blood from a 
cancer is poured into the stomach and afterwards ejected. 

The temperature ini this peculiar fever, if unsubdued, leads infallibly and of neces- 
sity to subsequent trouble, to destructive tissue changes, to blood poisoning, to black 
vomit, to albuminuria, to coma, or to convulsions. I have seen thorough and per- 
sistent sponging with ice-cold water, when combined with the use of tlie other 
agencies advised, reduce the temperature, lessen all the bad symptoms in a surpris- 
ingly short time; having the power seemingly to change the entire character of the 
disease and imparting comparative mildness to its whole subsequent career. I will 
stand to this truth, for in the iierceptiou and practical carrying out of it lies the 
whole virtue of the plan which I advocate and assert to be successful. 

In general terms, then, our first eft'orts must be directed to the relief of the intes- 
tinal and glandular torpor which always exist and which is marked by costiveness; 
we must diminish the cutaneous and general heat, empty tlie vessels of the system 
which are laden with impure blood, and obviate the tendency to renal engorgement 
indicated by the frequent presence of albumen. This is eti'ected by the revulsives, 
aided by a mild alkaline diiuetic, to be referred to subsequently. Then we must 
strive cautiously at construction, and whilst allowing the recuperative powers full 
exercise, we are to do nothing to impair the strength remaining, or weaken the ener- 
gies of the constitution which have become greatly enfeebled. The uuacclimated 
who are seized with the fever are nearly or quite always in a quasi-critical state, 
ready at any moment to take the descending path and to become dangerously ill; 
hence they require as careful handling as children do with scarlet fever. Whilst, 
therefore, nothing is omitted whicli will tend to diminish the fever, their strength 
must be carefully husbanded, for the slightest neglect, the failure to keep down the 
temperature by the application of cold water, or too much medication, though 
these may seem light transgressions, are powerful and weighty in turning the 

Mercurial and antiphlogistic purgatives, used at the beginning, serve to diminish 
the heart's action, to lessen the infiammation by sjioliation, by the drain of fluids 
from the body, augmented by the cooling operation of the salines. All of these are 
measures only to be employed at the beginning, using the agents in sufficient amounts 

*IUu3triatJon8 of Disease with the Microscopi). Prize Essay. CUarlestou, C. S. A., 1S61. 


to effect our object, which is to ciin»ty the l)o\vels once thoroiij^hly and cffcctnally, 
without, as I urged, Aveakeniug the patieut any more than is absolutely reiiuired. 
Purgatives are on no account to be persevered in. The failure to discontinue them 
after the eflicient action of those used on the first day is procure<l, is, I am sure, a 
grievous error. 

Several authorities committhefatal mistake ofrepeatingthe mercury and cathartics 
and pushing their use unicli too far. Even Blair, though in my judgment eminently 
on the right track, and for this reason very successful, permitted his xx of calomel 
and XXIV of quinine to be repeated under emergencies, and be used again and again 
as often as .-^ix times; I i)rescribe it invariably, but never more than once, uuless it 
is not retained or does not act. 

In a fever like this, of one paroxysm (but with a remission somewhere between 
the twelfth and thirty-sixth hour, occurring more distiuctly when the proper means 
are used early), which is exceedingly violent at the beginning, if unchecked, it 
does all the violence it is capable of in a very brief period. 

I have been the first, I believe, to make a most important declaration: that life is 
virtually compromised in the first fil'teen hours of its career. In such a fever, where 
the danger and the terrible sequehc are owing entirely to the extreme intensity of 
the eremaeausis, and the injury worked in the system by the high combustion which 
acts principally upon the blood, a certain treatment Hows logically. There is no 
time to be lost in setting about it, and it is only to be regretted that our measures 
can not anticipate the invasion of the attack. 

I sincerely believe that thousands of lives could have been, and can be, saved by 
a system of management begun at tiie very commencenu-nt of an attack of the dis- 
ease, before the fever has had time to produce its direful eftects, and by methods 
simple in their operation, perfectly compatible with reason and common sense, and 
also based upon a view of the pathology and progress of the di.sease. 

That. conse<iuently, where the demand for medical aid is so urgent, when physi- 
cians can uiit see their cases early — such precious time being lost by their enforced 
absence — an exception must be made to our usual ],rocedure, and the jjcople in such 
need must be tolil what to do belbre the physician arrives. This is reiiuired bj' the 
fact, which should be recognized by every one, that death results from the insidious 
and peculiar fever of the lirst six to ten hours — whenever this is permitted to go on 
unchecked — through failure to use these means which are perfectly adequate to 
restrain and keep down the temperature. So that when a num has been ill lor 
twenty-four hours or forty-eight hours with yellow fever, the attendant is not resjiou- 
sible, and treatment which would have been elfieient used early is not to be con- 
demned because it fails at the stage where irremediable organic changes have taken 
place; and the practitioner who boasts that he has 50 or 60 patients on his list does 
not know that the last installment (those he can not see for ten to fifteen hours) 
are, in nuiny instances, already irretrievably doomed. 

In fair cases and temperate individuals, treated early, there is no need for any 
violent third stage, for any black vomit, albuminuria, suppression of the urine, etc. 

It is a mistake to suppose that yellow fever is necessarily a fatal malady, that 
epidemics varj' greatly in malignity, and that we must fold our hands supinely. 
The truth is that physicians in this city and elsewhere report at the end of the 
season very few deaths. Belot, of Havana, claims that 95 out of 100 fair cases 
seen early may be cured, and I agree fully with him. I have practised with 
success the method to be jelated in detail (see also Charleston Medical Journal and 
Review, since 1858, and president's address before State Medical Association of South 
Carolina, 1872). Dr. C. W. Horsey adopted the same treatment in the fever of Fer- 
nandiua, Fla., 1878, others have employed it successfully, and Surgeon Sternberg 
refers to it approvingly in his elaborate and able article in Wood's Hand Book of 
the Medical Sciences. 1 had long shown that by the adoption of Blair's system, 
qjaterially modified, the application also of cold water was the foundation fact in 


the treatment. la coulinuatlou of this, Prof. T. O. Summers, of Nashville, says, 
"Cold water is the remedy in yellow fever" (paper on treatjuent of yellow fever 
in 1879). 

Treatment. — The treatment consists first in sponging assiduously the head, hands, 
and arms with ice-cold water at the very commeucemeut of the attack, not losing 
an hour, and repeating? this at iuters'als whenever the temperature rises, ice water 
being quite capable of reducing the temperature. Towels soaked in the ice water 
are preferable to sponging; fifteen to twenty minutes generally suffice for each 
aijplication, its necessity being determined by the existence of pyrexia. Few per- 
form this simple but essential procedure as efficiently as they should do. Secondlj', 
give immediately Blair's "Calomel, grs. xx; q.uiuiue, grs. xxv" (in proportion to 
ages), and but once. I have never seen the quinine produce a single ill effect, though 
given when the fever is intense. Thirdly, follow in three or four hours with a 
saline cathartic (sulphate of magnesia), which is cooling and antiphlogistic. Fourth, 
apply mustard plasters to the entire abdomen, and use hot mustard pediluvia from 
the beginning of the attack, aud repeat them frequently. These may be followed 
by acautharides plaster upon the abdomen — which certainly does no injury. After 
the saline has acted, give an eiSfervescent or antacid mixture of this nature (which 
also had the support of the late Prof. E. Geddiugs). Potas. acetate, 1 dram ad 2 
drams; potas. citrate, 1 dram; morjjhia, 1 grain; water, 6 ounces. A dessert spoonful 
every two or three hours. Used to «|uiet gastric irritation and to act slightly as a 
mild antacid and diuretic. 

No other treatment or active medication are required save the continuance of the 
cold application and pellets of ice given internally if necessary. Doubtless a few 
drops of tincture of aconite added to the mixture, or giveu separately, might prove 

By this method those recover, according to my experience, carefullj' recorded, 
who are seen early; who possess their organs in a state of integrity; with the 
intestinal canal, liver, kidneys, aud other emunctories in a fair condition. This 
surely is not asking too much; and to claim that recovery will almost invariably 
ensue in such cases, under the plans detailed elsewhere, and ou this occasion, is, if 
I am correct, making what I can not regard but as a true and important advance. 
This I hope and believe will one day be fully acknowledged. It is spoken seriously 
aud earnestly without lightly coming to the conclusions, and I sincerelj' trust that 
the expression of them will not be regarded as presumptuous or premature. 

How different is this from a former system of mercurial purgatives rej)eated every 
five or six hours, or a constant effort to induce ptyalism by giving mercury Avith 
opium at any and every stage of the disease — with the omission of other measures 
insisted on here as of the first importance. Persons seized with such a fever, who 
are not seen for ten or twenty hours, those who already suffer from organic lesions, 
whether of the stomach, liver, or kidneys, whose digestive organs (so essential to the 
nutrition, growth, and repair of the system) are irritated and iufiamed by the use 
of intoxicating drinks, can not be expected to respond to any treatment, however 
judicious and appropriate.*' In such subjects there is great tendency to irritability 
of stomach; the purgatives are not retained, the indammatory stage (fever) runs 
high, and can not be subdued. Congestion of the internal organs, kidneys, etc., with 
albuminuria, occurs; black vomit sets in; and iirtemic poisoning, with coma, gen- 
erally closes the scene — during attacks of violent convulsions. Under such condi- 
tions, all agents prove nugatory; every effort is necessarily unavailing; and these 
cases — falsely and illogically reasoned from — bring reproach ujion true and legiti- 
mate treatmeu't, which can be shown to be serviceable in those who. from the 
beginning, are not plainly beyond the reach of art. 

In my humble judgment, if not the height of folly, it is at least extremely unfair, 
to decry, or, which is worse, to abandon, a course of management which is e miiiently 

* "There is no hoije for the drunkard." — S. H. Dickson. 

S. Ex. 36 12 


and Khrikingly successriil in nearly or (|uite all the cases of the class previously 
described, because it fails to cure those who have uo right to expect a luiraclo to bo 
worked in their behalf. 

Any treatment which is successful is not so by accident, but because it is based 
upon the requirements and real nature of the disease and throughout does the 
jjatient no harm. It is high time for the intelligent members of our profession, par- 
ticularly if they be at all apathetic, to give up the pleasing idea that the practice of 
physics is all guess woik, in which one artist does full as well as another; that fate 
and the disease have the control, and tliat always when a child or man dies, the 
"physician who heals is death." 


By nKNRT SEWALL, Pii. D., }^I. D., of Denver, Colo. 

That it is through the means of physical exploration that medical diagnosis most 
nearly approaches an exact science is a doctrine which should be fruitful in good 
results. When a method of i)hysical examination for which masters in medicine 
have claimed unusual advantages has not come into general use, there must be some 
stiong and ]>ratical reason; and it will be the object of this paper to discover that 
reason and to urge the value in physical diagnosis of the a})plicatiou of steth'^scopic, 
or, as it is more commonly termed, auscultatory percussion. 

In 1840 Drs. G. P. Camman and Alonzo Clark jmblished in the New York Journal 
of Medicine and Surgery an article entitled "A new mode of ascertiiiuing tlie dimen- 
sions, form, and condition of internal organs by percussion." These authors recom- 
mended in carrying out their method a special form of stethoscope made of a single 
piece of wood, some 6 inches long and aTi inch in diameter, wedge-shajied iit tiie 
end to be applied to the body, and broad at the other to tit the ear of the observer. 
Percussion was carried out by the of a pleximeter, which was presumably manip- 
ulated by an assistant. No work which has been done on this subject bears the evi- 
denee of such exact and thoughtful observation as that of Camman and Clark, and 
their own words form an admirable description of the api)licatiou and results of the 
method. They say: 

The observer, sup])()se, practices first over the heart, listening and percussing on 
the same region. With each blow of percussion the ear receives a sudilen, clear, 
intense sound of high tone, attended with a degree of impulse even ]i;iinfnl, appear- 
ing to be immediately under the instnniieiit or produced within it; of short (lura- 
tion and ending witli some degree of abrnptuess. Now lind the longest diameter of 
the heart in contact with the walls of the chest — it may be S inches — listen at one 
extremity and percuss at the other. 'i"he sound is t lie same in character and has 
lost little of its energy. Percuss at the ])oint wliere the lung begins to overlay the 
heart; the sound is instantly modified and mixed, yet its cardiac ty))e is still pre- 
served. Kecede still further with percussion, moving by short stejjs toward the 
body of the lungs. At a certain point the sound suddenly changes; it loses its 
intensity and high tone; it is no longer im])ulsive; it is grave and distant, much 
more distinctly heard by the 0])cuear than by that applied to the instrument. Again, 
let the observer in like manner explore the he])atic region. Witliin short distances 
the sound is sudden, clear, intense, and immediately under the instrument as bctbre; 
yet it is less intense, less acute, and m(>r(> prolonged; it is even semire\ erberant. As 
ho increases the distance between the ]H)intsofauscultation and percussion, the sound 
dinnuishes more rapidly than over the heart, though it is not entirely lost till percus- 
sion passes olf from the organ on to another medium. By this mode of exploration 
the lieart and liver become distinguishable through a class of signs which, Judging 
even from the analogous consistency of these organs, would not 1)e supposed to 

In 1880 T. A. McBrido described in the New York Archives of Medicine a form of 
binaural stethoscope, composed of solid wooden ])ieccs, by which auscultatory per- 
cussion could be conveniently carried out by a single observer. These authors 
restricted themselves chielly to the determination of the outlines of the heart and 


liver. Various other observers, iucludiiig Roussel, de Mussy, * Zuelzer,t and, accord- 
ing to Weil,} even Laeunec and Piorry liave called attention to the facility with 
which organs and morbid growths could be differentiated by the stethoscope ajjldied 
to one side of the chest while percussion was carried out by an assistant on the 
opposite side. It is extraordinary, as is remarked by McBride, that in the recog- 
nized treatises on physical diagnosis the method of auscultatory percussion has 
received but little attention and no indorsement. Gerhardt^ appears to make no 
reference to it. Weil speaks slightingly of the method and declares that, as a rule, 
it offers no special advantages. Loomis|| and Page 51 mention the procedure on the 
authority of Cammau and Clark; but all these writers refer to the subject as if at 
second hand, as though they had failed to give it personal investigation. It is 
therefore not surprising that the active members of the medical profession are, for 
the most part, either wholly unfamiliar with the practical application of ausculta- 
tory percussion, or, in isolated instances, only use the method when some accident 
of experience has illustrated its value. 

The reasons why physical examination by the method of stethoscopic or ausculta- 
tory percussion has not come into general use are not far to seek. In the tirst place, 
the mechanical impediments to pursuit of the practice have been made burdensome; 
sj)ecial forms of stethoscopes, useful only in this particular kind of examination, 
have been recommended, and usually the services of a skilled assistant required to 
carry out the observations. In the second place, most de3crij>tions of the findings 
of stethoscopic percussion enter so fully into the pitch and quality differences of 
sounds elicited by percussion of various organs, as would manifestly need for their 
appreciation such a musical cultivation and training in the physics of acoustics as 
might well discourage tbe student in medicine from attacking so cumbersome a 

The writer of this paper has never employed the special instruments described by 
Camman and Clark or McBride, though it seems probable that the results so obtained 
must be i)articularly striking and accurate. But it is the particular design of 
this essay to show that auscultatory percussion may be advantageously and readily 
ciirried out by any single observer who uses a stethoscope; that it is the easiest of 
all methods of physical examination; that it allows the accurate outlining of organs 
and deposits impossible to delineate by ordinary means; and that, though capable 
of extensive development as a means of diagnosis under the acoustic skill of the 
observer, its limitations are so well marked as to instruct without confusing any 
ear that can hear. 

My own work has been done with the simplest form of binaural stethoscope. The 
diameter of the bell for applying to the body is but tive-eighthsof aninchatits mouth, 
so that it can usually be inserted between the ribs of a patient. It should be remarked, 
however, contrary to Mc Bride's statement, that by this method it makes little 
apparent difference whether the mouth]iiece of the stethoscope overlaps the ribs or 
lies wholly between them. I was tirst imi^ressed with the value of auscultatory per- 
cussion on attempting to outline the stomach in the case of an old man, the victim, 
apparently, of chronic peritonitis, whose intestines were inflated with gas. It was 
not possible by ordinary percussion to determine the lower border of the stomach. 
The stethoscope was applied over the upper left border of the epigastrium, and with 
the pulp of the middle linger of the right hand the abdominal wall was gently 
tapped, so gently that no sound was audible to the unaided ear, the finger being 
carried in a straight line from the stethoscope outwards. With each blow of the 
percussing finger a peculiar shock, with a certain loudness and quality of sound, 
was conveyd to the ear, gradually decreasing in intensity as the percussing finger 
receded from the stethoscope until a certain i)oint was reached; then the loudness 

* Quoted by McBride. § Lehrb. d. A uscult. u. Percussion. 

t Berlin. Klin. "Wocbscbr. , 1877. || I'liysical Uiag. 

X Topograph. PercussioH. TT Pliy a. Diagnosis. 


of tlio tone anil the intensity of the shock snddenly diminished; at the same time 
theqnality oliauged. But it is desired to especially observe that (jnality differences in 
sound are to be left to the unconscious appreciation of the examiner, and are not to 
be depended ou iu this description. Having marked the spot at wliich this ihango 
in sound occuired, the percussini; tin.iicr was carried iVoiu tlie stetlioscope as a center 
along other radii, and it was found tiiat tlio line joining all the points so determined 
represented the shape of the greater cnrvature of the stomach. Wlienever the ont- 
line of an organ was determined in this manner, the result was verified by placing 
the stethoscope outside its limits and percussing up to it. It frequently occurs that 
the boundary between two adjacent organs can be more readily determined when 
auscultation and percussion are performed ou one than on the other. 

In outlining an extensive body, as the stomach or the liver, it is frequently of 
advantage to shift the position of the stethoscope along the line of percussion. I 
have paid more attention to the determination of the outlines of the stomach than 
of any other organ, becaitse the difiiculties to be overcome are in this case, perhaps, 
on the whole the greatest. In six different autopsies the stomach was outlined iu 
the manner described, the boundaries being marked by inserting pins into the 
abdominal wall jierpendicnlar to the surface and their position among the viscera 
afterwards determined by sectiou. In f)ne of these cases the stomach was dilated, 
reaching far into the right hypochondriuni, was wholly covered by an enlarged 
liver, aud the abdominal cavity contained free gas. In another the stomach was 
contracted into the form of a tube, having a diameter of less than two inches. 
Nevertheless, the greater curvature of the organ was outlined in each case with 
almost perfect accuracy. The greatest error occurred iu a case in which the borfler 
of the stomach lay just under the free margin of the ribs. One piu was found to 
have been inserted into the stomach three-fourths of an inch from its edge, aud 
another one-half inch below it. It is worthy of remark that, though the stomach 
and colon are thus usually easily distinguishable, the stomach and duodenum do 
not ;i])i)ear to be, aud my pins sometimes traced the course of the gut for a distauco 
beyond the pylorus. Ijeichtenstern, quoted by Weil, used a somewhat similar mode 
of stethoscopic percussion to differentiate the stomach from colon, depending, 
however, on the pitch and quality of the notes elicited from the two organs. But 
it is worthy of being insisted on that though the pitch aud quality of the percus- 
sion note vary with the organ struck, and are at least unconsciously appreciated 
by the examiner, the most iuqjortant factors to be uoticed when the percussing 
finger passes from one organ to another are the changes in louduess and shock of 
the note. 

In those not infreciucut instances in which the stomach gives to ordinary percus- 
sion a dull sound, stethoscopic percussion is at no loss to distinguish the true boun- 
daries. In a recent clinical case in which this stomach dullness made it impossible 
to outline iu the ordinary way the contiguous borders of liver, spleen, aud lung, the 
difliculty disappeared at once under use of the stethoscope. 

In another patient iu w liom the determination of the superficial area of the liver 
was of great importance, the liver dulluess as made out by ordinary percussion ex- 
tended over only one costal interspace; stethoscopic percussion, however, declared 
the liver to reach the margin of the ribs, giving the organ a normal volnme. The 
next day, after free purgation, the normal limits of liver dulluess were determinable 
by ordinary percussion. Probably few examiners are capable of outlining with cer- 
tainty the border between the liver aud a superincumbent pleural effusion ; by steth- 
oscopic percussion, however, the matter is easily accomplished. Iu au autopsy on 
a case of pyo-pueumo thorax it was found ])ossiblc to define within one-fourth inch 
the boundaries of both relative and absolute liver tlulluess, as verified by asidration 
of the fluid aud by sectiou. To fix the liue of division between air and fluid in- 
volved, of course, no difficulty. The method offers valuable assistance iu determin- 
ing the level of eff'usious, pleuritic or abdomiual. In the latter case spleen, liver, 


and kidneys can easily be distinguished. Tlie splenic borders are readily deter- 
mined when obscured to ordinary percussion by contact with a distended stomach. 
The cranial sutures can usually be made out by stethoscopic percussion of a bald 
head or shaven scalp. I have watched in vain for an opportunity to outline, if i^os- 
sible, a superficial brain tumor. 

The most interesting application I have found for this method was in a case of 
]ineumonia in which an encysted empyema developed outside the left lower lobe of 
the lung. The pus touched the chest wall in contact with and parallel to the sixth 
and seventh ribs throughout their anterior and lateral portions. Neither by ordi- 
nary percussion nor by auscultation could the empyema be with certainty distin- 
guished from the adjacent solid lung tissue; but by stethoscopic percussion the 
cyst was outlined, and my colleague at the county hospital, Dr. John Boice, resected 
a rib near the lowest point of the area so determined, and declared that no l)etter 
])lace of incision could have been chosen. Had the chest been open in the ordinary 
region the cyst would have been missed altogether. In another case of a large 
empyema, encysted over the liver, stethoscopic percussion assisted the surgeon by 
exactly locating the top of the latter organ. The delicacy of this method is no- 
where better illustrated than in examination of the normal lungs. When the 
stethoscope is placed over one lobe and the percussion finger made to travel across 
to another, there is a distinct change in the sound as the interlobular fissure is 
passed. Though but little attention has been paid to this part of the subject, I 
have on two occasions at autopsies inserted long needles with considerable accuracy 
into the line of the interlobular fissures as determined by auscultation percussion. 

The limits of usefulness of the method of stethoseopic percussion as thus de- 
scribed are obvious. While a trained ear by the aid of special instruments, such as 
devised by Camman and Clark and McBride, could, no doulit, determine the physical 
condition of the organs investigated, as to their fluid, solid, or gaseous content, the 
present paper does not treat of this possibility^. The sudden diminution in the 
siiock and intensity of an auscultation-percussion note as the body surface is 
tapped by the finger moved along radii centering in the stethoscope, simply means 
that the percussion has I'eached an organ, growth, or eft'usion outside that over 
which the stethoscoiie is placed. This result is altogether to be expected, since 
vibrations set up in any homogeneous body must suff'er great diminution in energy 
when transmitted to an adjoining body of whatever consistence. Stethoscopic per- 
cussion must be used in cojuuction with ordinary percussion and with consideration 
of tojiographical anatomy. For examiile, the position of the border of the left lung 
upon the heart can usually be accurately determined; but whether this line does 
or does not mark the lower or upper margin of the heart, the sound elicited does 
not make clear. 

In fact, twice, at autopsies, needles were inserted into the margin of the lungs 
covering the heart with the thought that the lower border of the latter organ had 
been outlined; further experience cori-ected such mistakes. 

An advantage possessed by the method of stethoscopic percussion deserving of 
special mention, is the feeling of certainty with Avhich its results usually impress 
the examiner. In post mortem observations I have l)een interested to note that 
when stethoscopic percussion had given distinct evidence of the outlines of organs, 
no mistake was ever made. On the other hand, whenever an error was committed, 
the examination itself had been dubious in its indication. 



Por el DR. IK AN CISCO A. KfSQUEZ, do VMiozuela. 

En Venoznola el palntliamo rcviste formas tan variadas i anomalas, quo ofrece 
graniles dilicultades al practico jtara leconoccrlas. 

El corto tiempo de que puedo disponer para esta coniunicaci6n no nie permito 
descriliirlas dctallailamontc. Por tauto, hv do liniitarme ii niencionaiiaa, seualar las 
difionltades del diaf;c"ostico 6 indicar cl modio faril i sojjnro de (|uc acostnnibro 
valirnio para destubrir la oxistoncia del elenieiito ]ialndi('o, convencido de que el 
diaguostieo diferencial de ese Proteo de la patcdoijia intertropical es indispensable, 
so pi'iia de esponer la vida de los enfermos, ya por lalta de qninina, ya por Ja admi- 
nistraciitn inoi)Oituua de este agente. 

Me atendr6 en esta somera deseiipcion a las ciiatro formas clasicasdel paludismo, 
rt saber: (I) Formas iutermit«-ntes; (II) Formaa contiiuias; (III) Fornjas perniciosaa; 
(IV) Formas larvadas. 

Las formas intermitentes son. en lo jreneral. ile tipo onotidiano. a veees terriano, 
mni raras vcees de otros tiiif)s. 

De ordinario piieden reconoeerse por sns caraeteres clasicos: iin aeeeso brnsco quo 
coniienzaporescalofrio, en losadnltos, oporeniViamiento dr losestremos, en los nifios; 
seguido de elevacion t< rniiea notable, casi nnnca menos di' 40 ('., i que terniinapor 
un sudor que liace descender la cil'ra tcnnonietrica a nn^nos de 37'-' C; un acceso 
Bemejante, con tendencia a repetirse con una perioilicidad rejj^iilar, nioditicablo jjor 
la inilnencia del tratamiento. o ])or la persistencia del eleniento causal, serii siempre 
de oriiicn pali'idico, pn<^s los accesos ]>iolieniicos i los de orij^en tubercnloso, "que sc 
le parecen notablcraente, piieden reconocerse ])or la i)resencia di' tocos supurados, 6 

Sinenibarjio, casos se preseutan en que el diagnostico se liace diidoso, ya porque 
el acceso se prolonga nijis de 24. 36. I aim 4S lioras; ya por alguna anonialfa en su 
evolnciuu; 6 bien por la coexistencia en la localidad de algiinas otras afeccioues 
fcbriles, enddmicas, 6 epideniicas. I necesitandose en todo caso sin tratamiento 
apropiado, se requiere, como circimstaucia indispensable, uu diagnostico exacto i 


lias formas coutinuas afectan dos variedadcs: (n) la gastro-liepatica ; (h) la 

La priixiera (a) da la fiebrc biliosa simple, caracterizada por fiebre moderada, 
lengua saburosa, vcnnitos, sensibilldad cpigastrica i a ver-es diarrca. En un grado 
mayorde la intoxicaciiin sobrevienc la ictericia, la albuminuria, las lieinorragias 
gststricas, intestlnales 6 urinarias, los vomitos negros, la adinaniia, constitnyendo 
las modalirlades de fiebre biliosa grave, fiebre ictero-hemorragica, fiebre liematurica. 

En la biliosa simple, el diagn<')stico. aim siendo dudoso, no es urgente, porque 
se trata de una afeccion que se cura pronta, facil i aim esjiontaneamente. 

Pero la biliosa grave se parece tanto ii la fiebre amarilla, algunas vecea reinante 
conu) endemia, 6 epidemia, a la par del paludismo, que la duda subsiste aun despiies 
de observados varios casos. 

Abora bi(5n ; la necesidad de la distiucion entre estas dos pirexias es tauto mayor 
cuanto que el tratamiento es enteramente distinto en una i otra, pn(5s la qninina, 
que enla primera seria la tabla de salvaciou, en la segnnda serfa inutil, si no per- 

Ese diagn6stico diferencial lia sido fiientc de largas discusioues. de las cuales 
todavfa no se ha deducido un caracter discriininativo seguro; i fiic justamente en 
vista de esa oscuridad, que me proi>usc buscar uu medio facil 6 iuequivoco para 


declarar la existencia, 6 la uusencia del paludismo, en casos al parecer enteramento 

Laseguuda variedad (h) constitnye la titbidea paludica. 6 tlfo-iualaria, pirexia 
hi'brida que puede ocurrir, ya porque uua paludosa desarrolle uua aparieucia siri- 
tomiitiea que semeja el estado tifoideo (yo las llamaria pseiido-tifo-malaricas) ; ya 
porqne eu un impalndad se presenta el tifiis abdominal ; ya, cu fin. por(]ue el germen 
niaMrico se deteiiuina en el curso de una tifoidea. De todos niodos, la seniejanza, 
entre la tifoidea pura I la tifo-malaria es tan estrecba, que la sola observaci6n de 
Ids sintonias i marcba es insuficientc para la oportuua discriminacion i la necesidad 
de establecerla do un niodo rierto es t:tn urgeute como en la primera de estas dos 
variedades de formas coutiuuas. 


Las formas perniciosas propiamcnte dicbas, llamando asi on quo ol ger- 
men paliidioo exagora uno de los estadios del acceso, 6 provoca determinacioues 
sobrealgiin (irgano 6 aparato, que segiin las oscilacioues de la ftebre iieriodica, sou 
por lo general faciles de reconocer, sobro todo si ban precedido algunos accesos 
iiitermitentes. simples 6 peruiciosos. Asi, pueden prosontarse sudores, algides, oon- 
gestiones, bemorragias, estados comatosos, diarreicos, convulsivos, o paraliticos, que 
desapareceu i reaparecen con el acceso febril, constituyendo otras tautas variedades 
de fiebres perniciosas. 

Pero no siempre se podr^i esperar tranquilauiente la evoluciun de un accideuto 
pernicioso, 6 su repeticiou, para diagnostioarlo, sabido que toda fiebre perniciosa es 
grave i debe tratarse con el especifico desde su apariciou ; de donde la urgcncia de 
un diagnostico seguro i precoz. 

Eu la variedad do perniciosas d las cuales reservo yo el uomlire de complicadas, 1 
cuyo carilcter estriba en una determinaciou sobrc un (3rgano, bastante profunda 
para persistir en los intervalas de apirexia, como si fuera uua enfermedad aparte, el 
diagnostico se bace m:is dificil. Pero es urgonte precisarlo, a fin de dedicarse a com- 
batir al mismo tiempo la afeccidn principal, con ol especifico quiniua, i la secundaria 
con el plan especialmente dirigido d ella. En osta variedad ocurro de ordinario que 
la complicacinn oscoudo el elomento causal, i descuidando el combatirlo, se diliculta 
i aiin imposibilita la curacion. 


Las formas paludosas larvadas son de dos variedades : 

(a) Unas voces estan constituidas por un accidonto, como una neuralgia, una con- 
gesti6n, una bomorragia, una ijaralisis, etc., quo, acorapanadas o no de elevacion 
tsrmica, pueden reconocerse por la proutitud con que desaparecen i la periodicidad 
con que se ronuevan. Sinembargo, eu el primer acceso lavvado, a voces eu el sogundo 
i basta en el tercero, puode deseonocerse su origcn paliulico, i no siempre podran 
repararse las cousecuencias de semejante error. 

(b) Otras voces, el accidente larvado es uua enfermedad en cuya marcba ningun 
caracter revola su naturaleza paludosa, vieudose outonces resistir el mal al trata- 
miento, eu tauto que no se reconoce la vordadera causa i se aiilica el especifico 

De esta clase be visto colerinas, diarreas, disontorias, beinateniesis, pulmonfas, 
pleuresi'as, bronquitis, pseudo-tuberculosis, bemoptisis, meningitis, paralisis, convul- 
siones, i mucbas otras manifestacioues morbidas que, apareciendo como entidades 
protopaticas, no son siuo accitlentes paludicas que no ceden sino d la quiniua. 

Algunos pntcticos niogan la posibilidad de quo ol j)aludismopueda origiuar ciertas 
afecciones, es decir, que baya, iior ejemplo, disentcrfas, pulmonias, etc., palfidicas. 
Pero es un hecbo de diaria observaci(')n que un impaladado preseute, como linica 
manifestaci6n del infectivo, uua diseuteria, una pulmouia, una orquitis, etc., f quecs 


initil tratarlas por los medios ordinarios empleados -contra ellas, \n\6» no ceden sino 
al autinialurico. Como so oxi)li(|iie ol licclio, no rs de cste Ingar; pero me atrevo ^ 
creer que las ernbolias pigiiiciitarias i las a;;lomeraci ones de parasitos en los vasos 
sangnineos, que no se destriiyeu sino con la quinina, pueden esplicar pcrfectamente 
esas complicaeiones. 

Es enestasformas larvadas de lasegnnda variedad, piincipalmentc. qneel diagnrts- 
tioo so haoe .1 veces im}>08ilde, dando Ingar (i vacilarlones, i a que, 6 se doje de 
adininistrar oportnnamente el especifico Salvador, 6 al revos, que toniando por 
pali'idicas afeccionos que no lo sou, se agrave la enfermedad por la adiniuisLraci6n 
iuoportuua do la qiiiuiua. 

Se vc, sogi'iu lo dicho, que por los solos sfntomas del paludismo, en las formas lar- 
vadas de la segiinda variodad, lo mlsino quo en ol pritiiero i segun lo ac-osos de la 
varicdad precodente, el diagmisticocs casi siemprc iiiiposilde; que en lasiierniciosas, 
sobrotodoen las comiilicados, es porlo regular dificil; que en las continuas es atin 
dudoso en ocasiones, { en las iutoiuiitcntes, & voces inscguro 6 tardio. I sineni- 
bargo, ropito: la oxaetitu<l do ese diaguostico csnocesaria, f bastaurgenteen niuchos 
casos: la quinina, como piedra do toque, es mnelias veces rttil, f atin he observado 
que desenmascara las foruias larvadas, aparecieudo bajo su influeueia la liebre al 
desaparecer el arcidente larvado. Pero cste es un medio de efecto tardio, i no siem- 
pro seguro, por lo cual so liace necesario un medio incquivoco i sulicientemente 
sencillo para hacerlo practico, 1 cse medio lo suministra el examcn de la sangre. 

El descubriiuionto de Laveran ha dado ;t la cieneia una pruoba cicrta para 
rccouocorla malaria; pero la iuvestigacion delosliematozoariosde Laveran, como el 
misrao lo reconoce. requicre un conocimiento de latecuica microscopica, una habili- 
dad para la obsorvaciou i un tiempopara los detalles de mauipulaciou, que no estfiu 
al alealice de todos los practioos. 

De esas dificultades ha nacido el medio que acostumbro f propongo, el cual no es 
nuevo en su fundamento, aunque si lo es en su aplicacion a la clinica. 

Sabcse hoi que la intoxicafion paliidioa produce siemprc la raclanemia, f que esta 
es una manifestacion esclusiva del paludismo; luego la presencia del pigmento 
u.'gro en la sangre es un caracter patognomonico del imiialudismo. 

Si en un sugcto que se sospeche impaludado, se toma una gota de sangre, por la 
picadura do un dodo, 1 se estionde en capa dolgada eutre dos laminillas de vidrio, 
bastara un pcquofio aumento de 300 a 500 diiiinotros, para encontrar en medio del 
plasma las masas negras irregulares de pigmento. Si algnna duda quedare respecto 
a la naturaleza de alguna masa negra quo se hallase, bastarfa agregar una gota de 
;Icido sulfiirico concentrado quo. dostruyendo todos los globulos i las masas de 
houioglobina, dojari'a intaoto ol pigmento. 

Couio se ve, el procedimieuto es sencillo: el practico puede Uevar en su bolsillo 
algunas Ijiminas dc vidrio, toniar la sangre ri la cabocera del enfermo, como queda 
(licho, i guardarla para el examen, que no exige de cinco minutos, ni grandes 
aumentos, ni los procedimientos delicados de coloracion requeridos por todo examen 
bacteriologico. Es mfis facil i breve que el examen clinico de una orina. 

Las observacioues hcohas en los enfermos de la prjJctica civil i en los del Hospital 
Militar de Caracas, donde es ya un examen corriente entre los estudiantes, me ban 
dado los siguientes resultados : 

(1) En los accesos intermitentes, en las fiebres paludosas continuas, en los accidentes 
perniciosoS; en las formas larvadas i en la caquexia paliidica, se encuentra siempre 
pigmento ; 

(2) La abundancia i magnitud de las masas melauicas guardan relacion con el grado 
do la intoxicacion pahldica; 

(3) El pigmento dismiuuye en los int(;!rvalos de los accesos; pero no desaparece sino 
cuando queda cortiida la manifestacion paliidica; 


(4) En las flenuts afeceiones no pnluilicas no se encueutra pigmento ; d menos que el 
individno afectado de otra enfermedad snfra al misnio tiempo de palndismo. 

De todos luodos, la preseiicia de la nielanemia iudica siempre j)aludi.snio i rcclama el 
empleo de la quiniua, sea el palndismo la enfermedad iinica, 6 sea concomitante de 

A mi modo de ver, piies. en las localidadcs malaricas el medico debc estar provisto 
de vidrios porta-oLjetos, I siempe que sospecbe intervencion palndica, debe exammar 
la sangre como el medio miis sencillo, rapido I al alcance de todos para diagnosticar 
nn accidente del palndismo i precisar con toda certidnmbre la indicaciihi del espe- 
cifico quiuina. 

La cuestidn es de vida 6 muerte en ciertas fiebres continnas, accidentes pemiciosos 
1 formas larvadas: solo puede curarlas la quiniua osadamente administrata; mien- 
tras que si se toma j)ov manifestaciun paludosa lo que no es, la quiuina administrada 
por simple sospecba puede causar la muerte del eufermo. 


By WM. C. DABXEY, M. D., 
Professor of the Practice of 2[edicine in the TJnivenity of Virginia. 

Tbe atypical forms of typlioid fever dnriug the past few years liave received 
much attention, and donbt Las frequently been expressed wbetber atypical cases 
should be considered typhoid at all. A singularly favorable opportunity for studying 
cases of this character was furnished by an outbreak at the Universitj' of Virginia in 
the winter and spring of the present year (1893), and I propose to give a brief account 
of the outbreak in this paper. 

In order to understand the origin of these cases, it will be necessary to state 
briefly the arrangement of the lodging rooms and eating rooms at tbe institution. 

The buildings of the university used as dormitories by the students are scattered 
over a space of 10 or 12 acres, and there are four hotels, or '•'mess halls," at which 
the students get their meals. A student can select his own boarding house, so 
that each hotel has "table boarders" from all parts of the universitj* grounds. 

At the time of the outbreak — on February 17 — there were about 530 students at 
the university. Of this number, about 350 roomed in the university buildings and 
took their meals in the university hotels. 

There had been no typhoid fever at the institution for many mouths, nor were 
there any cases in the vicinity except one, of which I shall speak later. 

On the 19th of February I was consulted at my office by Mr. D. D. H., a law stu- 
dent, who complained of loss of appetite, debility, and headache. His temperature 
was between 101^ and 102°. Influenza was prevailing at the time, and I thought it 
probable that he was suffering with an attack of that disease, but a few days later 
he sent for me, and I found him with a well-marked attack of typhoid fever, which 
pursued a mild but typical course and ended in recovery. 

A few days later I saw Mr. K., an academic student, who had a severe headache, a 
temperature of 104°, aching in his limbs, and constipation. He had been sick only 
twenty-four hours. He was given salophen in six-grain doses every four hours, and 
the next day he went to his home in a neighboring city, where, as I was informed, 
he had a mild attack of typhoid fever. 

These two young men lived in different parts of the university, but took their 
meals at the same boarding house and sat at adjacent tables. 

Perhaps, before going further, I should mention that the water supply of the uni-' 
versity is perfect in all respects, and the system of sewerage is excellent. 

Just after the occurrence of the second suspicious case, I found that there was a 
negro man — a waiter — ill with typhoid fever in the basement of the hotel where 


these young men got their meals. On fnrtlier inquiry, I found he had been ill for 
about four weeks, and tliat another waiter, who lived outside of the university 
grounds, also liad the disease. I did not see either of these cases, but was infoiined 
by the physician wlio attended them that they were typical cases of typhoid, one 
being quite severe in character. 

Between this time and the 1st of April there were ten additional cases, making 
fourteen in all. and these patients lived in difterent parts of the university grounds, 
some being a (piarter of a mile apart, but all took their meals at the same hotel. 

Inunediately after tiie occnrreufe of the second rase and the discovery of the ill 
man in the basement of tiie Ixiarding hniisc, the dining room was closed and a thor- 
ough inspection of the building and premises was made by the health committee, 
consisting of three ])liysicians and two engineers. Nothing was found about the 
house to account for tlie sickness, and an examination was then made of the milk 
su])ply. It was found that a ]»art of the milk sujiply of this boar<ling house came 
from the dairy of the keeperof the house. An inspection showed that the dairy wag 
situated some dist.mce from the university :ind on the banks of a creek, into which 
one of the main university sewers ojiencd and at a point above the dairy. It was 
fuither found, by questioning the milkman, that he got water from a jioint about 20 
yards below the opening of the sewer, to wash the cows' udders before milking. 
Besides this, there liad been a case of typhoid fever on this creek a mile above tlie 
dairy during tiie previous autumn. ;ind the discharges from this patient — an ignorant 
negro — were thrown ujion the ground witliout disinfection. 

l?efore proceeding to consider the peculiar features of some of these cases, I wish 
to emphasize certain points that 1 have already mentioned: 

(1) There had been no tyjdioid fever in or around the university for several months, 
so far as I could learn, except one case in the vicinity, from which Infection was prac- 
tically impossible. 

(2) lift ween the middle of .Tanuary and the 1st of April there occurred fourteen 
cases of continued fever among persons living or employed in the university grounds. 

(3) The persons who had this continued fever had rooms in many cases widely 
separated from each other, but all took their meals at the same hotel. 

(4) The water supply of this hotel was the same as that of the other hotels and 

of the other parts of the university, and the sanitary condition of the building was 


(o) A part of the milk supply was obtained from cows whose udders had been 

washed with water contaminated by sewage and probably infected with typhoid- 
fever germs. It was in evidence also that at least live of the fourteen persons usejl 
milk at every meal. I'robably there were others who did so, but I could only get 
deiinite information as to live. 

Of the Amrteeu cases of this continued fever ten were under my professional care 
and four under the care of other physicians, though I saw one of these four cases at 
the commencement of the attack and another near convalescence; several of my 
cases were seen also l)y my colleagues, Drs. Towlesaud Barringer, of the University 
of Virginia. Of the fourteen cases one was in a child 12 years old. the daughter of 
the hotel keeper; the others were in young meu between the ages of 18 aiul 25 years. 

Of the ten cases under my immediate care there were but three that pursued any- 
thing like the typical typhoid-fever course. The first patient, Mr. D. D. H., was 
taken sick on February 17, and his evening temperature was normal for the first 
time on March 5. His temperature during tliis time ranged between 101*^ and 103°. 
The eruption in this ease was well marked. The bowels usually moved spontane- 
ously, but there was at no time any diarrhea. The only complication was an 
inability to ])ass urine, which for a week necessitated the use of the catheter. 

Mr. G. was taken sick on March 4 with nausea and Aomiting. His temperature 
ranged from lOl'^ to 105"- till March 2.5, when he had a profuse hemorrhage from the 
bowels, with extreme prostration; the hemorrhages recurred at intervals until the 
30th ; there were no more heuiorrhages after that time, but the stools were liquid, very 



oft'ensivp, and passed involuntarily. On Ainil 5 the morning temperature was 101° 
and th« evening temperature 103 , and by tlie lOtli the patient was free from fever, 
but there was still some delirium. In two or three days, however, this passed away, 
and he seemed to he progi'essing very favorably for a week, when he was suddenly 
taken with violent couvnlsious, which recurred in rapid succession till his death, 
twelve liours later. No autopsy could be obtained. 

There was but one other fairly well-marked case of typhoid fever among my ten 
cases. Mr. W. was taken sick on March 14, but I did not see him till the 19th; his 
temperature then was lOl-o"^; his pulse was rapid and his skin wet with sweat; he 
had severe headache, but there was no other disturl)!ince of any kind. His evening 
temperature did not fall to the normal for four weeks, and ranged during the attack 
between 103^ and 99"^. A peculiarity about this case was that the temperature was 
higher during the first week than ar any subsequent time. His bowels were con- 
stipated throughout and had to be moved Iiy enemata. There was no eruption in 
this case, nor was there any tympanites, and though I have jilaced it iu the list of 
well-marked cases, it was far from typical. 

The seven remaining cases presented more or less atypical features, and I shall 
consider the different symptoms in order to show their atypical course: 

(1) The onset was gradual iu six cases and sudden in one, coiumeucing in this 
latter with a cliill. 

(2) The duration was six days iu one case, eleven days in another, fifteen days in a 
third, eighteen daj's iu a fourth, and over four weeks in the remaining cases. 

(3) The temperature iu five cases was higher during the first three days than at 
any subsefiuent time ; the evening temperature on tlie day that I was called — the first 
or secondday of sickness — being 103-7, 102-8 , 102-, 101-8 , and 102-6- in the respec- 
tive cases. One of these cases lasted over four weeks. In the remaining cases the 
temperature was very variable and the attack in each lasted over four weeks. For 
example, Mr. A. C. I., a medical student, had a teihperature of 102^ on the morning 
of April 1, 103-4"" in the evening; on April 3. a. m. 100-(l-, p. m. 103*4; April 9. a. m. 
99-6°, p. m. 103-5'^; these striking variations were entirely irrespective of treatment 
and were marked throughout the whole attack: this was the only case, except the 
fatal one already mentioned, in which there was diarrhea. 

The following case i^resentssomewhat similar variations of temperature: Mr. D.P. 
was taken sick on — 


Marrh 26 
April 1-- 
April 9. .. 
April 11.. 
April 15.. 



P. M. 

100 -5 


100 -e 

108 -e 

100 2 



99 1 


99 --t 





Neither of these patients had ever had malaria in any form, nor did they live 
in malarial districts, one being from Highland County, Ya., the other from Win- 
chester, Ky. 

(4) The pulse presented no features of especial interest; it was rarely over 100, 
except in two cases — the one in which there was hemorrhage from the bowels, and 
in another, that of Mr. D. P., which ran a mild but tedious course. 

(5) The digesiive symptoms. — Tliere was loss of appetite iu all cases after the first 
week, but during the first week two of the patients complained of being very hun- 
gry. Nausea and vomiting were present for a short time in two or three of the cases, 
but these symptoms were not marked. Diarrhea occurred in only two cases — that 


of Mr. G., in which there washernorrhiiso from the howels, anrl that of Mr. A. C. I.; 
in both it was very obstinate and tr()nblc8f)ine. In all the other cases constipation 
was a niarkeil s.vnii)tom. Iliac tenderness was present in five cases, and tympanites 
in two. 

(6) The eruption was present in only two of the ten cases nnder my care. 

(7) The urinary sj'mptoms were not marked. In one case there was retention of 
urine, requiring the use of the catheter. Ehrlich's test (for diagnostic puri>ose8) 
was not employed in any of the cases, as previous experience had satisfied me that 
it was of little valnc. 

(8) Weakness, emaciation, and anemia were marked symptoms in the later stages 
of all the cases. 

I h.'ivc thought it well to ]tut the history of tliis outbreak of fever on record for 
the following reasons: 

(1) It furnished a singularly favorable opportunity for studying an unusual 
source of infection. 

(2) In an outbreak — of which the cause; could be determined with reasonable 
certainty — occurring at a time when no form of continued fever was prevailing in 
th<; community, we find a number of persons infected from the same source, some of 
wliom presented the typical features of typhoid fever, while others had a fever 
which would never have been classed with ty])hoid but for the suiroiinding circum- 

It is of course conceivable tliat tlie cases that seem to mo to be atypical typhoid 
fever were really of a ditl'ercMit ch.nacter. but in view of the facts that all origin.itcd 
from the same source and all grades of severity were observed, such a conclusion 
seems to me scarcely tenable. 


Ky KAKL VON RUCK, M. B., Aslieville, N. C, 
Medical Director Winyal Saniiariinn for Diseases of Lungs and Throat. 

It is not ray purpose to introduce this subject with a review of the opinions held 
by the profession on the value of rest as a therapeutic agent in general, nor even to 
cite nuiny of the contributions of recent years as to its utility in pulmonary tuber- 
culosis; and I am induced to bring it to your attention only because of a manifest 
tendency to overestimate its value and to recommend it as a general means for a 

In a recent paper by Dr. Mays, of Philadelphia, read before the American Clima- 
tological Association, May 25, 1893, this tendency is particularly manifest, and in it 
the author compares the condition of the phthisical patient to nutritive bankruptcy, 
due to excessive exjtenditure induced by wasting disease, and on that account ho 
advocates rest in bed for prolonged periods as a means for limiting excessive expendi- 
ture and for storing up new capital, implying that if the nutrition of the patient bo 
thus restored the disease would then be cured. 

Regrettable as it is, this simple formula does not act so specifically as we might 
wish it to do, and while I insist upon rest under "certain complications, in the course 
of phthisis, as highly essential, I can see in it only an aid toward complying with 
indications which may or may not be present in a given case. I therefore object to 
the recommendation of rest just because a patient is a consumptive, and proceed to 
consider more particularly its indications and limitations as I have found them in 
the course of my experience with many hundreds of phthisical patients. 

I presume that we are all agreed that rest in bed for jirolonged periods is not con- 
ducive to the best nutrition of the healthy organism; if ^\e resort to it ueverthe- 



less, we find our subjects soou to lose iu appetite, tliey take and assimilate less food, 
their muscles become soft and diminish in size, and after a time aniBmia and loss of 
flesh and strength are apt to result. If we attempt to counteract these effects by 
forced feeding, we find that larger quantities of solid food than the patient's appe- 
tite demands, soon lead to gastrointestinal complications and to loathing of the 
food offered, and that in most cases it is not appropriated even if we can induct, the 
subject to take it. Thus we soon become restricted to a more or less liquid diet, 
and considerable quantities, even of it, are apt to cause derangements of the digest- 
ive organs. 

To keep such a healthy subject in good condition under prolonged rest in bed we 
find it necessary to substitute massage or electricity, or both. Such a subject may 
then store up fat, which is, however, not always synonymous with improved nutri- 

All this is equally true iu chronic pulmonary tuberculosis, as long as no complica- 
tions have occurred by which the tubercular deposit is caused to break down and to 
suppurate; in other words, as long as the patient is in the so-called early stage. 

Such patient has either acquired or inherited conditions which temporarily or 
permanently left their stamp upon his constitution and resisting power, and which 
under the existing mode of life of the individual frequently induce defective nutri- 
tion, which makes the tubercular infection possible, or causes it to extend, and these 
same conditions, as well as the tubercular involvement of the lung, limit the amount 
of physical and mental labor that can be taken with advantage, but absolute rest 
for prolonged jieriods is not only not indicated; on the contrary, at this stage of the 
disease, an out-of-door life with proper exercise, limited for the individual to fall 
short of the production of sensible fatigue, is highly essential for the improvement 
of nutrition, and as an aid to an ultimate cure. 

I would therefore be understood that in my experience the chronic "purely tuber- 
cular" affection of the lung is not responsible for the nutritive deficiency, but that 
the latter precedes the manifestation of the tubercular disease and that the sul)se- 
quent wasting and fever are not caused by the tuberculosis directly, but are compli- 
cations which may or may not arise in its course. 

In some of the complications which occur in the course of the disease, rest in bed 
is essential until their removal is accomplished, and among these I may particularly 
mention pleurisy, hemorrhage, and septic fever. With an acute pleurisy or a pul- 
monary hemorrhage the patient seeks his bed voluntarily; not so with the se^jtic 
fever, especially when it is mild or intermittent. Indeed, many practitioners allow 
their patients to be about and advise exercise, regardless of its presence. 

The absorption into the circulation of noxious products which induce the septic 
fever can only occur when certain other pathogenic germs have gained entrance to 
the tubercular deposit, causing its softening and breaking down, and without such 
additional infection tubercular deposits do not undergo suppurative and destructive 
changes; on the contrary, they remain quiescent for indefinite periods and tend to 
the development of connective tissue proliferation and fibrosis, which lead to encap- 
suling and atrophy of the tubercular tissue and thus to a relative cure of the dis- 

If now prolonged rest in bed could prevent the additional infection spoken of, or 
if it could hasten or favor the connective tissue changes and encapsuliug of the 
tubercular deposit before septic infection has occurred, then the treatment could be 
recommended in the early uncomplicated stages of the disease also; that is to say, 
for the tubercular disease itself. That it can not do the former I need only mention, 
and since we can only with difficulty keep such a patient at his present nutrition 
under absolute rest, it remains only to inquire how and to what degree it may be 
useful to aid the patient in overcoming septic complications which, when once estab- 
lished, control the entire situation. 

In the presence of sepsis, no direct treatment for the tubercular disease can be of 
avail, and to give such a patient tubercubn, creosote or other supposed specific rem- 


edies against tuberculosis, I consider not only useless but as injurious, and as divert- 
ing our efforts from the real issue. 

Rest in bed ))ccoines now imperative, not because of the tuberculosis, but because 
of the com]»licMting septic fever, which damages the heart, induces degenerative 
pro'cesses in its inuscnilar fibers, and causes otlier deleterious effects upon the organ- 
ism, all tending to wasting and exhaustion of the organism. 

Even before the scjitic fever occurs, tbc hiart of tlie ]tatient is called upon for ex- 
tra lalior on account of mechanical obstruction in the lung to the free How of blood 
from the right to the left ventricle, and on that account the amount of physical and 
mental labor needs always to be regulated and often materially restricted from the 
very lieginning of the disease. I have heretf>fore called attention to this subject in 
a paxjer presented to the American Cliniatological Association, entitled "The Detri- 
mental Effects of Over-Exert ion in I'Mlnionary Tuberculosis," and published in the 
transactions of the association for 1(S!U). 

In the presence! of such comi)licatiug fever, the liciirt is called ni)on for additional 
labor still, and if its contractile power is steadily diminished by the fever, it is not 
difficult to see that the conditions for passive congestion, hemorrhage, and defec- 
tive nutrition of the involved lung tissue and the progressive breaking down of the 
tubercular deposits are highly favored. 

The indication under such circumstances is to secure a good heart action and to 
preserve it by lightening the heart's labor. For the former purpose we lujurish our 
patient as well as ]»ossible, and use Btimnlants whenever they appear necessary. 
For the latter, rest in the recumbeut position is one of our most important means, 
and it thus becomes an indirect aid to nutrition, not only in septic fever engrafted 
upon tulierculosis, but in all jtrolongf'd febrile states. 

1 lind from a large i)ractical expeiieuce that the more severe septic or so-called 
hectic fevers of pulmonary tuberculosis can not be successfully nninaged without rest 
in the recumbent position, and that oven slighter degrees are more quickly con- 
trolled by such rest; yet in severer cases we can not depend ui>on rest alone, although 
without any other aid we note its favorable intluence upon the ])ulse as well as ujion 
the local processes, and observe the cough and expectoration to diminish nnil the 
fever to become less intense: nevertheless it is not often entirely controlled, and the 
patient continues to go down only at a slower pace. 

Fortunately wo can under such a contingency bring to our aid other very useful 
remedies, of which deserve jiarticular mention hydro])athic ai)plications and the 
subcutaneous use of nitrate of strychnine; and there are few severe cases of septic 
fever in connection with tuberculosis in which we are not obliged to resort to one or 
both to help us through the critical i)eriot1. 

Even so simple an ai>plieation as an ice-bag over the region of the heart may turn 
the scale in the right direction^ aiul with the combined therapeutic resources at our 
conuuand, when wisely chosen and applied, we may bring a severe septic process to 
an arrestment. 

During this enforced rest the a])plicatiou of massage and the exposure of the 
liatieut to pure air and sunlight must be <arefully attended to; when improvement 
is well under way and the temperature remains noruuil, or nearly so, the patient 
may be jtermitted to sit uj) and walk out of doors, beginning with a (|uarter of an 
hour, and increasing the time slowly as the general condition and strength will 

These liberties must be controlled by their effect iipon the circulation, and when 
unfavorable must be abandoned, to be resumed .at a later date. Only when the 
pulse remains good and is not materially increased in frequency beyond the degree 
observed in comparative health, and after the temperature has for several weeks 
remained at or near the normal, can we think of allowing light exercise, and then 
its emidoymeut within the limits of fatigue will be found to aid still more rapid 
general improvement in the advanced, the same as in the early stage cases. 



By D. D. STEWART, M. D., 
Lecturer on Clinical Medicine in the Jefferson Medical College. 

Since Bright lirst directed attention to the relationship existing between albumi- 
nuria and diseases of the kidney, the presence in the urine of serum-albumin in 
cxuautity detectable by time-honored tests has properly been accepted to indicate 
renal derangement. So necessary is this association generally regarded that many 
otherwise acute clinicians, in pinning faith to the presence of albumin as an infalli- 
ble guide to the recognition of nephritis, are not infreciuently led into the error of 
interpreting this fact into the necessity of excluding kidney disease with the 
absence of albumin ; for not infrequently do we encounter in published reports of 
cases, otherwise admirably presented, in which a diagnosis may hinge upon the 
renal condition, the conclusion stated as if none other were possible, that the kid- 
neys are sound, the uriue being free from albumin. Search may also have been 
made for casts, which, unencountered, naturally strengthens the opinion previously 
reached. * In such cases no cognizance is taken of often a more important exami- 
nation, the determination of the nitrogenous output ; or of the highly momentous 
fact, apparently little known, that albumin may be totally absent from the urine 
throughout the course of chronic Bright's disease, and casts may be only detectable 
after much search, yet the case progresses steadily to a fatal termiuatiou, the 
remote ailment perhaps never being suspected, either ante or post mortem; the 
determining cause of death, a pneumonia or an inflammation of a serous membrane, 
alone being recoguized. It is, indeed, not improbable that chronic nephritis with- 
out associated albuminuria is of no uncommon occurrence. That it exists unde- 
tected and untreated there is no doubt. It thus must increase to some degree the 
mortality record of other ailments; death, in these cases, often ensuing less from 
total renal failure than liom visceral or serous complications induced by long- 
continued partial renal inadequacy. 

My attention was first directed especially to this subject by encountering the first 
two of the cases herein recorded. One of these, with certain symptoms suggestive 
of decided renal inadequacy, but withont those that are usually regarded as typical 
of chronic Bright's disease, had consulted several clinicians of note in this city, and 
Charcot in Paris, as to his ailment, which he suspected to be renal because of the 
small amount of urinary solids habitually excreted; but, because of nondetection of 
albumin and casts, the case had been dismissed by these as one of hypochondriasis 
or of neiTrasthenia. As laboratory work brought me not infrequently into coutact 
with this case, several cursory surveys of the symptoms, subjective and objective, 
caused me to suspect a latent kidney ailment, despite the negative opinions previ- 
ously given. I then instituted a careful examination of the urine for sometime. A 
brother of this patient, with somewhat similar symptoms, who also came under ob- 
servation, was believed on examination to be atiected similarly. Encountering these 
cases suggested a search for others. A number of these were so soon collected as to 
indicate that the combinatiou of chronic Bright's disease without albuminuria was 
of no unusual occurrence, and that I had iirobably overlooked many instances in 
the past. It likewise clearly showed that similar cases were undoubtedly commonly 

* In instances such as this it is not improbable that a microscopic examination is often not thor 
oiigh, the absence of albumin prejudging the observer against more than a perfunctory search ; for in 
any condition witli nonalbuminous urine, or urine containing but minute traces of alliumin, detecta- 
ble only by most delicate tests, renal epithelia or casts can not be numerous. Their discovery often, 
then, necessitates painstalsing search, even under such favorable conditions as tlie use of the cen- 
trifugal machine, to obtain concentration of sediment and intelligent employment of a low-power 
lens as a searcher. 


Not that the occurrence of tliis supposed uuusual condition is absolutely unknown, 
or, in connection with symptoms of typical granular or cirrhotic kidney, has passed 
altogether undetected; for more than four decades ago Wilks, * of Guy's Hospital, 
the liirtli place of our knowledge of albuminuria and of Bright's disease, in lirst 
describing tbe two i)rincipal Ibrnis of (hrouic nephritis, t to Avhich description all 
later English wi iters have more or less adhered, also pointed out that the granular 
kidney t could occur and run its course quite syiuptomlcss, albuminuria sometimes 
being absent. Since that time, however, though the occasional occurrence of typi- 
cal hbroid kidney without albuuiiuuria has not been forgotten, the likelihood of 
its existence has only been recognized by a few. No text-books on general medi- 
cine es])ecially notice the occurrence, and few special treatises on renal disease 
more tluin l)arcly meutiou what Wilks observed. Some of our leading authorities 
fail even to lay stress upon the occasional absence of albumin in tyi)ical granular 
kidney. These not only overlook the class of cases I now report, but neglect to 
note that, even Avith classical symptoms of iibroid kidney, such as pale, plentiful 
urine, Iibroid vessels, and liypertrophicd heart, occurring at middle life or in the 
aged, chronic Bright's disease may occur and run its course without albuminuria. 

Bartels.^S it is true, cites a case carefully studied in the five weeks preceding death, 
in which albumin was totally absent from the urine except during a few days iu 
which liigh fever occurred, duo to vaccination. Though with symi)t(mis suggestive 
of renal tibrosis, because of the absence of albumin, an antemortem diagnosis was 
not made. In narrating tliis case Bartols iudicates his idea of the infre([ucncy with 
which similar cases occur, tliough he states that he has reiJeatedly witnessed the 
temporary absence of albumin in chronic Bright's disease. 

Jaksch, whose work on lalxuatory and clinical medical diagnosis is our accepted 
authority, totally fails to recognize these cases. He speaks of periods of temporary 
absence of albumiu in granular kidney, but states that an examination of the total 
twenty-four hours' urine w^ill nearly always reveal its presence, which has not been 
discovered iu a singU> specimen ])assed ]ierha])s in the forenoon. Even the late Fagge, 
under whose eye in Guy's Hospital cases of typical arterio-capillary Iibroid kidney, 
reported by Mahomed, were studied, in which albuminuria was absent or was but 
an inconspicuous feature, lays little emphasis upon such a combination in his splendid 
classic on medicine. Our own writers on general medicine remark still less the oc- 
casional absence of albuuiin in these cases. The most recent and most widely read 
text-book is that of Osier, a name occupying a preeminent position in medical sci- 
ence. Tliis work, because of its inlierent worth, emljodyiug the results of years of 
faithful observation and patient research, and because of the deserved wide fame of 
the author, is easily first of its kiud. Yet Osier, too, here fails to assist in the recog- 
nition of the class of cases in question. Ho sjjeaks only in this relation of that 
variety of granular kidney, such as was described by Wilks, in which jiolyuria is 
common. In this he merely states tiiat traces of albumiu are found, but may be 
absent at times, particularly in the early morning urine. 

But two writers on diseases of the kidney, and these Americans — Millard and 

*See Guy's Hospital Reports, Vol. vir, secoud series. 

f'i'ho toriu iiopbritis is not used liere in a strict patliological sense, but refers equally to true 
iuflaiuniatiou of tlio rcual structure as to a condition which is actually noninjianDiiatori/, hut of the 
nature of a degeneration. 8ir William Gull pointed out, in describing the arteiio-capillary Iibroid 
kidney (American Journal Aledical Sciences, 1886, Vol. xci, p. 4U7) what previously, I believe, had 
been recognized by others, that the renal changes are not really of an inflammatory nature, so that 
the term nephritis is strictly not justified here. There is no acute stage; no acute' hyperamia; no 
diapedesis of leucocytes and blood cells, characteristic of ordinary inllunuuatiiui ; and no locator 
general symptoms indicating nephritis. 

:; Looked upon Wilks as an iudicaiion of senility, with its associated tortuous thickened radials, 
characteristic pale abundant urine, and tendency toward ura.'mia or apoplexy. 

^ V. Zicmssen's Cyclopa;dia, Vol. xv, p. 4i0. 


Purdy* — have especially directed atteutiou to the occurrence of chronic nephritis 
without albuminuria, referring, however, only to the usually described variety of 
u-rauular kidney with typical symptoms. Millard relates two cases in which albu- 
min, though frequently examined for, was at no time found. One of these was 
shovfn post-mortem to be interstitial nephritis, with a limited glomerulo-uephritis. 
The second was a probable case of renal hbrosis. Death did not occur while this 
case was under observation. The general health was good. Casts were repeatedly 
found in the urine, though albumin remained absent. 

Both Millard and Purdy refer to the important papers by Maliomedt, in which 
are analyzed a number of cases of granular kidney, under observation in Guy's 
Hospital during 1879 and 1880, in which albumin was more or less constantly absent 
from the urine in the period iu which observations were made. Most of these cases 
were in the degenerate period of life, with fibroid arteries and hypertrophied heart, 
but were without special symptoms referable to the kidney. 

Though a strikingly interesting series of cases, and ably reported by Mahomed, 
his description of at least a minority of them t does not make it clear that renal dis- 
ease was a certain accompaniment of the symptoms described — referable in the main 
to other organs. In this minority, no account of microscopic examination of iirine 
is fiven and in a number of cases the iirine is described as normal. Estimations 
of nitrogenous excretion iu any save a few, and in these to but an imperfect extent, 
were also not attempted. In a few of those in which death occurred while under 
observation and a necropsy was obtained, the kidneys were also stated to be healthy, 
though the cases were regarded by Dr. Mahomed as those of chronic liright's dis- 
ease, as he understood the term.§ 

* The former iu his work on Bright's disease; the latter in a special paper, "The pre-albuminuric 
stao'e of chronic Bright's disease," Chicago Medical Journal and Examiner, May, 1885. Purdy refers 
onlv to the typical arteriocapillary fibroid kidney of Sir "William Gull. Curiously, in his work on 
Bri"-ht's disease, published a year subsequent to the appearance of this paper, Purdy barely states, 
in discussing cirrhosis of the kidney, that " albiimin may be temporarily absent in the early stage, 
but as a rule it will be found, if it is sought for over a sufficient length of time." 

1 " The clinicalaspect of chronic Bright's disease," Guy's Ho-spital Ueports, 1879, Vol. xxiv. "Chronic 
Bright's disease without albuminuria," Guy's Hospital Reports, 1880-81, Vol. XXV. 

It is necessary here to state that in reviewing Mahomed's statistics. Dr. Purdy places the figure of 
nonalbuminuric cases among these as too high. He also assembles with these, I think improperly, 
76 cases out of a total of 98 in which a diagnosis of Bright's disease was not made, observed at the 
Birmino'liam General Hospital, reported from post-mortem records by Dr. Saundby, in a paper " On the 
occurrence of dropsy in granular kidney." Though it is not stated by Sauudby that albumin was 
searched for in tiio urine of the 70, Dr. Purdy thinks that it may be fairly assumed that such exam- 
inations were made, since the cases wrre under observations in hospital, and perhaps subjest to the 
usual rule for daily examination of urine. But as many of these were cases of hernia, bronchitis, frac- 
tures, amputations, burns, ulcers, skin diseases, and the like, in which a urine examination could not 
have seemed especially indicated, and as no account of such examination appears in Sauudby's report 
it is unfair to assume that albumin was habitually or even occasionally absent. [Since writing the 
above note, Dr. Saundby has kindly informed me by letter that Dr. Purdy is wrong in his assump- 
tion; that so far as he (Dr. S.) knows, no examinations for albumin were made; the cases came from 
anybody, and that he knew uothing of their clinical history. Dr. Saundby also tells me that he does 
not think albuminuria often absent in Bright's disease.] In the first report of Mahomed's, on 100 
cases of granular kidney observed in Guy's Hospital, in which death occurred in 26 directly from 
kidney disease, it is stated by Mahomed that albumin was absent from the urine, not in all, but iu 
a large proportion (exact number not stated), so that Dr. Purdy's figure of 74 per cent ol nonalbu- 
minous urine in 259 cases of granular kidney (Mahomed's ami Sauudby's) is not a little excessive. 
Apart from this, as I have elsewhere stated in this paper, it is not certain tliat a number of Mahomed's 
cases, though perhaps rightly styled by him cases of chronic Bright s disease, as he understood this 
term, were in reality suffering from actual renal disease. 

} Such as cases 16, 17, 18, 19, 22, 23, 24, 2."), 27, 30, 37, 42, , 43, 47, 48, 52, 53, and 56. 

§. As a result of certain considerations, which Dr. Mahomed thought supported his view, he recog- 
nized three stages of chronic Briglifs disease. Of these the first, a functional stage, he regarded as 
limited to a condition of simple persistently high arterial tension, without organic changes in the 
vascular system or in the kidneys. Tliis stage, he believed, might precede for years the onset of de- 
generation in the kidney. The second stage, he termed chronic Bright's disease without nephritis — 
using the term nephritis in the strict pathological seuso of a true inflammatory condition o f the kid- 

y. Ex. 3G 13 


Mahoinod adopted the teriii clnoiiif Bri^'lit's disease as a couvenicnt generic name 
for a condition wliicli Gull and Sutton had i)reviously described of generalized arte- 
rio-capillary fibroid change. Contrary to the view of Johnson, an extension of that 
of Bright, and following in thelcadof the above-mentioned investigators, Mahomed 
viewed the condition underlying the various stages of granular or fibroid kidney as 
a systematic disorder in which the cardio-vascular alterations were not dependent 
upon, but either antedated the development of the kidney fibrosis, or, more rarely, 
existed without renal change.* It was not necessary for him that the kidney 
should actually be the seat of degeneration to constitute Bright's disease. Fibroid 
kidney was but an unnecessary, if more or less to be expected, incident in the general 
morbid state. Renal fibrosis did not always appear, though general arterial change 
occurred. Yet MahonuMl thought kidney alterations present in most of the cases ho 
rejiorted at this time, although in a number of them, as has Ijeeu stated, there seemed 
no positive evidence of this, and in two it is recorded that a necropsy showed 
ht^altby liidneys. 

Malu)med's views were extreme in that he regarded a thickened vessel as a certain 
forerunniir of fibroid kidney, if the latter were not already existent. ^Vithout desir- 
ing to discuss here the still unsettled question as to the seciuence of events in chronic 
Bright's disease, whether cardio-vascular alteration precedes or accompanies the 
renal, ehiimiug a common origin, or i'olhtws the latter, dependent upon kidneys 
already inadcijuato through disease, I may say that I am by no means prepared to 
admit that a diseased kidney is the sole cause of increased vascular tension and sub- 
scijuent arterial degeneration; nor can I accept Mahomiid's teaching that persistent 
high arterial tension or a thickened vessel is a certain indication of present or 
expected kidney change. t 

Apart, however, from tlie doubtful cases of renal disease among thosc^ reported by 
Mahomed in which alljuminuria was absent, there remaiu a good number in which, 
with the urine free from albumin, undoubted granular kidney existed. Be that as 
it may, Maliomed's cases were all in middle or advanced life. Tliere were present 
decided cartlio-vascular changes, such as hypertrophied heart and thickened vessels. 
These cases were reported especially to show that in the stage of Bright's disease in 
which epithelial alterations in the tubules were absent — or, if occurring, were but 
transitory in character — albuminuria was al)sent, the urine remaining practically 
normal, and symptoms referable to the kidney, i. e., those of renal inade(|uacy, were 
uncommon. Death in these cases, as Mahomed remarks, is usual in granular kidney, 
resulted from failure of other organs, notably the heart. 

The few cases I here report, in wliich the character of symi)toms, together with 
result of frequent urine examinations, leave no doubt as to the existing diseased 
kidneys, although albumin is absent from the nriui', are of a class distinct from the 
cases hitherto described in which a diagnosis of fibroid kidney could be made frtim 
the association of age with cardio- arterial disease and with such a common symptom 
as abundant, low-gravity urine. In the latter, apart from general fibroid changes. 

uey. In this stage tho organic changes are apimront in the v.ascular system and in the kidney (an- 
terio-cai>illary fibro.sis— red granular kidney). The kidney, post-mortem, is found to be the scat of 
interstitial change, without e|iitholial alteration. In tho third stage, which Mahomed classed as 
c-liroiiic Bright's disease with n(!|(hrilis (tho mixed or mottled granular kidQcy). he regarded as the 
natural t)ul by no iiicaus invariable teniiiiiation of tho ailment. In this stage, epithelial changes 
have occurred in tho kiduey, tho cirrhotic alterations are marked, and the symptoms of renal disease 
])roniiuent. This, he stated, is the stage in which the disease is usually diagnosticated. The 61 
cases which he reported characterized by the absence of albumin from the urine, he considered as 
belonging to the second of these stages. 

*See preceding foot-note. 

t Mahomed styled a high-tension radial a renal pulse. He suggested that visible and tortnons tem- 
porals were an indication of renal disease, and regarded this as a point to aid in the separation of a 
mitral insudiciency, the result of a previous rheu. untie eailocarditis, from that arising from over- 
stretching of the left ventriclo as a result of resistance a /route iu the axteriaJ, sclerosis of Hbroid 


tlie kidney was in most c;»ses fairly liealthy and functionated accordingly. In my 
cases, without eardio-vascular symptoms other than increased tension, there are 
present those referable to the kiduey, witli, in several, marked renal iuadeiiuacy, 
both as regards excretion of wat(!r and of solids. 

In the nriuo examiuations of all the cases here recorded, the following methods 
were employed: Albumin was in every case examined for in mixed specimens of the 
twenty-four hours' urine, as well as in siugle specimens voided at varying times in 
the day. The tests used were a satiirated solution of plain picric acid — this was in 
every instance the test tirst a])plied to each specimen of urine examined; * Milhird's 
phenicacetic acid solution! — this was used when no response occurred to picric acid, 
aud on other occasions to coutinn results obtained by picric acid; metaphosi)horic 
acid was also often employed, not alone, but in addition to the other tests. Indi- 
cations of even a slight contact ring occurring to picric acid or Millard's solution, 
either immediately or after standing for some time, a second specimen of urine was 
treated with glacial acetic acid. If the urine was concentrated — rich in salts — an 
excess of acid was added to insure complete precipitation of any mucin present, t This, 
after agitation, was subsequently hltered and the filtrate exactly neutralized with 
strong (2.5 per cent) NaHO solution. § The filtrate was then slightly acidulated 
with acetic acid aud the various tests above mentioned once more applied. Any 
indications of response uow occurring, separate portions of the urine were further 
carefully tested with heat, with HNOj, aud often also with acetic acid aud potassium 

lu all the microscopic examinations the centrifugal machine was employed to ob- 

* Recent oxperiiuents in tlieso anil ia other cases have convinced mo that even plain (uiiacifliilated) 
inciic acid solution icill precipitate mucin. This I had before doubted, on the authority of Johnson, 
aud was inclined to accept as an indication of serum-albumin any sliglit though sharply-detiued rino' 
obtained by the contact method with cold jjicric acid solution aud clear urine, not subsequently dissi- 
pated by heat. Eecent experiments have shown me that mucin is occasionally present in non-(serum) 
albuminous urines in amount sufficient to respond to the picric acid test even so applied, and also to 
Millard's test, and to uietaphosphoric acid. This is not, however, usual, as I have repeatedly failed 
to obtain any response to clear uriuo by the overlying miithod with plain or citrated picric acid, exam- 
ining: the tube even after several hours' contact. It is usual to obtain a mucin reaction to the boiliu" 
test with acetic and picric acid, which is improperly sometimes employed as a delicate test for serum- 
albumin. The slight cloud obtained with acetic acid and boiling, in urines not rich in salts, is 
undoubtedly often duo to muciu, as can readily be proved. Fortunately little harm cau usually result, 
in cases of suspected kidney disease, from the error of mistaking muein for serum-albumin, since the 
presence in the urine of the former, with evidences of renal derangement, is often only the precursor 

of the latter, and probably arises from faulty metamorphosis of the cells of the renal tubules of 

course, excluding vesical, urethral, and vaginal catarrh as a factor in its i)roduction. 

With several years' steady use of the picric acid test, I still regard it as the most delicate reagent 
for the detection of traces of albumin, and, intelligi^utly used, as the best of the many tests in use. 
Millard's phenicacetic acid test I rank second, aud frequently It must be recalled that this 
also, like picric acid, will respond to so-called peptones, to mucin, and to urates, llesponse, therefore 
occurring with these, unless very decided and leaving no doubt as to its nature, requires conflrniation 
by the method above suggested. Tanret's solution, and other tests with mercuric chloride aud those 
with tannin, such as Sebelein's reagent, are uurelialile for the detection of albuniiu because of other 
sources of error even than those just mentioned. The same may be said of the tricldomcetic acid tost. 

t Glacial carbolic acid (C. P.) 95 per cent, 3u ; glacial acetic acid (C. P.) 3vij ; mix and add solution 
of potash, lij, 3vj. Filter. The specific gravity of this solution is 1027. 

J Concentrated urines, rich in salts, will not yield mucin, if present, to a small amount of acetic 
acid. An excess of that necessary to form acetates witli tlio salts present must be added before pre- 
cipitation can occur. This is a practical point of great importance little attended to. 

§ NaHO was used in preference to KHO, as an excess of the potash salt present in the urine would, 
in subsequently testing with picric acid, form a precipitate of potassium picrate, thus interfering 
•with the reaction for albumin. A strong solution of alkali was used, so that if but traces of albumin 
"were present tlie latter be iiot so diluted by addition of these reagents as to cease to respond to tests 
used for its reco;;nition. 


lain a sediment, aud usually from the precipitate takou from tlio uriue which had 
been staudiug for some hours.* 

Urea was estimated by the h.\i)obromite process (bromine itself always being em- 
ployed), with a modification of the liusscll and West ap])aratiis. which, as compari- 
son witli a tried and more complicated api)aratus had shown, was very accurate 

ITric acid was estimated by the mctliod of Haycraft. Acidity, when taken, was 
estimated by titration with ^KHO or NallO. The chlorides were estimated as total 
chlorine by Voihard's method.! The ligures indicating total urinary solids { in the 
tables are simply calculated in grains by mnltii)lying the last two ligures of the 
specific gravity by the number of ounces of urine passed in the twenty-four hours.^ 
This mctliod, of course, furnished only a very rougli approximation, but used with 
coincident urea, or ureji and chlorine estimations, it is all that is necessary. It 
alone may be made to furnish results of some clinical accuracy, provided the amoun t 
of NaCl excreted is also ascertained. || It is, of course, most essential that an accu- 
rate urinometer be employed and corrections for temperature made. 

Case I. — W. B., analytical chemist; aged 29years; unmarried; weight, 147ponnd8- 
No history of lead, syphilis, or alcohol. Habits studions and temperate. No dis" 
eases of childhood. As a boy, robust, laniily history as to renal or cardiac disease 
negative. His father has been a generous liver, and has had several attacks of typi- 
cal gout. For the past three years W. ii. has sutlen'd from severe hea<lache8 and in- 
capacity for exertion, worse in the latter half of this period. Constant headaches 
and muscular weakness have been ])resent, increased by slight physical exercise or 
mental strain. Two years ago, during a ])eriod in which he was feeling particularly 
bad, his urine, examined by himself with nitric acid, showed the j»resence of albu- 
min. This was discovered in a single unmixed specimen of the morning urine, and 
once only, though often afterward frei|uently examined for. An estimation then of 
the total urinary !)itrogen excreted showed a considerable diminution from the 
normal. Fancying himself the suliject of kiduey disease, he shortly after this con- 
sulted at odd times several practitioners in this city, and in the sninmerof 1892 
Charcot, in Paris. These were unable to tind either albumin or casts in the urine, 
and gave on this account a negative oi)inion as to renal disturbance, though the 
symptoms ceitainly were suggestive of grave inade(|uacy. There was no im- 
provement on the lines of treatment suggested, but rather an aggravation of symp- 
toms. Alter a course of spinal and loin douching under Charcot, loin pain devel- 
oped, which is now present, with headache, vertigo, and general malaise on any extra 
exertion or when a nonniirogeuous dietary is departed from. There is but little 

* Botli tlie two-bottle milktestiujr maclilne made by Mr. J. E. Lonergan & Co., of tliis city, and tho 
equally ellicient, and, for clinical work more practicable, araaller apparatus of Measrs. Queen &. Co. 
■were used. The utility of the centrifugal m icliiue as an aid in the production of urinary sediment 
for microscopic work is great indeed. In my experience the deposit resulting is both richer in quality 
and quantity than that obtained by gravity. Clear urines showing little or no sediment after some 
hours' standing can be readily m.ide to yield a precipitate by its use. and ca«ts but scantily present in 
the sediment resulting from standing without its employment, which might not be four.d, can often 
readily be secured by the aid of this adjuvant to the production and concentration of a precipitate'. 

i Estimations of chlorides were made as jjrobably the most important mineral constituent of the 
urine, and that which has been found diminished in cases of chronic nephritis. 

♦Normallj-, the total urinary solids excreted average about 65 grams, or 1,0'JO grains. The daily 
amount of urine averaging 1,500 <;ubic centimeters (50 fluid ounces), and the specific gravity = I, OJO, then 
50x20 =1,000 grains, or 60 grams. The average daily output of urea is between 30 and 40 grama 
(450 to 600 grains), or about one-half the total solids, the amount varying considerably with sex. body 
weight (about 1 gram should be excreted for each 5 pounds of body weight), and amount and char- 
acter of fo,)d eaten. 

Daily excretion of chlorides, calcnlated as NaCl, equals 10 to 15 grams (154 to 216 grains), or 
somewhat less than one-half the urea. Calculated .as chlorine, ch'orides equal 6 to OJ grams. The 
daily amount of uric acid excreted is varyiugly placed, the average probably being 0.5 grams (7 to 10 

§ This method is much more convenient, and gives approximate results of greater accuracy, than 
those obtaimnl by tho use of Christoson's (Haesen's* or Trapp's formula. It furnishes a figure mid- 
way between that of the two. By the former the last two figures of the specific gravity are multi- 
plied by 2-C3; the resnltaht is multiplied by the number of cubic centimeters of urine passed. 
This product divided by 1000 r= tho total amount of solids in grains. Trapp's factor is 2. 

II As my friend Dr. Letl'niann suggests to me. 


ansemia. Digestion is fairly good. No imlications of external crdema have ever been 
noticed. There are no eye changes. I have had the case under oliservation abont a 
year and a half. ^\ lien tirst exaniinedphjsically shortly before this, persistent high 
arterial tension was noted, ^^•ith accentuation of the aortic second sound at the apex. 
The area of cardiac dullness was not increased, nor has it since become so. The 
apex beat is still in the normal situation, about two inches below and a half- inch 
within the nipple. Persistent high tension, without as yet signs of notable thicken- 
ing of the arterial coats, has always existed since, except in the past three months, 
during which he has been on a strictly vegetable diet, eating no meat, meat soups, 
eggs, or tish. The inliuence of this diet upon symptoms and pulse tension is quite 
remarkable. Under it. if no extra physical or mental exertion is undertaken, very 
little headache, vertigo, or loin pain is ielt. 

The accompanying sphygmogram isone of several, all practically similar, taken at 
various times alter having been Ijetween two and three months on a uonnitrogenous 
diet. It is piactically a normal tracing, showing a moderate degree of tension. 

Fig. 1. 

W. B., Juae 10, 1893. Pj-essure, 1.^ Kiinces; sitting. 

Since the single occasion on which he detected albumin in his urine by nitric 
acid, two and a half years ago, very frequent observations, in both mixed twenty- 
four hours' specimens, and that passed at various times in the day, have never re- 
sulted in showing the slightest trace to heat or to nitric acid. For a long time met- 
aphosphoric acid was used in addition to heat and nitric acid, as a more delicate 
test for the recognition of small amounts. Though the tests with the last named 
were always resnltless, a slight response was often obtained with meta])hosphoric 
acid ; but as mucin, also precipitated by this acid, was not eliminated as a source of 
error, minute traces of albumin may or may m)t then have been present, as they are 
occasionally now. 

When urine is ordinarily pronounced albumin free, it is meant, almost without 
exception, absent to tests commonly employed, such as heat and nitric acid, which, 
applied with care, detect albumin in small amount, but not in minute traces (less 
than 1 to 100,000)." In the cases of granular kidney before referred to, such as those 
of Wilks and of Mahomed, in which no albumin was found in the urine, heat and 
nitric acid were the tests probably employed for its detection.! In ray cases the 
absolute absence of albumin was most usual, for during the period in which exami- 
nations were made, as a rule, reactions did not occur to tests (picric acid, the pheno- 
acetic acid solution) showing traces as minute as 1 to 200,000 to 300,000. 

In the past year, besides examinations by the patient and by myself, with picric 
acid as the reagent, of a number of unmixed specimens at short and more lengthy 
intervals — specimens passed at various times in the day. as regards food and exercise — 
I made careful daily tests of mixed twenty-four hours' samples in the period 
named in the accompanying table, except when piperazin was taken. As a rule, not 
a trace of a response could be obtained with the untreated, clear urine overlaid with 
picric acid ; occasionally a mucin response occurred, and, rarely, a ring which further 
treatment showed to be .serum albumin. No marked response was ever thus obtained 
to the picric acid or Millard s solution, and the results were always negative with 
heat and with nitric acid. In microscopic examinations, at various times, of speci- 
mens of the mixed urine typical granular and hyaline casts, broad and narrow^, were 
found on several occasions, but never in any amount, and only after some search. 
Cyliudroids were also present. Besides a variety of epithelium from the bladder 
and its accessories and cells of undetermined origin, occasionally those typical of the 

*I accept this limit of reaction, more extreme than is nsnally given, on the authority of Millard 
(Bright's Disease, third edition, p. 85), 

tin a very conxteous letter recently received from Dr. P. H. Pye-Smith, senior phy.sician to Guy's 
Ho.*pital, he informs me the tests employed by Dr. Mahomed were: (1) Heat, with the addition of acetic 
acid, to neutralize alkalinity, if pre.sent, and to neutralize any calcic phosphate precipitated by heat; 
(2) cold nitric acid, carefnllV overlaid by the urine. Dr. Pye-Smith also says that, though other tests, 
such as ferrocvanide of potassium and acetic acid, acidulated brine, and picric acid were employed 
from time to time in the hospital in 1879 to 1881. the date of Mahomed's observations referred to. the 
tests by heat and bv niiric acid onlv were those in constant use in the wards. Had other than these 
two been used by Dr. Mahomed in his observations. Dr. Pye-Smith remarks, Mahomed would have 
mentioned the fact in the Guy's Report*. 



convoluted tnhiilos were seen in small number. Isolated pus cells also were occa- 
sionally encountered. Au abundance of cab-ium oxalate crystals were present in 
nearly all specimens, and often consid<rabl«! free uric acid. Spc-rmatozoa \v(!re 
occasionally seen. As a rule, tlie urine, of li<iht amlicr color, yicldeil but little sedi- 
ment, and in cool wcatlcr renuiincd uii(tccom]>oscd ]onj;'cr tban is comnu)n. Hut 
whih^ ])ipera/,in was bcin^ taken, sediment was abundant and decfunposition occurred 
early, as is usual. At this time but three microscopic examinations were made, and 
these were cursoiy. No casts were seen. There was an aljundance of bacteria, 
calcium oxalate crystals, fn^e uric acid, atiimotiiuni urate, and anior]»liou8 ur.alcs. 

The followiui; is an an.alysis of the most imjiortant constituents of the urine over 
a periiMl (if twenty-tlire*^ days. Much mure lluid was invested than was re«]uire<l to 
satisfy tliirst, <luriii<i the greater ])art of tliis time, in oich'r to stinnilate the kidneys 
to jiTc.'iter a('ti\ity. .ScheriuLj's j)i]»era/.in. in doses of five <;Tains four times d;iily, tried for tlie same pur]»ose for a ]>eriod of a week. A])j>arently the only ctfcet 
of the piperazin was to render the urine more readily decomposable without nnirk- 
edly lowering; acidity. The aveiage daily quantity of urine passed in the twenty- 
three days (10^5 c. c.) is in excess of that iisiuilly voided. Polyuria has at no time 
existed. Prior to onset of symptoms of renal inadeijuacy thenriiu' had been of nor- 
mal amount. Subse<]ucntly it was commnnly diminished in quantity, and has 
rc^mained so. IS'itro<^enous cxeretion durinj^ the twenty-three days, thoujjh in excess 
of that ])assed when anal\ ses weic made l)y hiiiiself some months jireviously, is con- 
siderably below (lOU to ino irrains daily) what should ))e excreted by a healthy male 
adult in active, life. Thouj^h on ordinary diet durinjj this time, urea elimination was 
only about one-half the normal averajic of o") liranis (18.56 fjranis). The daily 
averafje ratio of uric acid to nrca (1 to 'JH) is much lower than what is rcffarded as 
normal. In this case, urea excretion beini; dimini.'^hed and elimination of uric acid 
l>robably not beinj;- iuterfi led with, the ratio Mould, of course, be less than the 
]diysioloj;ieal liiiure of 1 to 10 or 1 to 50. 'J he a\-ei:ijie excretion id' chlorides (as 
chlorine) is consideralijy below normal. This, however, does not necessarily indi- 
cate impaired renal excretion, though the latter is probably here ])resent, as other 
causes, notably i^astric liy]ieracidity or hypersecretion, which, apart from renal 
inade(juacy, i>roduce diminutinn, are absent. 


■~ C ■r. 




f acidity, eal- 
1 on 100 cnbio 
etersof nrino. 


£ a 



= B 


c S 
c c; 





c . . 


Kern .arks. 

. 5 ** 

=i 9 


c c r 

■5 o'C 

ci ^ 
















Jan. 31 ■ 



Liffbt amber. . . 





•76 J 


Over 4 

:Sleat diet 

Fel). 1 










Over 4 


Feb. 2 










Over 4 

tlie 23 days. 

Fob. 3 









Over 4 

Feb. 4 


Darker am bor.. 








Feb. 5 










Feb. 6 

Feb. 7 



Light amber... 









Feb. 8 










I'eb. 9 
Feb. 11 










trr. XX piper- 

a'/.in taken. 

Feb. 12 











Feb 13 




. . do 






3 50 




Feb. 14 


Fcl) 1.") 







... do 








6 45 




Feb. 10 



Feb. 17 

Darker amber. . 


Feb. 18 










Feb. 19 
IV.). 20 



Light amber . . 








Feb. 21 



Darker amber. . 








Feb. 22 



Light amber... 






5-25 . U 

* Not estimated. 

Average daily amount of nrine passed, 1085 c. e., or 36 fluid ounces; average daily amount of urea 
ex(Teted, 18-.50 grams, or 28^) S2 grain-!: a\-eragi' daily amount of uric acid excreted. 713 gr.ams, or II 
grains; averam? diiily r;itio of uric acid to urea, 1 to"'2G; average daily .amount ot chloriiles calculated 
a.s chlorine (18 d;xy8); 482 grams ; approximate daily average amount of total urinary solids, 43 grams, 
or 666 grains. 



Case II. — J. B., ageil 31 years; brother of Case I; iimnavrled; best wei'^lit 140 
pniuuls. No lues; no lead-iioisouinii;. Had sUi;lit attack of scarlatina wlicu au'ed 
eight years; no complications attended it. Between the ages ot" 18 and 20 occasion- 
ally drank a trille to excess of beer and wine; bnt excess for him would be inod- 
ei-ation in another of more robust bnild. Ho was easily affected by alcohol. Has 
been very temjierate since 20 years of age. Hns always been looked upon as 
delicate; was in best condition when rougiiing it on the plains four years ago. 
Began to visibly fail in health two years ago, shortly subsequent to a two weeks' 
vacation, during \\hicli he had indulged in a little mild dissipalion incicU'ut to hotel 
life at a fashionable seaside lesort. Lassitude, attacks of severe headaclie alxmt 
vertex and nucha were first noticed. Spells of headacdic have since been freciuent. 
Though these appear independent of exertion, tliey arc esi)ecially induced by it, 
especially by a long walk, as is the case with the brother. More or less steady pain 
across the loins has been notice<l for over a year. Accompnnying it is a feeling of 
tired, weak back. 1 luring the past six months vertigo has fretiuently accompanied 
headache. These are often present on rising in the morning. Kecently an attack 
of vertigo occurred, in which he states that, though lu^lid jiot lose consciousness, 
he felt "(lueer" anil nearly fell. He was dazed afterward and was not himself for 
over two days. Digestion has never been above the average. Within the ])ast year 

Fig. 2. 

i'lx's.sure, li ounces. 

it has been impaired. He is flatulent, and nansea after meals is frequent. A stom- 
ach examination recently made showed motiiitv lowered, with diminution in free 
HCl. The latter is probably usual. There is no \encreal addiction, and no seminal 
losses occur. There are no cardio-vascnlar changes evident. Apex of heart is in 
normal situation. At the time of the first examination a systolic murmur was 
noticed, most distinct immediately helow and to the leit of the apex. It was also 
distinct in the axilla. It was inconstant, audible steadily for two or tlu < c min- 

V\:. ::. 

Pressure, Ij ounces. Pulse, GO. 

utes, and then not evident save with chest fixed in full inspiration. On each 
occasion the second sound at the apex was mnch accentuated. The murmur conld 
not be distinguished when a cardiac examination was again (and last) made, several 
months after the first. There is no history of rheumatism. The pulse tension, when 
first nnder observation, was high. Later, after some time on a strictly vegetable 
diet, without meat, meat sou]), fish, or eggs being eaten, it is (juite normal, as the 
accompanying sphygmogram (Fig. 2), (me of a number similar, shows. '^ No tracings 
were taken before meat was abandoned. 

lumiediately after first sphygnmgram was obtained a meat diet was hegnn. 
ing second (Fig. 3).1aken one week later, indicates the ettect of retained nitrogenous 
waste on the pulse. Meat then had been eaten sonu-what freely once to twice daily. 
Other conditions which might modify the tracings were similar. The sphygniograra 
shows a typical high-tension pulse,* indicative of inadeciute kidneys. • 

The eye-ground, kindly examined for me by Dr. Schncidemau, .shows nothing 

During the past two years the nrine of different periods of the tweuty-fonr honrs 
has been frequently au<l carefully tested for albnmin by heat, nitric acid, and meta- 
phosphoric acid by the brother, who is a skilled chemist. A response has never been 
obtained to heat or to nitric acid. Occasionally, though more rarely thnn in Case I, 
a slight reaction has occurred to metaiihosphoric sicid and to jdcric acid; but mucin 
not having been eliminnted, it is uncertain if the resiionse was due to serum-albu- 
min. Since February, 1893, the urine has been frequently tested by myself. The 

* The npstroke is vertical, the tidal wave slight, and helow a line drawn from the apex of the up- 
stroke to the aortic notch (Mahonnd's test ot low tension). The pressure used was IJ to li ounces, a 
greater amonnt extiniriiishinji the imlse. which was 74, taken sitting. 

*The upstroke is less vertical, tlie tidal wave more pronounceil, a portion of it occupying a position 
above a line drawn from apex of upstroke to aortic notcli. which latter is jilaced liigli. Pies.sure tioiii 
IJ to 2 ounces, no minor pressure tracing pulsations. Pulse, 60; that and tracings taken sitting. 



result Las always been nofjative with heat and Avith nitric acid. On three occasions 
a reaction has lieen obtnincd with ])i(ric acid. In one ot these only was acetic acid 
used to remove mucin by the method licfore mentioned. On that occasion only, the 
untreated urine was tested with Milhird's solution. No trace of haziness or rini' 
occurred, and after removal of mucin l>y acetic acid no trace of response could be 
obtained with picric acid. Granular and hyaline casts have been found on several 
occasions. Hyaline were in excess of the <,nanular, but even hyaline occurred only 
in small number, as in Case I. A few <"pirhelia, the character of wliich indicated 
their probable origin from the convoluted tubuU's, were also occasionally encoun- 
tered. Calcium-oxalate crystals abounded in all speeiiuens examined, whether the 
iiriue was examined immediately after voiding or, as on some occasions, after stand- 
ing twelve to twenty-four hours. 

An analysis is subjoined of tlie most imiiortant constituents of the nrine for a 
period of six days. The amount, sjiecilie gravity, ami total daily output of nitrogen, 
irequrntly before estimated, tallies so closely witli this that it may be aeiepted as a 
sample of the usual condition. These also agree, as do the clinical symjitoms, with 
those of Case I. Uric-acid elimination, liowever, in Case II is somewhat higher than 
in Case I. The ratio to urea is 1 to L't. 





3 o 








'> -. 

~- z 

^ ™ 

= ;' 

sc- l?Ss 


r ." X 




« c i; 

.5 -I 

~ til 


= :; © 

■= J X ' i " a 

>— Zj 

O'S X 

«. _' 

& - 

= 5 a 




. p 


>^ =J 

>.= u. £'=3 

5 P.+- 





'a " 

c u es 

•^ c ^ 

E= a 








Feb. 28 












Mar. 1 











Mar. 2 












Mar. 3 





22 M 






Mar. 4 











Mar. 5 











*Not calcuLated. 

Averafie daily quantity of iirine, 832 c. c or 29.J fluid ounces: average daily eliniinaliiiT) of urea, 
18. (iG firani.s, or 287 jji-aiii.-*: average daily eliniiiialiou of uric acid, -794 grams, or 12graiu.s: average 
daily elimination of eliloride.s calculated a.s elilurine. 6-8 gram.s; approximate average daily elimina- 
tion of total urinary sohds, .');{ grams, or SIG grain.s. 

The following case is apparently of a type similar to the preceding, thongh of an 
age and with symptoms indicating a more advanced kidney ailment. The patient 
came under observation while this ])aper was in process of preparing. I could not 
forbe;ir rei)orting the case at this time, though not studied for a lengthy period, be- 
cause of its snggestiveness. In the few days that op]>ortnnity has permitted seeing 
the case, it has been carefully studied. Whether the urine has been previously, as 
uow, altogether albnrain-free, or whether in the future this condition will continue, 
it is, of course, impossible to more than conjecture. But that it should be so now, 
when marked renal incompetence and symptoms referable thereto are iiresent, ren- 
ders it well worthj' of mention in connection with the other cases: 

Case III.^-.J. MacC, aged .5"i years; married; weight, 150 pounds; stationary 
engineer. No history of lead, syphilis, or alcohol. First seen .June 11, 1893. About 
a year before he had been mueii overworked and had what was regarded as a slight 
attack of intlueuza. He had had no severe ailment prior to this and had always 
been robust. During the past nine months he had visibly failed in health. There 
■was increasing general muscular weakn(>ss and incapacity for exertion. Generalized 
headache was eonnnon, and, lately, had increased in severity; it was worse toward 
afternoon and at night, and was a.^isociated with s]eel)lessne^s and, on rising in the 
morning, with vertigo. The bowels were always inclined toward constipation, but 
had been maintained in a soluble condition by aperients. No other digestive dis- 
turbance was ])resent. Tongue was moder;itely clean. Appetite was poor. Shoot- 
ing })ains occasicmally occurred about the body. No indic;;tions of cedema were 
present, nor had there ever been, so far as he could tell. Knee jerk, station, and 
tactile sensation were normal. Some tremor of lips and rather i>ronounced of han<ls. 
on extending the latter, were remarked. Temporals are prominent and radials 
tense, but the arterial -wall was not more than slightly appreciable to the tinger 



when emptied above by pressure. The iiiilse was small and gave 
tracing of iiigli tension, shown in the accompanying sphygmograin. 

Via. 4. 



J.AlacC Pressure, If ounces; sitting. 

The second aortic sound was markedly accentuated at the apex, but the heart's 
imiiulse was normally placed within the linea mammalis. Both palpation and per- 
cussion showed no cardiac hypertrophy. He habitually passed but a moderate 
amount ofnrine, never rising at night. The color, so far as he had noticed, is never 
very light. 

His condition at the first visit, when the above symptoms were noted, suggested 
either phunbism or chronic Bright's disease. But as there was no blue line, history 
of colic, or other suggestive symptoms of the former, and as he had not worked at 
the branch of his trade for a year or more which necessitated handling lead, and no 
other source of exposure wa3 evideut, I informed him, on his asking for an opinion as 
to the nature of his ailment, that I felt confident theseat of the trouble was in the kid- 
ney. I then had him send the total twenty-four hours' urine. To my surprise not a 
trace of albumin could be detected by any test, even the most delicate. The urine 
was of normal, yellowish-red color, not resembling that of a case of contracted kid- 
ney. This, with freedom from albumin and a histrtry of no nocturnal bladder dis- 
turbance, was misleading, and had not I been on the watch tor such obscure cases 
and noted that not only the amount of urine but of urea was considerably sub- 
normal, I might have been longer in arriving at an accurate diagnosis. 

Careful consecutive daily examinations of tlie twenty-four hours' urine for albumin 
have been made up to the present writing. The urea, uric acid, chlorides, etc., were 
also calculated for a period of eleven days. Albumin, examined for daily, has at no 
time been present, even in the minutest trace. On two consecutive days, when the 
urine was especially concentrated and the weather excessively warm, a slight ring 
occurred with picric acid and a trifling cloud with Millard's reagent. But this was 
uudoul)tedly mticin. A second specimen treated with acetic acid,* filtered and 
neutralized with strong XaHO, and then again slightly acidulated, gave no trace of 
response to these tests, even after standing several hours. Considerable mucoid 
sediment was always present in the urine after it had stood for some hours. Two 
microscopic examinations were made and two to three hours occupied on each occa- 
sion. In the first examination a medium-breadth hyaline and a narrow granular 
cast were found. An aggregation of small cells forming a somewhat irregular- 
shaped epithelial cast was also seen. Free uric acid Avas present in large amount; 
calcinm oxalate crystals and a few leucocytes were also noted. On the second occa- 
sion a sample of mixed urine of two days was used. A number of narrow and broad 
hyaline casts (8 to ID) were found. Cyliudroi('.s, amorphous urates, free uric acid 
crystals, a few small round and oval nucleated cells Avith granular contents were 
also present, but no calcium oxalate. 



in cu- 
bic cen- 

in fluid 




tion of 
urea in 

urea in 

a1 ion of 
acid in 

tion of 
Ln grams 
lated as 

mate daily 
tion of 
total uri- 
solids in 

June 12 
•Tune IS 




Eeddish yellow 


12 -25 






12 -15 




2 •15 








June 1-1 
June 15 

520 ] 17i 
500 ! 16 
410 ! 13i 
760 1 25" 
670 22 


187 -340 
K10 -16S 


June 16 
June 19 

Redd ish yellow 











June 20 



June 21 
June 22 
June 23 



Eeddish yellow 

Deep reddish yellow. 
do .' 


June 24 

Light yellow 


a'Sot estimated. 

6 Exact estimation of the total urinary nitrogen eliminated on the 13th and 14th instants was liindly 
made for me by Dr. LefJtnan by tlie Kjeldahl-Gunning method, to compare the results thus obtained 
by the more ready approximate method for ascertaining total urinary solids. The iiguresare: 13tli 
in.stant. 18 grams' or 277 grains ; 14th instant. 28 giams or 431 grains. ' 

Daily average amount of urine in the 11 days. 643 c. c, or 21i fluid ounces; daily average amount 
of urea in the 11 days, Hi grams, or 177 grains; daily average amount of uric acid (9 days), 0-29 gram, 
or 3| grains: daily average amount of chlorides estimated as CI (9 days), 3 grams, or 46 grains; daily 
average amount of total urinary solids, 23J grams, or 362 grains. 

* See footnote ^, p. 195. 



Tho total daily output of urine unci total urinary solids in this case is much 
diniinislwd. Urea is especiallj' low. 

Alter tlie eleven daily observations -were made, during which the bowels were 
jnoved once daily by laxatives, 3.), three times daily, of potash bicarbonate, taken 
eli"ervescinn with Iciiiou Juice, was ]>rescribed. with excellent effect, as a diuretic. 
This, and trer purgation by calomel every third day, caused a ]irompt amelioration 


J. MacC. J'lfssurc, UJ ounces; sitliii.u- 

in symiitoms. The ])ulse tension, however, continued rai.sed. though not so markedly 
as at lirst. The !iccnm])anyiug tracing was taken fifteen ilays after the preceding 
one, and two days after beginning the i)otash. He had tlien been for a week on a 
vegetable diet. The ])ulse volume is greater than in the lirst tracing, with a ])rom- 
inent ])redicrotic wave. Uric acid was then iindiably in excess in the blood, and 
nitrogenous excretion greater than before. The diuretic, mercurial hixatives, and 
nonnitrogenous diet being continued, recently pulse tension is considerably lower 
than before, with amelioration in symptoms. 

The f(dlowiug is tiie rejiort of the eye examiuatidu in this case, furnished mo Ity 
Dr. .Schneidcman : 

Vision just shoit of normal. Uields of noniinl extent for form and color. Right 
eye: Nerve head reibleiied and somewhat lia/,y; outlines indistinct ; marUi'd venous 
]Milse; macuhe normal. Left eye: Not essenli.illy dilb-ienttVom right. 1 tiiink 
the uervi^s are redder aed more ha/y than is oiilinarily met with in coudititms of tiie 
refraction as notcid. 

The accompanying case is very similar clinically to the preceding. It was recently 
.seen in consultation with Dr. Lewis lirinton, who has kindly permitted me to report 
it here. From the absence of albumin, though the symptoms were suggestive of 
chronic IJrighfs disease, Dr. IJrinton had been somewhat incliucil to doubt this 
diagnosis which he has made, and sought my aid for a verification. 

Case IV.— Mrs. M.. aged 51 years; weight about 110 pounds. Throughout her life 
the i>atient had been subject to headaches, but during the past seven years frequent 
sjx'lls of another character occurred. The ache is in the oeci])ut and nucha. It 
comes on more often on rising, once in about five days. During the ])ast four <>r five 
years she has had backiulie ami loin ])ain; is tire<l on slight exertion. Occasidnally 
])ui1iness .-ibont eyes has been noticed. She is very nervous. Ajipetite is poor. No 
marked digestive disturbances exist; no vomiting. Pulse shows raised tension, but 
no thickening of arterial coats. No cardiac enlargement exists. Heart was noted 
to be irritable. A distinct apical nontransmitted systolic murmur was heard in the 
early part of the first examination. This was evidently due to temporary incom- 
petence. It could no longer be heard at the end of a half hoivr, during which she 
had been sitting iiuietly. Dr. P.rinton had not noticed it before this examinalion 
that we madetogef inr. Second s<iun<l was accentuated at the apex, more distinctly 
so when the nniruuir C(!;ised to be heard. 

She stated that she had been passing but about a pint of urine daily for .some 
years. Could not recall ever ])assing a large amount, but may have averaged 3 
pints scmie years ago. The specific gravity of a number of specimens examined by 
Dr. Hrinton ran between \0V2 :ind lOl'O. " Dr. Brinton could never discover even 
traces of albumin, though he had freiiuently examined the urine. The specimen 
examined on the dav of consultation was of amber color, specific gravity lOL'l, and 
gave no reaction with heat or nitric acid, but a ring occurred with picric acid not 
dissipated I>y heat. It is impossible now to state if this reaction was due to seruui- 
albumin or to mucin. The urine was concentrated, and but a few drops of acetic 
acid were added, entirely too little to precipitate mucin in presence of excess of salts. 

A number of other examinations were made, a response occurring only on one 
other occasion to ]Mcric acid, and never to heat and acetic acid, or to nitric acid. 
]}ut one nucroscopic examination was nuide. In this a considerable number of 
hyaline casts were seen, and one granular cast stud<led with minute oil globules. 
There were also ])rcsent cylindroids, a few leucocytes, a few red cells, and several 
small, fiTuMv granular, nucleated polyhedral cells of ajipareut renal origin. 

The elimination of urea, uric acid," and chlorides in this, as in the preceding, 
is much below normal. Estimations could only be made over a period of a few days, 



but as the urine is believed to vary little iu quantity, the averages here given are 
believed to probably represent the usual condition. 


I Daily 
'of urine 
in cubic 

of urine 
in fluid 

Apr. 27 
Apr. 28 
Apr. 29 
Apr. 30 



of ' 




Iteddish ycllrfw . . . 







tion of 

tion of 

urea in 

urea m 











tion of 
uric acid 


tion of 
as CI in 



tion of 


Average daily quantity of urine on 4 consecutive days, 500 c. c, or 16 ounces : average daily 
quantity of urea ou 4 consecutive days, 8^ grams, or 127 grains: average daily quantity of uric acid 
in 3 days, 0.2s) gram, or 4 grains; average daily quantity of chlorine in 3 days. 3 3 grams, or 35i 
grains; approximate daily quantity of total urinary solids, 22j grams, or 350 grains; ratio of uric 
acid to urea, 1 to 31. 

The next case, V, also resembles the foregoing. She was first seen during last 
May in the dispensary of the Episcopal Hospital. .Since then she has been constantly 
under observation, for a time in the wards of the hospital. 

Case V. — Miss R. L., aged 17 years, of delicate build; weight, 110 pounds. The 
symptoms of her ailment tirst noticed were that for the past two years there has been 
almost constant loin pain, with frequent spells of vertigo and headache. She was 
losing strength and was unable to attend to daily duties. There was anorexia aud 
a feeling of weight in the epigastrium after meals, and constipation. When aged fi 
years had had scarlatina, during the subsidence of which slight general drojisy 
occurred, lasting about a week. 

Fio. 6. 

R. L. Pressure, 2^ ounces; sitting. 

When first seen she was of ana'.iuic appearance. For a year or more she had not 
been getting the proper sort or amount of food because of the straighteiietl circum- 
stances of her people. An examination showed no cardiac hypertrophy. The first 
sound of the heart was distinct at the apex anil the second was there accentuated. 
The pulse was rapid, and furnished the subjoined tracing (Fig. 6), one of several, all 
showing a similar condition of low tension and well-marked dicrotism with the aortic 
notch low. 

Fig. 7. shows a tracing taken three weeks later, after a week spent in recumbency 
in hospital on soft diet (chicken once daily). In this tracing it will be noticed that 

Fig. 7. 

ILL. Pressure, 2 ounces ; sitting. 

tension is higher, the predicrotic as well as the dicrotic wave being quite well 
marked. Rest in bed and a more wholesome diet had evidently increased arterial 

During the two and a half months that she was under observation no drugs were 
given; a mild laxative was prescribed. An accurate record was kept of the daily 
quantity of urine for over one month. The average was 550 c. c. (18 Ihiid ounces). 
More or less loin pain, and spells of headache and vertigo continued throughout this 
time. These symptoms have since ameliorated somewhat under free purgation and 
large doses of potassium citrate, the last given to stimulate diuresis. 

The urine in this case always deposited considerable mucoid sediment, and a reac- 
tion was obtained on three occasions to picric acid, and on two a slight cloud was 
evident on cooling after boiling a specimen slightly acidulated with acetic acid. 
This was evidently due to the presence of mucin, us a specimen subsequently treated 



with excess of acetic acid, in the inaiiiier before described, gave tliem no trace of 
albumin resjyouse to any test.* 

In three microscoi)ic exahiiiiations casts were found on two occasions, once by Dr. 
Frank Massay, who kindly made an examination for me. Dr. Massay noted pale 
grannlar and' hyaline cylinders of medium breadth, and cylindroids. In a later 
examination by myself, broad and narrow hyaline casts only, were seen. Calcium 
oxalate crystals were present in very large quantity in all ex;iminations. 

The ligtires in the accompanying table indicate that nrea elimination in this case 


of urine 
iu cubic 


of urine 
in fluid 






tion of 

urea in 


tion of 

tion of 
nrid acid 


tion of 
lated in 
as CI. 




Apr. riO 
May IG 
May 17 








Reddish yellow 

. . . do 
















Jmie, 12 



Average daily amount of urine in the 6 days recorded above, 430 c. c, or 14 fluid ounces; average 
d.aily amount of urea in the 6 dayS, !6 <;rams. or 246 grains; approximate daily amount of total urin- 
ary solid.s in the li days, 27 grams or 4-21 grains. 

a Not estimated. 

is consid(nably diminished. The average daily amount for her weight shonld bo 
about S.jO grains, against the 216 noted. Hut one examination for nricacid was made. 
Tills (44 grains) showed diminution. Chlorine elimination, too, as shown in the two 
examinations, is considerably below the normal, vhich would account for the ratio 
of urea to the daily 

;imount of total solids being less than the usual one-half. 

The next case is interesting in that, with few symptoms snggestivo of chronic 
Bright's disease, renal degeneration in all probability exists. It was seen through 
the kindness of Dr. de Schweinitz, nnder whose care the patient was for failing 
vision. A renal ailment was not esiu'cially susi»ected by Dr. de Schweinitz, who h;id 
examined several specimens of urine for albumin with negative result. A cause for 
the symptoms — "chronic headache, Avith a curious form of optic neuritis in one eye 
and souH' degeneration in streaks in the other," as reported to me by Dr. de Schwein- 
itz — not being apparent, he had sent the total twenty-four hours' nrine to me for 
examination. On theurea being found somewhat diminished and casts being detected 
iu the urine, I was permitted, through the courtesy of Dr. de Schweinitz, to see the 
patient on several occasions and to make further examinations of the urine. 

Case VI. — Mrs. T., aged .51 years; widow; seamstress; weight 150 pounds. Had 
influenza two years ago. Following that has been subject to severe headaches, 
chiefly about vertex and frontal region. Has been subject to vertigo for a number 
of years. At times it is so severe that she has almost fallen with its occurrence when 
on the street. She has had more or less loin and sacral pain for some years, aggra- 
vated by being much on her feet. A tendency to const i])ation has always existed. 
No other sym])toms are ])resent save that eyesight began to fail unaccountably some 
montlis ago. That, lately. h;is improved under Dr. de Schweiuitz's treatment. She 
never has passed hirge (|unntities of nrine. Can not recall how long the small amount 
now voiding has been habitual. 

A cardiac examination showed a stnmg first sound and a highly accentuated apical 
second sound. No enlargement was detectable. Apex beat was in normal situation. 
Pulse tension was high, but after radial was emptied by pressure, arterial wall 
scarcely distinguishable. Temporals not prominent. Considerable pressure neces- 
sary to develop tracing, but sphyiiuiograms t;iken with from 2f ounces jiressure up to 
3f ounces similar ; 4 ounces causes rouuding of apex of upstroke. The accomjianying 

* This case has, of conrso, heen under oliscrvatioii for too short a time, and too few examinations 
for albumin have been made to permit it. like Cases III .ind IV, to be more than sussestive. Albumin 
may only have been absent for a time in the course of the clironir malady from which she is undoubt- 
edly su^'eriug. It is, however, signitieant that with small amounts of urine, with the presence of 
casts, and s^niiptoms indicating renal incompetency, albumin was at least then absent. 



tracing, with whicli others, takeu with the s:iuie degree of pressure, on tliis and 
other occasions are silluU^r, is very sigtiilicant, and by it alone a diagnosis of proba- 
ble renal degeneration miglit be made. Though there is no history of lues, and 

Fig. 8. 

Mrs. T. Pressure, 3J ounces; sitting. 

nothing to definitely indicate a present or past infection, Dr. de Schweinitz is 
inclined to regard the eye condition- as of specific origin, especially since ira])rove- 
meut in this has been decided while on antilnetic tri'atmeut. However that may 
he, there is little doubt that an underlying kidney ailment is contributor}- to certain 
of the symptoms. 

There were indications of albumin to picric acid in the first specimen of urine 
examined, acetic acid not being used to separate mucin. The urine was concen- 
trated, and deposited, after a few hours' standing, a heavy cloud of mucus and 
oxalates, to tlie former of which the reaction may have been due. No response of 
any sort occurred with snbseqtient specimen. But 1 specimen was examined 
microscopically. Several hours' search of 5 slides revealed 3 typical granular casts, 
1 long, very typical waxy cylinder and a number of pale, broad hyaline casts. 
There were also present small polyhedral nucleated granular cells, bladder and 
vagical epithelium, a few leucocytes and red disks, and a profusion of calcium 
oxtiate and uric acid crystals. 

The urea elimination in this case is more diminished than is that of the preced- 
ing. The amount calculated for body-weight should be from 400 to 4.50 grains, 
while there is actually excreted but about one-half of this, or 230 grains. The total 
urinary solids excreted do not much exceed what the figure for urea should be were 
the renal tubular structure doing full work. 


of urine 
in cubic 


of urine 
in fluid 


^^ ^ 




urea in 


urea in 
grains, a 

tion of 
uric acid 
in grams. 

tion of 
lated in 
grams as 





May 5 
May 10 





Eeddisb yellow 











2 19 



May 11 


May 12 
May 1-5 
May It 





Average daily amount of urine, 500 c. c, or 16 J fluid ounces ; average daily amount of urea, 15 grams, 
or 230 grains; averagii daily amount of uric acid, ^47^ gram, or 7J grains;' average daily amount of 
chlorine, 3 -90 grams; approximate average daily amount of total sali.ds, 32 grams, or 493 grains; ratio 
of uric acid to urea, 1 to 31J. 

a The urea determinations in this case were kindly made for me by Dr. Lefimann. 

6 Not estimated. 

In addition to the foregoing cases, through the courtesy of Dr. Charles A. Oliver 
I am able to report one, followed to its termination, in which albumin was evidently 
totally absent from the urine throughout the course of the disease. This case was 
originally sent to Dr. Oliver for an eye examination. No suspicious of renal trouble 
had been entertained until the fundal changes were noted. 

* Dr. de Schweinitz's report is as follows: 

Central viision, after the correction of an astigmatism, 6/6; field of vision for form normal, slightly 
contracted for colors. In the right eye iris somewhat sluggish to the reactions of light and shade; 
moderate optic neuritis, the apex of the swelling being 1 D. above the level of the surrounding eye- 
ground, the grayish swelling being chiefly confined to the disk; no hemorrhages or splotches. In the 
left eye, a vertically oval optic disk, gray in its deeper layers, the upper and lower edges hidden and 
the nasal edges veiled; a patch of atrophic retinochoroiditis up and out from the papilla, numerous 
glistening reflexes in the macula, and above the fovea some dark radiating streaks, apparently in the 
retina. Under the influence of iodide of potash and bichloride of mercury, in dose of 5 grrins aud one 
twenty-fourth of a grain, respectively, three times a day, the appearances of the eye-grounds steadUy 
improved, and at the last visit. May 23, 1893, one montli after instituting the treatment, the disk upon 
the right side was less swollen, the temporal edge being visible. The disk upon the left side had 
improx ed in appearance, but there was no change iu the patch of choroiditis or iu the macular lesions. 


Dr. Oliver has furnished mo the followiug note of this case: 

Miss X., afi<'<l 19 years, an a])])areii(iy stroii"; aiul healtliy uirl of refiiiemeut and 
(Hliication, witliont any lier<ulitary taint, was sent to tli<' writer liy her attendiuj^ 
])hysician for rcciirrent frontal ccplialali^ia, associated with ninscnlar and acconiino- 
dative asthenojiias. Careful examination of the Inndus oonli showed the existence 
of a few faint flecks and dots in.eaoh mainilar re>^iou. So hi<>hly significant of reual 
disease were tiiese changes that the medical adviser was warned as to their natnre. 
KejX'ated clicniieal and inicro8co])ic examinations of sani]tles of urine, voiiied at dif- 
ferent hours (d' th<! day and under varyinjjj conditions, up to witliin one week other 
death (the last examination), failed to reveal eitlier to her ])hysician. the writer (Dr. 
Oliver), and more conii)etent authority, any alhnmen. tube casts, or other character- 
istic oiganic or mineral excreta — the si)ecific gravity always remaining; aiiont normal. 
In spite of these negative results, low grades of neuio-retinitis, with and without 
fine spray-like hemorrhagic extravasations, came and went, until in ahoiit seven 
montiis after her eye-jirouuds were first studi«;d, a uraiuii^ attack suddenly a])])(^•lred 
after exf)osnre to cold, resulting in coma and death. Post-mortem oxamiuatiou 
revealed the prescnc*! of granular kidneys, witii cardiac hyjtertrophy. 

In references to your inijuiry as to tlui tests for all)uniin employed, I would state 
that, in every itistance in which I examined the urine, tin; specinu-n was tilteredand 
hoiled. followed hy the careful and slow addition of either nitricacid or acetic acid; 
this method was invariahly followed hy Heller's test, hoth by superimposing the 
urine upon the acid or allowing the acid to flow drop by drop beneath the urine 
along till' inclines test tube. In (|uit(s a number of instances 1 supplemented this l>y 
tJie a])plication of lu-at, proving the jiresenccs of acid urates, which I af"terwaril con- 
firmed by the microscopic ap])earances of the ordinary six-sided rhombs. 'Ihe spe- 
cific gravity in some oi' tlu-se latter specimens, I renuunber, was somewhat high — 

The specific gravity of the urine never fell below lOlfi, and 1021 was the highest. 

Since beginning this investigation specimens of urine liave been submitted to me 
from se,\ eral castss of undoubted chronic Bright's disease in which the accompany- 
ing symi)toms ami the presence, in three; of so-called "ali)urninuric" retinitis had 
rendered tlu' diagnosis very clear. In these, changes in the fundus were present in 
all, .and considerable hesitancy had been felt hy the medical attendants in accepting 
the opinion of the oculists as to the probable renal nature of the retinal condition 
becauseof the absence of albumin. In two of these cases albumin had been frei|ueut]y 
examined for by heat atul by nitric acid, over a long sjiacoof time, but never found; 
and casts had not been detected, save a single hyaline cylinder on one occasion in 
the urine of oiu) of tiiese. These exauiiuations of the uriue had not been made for 
some time wIkmi daily specimens of the twenty-four hours' urine were submitted to 
nie. Examinations for urea and uric acid over some days, as in the preceding cases, 
were instituted, the result of wiiich need not ho detailed here. In one, a senile case, 
passing scanty, light-colored iiriiu', of low gravity, out of 5 specimens of the mixed 
twenty-four hours' uriue examined, response for albumin occurred twice; on one of 
these occasions to acetic acid and potassium ferrocyanide, and, slightly, to heat an 1 
acid — these two tests were then the only ones used. No casts could be detected in 
two examinations, no sediment being obtainable even with the cujployment of the 
centrifugal machine. 

In tiio other case, under the care of the same physician, out of 8 specimens 
examined on different days, response to albumin occurred twice; on one occasion 
only to the more delicate tests, and on the other slightly also to heat. Epithelial 
and granular casts were found in the urine of this patient. Since these examina- 
tions the physician reports detecting albumin on a single occasion hy nitric acid, 
and also by heat. Because of the even occasional presence of albumin in these cases 
I have not included them in my list. Both pass a diminished amount of urine, but 
are without dropsy. Slight ur;emic symptoms are present. The arterial tension in 
both is habitually high. In one cardio- vascular changes are present. In the other, 
aged but 32, no arterio-sclcrosis exists. 

One other case of which I have notes, in which retinal changes occurred without 
albuminuria, is interesting, and may hero be briefly referred to. This I recently saw 
through the courtesy of Dr. L. Wolff. 

Symptoms of digestive disturbauce had at first alone been complained of. For 


these tlie patieut, a woiuau aged 50 years, was treated by Dr. Wolft". Subsequently, 
•when uot under tbe doctor's care, her eyesight begau to fail markedly. She theu 
sought the eye dispensary of St. Agues's Hospital for relief. The attendaut there 
told her the trouble was renal, advising her to seek her jihysician, that her urine 
might be examined. Repeated search was then made by Dr. Wolff for albumin, 
without result. Examinations were then also made by the oculist, who was unable 
to understand the absence of albumin with such symptoms. It is needless to state 
that his search at the time of Dr. Wolti's examinations was also resultless. Later, 
Dr. Wollf lost sight of the case, but recently sought her out for my benefit. We 
found lier suffering with pyelitis, which prevented the further study of the kidney 
condition from the point of view of absent albumin.* 

As to the probable pathological nature of the kidnej' lesion in the preceding cases, 
the histories of which I have detailed, little more than conjecture is possible. 
Clinically, they form a series of various stages of a common ailment. Three of 
the 6 are young adults, aud 3 in middle life. All present certain common symptoms 
which are referable to derangement of the renal functions, such as headache, 
vertigo, loin i>aiu, high-tension pulse, diminution in the amount of urine, and in 
the most important of its constituents; the presence of casts, hyaline, granular, and 
waxy, and of isolated renal ejnthelia; the absence of albumin and of dropsy. 

Detectable cardiac enlargement, hyi)ortrophy, or dilatation, is absent in all, and 
thickening of vessel wall is recognizable in but one (Case III), although raised 
arterial tension, save on a strictly uouuitrogeuous diet, is habitual in all save 
Case V. 

It may be said that the assemblage of symptoms presented by these cases is typical 
of no distinct form of chronic nephritis, though their trend is suggestive of granu- 
lar or cirrhotic kidney, or of the form described by Delatieldt in his pathological 
classification of renal disease, as chronic ditiuse nephritis without exu(Uition. 

The only form of chronic Bright's disease of which we have knowledge, in which 
the urine may bepersisteutiy albumin-free, is this or the red, granular, or cirrhotic 
kidney. Yet several, as regards age and absence of cardio vascular changes, aud all 
as regards diminution in the amount of urine habitually passed, with coincident 
more or less marked diminution in elimination of urinary solids, and especially of 
urea, do not respond to the type of so-called fibroid kidney. But that fibroid changes 
are present in the kidney in all, accompanying whatever other alterations that may 
exist, there is probably little doubt. 

As regards epithelial involvement, the absence" of albumin, of dropsy, aud of epi- 
thelial casts are against any extensive affection of the tubules ; yet the presence in 
the urine in all of tubular epithelium, of granalar, numerous hyaline, and, in one, 
of waxy casts, and the marked diminution of urinary solids indicate some involve- 
ment of these parts, though perhaps not as yet to a degree more than what may be 
termed /uwc/iOHa?. 

Glomerular nephritis of pronounced type is iiuite impossible without albuminuria, 
yet glomerular changes, of the nature of tbickeuiug of capsules, of tufts and of ves- 
sels, are not improbable,,: and may account for diminution in amount of tirine, a 
symptom present in all, aud especially in Case V., a young girl in whom scarlatinal 
dropsy occurred when aged six years, and in whom also, now, slight ephemeral dis- 
seminated redema of the skin occasionally occurs. 

Little further comment need now be madeou these cases, the purpose of this p.aper 
not being subserved by mere speculation. It is not claimed for them that the urine 
is perpetually albumin-free, or that it will remain so to the end, as in Dr. Oliver's 

■*Dr. "Wolflf informs me, as tliis paper is going to press, that she recently died suddenly. 'Ko 
autopsy was obtained. 

t American Journal Medical Sciences, October, 1891. 

! Mahomed believed that absent albumin, in certain cases of chronic Bright's disease, may be due to 
thickening of vessels of Malpighian tufts, through which it is difficult for albumin to transude; and 
also to thickening of the capsules of the tufts, prc-venting distention of vessels; and again, though 
less often in chronic Bright's disease than in acute, to protective contraction of the reual artery. 


case. The present report is intended but as preliminary, to direct attention to a very 
si Miliar class of cases of chronic Brij^ht's disease apparently of not uncommon occur- 
rence, in which, during the period of observation, albumin has been invariably absent 
to ordinary tests, and usually to those most refined — at a time, too, when marked 
indications of renal derangement have been evident. 

Subsequently a further rejiort on these cases will be made, with the addition of 
others that I may be able to encounter and study. My one object now, to which all 
other thoughts are subordinate, is to direct especial attention to this class of cases, 
the pathological classification of which will readily come when they obtain general 
recognition clinically. 

The most important teaching of this paper, to which all should give heed, is that 
there is no doubt that but little stress can be laid on the mere absence of albumin 
from the urine in rejecting or confirming a diagnosis of chronic Bright's disease; 
that in any instance in which an examination for albnmin is demanded as a part of 
an investieration to detect or exclude disease, no decided opinion dare be ventured as 
to the absence of the latter without further search of the urine, to determine not only 
the mere presence or absence of morphological kidney elements,* such as casts or 
epithelium, but also to discover the cojidition of the secretory renal function. As 
the latter can only be deti-rniined by an examination of a mixed twenty-four hours' 
specimen of urine, the total daily amount passed must be known. Itsluuild, there- 
fore, be a rule, admitting of no deviation, in all cases of suspected Bright's disease 
in which albumin is undetectable in a single unmixed specimen, to obtain thatof the 
total of one or, better, a consecutive series of twenty-four hours. Then, too, when 
albumin is absent in a single unmixed specimen, it may sometimes be discovered in 
that of the total twenty-four hours, when the more delicate tests are intelligently 



General Hospital, Barbados, ^yest Indies. 

During the past four years I have seen so many cases of chronic diarrhoea — often 
ending fatally — in which a ])eculiar inflammation of the mucous membrane of the 
mouth is accompanied by a clearly-defined symmetrical pigmentation of the dorsal 
aspects of the hands and feet, that 1 have been forced to the conclusion that this 
triple association is not an accidental one, but is pathognomic of an epithelial disease 
s«i (ye/icris, possibly peculiar to Barbados, or else closely allied to a specific disease 
of the alimentary canal wiiich has its habitat in the East Indies, and has been 
accurately described by Dr. Thin, of London, as "psilosis linguio et intestini." 

The nuiin features of this latter condition, as described by Dr. Thin, are "inflam- 
mation of the mucous nu^mbrane of the mouth and alimentary canal and chronic 
diarrhoea, portions of the tongue and the whole of the oesophagus being denuded of 
epithelium, and the entire mucous membrane of the ileum found in a shrunken, 
wasted, and sclerosed condition." The Dutch physicians of Java recognized the 
condition as possessing characteristics suflficiently unique to distinguish it from the 
ordinary chronic diarrhoeas and dysenteries prevalent in tropical countries, and 

* Kor should tliese be exclnded until a search of sediment, obtained by the use of the centrifiiff.i' 
machine, is made. Notwithstandinjj it is accepted th;it the mere presence of hyaline and granular 
casts, though highly suggestive, is not patliognomonic of an actual coarse kidney lesion, their pres- 
ence in the nrine always indicates at least functional disturbance of the kidney ; and when not due 
to alterations in blood-pressure (congestion and associated albuminuria), and when accompanied by 
the presence in the urine of renal epitlielium, or when associated with symptoms of renal inadequacy 
and persistently raised blood-pressure, it may be safely asserted that chronic nephritis exists. 



S. d<«< 1 1 Wilhdms luNi Co N T 


SKlcMitWyMrnlil>»Co KT 



gave it the name of "sprue." a terra also employed in certain parts of Scotland to 
designate apLtlions stomatitis. 

Like many terms still in U'^e, the word '•' sprue"' carried with it no indication of 
the nature of the disease; and in order to emphasize the peeled condition of the 
mucous membrane of the alimentary canal .always found in cases of "sj)rue,"Dr. 
Thin suggested the adoption of the word psilosis instead. 

This term, which is derived from the Greek fiXou (pluck, make bare, or strip), 
simply calls attention to the state of the tongue and mucous membrane, i. e., that 
they are stripped or denuded of their epithelium, a symptom not confined to ''sprue," 
but seen in cancer of the pyloric orifice, dysentery, and the final stages of exhaust- 
insr intestinal maladies. Hence I take it that any condition in which the tongue 
and mucous membranes are found bare of epithelium may, without impropriety, so 
far as the etymology of the word is concerned, be spoken of as a ji^i^osis. It is in 
this limited sense that I have ventured, in the absence of anj"- etiological data from 
which to elaborate a more appropriate or origiiial nomenclature, to borrow from Dr. 
Tilings vocabulary the term pfiUosi>< as a temjiorary heading under which to introduce 
the disease I am al)out to describe, it being distinctly understood that I do not 
believe that in Barbados we are dealing with the identical disease to Avhich the 
term psilosis, in its technical adaptation by Dr. Thin, strictly speaking, belongs, 
although clinically there is a strong resemblance between their respective alimen- 
tary manifestations. The difference in the tonnncs is well shown in the drawing 
(fig. 1), and there appears to be no accompanying cutaneous pigmentation in Dr. 
Thin's psilosis. At any rate, the qualifying adjective ''pigmentosa" will jirevent 
confnsion of the condition which forms. the subject of this jiaper with the class of 
cases recognized as psilosis in the East Indies, and at the same time will call atten- 
tion to one of the most prominent features of the former. 

The external manifestations of j^.si/o.sis pigmentosa, as we see it in Barbadoes, are 
a crimson peeled condition of the mucous membrane of the tongue and buccal cav- 
ity. The lips externally, as shown in the drawing (fig. 2), are bright red and espe- 
cially vivid in black people. In muhittoes the contrast with the surrounding skin is 
less marked, while in the latter the pigmentation on the dorsum of the hands and 
feet is naturally more pronounced. The tongue, when protruded, assumes a long, 
narrow, pointed shape. Its papilhe are elevated, and aphthous ulcers are often, 
though not invariably, found on its lateral margins. Saliva constantly dribbles 
from the mouth, the patient filling cup after cnp, both by day and night. This sal- 
ivation, Dr. Thin tells me, does not occur in East Indian psilosis. Partly owing to 
the rawness of the mouth and partly to the constant accumulation of the saliva, 
speech is both painful and difhcult, the secretion having to be swallowed or expec- 
torated with every sentence. When the disease attacks the robust, the general 
appearance ot the patient may be healthy, but in the latter stages the condition is 
one of extreme emaciation. The redness of the lips and tongue can be recognized 
from a considerable distance. In addition to these alimentary symptoms, the backs 
of the hands only in some cases, in others tlie dorsal aspects of the feet as well, are 
seen to have taken on a coal-black pigmentation. In light mulattoes it is more 
marked. It often assumes the form of a gauntlet. The pigmentation of the extremi- 
ties, in the only two instances in which I have seen the disease in white persons, was 
of the hue which results from painting the skin with tincture of ioiliue. As will be 
seen on reference to the accompanying drawings, the pigmentation is very symme- 
trical, its limits being almost identical on the two sides of the body. It often extends 
no higher tlian the flexures of the wrists, but in the majority of cases reaches the level 
shown in the illustration (fig. 3). The symmetry of these lesions is most striking and 
highly suggestive of syphilis; and, indeed, in the first few cases which came tinder 
my notice, there was undoubtedly a syi)hilitic accompaniment. 

Latterly, however, I have been able in several cases entirely to eliminate syphilis 
as an etiological factor. As regards the etiology of this curious disease I have at 

S. Ex. 3G 14 



present no snfjjgcstions to offer. The pathological process giving rise to the forego- 
iiifi pictiiid is by no means clear. Its clinical features are, however, uni(|ue, and 
-\\\U, I Miink, best be appreciated by a record of a few typical cases which I have 
selected out of some thirty which have presented themselves to ray iTotice at the 
general hospital, Barbadocs. The features of the disease are unmistakable and 
constant. Tiie only variation is in their severity. 

On October 23, 1890, a black woman, Mary Lynch, aged 50, was admitted to the 
general ho.spital in what appeared to be the final stage of paihsia pigmentosa. Her 
family history was good. She had been the mother often children, eight of whom, 
at the time of her admission, were dead. The fourth and tcntli child, aged 15 and 
9 respectively, wore alive anJ well. 81ie had never had au abortion or prema- 
ture labor. There was no history of rheumatism, alopecia, or sore throat. Her 
reputed husband had always been a very healthy man, and was at the time cohabit- 
ing with another woman, by whom he had several other healthy children. As far 
as I could gather from her statements, there had not been any syphilitic taint in 
any of the children. Still, the fact of eight out often being dead looked suspicious, 
and although I could detect in tin; mother no evidence of syphilis, 1 placed this case 
at the time in the category of "doubtful cases," — f. e., among a certain number in 
wliich I was unable absolutely to exclude syphilis as an etiological factor. Accord- 
ing to her own account she had always been a healthy woman until two years 
previous to her admission, when she began to have dysjjcptic symptoms, — i. e., a 
sense of distention at the epigastrium, eructations of gas, and water-hrash, the fluid 
eructated leaving a burning sensation in the ])harynx and down the cpsophagns. 
With this there has been an increased secretion of saljva and irregularity of the 
bowels. For some weeks there would be diarrhea and then spells of constipation. 

Finally, there had been constant diarrhea, salivation, and loss of flesh. On her 
admission this woman's condition was most pitiable. She wa« terribly emaciated, 
worn almost to a shadow, the lii)S and entire mucus membrane (jf the mouth glazed 
and red. Confluent patches of aphthre covered the tongue and lining raucous mem- 
brane of the mouth. Tlie tongue was scarlet, perfectly raw, devoid of moisture, 
and, when she fell asleep, apt to adhere to the gums and roof of the mouth. Swal- 
lowing of the blandest materials caused most excruciating pain. She had constant 
diarrhea of a grayish, frothy character, the passages so numerous that no record 
could be kept of them, and so offensive tliat the patient had to be isolated. The 
backs of the hands, as far as the flexures of the wrists, were pigmented. With the 
gradual auvelioration of the symptoms the pigmentation wore off, and when in six 
months' time she left the hospital, there were no traces of it to be seen. 

Tiie treatment in this case was purely empirical. Absolute milk diet, with flax- 
seed tea to moisten the tongue. Bismuth, pepsin, and opium, chlorate of potassium, 
turpentine, and nepenthe, and extract of coto, were all tried in various combina- 
tions, but without api)arent success. Finally, on February 10, Kirby's mixture was 
tried, and coiucidently with its administration there appeared to be a marked 
improvement. By March 12 she had so far recovered her digestive powers as to be 
able to assimilate raw chipped beef treated with hydrochloric acid, and on March 
23 she was given the " full " diet of the hospital. The points worthy of note in this 
instance were the apparent amenability to dietary and therapeutic measures of a 
case in such an advanced stage, which is the more puzzling when the severity of 
the pathological lesions in the intestines in similar cases is considered. I have 
heard nothing of the woman since she left the hospital, but I can not believe her 
relief was more than temporary, and I suj^pose she will return to the hospital when 
the final outbreak of the disease comes on. From this case we also get a typical 
picture of the third stage of psilosis pigmentosa. Death invariably ends the scene 
in a short time. I have not since seen a case in that advanced stage recover. 

October 10, 1891, a healthy looking mulatto woman, aged 54, came to the out- 
patient department of the general hospital, complaining merely of constant eruo 


tations of gas and s:ili\ alioii. She had been suffering for two months in this way, 
biit had had no niediiine. The salivation in cases of ji'^Hosis pigmenfosa bears no 
resemblance to that caused by mercury, and is not likely to mislead any one. This 
woman's general condition, family history, and previous history were excellent, with 
one exception. She was a nurse, the daughter of two well-known, respectable married 
people, and had had thirteen brothers and sisters. All her brothers and sisters had 
been quite healthy. Both her parents had lived to extreme old age. Twenty years 
previous to my seeing her, the elder Dr. Manning had amputated her left breast. 
(Cancer?) With this excex)tion, she had never had a day's illness. Her tongue was 
narrow and pointed, slightly glazed, and of the typical scarlet color. The lining 
of an ordinary red pill box is approximately the color of a, psilosis pigmentosa tongue 
in the acute stage. Saliva was being constantly secreted so as to interrupt her con- 
versation, and she complained of her intestines feeling "as though a pot was boiling 
inside them." 

At first there was no diarrhea, but great irregularity in the movements. A fort- 
niffht before her adniissiou she stated that her hands had turned black on the dorsal 
aspects, but at the time of her admission they were normal again. She stated that 
they had been black two months previous to that, and had similarly become normal 
by the blackened skin jieeling off. This often occurs, and in the recurrent cases 
patients assure me they can always associate the acuteness of the diarrhea with the 
increased pigmentary deposit on the hands and feet. On her admission she was 
placed on a milk and arrowroot diet, and given a mixture of bismuth and jnilv. kino 

This, however, failed to.check the diarrhea entirely. Rectal injections of nitrate 
of silver were also tried, and by November 10 she had so far improved as to be able 
to eat broth diet, and by November 19 full diet with meat. On December 9 the 
diarrhea came on again, and from this time her progress was rapidly downward. 
No medication seemed to check the constant diarrhea, and she died of exhaustion on 
the 31st of December, i. e., in eighty-two days from the time she presented herself in 
the out-patient department, complaining only of dyspeptic symptoms. 

In the later stage of the disease the sj-mptoms were identical with those of Mary 
Lynch, and need not be recapitulated. The lips fiery red, the tongue raw, adhering 
to the inllamed buccal cavity when not artificially moistened, and yet saliva con- 
stantly pouring from the mouth so as to fill many cups in a day; the body wasted 
to a shadow, and yet no physical signs to indicate trouble in any other organs than 
the intestines. At no time was there any vomiting, fever, or headache. In this 
case the post-mortem ajipearances, as in all the others, were in accord with the clin- 
ical features, and will be described later on, together with the microscopical appear- 
ances of the intestine, which are identical in all cases. 

This woman had a history of possibly cancer of the breast, and in a great many of 
the cases which I have seen thei'e has been great difficulty in eliminating syphilis, 
cancer, leprosy, tubercle, etc., as possible antecedent conditions. I will therefore 
omit the details of all but those in which I feel certain of the disease being purely 

F. I., aged 23, was sent to me by Dr. Bannister, in April, 1892. He had been for 
some time under treatment for chronic irregular diarrhea. He was a healthy- 
looking young man and presented the typical signs of x>silosis pigmentosa — i. e., the 
backs of his hands to the elbows were pigmented and the tongue long, narrow, 
pointed, glazed, and scarlet. I made a note of his condition, and he returned to 
Dr. Bannister's care. 

I then lost sight of him until August 1, when he was admitted to the hospital. 
He was placed on a milk diet, and given nitrate of silver and opium in pill form. 
By August 9 his diarrhea had so far improved that he was given middle diet, and a 
week later full diet. On September 13 he had diarrhea, and was put on milk diet 
exclusively. He was also given a mixture of bismuth, tincture of catechu, spirits of 


cliloioform, and infusion of krameria. On this he seemed to improve, and Septem- 
ber 30 he could take small quantities of chicken tea. On Sei)tember 30, as the 
diarrhea seemed to linger on, he was ordered injections per rectum of 8uli>hate of 
copper (gr. v-3i) after each movement. By Octol»er 11 his diarrhea was hotter, ap- 
])arently, and his diet was changed to rice, milk, chicken, bread, and English pota- 
toes. From November 2, quinine and arsenic were given him as a tonic. November 
19 he was given full diet, but two days later, as there were symptoms of diarrhea, 
he was placed on absolutely milk diet, and was kept on it until his death on Febru- 
ary 17, 1893, the usual astringent drugs being tried in succession, but to no purpose. 

At the time of his death he had been in the hospital seven months consecutively. 
I tlius had an opportunity of watching a case of this curious disease from its incep- 
tion in a healthy young man until its fatal issue in eleven months' time. The 
features of the disease in its later stages were identical with those recorded before. 
At the post-mortem, which I made the day following his death, I found the condi- 
tion of the organs as follows: The lungs were pale, white, friable, and apparently 
free from any tuberculous infiltration. Microscopically, a slight catarrhal bron- 
chitis was revealed, whicli during life had given evidence of its jtresence by a few 
moist rales, but otherwise the lung was perfectly liealthy. There were no pleuritic 
adiiosions on either side. The pericardium and heart were normal and all the valves 
coiiij)etent. The liver ajjpcand smaller than normal, but not to a greater extent 
tlian would be accounted for by the general wasting of the body. There were no 
signs of gummata about it. The spleen was somewhat softened, the cesophagiis was 
reddened, ap]»arently denuded of its epithcliimi, while the stomach was normal. 
The kidneys were unalteicd. The intestines were very thin, white, and transparent 
looking, the small intestines at intervals of a few feet being puckered, as though 
they had been ligatured at these spots. Tliis ])uckering corresponded to a circular 
ulceration on the inner side of the gut, which had destroyed the entire mucous mem- 
brane at the intervals indicated above. The remaining portitm of the intestine 
between the sides of this annular ulceration was highly inflamed. The large intes- 
tine was a mass of ulceration, being s])oTted with tiny circular ulcers varying in size 
from a })in's head to a split pea. Tiie ulceration was very intense in the rectum, but 
presented none of the characteristics of syphilis. Microscopically, the villi of the 
siuall iutt>stine were found to be entirely devoid of their columnar ejiithelium. This 
is well shown in the drawing (Fig. 7). Towards the seat of the aunular ulceration 
they dimiuislied gradiiully in size. The ulcer itself extended only partly through 
the submucous tissue. The glandular structure of the intestine was entirely de- 
stroyed, its place being taken by a purely adenoid reticuluui inliltrated with leu- 
cocytes. The circular muscular fibersgradnally disai>peared as they approached the 
annular ulcer, and were linally lost, the submucosa, greatly thiuned, forming the 
tloor of the ulcer. As tubercular ulceration often runs, as in these cases, trans- 
versely round the bowel, it may be as well to draw attention to the fact that the 
villi in tubercular ulceraticm are enlarged and intiltrated and the circular muscular 
fibres swollen and enlarged. The peritoneal coat also is thickened and vascular, 
a condition not observed in my case. Giant cells would of course be found in the 
submucosa, the tubercular nodules extending into the muscular coat. 

Besides this, there are no indications of psiiosis pigmentosa being clinically like 

While tlie pathological process underlying cases of j>si7osis pigmentosa is very 
evident under the microscoi)e, the etiology of the disease is obscure. Neither age, 
sex, nor occupation can be considered as etiological factors. The earliest age at 
which I have seen the condition is three years, yet the piiznuiitation of the hands 
and the scarlet tongue were as well marked as in the adult. In the majority of 
cases, however, my patients have been adults. It occurs more often, I think, in 
wf>meii than in men, but I have not seen enough cases to sjieak jiositively on the 
subject. The disease is li.ible to intermissions, but may run its course without 
abatement in six or seven months. 







T', vili entirelj- denuded of ipitheliuni: [', site of annular ulceration, the vili entirely 
destroyed: i?, blood vessel in circular nuisculai' c^at, showing thickening of wall : 
C, circular muscular coat, gradually disappeariug: L. longitudinal uuiscular coat ; P, 
peritoneal fat; ^1/, submucosa with entire loss of gland structure. 


In constitutions previously undermined by syphilis, leprosy, tuberculosis, or 
alcoholism, its course is more rapid. 

Until further researches reveal the cause, treatment can only be palliative. In 
mild cases absolutely milk diet and intestinal astringents will at any rate not aggra- 
vate the disease. Nitrate of silver and opium by the mouth and rectal injections of 
the sulphate of copper seem to be indicated at times; but so far as my therapeutic 
knowledge goes we have no remedy capable of restoring the epithelium to an intes- 
tine psilosed to the extent shown in the drawings. As Dr. Thin aptly remarks to me 
in a private letter, " We are only now beginning to distinguish separate tropical 
intestinal affections which have been all roughly jumbled up together on account of 
diarrhea, an abnormal tongue, digestive symptoms, and emaciation being common 
to all." In an. association of medical men in which the tropics are largely repre- 
sented, I trust much additional light may be thrown on this at present obscure con- 


Of the two classes of micro-organisms with which the bacteriologist has to deal, 
the aerobic bacteria have received the most, and the anaerobic bacteria the least 
attention. The introduction of liquid and of solid transparent media has enabled 
the culture of the former to be carried on with the greatest ease, and for that reason 
the vast majority of bacteria known at the present day and all those forms, with 
the exception of three or four, which are commonly cultivated in laboratories belong 
to the aerobic class. Systematic and thorough examinations are constantly ])eing 
made of the bacteria found in water, air, soil, in disease and in fermentation, and 
yet as a rule such examinations are conducted wholly with reference to thejiresence 
of aerobic bacteria. It is true that most of the pathogenic bacteria known at the 
present day belong to this class, but it is likewise true that in the anaerobic class 
are to be found bacteria equally important. 

The first known representative of this group was described by Pasteur in 1861 
under the name of ''vibriou butyriqne" or "butyric acid vibrio." This discovery 
and the subsequent work carried on in this connection firmly established the exist- 
ence of micro-organisms which were not only capable of living, but were actually 
compelled to live in the absence of oxygen. The next important step was made iu 
1878, when Pasteur, Joubert, and Chamberland described the first pathogenic anaero- 
bic bacillus, the " vibrion septique" which at present is known to tlie scientific world 
through the labors of Koch and of (JatFlcy as the bacillus of malignant oedema. 
Since then two other pathogenic anaerobic bacteria have been described, namely, 
the bacillus of symptomatic anthrax by Ai'loing, Cornevin, and Thomas (1880) and 
the bacillus of tetanus by Nicolaier (1885). 

As already stated, most of the bacteriological work carried on hitherto has been 
with aerobic bacteria, and as a result, the known representatives of this class maybe 
numbered by hundreds, while, on the other hand, the much neglected group of anae- 
robes scarcely includes a dozen. It must not be imagined for a moment that this 
great diH'erence actually represents the relative numerical existence of the represen- 
tives of these two classes, for such is not the case. There is every reason to believe 
that the number of patliogenic and nonpathogenic obligative anaerobic bacteria is 
much greater than is commonly supposed. 

The explanation for this marked difference must therefore be sought elsewhere. 
It may be said that the chief reason lies in the ease and convenience with which 
aerobic bacteria can be cultivated, whereas the culture of anaerobic bacteria is 
tedious and diliicult and requires special apparatus. Suitable apparatus and suita- 
ble culture media, especially the latter, are prime requisites in growing anaerobic 


bacteria. Numerous methods and different kinds of apparatus have been at various 
times described, and while some of these are good yet most of them, it must be con- 
fessed, are far from bein<j satisfactory. 

The methods of anaerobic culture can be described under the followinij heads: 
(1) Exclusion of oxygen; (2) exhaustion of air; (3) absorption of oxygen j (4) dis- 
placement of air; (5) cultures in the presence of air. 


The methods that have been described under this head attempt to exclude or pre- 
vent access of oxygen to the culture medium. ■ This object can be accomplished, 
to a greater or less extent, by the following methods: 

{!) Layer of oil. — Pasteur, as early as 1801, resorted to the covering of culture 
medium with a layer of oil, and this method was subsequently used by others and 
tested by liiborius. Api)roximately anaerobic conditions can thus be obtained, but 
the method is not one that can commend itself for neatness or exactness. 

(2) Mica plates. — In 1884 Koch suggested covering ordinary gelatin plates with a 
thin lilm of mica, but this was shown by Liborius to possess little or no merit when 
applied to the culture of obligative anaerobic bacteria. More recently Sanfelice has 
employed, with good results, a modilication of tliis method. Gelatin or agar plates 
are made as usual and then covered with a sterilized glass plate. The colonies 
which tlius develop can be readily examined under the microscope and are access- 
ible for trans])lantation. 

(3) Deep layer ciiUiire. — This method, so commonly and successfully employed at 
the present day, was introduced by Hesse (1885) and later was more extensively 
ap])lied by Liborius. It is exceedingly convenient and enables one to obtain stick 
cultures or isolated colonies in gelatin or in agar. All that is necessary is to employ 
;i deep layer of the nutrient medium 4 to 6 cm. high. Growth takes place in tlie 
lower part of the tube since access of oxygen is prevented by the upper layer of the 
medium. Very often an extra layer of agar or gelatin is poured upon the surface 
of the inoculated medium, but this, as a rule, is unnecessary. Colonies may be 
obtained by inoculating the culture medium while liquid, and then, after solidifica- 
tion, covering the contents of the tube with an extra layer of gelatin or agar. The 
hitter addition, however, is not necessary, since growth occurs without it, beginning 
at about 1 cm. below the surface of the medium. The colonies are usually reached, 
for purposes of transplantation, by breaking the tubes. The procedure of Sanfelice 
is undoubtedly preferable. In this the bottom of the agar tube is warmed and the 
agar cylinder is then shaken out upon a sterilized plate or dish, where il. is cut up 
into parallel disks or sections. The colonies can then be examined under the micro- 
scope and transplantations made in the usual manner. 

Liborius, in his work on the anaerobic bacteria, made plate cultures in the usual 
uumner and then covered these with an extra layer, 1.5 cm. deep, of agar. lu this way 
ho succeeded in obtaining colonies of malignant cedema, which he failed to obtain 
with ordinary plates in hydrogen. 

The roll-culture method has also been recommended by Esmareh for obtaining colo- 
nies of anaerobic bacteria. For this purpose the gelatin or agar is inoculated and 
dilution made, as usual. The medium is then caused to solidify on the inside of the 
tube in a thin layer, and while cold the tube is tilled with liquid gelatin or agar. 

The principle of deep-layer cultuie was applied in 1887 by Vigual to the so-called 
glass-tube culture. A tube about 1 m. in length is drawn out at one end and plugged 
with cotton at the other. When sterilized it is inserted into the inoculated gelatin 
or agar, and by suction this is now drawn up into the tube. When fui;, both ends 
are sealed and the tube is set aside to solidify and develop. Isolated colonies in this 
way are readily obtained and can be reached by cutting the tube. This pioceduro 
of VMgnal has virtually been redescribed in 18!t0 by Van Senus. who otnployed a tube 
bent in (J-form so as to siphon olf the iuoculated liquid gelatin from the test tube. 



The Roux pipette cultures, where special pipettes are filled with inoculated gelatin 
and then sealed at both ends, may also be spoken of as modified glass-tube cultures. 
Capillary tubes have similarly been used by Klebs and by Salomonsen and more 
recently by Nikiforoff. 

Another modification of the deep-layer cnltnre is to exclude the oxygen, not by an 
extra layer of the culture medium, but by growing on the surface of the agar or 
gelatine some germ which has marked avidity for oxygen. With this object in view 
Roux (1887) recommended the bacillus subtilis. The proteus vulgaris has been 
employed for a similar purpose by Liborius (1886). 

Under this same head may be mentioned the egg-culture of Hueppe (1888) and the 
deep potato cultures of Gaff ky (1881), by which he cultivated the bacillus of malig- 
nant oedema. 


It would almost naturally suggest itself to obviate the deleterious action which 
the oxygen of the air exerts on the growth of anaerobic bacteria by exhausting the 
air from the culture tube or apparatus by means of a suitable air pump. 

(1.) Direct vacuum cultures. — The principle of vacuum culture was applied by 
Pasteur, Joubert, and Chamberlandin their study of the "vibrion septique." These 
investigators employed a special and complicated form of glass apparatus consisting 
of a U tube, with sealed ends and with lateral attachments. The convex portion of 
the tube is connected with a glass tube which is sealed as soon as a vacuum is made. 

The method of Gruber (1887) is commonly employed at present for obtaining 
vacuum cultures. Special large-sized test tubes, with constricted necks, are 
employed. Wlien inoculated the tube is connected with an air pump, or an aspirator 
and is finally sealed in the flame of a Bunsen burner or blast lamp. A somewhat 
similar vacuum tube, provided with a side tube connection, has been employed in 
the same way by Roux (1887). An excellent advantage of this method lies in the 
fact that it can be utilized in obtaining colonies. For tliis purpose the tubes as 
soon as sealed, may be converted into Esmarch roll cultures. 

To obtain colonies in a vacuum, Roux recommended the use of a large tube, with 
constricted neck, which is evacuated, then sealed, and placed on its side to develop. 

The apparatus described by Klebs is adapted to show the effect of partial vacuum 
(or compression) and consists of a tabulated bell-jar inverted over mercury. 

(S.) Instead of producing a vacuum direct by exhaustion some investigators have 
resorted to the expulsion of air by aqueous vapor. The special tube or flask con- 
tains the nutrient medium which is boiled until all the air is expelled by the aqueous 
vapor, then sealed, and when cool the medium is inoculated from a side tube attach- 
ment. Such apparatus has been employed by Pasteur, Hiifner, Rosenbach, Liborius, 
and Aitken. This process, however, may be said to be obsolete at the present day, 
inasmuch as any desirable vacuum can be readily obtained with a pump without 
concentrating the culture fluid to such a marked extent as is usually done in this 


All methods based upon this principle utilize the fact that an alkaline solution of 
pyrogallic acid absorbs oxygen with avidity. This method was first employed by 
Nencki, in 1880, to demonstrate the existence of anaerobic organisms. A practical 
application, however, was not made until 1888, when H. Bucliner devised the method 
which bears his name. The culture tube is placed inside of a larger one, in the bottom 
of which is an alkaline solution of pyrogallic acid, and the outer tube is then closed 
with a rubber stopper. As can be readily seen, this method is exceedingly simple 
and can be resorted to at any time. Babes and Puscarin have employed the same 
method with excellent results for serial cultures of the bacillus of tetanus. For this 
purpose the tubes were placed in a Fresenius desiccator, in the bottom of which was 
a large quantity of alkaline pyjogallate solution. 


Trambnsti (1892) has constructed a special apparatus for obtaining plate cultures 
of auaerobic fiernis by moans of this solution. The principle has also been applied 
in two different ways in making hanging-drop examinations of anaerobic bacteria. 
Thus, Braatz (1890) designed a special slide made by Desaga, uf Heidelberg, whereas 
Nikiporoff (181)0) employed the ordinary concave slide, or that of Schultze, 


This can be readily accomplished by pa.ssing through the culture apparatus a cur 
rent of indifferent gas. Hydrogen is commonly used fortius pur])ose, inasnnich as 
it is ordinarily held to be an inert gas. There seems to be considerable reason to 
b('Ii(n'e, however, that hydrogen is not iibscdutely inert, inasmuch as it is a matter of 
frequent ex])erience to find cultures fail of developnunt where hydrogen has perfect 
access, as in plates, Esmarch roll tubes, and surface streaks on agar. Nevertheless, it 
may be truly said that hydrogen is the best gas that we have at present for anaerobic 

Carbonic acid has been used a great deal by the French bacteriologists. It is not, 
however, an indifferent gas, inasnnich as when absorbed by the culture medium it 
maj' render it acid and thus prevent growth. Franikel showed, in 18S9, that symji- 
tomntic anthrax bacillus in bouillon, and malignant O'dema bacillus in bouillon and 
gelatin, failed to develop in carbonic acid, and the experiments of Frankland (1889) <l 

also seem to show that carbonic acid not only inhibits the growth, but may even 
kill bacteiia. Kitasiito Iil<ewise failed to obtain growths of symptomatic anthrax 
in carbonic acid, altlioiigh the Fremh investigators of this disease emjiloyed this 
gas exclusively. Pasteur, .Joubert, and Chamberland ciMi)loyed carbonic acid 
in cultivating their "vibrion sejitique," but Galfky succeeded but once in obtaining 
cultures of the germ in this gas. 

The failure to obtain cultures in carbonic acid has led to its practical disuse for 
auaerobic work. 'I'lie difficulty, however, does not lie so much in the deleterious 
action of this gas as it does in the (pialitv and reaction of the culture medium. As 
already stated, the culture medium must be given tlie first attentiou, as it is the 
most important condition for the growth of anaerobic bacteria. By nsing fresh or 
reheated bouillon, esjtecially 2 per cent gelatin bouillon, or ordinary glucose gelatin 
having a suitable degree of alkalinity, no difficulty has been experienced in culti- 
vating the bacilli of tetanus, nuilignant ledema, sym])tomatic anthrax, and anew 
anaerobic bacillus, the " bacillus OMlematis maligni No. ii,'' which will be separately 
described. Not only that, but cultures of the latter bacillus and of tetanus have 
been kei)t in carbonic acid for a month without losing their vitality. 

Nitrogen has also been recommended as an inert gas, and possibly it may prove to 
bo best adai>te(l for aimerobic work. It has not been used to any extent, chiefly 
owing to the difficulty of (d»taiuing the gas in (luantity. In the absorjition methods 
already described the residuary gas is nitrogen, containing small auu)unts of carbon 

Other gases, as carbon monoxide, hydrogen sulphide, nitrous and nitric oxides, 
and suljihurous acids have been studied by Frankland. All these arc said to either 
inhibit the growth of bacteria or actually destroy them and are, therefore, not 

Illuminating has been highly recommended as a convenient means of displac- 
ing air from culture tuV)es and flasks by Wurtz and Foureur (1S89). Kladakis sub- 
sciiuently tested the action of illuminating gas on a large number of aerobic bac- 
teria, and also on the tetanus bacillus, and found that with the exception of " ]iroteus 
vulgaris'' the growtli was inhibited, an 1 that in same cases the micro-organisms were 
actually destroyed. For this reason he condemned the use of this gas for anaerobic- 
culture. The conclusion arrived at is not strictly correct, inasmuch as he tested the 
action of the gas on Esuiarch roll tubes made after Fraeukel's method. It is a fact 
that similar roll-cultures, and even plates often fail in hydrogen, aud yet this gas is 


usually held to be inert and is highly recommended for auaerobic-culture. Further- 
more, it shuold be borne in mind that the compositiou of the gas in diftereut locali- 
ties may vary considerably and that, therefore, the gas of one locality may be suit- 
able for culture, whereas that of another place may be wholly nutit. 

With a suitable culture medium it is not at all unlikely bnt that cultures of the 
anaerobic bacteria can thus be readily made. What has been said in connection 
with carbonic acid is equally true here, and cultures in illuminating gas have been 
obtained of the tetanus bacillus and the uew bacillus mentioned. Such cultures 
preserve their vitality in that gas for a considerable length of time. 

Having thus somewhat briefly considered the vai-ious gases which may be used to 
effect displacement of air, it is desirable to touch upon the various forms of appara- 
tus which have been recommended for use in this connection. 

The complex U-shaped apparatus of Pasteur, already mentioned as employed for 
vacuum cultures, has also been utilized for cultivating anaerobic germs in atmos- 
pheres of carbonic acid and hydrogen. The apparatus, however, is far from being 
satisfactory for general work and is scarcely employed at the present time. 

The first attempt at approximating the ordinary tube-culture was made in 1885, 
by Hauser, who employed test tubes with two lateral tubes through which a current 
of gas could be passed after which the tubes were sealed. This tube has been im- 
proved upon by Liborius, and with this well-known modillcation anaerobic-cultures 
can be readily made. As a convenient substitute for the Liborius tube, whicli may not 
always be on hand, Roux (18S7) recommended an ordinary test tube somewhat con- 
stricted below the neck by means of a lamp. Through the ■cotton plug a sterile 
capillary tube is inserted and through this hydrogen is passed until all the air is 
expelled. The delivery tube is then carefully withdrawn and the culture tube sealed 
in a flame. This same modification has been practically redescribed by Heim and 
by Ogata (1892). 

In the method of Liborius, or its modification, as just given, one serious disad- 
vantage is encountered. The tubes can be employed bnt once, and this at times— 
as where a large number of cultures are to be made — may be a source of consider- 
able expense. To obviate this difficulty and to combine the advautanges of the 
Liborius tube with that of Gruber, led Fraeukel (1888) to introduce a simple and 
excellent method. He employed ordinary wide test tubes which are closed with a 
double perforated stopper, through which pass two glass tubes, one of which 
extends almost to the bottom, and the other reaches just below the stopper. This 
culture tube, when filled with nutrient gelatin or agar, is sterilized, then inocula- 
ted and a current of hydrogen passed through the tube. When all the air is 
expelled the glass tubes are sealed and the stopper covered well with hard paraffin. 
In this way cultures can be readily prepared at a trifling expense. A further advan- 
tage of this method lies in the fact that the tubes can be used, if desirable, for 
Esmarch roll-culture, and moreover the growth is always readily accessible. 

Sternberg has slightly modified the Fraenkel method in this way. The cotton of 
the inoculated tube is cut off, then pushed down into the tube and the rubber stop- 
per with two glass tubes is inserted and hydrogen passed into the tube. The glass 
tubes are finally sealed and the cultures set aside to develop. Essentially the same 
process as that of Fraenkel was employed about the same time by Brieger and by 
Hueppe for flask cultures. 

Tlie tube-cultures just described are ordinarily employed for bouillon or gelatin 
cultures. For surface growths on agar or blood serum the method of Fuchs or any 
of its modifications may be utilized. According to Fuchs (1890^ the agar or blood- 
serum tube is inverted and a current of hydrogen passed in for one-half to one 
minute. The tube is then rapidly closed with a sterilized rubber stopper, which is 
rendered perfectly tight by means of paraffin, and set aside in an inverted position 
to develop. Van Semes (1890) modified this method by first consti'icting the neck 
of tb.c tube, and then, after passing hydrogen through a capillary tube inserted 


throtioh tlie cotton jiliie;, tbe culture tube is scaled in a flauu-. Tlii.s proiedure it will 
he seen is virtually the same as that employed by Roux, Ogata and ilcim. Bliiclier 
(1890) inverted tbe inoculated tubes over dilute glycerin and then passed in hydrogen, 
whilst still more recently Hesse has advised the nse of mercury. The culture tube 
is inverted over a crncible containing mercury, placed on the bottom of a narrow 
tall beaker, and hydrogen is passed into the tube until all the air is displaced. 

The ])riiiciple of displacement of air has also been utilized for obtaining colonies 
of anai'roltic bacteria by tbe usual plate method. LiViorius in 188G employed ordi- 
nary glass plates or l'<'tri dishes which were placed on a rubber base and covered 
with a flat strong cylinder jirovided witii two tnbulnres through which hydrogen 
could be passed. The ai)i)aratu8 was rendered gas-tight by compressing the glass 
jar against the rubber base by means of thumbscrews. Bliicher (1890) recommended 
a simple and easily constructed apparatus consisting virtually of a funnel inverted 
over a glass «lish containing dilute glycerin. Hydrogen is passed through the 
funnel and the air is forced out at tin; bottom. A more convenient a]»]>aratus is that 
of ISotkiu (1890). In this apparatus as numy as six Petri dishes can be jjlaced at the 
same time. Air is excluded by means of liquid parafhn. Hesse has suggested the 
inversion of a bell jar over mercury contained in a circular trough on a cast-iron 

Kitasato in connection with his study of the bacillus of tetanus employed a some- 
what peculiar apparatus for plate purposes. This is flat and flask-shaped with the 
rather wide neck turned upwards. Ou the upper surface near the farther end is a 
narrow glass tube which serves to connect with the next dish. These dishes of 
Kitasato are sterilized and the gelatin or agar, previously inoculated, is then poured 
in and allowed to solidify on the bottom in the same manner as in a Petri disb. 
They are now connected together and hydrogen is passed through. When all the 
air is disjdaced the ends of each flask are securely clamped, scaled with paratlin, and 
the flasks are then set aside to develop. A modification of Kitasato's dish has been 
recently (1893) described by Roth. 

The tube recommended by Roux for obtaining plate-cultures in a vacuum may also 
be employed in connection with hydrogen or other gases. The gas may be intro- 
duced by means of a capillary glass tube inserted through the cotton plug, and when 
the air is expelled this tube can be carefully withdrawn and the neck of the flask 
sealed in a flame. 

Special single plate dishes for anaerobic-culture have been devised by Gabrit- 
schewsky (1891), Kameu (1892), and by Ahrens. 

It is perhaps well to repeat in this connection that the tubes of Liborius or of 
Fraenkel can be treated as Esmrach roll tubes and in this way anaerobic colonies 
can be secured. 


All tbe methods thus far described are more or less complicated, and the ideal 
method for the growth of anaerobic bacteria would be the one which would do away 
entirely with special apparatus and in which the growth would take place under 
conditions similar to those employed in connection with the culture of aerobic 
bacteria. With such an object in view Kitasato and Weyl studied the action of a 
large number of reducing and oxidizing chemical compounds in the hope of finding 
some substance which would enable anaerobic bacteria to grow under ordinary con- 
ditions. Although they were unsuccessful in their search they have ueverthelcss 
shown that certain reducing compounds, as sodium formate, sodium indigo sulphate, 
resorcin, etc., can be used to advantage in cultivating anaerobic bacteria. 

Penzo (1891) has succeeded in obtaining growth of anaerobic bacteria in air by 
imitating the conditions which undoubtedly exist in uature. He showed that tubes 
inoculated with the bacillus of malignant cedema would develop in the air if 
inoculated at the same time with an aerobic germ as the micrococcus prodigiosus 

Fig. 1.— One-fouith natural size. 


or the proteus vulgaris. The cnltnres thus obtaiued are highly virulent, but are 

On tirst consideration it ■would seem to be impossible to obtain pure cultures of 
anaerobic bacteria in liquid media in the presence of air. Nevertheless this can be 
accomplished by paying special attention to the culture medium. Thus ordinary 
glucose gelatiu, especially when colored with litmus, readily furnishes cultures, at 
a temperature of 37-39° C, of the 4 anaerobic bacteria already referred to. Similar 
results have been obtained with a fresh 2 per cent gelatin glucose bouillon. Further- 
more an interesting fact bearing on this point maybe mentioned. In freshly solidi- 
fied glucose .agar a drop or two of water of condensation usually accumulates on the 
surface and if stick cultures are made in such tubes growth takes place not only 
along the stick but the surface liquid becomes turbid, gas bubbles form and on 
examination it will be found to swarm with actively growing anaerobic bacilli. This 
has been observed thus far with the bacillus of malignant oedema, the bacillus of 
symptomatic anthrax, and the "bacillus cederaatia maligni No. II." 

Of the methods thus briefly- described only a small number have met with favor 
among bacteriologists. The methods, more or less, in general use are: The deep 
layer culture of Hesse and Liborius. The vacuum tube cultures of Gruber. The 
hydrogen cultures in Liborius or Fraenkel tubes, or in Botkin's apparatus. The 
alkaline pyrogallate method of Biichner. 

For occasional single cultures either of these methods give excellent results. On 
the other hand there are times, as in the extended study of a given anaerobic germ, 
when it is desirable to make a lai-ge number of cultures, very often in sets. In such 
cases the insufficiency of the above methods soon becomes apparent. Thus, the 
vacuum tubes of Gruber and the hydrogen tabes of Liborius possess the disadvantage 
that they can be used but once, and therefore where a large number of cultures are 
to be made the expense becomes considerable. The matter of expense so far as 
hydrogen tubes are concerned has been reduced to a minimum by Fraenkel's modifi- 
cation, but even this, convenient as it may appear, has at times serious drawbacks. 
Thus the tubes require sealing in a flame, and while this operation is simple and 
easy it becomes very tedious and is not without danger when a large number of cul- 
tures are to be made. Furthermore sets of cultures made in this way are not strictly 
comparable, one with another, inasmuch as there is no positive uniformity in the 
series. The pressure of hydrogen in the difterent tubes may vary; the air may be 
more or less incompletely displaced, or a leakage may result without being noticea- 
ble. Similar objections may be likewise brought up against the vacuum tubes of 
Gruber. Moreover the operation of sealing tubes, whether with a vacuum or with 
hj'drogen, is not one which commends itself for general and extended use. 

These objections to the methods commonly in use were forcibly felt in connection 
with the study of the new pathogenic anaerobic bacillus, the bacillus cedematis 
maligni No. 11. The attempt was therefore made to devise or construct some simple 
apparatus which could be used for vacuum or for hydrogen cultures and which would 
permit the use of the ordinary 12 or 15 cm. test tubes and would not require sealing 
in a flame. 

The following apparatus has satisfied all requirements in that direction. It has 
been in constant use during the past year, and with it many hundreds of cultures of 
various anaerobic germs, including the bacilli of tetanus, maliguant oedema, and 
symptomatic anthrax, have been made either in vacuum, hydrogen, carbonic acid, 
or other gases. 

This apparatus was made for me by Greiner »& Friedrichs, of Stlitzerbach, i. Thii- 
riugen, and is constructed on the principle of the well-knowa gas wash bottle of 
these makers. The glass stopper is hollow and opens below, and on opposite sides 
are two openings into one of which is fused a glass tube which extends down to the 
bottom of the bottle. Into the neck of the bottle are fused two glass tubes, the 
openings of which correspond to the openings in the stopper. All that is therefore 
necessary to seal this bottle is to turn the stopper at an angle of 90°. 


Not only can this apparatus be euiploytMl for culture with various gasses, hut it can 
likewise bo used for vacuum cultures. lu tlmt case it is desirable to attach eitlier 
by fusion or by strouj^ rublxT tuVdnif, a j;lass stopcock to each arm. Screw clamps 
can, of course, be also employed, but are less desirable. This is necessary, since 
when a vacuum is produced witliiu the bottle it is almost impossible to turn the 
stopper. The accompaiiyinj^ H<j. 1 represeuta a bottle of this kind. 

The method of using this apparatus is briefly as follows: Ordinary culture tubes 
(12 or 15 cm. in length) are inoculated. The cotton plugs are cut off close to the 
tubes and are then raised slightly so as to be perfectly loose and thus aid dif- 
fusion. The tub(?s are placed by means of a pair of long forceps in the bottle, the 
bottom of which it is best to cover with a layer of cotton. In this way it is possible 
to make as many as 40 or 50 cultures, side hy side, and under exactly the same con- 
ditions. The stopper is then introduced, care being taken that the openings in the 
stopper correspond with the openings of the tubes in the neck of the bottle, and 
the apparatus is connected with a Chapman aspirator or other form of air pump. A 
vacuum, siiiricieut for all purposes, can be readily obtained. Thus a partial vacuum 
of GOO to Gr»0 niiu. readily grows such well-known anaerobic germs as those of tetanua 
malignant oedema and symptomatic anthrax. 

Instead of producing a vacuum in the culture bottle the air present may be dis- 
placed by hydrogen, or any other gas that it is desirable to experiment with. It is 
best to allow hydrogen to enter at the top and to leave the bottle at the bottom 
through the long tube. With carbonic acid the reverse is done ; it is passed through the 
long tube to the bottom and leaves the bottle at the top. The exit tube is connecteil 
witji a small wash bottle containing water which serves as a valve to prevent the 
entrance of air into the bottle. The gas is rapidly passed through for one to two 
honrs. The stopper is theu turned at right angles, and the bottle disconnected and 
set aside to develop. 

The displacement is accomplished more rapidly by first creating a vacuum in the 
bottle iiiid tlien admitting the hydrogen, or whatever gas is used, through one of 
the lateral stopcorks. When the bottle has become tilled with gas it may be 
reevacuated and hydrogen again aduiitted. By repeating this once or twice and 
then passing a steady current of the gas for about a half an hour perfect displace- 
ment is obtained. When working with a vacunra the stopper should not be turned 
so as to seal the bottle, inasmuch as it then would almost be impossible to open it. 
The lateral stopcocks or screw clamps must be used instead to hold the vacuum. 

Not only can such a bottle be employed for either vacuum or gas cultures, but it 
can and has be<^n used to obtain cultures by the absorption method. For this pur- 
pose the inoculated tubes are ])laced within the bottle on the bottom of which is a 
strong solution of sodium or potassium hydrate. The stopper is inserted and a con- 
centrated solution of pyrogallic acid is aspirated into the bottle through the glass 
side tube which connects with the inner tube that extends to the bottom. The 
stopper is then turned and the bottle is ready to be set aside for development. 

The above apparatus can be obtained of Greiner & Friedrichs (or through Messrs. 
Einier &. Amend, of New York) in two sizes. The sto))pers have a diameter of 4 cm. 
No. 1 has TlU internal diameter of 10 cm. and the height of the bottle to the neck is 
20 cm. It is iuteuded for the large 15 cm. culture tubes. No. 2 has an internal 
diameter of 8 cm. and the height of the bottle to the neck is 15 cm. It is intended 
for the small (12-5) test tubes. Either size can also be obtained with glass stop- 
cocks already fused into the lateral tubes. The price of the bottle without lateral 
stopcocks is about 6 marks, and with stopcocks, about 10 marks. 

A convenient substitute for the ajiparatus Just described can be constructed by 
any one in a very short time and at little expense. A strong wide-mouth bottle is 
selected which has an internal diameter of about 9 cm. The height to the neck is 
about 15 cm. The mouth of the bottle should be about 5 cm. wide and is closed with 
a double iierforated rubber stopper. It is desirable, especially when it is to be used 

Fig. 2.— One-fourth natural size 



for vacuum purposes, that the sides of this stopper sLint at a considerable angle in 
order to prevent tlie forcing of tlie stoitjicr into the bottle by atniosiiheric pressure. 
The stopper for the above bottle has a lower diameter of 5 cm. and an upper diameter 
of 5.7 cm. 

Two glass tubes with glass stopcocks are now selected and one arm of each is bent 
at right angles and inserted into the stopper. Below the stoppper one of these tnl)es 
is connected by means of a piece of rubber tubing with a glass tube which nearly 
reaches to the bottom of the bottle. The end of the other tube terminates on a level 
with the lower surface of the st0])per. Such an apparatus is represented in fig. 2. 

With this simple apparatus cultures can be made in the same manner as with the 
previously described l)ottle. The anaerobic pathogenic bacteria already mentioned 
can thus be readily grown in vacuum, or in hydrogen or other gases. The alkaline 
pyrogallate method can be used in the same way as that given in connection with 
the former bottle. 

The glass stopcocks will hold a vaeuum perfectly if covered well with vaseline. 
As a matter of precaution it is desirable to seal the rubber stopper with paraffin 
having a high melting point, 46 to 56^ C. 

The commendable features of the apparatus in either form may be summarized as 
follows: (l)-It is cheap, clean, simple, and effective. (2) It is adapted for culture 
with alkaline pyrogallate solution, or in vacuum, or with any desirable gas. (3) 
It does not re(^uire special cultur<; tubes— ordinary test tubes are used. (4) It per- 
mits parallel cultures to be made, even in large numbers, and all under exactly the 
same conditions. (5) It can be used for bouillon or gelatin cultures; for stich 
cultures; for streak cultures on agar, blood serum, or potato, and also for esmarch 
roll cultures. (6) It rec^iires no sealing in aflame. 

Colonies of anaerobic bacteria unless on plates or in Petri dishes are very difficult 
to study and to photograph. As plate cultures very oiteu fail for some unexplaina- 
ble reason, the following method has been used to obtain colonies: The flat bottles 
or dishes (6 cm. in diameter and about 0-8 cm. in thickness) as recommended by 
Krai for making permanent bacteriological collections of colonies are lilled about two- 
thirds full witli the nutrient medium, sterilized and then inoculated with the germ 
and set aside to develop. Owing to the flat, shallow form of the dish, it can now be 
placed on the stage of the microscope, and the colonies can be examined witli as 
nmch ease as on a plate. Unfortunately the colonies in these flat-dish cultures are 
not accessible for transplantation. 

Culture media. — The essential requirement to success in the culture of anaerobic 
bacteria lies in a suitable nutrient medium. In general terms it may be said that a 
slightly alkaline medium is best adapted for this purpose. Exceptions to thisstate- 
ment will be found among the anaerobic in the same way as such exist in the aerobic 
bacteria. The bacillus of symptomatic alithrax, for instance, is best grown accord- 
ing to Kitasato on slightly acid media. It can, however, grow on distinctly alkaline 
media, although perhaps less abundantly. 

The anaerobic bacteria readily grow in strongly alkaline bouillon, but the vitality 
of such cultures is rapidly lowered and finally they die out completely. Some times 
death results within two days after the inoculation and that in spite of the fact that 
the growth at first was excellent This was especially the case with "Bacillus ledem- 
atis maligni. No. II." 

Great stress is also frequently placed upon the use of perfectly fresh culture 
media. There can be no doubt but that fresh bouillon or agar is better ada^ited 
than old material for the growth of these organisms. Thus it is frequently observed 
in working with a given set of bouillon tubes that in the course of a week after 
they are made and often in less time the cultures develop more slowly and less 
abundantly than when the material was fresh. This difference in growth can be 
•lemonstrated by making parallel cultures in old bouillon and in the same after 
heating it in the steam sterilizer for about a half an hour. The set of heated bouil- 


Ion ttibes will show a much more abundant growth and more gas formation than 
the cultures in the old unlieatod bouillon. 

It is thereforii dosirable, when working with old bouillon or agar, to beat it up 
about once or twice a week to expel the dissolved gases. Gelatin tubes apparently 
do not require this ])rccaution. At least the same set of gelatin tubes have been used 
for more than six months without encountering any dithculty. 

Failure to grow, however, is more ofteu traceable to the culture employed than to 
the medium itself. Thus experiments with bouillon tubes of diverse age, ranging 
from one day to four montlis, were found to give negative results with most of the 
old tubes when the inoculation was made from old cultures, but when made from 
perfectly fresh, vigorous cultures, no difficulty was experienced in obtaining positive 
results in all of the tubes. 

In cultivating anaerobic bacteria, it is therefore desirable to employ either fresh or 
reheated nutrient media and to inoculate from fresh, vigorous cultures. 

With reference to the nutrient-media proper, it can be readily shown that the addi- 
tion of peptone favors tin* growth of anaerobic bacteria. Bouillon without peptone 
is a very poor medium for this purpose. When 1 per cent of peptone is added the nu- 
trient qualities of the medium are strikingly improved and this effect is still further 
brought out by increasing the amount to 2 per cent. Any considerable addition above 
this amount is without value and if anything tends to diminish the nutrient value of 
the medium. 

The culture media can be still further improved by the addition of 2 per cent of 
glucose as was originally rcconimtnded by Liborius. The sugar is said to act as a 
reducing substance wherclty any free oxygen that may be present is renjoved and thus 
the growth of the anaerobic germs is assisted. The action of other reducing sub- 
stances has been tested by Kitasato and Weyl, and although similar )>eneficial effects 
may be obtained by the use of small amounts of various organic reducing substances, 
nevertheless their moreor less poisonous action prevents their general use. Several of 
these, as sodium formate, sodium indigo sulphate, and resorcin have been strongly 
reconnuended by Kitasato and Weyl. There are times undoubtedly when the addition 
of these substances may prove useful. Thus, sodium indigo sulphate nujy serve as 
an indicator of the reducing action of a given germ. For general purposes, how- 
ever, they possess no marked advantage. 

Sodium indigo sulphate was used to indicate reduction changes as early as 1858 by 
Traube. In lf<37 Spina employed this compound and also indigo blue and methylene 
blue for similar purposes. Finally in .890 Kitasato and Weyl, independently of the 
others, studied the action of sodium indigo sulphate on the growth of anaerobic 
bacteria, and reconnuended its use in additions of 0-1 per cent, liraatz employed it 
in smaller amounts, 1,000 to 6,000 or 7,000. 

The addition of litmus to the nutrient medium is often of very great value. Litmus 
was originally recommended by Buchuer to indicate changes in reaction produced 
by bacteria. Subsequently Calien proposed to use it, not only as an indicator of 
the reaction, but also for its reducing powers. Many bacteria, especially the ana- 
erobic forms, readily reduce litmus to a colorless luco-substance which, according to 
the reaction, becomes converted into a red or blue color as soon as oxygen is admitted. 
If glucose is present acids are formed and as a result the litmus is colored red, other- 
wise it remains violet. 

To some extent the addition of litmus favors the growth of these micro-organisms 
but its special value rests in the protecting action which it exerts on anaerobic 
germs. Cultures of anaerobic bacteria, as those of tetanus, malignant oedema and 
symptomatic anthrax preserve their vitality for many months even in liquid nu^dia, 
exposed to air, provided they are colored with litmus. Tliis peculiar and valuable 
action is perhaps due to the litmus absorbing certain rays of light which tend to 
destroy these organisms. 

Another substance which can be employed to very great advantage iu the culture 


of anaerobic bacteria is gelatin. This substance has not to my knowledge been 
recommended as an addition to nutrient media for improving their value for ana- 
erobic work. As a matter of fact the addition of small amounts of gelatin is of 
as much value as the addition of peptone. Additions of 2 to 5 per cent gelatin 
have been used with great satisfaction. 

Perhaps of more importance than this beneficial action of small amounts of gelatin 
is the fact that suitable additions of gelatin to the nutrient media render it possible 
to obtain cultures of all of the pathogenic anaerobic bacteria under ordinary aerobic 
conditions. It has been previously stated that the ideal method of growing anaero- 
bic bacteria Avonld be to cultivate them in the presence of air, without any sjiecial 
apparatus, as is ordinarily done with aerobic bacteria. This goal is partially reached 
by deep stich cultures in glucose agar and gelatin, but these media are solid and the 
access of air is prevented by the upper layer. 

The object is more nearly attained by the following method in which liquid media 
are employed, presum ibly with full access of air. The method has been used during 
the past year Avith perfect success in cultivating the bacilli of tetanus, malignant 
oedema, symptomatic anthrax, and the Bacillus cedematis maligni. No. II, and is 
adapted for keeping up pure cultures of these bacteria. 

The medium employed is ordinary nutrieut 10 to 12 per cent gelatin containing 2 
per cent of glucose and colored distinctly blue with litmus. Ordinary' test tubes 
are filled with this medium to a height of 4-5 cm. These tubes when inoculated with 
pure cultures of the anaerobic bacteria and set aside in the incubator for twelve to 
twenty-four hours at 37^ to 39^ C. develop rapidly. The litmus is completely decol- 
ored, an abundant growth of the germ takes place, and considerable gas is given off. 
All this, in spite of the fact that the gelatin is liquefied, and that the oxygen of the 
air, at least apparently, has full access to the growth. It has not as yet been ascer- 
tained whether this development of the anaerobic bacteria is due directly to the 
gelatin that is present, or whether it is the result of the viscosity of the liquid which 
may possibly prevent penetration of oxygen. 

In the above manner it is possible to obtain with the greatest ease a large and 
abundant growth of anaerobic bacteria in a liquid medium. Furthermore, it 
should be stated that these litmus-glucose gelatin cultures preserve their vitality 
for a greater length of time than ordinary agar stick cultures. Thus, cultures of 
the four anaerobic bacteria mentioned, when four to six mouths old, possess apjjar- 
eiitly as much A^taIity as when perfectly fresh. 

Attempts have been made to obtain a liquid medium which would grow the 
anaerobic bacteria as readily and as surely iu the presence of air and at the body 
temperature as the 10 per cent glucose gelatin. This has been partly realized by 
employing an alkaline bouillon containing 2 per cent each of gelatin, peptone, and 
sugar. Anaerobic bacteria taken directly from the body grow in tliis bouillon 
under ordinary aerobic conditions. Care must be taken that the bouillon is fresh, 
or but recently reheated, and that it is not less than 7 or 8 cm. in height. The 
bacilli of symptomatic anthrax and malignant oedema, and the B. cedematis maligni 
No. II have thus been grown successfully in the presence of air. The cultures, 
however, have not been obtained with any degree of constancy. Failures frequently 
occur for some unaccountable reason. 

In conclusion, by way of recapitulation it may be said that the following nutrient 
media, with or without litmus, and slightly but distinctly alkaline in reaction, 
have been employed with best results in cultivating anaerobic bacteria. (1) Beef 
bouillon with addition of | per cent common salt. 2 per cent glucose, 2 per cent 
peptone. (2) Beef bouillon as above with the addition of 2 per cent of gelatin. 
(3) Nutrient 10 to 15 per cent gelatin with the same additions of salt, peptone, 
and glucose as above. (4) Nutrient 1^-2 per cent agar with the same additions of 
Bait, peptone, and glucose as above. 



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Kitasato, S., and We^l, Th. Zeitschr. f. Hygiene, viii, 41. 1890. 
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480. 1884. 
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Umler the name "Septiconiie" Pasteur, in 1877, dosciilied a ue^v cxpei iinontal dis- The affection, according to Pastenr, was characterized by a most intense in- 
flammation of the mnscles of the al)doinen and extremities, by accumulation of stink- 
ing gas in divers phices, especially in the axial regions. The lungs and liver were 


decolored, wliile the spleen, thougli not enlarged, was often softened, and the heart 
was free from clot. These effects were ascribed by him to a bacillus — vibrion sep- 
tlque — which formed threads so transparent as to easily escape observation and iu 
the blood they were said to attain considerable length. This bacillus, the first anaer- 
obic disease germ, was successfully cultivated by Pasteur, Joubert, and Chamber- 
land, and later by Gaff ky and others. 

In 1881 Koch pointed out that the characteristics of the disease as described by 
Pasteur were largely due to secondary causes — that is, to the presence of foreign 
bacteria — and that when pure material was employed the result was quite different. 
In such cases the fluid which fills the subcutaneous tissue, to a greater or less extent 
from the point of inoculation, is no longer of a gelatinous consistency, but is com- 
posed rather of a faint reddish colored serum, free from odor and gas. The internal 
organs show but slight changes. The spleen is usuall j' enlarged and darker and the 
lungs are of a pale grayish-red color. In the subcutaneous exudate anthrax-like 
bacilli are found which are usually non-motile, although occasionally some will be 
found possessing motion. These are also found iu varying numbers in the blood, at 
times appearing to be entirely absent and again are very numerous. They are never 
absent from the surfaces of the organs iu the thoracic and abdominal cavities. In 
mice it is not possible microscopically to distinguish the disease from anthrax; the 
serous exudate in the subcutaneous tissue of these auimals is very small. The spleen 
is enlarged, dark colored, and softened as iu anthrax, and the bacilli do not 
predominate on the serous surfaces of the internal organs, but, as in anthrax, are 
present in large numbers iu the organs and blood vessels. 

Owing to the fact that in other animals than mice the bacilli are especially com- 
mon in the subcutaneous tissue aud are rare in the blood, the term ''septicemic," 
as used by the French school, was deemed inappropriate by Koch, and he therefore 
suggested for this disease the name malignant oedema. 

From the above description it will be seen that the chief characterestic of the 
disease lies iu the cedematous condition brought on by the presence of a well- 
defined microorganism. Although at first a purely experimental disease, it was 
shown later to occur iu domestic animals, as the horse (Kitt, Jensen, and Sand), 
and also in man (Brieger and Ehrlich), and was described by Chauveau and Arloing 
as the " septicemic gangreneuse." 

In recent years a number of instances of malignant oedema have been reported in 
man, but unfortunately the diagnosis usually rests on the cedematous condition and 
on the presence of bacilli which from their microscopic appearance are assumed to be 
those described by Pasteur, Koch, and Gaffky. A thorough and exact identification 
has been made in but few instances. In view of these facts it is proper to ask 
whether or not such cases are true instances of malignant oedema. The production 
of an cedematous condition is not a sufficient criterion, either taken alone or in con- 
nection with the presence of a bacillus having the size and form of the well-known 
bacillus of malignant oedema. 

An cedematous condition is induced to a greater or less extent by the bacilli of 
anthrax, and of symptomatic anthrax. The bacillus cadaveris of Sternberg has a 
similar action and only recently Klein has described an aerobic bacillus of malignant 
oedema which is regarded by Sanfelice as identical with his "bacillus pseudo-cedema- 
tis maligni." All of these microorganisms therefore give rise to chemical products 
■which, by their action on the animal body, induce a more or less marked oedema. 

The bacillus of Pasteur aud Koch is therefore a cause, but not the only cause, of 
oedema. It must be evident on a j))-io?-j grounds that other bacilli may exist which 
give rise to the same or similar ijroducts as the classical bacillus of malignant 
oedema, and that therefore they may give rise to the same condition in animals. 
The only distinction, if any, is to be sought in the microorganisms which induce 
these effects, 

A very interesting case of this kind was met with last winter, and furnishes the 
subject-matter of this paper. Three guinea pigs were injected, in connection with 

S. Ex. 36 15 


another line of work, with a solution of milk niiclein. Tho latter was prepared 
from fresh casein obtniued from milk after Ilamiaarsten's method. The casein was 
digested at 37° C. with pepsin and hydrochloric acid, and the precipitated nuclein, 
after filtration and washing, was dissolsed in 0-25 per cent sodium carbonate, and 
the solution thus obtained was the one employed for the injections. 

Within a few hours the animals became very quiet and unwilling to move. The 
respiration became labored and a marked swelling over the abdomen was noticeable. 
Thi.s, on examination, gave fluctuation and crackling, showing the presence of tiuid 
and gas. All three aniuiuls died in from twenty-four to forty eight hours, and on 
post-mortem examination, the same striking condition was observed in all. 

The subcutaneous tissue was permeated with a thick (about 1 cm.) reddish or dark- 
colored gelatinous cedema, which at times was so adherent as to necessitate the use 
of a sharp scalpel in reflecting the skin. The subcutaneous blood vessels were 
deeply engorged; hemorrhagic spots were also present, and the muscles of the trunk 
were colored deep n-d. Tho thoracic and abdominal cavities contained considerable 
serous exudate. The heart was in- diastole and the lungs i)ale or mottled red. The 
liver was soft, but the spleen was not enlarged. 

Cover-glass preparations made from the subcutaneous tissue and peritoneum 
showed enormous numbers of a slender, rather long bacillus, which was almost 
invariably single. Tiiis was also present in the heart blood, luugs, liver, spleen, and 
kidney. Streak preparations made from the peritoneum ami stained with gentian 
vi(d('t showed, in addition to the bacilli which possessed the form aud size of the 
bacillus of malignant cedenia, tlie presence of colorless spiral boilies, the exact sig- 
nificance of which was at first overlooked, but later on in the work they were found 
to be large flagella. Such a preparation showing bacilli and three spirals is seen in 
photogram No. 1. 

The post-mortem appearances and the microscopical characteristics of the bacillus 
present suggested at once that these were cases of raaliguant oedema. This view 
was still further strengthened when attem])ts at culture sliowcd that the bacillus was 
an obligative anaerobe. On further study, however, the bacillus was found to be 
distinct from the classical one described by Past3ur, Koch, aud Gaff ky. It is pro- 
})osed to provisionally designate this new micro-organism as the bacillus oedematis 
Maligni No. II. 

Morphological characters. — The bacillus, as it occurs in tho animal body, as for 
example in a streak preparation from the peritoneum, presents the form of a per- 
fectly straight, slender rod with slightly rounded ends. The rods are almost inva- 
riably single and vary in length from 2*5 to 5 /i. The most common length is 
from 3-5 to 4-3 ju. The width is 0-8 to 0-9 ju- 

Very short, straight threads may also be found occasionally. These are usually 
about 8 to 14 u in length and only very rarely do they attain a length of 22 to 35 u. 

The streak preparation from the above source, stained with gentian violet, usually 
shows, on careful examination, colorless spiral forms, which usually vary in length 
from 17 to 25 ju, and occasionally some 43 and 63 jii in length have been observed. 
In width these spirals vary from a thin, wavy line, having the same thickness through- 
out its length, to forms which are spindle-shaped, tapering at both ends to a scarcely 
visible line. The width of such spindle forms usually ranges from 1*7 to 2"6 >u. 

At first it was supposed that these colorless forms might be artificial in nature due 
to shrinking of the proteid matter on coagulation, l)ut this view was soon unten- 
able, since on examining hanging drops of the reddish serous exudate in the abdom- 
inal cavity tho same bright, colorless spirals could be found. Subscijuently these 
spirals were found in pure cultures of the germ, and are demonstrated to be giant 

When cultivated under the usual anaerobic coaditions, the form sometimes under- 
goes marked changes. Thus in stich cultures in agar the germ forms straight, or but 
slightly bent narrow rods, and also short threads which are usually bent, twisted, 


or wavy. On incline;! asjar the rods appear to be mucli more bent, or comma-sbaped, 
and at the same time very long threads form which are oddly twisted and rolled up, 
as if involution changes were taking place. Wlien grown in bouillon the protoplasm 
of the cell is markedly granular or contracted, and numerous small round refracting 
bodies, many of which are free, while others are in the end of the bacilli, can be 

Motion. — The bacillus is motile, and this condition can be best observed by exam- 
ining the colonies in deep agar cultures with a suitable objecti%'e, as the D of Zeiss. 
In hanging drops, however, only a very slight movement of an oscillatory character 
is to be made out. In this respect itdiifers strikingly from the bacilli of symptomatic 
anthrax and malignant oedema, which are actively motile. Sometimes a marked for- 
ward, wavy motion can be observed, and this is especially true where yonug culture 
is employed and the examination is made as soon as possible, that is before the air 
begins to exercise an inhibitory action. 

The flagella are readily stained by Loffler's method, without the addition of acid 
or alkali to the mordant. Cover-gla«s preparations stained in this manner present 
a striking api^earance. Each bacillus is equipped with severallong, wavy flagella, 
which are attached to the sides <and ends, as is the case with Eberth's bacillus, the 
bacillus of malignant oedema, and several other well-known organisms. The flageUa 
vary considerably in size and thickness. But by far the most characteristic feature of 
these preparations is the occurrence of those enormous flagella which Loftier described 
in 1890 in connection with symptomatic anthrax. These giant whips, as they may 
indeed be called, are usually .spindle-shaped, tapering slowly on both sides from the 
thickened middle to the slender, scarcely-visible ends,-and the border has a beautiful 
wavy appearance. This form of spiral is well represented in photograms No. 2 and 
No. 5. 

The length varies considerably, but in artificial cultures is usually from 40 to 50 
//, and some have been found 72 /u, and even more in length. The width at the 
middle portion likewise varies greatly, and is not necessarily proportionate to the 
length. Thus we may find giant whips, without any median enlargement, presenting 
the form of a simple long, wavy line often with as many as twenty bends. This 
appearance, however, is rare, and is met with only occasionally under conditions not 
yet clearly made out. The usual form, however, is spindle-shaped, and the width of 
the center varies from 2 to 4 //, and not infrequently attains 7 /i or even more. A 
better idea of these dimensions can be obtained by comparing them with the length 
of the bacillus and of the ordinary flagella. The average length of the bacillus can 
be placed at about 3 /<, and the average length of the ordinary flagella at 6 to 9 fi. 

In order to find these giant whips it is not necessary to resort to the staining 
method of Liifiler. Indeed they were first met with in examining hanging drops of 
the thin bacillus. Their size is such that they can be readily seen in unstained jjreji- 
arations with a Zeiss D or with a one-twelfth homogeneous oil immersion objective, 
and, when stained, the larger spirals can be even found Avith an A objective. 

The large spindle-shaped whips possess invariably sharp, wavy borders, but fail 
to show any special structure. In very wide spirals, however, this is not the case. 
By careful focusing the central thickened portion can be resolved into several wavy 
lines running parallel to the border. In one instance five such lines were observed, 
but at other times only one or two could be found. 

Another peculiar feature deserves mention in this connection. Instead of the 
characteristic spindle-shaped whip already described, we may meet with forms 
which are double spindle-shaped, and look as if two large spirals were connected 
together at one eud and then diverged. The common end is attached, as has actually 
been observed, to the bacillus. The attachment of the single giant spirals can often 
be seen in carefully-prepared specimens. Similar double si)irals have been observed 
in agar cultures in hydfogeu of the bacillus of symptomatic anthrax. 

The formation of these large spirals is closely connected with the nature of the 
nutrieu t medium on which the bacillus has developed. Thus bouillon cultures are not 


satisfactory. Gelatin cultures are better, anfl the best results are obtained with aj^ar. 
Streali cultures on inclined aj^ar in hydrogen, or deep stich cultures iu agar in liydro- 
gen oriu air furnish excellent material. Especially is this true of thecoiKleusedlifjuid 
which accumulates in the bottom of the inclined agar tubes or on the top of perfectly 
fresh agar stich cultures. In bouillon, in an atmosjihereof carbonic acid, the spirals 
are either sniall or entirely lacking, whereas the germ itself is in excellent condi- 
tion — a marked contrast with hydrogen cultures. 

The spiral forms described as occurring in the body of guinea pigs and rabbits that 
died after inoculation are identical in form, size, and appearance with these Uagella. 

As already mentioned, similar spirals have been found and photographed by EiiHier 
in cultures of the bacillus of symptomatic anthrax on inclined blood serum in hydro- 
gen. I have found these same spirals in stich cultures of symptomatic anthrax b.uil- 
lus in fresh glucose agar, in air, and more especially in the condensed liijuid which 
accumulates on the top and which is turbid from actively growing bacilli. 

Similar long spirals have been also found in hanging drop examination of the 
bacillus of malignant oedema growing in the condensed liquid in the bottom of tubes 
of inclined agar, in hydrogen. The spirals, however, aj^pear to be much more rare, 
and are therefore more difficult to find than in the two bacteria mentioned. 

Tetanus cultures have not been specially examined for these large spirals, but at 
various times during the last year or two, cover-glass preparations made from agar- 
cultures and stained with concentrated gentian violet have shown distinct long 
slender spirals. It would seem, therefore, that all of the anaerobic pathogenic bac- 
teria known thus far are capable of giving rise to unusually developed flagella. 

As to the nature of these giant flagella very little can be said. Loftier who was the 
first, and to my knowledge the only one, to observe these strange forms regarded them 
as bundles or aggregations of flagella (Haarzopfen). Tiiis, however, can scarcely 
be considered a satisfactory explanation, inasmuch as the border of these large whips 
is almost invariably sharp and clear-cut. At no time has a spiral been found to be 
attached to more than one cell, and then always it is attached by the slender end. 
If mado up of aggregations of flagella we might occasionally expect to find frayed 
out edges to the spirals and bacilli attached to different parts of the spiral, but such 
is never the case. Furthermore, as already stated, we may have exceedingly long 
slender whips without any dilation of the middle portion. The conditions which 
give rise to the latter form, or elongated flagellum, undoubtedly also produce the 
characteristic .spindle-shaped form. It remains to be seen whether it is best to con- 
sider these abnormally large flagella as involution forms analogous to the malforma- 
tions which the bacterial cell itself at times viiulergoes. 

Spore formation has at no time been observed. In this respect it diflfers markedly 
from the three well-known anjerobic bacteria, those of tetanus, malignant oedema, 
and symptomatic anthrax, which invariably, under parallel conditions, readily yield 
an abundance of spores. In liquid media, as bouillon, in an atmosphere of hydrogen 
the protoplasm of the cell, which is ordinarily homogeneous, becomes granular, and 
a bright refractive body appears at one end. Occasionally two such bodies are 
observed, one at each end. The original form of the cell is iu nowise changed as a 
result of the presence of these bodies, which moreover are readily stained by the 
aniline dyes. 

Although the existence of spores can not be demonstrated as yet, the bacillus never- 
theless possesses a very high degree of resistance. Thus when exposed to a tempera- 
ture of 58° C. for one hour it develops readily when subsequently placed under suit- 
able conditions. 

Extreme cold is also apparently without effect, since cultures may be frozen solid 
for twenty-four hours and still maintain their vitality. 

It is readily stained by the aniline dyes and also by Gram's method, which is 
especially valuable in staining of sections. 

Cultural Properties. — The bacillus is an obligative anaerobe, and therefore requires 


special care in its culture. The best media for its jjrowth are a slightly alkaline 
bouillon, geltitiu, or agar containing 2 per cent of peptone and 2 per cent of 
glucose. The addition of 2 per cent of gelatine likewise seems to assist its growth 
to a marked degree. The addition of litmus to the nutrient media not only appears 
to favor the development of the bacillus but also seems to exert a protective action. 
Thus, litmus bouillon or gelatine cultures preserve their vitality better than cultures 
exposed to the light. Strongly alkaline media permit the growth of the bacillus, 
but such cultures soon lose their vitality — some in a few days. 

All the cultures referred to in the following description were made in the special 
apparatus which is described by mo in a separate paper. 

No growth takes place at the ordinary tempera ture, that is below 24° C. Above 
this limit it grows readily, and its optimum is about 35"^ to 38° C. 

Growth takes place in a vacuum, or in an atmosphere of hydrogen, carbonic acid, 
nitrogen, or even in illuminating gas. la this respect the bacillus behaves the same 
as the tetanus bacillus, which develops under the same conditions, whereas the 
bacilli of malignant oedema and symptomatic anthrax have thus far failed to 
develop in an atmosphere of illuminating gas, but have been successfully grown in 
carbonic acid. 

Carbonic acid, contrary to the commonly accepted view, does not seem to exercise 
any poisonous or even inhibiting action on the growth of this bacillus and those of 
tetanus, malignant oedema, and symptomatic anthrax. Cultures of the first two have 
been kept in carljonic acid for more than a month without any apparent effect. Fur- 
thermore, bouillon cultures in this gas show excellent well-formed rods which are 
much more favorable in appearance than cultures grown in hydrogen. The granula- 
tion of the protoplasm and the small terminal refractive bodies met with in hydro- 
gen cultures are lacking in carbonic acid cultures. Giant whips have been absent 
in the few examinations that have been made for that x^urpose. It may be stated 
that in order to be successful with carbonic acid it is necessary to employ perfectly 
fresh, or reheated, distinctly alkaline culture media and that the inoculations be 
made from fresh vigorous cultures. 

Colonies can be easily obtained in deep cultures in agar in ordinary test-tubes. 
The iiat bottles or dishes employed by Krai for his bacteriological museum are well 
adapted for this purpose, as they can be placed on the stage of the microscope and 
examined with ease. Not only can t bus the form of the colony be observed but also 
the presence of motion can frec[uently be ascertained. Photogram No. 4 is made 
from such a culture. Colonies can also be obtained by making successive streaks on 
inclined glucose agar, or by resorting to Esmarch roll tubes or agar plates in Botkin's 
apparatus. The latter, ho wever, have not been very satisfactory for some as yet 
unexplainable reason. 

Under favorable conditions excellent colonies develop in fifteen hours in glucose 
agar at 38° C. They tlieu appear as small white pinhead growths, which, tinder 
the microscope, look as if composed of a dense whorl of threads. The smaller colo- 
nies simply form a network of branching lines, resembling very much the branching 
colonies of tetanus bacillus. The larger colonies have a dark center, which is sur- 
rounded by an irregular, frayed border of very delicate filaments. These irregular 
borders on higher magnification are distinctly granular in appearance, and numerous 
small round dark spots are seen, which are usually at the end of the threads. 

Stich cultures in glucose agar are characterized by a distinctly visible growth 
along the entire line of inoculation, with the exception of the upper layer of about 
1 cm., where no growth takes place owing to the presence of air. The growth, 
however, is much less distinct than either that of the bacillus of malignant oedema 
or that of symptomatic anthrax. At a temperature of 38° C. development takes 
place in twelve to sixteen houxs. During the next twenty-four hours the growth 
reaches its maximum, after which the stich gradually becomes less visible. An 
energetic production of gas appears, and, as a result, the agar is torn apart and 


forced np the tube. The production of gas is marked in alkaline tubes and is almost 
entirely absent in neutral or atid nutrient media. No marked odor is observable in 
cultures of the bacillus after it had been grown for several months, but the earlier 
cultures, shortly after it had been isolated, possessed a strong penetrating odor of 
butyric acid. 

When placed in an atmosphere of hydrogen, growth takes place along the entire 
stich, and even the surface of the agar becomes covered by a thin white film. Stich 
cultures in hydrogen, and even in air, made in perfectlj" fresh glucose agar — that is, 
immediately after solidification — frequently have a drop or two of water of conden- 
sation on tlie surface, and in such cases this liquid is turbid ami full of small gas 
bubbles irom the presence of actively growing bacilli. This peculiar instance of 
growth, a]ipareiitly in contact with air, has also Ijcen observed with tlic bacilla of 
symptomafii- anthrax and of malignant cedema. In all three cases this liiniid is an 
excellent place for the spiral forms already described. 

Streak cultures on the surface of incline<l glucose agar, grown in hydrogeu, form 
a distinct white pellicle. Isolated colonies areronndish, white, somewhat elevated, 
and show markings. The water of condensation in the bottom of the tube lilvewise 
has an abundant groT\th. These cultures are likewise an excellent source for giant 

Owing to the relatively higli temperature which the bacillus requires in order to 
grow it follows that no development takes place in solid gelatin. Nevertheless 
cultures can be obtained in liquid gelatin with as much ease as with ordinary aerobic 
bacteria. These cultures are noteworthy because they are apparently made in the 
presence of air. With the exception of deep cultures in agar they are the only 
means of obtaining growths of the bacillus without resorting to the usual special 
apparatus for anaeroltic bacteria. 

The medium employed is ordinary, 10 to 15 per cent gelatin containing 2 per cent 
glucose, with or without litmus. The tubes are inoculated and set aside in an incu- 
bator at the body temperature. The gelatin of course, is liquefied, but in twelve to 
eighteen hours gas bubbles will be seen rising to the surface and at the same time 
tlie liquid becomes turbid. The maximum growth is reached in twenty-four to 
thirty-six hours. The germ then subsides in Hakes and forms a light florculent sedi- 
ment 1 to 2 cm. in height, ^vhile the liquid above becomes perfectly clear and the 
surface is free from scum. When set aside now at the temperature of the room the 
gelatin does not solidify but remains permauently liquefied. 

The other anaerobic bacteria, as the bacilli of tetanus, malignant cedema and 
symtomatic anthrax can be cultivated in the same manner. 

Attempts have been made to replace the 10 to 15 per cent gelatin by bouillon 
media containing a less amount of gelatin — 2 to 5 per cent. These attempts have 
been partly successful, but often failure in growth results for some unexplainable 
reason. Litmus-colored media are apparently better than uncolored for this pur- 
pose. The greater number of tubes which then develop cau only be ascribed to the 
favorable action of the litmus in excluding certain rays of light. The best medium 
found thus far is a fresh alkaline bouillon containing 2 per cent each of gelatin, 
glucose, aud peptone. The tubes shoulil be filled to a height of 6 to 8 cm. With 
such a medium perfectly pure cultures have been grown from inoculated animals 
under ordinary aerobic conditions at 38° C. 

Bouillon tubes when inoculated aud placed in hydrogen almost invariably develop. 
Failure to grow isj commonly due to the culture from wiiich the inoculation is made, 
since it may be weak or dead. The bacillus develops more or less abundantly in 
bouillon media of most varied composition. Old bouillon tubes are almost as good 
as when freshlj- prepared, and in this respect a marked dilYeience exists between 
the bacillus of symptomatic anthrax, whicli, according to Kitasato, requires perfectly 
iresh media in order to grow. 

The addition of 2 per cent of Witte's peptone aud 2 per cent of glucose to the 


bouillon furnislies an excellent nutrient medium. Gelatin appears to favor tlie 
gro-n-th of the bacillus to the same extent as peptone. Ei|ually good results can be 
obtained by substituting 2 per cent of gelatin in place of the peptone. The best 
results, however, have been obtained by the addition of 2 per cent each of gelatin, 
peptone, and glucose. 

The addition of sodium-indigo sulphate to bouillon or other culture media is with- 
out any beneficial eftect, and the only advantages it possesses is to indicate the reduc- 
ing action of the bacillus. Culture media containing this substance* are discolored 
by the growth of the bacillus in hydrogen, but on exposure to air the color returns. 

Litmus, for reasons already given, is to be preferred to sodium-indigo sulphate. 
Furthermore, it is of value as an indicator of the reducing action and also of the 
reaction. Thus, the litmus-colored medium is first discolored, showing a strong 
reducing power of the organism. The coloring matter is reduced to a colorless leuco- 
compound, which on subsequent exposure to air takes up oxygen and becomes con- 
verted into a pigment. If the bacillus has given rise to acid products their presence 
will be indicated by the wine-red color of the culture medium. 

In this manner it is easy to demonstrate the production by this bacillus of an acid 
reaction in bouillon containing glucose, whereas in the absence of glucose the color 
returns to a violet or blue. In this regard it agrees with the bacilli of symptomatic 
anthrox and of malignant oedema, whereas the bacillus of tetanus does not give rise 
to an acid reaction iu glucose media, and hence is colored blue. 

The characteristics of the bouillon culture are the same, no matter whether devel- 
oped in hydrogen, carbonic acid, illuminating gas, or in a vacuum. In from ten to 
fifteen hours at 38^C. the liquid becomes turbid and a greater or less amount of gas 
is given off, depending upon the age and alkalinity of the bouillon. Subsequently, 
in one and one-half to two days the suspended growth gathers iu flakes which settle 
to the bottom and form a light flocculent sediment 1 to 2 cm. in height, which readily 
rolls about when the tube is inclined. The supernatant fluid is perfectly clear and 
free from surface scum. The bouillon cultures are very distinct from those of either 
symptomatic anthrax or malignant cedema. Thus, the latter two form a tine growth 
which partly settles to the botton, forming a white, compact, nourolling sediment 
scarcely one-half cm. high, while the liquid above is turbid and remains so for 
several days. 

Vacuum cultures can be readily obtained. A perfect vacuum is not necessary, 
since excellent growths are obtained by the apparatus mentioned when the pressure 
is dinunished by 60 to 65 cm. It m:iy incidentally be added that the other three 
anaerobic bacilli likewise grow under these conditions. 

The so-called "mixed" aerobic cultures of this bacillus have also been thus far 
successful, and will be described later in connection with experiments on animals. 

The diftereuces that exist between this new bacillus and the bacilli of symptom- 
atic anthrax and of malignant oedema may be briefly summarized as follows: 

Bacillus of malignant cedema No. II in bouillon cultures, etc., is slightly longer 
and thicker than either of the other two. It shows no such active motion as the 
others, nor does it form spores. Giant whips are much more common. In bouillon 
culture the bacillus is often bent or comma-shaped and is single or forms short 
threads of 2 to 5 cells, which are invariably bent or twisted ; whereas both of the 
others show usually straight single rods and only rarely short threads, which are 

Cultural differences in bouillon and in agar are also marked and have already been 
mentioned. Further diftereuces exist in the greater pathogenic action and in the 
more rapid eftect on temperature, as seen in Table YI. 

Pathogenesis . — The extremely virulent character of this new bacillus can be readily 
demonstrated on a large variety of animals. The rabbit, guinea pig, white mouse, 
white rat, pigeon, and cat have been employed for this purpose, and all are highly 
susceptible. Subcutaneous injection into these animals of a one-fourth cc, or even 


one-teutli cc, of a pure culture invariably results fatally, and death takes place 
usually in from twelve to thirty-six hours. 

The first symptoms observable after injection is an indisposition to move about; 
the animal rests quietly in one corner and will not stir even when i)ronii)ted. Later 
the animal becomes uneasy, frequent cries of pain are given, and marked swelling 
over the abdominal region takes place. The animal then usually lies on its side and 
can not stand up. Distinct crackling and fluctuation can be made out over the ab- 
domen. Slight twitchiugs or convulsive tremors sometimes pass over the animals. 
The respiration becomes very slow and finally death results. 

The most marked effect is seen in the rapid fall of temperature. This takes place 
within a few hours after tlie injection, without any previous rise in temperature, and 
continues falling till death occurs. In rabbits the temperature bas been observed 
to sinlv as low as 29^^ C. a half an hour befoi'e death. A similar fall in temperature 
has likewise been observed in guinea-pigs. Table VI shows the comparative effect 
on tem])('ratnre in guinea pigs injected suboutaneously with oue-half cc. of fresh 
bouillon cultures, one and one-lialf days in hydrogen, of (edema bacillus Js'o. II, 
bacillus of malignant cedema, and of symptomatic anthrax. 

On post-mortem examination essentially tlie same condition is found as that which 
was observed in the original guinea pigs that died of infection. Thus an extensive, 
colorless, jelly-like subcutaneous cedema covers part or whole of the anterior part 
of the body and at times extends to the extremities. Occasionally it is slightly 
colored red. Gas is usually present, althougli In very small amount, and is often 
contined to the median line over the abdomen or to the axillae. Owing to the con- 
sistency of the oedema the skin can be readily reflected from the body. The subcu- 
taneous bloodvessels are as a rule engorged; slight hemorrhagic spots are often 
present and the abdominal wall bright red in appearance. 

The pleural cavity contains an enormous amount of colorless serous exudate, which 
at iirst is liquid, but if the examination is delayed some time after death it becomes 
gelatinous. The colorless fluid when transferred to a sterilized test tube coagulates 
to a solid mass in a few minutes. In rabbits and guinea pigs this condition of the 
pleural cavity is especially marked. The cavity is often full, and from such cases 
50 to 60 cc. of the serous fluid have been removed. 

The lungs are iisually pale and flabby. The heart is in diastole and its blood ves- 
sels are gorged full of blood. In the abdominal cavity a similar condition is observ- 
able. The amount of exudate, however, is relatively much less. The same tendency 
to gelatinize is seen, and in the larger animals a fibrous network often covers the 
intestines. The peritoneum is almost invariably bright red in appearance. The 
internal organs show very little change, and usually the bladder is full. 

One marked difference is noticeable in the appearance of the subcutaneous tissue 
in the animals Inoculated with pure cultures and in the guinea pigs iiu)culated with 
milk nuclein. The latter presented what might indeed be called a terrible condition. 
The subcutaneous tissue was filled with a solid gelatinous or fibrinous exudate which 
was exceedingly tough and so firmly connected the skin with the walls of the body 
that it necessitated the cutting away of the skin with a scalpel. Furthermore, the 
exudate and muscles were strongly colored red and more than a centimeter in thick- 

In the experiments with pure cultures this frightful condition was, as a rule, 
absent. The subcutaneous cedema was colorless, soft, and gelatinous in consistency, 
and not adhesive. Occasionally, however, the same condition is met as described 
above, and in such cases no foreign bacteria could be found present. 

Another striking diflerence was observable on microscopical examination. Cover- 
glass preparations from the ojdema, fluids, muscles, peritoneum, etc., of the mllk- 
nuclein guinea pigs showed enormous numbers of this new bacillus, as shown in 
photogram No. I. On the other hand, in animals that died after inoculation with 
pure cultures the bacilli were found in only relatively small numbers. Very often 


it was necessary to examine half a dozen cover glasses before their presence conld 
be established, and not iufrcLj^uently it was impossible to iind any. In the few 
exceptions mentioned the bacteria, however, were also found in enormous numbers. 

The fact that the experimental animals died very frequently without the presence 
of the bacillus showed that death was directly due to the toxic products injected 
and not to any development of the bacillus in the body. In the original guinea 
pigs, however, it was clearly evident from the enormous numbers of the germ pres- 
ent that it did find in the body suitable conditions for its development, and death 
resulted when it had produced p. sufficient amount of poisonous chemical products 
within the body. In tjae latter animals, then, the bacillus was capable of develop- 
ing, whereas in the experimental animals inoculated with pure cultures no such 
favorable conditions for growtli was as a rule present. 

A rational explanation of this difference would be that in the experimental ani- 
mals the natural resistance is such as to prevent or greatly retard the growth of the 
bacillus, whereas in the original guiuea pigs this same resistance must have been 
lowered by some product or organism to sucli an extent that the animal became an 
excellent medium for the development of the germ. 

These original guinea pigs, as already stated, w^ere injected with a milk-nuclein 
solution, prepared by digestion of casein with pepsin. The precipitated nucleiu was 
filtered off, washed, and dissolved in dilute alkali carbonate. This solution there- 
fore contained nuclein, small amounts of salts of lactic acid, besides any bacteria 
that might be present and resist the action of the alkali. Experiments were made 
to ascertain which of these elements favored the growth of the bacillus in the body. 
Several trials were made with fresh nuclein prepared in exactly the same manner, 
but without effect. 

Injections of lactic acid were more successful. Butyric acid was also tried, but the 
results were not ai^pareutly as good. Thus, white rats Nos. 18, 21, 27, and 28, Table 
III, which received subcutaneously one-fourth cc. of a fresh bouillon culture and 
immediately afterwards one-tenth cc. of a 20 per cent lactic-acid solution, yielded on 
post-mortem examination the characteristic appearances, and enormous numbers of 
the bacilli were found. Control animals died in about the same time, but the bacilli 
were as scarce as usual. 

Small amounts of phosphoric acid have effects similar to lactic acid, as seen in rat 
No. 22, Table 111. In several instances injections of lactic or phosphoric acids did 
not produce the characteristic appearances or perceptibly increase the number of 
bacilli in the tissues. On the other hand, the animals that gave positive results 
were found to contain foreign bacteria, which undoubtedly had secured entrance into 
the body through the slight local slough. 

A number of experiments were next made to ascertain to what extent foreign 
bacteria were capable of favoring the growth of this bacillus in the body. Instances 
of microbic associations are not entirely unknown. Thus, Roger (1889) was the 
first to show that pure cultures of the bacillus of malignant oedema, which in small 
doses produced no effect in rabbits, became intensely active and produced death 
in twenty-four hours if a culture of micrococcus prodigiosus was injected at the 
same time. More recently (1891) Penzo has shown that Proteus vulgaris acts in a 
similar manner, and, furthermore, the equally interesting and important fact was 
brought out that cultures of the anaerobic bacillus of malignant oedema conld be 
obtained in the presence of air if the culture tubes were inoculated at the same 
time with either of the above germs. 

The following experiments were therefore made to ascertain if this new bacillus 
■was capable of growing in the presence of air, in "mixed'' cultures. Ordinary 
bouillon tubes were inoculated with this oedema bacillus and also with the bacillus 
acidi lactici, micrococcus prodigiosus, Proteus vulgaris, and a coccus obtained from 
one of the milk-nuclein guiuea pigs. 

The tubes were then set aside in the incubator at a temperature of about 35^ C. 


for fifteen hours. At the end of that time the tuhes were takeu out anrl examined. 
A maiked dilleience was observed between the "mixed" cultures and control tubes 
of the aerobic bacteria. The growth in the former was considerably more vigorous 
than in the contnd tubes. Tiie "mixed" culture of Proteus vul'^aris and redema 
bacillus was most marked. A heavy Hocculent sediment was on the bottom, consid- 
erable gas was being given oif, and a strong hntyric-acid odor was present. The 
"mixed" culture witli lactic-acid bacillus also gave rise to much gas. Microscopic 
examination showed thepresence in all four tubes of actively growing oedema bacilli. 

A guinea i)ig (No. 16, Table I) inoculated subcutaneously with one-fourth cc. of 
the cedema-i^rotens vulgaris culture Avas found dead in nineteen hours. A post- 
mortem made at once showed a terrible condition. The skin was firmly adherent 
to the muscular walls of tlie body by a thick, reddish fibrous rodema. Considerable 
gas was present throughout the oidema, which, over the abdominal walls, was almost 
1 cm. in thickness. The blood vessels were highly injected. The peritoneum was 
bright red; considerable serous exudate in the abdominal and thoracic cavities. The 
lungs were pale and collapsed ; the heart was in diastole. A fibrous network covered 
the intestines. Microscopical examination showed the presence of enormous num- 
bers of the (edema bacilli in the subcutaneous tissue, aud on the peritoneum and 
in the spleen. The heart, blood, and the liver likewise contained the bacilli, but in 
small number. 

The picture presented in the above animal was au exact counterpart of that in the 
milk-nucleiu guinea pigs. This cxjierinu'ut and others of a similar nature show 
conclusively that this new (udenia b;u-illus gives rise to intensely iioisouous products, 
and that the fatal results following the injection of a pure culture of this germ are 
nsually due to the toxic products injected. As a rule no appreciable multiplication 
of the bacillus takes place in the normal, but if, on the other hand, impure 
cultures are employed the conditions become so changed that an enormous multpli- 
cation rajiidly takes place, aud the death which then results is due to the poisons 
elaborated within the body. 

This is a striking illustration of a "mixed" infection. A small number of this 
anaerobic bacillus may be introduced into the body without any bad effect so long 
as it is simply a question between the germ and the normal resistance of the body. 
If, however, this resistance is lowered or the germ is enabled to multiply through 
the assistance furnished by such common saprophytic bacteria as may accident;illy 
have been introduced, the outcome then becomes quite different and death results. 
What has thus been shown to be true for this bacillus is equ.illy true for the other 
anaerobic pathogenic bacteria. The danger of infection lies not so much in the 
introduction of any of these bacteria by themselves as it does in the simultaneous 
or subsequent introduction of other nonpathogenic bacteria which, by their pres- 
ence, render the body, or a portion of it, a suitable nidus for the development of 
these anaerobic forms. 

A further study of this new microorganism, and more especially of its chemical 
products, is reserved for the near future. 


Photograin No. 1 shows a streak preparation from the peritonejil exudate of a guinea-pig, and is 
staiued with gentian violet. In addition to the well-formed rods, two short and one long colorless 
spiral can be seen jnst above the middle. 340 X lamplight. 

Photogram No. 2 shows a giant whip from an inclined .agar culture in hydrogen, stained by Lott'- 
ler's method. Near one edge are two rods with ordinary tiagt'lla. 3-tO X lamplight. 

Photogram No. 3 shows a culture in Krafs flat tube, on foot, in glncose agar, presence of air, with 
colonies and production of gas. Natural size. 

Photogram No. 4 shows a colony in glucose agar. 50 X sunlight. 

Photogram No. 5 is made from the same cover-glass prep.iration as No. 1, and shows a spindle 
shaped giant whip. Two smaller ones are to be seen above it. 500 X sunlight. 

^ X 

No. 1. 

No. 3. 

M r 







No. 2. 

i|^^^gg& |^a«M|||»|^ 

No. 4. 

"< f/r. 


— / 









No. 5. 

NO. 6 




Table I. — Experiments wUTi gnine(t-2)igs. 

[In all cases bouillon cultures were iised unless otherwise .stated, aud tlie injections were made snb- 

cutaueously over tlie abdomen.] 



Culture used. 


Deatb in— 





9 d. vaCTium 

. .do 














About 10 hours . 
About 15 liours. 

1.'^ hours 

17 liours 






■ 381 







About 12 hours. 
About 15 hours. 

28 hours 

About 15 hours, 

Verv few . 


Very few . 




3 d.Tacuum 




3 d. hydroj^'en 

3 d. vacuum 

4 d. hydrogen 



About 12 bours- 
About 14 hours. 


3 d. hydrojren 

7 d. hydrogen 


17 hours 

About 15 hours. 


Eeceived previously two in- 
jections, J c. c. each, of 20 
per cent lactic acid. 

Keccived similar injections of 




19 hours 

Very num- 

butyric acid. 
Eeceived mixed culture of 

the bacillus and Proteus 

Recovered. Received mixed 



IJ d. hydrogen 

11 hours 

About 15 hours. 

Very num- 

culture ofbacillus and lactic 
acid bacillus. 
Spirals present. 


Table II. — Experiments with rabbits. 



















3 d. vacuum — 

2J d. hydrogen 

4 d. hydrogen. 

... do 

7 d. hydrogen. 

4 d. hydrogen.^.... 

2J d. hydrogen 

About 15 hours. 
27 hours 

About 15 hours. 

20 hours . 

Aboiit 30 hours. 
42 hours 

Very num- 



39 hours 
41 hours 

J ( About 36 hours. 
About 14 hours. 


Very few 


but con- 
t a ra i - 


Spirals present. 

Eeceived injection of sodium 

Received 1 c. c. of 20 per cent 
lactic acid. 

Received no lactic acid. 

Received previously 4 injec- 
tions, 5 c. c. eacli, intraperi- 
toneally, of sterilized serous 
fluid from thorax. 

Received 5 c. c. nuclein sub- 

Received J c. c. of 20 per cent 

lactic acid. 
Received J c. c. of 20 per cent 

lactic acid. 
• Do. 

Received no lactic acid. 


Table III. — Experiments with while rats. 
















Culture used. 

9 (1. vacuum. .. 

3 d. vacuum. .. 

3 d. Iij'drogen. 

2 d. liydrogt'U. 
9 d. vacuimi .. 

3 d. vacuiiin .. 
6 d. liydiogeu. 
9 d. hydrogen. 

3 d. hydrogen. 
2 d. hydrogen. 

2J d. hydrogen 

4 d. liydrngen. 
2J d. hydrogen 

4 d. liydrogen 



Death in — 

Ahout 12 hours 

20 hours 

About 15 hours 
About 30 liours 

About 18 hours 

17 lioiirs 

39 liours 

51 hour.-* 

About 33 liours 
27 hours 

31 hours 

About 15 hours 

About 30 hours 

8 hours 

About 15 hours 
31 hours 

About 15 hours 

About 40 hours 
About 12 hours 

.. do 

About 60 hours 

About 15 hours 

About 13 hours 
10 days, 19 hours 



Very few , .... 



Very few . 

Fairly nu- 
Very lew . 
Very nu- 


Very nu- 


Very few . 



Very nu- 

Few . 


Received previona injection 
of J c. c. of 20 per cent lactic 

Received previous injection 
of j'rt c.c. of 20 per cent lactic 

Received previous injection 
of 1 drop of phosphoric acid. 

Received previous injection 
of If c.c. of 20 per cent bu- 
tyric acid. 

Received previous injection 
of tV c.c. of 20 per cent lactic 

Received previous injection 
of -fn c. c. of 20 per cent bu- 
tyric acid. 

Table IV. — Experiments lotth ivhiie mice. 




4 d. hydrogen 






About 13 hours. 
About 15 hours. 
About 21 hours. 
About 14 hours. 

Very few . 


Very nu- 

Received previously ^ c.c 
per 'cent lactic acid. 




Table V. — Experiments with pigeons. 


4 d. hydrogen 



About 12 hours. 
3 days 20 hours. 

17 hours 

About 12 hours. 



Very few . 

Received previously J c.c. 20 



... .do - . 

per cent lactic acid. 



Received previously J c.c. 20 

per cent lactic acid. 



Table VI. — Experiments iviih guinea-pigs. 

[Sbo'ws comparative effect on temperature of the three anaerobic pathogenic Bacteria. Each .^Tlimal 
received h I'.c. subcutaneously of a bouillon culture grown 1^ to 2|^d. in hydrugeu at 38-.] 

CEdema Bacil- CEdema Bacil 


Bacillu.s of 

lus n. — No. 

18, weight 
452 grams. 

Ang. 2e. 1893— 

8: 15 a. m 

9: 15 a.m 

10: 45 a. m 

Inoculated at 11 : 30 a. m. 
Aug. 26, 1893 — 


12:30 p.m 

1 p. m 

1 : oO p. m 

2 p.m 

2:30 p.m 

3 p.m 

3:30 p.m 

4 p. m 

4: 30 p.m 

5 p. m 

5:30 p.m 

6 p.m 

7 p. m 

8 p.m 

9 p.m 

10 p.m 

11 p.m 

12 p.m 

Aug. 27, 1893— 

I a. m 

9 a. m 

10 a.m 

II a. m 

32 a.m 

3 p.m 

5 p. m 





lus II, 
19. weight 
725 grams. 










39 1 











35 ■? 


Bacillus of . 
OSdema. — 
No. 20, weight Xo.21, weight 
377 grams. 512 gram.s. 

-^ svmptoraatic 
^°- Anthrax.— i 






3* '5 





39 1 



38 '8 

38 '3 





































H8 1 
38 1 

* Recovered. 


Bottin, E. Centralbl. f. Balvt., xi, 231. 1892. 

Braatz, E. Baunigarten's Jabresbericbt, ill, 120. 1887. 

Bremer, L. Amer. Journal of iled Sciences, p. 594. 1888. 

Brieger u. Ehrlich. Berliner klin. Wochenschr. 1882. 

Charrin et Eoger. Baumgarten's Jabresbericbt, lll, 119. 1887. 

Chauveau et Arloing. Archives Veter., pp. 366, 817. 1884. 

Coze et Feltz. Eecherches esp6riiu. s.l. presence des infusoires dans les maladies infectieuses. 

Strasbourg. 1S66. 
Davaine. Bull, de I'Acadfemie de Medecine. 1872. 

Gaffky, G. Mittheilungen a. d. kaise.rl. Gesundheitsamte. Bd. I, 83. 1881. 
Hesse, W. & E. Deutsch. med. Wochenschr., xi, 214. 1885. 
Jensen u. Sand. Centralbl. f. Bakt., i, 265. 1887. 
Kerry, E. Centralbl. f. Bakt.. vil, 642. 1890. 
Kitt, Th. Baumgarten's Jahresb., r, 59, 1885 ; n, 135, 1886. 
Klein, E. Centralbl. f. Bakt., pp. 10, 186. 1891. 
Koch, E. Mittheilungen a. d.kaiserl. Gesundheitsamte, I, 54. 1831, 
Kiannhals, H. Zeitschr. f. Hygiene, ll. 297. 1887. 
Lustig. Jabresbericbt d. zu Hannover, xil, 54. 
Kekam.L. Centralbl. f. Bakt., xil. 160. 1892. 
Pasteur, L. Comptes Eendus, lxxxv, 101. 1877. 

Pasteur, Joubert et Chamberland. Comptes Eendus, Lxxxvi, 1039. 1878. 
Penzo, E. Centralbl. f. Bakt., X, 824. 1891. Atti Accad. Lincei, vil, 206. 1891. 
Roger. Baumgarten's Jabresbericbt, v, 165. 1889. 
Eoux et Chamberland. Annales d. I'lnstitut Pasteur, 1, 561. 1887. 

Sanfelice, F. Annali Istituto d' Igiene, Roma, i. 1892. Zeitachr. f. Hygiene, xrv, 339. 1893. 
VaiiCott,jr.,J. Centralbl. f. Bakt., IX, 303. 1891. 
TemeuU. Centralbl. f. Bakt., ix, 60. 1801. 
"Witte. Centralbl. f. Bakt., xii, 266. 1892. 



As early as 1872, Lewis and D. Ciiniiinjfham" demonstrated the fact that bacteria 
iiijeetcil into the circuhition rapidly disappear. In the blood of twelve animals, 
which liad been treated with sncii injections, bacteria could be found in only seven 
alter six hours. In thirty animals bacteria were found in the blood of only fourteen 
after twenty-four honrs, and in seventeen animals bacteria were found in only two 
when the examination was made from two to seven days after the injection. 

In 1874 Traul)e and Gscheidli'nt found that arterial blood taken under antiseptic 
precautions from a rabbit, into the juy,ular vein of which one and one-half cubic 
centimeters of a fluid rich in putrefactive germs had been injected forty-eight hours 
previousl}', failed to undergo decomposition for months. These investigators attrib- 
uted the germicidal properties of the blood to its ozonized oxygen. Similar results 
were obtained by Fodor t and by Wysokowicz.S The latter accounted for the disap- 
pearance of the germs not by supposing that they were destroyed by the blood, but 
that they found lodgment in the capillaries. 

The first experiments made with extra-vascular blood were conducted by Groh- 
mann,|| under the direction of A. Schmidt, in his researches upon the cause of coag- 
ulation. It "was found that anthrax bacilli, after being kei»t in plasma, were less 
virulent, as was demonstrated by their effect upon rabbits. Grohmann supposed 
that in some way the bacteria were influenced by the process of coagulation. 

In 188751 Fodor made a second contribution to this subject, and in this he com- 
batted the rct<>ntiou theory of Wysokowicz. One minute after the injection of one 
centimeter of anthrax culture into the jugular vein, in eight samples of bh)od, Fodor 
found only one colony of the bacillus. Then he took the blood from the heart with a 
sterilized pipette and added anthrax bacilli to it. This was kept at 38- C, and 
plates made from time to time showed a rapid diminuti(m of the number of germs, 
which, however, after a time, when the blood had lost its germicidal projierties, 
began to increase. 

In 1888 Nuttal,** working under the direction of Fliigge, used defibrinated blood 
taken from various species of animals, rabbits, mice, pigeons, and sheep, and found 
that this blood destroyed the bacillus anthracis, bacillus subtilis, bacillus mega- 
terium and staphylococcus pyogenes aureus when brought in contact with them. 
He also confirmed the further finding of Fodor that after awhile the blood loses its 
germicidal properties and becomes a suitable culture medium in which the germs 
grow abundantly. 

Nissentt continued this work under Fliigge's direction, and reached the following 
conclusions: (1) The addition of small quantities of sterilized salt solution or 
bouillon to the blood does not destroy its germicidal properties. (2) Cholera germs 
and Eberth's bacilli are easily destroyed by fresh blood. (3) For a given volume of 
T)lo(>d there is a maximum amount of bacilli which can be destroyed. (4) Blood 
whose coagulability has been destroyed by the injection of peptone is still germi- 
cidal. (5) Blood, in which coagulation is prevented by the addition of twenty -five 
per cent of magnesium sulphate, has its germicidal properties decreased. (6) Fil- 
tered blood jilasma from the horse is germicidal. 

Behriugtt has attributed the action of the blood serum of the white rat on anthrax 

* Eighth Annual Report of the Sanitary Commission of the Government of India. 
tScblesische Gesellschaft f. vaterlaud. Cultur, 1874. 
J Archiv f. Hysrieue, B. 4. 
§Zeit8chrift f. Hygiene, B. 1. 

llUeberdie Einwirkung des zellenfreicu Bliitplasma auf einigo ijflanlziche Mikroorgauismen, T)or 
pat, 1884. 

IT Deutsche mediciniache Wochcnschrift, 1887. 
** Zeitschrift f. llygiine, B. 4. 
It Zeitschrift f. Hygiene, B. 6. 


bacilli to the umisual alkalinity of the blood of the animal. He has made a num- 
ber of titrations by which he shows that the blood serum of the white rat is some- 
what more alkaline than that of certain animals which are more susceptible to 
anthrax, such as the rabbit, guinea pig, and cow. His deduction is not justified, be- 
cause there are many other and more important points in which these animals differ 
more markedly from the Avhite rat than in slight differences in the alkalinity of the 
blood serum. Had he shown that the blood of the adult rat, which is not suscepti- 
ble to anthrax, is more alkaline than that of theyoungrat, which is susceptible, his 
argument would have been more plausible; but even then it would not have de- 
served the dignity of positive evidence. 

In 1890 Buchner,*" aided by Voit, Sittmaun, and Orthenberger, made a most valu- 
able contribution to our knowledge of the germicidal properties of blood. The 
results of this work are stated as follows: 

(1) The germicidal action of blood is not due to phagocytes, because it is not 
influenced by the alternate freezing and thawing of the blood by which the leu- 
cocytes of the rabbit are destroyed. 

(2) The germicidal properties of the cell-free serum must be due to its soluble 

(3) Neither neutralization of the serum, nor the addition of pepsin, nor the re- 
moval of carbonic acid gas, nor treatment with oxygen have any effect upon the 
germicidal properties of the blood. 

(4) Dialysis of the serum against water destroys its activity, while dialysis against 
0-75 per cent salt solution does not. In the diffusate there is no germicidal sub- 
stance. The loss by dialysis with water must be due to the withdrawal of the inor- 
ganic salts of the serum. 

(o) The same is shown to be the case when the serum is diluted with water and 
when it is diluted with the salt solution. In the former instance the germicidal 
action is destroyed, while in the latter it is not. 

(6) The inorganic salts have in and of themselves no germicidal action. They are 
active only in so far as they affect the normal properties of the albuminates of the 
serum. The germicidal properties of the serum reside in its albuminous constituents. 

(7) The difference in the effects of the active serum and that which has been 
heated to 55^ C. is due to the altered condition of the albuminate. The difference 
may possibly be a chemical one (due to changes within the molecule) or it may be 
due to alterations in mycelial structure. The albuminous bodies work upon the 
bacteria only when the former are in an active state. 

We wish at this x>oint to call attention to an inconsistency between the results 
obtained by Buchuer and the conclusions which he draws. In experiment No. 45 
he renders the serum sliglitly acid and adds U'l gram of pepsin to each 5 c. c. of 
serum (showing by a side experiment that this pepsin actively digests coagulated 
egg albumin in neutral solution) and finds that the digestive action of the pepsin 
does not lessen the germicidal properties of the serum. In fact, he states this in his 
conclusions, but his ultimate opinion, and the one held by him in his latest contri- 
bution is that the germicidal constituent of the blood is the serum albumin. How 
much serum alTmmin remains in blood serum after it has been thoroughly digested 
Avith pepsin? He could scarcely have chosen a more positive method of demon- 
strating that the germicidal coustitnent is not serum albumin. Either his j^epsin 
was not active, and on this supposition his experiment is without value, or the 
active constituent of blood serum is a substance which is not destroyed or mate- 
rially altered by peptic digestion. We know that the peptones not only have no 
germicidal properties, but belong to that class of proteids which is most favorable to 
the growth and development of germs. We recognize this fact when we add pep- 
tones to the various artificial media on Avhich we cultivate germs. However, we 

*Archiv f. Hygiene, B. 10. 


will return to this subject again. At present we will proceed with the literature of 
the subject. 

The successful researches of Buchner led many other investigators to enter this 
field of experimentation, and some of them have made valuable contributions to our 
knowledge of the germicidal action of the blood under varying conditions, but so 
far as the nature of the germicidal constituent is concerned but little or no progress 
has been made. Prudden * found that ascitic and hydrocele fluids restrain the 
development of certain germs. Rovighi treported that the germicidal action of the 
blood is increased in febrile conditions. Pekelhariug iiuclosed anthrax spores in 
bits of parchment and introduced theui under the skin of rabbits. Thus treated, 
the spores soon lost their virulence and finally their capability of growth. The 
destruction of these spores could not have been duetophagoi-ytes, which did not pen- 
etrate the i)archnieiit, but must have been caused by soluble substances. $ Behring 
and Nissen found that the serum of the white rat, dog, and rabbit destroy anthrax 
bacilli; while serum obtained from the mouse, sheep, guinea pig, chicken, pigeon, 
and frog have no such actiou. It will be observed from this that there is no constant 
relation between the germicidal action of the blood of animals of different species 
and their susceptibility to the disease caused by the germ. Thus, the rabbit is 
highly susceptible to anthrax, notwithstanding the fact that its blood destroys large 
numbers of these germs. On the other hand, the chicken is immune to anthrax from 
the moment when it comes from the shell, and yet the bacillus anthracis grows lux- 
uriantly in the extra-vascul ir blood of the chick. Tliis demonstrates that there is 
a great difference between the action of extra-vascular blood and that circulating in 
the body and constantly fed, and, in case there may be need, altered in composition 
by certain glands. 

Halliburton has prepared from the lymphatic glands a globulin which he desig- 
nates as cell globulin 3, and which agrees with fibrin ferment in inducing coagula- 
tion in plasma, llankiu has tested the germicidal iirojierties of this cell globulin. 
His experiments have been conducted in the following manner: The lymphatic 
glands (in later experiments the spleen also) of a dog or cat are freed as much as 
possible from fat and connective tissue, then finely divided and extracted with 
dilute solution of sodium sulphate (one part of a saturated solution to nine parts of 
water). The cell globulin passes into solution while the other proteids are but 
sparingly soluble. After tAventy-four hours the fluid is filtered and mixed with an 
excess of alcohol. The voluminous precipitate containing the cell globulin is col- 
lected on a filter and washed with absolute alcohol. For use, a part is dissolved in 
water and a small (juantity of a bouillon culture of the anthrax bacillus is added. 
Plate cultures are made along with control plates from time to time, and in this way 
the germicidal properties of the substance is demonstrated. 

Hankinll closes this contribution with the following conclusions: (1) Hallibur- 
ton's cell globulin 3 has marked germicidal properties (2) In this respect it differs 
from fibrin ferment. (3) The germicidal properties of this substance seems to be 
identical with that of serum as described by Buchner, Nissen, and Nuttal. (4) The 
active properties of the serum are probably due to this or an allied body. 

Bitterf^ has repeated the experiments of Hankin, but fails to confirm them. Bittei 
states that he has followed Hankin's directions exactly. However this may be, it is 
certain that the spleen contains a germicidal substance, but whether it can be 
extracted l)y the method of Hankin or not we do not know. That the germicidal 
constituent of the spleen is identical with Halliburton's cell globulin or with any 
other globulin we A^ery much donbt. It certainly is a nuclein and it is altogether 
possible that Hankin obtained traces of this nuclein in his extracts. In this case 
the extract would show, or fail to show, germicidal properties according to the 

*M(>(lio:il Kecord, 1890. § Zeilschrift f. Hyjrieno.B. 8. 

t Atti (Iclla Accad. Med. diR oma, 1890 || Centralblatt f. Bakteriologie, B. 9. 

X Ziegler's Beitraige, B. 8. IT Zeitschrift f. Hygiene, B. 12. 


relative amounts of uuclein aud other siil»stances jiresent. The less globulin and 
the more nuclein present the more marked would the germicidal effect be. 

Christmas* has prepared a germicidal substance from the spleen and other organs 
by the following method : 

The animal is killed with ether, opened under antiseptic precautions and the 
organ removed, cut into tine pieces, covered with 50 c. c. of glycerine and allowed to 
stand for twenty-four hours, then filtered. The filtrate is precipitated with five 
times its volume of alcohol, and this fluid immediately decanted. The j^recipitate 
is washed with absolute alcohol in order to remove the glycerine. Then the traces 
of alcohol are removed by pressure aud the precipitate dissolved in 25 c. c. of dis- 
tilled water. Through this solution air is driven for some hours in order to destroy 
the last traces of alcohol. Then the fluid is filtered and its germicidal action tested. 
Bitter has also examined this method, and the impartial reader must see that he has 
not done so with fairness. However, this fact renders the work all the more valu- 
able, because his results confirm the statements of Christmas. Bitter killed his 
animals by venesection, and, in some cases at least, prepared the substance in 
nnsterilized vessels ; but even when this was done the solution was germ free and 
manifested marked germicidal properties. Bitter finally finds a ditference between 
this substance and the germicidal constituent of blood serum; the latter, he states, 
is certainly destroyed by a temperature of 65°, while the solution of Christmas, 
after having been heated to this temperature, is still able to destroy from 35,000 to 
40,000 typhoid bacilli within four hours. Buchnert in his latest contribution on 
the subject has the following to say in condemnation of Christmas: 

A method given by Christmas for the preparation of germicidal solutions from the 
organs of normal rabbits has also been tested by Bitter. Germicidal solutions were 
indeed obtained, which, however, differed materially from active serum, tor in three 
experiments, notwithstanding heating to Qo'^, the germicidal action remained. 

It is altogether possible that the more powerful action of the solution made by 
Christmas is due to the fact that it contains the germicidal substances in more 
nearly a chemically pure condition than it exists in blood serum. It is also highly 
probable that the cause of the arrest of the germicidal activity of blood serum by 
a temperature of 55^ is not due to the destruction of its germicidal constituent, but 
is due to the action of the heat on other constituents of the fluid. 

Some attempts have been made to determine the nature of the germicidal constit- 
ueul; by the action of precipitating reagents on the proteids of blood serum. In his 
latest contribution Buchner states that he has not been able to obtain a germicidal 
solution by precipitating all the proteids with absolute alcohol, freeing the precipi- 
tate from alcohol, drying it, and then redissolving. He does not give the methods 
employed in freeing the precipitate from alcohol, the temperature or conditions 
under which it was dried or the nature of the menstruum bj^ which resolution was 
effected. In the absence of these needed details, his conclusion that alcohol destroys 
the germicidal substance must remain open to question. On the other hand, Christ- 
mas states that when the proteids are precipitated with alcohol and the j)recipi- 
tate dissolved in a volume of water equal to that of the origiual serum, the solution 
thus obtained has a more powerful germicidal action than the serum. Bitter,| in an 
experimental review of the statement of Christmas, gives the following detailed 
statement of one experiment : 

Ten cubic centimeters of serum were poured into 50 cubic centimeters of alcohol 
(strength of alcohol not given), stirred, and the precipitate immediately separated 
from the alcohol by filtration. (He fails to state whether or not sterilized filter 
paper was used.) The precipitate was freed from alcohol by pressure between folds 
of filter paper (again he fails to state whether or not this paper was sterilized), then 
dried at 37°, and mixed with 10 cubic centimeters of sterilized distilled water. On 
being allowed to stand for a short time at 37° nearly all of the precipitate was redis- 

* Annates de I'Institut Pa.steur, T. 5. JZeitschril't f. Hygieue, B, 12. 

t Arcliiv t'. Hy};iene, I!. IT. 

S. Ex. 36 16 


solved. The solution was then separated from the deposit by filtration (through 
uusterilized filter paper?) and tested. 

It can scarcely be a matter of surprise that Bitter found germs nearly always pres- 
ent in the solution obtained in this careless manner. However, he did find that the 
germs present did not develop when the solution was kei)t at 37^^ and, moreover, that 
germs added to this solution were destroyed. Bitter concludes that in truth anthrax 
and typhoid bacilli are destroyed by "precipitated serum," but not so energetically 
as bj' normal serum. 

Emmerich, Tsuboi, Steinmetz and Low* have made interesting and valuable con- 
tributions relating to the efl'ect of precipitation of the proteids upon the germicidal 
action of blood serum. An active serum was dialyzed in a sterilized parchment 
paper tube against water for from twelve to eighteen hotirs. By the expiration of 
this time the serum globin, becoming insoluble on account of the withdrawal of 
inorganic salts, was deposited. The dialyzer was dried with sterilized filter paper 
and tlio globulin-free serum was precipitated with several volumes of alcohol. The 
precii)itate was collected on a sterilized falten-filter and the alcohol removed from 
the precipitate by sterilized porous plates and filter paper. The i)recipitate was 
then finely divided, dried for half an hour in vacuo at 36°, then rubbed up in a 
sterilized mortar and dissolved in sterilized water to which salt solution had been 
added. In the solution thus prepared germs did not show, after from three to four 
honrs, either a marked increase or decrease, but when the solution was heated to 
100°, allowed to cool, and then inoculated with germs, the increase was four hundred- 
fold within four hours. Next, it was found that if instead of water, a 0-05 per cent 
aqueous solution of potassium hydrate was employed in dissolving the alcoholic 
precipitate in the globulin-free serum, this solution possessed all the germicidal 
strength of the original serum. The same was found to be true of dilute alkaline 
solutions of the alcoholic preciiiitate in serum from which the globulin had not 
been removed. The dilute alkali was si own not to have any germicidal action in 
and of itself. 

From these experiments, the above mentioned investigators conclude that the 
germicidal constituent of blood serum is an alkaline compound of serum albumin. 
They also found that heating the serum-albumin alkaline solution to 65° or higher 
destroyed its germicidal action, and they explain this effect of heat on blood serum 
and on their artificial solution by supposing that the high temperature breaks up 
the combiuatiou of the alkali with the serum-albumlu. Furthermore, they found 
that a serum which had been rendered inactive by a temperature of 55° could bo 
regenerated in jiart at least by the addition of the small amount of alkali men- 
tioned above. 

Since Fodort and Zuntzt have shown that freshly drawn blood rapidly decreases 
in alkalinity on standing in vitro, an explanation of the fact that blood serum 
rapidly loses its germicidal properties naturally suggests itself. Emmerich and his 
coworkers confirm their belief in this theory by demonstrati ng that blood serum 
which has been rendered very feebly acid (0-67 part of sulphuric acid per mille) has 
no germicidal action, but furnishes a good culture medium. 

The above mentioned investigations are very valuable inasmuch as they show the 
important role which the small amount of alkali plays in the germicidal action of 
blood serum. This had, indeed, already been demonstrated by Fodor t by quite a 
diff'erent line of investigation. This experimenter had found that the resistance of 
rabbits to anthrax is markedly increased by the administration by stomach or sub- 
cutaneously of sodium phosphate, carbonate or bicarbonate or of potassium carbo- 

Low concludes that the introduction of alkali into the albumin molecule increases 
its lability and he cites examples from organic chemistry in support of this view. 

* Centralblatt f. Bakteriologie, B. 12. J Centralblatt f. Med. "SViaseuschaft, 1867. 

t Centralblatt f. Bakteriologie, £. 7. 


There are some additional points of interest in the theory of Emmerich and his 
assistants. As has been stated, they believe that the serum-albumin is the germi- 
cide, but they think it higlily probable that only a comparatively small part of the 
albumin is active and this small part, they suppose, originates in the albumin of the 
daily food, which is converted into lymph cells, and by the disintegration of these 
it passes into solution in the blood. They admit, however, that there are some 
reasons for believing, with Buchner, that the whole of the serum-albuinin is active. 
They state that it is possible, but highly improbable, that the germicidal agent is 
not the serum-albumin, but some substance which is precipitated along with this by 
alcohol and other agents. 

We hope to show that the germicidal agent is not serum-albumin, and that this 
"highly improbable" substance does exist. 

In a short and somewhat unsatisfactory review of the report of Emmerich and his 
coworkers, Buchner * devotes himself to a consideration of the question of the 
regeneration of serum rendered inactive by heating to 55^ on the addition of an 
alkali. He details one experiment made by himself on this point. The experiment 
confirms the work of Emmerich, but Buchner offers an interpretation which is wholly 
theoretical and by no means convincing. He tinds that the regenerated serum when 
heated to 60° still has a retarding effect upon the growth of germs, and he argues 
from this that the germicidal action of the '^ regenerated serum" is due to its being 
less suited (for some unknown reason) to the growth of bacteria. No one knows 
better than Buchner the iutluence of the various chemical substances on the tem- 
perature at which an active serum is converted into an inactive form, and yet he 
overlooks altogether the possible effect of increased alkalinity on this conversion. 
Had he heated the regenerated serum to 100^ he would have then found that it 
forms a very fertile culture medium. 

Hankin^ has recently published a paper which is more valuable in its suggestions 
than in its experimental details. He suggests that the germicidal substance is a 
special secretion of the eosinophile-granular cells. The granular matter in these 
cells is, according to his theory, the antecedent of the germicidal substance. 

There are many other minor contributions to this subject, but those mentioned 
above contain all the essential points, and there is no necessitj' of a further review 
of the literature. It is true that Aronsont has very recently announced to the Berlin 
Medical Society that he has isolated a iiowerful antitoxiue from the blood serum of 
animals rendered immune to diphtheria and that with this substance he has cured 
guinea pigs infected with this disease. Following the example of another illustrious 
German investigator, he refuses to tell how this curative substance is j)repared. It 
is needless for me to say that this manner of dealing with scientific investigations has 
not as yet found favor with the unsoj)histicated profession in the new world. 

From a careful and critical study of the investigations, which have been briefly 
reviewed, we have come to the following conclusions: (1) The serum-albumin is not 
the germicidal substance in blood serum. As has been stated, either this must be 
true or the experiment by which Buchner demonstrated that an active pepsin does 
not destroy the germicidal action of blood serum must have been an error; because 
peptic digestion readily and completely converts serum-albumin into peptones and 
we know that peptones are especially favorable to bacterial growth. (2) The 
germicidal substance must belong to the proteids. Otherwise it would be difficult 
to explain the fact that a temperature of 55° renders blood serum inactive. (3) The 
only proteid likely to be present in blood serum and which is not destroyed by peptic 
digestion is nuclein. 

Having reached these conclusions, the following questions naturally present them- 
selves: (1) Is there a nuclein in blood serum? (2) Has this nuclein, if there be one, 
germicidal properties? These questions we have attempted to answer. 

* Centralblatt f. Bakteriologie, B. 12. fBerliner klin. Wocliensclirift, 1893. 


Dogs ami rabbits were the animals from wbicb the serum was obtained. Healthy 
animals, which had not previously undergone any experimentation, were selected. 
The animal was firmly fixed in a holder; the carotid was laid bai'e under antiseptic 
precautious. A ligature and a small clamp were applied to the artery about 2 
inches apart, the former tlistally and the latter ceutrally. Then a slit in the artery 
was made with a sterilized knife, and a Small sterilized glass canula, with dterilized 
and dried rubber tube leading into a sterilized Erlenmayer llask, was introduced 
into the artery and held in ])lace by another ligature. Then the clamp was removed 
and the blood flowed into the flask. In each case the animal was bled to death. 
The flask containing the blood was placed in the ice chest and allowed to remain for 
twenty-four hours. By the expiration of this time a wiue-colored serum had 
separated. This serum was poured into a second sterilized flask and about tea 
volumes of a mixture of equal parts of absolute alcohol and ether were added. This 
produced a voluminous precipitate which was nearly white. This was allowed to 
stand twenty-four hours, and in some cases much longer, the alcohol and ether being 
decanted and replaced by equal volumes twice or oftener during the time. Then the 
supernatant fluid was decanted and an equal volume of a 0.2 per cent solution of 
hydrochloric acid, containing active pepsin, was added and the flask placed in an 
incubator at 38^, and the digestion was continued until the fluid failed to respond to 
the biuret test for peptones. 

Each time this test was made the fluid was decanted from the undigested portion 
and re]ilaced by an equ.'il volume of fresh digestive fluid. In some instances the 
flask containing this fluid was allowed to stand in the incubator for some days. 
This was not necessarj' in order to complete the digestion, but was allowed as a 
matter of convenience. In all cases the digestion was prompt, and proceeded to * 
certain i)oint, when it ceased altogether. The undigested portion was small in amount 
and gi'ayish in color. This was collected on a small sterilized filter, and \yashed 
first with 0-2 per cent hydrochloric acid and then with alcohol. After the washing 
with alcohol the filter was allowed to stand exposed to the air for half an hour or 
longer in order that all of the alcohol might pass through or eva])()rate. The precip- 
itate was then dissolved in a sterilized solution of potassium hydrate. The strength 
of this alkaline solution usually employed was 0"12 per cent. Usually this solution 
contaiiu'd, in addition to the alkali, O.t! per cent of sodium chloride. In some instances 
a solution, containing 12 grams of potassium hydrate, 6 grams of sodium chloride, 
and 1 gram each of sodium bicarbonate and disodium hydrogen phosphate to 1 liter 
of water, was employed as a solvent. The solution was filtered through a Chamber- 
land tube and received in a sterilized tiask. 

The solution obtained as above stated was perfectly clear, colorless, and did not 
respond to the biuret test. The addition of strong nitric acid produced a cloudiness, 
which dissolved on the further addition of the acid. This acid solution did not 
become yellow on being heated, but did so after the addition ofaunnonia. 

We have now answered the first question. Blood serum contains a nuclein. We 
hope to investigate, at some time in the future, the relation between this nuclein and 
fibrin ferment. 

The origin of the nuclein found now for the first time iu blood serum is an inter- 
esting question. Does it come from the disintegratiou of the polynuclear cells, or 
shall we regard certain white blood corpuscles as unicellular organs whose func- 
tion it is to secrete this nuclein? 

In proceeding to determine whether or not this nuclein has germicidal properties 
the solution was distributed in sterilized test tubes, five c. c. being placed in each 
tube. It should be stated that, in dissolving the nuclein, the volume of the solvent 
employed was in all cases the same as that of the blood serum from which the 
nuclein was obtained. These tubes were inoculated with different germs and plates 
made at varying intervals of time iu order to test the germicidal action. One and 


the same platlnniii loop was used in the preparation of each plate. The diameter of 
this loop is 2 millinietcrs. 

Experiment I. 

A nuclein tube was inoculated with the bacillus of Asiatic cholera and plates made 
from this gave the following results: 

Time Immediatelj% 5 min. 15 min. 30 min. 1 hr. H his. 22 hrs. 

Number of colonies. 2,100 43 54 71 90 115 1,200 

That the alkali in which this nuclein was dissolved did not cause the decrease in 
the number of germs is shown by the subsequent increase. 

Experiment II. 

StapliyJococmis pyogenes aureus. 

Time Immediately. 1 lionr. 4 hours. 7 hours. 24 hours. 

Number of colonies 4,000 1,720 1,050 810 

Experiment III. 

Anthrax iacillus icitliout spores. 

Time Immediately. 1 hour. 4 hours. 7 hours. 24 hours. 

Number of colonies 100 ' 43 10 1 

Experiment IV. 

Cholera germ. 

Time Immediately. 1 hour. 4 hours. 7 hours. 24 hours. 

Kumber of colouics 470 45 1 410 

It may be stated here that the final increase in the number of cholera germs 
occurred both in the nuclein solution prepared from the scrum of the rabbit aud that 
of the dog. 

Experiment V. 

Stajihylococcas pyogenes aureus. 

Time Immediately. 1 hour. 5 hours. 19 hours. 24 hours. 

Number of colonies Countless. 22,000 12,525 155 

Experiment VI. 

Anthrax hacillus without spores. 

Time Immediately. 1 hour. 5 hours. 10 hours. 24 hours. 

Number of colonies 1,120 155 

All of the foregoing experiments were made with the solution of nuclein in steri- 
lized water coutaining 0-12 per ceut potassium hydrate and 0'6 per cent of sodium 
chloride. The following were made in the other solution mentioned above. It may 
be stated that the culture of the aureus experimented with grew in water containing 
0'5 per cent of potassium hydrate. 

Experiment VII. 
Staphylococcus pyogenes aureus. 

Time Immediately. 1 hour. 4 hours. 7 hours. 24 hours. 

Number of colonies 5,000 2,500 1,600 1,200 

Experiment VIII. 

Anthrax bacillus without spores. 

Time Immediately. 1 hour. 4 hours. 7 hours. 24 hours. 

Number of colonies 43 7 


Experiment IX. 

Cholera haclllua. 

Time Immediately. 1 liour. I hours. 7 hours. 24 hours. 

Number of colonies 350 105 150 42 


Staphylococcus pyogenes aureus. 

Time Immediately. 1 hour. 5 hours. 19 hours. 24 hours. 

Number of colonies Countless. 25,000 5,525 (35 500 

Experiment XI. 

Anthrax bacillus without spores. 

Time Immediately, 1 lir. 5 hrs. 19 hrs. 24 hrs. 

Number of colonics 430 

Wc liavc made many other tests of the germicidal action of this nuclein obtained 
from blood serum, but, since all of tliom gave practically the same results, further 
repetition is unnecessary. 

We have also made many experiments on the effect of heat and other agents on 
the gerniicidal action of this nuclein, but we prefer to r('])oit these later, since we 
have obtaineil some unexpected results. .Suffice it to say tiiat while boiling destroys 
the germicidal action, the temperature to svhich these solutions may be heated and 
still show some retarding action on germs has surprised us. 

The fact that the germicidal constituent of bloo I serum can be isolated has an 
important practical bearing. Blood-scrum therapy has proven impracticable on 
account of the large amount of the lluid which must be iujected. Now, nuclein 
theraj>y ])romiscs to enal)le us to avoid this difficulty, and possibly the near future 
may fuid us using this agent in the treatment of disease. The nuclein may be 
obtained from an animal rendered immune to diphtheria and a suflScient quantity of 
this injected into the blood or under the skin of a child suffering with this disease 
may effect a cure, but we will not prophesy. The future will tell us what it has in 
store when it becomes the present. 


Professor of Clinical Medicine and Therapeutics in the Philaddphia Polyclinic; one of the physicians to 

the Philadelphia Hospital, etc. 

The present paper is intended merely as a record of personal observations, and 
presentation of conclusions based thereon; it will not, therefore, refer to facts and 
theories in literature, though many observations parallel with, and confirmatory of, 
the views expressed have been found. The exigencies of time necessitate citation of 
a few only of the cases studied, which, excluding the more numerous instances of 
slight departure from the norm, altogether number sixty-odd, accumulated in hos- 
pital and private practice during the course of some eight years; and such reports 
as are made must be brief. I would request, therefore, that it be assumed, in dis- 
cussion, that despite brevity of account these cases have been investigated from all 
standpoints, with as much thoroughness as I am capable of, or as the opportunities 

The varying susceptibilities of different individuals, and of the same individual 
at different times, to the same influences has long beeu a matter of every-day obser- 


vation. Of a number of persons exposed to cokl and wet at the same time and place, 
cue shall have articniar rheumatism, another pneumonia; one shall contract tonsil- 
litis, another nephritis; others shall escape apparently unharmed. Evidently there 
is something at work in addition to inclement weather and specific microbes; and 
this something, which is the determining and, therefore, the principal etiologic 
factor, is a something special to the individual — a physical personal equation. We 
call it, whether exhibited in relation to the exciting causes of disease or to the action 
of drugs, individual liability, predisposition, idiosyncrasy; and though our terms 
are singular in type, we recognize that the singularity is relative and may be exhib- 
ited by several persons. 

For every idiosyncrasy there must be a physiological basis. By comparing the 
phenomena, special and general, exhibited by a group of persons presenting similar 
or identical idiosyncrasies, we take a step toward the recognition of the basic phys- 
iological conditions. 

I would invite the attention of the section to-day to an idiosyncrasy of the cir- 
culatory mechanism, which, in its extreme degrees, manifests itself in the form of 
well-recognized symptom-complexes; in its minor degrees gives rise to puzzling 
manifestations of great variety of detail; and in its least-developed forms often 
passes unnoticed. For this condition — which seems to depend upon a feebleness in 
the coordinating mechanisms, in consequence of which the balance of the cardio- 
vascnlar action becomes disturbed by influences that in the great majority of persons 
have no such effect, and greatly disturbed Ijy influences that normally have slight 
effect, while the restoration of equilibrium is slow and imperfect — I would propose 
the self-explanatory name of vasomotor ataxia: ataxia rather than hyperkinesis, or 
hypokinesis, because excessive vascular dilatation and excessive vascular constric- 
tion may be either spasmodic or paretic, or both spasmodic and paretic, as dilator 
or constrictor nerves, or both, are aftected; and even in the extreme and opposite 
types of vasomotor ataxia, the phenomena, while always more or less paroxysmal, 
are neither exclusively tliose of dilatation nor exclusively those of constriction, but 
both abnormal dilatation and abnormal constriction are usually present in varying 
degree in the same patient. The influences under which these phenomena are dis- 
played are, more especially, temperature — and cold more than heat — emotion, visceral 
or internal reflex excitation, and the action of toxic agents formed in the organism 
or introduced from without. 

The most striking and easily recognized phenomena are those exhibited by the 
heart and by the peripheral vessels (arterioles, capillaries, and venules) ; but analogy 
indicates that similar manifestations occur in the vessels of glands and viscera, 
while certain symptoms are only to be explained by disturbance of cerebral circu- 
lation. The stimulus tliat results in cardiac and vascular disorder may be applied 
centrally or peripherally, but the defective inhibition upon wliich the phenomena 
depend must be relatively central, and is probablj' the expression of functional or 
nutritional defect in the great ganglia of the sympathetic system, or in the medullary 
centers, or in both. 

Functional and nutritional disturbance may result in structural, and finally in 
organic change ; but the discovery of gross anatomical change at necropsy would 
not prove that it had existed from the first. It is likewise to be borne in mind that 
functional, nutritional, or structural defect in the sympathetic ganglia or nerves 
may be priiuary, or the result of primary or secondary disease elsewhere. Further- 
more, as a result of disturbed innervation and consequent malnutrition, degenera- 
tive changes may take place in the vessel walls and in the myocardium. The phe- 
nomena of vasomotor ataxia may thus occitr indcpeiulently, or be merely apart of 
the symptomatology of functional and organic diseases of various kinds. In either 
event the mechanism is essentially the same, and it will facilitate study to consider 
the circulatory symptoms apart from other and complicating conditions. 

With the pronounced types of vasomotor ataxia, to which at the one extreme — 


that of vascular relaxation— the name of Graves's disease or exopbtlialmic f^oiter, 
and at the other extreme — that of vascuhir tetany — the name of Kaynaud's disease, 
local 8yneoi)c, local asphyxia, acroasphyxia, symmetrical gangrene, acrosphacclus, 
etc., have been given, all are familiar. All are familiar, too, with the association of 
other phenomena of vasomotor paresis or vasomotor spasm, with Graves's disease 
and with Kaynaud's disease. For example, angina pectoris occurs in both, and 
angioneiirotic oedema and spontaneous gangrene have been observed in Graves's 
disease. As pointing toward more than a superficial or accidental resemblance in 
such association of the two affections, the following two cases are submitted : 

Case I.* Acro-asphjixia, wiih inlermiUent enlargement of thyroid gland, and parox- 
ysmal iachycardia. — Sarah O'N., unmarried; seamstress; aged 25 years; native of 
Ireland; having fair skin, brown eyes, black hair; was seen at the Philadelj)hia 
Polyclinic, April 11, lf<!)2. For tliree or four months she has had almost constant 
headache, with occasional dizziness. N'ision at times misty. The feet sometimes 
swell. At times she has pain in the precordium, with cardiac palpitation. These 
attacks occur paroxysmally. For about two years she has noticed that se\eral 
times a day, es])eeialiy if exposed to cold, either by immersion in cold water or 
otherwise, the fingers suddenly become discolored — purplish. Both extremities are 
affeeted at onee. Tlie discoloration Ijcgin.S in the jtalm of the hand and extends 
downward. It lasts l)ut a few minutes, and disappears <iui(kly. The first phalanx 
of the middle linger of the right hand is thickened, the skin glossy, the v<'ius much 
distended Tiiere is a depressed cicatrix on its inner aspect. The patient states 
that twelve years ago tliere was a swelling at tliis ])]aee, which was lanced, and 
kept on discharging until within a few months, wiien the sinus finally closed. The 
bowels are constipated. Tlie patient does not rise at night to micturate. Menstru- 
ation is irregular. I'xjimination shows all over the arms mottled areas of irregular 
distribution, indicating by their varying color, and by the appearance of the dis- 
ten(ie<l vessels, botli cajiillary and venous cmigestion. Over the upper part of tlie 
chest, .interiorly and in tlie back, esi)eeially beneath the scapuhe, are congeries of 
distended snjxnMicial venules. The legs and feet ai)iiear not to be .alfected. No 
lesion of the hiiigs can be detected. At the tirst examination of the heart the rate 
is 96. At the base a soft systolic mnrinur is heard, more distinctly on the left. In 
the veins of the neck a marked musical hum is heard, louder on the right. It is 
continuous, with systolic intensification. The thyroid gland is easily demonstrated, 
but not markedly enlarged. ILemoglobin is 65 per cent by Fleischl's scale; red 
corpuscles number more than 1,000,00!); there is no excess of wJiite cells. Urine is 
lOlS, acid, no alhuniiii, no sugar, no casts, no red cells (Dr. P^shner). The fundus 
of the eye is normal; there is compound hyperopic astigmatism (Dr. .Jackson). 

Relief of constipation, togetlier with correction of visual error by glasses, appar- 
ently xoiieved tlie headache. .Vtter a few doses of nitroglycerin, the local asphyxia 
did not return while the drug was taken. 

Some three months later the ])atient returned, comjilaining of recurrent headache, 
with attacks of precordial pain and violent pilpitition. The nature of these at- 
tacks seemed to be that of tachyoirdia rather than simjile ]>alpitation. While under 
examination the pulse rate was variable, about I'M). The thyroid gland was slightly 
enlarged, and a bruit could be heard over the gland on auscultation. 

Picrotoxin, -,}q grain t. d., was prescribed, with apparent relief to headache. Dur- 
ing some ten weeks the thyroid was observed to enlarge and diminish irregularly, 
without reference to menstruation, which occurred twice during the period. The 
swelling soft, not expansile, and greatest on the right side. The patient was 
last seen some four months ago, when the thyroid gland was app.arently ; 
pulse-rate 96. 

Case II. Epilepsy; acroasphyxia; enlargement of thyroid gland. — Mary^X., aged nine- 
teen years; domestic, unmarried; of American birth. Irish parentage; fair skin, 
brown hair, blue eyes; seen at the Philadelphia Polyclinic, .January 4, 1893, liasliad 
mild epileptic paroxysms of about one-half hour's duration once a week since the pre- 
ceding October. There is no aura. She screams and turns pale before losing con- 
sciousness. The bowels are regular; the menses regular but painful. The pati<Mit 
is subject to paroxysmal tlushiug, with subjo-tive and ol)jective heat, especially of 
the face. There are iriegnlar sweats. She has urticaria in summer time. She is 
easily excited; and has fretiuent .attacks of )>alpitatiou and rapid thumping of the 
heart. The heart is not enlarged; the imjmlso is jerky ; the rate is 100; the first 
sound is short, the second sound is accentuated at the aortic cartilage and at mid- 
sternum. There is a soft .systolic murmur over the sternum, near the articulations 
of the second cartilages; it is not transmitted. The thyroid gland is enlarged, es- 
pecially in the right lobe; it is soft and pulsating; there is no thrill and no bruit. 

• Tide The riiilaibb.lna rolyclinic. June, 1892, p. 89. 


The hands are of a dusky-blue color, which slowly fades on elevation; the nails are 
purplish. Upon inuiiersing the hands in ice-cold water they soon become red. If 
one hand only is placed in the cold water, that one becomes red, the other a deeper 
blue. Deruiographism is marked. Factitious urticaria is produced by pressure, fol- 
lowed by cold. 

The patient states that only recently has she noticed occasional blueuess of the 
bauds; that it is not constant, and is usually produced by cold, but may come ou 
while at work in a warm room. 

There are on the cheeks of this patient three or four small reddish elevations, 
surrouuded by little radiating lines — a star, as it were — of dilated vessels. A num- 
ber of small telaugiectases are found on the arms and breast. She statefs that she 
bleeds easily if cut, but blood is stanched in a reasonable time. She frequently 
bleeds from the nose. No family history is attainable. 

Taken by themselv^es, these two cases might not appear to be of special signi- 
ficance; but to me they were of great interest, because they beemed to supply the 
links between two groups of cases that had occupied my attention for a number of 
years, and which I believed to be related to each other, as to Graves's disease in the 
case of the one group, and to Raynaud's disease in the case of the other group; and 
thus to complete the chain of observation, as of reasoning. This will become more 
apparent if I relate briefly, but in some detail, the case that first drew my thoughts 
to the subject. 

Case III. — In February, 1885, Miss X., of American birth and parentage, Hebrew 
race; fair complexion, brown hair, graj' eyes; an intelligent and truthlul, and not 
hysterical young lady, some 17 or IS years of age, apparently in perfect health, was 
alarmed at a sudden dimness of vision, progressing in the course of a few minutes to 
total blindness, which lasted "about a second." The return of sight was foUosved 
by intense headache, lasting about ten minutes. Ophthalmoscupic examination, 
some hours afterwards, and at ditfere'Lit times since, has never detected any abnor- 
mal it j\ 

Examination of the urine, jiassed the morning following this attack, showed the 
presence of a quantity of albumin too slight to be (luantitatively estimated, a few 
leucocytes, a few uric acid crystals, many red blood-cells, and in one or two fields 
a hyaline tube-cast, or a mucous cast. This condition lasted for two or three days. 
The urine was acid in reaction, and 1015 to 1018 specific gravity; the quantity was 
normal. Incjuiry revealed the fact that the patient blushed easily, and that in addi- 
tion, without known emotional cause, there occuired at times what she termed 
"burning flashes," in which the skin at various areas, sometimes circumscribed, as 
to a cheek, sometimes generalized, would for a few minutes, or a few hours, become 
intensely red, and with l>orh subiecti^'e and o!)jective sensation of heat. On one or 
two occasions the peculiar distribution of the red areas and their persistence for a 
day, had led to a false domestic diagnosis of measles. But the re]>etition of the 
attacks, their peculiar development and course, and the absence of all other nmrbid 
phenomena, soon i)roved the error. As a child, too, she was said to have had measles 
three timeij and rubella once. In one of these attacks tliat 1 saw, as the rash was 
fading, the skin of the arras, chest, and neck was covered with little pink spots, not 
elevated above the surface, thelargest of which was no larger than an ordinary pin- 
head; and I was told that the rash began in the same way, but that when at its 
height it presented either a uniform scarlet flush or the mottled appearance simu- 
lating measles. On another occasion I saw the patient when the right cheek was 
the seat of a vivid blush, the left being apparently normal, and was told that the 
left cheek had been the blushing one some hours earlier. The flushed right cheek 
had a surface temperature of 97^ F., the left cheek 95^ F., while the axillary tem- 
perature was yS'l'^ F. 

Over the middle portion of the left lower jaw this patient's skin invariably pre- 
sents during menstruation an area of fixed blushing; that is, it is reddened in an 
oval patch about two inches long and half an inch wide, the color being deepest in 
the center, and fading at the periphery into that of the surrouniling skin. Her 
nails are slightly convex, pink in color, longitudinally striated, and exhibiting 
crescentic markings. She has been under ol)servation continuously since the attack 
of blindness recorded, and during that time has presented, in addition to the flushes 
spoken of, an attack of erythema nodosum; several attacks of urticaria; one attack 
that I did not see, which appears from her description to have been a circumscript 
cedema of the arm; and one that I did see, which was circtimscript oedema of the 
calves of the legs. The transient blindness has been repeated, aftecting only one 
eye, however, and there was one attack of hemiopia, likewise transient, in which 
she did not determine which eye was aflected, or whether both were involved. In 
1889 an attack occurred, which (my notes being defective) she describes as follows: 


"Having been in fjood health for two years, I awoke one night with a great desire 
to nrinate; tliis was followed by a IVeling of laintness and great puin in tlie — 
I must liave been partly nnconsiious, as 1 walked down stairs without rcnieuibering 
how. When I became aware of my surroundings, there was intense itching of the 
palms of the hands and soles of the feet, and a trembling of the whole body, which, 
lor some minutes, I was unable to control. In the morning there was a red-ljlotdiy 
appearance on the chest, lasting several hours, and welts on the wrists. I felt well, 
and had no i)ain. I remeniln'r tliat the urinalysis for the next.six months frecjucntly 
showed albumin, but I felt perfectly well and strong. The rash and welts occa- 
sionally api)earcd." 

The urine is for months normal, but occasionally shows a trace of alhuniin, uric 
acid crystals, casts, cylindroids, or luemocytes. Sometimes allot these will be found 
together, sometimes albumin only, or blood cells only. General health and strength 
keep good; the eyes are emmetropic (Dr. .lackson), with large pupils, and the blootl 
is normal. Though there are occasional attacks of palj)itation, the heart and, so far 
as I can dtderuiiue, tiie lungs and all the other viscera — for I do not believe there is 
organiorenal di.sea.s(.' — are normal. Menstruation, however, is irregular at tiiues, and 
there is occasional dysmcnorrhtua. The attacks described arc not related with men- 
struation. The thyroid gland is demonstra))le, but not enlarged. 

The family history in this case is of great interest. It can hardly be a series of 
meaningless coincidences. The patient's father died of acute; pneumonia, after hav- 
ing for forty years sullered with pulmonary hemorrhages, attril)uted to " of 
one lung," of what nature I do not know. 

Several paternal cousins have leucoderma; one has had renal colic, passing nric 
acid gravel; another, highly myopic, has o1)Scure symptoms of disturbance of the 
sympathetic nervous system, diagnosticated by one observer as incipient Graves's 
disease; another has had chorea, and is very liable Co epistaxis and to panaris; 
another, likewise highly myopic, has had retinal hemorrhage; another has chilblains 
every winter, and is subject to sudden syncope from slight indigestion; another has 
bluencss of the hands every winter, with tendency to deep lissuring of the finger- 
tips, unless constantly protected by wo(den mittens; anothi r will get circuniscript 
(I'denia from slight knocks that in otluMs wouM pass unnoticed, and that even in 
him do not cause discolorati(m of the skin. A paternal aunt, still living, is afl'ected 
similarly to the father. A brother of the father's died at the age of thirty, of sufio- 
cation, in the course of a pulmonary hemorrhage. His son has progressive myopia 
of high type. There is likewise a rheumatic tendency in this family; one of its 
members has had dial)etes mellitus. The i)atient's mother is living and healthy, vt 
past sixty years of age. Severe mental shock, however, not long ago prostrated her 
in bed for a few d.ays, during which time the heart's action was feeble, excited, and 
irregular; the temperature was slightly subnoruial; albumin, tube-casts, red and 
white blood cells were found in the urine. I am satisfied that she hasno organic 
lesion. Several members of her family have had diabetes mellitus, living, however, 
to advanced age, ami two of her sisters and one niece have had carcinoma of the 
breast. There is also a gouty and a neurotic heredity in this family. 

As further exhibiting the essentially constitutional basis of vasomotor ataxia may 
be briefly stated : 

Case IV. — A brother of the preceding patient, aged 35 years, dark haired, blue- 
eyed, has been for some eight years the subject of ophthalmic migraine, and has 
attacks of spasmodic asthnui if exposed to the emanations of feathers, or to moist 
atmosphere at the seashore. He has hyperopic astigmatism (Dr. Gould). His 
thyroid gland is slightly enlarged. He exhibits along the borders of the ribs the 
peculiar ai)pearance which I have termed the costal fr'uuje, namely, a network of 
telangiectases, following the outlines <>f the costal arches. This apju-arance is 
found in some cases of hepatic cirrhosis, but this patient's liver is api)arently normal. 
He has no pulmonary or other visceral lesion, but is seized at times with gastric 
crises (])ain relieved by vomiting), that n])iiear to correspond with ]ieriods of lithuria 
and oxaluria. His urine has never shown albumin or casts; and red blood-cells 
have been found on but one occasion. His reflexes are normal, or perhaps slightly 

These two patients, and a sister of theirs who is subject to profuse epistaxis, 


occurring witTiout apparent eanse, but is otherwise healthy, exhibit three symptoms 
upon which I -n-ould lay special stress: 

1. DermograpMsm. — That is to say if, with a blunt probe, and using very light 
pressure, letters or other device be traced upon the skin of the patient, especially 
upon the inner aspect of the limbs, or over the sternum, the tracings soon appear 
in a rosy-red tint that lasts for some minutes, or even half an hour. 

2. Factitious urticaria. — If in tracing upon the skin, one uses a little deeper pres- 
sure than before, the red lines soon broaden, and finally the reddened portions show 
a more or less decided elevation, like the wheals of urticaria. In some cases the red 
color fades, in others it persists. The elevation remains in some instances, notably 
in cases of chorea and of exophthalmic goiter, for several hours. When factitious 
urticaria is not immediately apparent upon the use of pressure merely, it may in 
some cases be quickly developed by applying cold to the part, as with a lump of ice; 
in other cases the application of hot water will cause it to appear. When cold or 
heat is applied, the wheals are always reddened, and sometimes a diffuse redness 
that slowly fades is likewise seen upon the intervening skin. 

3. A modified form of Stelhoag's eye-nign of exophthalmic goiter. — When the patient 
looks fixedly before him, and opens the eyes, a distinct white rim of sclera is exposed 
above the cornea. It may be spontaneously exhibited in the excitement of conver- 
sation, or may have to be developed by the physician in the course of examination. 

I lay stress upon these signs on account of their occurrence in Graves's disease. 
Unfortunately I have not been systematically employing these tests for much more 
than a twelve-mouth, during which time I have not seen a large number of typical 
cases of exophthalmic goiter. I have records, however, of seven undoubted cases 
(one male, six females), in which dermographism and factitious urticaria were 
marked; and, indeed, I have never seen factitious urticaria so readily produced, so 
persistent, or so striking, as in the case of a colored woman with exopbtbalmic 
goiter, in the wards of one of my colleagues at the Philadelphia Hospital. I may 
briefly record in this connection, as a case linking the preceding ones with those to 
follow, a case from my own service at that hospital. 

Case V. Exophthalmic goiter %nth acro-asphij.ria. — (Xotes taken byDrs.Claribel Cone 
and S. Stivers, resident physicians, Philadelphia Hospital, February 2:3. 1893.) Charles 
P., aged 33 years, waiter, native of Ireland, unmarried. His motlier died of cancer 
of the breast ; his maternal grandmother, of cancer of the nose ; a maternal cousin, of 
phthisis. There is no neurosis in the family. The patient had the infective fevers 
of childhood. He has been a hard drinker. He had syphilis and gonorrhcea about 
twelve years ago. He has not had rheumatism. When a child he had attacks of 
palpitation of the heart, which ceased as he grew older. Twelve years ago he was 
occasionally attacked in the same way. Six years ago, after a debauch, more persist- 
ent rapid action of the heart developed, and has contiuued at intervals since. 
Attacks may be brought on by ills being startled. Tlie cardiac disturbance some- 
times prevents sleep. It is accompanied with dyspncea. There is no cough. For 
the same length of time he has been very nervous, ea^sily frightened; his hands trem- 
ble, and at times there is a general tremor. The cardiac storms and general nervous- 
ness develop synchronously. He has occasionally spat blood ; not sufficient to cause 
him to give attention to it. The present attack began about a month before admission. 
There is no pain, no auisesthesia, no motor paralysis. The eyes were always large, but 
have been getting more prominent for the last two years. Graefe's and Stellwag's 
signs are both present. Goiter has appcai'ed and disajipcared. No data of this are 
attainable. At present there is no demonstrable enlargement of the thyroid gland. 
The pulse rate varies from 81, under treatment, to 140 without treatmeut. The car- 
diac impulse is not strong. There is no murmur. In the vessels of the neck, especi- 
ally the jugulars, there is a marked music:il hum. Examination of the blood shows : 
Haemoglobin (Fleischl's scale), 30 per cent; red corpuscles, 4,036,000; white cells, 
11,000. There is no pulmonary lesion. There is nothing abnormal in the urine. 
The patient has frequent cold sweats. The skin is usually warm and moist. The 
hands, from time to time, become bluish and cold. They are always moist. At times 
after an atack of coldness and lividity, they become pink and warm. The attacks 
are independent of weatlier and of the tem])erature of the ward, but can be induced 
by exposure to cold. The duration is variable. The patient has an irregular tem- 
perature but no relation can be traced between temperature curve and paroxysms of 
acro-asphyxia. Dermographism and factitious urticaria are marked. The hands 


immersed in warm water (110° F.), become slij;htly red in aliont tlireo minutes. In 
cold water (JO"^ F.) they become quite red in two minutes. One hand being j)hiced 
in cold water becomes red; the other, left tree, becomes blue. White spots made by 
pressure on the bluish or reddened skin reinain for a lon.n' while. Elevation reduces 
lividity slowly, l)ut has no etl'ect on tiic i)inkish discoloration. The patient exhibits 
telajigiectases at different portions of the trunk, and has a hard, pinkish, sessile 
growth about the size of a bean, on the left cheek. 

Jucideutally, it may be remarked that this patient professed to feel better, and 
exhibited eligiit objective improvement during tlie administration of desiccated 
thyroid gland. The only abnormality observed in the urine was during tliis time, 
and consisted in an int(>nse bli)od red coloration. It did not respond to tests for 
Inemoglobin, and Dr. .John Marshall kindly examined the specimen, and reported 
the color to bo due to a modified form of indican. 

Bearing the foregoing case in mind, the observation now to bo recorded finds its 
place and explanation. The case is in many resi)ects similar to one that I observed 
in 1886 at the Jefferson Medical College Hospital, and in which Frof. Bartholow 
concurrtMl in my diagnosis of vasomotor paresis, as against cardiac hypertrojihy. 
In the earlier case acro-asjjhyxia was not present; temperature was elevated during 
paroxysms of flushing of the face. There was much headache. 

Case VI. Hamoptysis; tachycardia; aero-asphyxia. — I. H., aged 16 years, of Ru8.sian 
birth and parentage; Hebrew race; dark skin, hair, and eyes; a ])oor boy, who 
during the day teaclies languages to bcginni'rs, and at niglit, in a cold room, studies 
to tit himself for college, was scut to me by iiis attending physicians, Dr. (;. D. Spi- 
vak, Fel)ruary 20, ISIKS, with a note stating that lor a week he had had daily 
hemorrhages, slight in amouiit, believed to bo pulmonary, tlie blood being luight 
red and sometimes mixed with saliva. There was no c(uigh, no expectoration. 
Piiysical examination revealed no ])uImouary or laryngeal lesion. The heart was 
rapid (ISO) and fnrcilde, but not demonstrably enlarged. Tlie Hrst sound was some- 
what short, tlie second sound accentuated. The i>ulse was tense, 'llic hands were 
(lisc()h>red, the terminal idialanges being of a deeji ])iir]dc, the rest of the lingers and 
the dorsum of the hand being of various shades of jiliik, red, and blue, the pabns 
being mottled red and blue. Elevation slightly lessened the color, and secured 
a more even distribution of shades. The thyroid gland was slightly enlarged, 
and there was a taint hum in the vessels of the neck. The pupils were widely 
dilated, and there was evidently great eye-strain; the patient complaining of liead- 
aches brought on by rt>ading, and the left eye showing a tendency to wander. 
J>ater in the case, Dr. Georg(! M. Gould kindly examined the eyes, and found a high 
degree of compound hyperopic astigmatism; the eye-ground being normal. The 
urine has never contained albumin or casts, and red blood-cells were found on but 
one occasion. 

The patient was put to bed, with regulation of diet and secretions ; ice was applied 
over the heart, and tincture of aconite given until the pulse fell to 60. In the course 
of a w(!ek he was permitted to rise, when the ])ulse immediately shot u]) to 100. 
Dark glasses and paralysis of accommodation, adopted at Dr. Gould's suggestion, 
failed to ([iiict the heart. Suitable glasses were then prescribed, and aconite again 
administered until the pulse, in a sitting posture, fell to 80. On stoitiiiiig the 
aconite, tachycardia again manifested itself. Exaniinatlou of the urine showed 
notliing abnormal. Examination of the blood showed corpuscles and haMnoglobin 
about 75 per cent. The accentuation of the second heart-sound, and the high pulse- 
tension now I'cceived the consideration that perhaps they should have had earlier. 
Aconite was sto]iped, and nitroglycerin given in ascending doses until ])liyslological 
effect was uianirested. The imlse-ratc fell to 80 in the sitting posture, 00 in the 
standing position, it was still further increased upon exertion. Aconite was now 
given in conjuuction with nltroglycrin, and tincture of chloride of iron adminis- 
tered concomitantly. Under this treatment, with gradually decreasing doses of 
aconite and nitroglycerin, the pulse has become steady at about80. There has been 
no further hemorrhage. No sign of imlmouary lesion is to be discovered. There 
has been no history of rheumatism. While in the house, the room being kept warm, 
the discloratlou of the hands faded to a light duskiness. While going about in cold 
weather, the condition previously described returned. The hands sweat profusely 
at all times, even in cold weather. Since w.arui weather liiis set in the bauds have 
become normal in appearance. The patient exhibits dermographism, factitious 
urticaria, and the eye-sign already described. The pupils are persistently and 
t(|ually large. 

Coy-e I'll. (lulematniii^ acro-asphy.ria. — The brother of the preceding patient, a 
peddler, a native of Russia., aged 2:^ years; is suhject to chilblains. I had one ojijior- 
. unity to examine him — .July 17, 18ilo, a warm day. The hands were of a dusky 
color, mottled red and bluish; the nails puridish, and exhibiting the peculiar cres- 


centic markings. There was considerable sweating of the hands; he says that they 
get almost black in cold weather, and sometimes when not cold. At times they 
suddenly swell, and are often dark blue when they swell. The swelling lasts a few 
hours, rarely a day. Sometimes there are white patches on the hands when they 
are otherwise blue. The duskiness present on the occasion of my examination 
lessened on elevation. The heart was strong; there was no murmur; pulse 84 in 
sitting position, somewhat tense. 

There was mydriasis; the sclerotic was exposed on opening the eyes. Dermo- 
graphism and factitious urticaria were present. The hands trembled on being held 
out for a short time. This was said to be of frec|ueut occurrence. The thyroid 
gland was not demonstrable. There was no history of cardiac j)alpitation. This 
patient likewise has hyperopic astigmatism. 

Additional cases might be narrated were it necessary (and some will be published 
hereafter) in which what we may, for convenience of designation, call the Graves 
group of phenomena and the Raynaud group of phenomena are mingled in varying 
degree. But those selected are sufficiently indicative of the gradual transitions by 
which two diseases, apparently so opposite in their nature, may be brought under 
one clinical generalization. Leaving, now, the Graves group and those cases that 
stand on the far side of it, I desire to briefly submit some interesting cases on what 
we may call the hither side of the Raynaud phenomena; and it will be found, I 
think, that gradual transitions may also be traced here down to normality, which, 
like the srgil, completes our ring. 

Case VIII. Anwmia; hcematemesis; gastric ulcer (1); acro-asphyxia. — Mary T., aged 
17 years; of American birth and Irish parentage; fair skin, dark hair, gray eyes; 
syphilitic inheritance; was under my care in 1888 for profound aua-mia with htema- 
temesis and symptoms suggestive of gastric ulcer, and recovered under treatment 
based on such a diagnosis. Early last winter she returned, rosy in hue, without 
ana-mia, but again complaining of spitting blood. Her hands were of a deep-blue 
color, whicli was unaffected by position. I sent her to a friend to have her hands 
sketched, aud on the way to his office they resumed a normal color. Frequently 
during the cold weather they would become red or blue, or mottled red and blue. 
On severe exposure they once became dead white aud were excessively cold. When 
blue the hands are sujectively and objectively cold; when red they are objectively 
warm, but subjectively cold. The same changes take place in the feet. Both hands 
and feet sweat profusely. Capillary pulse was seen in the lips and nails. Occasion- 
ally she has a film before her eyes. There is no lesion of the eye ground, but glasses 
are worn for relief of headache (myopic astigmatism, Dr. Jackson). There is no car- 
diac or pulmonary lesion. The thyroid gland is not abnormal to palpation. The 
pulse is 80, and of low tension, as shown by sphygmogram. Examination of the 
blood showed: hremoglobiu, 80 per cent; corpuscles normal. The urine contained 
a few red corpuscles. 

Case IX. Hwinoplysis; ttihercalosis; acro-asphyxia. — M. M., a drug clerk, a native 
of Russia, of fair complexion, light hair, blue eyes, applied at the Philadelphia 
Polyclinic February, 1893, on account of pulmonary hemorrhages. Attention was 
attracted to the blueness of his hands. This was said to have manifested itself 
while out of doors during cold weather for several years, and to slowly fade into a 
pinkish tint while the patient remained in doors. Elevation caused very gradual 
disappearance of the discoloration. The heart was normal. There was found slight 
dullness and crackling at the left apex, and large and small mucous rales over both 
sides of the chest. After repeated examination of the sjrata a few tubercle bacilli 
were found. The patient stated that his mother's hands were similar to his, as were 
also those of one sister and one brother younger than himself. His father and his 
elder brothers and sisters did not exhibit it. The sister and brother who had blue 
bauds were quite subject to bleeding from the nose; with the sister, epistaxis ceased 
with her first pregnancy. 

This patient showed dermographism and factitious urticaria. There Avas no 
cardiac lesion and no abnormality of the thyroid gland. His hands and feet were 
constantly sweating both in hot aud cold weather. He had paroxysms of polyuria. 
His urine while under observation showed occasionally red blood cells, no albumin, 
no sugar, no excess of urates. He has myopic astigmatism (Dr. Jackson). Under 
treatment, with rest and calcium chloride, the pulmonary hemorrhages ceased, and 
the hands improved while kei>t wrajjped in cotton and treated daily with a 
descending galvanic current. 

In these cases of blue hands, and in many others of which I have record, there is 
a striking series of phenomena to be observed, which I have not thought it ueces • 
sary to relate in detail in each case. If, during a period of quiescence, that is to 


say, in wiirm wiiatlier, oi- after tlic effect of treatment, or if the warmtli of the room 
Las made the hands somewhat less blue, one hand be placed in ice water it will, in 
a few minutes, become a bright red, while the other hand, not exposed to local cold, 
becomes a deep blue. Control observations on not'nial hands do not show the same 
result. If, during an attack of local asphyxia, the blue hands be jilaccd in warm 
water, one of two things may occur: 1st. Tlie hands may quickly become red. In 
that event, on removal from the warm water the red fades to a dead white, then the 
normal color returns, then an abnormal blueness. Stroking the hands, either up or 
down, increases the rapidity with which the whiteness develops — and in some few 
mild cases, stroking alone, without resorting to immersion in cold water, will 
produce it. 2d. In other cases the hands become white on immersion in warm water, 
and red or pink when r'emoved into the air. In all cases, whether the hands be blue, 
pink, red, or mottled, pressure produces a whiteness whicli does not quickly disap- 
pear. In some cases the experiment was made of immersing the blue hands, during 
an attack, in cold water. They would either become red and warm, or almost black 
and intensely cold. 

I have alluded to the appearance of the finger nails. Setting aside the well-known 
appearance in typical Raynaud's disease and that produced by panaris, to which 
latter alfection these subjects seem quite prone, I have observed many varieties that 
fall into two groups: a clubbed finger end, with broad and Hat or Hippocratic 
parrot-beak nail; and secondly, a tapering finger end, with long and transversely 
curved nail. The nails are usually striated, sometimes thickly ridged longitudinally. 
Tliey are sometimes a, sometimes a purplish, sometimes a pink color. The 
broad, Hat nails are more frequently a leaden blue; the long nails more often pink. 
Both the pink and the blue nails exhibit crescentic markings. In the pink nails 
there is usually one narrow and deep-red crescent between two wider and whitisli 
crescents near the tip. The flat, leaden-colored nails usually show one wide, whitish 
crescent centrally. These markings diti'er from the whitish or reddish discoloration 
produced by varying pressure in normal persons. 

To resume the development of our circle of cases, I have now to submit two 
instances that would be merely curious in themselves, but find place and expla- 
nation through each other, especially in relation with the cases of haemoptysis and 
haematemesis recorded, and with the occurrence of blood spitting in Graves's dis- 
ease. I have seen two cases of hiemoptysis in exophthalmic goiter, in both of 
which pulmonary tuberculosis finally developed. 

Case X. Paroxysmal numbness of extremities; chlorosis; hemoptysis; pulmonary tuter- 
culosis; acute hemorrhagic varices {'i) of pharynx. — Miss V., of American birth and 
parentage, Scotch descent; fair complexion, brown-gold liair, gray-brown eyes; not 
hysterical; first had indications of numbness in the left hand and arm on nearing 
the menstrual ])eriod at the age of 14 years, l^revious to this she had enjoyed good 
health, with the exception of an abscess on the left side of the neck, at the age of 8, 
and fretjueut paroxysms of hard, barking cough. She was subject in warm weather 
to an erui)tion on the hands, which was relieved by applications of black wash. 
The fro([uency of the attacks of numbness and their extent continued to increase 
until the age of 20, when the patient was treated for anaemia. She had then 
had no period for six months, had lost flesh, was very pale, had cough, 
and constant headache. At this time the patient came under my care (1883) for 
pulmonary hemorrhages with fever, and physical signs of tuberculous infiltration 
of left apex. Under treatment complete recovery ensued, the menses appeared, and 
the general tone of the health was restored. The numbness disajipeared for about 
four years, when the attacks returned and still occur, with not so much frequemy 
but more severity, and aft'ecting likewise tlie tongue and throat. The face becomes 
very pale; the arm and hand seem perfectly lifeless, and can be placed in almost 
boiling water. When feeling is restored a A'iolent headache follows and the patient 
is weak for two days. The attacks generally follow disorder of the stomach or 
mental disturbance, or occur about the menstrual period. At times, not connected 
with the attacks of numbness, there occur in the throat during glutition what she 
terms " blood blisters," wiiich consist of little bluish elevations about the size of 
half a pea, and apparently of the nature of varices, that when ruptured, artificially 
or spontaneously, discharge black blood. Her sister is subject to similar but larger 

pan-a:merican medical coxgress. 255 

"blood blisters," wliicli, liowever, do not always discbarge tberaselves, and it is 
said that it is sometimes necessary to puncture them to prevent sutfocation. Her 
grandmother was liable to attacks of numbness from about the age of 30 until the 
age of 80. 

This patient exhibits dermographism, factitious urticaria, and the eye sign. Her 
nails are curved, pink, marked with crescents. She has hyperopic astigmatism 
(Dr. Tnrubull). The thyroid glaud is not enlarged; there is no heart lesion. 

Case XI. Blue oedema \f i^Jiftryux and uvula, loUli urticaria of fundament; angio- 
neurotic adema of trunk and face; paroxysmal tachycardia. — Mrs. B., aged 60 yeirs, on 
June 26, 1892, complained of sudden dyspucea of a few hours' duration, and soreness 
of the throat. For a day the patient has had urticaria of the fundament. She is 
subject to this form of urticaria at irregular intervals. The uvula is swollen, more 
upon the left, and the mucous membrane is of a grayish-blue color ; the left pos- 
terior palatine fold is similarly discolored and cedematous. The swellings pit upon 
pressure. Scarification gives esit to less than a drachm of black blood. Two or 
three days ago the patient had, -without known exciting cause, an attack of sudden 
violent beating, of the heart. She became cjuite faint, and lay down, and in the 
course of about half an hour the heart became quiet. An attack less violent and of 
shorter duration occurred later in the day. The attacks were accompanied with 
flushing and heat of the entire body. The patient has not menstruated for some 
years. She has had similar attacks previously. The first followed a mental shock 
twenty years ago. The attacks usually last twenty-four hours. Different portions 
of the body are swollen. Once the oedema occupied half the face; at another time 
half the abdomen. On three occasions it has begun in half the lip, afterwards 
extending to the whole structure. The tongue has been swollen. 

Her urine, examined on the day following the attack reported, was aTiberin color, 
turbid, acid reaction, 1019 specific gravity, containing no albumin, no sugar; leu- 
cocytes and red cells were x)resent. 

The patient exhibits dermographism and factitious urticaria. She is not specially 
susceptible to cold. Her family, while long-lived, is gouty and neurotic. One of 
her daughters has aggravated hysteria. One sister has diabetes mellitus. This 
sister likewise exhibits dermographism and factitious urticaria, and as a child and 
young Avoman was subject to paroxysmal flushing of one cheek. 

The following case will serve as a transition to a comi^aratively large group, in 
which digestive disorders are prominent : 

Case XII. Hysteria; burning and coldness of extremities; herpetic (f) eruption; hungry 
dyspepsia; exophthalmos. — Jtily 11, 1892. Mrs. E. O'D., a typical brunette, of Ameri- 
can birth, French parentage, aged 25 years; complains of subjective and objective 
coldness of the legs below the knee, for a week. There is cold perspiration of the 
feet. For a year the patie.t has been feeling worn out and languid. During this 
time the hands have been swollen, red, and burning when she rises in the morning. 
The redness passes oft' quickly. 

Sometimes there is a similar condition for half an hour toward evening. The 
patient is hysterical and easily frightened — the heart palpitates violently when she 
is nervous or excited. For three months subjective vertigo has occurred at irregu- 
lar intervals. There is no dimness of vision; she sees neither flashes of light nor 
dark specks. Ten years ago she had "fainting spells," in which, however, she did 
not lose consciousness. She became dizzy, then clenched her teeth and hands, and 
fell ; the image of the last object seen remained impressed on the retina. The attack 
lasted a few minutes; there was no convulsion, no subsequent drowsiness. There 
have been six such attacks in one day; they have become less frequent since mar- 
riage ; the last was six months ago. 

About a year ago there would, from time to time, appear on the legs and disap- 
pear after about two days, a papulovesicular eruption associated with itching. It 
did not pustulate and dried without scabbing. The bowels are constipated. There 
is headache. Sometimes there is pain referred to the stomach and relieved by eat- 
ing. There is no nausea, no vomiting, no pyrosis. Appetite is excessive. There is 
no polydipsia. The urine is excessive in quantity, and the patient rises at night to 
urinate. "Menstruation is irregular. The eyes are prominent, the eyelids tremble 
Avhen closed. The sclera is exposed when the eyes are opened. The reflexes are all 
exaggerated. The heart is irregular, not specially rapid; no murmur. The thy- 
roid glaud is not enlarged. Urine : acid, 1013, no albumin, no sugar; numerous disks 
that may be decolorized red cells. (Dr. Eshner.) 

The phenomena of disturbed and incoordinate circulation are often even more 
strikingly manifested in the cases diagnosticated of recent years as " neurotic dys- 
J)epsia" and " neurasthenia." In this connection I will briefly enumerate the salient 
features only of two additional cases : 

Case XIII. Xeurasthenia; lithainia; vertigo; membranous enter His. — Mr. J., aged 30 


years; attorney; American. Hyperopic asti<rniatism; uansea; no vumitinj;; parox- 
ysms of vertigo, with pallor, chilliness, and sweatinu;; aggravated nenrotic dys- 
pepsia; lavage jiroves absence of morbid secretion; emaciation; inability to attend 
to bnsiness; morl)id attention to 8ymi)tonis; no heart or lung lesion; throbbing and 
nmrmur in abdominal aorta; exaggerated rcHexes; mottled hands; pink, crescent- 
marked nails; dcrmogra]>hism, factitious urticaria; eye-sign; paroxysms of poly- 
uria. Urine contains no albumin, no sugar; at times leucocytes, red cells, uric acid, 
calcium, oxalate, phosphates. Patient has membranous euttritis. Has had attacks 
of urticaria; is extremely susceptible to both heat and cold; lunula and feet fre- 
(juently become c(dd without ajiparent cause. His child has a curious mottling of 
the skin of the trunk and limbs that resembles measles. At times it is a vivid red, 
at others it fades to a (hdicate ]>iidv or faint lu-o\vn. 

Case XIV. Hiplcrid in a nude, with uiinotic dijupepi^ia, hcrmatemesin, paroTjismul 
flushing, and sexual crises. — The princijial points in this case, of which space forbids 
a full report at ])resent, are as follows: The patient, a merchant, aged 45 years, and 
li;il)]tily married, is highly emotional and of an hysterical family. He' is stout, 
heavily built, with red cheeks, and dusky ])ink hands. His nails are of the leaden- 
blue variety. Dennograi)liism, the eye-sign. an<l the costal fringe are present. 
Factitious urticaria can readily b(; i)rodn(!ed, and the ]>atient has had hives repeat- 
edly. He is (|nite susceptible to nnxlerate heat, liusiiing and persi)iring when others 
feel comfortable. Ho has a liabit of working feverishly, and is an interminable 
talker. After a period of overwork his digesticm fails. He has burning pain in the 
stomach, with excessive thirst, and inability to retain anything except iced li(|nids. 
There are crises of gastric and abdominal cramp with vomiting — at times vomiting 
of lilood — with serous diarrhea, and at times passage of luenibrane. He does not 
use alcohol or tobacco, and always has been chaste. At times when sutlering with 
indigestion he will have sudden sensations of heat in the head ami coldness below 
the knees, or general heat fcdlowed by chilliness, which, as he lives iu a malarious 
region, has been called nuilaria. A peculiarly distressing form of the paroxysm is a 
feeling of heat beginning at the navel and spreading over the body, with pain in 
the testicles and unnatural sexual imaginings provoked by the sight of a strange 
man or woman "perhaps ugly as Satan;"' his face becomes dusivy red and his 
whole body trembles. This is followed by insomnia, anorexia nervosa, and tinally 
for two or three nights by excessive nocturnal micturition, the urine being colorless 
as water. iSuch urine has a specific gravity of about 1002, and contains nothing 
abnormal. His ordinarj- urine contains ntuther albumin nor sugar. On tsvo occa- 
sions colorless blood cells were found in largo (juantities. His blood is a))iiarently 
normal, and when examined in Philadelphia during a ])aroxysm of subjective heat, 
without elevation of general temin-raturc. maliirial organisms could not be found. 
Lavjige i)roved entire absence of gastric catarrh, and examinati(.r. of stomach 
contents after test breakfast showed absence of free acid with diminished total 
acidity. The eyes are normal. The knee jerks are sluggish. The heart is slow (60) 
and feeble; dilatation not demonstrable. There are attacks of )ialpitation Avitli 
dyspmea. The abdomen is not sensitive to j)ressure. Hepatic dullness is normal. 
The sjdenic dullness is not enlarged. 

In some cases of vasomotor ataxia there is a pronounced idiosyncrasy toward 

drugs, the most remarkable instance I have seen being the following: 

Case XV. Paro.r;isinal headache and vertigo; circumscrijyt oedema caused bi/ strych' 
nine and by picrotoxin. — Mrs. E. S., aged 47 years; of American nativity and parent- 
age; dark hair and eyes; full habit, Hushed face; was seen iu April, 1890. She 
complained of paroxysmal headache, subjective vertigo, and Hushes of heat, the 
symptoms being of several years' duration. There is no visual disturbance. Head- 
ache and vertigo occur together or inde])endently. The headache is not localized, 
but sometimes there is a feeling as of whirling inside the skull, in the vertical region. 
At times there is a sensation as of cold water being i>oured down the back. There 
is no rheumatic or other personal or family morbid history. The patient is regular 
in menstruation. There is no indigestion, but the bowels are inclined to be consti- 
pated. The thyroid gland is not enlarged; there is no thrill or bruit. There has 
been no urticaria, nor can factitious urticaria be produced. Dermographism is 
marked. The nails are pink and purple: they are striated and exhibit ])ink and 
white crescents. The hands are always warm, frequently sweating. The feet are 
cold even in warm weather; at times there are paroxysms of icy coldness, without 
loss of sensation or change of color. The urine is scanty, less than a quart in 
twenty-four hours; it contains nothing .•ibuormal. The pupils are much dilated. 
Dr. Hansell examined the eyes, and reports "presbyopia, no lesion of fundus, veins 
overfilled." The heart is slow and steady (rate 60), the pulse is full but not strong; 
superficial veins are not prominent. Strychnine (j;',i grain t. d.) administered medi- 
cinally caused marked (cilema of thi' faco. The patient recalled a previous experi- 
ence of the same kind. Nux vomica aud picrotgxiri cfvuse^ similar effects. Hyoa- 


cyamine rclioved the lieadache: alkaline ilinretics increased the nrine. The patient 
improved, bnt passed out of observation. August 31, 1^93. she reported at request. 
She is going through the menopause. The Hushes of heat are more frequent. The 
head, neck, chest, and arms to the finger tips become red. The redness passes oif 
in a few minutes. Sometimes it is accompanied by a uumbness of the left hand and 
arm, and tingling witli colduess iu the last two phalanges of all the lingers. Some- 
times the numbness will last for two hours after the redness has disappeared. A 
second flushing may 0( cur before the numbness ceases. There is no periodicity iu 
these occurrences. Pcrhajis they are worse when constipation exists. The hands 
are nsually warm and moist, the I'eet cold. Immersing one hand in ice water it 
becomes qnite red and slightly swollen. The wrist and forearm become bine in 
patches, with marked distention of vennles. The hand is objectively cold, sub- 
jectively warm. The other hand is not changed in color, but quite cold. On remov- 
ing the reddened hand from the cold water the fingertips first become white and 
numb, bnt after a few minutes redness returns, with a sensation of pins and needles, 
and both subjective and ol>jective warmth. 

Not now to detail additional instances, it may be stated that among other morbid 
associations fonud in cases of the same general character as those reported have 
been ecchymoses, petechi;e, h;ematuria, retinal hemorrhage, organic heart lesion, 
organic kidnej' lesion, arterio-capillary fibrosis, chorea, rheumatism, hay fever, 
paroxysmal engorgement of turbinate hodies, angina pectoris, and pseudo angina 
and glycosuria. In one case ha^noptysis occurred only during epileptic paroxysms; 
in another case of epilepsy, tachycardia and flushed face accompanied the convul- 
sions. In both these cases there was a soft enlargement of the thyroid gland. 

The obscurity in which the pathology of diseases of the sympathetic, or, to use 
Gaskell's term, the visceral nervous system, is still involved, cautions against pre- 
mature assertion of other than clinical facts. 

I believe that the phenomena herewith submitted for the consideration of the 
section are of considerable clinical significance. 

Leaving out of consideration for the present the diseases other than exophthahnic 
goitre (akromegalia, myscedema) known to be associated with abnormality of the 
thyroid gland, there are four affections of great moment in which functional or 
structural alteration of some jiortion of the visceral nervous system is an important" 
element, if not the essential feature. These are Graves's disease, Raynaud's disease, 
Addison's disease, and certain forms of diabetes mellitns. 

The cases here reported show the existence of lesser degrees of disturbance of 
that system; and indicate that in some instances, at least, there is a congenital ten- 
dency of such disturbance. They suggest, moreover, that this congenital want of 
balance in the circnlatory apparatus may he the germ from which, under the fructi- 
fying influence of various exciting causes, the more serious disorders develoii. Thus 
mental or even physical shock in a subject of congenital vasomotor ataxia might 
cause the oudden development of exophthalmic goiter; and an exposure to cold, 
from which a normal individual would quickly react, causes, in the subjects of this 
condition, local asphyxia, chilblains, frost-bite, or even extensive gangrene. So, too, 
slight indigestion, itself the result of influences that would he iuertectual in a normal 
individual, may, in the subjects of vasomotor ataxia, induce crises of vertigo, 
migraine, syncope, or even paroxysms of epilepsy. And similarly, other sources of 
perii)heral irritation — eye-strain, nasal abnormity, exiiosure to pollen, and the like, 
result in the production of an exaggerated reaction. The relationship of hay fever 
with the group of cases under consideration, may he best exhibited by comparing 
two of the descriptiveuames it has received: "Idiosyncratic coryza" (J. Solis-Cohen) 
and ••Periodic vasomotor rhinitis" (J. N. Mackenzie); in which connection I would 
cite the case of one of my patients with blue hands, who was comjjelled to give up 
his position in a drug house hecause of his excessive susceptibity to ipecacuanha. 

The occurrence of diabetes mellitns in members of the families of patients exhibit- 
ing the phenomena of vasomotor ataxia; of intermittent glycosuria in one of my 
cases of menstrual migraine with urticaria and almost constant flushing of the face; 
and of intermittent polyuria in many of my cases, are circumstances worthy of note — . 

S. Ex. 36 — ^17 


especially in relation with the wcll-kiiown occuricnce of glycosuria in some cases of 
(Jraves' diseasii, and witli the investij^ations of Tliiroloix upon pan<Tcatic diabetes. 

The tendency to hemorrhage must not be overlooked, especially incounection wiili 
the diagnosis of pulmonary tul)ercnlosis, of gastric ulcer, and of hypertrophy of the 
h(!art. Cases such as those I have reported may develoj) tuberculosis or cardiac 
liypertrophy, but these conditions need not necessarily be present at the time of 
Jiciiiorrhage, or later. I would call especial attention to the extraordinary frequency 
willi which, in cases of vasomotor ataxia, red blood cells are found in urine not dis- 
colore<l ; a tact rendered signilicaut to my mind by personal observation of haonaturia 
in a case of undeveloped Graves' disease that later exhibited the full comi)lexus of 
sym])toms, and by the records of h.cmaturia and ha-moglobinuria in Raynaud's 
disease. Unfortunately, the single case of paroxysmal ha-moglobinuria from cold 
that has come under my observation was not studied from the standpoint of the 
present paper, and is not available for comparison. In this connection, too, an inter- 
esting relation with hn-mo])hilia, and with the purpuric group of aflectious is sug- 
gested; but it would not be advisable at present to nunc than indicate this subject. 

The frequent association of refractive errors, and especially of hypcropic astig- 
matism, with instability of the circulatcn-y etinilibriuni, raises the question whether 
the ocular defects are to be classed in the category of exciting acting by 
rellectcd irritation, or whether there is a more fundanuntal relation. I am inclined 
to the opinion that abnormity of circulation aud nutrition bears a causative relation 
to the ametropia. The eye-strain may tlien react additionally upon the centers, 
increasing their irritability. 

Finally, as exempli lied by the case which first drew my attention to the subject 
(Case III), and by the case last reported (Case XV), we must recognize a class of 
cases to which, as yet, no definite nosological place has been given, and in which a 
varied .symptouuitology of circulatory disorder can not be referred to disease of any 
organ; though lesion of the digestive tract, of the kidney, of the heart, or even 
cerebral or spinal lesion may be suggested. For these cases, depending as they 
must, upon a want of contnd in the nervous system governing the caliber and 
tension of the vessels, a defect clearly of inhibition, and by the radius of its effects 
evidently central in location, it seems to me that the most appropriate name is 
vasomotor ataxia. 


(1) By the term vasomotor ataxia it is proposed to designate the condition of insta- 
bility of the mechanism of circulation present in certain persons and characterized 
by abnormal readiness of disturbance with tardiness of restoration, of the equilib- 
rium of the cardio-vasculiir apparatus. The manifestations are most strikingly 
displayed by the heart and by the peripheral vessels of the extremities, but analogy 
indicates the occurrence of similar phenomena in the vessels of the glands and o 
the viscera, more especially in those of the kidney, of the gastro-intestinal tract, 
and of the brain. They may occur apparently spontaneously, but often there is a 
recognizable exciting cause. Among the influences acting as excitants, are temper- 
ature, especially cold; toxic agents formed in the body, or introduced from without; 
visceral or internnl reflex excitation; and emotion. The stimulus may be applied 
centrally or peripherally, but in either case the resulting phenomena indicate a 
defect of central inhibition; the ex]H'ession, probably, of functional or nutritional 
aberration in the gieat ganglia of the visceral nervous system, in the medullary 
centers, or in both. The morbid anatomy is uncertain, and the results of necropsies 
necessarily inconclusive. 

(2) Vasomotor ataxia may be acquired as a sequela of disease; in many cases it 
is congenital; in some cases inherited; the condition is not rarely ])rescnt in several 
members of a family. 

(3) In some cases the phenomena are of paretic, in others of spasmodic charac- 


ter. Usually the two kinds of phenomena are displayed in varying degree in the 
same patient. AVhethei- spasmodic or paretic the symptoms are suggestive of inco- 
ordination. They are always in some degree paroxysmal. 

(4) In exophthalmic goiter, especially such cases as are produced by emotion or 
are markedly intermittent, is tmmd the extreme type of the "relaxing" variety of 
vasomotor ataxia. 

(5) The form of Raynand's disease, known as "local syncope" furnishes an extreme 
type of the "constrictive" variety; while "local asphyxia" exhibits phenomena of 
both abnormal relaxation and abnormal constriction of the vessels. 

(6) Between these extremes are numberless gradations down to the slightest de- 
parture from normality; while even the extreme symptom groups represent merely 
exatro-erations of phenomena that under certain conditions occur in normal indi- 


(7) Dermographism is an essential feature of vasomotor ataxia, and in most cases 
factitious urticaria can be readily produced by cold or by pressure or by both ; mot- 
tlings of the skin, certain peculiar markings of the nails, telangiectases, and stig- 
mata are common. 

(8) There is usually a hemorrhagic tendency, as shown by ecchymoses, petechias, 
epistaxis, hiemoptysis, luematemesis, hfematuria, and retinal hemorrhage. 

(9) Even in the absence of hematuria, red blood-cells are often found in the urine ; 
uric acid, urates, and oxalates are likewise common; the presence of albumin, tube 
casts, and cylindroids is less common, and is usually intermittent. Glycosuria has 
been observed. 

(10) In many striking cases .there has appeared to be morbid alteration, of the 
thyroid gland. 

(11) The action of the heart is usually rapid, irregular, and easily disturbed; 
palpitation is common, and in some cases intermittent tachycardia had been noticed. 
Hiemic and functional murmurs are not uncommon. 

(12) Among other symptoms and morbid associations observed are anaemia, hys- 
teria, drug idiosyncrasies, urticaria, local aHlema, hyperidrosis, angina pectoris and 
pseudo-angina, organic heart disease, pulmonary tuberculosis, asthma, hay fever, 
vertigo, migraine, and other forms of headache, transient hemiopia and other visual 
disturbance, persistent mydriasis, astigmatism, myopia, hyperopia, menstrual irreg- 
ularities, intermittent polyuria, rheumatism, rheumatoid arthritis, contractures of 
digits, chorea, epilejisy, neurasthenia, neurotic dyspepsia, gastralgia, enteralgia and 
membranous enteritis — most of which are doubtless fundamentally related, as effects 
of a common cause, or as secondary results. 

(13) In making the diagnosis of simple vasomotor ataxia it is necessarj' to exclude 
primary organic disease. The occurrence of such disease later does not invalidate 
the original diagnosis. The development of pulmonary tuberculosis in some cases is 
probably a sequence of vascular and trophic disturbance in the lung. Cardiac 
hypertrophy and renal lesion may likewise be among the results of disordered circu- 


By MART H. McLEAN, St. Louis, Mo. 


In this age of refined specialties many hoarse notes of warning are heard from the 
general practitioners about allowing one's special department to become a beam in 
one's own eye, shutting from view all other diseases and conditions. 

Very e8i)ecially, gynecologists have been arraigned again and again for their single 
eyes and shortsightedness, and for their great ingenuity in tracing all the ills of 


woman to some lesion in the pelvis. Not only so, but " hands ott" has heen the cry 
to the t^ynecologist; and some nenrologists Jiave traced long scries of severe and 
complicated nervous symptoms to a pelvic examination and gynecological treatment. 

No (lonht all of this brotherly counsel has been needed and has answered a good 
purpose. But sometimes an unusual series of cases or an occasional review of one's 
case book will lead the gynecologist to feel that, injustice to his fellows, the neurol- 
ogist and general practitioner, he too must utter a note of warning, and must point 
out another danger ([uite on tiio other side of the stream. 

Valuable time is often lost an<l a woman's strength wasted through useless eft'orts 
to overcome a distressing disorder, or tlirough tiuj general treatment of a protracted 
fever, in either of which the casual relation of a deep-seated pelvic trouble has been 

In the days when uterine displacements were the cause and substance of nearly 
all pelvic disease, and when the sympathetic nervous system was an unknown quan- 
tity, it is not strange that the general profession should have been skeptical as to 
the role played by ])elvic disease, and should have persisted in general tlierapcutics 
in the tedious chronic disorders of women. 

Hut since the endometrium with its extension into the Fallopian tubes has assumed 
so important a role in pathology, and since w(> have begun to learn sometiiing of its 
intinuite connection with the l>rain, heart, lungs, stomach, and entire alimentary 
canal, and of its subtle influence on tlie vaso motor and trophic nerve centers, it ill 
bec(uucs the phycician to ignore the possibilitj' of a pelvic lesion in any disease 
which does not quickly respond to a careful general therapeusis. 

Witliiu a few years Dr. I'ormad, of Philadelphia, lias astonished the world by pub- 
lishing the real pathological lindings in cases whose deaths wore attributed to 
"heart failure." In thirty-five cases of sudden death occurring in one city in one 
year, a ruptured extra-uterine pregnancy was found, a condition which is" now 
thought to be duo to a preexisting disease of the endonietriuni and Fallopian tubes. 
If statistics could bo gathered, we would probably tind an equally startling number 
of sud<len deaths ov(>r the country from ruptured ovarian and tubal abscesses, and 
from ])crforative appendicitis. 

But the sadness of such a list of deaths does not at all compare with the sadness 
of years of invalidism treated on general principles, which might have been relieved 
through the recognition of a causative pelvic ])athology. 

(iynecologists have been arraigned for subjecting young girls to unnecessary pelvic 
investigations, and the advice is still frequently given to treat the general condition, 
to surround the girl with all the hygienic advantages, and to let nature work the 
cure. To my mind the injury inflicted upon a girl by allowing a possibly incipient 
pelvic disease to develop, to gain control of the sympathetic nervous system, to 
Aveaken the digestive and muscular systems, and to limit the growth of the intel- 
lect, is far more serious and irreparable than any possible injury which could result 
from a properly conducted pelvic examination. 

A young woman, aged 19, was sent to me from southern Kansas. She had lieen a 
great nervous sutferer for almost three years. The origin of the trouble seemed to 
have been a jumj) from a barn 20 feet high to the ground. Slie was supposed to be 
suffering from some obscure injury to the spinal cord. She had constant headache 
and backache increasing in severity, great mental ai)athy, insomnia, and frequent 
hysterical convulsions. She had been treated during all the time by general ]irac- 
titioners with little or no improvement. She was considered too young for a pel\ ic 

I found on examination a severe endometritis with a left salpingitis, and some 
thickening and contraction of the left broad ligament drawing the uterus back and 
to the left. Under gynecological treatment the patient steadily improved and en- 
tirely recovered her health within a few months; but she greatly regrets the loss of 
those valuable years of her life. 


Another young lady of 19 years was sent to me by a general practitioner after she 
had been under various other physicians for about three years. Slie had a most 
obstinate gastric irritability. For throe or four weeks at a time she A'omited liter- 
ally all of the food she took. At all Times even the most carefully selected foods 
were digested with great discomfort. A great variety of treatment, several climatic 
changes, and faithful use of the stomach pump failed to check progressive emaciar- 
tion and debility. 

A pelvic examination revealed an endometritis, which was treated by aseptic 
cur, ttemont and relieved. Afterwards the stomach responded to treatment Ibrmerly 
used in vain, and the patient gained llesh and strength. 

A married woman of 40 years of age, the mother of four children, liad spent eight 
years of invalidism under the care of a well-educated physician aud surgeon. 81ie 
was a neurasthenic, put to bed for several days by any little domestic excitement, 
suffering several times a month Avith violent headache and nausea, 1 isting from 
forty to seventy hours, ciuite unable to endure the noise of her nursery, aud haunted 
with a constant dread of insanity. She was treated with tonics, sedatives, and 
stimulants, including bromides, pheuacetine, antipyriue, brandy, aud finally with 
increasing doses of morphine. 

An examination of the pelvis revealed a subinvoluted uterus with granular endo- 
metritis, and old lacerations of both cervix and perineum. 

Preparatory gynecological treatment and subsequent operative measures quite 
entirely relieved Jier, so that she had absolutely no headache, no gastric trouble, no 
nervous irritability, and no mental anxiety afterward. Rest and good food conijileteil 
a brilliant cure, which might have been attained years before, had not the pelvic dis- 
ease been overlooked. 

My friend, Dr. Bertha Van Hoosen, of C hicago, has given me the history of the 
following case which well illustrates the principle we wish to establish : 

Mrs. L., aged 35, married fifteen years; at 15 years of age had what the doctor 
called an abscess of the ovary, although he made no examination. She made a poor 
recovery from the attack and had other attacks similar to this before marriage. At 
20 she was married in her bed, being too sick to stand during the ceremony. She 
has been an invalid ever since, unable to do her housework or to social life. 
Last January (1893) she had an attack of peritonitis, ending in a rectal fistula that 
has been discharging large quantities of pus ever since. She has been treated for 
years for gnstralgia aud nervous prostration without benefit. No local examination 
was made until July, 1893, when I found a large exudate filling up the cul de sacs 
and embedding in it the uterus and appendages, with a fistulous opening high in 
the rectum discharging dailj- two ounces of oftensive pus. 

No one can doubt for a moment that such pathological tindings easily account for 
the years of suffering spent under the constant care of a general practitioner. 

A number of cases have been published during the past few years, in which ap])en- 
dicitis was found aud relieved by surgical measures after several weeks of fever 
diagnosticated as typhoid or tyi>ho-malarial fever. Such a case of recent date which 
failed to receive surgical relief has come to my knowledge. 

A brilliant young woman from Michigan was taken sick with a fever, pain iu the 
right iliac region, abdominal distension, etc., and was treated tiirough many weary 
weeks for typhoid fever. During wliat was supposed to be a slow convalescence 
she was taken to her Michigan home, where, after a sudden furious peritonitis, she 

The autopsy revealed a general purulent peritonitis, resulting from a secondary 
rupture of a perforative appendicitis. 

Dr. H. T. Byford, of Chicago, in a receiit lecture on tubercular diseases of the 
Fallopian tubes and peritoneum before the Chicago Post-Graduate School of Medi- 
cine, stated that in two cases of supposed typhoid fever of over two months' dura- 
tion, to which he had been called in consultation, he had found tubercular disease 
of the tubes to be the cause of the typhoid symptoms. 

The cases cited are sufficiently convincing to warrant us in drawing a few prac- 


ticiil coiK^lnsions: First, pelvic diseases Lave a wide and varied symptomatology, by 
reason of which they may simulate various general and nervous disorders; second, 
gravx errors in diagnosis have been made through neglect of a thorough examina- 
tion of the case, especially of the pelvis, thereby entailing upon the patient pro- 
longed sullering and even death; third, in the diagnosis of any disease which might 
be com])licated or induced by disease in the pelvis it is far better to make an 
unnecessary gynecological examination than to incur the risks of a mistaken diag- 


Medico Mayor Principal I'rimero del Cuerpo de Sanidad Militar Espaiiol, Tula de Cuba. 

En otra nota* he consignado sinteticamente mi opinion sobre la naturalcza toxi- 
iufecciosa del c6lera americano y su localizacion gastro-intestinal -. alii expongo el 
Irataniicuto (pic sigo y los resultados vordaderamentr r<uic]uyenti's (juc se obtienen 
cuaudo es eniploado desdc las primcras boras de la iuvasi('iu y quo cuando el caso es 
descuidado y se aceiitua la oliguria, la terapeutica ordinaria mejor dirigida resulta 
impotente para veneer la auto-intoxicaciou ureniLca. 

Una seric de trastornos, facilniente concebibles, exjjlican satisfactoriamentc este 
coniplexus sintomatico que cicrra con broche negro el cuadro al parccer halagiierio 
del ])criodo de remision. La dismiiuicion creciente de oxihemoglobiua diliculta el 
dcsdoblauiicnto de los cui'r])os azoadds en la glandula hepatica, y por retmcion de 
uiio de BUS productos se provoca la inliltraciiin grasosa imposibilitaudo las oxidaciones 
regresivas. Sin snfrir las snstancias coloides latransfonnMci(3n cristaloide no pijeden 
ser dialisadas por los liltros renales y jior lo tauto la colemia, la acolia y fiualmente 
la uremia son las fases sucesivns de la auto-iutoxicacion amarilla. 

Dos formas suele preseutar la uremia: la adiiuimica y la ataxo-adinamica. En la 
]>iimera alguuos casos raros conscrvan la iuteligencia; la seguuda es la mffs comun 
en la Isla de Cuba; no puede quedar en firms la opinion de M. Havelhurg de Rio de 
Janeiro quo ascgura, quo en los enfermos dc liebre amarilla t "la iuteligencia per- 
manece normal hasta la nuicrte;" en la Habana el Vu^, mueren inconscientcs pre- 
sentiindose la perturbaeiou intelectual veinte y treinta boras antes de la muerte. 

La terapt'^ntica seguida en esta fase de la enferinedad es en general lo mas ])ueri] 
que puede darse; todos casi sin escepcion mueren solicitamente atcndidos por los 
clinicos sin intentar algo que saiga del jiatron cortado que, a semejauza de los uni- 
formcs contratados para el ejiMcito, d ninguuo viene bieu; es prcciso tomar las 
dimcnsiones y "poner el remodio a la altura del mal." 

Creo tirmemeute que hay algo mas que barer y que la oxigenaci6n rectal, pulmo- 
uar 6 intersticial tieneu una nota iudicaciou; la hipodermo-clisis y esiiecialmcnte 
la iiiycccion intravenosa de sucro artificial estorilizado practicadascon oportnuidadi 
antes que la uremia se acentne, evitaran la graduacion del envenenamicnto y sal- 
varan muchos, senteueiados d muerte por la timorata terapeutica. 

Si la uremia es muy intensa, ann cuando se recnrra a estos medios, suele acontecer 
que el enfermo sigue comatoso, a pesar de haber elimiuado grandes cantidades de 
orina, pasadas seis li ocbo boras de la inyecciim intravenosa de dos d tres litros de 
suero artificial esterilizado (i 34°, morira el enfermo irrcmisiblemeute. Debera sin 
pcrdida de tieiupo procedeisi^ a practicar nuevamente otra inyeccinn intravenosa de 
su(!ro, al par que se dCi salida por una A-eua de otra estremidad, a ignal cantidad de 
sangre ampliada, pudiendo ambas calcularse en tres litros, y terminandopor la trans- 
fusii'in de un litro de sangre humaua 6 en su defecto de siete il ocho cientos ceutimetros 
ci'ibicos de sangre animal. A la combinaci6n de lainyeccion de suero con simultanea 

* Tratamii-nto medico del vomito uegro. 
tSeniaua M6dica, 2 marzo 1892. 


dejilecidn de saiigre seguida de transfusion sanguinea la dononiino difusi6n de los 
veneuos 6 ioxldifusion.^ 

Un frascode baca inferior sirve bicn para la transfusidn serosa: para la ioxidifusion 
los transfusores Colin, Matliin, etc., pndiendo remjilazarlos por un emlmdo de cristal 
grande 6 en ultimo caso de liqja de lata que en cnalquier parte se puede encontrar, 
una lancetJi, un trocar-agiija y tubes de goma: escusado es recomendar la mas 
rigorosa t^cnica asoptica. 

Once casos, amiricos de veinte a treinta boras, uremicos acentuados yla mayoria 
agouicos he tenido ocasion de tratar por la transfusion serosa y de ellos tres se ban 
salvado ; los restantes be pronosticado su muerte sino se recurria urgentemente ^ 
la toxidifusion. Circuustancias que no es pertinente exponer,tbicierouimposible8u 


Medico Ma'jor Principal Primero del Cuerpo de Sanidad Militar Espaiiol, Tela de Cuba. 

La bacteriologiabasta el preseute demuestra que la tiebre amarilla no es infeciion 
general y que al localizarla unicameute el tubo digesti%'o es el organo indicado. 

En espera de la demostraci6n esperimental cree el antor fundado en la observaciou 
cliiiica y uecropsica que es una infeccion gastro-iutestinal con toxemia microbiana 
concomitante y auto-intoxicacion uremica cousecutiva j)or la accion quelasdiastasas 
ejercen sobre la sangre, rebajaudo su funci6u respiratoria, dificultaudo la oxidaciou 
de la bemoglobina y dismiuuyendo cousiderableniente por lo tanto la cantidad de 
oxigeno eirculante, resultado final que da cumplida explicacion de la uremia por 
retardo 6 suspciisi6u del proceso de oxidacidn regresiva. 

Dcsde el ano 1878 en que en estas ideas se afirmo, con ellas consecuente, el antor ha 
tratado los enfermos por los purgantes, los antisi-pticos y los biperoxidantes, cam- 
biando frecueutemcnte los segundos d medida que la quimica y la clinica, nos los 
daban Ji conocer: desde 1888, en que d la uaftalina relevo el naftol A, antis^ptico 
ideal del tubo digestivo, no ha inducido caml)ios en el tratamiento, £ escei^cion de 
dar la jirefcrencia al beuzoato de sosa sobre el salicilato. 

He aqui como ijrocede: Administra j)or primera intencion de 60 fi 100 gramos de 
sulfato de sosa, en 300 de agua, repitie'ndole si es devuelto por las dos 
boras, sin esjierar el efecto purgante, una capsula con medio gramo a naftol, que se 
repite cada bora 6 cada dos, segun la intensidad del caso: diez gramos de benzoato 
de sosa por litro de agua azucarada para tomar cien, tras cada capsula, mezclada 
con igual cantidad de agua de Selz, permiticndole ademas la beba ad libitum, natural 
6 frill. 

La mas rigorosa dieta absoluta durante los ciuco prinieros dias por lo meuos : al 
colera americano, como al asiatico bay qui matarlos de hambre y en agua ahogarlos. 
La medicacidn siutomatica en el primer peri'odo, no debe distraer la atenciou de los 
asistentes, mas que en el caso que los trastornos que la exijansean de tal naturaleza 
que dificulten el tratamiento, intolerancia g^strica, 6 jjougan en j)eligro el fuucio- 
ualismo orgauico, liiperpirexia. 

Para lo primero bielo iuteriorm^-nte e inyecci6n atropomorfica. Para lo segundo 
banos prolongados Ji la temperatura ambiente 25 £ 30 centigrados y huir de los au- 
titermicos fiirmacologicos, que por accion retardadora de las oxidaciones deben ser 
proscritos en absoluto. Los vinos geuerosos y las pociones tonicas alcobolizadas, la 
estricnina, la cafeina, la entero-clisis de suero artificial fiio 6 caliente alternativa- 

* Eevista de Ciencias Mfedicaa, agosto 1891, Habana. 

tKesisteucias oficiales, teuiores de los encargadoa de su asistencia; falta de sangre. 


mente, para levantar las energias y auraeutar la tension arterial, general uicnte 
tan depriiuidas, son medios que dcben ser nsados, si \n6i\ con may pocas esperanzas 
de dxito, cuaudo el case cs grave y la oliguria se acentua. 

Las hemorragias no sondetonidas ni con el perclornro de hicrro por el estomago ni 
con la crgotina en inycecion hipodt'rniica. 

Contra la anuria y La uremia se liau agotado todas las niedicaciones y demostraria 
uo liaber visto enfennos, quien en medicacion alguna confie; todo rcsulta des- 
esiicranteniente ini'iti I. 

Los enfermos tratadoscomo queda dicho, en las doce ])rimera8 horasde la invasion 
dan una niortalidad tan pequena que apenas se llega al 1.50 por cieuto: el grupo de 
los (juc reciliieron el trataniicntodesdc las doce scgnndas Loras del juiincr dia cli'nico 
da un ])ronu-dio de 15 ]ior cieuto, los del segnndo dia 13 ]tor ciento, los del tercer dia 
30, los del cnarto y quinto 70 i)or ciento, cifras aproximndas. 

Las cstadisticas de otras niedicaciones scguidas tambien en cl Hospital Militar 
de la Habana, dan ciCras clocucutisinias. en los dos priineros grupos, o sea en los (juc; 
el trataniiento comienza en el primer dia, pues resnltan dccuidicadas, en los de 
segnndo dia triplicadas, siendo escasa la diCeriencia en los dcmaa. Ciiatro anos y uuis 
de dos mil casos dan valor a estos datos comi)arativos. 


ITV l.W'li: IX Ki;YSirKLAS. 

By JAME.S M. ANUKIJS. M. D., Ph. D., 

Professor of medicine and cUnieal medicine at the Medico Cliiniiyical College; phi/iician to the T'hila- 

deljihia Jloipital, etc. 

During the year just past 1 have been engaged in conducting an investigation into 
the disease erysipelas. A portion of the results obtained from these researches were 
given in a recent pajter on "The seasonal influences in erysipelas, with statistics."* 
More recently I read an article on "Some points in the etiology and clinical history 
of erysipelas, with statistics,"' before the section on the i)ractice of medicine of the 
American Medical Association at its last meeting, in Avhich article additional results 
were reported. To some of the conclusions reached in the latter paper I desire to 
make brief reference presently. While collecting data, with a view to determining 
the duration of erysipelas, I had occasion to inqnire into the efiect of com])li<ations 
on the general course of the disease. I'lion this jioint the following inferences may 
be found in my last paper: 

The average duration of the affection was co:u])uted in 1,880 cases and found to be 
(including relajises) 25*13 days. At any period of life, according to these observa- 
tions, the stay in a hosjtital or the duration of a case in ])rivate practice was length- 
eueil almost indetinitely when the ])aticnt had been i)rcviously in an enfeebled con- 
dition on account of ihronic disease and when complications existed. The average 
course was found to be much less in uncomjdicatcd <'ases occurring in persobs under 
40 years, which is the time of life corresponding with a preponderating proijortion of 
cases, A'iz, about fourteen days. 

These results also ])oint strongly to the important inactical fact that "erysipelas 
in a typical Ibrm is a self-limited disease; that the length of the attack is greatly 
influenced by the age of the patient 2)er se, its average duration in persons over 50 
years being considerably longer than in younger subjects. Sex has uo inlluence in 
this direction." 

I have directed attention to the influence of age upon the course of the disease — a 
factor that is especially o]icrative at a period of life when cases are relatively infre- 
quent — for two reasons: First, because it is an interesting and novel fact; and, 

* Koad at the meeting of tlie American Clim.-vtological Association, 1893. 


gecondly, that the other and more notalde factors, as complications, etc., shall not 
be overrated. 

Respecting those associated diseases that are not to he classed as true complica- 
tions additional data will in this connection be adduced. In my i>nblished article, 
before alluded to, may be found an analysis of 1,665 cases, aud the data show Avhich 
aftections predispose most potently tocrysipelas, as well as the comparative frequency 
of their occurrence, as follows: In the course of chronic leg ulcers 67 occurred; in 
chronic pulmonary tuberculosis and chronic nephiitis, 1.5 each: in chronic rheuma- 
tism, 14; in organic heart disease, 10; in urethral stricture, 6; in syphilis and synovitis, 
5 each; in asthma, chronic pleurisy, and chronic alcoholism, i each; in bone necrosis, 
malaria, locomotor ataxia, senile debility, and puerperal state, 3 each; in tyi>ljoid 
fever and sciatica, 2 each, tho^e bsing 7"8 per cent of the total number of instances. 

The result just narrated fitly corroburated the l)road f;ict — one long since appreci- 
ated by the profession — that certain conditions and diseases increase the liability to 
the complaint. 

1 purpose to present, in the next place, the results obtained from a study of a 
scries of 1,674 cases which were analyzed with ]Darticular reference to complications. 
Of the latter there were : abscesses, 105 (of which the following only were classified : 
Of eyelids, 5; abscesses with ulcers, 2; of leg, 3; of foot, 3; of finger, scalp, elbow, 
glandsat angleof jaw, leach) ; rheumatism, 20; pneumonia, 7; catarrhal pneumonia, 
2; plcuritis, 7; delirium tremens, 10; delirium, 7; albuminuria, 8; acute nephritis, 6; 
synovitis, 5; phlebitis, 7; diarrhea, 5; tonsilitis, 3; otitis media, pharyngitis, 
acute bronchitis, a'dema of larynx, 2 each; angina pectoris, iritis, epistaxis, scurvy, 
heniiglossitis, neuralgia, sciatica, mastoiditis, pyaemia, endocarditis, eczema, jaun- 
dice, paralysis, meningitis, carbuncle, hysteria, apoplexy, insanity, arthritis, diph- 
theria, followed by leg ulcer and repeated hemorrhages, 1 each. Not a few of the 
complications which are mentioned by authors of modern text-books and other 
recent writers as being leading ones are, according to the results of these obsorvatious, 
actually rare. On the other hand, certain complicating conditions not emphasized 
in medical literature occur relatively frequently, notably acute articular rheumatism. 
With reference to this latter affection it should be pointed out that the attention of 
the jirofession has not hitherto been directed to the fact that it is quite frequently 
associated with erysipelas. It is seen that, according to the above table, it ranks 
next to abscesses in i^oint of frequency, and that it is present twice as often as deli- 
rium tremens, which stands third as to frequency of occurrence. In only 3 in- 
stances did the rheumatic attack precede tlie appearance of the erysiiielas by two 
or three days. The symptoms of rheumatism usually came on several days after the 
onset of erysipelas. I will not at this time venture an opinion to explain why acute 
articular rheumatism should develop in the course of an existing erysipelas as often 
as would be indicated by these researches. So long as the specific agent on which 
rheumatism depends is not known, so long must we remain in ignorance of the true 
explanation of this combination of diseases. 

Itmight be argued with considerable showof reason that the arthritic disturbance 
is purely symptomatic of a pyemic condition, and hence nonrheumatic in nature; 
but this latter view can not be correct relative to at least one half-dozen instances 
in which a detailed desqription of the symptoms was given. Moreover, I' have 
endeavored to eliminate what might be regarded as doirbtful cases, classifying tlieju 
as '■' synovitis,'' etc. In connection with this, the fact before stated, that in fourteen 
instances chronic rheumatism preceded the attack and most probably operated as a 
pr.'disposing factor, should be borne in mind. From these statistics it may be seen 
that pneumonia and pleuritis complicate erysipelas in a small proportion — less than 
1 per cent — of the cases. In some instances pneumonia appeared early, hence it 
was due, most probably, to a special localization of fhe specific streptococcus. To 
such the term '•pneumo-erysipelas "' is here applied. The cases — 2 in number — in 
which acute nephritis developed during the first few days of the attack should be 
termed " nephro-erysipelas." 



I do not doubt that pneumonia, both lobar and catarrhal (the latter probably 
always), and acute nephritis, as well as pleuriti.s, may also occur as secondary 
results. It should be pointed out that acute endocarditis was present in but a single 
instance, and, since this complaint is held to be a relatively common complication 
by most recent authors, the present results may excite considerable surprise. 
Meningitis, which was formerly thought to be quite frequent, but is believed to be 
rare by a few recent writers, was present in one instance only, thus corroborating 
the latter view. Active delirium in this disease ])oints to a severe type of infection, 
and not, as a rule, to meningitis. Precisely what is implied by "a complicating 
synovitis" it would bo diflicnlt to determine, unless we believe it to be a pyjemic 
manifestation— a not unlikely theory, I think. Perhaps certain other conditions, 
sn])posed to be complications, are to be regarded as pya-mic indications, such as 
jaundice, etc. Mastoiditis, otitis, media, tonsilitis, and (edema of the glottis are 
to be looked upon as secondary developments. 

Some interesting facts relating to the mortality rate of this disease were also 
brought to light by these researches. In the opinion of all authors the death rate 
is exceedingly variaVde, ranging, according to some writers, from 1 to 50 per cent-. 
That it does exhibit great variations in this respect can not be reasonably denied, 
but the limits of its di versi ties have been by many too widely separated. The correct- 
ness of this latter assertion will be evident after a glance at the accompanying table, 
Avhich gives the number of cases from the different institutions separately, in which 
the terminations were recorded, with the number and percentage of deaths for each 
hospital, as well as the same points with reference to the cases derived from private 
practice : 


Source of cases. 

Bloclvlev Hos))ital 

I'eiinaylvaiii.i Hosjiital . 

E])is<'(>pal Hospital 

•loliiis Hopkins Hospital 

Gennau Hospital 

Private practice 


of termi- 







of deaths. 


age of 

5 1 
12 G 
IS -75 

ya a 

4 16 




General average mortality, 6 -57. 

It will be observed that tlie variations in the percentage of deaths are not so 
great in the larger individual series, which are composed of sufficient cases on 
which to base rcliaVile inferences. The general average mortality rate, it is seen, 
is G.59 per cent. The cases from private practice gave a lower death rate, or 4.16 
per cent. In the female sex it is l.o per cent lower than in the male, according to 
these statistics. Surgical or traumatic erysipelas has a higher ratio of deaths 
than indicated by the general average. There were 101 cases classified as purely 
traumatic, and for these the percentage of deaths was 14-5. 

A careful study of the cases which were preceded by chronic illness shows that 
they swell the general average mortality list, the increase being not less than 
25 per cent. Wiien occurring in the course of chronic Bright's disease the percent- 
age of deaths was as high as 40, while in pulmonary tuberculosis (first and second 
stages) it was 30. The disease proved fatal in 2 cases tbat occurred during conva- 
lescence from typhoid fever. 

The effect of complications upon the frequency of deaths is a question of lively 
interest and primary importance. This point also was investigated. 



The comparative gravity of tlie leading complicating conditions and diseases is 
shown by the following table: 





age of 







Acute rbeuinati.sin ....... . ........ 


Pneumonia .. 

57 1 

Pneumonia catarrhal 




57 1 



Acute nephritis 



Svnovitis - - .- . 


Gi^dema of lam yx ... .. 





It will be seen that while abscesses are common they do not to any extent augment 
the mortality rate. Pneumonia, delirium, delirium tremens, and acute nephritis are 
among the graver complications. Acute rheumatism, on the other hand, stands 
second in frequency, but is comparatively harmless. To account for the increase in 
the percentage of fatal cases due to acute articular rheumatism we possess no posi- 
tive knowledge. The opinion is, and long has been prevalent, that erysipelas bene- 
fits and even cares acute articular rheumatism and other affections, including car- 
cinoma and sarcoma. 

10 vrs. 10 to 20 20 to 30 30 to 40 40 to 50 50 to 60 60 to 70 70 to 80 














4^ 2.85t 35S 3.5ii 7jt u^ u.i,^ 4Uii 


Age modifies the mortality. Above may l>e foinid a tracing wliicli represents the 
percentage of deaths in erysipelas, for the different decades, from the time of birth 
to 80 years of age. The line rises in increments of live. Tiie mortality, it will be 
seen, is much loss than tiic general average — i. e., 0.57 ]>it cent — from birth to 40 or 
45 years, and then it gradually becomes greater until avc reach 00 years. After 00 
each year increases considerably the percentage of deaths, while after 70 the i)er- 
centage rises rapidly to 40. While age, perse, as has been stated, influences the 
death rate quite materially, it does so only in persons over 45 years of age. Other 
J'actors must not be overlooked. It was among middle-aged and old persons that, 
comparatively speaking, most of the cases occurred in whicli chroiiic affections were 
associated. These latter, as ])revioiisly shown, exert considerabli; innui^nce u])ou 
the mortality. The various complications before mentioned did not prevail more 
extensively during tlie later than during the earlier periods of life. 

In conclusion 1 would submit a few deductions which may serve not only to 
n^iterate sonu' of the lo;uling demonstrated facts, but also to facilitate a discussion 
of the same : 

(«) In typical cases erysipelas is a self-limited disease, the average duration in 
pei'sons under 10 years fif ago being fourteen days. 

(h) The course of the disease was greatly lengthened when complications were 
present or chronic affections preexisted, as well as wiien occurring in per.sons over 
50 years of age. 

(c) Certain chronic affections, notably pulmonary tuberculosis, chronic nephritis, 
chronic rheumatism, and organic diseases of tiie heart, increase the susceptibility to 
the complaint, hiiving been present in 7.8 per cent of the total uunilicr of cases. 

{(l) The most common complications were abscesses .and acute rheumatism; the 
rarest meningitis and ulcerative endocarditis, pericarditis not having furnished a 
single instance. 

(e) The general average mortality was 0.57 per cent, while in the cases from 
])rivate practice it was 4.16 per cent; in persons under 40 years it was only 3.5 per 
cent, in those over 70 years 40 per cent, and in the traumatic cases 14.5 per cent. 

(/) The mortality list was augmented as much as 25 per cent by the presence of 
coexisting chronic affections. 

{g) The numerous com))licatious also increased the percentage of deaths, and 
certain of them in an especial degree, notably lobar pneumonia, acute nephritis, 
delirium tremens, and active delirium. 

(/() Age has a decisive influence upon the mortality after the forty-lifth year, this 
effect becoming more pronounced after the sixtieth year. 


Chefe declinica encarregado do servifobaeteriologico da Clinica de Pedialria da I'oUclinica do JRto d- 
Janeiro, AsHstente do Laboratorio de Biologia, 2[embro effectioo do Gretnio dos hidenios dos Ilospie 
taes, actual BiblU'thecario do mesmo Oremio, Socio fundador da Hociedade Nacional de Acclima^do, 

Encetei ha cerca de tres auaos algumas iuvestiga? 5es sobre.ohematozoario do palu- 
dismo, assigualado ])or Laveran em 1881. Durante o anno de 1892, 21 casos servi- 
ram para o exame ilo sangue, alem de muitos outros observados nos aunos ante- 
riores. Usei nestas pesquizas dos processos de Laveran, Grand, Romanousky, Ronx, 
etc. Tive ensejo de fazer, por vezes, em dias consecutivos, o exame do sangue do 
mcsmo doente, accusando ora maior, ora inenor asceu(,"rio therniica, desde a tcmpe- 
ratura jjouco acima da normal ate acima de 40^ e mais, ouainda no p(iriodo de a]iyrexia. 
Todos 08 cnidados antisepticos presidiram os meses estudos. Escrupnloso coino deve 
ser todo o oxperimeutador, eu nao me julgo, em vista das iudicisoes que paivam 


jiiiula em men espirito, autorisado a tirav miia conclusfio dcfiiiitiva sobre grando 
uiiniero de casos oljsei'vados no Scrviro de Pediatria da Polirliuiea do Rio, debaixo 
do jjoiito de vista microscopico. 

Direi apeuas que taes obsoi'vapoes, realizadas com muito interesse e rigor scienti- 
fico, deixaram-me ate agora, gramle dnvida sbbreos resultados colhidos, pelo menos 
no tocante a infancia, sol)re a ((nal convergiram as nunhas poqiiizas, incitando-me 
dest'arte a uellas proscguiu com o maior empciiUo, para mais tarde pronuuciar-me 
a respeito. 

O Prof. Treille, da Algeria, cujas observagoos foram colhidas em fecuudo campo 
de estudo, bem como o Prof. Guido de Bacchcli, muito liesitam ainda em accitar as 
conclusoes de Laverau. O primeiro haveudo encontrado o hematozoario na urina de 
individuos uilo affectados de malaria e o seguudo nao o havendo encontrado no sanguo 
de doentes de febre palustre. 

Parecem-me pois dignas de uota as objegoes de tile distinctos investigadores. 

Niio devo, a proposito, esqnecer um facto curioso que verifiquei tambem no cor- 
rer das observagoes do anno proximo passado. Alguns observadores relatam que 
tcndo occasiao de examiuar 6 sangue de sens doentes malaricos submettidos as azul 
de methyleno eucoutraram as hematias coloridas daquella substancia. Tal tenta- 
raen tambem por mini foi practicado em alguns doentes do Servigo de Pediatria da 
Policlinica, sob a aci;ao daqucllo agente therapeutico; os globules de sangue, porem, 
a presentavam-se com a sua coloragao normal e mesmo nao pude veriticar a exis- 
tencia da menor particula daquella materia coraute apezar de se acbarcm coloridas 
de azul, a urina e as dejecgOcs dos referidos doentes. 



Asiistente do Laboratorio de Biologia do Sstado, Chefe de clinica do Servigo de Pediatria da Poli- 
clinica do Pio, Alembro do G-reinio dos Tnternos dos Hospitaes, Bibliuthecario do mcsiiio Greniio, Socio 
fundador da Sociedade Xacional de Acclimat;do, etc. 

Como tivesse ensejo de examinar diversos casos de lympliangite aguda debaixo do 
ponto de vista microscopico, e couseguisse um resultado bastante satisfactorio, entendi 
dever publicar as minhas pesquizas a respeito. 

Eis porqne apresso-me em fazer esta pequena nota. Encontrei logo, que me decidi 
a estudar tfio momentosa questao, 15 casos de lymphangite aguda onde pude operar 
OS meros estudos. 

Foram Verneuil e Clado (1889) os primeiros a demonstrar a identidade da erysi- 
jicla e da lymphangite aguda; depois delles Sabouraud, interuo do Prof. Besnier, 
encontrou no serosidade e no sangue extrahidos do membros eleplianciacos no periode 
de crises lympliangiticas o strejjtococcusdeFehleisen, 6 qual seria dest'arte para elle 
o microbio determinante das lympliangites e da elephantiasis europea. 

Em 12 dos 15 casos por niim examinados, encontrei o streptococcus de Fehleisen 
quasi sempre em estado de pureza. Foram practicadas culturas, ora em caldos 
li(juidos, ora em caldos solidos de gelose ou gelatina. 

A technica usada para a extracgao da serosidade era a seguiute: Dej)ois de bem 
lavada a regiao doeute com uma forte solugao antisei^tica e em seguida com agua 
distillada, com o anxilio de uma lancetaesterilisada, fazia-seuuia picada, a seguuda 
gotta de sangue ou de lympba que apparecia era recebida em baloezinbos esterilisa- 
dos e soldados a lampada. Ao cabo de dezoito ou vinto e quatro horas, delles me 
servia para semeagoes em caldos oupara preparagoes microscopicas. 

Trez caes e trez rates brancos serviram para a verifigao experimental. Tiveram 
a crysipela bem caracterisada se bem que o streptococcus inoculado tivesse provindo 
do casos de lymphangite aguda. 


Emfiiri jiara tiTiuiiiar, passo a iuscrir as coucliisOes do meu loiigo traballia aqui 
resumido uesta pei[iicua nota: 

1". Quo diante das dcinonstrativas investigagoes bacteriologicas de Venienil e 
Clado, de Sabonraud a das miiihas proprias rcalizadas sobre 15 casos, a lynipliaiigite 
agiida e a erj'sipela nada inais sao do quo modalidadcs diversaa de mini mesnia 
affccvao iiifecto-coutagiosa e bacteriana. 

2". (Jue o germon dellas productor 6 o streptococcus do Felileisen, microorgauisino 
liojo porfeitanioute estudado e conhecido; de facil pesquiza, cultura o iuoculavfio 

3". Que o streptococcus erysipolatus podo em certos casos coincidir com a pre- 
senga de outros microbios, como sejani o streptococcus pyogenus (alias repntado 
identico aquelle por II. Roger), o staphylococcus albus, ou aureus, ou citreus, etc. 

4". Quo as crises lympliangiticaa successivas, coui curto iutervallo de interrupvao 
muito notadas era certos iudividuos, principalmente em uossoclima, teni perfeita 
explicavfio, pela iiernianencia do niicrobio de Felileisen no sauguei)odendo alii cou- 
servar-so sem viruloncia alguni tempo devido a causas diversas, e tornar a adqui- 
ril-a e ainda mais proliferar, desde que certas outras causas para isso concorram. 

5". As contraprovas positivas daspesquizas de Verneuil e Clado, pareceni demou- 
strar defiuitivauHsiito a idontidade de cauza e natureza da lympliaugito aguda e da 
erysipola, outrom reputadas eutidades morbidas dlstiuctas. 


Eapport du Docteur GREGORIO MENDIZABAL. 

Invosti par le gouvernemont de I'fltat de Vera-Cruz, uu des plus importants do la 
Repiibli(iU0 Mexicaine, de I'liouneur do repr^sonter cot fitat au l'"^ Congrt-s Medical 
Pau-Am6ricain, je n'ai consenti a accepter cette mission ditiicilo a rciuplir que ponr 
rendro ce faible service h mon pays, et tout particnlicrement h I'fitat ou j'ai regu le 
jour, et ainsi (lue pour satisfaire mon vif dosir d'auginenter au soin do cette notable 
asseinblt^e le contingent de mes conuaissances mddicales, tout en ayant la certitude 
de mon iusntfisance pour occuper avantageusement uu poste aussi elev6. 

Pour mieux coiniirendre ce que je vais exposer, je coinmencerai par faire une 
description de la vall6e oil est assise la ville d'Orizaba, de sa situation topogra- 
phique, de son altitude, de sa latitude, des traits les plus saillants des phdnomfeues 
m^tcorologiques qui y out <^ to obscrv<?s, de sou orographic, de son hydrographie, des 
conditions hygitSniquos de la ville, et, sans sortir des limites dtroites que m'impose 
ce travail, de tout ce qui pent contribuor h nous reiidre coinpte de la manitre d'etre 
du paludisine dans ces contrdes, ainsi que de son influence sur les maladies qui 
corapliquent, tres spdcialement, la fievre typhoide et le typhus. 

Les plaiues 61ev6es du plateau central, forindes par le developpement et le partage 
de la Cordilliere des Andes, qui, depuis les confins de la cote occidentale de I'Aine- 
rique du Sud, produisent une clialne uon interrompue avec les montagnes gigantesques 
que nous ajipelons au Mexique "La Sierra Madre," vont terminer par une descente 
graduelle et lento aux plages embrasces du Golfe du Mexique et a la cote du Paci- 
fique, cr<5ant de superbes et splendidcs versants qui font de notre pays un des plus 
beaux, des plus pittoresques de la terre. 

Dans un des multiples versants orientaux de cette vaste chalne qui sopare I'l^tat 
de Vdra-Cruz du plateau central, ayaut pour noyau au point de d^jiart le pyramidal 
" Citlaltepetl " (Volcan d'Orizaba), se trouve une vaI16e riante et fleurie, au sol 
tr^s fertile. Par ses paysages, I'une des plus belles, des plus agrcablcs par son 
climat, des plus saines par sa situation tojiographique, uu priutoiiips eternel y regno 
comme dans la plupart des regions temperdea. 


Le A'oyageur qui descend dn plateau central en suivant Faudacieuse voio ferri^e 
qui relie Mexico a V^ra-Cruz commence a se reudre compto de la situation de cette 
valine, en sortant tout a coup dn tunnel numt^ro 10. II se remet bien vite de 
I'effrayaute impression qu'il a regue dans la vertigineuse descente des "Cumbres 
de Maltrata," que le train a cotoyee en serpentant au bord dn precipice ; et apres 
avoir traverse les de'lil6s terrifiants de ''La Joya" et de riufieruillo," il enibrasse 
du regard, dans toute son eteudue, le surprenant vallon, toujours vert, toujours 
<>ai, sillonue'e depetits ruisseanx, qui conduit le passager par une peute majestneuse 
et leute dans la grande et cliarmaute vall6e d'Orizaba. 

La ville d'Orizaba est situee par 18^ 50' et 56" de latitude N. et par 2° 7' et 54" de 
lou<'itude E. de Mexico. Elle se trouve a 1,23G nutres au dessus du niveau de la mer, 
ct a 104,263 metres de la cote du golfe. L'azimut de I'aiguille inagnetique est de 8° 
25' E. La ville est situee dans une plaine qui part du pied du coteau du " Cerro del 
Borrego;" rinclinaison de son sol est tellement accentuee quo dans une extension de 
3,352 metres que la ville a du levant au coucliaut, il y a une pente moyenne de 3^ 

Les terrains de la vallee d'Orizaba appartiennent au cretace sup»irieur (terrains k 
Lippurites et a radiolites), composes en gcne'ral de calcaires, alternant avec des 
marnes et des argiles; ils sont reconverts d'uue couche de terre v^gctale variable, 
mince dans de certains eudroits, comme, par exemple, au nord-ouest, mais presentant 
des qualitf's favorables a la culture. 

Les modifications atmospbericiues et les engrais que produiseut les detritus des 
plantesrepandues dans les champs out fertilise de plus en plus les terrains ou sejour- 
nent les vegdtaux meles avec la terre qui leur sert de base, en augmentaut dans 
certains lieux la coucbede. terre detritique. A proprement parler, il n'y a point de 
champs completement steriles dans la valine d'Orizaba. 

Au nord de la ville plusieurs niarais disparaissent gradnellenient, grace a des tra- 
vanx de canalisation. 

Ce n'est pas sans raison que les aborigtines de la vallee d'Orizaba lui donnerentle 
le nom poetique de "Ahauializapam," mot compose signiiiant dans la laugue expres- 
sive des anciens Mexicains: Gaite dans, 'on sur I'eau.' 

Eu eftet, il y a a Orizaba une infinite de sources qui fertiliseut les terres. Grace anx 
pentesdesCordillieres et auxinegalitos du sol, leurs eaux coulent imiietuensemeut et 
se x^r^cipitent de tr^s haiat, offrant de puissantes chutes aux iiulustriels qui les utili- 
sent chaque jour d'aA^antage. 

Parmi les cours d'eau les plus remarquables, citons le "Rio Blanco," qui prend sa 
source h 30 kilometres en amont d'Orizaba, sur le versaut de la montague appel6e 
"Cumbres de Acultzingo." II s'enrichit d'autres tributaires qu'il rec^oit dans sa 

Ce ruisseau, unpeu avant d'arriver a Orizaba, revolt un autre affluent forme p;^r les 
sources de " Nogales," qui charge ses eaux de produits calcaires, les rendant inipro- 
l)res aux usages domcstiques et impropres h I'alimentation des chaudifres a vapeur. 

Ce ruisseau court au sud de la ville, du coucliaut au levant, et opere sa jouction 
avec le " Papaloapam," d(5bouchant dans le Golfe du Mexique par la barre "d'Alva- 

La rivifere appel^e " Rio de Orizaba" prend son origine dans les montagnes de 
"Fesmelaca," et dans son cours augmente son volume d'eau par les diverses sources 
(|ui surgissent des coteaux adjacents. Elle passe en serpentant par le centre de la 
ville qu'elle traverse du nord-ouest au siid-est, et va deboiicher dans le "Rio 
Blanco" au sud-sud-est. De cette riviere aux eaux pures et limpides la plupartde 
I'ann^e la ville s'alimente d'eau potable, et quoique chaque jour son d^bit diminue 
par suite du d6boisement de nos coteaux et des nombreux emprunts que Ton y fait 
sans cesse pour les moteiirs des fabriques et des moulius 6tablis sur ses rives. 

Le ruisseau nomm6 "Arroyo Calieute," qui traverse la ville au uord-est et jalllit 


«lans les niarecagres appelles ••Tei>etlax«)," fertilise nne grande etenilue ile terrains 
qn"il croise pour aller se penlre ilaus le *■ Rio Blanco.'' 

AaeoaefaaDt du coteau •'Cerro de Escamela,*' an nonl-est aussi de la rille, nalt nn 
antren'-- ' •Ojode Agna." - -- ' - tut du "Ccrro de Esca- 

mela'"a . .ba. Cetteeau.: .., .- ..-:.:... ^ ..-, fraicheetaboudaute, 

possible, autre eela. les meillenrs conditions de Tean potable, et serait la plus con- 
venable iK>nr Tusage des habitants de la ville.pouvant foumir 80 litres par persoune 
et par jour. 

II y a un projet facile a realiser qui probablement sera procLainement mis a exe- 
cution pour rintrodnction de cette eaa dans la Tillc. 

Les vents qui ' 'it a Orizaba sout le nord-est, altt-mant pendant Thivfr et 

le printenips a-^v »^- riolents vents du ^nd-onest, en fomie d'onragaiis. Ces 
demiers sont sees, chaads et tellement inipetnenx que Ton croirait s'aspbvxier 
qnand ils sontSent. a tel point il3 rarefient I'atmosphere. lis cxpoacnt lieanconp 
;. ' " • ■ - ' ' ~: mais .:'_'--. ' ent 

- ^ ^ - - les ger - -- _ent 

eonvenablement Fair et les appartements. La temperature moyenne d'Orizaba est 
de 21- e .es, II tombe on terme moyen 2.5<X> mm. dVau dans Tannee. 

La vili> -■'•'■ '^ — '- nte ans, 22,000 habitants. Ce nenmero a double de 

nos jonrs. 

En fait dliygit-iie. la ville laisse beanconp a desirer. Elle a assez d'ean de bonne 
qnalite. " |ue la - ■ ue pendant la 

saison ('..- et pr> ..: :. j .^ ..; des catarrhes 


Dans la partie nord-est de la ville, qui est la plus basse, on se sert de Tean des 
puits. Cetr ' * - "'77 ' ' ••."' d'origine marecageuse, est 

celle qui a t .. - , - - - , iques. 

Jus«iu'a il y a tivs pen de temps les latrines de la ville nVtaient en general que «le 
ftusses ferm^^es. et a- re les - ifi Ton a <5tabli les amf-Iiorations 

que reclame ^-^ '■ ' - _ Li- -^.^.1 pen n.^j. .^..-es. II y a nne 1 •'-"*» d'annces 

qne Ton a c -.tmire des egonts sonterrains dans ly - rne.s de la 

ville. pour recevoir les rebuts, eaux sales, ordures, matieres fecales, etc. ; mais ces 
eg«>nts - " " - - • ^ qu'ils <ont p' ' - " ' . ' -.: qu'util*-*. 

Lesr-i. - -_ — - ... .:c-s. Lepavage .- : .. ...._: :_ . Les? mais«ms, 

en general, sont humides, a I'exeeption de celles que Ton construit depuis peu 

nees. mais avec le desavantage qn'avant elles «5taient spacieuses et bien aerees; 

- ' — ^^ient des grandes cours converties en beaux jardins: on en bati de moins 

-. il est vrai. mais beam^onp plus rednites, avec des tres petites conrs et peu 

d'amplenx dans les apparteraents, au detriment des commodites et de la aante des 

T - -e de Y:\ " . - rietaires. 

^.^^.i point L. ....- : .. ..-aba. La vie yest relativement chJre. et nean- 
moins aneun ne manque dn necessaire pour subvenir aux premiers besoins. 

Les gens sont generalement propres et coquets, et se nonrrissent assez bien. Les 
t"^'" ' - ' :-'- sont bonnes. L'irrogner: * * ''* fort rare pamii la 

" -- -- . - . il y a dix ou donze ans. I ^ - . - , lu •• pulque"' a ete 

intro<luit dans la contr«?e, en meme temps que les gens du plateau central y aont 
venue travailler anx fabriques a filature nonvellement etablies. ce vice repugnant 
s'est enraci'^' ••- ^ratd prejudice de la population pauvre. • ""^ '"■longe dans nne 
misere phy- _ e, Texposant aux maladies de tout genre • . .t et avilissaiit 

ITiomme. Maihenreusement, le vice degoatant de Tivrognerie a aussi jete des racines 
prof ' - ^ = ' ^ - ' -'e. 

II. - -tmetion du chemin de fer. les saisons ^taient a5«sez 

r^gulierement marquees k Orizal>a. Les pluies y etaient bien distribuees, les tem- 
peratures extremes y etaient a i>eu pres inconnues, et le sol. antant que le sons-sol, 
conservait un degre d"humidite qui donnait la Constance aux sources d'eau. D'apre^ 


Ics calciils approxiuiatils on aurait abattu au iltxiquc pour ]a construction do clie- 
mins tie fer 30 millions d'arbrcs, et pour aliiucnter I'insatiable ventre des locomotives 
oueu aurait consomm^ 100 millions! En ajoutaut a ces cliiflres ceux qui se cousoni- 
ment dans les fabriques comnie combustible les qiiantites de petits arbrcs que I'ou 
rcduits en cbarbon, le bois de teinture et de construction que Ton exportelous les 
jours en si grandes quantites, le bois que nos menuisiers, cbarpeutiers et ebcnisles 
travaillent, on aura une idee de I'abattage effrene et nuisible que nos forrts out 

On calcule que les cliemins de fer du Mexique consomment connne combustible 1,000 
tonnes de bois par jour. 11 ne faut done pas s'^touner de ce que ii Orizaba (et la 
san.s donte moius qu'en d'autrcs cndroits du pays, par suite do ses conditions par- 
ticulieres) la meteorologiciue ait subi des cliaiigements aussi remarquables. Av(;c 
les pluies il tombc pcut-ctro aujourdliui la memo (|u:nitite d'eau dans raniu'e 
(lu'anparavant, mais celle ([ui tombe dans quatre on six averses torrentiellcs tombait 
avant dans cinquante bieu distribuees, et Je manque d'arbrcs sur les cimes et les 
coteaux pour retcnir la rapidito de ces eaux, donne lion aux debordenients et aux 
aboudantes ernes qui ravagent tout ce qu'elles trouveut sur leur passage, empt)r- 
tant la couche mince d'bumus (jui constitne la fertilitt'' des terres, et inondant les 
bas-fonds, senuxnt partout la dtsolati(m et la mine. Nous avons eu deux on trois 
de ces exemples dans les dix dernieres annees, tels quo d'ancieus octogeuaires ne se 
souvienncut point avoir jamais assiste a de pareils degats. 

Par suite de cette coupe immoderce des arbres les sources qui approvisionncut la 
ville d'eau potable out tellement diminuocs qu'elle fait dc^ja complitement defaut. 
Les arbres (jui ombrageaient le ruisseau forme par ces eaux de sources manqueut, 
et I'evaporation a appauvri nolablcment leur volume. Autrefois, pendant presque 
toute la duree de Tliiver, les vents de Test et du uord-cst entrainaient les nuages 
suspeudus sur la mer qui restaient, pour ainsi dire, accroclies au fcuillage des arbres 
de nos bois, se condeusant et se tiausformant en pluie fine que Ton appelait avec 
raison "la salud del pueblo."' Dans ce temps la on ne vo\-ait pas le soleil de (piinze 
ou vingt jours, ce qui imprimaita la ville une teiute melancolique. L'air etait telle 
ment sature d'humidite qu'on aurait pu le couper au couteau ; les brouillards cousti- 
tnaient I'etat normal de notre atmospliire |)endant tout Thiver. Ou jouissait. il est 
vrai, de plus de sant^, les iuthunuiatiuus des organes respiratoires n'etaient point 
connues et les fievres iutermittentes fuyaient, pour ne plus reparaitre, jusqu'a I'ote 
suivant. Les temperatures les plus basses etaient de 12 a 14^^ au-dessus de zero. 

Aujourd'hui, les ^t^s sont bn'ilants et trcs prolonges. Les pluies parfois tres rarcs 
dans certaines anuses sont torreutielles dans autres. Nous avons des bivers accomp- 
agnes des fortes gelees. Les temji^ratures extremes se succedent souvent sans transi- 
tions lentes, notre ciel, autrefois convert de nuages, laisse tomber d'aplomb, pendant 
des jours et mois entiers, les rayons du soleil sur la terre qu"il desseclie et qu'il gerce. 
aneantissant les germes de la vegetation. Les plus mediocres rnisseaux se convertis- 
sent subitement en courants dcvastateurs; et si une main puissante n'y porte 2>as 
remede an plus tot nous courrons le grand risque de subir un jour le sort des departe- 
ments alpins, oii le sol disparait sous les pieds de I'liomme, et ou les plus fertiles et 
riches contrees sont devenuos (l(!s plaincs arides et sccbes et des tristes campagnes 

Le paludisme, cette ma ladie infectieuse et specifique, parasitaire, produite par la 
pullulation dans le sang des protozoaires, si bien decrits, il y a douze ans, par M. 
Laveran, r^gne depuis longtemps dans la vallee d'Orizaba, et d'apres ceux de 
mes collegues qui ont exercs la medecine pendant les cinquante dernii-res annees 
ecoul^es il dtait si benin, il se prt^sentait sous des formes si simples, (ju'll ne pre- 
occapait personae, et on le guerissait sans I'iutervention de I'art. La faiblesse de 
I'empoisonnement ou de I'intoxication etait telle, etpeut-etre aussi I'organisme de nos 
S. Ex. 36 18 


anotitres se troiivait dans ile meillenres coiiflitions goii6rales quo nous, qu'ils Int- 
taieut soiivenfc avoc avautage coutro lea parasites, sans employer aucuu medica- 
ment 8p(5ci{ique. 

On avait raremont besion d'adininistrer aux maladea anemies, sarmencs et mal 
nourris, denx on trois doses de sulphate de quinine, 30 centigrammes an plus, pour 
86 reiidre niaitre de la nialadie. Un bon regime ct du repos diminuant I'anemie 
compl6tait le traitement. Les rechntea ne so connaissaient presque pas alors. 

Les labonreurs dos alcntonrs de la villo, des villages ou plntot des fermes situdes 
dans les bas-fonds, dans les plaines buniides, qui le plus souveut vivaieut snr les 
bords fangenx des cours d'eau, isoles dans la campagne, pres des marais ou des terres 
irrigndes, allaient habitnellement chercher les secours des m6dccins pour se soigncr 
des " frios," comme Ton noninie vulgairoment a Orizaba les fievrcs interniittentes; 
etil n'etait pas rare de voir disparaitre la nialadie par le seul changemcnt de cliniat. 
De temps a autre il arrivait des cachectiques provenant des meraes endroits, dont la 
cachexie ne se dt^clarait jamais d'emblce, si ce n'etait qu'apres uue a<5rie d'accfes inter- 
mittents ou continns. 

Dans ces entrefaites snrvint I'anm'^e 18G7, 6poque i\ laquelle les travaux de clieniin 
de fer mexicaiu commencerent :\ Orizaba, travaux hercul^eus pour lesqnels il a 
fallu foniller profondomiMit la terre; et pendant Tautomne de cette meme annre les 
Ht'vrospaludrcnnes oclatirent inopintMueut sous les formes les plus graves, coustituant 
un des plus grands lleaux qui aient jamais afl9ig6 notre population, causant des 
dosastres terrildes, et occasionnant la mort de centaines d'individus, et assouvis- 
sant avec plus d'adiarnement encore snr lee travailleurs mrmes. 

Deux ans apris, j'arrivais a Orizaba. Le tiers des cas de maladies que je traitais 
6taient dft au paludisme sous la forme tree aigue du commencement. Mes collogues, 
((ui etaient profondi'mcnt oponvantos, appliquaient a temps la (]ninine par doses 
massives, et orui)loyaient doju, comme un secours Lcroique, les injections liypoder- 
miques, essay des avec beauconp de succiis en 1808 par les professeurs Talavera, Mesa 
et Fernandez. On employait le bi-sulpliate de quinine additionnd d'acide tartrique, 
et on faisait des injections dans le dos. II snrvenait assez souveut des absci-s ou des 
eschares sur la peau. 

Sans ces secours nous aurions perdu la plupart de nos malades, parce qu'il y avait 
de cas oh presentaiont sous de formes tres graves des accidents pernicienx procedant 
nnirinement de I'infection palustre, qui amcnaieut rai)idement la mort avaut I'ab- 
sorption lente de la quinine par les voies digestives. 

Au moins pendant huit ans consecutifs nous eilmes lameme constitution mddicale. 
II n'y avait pas une maladie quelle (ju'elle filt, ou le paludisme ne se grcffasse pas, 
en la compliquant et I'aggravant toiijours. Co fut alors (jue je vis les cas les plus 
caracteristiques <lo typhus malarien et de "typhoide malarienne," dont je i^arlerai 
apres. Ce fut alors aussi que j'ai en Toccasion d'obscrvcr le paludisme sous toutes 
les formes que nous decrivent si bien Laveran et Fernand Vidal. 

La maladie s'acharnait dans les qnartiers bas et hnmides de " Santa Gertrudis," 
"Tepatlaxco" et "La Concordia," qui sont arrosespar le ruisseau "Arroyo Caliente."' 

Les logements de ces qnartiers sont tr^s niauvais et habiti% par les gens les plus 
panvres, et par consequent ils se trouvcnt dans les mcilleures conditions pour faire 
pulluler les germes infecticnx de toute maladie quelle qn'elle soit. Pour dviter les 
frcqucntes recidives et les rechutes, nons faisioiis demrnager les malades dans les 
qnartiers dlcvds de la villc, on le jialudisme n'a jamais fait autant de ravages que dans 
les qnartiers bas. 

Pendant hnit ou dix ans nous avons eu le paludisme comme maladie saisonnidre. 
L'enddmie iipparaissait aux mois de niai et juiii. ft atfectait la forme end('>mo-opidd- 
miciue au mois d"octobie apres les grandes j)luies, epoque j\ laquelle les chalenrs 
proYoqucnt les fermentations du sol mardcagenx, et ddveloppent les miasmes palus- 
tres. Quand a la pluie aboiidante succedait ces coups de vent impetueux du sud- 
ouest, qui amenaieut la seeheresse et produisaient I'evaporation du sol, la maladie 


<?clat;tit tout de suite. Les premiers cas de firvre de premiere invasion se prcsen- 
taieut au piiiitfmps. Pendant cette saisou les formes doniinantes etaient les remi