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As a preface to my paper, I wish to acknowledge my indebtedness to the President of this Society, to our last ex-President, to the ex-President of the Ohio State Medical Society present, to Dr. Thomas, Dr. Barnes, Dr. Dickson and all others who have confirmed my diagnoses, watched the results of treatment, or in any way have aided me in my work; and to thank them for their very complimentary remarks in the discussion of my previous papers. Having my work characterized as the greatest discovery of the age by one member, my name associated with that of Jenner by another, and another give expression to his pride that a member of this Society had done what I have; would be exceedingly gratifying to me at any time, but especially just now when I am promulgating ideas which must arouse the indignation of every great medical professor in the world,

THE MESSAGE to editors and publishers of medical books and journals is growing more insistent: practice preventive medicine with your paper.The problem is the "brittle book syndrome"—too-rapid decay of paper in publications printed since the mid-1800s, when papermaking techniques changed. A subcommittee of the House of Representatives' Education Committee has been conducting hearings on the problem, and the National Library of Medicine (NLM), part of the National Institutes of Health in Bethesda, Md, is equally concerned.Specifically, the NLM wants medical publishers to use acid-free paper. This is "preventive medicine," according to NLM officials and others concerned with preserving the printed medical word, because 76 million books and countless periodicals on the shelves of libraries around the country are in danger of self-destruction from the acidic content of the paper they are printed on.That 76-million volume estimate for books on all subjects is from the Council on Library

The trail begins innocently enough—just a typeset line in the 1978 Author Index of the Cumulated Index Medicus:Darsee JR: EKG changes and anaphylaxis [letter] South Med J 70(10):1249, Oct 77.For the next month the index shows another letter by the same author in a different journal; two months later there is an another, and a few months later another. Rapidly the citations in the Index Medicus change. Letters to the editor are replaced by short, single-authored papers. Soon, longer manuscripts appear in the line listings, with two, then three, then four and five authors.With time, the names of the journals become more prestigious, small papers give way to substantial works, and researchers of national and international stature are listed as coauthors with increasing frequency.For the past five years, Darsee's name appears on an astounding 116 articles listed in the Science Citation Index (which does not include

During the past three years, from terminals within Beth Israel Hospital, Boston, 3,654 persons used a computer program called Paper-Chase to search the medical literature. While performing 39,022 searches, these persons had 1,976,421 references displayed and selected 449,690 of them for printing. Throughout this period, the program underwent continual modification. Each year the number of searches increased—from 10,678 to 11,541 to 16,803. Each year the percentage of new users who were unsuccessful decreased—from 16 to 13 to 11. By the end of the third year, 549 people had completed 20 or more searches. Paper-Chase enables people to search the medical literature themselves, and thus provides a new experience in computerized bibliographic retrieval. When made available without charge in a teaching hospital, Paper-Chase is widely used.(JAMA 1983;250:2494-2499)

It is just make believe, this "war" in Europe last June, but to 40 physicians of the Calcasieu Parish Medical Society, meeting in a Lake Charles, La., restaurant, it might well be the start of World War III. They are getting ready in earnest for the fourth annual U. S. civil defense exercise—planning emergency procedures, reviewing assignments for the society's 98 members, and discussing aggressions of the paper enemy.Already, the "enemy" is supposed to have invaded a friendly nation abroad. In three days, according to the exercise blueprint, the President will call Congress into session. On July 12, some 165 nuclear bombs would rain on key American targets, and tens of millions would die—all on paper. Of course it is not going to happen, but this night of Tuesday, June 25, is the last time for the medical society to plan its role in the test because the next

Why I should have been selected to read a paper to the Society on the "Advancement of Surgery" is incomprehensible to my mind, unless it was for the purpose of inducing me to post myself more thoroughly upon the literature of the subject. Sure it is, that I, probably of all the members, have paid less attention to the serial productions, as published in our overloaded journalism, than any other member here. And I think it is a well understood fact, that I read less of our periodical literature, as well as our secular papers, than any other member of this community. What has stood the test of ten years' popular favor becomes a part of our texts; and compared to-day with what has been introduced as novel and good, not one-tenth part bears the test of the decade. For this reason I have declined to place any of my

Every physician should know how to prepare a paper for presentation at a medical meeting or publication in a medical journal. Perhaps the most convincing reason for this is an altruistic one. Since writing is the only means the medical profession has of universally disseminating knowledge concerning new therapeutic concepts, medical discoveries, or clinical experience, it is the moral obligation of every physician who has made an original scientific observation, or has formulated from his own experience a new medical theory, to publish it for the information of his colleagues, and the ultimate benefit of mankind. Another good motive for writing medical articles is a purely selfish one. In addition to the sheer joy derived from effective self-expression, the physician who prepares an article on a certain subject broadens his own knowledge of that subject, for, before he can present his material in a comprehensive manner, he must have a

This disease is evinced by simple inflammation of gums around the teeth, followed by chronic inflammation with or without suppuration, with or without calcic deposits, a gradual destruction of the peridental membrane, with recession and absorption of the alveolar process and gums, concluding with loosening and exfoliation of the teeth. The physician is more familiar with this disease, as it appears to him as a consequence of scurvy, mercurial or iodid salivation.Few diseases have received as many names as that under discussion. More time has been spent in apology for and discussion of new names than in original research as to its etiology. The term pyorrhea alveolaris, which has become so popular, and which I have selected for the title of this paper, does not elucidate the exact condition, since many cases which come to the dentist do not suppurate.Riggs's disease seems a more appropriate title, since to

The relatively inexpensive mark-sense paper-and-pencil technique for administering a computer-generated and computer-processed health questionnaire is easy for patients to understand, simple to revise, and permits large-scale testing at low cost. The total questionnaire is designed to be administered in two or more portions or levels. Because each level after the first is a more detailed inquiry into positive responses made to questions of preceding levels, this multilevel approach permits the inquiry to be individualized to the patient. The questionnaires are generated from a question library, and the completed forms are read by an optical scanner. A summary of the patient's responses is printed for the physician's use.

A computer-generated and computer-processed health questionnaire has been evaluated for patient acceptance and reliability of content. Various formats have been tested and it was concluded that a mark-sense paper-and-pencil questionnaire offered significant advantages over a cardsort questionnaire. Studies of administration techniques showed that administration by a specially trained clerk is advantageous.

Since the publication of my paper on "The Autoserosalvarsan Treatment of Syphilis of the Central Nervous System,"1 thirteen additional cases have been treated. It is not the purpose of this communication to report these cases. During the clinical study of these twenty cases, however, many practical questions have arisen, a brief discussion of which appears to be timely. The points which I propose to discuss are along the lines of safety, efficiency and convenience. They are three in number:The problem of asepsis.Time of withdrawal of blood for serum.Dosage and dilution of salvarsanized serum. I. THE PROBLEM OF ASEPSIS In an early one of my last series of eleven cases an accidental infection of the spinal canal occurred. This patient has completely recovered from the infection, but the possibility of the recurrence of such an accident demanded such a critical review and revision of methods as would

In the course of my experience in the treatment of urinary and fecal fistulæ, as I encountered new difficulties, I have described from time to time the cases and the means by which I endeavored to overcome them, but all, especially the more recent of my results have not been published. The object of the paper, of which this is an abstract, is therefore, to set these latter before the profession, and to combine them with what I have already written. In this way, I hope to communicate, in amore systematic manner the results of my experience and observations, in this department of the subject of fistula, which have extended over a period of 34 years. The object of my method of treatment, preparatory to the performance of the operation for the closure of a fistulous opening, is to prevent and overcome the injurious effects of incontinence of urine, and

Mr. President and Gentlemen of the Association of Medical Colleges:—The paper of Dr. Vaughan, which has interested us so much, suggests great changes in medical education. During the past year my attention has been called to some of the details of laboratory work which must be faced by every one of you. Allow me to very briefly speak of some of the results of my thoughts and studies.Laboratory rooms must be light and roomy. Forty square feet of floor is the least amount which will accommodate a single student, and then only in the chemical laboratory. In all other laboratories at least sixty square feet of floor space, not including aisles, must be allowed each student. In the chemical laboratory students' desks may be placed twenty feet from the windows; in laboratories in which microscopes are to be used, fourteen feet is a maximum.The ordinary medical class in

It appears to me that no apology is necessary in introducing the subject of this paper. It is onty a few years since the opening of our great National highway brought the Northwest Territories into touch with the rest of the world; and only a few years further back since these vast plains and mountains, which are now so quickly becoming the homes of civilized man, were regarded as an inhospitable desert, fit only for the buffaloes which roamed their solitudes and the Indians subsisting on the chase. The past five years have been epoch-making so far as our great West is concerned. Coincident with, and following on the building of the Canadian Pacific Railway, a flood of light began to illumine the Eastern intelligence, and as a consequence settlement has steadily and in a gradually increasing stream poured into the Territories.It will be readily understood that a country

Dr. Edmund Andrews, of Chicago, expressed his appreciation of the valuable papers that had been read, and was ready to endorse much that had been said. He objected, however, to the too free resort to laparotomy in any cases, especially in diseases of the cæcum. Many of these affections will recover without resort to surgical interference. The abscess if left to itself will find an exit.He reported a case in which a patient having advanced Bright's disease, of the cystic kidney form, complicated with advanced heart disease, developed an abscess below the umbilicus. Where it came from the doctor in attendance did not know. Finally the fæces began to discharge through the abscess opening. Exploration was resorted to. In following the fistulous opening of the abscess, the operator found that it passed through a mass of fat in the lower outer abdominal wall, then passed inward and upward toward

DR. DENNISON OF DENVER, COLO. —We are indebted to Dr. McFarland and Dr. Rochester for their excellent papers read this morning, and I wish particularly to commend Dr. McFarland for his excellent statement of what tuberculosis is. I have no controversy with those gentlemen as to their treatment or the results of their experiments. I object to Dr. Cohen's warning against seeking after a specific for tuberculosis as if it were a will-o'-the-wisp. I commend the work of Prof. Klebs, Dr. von Ruck, Dr. Trudeau, and those men who are in search of a specific for tuberculosis. Their work is to be commended because it is painstaking, and for the hard lines which they are following. In the first place it seems to me impossible that we can prove anything by testing tuberculin on healthy persons, for tuberculin can only affect individuals previously infected with tuberculosis. The assertion of one

In an essay delivered before the Western Ophthalmological and Otolaryngological Association at New Orleans, Feb. 10, 1899, and published by Drs. Würdemann and Murray in the Annals of Ophthalmology, April, 1899, the authors noted the rarity of high myopia in America and the relative frequency of this condition in the ophthalmic statistical reports of Germany and other European countries. A number of statistical tables were given in this paper which have been amplified and are herewith appended. These are taken entirely from the authors' private practice during the last fourteen years, in which 10,500 pairs of glasses have been prescribed, this, of course, including renewals of prescriptions. The following table shows the refraction of 4,690 eyes under a cycloplegic:

A glucose-specific test paper which is sufficiently sensitive to react with the small amounts of glucose present in urine from normal persons in the fasting state can be used to discriminate between urine samples containing more than and those containing less than 1 to 1.5 mg of glucose per 100 ml of urine. This provides a screening method for significant bacteriuria in an apparently healthy population since urine samples, obtained under standardized conditions from subjects in the fasting state with such bacteriuria, contain either very little or no glucose.

Blood pressure sometimes varies in the right and left side, and I believe that it also varies in local parts of the body. For years I have tried to perfect an apparatus for obtaining readings in various parts of the body, but so far without success.In cases of paralysis following cerebral hemorrhage, it is quite usual to find the blood pressure from 20 to 30 mm. lower on the affected side than on the side unaffected. At first thought this would seem to be easily explained; e. g., that, owing to the cerebral rupture with its resultant paralysis, the vasoconstrictor nerves had become paralyzed, thus allowing an arterial and capillary dilatation. The arteries and capillaries thus have a larger caliber, and so the pressure falls. If that were so, the blood supply to the affected side would be increased, and atrophy of the part would not so quickly ensue.

Gentlemen of the Association:—Being under the impression that we of the medical profession have failed to secure such recognition of the necessity for sanitary laws and regulations, both State and national, as we earnestly feel should be enacted and maintained, the question naturally arises as to the cause of this apathy, or carelessness, or neglect, on the part of our law-making power? I believe that this is chiefly due to the fact that our efforts have been heretofore too often misdirected, by not addressing ourselves to the people more directly, instead of to the officials, who are, in point of fact, only temporary incumbents generally. A legislator, whether in high or low official position, has one desire that is paramount to all others, and that desire is to not be relegated to private life again. He is willing, and even anxious, to do that thing that he beliveves the majority

[Your attention is invited to a subject which from the humanitarian standpoint is of the greatest importance and of practical value to us as surgeons. Much of the effort of our profession is directed toward the relief or prevention of pain. Distinct advances in our art followed the introduction of the various narcotics, and the science of surgery took a long step forward when the use of sulphuric ether for anesthesia was discovered Sept. 30, 1846, by Dr. Wm. T. G. Morton, of Wellesley, Mass., and chloroform by Sir James Simpson, of Edinburgh, on Nov. 4, 1847; and these names will ever live in our memory.But the great boon of narcosis is not unalloyed. Thousands have died from the effects of the volatile anesthetics, and every time we administer them we take upon ourselves the responsibility of a human life. Ether kills once in 15,000 administrations; chloroform once in

CROUP AND TEMPERATURE IN MASSACHUSETTS.CROUP AND ABSOLUTE HUMIDITY IN MASSACHUSETTS.CONSUMPTION AND TEMPERATURE IN MASSACHUSETTS.SMALL-POX AND TEMPERATURE IN MASSACHUSETTS.DIPHTHERIA AND TEMPERATURE IN MASSACHUSETTS.PNEUMONIA AND TEMPERATURE IN MASSACHUSETTS.SCARLATINA AND TEMPERATURE IN MASSACHUSETTS.TEMPERATURE AND SICKNESS FROM PNEUMONIA IN U. S. ARMIES.SICKNESS FROM CONSUMPTION IN WHITE TROOPS, U. S. ARMY, AND TEMPERATURE.DEATHS FROM CONSUMPTION IN WHITE TROOPS, U. S. ARMY, AND TEMPERATURE.SICKNESS FROM DIPHTHERIA IN MICHIGAN, AND TEMPERATURE.

The subject of fibroid tumor of the uterus is too broad to be considered in all its aspects, in the time allotted, before this Society. I have therefore thought it advisable to speak of but two phases of the subject: 1, what cases require operation; 2, methods of operating.Clinical experience demonstrates that only a small percentage of those suffering from fibroids require operative interference for relief. This is so well known that the profession at large have come to regard them as purely innocent growths. This is true in the majority of cases. My experience, based upon more than two hundred carefully recorded cases, justifies me in saying that the majority of women from thirty-six to forty-five years of age suffering from fibroid tumors, do not require operative interference; but this fact increases our responsibility in determining early the cases really requiring operation.A great many women who are

The frequency of "floating kidney" associated with its varied complications, together with the errors in diagnosis, certainly warrant our taking up this subject, and considering it for a few moments before this Association.The experience of the writer both as a general practitioner and consultant, has led him to believe that the existence of a floating kidney is more likely to be misunderstood and taken for something else than any other one disease of the abdominal cavity.I have seen floating kidney treated for "lumbago,"also for so-called "sciatic rheumatism." In another case I saw an able practitioner tap it for "ascites," and still another case where it was mistaken for an enlarged ovary.On the other hand, I have seen an enlarged and pendant "gall bladder" filled with gall stones, mistaken for a movable kidney, and the mistake was not discovered until revealed by an operation. With these few examples,

In writing history it is necessary to begin at the beginning, thereafter following our subject along the stream of time until we reach either the end of its course or its present anchorage; but the beginning of our present subject is lost in the haze of the distant past. In the earliest dawn of history we find men fighting; and battles, no doubt, were fought even in the primitive days. The history of the human race is, in fact, a history of battles and their results. But history had no eyes for those who dropped out of the struggle; seldom are we told of the wounded. Nevertheless, we must credit these old time warriors with sympathies which led them to care for their wounded, so that our subject finds a beginning as far back and as undefined as history itself.We may assume that slaves, servants, companionsin-arms, friends or relatives

It is generally accepted that focal and other infections are the cause of many cases of arthritis. It is the belief of some that all cases are due to this agency alone, but dispassionate students of the disease are almost unanimous in the belief that other factors also play a rôle, and that focal infection is often only the "match to the priming," even when operative. There is also strong evidence that focal infection may arise as the result, as well as the cause, of the arthritic syndrome. In any event, the manner in which bacteriologic infection exercises its influence has not been made clear. There are cases of arthritis undoubtedly characterized by bacteria in situ and even by the formation of free pus; but the evidence that all cases of arthritis are caused and perpetuated by bacteria in the joint tissues is far from convincing. The inclination to ascribe

In presenting the subject of non-absorbent gauze for your consideration I am not offering a new topic for discussion; non-absorbent gauze takes its origin contemporaneously with the antiseptic dressings of Lister. Lister's1 earlier dressings were distinctly non-absorbent; the manner of their production secured it, for muslin was soaked in a heated mixture of paraffin 16 parts, resin 4 parts and carbolic acid crystal 1 part; while still warm the excess of the compound was wrung out. Lister2 shortly thereafter even suggested an 8 per cent. carbolic gauze made in the same manner. The paraffin counteracted the adhesiveness of the resin, and together they precluded a capillarity in gauzes thus treated. The faults of this carbolized gauze were early recognized and were its non-absorbence and its tendency to cake into a solid mass. In turn, Lister2 experimented with corrosive sublimate and cyanid of mercury; the former, he found, combined

INTRODUCTION.The animus of this contribution is the belief of the writers that trophopathy (trophos—food; pathos—disease) has more to do with the cause and cure of the so-called incurable diseases than the profession gives credit to; and to show that our belief is founded on facts, we will immediately proceed to the consideration of the subject in the concrete, to wit: the reading of histories of some patients that have been under our care.CASE HISTORIES.Case 1.—A little more than four years ago, a gentleman brought to our office a friend, who appeared to the senior writer almost moribund; indeed, he feared that the man would die then and there. Examination showed the case to be suffering from an enlarged heart, a fibroid liver and Bright's disease of the kidneys; the urine contained albumen, casts and fatty epithelia. We will here make the note that in our study of

I am here to-night to tell you a little of what I know about "The Swedish Movement and Massage Treatment," and if some things should seem strange, or you should think that I have claimed rather much for it, I beg you to remember that all that I have to say is based upon facts, and that I am here not as a special agent for myself, but as one who wants to lay before you a clear and true representation of what has been done.As Herodotus observed the curative effects of gymnastics on his own delicate health and thereby was brought to use movements in therapy, so did the Swede, Pehr Henrik Ling, in the beginning of this century, study the movement treatment, because he had cured himself of rheumatism in the arm by gentle percussions. Ling had been a fencing master and instructor of gymnastics, but now

For twenty-four hundred years, and probably during all preceding ages, some of the best minds the the world has ever produced have studied and coped with phthisis, and, in spite of the accumulated knowledge of all those years, about one-fifteenth of the human family falls a victim to it yearly. There is not a clime in which it does not exist, nor a period of life in which it does not occur. The rich and poor, the civilized and uncivilized, become its prey. Since it cannot be cured, it is but reasonable to try to prevent it, and much has been done in this direction during the last century. What percentage of deaths was due to consumption in the days of Hippocrates cannot be known, but that it was large would appear from his words in speaking of a certain period, viz., that "consumption was the most considerable of the

To those who have given study to the above subjects they rank them first in importance. They know that to construct a perfect water closet or privy vault, the complete mastery of the laws governing gases and organic germs must first be made. What is any house, however elegant in appearance, or expensive in construction, without either one or both of these appliances of the most recent pattern, but a modified "Black Hole of Calcutta?" It is but a place of confinement where malaise, headache, debility, and low vitality dwell, and where the organic germs of fever, diphtheria, scarlatina, measles, cholera and small-pox find their habitat.The sanitarian of to-day, to be at his best, should be familiar with all that chemistry can teach, mechanics demonstrate and engineering plan. So vast, intricate and numerous are the laws of sanitation, we can, at present, no more make them all subservient to

The property of diphtheria toxin-antitoxin mixtures to produce immunity in animals has been known for a number of years. Successful results have been obtained in the immunization of horses (Park, 1902), goats, guinea-pigs, etc. Theobald Smith suggested the immunization of children by this method, but no one undertook it until 1912, when von Behring made the attempt.In May, 1913, von Behring1 reported the results obtained in human beings with mixtures of diphtheria toxin-antitoxin. The combined substances were either neutral or slightly toxic to the guinea-pig, but the definite proportions of toxin and antitoxin were not stated. The early reports of von Behring and his co-workers2 were so favorable that we determined to make a similar attempt at the Willard Parker Hospital. The scarlet fever pavilion offered us exceptional opportunities to determine the efficiency of this prophylactic treatment against diphtheria.Mixtures of diphtheria toxin and antitoxin were accordingly prepared

Current descriptions of the pineal gland attribute to this organ the function of producing a secretion which inhibits growth of body and restrains mental and sexual development from exceeding the rate looked on as normal for preadult life. This inference arises from the occasional distinctive precocity of development following invasion of the pineal gland by neoplasms. It is assumed that such neoplasms destroy the gland, and that any resulting metabolic disturbances occur from the deprivation of the body of the pineal's elaborated substances.From a reactionary point of view, the groundwork for such a theory is both meager and unstable. From sixty-five to seventy authentic cases of pineal tumors have come under observation. These have been distributed over more than a century. Copies of the original descriptions are rarely readily accessible. By reason of faulty translations and inaccuracies in quotations, some descriptions of pineal gland syndromeshave come to resemble classical

In a former paper,1 introductory to this series, it was related that reliable perimetric observations had been possible in 123 patients in a series of 200 cases of cerebral tumors. These had shown normal fields in twenty-seven instances a tendency toward hemianopsia in forty-two, and colorinterlacing or inversion (dyschromatopsia), with more or less symmetrical constriction, in fifty-three instances. It is our present purpose to give specific illustrations of the cases showing dyschromatopsia and to correlate them, so far as possible, with the stages of an advancing choked disk, especial emphasis being laid on the field deviations coincident with, or antecedent to, the earliest ophthalmoscopic changes.There have been ten cases of tumor which have shown color-interlacing, either in the total absence of a choked disk or with a very incipient process observable in the eye-grounds. As the reader will surmise, therefore, these represent cases in which definite localizing (irritative)

Mr. President and Fellow-members of the Ohio State Medical Society: The subject of fever—in its general aspect—has been deemed worthy of so much labor and study on the part of the physiologist, the pathologist and the clinician, and is of such practical import to all who practice our art in any of its branches, that no apology is necessary, I trust, for bringing one of its numerous phases before this society for consideration.Looking at its most constant and evident symptom—the pyrexia—the physiologist points out, and the pathologist, and clinician confirm the probable •existence of heat-producing, heat controlling and heat dissipating areas, situated in the central nervous system, and influencing by their abnormal action the production of this particular symptom.That the pyrexia, however, does not constitute the disease is quite evident, since, it may be absent, controlled or even eliminated, and yet the patient be far from well.While,

At the time of our previous communication1 on Malta (Mediterranean) fever in Texas, in which we reported the isolation of the Micrococcus melitensis from two patients ill of continued fever, it was known to us that other cases existed in the vicinity of Langtry, Texas, and it seemed highly probable that the disease had a much wider distribution.The recent work of the British Mediterranean Fever Commission2 has conclusively shown that in the Island Malta Mediterranean fever is almost entirelly contracted trough drinking the milk of infected goats. All the cases observed by us had given a history of drinking goat's milk or of being actively engaged in the goatraising industry. In view of these facts, it was decided to make some study of continued fevers in the principal goat-raising section of the state, to ascertion if possible