improvement in stenosis; can breathe natu- hypertrophies protracted the affection and rally, but with difficulty. April 12: Pulse gave it the impress of gravity which after 92, temperature 100 F. Patient continues delivery it assumed, is unquestioned. to improve in strength; no change in treatment. April 13: Pulse 100, temperature larynx, it progressed through the various 101 F. Parotiditis, which had been slight for several days, now well marked; both glands much swollen, tender and painful. Prescribed R hours. Potass. iodide .3 ss .i Beginning as a slight catarrh of the stages with exacerbations and declines until it merged into laryngeal oedema. At the time of our consultation the nervous shock and unequal respiratory contest had well. nigh exhausted her. The fierce anxiety for more air had subsided with the increasing mental hebetude; the pulse was small and to be used externally freely. intermittent; she was unable to breathe in Internally, wine-glass doses of wine of recumbent posture; her lips were livid, voice coca instead of whisky every three hours, suppressed, and could be aroused only with and five grains of phenacetin every four difficulty. That the laryngeal stenosis demanded immediate tracheotomy to relieve April 14: Pulse 105, temperature 1012. the dyspnoea was the conclusion readily No improvement in parotiditis; other symp- reached, and, the husband consenting, pertoms better; treatment continued. April 15: formed. The details of the operation are Pulse 76, temperature 99 4-5. Parotiditis so well known that they need not be repeated.. subsiding; respiration easy. April 16: Pulse In no way did we depart from the usual 100, temperature 100%. Increase tempera- operation, but in the absence of a trachea. ture due to omission of phenacetin. Respi- tube or retractors a ligature was inserted at ration easy. Breathes with tube closed for from five to ten minutes without complaint. Parotiditis subsiding. April 17: Pulse 105, temperature 101. Can breathe with canula stopped for one-half hour. Other symptoms all improving. Rise in temperature proba- the operation, which was conducted under bly of emotional origin, her baby being anesthesia, there was immediate relief from dangerously ill and dying. April 19: the dyspnoea and improvement in the circu-Symptoms about same as 17th; more re-lation. Large quantities of mucous were signed to loss of her babe and strength im- ejected from the tracheal wound with inproving. April 21: Temperature normal, creasing relief to the patient. Liquid pulse 95. Parotid inflammation nearly gone; nourishment and stimulants were ordered, appetite good; sleeps well; expectoration a thermometer obtained and directions given. diminishing; breathes easily with tube re- to keep the temperature at a uniform height moved and wound closed. April 27: Re- of 75° and the atmosphere moist. each side of the opening in the trachea and. tied at the nape of the neck, securing the opening in the trachea in the same manner as the lead foil retractors, used and advocated long ago by Joseph Pancoast. After moved tube; closed wound by drawing together with adhesive plaster. Respiration free and easy. April 28: Patient rested well previous night; breathes without diffiTHE tablet-triturate form of preparing culty. Wound is healing rapidly. April medicines bids fair to do away in a large 30: Respiration good; wound closed except measure with the physician's dependence on a small sinus where tube was inserted. Pa- the drug store. The physician can now tient discharged. prescribe at the bedside or at the office in The history of this case is that of catar- the most palatable and accurate form for rhal laryngitis, modified by pregnancy and almost any ailment without recourse to outtreatment. That the puerperal period, with side sources. This will shortly settle the its altered blood tendencies to stasis and voracious counter-prescribing question. SOCIETY get through. I think what the doctor has PROCEEDINGS. proposed is the proper thing to do. The legislators think when there is a physician present that there is a scheme on foot which The Topeka Academy of Medicine and will give some one an advantage. The Surgery. registration act proposed would make the law on the statutes more effective. Our en Academy met in regular session, Monday dorsement should be given or a committee evening, December 12, 1892. appointed to take the matter in hand." Dr. Rodgers.-"It strikes me that the Dr. S. E. Sheldon in the chair. DISCUSSION. Dr. D. F. Rodgers was elected to act as profession are the proper persons to take temporary secretary. hold of it. Dr. O'Brien says we should have Present: Drs. O'Brien, Lewis, Stewart, a law requiring all physicians to register. Magee, McCrea, Barnes, Conger, Klemp, It seems to me we have a law of that kind Gilbert, W. E. McVey, Sheldon and Rodgers. now, or it has been required of physicians When I came to Paper by Dr. O'Brien on "The Present in some parts of the state. Status of Medical Legislation." Kansas in '81 there had been a law passed very similar to the one read. The trouble with it was that a board of examiners were Dr. Stewart. "This is one of the leading to be appointed to pass on men with diplomas questions—the subject of control by legis- and those who had not. A fee being relation of medical practice. The summary quired for one and a larger fee for the other. given in reference to schools is very interest- The faulty part of it was the fee charged ing. I can add nothing to the doctor's con- for registering a man who had a diploma. clusions. We all have opinions on this If a law such as that was passed, then it can subject. It has been my opinion that the be now. Dr. Pollock's law meets my apcontrol of practice lies with the honorable proval except in the fee for, having a members of the profession. The higher re- diploma." quirements are coming in. Three and four year courses are being adopted instead of two. I saw a statement in reference to the three-year course, made at the Southern Dr. Rodgers.-"The medical profession Association meeting, claiming this would don't seem to know that we have had these ruin them financially. This is the rock laws. The dentists and pharmacists have upon which it splits, i. e, the financial had for a number of years a law requiring point. New York took a backward step a a man to be registered to practice. few years ago. The purification of the law was fathered by the medical profession, ranks of medicine rests with the individual yet we have not succeeded in our efforts.” members. It has been my habit, when a Dr. Lewis.-"I wish to commend the student presented himself, to discourage him paper of Dr. O'Brien. I am in favor of anyif he had not the proper qualifications. It thing that will benefit the profession. I is true that many with only a glimmering of think a law should be considered until it is knowledge have succeeded, but we should discourage such from beginning. We do need laws of this kind in Kansas. I think the law formulated by Dr. O'Brien is a good one. I do not think the last one read would be practicable. We cannot get all we want." Dr. Magee. "I think the law read at the last is too lengthy and too cumbersome to Dr. Klemp.-"The defective part of the old law was that the board was not appointed by the governor." This exactly right. The registration law was enacted by the board of health. I have heard we had an effective law, but my own idea is we have no law." Dr. Gilbert.-"I am in sympathy with the law, but do not exactly like one part of the law for registration proposed-i. e., that a man can only register in one county.” Dr. Conger."I think with Dr. Stewart that the remedy lies with the profession. In the discussion of Dr. McIlhenny's paper, Adopting three and four-year courses will Dr. Sheldon said: "The doctor has given not correct it unless all the colleges adopt us a good explanation and one which I am it, as men will naturally take the shorter inclined to accept-i. e., the formation of course, and the matter must be regulated by some legal restriction. I prefer the registry act to the law of Dr. Pollock." the pelvis. It called to mind a woman who had five successive pelvic presentations (otherwise a healthy woman), and I think we Dr. O'Brien.—“There is no one who has find these presentations are apt to recur a less of a personal interest in the outcome of second and a third time. Where forceps a medical law than myself. I have a per- can be applied they should be used. The sonal pride in the medical profession. I doctor's plan of pressing occiput up and have no pet measure, but presented these bringing down chin is the proper treatment, points to bring out a discussion. I think but I think even in these cases forceps are these matters should be thoroughly dis- best used." cussed before the meeting of legislature. The law now on the statute has been sufficient to drive out of the practice several physicians." Dr. Rodgers."While I was a county health officer there were doctors who would not register nor report, and Dr. Redden informed me that they could not be compelled to. The state board of health have no authority and we have been bulldozed by a board which has no authority to enforce the law." Dr. Warner thought Dr. McLallen would have more influence with the legislature than any other man; and that if the profession would unite upon a plan they would get his entire support. He would be greatly interested in anything which would advance medical education." Drs. Warner, O'Brien and Sheldon were appointed a committee to wait on Dr. McLallin and invite his interest in the matter. A motion by Dr. Conger, that the president call a meeting of this society and invite members of the other schools to attend, for the purpose of having a general discussion on medical legislation, was carried. South Kansas Medical Society. [MEETING OF NOVEMBER 15TH CONTINUED.] Dr. Harris.-"My experience is that a pelvis does not change much after maturity. All my cases have occurred after other normal presentations. I am surprised at the number of these cases found by the physicians. I concur in the manner of delivery." Dr. McIlhenny.-"Three of the cases I reported were primipara, and this seems a further reason why we should expect some pelvic trouble." Dr. Lindsay, chairman of the committee on the case of paralysis, reported as follows: "This man, an Englishman fifty-one years old, four years ago began to have a feeling of numbness in right hand; previous to this he had a spell of typhoid fever. He had lived in southern Illinois and had fever and chills. He was exposed a great deal. Numbness extended to the arm and finally to the whole side, and to the other side and all of the body. He worked very hard, was much overdone and exhausted. He had at first pain in the bowels below the umbilicus, continuous except when using anodynes. This continued for six months. As the tremulousness increased, the pain diminished. find normal sensation of the skin and muscular action good. The knee jerk is somewhat exaggerated, but because of the stiffness of the muscles of the leg. The pupil of the left eye is larger than that of the right. You notice the effort and stooped position in walking; the tremulous mouth and position of hands and thumbs; and that when he sits down it is with a jerk. The muscles We Dr. G. Boyd proposed the name of Dr. S. E. Sheldon for honorary membership. The same being favorably considered, he was of the face seem stolid and expressionless. elected. We find that contrary to custom he has in herited this condition. His father has had ago was improved by oxide of zinc and the same trouble for twelve years. On the fluid extract hyoscyamus.' least excitement he is more agitated. The Dr. Peak. "I had a case which I diagtremor in these cases is usually controlled nosed paralysis agitans and treated accordat first. We find he can in a measure con- ingly with good results apparently, but with trol it. When he sleeps, the tremor stops, relief of the tremor, headache began. We though he does not sleep quietly. The case learned later that we had a tumor on the has already been diagnosed as paralysis left side of the base of brain. This has not agitans. We have one disorder to exclude yet been verified, as the man still lives. multiple sclerosis. While we have not the This opinion was given by Dr. Lyman, of pain of the latter, we do have the prominent Chicago. I thought at first it was a clear symptoms of paralysis agitans. It seems a case of paralysis agitans." clear clinical case of this disease. The inheritance is very unusual. The pathology case on account of the case referred to me. of this condition is very much disputed or In this case, on ophthalmic examination, I there is a variety of pathological conditions. found choked disc. Also of a friend of mine, We find, in some of the examinations made, who has all the symptoms of paralysis some parts of the cerebrum are diseased. agitans. He has been a very close student. The pons, corpus striatum, medulla and the I am mostly interested in the prevention of columns of spinal cord have all been found these cases. If we could see the approach to be the seat of the lesion. The motor of these troubles we might prevent by changtract is not disturbed." Dr. Klippel.-"I was interested in this ing the habits. The intense application of students is the most serious factor. In the case of Dr. Peak there was tumor of one side only." Dr. Klippel asked if there had been any examination of the urine or test of the vision. Dr. Lindsay replied in the negative. Continuing, he said: "This is one of the sad Dr. Halley. "I fully agree with Dr. conditions in which we are unable to do any- Klippel in one sense. In the case presented thing. Recorded recoveries are rare, though here the idea that it was caused by study resome are reported from the use of galvanism, quires a vivid imagination. The point behyoscyamine, etc. I have never seen one hind it is that there is a change of structure recover. They can be made more comfort- of tissue going on without proper eliminaable. The cause of this disorder is a ques- tion. The history of over-work and typhoid tion. Over-work has a great deal to do with fever serve the same purpose as the overit. I saw cases in New York among young study. It is a degeneration of nerve tissue, men who are doing a great deal of study. caused by the retention of some elements One man who is a specialist in nervous dis- which should be eliminated." eases. Inasmuch as we have such a variety Dr. Lindsay.—"I simply wish to call atof pathological conditions, it seems it may tention to one point, z. e., the fineness of the come from degeneration of the brain or tremor, which is a diagnostic sign. In the columns of the cord, from over-work or ex- tremor of lateral sclerosis we don't have this posure; anything which interferes with their nutrition. In some cases no seat of lesion could be found. As to treatment, I think central galvanism, 1-100 grain doses of hyoscyamine, increased to 1-12, or hydrobromic acid are all good." Dr. Axtell. "The treatment given has been principally fifteen to twenty amperes of the galvanic current. There was no benefit and it was discontinued." fine tremor. I did not wish to give the impression that this was brought on by overstudy. But the over-work in connection with his ill-health make up the necessary history." The next paper was on the subject of "Eye-strain and Headache," and presented by Dr. G. A. Wall, of Topeka. In the discussion following the paper, Dr. Klippel said: "I listened with interest to Dr. Harris.-"A case I treated some time the paper because I believe he has presented a prevalent cause of headache. I think we consider the extent of the optic tracts. I do who study in a special line are prone to over- not believe there were so many of these cases estimate this as a cause. There are other twenty or thirty years ago. I think, from very prevalent causes of headache." The our habits and methods of education, there doctor referred to a case where an oculist, is a tendency to degeneration of tissue. We after repeated trials, failed to relieve the should warn our patients against this inheadache by glasses. A gynecologist lo- tense application and worry." cated the pain at the top of the head, and on Dr. Purdue.-"Dr. Lindsay has struck examination proved it to be an erosion of the key-note. Most of us twenty or thirty os. Treatment relieved the headaches. "I years ago only went to school sixty days in heard a gynecologist state that seventy-five a year. I think our children are overper cent. of headaches were due to menstrual worked." disorder. I think we are prone to overestimate the percentage in these cases." It is no Dr. Cordier.-"I take exception to these views. I believe in proportion to the population there were as many headaches then as now. The result of education is that they seek the specialist for relief. Children are sent that we formerly would not have known of. It is useless to say we have more cases of salpingitis now than formerly. It is folly to think there were none of these cases before Tait first diagnosed and operated on one. It is the result of education." Dr. Minney.-"Dr. Cordier is right to a certain extent. Dr. Purdue and Dr. Lindsay are also right. Why is it we have so few of these cases from the country? They are not so closely confined. The reports of these cases in Germany show the result is the same." Dr. Minney. "We must not forget that with the ordinary hygiene and light of the school-room the eye, even when normal, will complain, and we have to give help to tide them over. When out, they get along without help. We should carefully examine the eye. We may find an error of refraction, but we should not stop unless complete relief is afforded by glasses, but examine the whole body. In respect to mydriatics I differ from the doctor. I have a tabulated report of forty of the American oculists. Of those some of the most prominent use atropine sparingly, while others use it more. I find that by long-continued reading in the office and repeated trials I can get along without it in the majority of cases. Dr. Halley reported for the committee on wonder that headaches are produced by eye- the case of cyst of orbit. He said: "The strain when we remember the close connec- history of this case goes back about nineteen tion of the eye with the brain. In fitting years. She was fond of horses and when glasses, where there is long-continued hyper- fondling a horse's head was struck on the metropia, the muscle is hypertrophied and orbit; at a later time was also struck on the we should not correct the error completely." nose. You will notice the supra-orbital Dr. Oldham. "These cases of eye-strain ridge on this side is larger than the other. come under the observation of the general The greatest pain and tenderness is over practitioner, but I do not attempt to treat the supra-orbital nerve. The enlargement them. Where they are in good health and no indication of any other trouble but eyestrain, I send them to an oculist, and there is usually relief. The gynecologist attributes headache to uterine disease because a large per cent. of patients going to him have uterine trouble. Comparing the children now with those of years ago I wonder how they were treated then." Dr. Lindsay. "It is not surprising that we have headaches from eye-strain when we is like an induration, extending around to the nasal process of the superior maxillary. There was a great deal of swelling a year ago. It was operated upon; the tumor being opened up, but no pus was found. On the 6th of last May, Dr. Axtell opened it up and found a sac which discharged freely of pus. The upper wall of the cavity was long and he could thrust, his finger two or three inches back into the orbit. The wall of the sac being thick and bony indicates that the |