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into the lumen, and in which the rings around the aortic valves may be involved. There is round cell infiltration, degeneration and calcification. Gummata may be found but are more frequent in the smaller vessels. In the hall of the scientific exhibit, Dr. Welch subsequently gave a demonstration and lecture, showing some beautiful examples, also a kidney, the half of which was nourished by a sclerosed artery, the other half by a normal artery. The hob-nail half stood out in strong contrast to the other, smooth one.
Dr. Thayer's paper and charts showed an etiological classification of arteriosclerosis, of the cases noted at Johns Hopkins Hospital during ten or more years. As the classification of causes from histories of cases no longer in the hospital and where two or more such causes might have coëxisted, viz.: syphilis, alcoholism, overwork, age, etc., it is difficult to see how arbitrary grouping can be avoided. Alcoholism, age and work were the most decided etiological factors, syphilis coming next, scarlatina, typhoid and other infectious diseases appearing last. The diagnosis consisted in finding radials palpable after shutting off the blood.
Dr. Drennen's paper was an elaboration of an opinion that much of the so-called syphilitic arteriosclerosis is due to excessive use of mercury for years without interruption. He advocated interrupted treatment by men competent to give it, using eliminants in the interim.
Dr. Dock's paper on " Arteriosclerosis of Nephritic Origin gave some examples of kidney disease that had been entirely overlooked until the subsequent heart and arterial changes called attention to them. Every sore throat or suspicious exanthem should be studied with care and the condition of the kidneys looked into. Arteriosclerosis due to typhoid fever is always of nephritic origin, and a case of typhoid ought to be kept under observation for a year, or as long as it is possible after recovery from the fever.
Dr. Billings' paper discussed the relation of lead to the disease. He cited a case of lead poisoning in which the only contact with lead was the carrying of bars of solder in the bare arms for some weeks.
Dr. Cabot then read his paper " Arteriosclerosis of Alcoholic
Origin," winding up with the statement that it was a myth. He had studied cases at the Massachusetts General Hospital, at the poor farm and at other hospitals, and had made many post-mortems of patients with palpable radials without finding any evidence of arterial disease. When found it could always be ascribed to other conditions. One man had drunk fourteen drinks a day, followed by fourteen "chasers," and on section there was no arteriosclerosis. Another had drunk a quart of whiskey for nine years and also was free from arterial disease. In closing the discussion, he insisted upon the point that alcohol in health was a curse and in disease only occasionally of value, but candor compelled him to report that he had been unable to find arterial degeneration as a result of the use of alcohol.
Dr. Osler's subject was "Arteriosclerosis and Angina Pectoris." The essayist had no paper, confining his remarks to a consideration of the distinction between cases of angina due to disease of the coronary arteries and those in which at the autopsy no organic disease is found. I failed to gather just what the pathology of these cases was and what the pain in such cases is due to.
Dr. Anders' paper on "Treatment of Arteriosclerosis" was a practical exposition of the subject. He showed sphygmographic tracings illustrating the beneficial effects of the nitrates, even late in the disease, when only palliation can be expected. He opposed the present system of violent exercise in the colleges, looking upon muscular overexertion, alcoholism (laughter) and syphilis as the principal causes.
The symposium was discussed by Drs. Stengel, Shattuck, Krauss, Stockton, Babcock, Meltzer, Tyson, Jacobi, Weber and others and closed by Thayer, Drennen and Cabot, the others having left the hall. The position of Dr. Drennen was attacked by Krauss and Jacobi. Cabot's paper was discussed by everybody amid much enthusiasm and applause. Dr. Shattuck spoke of the strenuous life as the most prolific cause. Dr. Meltzer thought none of the essayists had proved their point. Dr. Babcock spoke learnedly of the correlation of the cardio-vascular apparatus and its diseases. Dr. Weber dwelt upon intoxication as a cause (and so did the writer). “Unless
we study the chemistry of the poisons affecting the human body we will never write the history of arteriosclerosis," said Weber.
That afternoon the heart disease section had the floor and the writer went to the hall of the scientific exhibit where the system of lecturing and demonstrating was for the first time inaugurated. The attendance was not large, because all the sections were busy, but the audience was enthusiastic. A Japanese showed drawings of a mosquito found by him in Japan that carries only the estivo-autumnal parasite and none of the others. Dr. Greiwe, of Cincinnati, gave a most instructive lecture upon changes in the myocardium and demonstrated some valuable specimens. Other speakers were Wyman, Councilman, showing his smallpox parasite, Coplin, Wynn, Wiley and others. I returned to the medical section in time to hear the discussion of Dr. Frank Jones', of Memphis, paper by Babcock, Webster, Anders, Wells, and others, complimenting it very much.
On Thursday morning we had the gall bladder symposium. The trend of the discussion was that gall bladder disease was a surgical disease, even though it might not mean immediate operation. Dr. W. J. Mayo opened the discussion. Dr. Mayo said 10 per cent. of persons had gall stones, though in the majority they gave no trouble. The symposium was freely discussed, but the subject matter does not lend itself to abstracting. In the afternoon the writer's paper came first and was discussed only by Dr. Cabot, although Stengel, Osler, Thayer, Dock and several others had been supplied advance synopses of the paper. Many asked questions, evidently trying to confuse, but Dr. Cabot thought the paper had the merit of showing what can be done without the hemocytometer and would serve to remove a bugbear from the minds of some clinicians. The papers of Drs. Willson, Tuttle, Marvel and Knopf followed.
Drs. Krauss and Butterworth (New Orleans) were appointed a committee to solicit subscriptions for the Walter Reed mon
Tonight the reception of the president takes place in the ball-room of the Steel Pier; the wind is blowing a gale and
I preferred to come in early, write a few letters and get ready for tomorrow's departure.
The social features were numerous and well attended.
SECTION ON OPHTHALMOLOGY.
ATLANTIC CITY, N. J., June 10, 1904. To the Editor-This was the largest meeting the section has ever had, there being nearly 250 registered in it. Not only were there more men, but more good men, than were ever in attendance before. The mention of Knapp, Wood, Weeks, De Schweinitz, Jackson, Buller, Risley, Theobald, Woods, Würdemann, White, Standish, Calhoun, Bull and many others, as being present, is significant of the character of the proceedings. Only a few of the papers call for mention here.
The address of the chairman, Dr. Robt. L. Randolph, was a protest against our barbarous celebration of the Fourth of July, and attention was called to the numerous serious accidents incident thereto.
In the treatment of purulent ophthalmia, Standish was loud in the praise of argyrol, combined with the most gentle means of cleansing. He does not approve of the use of cold, and while nearly all who spoke seconded the idea of using argyrol, some clung to the ice pads. One lone voice rose in favor of nitrate of silver, to which I would gladly have added mine had not the discussion been cut off.
White prepares a ball for operation by filling the conjunctival sac with a mixture of bichloride of mercury, gr. i, sodii chlo. gr. v, and ung. petrolat. 3 vi. This is put in the evening before and the eye bandaged. Several testified to the value of the plan, which has been known and practiced for several years, but which was originated by White. He limits postoperative infections by reopening the wound, filling the anterior chamber with argyrol and using the actual cautery to the lips of the wound.
Würdemann presented a classification of orbital tumors, with numerous specimens and photographs. This collection will be published as an atlas.
A. Maitland Ramsay, of Glasgow, delivered a most entertaining address on the "Importance of General Therapeutics in the Management of Ocular Affections."
It was the writer's misfortune to be called next on list. A report of "Three Cases of Septic Thrombosis of the Cavernous Sinus" was justified by the rarity of the condition, its gravity and the rather large experience for one man. There were no special features about the cases, all of which ended fatally.
Calhoun opposed bilateral (simultaneous) operation for cataract, and this has long been and doubtless long will be the consensus of opinion.
Reclination of the lens, performed with doubtful success by Rogers, has some theoretical arguments in its favor, but as the usual sequel is iridochoroiditis and blindness, it must be reserved for a small class of cases, e. g., the very aged and feeble.
Risley has had such good results with syringing and small probes, if any, in lachrymal affections, that he opposes the use of large probes and all radical treatment. Those participating in the discussion rather, shared his views, with the exception of Theobald, but the growing tendency to go at once to extirpation of the lachrymal sac in chronic dacryocystitis was plainly evident.
Sympathetic ophthalmia was the subject of three papers, and two points are worthy of note; first, the accumulation of testimony favorable to the action of large doses of the salicylates, and second, the fact that Theobald advocated without contraversion, the ciliary nerve or reflex theory of the disease. A statement by Randolph, to the effect that sympathetic ophthalmia apparently does not occur and cannot be induced in animals, will doubtless surprise some. It prohibits experimental work on the cause of this condition.
Nelson Beach presented a very valuable study on the visual requirements of railway engineers and firemen, based on personal observation from an engine cab. The eminent practicality of such a study must be apparent. The publication of this paper will be looked forward to with much interest by all railway surgeons.
Most of the other papers were largely of scientific interest, hardly likely to attract others than those specially devoting themselves to ophthalmology. E. C. ELLETT.