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Dr. Parker (Versailles): Asked the question, "Is this backward condition of children due to lack of oxygenation or to septic condition?"

Dr. Willson (Frankfort): Wanted to be correctly understood. Strongly advocated tonsillotomy, but was opposed to tonsillectomy.

Dr. McClure (closing): It would be quite difficult to remove the tonsil and leave the capsule. It would be like removing an orange and leaving the white skin inside. Doesn't know what is meant by the body of the tonsil. If the bleeding comes from the capsule, then by tonsillectomy should have no bleeding as the capsule is taken out. Thought tonsillectomy should be done in 90 per cent. of

cases.

The Secretary having arrived, the minutes of the Louisville meeting were then read and adopted.

The following committees were appointed by the President:

Program Committee-Drs. Tuley, ParIrish and Smith.

Dr. O. B. Demaree (Frankfort) read a paper on "Treatment of Pneumonia." Discussion opened by Dr. U. V. Wil

liams.

Drs. Hill, Garr and Pope participated in the discussion.

Dr. Garr: Recommended the use of camphorated oil in impending collapse.

Dr. Pope: Alcohol is not a stimulant. By using the sphygnomanometer one can see the actual fall in blood pressure following the administration of alcohol. Prefers camphorated oil and digolen as stimulants.

Dr. Parrish: Moved that the Kentucky Midland Medical Society extend a vote of thanks to the members of Frankfort for their hospitality.

Carried by standing vote.

Meeting adjourned to meet in Paris, second Thursday in January, 1912.

CHAS. C. GARR, Secretary.

The Mississippi Valley Medical Association held a most successful meeting, from every standpoint, at Nashville,

Location Committee-Drs McClure, Tenn., October 17, 18 and 19, under

Austin and Williams.

Adjourned for dinner.

the presidency of Dr. Robert H. Babcock, of Chicago

The symposia were of great interest. and the discussion voluminous, the papers throughout of a high order of merit.

Afternoon session convened at 2 o'clock in the parlors of the Capitol Hotel. Dr. N. S. Garrett (Frankfort) read a paper on "Rupture of the Uterus." Discussion was opened by Dr. Tuley lightful and greatly enjoyed, especially

(Louisville), who mentioned fibroids in the dilating zone and forceps applied to a non-engaged head were causes. That rupture could be prevented by preventing the things which lead up to rupture.

The treatment is always surgical, and delivery of a child through the pelvis which had escaped through a rupture into the abdomen was out of the question.

The paper was further discussed by Dr. S. L. Beard and Dr. Garrett.

The entertainment provided was de

the trip on the last day to the home of Andrew Jackson, The Hermitage, where Dr. J. H. Witherspoon delivered a beautiful address on "Old Hickory."

The following officers were elected for the ensuing year: President, Louis Frank, Louisville; First Vice-President, Albert E. Sterne, Indianapolis, Ind.; Second Vice-President, F. Wm. Werner, Joliet, Ill.; Secretary, Henry Enos Tuley, Louisville (re-elected); Treasurer, Samuel Cecil Stanton, Chicago (re-elected).

The next meeting will probably be held in Chicago in October, 1912.

THE...

the tacit understanding that he was to

Louisville Monthly Journal do only enough work to secure this

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VINDICATION OF DOCTOR WILEY. The anxiously awaited letter from the President, regarding the controversy in the Bureau of Chemistry of the Department of Agriculture, over the alleged irregularities of Dr. Wiley in the appointment of experts in the department, has been published. The "condign punishment" recommended by Attorney General Wickersham and the personnel board of the department has been dropped.

Dr. Wiley's gentlemanly demeanor during the entire course of the Congressional Committee investigation, especially when on the stand, has gained the approval and endorsement of the entire country, except, of course, the "interests" which are behind the entire persecution.

The "Wiley case" arose over the employment by the Bureau of Chemistry of Dr. H. H. Rusby, of New York, pharmacognosist of the bureau. In effect, Dr. Wiley, Dr. L. F. Kebler, chief of the drug laboratory, and Dr. W. D. Bigelow, assistant chief of the bureau, charged with having conspired to pay Dr. Rusby a salary of $1,600 a year with

were

amount at the rate of $20 a day. This was held to violate the act of Congress approved March 15, 1898, which declared that no classified scientific investigator should receive more than $9 a day.

In addition to the recommendation that Dr. Wiley be allowed to resign, the personnel board held that Dr. Rusby should be dismissed, that Dr. Kebler be reduced and that Dr. Bigelow be allowed to quit the service. None of these recommendations is upheld in the President's opinion. Dr. Kebler is reprimanded for "disingenuous conduct" in his letter written to Dr. Rusby and the President says that the letters suggest a "willingness to resort to evasion" that calls for official reproof. Dr. Bigelow is held to be "overzealous" and a reprimand by Secretary of Agriculture Wilson, to whom the opinion, which is in letter form, is directed, is ordered by the President.

Dr. Rusby is held to be as guiltless as Dr. Wiley in this particular matter. A charge against him, however, of securing the appointment on the common "laborer's role" of a physician and expert "whom he could use to do his work at a very small stipend when he himself was called away," the President holds to be "not especially creditable." The case, the President says, has made apparent the "doubtful legislative policy of placing limitations on bureau chiefs to exact per diem compensation for experts."

The Government, he says, "ought not to be at a disadvantage in this regard. and one cannot withhold one's sympathy

with an earnest effort by Dr. Wiley to pay proper compensation and secure expert assistance in the enforcement of so important a statute as the 'pure food law,' certainly in the beginning, when the questions arising under it are of capital importance to the public."

The President's conclusions, he says, were ready weeks ago, but he did not put them on paper because he hoped for a time for the report of the committee of the House of Representatives that was investigating the Department of Agricul

ture.

How Dr. Wiley has been able to stand the pressure brought against him in his enforcement of the pure food law, with such equanimity, is almost beyond comprehension.

We trust that the shake-up intimated in the President's letter will take place, and Dr. Wiley be unhampered in his work.

FOOD AND DRUG LAW.

The Kentucky Agricultural Experiment Station, through its Food and Drug Division, has issued a bulletin containing notices of adulteration or misbranding of foods under Section 10 of the Kentucky Food and Drugs Act. Heretofore publications of adulterated or misbranded samples have been printed in tabulated form in the reports to the Governor and in special bulletins. In the future the Food and Drug Division of the Station will publish notices of adulteration and misbranding, under the Kentucky Food and Drugs Act, in a form similar to that

adopted by the United States Department of Agriculture.

The wisdom of this step upon the part of the Department will be agreed to by all and should have great effect in making fewer prosecutions necessary. In the first bulletin just issued is included the history of the prosecutions against dairymen, bakers, druggists, and ice cream dealers. The next bulletin will be devoted to instances of bleached flour and other adulterated or misbranded drug products shipped into the State of Kentucky from outside. No favoritism will be shown in the matter of publication of cases. In some instances in the first bulletin it is shown that no contest was made, the law acknowledged and the condition remedied. The Department has been most fair in all of its prosecutions; an attempt being made to help all departments of the trade in their labeling, sanitary and other problems under the law. The druggists were circularized and the law explained by a personal inspection. in each pharmacy before taking samples for examination and official action. The unsanitary conditions and application of the law with respect to materials used in bake shops were first pointed out by specific regulations and inspection in each case. Such inspections are directed both towards pointing out unsanitary conditions and suggesting practical remedies. The same method of procedure is fol lowed in the dairy, slaughtering house, and other lines of work.

We believe that this method of publication will result in the greatest good in the enforcement of the law.

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Dr. Thomas Crain Evans, former Dean of the Medical Department of Kentucky University, and of the merged Medical Schools, the University of Louisville, died at 4:30 a. m. October 26, after a long illness of chronic interstitial nephritis.

Dr. Evans was a native of Fleming County, Ky., born in Flemingsburg, February 9, 1860. He received his early education in the public schools of his native city and received his degree in medicine in 1883, and after practicing a few years in his native city, moved to Louisville, where he practiced ophthal

mology, otology and rhinology continuously until a year ago when ill health compelled his retirement.

He was an excellent organizer and one of the most efficient medical college Deans in the South. He was a lovable character and will be greatly missed.

The election of officers at the meeting of the Kentucky State Medical Association at Paducah, Ky., resulted as follows:

President, D. O. Hancock, Henderson; first vice-president, Dr. Delia Caldwell, Paducah; second vice-president, Dr. W. L. Mosby, Bardwell; third vice-president, Dr. J. R. Steele, Corbin; orator in medicine, Dr. Curran Pope, Louisville; orator in surgery, Dr. Arch Bankley, Lexington; delegates to the American Medical Asociation, Dr. W. W. Richmond, Clinton, and Dr. J. W Ellis, Masonville; counselor for the Fourth district, Dr. R. C. McChord, Lebanon; counselor for the Eleventh district, Dr. J. S. Lock, Barbourville. Secretary A. T. McCormack, of Bowling Green, and Treasurer W. B. McClure, of Lexington, hold over another year.

The election of a woman practitioner to an office in the Association establishes a precedent in State Association. Dr. Caldwell is eminently qualified scientifically and personally for the office and the Association is to be congratulated in the choice of the House of Delegates.

The next meeting of the Association. will be held in Louisville, as the constitution provides that every third year be held here, the other years in points in the State.

THE..

LOUISVILLE MONTHLY JOURNAL

OF MEDICINE AND SURGERY

VOLUME 18

LOUISVILLE, DECEMBER, 1911

NUMBER 7

Original Contributions

MEDICAL ASPECT OF THE "ACUTE ABDOMEN.”*

BY SIDNEY J. MEYERS, M. D.,

LOUISVILLE, KY.

It is not my purpose, in this short paper, to discuss any special condition or disease of the abdomen, but rather to ask ourselves how far the internist may go in treating the "acute abdomen" before resorting to surgical intervention.

It may be well to pause long enough to define the phrase "acute abdomen," as we see it. It is a symptom complex, made up of a number of decidedly apparent conditions, one or more of which may be absent or suppressed in a given case. The most striking phenomena would be pictured by such symptoms as pain, tenderness, distension, change in the pulse, temperature and respiration, alteration of the facial expression, and probably shock; also, the duration of the pain, the character of the paroxysms, alteration in the secretions and excretions of the body, especially with respect to the contents of the stomach as evidenced by vomiting, and its kind; the character of the bowels, whether active or inactive, and, not the least to be considered, the physical condition of the abdomen itself.

With so many conditions in mind, and with our own value placed upon each

*Read before the Medico-Chirurgical Society.

symptom, it should not be difficult to at least form an opinion as to the mildness or gravity of a given case. There is no condition that demands more accurate diagnostic methods, none that admits of less delay, and none that is more bewildering at times.

What causes errors in the diagnosis of abdominal conditions, and why are lesions in this locality so often overlooked? Is it because of the complex structure of this great cavity? Is it because its anatomical topography is so vaguely studied? Or, is it the individual physician himself? We will admit that all of these may be prominent factors in our inability to recognize the gravity of the acute abdomen, but the most potent of these is the physician himself. True, his are rather errors of omission than of commission. In the presence of an acute abdomen, delay often means death, or some decided complication which results in a tardy convalescence. and the statistics of the surgeon can only be further reduced by quickly recognizing the true condition and beginning treatment at once. Right here is where many of us differ. What shall be the treatment and who shall direct its administration, the physician or surgeon, or both?

What part shall medicine play in the treatment of these cases? In our opinion, only until the diagnosis is made, and not even until then, if it is obscure or delayed,

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