1788

treatment was continued, an improvement occurred. He was-of opinion that psoriasis was caused by a mixed infection ofthe skin by tubercle bacilli and streptococci.

Dr. LIEBERNEISTER (Dufen) said that active and inactivetuberculosis could not be distinguished by the presence oftubercle bacilli in the blood. He always found tuberclebacilli in the blood in " open

" tuberculosis and in 10 out of12 cases of "closed " tuberculosis. In the blood of 68 patientspresenting no clinical symptom of tuberculosis he foundacid-fast bacilli by the antiformin method. The same wasthe case in 5 cases of scrofulosis, in 10 cases of acute andsubacute arthritis, in 7 cases of pleurisy, in 3 cases ofperitonitis, and in 8 cases of recurrent endocarditis,as well as in chorea, erythema nodosum, sciatica, cirrhosisof the liver, and albuminuria. Six of the animalswhich had been inoculated with these bacilli becametuberculous.

Dr. MEINERTZ (Rostock) said that an animal in whosekidney the circulation was retarded became liable to tuber-culosis. The same was the case in a lung when an

atelectasis had formed. The cause was probably theformation of a thrombus in the capillary vessels.

Diseases of the Heart and Blood-vessels,

Dr. MAX STERNBERG (Vienna), speaking on the diagnosisof chronic aneurysm of the heart, said that the majority ofthe cases of chronic aneurysm were produced by thrombosisof a branch of the coronary arteries with myomalacia.The anatomical conditions of many instances of thedisease were well known, but its clinical diagnosis hadhitherto been difficult. Dr. Sternberg, by comparing thesymptoms of cases with the results of dissection, had castfresh light on the pathology of the disease, and had foundthat in its progressive development there were four stages-namely, (1) a stage of stenocardiac attacks ; (2) a stage ofstenocardiac pericarditis ; (3) a stage of latency or apparentrecovery ; and (4) a stage of serious deterioration of the heartmuscle. He had been able to diagnose cases from the abovesymptoms and to confirm the diagnosis afterwards bynecropsy.

Dr. MÜNZER (Prague) said that he had measured thevelocity of propagation of the pulse wave. In healthy personshe found a velocity varying from 9 to 12 metres per second ;ansemia and plethora did not exercise any influence on thevelocity. In a case of severe anæmia and bradycardia astriking retardation of the wave was observed. In arterio-sclerosis the velocity varied between 15 and 23 metres persecond. The velocity depended not on the blood pressurebut on the elasticity of the walls of the vessels.

Diseases of the Kidneys.Dr. SCHLAYER (Tiibingen) read a paper on Fatigue of the

Function of the Kidneys. He said that in some cases of

Bright’s disease, especially in chronic parenchymatous andcontracted kidney, the indiscriminate administration ofdiuretics and of chloride of sodium produced a state ofexhaustion of the kidneys, leading to anuria. In suchcases large doses of diuretics were very injurious, whilstunder a continued acministration of small doses the diuresis

might again become active.Dr. HEDINGER (Baden-Baden) stated that in healthy

kidneys the quantity and the concentration of the urineunderwent alteration after meals. In pathological condi-tions there were differences as to the influence of meals.Sometimes no reaction at all occurred after a meal ; insevere cases of Graves’s disease the excretion of urine mighteither be retarded or there might be no reaction to meals at all.

Influence of Adrenalin and Pituitrinum on the RespiratoryMetabolism.

Dr. BERNSTEIN and Dr. W. FALTA (Vienna) described theinfluence of adrenalin and of infundibular and glandularpituitrinum on the respiratory metabolism. They statedthat injections of adrenalin in healthy persons produced anincrease of the consumption of oxygen and of the productionof carbonic acid, together with an increase of the respiratoryquotient. After an injection of infundibular pituitrinum theconsumption of oxygen and the production of carbonic acidrapidly increased, but not the respiratory quotient. Glandularpituitrinum produced a decrease of the consumption ofoxygen and of the production of carbonic acid.

MEETING OF THE ASSOCIATION OFAMERICAN PHYSICIANS AT

ATLANTIC CITY.

(FROM OUR OWN CORRESPONDENT.)

THE twenty-seventh meeting of the Association ofAmerican Physicians was held at Atlantic City on May 14thand 15th under the presidency of Dr. George Adami,professor of pathology at McGill University, Montreal.The meeting in question was perhaps the most successfulfrom all standpoints which ever took place under theauspices of this association. As is usual at most of themedical and surgical meetings held on this side of theAtlantic, the papers presented were numerous. Not in-

frequently this plethora of papers is a decided drawback.On this occasion, however, although the papers read werenumerous, they were of such a uniformly high standard.that it would be a matter for regret if any of themhad been omitted. The President’s address was ex-

cellent, and was followed by papers dealing with thenervous and respiratory systems, the circulatory system,the kidneys, digestive system, infections and metabolism.Of these, perhaps the most noteworthy were those byDr. David L. Edsall, of Philadelphia, " Observations onthe Effects of Various Forms of Respiration " ; by Dr. M. J.Rosenau, of the United States Public Health and MarineHospital Service, on ’’ Organic Matter in the ExpiredBreath and its Significance"; and by Dr. David Reismanand Dr. John A. Kolmar, of Philadelphia, on "An Experi-mental Contribution to the Study of Pneumonia."

Dr. ROSENAU demonstrated in his paper the occurrenceof anaphylactic phenomena in animals that had been exposedin a used atmosphere, and showed that the expired breathcontains volatile protein matter.

Dr. REISMAN and Dr. KOLMAR reported that by employingMeltzer’s method they had obtained constant and extensivelesions in rabbits’ lungs by inoculations of pneumococci.They were doubtful, however, if these lesions should beclassed as those of a lobar or lobular broncho-pneumonia.-In the discussion that followed, ProfessorS. J. MELTZER pointed out that by employing a catheterwith lateral aperture for passage of the cultures into thebronchi they had not obtained the right distribution, and-that in order to obtain a complete picture it was necessary toemploy a catheter with terminal orifice and so completely tofill the bronchus into which it was passed with the fluidculture. The essential characteristic of lobar pneumoniawas the production of some substance that favoured thediffuse formation of fibrin in the inflammatory exudate, incontrast with the pus obtained in other infections.

Dr. E. LIDMAN (New York) presented the results ofstudies of more than 80 cases of subacute endocarditis, show-ing that an organism apparently identical with that ofPoynton and Paine was associated with a particular type oflesion, and that only where this organism was present thekidney and glomerular lesions described by Löhlein werefound. Where the ordinary pyogenic organisms were presentthese renal lesions were absent. He brought forward evidencetending to show that the disease was not necessarily fatal, there-being presumably mild cases which were clinically unrecog-nisable. All the cases recognised by him during life and,confirmed by blood culture had a fatal ending. He woulddistinguish, however, between this condition and acuterheumatic fever.

’

Dr. LEWIS A. CONNER (New York) presented a contribu-tion to the Symptomatology and Early Diagnosis of Thrombo-phlebitis, based on a long series of cases of typhoid fever.He drew attention to the significance of chills in the courseof this disease, as indicating the formation of thrombi in theveins of the calf of the leg and elsewhere.A most active discussion took place over the presentation

of a paper by Dr. MARTIN H. FISCHER (Cincinnati) onhis Colloidal Theory of (Edema and Nephritis and itsTreatment.-Dr. T. C. JANEWAY and Professor MELTZER(New York), Dr. ALONZO TAYLOR (Philadelphia), and otherstook part in the discussion.

Professor OSCAR KLOTZ (Pittsburg) gave an importantcommunication dealing with the Effeet of Acute Rheumatismupon the Arteries. He had found that small’ cell fnfiitratnoms

1789

occurred in the media of the aorta and of larger vessels of theeame order as those described by Aschoff as occurring in themyocardium, and resembling also these seen in syphilis,though of a milder degree. In the case of syphilis there werea definite degeneration and absorption of the elastic andmuscular elements of the media.

Dr. ABBOTT (Philadelphia) presented a paper by Dr.JOHNSTON showing that by the inoculation of B. coli vaccinesinto rabbits he had been able to cause the disappearance ofthe colon bacillus from the blood and gall-bladders of theseanimals when they had been previously inoculated withthese germs and had been rendered colon carriers. Dr.

Meakins, of Montreal, had last year published the results ofcertain studies indicating the possibility of successfullytreating typhoid carriers by this method. Dr. Johnston’s.studies would appear to be the first full experimental studieson this subject.

Dr. WILLIAM H. PARK. the head of the BacteriologicalDepartment of the New York Board of Health, read a paper ’,on the Advantages and Disadvantages of the Intravenous,;Intramuscular, and Subcutaneous Injections of DiphtheriaAntitoxin. He showed that several days elapsed before the.amount of antitoxin recognisable in the blood after intra-muscular and subcutaneous injections even approximated>that seen immediately after intravenous injection of theantitoxin.The outstanding feature of the meeting was the announce-

ment by Professor F. O. Novy, of Ann Arbor University,,that he had succeeded in gaining a singularly powerfulimmunity against trypanosoma Lewisi by preliminary in-oculations of laboratory animals with attenuated cultures of’the same organism. He further reported that experimentswith trypanosoma Brucei had yielded similar results.

Dr. Lewellys Barker was elected president of the associa-tion for the ensuing year and Dr. Simon Flexner vice-.president.

BRISTOL.

(FROM OUR OWN CORRESPONDENT.)

The Medical Profession and the Bristol Provisional InsuranceCommittee.

IN moving the appointment of a provisional committee of50 members to introduce the working of the National’Insurance Act, Mr. G. E. Davies told the Bristol city councilthat he had so far been unsuccessful in finding a medicali:uan willing to be duly nominated by the council as a memberof that committee. He, therefore, nominated Dr. A. B.

Prowse, senior physician to the Royal Infirmary, admittingthat it was without his consent. The position taken up bythe profession was explained by Mr. H. F. Devis, a memberof the council and a general practitioner of many years’standing, and (apart from a few desultory remarks) the dis-- cussion ended. In the local papers next morning there.appeared an admirable letter from Dr. Prowse decliningnomination on the ground that, though a Liberal and pre-disposed in favour of the Act, he could not support itbecause it treated the medical profession with unnecessaryharshness and injustice.Prosecution of a Man for Pretended Medical Qualifications.A man named Fortunato Vigna was charged a few days

ago at the Bristol police court for pretending to be a duly- qualified medical man. It will be remembered that (as wereported in these columns) he gave evidence at an inquest onthe body of a woman whom he had treated for rheumatismand who died from cancer. He had given an unofficial certi-ficate of death and had offered to give an official one if theproper form could be secured for him. Analysis of his

powders showed that they contained nothing beyond ferrousphosphate and magnesia. The reason for the police courtcharge was that he had advertised himself as a duly- qualified medical man by sending out circulars in whichhe appeared as I I F. Vigna, M. D., U. S. A.

" In these circularshe gave a list of patients whom he had cured; and"also issued an appeal for subscriptidns to the " Cosmo-politan Hocaesopathic Institute," an organisation ofwwhich he called himself director, which was situated in. tiournemonth, with branches in Bristol and Southampton ;41is appeal being based on the ground that this institutetreated a class not cared for by the hospitals-viz., those

suffering from chronic diseases and those who cannot spendhours in out-patient waiting-rooms. The defence was thathe was "M.D. New Jersey," and that "M.D. U. S. A. " wasmerely a readily understood method of presenting this factto the public. The magistrates decided to convict him ofassuming a false title (for, of course, there is no such thingas " M.D. U. S. A. "), without inquiring whether he really didpossess his alleged American and Italian qualifications, orwhether (as Mr. E. J. Watson, the solicitor instructed bythe Medical Defence Union for the prosecution, stated) hehad been impersonating another man, a practitioner actuallyliving in New Jersey, for 15 years. He was accordinglyfined L10 with .f:1O costs.

Workpeople’s Contributions to Ynl2cntary Hospitals under theInsurance Aot.

The secretaries of the Bristol General Hospital and of theRoyal Infirmary have received intimation from the BristolWagon and Carriage Works Co., Limited, to the effect thatthe employees of the firm have decided to make no alterationin their annual subscriptions to those institutions on accountof the Insurance Act. This is an important precedent, asthe firm is a large one, and workpeople’s contributions forma considerable share of the income of the Bristol hospitals.

-Bequests.Among the bequests under the will of Mr. Henry George

White, of Melksham, Wilts, are sums of .610,000 to the BathUnited Hospital and to the Royal Agricultural BenevolentSociety, £5000 each to Miiller’s Orphanage and to GeneralBooth, and £1000 each to the Cardiff Infirmary, Dr.Barnardo’s Homes, the Melksham Cottage Hospital, and theBristol R yal Infirmary. The residue of the property (about.f:200,OOO) will go to the Bishop of London for use on behalfof the Church of England.

SCOTLAND.

(FROM OUR OWN CORRESPONDENTS.)

Post- Graduate Instruction at Edinburgh.THE Committee of the University and Royal Colleges has

again organised a set of courses for graduates which will beheld during July, August, and September. The July course,which begins on July 15th, and for which entries must bereceived not later than the first day of July, deals with thediseases and defects of children. It is intended primarilyfor those whose work is connected with schools, such asmedical inspectors of school children ; it includes surgicaland medical cliniques, cliniques at the Institution for theEducation of Imbecile Children in Larbert, lectures on

physical defects in children, methods of medical inspection,&;o., practice in anthropometric methods, and demon-strations of skin, ear, and eye conditions. This is a

new course, and has been designed obviously to meeta demand for systematised instruction that is now

great and must become greater. Those attending thecourse meet five hours daily for a fortnight, and thefee is 5 guineas. The August course, as in previousyears, deals with internal medicine, and consists of practicalinstruction in methods of examining the heart, the nervoussystem, the blood, the urine and digestive products, togetherwith medical anatomy, clinical bacteriology, and cliniquestaking up the different organs systematically. The Septembercourses include : 1. A general course which may be attendedfor the first or second fortnight or for the whole month andcomprises subjects such as dermatology, diseases of the

eye, infant feeding, neurology, pathological anatomy andhistology, demonstrations on tropical diseases, and variousmedical, surgical, and obstetrical cliniques. There are also

special classes limited as to number of places upon bacterio-logy, diseases of the blood, diseases of the ear and throat,ophthalmoscopy, gynæcology, X ray and radium work,vaccine therapy, &c. 2. A surgical course on operations,surgical anatomy, and surgical pathology. 3. A limitedcourse on the ear, nose, and throat for specialists. Particularsof all these courses may be obtained by application to thesecretary, University New Buildings, Edinburgh.

Sanatorium Treatment in A berdeenshire.At a meeting of the Aberdeen district committee, held on the