1787 with chronic Rright’s disease MEETING OF THE THE ANNUAL CANADIAN MEDICAL ASSOCIATION. (FROM A CORRESPONDENT.) THE Forty-third Annual Meeting ...

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1787 with chronic Rright’s disease




THE Forty-third Annual Meeting of the Canadian Medical Association was held in Toronto on June 1st, 2nd, 3rd, and 4th. The general sessions took place in the Convocation Hall of the University of Toronto and the meetings of sections were held in other buildings of the University, which were lent to the Association for the occasion by the Medical Faculty. There was a large attendance of members, and a long programme was gone through in a satisfactory manner.


in many

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town of which the drainage was out of order. Dr. Herringham laid stress on the importance of diet in treating the disease, but while recognising this, he was not an advocate for restricting diet to fish or special foods. He was accustomed to order light ordinary diet and allowed the patients to partake of meat. Strict moderation as to quantity of food was necessary but not as to variety. In serious cases of the malady the main object was to avoid urasmia by main-

taining a fair excretion of urine with the help of suitable drugs. Difficulty in controlling hsematuria and in relieving oedema would also be met with, and would tax the physician’s resources. Referring to the high blood pressure found in patients with this malady, Dr. Herringham said that he did not regard this as a serious symptom in the young, though in the old, when the arteries were brittle and frail, such pressure A high blood pressure might was undoubtedly dangerous. be considered rather as a compensatory action than as a symptom in itself.

-First General Session :The Presidential Address : The Question of Milk. At the opening general session in the Convocation Hall the chair was taken by the retiring President, Dr. R. J. Third General Meeting: The Address in Surgery; BLANCHARD of Winnipeg. Addresses of welcome were given Exopthalmic Goitre. by representatives of the Provincial Government, of the city, At the general session on the afternoon of June 3rd the and of the University, after which the President-elect (Dr. Adam H. Wright, Toronto) was inducted. Dr. WRIGHT, in a Address in Surgery was given by Dr. JOHN B. MURPHY presidential address, considered the status of the general (Chicago). The subject was the Surgery of the Joints, and practitioner, the curriculum of the medical student, and the the general lesson of the address was that mistakes were relation of the specialist to the general practitioner. He not infrequently made by surgeons when treating injuries of contradicted the impression that the general practitioner joints through a faulty conception of the structural conditions. Dr. Murphy’s argument was that as the capsule of a joint is a was dying out ; far from being moribund in Canada, he thought that he showed symptoms of great vitality. On the non-vascular fibrous tissue of an inelastic nature it is wrong question of medical education of the present day it was to use force in correcting deformities of joints. The inevitable that he should think and say that there was too conditions should be relieved before pathological promuch cramming. Referring to the modern clinical lecture, cesses had developed producing ankylosis, as every acute Dr. Wright said that it frequently seemed to be the object of infective process of a joint might lead to ankylosis by The method of treatment employed by Dr. the lecturer to exhibit his own knowledge rather than to pressure. impart knowledge to the audience. At the conclusion of Murphy has been to aspirate with formalin and glycerine or Dr. Wright’s address the whole audience rose and sang " God turpentine and not to drain a joint by opening. Aspiration should be done promptly and the limb should be kept in an Save the King." In the case of the patella injections of Dr. CHARLES J. C. 0. HASTINGS (Toronto) presented the extended position. report of the Milk Commission which was appointed by the formalin and glycerine should be made eight or nine days If this were done there would be no Association in 1908 to inquire into the condition of the milk- before operation. supply of the Dominion, and to secure such legislation as effusion. Throughout the address Dr. Murphy illustrated might be found necessary to ensure a pure milk-supply. Dr. his arguments by beautiful photographs of joint injuries of Hastings sketched the work done by the Commission, and various kinds which had come under his hands and which he said that until accurate definitions of what was meant by had brought to a more or less successful issue. Dr. Murphy’s the terms "milk," "certified milk," "officially pasteurised presentment of his attitude on the subject of joint injuries milk,and "commercially pasteurised milk" had been was most graphic, and was followed with the closest attention adjusted to the satisfaction of the Dominion analyst, the and interest by a very large audience. Dr. S. P. BEEBE (New York) opened a symposium on Federal Government was unable to assist by legislation in the effort to obtain a pure milk-supply. However, the outlook Exophthalmic Goitre, discussing mainly its pathological He pointed out that iodine was readily taken up by was hopeful, and the measures taken in Toronto had resulted aspect. in a vast improvement of the milk-supply of that city. the thyroid gland, and that therefore the drug should be These measures were chiefly in the direction of pasteurisa- given in Graves’s disease with great caution. He mentioned tion, of which method Dr. Hastings showed himself to be a that a serum for the treatment of the disease had been prepared, which so far as could be judged from its as yet limited strong advocate. Dr. CHARLES E. NORTH (New York) read a paper on a employment had been satisfactory. Professor ALEX. MCPHEDRAN (Toronto) said that exophpure milk-supply, in which the milk-supply of New York was discussed. He confessed himself an upholder of thalmic goitre was not prevalent in Canada. In the Toronto pastei-irisation, because in large cities the inspection of milk- General Hospital during the past five years 55 cases out of a total of 8000 medical cases had been treated supplies at their source was usually ineffective. Referring to the comparative beneficial effects Veterinary Director-General J. G. RUTHERFORD (Ottawa) there. showed himself as a hard-and-fast believer in the theory of the of medical and surgical treatment, Professor McPhedran transmissibility of bovine tuberculosis to the human species, said that writers on surgery did not place much faith and argued that the only method of really stamping out in medical treatment and that statistics seem to justify this opinion, but he went on to say that it was no proof human tuberculosis was to eradicate the disease in cows. of the inefficacy of medical treatment that the results did S’econd General Session : The Address in Medicine. not lend themselves kindly to favourable statistics. An evening general session was held on June 1st, when Dr. F. SHEPHERD (Montreal) allowed freely that the Dr. W. P HERRINGHAM (London), physician to St. Bartholo- surgical treatment of the disease was not an ideal treatmew’s Hospital, delivered the Address in Medicine. He chose ment, and he looked forward to serum treatment as the as his subject Chronic Diffuse Parenchymatous Nephritis, only rational means for removing the cause. He nevertheless and illustrated certain phases of the disease by descriptions was of the opinion that in most cases operation had a very of cases which had come under his immediate notice. After favourable effect. He had not found local anaesthesia satismentioning that acute nephritis was rare in England, he gave factory when operating for Graves’s disease. He considered a clear exposition of chronic Brigbt’s disease* in different that the operation should be performed rapidly and that the stages and of varying degrees of virulence. He pointed out para-thyroids should be left as nearly in position as was that the great dangers of an attack of nephritis were the possible. In view of the fact that early cases of Graves’s delicacy left behind and the liability to recurrence, while the disease were much more amenable to surgical treatment than pathology of the disease was not clearly known. Some old cases, he thought that it would be as well if physicians medical men might comfort themselves by casting the blame sent cases to surgeons before they were far advanced. on false metabolism or on intestinal auto-intoxication, but A long discussion followed, the merits or otherwise of these explanations did not account for relapse. A patient medical and surgical treatment of exophthalmic goitre being


closely debated.

A point of interest made by Dr. HERRINGHAM was that he had not observed in the patients whom he had examined after operation that the tachycardia was relieved. Several other speakers agreed with this conclusion.

then the bacillus of acne vaccine is used, but if the staphyloalbus ccexists, then the albus vaccine must be also used. Out of 56 cases treated by Dr. Rose satisfactory results were obtained in 44 cases. In the remaining 12 cases improvement occurred in all but two. Among other papers read was one by Dr. J. A. AMYOT coccus

Fourth General

Meeting :Address in Gynæcology ;A Committee on Medical Eel2ecation. At the general session on the evening of June 3rd Dr. HENRY C. COE (New York) gave the address in Gynæcology. He propounded the view that the surgical side of gynaecology would soon become less prominent and that more attention would be given to diagnosis, and that the trained man of mature experience would hold his own against the halffledged specialist. He was of the opinion that procedures were too much in vogue in the United States at I the present time. The speaker also believed that State control of marriage would come to pass. Dr. J. C. CONNEL (Kingston, Ont.) read a paper on medical education, in which he compared the curricula of Canadian universities of 25 years ago with those of the present day, by no means altogether in favour of the latter. He therefore proposed the appointment of a committee of the Association to deal with the subject of medical education. The proposal was accepted by the Association, and a committee for the purpose was formed.

(Toronto), provincial analyst, on Rabies, in the Section of Pathology on June 3rd. After outlining the cause and treat.

I’, ment of



the disease, he made the statement that Professor McKenzie, of the pathological department of the University of Toronto, had many years ago discovered the germ of rabies and, in fact, anticipated the discovery by Negri, the Italian

pathologist, by

some years. The number of papers read in the Section of Pathology was larger than in any other section, and these were, moreover, of a high quality. Unfortunately, the room devoted to this section was somewhat out of the way, and the audiences were consequently small. The meeting terminated on June 4th.


Royal Infirmary. governors’ meeting on June 14th it was decided to The programme of the sections was very long, but the proceed with plans for the renovation of the Royal Infirmary. papers read were of a good average standard, while some The present building, which holds 270 beds, has become papers were of outstanding merit. Perhaps the best papers inadequate in the eyes of the committee for its duties ; and presented were those dealing with the psycho-neuroses. In it is therefore proposed to build a new block to contain 180 the Section of Medicine on June lst a symposium on the beds for surgical work on an adjoining site which is already psycho-neuroses was held. The first paper read was by Dr. being prepared, at the same time retaining only 170 beds in J. J. PUTNAM (Boston) on psycho-analysis. This paper was the old building. The two blocks, which are separated by a mainly a presentation of Professor Sigismund Freud’s views street, will be connected by subways. The president, and treatment. Dr. Putnam has been a friend and follower Sir George White, gave a detailed description of the of Dr. Freud for some time, and has treated patients by his proposed block, which will, it is felt, be a more satismethods during a period of a year with a considerable factory solution of the difficulty than a mere patching of the old building. It is to contain five large wards amount of success. Dr. AUGUST HOCH (New York) read the next paper on the of 24 beds each, 17 smaller wards, three large surgical same subject, and was followed by Dr. W. H. HATTIE theatres, and a new casualty department. Gardens will also (Halifax), who read a paper on the psycho-neuroses in asylum be provided for the patients. According to the estimates this will cost .650,000. In addition demolition of properties practice. Dr. A. ERNEST JONES (Toronto) then read a paper on the to provide the site will lead to a capital expenditure of general significance of the psycho-neuroses. Dr. Jones, like f.15,OOO, and E5000 needed for immediate changes in the Dr. Putnam, is a disciple of the Vienna professor, and his present building brings the total sum required up to £70,000. The Towards this the committee has collected f.35,OOO. paper was an exposition of the tenets of that school. In the discussion that followed several speakers took part, Lord Mayor and Sir Isambard Owen, Vice-Chancellor to the including Dr. C. K. CLARKE and Dr. MEYERS, both of University, spoke in favour of dealing radically with the Toronto, but neither of these dealt with Freud’s theories in renovation of the institution; and Mr. Samuel White, the detail or to any extent. Dr. JOSEPH COLLINS (New York), President’s brother, has generously offered f.5000 on conhowever, attacked the theories and practice of Freud and his dition that another £30,000 are raised within 12 months. followers warmly. He based his objections to some extent He further suggested that this extension scheme should on the ground that although these are but theories, and constitute the City’s memorial to the late King, a proposal fruitful which into have been of when (judging from letters in the local papers) may undergo although put practice they somewhat meagre results, Freud’s followers regarded him some modifications in view of the feeling that such a memorial fund should not be limited to one medical as almost an inspired prophet, and looked upon those who differed from him with a certain amount of intellectual institution only. The Centenary of the Bristol Eye Hospital. contempt, mingled, may be, with some pity for their inability to grasp, to them, such self-evident facts. From Wednesday, June 15th, to Saturday, June 18th, the On June 2nd Dr. COLLINS, in the Section in Medicine, read Clifton Zoological Gardens were devoted to a fete in recognia paper entitled, " The Psycho-neuroses : an Interpretation," tion of the hundredth birthday of the Bristol Eye Hospital, in which he set forth his views at length. According to which was founded on June 19th, 1810. Splendid weather Dr. Collins, the objections to Freud’s theory and practice are and there were good attendances daily. prevailed throughout, that his note of interpretation is too arbitrary, that the The committee organising the fete hopes to make a net profit psycho-analysis may become a source of auto-suggestion, and sufficient to wipe out the existing debt of E1200 and to that it gives a prominence to the sexual factor as a causative build a nurses’ home which is urgently needed; and’ though agency which it has not yet been proved to be. Further, at the time of writing it is not possible to say what has been even admitting that sexual factors have the importance in the actual outcome, it is confidently expected that a large the psychngenesis of hysteria that Freud maintains they do sum has been raised. The fete was opened by Mrs. have, very little has been vouchsafed us upon which to base F. Richardson Cross on Wednesday, and by the Lord the belief that psycho-analysis is a reliable therapeutic Mayor on Saturday, and on Saturday Mr. Richardson agency." Dr. Collins, in his paper, cavilled at the classifica- Cross entertainEd at dinner all those gentlemen who have tion of the psycho-neuroses made by Freud and took the view in the past 20 years acted as house surgeon to the hospital. that nothing whatever was to be gained by an effort to l2egistrarshzps at the Bristol General Hospital. classify these cases into separate disorders. The Bristol General Hospital has of late taken various Dr. GEORGE W. ROSE (Toronto) read a good paper in the Section of Medicine on the Treatment of Acne Vulgaris steps towards a fuller development of its resources for by Vaccines. Dr. Rose holds that this treatment is clinical teaching and investigation. The most recent of dependent upon the micro-organisms found in the pustules of these is the formation of medical and surgical registrarships. each case before commencing treatment. If the bacillus of I The first holders of these new offices are Dr. Arthur Fells acne is alone present, as in many cases of acne punctata, ), and Dr. W. J. H. Pinniger respectively.

Proceedi-ngs in the Sections.